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PubMed2005

Volar plating of dorsally comminuted fractures of the distal radius: a 6-year study.

This article describes a 6-year study of use of volar plating in treating unstable dorsally comminuted distal radius fractures. Forty-six fractures treated with volar plating were reviewed. All cases were followed for at least 6 months; 35 were followed for more than 1 year. Fractures treated with adjunctive protruding pins were excluded. Bone graft was used in 4 cases. Anatomical results were rated excellent or good in 39 cases (85%). Subsidence occurred in 9 fractures, 4 of which malunited. Flexor pollicis longus tendon attrition occurred in 2 cases. Mean operative time was less than 1 hour (range, 30-90 minutes). Study results support continued use of volar plating in treating selected unstable dorsally displaced fractures of the distal radius. Prominent plates and sharp-edged screws may imperil deep flexor tendons and should be removed. More liberal use of bone graft and improvements in plate design should reduce complications.

Adult↗
PubMed1985

Closed locked intramedullary nailing. Its application to comminuted fractures of the femur.

For many fractures of the femoral shaft, closed intramedullary nailing will not control rotation or telescoping of the fragments. Locked intramedullary nailing combines closed nailing with the percutaneous insertion of screws that interlock the bone and nail. This method permits static locking that controls rotation and telescoping and subsequently conversion to dynamic locking when weight-bearing is started after approximately twelve weeks. By providing greater stability, this method extends the indications for intramedullary nailing to severely comminuted, oblique, and spiral fractures as well as to fractures complicated by loss of bone and fractures in the proximal and distal ends of the femoral shaft. Of fifty-two patients with forty-nine severely comminuted fractures of the femoral shaft and three fractures that were complicated by loss of bone, forty-seven patients had uneventful consolidation of the fracture, with a mean time of 4.5 months for the severely comminuted fractures and seven months for the fractures that had a loss of bone. At follow-up, all forty-seven patients had normal motion of the hip, and forty-five had normal motion of the knee. Of the remaining five patients, four had a non-union that eventually healed (three after a second locked nailing and one after a third) and one had a septic non-union that eventually healed after removal of the nail and screws, débridement, and immobilization with an external fixator. Based on this experience, we concluded that this form of treatment has many advantages. The risk of infection and non-union is low, the incidence and severity of malunion are reduced, the hospital stay is short, and early mobilization of the patient is possible.

Adult↗
PubMed2005

Comminuted fractures of the radial head. Comparison of resection and internal fixation.

BACKGROUND: Satisfactory internal fixation of comminuted radial head fractures is often difficult to achieve, and radial head resection has been the accepted treatment. In this study, we compared the results of radial head resection with those of open reduction and internal fixation in patients with a comminuted radial head fracture. METHODS: Twenty-eight patients with a Mason type-III radial head fracture (some with associated injuries) were enrolled in the study. Fifteen patients underwent radial head resection as the initial treatment (Group I), and thirteen patients underwent open reduction and internal fixation (Group II). The age at the operation averaged 41.1 and 38.2 years, respectively, and the duration of follow-up averaged ten and three years, respectively. The outcomes were assessed on the basis of pain, motion, radiographic findings, and strength measured with Cybex testing. The overall outcome was rated with the functional rating score described by Broberg and Morrey and with the American Shoulder and Elbow Surgeons Elbow Assessment Form. RESULTS: Elbow motion averaged 15.5 degrees (extension loss) to 131.4 degrees (flexion) in Group I and 7.1 degrees to 133.8 degrees in Group II. The carrying angle and ulnar variance averaged 8.2 degrees and 1.9 mm in Group I and 1.5 degrees and 0.5 mm in Group II. Compared with Group II, Group I had a loss of strength in extension, pronation, and supination (p < 0.01). The Broberg and Morrey functional rating score averaged 81.4 points in Group I and 90.7 points in Group II (p = 0.0034). The score on the American Shoulder and Elbow Surgeons Elbow Assessment Form averaged 87.3 points in Group I and 94.6 points in Group II (p = 0.0031). CONCLUSIONS: The patients in whom the comminuted radial head fracture was treated with open reduction and internal fixation had satisfactory joint motion, with greater strength and better function than the patients who had undergone radial head resection. These results support a recommendation for open reduction and internal fixation in the treatment of this fracture.

Adult↗
PubMed2006

Comminuted fractures of the radial head: comparison of resection and internal fixation. Surgical technique.

