Strategies in Trauma and Limb Reconstruction

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2011 | August | Volume 6 | Issue 2

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Juan Pretell Mazzini, Juan Rodriguez-Martin, Ismael Auñon-Martin, José Alberto Zafra-Jimenez

Controversial topics in the management of displaced supracondylar humerus fractures in children

[Year:2011] [Month:August] [Volume:6] [Number:2] [Pages:8] [Pages No:43 - 50]

Keywords: Closed reduction, Pin configuration, Vascular injury, Supracondylar humerus fracture, Children

   DOI: 10.1007/s11751-011-0114-3  |  Open Access |  How to cite  | 


The aim of our study was to review the literature looking for the up to date information regarding these controversial topics. An electronic literature search was performed using the Medline/PubMed database. A closed reduction attempt should always be done first. It is more important to engage both columns as well as divergence of the pins no matter whatever configuration is applied. Time to surgery seems to be not an important factor to increase the risk of complications as well as open reduction rate. Usually neurological injuries present a spontaneous recovery. If there is absent pulse, we should follow the algorithm associated with the perfusion of the hand.



Remco J. A. van Wensen, Michel P. J. van den Bekerom, René K. Marti, Ronald J. van Heerwaarden

Reconstructive osteotomy of fibular malunion: review of the literature

[Year:2011] [Month:August] [Volume:6] [Number:2] [Pages:7] [Pages No:51 - 57]

Keywords: Ankle, Fracture, Osteotomy, Malunion, Operative procedures, Fibula

   DOI: 10.1007/s11751-011-0107-2  |  Open Access |  How to cite  | 


The treatment of ankle fractures has a primary goal of restoring the full function of the injured extremity. Malunion of the fibula is the most common and most difficult ankle malunion to reconstruct. The most frequent malunions of the fibula are shortening and malrotation resulting in widening of the ankle mortise and talar instability, which may lead to posttraumatic osteoarthritis. The objective of this article is to review the literature concerning the results of osteotomies for correcting fibular malunions and to formulate recommendations for clinical practice. Based on available literature, corrective osteotomies for fibular malunion have good or excellent results in more than 75% of the patients. Reconstructive fibular osteotomy has been recommended to avoid or postpone sequela of posttraumatic degeneration, an ankle arthrodesis or supramalleolar osteotomy. The development of degenerative changes is not fully predictable; therefore, it is advisable to reconstruct a fibular malunion soon after the diagnosis is made and in presence of a good ankle function. Recommendations were made for future research because of the low level of evidence of available literature on reconstructive osteotomies of fibular malunions.


Original Article

Freih Odeh Abu Hassan

Subperiosteal resection of mid-clavicle in Sprengel's deformity correction

[Year:2011] [Month:August] [Volume:6] [Number:2] [Pages:9] [Pages No:59 - 67]

Keywords: Clavicle, Shoulder, Deformity, Sprengel's

   DOI: 10.1007/s11751-011-0115-2  |  Open Access |  How to cite  | 


We report the results of fifteen cases of Sprengel's deformity treated surgically by initial subperiosteal resection of the middle third of the clavicle in conjunction with surgical release of all attachments of the scapula to the spine, excision of any omovertebral bone and resection of prominent supraspinous process of scapula. The patients included ten female and three male patients (age range at the time of operation, 3.3–10 years; mean: 6.11 years). The deformity involved the left shoulder in eight patients, the right shoulder in three and two were bilateral. All patients were followed for an average of 5.9 years (range 4–11 years). Preoperatively, the arc of total abduction (glenohumeral and scapulothoracic) ranged from 80 to 140°, and the average was 110°. The shoulders were level, and the range of motion was dramatically improved with an average range of abduction of 166.5° (range 140–180°). The age of the patients and the presence of an omovertebral bone did not influence the results. All patients and their parents expressed satisfaction with the operative results. We feel that our procedure is a simple one, which helps to improve the degree of correction, avoid neurovascular complications and has the advantage of complete regeneration of the clavicle. The technique provides an easy, safe method of repositioning the scapula at its normal level.


