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Giannetti S, Smimmo A, Torre G, Stancati A, Pagano E, Santucci A. Percutaneous treatment of radial neck fractures in adult patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1413-1418. [PMID: 38227012 DOI: 10.1007/s00590-023-03811-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/15/2023] [Indexed: 01/17/2024]
Abstract
INTRODUCTION Radial neck fractures in adults are rare, but outcomes are often poor. Closed reduction and internal fixation (CRIF) technique has been advocated for the treatment of minimally displaced fractures in children, with a few reports on adult subjects. The aim of the present paper is to investigate mid-term results of a CRIF technique in adults with retrograde intramedullary K-wires in Mason's type II and III fractures. The proposed technique yields to good anatomical reduction of displaced neck fractures, faster rehabilitation, and easier hardware removal after fracture consolidation. MATERIAL AND METHODS A consecutive series of 17 patients were treated with closed reduction and intramedullary osteosynthesis, and outcomes were retrospectively evaluated. Elbow X-ray (XR) and CT scan were obtained preoperatively. Objective assessment before surgery and at an average 36-month follow-up included active and passive elbow range of motion (ROM). Functional evaluation was carried out through the collection of the Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder, and Hand (DASH) score, and Elbow Self-Assessment Score (ESAS). XR at last follow-up was evaluated. RESULTS The cohort included 10 males and seven females, with a mean age of 32 years. Patients returned for a follow-up evaluation at a mean of 36 months (range 6-43 m) form the surgery. The DASH score revealed good to excellent outcomes with a mean of 6.32 ± 10.24 points at last follow-up. The ESAS was 98.35 ± 1.89, indicating a non-restricted elbow function. Acceptable radiographic healing was achieved in all patients. CONCLUSIONS The advocated technique is promising for obtaining good reduction and stabilization, and good to excellent satisfaction for patients. Given the challenging technique, the learning curve could be long and initial results unsatisfactory. More research with larger cohorts and improved study design could be carried out, comparing the technique with the current choice of treatment (ORIF, radial head resection).
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Affiliation(s)
- Silvio Giannetti
- Casa Di Cura Villa Stuart, Via Trionfale, 5952, 00135, Roma, Italy
| | | | - Guglielmo Torre
- Casa Di Cura Villa Stuart, Via Trionfale, 5952, 00135, Roma, Italy
| | - Andrea Stancati
- Casa Di Cura Villa Stuart, Via Trionfale, 5952, 00135, Roma, Italy
| | - Ernesto Pagano
- Casa Di Cura Villa Stuart, Via Trionfale, 5952, 00135, Roma, Italy
| | - Attilio Santucci
- Casa Di Cura Villa Stuart, Via Trionfale, 5952, 00135, Roma, Italy
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Jordan R, Remtulla M, Jones A, Malik S, Chan S, Shyamalan G. The use of intramedullary devices for adult radial head and neck fractures. A systematic review. Acta Orthop Belg 2023; 89:362-368. [PMID: 37924555 DOI: 10.52628/89.2.9824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Abstract
The management of isolated radial neck and head fractures is controversial. Plate fixation and tripod fixation are two commonly employed techniques but risk damage to soft tissues and implant-related complications. Intramedullary fixation is commonly used in pediatric cases and reduces the potential drawbacks of open fixation. This systematic review aimed to analyze outcomes of intramedullary fixation in adults in terms of function, union, and complication rates. A systematic review of the literature was conducted following the PRISMA guidelines using Medline and EMBASE's online databases. The review was registered on the PROSPERO database. Studies were appraised using the Methodological Index for non-randomized studies (MINORS) tool. Seven studies were deemed eligible for inclusion (n=55). Mean ages of patients ranged from 31.3 to 44.2 years, and mean follow-up ranged from 9 to 86 months. The Mayo Elbow Performance score (MEPs) was reported in five case series (mean scores 81.8 -97.9) and the prevalence of excellent results ranged from 71% and 83%. Although 100% of fractures united, the pooled complication rate was 24% (range 0-50%). The most common complications were elbow stiffness (7%), superficial radial nerve neuropraxia (7%), malunion (5%), and AVN (1.8%). No study reported any patients requiring revision surgery. Intramedullary fixation for radial head and neck fractures appears to provide a reliable alternative treatment option in terms of union, range of motion, and functional outcomes. Further robust trials direct comparing against open fixation techniques are required.
