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PubMed2003

Open reduction and internal fixation of comminuted fractures of the radial head using low-profile mini-plates.

Between 1996 and 2000, we treated ten patients with severely comminuted fractures of the radial head using low-profile mini-plates. Their mean age was 42 years (24 to 71). Three fractures were Mason type III and seven were Mason-Johnston type IV. At a mean follow-up of 28.5 months (15 to 44), all fractures had united. The plates were removed in nine patients. No patient had difficulty with daily activities or symptoms of instability of the elbow. The mean range of flexion of the elbow was from 7 degrees to 135 degrees, with 74 degrees of supination and 85 degrees of pronation. According to the Broberg and Morrey functional elbow index, the mean score was 90.7 points (73 to 100), and the outcome was excellent in three patients, good in six and fair in one. These results compare favourably with those reported previously. The technique is applicable to severely comminuted fractures of the radial head which otherwise would require excision.

Adult↗

PubMed2006

Comminuted fractures of the radial head treated by the Judet floating radial head prosthesis.

Excision is not a suitable treatment for all comminuted fractures of the radial head. In elbows where instability can be predicted, a replacement arthroplasty of the radial head is more effective. The aim of this paper was to present the medium-term results of the Judet floating radial head prosthesis. This operation was performed on 14 patients between 1992 and 2003, of whom 12 were reviewed at a mean follow-up of five years and three months (1 to 12 years). The outcome was assessed using the Mayo elbow performance score and a modified Disability of Arm Shoulder Hand (DASH) questionnaire. There were six excellent results, four good, one fair and one poor, as graded by the Mayo score. The mean DASH score was 23.9/100 (0 to 65.8/100). The only significant complication occurred in one patient who developed a severe complex regional pain syndrome. There were no patients with secondary instability of the elbow, implant loosening, cubitus valgus, osteoporosis of the capitellum, or pain in the forearm and wrist. Our experience, combined with that of other authors using this device, has encouraged us to continue using the Judet prosthesis in comminuted fractures of the elbow where instability is a potential problem.

Adolescent↗

PubMed1995

Open-packing method for the severely comminuted fractured mandible due to missile injury.

A new approach is introduced to treat a severely comminuted fractured mandible due to missile injury, whereby denuded bony pieces are re-incorporated into the defect. These are then immobilized by open-packing with iodoform ribbon gauze. The pack is changed regularly every 10-14 days until the cavity is completely obliterated with healthy granulation tissue by which time the mandible shows good consolidation with re-alignment of all displaced bony fragments. The method is simple, safe, does not need an expert surgeon and avoids the need for a future bone graft. Iodoform packs were used in different sites of the facial skeleton and none of our patients showed signs of sensitivity to iodoform or to iodine toxicity.

Adult↗

PubMed2006

Percutaneous fixation of comminuted fractures of the humerus: initial experience at Al Razi hospital, Kuwait.

OBJECTIVE: To present initial experience of 12 cases of percutaneous plating of the comminuted fractures of the humerus using minimal access surgery and standard low-contact dynamic compression plate. PATIENTS AND METHODS: Twelve patients (11 males and 1 female) with an average age of 29.8 years (range 17-46 years) with comminuted diaphyseal fractures of the humerus were treated by minimal access surgery using standard AO/ASIF implants. Fracture was reduced indirectly either by manipulation or by a femoral distractor. Image intensifier was used to monitor the reduction and fixation. The plate was fixed on the anterior surface of the humerus using proximal and distal minimal incision on the anterior aspect of the upper arm. RESULTS: All fractures were united, and all patients had a good range of motion in the adjacent joints. In 1 patient, there was a transient neurological deficit. CONCLUSION: Percutaneous fixation of comminuted fractures of the humeral shaft is an alternative to standard open surgery, reducing the surgical impact and giving an excellent functional result.

Adolescent↗

PubMed1996

Use of a type-III trilateral external skeletal fixation device in three deer with comminuted fractures.

A type-III trilateral external skeletal fixation device was used to repair comminuted fractures of metacarpal and tibial bones in 3 deer. Mean weight of the deer was 25 kg, and mean age was 4 months. Mean interval from application until removal of the device was 6.5 weeks. All deer had complete function of their previously fractured limbs and had minimal complications during healing. Several factors should be considered when choosing a method of repair for wildlife with fractured limbs. Economic constraints and demeanor of the animal may limit the number of options. Analysis of results of our findings indicated that type-III trilateral external skeletal fixation devices can be used for the repair of comminuted fractures in young deer.

Animals↗

PubMed1994

[Transfixation upper arm plaster bandage for treatment of comminuted fractures of the distal radius].

Thirty-five comminuted fractures of the distal radius in 34 patients were reduced by manipulation and pins, then immobilised with plaster. The Kirschner wires were inserted into the first metacarpal and the olecranon. In five cases, problems with the proximal pin occurred. A clinical and radiological examination could be done in 21 patients three to nineteen years after the accident. Using the demerit-point-system of Gartland and Werley, the result was excellent in three patients, good in nine, and fair in nine; there were no poor results. After careful retrospective consideration of treatment alternatives for these comminuted distal radial fractures, there remain the following indications for pins and plaster: 1. selected cases treated by surgeons experienced with the method, 2. as an emergency procedure when an external fixator seems to be indicated but is not available.

