Plate osteosynthesis in humeral shaft fractures. Indications and results

Non operative management of humeral shaft fractures is well recognized as the standard of care for uncomplicated injuries. Operative treatment of humeral fractures may be performed when limited indications are present as in patients with multiple trauma including ipsilateral forearm injuries, arterial injury or primary radial nerve palsy. 18 patients with humeral shaft fractures underwent open reduction and internal fixation (ORIF) using the AO plating technique at the Kantonsspital Chur from 1980 to 1986. Follow-up was available for 17 patients of whom 16 suffered from multiple injury trauma. The broad DC plate combined with lag screws was used in most cases. Two brachial artery transections were repaired at the time of primary osteosynthesis by the same surgeons with full functional recovery. Concomitant nerve injuries were repaired primarily in one case and postprimarily in 3 more cases. The overall result was excellent in 9 patients, good in 5 patients, fair in 2 patients and poor in one patient with complete brachial plexus injury. Bone healing was uneventful in all 17 patients. No infection and no delayed union or pseudarthrosis has been observed.     

微创经皮钢板内固定治疗胫骨干C型骨折

目的 探讨微创经皮钢板内固定(MIPPO)治疗胫骨FC型骨折的临床疗效。方法采用间J接复位和MIPPO治疗12例胫骨C型骨折。结果平均随访9个月,临床愈合时间3～5个月,无畸形愈合、感染、钢板断裂。采用Johm-Wruhs评分标准,结果：优9例,良3例。结论对于胫骨于C型复杂骨折微创经皮钢钢板内固定是一种较好的方法,可以减少骨折端血供的破坏,促进骨折的愈合,减少并发症。     

Minimally invasive plate osteosynthesis using posterolateral approach for distal tibial and tibial shaft fractures

ObjectiveThe objective of the study was to evaluate the effectiveness of the posterolateral minimally invasive plate osteosynthesis (MIPO) method for managing distal tibial or tibial shaft fractures with severe anterior and medial soft tissue injuries.Materials and methodsFive consecutive patients with three distal tibial and two tibial shaft fractures (three open fractures) at a level-1 trauma and tertiary referral center were retrospectively reviewed. All patients were definitively treated and followed to bone union. Main outcome was measured by American Orthopaedic Foot and Ankle Society (AOFAS) ankle–hindfoot score, complications, and bone union on radiographs.ResultsThe average follow-up period was 15.8 months (range, 12–24 months). The average AOFAS score was 88.2 (range, 81–90). There were no complications, such as incision breakdown, deep infection, or impingement of the flexor hallucis longus tendon. Bone union was achieved in all cases.ConclusionsPosterolateral MIPO is a feasible option when treating these fractures, especially in cases with severe anterior and medial soft tissue injuries.     

Indications for a bridging plate osteosynthesis of compound femoral shaft fractures]

We performed the clinical and radiological follow-up of 29 comminuted fractures of the femoral shaft treated by bridging plate osteosynthesis. Complete bone healing in 6 open fractures took place within 33 weeks, in 15 closed fractures within 22 weeks. We had to meet 5 postoperative complications: 2 cases of osteomyelitis following open fractures, 1 early wound infection and 2 haematomas. Primary cancellous bone grafting we found unnecessary in all of the 29 fractures. We recommend the technique of bridging plate osteosynthesis for the stabilization of comminuted fractures of the femur especially under the clinical circumstances as follows: 1. Polytrauma, 2. Metaphyseal or condylar fracture, 3. Open fracture, 4. Redisplacement, 5. Fracture in children.     

