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A13 IntrameduUary osteosynthesis with the XS-nail in ulna shortening osteotomy
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Oral presentations / Injury, Int. J. Care Injured 42 (2011) S3, S1–S24
extremities. The intramedullary nail showed significant advantages in comparison to the plate. A12 Intramedullary locked nailing for extraarticular fracturues of the distal radius. 2 years results of a aprospective randomized trial in comparison to palmar locked plating G. Gradl, M. Wendt, N. Mielsch, H.W. Stedtfeld, Th. Mittlmeier. University of Rostock, Department of Trauma and Reconstructive Surgery, Germany Aim: This study compares angular stable intramedullary nailing with volar plating for the treatment of displaced fractures of the distal radius. Material and Methods: In a prospective randomized trial patients with extraarticular fractures of the distal radius (AO 23 A3) were randomly assigned to receive either palmar plating (PP) (2.4mm, Synthes, USA) or intramedullary nailing (TDR) (Targon DR, Aesculap, Germany). Follow up examinations were performed 8 weeks and 2 years post surgery. Results: 152 patients (129 female and 23 male, mean age 62.9±15.6 years) were included and randomly assigned to receive either PP (n = 72) or TDR (n = 80). Complete clinical and radiological follow up was obtained in 122 patients. All fractures united. The mean palmar tilt was 2.2° for palmar plating and 2.9° for intramedullary nailing. Significant differences within groups (p < 0.05, students-t-test, posthoc: Bonferroni) were recorded for time for surgery (Targon DR: 41±21 min; 2.4 mm plate: 51±18 min) for x-ray time (Targon DR: 1.2±0.3 min; 2.4 mm plate: 0.9±0.2 min) as well as for early pain and motor function (Targon DR: VAS 1.2±0.2, Ext./Flex. 82%; 2.4 mm plate: VAS 1.6±0.4, Ext./Flex. 76%). No differences were seen after two years. Osteopenic bone loss as measured by pQCT was seen in 73% of cases and qualitiy of life assessment (SF 36) revealed excellent social and physical function without differences within groups. Complications were CTS (4 PP, 2 TDR), temp. paresthesia of the superficial n. radialis branch (2 TDR), screw overlength (n = 2 PP, n = 2 TDR), intraarticular screw location (n = 2 PP) or extensor tendon affection (n = 4 PP). Conclusion: Intramedullary nailing for distal radial fractures is advantageous in terms of pain reduction and early motion when compared to volar plating. The late functional results of both techniques are comparable as well as the fixation stability in osteoporotic fractures. A13 Intramedullary osteosynthesis with the XS-nail in ulna shortening osteotomy W. Friedl, J. Gehr. Klinikum Aschaffenburg, Germany Aim: Ulna longer than radius causes leads to impingement of discus ulnaris and secondary to wrist problems. For shortening osteotomy of the ulna oblique resection and plate and compression screw osteosyntheses are usually used. Instability, osteotomy pseudarthrosis and soft tissue problems due to thin soft tissue coverage are common problems. Material and Methods: In a series of 8 patients ulna shortening was performed with a intramedullary locked angle stable compression nail system between 2002 and 2006. The XS nail has a 4.5 mm diameter and is locked proximal and distal to the osteotomy with 2.0 or 2.4 mm threaded wires. A compression screw inserted in the nail allows compression of the osteotomy performed at a 90 degree angle to the ulna shaft direction. The intramedullary locked nail gives higher stability and the compression a circumferencial bone comprssion of the osteotomy. Results: In no case pseudarthrosis or implant failure occurred. In one case with too long threaded wires however soft tissue irritation occurred.
