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P07 Distal radio-ulnar joint inclination affects postoperative functional result after ulnar shortening osteotomy, a retrospective cohort analysis
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Osteosynthese International 2016 / Injury, Int. J. Care Injured 47S5 (2016) S1–S38
Conclusion: Despite a strong negative preselection of the patients overall satisfactory results could be achieved. Results and complication rates are at least comparably to the alternative treatment options. P07 Distal radio-ulnar joint inclination affects postoperative functional result after ulnar shortening osteotomy, a retrospective cohort analysis F. Gilbert1, R. Meffert1, M. Jakubietz1, J. Erdmann1, R. Jakubietz1. 1 Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University of Würzburg, Würzburg, Germany Introduction: Ulna shortening osteotomy is a standard procedure for idiopathic and posttraumatic ulnar impaction syndrome and has shown good clinical results in midterm follow up studies. Reverse oblique distal radio-ulnar joint (DRUJ) inclination is assumed to show inferior postoperative results, as the joint force pressure in the DRUJ may be increased after USO. Purpose: The purpose of this study was the evaluation and comparison of the postoperative functional result with focus on the DRUJ inclination. Methods: 45 Patients with ulna shortening osteotomy were included. The minimum follow up was 5 years. The preoperative x-rays were assessed for the DRUJ inclination according to the Tolat classification. Function and pain were assessed using the Disability of the Arm, Shoulder, and Hand score (DASH) measuring the range of motion and the grip strength. Result: Statistical analysis revealed significant better results in patients with a Tolat type 1 configuration for DASH score, grip strength and range of motion (supination). In the Tolat Type 1 configurated DRUJ mean DASH score was 9 compared to 18 in the Tolat type 2 and 3 group. Conclusion: These data indicate that patients with parallel aligned distal radio-ulnar joint surfaces show better clinical results than patients with a reverse or a reverse oblique configuration of the DRUJ. Level of Evidence IV P08 Osteosynthesis in metastatic bone lesions of limbs V. Protsenko1, O. Ilnitskyi1, V. Chorneyi1. 1Onco-orthopedics, Institute of Traumatology and Orthopedics of NAMS of Ukraine, Kiev, Ukraine Introduction: Skeletal metastatic lesions can significantly limit the function of limbs and leads to bone fractures. Osteosynthesis with bone metastases is aimed at restoration of function of the affected limb, improve the quality of life of patients and the possibility of continuing specific treatment. Materials and methods: During the period from 2009 to 2015 surgical treatment for bone metastases of limb received 64 patients. Tumor localization: femur – 38, shoulder – 20, tibial – 6. Reinforced metalosteosynthesis used in 31 patients, transosseous extrafocal osteosynthesis – 33. The functional outcome of the operated limb was calculated by MSTS scale. Quality of life of patients before and after surgery was carried out on the system EORTC QLQ – C30. The survival rate of the patients was determined by the KaplanMeier method. Results: Postoperative complications were found in 2 (3.1%) patients, recurrent metastatic tumors in 4 (6.2%) patients. Functional results after the operated limb reinforced metal osteosynthesis was 78%, after extrafocal osteosynthesis – 70.2%. The quality of life of patients after osteosynthesis reinforced improved from 40 to 72 points, after extrafocal osteosynthesis with 30 to 66 points. Three-year overall survival: 48.6 ± 0.54%, five-year: 32.4 ± 0.78%. Сonclusions: The use of osteosynthesis in metastatic lesions of the long bones of limbs leads to a better functional outcome of the operated limb, decrease in pain, and improves the quality of life of patients.
