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A4 Antegrade interlocking nailing versus locking compression plating for treatment of humeral shaft fractures
Injury, Int. J. Care Injured 42 (2011) S3, S1–S24
Contents lists available at ScienceDirect
Injury journal homepage: www.elsevier.com/locate/injury
Oral presentations A1 Operative management of an isolated capitellum humeri fracture with different types of screws R. Pavic1 , M. Malovic1 . 1 University Hospital of Traumatology, Zagreb, Croatia Purpose & Aim: This is a retrospect study tracking the functional recovery following osteosynthetic repair of isolated capitellum humeri fracture. Material & Methods: Fractures of the capitellum humeri are rare with an annual incidence of 1.5 per 100,000 in a population over 13 years of age. In the literature, the higher prevalence of this injury is found in women, especially over 60 years of age, and it has been suggested this is related to the greater carrying angle of the female elbow and postmenopausal osteoporosis. Our patient population was generally younger, our average was 38.6 years. We present 40 patients with isolated fracture of the capitellum humerus. All patients were categorized as Type I (Hahn-Steinthal) and all were operated using the Kochner approach. The osteosynthetic materials used were screws (AO screws, Herbert screws or Twin-Fix screws). Results: The postoperative function of the operated elbow was compared to the contralateral elbow and preoperative range of motion, and 1 and 3 month postoperatively. Conclusions: We show that following injury early treatment and early rehabilitation increase the functional results and full recovery. A2 Elastic Stable Intramedullary Nailing compared with plate osteosynthesis in dislocated clavicle fractures: Results of a retrospective cohort study P.W.J. van Rutte1 , H.R. van den Berg1 , G. van Montfort1 , A.H. van der Veen1 . 1 Department of Trauma Surgery, Catharina Hospital Eindhoven, The Netherlands Aims: Because of high rates of nonunion and malunion, plate osteosynthesis (POS) is the gold standard in treating dislocated midshaft clavicle fractures nowadays. An alternative minimal invasive surgical treatment is Elastic Stable Intramedullary Nailing (ESIN). Aim of the study was to compare the results of ESIN with plate osteosynthesis in dislocated midshaft clavicle fractures. Materials and Methods: A retrospective cohort study of all patients aged ≥15 year who underwent surgical treatment for a dislocated midshaft clavicle fracture between January 2005 and August 2010. Medical records and X-rays were reviewed. All patients were invited to the outdoor patient clinic for an interview and a standardized clinical examination according to the DASH- and the Constant Shoulder Score respectively. Results: Seventy-one patients were included. Sixty-two patients (44 ESIN, 18 POS) underwent a final interview and clinical examination. Duration of surgery was significantly shorter when performing ESIN. 19 patients in the ESIN group developed neurological complaints, 11 patients in the POS group. No wound infection occurred in both groups. Consolidation was excellent in both groups. Resurgery was performed in 8 patients in the ESIN group 0020-1383/ $ – see front matter © 2011 Elsevier Ltd. All rights reserved.
