TREATMENT OF PUBIC DISJUNCTION IN YOUNG-BURGUESS TYPE II AND III PELVIC RING FRACTURES.

AIM: To present the personal experience in assessing the treatment of pubic disjunction in Young-Burguess type II and III pelvic ring fractures. MATERIAL AND METHODS: Included in the study were 30 patients with type II and III pelvic ring fractures, aged 32 to 76 years. Of these, 18 patients were treated with external fixation, and 12 patients were treated surgically: type II fractures were treated with open reduction and internal fixation (ORIF) of pubic disjunction and type III fractures underwent additionally posterior fixation. RESULTS: Mean follow-up was 1.6 years. After external fixation we found the persistence of diastasis (1.5 to 4 cm), which was asymptomatic in all cases. Complications included implant failure in 3 patients, and postoperative infection in 2 patients. Among the 5 patients with type II lesions the clinical and radiological scores were excellent in 3, good in 1, and poor in 1. Among the patients with type III lesions the clinical outcomes were excellent in 5 and good in 2. CONCLUSIONS: External fixation has proved a good treatment option for patients who cannot tolerate a more extensive surgery. There is no conclusive clinical evidence favoring the use of two perpendicular plates vs. 1 plate for pubic symphysis fixation. In osteonorotic patients the use of 2 plates is recommended.

Treatment of proximal humeral fractures using telegraph rod: retrospective study of 47 cases.

AIM: To assess the early results observed in a series of patients treated with a first-intention Telegraph rod. MATERIAL AND METHODS: In the interval 2011-2013 forty-seven patients with fractures of the upper extremity of the humerus were assessed both clinically and radiologically. Mean follow-up was 8.9 months. The median age was 61 years. The study group included 39 women and 8 men, the left shoulder being most commonly affected (33 cases). Cause of injury was accidental fall in 39 cases fall, sports injury in 6 cases, and car crash injury in 2 cases. Neer classification was used to assess the type of fracture. For qualitative analysis, we used the functional Constant-Murley score in comparison with the contralateral side. The analysis of fracture reduction was based on plain X-rays in anterior-posterior plane and measurement of humeral head tilt relative to diaphyseal shaft. RESULTS: No case showed infection, humeral head necrosis occurred in 2 cases, loss of reduction in 3 cases which required repeat reduction, and a subacromial impingement syndrome in 2 cases. Average Constant-Murley score was 70.33 points for the injured and 86.4 points for the healthy shoulder. Mean value of reduction angle of the humeral head relative to diaphyseal shaft was 33.75 degrees (range 3 to 81 degrees). CONCLUSIONS: Telegraph rods provide a secure fit in extra-articular and simple articular fractures of the proximal humerus. When performing a closed anatomical reduction, the method provides good functional results in most patients. This option should be considered in young patients and even in the elderly, the results being comparable to those obtained by hemiarthroplasty.