Comparison between intramedullary nailing and minimally invasive plate osteosynthesis for tibial shaft fractures

IntroductionIntramedullary nailing (IMN) is currently considered the gold standard in the surgical treatment of tibial shaft fractures in adult patients. In this case-control comparative study, we aimed to compare the efficacy of minimally invasive plate osteosynthesis (MIPO) and IMN in treating tibial shaft fractures.Materials and methodsThe clinical and radiological outcomes, such as a modified trauma scale, operation time, fracture healing, rate of re-operation, and complications such as malunion, nonunion, shortening, and infection were assessed between IMN and MIPO for the treatment of tibial shaft fractures.ResultsSeventy-three skeletally mature patients who underwent IMN (group I) or MIPO (group M) for a closed extra-articular tibial shaft fracture (AO/OTA type 42) from June 2010 to May 2016 were retrospectively reviewed. The mean age was 51.16 (18~79) years, and the mean follow-up period was 22 (12~50) months. Bony union was achieved in all cases but one for each group - group I (35 cases) and group M (36 cases) (p > 0.05). Mean callus formation was observed in 12 (8 – 16) weeks in both groups (p > 0.05). There was no significant difference in operative time, hospital stay, bone healing, and the rate of complications among the two groups (p > 0.05). There was also no postoperative difference in functional evaluation between the two methods (p > 0.05).ConclusionsNo discrepancy was found in radiological and clinical outcomes between IMN and MIPO for tibial shaft fractures. It can be concluded that both IMN and MIPO are equally effective treatment modalities for tibial shaft fractures.     

Intramedullary osteosynthesis of tibial shaft fractures]

Thirty seven patients with fracture of tibia were treated by closed method intramedullary osteosynthesis with Küntscher nail (22 cases) and with elastic rods designed by the authors. Complete bony union was achieved on average after 30 and 47 weeks in fresh and old fractures respectively. There was 1 case of mild osteitis after second osteosynthesis and 1 patient with multiple trauma has died. No union disturbance was observed.     

Indications and osteosynthesis procedures in humeral shaft fractures

In the therapy of fractures of the humeral shaft, the individual patient's total condition should be taken into consideration when selecting the adequate method of treatment. Conservative treatment of humeral shaft fractures is still preferred, and Sarmiento's functional therapy has expanded the therapeutic possibilities. The decision for operative treatment is clarified by dividing the indications into the following categories: absolute, relative and recommended indications. In order to reduce complication rates and to ensure stability, we chose among three osteosynthetic procedures: 1. Bundle nailing. 2. Compression plate. 3. Fixateur externe (De Bastiani's mono-fixateur). In simple fractures of the shaft, bundle nailing is an effective and low-risk treatment. Compression plate is indicated in the presence of radial nerve palsy and in very distal shaft fractures. In open fractures and fractures with accompanying blood vessel damage, we favour stabilization with the De Bastiani's unilateral fixateur externe.     

Bridging plate osteosynthesis of humeral shaft fractures

This study was approved by the Ethics Committee of the Faculty of Medical Sciences and developed during November 2000 and July 2001 in the Orthopedic and Traumatology Department of UNICAMP. There were 15 patients, 11 males, age between 14 and 66 years. All fractures were unilateral. Of the 15 patients eight were polytraumatised, two of them had open fractures. The others had an isolated fracture of the humerus, of which one was open. None of the patients had previous lesions of the radial nerve, but in two patients there was a lesion of the brachial plexus. All of the patients underwent a bridging plate osteosynthesis of the humeral shaft fractures using only two small incisions proximal and distal to the fracture site. We used broad or narrow D.C.P.^® plates for large fragments mostly with 12 holes, fixed with two or three screws at each end. All cases united with an average time of 8-12 weeks, with the exception of one case with a grade III open fracture and a brachial plexus lesion on the same side. We had no major complications. All patients recovered good function of the limb without significant residual deformity.     

经皮微创解剖型锁定钢板治疗胫骨中下段骨折

目的 探讨经皮微创解剖型锁定钢板治疗胫骨中下段骨折的手术方法和临床疗效.方法 对25例胫骨中下段骨折患者采取经皮微创解剖型锁定钢板治疗.结果 患者均获随访,时间5~18个月.骨折均临床愈合,时间3~6个月.按Johner-Wruhs评分法评价:优18例,良5例,中2例.结论 经皮微创解剖型锁定钢板治疗胫骨中下段骨折具有创伤小、固定可靠、骨折愈合率高等优点,是一种较理想的治疗方法.     

