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Su1.9 Intramedullary nailing for pathological long bone fractures
Osteosynthese International 2013 – Sunday, 15 February / Injury, Int. J. Care Injured 44S2 (2013) S29–S35
fixation. The ankle movement apertures were recorded together with the healthy side. Results: The Student’s t test was used for the statistical comparisons. No statistical significant difference was observed between the AOFAS scores (p >0.05). The angles of dorsiflexion of the elastic fixation group at the 3rd, 6th and 12th months and plantar flexion at the 6th and 12th months were significantly better (p <0.01). Conclusion: Elastic fixation is as functional as screw fixation in the treatment of syndesmosis injuries. Su1.7 Is 25% = 25%? The value of computed tomography in understanding the morphological characteristics measurement of ankle joint U. Özkaya1 , A. Aybar1 , H. Mutlu1 , E. Çetinkaya1 , A.S. Parmaksizoglu1 . 1Taksim Research and Education Hospital, Orthopaedics and Traumatology Department, Istanbul, Turkey Introduction: The standard indication for fixation of a displaced posterior malleolus fragment is involvement of more than 25% of the distal articular tibia measured on the standard lateral x-rays. As precise positioning of ankle radiography is not possible, quantitative measurement of posterior malleolar fractures on ankle x-ray films may be of little value. The purpose of this study was to compare the size of the posterior malleolar fractures on lateral x-rays and computed tomography images to assess the reliability of x-rays. Materials and Methods: Between 2010 and 2012, twenty-five consecutive patients with a trimalleolar ankle fracture were managed at our hospital. The ratio of the posterior fragment area to the total cross-sectional area of the tibial plafond was measured on the patients’ preoperative computed tomographic scans using Adobe Photoshop CS5 program, and also on lateral ankle x-ray films. Results: Five of the twenty-five fractures were not visible on standard lateral x rays, but could only be detected with preoperative computed tomographic evaluation. Seven patients had a posterior malleolus fracture smaller than the generally accepted 25% threshold ratio an lateral x rays; however computed tomographic evaluation showed a ratio larger than 25% with an extension to the medial side. There was only one patient who had a ratio of 33% on both methods. All of the other patients had a larger posterior fragment (mean 16.27±10.20%) than observed on the standard lateral x-rays (mean 10.45±10.88%). Conclusion: The fragment size of the posterior malleolar fractures appear to be highly variable. Standard x-rays are shown to be of little value in evaluating the patient and thus misleading the surgeon for operative intervention. Although the ratio of the fractures extending to the medial malleolus was relatively small, the instability caused by these circumferentially long fractures may be one of the reasons of unsatisfactory functional results following trimalleolar fractures. Su1.8 Our results of double plate application for humeral shaft nonunions 1 , M. Çobanoglu1 , B. Alparslan1 , M.K. Peker1 . ¸ Ö. Özbey1 , Ö. Savk 1Adnan Menderes University, Aydin, Turkey Introduction: Purpose of this study was to evaluate the results of the double plate application of humeral shaft nonunion. Our thesis in this study is that using a second plate for treatment of humeral shaft nonunion does not increase the complication risk. Nevertheless it has high union rate and good clinical outcomes. Methods and Materials: We evaluated retrospectively the patients who were operated for humeral shaft nonunion in our clinic. VAS, DASH and Stewart–Hundley classification were used to evaluate the functional status at the last control. Results: There were 11 patients who were operated with this method in our clinic. Union was achieved in 90.9% of patients on average 5.8 months. The mean follow-up duration was 46.7 months (range, 8–72 months). No implants were loosened or broken. No infection and
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radial nerve palsy was noted. Functional results were excellent and good in most of our patient. The mean VAS pain score decreased from 6.8 to 2. The mean DAS score decreased from 75.8 to 25.4. Conclusions: Double plate application for treatment humeral shaft nonunion does not increase the risk of complication. With this method, high union rates and excellent–good functional results can be obtained. We recommend using a second plate for treatment of humeral shaft nonunions in patients who have bad bone quality. Su1.9 Intramedullary nailing for pathological long bone fractures B. Kececi1 , S. Özcan1 , T.S. Colak1 , R.S. Eyiceyurt1 , D. Sabah2 . 