Top PDF Open reduction and internal fixation of humeral midshaft fractures: anterior versus posterior plate fixation

Open reduction and internal fixation of humeral midshaft fractures: anterior versus posterior plate fixation

Open reduction and internal fixation of humeral midshaft fractures: anterior versus posterior plate fixation

and anatomical fixation of the fracture and can enable primary or secondary fracture healing depending on the type of osteosynthesis and fracture pattern. Although there were no significant differences between our two groups according to the primary and secondary outcome measures, an anterior approach offers advantages. It allows supine positioning of the patient and offers safe exposure of the humerus as the radial nerve is not dir- ectly explored [10]. To the best of our knowledge, there have been no prospective randomized studies comparing anterior and posterior plate fixation in terms of the heal- ing rate and clinical outcomes. Nevertheless, the cur- rently available literature confirms our finding that an anterior surgical approach with plating is a safe and effi- cacious treatment option for humeral shaft fractures. Re- liable results have been reported in one biomechanical study [32] and one retrospective clinical study [33] for anteromedial plating for shaft fractures in the upper ex- tremities with regard to bone union and iatrogenic neu- rovascular injury. One retrospective study of 96 humeral fractures treated with anteromedial plating presented a union rate of 97%, although 20% of the fractures in- cluded were open fractures [16]. According to the neurological status, 18 patients with primary radialis palsy and one patient with brachial plexopathy were in- cluded in this study. Of these 19 patients, twelve achieved remission after ORIF. Two patients (2.1%) were noted to have secondary palsy (hypoesthesia in the lat- eral antebrachial cutaneous nerve distribution) after sur- gery. Another retrospective study was published by Boschi et al. [15] investigating the outcomes of the treat- ment of 280 humeral shaft fractures with ORIF in terms of the approach and plate location. The overall healing rate was 98.2%, without a significant difference in the approach or plate location. In accordance with the find- ings reported by Boschi et al. [15], no significant differ- ence in the operative duration was found between the two groups in our study; however, we found a wide vari- ation in the operative duration within the groups. As a level one trauma center and a university hospital, all op- erative procedures in both groups were performed by ei- ther trainee registrars or junior consultants, which might be one reason for the wide variation in the operative duration within the groups. The fact that the number of
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Effects of different surgical techniques on mid distal humeral shaft vascularity: open reduction and internal fixation versus minimally invasive plate osteosynthesis

Effects of different surgical techniques on mid distal humeral shaft vascularity: open reduction and internal fixation versus minimally invasive plate osteosynthesis

The right and left humeri of each cadaver were randomized to undergo either ORIF or MIPO. MIPO was commenced with a 3-cm-long proximal incision made medial to the in- sertion of the deltoid and lateral to the biceps. Then, the cortex of the anterior humeral shaft was exposed. Another 3-cm-long distal incision was made proximal to the flexion crease, along the lateral border of the biceps. The brachialis was bluntly split to expose the humeral shaft. A submuscu- lar tunnel was prepared and a plate was submuscularly inserted from the distal incision, adjusted to adhere to the anterior aspect of the humeral shaft, and fixed with screws placed distally and proximally [10]. On the contralateral humerus, ORIF was performed by making a conventional posterior longitudinal incision through the triceps, followed
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Internal fixation of proximal humeral fractures with locking proximal humeral plate (LPHP) in elderly patients with osteoporosis

Internal fixation of proximal humeral fractures with locking proximal humeral plate (LPHP) in elderly patients with osteoporosis

