Comparison of outcomes after triceps split versus sparing surgery for extra-articular distal humerus fractures

Objectives

To compare elbow range of motion (ROM), triceps extension strength, and functional outcome of AO/OTA type A distal humerus fractures treated with a triceps-split or -sparing approach.

Design

Retrospective review.

Setting

Two level one trauma centres.

Patients

Sixty adult distal humerus fractures (AO/OTA 13A2, 13A3) presenting between 2008 and 2012 were reviewed. Exclusion criteria removed 18 total patients from analysis and three patients died before final follow-up.

Intervention

Patients were divided into two surgical approach groups chosen by the treating surgeon: triceps split (16 patients) or triceps sparing (23 patients).

Main outcome measurements

Elbow ROM and triceps extension strength testing were completed in patients after fractures had healed. All patients were also given the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire.

Results

Compared to the triceps-split cohort, the triceps-sparing cohort had greater elbow flexion (sparing 143 ± 7° compared to split 130 ± 12°, p = 0.03) and less extension contracture (sparing 6 ± 8° compared to split 23 ± 4°, p < 0.0001). Triceps strength compared to the uninjured arm also favoured the triceps-sparing cohort (sparing 88.9 ± 28.3% compared to split 49.4 ± 17.0%, p = 0.007). DASH scores were not statistically significant between the two cohorts (sparing 14.5 ± 12.2 compared to split 23.6 ± 22.3, p = 0.333).

Conclusions

A triceps-sparing approach for surgical treatment of extra-articular distal humerus fractures can result in better elbow ROM and triceps strength than a triceps-splitting approach. Both approaches, however, result in reliable union and similar functional outcome.

Level of evidence

Level III.     

Repairing the annular ligament is not necessary in the operation of Mason type 2, 3 isolated radial head fractures if the lateral collateral ligament is intact: Minimum 5 years follow-up

Introduction

The repair of annular ligament after open reduction and internal fixation of radial head fracture could produce the irritation or crepitation during range of motion exercise. The purpose of this study is to evaluate the significance of unrepaired annular ligament during fixation of isolated radial head fractures.

Materials and methods

Retrospectively we reviewed the twenty-five patients who underwent surgical fixation with a plate for Mason type 2, 3 isolated radial head fracture without annular ligament repair. All the radial head fracture did not have the associated injuries which could cause the elbow instabilities. The average length of follow-up was 6.9 years. The outcomes were evaluated clinically (range of motions, instabilities, pain VAS, Broberg & Murrey functional rating score, DASH score) and radiographically (bony union, arthritic change, lateral translation of the radial head, humero-ulnar angle with maximum varus stress of elbow, ulnar variance).

Results

The range of motions between affected and contralateral side were not significantly different at last follow-up. No one showed the instabilities of elbow. The mean pain VAS, Broberg & Murrey functional rating score, and DASH score were 2.7 ± 0.5, 95.3 ± 2.5, and 14.8 ± 5.3 points respectively. Bony union was observed for all cases. There was no significant difference in the lateral translation of the radial head, humero-ulnar angle with maximum varus stress of elbow, and ulnar variance between the affected and the contralateral arm.

Conclusion

The isolated role of the annular ligament seems overestimated. We scrutinize that the annular ligament repair is not essential in the operative treatment of isolated radial head fractures if the lateral collateral ligament is intact.     

Post-operative numbness and patient satisfaction following plate fixation of clavicular fractures

Introduction and aim

Numbness across the shoulder and upper chest wall is a frequent complication following plate fixation of clavicular shaft fractures. This is usually attributed to damage to branches of the supraclavicular nerve caused by the surgical approach. We investigate whether the use of an incision perpendicular to the long axis of the clavicle (vertical incision) rather than one parallel to it (horizontal incision) is associated with reduced post-operative numbness and improved patient satisfaction.

Methods

We retrospectively assessed a group of patients who underwent plate fixation of a fractured clavicle at our institution. Using a patient-completed questionnaire, we compared differences in numbness, scar satisfaction, pain, and overall satisfaction with the operation, between those who received a horizontal incision (n = 21) versus those treated using a vertical incision (n = 14).

Results

The likelihood of experiencing post-operative numbness was less in the vertical incision group. Those who had undergone vertical incisions also reported a significantly reduced degree of numbness and significantly less awareness of the numbness with clothing and shoulder straps. There was no statistically significant difference between the groups in terms of pain and scar satisfaction. Patients who reported being most bothered by their numbness also tended to report the highest dissatisfaction with the operation.

