Proximal ulnar fractures in adults: a review of 163 cases.

The aim of this study was to report the epidemiological characteristics and the experience of 5 departments of trauma, in France, in the management of fractures of the proximal ulna. 163 patients with fractures of the proximal ulna with a mean age of 49.9 years (range 16-97) were managed. The most common mode of injury was a motor vehicle collision (48%). 18% sustained associated injuries to the ipsilateral limb. Open fractures were present in 42 patients (25%). A total of 109 patients had a fracture of the olecranon, with the Mayo 2A and B types most frequently seen (66%). The patients were invited for clinical examination at a mean duration of 16 months, retrospectively. Validated patient-oriented assessment scores involving the Mayo Elbow Performance Index (MEPI) and the Broberg and Morrey score were evaluated. All patients had follow-up radiographs. The mean arc of elbow motion was 130° (70-150°). The mean MEPI was 91 (20-100) with good results in 23% and excellent results in 52% of the patients. The mean Broberg and Morrey score was 90 after isolated olecranon fracture, and decreased with the complexity of the lesion. 117 fractures (72%) healed with ulnohumeral congruity. 9 fracture non-unions occurred (6%). Although the fracture of the proximal ulna can be described in several classifications, none of them accommodate it satisfactorily, because of the complexity of the lesion. The coronoid process is the keystone for the stability of the elbow. It forms the anterior buttress with the radial head. Tension band wire fixation is by far the commonest technique of internal fixation used for the treatment of non-comminuted olecranon fractures. Dorsal plate fixation is a useful option by providing improved fixation of complex comminuted fractures and fracture-dislocations. The radiocapitellar joint has to be restored appropriately, preserving the radial head when possible and replacing it with a prosthesis otherwise. The lateral collateral ligament complex is commonly disrupted and usually can be reattached to its origin from the lateral epicondyle. In addition, a brief period of hinged external fixation should be considered.

Reconstruction of femoral bone loss with a monoplane external fixator and bone transport.

BACKGROUND: Treatment of femoral bone loss is difficult. Ilizarov described the bone lengthening technique using a circular external fixator, but this technique is uncomfortable on the femur because of the circular fixator. We have therefore opted for use of a monoplane external fixator to treat femoral bone loss with bone lengthening. The objectives of this study were to determine whether (1) bone union can be obtained with a monoplane external fixator; (2) infections can be treated; (3) the lower limb axes and alignment can be controlled; and (4) patient satisfaction is high. HYPOTHESIS: A monoplane external fixator provides a high rate of bone union during bone transport with no risk of deformity over the long term. MATERIAL AND METHODS: Between 2007 and 2012 seven patients were treated with bone transport using a monoplane external fixator for femoral bone loss measuring a mean 8.1cm (range, 6-10cm). All were infected (osteomyelitis) or contaminated following Gustilo type IIIB fractures. The mean time from initial injury to the beginning of bone loss management was 3.9months (range, 1.5-8 months) for six of them and 108 months for one patient. RESULTS: At the mean follow-up of 4.7 years (range, 2-7 years), all of the patients showed union after a mean 11.1months (range, 8-18 months), i.e., 41.2 days/cm of transport, and all infections were resolved. Only one patient had unequal leg length measuring 2cm and another showed 3° varus. Five patients were satisfied despite disappointing functional results. All could fully extend the knee but the mean flexion was 50° (range, 20-90°). DISCUSSION: This series confirms that use of the monoplane external fixation with descending bone transport to treat infected femoral bone loss is efficient and provides bone union, treatment of the infection, and control of bone axes and lengths. This technique does not allow recuperation of complete knee flexion. LEVEL OF EVIDENCE: IV, retrospective study.

Acetabular component navigation in lateral decubitus based on EOS imaging: A preliminary study of 13 cases.

INTRODUCTION: Acetabular component navigation classically requires palpation of the bone landmarks defining the anterior pelvic plane (APP) (anterior superior iliac spine [ASIS] and pubis), the recording of which is not very reliable when performed in lateral decubitus. The objectives of the current experimental study were: (1) to assess the clinical feasibility of NAVEOS navigation (based on EOS imaging) in lateral decubitus; and (2) to compare precision versus classical APP-based navigation (NAVAPP). HYPOTHESIS: Iliac plane navigation using EOS is as reliable as APP navigation. PATIENTS AND METHODS: A continuous prospective series of 13 total hip replacements were implanted in lateral decubitus under APP-guided navigation (NAVAPP). Planning used preoperative EOS measurement. The ASIS, pubis and ipsilateral posterior superior iliac spine (PSIS) were located and exported to the navigator. Intra-operatively, NAVEOS landmarks (acetabular center, ASIS and PSIS on the operated side) were palpated. Postoperatively, cup inclination and anteversion with respect to the APP were measured on EOS imaging (SterEOS3D software). The SterEOS3D measurements were compared to those of the performed NAVAPP and simulated NAVEOS navigations. RESULTS: Three patients were excluded for technical reasons. In the remaining 10, inclination on NAVAPP and SterEOS3D differed by a median 4° (range, 0-12°), and on NAVEOS versus SteEOS3D by 5° (range, 2-10°); anteversion on NAVAPP and SterEOS3D differed by a median 4.5° (range, 0-12°), and on NAVEOS versus SteEOS3D by 4° (range, 0-14°). CONCLUSION: Precision was comparable between NAVEOS and classical navigation. NAVEOS simplifies cup navigation in lateral decubitus on initial acquisition. These results require validation on a larger sample.

Acetabular fracture: long-term follow-up and factors associated with secondary implantation of total hip arthroplasty.

HYPOTHESIS: The present study sought to determine long-term outcome in acetabular fracture and the factors associated with secondary implantation of a total hip arthroplasty and/or with poor functional results. MATERIAL AND METHODS: Seventy-two patients admitted between 2000 and 2005 were followed up for a maximum 11 years (mean, 6.8 years): 16 females, 56 males; mean age at injury, 41.6 years (median, 40 years). There were 45 simple acetabular fractures, 27 complex fractures and 27 dislocations. Late complications were: osteoarthritis (n=29), osteonecrosis of the femoral head (ONFH: n=8) and heterotopic ossification (n=2). RESULTS AND DISCUSSION: Twenty-five total hip arthroplasties (THA) were performed, with a mean time to surgery of 3.7 years. Associated factors for THA were: VAS (P<0.0001), PMA (P<0.0001), osteoarthritis (P<0.0001), ONFH (P<0.0002), initial dislocation (P=0.0002), no functional treatment (P=0.0014), surgical treatment (P=0.0065), initial traction (P=0.0068), anterior and posterior congruency defect (P=0.0072 and P<0.0001), and initial intra-articular foreign body (P=0.045). Factors associated with poor or bad functional results were the same, plus: etiology (P=0.0021), BMI (P=0.03) and posterior wall fracture (P=0.0325). LEVEL OF EVIDENCE: 4; retrospective study.