RESUMEN
PURPOSE: Posterior MIPO approach in the humerus has been described by using a 4.5mm LCP plate. Although straight plates have shown good results, they have not been designed to adapt to the distal humeral metaphysis. The goal of the study was to test the null hypothesis that there is no difference in hardware removal after posterior MIPO with either a straight or a pre-contoured plate. METHODS: Patients older than 18 years, who had suffered mid-distal humeral shaft fracture, were treated by a posterior MIPO technique with a locking plate and had a minimum of 12-month follow-up were retrospectively included. Patients were separated into: group 1 (LCP 4.5mm straight plate); and group 2 (3.5mm anatomically shaped plate). Clinical and radiological evaluation were performed in the postoperative period. Patient-reported outcomes and the need of hardware removal because of pain were assessed. RESULTS: Sixty-seven patients fulfilled the inclusion criteria. Twenty-seven patients in group 1 and 40 in group 2. No patient was lost to follow-up. There were no statistical differences between in patient reported outcomes measures. All the fractures healed. Within group 1, 18% (95%CI: 6-38%) of the patients required implant removal while in group 2 this incidence was 0% (95%CI: 0-9%) (P 0.009). CONCLUSION: These results suggest that the use of a 4.5mm LCP compared to an anatomical 3.5mm LCP in posterior MIPO of the humerus generates greater discomfort and therefore leads to a 18% increase in the risk of implant removal.
RESUMEN
PURPOSE: Posterior MIPO approach in the humerus has been described by using a 4.5mm LCP plate. Although straight plates have shown good results, they have not been designed to adapt to the distal humeral metaphysis. The goal of the study was to test the null hypothesis that there is no difference in hardware removal after posterior MIPO with either a straight or a pre-contoured plate. METHODS: Patients older than 18 years, who had suffered mid-distal humeral shaft fracture, were treated by a posterior MIPO technique with a locking plate and had a minimum of 12-month follow-up were retrospectively included. Patients were separated into: group 1 (LCP 4.5mm straight plate); and group 2 (3.5mm anatomically shaped plate). Clinical and radiological evaluations were performed in the postoperative period. Patient-reported outcomes and the need of hardware removal because of pain were assessed. RESULTS: Sixty-seven patients fulfilled the inclusion criteria. Twenty-seven patients in group 1 and 40 in group 2. No patient was lost to follow-up. There were no statistical differences between in patient reported outcomes measures. All the fractures healed. Within group 1, 18% (95%CI: 6-38%) of the patients required implant removal while in group 2 this incidence was 0% (95%CI: 0-9%) (P 0.009). CONCLUSION: These results suggest that the use of a 4.5mm LCP compared to an anatomical 3.5mm LCP in posterior MIPO of the humerus generates greater discomfort and therefore leads to a 18% increase in the risk of implant removal.
RESUMEN
The aim of the present study was to evaluate long-term functional and radiographic outcome in the distal radioulnar joint (DRUJ) for Galeazzi fracture-dislocation after anatomic reduction and rigid fixation of the radius. Fourteen patients, with an average age of 38 years, presenting with Galeazzi fracture-dislocation treated by open reduction and internal fixation (ORIF) of the radius and closed reduction of the DRUJ were retrospectively evaluated, with a minimum follow-up of 6 years. At final evaluation (mean: 8 years), the DRUJ was objectively and subjectively evaluated for range of motion (RoM), grip strength, ballottement test, pain on axial loading, function on visual analog scale (VAS) and DASH score. Radiographs and dynamic CT scans were performed to screen for DRUJ instability and/or osteoarthritis. Six of the patients had a positive comparative ballottement test, but none reported pain during the maneuver. No significant differences in RoM were found between the injured and uninjured wrist. Mean grip strength in the injured wrist was 77% of the contralateral value. Mean pain on VAS was 0.6. Mean global function on VAS was 9. Mean DASH score was 3. Dynamic CT showed no clear subluxation in any of the patients, and none showed severe articular changes. Our findings suggest that long-term clinical and radiological prognosis for the DRUJ in Galeazzi lesions is favorable when adequate closed reduction of the ulna is achieved after anatomical ORIF of the radius. LEVEL OF EVIDENCE: IV. Therapeutic case series.
