The use of articulated external fixation for complex elbow trauma treatment.

INTRODUCTION: We use external elbow joint fixator (FE-F4) for fracture and dislocation of the ulnohumeral joint to evaluate the early articular mobilization maintaining concentric reduction, protecting the osteoligamentous reconstruction and avoiding postoperative stiffness. MATERIALS AND METHODS: Thirty-two patients (13 men and 19 women) were treated with FE-F4: 7 simple dislocations (21.9%), 15 distal humerus fractures (46.9%), 4 fractures and dislocations of which 1 terrible triad (12.5%), and 6 complex dislocations (18.7%). The mean age was 64 years. The average follow-up (FU) was 47 months. We evaluated the flexion-extension and prone-supination movement arc, VAS (Visual Analogue Scale), Quick DASH (Disability of the Arm, Shoulder and Hand score), MEPI (Mayo Elbow Performance Index) and the Broberg and Morrey rating system. RESULTS: The average ROM was 125.9° for flexion-extension, 77.8° for pronation and 79.7° for supination. The average VAS was 0.56 at the FU, the MEPI score of 93.6, the Broberg and Morrey rating system of 92.4 and the Quick DASH of 8.7. No major complications were found after surgery, and no objective or subjective posterolateral or medial joint instability was found. No patients at the FU had a new surgery with arthromyolysis or elbow arthroplasty. DISCUSSION: The elbow joint stiffness is the main cause of functional inability for the patient suffering from posttraumatic outcomes. The FE-F4 allows an early mobilization, even in case of injuries or complex reconstructions, keeping the joint stable and protecting any bone synthesis and the damaged capsule-ligament structures. LEVELS OF EVIDENCE: IV.

The use of TightRope fixation for ankle syndesmosis injuries: our experience.

PURPOSE: Ten percentage of all ankle fractures sustain an associated syndesmotic injury. TightRope is a relatively new technique for syndesmosis fixation, characterized by a non-absorbable FibreWire held tight between two cortical metal buttons. The purpose of this study was to evaluate the results obtained with the use of this device. METHODS: From January 2011 to December 2015, 54 patients with ankle diastases were treated. Eighteen patients were excluded from the study. Fractures of the fibula or tibia requiring fixation were internally fixed using standard AO techniques. Preoperative and the most recent postoperative ankle radiographs were reassessed for measurements of the tibiofibular clear space (TFCS), medial clear space (MCS) and tibiofibular overlap (TFO). Clinical outcomes were assessed at the time of follow-up using the American Orthopaedic Foot and Ankle Society (AOFAS) score, a self-administered Foot and Ankle Disability Index (FADI) score and patients satisfaction. RESULTS: The mean follow-up was 28, 64 months. Mean values for MCS, TFCS and TFO were 1.51-1.53 and 0.25 cm, respectively. The mean AOFAS score was 93.11, and the mean FADI score was 130.11. Twenty-nine (80.6 %) patients reported their outcome as excellent or very good. CONCLUSIONS: TightRope technique can achieve flexible fixation of the syndesmosis and permit full range of motion of the tibiofibular joint. Patients can start rehabilitation exercise at an early stage after operation. The results of this study indicate that TightRope fixation is a valid option for syndesmotic injuries.

Hinged external fixation for complex fracture-dislocation of the elbow in elderly people.

The authors report their experience of treating complex elbow fracture-dislocations in elderly people, using a minimally-invasive approach with a new articulated external fixator that is associated with minimal internal fixation. The clinical results for 19 patients are presented according to outcome factors, such as range of motion, pain and function, rate and type of complications, and reoperation rate. The results indicate that this treatment strategy should be considered as a good alternative to other treatment options reported in the literature, including conservative treatment, ORIF with angular stable plates and total elbow arthroplasty.

Treatment of non-union of the humerus using the Orthofix external fixator.

