Functional outcome of displaced intra-articular fractures of the distal radius: Comparison of closed reduction percutaneous pinning with or without external fixation versus open reduction plate fixation

OBJECTIVES@#The purpose of the study was to determine the outcomes of closed reduction percutaneous pinning (CRPP) with or without external fixation (EF) with open reduction and internal fixation (ORIF) using plate and screws. @*METHODS@#Outcomes of ORIF versus CRPP, with or without external fixation for intra-articular distal radius fractures were compared through a multicenter, non-randomized, ambispective cohort study. A validated Filipino version of the DASH score (FIL-DASH) was used as primary outcome measure.@*RESULTS@#The ORIF group consisted of 13 patients and the CRPP group, eight patients. Pain scores, post-operative complications and radiographic measurements were also evaluated. Mean FIL-DASH score for the ORIF group (M=26.69, SD=4.88) was significantly higher versus the CRPP group (M=14.59, SD=10.64; t(19)=3.58, p=0.002). No significant differences in radiologic parameters, pain scores, and complications were found.@*CONCLUSION@#The study demonstrates that functional outcomes post-CRPP with or without external fixation compares favorably over ORIF for distal radius fractures at one-year post-surgery.

Evaluation of Functional Results in the Management of Supracondylar Fracture of Humerus in Children by Various Methods

Introduction: Supracondylar fractures of Humerus are one of the most common fractures in pediatric age group. The aim ofthe study was to evaluate the functional results in the management of supracondylar fracture of humerus in children by variousmethods.Materials and Methods: This study was conducted at the Orthopaedics department of Mahatma Gandhi MemorialHospital, Warangal. This was a 2 years prospective, longitudinal, hospital based, observational study and its outcomes.Participants were a total of 30 children aged 0 to 14 years (21 males, 9 females) diagnosed with supracondylar fractureof humerus.Results: Patients were assessed by Flynn’s criteria. Results were excellent in 70%, good in 20%, fair in 6.66%, and poor in 3.33%.Conclusion: Closed reduction and external immobilization are reserved for Gartland’s type 1 and select type 2 fractures. Inunstable type 2 and type 3, closed or open reduction and K-wire fixation give better results.

Percutaneous Pinning For Management of Non-Comminuted Extra-Articular Distal Radial Fractures: A Prospective Study

Distal radius fractures are one of the common injuries for which orthopedic consultations are sought. These injuries make up to 10-15% of all bony injuries in adult population. High energy trauma as seen in road traffic accidents is common cause of these injuries. Noncomminuted extra-articular fractures of distal radius are common in adult males following vehicular accidents. Majority of the patients with distal radial fractures are managed by closed reduction and immobilization. Poor functional outcome and complications such as malunion has made many researchers to look for alternative methods of managing these patients. An attractive alternative for managing these cases consist of Percutaneous pinning followed by immobilization of the fracture for 3 weeks. This method is simple and affordable and reported to have excellent functional outcome.Methods:This was a prospective cohort study conducted in the department of orthopedics of a tertiary care medical college situated in an urban area. 40 adult patients with Noncomminuted extraarticular fractures of distal radius were included in this study on the basis of a predefined inclusion and exclusion criteria. All patients were treated by closed reduction followed by percutaneous pinning using K-wires. Below elbow plaster cast was given for 3 weeks after which plaster was removed and physiotherapy was started. Follow up X-rays were taken at 3 and 6 weeks. Functional outcome was assessed by Quick DASH scores. SSPE 21.0 was used for statistical analysis and p value less than 0.05 was taken as statistically significant.Results: Out of the 40 studied cases there were 34 (85%) males and 6 (15%) females a M:F ratio of 1:0.17. The most common affected age group was found to be <30 years (55%) and most common mechanism of injury was motor vehicular accidents (65%). All patients were treated by closed reduction followed by percutaneous pinning using K-wires. Excellent or good functional outcome was seen in 34 (85%) patients. 4 (10%) patients were found to have fair functional outcome and remaining 2 (5%) patients were found to have poor functional outcome as assessed by Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire.Conclusion:Percutaneous pinning followed by immobilization of the fracture is an effective treatment for Non-comminuted extra-articular fractures of distal radius having excellent functional outcome.

