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PubMed2005

Coupled exofixator for comminuted fracture of humeral shaft.

OBJECTIVE: To report and assess the efficacy of a coupled exofixator in the treatment of comminuted fracture of the humeral shaft. METHODS: From June 1999 to September 2003, 24 patients with comminuted fracture of the humeral shaft were treated in our department, in whom 11 were involved in left humerus fractures and 13 in right humerus fractures. Closed reduction or open reduction with a small incision as well as a coupled exofixator was used to treat these patients. RESULTS: All cases got anatomical reduction after 6-12 months follow-up. The time for fracture union averaged 5.8 months with a good functional recovery of the shoulder-elbow joints. CONCLUSIONS: The coupled exofixator is favorable to the treatment of comminuted humeral shaft fractures. It can shorten union time and avoid nonunion occurrence.

Adolescent↗
PubMed1997

Plaster cast versus percutaneous pin fixation for comminuted fractures of the distal radius in patients between 46 and 65 years of age.

OBJECTIVE: To compare the results of treating unstable distal radius fractures either by percutaneous pinning and casting, or by traditional closed reduction and casting. DESIGN: Prospective, randomized. SETTING: University hospital. PATIENTS: Forty patients with unstable Frykmann III-VIII distal radius fractures resulting from a fall. INTERVENTIONS: Twenty patients were treated with closed reduction, consisting of manipulation, under local anesthesia, followed by casting. Twenty patients were treated with percutaneous fixation using K-wires, followed by casting. MAIN OUTCOME MEASUREMENTS: Initial displacement, quality of reduction, carpal malalignment, articular step-off. Range of motion and grip strength were measured using a scoring system reported by Home et al. (10). RESULTS: Functional results in the pinning group were better (excellent, 12; good, 6; fair, 2) than in the plaster group (excellent, 3; good, 8; fair, 5; poor, 4). Anatomic results also were better in the pinning group. CONCLUSION: The best anatomic and functional results were obtained by percutaneous pinning. Although the cost of pins and plaster treatment is significantly greater than plaster treatment, the author believes that the positive end result justifies the cost.

Aged↗
PubMed2003

Use of titanium mesh in comminuted fractures of frontal sinus anterior wall.

The personal experience with the surgical treatment of reduction and fixation of comminuted fractures of the anterior wall of the frontal sinus is reported. Cosmetic results were examined with regard to patients' degree of satisfaction on a 0 to 2 scale and nasal function assessed via rhinoscopy and nasal endoscopy during clinical follow-up, in the course of which the integrity and functionality of the supraorbitary and facial nerves were evaluated. All patients were satisfied, on the whole, with the aesthetic result, with 0-degree satisfaction (no deformity compared with their condition prior to the injury). The operations were performed between the 2nd and 7th post-injury day. The importance of the preoperative clinico-radiological work-up is stressed, with particular regard to the detection of simultaneous involvement of the inferior and/or posterior wall, and to the choice of surgical approach. The evolution of the surgical techniques in the treatment of frontal sinus fractures is discussed. With reference to the new means of fixation, in cases of comminuted fractures of the anterior wall, titanium mesh is preferred. In the Authors' opinion it combines excellent fixation with easy adaptability (cosmetic results are good) without requiring in the majority of cases, autologous bone grafts.

Adult↗
PubMed1994

[Modular construction (2 HS-1 SH), using Cotrel-Dubousset's universal instrumentation for comminuted fractures of the thoracolumbar junction. Comparison with various other constructions].

INTRODUCTION: The authors' objective was to study the anatomical and functional results of an original construct using the Cotrel-Dubousset instrumentation. MATERIAL AND METHODS: This construct is called "Modular construct" or "2 H.S.-1 S.H." fits up two vertebrae above the fracture and a single below. So if the fracture is situated on the L1 level, a supra-laminar hook is set up on each side of T11, and two pedicular screws in T12 (2 H.S.). In the same way, a pedicular screw and an infra-laminar hook are set up on each side of L2 (1.S.H.). Two transverse bars connect together the right and the left rod. This retrospective work is based on the study of 24 patients who had a Thoraco-lumbar burst fracture according to Denis'classification, who were operated on in our Department, and started again to walk without external contention. All the patients had a postero-lateral bone graft. There were no [corrected] anterior arthrodesis performed. The average follow up was 4 years. This series was compared with a concomitant series of miscellaneous constructs realized by the same operators with the C.D. instrumentation. RESULTS: The average regional kyphosis angles went from 16.9 degrees in pre-operative to 3.9 degrees in post-operative, and 8 degrees at the maximum follow up. The average vertebral kyphosis angles went from 18 degrees in pre-operative to 3.8 degrees in post-operative, and 6.3 degrees at the maximum follow up. The miscellaneous constructs had poorer results. There were two severe infections, one early the other late. DISCUSSION: These results compared with the literature show that the 2 H.S.-1 S.H. construct is a competitive one. We think that its mechanical qualities arise from adding systematically hooks at the ends of the construct. These hooks protect the screws during flexion and from pull out constraints.

