Intra-medullary, at fracture site introduction of K-wires for metacarpal fracture fixation (in-site technique). A new fixation technique and a case series

Distal fibula fractures represent a common problem in orthopaedics. When fibula fractures require operative fixation, implants are typically made from stainless steel or titanium alloys. Carbon fiber implants have been used elsewhere in orthopaedics for years, and their advantages include a modulus of elasticity similar to that of bone, biocompatibility, increased fatigue strength, and radiolucency. This study hypothesized that carbon fiber plates would provide similar outcomes for ankle fracture fixation as titanium and steel implants. A retrospective chart review was performed of 30 patients who underwent fibular open reduction and internal fixation (ORIF). The main outcomes assessed were postoperative union rate and complication rate. The nonunion or failure rate for carbon fiber plates was 4% (1/24), and the union rate was 96% (23/24). The mean follow-up time was 20 months, and the complication rate was 8% (2/24). Carbon fiber plates are a viable alternative to metal plates in ankle fracture fixation, demonstrating union and complication rates comparable to those of traditional fixation techniques. Their theoretical advantages and similar cost make them an attractive implant choice for ORIF of the fibula. However, further studies are needed for extended follow-up and inclusion of larger patient cohorts. Levels of Evidence: Level IV: Retrospective Case series

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Radius-ulna shaft fracture with distal radioulnar joint instability in a case of ipsilateral malunited colles fracture: a case report

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20211635 ◽

2021 ◽

Vol 7 (3) ◽

pp. 695

Author(s):

Neetin P. Mahajan ◽

Prasanna Kumar G. S. ◽

Kishor Jadhav ◽

Kartik Pande ◽

Tushar Patil

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Shaft Fracture ◽

Distal Radioulnar Joint ◽

Fracture Site ◽

Ulnar Variance ◽

Radioulnar Joint ◽

Druj Instability ◽

Colles Fracture ◽

K Wires

<p class="abstract">Malunion of the distal end of radius is a known consequence of the conservative management. The functional impairment depends on the severity of the deformity and it can be associated with distal radioulnar joint (DRUJ) instability. Subsequent radius ulna fracture in an elderly osteoporotic patient is a challenging task to manage. A 60 year old female patient came with radius ulna shaft fracture with DRUJ instability with ipsilateral malunited distal radius fracture. We managed with open reduction and internal fixation using 3.5 mm locking compression plate (LCP) with ulnar shortening and K wires for DRUJ. At one year, follow-up, patient is having good clinical and radiological outcome without any complications. Radius ulna shaft fracture in cases of malunited colles fracture with positive ulnar variance with DRUJ instability can be managed well with open reduction and internal fixation of radius-ulna shaft which provides stable fixation, ulnar shortening at the fracture site to maintain the neutral/negative ulnar variance and DRUJ fixation using K wires. Use of multiple vicryl sutures to tie the plate to the bone gives additional stability in osteoporotic bones till the fracture unites and prevents implant failure. Combination of the above mentioned procedures helps in getting good functional outcome in elderly osteoporotic patients.</p>

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Efficacy of threading lasso fixation in repairing partial articular supraspinatus tendon avulsion lesions: a retrospective study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04739-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Sun-Yu Chen ◽

Zhan-Hao Xiao ◽

Jian-Kun Wang

Keyword(s):

