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Operative treatment for volar plate avulsion fractures of the fingers.

Arch Orthop Trauma Surg. 2013 Jul 28;

Authors: Lee S, Jung EY, Kim JY

Abstract
We present our experience with 14 volar plate avulsion fractures of the fingers that were treated by excision or internal fixation and discuss the factors affecting the operative techniques and results. Fourteen cases were divided into two groups: the volar plate avulsions with excision (eight cases) and the volar plate avulsions with fixation (six). We compared clinical factors between fracture groups and between fixation methods. Fractures treated with fixation had the larger fragment, a shorter preoperative period, and the larger articular surface involvement than fractures treated with excision. Postoperative pain, average age, patients' satisfaction measured by VAS, DASH scores, grip, and pinch strength were not different between two groups. All fixated fractures healed and the time to union did not differ based on fixation method. The true size of the fracture fragment was larger than expected based on the X-ray and the fragments were usually rotated by pull of the volar plate or ligament. The size and shape of the avulsed fragment might be important factors to determine the treatment method, but the results after operation were not significantly different whether the fragment was excised or fixed.

PMID: 23892555 [PubMed - as supplied by publisher]

Read more... http://www.ncbi.nlm.nih.gov/pubmed/23892555?dopt=Abstract

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Posterior translation of the fibula may indicate malreduction: CT study of normal variation in uninjured ankles.

J Orthop Trauma. 2013 Jul 28;

Authors: Lepojärvi S, Pakarinen H, Savola O, Haapea M, Blanco R, Niinimäki J

Abstract
OBJECTIVES:: The aim of our study was to assess the intersubject and intrasubject variation of distal tibiofibular syndesmosis on computed tomography (CT) scans and to define standardized measures to verify syndesmosis reduction.
DESIGN:: A retrospective study of 107 CT scans of ankles with normal tibiofibular syndesmosis.
SETTING:: Main trauma center, university teaching hospital PATIENTS:: The CT scans of 64 patients were reviewed by two musculoskeletal radiologists MAIN OUTCOME MEASUREMENTS:: Bilateral variation was estimated. The intra- and interobserver reliabilities were calculated using standardized measurement points. CT measurements included the length of the tibial incisura (LI), anterior width (AW) and posterior width of the incisura (PW), depth of the incisura (DI), narrowest part of the incisura (NI), and sagittal translation of the fibula (ST).

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Technique for reduction and percutaneous fixation of U- and H-shaped sacral fractures.

Orthop Traumatol Surg Res. 2013 Jul 23;

Authors: Ruatti S, Kerschbaumer G, Gay E, Milaire M, Merloz P, Tonetti J

Abstract
We describe an early reduction and percutaneous fixation technique for isolated sacral fractures. Strong manual traction combined with manual counter-traction on the torso is used to disimpact the fracture. Transcondylar traction is then applied bilaterally and two ilio-sacral screws are inserted percutaneously on each side. Open reduction and fixation, with sacral laminectomy in patients with neurological abnormalities, remains the reference standard. Early reduction and percutaneous fixation ensures restoration of the pelvic parameters while minimising soft-tissue damage and the risk of infection. Decompression procedures can be performed either during the same surgical procedure after changing the installation or after a few days. These complex fractures warrant patient referral to specialised reference centres.

PMID: 23890706 [PubMed - as supplied by publisher]

Read more... http://www.ncbi.nlm.nih.gov/pubmed/23890706?dopt=Abstract

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Internal Fixation of the Distal Humerus: A Comprehensive Biomechanical Study Evaluating Current Fixation Techniques.

J Orthop Trauma. 2013 Jul 29;

Authors: Caravaggi P, Laratta JL, Yoon RS, Biasio JD, Ingargiola M, Frank MA, Capo JT, Liporace FA

Abstract
OBJECTIVES:: The purpose of this study was to evaluate current fixation techniques in the operative fixation of distal humerus fractures, both with conventional and locked plating in both parallel and orthogonal orientation.
METHODS:: Twenty-eight upper extremities from fourteen cadavers were prepared to create four implant testing constructs: Synthes locking plates (IMP1), medial and posterolateral with lateral flange), Acumed parallel locking plates (IMP2), Smith & Nephew orthogonal locking plates (IMP3), and Synthes orthogonal 3.5-reconstruction plating (IMP4), one posterolateral and one medial). A 5mm supracondylar osteotomy was made to simulate the fracture. Stiffness in axial and sagittal-plane loading, fatigue properties (over 5000 cycles), and ultimate strength were determined for each construct via biomechanical testing.