Clinical Evaluation of Demineralized Bone Matrix Allograft in Femur Fracture in Dogs

Eight clinical cases of dogs having femur fracture, were divided into two groups, A and B with four dogs (n=4) in each group. Group A animals were treated with intramedullary pinning (IMP) alone and group B were treated using IMP alongwith demineralized bone matrix (DBM) implantation at the fracture site. The efficacy of healing was evaluated on the basis of clinical evaluation, haemato-biochemical and radiographic parameters on the day of admission (day 0), followed by 7th, 15th, 30th, 45th and 60th post-operative days. The weight bearing was observed to be better in dogs of group A. Swelling was completely absent after 15th post-operative day in dogs of both the groups. The mean values of Hb, PCV, TLC and DLC showed a non-significant variation on subsequent post-operative days in both the groups. There was a significant increase in serum calcium up to 30th post-operative day and thereafter, followed a decreasing trend. The serum alkaline phosphatase values showed non-significant variation in group A while in group B animals significant increase observed on 15th, 30th and 45th post-operative day. Radiographically, the dogs of group B showed better radiographic union of fracture evidenced by early disappearance of fracture line than those of group A

Percutaneous transolecranon pinning and lateral pinning Vs lateral pinning in displaced supracondylar fractures of humerus in children: an observative study

Background: Supracondylar fracture (humerus) is type of extra-articular fracture occurring in the distal metaphyseal site of humerus. It is almost exclusively a fracture of the immature skeleton, seen in children and young teenagers. Fractures around the elbow are a great challenge to orthopaedic surgeons. Clinical diagnosis may be difficult due to noncooperative patient and massive swelling around the elbow. Displaced type of supracondylar fractures poses problem not only in reduction but also in maintenance of reduced fracture   and   rapid   inclusion   of nerves and vessels.Methods: The present study was conducted on 30 cases of displaced supracondylar fracture humerus in children, aged 2-14 years, who were treated by CRPP with either lateral entry of k-wires or a lateral wire and a vertical wire through olecranon (transolecranon).Results: Both the Groups achieved 90% satisfactory results, but 10% unsatisfactory results recorded in Group A only rather than in Group B.Conclusions: Although the transolecranon wire has the disadvantage of limiting the flexion and extension of the elbow, this does not influence the final-outcome much as the elbow is fixed in a POP splint for minimum 3 weeks-in all patients in both groups.

A Comparative Study Of Closed Reduction And Percutaneous Crossed Pinning Vs Open Reduction And Crossed Pinning In Gartland Type Iii Supracondylar Fracture Of Humerus In Children.

Background: Many methods have been proposed to treat displaced supracondylar fractures of the humerus in children, most are either closed reduction and pinning in different configurations or Open reduction and pinning with.different approaches. There remains controversy in the literature with regards to some topics, these topics could be grouped into: method of reduction (open vs. closed), pin configurations, iatrogenic nerve injury and impact of time to surgery in complications. Methodology: Atotal of 70 patients with Type III supracondylar humerus fracture who fulfilled the inclusion criteria were randomly divided into two groups, 35 in each. Group I children were treated with closed reduction and crossed pinning and Group II with open reduction and crossed pinning. Both the groups were followed up for a period of 12 months at regular intervals. Assessment of cosmetic factor & functional factor was done by using Flynn's Criteria.. Results: All the fractures were found to be united clinically and radiologically by 6 wks. As per Flynn's Criteria 91% cases in closed group showed excellent results whereas 80% cases in open group showed excellent results after 1 year of follow up. 3 cases in closed group had iatrogenic ulnar nerve injury. No cubitus varus deformity encountered in any group. Conclusion: Both open and closed reduction with crossed pin configuration provide stable fixation. Restriction of range of motion was more in the open group at 6 months follow up however at 12th month follow up the outcomes were similar. Closed reduction and crossed pinning allows early range of motion but it is technically difficult and satisfactory reduction is difficult to obtain in cases with severe soft tissue swelling.

