Three-wire fixation technique for displaced fifth metatarsal base fractures

Fractures of the tuberosity of the fifth metatarsal are the most common type of fifth metatarsal fractures. This particular fracture usually produces low morbidity and low rates of nonunion when treated nonoperatively. However, on occasion, significant displacement, comminution, or significant intra-articular involvement may warrant operative intervention. Multiple techniques have been described for the operative care of this fracture. We present a somewhat simplified fixation method for displaced fifth metatarsal fractures in a small set of patients who were all followed up to final healing of the fracture.     

New reduction technique for severely displaced pediatric radial neck fractures

This study describes a new maneuver to assist in the closed reduction of severely displaced (angulated >60 degrees) pediatric radial neck fractures. Four patients with displaced radial neck fractures were identified prospectively when attempts at reduction in the emergency department failed. The new reduction maneuver was performed in the operating room with the patient under general anesthesia. All fractures were reduced to near-anatomic position, and all fractures were followed to union. No reduction was lost. The authors conclude that the proposed reduction technique can be of assistance in the nonoperative management of these fractures. The authors also recommend that all attempts at reduction of these severely displaced fractures be performed with the patient under general anesthesia.     

A new fixation technique for metatarsal fractures.

Intramedullary nail fixation is an excellent option for open reduction and internal fixation of metatarsal neck and shaft fractures. In the authors' experience, the reduction of these fractures with Steinmann pin fixation provided excellent stability, required minimal soft-tissue dissection, and allowed for preservation of the periosteal tissue. Minimal disruption to the periosteum protects the osteoprogenitor cells located in the cambium layer. These cells stimulate osteoblastic activity, allowing for excellent secondary bone healing. Intramedullary nail fixation is the authors' chosen procedure for reduction of lesser metatarsal fractures.     

Results in displaced radial neck fractures in children. Metaizeau technique versus arthrotomy

The aim of the present article is to ascertain the differences between two surgical treatments commonly used in displaced radial neck fractures in children. We report the retrospective results of 20 displaced radial neck fractures with > 30 degrees of tilt (Judet grades 3-4) in children aged between 7 and 14 years treated with closed intramedullary pinning according to the Metaizeau technique (6 cases) or with arthrotomy and pinning (14 cases). Sex distribution was 14 girls and 6 boy. The average follow-up was 43 months. We found no relationship between delay in the surgical treatment and functional results. On the other hand, a relationship between residual final tilt and poorer functional results appears. The Metaizeau technique produced better results and fewer complications than arthrotomy and pinning, and, in our opinion, is the treatment of choice in this type of fracture.     

Functional outcomes following displaced talar neck fractures

OBJECTIVES: To determine the outcome of displaced talar neck fractures at long-term follow-up in terms of functional outcome and secondary reconstructive surgery. DESIGN: Retrospective cohort study. SETTING: Academic level 1 trauma center. PATIENTS: Seventy patients with displaced talar neck fractures. INTERVENTION: All patients were treated with open reduction and screw fixation. MAIN OUTCOME MEASUREMENTS: Functional outcome of patients who did not require secondary surgery was assessed using the Short Musculoskeletal Function Assessment, Ankle Osteoarthritis Scale score, and the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score. The incidence of secondary reconstructive hindfoot surgery, including arthrodesis or talectomy, was measured using life table analysis. RESULTS: Mean Short Musculoskeletal Function Assessment score was 20 +/- 18 out of 100, with a lower score indicative of better outcome; mean Ankle Osteoarthritis Scale score was 3.8 +/- 2.4 out of 10 (lower score better); and mean Ankle Society Ankle-Hindfoot Score was 71 +/- 19 out of 100 points (higher score better). The incidence of secondary reconstructive surgery increased from 24 +/- 5% at 1 year to 48 +/- 10% at 10 years postinjury. CONCLUSIONS: Functional outcome varied and was most dependent upon the development of complications. The incidence of secondary reconstructive surgery following talar neck fractures increased over time and was most commonly performed to treat subtalar arthritis or misalignment.     

