[Osteosynthesis by intramedullary headless screw in digital fractures: A retrospective scannographic and anatomical study]. / Ostéosynthèse par vis centromédullaire sans tête dans les fractures digitales : une étude rétrospective scanographique et anatomique.

INTRODUCTION: Long finger skeletal fractures are common injuries. In displaced forms, surgical treatment is required. With the advent of headless cannulated screws, the technique has been simplified and allows reduction in both planes. The objective of our study was to evaluate the functional recovery of patients operated on by this technique. MATERIAL AND METHOD: We conducted a retrospective single-center study between 2019 and 2022. Eleven patients were followed and 12 fractures analyzed. A radio-clinical follow-up was carried out at 1 month then at the last follow-up with an evaluation of the articular amplitudes and a quality of life score (QuickDash, QD). The time to return to professional and sporting activities, pain (EVA) was collected. An anatomical/scannographic evaluation was performed to assess tendon and cartilage damage. RESULTS: At the last follow-up, the average global flexion was 266° and the extension was total. An average QD score of 15.9 and a Jamar force of 106% compared to the healthy side were observed. The return to physical and professional activities was earlier and the pain quickly tolerable. No secondary displacement was objectified and all were consolidated at the last follow-up, without malunion. No patient had been operated on secondarily. CONCLUSION: This technique seems to be a safe and non-traumatic. It allows a faster return to sports and professional activities with fewer complications and no need to remove the material.

[Management of a patient with severe limb trauma]. / La prise en charge d'un patient victime d'un traumatisme sévère de membre.

The management of a patient with limb trauma begins with a rapid assessment of the lesions in order to prioritise the treatment of life-threatening lesions, primarily haemorrhage. Severe limb trauma is defined by the presence of specific severity criteria and requires the injured person to be referred to a specialised severe trauma centre. The prognosis is twofold, both vital and functional, based on the speed as well as the quality of immediate pre-hospital care, specific hospital care and the prevention of secondary complications.

Omental flap for treatment of spondylodiscitis with lumbosacral dehiscence: A case report.

We report a case of pedicled omental flap use together with osteosynthesis treatment of a chronic L4-L5 spondylodiscitis due to a large sacral eschar. The 43-years-old patient was paraplegic and had depleted regional flaps solutions due to multiple previous surgeries. The procedure was carried out in supine position then in prone position whereby the dissected flap was recovered through the spine. The surgery was performed by a multidisciplinary team. First, we used an anterior approach for spine osteosynthesis with a metal implant and flap harvest. Then, in a prone position, we completed the vertebral reconstruction by an L3 athrodesis to the pelvis. The flap was recovered through the spine defect, on the side of the implant. It was a right sided pedicled. Complete wound healing was 120 days. The omental flap proved to be a reliable solution in the absence of recipient vessels for free flap transfer and depleted regional flap solutions. It also spared the latissimus dorsi muscle required for a wheelchair user as in our case. The omental flap is still performed in spine surgery especially in oncologic context to prevent wound dehiscence and for spondylodiscitis coverage. The anterior approach allows for both spine osteosynthesis and flap dissection.

[Simple repair of Monteggia fractures in the cat]. / Einfache Methode zur Stabilisierung von Monteggia Frakturen bei der Katze.

INTRODUCTION: Monteggia fractures are rare traumatic injuries in cats and dogs. Ulna repair is mostly achieved by plates. Stable radial head fixation however is challenging. Temporary position screws have to be removed due to rotation forces in the elbow joint causing screw loosening. We present a novel and simple method using a sling technique, which holds the radial head in its physiological position and allows normal elbow movement.

[Navicular bone fractures in horses: Prognosis after conservative and surgical treatment]. / Strahlbein-Frakturen beim Pferd: Prognose nach konservativer und chirurgischer Therapie.