BACKGROUND: Satisfactory internal fixation of comminuted radial head fractures is often difficult to achieve, and radial head resection has been the accepted treatment. In this study, we compared the results of radial head resection with those of open reduction and internal fixation in patients with a comminuted radial head fracture. METHODS: Twenty-eight patients with a Mason type-III radial head fracture (some with associated injuries) were enrolled in the study. Fifteen patients underwent radial head resection as the initial treatment (Group I), and thirteen patients underwent open reduction and internal fixation (Group II). The age at the operation averaged 41.1 and 38.2 years, respectively, and the duration of follow-up averaged ten and three years, respectively. The outcomes were assessed on the basis of pain, motion, radiographic findings, and strength measured with Cybex testing. The overall outcome was rated with the functional rating score described by Broberg and Morrey and with the American Shoulder and Elbow Surgeons Elbow Assessment Form. RESULTS: Elbow motion averaged 15.5 degrees (extension loss) to 131.4 degrees (flexion) in Group I and 7.1 degrees to 133.8 degrees in Group II. The carrying angle and ulnar variance averaged 8.2 degrees and 1.9 mm in Group I and 1.5 degrees and 0.5 mm in Group II. Compared with Group II, Group I had a loss of strength in extension, pronation, and supination (p < 0.01). The Broberg and Morrey functional rating score averaged 81.4 points in Group I and 90.7 points in Group II (p = 0.0034). The score on the American Shoulder and Elbow Surgeons Elbow Assessment Form averaged 87.3 points in Group I and 94.6 points in Group II (p = 0.0031). CONCLUSIONS: The patients in whom the comminuted radial head fracture was treated with open reduction and internal fixation had satisfactory joint motion, with greater strength and better function than the patients who had undergone radial head resection. These results support a recommendation for open reduction and internal fixation in the treatment of this fracture.

Adult↗
PubMed2000

Surgical treatment of comminuted fractures of the distal clavicle using Wolter clavicular plates.

Surgical reduction and fixation using Wolter clavicular plates was performed in 16 patients with distal clavicle fractures. Good bony union was obtained in all cases. The patients had neither postoperative pain nor muscle weakness. Compared with tension band wiring, the Wolter clavicular plates were better able to maintain the anatomic repositioning of comminuted distal clavicle fractures. However this method takes longer and requires a second operation for plate removal. Wolter clavicular plate placement is the treatment of choice for unstable distal clavicle fractures with small comminuted fragments.

Adult↗
PubMed1989

[Radiodiagnosis of the reparative osteogenesis during the treatment of comminuted fractures of the humerus].

Roentgenoradiological control of a reparative process after diaphysial comminuted shoulder fractures was exercised at all stages of the treatment after G. A. Ilizarov's method. Osteoscanning permitted the assessment of the viability of bone splinters on the first days after trauma and quantitative assessment of the activity of osteogenesis. A study of the optical density of radiograms provided an opportunity for evaluation of mineral content in regenerating bones, their structure only at late stages of treatment when it was rather high.

Adult↗
PubMed1980

Tension band wiring for fixation of comminuted fractures of the distal radius.

In the treatment of unstable comminuted and intra-articular fractures of the lower end of the radius, we have found that is is essential to reconstitute the normal anatomical relationship of the radius to the carpus and to the ulna. This is possible by performing an open reduction and by maintaining the fractured fragments by Kirschner wires and adding a tension band. Patients treated thus are reported. There have been no complications and the patients regained full function of the wrist without unsightly deformity.

Adult↗
PubMed1993

Prediction of fixation failure in femoral neck fractures. Comminution and avascularity studied in 40 patients.

We performed 99m-Tc diphosphonate scintimetries in 40-elderly patients who had undergone screw fixation for a recent subcapital femoral fracture and analyzed their preoperative radiographs. The data were subjected to a logistic regression analysis. Both comminution of the calcar femorale and reduced scintimetric uptake were predictive for failure of the osteosynthesis during the first year. Fracture comminution was more predictive for early failures during 3 months and scintimetry for the later failures.

Aged↗
PubMed1981

Comminuted fractures of the radial head. The role of silicone-implant replacement arthroplasty.

Radial head resection is the accepted treatment of comminuted radial-head fractures in adults, but the results are not always satisfactory. This study examines the results of silicone replacement arthroplasty of the radial head in acute fractures and as a salvage procedure after failed resections of the radial head. The first group of patients was evaluated both before and after silicone replacement arthroplasty had been done as a salvage procedure following a previous radial head fracture. This group comprised twelve patients with an average follow-up of 3.8 years. Improvement was found in a number of parameters, including supination and grip strength. The second group of patients had had a primary silicone replacement arthroplasty following a comminuted radial-head fracture. This group was composed of six patients with an average follow-up of 3.6 years. The radial head implant was found to provide a spacer effect that maintained good radiocapitellar contact and prevented radial shortening. Silicone replacement arthroplasty has a role as a useful, safe, and reliable alternative in the treatment of comminuted radial-head fractures in adults and as a salvage procedure in patients with failed radial-head resections. This is especially true in young, active individuals, who were found to be at the greatest risk of failure after radial head resection alone. This was attributed to greater demands being placed on the involved extremity.