and in 2 patients of the POS group. According to the DASH-score and the CSS no statistically significant difference in functional outcome was found. Cosmetic results did not differ between the two groups. Conclusion: ESIN is a faster and a less invasive procedure for dislocated midshaft clavicle fractures than POS. There is no difference in post operative complication rates between ESIN and POS in this cohort. Functional outcome measured by DASH- and Constant Shoulder Score is not different between ESIN and POS. A randomized controlled trial should be performed to compare the results of both treatment modalities prospectively and draw definitive conclusions A3 A cadaver study of the clavicle hook-plate for treatment of Acromioclavicular Joint Dislocation M. Terra1 , P.H.A.F. Nagel2 , A. Noor3 , G.F. Giannakopoulos1 , W.P. Zuidema1 . 1 VU-University medical center, department of traumasurgery, Amsterdam, 2 Red Cross Hospital, department of traumasurgery, Beverwijk, 3 Medical Center Alkmaar, department of traumasurgery, Alkmaar, The Netherlands Aim: To determine if an angle stable clavicle hook-plate causes subacromial bony or rotator cuff impingement and to evaluate if this is caused by surgical technique or characteristics of the implant in the treatment of acromioclavicular (AC) joint dislocation. Methods: A fresh-frozen cadaver torso was utilized. Open reduction and internal fixation of the AC joint was accomplished with the Synthes® clavicle hook-plate in two positions. Afterwards dissection of the shoulder region was performed. Evaluations was performed with the shoulder in various glenohumeral positions to assess for subacromial bony or soft-tissue impingement. Results: The dissection of the shoulder showed that there was no subacromial bony impingement of the hook-plate if placed in the correct position. The distance between the greater tuberosity and the hook-plate with 90 degrees of shoulder forward flexion and with 90 degrees of abduction was more than sufficient if the hookplate was in the correct position. A more anterior placement of the hook-plate causes subacromial bony impingement. Conclusion: This study demonstrated that the clavicle hookplate can reduce the AC joint anatomically, does not cause bony impingement, and does not cause rotator cuff impingement if correctly positioned. A slightly more anterior position could be responsible for pain and impingement symptoms reported in patients after treatment with the angle-stable hook-plate. A4 Antegrade interlocking nailing versus locking compression plating for treatment of humeral shaft fractures A. Baltov, N. Tzachev, A. Iotov. Orthopedics Trauma Dept, Military Medical Academy, Sofia, Bulgaria Aim: To evaluate and compare the results of 2-nd generation antegrade interlocking nailing (ILN) and locking compression plating (LCP) in humeral shaft fractures (HSF). Material & Methods: During 8 years period 132 patients with HSF (84 males and 48 females) were operated and followed up for
S2
Oral presentations / Injury, Int. J. Care Injured 42 (2011) S3, S1–S24
12–60 months. According to AO there were 48 Type A, 54 Type B and 30 Type C fractures. Of 11 open injuries there were 3 grades I, 5 grades II and 3 grades IIIA. There were 30 patients with polytrauma (20 vs. 10) and 4 cases with floating elbow (3 vs.1). In 77 fractures ILN was performed and LCP in rest 55. Results: The mean operative time was 80 min for ILN vs. 120 min for LCP and the mean blood loss 100 ml vs./ 250 ml. Healing occurred in 127 fractures with mean healing time 93 vs./ 115 days. Functional results according to Rommence score were as follows. Shoulder: excellent 43 vs. 31, good 30 vs. 11, poor 4 vs. 3. Elbow: excellent 74 vs. 44, good 3 vs. 11. Complications noted were iatrogenic nerve palsy 1 vs. 3, delayed union 2 vs. 2, non union 2 vs. 3, infection 1 vs. 1, fixation failure and reosteosynthesis 2 vs. 3, shoulder impingement 13 vs. 2. Conclusions: Antegrade ILN wrong shoulder function and should be using only in pitients with polytrauma and C type fractures. LCP is better option for treatment of HSF. A5 Displaced proximal humerus fractures; comparison non-operative vs. operative treatment using intramedullary nailing targon PH 1
2
2
1
1
