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Clinical experiences and retrospective study on osteo syntheses of the hand with the PROFYLE titanium hand and small fragment system
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Secondary displacement frequently occurs because of the compaction that eliminates metaphyseal bone support to the distal radius joint surface. Ligamentotaxis or internal fixation adresses the problem only indirectly, and a more direct approach would be bone grafting or cementing of the fracture which could minimize axial shortening and joint incongruity. Bone transplantation (auto- or allograft) has potential problems including donor site complications or transmission of viral disease. Bone cement may cause thermal damage to surrounding bone and soft tissues. The use of an injectable, in situ hardening, remodelable calcium phosphate bone mineral substitute presents, in principle, the required mechanical and biologic properties for stabilization through healing of the comminuted fracture by filling of the cancellous bone defect.
Methods Six patients with a distal radius fracture which redislocated after initial satisfactory reduction were operated on 8 days (2-11) after the fracture. The fractures were rereduced with a traction device, partially exposed through a short dorsal incision, and when necessary, complementary reduction was done. Norian SRS T M calcium phosphate was injected into the bone defect. The entire procedure was controlled using image intensification. A short arm cast was applied dorsally for two weeks, and then the wrist was mobilized.
Results Seven weeks after surgery the patients achieved 75% (25-100) of their contralateral motion for pronation, 63% (10-88) for supination, 55% (28=75) for extension and 50% (38-62) for flexion. The grip strength was almost half (28-75) of the contralateral non-injured side. Patients did not have pain or major limitation of their function in daily activities. At six months the results were improved with 98% (87-112) of their contralateral motion for pronation, 92% (66-100) for supination, 79% (50-100) for extension and 64% (38-80) for flexion. Grip strength was 75% (54-105) compared with the non-injured wrist. The results persisted over time and were similar at one year. The radiographic measurements did not show major displacement of the fracture during the follow-up except for one case where a redislocation of the fracture was noted at two weeks. This case is the only reportable complication and in relation with a, now solved, technical problem.
Conclusion The rapid recovery of wrist mobility and grip strength with this new method appears to be due to the shortened immobilization time. This was possible because of the stability attained by filling the defect with this bone substitute. We now perform a prospective randomised study which compares distal radius fractures treated with Norian SRS T M and external fixation. Nine patients in each group have been included till now and so far the Norian SRS T M compare well with the control group.
Associated injuries of the radial hand and distal radioulnar joint (Essex-Lopresti damage) E. E Apergis, G. Theodoratos, K. Chorianopoulos, N. A d o n i o u
Evagelistrias 13, Ag. Paraskevi, 15342 Athens, Greece Displaced or comminuted fracture of the radial head, rupture of the central band of the interosseous membrane and rupture
T H E J O U R N A L O F H A N D SURGERY VOL. 21B S U P P L E M E N T I
of the triangular fibrocartilage complex, are the components of an injury known as Essex-Lopresti, the delayed diagnosis of which can lead to devastating results. The aim of this paper is to study 5 patients who sustained this uncommon injury and to report the methods of early diagnosis and management. Our material was 5 male, 25-43 years old (average 33.7 years old), who sustained a comminuted fracture of the radial head after a fall on the outstretched hand. Three of them sustained a concomitant distal radial fracture of the contralateral wrist. The initial management in 4 patients was the excision and in 1 patient the fixation with K-wires of the radial head. All patients presented with positive ulnar variance average 12.5 mm (range 9-15 mm). The management of the distal radioulnar dislocation in 4 cases was delayed, 4 months average postinjury. Main complaints were pain at the elbow and ulnar wrist, in addition with limited range of motion of the elbow, wrist and forearm rotation. Radiocarpal arthrography revealed avulsion of the triangular fibrocartilage complex from the base of the ulnar styloid. The cases with delayed diagnosis were managed with recession osteotomy of the ulna, suturing of the triangular fibrocartilage complex with transosseous sutures and a K-wire that immobilized the distal radioulnar joint in supination for 6 weeks. • Results graded according to complaints, range'of motion and X-ray findings, as excellent in 2 cases, good in 1 case, fair in 1 case and poor in 1 case. In conclusion: 1. Early diagnosis of the concomitant injuries of the radial head and the distal radioulnar joint is essential but not the only prerequisite in order to obtain a good longterm result. 2. The stable fixation of the radial head is not sufficient for the proper management of these unstable injuries. 3. The management of Essex-Lopresti damage is different depending on the time elapsed from the injury.
Clinical experiences and retrospective study on osteo syntheses of the hand with the PROFYLE titanium hand and small fragment system P. Helaly
Kantonsspital Aarau, Clinicfor Plastic and Reconstructive Surgery, Buchserstra3e, CH-5001 Aarau, Switzerland Our clinical experience with the Profyle Hand and Small Fragment System has been analysed in a retrospective study. The implant system was developed and clinically evaluated between 1988 and 1992. Since then it has been routinely used in our hospital (Kantonsspital Aarau). More than 2000 implants have been used for fractures, avulsions, arthrodeses, corrective osteotomies, re-osteosyntbeses using bone grafts and replantations. Lag screw fixation techniques were sometimes used as well. Out of more than 600 patients treated, a representative group of 350 cases was selected and evaluated in this retrospective study. The results clearly demonstrate that exercise withstanding osteosynthesis is easily and quickly achieved by using titanium screws and plates. This allows earlier mobilization and rehabilitation and reduces the need for secondary surgery.