INTRODUCTION: The aim of this retrospective study is to describe and compare conservative and surgical treatment of navicular fractures in horses. An attempt is made to identify critical points that can favorably influence the prognosis of this orthopedic disease. All horses treated for a navicular fracture at the Equine Clinic, Vetsuisse Faculty, University of Zurich between 2005 and 2017 were included in this study. The severity of lameness at initial examination, radiographic assessment, hoof conformation, treatment (conservative or surgical), complications and outcome were determined from the medical records. Conservative and surgical treatment consisted of stable rest, a controlled exercise program and therapeutic orthopedic shoeing. During surgical treatment, fracture reduction was also carried out with a cortical screw. Computer assisted surgery were used in five horses and computer tomography in three horses. Follow-up examinations included clinical and radiographic examinations. The outcome was divided into three categories: 1 = very good; 2 = good; 3 = poor. Twelve horses met the inclusion criteria; Four horses were treated conservatively and eight were treated surgically. After conservative treatment, two horses (50 %) had a very good outcome and two (50 %) had a good outcome. After surgical treatment, four horses (50 %) had a very good outcome and four (50 %) had a poor outcome. Overall, 67 % of horses had a very good or good outcome, although radiographic signs of bone healing was not present in any of these cases. Various complications were identified, such as the fracture of a screw, the fragmentation of the small navicular bone fragment, the development of osteoarthrosis in the coffin joint and progressive podotrochosis. This study shows that the prognosis of navicular fractures is generally cautious and that degenerative changes to the navicular apparatus worsen the prognosis. In the present study, surgical treatment did not improve the prognosis of navicular fractures despite the intrasurgical use of three-dimensional imaging. However, technical advances could reduce the complication rate in the future.

INTRODUCTION: Le but de cette étude rétrospective était de décrire et de comparer le traitement conservateur et chirurgical des fractures de l'os naviculaires chez le cheval. Une tentative est faite pour identifier les points critiques qui peuvent influencer favorablement le pronostic de cette maladie orthopédique. Tous les chevaux traités pour une fracture de l'os naviculaire à la Clinique équine de la Faculté Vetsuisse de l'Université de Zurich entre 2005 et 2017 ont été inclus dans cette étude. La gravité de la boiterie lors de l'examen initial, l'évaluation radiographique, la conformation du sabot, le traitement (conservateur ou chirurgical), les complications et le résultat ont été déterminés à partir des dossiers médicaux. Le traitement conservateur et chirurgical consistait en un repos au box, un programme d'exercice contrôlé et un ferrage orthopédique thérapeutique. Au cours du traitement chirurgical, une réduction de la fracture a également été effectuée à l'aide d'une vis corticale. La chirurgie assistée par ordinateur a été utilisée sur cinq chevaux et la tomographie assistée par ordinateur sur trois chevaux. Les examens de suivi comprenaient des examens cliniques et radiographiques. Les résultats ont été divisés en trois catégories: 1 = très bon; 2 = bon; 3 = mauvais. Douze chevaux répondaient aux critères d'inclusion ; quatre chevaux ont été traités de manière conservatrice et huit ont été traités chirurgicalement. Après un traitement conservateur, deux chevaux (50 %) ont eu un très bon résultat et deux (50 %) un bon résultat. Après le traitement chirurgical, quatre chevaux (50 %) ont eu un très bon résultat et quatre (50 %) un mauvais résultat. Dans l'ensemble, 67 % des chevaux ont eu un très bon ou un bon résultat, bien que les signes radiographiques de guérison osseuse n'aient été présents dans aucun de ces cas. Diverses complications ont été identifiées, telles que la fracture d'une vis, la fragmentation du petit fragment de l'os naviculaire, le développement d'une arthrose dans l'articulation interphalangienne distale et une podotrochlose progressive. Cette étude montre que le pronostic des fractures de l'os naviculaire est généralement réservé et que les modifications dégénératives de l'appareil naviculaire aggravent le pronostic. Dans la présente étude, le traitement chirurgical n'a pas amélioré le pronostic des fractures du naviculaire malgré l'utilisation intra-chirurgicale de l'imagerie tridimensionnelle. Cependant, les progrès techniques pourraient réduire le taux de complications dans le futur.

Radial nerve lesion after medial epicondyle osteosynthesis in a pediatric patient: A rare complication of surgery.

Fractures of the medial epicondyle are relatively common in children and may be associated with nerve lesion, especially in case of displacement. Incarceration of the ulnar nerve in the fracture site is feared in Watson-Jones stage II, rarely directly related to osteosynthesis. Depending on the degree of fracture displacement, various osteosynthesis techniques may be used; nerve injuries are a rare but known complication of these procedures. We report a case of radial nerve injury related to pinning osteosynthesis of a medial epicondyle fracture.

Radius palmar plate removal without carpal tunnel release: Correlation between plate position and median nerve symptoms.

