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PubMedDate not supplied

Late open reduction internal fixation of lateral condyle fractures.

To study the effects of late open reduction of lateral condyle fracture (LCF) on avascular necrosis (AVN), amount of displacement, and improvement, the records of 11 children with an open capitellar physis and a malunion or a nonunion treated >3 weeks after injury were reviewed. Preoperative and postoperative displacement amounts were recorded. Radiographs were reviewed for AVN, lateral overgrowth, or fishtail deformity. There were no cases of AVN. Three patients had occasional pain. Four patients had displacement of >10 mm before surgery. In fractures with >1 cm of displacement, fragment position was minimally improved surgically, but final alignment and range of motion were good. These fractures showed more radiographic deformities at the time of late open reduction. The risk of AVN with late open reduction of LCF at >3 weeks is reduced if no tissue is stripped off the fracture fragment posteriorly. Even children without anatomic reduction had functional arms with little or no pain.

Child↗
PubMed2002

[Internal fixation of proximal humerus fracture by "palm tree" pinning].

PURPOSE OF THE STUDY: Fractures of the proximal humerus are increasingly frequent. Conservative treatment is most often proposed, but surgery must be performed when the displacement is significant and/or when the fracture is unstable. Osteoporosois and comminution are two essential elements for deciding on the surgical technique. MATERIAL AND METHODS: This retrospective study included 31 patients who underwent pinning from the deltoid V according to the Kapandji procedure. There were 19 females and 12 males. Mean age was 61 years. There was a fracture of one of the tuberosities in 12 cases and significant metaphyseal comminution in 8. RESULTS: Mean follow-up was 26 months. Outcome was excellent or good in 22 cases (70.9%), fair in 4 (12.9%), and poor in 5 (16.2%). Fifteen complications were noted (48.4%): material displacement 8 cases, reflex sympathic dystrophy 3 cases, radial nerve palsy 2 cases, head osteonecrosis 1 case, and humeral fracture at the site of insertion of the K wires 1 case. DISCUSSION: At the present time, there is no consensus for the surgical management of fractures of the proximal humerus, including proximal metaphyseal fracture with or without fracture of one of the tuberosities. Closed reduction and pinning is not really an invasive procedure, and does not injure the rotator cuff. Surgical approach at the level of the deltoid V according to the Kapandji technique avoids elbow pain and stiffness. The procedure requires a fluoroscan and experience to obtain satisfactory divergence of the K wires in the humeral head, an essential technical point. This procedure cannot be recommended for elderly patients whose bone quality is too poor to obtain good fixation of the K wires.

Adolescent↗
PubMed2003

Varus collapse of comminuted distal femur fractures after open reduction and internal fixation with a lateral condylar buttress plate.

Twenty-six comminuted distal femur fractures treated with a lateral condylar buttress plate were followed up until fracture union or implant revision (mean follow-up, 26 months). Mean postoperative angle (medial distal femoral angle immediately after surgery) was 96 degrees, and mean final angle (angle at fracture healing or implant revision) was 91 degrees (P = .06). Distal femoral angle decreased 5 degrees or less in 15 patients, 6 degrees to 10 degrees in 8 patients, and more than 10 degrees in 3 patients. Final distal femoral angle was 90 degrees or less in 13 of the 26 fractures: 38% of these 13 fractures required reconstruction for nonunion, malunion, or knee arthrosis. The lateral condylar buttress plate, which is not a fixed-angle device, allowed more than 5 degrees of varus collapse to occur in 42% of the comminuted distal femur fractures.

Adult↗
PubMed2003

Sacroiliac joint dislocation in 11 years old boy treated by open reduction and internal fixation.

Pelvic fractures in children are relatively rare, especially unstable pelvic ring disruptions. Generally, nonoperative treatment has been recommended for children with these injuries because healing is rapid and remodeling extensive in children. Treatment generally is a period of recumbency until the fractures heal, followed by gradual weight bearing. Various methods of operative treatment were advised by some authors. They reported a higher incidence of residual problems after pelvic disruption such as malunion, hemipelvic undergrowth, low back pain and leg length discrepancy. These authors are of opinion, that principles of treatment should not differ from the treatment of adults if the pelvis is unstable and if there is significant displacement. We describe a case of a vertically unstable pelvic ring injury with sacroiliac joint dislocation and limb length discrepancy in 11 year old boy. Patient was received for treatment 14 days after trauma. He was treated by open reduction from anterior approach and percutaneous screw fixation. In one year follow-up he has very good functional result.

Child↗
PubMed2000

Internal fixation of fractures in a peripheral set-up in Kenya.

OBJECTIVE: To determine the pattern of fractures in Nyeri and the types of operations done for their treatment. DESIGN: A simple retrospective descriptive study. SETTING: Five of the main hospitals in Nyeri metropolis, namely, Central Provincial General Hospital, Mount Kenya Hospital, Nyeri Nursing Home, Jamii Hospital and the Presbyterian Church of East Africa Hospital, Tumutumu. SUBJECTS: One hundred and twenty patients with 134 fractures who were admitted and operated on by the author at the above hospitals between July 1995 and July 1998. RESULTS: There were 80 males and 40 females. The youngest patient was a seven year old male and the oldest an 83-year old female. The highest number of fractures involved the femur followed by the tibia. Road traffic accidents accounted for 56.6% of the fractures, falls 31.7% and assault 6.7%. Various forms of plates constituted the commonest implants used followed by Kuntscher nails. The complication rate was 14.2% with a deep infection rate of three per cent. Four deaths were recorded. CONCLUSION: Operative treatment of fractures can safely be done in our peripheral hospitals. These hospitals should therefore be adequately equipped for this form of treatment.

Adult↗
PubMed2003

[Selection of dorsal or volar internal fixation for unstable distal radius fractures].

OBJECTIVE: To assess the results of T-plate in the treatment of unstable distal radius fractures. METHODS: Dorsal or volar T-plate fixation was used for unstable distal radius fractures according to different types of fracture. For comminuted fractures with severe cortex destruction and insufficient buttress, artificial bone graft or autograft was adopted to restore local stability. RESULTS: Satisfactory reduction was achieved after surgery. Functional rehabilitation under surveillance began from the 2nd or 3rd post-operative day. The overall excellent or good recovery rate was 90.77% after a mean follow-up of 29.63 months. For the 55 sides of volar fixation (30 sides with a dorsal displacement fragment), excellent or good recovery rate was 92.72%. Dorsal fixation was used in delayed cases (> 6 weeks) or certain fracture patterns unsuitable for volar approach. The excellent on good recovery rate was 77.77%. CONCLUSIONS: Volar approach is an ideal option not only for distal radius fracture with a volar displaced fragment but also for dorsal displaced fractures (Colles' fracture). The advantages of this approach include flat cortex for easy plate fixation, better tension band effect, less soft tissue destruction, leaving dorsal soft tissue hinge intact, and avoiding bone graft leakage. Satisfactory results can be obtained in those patients with unstable distal radius fracture through volar approach plate fixation, especially in those with fresh fractures. If possible, volar approach can also be used in delayed fractures within 6 weeks. The results of dorsal fixation is a little bit inferior.

Adolescent↗