Outcomes of surgically treated distal radius fractures associated with triangular fibrocartilage complex injury

Study DesignProspective cohort.IntroductionClinical studies that evaluate the correlation between associated lesions of the triangular fibrocartilage complex (TFCC) and outcome of distal radius fractures expressed with the patient-rated disability are missing. The purpose of this study was to evaluate the outcomes of distal radius fractures associated with or without an injury of the TFCC.MethodsPatients undergoing operative treatment for distal radius fracture were prospectively enrolled (n = 70). TFCC was examined by wrist arthroscopy and injuries classified according to Palmer. Comparative analyses were performed on 45 patients with TFCC injury (injured group) and 25 patients with intact TFCC (intact group). The outcome measures included the Patient-Rated Wrist Evaluation (PRWE) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires, 3 and 12 months after injury.ResultsTFCC was injured in 45 patients (64%). In patients with intact TFCC, mean total PRWE score was 27 (3 months) and 16 (12 months), compared to patients with TFCC injury with 40 (at 3 months) and 24 (at 12 months). Mean DASH scores were 26 and 13 at 3 and 12 months for the intact group and 39 and 27 for the injured group. PRWE and DASH results showed significant difference at 3 and 12 months when compared with Mann–Whitney test.DiscussionPRWE and DASH scores evaluation showed that patients with associated TFCC injury had greater pain and disability at 3 and 12 months after injury.ConclusionsDisability outcomes were worse in patients with distal radius fracture, where TFCC was injured. TFCC injuries are an important cofactor affecting the outcome of distal radius fractures.     

Modern radial head arthroplasty for terrible triad fracture-dislocations: a retrospective case series with minimum 3-year follow-up

BackgroundTo report mid-term clinical outcomes after radial head arthroplasty for terrible-triad fracture dislocations.MethodsFourteen patients with terrible triad fracture dislocations treated acutely with arthroplasty and minimum 3-year follow-up. Mayo Elbow Performance Scale (MEPS) and QuickDASH scores.ResultsAll patients achieved excellent (58%) or good (42%) results on the MEPS. Average QuickDASH score was 9.1 (range 0-25). Reoperation rate was 28%.ConclusionsAcute radial head arthroplasty as a treatment for nonreconstructable radial head fractures in the setting of terrible triad elbow injuries demonstrates good midterm functional outcomes.Level of EvidenceLevel IV; Retrospective Case Series Study     

Flexible intramedullary nailing for stabilization of displaced midshaft clavicle fractures: Technique and results in 87 patients

Background?Elastic, stable intramedullary nailing (ESIN) with titanium nails is a promising minimally treatment for displaced midclavicular fractures, which may be an alternative to plate fixation (ORIF) or even nonoperative treatment. We describe the surgical technique and outcome in 87 patients.

Methods?The nail was inserted at the medial inferior end of the clavicle in 83 patients and in the acromial end in 12 patients. An open fracture reduction via an additional small incision was necessary in 53 patients and closed manoeuvre was successful in 42. Implant removal was performed in 82 patients.

Results?The functional status of 87 patients after 13 months reached 6.8 (0–43) points on the DASH score and 81 (46–100) points on the self-reported Constant score. The fracture healed in correct anatomical axis in 80 of 87 patients, 2 cases ended in a nonunion. Implant migration of the nail occurred in 4 patients, who required early implant removal. Repeated nailing was necessary in 2 patients in whom the nail missed the lateral medullar canal, and plate fixation was necessary in 2 other patients who had secondary dislocation after early nail removal.

Interpretation?Flexible intramedullary nailing, a minimally invasive technique for stabilization of displaced midshaft clavicle fractures, has minor risks and complications.     