Original Article

Alexandros Tsarouhas, Michael E. Hantes, Theohilos Karachalios, Konstantinos Bargiotas, Konstantinos N. Malizos

Reconstruction nailing for ipsilateral femoral neck and shaft fractures

[Year:2011] [Month:August] [Volume:6] [Number:2] [Pages:7] [Pages No:69 - 75]

Keywords: Femoral shaft fractures, Ipsilateral hip, Reconstruction nail

   DOI: 10.1007/s11751-011-0117-0  |  Open Access |  How to cite  | 


The surgical management of ipsilateral fractures of the femoral neck and shaft presents a difficult and challenging problem for the orthopaedic surgeon. The purpose of the present study was to report the mid-term results and complications in a series of patients who sustained ipsilateral femoral neck and shaft fractures and treated in our trauma department with a single reconstruction nail for both fractures. Eleven patients were included in the study with an average age of 46.4 years. The mean follow-up was 47 months (range, 15–75 months). There were no cases of a missed diagnosis at initial presentation. The mean time to union was 4.5 months for the neck fracture and 8.2 months for the shaft. There were no cases of avascular necrosis of the femoral head or non-union of the neck fracture. The mean Harris Hip Score was (85 ± 4.3). Complications included two cases of shaft fracture non-union and one case of peroneal nerve palsy. Heterotopic ossification at the tip of the greater trochanter was evident in two cases without causing any functional deficit. The current study suggests that reconstruction nailing produces satisfactory clinical and functional results in the mid-term. The complications involved only the femoral shaft fracture and were successfully treated with a single operative procedure.


Original Article

Pedro Antonio Sánchez Mesa

Transiliac lengthening with posterior lumbar-iliac percutaneous fusion in sacral hemiagenesis

[Year:2011] [Month:August] [Volume:6] [Number:2] [Pages:5] [Pages No:77 - 81]

Keywords: Postural imbalance, Hemiagenesis, Rotoscoliosis, Pelvis, Hemisacrum

   DOI: 10.1007/s11751-011-0109-0  |  Open Access |  How to cite  | 


Sacral agenesis is a term that applies to a wide range of developmental disorders of the lower portions of the spine and pelvis. Hemisacrum patients with all sacral segments present on one side of the spine, and decompensated lumbar rotoscoliosis, whit instability torac-pelvic that had transiliac lengthening of the lower extremity, accomplished by an innominate osteotomy with interposition of a rectangular iliac-bone graft in the osteotomy site, besides a posterior lumbar-iliac percutaneous fusion. We reported 5 adolescent patients, 2 men and 3 women, treated from 2000 to 2009, associated with average pelvic imbalance of 3.2 cm (2.5–4.5 cm) without other associated congenital anomalies. Patients classified as Vergara (Acta Ortop Mex 19:6–12, 2005) type IB unilateral partial agenesis of the sacrum, asymmetry of the pelvic ring there's a torac-pelvic cifoscoliotic deformity. Mean age was 12.2 years-old (range from 8.2 to 13.7). The mean follow-up was 7.2 years (from 2 to 8). The consolidation process of the osteotomy site was in an average of 6.4 (5–8.7 weeks) (P = 0.036). None of the patients presented family medical history of diabetes on their mothers. None residual femoral nerve palsy. The procedure offers postural correction at the level of the pelvis, low morbidity and no additional operations were required to achieve the surgical objective. Level of evidence Level IV, therapeutic study: Case series (no, or historical, control group), Prospective: The study was started before the first patient was enrolled.


Original Article

B. A. MacWilliams, B. Harjinder, P. M. Stevens

Guided growth for correction of knee flexion deformity: a series of four cases

[Year:2011] [Month:August] [Volume:6] [Number:2] [Pages:8] [Pages No:83 - 90]

Keywords: Fixed knee flexion deformity, Crouch gait, Guided growth, Hemiepiphysiodesis, 8-plate

   DOI: 10.1007/s11751-011-0110-7  |  Open Access |  How to cite  | 


Fixed knee flexion deformity can present as an insidious and significant problem in diverse etiologies, most commonly in cerebral palsy. Traditional surgical intervention has included posterior capsulotomy and supracondylar femoral osteotomy, both of which carry significant associated morbidity and risks. In the skeletally immature patient, guided growth may be used to correct or substantially diminish the deformity. We are presenting our early experience encompassing four subjects who completed instrumented gait analysis both prior to and after distal femoral anterior guided growth (hemiepiphysiodesis). Changes in gait and function resulting from surgery in each individual are reported. Outcomes indicate improved knee range of motion and alleviation of crouch at the knee with secondary improvements in the ankle, hip and pelvis. Three subjects with initially slow gait velocity improved to within normal limits by demonstrating increased stride length. A measure of overall gait kinematics showed improvements in all limbs. Anterior guided growth (hemiepiphysiodesis) of the distal femur resulted in positive quantitative changes in all four patients, though degree and types of changes were variable in this small series. Encouraged by these findings, we now prefer guided growth to extension supracondylar osteotomy for the skeletally immature patient with fixed knee flexion deformity.


