Internal Fixation with a Locking T-Plate for Proximal Humeral Fractures in Patients Aged 65 Years and Older

BACKGROUND: The purpose of this study was to evaluate the clinical and radiographic outcomes of internal fixation with locking T-plates for osteoporotic fractures of the proximal humerus in patients aged 65 years and older. METHODS: From January 2007 through to December 2015, we recruited 47 patients aged 65 years and older with osteoporotic fractures of the proximal humerus. All fractures had been treated using open reduction and internal fixation with a locking T-plate. We classified the fractures in accordance to the Neer classification system; At the final follow-up, the indicators of clinical outcome-the range of motion of the shoulder (flexion, internal rotation, and external rotation) and the presence of postoperative complications-and the indicators of radiographic outcome-the time-to-union and the neck-shaft angle of the proximal humerus-were evaluated. The Paavolainen method was used to grade the level of radiological outcome in the patients. RESULTS: The mean flexion was 155.0° (range, 90°–180°), the mean internal rotation was T8 (range, T6–L2), and the mean external rotation was 66.8° (range, 30°–80°). Postoperative complications, such as plate impingement, screw loosening, and varus malunion were observed in five patient. We found that all patients achieved bone union, and the mean time-to-union was 13.5 weeks of the treatment. The mean neck-shaft angle was 131.4° at the 6-month follow-up. According to the Paavolainen method, “good” and “fair” radiographic results each accounted for 38 and 9 of the total patients, respectively. CONCLUSIONS: We concluded that locking T-plate fixation leads to satisfactory clinical and radiological outcomes in elderly patients with proximal humeral fractures by providing a larger surface area of contact with the fracture and a more rigid fixation.

Internal Fixation with a Locking T-Plate for Proximal Humeral Fractures in Patients Aged 65 Years and Older

BACKGROUND: The purpose of this study was to evaluate the clinical and radiographic outcomes of internal fixation with locking T-plates for osteoporotic fractures of the proximal humerus in patients aged 65 years and older. METHODS: From January 2007 through to December 2015, we recruited 47 patients aged 65 years and older with osteoporotic fractures of the proximal humerus. All fractures had been treated using open reduction and internal fixation with a locking T-plate. We classified the fractures in accordance to the Neer classification system; At the final follow-up, the indicators of clinical outcome-the range of motion of the shoulder (flexion, internal rotation, and external rotation) and the presence of postoperative complications-and the indicators of radiographic outcome-the time-to-union and the neck-shaft angle of the proximal humerus-were evaluated. The Paavolainen method was used to grade the level of radiological outcome in the patients. RESULTS: The mean flexion was 155.0° (range, 90°–180°), the mean internal rotation was T8 (range, T6–L2), and the mean external rotation was 66.8° (range, 30°–80°). Postoperative complications, such as plate impingement, screw loosening, and varus malunion were observed in five patient. We found that all patients achieved bone union, and the mean time-to-union was 13.5 weeks of the treatment. The mean neck-shaft angle was 131.4° at the 6-month follow-up. According to the Paavolainen method, “good” and “fair” radiographic results each accounted for 38 and 9 of the total patients, respectively. CONCLUSIONS: We concluded that locking T-plate fixation leads to satisfactory clinical and radiological outcomes in elderly patients with proximal humeral fractures by providing a larger surface area of contact with the fracture and a more rigid fixation.

Causative Factors Regarding the Clinical Outcomes after Arthroscopic Treatment for Pyogenic Knee Arthritis / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to analyze the causative factors that affect the recurrence and positive culture results of pyogenic knee arthritis after arthroscopic treatment. MATERIALS AND METHODS: A total of 69 patients, who were followed-up for more than one year after arthroscopid lavage and debridement for pyogenic knee arthritis, between February 2011 and February 2015, were retrospectively reviewed for analysis. We analyzed the factors affecting the recurrence rate, preoperative C-reactive protein (CRP) level, neutrophil count in synovial fluid, growth of bacteria in culture, and normalization of CRP level, and also analyzed potential factors that may influence the treatment results and recurrence. RESULTS: The recurrence rate was significantly higher in the culture-positive group (p=0.014). Culture-positive patients had low preoperative CRP (p=0.004), shorter duration for normalization of CRP (p=0.037), shorter duration of hospital stay (p=0.001) and intravenous antibiotics use (p=0.021). The duration for normalization of the CRP level had was associated with symptom-to-treatment interval (p=0.005), neutrophil count in synovial fluid (p=0.007), and growth of bacteria in the culture (p=0.001). There were 16 cases (23.2%) culture-positive cases and 15 cases (21.7%) recurrent cases. CONCLUSION: According to our study, early diagnosis and management affect rapid recovery of the CRP level in pyogenic arthritis of the knee. Preoperative CRP and leukocyte counts in the joint fluid are of diagnostic value in acute infection. However, it should not be overlooked that their diagnostic value is limited as a single factor as they may have low preoperative values. Therefore preoperative CRP and leukocyte counts in the joint fluid should be considered in conjunction with symptoms and intra-articular fluid manifestations. Bacteria growth in the culture are meaningful factors in an evaluation for postoperative recovery and recurrence.

The Impacts of Fixation Tightness and Duration on the Remnant Syndesmotic Widening and Clinical Symptom after Removal of Screws / 대한족부족관절학회지

PURPOSE: We aimed to analyze the effect of fixation tightness of the syndesmotic screw and its indwelling period on the recurrence of the syndesmosis widening after screw removal and the clinical outcomes. MATERIALS AND METHODS: Forty consecutive patients with acute syndesmotic injury were retrospectively reviewed. The tibiofibular clear space is measured by digitalized measurement tool on serial radiographs. We analyzed the effect of time from trauma to fixation, syndesmotic screw indwelling duration, and fixation methods. Residual symptoms at the last follow up were evaluated. The student t-test, correlation test, and chi-square test were used for statistical analysis. RESULTS: Eighteen ankles (45%) had recurrent syndesmosis widening (greater than 5% compared to the contralateral side). Seven patients had pain and five had limitation of motion in the ankle joint. Fixation tightness had significant effect on reducing the recurrence while the severity of the initial widening, time to fixation, and duration of fixation did not affect the outcome. CONCLUSION: Tight fixation of syndesmotic screw is essential for achieving final syndesmotic stability and reducing recurrence.