We aimed to report the clinical results of volar plate removal without carpal tunnel release in patients with late-onset median neuropathy and to evaluate the relationship between plate position and median nerve symptoms. Part I. Twelve consecutive patients with late-onset median neuropathy treated with volar plate removal without carpal tunnel release were enrolled for analysis. Pre- and post-operative Tinel sign, Phalen and Ten test, subjective rating of tingling sensation, Mayo wrist score and Disabilities of the Arm, Shoulder and Hand (DASH) score were collected. Part II. 232 consecutive patients underwent volar plating for distal radius fracture. The relationships between median nerve symptoms and volar plate prominence on the Soong classification, fracture classification, gender and age were investigated. All cases except one showed complete symptom resolution at final follow-up, with negative Tinel sign and Ten test score of 10/10. Tingling was rated 0 at final follow-up. Mean Mayo wrist and DASH scores improved to 86.7 and 23.1, respectively. The incidence of the median nerve symptoms in our cohort was 5.6%. Even though the odds ratio in Soong grade 2 was 4.0957 (95% CI, 0.93-16.9) compared to the combination of grades 0 and 1, no statistically significant relationship was found between the median nerve symptoms and volar plate prominence (p > 0.05). Plate removal without carpal tunnel release adequately relieved symptoms of late-onset median neuropathy after volar plating in patients with distal radius fracture. LEVEL OF EVIDENCE: IV; Therapeutic.

Management of Allen type III nail bed injuries and distal phalangeal fractures with and without fixation.

For combined nail bed injuries and distal phalangeal fractures, fixation may be indicated when there is fracture instability and if a K-wire can be successfully placed in the fracture fragments. We determined the outcomes when these criteria were applied for patients with Allen type III injuries without substantial tissue loss. We retrospectively analyzed 57 patients who had surgery for nail bed injuries with distal phalangeal fractures between October 2017 and January 2020. All patients underwent anatomical nail bed repair, and some had fracture fixation, according to specific surgical criteria. We obtained data about demographic and clinical characteristics, postoperative radiographs, complications, range of motion, and satisfaction. To achieve our primary objective, we evaluated the patient population as a whole. The median follow-up was 12 months (range, 7-21). After 90 days, all 57 patients achieved satisfactory fracture union, 54 (95%) had excellent range of motion, and 54 (95%) were either satisfied or very satisfied with the outcome. Though 6 (10%) patients had residual fracture displacement, none had complications. In patients with Allen type III fingertip injuries without substantial tissue loss, anatomical nail bed repair and triage of patients to fixation or no fixation are likely to result in excellent functional outcomes and high patient satisfaction. However, fixation can neither be recommended nor rejected for these injuries based on this study alone. Level of evidence: IV.

Flexor tendon rupture after volar plating of distal radius fracture: A systematic review of the literature.

Flexor tendon rupture after volar plate fixation of distal radius fracture (DRF) is rare. There is no consensus as to how to prevent them. The aim of our study was to identify the pathological mechanisms, and to establish the clinical and epidemiological profile of patients suffering from this complication. We carried out a systematic review using the PubMed, Scopus and Cochrane databases. Studies were included if they described complete or partial flexor tendon rupture following volar plate fixation of DRF. Forty-six 46 were included, for a total of 145 patients were reported: 138 from the literature, and 7 from our personal experience. Etiology was usually mechanical, by impingement with either the plate or protruding screws. Plate impingement was due to positioning beyond the watershed line, consolidation with posterior tilt, plate thickness, or low palmar cortical angle. Mean patient age was 62.4 years (range, 23-89 years). Median postoperative interval was 8 months (range, 3-120 months). Flexor pollicis longus was the most frequently injured tendon. The plate should be positioned proximally to the watershed line if possible, to ensure good initial reduction. Hardware should be removed 4 months after surgery if the plate is causing impingement according to the Soong criteria or if signs of tenosynovitis appear.

Effectiveness of early versus delayed motion in patients with distal radius fracture treated with volar locking plate: A systematic review and meta-analysis.

