Strategies in Trauma and Limb Reconstruction

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2010 | August | Volume 5 | Issue 2

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Juan Pretell Mazzini, Juan Rodriguez-Martin, Eva María Andres-Esteban

Does open reduction and pinning affect outcome in severely displaced supracondylar humeral fractures in children? A systematic review

[Year:2010] [Month:August] [Volume:5] [Number:2] [Pages:8] [Pages No:57 - 64]

Keywords: Open reduction, Closed reduction, Functional outcome, Anatomical reduction, Supracondylar fracture, Children

   DOI: 10.1007/s11751-010-0091-y  |  Open Access |  How to cite  | 


Supracondylar fracture of the humerus is the second most common fracture in children (16.6%) and the most common elbow fracture. These fractures are classified using the modified Gartland classification. Type III and type IV are considered to be totally displaced. A totally displaced fracture is one of the most difficult fractures to manage and may lead to proceeding to open procedures to achieve acceptable reductions. Many surgeons are concerned about its outcome compared to closed procedures. We therefore performed a systematic review of the literature to investigate the existing evidence regarding functional and radiological outcomes as well as postsurgical complications of primary open compared to primary closed reduction.


Original Article

Arno P. W. van Lieshout, Christiaan J. van Manen, Karel J. du Pré, Ydo V. Kleinlugtenbelt, Rudolf W. Poolman, J. Carel Goslings, Peter Kloen

Peak incidence of distal radius fractures due to ice skating on natural ice in The Netherlands

[Year:2010] [Month:August] [Volume:5] [Number:2] [Pages:5] [Pages No:65 - 69]

Keywords: Distal radius fractures, Ice skating

   DOI: 10.1007/s11751-010-0087-7  |  Open Access |  How to cite  | 


An increase of distal radius fractures was seen in 2009 when an extended cold spell allowed natural ice skating in Amsterdam. This resulted in overload of our Emergency Departments and operating rooms. This study reports patient and fracture characteristics of these injuries. We also determined potential skating-related risk factors. All patients who sustained a distal radius fracture during natural ice skating between January 3 and January 12, 2009 were included. Patient and fracture characteristics, treatment, validated outcome (Quick DASH) at 3 months after injury were determined. Natural ice skating accounted for a 5.5-fold increase of distal radius fractures (92 fractures) compared to a similar time period without natural ice skating in 2008. Fracture types were AO-type A, n = 50, type B, n = 11 and type C, n = 31. Twenty-eight patients were casted without reduction. Fifty-four patients underwent at least one reduction before casting. The non-operative group consisted of 67 patients (68 fractures, male/female 18/49) with an average age of 55.5 years. Twenty-three patients (24 fractures) underwent internal fixation. Quick DASH for the whole group was a mean of 23.1 points (range 0–95). The mean Quick DASH for the non-operatively treated group was 19.9 points (range 0–95), for the operatively treated group 31.7 points (range 2–65). Distal radius fractures increased 5.5-fold during a period with natural ice skating. Women aged 50 and over were predominantly affected. Most fractures were extra-articular, and the vast majority was treated non-operatively. Utilization of wrist-protecting devices should be considered during future natural ice periods.


Original Article

Francisco Forriol, Luca Denaro, Umile Giuseppe Longo, Hirofumi Taira, Vincenzo Denaro

Bone lengthening osteogenesis, a combination of intramembranous and endochondral ossification: an experimental study in sheep

[Year:2010] [Month:August] [Volume:5] [Number:2] [Pages:8] [Pages No:71 - 78]

Keywords: Callotasis, Bone lengthening, Callus, Intramembranous ossification, Endochondral ossification

