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Review of proximal humeral fracture fixation with the PHILOS® Plate System in a District General Hospital
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Abstracts / Injury Extra 42 (2011) 95–169
the optimal pin position is not established from clinical trials. The aim of this study was to evaluate the radiological outcome of distal radius fractures after extra-focal k-wire fixation and to compare 3 wire with 2 wire technique. Methods: All distal radius fractures treated extra focal k-wire fixation with available digital radiographs were reviewed between August 2007 and February 2010, yielding 70 cases. 52 patients had been treated with 2 wire technique and 18 with 3 wire technique. Pre-operative, post fixation and follow up radiographs were evaluated and radial inclination, volar/dorsal tilt and ulnar variance measured. The radius was defined as short with a positive ulnar variance >2 mm. Radial inclination and volar tilt angle were compared between the 2 groups using Student’s t-tests. Results: Mean ages in the 2 wire and 3 wire groups were 59.4 and 64.8 respectively (p = 0.15) and time for injury to fixation was 5.9–8.3 days. Initial volar tilt was −15.9 in the 2 wire group versus −11.6 in the 3 wire group (p = 0.048) and after fixation were −0.6 versus +4.5 respectively (p = 0.034). There was no significant difference in the improvement in volar tilt between the 2 groups (15.3 versus 16.1). Final volar tilt measurement (−3.4 versus −0.4) demonstrated no significant difference between the 2 groups. There were no significant differences in terms of radial inclination between the 2 groups initially, after reduction and at follow up (17.5 versus 15.3, 20.6 versus 21.5, 20.9 versus 19.9). In the 2 wire group 22 out of 52 patients gained more than 2 mm of radial length after reduction and fixation. 12 out of 22 (54.5%) patients subsequently lost this reduction, falling back to their initial lengths. In the 3 wire group 13 out of 18 patients gained more than 2 mm of radial length after reduction and fixation. 7 out of 13 (53.8%) patients subsequently lost this reduction, falling back to their initial lengths. Conclusions: This study has not been able to show any differences in the radiological outcomes between 2 wire and 3 wire pinning techniques. Percutaneous pinning does appear to be able to hold the improvements made in radial inclination and volar tilt angle after MUA. Percutaneous pinning appears to be an unreliable method of maintaining improvements in radial length, with more than 50% of patients’ who had improvement falling back to their original lengths at follow up. doi:10.1016/j.injury.2011.06.270 1B.19 Review of proximal humeral fracture fixation with the PHILOS® Plate System in a District General Hospital L. Murugesan, G. Pavlou, J. Stevenson ∗ , D. Giebaly, I.G. Bhoora Stafford Hospital, Mid Staffordshire NHS Foundation Trust, Stafford, UK Proximal humeral fractures present a challenge to the orthopaedic surgeon and the use of the Proximal Humeral Interlocked Osteosynthesis (PHILOS® ) plate as a means to facilitate secure internal fixation has been retrospectively reviewed in a District General Hospital. Methods: 38 patients underwent internal fixation for displaced fractures of the proximal humerus between 2007 and 2010. There were 23 two part, 9 three part and 5 four part Neer classification fractures. 3 cases were lost to follow up. 28 women and 7 men with a mean age of 64.9 years (range 41–96 years) were available for follow up (mean: 12 months; range 6–33 weeks). Clinical notes and radiographs were reviewed and functional assessments were recorded using the Disabilities of Arm, Shoulder and Hand (DASH) scoring system.
