ABSTRACT
BACKGROUND: Distal femoral fractures represent a challenging injury, with many different factors such as the method of fixation, complexity of fracture pattern, and patient co-morbidities affecting the outcome. Lots of surgical treatment options have been described, but recently double construct fixation, using a nail/plate combination, has received lots of attention, a technique that leads to faster weight-bearing, low risk of metalwork failure, and non-union. The purpose of this study was to investigate the effectiveness of the linked nail/plate construct in the management of complex distal femur fractures and to investigate if the above technique leads to faster recovery and earlier radiographic union. MATERIALS AND METHODS: In total 15 cases were included in the study, that underwent a combined nail/plate construct for a distal femur fracture between January 2021 and December 2022. Only cases with a linked nail/plate construct were included, with a minimum follow-up of 1 year. Open femur fractures, single implant fixation cases, and revision procedures were excluded. RESULTS: In this cohort study, 11 cases were periprosthetic distal femur features, and 4 cases were distal femur fractures around a native knee joint. The mean age group was 74 years, 86.6% of the patients had a BMI > 25 and the mean time to fracture union was 24 weeks (range from 20 to 26 weeks). All cases healed uneventfully and the complication rate was 6.6%, including 1 case of superficial infection which resolved completely with oral antibiotics. CONCLUSION: The increasing age population, the complexity of distal femoral fractures along with the increasing physiological demands of the elderly population, drive the need for double fixation constructs that allow early mobilization and enhance fracture stability. In our study, the linked nail/plate construct seems to provide adequate stability and excellent union rates (100%) with no associated increased risk of complications.
ABSTRACT
For complex distal femoral fractures, a single lateral locking compression plate or retrograde intramedullary nail may not achieve a stable environment for fracture healing. Various types of double fixation constructs have been featured in the current literature. Double-plate construct and nail-and-plate construct are two common double fixation constructs for distal femoral fractures. Double fixation constructs have been featured in studies on comminuted distal femoral fractures, distal femoral fracture with medial bone defects, periprosthetic fractures, and distal femoral non-union. A number of case series reported a generally high union rate and satisfactory functional outcomes for double fixation of distal femoral fractures. In this review, we present the state of the art of double fixation constructs for distal femoral fractures with a focus on double-plate and plate-and-nail constructs.
ABSTRACT
To prevent fixation defects or artifacts in the whole bodies of fish caused by conventional fixatives, such as formalin solution, Bouin's fluid (BF), and Davidson's fluid (DF), the optimal fixatives and fixing method were examined. An improved method of fixing the whole bodies of fish was examined that makes use of a combination of 20% formalin and BF or DF. The fixatives were examined with four representative tissues, i.e., the gill, liver, intestinal tract, and kidney, to evaluate end points including the appearance of degraded tissues and artifacts caused by each fixative, overall morphological clarity of nuclei, staining intensity, and integrity of the other tissues. The best results were obtained when the fresh whole bodies were initially fixed in 20% formalin (primary fixation) at 4°C for 1 h and subsequently fixed in BF for 5 h at 4°C (secondary fixation). Therefore, the current findings led the authors to conclude that the combination of primary fixation with 20% formalin at 4°C for 1 h and secondary fixation with BF at 4°C for 5 h was suitable for fixation of the whole bodies of fish.
ABSTRACT
Objective@#To investigate the clinical effect of modified three minimally invasive blepharoplasty of double-fixation method.@*Methods@#From April 2015 to December 2016, 82 patients were included, all received minimally invasive blepharoplasty. Three 3 mm-long small incision (at medial, middle and lateral) were designed, then part of the orbicularis oculi muscle and pretarsal fat were removed. Pretarsal fascia was then sutured with orbicularis oculi muscle and skin with two-layer-suture to form double eyelid respectively.@*Results@#With up to 18 months follow-up, all patients had short period of detumescence within 7-12 days, high satisfaction rate with long lasting and natural double eyelid shape were achieved, no obvious scarring was noted.@*Conclusions@#Modified three minimally invasive blepharoplasty of double-fixation method has presented the merits of accurate presentation, natural shape, quicker recovery and less trauma, which makes it worthy of clinical presentation.
ABSTRACT
Introducción: La rotura del bíceps distal es una lesión poco frecuente producida por la aplicación de una fuerza excéntrica sobre el codo flexionado. El objetivo de este trabajo es analizar los resultados obtenidos para la reinserción del bíceps distal mediante técnica de doble fijación con botón de anclaje cortical y tornillo interferencial de biotenodesis a través de una incisión anterior única. Materiales y Métodos: Entre agosto de 2008 y febrero de 2013, registramos 19 casos de rotura del bíceps distal tratados quirúrgicamente por vía anterior limitada. Los 17 últimos casos consecutivos fueron tratados con doble fijación utilizando botón extracortical y tornillo de biotenodesis, y forman parte del estudio. Todos eran hombres, con una mediana de la edad de 41 años (rango 27-59). Los pacientes fueron evaluados con el Cuestionario DASH y el Puntaje Subjetivo/Objetivo de Andrews y Carson, y la fuerza de flexión y supinación se controló con la escala del British Medical Research Council modificada por Mackinnon y Dellon (M0-M5). Resultados: El cuestionario DASH arrojó un valor mediano de 1,7 (0-5,83) y el de Andrews y Carson, de 195 (170-200) para el total; con 15 resultados excelentes y 2 buenos. Todos consiguieron una fuerza M5 para flexión y supinación de antebrazo. El seguimiento tuvo una mediana de 12 meses (4-32). En dos pacientes, se registraron complicaciones, ambas con recuperación ad íntegrum. Conclusión: La técnica descrita ha demostrado ser confiable y eficaz, y permitió lograr resultados satisfactorios y una baja tasa de complicaciones.(AU)
Background: The distal biceps rupture is an unusual lesion produced when an eccentric force is applied to the bent elbow. The aim of this work is to analyze the results for the reinsertion of the distal biceps with a double fixation technique of cortical button and biotenodesis interference screw through a single anterior incision. Methods: Between August 2008 and February 2013 we registered 19 cases of distal biceps rupture, surgically treated through an anterior limited procedure. The last 17 consecutive cases were treated with double fixation using an extracortical button and biotenodesis screw and are part of this study. All the patients were males with a median age of 41 years (range 27-59). The patients were evaluated using the DASH questionnaire and the subjective/ objective scoring system of Andrews and Carson, controlling the flexion and supination forces with the British Medical Research Council scale, modified by Mackinnon and Dellon (M0-M5). Results: DASH questionnaire obtained a median value of 1.7 (0-5.83), and the Andrews and Carson score had a median value of 195 (170-200) for the total; with 15 excellent results and 2 good results. All patients achieved a force of M5 in flexion and supination of the forearm. The follow-up had a median of 12 months (4-32). Complications were registered in two patients, both recovered ad integrum. Conclusion: The described technique proved to be both reliable and effective, giving satisfactory results with a low complication rate.(AU)
