Double Fixation Research Articles

Double plate fixation via the upper arm posterior approach for fractures of middle-inferior humerus

Objective To investigate the clinical outcomes of treating fractures of the middle-inferior humerus with double plate fixation via the upper arm posterior approach through the inner edge of the joint triceps tendon. Methods From May 2013 through May 2015, 32 fractures of the middle-inferior humerus were treated with open reduction and double plate fixation by the upper arm posterior approach via the inner edge of the joint triceps tendon. They were 19 males and 13 females, aged from 17 to 54 years (mean, 36.8 years). In-volved were 14 left sides and 18 right sides. By AO classification, 21 cases were type B and 11 type C, all closed fractures. X-ray examinations were regularly conducted at postoperative follow-ups; function of the elbow joint was assessed according to the Jupiter elbow joint grading system at the final follow-up. Results All the 32 patients were followed up for 6 to 20 months (average, 11.5 months). The fractures healed after 4 to 7 months (average, 5.0 months). The flexion ranged from 120° to 135° (average, 125°), and the extension ranged from 0 to 8° (average, 5°). There were no such complications as postoperative infection, plate breakage, or nonunion. According to the Jupiter elbow joint grading system at the final follow-up, there were 15 excellent cases, 14 good ones, and 3 fair ones, giving a good to excellent rate of 90.6%. Conclusion Open re-duction and double plate fixation by the upper arm posterior approach via the inner edge of the joint triceps tendon is simple for fractures of the middle-inferior humerus and leads to satisfactory reduction, reliable fixation, and fine outcomes. Key words: Humeral fractures; Elbow joint; Fracture fixation, internal; Bone plates

Failure analysis of a sleeper anchor model used in railroads

Abstract The sleeper anchors are important elements in railroads. They are introduced into the ballast, and, as the name suggest, they have an anchor function, increasing the railway stiffness. Many rail companies have used a double fixing sleeper anchor model for many years. However, with the increasing of the transported load last decades, this model has failed in service, allowing the undesired ballast movement and creating a dangerous situation, with imminent risk of accidents. In this context, this work presents a complete failure analysis of this sleeper anchor model. Chemical, macro and microstructural analysis were done, and mechanical tests were performed. An alternative European model was also characterized, aiming to compare their metallurgical characteristics. The obtained results showed that the recurrent failures are associated to an overload applied to the studied device. This overload promotes an undesirable plastic strain and the anchor is removed from the ballast. It was possible to conclude that the mechanical properties of this double fixation anchor do not meet the specifications for the actual load demand in railways. The European model presented best characteristics for this application.

Double fixation for abdominal aortic aneurysm repair using AFX body and Endurant proximal aortic cuff: mid-term results.

Our goal was to evaluate the use of an AFX main body combined with an Endurant proximal aortic cuff to treat selected patients with an abdominal aortic aneurysm (AAA) associated with anatomical challenges, such as a small distal aortic diameter and a hostile aortic neck. A retrospective analysis of prospectively collected data from 2 vascular institutions identified 14 elective patients with an AAA (all men, 73.5 ± 5.1 years) treated with the AFX main body combined with an Endurant proximal aortic cuff. Patients had a small distal aortic diameter (median 19 mm) and a short or angulated proximal aortic neck (median length 20 mm, range 9-26 mm, median angulation 41.5°, range 23-80°). Six patients (42.9%) had an aortic neck that did not meet the indications for use of the AFX proximal aortic cuff. Primary technical success was achieved in all patients with no 30-day device-related complications or deaths. During a median follow-up period of 13 months (range 6-28 months), no re-intervention was needed. The diameter of the aneurysmal sac decreased from 57.6 ± 5.6 mm preoperatively to 50.4 ± 4.9 mm (P < 0.001) postoperatively. There were no aneurysm-related deaths or ruptures. No migration, disconnection or type I or III endoleak was observed. In 5 of the 6 patients, the initial type II endoleak spontaneously resolved during follow-up, whereas that in the remaining patient persisted without any change in the diameter of the aneurysmal sac. In patients with complex AAA anatomical configurations combining a hostile aortic neck and a narrow aortic bifurcation, the use of an AFX main body combined with an Endurant proximal aortic cuff seems to be feasible with favourable mid-term results.

