La utilización de un implante anatómico comparado a una LCP recta disminuye su extracción en la osteosíntesis percutánea posterior del húmero / The use of an anatomical implant compared to a straight LCP decreases extraction in posterior humeral MIPO

Antecedentes y objetivo: El abordaje posterior percutáneo del húmero se ha descrito utilizando una placa LCP de 4,5mm. A pesar de que las placas rectas han demostrado buenos resultados, estas no han sido diseñadas para adaptarse a la metáfisis del húmero distal. El objetivo de este estudio es probar la hipótesis nula de que no existen diferencias en la extracción de la osteosíntesis después de una MIPO posterior utilizando una placa recta comparado a una placa anatómica. Materiales y métodos: Se incluyeron retrospectivamente en 2 instituciones pacientes mayores de 18 años que habían sufrido una fractura diafisaria de húmero distal tratados mediante técnica percutánea posterior con una placa bloqueada y con un seguimiento mínimo de 12 meses. Los pacientes se dividieron en: grupo 1 (placa recta LCP de 4,5mm) y grupo 2 (placa de forma anatómica de 3,5mm). Durante el postoperatorio se reportó la evaluación clínica y radiológica, así como la necesidad de retirar el implante debido al dolor. Resultados: Sesenta y siete pacientes cumplieron los criterios de inclusión. Veintisiete pacientes en el grupo 1 y 40 en el grupo 2. No se perdió ningún paciente durante el seguimiento. Dentro del grupo 1, el 18% (IC 95%: 6-38%) de los pacientes requirieron extracción del implante, mientras que en el grupo 2 esta incidencia fue del 0% (IC 95%: 0-9%) (p 0,009). No hubo diferencias estadísticas entre las medidas de resultado informadas por los pacientes; todas las fracturas consolidaron. Conclusión: Los resultados de nuestro estudio demostrarían que el uso de placas LCP rectas de 4,5mm comparado a las placas anatómicas LCP de 3,5mm en MIPO posterior de húmero genera mayores molestias y, por lo tanto, conllevan un incremento en el riesgo de extracción del implante de un 18%.(AU)

Purpose: Posterior MIPO approach in the humerus has been described by using a 4.5mm LCP plate. Although straight plates have shown good results, they have not been designed to adapt to the distal humeral metaphysis. The goal of the study was to test the null hypothesis that there is no difference in hardware removal after posterior MIPO with either a straight or a pre-contoured plate. Methods: Patients older than 18 years, who had suffered mid-distal humeral shaft fracture, were treated by a posterior MIPO technique with a locking plate and had a minimum of 12-month follow-up were retrospectively included. Patients were separated into: group 1 (LCP 4.5mm straight plate); and group 2 (3.5mm anatomically shaped plate). Clinical and radiological evaluation were performed in the postoperative period. Patient-reported outcomes and the need of hardware removal because of pain were assessed. Results: Sixty-seven patients fulfilled the inclusion criteria. Twenty-seven patients in group 1 and 40 in group 2. No patient was lost to follow-up. There were no statistical differences between in patient reported outcomes measures. All the fractures healed. Within group 1, 18% (95%CI: 6-38%) of the patients required implant removal while in group 2 this incidence was 0% (95%CI: 0-9%) (P 0.009). Conclusion: These results suggest that the use of a 4.5mm LCP compared to an anatomical 3.5mm LCP in posterior MIPO of the humerus generates greater discomfort and therefore leads to a 18% increase in the risk of implant removal.(AU)

[Translated article] The use of an anatomical implant compared to a straight LCP decreases extraction in posterior humeral MIPO / La utilización de un implante anatómico comparado a una LCP recta disminuye su extracción en la osteosíntesis percutánea posterior del húmero

Purpose: Posterior MIPO approach in the humerus has been described by using a 4.5mm LCP plate. Although straight plates have shown good results, they have not been designed to adapt to the distal humeral metaphysis. The goal of the study was to test the null hypothesis that there is no difference in hardware removal after posterior MIPO with either a straight or a pre-contoured plate. Methods: Patients older than 18 years, who had suffered mid-distal humeral shaft fracture, were treated by a posterior MIPO technique with a locking plate and had a minimum of 12-month follow-up were retrospectively included. Patients were separated into: group 1 (LCP 4.5mm straight plate); and group 2 (3.5mm anatomically shaped plate). Clinical and radiological evaluations were performed in the postoperative period. Patient-reported outcomes and the need of hardware removal because of pain were assessed. Results: Sixty-seven patients fulfilled the inclusion criteria. Twenty-seven patients in group 1 and 40 in group 2. No patient was lost to follow-up. There were no statistical differences between in patient reported outcomes measures. All the fractures healed. Within group 1, 18% (95%CI: 6–38%) of the patients required implant removal while in group 2 this incidence was 0% (95%CI: 0–9%) (P 0.009). Conclusion: These results suggest that the use of a 4.5mm LCP compared to an anatomical 3.5mm LCP in posterior MIPO of the humerus generates greater discomfort and therefore leads to a 18% increase in the risk of implant removal.(AU)

