Early Results of Minimally Invasive Percutaneous Plate Osteosynthesis for Fractures of the Distal Tibia: A Retrospective Case Series and Review of the Literature.

Minimally invasive percutaneous plate osteosynthesis was developed on the concept that preservation of the soft tissue envelope during surgical management of distal tibial fractures is of paramount importance. We report on our early experience using this technique over a 1-year period with 14 such injuries that were treated by a locking compression plate via minimally invasive surgery. The surgical reduction was excellent in most of the cases and all fractures healed uneventfully. One superficial infection and a wound slough were the only complications recorded. The mean follow-up was at 15 months, and all patients were satisfied with a mean ankle-hindfoot score of 84. Early results of such management are very encouraging.

Provision of total hip replacement for displaced intracapsular hip fracture and the outcomes: audit of local practice based on NICE guidelines.

INTRODUCTION: Hip fractures are becoming an increasing public health issue due to an ageing population (1). Total hip replacements (THR) produce better outcomes in certain patients who were functioning independently before the injury (2). We aimed to assess whether the management of intracapsular hip fracture is carried out in accordance with the National Institute for Health and Care Excellence (NICE) hip fracture guidance (1) and the outcomes with regards to performing THRs on those patients who fulfil the described criteria. METHOD: Data was collected retrospectively from the 1st April 2012 to 31st March 2013 from all fractured neck of femur patients admitted to our hospital. RESULTS: Of the 382 patients fit for an operation, 78 (20.4%) met with the NICE hip fracture guidance for a total hip replacement. Of those eligible, 32 (41.0%) did receive a THR and 4 (2.8%) patients of the 142 not eligible for a total hip replacement also received a THR. DISCUSSIONS: Of those eligible for a THR, the patients who underwent that procedure had a significantly lower mortality rate compared to those who underwent a hemiarthroplasty (0% versus 19.6% at 1 year, p = 0.007). However, those who did not meet the NICE criteria but underwent a THR had the worst mortality rate (50% at 30 days and 1 year). The provision rate of THR in displaced intracapsular hip fracture is low at 41.0% for those who met the NICE criteria. The results suggest that the decision process when determining if a patient should undergo THR for a fractured neck of femur is multifactorial.

Can DCP and LCP plates generate more compression? The effect of multiple eccentrically placed screws and their drill positioning guides.

AIMS: The purpose of this biomechanical study was to assess the capacity of dynamic and locking compression plates (DCP and LCP) in improving fracture compression through the use of multiple compression screws, and the effect of alternating their placement between the two sides of the fracture compared with placing them all on one side. The study also compared fracture compression between DCP and LCP, and between the loading and universal drill guides in DCP. MATERIALS AND METHODS: Fracture compression was measured using a customised load cell placed in a transverse osteotomy in synthetic bone models. The starting pressure across the osteotomy site was standardised to allow comparison. Large fragment DCP and LCP plates were used for fixation. The eccentrically placed compression screws were inserted in two sequences: all on the initial compression screw side, or alternating between the initial compression and neutral sides. In the DCP, the effect of using the universal guide for eccentric screw insertion point was compared with the loading guide. RESULTS: In the DCP, the second eccentrically placed screw improved fracture compression in both sequences (p=0.002). A third eccentrically placed screw improved compression only when placed in alternating sequence (p=0.002), whereas the fourth screw had no significant effect (p=0.13). The universal guide generated higher compression than the loading guide (p=0.0001). In the LCP, fracture compression significantly improved following insertion of a second compression screw (p=0.002), but the initial neutral screw failed to re-engage completely into its hole due to lack of space for horizontal gliding towards the fracture. There was no significant difference in compression between the first two compression screws in DCP and LCP (p=0.64, 0.92). CONCLUSION: Fracture compression can be improved either using multiple eccentrically placed screws alternated between the two sides of the plate in LCP and DCP, or by the use of a universal drill guide in DCP. Although the compression hole in the LCP is shorter, it generates compression comparable to the DCP.

Retrieval of an impacted trial implant during unicompartmental knee arthroplasty.

We report a case of impacted trial implant during Oxford unicompartmental knee arthroplasty. We have successfully used AO-ASIF (Association for the Study of Internal Fixation) principles to retrieve the implant without any damage to the metallic implant and adjacent bone and joint.