Anterior approach for fixation of isolated type III coronoid process fracture.

Authors chose anterior approach through the antecubital fossa for better exposure in that case of isolated coronoid process fracture. The objective of the study was to report validity of anterior approach for the Regan and Morrey type III, isolated fracture of the coronoid process of the ulna without residual valgus or varus instability. From January 2007 and January 2010, we evaluated eleven consecutive patients (7 men, 4 women; mean age 44 years; range 25-67 years) who underwent surgical fixation through the anterior approach. The mean follow-up period was 21 months (range 15-34 months). Preoperative and follow-up roentgenograms were evaluated for assessment of the fracture configuration and confirmation of fracture union. Clinical evaluation included an analysis of surgical complication, range of motion, Mayo elbow performance score, and DASH (disability of the arm, shoulder, and hand) score. Fractures were mainly fixed with plate and screws in 8 cases, cannulated screws in 3 cases. There was no residual joint instability after fracture fragment fixation. All fractures were united, and the average union time was 15.2 weeks with a range of 11-20 weeks. Mean flexion contracture of the elbow was 3.6° (range 0°-10°), and further flexion was 130.9° (range 125°-140°) at the last follow-up. Mean Mayo elbow performance score was 92.3 (range 80-100 points), and mean DASH score was 5.9 (range 1.6-8.3 points). In conclusion, Primary fixation of the coronoid process fractures through the anterior approach could be particularly useful in the Regan and Morrey type III isolated coronoid process fractures.

Percutaneous retrograde intramedullary single wire fixation for metacarpal shaft fracture of the little finger.

This study aimed to evaluate the anatomic and functional outcome of retrograde intramedullary single wire fixation for metacarpal shaft fractures of the little finger. Forty consecutive patients with closed metacarpal shaft fractures of the little finger who have been treated with retrograde intramedullary single wire fixation were evaluated. Fracture union and angulation were analyzed radiologically, and clinical evaluations were performed including the percentage of total active motion (%TAM), disabilities of the arm, shoulder and hand (DASH) score, and complications. Fracture union was achieved in all cases, and callus formation was obvious at 42 days postoperatively. The average angulation of the fracture site was 2.7° in the coronal plane and 1.0° in the sagittal plane at the last follow-up, and no measurable metacarpal shortening was observed. Mean %TAM was 92.0 ± 6.2% (range, 84.6-100%), and DASH score was 2.8 ± 1.2 (range, 0-6). There were two cases of pin migration as intermediate complications. A closed reduction with subsequent percutaneous retrograde K-wire fixation produced good radiological and functional results. We recommend this minimally invasive technique which provides adequate fixation of displaced little finger metacarpal shaft fractures with good functional results and low morbidity.

Percutaneous transphyseal pin fixation through the distal physis of the ulna in pediatric distal fractures of the forearm.

OBJECTIVE: The purpose of this study is to report the long-term results of transphyseal Kirschner (K) wire fixation through the distal physis of ulna in distal fractures of forearm in pediatrics and to determine the safety of this procedure. DESIGN: We performed the study retrospectively. SETTING: All of the patient was treated operatively in the level 2 trauma center. PATIENTS: The medical records and radiographs of 44 pediatric patients who had the distal fractures of forearm retrospectively reviewed. INTERVENTION: After fixation of the radius percutaneously, retrograde percutaneous K-wire fixation through the distal physis of ulna was performed. MAIN OUTCOME MEASUREMENT: At final follow-up, the clinical results according to the system described by Price et al were graded and the range of motion of forearm and wrist was compared with contralateral normal arm. Radiologically, the length discrepancy of ulna and ulnar variance for analysis of premature physis closure was measured. RESULTS: The clinical results were excellent in 31 patients, good in 12, and fair in 1. There was no significant difference in the range of motion of forearm and wrist between arms. Radiologically, there was no evidence of physis closure in all patients. CONCLUSIONS: Retrograde percutaneous transphyseal K-wire fixation through the distal physis of ulna in pediatrics is a minimally invasive and technically easy treatment option.