M. Falis , P. Czarnecki , L. Romanowski , J. Wcislek . Department of Trauma and Orthopaedic Surgery Ostrow Wlkp, 2 Hand Surgery Department Poznan University of Medical Sciences, Poland Aim: Still it is open question of choice between non-operative or operative treatment of displaced proximal humeral fractures(dphf). The aim of this research was: 1. Evaluation of shoulder function after non-operative and operative treatment of dphf with use of Targon Ph intramedullary nailing. 2. Comparison of non-operative treatment and operative treatment of dphf. Material and methods: The material was 25 patients treated non-operatively and 42 operatively. Non-operative treatment was done by short splint immobilization and next rehabilitation since the second week. Targon Ph was used in operative treatment. Non-operative and operative treatment was done by the same five orthopedists. Average period of patients’ observation was 19 months. We performed shoulder function evaluation by means of ConstantMurley and UCLA scores. Results: Patients after non-operative treatment of dphf acc. Constant-Murley score obtained 52/100; in UCLA score 25/35. Patients after operative treatment of dphf in Constant-Murley score obtained 70/100; in UCLA score 26/35. Conclusions: The results of operative treatment of dphf were significantly better than non-operative treatment in ConstantMurley score. Testing by UCLA score – there were no statistical differences between both treatment groups. A6 Evaluation of the use of gamma nail for the treatment of trochanteric hip fractures. A retrospective study D. Georgiannos, I. Bisbinas, M. Savvidis, M. Karanassos, I. Theodoroudis, G. Gouvas. 1st Orthopaedic Department, 424 Military General Hospital, Thessaloniki, Hellas, Greece Aim: Aim of this study is to retrospectively evaluate the complications of the use of Gamma nail for the treatment of trochanteric hip fractures in our Department, due to serious concerns that have been raised recently regarding the implant’s complication rate and especially the risk for subsequent femoral shaft fracture. Material and Method: 165 patients were treated for trochanteric hip fractures between 2005–2010, using Gamma nail (122 Gamma-3 and 43 first version Gamma nail). All patients were retrospectively analyzed and intra- and postoperative complications
and outcomes were retrieved from patients’ notes. Complications recorded, were technical complications during surgery and postop fracture-related complications. Results: Patients were followed up for 1 year (4m-2y). Median age was 79y (29y-97y). The fractures were classified according to AO/ASIF classification as: 28 basocervical (31-B2.1), 121 intertrochanteric (31-A) and 16 subtrochanteric (32-A, 32-B). Postoperatively and during follow-up, 13 complications (7.8%) were detected. The most frequent mechanical complication was the cutout of the lag screw from the femoral head (6 cases, 3.6%). In 2 cases (1.2%) lag screw migration into the pelvis was occurred. Other complications, such as nonunion and distal screw breakage occurred in 5 cases (3%). No femoral shaft fracture was occurred. All of the complicated cases but the screw breakage, the nail was revised either with THR or bipolar hemiarthroplasty. Conclusion: The use of Gamma nail and especially the latest version of Gamma-3 nail for fixation of trochanteric hip fractures is a safe method with low complication rate. The implant use can lead to very good outcome when the correct surgical technique is respected. A7 From beginning to present, inflatable intramedullary nailing a therapeutic dilemma! K. Gokku ¨ s¸ 1 , M. Saylik2 , A.T. Aydin3 . 1 Ozel Antalya Memorial Hospital, MD, Orthopaedic specialist, Antalya, 2 Ozel Bursa Bahar Hospital, MD, Orthopaedic specialist, Bursa, 3 Akdeniz University Faculty of Medicine, Orthopaedics and Traumatology Department, Antalya, Turkey Aims: The aim of the study is to share and to discuss the disadventages of the inflatable nails in the humeral region. Material and methods: This article presents 3 cases of Hipertrophic nonunion of humeral diaphysis due to inflatable intramedullary nailing and final treatment with locking dynamic compression plate and autugrafting with spongiose bone. The anterolateral approach applied and radial nerve protected in all cases than Locking dynamic compression plate and spongiose bone autugrafting performed. At the second post operative month the union established in all cases. Results: In closed humeral diaphysis fractures the role of IMN at the treatment is not defined clearly. IMN is preferrable; If the patient had pathological fracture, widely seperate segmental fracture or fracture with soft tissue injuries that would not permit the surgeon to make incision on fracture side such as local burns. Inflatable intramedullary nail was a popular device at early 2000’s. The easiness of non locking technique was attractive to tired orthopaedic surgeon exposed the radiation during the distal locking period. At the upper extremity (because of non weight bearing characteristic) inflatable nailing failed in comparison with lower extremity. In our experience rotational instability, and distraction of fracture side has been concern with the inflatable nail, many bad results reported about the inflatable nailing at