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[Osteosynthesis of extra-articular proximal tibial fractures]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:55-66. [PMID: 36542118 DOI: 10.1007/s00113-022-01274-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Abstract
The treatment of extra-articular proximal tibial fractures is a therapeutic challenge due to the frequently significant soft tissue injury, the effect of the deforming forces and the need for an exact restoration of the bony alignment. Various methods of osteosynthesis are available for surgical stabilization. The locking plate osteosynthesis is the most frequently used procedure because of its good biomechanical stability, especially in osteoporotic bones, and the protection of the periosteal blood flow. Depending on the extent and stability of the defect zone, especially in the case of a medial comminuted zone and the bone quality, bilateral plate osteosynthesis can be necessary. If the proximal fragment is big enough, closed reduction and intramedullary nailing are possible. In the case of severely compromised soft tissue or very short epiphyseal fragments, the construction of an external fixator, e.g. hybrid external fixator, is recommended, which also allows definitive treatment under early full weight bearing. The most important complications are axial and torsional malalignments.
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Greenfield J, Appelmann P, Wunderlich F, Mehler D, Rommens PM, Kuhn S. Retrograde tibial nailing of far distal tibia fractures: a biomechanical evaluation of double- versus triple-distal interlocking. Eur J Trauma Emerg Surg 2021; 48:3693-3700. [PMID: 34859267 PMCID: PMC9532294 DOI: 10.1007/s00068-021-01843-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/14/2021] [Indexed: 01/08/2023]
Abstract
Objectives Retrograde tibial nailing using the Distal Tibia Nail (DTN) is a novel surgical option in the treatment of distal tibial fracture. Its unique retrograde insertion increases the range of surgical options in far distal fractures of the tibia beyond the use of plating. The aim of this study was to assess the feasibility of the DTN for far distal tibia fractures where only double rather than triple-distal locking is possible due to fracture localisation and morphology. Methods Six Sawbones® were instrumented with a DTN and an AO/OTA 43-A3 fracture simulated. Samples were tested in two configurations: first with distal triple locking, second with double locking by removing one distal screw. Samples were subjected to compressive (350 N, 600 N) and torsional (± 8 Nm) loads. Stiffness construct and interfragmentary movement were quantified and compared between double and triple-locking configurations. Results The removal of one distal screw resulted in a 60–70% preservation of compressive stiffness, and 90% preservation of torsional stiffness for double locking compared to triple locking. Interfragmentary movement remained minimal for both compressive and torsional loading. Conclusions The DTN with a distal double locking can, therefore, be considered for far distal tibia fractures where nailing would be preferred over plating.
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Affiliation(s)
- Julia Greenfield
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Philipp Appelmann
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Felix Wunderlich
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Dorothea Mehler
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Pol Maria Rommens
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Sebastian Kuhn
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany. .,Department of Digital Medicine, Medical School OWL, Bielefeld University, Universitätsstr. 25, 33615, Bielefeld, Germany.
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Song X, Huang X, Yakufu M, Yan B, Feng C. Minimally invasive plate osteosynthesis or conventional intramedullary nailing for distal tibial fractures: A cohort study protocol. Medicine (Baltimore) 2020; 99:e21779. [PMID: 32872079 PMCID: PMC7437767 DOI: 10.1097/md.0000000000021779] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Currently, both minimally invasive plate osteosynthesis (MIPO) and intramedullary nailing are the two most commonly used methods of treatment in distal tibial fractures, but controversy still exists regarding the clinical effects of 2 techniques. Our purposes were to compare MIPO and intramedullary nailing for distal tibia shaft fractures by assessing functional outcomes and complications. METHODS Data were collected retrospectively from the charts of patients treated for distal tibial extra-articular fractures between May 2012 and July 2018. All cases were performed by a single surgeon. Institutional review board approval in the Second Affiliated Hospital of Army Medical University was obtained prior to conducting chart review and analysis. The criteria for inclusion in the study were being aged at least 18 years at the time of diagnosis and having a closed or type I open fracture of the distal third of the tibial diaphysis. The primary outcome compared between the 2 groups was the American Orthopedic Foot and Ankle surgery score. The secondary outcome measures in this trial included Olerud and Molander Ankle Score, radiographic outcomes, and complications. Statistical analysis was performed using SPSS version. P values < .05 were considered statistically significant. RESULTS We hypothesized that MIPO would be associated with better functional outcomes and fewer complications. TRIAL REGISTRATION This study protocol was registered in Research Registry (researchregistry5808).