Asunto(s)
Fijación Interna de Fracturas , Fracturas del Radio , Adulto , Femenino , Humanos , Masculino , Pronóstico , Fracturas del Radio/diagnóstico por imagen , Fracturas del Radio/cirugía , Estudios Retrospectivos , Articulación de la Muñeca/diagnóstico por imagen , Articulación de la Muñeca/cirugíaRESUMEN
OBJECTIVES: The purpose of this study was to evaluate the results and complications of locked palmar plating in patients with articular fracture of the distal radius. METHODS: Twenty-two patients were reviewed retrospectively. The average age was 68 years. All fractures were classified as Type C according to the AO classification. Clinical and functional examination including range of motion, grip strength, pain and return to previous activities were assessed. Loss of radial height, radial inclination, palmar tilt and ulnar variance were evaluated with preoperative and postoperative radiographs. RESULTS: At an average follow-up of 10 months, the range of motion was 124 degrees in flexion and extension and 178 degrees in pronation and supination. Grip strength was 80% of the opposite side. Fifteen patients were free of pain. Three patients suffered tenosynovitis of the extensor tendons. Radiographic measurements averaged 11 mm radial height, 21 degrees radial inclination, 4 degrees palmar tilt and 1 mm ulnar variance. CONCLUSIONS: The result of this study showed that locked palmar plating of articular distal radius fractures is effective even in cases of metaphyseal comminution with a low rate of complications.
Asunto(s)
Placas Óseas , Fijación Interna de Fracturas , Fracturas del Radio/cirugía , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Rango del Movimiento Articular , Estudios Retrospectivos , Articulación de la Muñeca/cirugíaRESUMEN
Antecedentes y objetivo: El abordaje posterior percutáneo del húmero se ha descrito utilizando una placa LCP de 4,5mm. A pesar de que las placas rectas han demostrado buenos resultados, estas no han sido diseñadas para adaptarse a la metáfisis del húmero distal. El objetivo de este estudio es probar la hipótesis nula de que no existen diferencias en la extracción de la osteosíntesis después de una MIPO posterior utilizando una placa recta comparado a una placa anatómica. Materiales y métodos: Se incluyeron retrospectivamente en 2 instituciones pacientes mayores de 18 años que habían sufrido una fractura diafisaria de húmero distal tratados mediante técnica percutánea posterior con una placa bloqueada y con un seguimiento mínimo de 12 meses. Los pacientes se dividieron en: grupo 1 (placa recta LCP de 4,5mm) y grupo 2 (placa de forma anatómica de 3,5mm). Durante el postoperatorio se reportó la evaluación clínica y radiológica, así como la necesidad de retirar el implante debido al dolor. Resultados: Sesenta y siete pacientes cumplieron los criterios de inclusión. Veintisiete pacientes en el grupo 1 y 40 en el grupo 2. No se perdió ningún paciente durante el seguimiento. Dentro del grupo 1, el 18% (IC 95%: 6-38%) de los pacientes requirieron extracción del implante, mientras que en el grupo 2 esta incidencia fue del 0% (IC 95%: 0-9%) (p 0,009). No hubo diferencias estadísticas entre las medidas de resultado informadas por los pacientes; todas las fracturas consolidaron. Conclusión: Los resultados de nuestro estudio demostrarían que el uso de placas LCP rectas de 4,5mm comparado a las placas anatómicas LCP de 3,5mm en MIPO posterior de húmero genera mayores molestias y, por lo tanto, conllevan un incremento en el riesgo de extracción del implante de un 18%.(AU)
Purpose: Posterior MIPO approach in the humerus has been described by using a 4.5mm LCP plate. Although straight plates have shown good results, they have not been designed to adapt to the distal humeral metaphysis. The goal of the study was to test the null hypothesis that there is no difference in hardware removal after posterior MIPO with either a straight or a pre-contoured plate. Methods: Patients older than 18 years, who had suffered mid-distal humeral shaft fracture, were treated by a posterior MIPO technique with a locking plate and had a minimum of 12-month follow-up were retrospectively included. Patients were separated into: group 1 (LCP 4.5mm straight plate); and group 2 (3.5mm anatomically shaped plate). Clinical and radiological evaluation were performed in the postoperative period. Patient-reported outcomes and the need of hardware removal because of pain were assessed. Results: Sixty-seven patients fulfilled the inclusion criteria. Twenty-seven patients in group 1 and 40 in group 2. No patient was lost to follow-up. There were no statistical differences between in patient reported outcomes measures. All the fractures healed. Within group 1, 18% (95%CI: 6-38%) of the patients required implant removal while in group 2 this incidence was 0% (95%CI: 0-9%) (P 0.009). Conclusion: These results suggest that the use of a 4.5mm LCP compared to an anatomical 3.5mm LCP in posterior MIPO of the humerus generates greater discomfort and therefore leads to a 18% increase in the risk of implant removal.(AU)