Adolescent↗
PubMed1990

Skeletal transfixation in treatment of comminuted fractures of the distal end of the radius in the elderly.

Ninety-five patients (71 females and 24 males), average age, 69 years (35-92 years), with comminuted distal radial fractures were treated with transfixation wires (Kirschner wires) through the bases of metacarpals II-V and an above-elbow plaster cast. Two cases of early infections and four of Sudeck's dystrophy (4.2%) were encountered. Followup studies which lasted an average of 24 months (9-50 months) could be conducted on 77 patients. Using Sarmiento's ratings 27 patients fell into the very good category, 44, good, eight, fair, and two, poor. Although most of the cases were of the comminuted intra-articular fracture types, good results were achieved with this simple and quite straightforward method.

Adult↗
PubMed1994

[Results of management of pertrochanteric comminuted fractures in the elderly with a tumor shaft endoprostheses].

Pertrochanteric fractures are typical injuries of elderly people, that can be treated with osteosynthesis in most cases. From 1984 to 1991 we performed 105 implantations of tumor-endoprosthesis in elderly patients with comminuted pertrochanteric fractures with simultaneous coxarthrosis or osteoporosis. The mean age of these patients was 82.7 years. 81.9% of the patients had concomitant systemic diseases (coronary heart disease, hypertension, diabetes etc.), 51.4% showed several risk factors. General postoperative complications were diagnosed in 63.8% of all cases, mostly nosocomial urinary tract infections, pressure sores and cardiovascular disorders. In 14.3% of the patients local (surgical) complications occurred. 83.3% of the patients were able to walk when they left the hospital, the in-hospital mortality was 13.3% (30-day-mortality 12.4%). Although primary osteosynthesis of pertrochanteric fractures with dynamic hip screw or gamma-nail show a smaller risk, implantation of a tumor-endoprosthesis can be an alternative in patients with severe osteoporosis, coxarthrosis or after instable osteosynthesis.

Aged↗
PubMed1992

Treatment of femoral supracondylar unstable comminuted fractures. Comparisons between plating and Grosse-Kempf interlocking nailing techniques.

A prospective study was done of 66 consecutive unstable comminuted supracondylar femoral fractures in adults, fixed with either plates (28 cases) or Grosse-Kempf interlocking nails (38 cases). Patients were followed up for at least 1 year (average 44 months). Interlocking nails led to a higher union rate and more satisfactory functional results. Nevertheless, the first distal transverse screw hole took a potential risk of breakage due to stress concentration. The authors conclude that for a cooperative patient, a closed static interlocking nail with strict non-weight-bearing should be the treatment of choice, and for an uncooperative patient, a closed static interlocking nail should be supplemented with a cast brace to reduce the complication rate.

Adolescent↗
PubMed1992

[The optimization of bone repair in open comminuted fractures of the long bones].

Clinical and experimental researches were conducted to study the possibilities for enhancing the efficiency of treatment of open composite comminuted and crushed fractures of long bones with the help of repercussive action of electrets. The results of roentgenomorphometric, clinical and biomechanical researches have shown the efficiency of electrets that could shorten the healing time of the infected wounds, stop the inflammatory reaction and promote the repairing process of bones. The application of electrets using the repercussive methods in complex treatment of complicated open fractures in cases with multiorgan and concomitant injuries creates favourable conditions for the healing process. This method is simple, atraumatic and economical.

Adult↗
PubMed1975

Pins and plaster treatment of comminuted fractures of the distal end of the radius.

The technique used in the treatment of seventy-five patients with severely comminuted, often intra-articular fractures near the wrist was as follows- Pins were inserted through the metacarpals and proximal part of the ulna, reduction was done, and the pins were incorporated in a cast from elbow to knuckles. This allowed movement of the fingers and the elbow. The main complications - loss of radial length and pintract infection - are avoided by attention to technical details. Of the patients with adequate follow-up, 86 per cent had good or excellent results.

Carpal Bones↗
PubMed1986

Comminuted fractures of the proximal humerus treated with hook plate.

Good results were obtained using a hook plate to fix bone in 18 cases of fracture of the proximal humerus in which the bone was greatly comminuted or dislocated. The hook plate protects the fixed area against rotation, shear stress and flexion much better than other fixation methods.

Adolescent↗