1Ege University Hospital, 2Ege University Hospital, Izmir, Turkey Introduction: Pathologic fractures occur in tumor-like lesions, primary sarcomas and frequently in cancer metastasis cases. Histological diagnosis must be done in these cases. Especially in malignant cases, orthopaedic procedures should be done immediately and minimally invasive in order to avoid additional surgical morbidity and to achieve rapid functional recovery with pain relief. Patients and Methods: Twenty-one fractures were reviewed in 20 patients with pathological fractures. Sixteen lesions were located in the femur (one patient, bilateral) and the remaining five lesions were located in the humerus. All patients were treated with intramedullary nailing with/without bone cementing combined with adjuvant radiotherapy. Mean age of the patients was 54 (26–71) years. Patients were followed up for at least 2 years or until their death. Results: In most patients there was a satisfactory return to daily activities within six weeks of surgery. The consolidation rate was 20%. Fourteen patients died at a mean of 2 years. Conclusion: Immediate treatment of cancer metastasis patients with intramedullary nailing is an effective, safe and minimally invasive procedure. Su1.10 The effect of using an ischium support brace after treatment with dynamic hip screw in unstable intertrochanteric fracture of the femur K. Durak1 , A. Kucukalp2 , V.A. Durak3 , F. Burgucu4 . 1Uludag University Faculty of Medicine Department of Orthopedics and Traumatology, 2Susehri State Hospital Sivas Department of Orthopedics and Traumatology, 3Uludag University Faculty of Medicine Department of Emergency Medicine, 4Uludag University Faculty of Medicine Department of Orthopedics and Traumatology, Bursa, Turkey Introduction: Between December 2008 and February 2012, 42 patients were operated for unstable intertrochanteric fracture of femur with minimally invasive approach for the determination of the dynamic hip screw (DHS) in Uludag University Medical Faculty, Department of Orthopaedics and Traumatology. Patients treated with dynamic condylar screw and anatomic plates were excluded. Methods: After surgery all patients used ischium support brace and mobilized with the help of a walker with full weight bearing. Age, sex, fracture types, timing of operation, amount of bleeding, early and late complications, length of hospitalization, union time, mobilization capacity, mortality rates and functional outcomes were evaluated. Results: In the follow-up period 3 of 42 patients died and the mortality rate was 7.1%. There were no intraoperative complications. Implant failure developed in three patients in the postoperative period, two of these patients underwent revision with total hip arthroplasty and the other patient underwent revision DHS. Preoperative and postoperative functional status were similar except for one patient (p = 0.317). The mean Harris hip score was 78±9.76. Conclusions: Patients with unstable intertrochanteric fracture of femur operated with the use of DHS can be mobilized with ischium support brace safely, application of the DHS, such as proximal femoral
fixation. The ankle movement apertures were recorded together with the healthy side. Results: The Student’s t test was used for the statistical comparisons. No statistical significant difference was observed between the AOFAS scores (p >0.05). The angles of dorsiflexion of the elastic fixation group at the 3rd, 6th and 12th months and plantar flexion at the 6th and 12th months were significantly better (p <0.01). Conclusion: Elastic fixation is as functional as screw fixation in the treatment of syndesmosis injuries. Su1.7 Is 25% = 25%? The value of computed tomography in understanding the morphological characteristics measurement of ankle joint U. Özkaya1 , A. Aybar1 , H. Mutlu1 , E. Çetinkaya1 , A.S. Parmaksizoglu1 . 1Taksim Research and Education Hospital, Orthopaedics and Traumatology Department, Istanbul, Turkey Introduction: The standard indication for fixation of a displaced posterior malleolus fragment is involvement of more than 25% of the distal articular tibia measured on the standard lateral x-rays. As precise positioning of ankle radiography is not possible, quantitative measurement of posterior malleolar fractures on ankle x-ray films may be of little value. The purpose of this study was to compare the size of the posterior malleolar fractures on lateral x-rays and computed tomography images to assess the reliability of x-rays. Materials and Methods: Between 2010 and 2012, twenty-five consecutive patients with a trimalleolar ankle fracture were managed at our hospital. The ratio of the posterior fragment area to the total cross-sectional area of the tibial plafond was measured on the patients’ preoperative computed tomographic scans using Adobe Photoshop CS5 program, and also on lateral ankle x-ray films. Results: Five of the twenty-five fractures were not visible on standard lateral x rays, but could only be detected with preoperative computed tomographic evaluation. Seven patients had a posterior malleolus fracture smaller than the generally accepted 25% threshold ratio an lateral x rays; however computed tomographic evaluation showed a ratio larger than 25% with an extension to the medial side. There was only one patient who had a ratio of 33% on both methods. All of the other patients had a larger posterior fragment (mean 16.27±10.20%) than observed on the standard lateral x-rays (mean 10.45±10.88%). Conclusion: The fragment size of the posterior malleolar fractures appear to be highly variable. Standard