Should ulnar styloid be fixed following fixation of a distal radius fracture?,

IntroductionFracture of the base of the ulnar styloid has shown to have higher incidence of TFCC tears and DRUJ instability leading to nonunion and impaired function. Poorer functional outcomes of the distal radius fracture have been attributed to the untreated associated ulnar styloid fractures while some studies have shown no difference. Thus, the treatment remains controversial. However, it has been shown that fractures at the base of the ulnar styloid have a higher incidence of tears in the triangular fibrocartilage complex (TFCC) and instability in the distal radioulnar joint (DRUJ), which can lead to nonunion and impaired function. Despite this, there are currently no studies comparing the outcomes of surgically and conservatively treated patients.MethodsA retrospective study was conducted to analyze the outcomes of intra-articular distal radius fractures associated with base of ulnar fracture treated with distal radius LCP fixation. The study included 14 patients who were treated surgically and 49 patients who were treated conservatively, with a minimum follow-up of 2 years. Radiological parameters such as union and amount of displacement, VAS score for ulnar-sided wrist pain, functional assessment using the modified Mayo score and the quick DASH questionnaire and complications were analyzed.ResultsAt the final follow-up, the mean scores for pain (VAS), functional outcomes (modified Mayo score), disability (QuickDASH score), range of motion, and non-union rate were found to be statistically insignificant (p > 0.05) between the surgically treated and conservatively treated groups. However, patients with non-union had statistically significant higher scores for pain (VAS), greater post-operative displacement of the styloid, poorer functional outcomes, and higher disability (p < 0.05).ConclusionWhile there was no significant difference in ulnar-sided wrist pain and functional outcomes between the surgically treated and conservatively treated groups, the conservatively treated cases had a higher risk of non-union, which can negatively impact functional outcomes. The amount of pre-operative displacement was found to be a key factor in predicting non-union and can be used as a guide for determining the management of this type of fracture.     

Fifth metatarsal base fractures: A simple classification

MethodsA proposed classification for fifth metatarsal fractures based on review of 160 fractures was developed and validated. A prospective study of all patients with newly diagnosed fifth metatarsal base fractures was performed with each fracture classified using the new simple classification. Treatment for each fracture was determined by a standard protocol. The clinical and functional outcome between the new fracture types was compared using the AOFAS score.ResultsOf 189 patients 154 patients were recruited for the study. The majority of fractures were classified as Types I and II. Three patients required surgical fixation. By 3 months the average AOFAS score for each of the fracture types were greater than 80. Satisfactory outcomes were achieved for all patients with no difference between the fracture types.ConclusionsThe proposed new classification and treatment protocol enables fractures of the fifth metatarsal to be classified easily and treated appropriately.     

Is primary total elbow arthroplasty safe for the treatment of open intra-articular distal humerus fractures?

ObjectivesTotal elbow arthroplasty (TEA) is a viable treatment for elderly patients with distal humerus fracture who frequently present with low-grade open fractures. This purpose of this study was to evaluate the results of a protocol of serial irrigations and debridements (I&Ds) followed by primary TEA for the treatment of open intra-articular distal humerus fractures.MethodsSeven patients (mean 74 years; range 56–86 years) with open (two Grade I and five Grade 2) distal humerus fractures (OTA 13C) who were treated between 2001 and 2007 with a standard staged protocol that included TEA were studied. Baseline Disabilities of the Arm, Shoulder and Hand (DASH) scores were obtained during the initial hospitalization, and the 6- and 12-month follow-up visits. Elbow range of motion (ROM) measurements were obtained at each follow-up visit.ResultsFollow-up averaged 43 (range 4–138) months. There were no wound complications and no deep infections. Complications included one case of heterotopic ossification with joint contracture, one olecranon fracture unrelated to the TEA, and two loose humeral stems. The average final ROM was from 21° (range 5–30°) to 113° flexion (range 90–130°). DASH scores averaged 25 at pre-injury baseline and 48 at the most recent follow-up visits.ConclusionsTEA has become a mainstream option for the treatment of distal humerus fractures which are on occasion open. There is hesitation in using arthroplasty in an open fracture setting due to a potential increased infection risk. The absence of any infectious complications and satisfactory functional outcomes observed in the current series indicates that TEA is a viable treatment modality for complex open fractures of the distal humerus.     