Prophylactic pinning should be considered in patients at risk for slipped capital femoral epiphysis / Journal of Rural Medicine

Background: The use of prophylactic contralateral pinning for slipped capital femoral epiphysis (SCFE) remains controversial. This study evaluated the outcome of SCFE treatment and examined the use of prophylactic pinning.Methods: The study included 44 patients (33 men, 11 women; 54 hips [right, 31; left, 23]), with mean age of 12.9 (7.3–29) years, who underwent treatment between 1986 and 2017, with follow-up for more than 6 months. Patients were divided into 3 groups: group 1 had bilateral SCFE at first presentation, group 2 developed contralateral side SCFE during follow-up, and group 3 had unilateral SCFE until final follow-up. Three patients who received prophylactic pinning were excluded. Univariate and multivariate logistic analyses were performed.Results: Overall, 93% (50/54) of hips underwent positional reduction and in situ fixation and 7.4% (4/54) underwent open reduction. Mean follow-up period was 4.8 (0.5–25) years. Groups 1, 2, and 3 had 7, 3, and 31 cases, respectively. Sex, age, and follow-up period showed no significant differences among the groups. The Rohrer index was significantly higher in group 1, the affected side posterior sloping angle (PSA) was significantly higher in group 3, and the contralateral side PSA and percentage with endocrinopathy were significantly higher in group 2. In multivariate logistic analysis, age, sex, Rohrer index, affected side PSA, and endocrinopathy were significantly correlated with bilateral SCFE.Conclusion: We recommend prophylactic contralateral side pinning in patients with risk factors of obesity, high PSA before slipping, and endocrinopathy. Careful observation until growth plate closure is required in patients without risk factors.

Oblique Percutaneous In-Situ Cannulated Screw Fixation Of Stable Slipped Capital Femoral Epiphysis- Our Surgical Experience

Introduction: The percutaneous in-situ pinning perpendicular to the physis has been described as the standard technique for fixing mild to moderate stable Slipped capital femoral epiphysis. In this study we are going to discuss about our results using an alternative anterolateral oblique pinning technique for SCFE. Methods: We treated 10 patients by this technique from June 2015 to May 2017. The average age of the patients was 12 years with the range between 10 to 15 years. Only mild to moderate slips as measured by Southwick angle of less than 60 degrees in frog leg lateral view were included in this study. Results: None of the patients developed complications like screw penetration, AVN, chondrolysis, slip progression or breakage of screw. There was restriction of terminal 10 degrees abduction in 6 patients and obligatory external rotation on hip flexion in 3 patients. Conclusion: To conclude anterolaterally based insitu oblique screw fixation is a relatively easier technique providing better stability without risk of complications.

Femoral pseudoaneurysm as a complication of slipped capital femoral epiphysis treatment / Pseudoaneurisma femoral como complicação do tratamento cirúrgico de epifisiólise proximal do fêmur

ABSTRACT Slipped capital femoral epiphysis is a very frequently seen condition in orthopedics centers worldwide. Even in successfully treated cases, complications related either with the pathology per se or with the chosen synthesis method are not rare. This report presents a case of bilateral slipped capital femoral epiphysis treated with pinning, in which one of the limbs developed a very rare condition: the formation of a femoral pseudoaneurysm that ruptured.

RESUMO A epifisiólise proximal da cabeça femoral é uma patologia frequentemente tratada em centros de ortopedia. Mesmo nos casos de tratamento bem-sucedido, complicações relacionadas tanto ao fenômeno em si quanto à síntese escolhida não são raras. Os autores relatam um caso de epifisiólise da cabeça femoral bilateral, submetido a pinagem, que evoluiu com uma complicação raríssima em um dos membros: a formação de um pseudoaneurisma femoral, com posterior rotura.