The aim of this study was to determine the effectiveness of early versus delayed motion on the functional outcomes in patients with distal radius fracture (DRF) treated with a volar locking plate. A systematic review and meta-analysis of randomized clinical trials was performed. An electronic search was performed in the Medline, Central, Embase, PEDro, Lilacs, Cinahl, SPORTDiscus, and Web of Science databases. The eligibility criteria included randomized clinical trials that compared the effect of early versus delayed motion on wrist and/or upper limb function, pain, grip strength, and wrist range of motion in subjects older than 18 years with DRF treated with a volar locking plate. Five clinical trials were included that met the eligibility criteria for the quantitative synthesis. At 6 weeks, the PRWE questionnaire showed a mean difference (MD) of -10.6 points (p < 0.001), the MD was -11.1 points for the DASH questionnaire (p < 0.001), -0.56 cm for pain on VAS (p = 0.01), 5.0 kg for grip strength (p = 0.01), 12.5 degrees for wrist flexion (p = 0.07), and 12.8 degrees for wrist extension (p = 0.05). All differences favored the early motion treatment. At 3 months of follow-up, only the DASH, pain on VAS, and grip strength showed significant differences in favor of early motion. At 1 year of follow-up, none of the variables studied were different between groups. In the short term, there was moderate to high evidence of clinically and statistically significant differences in the functional outcomes in favor of early versus delayed motion in patients with DRF treated with a volar locking plate. But these differences were not observed at 1 year of follow-up. PROSPERO registration no.: CRD42020158706.

[Aseptic nonunion of patella at the Centre Hospitalier Universitaire Bocar Sidy Sall de Kati about 25 cases]. / Pseudarthrose aseptique de la patella au Centre Hospitalier et Universitaire Bocar Sidy Sall (CHU-BSS) de Kati a propos de 25 cas.

OBJECTIVE: The objective of Our study was to describe the epidemiological, clinical, therapeutic and prognostic aspects of Nonunion of patella fractures. PATIENTS METHODS: It was a retrospective study done concerning 25 patients treated fromJanuary 2005 to December 2015 in the orthopedic trauma service CHU Bocar Sidy SALL Kati. RESULTS: We gather together 25 cases of Nonunion of patella fractures disease among 28 caseswhich was about 89.28%. Our patients were divided into 20 men and 5 women, mean age was 36 years, ranging from ages 22 to 75 years. Posttraumatic period was 6-18 months. The initial fracture was neglected in 21 cases and treated in 4 cases. Physical examination revealed lameness in 92% of cases, atrophy of the quadriceps in 56% of cases, joint stiffness, 56% and an inter-fragmentary gap in 92% of patients. The radiographic data were consistent with pseudoarthrosis in all cases. The inter-fragmentary gap was 36 mm on average. The care of our patients was based on plugging and guy-wiring in 64 % of cases and strapping pre- and peri patella in 12% of cases. A partial patellectomy was practiced in 2 cases. A VY plasty of the quadriceps was recommended in 4 cases.The patients were reviewed after a mean of 10 months (8 months- 24 months). Functional outcomes analyzed using Bostman scores were excellent in 4 cases (16%), good in 18 cases (72%) and poor in 3 cases (12%). CONCLUSION: Nonunion of the patella is mostly due to the lack of treatment or wrong treatment leads. Treatment with plugging and guy-wiring seems the most appropriate method.

OBJECTIF: l'objectif de notre étude était décrireles aspects épidémiologiques, cliniques, thérapeutiques et pronostiques de la pseudarthrose de la patella. PATIENTS ET MÉTHODES: Il s'agissait d'une étude rétrospective concernant 25 patients colligés entre janvier 2005 et décembre 2015 dans le service d'orthopédie et de traumatologie du CHU Bocar Sidy SALL de Kati. RÉSULTATS: Nous avons colligé 25 cas de pseudarthrose aseptique de la patella sur 28 cas, soit 89,28%. Nos patients se répartissaient en 20 hommes et 5 femmes. L'âge moyen était de 36 ansavec des extrêmes de 22 et 75 ans. Ledélai post traumatique était de 6-18 mois. La fracture initiale était négligée dans 21 cas et traitée dans 4 cas. L'examen clinique retrouvait une boiterie dans 92%, une amyotrophie du quadriceps dans 56%, une raideur du genou dans 56%, et un vide inter-fragmentaire dans 92%. Les données radiographiques étaient compatibles avec la pseudarthrose de la patella dans tous les cas. L'écart inter-fragmentaire était de 36 mm en moyenne. La prise en charge de nos patients reposait sur l'embrochage-haubanage dans 64%, le cerclage péri-rotulien dans 12%, une patellectomie partielle dans 2 cas (8%) et une plastie du quadriceps en VY était préconisée dans 4 cas (16%). Les patients étaient revus après un recul moyen de 10 mois (8mois-24mois). Les issues fonctionnelles analysées selon le score de Bostman étaient excellentes dans 4 cas (16%), bonnes dans 18 cas (72%) et mauvaises dans 3 cas (12%). CONCLUSION: la pseudarthrose de la patella est surtout le fait de l'absence du traitement ou d'un traitement mal conduit. Le traitement par l'embrochage-haubanage semble la méthode la plus indiquée.