A threshold disability score corresponds with an estimated diagnosis of clinical depression in patients with upper extremity disease

BackgroundThe purpose of this study was to assess whether there is a threshold Disability of Arm, Shoulder and Hand (DASH) score among patients with common hand diagnoses that corresponds with an estimated diagnosis of clinical depression.MethodsTwo hundred sixty-nine patients with one of five common upper extremity disorders completed a measure of upper extremity-specific disability (QuickDASH or DASH) and a questionnaire assessing depressive symptoms (Patient Health Questionnaire (PHQ) or Center for Epidemiologic Studies Depression scale (CES-D). A receiver operating characteristic (ROC) analysis of the discriminatory value of a threshold DASH score for an estimated diagnosis of clinical depression was assessed. The threshold DASH score with the highest positive predictive value for an estimated diagnosis of clinical depression was selected. In bivariate analysis, the association between demographic factors, disease factors, and an estimated diagnosis of clinical depression was examined.ResultsThe area under the ROC curve for a threshold DASH value diagnostic of an estimated diagnosis of clinical depression was 0.75, indicating clinical usefulness for a threshold DASH score as a screening test for depression. The highest positive predictive value of 72 % occurred at a threshold QuickDASH/DASH score of 55. In bivariate analysis, only diagnosis and years of education were significantly different between patients with and without an estimated diagnosis of clinical depression.ConclusionA DASH score of 55 or greater in patients with common upper extremity disorders has an acceptable area under the curve and positive predictive value for an estimated diagnosis of clinical depression.Level of Evidence: Level 3, diagnostic study     

Treatment of proximal interphalangeal joint fractures by the pins and rubbers traction system: a follow-up

Abstract

A fracture of the proximal interphalangeal (PIP) joint at the base of the middle phalanx is rare, but is a challenge to treat. Posttraumatic osteoarthritis is a known complication causing impaired hand function and disability. The aim of the present retrospective study was to evaluate characteristics and outcome of complex PIP joint fractures treated by the pins and rubbers traction system (PRTS). Medical records of 42 patients with fractures treated with a PRTS in 1999–2010 were reviewed, and followed-up by questionnaires (QuickDASH, CISS, self-composed questionnaire). Eighteen of the 42 were clinically examined. The fractures were divided into three types of fractures: volar lip, dorsal lip, and pilon fractures. The volar lip fracture was most frequent (26/42; dorsal lip 3/42; pilon 13/42). Most fractures were sport-related (19/42; 45%) and males predominated (M:F ratio = 1.8). All fractures united. Infection occurred in 17/41 (41%) cases. Radiological signs of posttraumatic osteoarthritis were found in 25/41 (61%) patients. In 18/42 patients, where a clinical evaluation was performed, 66% of contralateral total active range of motion (TAM), 93% grip strength, and 100% pinch strength were achieved. The volar lip fracture had the best outcome according to the self-reported QuickDASH and CISS score and regained 77% of contralateral TAM. Fractures of the PIP joint in the middle phalanx can be treated with the PRTS, but reduced mobility, grip strength, infection, and osteoarthritis are seen. The device is well tolerated by the patients, easy to apply, and with ready accessible materials for the surgeon.     

Volar locking plate: Age related outcomes and complications

BackgroundThere is no unanimity for the treatment of distal radius fractures in older people. The purpose of our study is to assess the efficacy of volar locking plate for the treatment of unstable distal radius fractures in older independent individuals.MethodsA retrospective comparative study of 105 patients. 58 patients were below the age of 55 years and 47 above the age of 55 years. Mean follow-up was 18.4 months in patients below the age of 55 years and 18.1 months above the age of 55 years. Wrist movements, complications, reoperations, grip strength, Visual Analogue Score (VAS) for pain, Quick Disabilities of the Arm, Shoulder and Hand (DASH) score, and Mayo wrist score were analysed.ResultsThere was no statistical difference in the wrist movements, grip strength, complications, reoperations, VAS, QuickDASH and Mayo scores. Mean grip strength under 55 was 84.1 and above 55 was 84.5 (p = 0.87). The complication rate was 19.1% above 55 years of age and 17.2% below the age of 55years (p = 0.79). The reoperation rate above 55 years was 8.5% and below 55 years was 8.6% (p = 0.50). Mean VAS under 55 years of age was 1.6 and above 55 years was 1.7 (p = 0.58). Mean Mayo score in under 55 was 80.7 and 80.1 in above 55 (p = 0.78). Mean Quick DASH score under 55 was 20.9 and above 55 was 21.0 (p = 0.97).ConclusionOur results indicate that outcomes in older independent patients are satisfactory with a comparable complication and reoperation rate with younger individuals. We conclude that a volar locking plate is a favourable modality for the treatment of unstable distal radius fractures in older patients.     

