Strategies in Trauma and Limb Reconstruction

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2008 | April | Volume 3 | Issue 1

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Original Article

Wael A. El-Adl, Mohammed A. El-Said, George W. Boghdady, Al-Sayed M. Ali

Results of treatment of displaced supracondylar humeral fractures in children by percutaneous lateral cross-wiring technique

[Year:2008] [Month:April] [Volume:3] [Number:1] [Pages:7] [Pages No:1 - 7]

Keywords: Humeral supracondylar fracture, Percutaneous pinning, Lateral cross-wiring technique

   DOI: 10.1007/s11751-008-0030-3  |  Open Access |  How to cite  | 

Abstract

Seventy children with displaced type II and III supracondylar fractures of the humerus were managed with percutaneous lateral cross-wiring technique from January 2006 to January 2007. There were 54 boys and 16 girls with a mean age of 6.1 ± 3.07 years. All patients were operated within 24 h after trauma using the Dorgans percutaneous lateral cross-wiring technique. Patients were followed up for a mean period of 6.1 ± 2.6 months and assessed both radiologically for union; and functionally and cosmetically according to Flynn's criteria. All patients achieved solid union. Functionally, all patients achieved satisfactory results, while cosmetically, 91.4% of patients had satisfactory results and 8.6% had unsatisfactory results. The most frequently occurring complications were minor pin tract infection in six patients, deep infection in two patients, and 32 patients suffered excessive granulation tissue formation mostly around the proximal pin. There was no iatrogenic neurological injury either for the ulnar or for the radial nerves. The obtained results and minor complications reported signify this technique as a viable treatment method for displaced type II and III supracondylar fractures in children.

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Original Article

Rinaldo Giancola, Guido Antonini, Giacomo Delle Rose, Cornelio Crippa

Percutaneous compression plating versus gamma nail for the treatment of pertrochanteric hip fractures

[Year:2008] [Month:April] [Volume:3] [Number:1] [Pages:6] [Pages No:9 - 14]

Keywords: Hip fracture, Pertrochanteric fracture, Minimally invasive, Percutaneous, Fracture fixation, Percutaneous compression plate

   DOI: 10.1007/s11751-008-0032-1  |  Open Access |  How to cite  | 

Abstract

The objective of this study is to compare percutaneous compression plating (PCCP) device with standard gamma nail (GN). A sample was prospectively followed and compared to a historical cohort: 82 intertrochanteric hip fractures in 81 patients treated with PCCP in 2004 versus 51 hip fractures treated with GN in 2003 (AO type 31A1, 31 A2). The main outcome measures were: surgery times, blood loss (Hb serum level and transfusions), complication, costs, for a 1-year follow-up. The minimally invasive PCCP technique resulted in a lower blood loss and consequently lower transfusion need (statistically significant), fewer implant-related complications and comparable surgery times. Overall surgical costs were lower for a comparable outcome in terms of healing and surgical time.

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Original Article

F. Lavini, L. Renzi-Brivio, R. Aulisa, F. Cherubino, P. L. Di Seglio, N. Galante, W. Leonardi, M. Manca

The treatment of stable and unstable proximal femoral fractures with a new trochanteric nail: results of a multicentre study with the Veronail

[Year:2008] [Month:April] [Volume:3] [Number:1] [Pages:8] [Pages No:15 - 22]

Keywords: Multi-center clinical trail, Outcome study, Hip fractures, Intramedullary nail, Sliding parallel screws

   DOI: 10.1007/s11751-008-0035-y  |  Open Access |  How to cite  | 

Abstract

The incidence of hip fractures continues to rise. This study is the first evaluation of a new intramedullary implant, the Veronail, that provides double axis fixation into the femoral head and allows the surgeon to choose whether to use sliding or fixed locked proximal screw fixation for trochanteric femoral fractures. The fractures were classified according to the AO classification, and function was assessed with the Modified Harris Hip Score. 111 patients with trochanteric fractures were evaluated in eight Italian hospitals. The stable 31.A1 fractures were treated with sliding proximal screws, the subtrochanteric 31.A3 fractures with converging proximal screws, and the unstable 31.A2 fractures were treated with both types of proximal fixation. The unstable fractures treated with locked converging screws had the same function at one year as those treated with sliding screws. This study suggests a possible new method of treating unstable trochanteric femoral fractures. This may be the solution to prevent excessive collapse of the fracture with the resultant poor function and persisting pain noted in the literature. Two converging locked proximal screws seem to provide stable fixation in 31.A2 femoral fractures and produce as good a result as the use of traditional sliding screws. The role of converging locked proximal screws in unstable trochanteric fractures requires further evaluation.

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CASE REPORT

Tibor Antonius Johannes Poelmann, Heleen Muriel Staal, Willem Jacob Willems

A pseudo-iatrogenic case of medial clavicular fracture

[Year:2008] [Month:April] [Volume:3] [Number:1] [Pages:3] [Pages No:23 - 25]

Keywords: Clavicle, Stress fracture, CT, Occupational history, Usura

   DOI: 10.1007/s11751-007-0027-3  |  Open Access |  How to cite  | 

Abstract

Medial fractures are the least common type of clavicular fracture (2–10%). The patient is a 29-year-old gynaecology resident with hyper-laxity and sternoclavicular instability. The latter had been surgically stabilized with Dacron® tape, which eroded the bone causing an usura. Acute right shoulder pain occurred 10 years later. CT revealed medial clavicular stress fracture. After 4 weeks of conservative management, internal fixation followed. Five months postoperatively the patient performed all activities without pain. In this patient the weakened medial clavicle due to usura clearly played a role in both the site and nature of the fracture. Furthermore, CT is essential in arriving at the correct diagnosis.