Adolescent↗

PubMed2003

Separate vertical wiring for the fixation of comminuted fractures of the inferior pole of the patella.

Comminuted and displaced fractures of the inferiorole of the patella are not easy to reduce and it is difficult to fix the fragments soundly enough to allow early movement of the knee. We have evaluated the clinical effectiveness of the separate vertical wiring technique in acute comminuted fractures of the inferior pole of the patella. A biomechanical study was also performed using ten pairs of embalmed cadaver knees. A four-part fracture was made on the inferior pole of the patella and fixed by two separate vertical wires on one side and two pull-out sutures after partial patellectomy on the other. The ultimate load to failure in the first group was significantly higher than in the second (250.1+/- 109.7 N v 69.7 +/- 18.9 N, p < 0.002), as was the stiffness (279.9 +/- 76.4 N/mm v 23.2 +/- 11.4 N/mm, p < 0.001). The separate wire technique was used in 25 patients with comminuted fractures of the inferior pole of the patella who were followed up for a mean period of 22 months (10 to 50). All the fractures healed at a mean of seven weeks (6 to 10). No breakage of a wire or infection occurred. The mean grading at the final follow-up was 29.5 points (27 to 30) using the Böstman method. This technique preserved the length of the patella, fixed the comminuted fragments of the inferior pole and avoided long-term immobilisation of the knee.

Adolescent↗

PubMed2003

Comminuted fracture of the talus not visible on the initial radiograph.

Fractures of the talus are rare injuries and fractures of the body of the talus are particularly rare. Diagnosis of these fractures is also difficult as initial radiographs may be normal, particularly with osteochondral talar dome fractures. Long term morbidity is common after fractures of the talus. A case is presented of a patient with a comminuted fracture of the body of the talus with non-diagnostic initial standard ankle radiographs. Accident and emergency doctors should be aware of this injury, and be suspicious that patients with an appropriate mechanism of injury and pronounced pain may require further investigation despite normal standard ankle radiographs, as an occult fracture of the talus may be present.

Accidental Falls↗

PubMed2005

Helical plate fixation for treatment of comminuted fractures of the proximal and middle one-third of the humerus.

When an operative treatment is indicated for comminuted fractures of the proximal and middle one-third of the humerus, plate fixation is one of the better options. However, a long plate must be applied from the lateral aspect of the greater tuberosity to the shaft of the humerus, which requires dissection of the deltoid muscle insertion. We twisted the long plate and fixed it from the lateral aspect of the greater tuberosity to the anterior or antero-medial aspect of the mid or the distal shaft of the humerus preserving the deltoid muscle insertion in nine patients (10 limbs). Eight out of 10 cases involved comminuted segmental fractures of the proximal humeral shaft, the surgical neck, and the greater tuberosity. Tricortical autoiliac bone graft was necessary in two patients to restore the neck-shaft angle. All fractures healed uneventfully at 19 weeks on average without additional procedure (range: 14-28 weeks). Shoulder function was evaluated according to Neer's criteria. Three patients were classified as excellent, five satisfactory, and as two unsatisfactory, there was no failure.

Adult↗

PubMed2001

Comminuted fractures of the olecranon. Management by bone graft from the iliac crest and multiple tension-band wiring.

Between 1993 and 1999, we treated ten patients with comminuted fractures of the olecranon by multiple tension-band wiring and a graft from the iliac crest. Their mean age was 35 years (19 to 56). The mean follow-up was for 28.5 months (15 to 46) and the mean time to union of the fractures was four months (3 to 7). No patient reported difficulties with activities of daily living or symptoms of instability of the elbow. The mean flexion was to 135 degrees (125 to 145) with a mean flexion contracture of 15 degrees (10 to 30). The mean pronation was 70 degrees (60 to 80) and mean supination 79 degrees (70 to 90). Only three patients had mild pain and loss of strength. Five patients had excellent and five good results with a mean Broberg and Morrey index score of 94.5 points (84 to 100). Our results compare favourably with those previously reported and the technique is thought to be a practical alternative to plate fixation in fractures with extreme comminution.

Adult↗

PubMed2004

[Retrograde intramedullary locked nail and bolt for comminuted fracture in the femur condyles].

OBJECTIVE: To evaluate the therapeutic effects of locked supracondylar intramedullary nail and bolt for treating comminuted fracture in the distal end of the femur. METHODS: Forty-two patients (including 31 male and 11 female patients) with supracondylar and intercondylar fractures, classified into type C1 in 20 cases and type C2 in 22 cases according to AO classification, were treated with retrograde intramedullary nail and bolt. RESULTS: The follow-up period ranged from 3 to 18 months and the average time of bone healing was 4.6 months. Assessed by functional scoring, the results were excellent in 31 patients, good in 10, and acceptable in 1, with the rate of excellent result as high as 97.6%. CONCLUSIONS: Retrograde intramedullary nail and bolt can be ideal for treating supracondylar and intercondylar fractures. The bolt can effectively control the dissociation of the intercondylar fractures and good functional recovery of the knee joint can be achieved through early functional training.