humeral side in the literature by contrast with lower extremity. Conclusion: Based on these clinical observations, previously reported advantages of inflatable nails, reduced operation time and high union rates is not reasonable at humeral region. A8 Retrograde tibiotalocalcaneal nails: an option for complex pilon fractures C. Bowlin, L. Zagrocki, C. Mauffrey, D. Seligson. University Hospital Louisville, Louisville KY, USA Aim: There is no consensus on the treatment method of type III open pilon fractures. Despite staged management, the outcome is unsatisfactory. The aim of this study is to present primary retrograde tibiotalocalcaneal nailing for the management of acute open type III pilon fractures. Materials and Methods: We prospectively collected a series of 6 open grade III pilon fractures between 2008 and 2010. Inclusion
Contents lists available at ScienceDirect
Injury journal homepage: www.elsevier.com/locate/injury
Oral presentations A1 Operative management of an isolated capitellum humeri fracture with different types of screws R. Pavic1 , M. Malovic1 . 1 University Hospital of Traumatology, Zagreb, Croatia Purpose & Aim: This is a retrospect study tracking the functional recovery following osteosynthetic repair of isolated capitellum humeri fracture. Material & Methods: Fractures of the capitellum humeri are rare with an annual incidence of 1.5 per 100,000 in a population over 13 years of age. In the literature, the higher prevalence of this injury is found in women, especially over 60 years of age, and it has been suggested this is related to the greater carrying angle of the female elbow and postmenopausal osteoporosis. Our patient population was generally younger, our average was 38.6 years. We present 40 patients with isolated fracture of the capitellum humerus. All patients were categorized as Type I (Hahn-Steinthal) and all were operated using the Kochner approach. The osteosynthetic materials used were screws (AO screws, Herbert screws or Twin-Fix screws). Results: The postoperative function of the operated elbow was compared to the contralateral elbow and preoperative range of motion, and 1 and 3 month postoperatively. Conclusions: We show that following injury early treatment and early rehabilitation increase the functional results and full recovery. A2 Elastic Stable Intramedullary Nailing compared with plate osteosynthesis in dislocated clavicle fractures: Results of a retrospective cohort study P.W.J. van Rutte1 , H.R. van den Berg1 , G. van Montfort1 , A.H. van der Veen1 . 1 Department of Trauma Surgery, Catharina Hospital Eindhoven, The Netherlands Aims: Because of high rates of nonunion and malunion, plate osteosynthesis (POS) is the gold standard in treating dislocated midshaft clavicle fractures nowadays. An alternative minimal invasive surgical treatment is Elastic Stable Intramedullary Nailing (ESIN). Aim of the study was to compare the results of ESIN with plate osteosynthesis in dislocated midshaft clavicle fractures. Materials and Methods: A retrospective cohort study of all patients aged ≥15 year who underwent surgical treatment for a dislocated midshaft clavicle fracture between January 2005 and August 2010. Medical records and X-rays were reviewed. All patients were invited to the outdoor patient clinic for an interview and a standardized clinical examination according to the DASH- and the Constant Shoulder Score respectively. Results: Seventy-one patients were included. Sixty-two patients (44 ESIN, 18 POS) underwent a final interview and clinical examination. Duration of surgery was significantly shorter when performing ESIN. 19 patients in the ESIN group developed neurological complaints, 11 patients in the POS group. No wound infection occurred in both groups. Consolidation was excellent in both groups. Resurgery was performed in 8 patients in the ESIN group 0020-1383/ $ – see front matter © 2011 Elsevier Ltd. All rights reserved.
and in 2 patients of the POS group. According to the DASH-score and the CSS no statistically significant difference in functional outcome was found. Cosmetic results did not differ between the two groups. Conclusion: ESIN is a faster and a less invasive procedure for dislocated midshaft clavicle fractures than POS. There is no difference in post operative complication rates between ESIN and POS in this cohort. Functional outcome measured by DASH- and Constant Shoulder Score is not different between ESIN and POS. A randomized controlled trial should be performed to compare the results of both treatment modalities prospectively and draw definitive conclusions A3 A cadaver study of the clavicle hook-plate for treatment of Acromioclavicular Joint Dislocation M. Terra1 , P.H.A.F. Nagel2 , A. Noor3 , G.F. Giannakopoulos1 , W.P. Zuidema1 . 