Asunto(s)
Humanos , Masculino , Femenino , Fijación Interna de Fracturas , Fracturas del Húmero/cirugía , Húmero/lesiones , Húmero/cirugía , Prótesis e Implantes , Procedimientos Quirúrgicos Mínimamente Invasivos , Estudios Retrospectivos , Ortopedia , Procedimientos Ortopédicos , Traumatología , Fracturas Óseas/cirugíaRESUMEN
Purpose: Posterior MIPO approach in the humerus has been described by using a 4.5mm LCP plate. Although straight plates have shown good results, they have not been designed to adapt to the distal humeral metaphysis. The goal of the study was to test the null hypothesis that there is no difference in hardware removal after posterior MIPO with either a straight or a pre-contoured plate. Methods: Patients older than 18 years, who had suffered mid-distal humeral shaft fracture, were treated by a posterior MIPO technique with a locking plate and had a minimum of 12-month follow-up were retrospectively included. Patients were separated into: group 1 (LCP 4.5mm straight plate); and group 2 (3.5mm anatomically shaped plate). Clinical and radiological evaluations were performed in the postoperative period. Patient-reported outcomes and the need of hardware removal because of pain were assessed. Results: Sixty-seven patients fulfilled the inclusion criteria. Twenty-seven patients in group 1 and 40 in group 2. No patient was lost to follow-up. There were no statistical differences between in patient reported outcomes measures. All the fractures healed. Within group 1, 18% (95%CI: 638%) of the patients required implant removal while in group 2 this incidence was 0% (95%CI: 09%) (P 0.009). Conclusion: These results suggest that the use of a 4.5mm LCP compared to an anatomical 3.5mm LCP in posterior MIPO of the humerus generates greater discomfort and therefore leads to a 18% increase in the risk of implant removal.(AU)
Antecedentes y objetivo: El abordaje posterior percutáneo del húmero se ha descrito utilizando una placa LCP de 4,5mm. A pesar de que las placas rectas han demostrado buenos resultados, estas no han sido diseñadas para adaptarse a la metáfisis del húmero distal. El objetivo de este estudio es probar la hipótesis nula de que no existen diferencias en la extracción de la osteosíntesis después de una MIPO posterior utilizando una placa recta comparado a una placa anatómica. Materiales y métodos: Se incluyó retrospectivamente en 2 instituciones a pacientes mayores de 18 años que habían sufrido una fractura diafisaria de húmero distal tratados mediante técnica percutánea posterior con una placa bloqueada y con un seguimiento mínimo de 12 meses. Los pacientes se dividieron en: grupo 1 (placa recta LCP de 4,5mm) y grupo 2 (placa de forma anatómica de 3,5mm). Durante el postoperatorio se reportó la evaluación clínica y radiológica, así como la necesidad de retirar el implante debido al dolor. Resultados: Sesenta y siete pacientes cumplieron los criterios de inclusión. Veintisiete pacientes en el grupo 1 y 40 en el grupo 2. No se perdió ningún paciente durante el seguimiento. Dentro del grupo 1, el 18% (IC del 95%: 6-38%) de los pacientes requirieron extracción del implante, mientras que en el grupo 2 esta incidencia fue del 0% (IC del 95%: 0-9%) (p = 0,009). No hubo diferencias estadísticas entre las medidas de resultado informadas por los pacientes; todas las fracturas consolidaron. Conclusión: Los resultados de nuestro estudio demostrarían que el uso de placas LCP rectas de 4,5mm comparado a las placas anatómicas LCP de 3,5mm en MIPO posterior de húmero genera mayores molestias y, por lo tanto, conllevan un incremento en el riesgo de extracción del implante de un 18%.(AU)
Asunto(s)
Humanos , Masculino , Femenino , Fijación Interna de Fracturas , Fracturas del Húmero/cirugía , Húmero/lesiones , Húmero/cirugía , Prótesis e Implantes , Procedimientos Quirúrgicos Mínimamente Invasivos , Estudios Retrospectivos , Ortopedia , Procedimientos Ortopédicos , Traumatología , Fracturas Óseas/cirugíaRESUMEN
The authors present a case of an infected nonunion of the humerus treated initially with reaming of the medullar canal followed by the introduction of an antibiotic-impregnated intramedullary rod. Reconstruction of the humerus with bone fixation and bone graft was performed in a second stage. The final result was healing of the fracture and a good functional result with no evidence of recurrence of infection at a 25 months follow up.