Conclusion

Vertical incisions for plate fixation of clavicular shaft fractures may be associated with reduced post-operative numbness and avoid some cases of patient dissatisfaction. Surgeons should consider using this approach in plate fixation of clavicle fractures.     

Reoperation following open reduction and plate fixation of displaced mid-shaft clavicle fractures

Background

Operative fixation of displaced, mid-shaft clavicle fractures has become an increasingly common practice. With this emerging trend, data describing patient outcomes with longer follow-up are necessary.

Patients and Methods

We retrospectively reviewed the medical records of subjects treated with plate fixation for displaced mid-shaft clavicle fractures from 2003 to 2009 at a Level I trauma hospital. All subjects were greater than 12 months post-index surgery. Treatment involved ORIF with either a low-contact dynamic compression plate (LCDC) or a contoured plate (pre-contoured or pelvic reconstruction plate). Our primary outcome was reoperation for any indication.

Results

143 subjects were included. The mean age was 36 ± 14 years and the mean time to reoperation or chart review was 33 months. Contoured plates were used in 64% of cases and LCDC plates were used in the remaining subjects. Twenty-nine subjects (20%) underwent reoperation: 23.5% of subjects treated with LCDC plates and 18.5% of subjects treated with contoured plates (p = 0.52). Indications for reoperation included implant irritation (n = 25), implant failure (n = 2), and non-union (n = 2). There was near statistically significant association with reoperation and female gender (p = 0.05) but no association between reoperation and age (p = 0.14), fracture class (p = 0.53), plate type (p = 0.49), or plate location (p = 0.93). The mean QuickDASH score for the population surveyed was 8.8 (5.5–12.1; 95% CI) with near statistically significant and clinically relevant difference between those considering reoperation and those not 22.3 (8.6–36.0; 95% CI) versus 6.7 (3.6–9.8; 95% CI).

Conclusions

This study represents a large series of displaced clavicle fractures treated with open reduction and plate fixation. Reoperation following plate fixation is relatively common, but primarily due to implant irritation. No difference in reoperation rates between plate types or location could be detected in our current sample size. Also, excellent functional outcomes continue to be observed several years after clavicle fracture fixation.     

Outcome of proximal femoral fractures caused by cycling in the young and mid-aged

Background

Cycling is gaining more popularity both as a sport, on and off-road and also as a means of commute. Cycling accidents harbour significant injury risks including fractures. Proximal femoral fractures are uncommonly associated with cycling in the young adult population. The purpose of this study is to describe this unique pattern of injury as well as the outcome of proximal femoral fractures caused by cycling in the young to mid age population.

Methods

Study design: retrospective cohort study. 23 fractures in 22 patients were available for analysis. 11 were femoral neck fractures, with six displaced ones, and the rest trochanteric fractures. 21 patients were male patients, and the average age was 42 (range 27–60). All patients but two were operated within 24 h from admission. Radiographic analysis included reduction quality, fracture classification and arthritic changes. Clinical outcome was measured using SF-12 and Oxford hip scores.

Results

All fractures healed. Two patients with displaced femoral neck fractures developed avascular necrosis requiring arthroplasty. One patient developed an AVN 2 years after a stable trochanteric fracture but did not require an arthroplasty as of yet. Eight patients required hardware removal due to symptoms. 77% of patients had resumed cycling at the pre-injury level. Mean SF-12 score was 47.1 ± 11.7 for the physical component and 53.7 ± 6.3 for the mental component. Mean oxford hip score as was 40.1 ± 12.2. Radiographic analysis revealed good to acceptable reduction quality. Fracture type, age, cycling type and reduction were not significantly associated with outcome.

Conclusion

Proximal femoral fractures caused by cycling in young to mid-aged adults are an emerging pattern of injury. Overall favourable result can be expected in the majority of cases, with displaced femoral neck fractures having a risk for AVN. Further delineation of the exact cause for this phenomenon is required with possible intervention for injury prevention.     

Transosseous suturing of patellar fractures with braided polyester – A prospective cohort with a matched historical control study

Background

Although tension-band wiring is the most widely used technique to fix patellar fractures, metal implant-related complications including implant failure and postoperative pain are very common and additional procedures are often necessary to treat the complications. The purpose of this study is to evaluate a totally metal-free technique using a transosseous suturing method and to compare it with the traditional fixation technique.