   DOI: 10.1007/s11751-010-0083-y  |  Open Access |  How to cite  | 


We evaluated the morphological features of the newly formed tissue in an experimental model of tibial callotasis lengthening on 24 lambs, aged from 2 to 3 months at the time of operation. A unilateral external fixator prototype Monotube Triax® (Stryker Howmedica Osteonics, New Jersey) was applied to the left tibia. A percutaneous osteotomy was performed in a minimally traumatic manner using a chisel. Lengthening was started 7 days after surgery and was continued to 30 mm. The 24 animals were randomly divided into three groups of 8 animals each: in Group 1, lengthening took place at a rate of 1 mm/day for 30 days; in Group 2, at a rate of 2 mm/day for 15 days; in Group 3, at a rate of 3 mm/day for 10 days. In each group, 4 animals were killed 2 weeks after end of lengthening, and the other 4 animals at 4 weeks after end of lengthening. To assess bony formation in the distraction area, radiographs were taken every 2 weeks from the day of surgery. To study the process of vascularization, we used Spalteholz's technique. After killing, the tibia of each animal was harvested, and sections were stained with hematoxylin and eosin, Masson's trichrome, and Safranin-O. Immunohistochemistry was performed, using specific antibodies to detect collagens I and II, S100 protein, and fibronectin. A combination of intramembranous and endochondral ossification occurred together at the site of distraction. Our study provides a detailed structural characterization of the newly formed tissue in an experimental model of tibial lengthening in sheep and may be useful for further investigations on callotasis.


Original Article

Hany Hefny, H. Shalaby

A safer technique for the double elevation osteotomy in severe infantile tibia vara

[Year:2010] [Month:August] [Volume:5] [Number:2] [Pages:7] [Pages No:79 - 85]

Keywords: Tibia vara, Blount's disease, Double elevation osteotomy, Ilizarov, Gradual correction

   DOI: 10.1007/s11751-010-0088-6  |  Open Access |  How to cite  | 


Infantile tibia vara is a deformity of abrupt angulation into varus due to an affection of the postromedial aspect of the proximal tibial physis. The deformity often includes internal tibial torsion and limb length discrepancy. Gradual correction of the deformity is currently the treatment of choice for these challenging cases as it requires less invasive surgery, allows progressive and adjustable correction, permits bone lengthening if needed and achieves a more accurate correction compared to acute correction. Elevation of the depressed medial tibial condyle allows restoration of the joint architecture. Different techniques described to elevate the depressed medial tibial plateau are all technically demanding and carry potential risks of unsalvageable intra-operative complications. The aim of this study is to report the results of a safer technique for the double elevation osteotomy combined with gradual correction using the Ilizarov frame, allowing it to be more reproducible, less technically demanding and avoid those potential complications. This study included 12 limbs in 8 patients (mean age 9 years), all were classified as stage V or VI according to the Langenskiold classification. All osteotomies healed completely in all patients. The mean time in the frame was 23 weeks. The mean preoperative femoral shaft-tibial shaft angle was 36° of varus. This improved to 5° of varus. The mean preoperative femoral condyle-tibial shaft angle was 58°. This improved to 84°. The mean preoperative angle of depressed medial tibial plateau was 63°. This improved to 8°. All patients were maintaining full extension of the knee at the final follow-up, and all patients noticed a significant improvement in their gait pattern. We believe that this technique is safer and less invasive compared to traditional and even newly described techniques for elevating the depressed medial tibial plateau and correcting the deformity in severe infantile tibia vara, which will allow it to be more reproducible.


Original Article

Mohamed F. Mostafa, Gamal El-Adl, Ehab Y. Hassanin, M-Serry Abdellatif

Surgical treatment of displaced intra-articular calcaneal fracture using a single small lateral approach

[Year:2010] [Month:August] [Volume:5] [Number:2] [Pages:9] [Pages No:87 - 95]

Keywords: Foot injuries, Fracture fixation, Internal, Minimally invasive surgical procedures

   DOI: 10.1007/s11751-010-0082-z  |  Open Access |  How to cite  | 


The objective of this study was to evaluate the outcome of semi-open reduction and minimal internal fixation through a single small lateral approach as a minimally invasive technique for treatment of displaced intra-articular calcaneal fractures. This prospective study was conducted on eighteen patients (16 men and 2 women). The average age was 37.7 (22–55). The most common cause of injury was a fall from height in fourteen patients. Patients were operated on within a mean time of 4.8 days of admission (1–11 days) and were followed up for an average period of 24.1 months (6–39 months). Patients were evaluated clinically using the Creighton-Nebraska Heath Foundation Assessment score of Crosby and Fitzgibbons (J Bone Joint Surg (Am) 72-A:852–859, 1990). The scoring system proposed by Knirk and Jupiter was used for radiological assessment of the posterior subtalar joint (Knirk and Jupiter in J Bone Joint Surg (Am) 68-A: 647–659, 1986). The skin incision healed in all cases without necrosis, infection, or sural nerve injury. All fractures healed after an average of 8 weeks (7–10 weeks), and patients returned to the routine daily activities after an average time of 4.3 months (3–7 months). In conclusion, semi-open reduction and minimal internal fixation through a small lateral approach is an effective treatment for carefully selected cases of displaced intra-articular calcaneal fractures.


