Functional outcome of open distal femoral fractures managed with lateral locking plates.

PURPOSE: This prospective study evaluated the functional outcome and union rates of open distal femoral fractures managed with anatomic lateral locking plates. METHODS: Thirty-four patients with open distal femur fractures with mean age of 40.8 years (range 20-65 years) were included in the study. Patients with Gustilo-Anderson grade IIIC fractures and those managed with non-locking modalities were excluded. In total, 70.6% (n = 24) of the fractures were Type IIIA and 55.9% (n = 19) were AO/OTA Type C3 fractures. In 23.5% (n = 8) patients, knee spanning external fixator was applied initially before definitive fixation. Patients were followed up for a mean period of 11.6 months (range 8-22.5 months). Functional outcome was evaluated using Sanders Score. RESULTS: In the primary plating group, 69.2% (n = 18) fractures united at an average of 27 weeks (range 21-40 weeks), while eight patients had non-union and required bone grafting. All eight patients with external fixator underwent lateral locked plating with bone grafting and united at an average time of 39.6 weeks (range 31-50 weeks). There were two cases each of infection and screw failure. The final mean Sanders Score was 30.1 (range19-40) with 73.5% (n = 25) patients having good to excellent functional outcomes. CONCLUSIONS: Lateral locking plates offer excellent stability to allow fracture union in open distal femoral fractures. A proactive approach to identify and manage potential healing difficulties is advisable to promote bone healing.

Outcome of anatomic locking plate in extraarticular distal humeral shaft fractures.

BACKGROUND: Extraarticular fractures of distal humerus are challenging injuries to treat because of complex anatomy and fracture patterns. Functional bracing may not provide adequate stability in these injuries and operative treatment with intramedullary nails or conventional plates also has the limitation of inadequate fixation in the short distal fragment. The 3.5 mm precontoured single column locking plate (extraarticular distal humerus plate [EADHP]) has been introduced to overcome this problem. We evaluated the clinical and functional outcomes of treating these fractures with the EADHP. MATERIALS AND METHODS: 26 patients with extraarticular fractures of distal humerus presenting within 3 weeks of injury between January 2012 and June 2015, were included in this prospective study. Open IIIB and IIIC fractures, nonunions, or those with a history of previous infection in the arm were excluded. Operative fixation was done using the EADHP in all the cases. The time for union, range of motion at shoulder and elbow and secondary procedures were recorded in followup. The shoulder and elbow function was assessed using the University of California Los Angeles (UCLA) shoulder scale and Mayo Elbow Performance Score (MEPS) respectively. RESULTS: There were 21 males and 5 females with mean age of 37.3 years (range 18-72 years). Twenty two (84.6%) cases had complex fracture patterns (AO/OTA Type 12-B and C). The mean time to fracture union was 22.4 weeks (range 16-28 weeks). The mean followup time was 11.6 months, (range 4-24 months). Four patients (15.4%) had failure of cortical screws in the proximal fracture fragment, of which two required revision fixation with bone grafting. Another nonunion was seen following a surgical site infection, which healed after wound lavage and bone grafting. The MEPS (average: 96.1; range 80-100) was excellent in 81% cases (n = 21) and good in 19% cases (n = 5). UCLA score (average: 33.5; range 25-35) was good/excellent in 88.5% cases (n = 23) and fair in 11.5% cases (n = 3). CONCLUSION: EADHP is a reliable option in treating extraarticular distal humeral fractures as it provides stable fixation with an early return to function.

Chronic Plantar Fasciitis: Effect of Platelet-Rich Plasma, Corticosteroid, and Placebo.

Plantar fasciitis is a common cause of heel pain. It is a disabling disease in its chronic form. It is a degenerative tissue condition of the plantar fascia rather than an inflammation. Various treatment options are available, including nonsteroidal anti-inflammatory drugs, corticosteroid injections, orthosis, and physiotherapy. This study compared the effects of local platelet-rich plasma, corticosteroid, and placebo injections in the treatment of chronic plantar fasciitis. In this double-blind study, patients were divided randomly into 3 groups. Local injections of platelet-rich plasma, corticosteroid, or normal saline were given. Patients were assessed with the visual analog scale for pain and with the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle and Hindfoot score before injection, at 3 weeks, and at 3-month follow-up. Mean visual analog scale score in the platelet-rich plasma and corticosteroid groups decreased from 7.44 and 7.72 preinjection to 2.52 and 3.64 at final follow-up, respectively. Mean AOFAS score in the platelet-rich plasma and corticosteroid groups improved from 51.56 and 55.72 preinjection to 88.24 and 81.32 at final follow-up, respectively. There was a significant improvement in visual analog scale score and AOFAS score in the platelet-rich plasma and corticosteroid groups at 3 weeks and at 3-month follow-up. There was no significant improvement in visual analog scale score or AOFAS score in the placebo group at any stage of the study. The authors concluded that local injection of platelet-rich plasma or corticosteroid is an effective treatment option for chronic plantar fasciitis. Platelet-rich plasma injection is as effective as or more effective than corticosteroid injection in treating chronic plantar fasciitis.

Open posterior dislocation of hip in a 6-year-old boy: a rare case report.

Open hip dislocation in pediatric patients is a rare injury. Open posterior dislocation because of soft tissue damage is unstable after reduction. There is no treatment protocol in the literature for this injury in pediatric patients. We treated a 6-year-old boy presented with open posterior hip dislocation. Thorough debridement was performed and antibiotics were administered to prevent infection, and fixation of reduction with Kirschner-wires (K-wires) was performed. Nonthreaded K-wires were used under an image intensifier to minimize the risk of physeal injury. A hip spica cast was used to prevent the breakage of K-wires into the joint because of movements at the hip.

Suture anchors and tacks for shoulder surgery, part II: the prevention and treatment of complications.

The use of suture anchors and tacks around the shoulder requires a thorough knowledge of the proper use of the devices and how to insert them. Although typically not technically demanding, suture anchors and tacks can present unique and frustrating challenges to the patient and the surgeon. These challenges can occur whether the procedure is performed via an open or arthroscopic approach, but knowledge of the potential challenges may optimize the surgical result and prevent complications. Complications can be categorized as technique-related or device-related issues (mechanical or biologic failure). Technique-related complications include problems with the delivery systems, anchor malpositioning, and suture management issues, such as knots not sliding. Device-related complications include implant fracture, migration secondary to poor fixation, synovitis from implant degradation, and osteolysis. This review describes the prevention of these and other complications, addresses the indications or need for intervention, and suggests potential solutions when intervention is indicated.

Suture anchors and tacks for shoulder surgery, part 1: biology and biomechanics.

The development and successful clinical application of suture anchors and tacks have revolutionized the surgeon's ability to secure soft tissues to bone via open or arthroscopic surgical techniques. When used carefully and with proper technique, these devices provide viable options for the repair and reconstruction of many intra-articular and extra-articular abnormalities in the shoulder, including rotator cuff tears, shoulder instability, and biceps lesions that require labrum repair or biceps tendon tenodesis. Like many technologies, however, the successful application of these devices requires an understanding of the biology and biomechanics that affect their use in the shoulder as well as knowledge of the factors that can affect subsequent clinical outcomes, including complications.