Functional outcome of biological condylar blade plating of subtrochanteric fractures.

BACKGROUND: The aim of this study was to review high-energy subtrochanteric fractures treated biologically with the 95° angled blade plate, to assess the time to union and return to work, and to perform a functional evaluation using the traumatic hip rating scale. PATIENTS AND METHODS: This study is a retrospective review of 22 patients with 23 fractures. Twenty-one patients (96%) with 22 fractures were available for analysis. The average age was 33 years (range 18-47). There were seventeen males and four females. The right side was involved in fifteen patients, the left in five patients, and one patient had bilateral fractures. Motor vehicle accident was the predominant mode of injury in eleven patients. Seven patients had other associated injuries. 32B2.1 (40%) was the commonest fracture pattern according to the OTA classification. RESULTS: The average follow-up period was 29 months (range 12-49). The mean time to fracture healing was 16 weeks (range 12-32). All patients returned to their pre-fracture occupation (100%). Eighteen patients (86%) healed without any additional surgery. The outcome according to the hip rating scale was excellent in ten patients and good in eleven patients. Two patients (9%) required additional surgery. CONCLUSIONS: Biological fixation of subtrochanteric fractures using 95° CBP results in a high union rate with low morbidity and good functional outcome.

Non-vascularised fibular graft as an intramedullary strut for infected non-union of the humerus.

PURPOSE. To review outcomes of 7 patients who underwent revision surgery for infected non-union of the humerus using a fibular graft as an intramedullary strut. METHODS. Records of 7 men aged 29 to 59 (mean, 40) years with humeral diaphyseal infected non-union who underwent fixation using a compression plate and a non-vascularised fibular graft as an intramedullary strut were reviewed. The mean number of previous surgeries was 2.7 (range, 2-4). Three of the patients had active draining sinuses previously. Their C-reactive protein levels were normal and tissue cultures negative. The remaining 4 patients had active draining sinuses. They first underwent implant removal and debridement. Tissue cultures confirmed infection in 3 of them. The mean duration between debridement and the index surgery was 5 (range, 3-10) months. RESULTS. The mean length of the fibulae harvested was 13 (range, 12-15) cm. All 7 non-unions healed. The mean time to healing was 5.4 (range, 4-8) months. The mean follow-up period was 15 (range, 13-24) months. All patients had weakness of the extensor hallucis longus, which improved to near normal at month 3. There was no donor-site morbidity. Three patients with active infection at presentation underwent repeat surgery. Two of them had wound washouts, and their non-unions went on to heal successfully; one underwent implant removal after union due to an active sinus. Six of the patients returned to their pre-injury activity level, and one endured a brachial plexus injury. CONCLUSION. Fixation using a compression plate and a non-vascularised fibular graft as an intramedullary strut achieved good outcome for infected non-union of the humerus despite prior multiple failed surgeries.