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Qawasmi F, Qawasmi L, Safadi H, Dasari SP, Yassin M. Triceps aponeurosis and deltoid tuberosity as a landmarks for radial nerve dissection: a cadaveric study. JSES Int 2024; 8:1122-1125. [PMID: 39280145 PMCID: PMC11401578 DOI: 10.1016/j.jseint.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2024] Open
Abstract
Background The radial nerve, originating from the posterior cord of the brachial plexus, traverses the posterior humerus. Incidences of radial nerve injury have been noted following surgical interventions like fracture fixation and exploration in this area. There's a paucity of literature detailing soft tissue anatomical cues for radial nerve dissection. This study aimed to identify reliable soft tissue and bony landmarks (triceps aponeurosis and deltoid tuberosity) that can be of substantial importance in dissecting the radial nerve and reducing iatrogenic nerve injury utilizing the posterior approach. Methods Thirty-two fresh-frozen cadaver specimens underwent dissection using a posterior triceps-splitting approach to expose the radial nerve. The distance between the apex of the triceps aponeurosis and the radial nerve was measured, alongside noting the radial nerve's position relative to the deltoid tuberosity. Results Of the cadavers, 78% were female, and 22% were male, with a mean age of 76 (range: 62-85). The average distance between the aponeurosis apex and the radial nerve was 40.3 mm (range: 28-60). The radial nerve was consistently found in all specimens, situated posteriorly at the humerus's mid-axial level at the distal part of the deltoid tuberosity. Conclusion The triceps aponeurosis and distal deltoid tuberosity serve as reliable and practical landmarks for dissecting and exploring the radial nerve during posterior humeral approaches. These landmarks prove especially valuable when fractures obscure conventional anatomical cues.
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Affiliation(s)
- Feras Qawasmi
- Department of Orthopedic Surgery, Hasharon Hospital, Petah Tikva, Israel
| | - Lena Qawasmi
- Jerusalem Shoulder and Elbow Center, Jerusalem, Israel
| | - Hazem Safadi
- Jerusalem Shoulder and Elbow Center, Jerusalem, Israel
| | - Suhas P Dasari
- Orthopedic Department, University of Washington Medical Center, Seattle, WA, USA
| | - Mustafa Yassin
- Department of Orthopedic Surgery, Hasharon Hospital, Petah Tikva, Israel
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Spierings JF, Nijdam TMP, van der Heijden L, Schuijt HJ, Kokke MC, van der Velde D, Smeeing DPJ. Cast versus removable orthosis for the management of stable type B ankle fractures: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2023; 49:2085-2095. [PMID: 36383226 PMCID: PMC10520166 DOI: 10.1007/s00068-022-02169-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/04/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE There is currently no consensus on nonoperative management in adult patients after a stable type B ankle fracture. The aim of this review is to compare a removable orthosis versus a cast regarding safety and functional outcome in the NOM of stable type B ankle fractures. METHODS A systematic review and meta-analysis were performed using randomized clinical trials and observational studies. The methodological quality of the included studies was assessed with the methodological index for non-randomized studies instrument. Nonoperative management was compared using the number of complications and functional outcome measured using the Olerud and Molander Score (OMAS) or the American Academy of Orthopaedic Surgeons Ankle Score. RESULTS Five studies were included. Two were randomized clinical trials, and three were observational studies, including a total of 516 patients. A meta-analysis showed statistically significant higher odds of developing complications in the cast group [odds ratio (OR), 4.67 (95% confidence interval (CI) 1.52-14.35)]. Functional outcome in OMAS did not vary significantly at 6 weeks, mean difference (MD) - 6.64 (95% CI - 13.72 to + 0.45), and at 12 weeks, MD - 6.91 (95% CI - 18.73 to + 4.91). The mean difference of functional outcome in OMAS at 26 weeks or longer was significantly better in the removable orthosis group; MD - 2.63 (95% CI - 5.01 to - 0.25). CONCLUSION Results of this systematic review and meta-analysis show that a removable orthosis is a safe alternative type of NOM, as complication numbers are significantly lower in the orthosis group. In addition, no statistically significant differences were found in terms of functional outcome between a removable orthosis and a cast at 6 and 12 weeks. The 6-week and the 26-week OMAS results show that in patients with stable type B ankle fractures, a removable orthosis is non-inferior to a cast in terms of functional outcome.