Los Angeles ◽

Clinical Outcomes ◽

Case Series ◽

Visual Analog Scale Score ◽

Supraspinatus Tendon ◽

Fixation Technique ◽

Retrospective Case ◽

The Mean ◽

Tendon Avulsion

Abstract Background The partial articular supraspinatus tendon avulsion (PASTA) lesion repair remains a topic of debate. We have performed in situ repair of PASTA lesions using a potentially viable threading lasso fixation technique. This retrospective case series aimed to evaluate the clinical outcomes of PASTA lesion repair using threading lasso fixation. To the best of our knowledge, this is the first study to review this technique and its outcomes in terms of pain and upper extremity function. Methods Twenty-five patients with PASTA lesions who were treated with threading lasso fixation were reviewed. All patients were followed up for at least 1 year. Preoperative and follow-up data were retrospectively collected and reviewed. Clinical outcomes were assessed to evaluate the efficacy of the surgery. Results There were no postoperative complications. The average follow-up period was 25.7 (22–27) months. At the last follow-up, all patients underwent follow-up magnetic resonance imaging; only two cases showed a partially healed tendon and no case converted to full-thickness tear. Furthermore, shoulder pain decreased and mobility was recovered, with statistically significant differences in all scoring measures. Specifically, the mean visual analog scale score decreased from 5.4 ± 1.2 before surgery to 1.1 ± 0.8 at the last follow-up (t = 14.908, P < 0.01), and the mean American Shoulder and Elbow Surgeons Shoulder Assessment Form score improved significantly from 51.6 ± 6.4 to 89.3 ± 5.2 (t = 22.859, P < 0.01). Additionally, the mean University of California Los Angeles score improved from 17.8 ± 3.5 preoperatively to 32.3 ± 1.4 (t = 19.233, P < 0.01). Conclusions Arthroscopic repair using threading lasso fixation is a novel transtendinous technique for patients with partial articular supraspinatus tendon avulsion. Tendon integrity is preserved with this method, which may result in improved function. Overall, threading lasso fixation technique is an effective treatment.

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Subtrochanteric Fractures: Minimally Invasive Extramedullary Fracture Fixation Technique

An Operative Manual of Proximal Femoral Fractures ◽

10.5005/jp/books/12809_16 ◽

2016 ◽

pp. 125-125

Author(s):

Amite Pankaj

Keyword(s):

Minimally Invasive ◽

Fracture Fixation ◽

Fixation Technique ◽

Subtrochanteric Fractures

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Trochanteric osteotomy for acetabular fracture fixation: a case series and literature review

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-020-02753-9 ◽

2020 ◽

Author(s):

Michael J. Chen ◽

Harsh Wadhwa ◽

Seth S. Tigchelaar ◽

Christopher S. Frey ◽

Michael J. Gardner ◽

...

Keyword(s):

Literature Review ◽

Fracture Fixation ◽

Acetabular Fracture ◽

Case Series ◽

Trochanteric Osteotomy

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Treatment of Infected Tibial Non-Unions with Ilizarov Technique: A Case Series

Journal of Clinical Medicine ◽

10.3390/jcm9051352 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1352 ◽

Cited By ~ 1

Author(s):

Gianluca Testa ◽

Andrea Vescio ◽

Domenico Costantino Aloj ◽

Danilo Costa ◽

Giacomo Papotto ◽

...

Keyword(s):

Bioactive Glass ◽

Antibacterial Properties ◽

Case Series ◽

Long Bone ◽

Ilizarov Technique ◽

Fixation Technique ◽

Bone Resection ◽

Bone Segment ◽

The Mean

Background: The Ilizarov external fixation technique has been widely used for the treatment of long-bone infected non-unions. After surgical infected bone resection, to allow filling of the remaining bone gap, biomaterials with antibacterial properties could be used. The aim of this study was to report outcomes of infected tibial non-unions treated using the Ilizarov technique and antibacterial bioactive glass. Methods: Between April 2009 and December 2014, 26 patients with infected tibial non-unions were treated with the Ilizarov technique and possible use of the bioactive glass, S53P4. The Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria, a clinical and radiographic evaluating tool, was used for assessing the sample. Results: The average age at the start of treatment was 51 years. The mean follow-up time was 113 weeks. According to the ASAMI Functional Scoring System, 10 excellent (38.5%) cases and 12 good (46.1%) values were recorded. According to the ASAMI Radiological System, they were excellent in 16 (61.5%) cases and good in nine (34.6%). Conclusions: Treatment of infected tibial non-unions using the Ilizarov technique was effective in bone segment regeneration. To fill the remaining bone gap, additional bioactive glass S53P4 could be used, allowing a decrease in re-interventions and minimizing complications.

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TENSION BAND WIRING (TBW) OF DISTAL END CLAVICLE : A FORGOTTEN TECHNIQUE : SIMPLER, CHEAPER AND BETTER

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00066 ◽

2020 ◽

Vol 8 (5_suppl5) ◽

pp. 2325967120S0006

Author(s):

S Zufahrizzat ◽

AS Nadzim ◽

O Saifudin ◽

Rauf A Abdul

Keyword(s):

