Metacarpal Locked Intramedullary Nail: Surgical Technique and Preliminary Outcome Report.

In surgically indicated metacarpal fractures, the ideal fixation should provide an ample stability for early rehabilitation. Damage to surrounding tissue should be minimized as well, to prevent stiffness which determine the outcomes. We have created the metacarpal locked intramedullary nail (MCLN) that allows immediate motion even in unstable fractures. This preliminary report is objected to demonstrate the surgical technique and outcomes of novel metacarpal fixation. Three surgical indicated metacarpal fractures were treated by MCLN. Unlimited motion was started a day after surgery without external immobilization. Clinical and radiographic control were performed up to two years after the surgery. All of patients returned to previous level of daily activities within six weeks with minimal scar. All fractures were united. The total active motions were above 260° in every patient. Complications were not observed. With this encouraged clinical results, the MCLN could be the promising alternative surgical fixation for metacarpal shaft fractures.

Effectiveness of sonography assisted minimal invasive plate osteosynthesis (MIPO) compare with fluoroscope assisted in femoral shaft fracture: A cadaveric study.

INTRODUCTION: A minimal invasive plate osteosynthesis (MIPO) has an advantage of biological soft tissue preservation that consists of preserving bony blood supply, fracture hematoma and less soft tissue damage which leads to decreasing of infection rate and rapid bone healing. However, the radiation exposure is still a disadvantage of this technique. A sonography that provides dynamic real time imaging may be used as an alternative technique for assisting MIPO. The aim of this study was to compare the effectiveness of MIPO in femoral shaft fracture between the sonography assisted and the fluoroscopy assisted. METHODS: Twenty-eight cadaveric limbs were subjected to create femoral shaft fracture. Then, sonography assisted reduction with temporary external fixation and MIPO were performed. Images of the sonography and the fluoroscopy were recorded including before reduction, after reduction and after MIPO in order to identify fracture displacements in anteroposterior and mediolateral directions. Moreover, the anterior and posterior distances from edge of the bone to the plate were measured to confirm plate position. The effectiveness of this technique was defined as the proper plate position and acceptable alignment after fixation. All distances from the sonography and the fluoroscopy were also analyzed and compared using Pearson correlation and Bland-Altman method to assess the agreements between two tests. RESULT: All of the subjects were met the criteria for acceptable alignment. We found only three femoral shaft fracture (11%) operated with MIPO by sonography assisted that showed slipped plate off femoral bones. According to Pearson correlation, there were good to excellent agreements in term of measuring fracture displacement before (Pearson Correlation >0.7) and after reduction (Pearson Correlation >0.7) between these two tests. There was moderate agreement regarding to evaluation of plate position (Pearson Correlation 03.-0.7). When we compared two methods of measurement using Bland-Altman plot, there were no statistical significant difference (P<0.05). CONCLUSION: Images from the sonography could provide visualization of the fracture during reduction and MIPO as accurately as the radiography. Thus, the sonography assisted MIPO in femoral shaft fracture can be done effectively comparing with radiographic assisted.

Surgical complications following ESIN for clavicular mid-shaft fractures do not limit functional or patient-perceived outcome.