An Orthofix monolateral axial external fixator was used to treat 31 patients with non-union of the humeral shaft, 30 of whom had been previously treated surgically. In seven cases the non-union was hypertrophic and one of these cases had been treated by simple fixation anol compression, the others by fixation, bone grafting and decortication; in 20 cases the non-union was hypotrophic and had been treated by fixation and decortication with bone grafting. The remaining four cases had septic non-union, treated by debridement of the focus of infection and fixation, followed in three cases by a bone graft and osteomuscular decortication once the infection had been eradicated. The fracture site consolidated in all patients in a mean time of 4.9 months. Five patients required further surgery: three in the group with infected non-union and two who had had a new bone graft and application of the external fixator, one because of a refracture (the patient was receiving chronic treatment with antimitotic agents) and one because of persistent non-union. There were no major complications (e.g. radial nerve palsy, joint stiffness, deep infection), and only six cases of pin track infection (5% of the screws implanted). The authors believe that this method is reliable, effective and low risk provided that the patient is cooperative; furthermore, the monolateral axial external fixator is tolerated well and allows movement of the shoulder and elbow throughout the period of treatment.

Preoperative, single-fraction irradiation for prophylaxis of heterotopic ossification after total hip arthroplasty.

We gave a single fraction of 750 cGy preoperatively (within 16 h of surgery) to 143 patients prior to total hip arthroplasty. The patients were evaluated for heterotopic ossification at 1, 3 and 6 months. The preoperative radiation did not affect the surgical procedure. After a median follow-up of 12 (6-24) months we encountered six patients with heterotopic ossifications of Brooker grade I-II. Potential late risks from ionising radiation should be considered when treating younger patients.

External dynamic fixation in fractures of the humerus: can it still be considered treatment of second choice?

The authors report 40 patients affected with diaphyseal fracture of the humerus treated by dynamic axial fixator (FAD Orthofix). Minimum follow-up was 2 years. A clinical and radiographic retrospective study was conducted with the purpose of verifying the validity of external fixation as treatment of choice in diaphyseal fractures of the humerus. The results were evaluated considering healing time, extent and type of complications, long-term clinical, radiographic and functional findings. Results were: excellent: 35; good: 2; fair: 2; poor: 1. Complications were: nonunione: 1; reimplantation of FAD screws: 1; 4 infections of the screw holes, 3 realignments due to secondary displacement, 1 re-fracture after removal of the implant. There were no iatrogenic lesions of the radial nerve, or infections of the fracture site. The authors conclude that this semi-invasive, versatile and well-tolerated method, may be considered a valid alternative to conservative treatment, or to internal fixation even in cases of single trauma, despite limits related to the degree of collaboration of the patient, particularly with regard to debridement of the screw holes and periodical clinical and radiographic monitoring.

[Surgical correction of osteoarthritic genu varum by the hemicallotasis technique]. / La correction chirurgicale du genu varum arthrosique par la technique de l'hémicallotasis.

PURPOSE OF THE STUDY: The aim of this short study is to highlight the role of the hemicallotasis method in correcting genu varum associated with osteoarthritis. MATERIAL AND METHOD: 160 cases are described. The first step was to apply a Dynamic Axial Fixator (DAF) with a lockable ball joint. A metaphyseal osteotomy was performed proximal to the anterior tuberosity of the tibia together with an osteotomy of the middle third of the fibula. After an initial 10 to 12 day neutralization period, distraction began with gradual axial correction to achieve an over correction of 2-3 degrees valgus. This was confirmed by a full limb radiograph allowing evaluation of the mechanical axes. The mean duration of distraction in this series was 14 days and the fixator was removed on the average at 3 months. Partial weight bearing was allowed with crutches on the first postoperative day. RESULTS: Preliminary clinical and radiographic review of 58 patients with an average follow-up of 18 months showed satisfactory results in 80 per cent of the cases. Clinical evaluation was performed with the standardized parameters in use at the Hospital for Special Surgery. Only 2 postoperative complications of any importance occurred, requiring early removal of the fixator. DISCUSSION: Comparison of the hemicallotasis method with traditional methods highlights the quick easy application of the technique with the possibility of gradual axial correction and early weight bearing. In addition, the technique does not preclude subsequent total knee replacement. CONCLUSION: The authors conclude that the method is safe particularly when the indication is well determined.

[Reconstruction in loss of bony tissue]. / La ricostruzione delle perdite di sostanza ossea.

The aetiology and pathogenesis of wide loss of bony tissue are discussed. Methods of treatment are described. Five cases thus treated and cured are reported.