Outcomes of Treatment of Monteggia Fractures with Reduction and Internal Titanium Elastic Nail Fixation of the Ulna

2021 ◽  
Vol 23 (2) ◽  
pp. 79-91
Author(s):  
Joanna Gradek ◽  
Tomasz Rawo ◽  
Aleksander Psuja ◽  
Karol Gawelowicz ◽  
Jacek Kąpiński ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Radial Head ◽  
Closed Reduction ◽  
Mayo Elbow Performance Score ◽  
Titanium Elastic Nail ◽  
Head Displacement ◽  
Radiographic Outcomes ◽  
Radiographic Parameters ◽  
Elastic Nail

Background. The purpose of this paper is to evaluate the usefulness of radiographic indices of humero-radial joint instability in order to predict treatment outcomes in Monteggia fractures. Material and methods. A retrospective analysis was conducted in a group of patients who underwent closed reduction and internal titanium elastic nail (TEN) fixation of the ulna and closed reduction of a dislocation of the radial head between 2016 and 2018. The indications for intrame­dullary fixation comprised transverse or short oblique fractures. The direction of the dislocation was classified according to Bado. The following radiographic indies were assessed: Radiocapitellar Line, Lateral Humeral Line, Proximity Index, and Radial Head Displacement Index. Results. Treatment outcomes were assessed with the Oxford Elbow Score and Mayo Elbow Performance Score, and com­plications were assessed with a modified Clavien-Dindo-Sink scale. No coincidence between poor functional and radio­graphic outcomes was demonstrated. Conclusions. 1. Regardless of the severity of the injury, eligibility for surgery and correctly performed surgical treatment guarantee a good final outcome. 2. Patients treated with TEN regain their preoperative mobility. 3. There was no coincidence between poor functional and radiographic outcomes, except for one patient in whom subluxation of the radial head persisted despite surgery and was confirmed radiographically and functionally. 4. It would be beneficial for clinical practice to introduce simple, reproducible radiographic parameters for unambiguous assessment of the effectiveness of treatment and predicting treatment outcomes; unfortunately none of the parameters we investigated were sufficiently reliable. 5. The radiographic parameters analysed in this paper are dependent on the quality of the radiological examinations performed.

scholarly journals Cost-Effectiveness of Titanium Elastic Nail (TEN) in the Treatment of Forearm Fractures in Children

Medicina ◽  
2020 ◽  
Vol 56 (2) ◽  
pp. 79
Author(s):  
Ovidiu Adam ◽  
Vlad Laurentiu David ◽  
Florin George Horhat ◽  
Eugen Sorin Boia
Keyword(s):  
Closed Reduction ◽  
Diagnosis Related Groups ◽  
Financial Burden ◽  
Treatment Options ◽  
Indirect Costs ◽  
Forearm Fractures ◽  
Titanium Elastic Nail ◽  
Fractures In Children ◽  
Elastic Nail ◽  
The Cost

Background and objectives: There are various methods in the management of forearm fractures in children. Elastic stable intramedullary nailing using Titanium Elastic Nail (TEN) is nowadays employed in diaphysis fractures of children, with clear benefits over other treatment options. However, in the case of TEN versus other treatment methods of forearm fractures in children, cost is an important issue. This report will focus on the cost assessment of using TEN versus other therapeutic means in the treatment of forearm fractures in children. Materials and Methods: We performed a retrospective longitudinal study of 173 consecutive patients with forearm fractures treated in a single institution during 2017. We calculated the cost for each patient by summing up direct costs plus indirect costs, calculated at an aggregate level. Hospital income data were extracted from the Diagnosis Related Groups database. Results: A total of 173 patients with forearm fractures were treated, 44 using TEN, 86 using K-wire, and 46 using closed reduction and cast. There were 66 radius fractures, 1 ulna fracture, and 106 that were both radius and ulna fractures. Mean treatment cost were $632.76 for TEN, $499.50 for K-wire, and $451.30 for closed reduction and cast. Costs for TEN were higher than for K-wire insertion (p = 0.00) and higher than closed reduction and cast ($182.42; p = 0.00). Reimbursement per patient was higher with TEN versus K-wire patients; $497.88 vs. $364.64 /patient (p = 0.00), and higher than for patients treated with closed reduction and cast (p = 0.00). Conclusions: The treatment of upper extremity fractures using TEN was more expensive than the other methods. In Romania, because the reimbursement for TEN is higher as well, there are no differences in the financial burden when treating forearm fractures with TEN versus K-wire. Non-surgical treatment has the lowest cost but also the lowest reimbursement.

