Internal fixation of undisplaced femoral neck fractures in the elderly: a retrospective comparison of fixation methods.

BACKGROUND: There has been no report related to comparison of fixation methods using minimally invasive dynamic hip screw (MIDHS), conventional dynamic hip screw (CDHS), and multiple cannulated screws (MCS) for treating the undisplaced femoral neck fractures. METHODS: The study retrospectively evaluates the comparison of fixation methods. Ninety elderly patients (>60 years) with the undisplaced intracapsular femoral neck fractures were treated with osteosynthesis by either dynamic hip screw (DHS) or MCS. The patient distribution was regarded as randomized. A new minimally invasive technique of DHS (MIDHS) was presented. Pauwels' classification was used to evaluate the fracture verticality. Singh index was used to evaluate the bone quality. All patients were followed up retrospectively for at least 12 months to compare the clinical results among the MIDHS, CDHS, and MCS groups. RESULTS: Pauwels types and Singh index were similar among the three groups (all p values >/=0.78). The CDHS group had significantly larger wound incision, greater hemoglobin level drop, and longer hospital stay than either the MIDHS or MCS groups (all p values /=0.28). The MIDHS group showed a trend of an increased rate of overall success compared with the MCS group, although this was not statistically significant (97% vs. 84.4%, p = 0.11). CONCLUSION: CDHS had more disadvantages related to more soft tissue stripping than either MIDHS or MCS. MIDHS showed a trend of an increased rate of overall success in an elderly patient with undisplaced femoral neck fracture when compared with MCS.

Intramedullary fixation of tibial shaft fractures: a comparison of the unlocked and interlocked nail.

The study is a prospective evaluation and comparison. Eighty-two patients with tibial shaft fractures were treated with intramedullary fixation by either an unlocked nail (ULN) or an interlocked nail (ILN). All patients were followed up for 12 months with a functional score evaluation. The patients were divided into two groups, based on the method of treatment. The ULN group included 42 patients with an average age of 43.1 years. The ILN group included 40 patients with an average age of 40.0 years. Both groups were similar in the injury mechanism, fracture location, open fracture type and associated medical conditions (all P > 0.05). The operative time was shorter and the wound size smaller in the ULN group when compared to the ILN group (P < 0.001). The union rate, healing time and malunion rate were not significantly different between the two groups (P > 0.05). Although the functional score showed no difference between the groups (P = 0.3), the ILN group had a greater ability to return to their work 6 months after surgery (P = 0.03). In conclusion, unlocked nailing for tibial shaft fractures is a simple and effective method especially in the treatment of middle-third fractures. Interlocked nailing gives stable fixation without cast immobilisation, which resulted in a greater ability for the patients to return to their previous work 6 months after surgery.

Surgical treatment of midclavicular fractures: a prospective comparison of Knowles pinning and plate fixation.

Although several surgical techniques for midclavicular fractures have been reported, Knowles pinning has rarely been compared with plating. The purpose of this study is to compare the clinical results of these two alternative techniques. There were 88 patients with midclavicular fractures surgically treated with either a Knowles pin or a plate. All patients were followed up for 12 months with a shoulder score evaluation. The Knowles pin group included 56 patients, with an average age of 40.1 years. The plate group included 32 patients, with an average age of 38.2 years. Both groups were similar in injury mechanism and fracture types (all p values>0.5). Plating has a significantly longer operation time, larger wound incision, higher pain level, more analgesic use, more complications and more symptomatic hardware (all p value<0.05). The shoulder score, union rate and healing time are not significantly different between the two groups (all p values>0.2). In conclusion, if the surgery of mid-third clavicular fractures is indicated, fixation with a Knowles pin has more advantages than plate fixation.

Dynamic hip screw in the treatment of intertrochanteric fractures: a comparison of two fixation methods.

The study is a prospective evaluation and comparison. A minimally invasive Dynamic Hip Screw (MIDHS) technique is presented. One hundred and two patients with intertrochanteric fractures were treated with either a MIDHS or a conventional dynamic hip screw (CDHS). We used the Singh index as a measure of osteoporosis and also classified the fractures according to three different systems (OTA, Boyd-Griffin, and Evans). All patients were followed up for 12 months with a hip score evaluation. The patients were divided into two groups, based on the method of treatment. The MIDHS group includes 42 patients with an average age of 72.6 years. The CDHS group includes 60 patients, with an average age of 71.3 years. Both groups were similar in injury mechanism, fracture types, mean Singh index and confounding medical condition (all p values >0.05). The CDHS group had significantly larger wound incision, greater haemoglobin level drop, higher pain level, more total analgaesic use and longer hospital stay than the MIDHS group (all p values<0.05). The hip score, union rate, healing time, adequate reduction and adequate screw position rate was not significantly different between the two groups (all p values >0.05). In conclusion, either a MIDHS or a CDHS in the treatment of intertrochanteric fractures is an effective, simple and safe method. The mini-invasive technique as opposed to the conventional technique has smaller wound size, lower pain level, and lower blood loss. Hospital stay and total analgaesic use were decreased, benefitting the patient and reducing hospital cost.

Lateral fixation of AO type-B2 ankle fractures in the elderly: the Knowles pin versus the plate.

The study was a retrospective evaluation and comparison. Seventy-five elderly patients (>50 years) with AO type-B2 ankle fractures were treated by open reduction and internal fixation. All patients were followed up retrospectively for at least 12 months. The 75 patients were divided into two groups, based on the method of treatment. The Knowles pin (KP) group included 45 patients with an average age of 62.7 years. The tubular plate (TP) group included 30 patients with an average age of 60.0 years. The clinical results were compared between the two groups. Both of the groups were similar in respect to the injury mechanisms, fracture pattern, open fracture grade, compounding medical conditions, and ankle score (all P values <0.28). However, the KP group had significantly smaller wound incisions, shorter surgery time, shorter hospital stay, less meperidine use, less symptomatic hardware, and lower complication rates than the TP group (all P values <0.03). In conclusion, lateral fixation of AO type-B2 ankle fractures in the elderly by the Knowles pin is recommended due to its simplicity, efficacy and low complication rate.