MIPO con placa helicoidal en fractura de húmero

Introducción: Las fracturas humerales diafisarias multifragmentarias con extensión proximal son patrones infrecuentes de lesión causados principalmente por trauma de alta energía. La forma anatómica del húmero, la presencia de la tuberosidad deltoidea y la proximidad del nervio radial al surco radial representan retos a tratar, por ello se recomiendan incisiones mínimamente invasivas y la estabilización de la fractura con placa proximal humeral internal locking system. Objetivo: Demostrar la eficacia de la técnica minimally invasive plate osteosynthesis con el moldeamiento helicoidal de la placa proximal humeral internal locking system. Presentación del caso: Paciente de 29 años que sufrió accidente de tránsito y presentó fractura diafisaria multifragmentaria extendida al húmero proximal. Se trató con la técnica minimally invasive plate osteosynthesis y placa helicoidal proximal humeral internal locking system. Alcanzó la consolidación completa y rápida recuperación funcional. Conclusiones: La técnica minimally invasive plate osteosynthesis con placa helicoidal proximal humeral internal locking system es una opción quirúrgica eficaz y segura para las fracturas humerales diafisarias multifragmentarias con extensión proximal, ya que preserva la inserción muscular deltoidea, mejora el contacto placa hueso con riesgo mínimo de lesión neurológica axilar y radial, favorece la curación ósea y mejora el resultado funcional.

Introduction: Multifragmentary diaphyseal humeral fractures with proximal extension are infrequent patterns of injury caused mainly by high-energy trauma. The anatomical shape of the humerus, the presence of the deltoid tuberosity and the proximity of the radial nerve to the radial groove represent challenges to be treated, therefore minimally invasive incisions and fracture stabilization with the proximal humeral internal locking system plate are recommended. Objective: To establish the efficacy of the minimally invasive plate osteosynthesis technique with helical molding of the proximal humeral plate internal locking system. Case report: We report the case of a 29-year-old patient who suffered a traffic accident and had a multifragmentary diaphyseal fracture extended to the proximal humerus. He was treated with the minimally invasive plate osteosynthesis technique and the humeral proximal helical plate internal locking system. He achieved complete consolidation and rapid functional recovery. Conclusions: The minimally invasive plate osteosynthesis technique with the humeral proximal helical plate internal locking system is an effective and safe surgical option for multifragmentary diaphyseal humeral fractures with proximal extension, since it preserves the deltoid muscle insertion, improves bone-plate contact with minimal risk of fracture. Axillary and radial neurological injury, promotes bone healing and improves functional outcome.

A meta-analysis of expandable intramedullary nail versus interlocking intramedullary nail for treatment of femoral shaft fracture / 中国组织工程研究

BACKGROUND: A large number of studies have confirmed that expandable intramedullary nails and interlocking intramedullary nails have a good effect in repairing limb fractures. However, for the treatment of femoral shaft fractures, the advantages and disadvantages of the two kinds of fixation methods are not inconclusive. OBJECTIVE: To systematically review the safety and effectiveness of expandable intramedullary nail and interlocking intramedullary nail for treatment of femoral shaft fracture. METHODS: A computer-based online search was conducted in PubMed, Web of Science, EBSCO, The Cochrane Library, CNKI, VIP and Wanfang databases to screen the relevant clinical controlled trials of expandable intramedullary nail versus interlocking intramedullary nail for the treatment of femoral shaft fractures. Two reviewers screened the literature according to the strict inclusion criteria, and assessed the research quality of the finally included literatures, and extracted the data. Meta-analysis was performed using Stata 13. 0 software. RESULTS AND CONCLUSION: (1) A total of 7 studies (3 randomized controlled and 4 non-randomized controlled trials) were included, involving 492 patients. Expandable intramedullary nailing group contained 246 patients. Interlocking intramedullary nailing contained 246 patients. (2) The results of meta-analysis showed that compared with the interlocking intramedullary nailing group, fracture healing time, operation time, fluoroscopy time and hospital stay were shorter in the expandable intramedullary nailing group [SMD=-0. 87, 95%CI(-1. 20, -0. 54), P=0; SMD=-2. 45, 95%CI(-3. 33, -1. 58), P=0; SMD=-2. 83, 95%CI(-3. 68, -1. 97), P=0; SMD=-0. 96, 95%CI(-1. 73, -0. 18), P=0. 016]. Intraoperative blood loss was less in the expandable intramedullary nailing group than that in the interlocking intramedullary nailing group [SMD=-4. 12, 95%CI(-6. 38, -1. 87), P=0]. There was no significant difference in the rate of bone nonunion or delayed healing and the overall incidence of complications between the two groups. (3) Therefore, we theoretically believe that expandable intramedullary nailing is more advantageous than interlocking intramedullary nailing in the treatment of femoral shaft fractures, but the postoperative recovery is similar. Limited to the quality of the methodology of this study, it fails to consider the effect of the type of fracture and the interference of the field. The results need to be treated with caution, and more randomized controlled trials are needed to confirm.