Asunto(s)
Antibacterianos/administración & dosificación , Fijación Intramedular de Fracturas , Fracturas no Consolidadas/cirugía , Fracturas del Húmero/cirugía , Osteomielitis/tratamiento farmacológico , Vancomicina/administración & dosificación , Adulto , Antibacterianos/análisis , Cementos para Huesos/química , Sistemas de Liberación de Medicamentos , Femenino , Humanos , Polimetil Metacrilato/química , Complicaciones Posoperatorias/cirugía , Polvos , Vancomicina/análisisRESUMEN
UNLABELLED: The aim of this study was to evaluate the clinical, radiographic, and functional outcomes of a cohort of patients with distal third humeral shaft fractures treated using a posterior minimally invasive plate osteosynthesis (MIPO) technique. Twenty-one patients were retrospectively evaluated, 13 men and 8 women with an average age of 37 years. The surgery was performed through two posterior incisions away from the fracture site. The radial nerve was identified and protected. The fracture was fixed with a narrow 4.5/5.0mm locking compression plate. After an average follow-up of 22 months, flexion-extension of the elbow was 138°±7°, with a range of motion of 131°. Shoulder motion was 160° in forward flexion, 59° in external rotation, and internal rotation was to the spinous process of 9th thoracic vertebra. Pain severity was 0.5 on the VAS. The DASH score was 9. Average Constant score was 84. MEPI was 97. Fracture union was obtained in all patients. One patient developed transient postoperative radial nerve palsy. These results demonstrate that the posterior MIPO technique is a reliable option for treating distal third humeral shaft fractures. LEVEL OF EVIDENCE: 4.
Asunto(s)
Placas Óseas , Fijación Interna de Fracturas/métodos , Fracturas del Húmero/cirugía , Nervio Radial , Adulto , Anciano , Diáfisis/lesiones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
We retrospectively evaluated the clinical and radiological outcomes of a consecutive cohort of patients aged > 70 years with a displaced fracture of the olecranon, which was treated non-operatively with early mobilisation. We identified 28 such patients (27 women) with a mean age of 82 years (71 to 91). The elbow was initially immobilised in an above elbow cast in 90° of flexion of the elbow for a mean of five days. The cast was then replaced by a sling. Active mobilisation was encouraged as tolerated. No formal rehabilitation was undertaken. At a mean follow-up of 16 months (12 to 26), the mean ranges of flexion and extension were 140° and 15° respectively. On a visual analogue scale of 1 (no pain) to 10, the mean pain score was 1 (0 to 8). Of the original 28 patients 22 developed nonunion, but no patients required surgical treatment. We conclude that non-operative functional treatment of displaced olecranon fractures in the elderly gives good results and a high rate of satisfaction.
Asunto(s)
Fijación de Fractura/métodos , Fracturas Óseas/cirugía , Olécranon/lesiones , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Moldes Quirúrgicos , Articulación del Codo/fisiopatología , Femenino , Fijación de Fractura/efectos adversos , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/rehabilitación , Humanos , Masculino , Olécranon/diagnóstico por imagen , Satisfacción del Paciente , Radiografía , Rango del Movimiento Articular , Estudios Retrospectivos , Resultado del Tratamiento , Lesiones de CodoRESUMEN
A prospective study was performed in 19 patients with trigger thumbs to define the anatomy of the A1 pulley of the thumb in this condition and to evaluate biomechanical parameters of the thumb after complete division of the A1 pulley. Pre- and postoperatively, flexion of the interphalangeal and metacarpophalangeal joints, key pinch strength and tip pinch strength were measured and compared with these measurements on the contralateral thumb. We identified three types of A1 pulley. The clinical data showed that there is no deficit with respect to motion and strength of the thumb after completely sectioning any of the three types of A1 pulley.