Strategies in Trauma and Limb Reconstruction

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2006 | December | Volume 1 | Issue 1

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EDITORIAL

Durai Nayagam, Konrad Mader

Editorial

[Year:2006] [Month:December] [Volume:1] [Number:1] [Pages:1] [Pages No:1 - 1]

   DOI: 10.1007/s11751-006-0009-x  |  Open Access |  How to cite  | 

438

Review

K. Mader, D. Pennig

The treatment of severely comminuted intra-articular fractures of the distal radius

[Year:2006] [Month:December] [Volume:1] [Number:1] [Pages:16] [Pages No:2 - 17]

Keywords: Distal radius fractures, External fixation, Plate osteosynthesis, Meta-analysis

   DOI: 10.1007/s11751-006-0001-5  |  Open Access |  How to cite  | 

Abstract

Comminuted fractures of the distal end of the radius are caused by high-energy trauma and present as shear and impacted fractures of the articular surface of the distal radius with displacement of the fragments. The force of the impact and the position of the hand and carpal bone determine the pattern of articular fragmentation and their displacement and the amount and the extent of frequent concommitant ligament and carpal bone injury. The result of the osseous lesion in comminuted fractures was termed “pilon radiale”, which emphasizes the amount of damage to the distal radius and the difficulties to be expected in restoring the articular congruity. Besides this the additional injury, either strain of disruption of the ligaments and the displacement of the carpus and/or the triangular fibrocartilage complex will equally influence the functional outcome. This review will expand on the relevant anatomy, correct classification and diagnosis of the fracture, diagnostic tools and operative treatment options. Current treatment concepts are analysed with regard to actual literature using the tools of evidence based medicine criteria. A new classification of severely comminuted distal radius fractures is proposed using CT data of 250 complex intraarticular radius fractures. Finally a standardized treatment protocol using external fixation in combination with minimal invasive internal osteosynthesis is described.

616

Review

B. Narayan, C. Harris, S. Nayagam

Treatment of high-energy tibial plateau fractures

[Year:2006] [Month:December] [Volume:1] [Number:1] [Pages:11] [Pages No:18 - 28]

Keywords: External fixation, Fracture, Tibia, Ilizarov, Plateau, Internal fixation, Minimally invasive

   DOI: 10.1007/s11751-006-0002-4  |  Open Access |  How to cite  | 

Abstract

Treatment of high-energy fractures of the tibial plateau requires an inordinate degree of surgical effort in order to avoid complications. Fracture reduction can be a challenge to experienced hands and the soft tissue conditions are intolerant of careless dissection. In general, it is an oversimplification to use one technique of stabilisation for such a heterogenous group (even within one classification tier). This article describes the specific attributes of Schatzker type 6 injuries (AO 41C) that enable decision making algorithms to be generated and balances the merits for plate stabilisation and external fixation against injury characteristics. A detailed description is given for circular fixation in these injuries to assist those unfamiliar with the technique.

475

Review

P. M. Stevens

Guided growth: 1933 to the present

[Year:2006] [Month:December] [Volume:1] [Number:1] [Pages:7] [Pages No:29 - 35]

Keywords: Epiphysiodesis, Hemi-epiphysiodesis, Guided growth, Paediatric angular deformities

   DOI: 10.1007/s11751-006-0003-3  |  Open Access |  How to cite  | 

Abstract

While osteotomies are necessary for rotational correction and limb lengthening, angular correction or moderate length inhibition may be achieved by other, less invasive means. Several techniques of epiphysiodesis have evolved, enabling gradual correction of angular correction and/or length equalisation through guided growth. This manuscript comprises a historical and comparative review of those techniques. The 8-plate method of guided growth affords the opportunity to provide a tension band (rather than compression) that expedites angular correction, compared to stapling or transphyseal screws, which rely upon the principle of compression. When applied to each side of a given physis, longitudinal growth is inhibited, in the same fashion as stapling or epiphysiodesis. The physis and periosteum are spared any direct insult, thus making this a reversible process, suitable for use in younger children. The 8-plate is simple to insert and, compared to staples or transphyseal screws, easy to remove.

