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Yap W, Ng JW, Lee M, Kwek E. Lower Limb Malrotation following Minimally Invasive Plating in Distal Tibia Fractures. Malays Orthop J 2024; 18:140-149. [PMID: 38638650 PMCID: PMC11023353 DOI: 10.5704/moj.2403.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/16/2023] [Indexed: 04/20/2024] Open
Abstract
Introduction Minimally invasive percutaneousosteosynthesis (MIPO) plating techniques havedemonstrated good outcomes in the treatment of distal tibia fractures. Early arthritis and functional impairment mayoccur if length and rotation are not restored. This study aims to determine the incidence and severity of tibia malrotation following MIPO plating of isolated unilateral distal tibia fractures, defined as torsional difference of greater than 10° as compared to the contralateral limb and whether the degree of malrotation affects functional outcomes scores. Materials and methods This was a level 2 prospective cohort study. All patients with fractures of the distal tibia who underwent surgical fixation with the exclusion ofpatients with polytrauma, neurovascular injuries or pre-existing disabilities were recruited. Patients underwent MIPO plating followed by a post-operative ComputedTomography (CT) scan of bilateral lower limbs. AOFAS ankle-hindfoot score was recorded at six months and one year follow-up. Results A total of 24 patients (28 to 83 years old) were recruited. Nineteen patients obtained CT scans. Nine of the 19 patients (47.3%) had tibia malrotation. The mean tibia malrotation angle was 10.3° (0° - 45°). The average AOFAS scores was 82.4 and 84.3 at 6 months and 1 year follow-up. Degree of CT malrotation was not significantly associated with AOFAS scores at 6 month (spearman rho -0.386) and 1 year (spearman rho -0.343). Conclusions Tibia malrotation following MIPO plating of distal tibia fractures is common, with an incidence of 47.3% and an average malrotation angle of 10.3°. The degree of malrotation does not appear to have significant mid-term functional impact on the patient.
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Affiliation(s)
- Wmq Yap
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - J W Ng
- Department of Orthopaedic Surgery, Woodlands Health, Singapore
| | - Mjjr Lee
- Department of Orthopaedic Surgery, Woodlands Health, Singapore
| | - Ebk Kwek
- Department of Orthopaedic Surgery, Woodlands Health, Singapore
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La Banca V, Lima GHV, Vigano AVP, Gonzalez FF, Schaffhausser HDL, Almeida LHO, Nascimento LGP, Murachovsky J, Ikemoto RY. Complications and clinical outcomes with minimally invasive plate osteosynthesis ( MIPO) technique for midshaft clavicle fractures: a systematic review and meta-analysis. JSES Int 2024; 8:257-267. [PMID: 38464441 PMCID: PMC10920130 DOI: 10.1016/j.jseint.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Background Clavicle fractures are among the most common upper limb fractures in adults, with the midshaft region being the most frequently affected site. Minimally invasive plate osteosynthesis (MIPO) has emerged as an alternative to the traditional open reduction and internal fixation (ORIF) technique, offering potential advantages. The purpose of this study was to conduct a systematic review to explore the results of this technique in the existing literature, with emphasis on the occurrence of surgical complications and functional outcomes and also to provide a comprehensive comparison of MIPO and ORIF in the management of midshaft clavicle fractures. Methods We conducted a systematic review to evaluate the complication incidence and clinical outcomes of MIPO for midshaft clavicle fractures. We searched PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, the Cochrane Database of Controlled Trials, and the Cochrane Database of Systematic Reviews databases without language or date restrictions. Studies focusing on midshaft clavicle fractures treated with MIPO were included, while other clavicle fractures and nonclinical studies were excluded. The risk of bias was assessed using the Methodological Index for Nonrandomized Studies criteria and the Risk of Bias Tool 2 Cochrane tool. Data synthesis included qualitative analysis, and if applicable, quantitative analysis and meta-analysis. Adherence to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines ensured reporting quality. Results A total of 107 studies were initially identified, after applying inclusion and exclusion criteria, 22 studies were included for data extraction. These studies involved the evaluation of 714 clavicles treated with the MIPO technique. Of the 714 MIPO cases, 11 cases of implant failure, 5 nonunions, 2 infections, and 28 cases with neurological impairment were observed. Quantitative analysis comparing MIPO with ORIF revealed that MIPO had significantly shorter surgery time (mean difference -12.95, 95% confidence interval [-25.27 to -0.63], P = .04) and lower occurrence of numbness (odds ratio 0.29, 95% CI [0.15-0.56], P = .0002) compared to ORIF. Time to bone union, functional outcomes, and other complications were similar between MIPO and ORIF at the final follow-up. An overall moderate risk of bias was found across the studies. Conclusion The MIPO technique yields good and comparable results to ORIF for midshaft clavicle fractures. Additionally, the MIPO technique may offer advantages such as reduced surgical time and lower chances of neurological impairment.
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Affiliation(s)
- Vitor La Banca
- Disciplina de Ortopedia - Faculdade de Medicina do ABC, Santo André, SP, Brazil
- Instituto Brasil de Tecnologia da Saúde, Rio de Janeiro, RJ, Brazil
| | | | - Ana Victoria Palagi Vigano
- Disciplina de Ortopedia - Faculdade de Medicina do ABC, Santo André, SP, Brazil
- Hospital Ipiranga, São Paulo, SP, Brazil
| | | | | | | | | | - Joel Murachovsky
- Disciplina de Ortopedia - Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | - Roberto Yukio Ikemoto
- Disciplina de Ortopedia - Faculdade de Medicina do ABC, Santo André, SP, Brazil
- Hospital Ipiranga, São Paulo, SP, Brazil
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Lim S, Song HK, Kim TH, Park DY, Lee JW, Chung JY. Suprapatellar intramedullary nail combined with screw fixation has comparable surgical outcomes to minimally invasive locking plate fixation in ipsilateral tibial plateau and shaft fractures. Arch Orthop Trauma Surg 2024; 144:673-681. [PMID: 38032381 DOI: 10.1007/s00402-023-05147-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 11/13/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE To compare union rate, union time, alignment, and complication rate in ipsilateral tibia plateau and shaft fractures treated via suprapatellar intramedullary nailing with screw fixation and minimally invasive locking plate fixation. MATERIALS AND METHODS A retrospective study was conducted on 48 patients who underwent minimally invasive plate fixation (n = 35) or suprapatellar intramedullary nailing with screw fixation (n = 13), for the treatment of ipsilateral tibial plateau and shaft fractures with at least 1-year follow-up. Union rate, union time, radiologic alignment, and complication rate such as malalignment, nonunion, and fracture-related infection (FRI) were investigated. RESULTS Demographic data were not different between the two groups. Coronal plane alignment was 0.17 ± 4.23 in the plate group and -0.48 ± 4.17 in the intramedullary nail group (p = 0.637). Sagittal plane alignment was -0.13 ± 5.20 in the plate group and -1.50 ± 4.01 in the suprapatellar intramedullary nail group (p = 0.313). Coronal and sagittal malalignment recorded equal results: (p > 0.99), FRI (p = 0.602), nonunion and union times recorded (p = 0.656) and (p = 0.683, 0.829), respectively, and showed no significant difference between the two groups. CONCLUSION Suprapatellar intramedullary nailing with screw fixation had similar surgical outcomes with minimally invasive locking plate fixation in ipsilateral tibial plateau and shaft fractures in terms of union rate, union time, alignment, and complication rate. Thus, frequent use of intramedullary nailing combined with screw fixation is anticipated in patients with ipsilateral tibial plateau and shaft fractures when the soft tissue condition is not desirable. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Sumin Lim
- Department of Orthopedic Surgery, Ajou University School of Medicine, 164 Worldcup-Ro, Yongtong-Gu, Suwon, 16499, Korea
| | - Hyung Keun Song
- Department of Orthopedic Surgery, Ajou University School of Medicine, 164 Worldcup-Ro, Yongtong-Gu, Suwon, 16499, Korea
| | - Tae Hun Kim
- Department of Orthopedic Surgery, Ajou University School of Medicine, 164 Worldcup-Ro, Yongtong-Gu, Suwon, 16499, Korea
| | - Do Young Park
- Department of Orthopedic Surgery, Ajou University School of Medicine, 164 Worldcup-Ro, Yongtong-Gu, Suwon, 16499, Korea
| | - Jong Wha Lee
- Department of Orthopedic Surgery, Ajou University School of Medicine, 164 Worldcup-Ro, Yongtong-Gu, Suwon, 16499, Korea
| | - Jun Young Chung
- Department of Orthopedic Surgery, Ajou University School of Medicine, 164 Worldcup-Ro, Yongtong-Gu, Suwon, 16499, Korea.
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Jiamton C, Rungchamrussopa P, Taweekitikul P, Leelasestaporn T, Anantasinkul P, Apivatthakakul T. Lateral minimally invasive plate osteosynthesis ( MIPO) with long PHILOS for proximal metaphyseal-diaphyseal humeral fracture: surgical techniques and a clinical series. Eur J Orthop Surg Traumatol 2024; 34:689-697. [PMID: 37688639 DOI: 10.1007/s00590-023-03722-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/27/2023] [Indexed: 09/11/2023]
Abstract
The minimally invasive plate osteosynthesis (MIPO) for proximal metaphyseal-diaphyseal humeral fracture is an effective alternative treatment with satisfactory outcomes. In this study, we described the surgical techniques and clinical results using MIPO via a lateral approach and long PHILOS plate fixation in 23 patients. All fractures were successfully united within a mean union time of 13.5 weeks (range 9-18). There was no iatrogenic radial nerve palsy. The deltoid power was grade 5 in all patients, except for 2 patients who had associated brachial plexus injury and gunshot injury at the deltoid muscle. The mean Constant-Murley score was 85.6 (range 16-98) and DASH score was 12.1 (range 1.7-85). Based on these findings, the lateral MIPO with long PHILOS plate fixation could be an alternative for the proximal metaphyseal-diaphyseal fractures of the humeral shaft.
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Affiliation(s)
- Chittawee Jiamton
- Department of Orthopaedics, Queen Savang Vadhana Memorial Hospital, 209, Jerm Jom Phol Road, Si Racha, Chonburi, 20110, Thailand.
| | | | - Pariwat Taweekitikul
- Department of Orthopaedics, Queen Savang Vadhana Memorial Hospital, 209, Jerm Jom Phol Road, Si Racha, Chonburi, 20110, Thailand
| | - Techit Leelasestaporn
- Department of Orthopaedics, Queen Savang Vadhana Memorial Hospital, 209, Jerm Jom Phol Road, Si Racha, Chonburi, 20110, Thailand
| | - Pattraluck Anantasinkul
- Institute of Orthopaedics, Lerdsin Hospital, Silom, Bang Rak, Bangkok, 10500, Thailand
- Department of Orthopaedics, Nakornping Hospital, Mae Rim, Chiang Mai, 50180, Thailand
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Jirangkul P, Lorsuwannarat N, Wanichjaroen N. Precontoured dynamic compression plate using patient-specific 3D-printed models in minimally invasive surgical technique for midshaft clavicle fractures. Arch Orthop Trauma Surg 2024; 144:103-111. [PMID: 37658855 DOI: 10.1007/s00402-023-05042-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 08/17/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION This study introduced a novel approach for the treatment of midshaft clavicle fractures, utilizing patient-specific 3D-printed models for accurate preoperative contouring of dynamic compression plates (DCPs) and an alternative minimally invasive plate osteosynthesis (MIPO) technique with precontoured DCPs through small vertical separated incisions. PATIENT AND METHODS Mirror image 3D clavicular models were reproduced from 40 patients with acute displaced midshaft clavicle fractures who underwent MIPO using precontoured DCPs inserted through small, vertical separated incisions. Exclusion criteria included patients with open fractures, pathological fractures, ipsilateral limb injury, skeletal immature patients, and those who had previous clavicle fractures or surgery. Postoperative evaluation was conducted using clinical and radiographic review. The Constant-Murley and American Shoulder and Elbow Surgeons Shoulder Scores were used for clinical evaluations, and the Patient and Observer Scar Assessment Scale was used to assess surgical scars. RESULTS The average time to union of all fractures was 12.88 weeks (range, 8-15) without loss of reduction. The patient-specific precontoured DCPs fitted well in all cases, with fracture consolidation and minimal three cortical sides connecting the fracture fragment. No hardware prominence and skin complications occurred, and clinical evaluation showed no existing difference compared with the contralateral sides. The average Constant-Murley and American Shoulder and Elbow Surgeons Shoulder Scores were 96.33 ± 3.66 and 93.26 ± 5.15, respectively. Two patients requested their implant removal, and scar qualities were satisfactory. CONCLUSIONS Our study demonstrated that the use of a patient-specific precontoured DCP, in combination with 3D printing technology, provides accurate preoperative planning, effective fracture reduction, and improved postoperative outcomes in displaced midshaft clavicle fractures. The MIPO with a patient-specific precontoured DCP through separated vertical incisions along the Langer's lines appears to be a promising option, regarding appearance, avoiding associated complications, and obviating the need for reoperation. These results suggest that this technique has merit and can be a viable option for the treatment of midshaft clavicle fractures.
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Affiliation(s)
- Puripun Jirangkul
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.
| | | | - Nutthapong Wanichjaroen
- Department of Plastic Surgery, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
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Sourougeon Y, Barzilai Y, Haba Y, Spector B, Prat D. Outcomes following minimally invasive plate osteosynthesis ( MIPO) application in tibial pilon fractures - A systematic review. Foot Ankle Surg 2023; 29:566-575. [PMID: 37532663 DOI: 10.1016/j.fas.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/22/2023] [Accepted: 07/25/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND This systematic review evaluates postoperative complications and functional outcomes of minimally invasive plate osteosynthesis (MIPO) for distal tibial pilon fractures. This paper aims to fill a key literature gap, as no previous reviews have specifically addressed MIPO for tibial pilon fractures or fractures other than those involving the humeral shaft. METHODS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic literature search was done using PubMed, Embase, Web of Science, and Scopus databases from 2000 to 2022. Inclusion criteria were MIPO treatment in skeletally mature patients, while exclusion criteria were non-English papers, conference abstracts, papers with multiple treatment modalities that didn't analyze MIPO outcomes separately, skeletally immature patients, case reports, and cohorts smaller than five patients. Unpublished papers were also searched using Clinical Trials. Data extraction included general study information, injury specification, outcome measures, and complications. Finally, a risk of bias assessment (RoB) was performed. RESULTS A total of 1732 studies were identified, of which 23 were included in this review, with 673 patients and 678 fractures analyzed. The mean follow-up ranged from 6 to 62.53 months, with most studies representing intermediate to long-term follow-up. Primary outcome measures showed that 87.33% achieved 'excellent to good' results, 8.67% achieved 'fair' results, and 4% achieved 'poor' results. Stratified by fracture type, 76.47%, 80.05%, and 76.92% of AO/OTA type A, B, and C fractures, respectively, achieved 'excellent to good' results. 35.06% of cases reported complications (236 in total). These included one case of deep infection (0.148%), 28 superficial wound infections (4.16%), 4 nonunion cases (0.59%), and 22 malunion instances (3.27%). RoB assessment showed that 52.17% had a moderate overall risk of bias, 39.13% had a serious overall risk of bias, and 8.7% had a critical overall risk of bias. CONCLUSION MIPO technique for pilon fractures showed good functional outcomes and reliability, with low complication rates and should be considered in cases where proper indirect reduction is possible. However, while the evidence is promising, further high-quality studies with larger sample sizes, longer-term follow-up, and comparison to other techniques are needed to evaluate the efficacy and safety of this technique. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Yosef Sourougeon
- Department of Orthopedic Surgery, Chaim Sheba Medical Center at Tel Hashomer, Derech Sheba 2, Ramat Gan, Israel.
| | - Yuval Barzilai
- Chaim Sheba Medical Center at Tel Hashomer, Derech Sheba 2, Ramat Gan, Israel.
| | - Yahav Haba
- Israeli Defense Forces Medical Corps, Israel.
| | - Barak Spector
- Sackler Faculty of Medicine, Tel Aviv University, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Dan Prat
- Department of Orthopedic Surgery, Chaim Sheba Medical Center at Tel Hashomer, Derech Sheba 2, Ramat Gan, Israel.