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Affiliation(s)
- Xin Song
- Department of Orthopedics, The Second Affiliated Hospital of Army Medical University, Chongqing
| | - Xun Huang
- Department of beauty, Guangzhou Deen Medical Plastic and Aesthetic Hospital, Guangdong
| | - Maihemuti Yakufu
- Department of Orthopedics, The Sixth Affiliated Hospital of Xinjiang Medical University
| | - Bin Yan
- Department of Orthopedics, The Seventh Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Chencheng Feng
- Department of Orthopedics, The Second Affiliated Hospital of Army Medical University, Chongqing
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Liu XK, Xu WN, Xue QY, Liang QW. Intramedullary Nailing Versus Minimally Invasive Plate Osteosynthesis for Distal Tibial Fractures: A Systematic Review and Meta-Analysis. Orthop Surg 2020; 11:954-965. [PMID: 31823496 PMCID: PMC6904655 DOI: 10.1111/os.12575] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 10/16/2019] [Accepted: 10/16/2019] [Indexed: 12/14/2022] Open
Abstract
To evaluate the application, safety and efficacy of the patients treated with intramedullary nailing (IMN) and minimally invasive plate osteosynthesis (MIPO) in distal tibia fractures. Following the Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) guidelines, we searched databases PubMed, Cochrane library, EMBASE and Web of Science from inception of the database up to 10 October 2018, using the keywords "distal tibia fractures", "plate", "intramedullary nailing" and "RCT" to identify randomized clinical trials about distal tibia fractures. The included studies were assessed by two researchers according to the Cochrane risk-of-bias criteria. The primary outcome of measurement included operation time, malunion rate, nonunion/delayed union rate, and wound complication. Data analysis was conducted with Review Manager 5.3 software. A total of 10 RCTs involving 911 patients fulfilled the inclusion criteria with 455 patients in the IMN group and 456 patients in the MIPO group. There were no significant differences in radiation time, nonunion or delayed union rate, union time and operation time between the two groups. Patients treated with MIPO had lower incidence of malunion compared with IMN (RR = 1.85, 95%CI: 1.21 to 2.83, P = 1.00), while IMN seemed to have lower surgical incision complications whether in closed or opening fractures (RR = 0.49, 95%CI 0.33 to 0.73, P = 0.43). But in patients classified as 43A, the result of subgroup analysis suggested that there was no significant inwound complication between the two groups. MIPO was superior in preventing malunion compared with IMN, and intramedullary nailing appeared to have lower wound complications. However, in patients with 43A distal tibial fractures, MIPO was more recommended for its prevention of malunion. No matter which method we choose, we should notice and prevent the associated complications.
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Affiliation(s)
- Xiao-Kai Liu
- Joint Surgery Department, Chaoyang Central Hospital, Chaoyang City, Liaoning Province, China
| | - Wen-Nan Xu
- Department of Orthopaedic, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Qing-Yun Xue
- Department of Orthopaedic, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Qing-Wei Liang
- Department of Orthopaedic, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
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MacLeod AR, Pankaj P. Pre-operative planning for fracture fixation using locking plates: device configuration and other considerations. Injury 2018; 49 Suppl 1:S12-S18. [PMID: 29929685 DOI: 10.1016/s0020-1383(18)30296-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Most locked plating failures are due to inappropriate device configuration for the fracture pattern. Several studies cite screw positioning variables such as the number and spacing of screws as responsible for occurrences of locking plate breakage, screw loosening, and peri-prosthetic re-fracture. It is also widely accepted that inappropriate device stiffness can inhibit or delay healing. Careful preoperative planning is therefore critical if these failures are to be prevented. This study examines several variables which need to be considered when optimising a locking plate fixation device for fracture treatment including: material selection; screw placement; the effect of the fracture pattern; and the bone-plate offset. We demonstrate that device selection is not straight-forward as many of the variables influence one-another and an identically configured device can perform very differently depending upon the fracture pattern. Finally, we summarise the influence of some of the key parameters and the influence this can have on the fracture healing environment and the stresses within the plate in a flowchart.