Female↗
PubMed1998

Non-operative treatment of comminuted fractures of the proximal humerus in elderly patients.

The purpose of this retrospective study was to assess the clinical and radiographical results of non-operative treatment of displaced multifragmental fractures of the proximal humerus with a minimum follow-up of 10 years. Fifteen patients (one man, 14 women) with 17 injured shoulders were examined. The Neer classification system was used to classify the fractures, and the functional outcome was assessed using the Constant score. At the 10 year review, the mean Constant score for the patients in the three-part fracture group was 59, and 47 in the four-part fracture group. The range of motion was satisfactory with a mean flexion and abduction over 90 degrees. Only four patients reported pain and it was graded as mild. In spite of low functional scoring and poor fracture reduction in many shoulders, the patient's contentment with their injured shoulder after 10 years with high. Radiographical examination revealed severe osteoarthrosis in one shoulder, and humeral head osteonecrosis in two shoulders. Results from this study suggests that non-operative treatment of displaced three-part fractures of the proximal humerus should be considered.

Activities of Daily Living↗
PubMed1997

Bridge plating osteosynthesis of 20 comminuted fractures of the femur.

We retrospectively studied the outcome of 20 comminuted fractures (20 patients, 15 men) of the femur treated in accordance with the principles of indirect reduction and biological osteosynthesis technique. The patients were followed for mean 1.5 (1-4.5) years. 11 fractures were subtrochanteric (type C), 6 complex diaphyseal and the remaining 3 were supracondylar (2 type C3 and 1 type A3); 3 fractures were open (type I, II, IIIA). Subtrochanteric fractures were treated with either 95 degrees dynamic condylar screw (DCS; 5 fractures) or with 135 degrees dynamic hip screw (DHS; 6 fractures). Autocompression plates (ACP) implants were chosen for diaphyseal fractures in 4 fractures, and a limited contact dynamic compression plate (LC/DCP) implant in 2. The 3 supracondylar fractures were treated with a 95 degrees DCS implant (1 fracture) and the Condylar Buttress Plate (2 fractures). 11 fractures were bone grafted. There were no immediate postoperative complications. All fractures united on an average of 5 months, irrespective of use of bone grafts. Late complications consisted of mild knee stiffness (4 patients) and 1-2 cm shortening (4 patients).

Adolescent↗
PubMed1995

Double-plate fixation of comminuted fractures of the second phalanx in horses: 10 cases (1985-1993).

OBJECTIVE: To determine the technique used, and the outcome for, double-plate fixation of comminuted fractures of the second phalanx of horses. DESIGN: Retrospective analysis of medical records. ANIMALS: 10 horses with comminuted fractures of the second phalanx that were treated by use of double-plate fixation. PROCEDURE: Two 4- to 6-hole dynamic compression plates were abaxially placed to achieve arthrodesis of the proximal interphalangeal joint and fixation of the fracture of the second phalanx. RESULTS: Arthrodesis and fracture healing were detected in all horses. CLINICAL IMPLICATIONS: Horses with comminuted fractures of the second phalanx that are treated with double-plate fixation have an excellent prognosis for survival and use as broodstock, and have an increased potential for return to useful function.

Animals↗
PubMedDate not supplied

Percutaneous fixation of comminuted fractures of the femur and tibia. Preliminary study.