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Lim S, Song HK, Kim TH, Park DY, Lee JW, Chung JY. Comparison of suprapatellar intramedullary nailing versus minimal invasive locked plating for proximal tibia fractures. Arch Orthop Trauma Surg 2023; 143:7009-7017. [PMID: 37468712 DOI: 10.1007/s00402-023-04994-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/11/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE To compare the radiological alignment, union time, union rate, and complication rate between suprapatellar intramedullary nails and minimally invasive locking plate fixation in the treatment of proximal tibial fractures. MATERIALS AND METHODS We retrospectively analyzed 103 patients who underwent plate fixation (n = 50) or suprapatellar intramedullary nailing (n = 53) for proximal tibial fractures involving the meta-diaphyseal junction between November 2015 and October 2020 at our institution. The union rate, union time, radiologic alignments, and complications, such as malalignment, nonunion, and deep infection, were investigated. RESULTS The demographic data did not differ between the plate and suprapatellar intramedullary nail groups. The alignment of the coronal plane was 0.24 ± 3.19 in the plate group and - 0.49 ± 2.22 in the intramedullary nail group (p = 0.196). Sagittal plane alignment was - 0.29 ± 4.97 in the plate group and 0.24 ± 4.12 in the intramedullary nail group (p = 0.571), and coronal malalignment (p = 0.196), sagittal malalignment (p = 0.57), deep infection (p = 0.264), nonunion (p = 0.695), union time (p = 0.329), and final union rate (p = 0.699) were not significantly different between groups. CONCLUSION Compared with the minimally invasive locking compression plate group, the suprapatellar intramedullary nail group yielded comparable results in terms of radiological alignment and complications. Considering that proximal tibial fractures are associated with high-energy trauma and severe soft tissue damage, we believe that a suprapatellar intramedullary nail may be a good alternative. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Sumin Lim
- Department of Orthopedic Surgery, School of Medicine, Ajou University, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499, Korea
| | - Hyung Keun Song
- Department of Orthopedic Surgery, School of Medicine, Ajou University, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499, Korea
| | - Tae Hun Kim
- Department of Orthopedic Surgery, School of Medicine, Ajou University, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499, Korea
| | - Do Young Park
- Department of Orthopedic Surgery, School of Medicine, Ajou University, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499, Korea
| | - Jong Wha Lee
- Department of Orthopedic Surgery, School of Medicine, Ajou University, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499, Korea
| | - Jun Young Chung
- Department of Orthopedic Surgery, School of Medicine, Ajou University, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499, Korea.
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van de Wall BJM, Hoepelman RJ, Michelitsch C, Diwersi N, Sommer C, Babst R, Beeres FJP. Minimally invasive plate osteosynthesis ( MIPO) for scapular fractures. Oper Orthop Traumatol 2023; 35:390-396. [PMID: 37594566 DOI: 10.1007/s00064-023-00819-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/02/2023] [Accepted: 02/08/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVE Presentation of a minimally invasive surgical approach for the treatment of scapular fractures and the clinical outcome using this technique. INDICATIONS Displaced extra-articular fractures of the scapula body and glenoid neck (AO 14B and 14F) and simple intra-articular fractures of the glenoid. CONTRAINDICATIONS Complex intra-articular fractures and isolated fractures of the coracoid base. SURGICAL TECHNIQUE Make a straight or slightly curved incision along the lateral margin of the scapula leaving the deltoid fascia intact. Identify the interval between the teres minor muscle and infraspinatus to visualize the lateral column, whilst retracting the deltoid to visualize the glenoid neck. Reduce and align the fracture using direct and indirect reduction tools. A second window on the medial border of the scapula can be made to aid reduction and/or to augment stability. Small (2.0-2.7 mm) plates in a 90° configuration on the lateral border and, if required, on the medial border are used. Intra-operative imaging confirms adequate reduction and extra-articular screw placement. POSTOPERATIVE MANAGEMENT Direct postoperative free functional nonweight-bearing rehabilitation limited to 90° abduction for the first 6 weeks. Sling for comfort. Free range of motion and permissive weight-bearing after 6 weeks. RESULTS We collected data from 35 patients treated with minimally invasive plate osteosynthesis (MIPO) between 2011 and 2021. Average age was 53 ± 15.1 years (range 21-71 years); 17 had a type B and 18 a type F fracture according the AO classification. All patients suffered concomitant injuries of which thoracic (n = 33) and upper extremity (n = 25) injuries were most common. Double plating of the lateral border (n = 30) was most commonly performed as described in the surgical technique section. One patient underwent an additional osteosynthesis 3 months after initial surgery due to pain and lack of radiological signs of healing of a fracture extension into the spine of the scapula. In the same patient, the plate on the spine of scapula was later removed due to plate irritation. In 2 patients postoperative images showed a screw protruding into the glenohumeral joint requiring revision surgery. After standardisation of intra-operative imaging following these two cases, intra-articular screw placement did not occur anymore. No patient suffered from iatrogenic nerve injury and none developed a wound infection.
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Affiliation(s)
- B J M van de Wall
- Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Spitalstrasse, 6000, Luzern, Switzerland
- University of Luzern, Luzern, Switzerland
| | - R J Hoepelman
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C Michelitsch
- Unfallchirurgie, Kantonsspital Graubünden, Chur, Switzerland
| | - N Diwersi
- Klinik für Chirurgie, Kantonsspital Obwalden, Sarnen, Switzerland
| | - C Sommer
- Unfallchirurgie, Kantonsspital Graubünden, Chur, Switzerland
| | - R Babst
- Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Spitalstrasse, 6000, Luzern, Switzerland
- University of Luzern, Luzern, Switzerland
| | - F J P Beeres
- Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Spitalstrasse, 6000, Luzern, Switzerland.
- University of Luzern, Luzern, Switzerland.
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Pham Van N, Nguyen H, Nguyen Anh T, Chanh XT, Nguyen Anh T. Minimal invasive plate osteosynthesis for the dislocated humeral head fracture associated with ipsilateral humeral shaft fracture: A case report. Orthop Rev (Pavia) 2023; 15:89425. [PMID: 38025827 PMCID: PMC10667264 DOI: 10.52965/001c.89425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
The condition combining a dislocated humeral head fracture and an ipsilateral humeral shaft fracture is seen to be rare in literature, which is limited to case report or case series. Furthermore, effective management of these coexistent injuries is still a subject of debate. The essential purpose of this article is to report another treatment method for this condition. We present a case of a 79-year-old female patient who suffered a three-part humeral head fracture-dislocation associated with the ipsilateral humeral shaft fracture. The combined injuries were managed by minimal invasive plate osteosynthesis (MIPO) through the deltopectoral approach with the eventual result of bone healing and good function after thirty-three months of follow-up. In conclusion, MIPO should be considered a safe and effective option, however, the risk of traumatic osteonecrosis of the humeral head is taken into account before operation decision-making.
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Affiliation(s)
| | | | - Tuan Nguyen Anh
- Lower Limb Surgery Department Hospital For Traumatology and Orthopaedics Ho Chi Minh City
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Pastor T, Zderic I, Pastor T, Drenchev L, Skulev HK, van Knegsel KP, Lenz M, Link BC, Gueorguiev B, Beeres FJP. Helical Plating Compared with Straight Plating and Nailing for Treatment of Proximal Third Humeral Shaft Fractures-A Biomechanical Study. Medicina (Kaunas) 2023; 59:2043. [PMID: 38004092 PMCID: PMC10672748 DOI: 10.3390/medicina59112043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/04/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: The surgical treatment of proximal humeral shaft fractures usually considers application of either long straight plates or intramedullary nails. By being able to spare the rotator cuff and avoid the radial nerve distally, the implementation of helical plates might overcome the downsides of common fixation methods. The aims of the current study were (1) to explore the biomechanical competence of different plate designs and (2) to compare their performance versus the alternative treatment option of using intramedullary nails. Materials and Methods: Twenty-four artificial humeri were assigned to the following four groups for simulation of an unstable proximal humeral shaft fracture and instrumentation: Group 1 (Straight-PHILOS), Group 2 (MULTILOC-Nail), Group 3 (45°-Helical-PHILOS), and Group 4 (90°-Helical-PHILOS). All specimens underwent non-destructive, quasi-static biomechanical testing under loading in axial compression, torsion in internal/external rotation, and pure bending in four directions, accompanied by motion tracking. Results: Axial stiffness/displacement in Group 2 was significantly higher/smaller than in all other groups (p ≤ 0.010). Torsional displacement in Group 2 was significantly bigger than in all other groups (p ≤ 0.017). Significantly smaller coronal plane displacement was identified in Group 2 versus all other groups (p < 0.001) and in Group 4 versus Group 1 (p = 0.022). Significantly bigger sagittal plane displacement was detected in Group 4 versus all other groups (p ≤ 0.024) and in Group 1 versus Group 2 (p < 0.001). Conclusions: Intramedullary nails demonstrated higher axial stiffness and smaller axial interfragmentary movements compared with all investigated plate designs. However, they were associated with bigger torsional movements at the fracture site. Although 90°-helical plates revealed bigger interfragmentary movements in the sagittal plane, they demonstrated improved resistance against displacements in the coronal plane when compared with straight lateral plates. In addition, 45°-helical plates manifested similar biomechanical competence to straight plates and may be considered a valid alternative to the latter from a biomechanical standpoint.
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Affiliation(s)
- Torsten Pastor
- AO Research Institute Davos, 7270 Davos, Switzerland; (T.P.); (I.Z.); (K.P.v.K.)
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, 6000 Lucerne, Switzerland; (B.-C.L.); (F.J.P.B.)
| | - Ivan Zderic
- AO Research Institute Davos, 7270 Davos, Switzerland; (T.P.); (I.Z.); (K.P.v.K.)
| | - Tatjana Pastor
- AO Research Institute Davos, 7270 Davos, Switzerland; (T.P.); (I.Z.); (K.P.v.K.)
- Department for Plastic and Hand Surgery, Inselspital University Hospital Bern, University of Bern, 3012 Bern, Switzerland
| | - Ludmil Drenchev
- Institute of Metal Science, Equipment and Technologies for Hydro- and Aerodynamics Center “Acad. A. Balevski”, Bulgarian Academy of Sciences, 1000 Sofia, Bulgaria; (L.D.); (H.K.S.)
| | - Hristo Kostov Skulev
- Institute of Metal Science, Equipment and Technologies for Hydro- and Aerodynamics Center “Acad. A. Balevski”, Bulgarian Academy of Sciences, 1000 Sofia, Bulgaria; (L.D.); (H.K.S.)
| | - Kenneth P. van Knegsel
- AO Research Institute Davos, 7270 Davos, Switzerland; (T.P.); (I.Z.); (K.P.v.K.)
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, 6000 Lucerne, Switzerland; (B.-C.L.); (F.J.P.B.)
| | - Mark Lenz
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, 07747 Jena, Germany;
| | - Björn-Christian Link
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, 6000 Lucerne, Switzerland; (B.-C.L.); (F.J.P.B.)
| | - Boyko Gueorguiev
- AO Research Institute Davos, 7270 Davos, Switzerland; (T.P.); (I.Z.); (K.P.v.K.)
| | - Frank J. P. Beeres
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, 6000 Lucerne, Switzerland; (B.-C.L.); (F.J.P.B.)
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Videla-Cés M, Comas-Aguilar M, Endemaño-Lucio A, Sánchez-Navés R, Romero-Pijoan E, Videla S. Percutaneous helical plate fixation in humeral shaft fractures with proximal extension. Injury 2023; 54 Suppl 6:110750. [PMID: 38143117 DOI: 10.1016/j.injury.2023.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/05/2023] [Accepted: 04/14/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Humeral shaft fractures with extension to the proximal third are increasingly frequent and technically more demanding. Surgical management of proximal metaphyseal junction humeral fractures is challenging. The aim of this study was to assess the safety, reproducibility, and possibility of early and completed rehabilitation in the percutaneous treatment with helical plates in humeral shaft fractures with proximal extension. PATIENTS AND METHODS This was a descriptive, retrospective, single-centre cohort study based on consecutive patients with proximal metaphyseal junction humeral fractures (MIPO-helical-plate-Broggi's cohort). Surgical technique (minimally invasive approach and osteosynthesis): percutaneous treatment with a twisted plate (helical plates). STUDY VARIABLES i): Intraoperative and postoperative (up to 1 year after surgery) safety; ii) Reproducibility of the surgical technique [number (percentage) of patients with surgical technique success]. The surgical technique success was defined as the recovering without neurovascular, implant failures and infection issues after one year follow up; and iii) Early and completed (3 months) rehabilitation [number (percentage) of patients]. A descriptive analysis was performed. RESULTS Between April 2010 to January 2022, we received 443 humeral shaft fractures at our unit. Of these, 350 fractures were treated surgically. 157 (44.9%) were treated using the minimally invasive approach and osteosynthesis technique with extramedullary implants, of which 46 (46/157, 29.3%, 9 men and 37 women) were performed with almost orthogonally twisted Philos® helical plates. The median (range) age was 67 (51-94) years. STUDY OUTCOMES i) Safety: None intraoperative events were gathered. No neurovascular, implant failure and infection issues were reported one year after surgery.; ii) Reproducibility of the surgical technique: only 1 failure (2%, 95%CI:0-11%), who was reoperated; and iii) Early and 3 month of rehabilitation was completed in 45 (98%, 95%CI:89-100%) patients. Forty-five (98%, 95%CI:89-100%) patients recovered their previous function the year after surgery. CONCLUSIONS The treatment of humeral shaft fractures with proximal extension based on a minimally invasive approach and osteosynthesis: percutaneous treatment with a twisted plate (helical plates), as this is a submuscular and extraperiosteal technique, is a safe and reproducible technique, and promotes early rehabilitation. In our opinion, it is surgical technique whose main requirement is a good knowledge of topographic anatomy.
