Current Issue : October - December Volume : 2015 Issue Number : 4 Articles : 7 Articles
An unicondylar fracture of the femur is uncommon\nand of the medial condyle more so. Open reduction\nand internal fixation of these fractures is most\ncommonly performed with screws or plate and screws.\nSecure bone fixation is compromised by osteoporosis in\nelderly patients; additional measures may be required. We\nreport the case of an elderly osteoporotic patient with a\nmedial condyle fracture nonunion treated successfully\nthrough retrograde intramedullary nailing. A 78-year-old\nosteoporotic woman suffered medial condyle fracture of\nthe femur 9 months before visiting our hospital. She had\nbeen treated conservatively, and the fracture demonstrated\na complete nonunion with gross instability. The edge\nfragments appeared sclerotic, and the nonunion site was\naccompanied by a bony defect. Although fixation by a plate\nand screw is the standard method for the treatment of such\nfracture, we judged that stability would be difficult to\nachieve with this method due to the accompanying bony\ndefect and osteoporosis. Thus, we performed open reduction\nand fixation by retrograde intramedullary nailing with\nthe use of ââ?¬Ë?ââ?¬Ë?condyle screw and nutââ?¬â?¢Ã¢â?¬â?¢ system, followed by\nbone grafting. Bony union was successfully obtained. The\nstability and range of motion of the knee were recovered,\nand the patient regained the ability to walk. We suggest the\nunique application of retrograde intramedullary nailing\nwith condyle screw and nut for the treatment of specific,\ncomplex cases of femoral medial condyle fracture....
Exposure of the distal humerus in case of an\narticular fracture is often performed through a Chevron\nosteotomy of the olecranon. Several options have been\ndescribed for re-fixation of the Chevron osteotomy. Pullout\nof the hard-wear is often seen as complication. In this\nstudy, an evaluation of the re-fixation of the Chevron osteotomy\nthrough a cancellous screw and suture tension\nband was performed. The data of 19 patients in whom a\nChevron osteotomy was re-fixated with a cancellous screw\nin combination with a suture tension band were used.\nEvaluation was performed by assessment of the post-operative\nX-rays and documentation of complications. In all\n19 cases, evaluation of the post-operative X-rays showed\ncomplete consolidation without dislocation or other complications.\nRe-fixation of a Chevron osteotomy of the\nolecranon with a large cancellous screw with a suture\ntension band provides adequate stability to result in proper\nhealing of the osteotomy in primary cases when early postoperative\nmobilisation is allowed. Complications as pullout\nof the hard-wear were not reported....
Proximal tibio-fibular joint is routinely stabilised\nduring leg lengthening, peri-articular fractures and\ndeformity corrections of tibia. Potential injury to the\ncommon peroneal nerve at the level of the fibula head/neck\njunction during wire insertion is a recognised complication.\nPrevious studies have mapped the course of the common\nperoneal nerve and its branches at the level of the fibular\nhead, and guidelines are published regarding placement of\nproximal tibial wires. This study aims to relate the course\nof the common peroneal nerve to the placement of a lateral\ninsertion fibula head transfixion wire. Standard 1.8-mm\nIlizarov ââ?¬Ë?oliveââ?¬â?¢ wires were inserted in the fibula head of 10\nun-embalmed cadaveric knees. Wires were inserted percutaneously\nto the fibula head using surface anatomy\nlandmarks and palpation technique. The course of the\ncommon peroneal nerve was then dissected. Distances\nfrom wire entry point to the course of the common peroneal\nnerve were measured post-wire insertion. The mean distance\nof the common peroneal nerve from the anterior\naspect of the broadest point of the fibular head was\n24.5 mm (range 14.2ââ?¬â??37.7 mm). Common peroneal nerve\nwas seen to cross the neck of fibula at a mean distance of\n34.8 mm from the tip of fibula (range 21.5ââ?¬â??44.3 mm).\nWire placement was found to be on average, 52 % of the\nmaximal AP diameter of the fibula head and 64 % of the\ndistance from tip of fibula to the point of nerve crossing\nfibula neck. When inserting a fibula head transfixion wire,\ncare must be taken not to place wire entry point too distal\nor posterior on the fibula head. Observing a safe zone in the\nanterior half of the proximal 20 mm of the fibula head\nwould avoid injury to the nerve. In cases where palpation\nof fibula is difficult due to patient habitus, we recommend\nconsideration of the use of fluoroscopic guidance during\nwire transfixion of the proximal tibio-fibular articulation to\navoid wire insertion too distally and subsequent potential\nnerve injury....
The Ortho-SUV frame (OSF) is a novel hexapod\ncircular external fixator which draws upon the innovation\nof the Ilizarov method and the advantages of\nhexapod construction in the three-dimensional control of\nbone segments. Stability of fixation is critical to the success\nor failure of an external circular fixator for fracture or osteotomy\nhealing. In vitro biomechanical modelling study\nwas performed comparing the stability of the OSF under\nload in both original form and after dynamisation to the\nIlizarov fixator in all zones of the femur utilising optimal\nframe configuration. A superior performance of the OSF in\nterms of resistance to deforming forces in both original and\ndynamised forms over that of the original Ilizarov fixator\nwas found. The OSF shows higher rigidity than the Ilizarov\nin the control of forces acting upon the femur. This suggests\nbetter stabilisation of femoral fractures and osteotomies\nand thus improved healing with a reduced\nincidence of instability-related bone segment deformity,\nnon-union and delayed union....
The prevalence of known solitary exostosis is\naround 1ââ?¬â??2 % in the general population. Treatment of an\nexostosis may consist of resection with or without further\ntreatment for deformity. The distal radioulnar joint (DRUJ)\nacts as the link between radius and ulna at the wrist and is\nimportant in the transmission of load. Its anatomic integrity\nshould be respected in surgical procedures or ulnar-sided\nwrist pain because of instability, limitation of forearm rotation\nand potential development of grip weakness may\ndevelop. We present a case of reconstruction of the DRUJ\nwith distraction lengthening of the ulna after resection of a\nlarge exostosis of the distal radius that had resulted in a\nmalformed and dysplastic ulna. This treatment in a young\npatient resulted in a stable, functional and congruent distal\nradioulnar joint....
Little evidence exists about the incidence of\ndeep vein thrombosis (DVT) and pulmonary embolism\n(PE) with the use of external fixators. We investigated this\nin a cohort of 207 consecutive patients undergoing 258\nelective frame applications by case note review. Case notes\nwere obtained for 84 % of the sample population. The type\nof surgery, demographic data, thromboembolic risk factors\nand the incidence of DVT/PE were recorded. One patient\nexperienced DVT (0.39 %) and one a PE (0.39 %). Both\nwere of high risk and had received mechanical and chemical\nthromboprophylaxis during their inpatient stay.\nThese complications were identified at least 3 months postoperatively.\nThese findings help to more accurately counsel\npatients undergoing elective frame surgery on the risks of\nDVT/PE and also contribute to the discussion between\nsurgeons about whether or not extended course chemical\nthromboprophylaxis would be of overall benefit...
Loading....