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Affiliation(s)
- Jelle Friso Spierings
- Department of Trauma Surgery, St. Antonius Hospital, Soestwetering 1, 3543 AZ, Utrecht, The Netherlands.
| | | | - Lizz van der Heijden
- Department of Orthopedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Henk Jan Schuijt
- Department of Trauma Surgery, St. Antonius Hospital, Soestwetering 1, 3543 AZ, Utrecht, The Netherlands
| | - Marike Cornelia Kokke
- Department of Trauma Surgery, St. Antonius Hospital, Soestwetering 1, 3543 AZ, Utrecht, The Netherlands
| | - Detlef van der Velde
- Department of Trauma Surgery, St. Antonius Hospital, Soestwetering 1, 3543 AZ, Utrecht, The Netherlands
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Singh R, Seth I, Seth A, Singh S, Aiyappan RK, Yadav CM, Jain H, Tawde A, Agrawal GK, Jain A. How Not To Fix a Tibial Fracture: A Case Report on Treatment By a Quack. Cureus 2023; 15:e40203. [PMID: 37435249 PMCID: PMC10331172 DOI: 10.7759/cureus.40203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 07/13/2023] Open
Abstract
Quackery in the orthopaedic profession has existed for quite a long time. Due to the shortage of orthopaedic healthcare staff in public hospitals and the high costs in private facilities, members of disadvantaged communities turn to unlicensed and unskilled practitioners (quacks). The main factors responsible for the increased number of quacks performing orthopaedic treatment are illiteracy, high treatment cost, mismatch in the orthopaedic surgeon-to-population ratio, especially in rural areas, and the absence of any form of health insurance. Moreover, their easy availability and offer of low-cost treatment draw innocent and illiterate patients to them, even though these quacks perform orthopaedic treatment in the most unhygienic, unsterilized, and unconventional manner. The government should intervene and take measures to make orthopaedic treatment more affordable and accessible, especially to the rural population.
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Affiliation(s)
- Roop Singh
- Orthopaedics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Isha Seth
- Obstetrics and Gynaecology, Amrita Hospital, Faridabad, IND
| | - Aditya Seth
- Orthopaedics, Krishna Institute of Medical Sciences (KIMS) Sunshine Hospital, Hyderabad, IND
| | - Sunayana Singh
- Obstetrics and Gynecology, Government Medical College and Hospital, Chandigarh, IND
| | | | - Chander Mohan Yadav
- Orthopaedics and Rehabilitation, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Harsh Jain
- Orthopaedics and Rehabilitation, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Anish Tawde
- Arthroplasty, Krishna Institute of Medical Sciences (KIMS) Sunshine Hospital, Hyderabad, IND
| | - Gaurav K Agrawal
- Orthopaedics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Aditi Jain
- Internal Medicine, Sawai Man Singh Medical College, Jaipur, IND
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Gait Analysis to Monitor Fracture Healing of the Lower Leg. Bioengineering (Basel) 2023; 10:bioengineering10020255. [PMID: 36829749 PMCID: PMC9952799 DOI: 10.3390/bioengineering10020255] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Fracture healing is typically monitored by infrequent radiographs. Radiographs come at the cost of radiation exposure and reflect fracture healing with a time lag due to delayed fracture mineralization following increases in stiffness. Since union problems frequently occur after fractures, better and timelier methods to monitor the healing process are required. In this review, we provide an overview of the changes in gait parameters following lower leg fractures to investigate whether gait analysis can be used to monitor fracture healing. Studies assessing gait after lower leg fractures that were treated either surgically or conservatively were included. Spatiotemporal gait parameters, kinematics, kinetics, and pedography showed improvements in the gait pattern throughout the healing process of lower leg fractures. Especially gait speed and asymmetry measures have a high potential to monitor fracture healing. Pedographic measurements showed differences in gait between patients with and without union. No literature was available for other gait measures, but it is expected that further parameters reflect progress in bone healing. In conclusion, gait analysis seems to be a valuable tool for monitoring the healing process and predicting the occurrence of non-union of lower leg fractures.
