scholarly journals An anterior neurovascular interval approach to coronal shear fractures of the distal humerus: a prospective clinical study with short- to mid-term follow-up

2019 ◽  
Vol 65 (3) ◽  
pp. 355-360
Author(s):  
Xiao-Hua Yang ◽  
Chen Wei ◽  
Guo-Ping Li ◽  
Jian-Ji Wang ◽  
Hai-Tao Zhao ◽  
...  
Keyword(s):  
Shear Fracture ◽  
Articular Surface ◽  
Vascular Complications ◽  
Distal Humerus ◽  
Prospective Clinical Study ◽  
Time Interval ◽  
X Rays ◽  
Interval Approach ◽  
Elbow Function

SUMMARY OBJECT: To explore the treatment effect of the anterior medial neurovascular interval approach to coronal shear fractures of the distal humerus. METHODS: This prospective study included two female patients who were 30-64 years old, with a mean age of 47 years. Fractures were caused by falling from a bicycle. The time between the injury and operation was 1-2 days, with a mean time interval of 1.5 days. Two patients with coronal shear fracture of the distal humerus were treated with open reduction and internal fixation using anterior neurovascular interval approach. RESULTS: There were no intraoperative and postoperative neurological and vascular complications or infections, and the fracture was united. At 12 months after the surgery, the patient returned to work without pain, and with a normal range of motion for elbow and forearm rotation. The X-rays revealed excellent fracture union, no signs of heterotopic ossification, and no traumatic arthritis. According to Mayo's evaluation standards for elbow function, a score of 100 is excellent. CONCLUSIONS: The application of the anterior neurovascular interval approach of the elbow in the treatment of shear fracture of the articular surface of the distal humerus, particularly the trochlea of the humerus, can reduce the stripping of the soft tissue.

Elbow Dislocation and Articular Fracture of the Distal Humerus

2010 ◽  
Vol 2 (2) ◽  
pp. 111-117 ◽  
Author(s):  
Thierry G. Guitton ◽  
Andrew D. Duckworth ◽  
Margaret M. Mcqueen ◽  
Peter Kloen ◽  
David Ring
Keyword(s):  
Medial Collateral Ligament ◽  
Articular Surface ◽  
Present Report ◽  
Elbow Dislocation ◽  
Distal Humerus ◽  
Fracture Dislocation ◽  
Elbow Fracture ◽  
Collateral Ligament ◽  
Articular Fracture

Background The present report describes subluxation and dislocation of the elbow with articular fracture of the distal humerus and injury to the medial collateral ligament, a type of elbow fracture-dislocation about which little is available in the literature. Methods Twenty-two patients with subluxation or dislocation of the elbow (with injury to the medial collateral ligament) and a fracture of the distal humerus articular surface (capitellum/trochlea) were identified. Seventeen patients had a minimum of 12 months follow-up and eight patients returned for a long-term follow-up at a median of 36 months (range 12 months to 154 months) after injury. Results Nine patients had one or more subsequent surgeries. Seven patients had surgery to address complications and two had a planned implant removal. The final median arc of elbow flexion was 120° (range 100° to 145°) and the median arc of forearm rotation was 175° (range 150° to 180°). The median Broberg and Morrey score was 88 points (range 63 points to 100 points) and the median Disabilities of the Arm Shoulder and Hand score was 9 points (range 1 point to 43 points). Discussion Some elbow dislocations and subluxations are associated with osteochondral fractures of the distal humeral articular surface.

scholarly journals Minimally invasive treatment of tibial plateau depression fractures using balloon tibioplasty: Clinical outcome and absorption of bioabsorbable calcium phosphate cement

2020 ◽  
Vol 28 (1) ◽  
pp. 230949902090872 ◽  
Author(s):  
Felix Greimel ◽  
Markus Weber ◽  
Tobias Renkawitz ◽  
Florian Voellner ◽  
Thomas Freude ◽  
...  
Keyword(s):  
Calcium Phosphate ◽  
Clinical Outcome ◽  
Calcium Phosphate Cement ◽  
Tibial Plateau ◽  
Articular Surface ◽  
Womac Score ◽  
Lateral View ◽  
X Rays ◽  
Invasive Treatment