Indirect reduction technique using a distraction support in minimally invasivepercutaneous plate osteosynthesis of tibial shaft fractures

Purpose: To describe an indirect reduction technique during minimally invasive percutaneous plateosteosynthesis (MIPPO) of tibial shaft fractures with the use of a distraction support.Methods: Between March 2011 and October 2014, 52 patients with a mean age of 48 years (16-72 years)sustaining tibial shaft fractures were included. All the patients underwent MIPPO for the fractures using a distraction support prior to insertion of the plate. Fracture angular deformity was assessed by goniometer measurement on preoperative and postoperative images.Results: Preoperative radiographs revealed a mean of 7.6 (1.2-28 ) angulation in coronal plane and amean of 6.8 (0.5-19 ) angulation in sagittal plane. Postoperative anteroposterior and lateral radiographs showed a mean of 0.8 (0-4.0 ) and 0.6 (0-3.6 ) of varus/valgus and apex anterior/posterior angulation, respectively. No intraoperative or postoperative complications were noted.Conclusions: This study suggests that the distraction support during MIPPO of tibial shaft fractures is an effective and safe method with no associated complications.     

Minimally invasive plate osteosynthesis of tibial fracture using self-navigated plate

This study aims to introduce a self-navigated plate, which is characterized by the presence of a groove at each end of the plate, in treating tibial fractures. The plate is inserted subperiosteally across the fracture line when the fracture is effectively reduced. A second plate of the same is then placed over the subcutaneous one and serves as a guide for percutaneous insertion of screws through the holes of subperiosteal plate into the bones to secure the fracture. Seven patients with tibial shaft fractures were treated by minimally invasive plate osteosynthesis (MIPO) using this plate. The average operative time was 47 min, and the average fluoroscopy time was 19 s. All fractures healed from 3 to 6 months postoperatively, and excellent functional recovery was observed in all patients. In conclusion, the economical-friendly self-navigated plate is a good and effective alternative fixation method in treating tibia fractures by MIPO.     

Conservative management versus osteosynthesis in the treatment of tibial shaft fractures

Treatment was rendered to 1,693 patients with 1,728 tibial shaft fractures at the University Hospital of Granada, Spain, between 1971 and 1987. After 139 patients had died, 1,554 patients with 1,571 tibial fractures were actually left for treatment. Forms of fractures were subdivided according to Johner and Wruhs. Conservative treatment, according to B?hler-Sarmiento, was applied to 589 cases, while surgery was performed on 982. Different ways of osteosynthesis were used, including tibial plates (n = 284), intramedullary nailing according to Küntscher (n = 308), and lock nailing according to Klemm (n = 336). Other methods of osteosynthesis, such as elastic nailing according to Ender (n = 36) and external fixation (n = 18) were rarely used and, therefore, were not statistically evaluated. --The author's result have provided evidence to the effect that conservative treatment according to B?hler (and modified by Sarmiento) worked well, with only 11.4 per cent complications in cases of closed and open fractures. However, only moderate results were obtained from follow-up checks, since compensation was usually not possible for the majority of primary lateral fragment displacements, so that for consolidation limbs had to be kept immobilised for much longer periods of time, and this entailed poor functional results. --Very poor results were obtained from plate osteosynthesis, in the context of surgical treatment, with the rate of complications being as high as 34.9 per cent. Better results were achieved by intramedullary nailing, with complications in 14.9 per cent of all cases. Yet, it is the author's view that lock nailing has become the established optional method.     