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Zhou X, Wang B, Liu Y, Wang Z, Zhao X, Liu F, Lu S, Xu W, Li L, Dong J. Comparative Study Between the Mini-Open (≤2.5 Cm) Approach and Conventional Open Lateral Approach in the Surgical Treatment of Radial Head Fractures. J Pain Res 2022; 15:3413-3422. [PMID: 36320225 PMCID: PMC9618242 DOI: 10.2147/jpr.s374599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022] Open
Abstract
Purpose The conventional lateral approach is widely used to treat radial head fractures with screws. However, the traditional incision may have shortcomings, including excessive exposure and significant scarring. We propose an innovative method – a mini-open lateral approach of less than 2.5 cm for surgical treatment of radial head fractures with screws. Methods From Jan 2017 to Dec 2020, 34 patients diagnosed with closed radial head fracture were treated with open reduction and internal fixation (ORIF) in this study. The novel group (mini-open group) included 15 patients, and the other 19 patients were in the traditional group. The time of operation and the blood loss during operation were recorded. Postoperative clinical outcomes and radiographic results were recorded and compared between the two groups. The range of motion (ROM) in the elbow, the Visual Analogue Scale (VAS), the Mayo Elbow Performance Score (MEPS), Rating Scale of the American Shoulder and Elbow Surgeons (ASES), and the Shortened Disabilities of the Arm, Shoulder and Hand Questionnaire (Q-DASH) score and complications, such as wound infection, vascular and nerve damage, and fragment redisplacement were observed in the two groups. Results In the comparison between the two groups, there was no significant difference in age, sex, cause of radial head fracture, or other basic information. The operation time, intraoperative blood loss, and VAS score at 3 days postoperation were significantly reduced in the novel group (p < 0.05). The follow-up results showed that there was no significant difference in MEPS, ASES, or Q-DASH scores between the two groups. Conclusion The mini-open approach reduced intraoperative blood loss, shortened operation time, relieved patient pain, and achieved a satisfactory postoperative clinical result, which demonstrates that the novel approach is a safe and effective option for treating radial head fractures.
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Affiliation(s)
- Xiaofeng Zhou
- Department of Orthopaedics Surgery, Shandong Provincial Hospital, Shandong University, Jinan, People’s Republic of China
| | - Bingzhi Wang
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Yu Liu
- Department of Orthopaedics Surgery, Shandong Provincial Hospital, Shandong University, Jinan, People’s Republic of China
| | - Zicheng Wang
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Xuehui Zhao
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Fanxiao Liu
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Shun Lu
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Weicheng Xu
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Lianxin Li
- Department of Orthopaedics Surgery, Shandong Provincial Hospital, Shandong University, Jinan, People’s Republic of China,Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China,Correspondence: Lianxin Li, Department of Orthopaedics, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, 250021, People’s Republic of China, Tel +8613505312449, Email
| | - Jinlei Dong
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China,Jinlei Dong, Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of China, Tel +861509874540, Email
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Pogorelić Z, Capitain A, Jukić M, Žufić V, Furlan D. Flexible intramedullary nailing for radial neck fractures in children. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:618-622. [PMID: 33423995 DOI: 10.5152/j.aott.2020.19223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the outcomes of treatment and the rate of complications in children treated with flexible intramedullary nailing (FIN) for radial neck fractures. METHODS The study included 26 children (11 males and 15 females) with a median age of 9.5 years, treated with FIN for the radial neck fractures between May 2011 and May 2018. Immobilization after the surgery was not used. The median follow-up was 41 months. According to the Judet classification, 15 fractures were classified as type III and 11 as Type IV. For each patient, clinical, radiological, and disability of the arm, shoulder, and hand (DASH) scores were calculated. RESULTS All patients achieved complete radiographic healing at a median of 5 weeks. The nails were removed at a median of 4 months. The rate of complications was 11.5%, including 1 radial head necrosis, 1 angulation of 15°, and 1 displacement of the radial head. Twenty patients (76.9%) achieved a perfect clinical healing, while 23 patients (88.5%) achieved a perfect radiological healing. The median DASH score was 1.25. No cases of delayed healing were recorded. After removing of the nails, all patients returned to full function of the extremity and all complications were resolved. CONCLUSION The use of FIN for treating fractures of the radial neck in children shows very good functional and cosmetic results. It allows mobilization with rapid pain reduction. It is a minimally invasive, simple, and reproducible technique with a low rate of complication. Owing to excellent results, surgical stabilization of radial head and neck fractures using FIN is recommended in children and adolescents. LEVEL OF EVIDENCE Level IV, Therapeutic study.