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Affiliation(s)
- Miquel Videla-Cés
- Orthopaedic and Trauma Surgery Department. Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Catalonia, Spain.
| | - Marta Comas-Aguilar
- Orthopaedic and Trauma Surgery Department. Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Catalonia, Spain; Orthopaedic and Trauma Surgery Department. Hospital Universitari de Girona Doctor Josep Trueta, Girona, Catalonia, Spain
| | - Amaia Endemaño-Lucio
- Orthopaedic and Trauma Surgery Department. Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Catalonia, Spain
| | - Rubén Sánchez-Navés
- Orthopaedic and Trauma Surgery Department. Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Catalonia, Spain
| | - Eudald Romero-Pijoan
- Orthopaedic and Trauma Surgery Department. Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Catalonia, Spain
| | - Sebastián Videla
- Clinical Research Support Unit (HUB-IDIBELL), Clinical Pharmacology Department, Bellvitge University Hospital / Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
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12
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Jirangkul P, Kosiyatrakul A, Lorsuwannarat N. Minimally invasive plate osteosynthesis for displaced midshaft clavicle fractures: An indirect reduction using joystick technique. J Orthop Sci 2023; 28:1365-1372. [PMID: 36184268 DOI: 10.1016/j.jos.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 07/11/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND A minimally invasive plate osteosynthesis (MIPO) technique has become increasingly popular in long bone fracture fixation as it could eliminate postoperative complications. However, the most challenging aspect of employing the MIPO for midshaft clavicle fractures among general orthopedic surgeons is the technically demanding that indirect reduction is typically a closed maneuver. METHODS We present a consecutive series of patients with displaced midshaft clavicle fractures undergoing clavicular fixation using the MIPO technique between January 2017 and October 2019. The joystick technique was used to obtain anatomical reduction. Clinical outcomes were assessed using the Constant-Murley and the American shoulder and elbow surgeons shoulder scores. RESULTS Thirty patients with a mean age of 42.44 years were included. The functional shoulder scores showed no disabilities compared with those of a healthy population. No major complications requiring re-operation were noted, and all fractures were completely healed with an average time of 12.53 weeks. CONCLUSION This study demonstrated that facilitating the MIPO for midshaft clavicle fractures using simple operative devices and techniques was possible. The joystick technique with the use of an external fixator for temporary stabilization is a safe and effective method that can be added to achieve anatomical alignment with the fracture site unexposed. This technique could be performed either in a fresh fracture or a delayed case with failed conservative treatment.
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Affiliation(s)
- Puripun Jirangkul
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.
| | - Arkaphat Kosiyatrakul
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
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13
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Hamoudi C, Sapa MC, Facca S, Xavier F, Goetsch T, Liverneaux P. Influence of surgical performance on clinical outcome after osteosynthesis of distal radius fracture. Hand Surg Rehabil 2023; 42:430-434. [PMID: 37356571 DOI: 10.1016/j.hansur.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 06/27/2023]
Abstract
INTRODUCTION Clinical outcome after surgery depends on the surgeon's level of expertise or performance. The present study of minimally invasive plate osteosynthesis (MIPO) with anterior plate for distal radius fracture assessed whether clinical outcome correlated with surgeon performance. METHODS The series included 30 distal radius fractures: 15 operated on by 4 level III surgeons (Group 1) and 15 by 4 level V surgeons (Group 2), utilizing the MIPO technique. The surgical performance of all 8 surgeons was assessed using the OSATS global rating scale. Clinical outcomes were assessed at 3 months' follow-up using the modified Mayo score (MMS), in 4 grades: 0-64 (poor), 65-79 (moderate), 80-89 (good), and 90-100 (excellent). The QuickDASH score (QDASH) was also calculated, and complications were recorded. RESULTS Median MMS was better for level V (75 = fair result) than level III surgeons (62 = poor result). Median QDASH score likewise was better in group 2 (9.1) than group 1 (22.7). In group 1, there were 2 paresthesias in the median nerve territory, 1 type-1 complex regional pain syndrome, and 1 hypoesthesia in the scar area. Mean correlation between the 2 scores was -0.68. Group 1 patients were on average 7 years older. The number of patients, number of surgeons and distribution of OA A and C fractures were almost identical in the two groups. On MMS, the overall result of the two groups was moderate (70.5), which can be explained by short mean follow-up. DISCUSSION Quality of the clinical outcome on MMS and QDASH increased with surgical performance, with fewer complications. In the patients' interest, protocols for improving surgical performance should be implemented, for example, through deliberate practice.
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Affiliation(s)
- Ceyran Hamoudi
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 Avenue Molière, 67200 Strasbourg, France.
| | - Marie-Cécile Sapa
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 Avenue Molière, 67200 Strasbourg, France
| | - Sybille Facca
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 Avenue Molière, 67200 Strasbourg, France; ICube CNRS UMR7357, Strasbourg University, 2-4 Rue Boussingault, 67000 Strasbourg, France
| | - Fred Xavier
- Orthopedic Surgery & Biomedical Engineering, Bayside, NY 11360, USA
| | - Thibaut Goetsch
- Department of Public Health, Strasbourg University Hospital, FMTS, GMRC, 1 Avenue De l'Hôpital, 67000 Strasbourg Cedex, France
| | - Philippe Liverneaux
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 Avenue Molière, 67200 Strasbourg, France; ICube CNRS UMR7357, Strasbourg University, 2-4 Rue Boussingault, 67000 Strasbourg, France
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14
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Lee JY, Lee HJ, Yang SH, Ryu JH, Kim HT, Lee BH, Kim SH, Kim HS, Lee YK. Treatment of Soft Tissue Defects after Minimally Invasive Plate Osteosynthesis in Fractures of the Distal Tibia: Clinical Results after Reverse Sural Artery Flap. Medicina (Kaunas) 2023; 59:1751. [PMID: 37893469 PMCID: PMC10608781 DOI: 10.3390/medicina59101751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
Introduction: Distal tibial fractures make up approximately 3% to 10% of all tibial fractures or about 1% of lower extremity fractures. MIPO is an appropriate procedure and method to achieve stable metal plate fixation and osseointegration by minimizing soft tissue damage and vascular integrity at the fracture site. MIPO to the medial tibia during distal tibial fractures induces skin irritation due to the thickness of the metal plate, which causes discomfort and pain on the medial side of the distal leg, and if severe, complications such as infection and skin defect may occur. The reverse sural flap is a well-researched approach for covering defects in the lower third of the leg, ankle, and foot. Materials and Methods: Among 151 patients with distal tibia fractures who underwent minimally invasive metal plate fixation, soft tissue was injured due to postoperative complications. We treated 13 cases with necrosis and exposed metal plates by retrograde nasogastric artery flap surgery. For these patients, we collected obligatory patient records, radiological data, and wound photographs of the treatment results and complications of reconstructive surgery. Results: In all the cases, flap survival was confirmed at the final outpatient follow-up. The exposed area of the metal plate was well coated, and there was no plate failure due to complete necrosis. Three out of four women complained of aesthetic dissatisfaction because the volume of the tunnel through which the skin mirror passed and the skin plate itself were thick. In two cases, defatting was performed to reduce the thickness of the plate while removing the metal plate. Conclusions: Metal plate exposure after distal tibial fractures have been treated with minimally invasive metal plate fusion and can be successfully treated with retrograde nasogastric artery flaps, and several surgical techniques are used during flap surgery.
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Affiliation(s)
- Jun Young Lee
- Department of Orthopaedic Surgery, College of Medicine, Chosun University, 365 Pilmundae-ro, Dong-gu, Gwangju 61453, Republic of Korea; (J.Y.L.); (H.J.L.); (S.H.Y.); (J.H.R.); (H.T.K.)
| | - Hyo Jun Lee
- Department of Orthopaedic Surgery, College of Medicine, Chosun University, 365 Pilmundae-ro, Dong-gu, Gwangju 61453, Republic of Korea; (J.Y.L.); (H.J.L.); (S.H.Y.); (J.H.R.); (H.T.K.)
| | - Sung Hoon Yang
- Department of Orthopaedic Surgery, College of Medicine, Chosun University, 365 Pilmundae-ro, Dong-gu, Gwangju 61453, Republic of Korea; (J.Y.L.); (H.J.L.); (S.H.Y.); (J.H.R.); (H.T.K.)
| | - Je Hong Ryu
- Department of Orthopaedic Surgery, College of Medicine, Chosun University, 365 Pilmundae-ro, Dong-gu, Gwangju 61453, Republic of Korea; (J.Y.L.); (H.J.L.); (S.H.Y.); (J.H.R.); (H.T.K.)
| | - Hyoung Tae Kim
- Department of Orthopaedic Surgery, College of Medicine, Chosun University, 365 Pilmundae-ro, Dong-gu, Gwangju 61453, Republic of Korea; (J.Y.L.); (H.J.L.); (S.H.Y.); (J.H.R.); (H.T.K.)
| | - Byung Ho Lee
- Department of Orthopaedic Surgery, Daejung Hospital, 180 Daein-ro, Dong-gu, Gwangju 61473, Republic of Korea;
| | - Sung Hwan Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Bucheon, 170 Jomaru-ro, Wonmi-gu, Bucheon-si 14584, Republic of Korea; (S.H.K.); (H.S.K.)
| | - Ho Sung Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Bucheon, 170 Jomaru-ro, Wonmi-gu, Bucheon-si 14584, Republic of Korea; (S.H.K.); (H.S.K.)
| | - Young Koo Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Bucheon, 170 Jomaru-ro, Wonmi-gu, Bucheon-si 14584, Republic of Korea; (S.H.K.); (H.S.K.)
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15
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Boretto JG, Arroyo Sánchez C, Abril Gaona C, Donndorff AG, de Carli P, Gallucci GL, Rellán I. [Translated article] The use of an anatomical implant compared to a straight LCP decreases extraction in posterior humeral MIPO. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T394-T400. [PMID: 37315919 DOI: 10.1016/j.recot.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 02/14/2023] [Indexed: 06/16/2023] Open
Abstract
PURPOSE Posterior MIPO approach in the humerus has been described by using a 4.5mm LCP plate. Although straight plates have shown good results, they have not been designed to adapt to the distal humeral metaphysis. The goal of the study was to test the null hypothesis that there is no difference in hardware removal after posterior MIPO with either a straight or a pre-contoured plate. METHODS Patients older than 18 years, who had suffered mid-distal humeral shaft fracture, were treated by a posterior MIPO technique with a locking plate and had a minimum of 12-month follow-up were retrospectively included. Patients were separated into: group 1 (LCP 4.5mm straight plate); and group 2 (3.5mm anatomically shaped plate). Clinical and radiological evaluations were performed in the postoperative period. Patient-reported outcomes and the need of hardware removal because of pain were assessed. RESULTS Sixty-seven patients fulfilled the inclusion criteria. Twenty-seven patients in group 1 and 40 in group 2. No patient was lost to follow-up. There were no statistical differences between in patient reported outcomes measures. All the fractures healed. Within group 1, 18% (95%CI: 6-38%) of the patients required implant removal while in group 2 this incidence was 0% (95%CI: 0-9%) (P 0.009). CONCLUSION These results suggest that the use of a 4.5mm LCP compared to an anatomical 3.5mm LCP in posterior MIPO of the humerus generates greater discomfort and therefore leads to a 18% increase in the risk of implant removal.
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Affiliation(s)
- J G Boretto
- Servicio de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Instituto de Ortopedia y Traumatología «Carlos E. Ottolenghi», Potosí, Buenos Aires, Argentina.
| | - C Arroyo Sánchez
- Servicio de Ortopedia y Traumatología, Clínica Foscal, Bucaramanga, Colombia
| | - C Abril Gaona
- Servicio de Ortopedia y Traumatología, Clínica Foscal, Bucaramanga, Colombia
| | - A G Donndorff
- Servicio de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Instituto de Ortopedia y Traumatología «Carlos E. Ottolenghi», Potosí, Buenos Aires, Argentina
| | - P de Carli
- Servicio de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Instituto de Ortopedia y Traumatología «Carlos E. Ottolenghi», Potosí, Buenos Aires, Argentina
| | - G L Gallucci
- Servicio de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Instituto de Ortopedia y Traumatología «Carlos E. Ottolenghi», Potosí, Buenos Aires, Argentina
| | - I Rellán
- Servicio de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Instituto de Ortopedia y Traumatología «Carlos E. Ottolenghi», Potosí, Buenos Aires, Argentina
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16
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Boretto JG, Arroyo Sánchez C, Abril Gaona C, Donndorff AG, de Carli P, Gallucci GL, Rellán I. The use of an anatomical implant compared to a straight LCP decreases extraction in posterior humeral MIPO. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:394-400. [PMID: 36842670 DOI: 10.1016/j.recot.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 02/28/2023] Open
Abstract
PURPOSE Posterior MIPO approach in the humerus has been described by using a 4.5mm LCP plate. Although straight plates have shown good results, they have not been designed to adapt to the distal humeral metaphysis. The goal of the study was to test the null hypothesis that there is no difference in hardware removal after posterior MIPO with either a straight or a pre-contoured plate. METHODS Patients older than 18 years, who had suffered mid-distal humeral shaft fracture, were treated by a posterior MIPO technique with a locking plate and had a minimum of 12-month follow-up were retrospectively included. Patients were separated into: group 1 (LCP 4.5mm straight plate); and group 2 (3.5mm anatomically shaped plate). Clinical and radiological evaluation were performed in the postoperative period. Patient-reported outcomes and the need of hardware removal because of pain were assessed. RESULTS Sixty-seven patients fulfilled the inclusion criteria. Twenty-seven patients in group 1 and 40 in group 2. No patient was lost to follow-up. There were no statistical differences between in patient reported outcomes measures. All the fractures healed. Within group 1, 18% (95%CI: 6-38%) of the patients required implant removal while in group 2 this incidence was 0% (95%CI: 0-9%) (P 0.009). CONCLUSION These results suggest that the use of a 4.5mm LCP compared to an anatomical 3.5mm LCP in posterior MIPO of the humerus generates greater discomfort and therefore leads to a 18% increase in the risk of implant removal.
