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Jia Z, Qin H, Lin J, Wang X, Bai R, Zou S, Huang W, Hu X. Minimally Invasive Treatment of Pelvic Fractures with Titanium Elastic Nailing: An Innovative Technology. Surg Innov 2024:15533506241249260. [PMID: 38654530 DOI: 10.1177/15533506241249260] [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] [Indexed: 04/26/2024]
Abstract
BACKGROUND Minimally invasive treatment has become the most popular and effective treatment for pelvic fractures. This study aimed to evaluate the safety and efficacy of a new technique, titanium elastic nailing (TEN), for the minimally invasive treatment of pelvic fractures. METHOD Twenty-four patients with pelvic fractures were referred to us between January 2020 to January 2022, including sixteen males and 8 females. Pelvic fractures were temporarily fixed by pelvic fixation belt accompanied by traction from the lower limb bone. Anterior pelvic ring injuries (superior ramus of pubis) and ilium fractures were treated with closed reduction and intramedullary fixation with minimally invasive TEN. Intraoperative C-arm, including pelvic anteroposterior, pelvic outlet, inlet and ilium oblique views, and O-arm fluoroscopy (intraoperative CT) were employed to assess fractures reduction and determine the location of the elastic titanium nail within the bone channel. RESULTS By adopting closed reduction and minimally invasive incision techniques, pelvic fractures could be safely fixed by placing an elastic titanium nail in the osseous medullary cavity channels of the pelvis. Postoperative investigation indicated that the wounds of all patients were healed in the first stage without any occurrence of complications, such as injuries to the nerves, blood vessels, and important tissue structures. Patients are essential quickly after the operation and could perform the functional exercise in the early stages of the recovery. CONCLUSION TEN can be used for minimally invasive treatment of pelvic fractures. This novel technique has no obvious complications and is worthwhile in clinical practice.
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Affiliation(s)
- Zhaofeng Jia
- Department of Traumatic Orthopedics and Institute of Orthopedic Research, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Hanjun Qin
- Department of Traumatic Orthopedics and Institute of Orthopedic Research, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Jiandong Lin
- Department of Traumatic Orthopedics and Institute of Orthopedic Research, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Xin Wang
- Department of Traumatic Orthopedics and Institute of Orthopedic Research, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Ruochen Bai
- Department of Traumatic Orthopedics and Institute of Orthopedic Research, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Suying Zou
- Department of Traumatic Orthopedics and Institute of Orthopedic Research, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Wenjun Huang
- Department of Traumatic Orthopedics and Institute of Orthopedic Research, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Xinjia Hu
- Department of Traumatic Orthopedics and Institute of Orthopedic Research, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and Technology, Shenzhen, China
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Jeremic D, Grubor N, Bascarevic Z, Slavkovic N, Krivokapic B, Vukomanovic B, Davidovic K, Jovanovic Z, Tomic S. Comparative Analysis of Complication Rates in Tibial Shaft Fractures: Intramedullary Nail vs. Ilizarov External Fixation Method. J Clin Med 2024; 13:2034. [PMID: 38610799 PMCID: PMC11012543 DOI: 10.3390/jcm13072034] [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: 01/11/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Background: The external fixation (EF) Ilizarov method, shown to offer efficacy and relative safety, has unique biomechanical properties. Intramedullary nail fixation (IMN) is an advantageous alternative, offering biomechanical stability and a minimally invasive procedure. The aim of this study was to assess outcomes in patients undergoing tibia fracture fixation, comparing the Ilizarov EF and IMN methods in an early phase of IMN implementation in Serbia. Methods: This was a retrospective study including patients with radiologically confirmed closed and open (Gustilo and Anderson type I) tibial diaphysis fractures treated at the Institute for Orthopedic Surgery "Banjica'' from January 2013 to June 2017. The following demographic and clinical data were retrieved: age, sex, chronic disease diagnoses, length of hospital stay, surgical wait times, surgery length, type of anesthesia used, fracture, prophylaxis, mechanism of injury, postsurgical complications, time to recovery, and pain reduction. Pain intensity was measured by the Visual Analog Scale (VAS), a self-reported scale ranging from 0 to 100 mm. Results: A total of 58 IMN patients were compared to 74 patients who underwent Ilizarov EF. Study groups differed in time to recovery (p < 0.001), length of hospitalization (p = 0.007), pain intensity at the fracture site (p < 0.001), and frequency of general anesthesia in favor of intramedullary fixation (p < 0.001). A shorter surgery time (p < 0.001) and less antibiotic use (p < 0.001) were observed when EF was used. Additionally, we identified that the intramedullary fixation was a significant predictor of pain intensity. Conclusions: The IMN method offers faster recovery and reduced pain intensity in comparison to EF, while the length of surgery predicted the occurrence of any complication.
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Affiliation(s)
- Danilo Jeremic
- Institute for Orthopeadics “Banjica”, 11000 Belgrade, Serbia; (Z.B.); (N.S.); (B.K.); (B.V.); (Z.J.); (S.T.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Nikola Grubor
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Zoran Bascarevic
- Institute for Orthopeadics “Banjica”, 11000 Belgrade, Serbia; (Z.B.); (N.S.); (B.K.); (B.V.); (Z.J.); (S.T.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Nemanja Slavkovic
- Institute for Orthopeadics “Banjica”, 11000 Belgrade, Serbia; (Z.B.); (N.S.); (B.K.); (B.V.); (Z.J.); (S.T.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Branislav Krivokapic
- Institute for Orthopeadics “Banjica”, 11000 Belgrade, Serbia; (Z.B.); (N.S.); (B.K.); (B.V.); (Z.J.); (S.T.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Boris Vukomanovic
- Institute for Orthopeadics “Banjica”, 11000 Belgrade, Serbia; (Z.B.); (N.S.); (B.K.); (B.V.); (Z.J.); (S.T.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Kristina Davidovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Zelimir Jovanovic
- Institute for Orthopeadics “Banjica”, 11000 Belgrade, Serbia; (Z.B.); (N.S.); (B.K.); (B.V.); (Z.J.); (S.T.)
| | - Slavko Tomic
- Institute for Orthopeadics “Banjica”, 11000 Belgrade, Serbia; (Z.B.); (N.S.); (B.K.); (B.V.); (Z.J.); (S.T.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
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Hassan K, Blumenthal S, Jehle CC, Sobel AD. Intramedullary Fixation of Hand Fractures and Arthrodeses. J Hand Surg Am 2024; 49:42-49. [PMID: 37777934 DOI: 10.1016/j.jhsa.2023.08.011] [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: 10/09/2022] [Revised: 05/25/2023] [Accepted: 08/26/2023] [Indexed: 10/02/2023]
Abstract
Intramedullary fixation has long been popular for fracture fixation in the upper extremity from the shoulder through the carpus. Recently, intramedullary fixation in the hand has gained increasing interest, specifically in the metacarpals and phalanges, corresponding with the development of improved cannulated headless screw technology. Along with the advantages of increased operative speed and less surgical dissection, which can promote rapid healing, many benefits exist, supporting their use despite some drawbacks. This article reviews the background and biomechanics of intramedullary fixation with a specific focus on cannulated headless screws, describes the application and techniques of intramedullary screw fixation in the hand, and details the associated outcomes and costs for metacarpal fractures, phalangeal fractures, and interphalangeal joint arthrodesis.
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Affiliation(s)
- Kareem Hassan
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Sarah Blumenthal
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Charles C Jehle
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Andrew D Sobel
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA.
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Lin S, Huang J, Lamin BM, Zeng T, Tian Y, Liu L, Luo H. Effect of intramedullary fixation and plate fixation on postoperative wound complications in clavicle fractures: A meta-analysis. Int Wound J 2024; 21:e14361. [PMID: 37641210 PMCID: PMC10781614 DOI: 10.1111/iwj.14361] [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: 07/23/2023] [Revised: 08/06/2023] [Accepted: 08/08/2023] [Indexed: 08/31/2023] Open
Abstract
More and more meta-analyses have been conducted to compare the effects of intramedullary fixation (IF) and plate fixation (PF) on the outcome of midshaft clavicle fractures. It can affect the doctors' treatment decisions. A number of studies have been conducted in order to assist surgeons in selecting optimal operative procedures and to recommend operative treatment of clavicle fractures in accordance with the best available research. Our analysis of the IF and PF of clavicle fractures was done through a search for PubMed, Emabase, Web of Science, and Cochrane Library. Two different researchers analysed the research literature for quality of analysis and data extraction. The analysis of the data was done with RevMan 5.3. The 95% CI and OR models have been computed by means of either fixed-dose or randomize. In addition, RCT in 114 references have been reviewed and added for further analysis. It is concluded that the application of plate and intramedullary fixation in the middle clavicle operation has remarkable influence on the outcome of post-operation. There was a lower risk of postoperative wound infection in IF (OR, 5.92; 95% CI, 2.46, 14.27 p < 0.0001), smaller surgical incisions (MD, 6.57; 95% CI, 4.90, 8.25 p < 0.0001), and shorter operative time (MD, 17.09; 95% CI 10.42, 23.77 p < 0.0001), less blood loss (MD, 63.62; 95% CI, 55.84, 71.39 p < 0.0001) and shorter hospital stay (MD, 1.05; 95% CI, 0.84, 1.25 p < 0.0001). However, there is no statistical significance in the incidence of wound dehiscence. Thus, the effect of IF on the incidence of injury is better than that of the inner plate in the middle of the clavicle.
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Affiliation(s)
- Shangce Lin
- Medical SchoolYangtze UniversityJingzhouChina
- Department of OrthopedicsThe First People's Hospital of JingzhouJingzhouChina
| | - Jin Huang
- Medical SchoolYangtze UniversityJingzhouChina
| | | | - Teng Zeng
- Department of OrthopedicsThe First People's Hospital of JingzhouJingzhouChina
| | - Yaqin Tian
- Department of OrthopedicsThe First People's Hospital of JingzhouJingzhouChina
| | - Lian Liu
- Medical SchoolYangtze UniversityJingzhouChina
| | - Huasong Luo
- Department of OrthopedicsThe First People's Hospital of JingzhouJingzhouChina
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Kohls MR, Robertson ED, Beckwitt CH, Ghodadra AA, Kaufmann RA. Computed Tomography-Based Humeral Templating for Uncemented Elbow Arthroplasty. Hand (N Y) 2023:15589447231209066. [PMID: 37946495 DOI: 10.1177/15589447231209066] [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: 11/12/2023]
Abstract
BACKGROUND Intramedullary (IM) screw insertion into the distal humerus provides fixation for a novel, uncemented elbow arthroplasty. A multitude of screw sizes is required to accommodate variable humeral morphology. The goal of this study was to use computed tomography (CT) for IM screw sizing and to validate this templating by inserting screws into three-dimensionally (3D) printed models. METHODS Computed tomography humerus scans for 30 patients were reformatted in the plane of the distal IM canal. Screw size was templated by measuring the canal diameter at 3 locations corresponding to the lengths of the screws being tested. Interrater and intrarater reliabilities of the measurements were assessed. Three-dimensional models of 5 humeri were printed, and IM screws were placed to achieve a secure endosteal fit. RESULTS We identified combinations of body components and IM screw length and diameter for all patients to seat this uncemented elbow arthroplasty. The measurements and screw width determinations were reliable. Canal diameter correlated with age but was unrelated to sex. Screws were inserted into five 3D-printed models which matched the templates and demonstrated mechanical and radiographic evidence of secure fit. CONCLUSIONS This study characterizes distal humerus anatomy in the context of IM screw fixation. Humerus CT scans of 30 patients were able to be templated, and validation via implantation of IM screws into 3D models was successful. Computed tomography templating will allow surgeons to predict the optimal screw size prior to implantation. A broad range of screw lengths and diameters is critical for implantation of this novel elbow arthroplasty.
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Affiliation(s)
- Morgan R Kohls
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, PA, USA
| | - Emerald D Robertson
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, PA, USA
| | - Colin H Beckwitt
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, PA, USA
| | - Anish A Ghodadra
- Department of Radiology, University of Pittsburgh Medical Center, PA, USA
| | - Robert A Kaufmann
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, PA, USA
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Şensöz E, Cecen G. Comparison of Intramedullary and Extramedullary Fixation Results in Subtrochanteric Femur Fractures. Cureus 2023; 15:e49258. [PMID: 38143672 PMCID: PMC10746348 DOI: 10.7759/cureus.49258] [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] [Accepted: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
OBJECTIVE The subtrochanteric femur is a load-bearing region where deforming forces are effective. These fractures are difficult to treat for orthopedic surgeons. In this article, we aimed to compare intramedullary (IM) and extramedullary (EM) fixation methods for these fractures that do not have gold standard treatment. METHODS Eighty-five patients were retrospectively evaluated. Patients with IM implants (IM femoral nail, proximal femoral nail) were grouped as Group 1, and patients with EM implants were grouped as Group 2 (95° condylar plate, locked anatomical proximal femoral plate). Patients' age, gender, fractured hip side, etiology, anesthesia type, preoperative waiting time, follow-up period, fracture type, Harris hip score (HHS), and mechanical complications were examined. RESULTS The mean age of the patients was 44.13 years. There was no difference between the groups in terms of age and gender. The mean follow-up period of the patients was 13.28 months. Falling from a height was the most common cause of subtrochanteric fracture. IM fixation was applied to 62 patients, and EM fixation was applied to 23 patients. No significant difference was found between Groups 1 and 2 in non-union, delayed union, implant failure, shortness rates, and HHS. CONCLUSION Both IM and EM fixation methods have advantages and disadvantages in treating subtrochanteric fractures. These methods yield similar results in both groups in our study. The issue of fixation methods remains controversial in the literature, and further studies are needed on this subject.
