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OTA Classification
Abstracts / Injury Extra 42 (2011) 95–169
B responses agreed on better discharge planning (U = 477.00, p = .19, r = .17). Conclusions: There was no statistical difference between group A and B responses. Therefore, doctors, nurses and allied health professionals agreed that the new model provided better quality of patient care, improved discharge planning and expressed their preference for working in the new model. doi:10.1016/j.injury.2011.06.380 11.3 Talar body fracture with pantalar subluxation: Modification of Müller AO/OTA Classification K.S.R.K. Prasad, G. Clewer Department of Trauma & Orthopaedic Surgery, Prince Charles Hospital, Merthyr Tydfil, United Kingdom Aim: Our primary purpose is to present a unique combination of a closed comminuted coronal shear fracture of talar body in association with pantalar subluxation, clinical pathodynamics and modification of Müller AO/OTA Classification as fractures of talar body represent uncommon high energy injuries with potential for grave prognosis and current literature of definition, classification, timing of surgery and outcomes remains controversial. Methods and results: A 63-year old man was brought to Accident unit with history of fall from 5 feet height and injury to right ankle. He had marked swelling and tenderness over ankle with no neurovascular deficit. Radiographs and Computerised Tomography showed a comminuted coronal shear fracture of talar body with subluxation of ankle, subtalar and talonavicular joints in addition to Weber A fracture of lateral malleolus. Under general anaesthesia, closed anatomical reduction was achieved and stable osteosynthesis of fracture was accomplished with two percutaneous cannulated screws from posteromedial and anterolateral approaches. Talonavicular joint was stable. He was immobilised in a below knee nonweightbearing cast. After six weeks, fracture united. Hawkins sign was negative. He was given a non-weightbearing brace for 7 weeks to facilitate active exercises. Two cases of talar body fractures with pantalar dislocation (but not subluxation), treated by open reduction, were reported. Müller AO/OTA Classification of fractures of talar body comprises CI—ankle joint involvement, C2—subtalar joint involvement, C3—ankle and subtalar joint involvement. We extend the classification to include C4—ankle, subtalar and talonavicular joint involvement. Conclusions: Our patient has a unique association of coronal shear fracture of talar body with pantalar subluxation, sustained by axial compression on plantarflexed foot and treated by closed anatomical reduction and stable percutaneous osteosynthesis. Our modification fills the void in Müller AO/OTA Classification of fractures of talar body by inclusion of C4. doi:10.1016/j.injury.2011.06.381
159
12.1 Concomitant deficiency of quadriceps and patellar tendons: Surgical outcome with Ligament Augmentation and Reconstruction System (LARS) K.S.R.K. Prasad, H. Gakhar, K. Karras Trauma and Orthopaedic Surgery, Prince Charles Hospital, Merthyr Tydfil, UK Concomitant deficiency of quadriceps and patellar tendons, presenting as chronic injury, is rare. Simultaneous surgical reconstruction of concomitant deficiency of quadriceps and patellar tendons poses a unique challenge. We are reporting chronic concomitant deficiency of quadriceps and patellar tendons, which we managed surgically by using LARS (Ligament Augmentation and Reconstruction System, Corin). A 50-year old man was referred to our clinic with anterior pain and instability of right knee, after he slipped downstairs about 2 years ago. He found the pain excruciating intermittently. Examination revealed quadriceps wasting and tenderness over quadriceps insertion. He could straight leg raise against resistance and had no collateral or cruciate instability. Radiographs were normal. MR Imaging demonstrated considerable disruption of soft tissues anterior to patella as well as attenuation and partial injury at insertion of quadriceps tendon and origin of patellar tendon. On exploration, both Quadriceps and patellar tendons were deficient at patella. Quadriceps tendon was split coronally with ruptured superficial portion, while deep portion was split sagitally into two bands. Deep portion was approximated with vicryl and reinforced further with LARS tumour band, suturing with Ethilon. Superficial layer was closed over LARS tumour band. At lower end, LARS tumour band was sutured to distal margins of patellar ligament. After 1 year, he gained full function and grade V power with no instability. He was asymptomatic, pleased with the result and returned to pre-injury activities. Simultaneous surgical reconstruction of concomitant deficiencies of quadriceps and patellar tendons using LARS tumour band is effective with excellent clinical and functional results. doi:10.1016/j.injury.2011.06.382 12.2 Breakages of the third generation gamma nail and a novel technique for its extraction N.P.M. Jain, N. Bell, A. Hasan, P. Dunkow Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, Lancashire, UK Introduction: We report the first case of nail breakage of the third generation gamma nail in the literature. Methods: Nail breakage is a recognised complication of the (second generation) gamma nail and has been reported many times in the modern literature. In 2005 STRYKER® introduced the third generation gamma nail which included a number of modifications designed to present such a complication. Such changes included redesigning the aperture of the proximal screw hole to increase the yield point of this area, which has been a site of previous nail breakage. The case involved a 21 year old 110 kg male sustained a subtrochanteric fracture to his right femur following a fall from a wall. He underwent operative fixation with a 3rd generation gamma nail without any early complications, mobilising fully weight bearing from Day 1 post-operatively. After initially progressing well he re-