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Affiliation(s)
- Zenon Pogorelić
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia;Department of Surgery, University of Split, School of Medicine, Split, Croatia;Clinic of Pediatric Surgery, General Hospital Zadar, Zadar, Croatia
| | - André Capitain
- Department of Surgery, University of Split, School of Medicine, Split, Croatia
| | - Miro Jukić
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia;Department of Surgery, University of Split, School of Medicine, Split, Croatia
| | - Vanja Žufić
- Clinic of Pediatric Surgery, General Hospital Zadar, Zadar, Croatia
| | - Dubravko Furlan
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia
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Singh N, Pandey CR, Tamang B, Singh R. Scranton Type V Osteochondral Defects of Talus: Does one-stage Arthroscopic Debridement, Microfracture and Plasma Rich in Growth Factor cause the Healing of Cyst and Cessation of Progression to Osteoarthritis? Malays Orthop J 2020; 14:64-71. [PMID: 32983379 PMCID: PMC7513663 DOI: 10.5704/moj.2007.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: The study was conducted to evaluate the efficacy of arthroscopic debridement, microfracture and plasma rich in growth factor (PRGF) injection in the management of type V (Scranton) osteochondral lesions of talus and its role in healing the subchondral cyst and cessation of progression of ankle osteoarthritis. Material and Methods: This is a prospective case series conducted on patients who were diagnosed with type V osteochondral lesions of talus. All the cases were treated with arthroscopic debridement, microfracture, and PRGF injections. The patients were evaluated for the healing of subchondral cysts and progression of osteoarthritis with radiography (plain radiographs and computerised tomography Scan). Also, the patients’ outcome was evaluated with Quadruple Visual Analogue Scale, Ankle Range of Motion, Foot and Ankle Disability Index, Foot and Ankle Outcome Instrument and a Satisfaction Questionnaire. Results: Five male patients underwent arthroscopic debridement, microfracture and PRGF injection for type V osteochondral lesion of talus. The mean age of patients was 27.4 years (19-47 years). All the patients gave history of minor twisting injury. Subchondral cyst healing was achieved in all patients by six months post-surgery. However, four out of five patients had developed early osteoarthritic changes of the ankle by their last follow-up [mean follow-up 29 months (ranged 15-36 months)]. Despite arthritic changes, all the patients reported ‘Good’ to ‘Excellent’ results on satisfaction questionnaire and Foot and Ankle Disability Index and could perform their day to day activities including sports. Conclusion: Arthroscopic debridement, microfracture, and PRGF causes healing of the subchondral cyst but does not cause cessation of progression to osteoarthritis of ankle in type V osteochondral defects of talus. However, despite progress to osteoarthritis, patient satisfaction post-procedure is good to excellent at short-term follow-up.