Long-term results of displaced talar neck fractures

Of 36 fractures of the talar neck without comminution of the body, eight were undisplaced, treated closed, and 28 were displaced and treated by open reduction. Twenty of the operations were less than 12 hours after injury. Nineteen of 20 were performed through a medial approach, six with a medial malleolar osteotomy. The long-term results were evaluated by a standard rating system based on classification by the fracture. A protective brace was developed for non-weight-bearing in two patients with complete avascular necrosis, and ankle protection with weight-bearing in ten with partial necrosis. Prompt open reduction and internal fixation, malleolar osteotomy, and protected weight-bearing are recommended in selected cases.     

Cemented or uncemented hemiarthroplasty for displaced intracapsular femoral neck fractures

The aim of this study was to establish whether or not to cement the hemiarthroplasty for displaced intracapsular femoral neck fractures in the elderly. Consecutive patients treated by hemiarthroplasty in adjacent hospitals were reviewed. The same monoblock prosthesis was used; in hospital A they were uncemented (121 patients), and in hospital B they were cemented (123 patients). Notes were reviewed retrospectively. Surviving patients (50 and 56 respectively) were assessed prospectively for pain and functional ability using validated scoring systems. Follow-up was 32-36 months. Patient demographics were similar. Fewer of the cemented group had been revised or were awaiting revision ( P=0.036). There was no difference in general complication or mortality rates. There was a highly statistically significant greater deterioration in pain ( P=0.003), walking ability ( P=0.002), use of walking aids ( P=0.003) and activities of daily living ( P=0.009) in the uncemented group. Our findings support the use of cemented hemiarthroplasty in the elderly.     

老年移位性股骨颈骨折手术治疗选择

老年移位性股骨颈骨折患者骨折愈合缓慢、全身情况较差等,使得手术治疗颇为棘手.在选择手术方法时要综合考虑各种因素.内固定治疗引起的创伤相对较小,但手术后并发症较多;半髋关节置换术后并发症大大减少,但远期效果不如全髋关节置换术.该文就内固定术、半髋关节置换术、全髋关节置换术及其治疗中的若干问题作一综述.     

Noncemented Cathcart elliptical head endoprosthesis for displaced femoral neck fractures

A total of 93 patients (95 hips) undergoing unipolar noncemented elliptical head endoprosthetic replacement for an acute displaced femoral neck fracture were reviewed clinically and radiographically at an average follow-up of 28 months. The 12-month mortality rate was 22%. The medical complication rate was 15%, and the surgical complication rate was 19%. At most recent follow-up, 66% of patients used an assist device for ambulation or were nonambulatory. Of patients, 64% required full-time nursing care. Radiographically, subsidence of the component was identified in 66% of the hips and acetabular erosion in 29%. More than half of these patients had complaints of either thigh or groin pain. Hips with evidence of subsidence had a statistically significant greater length of follow-up (36 months) compared with hips that did not show subsidence (18 months; P = .014). Noncemented unipolar replacement for displaced femoral neck fractures is an accepted form of treatment. In this group of predominantly male patients, noncemented elliptical head unipolar replacement was associated with a high medical and surgical complication rate as well as poor clinical and radiographic results.     

Early fixation failure in displaced femoral neck fractures

Summary A study of 76 displaced femoral neck fractures treated by reduction and Knowles pins or AO (ASIF) cancellous bone screws was carried out. Fixation failure within 3 months occurred in 17 cases (22%). Advanced age, inaccurate reduction, a poor mental state of the patient, the number of Knowles pins used, and the preinjury functional ability of the patient are significant risk factors for fixation failure. Neurological disease, the type of fracture according to Garden, delay before operation, and the method of fixation are not significantly related to fixation failure.

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Zusammenfassung Eine Studie über 76 verschobene Schenkelhalsbrüche, behandelt durch Reduktion und Knowlesstiften oder AO (ASIF) Spongiosaschrauben wurde durchgeführt. Instabilitätsprobleme in den ersten 3 Monaten gab es in 17 Fällen (22%). Hohes Alter, unzureichende Reduktion, schlechter mentaler Zustand, die Anzahl der Knowlesstifte, sowie der prätraumatische funktionelle Status sind signifikante Risikofaktoren i. B. a. Instabilität der Osteosynthese. Neurologische Erkrankung, Frakturtyp nach Garden, Zeitspanne vor der Operation, und die Wahl der Osteosynthese sind nicht signifikant i. B. a. Instabilitat der Osteosynthese.