Results: In 32 patients (91%), the fracture united clinically and radiologically at a mean of 5.6 weeks (4.5–24 weeks). There were 2 cases of fibrous non-union and 1 case of non-union secondary to deep infection which required revision to excision arthroplasty, and all were 2 part fractures. Complications related to wound infection, nerve injury, screw perforation and avascular necrosis were not found in our case series. The mean DASH score at final review was found to be 36.7 (range 0–88). Conclusion: In our series, non-union has been the principal complication with a single case requiring revision in the short term. Fixation with PHILOS® plate seems to be acceptable for all types of proximal humeral fractures otherwise, with satisfactory functional outcome and no other complications. doi:10.1016/j.injury.2011.06.271 1B.20 Clavicle midshaft fracture non-union treated surgically, with bone grafting or demineralised bone matrix: A comparative outcome analysis A.K. Singh, P. Mestha, A. Tavakkolizadeh, J. Sinha King’s College Hospital, London, United Kingdom The study compares the result of mid-shaft fracture non-unions treated with open reduction and internal fixation (ORIF) and autogenous bone grafting or demineralised bone matrix (DBX). It is based on our hypothesis that demineralised bone matrix provides the same osteoinductive and osteoconductive environment as the bone graft for fracture healing. This is a retrospective study of 30 patients with mid shaft clavicle fracture non-union treated with ORIF and bone grafting or DBX from 2000 to 2010. Of these, 20 were in bone graft group while 10 belonged to the DBX group. Most fractures, 27 out of 30 were initially managed conservatively, while three had primary fixation. Two belonged to the bone graft group and one to the DBX group. The median age for the bone graft group was 44.5 years (range 30–74 yeas), and DBX group was 35.5 years (range 24–78 years). There were 23 male and 7 female patients. Seventeen fractures were left sided. The exclusion criteria were open fracture, fracture with neurovascular deficits or septic non-unions. The results were compared clinically, radiologically and through DASH (Disabilities of Arm, Shoulder and Hand) questionnaire at the time of follow up. The union rate in both the groups were comparable with 18 out of 20 in bone graft group, and 9 out of 10 in DBX group achieving union. One of the non-unions in the bone graft group required re-plating, leading to union. The other two, one belonging to each group, were asymptomatic with fibrous union and full range of shoulder movement. They decided not to opt for any further surgical intervention. The median radiological union time was 6 months in both groups. To conclude, DBX obviates the need for an additional surgery and associated morbidities, and hence should be considered as a replacement of bone graft for non-union surgery. doi:10.1016/j.injury.2011.06.272
Abstracts / Injury Extra 42 (2011) 95–169
the optimal pin position is not established from clinical trials. The aim of this study was to evaluate the radiological outcome of distal radius fractures after extra-focal k-wire fixation and to compare 3 wire with 2 wire technique. Methods: All distal radius fractures treated extra focal k-wire fixation with available digital radiographs were reviewed between August 2007 and February 2010, yielding 70 cases. 52 patients had been treated with 2 wire technique and 18 with 3 wire technique. Pre-operative, post fixation and follow up radiographs were evaluated and radial inclination, volar/dorsal tilt and ulnar variance measured. The radius was defined as short with a positive ulnar variance >2 mm. Radial inclination and volar tilt angle were compared between the 2 groups using Student’s t-tests. Results: Mean ages in the 2 wire and 3 wire groups were 59.4 and 64.8 respectively (p = 0.15) and time for injury to fixation was 5.9–8.3 days. Initial volar tilt was −15.9 in the 2 wire group versus −11.6 in the 3 wire group (p = 0.048) and after fixation were −0.6 versus +4.5 respectively (p = 0.034). There was no significant difference in the improvement in volar tilt between the 2 groups (15.3 versus 16.1). Final volar tilt measurement (−3.4 versus −0.4) demonstrated no significant difference between the 2 groups. There were no significant differences in terms of radial inclination between the 2 groups initially, after reduction and at follow up (17.5 versus 15.3, 20.6 versus 21.5, 20.9 versus 19.9). In the 2 wire group 22 out of 52 patients gained more than 2 mm of radial length after reduction and fixation. 