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A24 Technique tip for the backstrike of a tibial nail (Expert Tibial Nail)
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Oral presentations / Injury, Int. J. Care Injured 42 (2011) S3, S1–S24
foot deformity (stage IV), one patient had received no treatment for his Talipse Equinus Varrus deformity in the past, two patients had developed an nonunion after the ORIF that they had received as a treatment to their ankle fractures, and finally one patient was a revision case. Results: Fusion was achieved in 13 patients (93%); the mean time was between 12 to 15 weeks. One patient (7%) developed delayed union. Two patients (14%) developed an immediate superficial infection, two patients (14%) developed an early mid foot pain (in the first 6 post op months), and one patient (7%) underwent a hardware removal. The AOFAS post operatively score was improved up to 38%. Conclusions: Although tibiotalocalcaneal arthrodesis is a salvage procedure, most of the patients benefit from it. Unfortunately the post op complications rate still can be quite high (up to 30%). A21 Against all odds? Lateral malleolus non-union in ’stable’ Danis-Weber type B ankle fractures R.J. Derksen1 , Y. Tank2 , R.S. Breederveld1 . 1 Red Cross Hospital Beverwijk, 2 VU University Medical Center, Amsterdam, the Netherlands Aim: Assess the cause of non-union in non-displaced Weber B fractures. Materials and Methods: Two cases of non-union in presumed stable Weber B ankle fractures are described and shown, together with a discussion on the cause of this rare complication. Results: Ct-images revealed subtle signs of associated syndesmotic injury, indicative of syndesmotic instability in what seemed to be a stable ankle on plain radiographs. The importance of a thorough understanding of not only the Danis–Weber classification system, but also of the biomechanics of ankle fractures described in the Lauge-Hansen classification system is put forward. Conclusion: The assessment of complete syndesmotic disruption is advocated by either testing fibulo-tibial stability clinically or by performing a MRI or ultrasound to exclude a complete syndesmotic rupture before a presumed stable ‘Weber B’ fracture is treated conservatively. A22 Intra-bone reduction of articular calcaneal fractures M. Goldzak. Clinique de l’Union, Toulouse/France Aim: Objective of the new surgical approach is to avoid soft tissues damage usually found in ORIF techniques. Method: Minimal invasive posterior approach through a short incision and opening of the calcaneus with a hollow reamer. Associated with distraction of the fracture, we use an intra-bone technique to reduce the articular fragments according the shape of the dorsal talo-calcaneal joint. This particular technique will give the opportunity to adapt the usual percutaeous operative procedure normally used in type 2 and 3 of the new Calcaneal Architectural Fracture Classification (CAFC). Results: The first outcomes in 10 cases were assessed according the SOFCOT SCORE (Societ ´ e´ francaise de Chirurgie Orthopedique) ´ Symposium sur les fractures du calcaneum ´ 1998: 3 items classified from 0 to 5: very good, good, mean and bad.) . . . . The score in this group is very good and good in 8 cases 2 mean. We have no cutaneal complications or nerve injuries in these first 10 patients. Treated with this procedure. This experience led us to the development of a new implant basically consisting of a short nail by which we cover up the large scale of all calcaneal fractures. Actually it is still in a preclinical status. Conclusion: This new surgical approach permits reliable intrabone reduction for calcaneal fractures and allows for either good anatomic reconstruction or arthrodesis. It reduces skin complications and infections.
