- Email: [email protected]
A83 Treatment of humeral shaft fractures with intramedullary nailing
S22
Oral presentations / Injury, Int. J. Care Injured 42 (2011) S3, S1–S24
Results: The virtual and hands on application showed that the fracture site can be addressed nicely by the polyax-mechanism. The cantilever test showed a higher stiffness at the PolyAxNail. Conclusions: With the herewith introduced novel poly-axial intramedullary nailing concept the authors believe to even widen the spectrum of indications. This concept combines the advantages of the poly-axial plates with the advantages of the intramedullary locking nails. Because of the better fragment adaption this new intramedullary nailing concept should perform faster bone healing and less pseudarthrosis. Regarding Poliaxiality, Angle Stability and Targeting the feasibility of the PoliAx-Nailing Concept had been proven. A81 First experience with a new fixation implant: Technical tips from the clinical application of Proximal Femoral Nail-A II (PFNA-II) D. Karataglis, A. Boutsiadis, P. Papadopoulos, P. Antonarakos, K. Ditsios, An. Christodoulou. A Orthopaedic Department of Aristotle University of Thessaloniki, General Hospital G Papanikolaou, Exohi, Thessaloniki, Greece Aim: PFNA-II is a specified proximal femoral nail initially designed for Asian patients, in order to better fit to their small trochanteric area and narrow IM canal. The manufactures support that the lateral flat surface, the 5° medial-lateral bending and the smaller proximal diameter result in an anatomic shape and in a superior implant than the PFNA I. Materials & Methods: Prospectively 31 cases (all female, mean age 83 years) of extraarticular inter/pertrochanteric fractures (AO 31A) were treated with PFNA II, from 2/2010 to 4/2011. Fracture classification, intraoperative technical problems or advantages, postoperative results and technical features of the implants applied were documented. At the same time the tip apex distance (TAD) was also measured. Results: In details, 5 patients had a Type A1 fracture, 18 Type A2 and 8 patients Type A3. In 28 cases implant with CCD angle 125° was used and in only 3 cases the 130° implant was applied. The mean TAD was 15mm while the mean distance from the lateral cortex was 5mm. We observed easier insertion than PFNA I and no loss of reduction during application. However, 130° implants are prone to higher TAD (1 cut out case). Finally, all the instrumentation is very good and facilitates its application, better than PFNA I. Conclusions: PFNA II is a new implant with small technical differences but with big advantages during its application, compared with the PFNA I, promising better clinical results and fewer complications. A82 Treatment of humeral shaft non-unions after intramedullary nailing A. Baltov, N. Tzachev. Department of Orthopedics and Trauma Surgery, Military Medical Academy, Sofia, Bulgaria Aim: The nonunion of humeral shaft fractures treated with intramedullary osteosynthesis (IS) or interlocked intramedullary nailing (ILN) presents with specific symptoms such as rotatory instability, medullar thinning of the inner part of the cortex, bone resorption around the locking screws and implant ends. The delayed set of diagnosis due to the residual relative stability leads to alteration of bone architectonic and impaired shoulder and elbow function. Material and method: For a period of 5 years 13 patients – 6 after IS (osteosynthesis with multiple K wires – 2, retrograde Ender nails – 4) and 7 after ILN were treated. There were 6 women and 7 men at the average age of 41 (22–84). According to the Weber– Cˆech classification the non-unions were as follows: 9 atrophic, 3 oligorophic and 1 hypertrophic. In two cases taken material for microbiological test was positive for infection. In all cases bone resorption around the implants was observed. In 4 cases there was
debricolage – 3 after IS and 1 after ILN. The time past after the first operation was between 12 and 36 months. The main reason for non-union in 7 cases was distraction, in 5 cases unstable fixation and in 9 wrong operative technique. The operative procedure in all cases included implant removal, abbreviation of bone ends, bone grafting and reosteosynthesis – in 3 cases with DCP, in 8 LCP with hybrid fixation and in two cases ILN. In 12 patients autologous bone grafting and in one case allograft was used and again in one case structural cortical crioallograft was used. Results: In all nonunions bone healing was achieved between 8–12 months. The follow up period was 12–48 months. In one case the postoperative debricolage led to reostheosynthesis. There was no case of iatrogenic nerve or vascular injury. The final functional outcome was assessed according to Constant score (5 excellent, 6 good and 2 fair) and Murrey score (10 excellent, 2 good and 1 fair). Conclusions: In cases with rotatory instability or persistent fracture distraction for more than 8 months an additional operative procedure is recommended. In cases without bone resorption around the locking screws or at the implant ends – debridement and autogenous bone grafting is enough as an operative procedure. In case of clinically observed movements at the fracture site implant removal, autologous bone grafting and reosteosynthesis either with DCP or LCP with hybrid fixation is a method of choice. Reosteosynthesis by interlocked intramedullary nail with reaming is not an appropriate treatment option. A83 Treatment of humeral shaft fractures with intramedullary nailing S. Paraschou1 , H. Anastasopoulos1 , G. Chatziliadis1 , A. Papapanos2 , J. Alexopoulos2 , A. Karanikolas1 , K. Veltsistas1 . 