In present study, LPHP has shown encouraging results in displaced proximal humeral fractures in osteoporotic bones. Sound union was achieved in all patients. Secondary loss of reduction occurred in 4% patients after screw loosening in proximal fragment. Secondary varus deformity (head–shaft axis angle \ 120°) and retroversion of humeral head occurred in 14% patients in conventional plate osteosyn- thesis. Bone cement had been used to improve the holding power of screws in osteoporotic bones. Implant failure with screw loosening and secondary displacement of fracture fragments necessitated refixation of fracture in 4% patients [3]. No revision surgery was performed in our study due to implant failure. LPHP was associated with significant lower risk of screw loosening and secondary loss of reduction as compared to conventional plates in the present series. LPHP offers the advantage of locking head screws, which enter the humeral head at various angles in order to maximise pur- chase [14]. Fracture in a poor position is associated with poor functional results [3, 5]. Malunion was mainly a hardware related problem. Insufficient fixation of the screws may cause partial loss of reduction with secondary displacement of the humeral head into varus position leading to unsatis- factory result. Whereas, a higher rate (12%) of varus malunion was observed in conventional plate osteosynthesis [3]. We did not have any secondary varus deformity. How- ever, fracture was fixed in varus primarily in 8% patients in our series and both these patients had moderate outcome. Primary malunion can be prevented if fracture is fixed in near anatomical position at the time of fixation. We feel that near anatomical reduction must be achieved before applying multidirectional screws, as plate does not help in reduction of proximal fragments. Rather it fixes the proximal fragments wherever they are. With varus malalignment, the plate must not be positioned too far cranially, otherwise there could be subacromial impingement which occurred in our two patients with varus malnion. Wanner et al. [16] treated dis- placed proximal humerus fractures with open reduction and internal fixation with two one-third tubular plates on the anterior and lateral aspects of the proximal humerus. High Table 2 Functional outcome in different fracture types, presented as
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Evaluation of 3 Dimensional Plates in Open Reduction and Internal Fixation of Subcondylar Fractures

Evaluation of 3 Dimensional Plates in Open Reduction and Internal Fixation of Subcondylar Fractures

During functional activity there are tensile strains at the antero - lateral border, compressive strain along the posterior-medial border and permanent latero medial bending of the condyle 4 . These principles mandate that, in order to provide the best possible bio functionality, the plates must be placed along the ideal lines of osteosynthesis. The plate is trapezoidal in shape, so that the anterior arm of the plate can be superimposed over the tension lines under the sigmoid notch. Because of their grids form, the TCP plates belong to 3D plates which were developed by Farmard 46 in nineties. The 3D plates were developed to offer
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Study of Functional Outcome in Calcaneal Fractures, Managed Conservatively and Open Reduction and Internal Fixation with Plate

Study of Functional Outcome in Calcaneal Fractures, Managed Conservatively and Open Reduction and Internal Fixation with Plate

(2) the size and displacement of sustentacular tali relative to superior medial fragments, (3) the presence of a step or diastasis of the posterior facet, and (4) impingement of the fibular malleolus on the tuberosity of the Calcaneum. Such scans also provide information regarding fractures involving the sinus tarsi, calcaneocuboid joint, and anterior calcaneal process, all of which could be relevant while planning the lateral surgical approach. Thus a better surgical planning became possible. CT evaluation of calcaneal fractures has allowed classification systems to offer prognostic significance.
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Ligamentotaxis versus Open Reduction and Internal Fixation for Distal Radius Intra Articular  Fractures

Ligamentotaxis versus Open Reduction and Internal Fixation for Distal Radius Intra Articular Fractures

operatively by manual testing after completion of the surgery in all cases. We reduced radioulnar joint injury for 11 patients (45.8%) by using medial K-wire, and if the joint was still instable, the transfixing wire through DRUJ was retained for 6 weeks. The external fixator frames were removed after 6 to 8 weeks for all patients; however K-wires were not removed until complete consolidation of the fractures occurred. Wrist joint mobilization was allowed after removal of the ex- ternal fixator frame, regardless of the removal of the wire or its retention until 2 weeks. Group II: The patients of this group were treated by ORIF using distal volar radial locked plate. After reduction, K-wires were placed through the radial styloid provisionally, if required. An anterior locking plate was then positioned. All the plates were precontoured for anterior flare of the distal radius. The plate position was adjusted based on intra-operative fluoroscopy finding. The plate position was verified in both anteroposterior (AP) and lateral planes before the distal screws were placed. Among the cases where the distal fragment was se- verely comminuted, the plate was adjusted as far as possible, but not farther beyond the watershed line of the radius. Double plating was used in two cases, as the screw caused disfigurement of the dorsal articular surface, which necessi- tated buttressing from the dorsal surface (Figure 2). DRUJ was checked ma- nually after the surgery. After fixation of the distal radius, the distal end of the radius was grasped with the forearm in a neutral position, and the distal end of the ulna was grasped by the contra-lateral hand by moving distal ulna from the dorsal to the palmar direction. If there was a translation of 5 to 10 mm as com- pared with the uninjured wrist, it was considered as DRUJI. Transverse wire through the DRUJ was inserted in 12 patients (54.5%) who had significant DRUJI after plate fixation.
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Clinical and Radiological Results of Open Reduction and Internal Fixation for the Treatment of Lately Presented Lateral Humeral Condyle Fractures in Children

