Despite the popularity and success of volar fixed angle plating, variations in distal radius fracture presentation underscore the importance of understanding different surgical treatment options to ...maximize patient outcomes. The 3-column theory of wrist mechanics provided the foundation for using a column-specific fixation approach. Implant placement within the ulnar column can be challenging because of anatomical constraints. Some have described “safe zones” for implant position to decrease the potential for tendon impingement. A thorough understanding of the surrounding anatomy can allow fixation decisions based on fracture fragment location. Literature reports have shown excellent results when using fragment specific fixation constructs and similar outcomes when comparing these constructs with volar locked plating. Achieving optimal outcomes in surgically treated distal radius fractures requires the surgeon to be competent along a spectrum of surgical approaches and fixation constructs.
•O’Driscoll described linking the distal humerus columns to create a stable construct which can withstand early rehabilitation.•An interlocking beam linking the medial & lateral plates provides ...greater stability compared to a similar unlinked construct.•The beam’s double supported design resists cantilever bending and provides robust compression of the fractured fragments.
Concerning rates of nonunion in articular distal humerus fractures indicate an unsolved problem. The fixation principles of O'Driscoll describe linking the fractured articular segment to the distal humerus columns with compression screws which creates a stable fixed angle construct. A novel device has been introduced which utilizes an interlocking beam through the articular segment to connect the distal aspect of the medial and lateral plates, creating a linked construct. We sought to evaluate the stability of this linked construct using an articular model of distal humerus fracture.
Ten matched pair specimens of 65 years of age or older were randomized to the use (LB group) or non-use (NLB group) of an interlocking beam to link the medial and lateral locking plates in fixation of an AO Type C3 fracture model. Outside of the linking beam, fixation between the matched pairs was consistent using 2.7 mm locking screws distally with fixed trajectories and +/- 2 mm lengths.
Mean stiffness was 273 Newtons/mm in the LB group and 225 Newtons/mm in the NLB group (p = 0.001). Mean maximum displacement was 0.28 in the LB group and 0.93 mm in the NLB group (p = 0.006). Mean load to failure was 277 pounds in the LB group and 280 pounds in the NLB group (p = 0.94).
Our results indicate that an interlocking beam which links the medial and lateral plates provides greater stability compared to a similar construct without an interlocking beam. We attribute this finding to the beam's double supported design which resists cantilever bending and provides robust compression of the fractured fragments.
We describe a medial approach to the coronoid where the flexor-pronator mass is released from its humeral origin by creating a proximally based tendinous flap. This technique facilitates access to ...the coronoid, preservation of the medial collateral ligament origin, and repair of the flexor-pronator mass. This approach has utility for all coronoid fracture variations but especially the O'Driscoll anteromedial subtype 3, which includes fractures of the sublime tubercle, the anteromedial facet, and the coronoid tip.
The Single-Incision Power Optimizing Cost-Effective Repair (SPOC) method reattaches the distal biceps tendon to its original posterior anatomic footprint and utilizes the anterior cortex of the ...supinated radius for fixation. The purpose of the study was to define the long-term complications and durability of the SPOC method.
Two hundred and eighteen patients underwent the SPOC repair of distal biceps ruptures from 2008 to 2020, with 185 having at least 1-year follow-up data. The average follow-up was 50.1 months. Information regarding smoking, body mass index, interval between injury and surgery, peripheral nerve injury, heterotopic ossification, vascular injury, re-rupture, chronic regional pain syndrome, fracture of the radius, loss of motion, pain with use, and deformity were acquired.
No complication occurred beyond the third postoperative month. No patient complained of severe lateral antebrachial cutaneous nerve-related symptoms. Major complications exclusive of re-rupture occurred include 1 case of heterotopic ossification and 1 deep infection. Major complications with re-ruptures occurred in 9 patients (4.8%). Seven of the re-ruptures (78%) were associated with an unexpected forceful contraction within the first 4 weeks postop. All complications aside from 1 minor complication occurred in the chronic group. Long term follow-up revealed no re-ruptures and high satisfaction rate with return of strength, motion, and biceps profile.
The safety profile of the SPOC repair is consistent with those of other published repairs. Major complications were associated with prolonged intervals between injury and reconstruction. Re-ruptures were associated with worker’s compensation status and patient noncompliance with postoperative protocols.
A variety of fixation options exist for treatment of unstable proximal phalanx fractures. Variables which require consideration include the strength of fixation, the invasiveness of the technique and ...the postoperative rehabilitation protocol. Here we present a minimally invasive technique for dual headless compression screw fixation of proximal phalanx fractures which reduces extensor tendon violation and allows early motion in the immediate postoperative period.