Long-term follow-up of patients with displaced scapular fractures managed surgically and non-operatively

IntroductionControversy remains on which patients with displaced scapula fractures benefit from surgery. This retrospective cohort study aims to compare and describe long-term patient-reported outcomes of patients with displaced scapula fractures treated both surgically and conservatively.MethodsThis study included patients with intra- and extra-articular scapula fractures, treated between 2010 and 2020 in a Swiss level 1 trauma centre. The decision to operate was based on standardized criteria for fracture displacement. Patients with isolated Bankart lesions (Ideberg 1) and process fractures (AO type 14-A) were excluded. Primary outcomes were functional patient reported measures (DASH score) and quality of life (EQ5D score). Secondary outcomes were complications, radiological union, satisfaction with treatment, pain and range of motion.ResultsOut of 486 cases, 74 patients had displaced scapula fractures. Forty patients were treated surgically and 34 were treated conservatively. Significantly more patients with intra-articular fractures and high-energy trauma were treated surgically. Fifty percent returned the questionnaires after a mean follow-up of 47 months (± SD 36). The mean DASH score of this group was 12 (SD 15.6), with a mean of 14.7 (SD 15.9) in the surgery group and 9.8 (SD 14.6) in the non-operative group (p = 0.7). Multivariate analysis did not show statistically significant correlating factors. No significant differences in quality of life were observed. Patients rated their treatment with a mean of 8.6/10 (SD 1.8). Among surgically treated patients, 19 underwent a deltoid sparing procedure with significant shorter time to union than those that underwent deltoid release (23 vs. 49 weeks, p<0.01). Complications occurred in 3/28 surgically treated patients and all three required a reoperation.ConclusionIn this cohort, functional results after conservative and surgical treatment were similar, despite more complex fractures and more intra-articular fractures being treated surgically. Osteosynthesis of both intra- and extra-articular scapula fractures is safe and leads to good functional results, furthermore, new minimal invasive techniques may lead to faster bone healing and return to work and sports     

Complex Fractures of the Distal Radius

Abstract Objective: Outcome of complex distal radius fractures. Design: Retrospective clinical observation. Setting: Outcome assessment of a clinical series of patients with complex distal radius fractures treated according to a structured, stepwise treatment algorithm. Patients: 17 patients (average age 47 years) with mostly high-energy injuries, 16/17 articular fractures including concomitant carpal injuries, fracture dislocations, extension of the fracture into the diaphysis, and large defects. Intervention: Initial external fixation, followed by soft tissue treatment and further diagnostics and, finally, definitive adapted surgical therapy including combination of external fixation, plates, screws, K-wires, bone graft, and ligament repair. Main Outcome Measurements: DASH, range of motion, radiologic outcome. Results: Average subjective overall performance score (DASH) 16.4 (0–36.7, standard deviation [SD] 11.82, 95% confidence interval [CI] 8.0–23.6), 73% of the patients back to premorbid work and activities. Conclusions: Using a clearly structured, stepwise approach, complex distal radius fractures can be treated with good clinical outcome preserving hand function.     

Scapular body fractures: Short-term results of surgical management with extended indications