微创经皮钛板植入治疗胫骨骨折46例

目的 探讨微创经皮钛板植入法治疗胫骨中远段骨折的临床疗效。方法 对46例胫骨中远段骨折患者随机分两组,微创经皮钛板植入法24例,传统切开法22例。结果 46例均获随访,时间6～24个月,平均18个月。与传统切开组比较,微创经皮钛板植入组术后疼痛轻,炎性反应小。发热期平均2．4d,住院时间平均6．8d,骨折临床愈合时间平均12周,无骨延迟愈合及骨不连,无感染及内固定失败等并发症。结论 微创经皮钛板植入治疗胫骨中远段骨折具有损伤小、恢复快、无骨延迟愈合及骨不连优点,符合生物学固定理念及美学要求。     

经皮微创接骨板技术治疗胫骨远端骨折的疗效分析

目的 探讨经皮微创接骨板(MIPO)技术治疗胫骨远端骨折的的手术方法及疗效.方法 2006年3月至2010年2月采用MIPO技术治疗22例胫骨远端骨折患者,男8例,女14例;年龄24～75岁,平均45.3岁.术后定期复查X线片,观察骨折愈合情况,应用Johne-Wruhs方法评估患肢功能和骨折愈合情况.结果 所有患者术后获6～33个月(平均14个月)随访.全部患者骨折均获愈合,愈合时间为15～24周,平均18.6周,1例出现软组织损伤.按照Johner-Wruhs评分评定疗效:优12例,良9例,可1例,优良率为95.5%.结论应用MIPO技术治疗胫骨远端骨折,可有效提高骨折愈合率,获得良好功能,并能减少并发症的发生.

Abstract：

Objective To report the efficacy of treatment of distal tibial fractures with minimally invasive plate osteosynthesis (MIPO). Methods From March 2006 to January 2010, 22 cases of distal tibial fractures were treated with close reduction and the MIPO technique. They were 8 men and 14 women,with an average age of 45. 3 years (range, 24 to 75 years). The fracture healing was observed through regular follow-up radiography. Functional recovery of affected lower extremity was evaluated according to Johner-Wruhs scoring system. Results All the patients were followed up for an average of 14 months (range,6 to 33 months). All the fractures were healed after an average time of 18. 6 weeks (range, 15 to 24 weeks). Soft tissue problem occurred in only one case. According to Johner-Wruhs scoring, 12 cases were excellent, 9 good and one fair. The total excellent to good rate was 95. 5%. Conclusion In treatment of distal tibial fractures, MIPO technique can improve fracture healing and functional recovery through decreasing postoperative complications.     

锁定加压钢板微创固定治疗肱骨干骨折的初步报告

目的探讨锁定加压钢板(LCP)经肱骨前侧入路微创穿皮固定治疗肱骨干骨折的方法及疗效。方法2004年2月-2005年1月间,使用LCP经肱骨前侧入路微创穿皮固定治疗肱骨干骨折17例,男12例,女5例;年龄18-75岁(平均48岁)。根据AO分型:A型3例,B型10例,C型4例。结果经14-25个月(平均19．1个月)随访,17例患者全部愈合。骨折愈合时间为9-14周(平均11．3周)。末次随访时,肩关节前屈135°-180°(平均174°),后伸20°-40°(平均38°),外展70°-90°(平均87°);肘关节前屈115°-135°(平均133°),后伸-10°-0°(平均-1°);手臂肩残疾问卷表(DASH)评分6-44分(平均11分)。术后3例出现并发症:1例GustiloⅢB型开放性骨折发生浅表感染,经保守治疗后痊愈;1例术后出现一过性桡神经麻痹,3个月后症状完全消退;另有1例出现明显的肩肘关节功能障碍。无继发骨折移位及内固定物失效或断裂。结论LCP经肱骨前侧入路微创穿皮固定治疗肱骨干骨折可以提供稳定的固定,骨折愈合率较高,神经血管结构相对安全;更适合于粉碎性或骨质较差的肱骨干骨折。     

Experience with plate osteosynthesis in femoral shaft fractures]

Today, femoral shaft fractures are often treated by open or closed intramedullary nailing because of a lower rate of complications with this method. Therefore, the practice of plating these fractures is now decreasing. We studied the indications for nailing and for plating, as well as the indications when both methods can be used with the same results. At the University Clinic of Surgery in Graz, 107 femoral shaft fractures were plated between 1983-1986. We could find no higher incidence of complications between plating or nailing femoral fractures described by previous authors compared with our own results.