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Affiliation(s)
- Ersin Şensöz
- Orthopedics, Dr. Lutfi Kirdar Kartal City Hospital, Istanbul, TUR
| | - Gultekin Cecen
- Orthopedics and Traumatology, Bahçeşehir University Medical School, Istanbul, TUR
- Orthopedics and Traumatology, VM Medical Park Pendik Hospital, Istanbul, TUR
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Kavanagh AM, Schumann J, Burgess BJ. Intramedullary Nail Fixation for the Treatment of Symptomatic Fibular Nonunion: A Case Series. Foot Ankle Spec 2023:19386400231193620. [PMID: 37608750 DOI: 10.1177/19386400231193620] [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: 08/24/2023]
Abstract
Ankle fractures are a relatively common injury in the lower extremity. They can be treated with conservative management if they are nondisplaced and only involve the fibula. Nonunions at the fracture site, however, are a potential complicating factor during treatment. There is growing literature supporting the use of intramedullary fixation for fracture care. Not only does it have the advantages of using smaller incisions to preserve periosteum while providing improved biomechanical outcomes, but intramedullary reaming can help stimulate cells to promote bone healing. Few articles discuss the use and success of intramedullary reaming in revision surgery of the distal fibula. We present 3 cases of computed tomography-confirmed fibular nonunion following conservative fracture care, which underwent revision surgery with fibular nail fixation technique. These cases illustrate clinical and image findings as well as highlight the surgical technique used for each patient. At follow-up, all patients were asymptomatic and radiographs confirmed healing of the previous nonunion site. These cases are examples of successful revision for fibular fracture nonunion using intramedullary nail fixation.Level of Evidence: Level IV: Case series.
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Affiliation(s)
- Amber M Kavanagh
- Division of Hinsdale Orthopaedics, Illinois Bone & Joint Institute, Joliet, Illinois
| | - Jaclyn Schumann
- Division of Hinsdale Orthopaedics, Illinois Bone & Joint Institute, Joliet, Illinois
| | - Brian J Burgess
- Division of Hinsdale Orthopaedics, Illinois Bone & Joint Institute, Joliet, Illinois
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Schumann J, Burgess B, Ryan D, Garras D. A Retrospective Analysis of Distal Fibula Fractures Treated With Intramedullary Fibular Nail Fixation. J Foot Ankle Surg 2023:S1067-2516(23)00068-6. [PMID: 36966965 DOI: 10.1053/j.jfas.2023.03.005] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 12/15/2022] [Accepted: 03/18/2023] [Indexed: 04/26/2023]
Abstract
There is growing literature supporting the use of intramedullary fixation for fracture care because of its smaller incisions, improved biomechanical outcomes, and faster time to weightbearing than traditional internal fixation methods. The aim of this study is to investigate the postoperative outcomes in ankle fractures treated with intramedullary nail fixation in the largest patient cohort to date. From 2015 to 2021, 151 patients were evaluated following surgical treatment of fibular fractures with intramedullary nail fixation. Patients were identified through a medical record database search for appropriate ankle fracture procedure codes. Patient information was reviewed for fracture type, adjunct procedures, time to weightbearing and postoperative complications. Radiographs were assessed for quality and time to radiographic union. The mean time to weightbearing was 4.8 weeks. Minor wound dehiscence was identified in 2 patients (1.3%). Superficial infection was present in 4 patients (2.6%) and a deep infection developed in 2 patients (1.3%). Two patients developed a nonunion (1.5%). There were no DVTs reported, although 1 patient developed a PE postoperatively. Radiographic quality of reduction and time to union is comparable to literature reported plate and screw construct outcomes. Reduction was classified as good in 86.1% of patients and radiographic union was appreciated in 98.5% of patients. This is the largest cohort study evaluating the outcomes of intramedullary nail fixation for ORIF of ankle fractures. These data reinforce that intramedullary nailing provides a minimally invasive approach with accurate anatomic reduction, excellent fracture union rates, low complication rates, and an early return to weightbearing.
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Affiliation(s)
- Jaclyn Schumann
- Foot and Ankle Fellow, Hinsdale Orthopaedics a Division of Illinois Bone & Joint Institute, Joliet, IL.
| | - Brian Burgess
- Director of Hinsdale Orthopaedics (IBJI) Foot and Ankle Fellowship, Hinsdale Orthopaedics a Division of Illinois Bone & Joint Institute, Joliet, IL
| | - Daniel Ryan
- Podiatric Medicine and Surgery Residency Program PGY-2, Advocate Christ Medical Center, Oak Lawn, IL
| | - David Garras
- Foot and Ankle Orthopedic Surgeon, Midwest Orthopedic Consultants, Oak Lawn, IL
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Klahs KJ, Heh E, Yousaf M, Tadlock J, Thabet AM. Operative challenges of intramedullary nailing for subtrochanteric blastic pathological femur fracture: a case report. J Surg Case Rep 2023; 2023:rjac630. [PMID: 36685131 PMCID: PMC9844961 DOI: 10.1093/jscr/rjac630] [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: 11/18/2022] [Accepted: 12/19/2022] [Indexed: 01/20/2023] Open
Abstract
Prostate adenocarcinoma metastasizes to bone and forms fragile blastic lesions, which can present as dense obstacles intraoperatively. There are limited reports on the challenges surgeons face when operating through these lesions. A 60-year-old male with a pathologic subtrochanteric femur fracture in the presence of blastic lesions was successfully treated with intramedullary (IM) fixation. Pathologic fractures from blastic bone lesions are expected to increase in prevalence as survivability improves for metastatic prostate cancer. Orthopedic surgeons, when performing IM fixation for these fractures, should be prepared to utilize accessory equipment and should adopt creative techniques for reduction and fixation.
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Affiliation(s)
- Kyle J Klahs
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, El Paso TX, USA
| | - Ethan Heh
- El Paso Paul Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso TX, USA
| | - Mohammad Yousaf
- El Paso Paul Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso TX, USA
| | - Joshua Tadlock
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, El Paso TX, USA
| | - Ahmed M Thabet
- Correspondence address. Department of Orthopaedic Surgery, El Paso Paul Foster School of Medicine, Texas Tech University Health Sciences Center, 4801 Alberta Ave El Paso, TX 79905, USA. Tel: (915) 215-5400; E-mail:
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Abstract
BACKGROUND Intramedullary nail (IMN) fixation of metacarpal fractures is an alternative to Kirschner wire (K-wire) fixation. The goal of this study was to compare the biomechanical properties of K-wire fixation with a threaded IMN (InNate; ExsoMed, Aliso Viejo, California). METHODS The study design was based on previously described biomechanical models for evaluating metacarpal fractures. Sixteen fresh frozen small finger-matched and ring finger-matched pairs were randomized to either IMN or 0.045 in K-wire fixation after receiving a standardized neck osteotomy. Proper implant placement was confirmed with plain radiographs. Specimens then underwent loading in a 3-point bend configuration. Load to failure (LTF), stiffness, and fracture displacement were recorded. Mechanical failure was defined by a sharp change in the load-displacement curve. RESULTS Age, sex, sidedness (left or right), and digit (ring or small finger) were evenly distributed between groups. The IMN had a significantly higher LTF than K-wires (546 N vs 154 N, P < .001). The K-wire fixation demonstrated plastic deformation between 75 and 150 N. Intramedullary nail stiffness was higher than that of K-wires (155.89 N/mm vs 59.28 N/mm, P < .001). CONCLUSIONS When surgical fixation is indicated for metacarpal neck and shaft fractures, the threaded IMN is biomechanically superior to crossed K-wires with the application of 3-point bend.
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Affiliation(s)
- Midhat Patel
- The University of Arizona College of
Medicine – Phoenix, USA
| | - Paulo Castañeda
- The University of Arizona College of
Medicine – Phoenix, USA
| | | | - Jill G. Putnam
- The University of Arizona College of
Medicine – Phoenix, USA
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11
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Guo W, Wu F, Chen W, Tian K, Zhuang R, Pan Y. Can Locked Fibula Nail Replace Plate Fixation for Treatment of Acute Ankle Fracture? A Systematic Review and Meta-Analysis. J Foot Ankle Surg 2022; 62:178-185. [PMID: 36333182 DOI: 10.1053/j.jfas.2022.10.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 09/13/2022] [Accepted: 10/01/2022] [Indexed: 11/07/2022]
Abstract
The standard surgical treatment for unstable ankle fractures involves open reduction and internal fixation (ORIF) with plates. However, ORIF has been associated with several complications, such as soft tissue irritation, wound infection, and nerve injury. Previous studies have shown that closed reduction and internal fixation with locked intramedullary nails (LIMNs) yields satisfactory efficacy in the treatment of ankle fractures and is associated with low complication rates. Therefore, a systematic review and meta-analysis of randomized controlled trials is imperative to provide evidence on whether or not LIMN fixation is comparable to or superior than traditional ORIF. We conducted a comprehensive literature search in the PubMed, Cochrane Library and EMBASE databases. A total of 4 randomized controlled trials involving 359 participants who suffered ankle fractures were included in this systematic review and meta-analysis. The results showed that the LIMN fixation group was statistically significant in terms of functional outcomes at the 3-month follow-up and wound-related complications. There was no statistical advantage for patients in the LIMN fixation group in terms of nonwound-related complications, total complications, or mid-term follow-up functional outcomes. There was no statistical difference between the LIMN and ORIF groups regarding operation time and quality of reduction. We believe LIMN fixation is a viable option for the treatment of unstable ankle fractures in both young and elderly individuals.
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Affiliation(s)
- Wenxuan Guo
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Fan Wu
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Wenhuan Chen
- Third Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Kun Tian
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Rujie Zhuang
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yu Pan
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
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Bastías GF, Bravo F, Astudillo C, Giannini E, Contreras M, Melo R, Muñoz G, Pellegrini MJ, Cuchacovich N. Restoration of Anatomic Parameters and Syndesmotic Reduction After Intramedullary Nailing of Distal Fibular Fractures. Foot Ankle Orthop 2022; 7:24730114221141388. [PMCID: PMC9742579 DOI: 10.1177/24730114221141388] [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] [Indexed: 12/13/2022] Open
Abstract
Background: Intramedullary nailing of the fibula (FN) is a method of fixation that has proven to be useful for treating distal fibular fractures (DFs). FN minimizes soft tissue complications and provides similar stability to plating, with fewer hardware-related symptoms. Nevertheless, FN has been associated with syndesmotic malreduction and the incapacity of restoring length and rotation of the fibula. We aimed to evaluate the fibular position and syndesmotic reduction after fixation with FN compared with the uninjured ankle in the immediate postoperative period. Methods: Prospective cohort study. Patients with DF fractures treated with IN between January 2017 and January 2020 were included. Immediate postoperative bilateral ankle CT was obtained in all cases. Fibular rotation, length, and translation as well as syndesmotic diastasis were measured on both ankles and compared by 3 independent observers. Results: Twenty-eight patients were included (16 women). The mean age was 46 years (range 16-91). Fracture type distribution according to AO/ASIF classification included 19 patients with 44.B (67.9%), 8 patients with 44.C (28.6%), and 1 patient with a 44.A fracture (3.6%). No significant differences were identified considering fibular rotation (P = .661), syndesmotic diastasis (P = .147), and fibular length (P = .115) between the injured and uninjured ankle. Fibular translation had statistical differences (P = .01) compared with the uninjured ankle. The intraclass correlation coefficient showed an excellent concordance between observers except for fibular translation on the injured ankle. Conclusion: In this cohort, fixation of DF fractures with FN allows restoration of anatomical parameters of the ankle in terms of fibular rotation, length, and syndesmotic diastasis. However, fibular translation had significant differences compared with the uninjured ankle based on bilateral CT scan evaluation. Level of Evidence: Level II, prospective cohort study.
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Affiliation(s)
- Gonzalo F. Bastías
- Department of Orthopedic Surgery, Foot and Ankle Unit, Clínica Las Condes—Hospital del Trabajador, Universidad de Chile, Las Condes, Santiago, Chile
| | - Francisco Bravo
- Department of Orthopedic Surgery, Foot and Ankle Unit, Complejo Hospitalario San José—Mutual de Seguridad, Santiago, Chile
| | - Claudia Astudillo
- Department of Radiology, Clinica Las Condes, Las Condes, Santiago, Chile
| | - Esteban Giannini
- Department of Radiology, Hospital del Trabajador-Clinica MEDS, Santiago, Chile
| | - Martin Contreras
- Department of Orthopedic Surgery, Hospital del Trabajador, Santiago, Chile
| | - Rodrigo Melo
- Department of Orthopedic Surgery, Foot and Ankle Unit, Clinica Las Condes—Hospital Militar de Santiago, Santiago, Chile
| | - Gerardo Muñoz
- Department of Orthopedic Surgery, Foot and Ankle Unit, Clinica Las Condes, Las Condes, Santiago, Chile
| | - Manuel J. Pellegrini
- Department of Orthopedic Surgery, Foot and Ankle Service, Clinica Universidad de los Andes—Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Natalio Cuchacovich
- Department of Orthopedic Surgery, Foot and Ankle Unit, Clínica Las Condes—Hospital del Trabajador, Universidad de Chile, Las Condes, Santiago, Chile,Natalio Cuchacovich, MD, Department of Orthopedic Surgery, Foot and Ankle Unit, Clinica Las Condes—Hospital del Trabajador, Estoril 450, Las Condes, Santiago, 7591047, Chile.