Combined volar and dorsal plating vs. volar plating of distal radius fractures. A single-center study of 105 cases.

Despite recent advances in the surgical management of distal radius fractures (DRFs), the optimal treatment remains controversial as different fixation methods often have similar clinical functional and radiographic outcomes. The objective of this study was to assess the differences in outcomes 1 year postoperatively between volar plating and combined plating for DRFs. In a retrospective cohort study, we evaluated 105 consecutive patients operated with either a volar locking plate or combined dorsal and volar plating. The primary outcome was wrist range of motion (ROM). Secondary outcome measures included hand grip strength, visual analog scale (VAS) pain scores, radiographic examination and patient-related outcome measures. Patients treated with combined plating had significantly inferior wrist flexion, extension and ulnar deviation. The radiographic Batra score 1 year postoperatively was similar for both groups. The PRWE (patient-rated wrist evaluation) score was 16 for the volar plating group and 14 for the combined plating group. The QuickDASH (Quick disabilities of the arm, shoulder and hand) score was 9 for the volar plating group and 16 for the combined plating group. VAS pain scores were 0 at rest and 2 during activity for both groups. Grip strength was similar between the two groups. Hardware removal was done in 18/78 patients for the combined plating group and 1/27 for the volar plate group. Two patients operated with combined plating had tendon ruptures. Our findings indicate that both methods can yield satisfactory clinical and radiographic outcomes. However, combined plating resulted in inferior wrist ROM and substantially higher frequency of hardware removal. The potential advantages of combined plating in stabilizing a comminuted DRF must be balanced by the potential drawbacks such as inferior wrist ROM and higher frequency of hardware removal.

[Long bone fractures in cattle: A retrospective study of treatment and outcome in 194 cases]. / Frakturen der langen Röhrenknochen beim Rind: Eine retrospektive ­Auswertung der Therapie und des Verlaufs bei 194 Tieren.

INTRODUCTION: The present retrospective study investigated the localization, cause, treatment and healing of long bone fractures in cattle. Over a period of ten years, medical records of 194 cattle of all ages with a long bone fracture, presented at the Clinic for Ruminants with Ambulatory and Herd Health Services at LMU Munich, were evaluated. The majority of patients (n = 131, 67.5%) were younger than two weeks of age. Of these, 118 calves sustained the fracture on the day of birth (60.8%). An obstetrical assistance was found in 57.4% (n = 58) of birth-related cases as a fracture cause. The femur was most frequently affected in calves aged up to two weeks (n = 35; 26.7%). The second most frequent fractures occurred in the metacarpus (n = 31; 22.9%) in this age group, followed by metatarsus (n = 28; 21.4%) and tibia (n = 27; 20.6%). Fractures of the antebrachium (n = 9; 6.9%) and the humerus were rare (n = 1; 0.8%). A total of 194 patients were diagnosed with 50 femur fractures (25.8%), 53 metacarpal fractures (27.3%), 43 metatarsal fractures (22.2%), 30 tibial fractures (15.5%), 11 antebrachial fractures (5.7%) and 7 humeral fractures (3.6%). Of the 194 animals, 78 (40.2%) had to be euthanized, 42 of them (53.8%) without treatment. In 150 patients, treatment was initiated, of which 110 patients (73.3%) were dismissed healthy from the clinic. Among the conservative treatment methods were stall rest, casts, casts combined with a U-shaped metal rail (walking casts) and the Thomas splint. Surgical therapy (internal fixation with plates or screws, transfixation pin casts) was used to treat 65 animals (33.5%). While 86.9% (74 out of 85) of the conservatively treated animals left the clinic alive, it were only 58.1% (36 out of 65) animals after surgical treatment. In the newborn calves, colostrum supply had a significant effect on the success of the treatment. If the gamma-glutamyl transferase concentration was below 200 IU/L in the calves aged under 4 days, the healing rate was significantly different from the cure rate of sufficiently immunized patients (26.9% (7 out of 26) vs. 65.3% (47 out of 72), P = 0.001).