Conclusions: The XS nail is a safe and stable method for ulna shortening osteotomy. Special attention must be given to the correct length of the threaded wires. A14 Comparison of augmented external fixation therapy with locking palmar plate in AO – C type fractures of distal radius K. Gokku ¨ s¸ 1 , M. Saylik2 , A.T. Aydin3 . 1 Ozel Antalya Memorial Hospital, Antalya, 2 Ozel Bursa Bahar Hospital, Bursa, 3 Akdeniz University Faculty of Medicine, Orthopaedics and Traumatology Department, Antalya, Turkey Aims: This study was designed to compare the results of palmar locking plate and K-wire augmented external fixation in the treatment of intra-articular comminuted distal radius fractures. Materials and Methods: The study included 28 patients with intra-articular comminuted distal radius fractures.eighteen patients (average age 40.9) underwent open reduction and palmar locking plate fixation, (11 male, 7 female), ten patients (average age 44.2) underwent closed reduction and K-wire augmented external fixation. According to the AO/ASIF classification, there were six C1, ten C2, and four C3 fractures in the locking plate group, and one C1, three C2, and six C3 fractures in the external fixation group. For functional assessment, joint range of motion and grip strength were measured. Subjective functional assessment was made using the QuickDASH scale.the follow up period ranges from 3 months to 2 years. Results: Wrist flexion and dorsiflexion degrees at final follow-up were significantly greater in the locking plate group. The mean QuickDASH scores and time to return to work were better in patients treated with a locking plate than external fixatorgroup.. The mean loss of strength compared to the healthy side at final follow-up was 4.2% in the locking plate group, and 6.1% in the external fixation group. Conclusion: Our results showed palmar locking plate technique is better outcome measures than external fixation technique. But K-wire augmented external fixation can be used as a safe method in selected cases in which the severity of distal radius fracture would not allow palmar locking plate fixation. A15 Knife edge plating for bicondylar plateau fracture D. Seligson, C. Mauffrey, R. Snowden. Department of Orthopedics University of Louisville, The Fracture Service, Kentucky, USA Aims: The sequence of fixation of complex bicondylar tibial plateau fractures has not been well described. In this paper we present ‘knife edge plating’ of the medial tibial border as a method to insure accurate alignment of the proximal tibia. Materials and Methods: The approach to the ‘knife edge’ is through a short medial incision with dissection under the pes anserinus to reach the medial tibial border and reduce and plate it. The method is illustrated with an anatomic dissection and five case examples. Results: Plating the medial tibial border improves accuracy of reduction of bicondylar tibial fractures with improved outcomes. Conclusions: The bicondylar plateau fracture with displacement shoud be approached first medial to plate the ‘knife edge’ and then laterally. A16 The PEEK nail D. Seligson, L. Robinson, P. Collis, T. Clegg. University of Louisville, Kentucky, USA Aims: The purpose of this presentation is to introduce a new intramedullary nail fabricated in poly ethyl ethyl ketone (PEEK) for the treatment of long bone fractures. Materials and Methods: Better fatigue properties and radiolucency make PEEK and attractive material for intramedullary fixation of the humerus. We report their use of PEEK nails for the
Oral presentations / Injury, Int. J. Care Injured 42 (2011) S3, S1–S24
extremities. The intramedullary nail showed significant advantages in comparison to the plate. A12 Intramedullary locked nailing for extraarticular fracturues of the distal radius. 2 years results of a aprospective randomized trial in comparison to palmar locked plating G. Gradl, M. Wendt, N. Mielsch, H.W. Stedtfeld, Th. Mittlmeier. University of Rostock, Department of Trauma and Reconstructive Surgery, Germany Aim: This study compares angular stable intramedullary nailing with volar plating for the treatment of displaced fractures of the distal radius. Material and Methods: In a prospective randomized trial patients with extraarticular fractures of the distal radius (AO 23 A3) were randomly assigned to receive either palmar plating (PP) (2.4mm, Synthes, USA) or intramedullary nailing (TDR) (Targon DR, Aesculap, Germany). Follow up examinations were performed 8 weeks and 2 years post surgery. Results: 152 patients (129 female and 23 male, mean age 62.9±15.6 years) were included and randomly assigned to receive either PP (n = 72) or TDR (n = 80). Complete clinical and radiological follow up was obtained in 122 patients. All fractures united. The mean palmar tilt was 2.2° for palmar plating and 2.9° for intramedullary nailing. Significant differences within groups (p < 0.05, students-t-test, posthoc: Bonferroni) were recorded for time for surgery (Targon DR: 41±21 min; 2.4 mm plate: 51±18 min) for x-ray time (Targon DR: 1.2±0.3 min; 2.4 mm plate: 0.9±0.2 min) as well as for early pain and motor function (Targon DR: VAS 1.2±0.2, Ext./Flex. 82%; 2.4 mm plate: VAS 1.6±0.4, Ext./Flex. 76%). No differences were seen after two years. Osteopenic bone loss as measured by pQCT was seen in 73% of cases and qualitiy of life assessment (SF 36) revealed excellent social and physical function without differences within groups. Complications were CTS (4 PP, 2 TDR), temp. paresthesia of the superficial n. radialis branch (2 TDR), screw overlength (n = 2 PP, n = 2 TDR), intraarticular screw location (n = 2 PP) or extensor tendon affection (n = 4 PP). Conclusion: Intramedullary nailing for distal radial fractures is advantageous in terms of pain reduction and early motion when compared to volar plating. The late functional results of both techniques are comparable as well as the fixation stability in osteoporotic fractures. A13 Intramedullary osteosynthesis with the XS-nail in ulna shortening osteotomy W. Friedl, J. Gehr. Klinikum Aschaffenburg, Germany Aim: Ulna longer than radius causes leads to impingement of discus ulnaris and secondary to wrist problems. For shortening osteotomy of the ulna oblique resection and plate and compression screw osteosyntheses are usually used. Instability, osteotomy pseudarthrosis and soft tissue problems due to thin soft tissue coverage are common problems. Material and Methods: In a series of 8 patients ulna shortening was performed with a intramedullary locked angle stable compression nail system between 2002 and 2006. The XS nail has a 4.5 mm diameter and is locked proximal and distal to the osteotomy with 2.0 or 2.4 mm threaded wires. A compression screw inserted in the nail allows compression of the osteotomy performed at a 90 degree angle to the ulna shaft direction. The intramedullary locked nail gives higher stability and the compression a circumferencial bone comprssion of the osteotomy. Results: In no case pseudarthrosis or implant failure occurred. In one case with too long threaded wires however soft tissue irritation occurred.