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Paley D, Lamm BM, Robbins C, Sullivan A, Ernst J, Danne E, Lichtblau C. Simultaneous Limb Lengthening With Ankle Fusion Using an Internal Lengthening Nail. J Foot Ankle Surg 2022; 61:e15-e20. [PMID: 34969598 DOI: 10.1053/j.jfas.2021.11.020] [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: 08/17/2019] [Revised: 11/04/2021] [Accepted: 11/28/2021] [Indexed: 02/03/2023]
Abstract
We reviewed 18 limbs in 17 patients who underwent ankle fusion with simultaneous tibial lengthening with a magnetic internal lengthening nail. All patients had preoperative limb length discrepancy (LLD) (mean 4.9 cm (2.6-7.6 cm)) with ankle deformity. The ankle was fused from medial or lateral approaches using screws/plate constructs placed adjacent to the retrograde Precise nail. Lengthening was carried out by a distal 1/3 tibial osteotomy. Clinical and radiographic measures were performed after a mean follow-up of 20 months (12-37 months). The mean amount of lengthening performed was 4 cm (1.8-7.2 cm). The final mean LLD was 1 cm (0.7-1.1 cm), which was statistically significant (p<0.01) as compared to preoperative. The foot was plantigrade in all cases. The mean foot rotation was 10° (5-15°) external, relative to the knee. At final follow-up all patients reported minimal to no pain, and all claimed to be walking more functionally than before surgery. Ankle fusion and limb lengthening was achieved in all cases. Combining both treatments by using an internal lengthening nail was very effective and avoided leaving patients with a dysfunctional LLD or of having a separate limb lengthening procedure. This is the first report of such a combined treatment of ankle fusion with internal tibial lengthening nail.
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Affiliation(s)
- Dror Paley
- Director, Paley Orthopedic & Spine Institute, West Palm Beach, FL
| | - Bradley M Lamm
- Chief of Foot and Ankle Surgery at St. Mary's Medical Center and The Palm Beach Children's Hospital, Director, Foot and Ankle Deformity Center and Fellowship at Paley Orthopedic & Spine Institute, West Palm Beach, FL.
| | - Craig Robbins
- Orthopedic Surgeon, Paley Orthopedic & Spine Institute, West Palm Beach, FL
| | - Alex Sullivan
- Medical Student, Florida Atlantic University, Boca Raton, FL
| | - Jordan Ernst
- Fellow, Foot and Ankle Deformity Correction Fellowship, Paley Orthopedic & Spine Institute, West Palm Beach, FL
| | - Elvis Danne
- Fellow, Foot and Ankle Deformity Correction Fellowship, Paley Orthopedic & Spine Institute, West Palm Beach, FL
| | - Craig Lichtblau
- Physical Medicine and Rehabilitation consultant, Paley Orthopedic & Spine Institute, West Palm Beach, FL
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Jia Z, Hong Y, Li C, Lin J, Hu X. The clinical efficacy of the minimally invasive treatment of Mason type II radial head fractures using intramedullary fixation with double titanium elastic nails. Am J Transl Res 2021; 13:12807-12815. [PMID: 34956495 PMCID: PMC8661165] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/24/2021] [Indexed: 06/14/2023]
Abstract
Radial head fractures (RHFs) occur most frequently among all elbow fractures. Current treatments pose several limitations for the Mason type II radial head fractures. This study was performed to evaluate the clinical efficacy of a new minimally invasive treatment for Mason type II radial head fractures using intramedullary fixation with double titanium elastic nails. Between January 2018 and December 2019, our group used double titanium elastic intramedullary nails as a minimally invasive treatment for 32 cases of Mason II type radial head fractures. After the treatments, we summarized and conducted a retrospective analysis to evaluate the surgical operation itself, the quality of the fracture reductions, the fracture healing, and any complications. The Mayo elbow function scores (MEPS) and the visual analog scale (VAS) pain scores were used to evaluate the clinical efficacy of this approach. All the patients recovered from their surgeries without any complications. We followed all the cases for an average of 12 months. The elbow extension range of motion was 5 degrees (range: 0-15 degrees), the elbow flexion range of motion was 140 degrees (range: 135-146 degrees), and the average forearm pronation range of motion was 84.1 degrees (range: 78-90 degrees). The average forearm supination range of motion was 80.4 degrees (range: 75-85 degrees). All the fractures healed (a 100% healing rate), the MEPS score was 96.7 (range: 85-100), and the MEPS ratings of excellent and good were both 100%. The VAS pain scores ranged from 0-1. The minimally invasive treatment of Mason type II radial head fractures using intramedullary fixation with double elastic nails proved to be a simple approach with a relatively short operation time. It required only a small incision with little trauma and had few complications, so it is worth consideration for wider use.
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Affiliation(s)
- Zhaofeng Jia
- Department of Osteoarthropathy, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affiliated Hospital of Southern University of Science and Technology Shenzhen 518035, Guangdong Province, China
| | - Yixia Hong
- Department of Osteoarthropathy, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affiliated Hospital of Southern University of Science and Technology Shenzhen 518035, Guangdong Province, China
| | - Chuangli Li
- Department of Osteoarthropathy, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affiliated Hospital of Southern University of Science and Technology Shenzhen 518035, Guangdong Province, China
| | - Jiandong Lin
- Department of Osteoarthropathy, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affiliated Hospital of Southern University of Science and Technology Shenzhen 518035, Guangdong Province, China
| | - Xinjia Hu
- Department of Osteoarthropathy, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affiliated Hospital of Southern University of Science and Technology Shenzhen 518035, Guangdong Province, China
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15
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Kho DH, Cho BK, Choi SM. Midterm Outcomes of Unstable Ankle Fractures in Young Patients Treated by Closed Reduction and Fixation With an Intramedullary Fibular Nail vs Open Reduction Internal Fixation Using a Lateral Locking Plate. Foot Ankle Int 2021; 42:1469-1481. [PMID: 34184908 DOI: 10.1177/10711007211017470] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 02/01/2023]
Abstract
BACKGROUND We aimed to compare midterm radiological and clinical outcomes between closed reduction and internal fixation (CRIF) using the fibular intramedullary nail (IMN) and open reduction and internal fixation (ORIF) using the locking plate for the treatment of unstable ankle fractures in active young patients. METHODS In this retrospective cohort study, 204 patients treated with CRIF using the fibular IMN (94 patients) or ORIF using the locking plate (110 patients) were included after at least 3 years of follow-up. The mean patient age was 41.4 years. Radiographic evaluation included the quality of reduction assessed by plain radiography and 3-dimensional (3D)-reconstructed computed tomography as well as the development of posttraumatic osteoarthritis (PTOA) of the ankle assessed by weightbearing plain radiography. Clinical evaluation included the American Orthopaedic Foot & Ankle Society hindfoot score, Olerud and Molander Score, the Foot and Ankle Outcome Score, and visual analog scale pain score as well as complications. RESULTS At median follow-up greater than 4 years, we found no significant differences in measured clinical outcomes between the 2 groups. There were significantly fewer postoperative complications in the IMN group than in the ORIF group (9.5% vs 39%, P < .001). However, we did find a greater proportion of radiographically fair or poor reductions in the IMN group than in the ORIF group (P < .001). The poor reductions in the IMN group were primarily related to Weber type C, pronation-type injury, and comminuted fibular and trimalleolar fractures (P < .001). PTOA was also more frequently observed in the IMN group than in the ORIF group (21.3% vs 9.1%, P = .024). CONCLUSION Given the current prevailing technologies for fracture fixation, this study suggests that surgeons should consider ORIF for unstable ankle fractures in active young patients with Weber type C, pronation-type injury, and comminuted fibular and trimalleolar fractures. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Duk-Hwan Kho
- Department of Orthopaedic Surgery, Konkuk University Chungju Hospital, Konkuk University School of Medicine, Chungju, Korea
| | - Byung-Ki Cho
- Department of Orthopaedic Surgery, School of Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Seung-Myung Choi
- Department of Orthopedic Surgery, Eulji University School of Medicine, Gyeonggi-do, Korea
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Li H, Liu D, Tang X, Wang N, Gong D, Wu Y, Zhang Y, Li W, Gou Y. [Efficacy and safety of intravenous combined with topical administration of tranexamic acid in reducing blood loss after intramedullary fixation of intertrochanteric femoral fractures]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2021; 35:550-555. [PMID: 33998206 DOI: 10.7507/1002-1892.202010040] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the efficacy and safety of intravenous combined with topical administration of tranexamic acid (TXA) in reducing blood loss after intramedullary fixation of intertrochanteric femoral fractures by a prospective controlled trial. Methods Patients with intertrochanteric femoral fractures, who were admitted for intramedullary fixation between June 2015 and July 2019, were selected as the study subjects, 120 of whom met the selection criteria. The patients were randomly assigned to 3 groups: intravenous administration group (group A, 41 cases), topical administration group (group B, 40 cases), and combined administrations group (group C, 39 cases). In group A, 4 patients occurred deep vein thrombosis of lower extremity before operation, 1 patient died of myocardial infarction on the 5th day after operation, and 1 patient developed severe pulmonary infection after operation. In group B, 2 patients occurred deep vein thrombosis of lower extremity before operation and 1 patient had iatrogenic fracture during operation. In group C, 3 patients occurred deep vein thrombosis of lower extremity before operation and 1 patient developed pulmonary infection before operation and gave up surgical treatment. All the above patients were excluded from the study, and the remaining 107 cases were included in the analysis, including 35, 37, and 35 cases in groups A, B, and C, respectively. There was no significant difference in gender, age, height, body mass, injury cause, fracture side and type, the interval between injury and operation, and preoperative hemoglobin (Hb), hematocrit between groups ( P>0.05). Intraoperative TXA (15 mg/kg) was injected intravenously in group A at 30 minutes before operation, and 1 g of TXA was injected into the medullary cavity in group B after the proximal femur was grooted and before the intramedullary nail implantation, respectively. TXA was given in group C before and during operation according to the administration methods and dosage of groups A and B. Total blood loss, maximum Hb decrease, blood transfusion rate, operation time, fracture healing time, and the incidence of complications were recorded and compared between groups. The hip joint function were evaluated by Harris score. Results There was no significant difference in operation time between groups ( P>0.05). The total blood loss, the maximum Hb decrease, and the blood transfusion rate in group B were the highest, followed by group A and group C, and the differences between groups were significant ( P<0.05). No incision infection or pulmonary embolism occurred in the 3 groups after operation. The incidence of anemia in group C was significantly lower than that in groups A and B, the difference was significant ( P<0.05). There was no significant difference in the incidence of subcutaneous hematoma, aseptic exudation, and deep vein thrombosis of lower extremity between groups ( P>0.05). All patients in the 3 groups were followed up 8-35 months, with an average of 16.2 months. The fracture healing time of groups A, B, and C was (6.12±1.78), (5.89±1.63), and (5.94±1.69) months, respectively, and there was no significant difference between groups ( P>0.05). At last follow-up, the Harris scores of the hip joints in groups A, B, and C were 83.18±7.76, 84.23±8.01, and 85.43±8.34, and the difference was not significant ( P>0.05). Conclusion Preoperative intravenous injection combined with intraoperative topical application of TXA can effectively reduce blood loss and blood transfusion after intramedullary fixation of femoral intertrochanteric fracture, without increasing the risk of deep vein thrombosis, and the efficacy is better than that of intravenous injection or topical administration.
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Affiliation(s)
- Haibo Li
- Department of Orthopaedics, West China-KongGang Hospital of Sichuan University (Chengdu Shuangliu District First People's Hospital), Chengdu Sichuan, 610200, P.R.China
| | - Dahai Liu
- Department of Orthopaedics, West China-KongGang Hospital of Sichuan University (Chengdu Shuangliu District First People's Hospital), Chengdu Sichuan, 610200, P.R.China
| | - Xuexia Tang
- Department of Orthopaedics, West China-KongGang Hospital of Sichuan University (Chengdu Shuangliu District First People's Hospital), Chengdu Sichuan, 610200, P.R.China
| | - Na Wang
- Department of Orthopaedics, West China-KongGang Hospital of Sichuan University (Chengdu Shuangliu District First People's Hospital), Chengdu Sichuan, 610200, P.R.China
| | - Dezhi Gong
- Department of Orthopaedics, West China-KongGang Hospital of Sichuan University (Chengdu Shuangliu District First People's Hospital), Chengdu Sichuan, 610200, P.R.China
| | - Yan Wu
- Department of Orthopaedics, West China-KongGang Hospital of Sichuan University (Chengdu Shuangliu District First People's Hospital), Chengdu Sichuan, 610200, P.R.China
| | - Yue Zhang
- Department of Orthopaedics, West China-KongGang Hospital of Sichuan University (Chengdu Shuangliu District First People's Hospital), Chengdu Sichuan, 610200, P.R.China
| | - Wen Li
- Department of Orthopaedics, West China-KongGang Hospital of Sichuan University (Chengdu Shuangliu District First People's Hospital), Chengdu Sichuan, 610200, P.R.China
| | - Yongsheng Gou
- Department of Orthopaedics, West China-KongGang Hospital of Sichuan University (Chengdu Shuangliu District First People's Hospital), Chengdu Sichuan, 610200, P.R.China
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Eisenberg G, Clain JB, Feinberg-Zadek N, Leibman M, Belsky M, Ruchelsman DE. Clinical Outcomes of Limited Open Intramedullary Headless Screw Fixation of Metacarpal Fractures in 91 Consecutive Patients. Hand (N Y) 2020; 15:793-797. [PMID: 30880471 PMCID: PMC7850249 DOI: 10.1177/1558944719836235] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 11/15/2022]
Abstract
Background: The objective of the study is to evaluate clinical and radiographic outcomes in patients treated with limited-open retrograde intramedullary headless screw (IMHS) fixation for metacarpal neck and shaft fractures. Methods: Retrospective review of 91 consecutive patients (79 men; 12 women), mean age 28 (range =15-69) years, treated with IMHS fixation for acute displaced metacarpal neck (N = 56) and shaft (N = 35) fractures at a single institution. Mean follow-up was 10 (range = 1-71, median = 3) months. Preoperative mean magnitude of metacarpal neck angulation was 48° (range = 0°-90°), and mean shaft angulation was 42° (range = 0°-70°). Active motion was initiated within 5 days postoperatively. Clinical outcomes were assessed with digital goniometry, grip strength, and return to full activity. The time to radiographic union and radiographic arthrosis was assessed. Results: All 91 patients achieved full functional arc of metacarpophalangeal (MCP) motion, and all achieved full active MCP extension or hyperextension. At mean follow-up of 10 months, postoperative mean MCP joint flexion-extension arc was 88° (range = 55°-110°). Grip strength was available for 52 patients and measured 104.1% of the contralateral hand (range = 58%-230%). Radiographic union data were available for 86 patients. Seventy-six percent (65/86) achieved radiographic union by the end of week 6 (range = 2-10 weeks). Early arthrosis was noted in 1 patient at the MCP. There were 3 cases of shaft refracture after recurrent blunt trauma, following prior evidence of full osseous union. Conclusions: The IMHS fixation is safe, reliable, and durable for metacarpal neck/subcapital, axially stable shaft fractures, and select delayed unions or malunions. It allows for early postoperative motion without affecting union rates and obviates immobilization. This technique offers distinct advantages over formal open reduction and percutaneous Kirschner wire techniques.
