Functional results of braced humeral diaphyseal fractures; why do 38% lose external rotation of the shoulder?

BACKGROUND: This prospective clinical study was performed to evaluate the efcacy and functional outcome in proximal humeral fractures following surgery with locking plates. MATERIAL & METHODS: from August 2013 to April 2015, 32 patients were enrolled in this study following exclusion and inclusion criteria. The evaluation parameters included Time taken for fracture union, functional scores, radiographs of the shoulder and ROM (Range of motion- exion, abduction, internal and external rotation etc.). Patients were followed up regularly at 6 weeks, 12 weeks, 24 weeks and 12 months. Functional results were evaluated using Neer's score. All data were collected and analyzed with the help of suitable statistical parameters. RESULTS: The nal results were evaluated by using NEER'S Score. In our study, the minimum score was 65 and maximum was 94. The average score was 83.9 (Mean ± S.D. : 83.875 ± 6.73). We had excellent results in 6(18.75%) patients, 19(59.375%) had satisfactory results, 7(21.875%) patients had unsatisfactory results but none of the case is failure in our study. CONCLUSION: Open reduction and internal xation with Locking Compression Plates, has given good results and it is the implant of choice now-a-days particularly in comminuted fractures and in osteoporotic bones in elderly patients.

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Closed diaphyseal fractures of femur in children treated by hip spica: early result of a clinical study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20175113 ◽

2017 ◽

Vol 4 (1) ◽

pp. 22

Author(s):

M. A. Q. Ansari ◽

M. M. Farhan ◽

M. Nayeemuddin

Keyword(s):

External Rotation ◽

Age Distribution ◽

Femoral Shaft ◽

Patient Characteristics ◽

Spica Cast ◽

Shaft Fractures ◽

Fractures In Children ◽

Diaphyseal Fractures ◽

Hip Spica Cast ◽

A Prospective Study

Background: Diaphyseal fracture of femur is a common injury in children with bimodal age distribution. The treatment modality of these fractures depend on several factors such as age of the patient, characteristics of the fracture– degree of displacement, location of fracture in femur, comminution, and open or closed injury. With the invention of titanium elastic nails, the recent trend in treating these fractures is by closed reduction and TENS, but the surgical management is not without complications hence we share our experience to reemphasize the role of hip spica cast immobilisation in treating these injuries.Methods: This is a prospective study of 30 cases of diaphyseal fractures of femur in children between the ages of 6 month to 6 years. History and mode of injury were recorded and complete physical examination was done. Plain anteroposterior and lateral radiographs confirmed diagnosis. Hip spica cast was applied under sedation or short general anesthesia. One and half spica was applied over thick padding with hip flexed 45 degrees abducted 30 degrees and external rotation of 10 degree. No attempt was made to obtain an end to end reduction. Patients were allowed to go home the same day after giving instructions regarding spica care. Follow up was done and radiographs were taken at 1, 2, 4 and 12 weeks. Any malunion– LLD, angulation or rotation were recorded.Results: The mean age of patients was 3.5 years (range 0.5 to 6 years). Of these 12 (40%) were male and 18 (60%) were female. The commonest mode of injury was fall while play in 73.33% (n=22) of patients. Mid shaft fractures are more common 53.33% (n=16) followed by upper third 40% (n=12). Average time for fracture union was 6 weeks (range 4-10 weeks). At one year all fractures healed in a satisfactory position without any LLD. Two patients had minor skin problems which were easily treated and cast continued. No stiffness of hip, knee or ankle was noted. Conclusions: Hip spica casting is an effective and reliable method for treating femoral shaft fractures in children with a union rate of 100%. The advantages of conservative treatment such as the avoidance of general anaesthesia on two occasions and the avoidance of surgery make a compelling argument in favour of this form of treatment.

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Tratamiento artroscópico de las fracturas de tercio distal de clavícula tipo 2 de Neer con sistema ZipTight.

Revista Española de Cirugía Osteoarticular ◽

10.37315/sotocav201928054149 ◽

2019 ◽

pp. 149-155

Keyword(s):