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Affiliation(s)
- J G Boretto
- Servicio de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Instituto de Ortopedia y Traumatología «Carlos E. Ottolenghi», Potosí, Buenos Aires, Argentina.
| | - C Arroyo Sánchez
- Servicio de Ortopedia y Traumatología, Clínica Foscal, Bucaramanga, Colombia
| | - C Abril Gaona
- Servicio de Ortopedia y Traumatología, Clínica Foscal, Bucaramanga, Colombia
| | - A G Donndorff
- Servicio de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Instituto de Ortopedia y Traumatología «Carlos E. Ottolenghi», Potosí, Buenos Aires, Argentina
| | - P de Carli
- Servicio de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Instituto de Ortopedia y Traumatología «Carlos E. Ottolenghi», Potosí, Buenos Aires, Argentina
| | - G L Gallucci
- Servicio de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Instituto de Ortopedia y Traumatología «Carlos E. Ottolenghi», Potosí, Buenos Aires, Argentina
| | - I Rellán
- Servicio de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Instituto de Ortopedia y Traumatología «Carlos E. Ottolenghi», Potosí, Buenos Aires, Argentina
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Orapiriyakul W, Apivatthakakul V, Theppariyapol B, Apivatthakakul T. Humerus shaft fractures, approaches and management. J Clin Orthop Trauma 2023; 43:102230. [PMID: 37588079 PMCID: PMC10425411 DOI: 10.1016/j.jcot.2023.102230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/30/2023] [Accepted: 08/03/2023] [Indexed: 08/18/2023] Open
Abstract
Humeral shaft fracture is a common injury which can be treated either conservatively with functional bracing or with surgical fixation. Current evidence shows an increase in the rate of nonunion after conservative treatment, suggesting that indications for conservative treatment may need to be re-examined. This article updates trends in treatment for humeral shaft fracture. Indications for surgery, both for plate osteosynthesis with open reduction and internal fixation (ORIF) as well as for minimally invasive plate osteosynthesis (MIPO) and intramedullary nailing (IMN) are described. Recognition of the advantages and disadvantages of each technique can better define the role of the plate or nail and can aid in the selection of an appropriate surgical approach. ORIF with compression plate continues to have a role in the treatment of simple or AO/OTA type A fractures. The primary goal of minimal invasive osteosynthesis, a surgical technique involving small incisions, closed reduction or mini-open reduction that minimizes soft tissue dissection and helps preserve the periosteal blood supply, is to achieve bone union and the best possible functional outcomes. MIPO of the humerus is now well accepted as being less invasive and providing relative stability to allow indirect (secondary) bone healing with callus formation. MIPO approaches can be performed circumferentially to the humerus, including the proximal, middle and distal shaft. The classic MIPO approach is anterior MIPO, followed by posterior, anterolateral and anteromedial MIPO. IMN is also an option for treating humerus fractures. In the past, IMN was not widely used due to the potential for complications such as shoulder impingement and elbow problems as well as the limited availability of implants and the steep learning curve of this surgical technique. Over the past decade, the launch of a new design of straight antegrade and retrograde IMN with established techniques has encouraged more surgeons to use IMN as an alternative option. Methods of dealing with concomitant and post-treatment radial nerve palsy have also been evolving, including the use of ultrasound for diagnosis of radial nerve conditions. Radial nerves with contusion, entrapment or laceration can be detected using ultrasound with reliability comparable to intraoperative findings. Trends in treatment of radial nerve palsy are described below. Future larger randomized controlled trials comparing conservative and operative management are necessary to further develop appropriate guidelines.
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Affiliation(s)
- Wich Orapiriyakul
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand
| | - Varat Apivatthakakul
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Bodin Theppariyapol
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
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Oldrini LM, Sangiorgio A, Feltri P, Marbach F, Filardo G, Candrian C. Proximal humerus fractures: deltopectoral open reduction and internal fixation vs deltosplit minimally invasive plate osteosynthesis: which surgical approach provides superior results? EFORT Open Rev 2023; 8:662-671. [PMID: 37526265 PMCID: PMC10441256 DOI: 10.1530/eor-22-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
Purpose To compare the two main surgical approaches to address proximal humerus fractures (PHFs) stratified for Neer fracture types, to demonstrate which approach gives the best result for each fracture type. Methods A literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in PubMed, Web of Science, and Cochrane databases up to 4 January 2022. Inclusion criteria were studies comparing open reduction and internal fixation (ORIF) with deltopectoral (DP) approach and minimally invasive plate osteosynthesis (MIPO) with deltosplit (DS) approach of PHFs. Patient's demographic data, fracture type, Constant-Murley Score (CMS), operation time, blood loss, length of hospital stay, complications, fluoroscopy time, and radiological outcomes were extracted. Results were stratified for each type of Neer fracture. Results Eleven studies (798 patients) were included in the meta-analysis. No functional difference was found in the CMS between the two groups for each type of Neer (P = n.s.): for PHFs Neer II, the mean CMS was 72.5 (s.e. 5.9) points in the ORIF group and 79.6 (s.e. 2.5) points in the MIPO group; for Neer III, 77.8 (s.e. 2.0) in the ORIF and 76.4 (se 3.0) in the MIPO; and for Neer IV, 70.6 (s.e. 2.7) in the ORIF and 60.9 (s.e. 6.3) in the MIPO. The operation time in the MIPO group was significantly lower than in the ORIF group for both Neer II (P = 0.0461) and Neer III (P = 0.0037) fractures. Conclusion The MIPO with DS approach demonstrated no significant differences in the results to the ORIF with DP approach for the different Neer fractures in terms of functional results, with a similar outcome, especially for the Neer II and III fracture types. The MIPO technique proved to be as safe and effective as the ORIF approach.
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Affiliation(s)
| | - Alessandro Sangiorgio
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Pietro Feltri
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Francesco Marbach
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Christian Candrian
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
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Lederer XJ, Lewis DD. Comparison of cranial versus medial minimally invasive plate osteosynthesis applications for the stabilization of simulated radius and ulna fractures in dog cadavers. Open Vet J 2023; 13:501-509. [PMID: 37304599 PMCID: PMC10257463 DOI: 10.5455/ovj.2023.v13.i5.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/03/2023] [Indexed: 06/13/2023] Open
Abstract
Background Minimally invasive plate osteosynthesis (MIPO) is an emerging fracture management modality in small animal orthopedics. Although cranial plate application has been consistently advocated when performing radial MIPO, medial plating affords several purported advantages including improved screw purchase through the wider medial-to-lateral dimension of the radius, the potential to use smaller plates allowing more screws per unit length, and avoidance of extensor tendons which can complicate cranial plate placement in distal diaphyseal or metaphyseal fractures. Aim To compare cranial versus medial MIPO applications for the stabilization of diaphyseal radius and ulna fractures in dog cadavers. Methods Simulated bilateral antebrachial fractures were stabilized with cranial MIPO on one forelimb and medial MIPO on the contralateral limb, facilitated by a two-ring circular fixator construct. Procedure times and ease, number of fluoroscopic images obtained, and post-procedural frontal and sagittal alignment and radial length were compared between plating groups. The ease of construct placement, fracture reduction, radial approach, and plate application, were subjectively scored 1-5 for each procedure. Paired t-tests were performed to identify significant differences (p < 0.05) between the two plating groups. Results There was no difference in total or incremental procedural times, subjective ease scores, or the number of fluoroscopic images obtained between plating groups. Both plating groups had comparable post-procedural frontal and sagittal plane alignment. There was a significant difference between plating groups for final radial length (p = 0.004) and change in radial length compared to the intact radii, (p = 0.002). Medial-plated radii measured longer than cranial-plated radii. Conclusion The only outcome measure significantly different between plating groups was the post-procedural radial length. The change in length compared to intact radii was <1%, regardless of the plating group, and unlikely to be clinically relevant.
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Affiliation(s)
| | - Daniel Dean Lewis
- Corresponding Author: Daniel D. Lewis. Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32608, USA.
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Pastor T, Zderic I, van Knegsel KP, Beeres FJP, Migliorini F, Babst R, Nebelung S, Ganse B, Schoeneberg C, Gueorguiev B, Knobe M. Biomechanical analysis of helical versus straight plating of proximal third humeral shaft fractures. Arch Orthop Trauma Surg 2023. [PMID: 36821049 DOI: 10.1007/s00402-023-04814-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 02/07/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Proximal humeral shaft fractures are surgically challenging and plate osteosynthesis with a long straight plate is one operative treatment option in these patients although endangering the radial nerve distally. Helical plates potentially avoid the radial nerve by twisting around the humeral shaft. Aim of the study was to investigate in a human cadaveric model the biomechanical competence of helical plates versus straight lateral plates used for fixation of proximal third comminuted humeral shaft fractures. METHODS Eight pairs of humeral cadaveric humeri were instrumented using either a long 90°-helical plate (Group1) or a straight long PHILOS plate (Group2). An unstable proximal humeral shaft fracture was simulated by means of a 5 cm osteotomy gap. All specimens were tested under quasi-static loading in axial compression, internal and external rotation, and bending in four directions. Subsequently, progressively increasing cyclic loading in internal rotation until failure was applied and interfragmentary movements were monitored by motion tracking. RESULTS During static testing flexion/extension deformation in Group1 was significantly higher, however, varus/valgus deformation as well as shear and torsional displacement under torsional load remained statistically indifferent between both groups. During cyclic testing shear and torsional displacements were both significantly higher in Group1 compared to Group 2. However, cycles to catastrophic failure remained statistically indifferent between the groups. CONCLUSIONS From a biomechanical perspective, although 90°-helical plating is associated with higher initial stability against varus/valgus collapse and comparable endurance under dynamic loading, it demonstrates lower resistance to flexion/extension and internal rotation with bigger shear interfragmentary displacements versus straight lateral plating and, therefore, cannot be considered as its real alternative. Alternative helical plate designs should be investigated in the future.
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Pastor T, Kastner P, Souleiman F, Gehweiler D, Migliorini F, Link BC, Beeres FJP, Babst R, Nebelung S, Ganse B, Schoeneberg C, Gueorguiev B, Knobe M. Anatomical analysis of different helical plate designs for proximal humeral shaft fracture fixation. Eur J Trauma Emerg Surg 2023; 49:411-418. [PMID: 35986752 DOI: 10.1007/s00068-022-02082-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/08/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Helical plates are preferably used for proximal humeral shaft fracture fixation and potentially avoid radial nerve irritation. AIMS Safety of applying four different long plate designs (straight, 45°-, 90°-helical and ALPS) with MIPO technique as well as assessment and comparison of their distances to adjacent anatomical structures. METHODS MIPO was performed in 16 human cadaveric humeri using either a straight (group 1), a 45°-helical (group 2), a 90°-helical (group 3) plate, or an ALPS (group 4). Applying CT angiography, distances between brachial arteries and plates were evaluated. All specimens were dissected and distances to the axillary, radial and musculocutaneous nerve were evaluated. RESULTS No specimens demonstrated injuries of the anatomical structures at risk after MIPO with all investigated plate designs. Closest overall distance (mean (range); mm) between each plate and the radial nerve was 1 (1-3) in group 1, 7 (2-11) in group 2, 14 (7-25) in group 3 and 6 (3-8) in group 4. It was significantly bigger in group 3 and significantly smaller in group 1 compared to all other groups, p < 0.001. Closest overall distance between each plate and the musculocutaneous nerve was 16 (8-28) in group 1, 11 (7-18) in group 2, 3 (2-4) in group 3 and 6 (3-8) in group 4. It was significantly bigger in group 1 and significantly smaller in group 3 compared to all other groups, p < 0.001. CONCLUSIONS MIPO with 45°- and 90°-helical plates as well as with ALPS is safely feasible and demonstrates significantly bigger distances to the radial nerve compared to straight plates. However, the distances remain small and attention must be paid to the musculocutaneous nerve and the brachial artery when MIPO is applied using ALPS, 45°- and 90°-helical implants.
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Affiliation(s)
- Torsten Pastor
- AO Research Institute Davos, Davos, Switzerland.
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
| | - Philipp Kastner
- AO Research Institute Davos, Davos, Switzerland
- Department for Orthopaedics and Traumatology, Johannes Kepler University, Linz, Austria
| | - Firas Souleiman
- AO Research Institute Davos, Davos, Switzerland
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | | | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH, University of Aachen Hospital, Aachen, Germany
| | - Björn-Christian Link
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Frank J P Beeres
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Reto Babst
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Department of Health Science and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Sven Nebelung
- Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Aachen, Germany
| | - Bergita Ganse
- Werner Siemens Foundation Endowed Chair for Innovative Implant Development, Clinics and Institutes of Surgery, Saarland University, Homburg, Germany
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany
| | - Carsten Schoeneberg
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany
| | | | - Matthias Knobe
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
- Medical Faculty, RWTH Aachen University Hospital, Aachen, Germany
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Ducournau F, El Amiri L, Vernet P, Sapa MC, Liverneaux P. Methods of assessment of the level of surgeons for minimally invasive fixation of distal radius fractures: "expertise" versus "performance". Int Orthop 2023; 47:193-199. [PMID: 36264303 DOI: 10.1007/s00264-022-05609-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The results of surgical techniques vary depending on the level of the surgeon's experience. The level of expertise can be evaluated quantitatively or qualitatively. In this study, we evaluated the duration of the procedure and the size of the incision of minimally invasive fixation of distal radius fractures as a means of grading expertise and surgical performance. The null hypothesis of our study was that the level of expertise did not match the level of performance. MATERIAL AND METHODS The study included 52 surgeons split in five levels of expertise who had performed 467 minimally invasive fixations of distal radius fractures. The performance of the surgeons in terms of duration of the procedure and size of the incision were scored according to the five levels of surgical experience using four different methodologies: clinical (setting limits compared to data found in literature), statistical (setting statistical limits of comparison in percentiles (20th, 40th, 60th, 80th) for each of the two parameters measured), arithmetical (setting limits compared to equal intervals for each of the 2 variables), and success rate (setting a threshold for each of the 2 variables). RESULTS Our results showed a great disparity between levels of experience depending on the method used. The scores for levels 1 and 2 were 72% for expertise, 13% for performance according to the clinical method, 75% for the statistical method, 0% for the arithmetical method, and 57% according the success rate. The rate of level 3 was 23% for expertise, 41% for performance by the clinical method, 17% by the statistical method, 17% by the arithmetical method, and 15% by the success rate. The rates of levels 4 and 5 were 5% for expertise, 46% for performance clinical method, 8% by the statistical method, 83% by the arithmetical method, and 28% by the success rate. DISCUSSION The null hypothesis of our study was confirmed by the results which show that there was no correlation between levels of expertise and performance. The clinical method of assessment appears to reflect best the true level of performance of the surgeon. CONCLUSION Publications reporting the results of a surgical technique for a given pathology should always mention the level of performance as measured on a clinical scale.
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Affiliation(s)
- François Ducournau
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 avenue Molière, 67200, Strasbourg, France
| | - Laela El Amiri
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 avenue Molière, 67200, Strasbourg, France
| | - Paul Vernet
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 avenue Molière, 67200, Strasbourg, France
| | - Marie-Cécile Sapa
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 avenue Molière, 67200, Strasbourg, France
| | - Philippe Liverneaux
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 avenue Molière, 67200, Strasbourg, France.
- ICube CNRS, UMR7357, Strasbourg University, 2-4 rue Boussingault, 67000, Strasbourg, France.
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23
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Wang C, Huang Q, Lu D, Wang Q, Ma T, Zhang K, Li Z. A clinical comparative study of intramedullary nailing and minimally invasive plate osteosynthesis for extra-articular distal tibia fractures. Am J Transl Res 2023; 15:1996-2005. [PMID: 37056820 PMCID: PMC10086916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/17/2023] [Indexed: 04/15/2023]
Abstract
INTRODUCTION The treatment of extra-articular distal tibia fractures is a difficult challenge. Minimally invasive plating osteosynthesis (MIPO) and intramedullary nailing (IMN) are satisfactory extra-articular distal tibia fractures. The optimal surgical treatment for extra-articular distal tibia fractures remains controversial. The purpose of this retrospective study was to compare the clinical and functional outcomes of patients with extra-articular distal tibia fractures treated with MIPO or IMN. METHODS For this retrospective study, a total of 266 patients with closed extra-articular distal metaphysis (AO type 43-A) or closed distal tibial fracture (AO type 42) were enrolled and included; 110 patients were treated with MIPO, and 156 patients underwent IMN. RESULTS There was no significant difference in the primary operation union rate, the American Orthopaedic Foot and Ankle surgery (AOFAS) score, deep surgical site infection or malalignment between the MIPO and IMN groups. However, there was a longer operation time, more prospective times, more intraoperative blood loss and more frequent anterior knee pain in the IMN groups than that in the MIPO group. There was a significantly shorter time to union in the IMN group than that in the MIPO group (138.8±11.0 vs. 153.5±17.1 days, P < 0.05) and a lower superficial surgical site infection in the IMN group than that in the MIPO group (1.9% vs. 8.2%, P < 0.05). CONCLUSIONS We found that extra-articular distal tibia fractures can be treated satisfactorily with IMN or MIPO. Poller blocking screws have a main role in improving the efficacy of IMN. For patients with poor basic physical conditions or knee pain before fracture, MIPO is preferred to treat extra-articular distal tibia fractures. Whereas, for patients with poor local soft tissue conditions, IMN was recommended as a first choice.