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CASE REPORT

N. Verhoeven, R. Hierner

High-pressure injection injury of the hand: an often underestimated trauma: case report with study of the literature

[Year:2008] [Month:April] [Volume:3] [Number:1] [Pages:7] [Pages No:27 - 33]

Keywords: Injection injuries, Hand, High-pressure injuries, Management, Function

   DOI: 10.1007/s11751-008-0029-9  |  Open Access |  How to cite  | 

Abstract

The real extent of damage in high-pressure injection injuries (grease gun injuries, paint gun injuries, pressure gun in juries) is hidden behind a small and frequently painless punctiform skin lesion on the finger or the hand. These kinds of injuries require prompt surgical intervention with surgical debridement of all ischemic tissue. Possibility of a general intoxication by the fluid must always be ruled out. Postoperative intensive physiotherapy is essential for the final hand function. The initial benign aspect is frequently causing a delay for an adequate treatment while in the mean time the possibility for subcutaneous damage continuously increases. Because of this delay the chance of permanent reduced functionality in the hand or finger amputation raises. Not only the latency time to adequate treatment but also the injected fluid's nature, the pressure, the volume and the location of injection, has influence on the seriousness and extensiveness of subcutaneous damage. All these factors influence the functional outcome of the patient.

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CASE REPORT

Ata George Kasis, I. Stockley, M. Saleh

External fixator-assisted acute shortening with internal fixation for leg length discrepancy after total hip replacement

[Year:2008] [Month:April] [Volume:3] [Number:1] [Pages:4] [Pages No:35 - 38]

Keywords: External fixator, Femoral shortening, Total hip replacement

   DOI: 10.1007/s11751-008-0031-2  |  Open Access |  How to cite  | 

Abstract

We report a case of a 51-year-old lady, who underwent a femoral shortening using a fixator assisted blade plate after total hip replacement. The patient had a total hip replacement on the other side with previous revisions, which resulted in a leg length discrepancy. We used the above technique to control the shortening and preserve the mechanical and anatomical axis of the femur.

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CASE REPORT

A. Reggiori, G. Brugo

Traumatic anterior hip dislocation associated with anterior and inferior iliac spines avulsions and a capsular–labral lesion

[Year:2008] [Month:April] [Volume:3] [Number:1] [Pages:5] [Pages No:39 - 43]

Keywords: Hip fracture, Hip dislocation, Avulsion, Capsular lesion

   DOI: 10.1007/s11751-008-0033-0  |  Open Access |  How to cite  | 

Abstract

A 16-year-old man had a traumatic accident during motor-cross racing and sustained an anterior hip dislocation with fracture of anterior superior and anterior inferior iliac spines. The hip was emergently reduced and further imaging was obtained to evaluate the lesion and bony fragments. Computed tomography confirmed the presence of two large fragments and a small fragment from the antero-inferior acetabulum. The patient underwent open reduction and internal fixation of the iliac spines and the reparation of anterior hip capsule. No complications occur after 1 year of follow-up. We present the case and a review of the literature for this lesion.

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CASE REPORT

A. J. Johnston, C. T. Andrews

Fibular lengthening by Ilizarov method secondary to shortening by osteochondroma of distal tibia

[Year:2008] [Month:April] [Volume:3] [Number:1] [Pages:4] [Pages No:45 - 48]

Keywords: Fibular shortening, Osteochondroma, Deformity, Ilizarov

   DOI: 10.1007/s11751-007-0028-2  |  Open Access |  How to cite  | 

Abstract

Osteochondroma is the most common benign bone tumour. They most commonly affect the long tubular bones and almost half of osteochondromata are found around the knee. Osteochondroma arising from the distal metaphysis of the tibia typically result in a valgus deformity of the ankle joint secondary to relative shortening of the fibula. This case describes the use of Ilizarov technique for fibular lengthening following excision of a distal tibial osteochondroma. A 12-year-old girl presented with a 3-year history of a large swelling affecting the lateral aspect of the right distal tibia. Plain radiographs confirmed a large sessile osteochondroma arising from the postero-lateral aspect of the distal tibia with deformity of the fibula and 15 mm of fibular shortening. The patient underwent excision through a postero-lateral approach and subsequent fibular lengthening by Ilizarov technique. The patient made excellent recovery with removal of frame after 21 weeks and had made a full recovery with normal ankle function by 6 months. The Ilizarov method is a commonly accepted method of performing distraction osteogenesis for limb inequalities; however, this is mainly for the tibia, femur and humerus. We are unaware of any previous cases using the Ilizarov method for fibular lengthening. This case demonstrates the success of the Ilizarov method in restoring both fibular length and normal ankle anatomy.

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