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Affiliation(s)
| | | | | | | | | | - David E. Ruchelsman
- Newton-Wellesley Hospital, MA, USA,Tufts University School of Medicine, Boston, MA, USA,Hand Surgery Research and Education Foundation, Newton, MA, USA,David E. Ruchelsman, Division of Hand Surgery, Newton-Wellesley Hospital, 2000 Washington Street, Blue Building, Suite 201, Newton, MA 02462, USA.
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18
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Ju W, Mohamed SO, Qi B. Comparison of plate fixation vs. intramedullary fixation for the management of mid-shaft clavicle fractures: A systematic review and meta-analysis of randomised controlled trials. Exp Ther Med 2020; 20:2783-2793. [PMID: 32765773 PMCID: PMC7401851 DOI: 10.3892/etm.2020.9002] [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: 01/15/2020] [Accepted: 05/22/2020] [Indexed: 11/06/2022] Open
Abstract
A number of meta-analyses have compared clinical outcomes following plate vs. intramedullary fixation for midshaft clavicle fractures (MSCF), but with conflicting results. There is a requirement for updated level-1 evidence to guide clinicians managing MSCF. The aim of the present systematic review and meta-analysis was to compare clinical outcomes following plate vs. intramedullary fixation of MSCF. The PubMed, Scopus, BioMed Central, Cochrane Central Register of Controlled Trials and Google Scholar databases were searched for records added until 1st July 2019. A total of 10 randomised controlled trials (RCTs) were included. Shoulder function was assessed using the Constant-Murley Shoulder Outcome questionnaire and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). There was no statistically significant difference in Constant-Murley scores between plate and intramedullary fixation [Mean difference (MD)=0.75; 95% CI: -2.49 to 3.99; P=0.65; I2=85%]. Similarly, there was no statistically significant difference in DASH scores between the two groups (MD=1.55; 95% CI: -1.12 to 4.23; P=0.26; I2=89%). There was no statistically significant difference in complications requiring non-routine surgery between plate and intramedullary fixation [risk ratio (RR)=1.80, 95%CI: 0.80-4.05, P=0.15; I2=0%]. There was an increased risk of complications that did not require non-routine surgery with plate fixation as compared to intramedullary fixation (RR=2.38, 95%CI: 1.22-4.62, P=0.01; I2=70%). Plate fixation was also associated with an increased risk of infection and complications of cosmetic dissatisfaction. The present results indicated no difference in long-term functional outcomes between plate and intramedullary fixation of MSCF. Plate fixation was associated with an increased risk of complications not requiring non-routine surgery. Further high-quality RCTs shall strengthen the evidence on this subject.
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Affiliation(s)
- Weina Ju
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Sayid Omar Mohamed
- Department of Orthopedics, Jazeera University Hospital, Mogadishu BN SO 935, Somalia
| | - Baochang Qi
- Department of Orthopedic Traumatology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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Sun D, Wang C, Chen Y, Liu X, Zhao P, Zhang H, Zhou H, Qin C. A meta-analysis comparing intramedullary with extramedullary fixations for unstable femoral intertrochanteric fractures. Medicine (Baltimore) 2019; 98:e17010. [PMID: 31517820 PMCID: PMC6750238 DOI: 10.1097/md.0000000000017010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To find out whether the intramedullary fixations are superior to the extramedullary fixations in treating unstable femoral intertrochanteric fractures (UFIFs). METHODS The meta-analysis of randomized controlled trials (RCTs) was conducted by searching the PubMed, Cochrane Library, and Embase databases to evaluate functional scores, surgical outcomes, and adverse events in adult patients receiving intramedullary fixations in comparison to extramedullary fixations. Risk ratio (RR) or weighted mean difference (WMD)/standard mean difference (SMD) with 95% confidence intervals (CIs) were calculated as effect sizes. RESULTS A total of 18 RCTs, comprising 2414 patients, were included in this meta-analysis. Primary efficacy outcome: Parker scores [weighted mean difference, 1.10, 95% confidence interval (CI), 0.64-1.55; P < .0001] and Harris hip scores [risk ratio, 1.24, 95%CI, 1.09 -1.41; P = .0008] were higher in the intramedullary fixation group. Moreover, blood loss, operative time, length of incision, hospital stay, and implant failure were superior in the intramedullary fixation group. Other secondary efficacy outcome: No significant differences were found between the 2 groups in terms of fluoroscopy time, mortality, cut-out, nonunion, superficial wound infection, later fracture, and reoperation. CONCLUSIONS This meta-analysis suggested that intramedullary fixation is more effective and safer than extramedullary fixation in treating UFIFs. Furthermore, blood loss, operative time, length of incision, hospital stay, and implant failure were superior in the intramedullary fixation group.
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Affiliation(s)
- Dawei Sun
- Department of Orthopedics & Microsurgery, Guangdong Second Provincial General Hospital
- Academy of Orthopedics, Guangdong Province, Department of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou
| | - Chunling Wang
- Department of Orthopedics, Hubei traditional Chinese Medicine University Affiliated Hospital of Xiangyang traditional Chinese Medicine hospital, Xiangyang
| | - Yuhui Chen
- Academy of Orthopedics, Guangdong Province, Department of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou
| | - Xiaochun Liu
- Department of Orthopedics & Microsurgery, Guangdong Second Provincial General Hospital
| | - Peng Zhao
- Department of Orthopedics & Microsurgery, Guangdong Second Provincial General Hospital
| | - Hongan Zhang
- Department of Orthopedics & Microsurgery, Guangdong Second Provincial General Hospital
| | - Hui Zhou
- Physical Examination Center, Aerospace Central Hospital, Beijing, China
| | - Chenghe Qin
- Department of Orthopedics & Microsurgery, Guangdong Second Provincial General Hospital
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20
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Tas DB, Smeeing DPJ, Emmink BL, Govaert GAM, Hietbrink F, Leenen LPH, Houwert RM. Intramedullary Fixation Versus Plate Fixation of Distal Fibular Fractures: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Studies. J Foot Ankle Surg 2019; 58:119-126. [PMID: 30583773 DOI: 10.1053/j.jfas.2018.08.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 07/07/2018] [Indexed: 02/03/2023]
Abstract
Intramedullary fixation (IMF) has been described as a minimally invasive alternative to open reduction and internal fixation for operative treatment of distal fibular fractures in case of compromised soft tissue or severe comorbidities. The objective was to compare postoperative complications and functional outcomes of intramedullary versus plate fixation (PF) in distal fibular fractures. A systematic review and meta-analysis was performed. The PubMed/MEDLINE, Embase, Cochrane, and CINAHL databases were searched for both randomized controlled trials and observational studies. A total of 26 studies was included, reporting on 1710 patients with a mean age of 51.6 years. Meta-analysis was performed on 8 comparative studies, including subgroup and sensitivity analyses on all outcomes. IMF was associated with significantly fewer wound related complications (odds ratio [OR], 0.11; 95% confidence interval [CI], 0.04 to 0.25; p < .01), implant removals (OR, 0.54; 95% CI, 0.31 to 0.93; p = .03), and nonunions (OR, 0.31; 95% CI, 0.15 to 0.62; p < .01). No differences were found regarding malunion (OR, 0.45; 95% CI, 0.17 to 1.21; p = .11) and the Olerud Molander Ankle Score for long-term functional outcome (mean difference, 9.56; 95% CI, 1.24 to 20.37; p = .08). Results of this study apply to a select group of patients, in which the advantages of minimal soft tissue damage by IMF are preferable to optimal fracture reduction by PF. IMF of distal fibular fractures resulted in fewer wound-related complications, implant removals, and nonunions compared with PF. Especially in elderly patients, patients with chronic comorbidity, and patients with compromised soft tissue, IMF may be preferred over PF.
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Affiliation(s)
- David B Tas
- Medical Student, Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Diederik P J Smeeing
- Surgical Resident, Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Surgical Resident, Department of Trauma Surgery, Antonius Hospital Utrecht, Utrecht, The Netherlands
| | - Benjamin L Emmink
- Surgical Resident, Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geertje A M Govaert
- Trauma Surgeon, Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Falco Hietbrink
- Trauma Surgeon, Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Luke P H Leenen
- Medical Student, Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roderick M Houwert
- Professor of Trauma, Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Trauma Surgeon, Utrecht Traumacenter, Utrecht, The Netherlands
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21
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Guo J, Dong W, Yin B, Jin L, Lin Z, Hou Z, Zhang Y. Intramedullary nails with cannulated screw fixation for the treatment of unstable femoral neck fractures. J Int Med Res 2018; 47:557-568. [PMID: 30526163 PMCID: PMC6381514 DOI: 10.1177/0300060518816185] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 12/18/2022] Open
Abstract
Objective Unstable femoral neck fractures are typically high-angled shear fractures
caused by high-energy trauma. Internal fixation of femoral neck fractures
with placement of parallel cannulated screws in an inverted triangle
configuration is commonly performed in the clinical setting. This study was
performed to investigate the primary results of intramedullary nailing with
cannulated screws for the treatment of unstable femoral neck fractures in
young and middle-aged patients. Methods In total, 96 consecutive patients with no history of hip surgery using
inverted triangular cannulated compression screws or construction nails with
cannulated screws were reviewed. Their demographic and radiological data
were retrospectively collected from our institutional database. Results Inverted cannulated screws had an excellent effect on decreasing the blood
loss volume and incision size, but intramedullary nails exhibited superior
advantages in decreasing screw exit and shortening the hospital stays. The
Harris hip scores were comparable between the two groups. Conclusions Intramedullary fixation with cannulated screws has advantages in treating
complicated femoral neck fractures. Besides cannulated screws,
intramedullary fixation with cannulated screws might be another method to
treat unstable femoral neck fractures in young and middle-aged patients. The study was registered in ClinicalTrials.gov. Unique Protocol ID: 11156458.
The ClinicalTrial number is NCT03550079.
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Affiliation(s)
- Jialiang Guo
- 1 Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, PR China.,2 Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, PR China.,3 Orthopaedic Research Institution of Hebei Province, Hebei, PR China
| | - Weichong Dong
- 5 Department of Pharmacy, the Second Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Bing Yin
- 1 Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, PR China.,2 Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, PR China.,3 Orthopaedic Research Institution of Hebei Province, Hebei, PR China
| | - Lin Jin
- 1 Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, PR China.,2 Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, PR China.,3 Orthopaedic Research Institution of Hebei Province, Hebei, PR China
| | - Zhe Lin
- 1 Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, PR China.,2 Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, PR China.,3 Orthopaedic Research Institution of Hebei Province, Hebei, PR China
| | - Zhiyong Hou
- 1 Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, PR China.,2 Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, PR China
| | - Yingze Zhang
- 1 Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, PR China.,2 Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, PR China.,3 Orthopaedic Research Institution of Hebei Province, Hebei, PR China.,4 Chinese Academy of Engineering, Beijing, PR China
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22
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Rancy SK, Malliaris SD, Bogner EA, Wolfe SW. Intramedullary Fixation of Distal Radius Fractures Using CAGE-DR Implant. J Wrist Surg 2018; 7:358-365. [PMID: 30349747 PMCID: PMC6196090 DOI: 10.1055/s-0038-1669438] [Citation(s) in RCA: 2] [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] [Received: 04/11/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
Abstract
Purpose CAGE-DR implant is a novel Food and Drug Administration approved intramedullary fracture fixation device used for distal radius fractures. We examine a series of 22 patients and report the outcomes with this device. Materials and Methods A total of 24 patients with distal radius fractures (8 articular AO type C1/C2; 16 extra-articular AO type A2/A3) underwent open reduction and internal fixation (ORIF) using CAGE-DR implant by a single surgeon. Data including fracture type, angle of displacement, radiographic consolidation, grip strength, wrist range of motion (ROM), patient-rated wrist evaluation (PRWE), and Visual Analog Scale (VAS) pain scores were recorded at time of surgery and at standard follow-up. Results All 24 patients underwent uneventful ORIF. At first follow-up visit (9 days), all patients had full digital ROM (measured as 0 cm tip-to-palm distance). Two patients were lost to follow-up. Eighteen of the remaining 22 patients had sufficient radiographic follow-up and all 18 demonstrated healing. At latest follow-up (mean 9.7 months, range, 3-20), VAS pain scores averaged 0.6 (range, 0-8) and PRWE averaged 12.1 (range, 0-53.5). Grip strength of the operated hand averaged 58 lbs (range, 20-130). ROM included: wrist flexion 73° (50-95), wrist extension 78° (60-110), pronation 77° (60-90), supination 79° (60-90), ulnar deviation 31° (5-45), and radial deviation 17° (10-30). Three patients underwent screw removal to prevent tendon irritation. One patient underwent hardware removal due to prominence on imaging but was asymptomatic. There were otherwise no major complications, including complex regional pain syndrome, in the series to date. Conclusion The CAGE-DR fracture fixation system is a promising alternative to established methods of distal radius internal fixation. This series has a low reported pain score starting immediately postoperatively and a low complication rate. This novel device is a promising option for internal fixation of displaced distal radius fractures with a low complication profile. Level of Evidence This is a level IV, therapeutic study.