704

Original

K. Mader, S. Kirchner, B. Wolfgarten, D. Pennig

Efficacy of the A-V Impulse System versus cryotherapy in the reduction of postoperative oedema of the hand: a prospective randomised trial

[Year:2006] [Month:December] [Volume:1] [Number:1] [Pages:6] [Pages No:36 - 41]

Keywords: Postoperative swelling, Intermittent compression pump, Cryotherapy, Hand, Distal radius fracture

   DOI: 10.1007/s11751-006-0004-2  |  Open Access |  How to cite  | 

Abstract

In a prospective randomised trial, the effects of an intermittent compression hand pump vs. cryotherapy were compared on reduction of postoperative hand swelling and gain in finger movement after distal radius fractures. Although intermittent compression as a physical method for thromboprophylaxis and swelling reduction in orthopaedic and trauma patients of the lower leg are established, a prospective randomised trial for an objective evaluation of the effects of intermittent compression in the upper extremity has not been previously performed. Forty-three subjects (63±33 years, 32 women, 11 men) with a unilateral distal radius fracture treated with transarticular external fixation were randomised into two treatment groups. In group A 21 patients were treated with cryotherapy. In group B 22 patients were treated with an intermittent compression hand pump. Reduction in swelling of the treated hand and MP and PIP joint movement were recorded with computerised assessment software (EVAL Hand Evaluation System) in comparison to the uninjured contralateral side. Reduction of swelling in group A was not statistically significant (28.5% of total swelling or 0.61 cm, SD 0.39, p=0.42), but in group B it was significant (92% of total swelling, 3.62 cm, SD 1.48, p<0.001). Comparison of increases in MP and PIP joint movement (p<0.0016) showed statistically significant differences in favour of the intermittent compression pump. This study demonstrates that intermittent compression is more effective in the reduction of postoperative oedema and gain of finger movement of the hand than cryotherapy.

370

Original

R. Varsalona, G. T. Liu

Distal tibial metaphyseal fractures: the role of fibular fixation

[Year:2006] [Month:December] [Volume:1] [Number:1] [Pages:9] [Pages No:42 - 50]

Keywords: Distal tibial fractures, Fibular fixation, External fixation, Intramedullary nailing

   DOI: 10.1007/s11751-006-0005-1  |  Open Access |  How to cite  | 

Abstract

Distal tibial extra-articular fractures are often a result of complex high-energy trauma, which commonly involves associated fibular fractures and soft tissue injury. The goal of tibial fixation is to maximise fracture stability without increasing soft tissue morbidity from surgical intervention. The role of adjunctive fibular fixation in distal tibial metaphyseal fractures has been controversial; although fibular fixation has been shown to improve stability of distal tibial fractures, there has been increased potential for soft tissue-related complications and a delay to tibial fracture healing. Adjunctive fixation of concomitant fibular fractures without associated syndesmotic or ankle pathology is not necessary in surgically stabilised extra-articular metaphyseal fractures of the distal tibia.

960

CASE REPORT

J. Mukhopadhaya, S. Shivapuri

Congenital pseudarthrosis of radius. A case report

[Year:2006] [Month:December] [Volume:1] [Number:1] [Pages:4] [Pages No:51 - 54]

Keywords: Congenital pseudarthrosis of radius, Deformity, Café au lait spots, Non-union, Strut grafting, Open reduction, Internal fixation