B responses agreed on better discharge planning (U = 477.00, p = .19, r = .17). Conclusions: There was no statistical difference between group A and B responses. Therefore, doctors, nurses and allied health professionals agreed that the new model provided better quality of patient care, improved discharge planning and expressed their preference for working in the new model. doi:10.1016/j.injury.2011.06.380 11.3 Talar body fracture with pantalar subluxation: Modification of Müller AO/OTA Classification K.S.R.K. Prasad, G. Clewer Department of Trauma & Orthopaedic Surgery, Prince Charles Hospital, Merthyr Tydfil, United Kingdom Aim: Our primary purpose is to present a unique combination of a closed comminuted coronal shear fracture of talar body in association with pantalar subluxation, clinical pathodynamics and modification of Müller AO/OTA Classification as fractures of talar body represent uncommon high energy injuries with potential for grave prognosis and current literature of definition, classification, timing of surgery and outcomes remains controversial. Methods and results: A 63-year old man was brought to Accident unit with history of fall from 5 feet height and injury to right ankle. He had marked swelling and tenderness over ankle with no neurovascular deficit. Radiographs and Computerised Tomography showed a comminuted coronal shear fracture of talar body with subluxation of ankle, subtalar and talonavicular joints in addition to Weber A fracture of lateral malleolus. Under general anaesthesia, closed anatomical reduction was achieved and stable osteosynthesis of fracture was accomplished with two percutaneous cannulated screws from posteromedial and anterolateral approaches. Talonavicular joint was stable. He was immobilised in a below knee nonweightbearing cast. After six weeks, fracture united. Hawkins sign was negative. He was given a non-weightbearing brace for 7 weeks to facilitate active exercises. Two cases of talar body fractures with pantalar dislocation (but not subluxation), treated by open reduction, were reported. Müller AO/OTA Classification of fractures of talar body comprises CI—ankle joint involvement, C2—subtalar joint involvement, C3—ankle and subtalar joint involvement. We extend the classification to include C4—ankle, subtalar and talonavicular joint involvement. Conclusions: Our patient has a unique association of coronal shear fracture of talar body with pantalar subluxation, sustained by axial compression on plantarflexed foot and treated by closed anatomical reduction and stable percutaneous osteosynthesis. Our modification fills the void in Müller AO/OTA Classification of fractures of talar body by inclusion of C4. doi:10.1016/j.injury.2011.06.381
159
12.1 Concomitant deficiency of quadriceps and patellar tendons: Surgical outcome with Ligament Augmentation and Reconstruction System (LARS) K.S.R.K. Prasad, H. Gakhar, K. Karras Trauma and Orthopaedic Surgery, Prince Charles Hospital, Merthyr Tydfil, UK Concomitant deficiency of quadriceps and patellar tendons, presenting as chronic injury, is rare. Simultaneous surgical reconstruction of concomitant deficiency of quadriceps and patellar tendons poses a unique challenge. We are reporting chronic concomitant deficiency of quadriceps and patellar tendons, which we managed surgically by using LARS (Ligament Augmentation and Reconstruction System, Corin). A 50-year old man was referred to our clinic with anterior pain and instability of right knee, after he slipped downstairs about 2 years ago. He found the pain excruciating intermittently. Examination revealed quadriceps wasting and tenderness over quadriceps insertion. He could straight leg raise against resistance and had no collateral or cruciate instability. Radiographs were normal. MR Imaging demonstrated considerable disruption of soft tissues anterior to patella as well as attenuation and partial injury at insertion of quadriceps tendon and origin of patellar tendon. On exploration, both Quadriceps and patellar tendons were deficient at patella. Quadriceps tendon was split coronally with ruptured superficial portion, while deep portion was split sagitally into two bands. Deep portion was approximated with vicryl and reinforced further with LARS tumour band, suturing with Ethilon. Superficial layer was closed over LARS tumour band. At lower end, LARS tumour band was sutured to distal margins of patellar ligament. After 1 year, he gained full function and grade V power with no instability. He was asymptomatic, pleased with the result and returned to pre-injury activities. Simultaneous surgical reconstruction of concomitant deficiencies of quadriceps and patellar tendons using LARS tumour band is effective with excellent clinical and functional results. doi:10.1016/j.injury.2011.06.382 12.2 Breakages of the third generation gamma nail and a novel technique for its extraction N.P.M. Jain, N. Bell, A. Hasan, P. Dunkow Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, Lancashire, UK Introduction: We report the first case of nail breakage of the third generation gamma nail in the literature. Methods: Nail breakage is a recognised complication of the (second generation) gamma nail and has been reported many times in the modern literature. In 2005 STRYKER® introduced the third generation gamma nail which included a number of modifications designed to present such a complication. Such changes included redesigning the aperture of the proximal screw hole to increase the yield point of this area, which has been a site of previous nail breakage. The case involved a 21 year old 110 kg male sustained a subtrochanteric fracture to his right femur following a fall from a wall. He underwent operative fixation with a 3rd generation gamma nail without any early complications, mobilising fully weight bearing from Day 1 post-operatively. After initially progressing well he re-