Method

A total of 25 patients (mean age of 59.60 years) with displaced patellar fractures treated by a transosseous suturing technique were compared with a 1:1 matched historical control group that underwent modified tension-band-wire fixation. Union time, union rate, operation time, number of procedures, mean hospitalisation days and complications were compared between cases and controls.

Results

Union time (8.43 ± 2.92 vs. 8.64 ± 2.82 weeks) and operation time (69.00 ± 19.31 vs. 64.89 ± 14.27 min) were not different between the two groups. Mean hospitalisation days (4.04 ± 1.40 vs. 5.76 ± 1.50 days; P < 0.001), number of procedures and the frequency of complications were significantly lower in the transosseous suturing group.

Conclusion

The transosseous suturing technique is safe and effective in the transverse or comminuted fractures of the patella. The complication rate is significantly lower than with the tension-band-wiring technique.     

Identification of Shoulder-specific Patient Acceptable Symptom State in Patients with Rheumatic Diseases Undergoing Shoulder Surgery

Study Design

Clinical measurement study with a longitudinal design.

Objective

Estimate Patient Acceptable Symptom State (PASS) thresholds in six shoulder outcome measures and two pain scales.

Methods

Patients with rheumatic diseases undergoing shoulder surgery were assessed at baseline and one-year follow-up (with Bostrom Shoulder Movement Impairment Scale, Constant, Disability of the Arm, Shoulder and Hand [DASH], Oxford Shoulder Score [Oxford], Shoulder Function Assessment Scale, Shoulder Pain and Disability Index [Spadi], and two visual analog pain scales [VAS]). PASS thresholds were estimated using the 75th percentile and the receiver operating characteristic curve approach.

Results

One hundred patients were included; 74 (74%) patients considered their shoulder function to be acceptable (PASS+), which was significantly associated with being female, odds ratio (OR) 4.54, and having better functional status (Health Assessment Questionnaire), OR 0.17 (p < 0.05). Activity-related pain (VAS), the Oxford, and the Spadi showed best discriminative accuracy for PASS. All measures estimated changes exceeding the minimal clinical important difference.

Conclusion

The Oxford and the Spadi showed better discriminant ability for PASS than the more commonly used Constant score and the DASH. The PASS thresholds for pain showed that patients accepted less pain at rest than during activity, underlining the importance of assessing both aspects of pain.

Level of Evidence

3. Diagnostic study.     

Management of unstable distal third clavicle fractures: clinical and radiological outcomes of the arthroscopy-assisted conoid ligament reconstruction and fracture cerclage with sutures

Introduction

Surgical treatment is indicated for the management of Neer type IIB fractures of the distal third of the clavicle. The aim of this study was to assess the clinical and radiological outcomes, in cases of unstable distal third clavicle fractures managed by means of an arthroscopy-assisted conoid ligament reconstruction and fracture cerclage with sutures.

Methods

Nine patients with unstable distal third clavicle fractures (Neer type IIB) managed arthroscopically by means of a conoid ligament reconstruction and fracture cerclage with sutures, between 2008 and 2012, were included. The QoL was evaluated at the last follow-up visit, by means of the Health Survey questionnaire (SF36), the visual analogue scale (VAS) for pain, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the constant score, and a Global Satisfaction scale (from 0 to 10). The mean time from fracture fixation until radiological union, the development of hardware loosening, nonunion, infections, and hardware skin discomfort were evaluated.

Results

The mean age was 36 [21–48] years old. The mean [range] time from surgery until the last follow-up visit was 49 [46–52] months. Values of the questionnaires assessed at the last follow-up visit were: (1) physical SF36 score (50.72 ± 6.88); (2) mental SF36 score (50.92 ± 11.65); (3) VAS for pain (1.86 ± 1.35); (4) DASH questionnaire (11.97 ± 7.03); (5) constant score (89.67 ± 8.55), and (6) Global Satisfaction (8.17 ± 0.98). The mean time elapsed from fracture fixation to radiological union was 8.41 ± 3.26 months. Hardware loosening was observed in none of the patients. Nonunion was observed in 11.11% (1/9) of the patients. Hardware skin discomfort was observed in 11.11% (1/9) of the patients.

Conclusion

Patients with unstable distal third clavicle fractures managed by means of an arthroscopy-assisted conoid ligament reconstruction and fracture cerclage with sutures may have good clinical and radiological outcomes, with no need for a second surgical procedure to remove any metal hardware.

