Salvataje de fracturas laterales de cadera con clavo-placa de 95º (AO/ASIF) / Lateral hip fracture salvage with 95º blade plate (AO/ASIF)

Introducción: Con las técnicas contemporáneas de reducción y osteosíntesis, la mayoría de las fracturas intertrocantéricas de cadera y de cuello femoral suelen consolidar sin problemas. La mayoría de estas fracturas se tratan mediante reducción cerrada y fijación interna con excelentes resultados. El fracaso terapéutico, por lo general, conduce a dolor y discapacidad funcional. En estos casos, los posibles tratamientos se reducen a dos, si se exceptúa el manejo conservador para pacientes críticos, una opción es una nueva osteosíntesis o la artroplastia total de cadera. La valguización de la falla de las fracturas tiene como objetivo transformar las fuerzas de cizallamiento de la zona de seudoartrosis en fuerzas compresivas, estimulando así la consolidación de las fracturas. Materiales y Métodos: Se evaluó retrospectivamente a 14 pacientes con seudoartrosis de fracturas intertrocantéricas de cadera, entre enero de 2010 y febrero de 2014, operados en nuestra institución. Todos fueron sometidos a una revisión con el objetivo de lograr una posición en valgo del fragmento proximal fijado siempre con clavo-placa de 95º (AO/ASIF). El objetivo de este estudio fue evaluar los resultados clínicos y radiológicos de seudoartrosis de fracturas intertrocantéricas de cadera. Resultados: Se logró la consolidación de la fractura en los 14 pacientes. El tiempo de consolidación promedio varió de tres a seis meses. El puntaje de Harris promedio para la valoración subjetiva fue de 82,65. En ningún caso, se extrajo el material luego de la consolidación de la fractura. Conclusión: El clavo-placa de 95º (AO/ASIF) sigue siendo una muy buena opción en los casos de seudoartrosis de fémur proximal, siempre que la planificación preoperatoria y la técnica quirúrgica sean correctas, y el posoperatorio sea adecuado.

Introduction: Contemporary techniques for reduction and internal fixation make most femoral neck and intertrochanteric hip fractures heal without problems. Most of these fractures are treated with closed reduction and internal fixation achieving excellent results. Treatment failure of hip fractures usually leads to pain and disability. Therapeutic alternatives can be limited to two options, with the exception of the conservative non-operative treatment in critical patients: a new fixation system or an arthroplasty. The valgus osteotomy aims to transform the shear forces in the area of nonunion into compressive forces, thereby stimulating fracture healing. Methods: Fourteen patients with intertrochanteric hip fracture nonunion were retrospectively evaluated between January 2010 and February 2014. All patients underwent revision surgery in order to achieve a valgus position of the proximal fragment, using a 95º blade plate (AO/ASIF). The objective of this study was to evaluate the clinical and radiographic results of intertrochanteric hip fracture nonunion treated with this method. Results: Fracture healing was achieved in all 14 patients. Average healing time ranged from three to six months. The Harris score averaged 82.65. Hardware removal was not performed after fracture healing. Conclusion: The 95° blade plate is still a very good option in cases of proximal femur nonunion, provided the preoperative planning and the surgical technique are correct and the postoperative care is adequate.

Treatment of Subtrochanteric Nonunion with a Blade Plate / 대한정형외과학회잡지

PURPOSE: Although nonunion is a relatively common complication in the management of subtrochanteric fractures, there are few studies regarding the treatment of nonunion. The purpose of this study was to evaluate clinical and radiological results for the treatment of subtrochanteric nonunions with a blade plate. MATERIALS AND METHODS: We retrospectively analyzed 16 cases of subtrochanteric nonunions that were treated with a blade plate between April 1997 and June 2008 and were followed for at least one year after the index operation. There were 8 males and 8 females with an average age of 58 years (range, 42-77 years). Outcome variables included the time to union, postoperative complications, Harris hip score, and the functional rating scale of Sanders. The average follow-up period was 26 months (range, 12-63 months). RESULTS: Union was achieved in 15 (94%) of 16 subtrochanteric nonunions after an average of 7 months (range, 4-11 months). One patient who did not reach union after the index operation underwent repeated surgery with a longer blade plate and bone graft, but this patient was eventually treated with total hip arthroplasty because of persistent nonunion and breakage of the blade plate. Two patients developed complications. One patient had bursitis around the greater trochanter and the other developed avascular necrosis of the femoral head. Of these, the patient with avascular necrosis of the femoral head was treated with total hip arthroplasty because of persistent hip pain 2 years after the index operation. At latest follow-up, the mean Harris hip score was 88 points (range, 36-100 points) and the functional rating scale of Sanders was good or excellent in 14 (88%) of 16 patients. CONCLUSION: The treatment of subtrochanteric nonunions with a blade plate is associated with a very high union rate and good clinical results.