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Buchmann L, van Lieshout EMM, Zeelenberg M, den Hartog D, Pfeifer R, Allemann F, Pape HC, Halvachizadeh S. Proximal humerus fractures (PHFs): comparison of functional outcome 1 year after minimally invasive plate osteosynthesis ( MIPO) versus open reduction internal fixation (ORIF). Eur J Trauma Emerg Surg 2022; 48:4553-4558. [PMID: 34216222 PMCID: PMC9712325 DOI: 10.1007/s00068-021-01733-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Osteosynthetic treatment strategies of PHFs include MIPO or ORIF techniques. The aim of this study was to compare the 1 year outcome following either technique in type B PHFs. METHODS This study was designed as a retrospective cohort study of patients treated at one academic Level 1 trauma center. Patients from 2009 to 2019 who required surgical treatment of a type B PHF were eligible to be included in this study. Patients with A- or C-type fractures or patients requiring arthroplasty were excluded. All patients were treated with Proximal Humerus Interlocking System (PHILOS) and stratified according the approach into Group MIPO or Group ORIF. Outcome measures include local complications that occurred during hospitalization, nonunion after 12 months, and range of motion after 1 year follow-up. RESULTS This study included 149 (75.3%) patients in Group ORIF, and 49 (24.7%) in Group MIPO. The fracture morphology and concomitant injuries were comparable amongst these groups. When compared with Group MIPO, Group ORIF had a 2.6 (95% CI 0.6-11.7) higher risk of suffering from local complications. The rate of postoperative nerve lesions was comparable (OR 0.9, 95% CI 0.1-9.7) as was the rate of soft tissue complications (OR 2.0, 95% CI 0.2-17.2). The risk for nonunion was 4.5 times higher (95% 1.1-19.5) in Group ORIF when compared with Group MIPO. Group MIPO had a higher chance of flexion above 90° (OR 8.2, 95% CI 2.5-27.7). CONCLUSION This study provides indications that patients following surgical treatment of PHFs in MIPO technique might have favourable outcome. Large-scale and high-quality studies are warranted to confirm these results.
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Affiliation(s)
- Laura Buchmann
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Raemistrasse 75, 8006, Zurich, Switzerland
| | - Esther M M van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Miliaan Zeelenberg
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Dennis den Hartog
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Roman Pfeifer
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Raemistrasse 75, 8006, Zurich, Switzerland
| | - Florin Allemann
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Raemistrasse 75, 8006, Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Raemistrasse 75, 8006, Zurich, Switzerland
| | - Sascha Halvachizadeh
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
- Faculty of Medicine, University of Zurich, Raemistrasse 75, 8006, Zurich, Switzerland.
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Ortega-Yago A, Balfagón-Ferrer A, Barrés-Carsí M, Bas-Hermida JL. Treating multifocal humerus fractures: A comparison between the mipo technique and intramedullary nailing. Injury 2022; 53:3332-8. [PMID: 35970638 DOI: 10.1016/j.injury.2022.07.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/19/2022] [Accepted: 07/29/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION AND OBJECTIVE Proximal humerus fractures with metaphysodiaphyseal extension represent a challenge for the orthopedic surgeon due to their reduced incidence and the difficulty in the treatment decision. These can be treated with an intramedullary nail or using the MIPO technique, associating different advantages and complications depending on the procedure. The objective of this study was to compare metaphyseal-diaphyseal fractures of the humerus treated with antegrade intramedullary nailing and those operated using the MIPO technique to see if there were significant differences in terms of functional, clinical, and radiological results. MATERIAL AND METHODS retrospective, analytical and unicentric review of 29 patients with proximal fracture with metaphyseal-diaphyseal extension treated by MIPO technique and 33 patients surgically treated by antegrade intramedullary nailing (IMN) in our hospital from 2014 to 2020. Demographic, functional, radiographic and clinical data were obtained.. RESULTS No significant differences were observed between both groups in terms of fracture mechanism (p=0.34), fracture type (p=0.13) or Maresca classification (p=0.32). Surgical time was significantly shorter in the IMN group compared to the MIPO technique (p=0.014). No significant difference was observed regarding the need for blood transfusion (p=0.32). The mean consolidation in the MIPO group was 21 weeks compared to 21 weeks in the IMN, with no significant differences between both groups (p= 0.88). No significant differences were observed between CONSTANT test at one year in the MIPO group versus the IMN group (p=0.79), nor in radial nerve palsies (p=0.28). CONCLUSIONS Proximal fractures with metaphyseal-diaphyseal extension are a challenge for the orthopedic surgeon due to the infrequency, the complexity of these fractures and the fact that there is no established consensus on the ideal treatment for this type of injury. Both the MIPO technique with the Philos plate and the intramedullary nail are valid options for the treatment of these fractures, with no differences observed in terms of fracture consolidation time or in terms of functional results.
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Pastor T, Beeres FJP, Kastner P, Gehweiler D, Migliorini F, Nebelung S, Scaglioni MF, Souleiman F, Link BC, Babst R, Gueorguiev B, Knobe M. Anatomical analysis of different helical plate designs for distal femoral fracture fixation. Injury 2022; 53:2636-2641. [PMID: 35346508 DOI: 10.1016/j.injury.2022.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 02/22/2022] [Accepted: 03/18/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Helical plates potentially avoid the medial neurovascular structures of the thigh. Two implant designs for additional medial 90° helical plate in double plate constructs for geriatric patients and 180° helical plate for single plating in young patients are potential alternatives to widely used standard straight plates. AIMS (1) assess the distances to adjacent anatomical structures being at risk when applying medial 90° and 180° helical plates with MIPO technique to the femur, (2) compare these distances with medial straight plates, and (3) correlate measurements performed during surgical dissection with CT angiography. METHODS MIPO was performed in ten human cadaveric femoral pairs using either a 90° helical 14-hole LCP (Group 1) or a 180° helical 15-hole LCP-DF (Group 2). Using CT angiography, distances between femoral arteries and plates as well as distances between plates and perforating vessels were evaluated. Following, specimens were dissected and distances determined again. All plates were removed and measurements were repeated with straight medial plates (Group 3). RESULTS Overall closest distances between plates and femoral arteries were 14.5 mm (11-19 mm) in Group 1, 21.6 mm (15-24 mm) in Group 2 and 6.5 mm (5-8 mm) in Group 3, with significant differences between Group 3 and both other groups (p < 0.001). Distances to the nearest perforating vessels were 22.4 mm (15-30 mm) in Group 1 and 1.2 mm (1-2 mm) in Group 2. Measurement techniques (visual after surgical disection and CT angiography) demonstrated a strong correlation (p < 0.010). CONCLUSIONS Inserting 90° and 180° helical plates with MIPO technique is safe, however, attention must be paid to the medial neurovascular structures with 90° helical plates and to the proximal perforating vessels with 180° helical plates. Helical plates can avoid irritation of medial neurovascular structures - compared with straight plates - although care must be taken during their distal insertion. Measurements during surgical dissection correlate with CT angiography.
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Affiliation(s)
- Torsten Pastor
- AO Research Institute Davos, Davos, Switzerland; Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
| | - Frank J P Beeres
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Philipp Kastner
- AO Research Institute Davos, Davos, Switzerland; Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University, Linz, Austria
| | | | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH, University of Aachen Hospital, Aachen, Germany
| | - Sven Nebelung
- Department of Radiology, University of Aachen Medical Center, Aachen, Germany
| | - Mario F Scaglioni
- Department of Plastic and Hand Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Firas Souleiman
- AO Research Institute Davos, Davos, Switzerland; Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Björn-Christian Link
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Reto Babst
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | | | - Matthias Knobe
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
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Goorens CK, Debaenst N, Van Royen K, Provyn S, Goubau JF. Minimally Invasive Pronator Quadratus Sparing Approach versus Extended Flexor Carpi Radialis Approach with Pronator Quadratus Repair for Volar Plating in Distal Radial Fractures. J Wrist Surg 2022; 11:41-47. [PMID: 35127263 PMCID: PMC8807095 DOI: 10.1055/s-0041-1731329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/21/2021] [Indexed: 10/20/2022]
Abstract
Background Several volar plating techniques exist to treat distal radial fractures. Question We investigated minimally invasive plate osteosynthesis (MIPO) with pronator quadratus (PQ) sparing versus conventional flexor carpi radialis approach for volar plating with PQ repair after distal radial fractures during the first postoperative year. Patients and Methods Prospective data of two consecutive cohorts were compared: 62 patients in MIPO group with an average age of 61.2 years and 66 patients in PQ repair group with an average age of 61.4 years completed the entire follow-up period. Results Range of motion was not significantly different, except flexion-extension that was significantly higher in the MIPO group. Quick Disabilities of the Arm, Shoulder and Hand was significantly lower in the MIPO group. Pain visual analogue scale was only significantly lower at 6 weeks. Grip strength measurements and patient satisfaction were not significantly different. Conclusions MIPO volar plating with PQ sparing is a surgical technique that can be chosen according to surgeon's preference and expertise, resulting in a better flexion-extension mobility and function score according to our study. Level of evidence This is a Level 3 study.
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Affiliation(s)
- Chul ki Goorens
- Department of Orthopaedics and Traumatology, Regional Hospital Tienen, Tienen, Belgium
| | - Niels Debaenst
- Department of Orthopaedics and Traumatology, Regional Hospital Tienen, Tienen, Belgium
- Department of Orthopaedics and Traumatology, University Hospital Brussels, Vrije Universiteit Brussel, Brussels, Belgium
| | - Kjell Van Royen
- Department of Orthopaedics and Traumatology, University Hospital Brussels, Vrije Universiteit Brussel, Brussels, Belgium
| | - Steven Provyn
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jean F. Goubau
- Department of Orthopaedics and Traumatology, University Hospital Brussels, Vrije Universiteit Brussel, Brussels, Belgium
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Bleeker NJ, van Veelen NM, van de Wall BJM, Sierevelt IN, Link BC, Babst R, Knobe M, Beeres FJP. MIPO vs. intra-medullary nailing for extra-articular distal tibia fractures and the efficacy of intra-operative alignment control: a retrospective cohort of 135 patients. Eur J Trauma Emerg Surg 2022; 48:3683-3691. [PMID: 34984496 DOI: 10.1007/s00068-021-01836-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/08/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Definitive treatment of distal extra-articular fractures of the tibia is challenging and both minimal invasive plate osteosynthesis (MIPO) and intramedullary nailing (IMN) are considered to be feasible surgical modalities with their own implant-specific merits and demerits. This retrospective study was designed to compare MIPO versus IMN in terms of fracture healing, complications, functional and radiological outcomes and to assess the efficacy of intra-operative alignment control to reduce the rate of malalignment after definitive fixation of distal extra-articular fractures of the tibia. MATERIALS AND METHODS All consecutive adult patients with extra-articular distal meta- or diaphyseal tibia fractures that were treated between January 2012 and September 2019 either with MIPO or IMN were included. Outcome measures included fracture healing, complications (infection, malalignment, subsequent surgeries), functional and radiological outcomes. Intra-operative alignment control encompassed bilateral draping of the lower extremities. RESULTS A total of 135 patients were included out of which 72 patients (53%) were treated with MIPO and 63 patients (47%) underwent IMN. There was a significantly higher incidence of non-union for fractures treated with IMN (13 (22%) vs. 4 (6%), p = 0.04). There was no significant difference between both groups in terms of rotational malalignment (3% vs. 10%) and angular malalignment (4% vs. 5%). A significantly higher rate of infection was found after MIPO after correction of significant differences in baseline characteristics. No differences were found in subsequent surgeries or functional outcomes. CONCLUSION Both MIPO and IMN are reliable surgical techniques. IMN is associated with higher rates of non-union, whereas MIPO results in a higher risk for infection. The incidence of malalignment was surprisingly low endorsing the utility of the intra-operative alignment control.
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Affiliation(s)
- Nils Jan Bleeker
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne (LUKS), Lucerne, Switzerland
| | - Nicole M van Veelen
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne (LUKS), Lucerne, Switzerland
| | - Bryan J M van de Wall
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne (LUKS), Lucerne, Switzerland
| | - Inger N Sierevelt
- Specialized Center of Orthopaedic Research and Education (SCORE), Orthopaedic Department, Xpert Clinics, Amsterdam, The Netherlands
| | - Björn-Christian Link
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne (LUKS), Lucerne, Switzerland
| | - Reto Babst
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne (LUKS), Lucerne, Switzerland.,Department of Health Science and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Matthias Knobe
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne (LUKS), Lucerne, Switzerland
| | - Frank J P Beeres
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne (LUKS), Lucerne, Switzerland
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Delbarre M, Hidalgo Diaz JJ, Xavier F, Meyer N, Sapa MC, Liverneaux P. Reduction in ionizing radiation exposure during minimally invasive anterior plate osteosynthesis of distal radius fracture: Naive versus deliberate practice. Hand Surg Rehabil 2021; 41:194-198. [PMID: 34920144 DOI: 10.1016/j.hansur.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/28/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022]
Abstract
This study aimed to decrease surgeon exposure to ionizing radiation through a new learning technique, "deliberate practice", which consists in improving performance by setting goals with feedback. The hypothesis was that exposure to ionizing radiation during distal radius fracture surgery using the minimally invasive plate osteosynthesis (MIPO) technique decreased faster with "deliberate" practice than with "naïve" practice. Radiographic dosimetry was measured in the first 30 fractures operated on by MIPO by 6 surgeons. The first 3 surgeons operated "naively" (Group 1) and the next 3 according to the "deliberate" procedure (Group 2). Group 2 received weekly feedback (number of exposed hands, number of fluoroscopic views, exposure duration, and X-ray dose). An expert, using fluoroscopic images and surgical videos, provided suggestions for improvement. Mean number of exposed hands was 23.66 in Group 1 and 1.9 in Group 2. Mean number of fluoroscopic views was 78.31 and 35.0, respectively. Mean X-ray exposure time was 74.34 and 32.89 s, respectively. Mean dosimetry was 1.40 mGy (and 0.59 mGy, respectively. The hypothesis was thus confirmed: dosimetry decreased faster in Group 2 than in Group 1. Teaching this deliberate practice should be generalized, to decrease the growth phase and increase the plateau phase of the learning curve.