Level of evidence

Therapeutic; case series, Level IV.

     

Meta-analysis of joint preservation versus arthroplasty for the treatment of displaced 3- and 4-part fractures of the proximal humerus

Purpose

This meta-analysis compares the clinical outcomes of joint preservation versus arthroplasty in the treatment of displaced proximal humerus fractures.

Methods

Medline, CINAHL, and EMBASE were searched for studies published between 1970 and 2011 reporting outcomes of the treatment of 3- or 4-part proximal humerus fractures using the Constant–Murley score in skeletally mature patients. Randomised and cohort studies with ≥1-year follow-up were included. Two individuals independently extracted data, and study results were divided into subgroups based on type of treatment.

Results

A meta-analysis with meta regressions was performed on the mean Constant score. Of 610 total participants in the studies analysed, 340 were treated with joint-preserving techniques. The random-effects mean Constant score across all treatment types was 62.7 (95% CI, 61.6–63.9, P < 0.001), with joint-preserving treatments demonstrating higher scores than arthroplasty (70 vs. 49, P < 0.001). The studies displayed significant heterogeneity (Q statistic = 516, P < 0.001, I² = 94.8). In the meta-regression analyses, Constant scores decreased significantly with increasing age, fracture severity, and rate of osteonecrosis (P < 0.001).

Conclusions

In the existing literature, displaced proximal humerus fractures demonstrate improved Constant scores when treated with joint-preserving options. Age, fracture pattern, and complication rate are significant predictors of the Constant score independent of the selected treatment. Given the observed heterogeneity and variance in treatment techniques in the included studies, more comparative studies are needed to definitively recommend joint-preserving techniques versus arthroplasty for specific fracture patterns.     

Differences in patients with systemic sclerosis recruited from associations and tertiary care settings

Objective

To compare patients with systemic sclerosis (SSc) recruited from a patient association or a tertiary care setting.

Methods

We evaluated 248 SSc patients attending 4 annual meetings of a patient association between 2004 and 2007 (177) or during hospitalization (71). health-related quality of life (HRQoL) was assessed by the SF-36, global disability by the health assessment questionnaire (HAQ), hand disability by the Cochin Hand Function Scale (CHFS), mouth disability by the Mouth Handicap in Systemic Sclerosis (MHISS) scale, global hand and wrist mobility by the Kapandji index.

Results

As compared with hospitalized patients, those from the patient association were significantly older (mean age 58.73 ± 12.04 vs 53.818 ± 13.1; p = 0.001) and had a longer disease duration (10.98 ± 8.7 vs 7.13 ± 6.723 p = 0.0001). Association patients had significantly increased disability of the hand (CHFS 21.8 ± 19.8 vs 9.8 ± 14.1; p = 0.0001) and mouth (MHISS 20.65 ± 10.8 vs 13.25 ± 9.3; p = 0.0001) and impaired hand and wrist mobility (Kapandji score 38.05 ± 10.26 vs 43.90 ± 8.26, p = 0.001). The 2 groups did not differ in global disability or physical and mental scores of the SF36.

Conclusion

Patients recruited from a patient association have more severe SSc than do hospitalized patients. This finding must be taken into account in the design of surveys and clinical trials.     

Applied anatomy of the calcaneocuboid articular surface for internal fixation of calcaneal fractures

Background

Many types of steel plates are used for internal fixation of calcaneal fractures through extensive lateral approach. The fixation screw at the anterior calcaneal process must be placed into the dense compression trabeculae located directly under the calcaneocuboid articular surface to achieve a stable fixation.

Methods

The transverse diameter and inner tilt angle of the calcaneocuboid articular surface were measured and the inner structures near the calcaneocuboid articular surface were observed in forty adult calcaneus bone specimens to provide an anatomical basis for internal fixation of calcaneal fractures.

Results

The transverse diameter was 22.67 ± 2.14 mm and the inner tilt angle was 60.4 ± 7.1°.

Conclusion

Screws should be implanted under the calcaneocuboid articular surface and the length and direction of the screw should be selected according to the transverse diameter of the calcaneal articular surface and the inner tilt angle, respectively.     

Exercise training to improve health related quality of life in long term survivors of major burn injury: A matched controlled study

Objective

Patients often experience reduced health-related quality of life (HRQOL) following burn injury. Exercise training has been demonstrated to improve HRQOL in a number of clinical populations, yet it is unknown whether exercise can improve HRQOL in burns patients.