Adult↗

PubMed1997

[The treatment of patients with comminuted fractures of the bones of the zygomatico-orbital complex].

The paper presents a new method for fixing bone fragments and the entire zygomatic bone in patients with comminuted fractures of the zygomatico-orbital complex. Demonstrates the possibility of repair of the zygomatic bone and the contours of the zygomatico-orbital area. Discusses the probability of venous inclusion in the treatment of patients with posttraumatic deformations of the upper and median zones of the face. Stable cosmetic and functional results were attained in 12 patients treated by this method.

Bone Plates↗

PubMed2005

The basket plate in the osteosynthesis of comminuted fractures of distal pole of the patella.

The purpose of this study was to evaluate the basket plate in the treatment of comminuted fractures of the distal pole of the patella (patellar apex fracture). The basket plate was designed by Smiljanić Branimir M.D., Clinical Professor of Surgery, at the Department of Surgery, The University Hospital Sestre milosrdnice, Zagreb, Croatia. In the period from 1988 to 2003, more than 100 patients with comminuted patellar apex fractures had been treated with basket plate osteosynthesis in the Department of Surgery. Only 51 patients were subsequently available for knee examination. For evaluation of the knee, we used a modified Cincinnati knee rating system, using a manual dynamometer in the evaluation of the knee extension. The results were excellent in 30 patients, good in 16 and satisfactory in 5 patients; no poor results were observed. The stability of the osteosynthesis by basket plate allows osseous consolidation if the fracture and permits loading the leg with full body weight early in the postoperative period.

Adult↗

PubMed1987

[Treatment of comminuted fractures of the femoral diaphysis].

The management of 51 comminuted fractures of the shaft of the femur, treated in Africa with limited facilities, is described. The majority were immobilised on traction followed by a period in a plaster cast. Two thirds of the results were judged to be good or very good. In fifteen cases traction did not produce satisfactory alignment. Intramedullary nailing was then employed between the 16th and 47th days, when the fractures were beginning to unite. The fracture site was opened but intramedullary reaming was not used. These relatively unsophisticated methods produced satisfactory results.

Adolescent↗

PubMed1990

An effective treatment of comminuted fractures of the distal radius.

One hundred cases of comminuted fracture of the distal radius were treated by a simple uniform method consisting of distraction by an external fixator for 3 weeks followed by functional bracing. During the application of the external fixator, autogenous cancellous bone chips were taken from the iliac crest and packed into the fracture site to realign the juxtaarticular fragments and to fill up the bone gap. Complications have been minimal. The results, after an average follow-up period of 20 months, taking into consideration subjective assessment of pain, objective measurement of wrist motion, and radiologic angles, have been excellent.

Adult↗

PubMed1991

Radio-scapho-lunate partial wrist arthrodesis following comminuted fractures of the distal radius.

Painful radiocarpal arthritis following comminuted fractures of the distal radius may be treated either by total wrist fusion or by procedures which preserve movement. The authors have reviewed 15 patients with such fractures who have undergone radio-scapho-lunate partial arthrodesis. They report the results with an average follow-up of 23.8 months. Pain was abolished in 7 patients and resolved virtually completely in 4 cases. Restored grip strength averaged 49% of the contralateral side. There was considerable limitation of postoperative range of motion which was restricted to an oblique plane extending dorso-radial to palmar-ulnar. Most patients did not report this as a problem. Two cases of non-union were reported as well as a 35.7% incidence of secondary degenerative change in the midcarpal joint. This feature casts doubt on the predictability of outcome of this procedure.

Adult↗

PubMed1992

Tension-band wiring and lag screw fixation of a transverse, comminuted fracture of a patella in a horse.

A transverse, comminuted fracture of the patella was treated surgically by combining tension-band wiring and lag-screw fixation in a horse. Partial patellectomy or smaller detached fragments of the patella was performed. Satisfactory healing of the fracture was evident 10 weeks after surgery, and there were no complications. Implants were not removed. The horse was sound at a trot 4 months after surgery and was used for pleasure riding 8 months later.

Animals↗

PubMed1991

[Tension band osteosynthesis with absorbable cords in proximal comminuted fractures of the humerus].

We reviewed 25 cases of comminuted fractures of the proximal humerus that were operatively treated from December 1984 to December 1988. Ten patients were treated by a Magerl operation modified by Marti using a metallic wire as a tension band. Twelve patients were operated on using a resorbable PDS (Polydioxanon) thread in the same manner. In this paper the PDS thread technique is described. The two groups are clinically and radiologically comparable. Using a PDS thread as a tension band has evident advantages: the relatively simple technique and the absence of implant removal.

Adult↗