     

Early fixation failure in displaced femoral neck fractures

A study of 76 displaced femoral neck fractures treated by reduction and Knowles pins or AO (ASIF) cancellous bone screws was carried out. Fixation failure within 3 months occurred in 17 cases (22%). Advanced age, inaccurate reduction, a poor mental state of the patient, the number of Knowles pins used, and the preinjury functional ability of the patient are significant risk factors for fixation failure. Neurological disease, the type of fracture according to Garden, delay before operation, and the method of fixation are not significantly related to fixation failure.     

Prong plate fixation for displaced intracapsular fractures of the femoral neck

The design and use of a prong plate for the treatment of displaced fractures of the femoral neck is described. The prongs hold the femoral head, and the plate is screwed to the anterior cortex of the femoral neck and trochanteric region. The new plate has been used in 32 patients with Garden stage III or IV fractures and 29 had a good result. Bony union was seen within 11 weeks in all patients in whom bleeding of the femoral head was noted at operation, but was much delayed in patients without bleeding. Late segmental aseptic necrosis was seen in four patients after follow-up of at least two years, and successfully treated. The prong plate allows accurate reduction, impaction and strong rigid fixation with less disturbance of the intramedullary blood flow than other fixation methods.     

Radiographic analysis of the Canale view for displaced talar neck fractures

Fractures of the talar neck comprise almost 50% of fractures of the talus and may result in significant long-term morbidity. It is of paramount importance to ensure anatomic reduction of the fracture not only for fracture healing but also for minimizing future posttraumatic arthritic sequelae. In addition to conventional radiographs and computed tomography scans, the Canale view has proven to be beneficial, especially when evaluating for varus displacement. This study investigated whether the original method of performing the Canale view could be modified for improved evaluation for varus displacement. Simulated talar neck fractures were created in 6 cadaveric specimens. These were placed into varying amounts of varus displacement; the Canale view was performed with progressive degrees of eversion, from 0° to 25°, resulting in 108 total views. Blinded evaluation was performed, and a ranking system was used to determine the most beneficial degree(s) of eversion for evaluating varus malalignment. Multiple statistical analyses were performed. A significant difference was seen between the high and low range of values of eversion. A significantly lower ranking was achieved with 10° of eversion. As opposed to a single view taken at 15° of eversion, a range of angles may be most beneficial in evaluating varus displacement in talar neck fractures.     

The direct anterior approach in hemiarthroplasty for displaced femoral neck fractures

Purpose

Hip replacement is the most common treatment for displaced femoral neck fractures in the elderly, and minimally invasive surgery is popular in the field of orthopaedic surgery. This study evaluated the outcome of monopolar hemiarthroplasty by the direct anterior approach over a postoperative period up to 2.5 years.

Methods

A total of 86 patients with displaced femoral neck fractures were included (mean age of 86.5 years). Surviving patients were reviewed three months (retrospectively) and one to 2.5 years (prospectively) after surgery. One-year mortality was 36 %.

Results

For all stems, implant positioning with respect to stem alignment, restoration of leg length and femoral offset was correct. Acetabular protrusion was observed in 55 % of the patients one to 2.5 years postoperatively. Subsidence and intraoperative periprosthetic fractures occurred in three patients (3 %) each. All revision stems for postoperative periprosthetic fractures could be implanted using the initial surgical technique without extension of the previous approach. The mean Harris hip score was 85 points at the one to 2.5-year follow-up; 85 % of the patients were satisfied with their hip and 57 % returned to their preoperative level of mobility.

Conclusion

Based on these findings, hemiarthroplasty for hip fractures can be performed safely and effectively via the direct anterior approach with good functional outcome and high patient satisfaction.