INTRODUCTION: La présente étude rétrospective a examiné la localisation, la cause, le traitement et la guérison des fractures des os longs chez les bovins. Sur une période de dix ans, les dossiers médicaux de 194 bovins de tous âges souffrant d'une fracture d'un os long et présentés à la Clinique pour les ruminants avec services ambulatoires et services de santé du troupeau à la Ludwig-Maximilians-Universität de Munich, ont été évalués. La majorité des patients (n = 131, 67,5%) étaient âgés de moins de deux semaines. Parmi ceux-ci, 118 veaux ont subi la fracture le jour de leur naissance (60,8%). Une assistance obstétricale par traction a été trouvée dans 57,4% (n = 58) des cas liés à la naissance en tant que cause de fracture. Le fémur était le plus souvent touché chez les veaux âgés de moins de deux semaines (n = 35; 26,7%).). La deuxième fracture la plus fréquente survenait au niveau du métacarpe (n = 31; 22,9%)), suivi du métatarse (n = 28; 21,4%) et du tibia (n = 27; 20,6%).). Les fractures de l'antebrachium (n = 9; 6,9%) et de l'humérus étaient rares (n = 1; 0,8%). Au total, sur les 194 patients ont a diagnostiqué 50 fractures du fémur (25,8%), 53 fractures du métacarpe (27,3%), 43 fractures du métatarse (22,2%), 30 fractures du tibia (15,5%), 11 fractures antébrachiales (5,7%) et 7 fractures de l'humérus (3,6%). Sur les 194 animaux, 78 (40,2%) ont dû être euthanasiés, dont 42 (53,8%) sans traitement. Deux animaux (1.0%) ont été abattus. Sur les 150 patients traités, 36 (24.0%) ont été euthanasiés et 4 ont péri. 110 patients (73,3%) ont été renvoyés en bonne santé de la clinique. Parmi les méthodes de traitement conservatif figurent le repos en stalle, les plâtres en résine, les plâtres en résine combinés à une attelle en métal en forme de U comme attelle de marche et l'attelle de Thomas. Un traitement chirurgical (fixation interne à l'aide de plaques et/ou de vis de traction, broches de transfixion avec pont en matière synthétique) a été utilisé pour traiter 65 animaux (33,5%). Alors que 86,9% (74 sur 85) des animaux traités de manière conservatrice ont quitté la clinique en vie, ce ne sont que 58,1% (36 sur 65) des animaux après traitement chirurgical. Chez les veaux nouveau-nés, l'apport de colostrum a eu un effet significatif sur le succès du traitement. Si la concentration de gamma-glutamyl transférase était inférieure à 200 UI / L chez les veaux âgés de moins de 4 jours, le taux de guérison était significativement différent du taux de guérison de patients suffisamment immunisés (26,9% (7 sur 26) contre 65,3% (47 sur 72), p = 0,001).

Bennett's fracture: Comparative study between open and closed surgical techniques.

The aim of this study was to assess long-term outcomes of surgically treated Bennett fractures, while comparing open reduction and internal fixation (ORIF) with closed reduction and percutaneous fixation (CRPF). Patients treated between 1994 and 2010 were assessed retrospectively during an outpatient visit using a validated questionnaire (i.e. DASH, pain assessed through VAS), sensory testing, grip- and pinch-strength and radiographic analysis for post-traumatic arthritis. Fifty patients were included. Mean follow-up was 10 years. Mean age at trauma was 34 years. ORIF was used in 35 patients. CRPF was used in 15 patients. No differences in grip- and pinch-strength were found. Re-operations were needed in five ORIF-treated patients. Higher Pain Scores (VAS) were seen in the ORIF-treated patients. No correlation was found between surgical technique and functional outcomes. A persistent step-off or gap larger than 2 mm after surgical fixation was significantly correlated with post-traumatic arthritis at 10 years' follow-up. The need to perform ORIF for anatomical reduction seems to be less important in preventing post-traumatic arthritis as a persistent step-off or gap of more than 2 mm was found to be significantly correlated with the development of post-traumatic arthritis. Secondly, both techniques lead to good functional outcomes, although persistent pain was seen in the ORIF-treated patients. Bennett fractures can therefore be safely treated with CRPF when the persistent step-off and gap after fixation do not exceed 2 mm. LEVEL OF EVIDENCE: Therapeutic study, Level III.

Distal locking screw length for volar locking plate fixation of distal radius fractures: Postoperative stability of full-length unicortical versus shorter screws.

