Locked Intramedullary Nailing versus Compression Plating for Stable Ulna Fractures: A Comparative Study

Background: Isolated ulna shaft fractures (USFs) are a relatively uncommon, but significant, injury. For unstable USF treatment, open reduction and internal fixation (ORIF) is the gold standard, while for stable USFs several procedures were described. The aim of this study is to compare the outcomes in patients with stable USFs treated by either ORIF or intramedullary nail (IMN). Methods: According to their surgical treatment, 23 eligible USF-affected patients were divided into ORIF (14 subjects) and IMN (nine subjects) groups. The subjects underwent postoperative clinical follow-up at 1, 3, 6, and 12 months, which included calculation of the Disabilities of the Arm, Shoulder and Hand (DASH) score and radiological follow-up. Time to union, time to return to sporting and occupational activities, duration of physical therapy, and surgical complications were recorded. Results: DASH scores improved in both groups at the 6-month follow-up (p < 0.001). The IMN cohort recorded better DASH scores at the 1- and 3-month follow-ups, while similar results were reported at the 6- and 12-month follow-ups. Earlier fracture union (p = 0.001) and return to sporting activities and work (p = 0.002) were seen in the IMN group, compared with the ORIF group. No complications were observed in the IMN group. Conclusions: The surgical treatment of isolated USF results in excellent functional and radiographic outcomes. IMN may be preferable, compared with ORIF, due to its faster recovery time, expedited union, and reduced likelihood of complications.

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Surgical treatment of the radial head is crucial for the outcome in terrible triad injuries of the elbow

The Bone & Joint Journal ◽

10.1302/0301-620x.102b12.bjj-2020-0762.r1 ◽

2020 ◽

Vol 102-B (12) ◽

pp. 1620-1628

Author(s):

Alexander Klug ◽

Angela Nagy ◽

Yves Gramlich ◽

Reinhard Hoffmann

Keyword(s):

Surgical Treatment ◽

Radial Head ◽

Independent Effect ◽

Type I ◽

Dash Score ◽

Type Ii ◽

Terrible Triad ◽

Radial Head Fractures ◽

Type Iii

Aims To evaluate the outcomes of terrible triad injuries (TTIs) in mid-term follow-up and determine whether surgical treatment of the radial head influences clinical and radiological outcomes. Methods Follow-up assessment of 88 patients with TTI (48 women, 40 men; mean age 57 years (18 to 82)) was performed after a mean of 4.5 years (2.0 to 9.4). The Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), and Disabilities of the Arm, Shoulder and Hand (DASH) score were evaluated. Radiographs of all patients were analyzed. Fracture types included 13 Mason type I, 16 type II, and 59 type III. Surgical treatment consisted of open reduction and internal fixation (ORIF) in all type II and reconstructable type III fractures, while radial head arthroplasty (RHA) was performed if reconstruction was not possible. Results At follow-up the mean MEPS was 87.1 (20 to 100); mean OES, 36.9 (6 to 48); and mean DASH score, 18.6 (0 to 90). Mean movement was 118° (30° to 150°) for extension to flexion and 162° (90° to 180°) for pronation to supination. The overall reoperation rate was 24%, with nine ORIF, ten RHA, and two patients without treatment to the radial head needing surgical revision. When treated with RHA, Mason type III fractures exhibited significantly inferior outcomes. Suboptimal results were also identified in patients with degenerative or heterotopic changes on their latest radiograph. In contrast, more favourable outcomes were detected in patients with successful radial head reconstruction after Mason type III fractures. Conclusion Using a standardized protocol, sufficient elbow stability and good outcomes can be achieved in most TTIs. Although some bias in treatment allocation, with more severe injuries assigned to RHA, cannot be completely omitted, treatment of radial head fractures may have an independent effect on outcome, as patients subjected to RHA showed significantly inferior results compared to those subjected to reconstruction, in terms of elbow function, incidence of arthrosis, and postoperative complications. As RHA showed no apparent advantage in Mason type III injuries between the two treatment groups, we recommend reconstruction, providing stable fixation can be achieved. Cite this article: Bone Joint J 2020;102-B(12):1620–1628.

