Triangular Fixation Technique for Bicolumn Restoration in Treatment of Distal Humerus Intercondylar Fracture

BACKGROUND: Distal humerus intercondylar fractures are intra-articular and comminuted fractures involving soft tissue injury. As distal humerus is triangle-shaped, parallel plating coupled with articular fixation would be suitable for bicolumn restoration in treatment of distal humerus intercondylar fracture. METHODS: This study included 38 patients (15 males and 23 females) who underwent olecranon osteotomy, open reduction and internal fixation with the triangle-shaped cannulated screw and parallel locking plates (triangular fixation technique). Functional results were assessed with the visual analog scale (VAS) scores, Mayo elbow performance (MEP) scores and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires. Anteroposterior and lateral elbow radiographs were assessed for reduction, alignment, fracture union, posttraumatic arthrosis, and heterotopic ossification, and computed tomography (CT) scans were used to obtain more accurate measurements of articular discrepancy. RESULTS: All fractures healed primarily with no loss of reduction. The mean VAS, MEP, and DASH scores of the affected elbow were not significantly different from those of the unaffected elbow (p = 0.140, p = 0.090, and p = 0.262, respectively). The mean degree of flexion was significantly lower in the affected elbow than in the unaffected elbow, but was still considered as functional (p = 0.001, > 100degrees in 33 of 38 patients). Two cases of articular step-offs (> 2 mm) were seen on follow-up CT scans, but not significantly higher in the affected elbow than in the unaffected elbow (p = 0.657). Binary logistic regression analysis revealed that only Association for Osteosynthesis (AO) type C3 fractures correlated with good/excellent functional outcome (p = 0.012). Complications occurred in 12 of the 38 patients, and the overall reoperation rate for complications was 10.5% (4 of 38 patients). CONCLUSIONS: Triangular fixation technique for bicolumn restoration was an effective and reliable method in treatment of distal humerus intercondylar fracture. This technique maintained articular congruency and restored both medial and lateral columns, resulting in good elbow function.

A Separate Approach and Cephalo-Diaphyseal Plate Fixation for the Comminuted Metadiaphyseal Fractures of the Proximal Humerus

PURPOSE: To evaluate clinical and radiological outcomes for the comminuted metadiaphyseal fractures of the proximal humerus treated with a separate minimally invasive approach deltopectoral approach for fracture fragment reduction and deltoid splitting approach for cephalo-diaphyseal plate fixation. MATERIALS AND METHODS: Eighteen patients (6 men and 12 women), who underwent surgery between March 2007 and February 2011, were included. A deltopectoral approach was used to expose and reduce the fracture fragments and an additional deltoid splitting approach was used to expose the humeral head. A locking plate was inserted under the muscle window and a cephalo-diaphyseal fixation was performed. All patients were examined and interviewed using the Visual Analog Scale (VAS) score, Constant score and standardized X-rays to check the time to fracture healing, neck-shaft angle (NSA). RESULTS: All fractures were united, and mean healing time was 20 weeks. The average VAS score was 3.5 points (range, 0-5) and the average Constant score was 66.5 points (range, 30-90). Final functional outcomes were four cases of excellent, six cases of good, six cases of fair and two cases of poor. The average NSA was 127.5degrees (range, 100-140). CONCLUSION: A separate approach and cephalo-diaphyseal plate fixation in operative treatment of the metadiaphyseal fractures of the proximal humerus is an effective, reliable treatment option that could reduce the fracture fragments accurately, with less dissection of the soft tissue and lower the complications. A further study including many cases and longer follow-up will be needed to improve the quality of the study.

Indirect Reduction Maneuver and Minimally Invasive Approach for Displaced Proximal Humerus Fractures in Elderly Patients

BACKGROUND: This study examined the clinical outcomes of indirect reduction maneuver and minimally invasive approach for treating displaced proximal humerus fractures in patients older than 60. METHODS: Thirty-two patients (11 male and 21 female) who had undergone treatment for displaced proximal humerus fracture were evaluated. The mean age of the patients was 72.4 years (range, 60 to 92 years). All cases were followed up for at least 12 months. All patients were interviewed and evaluated on the visual analog scale, with gender-specific constant score correction for age, standardized X-rays to check the neck-shaft angle (NSA) and the presence of medial support, and bone mineral density. Statistical analysis was performed with a multiple regression analysis. RESULTS: The average visual analog scale score was 2.4, and the average gender-specific constant score correction for age was 80.6 points. Final functional outcomes were 8 excellent, 15 good, 7 fair, and 2 poor. The average NSA was 122.8degrees; and the radiological results were 20 good, 11 fair, and 1 poor. There was significant difference of the gender-specific constant score for age between the group of NSA more than 110degrees and the group of NSA less than 110degrees (p = 0.00). There were 26 cases with and 6 cases without medial support, with significant difference between the gender-specific constant score correction for age of these groups (p = 0.01). Complications occurred in 4 patients (12.5%). CONCLUSIONS: The indirect reduction maneuver and minimally invasive approach were safe and reliable options for the treatment of displaced proximal humerus fractures in the elderly patients. An inadequate reduction (i.e., less than 110degrees NSA) or lack of medial support (e.g., no cortical or screw support) were significant factors contributing to poor functional outcomes.