We compared post-operative distal radius fracture (DRF) displacement after volar locking plate fixation using full-length unicortical and shorter-length distal locking screws. In this non-inferiority, retrospective cohort study, DRFs treated with volar locking plate fixation were evaluated on X-rays. In the full-length group, volar locking plate fixation was performed with full-length unicortical distal locking screws. In the shorter-length group, the distal locking screws were planned pre-operatively to be approximately 75% of the distal radius depth based on the lunate depth, and the same depth was drilled. Three radiographic parameters - ulnar variance, volar tilt, and radial inclination - were measured intra-operatively and at the final follow-up. The displacements were compared between the two groups. Each group contained 34 fractures. The mean ulnar variance between the two periods increased 1.1 mm in the full-length group and 1.3 mm in the shorter group (mean difference, 0.2 mm; 90% confidence interval, -0.3 to 0.6). The shorter group was not significantly inferior to the full-length one. Volar tilt increased 0.6° in the full-length group and -0.1° in the shorter group, while the radial inclination increased 0.1° in the full-length group and 0.2° in the shorter one. The differences in the increases were not significant. The post-operative DRF stability of 75%-length distal locking screws was not inferior to that of full-length unicortical screws. To prevent extensor pollicis longus tendon rupture, shorter distal locking screws and the same drilling depth may be preferable for volar locking plate fixation.

Fracture-dislocation of the proximal interphalangeal joint of the long fingers: Report of an unusual case requiring open surgery.

Dorsal fracture-dislocations of the proximal interphalangeal (PIP) joint of the long fingers are in most cases unstable. They require surgery, whose primary aim is to restore and maintain articular congruency. While numerous techniques exist to treat these injuries, none have been shown to be superior to any of the others in terms of outcomes and complications. The least invasive techniques should be used as much as possible. We report here a rare case of incarceration of the flexor tendons in the PIP fracture which required open surgery.

Retrograde fixation of metacarpal fractures with intramedullary cannulated headless compression screws.

We analyzed the results of 20 unstable metacarpal fractures in 15 patients treated with a cannulated compression screw and no immobilization. All fractures healed within 6 weeks. One patient with multiple fractures and a flexion deficit required arthrolysis of two metacarpophalangeal joints. Another patient had an extension lag. There were no other complications. This fast and easy technique results in good outcomes for unstable metacarpal fractures. The advantages are early active motion without immobilization and stable fixation. Surgical removal of the screw is rarely needed. LEVEL OF EVIDENCE: IV (therapeutic).

Distal radius fracture fixation with a volar locking plate and endoscopic carpal tunnel release using a single 15mm approach: Feasibility study.

Distal radius fractures (DRF) may trigger, reveal or decompensate acute carpal tunnel syndrome (CTS) in 0.5-21% of cases. Internal fixation and median nerve release must then be carried out urgently. Less invasive approaches have been described for both the median nerve release using an endoscopic device and for the DRF fixation using a volar locking plate. We assessed the feasibility of DRF fixation and median nerve release through a single, minimally-invasive 15mm approach on a series of 10 cases. We reviewed retrospectively 10 consecutive cases of DRF associated with symptomatic CTS in 8 women and 2 men, aged 57 years on average. CTS was diagnosed clinically. All patients were treated during outpatient surgery with a volar locking plate and endoscopic carpal tunnel release using a single 15mm minimally-invasive approach. In one case, arthroscopic scapholunate repair was also required. Six months after the procedure, all patients were reviewed with a clinical examination and a radiological evaluation. The average values for the clinical and radiological outcomes were as follows: pain on VAS 1.5/10; QuickDASH 14.3/100; flexion 90%; extension 90.6%; pronation 95.6%; supination 87.9%; grip strength 90.1%; 2PD test 5.2mm (4-8mm). Five complications occurred: two cases of temporary dysesthesia in the territory of the median nerve and one case of temporary hypoesthesia of the palmar branch of the median nerve, which had all completely recovered; two cases of complex regional pain syndrome type I, which were still active at 6 months. Despite its methodological weaknesses, our study is the only one to describe the technical feasibility of a single 15mm minimally-invasive approach for both internal fixation using a volar locking plate and endoscopic nerve release, with no serious complications. This technique should be added to the surgical toolbox of minimally-invasive procedures for the hand and wrist.

Surgical management of closed, isolated proximal phalanx fractures in the long fingers: Functional outcomes and complications of 87 fractures.