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Surgical treatment of the radial head is critical to the outcome of Monteggia-like lesions

The Bone & Joint Journal ◽

10.1302/0301-620x.101b12.bjj-2019-0547.r1 ◽

2019 ◽

Vol 101-B (12) ◽

pp. 1512-1519 ◽

Cited By ~ 3

Author(s):

Alexander Klug ◽

Felix Konrad ◽

Yves Gramlich ◽

Reinhard Hoffmann ◽

Kay Schmidt-Horlohé

Keyword(s):

Surgical Treatment ◽

Radial Head ◽

Type I ◽

Dash Score ◽

Type Ii ◽

Coronoid Fracture ◽

Radial Head Arthroplasty ◽

Type Iii ◽

Clinical And Radiological Results

Aims The aim of this study was to evaluate the outcome of Monteggia-like lesions at midterm follow-up and to determine whether the surgical treatment of the radial head influences the clinical and radiological results. Patients and Methods A total of 78 patients with a Monteggia-like lesion, including 44 women and 34 men with a mean age of 54.7 years (19 to 80), were available for assessment after a mean 4.6 years (2 to 9.2). The outcome was assessed using the Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), Mayo Modified Wrist Score (MMWS), and The Disabilities of the Arm, Shoulder and Hand (DASH) score. Radiographs were analyzed for all patients. A total of 12 Mason type I, 16 type II, and 36 type III fractures were included. Surgical treatment consisted of screw fixation for all type II and reconstructable type III fractures, while radial head arthroplasty (RHA) or excision was performed if reconstruction was not possible. Results The mean MEPS was 88.9 (40 to 100), mean OES was 40.1 (25 to 48), mean MMWS was 88.1 (50 to 100), mean DASH score was 14.7 (0 to 60.2), and mean movement was 114° (sd 27) in extension/flexion and 155° (sd 37) in pronation/supination. Mason III fractures, particularly those with an associated coronoid fracture treated with RHA, had a significantly poorer outcome. Suboptimal results were also identified in patients who had degenerative changes or heterotopic ossification on their latest radiograph. In contrast, all patients with successful radial head reconstruction or excision had a good outcome. Conclusion Good outcomes can be achieved in Monteggia-like lesions with Mason II and III fractures, when reconstruction is possible. Otherwise, RHA is a reliable option with satisfactory outcomes, especially in patients with ligamenteous instability. Whether the radial head should be excised remains debatable, although good results were achieved in patients with ligamentous stability and in those with complications after RHA. Cite this article: Bone Joint J 2019;101-B:1512–1519

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A Retrospective Study in the Treatment of a 2-Part Greater Tuberosity Fracture Using the F3 Biomet Plate

International Surgery ◽

10.9738/intsurg-d-16-00106.1 ◽

2016 ◽

Vol 101 (9-10) ◽

pp. 465-472

Author(s):

Jun Ma ◽

Liangyu Zhao ◽

Tao Liu ◽

Qiang Fu ◽

Aimin Chen

Keyword(s):

Surgical Treatment ◽

Clinical Outcomes ◽

Constant Score ◽

Shoulder Function ◽

Open Reduction Internal Fixation ◽

Dash Score ◽

X Rays ◽

Level Of Evidence ◽

Greater Tuberosity

The purpose of this study was to evaluate the clinical efficacy of the F3 Biomet plate in the treatment of 2-part displaced humeral greater tuberosity fractures. We compared the clinical outcomes of patients with displaced greater tuberosity fractures who underwent surgical treatment using an F3 plate with those of patients who were treated nonsurgically. Eleven patients with 2-part displaced humeral greater tuberosity fractures were surgically treated with use of an F3 Biomet plate, whereas 12 patients with equal injuries were treated nonsurgically. Each patient underwent follow-up for at least 1 year. We retrospectively collected data and analyzed the clinical outcomes. The Constant score and DASH score were used to assess the shoulder function, and X-rays were taken to evaluate the fracture healing. X-rays of the patients in both groups showed that the fractures achieved union after the 1-year follow-up. Patients treated surgically with an F3 plate and open reduction internal fixation had better Constant score and DASH score results for shoulder function than those treated nonsurgically. In the present study, surgical treatment of displaced humeral greater tuberosity fractures with the use of an F3 plate led to a 100% union rate and good clinical outcomes. The F3 Biomet plate can be considered an effective implant for the treatment of displaced humeral greater tuberosity fractures. The level of evidence is therapeutic III.

