PubMed · 14928693
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G KUNTSCHER. 1951-11-17. [Stable osteosynthesis].. https://pubmed.ncbi.nlm.nih.gov/14928693/
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Nutcracker fractures of the tarsal navicular and cuboid usually result from dislocations of the midtarsal (Chopart's) joint. The classic pathomechanism consists of forced adduction or abduction (medial or lateral stress) mostly in combination with axial force. The resulting injuries are frequently misjudged or underestimated with respect to their potential consequences for global foot function. Radiographic imaging includes plain radiographs in exact standard projections and computed tomographic scanning. Classification of Chopart fracture-dislocations is based on the proposed pathomechanics and the direction of the dislocating force. The goals of open reduction and stable internal fixation of Chopart fracture-dislocations are realignment of the medial and lateral columns of the foot, restoration of joint congruity and temporal transfixation in case of ligamentous instability to ensure proper ligament healing.
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BACKGROUND: The purpose of the present retrospective study was to evaluate the results of open reduction and internal fixation of delayed unions and nonunions of fractures of the distal part of the humerus. METHODS: Between 1976 and 2001, fifty-two patients with a delayed union (thirteen patients) or nonunion (thirty-nine patients) of the distal part of the humerus were treated with open reduction and internal fixation along with selective elbow joint arthrolysis and bone-grafting. The average time to presentation was eighteen months (range, two to 192 months) after the injury. Thirty-nine of the fifty-two patients had undergone an average of 1.6 previous operations. There were twenty-seven supracondylar, six transcondylar, thirteen intercondylar, two lateral condylar, and four medial condylar delayed unions or nonunions. The average duration of follow-up was thirty-three months (range, three to 198 months). RESULTS: Fifty-one of the fifty-two patients had healing of the delayed union or nonunion after the index operation; the average time to union was six months (range, two to twenty-four months). The average range of elbow motion increased from 71 degrees preoperatively to 94 degrees postoperatively. Complications included two superficial infections, two deep infections, and five cases of ulnar neuropathy. Fifteen patients (29%) needed additional surgery after the index procedure. Specifically, seven patients underwent removal of prominent hardware; six underwent hardware removal along with excision of heterotopic bone, ulnar neurolysis, and/or manipulation under anesthesia; one underwent irrigation and débridement; and one underwent compartment release. CONCLUSIONS: Open reduction through an extensile exposure and rigid internal fixation consistently results in healing of a delayed union or nonunion of the distal part of the humerus. An improved range of motion of the elbow can be achieved by securing the site of the nonunion and performing aggressive elbow joint arthrolysis and soft-tissue releases in patients with severe contractures.