[Fixation of trochanteric or subtrochanteric fractures using dynamic external fixators]. / Ostéosynthèse des fractures trochantériennes ou sous-trochantériennes par fixateur externe dynamique.

We present a fixation system for trochanteric or subtrochjanteric fractures using a dynamic external fixator. The Citieffe/CH-N fixator was proposed for elderly patients with a significant operative risk (ASA III or IV). A long dynamic screw measuring 9 mm in diameter is inserted into the neck and the head of the femur on a guide wire through a tube protecting skin and muscles. This long screw is connected to the body of the fixator to enable impaction at the fracture level if compression is needed. The dynamic screw can be released to allow free gliding to achieve a dynamic fixation of the fracture. Distraction with the fixator can also be used for subtrochanteric unstable fractures to correct a varus deformity. This technique is a simple rapid solution with minimal operative risk. Complications are minimal and generally temporary, e.g. pin tract infections.

Results of surgical treatment of tibial plafond fractures.

To clarify which factors influence the final result of surgical management of plafond or pilon fractures, 66 patients with 67 pilon fractures treated at the Orthopaedic Department of the University of Athens between 1978 and 1993 were reviewed. There were eight (11.95%) Type I, 33 (49.25%) Type II, and 26 (38.8%) Type III fractures according to the Ruedi-Allgower classification. Eleven (16.4%) were open injuries. Fifty of the 67 fractures were treated by internal fixation following the AO principles, whereas minimal osteosynthesis was performed in nine cases, and the remaining eight cases were managed by external fixation. The final outcome of the treatment was evaluated after 2 to 17 years followup (mean, 8.1 years) and was based on the subjective, objective, and radiographic results of each case, using the method of Burwell and Charnley. The findings indicate that three parameters significantly influenced the outcome of plafond fracture management. Specifically, the results of surgical management were affected by the clinical type of the fracture, the quality of reduction achieved at surgery, and the specific surgical procedure by which the fracture was managed.

[Treatment of trochanteric fractures by external fixator]. / Le traitement des fractures trochantériennes par fixateur externe.

INTRODUCTION: The goal of this study was to report and evaluate the place of external fixation in the treatment of trochanteric fractures in patients with high unacceptable operative risk to withstand conventional osteosynthesis. MATERIAL AND METHODS: From January 1990 to December 1991 (2 years period), 42 patients, 13 males and 29 female, mean age 84.1 years, suffering from trochanteric fracture and considered preoperatively as "poor medical status" were treated by external fixation and immediate mobilisation. The average operative time was 18 minutes and no blood transfusion was necessary per or post-operatively. The mean hospital stay was 19 days. RESULTS: All patients were followed up for 6 months post-operatively. During this time 8 patients (19 per cent) died due to medical problems unrelated to the fracture. All fractures united in an acceptable position at an average time of 10.4 weeks with no loss of reduction, no pin breakage, no deep infection. All hips were painless. COMPLICATIONS: proximal pin migration occurred in 3 patients (7 per cent) due to fracture impaction and superficial pin tract infection in 16 (38 per cent) with no further consequence. DISCUSSION: External fixation in trochanteric fractures has been applied since 1957 with good results. This series confirms the advantages of the method in patients with a high operative risk; these are short operative time, minimal blood loss, early mobilisation and acceptable morbidity and mortality rates, considering the old and senile age group with poor medical condition, not allowing conventional treatment. The minor complications such as superficial pin tract infection and proximal pin migration are easily controlled.

[Treatment of pseudarthrosis of the clavicle by bone plate with screw fixation and autologous spongiosa graft]. / Traitement des pseudarthroses de la clavicule par plaque vissée et greffe spongieuse autogène.

PURPOSE OF THE STUDY: The authors review and evaluate the operative treatment of mid-shaft clavicular non-union by compression plate osteosynthesis and most frequently by decortication and autogenous bone grafting. MATERIAL AND METHODS: From 1979 to 1990, 11 consecutive patients, 9 males and 2 females, mean age 33.5 years, with symptomatic non-union of mid-shaft clavicular fracture were operated and followed-up for an average of 4 years. The pseudarthrosis was atrophic in 10 and hypertrophic in 1 patient. The initial treatment of the fracture was always conservative. RESULTS: All patients achieved bone union by 3-7 months post operatively. The functional results were excellent in 9 patients. The remaining two patients had mild symptoms such as occasional pain related to weather, soreness of the muscles with overhead lifting and discomfort of the shoulder. Minor complications were noted such as 1 delayed wound healing, 3 cheloid scars and 1 transient partial paresis of the brachial plexus. DISCUSSION: Symptomatic non-union of the mid-shaft clavicular is a rare complication, mainly after non-operative treatment (11 cases in 12 years in our series). Factors responsible for non-union are the initial high velocity injury, the cominution, the overlapping and great displacement, the paucity of cancellous bone at this site and the trapezius interposition. Internal fixation by compression plating, decortication and bone grafting in atrophic non-union often encountered is a safe reliable method allowing uncomplicated healing and acceptable functional results.