OSTEOCUTANEOUS RADIAL FOREARM FREE FLAPS: PROPHYLACTIC FIXATION OF DONOR SITE USING LOCKING PLATE AUGMENTED WITH MINERAL CEMENT

Hand Surgery ◽  
2011 ◽  
Vol 16 (02) ◽  
pp. 215-222
Author(s):  
F. Ya'ish ◽  
A. Waton ◽  
H. B'Durga ◽  
A. Nanu
Keyword(s):  
Locking Plate ◽  
Structural Strength ◽  
Plate Fixation ◽  
Donor Site ◽  
Free Flaps ◽  
Friction Forces ◽  
Phosphate Mineral ◽  
Radial Forearm ◽  
Fixation Principles

Prophylactic plating of donor site in osteocutaneous radial forearm free flaps have demonstrated improvement in fracture rates. Previous series used conventional plating systems which rely on plate-bone friction forces to generate stability and can result in iatrogenic fractures if not accurately contoured. Locking plates have superior stability and do not require contouring. This retrospective series reports our experience using locking plate fixation augmented with calcium phosphate mineral cement. Twenty patients' records were reviewed; 13 were alive and reviewed clinically. Mean radiological follow-up was 28.2 months. Two deceased patients had donor site fractures diagnosed on the first postoperative radiograph. These fractures were related to technical fixation errors and failure to apply correct locking fixation principles. None of the other patients with proper locking fixation had fractures or metalwork related complications. We believe that locking fixation augmented with mineral cement can provide more biological stability and enhance restoration of bone structural strength.

Is there an ideal way to close the donor site of radial forearm free flaps?

2018 ◽  
Vol 56 (6) ◽  
pp. 444-452 ◽  
Author(s):  
A.M. Pabst ◽  
R. Werkmeister ◽  
J. Steegmann ◽  
F. Hölzle ◽  
A. Bartella
Keyword(s):  
Donor Site ◽  
Free Flaps ◽  
Radial Forearm

scholarly journals The comparison of Nice knots and traditional methods as an auxiliary reduction-fixation technique in pre-contoured locking plate fixation for comminuted Robinson type 2B clavicle fracture: a retrospective study

2020 ◽  
Author(s):  
Shengkun Hong ◽  
Wei Wang ◽  
Jinku Guo ◽  
Feixiong He ◽  
Cong Wang
Keyword(s):  
Locking Plate ◽  
Plate Fixation ◽  
Clavicle Fracture ◽  
Operation Time ◽  
Locking Plate Fixation ◽  
Traditional Methods ◽  
Traditional Group ◽  
Lag Screw ◽  
Clavicle Fractures

Abstract Background: Open reduction and pre-contoured locking plate fixation is a popular treatment option for displaced midshaft clavicle fracture. Lag screw and cerclage are two main intraoperative techniques to reduce and fix fragments. However, both lag screw and metallic cerclage have disadvantages. The doubled-suture Nice knot has been reported in many areas of orthopedic surgery for its effectiveness. This study aims to compare the outcomes of comminuted mid-shaft clavicle fractures reduced by Nice knots versus traditional techniques (lag screw or/and metallic cerclage) when bridged with pre-contoured locking plates.Methods: We retrospectively reviewed 101 patients (65 females and 36 males) diagnosed with midshaft clavicle fractures with at least one wedge fragment reduced by either Nice knots or traditional methods and bridged with pre-contoured locking plates between December 2016 and April 2019. Operation time, functional outcomes, pain, patient satisfaction, fracture healing and complications were assessed at a follow-up of 12 to 40 months.Results: The mean age of all the patients was 50.8 years. There were 52 and 49 patients in Nice knot group and traditional group respectively, and no differences between two groups was found in general patient characteristics, fracture type, follow up and injury-to-surgery duration. The Nice knot group had significant less operation time (p < 0.01) than the traditional group (mean and standard deviation [SD], 78.6±19.0 compared with 94.4±29.9 minutes, respectively). For healing time, functional score, pain, satisfaction and complications, there was no significant differences between groups, despite the Nice knot group had slightly better results.Conclusions: Both Nice knots and traditional methods treated for comminuted Robinson type 2B clavicle fractures were effective and safe. And the Nice knots seemed to be superior with significant less operation time.

scholarly journals Outcomes of Proximal Femoral Locking-plate Fixation for Pathological Fractures of the Proximal Femur