Procedures

Nine burn-injured participants (42 ± 18.38%TBSA: 6.56 ± 3.68 years after injury) and 9 matched controls participated in a 12-week exercise programme. HRQOL was assessed via the Burn Specific Health Scale-Brief (BSHS-B) and the Medical Outcomes Study 36-Item Short Form (SF-36). Activity limitation was measured using the quick Disabilities of the Arm, Shoulder and Hand (QuickDASH).

Results

The burns group had decreased HRQOL compared to the controls at baseline, as reported by the BSHS-B (t (16) = 3.51, p = 0.003) and some domains of the SF-36 including role physical (t (16) = 3.79, p = 0.002). Burned participants reported decreased activity levels compared to the controls as measured by the QuickDASH (t (16) = 2.19, p = 0.044). Exercise training improved SF-36 scores in both burn (t (8) = 3.77, p = 0.005) and control groups (t (8) = 2.71, p = 0.027). Following training there was no difference between the groups on the SF-36 or QuickDASH.

Conclusion

Exercise training improves HRQOL and activity limitations in burn-injured patients to a level that is equivalent to that of their uninjured counterparts.     

Clinical outcomes of midclavicular fractures treated with titanium elastic nails

Background

Midclavicular fractures are common clinically, accounting for about 76% of all clavicular fractures. Recent studies have revealed a previously unrecognized incidence of nonunion and malunion after conservative treatment of more severe midclavicular fractures. Our aim was to evaluate the clinical outcomes of midclavicular fractures treated with titanium elastic nails.

Methods

From February 2005 to February 2007, 41 patients with displaced midclavicular fractures received open reduction and internal fixation with a titanium elastic nail inserted through the sternal end of the clavicle. We evaluated the visual analogue scale (VAS), the Constant score and the Disabilities of the Arm, Shoulder and Hand (DASH) scale to determine outcomes.

Results

A mean follow-up of 14.5 months (range 7–24 mo) revealed radiographic fracture union in all patients with an average clinical healing time of 2.2 months. Mean subjective pain 3 days after surgery was significantly lower than the day before surgery (p < 0.001). The mean range of motion 3 days after surgery was significantly improved compared with the day before surgery (p < 0.001). The nails were removed in all patients a mean of 7.2 months (range 5.4–9.5 mo) after surgery, and no fractures recurred. The mean postoperative DASH score was 2.5 (range 0.5–8.0) and the mean postoperative Constant score was 95.2 (range 86.5–97.0).

Conclusion

Limited open reduction and internal fixation with titanium elastic nails is a safe and minimally invasive surgical procedure for the treatment of displaced midclavicular fractures in adults and achieves good functional results and high patient satisfaction.     

Humeral head necrosis rate at mid-term follow-up after open reduction and angular stable plate fixation for proximal humeral fractures

Introduction

Short-term follow-up of angular stable fixation for proximal humeral fractures has been well documented in the literature. Longer follow-up series are difficult to find. However, especially regarding the risk of avascular humeral head necrosis longer follow-up series are high of clinical relevance.

Methods

Forty-eight patients with a mean age of 66 years and treated with open reduction and angular stable internal fixation for proximal humeral fractures were followed up for a mean of 45 months. The clinical and radiographic follow-up (Constant Score (CS), age and gender related Constant Score (agCS), Constant Score in comparison to the contralateral side (%CS) and shoulder anterior-posterior and lateral view and axial view X-rays) was performed postoperatively.

Results

Clinical results after 45 months showed a mean CS of 66.2 ± 15.4 points with a mean agCS of 90.0 ± 23.1%. Evaluation of the %CS showed 77.7 ± 17.8%. %CS results showed no significant differences after 45 months in comparison to those obtained after 12 months. However, incidence of avascular necrosis of the humeral head doubled over the follow-up period from 4 cases at 12 months follow-up to 9 cases at final follow-up.

Conclusion

Results of open reduction and internal fixation with angular stable implants for proximal humeral fractures are reliable, however long-term complications such as avascular necrosis of the humeral head need to be evaluated further on since its incidence increases over the time.     

The development and preliminary validation of the Taiwanese Manual Ability Measure for Burns

Objective

To develop and validate the Taiwanese Manual Ability Measure for Burns (T-MAM for Burns), a task-oriented functional evaluation tool to assess self-reported manual ability in burn patients.

