Behandeling van instabiele enkelfragiliteitsfracturen: nieuwe inzichten

Treatment of unstable ankle fragility fractures: current concepts Displaced ankle fractures are frequently seen in the geriatric population. It is well known that diabetes, osteoporosis and peripheral vascular disease, which are common in the geriatric population, have a negative impact on the postoperative outcome of these fractures. Therefore, the management of these ankle fragility fractures poses specific challenges. The standard in the treatment of unstable ankle fractures, even in the elderly, is an open reduction and internal fixation (ORIF). Major complications (infections, malunion, implant failure), however, often occur. In recent years, new osteosynthesis techniques (intramedullary fibular nailing, fixation with an external fixator, hindfoot nailing) in combination with optimized perioperative care have reduced the risk of complications. In this study, the case report of an unusually severe complication after plate-and-screw fixation augmented with retrograde pinning in an 87-year-old male patient is presented, as well as a review of the literature concerning the optimal treatment of unstable ankle fractures in the elderly. This review can be used as a guideline for the general practitioner, geriatrician, emergency doctor and orthopaedic surgeon treating these difficult injuries.

C1-C2 Wiring With Timed Self-Obsolescence for Complex C2 Body Fracture

BACKGROUND AND IMPORTANCE Fractures of C2 are typically managed nonoperatively with good rates of healing. Management decisions are complicated, however, when there are additional fractures in the axis possibly leading to increased instability. Additionally, the techniques used for treating these unstable axis fractures can have either significant complications or permanent loss of range of motion. Here, we present a novel technique for the reduction and stabilization of complex C2 body fracture. CLINICAL PRESENTATION A 34-yr-old woman with a complex C2 body fracture, which included a right pars and left lateral mass fracture, presented after a water slide accident. It was felt that this fracture was both unstable and would not heal in an anatomically acceptable way so an open surgical reduction was needed. After consideration of more traditional fusion and osteosynthesis techniques, we chose to perform a C1-C2 internal stabilization with C1 sublaminar and C2 spinous process wiring. The patient was then instructed to wear a Miami J collar for 3 mo. CONCLUSION The outcome was favorable with good approximation and healing with preserved range of motion.

Osteosynthesis of ankle fractures with an intramedullary nail of the fibula: surgical technique

Ankle fractures are common and represent approximately a quarter of all lower limb fractures. The general concepts for osteosynthesis techniques for deviated and unstable fractures have undergone little change since the 1960s. The presence of comorbidities and poor soft tissue conditions, especially in elderly patients, is associated with a higher rate of postoperative complications. Intramedullary implants have the advantage of using smaller incisions, which minimizes skin damage allowing for early loading. The present technical note describes the use of the fibular intramedullary nail with a minimally invasive approach to deviated and unstable ankle fractures.

Osteosynthesis at pelvic injuries in toy-breed dogs

Pelvic injuries account for 16 to 25% of all skeletal trauma in small pets. Small dogs as companion dogs are now widespread. Unusual exterior and behavioral features have made them popular and at the same time vulnerable in the modern urban environment. The author defined the nature of injuries and adapted technique of transosseous osteosynthesis for the treatment of toy-breed dogs with pelvic trauma. The study of the X-rays in 226 dogs with pelvic injuries demonstrated that toy-breed dogs accounted for 16% of the total. Multiple pelvic trauma was revealed in 95% of them. Surgical treatment was performed in 24 dogs, conservative one - in 13, that amounted to 65% and 35%, respectively. Surgical treatment consisted in open juxtaposing of fragments and focal transosseous and/or internal osteosynthesis with subsequent external fixation using devices of various designs. The external structures were of three types: half-ring support or U-shaped staple, pair of parallel curved plates connected by two threaded rods with each other, and pair of curved plates located bilaterally on both sides of the pelvis and connected by two threaded rods with the help of threaded ends. The terms of fixation for pelvic injuries in toy-breed dogs at the age under one year were 42 days on the average, and in the dogs at the age above one year - 60 days. Surgical treatment in toy-breed dogs with pelvic injuries was performed more often in comparison with conservative one. Pelvic trauma was accompanied by pronounced pain shock. The osteosynthesis techniques used in toy-breed dogs are little traumatic and not limiting functions thereby contributing to recovery of all the structures of pelvis and pelvic limbs.

A biomechanical study comparing the mean load to failure of two different osteosynthesis techniques for the Step-Cut Olecranon Osteotomy

Background: A tension band wiring technique is the current gold standard for osteosynthesis of olecranon osteotomies, although the technique has several practical disadvantages and its theoretical advantages have been questioned. The Step-Cut Olecranon osteotomy is an interesting new option for surgeons to access distal intra-articular humerus fractures, but its stability has only been assessed using the tension band wiring osteosynthesis. Therefore, the mean load to failure of this osteotomy with two different osteosynthesis techniques (tension band wiring and compression screws) was assessed. A higher load to failure was hypnotized for the tension-band-wiring osteosynthesis group. Methods: A Step-Cut Olecranon osteotomy was performed on 32 Sawbones. Half were secured by a tension band wiring and the other half by two compression screws. The humero-ulnar joint was simulated using an established test setup, which allows the application of triceps traction force through a tendon model to the ulna model, while the joint is in a fixed position. Eight models of each group were tested at one of two angles (20° and 70° of flexion) by isometrical loading until failure. A failure was defined as either complete fracture or gap formation of more than 2mm between osteotomy and the remaining model. Results: At 20° of flexion, the mean load to failure in the tension band wiring group was 1360 N (SD 238) and 1401 N (SD 261) in the compression screw group. At 70° of flexion, it was 1398 N (SD 215) and 1614 N (SD 427), respectively. Differences did not reach significance (p = 0.88 at 20°, p = 0.28 at 70°).Conclusions: A tension band wiring osteosynthesis does not provide higher stability than a compression screw osteosynthesis for the Step-Cut Olecranon osteotomy. A Step-Cut Olecranon osteotomy with screw osteosynthesis might be an interesting option for surgeons when treating intra-articular distal humeral fractures.

Right mandibular angle and left comminuted mandibular body fractures stabilised with a combination of an acetabular plate and secured pin intermandibular ventral epoxy resin (SPIVER) frame in a four-month-old puppy

This case report aimed to describe a surgical technique combining a secured pin intermandibular ventral epoxy resin (SPIVER) frame and an acetabular plate to manage a complex mandibular fracture configuration in a puppy. A four-month-old, entire male, German wirehaired pointer was referred for assessment of a combination of recent (three days before hospitalisation) and older traumatic (45 days before hospitalisation) facial injuries inflicted by the dam. CT revealed multiple mandibular and maxillary fractures with complex acute mandibular fractures requiring surgical stabilisation. wo techniques were combined on stabilisation of the mandible: a single acetabular plate 2.7 to repair the mandibular angle fracture and a SPIVER frame to repair the comminuted mandibular fracture. Both fractures healed uneventfully, and the dog had normal jaw function one year postoperatively. Occlusion was not modified compared with the preoperative condition, considering that the patient already had a malocclusion defect due to old lesions. The combination of two different osteosynthesis techniques had satisfactory short-term and long-term outcomes in this puppy.