Supplementary Technique for Unstable Clavicle Shaft Fractures: Interfragmentary Wiring and Temporary Axial K-Wire Pinning

BACKGROUND: Treatment of unstable clavicle fractures remains a challenge for orthopedic surgeons, but the evolution of treatment strategies has allowed for reliable results with minimal complications. Although several surgical options exist, open reduction with plating remains the treatment of choice for clavicle fractures. The purpose of this study is to determine an easy way to achieve successful preplating reduction while minimizing surrounding soft tissue damage during treatment of midshaft fractures of the clavicle. METHODS: A retrospective study included all consecutive adult patients operated on by a single surgeon for acute displaced clavicular midshaft fracture between January 2010 and October 2014. Hybrid technique with interfragmentary cerclage wiring, temporary axial K-wire pinning, or their combination was used in all patients. The demographic data and clinical outcomes, including operation time, union time, restoration of anatomy, shoulder functional score, and complications were evaluated. RESULTS: There were 54 male and 19 female patients, with an average age of 39.3 years (range, 18 to 77 years) for males and 58.3 years (range, 39 to 77 years) for females. They were followed up for 24 months (range, 12 to 44 months). All patients had reliable bone union after surgery using interfragmentary cerclage wiring and temporary axial K-wire fixation; fracture union was obtained at an average of 11.7 weeks (range, 8 to 21 weeks) postoperatively. Additionally, there was no postoperative loss of fracture reduction or plate loosening. At the final follow-up, all patients had regained excellent functional outcomes. CONCLUSIONS: The cognizant effort to achieve anatomic reduction without surrounding soft tissue insult before definitive plating allows excellent radiologic and functional outcomes. Interfragmentary cerclage wiring and temporary axial K-wire pinning can overcome difficulties associated with unstable clavicle fractures to allow proper fracture reduction. In this article, we introduce a concise technique for achieving the desired outcomes reliably and efficiently when treating unstable clavicle midshaft fractures.

Paediatric supracondylar humeral fractures: a technique for safe medial pin passage with zero incidence of iatrogenic ulnar nerve injury

INTRODUCTION@#The cross Kirschner wire (K-wire) configuration in closed reduction and percutaneous pinning of paediatric supracondylar humeral fracture affords superior stability. However, medial pin placement presents a risk of iatrogenic ulnar nerve injury. This study describes, in step-by-step detail, another safe method of percutaneous medial pin insertion.@*METHODS@#The technique involved placing the patient's arm in external rotation, with elbow flexed no more than 45° after closed reduction. The surgeon held the K-wire close to its sharp end to pass it percutaneously onto the medial epicondyle, then adjusted his grip toward the blunt end. After fluoroscopy check, the wire driver was engaged and an anteriorly directed force was applied to the distal humerus fragment using the thumb of the surgeon's free hand. The K-wire was inserted at a 45° angle to the longitudinal axis of the humerus shaft. Clinical notes and radiographs of patients who underwent surgery with this technique from 2006 to 2008 were reviewed.@*RESULTS@#A total of 125 patients (84 boys, 41 girls) were included, with a mean age of 7.1 (range 2-14) years. Most injuries were left-sided (72.8%, n = 91, vs. right: 27.2%, n = 34). 72 (57.6%) patients had two-pin cross K-wire configuration, while 53 (42.4%) patients had an additional lateral pin inserted. No patient had postoperative ulnar neuropathy. There were no complications of non-union, malunion or infection.@*CONCLUSION@#This safe method of medial pin placement for surgical stabilisation of paediatric supracondylar humeral fractures is easily learnt and reproducible, and produces excellent results.

Efficacy of External Fixation and Transfixation Pinning of Distal Radioulnar Joint in Distal Radius Fracture

PURPOSE: The purpose of this study is to evaluate efficacy of percutaneous pinning of distal radioulnar joint in patient with distal radius fracture. METHODS: Thirty-eight patients who underwent percutaneous pinning and external fixation for distal radius fracture were included in this study. Radiologic and clinical outcomes were compared between the patients who underwent percutaneous pinning on the radius only (PD group) and the patients with supplementary pinning on distal radioulnar joint (DRU group) after percutaneous pinning on the radius. External fixation was performed in all patients. RESULTS: Twenty-three patients were PD group and fifteen patients were DRU group. Radial height and radial inclination was significantly higher in DRU group. There was no significant difference in ulnar variance, volar tilt and articular step off between two groups. Among the clinical outcome, there was no significant difference in range of motion between two groups but grip strength was significantly larger in DRU group. CONCLUSION: Percutaneous pinning with K-wires on distal radioulnar joint in distal radius fracture can be a useful procedure for prevention of radial shortening without loss of range of motion of the wrist.