A23 Proximal third tibial fractures: fixator assisted nailing A.N. Chelnokov, D.A. Bekreev. Ural Scientific Institute of Traumatology and Orthopaedics named after V.D. Chaklin, Ekaterinburg, Russia Purpose and Aim: Proximal third fractures of the tibia can be difficult to nail using conventional technique. Typical problems include valgus malalignment, antecurvation and posterior shift of the distal fragment. Different methods of avoiding these pitfalls have been suggested, but use of the Ilizarov technique seems to be underestimated. The aim of our study was to refine the technique of closed interlocking nailing in fractures of the proximal tibia introducing an Ilizarov-based small wire external distractor. Material and Methods: Over a 7-year period, 56 proximal tibia fractures and nonunions were treated with closed interlocked nailing. All nailings were performed on a flat radiolucent table. Reduction was provided by a distractor consisting of two halfrings connected with three telescopic rods. Spatial control over the proximal fragment was gained by two K-wires inserted in coronal plane. Nailing was performed in knee flexion. Solid titanium nails with minimal reaming were used. Results: Only 7/56 proximal fractures had angulation of 5° or greater in the frontal or sagittal plane. In 4/56 proximal cases there was partial loss of fixation. All of them occurred at the initial period of the study. In 7/56 cases healing was reached after exchange nailing. Conclusion: The technique allows low invasive nail insertion in knee hyperflexion. It renders unnecessary measures like lateral point of insertion, knee semiextension, extended incision, Poller screws, reduction clamps, and provisional buttress plating. A24 Technique tip for the backstrike of a tibial nail (Expert Tibial Nail) M. Gaisl, K. Hasenhuettl, F.J. Seibert. Trauma Hospital Graz, Goestingerstrasse 24–26, A-8021 Graz, Austria We report on a case of nailing a complex open tibial fracture with an Expert Tibial Nail on a fracture table. The operation was performed according to the operating instructions of the manufacturer. We used the standard insertion handle for tibial and femoral nails to insert the nail. After distal interlocking we applied the so called backstrike technique to reduce a remaining fracture gap. At first sight it seemed impossible for us to reduce the fracture gap completely. Due to a technical specification of the insertion handle it was entrapped under the patella. We discuss the settings of this case and the importance of completely diminishing a remaining fracture gap in nailing complex tibial fractures. A25 A five year experience in using poller screws in lower limb im nailing in a military hospital in Greece M. Savvidis, I. Bisbinas, D. Georgiannos, G. Gouvas. A’ Orthopaedic and Trauma Dept, 424 Military General Hospital, Thessaloniki, Greece Aim: Intramedullary nailling is a well-established method of fixation in lower limb long bone fractures. In order to achieve it we need an acceptable reduction and often poller (blocking) screws is the key to achieve it. The aim is review our practice as well as the clinical outcome using poller screws in patients with femoral-tibial fractures.and non-unions, who were treated with im nailing. Material and Methods: Patients notes and x-rays and IITV views with lower limb im nailing during the last five years were collected and reviewed, and the use of poller screws were noted.115 patients were collected 50 with femoral and 65 with tibial nailing. The mean patients age was 35 years and the average follow up was 14 months. In 12 patients (4 femoral and 8 tibial fractures) poller screws were used in order to correct valgus or varus reduction
Oral presentations / Injury, Int. J. Care Injured 42 (2011) S3, S1–S24
foot deformity (stage IV), one patient had received no treatment for his Talipse Equinus Varrus deformity in the past, two patients had developed an nonunion after the ORIF that they had received as a treatment to their ankle fractures, and finally one patient was a revision case. Results: Fusion was achieved in 13 patients (93%); the mean time was between 12 to 15 weeks. One patient (7%) developed delayed union. Two patients (14%) developed an immediate superficial infection, two patients (14%) developed an early mid foot pain (in the first 6 post op months), and one patient (7%) underwent a hardware removal. The AOFAS post operatively score was improved up to 38%. Conclusions: Although tibiotalocalcaneal arthrodesis is a salvage procedure, most of the patients benefit from it. Unfortunately the post op complications rate still can be quite high (up to 30%). A21 Against all odds? Lateral malleolus non-union in ’stable’ Danis-Weber type B ankle fractures R.J. Derksen1 , Y. Tank2 , R.S. Breederveld1 . 1 Red Cross Hospital Beverwijk, 2 VU University Medical Center, Amsterdam, the Netherlands Aim: Assess the cause of non-union in non-displaced Weber B fractures. Materials and Methods: Two cases of non-union in presumed stable Weber B ankle fractures are described and shown, together with a discussion on the cause of this rare complication. Results: Ct-images revealed subtle signs of associated syndesmotic injury, indicative of syndesmotic instability in what seemed to be a stable ankle on plain radiographs. The importance of a thorough understanding of not only the Danis–Weber classification system, but also of the biomechanics of ankle fractures described in the Lauge-Hansen classification system is put forward. Conclusion: The assessment of complete syndesmotic disruption is advocated by either testing fibulo-tibial stability clinically or by performing a MRI or ultrasound to exclude a complete syndesmotic rupture before a presumed stable ‘Weber B’ fracture is treated conservatively. A22 Intra-bone reduction of articular calcaneal fractures M. Goldzak. Clinique de l’Union, Toulouse/France Aim: Objective of the new surgical approach is to avoid soft tissues damage usually found in ORIF techniques. Method: Minimal invasive posterior approach through a short incision and opening of the calcaneus with a hollow reamer. Associated with distraction of the fracture, we use an intra-bone technique to reduce the articular fragments according the shape of the dorsal talo-calcaneal joint. This particular technique will give the opportunity to adapt the usual percutaeous operative procedure normally used in type 2 and 3 of the new Calcaneal Architectural Fracture Classification (CAFC). Results: The first outcomes in 10 cases were assessed according the SOFCOT SCORE (Societ ´ e´ francaise de Chirurgie Orthopedique) ´ Symposium sur les fractures du calcaneum ´ 1998: 3 items classified from 0 to 5: very good, good, mean and bad.) . . . . The score in this group is very good and good in 8 cases 2 mean. We have no cutaneal complications or nerve injuries in these first 10 patients. Treated with this procedure. This experience led us to the development of a new implant basically consisting of a short nail by which we cover up the large scale of all calcaneal fractures. Actually it is still in a preclinical status. Conclusion: This new surgical approach permits reliable intrabone reduction for calcaneal fractures and allows for either good anatomic reconstruction or arthrodesis. It reduces skin complications and infections.
