Treatment of midshaft clavicular fractures with elastic titanium nails.

BACKGROUND: One of the modern techniques for the treatment of clavicle fracture (Fx) is elastic titanium intramedullary nailing. But, there are different opinions about this technique. We studied this technique in 12 patients with clavicle Fx and assessed its outcome. OBJECTIVES: We aimed to study the prognosis of midshaft clavicular Fx treated via minimally invasive stable elastic intramedullary nailing. PATIENTS AND METHODS: We operated on 13 clavicle Fx in 12 patients from 2008 through 2012. We used a new technique called minimally invasive titanium elastic intramedullary nailing for operating patients with midshaft clavicular Fx. RESULTS: Clinical union was achieved 3-5 weeks after the operation with no pain over Fx sites upon physical examination. Radiologic union appeared at 6 to 12 weeks .We did not encounter nonunion or infection, but one of the comminuted Fx united 1 cm shorter; however, it had a solid union with a good score. All but two patients had good scores. CONCLUSIONS: Although controversy exist regarding intramedullary nailing of clavicle Fx, our results using this technique for minimally comminuted midshaft clavicular Fx were very good.

Clinical results of using the proximal humeral internal locking system plate for internal fixation of displaced proximal humeral fractures.

Proximal humerus fractures are accounting for 4-5% of all fractures with increasing incidence. Proximal Humeral Internal Locking System (PHILOS) plate is a new plate which permits early mobility and lowers the risk of complications. The aim of this study was to evaluate the functional outcome and the complication rate after using this plate. Between 2006-2008, 37 patients with displaced 2-, 3-, and 4-part fractures of the proximal humerus underwent surgery using PHILOS plate. The mean range of follow-up was 12 months. Twenty patients were aged 60 years and younger, and 17 were aged older than 60 years. The average American Shoulder and Elbow Surgeons (ASES) score at the final follow-up was 77.62. According to Michener and colleagues classification, 5.4% of patients had an excellent outcome, 72.9% were minimally functionally limited, 16.2% were moderately functionally limited, and 5.4% were maximally functionally limited. The average ASES score between patients 60 years and older and those 60 years and younger was not different significantly. One patient developed avascular necrosis of the humeral head, 2 patients developed an infection, and no patients developed a nonunion. Fixation with PHILOS plate can be considered a good method with high union rates for this kind of fracture, especially in the older population with osteoporotic bone.

Treatment of nonunion of femoral neck fracture by valgus osteotomy in 33 cases.

In spite of advances in treatment, femoral neck fractures are complicated fractures with a relatively high incidence of nonunion. Between 1990 and 2004, 33 patients with nonunion of femoral neck fractures were treated by valgus osteotomy in our department. The mean age of patients at the time of operation was 38 years (range 16-60 years). Reasons for nonunion were implant failure in 21 and osteomalacia in two patients. The remaining ten patients were treated nonoperatively. Average neck-shaft angle was 109° (78°-125°), and the average shortening of the involved limb was 2.5 cm (0.5-4.5). After subtrochanteric valgus osteotomy, fracture healing occurred in 32 of 33 patients. The average time for healing was five months (range 3-8 months). Pain and limitation of motion improved remarkably, and the majority of patients did not need to use crutches. Postoperatively, the neckshaft angle was 140° (125°-160°), and shortening reduced to an average of 1 cm. Partial avascular necrosis of the femoral head developed in five patients after 6-12 months. Valgus osteotomy of the femur is a suitable procedure for treatment of femoral neck nonunion in young patients, since it is easy to perform and yields relatively good results.