External Rotation ◽

Surgical Techniques ◽

Functional Results ◽

High Rate ◽

Type Ii ◽

Rotator Cuff Injuries ◽

Technical Modifications ◽

Clavicle Fractures ◽

Clinical And Radiological Results ◽

Coracoclavicular Fixation

PURPOSE. Neer type II fractures of the external third of the clavicle are fractures with a high rate of nonunion or malunion (up to 30%). Multiple surgical techniques have been describe their treatment. Also, several arthroscopic techniques. METHODS. We have retrospectively reviewed 29 cases with Neer type II distal third clavicle fractures treated with coracoclavicular fixation with a suspension system. RESULTS. All fractures except 1 have undergone complete consolidation in 3 months,without the disadvantages of other systems such as KW,screws or plates. The rate of consolidation has been 96.5% (all but 1 patient).The mobility obtained was very satisfactory: flexion of 176º, abduction of 145º, an external rotation of 80º, an internal rotation with the hand until T11 and horizontal adduction of 132º. The functional results obtained have been excellent in most patients: obtaining 96 points on the Constant scale and excellent UCLA in 26 cases. This is one of the studies with more patients treated with this type of technique. All patients have been followed until the clinical and radiographic consolidation of the fractures.We also contribute some technical modifications to the initial technique that we have been obtaining with the experience to improve the clinical and radiological result of the patients. CONCLUSION.The arthroscopic assisted treatment of Neer type II distal third clavicle fractures with a Ziptight system is a reproducible technique that allows us to reduce and stabilize the fracture and also to diagnose and treat possible glenohumeral o rotator cuff injuries, obtaining excellent clinical and radiological results.

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Management of Fractures Shaft of Tibia in Adult Interlocking Nailing Versus Plating in: A Comparative Study

KYAMC Journal ◽

10.3329/kyamcj.v10i2.42788 ◽

2019 ◽

Vol 10 (2) ◽

pp. 99-105

Author(s):

Md Ashraful Islam ◽

Md Abdur Rashid ◽

Md Rafiqul Islam ◽

Md Hafizur Rahman Milon ◽

Md Kaiser Mahmud

Keyword(s):

Patient Satisfaction ◽

Bone Fractures ◽

Plate Osteosynthesis ◽

Meta Analysis ◽

Functional Results ◽

Long Bone ◽

Medical College ◽

Interlocking Nailing ◽

Significant Difference ◽

Diaphyseal Fractures

Background: Tibial shaft fractures are the commonest long bone fractures in adults, most commonly managed by intramedullary interlocking nailing. However, several meta-analysis show that locking plate osteosynthesis is equally effective in managing tibial diaphyseal fractures and are associated with less number of complications. Aim: To compare the results of fixation of tibial fractures followingplating and nailing in terms of union, patient satisfaction and complications. Materials and Methods: Khwaja Yunus Ali Medical College and Hospital based non randomized clinical trial was performed from September 2014 to August 2017 where closed or open diaphyseal or metaphyseo- diaphyseal fractures of the tibia (closed or open Gustilo Anderson type 1 through 3B) were included. Simple sequential allocation was used for allotting the patients to two groups, one for interlocking nailing and other for plating. The patients were followed up for clinical, radiographic and functional results. Results: Forty patients with 41 involved limbs completed followup for one year. in our study was 19.55±0.69 weeks in case of interlocking nailing and 20.38±1.39 weeks in case of plating and there was no statistically significant difference between the two. Conclusion: There was no difference between the twomodalities in terms of fracture union. Complications were lesser but more serious in case of plating. Patient satisfaction was more with plating. KYAMC Journal Vol. 10, No.-2, July 2019, Page 99-105

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Anatomical and Microsurgical Implications in Total and Midarm Transplantation

Journal of Reconstructive Microsurgery Open ◽

10.1055/s-0037-1604342 ◽

2017 ◽

Vol 02 (02) ◽

pp. e94-e102 ◽

Cited By ~ 2

Author(s):

Martin Iglesias ◽

Fernanda Salazar-Hernández ◽

María Ramírez-Berumen ◽

Patricia Butrón ◽

Josefina Alberú-Gómez ◽

...

Keyword(s):

Glenohumeral Joint ◽

External Rotation ◽

Thermal Sensitivity ◽

Elbow Flexion ◽

Functional Results ◽

Clinical Results ◽

Wrist Extension ◽

Ischemia Time ◽

Total Ischemia ◽

The Right

Background Arm transplantations are performed less frequently than forearm and hand transplantations. We present the surgical and microsurgical technique and its relationship with the clinical results in a patient with bilateral arm transplantation. Methods A 51-year-old male patient underwent bilateral arm transplantation in October 2015. The right arm was transplanted at the glenohumeral joint. The vascular repair was at the axillary level, and the nerves were repaired at their origin. The total ischemia time was 3 hours and 48 minutes. The left arm was transplanted at the midhumeral level; all muscles were completely transplanted. The nerves were repaired at the distal third of the arm. Additionally, terminolateral neurorrhaphy was performed from the donor musculocutaneous nerve to the recipient radial nerve. The total ischemia time was 6 hours and 35 minutes. Results At 15 months posttransplantation, the right shoulder had an abduction of 90 degrees and muscle strength of M4; flexion of 100 degrees and M4; internal and external rotation of M1; elbow flexion of 120 degrees and M3; elbow extension of M5; pronosupination of M2; and wrist extension of M2. There was no mobility in the fingers. The left transplanted limb had total elbow flexion and extension of M5, pronosupination of M2, wrist extension of M4, and finger flexion of M2. Both extremities had thermal sensitivity that allowed discrimination of cold and heat with residual deep pressure. Conclusion Although the functional results of arm transplantation are so far unknown, they may be considered beneficial compared with the devastating disability caused by arm amputation.

