Mason type-I radial head fractures and interosseous membrane lesions--a prospective study.

BACKGROUND: The role of the forearm interosseous membrane (IOM) in trauma remains not fully understood. Information from experimental models simulating sudden axial loading of the IOM is limited. The results from several cadaver studies are controversially discussed in literature. Pronation and supination of the forearm as well as varus and valgus position of the elbow joint have been suspected to have influence on the injury pattern. The purpose of the current study, therefore, was to further investigate the role of the IOM in trauma mechanism. METHODS: We prospectively screened the forearms of 14 patients with Mason type-I radial head fractures for additional occult IOM lesions. The fractures were classified according to the Mason classification using plain radiographs. All patients were subjected to forearm magnetic resonance imaging visualizing the entire IOM within a week. Treatment consisted of nearly total immobilization of the elbow joint using a special elastic and gauze bandage for 7 days followed by an early motion recovery program. RESULTS: Partial disruptions of the distal part of the IOM were found in nine cases. The biomechanically essential interosseous ligament was not attained by these ruptures in any of the cases. None of the patient had the classical findings of the Essex Lopresti lesion. All patients had regular roentgenograms of both wrists. Patients were asymptomatic at the time of a 4-week follow-up. CONCLUSION: Our results suggest that injuries of the IOM are more frequent than generally expected. The findings support the conclusions of some of the previous cadaver studies. If IOM lesions are suspected, magnetic resonance imaging tomography should be performed.

Surgical treatment of pathological fractures of the shaft of the humerus.

BACKGROUND: This report deals with the advantages and disadvantages associated with the most commonly used methods of stabilization after a pathologic fracture of the humerus shaft. PATIENTS: A total of 39 patients with 41 metastatic lesions and pathologic fractures of the humerus, treated surgically between 1992 and 2007, were retrospectively analyzed. RESULTS: The rate of local complications was 14.6% (6 of 41). Radial nerve injury was the only local complication and was exclusively observed in patients who underwent open reduction and plate fixation. The overall rate of osteosynthesis failure was 12.2% (5 of 41). Two failures were observed in 21 patients with open reductions and plate fixations, compared with three failures in 20 procedures involving closed reductions and intramedullary stabilization. The 1- and 2-year survival rates were 0.35 and 0.2 in ORIF and 0.07 and 0 in patients with IM fixation retrospectively. CONCLUSION: Intramedullary stabilization is a reliable method for fixation of pathologic fractures of the humerus diaphysis for patients in the advanced stage of metastatic disease. ORIF are preferable to IM fixations for the treatment of metaphyseal fractures and for those patients with a solitary metastasis in the humerus or those with a better prognosis.

Surgical treatment of metastatic fractures of the femur: a retrospective analysis of 142 patients.

BACKGROUND: Pathologic fractures of long bones are common complications of the metastatic disease; however, the influence of the primary tumor, the stage of metastatic disease, different surgical techniques, and the postoperative mobility on the postoperative survival has not been clearly defined. The aim of this retrospective study was to evaluate outcome after surgical treatment for pathologic femur fractures. PATIENTS AND METHODS: A consecutive series of 142 patients with metastatic fractures of femur were retrospectively studied. The operative treatment was based on intramedullary fixation (n = 94), gliding screws (n = 15), other extramedullary fixation devices (n = 7), and arthroplasty (n = 23). RESULTS: Seventeen percent and 6% of the patients survived 1 year and 2 years, respectively, postoperatively. Postoperative survival was higher in patients with pathologic femur fractures because of breast carcinoma than in patients with other primary tumors. The rate of complications for patients with intramedullary stabilization, gliding screw fixation, and endoprosthetic replacement was 3.2%, 20%, and 8.6%, respectively. CONCLUSION: Although many studies describe the endoprosthetic replacement as the safer method to treat pathologic femur fractures, our data showed that intramedullary stabilization and endoprosthetic replacement to be safe, and equivalent alternatives to treat complete pathologic fractures of the femur in patients with advanced metastatic disease.

Biomechanical comparison of modified Kessler and running suture repair in 3 different animal tendons and in human flexor tendons.

PURPOSE: To establish the animal flexor tendon that best mimics the biomechanical performance of human flexor tendons. We investigated the biomechanical behavior of core and running sutures in 3 different animal flexor tendons and in human flexor tendons. Additionally, we attempted to help standardize future flexor tendon studies. To that purpose, nearly all variables occurring in the test setup have been highlighted. METHODS: The species selected were pig, calf, sheep, and human. Two groups were formed. In the first group we tested 3-0 core sutures (Ticron; Tyco Healthcare, Vienna, Austria), and in the second group we tested 5-0 running sutures (Ethilon; Ethicon, Vienna, Austria). In each group, 10 tendons of each specimen were tested, which yielded a total of 80 tendons. In each group, the repaired tendons were subjected to 3,000 linear load cycles at a load of 15 N. At the end of this procedure, final gap values were recorded. In the next step, ultimate load-to-failure data were obtained from each specimen. RESULTS: Core sutures behaved similarly in the human, sheep, and pig tendons with respect to ultimate loads. With respect to gap formation, core sutures behaved similarly in the human, sheep, and calf tendons. Deep running sutures behaved similarly in the human, sheep, and pig tendons in terms of ultimate load to failure. CONCLUSIONS: In this study, sheep tendons were found to best mimic the biomechanical behavior of human tendons. Calf tendons seem to be unsuitable. There is a strong need for consistency in biomechanical test setups.