Fixation of basicervical and related fractures using DHS with DRS.

Background: Basicervical fracture is a fracture through the base of femoral neck at its junction with the intertrochanteric region. Due to this location, it represents an intermediate form between femoral neck, usually fixed with multiple cancellous screws, and the intertrochanteric fracture, fixed with a sliding screw device. Previous studies recommended treating basicervical fractures as intertrochanteric fractures with the dynamic hip screw (DHS). However, because basicervical fractures have greater instability than stable intertrochanteric fractures, poor functional outcome may be expected when the DHS used alone. Aims & Objective: To evaluate the outcome of fixation of basicervical and related fractures using DHS with DRS. Materials and Methods: We prospectively studied 42 patients in order to identify a group of proximal femoral fractures having liability for axial and rotational instability, and to present results of their fixation using the dynamic hip screw (DHS) with derotation screw (DRS). Results: At 12 months postoperatively, patients were functionally evaluated and the radiological outcome was analysed. All fractures united within an average period of 11.5 weeks. The mean sliding distance was 5.5 mm and mean shortening of the limbs was 2 mm. According to the criteria of Kyle et al. (J Bone Joint Surg [Am] 61-A:216–221), 39 patients obtained excellent results, two good and one fair. Conclusion: We conclude that the AO types B2.1, A1.1, A2.1, A2.2 and A2.3 have a common instability denominator and therefore should be treated alike. The sliding component of the DHS allows solid fixation of the two major fragments in two planes and the DRS in the third plane.

Post-amputation rehabilitation is an emergency crisis: from preoperative to the community.

Background: Losing a limb (or a part of a limb) usually leads to loss of functionality and subsequent disability. Aims & Objective: This paper aims at pointing out the importance of comprehensive and multidisciplinary care that includes early, direct or indirect, involvement of rehabilitation service providers even in an emergency context. Materials and Methods: We underline the links between amputation and disability as well as the milestones and main purposes of the rehabilitation process following amputation. We then emphasise the influence that the level of amputation has on functional outcomes. Results: In order for functional outcomes to balance purely medical factors when identifying the best site for amputation in emergency settings where preoperative involvement of a rehabilitation professional is difficult due to limited resources, we enunciate five general rules to be used as guidelines by the medical team in the absence of a rehabilitation service provider. These five rules, remaining general enough to apply to most contexts and patients, still need to be balanced against contextual and personal factors that can only be identified at the time of the amputation. Conclusion: The main expectations of people who undergo surgery are, usually, to remain actors in the society and regain functional abilities. Therefore, surgical outcomes are closely related to functional outcomes. In order for the functional and personal factors to be taken into account, we recommend, even in an emergency context, preoperative involvement of rehabilitation care providers.

Distal radius fractures with diaphyseal involvement:fixation with fixed angle volar plate.

Background: Fractures of the distal radius involving the metaphyseal and diaphyseal junction are commonly the result of high energy trauma, and represent a challenge for the orthopedic surgeon. Fractures are often comminuted: optimal reduction, restoration of normal radial length, and a correct radioulnar relationship may be difficult to achieve. Only a few reports in the literature have studied these lesions, and the best treatment approach is still the source of debate. Aims & Objective: To evaluate the outcome of fractures of the distal radius with metaphyseal and diaphyseal involvement treated with fixed angle volar plates. Materials and Methods: Twenty-one patients with fracture of the radius involving the diaphyseal, metaphyseal and epiphyseal parts were treated with fixed angle plate fixation through an extended volar Henry’s approach. Circle wire loops, screws and intrafocal wire fixations were associated in 12 cases. Coexisting ulnar fractures were fixed with plates or K-wires in 8 cases. All patients were prospectively followed using radiographs, physical examination, and DASH (Disabilities of the Arm, Shoulder and Hand) scores. Results: All fractures except one, which needed a secondary bone graft to achieve consolidation, united by an average of 90 days. One case developed a radioulnar synostosis. Radiographs showed optimal reduction in 17 of 21 cases, with restoration of radial length in all cases and a neutral average ulnar variance. Non-anatomical reduction was associated with the worst results (P = 0.0006). Flexion and extension averaged 62.8 degree and 73.8 degree and pronation and supination 85.2degree and 80.2degree respectively. The average DASH scores were 30 points at 3 months, 14 points at 6 months, and 6.7 points at the time of final follow-up (at an average of 11 months). According to the Mayo wrist rating system, 14 patients showed excellent results, 5 showed good results, and 2 showed fair results. Conclusion: Fixed angle volar plates were demonstrated to be a safe and efficient treatment in these challenging fractures.

[RETRACTED ARTICLE] Post-traumatic flexion contractures of the elbow release via limited lateral.

Background: Varying surgical techniques, patient groups and results have been described regards the surgical treatment of post traumatic flexion contracture of the elbow. Aims & Objective: We present our experience using the limited lateral approach on patients with carefully defined contracture types. Materials and Methods: Surgical release of post-traumatic flexion contracture of the elbow was performed in 23 patients via a limited lateral approach. All patients had an established flexion contracture with significant functional deficit. Contracture types were classified as either extrinsic if the contracture was not associated with damage to the joint surface or as intrinsic if it was. Overall, the mean preoperative deformity was 55 degrees (95%CI 48 – 61) which was corrected at the time of surgery to 17 degrees (95%CI 12 – 22). Results: At short-term follow-up (7.5 months) the mean residual deformity was 25 degrees (95%CI 19 – 30) and at medium-term followup (43 months) it was 32 degrees (95%CI 25 – 39). This deformity correction was significant (p < 0.01). One patient suffered a postoperative complication with transient dysaesthesia in the distribution of the ulnar nerve, which had resolved at six weeks. Sixteen patients had an extrinsic contracture and seven an intrinsic. Although all patients were satisfied with the results of their surgery, patients with an extrinsic contracture had significantly (p = 0.02) better results than those with an intrinsic contracture. (28 degrees compared to 48 degrees at medium term follow up). Conclusion: Surgical release of post-traumatic flexion contracture of the elbow via a limited lateral approach is a safe technique, which reliably improves extension especially for extrinsic contractures. In this series all patients with an extrinsic contracture regained a functional range of movement and were satisfied with their surgery.