Clinical and Radiological Results of Open Reduction and Internal Fixation for the Treatment of Lately Presented Lateral Humeral Condyle Fractures in Children

All surgeries were performed by one fellowship trained hand surgeon (F.N.M). Surgeries were done under general anesthesia after applying pneumatic tourniquet and pro- phylactic antibiotic (Cefazolin 30 mg/kg IV). We used a lat- eral approach between triceps in the posterior and bra- chioradialis in the anterior. By shaving the anterior cap- sule from the anterior surface of distal humerus we were able to assess the situation. We did not find any bony union in the fracture sites and all displaced lateral condyles were mobile. The crucial step of the treatment was the reduc- tion process. In order to prevent avascular necrosis of the lateral condyle, we did our best to be gentle and avoid any soft tissue damage to the posterior part of the displaced lat- eral condyle, assuming that the major blood supply of this part is originating from the posteriorly entered vessels. We used small towel clips and “joystick” Kirschner wire (KW) to move and reduce the condyle fragment after refreshing the fracture site and removing any fibrotic tissue by a small curette. Our main goal was to reduce the articular surface regardless the irregularity of the metaphysis. Anatomic
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Treatment of open tibial diaphyseal fractures by external fixation combined with limited internal fixation versus simple external fixation: a retrospective cohort study

Treatment of open tibial diaphyseal fractures by external fixation combined with limited internal fixation versus simple external fixation: a retrospective cohort study

The fixation methods for open tibial diaphyseal frac- tures have evolved over the years but remain controver- sial [4–6]. Damage control orthopaedics (DCO) with external fixation followed by definitive internal fixation with nailing or plating is a popular strategy for signifi- cantly decreased complications [7]. However, the sec- ondary fixation procedure causes economic, physical, and psychological burdens, making the strategy less than ideal [7–9]. Thus, external fixation is an alternative as the definitive fixation in some cases such as improper conditions of soft tissues or patients’ non-compliance for the staged surgeries. Nevertheless, based on relevant studies, external fixation as a definitive treatment should warrant more attention for possible issues related to pin-track infection, unsatisfactory alignment, and poor union, leading to unplanned secondary fixation proce- dures and consequent additional burdens to patients in physiology and economy [5, 10–14].
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The calcar screw in angular stable plate fixation of proximal humeral fractures - a case study

The calcar screw in angular stable plate fixation of proximal humeral fractures - a case study

named above was required in 6 (C+, 15.4%) and 4 (C-, 19.0%) patients (Table 2). No neurological deficits were observed in group C-, while in group C+ one patient had persistent dysaesthesia in his palm, most likely because of intraoperative stretch of the brachial plexus. Another patient in group C+ complained about par- esthesia in all fingers of the operated arm although an electroneuromyography revealed no traceable nerval lesion and his underlying schizophrenic disease might have influenced the patient’s perception. There was no clinical indication of a lesion to the axillary nerve in any of the 60 patients (Table 3). The measurement of the head-plate distance was only possible in 44 patients (C-: n = 16, C+: n = 28) due to incorrect projection of the radiographs in 16 patients. Measurements of head-plate distance (Figure 4) yielded a significant loss of reduction in group C- (2.56 ± 2.65 mm) compared to C+ (0.77 ± 1.44 mm; p = 0.01). Post-hoc analysis revealed a power of 0.97 for measurements of a loss of reduction (n = 44). Table 1 Fracture morphology
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Evaluation of Functional results of distal end radius fractures managed by ligamentotaxis with or without percutaneous   K -wire augmentation

Evaluation of Functional results of distal end radius fractures managed by ligamentotaxis with or without percutaneous K -wire augmentation

The basic principle of fracture treatment is to obtain accurate fracture reduction and then to use a method of immobilization that will maintain and hold that reduction. Patients with fracture distal end of radius have serious complications more frequently than generally appreciated and failure in management may cause permanent disability. Restoration of normal alignment and articular congruence is essential for a good functional outcome in terms of early wrist motion; improvement in range of motion and grip strength (9). Non-operative management is reserved for undisplaced stable fractures and requires no fixation
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Open reduction and internal fixation with bone grafts for comminuted mason type II radial head fractures

Open reduction and internal fixation with bone grafts for comminuted mason type II radial head fractures

