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New operative technique in the treatment of unstable dorsal fracture–dislocation of Proximal Interphalangeal Joint of finger
Abstracts
143
Keywords: Intraarticular fractures; Pilon fractures; Proximal interphalangeal joint
Keywords: PIP joint injury; Novel operative technique; Mini suture anchor repair
doi:10.1016/j.injury.2006.12.115
doi:10.1016/j.injury.2006.12.116
O91 New operative technique in the treatment of unstable dorsal fracture—dislocation of Proximal Interphalangeal Joint of finger
PARALLEL SESSION: LOWER LIMB
R. Chidambaram ∗ , D. Mok Epsom General Hospital, UK Introduction: Unstable dorsal fracture dislocation of PIP joint is a complex injury and difficult to treat. Various treatment options like dynamic traction, extension block splinting/pinning, trans-articular pinning, ORIF and volar plate arthroplasty using pull out sutures have been described with varying results. We describe a novel technique to combine fracture fixation with volar plate repair using micro anchor suture. Material and methods: In the year 2005, 11 patients with type III unstable dorsal PIP joint fracture dislocations underwent open reduction and volar plate repair using our technique. Two were delayed presentations. All patients were males and their average age was 23 years. All patients were reviewed with the minimum follow up of 6 months. The pain score, range of movements and grip strength were recorded and compared to the contra-lateral normal side. Operative technique: Volar approach was made using a semi Brunar incision. One or two micro bioabsorbable anchors (Mitek, Ethicon Ltd., UK) were used to stabilize the joint and repair the volar plate. Postoperatively the hand was rested in Edinburgh functional splint for 10 days followed by active and assisted range of movements under hand physiotherapist supervision. Results: Ten out of 11 patients had excellent pain relief. The average range of movement of the PIP joint was 100◦ . One patient with neglected PIP joint fracture dislocation for 10 weeks had mild residual pain and stiffness. The overall grip strength was comparable to contra-lateral normal side. All patients were satisfied with the functional outcome. Conclusion: Combined fracture fixation and volar plate repair through anterior approach using micro bioabsorbable anchors appears to be very effective way of treating this otherwise complex unstable fracture dislocation of PIP joint.
O92 A prospective outcome analysis fracture neck of femur I. Ibrahim ∗ , Y. Lodhi, C.P. Shahid, A.I. Zubairy, V. Tandon
Charalombous, R.
Burnley General Hospital, UK Introduction: To prospectively study outcome of patients with fracture neck of femur and its predictors, an experience in a district general hospital in the UK. Method: Over a period of 1 year, we collected data on 175 consecutive patients with fracture neck of femur admitted to a district general hospital. We studied the co-relation between outcome of treatment and ‘pre-admission’, ‘during admission’ and ‘post-admission’ factors. Pre-admission factors included place of accommodation, mobility and comorbidities. Admission factors included ASA grade, time between admission and operation, and postadmission included the place to which patients were discharged. The effects of pre-admission and admission factors to the duration of hospital stay and all of these to mortality and morbidity over a period of up to 2 years were studied. We compare our results with available literature and POSSUM (Acute Physiology and Operative Scoring System for enumeration of Morbidity & Mortality). Results: Postoperative 30-days mortality was 6.8% versus POSSUM predicted 19% and published literature 4—30%. Thirty days Mortality is higher in patients with other co-morbidities, irrespective of whether patients were treated operatively (18% versus 1%) or conservatively (50% versus 16%). Housebound patients’ mortality was 15% versus 5% of more mobile patients. Morbidity and mortality was higher in males at 47% (each) versus 34% and 28% in females. Mortality and morbidity increased if operation was delayed for more than 24 h from 32% to 49% and 27% to 47%, respectively, for similar ASA grades. Discussion: Most published studies are retrospective. This prospective study suggests that male patients, patients who are housebound and those with co-morbidities have relatively high mortality. Patients with similar ASA grades had better prognosis when operated upon within 24 h of admis-