Original Article

Tim Schepers, Brenda C. T. Kieboom, Gert H. J. M. Bessems, Lucas M. M. Vogels, Esther M. M. van Lieshout, Peter Patka

Subtalar versus triple arthrodesis after intra-articular calcaneal fractures

[Year:2010] [Month:August] [Volume:5] [Number:2] [Pages:7] [Pages No:97 - 103]

Keywords: Calcaneus, Arthrodesis, Outcome

   DOI: 10.1007/s11751-010-0084-x  |  Open Access |  How to cite  | 


Depending upon initial treatment, between 2 and 30% of patients with a displaced intra-articular calcaneal fracture require a secondary arthrodesis. The aim of this study was to investigate the effect of subtalar versus triple arthrodesis on functional outcome. A total of 33 patients with 37 secondary arthrodeses (17 subtalar and 20 triple) with a median follow-up of 116 months were asked to complete questionnaires regarding disease-specific functional outcome (Maryland Foot Score, MFS), quality of life (SF-36) and overall satisfaction with the treatment (Visual Analogue Scale, VAS). Patient groups were comparable considering median age at fracture, initial treatment (conservative or operative), time to arthrodesis, median follow-up, and post-arthrodesis radiographic angles. The MFS score was similar after subtalar versus triple arthrodesis (59 vs. 56 points; P = 0.79). No statistically significant difference was found for the SF-36 (84 vs. 83 points; P = 0.67) and the VAS (5 vs. 6; P = 0.21). Smoking was statistically significantly associated with a non-union (χ2 = 6.60, P = 0.017). The current study suggests that there is no significant difference in functional outcome between an in situ subtalar or triple arthrodesis as a salvage technique for symptomatic arthrosis after an intra-articular calcaneal fracture. Smoking is a risk factor for non-union.



Matthijs P. Somford, Maarten F. A. M. Sturm, Jos P. A. M. Vroemen

Reconstruction of isolated scaphoid dislocation with carpal dissociation, associated with a carpal anomaly

[Year:2010] [Month:August] [Volume:5] [Number:2] [Pages:6] [Pages No:105 - 110]

Keywords: Scaphoid dislocation, Axial carpal dissociation, Lunato-triquetral coalition, Carpal trauma

   DOI: 10.1007/s11751-010-0092-x  |  Open Access |  How to cite  | 


A case is presented of isolated scaphoid dislocation with carpal dissociation in the presence of a lunato-triquetral coalition. We present the treatment and follow-up of this case. In addition, the literature on scaphoid dislocation and its treatment is reviewed. We emphasize the need to reconstruct the carpal alignment and scapho-lunate linkage.



Steffen Brodt, Gunther O. Hofmann, Andreas H. Tiemann

Preservation of the shoulder joint by the use of a hybrid-spacer after septic loosening of a reversed total shoulder joint arthroplasty: a case report

[Year:2010] [Month:August] [Volume:5] [Number:2] [Pages:4] [Pages No:111 - 114]

Keywords: Hybrid-spacer, Infection, Shoulder, TJR

   DOI: 10.1007/s11751-010-0086-8  |  Open Access |  How to cite  | 


Infections of a total joint replacement (TJR) of the shoulder are rare complications. After revision surgery, the incidence rises dramatically. If infection occurs, it leads to a loss of function and may be devastating to the joint. Treatment options range from single- to multiple-staged revision programs, permanent resection arthroplasty or exarticulation. In this case, a reversed shoulder endoprosthesis, which was implanted after multiple revisions of a TJR due to a posttraumatic omarthrosis and rotator cuff insufficiency, got infected. A hybrid-spacer, made of a humeral nail and a custom-made PMMA spacer forming the humeral head, was used during the revision program. After two operations, clinical and paraclinical signs turned back to normal. The patient felt well and was satisfied with the result of the therapy. The hybrid-spacer was then left in situ as a definitive solution with a satisfying range of motion. This case report shows that a hybrid-spacer can be helpful in the treatment of an infected shoulder TJR.


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