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Affiliation(s)
- M Delbarre
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 Avenue Molière, 67200 Strasbourg, France
| | - J J Hidalgo Diaz
- Department of Orthopedics, Centre Hospitalier Universitaire de Reims, Hôpital Maison Blanche, 45 Rue Cognacq Jay, 51100 Reims, France
| | - F Xavier
- Department of Pediatric Surgery, Brest University Hospitals, 2 Avenue Foch, 29200 Brest, France
| | - N Meyer
- Strasbourg University Hospital, Service de Santé Publique, GMRC, 1 Place de L'Hôpital, 67091 Strasbourg Cedex, France
| | - M-C Sapa
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 Avenue Molière, 67200 Strasbourg, France
| | - P Liverneaux
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 Avenue Molière, 67200 Strasbourg, France; ICube CNRS, UMR 7357, Strasbourg University, 2-4 Rue Boussingault, 67000 Strasbourg, France.
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Ducournau F, Meyer N, Xavier F, Facca S, Liverneaux P. Learning a MIPO technique for distal radius fractures: Mentoring versus simple experience versus deliberate practice. Orthop Traumatol Surg Res 2021; 107:102939. [PMID: 33901718 DOI: 10.1016/j.otsr.2021.102939] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 11/24/2020] [Accepted: 11/30/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Performance skills of a surgeon for a specific surgical technique range from 1 (novice) to 5 (expert). Mentoring can bring the surgeon to level 3. Simple experience rarely allows achievement of level 5, in contrast to deliberate practice, in which performance skills are improved by setting learning goals based on feedback about the trainee's previous performance. HYPOTHESIS When learning a technique for the internal fixation of distal radius fractures, the level of performance skills achieved is higher with deliberate practice than with mentoring or simple experience. MATERIAL AND METHODS Four surgeons each performed minimally invasive plate osteosynthesis (MIPO) of 15 distal radius fractures. The procedures were recorded by an HD camera. The first five fractures (step 1) were treated after mentoring, the next 5 fractures after reading an article and viewing a reference video (step 2), and the last 5 fractures after viewing and commenting 20 short videos highlighting possible errors (step 3). Each recording of the procedures performed by the surgeons was scored using the Objective Structured Assessment of Technical Skills (OSATS, 10 items on basic skills [B] and 10 on MIPO-specific skills [S]). RESULTS For the basic skills, the mean OSATS scores (on 50) were 31 for step 1, 31 for step 2, and 43 for step 3. For the specific skills, the mean OSATS scores (on 50) were 25 for step 1, 29 for step 2, and 48 for step 3. For overall skills (B+S), the mean OSATS score (on 100) was 56 for step 1, 60 for step 2, and 91 for step 3. DISCUSSION Our study confirms that the deliberate practice teaching method is more efficient in improving surgeon skills than simple experience. Deliberate practice consists of four essential steps: (i) setting a well-defined goal; (ii) being motivated to improve one's performance; (iii) receiving immediate feedback; and (iv) having multiple opportunities to repeat and gradually perfect one's performance. Our main hypothesis was verified, since the results of learning a MIPO technique, as assessed using the OSATS scale, were significantly better with a video-assisted deliberate practice technique than with mentoring or simple experience. CONCLUSION Video-assisted deliberate practice deserves to be widely used in order to optimise learning curves and to improve risk management in surgery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- François Ducournau
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1, avenue Molière, 67200 Strasbourg, France
| | - Nicolas Meyer
- Service de santé publique, GMRC, Strasbourg University Hospital, 67091 Strasbourg, France; ICube CNRS UMR7357, Strasbourg University, 2-4, rue Boussingault, 67000 Strasbourg, France
| | - Fred Xavier
- Department of Paediatric Orthopaedics, Armand-Trousseau Hospital, 26, avenue du Dr-Arnold-Netter, 75571 Paris cedex 12, France
| | - Sybille Facca
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1, avenue Molière, 67200 Strasbourg, France; ICube CNRS UMR7357, Strasbourg University, 2-4, rue Boussingault, 67000 Strasbourg, France
| | - Philippe Liverneaux
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1, avenue Molière, 67200 Strasbourg, France; ICube CNRS UMR7357, Strasbourg University, 2-4, rue Boussingault, 67000 Strasbourg, France.
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Yañez Arauz JM. Minimally invasive treatment of AO B ankle fractures: Surgical technique and long-term outcomes. Foot Ankle Surg 2021; 27:742-749. [PMID: 33097404 DOI: 10.1016/j.fas.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/22/2020] [Accepted: 09/21/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ankle fractures are the most common traumatic bone injuries of the lower limb. Over 50% of ankle fractures occur at the syndesmosis level (type AO B). The goal of treatment is to achieve an anatomical reduction and appropriate stabilization. The present study aimed to evaluate the clinical-functional and radiological results, and complications of minimally invasive reduction and fixation technique for ankle fractures type AO B. The surgical technique also is detailed. MATERIAL AND METHODS A prospective analysis of 451 patients undergoing surgery for type AO B displaced ankle fracture was performed. All patients were treated with minimally invasive surgery. The following times were recorded: time between trauma and osteosynthesis, hospitalization length, surgical time, and exposure time to fluoroscopy. Age and gender, mechanism of injury, and characteristics of fractures were recorded. For functional outcome, AOFAS score, VAS, and Weber score were used. Radiographic analysis was performed. The average follow-up was 112 months. RESULTS Mean age was 48.2 years old. Average length of stay in hospital was 5.72 h. Mean duration of the surgery was 32.8 min. Average fluoroscopic exposure time during surgery was 9.25 s. Mean bone union time was 38.2 days. Weber's score was on average 1.5/24 points and the long-term follow-up AOFAS score was on average 97.5/100. Postoperative complications incidence was 2.7%. CONCLUSIONS Distal fibula fixation with the MIPO technique presented good functional outcomes and could be helpful in the avoidance of the complications associated with conventional open reduction and internal fixation. However, it needs more exposition to intraoperative fluoroscopy. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Juan Manuel Yañez Arauz
- Austral University Hospital, Buenos Aires, Argentina; Universidad de Buenos Aires (UBA), Argentina; Austral University, Buenos Aires, Argentina.
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Sim JA, Shon OJ, Joo YB, Sohn HS, Byun SE, Kim JW. Clinical outcomes of osteosynthesis of well-fixed periprosthetic proximal tibial fractures (Felix type 2A) after total knee arthroplasty. Injury 2021; 52:3099-3103. [PMID: 34253352 DOI: 10.1016/j.injury.2021.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/21/2021] [Accepted: 06/24/2021] [Indexed: 02/02/2023]
Abstract
AIMS This study aimed to evaluate the clinical and radiologic outcomes of well-fixed periprosthetic tibial fractures after TKA. PATIENTS AND METHODS The medical records of patients who presented with Felix type 2A periprosthetic tibial fractures after TKA between March 2015 and February 2020 were retrospectively obtained from 5 institutions. Data on injury mechanism, fracture pattern including open fractures and Felix classification, and surgical method were recorded. Functional outcomes including range of motion (ROM) and Knee Society Score (KSS) at postoperative 1 year were reviewed. The need for reoperation was also reviewed. Radiologic findings included union time and mechanical proximal tibial angle (MPTA) at the last radiologic follow-up. RESULTS Eighteen patients (13 women, 5 men; average age, 73.9 years) were included. The average follow-up duration was 20.8 months. The fractures resulted from high-energy (11 cases) and low-energy (7 cases) injuries. Two cases involved open fractures. Anatomical locking plates were used in all cases: single plate (4 cases) and dual plates (14 cases). The average number of proximal screws was 7.1 (range, 4-9). All patients achieved bone union at an average of 18.6 weeks without secondary intervention. No infection occurred; however, 1 patient with skin necrosis required local flap. Implant removal was performed in 5 cases: 1 case, skin defect and 4 cases, discomfort due to plate prominence. The average ROM and KSS were 120.3° and 85.9, respectively. The mean MPTA was 87.8°; the MPTA was higher in the single-plate group (94.0° vs. 88.1°, p=0.013). Three cases involved values beyond the normal MPTA range (85-90°): 104° and 96° with a single plate and 92° with dual plates. The malalignment rate was higher in the single-plate group (p=0.043). CONCLUSION Felix type 2A periprosthetic tibial fractures treated with minimally invasive osteosynthesis showed excellent clinical outcomes, and tibial alignment was well maintained in the dual-plate group.
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Affiliation(s)
- Jae-Ang Sim
- Department of Orthopaedic Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Oog-Jin Shon
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Yong Bum Joo
- Department of Orthopaedic Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Hoon-Sang Sohn
- Department of Orthopaedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Seong-Eun Byun
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Ji Wan Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505,Republic of Korea.
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Yang J, Liu D, Zhang L, Lu Z, Liu T, Tao C. Treatment of humeral shaft fractures: a new minimally-invasive plate osteosynthesis versus open reduction and internal fixation: a case control study. BMC Surg 2021; 21:349. [PMID: 34551734 PMCID: PMC8459486 DOI: 10.1186/s12893-021-01347-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 09/13/2021] [Indexed: 11/24/2022] Open
Abstract
Background To evaluate the feasibility and safety of a new minimally-invasive surgical approach–anteromedial minimally-invasive plate osteosynthesis (MIPO)–in the treatment of middle and distal humeral shaft fractures. Methods Fourteen patients with humeral shaft fracture treated with anteromedial MIPO from November 2016 to March 2020 (MIPO Group) were selected as the study subjects. Open reduction and internal fixation (ORIF) were used to treat 14 patients with humeral shaft fractures as the control group (ORIF group). The two groups were fixed with a locking compression plate (LCP) or LCP + multi-directional locking screw system (MDLS). The incision length, intraoperative blood loss, intraoperative fluoroscopy time, operation time, length of hospital stay, fracture healing time, QuickDASH score and Constant score were observed and compared between the two groups. Results Fourteen patients were enrolled in each group. The incision length (7.79 ± 2.39 cm), intraoperative blood loss (96.07 ± 14.96 mL), operative time (110.57 ± 21.90 min), hospital stay (6.29 ± 1.49 days) and fracture healing time (14.94 ± 0.99 weeks) in the MIPO group were all lower than those in the ORIF group, and the difference was statistically significant for each parameter (P < 0.05). The intraoperative fluoroscopy time (20.07 ± 3.22) in the MIPO group was significantly higher than that in the ORIF group (P < 0.05). There were no significant differences in age (P = 0.078), QuickDASH score (P = 0.074) or Constant score (P = 0.293) between the two groups and no postoperative complications occurred in any of the patients. Conclusion The anteromedial approach MIPO technique has the advantages of less trauma, less bleeding, low risk of nerve injury and high rate of fracture healing. It is one of the most effective methods for the treatment of middle and middle–distal humeral shaft fractures.
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Affiliation(s)
- Jing Yang
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, 410000, Hunan, China.,Department of Orthopedics, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, Xinjiang, China
| | - Dapeng Liu
- Department of Orthopedics, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, Xinjiang, China
| | - Lina Zhang
- Department of Mental Health Institute, The Second Xiangya Hospital, Central South University, Changsha, 410000, Hunan, China
| | - Zhanxin Lu
- Department of Orthopedics, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, Xinjiang, China
| | - Tang Liu
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, 410000, Hunan, China.
| | - Cheng Tao
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, 410000, Hunan, China.
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Jitprapaikulsarn S, Gromprasit A, Sukha K, Patamamongkonchai C, Kritsaneephaiboon A. The utility of reverse distal femur locking compression plate in minimally invasive osteosynthesis for type C subtrochanteric fractures of the femur: technical description and a clinical series of 50 cases. Eur J Orthop Surg Traumatol 2021; 32:1423-1433. [PMID: 34491445 DOI: 10.1007/s00590-021-03116-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Establishing fracture consolidation and avoiding postoperative complications of comminuted subtrochanteric fractures of the femur are technically challenging. The authors delineated a technical description of minimally invasive plate osteosynthesis (MIPO) by using a reverse distal femur locking compression plate (LCP-DF) and retrospectively reviewed the outcomes of these particular fractures. METHODS Fifty patients with 51 type C subtrochanteric fractures of the femur were operated on by MIPO and reverse LCP-DF fixation. The collected data included postoperative complications, union times, and clinical outcomes. RESULTS All fractures were united with a mean union time of 19.4 weeks (range 16-22). Regarding postoperative complications, asymptomatic valgus angulation occurred in five patients and trochanteric pain in six. According to Harris hip score, nine patients were determined to be excellent, 36 to be good and five to be fair. CONCLUSION MIPO by reverse LCP-DF is reliable and effective for type C subtrochanteric fractures of the femur particularly in situations where intramedullary nailing is not feasible.
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Affiliation(s)
- Surasak Jitprapaikulsarn
- Department of Orthopedics, Buddhachinaraj Hospital, 90 Srithamtraipidok Road, Phitsanulok, 65000, Thailand.
| | - Arthit Gromprasit
- Department of Orthopedics, Buddhachinaraj Hospital, 90 Srithamtraipidok Road, Phitsanulok, 65000, Thailand
| | - Kritsada Sukha
- Department of Orthopedics, Buddhachinaraj Hospital, 90 Srithamtraipidok Road, Phitsanulok, 65000, Thailand
| | - Chawanan Patamamongkonchai
- Department of Orthopedics, Buddhachinaraj Hospital, 90 Srithamtraipidok Road, Phitsanulok, 65000, Thailand
| | - Apipop Kritsaneephaiboon
- Department of Orthopedic Surgery and Physical Medicine, Prince of Songkla University, Songkla, Thailand
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Keshav K, Baghel A, Kumar V, Neradi D, Kaustubh K, Mishra P. Is Minimally Invasive Plating Osteosynthesis Better Than Conventional Open Plating for Humeral Shaft Fractures? A Systematic Review and Meta-Analysis of Comparative Studies. Indian J Orthop 2021; 55:283-303. [PMID: 34306542 PMCID: PMC8275817 DOI: 10.1007/s43465-021-00413-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/26/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The aim of systematic review and meta-analysis was to find out whether minimally invasive plate osteosynthesis (MIPO) is better than open reduction and internal plate fixation (ORIF) in terms of functional outcome, achieving union (union time and incidence of non-union), intraoperative parameters (surgical duration, blood loss, and radiation exposure), and complications (iatrogenic radial nerve palsy and infection) for humeral shaft fractures. MATERIALS AND METHODS We searched online databases (Pubmed, Embase, Scopus, and The Cochrane Library) from inception till 3rd September 2020 for articles comparing MIPO with ORIF for humeral shaft fractures. The methodological quality of randomized controlled trials (RCTs) was done by Cochrane Risk of Bias assessment tool 2 (RoB2) and of non-randomized studies (case-control and cohort studies) by Methodological Index for non-randomized studies (MINORS). Meta-analysis was performed using Review Manager 5.4 software. RESULTS 11 studies (5 RCTs and 6 non-randomized comparative studies) involving a total of 582 patients (MIPO-290, ORIF-292) meeting our inclusion criteria were included in the study. There was no statistically significant difference in pooled analysis of functional outcome scores between MIPO and ORIF. Union time was significantly lesser (mean difference = 3.12 weeks) and incidence of non-union lower (odd's ratio = 0.27) in MIPO group. Surgical duration and intraoperative blood loss were significantly lesser in MIPO group. Iatrogenic radial nerve palsy and infection were higher in ORIF group. CONCLUSIONS This study showed that MIPO gives similar functional outcomes as compared to ORIF but causes significantly lesser blood loss, requires lesser operative duration and has a lesser incidence of major complications. TRIAL REGISTRATION International prospective register of systematic reviews (PROSPERO)-CRD42020208346, Date of registration 09/10/2020. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43465-021-00413-6.