1 A’ Orthopaedic Department-Kilkis General Hospital, 2 Orthopaedic Department-Agrinio General Hospital, Greece Aim: We want to present our experience in the treatment of humeral shaft fractures with intramedullary nail. Material and Methods: From 2001 to 2010 42 patients with equal number of fractures were treated with reamed intramedullary nailing. 25 of them were males and 17 females. Mean age was 42.5 years (19–65). According to AO classification 23 fractures were type A, 13 were type B and 6 type C. All fractures were treated with reamed antegrade intramedullary nailing locked distally. Results: Union was achieved in 40 out of 42 fractures. We had 2 pseudarthroses treated succesfully with plate-screws and iliac grafts and 2 radial nerve palsies recovered in 4 and 6 months respectively. Conclusions: We think that reamed interlocking intramedullary nailing is an acceptable method in the treatment of humeral shaft fractures with high incidence of union and low rate of complications although plate and screws remain the golden standard. A84 Floating shoulder – operative treatment and primary results A. Baltov, V. Rusimov, N. Tzachev. Department of Orthopedis and Trauma Surgery, Military Medical Academy, Sofia, Bulgaria Aims: To share our primary results of the operative treatment of the ipsilateral fractures of the clavicle and the scapula (floating shoulder). Material and method: For a period of two years 8 patients with floating shoulder were treated in the Military Medical Academy of Sofia. All of them had polytrauma combined with chest trauma – 6 after road accidents and 2 after height trauma. Index ISS mean 25 (19–49), 6 high-energetic. There were 4 cases with aassociated fractures of the upper extremity, including one case with floating elbow. In one case we had lesion of a.axillaris and two plexus injuries. According to the classification of Euler–Reudi ¨ the scapula
Oral presentations / Injury, Int. J. Care Injured 42 (2011) S3, S1–S24
Results: The virtual and hands on application showed that the fracture site can be addressed nicely by the polyax-mechanism. The cantilever test showed a higher stiffness at the PolyAxNail. Conclusions: With the herewith introduced novel poly-axial intramedullary nailing concept the authors believe to even widen the spectrum of indications. This concept combines the advantages of the poly-axial plates with the advantages of the intramedullary locking nails. Because of the better fragment adaption this new intramedullary nailing concept should perform faster bone healing and less pseudarthrosis. Regarding Poliaxiality, Angle Stability and Targeting the feasibility of the PoliAx-Nailing Concept had been proven. A81 First experience with a new fixation implant: Technical tips from the clinical application of Proximal Femoral Nail-A II (PFNA-II) D. Karataglis, A. Boutsiadis, P. Papadopoulos, P. Antonarakos, K. Ditsios, An. Christodoulou. A Orthopaedic Department of Aristotle University of Thessaloniki, General Hospital G Papanikolaou, Exohi, Thessaloniki, Greece Aim: PFNA-II is a specified proximal femoral nail initially designed for Asian patients, in order to better fit to their small trochanteric area and narrow IM canal. The manufactures support that the lateral flat surface, the 5° medial-lateral bending and the smaller proximal diameter result in an anatomic shape and in a superior implant than the PFNA I. Materials & Methods: Prospectively 31 cases (all female, mean age 83 years) of extraarticular inter/pertrochanteric fractures (AO 31A) were treated with PFNA II, from 2/2010 to 4/2011. Fracture classification, intraoperative technical problems or advantages, postoperative results and technical features of the implants applied were documented. At the same time the tip apex distance (TAD) was also measured. Results: In details, 5 patients had a Type A1 fracture, 18 Type A2 and 8 patients Type A3. In 28 cases implant with CCD angle 125° was used and in only 3 cases the 130° implant was applied. The mean TAD was 15mm while the mean distance from the lateral cortex was 5mm. We observed easier insertion than PFNA I and no loss of reduction during application. However, 130° implants are prone to higher TAD (1 cut out case). Finally, all the instrumentation is very good and facilitates its application, better than PFNA I. Conclusions: PFNA II is a new