P09 The anterior intrapelvic approach to the acetabulum K. MacKinlay1, B. Houseman1, D. Seligson1. 1Orthopedics, University of Louisville, Louisville, United States New tools and new implants make the anterior intrapelvic approach a current technique for anterior column and transverse fractures of the acetabulum. In Our early cases six patients with significant pelvic fractures at the pectinate eminence had a modified Stoppa approach with plate fixation. There were four excellent and two results. Blood loss and operating time were greater than for the more familiar Judet – Letournel approach but the difference was not significant. There was one obturator nerve avulsion. There were no wound complications. The method is promising. P10 Posterior bridging osteosynthesis for traumatic sacroiliac joint dislocation: a report of seven cases E. Hoffmann1. 1Chirurgie Orthopédique, Clinique Sainte Marie, Osny, France Objective: To evaluate the long-term clinical and radiographic results in patients treated for 61C3-2 (OTA class) pelvic ring disruption with a posterior bridging sacroiliac fixation. Design: Retrospective clinical and radiological study. Setting: University Hospital. Beaujon and Clinique Sainte -Marie Patients/participants: Between May 2002 and March 2003, seven patients with sacroiliac dislocation were treated with a technique developed for the treatment of pelvic injuries with vertical and horizontal instability. Intervention: We applied spino-pelvic fixation techniques, using spine instrumentation, to stabilize an SI dislocation. This technique consists of two 5 mm diameter screws inserted into the S1 pedicle and S2 ala. A 5.5 mm joins the 2 sacral screws to two 7 mm screws placed into the posterior iliac crest and secured into the cancellous mass of the posterior ilium. The described technique stabilizes the SI-joint by performing a bridging osteosynthesis instead of the commonly performed iliosacral screw osteosynthesis passing the SI joint. Symphyseal platting is performed to reduce and stabilize the anterior ring if necessary. Main outcome measurements – data were analyzed as follows: pelvic fracture classification; functional outcome; radiographic outcome; Leg length discrepancy; and CT scan aspect of the sacroiliac joint. Results: Associated pelvic injuries were present in all the patients and include symphysis rupture and acetabular fractures. Four of the seven patients had fractures of the lower extremities. Follow-up was available for all patients at an average of 27 months (range, 32–24 months). Neither septic nor cutaneous complications were reported. No loss of post-op reduction and no fixation failure were observed. The functional results noted at the last examination were satisfactory with a mean Majeed score of 93. Conclusion: In our opinion, this surgical technique may be indicated in Tile type C1.2 (61C3-2 OTA class) pelvic ring disruption. It obviously reaches its limits in sacral fractures. The technique described provides effective control of vertical displacement while providing a certain degree of horizontal mobility to facilitate reduction and osteosynthesis of anterior lesions. The quality of the fixation allowed early P11 Outcome of surgical treatment of posterior wall and posterior column fractures of acetabulum A.M. Teja1, R.C. Banshiwal1, M.K. Yadav. 1Orthopaedics, Sawai Man Singh Medical College and Hospital, Jaipur, India Introduction: 7Acetabulum is a part of major weight bearing joint of lower extremity for that their fractures assume a great clinical importance. Approximately 35% of all acetabular fractures have involvement of posterior wall approximately and 76% of these injuries have additional complex fractures. Displacement of the
Osteosynthese International 2016 / Injury, Int. J. Care Injured 47S5 (2016) S1–S38
Conclusion: Despite a strong negative preselection of the patients overall satisfactory results could be achieved. Results and complication rates are at least comparably to the alternative treatment options. P07 Distal radio-ulnar joint inclination affects postoperative functional result after ulnar shortening osteotomy, a retrospective cohort analysis F. Gilbert1, R. Meffert1, M. Jakubietz1, J. Erdmann1, R. Jakubietz1. 1 Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University of Würzburg, Würzburg, Germany Introduction: Ulna shortening osteotomy is a standard procedure for idiopathic and posttraumatic ulnar impaction syndrome and has shown good clinical results in midterm follow up studies. Reverse oblique distal radio-ulnar joint (DRUJ) inclination is assumed to show inferior postoperative results, as the joint force pressure in the DRUJ may be increased after USO. Purpose: The purpose of this study was the evaluation and comparison of the postoperative functional result with focus on the DRUJ inclination. Methods: 45 Patients with ulna shortening osteotomy were included. The minimum follow up was 5 years. The preoperative x-rays were assessed for the DRUJ inclination according to the Tolat classification. Function and pain were assessed using the Disability of the Arm, Shoulder, and Hand score (DASH) measuring the range of motion and the grip strength. Result: Statistical analysis revealed significant better results in patients with a Tolat type 1 configuration for DASH score, grip strength and range of motion (supination). In the Tolat Type 1 configurated DRUJ mean DASH score was 9 compared to 18 in the Tolat type 2 and 3 group. Conclusion: These data indicate that patients with parallel aligned distal radio-ulnar joint surfaces show better clinical results than patients with a reverse or a reverse oblique configuration of the DRUJ. Level of Evidence IV P08 Osteosynthesis in metastatic bone lesions of limbs V. Protsenko1, O. Ilnitskyi1, V. Chorneyi1. 1Onco-orthopedics, Institute of Traumatology and Orthopedics of NAMS of Ukraine, Kiev, Ukraine Introduction: Skeletal metastatic lesions can significantly limit the function of limbs and leads to bone fractures. Osteosynthesis with bone metastases is aimed at restoration of function of the affected limb, improve the quality of life of patients and the possibility of continuing specific treatment. Materials and methods: During the period from 2009 to 2015 surgical treatment for bone metastases of limb received 64 patients. Tumor localization: femur – 38, shoulder – 20, tibial – 6. Reinforced metalosteosynthesis used in 31 patients, transosseous extrafocal osteosynthesis – 33. The functional outcome of the operated limb was calculated by MSTS scale. Quality of life of patients before and after surgery was carried out on the system EORTC QLQ – C30. The survival rate of the patients was determined by the KaplanMeier method. Results: Postoperative complications were found in 2 (3.1%) patients, recurrent metastatic tumors in 4 (6.2%) patients. Functional results after the operated limb reinforced metal osteosynthesis was 78%, after extrafocal osteosynthesis – 70.2%. The quality of life of patients after osteosynthesis reinforced improved from 40 to 72 points, after extrafocal osteosynthesis with 30 to 66 points. Three-year overall survival: 48.6 ± 0.54%, five-year: 32.4 ± 0.78%. Сonclusions: The use of osteosynthesis in metastatic lesions of the long bones of limbs leads to a better functional outcome of the operated limb, decrease in pain, and improves the quality of life of patients.
