PubMed · 867937
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Z Stanojlović. [Our studies on errors in osteosynthesis].. https://pubmed.ncbi.nlm.nih.gov/867937/
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The minimally-invasive treatment of metacarpal and phalangeal fractures with a low profile external fixator is described. In most sites fixator pins are inserted percutaneously and closed reduction of the fracture is performed. Due to the special design bridging of adjacent joints in shaft, distal or proximal fractures is not necessary unless the fracture is intraarticular. The results of treatment are described. Advantages and disadvantages of a small external fixator in relation to conservative management and open reduction and internal fixation are discussed.
Surgical management of two-part and three-part proximal humerus fractures is difficult and requires familiarity with more than one method of fixation. Poor bone quality, comminution, and the deforming forces of the rotator cuff on the tuberosities influence the choice of operative approach and fixation techniques. Closed reductions and percutaneous pinning offer the potential advantage of minimal soft-tissue dissection; however, good bone quality and minimal comminution are prerequisites. Selected two-part surgical neck fractures and valgus-impacted fractures lend themselves well to this technique. Open reduction and internal fixation is indicated in two-part surgical neck fractures with poor bone quality or extensive comminution, two-part greater tuberosity or lesser tuberosity fractures, and most three-part fractures. The choice of surgical approach is dictated by the fracture pattern and includes an extended deltopectoral approach and a superior deltoid-splitting approach. Fixation techniques are myriad and are dependent on the fracture pattern. Potential fixation methods include intramedullary rods, interfragmentary sutures or wires, and extramedullary plates and screws or blade plates. Successful results are predicated on obtaining adequate enough fixation to allow early passive motion. Results also are influenced by the quality of the reduction and patient compliance.
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