Management of Grossly Displaced Paediatric Supracondylar Humeral Fractures with Delayed Presentation by Closed Reduction and Percutaneous Pinning.

Background: Management guidelines are not yet clear for these patients who present late with displaced supracondylar fracture. The aim of this prospective study was to evaluate the clinical, radiological and functional outcome following closed reduction and percutaneous pinning of widely displaced supracondylar fractures of the humerus presenting 24 hours or more after injury. Patients and Methods: This prospective study was conducted at the Orthopaedic and Trauma Department of Dr Pinnamaneni Siddartha Institute of Medical Sciences and Research Foundation, Chinnoutpalli from January 2010 to July 2011. A total of 44 children were included in this study who had displaced supracondylar fracture of humerus presenting late ie, after 24 hours after injury and within a week. They were treated with closed reduction of the fracture and percutaneous pinning. Follow-up was done up to 12 months. Results: Patients were assessed on the basis of Flynn’s criteria, there were 37 excellent, 6 good results and fair results in 1 case. There were 25 boys and 19 girls. The average age of the patients was 7.5 years (range: 4 to 12 years). Fall on the outstretched hand was the mechanism of injury in 36 patients, and the other 8 patients were pedestrians struck by a motor vehicle. Non-dominant extremity was more commonly involved (30 patients). In 24 patients the fracture was displaced posteromedially (54.54%), in 18 patients posterolaterally (40.90%), and 2 patients had isolated posterior displacement (2.54%). The average delay in presentation was 57.56 hours (range: 1 day to 6 days). The mean time to surgery after presentation was 9.83 hours (range: 4 hours to 13 hours) and the mean time to surgery after trauma was 67.39 hours. Sixteen patients had one or more attempts of reduction by massaging by a quack and in 2 patients it was attempted by a qualified surgeon before they presented to us. 26 patients (59.09) visited a quack prior to presentation to us. There was a direct relation between duration of delayed presentation and the times of manoeuvre. Sixteen patients (36.36%) had neurologic complications at presentation to the emergency room of which three had median nerve palsy (6.81%) where as seven (15.90%) had isolated anterior interosseous nerve palsy and six (13.6%) had radial nerve palsy all patients showed total neurological recovery at 12 weeks follow-up. Six patients (13.63%) had vascular compromise at initial presentation of which five patients had feeble radial pulse and one had absent radial pulse, but capillary filling was adequate in all. The pulse was restored within 24 hours in all patients following reduction. Conclusion: Our preliminary results support our recommendation ie, closed reduction and percutaneous pin fixation as an effective treatment option for grossly displaced supracondylar fractures presenting late but requires good and careful judgment and also technique by the surgeon to avoid complications. Our results also support the chances of spontaneous recovery of peripheral nerve palsy and brachial artery spasm post reduction over a period of time in majority of cases though they present late.

Functional Outcomes of Percutaneous K-Wire Fixation for Distal Radius Fractures with or without Osteoporosis

PURPOSE: To determine the influence of osteoporosis on the results of percutaneous K-wire fixation for distal radius fractures. MATERIALS AND METHODS: Between March 2007 and February 2011, Fifty seven patients who underwent fixative surgery with K-wires after closed reduction and those available for follow-up for at least 6 months were reviewed. They were divided into the two groups of T score -3 or more (group 1) and T score less than -3 (group 2). These groups were compared by the range of motion of the wrist and Disabilities of the Arm, Shoulder and Hand (DASH) score. Radiologic evaluations consisting of radial length, radial inclination and volar tilt were compared. In group 1 with 34 cases, the average age was 65.4 years (50 to 78 years) and T score was -1.97 (-0.1 to -2.93). In group 2 with 23 cases, the average age was 74 years (54 to 89 years) and T score was -4.11 (-3.1 to -6.97). RESULTS: There was no statistical difference between group 1 and group 2 in terms of range of motion, DASH score and radiologic evaluations. CONCLUSION: In the case of no volar side cortical comminution, percutaneous K-wire fixation can be applied for the treatment of distal radius fracture with osteoporosis.

