Multiple intramedullary nailing of proximal phalangeal fractures of hand

Background:

Proximal phalangeal fractures are commonly encountered fractures in the hand. Majority of them are stable and can be treated by non-operative means. However, unstable fractures i.e. those with shortening, displacement, angulation, rotational deformity or segmental fractures need surgical intervention. This prospective study was undertaken to evaluate the functional outcome after surgical stabilization of these fractures with joint-sparing multiple intramedullary nailing technique.

Materials and Methods:

Thirty-five patients with 35 isolated unstable proximal phalangeal shaft fractures of hand were managed by surgical stabilization with multiple intramedullary nailing technique. Fractures of the thumb were excluded. All the patients were followed up for a minimum of six months. They were assessed radiologically and clinically. The clinical evaluation was based on two criteria. 1. total active range of motion for digital functional assessment as suggested by the American Society for Surgery of Hand and 2. grip strength.

Results:

All the patients showed radiological union at six weeks. The overall results were excellent in all the patients. Adventitious bursitis was observed at the point of insertion of nails in one patient.

Conclusion:

Joint-sparing multiple intramedullary nailing of unstable proximal phalangeal fractures of hand provides satisfactory results with good functional outcome and fewer complications.     

Analysis of 3 Different Operative Techniques for Extra-articular Fractures of the Phalanges and Metacarpals

Background: Several techniques have been described for treating metacarpal and phalangeal fractures. We sought to compare the 3 techniques most frequently used for extra-articular metacarpal and phalangeal fractures: plate screw (PS), Kirschner wire (KW), and retrograde intramedullary screw (RIS) fixation. We aimed to determine whether using an RIS provides better clinical outcomes than using either a PS or a KW fixation. Methods: We conducted a retrospective review of patients who underwent surgical treatment of metacarpal and phalangeal fractures from January 2011 to December 2017 in our department. Only patients with an acutely displaced short oblique or transverse extra-articular metacarpal or phalangeal fracture were included. Patients were classified into 3 groups depending on the treatment they received: PS, KW, or RIS fixation. The duration of each procedure was recorded. Clinical assessments included measuring total active motion (TAM), grip strength, and an evaluation of plain radiographs through to ultimate healing. A Disabilities of the Arm, Shoulder and Hand (QuickDASH) score was collected on all patients. Data were analyzed by analysis of variance or Kruskal-Wallis rank test, as indicated. Results: A total of 253 fractures (202 metacarpal and 51 phalangeal) in 230 patients were included in analysis. In all, 135 fractures (53.3%) underwent PS fixation; 53 (20.9%), KW fixation; and 65 (25.6%), RIS fixation. In the KW fixation group, Bouquet pinning was performed for metacarpal fractures and cross pinning for phalangeal fractures. When more than 1 fracture coexisted in the same patient, they were considered separate instances. No differences among the 3 groups were observed when evaluating mean time to radiological union, grip strength, TAM, or QuickDASH score. Mean surgery time was significantly shorter with KW (20 minutes) and RIS (25 minutes), than with PS (32 minutes). Mean return to work or routine activities time was significantly less in the RIS (7.8 weeks) group than in the PS and KW groups (8.3 and 9.2 weeks, respectively). Conclusions: Surgical treatment is recommended in patients with unstable metacarpal and phalangeal fractures. The use of RIS was associated with shorter mean surgery duration and return to work times than PS and KW, respectively.     

Management of Proximal Phalangeal Fractures of the Hand Using Finger Nail Traction and a Digital Splint: A Prospective Study of 43 Cases

Background

Proximal phalangeal fractures are common fractures of the hand. The fractures are difficult to treat because of vicinity of two important joints and crossing long tendons. The purpose of this study was to evaluate the efficacy of nail traction technique in the management of proximal phalangeal fractures of the hand.

Methods

Patients (n=43) with proximal phalangeal fractures were treated by nail traction and evaluated prospectively. We assessed all the patients at the time of presentation and then followed a standard protocol for recruiting patients. After application of nail traction, the patients were initially assessed at 12th day. The outcome measures included post reduction radiographic evaluation and total active motion (TAM) in finger at the final follow-up appointment. All the patients were followed for one year.

Results

The post-reduction X-ray evaluation showed good reduction in 33 cases, fair reduction in 8 and poor reduction in 2 cases. At final assessment, 35 patients had good TAM score, six had fair and two had poor TAM score. Complications were noted in two patients and these included pressure necrosis in palm and stiffness in proximal interphalangeal joint.