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Editorial Comment: Symposium: Tscherne Festschrift: Editorial Comment.

Clin Orthop Relat Res. 2013 Jul 26;

Authors: Pape HC, Vrahas MS

PMID: 23888324 [PubMed - as supplied by publisher]

Read more... http://www.ncbi.nlm.nih.gov/pubmed/23888324?dopt=Abstract

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Health Literacy in an Orthopaedic Trauma Patient Population: Improving Patient Comprehension with Informational Intervention.

J Orthop Trauma. 2013 Jul 29;

Authors: Tsahakis JM, Issar NM, Kadakia RJ, Archer KR, Barzyk T, Mir HR

Abstract
OBJECTIVES:: This study aims to evaluate the change in comprehension of diagnoses, treatment plans, and discharge instructions after orthopaedic trauma patients are given an informational document that includes pictorial representations at the time of discharge. It also seeks to determine if the intervention has a greater impact on patients with lower educational backgrounds.
DESIGN:: Prospective comparative cohort study.
SETTING:: Academic Level 1 trauma center.
PATIENTS:: From April to December 2011, 529 orthopaedic trauma patients with an operatively fixed isolated fracture were eligible for inclusion. 299 eligible questionnaires were collected (56.5% response rate).
INTERVENTION:: Patients were administered a questionnaire regarding their treatment and discharge instructions during their first postoperative clinic visit prior to being seen by a physician. The questionnaire included demographic information and questions regarding: (1) which bone was fractured; (2) type of implanted fixation; (3) weight-bearing status; (4) expected recovery time; and (5) need for DVT prophylaxis. All patients had received verbal instructions outlining this information

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Repair of a degloving injury of the thumb with a combined dorsal great toenail flap and dorsalis pedis flap: a case report.

Arch Orthop Trauma Surg. 2013 Jul 26;

Authors: Ju JH, Hou RX

Abstract
Many methods for the repair of degloving injuries of the thumb have been reported, but none are entirely satisfactory. Herein, we report a method in which the injury is divided into the dorsal and palmar area for repair. A great toenail flap is used to repair the dorsal injury to restore the nail defect, and a dorsalis pedis flap is used to repair the palmar injury. The described technique provides good restoration of morphology and aesthetic outcome, good functional and sensory recovery, and is associated with minimal donor-site morbidity.

PMID: 23887868 [PubMed - as supplied by publisher]

Read more... http://www.ncbi.nlm.nih.gov/pubmed/23887868?dopt=Abstract

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Low Wear of a Second-generation Highly Crosslinked Polyethylene Liner: A 5-year Radiostereometric Analysis Study.

Clin Orthop Relat Res. 2013 Jul 27;

Authors: Callary SA, Field JR, Campbell DG

Abstract
BACKGROUND: A sequentially irradiated and annealed, second-generation highly crosslinked polyethylene (XLPE) liner was introduced clinically in 2005 to reduce in vivo oxidation. This liner design has also been shown to reduce wear in vitro when compared with conventional and first-generation crosslinked liners. To date, there is only one study reporting an in vivo wear rate of this liner at 5 years' followup. However, that study used measurements made from plain radiographs, which have limited sensitivity, particularly when monitoring very low amounts of wear.
QUESTIONS/PURPOSES: What is the amount and direction of wear at 5 years using radiostereometric analysis (RSA) in patients who had THAs that included second-generation XLPE?
METHODS: We prospectively reviewed 21 patients who underwent primary cementless THA with the same design of XLPE acetabular liner and 32-mm articulation. Tantalum markers were inserted during surgery and all patients had RSA radiographs at 1 week, 6 months, and 1, 2, and 5 years postoperatively. Femoral head penetration within the acetabular component was measured with UmRSA(®) software. One patient died and two had incomplete radiographs leaving 18 radiographic series for analysis.

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Proximal radioulnar translocation associated with elbow dislocation and radial neck fracture in child: a case report and review of literature.

Arch Orthop Trauma Surg. 2013 Jul 25;

Authors: Yoon HK, Seo GW

Abstract
Proximal radioulnar translocation with radial neck fracture and elbow dislocation is extremely rare. We report a case of a 5-year-old boy who was presented with elbow dislocation, and proximal radioulnar translocation was diagnosed a day after the injury. Mini-open technique was used to reduce the translocation and radial neck fracture. The patient finally regained full range of elbow motion and forearm rotation. This case had clinical importance in that the reverse instability of the elbow was observed compared with the previous reports.

PMID: 23884463 [PubMed - as supplied by publisher]

Read more... http://www.ncbi.nlm.nih.gov/pubmed/23884463?dopt=Abstract