12 out of 22 (54.5%) patients subsequently lost this reduction, falling back to their initial lengths. In the 3 wire group 13 out of 18 patients gained more than 2 mm of radial length after reduction and fixation. 7 out of 13 (53.8%) patients subsequently lost this reduction, falling back to their initial lengths. Conclusions: This study has not been able to show any differences in the radiological outcomes between 2 wire and 3 wire pinning techniques. Percutaneous pinning does appear to be able to hold the improvements made in radial inclination and volar tilt angle after MUA. Percutaneous pinning appears to be an unreliable method of maintaining improvements in radial length, with more than 50% of patients’ who had improvement falling back to their original lengths at follow up. doi:10.1016/j.injury.2011.06.270 1B.19 Review of proximal humeral fracture fixation with the PHILOS® Plate System in a District General Hospital L. Murugesan, G. Pavlou, J. Stevenson ∗ , D. Giebaly, I.G. Bhoora Stafford Hospital, Mid Staffordshire NHS Foundation Trust, Stafford, UK Proximal humeral fractures present a challenge to the orthopaedic surgeon and the use of the Proximal Humeral Interlocked Osteosynthesis (PHILOS® ) plate as a means to facilitate secure internal fixation has been retrospectively reviewed in a District General Hospital. Methods: 38 patients underwent internal fixation for displaced fractures of the proximal humerus between 2007 and 2010. There were 23 two part, 9 three part and 5 four part Neer classification fractures. 3 cases were lost to follow up. 28 women and 7 men with a mean age of 64.9 years (range 41–96 years) were available for follow up (mean: 12 months; range 6–33 weeks). Clinical notes and radiographs were reviewed and functional assessments were recorded using the Disabilities of Arm, Shoulder and Hand (DASH) scoring system.
Results: In 32 patients (91%), the fracture united clinically and radiologically at a mean of 5.6 weeks (4.5–24 weeks). There were 2 cases of fibrous non-union and 1 case of non-union secondary to deep infection which required revision to excision arthroplasty, and all were 2 part fractures. Complications related to wound infection, nerve injury, screw perforation and avascular necrosis were not found in our case series. The mean DASH score at final review was found to be 36.7 (range 0–88). Conclusion: In our series, non-union has been the principal complication with a single case requiring revision in the short term. Fixation with PHILOS® plate seems to be acceptable for all types of proximal humeral fractures otherwise, with satisfactory functional outcome and no other complications. doi:10.1016/j.injury.2011.06.271 1B.20 Clavicle midshaft fracture non-union treated surgically, with bone grafting or demineralised bone matrix: A comparative outcome analysis A.K. Singh, P. Mestha, A. Tavakkolizadeh, J. Sinha King’s College Hospital, London, United Kingdom The study compares the result of mid-shaft fracture non-unions treated with open reduction and internal fixation (ORIF) and autogenous bone grafting or demineralised bone matrix (DBX). It is based on our hypothesis that demineralised bone matrix provides the same osteoinductive and osteoconductive environment as the bone graft for fracture healing. This is a retrospective study of 30 patients with mid shaft clavicle fracture non-union treated with ORIF and bone grafting or DBX from 2000 to 2010. Of these, 20 were in bone graft group while 10 belonged to the DBX group. Most fractures, 27 out of 30 were initially managed conservatively, while three had primary fixation. Two belonged to the bone graft group and one to the DBX group. The median age for the bone graft group was 44.5 years (range 30–74 yeas), and DBX group was 35.5 years (range 24–78 years). There were 23 male and 7 female patients. Seventeen fractures were left sided. The exclusion criteria were open fracture, fracture with neurovascular deficits or septic non-unions. The results were compared clinically, radiologically and through DASH (Disabilities of Arm, Shoulder and Hand) questionnaire at the time of follow up. The union rate in both the groups were comparable with 18 out of 20 in bone graft group, and 9 out of 10 in DBX group achieving union. One of the non-unions in the bone graft group required re-plating, leading to union. The other two, one belonging to each group, were asymptomatic with fibrous union and full range of shoulder movement. They decided not to opt for any further surgical intervention. The median radiological union time was 6 months in both groups. To conclude, DBX obviates the need for an additional surgery and associated morbidities, and hence should be considered as a replacement of bone graft for non-union surgery. doi:10.1016/j.injury.2011.06.272