Conclusions

The results of this prospective study show that with careful selection of patients, nail traction seems to be simple, safe and effective technique for managing proximal phalangeal fractures.     

Composite wiring of metacarpal and phalangeal fractures

Composite wiring techniques using various configurations of Kirschner pins and stainless steel wire sutures have been applied to the treatment of 63 fractures of the long bones of the hand. The secure fixation achieved allowed active motion within 1 week of operation. Thirty-three metacarpal fractures achieved a final mean total active motion of 256 degrees (standard deviation 13.4) (normal total active motion -260 degrees). Twenty-one phalangeal fractures achieved a mean total active motion of 215 degrees (standard deviation, 46 degrees). There were no instances of infection, malunion, nonunion, loss of reduction, or tendon rupture in the 63 fractures that were treated.     

Evaluation of the syndesmotic-only fixation for Weber-C ankle fractures with syndesmotic injury

Background:

With the length of the fibula restored and the syndesmosis reduced anatomically, internal fixation using a plating device may not be necessary for supra-syndesmotic fibular fractures combined with diastasis of inferior tibio-fibular joint. A retrospective observational study was performed in patients who had this injury pattern treated with syndesmosis-only fixation.

Materials and Methods:

12 patients who had Weber type-C injury pattern were treated with syndesmosis only fixation. The treatment plan was followed only if the fibular length could be restored and if the syndesmosis could be anatomically reduced. Through a percutaneous or mini-open reduction and clamp stabilization of the syndesmosis, all but one patient had a single tricortical screw fixation across the syndesmosis. Patients were kept non-weight-bearing for 6 weeks, followed by screw removal at an average of 8 weeks. Outcomes were assessed using an objective ankle scoring system (Olerud and Molander scale) and by radiographic assessment of the ankle mortise.

Results:

At a mean follow-up of 13 months, the functional outcome score was 75. Excellent to good outcomes were noted in 83% of the patients. Ankle mortise was reduced in all cases, and all but one fibular fracture united without loss of fixation. Six patients had more than one malleolar injury, needing either screw or anchor fixations. One patient had late diastasis after removal of the syndesmotic screw and underwent revision surgery with bone grafting of the fibula. This was probably due to early screw removal, before union of the fibular fracture had occurred.

Conclusion:

We recommend syndesmosis-only fixation as an effective treatment option for a combination of syndesmosis disruption and Weber type-C lateral malleolar fractures.     

External fixation of metacarpal and phalangeal fractures

External fixation is rarely employed in the treatment of hand fractures, and few reports describing this technique have been published. This is a report on 26 patients with 30 hand fractures (19 metacarpal and 11 phalangeal) treated by closed reduction and external fixation. The fixation consisted of percutaneous and transversely applied Kirschner wires that were fixed externally with methylmethacrylate rods. Active range of motion exercises were started 1 week after reduction with the external fixator in place. Percentage return of total range of motion in phalangeal fractures varied from 66% to 98% (mean, 84%), and in metacarpal fractures it varied from 77% to 100% (mean, 96%).     

Percutaneous fixation with Schanz screws for displaced two- and three- part fractures of the proximal humerus in patients above fifty years of age

Purpose:

The aim of this study is to evaluate whether two 3.0 mm Schanz screws in two-part proximal humeral fractures (plus one additional Schanz screw or K wire in three-part fractures) can provide enough stability to allow early mobilization until healing occurs in elderly patients.

Settings and Design:

This prospective study was performed in the Orthopaedic Department of our University Hospital.

Patients and Methods:

We performed closed reduction and percutaneous pinning for thirty-three patients with proximal humerus fractures. Twenty-seven patients were available for the final follow-up. Of those 27 patients, 17 had two-part surgical neck fractures; while 10 had three-part fractures. For fixation, we used two 3.0 mm Schanz screws in patients with two-part fractures plus one additional Schanz screw or K wire in the 10 patients with three-part fractures.

Results:

The mean Constant score modified according to the age and sex was 89.8% (range: 77.3-97.2%). Fifteen patients had excellent results, 11 patients had good results, and one patient had a fair result.

Conclusion:

Closed reduction and percutaneous pinning with two Schanz screws for two-part surgical neck humeral fractures, plus an additional Schanz screw or K wire for three-part proximal humeral fractures is a useful and effective technique that provides enough stability to allow an early rehabilitation program till union occurs in elderly patients.

Level of Evidence:

IV; therapeutic study, case series.     

