A comparative study of Colles' fractures in patients between fifty and seventy years of age: percutaneous K-wiring versus volar locking plating.

PURPOSE: This retrospective study was to compare the clinical outcomes of volar locking plating (VLP) and percutaneous Kirschner wiring (PKW) for the management of displaced Colles type distal radius fractures in patients between 50 and 70 years old. METHODS: There were 31 elderly patients with displaced Colles' fractures treated by VLP. We compared them to 31 match-paired patients treated by PKW. The patients were matched according to age (within five years) and sex. All patients were followed up retrospectively for at least 12 months. The functional outcomes and radiological results were compared between the two groups. RESULTS: All fractures healed within three months. There were two complications (6.5%) in the PKW group and one complication (3.2%) in the VLP group. At final follow-up, wrist flexion, extension, and ulnar deviation were significantly better in the VLP group compared with the PKW group (all p values<0.05). According to modified Green and O'Brien criteria, the VLP group showed a trend towards increased rate of satisfactory outcome compared with the PKW group (p = 0.09). CONCLUSION: For the treatment of displaced Colles' fractures in patients between 50 and 70 years old, both groups had high union rate and low complication rate. However, better functional results can be expected in association with open reduction and volar locking plating.

Lateral fixation of AO type-B2 ankle fractures: the Acutrak plus compression screw technique.

The Acutrak plus compression screw (APCS) (Acumed Inc., Beaverton, OR, USA) is an intramedullary implant which can achieve stable fixation with minimum soft tissue dissection. The characteristics of the APCS include fully-threaded length, headless, cannulated, and variable thread pitch. Twenty-three patients with AO type-B2 ankle fractures treated with lateral fixation by an APCS were retrospectively reviewed. Evaluation of postoperative roentgenograms for adequacy of reduction revealed a good reduction in 22 of 23 (95.7%) patients. The average wound incision was 4.1 cm. The operative time was 25.3 minutes. All the ankle fractures showed radiographic evidence of healing within four months. At the final follow-up, the ankle scores of the patients were evaluated for functional outcomes. Good to excellent results were obtained in 21 (91.3%) patients. No patient complained of symptomatic hardware. In conclusion, lateral fixation of AO type-B2 ankle fractures by APCS offers several advantages including stable fixation, a small surgical wound, less dissection of soft tissue, no palpable hardware, and easy application with a short operating time.

Surgical treatment of midclavicular fractures in the elderly: a comparison of locking and nonlocking plates.

Operative treatment of midclavicular fractures in patients older than 60 years poses an increased risk of fixation failure. Although plating of midclavicular fractures in the elderly is still a popular fixation method, osteopenic bone may result in plate loosening and fixation failure. The purpose of this study is to prospectively evaluate and compare the clinical outcomes of midclavicular fractures in patients older than 60 years who are treated with either a locking compression plate or nonlocking plate. Sixty-four elderly patients with midclavicular fractures were surgically treated with either a locking compression plate or nonlocking plate, which included dynamic compression plates and reconstruction plates. The locking compression plate group included 29 patients with an average age of 69.1 years. The nonlocking plate group included 35 patients with an average age of 66.3 years. Both groups were similar for age, gender, injury mechanism, fracture patterns, and confounding medical condition (P>.5). However, the locking compression plate group had lower complication rates compared to the nonlocking plate group (P=.087). In addition, the locking compression plate group had higher rates of return to work and exercise (P=.02, P=.016, respectively). If surgery of elderly patients with midclavicular fractures is indicated, internal fixation with a locking compression plate is preferable to a nonlocking plate.

Surgical treatment of distal tibia fractures: a comparison of medial and lateral plating.