   DOI: 10.1007/s11751-006-0006-0  |  Open Access |  How to cite  | 

Abstract

We report a case of a 9 year old female child with congenital pseudarthrosis of the radius. She had a history of fractures of both bones of the left forearm after trivial trauma at the age of 7 years (2003) and 8 years (2004). On each occasion she was treated conservatively in a POP cast 4 weeks. She reported to us in January 2005 complaining of a gradually increasing deformity of the left forearm. Radiologically, it was an apex anterior deformity of the distal aspect of the left radius. Clinically she had multiple café au lait spots over her body. Neurological and ophthalmological examinations were normal. The fibrous tissue and the fracture ends were excised. The fracture was stabilized with a 6-hole DCP with iliac crest graft to bridge the gap along with cortico-cancellous chips. The fracture united uneventfully at 3 months post-operatively. At 17 months post-operatively there is no evidence of recurrence of pseudarthrosis with a near normal range of movements. Congenital pseudarthrosis of the radius is an extremely rare condition with only 10 cases seems to have been reported. Dual onlay bone graft, vascularised fibular graft has been the treatment options the latter being the preferred one. But the disease being extremely rare not much has been documented about the treatment options. We treated this case by excision of the sclerotic bone ends along with a cuff of periosteum and internal fixation with DCP along with iliac strut graft to restore the length. Successful union was achieved in 3 months and the patient has satisfactory follow-up at 17 months.

416

CASE REPORT

Y. Watanabe, T. Matsushita

Salvage of a failed valgus osteotomy for non-union of an unstable pertrochanteric fracture

[Year:2006] [Month:December] [Volume:1] [Number:1] [Pages:3] [Pages No:55 - 57]

Keywords: Valgus intertrochanteric osteotomy, Mal-union, Hip fracture, Complications

   DOI: 10.1007/s11751-006-0007-z  |  Open Access |  How to cite  | 

Abstract

Salvage of a failed valgus osteotomy for nonunion of an unstable pertrochanteric fracture is reported. A valgus intertrochanteric osteotomy was performed for a failed sliding hip screw fixation of an unstable pertrochanteric fracture at another institution. Four months following osteotomy, the fracture was still un-united with two distal screws of the hip plate broken and a coxa vara deformity. Reconstruction was performed with a nine-hole 95° angle blade plate and cancellous bone graft, because the insufficient fixation of the distal fragment was considered to be the main reason for failure. The osteotomy was healed at six months post-surgery and the patient reported complete resolution of symptoms. Intertrochanteric valgus osteotomy is an effective procedure for mal-union and non-union of pertrochanteric fracture but stable fixation is required for a good result. The blade of the angle plate offers good purchase of the proximal fragment and secures it under rotational and bending stresses. We recommend that distal fragments should be fixed with at least seven cortices for this type of osteotomy.

382

TECHNICAL REPORT

M. Mooney, J. Gilbody

Techniques in splintage and support during reconstruction of the tibia

[Year:2006] [Month:December] [Volume:1] [Number:1] [Pages:8] [Pages No:58 - 65]

Keywords: Ilizarov, External fixator, Splint, Orthotic, Fracture, Deformity

   DOI: 10.1007/s11751-006-0008-y  |  Open Access |  How to cite  | 

Abstract

The aim of this article is to help clinicians and allied professionals understand problems that may arise with use of external fixators in limb reconstruction and trauma, and in particular describe how preventative strategies can be implemented. The indications for splinting and orthotic use with external fixators can be broadly subdivided into those that facilitate functional loading and those that maintain joint integrity and function. Specific techniques to accompany use of external fixators in fracture management and limb reconstruction are described. In particular, problems concerning knee, ankle and foot support together with leg length issues are covered and proposals for dealing with joint subluxation, forefoot deformity and toe clawing, regenerate deformity after fixator removal and oedema control are discussed. The solutions described and illustrated are intended to assist those who use external fixators but do not have regular therapist input for support in the after-care of their patients.

774

Calendar of Congresses

Calendar of Congresses

[Year:2006] [Month:December] [Volume:1] [Number:1] [Pages:1] [Pages No:66 - 66]

   DOI: 10.1007/s11751-006-0010-4  |  Open Access |  How to cite  | 

382

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