克氏针治疗掌指骨骨折后致手指屈曲畸形的分析

目的分析掌、指骨骨折治疗后出现手指屈曲畸形的原因。方法2003年1月--2007年12月,采用克氏针固定治疗掌、指骨骨折128例,其中掌骨骨折25例,近节指骨骨折37例,中节指骨骨折42例,混合性骨折24例;闭合性骨折38例,开放性骨折90例,均采用不贯穿关节的交叉克氏针及斜行克氏针固定骨折,外固定均采用石膏,其中指间关节屈曲位固定53例,伸直位固定75例,石膏固定3～4周,克氏针固定6～15周。结果随访3～12月,出现近侧指间关节屈曲畸形、活动受限19例（15％）。结论克氏针治疗掌、指骨骨折时常因躲避克氏针而采用屈曲手指位外固定,再由于克氏针本身对指背筋膜的损伤导致关节屈曲畸形。     

国产PDLLA可吸收定位螺钉治疗手部掌指骨骨折

目的评价应用国产PDLLA可吸收定位螺钉治疗手部掌骨、指骨骨折的临床疗效。方法2005年10月-2008年12月对126例手部不同部位的掌骨、指骨骨折患者应用国产PDLLA可吸收定位螺钉进行骨折内固定，术后观察其骨折移位、切口及骨折愈合等情况。结果术后123例伤12一期愈合，3例伤口经换药后痂下愈合。随访时间为6～28个月，平均13．6个月，无肿胀、渗出或感染发生，无1例骨折再移位，均获骨性愈合，手功能恢复良好。结论国产PDLLA可吸收定位螺钉应用于手部掌骨、指骨骨折，能够取得满意的疗效，是一种可取的临床治疗方法。     

Outcome of complex tibial plateau fractures treated with external fixator

Background:

Tibial plateau fractures are usually associated with communition and soft tissue injury. Percutaneous treatment of these complex fractures is intended to reduce soft issue complications and postoperative stiffness of the knee joint. We assessed the complications, clinical outcome scores, and postoperative knee range of movements, after fluoroscopic assisted closed reduction and external fixator application.

Materials and Methods:

Seventy eight complex tibial plateau fractures in 78 patients were included in the study. All fractures were managed with closed reduction and external fixator application. In 28 cases with intraarticular split, we used percutaneous cancellous screw fixation for reduction and fixation of condylar parts. In nine open fractures, immediate debridement was done. In 16 cases, elevation of depressed segment and bone grafting was required, which was done from a very small incision. All patients were clinically and radiographically evaluated at a mean followup of 26.16 months (range 6–60 months).

Results:

Clinical results were evaluated according to the Rasmussen''s criteria. Average healing time was 13.69 weeks (range 12– 28 weeks). Mean knee range of motion was 122.60° (range 110°–130°). Forty seven results were scored as excellent, 25 good, 2 fair, and 1 as poor.

Conclusion:

We believe that minimally invasive treatment by percutaneous techniques and external fixation is a fairly reasonable treatment alternative, if near anatomical reduction of joint surface can be confirmed on fluoroscopy.     

Role of gamma nail in management of pertrochanteric fractures of femur

Background:

Pertrochanteric fractures which involve trochanteric fractures with varying fracture geometry pose a significant challenge to the treating orthopedic surgeon. The aim of this study is to evaluate the management of pertrochanteric fractures of the femur using gamma nail [Asia pacific (AP)].

Materials and Methods:

Sixty patients of pertrochanteric fractures were treated by closed reduction internal fixation by gamma nail from 1 January 1993 to 31 December 2000. Four patients were lost to follow-up. The remaining 56 patients were followed for a mean period of 3.2 years (range 2-4 years).The results were evaluated by assessing the patients regarding their clinical and functional outcome at follow-up as per Kyle''s criteria.

Results:

Peroperative jamming of nail (n = 1), failed distal locking (n = 1), superior cut out of lag screw (n = 1) and postoperative varus malreduction (n = 1) were the complications observed. End results were excellent in 46.34%, good in 36.58%, fair in 14.64%, poor in 2.43%.

Conclusion:

Gamma nail in expert hands is a suitable implant for management of pertrochanteric fractures of the femur.     

Handgun injuries with metacarpal and proximal phalangeal fractures: early definitive treatment

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.     