The surgical method of repairing distal tibial fractures remains controversial. Open reduction and plating is a popular method that can result in good fixation and retention of the achieved position. The usual approach for open plating is anterior. Although it offers good exposure to the tibia, the medial plating is at high risk of wound problems and nonunions. Also, if fixation of the fibula is required, an additional incision must be made on the lateral side of the shin. Lateral plating using a single lateral approach for treating distal tibial and fibular fractures has been reported to have good results; however, most of these studies were small series. We retrospectively evaluated and compared the clinical outcomes of distal tibial fractures treated with medial plating using an anterior approach and lateral plating using a lateral approach. Eighty-eight patients with distal tibial fractures treated with medial or lateral plating were retrospectively reviewed. The 88 fractures were divided into 2 groups: the medial plating group used an anterior approach and included 49 patients and the lateral plating group used a lateral approach and included 39 patients. Both groups were similar with respect to injury mechanism, union rate, malunion rate, operative time, functional score, and range of ankle motion (P>or=.14). Both medial and lateral plating for treating distal tibial fractures achieved good functional outcomes with a low malunion rate; however, the lateral plating group had a lower complication rate (P=.047) and fewer hardware problems (P<.001).

Comparison of the efficacy of hook plate versus tension band wire in the treatment of unstable fractures of the distal clavicle.

Fifty-two patients with unstable fractures of distal clavicle treated by open reduction and internal fixation with hook plates or tension band wires were retrospectively reviewed. The 52 patients were divided into two groups based on the method of treatment. The hook plate (HP) group included 32 patients and the tension band wire (TBW) group included 20 patients. Both groups were similar in respect to injury mechanisms, compounding medical conditions, and shoulder score (p > 0.1). However, hook plating had a significantly lower rate of complication (p = 0.01) and symptomatic hardware (p = 0.001). In addition, hook plating better facilitated the return to work and athletic activity (p = 0.004 and p = 0.003, respectively). In conclusion, if surgery of distal clavicular fractures is indicated, internal fixation with a hook plate has more advantages than with tension band wires.

Lateral fixation of open AO type-B2 ankle fractures: the Knowles pin versus plate.

Forty-seven patients with open lateral malleolar (AO type-B2) fractures treated with copious irrigation and radical debridement, reduction, and immediate fixation by Knowles pins or lateral plates were retrospectively reviewed with an average follow-up period of 29 months. The 47 patients were divided into two groups, based on the method of treatment. The Knowles pin group included 25 patients. The plate group included 22 patients. There was no difference between the Knowles pinning and lateral plating with respect to the rate of good reduction (96% vs. 95.5%, p = 1). Both of the groups were similar in good and excellent results (92% vs. 86.4%, p = 0.65). However, Knowles pinning had significantly shorter operation time, smaller wound size, less symptomatic hardware, and lower complication rate than lateral plating (all p values <0.04). In conclusion, lateral fixation of open AO type-B2 ankle fractures by the Knowles pin is recommended due to its efficacy, simplicity, and low complication rate.

Stabilisation of the fractured fibula plays an important role in the treatment of pilon fractures: a retrospective comparison of fibular fixation methods.

Ninety-eight pilon fractures associated with ipsilateral distal fibular fracture were included in this study. The pilon fractures were treated by open reduction and plating. The 98 fractures were divided into three groups based on the treatment method of fractured fibula. Group A was composed of 50 fibular fractures treated by open reduction and plate fixation. Group B was composed of 23 fibular fractures treated by open reduction and pin fixation. Group C was composed of 25 fibular fractures treated conservatively by closed reduction. The radiographs were reviewed for adequacy of fracture reduction and posttraumatic arthrosis. At the end of follow-up, the clinical outcomes were evaluated using a rating scale. The three groups were similar in respect to Ruedi type, open fracture grade, and demographics (all p values >0.25). Group A showed a decreasing trend of malunion and ankle arthrosis compared to group C (p = 0.091 and p = 0.099, respectively). Group A had a better clinical outcome than group C (p = 0.008). In addition, group A showed an increasing trend of satisfactory outcome compared to group B (p = 0.096). In conclusion, for pilon fractures associated with ipsilateral fibular fractures, stabilisation of the fractured fibula plays an important role in the decrease of distal tibial malunion and post-traumatic ankle arthrosis as well as improvement of clinical outcomes.

