Results of internal fixation of distal humeral articular fractures in old age, study of 10 cases

In elderly patients the tolerance of elbow joint to immobilization is very poor and stiffness develops easily, so conservative treatment is not suitable method for intraarticular fractures of the distal humerus. Although open reduction and internal fixation is the treatment of choice for these fractures in adults, in elderly patients disagreement remains on how to treat these fractures. Also the reports on the functional results after internal fixation of these fractures in elderly patients are rare. The purpose of this study is to evaluate the results of open reduction and stable internal fixation for treatment of intra-articular fractures of distal humerus in elderly patients above 60 years old. 10 patients with 10 intr a-articular fractures of distal humerus. The average age was 63 years [ranged 60-73 years]. There were sex females [60%] and four male [40%]. The right side was affected in seven patients [70%] and left side in three patients [30%]. The fractures were classified according to the AO/ASIF classification. There was one fracture [10%] type B1, four fractures [40%] type C1, three fractures [30%] type C2 and two fractures [20%] type C3. All the patients were treated by open reduction and internal fixation through a posterior approach. The average follow up period was 18 months [ranged 12-32 months] During it the patients were examined both clinically and radiographically for union of the fractures, Post-traumatic arthritis, range of motion, the elbow and forearm, muscle strength, degree of pain, return to previous activities. The final results tuere evaluated according to the Mayo Elbow scoring points system. Average time to union were 3.5 months [ranged 2-4.5months]. Four patients [40%] had Post-traumatic arthritis of the elbow [three patients with mild degree and one patient with severe degree]. The motion at the elbow was mainly affected, the median arc of flexion/ extension was 1000 [ranged 600-1300]. The forearm motion was not affected and it was near normal in all of the cases. The final clinical results were excellent in three patients [30%], good in five patients [50%], fair in one patient [10%], and poor in one patient [10%]. Open reduction and internal fixation of distal humeral intra-articular fractures in elderly patients can achieve excellent and good results in majority of the patients. Advancing age is not a contraindication for open reduction and internal fixation of these fractures

Modified extension block pinning for large mallet fractures

Treatment of a mallet finger due to an intra-articular fracture of the distal phalanx involving one-third or more of the articular surface is controversial Twenty one mallet fractures involving more than 33% of the articular surface and fractures associated with subluxation of the distal phalanx that could not be corrected by closed reduction are treated with an extension block pin and transarticular fixation of the distal interphalangeal joint. The average patient age was 26.8 years and the average fracture size was 40.5% of the joint surface. The average delay after injury was 5.6 days [range, 0-14 days] Average time to fracture union was 32 days. The average active flexion of the distal interphalangeal joint was 81.2° and the average extensor lag was 1.4°. There were no major complications. Using the established outcome criteria for mallet injuries, 95.2% had excellent or good results. This surgical technique resulted in rapid fracture union with only minor complications and has excellent functional outcome

Closed retrograde locked nailing of the diaphyseal humeral fractures

Locked intramedulary nailing of humeral shaft fractures combines the advantages of intramedulary nailing with the added fixation of locked principles allowing for the extension of indications of interlocked nailing as in comminuted fractures. Also the interlocking nailing is superior to plating of diaphyseal fractures as it is a load sharing and control of bending stresses. In addition, the closed technique preserves the soft tissue blood supply and the fracture haematoma preserving the biologic process of fracture healing undisturbed. With retrograde technique most of the complications related to the shoulder joint and rotator cuff violation can be avoided. Fourteen patients with humeral shaft fractures had been treated by retrograde closed locked nailing using interlocking humeral nails. The average follow up period was four months [range from 3 to 10 months]. The average healing time of all fractures was eight weeks. After consolidation, the elbow function was excellent in twelve patients [85.7%], the shoulder function was excellent in thirteen patients [92.9%]. The functional end results were excellent in nine patients [64.2%], good in three patients [21.4%], fair in one patient [7.1%], and poor in one patient [7.1%]. Two patients [14.2%] had postoperative radial nerve palsy. There was comminution at the fracture site in three cases. There was one case [7.1%] of deep infection. Two patients [14.2%] had shortening and one case [7.1%] had varus deformity. There were no cases with implant failure. We concluded that closed retrograde locked nailing of fractures of the humeral shaft is an excellent method of fixation with added benefit over antegrade nailing that it does not affect the shoulder movement or disturb the rotator cuff insertion site

Arthroplasty of the trapeziometacrpal joint. A study of 36 cases

This retrospective study was done during the period 1998 - 2002 to evaluate two types of surgeries for symptomatic osteoarthritis of the trapeziometacarpal joint at the base of the thumb in 36 hands. There were 19 females and 7 males. Follow up period ranged from 18 to 39 months [mean 32 months]. The study reviewed fifteen [41.7%] hands treated by tendon interposition arthroplasty with ligamentoplasty and twenty one [58.3%] hands treated by silicone replacement arthroplasty. The clinical outcome was measured depending on the assessment of pain, function, movement and strength. Radiologic follow up was done for proximal shift of the thumb metacarpal as well as signs of implant instability or wear. For this short term follow up, there was no significant difference regarding the power, movement, or function between either groups. In the tendon interposition arthroplasty group; pain relief was much better, no significant complications and the ultimate clinical score was excellent [36 points]. In the silicone replacement group; the clinical score was good [32 points] and complication rate was high with four implant dislocations [19%] and two symptomatic synovitis [9.5%]. Six hands of the silicone replacement group [28.5%] needed revision by removal of the implant while in the tendon interposition group no revision was needed