Odontoid fractures: A retrospective analysis of 53 cases

Background:

The management of odontoid fracture has evolved but controversy persists as to the best method for Type II odontoid fractures with or without atlantoaxial (AA) instability. The anterior odontoid screw fixation can be associated with significant morbidity while delayed odontoid screw fixation has shown to be associated with reasonable good fusion rates. We conducted a retrospective analysis to evaluate the outcome of a trial of conservative management in type II odontoid fractures without atlantoaxial instability (Group A) followed by delayed odontoid screw fixation in cases in which fusion was not achieved by conservative treatment. The outcome of type II odontoid fracture with AA subluxation (Group B) was also analysed where closed reduction on traction could be achieved and in those atlantoaxial subluxations that were irreducible an intraoperative reduction was done.

Materials and Methods:

A retrospective evaluation of 53 cases of odontoid fractures treated over a 9-year period is being reported. All odontoid fractures without AA instability (n=29) were initially managed conservatively. Three patients who did not achieve union with conservative management were treated with delayed anterior screw fixation. Twenty-four cases of odontoid fractures were associated with AA instability; 17 of them could be reduced with skeletal traction and were managed with posterior fusion and fixation. Of the seven cases that were irreducible, the initial three cases were treated by odontoid excision followed by posterior fusion and fixation; however, in the later four cases, intra operative reduction was achieved by a manipulation procedure, and posterior fusion and fixation was performed.

Results:

Twenty-six of 29 cases of odontoid fracture without AA instability achieved fracture union with conservative management whereas the remaining three patients achieved union following delayed anterior odontoid screw fixation. 17 out of 24 odontoid fracture with atlantoaxial dislocation could be reduced on traction and these patients underwent posterior fusion and fixation. Optimal or near optimal reduction was achieved by on table manipulation in four cases which were irreducible with skeletal traction. Atlantoaxial stability was achieved in all cases. All cases were noted to be stable on evaluation with x-rays at six months.

Conclusions:

The initial conservative management and use of odontoid screw fixation only in cases where conservative management for 6–12 weeks has failed to provide fracture union have shown good outcome in type II odontoid fracture without AA instability rates. Intraoperative manipulation and reduction in patients where AA subluxation failed to reduce on skeletal traction followed by posterior fusion obviates the need for transoral odontoid excision.     

微型万向外固定器与微型钢板治疗掌指骨关节内骨折脱位的疗效比较

目的 比较采用微型万向外固定器与微型钢板治疗掌指骨关节内骨折的疗效.方法 2002年10月至2008年3月,手术治疗掌指骨关节内骨折脱位患者106例,将患者随机分为外固定组和钢板组进行治疗.外固定组53例,采用微型万向外固定器或联用骨片钉、克氏针固定,男28例,女25例;年龄20.～62岁,平均33.5岁;拇指损伤24例,其余四指损伤29例;近端指间关节骨折脱位36例,掌指关节骨折脱位17例.钢板组53例,采用微型纯钛板螺钉进行固定,男30例,女23例;年龄23～66岁,平均36.5岁;拇指损伤22例,其余四指损伤31例;近端指间关节骨折脱位30例,掌指关节骨折脱位23例.采用Duncan等评分标准对两组患者手指关节活动度进行比较.结果 术后外固定组平均随访16.8个月,钢板组平均随访17.5个月.采用Duncan等评分标准评价手指功能的优良率:外固定组,优33例,良16例,可3例,差1例,优良率92.5%(49/53);钢板组,优30例,良17例,可5例,差1例,优良率88.7%(47/53).外固定组1例发生伤口感染,拇指关节平均活动度为134°±21°,其余四指为248°±19°;钢板组无伤口感染,拇指关节平均活动度为122°±18°,其余四指为225°±17°.结论 采用微型万向外固定器或联用经皮骨片钉、克氏针治疗掌指骨关节内骨折的术后疗效优于钢板螺钉固定的方法.     

Double parabolic Kirschner-wires as dynamic distractor for treatment of unstable intraarticular phalangeal fractures of hand

Background:

Treatment of complex injuries of interphalangeal joints (IPJs) is difficult. The restoration of joint stability for early joint mobility till fracture union is the key for successful outcome. Although various treatment options like dynamic splinting, external fixator, closed reduction, transarticular Kirschner (K)-wire and ORIF, etc., are available in literature, a universally accepted ideal treatment for complex intraarticular fractures of IPJs is still evolving. Open reduction is difficult because fixation of volar fragment is often impractical and radical procedures like volar plate arthroplasty, arthrodesis or joint replacement, etc., may become mandatory for salvage. We describe percutaneous technique to treat unstable fractures and dorsal fracture–dislocations of the PIP joint and report short-term postoperative results.