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Karimi M, Kamali M. The effectiveness of functional brace in the treatment of tibia fracture: A review of literature. ARCHIVES OF TRAUMA RESEARCH 2021. [DOI: 10.4103/atr.atr_74_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Goodier WD, Calder PR. External fixation for the correction of adult post-traumatic deformities. Injury 2019; 50 Suppl 1:S36-S44. [PMID: 31054864 DOI: 10.1016/j.injury.2019.03.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 03/28/2019] [Indexed: 02/02/2023]
Abstract
Malalignment of the lower limb is a significant factor in the progression of arthritis of the knee and ankle, and correction of deformity can slow the progress and reduce symptoms. It is less clear that malalignment can cause arthritis de novo, but in post traumatic deformity it has been shown that a fracture of the tibia can increase the risk of pain and stiffness of the knee and ankle irrespective of deformity. The management of deformity of the lower limb by external fixation requires a careful systematic method of deformity analysis combining clinical and radiographic assessment is essential to avoid the pitfalls of overlooking potential soft tissue problems, and hidden secondary deformities. External fixators are powerful tools for the correction of deformity, but a sound grounding in deformity analysis is essential.
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Affiliation(s)
- W David Goodier
- The Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK.
| | - Peter R Calder
- The Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
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7
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Takeuchi A, Matsubara H, Yamamoto N, Hayashi K, Miwa S, Igarashi K, Inatani H, Tsuchiya H. Successful treatment of pathologic femoral shaft fracture associated with large arteriovenous malformations using a 3-dimensional external fixator and teriparatide: a case report. BMC Surg 2019; 19:35. [PMID: 30953554 PMCID: PMC6451220 DOI: 10.1186/s12893-019-0498-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 03/28/2019] [Indexed: 01/19/2023] Open
Abstract
Background Arteriovenous malformations (AVMs) are rare congenital vascular lesions associated with early quiescence, late expansion, and, ultimately, infiltration and destruction of local soft tissue and bone. The extremities are a common location. Incidence of bony involvement by AVM has been reported as high as 31%. However, there are few reports on management of pathologic fracture associated with AVM. Teriparatide is a recombinant parathyroid hormone (PTH) analogue consisting of the 1–34 fragment of PTH. Recently, some reports have shown the ability of teriparatide to improve fracture healing. Here, we present a case of pathologic femoral shaft fracture associated with large AVMs that was treated successfully by external fixation and teriparatide. Case presentation A 68-year-old Japanese woman, previously diagnosed as having large AVMs, sustained a right femoral shaft fracture due to a fall. At the time of admission, she presented with massive swelling and venous varicosities of the right thigh. Plain radiography of the right thigh revealed femoral shaft fracture with bony erosion and calcification of soft tissue. We planned closed reduction and intramedullary nailing with a unilateral external fixator following embolization of the feeding artery. However, closed reduction using the fracture table was difficult. When we attempted open reduction, massive bleeding (1000 mL) after incision of subcutaneous tissue occurred. Finally, we carefully applied a Taylor Spatial Frame. Fracture displacement was corrected successfully and bony union was obtained with administration of teriparatide 15 months after the initial surgery. The patient is able to walk using 1 cane. Conclusion We present the first report of pathologic fracture associated with large AVMs that achieved bony union using a 3-dimensional external fixator and teriparatide.
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Affiliation(s)
- Akihiko Takeuchi
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa-shi, Ishikawa-ken, 920-8641, Japan.
| | - Hidenori Matsubara
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa-shi, Ishikawa-ken, 920-8641, Japan
| | - Norio Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa-shi, Ishikawa-ken, 920-8641, Japan
| | - Katsuhiro Hayashi
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa-shi, Ishikawa-ken, 920-8641, Japan
| | - Shinji Miwa
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa-shi, Ishikawa-ken, 920-8641, Japan
| | - Kentaro Igarashi
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa-shi, Ishikawa-ken, 920-8641, Japan
| | - Hiroyuki Inatani
- Department of Orthopaedic Surgery, Fukui-ken Saiseikai Hospital, 7-1 Funabashi Wadanakacho, Fukui-shi, Fukui-ken, 918-8503, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa-shi, Ishikawa-ken, 920-8641, Japan
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Ayoub MS, Tarkin IS. Best care paradigm to optimize functionality after extra-articular distal humeral fractures in the young patient. J Clin Orthop Trauma 2018; 9:S116-S122. [PMID: 29628712 PMCID: PMC5883908 DOI: 10.1016/j.jcot.2018.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 02/03/2018] [Indexed: 12/27/2022] Open
Abstract
For younger patients with extra-articular distal humerus fractures closed management is plagued with high rates of malunion, suboptimal functional outcomes, extended immobilization with loss of early motion, a delay in return to work, and a general period of lost productivity. Surgical management offers an appealing alternative. Maintaining respect for the triceps musculature and minimizing iatrogenic injury to the radial nerve are primary concerns with operative treatment. Accordingly, use of a triceps-sparing approach and single column plating may be the optimal treatment paradigm in the young patient presenting with an extra-articular distal humerus fracture.