2021 ◽  
Vol 73 (9) ◽  
pp. 603-608
Author(s):  
Kongkhet Riansuwan ◽  
Somkiat Jivasomboonkul ◽  
Rapin Phimolsarnti ◽  
Chandhanarat Chandhanayingyong ◽  
Apichat Asavamongkolkul
Keyword(s):  
Proximal Femur ◽  
Locking Plate ◽  
Plate Fixation ◽  
Clinical Results ◽  
Assistive Device ◽  
Locking Plate Fixation ◽  
Pathological Fractures ◽  
Hardware Failure ◽  
Estimated Blood Loss

Objective: To study the treatment outcomes of proximal femoral locking-plate fixation of pathological fractures ofthe proximal femur relative to clinical results, implant failure, and surgical complications.Materials and Methods: From 2007 to 2018, 17 patients (18 femurs) with a diagnosis of impending or existingpathological fracture of the proximal femur were treated with proximal femoral locking-plate fixation. Data collectedincluded operative duration, estimated blood loss, ambulatory status, hardware failure events, and postoperativecomplications.Results: Of the 18 femurs that were included, 13 were existing pathological fractures and 5 were impending fractures.The mean age of patients was 53.7 years (range: 28-89), and 12 of them were female. The mean follow-up was 11.3months (range: 1-67). Ten of 17 patients (62.5%) had progressive lung disease from pulmonary metastasis or fromlung primary. No patient developed oxygen desaturation or cardiac arrest during the intraoperative or postoperativeperiod. Thirteen of 17 patients (76.5%) could walk with or without an assistive device at the time of final follow-up.Two patients required close postoperative monitoring in the intensive care unit due to poor preoperative status,and both of those patients died within one month after surgery from other medical problems. No hardware failureoccurred.Conclusion: For pathological fracture of the proximal femur, proximal femoral locking-plate fixation is a treatmentoption that results in fewer perioperative and postoperative cardiopulmonary events and surgical complications.Most patients can ambulate with or without an assistive device at the final follow-up.

scholarly journals Versatility of radial forearm free flap for intraoral reconstruction

2015 ◽  
Vol 143 (5-6) ◽  
pp. 256-260 ◽  
Author(s):  
Jelena Jeremic ◽  
Zivorad Nikolic
Keyword(s):  
Free Flap ◽  
Donor Site ◽  
Free Flaps ◽  
Radial Forearm Free Flap ◽  
Sphincter Reconstruction ◽  
Vein Thrombosis ◽  
Single Donor ◽  
Radial Forearm ◽  
Acceptable Method ◽  
Palmaris Longus Tendon

Introduction. The radial forearm free flap has an important role in reconstruction of the oncologic defects in the region of head and neck. Objective. The aim was to present and evaluate clinical experience and results in the radial forearm free transfer for intraoral reconstructions after resections due to malignancies. Methods. This article illustrates the versatility and reliability of forearm single donor site in 21 patients with a variety of intraoral oncologic defects who underwent immediate (19 patients, 90.5%) or delayed (2 patients, 9.5%) reconstruction using free flaps from the radial forearm. Fascio-cutaneous flaps were used in patients with floor of the mouth (6 cases), buccal mucosa (5 cases), lip (1 case) and a retromolar triangle (2 cases) defects, or after hemiglossectomy (7 cases). In addition, the palmaris longus tendon was included with the flap in 2 patients that required oral sphincter reconstruction. Results. An overall success rate was 90.5%. Flap failures were detected in two (9.5%) patients, in one patient due to late ischemic necrosis, which appeared one week after the surgery, and in another patient due to venous congestion, which could not be salvaged after immediate re-exploration. Two patients required re-exploration due to vein thrombosis. The donor site healed uneventfully in all patients, except one, who had partial loss of skin graft. Conclusion. The radial forearm free flap is, due to multiple advantages, an acceptable method for reconstructions after resection of intraoral malignancies.

