- Email: [email protected]
PF15 Which treatment option for school-age paediatric femoral fractures; elastic nail or spica casting?
Osteosynthese International 2013 – Poster Sessions / Injury, Int. J. Care Injured 44S2 (2013) S37–S46
screw slowly creating a fracture in calcaneus. A trial with a hook to remove the proximal part of the nail was unsuccessful so we decided to push it forward in tibial canal. Results: 6 months later the fracture achieved bone healing and the patient was satisfied without any problem, except that the proximal part of the nail remained into the tibia. PF15 Which treatment option for school-age paediatric femoral fractures; elastic nail or spica casting? 1 , E. Inkaya1 , K. Yener1 , M. Bulb F. Say1 , D. Gurler ¨ ¨ ul ¨ 2 . 1Samsun OMU Department of Orthopaedics and Traumatology, 2Istanbul Medipol University, Istanbul, Turkey Introduction: Titanium elastic nails and immediate spica casts are treatment options for school-aged children femoral fractures. This study aimed to compare the results of elastic nail and immediate spica cast methods for treating school-aged children’s femoral fractures. Materials and Methods: A retrospective evaluation was made of a total of 42 patients who underwent immediate spica cast or titanium elastic nail for femoral fracture. Groups were compared in terms of complications, clinical and radiographic union, duration of hospitalization, range of knee motion and walking independently. The mean follow-up period was 14.6 (6–24) months. Results: Titanium elastic nails were used in 22 patients. The mean age was 9.8±1.3 years. Immediate spica cast were used in 20 patients. The mean age was 6.4±1 years. All fractures were closed. All fractures healed. Two superficial infections and two malaligment were detected in elastic nail group. Three superficial infections and four malaligment was detected in immediate spica cast group. The duration for independent walking was mean 49.2±12 days in elastic nail group and 79.8±9.9 days in immediate spica cast group (p <0.001). Duration of hospitalization was mean 7.1±2.1 days in elastic nail group and 2.2±0.8 days in immediate spica cast group (p <0.001). Range of knee motion was 129±5.2° in elastic nail group and 139±2.9° in the cast group (p <0.001). Conclusion: We detected that titanium elastic nail and immediate spica cast tretment options were similar in regard to complications and walking independently was earlier in elastic nail group for treating femoral fractures in school-aged children. We recommend to choose treatment method according to patient characteristics. PF16 Radiological outcomes of intramedullary hip nail osteosynthesis of the geriatric population E. Erturer ¨ 1 , M. Sonmez2 , F. Seckin2 , A. Seker2 , M. Tezer1 , I. Ozturk3 . 1Istanbul Medipol University, 2Sisli Etfal Research and Training Hospital, 3Istanbul University, Istanbul, Turkey Introduction: Radiological outcomes of intramedullary hip nail osteosynthesis of the geriatric population. Objective: In this study we aimed to evaluate the radiological outcomes of the patients older then 65 years old whom were treated with intramedullary hip nail for unstable hip fractures. Materials and Methods: 266 patients in geriatric age group were treated with intramedullary nail between November 2002 and December 2011. 184 patients [112 women (60.9%) and 72 men (39.1%), mean age 79.2 years (65–111)] with at least a one year follow up were included in the study. 109 of the patients had right, 75 of them had left hip fracture. Trauma mechanism was low energy in 105 patients and high energy in 62 patients. PFN® (n:33), Profin® (n:32) and PFN-A® (n:119) nails were used in fracture fixation. All of the fractures were classified unstable according to AO classification (AO 31-AII and AIII). Reduction and fixation were achieved on fracture table and use of C-arm. Post operative reduction and radiological outcomes were assessed retrospectively according to Baumgaertner criteria modified by Fogagnolo.
S41
Results: 82.4% of patients had good or acceptable reduction. Femoral shaft fracture in 3 patients and additional greater trochanter fracture occurred in 34 patients during surgery. K-wire cerclage was used in 9 patients to achieve reduction. Nonunion was occurred in 8 patients. We observed secondary varus in 22 patients. Late complications were; calcification in the tip trochanter majus in 17 cases, the reverse Z-effect in 5 cases, loosening of screws in 13 cases and screw cut out in 8 cases. 17 patients (7 of them hemiarthroplasty) were underwent secondary surgery. Conclusion: The radiological outcomes of intramedullary nails to treat unstable trochanteric fractures in elderly patients have satisfactory results. Most of the complications do not effect union and the need of secondary surgery is low. These findings show that a stable fixation was achieved.