The exact reconstruction of the tibial plateau and articular surface is the main operative aim in the treatment of tibial plateau depression fractures. For selected cases, a novel technique with the use of balloon tibioplasty in combination of bioabsorbable calcium phosphate cement is available. In this study, the first objective was to answer the question whether the clinical outcome parameters after balloon tibioplasty are comparable to open reduction procedures described in the literature. Secondly, we asked whether the cement absorption is safe in relation to adverse effects like osteolysis and measured the absorption ability during the bone conversion process in the proximal tibia bone. Eight patients (mean age 54 years; 4 males and 4 females) received the abovementioned surgical procedure. Mean follow-up period was 27 months. This study evaluated clinical outcome and radiological measured cement absorption within the postoperative course. Cement absorption was measured on X-rays and calculated based on the greatest extend on anterior–posterior and lateral view radiographs just after the operation on the latest available follow-up. WOMAC score showed a mean of 93. Radiologic absorption was 1/5 at a mean of 18 months. No osteolysis reaction was seen surrounding the cement. This far, promising clinical and radiological results have been shown with WOMAC scores comparable to the results of noninjured knees. The indication for this relatively new technique is restricted to isolated depression fractures. It is a useful tool to facilitate the reduction of select depressed tibial fractures. The radiologic absorption effect seems to be quite fast in bone remodeling and safe without any osteolysis or osseous reaction.

Are Follow-up X-rays Necessary

PEDIATRICS ◽  
1979 ◽  
Vol 64 (1) ◽  
pp. 123-124
Author(s):  
Wilbur L. Smith
Keyword(s):  
Data Base ◽  
Clinical Improvement ◽  
Pediatric Patient ◽  
Clinical Symptoms ◽  
Time Interval ◽  
X Rays ◽  
Significant Time ◽  
Interesting Study ◽  
Acute Pneumonia

Grossman, Wald, Nair, and Papiez have reported an interesting study on roentgenographic follow-up of acute pneumonia (Pediatrics 63:30, 1979). Their data suggest that routine follow-up radiographs are not reliably normal until six weeks to three months after initial diagnosis despite the patient's clinical improvement. Their emphasis on not radiographing a clinically well pediatric patient until a significant time interval after onset of disease is certainly reasonable. From this data base they go on, however, to recommend that routine follow-up radiographs in pneumonia patients are only needed if clinical symptoms persist.

scholarly journals Treatment of pediatric lateral condylar humerus fractures with closed reduction and percutaneous pinning

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Li-wei Xie ◽  
Juan Wang ◽  
Zhi-qiang Deng ◽  
Ren-huan Zhao ◽  
Wei Chen ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Closed Reduction ◽  
Open Reduction ◽  
Articular Surface ◽  
Stage Iv ◽  
Distal Humerus ◽  
Percutaneous Pinning ◽  
Type Iii ◽  
Humerus Fractures

Abstract Background Lateral condylar humerus fractures (LCHFs) are the second most common pediatric distal humerus fractures. Open reduction and internal fixation is recommended for fractures displaced by more than 2 mm. Few studies described using closed reduction and percutaneous pinning (CRPP) for treating fractures with greater displacements. This study aims to explore the feasibility of CRPP in treating displaced LCHFs. Methods All patients underwent attempted CRPP first. Once a satisfying reduction was obtained, as determined using fluoroscopy based on the relative anatomical position of the fragments, an intraoperative arthrogram was performed to further confirm the congruence of the articular surface of the distal humerus. Open reduction is necessary to ensure adequate reduction if the fracture gap is more than 2.0 mm on either anteroposterior view or oblique internal rotational view by fluoroscopy after CRPP. All included fractures were treated by a single pediatric surgeon. Results Forty-six patients were included, 29 boys and 17 girls, with an average age of 5.2 years. Of these, 22/28 (78%) Jakob type II fractures and 14/18 (78%) Jakob type III fractures were treated with CRPP. All cases in Song stages II and III, 19/25 (76%) cases in Song stage IV, and 14/18 (78%) cases of Song stage V were treated with CRPP. The remaining converted to open reduction with internal fixation. Overall, 36 of the 46 patients (78%) were treated with CRPP. The average pre-op displacement was 7.2 mm, and the average post-op displacement was 1.1 mm on the anteroposterior or oblique internal rotational radiograph in cases treated with CRPP. CRPP was performed in an average of 37 min. The average casting period was 4 weeks and the average time of pin removal was 6 weeks postoperatively. The average time of follow-up was 4 months. All patients achieved union, regardless of closed or open reduction. No infection, delayed union, cubitus varus or valgus, osteonecrosis of the trochlea or capitellum, or pain were recorded during follow-up. Conclusions Closed reduction and percutaneous pinning effectively treats LCHFs with displacement more than 4 mm. More than 3/4 of Song stage V or Jakob type III patients can avoid an incision.