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Affiliation(s)
- Mark S. Ayoub
- UCSF-Fresno, Department of Orthopaedic Surgery, 2823 Fresno Street, Fresno, CA 93721, United States,Corresponding author.
| | - Ivan S. Tarkin
- University of Pittsburgh Medical Center, Department of Orthopaedic Surgery, Kaufmann Medical Building, 3471 5th Avenue, Suite 1010, Pittsburgh, PA 15213, United States
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10
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Editorial: What Makes Young Surgeons Tick (or Cut)? Clin Orthop Relat Res 2015; 473:1853-5. [PMID: 25773905 PMCID: PMC4419024 DOI: 10.1007/s11999-015-4253-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 03/06/2015] [Indexed: 01/31/2023]
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McCann PA, Smith GCS, Clark D, Amirfeyz R. The tricipital aponeurosis--a reliable soft tissue landmark for humeral plating. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2015; 20:53-8. [PMID: 25609275 DOI: 10.1142/s0218810415500070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This study aims to identify the relationship of the radial nerve as it descends across the humerus with reference to a reliable soft tissue landmark, the tricipital aponeurosis. Following cadaveric dissection of 10 adult humerii, the radial nerve was located as it crossed the lateral midsagittal point of the humeral diaphysis. A horizontal line was then subtended medially from this point to another line subtended vertically from the lateral border of the tricipital aponeurosis. The vertical distance from this intersection to the lateral apex of the aponeurosis was recorded in three positions (full flexion, 90° of flexion and full extension). The location of the radial nerve on the posterior aspect of the humeral diaphysis to the medial apex of the tricipital aponeurosis was also noted. In 90° of flexion the radial nerve at the lateral midsagittal point of the humerus was 0.9 mm proximal to the lateral apex of the tricipital aponeurosis. Flexion and extension of the elbow changed the interval to 16.3 mm (nerve proximal) in full flexion and 7.1 mm in full extension (nerve distal). On the posterior aspect of the humerus the radial nerve was 21.8 mm proximal to the medial aspect of the tricipital aponeurosis. The aponeurosis provides a reference point from which the nerve can be easily located on the lateral aspect of the humerus intraoperatively in a range of positions, whilst the medial apex provides a guide to the location of the nerve on the posterior aspect of the arm.
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Affiliation(s)
- P A McCann
- Department of Trauma and Orthopaedics, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK
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12
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Affiliation(s)
- Anil K Jain
- Editor, Indian Journal of Orthopaedics, and Professor, Orthopaedics, University College of Medical Sciences & GTB Hospital, Delhi, India,Address for correspondence: Dr. Anil K Jain, Department of Orthopaedics, University College of Medical Sciences, Delhi, India. E-mail:
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Deakin DE, Winter H, Jain P, Bache CE. Malunion following flexible intramedullary nails for tibial and femoral fractures in adolescents. J Child Orthop 2010; 4:571-7. [PMID: 22132035 PMCID: PMC2981706 DOI: 10.1007/s11832-010-0300-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Accepted: 10/14/2010] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Flexible intramedullary nails (FIN) are increasingly used in the management of paediatric tibial and femoral fractures. Concerns have recently been raised regarding the use of FIN in older children. The aim of this study was to determine how effective FIN is in treating tibial and femoral fractures in adolescents. METHODS Patients aged 11 years or older undergoing FIN for tibial and femoral fractures between 2003 and 2009 were identified. Radiographs and case notes were reviewed to identify complications. RESULTS Thirty-five consecutive adolescent patients underwent FIN for tibial (n = 21) and femoral fractures (n = 15), with a mean age of 12.9 years. The mean radiographic follow up was 29 weeks. Sixty percent (60%, n = 9) and 38% (n = 9) of femoral and tibial fractures, respectively, malunited. Fracture severity was associated with increased malunion for both tibial and femoral fractures (P = 0.046 and P = 0.044, respectively). Two femoral fractures took longer than 20 weeks to unite and seven tibial fractures took longer than 16 weeks to unite. CONCLUSION The higher than expected rates of malunion and delayed union in this study suggest that other treatments should be considered when treating adolescents with unstable tibial or femoral fractures.