Clinical application of combining double suture fixation and resection partial fat retro-orbicularis oculus in some specially difficult blepharoplasty

Objective To summarize the experience of clinical application of combining double suture fixation and resection of partial fat retro-orbicularis oculus in some specially difficult blepharoplasty. Methods During upper blepharoplasty, patients with heaviness and bulkiness in the both upper eyelid and lateral upper orbital region, we combined double suture fixation and resection partial fat retro-orbicularis oculus. First, partial pretarsal bulky fat was resected, and to form skin-orbicularis-oculi composite below incision line. And then, some thickened fat retro-orbicularis oculus was resected, which was also named preseptal and retro-orbicularis oculus fat (ROOF). Double suture fixation techniques were applied to form dynamic and physiological double eyelid. Results 146 cases had satisfactory effectiveness, except for 2 cases with secondary operation because of some superficial double eyelid creases, and 1 case had hematoma, and 3 had transient numbness in the lateral supraorbital nerve region. They were satisfied with healthy eyelid skins, concealed incision and non-serious complications followed at 3-24 months postoperatively. Conclusions Combining double suture fixation and resection of partial fat retro-orbicularis oculus would appear to be a useful adjunct to standard blepharoplasty techniques in selected patients. Key words: Blepharoplasty; Double suture fixation; Fat retro-orbicularis oculus

Treatment of lateral tibial plateau fractures involving posterolateral condyle with double plate fixation via combined anterolateral and posterolateral approaches

Objective To evaluate the treatment of lateral tibial plateau fractures involving the posterolateral condyle with double plate fixation via the combined anterolateral and posterolateral approaches. Methods From January 2013 to August 2015, 12 patients with lateral tibial plateau fracture involving the posterolateral condyle were treated by double plate fixation via the combined anterolateral and posterolateral approaches. They were 8 males and 4 females, with an average age of 36.9 years (range, from 23 to 58 years). According to the Schatzker classification, we had 8 ones of type Ⅱ, 3 ones of type Ⅴ and one of type Ⅵ. Firstly, the posterolateral condylar fractures were stabilized temporarily by the Kirschner wire after reduction through the posterolateral approach. Secondly, the lateral tibial plateau fractures were dealt with via the anterolateral approach, and fixated with a proximal tibial locking plate. Finally, a T-shaped plate for the distal radius was used to support the posterolateral condyle. The clinical and radiographic results were evaluated using the Hospital for Special Surgery (HSS) knee score and the Rasmussen Score, respectively. Results The average operative time was 143.3 min (range, from 110 to 210 min); the average intraoperative blood loss was 190.0 mL (range, from 100 to 300 mL). The follow-ups for the 12 cases ranged from 12 to 24 months (average, 16.6 months). All the cases obtained clinical healing after 12 to 24 weeks (average, 16 weeks). At the last follow-up, the HSS knee-scores ranged from 65 to 98 points (average, 84.6 points), giving 7 excellent cases, 3 good ones and 2 fair ones. The Rasmussen radiological scores ranged from 13 to 18 points (average, 17.1 points), giving 8 excellent and 4 good cases. Conclusions The combined anterolateral and posterolateral approaches can offer excellent exposure for articular reduction and fixation with double plates, achieving satis-factory radiological and functional results in lateral tibial plateau fractures involving the posterolateral condyle. First reduction of the posterior lateral condylar fractures, followed by reduction and fixation of the anterolateral plateau fractures and finally fixation of the lateral condylar fractures, can lead to effectively improved knee function for the patients. Key words: Tibial fractures; Fracture fixation, internal; Bone plates

Biomechanical comparison of anatomical plating systems for comminuted distal humeral fractures