Anatomic Reduction of Mallet Fractures Using Extension Block and Additional Intrafocal Pinning Techniques

BACKGROUND: The purpose of this article is to report the efficacy of the extension block pinning and additional intrafocal pinning technique applied to cases whose mallet fractures were not reduced with extension block pinning alone. METHODS: We retrospectively reviewed 14 digits with 14 patients who were treated with the extension block pinning and additional intrafocal pinning technique. There were eight men and six women with an average age of 34 years. The average articular surface involvement was 52%. The average follow-up was 16 months and the mean time from injury to operation was 23 days. RESULTS: All the cases achieved anatomic reduction of fractures. By Crawford's classification, 9 were excellent and 5 were good. The average active flexion of the distal interphalangeal joint was 78 degrees and the average extension loss was 1.8 degrees. Bone union was observed in all cases after a postoperative mean of 38.4 days. Complications such as skin necrosis, fracture of bony fragments, and nail-plate deformity were not found. CONCLUSIONS: Additional intrafocal pinning technique is considered a simple and useful method to obtain anatomic reduction of mallet fractures in cases where extension block pinning alone is insufficient to restore the anatomic configuration of the articular surface.

Anatomic Reduction of Mallet Fractures Using Extension Block and Additional Intrafocal Pinning Techniques

BACKGROUND: The purpose of this article is to report the efficacy of the extension block pinning and additional intrafocal pinning technique applied to cases whose mallet fractures were not reduced with extension block pinning alone. METHODS: We retrospectively reviewed 14 digits with 14 patients who were treated with the extension block pinning and additional intrafocal pinning technique. There were eight men and six women with an average age of 34 years. The average articular surface involvement was 52%. The average follow-up was 16 months and the mean time from injury to operation was 23 days. RESULTS: All the cases achieved anatomic reduction of fractures. By Crawford's classification, 9 were excellent and 5 were good. The average active flexion of the distal interphalangeal joint was 78 degrees and the average extension loss was 1.8 degrees. Bone union was observed in all cases after a postoperative mean of 38.4 days. Complications such as skin necrosis, fracture of bony fragments, and nail-plate deformity were not found. CONCLUSIONS: Additional intrafocal pinning technique is considered a simple and useful method to obtain anatomic reduction of mallet fractures in cases where extension block pinning alone is insufficient to restore the anatomic configuration of the articular surface.

A Comparative Study of Three Different Fixation Techniques for Displaced Two- and Three-Part Proximal Humeral Fractures / 대한정형외과학회잡지

PURPOSE: To analyze and compare the results of three different surgical methods - closed reduction and percutaneous pinning (Group I), bifurcated plate and tension band wiring (Group II), locking compression plate (Group III), - for displaced two- and three-part proximal humeral fractures. MATERIALS AND METHODS: Sixteen patients were treated with a closed reduction and percutaneous pinning, 19 with bifurcated plate and tension band wiring and 18 with locking compression plate. All patients were followed up for more than 1 year, and were reviewed and evaluated with respect to radiological and clinical results. The radiological results were evaluated by bony union and humerus neck shaft angle using the Paavolainen method. The clinical results were evaluated by Neer's evaluation criteria. RESULTS: Bony union rate, time period to achieve bony union, neck shaft angle and clinical results in Groups II and III were better than those in Group I (p<0.05). There were no significant differences between Groups II and III. We observed trends for worse clinical outcomes in patients older than 65 years compared with those in patients younger than 65 years. Clinical outcome for patients older than 65 years in Group III (average 87.5 points) was better than that for the same age group in Groups I (average 77.2 points) and II (average 79.3 points), but the cohorts were too small to obtain statistical significance. Complication rate in Groups II, III was lower than that in Group I (p=0.005). CONCLUSION: The radiological and clinical results in Groups II and III were significantly better than those in Group I, and there were no significant differences between Groups II and III. We thought that bifurcated plate and tension band wiring and locking compression plate were useful surgical methods for displaced two- and three-part proximal humeral fractures.