Poster Session II: Varia PS1 Minimal invasive plate osteosynthesis (MiPO) in humerus A. Baltov1 . 1Military Medical Academy, Sofia, Bulgaria Introduction: The conventional plating of the humerus is attended by soft tissue striping that leads sometimes to delayed union, nonunion, jatrogenic demage of nerve, infection and debricolage. Aim: To present inicial results with MiPO technique for treatment of proximal and diaphyseal humeral fracture. Material and Method: For a period of 3 years, 12 patients at the average age of 52 (25–80). Six high energetic in young patients with polytrauma and associated fractures of the upper limb and six in eldry patients with osteoporosis. Two of the patients with primary neurological deficit. The intervention was made with a front access between the 1st and 7th day of the trauma. We applied LC-LCP 4.5/5.0 mm – 8 cases and LCP reconstructive with combined holes 4.5/5.0 mm in 1 case, long PHiLOS in 2 and long PHLPLP in 1, as we observed index screws/holes of the plate 0.35–0.5. The mean operative time was 60 min (45–100). X-ray exposure up to 2 min. Mean blood loss 150 ml. Results: The observed complications were: varus deformation up to 30° – 2 cases (17%), malrotation – 1 (8%), impingement of the shoulder – 1 (8%). All of the fractures healed, exepting one for the period of observation 12–24 months. The functional outcome was assessed according to Constant score for shoulder: in 7 (58%) excellent, in 3 (25%) very good and in 2 (17%) poor. According to Murley score for elbow: excellent for all of the patients. Conclusion: MiPO keeps the micro movements with relative stable osteosynthesis as decreasing the mean operative time and the blood loss. The disadvantages of the method are the X-ray explosure, danger of neurological injury and the difficult removing of the massive implant. PS2 The effect of kinesiotaping with exercise therapy for the treatment of shin splints: a case report S. Inal1 , F. Taspinar2 , B. Taspinar2 , I. Isik3 , C. Inal4 . 1Dumlupinar University, School of Medicine, Department of Orthopaedic Surgery, Kutahya, 2Dumlupinar University, Kutahya Graduate School of Health, Department of Physiotherapy and Rehabilitation, Kutahya, 3Dumlupinar University, Kutahya Evliya Celebi Education and Research Hospital, Department of Nuclear Medicine, Kutahya, 4Dumlupinar University, Kutahya Evliya Celebi Education and Research Hospital, Department of Anesthesia and Reanimation, Kutahya, Turkey Introduction: Shin Splints, commonly known as “Medial Tibial Stress Syndrome” is an overuse or a repetitive stress injury which is usually seen at the distal third of the tibia. Treatment choices consist of a wide range procedure such as exercise therapy, ice therapy, activity
screw slowly creating a fracture in calcaneus. A trial with a hook to remove the proximal part of the nail was unsuccessful so we decided to push it forward in tibial canal. Results: 6 months later the fracture achieved bone healing and the patient was satisfied without any problem, except that the proximal part of the nail remained into the tibia. PF15 Which treatment option for school-age paediatric femoral fractures; elastic nail or spica casting? 1 , E. Inkaya1 , K. Yener1 , M. Bulb F. Say1 , D. Gurler ¨ ¨ ul ¨ 2 . 1Samsun OMU Department of Orthopaedics and Traumatology, 2Istanbul Medipol University, Istanbul, Turkey Introduction: Titanium elastic nails and immediate spica casts are treatment options for school-aged children femoral fractures. This study aimed to compare the results of elastic nail and immediate spica cast methods for treating school-aged children’s femoral fractures. Materials and Methods: A retrospective evaluation was made of a total of 42 patients who underwent immediate spica cast or titanium elastic nail for femoral fracture. Groups were compared in terms of complications, clinical and radiographic union, duration of hospitalization, range of knee motion and walking independently. The mean follow-up period was 14.6 (6–24) months. Results: Titanium elastic nails were used in 22 patients. The mean age was 9.8±1.3 years. Immediate spica cast were used in 20 patients. The mean age was 6.4±1 years. All fractures were closed. All fractures healed. Two superficial infections and two malaligment were detected in elastic nail group. Three superficial infections and four malaligment was detected in immediate spica cast group. The duration for independent walking was mean 49.2±12 days in elastic nail group and 79.8±9.9 days in immediate spica cast group (p <0.001). Duration of hospitalization was mean 7.1±2.1 days in elastic nail group and 2.2±0.8 days in immediate spica cast group (p <0.001). Range of knee motion was 129±5.2° in elastic nail group and 139±2.9° in the cast group (p <0.001). Conclusion: We detected that titanium elastic nail and immediate spica cast tretment options were similar in regard to complications and walking independently was earlier in elastic nail group for treating femoral fractures in school-aged children. We recommend to choose treatment method according to patient characteristics. PF16 Radiological outcomes of intramedullary hip nail osteosynthesis of the geriatric population E. Erturer ¨ 1 , M. Sonmez2 , F. Seckin2 , A. Seker2 , M. Tezer1 , I. Ozturk3 . 1Istanbul Medipol University, 2Sisli Etfal Research and Training Hospital, 3Istanbul University, Istanbul, Turkey Introduction: Radiological outcomes of intramedullary hip nail osteosynthesis of the geriatric population. Objective: In this study we aimed to evaluate the radiological outcomes of the patients older then 65 years old whom were treated with intramedullary hip nail for unstable hip fractures. Materials and Methods: 266 patients in geriatric age group were treated with intramedullary nail between November 2002 and December 2011. 184 patients [112 women (60.9%) and 72 men (39.1%), mean age 79.2 years (65–111)] with at least a one year follow up were included in the study. 109 of the patients had right, 75 of them had left hip fracture. Trauma mechanism was low energy in 105 patients and high energy in 62 patients. PFN® (n:33), Profin® (n:32) and PFN-A® (n:119) nails were used in fracture fixation. All of the fractures were classified unstable according to AO classification (AO 31-AII and AIII). Reduction and fixation were achieved on fracture table and use of C-arm. Post operative reduction and radiological outcomes were assessed retrospectively according to Baumgaertner criteria modified by Fogagnolo.