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Affiliation(s)
| | - Stephanie D. Malliaris
- Division of Hand and Upper Extremity Surgery, Denver Health Medical Center, University of Colorado School of Medicine, University of Colorado Denver, Denver, Colorado
| | - Eric A. Bogner
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Scott W. Wolfe
- Division of Hand and Upper Extremity Surgery, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
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23
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Domos P, Tytherleigh-Strong G, Van Rensburg L. Increased wound complication with intramedullary screw fixation of clavicle fractures: Is it thermal necrosis? J Orthop Surg (Hong Kong) 2018; 25:2309499017739482. [PMID: 29129131 DOI: 10.1177/2309499017739482] [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: 11/16/2022] Open
Abstract
PURPOSE Adult mid-shaft clavicle fractures are common injuries. For displaced fractures, open reduction with plate or intramedullary (IM) fixation is the widely used techniques. All methods have their own potential drawbacks, especially related to local soft tissue complications. There is little information about outcome and management of local wound complications after clavicle fracture fixations. METHODS Ninety-seven patients underwent open reduction and internal fixation, 17 were treated with IM screw fixation and 80 with plate fixation. Wound complication occurred in eight patients (8.2%) and rates differed significantly between IM and plate fixations (29.4% vs. 3.8%). Patients were assessed on average 58.3 months with visual analogue pain scores (VASs), Oxford Shoulder Score (OSS), and QuickDash (QD) score. RESULTS Five patients had wound breakdown and three patients had wound erythema. In seven patients with stable fixation, it was possible to "dress and suppress" with average 3 weeks of oral antibiotics. One patient had unstable fixation and required longer antibiotic treatment with early screw removal. One patient developed a chronic discharging wound, requiring debridement and later plate removal. At final follow-up, all wounds remained healed, bony union was achieved in all. The average scores were: VAS 1, OSS 46, and QD 4.5. CONCLUSIONS Good function with dry healed wound and united clavicle can be achieved. Further studies are required to investigate the difference in soft tissue complication rates, which may be due to the IM technique of retrograde drilling with a guide wire and due to aseptic thermal bone necrosis, rather than true infection.
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Affiliation(s)
- Peter Domos
- 1 Department of Trauma and Orthopaedics, Royal Free Hospital NHS Foundation Trust, London, UK
| | - Graham Tytherleigh-Strong
- 2 Department of Trauma and Orthopaedics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Lee Van Rensburg
- 2 Department of Trauma and Orthopaedics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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24
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Radaideh AM, Qudah HA, Audat ZA, Jahmani RA, Yousef IR, Saleh AAA. Functional and Radiological Results of Proximal Femoral Nail Antirotation (PFNA) Osteosynthesis in the Treatment of Unstable Pertrochanteric Fractures. J Clin Med 2018; 7:E78. [PMID: 29649099 PMCID: PMC5920452 DOI: 10.3390/jcm7040078] [Citation(s) in RCA: 16] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 04/06/2018] [Accepted: 04/09/2018] [Indexed: 11/29/2022] Open
Abstract
Pertrochanteric femur fractures are considered amongst the most commonly encountered fractures in the geriatric age group. We evaluated radiographic and functional outcomes of patients with unstable pertrochanteric fractures treated with the proximal femur nail antirotation (PFNA). Between March 2013 and December 2015, fifty patients (28 male and 22 females with a mean age of 72.8 years (range, 20-94)) with unstable pertrochanteric fractures (AO 31.A2 and 31.A3) were fixed with the PFNA at our institution, and they were retrospectively evaluated. Forty one patients were treated with short PFNA and nine with long PFNA. Operative time ranged between 30 and 150 (average 73.60) min, blood loss ranged between 50 and 250 (average 80) milliliter and hospital stay ranged between 3 and 18 (6.86) days. The mean follow-up period was 18 months (range, 11-31). At final follow-up, solid union of all fractures had been achieved without any implant-related complications, the mean Harris Hip Score (HHS) was 79.34 ± 9.10 points and the mean neck-shaft angle was 127.2° ± 5.07°. No significant differences were encountered between the functional and radiographic outcomes of the PFNA with regards to the AO fracture classification and the implant version. PFNA is a recommended option for the treatment of unstable pertrochanteric fractures owing to its easy insertion, reduced blood loss, stable fixation and satisfactory functional and radiological outcomes.
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Affiliation(s)
- Ahmad M Radaideh
- Department of Orthopedics, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid 22110, Jordan.
| | - Hashem A Qudah
- Department of Orthopedics, Jordan Hospital, Amman 11152, Jordan.
| | - Ziad A Audat
- Department of Orthopedics, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid 22110, Jordan.
| | - Rami A Jahmani
- Department of Orthopedics, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid 22110, Jordan.
| | - Ibraheem R Yousef
- Department of Orthopedics, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid 22110, Jordan.
| | - Abed Allah A Saleh
- Department of Orthopedics, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid 22110, Jordan.
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25
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Poggetti A, Nucci AM, Giesen T, Calcagni M, Marchetti S, Lisanti M. Percutaneous Intramedullary Headless Screw Fixation and Wide-Awake Anesthesia to Treat Metacarpal Fractures: Early Results in 25 Patients. J Hand Microsurg 2018; 10:16-21. [PMID: 29706731 DOI: 10.1055/s-0037-1618911] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 03/12/2017] [Accepted: 11/06/2017] [Indexed: 10/17/2022] Open
Abstract
Metacarpal fractures constitute 7.8% of the upper extremity fractures. The common treatments remain nonsurgical procedure, but high-demanding patients or unstable fractures require fixation with Kirschner wire (K-wires), plate, and screws. However, these approaches may cause scarring and adhesion with poor functional results. From 2014 to 2015, the authors used an intramedullary headless screw to treat 25 patients (24 men, 1 woman) with metacarpal bones fractures (20 V, 3 IV, 1 III, and 1 II). The fractures patterns were 23 fractures of distal third of metacarpal bone (16 oblique, 5 comminute configurations, and 2 transverse), 1 fracture of the base of the II metacarpal bone. One case presented a multiple metacarpal and phalangeal facture associated. The authors used wide-awake anesthesia (bupivacaine-epinephrine 1:100,000) and intramedullary titanium headless screw fixation percutaneously inserted (CCS Medartis and HCS Synthes 3 mm of diameter). No open reduction was needed. Early active mobilization started with a buddy strapping soon after surgery (0-3 days). The authors followed all patients until satisfactory function was achieved (4-6 weeks) and recorded the time till return to work. All fracture healed with less than 5 degrees of rotational or axial deformities. All patients return to work within 2.38 weeks after surgery (0.5-6 weeks). No cases of complex regional pain syndrome (CRPS), tendon lesions, nerve injuries, infection, hardware protruding, or mobilization were reported. Intramedullary screw fixation with wide-awake anesthesia for transverse, oblique, and select comminuted fractures treatment metacarpal fractures represent a reliable option to early active mobilization recovery and a quick return to the work and ordinary activities.
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Affiliation(s)
- Andrea Poggetti
- Orthopaedic and Trauma Unit, University Hospital of Pisa, Pisa, Italy
| | - Anna Maria Nucci
- Orthopaedic and Trauma Unit, University Hospital of Pisa, Pisa, Italy
| | - Thomas Giesen
- Department of Plastic and Hand Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Maurizio Calcagni
- Department of Plastic and Hand Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Stefano Marchetti
- Orthopaedic and Trauma Unit, University Hospital of Pisa, Pisa, Italy
| | - Michele Lisanti
- Orthopaedic and Trauma Unit, University Hospital of Pisa, Pisa, Italy
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26
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Mirza A, Mirza J, Healy C, Mathew V, Lee B. Radiographic and Clinical Assessment of Intramedullary Nail Fixation for the Treatment of Unstable Metacarpal Fractures. Hand (N Y) 2018; 13:184-189. [PMID: 28719990 PMCID: PMC5950961 DOI: 10.1177/1558944717695747] [Citation(s) in RCA: 3] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of the article was to evaluate clinical and radiographic outcomes in a case series of unstable metacarpal fractures treated with flexible intramedullary nail (IMN) fixation. METHODS A total of 55 patients with unstable metacarpal fractures between 2003 and 2010 were treated with IMN fixation and followed for a minimum of 1 year. The outcomes were assessed via a radiological study of longitudinal and angular collapse, Disabilities of the Arm, Shoulder, and Hand (DASH) score, total active range of motion (ROM) of the wrist, and grip strength testing. RESULTS In the 55 patients, metacarpal fractures were healed by clinical and radiographic assessment at an average of 12.7 weeks. IMNs were removed in all cases at an average of 13.9 weeks. Patients regained full finger ROM at the final follow-up and were capable of 72.4% of motion at 2 weeks postoperatively. The mean DASH score at the final follow-up was 6.5. Complications included 3 cases of extensor tendon irritation that resolved without functional impairment and 2 cases of "backing out" that required reoperation to replace the pin. In one case, a bony exostosis formed on the affected metacarpal that led to tendon irritation and required operative excision. CONCLUSIONS We found that this technique allowed for the stabilization of fractures, early ROM, resumption of usual activities, reduced immobilization, and minimal complications. A removable orthosis, instead of a cast, allowed for earlier mobilization of the wrist, metacarpophalangeal, and proximal interphalangeal joints.
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Affiliation(s)
- Ather Mirza
- North Shore Surgi-Center, Smithtown, NY, USA,Ather Mirza, North Shore Surgi-Center, 987 West Jericho Turnpike, Smithtown, NY 11787, USA.
| | | | - Chris Healy
- North Shore University Plainview Hospital, NY, USA
| | | | - Brian Lee
- North Shore Surgi-Center, Smithtown, NY, USA
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27
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Chan G, Korac Z, Miletic M, Vidovic D, Phadnis J, Bakota B. Plate versus intramedullary fixation of two-part and multifragmentary displaced midshaft clavicle fractures - a long-term analysis. Injury 2017; 48 Suppl 5:S21-S26. [PMID: 29122117 DOI: 10.1016/s0020-1383(17)30734-9] [Citation(s) in RCA: 7] [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] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Surgical fixation of displaced midshaft clavicle fractures is predominantly achieved with intramedullary (IM) or plate fixation. Both techniques have potential pitfalls: plate fixation involves greater periosteal stripping and protuberance of the implant, whereas IM fixation may be associated with implant-related complications, such as migration or skin irritation, which may lead to further surgery for implant removal. The aim of this study was to compare these two methods in simple (Robinson 2b.1) and multifragmentary (Robinson 2b.2) displaced midshaft clavicle fractures. METHODS A total of 133 consecutive patients who underwent surgical fixation for a displaced midshaft clavicle fracture with either IM fixation using a 2.5-mm Kirschner wire or plate fixation using an 8-hole Dynamic Compression Plate (DCP) were retrospectively reviewed. Follow-up was a minimum of 1 year. The patients were allocated into two injury groups: displaced simple 2-part fractures (64 IM vs. 16 DCP) and displaced multifragmentary fractures (27 IM vs. 26 DCP). The major observed outcome measures were: infection rate, non-union rate, reoperation rate and postoperative range of motion (ROM). RESULTS Rates of non-union for displaced 2-part fractures were 2/64 (3.13%) with IM fixation and 0/16 (0.00%) with plate fixation (p = 0.477). For displaced multifragmentary fractures, rates of non-union were 2/27 (7.41%) with IM fixation and 0/26 (0.00%) with plate fixation (p = 0.161). No significant difference was observed between the two fixation modalities in patient-reported time to regain ROM on the injured side for displaced 2-part fractures (p = 0.129) and displaced multifragmentary fractures (p = 0.070). Deep infection rate was zero (p = 1.000) overall in the study, and reoperation rate for IM and plate fixation, respectively, was 3.13% and 6.25% in the Robinson 2b.1 group (p = 0.559) and 7.41% and 7.69% in the Robinson 2b.2 group (p = 0.969). CONCLUSION IM fixation of displaced midshaft clavicle fractures (Robinson 2b.1) has an equivalent non-union rate to plate fixation and similarly low complication and reoperation rates. For displaced midshaft multifragmentary clavicle fractures (Robinson 2b.2), the higher non-union rates observed with IM fixation leads us to recommend consideration of plate fixation for Robinson 2b.2 fractures.