PurposeSix different mono-axial and poly-axial distal humeral plating systems with an anatomical plate design were compared. The aim of the biomechanical tests was to examine differences regarding system stiffness, median fatigue limit, and failure mechanisms.MethodsDifferent configurations of two double plate fixation systems by two manufacturers for the treatment of complex distal humeral fractures (AO/OTA type C2.3) were biomechanically tested in a physiologically relevant setup.ResultsThe 180° Stryker configuration presented itself as the system with the highest stiffness, being significantly stiffer (p < 0.001) than every system other than the poly-axial 180° aap system (p = 0.378). For the median fatigue limit the 180° Stryker and poly-axial aap systems were ranked first and second. The failure mechanism for all 90° systems was a fatigue breakage of the posterolateral plate. The 180° aap systems demonstrated breakage of the most distal screws of the lateral plate. The 180° Stryker system demonstrated screw breakage on both the medial and lateral plates.DiscussionBreakage of the posterolateral plate as a failure mechanism for the 90° systems was expected. The 180° systems demonstrated a higher stiffness compared to the 90° constructs for the axial loading. In conclusion, both poly-axial anatomical plating systems provide sufficient stability in this scenario, and the 180° configurations demonstrated superior stiffness.

OS2-16 Risk factors for cut-out of double lag screw fixation in proximal femoral fractures

OS2-16 Risk factors for cut-out of double lag screw fixation in proximal femoral fractures

Tibiofemoral syndesmosis injury treated by temporary screw fixation and ligament repair

IntroductionTibiofemoral syndesmosis injuries are common but have not been extensively researched. The primary objective of this study was to evaluate the outcomes after temporary screw fixation with ligament repair of these injuries. The secondary objective was to look for factors that could impact these outcomes. We hypothesised that this double fixation (screw+suture) would lead to good outcomes with minimal secondary opening of the syndesmosis upon screw removal. Material and methodsThis was a retrospective study of 285 patients with a tibiofemoral syndesmosis injury (01/2004–12/2011) who were treated by temporary tricortical or quadricortical screw fixation and ligament repair. The operated leg was unloaded for 6–8 weeks postoperative with the patient wearing a walking cast. The screw was removed in all patients before weight bearing was allowed. At follow-up, the range of motion, return to sports, pain, and functional scores (AOFAS and OMAS) were determined, and a radiological assessment was performed. ResultsOne hundred twenty-six patients were reviewed after a mean follow-up of 5.9±5.7years (2.9–10.5). Mean plantarflexion was 95% of the contralateral side and mean dorsiflexion was 93%. Return to sports occurred after a mean of 10weeks; 83% of patients returned to their pre-injury level of participation. Pain on VAS was 0.8/10 on average. The mean AOFAS and OMAS scores were both above 90 points. At the review, 4% of screws had broken. Diastasis was found in 5.6% of cases, osteoarthritis in 6.3% and an osteophyte in 11.1% of cases, but with no clinical repercussions. No risk factors were identified. Discussion and conclusionTreatment by temporary screw fixation and ligament repair leads to good objective results, confirming our hypothesis. However, there is little published data and no consensus on the fixation method or the need to remove the screw. Level of evidenceIV, retrospective, non-comparative.

Arthroscopic treatment of both anterior and posterior cruciate ligament tibial insertion avulsion fractures with suture and absorbable screw double fixation

?To evaluate the effectiveness of arthroscopic suture and absorbable screw double fixation for both anterior and posterior cruciate ligament avulsion fractures of tibial insertions. ?Between June 2006 and September 2013, 8 patients with anterior and posterior cruciate ligament avulsion fractures of the tibial eminence underwent arthroscopic treatment with suture and absorbable screw double fixation. There were 5 males and 3 females, with a mean age of 28.9 years (range, 18-43 years). The causes of injury included traffic accident in 5 cases and falling from height in 3 cases. The time from injury to operation was 3-10 days (mean, 6.2 days). The Lysholm knee score, International Knee Documentation Committee (IKDC) score, and Tegner rating scales were used to evaluated the knee function. ?Primary healing of incision was obtained, without infection or deep vein thrombosis. The mean follow-up period was 42.4 months (range, 24 to 65 months). At 3 months after operation, X-ray films showed good reduction and healing of fracture. The anterior and posterior drawer tests were negative. The knee range of motion was normal (0-125°), and it recovered to preoperative level in 7 cases. The IKDC score, Tegner score, and Lysholm score were significantly improved to 90.4±5.2, 7.5±1.6, and 89.2±3.5 from preoperative 52.1±3.3, 3.3±1.0, and 51.9±3.5 respectively (t=-38.680, P=0.000; t=-39.520, P=0.000; t=-41.150, P=0.000). ?A combined injury of anterior and posterior cruciate ligament avulsion fractures of tibial insertions is rare. Arthroscopic treatment with suture and absorbable screw double fixation is a useful technique to restore tibial avulsion injuries with well-documented radiographic healing, good clinical outcomes, and low complication rates.