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Affiliation(s)
| | - Pankaj Pankaj
- School of Engineering, The University of Edinburgh, UK.
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Dong WW, Shi ZY, Liu ZX, Mao HJ. Indirect reduction technique using a distraction support in minimally invasive percutaneous plate osteosynthesis of tibial shaft fractures. Chin J Traumatol 2016; 19:348-352. [PMID: 28088940 PMCID: PMC5198924 DOI: 10.1016/j.cjtee.2016.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To describe an indirect reduction technique during minimally invasive percutaneous plate osteosynthesis (MIPPO) of tibial shaft fractures with the use of a distraction support. METHODS Between March 2011 and October 2014, 52 patients with a mean age of 48 years (16-72 years) sustaining tibial shaft fractures were included. All the patients underwent MIPPO for the fractures using a distraction support prior to insertion of the plate. Fracture angular deformity was assessed by goni- ometer measurement on preoperative and postoperative images. RESULTS Preoperative radiographs revealed a mean of 7.6°(1.2°-28°) angulation in coronal plane and a mean of 6.8°(0.5°-19°) angulation in sagittal plane. Postoperative anteroposterior and lateral radio- graphs showed a mean of 0.8°(0°-4.0°) and 0.6°(0°-3.6°) of varus/valgus and apex anterior/posterior angulation, respectively. No intraoperative or postoperative complications were noted. CONCLUSIONS This study suggests that the distraction support during MIPPO of tibial shaft fractures is an effective and safe method with no associated complications.
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Ehlinger M, Scheibling B, Rahme M, Brinkert D, Schenck B, Di Marco A, Adam P, Bonnomet F. Minimally invasive surgery with locking plate for periprosthetic femoral fractures: technical note. INTERNATIONAL ORTHOPAEDICS 2015; 39:1921-6. [DOI: 10.1007/s00264-015-2928-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 05/15/2015] [Indexed: 10/23/2022]
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Abdullah MR, Goharian A, Abdul Kadir MR, Wahit MU. Biomechanical and bioactivity concepts of polyetheretherketone composites for use in orthopedic implants-a review. J Biomed Mater Res A 2015; 103:3689-702. [DOI: 10.1002/jbm.a.35480] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 03/22/2015] [Accepted: 04/06/2015] [Indexed: 01/13/2023]
Affiliation(s)
- Mohamed Ruslan Abdullah
- Centre for Composites; Department of Applied Mechanics and Design; Universiti Teknologi Malaysia (UTM); 81310 Skudai, Johor Malaysia
| | - Amirhossein Goharian
- Medical Devices & Technology Group; Faculty of Biosciences & Medical Engineering, Universiti Teknologi Malaysia (UTM); 81310 Skudai, Johor Malaysia
- R&D Department; Leonix Sdn. Bhd.; Penang 11960 Malaysia
| | - Mohammed Rafiq Abdul Kadir
- Medical Devices & Technology Group; Faculty of Biosciences & Medical Engineering, Universiti Teknologi Malaysia (UTM); 81310 Skudai, Johor Malaysia
| | - Mat Uzir Wahit
- Center for Composites, Institute of Vehicle System and Engineering (IVeSE), Universiti Teknologi Malaysia (UTM); 81310 Skudai, Johor Malaysia
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Kinner B, Kerschbaum M, Bley C, Spiegel A, Roll C. Bionic plate design for calcaneal fracture treatment. A biomechanical analysis and first clinical results. INTERNATIONAL ORTHOPAEDICS 2014; 39:111-7. [PMID: 25315027 DOI: 10.1007/s00264-014-2561-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 09/29/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Calcaneal fracture treatment is challenging. Implant failure is one problem encountered with plate osteosynthesis. Therefore a new "bionic" plate was developed, which imitates the trabecular orientation of the human calcaneus. The aim of this study was to biomechanically test this new plate in comparison to a "standard" calcaneal locking plate and present the first clinical results. METHODS Six "bionic" and six "standard" calcaneal plates were biomechanically tested for stability and fatigue using synthetic calcanei. Between 4/2012 and 04/2013 the first ten consecutive patients meeting the inclusion criteria were treated with the novel implant and followed-up clinically and radiologically. The 12-month follow-up results are reported. RESULTS The "bionic" plate design showed significantly higher fatigue life (68%), load to failure (100%) and reduced displacement under load (90%) if compared to a "standard" locking plate. No major complications were seen; most notably there was no implant failure and no loss of reduction. Mean AOFAS/hindfoot score was 79 (69-86). CONCLUSIONS The novel plate architecture offers higher stability and load tolerance while being more resistant to fatigue. The preliminary clinical results are promising. These findings will have to be proved by larger clinical trials.