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Affiliation(s)
- Gareth Chan
- Department of Trauma & Orthopaedics, Brighton & Sussex University Hospitals, United Kingdom
| | - Zelimir Korac
- Department of Trauma & Orthopaedics, General Hospital Karlovac, Croatia
| | - Matija Miletic
- Department of Trauma & Orthopaedics, General Hospital Karlovac, Croatia
| | - Dinko Vidovic
- Clinic for Traumatology, University Clinical Centre "Sisters of Mercy", Croatia
| | - Joideep Phadnis
- Department of Trauma & Orthopaedics, Brighton & Sussex University Hospitals, United Kingdom
| | - Bore Bakota
- Department of Trauma & Orthopaedics, Brighton & Sussex University Hospitals, United Kingdom.
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28
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Bakota B, Chan G, Staresinic M, Rajput V, Phadnis J, Korac Z. Safe intramedullary fixation of displaced midshaft clavicle fractures with 2.5mm Kirschner wires - technique description and a two-part versus multifragmentary fracture fixation outcome comparison. Injury 2017; 48 Suppl 5:S27-S33. [PMID: 29122118 DOI: 10.1016/s0020-1383(17)30735-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 02/02/2023]
Abstract
INTRODUCTION The aim of this study was to present a modified Murray and Schwarz 2.5-mm Kirschner wire (K-wire) intramedullary (IM) technique for fixation of displaced midshaft clavicle fractures (DMCF), and to compare the differences in treatment outcome of two-part (Robinson 2B.1) and multifragmentary (Robinson 2B.2) DMCF. METHODS A retrospective analysis of 91 patients who underwent IM fixation with a 2.5-mm K-wire for DMCF and had a 1-year post-operative follow-up between 2000 and 2012 was performed. The patients were allocated into two groups: Robinson 2B.1 (n = 64) and Robinson 2B.2 (n = 27). Assessed outcomes were non-union, reoperation rate, wire migration and infection. RESULTS There was no statistically significant difference in the rate of non-union (2B.1,2B.2; 3.13%, 7.41%; p = 0.365), reoperation (2B.1, 2B.2; 3.13%, 7.41%; p = 0.365), K-wire migration (2B.1, 2B.2; 0.00%, 0.00%; p = 1.00) and clavicle shortening at 12-months (2B.1, 2B.2; 3.13%, 7.41%; p = 0.365). CONCLUSION Intramedullary clavicle fixation with a 2.5-mm K-wire is a safe surgical technique. 2B.1 injuries treated with 2.5-mm IM K-wire fixation have relatively improved outcome compared with displaced 2B.2 fractures for both non-union and reoperation rates. There were no occurrences of implant migration with either 2B.1 or 2B.2 injuries, and a non-significant difference in implant irritation was documented with IM K-fixation. The non-union rate with K-wire IM fixation of 2B.1 injuries concords with the published results of other IM devices and thus this technique should be added to the surgeon's armamentarium when considering surgical treatment of such injuries.
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Affiliation(s)
- Bore Bakota
- Department of Trauma & Orthopaedics, Brighton & Sussex University Hospitals NHS Trust, United Kingdom; Department of Trauma & Orthopaedics, General Hospital Karlovac, Croatia.
| | - Gareth Chan
- Department of Trauma & Orthopaedics, Brighton & Sussex University Hospitals NHS Trust, United Kingdom
| | - Mario Staresinic
- Department of Trauma & Orthopaedics, University Hospital Merkur, Zagreb, Croatia
| | - Vishal Rajput
- Department of Trauma & Orthopaedics, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, United Kingdom
| | - Joideep Phadnis
- Department of Trauma & Orthopaedics, Brighton & Sussex University Hospitals NHS Trust, United Kingdom
| | - Zelimir Korac
- Department of Trauma & Orthopaedics, General Hospital Karlovac, Croatia
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29
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Abstract
BACKGROUND More and more studies conduct to compare intramedullary fixation (IMF) with arthroplasty in treating intertrochanteric hip fractures, but it remains controversy. The aim of this meta-analysis was to find out whether IMF or arthroplasty was more appropriate for treating intertrochanteric hip fractures in elderly patients. METHODS Relevant studies were searched in the electronic databases of PubMed, Embase, and The Cochrane Central Register of Controlled Trials from January 1980 to September 2016 with English language restriction. Surgical information and postoperative outcomes were analyzed using RevMan 5.3 version. RESULTS A total of 1239 patients from 11 studies which satisfied the eligibility criteria were included. Compared with IMF, the use of arthroplasty reduced implant-related complications (odds ratio [OR]: 2.05, P = .02) and reoperation rate (OR: 7.06, P < .001), and had similar length of hospital stay (weighted mean difference [WMD]: -0.41, P = .63). However, IMF reduced blood loss (WMD: -375.01, P = .001) and transfusion requirement (OR: 0.07, P < .001), shorter operation time (WMD: -18.92, P = .010), higher Harris hip score (WMD: 4.19, P < .001), and lower rate of 1-year mortality (OR: 0.67, P = .02) compared with arthroplasty. CONCLUSION The main treatment of intertrochanteric hip fractures is internal fixation using IMF. In the absence of concrete evidence, arthroplasty should be undertaken with caution in carefully selected patient and surgeon should be aware of the increased complexity of doing the arthroplasty in these elderly patients. Further high-quality randomized controlled trials (RCTs) are needed to provide robust evidence and evaluate the treatment options.
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Affiliation(s)
- Boyuan Nie
- Department of Orthopedics, Dayi Hospital of Shanxi Medical University Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China
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30
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Inui H, Nobuhara K. Assessment of the restriction of arm elevation after intramedullary fixation for proximal humeral fractures. Shoulder Elbow 2017; 9:100-104. [PMID: 28405221 PMCID: PMC5384541 DOI: 10.1177/1758573216687265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 07/16/2016] [Accepted: 12/02/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nail protrusion is suspected as a reason for the restriction of arm elevation after antegrade nailing of proximal humeral fractures, although assessment of the restriction of the glenohumeral joint during arm elevation has been insufficient. METHODS In this retrospective study, 30 shoulders with proximal humeral fractures in 29 cases were treated with Polarus short nails (Acumed, Beaverton, OR, USA). At a mean final follow-up of 14 months, clinical outcomes, bony union, alignment including retroversion of the head and entry points of the nails were evaluated. The ability of a subject to achieve maximum elevation above the zero position was also evaluated. RESULTS Constant and Japanese Shoulder Association scores were a mean (SD) of 54 (12) and 71 (8.9) points, respectively. Even though all cases achieved bony union without mal-alignment of the head and greater tuberosity height or protrusion of the nail at its entry point, only six subjects could achieve maximum elevation above the zero position. CONCLUSIONS Based on these findings, treatment of proximal humeral fractures with an antegrade humeral nail inserted from the top of the humeral head results in restricted arm elevation, even in patients without nail protrusion or fragment malalignment.
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Affiliation(s)
- Hiroaki Inui
- Hiroaki Inui, Nobuhara Hospital & Institute of Biomechanics, 720 Haze Issaicho, Tatsunoshi, Hyogo, 679-4017 Japan.
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31
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van der Meijden OA, Houwert RM, Wijdicks FJG, Dijkgraaf MGW, Leenen LPH, Verhofstad MHJ, Verleisdonk EJMM. Introducing the Surgical Therapeutic Index in trauma surgery: an assessment tool for the benefits and risks of operative fracture treatment strategies. J Shoulder Elbow Surg 2016; 25:2005-2010. [PMID: 27514633 DOI: 10.1016/j.jse.2016.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/24/2016] [Revised: 04/28/2016] [Accepted: 05/07/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Surgical Therapeutic Index (STI) has been described as an indicator of the benefits and risks of surgical treatment. The index is calculated by dividing the cure rate of an operative treatment by the complication rate. This study introduces the STI in trauma surgery by comparing the indices for surgical plate fixation (PF) and intramedullary fixation (IMF) of displaced midshaft clavicular fractures. METHODS In a previously reported, randomized controlled fashion, 120 patients were assigned to PF or IMF. Cure was defined by a Disabilities of the Arm, Shoulder and Hand score of 8 or less. Complications were noted as present or not present for each follow-up assessment, and a panel of experts provided weights to the severity of complications. STIs were reported along with their 95% confidence intervals. The higher a procedure's STI, the higher the benefit/risk balance of that procedure. RESULTS The nonweighted STI after 6 weeks was significantly higher in the PF group. During further follow- up, the differences leveled out and became nonsignificant. When weighting the STI for severity, the indices decrease but are significantly in favor of the PF group at 6 weeks and 6 months after surgery. At 1 year postoperatively, differences are not significant. CONCLUSION The STI may be a reliable tool to assess the benefits and risks of operative fracture treatment. Further studies with consistent results of this new scoring system are needed before conclusions can be generalized. When determining the indices of PF and IMF, a significant difference in favor of PF was observed during the early phase of recovery.
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Affiliation(s)
| | - R Marijn Houwert
- Utrecht Traumacenter, Utrecht, The Netherlands; Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | | | - Loek P H Leenen
- Department of Surgery, University Medical Center, Utrecht, The Netherlands
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Chuanjun C, Xiaoyang C, Jing C. [Extramedullary fixation combined with intramedullary fixation in the surgical reduction of sagittal mandibular condylar fractures]. Hua Xi Kou Qiang Yi Xue Za Zhi 2016; 34:474-477. [PMID: 28326704 DOI: 10.7518/hxkq.2016.05.008] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study aimed to evaluate the clinical effect of extramedullary fixation combined with intramedullary fixation during the surgical reduction of sagittal mandibular condylar fractures. METHODS Twenty-four sagittal fractures of the mandibular condyle in18 patients were fixed by two appliances: intramedullary with one long-screw osteosynthesis or Kirschner wire and extramedullary with one micro-plate. The radiologically-recorded post-operative stability-associated com-plications included the screw/micro-plate loosening, micro-plate twisting, micro-plate fractures, and fragment rotation. The occluding relations, the maximalinter-incisal distances upon mouth opening, and the mandibular deflection upon mouth opening were evaluated based on follow-up clinical examination. RESULTS Postoperative panoramic X-ray and CT scans showed good repositioning of the fragment, with no redislocation or rotation, no screw/plate loosening, and no plate-twisting or fracture. Clinical examination showed that all patients regained normal mandibular movements, ideal occlusion, and normal maximal inter-incisal distances upon mouth opening. CONCLUSIONS Extramedullary fixation combined with intramedullary fixation is highly recommended for sagittal condylar fractures because of the anti-rotation effect of the fragment and the reasonable place-ment of the fixation appliances.
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Affiliation(s)
- Chen Chuanjun
- Stomatological School, Wannan Medical College, Wuhu 241002, China
| | - Chen Xiaoyang
- Dept. of Oral and Maxillofacial Surgery, The Third Affiliated Hospital of Anhui Medical University, Hefei 230061, China
| | - Chen Jing
- Dept. of Stomatology, Anhui Jimin Tumor Hospital, Hefei 230011, China
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Tobert DG, Klausmeyer M, Mudgal CS. Intramedullary Fixation of Metacarpal Fractures Using Headless Compression Screws. J Hand Microsurg 2016; 8:134-139. [PMID: 27999455 DOI: 10.1055/s-0036-1593390] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 06/02/2016] [Accepted: 08/10/2016] [Indexed: 10/21/2022] Open
Abstract
Introduction The purpose of this study is to examine the clinical results of retrograde intramedullary headless screw (IMHS) fixation for metacarpal fractures. Methods A retrospective review was performed on 16 patients with 18 metacarpal fractures who underwent IMHS fixation at a single institution. The average age was 32 years. The indications for surgery included rotational malalignment (five patients), multiple metacarpal fractures (five patients), angular deformity (four patients), and shortening greater than 5 mm (two patients). The average length of follow-up was 19.4 weeks (median 10.2 weeks). Results Functional outcome was considered excellent in all patients with total active motion in excess of 240 degrees. Active motion was initiated within 1 week of surgery. No secondary surgeries were performed related to a complication of IMHS fixation. Conclusion IMHS fixation of metacarpal fractures is an efficacious treatment modality for patients with comminution, multiple fractures, malrotation, and those who require rapid mobilization. It obviates the need for immobilization or more extensive plate and screw fixation techniques with excellent clinical results.