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Treatment of femoral and tibial fractures in puppies by elastic plate osteosynthesis

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0037-1616588 ◽

2007 ◽

Vol 20 (01) ◽

pp. 51-58 ◽

Cited By ~ 15

Author(s):

F. Meige ◽

A. Autefage ◽

S. Sarrau

Keyword(s):

Femoral Head ◽

Elastic Plate ◽

Plate Osteosynthesis ◽

Functional Results ◽

Tibial Fractures ◽

Plate Bending ◽

Diaphyseal Fracture ◽

Clinical Consequences ◽

Diaphyseal Fractures

SummarySeventeen puppies, two to four months old, with a femoral (n=12) or tibial (n=5) diaphyseal fracture were treated by elastic plate osteosynthesis with a Veterinary Cuttable Plate (VCP) or straight plate. In one case of femoral fracture treated with a VCP, plate bending due to an excessive elasticity of the implant was observed three days after the osteosynthesis and surgical revision was required. Two cases of femoral overgrowth and one case of slight femoral head and neck retroversion were identified during the radiographic follow-up but without any clinical consequences. Bone healing was obtained for all fractures four to eight weeks (5.64±0.88 weeks) after the surgical procedure, and functional results were excellent in all cases. Our study confirms that elastic plate osteosynthesis with either a VCP or straight plate can be used to treat femoral diaphyseal fractures in medium and large breed puppies less than four months old, but that modification of implant elasticity or rigid osteosynthesis use is required when such puppies reach four months. The same technique can also be used successfully to treat tibial fractures in puppies younger than four months old.

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(P1-105) Osteosynthesis of Children with Femur Fractures from Traffic Accidents

Prehospital and Disaster Medicine ◽

10.1017/s1049023x11004389 ◽

2011 ◽

Vol 26 (S1) ◽

pp. s133-s133

Author(s):

V.M. Rozinov ◽

S.I. Jandiev ◽

V.I. Petlakh

Keyword(s):

Traffic Accidents ◽

Functional Results ◽

Infectious Complications ◽

Optimum Treatment ◽

Number Of Children ◽

Intramedullary Osteosynthesis ◽

Femur Fractures ◽

Fractures In Children ◽

Diaphyseal Fractures ◽

Elastic Nails

IntroductionThe growing number of children suffering polytrauma from traffic accidents dictates the expansion of the indications for osteosynthesis. Elastic-stable intramedullary osteosynthesis (ESIN) is the optimum treatment of fractures of long bones in children.MethodsClosed intramedullary osteosynthesis of diaphyseal femur fractures with flexible nails was performed in 74 patients (76 fractures) during 2006–2010. The patients were children ages 1–8 years. Titanium elastic nails (TEN) (Synthesis, Switzerland) were used in the procedures. AO Foundation recommendations were adhered to when selecting the size of the implant (i.e., diameter approximately 1/3 the diameter of the femur medullar canal at its narrowest part).ResultsThere was a prevalence (n = 53) of simple fractures (Ð3 by AO classification) in this group of patients. Sixteen children had Ð2-type fractures, five with spiral (Ð1), and two with slanting (Ð2) fractures. There were no type Ð1 or Ð3 complex fractures in this group. Good functional results of closed intramedullary osteosynthesis with TEN at diaphyseal fractures of the femur in children with isolated and associated damages were achieved. There were no post-operative complications. This method provided stability of osteosynthesis, which allows activating patients in the short- term, i.e., during the post-operative period.ConclusionTreating femur fractures in children with ESIN provides optimum treatment of polytrauma. Osteosynthesis without exposure to the area of damage, and the early activation of children can prevent infectious complications and contractures.

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Results of Sever- L’ Episcopo procedure for obstetric brachial plexus palsy

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164628 ◽

2016 ◽

Vol 3 (1) ◽

pp. 50

Author(s):

Karthi Sundar V. ◽

Anil Kumar S.V.

