RESUMO
Objectives Anterior column fractures can be seen as either isolated or accompanied by many types of complex acetabulum fractures. The aim of this study was to biomechanically compare the stability of a standard pelvic brim plate with a more laterally located suprapectineal plate, which is more commonly used in minimally invasive application, on an intermediate height anterior column fracture model under dynamic and static loading. Materials and methods Right side, adult, foam cortical shell artificial hemipelvis models were used (Sawbones, Pacific Research Laboratories, Vashon, WA, USA). Twenty-four (24) pieces of foam cortical shell artificial hemipelvis models were separated into three groups (M, L, and control). In group "M," a suprapectineal plate was placed medially just adjacent to the pelvic brim. In group "L," a laterally located suprapectineal plate was placed 2 cm lateral of the pelvic brim at its most proximal point. Then, dynamic load testing of 1000 cycles between 50 N and 500 N force and a static load test of 1.2 kN at 2 mm/minute were applied. Dynamic and static tests were conducted on an axial compression device. Displacements were measured after dynamic and static loading conditions. Results In the dynamic loading test at the AL point (superior intersection of the fracture line with the acetabular roof), the median displacement was significantly higher in group L than in group M (0.12 (IQR: 0.058-0.8125) mm and 0.04 (IQR: 0.03-0.065) mm (p = 0.02)). There was no other statistically significant difference in the displacement amounts in both dynamic and static loading conditions at other measurement points. The comparison of the stiffness of the M and L groups showed no statistically significant results, while the control group was significantly more rigid than both the M and L groups (p = 0.04 for both). None of the artificial hemipelvis models was found to be fractured at the end of the test. Conclusion Suprapectineal plates, placed on either the medial or lateral aspect of the pelvic brim, may be used for the fixation of anterior column-type fractures to provide rigid fixation and stability. As plate location did not impact stiffness and stability, the results suggest that surgeons have flexibility in determining the fixation based on accessibility, fracture pattern, and surgeon experience.
RESUMO
Background Knee arthroscopy is the most common surgery performed to treat meniscal injuries. The pie crust (PC) technique is applied during knee arthroscopy to increase joint vision of the medial femorotibial compartment and reduce the risk of iatrogenic damage. Medial collateral ligament (MCL) release is applied in the PC technique. Currently, there are no studies directly comparing the release of the superficial MCL (sMCL) or deep MCL (dMCL) when applied during the PC technique. In this study, we compared the clinical and functional results of the release of the deep and proximal tibial attachment of the superficial fibers of the MCL. Methodology We evaluated the results of 67 (27 women and 40 men) patients who underwent the PC technique during knee arthroscopy due to a medial meniscal tear. The patients who underwent the PC technique were divided into two groups according to the release of the deep and superficial fibers of the MCL. All patients were evaluated for pain, functional capacity, and laxity using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Oxford Knee scores. All patients were evaluated with radiographic examinations such as valgus laxity angle and medial tibiofemoral compartment opening height. Results The KOOS and Oxford Knee Scores in both groups showed a statistically significant increase at 12 months postoperatively compared with the preoperative values (p = 0.005, 0.002, 0.002, and 0.01, respectively). No statistically significant difference was found between the groups (p > 0.05). When the valgus laxity angle before the PC technique was compared with the 12-month result after the procedure, no statistically significant difference was noted (p > 0.05). There was no evidence of complications such as chondral injury and saphenous nerve or vein injury among patients in either group. Conclusions In this study, we did not observe laxity in the long-term follow-up of the groups in which the superficial or deep fibers of the MCL were released. In our view, the PC technique has similar effects on surgical outcomes regardless of sMCL and dMCL release techniques.
RESUMO
Most gunshot injuries to the hand involve a combination of tissue types. The goal of this study is to report the results of early definitive treatment in extra-articular metacarpal and proximal phalangeal fractures due to low velocity gunshot wounds and to analyse their outcomes. A retrospective analysis of 51 metacarpal and 41 proximal phalangeal fractures of 76 patients due to low velocity gunshot wounds treated between January 2001 and December 2004 was carried out. We applied acute fixation in the first 24 hours. The patients were evaluated with total active motion scores, radiographic control, complication rate and the need for revision surgery. The infection frequency was 10.5% and the need for a revision surgery was 7%. The plate fixation group had significantly higher total active motion scores than the external fixation group. The K wire group had the highest revision rate. The bone grafting group was associated with good total active motion scores and low complication rates. The majority of the low velocity gunshot injuries are surgically clean wounds which allow not only early fracture fixation, but also early bone grafting and soft tissue reconstruction. Plate and screw fixation is associated with significantly better functional outcomes than the minimal fixation group.
