Osteosynthesis in fractures of the distal third of humeral diaphysis.

OBJECTIVES: To compare the clinical results of osteosynthesis with plate and screws versus anterograde locked intramedullary nail in fractures of the distal third of humeral diaphysis. MATERIAL AND METHODS: 184 patients with fractures of the distal third of humeral diaphysis were included in a prospective study. 82 patients underwent open reduction and internal fixation with plate and screws (Group 1), while in 102 cases, closed reduction and osteosynthesis with locked intramedullary nail was performed (Group 2). The 2 groups were similar in terms of age and gender distribution and pattern of fractures. The function of shoulder and elbow were assessed using the Oxford Shoulder Score (OSS) and Oxford Elbow Score (OES). Operating time, duration of hospital stay, complications and moment of union were recorded. OUTCOMES: 6 months after surgery the average OSS was 44.42 in Group I and 40.23 in Group II, while the mean OES was 40.88 in Group I and 46.54 in Group II. The average duration of the surgical procedure was 87 min in Group1 and 43 min in the nail group (p<0.001).The mean duration of hospital stay was 2.6 days in Group 1 and 1.8 days in Group 2 (p<0.05). The rate of non-unions was 3.66% in the plate group and 2.94% in the retrograde nail group (p>0.05). CONCLUSIONS: The clinical results of the 2 methods of osteosynthesis were similar, but the operating time and the duration of hospital stay were longer after plate osteosynthesis. Shoulder function was slightly impaired in the nail group but not statistically significant.

Extended exposure in difficult total knee arthroplasty using tibial tubercle osteotomy.

OBJECTIVES: In some total knee arthroplasty cases, the usual medial parapatellar approach does not allow the appropriate patellar eversion and the desired exposure of the knee joint. Partial disinsertion of the patellar tendon doesn't substantially improve the surgical exposure and can lead to extensor apparatus weakening and complete secondary ruptures, while the V-Y quadricipital plasty leads to post-op immobilization of the knee, which delays the functional rehabilitation, with negative impact on the range of motion. The tibial tubercle osteotomy, however, allows an extension of the approach in total knee arthroplasty, without endangering the quadricipital extensor apparatus. MATERIAL AND METHODS: In this study we analysed the post-operative results of 11 cases of primary total knee arthroplasty in which a frontal plane osteotomy of the tibial tubercle was performed in addition to the standard medial parapatellar approach, as a result of the patients associated conditions, like rheumatoid arthritis with an extension deficit higher than 150, previous knee synovectomy by arthrotomy, progressive genu varum with more than 150 deviation, varus deviation of the lower limb with previous closing wedge proximal tibial osteotomy or patellar fractures with vicious consolidation. OUTCOMES: Overall, the results were more than satisfactory with a significant increase in the patients mean range of motion and Knee Society Score. There were some post-op issues in some of the patients, but they were adressed accordingly, having no long-term impact on the results. CONCLUSIONS: . We could thus conclude that, in special cases, the frontal plane tibial tubercle osteotomy is an effective technique which can provide a wide approach with appropriate protection of the knee extensor apparatus.