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Affiliation(s)
- Kumar Keshav
- Department of Orthopaedics, Apex Trauma Centre, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh 226029 India
| | - Anurag Baghel
- Department of Orthopaedics, Apex Trauma Centre, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh 226029 India
| | - Vishal Kumar
- Spine Surgery, Department of Orthopaedics, PGIMER, Chandigarh, 160012 India
| | - Deepak Neradi
- Spine Surgery, Department of Orthopaedics, PGIMER, Chandigarh, 160012 India
| | | | - Prabhaker Mishra
- Department of Biostatistics and Health Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh 226029 India
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Wasky PR, Beltran MJ. Extreme Nailing or Less Invasive Plating of Lower Extremity Periarticular Fractures. Orthop Clin North Am 2021; 52:111-21. [PMID: 33752832 DOI: 10.1016/j.ocl.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Periarticular fractures of the lower extremity can be difficult injuries to stabilize effectively. Modern advances in technique and implant design now allow many of these fractures to be fixed with an extreme intramedullary nail. When nailing is not possible, less invasive plating through percutaneous incisions is a reliable option. The decision to perform extreme nailing is multifactorial and is based on the fracture pattern, the condition of the soft tissues, the medical condition of the patient, and the importance of earlier or immediate weightbearing.
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Beeres FJ, Diwersi N, Houwert MR, Link BC, Heng M, Knobe M, Groenwold RH, Frima H, Babst R, Jm van de Wall B. ORIF versus MIPO for humeral shaft fractures: a meta-analysis and systematic review of randomized clinical trials and observational studies. Injury 2021; 52:653-663. [PMID: 33223254 DOI: 10.1016/j.injury.2020.11.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is no consensus on the optimal operative technique for humeral shaft fractures. This meta-analysis aims to compare minimal-invasive plate osteosynthesis (MIPO) with open reduction internal fixation (ORIF) for humeral shaft fractures regarding non-union, re-intervention, radial nerve palsy, time to union, operation duration and functional outcomes. METHODS PubMed/Medline/Embase/CENTRAL/CINAHL were searched for both randomized clinical trials (RCT) and observational studies comparing MIPO with ORIF for humeral shaft fractures. Effect estimates were pooled across studies using random effects models and presented as weighted odds ratio (OR), risk difference (RD), mean difference (MD) and standardized mean difference (SMD) with corresponding 95% confidence interval (95%CI). Subgroup analysis was performed stratified by study design (RCTs and observational studies). RESULTS A total of two RCT's (98 patients) and seven observational studies (263 patients) were included. The effect estimates obtained from observational studies and RCT's were similar in direction and magnitude. MIPO carries a lower risk for non-union (RD: 5%; OR 0.3, 95% CI 0.1-0.9) and secondary radial nerve palsy (RD 5%; OR 0.3, 95%CI 0.1- 0.9). Nerve function eventually restored spontaneously in all patients in both groups. Results were inconclusive regarding re-intervention (RD 7%; OR: 0.7, 95%CI 0.2-1.9), infection (RD 4%; OR 0.4, 95%CI 0.1-1.5), time to union (MD -1 week, 95%CI -3 - 1) and operation duration (MD -13 minutes, 95%CI -38.9 - 11.9). Functional shoulder scores (SMD 0.01, 95%CI -0.3 - 0.3) and elbow scores (SMD 0.01, 95%CI -0.3 - 0.3) were similar for the different operative techniques. CONCLUSION MIPO has a lower risk for non-union than ORIF for the treatment of humeral shaft fractures. Radial nerve palsy secondary to operation is a temporary issue resolving in all patients in both treatment groups. Although both treatment options are viable, the general balance leans towards MIPO having more favorable outcomes.
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Affiliation(s)
- Frank Jp Beeres
- Lucerne Cantonal Hospital, Department of Orthopedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Nadine Diwersi
- Lucerne Cantonal Hospital, Department of Orthopedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Marijn R Houwert
- University Medical Center Utrecht, Department of Trauma Surgery, Heidelberglaan 100, 3584CX, Utrecht, the Netherlands
| | - Björn C Link
- Lucerne Cantonal Hospital, Department of Orthopedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Marilyn Heng
- Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital Boston, Department of Orthopedic Surgery, Boston, USA
| | - Matthias Knobe
- Lucerne Cantonal Hospital, Department of Orthopedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Rolf Hh Groenwold
- Leiden University Medical Center, Department of Clinical Epidemiology, Leiden, the Netherlands
| | - Herman Frima
- Northwest Hospital group, Department of Trauma Surgery, Wendelaarstraat 58, 1814 GS Alkmaar, the Netherlands
| | - Reto Babst
- Lucerne Cantonal Hospital, Department of Orthopedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Bryan Jm van de Wall
- Lucerne Cantonal Hospital, Department of Orthopedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland.
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Ekdahl M, Dominguez C, Pinedo M, López S, Gutiérrez V. New precontoured long locking plate for proximal metadiaphyseal fractures of the humerus: a cadaveric study for its use with the minimally invasive technique. JSES Int 2021; 5:540-545. [PMID: 34136867 PMCID: PMC8178608 DOI: 10.1016/j.jseint.2020.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background The purpose of this study was to identify nerves at risk when using a minimally invasive plate osteosynthesis precontoured long proximal humerus locking plate and to evaluate the risk of injury to deltoid insertion and brachialis muscle. Methods Ten cadaveric upper limb specimens were used. A transdeltoid anterolateral approach was performed proximally and a second anterior approach was performed distally. A 14-hole “low” long precountored ALPS locking plate (Biomet Trauma; Zimmer Biomet, Warsaw, IN, USA) was used. Subsequently, anatomic dissection to measure the anatomic relationship of the plate with the deltoid insertion, with the brachialis muscle, and with the axillary, radial, and musculocutaneous nerves was performed. Results The mean humeral length was 302 mm (standard deviation 52.3, 99% confidence interval: 259.3-344.6). In 6 specimens, the axillary nerve was located at the level of the third row of holes of the plate; in 3 specimens, at the level of the fourth row; and in one specimen, at the level of the second row. The distance between the plate and the musculocutaneous nerve was on average 10.2 mm (standard deviation 4, 99% confidence interval: 6.9-13.5) and between the plate and the radial nerve was on average 7.9 mm (standard deviation 4.7, 99% confidence interval: 4-11.8). The plate pierced the anterior distal fibers of the deltoid in all specimens. In 8 specimens, no brachialis muscle fibers were located under the plate. Conclusions The use of the long precontoured 14-hole ALPS locking plate with the minimally invasive plate osteosynthesis technique, previously identifying the axillary and musculocutaneous nerves, is feasible; however, the distances between the plate and the nerves remain low, so caution should be maintained. Despite the curved design of the plate, the deltoid insertion is partially compromised in all cases.
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Affiliation(s)
- Max Ekdahl
- Corresponding author: Max Ekdahl, MD, Orthopaedic Surgery Department, Clinica Las Condes, Santiago, Chile.
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Belangero WD, Zublin CM, Quintero RAC, Romero FAS, Fernandes HJA, Siekavizza SNM, Rosenberg GFS, Azi ML, Elguezaba IE, Badell G, Mouraria G, Kojima KE, Triana M, Mere JAP, Baldo MJM, Mariolani JRL. Quick-DASH as a main early outcome of humeral shaft fractures: A Latin American multicenter prospective study. J Orthop Surg (Hong Kong) 2021; 28:2309499020929436. [PMID: 32552372 DOI: 10.1177/2309499020929436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The main objective of this study was to evaluate the Quick-Disabilities of the Arm, Shoulder and Hand Score (DASH) score as the main early (90 days) outcome in a prospective multicenter observational Latin American study on isolated humeral shaft fractures. METHODS From December 2015 to April 2017, in six Latin American countries, patients 18 years or older with a closed, isolated nonpathological 12A, 12B, or 12C AO/OTA (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association) fractures were included. The 90 (±10)-day Quick-DASH score was used to compare the results of the different treatments. The secondary outcomes were patient treatment satisfaction, shoulder and elbow range of motion, and radiographic evaluation. RESULTS A total of 92 patients successfully completed the Quick-DASH questionnaire. Surgical treatments resulted in better outcomes than nonsurgical treatment, but only minimally invasive plate osteosynthesis produced significantly lower Quick-DASH scores than nonsurgical treatment (p < 0.05). There were strong correlations between patient self-evaluation and the Quick-DASH score (p < 0.0005) but not between the Quick-DASH score and radiographic fracture healing. No significant difference was found between the treatments regarding the rate of return to work, but the medical center had a significant influence on treatment choice (p < 0.0005). CONCLUSION The high correlation between Quick-DASH score and patient satisfaction and functional outcome indicates that the Quick-DASH questionnaire is a suitable tool for evaluating adult humeral shaft fracture outcomes. Patients with a Quick-DASH score below 15 could be considered recovered, and patients with a Quick-DASH score above 40 could be considered not yet recovered. Quick-DASH scores were not significantly associated with radiographic fracture healing.
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Affiliation(s)
- William Dias Belangero
- Orthopaedics and Traumatology Department, School of Medical Sciences, University of Campinas, Brazil
| | | | | | | | | | | | | | - Matheus Lemos Azi
- Manoel Victorino Hospital, Secretary of Health for the State of Bahia, Salvador, Brazil
| | | | - Gerardo Badell
- Central of Medical Services of the State Insurance Bank, Montevideo, Uruguay
| | | | - Kodi Edson Kojima
- Orthopaedics and Traumatology Institute, University of Sao Paulo, Sao Paulo, Brazil
| | - Miguel Triana
- Children's Heart Foundation Cardiologic Institute and University Foundation of Health Sciences, Bogotá, Colombia
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van de Wall BJM, Beeres FJP, Knobe M, Link BC, Babst R. Minimally invasive plate osteosynthesis: An update of practise. Injury 2021; 52:37-42. [PMID: 33228999 DOI: 10.1016/j.injury.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/22/2020] [Accepted: 11/01/2020] [Indexed: 02/02/2023]
Abstract
Since its conception in 1989, minimally invasive plate osteosynthesis (MIPO) has gained widespread popularity. It has been studied in over forty countries with most of the publications originating from Asia, Europe and North America. This review aims to describe the scientific path of MIPO from the very beginning to where it stands in current day times; study the pattern and contributing factors influencing its global spread. Finally, the up to date evidence is discussed with regard to several anatomical regions in which MIPO is mostly used. In the meantime, MIPO treads steadily towards accomplishing the same or better outcomes for more and more indications with the goal to leave a smaller surgical footprint to allow for undisturbed bone healing.
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Affiliation(s)
- Bryan J M van de Wall
- Lucerne Cantonal Hospital, Department of Orthopaedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland.
| | - Frank J P Beeres
- Lucerne Cantonal Hospital, Department of Orthopaedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Matthias Knobe
- Lucerne Cantonal Hospital, Department of Orthopaedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Björn C Link
- Lucerne Cantonal Hospital, Department of Orthopaedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Reto Babst
- Lucerne Cantonal Hospital, Department of Orthopaedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
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Vernet P, Gouzou S, Hidalgo Diaz JJ, Facca S, Liverneaux P. Minimally invasive anterior plate osteosynthesis of the distal radius: A 710 case-series. Orthop Traumatol Surg Res 2020; 106:1619-1625. [PMID: 33153957 DOI: 10.1016/j.otsr.2020.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/04/2020] [Accepted: 04/21/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Since the 2000s, internal fixation of distal radius fracture by volar locking plate on an extended flexor carpi radialis (FCR) approach has become the gold standard. OBJECTIVE The present study aimed to assess medium-term results of minimally invasive plate osteosynthesis (MIPO) in distal radius fracture. MATERIAL AND METHODS The series comprised of 710 cases (512 female; mean age, 58 years). The 15mm approach was on the lateral edge of the FCR. The plate was slipped under the pronator quadratus. Closure used intradermal running suture without drain or orthosis. RESULTS At a mean 7 months' follow-up, mean scar length was 17mm (range, 10-40mm), pain 1.13/10 (0-8), Quick-DASH 13.28 (0-86.36), and patient-rated wrist evaluation (PRWE) 11.48 (0-91). Compared to contralateral values, mean flexion was 87.23%, extension 88.52%, pronation 96.17%, supination 93.41%, and grip strength 79.68%. Hardware was removed in 45.92% of cases. There were 16 cases of secondary displacement, with 4 revision procedures, one of sepsis at 6 months, 10 of complex regional pain syndrome, and 14 of median nerve paresthesia, with 4 carpal tunnel release procedures. DISCUSSION The minimally invasive FCR approach can be used for volar plate fixation of distal radial fracture. It has the advantage of conserving ligamentotaxis, facilitating reduction and improving scar esthetics. The incision can be extended if need be. LEVEL OF EVIDENCE III; single-centre retrospective study.
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Affiliation(s)
- Paul Vernet
- Department of hand surgery, SOS Hand, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 1, avenue Molière, 67000 Strasbourg, France
| | - Stéphanie Gouzou
- Department of hand surgery, SOS Hand, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 1, avenue Molière, 67000 Strasbourg, France
| | - Juan José Hidalgo Diaz
- Department of hand surgery, SOS Hand, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 1, avenue Molière, 67000 Strasbourg, France
| | - Sybille Facca
- Department of hand surgery, SOS Hand, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 1, avenue Molière, 67000 Strasbourg, France
| | - Philippe Liverneaux
- Department of hand surgery, SOS Hand, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 1, avenue Molière, 67000 Strasbourg, France.