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Affiliation(s)
- N Singh
- Department of Orthopaedics and Traumatology, Grande International Hospital, Kathmandu, Nepal
| | - C R Pandey
- Department of Orthopaedics and Traumatology, Grande International Hospital, Kathmandu, Nepal
| | - B Tamang
- Department of Orthopaedics and Traumatology, Grande International Hospital, Kathmandu, Nepal
| | - R Singh
- Department of Physiotherapy and Rehabilitation, Grande International Hospital, Kathmandu, Nepal
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Gao X, Yin HL, Zhou GJ. Minimally Invasive Treatment of Mason Type II Radial Head Fracture by Intramedullary Pinning. Orthop Surg 2019; 11:879-885. [PMID: 31532071 PMCID: PMC6819192 DOI: 10.1111/os.12540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/29/2019] [Accepted: 08/21/2019] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the outcome of Mason type II radial head fractures treated by intramedullary pinning. Methods From May 2013 to March 2017, we respectively reviewed 25 patients affected by Mason type II radial head fractures. A total of 12 patients who met criteria for inclusion and exclusion were collected and analyzed. They were all isolated displaced partial articular radial head fractures and treated with intramedullary pinning using titanium elastic nails (TEN). The patients comprised eight men and four women with the mean age of 40 years (range, 21–58 years). The clinical evaluation included the range of motion (ROM) in the elbow, the shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH), the visual analogue scale (VAS) for pain rating, and the Mayo Elbow Performance Score (MEPS). Follow‐up radiographs to monitor related complications were evaluated as well. Results All patients were followed‐up with a mean of 21.8 months (range, 12–28 months). The average range of elbow flexion‐extension was barely unaffected in the injured side when compared to the uninjured side (139.08° ± 3.14° vs 140.16° ± 3.01°, P = 0.398) as were pronation of the forearm (86.50° ± 2.75° vs 87.83° ± 2.12°, P = 0.197) and supination of the forearm (87.41° ± 2.53° vs 88.17° ± 1.95°, P = 0.425). The MEPS was 93.75 ± 5.28 points (range, 85–100), the QuickDASH revealed good to excellent results with 2.33 ± 4.56 points (range, 0–14), and the VAS for pain was 0.33 ± 0.78 (range, 0–2). Only two patients had a minor complication with constant affection of the superficial branch of radial nerve. Conclusion Intramedullary pinning technique in the treatment of Mason type II radial head fractures is minimally traumatic and effective and represents good to excellent results in adults.
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Affiliation(s)
- Xu Gao
- Department of Orthopaedic and Traumatic Surgery, Qingdao University, Qingdao, China
| | - Hai-Lei Yin
- Department of Orthopaedic and Traumatic Surgery, No. 971 Hospital of the People's Liberation Army (PLA), Qingdao, China
| | - Guang-Jie Zhou
- Department of Orthopaedic and Traumatic Surgery, Qingdao University, Qingdao, China
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Gao X, Yin H, Lu J. [Closed reduction and internal fixation with elastic nail for Mason type Ⅱ radial head fracture in adults]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:981-985. [PMID: 31407557 DOI: 10.7507/1002-1892.201903117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effectiveness of closed reduction and internal fixation with elastic nails in treatment of Mason type Ⅱ radial head fracture in adults. Methods A clinical data of 28 patients with Mason type Ⅱ radial head fractures between May 2013 and March 2017 was retrospectively analyzed. Thirteen patients were treated with closed reduction and internal fixation with elastic nails (trial group); 15 patients were treated with open reduction and internal fixation with Herbert screws (control group). There was no significant difference in gender, age, cause of injury, side of fracture, and the time from injury to operation between the two groups ( P>0.05). The operation time, blood loss, and fluoroscopy times in the two groups were recorded and compared. Postoperative X-ray films were used to evaluate the bone healing, heterotopic ossification, and necrosis of radial head. The effectiveness was evaluated according to Mayo score criteria of the elbow at last follow-up. Results All patients were followed up 12-30 months (mean, 21.9 months). The operation time and blood loss were significantly less in the trial group than in the control group ( P<0.05), while the fluoroscopy times significantly increased in the trial group than in the control group ( P<0.05). X-ray films showed that all fractures healed with the bone healing time of (2.85±0.69) months in the trial group and (3.35±0.88) months in the control group. There was no significant difference in bone healing time between the two groups ( t=1.654, P=0.110). Heterotopic ossification occurred in 2 cases in the control group. At last follow-up, there was no significant difference in the Mayo scores between the trial group (90.6±5.3) and the control group (86.4±7.1) ( t=1.750, P=0.092). Conclusion Closed reduction and internal fixation with elastic nails, as a minimally invasive technique, has advantages of short operation time and less bleeding in the treatment of Mason type Ⅱ radial head fracture.