Conclusions: The XS nail is a safe and stable method for ulna shortening osteotomy. Special attention must be given to the correct length of the threaded wires. A14 Comparison of augmented external fixation therapy with locking palmar plate in AO – C type fractures of distal radius K. Gokku ¨ s¸ 1 , M. Saylik2 , A.T. Aydin3 . 1 Ozel Antalya Memorial Hospital, Antalya, 2 Ozel Bursa Bahar Hospital, Bursa, 3 Akdeniz University Faculty of Medicine, Orthopaedics and Traumatology Department, Antalya, Turkey Aims: This study was designed to compare the results of palmar locking plate and K-wire augmented external fixation in the treatment of intra-articular comminuted distal radius fractures. Materials and Methods: The study included 28 patients with intra-articular comminuted distal radius fractures.eighteen patients (average age 40.9) underwent open reduction and palmar locking plate fixation, (11 male, 7 female), ten patients (average age 44.2) underwent closed reduction and K-wire augmented external fixation. According to the AO/ASIF classification, there were six C1, ten C2, and four C3 fractures in the locking plate group, and one C1, three C2, and six C3 fractures in the external fixation group. For functional assessment, joint range of motion and grip strength were measured. Subjective functional assessment was made using the QuickDASH scale.the follow up period ranges from 3 months to 2 years. Results: Wrist flexion and dorsiflexion degrees at final follow-up were significantly greater in the locking plate group. The mean QuickDASH scores and time to return to work were better in patients treated with a locking plate than external fixatorgroup.. The mean loss of strength compared to the healthy side at final follow-up was 4.2% in the locking plate group, and 6.1% in the external fixation group. Conclusion: Our results showed palmar locking plate technique is better outcome measures than external fixation technique. But K-wire augmented external fixation can be used as a safe method in selected cases in which the severity of distal radius fracture would not allow palmar locking plate fixation. A15 Knife edge plating for bicondylar plateau fracture D. Seligson, C. Mauffrey, R. Snowden. Department of Orthopedics University of Louisville, The Fracture Service, Kentucky, USA Aims: The sequence of fixation of complex bicondylar tibial plateau fractures has not been well described. In this paper we present ‘knife edge plating’ of the medial tibial border as a method to insure accurate alignment of the proximal tibia. Materials and Methods: The approach to the ‘knife edge’ is through a short medial incision with dissection under the pes anserinus to reach the medial tibial border and reduce and plate it. The method is illustrated with an anatomic dissection and five case examples. Results: Plating the medial tibial border improves accuracy of reduction of bicondylar tibial fractures with improved outcomes. Conclusions: The bicondylar plateau fracture with displacement shoud be approached first medial to plate the ‘knife edge’ and then laterally. A16 The PEEK nail D. Seligson, L. Robinson, P. Collis, T. Clegg. University of Louisville, Kentucky, USA Aims: The purpose of this presentation is to introduce a new intramedullary nail fabricated in poly ethyl ethyl ketone (PEEK) for the treatment of long bone fractures. Materials and Methods: Better fatigue properties and radiolucency make PEEK and attractive material for intramedullary fixation of the humerus. We report their use of PEEK nails for the