Intra-articular displaced fractures of the calcaneus. Operative vs non-operative treatment.
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Twenty-eight patients with displaced intra-articular fractures of the calcaneus treated by open reduction and fixation were compared with 30 patients with similar fractures treated conservatively. Judged by the clinical and radiographic criteria results were more satisfactory in the surgical group than in the nonoperative group, although high rates of poor results were encountered in both groups. (+info)
Primary endoprosthesis in comminuted humeral head fractures in patients over 60 years of age.
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The purpose of this study was to determine the early subjective and functional results after primary endoprosthesis replacement for comminuted humeral head fractures in patients over 60 years old. Twenty comminuted humeral head fractures in 20 patients were treated primarily (within 3.5 days (range 0-17 days) with a Neer II modular shoulder prosthesis, and were then followed up for an average of 32. 5 months (range 17-44 months). The average age of the patients was 77 years (range 63-91 years). The average post-operative Constant score was 52 points (range 30-76). This was significantly less than that of the contralateral side where the score was 80 points (range 53-100), P=0.0001. The average active abduction was 90 degrees (contralateral 157 degrees ) and active flexion 99 degrees (contralateral 161 degrees ). Eighteen of the 20 patients experienced relief of pain and would accept the same procedure again. (+info)
Surgical treatment of comminuted fractures of the distal clavicle using Wolter clavicular plates.
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Surgical reduction and fixation using Wolter clavicular plates was performed in 16 patients with distal clavicle fractures. Good bony union was obtained in all cases. The patients had neither postoperative pain nor muscle weakness. Compared with tension band wiring, the Wolter clavicular plates were better able to maintain the anatomic repositioning of comminuted distal clavicle fractures. However this method takes longer and requires a second operation for plate removal. Wolter clavicular plate placement is the treatment of choice for unstable distal clavicle fractures with small comminuted fragments. (+info)
High density polyetherurethane foam as a fragmentation and radiographic surrogate for cortical bone.
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BACKGROUND: Although one of the most important factors in predicting outcome of articular fracture, the comminution of the fracture is only subjectively assessed. To facilitate development of objective, quantitative measures of comminution phenomena, there is need for a bone fragmentation surrogate. METHODS: Laboratory investigation was undertaken to develop and characterize a novel synthetic material capable of emulating the fragmentation and radiographic behavior of human cortical bone. RESULT: Screening tests performed with a drop tower apparatus identified high-density polyetherurethane foam as having suitable fragmentation properties. The material's impact behavior and its quasi-static mechanical properties are here described. Dispersal of barium sulfate (BaSO4) in the resin achieved radio-density closely resembling that of bone, without detectably altering mechanical behavior. The surrogate material's ultimate strength, elastic modulus, and quasi-static toughness are within an order of magnitude of those of mammalian cortical bone. The spectrum of comminution patterns produced by this material when impacted with varying amounts of energy is very comparable to the spectrum of bone fragment comminution seen clinically. CONCLUSIONS: A novel high-density polyetherurethane foam, when subjected to impact loading, sustains comminuted fracture in a manner strikingly similar to cortical bone. Moreover, since the material also can be doped with radio-opacifier so as to closely emulate bone's radiographic signature, it opens many new possibilities for CT-based systematic study of comminution phenomena. (+info)
Nonunion of the humerus after failure of surgical treatment. Management using the Ilizarov circular fixator.
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We used the Ilizarov circular external fixator to treat 16 patients with persistent nonunion of the diaphysis of the humerus despite surgical treatment. All patients had pain and severe functional impairment of the affected arm. In ten, nonunion followed intramedullary nailing. We successfully treated these by a closed technique. The nail was left in place and the fracture compressed over it. The fractures of the other six patients had previously been fixed by various methods. We explored these nonunions, removed the fixation devices and excised fibrous tissue and dead bone before stabilising with the Ilizarov fixator. In five patients union was achieved. Bone grafting was not required. In the single patient in whom treatment failed, there had been a severely comminuted open fracture. All except one patient had reduction of pain, and all reported an improvement in function. (+info)
Ilizarov external fixation for severely comminuted supracondylar and intercondylar fractures of the distal femur.
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Our aim was to determine the clinical effectiveness and safety of Ilizarov external fixation for the acute treatment of severely comminuted extra-articular and intercondylar fractures of the distal femur. A total of 14 consecutive patients with complex fractures was treated. There were three type-A3, two type-C2 and nine type-C3 fractures according to the AO/ASIF system. The mean follow-up was 14 months. Most fractures (13) united primarily at a mean of 16 weeks. One patient with a type-IIIA open fracture had infection and nonunion. The mean range of flexion of the knee at the final follow-up was 105 degrees (35 to 130). We conclude that, in the treatment of comminuted fractures of the distal femur, the Ilizarov fixator is safe and effective in providing stability and allowing early rehabilitation. (+info)
Comminuted fractures of the olecranon. Management by bone graft from the iliac crest and multiple tension-band wiring.
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Between 1993 and 1999, we treated ten patients with comminuted fractures of the olecranon by multiple tension-band wiring and a graft from the iliac crest. Their mean age was 35 years (19 to 56). The mean follow-up was for 28.5 months (15 to 46) and the mean time to union of the fractures was four months (3 to 7). No patient reported difficulties with activities of daily living or symptoms of instability of the elbow. The mean flexion was to 135 degrees (125 to 145) with a mean flexion contracture of 15 degrees (10 to 30). The mean pronation was 70 degrees (60 to 80) and mean supination 79 degrees (70 to 90). Only three patients had mild pain and loss of strength. Five patients had excellent and five good results with a mean Broberg and Morrey index score of 94.5 points (84 to 100). Our results compare favourably with those previously reported and the technique is thought to be a practical alternative to plate fixation in fractures with extreme comminution. (+info)
Subtalar distraction bone block arthrodesis.
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This retrospective study analyses the results of subtalar bone block distraction arthrodesis used in the treatment of late complications of calcaneal fractures, acute severely comminuted fractures, nonunion (and malunion) of attempted subtalar arthrodeses, avascular necrosis of the talus, and club-foot deformity. Of 39 patients (41 feet) who had this procedure, 35 (37 feet) returned for follow-up after a mean of 70 months (26 to 140). There were 24 men (25 feet) and 11 women (12 feet) with a mean age of 41 years (16 to 63). Each completed a standardised questionnaire, based on the hindfoot-scoring system of the American Orthopaedic Foot and Ankle Society and were reviewed both clinically and radiologically. Of the 37 operations, 32 (87%) achieved union. The mean hindfoot score (maximum of 94 points) increased from 21.1 points (8 to 46) preoperatively to 68.9 (14 to 82) at the final follow-up. The mean talocalcaneal and calcaneal pitch angles were 20.5 degrees and 4.9 degrees before operation, 25.9 degrees and 8.3 degrees immediately after, and 24.6 degrees and 7.7 degrees at the final follow-up, respectively. The mean talar declination angle improved from 6.5 degrees (-10 to 22) before operation to 24.8 degrees (14 to 32) at the final follow-up. The mean talocalcaneal height increased from 68.7 mm before operation to 74.5 mm immediately after and 73.5 mm at the final follow-up. Of the 37 arthrodeses available for review, 32 were successful; 29 patients (30 arthrodeses) were satisfied with the procedure. Minimal loss of hindfoot alignment occurred when comparing radiographs taken immediately after operation and at final follow-up. (+info)