Dynamic Hip Screw Compared to Condylar Blade Plate in the Treatment of Unstable Fragility Intertrochanteric Fractures

Dynamic hip screw (DHS) fixation is considered standard treatment for most intertrochanteric fractures. However, excessive sliding at the fracture site and medialisation of femoral shaft may lead in fixation failure. In contrast, fixedangled 95 condylar blade plate (CBP) has no effective dynamic capacity and causes little bone loss compared to DHS. We compared the outcome of 57consecutive unstable intertrochanteric fragility fractures treated with these two fixation methods. CBP instrumentation is more difficult requiring longer incision, operating time and higher surgeonreported operative difficulty. The six month post operative mortality rate is 16%. Post operative Harris hip scores were comparable between the two methods. Limb length shortening more than 20 mm was 6 fold more common with DHS. In elderly patients with unstable intertrochanteric fragility fractures, fixed angled condylar blade plate appears to be a better choice than dynamic hip screws for preventing fixation failures.

The Change of Stress Distribution according to Fixation Devices and Osteotomy Methods in High Tibial Osteotomy / 대한정형외과연구학회지

PURPOSE: To evaluate the necessity of lateral translation and the primary stability of the fixation devices in a closed wedge high tibial osteotomy. MATERIALS AND METHODS: The authors studied four pairs of high tibial osteotomy: Pair I, lateral translation with blade plate fixation; Pair II, lateral translation with staple fixation; Pair III, no translation with blade plate fixation; Pair IV, no translation with staple fixation. Four models of bovine tibia were taken and analyzed for stress distribution at the osteotomy site under axial loading. After axial loading, information recorded in pressure sensitive film was transformed to image file. After, by using image analysis software, the mean stress value and maximum stress value was calculated. RESULTS: The mean stress calculated at each osteotomy site is as follows; 3.89 MPa in the first pair; 4.55 MPa in the second pair; 4.62 MPa in the third pair; and 4.67 MPa in the fourth pair. In Group I, stress value was distributed evenly. But in group II, III, IV, the stress was concentrated at posteromedial area of the osteotomy site. CONCLUSION: The primary in the high tibial osteotomy was dependent more on the rigid fixation than on the continuity of the medial cortex. The pairs on which blade plate fixation was used more stable than the pairs on which staple fixation was used regardless of lateral translation.

Clinical value of MSCT scanning and three-dimensional reconstructing well-liking shinbone prefabricating internal plate to repair catagmatic shinbone / 中国矫形外科杂志

[Objective]To explore a new technique of prefabricating internal plate.[Method]Three-dimensional reconstruction of the well-liking shinbone was performed by MSCT scanning and the length and shape of the catagmatic shinbone for operation was measured on well-liking shinbone.The shinbone curve was depicted using a self-designed skeletal curve-depicting.Then shape of the material for internal fixation was determined.[Result]The length and shape of the shinbone curve was accurately measured.The physiological curve of the shinbone was depicted.Then shape of the material for internal fixation was determined.[Conclusion]Three-dimensional well-liking shinbone reconstruction with MSCT and measurement facilitates the determination of the optimal length and shape of the internal fixation material to enhance the attachment between the material and the bone surface and consequently the therapeutic effects.One case's length and shape of internal fixation was dissatisfactory for hyperplasia of bone.But the length and shape of internal fixation has basal shape.

Blade Plate Fixation for Failed Internal Fixation of Intertrochanteric Hip fractures

Purpose: To evaluate the results of blade plate fixation and bone grafting for the treatment of failed intertrochanteric hip fractures. Materials and Methods: Eight patients were treated with 95° blade plate fixation and bone grafts were performed in 7 patients. The mean age of the patients was 73 years old and the mean follow-up period was 26 months (range, 6 to 65 months). Clinical and radiological results were evaluated based on pain, walking ability, union period, and maintenance of reduction. Results: 6 of 8 patients obtained a solid union after a median period of 20 weeks. The neck-shaft angle was changed from 118° to 133° postoperatively. One patient underwent revision of a bipolar hemiarthroplasty due to failed blade plate fixation and varus malunion occurred in one patient Conclusion: Blade plate fixation and bone grafting for failed internal fixation of intertrochanteric hip fractures can provide a solid union and a good clinical result.

Comparison of Two Kinds of Internal Fixation after High Tibia Osteotomy for the Treatment of Osteoarthritis of Knee with Genu Varus Deformity / 中国康复理论与实践

@#ObjectiveTo compare the effect and prognosis of two kinds of internal fixation (improved Giebel blade plate and traditional straddle nail) after high tibial osteotomy (HTO) on osteoarthritis of knee with genu varus deformity. Methods37 knees of 32 cases were treated with straddle nail (25 knees) or Giebel blade plate (12 knees). All the cases were followed up for 6～28 months. ResultsThe clinical bone healing time of osteotomy was 8～12 weeks. There was no significant differences between 2 groups in the increased score in HSS Standard and in the clinical bone healing time. ConclusionBoth internal fixation with improved Giebel blade plate and traditional straddle nail get similarly satisfactory prognosis, while the former shows more advantages to allow early functional exercises.