Extensor Tendon Transfer for Chronic Rupture of Finger Extensors

PURPOSE: The objective of this study was to evaluate the clinical outcome of extensor tendon transfer that involves increased tensioning for delayed repair of ruptured finger extensor tendons. MATERIALS AND METHODS: Eighteen patients (11 women and 7 men) with old ruptures of one or more finger extensors underwent tendon transfers was evaluated. Instead of the standard tensioning, the tensioning was performed with the thumb or finger in full extension and the wrist in the neutral position during the tendon transfers. RESULTS: The mean overall range of motion of the fingers improved from 115degrees preoperatively to 160degrees postoperatively. The mean extension lag improved from 47degrees preoperatively to 11degrees postoperatively. The mean fingertip to palm distance was 0.2 cm preoperatively to 0.6 cm postoperatively. The mean finger grip strength was 35 g preoperatively to 27 g postoperatively. CONCLUSION: Extensor tendon transfer with increased tensioning is a reliable alternative for the reconstruction of chronic ruptures of finger extensor mechanism.

Brachial Plexus Injury as a Complication of Arthroscopic Bankart Repair: A Case Report / 대한정형외과학회잡지

Shoulder arthroscopy is widely used through the development of arthroscopic technique and equipment but some complications have been reported that are related to the complexity of technique and the long duration time of operation. Brachial plexus injury, as a complication of arthroscopic Bankart repair, is rare, but remains a serious sequelae. We performed the neurorrhaphy and neurolysis of brachial plexus and showed relatively good functional outcome after 2 years.

Distally based Ulnar Artery Flap for Reconstruction of Hands

PURPOSE: We reconstructed the skin defect of hands exposing tendons and/or bone with distally based ulnar artery flap and report our cases. MATERIALS AND METHODS: Between March 2005 and September 2007, 6 cases of skin defect were reconstructed with distally based ulnar artery flap. Defect site were 5 cases of hand dorsal side and 1 case of hand volar side. The average defect size was 3x3 cm2. There were 4 men and 2 women and mean age was 55.5 years. We evaluated the viability of flap, postoperaive complication, healing time, patient's satisfaction. RESULTS: There was no flap failure in 6 cases. But 1 case with recurrent discharge was healed with several times adequate debridement and delayed suture. 1 case with flap edema which might be due to venous congestion was healed with hand elevation and use of low molecular weight heparin. Mean time to heal the skin defect was 4 weeks. No infection and recurrence was found in follow up period. Cosmetic results as judged by patients were that 3 cases are good and 3 cases are fair. CONCLUSION: Distally based ulnar artery flap is good treatment method among the numerous methods in the cases of skin defect, with soft tissue exposed, which is not covered with debridment and skin graft. Distally based ulnar artery flap is useful method for the skin defect of hands because it is simple procedure, has constant blood supply and relatively good cosmetic effect.

Sural Artery Flap for Skin Defect of Lower Legs

PURPOSE: We reconstructed the skin defect of lower legs exposing muscles, tendons and bone with fasciocutaneous sural artery flap and report our cases. MATERIALS AND METHODS: Between March 2005 and September 2006, 8 cases of skin defect were reconstructed with fasciocutaneous sural artery flap. Defect site were 4 case of ankle and foot and 4 cases of lower leg. The average defect size was 4x4 cm2. There were 5 men and 3 women and mean age was 52.2 years. We evaluated the viability of flap, postoperative complication, healing time, patient's satisfaction. RESULTS: There was no flap failure in 8 cases. But recurrent discharge in 2 cases was healed through several times adequate debridement and delayed suture without complication. Flap edema may be due to venous congestion was healed through leg elevation and use of low molecular weight heparin. Mean time to heal the skin defect was 4 weeks. No infection and recurrence in follow up period. Cosmetic results as judged by patients were that 5 cases are good and 3 cases are fair. CONCLUSION: Sural artery flap is good treatment method among the numerous methods in the cases of skin defect, with soft tissue exposed, which is not covered with debridment and skin graft. Sural artery flap is useful method for the skin defect of lower legs because it is simple procedure, has constant blood supply and relatively good cosmetic effect.