Materials and Methods:

Ten cases of unstable or potentially unstable intraarticular fractures including pilon fractures and fracture-dislocations of IP joints were treated percutaneously by double parabolic K-wire technique (DPK). The device was used as a dynamic distraction, using the principle of ligamentotaxis. The idea was to commence early postoperative continuous active and active-assisted joint motion exercises and to carry on the frame as a definitive treatment for achieving fracture union.

Results:

In all patients of fracture-dislocation the reduction was satisfactory and early mobility was achieved. Although there is a tendency towards over-distraction, no loss of reduction occurred. Pin tract infection occurred in one with no delayed union or nonunion. The average total range of motion for each involved IP joint was 93.5 degree and the average total active range of motion was 90.8° each at the end of 4 months followup. Excellent to good results were restored in nearly all cases without further interventions.

Conclusion:

DPK technique may be a cheap and valuable definitive treatment option in the management of unstable or potentially unstable intraarticular fractures of IPJs. The technique gave satisfactory radiological union and functional outcome in our small series. This technique may be worth considering in unstable or potentially unstable intraarticular fractures of IPJs with intact collateral ligaments and when other treatment options are impractical.     

Functional outcome of closed fractures of proximal humerus managed by Joshi's external stabilizing system

Background:

Proximal humeral fractures account for 4–5% of all fractures; most of them involving elderly and osteoporotic people. 1 51% of such fractures are displaced. Two Fractures with minimal displacement, regardless of the number of fracture lines, can be treated with closed reduction and early mobilization, but anatomical reduction in displaced fractures is difficult to obtain and the incidence of pseudarthrosis is high 3-5. We evaluated the functional results of closed Neer''s 2- and 3-part proximal humerus fractures treated by Joshi''s external stabilizing system.

Materials and Methods:

Sixteen patients with proximal humeral fractures were managed from 2008 to 2010 by Joshi''s stabilizing external fixation. They were 10 males and 6 females, with a mean age of 57.5 years. Based on Neer''s classification, there were eleven 3-part fractures and five 2-part fractures. The mechanism of injuries included seven road traffic accidents and nine fall. Shoulder mobilization exercises were started within 1 week after stabilization with JESS. External fixation was removed after the evidence of union (6–8 weeks). Pain was evaluated by visual analogue scale (VAS) and shoulder range of motion was evaluated by Constant Scoring System. Followup was done at 4 weeks, 8 weeks, 12 weeks, and then at every 4 weeks.

Results:

Mean followup was of 20.5 months (range 9-30 months). Postoperative mean VAS score and Constant Score of patients was 2.1 (±0.73) and 78.1 (±9.61) at an average followup of 6 months. Mean duration for union was 6.5 (±1.18) weeks. One case of K-wire loosening and one case of pin tract infection were the complications noted.

Conclusion:

External fixation by JESS is an alternative option to treat Neer''s 2 and 3 part proximal humerus fractures with good results.     

Intramedullary fixation of forearm fractures with new locked nail

Background:

Lack of availability of interlocked nails made plate osteosynthesis the first choice of treatment of forearm fractures inspite of more surgical exposure, periosteal stripping and big skin incision subsequent scar along with higher risk of refracture on implant removal. We hereby report the first 12 cases with 19 forearm bone fractures internally fixed by indegenous interlocked nail.

Materials and Methods:

Existing square nails were modified to have a broad proximal end of 5.5 mm with a hole for locking screw of 2.5 mm. The nail has a distal hole of 1/1.2/1.5 mm in 2.5/3/3.5 mm diameter nail, respectively. A new method of distal locking with a clip made of k wire is designed. The clip after insertion into the bone and hole in nail and opposite cortex snuggly fits the bone providing a secure locking system. Twelve skeletally mature patients, mean age 32 years (range 24-45 years) with 19 diaphyseal fractures of the forearm were treated with this indigenously made new nail. The patient were evaluated for fracture union, functional recovery and complications. The functional outcome was assessed by disabilities of arm, shoulder and hand questionnaire (DASH score).

Results:

Time to radiographic union ranged between 12 and 28 weeks, with a 100% union rate. Complications were minimal, with mild infection in open fracture (n=1) and delayed union (n=1) in patient with comminuted fracture of the ulna only. The clinical results were excellent. The DASH score ranged between 0 and 36 points.

Conclusion:

This new interlocking nail may be considered as an alternative to plate osteosynthesis for fractures of the forearm in adults. The advantages are benefit of closed reduction, smaller residual scar, reduced cost and early union with allowance of immediate movements.     