implant with small technical differences but with big advantages during its application, compared with the PFNA I, promising better clinical results and fewer complications. A82 Treatment of humeral shaft non-unions after intramedullary nailing A. Baltov, N. Tzachev. Department of Orthopedics and Trauma Surgery, Military Medical Academy, Sofia, Bulgaria Aim: The nonunion of humeral shaft fractures treated with intramedullary osteosynthesis (IS) or interlocked intramedullary nailing (ILN) presents with specific symptoms such as rotatory instability, medullar thinning of the inner part of the cortex, bone resorption around the locking screws and implant ends. The delayed set of diagnosis due to the residual relative stability leads to alteration of bone architectonic and impaired shoulder and elbow function. Material and method: For a period of 5 years 13 patients – 6 after IS (osteosynthesis with multiple K wires – 2, retrograde Ender nails – 4) and 7 after ILN were treated. There were 6 women and 7 men at the average age of 41 (22–84). According to the Weber– Cˆech classification the non-unions were as follows: 9 atrophic, 3 oligorophic and 1 hypertrophic. In two cases taken material for microbiological test was positive for infection. In all cases bone resorption around the implants was observed. In 4 cases there was
debricolage – 3 after IS and 1 after ILN. The time past after the first operation was between 12 and 36 months. The main reason for non-union in 7 cases was distraction, in 5 cases unstable fixation and in 9 wrong operative technique. The operative procedure in all cases included implant removal, abbreviation of bone ends, bone grafting and reosteosynthesis – in 3 cases with DCP, in 8 LCP with hybrid fixation and in two cases ILN. In 12 patients autologous bone grafting and in one case allograft was used and again in one case structural cortical crioallograft was used. Results: In all nonunions bone healing was achieved between 8–12 months. The follow up period was 12–48 months. In one case the postoperative debricolage led to reostheosynthesis. There was no case of iatrogenic nerve or vascular injury. The final functional outcome was assessed according to Constant score (5 excellent, 6 good and 2 fair) and Murrey score (10 excellent, 2 good and 1 fair). Conclusions: In cases with rotatory instability or persistent fracture distraction for more than 8 months an additional operative procedure is recommended. In cases without bone resorption around the locking screws or at the implant ends – debridement and autogenous bone grafting is enough as an operative procedure. In case of clinically observed movements at the fracture site implant removal, autologous bone grafting and reosteosynthesis either with DCP or LCP with hybrid fixation is a method of choice. Reosteosynthesis by interlocked intramedullary nail with reaming is not an appropriate treatment option. A83 Treatment of humeral shaft fractures with intramedullary nailing S. Paraschou1 , H. Anastasopoulos1 , G. Chatziliadis1 , A. Papapanos2 , J. Alexopoulos2 , A. Karanikolas1 , K. Veltsistas1 . 1 A’ Orthopaedic Department-Kilkis General Hospital, 2 Orthopaedic Department-Agrinio General Hospital, Greece Aim: We want to present our experience in the treatment of humeral shaft fractures with intramedullary nail. Material and Methods: From 2001 to 2010 42 patients with equal number of fractures were treated with reamed intramedullary nailing. 25 of them were males and 17 females. Mean age was 42.5 years (19–65). According to AO classification 23 fractures were type A, 13 were type B and 6 type C. All fractures were treated with reamed antegrade intramedullary nailing locked distally. Results: Union was achieved in 40 out of 42 fractures. We had 2 pseudarthroses treated succesfully with plate-screws and iliac grafts and 2 radial nerve palsies recovered in 4 and 6 months respectively. Conclusions: We think that reamed interlocking intramedullary nailing is an acceptable method in the treatment of humeral shaft fractures with high incidence of union and low rate of complications although plate and screws remain the golden standard. A84 Floating shoulder – operative treatment and primary results A. Baltov, V. Rusimov, N. Tzachev. Department of Orthopedis and Trauma Surgery, Military Medical Academy, Sofia, Bulgaria Aims: To share our primary results of the operative treatment of the ipsilateral fractures of the clavicle and the scapula (floating shoulder). Material and method: For a period of two years 8 patients with floating shoulder were treated in the Military Medical Academy of Sofia. All of them had polytrauma combined with chest trauma – 6 after road accidents and 2 after height trauma. Index ISS mean 25 (19–49), 6 high-energetic. There were 4 cases with aassociated fractures of the upper extremity, including one case with floating elbow. In one case we had lesion of a.axillaris and two plexus injuries. According to the classification of Euler–Reudi ¨ the scapula