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Affiliation(s)
- Daniel G Tobert
- Department of Orthopaedic Surgery, Orthopaedic Hand Surgery Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States; Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Melissa Klausmeyer
- Department of Plastic Surgery, University of Southern California, Los Angeles, California, United States
| | - Chaitanya S Mudgal
- Department of Orthopaedic Surgery, Orthopaedic Hand Surgery Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
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Houwert RM, Smeeing DP, Ahmed Ali U, Hietbrink F, Kruyt MC, van der Meijden OA. Plate fixation or intramedullary fixation for midshaft clavicle fractures: a systematic review and meta-analysis of randomized controlled trials and observational studies. J Shoulder Elbow Surg 2016; 25:1195-203. [PMID: 27068381 DOI: 10.1016/j.jse.2016.01.018] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [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: 10/06/2015] [Revised: 01/15/2016] [Accepted: 01/22/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND The last decade has shown a shift toward operative treatment of a subset of midshaft clavicle fractures. However, it is unclear whether there are differences between plate fixation and intramedullary fixation regarding complications and functional outcome. The aim of this systematic review and meta-analysis was to compare plate fixation and intramedullary fixation for midshaft clavicle fractures. METHODS The Medline, Embase, and Cochrane databases were searched for both randomized controlled trials and observational studies. The methodologic quality of all included studies was assessed using the Methodological Index for Non-Randomized Studies. RESULTS Twenty studies were included. Ten of the 20 included studies used a fracture classification. Seven of these studies reported exclusion of patients with comminuted fractures. No difference in the total re-intervention rate was found (odds ratio [OR], 1.21; 95% confidence interval [CI], 0.71 to 2.04). Major re-interventions occurred more often after plate fixation (OR, 1.88; 95% CI, 1.02 to 3.46). The mean implant removal rates were 38% after plate fixation and 73% after intramedullary fixation. Re-fracture after implant removal occurred more often after plate fixation (OR, 3.42; 95% CI, 1.12 to 10.42). The Constant-Murley scores showed no differences at both short term (mean difference, -1.18; 95% CI, -13.41 to 11.05) and long term (mean difference, 0.15; 95% CI, -1.57 to 1.87). No differences were observed regarding nonunion (OR, 1.50; 95% CI, 0.82 to 2.75). The rate of infections showed no differences when outlier studies were excluded (OR, 1.54; 95% CI, 0.88 to 2.69). CONCLUSION Major re-intervention and re-fracture after implant removal occurred more frequently after plate fixation of non-comminuted, displaced midshaft clavicle fractures. No differences in terms of function and nonunion between plate fixation and intramedullary fixation were observed.
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Wilson DJ, Scully WF, Min KS, Harmon TA, Eichinger JK, Arrington ED. Biomechanical analysis of intramedullary vs. superior plate fixation of transverse midshaft clavicle fractures. J Shoulder Elbow Surg 2016; 25:949-53. [PMID: 26775744 DOI: 10.1016/j.jse.2015.10.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 02/23/2015] [Revised: 10/14/2015] [Accepted: 10/18/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Middle-third clavicle fractures represent 2% to 4% of all skeletal trauma in the United States. Treatment options include intramedullary (IM) as well as plate and screw (PS) constructs. The purpose of this study was to analyze the biomechanical stability of a specific IM system compared with nonlocking PS fixation under low-threshold physiologic load. METHODS Twenty fourth-generation Sawbones (Pacific Research Laboratories, Vashon, WA, USA) with a simulated middle-third fracture pattern were repaired with either an IM device (n = 10) or superiorly positioned nonlocking PS construct (n = 10). Loads were modeled to simulate physiologic load. Combined axial compression and torsion forces were sequentially increased until failure. Data were analyzed on the basis of loss of rotational stability using 3 criteria: early (10°), clinical (30°), and terminal (120°). RESULTS No significant difference was noted between constructs in early loss of rotational stability (P > .05). The PS group was significantly more rotationally stable than the IM group on the basis of clinical and terminal criteria (P < .05 for both). All test constructs failed in rotational stability. CONCLUSIONS When tested under physiologic load, fixation failure occurred from loss of rotational stability. No statistical difference was seen between groups under early physiologic loads. However, during load to failure, the PS group was statistically more rotationally stable than the IM group. Given the clavicle's function as a bony strut for the upper extremity and the biomechanical results demonstrated, rotational stability should be carefully considered during surgical planning and postoperative advancement of activity in patients undergoing operative fixation of middle-third clavicle fractures. LEVEL OF EVIDENCE Basic Science Study; Biomechanics.
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Leow JM, Clement ND, Tawonsawatruk T, Simpson CJ, Simpson AHRW. The radiographic union scale in tibial (RUST) fractures: Reliability of the outcome measure at an independent centre. Bone Joint Res 2016; 5:116-21. [PMID: 27073210 PMCID: PMC5009237 DOI: 10.1302/2046-3758.54.2000628] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 02/26/2016] [Indexed: 01/09/2023] Open
Abstract
Objectives The radiographic union score for tibial (RUST) fractures was developed by Whelan et al to assess the healing of tibial fractures following intramedullary nailing. In the current study, the repeatability and reliability of the RUST score was evaluated in an independent centre (a) using the original description, (b) after further interpretation of the description of the score, and (c) with the immediate post-operative radiograph available for comparison. Methods A total of 15 radiographs of tibial shaft fractures treated by intramedullary nailing (IM) were scored by three observers using the RUST system. Following discussion on how the criteria of the RUST system should be implemented, 45 sets (i.e. AP and lateral) of radiographs of IM nailed tibial fractures were scored by five observers. Finally, these 45 sets of radiographs were rescored with the baseline post-operative radiograph available for comparison. Results The initial intraclass correlation (ICC) on the first 15 sets of radiographs was 0.67 (95% CI 0.63 to 0.71). However, the original description was being interpreted in different ways. After agreeing on the interpretation, the ICC on the second cohort improved to 0.75. The ICC improved even further to 0.79, when the baseline post-operative radiographs were available for comparison. Conclusion This study demonstrates that the RUST scoring system is a reliable and repeatable outcome measure for assessing tibial fracture healing. Further improvement in the reliability of the scoring system can be obtained if the radiographs are compared with the baseline post-operative radiographs. Cite this article: Mr J.M. Leow. The radiographic union scale in tibial (RUST) fractures: Reliability of the outcome measure at an independent centre. Bone Joint Res 2016;5:116–121. DOI: 10.1302/2046-3758.54.2000628.
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Affiliation(s)
- J M Leow
- College of Medicine and Veterinary Medicine, University of Edinburgh, 11 Montague Street, Edinburgh EH8 9QT, UK
| | - N D Clement
- Trauma and Orthopaedics, Orthopaedic Department, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - T Tawonsawatruk
- School of Medicine and Dentistry, University of Aberdeen, Westburn Dr, Aberdeen AB25 3BZ, UK
| | | | - A H R W Simpson
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, UK
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Xiao H, Gao H, Zheng T, Zhao J, Tian Y. Plate fixation versus intramedullary fixation for midshaft clavicle fractures: Meta-analysis of complications and functional outcomes. J Int Med Res 2016; 44:201-15. [PMID: 26880791 PMCID: PMC5580056 DOI: 10.1177/0300060515621638] [Citation(s) in RCA: 13] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 11/17/2015] [Indexed: 11/17/2022] Open
Abstract
Objective This analysis critically compares publications discussing complications and functional outcomes of plate fixation (PF) versus intramedullary fixation (IF) for midshaft clavicle fractures. Methods Relevant studies published between January 1990 and October 2014, without language restrictions, were identified in database searches of PubMed®, Medline®, Embase and the Chinese National Knowledge Infrastructure (CNKI). Studies that compared postoperative complications and functional outcomes between PF and IF for midshaft clavicle fractures, and provided sufficient data for analysis, were included in this meta-analysis. Results After strict evaluation, 12 studies were included in this meta-analysis. Studies encompassed 462 participants in the PF group and 440 in the IF group. Study participants were followed up for ≥1 year. Outcomes were superior with IF compared with PF in terms of shoulder constant score at 6-month follow-up, fewer symptomatic hardware complications, lower rate of refracture after hardware removal and less hypertrophic scarring. In other aspects, such as functional recovery at 12-months and 24-months, Disability of Arm, Shoulder and Hand (DASH) questionnaire results at 12-month follow-up, shoulder motion range, rates of superficial infection, temporary brachial plexus lesion, nonunion, malunion, delayed union, implant failure and need for major revision, both techniques were similar. Conclusions Findings of this meta-analysis suggest that, in many respects, IF was superior to PF for the management of midshaft clavicle fractures. This finding could aid surgeons in making decisions on the optimum internal fixation pattern for midshaft clavicular fractures.
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Affiliation(s)
- Hao Xiao
- Emergency Department, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hengbo Gao
- Emergency Department, The Second Hospital of Hebei Medical University, Shijiazhuang, China Key Laboratory of Emergency Medicine of Hebei Province, Shijiazhuang, China
| | - Tuokang Zheng
- Emergency Department, The Second Hospital of Hebei Medical University, Shijiazhuang, China Key Laboratory of Emergency Medicine of Hebei Province, Shijiazhuang, China
| | - Jianhui Zhao
- Emergency Department, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yingping Tian
- Key Laboratory of Emergency Medicine of Hebei Province, Shijiazhuang, China
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Affiliation(s)
- David M Walton
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Samuel B Adams
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Selene G Parekh
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA Duke Fuqua School of Business, Durham, NC, USA North Carolina Orthopaedic Clinic, Durham, NC, USA
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del Piñal F, Moraleda E, Rúas JS, de Piero GH, Cerezal L. Minimally invasive fixation of fractures of the phalanges and metacarpals with intramedullary cannulated headless compression screws. J Hand Surg Am 2015; 40:692-700. [PMID: 25661294 DOI: 10.1016/j.jhsa.2014.11.023] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [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: 08/11/2014] [Revised: 11/12/2014] [Accepted: 11/13/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To present the technique, indications, and outcomes of metacarpal and phalangeal fractures fixed with intramedullary cannulated headless screws (CHS). METHODS We retrospectively reviewed all charts of patients whose metacarpal and phalangeal fractures had been treated with intramedullary CHS in our practice. A total of 69 fractures (48 metacarpal and 21 phalangeal) were identified in 59 patients. Seventeen were open fractures. Eleven patients had multiple fractures (29 in total); of those, 21 were managed with CHS. In 4 other fractures the method was abandoned intraoperatively. The defect created by the entrance of the screw in the proximal phalanx was identified by computed tomography in 20 patients. RESULTS In 63 fractures a single screw was used; in 6 fractures 2 screws were used to provide stronger fixation. All patients returned to full duties or sport activities at an average of 76 days (range, 3 wk to 15 mo). At the latest follow-up (range, 5-54 mo; average, 19 mo) total active motion was on average 247° (range, 150° to 270°) for all fractures, 249° (range, 210° to 270°) for metacarpal, and 243° (range, 150° to 270°) for proximal phalangeal fractures. All fractures were healed and within acceptable radiological parameters. A comminuted basilar phalangeal fracture displaced secondarily yielding a poor functional result. Two patients required tenolysis and further procedures before the final result was achieved. The screw hole represents around 20% of the proximal phalanx distal articular surface. CONCLUSIONS Unstable transverse fractures in the phalanx and metacarpal are amenable to single intramedullary CHS fixation. Comminuted fractures require more complex configurations. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Francisco del Piñal
- Instituto de Cirugía Plástica y de la Mano and Radiology Section, Private Practice, and Hospital Mutua Montañesa, Santander, Spain.
| | - Eduardo Moraleda
- Instituto de Cirugía Plástica y de la Mano and Radiology Section, Private Practice, and Hospital Mutua Montañesa, Santander, Spain
| | - Jaime S Rúas
- Instituto de Cirugía Plástica y de la Mano and Radiology Section, Private Practice, and Hospital Mutua Montañesa, Santander, Spain
| | - Guillermo H de Piero
- Instituto de Cirugía Plástica y de la Mano and Radiology Section, Private Practice, and Hospital Mutua Montañesa, Santander, Spain
| | - Luis Cerezal
- Instituto de Cirugía Plástica y de la Mano and Radiology Section, Private Practice, and Hospital Mutua Montañesa, Santander, Spain
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Ruchelsman DE, Puri S, Feinberg-Zadek N, Leibman MI, Belsky MR. Clinical outcomes of limited-open retrograde intramedullary headless screw fixation of metacarpal fractures. J Hand Surg Am 2014; 39:2390-5. [PMID: 25240434 DOI: 10.1016/j.jhsa.2014.08.016] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [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: 03/12/2014] [Revised: 08/11/2014] [Accepted: 08/12/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate clinical and radiographic outcomes in patients treated with limited-open retrograde intramedullary headless compression screw (IMHS) fixation for metacarpal neck and shaft fractures. METHODS Retrospective review of prospectively collected data on a consecutive series of 39 patients (34 men; 5 women), mean age 28 years (range, 16-66 y) treated with IMHS fixation for acute displaced metacarpal neck/subcapital (N = 26) and shaft (N = 13) fractures at a single academic practice between 2010 and 2014. Preoperative magnitude of metacarpal neck angulation averaged 54° (range, 15° to 70°), and shaft angulation averaged 38° (range, 0° to 55°). Patients used a hand-based orthosis until suture removal and began active motion within the first week. Clinical outcomes were assessed with digital goniometry, pad-to-distal palmar crease distance, and grip strength. Time to union and radiographic arthrosis was assessed. Twenty patients reached minimum 3-month follow-up, with a mean of 13 months (range, 3-33 mo). RESULTS All 20 patients with minimum 3 months of follow-up achieved full composite flexion, and extensor lag resolved by 3-week follow-up. All patients demonstrated full active metacarpophalangeal joint extension or hyperextension. Grip strength measured 105% (range, 58% to 230%) of the contralateral hand. No secondary surgeries were performed. There were 2 cases of shaft re-fracture from blunt trauma following prior evidence of full osseous union with the screw in place. All patients achieved radiographic union by 6 weeks. There was no radiographic arthrosis at latest follow-up. One patient reported occasional clicking with metacarpophalangeal joint motion not requiring further treatment. CONCLUSIONS Limited open retrograde IMHS fixation proved to be safe and reliable for metacarpal neck/subcapital and axially stable shaft fractures, allowed for early postoperative motion without affecting union rates, and obviated immobilization. This technique offers distinct advantages in select patients. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- David E Ruchelsman
- Hand Surgery, P.C., Newton, MA; Newton-Wellesley Hospital/Tufts University School of Medicine, Boston, MA.
| | - Sameer Puri
- Hand Surgery, P.C., Newton, MA; Newton-Wellesley Hospital/Tufts University School of Medicine, Boston, MA
| | - Natanya Feinberg-Zadek
- Hand Surgery, P.C., Newton, MA; Newton-Wellesley Hospital/Tufts University School of Medicine, Boston, MA
| | - Matthew I Leibman
- Hand Surgery, P.C., Newton, MA; Newton-Wellesley Hospital/Tufts University School of Medicine, Boston, MA
| | - Mark R Belsky
- Hand Surgery, P.C., Newton, MA; Newton-Wellesley Hospital/Tufts University School of Medicine, Boston, MA
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Xu J, Xu L, Xu W, Gu Y, Xu J. Operative versus nonoperative treatment in the management of midshaft clavicular fractures: a meta-analysis of randomized controlled trials. J Shoulder Elbow Surg 2014; 23:173-81. [PMID: 24129054 DOI: 10.1016/j.jse.2013.06.025] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [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: 04/06/2013] [Revised: 06/01/2013] [Accepted: 06/09/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is no consensus on the effects of operative versus nonoperative treatment on the outcomes of midshaft clavicular fractures in adults. We conducted a meta-analysis of randomized clinical studies. MATERIALS AND METHODS We searched the literature and included studies that investigated the effects of operative versus nonoperative intervention on the outcome of midshaft clavicular fractures. Patient data were pooled by use of standard meta-analytic approaches. For the continuous variables, the weighted mean difference was used. For dichotomous data, the relative risk was calculated. RESULTS Seven studies reported in 8 publications were eligible for data extraction. The pooled analyses showed that, compared with nonoperative treatment, operative treatment led to significantly lower incidences of nonunion and fewer symptomatic malunions. Subgroup analysis indicated that these advantages could be ascribed to plate fixation. Furthermore, surgery with plates resulted in significantly fewer complications. Patients undergoing surgery had better Disabilities of the Arm, Shoulder and Hand and Constant scores and lower dissatisfaction with their appearance. CONCLUSION In the management of midshaft clavicular fractures, surgery is superior to nonoperative treatment. Surgery with plates results in lower incidences of nonunion, fewer total complications, and fewer symptomatic malunions compared with nonoperative treatment.