P09 The anterior intrapelvic approach to the acetabulum K. MacKinlay1, B. Houseman1, D. Seligson1. 1Orthopedics, University of Louisville, Louisville, United States New tools and new implants make the anterior intrapelvic approach a current technique for anterior column and transverse fractures of the acetabulum. In Our early cases six patients with significant pelvic fractures at the pectinate eminence had a modified Stoppa approach with plate fixation. There were four excellent and two results. Blood loss and operating time were greater than for the more familiar Judet – Letournel approach but the difference was not significant. There was one obturator nerve avulsion. There were no wound complications. The method is promising. P10 Posterior bridging osteosynthesis for traumatic sacroiliac joint dislocation: a report of seven cases E. Hoffmann1. 1Chirurgie Orthopédique, Clinique Sainte Marie, Osny, France Objective: To evaluate the long-term clinical and radiographic results in patients treated for 61C3-2 (OTA class) pelvic ring disruption with a posterior bridging sacroiliac fixation. Design: Retrospective clinical and radiological study. Setting: University Hospital. Beaujon and Clinique Sainte -Marie Patients/participants: Between May 2002 and March 2003, seven patients with sacroiliac dislocation were treated with a technique developed for the treatment of pelvic injuries with vertical and horizontal instability. Intervention: We applied spino-pelvic fixation techniques, using spine instrumentation, to stabilize an SI dislocation. This technique consists of two 5 mm diameter screws inserted into the S1 pedicle and S2 ala. A 5.5 mm joins the 2 sacral screws to two 7 mm screws placed into the posterior iliac crest and secured into the cancellous mass of the posterior ilium. The described technique stabilizes the SI-joint by performing a bridging osteosynthesis instead of the commonly performed iliosacral screw osteosynthesis passing the SI joint. Symphyseal platting is performed to reduce and stabilize the anterior ring if necessary. Main outcome measurements – data were analyzed as follows: pelvic fracture classification; functional outcome; radiographic outcome; Leg length discrepancy; and CT scan aspect of the sacroiliac joint. Results: Associated pelvic injuries were present in all the patients and include symphysis rupture and acetabular fractures. Four of the seven patients had fractures of the lower extremities. Follow-up was available for all patients at an average of 27 months (range, 32–24 months). Neither septic nor cutaneous complications were reported. No loss of post-op reduction and no fixation failure were observed. The functional results noted at the last examination were satisfactory with a mean Majeed score of 93. Conclusion: In our opinion, this surgical technique may be indicated in Tile type C1.2 (61C3-2 OTA class) pelvic ring disruption. It obviously reaches its limits in sacral fractures. The technique described provides effective control of vertical displacement while providing a certain degree of horizontal mobility to facilitate reduction and osteosynthesis of anterior lesions. The quality of the fixation allowed early P11 Outcome of surgical treatment of posterior wall and posterior column fractures of acetabulum A.M. Teja1, R.C. Banshiwal1, M.K. Yadav. 1Orthopaedics, Sawai Man Singh Medical College and Hospital, Jaipur, India Introduction: 7Acetabulum is a part of major weight bearing joint of lower extremity for that their fractures assume a great clinical importance. Approximately 35% of all acetabular fractures have involvement of posterior wall approximately and 76% of these injuries have additional complex fractures. Displacement of the