Clavicle Fracture ◽

Fracture Site ◽

Tension Band ◽

Left Shoulder ◽

Rigid Fixation ◽

Type Ii ◽

Distal Clavicle ◽

Distal Clavicle Fracture ◽

Advantages And Disadvantages ◽

K Wires

Clavicle fracture is a common injury, and can be classified into middle third, medial third, and distal third fractures. Only 10-15% of clavicle fracture occur in the distal third segment. Neer classified the distal clavicle fracture into five types ; type II and V are unstable and requiring fixation . Various common methods of stabilizations are introduced such as K-wiring , tension band fixation , plate fixation, osteosynthesis with hook plate and coracoclavicular screw however all those operative methods have their own advantages and disadvantages. Materials and Methods: We presented a case of 21 years old male with left shoulder pain after motor vehicle accident. Examination revealed tenderness on his left shoulder, and radiograph showed fracture of distal end left clavicle Neer type II, requiring fixation. He was counselled for lateral extension clavicle locking plate but unable to pay due to financial constraint. Results: The patient underwent open reduction and internal fixation using Kirschner wire with tension band fixation . The fracture site was visualized and the hematoma was curetted and washed. The fracture was reduced and fixed with two 1.4 mm trans-acromial Krischner wires and the reduction was checked with an image intensifier. Then the TBW is applied using stainless steel wire size 1.0 . The K-wires are bent beneath the skin. Sling immobilization is used for 2 weeks after the operation. Unrestricted tolerable shoulder motion is permitted. Stretched and exertional exercise is allowed after radiography shows osseous union and the implants are removed. Discussions: TBW is widely employed to treat limb fractures, such as patella and olecranon fracture but seldom used for distal clavicle nowadays. The advantages of TBW are higher antirotation and antibending force compared with that in K-wire fixation and lower profile compared with the bone plate, which reduces tendon irritation and prominent implant. The use of K-wires and TBW also required only the exposure of the fracture site. The soft tissue around the clavicle incurred little damage, leading to a lower infection rate. In addition, the use of K-wires and TBWs can provide a more rigid fixation than K-wires only. Rigid fixation with little complication contributes to good results . Conclusion: Surgical management is recommended for unstable distal clavicle fracture. TBW can be preferred because of the simplicity of the procedure, low cost, simple hardware, high union rate and easy availability of the implant.

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Pediatric Scaphoid Nonunions: A Case Series, Review of the Literature, and Evidence-Based Guidelines

Journal of Wrist Surgery ◽

10.1055/s-0039-3401035 ◽

2019 ◽

Vol 09 (01) ◽

pp. 002-012 ◽

Cited By ~ 1

Author(s):

Kerstin Oestreich ◽

Tatiana Umata Yoko Jacomel ◽

Sami Hassan ◽

Maxim David Horwitz ◽

Tommy Roger Lindau

Keyword(s):

Nonoperative Management ◽

Pediatric Population ◽

Scaphoid Fracture ◽

Case Series ◽

Fracture Site ◽

X Rays ◽

Review Of The Literature ◽

Level Of Evidence ◽

Scaphoid Fractures ◽

Magnetic Resonance Imaging Mri

Abstract Background Scaphoid fractures represent less than 3% of hand and wrist fractures in the pediatric population. Nonunions are very rare. We present a case series (n = 18) of nonunions in skeletally immature children and adolescents. We further present a review of the literature on pediatric scaphoid nonunions. Materials and Methods We reviewed the literature by searching the main databases on pediatric scaphoid nonunions, but to identify factors that lead to nonunion, we also searched for databases on scaphoid fractures. Seventy articles were found for the period between 1961 and 2019, all with level 4/5 evidence. Results The nonunion rate of pediatric scaphoid fractures in the literature is on average 1.5%, occurring mostly as a result of missed or underdiagnosed injuries, similar to our presented case series. Half (n = 9) of the injuries in our case series were missed initial injuries, leading to scaphoid nonunions and half developed nonunions after initial treatment. We found excellent outcomes and with surgical and nonoperative management, with few complications. Not surprisingly, the duration of immobilization is longer with nonoperative management. Conclusions Based on the literature, we recommend a period of nonoperative management before surgery in undisplaced nonunions. In displaced nonunions, open reduction and internal fixation ± bone grafting is necessary. In pediatric scaphoid fractures, similar to adult cases, we identified that suspicious scaphoid fractures should be considered for initial immobilization, and repeat X-rays and early magnetic resonance imaging (MRI) or computed tomography (CT) scans should be considered at follow-up. Immobilization time and type of plaster should be appropriate in relation to the fracture site, similar to the adult scaphoid fracture. Level of Evidence This is a Level IV study.

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