1 VU-University medical center, department of traumasurgery, Amsterdam, 2 Red Cross Hospital, department of traumasurgery, Beverwijk, 3 Medical Center Alkmaar, department of traumasurgery, Alkmaar, The Netherlands Aim: To determine if an angle stable clavicle hook-plate causes subacromial bony or rotator cuff impingement and to evaluate if this is caused by surgical technique or characteristics of the implant in the treatment of acromioclavicular (AC) joint dislocation. Methods: A fresh-frozen cadaver torso was utilized. Open reduction and internal fixation of the AC joint was accomplished with the Synthes® clavicle hook-plate in two positions. Afterwards dissection of the shoulder region was performed. Evaluations was performed with the shoulder in various glenohumeral positions to assess for subacromial bony or soft-tissue impingement. Results: The dissection of the shoulder showed that there was no subacromial bony impingement of the hook-plate if placed in the correct position. The distance between the greater tuberosity and the hook-plate with 90 degrees of shoulder forward flexion and with 90 degrees of abduction was more than sufficient if the hookplate was in the correct position. A more anterior placement of the hook-plate causes subacromial bony impingement. Conclusion: This study demonstrated that the clavicle hookplate can reduce the AC joint anatomically, does not cause bony impingement, and does not cause rotator cuff impingement if correctly positioned. A slightly more anterior position could be responsible for pain and impingement symptoms reported in patients after treatment with the angle-stable hook-plate. A4 Antegrade interlocking nailing versus locking compression plating for treatment of humeral shaft fractures A. Baltov, N. Tzachev, A. Iotov. Orthopedics Trauma Dept, Military Medical Academy, Sofia, Bulgaria Aim: To evaluate and compare the results of 2-nd generation antegrade interlocking nailing (ILN) and locking compression plating (LCP) in humeral shaft fractures (HSF). Material & Methods: During 8 years period 132 patients with HSF (84 males and 48 females) were operated and followed up for
S2
Oral presentations / Injury, Int. J. Care Injured 42 (2011) S3, S1–S24
12–60 months. According to AO there were 48 Type A, 54 Type B and 30 Type C fractures. Of 11 open injuries there were 3 grades I, 5 grades II and 3 grades IIIA. There were 30 patients with polytrauma (20 vs. 10) and 4 cases with floating elbow (3 vs.1). In 77 fractures ILN was performed and LCP in rest 55. Results: The mean operative time was 80 min for ILN vs. 120 min for LCP and the mean blood loss 100 ml vs./ 250 ml. Healing occurred in 127 fractures with mean healing time 93 vs./ 115 days. Functional results according to Rommence score were as follows. Shoulder: excellent 43 vs. 31, good 30 vs. 11, poor 4 vs. 3. Elbow: excellent 74 vs. 44, good 3 vs. 11. Complications noted were iatrogenic nerve palsy 1 vs. 3, delayed union 2 vs. 2, non union 2 vs. 3, infection 1 vs. 1, fixation failure and reosteosynthesis 2 vs. 3, shoulder impingement 13 vs. 2. Conclusions: Antegrade ILN wrong shoulder function and should be using only in pitients with polytrauma and C type fractures. LCP is better option for treatment of HSF. A5 Displaced proximal humerus fractures; comparison non-operative vs. operative treatment using intramedullary nailing targon PH 1
2
2
1
1
M. Falis , P. Czarnecki , L. Romanowski , J. Wcislek . Department of Trauma and Orthopaedic Surgery Ostrow Wlkp, 2 Hand Surgery Department Poznan University of Medical Sciences, Poland Aim: Still it is open question of choice between non-operative or operative treatment of displaced proximal humeral fractures(dphf). The aim of this research was: 1. Evaluation of shoulder function after non-operative and operative treatment of dphf with use of Targon Ph intramedullary nailing. 2. Comparison of non-operative treatment and operative treatment of dphf. Material and methods: The material was 25 patients treated non-operatively and 42 operatively. Non-operative treatment was done by short splint immobilization and next rehabilitation since the second week. Targon Ph was used in operative treatment. Non-operative and operative treatment was done by the same five orthopedists. Average period of patients’ observation was 19 months. We performed shoulder function evaluation by means of ConstantMurley and UCLA scores. Results: Patients after non-operative treatment of dphf acc. Constant-Murley score obtained 52/100; in UCLA score 25/35. Patients after operative treatment of dphf in Constant-Murley score obtained 70/100; in UCLA score 26/35. Conclusions: The results of operative treatment of dphf were significantly better than non-operative treatment in ConstantMurley score. Testing by UCLA score – there were no statistical differences between both treatment groups. A6 Evaluation of the use of gamma nail for the treatment of trochanteric hip fractures. A retrospective study D. Georgiannos, I. Bisbinas, M. Savvidis, M. Karanassos, I. Theodoroudis, G. Gouvas. 