IntroductionScapular body fractures represent less than 1% of all skeletal fractures. Operative criteria and risk factors for scapular fracture instability are well defined. Non-operative management of scapular body fractures show satisfactory results but with shortening and medialization of the scapular body. The aim of this study is to evaluate if surgical treatment will result in an improved quality of life and shoulder function compared to non-operative treatment on patients suffering from a scapular body fracture.Materials and MethodsFrom a total of 381 retrospectively identified scapular body fractures, we included 45 patients. The enrolled patients were divided into two groups: the surgical treatment (ST, n = 20) group and the non-operative treatment (NOT, n = 25) group. The Non-Union Scoring System (NUSS) was used to assess bone healing on radiographs. The functional evaluation of the two groups during the follow-up were performed using the Constant Shoulder Score (CSS) and the Quick Disabilities of the Arm, Shoulder and Hand Score (QuickDASH). Complications, reoperation rates, and time until bony union were also documented. The minimum follow-up for this study was designated as 12 months.ResultsThe ST group had better mean CSS and QuickDASH scores compared to the NOT group at 1, 3 and 6 months of follow-up. No statistically significant difference was detected at 12 months follow-up. ST group also demonstrated improved results in time until bone union, reduction of rehabilitation time, complications and return to work rates.ConclusionThis study suggests that surgical treatment for extraarticular scapular fractures can achieve better short-term functional outcomes (3 to 6 months) compared to conservative treatment.     

The functional outcome of acute scapholunate ligament repair in patients with intraarticular distal radius fractures treated by internal fixation

Background

Intra-articular fractures of the distal radius (DRF) are associated with a twofold increase in the risk of scapholunate ligament injury (SLI). The aim of this study was to compare functional outcome, pain, and disability between patients with operatively treated DRF and either an acute, repaired scapholunate ligament injury or no ligament injury.

Methods

We retrospectively analyzed 18 patients with an intraarticular DRF and SLI that was diagnosed and treated (Group I) and compared them with 20 patients with DRF without associated ligament injury (Group II) (20 women, 18 men; average age 55 years, range 19–72). The two cohorts were analyzed for differences in motion, grip strength, pain, Mayo wrist score, and Quick Disabilities of the Arm, Shoulder, and Hand (DASH) score an average of 43 months (range 12–73) after surgery. Radiographic assessment included fracture union, palmar tilt, radial inclination, ulnar variance, intercarpal angles, and arthrosis (according to Knirk and Jupiter). We used T-tests to compare range of motion, grip strength, pain (visual analog scale), DASH scores, and radiographic alignment between cohorts. A Chi-squared analysis was used to determine radiographic differences of arthritis.

Results

There were no significant differences in mean range of motion, grip strength, Quick DASH score, Mayo wrist score, pain level, or radiographic arthrosis between cohorts. There was no correlation between radiographic signs of osteoarthritis and the QuickDASH score, and pain level.

Conclusion

The outcomes of intraarticular fractures of the distal radius with operatively treated associated SLI are comparable with the outcomes of intraarticular fractures of the distal radius without associated SLI.     

超声引导下手法复位牵引托板固定治疗掌骨颈骨折

目的 :探讨超声在掌骨颈骨折手法复位牵引治疗中的临床价值。方法 :自2013年4月至2016年8月在超声引导下手法复位牵引托板固定治疗30例掌骨颈骨折患者,其中男26例,女4例;年龄14~56(25.6±1.6)岁;病程7 h~5 d(2.7±0.6)d。第5掌骨颈骨折20例,第4、5掌骨颈骨折7例,第2掌骨颈骨折3例。观察并比较骨折愈合情况、双侧头干角角度﹑掌指关节主动活动范围,并采用DASH评分进行功能评价。结果:除3例胶布脱落放弃治疗外,27例均获得随访,时间6~11(7.2±0.8)个月。骨折均获愈合,愈合时间5~8(5.6±0.4)周。随访时患侧头干角(15.1±1.8)°与健侧头干角(13.5±2.8)°比较差异无统计学意义(t=1.54,P0.05);患侧掌指关节主动活动度(86.3±2.6)°与健侧(91.8±1.6)°比较差异无统计学意义(t=1.16,P0.05)。术后7个月患肢DASH评分为4.3±1.5。结论 :超声引导下闭合复位掌骨颈骨折,可实时、动态观察骨折对位情况,患者接受度高,是治疗掌骨颈骨折的可行方法。     

Early palmar plate fixation of distal radius fractures may benefit patients aged 50 years or older: a randomized trial comparing 2 different treatment protocols

Background and purpose — There is no consensus regarding optimal treatment of displaced distal radius fractures (DRFs). We compared the results of 2 treatment protocols: early palmar plating vs. primary nonoperative treatment of displaced DRFs.