x-rays are shown to be of little value in evaluating the patient and thus misleading the surgeon for operative intervention. Although the ratio of the fractures extending to the medial malleolus was relatively small, the instability caused by these circumferentially long fractures may be one of the reasons of unsatisfactory functional results following trimalleolar fractures. Su1.8 Our results of double plate application for humeral shaft nonunions 1 , M. Çobanoglu1 , B. Alparslan1 , M.K. Peker1 . ¸ Ö. Özbey1 , Ö. Savk 1Adnan Menderes University, Aydin, Turkey Introduction: Purpose of this study was to evaluate the results of the double plate application of humeral shaft nonunion. Our thesis in this study is that using a second plate for treatment of humeral shaft nonunion does not increase the complication risk. Nevertheless it has high union rate and good clinical outcomes. Methods and Materials: We evaluated retrospectively the patients who were operated for humeral shaft nonunion in our clinic. VAS, DASH and Stewart–Hundley classification were used to evaluate the functional status at the last control. Results: There were 11 patients who were operated with this method in our clinic. Union was achieved in 90.9% of patients on average 5.8 months. The mean follow-up duration was 46.7 months (range, 8–72 months). No implants were loosened or broken. No infection and
S31
radial nerve palsy was noted. Functional results were excellent and good in most of our patient. The mean VAS pain score decreased from 6.8 to 2. The mean DAS score decreased from 75.8 to 25.4. Conclusions: Double plate application for treatment humeral shaft nonunion does not increase the risk of complication. With this method, high union rates and excellent–good functional results can be obtained. We recommend using a second plate for treatment of humeral shaft nonunions in patients who have bad bone quality. Su1.9 Intramedullary nailing for pathological long bone fractures B. Kececi1 , S. Özcan1 , T.S. Colak1 , R.S. Eyiceyurt1 , D. Sabah2 . 1Ege University Hospital, 2Ege University Hospital, Izmir, Turkey Introduction: Pathologic fractures occur in tumor-like lesions, primary sarcomas and frequently in cancer metastasis cases. Histological diagnosis must be done in these cases. Especially in malignant cases, orthopaedic procedures should be done immediately and minimally invasive in order to avoid additional surgical morbidity and to achieve rapid functional recovery with pain relief. Patients and Methods: Twenty-one fractures were reviewed in 20 patients with pathological fractures. Sixteen lesions were located in the femur (one patient, bilateral) and the remaining five lesions were located in the humerus. All patients were treated with intramedullary nailing with/without bone cementing combined with adjuvant radiotherapy. Mean age of the patients was 54 (26–71) years. Patients were followed up for at least 2 years or until their death. Results: In most patients there was a satisfactory return to daily activities within six weeks of surgery. The consolidation rate was 20%. Fourteen patients died at a mean of 2 years. Conclusion: Immediate treatment of cancer metastasis patients with intramedullary nailing is an effective, safe and minimally invasive procedure. Su1.10 The effect of using an ischium support brace after treatment with dynamic hip screw in unstable intertrochanteric fracture of the femur K. Durak1 , A. Kucukalp2 , V.A. Durak3 , F. Burgucu4 . 1Uludag University Faculty of Medicine Department of Orthopedics and Traumatology, 2Susehri State Hospital Sivas Department of Orthopedics and Traumatology, 3Uludag University Faculty of Medicine Department of Emergency Medicine, 4Uludag University Faculty of Medicine Department of Orthopedics and Traumatology, Bursa, Turkey Introduction: Between December 2008 and February 2012, 42 patients were operated for unstable intertrochanteric fracture of femur with minimally invasive approach for the determination of the dynamic hip screw (DHS) in Uludag University Medical Faculty, Department of Orthopaedics and Traumatology. Patients treated with dynamic condylar screw and anatomic plates were excluded. Methods: After surgery all patients used ischium support brace and mobilized with the help of a walker with full weight bearing. Age, sex, fracture types, timing of operation, amount of bleeding, early and late complications, length of hospitalization, union time, mobilization capacity, mortality rates and functional outcomes were evaluated. Results: In the follow-up period 3 of 42 patients died and the mortality rate was 7.1%. There were no intraoperative complications. Implant failure developed in three patients in the postoperative period, two of these patients underwent revision with total hip arthroplasty and the other patient underwent revision DHS. Preoperative and postoperative functional status were similar except for one patient (p = 0.317). The mean Harris hip score was 78±9.76. Conclusions: Patients with unstable intertrochanteric fracture of femur operated with the use of DHS can be mobilized with ischium support brace safely, application of the DHS, such as proximal femoral