Methods: From July 2010 to July 2014, 20 consecutive patients who underwent open reduction and internal fixation for a closed Mason type II radial head fracture were retrospectively reviewed. Patients with Mason type I, III, simple type II, and comminuted type II fractures treated without bone grafting were excluded. A clinical examination and radiographic evaluation were performed. The overall functional result was evaluated using the Mayo Elbow Performance Score (MEPS). The Broberg and Morrey classification was used to evaluate traumatic arthritis. Results: The average follow-up duration was 31 months (range, 24 – 50 months). Bone union of the radial head fracture was achieved in all patients at an average of 13.5 weeks (range, 12 – 17 weeks). Postoperative radiographs showed no cases of postsurgical ligamentous instability, necrosis of the radial head, or internal fixation failure. The mean range of motion of the affected elbow was 128° ± 8.4° in flexion, 14.5° ± 11.1° in extension, 68.7° ± 14.1° in pronation, and 65.2° ± 18.2° in supination. The mean MEPS was 92 ± 7.9 points (range, 80 – 100); the outcome was excellent (90 – 100 points) in 13 patients and good (75 – 89 points) in 7 patients. The MEPS tended to be higher in patients with an isolated fracture ( p = 0.016). Based on the Broberg and Morrey classification for radiographic assessment of post-traumatic arthritis, 15 elbows had no evidence of degenerative changes (grade 0), and 5 elbows had grade 1 changes.
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Internal fixation of proximal humeral fractures with a Polarus humeral nail

Internal fixation of proximal humeral fractures with a Polarus humeral nail

Under general anesthesia, the patient was placed in beach-chair position on a radiolucent operating table. A longitudinal skin incision was made along the greater tuberosity of the humerus. The deltoid muscle was bluntly split to expose the rotator cuff. In cases of 2-part (surgical neck) fracture, a Kirschner pin was inserted through the rotator cuff, and its position was confirmed by C-arm. A 10 mm longitudinal incision was made on the supraspina- tus tendon right medial to the greater tuberosity and the entry portal of the nail was created with a drill and enlarged with a hand reamer. While maintaining fracture reduction by manual manipulation, a 2.0-mm guide wire was passed
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OpenReductionwithInternalFixation ofProximal Humeral Fractures with Plates:Results of 20 Operated Patients

Open Reduction with Internal Fixation of Proximal Humeral Fractures with Plates: Results of 20 Operated Patients

This retrospective study was conducted in Hotel Dieu de France Hospital in Beirut. Inclusion criteria were: (1) Age>18 years old and (2) proximal humeral fracture operated on with the use of a plate (Conventional or LCP). Exclusion criteria: (1) death of patients and (2) surgical treatment methods other than a plate (nail, screws, K wires…). Only 45 patients met these criteria since more than 70% of patients operated on were treated by other methods or died. 25 patients refused to participate in the follow up study and hence only 20 patients were evaluated.
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Hangman’s Fracture with Concomitant Atlantoaxial Dislocation

Hangman’s Fracture with Concomitant Atlantoaxial Dislocation

A 32-year-old woman became a victim of a motor ve- hicle accident as her car collided with another car. The patient was brought to the trauma center of Shariati Hospital by family members. There were no reported significant past medical or surgical illnesses. She had a blood pressure of 115/80 mmHg and a pulse rate of 105 beats/min. Her Glasgow Coma Scale (GCS) was 15/15. She had equal and reactive pupils bilaterally. She had severe pain radiating from the occipital region of the head to the posterior neck. There was tenderness at the upper part of her neck in the posterior midline and mild torticollis (left lateral flexion) but no neurological deficit was detected.
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Comparative study of operative and non operative management of intra- articular calcaneal fractures – a prospective study

Comparative study of operative and non operative management of intra- articular calcaneal fractures – a prospective study

The aim of surgery is to achieve anatomical reconstruction of all articular surfaces, restore Bohler’s and Gissane angles, to carry out primary stable fixation and begin early mobilization. Patients were given a below knee slab. Strict limb elevation and anti-edema measures were done and watched for the swelling to subside and appearance of “wrinkle sign”. Surgery was performed only after the edema had resolved. All patients were operated with an average of 7-15 days from the time of fracture if the soft tissue condition was good.