Elastic intramedullary nailing (ESIN) has been proposed as an alternative minimal-invasive method for the operative management of mid-shaft fractures of the clavicle. However, a relevant complication rate has been reported in previous cohorts. The present retrospective single-centre study aimed to analyse the complications following ESIN in adult patients with clavicular mid-shaft fractures (Allman type I) and their impact on functional and patient-perceived outcome measures. Results were compared to a control group receiving locking plate osteosynthesis. The clinical course and outcome of operatively managed patients with clavicular mid-shaft fractures were retrospectively analysed. Patients were assigned to group A (ESIN) and group B (plate fixation). Radiological, functional (Constant Murley Shoulder Outcome Score (CS), the Disabilities of the Arm, Shoulder and Hand (DASH) Score, the Oxford Shoulder Score (OSS)), and patient perceived aesthetic and clinical outcome were measured. A total of 47 (33 male, 14 female) operatively managed patients with a mean age of 26.7 ± 14.9 years and a follow up time of 38.1 ± 19.4 months were analysed. 36 patients were treated by ESIN (Group A), whereas 11 patients received open reduction and internal plate fixation (Group B). Patients were operatively treated with a mean delay of 7.4 ± 9.3 days (group A: 6.6 ± 8.7 days, group B: 10.2 ± 11.1 days, p=0.326) between trauma and the surgical index procedure. There were no significant differences in the functional (CS: p=0.338, DASH: p=0.247, OSS: p=0.434) and patient-perceived (p=0.346) outcome measures between both groups. Surgical complications were noted in 14 patients (group A: 12, group B: 2) and non-union in 4 patients (group A: 3, group B: 1). There was no correlation between the recorded complications as assessed by the Clavien and Dindo classification and the functional as well as the patient-perceived outcome measures. Despite a relevant incidence rate of surgical complications, ESIN provides good to excellent functional and patient-perceived results in the treatment of clavicular mid-shaft fractures.

Fixation of the Femoral Subtrochanteric Fracture with Minimally Invasive Reduction Techniques

PURPOSE: To evaluate the results of using minimally invasive reduction techniques in patients with femoral subtrochanteric fracture. MATERIALS AND METHODS: We retrospectively analyzed 40 patients (41 cases) with subtrochanteric fracture who underwent using minimally invasive reduction techniques. The mean age was 61.4 years (15-89 years), and the mean follow-up period was 32.7 months (12-66 months). Clinical results were assessed using the Parker-Palmer mobility score and the Salvati-Wilson hip functional score. Radiographic results were evaluated using bone union time and femur neck-shaft angle. RESULTS: No significant difference was observed in the pre- and postoperative Parker-Palmer mobility score. Salvati-Wilson hip functional score showed more than good grade in 37 cases (90%) at the last follow-up. Union was achieved in all 41 cases at an average of 22.5 weeks (18-30 weeks). The mean femoral neck-shaft angle immediately postoperatively was 128.8 degrees (120-140 degrees), and the mean difference versus contralateral sides was 2.5 degrees varus (-6-13 degrees). CONCLUSION: Fixation of femoral subtrochanteric fracture using minimally invasive reduction techniques showed excellent clinical and radiographic results and low complication rate.

Minimal Invasive PHILOS(®)-Plate Osteosynthesis in Proximal Humeral Fractures.

INTRODUCTION: The anterior delto-pectoral approach is the standard approach for the fixation of proximal humeral fractures with the PHILOS(®)-Plate system. However, this approach can impair the vascular supply and can increase avascular necrosis. The objective of this study was to evaluate the results and complexity of surgery of proximal humeral fractures with a minimal invasive (MIPO) approach. METHODS: All PHILOS(®)-plate osteosynthesis operated between Januray 2003 and June 2006 were evaluated prospectively. A minimal invasive antero-lateral deltasplit-approach was performed in all two to four fragment instable fractures meeting the indication for osteosynthesis according to Neer. An open approach (ORIF) was chosen in all other fractures mainly dislocated fractures and particularly in fractures with major subcapital displacement. RESULTS: A cohort of 68 patients suffered a proximal humerus fracture and qualified for a minimal invasive approach with a PHILOS(®)-plate osteosynthesis. Of these 68 patients, 41 were locally resident. Eight patients refused a follow-up, two patients were in constant care, and two patients died; 29 patients (71%) (20 females, 9 males) could be documented entirely with a median age of 64 years. The median operation time amounted to 75 min with a fluoroscopic time of 160 s. The median Constant score was 78 after 12 months. All fractures healed in adequate time. One patient showed a lesion of the ventral part of the axillary nerve. No patient suffered an avascular necrosis. DISCUSSION: The minimal invasive PHILOS(®) plate osteosynthesis through an antero-lateral delta-split approach proved to be an elegant procedure for selected fractures of the proximal humerus with a low morbidity and good functional outcome.