Internal fixation of undisplaced femoral neck fractures in the elderly: a retrospective comparison of fixation methods.

BACKGROUND: There has been no report related to comparison of fixation methods using minimally invasive dynamic hip screw (MIDHS), conventional dynamic hip screw (CDHS), and multiple cannulated screws (MCS) for treating the undisplaced femoral neck fractures. METHODS: The study retrospectively evaluates the comparison of fixation methods. Ninety elderly patients (>60 years) with the undisplaced intracapsular femoral neck fractures were treated with osteosynthesis by either dynamic hip screw (DHS) or MCS. The patient distribution was regarded as randomized. A new minimally invasive technique of DHS (MIDHS) was presented. Pauwels' classification was used to evaluate the fracture verticality. Singh index was used to evaluate the bone quality. All patients were followed up retrospectively for at least 12 months to compare the clinical results among the MIDHS, CDHS, and MCS groups. RESULTS: Pauwels types and Singh index were similar among the three groups (all p values >/=0.78). The CDHS group had significantly larger wound incision, greater hemoglobin level drop, and longer hospital stay than either the MIDHS or MCS groups (all p values /=0.28). The MIDHS group showed a trend of an increased rate of overall success compared with the MCS group, although this was not statistically significant (97% vs. 84.4%, p = 0.11). CONCLUSION: CDHS had more disadvantages related to more soft tissue stripping than either MIDHS or MCS. MIDHS showed a trend of an increased rate of overall success in an elderly patient with undisplaced femoral neck fracture when compared with MCS.

Arthrodesis for ankle osteoarthritis after harvesting of free vascularized fibular bone: a case report.

INTRODUCTION: Although free vascularized fibular bone grafting is a good method for the reconstruction of large bone defects, it might cause morbidity of the donor leg. Progression of ankle osteoarthritis, valgus deformity and instability of the donor leg subsequently leading to arthrodesis has rarely been reported. MATERIALS AND METHODS: A 53-year-old man suffered from a left tibial comminuted and Gustilo type IIIb open fracture. A folded free vascularized osteoseptocutaneous flap was harvested from the right fibula and transferred to the left tibial bone defect. After the reconstructive surgery, the patient obtained a solid union of the left tibial shaft uneventfully. Ten years later, he suffered intermittent pain on his right ankle. Plain radiographs revealed progressive tibiotalar osteoarthritis. Right ankle arthrodesis with crossed cannulated screws fixation and osteosynthesis of the fibula to the tibia and talus were performed. However, this procedure failed due to a deep infection and osteomyelitis. A revision of the failed ankle fusion was performed by using a vascularized iliac bone flap to strut the anterolateral aspect of the tibiotalar bone defect. A ventral plate fixation and supplementary onlay bone grafting were applied across the anterior aspect of the tibiotalar joint. At the 2-year follow-up, the patient had no pain and resumed his regular daily activities. CONCLUSIONS: Harvesting of the fibula may cause longterm ankle osteoarthritis that requires ankle arthrodesis. In revision arthrodesis a ventral plate fixation and vascularized iliac bone flap may be the treatment of choice, neutralizing the large moment due to the long lever arms.

Intramedullary fixation of tibial shaft fractures: a comparison of the unlocked and interlocked nail.