Design

A longitudinal study.

Participants

A sample of 45 burn patients from burn rehabilitation centers with varying degrees of hand involvement.

Methods

The preliminary testing version was formed by adding burn specific items to the Taiwanese version of the Manual Ability Measure. A field test was then conducted for item reduction and psychometric properties testing.

Results

Out of 55 initial items, 20 were selected into the final version of the T-MAM for Burns. Psychometric analyses indicated that it was reliable (test–retest ICC = .99), with adequate concurrent validity with various other hand function tests (r = −.79 with the short form Disabilities of the Arm, Shoulder, and Hand, or, the QuickDASH) and discriminative validity (significant difference (t = 2.99, P = .005) between groups with unilateral vs. bilateral hand burns), and responsive (ES = .24 and .44 at one- and 3-month evaluations).

Conclusion

This study shows that the T-MAM for Burns has great potential to be a functional outcome measure for burn rehabilitation. Additional research with a larger sample should be conducted to further confirm its validity and reliability.     

Outcome of delayed primary internal fixation of distal radius fractures: A comparative study

Introduction and aim

Operative fixation of distal radius fractures using fixed-angle devices has become increasingly common. Although good to excellent results have been reported in acute fractures, little is currently known regarding the fixation of healing displaced distal radius fractures that were presented late. The aim of this study was to evaluate the results of internal fixation of distal radius fractures presented late (>21 days) as compared with an acute-care control group.

Methods

Forty patients operated on for displaced distal radius fractures, presenting more than 21 days after injury (delayed treatment (DT) group), were compared with 75 age-matched controls with acute fracture repair (≤21 days). The same surgical approach was used in both groups, together with dorsal soft-tissue and brachioradialis release. No osteotomy was required. Direct and indirect reduction aids were used. A fixed-angle device (DVR; Biomet Inc., Warsaw, IN, USA) was used in both groups. Mean follow-up was 3.4 years. Quick DASH (Disabilities of the Arm, Shoulder and Hand) and Short Form 12 scores were used to evaluate outcome, as well as radiographic analysis for Arbeitsgemeinschaft für Osteosynthesefragen(AO)/Orthopaedic Trauma Association(OTA) classification, volar tilt, radial inclination and radial length.

Results

Average age was 53 years in both groups and male to female (M/F) ratio was similar in the study groups. Mean time to surgery was 30 days in the DT group and 8 days in the control group. There were significantly more type C (91.5% vs. 67.5%) fractures in the control group. The average quick DASH score was 27.1 in the DT group as compared with 6.3 in the control group (p < 0.03); however, when controlling for two outlier cases with complications (hardware irritation and a sensory neuropathy) there was no significant difference. Volar tilt, radial inclination and length were similar in both groups and were within normal anatomical values.

Conclusions

Delayed primary operative fixation of displaced unstable distal radial fractures is a viable option for cases that were presented late, with predictable, favourable results. Neither extensile approaches nor formal osteotomies are required.     

Outcome of dorsally comminuted versus intact distal radial fracture fixed with volar locking plates

Objective

Distal radial fractures are common. Modern trends favour operative treatment in many instances, providing stable fixation and early functional recovery. Recent biomechanical evidence suggests that volar locking plates (VLPs) enable adequate stability for dorsally displaced fractures, both in dorsally intact (DI) and in dorsally comminuted (DC) fractures. The aim of the study was to compare the clinical outcome of these two fracture groups treated with a VLP.

Methods

Retrospective case-control analysis of 91 distal radial fractures treated surgically using VLP by a single surgeon between the years 2006 and 2008 was carried out. Fractures were classified according to the Arbeitsgemeinschaft für Osteosynthes/Orthopaedic Trauma Association (AO/OTA) classification. Based on initial pre-reduction X-rays and computed tomography (CT) scans, fractures were classified into two groups of DI and DC fractures. The patients were re-evaluated at 2 and 6 weeks, 3 and 6 months and 1 year.

Results

Forty-one fractures (45%) were dorsally comminuted. Patients in the DC group were significantly older (mean 59 vs. 46 years, p < 0.01) and included more female patients, as well as significantly more C3 type fractures than the DI group (p < 0.04). The mean Disabilities of the Arm, Shoulder and Hand (DASH) score at 1 year postoperatively was 6.3 ± 2.3 for the DC group, as compared with 6.6 ± 2.02 for the DI group (p = 0.64). Average time to return to work was longer in the DC group (81.2 vs. 63.6 days, p = 0.05). Range of motion, volar tilt, and radial inclination were within clinically acceptable values and did not differ significantly among the two groups.