Anatomical study on isocentric C-arm three-dimensional imaging navigated percutaneous double screw fixation of pubic symphysis diastasis

Objective With the isocentric C-arm (Iso-C) three-dimensional computerized navigation system, cadaveric pelvic specimens were used to imitate double screw fixation of the symphysis pubic. Practicability and safety of the screw trajectory were examined postoperatively by local cadaveric dissections and imaging tests. Methods Pelvic specimens were harvested from 8 male and 7 female adult cadavers. Double screw placement in symphysis pubic was performed using the Iso-C three-dimensional navigation and entry point and safety trajectory was achieved. With the detailed local dissection postoperatively, distances from screw entry and exit points to unilateral structures (spermatic cord, femoral artery and vein, femoral nerve, obturator artery and vein, obtrurator nerve, and so on) were measured respectively. After complete removal of surrounding soft tissues of the specimen with only bony structure kept, the entry angle and length were calculated. Accuracy of double screw fixation of symphysis pubic was further checked using X-ray and CT. Results Entry point of the first screw was at the junction of unilateral pubic tubercle and transitional site of superior pubic ramus. Mean angle of the first screw with the horizontal plane was (7.7±1.9)° in men and (8.1±1.7)° in women. Mean angle between the first screw and coronal plane was (7.8±1.8)° in men and (7.7±2.0)° in women. Entry point of the second screw was in the same place in the contralateral pubic tubercle. Mean angle between the second screw and horizontal plane was (30.6±4.0)° in men and (30.8±3.4)°in women. Mean angle between the second screw and coronal plane was (9.1±3.0)°in men and (9.2±3.3)°in women. Conclusions With the three-dimensional computerized navigation system, the bony channels of double screws implanted in the symphysis pubic are achieved and reliable. Percutaneous double screw fixation is feasible to treat the pubic symphysis diastasis. Key words: Pubic symphysis diastasis; Bone nails; Anatomy, regional; Surgery, computer-assisted

Arthroscopy for scaphoid nonunions: Inception of therapeutics associating mini-invasive surgery with biological treatment, a preliminary series

Introduction Arthroscopic surgery was an improvement for scaphoid fractures; besides, bone-inducing proteins (BMP) were a major improvement in diaphyseal nonunions. However, scaphoid nonunion treatments are still surgical challenges. This preliminary series wants to improve recovery and outcomes of scaphoid nonunion treatments by associating an arthroscopic debridement and double screw fixation on the one hand with a bone inducing protein on the other hand. Materials and methods Over a period of one year, 4 recent ( – perioperative: presence of arthritis, nonunion tissue, duration of surgery – postoperative: pain, wrist motion (F/E°; inclinations; P/S°), grasp strength, time off work and sports, radiographic analysis (reduction, CT-scan consolidation, secondary displacement). Results Duration of surgery was 60 minutes (50–90), we noticed none scapho-lunate ligament injury, beginning of arthritis in 3 cases and none nonunion tissue in 2 cases. About strength and mobility: – after 6 weeks: F/E: 50/45°, I°R/I°C 5°/10°, P/S 70°/75°, grasp 30%; – after 3 months: F/E: 70/60°, I°R/I°C 10°/20°, P/S 75°/80°, grasp 55%; – after 6 months: F/E: 85/75°, I°R/I°C 10°/25, P/S 75°/80°, grasp 85%. We noticed 3 anatomic reductions. Two patients got consolidation after 3 months, 1 after 6 months and one did not obtained consolidation after 6 months without secondary displacement. One patient was still experiencing pain in full extension after 6 months but was still able to play rugby. Time off work was 6 weeks (4–10). Discussion and conclusion This is a preliminary series and more cases will come to precise outcomes. However, it seems possible to treat successfully scaphoid nonunion, without bone grafting, by using an arthroscopic procedure associating a double screw fixation with a bone inducing protein. In the future, improvement of surgical skills on the one hand and drug development focused on scaphoid nonunion on the other hand should improve results and enlarge indications.