Osteosynthesis of Combined Injuries of the Capitellum humeri and the Radial Head

Swiss Surgery ◽  
2003 ◽  
Vol 9 (6) ◽  
pp. 275-282
Author(s):  
Ott ◽  
Rikli ◽  
Babst
Keyword(s):  
Range Of Motion ◽  
Radial Head ◽  
Performance Score ◽  
Anatomische Rekonstruktion ◽  
Mayo Elbow Performance Score ◽  
Capitulum Humeri ◽  
Combined Injuries

Einleitung: Kombinierte Verletzungen des Capitulum humeri und des Radiusköpfchens sind selten. Meist sind neben den osteocartilaginären Schäden am Gelenk auch Verletzungen der Kollateralbänder assoziiert. Behandlungsempfehlungen für diese seltenen schwerwiegenden Ellenbogenverletzungen fehlen. Studientyp: In einer retrospektiven Analyse werden fünf Fälle untersucht, bei denen die osteocartilaginären Verletzungen des Capitulum humeri durch den gleichen Zugang, der zur Versorgung des Radiusköpfchens verwendet wurde, versorgt wurden. Die Osteosynthese erfolgte mit Mini-Titanimplantaten z.T. kombiniert mit resorbierbaren Pins. Patienten und Methode: Zwischen 1996-1999 wurden fünf Patienten (vier Männer, eine Frau) mit einer Kombinationsverletzung von Radiuskopf und Capitulum humeri operativ stabilisiert. Das Durchschnittsalter beträgt 34 Jahre (31-40 Jahre). Alle Frakturen wurden über einen direkten radialen Zugang mittels 1.5mm oder 2.0mm Zugschrauben, zum Teil mit resorbierbaren Pins stabilisiert. Anschliessend wurden die Patienten radiologisch und klinisch gemäss dem Mayo-elbow-performance Score beurteilt. Resultate: Alle Patienten konnten persönlich durch einen nicht in die Initialtherapie involvierten Untersucher nach durchschnittlich 12.8 Monaten (8-24 Monate) nachuntersucht werden. 4/5 Patienten konnten bezüglich ihrer subjektiven Einschätzung befragt werden. Radiologische Zeichen einer Nekrose des Capitulum humeri oder Arthrosezeichen fanden sich nicht. Bei drei Patienten fanden sich periartikuläre Verkalkungen. Der range of motion beträgt durchschnittlich 124 Grad (Extension 5-30 Grad, Flexion 110-145 Grad) in drei von fünf Fällen waren Sekundäreingriffe zu Mobilitätsverbesserung nötig. Der Mayo-elbow-performance Score beträgt im Mittel 85 Punkte (range 70-100 Punkte). Schlussfolgerung: Die direkte Verschraubung mit Miniimplantaten zum Teil in Kombination mit resorbierbaren Pins ermöglicht eine stabile anatomische Rekonstruktion des Capitulum humeri durch den gleichen Zugang wie er für die Stabilisierung des Radiusköpfchens notwendig ist. Die transartikuläre Fixation der kleinen Schalenfragmente des Capitulum humeri erlaubt eine sichere interfragmentäre Kompression und damit eine frühfunktionelle Rehabilitation. Sekundäreingriffe zur Verbesserung der Gelenkbeweglichkeit waren in drei von fünf Fällen nötig.

scholarly journals A study on the outcome of displaced midshaft non-comminuted clavicle fractures treated with anatomical locking plate versus titanium elastic nail