Keyword(s):

Brachial Plexus ◽

External Rotation ◽

Social Stigma ◽

Functional Results ◽

Functional Improvement ◽

Brachial Plexus Palsy ◽

Obstetric Brachial Plexus Palsy ◽

Obstetric Brachial Plexus ◽

Teres Major

Background: The reported incidence of obstetric brachial plexus palsy (OBPP) varies from 0.3 to 2.5 per 1000 live birthsresulting in internal rotation deformity and weak abduction of the involved side shoulder.Methods: To retrospectively analyse the functional results of the Sever- L‘ Episcopo procedure for OBPP with a minimum follow-up of 2 years to a maximum of 13 years using modified Mallet scoring system for shoulder.Results: A significant improvement in the range of abduction and the restoration of external rotation of shoulder was achieved with Sever- L’Episcopo procedure. Conclusions: The results of secondary reconstruction of a dysfunctional shoulder by means of a Lattismus dorsi & Teres major transfer as described by Sever- L’Episcopo is definitely beneficial. However this procedure will improve, but will not normalize, function. Apart from functional improvement this procedure corrects a deformity thereby easing the psycho-social stigma associated with it.

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Shoulder Arthrodesis for Traumatic Brachial Plexus Injuries: Functional Outcomes and Complications

Hand ◽

10.1177/1558944721998008 ◽

2021 ◽

pp. 155894472199800

Author(s):

Alvaro Baik Cho ◽

Helio Jiseok Choi ◽

Carlos Henrique Vieira Ferreira ◽

Leandro Yoshinobu Kiyohara ◽

Gustavo Bersani Silva ◽

...

Keyword(s):

Brachial Plexus ◽

Brachial Plexus Injury ◽

External Rotation ◽

Therapeutic Option ◽

Functional Results ◽

Shoulder Abduction ◽

Subacromial Space ◽

Nerve Reconstruction ◽

The Mean ◽

Shoulder Arthrodesis

Background The external rotation and abduction of shoulder are considered one of the priorities of reconstruction in brachial plexus injury. The aim of this study was to evaluate the functional results and complications of shoulder arthrodesis in patients with brachial plexus injury to better comprehend the benefits of this procedure. Methods Between 2015 and 2019, 15 shoulder arthrodesis were performed in patients with long-standing brachial plexus injury. The main indication for arthrodesis was absent or poor recovery of shoulder abduction and external rotation. Patients presented different levels of injury. Shoulder measurements of active abduction and external rotation were made based on image records of the patients. A long 4.5-mm reconstruction plate was fit along the scapular spine, acromion, and lateral proximal third of the humerus. Structured bone graft was fit into the subacromial space. Results The mean preoperative abduction was 16°, and the mean postoperative abduction was 42°. The mean preoperative external rotation was −59°, and the mean postoperative external rotation was −13°. The mean increase in abduction and external rotation was 25° and 45°, respectively. Bone union was achieved in all cases at an average time of 5.23 months. We experienced humeral fractures in 26.66% of the cases, which were all successfully treated nonoperatively. Conclusions Shoulder arthrodesis is a rewarding procedure for patients with brachial plexus injuries. A marked improvement in the upper limb positioning was observed in all patients. It should be considered as the main therapeutic option in cases where nerve reconstruction is no longer possible.

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Characteristics and Outcomes of Ankle Injuries in Winter and Summer Seasons

Proceedings of the Latvian Academy of Sciences Section B Natural Exact and Applied Sciences ◽

10.2478/prolas-2020-0038 ◽

2020 ◽

Vol 74 (4) ◽

pp. 237-243

Author(s):

Ruta Jakušonoka ◽

Toms Arcimovičs ◽

Gunita Vinčela ◽

Andris Jumtiņš ◽

Ilze Čerņavska ◽

...

Keyword(s):

External Rotation ◽

Winter Season ◽

Stage Iv ◽

Functional Results ◽

Outcome Evaluation ◽

Ankle Injuries ◽

Daily Activities ◽

Tibiofibular Syndesmosis ◽

Ankle Trauma ◽

Supination External Rotation

AbstractThe diagnostics and treatment of ankle trauma remain challenging as they enable the patients’ return to work and ability to perform daily activities. The aim of the study was to evaluate characteristics and outcomes of ankle injuries, focusing on the trauma mechanisms in winter and summer seasons. A retrospective study was conducted of 182 patients with ankle injuries, admitted to the Hospital of Traumatology and Orthopaedics in 2014, 2015, and 2016 from the months December to February, and from June to August. Patients with supination-external rotation (SER) type ankle injuries were included in the functional outcome evaluation. Our results suggested that most of the injuries were SER type, stage IV in both seasons, and that more than 2/3 of the SER type ankle injuries that needed surgery were in the winter season. In patients with tibiofibular syndesmosis (TFS) rupture the functional results were worse than in those without TFS rupture, but in winter and summer seasons they seemed to be without statistical difference.

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