Arthroscopic double strand wire fixation anteriorly and posteriorly to anterior cruciate ligament for tibial intercondylar eminence fracture

To explore the clinical outcomes of arthroscopic double strand wire fixation anteriorly and posteriorly to anterior cruciate ligament (ACL) for tibial intercondylar eminence fracture. From January 2009 to February 2012, 12 patients with tibial intercondylar eminence fracture were selected. There were 4 males and 8 females with an average age of 19.5 ± 10 (10-50) years. Time from injury to operation was 4 days to 2 years. All cases belonged to Meyers-Mekeever type II and type III. Arthroscopic double strand wire compressive fixation was performed anteriorly and posteriorly to ACL. Other measures included postoperative rehabilitation and supports with brace in knee extension when weight-bearing for 4-6 weeks. The average follow-up period was 15.6 (6-30) months. Final clinical results showed good range of motion and good knee stability. On postoperative radiology, there were good reduction of intercondylar eminence fracture and excellent healing. There was no occurrence of wire rupture. Postoperative IKDC and Lysholm scores were excellent (n = 10) and good (n = 2). There was no such complication as fragmentation of intercondylar eminence fracture bone, neurovascular injury or infection. Arthroscopic double strand compressive fixation for tibial intercondylar eminence fracture may be easily performed without injury to ACL substance. The reduction is both stable and reliable. And the clinical outcome is excellent.

Concentric double cables fixation as an alternative suspension method for the endoscopic forehead lift

Fixation of the elevated eyebrow is an important final step in endoscopic forehead lifting. One of the most common methods of fixation includes temporal fasciae sutures for the tail of the eyebrow, and mini-screws for the body of the eyebrow. The concentric cables fixation is an alternative method for elevation of both the tail and the body of the eyebrow. This technique is compared to temporal fasciae suture and mini-screws fixation. Thirty-one patients were included in this study. They were divided into two groups; group I included patients who underwent fixation using fascia sutures and mini-screws, while group II patients underwent concentric cables suspension. Traditional screw and suture technique elevated the eyebrow tail by 7.2, 6.7, 6.3, and 6.0 mm, while the concentric cables resulted in 7.6, 6.8, 6.5, and 6.3 mm elevation at 1, 3, 6, and 12 months postoperatively, respectively. The mean values of brow body elevation were 6.8, 6.4, 6.2, and 5.9 mm for group I, while the mean values of group II were 6, 5.4, 4.8, and 4.7 mm. The concentric cables technique showed a fewer complications rate compared to traditional fixation. The concentric cables fixation offers an alternative inexpensive method to suspend the tail, and to a lesser extent the body, of both eyebrows simultaneously with long-term stability. A fewer complications rate was documented compared to traditional temporal fasciae sutures and mini-screws fixation.

REDESCRIPTION OF DAPHNIA LONGISPINA (CRUSTACEA: CLADOCERA), INHABITING EGYPTIAN WATER WITH SPECIAL REFERENCE ON ITS FILTER THORACIC APPENDAGES

Specimens of cladoceran zooplankton including Daphnia longispina were collected from three different fresh water streams around Kafr El-zayat, North Delta region, Egypt. They were microscopically examined and identified. Detailed morphological and morphometric studies were carried out of Daphnia logispina. Because of the importance of the trunk limbs of D. longispina, which are responsible for feeding and are modified to extract food particles from the water in which it lives, the limbs were examined with a scanning electron microscope after double fixation and critical point drying techniques. The study revealed some fine structures of these limbs and setae. Their morphology and arrangement as well as their armature, were revealed by SEM observations, the armature of limbs 3 and 4 dominates the trunk limb complex and make up an extensive filter chamber.