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Affiliation(s)
- Jing Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Lei Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Wendong Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yudong Gu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jianguang Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.
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Abstract
OBJECTIVE The purpose of this study was to determine if surgeons could reliably predict if patients with tibia fractures treated with intramedullary nails will proceed to nonunion based on their clinical scenario and radiographs at 3 months. DESIGN Blinded randomized questionnaire based on a retrospective cohort. SETTING University level 1 trauma center. PATIENTS/PARTICIPANTS Fifty-six patients who underwent intramedullary fixation for tibia fractures with incomplete healing at 3 months. METHODS A questionnaire was applied to 56 consecutive patients treated between 2005 and 2009 with intramedullary fixation for tibia fractures who had incomplete healing at 3 months. Each case was developed into a vignette that included the 3-month radiographs and detailed clinical histories. The questionnaire was distributed to 3 fellowship-trained trauma surgeons who were asked to predict if the fracture would go onto nonunion. MAIN OUTCOME MEASUREMENTS Diagnostic accuracy of predicting nonunion in patients with incomplete healing of their tibia fracture at 3 months. RESULTS The combined overall diagnostic accuracy of all 3 surgeons was 74%. Sensitivity and specificity was 62% and 77%, respectively. Radiographic features and injury mechanism were the most commonly cited clinical information used to predict fracture healing. The average positive predictive value was 73%. In 9 patients with diabetes, the diagnostic accuracy was 88%. CONCLUSIONS Clinical judgment at 3 months allows for correct prediction of eventual nonunion development in a majority of patients. We suggest that analysis of the entire clinical picture be used to predict fracture healing at 3 months. A protocol of waiting for 6 months before reoperation in all patients treated with intramedullary nailing for tibia fractures may subject patients to prolonged disability and discomfort. LEVEL OF EVIDENCE Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Rammelt S, Pyrc J, Agren PH, Hartsock LA, Cronier P, Friscia DA, Hansen ST, Schaser K, Ljungqvist J, Sands AK. Tibiotalocalcaneal fusion using the hindfoot arthrodesis nail: a multicenter study. Foot Ankle Int 2013; 34:1245-55. [PMID: 23613330 DOI: 10.1177/1071100713487526] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tibiotalocalcaneal arthrodesis is a salvage option for severe ankle and hindfoot deformities, arthritis of the ankle and subtalar joints, avascular necrosis of the talus, failed total ankle arthroplasty, and Charcot arthropathy. This multicenter study reports clinical experience with the hindfoot arthrodesis nail (HAN) in the treatment of patients with severe ankle and foot abnormalities. METHODS Seven participating clinics from Europe and North America recruited 38 patients who underwent ankle/subtalar arthrodesis using retrograde nailing with the HAN. Information was collected regarding technical details, complications, and functional and quality of life outcomes (Short Form-36 [SF-36], American Academy of Orthopaedic Surgeons-Foot and Ankle Outcomes [AAOS-FAO], and numeric rating scale [NRS] for pain) after an average of 2 years of follow-up. RESULTS The rate of superficial wound infection was 2.4%. No deep soft tissue or bone infections were reported. The overall union rate was 84%. At the time of follow-up, low pain levels were reported, with a mean NRS of 2.2; the mean AAOS-FAO score was 38; and the SF-36 mean physical and mental health component scores were 41.2 and 52.5, respectively. All 13 patients who were unable to work prior to surgery were able to fully return to work. CONCLUSIONS The HAN offered a safe and reliable salvage option for tibiotalocalcaneal arthrodesis in patients with severe ankle and hindfoot disease. It achieved acceptable functional outcome and low complication rates despite the challenging patient cohort. A considerable socioeconomic benefit appeared to result based on the high proportion of patients who were able to return to work postoperatively. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Stefan Rammelt
- Department of Trauma & Reconstructive Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
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Abstract
BACKGROUND Nonunion of humeral shaft fractures after previously failed surgical treatment presents a challenging therapeutic problem especially in the presence of osteoporosis, bone defect, and joint stiffness. It would be beneficial to combine the use of external fixation technique and intramedullary rod in the treatment of such cases. The present study evaluates the results of using external fixator augmented by intramedullary rod and autogenous iliac crest bone grafting (ICBG) for the treatment of humerus shaft nonunion following previously failed surgical treatment. MATERIALS AND METHODS Eighteen patients with atrophic nonunion of the humeral shaft following previous implant surgery with no active infection were included in the present study. The procedure included exploration of the nonunion, insertion of intramedullary rod (IM rod), autogenous ICBG and application of external fixator for compression. Ilizarov fixator was used in eight cases and monolateral fixator in ten cases. The monolateral fixator was preferred for females and obese patients to avoid abutment against the breast or chest wall following the use of Ilizarov fixator. The fixator was removed after clinical and radiological healing of the nonunion, but the IM rod was left indefinitely. The evaluation of results included both bone results (union rate, angular deformity and limb shortening) and functional outcome using the University of California, Los Angeles (UCLA) rating scale. RESULTS The mean follow-up was 35 months (range 24 to 52 months). Bone union was obtained in all cases. The functional outcome was satisfactory in 15 cases (83%) and unsatisfactory in 3 cases (17%) due to joint stiffness. The time to bone healing averaged 4.2 months (range 3 to 7 months). The external fixator time averaged 4.5 months (range 3.2 to 8 months). Superficial pin tract infection occurred in 39% (28/72) of the pins. No cases of nerve palsy, refracture, or deep infection were encountered. CONCLUSION The proposed technique is effective in treating humeral nonunion especially in the presence of osteoporosis and short bone segments. The inclusion of intramedullary rod as internal splint improves stability of fixation and prevents refracture after fixator removal.
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Affiliation(s)
- Mahmoud A El-Rosasy
- Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine, University of Tanta, Egypt,Address for correspondence: Dr. Mahmoud A El-Rosasy, Ass. Prof. of Orthopaedic Surgery Tanta University Hospitals. Al-Geish Street, Tanta, Egypt. E-mail:
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45
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Abstract
BACKGROUND Lack of availability of interlocked nails made plate osteosynthesis the first choice of treatment of forearm fractures inspite of more surgical exposure, periosteal stripping and big skin incision subsequent scar along with higher risk of refracture on implant removal. We hereby report the first 12 cases with 19 forearm bone fractures internally fixed by indegenous interlocked nail. MATERIALS AND METHODS Existing square nails were modified to have a broad proximal end of 5.5 mm with a hole for locking screw of 2.5 mm. The nail has a distal hole of 1/1.2/1.5 mm in 2.5/3/3.5 mm diameter nail, respectively. A new method of distal locking with a clip made of k wire is designed. The clip after insertion into the bone and hole in nail and opposite cortex snuggly fits the bone providing a secure locking system. Twelve skeletally mature patients, mean age 32 years (range 24-45 years) with 19 diaphyseal fractures of the forearm were treated with this indigenously made new nail. The patient were evaluated for fracture union, functional recovery and complications. The functional outcome was assessed by disabilities of arm, shoulder and hand questionnaire (DASH score). RESULTS Time to radiographic union ranged between 12 and 28 weeks, with a 100% union rate. Complications were minimal, with mild infection in open fracture (n=1) and delayed union (n=1) in patient with comminuted fracture of the ulna only. The clinical results were excellent. The DASH score ranged between 0 and 36 points. CONCLUSION This new interlocking nail may be considered as an alternative to plate osteosynthesis for fractures of the forearm in adults. The advantages are benefit of closed reduction, smaller residual scar, reduced cost and early union with allowance of immediate movements.
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Affiliation(s)
- Himanshu Bansal
- Consultant Orthopaedic Surgeon, Anupam Hospital, Rudrapur, Uttarakhand, India,Address for correspondence: Dr. Himanshu Bansal, Anupam Hospital, Kashipur Road, Rudrapur, Uttarakhand, India. E-mail:
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Kulkarni RS, Kulkarni RM, Arora P, Shyam AK. Bilateral Fracture Clavicles occurring Simultaneously and treated with Intramedullary Fixation. J Orthop Case Rep 2011; 1:29-32. [PMID: 27298840 PMCID: PMC4701109] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The standard treatment for clavicle fractures non operative but surgical management is essential in certain specific indications. The purpose of this study is to report a not very commonly seen bilateral fracture of a clavicle in a young female patient treated with intramedullary fixation. CASE REPORT A 23 year old female patient sustained a bilateral clavicle fracture as a result of direct blow to shoulder and was treated with intramedullary K wires on both sides in single sitting. Postoperatively arm was maintained in a sling for 3 weeks. The implant was removed after a month when radiographs showed good bridging callus. After 8 weeks of fixation, she achieved full range of motion in both shoulders without any pain and was thus subsequently allowed to return to her daily activities. CONCLUSION For bilateral fractures clavicle, intramedullary fixation with K wire is a safe and effective modality for good pain relief and rapid recovery of range of motion. We did not encounter any complications.
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Affiliation(s)
| | - Rachana M Kulkarni
- Civil Hospital, Sindhudurg, Sindhudurgnagari, Maharashtra,*Address of Correspondance Dr RS Kulkarni District Civil Surgeon, Sindhudurg, Maharashtra, India Email -
| | - Pankush Arora
- Sancheti Institute for Orthopaedics and Rehabilitation, Pune
| | - A K Shyam
- Sancheti Institute for Orthopaedics and Rehabilitation, Pune,Indian Orthopaedic Research Group
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47
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Abstract
BACKGROUND The management of an atrophic nonunion with a gap following a fracture of the radius and/or ulna is a challenging problem. Various methods of treatment available in the literature are cortical tibial graft (Boyd), ulnar segment graft (Miller and Phalen), iliac crest graft (Spira), cancellous insert graft (Nicoll), vascularized fibular graft (Jupiter), and bone transport by ring fixator (Tesworth). The present study reports the results of tricorticocancellous bone block grafts using modified Nicoll's technique, in diaphyseal defects of forearm bones. MATERIALS AND METHODS A total of 38 forearm bones (either radius or ulna or both) in 23 patients with a gap of 1.5-7.5 cm were treated by debridement and tricorticocancellous bone block graft under compression with intramedullary nail fixation between June 1985 and June 2005. There were 15 male and 8 female patients. Sixteen patients had open and seven patients had closed fractures initially. Time of presentation since the original injury varied from 9 months to 84 months. Eighteen patients had already undergone one to three operations. RESULTS Thirty-six bones showed union at both host graft junctions. The mean duration of union was 17.5 weeks (range, 14-60 weeks). Two bones had union only at one host graft junction and did not show any evidence of callus formation up to 9 months on the other end, hence requiring subsequent procedure in the form of phemister bone grafting. Patients were followed for a minimum period of 2 years (range, 2-7 years). Results were based on the status of union and range of motion (ROM) for elbow/wrist and grip strength at the final follow-up. Complications observed were the reactivation of infection (n = 1) and herniation of the muscles at the donor site (n = 1). CONCLUSION The tricorticocancellous strut bone grafting under optimal compression, augmented with intramedullary fixation, provides a promising solution to difficult problem of an atrophic nonunion of forearms bones with gap.
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Affiliation(s)
- Dinesh K Gupta
- Department of Orthopaedics, MLB Medical College, Jhansi, Uttar Pradesh, India,Address for correspondence: Dr. DK Gupta, H 7/8, Veerangana Nagar, JDA Colony, Kanpur Road, Jhansi, Uttar Pradesh – 284 128, India. E-mail:
| | - Gaurav Kumar
- Department of Orthopaedics, Jhansi Orthopaedic Hospital and Research Centre, Jhansi, Uttar Pradesh, India
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