The Spatial Weaving Screw Technique Combined With Minimally Invasive Treatment of Calcaneal Fracture

2021 ◽  
Author(s):  
Yong Zhang ◽  
Qiuyan Weng ◽  
Jianming Chen ◽  
Yunfeng Yang
Keyword(s):  
Minimally Invasive ◽  
Articular Surface ◽  
Wound Complication ◽  
Clinical Results ◽  
Healing Time ◽  
X Rays ◽  
Type Ii ◽  
Invasive Treatment ◽  
Surgical Methods

Abstract Background: The conventional surgical method for calcaneal fractures is the extensile lateral approach to reduce and fix fractures using plates and screws, Unfortunately, this method has been associated with high rates of wound and steel plate complications. Similarly, it is still difficult for minimally invasive surgical methods to achieve effective reduction and internal fixation. Therefore, this article proposes a new method of lateral minimally invasive incision combined with percutaneous, screw-only fixation and the screws are individually knitted according to the type of fracture.Methods: Between October 2015 and October 2019, 31 patients who underwent the spatial weaving screw technique combined with minimally invasive were recruited. Any operative complication was recorded. The clinical results were evaluated based on pre-operative X-rays (axial and lateral calcaneus), CT and three-dimensional reconstruction, AOFAS, VAS during follow-up.Results: Bone healing was achieved in all patients, with an average healing time of 7.3±4.2ml weeks. No serious complications occurred after operation, no case of reduction failure or screw displacement were found. The evaluation of the posterior subtalar and calcaneocuboid articular surface respectively showed 80.6% and 90.3% cases got excellent and good reduction. The average AOFAS score was 89.5 at the end of 1 year after the operation, the mean VAS in our series was 2.4 at the last follow-up. Conclusion: Combined with minimally invasive screw spatial weaving technique, displaced Sanders type II and III can be successfully treated displaced Sanders type II and III fractures. The method allows for adequate reduction and effective fixation by screws. It also clearly avoids the major wound complication problems, improve the accuracy of reduction and implantation, simplify surgical procedure.

scholarly journals Reconstruction of Distal Radius Osteochondral Defects Using Metatarsal Autografts: a Multi-case Series

2019 ◽  
Vol 47 (01) ◽  
pp. 003-009
Author(s):  
Patrick K.Y. Goon ◽  
Shirley D. Stougie ◽  
Kalpesh R. Vaghela ◽  
J. Henk Coert
Keyword(s):  
Distal Radius ◽  
Free Flap ◽  
Articular Surface ◽  
Donor Site ◽  
Case Series ◽  
Donor Site Morbidity ◽  
Difficult Problem ◽  
Prospective Clinical Study ◽  
Level Of Evidence

Objective Delayed reconstruction of the articular surface of the distal radius after trauma is a difficult problem for hand surgeons, and the common solution is usually partial or total wrist fusion, relieving pain but sacrificing motion. A relative novel reconstructive technique addresses the problem with a free microvascular osteochondral flap, using the 3rd metatarsal (3MT) bone. We investigate the possibility of using the same donor as a graft rather than a free flap. Methods This was a prospective clinical study of patients with isolated lunate facet damage following trauma who underwent surgery to remove the damaged articular surface and in whom the defect was reconstructed with an osteochondral graft from the base of the 3MT. All of the patients were followed-up at specific time intervals, with pre- and postoutcome measures taken, including pain, grip strength, range of motion (ROM), and postoperative radiographs and computed tomography (CT) scans to evaluate graft resorption and union. Only patients with isolated distal radius defects were included. Results The average follow-up period was of 51 months (range: 14–73 months). The results of 7 patients included an average improvement of the pain score in the visual analogue scale (VAS) by 3 points, with an average arc of motion of 135°. In all, there was radiographic evidence of full incorporation of the graft, with no resorption. Donor site morbidity was minimal. Conclusions The current gold standard for distal radius articular surface reconstruction remains a free 3MT osteochondral flap. However, our results using the base of the 3MT as a graft shows promise, and if further follow-up confirms comparable results to the free flap technique, this would mean an easier and equally robust reconstruction without complicated microsurgery. Level of Evidence Therapeutic, Level V case series.

scholarly journals Radiographic progression can still occur in individual patients with low or moderate disease activity in the current treat-to-target paradigm: real-world data from the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry

2019 ◽  
Vol 21 (1) ◽  
Author(s):  
Peter M. ten Klooster ◽  
Letty G. A. Versteeg ◽  
Martijn A. H. Oude Voshaar ◽  
Inmaculada de la Torre ◽  
Francesco De Leonardis ◽  
...  
Keyword(s):  
Disease Activity ◽  
Radiographic Progression ◽  
Treat To Target ◽  
Remission Induction ◽  
Time Interval ◽  
X Rays ◽  
Radiographic Damage ◽  
Early Ra ◽  
Over Time