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Affiliation(s)
- Bernd Kinner
- Department of Orthopaedic and Trauma Surgery, Robert-Bosch-Krankenhaus, Auerbachstrasse 110, 70376, Stuttgart, Germany,
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Plate fixation versus intramedullary nailing for displaced extra-articular distal tibia fractures: a system review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 25:53-63. [PMID: 24253957 DOI: 10.1007/s00590-013-1362-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 11/03/2013] [Indexed: 01/01/2023]
Abstract
PURPOSE The optimal surgical procedure for displaced extra-articular distal tibia fractures remains debated at present. The objective of this systematic review is to compare the complications and functional outcomes of this type of fracture after plate fixation and intramedullary nailing . METHODS A computer-aided search of PubMed, Embase and Cochrane was carried out on July, 2012. Two independent reviewers screened and assessed abstracts. Every study published in English about the comparison between plate fixation and intramedullary nailing for displaced extra-articular distal tibia fractures was included. The outcomes were pooled or summarized separately per study according to heterogeneity between studies. Pooled risk ratios (RR) with 95 % confidence intervals (95 % CIs) were calculated by Mantel-Haenszel method using either the fixed effects model or random effects model. RESULTS Eight studies, with 270 patients in the intramedullary nailing and 217 patients in the plates fixation group, met the inclusion criteria. Functional outcome, days of hospital stay and time for bone union were comparable between intramedullary fixation and plate fixation. Total complication rate was significant higher for intramedullary nailing compared with plate fixation (44.5 vs. 25.8 %, P < 0.001). Similarly, the rate of minor complications was higher for intramedullary nailing than that for plate fixation (35.9 vs. 21.2 % P < 0.001). Major complication rate was 8.52 % for intramedullary nailing and 4.6 % for plate fixation, but the difference had no statistical significance (P = 0.06). Our pooled estimates showed a decreased risk of total complication in plate fixation (RR, 2.38; 95 % CI, 1.13-5.03; P = 0.02). Among these complications, malunion and anterior knee pain were more common in intramedullary nailing than in plate fixation (20.1 vs. 4.5 %, P < 0.001; 4.2 vs. 0.45 %, P = 0.02, respectively). Meanwhile, significantly less wound problems happened in intramedullary nailing than in plate fixation (2.9 vs. 7.5 %, P = 0.03). In addition, locking plate fixation with mini-invasive technique tended to have a lower complication rate than conventional plate fixation, although the difference was not significant (21 vs. 28.4 %, P = 0.26). CONCLUSIONS The results of this systematic review suggested that plate fixation, especially minimally invasive percutaneous plating osteosynthesis technique would be preferred for extra-articular distal tibia fractures because of its low complication rate. Nevertheless, intramedullary fixation should be taken priority for distal tibia fractures with serious soft tissue injuries.