1st Orthopaedic Department, 424 Military General Hospital, Thessaloniki, Hellas, Greece Aim: Aim of this study is to retrospectively evaluate the complications of the use of Gamma nail for the treatment of trochanteric hip fractures in our Department, due to serious concerns that have been raised recently regarding the implant’s complication rate and especially the risk for subsequent femoral shaft fracture. Material and Method: 165 patients were treated for trochanteric hip fractures between 2005–2010, using Gamma nail (122 Gamma-3 and 43 first version Gamma nail). All patients were retrospectively analyzed and intra- and postoperative complications
and outcomes were retrieved from patients’ notes. Complications recorded, were technical complications during surgery and postop fracture-related complications. Results: Patients were followed up for 1 year (4m-2y). Median age was 79y (29y-97y). The fractures were classified according to AO/ASIF classification as: 28 basocervical (31-B2.1), 121 intertrochanteric (31-A) and 16 subtrochanteric (32-A, 32-B). Postoperatively and during follow-up, 13 complications (7.8%) were detected. The most frequent mechanical complication was the cutout of the lag screw from the femoral head (6 cases, 3.6%). In 2 cases (1.2%) lag screw migration into the pelvis was occurred. Other complications, such as nonunion and distal screw breakage occurred in 5 cases (3%). No femoral shaft fracture was occurred. All of the complicated cases but the screw breakage, the nail was revised either with THR or bipolar hemiarthroplasty. Conclusion: The use of Gamma nail and especially the latest version of Gamma-3 nail for fixation of trochanteric hip fractures is a safe method with low complication rate. The implant use can lead to very good outcome when the correct surgical technique is respected. A7 From beginning to present, inflatable intramedullary nailing a therapeutic dilemma! K. Gokku ¨ s¸ 1 , M. Saylik2 , A.T. Aydin3 . 1 Ozel Antalya Memorial Hospital, MD, Orthopaedic specialist, Antalya, 2 Ozel Bursa Bahar Hospital, MD, Orthopaedic specialist, Bursa, 3 Akdeniz University Faculty of Medicine, Orthopaedics and Traumatology Department, Antalya, Turkey Aims: The aim of the study is to share and to discuss the disadventages of the inflatable nails in the humeral region. Material and methods: This article presents 3 cases of Hipertrophic nonunion of humeral diaphysis due to inflatable intramedullary nailing and final treatment with locking dynamic compression plate and autugrafting with spongiose bone. The anterolateral approach applied and radial nerve protected in all cases than Locking dynamic compression plate and spongiose bone autugrafting performed. At the second post operative month the union established in all cases. Results: In closed humeral diaphysis fractures the role of IMN at the treatment is not defined clearly. IMN is preferrable; If the patient had pathological fracture, widely seperate segmental fracture or fracture with soft tissue injuries that would not permit the surgeon to make incision on fracture side such as local burns. Inflatable intramedullary nail was a popular device at early 2000’s. The easiness of non locking technique was attractive to tired orthopaedic surgeon exposed the radiation during the distal locking period. At the upper extremity (because of non weight bearing characteristic) inflatable nailing failed in comparison with lower extremity. In our experience rotational instability, and distraction of fracture side has been concern with the inflatable nail, many bad results reported about the inflatable nailing at humeral side in the literature by contrast with lower extremity. Conclusion: Based on these clinical observations, previously reported advantages of inflatable nails, reduced operation time and high union rates is not reasonable at humeral region. A8 Retrograde tibiotalocalcaneal nails: an option for complex pilon fractures C. Bowlin, L. Zagrocki, C. Mauffrey, D. Seligson. University Hospital Louisville, Louisville KY, USA Aim: There is no consensus on the treatment method of type III open pilon fractures. Despite staged management, the outcome is unsatisfactory. The aim of this study is to present primary retrograde tibiotalocalcaneal nailing for the management of acute open type III pilon fractures. Materials and Methods: We prospectively collected a series of 6 open grade III pilon fractures between 2008 and 2010. Inclusion