Posterior minimally invasive plate osteosynthesis (MIPO) of distal third humeral shaft fractures with segmental isolation of the radial nerve.

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.

Non-surgical functional treatment for displaced olecranon fractures in the elderly.

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.

Comparative clinical study of locking screws versus smooth locking pegs in volar plating of distal radius fractures.

The present study was performed to test the null hypothesis on no difference in stability of fixation after volar plating of intra-articular distal radius fractures (AO C2-C3) with either locking smooth pegs or locking screws in a clinical setting. A retrospective evaluation included adult patients with C2-C3 AO fractures treated with a volar plate with locking smooth pegs or locking screws. Radiographic assessment was performed to evaluate extra- and intra-articular parameters in the early postoperative period and after bone union. Twenty-seven consecutive patients were included. Thirteen cases had fixation with locking screws and 14 had fixation with locking smooth pegs. Both groups had bone fragment displacement after fixation. However, there were no significant differences between the groups either in extra- or intra-articular parameters defined by Kreder et al. (1996). Our study shows that, in a clinical setting, there is no difference in stability fixation between locking screws or smooth locking pegs in C2-C3 distal radius fractures.

[Dorsally displaced intra-articular distal radius fractures treated by locked palmar plate. Technique and results]. / Les fractures intraarticulaires du radius distal à déplacement postérieur traitées par plaque palmaire à stabilité angulaire. Technique et résultats.

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.

A prospective clinical study of the A1 pulley in trigger thumbs.

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.

Fat embolism and related effects during reamed and unreamed intramedullary nailing in a pig model.

OBJECTIVES: To determine whether reamed or unreamed femoral intramedullary nailing is more adverse to pulmonary function, the authors compared three populations of healthy pigs, analyzing the biochemical and hemodynamic effects related to fat embolism. Likewise, the authors histologically evaluated the presence of bone marrow fat embolism in lungs, heart, kidney, brain, and retina. DESIGN: Randomized, experimental model. SETTING: Laboratory. PARTICIPANTS: Twenty-five male Duroc Jersey adult healthy pigs divided in three groups. INTERVENTION: Reamed and unreamed intramedullary nailing. OUTCOME MEASUREMENTS: Biochemical, hemodinamical, and histologic analysis. METHODS: In the first group of ten pigs, a reamed nail was inserted; in the second group of ten specimens, the authors placed an unreamed nail; and in the third group of five animals (control), only the surgical approach was made without opening the medullary cavity. RESULTS: The authors did not find statistically significant differences in pulmonary function between the reamed and unreamed group in the hemodynamic, biochemical, and histopathologic parameters evaluated. The histologic analysis of the lung tissue revealed a statistically significant difference between the nailed groups and the control (P < 0.04). CONCLUSIONS: In this animal model, the results indicate that pulmonary changes and fat embolization during intramedullary nailing occur to the same degree in reamed and in unreamed femurs.

Análisis comparativo de la embolia grasa durante el enclavado intramedular fresado y no fresado del femur en cerdos / Comparative analysis of the fat embolism during the milling and not milling intramedulary nailing of the femur in pigs

El propósito del siguiente trabajo fue analizar en un grupo de 25 cerdos la presencia de embolia adiposa de médula ósea en pulmones, corazón, riñón, cerebro y retina durante el enclavado endomedular del fémur, utilizando clavos con y sin fresado. Asimismo, se evaluaron las diferencias en los 3 subgrupos mediante estudios hemodinámicos y bioquímicos. En 10 animales se realizó el enclavado fresado, en otros 10 se colocó un clavo sin fresado de la cavidad y en otros 5 cerdos, denominado grupo control, se llevó a cabo solamente la anestesia general y el abordaje quirúrgico sin apertura de la cavidad medular. El análisis histológico del tejido pulmonar demostró una mayor incidencia de embolia grasa en ambos grupos enclavados al compararlos con el grupo control (p<0,04). Sin embargo, no se evidenció una diferencia significativa entre los grupos fresado y no fresado. No se observaron diferencias significativas en la función pulmonar según los parámetros histopatológicos, hemodinámicos y bioquímicos analizados entre los grupos fresado y no fresado. Según los resultados obtenidos en este modelo, los clavos fresados del fémur no presentan una mayor incidencia de embolia grasa en comparación con los clavos no fresados.

Análisis comparativo de la embolia grasa durante el enclavado intramedular fresado y no fresado del femur en cerdos / Comparative analysis of the fat embolism during the milling and not milling intramedulary nailing of the femur in pigs

El propósito del siguiente trabajo fue analizar en un grupo de 25 cerdos la presencia de embolia adiposa de médula ósea en pulmones, corazón, riñón, cerebro y retina durante el enclavado endomedular del fémur, utilizando clavos con y sin fresado. Asimismo, se evaluaron las diferencias en los 3 subgrupos mediante estudios hemodinámicos y bioquímicos. En 10 animales se realizó el enclavado fresado, en otros 10 se colocó un clavo sin fresado de la cavidad y en otros 5 cerdos, denominado grupo control, se llevó a cabo solamente la anestesia general y el abordaje quirúrgico sin apertura de la cavidad medular. El análisis histológico del tejido pulmonar demostró una mayor incidencia de embolia grasa en ambos grupos enclavados al compararlos con el grupo control (p<0,04). Sin embargo, no se evidenció una diferencia significativa entre los grupos fresado y no fresado. No se observaron diferencias significativas en la función pulmonar según los parámetros histopatológicos, hemodinámicos y bioquímicos analizados entre los grupos fresado y no fresado. Según los resultados obtenidos en este modelo, los clavos fresados del fémur no presentan una mayor incidencia de embolia grasa en comparación con los clavos no fresados. (AU)