Arthroscopy-assisted minimally invasive removal of a plate in the distal femur

Arthroscopic fixation of humeral greater tuberosity fracture using a W-shaped suture

Background

Patients with greater tuberosity fractures of the humerus often require surgery. Therefore, there is a need to find a minimally invasive and effective surgical procedure with great patient outcomes.

Aim

To evaluate the clinical outcomes of the W-shaped suture technique under shoulder arthroscopy in the treatment of greater tuberosity fractures of the humerus.

Methods

In this retrospective study, a total of 17 patients were included. The fractures were closed, and there was no neurovascular injury. These patients underwent arthroscopically assisted reduction and internal fixation of the greater tuberosity fractures. Fixation was performed using sighting nails combined with a W-shaped suture. The imaging data of the patients were collected, and the ASES score, Constant-Murley score, and VAS score were used to evaluate the patient’s outcome. At the last follow-up (at least 1 year), the range of motion in the affected shoulder was compared with that of the contralateral side.

Results

The operation was successful in all the patients. The average follow-up time was 13 months. There were no reported complications such as fracture displacement, nonunion, and internal fixation failure during the follow-up period. Post-operative X-ray examinations revealed good function recovery, with a healing time of between 10 and 12 weeks, and an average healing time of 11.5 weeks. Following the operation, patients reported reduced shoulder joint pain that no longer influenced their activity or caused discomfort in their daily life. The patient’s VAS score ranged from 0 to 3, with an average of 0.52 ± 0.73, while at the last follow-up, the Constant-Murley score ranged from 83 to 97, with an average of 92.33 ± 7.55. The ASES score ranged from 81 to 98, with an average of 93.15 ± 6.93. At the last follow-up, there was no significant difference in the overall range of motion with the unaffected limb.

Conclusion

This study demonstrates that the W-shaped suture can be used to effectively fix the fractures of the greater tuberosity of the humerus, by increasing the fixed area to promote healing.

Minimally Invasive Endoscopic-Assisted Technique for Implant Removal After Pelvic Bridge Plating

Subcutaneous internal plate fixation for anterior pelvic ring injuries has become more common, but implants require removal, usually by 12 weeks. The purpose of this article is to report a novel, minimally invasive, endoscopic-assisted technique for the removal of subcutaneous anterior pelvic plates safely and atraumatically without violating the underlying fascia.

Arthroscopic-assisted removal of proximal tibia locking plates

We present a new technique to remove plates from the proximal tibia arthroscopic-assisted with all advantages of the minimally invasive surgery and the possibility to treat concomitant intraarticular pathologies. The initial results (n = 7) are promising with an increase of the Lysholm score in all cases studied [preop. median 78 (range 32–100), postop. median 89 (range 60–100)]. In conclusion, arthroscopic-assisted hardware removal at the proximal tibia is feasible and may provide patients with all the benefits of minimal-invasive hardware removal. The described technique can be recommended for all surgeons familiar with arthroscopic surgery.