Strategies in Trauma and Limb Reconstruction

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2008 | September | Volume 3 | Issue 2

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A. J. Logan, T. R. Lindau

The management of distal ulnar fractures in adults: a review of the literature and recommendations for treatment

[Year:2008] [Month:September] [Volume:3] [Number:2] [Pages:8] [Pages No:49 - 56]

Keywords: Ulnar fractures, Adult, Injuries, Fracture fixation

   DOI: 10.1007/s11751-008-0040-1  |  Open Access |  How to cite  | 


The distal ulna represents the fixed point around which the radius and the hand acts in daily living. The significance of distal ulnar fractures is often not appreciated and often results in inadequate treatment in comparison to its larger counterpart; the radius. There is little guidance in the current literature as how to manage these fractures and their associated injuries. This paper aims to critically review the current literature and combine it with treatment suggestions based on the experience of the authors to help guide investigation and management of these often complex injuries.


Original Article

Lin Zhao, Jun-Li Zhao, Lin Wan, Shuan-Ke Wang

The study of the feasibility of segmental bone defect repair with tissue- engineered bone membrane: a qualitative observation

[Year:2008] [Month:September] [Volume:3] [Number:2] [Pages:8] [Pages No:57 - 64]

Keywords: Osteogenesis, Tissue engineering, Mesenchymal stem cells, Stem cell transplantation, Osteogenic membrane

   DOI: 10.1007/s11751-008-0034-z  |  Open Access |  How to cite  | 


The objective of the study was to investigate the feasibility of intramembranous osteogenesis from tissue-engineered bone membrane in vivo. Bone marrow mesenchymal stem cells (MSCs) of rabbits were harvested, expanded and some of them were induced into osteoblasts. Porcine small intestinal submucosa (SIS) was converted by a series of physical and chemical procedures into a scaffold. MSCs and induced osteoblasts were seeded separately onto the scaffold, thus fabricating two kinds of tissue-engineered bone membrane. A total of 12 New Zealand rabbits were subjected to a surgical operation; a 15 mm bone segment, including the periosteum, was resected from the radius on both sides of each rabbit to create critical bone defects. The two kinds of tissue-engineered bone membrane and SIS (as control) were implanted randomly into the site of bone defect. The animals had radiographs and were killed after 4 weeks. The specimens were harvested and histological examination performed for evidence of osteogenesis. Bone tissue had formed in defects treated by the two kinds of tissue-engineered bone membrane at 4 weeks. This was supported by the X-ray and histological examination, which confirmed the segmental gap bridged by bone. There was no attempt to bridge in the bone defect treated by SIS. Tissue-engineered bone membrane, constructed by seeding allogeneic cells on an xenogeneic and bio-derived scaffold, can repair critical bone defects successfully.


Original Article

Annette Høgh, Lene Dremstrup, Steffen Skov Jensen, Jes Lindholt

Fascia iliaca compartment block performed by junior registrars as a supplement to pre-operative analgesia for patients with hip fracture

[Year:2008] [Month:September] [Volume:3] [Number:2] [Pages:6] [Pages No:65 - 70]

Keywords: Fascia iliaca compartment block, Hip fracture, Pre-operative analgesia

   DOI: 10.1007/s11751-008-0037-9  |  Open Access |  How to cite  | 


This study investigate the efficacy of pre-operative pain treatment for patients with hip fractures using fascia lliaca compartment block (FIB) technique performed by junior registrars (JR) as a supplement to conventional pain treatment. The FIB technique has routinely been used pre-operatively in the emergency department since 1 January 2004 for all patients with hip fractures. Over an 8-month period, 187 patients were treated. FIB was performed with 40 ml lidocaine and bubivacaine. A simple 5-step verbal pain score and maximal passive hip flexion was used as objective and subjective pain measurements. Effect of FIB was prospectively assessed on 70 patients: 2/3 females, mean age 80.7 (SD = 7.8), 36% in ASA-group III and IV (95% CI, 0.25–0.48). The median pain-free hip flexion pre-block was 15° (SD = 17) this improved to a median of 28° (SD = 21) 15 min post-block (P = 0.014) and 37° (SD = 26) 60 min post-block (P = 0.030). The median simple verbal pain score (0–4) pre-block was 2.2 (SD = 0.92). This decreased to a median of 1.5 (SD = 0.78) 15 min post-block (P < 0.001) and 1.3 (SD = 0.71) 60 min post-block (P = 0.021). No side-effects were observed. There was no correlation between the number of FIB previously performed by the attending registrar and the improved maximal hip flexion (ρ = 0.090, P = 0.50) or reduction in subjective pain score (ρ = 0.005, P = 0.971). FIB performed by JR is a feasible, efficient pre-operative supplement to conventional pain-treatment for patients with hip fractures. FIB is easy to perform, requires minimal introduction, no expensive equipment and is connected with a minimal risk approach.


