Comparative Assessment of Outcomes of Surgical Treatment of Smith and Colles Distal Radius Fractures.

BACKGROUND: The aim of the present study was to assess the effectiveness of surgical treatment of distal radial fractures following open reduction and fixation with an angle-stable plate in relation to the type of injury (flexion vs. extension fracture). MATERIAL AND METHODS: A group of 25 patients with Colles fractures and 25 patients with Smith fractures treated surgically in the years 2012-2013 was analysed retrospectively. The results were evaluated using the quickDASH and Mayo Wrist Score. Radiographic follow-up assessments included radial inclination, radial height, volar tilt and articular step-off. RESULTS: The mean Mayo Wrist Score was 72.8 points for Colles fractures and 68.3 points for Smith fractures. The mean quickDASH score was 18.2 points for Colles fractures and 20.5 points for Smith fractures. However, these differences were not statistically significant. The only significant difference in the radiographic parameters investigated was in volar tilt, which was normal in the group of patients with Smith fractures (11°), whereas in the group with Colles fractures it was 5°. CONCLUSIONS: 1. In fractures of the distal radius, the type of displacement has no significant effect on the final outcome of surgical plate fixation. 2. In fractures with dorsal displacement of fragments, it is more difficult to restore volar tilt from a volar approach.

Long-term Results of Operative Treatment of Calcaneal Fractures.

BACKGROUND: This paper presents the long-term results of surgical treatment of intra-articular calcaneal fractures, including subjective evaluation, orthopaedic examination and radiographic evaluation. MATERIAL AND METHODS: A total of 126 patients with 135 calcaneal fractures were treated surgically at the Department of Traumatology of the Military Medical Institute in Warsaw between 2008 and 2012. The analysis involves 73 patients (53 persons were lost to follow-up), including 45 men (61.6%). The mean age of the patients was 46.2 years (18-77 years). Based on imaging studies, patients required specific surgical techniques: the minimally invasive Westhues method involving fixation with a bundle of K-wires or open reduction and internal fixation with a plate and screws. The outcomes of the surgical treatment of calcaneal fractures were assessed on the basis of a subjective evaluation and orthopaedic and radiographic examinations. Statistical analysis was performed using Microsoft Excel. RESULTS: Based on the Creighton-Nebraska scores, in the group of patients treated with a bundle of K-wires (minimally invasive Westhues method), there were 12 excellent results (42.8%), 5 good (17.9%), 6 satisfactory (21.4%) and 5 poor (17.9%). In the group of patients treated with a plate and screws, excellent and good results (58.1%) prevailed in Sanders type II fractures. Most of the poor results were recorded in patients with type IV fractures. In general, radiographic results were better than functional and subjective evaluation. A statistically significant relationship between the subjective outcome of treatment and patient age was found (p <0.001). The least satisfying results were found for patients younger than 39 years of age. CONCLUSIONS: 1. The key to success in the surgical treatment of calcaneal fractures is appropriate restoration of Bôhler's angle 2. A good or excellent radiographic outcome did not always coincide with good functional results and good subjective evaluation 3. The poorer subjective scores in younger patients resulted from their inability to return to pre-injury activity levels.

Outcomes after Open Reduction and Plate Fixation of Distal Humerus Fractures.

BACKGROUND: Distal humerus fractures (DHFs) have been a serious challenge since the beginning of surgery. The outcome of surgical treatment of a DHF should not only be assessed with clinical ratings. It is also important to take into account the patient's subjective evaluation of limb function. MATERIAL AND METHODS: The study involved 26 patients after surgical treatment of DHF. The Quick DASH (QDASH) scale was used to assess the subjective results of surgical treatment of DHF, and the objective Mayo Elbow Performance Score (MEPS) was used to assess the clinical outcome. Relationships between the subjective and objective scores were tested with Pearson's correlation coefficient. RESULTS: 85% of the patients had excellent or good QDASH scores, and 65% of patients had excellent or good MEPS scores. The Pearson correlation coefficient between the subjective and objective assessments was -0.91, indicating total dependence. CONCLUSIONS: Open reduction and internal fixation using two perpendicular plates allows for achieving good stability of fixation, early rehabilitation and quick return to the desired level of activity, which contributes to a high percentage of good objective and subjective results of treatment. Subjective assessment of upper limb function after DHF surgery fully correlates with objective assessment.

Results of the use of platelet rich plasma in the treatment of delayed union of long bones.

BACKGROUND: The aim of this study was to assess the efficacy of platelet rich plasma in the treatment of delayed union of long bones according to fracture location, the time between the fracture and PRP administration, and the type of surgical fixation. MATERIAL AND METHODS: A total of 1620 patients with long bone fractures were treated surgically at the Department of Traumatology of the Military Medical Institute in Warsaw between 2009 and 2012. Delayed union was diagnosed in 158 (9.75%) patients. Our analysis includes 132 patients (26 persons were lost to follow-up), with 53 women (40.15%) and 79 men (59.85%) aged 16 to 85 years (mean age 41). RESULTS: Bone union after PRP administration was found in 108 patients (81.8%) while the method proved ineffective in 24 patients (18.2%). It was most effective in patients with delayed union of the proximal tibia treated surgically by open reduction and plate fixation (100%), on average 3.5 months after PRP administration. The lowest efficacy was observed in patients with delayed union of the proximal humerus treated surgically by open reduction and plate fixation (63.64%), on average 3.2 months after PRP administration. CONCLUSIONS: 1. PRP is effective in the treatment of delayed union of long bones. 2. The highest incidence of delayed bone union was seen after the treatment of long bone fractures by open reduction and plate fixation whereas the lowest number of such cases was observed in patients treated by closed reduction with intramedullary nail fixation. 3. The mean time between surgical treatment and diagnosis of delayed bone union followed by PRP administration was 4.05 months.

Results of two-stage operative treatment of anteromedial instability of the knee.

BACKGROUND: Proper treatment of massive knee injuries still constitutes a challenge for clinicians. Most often a torsion knee injury results in a rupture of the medial collateral ligament and anterior cruciate ligament. There is still no consensus on whether total rupture (Grade III) of the medial collateral ligament requires surgery, but it is well known that anterior cruciate ligament injury will require reconstructive surgery. MATERIAL AND METHODS: A total of 27 patients treated with two-staged surgery (primary MCL repair and delayed ACL reconstruction) were enrolled. Treatment outcomes were evaluated using the IKDC scale and Lysholm scale. The range of motion and knee stability was assessed during a clinical examination. Radiographs were used to evaluate the placement of suture anchors and development of osteoarthritic lesions. Static and dynamic ultrasound examinations were also performed to assess the post-operative morphology and performance of the medial collateral ligament. RESULTS: The patients who had undergone surgery for combined anteromedial instability of the knee, achieved good or very good clinical outcome according to the IKDC scale (63%, 17 of 27) and the Lysholm scale (74%, 20 of 27). Unsatisfactory functional outcomes were more often seen in older patients. Some patients developed complications, which significantly worsened the outcome. Those mainly included a limited range of movement, arthrofibrosis and Pellegrini-Stieda lesions. CONCLUSIONS: 1.Two-stage operative treatment produces good or very good results in most patients. Nevertheless, there is a risk of complications in some cases, mostly in patients aged 40 years. Accordingly, two-stage treatment is currently recommended in younger individuals. 2. A complete MCL tear at the distal attachment should be given particular attention. Although such injury is rare, due to the anatomical determinants and the risk of Stener-like lesions, i.e. unhealed ML, surgery is recommended. Surgery produces good clinical and functional results.