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Open, Arthroscopic, and Percutaneous Surgical Treatment of Lateral Epicondylitis: A Systematic Review

Hand ◽

10.1177/1558944717701244 ◽

2017 ◽

Vol 13 (3) ◽

pp. 264-274 ◽

Cited By ~ 5

Author(s):

Matthew B. Burn ◽

Ronald J. Mitchell ◽

Shari R. Liberman ◽

David M. Lintner ◽

Joshua D. Harris ◽

...

Keyword(s):

Systematic Review ◽

Patient Satisfaction ◽

Surgical Treatment ◽

Functional Outcome ◽

Lateral Epicondylitis ◽

Percutaneous Treatment ◽

Cochrane Central Register ◽

Dash Score ◽

Clinically Significant

Background: Approximately 10% of patients with lateral epicondylitis go on to have surgical treatment; however, multiple surgical treatment options exist. The purpose of this study was to review the literature for the clinical outcomes of open, arthroscopic, and percutaneous treatment of lateral epicondylitis. The authors hypothesized that the clinical outcome of all 3 analyzed surgical treatments would be equivalent. Methods: A systematic review was performed using PubMed, Cochrane Central Register of Controlled Trials, and Google Scholar in July 2016 to compare the functional outcome, pain, grip strength, patient satisfaction, and return to work at 1-year follow-up for open, arthroscopic, and percutaneous treatment of lateral epicondylitis. Results: Six studies (2 Level I and 4 Level II) including 179 elbows (83 treated open, 14 arthroscopic, 82 percutaneous) were analyzed. Three outcome measures (Disabilities of the Arm, Shoulder, and Hand [DASH] score, visual analog scale [VAS], and patient satisfaction) were reported for more than one category of surgical technique. Of these, the authors noted no clinically significant differences between the techniques. Conclusions: This is the first systematic review looking at high-level evidence to compare open, percutaneous, and arthroscopic techniques for treating lateral epicondylitis. There are no clinically significant differences between the 3 surgical techniques (open, arthroscopic, and percutaneous) in terms of functional outcome (DASH), pain intensity (VAS), and patient satisfaction at 1-year follow-up.

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Clinical results of the BoneWelding®Fiji® anchor for the treatment of Stener lesions of the thumb

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-020-03625-x ◽

2020 ◽

Author(s):

Tobias Kastenberger ◽

Peter Kaiser ◽

Gernot Schmidle ◽

Kerstin Stock ◽

Stefan Benedikt ◽

...

Keyword(s):

Surgical Treatment ◽

Range Of Motion ◽

Traumatic Event ◽

Ulnar Collateral Ligament ◽

Metacarpophalangeal Joint ◽

Contralateral Side ◽

Pinch Strength ◽

Dash Score ◽

Collateral Ligament

Abstract Introduction A new technology (Sportwelding®) was recently presented, which uses ultrasonic energy to meld a resorbable suture anchor at the interface with the host bone. A standardized clinical use was not investigated yet. This study prospectively evaluated the surgical and clinical outcomes of the Fiji Anchor® (Sportwelding®, Schlieren, Switzerland) in the repair of an ulnar collateral ligament lesion of the metacarpophalangeal joint of the thumb. Material and methods The range of motion, grip and pinch strength, disability of arm, shoulder and the hand (DASH) and patient rated evaluation (PRWE) score, pain, satisfaction, complications and adverse events were assessed in 24 patients after surgical treatment for an acute displaced rupture or avulsion of the ulnar collateral metacarpophalangeal ligament of the thumb using the Fiji Anchor® after 6, 12 and 52 weeks. Results At final follow up, the range of motion of the metacarpophalangeal joint reached almost the contralateral side (49.3° SD 11.7°). Thumb opposition showed a Kapandji score of 9.7 (SD 0.5; range 9–10). Grip strength, the lateral, tip and the three jaw pinch showed nearly similar values compared to the contralateral side (83–101%). Pain was low (0.2 SD 0.7 at rest and 0.6 SD 1.0 during load). The DASH score was 5.0 (SD 7.3) and the PRWE score was 4.1 (SD 9.0). 81% of patients were very satisfied at final follow-up. Two patients were rated unstable during the follow-up period due to a second traumatic event. Three cases experienced difficulties during anchor insertion, whereby incorrect anchor insertion resulted in damage to the suture material; however, this was resolved after additional training. Conclusion One advantage of this anchor appears to be its stable fixation in cancellous bone. The surgical treatment of an ulnar collateral ligament lesion of the thumb using the Fiji Anchor® can lead to an excellent clinical outcome with a minor complication rate; however, long-term dangers and the cost effectiveness of the procedure are not known yet.