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Marazzi C, Wittauer M, Hirschmann MT, Testa EA. Minimally invasive plate osteosynthesis ( MIPO) versus open reduction and internal fixation (ORIF) in the treatment of distal fibula Danis-Weber types B and C fractures. J Orthop Surg Res 2020; 15:491. [PMID: 33092616 PMCID: PMC7583231 DOI: 10.1186/s13018-020-02018-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/14/2020] [Indexed: 12/02/2022] Open
Abstract
Background Minimally invasive plate osteosynthesis (MIPO) has been reported to be superior to open reduction and internal fixation (ORIF) in the treatment of different long bone fractures. Nevertheless, in distal fibula fractures, the evidence of MIPO remains scarce. The aim of this retrospective study was to compare the clinical and radiological outcomes of the minimally invasive techniques applied to the distal fibula with open reduction and internal fixation within a 12 months follow-up. Methods A consecutive series of patients who underwent surgery using either ORIF or MIPO for the treatment of distal fibula fractures between 2010 and 2014 were retrospectively analyzed. All distal fibular fractures requiring an operative treatment (Danis-Weber type B ≙ AO type 44 B1, 2, 3 and Danis-Weber type C ≙ AO type 44 C1, 2) were included (ORIF n = 35, MIPO n = 35). Patients were assessed for postoperative pain using a visual analog scale (VAS) for pain (ranging from 0 to 10) and classified into 4 groups: “no pain” for VAS = 0, “low” for VAS = 1–3, “moderate” for VAS = 3–5, and “severe” for VAS = 5–10. In addition, complications of postoperative fracture-related infection, wound healing disorders, vascular and nerve injury and development of nonunion were evaluated and analyzed. Radiologic outcome measures assessing the talocrural angle, lateral and medial clear space, tibiofibular overlap, and talar tilt angle were evaluated postoperatively. Results The overall complication rate showed to be lower in the MIPO group compared to the ORIF group (14% vs. 37%, p = 0.029). Even though not statistically significant, specific surgery-related complications such as skin necrosis (3% vs. 9%, p = 0.275), nonunion (0% vs. 6%, p = 0.139), infections and wound healing disorders (9% vs. 20%, p = 0.141), as well as postoperative pain (17% vs. 26%, p = 0.5) were found more frequently in the ORIF group. The tibiofibular overlap demonstrated to be significantly lower in the ORIF group (3.3 mm vs. 2.7 mm, p = 0.033). The talocrural angle, talar tilt angle, and lateral and medial clear space showed to be equivalent in both groups. Conclusion In this retrospective single-center consecutive series, MIPO was superior to ORIF in the surgical treatment of distal fibula fractures with respect to the overall complication rate. Trial registration EKNZ Project-ID: 2019-02310, registered on the 20th of December 2019 with swissethics
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Affiliation(s)
- Cesare Marazzi
- Department of General Surgery, Hospital Oberengadin, Samedan, Switzerland.,University of Basel, Basel, Switzerland
| | - Matthias Wittauer
- University of Basel, Basel, Switzerland. .,Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland.
| | - Michael T Hirschmann
- University of Basel, Basel, Switzerland.,Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, Switzerland
| | - Enrique A Testa
- Department of Orthopaedic and Trauma Surgery, Hospital Lugano, Lugano, Switzerland
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Cheng L, Li YH, Chu Y, Yang G, Zhu D, Tan L. Intramedullary nailing via suprapatellar approach versus locked plating of proximal extra-articular tibial fractures: a randomized control trial. Int Orthop 2020; 45:1599-1608. [PMID: 32978652 DOI: 10.1007/s00264-020-04821-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/15/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Currently, nailing through the suprapatellar approach and minimally invasive plating have been generally accepted in the management of displaced proximal tibial fractures. This investigation was aimed at comparing these two treatment methods in terms of their effectiveness and safety. METHODS We randomized 328 patients into one of two groups: one underwent intramedullary nailing via the suprapatellar approach (IMN group), while the other underwent locking compressive plate (LCP group) placement. The primary outcome was the Iowa Knee Score at 12 months. The clinical history, amount of intra-operative blood loss, rate of fracture healing, and post-operative complications were assessed as secondary outcomes. Participants were assessed at one, two, three, six and 12 months after surgery. RESULTS Follow-up data for a year were available for 152 and 154 patients in the IMN group and LCP group, respectively. No intergroup difference was detected with regard to the Iowa Knee Scores (91 ± 8.2 in the IMN group and 90 ± 7.3 in the LCP group, respectively (p = 0.26)), at 12 months. Duration of operation (83.5 ± 35.3 min), amount of blood loss (55 ± 43 mL), duration of fluoroscopy (53.7 ± 3.9 s), and cases with difficult reduction (n = 46) in the IMN group did not differ significantly from those in the LCP group (80.1 ± 43.6 min; 65 ± 56 mL; 48 ± 12 s; 32) (p < 0.05). The two groups had similar post-operative complications and rate of fracture union, with the pre-injury activity level being restored in most patients. Removal of the implants was performed in 31.6% and 63.0% of the cases in the IMN and LCP groups, respectively, indicating a significant intergroup difference. CONCLUSION Both IMN through the suprapatellar approach and minimally invasive LCP were found to yield no significant intergroup difference of clinical outcomes in the treatment of proximal, extra-articular tibial fractures. However, the requirement of implant removal was more relevant to LCP.
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Affiliation(s)
- Long Cheng
- Department of Orthopedic Trauma, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, Jilin, 130021, China
| | - Yan-Hui Li
- Department of Cardiology and Echocardiography, the First Hospital of Jilin University, Changchun, 130021, China
| | - Yan Chu
- Department of Obstetrics and Gynecology, Second Hospital of Jilin University, Changchun, 136461, China
| | - Guang Yang
- Department of Orthopedic Trauma, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, Jilin, 130021, China
| | - Dong Zhu
- Department of Orthopedic Trauma, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, Jilin, 130021, China
| | - Lei Tan
- Department of Orthopedic Trauma, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, Jilin, 130021, China.
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Kim JY, Lee J, Kim SH. Comparison between MIPO and the deltopectoral approach with allogenous fibular bone graft in proximal humeral fractures. Clin Shoulder Elb 2020; 23:136-143. [PMID: 33330248 PMCID: PMC7714291 DOI: 10.5397/cise.2020.00199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/12/2020] [Accepted: 08/15/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the clinical differences between open reduction and plate fixation via a deltopectoral approach with allogenous fibular bone graft and a minimally invasive plate osteosynthesis (MIPO), in Neer's classification two-, three- part proximal humeral fractures. METHODS In this retrospective study, 77 patients with two-, three-part proximal humeral fractures were treated at two different institutions. Clinical and radiological evaluations were performed in 39 patients, who underwent MIPO at one institution (group A), and 38 patients, who underwent a deltopectoral approach with allo-fibular bone graft (group B) at another institution. The results between the groups were compared. RESULTS The MIPO technique was significantly less time consuming and caused less bleeding than the deltopectoral approach with allo-fibular bone graft (P<0.05). The duration of the fracture union was significantly reduced in group A (14.5±3.4; range, 10-22 weeks) compared to group B (16.4±4.3; range, 12-28) weeks (P<0.05). There were no statistically significant differences between the two groups when evaluating the visual analog scale and Constant scores between the two groups, 1 year postoperatively. In radiological evaluation, there was no difference in radiological outcomes between the two groups. There were no statistically significant differences in malunion between the two groups. CONCLUSIONS The MIPO technique and deltopectoral approach with allo-fibular bone graft for two-, three-part proximal humeral fractures, show similar clinical and radiological results. However, allogenous fibular grafts require longer surgery, cause more bleeding, and result in longer fracture healing time than MIPO technique.
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Affiliation(s)
- Joon Yub Kim
- Department of Orthopaedic Surgery, Yeson Hospital, Bucheon, Korea
| | - Jinho Lee
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Seong-Hun Kim
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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Abstract
Backgrounds Poor prognosis was reported for complex Pilon fractures involving severe soft tissue damage. It is therefore useful to explore the evolution of different treatment strategies in an effort to reconstruct the axial alignment and articular surface, while minimizing additional damage to the surrounding soft tissues. Methods Seventeen patients with Pilon fractures were enrolled in this retrospective study from December 2009 to October 2014. The injuries were graded according to AO Classification and the Gustilo-Anderson system. Patients were treated with minimally invasive plate osteosynthesis (MIPO) combined with curved incision on the anterior area of ankle. The ankle function and radiological outcome were assessed by the modified Mazur ankle score and Burwell-Charnley criteria, respectively. Visual analogue score (VAS) score was used to assess the degree of patient’s ankle pain, and related complications were also recorded. Results The mean time for fracture healing was 3.6 months (range: 3–6 months). According to Mazur’s criteria, surgical treatment achieved good or excellent outcome in 15 (88.2%) cases, and the average VAS score was 1.19 ± 0.52. On the basis of Burwell-Charnley score, 12 (70.5%) patients achieved anatomic recovery, 4 (23.5%) obtained good reduction, and only 1 (5.9%) patient was diagnosed with valgus deformity. Additionally, 1 (5.9%) patient developed a superficial infection around incision, and 2 (11.8%) experienced superficial peroneal nerve damage. In addition, 2 (11.8%) patients showed radiographic evidence of existing ankle osteoarthritis at the final follow-up. Conclusions This retrospective study is the first to assess the application of a curved incision on the anterior area of ankle with MIPO for the treatment of Pilon fractures, which achieves high functional recovery with a low complication rate. However, large randomized controlled trials comparing different approaches and fixation methods are still needed to conclusively identify the optimal treatment protocol.
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Affiliation(s)
- Dankai Wu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, 130041, China
| | - Chuangang Peng
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, 130041, China
| | - Guangkai Ren
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, 130041, China
| | - Baoming Yuan
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, 130041, China
| | - He Liu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, 130041, China. .,Orthopaedic Research Institute of Jilin Province, Changchun, 130041, People's Republic of China.
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Shon HC, Bang JY, Lee Y, Koh KH, Kim JW. Optimal plate position in minimally invasive plate osteosynthesis for mid-shaft clavicle fractures: simulation using 3D-printed models of actual clinical cases. Eur J Trauma Emerg Surg 2021; 47:1411-6. [PMID: 32078702 DOI: 10.1007/s00068-020-01330-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 02/11/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION This study evaluated the optimal anatomical locking plate position using three-dimensional printed models of the clavicle. MATERIALS AND METHODS Three-dimensional models of the fractured clavicle were reproduced from seventeen patients who underwent minimally invasive plate osteosynthesis (MIPO) procedures. The fracture location-the percentage of the distal fragment length compared to the entire clavicle-ranged from 30-44%. We evaluated four commercially available plate systems for position and fitting with the bone. After reducing the fracture on each three-dimensional model, we determined the optimal plate and its position. RESULTS The anatomical plate fitted well when positioned in the middle of the clavicle for a fracture location ranging from 40 to 60%. When the fracture location was 30-40%, the anatomical plate fit well onto the bone model only in 36% of clavicles; otherwise, the reversed position of the anatomical plate or the lateral plate fit well. The anatomical plate was found to be unsuitable when the fracture location was less than 30%; in this case, the lateral plate was the best fit. CONCLUSION Fitting the anatomical plate in MIPO for clavicle fractures depends on the fracture location. This can help surgeons determine the optimal plate for clavicle MIPO.
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van de Wall BJM, Theus C, Link BC, van Veelen N, van de Leeuwen RJH, Ganzert C, Babst R, Beeres FJP. Absolute or relative stability in plate fixation for simple humeral shaft fractures. Injury 2019; 50:1986-1991. [PMID: 31431330 DOI: 10.1016/j.injury.2019.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/04/2019] [Accepted: 08/06/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Minimal invasive plating (MIPO) techniques for humeral shaft fractures appear to have fewer complications and higher union rates compared to open reduction and internal fixation (ORIF). It is questionable if this also applies to simple humeral shaft fractures, as simple fractures are generally treated with absolute stability which cannot be obtained with MIPO. This raises the question whether biology or biomechanics is more important in fracture healing. This study was developed to investigate the biomechanical part of this equation. The aim of the study was to compare relative stability to absolute stability in simple humeral shaft fractures with regard to fracture healing METHODS: This was a retrospective study of all patients treated with plate fixation for AO/OTA type A1-B3 humeral shaft fractures. Patients were categorized into two groups: absolute stability and relative stability. Both groups were compared with regard to time to radiological union and full weight bearing RESULTS: Thirty patients were included in the relative-stability-group with either an AO/OTA type A (n = 18) or type B (n = 12) humeral shaft fracture and a mean age of 55 (SD 21) years. A total of 46 patients were included in the absolute-stability-group: 27 patients had a type A and 19 type B fracture. The mean age in this group was 45 (SD 19) years. Median follow-up was 12 months (IQR 8-13). Minimally invasive approach was used in 15 (50%) patients in the relative stability group. Time to radiological union was significantly shorter in the absolute-stability-group with a median of 14 (IQR 12-22) versus 25 (IQR17-36) weeks and HR 2.60 (CI 1.54-4.41)(p < 0.001). This difference remained significant after correction for type of approach (adjusted HR 3.53 CI 1.72-7.21) (p 0.001). There was no significant difference in time to full weight bearing. The addition of lag screws in the absolute stability group did not influence time to radiological healing or full weight bearing. CONCLUSION Absolute stability for simple humeral shaft fractures leads to a significantly shorter time to radiological union compared to relative stability. The addition of lag screws to gain interfragmentary compression does not reduce fracture healing time.
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Affiliation(s)
- B J M van de Wall
- Lucerne Cantonal Hospital, Department of Orthopedics and Trauma, Spitalstrasse 16, 6000 Luzern, Switzerland; University Medical Center Utrecht, Department of Traumatology, Heidelberglaan 100, 3584CX Utrecht, the Netherlands
| | - C Theus
- Lucerne Cantonal Hospital, Department of Orthopedics and Trauma, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - B C Link
- Lucerne Cantonal Hospital, Department of Orthopedics and Trauma, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - N van Veelen
- Lucerne Cantonal Hospital, Department of Orthopedics and Trauma, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - R J H van de Leeuwen
- Lucerne Cantonal Hospital, Department of Orthopedics and Trauma, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - C Ganzert
- Lucerne Cantonal Hospital, Department of Orthopedics and Trauma, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - R Babst
- Lucerne Cantonal Hospital, Department of Orthopedics and Trauma, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - F J P Beeres
- Lucerne Cantonal Hospital, Department of Orthopedics and Trauma, Spitalstrasse 16, 6000 Luzern, Switzerland.
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Abstract
A concise review of the history of meta-bone fracture repair is provided. The relevant surgical anatomy, available instrumentation, and execution of preoperative, intraoperative, and postoperative surgical care using minimally invasive plate osteosynthesis are discussed in detail. A short discussion that touches on future directions for care of meta-bone fractures follows.
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Abstract
Minimally invasive plate osteosynthesis (MIPO) is a biologically friendly approach to fracture reduction and stabilization that is applicable to many radius and ulna fractures in small animals. An appropriate knowledge of the anatomy of the antebrachium and careful preoperative planning are essential. This article describes the MIPO technique, which entails stabilization of the fractured radius with a bone plate and screws that are applied without performing an extensive open surgical approach. This technique results in good outcomes, including a rapid time to union and return of function.
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Affiliation(s)
- Caleb C Hudson
- Gulf Coast Veterinary Specialists, 8042 Katy Fwy, Houston, TX 77024, USA.
| | - Daniel D Lewis
- Small Animal Surgery, Canine Sports Medicine and Comparative Orthopedics, Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, 2015 Southwest 16th Avenue, PO Box 100126, Gainesville, FL 32610-0126, USA
| | - Antonio Pozzi
- Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Zurich CH-8057, Switzerland
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Peirone B, Rovesti GL, Baroncelli AB, Piras LA. Minimally Invasive Plate Osteosynthesis Fracture Reduction Techniques in Small Animals. Vet Clin North Am Small Anim Pract 2019; 50:23-47. [PMID: 31635912 DOI: 10.1016/j.cvsm.2019.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Indirect fracture reduction is used to align diaphyseal fractures when using minimally invasive fracture repair. Indirect reduction achieves functional fracture reduction without opening the fracture site. The limb is restored to length and spatial alignment is achieved to ensure proper angular and rotational alignment. Fracture reduction can be accomplished using a variety of techniques and devices, including hanging the limb, manual traction, distraction table, external fixators, and fracture distractors.
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Affiliation(s)
- Bruno Peirone
- Department of Veterinary Science, University of Turin, Largo Paolo Braccini 2-5, Grugliasco, Turin 10095, Italy
| | - Gian Luca Rovesti
- Clinica veterinaria M. E. Miller, Via della Costituzione 10, Cavriago, Reggio Emilia 42025, Italy
| | | | - Lisa Adele Piras
- Department of Veterinary Science, University of Turin, Largo Paolo Braccini 2-5, Grugliasco, Turin 10095, Italy.
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