Treatment of volar Barton's fractures: comparison between two common surgical techniques.

BACKGROUND: Volar Barton's fractures are not uncommon but more convincing treatment methods are still controversial. Currently, open reduction with buttress plating or closed reduction with external fixation and percutaneous Kirschner wire fixation have achieved most support. METHODS: Twenty-three consecutive volar Barton's fractures treated with either open reduction and buttress plate fixation (12 cases) or closed reduction with external fixation and percutaneous Kirschner wire fixation (11 cases) were compared retrospectively. The fractures were followed-up for a mean of 30 months (range, 24-50 months). RESULTS: All 23 fractures healed without major complications. The wrist function was satisfactory in all plating patients (12 out of 12) and nine out of 11 external fixation patients (p = 0.22). CONCLUSION: Both the above mentioned surgical techniques give a high success rate. Despite the fact that each technique has advantages and disadvantages, the results from the plating treatment seem to be superior.

Subacromial injections of corticosteroids and xylocaine for painful subacromial impingement syndrome.

BACKGROUND: Subacromial impingement syndrome, with pain and limited motion, is a common disease encountered daily in clinics. This study determined the efficacy of subacromial injections of corticosteroids and local anesthesia for treatment of painful subacromial impingement syndrome. METHODS: A total of 238 shoulders in 209 patients, with regular follow-up, were enrolled in this study. Mean patient age was 51 years (range 31-72 years). Each patient complained of shoulder pain with progressive motion limitation present for more than one month, which was not relieved by various nonsurgical treatments. The mean duration of symptoms before injection was five months (range 1-12 months). Each patient had a positive Neer impingement sign, Hawkins impingement sign, painful tendon sign, limited range of motion and did not show clinical evidence of a rotator cuff tear. Each patient was administered an injection of 1 ml of 2% Xylocaine and 1 ml of Rinderon suspension. A second injection was administered one week later for patients without obvious improvement. Following injections, patients were instructed to perform a home rehabilitation program for four weeks. Follow-up examinations were scheduled for one, two and four weeks, and three, six, nine and 12 months after injection. Outcome measures included the Constant-Murley score and shoulder range of motion. RESULTS: At follow-up four weeks after the first injection, 216 shoulders (91%) had satisfactory improvement in amount of pain and range of motion: mean improvements in the active range of motion of forward elevation, abduction, internal rotation and external rotation were 56 degrees, 48 degrees, 18 degrees and 22 degrees, respectively. However, at the first year follow-up, the satisfaction rate was slightly down at 88%, and 19 shoulders (8%; 16 patients) had recurrent pain and motion limitation after an average of 5.4 months (range 3-12 months). Each of these patients received another injection. Surgery was recommended for 22 shoulders (9%; 18 patients) that did not have satisfactory improvement. Of these patients, eight shoulders (seven patients) had a partial tear of the rotator cuff and 10 shoulders (eight patients) had complete rotator cuff tears. CONCLUSION: Subacromial injection of corticosteroids and local anesthesia is an effective therapy for the treatment of symptomatic subacromial pathology, such as impingement pain, tendonitis and bursitis. The injection can substantially reduce pain and increase range of motion of the shoulder. If there is no improvement following injections, a rotator cuff tear should be suspected.