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Surgical Treatment of Low-Grade Isthmic Spondylolisthesis With Transsacral Fibular Strut Grafts

Neurosurgery ◽

10.1227/neu.0b013e3182338b2b ◽

2011 ◽

Vol 70 (3) ◽

pp. 758-763 ◽

Cited By ~ 5

Author(s):

Peter G. Passias ◽

Michal Kozanek ◽

Kirkham B. Wood

Keyword(s):

Surgical Treatment ◽

Posterior Approach ◽

Low Grade ◽

Complication Rates ◽

Isthmic Spondylolisthesis ◽

Modified Technique ◽

Instrumented Fusion ◽

Radiographic Outcomes ◽

Circumferential Fusion

Abstract Background: The ideal surgical treatment for adult low-grade isthmic spondylolisthesis (ALIS) remains unknown. Isolated anterior and posterior procedures are popular but have resulted in equivocal outcomes, whereas combined anterior and posterior procedures are associated with higher complication rates despite improved outcome. Objective: To evaluate the clinical and radiographic outcomes following the treatment of ALIS using a 1-stage posterior approach with posterior decompression and posterolateral arthrodesis combined with an interbody fibular allograft strut. Methods: Fifteen patients underwent fusion by a single surgeon using our modified technique. Seven patients were female and 8 were male, with a mean age of 48 years. All patients were classified as Meyerding grade II slips and underwent a posterior approach only, a decompressive laminectomy, and a circumferential fusion with the use of a transsacral fibular allograft and a posterolateral instrumented fusion. Postoperative clinical and radiographic evaluations were performed at 3, 6, and 12 months, and then on an annual basis. Results: The average follow-up interval was 61 months. Three complications were seen: a single dural tear, an L5 radiculopathy secondary to a malpositioned pedicle screw, and one patient with urinary retention. The spines of all patients were determined to be fused by the 6-month postoperative visit. All patients returned to their normal activities of daily living. Significant improvements in the visual analog score were seen at all follow-up intervals. Conclusion: Transsacral interbody fibular allograft can be used successfully to supplement a posterolateral instrumented fusion in selected patients with low-grade ALIS.

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Radiographic and Clinical Assessment of Intramedullary Nail Fixation for the Treatment of Unstable Metacarpal Fractures

Hand ◽

10.1177/1558944717695747 ◽

2017 ◽

Vol 13 (2) ◽

pp. 184-189 ◽

Cited By ~ 3

Author(s):

Ather Mirza ◽

Justin Mirza ◽

Chris Healy ◽

Vishaaq Mathew ◽

Brian Lee

Keyword(s):

Intramedullary Nail ◽

Case Series ◽

Extensor Tendon ◽

Dash Score ◽

Metacarpal Fractures ◽

Radiographic Outcomes ◽

Active Range Of Motion ◽

The Mean ◽

Flexible Intramedullary Nail

Background: The purpose of the article was to evaluate clinical and radiographic outcomes in a case series of unstable metacarpal fractures treated with flexible intramedullary nail (IMN) fixation. Methods: A total of 55 patients with unstable metacarpal fractures between 2003 and 2010 were treated with IMN fixation and followed for a minimum of 1 year. The outcomes were assessed via a radiological study of longitudinal and angular collapse, Disabilities of the Arm, Shoulder, and Hand (DASH) score, total active range of motion (ROM) of the wrist, and grip strength testing. Results: In the 55 patients, metacarpal fractures were healed by clinical and radiographic assessment at an average of 12.7 weeks. IMNs were removed in all cases at an average of 13.9 weeks. Patients regained full finger ROM at the final follow-up and were capable of 72.4% of motion at 2 weeks postoperatively. The mean DASH score at the final follow-up was 6.5. Complications included 3 cases of extensor tendon irritation that resolved without functional impairment and 2 cases of “backing out” that required reoperation to replace the pin. In one case, a bony exostosis formed on the affected metacarpal that led to tendon irritation and required operative excision. Conclusions: We found that this technique allowed for the stabilization of fractures, early ROM, resumption of usual activities, reduced immobilization, and minimal complications. A removable orthosis, instead of a cast, allowed for earlier mobilization of the wrist, metacarpophalangeal, and proximal interphalangeal joints.

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