Functional Outcome of Comminuted Fracture Shaft of Humerus Operated by Minimally Invasive Anterior Plate Osteosynthesis – A Prospective Study

Introduction: Minimally invasive plate osteosynthesis (MIPO) has been advocated as a safe approach to humeral shaft fracturemanagement.Aim: This study aims to analyze and evaluate the functional outcome of surgical management of comminuted shaft of humerusby minimally invasive anterior plate osteosynthesis.Materials and Methods: In this prospective study, patients with humeral shaft fractures were included in the study. All thepatients with a comminuted diaphyseal fracture of humerus underwent MIPO technique. Constant–Murley score for shoulderand Mayo Elbow Performance Score (MEPS) for elbow were assessed postoperatively at 3 months, 6 months, and 2 yearsfollow-up and score calculated at each visit.Results: In 15 patients, the mean Constant score was 87 on the affected side and 90.67 on the unaffected side. The meanMEPS was 97.33 ranging from 85 to 100. The mean surgical time with MIPO was 69 min (range: 60–90 min). The averageblood loss with MIPO was 109 ml (range: 75–150 min).Conclusion: MIPO of the humerus gives good functional and cosmetic results and should be considered one of the managementoptions in the treatment of humeral diaphyseal fractures.

Functional outcome of diaphyseal fractures of forearm in adolescents treated with TENS

Background:A retrospective case series study was done onforearm diaphyseal fracture in adolescents treated with TENS (titanium elastic nailing system).Purpose of the study was analysis of functional outcome of TENS in forearm diaphyseal fractures in children between 12-18 year age group. Methods:We retrospectively evaluated 30 patients operated by same senior surgeon during the period from March 2014 to February 2015 with closed diaphyseal forearm fractures in age group 12–18 years treated with TENS in whom closed reduction could not be achieved. Nail diameter taken as 33-40% of narrowest diameter of diaphysys were introduced proximally in ulna and distally in radius under image intensifier in closed manner. Postoperatively, patients encouraged for active shoulder, elbow and finger movements and suture removal done after 2 weeks. Patients were followed up for minimum period of one year.Results:In terms of union and range of motion using Anderson et al criteria 24 patients had excellent results, 4 patients had satisfactory results and one patienthad poor result having non-union of ulna. Two patients had superficial infection at the nail entry site which eventually resolved. One patient lost for follow up.Conclusions:We conclude that TENS in both bone forearm fractures in adolescent age group interms of union and range of motion is a minimally invasive and effective method of fixation.

Percutaneous Transphyseal Intramedullary K-wire Fixation for the Diaphyseal Forearm Fractures in Children

PURPOSE: Although the standard treatment of diaphyseal forearm fractures in children is conservative treatment with closed reduction and cast immobilization, unstable or irreducible fractures are usually needed by surgical intervention. The aim of this article is to determine the efficacy of the percutaneous transphyseal intramedullary K-wires fixation for the forearm diaphyseal fractures in children. MATERIALS AND METHODS: In this retrospective study, we reviewed 18 cases of forearm diaphyseal fractures in children, which were treated with percutaneous transphyseal intramedullary nailing using K-wires from January 2001 to December 2004. We analyzed the period for radiologic bone union and the complications until the last follow-up. RESULTS: The average period of follow-up was 15 months with mean age of 7.8 years. The average time to bone union was 6.2 weeks and nonunion, malunion, radio-ulnar synostosis and refracture were not found, just 2 local pin site infections were seen but healed by conservative treatment. Postoperative scar was small and the complications until the last follow-up were not found. CONCLUSION: In the operative treatment of the forearm diaphyseal fractures in children, we think percutaneous transphyseal intramedullary K-wire fixation is one of the effective methods because of the minimal invasiveness, simplicity and easiness in removal.

Comparative Study of Interlocking and Ender Nails fixation of Diaphyseal Fracture of Femur / 대한정형외과학회잡지

Interlocking and Ender nail fixations have been widely used for the surgical treatment of diaphyseal fractures of femur. Interlocking nail could give advantage of high stability to unstable, cominuted fractures. It requires, however, advanced technique and exposure to radiation harzard, often complicated by further comminution, displacement, breakage of drill bit or loosening of locking screws. Ender nail, on the contrary, is easier in procedure without reaming, thereby maintaining endosteum and requiring short operation time. It, however, cannot avoid complications of shortening, rotational deformity, migration of nails, etc. This study aimed at comparative evaluation of the clinical results of two different nailings(23 Interlocking and 19 Ender nails) performed from March 1987 to March 1993. The study materials were 42 femoral fractures out of 41 adult patients with the followed-up between one and seven years(average 3.5 years). The results are summarized as below: 1. Fracture occurred mostly in the mid-diaphysis(81%) and the Type III comminution(63%) was most common according to the Winquist-Hansen classifiaction. 2. The operative time averaged ninty five minutes in Interlocking nailing, while sixty minutes in Ender nailing. The blood loss was negligible in both techniques. 3. Fluoroscopic assessment after insertion of the nails revealed that Interlocking gave superior stability to Ender nail, while Ender nail produced earlier callus formation(7.5 weeks in average) than Interlocking nail(9.0 weeks in average, p 0.05). 4. Interlocking nail was complicated by loosening of locking screws in two, angulation in one, breakage of drill bit in one cases. Ender nail showed protrusion in two, limb shortening in three, rotational deformity in three cases respectively. There was neither operative infection nor nonunion.