The Treatement of the Unstable Proximal Humerus Fracture Using Bifurcate Angled Blade Plate with Tension Band Wiring

PURPOSE: To evaluate the results of internal fixation with bifurcate angled blade plate and tension band wiring of greater tuberosity or rotator cuff for the unstable proximal humerus fracture. MATERIALS AND METHODS: Nineteen cases of unstable proximal humerus fracture who were followed up for more than 1 year were treated using bifurcate angled blade plate and tension band wiring between March 2003 and March 2005. Average age of the patients was 46.5 years (range, 24 to 69), and there were 9 male and 10 female patients. The radiological results were evaluated by bony union and neck shaft angle. In addition, the clinical results were evaluated by Neer's evaluation criteria. RESULTS: In 18 out of 19 cases, bony union was obtained in average 12.5 weeks after operation. The neck shaft angles of sixteen cases were between 120 and 140 degrees by Paavolainen method. According to Neer's evaluation criteria, 17 cases showed excellent or good results. CONCLUSION: The patients treated using bifurcate angled blade plate and tension band wiring could exercise earlier because of good initial stability. Also, the radiological and clinical results were relatively good. The treatment of unstable proximal humerus fracture with bifurcate angled blade plate and tension band wiring was considered as a good method.

Results of Operative Treatment of Distal Femoral Fracture

PURPOSE: To evaluate the result of comparative study about the cases in the fracture of the distal femur treated with plate and screw, dynamic condylar screw, blade plate, retrograde intramedullary nail and external fixator. MATERIALS AND METHODS: The AO classification system was used. 84 cases who were preformed operation during the period from March 1996 to May 2002, were included in this study. The mean duration of follow-up was 25 months. According to Sachatzker criteria, we classified the following results to excellent, good, fair and poor. RESULTS: Type A were excellent or good result when treated with plate and screw, dynamic condylar screw and retrograde intramedullary nail. Type B were excellent or good result when treated with cannulated screw. Type C were excellent or good result when treated with plate and screw and blade plate. CONCLUSION: We conclude that the most important thing in operation is firmly internal fixation and to obtain this, accurately anatomical reduction and the choice of suitable instrument for the type of the fracture are needed. cannulated screw. Type C were excellent or good result when treated with plate and screw and blade plate.

Treatment of Failed Internal Fixation of Intertrochanteric Fractures of Femur

PURPOSE: To compare the result of failed internal fixation of intertrochanteric fractures treated with arthroplasty and 95degrees angled blade plate. MATERIALS AND METHODS: From June 2000 to may 2003, there were 12 cases with failed internal fixation of intertrochanteric fractures among 185 cases treated with dynamic hip screw and followed up for more than 1 year. The 4 cases were treated with bipolar hemiarthroplasty, 1 case with total hip arthroplasty, and other 7 cases were treated with 95degrees angled blade plate with allograft, evaluated clinically the operation times, blood loss, walking ability and complication. RESULTS: In the 7 cases, which treated with 95degrees angled blade plate, the average operation time was 109 minutes, the average blood loss was 431 ml. The result of keeping abreast of 1 year, no aid ambulation was 4 cases, the cane ambulation was 2 cases, the walker ambulation was 1 case, and there was no pain in 3 cases, mild pain in 4 cases, and no moderate pain. In the 5 cases, which treated with arthroplasty, the average operation time was 157 minutes, the average blood loss was 618 ml. During 1 year, no aid ambulation was 3 cases, the cane ambulation was 1 case, the walker ambulation was 1 case, and no pain in 2 cases, mild pain in 1 case, moderate pain in 1 case. CONCLUSION: Both 95degrees angled blade plate and arthroplasty can be useful for failed internal fixation of intertrochanteric fractures, and the choice of implant must be determined with caution, considering the surgical conditions of patient, as well as benefits of each devices

Comparison of high tibial osteotomy with giebel blade plate orstraddle nail internal fixation / 重庆医科大学学报

Objective:To compare the clinical effect of high tibial osteotomy (HTO) with Giebel blade plate or straddle nail internal fixation for the treatment of osteoarthritis of knee with varum.Methods:Twenty-three cases of knee OA with genu varum were performed with HTO,in which 8 case by using Giebel blade plate and 15 cases by using straddle nail.Results:All patients were followed up.The genu varum defection were corrected obviously.Six months after operation,comparison between the two groups showed no significant differences in scoring on HSS standard.One case of nail rupture and two cases of loss of anticipant angle occurred in the group of straddle nail.Conclusion:HTO with either Giebel blade plate or straddle nail both apparently shows many advantages in the treatment of osteoarthritis of knee.HTO with Giebel blade plate can exercise more early and have much less complications than HTO with straddle nail internal fixation.