Conclusions

VLP fixation of DC distal radial fractures results in the maintenance of reduction and comparable functional and radiographical outcome with respect to DI fractures.     

Effect of isokinetic training on muscle strength,size and gait after healed pediatric burn: A randomized controlled study

Objective

The aim of this study was to investigate the effects of isokinetic training program on muscle strength, muscle size and gait parameters after healed pediatric burn.

Design

Randomized controlled trial.

Subjects

Thirty three pediatric burned patients with circumferential lower extremity burn with total body surface area (TBSA) ranging from 36 to 45%, and ages from 10 to 15 years participated in the study and were randomized into isokinetic group and a control group. Non-burned healthy pediatric subjects were assessed similarly to burned subjects and served as matched healthy controls.

Methods

Patients in the isokinetic group (n = 16) participated in the isokinetic training program for 12 weeks for quadriceps dominant limb, 3 times per week, at angular velocity 150°/s, concentric mode of contraction, time rest between each set for 3 min, 3 sets/day and control group (n = 17) participated in home based physical therapy exercise program without isokinetic.

Main measures

Assessment of quadriceps strength by isokinetic dynamometer, quadriceps size and gait parameters were performed at baseline and at the end of the training period for both groups.

Results

Patients in isokinetic group showed a significant improvement in quadriceps strength, quadriceps size and gait parameters as compared with those in the control group. Quadriceps strength and percentage of improvement was 79.25 ± 0.93 Nm (68.40%) for isokinetic group and 51.88 ± 1.31 Nm (9.84%) for the control group. Quadriceps size and percentage of improvement was 31.50 ± 0.89 cm (7.47%) for isokinetic group and 29.26 ± 1.02 cm (1.02%) for the control group. Stride length, step length, velocity and cadence and percentage of improvement for isokinetic group was 135.50 ± 2.82 (53.97%), 63.25 ± 2.97 (63.77%), 135.94 ± 1.65 (81.42%), 137.63 ± 1.36 (66.96%) and for the control group was 94.00 ± 2.69 (6.68%), 43.76 ± 1.34 (15.15%), 81.11 ± 1.91 (8.6%), 90.35 ± 1.32 (9.01%) respectively.

Conclusions

Participation in the isokinetic training program resulted in a greater improvement in quadriceps muscle strength, size and gait parameters in pediatric burn.     

Balloon kyphoplasty for osteoporotic spinal fractures with middle column compromise

Background

Balloon kyphoplasty (BKP) is an effective method for osteoporotic vertebral compression fractures. However osteoporotic spinal fractures with middle column compromise are mentioned as a relative contraindication to BKP. Thus we investigated the safety and efficacy of BKP in the treatment of osteoporotic spinal fractures with middle column compromise but without neurological deficit.

Methods

In this retrospective study, 45 patients who suffered osteoporotic fractures with middle column compromise but without neurological deficits were treated by BKP from May 2007 to December 2010. The final follow-ups were finished during the time of July 2011–September 2011. The mean follow-up period was 20.2 months. The height of the compromised vertebral body, the kyphotic angle and spinal canal compromise were measured before surgery, one day after surgery, and at the final follow-up. A visual analogue scale (VAS) and the Oswestry disability index (ODI) were chosen to evaluate pain and functional activity.

Results

The mean VAS and ODI scores improved significantly from pre- to post-operation (p < 0.05), and this improvement was sustained at the final follow-up. The mean anterior vertebral body height ratio improved from 57.6% ± 11.8% preoperatively to 86.2% ± 12.2% postoperatively (p < 0.05), so did the mean middle vertebral body height ratio. The kyphotic angle improved from 16.3° ± 3.7° preoperatively to 9.3° ± 2.6° postoperatively (p < 0.05). At final follow-up, BKP stabilised vertebral height and prevented further kyphotic deformity. While there were no differences in spinal canal compromise between pre-operation and one day after surgery (p > 0.05), there was a significant difference from the measurement at the final follow-up (p < 0.05).

Conclusion

BKP is a safe and effective method for osteoporotic spinal fractures with middle column compromise but without neurological deficit. Spontaneous remodelling of the spinal canal also occurs after BKP.