The study is a prospective evaluation and comparison. Eighty-two patients with tibial shaft fractures were treated with intramedullary fixation by either an unlocked nail (ULN) or an interlocked nail (ILN). All patients were followed up for 12 months with a functional score evaluation. The patients were divided into two groups, based on the method of treatment. The ULN group included 42 patients with an average age of 43.1 years. The ILN group included 40 patients with an average age of 40.0 years. Both groups were similar in the injury mechanism, fracture location, open fracture type and associated medical conditions (all P > 0.05). The operative time was shorter and the wound size smaller in the ULN group when compared to the ILN group (P < 0.001). The union rate, healing time and malunion rate were not significantly different between the two groups (P > 0.05). Although the functional score showed no difference between the groups (P = 0.3), the ILN group had a greater ability to return to their work 6 months after surgery (P = 0.03). In conclusion, unlocked nailing for tibial shaft fractures is a simple and effective method especially in the treatment of middle-third fractures. Interlocked nailing gives stable fixation without cast immobilisation, which resulted in a greater ability for the patients to return to their previous work 6 months after surgery.

Surgical treatment of midclavicular fractures: a prospective comparison of Knowles pinning and plate fixation.

Although several surgical techniques for midclavicular fractures have been reported, Knowles pinning has rarely been compared with plating. The purpose of this study is to compare the clinical results of these two alternative techniques. There were 88 patients with midclavicular fractures surgically treated with either a Knowles pin or a plate. All patients were followed up for 12 months with a shoulder score evaluation. The Knowles pin group included 56 patients, with an average age of 40.1 years. The plate group included 32 patients, with an average age of 38.2 years. Both groups were similar in injury mechanism and fracture types (all p values>0.5). Plating has a significantly longer operation time, larger wound incision, higher pain level, more analgesic use, more complications and more symptomatic hardware (all p value<0.05). The shoulder score, union rate and healing time are not significantly different between the two groups (all p values>0.2). In conclusion, if the surgery of mid-third clavicular fractures is indicated, fixation with a Knowles pin has more advantages than plate fixation.

Operative treatment of midclavicular fractures in 62 elderly patients: knowles pin versus plate.

This prospective, randomized trial compared treatment with Knowles pins and plates in 62 elderly patients (>50 years) with midclavicular fractures. The clinical outcomes were evaluated at 30 months postoperatively. The mean shoulder score of the Knowles pinning was 85 points and the plating was 84 points (P=.7). Knowles pinning requires significantly shorter operative time (P<.001), smaller wound size (P<.001), shorter hospital stay P=.03), less meperidine use (P=.02), lower complication rate (P=0.04), and less symptomatic hardware (P=.015). If surgery of mid-third clavicular fractures is indicated, fixation with a Knowles pin has more advantages than plate fixation in elderly patients.

Lateral fixation of AO type-B2 ankle fractures in the elderly: the Knowles pin versus the plate.

The study was a retrospective evaluation and comparison. Seventy-five elderly patients (>50 years) with AO type-B2 ankle fractures were treated by open reduction and internal fixation. All patients were followed up retrospectively for at least 12 months. The 75 patients were divided into two groups, based on the method of treatment. The Knowles pin (KP) group included 45 patients with an average age of 62.7 years. The tubular plate (TP) group included 30 patients with an average age of 60.0 years. The clinical results were compared between the two groups. Both of the groups were similar in respect to the injury mechanisms, fracture pattern, open fracture grade, compounding medical conditions, and ankle score (all P values <0.28). However, the KP group had significantly smaller wound incisions, shorter surgery time, shorter hospital stay, less meperidine use, less symptomatic hardware, and lower complication rates than the TP group (all P values <0.03). In conclusion, lateral fixation of AO type-B2 ankle fractures in the elderly by the Knowles pin is recommended due to its simplicity, efficacy and low complication rate.

Dynamic hip screw in the treatment of intertrochanteric fractures: a comparison of two fixation methods.