Intercarpal Ligament Injuries Associated with Distal Radius Fractures: Relation with the Radiographic Findings and Arthroscopic Treatment / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to analyze the relationship between intercarpal ligament injuries associated with distal radius fracture and the fracture patterns and radiologic parameters, and to report on the clinical results of arthroscopic treatment for these injuries. MATERIALS AND METHODS: Fifty-two patients who underwent arthroscopic surgery for intercarpal ligaments injuries associated with distal radius fracture and who had a minimum 1 year follow-up were enrolled. There were 44 patients who sustained scapholunate interosseous ligament injury (SLIL) and 30 patients who sustained lunotriquetral interosseous ligament (LTIL) injury. Among them, 22 patients had both SLIL and LTIL injuries. The carpal ligament injuries were graded according to the Geissler classification and they treated with arthroscopic debridement only for a grade I and II injury and arthroscopic reduction and percutaneous pinning for a grade III and IV injury. The patients were divided into two groups and we assessed the functional and radiological outcomes: Group 1 consisted of the patients with a grade I and II injury and group 2 consisted of the patients with a grade III and IV injury. RESULTS: The preoperative mean radial inclination of group 2 with lunotriquetal interosseous ligament injury was 15.1+/-9.9degrees, which was significantly different from 20.4+/-5.1degrees of group 1, and the extra-articular type injury was more common in group 2 (p<0.05). On the follow-up radiographs, the mean scapholunate interval measured 2.1+/-0.5 mm in group 1 and 1.7+/-0.5 mm in group 2, which was significantly different (p<0.05). CONCLUSION: The grade of LTIL injury combined with distal radius fractures is associated with the loss of radial inclination and the extra-articular fracture type at the time of initial presentation. Complete tears of the SLIL can be stabilized with arthroscopic reduction and percutaneous pinning.

Outcome of Closed and Open Reduction with Cross Pinning Fixation for Displaced Supracondylar Humeral Fracture

Introduction: In areas where intraoperative radiography facilities are not available, open reduction is an acceptable treatment option for fracture treatment. The aim of this investigation was to compare the outcomes of closed reduction to open reduction with cross pinning fixation in Gartland Type III supracondylar humeral fracture extensions. Methods: In this retrospective study, closed reduction with cross pinning fixation was performed in 7 patients with closed fractures, and open reduction with cross

Risk Factors for Avascular Necrosis and Nonunion after Multiple Pinning for an Intracapsular Femoral Neck Fracture

PURPOSE: We wanted to analyze the influences of risk factors on avascular necrosis and nonunion after multiple pinning for a femoral neck fracture. MATERIALS AND METHODS: Among the cases of multiple pinning for a femoral neck fracture that were seen at our department from June 1995 to May 2006, we analyze 102 cases that had more than 2 years of follow-up. We evaluated the influence of such factors as the age, gender, injury on the right- or left-side, the degree of displacement, the time to operation, the angle of fracture, the accuracy of reduction and posterior cortex comminution on avascular necrosis and nonunion after multiple pinning for a femoral neck fracture. RESULTS: The incidences of AVN and nonunion were 13.7% (14/102) and 10.7% (11/102), respectively. The degree of displacement was a significant factor that influenced the development of nonunion (p<0.05). The time to operation and the angle of fracture were significant factors that influenced nonunion (p<0.05 & p<0.05) and avascular necrosis (p<0.05 & p<0.05). The posterior cortex comminution was a significant factor that influenced nonunion (p<0.05) and avascular necrosis (p<0.05). CONCLUSION: The important risk factor for avascular necrosis was the angle of fracture over 60 degrees. The important risk factors for nonunion were the time to operation (over 24 hours), posterior cortex comminution and an angle of fracture over 60 degrees.