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Affiliation(s)
- D. E. Deakin
- Department of Trauma and Orthopaedics, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH United Kingdom
| | - H. Winter
- Department of Trauma and Orthopaedics, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH United Kingdom
| | - P. Jain
- Department of Trauma and Orthopaedics, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH United Kingdom
| | - C. E. Bache
- Department of Trauma and Orthopaedics, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH United Kingdom
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Papasoulis E, Drosos GI, Ververidis AN, Verettas DA. Functional bracing of humeral shaft fractures. A review of clinical studies. Injury 2010; 41:e21-27. [PMID: 19523625 DOI: 10.1016/j.injury.2009.05.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 03/26/2009] [Accepted: 05/05/2009] [Indexed: 02/02/2023]
Abstract
Functional bracing has been widely accepted as the gold standard for treating humeral shaft fractures conservatively. We conducted a literature review to verify the efficacy of this treatment method. Sixteen case series and two comparative studies fulfilled the criteria set. Analysis of these clinical studies showed that humeral shaft fractures when treated with functional bracing heal in an average of 10.7 weeks. Union rate is high (94.5%). Statistical analysis showed that proximal third fractures and AO type A fractures have a higher non-union rate although this is not statistical significant. Residual deformity and joint stiffness are considered the main drawbacks of conservative treatment. Angulation--usually varus--rarely exceeded 10 degrees, while full shoulder and elbow motion was achieved in 80% and 85% of the patients, respectively. Nevertheless, in the few studies that subjective parameters such as functional scores, pain and quality of life were assessed results were not so promising.
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Affiliation(s)
- Efthimios Papasoulis
- Department of Orthopaedic Surgery, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece.
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Garnavos C, Lasanianos N, Kanakaris NK, Arnaoutoglou C, Papathanasopoulou V, Xenakis T. A new modular nail for the diaphyseal fractures of the humerus. Injury 2009; 40:604-10. [PMID: 19394611 DOI: 10.1016/j.injury.2009.01.130] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Revised: 01/14/2009] [Accepted: 01/20/2009] [Indexed: 02/02/2023]
Abstract
Over a period of 5 years, 63 traumatic and eight pathological diaphyseal humeral fractures were treated with a new modular humeral nail. The nail is cannulated, square in shape--with concave sides--and has two different extensions that can be used with either the antegrade or the retrograde approach. Adequate rotational and axial stability is provided without the need for distal locking screws in the majority of fractures, while the need for proximal locking screws during the antegrade procedure is abolished. This study aims to present the 'Garnavos' nail and the results of its use, along with proposals and guidelines that should be considered whenever intramedullary nailing is selected for the treatment of diaphyseal humeral fractures.
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Affiliation(s)
- Christos Garnavos
- Orthopaedic Department of Evangelismos General Hospital, 5 Poseidonos st., Glyfada 16674, Athens, Greece.
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Fractures of the middle third of the tibia treated with a functional brace. Clin Orthop Relat Res 2008; 466:3108-15. [PMID: 18719973 PMCID: PMC2628234 DOI: 10.1007/s11999-008-0438-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Accepted: 07/18/2008] [Indexed: 01/31/2023]
Abstract
UNLABELLED It generally is accepted that fractures of the tibia located in the proximal and distal thirds tend to angulate more than midshaft fractures when treated with intramedullary nails. We therefore compared the angular deformities and final shortening of 434 closed fractures located in the middle third of the tibia treated with a functional brace with those in fractures in the proximal and distal thirds treated in the same manner. Ninety-seven percent in the middle third healed with 8 degrees or less angulation in the mediolateral plane, which was a higher percentage than we had experienced in distal and proximal third fractures treated with this method. Nonunions occurred in four (0.9%) fractures. We found correlations between initial shortening, final shortening, initial displacement, final displacement, and time to brace with initial angulation and final angulation in the mediolateral and anteroposterior planes. The overall mean final shortening of the fractures located in the middle third was 4.3 mm. These experiences suggest satisfactory results can be obtained in most instances using a functional brace for management of closed fractures of the middle third of the tibia. LEVEL OF EVIDENCE Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Abstract
Functional bracing of humeral diaphyseal fractures was conceived after initial experiences with a similar method was used in the management of diaphyseal tibial fractures. Over the years, tibial functional bracing underwent major evolutionary changes, and found its indications basically limited to a smaller group of fractures, consisting of closed, axially unstable fractures that experience at the time of the injury an acceptable degree of shortening, and to transverse fracture that are appropriately reduced and rendered stable. On the other hand, functional bracing of diaphyseal humeral fractures has, maintained the initial indications, contraindications and methodology. This article describes the concept, indications and contraindications of functional bracing of humeral diaphyseal fractures and provides results of 620 fractures with complete follow-up. In 97.5% of the patients, the average healing time was 11.5 weeks. 16 patients (2.5%) required operative intervention because of a nonunion and 4 patients (<1 degrees) of the patient had a refracture after brace removal. Nerve function did not return in only one of the 67 patient who had radial nerve palsy.