Original Article

Bruno Livani, Gabriel Castro, Jose Roberto Tonelli Filho, Tâmara Ramos Morgatho, Mauricio Leal Dias Mongon, William Dias Belangero, Michael Davitt, Jose André Carvalho

Sensate composite calcaneal flap in leg amputation: a full terminal weight-bearing surface—experience in eight adult patients

[Year:2011] [Month:August] [Volume:6] [Number:2] [Pages:6] [Pages No:91 - 96]

Keywords: Heel, Leg, Extremities

   DOI: 10.1007/s11751-011-0118-z  |  Open Access |  How to cite  | 


Despite modern reconstruction techniques and replantation, the preservation of a severely traumatised limb, or even a limb affected by a congenital malformation, usually gives poorer functional results compared with amputation and prosthetisation. The aim of this study was to describe a hind foot (including the calcaneum and fat pad) sensate flap with a surface that allows full terminal weight bearing in transtibial amputations in adults. Between June 2007 and September 2008, eight patients underwent leg amputations with a sensate composite calcaneal flap reconstruction of the stump. Patients consisted of four men and four women with a mean age of 46.5 (26–66) years. All amputations were unilateral. The mean follow-up was 28.3 (25–42) months. There were no complications. Calcaneum tibial fusion was observed in all patients in a mean time of 3.5 (3–4) months. A below-knee prosthesis was adapted at 16 weeks postoperatively in all cases, and no need for stump revision occurred in this series during the entire follow-up period. A transtibial amputation covered with a sensate plantar flap preserving the calcaneum was proposed. In theory, the anatomic structures spared in this technique provide a strong, full, weight-bearing terminal surface of the stump that will last a lifetime.



Subramaniam Ramesh, Yi-Jia Lim

Complex elbow dislocation associated with radial and ulnar diaphyseal fractures: a rare combination

[Year:2011] [Month:August] [Volume:6] [Number:2] [Pages:5] [Pages No:97 - 101]

Keywords: Elbow dislocation, Monteggia fracture, Radius, Ulna, Medial collateral ligament

   DOI: 10.1007/s11751-011-0112-5  |  Open Access |  How to cite  | 


We illustrate a rare complex dislocation of the elbow involving a posterior ulno-humeral dislocation associated with open diaphyseal fracture of the ulna, radial shaft fracture, Type 1 coronoid fracture and neuropraxia of the deep branch of the radial nerve. The isolated ulno-humeral dislocation without radio-capitellar involvement, and ulnar diaphyseal fracture, makes this “reverse Monteggia” type of injury pattern very unique. This patient was managed with an initial reduction of his ulno-humeral joint and stabilization of his radius and ulna fractures. He underwent a delayed medial collateral ligament reconstruction a few days later. His fractures went on to unite fully, his elbow joint remained stable, and he achieved good range of motion of his elbow.



Isidre Gracia, Ignacio R. Proubasta, Laura Trullols, Ana Peiró, Esther Moya, Sarah Cortés, Oscar Buezo, Joan Majó

Distal radioulnar joint prosthesis for the treatment of giant cell tumor of the distal ulna: a case report and literature review

[Year:2011] [Month:August] [Volume:6] [Number:2] [Pages:4] [Pages No:103 - 106]

Keywords: Distal ulna, Giant cell tumor, Resection, Radioulnar prosthesis

   DOI: 10.1007/s11751-011-0113-4  |  Open Access |  How to cite  | 


Giant cell tumor (GCT) of the distal end of the ulna is an uncommon site for primary bone tumors. When it occurs, en-bloc resection of the distal part of the ulna with or without reconstruction stabilization of the ulnar stump is the recommended treatment. We present a case of a 56-year-old man with a GCT of the distal ulna treated successfully with an en-bloc resection of the distal ulna with reconstruction using radioulnar joint prosthesis. Although the experience with this type of treatment is limited, implantation of a metallic prosthesis to replace the distal part of the ulna can also be considered as a salvage procedure for the treatment of this difficult pathology.


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