The study is a prospective evaluation and comparison. A minimally invasive Dynamic Hip Screw (MIDHS) technique is presented. One hundred and two patients with intertrochanteric fractures were treated with either a MIDHS or a conventional dynamic hip screw (CDHS). We used the Singh index as a measure of osteoporosis and also classified the fractures according to three different systems (OTA, Boyd-Griffin, and Evans). All patients were followed up for 12 months with a hip score evaluation. The patients were divided into two groups, based on the method of treatment. The MIDHS group includes 42 patients with an average age of 72.6 years. The CDHS group includes 60 patients, with an average age of 71.3 years. Both groups were similar in injury mechanism, fracture types, mean Singh index and confounding medical condition (all p values >0.05). The CDHS group had significantly larger wound incision, greater haemoglobin level drop, higher pain level, more total analgaesic use and longer hospital stay than the MIDHS group (all p values<0.05). The hip score, union rate, healing time, adequate reduction and adequate screw position rate was not significantly different between the two groups (all p values >0.05). In conclusion, either a MIDHS or a CDHS in the treatment of intertrochanteric fractures is an effective, simple and safe method. The mini-invasive technique as opposed to the conventional technique has smaller wound size, lower pain level, and lower blood loss. Hospital stay and total analgaesic use were decreased, benefitting the patient and reducing hospital cost.

Long-term results of pilon fractures.

INTRODUCTION: The long-term results of pilon fractures are rarely documented. The present study evaluated the long-term results related to each fracture pattern of a pilon fracture treated with open reduction and plating. PATIENTS: One hundred and twenty-eight pilon fractures with a mean 10-year follow-up were divided into three groups, based on the Ruedi-Allgower classification. Group A was composed of 39 patients with Ruedi-Allgower type I fractures; group B comprised 62 patients with type II fractures; and group C included 27 patients with type III fractures. The radiographs were reviewed for adequacy of fracture reduction and posttraumatic arthrosis. At the end of follow-up, the clinical results were evaluated using a rating scale. RESULTS: Group C had significantly lower excellent and good reduction rates than group A or B (P < 0.05). Groups B and C had progressively increased ankle arthrosis with time (P = 0.043, P = 0.049, respectively). Group C had more unsatisfactory clinical outcomes than group A or B (P < 0.05). Operative concurrent fixation of the fractured fibula resulted in a better outcome than non-operative treatment (P < 0.05). Open fractures had significantly lower satisfactory outcomes than closed fractures (60.5% versus 78.9%, P < 0.05). CONCLUSIONS: Open reduction with plating was a reasonably effective procedure for the treatment of Ruedi type I pilon fractures. The long-term outcome of pilon fractures was affected by fracture patterns, fibular length restoration, quality of reduction, and severity of soft tissue injury. Posttraumatic arthrosis affecting the ankle after a severe pilon fracture (Ruedi type II or III) was a progressive disease, and required long-term follow-up.

Operative treatment of displaced lateral malleolar fractures: the Knowles pin technique.

OBJECTIVES: To assess the use of Knowles pin fixation for isolated displaced lateral malleolar fractures and to present our surgical experience using this method. DESIGN: Retrospective evaluation. SETTING: The study was carried out at a municipal teaching hospital. The senior surgeons were all orthopedic trauma subspecialists. PATIENTS: A total of 168 patients meeting our inclusion criteria, an isolated displaced lateral malleolar fracture surgically treated by a Knowles pin between 1995 and 2000, were studied. All the patients had a stable syndesmosis, less than 50% comminution, and had no other operations in the same extremity. Patients were assigned into 4 groups according to the Orthopedic Trauma Association classification of ankle fractures. INTERVENTION: Open reduction and internal fixation with a Knowles pin fixation of the lateral malleolus. MAIN OUTCOME MEASUREMENTS: Functional results were evaluated using the Baird and Jackson ankle scoring system. RESULTS: There was a 100% union rate. The average satisfactory outcome of the 4 groups was 88.1%. No instrumentation problems were encountered. Three complications occurred, but resolved with nonoperative therapy. CONCLUSIONS: Knowles pin fixation for displaced lateral malleolar fractures is a useful and effective method. This implant offers several advantages, including easy application, less soft tissue dissection, less palpable instrumentation, stable fixation, and a short operating time.