Background Compared to total elbow arthroplasty, elbow hemiarthroplasty (EHA) does not have an ulnar component or a hinge/link which eliminates complication risk due to polyethylene wear and ulnar ...loosening. There are notable gaps in the existing EHA literature. Patient age is often identified as an important determinant when deciding to treat with EHA; however, there is limited age-based evidence. Our systematic review objectives were (a) to compare EHA outcomes between younger and older adults, and (b) to stratify outcomes for EHA by prosthesis. Methods In compliance with PRISMA guidelines, databases were searched for EHA studies and 65 years was used to delineate younger and older adults. Results Older adults (N = 159) had a significantly higher elbow arc of motion compared to younger adults (N = 121) at a mean follow-up of 51 months. There was a significantly increased risk for a MEPS below 75 in younger compared to older adults. Mean Disabilities of the Arm, Shoulder, and Hand scores and rates of revision/removal were comparable between age groups. Conclusion The current findings suggest that although elbow range of motion may be limited in younger adults following EHA, function is satisfactory and comparable to the function in older adults. Additionally, the risk of revision/removal surgery is similar between younger and older adults across short to mid-terms of follow-up.
Total Wrist Arthrodesis Li, Jefferson; Wilson, Daniel C.; Hoekzema, Nathan A.
Operative techniques in orthopaedics,
December 2020, 2020-12-00, Letnik:
30, Številka:
4
Journal Article
Recenzirano
Total wrist arthrodesis is a reliable procedure for pain relief in arthritic wrists. While it eliminates all motion of the wrist, excellent hand function can be maintained and the stability of the ...construct allows the patient to return to heavy work including manual labor. Numerous fixation methods have been described and all have satisfactory clinical outcomes. Optimal wrist fusion position, fixation method, concomitant proximal row carpectomy, and inclusion of the third carpometacarpal joint remain controversial.
Peri-articular fractures of the hand Li, Jefferson; Ghulam-Jelani, Zohal; Hoekzema, Nathan
Journal of Hand Surgery (European Volume),
09/2023, Letnik:
48, Številka:
2_suppl
Book Review, Journal Article
Recenzirano
Odprti dostop
Peri-articular fractures of the hand are common injuries. Long-term consequences can be relatively innocuous or severely disabling. Due to the specific anatomy of the hand, avulsion fractures are ...likely more common here than anywhere else in the body and often occur at or near joints. The management of peri-articular fractures of the hand requires consideration of both the articular reduction and the status of ligament and tendon attachments. In general, these fractures can be treated non-operatively. Operative treatment can be percutaneous or open and should be individualized.
Triceps avulsion fractures have become an increasingly common postoperative complication of olecranon fracture repair with proximal ulna plate (PUP) fixation. The purpose of this study is to create ...an efficient, reproducible mechanism to mitigate this issue.
Ten matched pair cadaveric specimens underwent a complete transverse osteotomy to simulate an olecranon fracture, followed by fracture reduction with a PUP. One arm from each pair underwent an additional augmented suture repair, where the triceps tendon was sutured directly to the plate. A custom jig was used to hold the specimen in position and apply a tensile force on the triceps until mechanical failure.
All control specimens (without augmented suture repair) failed through a full-thickness triceps avulsion fracture at an average force of 967.7 N. The augmented suture-repaired specimens failed at an average force of 1204.3 N through partial avulsion fractures, widening of the osteotomy site, and triceps ruptures.
Our study demonstrated that an augmented suture repair of PUP fixation for olecranon fractures is a simple and effective way to significantly increase fixation strength and change the potential failure mechanism.
OBJECTIVES:To identify the incidence of orthopaedic injuries secondary to dog bites, determine the responsible breeds, and assess the severity of injury by dog breed.
DESIGN:Retrospective.
...SETTING:Single Level I trauma center.
PATIENTS:Ninety-five patients treated for a dog bite that resulted in an orthopaedic injury between January 2010 and July 2016.
INTERVENTION:Patients were treated according to their specific orthopaedic injury.
MAIN OUTCOME MEASUREMENTS:Dog breed and type of orthopaedic injury.
RESULTS:Thirty-nine percent of all dog bite–related emergency department visits resulted in an orthopaedic injury requiring specialist treatment. Of the 95 patients, 50% were the result of a pit bull terrier bite and 22% by a law enforcement dog. A total of 32% were attacked by multiple dogs. There was a 51% incidence of severe injury (amputation or fracture) with a significant association with breed.
CONCLUSIONS:Thirty-nine percent of all dog bite–related emergency department visits at our facility resulted in an injury requiring orthopaedic treatment. Pit bull terrier bites were responsible for a significantly higher number of orthopaedic injuries and resulted in an amputation and/or bony injury in 66% of patients treated, whereas bites from law enforcement dogs and other breeds were less associated with severe injuries.
LEVEL OF EVIDENCE:Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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