Secondary displacement frequently occurs because of the compaction that eliminates metaphyseal bone support to the distal radius joint surface. Ligamentotaxis or internal fixation adresses the problem only indirectly, and a more direct approach would be bone grafting or cementing of the fracture which could minimize axial shortening and joint incongruity. Bone transplantation (auto- or allograft) has potential problems including donor site complications or transmission of viral disease. Bone cement may cause thermal damage to surrounding bone and soft tissues. The use of an injectable, in situ hardening, remodelable calcium phosphate bone mineral substitute presents, in principle, the required mechanical and biologic properties for stabilization through healing of the comminuted fracture by filling of the cancellous bone defect.
Methods Six patients with a distal radius fracture which redislocated after initial satisfactory reduction were operated on 8 days (2-11) after the fracture. The fractures were rereduced with a traction device, partially exposed through a short dorsal incision, and when necessary, complementary reduction was done. Norian SRS T M calcium phosphate was injected into the bone defect. The entire procedure was controlled using image intensification. A short arm cast was applied dorsally for two weeks, and then the wrist was mobilized.
Results Seven weeks after surgery the patients achieved 75% (25-100) of their contralateral motion for pronation, 63% (10-88) for supination, 55% (28=75) for extension and 50% (38-62) for flexion. The grip strength was almost half (28-75) of the contralateral non-injured side. Patients did not have pain or major limitation of their function in daily activities. At six months the results were improved with 98% (87-112) of their contralateral motion for pronation, 92% (66-100) for supination, 79% (50-100) for extension and 64% (38-80) for flexion. Grip strength was 75% (54-105) compared with the non-injured wrist. The results persisted over time and were similar at one year. The radiographic measurements did not show major displacement of the fracture during the follow-up except for one case where a redislocation of the fracture was noted at two weeks. This case is the only reportable complication and in relation with a, now solved, technical problem.
Conclusion The rapid recovery of wrist mobility and grip strength with this new method appears to be due to the shortened immobilization time. This was possible because of the stability attained by filling the defect with this bone substitute. We now perform a prospective randomised study which compares distal radius fractures treated with Norian SRS T M and external fixation. Nine patients in each group have been included till now and so far the Norian SRS T M compare well with the control group.
Associated injuries of the radial hand and distal radioulnar joint (Essex-Lopresti damage) E. E Apergis, G. Theodoratos, K. Chorianopoulos, N. A d o n i o u
Evagelistrias 13, Ag. Paraskevi, 15342 Athens, Greece Displaced or comminuted fracture of the radial head, rupture of the central band of the interosseous membrane and rupture
T H E J O U R N A L O F H A N D SURGERY VOL. 21B S U P P L E M E N T I
of the triangular fibrocartilage complex, are the components of an injury known as Essex-Lopresti, the delayed diagnosis of which can lead to devastating results. The aim of this paper is to study 5 patients who sustained this uncommon injury and to report the methods of early diagnosis and management. Our material was 5 male, 25-43 years old (average 33.7 years old), who sustained a comminuted fracture of the radial head after a fall on the outstretched hand. Three of them sustained a concomitant distal radial fracture of the contralateral wrist. The initial management in 4 patients was the excision and in 1 patient the fixation with K-wires of the radial head. All patients presented with positive ulnar variance average 12.5 mm (range 9-15 mm). The management of the distal radioulnar dislocation in 4 cases was delayed, 4 months average postinjury. Main complaints were pain at the elbow and ulnar wrist, in addition with limited range of motion of the elbow, wrist and forearm rotation. Radiocarpal arthrography revealed avulsion of the triangular fibrocartilage complex from the base of the ulnar styloid. The cases with delayed diagnosis were managed with recession osteotomy of the ulna, suturing of the triangular fibrocartilage complex with transosseous sutures and a K-wire that immobilized the distal radioulnar joint in supination for 6 weeks. • Results graded according to complaints, range'of motion and X-ray findings, as excellent in 2 cases, good in 1 case, fair in 1 case and poor in 1 case. In conclusion: 1. Early diagnosis of the concomitant injuries of the radial head and the distal radioulnar joint is essential but not the only prerequisite in order to obtain a good longterm result. 2. The stable fixation of the radial head is not sufficient for the proper management of these unstable injuries. 3. The management of Essex-Lopresti damage is different depending on the time elapsed from the injury.
Clinical experiences and retrospective study on osteo syntheses of the hand with the PROFYLE titanium hand and small fragment system P. Helaly
Kantonsspital Aarau, Clinicfor Plastic and Reconstructive Surgery, Buchserstra3e, CH-5001 Aarau, Switzerland Our clinical experience with the Profyle Hand and Small Fragment System has been analysed in a retrospective study. The implant system was developed and clinically evaluated between 1988 and 1992. Since then it has been routinely used in our hospital (Kantonsspital Aarau). More than 2000 implants have been used for fractures, avulsions, arthrodeses, corrective osteotomies, re-osteosyntbeses using bone grafts and replantations. Lag screw fixation techniques were sometimes used as well. Out of more than 600 patients treated, a representative group of 350 cases was selected and evaluated in this retrospective study. The results clearly demonstrate that exercise withstanding osteosynthesis is easily and quickly achieved by using titanium screws and plates. This allows earlier mobilization and rehabilitation and reduces the need for secondary surgery.