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Ducrot G, Ehlinger M, Adam P, Di Marco A, Clavert P, Bonnomet F. Complex fractures of the distal humerus in the elderly: is primary total elbow arthroplasty a valid treatment alternative? A series of 20 cases. Orthop Traumatol Surg Res 2013; 99:10-20. [PMID: 23273377 DOI: 10.1016/j.otsr.2012.10.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 07/24/2012] [Accepted: 10/05/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Distal humerus fractures are fairly rare. But as our population ages, these fractures become more complex and the choice of treatment more delicate. Poor bone quality results in many technical problems and the fixation hardware stability remains at risk. The goal of this study was to evaluate the functional recovery and morbidity of complex distal humerus fractures in elderly patients when treated with elbow prosthesis. HYPOTHESIS Good functional recovery can be achieved with a total joint replacement. PATIENTS AND METHODS This series consisted of 20 patients (18 women and two men) having an average age of 80years (range 65-93, median 80). Based on the AO classification, there were two Type A2 fractures, two Type B fractures, 15 Type C fractures and one fracture that could not be classified because of previous rheumatoid disease history at this elbow. Two fractures were open. In two cases, the olecranon was also fractured. Treatment consisted of the implantation of a Coonrad-Morrey, hinge-type total elbow prosthesis (Zimmer(®), Warsaw, IN, USA). The Mayo Clinic surgical approach was used 17 times and the transolecranon approach was used three times. Primary arthroplasty was performed in 19 cases and the surgery was performed after six weeks of conservative treatment (diagnostic delay) in one case. Unrestricted motion was allowed after surgery, but a maximum of 0.5kg could be carried during the first 3months; this was subsequently increased to 2.5kg. RESULTS Fifteen of the 20 patients were available for reevaluation with an average follow-up of 3.6years (range 1.7-5.5, median 3.4). Four patients had died and one was lost to follow-up. The average range of motion was 97° (range 60-130°), comprising an average flexion of 130° (range 110-140°) and average loss of extension of 33° (range 0-80°). Pronation and supination were normal. The average Mayo Elbow Performance Score (MEPS) was 83 (range 60-100, median 80). X-rays revealed seven cases of radiolucent lines, with two being progressive. There was no visible wear of the polyethylene bushings at the hinge. Six patients had moderate periarticular heterotopic ossification. The two cases of olecranon osteotomy and one case of olecranon fracture had healed. There were no surgical site infections but two cases of ulnar compression, one of which required neurolysis. There was one case of humeral component loosening after 6years, but the implant was not changed. DISCUSSION The clinical range of motion results were comparable to published data. The functional scores were slightly lower, mainly because of the pain factor. The initial results were encouraging and consistent with published data as long as the indications were well-chosen. Based on this retrospective study, total elbow arthroplasty can be a valid alternative in the surgeon's treatment armamentarium for complex distal humerus fractures in elderly patients who have moderate functional demands. Our results support our hypothesis, since we found good functional recovery without associated morbidity. LEVEL OF EVIDENCE Level IV retrospective study without comparator.
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Affiliation(s)
- G Ducrot
- Orthopaedic and Trauma Surgery Department, Hautepierre Hospital, Strasbourg University Hospitals, 1, avenue Molière, 67098 Strasbourg, France.
