Subchondral raft construction with locking plates for the treatment of Schatzker type II fractures.

OBJECTIVES: To evaluate the functional and radiological results of Schatzker type II fractures treated via subchondral raft screws combined with locking plates. METHODS: Twenty-four individuals were enrolled in this study between 2010 and 2014. The depressed joint line was elevated and the defect was filled with allograft. Next, two or three subchondral screws were placed in combination with a locking plate. At the last follow-up, clinical and radiological data were recorded. RESULTS: The mean follow-up period was 21.4 months (12-39). The mean Knee Society Score (KSS) and Rasmussen clinical scores were 91.5 (range, 77-100) and 16.75 (range, 14-18), respectively. The mean Rasmussen radiological score was 27.9 (range, 24-30) during the follow-up. There was no statistically significant difference between injured and non-injured sides with respect to the mechanical axis, the proximal medial tibial angle, and tibial slope. In addition, arthritis showed no difference on the non-injured side, although follow-up was short. CONCLUSIONS: The periarticular raft construction combined with the locking plate helps surgeon to maintain the anatomic line of the joint and the mechanical axis obtained during the surgery. Secondary arthritis seems to be major complication after fractures of the tibial plateau, although the functional results were satisfactory. Level of Evidence IV, Case Series.

OBJETIVOS: Avaliar os resultados funcionais e radiológicos das fraturas de Schatzker tipo II tratadas com parafusos de plataforma subcondral em combinação com placas de trava. MÉTODOS: Vinte e quatro indivíduos foram selecionados para este estudo entre 2010 e 2014. A linha articular deprimida foi elevada e o defeito foi preenchido com aloenxerto. A seguir, dois ou três parafusos subcondrais foram colocados em combinação com uma placa de trava. No último acompanhamento, foram registrados os dados clínicos e radiológicos. RESULTADOS: O período médio de acompanhamento foi 21,4 meses (12-39). A média do Knee Society Score (KSS) e dos escores clínicos de Rasmussen foram 91,5 (faixa, 77-100) e 16,75 (faixa, 14-18), respectivamente. A média do escore radiológico de Rasmussen foi 27,9 (faixa, 24-30) durante o acompanhamento. Não houve diferença estatisticamente significante entre o lado com lesão e sem lesão, com relação ao eixo mecânico, ao ângulo medial proximal da tíbia e à inclinação tibial. Além disso, a artrite não apresentou diferença no lado sem lesão, embora o acompanhamento tenha sido curto. CONCLUSÕES: A construção de plataforma periarticular combinada com placa de trava ajuda o cirurgião a manter a linha anatômica da articulação e o eixo mecânico obtido durante a cirurgia. A artrite secundária parece ser uma complicação importante depois de fraturas do platô tibial, embora os resultados funcionais sejam satisfatórios. Nível de Evidência IV, Série de Casos.

Subchondral raft construction with locking plates for the treatment of Schatzker type II fractures / Construção de plataforma subcondral com placas de trava para o tratamento de fraturas do tipo II de Schatzker

ABSTRACT OBJECTIVES: To evaluate the functional and radiological results of Schatzker type II fractures treated via subchondral raft screws combined with locking plates. METHODS: Twenty-four individuals were enrolled in this study between 2010 and 2014. The depressed joint line was elevated and the defect was filled with allograft. Next, two or three subchondral screws were placed in combination with a locking plate. At the last follow-up, clinical and radiological data were recorded. RESULTS: The mean follow-up period was 21.4 months (12-39). The mean Knee Society Score (KSS) and Rasmussen clinical scores were 91.5 (range, 77-100) and 16.75 (range, 14-18), respectively. The mean Rasmussen radiological score was 27.9 (range, 24-30) during the follow-up. There was no statistically significant difference between injured and non-injured sides with respect to the mechanical axis, the proximal medial tibial angle, and tibial slope. In addition, arthritis showed no difference on the non-injured side, although follow-up was short. CONCLUSIONS: The periarticular raft construction combined with the locking plate helps surgeon to maintain the anatomic line of the joint and the mechanical axis obtained during the surgery. Secondary arthritis seems to be major complication after fractures of the tibial plateau, although the functional results were satisfactory. Level of Evidence IV, Case Series.