S41
Results: 82.4% of patients had good or acceptable reduction. Femoral shaft fracture in 3 patients and additional greater trochanter fracture occurred in 34 patients during surgery. K-wire cerclage was used in 9 patients to achieve reduction. Nonunion was occurred in 8 patients. We observed secondary varus in 22 patients. Late complications were; calcification in the tip trochanter majus in 17 cases, the reverse Z-effect in 5 cases, loosening of screws in 13 cases and screw cut out in 8 cases. 17 patients (7 of them hemiarthroplasty) were underwent secondary surgery. Conclusion: The radiological outcomes of intramedullary nails to treat unstable trochanteric fractures in elderly patients have satisfactory results. Most of the complications do not effect union and the need of secondary surgery is low. These findings show that a stable fixation was achieved.
Poster Session II: Varia PS1 Minimal invasive plate osteosynthesis (MiPO) in humerus A. Baltov1 . 1Military Medical Academy, Sofia, Bulgaria Introduction: The conventional plating of the humerus is attended by soft tissue striping that leads sometimes to delayed union, nonunion, jatrogenic demage of nerve, infection and debricolage. Aim: To present inicial results with MiPO technique for treatment of proximal and diaphyseal humeral fracture. Material and Method: For a period of 3 years, 12 patients at the average age of 52 (25–80). Six high energetic in young patients with polytrauma and associated fractures of the upper limb and six in eldry patients with osteoporosis. Two of the patients with primary neurological deficit. The intervention was made with a front access between the 1st and 7th day of the trauma. We applied LC-LCP 4.5/5.0 mm – 8 cases and LCP reconstructive with combined holes 4.5/5.0 mm in 1 case, long PHiLOS in 2 and long PHLPLP in 1, as we observed index screws/holes of the plate 0.35–0.5. The mean operative time was 60 min (45–100). X-ray exposure up to 2 min. Mean blood loss 150 ml. Results: The observed complications were: varus deformation up to 30° – 2 cases (17%), malrotation – 1 (8%), impingement of the shoulder – 1 (8%). All of the fractures healed, exepting one for the period of observation 12–24 months. The functional outcome was assessed according to Constant score for shoulder: in 7 (58%) excellent, in 3 (25%) very good and in 2 (17%) poor. According to Murley score for elbow: excellent for all of the patients. Conclusion: MiPO keeps the micro movements with relative stable osteosynthesis as decreasing the mean operative time and the blood loss. The disadvantages of the method are the X-ray explosure, danger of neurological injury and the difficult removing of the massive implant. PS2 The effect of kinesiotaping with exercise therapy for the treatment of shin splints: a case report S. Inal1 , F. Taspinar2 , B. Taspinar2 , I. Isik3 , C. Inal4 . 1Dumlupinar University, School of Medicine, Department of Orthopaedic Surgery, Kutahya, 2Dumlupinar University, Kutahya Graduate School of Health, Department of Physiotherapy and Rehabilitation, Kutahya, 3Dumlupinar University, Kutahya Evliya Celebi Education and Research Hospital, Department of Nuclear Medicine, Kutahya, 4Dumlupinar University, Kutahya Evliya Celebi Education and Research Hospital, Department of Anesthesia and Reanimation, Kutahya, Turkey Introduction: Shin Splints, commonly known as “Medial Tibial Stress Syndrome” is an overuse or a repetitive stress injury which is usually seen at the distal third of the tibia. Treatment choices consist of a wide range procedure such as exercise therapy, ice therapy, activity