Abstract Background The aim of this retrospective study was to examine the longitudinal association between disease activity and radiographic damage in a cohort of patients with early RA (symptom onset < 1 year) treated according to treat-to-target (T2T) therapy. Methods Baseline to 3-year follow-up data were used from patients included in the DREAM remission induction cohort. Patients received protocolized T2T treatment, aimed at 28-joint disease activity score-erythrocyte sedimentation rate (DAS28-ESR) remission. Disease activity (DAS28-ESR and C-reactive protein, CRP) were assessed at least every 3 months; X-rays of the hand and feet at inclusion, 6 months, and 1, 2, and 3 years were scored using modified Sharp/van der Heijde scoring (SHS). Between and within-person associations between time-integrated disease activity and radiographic progression over time were examined. Results A subset of 229 out of 534 included patients were available for analysis. At the between-patient level, time-integrated DAS28-ESR scores were not significantly correlated with progression at the 6 month and 2-year follow-up and only weakly at the 1-year (Pearson’s correlation coefficient r = 0.17, P < 0.05) and 3-year follow-up (r = 0.21, P < 0.05). Individual slopes of the relationship between DAS28-ESR and progression scores in each time interval were significantly correlated over time and the slope of the first 6 months was moderately associated with this slope at later time points (r between 0.39 and 0.59; P values < 0.001). Between 15.9 to 22.7% and 16.7 to 38.5% of patients with low and moderate time-integrated disease activity, respectively, experienced relevant (ΔSHS ≥ 3) radiographic progression at the different time intervals. Analyses using CRP showed similar results. Conclusions In early RA patients treated according to T2T, radiographic progression appears to be an individually determined disease process, driven by factors other than consistent high disease activity. For individual patients, the intra-patient relation between disease activity and cumulative radiographic damage during the first 6 months is a good indicator for this relation in later years. Trial registration Netherlands Trial Register NTR578, 12 January 2006.

scholarly journals Osteosynthesis of Intercondylar Humerus Fracture Using Bryan and Morrey Approach

2010 ◽  
Vol 49 (178) ◽  
Author(s):  
S Lakhey ◽  
S Sharma ◽  
RL Pradhan ◽  
BK Pandey ◽  
RR Manandhar ◽  
...  
Keyword(s):  
Fracture Fixation ◽  
Road Traffic ◽  
Articular Surface ◽  
Distal Humerus ◽  
Humerus Fracture ◽  
Surgical Approaches ◽  
Osteotomy Site ◽  
Distal Articular Surface ◽  
The Mean

INTRODUCTION: The olecranon approach has been the gold standard for surgical approaches to fracture fixation of distal articular surface of humerus. Although it provides a good exposure, it also has disadvantages of delayed union, nonunion and implant related complications at the osteotomy site. OBJECTIVE: The aim of this study was to determine the functional outcome of displaced intra-articular distal humerus fracture fixation using an alternative approach: the Bryan and Morrey approach. MATERIALS AND METHODS: Twenty patients with twenty AO type C1 and C2 intercondylar fractures of the distal humerus had bicolumnar fixationof the distal humerus with two contoured reconstruction plates and screws on the dorsal surface or various combinations of a single reconstruction plate, screws and K-wires using a Bryan and Morrey approach. Twelve of the patients were male and eight were female. The average age of the patients was 44.8 years. Eleven patients had sustained the injury as result of fall and nine of the patients had sustained it in road traffic accidents. Right elbow was involved in fifteen patients and left in five. All patients were followed up for 12 months post operatively. RESULTS: All twenty fractures had united at 4 months follow-up. The mean fixed flexion deformity was 9.0º (range 0º-15º) and the mean arc of motion was 115.0 º (range 85 º- 130º). All patients had grade 4 triceps strength and stable elbows at the end of 12 months follow up. One patient had deep seated wound infection resulting in necrosis of the triceps tendon requiring a second operative procedure. CONCLUSIONS: Bryan and Morrey approach is a simpler, easier and better approach as compared to the other posterior approaches to the elbow joint, and therefore, can be used as the approach of choice for fixation of fractures of the distal articular surface of humerus. KEYWORDS: fracture, Humerus, intercondylar, osteosynthesis.

scholarly journals A study of functional outcome after osteosynthesis of intercondylar fracture of distal humerus in adults with pre-contoured locking compression plate system

