International orthopaedics
-
Varus failure is one of the most common failure modes following surgical treatment of proximal humeral fractures. Straight antegrade nails (SAN) theoretically provide increased stability by anchoring to the densest zone of the proximal humerus (subchondral zone) with the end of the nail. The aim of this study was to biomechanically investigate the characteristics of this "proximal anchoring point" (PAP). We hypothesized that the PAP would improve stability compared to the same construct without the PAP. ⋯ The PAP provided significantly increased stability in SAN constructs compared to the same setup without this additional proximal anchoring point. Varus-displacing forces to the humeral head were superiorly reduced in this setting. This study provides biomechanical evidence for the "proximal anchoring point's" rationale. Straight antegrade humeral nailing may be beneficial for patients undergoing surgical treatment for unstable proximal humeral fractures to decrease secondary varus displacement and thus potentially reduce revision rates.
-
Patients with haemodynamic instability due to pelvic fracture-related bleeding can have life-threatening haemorrhage. Management options for haemorrhage control in complex pelvic fractures include bony stabilization, angioembolization, and preperitoneal pelvic packing (PPP). ⋯ PPP directly addresses the bony and venous bleeding of complex pelvic fractures, which results in the majority of blood loss in exsanguinating patients. As such, PPP should be considered for pelvic fracture patients who remain haemodynamically unstable despite red cell transfusion.
-
Recently we modified the Masquelet technique by using an antibiotic cement-coated locking plate as a temporary internal fixator when treating septic bone defects. This modification is in order to prevent the complications related to external fixator use and provides the involved limb with a greater stability to undergo earlier and more vigorous physical therapy for recovery of joint function. The purpose of this study was to assess the outcomes of large femoral osteomyelitis defects managed by Masquelet technique combined with the antibiotic cement-coated locking plate used as a temporary internal fixator. ⋯ Based on our experience, we believe that antibiotic cement-coated locking plate is a viable fixation method in the first stage of Masquelet technique for the management of large femoral osteomyelitis defects. It may offer a better chance of infection eradication as well as improved recovery of joint function without increasing the infection recurrence rate and without compromising bone graft union.
-
Intramedullary nail fixation remains the standard treatment for displaced tibial shaft fractures. Establishing an appropriate starting point remains a crucial step in the surgical procedure. Tibial nailing using an infrapatellar starting point with the knee flexed over a radiolucent triangle has been established as a widely-used standard technique. ⋯ Recent technological advances have provided the surgical community with instrumentation systems that allow for tibial nailing in the semi-extended position using a suprapatellar portal with nail insertion through the patellofemoral joint. Preliminary clinical studies have suggested favorable outcomes that can be achieved with this technique. This article provides a description of the surgical technique and a review of the currently available evidence.
-
A four-column classification system offers a different way of evaluating tibial plateau fractures. The aim of this study is to compare the intra-observer and inter-observer reliability between four-column and classic classifications. ⋯ The proposed four-column classification showed the highest intra and inter-observer agreement. When taking into account the agreement that occurs by chance, Schatzker classification showed the highest inter-observer kappa, but again the four-column had the highest intra-observer kappa value. The proposed classification is a more inclusive classification for the posteromedial and posterolateral fractures. We suggest, therefore, that it be used in addition to one of the classic classifications in order to better understand the fracture pattern, as it allows more attention to be paid to the posterior columns, it improves the surgical planning and allows the surgical approach to be chosen more accurately.