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Bonnevialle P, Bonnomet F, Philippe R, Loubignac F, Rubens-Duval B, Talbi A, Le Gall C, Adam P. Early surgical site infection in adult appendicular skeleton trauma surgery: a multicenter prospective series. Orthop Traumatol Surg Res 2012; 98:684-9. [PMID: 22986015 DOI: 10.1016/j.otsr.2012.08.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 06/08/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Surgical site infections (SSI) studies rely on an imprecise and debatable definition. The term "wound healing problems" (WHP), not necessarily septic, is also frequently cited. This study had the objectives of determining the frequency of early SSIs in traumatology, these terms eventual correlation, and the factors influencing onset. PATIENTS AND METHODS A multicenter prospective observational study was conducted in 12 centers. The exclusion criteria were open lesions as well as multiple injuries and multiple fractures (more than two fractures treated surgically). All patients were followed for the first three postoperative months until there was clinical certainty of healing and absence of infection. The presence of any WHP or SSI required a minimum follow-up of 1 year. WHP and SSI risk factors were determined using logistical regression adjusted on the centers. RESULTS Out of 1617 cases, 103 were complicated by a WHP and 22 by a SSI. The SSIs were mainly secondary to Staphylococcus infections. The factors predisposing the patients to WHP and SSI (p≤0.05) were age; the NNIS, ASA, and Parker scores; alcoholism; antiaggregant use; and the locoregional aspect at the time of injury. The 522 subcutaneous osteosyntheses "near the skin" resulted in 58 WHPs (11%) and 14 SSIs (2.7%); 13 of the 58 WHPs (22%) resulted in one SSI. Out of 707 deep osteosyntheses, 24 (3.4%) presented a WHP and seven (1%) a SSI; Four SSIs originated from a WHP. The 352 fractures of the trochanter were complicated by a WHP in 15 cases (5.5%) and a SSI in one case (0.4%) after interlocked nailing and two WHPs and two SSIs (2.5%) after screw and plate fixation. Of the 388 first-line arthroplasties, only the prostheses implanted for a proximal femur fracture presented complications: 21 WHPs (6%) and one SSI (0.02%). Of the 103 WHPs of the entire series, 18 became SSIs. In absence of WHP, the SSI rate was 0.2%, whereas the probability of a WHP evolving toward a SSI was 100 times higher. The only factor significantly associated with a WHP becoming a SSI was osteosynthesis material exposure. DISCUSSION This prospective study can be criticized on several points: the deliberately limited inclusion criteria, the short follow-up, and the possible subjectivity of the data collection. The SSI rates reported are for the most part in agreement with the literature. This study is innovative in traumatology given the large number of patients and the notion of WHP that was preferred over superficial infection. It demonstrates the relations between WHP and SSI, in particular for osteosyntheses near the skin. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- P Bonnevialle
- Musculoskeletal Institute, Toulouse Teaching Hospital Center, Purpan Orthopaedic and Trauma Surgery Unit, place Baylac, 31052 Toulouse cedex, France.
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Ehlinger M, Rahme M, Moor BK, Di Marco A, Brinkert D, Adam P, Bonnomet F. Reliability of locked plating in tibial plateau fractures with a medial component. Orthop Traumatol Surg Res 2012; 98:173-9. [PMID: 22342730 DOI: 10.1016/j.otsr.2011.10.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 10/05/2011] [Accepted: 10/13/2011] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tibial plateau fractures are notoriously difficult to manage, particularly when there is a medial or posteromedial component. We report a retrospective analysis of our experience with consecutive tibial plateau fractures including a medial component that were managed using a single lateral locking plate. HYPOTHESIS Tibial plateau fractures with a medial component can be effectively managed using a single lateral locking plate. MATERIALS AND METHODS From January 2005 to December 2008, 20 patients (ten women and ten men, mean age 47 years) were managed for tibial plateau fractures having a medial component, including five Schatzker IV, five Schatzker V, and ten Schatzker VI. One patient had an open fracture. A single lateral anatomically contoured locking compression plate (LCP™) was used with or without additional isolated screws. Mobilization was started immediately after the procedure, and non-weight-bearing was maintained for at least 6 weeks. RESULTS All patients were followed until healing. A final evaluation was available for 13 patients after a mean of 39.1 months (12-72); five patients were lost to follow-up and two died. Early revision was needed in one patient for 20° malreduction within the fracture site. We recorded one case each of deep vein thrombosis, superficial infection, knee stiffness, and spontaneously regressive common fibular nerve dysfunction. At final evaluation (n=13), mean range of motion was 0°/2°/130° with a mean Lysholm score of 94.1 (73-100) and a mean HSS score of 93.6 (74-99). All previously employed patients returned to work at the same level after a mean of 4.5 months. Mean healing time (n=20) was 10 weeks (6-12). Initially, articular step-offs greater than 2mm were noted in five patients. At healing, no further displacements or aggravation of articular step-offs were recorded. The reductions remained stable over time. At final evaluation (n=13), mean tibiofemoral mechanical angle was 179.7° (176-184) and no patients had evidence of osteoarthritis. DISCUSSION The radiological and clinical outcomes in our patients were satisfactory. A single lateral locked plate ensured stable reduction of tibial plateau fractures with a medial component. Biomechanical studies of these fractures have provided conflicting data on the stability of reduction using single plate systems. However, previously reported clinical outcomes are similar to those found in our study and support the effectiveness of favouring the use of single locking plate fixation. LEVEL OF EVIDENCE Level IV, noncomparative retrospective study.