Patients and methods — We performed a prospective randomized controlled study including 80 patients aged ≥ 50 years with dorsally displaced DRFs, excluding AO type C3 fractures. Patients were randomized to undergo either immediate surgery with palmar plating (n = 38), or initial nonoperative treatment (n = 42) after successful closed reduction in both groups. Delayed surgery was performed in nonoperatively treated patients showing early loss of alignment (n = 16). The primary outcome measure was Disabilities of the Arm, Shoulder, and Hand (DASH) score.

Results — Mean DASH scores at 24 months in the early surgery group were 7.9 vs. 14 in the initial nonoperative group (difference between means 6, 95% CI 0.1–11, p = 0.05). Delayed operation was performed on 16/42 of patients due to secondary displacement in the initial nonoperative group. In “as treated” analysis, DASH scores were 7 in the early surgery group, 13 in the nonoperative group, and 17 after delayed surgery (p = 0.02). The difference in DASH scores between early and delayed surgery was 9 points (CI 0.3–19, p = 0.02)

Interpretation — Treatment of DRFs with early palmar plating resulted in better 2-year functional outcomes for ≥50-year-old patients compared with a primary nonoperative treatment protocol. Delayed surgery in case of secondary displacement was not beneficial in terms of function.     

Retrospective analysis of 35 pediatric femoral neck fractures

Objective

Pediatric proximal femur fracture is extremely rare trauma comparing to other fractures. The proximal femur fracture is 1% of all pediatric fractures. The aim of current study is to compare the incidence of early complications and outcomes of pediatric proximal femur fractures regarding fracture types retrospectively.

Design

Our study includes 35 cases which are criticized by Delbet classification system, modalities of treatment, duration of waiting for surgery, duration of follow-up and also complications. Our inclusion criteria are age below 16 years old, proximal femur fractures with no evidence of tumoral, romathologic and methabolic conditions. Age, sex and surgery type (open-closed) were noted, and the data were statistically assessed. Assessment of the final outcome was made at the last follow-up visit using the Ratliff’s method.

Results

The mean of age of patients in our study is 9.5 ± 5.06 years. The average follow-up was 25.6 ± 13.2 months. 15 patients (42.9%) are type 2 Delbet fracture, 5 patients (14.2%) are Delbet type 3 and 15 patients (42.9%) are Delbet type 4 fracture. Using the Ratliff’s method, 25 patients (71.4%) had satisfactory outcomes. Ten patients (28.6%) had unsatisfactory outcomes. The complications as AVN, coxa vara and premature closure of physis, non-union and postoperative infections have been detected in this study. AVN was seen in four (11.4%) patients. In addition, coxa vara was seen in six (17.2%) patients.

Conclusion

Pediatric femoral neck fractures are extremely rare fractures and can be treated with low complication rates in cases with early treatment and anatomic reduction.

     

Anteromedial coronoid facet fractures and associated ligament lesions: A case series

IntroductionVarus posteromedial rotational injury mechanisms lead to fractures of the coronoids process' anteromedial facet. As these fractures are often unstable, rapid fracture treatment is vital to prevent progressive osteoarthritis.Materials and methodsTwelve patients with a fracture of the anteromedial facet treated surgically were enrolled in the study. Computed tomography images were used to classify the fractures according to the system by O'Driscoll et al. Clinical follow-up included each patient's medical record, surgical treatment algorithm, all complications encountered during the follow-up period, Disabilities of the arm, shoulder, and hand score, subjective elbow value, and pain.ResultsA total of 8 men (66.7%) and 4 women (33.3%) were treated surgically and followed-up after a mean period of 45 ± 23 months. The mean DASH score was 11.9 ± 12.9 points. One patient complained of transient neuropathy in the innervation area of the ulnar nerve, however, this existed already pre-operatively and resolved after less than three months.ConclusionsThe presented patient cohort shows that AMF fracture of the coronoid process are unstable lesions according to the bony instability and the frequently ruptured collateral ligament complexes which need to be addressed. The MCL seems to be affected more frequently than previously appreciated.Level of evidenceLevel IV; Case Series; Treatment Study.     