Two peg spade plate for distal radius fractures: A novel technique

Background:

The management of distal radius fractures raises considerable debate among orthopedic surgeons. The amount of axial shortening of the radius correlates with the functional disability after the fracture. Furthermore, articular incongruity has been correlated with the development of arthritis at the radiocarpal joint. We used two peg volar spade plate to provide a fixed angle subchondral support in comminuted distal radius fractures with early mobilization of the joint.

Materials and Methods:

Forty patients (26 males and 14 females) from a period between January 2009 and December 2011 were treated with two peg volar spade plate fixation for distal radius fracture after obtaining reduction using a mini external fixator. Patients were evaluated using the demerit point system of Gartland and Werley and Sarmiento modification of Lindstrom criteria at final followup of 24 months.

Results:

The average age was 43.55 years (range 23-57 years). Excellent to good results were seen in 85% (n = 34) and in all patients when rated according to the demerit point system of Gartland and Werley and Sarmiento modification of Lindstrom criteria, respectively. Complications observed were wrist stiffness in 5% (n = 2) and reflex sympathetic dystrophy in 2.5% (n = 1).

Conclusions:

The two peg volar spade plate provides a stable subchondral support in comminuted intraarticular fractures and maintains reduction in osteoporotic fractures of the distal radius. Early mobilization with this implant helps in restoring wrist motion and to prevent development of wrist stiffness.     

A retrospective analysis of loss of reduction in operated supracondylar humerus fractures

Background:

Loss of reduction following closed or open reduction of displaced supracondylar fractures of the humerus in children varies widely and is considered dependent on stability of the fracture pattern, Gartland type, number and configuration of pins for fixation, technical errors, adequacy of initial reduction, and timing of the surgery. This study was aimed to evaluate the factors responsible for failure of reduction in operated pediatric supracondylar fracture humerus.

Materials and Methods:

We retrospectively assessed loss of reduction by evaluating changes in Baumann''s angle, change in lateral rotation percentage, and anterior humeral line in 77 consecutive children who were treated with multiple Kirschner wire fixation and were available for followup. The intraoperative radiographs were compared with those taken immediately after surgery and 3 weeks postoperatively. Multivariate logistic regression analysis was performed by STATA 10.

Results:

Reduction was lost in 18.2% of the patients. Technical errors were significantly higher in those who lost reduction (P = 0.001; Odds Ratio: 57.63). Lateral pins had a significantly higher risk of losing reduction than cross pins (P = 0.029; Odds Ratio: 7.73). Other factors including stability of fracture configuration were not significantly different in the two groups.

Conclusions:

The stability of fracture fixation in supracondylar fractures in children is dependent on a technically good pinning. Cross pinning provides a more stable fixation than lateral entry pins. Fracture pattern and accuracy of reduction were not important factors in determining the stability of fixation.     

Monosegmental fixation for the treatment of fractures of the thoracolumbar spine

Background:

A short vertebral arthrodesis has been one of the objectives of the surgical treatment of fractures of the thoracolumbar spine. We present here clinical, functional and radiographic outcome obtained after monosegmental fixation (single posterior or combined anterior and posterior) of specific types of unstable thoracolumbar fractures.

Materials and Methods:

Twenty four patients with fractures of the thoracolumbar spine submitted to monosegmental surgical treatment (Group I - 18 single posterior monosegmental fixations and Group II - 6 combined anterior and posterior fixations) were retrospectively evaluated according to clinical, radiographic and functional parameters. The indication for surgery was instability or neurological deficit. All the procedures were indicated and performed by the senior surgeon (Helton LA Defino).

Results:

The patients from group I were followed-up from 2 to 12 years (mean: 6.65±2.96). The clinical, functional and radiographic results show that a single posterior monosegmental fixation is adequate and a satisfactory procedure to be used in specific types of thoracolumbar spine fractures, The patients from group II were followed-up from 9 to 15 years (mean: 13 ± 2,09 years). On group II the results of clinical evaluation showed moderate indices of residual pain and of satisfaction with the final result. The values obtained by functional evaluation showed that 66.6% of the patients were unable to return to their previous job and presented a moderate disability index (Oswestry = 16.6) and a significant reduction of quality of life based on the SF-36 questionnaire. Radiographic evaluation showed increased kyphosis of the fixed vertebral segment during the late postoperative period, accompanied by a reduction of the height of the intervertebral disk.

Conclusion:

It is possible to stabilize the fractures which have an anterior good load-bearing capacity by a standalone posterior monosegmental fixation. However this procedure, even with an anterior support is not suitable for fracture involving the vertebral body.