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Affiliation(s)
- Xu Gao
- Qingdao University, Qingdao Shandong, 266071, P.R.China;Department of Orthopedics, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266071, P.R.China
| | - Hailei Yin
- The Second Department of Orthopedics, No.401 Hospital of the Chinese PLA, Qingdao Shandong, 266071,
| | - Jianfeng Lu
- The Second Department of Orthopedics, No.401 Hospital of the Chinese PLA, Qingdao Shandong, 266071, P.R.China
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Pedrazzini A, Bastia P, Bertoni N, Pedrabissi B, Simo HCY, Medina V, Ceccarelli F, Pogliacomi F. Atypical use of pediatric flexible nails in the treatment of diaphyseal fractures in adults. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:300-307. [PMID: 31125010 PMCID: PMC6776213 DOI: 10.23750/abm.v90i2.8284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 01/22/2023]
Abstract
Background and aim of the work: Elastic intramedullary nails are commonly used for the treatment of diaphyseal fractures in adolescents and children. The major advantages are the minimally invasive nature of the technique, the short operation time, and the preservation of the growth plate and periosteum thus allowing bone healing within a closed and intact biological environment. Elastic nails are rarely applied to the adult fractures. Methods: Five selected adult patients affected by diaphyseal fractures were treated using paediatric flexible nails T2 Kids (Stryker®, Mahwah, NJ, USA) as consequence of their poor clinical conditions, high risk of neurovascular injuries and skin/soft tissues problems. All patients were monthly clinically and radiographically evaluated after surgery until fracture healing. Results: Radiological and clinical outcomes were satisfying. All fractures healed after a mean period of 3 months. No losses of reduction as well as mobilization/breakage of implant were observed. Conclusions: Use of pediatric elastic nails is a valid surgical option in treatment of diaphyseal fractures in selected adult patients who request fast and minimally invasive surgery as consequence of precarious clinical or soft tissues conditions. (www.actabiomedica.it)
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Beirer M, Biberthaler P. [Importance of self-assessment in functional evaluation of trauma patients]. Unfallchirurg 2018; 121:956-961. [PMID: 30298189 DOI: 10.1007/s00113-018-0564-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The principle of self-assessment is performed successfully in a wide variety of medical disciplines and is increasingly gaining importance in orthopedic trauma surgery. Through the development and validation of joint-specific self-assessment questionnaires that enable estimation of the range of motion, a large number of patient-based instruments are available for comprehensive follow-up examination. A recently performed proof of concept study showed a high patient acceptance and therefore the development of a prospective, patient-centered fracture register based on the self-assessment functional analysis seems to be promising. The data obtained should reflect not only the reality of fracture treatment but also generate valuable epidemiological data with which evidence-based guidelines can be formed.
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Affiliation(s)
- M Beirer
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - P Biberthaler
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland.
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Kaziz H, Benzarti S, Triki MA, Mouelhi T, Naouar N, Ben Ayeche ML. Outcome of intramedullary pinning of isolated radial neck fractures in adulthood. J Shoulder Elbow Surg 2018; 27:1650-1655. [PMID: 30104099 DOI: 10.1016/j.jse.2018.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/31/2018] [Accepted: 06/02/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The treatment of radial neck fractures is controversial and typically depends on displacement. Surgical procedures based on open reduction-internal fixation (ORIF) may lead to several complications, such as avascular necrosis of the radial head, nonunion, malunion, and elbow stiffness. Closed reduction with intramedullary pinning of radial neck fractures, which is commonly used in children, is a viable option for these fractures in adults and may allow for a lower complication rate compared with ORIF. The aim of this study was to report the functional outcome of closed reduction and intramedullary stabilization in isolated radial neck fractures. METHODS Fourteen cases were retrospectively reviewed between January 2007 and December 2016. The inclusion criteria were isolated radial neck fractures of type I to III according to the Mason classification, absence of previous injuries of the elbow, and a minimum of 1 year of follow-up. The Mason classification was used to classify these injuries. At final follow-up, functional assessment was established based on functional scores: Morrey Elbow Score, Elbow Self-Assessment Score, and QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) score. Range of motion was evaluated similarly. RESULTS The mean follow-up period was 86 months. The mean age was 44.2 years. Regarding the functional outcome, 78% of patients claimed satisfaction. Concerning the functional scoring, the mean visual analog scale score was 0.2 (range, 0-4) and the mean Morrey Elbow Score was 95.7 (range, 85-100). The mean QuickDASH score was 6.4 (range, 7-22). The complication rate was 35%. Malunion was observed in 7% of patients. CONCLUSION Intramedullary pinning of radial neck fractures represents a viable technique in adults because of its safety and simplicity. The complication rates are lower than those in other reports of ORIF.
