Intercondylar distal humerus fractures--surgical treatment and results.

INTRODUCTION: Controversy persists concerning the preferred treatment for intercondylar distal humerus fractures. The present study was undertaken to evaluate the clinical results after the surgical treatment of 40 intercondylar distal humerus fractures with an average follow-up of 3.9 years. METHODS: The fractures were classified following the AO/ASIF comprehensive classification. Eight patients presented multiplane fractures. Skeletal traction was used temporarily in two cases. The stabilization method was selected according to the fracture pattern, bone quality and associated lesions. Bone graft was used in seven cases. Fibrin-glue was used in two cases. Unilateral hinged external fixators were used in addition in four cases. Functional assessment was done according to the scoring system of the Orthopedic Trauma Association and additional parameters taken from the system of Jupiter. RESULTS: Final global results were excellent in 13 patients, good in 21, fair in four and poor in two. Complications included three non-unions, two heterotopic ossifications, two internal fixation failures and two lateral condyle resorptions (avascular necrosis). DISCUSSION: Final results are related to the severity of the initial trauma, time elapsed between the accident and definitive surgery, associated lesions, bone quality, precise reconstruction of a smooth and congruent joint surface, surgical technique, implants used, stability obtained and patient cooperation. The type, number and location of the osteosynthesis material must be selected according to the fracture pattern, bone quality and associated lesions.

Osteoarthritis of the wrist secondary to non-union of the scaphoid.

The surgical treatment of osteoarthritis of the wrist secondary to pseudarthrosis of the scaphoid is presented in the light of twenty years experience, and with improved knowledge of the pathological anatomy of this problem. The condition is difficult to treat owing to the varied pathology, the different needs of the patients and the alternative treatments available. Where a pseudarthrosis exists with involvement of the scaphoid-radius joint only, we recommend radial styloidectomy and repair of the pseudarthrosis. Where the pseudarthrosis is associated with carpal collapse which can be corrected, and osteoarthritis is confined to the joint between the capitate and lunate bones, we recommend correction of the carpal collapse and an arthrodesis between the lunate, capitate, hamate and triquetrum, with either anatomical repair of the scaphoid or eventual replacement with a Silastic implant. Where there is irredicable carpal collapse or lunate dislocation, proximal row carpectomy is recommended as an alternative to arthrodesis. Pseudarthrosis of the proximal pole of the scaphoid is best treated by replacement of the small bone fragment with a Silicone rubber implant. For pseudarthrosis with a painful arthritic joint of radius, scaphoid and lunate without involvement of the other periscaphoid joints, we recommend arthrodesis of the affected joints only. Finally, in cases of pseudarthrosis with advanced degenerative changes in the radiocarpal and intercarpal joints with associated collapse and deformity, or following unsuccessful resection, we recommend arthrodesis of the wrist.

Tension-band arthrodesis in the finger joints.

Tension-band arthrodesis was employed in 26 finger joints with various pathological lesions. This is a simple procedure based on the principles of compression osteosynthesis. Stability thus achieved makes immobilization of the hand unnecessary and allows full motion of all adjacent joints.

Wrist arthrodesis.

Arthrodesis of the wrist is an excellent procedure indicated only in carefully selected and evaluated cases. Eleven patients with various pathological lesions were treated by a modification of standard surgical techniques. Good stability and bone graft placement was secured by an easily removed internal fixation device. External immobilization was required for minimal periods of time. The end results were satisfactory.