Radial head fractures with interposed capitellar cartilage fragment–hindrance to bone healing–a case series

Introduction Radial head fractures account for the majority of bony elbow injuries. The individual treatment options have been described in detail. In some cases, however, an unusual concomitant injury occurs, which can significantly impede primary osteosynthesis and healing. This concomitant injury can be an interposing cartilaginous capitellar fragment. Methods This retrospective study describes four cases of trapped cartilage fragments of the capitellum that compromised primary osteosynthesis or primary conservative healing of a radial head fracture. Radiological imaging, function and pain level are presented pre- and postoperatively (mean follow-up 9.25 months). Results None of the four cases showed preoperative evidence of an incarcerated cartilage fragment of the capitellum. They all showed limited elbow range of motion. CT examinations were performed in all cases. In each case, the cartilage fragment was first sighted upon surgery, subsequently removed and the fractures treated with ORIF. Mean follow-up was of 9.25 months. All fractures healed, with excellent function and low pain scores. Conclusions This study presents rare cases of a trapped humeral cartilage fragment in radial head fractures. Radiological imaging including CT scans cannot reliably detect this concomitant injury. Therefore, this problem becomes apparent and treatable only during surgery. A high degree of suspicion is necessary especially in patients with minimally displaced fractures associated with limited elbow motion and a gap at the fracture site as treating these injuries conservatively may lead to poor outcome.

Comparative analysis of the economic costs of treating patients with non-infectious diseases of internal osteosynthesis

A comparative analysis of the economic costs of revision surgical treatment of 121 patients with non-infectious complications of internal osteosynthesis and 59 patients who underwent primary osteosynthesis for fractures of the long bones of the limbs with an uncomplicated course was carried out. General economic costs include direct and indirect costs. It was found that the total costs for the treatment of patients suffering from non-infectious complications of internal osteosynthesis of the long bones of the extremities, who are in the clinic of military traumatology and orthopedics. G.I. Turner of the Military Medical Academy in the period from 2007 to 2018 revision surgery was performed, amounted to 279637238 rubles, which corresponds to 2311051,55 rubles per patient. At the same time, the total costs for the treatment of patients with fractures of the long bones of the extremities without complications amounted to 44960873 rubles (762048,69 rubles per patient). The total cost per patient with a non-infectious complication of internal osteosynthesis of the femur was 2540499,54 rubles (483824,85 straight, 2056674,69 indirect), of the leg bones 2333762,17 rubles (474501,47 straight, 1859260,70 indirect), the humerus 1830362,75 rubles (399942 straight, 1430420,75 indirect), the bones of the forearm 1804664,6 rubles (339700 straight, 1464964,6 indirect). It was revealed that due to failures after primary osteosynthesis of limb fractures and complications, the costs associated with the direct and indirect costs of their treatment increase. In this regard, further research is needed to improve the treatment of complications of internal osteosynthesis and to develop a set of measures for their prevention. This is important both for the patient and for the health care system as a whole.

Differences between primary and secondary osteosynthesis for fractures of the lower limb with acute compartment syndrome

To analyze the differences between primary and secondary osteosynthesis for fractures of the lower limb with acute compartment syndrome (ACS). From our trauma database, we indentified a total number of 107 patients with 126 fractures of AO/OTA type 41 to 44 and 120 ACS from January 01, 2001 to December 31, 2015 who were treated with primary or secondary osteosynthesis after compartment incision. 71 patients with 77 fractures of AO/OTA classification type 41 to 44 suffering ACS received primary osteosynthesis after compartment incision (POCI) and were compared to 36 patients with 49 fractures of AO/OTA type 41 to 44 and ACS, who were treated by secondary osteosynthesis after compartment incision (SOCI). Patients with POCI showed a significantly shorter length of stay in the hospital with significantly less necessary surgeries for definitive treatment of the fractures and the soft tissue closure than SOCI patients (p < 0,001). The overall rate of infections in both groups were 13% without any difference between POCI and SOCI. The POCI of AO/OTA fractures type 41 to 44 with ACS is a safe and effective procedure for unilateral und single fractures of the lower limb without an increasing infection rate.

Treatment of Open Crus Fractures

Results of treatment of 112 patients were analyzed. All patients were treated at the Moscow Clinical Hospital named after N.l. Pirogov during the period from 1998 to 2002. Fifty-four patients had I and 11 type, 38 - IIIA, 14 - IIIB and 6 patients - IIIC type of fractures by Gustilo classification. Tactics of treatment was defined by patient's general condition and the degree of soft tissue injury. In fractures of I and II type primary UTN osteosynthesis was preferable; in fractures of IIIA type primary osteosynthesis with AO rod device or Piless device followed by final UTN osteosynthesis were performed. In fractures of IIIB type osteosynthesis was carried out using device. To all patients with fractures of IIIC type the limb amputation was performed. Healing by first intention took place in fractures of I and II type. In fractures of IIIA and IIIB type the open management of wound with following closure during sequential debridement was preferred. When tibia necrosis developed, the resection in fractures zone with following early defect substitution by IHzarov technique was carried out.