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Affiliation(s)
- Hamdi Kaziz
- Department of Orthopedics, Sahloul University Hospital, Sousse, Tunisia.
| | - Sofien Benzarti
- Department of Orthopedics, Sahloul University Hospital, Sousse, Tunisia
| | | | - Thabet Mouelhi
- Department of Orthopedics, Sahloul University Hospital, Sousse, Tunisia
| | - Nader Naouar
- Department of Orthopedics, Sahloul University Hospital, Sousse, Tunisia
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Singh N, Pandey CR, John R, Singh R, Tamang B, Bhandari S. The effectiveness of a modified Metaizeau technique in fixation of adult radial neck fractures: a prospective study with a modification of the Broberg-Morrey classification. J Shoulder Elbow Surg 2018; 27:411-417. [PMID: 29224986 DOI: 10.1016/j.jse.2017.09.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 09/25/2017] [Accepted: 09/30/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The incidence of adult radial neck fractures is lower compared with its pediatric counterpart. The literature on adult radial neck fracture management is limited; also, there is a lack of a detailed fracture classification system. In our study, we are evaluating the modified Metaizeau technique for the treatment of adult radial neck fractures. We also describe a modification to the existing fracture classification proposed by Broberg and Morrey to make it more inclusive of different fracture patterns. MATERIALS AND METHODS This is a prospective case series in which we included all the patients who presented to us with adult radial neck fractures. We used a modified Metaizeau technique to treat these fractures. Postoperatively, patients were followed up for a minimum duration of 1 year with a visual analog scale score, the Mayo Elbow Performance Score, the Oxford Elbow Score, the Disabilities of the Arm, Shoulder, and Hand score, and a subjective satisfaction questionnaire. RESULTS We included a total of 7 patients who had completed follow-up of 1 year. Of the total 7 cases, 3 cases had an associated radial head fracture (undisplaced), and 1 had an associated radial shaft fracture (segmental pattern). Elastic nails were removed at 6 weeks, and all fractures united. The subjects returned to their preinjury activity levels by the end of 3 months and had excellent outcomes as measured by various outcome scores. CONCLUSION The modified Metaizeau technique for closed reduction and internal fixation of adult radial neck fractures is effective and simple and has no complications compared with other treatment methods. However, further studies with larger sample sizes are needed to arrive at a more meaningful conclusion.
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Affiliation(s)
- Nagmani Singh
- Department of Orthopaedics and Traumatology, Grande International Hospital, Kathmandu, Nepal.
| | - Chakra Raj Pandey
- Department of Orthopaedics and Traumatology, Grande International Hospital, Kathmandu, Nepal
| | - Rakesh John
- Department of Orthopaedics, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Rajesh Singh
- Department of Physiotherapy and Rehabilitation, Grande International Hospital, Kathmandu, Nepal
| | - Bhupal Tamang
- Department of Orthopaedics and Traumatology, Grande International Hospital, Kathmandu, Nepal
| | - Sandeep Bhandari
- Department of Orthopaedics and Traumatology, Grande International Hospital, Kathmandu, Nepal
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Huang YC, Renn JH, Tarng YW. The titanium elastic nail serves as an alternative treatment for adult proximal radial shaft fractures: a cohort study. J Orthop Surg Res 2018; 13:10. [PMID: 29334971 PMCID: PMC5769387 DOI: 10.1186/s13018-017-0704-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 12/26/2017] [Indexed: 11/10/2022] Open
Abstract
Background To investigate whether closed reduction and internal fixation (CRIF) with titanium elastic nails (TENs) is a viable alternative treatment in proximal radial fractures. Methods In Kaohsiung Veterans General Hospital, from November 2013 to April 2015, five adult male patients with forearm injuries (average age 43 years; range 35–64 years) were treated for proximal radial shaft fractures. CRIF with TENs for radial shaft fractures was performed in these five patients. Radiographs; range of motions; visual analog scale (VAS); quick disabilities of the arm, shoulder, and hand (Quick DASH) questionnaire; and time to union were evaluated in our study. Results Mean follow-up period was 30 months (range 28–36 months). Average time of radius union was 7.3 months (range 6–10 months). Functional outcomes 1 year after operation revealed an average Quick DASH score of 7.92 (range 4.5–25), an average VAS of 1.5 (range 1–3), and average forearm supination and pronation of 69.2° (range 45°–75°) and 82.5° (range 80°–85°). No major complication was noted. Conclusions CRIF with TEN for adult proximal radial fractures is a method to avoid extensive exposure or nerve injury during ORIF, especially in multiple trauma patients who require short operative time, uremia patients with ipsilateral forearm AV shunt, severe soft tissue swelling due to direct muscle contusion or strong muscularity before surgery, extensive radial fracture, and those in pursuit of cosmetic outcomes.
