Distal humerus fractures nonunion with elbow stiffness in working adults: Can triple tension band technique and Lambda Plate(®) be a standby solution?

BACKGROUND: Distal humerus fracture nonunion and associated elbow stiffness are two intermingled orthopaedic challenges for working adults. This prospective study aimed to evaluate the short-term results of the triple tension band and Lambda plate in managing both problems. METHODS: The study included fourteen cases. The mean age was 35.7 ± 8.5 years (range 25-49). Eight cases were males. Initial management was conservative in three cases. Three cases had a history of infected nonunion. Eight cases had initially OTA type C injuries and six cases had type A injuries. All cases had olecranon osteotomy, triple tension band, Lambda plating, and autogenous bone grafting. Five cases had ulnar nerve anterior transposition. Evaluation of the cases was objectively via Mayo Elbow Performance (MEP) score and subjectively through Disabilities of the Arm, Shoulder and Hand (DASH) score. RESULTS: The average follow-up period was 23.7 ± 5.3 months. All cases had a solid bony union in a mean of 16.4 ± 2.1 weeks and the final range of motion averaged 100 ± 19.6°. MEP and DASH scores had significant improvement at the final follow-up periods (P = 0.001). Cases with transposed ulnar nerve had significantly less MEP scores (P = 0.028) and more DASH scores (P = 0.013). CONCLUSIONS: The prescribed technique could be a good alternative to the known traditional methods with the advantages of: good exposure for arthrolysis; rigid and stable internal fixation even with low bone quality or small-sized distal fragments; and secure early rehabilitation.

Standalone percutaneous transiliac plating of vertically unstable sacral fractures: outcomes, complications, and recommendations.

PURPOSE: The aim of this study is to evaluate results of a standalone percutaneous posterior plating of the vertically unstable sacral fractures, to analyze the influencing factors, to discuss encountered complications, and to express the related recommendations. METHODS: Forty two cases were included; all of them had type C vertical sacral fractures; and 16 cases had associated nerve roots injury. Subcutaneous 3.5-mm reconstruction plate was used in all cases, through vertical incisions in 28 cases and transverse incisions in 14 cases. Hannover pelvic outcome scoring system was implemented for results evaluation. RESULTS: The mean follow-up period was 22.1 ± 7.5 months; the mean operative time was 43.3 ± 7 min; the mean surgical incision length was 4.6 ± 1.1 cm. 14 cases had excellent scores, 16 cases had good scores, 6 cases had fair scores, and 6 cases had poor scores. Younger age groups had significantly better outcome (P = 0.015), whereas the comminuted sacrum had significantly worse score (P = 0.041). Final residual posterior displacements significantly improved (P = 0.001) in comparison to the initial displacement. The nerve roots injury had final significant recovery (P = 0.012). Transverse skin incisions had subjectively significant satisfaction (P = 0.017). CONCLUSIONS: Percutaneous 3.5-mm reconstruction plate is a good alternative to percutaneous iliosacral screws in vertically unstable sacral fractures; especially in the presence of contraindication to the latter. It is simple procedure with minimal incisions; short operative time; less radiological exposure; good mechanical stability; and less iatrogenic injuries.

Hind-foot correction and stabilization by pins in plaster after surgical release of talipes equino varus feet in older children.

Congenital talipes equino varus (CTEV) is a three dimensional deformity and is one of the most common congenital abnormalities affecting the lower limb and can be challenging to manage. Hind-foot deformity is considered the most difficult to treat. Unfortunately, the calcaneus is often small and thus difficult to control during casting after surgical release in severe or relapsed cases. We used three pins to control and maintain the hind foot correction, after surgical release, during casting in 47 cases (59 feet). We introduced a modified, coronal plane, transverse calcaneal pin. This pin is inserted from medial to lateral through the calcaneus to correct the varus mal-positioning of the calcaneus in the sagittal plane and to provide a better control on the small sized, hind-foot during casting. We paid special attention to the final hind-foot deformity after surgery, and the results were favorable after the application of this transverse pin.