Finger fractures are the most common skeletal injuries of the upper limbs. The purpose of this study was to evaluate the functional outcomes and complications after surgical management of isolated, closed fractures of the proximal phalanx (PP) of the hand (thumb excluded). Surgical management was indicated in 87 PP fractures. Fractures were reduced and fixed with pins, screws or a plate. Functional outcomes were assessed through the range of motion (ROM) in flexion-extension, hand and finger strength, and the QuickDASH and PRWHE scores. Fixation was done with pins in 32 cases, screws in 41 cases, and a plate in 14 cases. Rehabilitation was started an average of 1.7 weeks after surgery. There was no significant difference in the functional outcomes based on either fracture type or surgical approach. Nevertheless, the following significant differences were observed: PRWHE score (P=0.017) by injured finger; proximal interphalangeal (PIP) ROM (P=0.037) by fixation type; and grip strength (P=0.019), Quick DASH (P=0.017), and PRWHE (P=0.045) by rehabilitation delay. The most common clinical complications were minor malrotation and cold intolerance. Radiological assessment showed complete union in all cases. Surgical management of PP fractures leads to good functional outcomes, including a satisfactory recovery of finger ROM. The functional recovery of a fractured digit is dependent on the right fixation choice, complete bone union, and early rehabilitation. We suggest using screw fixation to achieve patient satisfaction and optimal functional recovery of closed, isolated PP fractures of the long fingers.

Fracturas trocántereas inestables. ¿Fijación extramedular o intramedular? / Unstable trochanteric fractures. Extramedullary or intramedullary fixation?

Introducción: Las fracturas trocantéreas inestables presentan dificultad para lograr la osteosíntesis estable, el apoyo precoz y la rápida reintegración social. Se tratan mediante osteosíntesis extra o intramedular. La osteosíntesis extramedular mediante placa atornillada estática o dinámica. Los implantes intramedulares poseen clavos o tornillos deslizantes. Objetivo: Revisar la literatura publicada entre 2015 y 2020 que comparen los diferentes métodos de fijación quirúrgica de las fracturas trocantéreas inestables. Estrategia de búsqueda: En PubMed de publicaciones entre los años 2010-2020 en ingles con los términos: fracturas trocantéreas inestables, tratamiento de las fracturas extracapsulares de fémur proximal, osteosíntesis en fracturas trocantéreas femorales inestables. Conclusiones: Las fracturas trocantéreas inestables poseen tendencia al desplazamiento en varo con medialización de la diáfisis. El clavo-placa estático muestra elevados índices de fallo, superiores al del clavo-placa deslizante (DHS), pero la placa estabilizadora trocantérea (TSP) parece ser el mejor implante para osteosíntesis extramedular muy semejante a lo reportado con los implantes intramedulares(AU)

Introduction: Unstable trochanteric fractures show difficulty in achieving stable osteosynthesis, early support and rapid social reintegration. They are treated by intra or extramedullary osteosynthesis, the later, by using a static or dynamic screw plate. Intramedullary implants have sliding nails or screws. Objective: To review the literature published from 2015 and 2020 that compares the different methods of surgical fixation of unstable trochanteric fractures. Search strategy: We searched in PubMed for publications from 2010 to 2020 in English with the terms unstable trochanteric fractures, treatment of extracapsular fractures of the proximal femur, osteosynthesis in unstable femoral trochanteric fractures. Conclusions: Unstable trochanteric fractures have a tendency to varus displacement with medialization of the diaphysis. The static nail-plate shows high failure rates, higher than that of the sliding nail-plate (DHS), but the trochanteric stabilizing plate (TSP) seems to be the best implant for extramedullary osteosynthesis, which is very similar to that reported with intramedullary implants(AU)

Introduction: Les fractures trochantériennes instables présentent des difficultés pour obtenir une ostéosynthèse stable, un soutien précoce et une réinsertion sociale rapide. Ils sont traités par ostéosynthèse extra ou intramédullaire. Ostéosynthèse extramédullaire à l'aide d'une plaque vissée statique ou dynamique. Les implants intramédullaires ont des clous ou des vis coulissants. Objectif: Bilan des travaux 2015-2020 comparant les différentes méthodes de fixation chirurgicale des fractures trochantériennes instables. Stratégie de recherche: Dans PubMed des publications 2010-2020 en anglais avec les termes: instable trochanteric fractures, treatment of extracapsular fractures of the proximal fémur, Ostéosynthesis in instable fémoral trochantic fractures. Conclusions: Les fractures trochantériennes instables ont tendance à se déplacer en varus avec médialisation de la diaphyse. La plaque à clous statique présente des taux d'échec élevés, supérieurs à ceux de la plaque à clous coulissante (DHS), mais la plaque de stabilisation du trochanter (TSP) semble être le meilleur implant pour l'ostéosynthèse extramédullaire très similaire à celle rapportée avec les implants intramédullaires(AU)