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Affiliation(s)
- Ying-Cheng Huang
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Rd, Kaohsiung, 81346, Taiwan, Republic of China
| | - Jenn-Huei Renn
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Rd, Kaohsiung, 81346, Taiwan, Republic of China.,National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Yih-Wen Tarng
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Rd, Kaohsiung, 81346, Taiwan, Republic of China. .,National Defense Medical Center, Taipei, Taiwan, Republic of China.
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Crönlein M, Zyskowski M, Beirer M, Imhoff FB, Pförringer D, Sandmann GH, Kirchhoff C, Biberthaler P, Siebenlist S. Using an anatomically preshaped low-profile locking plate system leads to reliable results in comminuted radial head fractures. Arch Orthop Trauma Surg 2017; 137:789-795. [PMID: 28432459 DOI: 10.1007/s00402-017-2693-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Indexed: 02/09/2023]
Abstract
INTRODUCTION For comminuted and displaced fractures of the radial head open reduction and internal fixation (ORIF) is recommended nowadays as the treatment of choice. Due to the development of locking plates the possibilities of ORIF in complex fracture types were extended. The purpose of this retrospective survey therefore was to review the preliminary subjective and objective results in patients treated by anatomically preshaped locked plating. A reliable fracture healing for these recently introduced plating devices was hypothesized. MATERIALS AND METHODS Subjective and objective criteria included patient's satisfaction, pain rating on a visual analogue scale (VAS) and active range of motion (ROM) compared to the contralateral armside. Functional scoring included the Morrey elbow performance score (MEPS), the QuickDASH and the elbow self-assessment score (ESAS). Furthermore, follow-up radiographs were reviewed. RESULTS Between 2011 and 2014 a total of 24 patients were managed with ORIF using anatomically preshaped low-profile locking plates. All patients had suffered from comminuted radial head fractures (type III-IV according to Mason classification). Twenty of 24 patients returned for follow-up examination after a mean of 30 months (range 18-53 months). Patients' satisfaction was rated as highly satisfied in 17 cases and satisfied in 3 cases. An unrestricted ROM for extension-flexion arc and pronation-supination arc was rated in 10 cases. Minor ROM deficiencies with a 5° limited extension compared to the contralateral side was evaluated in 6 cases. Only four patients were rated with and extension and supination deficiency of 10°, one of whom with an additional pronation deficiency of 10°. The calculated MEPS was Ø 98 ± 4 (range 85-100), and the QuickDASH was Ø 3 ± 6 (range 0-21). The ESAS was completed by 18 patients with a mean of Ø 96.54 ± 2.95 (range 94-100) indicating a non-restricted elbow function. CONCLUSIONS The treatment of comminuted radial head fractures using anatomically preshaped locking radial head plates represents a reliable and safe surgical approach, leading to good to excellent functional results. Being aware of the importance of the radial head for elbow stability, open reduction and internal fixation should be preferred prior to radial head resection or replacement in complex radial head fractures. Further trials with a higher number of patients are needed to confirm the advantages of preshaped radial head plates.
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Affiliation(s)
- Moritz Crönlein
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
| | - Michael Zyskowski
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Marc Beirer
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Florian B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dominik Pförringer
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | | | - Chlodwig Kirchhoff
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Peter Biberthaler
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Sebastian Siebenlist
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.,Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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