The management of segmental femur fractures: the radiographic 'cover-up' test to guide decision making.

BACKGROUND: Segmental femur fractures often pose management challenges regarding the optimal fixation choice and sequence of surgical events. METHODS: Retrospective review of clinical records and radiographic data of adult patients with segmental femur fractures treated by a conceptual radiographic cover-up test to determine the ideal fixation method between January 2019 and December 2020. RESULTS: Forty patients with 84 individual fractures underwent fracture fixation. The most consistent fracture combinations were intertrochanter-diaphysis (AO31A-AO32) fractures (25%, n = 10) and femur neck-diaphysis (AO31B-AO32) fractures (20%, n = 8). Compared to evidence-based fracture management, the gold standard treatment was used for the fixation of 78 fractures (93%). One patient required revision for fixation failure of a diaphyseal fracture, and two fractures, both open diaphysis injuries, developed fracture-related infections. CONCLUSION: Anatomical alignment and high union rates are possible for segmental femur fractures treated by evidence-based fracture fixation principles. A conceptual radiographic cover-up test assists in matching the best possible implant for each fracture.

Incidence of spinal deformities and the relationship with physical status and back pain in ambulant adults with cerebral palsy and spastic diplegia.

PURPOSE: The purpose of this study was to determine the incidence of spinal deformities in ambulant adults with cerebral palsy (CP) and spastic diplegia, more than 15 years after orthopaedic interval surgery approach (ISA) treatment, and its relationship to contextual factors, level of pain and physical status. METHODS: Spinal X-rays, pain (Oswestry Disability Index (ODI) and location/frequency) questionnaires and physical examination assessing lower extremity muscle strength (Medical Research Council scale), motor control (selectivity scale) and muscle tone (Ashworth score) were conducted in 30 adults with spastic diplegic CP. RESULTS: Mild scoliosis (curve 12-22°) was determined in eight (28%) participants. Hyperkyphosis (> 50°) was reported in two (7%) and lumbar hyperlordosis (> 60°) in five (17%) participants. Pain was most commonly reported at cervical (n = 19, 63%) and lumbosacral (n = 18, 60%) area, resulting in 'moderate disability' for six (20%) and 'severe disability' for one (3%) participant. Most apparent physical abnormalities determined were hip abduction weakness and increased rectus femoris muscle tone. Regarding correlations, no relations were found for scoliosis curvature, but kyphosis curvature was related to females, ODI scores (lifting and sitting) and increased muscle tone of ankle plantar flexor muscles, lordosis curvature to passive hip extension mobility, and hip flexors and ankle plantar flexors muscle tone. CONCLUSION: Adults with spastic diplegic CP who received their first orthopaedic intervention more than 15 years ago (based on ISA) showed similar incidence of spinal deformities as reported in the younger CP population, suggesting stability of spinal curvature into adulthood. These slides can be retrieved under Electronic Supplementary Material.