Comparison of Five Years Clinical and Radiological Outcomes between Progressive and Non-Progressive Wrist Osteoarthritis after Volar Locking Plate Fixation of Distal Radius Fractures

2019 ◽  
Vol 24 (01) ◽  
pp. 30-35 ◽  
Author(s):  
Takeshi Katayama ◽  
Hiroshi Ono ◽  
Shohei Omokawa
Keyword(s):  
Clinical Outcomes ◽  
Distal Radius ◽  
Locking Plate ◽  
Plate Fixation ◽  
Distal Radius Fractures ◽  
Volar Locking Plate ◽  
Wrist Flexion ◽  
Radius Fractures ◽  
Locking Plate Fixation

Background: This study aimed to identify the effect of the progression of postoperative wrist osteoarthritis on 5 years clinical and radiological outcomes after volar locking plate fixation of distal radius fractures. Methods: Altogether, 56 patients with distal radius fractures were followed up 5 years after surgery. Clinical assessment was performed using the Mayo modified wrist score, a visual analogue scale of pain, the Japanese version of the Disabilities of the Arm, Shoulder, and Hand score, and Patient-related wrist evaluation. Standardized wrist radiographs were used to assess wrist morphology and the Knirk and Jupiter’s degree of osteoarthritis. Multivariate logistic regression was used to analyze postoperative morphological changes in the wrist and carpal alignment regarding their correlation with progression of wrist osteoarthritis. Results: Progression of postoperative wrist osteoarthritis was recognized in 37 of the 56 cases (66.1%). Compared with the clinical outcomes at the time of the fracture union completion, almost clinical outcomes improved up to 5 years follow-up time as well as at 1 year after surgery. The range of wrist flexion at 5 years follow-up was significantly less in the progressive osteoarthritis group than in those with non-progressive osteoarthritis. The persistent step-off immediately after surgery significantly affected the postoperative progression of wrist osteoarthritis. Changes in the radial inclination, volar tilt, and radioscaphoid angle correlated with progression of wrist osteoarthritis. The highest correlation was with the change of radioscaphoid angle. Conclusions: Good clinical results were maintained at 5 years after surgery, but progression of postoperative wrist osteoarthritis interfered with improvement of wrist flexion. Change in the radioscaphoid angle was the factor that was most highly correlated with progression of postoperative wrist osteoarthritis.

Mid-term outcome of volar plate fixation for scaphoid nonunion

2020 ◽  
Vol 102-B (12) ◽  
pp. 1697-1702
Author(s):  
Philip Marcel Jozef Schormans ◽  
Maria A. Kooijman ◽  
Jan A. Ten Bosch ◽  
Martijn Poeze ◽  
Pascal F. W. Hannemann
Keyword(s):  
Functional Outcome ◽  
Cancellous Bone ◽  
Bone Grafting ◽  
Locking Plate ◽  
Plate Fixation ◽  
Ct Scans ◽  
Scaphoid Nonunion ◽  
Cancellous Bone Grafting ◽  
The Mean

Aims Fixation of scaphoid nonunion with a volar locking plate and cancellous bone grafting has been shown to be a successful technique in small series. Few mid- or long-term follow-up studies have been reported. The aim of this study was to report the mid-term radiological and functional outcome of plate fixation for scaphoid nonunion. Methods Patients with a scaphoid nonunion were prospectively enrolled and treated with open reduction using a volar approach, debridement of the nonunion, and fixation using a locking plate and cancellous bone grafting, from the ipsilateral iliac crest. Follow-up included examination, functional assessment using the patient-rated wrist/hand evaluation (PRWHE), and multiplanar reformation CT scans at three-month intervals until union was confirmed. Results A total of 49 patients with a mean age of 31 years (16 to 74) and a mean duration of nonunion of 3.6 years (0.4 to 16) were included. Postoperatively, the nonunion healed in 47 patients (96%) as shown on CT scans. The mean time to union was 4.2 months (3 to 12). Due to impingement of the plate on the volar rim of the radius and functional limitation, the hardware was removed in 18 patients. At a median follow-up of 38 months in 34 patients, the mean active range of motion (ROM) improved significantly from 89° to 124° (SD 44°; p = 0.003). The mean grip strength improved significantly from 52% to 79% (SD 28%; p < 0.001) of the contralateral side. The mean PRWHE score improved significantly from 66 to 17 points (SD 25; p < 0.001). Conclusion Locking plate fixation supplemented with autologous cancellous bone grafting is a successful form of treatment for scaphoid nonunion. Functional outcomes improve with the passage of time, and mid-term results are excellent with a significant improvement in ROM, grip strength, and functional outcome as measured by the PRWHE. Cite this article: Bone Joint J 2020;102-B(12):1697–1702.

scholarly journals Microsurgical free tissue transfer as avaluable reconstructive procedure in foot reconstruction

2007 ◽  
Vol 40 (02) ◽  
pp. 141-146
Author(s):  
mohamed el-shazly ◽  
mohamed makboul
Keyword(s):  
Free Flap ◽  
Motor Vehicle ◽  
Donor Site ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Vehicle Accidents ◽  
Tissue Transfer ◽  
Scapular Flap ◽  
Radial Forearm ◽  
Foot Reconstruction