2020 ◽  
pp. 221049172097518
Author(s):  
Vineet Thomas Abraham ◽  
Chandrasekaran Marimuthu
Keyword(s):  
Functional Outcome ◽  
Locking Plate ◽  
Plate Versus ◽  
Dash Score ◽  
Titanium Elastic Nail ◽  
Constant Murley Score ◽  
Elastic Nail ◽  
Clavicle Fractures ◽  
The Mean ◽  
Quick Dash

Purpose: Fixation of displaced midshaft clavicle is well known to decrease nonunion, malunion and shoulder disability as compared to nonoperative treatment. This study was done to compare the clinical and functional outcome of group 1 clavicle fractures treated with anatomic locking plates (ALP) versus Titanium elastic nail (TEN). Methods: We studied patients presenting with displaced midshaft clavicle fractures treated with ALP or TEN. The study period was from Jan 2013 to Dec 2016. Patients were reviewed and at each visit clinical and radiological progress of union was noted, complications if any were noted, functional assessment was done using the quick Dash score and Constant Murley score. Results: A total of 116 patients met our inclusion criteria. 62 patients were treated with TEN and 54 with ALP. Bony union was achieved at an average of 11.8 weeks in the TENS group and 12.8 weeks in the ALP group post operatively and this was found to be significant. The mean postoperative Constant Murley score in the ALP and the TEN groups were 92.8 (range 80–97), and 93.7 (82–97) respectively. The mean postoperative quick dash score in the ALP and TEN groups were 2.48(range from 0 to 6.8) and 2.1 (range 0–9.1) respectively. Conclusion: Both Anatomical locking plate and TEN are good options for the treatment of non-comminuted mid clavicular fractures as they have a similar functional outcome. TEN nail insertion has the advantage of being minimally invasive, having a faster union time and may be recommended in midshaft clavicle fractures without comminution.

scholarly journals Treatment of Displaced Mid-Clavicle Fractures by Closed Titanium Elastic Nail

2016 ◽  
Vol 07 (02) ◽  
pp. 49-53
Author(s):  
Hrushikesh Saraf ◽  
Sarang Kasture
Keyword(s):  
Titanium Elastic Nail ◽  
Elastic Nail ◽  
Clavicle Fractures

scholarly journals A Hybrid Technique Combining Intramedullary Pinning With Extramedullary Plate Fixation in Unstable and Comminuted Radial Head Fractures Following on-Table Reconstruction

2020 ◽  
Author(s):  
Xu Gao ◽  
Fei Li ◽  
Yong-Qiang Sui ◽  
Rui Huang ◽  
Hai-yu Fan ◽  
...  
Keyword(s):  
Radial Head ◽  
Plate Fixation ◽  
Visual Analog Scale Score ◽  
Reconstruction Technique ◽  
Hybrid Technique ◽  
Self Assessment ◽  
Radial Head Fractures ◽  
Mayo Elbow Performance Score ◽  
Intramedullary Pinning