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Affiliation(s)
- A Sarmiento
- Department of Orthopaedics and Rehabilitation, 72 Avenue, 10333 SW, 33156, University of Miami, Florida, USA.
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Rajan S, Jain S, Ray A, Bhargava P. Radiological and functional outcome in extra-articular fractures of lower end radius treated conservatively with respect to its position of immobilization. Indian J Orthop 2008; 42:201-7. [PMID: 19826528 PMCID: PMC2759629 DOI: 10.4103/0019-5413.40258] [Citation(s) in RCA: 9] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Extra-articular fractures of lower end radius are conventionally immobilized in palmar flexion and ulnar deviation. In view of poor functional results, the conventional method of immobilization is giving way to dorsiflexed-immobilized method. The aim of our study is to evaluate and compare the radiological and functional outcome in extra-articular fractures of lower end radius treated conservatively with respect to its position of immobilization. MATERIALS AND METHODS Sixty-four patients, all above 20 years of age with closed extra-articular fractures of lower end radius who were treated conservatively by close reduction and below elbow cast application constitute the clinical material. Irrespective of fracture geometry the patients were randomly allocated to dorsal or palmar flexed immobilized position of wrist. Patients were followed up for a minimum six-month period. The radial tilt, palmar tilt and ulnar variance are measured at prereduction, postreduction and at 6 month followup. The results were scored by Demerit Scoring System of Saito. RESULTS All fractures united. Individual movement of dorsiflexion, palmar flexion, supination, pronation and radial-ulnar deviation were all significantly better in the dorsiflexed-immobilized group as compared with the palmar flexed immobilized group. Grip strength recovery with subjective assessment was better in the dorsiflexed group (77%) as compared to the palmar flexed group (23%). Radiological parameters were markedly better in the dorsiflexed group. Ninety-one per cent of patients in the dorsiflexed group had excellent to good results as compared to 66% in the palmar flexed group. CONCLUSION Functional results of extra-articular fractures of lower end radius are superior if the fractures after reduction are immobilized in dorsiflexion of wrist rather than in conventional palmar flexion position.
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Affiliation(s)
- Sunil Rajan
- Department of Orthopedics and Traumatology, MGM Medical College and M.Y. Hospital, Indore, Madhya Pradesh, India,Correspondence: Dr. Sunil Rajan, 49, Jai Rampur Colony, Indore - 452 004, Madhya Pradesh, India. E-mail:
| | - Saurabh Jain
- Department of Orthopedics and Traumatology, MGM Medical College and M.Y. Hospital, Indore, Madhya Pradesh, India
| | - A Ray
- Department of Orthopedics and Traumatology, MGM Medical College and M.Y. Hospital, Indore, Madhya Pradesh, India
| | - P Bhargava
- Department of Orthopedics and Traumatology, MGM Medical College and M.Y. Hospital, Indore, Madhya Pradesh, India
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Abstract
Understanding of the adult acquired flatfoot deformity (AAFD) continues to grow, as does the sophistication of orthotics and braces used to treat this disorder. This article reviews these advances and some of the devices commonly used to treat patients who have AAFD. Additionally, the recent proliferation and potential implications of mass-manufactured products is discussed.
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Affiliation(s)
- John D Logue
- D&J Medical, 2 Colgate Drive, Suite 202, Forest Hill, MD 21050, USA.
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Dubrana F, Genestet M, Moineau G, Gérard R, Le Nen D, Lefèvre C. Fractures ouvertes de jambe. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s0246-0521(07)41018-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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