ABSTRACT Background: owing to the limited soft tissue donor sites in the foot area, the use of microsurgical tissue transfer is frequently becoming mandatory in this area, especially in cases of massive defects due to the common motor vehicle accidents in the territory of upper egypt. free flaps offer a great variety of available tissues to cover larger, multifocal or multistructural defects. they also improve the perfusion of the infected poorly perfused areas.Objectives: in this study, we tried to evaluate foot defects according to their size, shape and site and to determine the general and specific parameters of free tissue transfer to the foot area in concomitance with the patients needs.Materials and methods: eleven patients were included in this study. for each patient, complete history was taken, general and local examination, photographic documentation, laboratory investigations, imaging and other investigations were performed. free flap transfers were applied in all cases as follows: latissimus dorsi flap in five cases, rectus abdominis flap in three cases, scapular flap in one case, gracilis flap in one case and radial forearm flap in one case.Results: nine flaps survived. no infection or donor site complications were recorded. every patient had the optimum free flap as regards the defect size, site, depth, condition, shape, donor site availability and the recipient vessels′ condition.Conclusion: the study of the optimum free flap for foot reconstruction in relation to the defect present and patient conditions is crucial to have significant results.

Clinical outcomes of unstable metacarpal and phalangeal fractures treated with a locking plate system: a prospective study

2020 ◽  
Vol 45 (6) ◽  
pp. 582-587
Author(s):  
Takeshi Katayama ◽  
Kazuhiko Furuta ◽  
Hiroshi Ono ◽  
Shohei Omokawa
Keyword(s):  
Clinical Outcomes ◽  
Locking Plate ◽  
Plate Fixation ◽  
Bony Union ◽  
Complication Rates ◽  
Locking Plate Fixation ◽  
Level Of Evidence ◽  
Finger Motion ◽  
Phalangeal Fractures

We prospectively assessed clinical and radiological outcomes of locking plate fixation in treating unstable fractures in 11 metacarpals, 15 proximal phalanges, and eight middle phalanges in 34 consecutive patients from October 2011 to December 2016. Median length of follow-up was 14 months (range 12–24). The motion of finger joints, bony union, and complication rates were recorded. The median postoperative range of motion of the two interphalangeal joints and the metacarpophalangeal joint was 82% of the contralateral hands. Fractures in the three locations had significantly different recovery of the finger motion, with the best recovery for the metacarpal fractures. Closer distance between the plate edge and joint line was associated with a more limited range of the finger motion. The clinical outcomes approached an acceptable level at final follow-up. Finger stiffness is unavoidable after locking plate fixation of metacarpal and phalangeal fractures even with early hand therapy, with stiffness occurring in 10 out of 34 cases at the time of final follow-up 1 year after surgery. Level of evidence: II

LOCKING PALMAR PLATE FIXATION FOR DORSALLY DISPLACED FRACTURES OF THE DISTAL RADIUS: A PRELIMINARY REPORT

Hand Surgery ◽  
2011 ◽  
Vol 16 (03) ◽  
pp. 263-269 ◽  
Author(s):  
Koji Moriya ◽  
Hidehiko Saito ◽  
Yuji Takahashi ◽  
Hiroyuki Ohi
Keyword(s):  
Distal Radius ◽  
Locking Plate ◽  
Plate Fixation ◽  
Functional Results ◽  
Wrist Pain ◽  
Point System ◽  
Articular Fractures ◽  
Palmar Plate ◽  
Ulnar Wrist Pain

We reviewed a series of 62 consecutive patients with dorsally displaced fractures of the distal radius, including 20 extra-articular and 42 intra-articular fractures. All patients were treated with palmar locking plate systems at our institution between 2002 and 2006. After a minimum follow-up time of 12 weeks, the fractures had healed with satisfactory radiographic and functional results. According to the demerit point system of Gartland and Werley, 35 patients were rated excellent, 26 good, and one fair. In the good and fair groups, the demerit points were almost all for ulnar wrist pain. Our results suggest that palmar locking plate systems enable early functional mobilization with good reproducible radiographic and clinical outcomes. Since nine out of 62 patients had residual ulnar wrist pain at the final follow-up evaluation, further investigation of the pathogenesis of ulnar wrist pain is necessary to obtain better functional outcomes.

Sign in / Sign up

Export Citation Format

Share Document