Lateral minimally invasive plate osteosynthesis (MIPO) with long PHILOS for proximal metaphyseal-diaphyseal humeral fracture: surgical techniques and a clinical series.

The minimally invasive plate osteosynthesis (MIPO) for proximal metaphyseal-diaphyseal humeral fracture is an effective alternative treatment with satisfactory outcomes. In this study, we described the surgical techniques and clinical results using MIPO via a lateral approach and long PHILOS plate fixation in 23 patients. All fractures were successfully united within a mean union time of 13.5 weeks (range 9-18). There was no iatrogenic radial nerve palsy. The deltoid power was grade 5 in all patients, except for 2 patients who had associated brachial plexus injury and gunshot injury at the deltoid muscle. The mean Constant-Murley score was 85.6 (range 16-98) and DASH score was 12.1 (range 1.7-85). Based on these findings, the lateral MIPO with long PHILOS plate fixation could be an alternative for the proximal metaphyseal-diaphyseal fractures of the humeral shaft.

Traction-Internal Rotation Radiograph Can Improve Agreement in AO/OTA Classification System for Intertrochanteric Fracture.

Purpose: The objective of our study was to evaluate the inter- and intra-observer reliability of the standard anteroposterior of both hips, traction-internal rotation, and the combination of the two radiographs for intertrochanteric fracture. Methods: In one hundred cases, three sets of radiographs of intertrochanteric fracture were prepared. Two senior and two junior orthopedic trauma surgeons were asked to classify the radiograph according to AO/OTA classification. The standard both hips radiograph, traction-internal rotation radiograph and combination of both techniques were evaluated. All radiographs were evaluated at two different points in time for all observers. The inter- and intra-observer reliability were analyzed with the Kappa agreement index. Results: Inter-observer agreement for standard radiographs was "substantial" in one while "moderate" in five among observers. After adding the traction radiograph to the standard radiograph, the agreement was improved to "substantial" in 4 while the rest was "moderate."Intra-observer agreement for standard radiographs was "substantial" in two observers and "moderate" in two observers. Adding traction to standard radiographs resulted in "substantial" in three observers and "moderate" in one observer.Overall pattern stability was changed in 19% after adding the traction film. Thirty-four percent of the fracture which initially diagnosed as A2.1 was changed from stable to unstable fracture patterns after adding the traction film. Conclusions: Adding traction-internal rotation radiograph to the standard radiograph is a useful method for improving agreement to classify intertrochanteric fracture regarding AO/OTA classification. This may be helpful in determining fracture classification.

Hybrid Achilles Tendon Repair.

In the treatment of acute Achilles tendon rupture, recent studies demonstrate that conservative treatment with functional rehabilitation provides good results, with nearly identical postoperative rerupture rates when compared with surgical treatment. Surgical treatment is indicated in patients with particular conditions, such as patients who are young active athletes who require early return to play or those who wish to avoid the muscle atrophy associated with conservative methods. If surgery is the selected option for treatment, the postoperative complications of each type of surgery must be considered. In conventional open repair, the most common complication is soft-tissue infection due to the high tension of soft tissue affected from the bowstring of the repaired tendon being kept in the equinus position of the ankle. For percutaneous methods, sural nerve entrapment and injury are the most commonly reported complications. Other methods, including endoscopy, require technical expertise as well as special equipment. Several types of combination approaches have been explored in the literature. We describe a combined open and percutaneous technique to repair the Achilles tendon, called the hybrid Achilles tendon repair. This technique has been developed to provide a simplified and reproducible method of hybrid repair in which the complications of previous methods are avoided and which can be done without special equipment.