Antecedentes y objetivo: El abordaje posterior percutáneo del húmero se ha descrito utilizando una placa LCP de 4,5mm. A pesar de que las placas rectas han demostrado buenos resultados, estas no han sido diseñadas para adaptarse a la metáfisis del húmero distal. El objetivo de este estudio es probar la hipótesis nula de que no existen diferencias en la extracción de la osteosíntesis después de una MIPO posterior utilizando una placa recta comparado a una placa anatómica. Materiales y métodos: Se incluyó retrospectivamente en 2 instituciones a pacientes mayores de 18 años que habían sufrido una fractura diafisaria de húmero distal tratados mediante técnica percutánea posterior con una placa bloqueada y con un seguimiento mínimo de 12 meses. Los pacientes se dividieron en: grupo 1 (placa recta LCP de 4,5mm) y grupo 2 (placa de forma anatómica de 3,5mm). Durante el postoperatorio se reportó la evaluación clínica y radiológica, así como la necesidad de retirar el implante debido al dolor. Resultados: Sesenta y siete pacientes cumplieron los criterios de inclusión. Veintisiete pacientes en el grupo 1 y 40 en el grupo 2. No se perdió ningún paciente durante el seguimiento. Dentro del grupo 1, el 18% (IC del 95%: 6-38%) de los pacientes requirieron extracción del implante, mientras que en el grupo 2 esta incidencia fue del 0% (IC del 95%: 0-9%) (p = 0,009). No hubo diferencias estadísticas entre las medidas de resultado informadas por los pacientes; todas las fracturas consolidaron. Conclusión: Los resultados de nuestro estudio demostrarían que el uso de placas LCP rectas de 4,5mm comparado a las placas anatómicas LCP de 3,5mm en MIPO posterior de húmero genera mayores molestias y, por lo tanto, conllevan un incremento en el riesgo de extracción del implante de un 18%.(AU)

[Translated article] The use of an anatomical implant compared to a straight LCP decreases extraction in posterior humeral MIPO.

PURPOSE: Posterior MIPO approach in the humerus has been described by using a 4.5mm LCP plate. Although straight plates have shown good results, they have not been designed to adapt to the distal humeral metaphysis. The goal of the study was to test the null hypothesis that there is no difference in hardware removal after posterior MIPO with either a straight or a pre-contoured plate. METHODS: Patients older than 18 years, who had suffered mid-distal humeral shaft fracture, were treated by a posterior MIPO technique with a locking plate and had a minimum of 12-month follow-up were retrospectively included. Patients were separated into: group 1 (LCP 4.5mm straight plate); and group 2 (3.5mm anatomically shaped plate). Clinical and radiological evaluations were performed in the postoperative period. Patient-reported outcomes and the need of hardware removal because of pain were assessed. RESULTS: Sixty-seven patients fulfilled the inclusion criteria. Twenty-seven patients in group 1 and 40 in group 2. No patient was lost to follow-up. There were no statistical differences between in patient reported outcomes measures. All the fractures healed. Within group 1, 18% (95%CI: 6-38%) of the patients required implant removal while in group 2 this incidence was 0% (95%CI: 0-9%) (P 0.009). CONCLUSION: These results suggest that the use of a 4.5mm LCP compared to an anatomical 3.5mm LCP in posterior MIPO of the humerus generates greater discomfort and therefore leads to a 18% increase in the risk of implant removal.

The use of an anatomical implant compared to a straight LCP decreases extraction in posterior humeral MIPO. / La utilización de un implante anatómico comparado a una LCP recta disminuye su extracción en la osteosíntesis percutánea posterior del húmero.

PURPOSE: Posterior MIPO approach in the humerus has been described by using a 4.5mm LCP plate. Although straight plates have shown good results, they have not been designed to adapt to the distal humeral metaphysis. The goal of the study was to test the null hypothesis that there is no difference in hardware removal after posterior MIPO with either a straight or a pre-contoured plate. METHODS: Patients older than 18 years, who had suffered mid-distal humeral shaft fracture, were treated by a posterior MIPO technique with a locking plate and had a minimum of 12-month follow-up were retrospectively included. Patients were separated into: group 1 (LCP 4.5mm straight plate); and group 2 (3.5mm anatomically shaped plate). Clinical and radiological evaluation were performed in the postoperative period. Patient-reported outcomes and the need of hardware removal because of pain were assessed. RESULTS: Sixty-seven patients fulfilled the inclusion criteria. Twenty-seven patients in group 1 and 40 in group 2. No patient was lost to follow-up. There were no statistical differences between in patient reported outcomes measures. All the fractures healed. Within group 1, 18% (95%CI: 6-38%) of the patients required implant removal while in group 2 this incidence was 0% (95%CI: 0-9%) (P 0.009). CONCLUSION: These results suggest that the use of a 4.5mm LCP compared to an anatomical 3.5mm LCP in posterior MIPO of the humerus generates greater discomfort and therefore leads to a 18% increase in the risk of implant removal.

Galeazzi fracture-dislocations: Long-term prognosis of the distal radioulnar joint.

The aim of the present study was to evaluate long-term functional and radiographic outcome in the distal radioulnar joint (DRUJ) for Galeazzi fracture-dislocation after anatomic reduction and rigid fixation of the radius. Fourteen patients, with an average age of 38 years, presenting with Galeazzi fracture-dislocation treated by open reduction and internal fixation (ORIF) of the radius and closed reduction of the DRUJ were retrospectively evaluated, with a minimum follow-up of 6 years. At final evaluation (mean: 8 years), the DRUJ was objectively and subjectively evaluated for range of motion (RoM), grip strength, ballottement test, pain on axial loading, function on visual analog scale (VAS) and DASH score. Radiographs and dynamic CT scans were performed to screen for DRUJ instability and/or osteoarthritis. Six of the patients had a positive comparative ballottement test, but none reported pain during the maneuver. No significant differences in RoM were found between the injured and uninjured wrist. Mean grip strength in the injured wrist was 77% of the contralateral value. Mean pain on VAS was 0.6. Mean global function on VAS was 9. Mean DASH score was 3. Dynamic CT showed no clear subluxation in any of the patients, and none showed severe articular changes. Our findings suggest that long-term clinical and radiological prognosis for the DRUJ in Galeazzi lesions is favorable when adequate closed reduction of the ulna is achieved after anatomical ORIF of the radius. LEVEL OF EVIDENCE: IV. Therapeutic case series.