OBJECTIVE: To present initial experience of treating patients with comminuted fractures of the diaphyseal and metaphyseal areas of the femur and tibia. SUBJECTS AND METHODS: Sixteen patients were involved in the study. All the 16 patients (11 males and 5 females, average age 34 years) with closed, comminuted fractures of femur (n = 9) and tibia (n = 7) were operated on using the principle of minimal access surgery and biological fixation that maximally preserved the soft tissues and fracture hematoma. RESULTS: All the fractures united, operated limbs had good function, and no complications occurred. CONCLUSION: Our findings indicate that minimal access surgery is a useful fixation method in the treatment of comminuted diaphyseal and metaphyseal fractures of the femur and tibia.

Adolescent↗
PubMed1980

Comminuted fractures of the femoral shaft treated by intramedullary nailing.

We evaluated 245 cases of comminuted femoral fractures treated by intramedullary nailing and graded them by fracture pattern and degree of stability as segmental fractures, and grade I, grade II, grade III, and grade IV comminuted fractures. The infection rate was 0.4 per cent, and the nonunion rate was 0.8 per cent. Shortening of more than 2 cm. was seen in seven cases (3 per cent), and malrotation of more than 20 degrees was noted in four cases (1.7 per cent). These more common problems of shortening and rotation were almost eliminated by the increased use of cerclage wire and postoperative traction and spica casts. Knee range of motion averaged 128 degrees. These fractures provide interesting and difficult challenges. Intramedullary nailing of the segmental fractures is technically demanding but offers excellent results in these otherwise difficult fractures. Patients with grade I and grade II comminuted fractures do well with intramedullary nailing and the bones remain stable. Grade III and grade IV comminuted fractures are unstable and pose the risk of shortening and rotation. Therefore, to gain anatomic restoration in a young person we believe that it is reasonable to perform an open reduction and cerclage wiring of these fractures. The postoperative treatment of the comminuted femoral fracture is determined by both fracture stability and patient reliability, and frequent roentgenograms are indicated. Most importantly, the surgeon should be prepared to apply whatever form of treatment he believes to be necessary to gain optimal results in each individual.

Adolescent↗
PubMed2000

Comminuted fractures of the iliac wing.

PURPOSE: Comminuted iliac fractures are uncommon and difficult to treat. The purpose of this study is to further delineate the fractures, to present a management protocol, and to evaluate the results of treatment. DESIGN: Retrospective clinical study. SETTING: Level one trauma center at Harborview Medical Center. PATIENTS: During a sixty-eight-month period, 695 patients with pelvic ring disruptions were treated at a level one trauma center. Thirteen (1.9%) of these patients had a severely comminuted iliac fracture. All patients were men, ranging in age from twenty to eighty years (mean, 38 years). These patients were polytraumatized and had a mean Injury Severity Score of 23. Eleven of the thirteen patients had severe iliac and flank degloving injuries. Five patients had open fractures, one with fecal contamination requiring diverting colostomy. Six patients with clinical signs of hemodynamic instability had local arterial injuries associated with their fractures. All five patients with extension of the fracture into the greater sciatic notch were found to have a local arterial injury on angiography. One patient had a lumbosacral plexopathy on the fractured side. Four patients had traumatic brain injuries. INTERVENTION: All thirteen patients were treated operatively. Routine pelvic external fixation was not possible because of the iliac comminution. Stable internal fixation was accomplished by an anterior iliac surgical exposure using lag screw and plate combinations. The open wounds and degloving injuries were treated with irrigation, debridement, and closed suction drainage. MAIN OUTCOME MEASUREMENTS: Healing and stability of fixation were assessed clinically and on pelvic radiographs. RESULTS: Comminuted iliac fractures were divided into two patient groups, according to associated pelvic ring disruption. Follow-up evaluations were available for all patients at a mean of eighteen months after injury. There were no deaths. All of the fractures healed clinically and radiographically. In one patient, fecal contamination caused a polymicrobial wound infection, and this patient had an associated delay in union of the fracture. Another patient with an open fracture developed a deep wound infection. Both infections responded to local management and antibiotics. There were no complications associated with the degloving injuries. CONCLUSIONS: Comminuted iliac fractures occur in two distinct patterns and are associated with numerous local injuries that complicate management. Management protocols should include early open reduction and stable internal fixation. Traumatic open wounds should not be closed primarily. Primary closure with closed suction drainage is effective in the management of associated degloving injuries. Extension of the fracture into the greater sciatic notch warrants further evaluation with pelvic angiography.

Adult↗