Static monolateral external fixation for the Rolando fracture: a simple solution for a complex fracture

INTRODUCTION

Rolando fractures are often difficult to manage because of their inherent instability. We describe a simple technique for the treatment of this fracture using the principle of ligamentotaxis, with a static, two-pin external fixator spanning the trapeziometacarpal joint, and present the results of a single-surgeon case series.

METHODS

Eight consecutive patients (mean age: 32.8 years) with Rolando fractures were treated using a Hoffmann II® Micro small bone external fixator using blunt ended 2.0mm half pins, inserted into the trapezium and diaphysis of the first metacarpal. Functional outcome was assessed with the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score at a mean time of 2.7 years following the fracture (range: 4 months – 6.0 years). The mean time to frame removal was 28 days.

RESULTS

There were three cases of superficial pin site infection. Follow-up x-rays at four months did not demonstrate significant joint incongruity or malunion in any case. The mean QuickDASH score was 7.95 and all patients returned to their previous levels of activity.

CONCLUSIONS

Although external fixation risks pin site infection, the results of this study support the use of spanning trapeziometacarpal external fixation for Rolando fractures as it reliably gives excellent functional outcomes.     

Acute versus delayed reverse total shoulder Arthroplasty for the management of Proximal Humerus Fractures

ObjectivesProximal humerus fractures (PHF) are common, yet their optimal management remains debated. Reverse total shoulder arthroplasty (rTSA) is an increasingly popular option, particularly for non-reconstructible or osteoporotic fractures. Despite this trend, current literature provides limited guidance with regards to surgical timing and patient selection for rTSA. A trial of non-operative management might be beneficial for many patients who are not clearly indicated for surgery, provided this does not have a major negative impact on results for those who ultimately require rTSA. The purpose of this study was to investigate whether delayed reverse shoulder arthroplasty for fracture (>28 days from injury) is associated with any difference in complication rates or functional outcomes relative to acute surgery.DesignRetrospective cohort studyPatients/Participants114 consecutive patients who underwent rTSA as the primary management of a PHF at two Level 1 trauma centers and one academic community hospital between 2004 and 2016.InterventionrTSA as primary management of proximal humerus fractureMain Outcome MeasurementsComplications, range of motion, and patient-reported functional outcomes scores (DASH, PROMIS physical function, and EQ-5D)ResultsEighty-two of 114 patients (72%) underwent early surgery. Complex (4-part, head-split, dislocated) fractures were significantly more common in the acutely treated group. There was no significant difference in complications. Overall complication rate was 11.4%. There was a significant difference in DASH score favoring early surgery, with an average score of 22.4 in acutely treated patients versus 35.1 in delayed patients (p = 0.034). There was a non-statistically significant trend towards better PROMIS physical function scores and ROM in the acutely treated group.ConclusionDelay in performing primary rTSA for management of PHF does not lead to an increase in complication rates but it may come at the cost of worse functional outcomes in patients who ultimately require rTSA.     

The Polarus intramedullary nail for proximal humeral fractures Outcome in 28 patients followed for 1 year

Background?One of the new treatment options for proximal humeral fractures is the minimally invasive intramedullary nail. In this study, we reviewed the early clinical results after 1 year.

Patients?and methods 35 patients with proximal humeral fractures were treated using the Polarus nail. In 14 cases the initial treatment was operative; the other 21 patients were initially treated nonoperatively. 19 patients had a 2-part fracture, 5 had a 3-part fracture and 2 had a 4-part fracture. In 9 patients the fracture extended metaphyseally. The functional outcome was assessed by the Constant score.

Results?28 patients were available for 1-year followup. 17 patients showed excellent functional outcome (with an average Constant score of 81%). 6 patients required revision surgery, 1 because of nonunion and 1 because of an avascular necrosis. 4 others were reoperated because of inadequate position of the osteosynthesis or migration of the screws.

Interpretation?The Polarus nail is of value for (displaced) 2-, 3-, and even 4-part proximal humeral fractures and enables early postoperative mobilization with a limited amount of pain.