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Management of irreducible unilateral facet joint dislocations in subaxial cervical spine: two case reports and a review of the literature

Management of irreducible unilateral facet joint dislocations in subaxial cervical spine: two case reports and a review of the literature

A 25-year-old Asian woman fell from a height of approximately 3 m, and her face contacted the floor first. On presentation to our hospital, she complained of severe neck pain, skin numbness of forearms, and weak limbs. A neurological examination showed impaired triceps brachii muscles (strength of 3+ on a 5-point scale). CT with three-dimensional reconstruction revealed an articular process fracture and unilateral facet dislocation on the right side at C6/7 (Fig. 6). MR imaging showed mild cord compression. Preoperative use of a cervical collar maintained her spinal alignment. Posterior reduction with wiring of the C6/7 spinous processes was performed after removal of the facet fragments. Anterior decompression and fixation using a cage with iliac bone and a plate was then performed. A halo vest was used postoperatively for the instability of the upper cervical spine due to atlas fracture. At 3 months postoperatively, loosening of the fixators had not occurred (Fig. 7), the aberrant skin
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The Effect of Percutaneous Screw Fixation of Lateral Malleolus on Ankle Fracture Healing and Function

The Effect of Percutaneous Screw Fixation of Lateral Malleolus on Ankle Fracture Healing and Function

At our institution which is Level-One Trauma Centre and Tertiary centre for Trauma in Dubai, UAE, we adopt internal fixation policy of simple Weber A and low We- ber B fibular fractures with a long intramedullary screw. It has been utilized because it is felt that this technique is simpler than buttress plating and with less hardware complications. The long intramedullary screw also al- lows better purchase within the fibular canal than a smooth pin (while accommodating the distal fibular lat- eral bow), therefore eliminating hardware migration [5]. Furthermore, Bankston et al. demonstrated biomechani- cally that this particular fixation device was superior in strength, although not statistically followed up compared
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Minimally invasive plate osteosynthesis with a locking compression plate is superior to open reduction and internal fixation in the management of the proximal humerus fractures

Minimally invasive plate osteosynthesis with a locking compression plate is superior to open reduction and internal fixation in the management of the proximal humerus fractures

In the MIPO group, 5/43 patients experienced compli- cations and 4/43 patients experienced complications in the ORIF group (Table 4). No patients developed wound infection and nonunion after one year of follow-up in both groups. In 3 patients (group MIPO, 2 patients, type B and C; group ORIF, 1 patient, type B), the fracture collapsed after 3 months, leading to a varus malalignment. These patients developed loss of reduction and underwent reoperation either by reosteosynthesis combined with cancellous grafting or by joint replace- ment. One patient in the MIPO group presented with clinical signs of axillary injury, which was characterized by poorly localized posterior shoulder pain, parenthesis over the lateral aspect of the shoulder, and deltoid muscle weakness. Axillary nerve injury was confirmed on electromyography examination. However, there was no functional impairment when the patient was assessed at one year follow-up. One plate in the MIPO group and two plates in the ORIF group were removed due to subacromial impingement after radiographs confirmed fracture union at about 5 months. In the ORIF group, one patient underwent reoperation to change a perforated screw 3 months after the initial operation.
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Comparison between minimally invasive, percutaneous osteosynthesis and locking plate osteosynthesis in 3 and 4 part proximal humerus fractures

Comparison between minimally invasive, percutaneous osteosynthesis and locking plate osteosynthesis in 3 and 4 part proximal humerus fractures

However, unsatisfactory complication rates of up to 40 %, after locking plate osteosynthesis show that the ideal joint-preserving method for treating proximal humeral fractures has not yet been found [11]. The Humerusblock is a k-wire based implant consisting of two locked, crossed k-wires, which allow for the minimally invasive, closed reduction and internal fixation of proximal humeral frac- tures. Although previous studies have shown that the Humerusblock provides all of the advantages of a minim- ally invasive device, high rates of pin perforation and high implant removal rates have been observed [8, 12–15].
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OUTCOME OF OPEN REDUCTION AND INTERNAL FIXATION IN LATERAL CONDYLE HUMERAL FRACTURES IN PEDIATRICS

OUTCOME OF OPEN REDUCTION AND INTERNAL FIXATION IN LATERAL CONDYLE HUMERAL FRACTURES IN PEDIATRICS

In our study, 33.3% were complicated; one case with stiffness and valgus; one case with varus and two cases with superficial infection. There were no significant differences between complicated and non- complicated cases regarding age, sex, side, type of fracture and displacement. In the study done by Leonidou et al. [8], one patient had a superficial infection around the K- wires, which responded well and eventually resolved with the administration of oral antibiotics. The majority of the fractures demonstrated radiological union between 4 and 6 weeks with the exception of one patient with a Jacob III fracture who reached 8 weeks.
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