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Affiliation(s)
- M Ehlinger
- Department of Orthopaedic Surgery and Traumatology, Hautepierre Hospital, Strasbourg University Hospitals group, 1, avenue Molière, 67098 Strasbourg cedex, France.
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Pellegrini M, Cuchacovich N, Lagos L, Henríquez H, Carcuro G, Bastias C. Minimally-invasive alternatives in the treatment of distal articular tibial fractures. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.fuspru.2012.01.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Schulz AP, Reimers N, Wipf F, Vallotton M, Bonaretti S, Kozic N, Reyes M, Kienast BJ. Evidence Based Development of a Novel Lateral Fibula Plate (VariAx Fibula) Using a Real CT Bone Data Based Optimization Process During Device Development. Open Orthop J 2012; 6:1-7. [PMID: 22312417 PMCID: PMC3271305 DOI: 10.2174/1874325001206010001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Revised: 12/01/2011] [Accepted: 12/01/2011] [Indexed: 11/22/2022] Open
Abstract
Development of novel implants in orthopaedic trauma surgery is based on limited datasets of cadaver trials or artificial bone models. A method has been developed whereby implants can be constructed in an evidence based method founded on a large anatomic database consisting of more than 2.000 datasets of bones extracted from CT scans. The aim of this study was the development and clinical application of an anatomically pre-contoured plate for the treatment of distal fibular fractures based on the anatomical database. 48 Caucasian and Asian bone models (left and right) from the database were used for the preliminary optimization process and validation of the fibula plate. The implant was constructed to fit bilaterally in a lateral position of the fibula. Then a biomechanical comparison of the designed implant to the current gold standard in the treatment of distal fibular fractures (locking 1/3 tubular plate) was conducted. Finally, a clinical surveillance study to evaluate the grade of implant fit achieved was performed. The results showed that with a virtual anatomic database it was possible to design a fibula plate with an optimized fit for a large proportion of the population. Biomechanical testing showed the novel fibula plate to be superior to 1/3 tubular plates in 4-point bending tests. The clinical application showed a very high degree of primary implant fit. Only in a small minority of cases further intra-operative implant bending was necessary. Therefore, the goal to develop an implant for the treatment of distal fibular fractures based on the evidence of a large anatomical database could be attained. Biomechanical testing showed good results regarding the stability and the clinical application confirmed the high grade of anatomical fit.
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16
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Ehlinger M, Adam P, Arlettaz Y, Moor BK, DiMarco A, Brinkert D, Bonnomet F. Minimally-invasive fixation of distal extra-articular femur fractures with locking plates: limitations and failures. Orthop Traumatol Surg Res 2011; 97:668-74. [PMID: 21924968 DOI: 10.1016/j.otsr.2011.05.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 04/14/2011] [Accepted: 05/06/2011] [Indexed: 02/02/2023]
Abstract
Minimally-invasive fixation using a locking plate and early motion is normal practice. However, technical errors and pitfalls are common. This surgery has a set of rules that encompass both the mechanics of the internal fixation system and the implantation itself. If these rules are not strictly followed, alignment defects and/or early failure of the fixation can occur. We analysed four cases of clinical failure that were encountered after minimally-invasive distal femoral extra-articular fixation with locking plates. The following rules must be followed with this technique: extra-articular fracture, minimally-invasive approach, long plate alternating between locking screw and empty hole (five holes on either side of fracture), bi-cortical screws, placement of locking screws near a complex fracture but away from a simple fracture. Osteoporotic bone, obesity that interferes with the instrumentation, articular fracture, horizontal fracture line and surgeon experience are all limitations of this minimally-invasive technique.
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Affiliation(s)
- M Ehlinger
- Orthopaedic Surgery and Traumatology Department, Hautepierre Hospital, Strasbourg University Hospitals, 1, avenue Molière, 67098 Strasbourg cedex, France.
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