Treatment outcomes in humeral fractures of different location (review)

The choice of treatment (open reduction and internal fixation) for a humeral fracture with a plate versus an intramedullary nail is highly debated. We compared outcomes (fracture union, reoperation, and adverse events) of intramedullary nailing and plate fixation in patients with proximal humeral, humeral shaft, and distal humeral fractures. No significant differences were found between intramedullary nailing and plate fixation for fracture union, reoperation, or adverse events in patients with proximal humeral or humeral shaft fractures. There is a scarcity of evidence comparing intramedullary nailing and plating for distal humeral fractures. No recommendations can be given from current evidence. Surgeons may have to continue to use discretion based on their personal preference, experience as well as patient’s characteristics and fracture features before more high-quality evidence is available.

Four-Corner Fusion with Locking Dorsal Circular Plate versus Headless Compression Screws: A Clinico-Radiological Comparative Study

Introduction Four-corner fusion is a technique for the treatment of carpal advanced collapse. It consists of scaphoid excision and arthrodesis of the lunate, triquetrum, hamate, and capitate bones. This can be accomplished with different kinds of osteosynthesis. In the first reports of the use of a circular plate, poor outcomes are described, with high rates of non-union, which decreased in later studies, which highlight certain aspects of the surgical technique. Objective To report our experience with four-corner fusion with the use of a dorsal locking plate (Xpode, Trimed Inc., Santa Clarita, CA, US), and compare it with another traditional fixation method (3.0-mm headless compression screws [HCSs], Synthes, Slothurn, Switzerland), with an emphasis on union, an assessment of the fincitonal outcomes, and the presence of complications. Material and Methods A comparative study of two prospective series of patients operated on through two fixation techniques for four-corner fusion using autologous bone graft from the iliac crest.The first group of patients, evaluated between 2010 and 2012, underwent osteosynthesis with 2 HCSs, with a minimum follow up of 18 months. The second group, evaluated between 2011 and 2014, underwent osteosynthesis with a dorsal locking plate, with a minimium foloow up of 12 months. The patients were operated on by four different surgeons in four centers.The patients were evaluated with radiographs to establish the presence of union and the time it took to occur. In case of doubt, union was confirmed through a computed tomography (CT) scan at 8 weeks postoperatrively. We also assessed the range of motion, the presence of complications, and function through the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and a grip strength score. Results We achieved a union rate of 100% in both groups at similar times. In the dorsal locking plate group, we obtained better full range of motion, particularly in wrist extension, which was statistically significant (p = 0.0016), as well as lower DASH scores, which was also statistically significant (p = 0.0066). Complications were only present in two patients in the HCS group. Conclusion Both techniques are valid and reproducible for the treatment of wrists with scapholunate advanced collapse (SNAC) and scaphoid non-union advanced collapse (SLAC). Based on the outcomes, with the Xpode plate, the patients presented better ranges of motion and DASH scores; therefore it may be an excellent fixation option in the open four-corner fusion surgical technique. The entry point and configuration of the HCS are fundamental variables to analyze.The union rate of 100% obtained in the present study contrasts with the high rates of non-union reported in the literature published in the early 2000s.

Treatment Outcomes of Anterior Sternoclavicular Joint Dislocation Using an Acromioclavicular Joint Hook Plate Versus a Locking Plate: A Retrospective Study

Background: We aimed to compare the efficacy and functional outcomes of using an acromioclavicular joint hook plate (AJHP) versus a locking plate (LP) in the treatment of anterior sternoclavicular joint dislocation.Methods: Seventeen patients with anterior sternoclavicular joint dislocation were retrospectively analyzed from May 2014 to September 2019. Six patients were surgically treated with an AJHP, and 11 were surgically treated with an LP. Five male and one female patients composed the AJHP group, and nine male and two female patients composed the LP group. The mean age of all patients was 49.5 years.Results: Reduction and fixation were performed with AJHP or LP in all 17 patients. All patients were followed up for a mean duration of 14.4 months. There were no reported complications, wound infections, or instances of plate or screw breakage. The mean operative blood loss, operative time, and length of incision in the AJHP group were significantly better than those in the LP group. Shoulder girdle movement of the AJHP group was significantly better than that of the LP group.Conclusions: This study revealed that AJHP facilitated glenohumeral joint motion, reduced the risk of rupture of mediastinal structures, required a shorter incision, and had lesser blood loss and a shorter duration of operation compared with LP. However, some deficiencies require further improvement.

Comparison of clinic-radiological and functional outcome of intra articular distal end radius fractures managed by volar locking plate versus external fixation

Background: Distal end radius (DER) fractures are most common fractures in upper limb. Intra articular fractures can be managed either by open reduction and internal fixation by volar locking plate or can be managed by closed reduction and external fixator application or by percutaneous pinning. The purpose of our study was to compare the functional outcome of volar locking plate with that of external fixation.Methods: A prospective cohort study was conducted between June 2019 to June 2020 in Government Medical College, Jammu on 46 patients with intra articular distal end radius fractures. Of which 26 were managed by volar locking plate and 20 were managed by external fixator. the results of both groups were compared on the basis of radiological parameter and range of motion achieved post operatively. The functional outcome was evaluated using DASH score and Gartland–Werley scale. Results: Final range of motion, grip strength were better in patients managed with volar locking plate (VLP) as compared to those who were managed with external fixator (EF). Radiographically, volar tilt, radial height were all better in VLP group than EF.Conclusions: We concluded that VLP is superior method to maintain reduction till the union occurs and prevents the fracture collapse in intra articular distal end radius fractures as compared with external fixator. Thus, giving better functional and radiological outcome than the external fixator.

Intramedullary Nailing Combined With Adjunct Plate or Blocking Screw for Proximal Tibial Fractures

Objective: To compare the traditional approach of intramedullary nail with an extra plate versus the nail combined with blocking screws for proximal tibia fractures without the knee involved. Methods: From January 2013 to January 2017, a total of 36 patients who suffered from proximal tibial fractures unaffecting the knee were enrolled into this prospective study, and divided into two groups by random number table method. Of them, 19 patients received an interlocking intramedullary nail combined with an extra plate for internal fixation of the fractures (the plate group), while the remaining 17 patients had fractures fixed with the nail combined with blocking screws (the screw group). The perioperative, follow-up and radiographic data were compared between the two groups. Results: All the 36 patients underwent operation smoothly without iatrogenic neurovascular injuries. The plate group proved superior the screw group regarding to operation time and intraoperative X-ray exposure (P＜0.05) , nevertheless the former was inferior to the latter in implant cost and hospital stay (P＜0.05) . The follow-up period lasted for 12～24 months with a mean of (15.62±4.71) months. There were no statistically significant differences in the time to return ambulation and the time to full weight-bearing activity between the two groups (P＞0.05) . At the latest follow up, no statistically significant differences were found between the two groups regarding knee range of motion and Johner-Wruhs grades for clinical consequences (P＞0.05) . In terms of anterior knee pain, the difference between the two groups was not statistically significant (P＞0.05) . In respect of radiographic assessment, the plate group had significantly less residual malalignment than the screw group, including anteroposterior and lateral displacements, as well as angulations in coronal and sagittal planes (P＜0.05) . To the latest follow up, all patients in both group got bony healing of the fractures without a statistical difference in fracture healing time between them (P＞0.05) , and no loosening or breaking of the implants were showed on images in anyone of them. Conclusion: Both the nail plus plate and nail plus blocking screw do achieve satisfactory clinical outcomes for proximal tibial fractures unaffecting the knee. By comparison, the nail combined with plate facilitates to regain and maintain better alignment of the leg regardless of higher implant cost.