2019 ◽  
Vol 5 (6) ◽  
pp. 1107
Author(s):  
Ankur Ojha ◽  
Shashi Kant Kumar Singh
Keyword(s):  
Functional Outcome ◽  
Distal Humerus ◽  
High Rate ◽  
Humerus Fracture ◽  
Time Interval ◽  
Distal Humerus Fracture ◽  
Ulnar Nerve Palsy ◽  
Dual Plating ◽  
Plate System

<p class="abstract"><strong>Background:</strong> Intra-articular fracture of distal humerus is considerable cause of morbidity in adults. The new pre-contoured LCP system provides better angular stability in fixation of inter-condylar distal humerus fracture.</p><p class="abstract"><strong>Methods:</strong> A prospective study of 25 patients with distal humerus fracture treated with pre-contoured double plate system is conducted in Department of Orthopaedics, RIMS, Ranchi between April 2017 to March 2018. These patients were followed up 3 weekly in first 3 months, then 6 weekly in next 6 months, then at every 3 month interval. Clinical and functional outcome was evaluated on the basis of Mayo elbow performance score (MEPS).<strong></strong></p><p class="abstract"><strong>Results:</strong> 24 fixed elbows were reviewed at a follow-up period of 1 year. Results obtained were graded on the basis of MEPS, 21 patients (87.5%) were graded excellent to good, fair in 2 patients (8.3%) and poor in 1 case (4.1%). Average time interval between surgery and admission was 9 days (average 4-14 days). All the fractures as well as the olecranon osteotomies united by 10-16 weeks (12.56 weeks). Superficial wound infection and transient ulnar nerve palsy was reported in 3 (12.5%) and 1 (4.16%) respectively and was managed conservatively. 1 patients did not reported in follow up.</p><p class="abstract"><strong>Conclusions:</strong> We conclude that osteosynthesis with pre contoured dual plating of closed intracondylar distal humerus fractures provide good fixation and early rehabilitation, leading to high rate of bone union and minimal soft tissue damage.</p>

scholarly journals Treatment of pediatric lateral condylar humerus fractures with closed reduction and percutaneous pinning

2020 ◽  
Author(s):  
Li-wei Xie ◽  
Juan Wang ◽  
Zhi-qiang Deng ◽  
Ren-huan Zhao ◽  
Wei Chen ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Closed Reduction ◽  
Open Reduction ◽  
Articular Surface ◽  
Stage Iv ◽  
Distal Humerus ◽  
Percutaneous Pinning ◽  
Type Iii ◽  
Humerus Fractures

Abstract Background: Lateral condylar humerus fractures (LCHFs) are the second most common pediatric distal humerus fractures. Open reduction and internal fixation is recommended for fractures displaced by more than 2 mm. Few studies described using closed reduction and percutaneous pinning (CRPP) for treating fractures with greater displacements. This study aims to explore the feasibility of CRPP in treating displaced LCHFs. Methods: All patients underwent attempted CRPP first. Once a satisfying reduction was obtained, as determined using fluoroscopy based on the relative anatomical position of the fragments, an intraoperative arthrogram was performed to further confirm the congruence of the articular surface of the distal humerus. Open reduction is necessary to ensure adequate reduction if the fracture gap is more than 2.0 mm on either anteroposterior view or oblique internal rotational view by fluoroscopy after CRPP. All included fractures were treated by a single pediatric surgeon.Results: Forty-six patients were included, 29 boys and 17 girls, with an average age of 5.2 years. Of these, 22/28 (78%) Jakob type II fractures and 14/18 (78%) Jakob type III fractures were treated with CRPP. All cases in Song stages II and III, 19/25 (76%) cases in Song stage IV, and 14/18 (78%) cases of Song stage Ⅴ were treated with CRPP. The remaining converted to open reduction with internal fixation. Overall, 36 of the 46 patients (78%) were treated with CRPP. The average pre-op displacement was 7.2 mm, and the average post-op displacement was 1.1 mm on the anteroposterior or oblique internal rotational radiograph in cases treated with CRPP. CRPP was performed in an average of 37 minutes. The average casting period was 4 weeks and the average time of pin removal was 6 weeks postoperatively. The average time of follow-up was 4 months. All patients achieved union, regardless of closed or open reduction. No infection, delayed union, cubitus varus or valgus, osteonecrosis of the trochlea or capitellum, or pain were recorded during follow-up. Conclusions: Closed reduction and percutaneous pinning effectively treats LCHFs with displacement more than 4 mm. More than 3/4 of Song stage V or Jakob type III patients can avoid an incision.

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