Cadaveric Study of Bone Tissue Temperature During Pin Site Drilling Using Fluoroptic Thermography.

BACKGROUND: Using fluoroptic thermography, temperature was measured during pin site drilling of intact cortical human cadaver bone with a combination of 1-step drilling, graduated drilling, and 1-step drilling with irrigation of 5.0-mm Schanz pins. MATERIALS AND METHODS: A 1440 revolutions per minute constant force drilling was used on tibial diaphyses while a sensor probe placed 0.5 mm adjacent to the drill hole measured temperature. Four drilling techniques on each of the tibial segments were performed: 3.5-mm drill bit, 5.0-mm Schanz pin, 5.0-mm Schanz pin in a 3.5-mm predrilled entry site, and 5.0-mm Schanz pin using irrigation. RESULTS: One-step drilling using a 5.0-mm Schanz pin without irrigation produced a temperature that exceeded the threshold temperature for heat-induced injury in 5 of the 8 trials. With the other 3 drilling techniques, only 1 in 24 trials produced a temperature that would result in thermal injury. This difference was found to be statistically significant (P = 0.003). The use of irrigation significantly reduced the maximum bone tissue temperature in 1-step drilling of a 5.0-mm Schanz pin (P = 0.02). One-step drilling with a 3.5-mm drill bit achieved maximum temperature significantly faster than graduated drilling and drilling with irrigation using a 5.0-mm Schanz pin (P < 0.01). CONCLUSIONS: One-step drilling with a 5.0-mm Schanz pin into cortical bone can produce temperatures that can lead to heat-induced injury. Irrigation alone can reduce the temperatures sufficiently to avoid damage. Predrilling can increase temperatures significantly, but the extent of any injury should be small.

Results of a computed tomography protocol evaluating distal third tibial shaft fractures to assess noncontiguous malleolar fractures.

BACKGROUND: Intra-articular tibia fractures are reported to occur in 1% to 25% of tibia diaphyseal fractures. The objective of this study was to create a standard protocol to evaluate noncontiguous malleolar fractures associated with distal third tibial diaphyseal fractures using computed tomography (CT). METHODS: Sixty-six patients with 67 distal third tibia fractures were treated at a level one trauma center from December 2005 to November 2007. These patients were then evaluated using a CT protocol to assess the ankle joint. There were 45 men and 21 women with average age of 44 years (range 18-69 years). All films were independently examined by two orthopedic traumatologists and one musculoskeletal radiologist. RESULTS: Twenty-nine of 67 (43%) distal third tibial shaft fractures had associated intra-articular fractures determined by CT scan. There were 23 posterior malleolus fractures, 3 anterolateral fragments, and 3 medial malleolus fractures. Twenty-seven of 29 fractures (93%) were associated with spiral type fracture patterns (p = 0.001). Seventeen of 29 (59%) intra-articular fractures required operative fixation. Seventy-six percent were noncontiguous fractures. The radiologist detected 20 of 29 (69%) intra-articular fractures using high-resolution monitors, and the orthopedic surgeons averaged 13 of 29 (45%) using initial injury radiographs in the emergency department. CONCLUSION: Plain radiographs are often insufficient for detecting posterior malleolus fractures in conjunction with ipsilateral distal third diaphyseal tibia fractures. Using a preoperative CT protocol for tibial shaft fractures can significantly improve the ability to diagnose associated intra-articular fractures that may not be evident on plain radiographs. Knowledge of these associated intra-articular fractures may prompt fracture stabilization and can prevent displacement during intramedullary nailing of tibia shaft fractures.

Minimally invasive plate osteosynthesis for proximal humerus fractures: functional results of treatment.

Proximal humeral fractures can safely and effectively be treated with minimally-invasive plate osteosynthesis (MIPO). Twenty-one patients treated with MIPO for 2-, 3-, and 4-part proximal humerus fractures were treated at a mean 6.8 days (range, 1-24 days) after injury and followed for a mean of 24 months (range, 5-38 months). All fractures healed by 8 weeks postoperatively, with reductions "good" in 18 (86%) of patients and "fair" in 3 (14%). There were no infections or nerve or vascular injuries. One patient had loss of reduction that healed but required hardware removal. The neck-shaft angle was measured intraoperatively and at final follow-up, with mean (SD) of 139° (9.3; range, 123°- 156°) and 138° (8.9; range, 123°- 159°), respectively. Mean (SD) displacement from the most superior aspect of the humeral head articular surface to the top of the greater tuberosity was 4.3 (10) mm. Mean (SD) active range of motion was 143° (35.04; range, 80°- 180°) for forward flexion, 118° (46.8; range, 45°- 180°) for elevation, and 33° (19.2; range, 10°- 65°) for external rotation. The mean Disability of the Arm, Shoulder, and Hand (DASH) score was 25.95 (range, 0-80). Excluding patients with associated injuries, a statistically significant difference (P<.05) was found in the DASH scores for those patients with greater tuberosity displacements between 3 mm and 8 mm and those patients with greater tuberosity displacement greater than 8 mm inferior to the articular surface. Clinical outcomes depended upon reduction of the greater tuberosity, which is facilitated by the MIPO technique.

Outcomes of nonoperatively treated displaced scapular body fractures.

BACKGROUND: Displaced scapular body fractures most commonly are treated conservatively. However there is conflicting evidence in the literature regarding the outcomes owing to retrospective design of studies, different classification systems, and diverse outcome tools. QUESTIONS/PURPOSES: The functional outcome after nonoperative management of displaced scapular body fractures was assessed by change in the DASH (Disability of Arm, Shoulder and Hand) score; (2) the radiographic outcome was assessed by the change of the glenopolar angle (GPA); and (3) associated scapular and extrascapular injuries that may affect outcome were identified. PATIENTS AND METHODS: Forty-nine consecutive patients were treated with early passive and active ROM exercises for a displaced scapular body fracture. We followed 32 of these patients (65.3%) for a minimum of 6 months (mean, 15 months; range, 6-33 months). Mean age of the patients was 46.9 years (range, 21-84 years) and the mean Injury Severity Score (ISS) was 21.5 (range, 5-50). Subjective functional results (DASH score) and radiographic assessment (fracture union, glenopolar angle) were measured. RESULTS: All fractures healed uneventfully. The mean change of glenopolar angle was 9° (range, 0°-20°). The mean change of the DASH score was 10.2, which is a change with minimal clinical importance. There was a correlation between the change in this score with the ISS and presence of rib fractures. CONCLUSIONS: Satisfactory outcomes are reported with nonoperative treatment of displaced scapular body fractures. We have shown that the severity of ISS and the presence of rib fractures adversely affect the clinical outcome.

Irreducible posterolateral knee dislocation with entrapment of the adductor magnus tendon and medial skin dimpling.

This case report describes an irreducible posterolateral knee dislocation with a bone avulsion of the medial epicondyle attached to the medial collateral ligament and adductor magnus tendon entrapped within the joint space.