Original Article

Laurens Kaas, Roger P. van Riet, Jos P. A. M. Vroemen, Denise Eygendaal

The incidence of associated fractures of the upper limb in fractures of the radial head

[Year:2008] [Month:September] [Volume:3] [Number:2] [Pages:4] [Pages No:71 - 74]

Keywords: Radial head fracture, Associated injury, Epidemiology

   DOI: 10.1007/s11751-008-0038-8  |  Open Access |  How to cite  | 


Radial head fractures are common injuries. In American publications, one-third of the patients with these fractures have been shown to have associated injuries. The aim of this retrospective study is to describe the epidemiology of radial head fractures and associated fractures of the ipsilateral upper extremity in a European population. This study describes the epidemiology of radial head and associated fractures of the upper extremity in a Dutch population by a retrospective radiographic review of all patients with a radial head fracture between 1 January 2006 and 1 July 2007. A total of 147 radial head fractures were diagnosed in 145 patients. The incidence in the general population was 2.5 per 10.000 per year. The average age was 45.9 (SD 17.3) years and male–female ratio was 2:3. The mean age of males was significantly lower (37.1, SD 14.2 years) than of women (53.9, SD 16.4 years). Associated fracture of the upper extremity was found in 10.2%. Coronoid fractures were most common (4.1%). Associated upper limb fractures in patients with a radial head fracture are common in the European population. It is of clinical importance to suspect associated lesions and to perform a thorough physical examination and additional radiological examination on demand.


Original Article

Pedro Antonio Sánchez Mesa

Bone lengthening with extra-articular arthrodesis of the hip using external fixation

[Year:2008] [Month:September] [Volume:3] [Number:2] [Pages:7] [Pages No:75 - 81]

Keywords: Arthrodesis, Extra-articular, Hip, Lengthening, Femur

   DOI: 10.1007/s11751-008-0041-0  |  Open Access |  How to cite  | 


This is a case series of 11 children and adolescents who underwent femoral lengthening and percutaneous hip arthrodesis using a method of extra-articular joint compression in combination with callotasis. Clinical review indicated a significant improvement in physical function and psychological well-being. The average lengthening was 5.3 cm or 16% of the initial length. Complications were more frequent in patients older than 14 years (P = 0.034) as was a higher maturation index (P = 0.021). No additional operations were required to achieve the surgical objective.



Dimitrios Pafilas, Selvadurai Nayagam

The pelvic support osteotomy: indications and preoperative planning

[Year:2008] [Month:September] [Volume:3] [Number:2] [Pages:10] [Pages No:83 - 92]

Keywords: Fixators, external, Ilizarov technique, Bone lengthening

   DOI: 10.1007/s11751-008-0039-7  |  Open Access |  How to cite  | 


The pelvic support osteotomy is a double level femoral osteotomy with the objective of eliminating a Trendelenburg and short limb gait in young patients with severe hip joint destruction as a consequence of neonatal septic arthritis. The osteotomy has seen several changes and a brief historical overview is provided to set the evolution of the modifications of the procedure in context. We present an analysis of the preoperative assessment that will assist the surgeon to plan out the procedure. Specifically, we set out to answer the following questions: (a) Where should the first osteotomy be performed and what is the magnitude of valgus and extension correction desired at this level? (b) Where should the second osteotomy be performed and what is the magnitude of varus and derotation desired at this level?



Bashir Ahmed Mir, Shabir A Dhar, Mohammed Ramzan Mir, Mohammed Farooq Butt, Asif Sultan, Tahir Ahmed Dar, Mohammed Iqbal Wani

Open reduction and internal fixation in a case with transscaphoid perilunate dislocation 8 months after the injury: a patient with a 5-year follow-up

[Year:2008] [Month:September] [Volume:3] [Number:2] [Pages:4] [Pages No:93 - 96]

Keywords: Transscaphoid perilunate, Non union, Dislocation

   DOI: 10.1007/s11751-008-0036-x  |  Open Access |  How to cite  | 


The management of perilunate dislocations diagnosed later than three months continue to elicit debate with literature being scarce. We report a 22-year-old male with transscaphoid perilunate dislocation who reported to our hospital 8 months after sustaining the injury. Open reduction was done along with bone grafting. Five years after the surgery the patient is symptom-free with an excellent range of motion.



Silas N. S. Motsitsi

Methicillin-resistant Staphylococcus aureus infected pseudo-arthrosis of the distal tibia treated with debridement, mesh cage, autologous grafting and locking plate fixation

[Year:2008] [Month:September] [Volume:3] [Number:2] [Pages:3] [Pages No:97 - 99]

Keywords: Methicillin-resistant Staphylococcus aureus, Infected non-union, Mesh cage, Locking plate

   DOI: 10.1007/s11751-008-0042-z  |  Open Access |  How to cite  | 


Infected non-union of long bones is a challenge to manage. It has a high morbidity and mortality. Treatment is very demanding and has a significant complication rate. Methicillin-resistant infected non-union has a higher morbidity and mortality compared to Methicillin-sensitive Staphylococcus aureus infection. Approximately half of all Staphylococci isolated in infected orthopaedic operations are caused by Methicillin-resistant S. aureus. We present a 42-year-old patient who had Methicillin-resistant S. aureus infected pseudo-arthrosis of the tibia that was treated with debridement, mesh cage, autologous bone-grafting, and plating of the tibia. The outcome was satisfactory despite residual limb deformity and discrepancy.


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