Abstract BackgroundManagement of comminuted radial fractures remains controversial. Currently, the emergence of on-table reconstruction technique has made fixation in comminuted radial head fractures more viable. However, since only a few previous studies have investigated small amounts of patients with conflicting complication rates, the treatment effects of on-table technique may be discrepant in different cases and its reliability needs to be evaluated cautiously in the practical surgical process. The present study reported an intro-operative unstable displacement from the reconstructed radial head to the neck during plate fixation, characterized by a poor radiocapitellar contact and incongruity between the radial head and neck. Subsequently, a hybrid technique combining with intramedullary pining was performed to restore the normal alignment and maintain the stability of fixation. Therefore, the purpose of this article aimed to prove the feasibility of unstable comminuted radial head fractures treated with the extramedullary plate and intramedullary pinning fixation using titanium elastic nails. MethodsFive patients with unstable comminuted radial head fractures (Mason type-III) were selected from January 2012 to May 2018 in this study. All patients were treated with open reduction and internal fixation using extramedullary plate and intramedullary pinning. During follow-up, the radiographic examination was conducted to evaluate the status of bone union, heterotopic ossification and post-traumatic arthritis. The functional assessment was performed to evaluate clinical effects, which included measurements of range of motion in the elbow, Visual Analog Scale score, Elbow Self-Assessment score, Mayo Elbow Performance score, and Disabilities of the Arm, Shoulder, and Hand (DASH)Outcome Measure score.ResultsAfter a mean follow-up of 44 months (range, 36 to 48), the average range of motion in elbow flexion-extension was 125° with supination of 84°and pronation of 74°. Based on the Elbow Self-Assessment score, there was one very good, two good, one satisfied, and one sufficient, respectively. The mean Visual Analog Scale score for pain was 1 (range, 0 to 3) and the mean Mayo Elbow Performance score was 83 (range, 70 to 95). The DASH score revealed good to excellent results with a mean score of 10 (range, 2.3 to 27). Two patients had mild signs of posttraumatic arthritis, and heterotopic ossifications rating as grade I were observed in three patients. However, none of them was affected in daily life. ConclusionCollectively, intramedullary pinning with extramedullary plate fixation is feasible in unstable comminuted radial head fractures, which can be considered as a remedial surgery for on-table reconstruction technique.

scholarly journals Rheumatoid forefoot reconstruction in the non-rheumatoid patient

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Devon Nixon ◽  
Richard McKean ◽  
Sandra Klein ◽  
Jeffrey Johnson ◽  
Jeremy J. McCormick
Keyword(s):  
Rheumatoid Arthritis ◽  
Sagittal Plane ◽  
Deformity Correction ◽  
Metatarsal Head ◽  
Rheumatoid Patient ◽  
Radiographic Outcomes ◽  
Radiographic Parameters ◽  
Forefoot Surgery ◽  
Forefoot Reconstruction

Category: Lesser Toes, Midfoot/Forefoot Introduction/Purpose: Residual pain and recurrent deformity following forefoot surgery can cause significant disability. In patients with rheumatoid arthritis, first metatarsophalangeal (MTP) joint arthrodesis with lesser metatarsal head resection – often referred to as a rheumatoid forefoot reconstruction – has been shown to be a reliable operation for pain relief and deformity correction. Limited data, however, has been published on outcomes of the same forefoot reconstruction operation in the non- rheumatoid patient. Here, we review our experience with this procedure in patients without rheumatoid disease, hypothesizing improved clinical and radiographic outcomes following surgery. Methods: Following chart review and surveying billing codes, we retrospectively identified patients from 2007-2015 without a diagnosis of rheumatoid arthritis who underwent first MTP arthrodesis with lesser metatarsal head resection (rheumatoid forefoot reconstruction). Phone surveys were then conducted to assess clinical outcomes including pain and satisfaction scores. Preoperative and postoperative radiographs were reviewed for 1, 2 intermetatarsal angle (IMA), hallux valgus angle (HVA), 2nd MTP angle (MTP-2), and lesser MTP alignment (in both sagittal and axial planes). Postoperative radiographs were also assessed for radiographic union. Results: We identified 14 non-rheumatoid patients (16 feet) who underwent forefoot reconstruction – of those, 13 patients (15 feet) were successfully contacted via follow-up phone survey. Mean postoperative follow up was 42.3 (range: 12-76) months from surgery to phone interview. Mean postoperative satisfaction scores were 9.1 (out of 10), and no patients required further surgery after forefoot reconstruction. Pain scores significantly decreased from 6.2 preoperatively to 2.0 postoperatively (P<.001). Radiographic parameters (IMA, HVA, MTP-2, and lesser MTP alignment in the sagittal plane) all improved with surgery (P<.05). All 16 feet achieved union of the first MTP arthrodesis. Conclusion: With decreased pain, high satisfaction rates, and improved radiographic parameters, first MTP arthrodesis coupled with metatarsal head resection (rheumatoid forefoot reconstruction) is a viable surgical option for non-rheumatoid patients who have failed prior attempts at forefoot reconstruction or have chronic forefoot pain with deformity.

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