A23 Proximal third tibial fractures: fixator assisted nailing A.N. Chelnokov, D.A. Bekreev. Ural Scientific Institute of Traumatology and Orthopaedics named after V.D. Chaklin, Ekaterinburg, Russia Purpose and Aim: Proximal third fractures of the tibia can be difficult to nail using conventional technique. Typical problems include valgus malalignment, antecurvation and posterior shift of the distal fragment. Different methods of avoiding these pitfalls have been suggested, but use of the Ilizarov technique seems to be underestimated. The aim of our study was to refine the technique of closed interlocking nailing in fractures of the proximal tibia introducing an Ilizarov-based small wire external distractor. Material and Methods: Over a 7-year period, 56 proximal tibia fractures and nonunions were treated with closed interlocked nailing. All nailings were performed on a flat radiolucent table. Reduction was provided by a distractor consisting of two halfrings connected with three telescopic rods. Spatial control over the proximal fragment was gained by two K-wires inserted in coronal plane. Nailing was performed in knee flexion. Solid titanium nails with minimal reaming were used. Results: Only 7/56 proximal fractures had angulation of 5° or greater in the frontal or sagittal plane. In 4/56 proximal cases there was partial loss of fixation. All of them occurred at the initial period of the study. In 7/56 cases healing was reached after exchange nailing. Conclusion: The technique allows low invasive nail insertion in knee hyperflexion. It renders unnecessary measures like lateral point of insertion, knee semiextension, extended incision, Poller screws, reduction clamps, and provisional buttress plating. A24 Technique tip for the backstrike of a tibial nail (Expert Tibial Nail) M. Gaisl, K. Hasenhuettl, F.J. Seibert. Trauma Hospital Graz, Goestingerstrasse 24–26, A-8021 Graz, Austria We report on a case of nailing a complex open tibial fracture with an Expert Tibial Nail on a fracture table. The operation was performed according to the operating instructions of the manufacturer. We used the standard insertion handle for tibial and femoral nails to insert the nail. After distal interlocking we applied the so called backstrike technique to reduce a remaining fracture gap. At first sight it seemed impossible for us to reduce the fracture gap completely. Due to a technical specification of the insertion handle it was entrapped under the patella. We discuss the settings of this case and the importance of completely diminishing a remaining fracture gap in nailing complex tibial fractures. A25 A five year experience in using poller screws in lower limb im nailing in a military hospital in Greece M. Savvidis, I. Bisbinas, D. Georgiannos, G. Gouvas. A’ Orthopaedic and Trauma Dept, 424 Military General Hospital, Thessaloniki, Greece Aim: Intramedullary nailling is a well-established method of fixation in lower limb long bone fractures. In order to achieve it we need an acceptable reduction and often poller (blocking) screws is the key to achieve it. The aim is review our practice as well as the clinical outcome using poller screws in patients with femoral-tibial fractures.and non-unions, who were treated with im nailing. Material and Methods: Patients notes and x-rays and IITV views with lower limb im nailing during the last five years were collected and reviewed, and the use of poller screws were noted.115 patients were collected 50 with femoral and 65 with tibial nailing. The mean patients age was 35 years and the average follow up was 14 months. In 12 patients (4 femoral and 8 tibial fractures) poller screws were used in order to correct valgus or varus reduction