143
Keywords: Intraarticular fractures; Pilon fractures; Proximal interphalangeal joint
Keywords: PIP joint injury; Novel operative technique; Mini suture anchor repair
doi:10.1016/j.injury.2006.12.115
doi:10.1016/j.injury.2006.12.116
O91 New operative technique in the treatment of unstable dorsal fracture—dislocation of Proximal Interphalangeal Joint of finger
PARALLEL SESSION: LOWER LIMB
R. Chidambaram ∗ , D. Mok Epsom General Hospital, UK Introduction: Unstable dorsal fracture dislocation of PIP joint is a complex injury and difficult to treat. Various treatment options like dynamic traction, extension block splinting/pinning, trans-articular pinning, ORIF and volar plate arthroplasty using pull out sutures have been described with varying results. We describe a novel technique to combine fracture fixation with volar plate repair using micro anchor suture. Material and methods: In the year 2005, 11 patients with type III unstable dorsal PIP joint fracture dislocations underwent open reduction and volar plate repair using our technique. Two were delayed presentations. All patients were males and their average age was 23 years. All patients were reviewed with the minimum follow up of 6 months. The pain score, range of movements and grip strength were recorded and compared to the contra-lateral normal side. Operative technique: Volar approach was made using a semi Brunar incision. One or two micro bioabsorbable anchors (Mitek, Ethicon Ltd., UK) were used to stabilize the joint and repair the volar plate. Postoperatively the hand was rested in Edinburgh functional splint for 10 days followed by active and assisted range of movements under hand physiotherapist supervision. Results: Ten out of 11 patients had excellent pain relief. The average range of movement of the PIP joint was 100◦ . One patient with neglected PIP joint fracture dislocation for 10 weeks had mild residual pain and stiffness. The overall grip strength was comparable to contra-lateral normal side. All patients were satisfied with the functional outcome. Conclusion: Combined fracture fixation and volar plate repair through anterior approach using micro bioabsorbable anchors appears to be very effective way of treating this otherwise complex unstable fracture dislocation of PIP joint.
O92 A prospective outcome analysis fracture neck of femur I. Ibrahim ∗ , Y. Lodhi, C.P. Shahid, A.I. Zubairy, V. Tandon
Charalombous, R.
Burnley General Hospital, UK Introduction: To prospectively study outcome of patients with fracture neck of femur and its predictors, an experience in a district general hospital in the UK. Method: Over a period of 1 year, we collected data on 175 consecutive patients with fracture neck of femur admitted to a district general hospital. We studied the co-relation between outcome of treatment and ‘pre-admission’, ‘during admission’ and ‘post-admission’ factors. Pre-admission factors included place of accommodation, mobility and comorbidities. Admission factors included ASA grade, time between admission and operation, and postadmission included the place to which patients were discharged. The effects of pre-admission and admission factors to the duration of hospital stay and all of these to mortality and morbidity over a period of up to 2 years were studied. We compare our results with available literature and POSSUM (Acute Physiology and Operative Scoring System for enumeration of Morbidity & Mortality). Results: Postoperative 30-days mortality was 6.8% versus POSSUM predicted 19% and published literature 4—30%. Thirty days Mortality is higher in patients with other co-morbidities, irrespective of whether patients were treated operatively (18% versus 1%) or conservatively (50% versus 16%). Housebound patients’ mortality was 15% versus 5% of more mobile patients. Morbidity and mortality was higher in males at 47% (each) versus 34% and 28% in females. Mortality and morbidity increased if operation was delayed for more than 24 h from 32% to 49% and 27% to 47%, respectively, for similar ASA grades. Discussion: Most published studies are retrospective. This prospective study suggests that male patients, patients who are housebound and those with co-morbidities have relatively high mortality. Patients with similar ASA grades had better prognosis when operated upon within 24 h of admis-