RESUMO OBJETIVOS: Avaliar os resultados funcionais e radiológicos das fraturas de Schatzker tipo II tratadas com parafusos de plataforma subcondral em combinação com placas de trava. MÉTODOS: Vinte e quatro indivíduos foram selecionados para este estudo entre 2010 e 2014. A linha articular deprimida foi elevada e o defeito foi preenchido com aloenxerto. A seguir, dois ou três parafusos subcondrais foram colocados em combinação com uma placa de trava. No último acompanhamento, foram registrados os dados clínicos e radiológicos. RESULTADOS: O período médio de acompanhamento foi 21,4 meses (12-39). A média do Knee Society Score (KSS) e dos escores clínicos de Rasmussen foram 91,5 (faixa, 77-100) e 16,75 (faixa, 14-18), respectivamente. A média do escore radiológico de Rasmussen foi 27,9 (faixa, 24-30) durante o acompanhamento. Não houve diferença estatisticamente significante entre o lado com lesão e sem lesão, com relação ao eixo mecânico, ao ângulo medial proximal da tíbia e à inclinação tibial. Além disso, a artrite não apresentou diferença no lado sem lesão, embora o acompanhamento tenha sido curto. CONCLUSÕES: A construção de plataforma periarticular combinada com placa de trava ajuda o cirurgião a manter a linha anatômica da articulação e o eixo mecânico obtido durante a cirurgia. A artrite secundária parece ser uma complicação importante depois de fraturas do platô tibial, embora os resultados funcionais sejam satisfatórios. Nível de Evidência IV, Série de Casos.

[Comparison of 90° and 180° plate constructions for comminuted distal humerus fractures in adults, and effects on clinical results]. / Eriskin humerus alt uç eklem içi parçali kiriklarda 90° ve 180° plak uygulamalarinin karsilastirilmasi ve klinik sonuçlar üzerine etkisi.

BACKGROUND: The present objective was to compare 90° and 180° double-plate constructions for complex distal humerus fractures, as well as to evaluate superiority of construction type. METHODS: Retrospectively evaluated were 17 patients treated for type C distal humerus fracture according to AO/ASIF classification between January 2009 and January 2013. All attended minimum 6-month follow-up. Elbow function was assessed with anteroposterior and lateral x-ray, and Mayo elbow performance score evaluation at outpatient clinics. RESULTS: Patient population included 14 males (82.3%) and 3 females (17.7%). Mean patient age was 40.5 years. According to AO/ASIF distal humerus classification, 3 (17.7%) type C1, 9 (52.9%) type C2, and 5 (29.4%) type C3 fractures were included. Six were open fractures (35.3%). According to Gustilo-Anderson classification, 4 (23.5%) fractures were type 1, and 2 (11.7%) were type 2. Construction performed was 90° in 11 cases (64.7%) and 180° in 6 cases (36.3%). Chevron osteotomy was performed in all cases. Mean follow-up period was 25.6 (6-52) months. Upon final examination, mean elbow flexion was 105º (85º-130º), and mean extension loss was 10º (0º-20º). According to Mayo elbow performance scoring system, 12 (70.5%) results were excellent, and 5 (29.5%) were good. No statistically significant clinical difference was found between 90° and 180° plate construction groups (p=0.169). DISCUSSION: Surgeons should determine the construction type appropriate to individual cases of adult distal humerus type C fractures using preoperative x-rays and intraoperative means. Choice of construction type has particular importance in cases of lateral columnar fracture complexity. If no comminution is present in the lateral column, 90º double-plating leads to satisfactory outcome, while 180º plating leads to satisfactory outcome when comminution is present in the lateral column.

The effect of early weight-bearing on comminuted calcaneal fractures treated with locking plates.

OBJECTIVES: This study aims to evaluate the possible effects of early weight-bearing on clinical and radiological outcomes of comminuted calcaneal fractures treated with locking plates. PATIENTS AND METHODS: This retrospective study included 15 patients (12 males, 3 females; mean age 40.1 years; range 18 to 55 years) with comminuted calcaneal fractures between October 2010 and April 2012. Standard lateral extensile approach was carried out for surgical exposure. A corticocancellous allograft was used to fill the defect following the reduction and fixation of posterior facet. Titanium locking plates and screws were used to maintain reduction. The patients were encouraged for a limited weight-bearing at six weeks postoperatively, if tolerated. All patients were able to full weight-bear at 12 weeks postoperatively. Clinical and radiological assessments were performed using the American Orthopaedic Foot and Ankle Society (AOFAS) and Maryland scores. RESULTS: The mean follow-up was 19 months (range, 12 to 27 months). The AOFAS and Maryland scores were 89 and 88.46 points, respectively. The Böhler's angle showed 0.3° loss from early post-surgery to the last visit. Among the workers, all returned to work but one with Sanders type IV fracture and all retired patients returned to their daily activities. The functional status of the patient with Sanders type IV fracture was poor according to the AOFAS and Maryland criteria. CONCLUSION: Based on radiographic and clinical assessment, there was no unfavorable effect of early weight-bearing after calcaneal fracture surgery. Therefore, these results suggest that sufficient stability can be achieved by locking plates in comminuted calcaneal fractures, when early weight-bearing is recommended, even.

A rare complication after intertrochanteric fracture treated with proximal femoral nail: femoral neck insufficiency fracture.

We present a case, 82-year-old woman, sustaining intertrochanteric fracture treated with proximal femoral nail. Up to 14 months postoperatively, everything went on seamlessly. Then, there was a rapid onset of worsening of the functional capacity. She came to outpatient clinic by using wheelchair. Plain X-rays revealed a femoral neck fracture on the operative side with no history of trauma. Laboratory studies showed no significant abnormalities but vitamin D [25 (OH) D] level was 14.82 ng/ml. X-ray survey of skeletal system was not indicative of osteomalacia. We performed total hip replacement instead of internal fixation due to patient's age. Vitamin D replacement therapy was launched. Three months later, she was totally satisfactory with clinical result and 25 (OH) D level increased to 53.68 ng/ml. At the last visit, the patient was pain free and active in all her recreational activities.

Interposition arthroplasty in the treatment of hallux rigidus.

OBJECTIVES: We evaluated the outcomes of interposition arthroplasty performed for the treatment of hallux rigidus. METHODS: The study included 19 feet (4 left, 15 right) of 17 patients (14 females, 3 males; mean age 61+/-5 years; range 55 to 71 years) who were treated with interposition arthroplasty for hallux rigidus. According to the grading system of Coughlin and Shurnas, 18 feet were grade 3, one foot was grade 4. One-third of the base of the proximal phalanx was resected at surgery. Preoperative and postoperative radiographic assessments included the measurements of the joint space width of the first metatarsophalangeal (MTP) joint, hallux valgus angle, and intermetatarsal angle. Clinical evaluations were made using the AOFAS (American Orthopaedic Foot and Ankle Society) hallux metatarsophalangeal-interphalangeal scale. Postoperative satisfaction levels of the patients were questioned. The mean follow-up period was 21 months (range 9 to 32 months). RESULTS: According to the AOFAS scale, the results were excellent in seven feet (36.8%), good in nine feet (47.4%), and fair in three feet (15.8%), with excellent and good results accounting for 84.2%. The mean total AOFAS score increased by 24.6 points postoperatively (p<0.05). The mean range of motion of the first MTP joint improved significantly from preoperative 24.2+/-5.4 degrees (range 10 degrees to 30 degrees) to postoperative 54.3+/-9.4 degrees (p<0.05). The mean joint space width of the first MTP joint was 1.0+/-0.3 mm (range 1 to 2 mm) preoperatively, it increased to 3.0+/-1.1 mm (range 1 to 5 mm) on final radiographs (p<0.05). The mean hallux valgus angle decreased from preoperative 13.8 degrees (range 9 degrees to 17 degrees) to postoperative 10.2 degrees (range 4 degrees to 13 degrees), and the mean intermetatarsal angle increased from preoperative 10.5 degrees (range 8 degrees to 14 degrees) to postoperative 11.2 degrees (range 8 degrees to 15 degrees). Patient satisfaction levels were very good in nine feet (47.4%), good in seven feet (36.8%), moderate in one foot (5.3%), and poor in two feet (10.5%). Complications included metatarsalgia aggravated by long walks (n=11, 57.9%), hypoesthesia of the big toe (n=3, 15.8%), and loss of ground contact of the big toe (n=15, 79%). The push-off power of the big toes was measured as 3/5 in five cases, 4/5 in 11 cases, and 5/5 in three cases. None of the patients developed infection or osteonecrosis postoperatively. CONCLUSION: Interposition arthroplasty is an appropriate surgical treatment method for hallux rigidus for elderly patients with low functional capacity.