Rotura del Bíceps Distal. Evaluación de resultados con técnica de doble fijación

&lt;div class="page" title="Page 1"&gt;&lt;div class="layoutArea"&gt;&lt;div class="column"&gt;&lt;p&gt;&lt;strong&gt;In­tro­duc­ción: &lt;/strong&gt;&lt;span&gt;La rotura del bíceps distal es una lesión poco frecuente producida por la aplicación de una fuerza excéntrica sobre el codo flexionado. El objetivo de este trabajo es analizar los resultados obtenidos para la reinserción del bíceps distal mediante técnica de doble fijación con botón de anclaje cortical y tornillo interferencial de biotenodesis a través de una incisión anterior única. &lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materiales­ y­ Métodos: &lt;/strong&gt;&lt;span&gt;Entre agosto de 2008 y febrero de 2013, registramos 19 casos de rotura del bíceps distal tratados quirúrgicamente por vía anterior limitada. Los 17 últimos casos consecutivos fueron tratados con doble fijación utilizando botón extracortical y tornillo de biotenodesis, y forman parte del estudio. Todos eran hombres, con una mediana de la edad de 41 años (rango 27-59). Los pacientes fueron evaluados con el Cuestionario DASH y el Puntaje Subjetivo/Objetivo de Andrews y Carson, y la fuerza de flexión y supinación se controló con la escala del British Medical Research Council modificada por Mackinnon y Dellon (M0-M5).&lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Resultados: &lt;/strong&gt;&lt;span&gt;El cuestionario DASH arrojó un valor mediano de 1,7 (0-5,83) y el de Andrews y Carson, de 195 (170-200) para el total; con 15 resultados excelentes y 2 buenos. Todos consiguieron una fuerza M5 para flexión y supinación de antebrazo. El seguimiento tuvo una mediana de 12 meses (4-32). En dos pacientes, se registraron complicaciones, ambas con recuperación ad íntegrum. &lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusión: &lt;/strong&gt;&lt;span&gt;La técnica descrita ha demostrado ser confiable y eficaz, y permitió lograr resultados satisfactorios y una baja tasa de complicaciones.&lt;/span&gt;&lt;/p&gt;&lt;div class="page" title="Page 1"&gt;&lt;div class="layoutArea"&gt;&lt;div class="column"&gt;&lt;p&gt; &lt;/p&gt;&lt;/div&gt;&lt;/div&gt;&lt;/div&gt;&lt;/div&gt;&lt;/div&gt;&lt;/div&gt;

Analysis of the clinical efficacy of closed reduction and antegrade double elastic nail fixation of metacarpal fractures

Objective To analyze the clinical efficacy of closed reduction and antegrade double elastic nail fixation of metacarpal fractures.Methods A retrospective review of 35 metacarpal fractures in 26 patients who had complete follow-up was conducted.All these metacarpal fractures were closed ones and were treated with closed reduction and double elastic nail fixation.TAFS system was adopted to measure and evaluate finger flexion and extension functional recovery.Muscle power and sensation of the involved fingers were also evaluated.Results No fracture displacement or loss of reduction was noted after 8 to 24 months (mean,11 months) of postoperative follow-up.There were no complications such as wound infection or nonunion.The average fracture healing time was (6.27±3.77) weeks.Based on the TAFS functional efficacy scoring system the metacarpophalangeal joint function was rated as excellent in 92.23％ of the cases.The strength and sensation of the affected fingers were not significantly different from those of the unaffected fingers.Conclusion Closed reduction and antegrade double elastic nail fixation of metacarpal fractures allows early functional exercises and reduces tendon adhesion and joint stiffness.It is minimally invasive and leads to satisfactory recovery of finger movement. Key words: Metacarpal; Fracture; Internal fixation

Fijación doble para luxación acromioclavicular aguda: recuperación de la estabilidad horizontal de la clavícula como factor clave para la reducción anatómica

IntroductionDifferent publications have concluded that coracoclavicular and acromioclavicular ligament complex reconstructions with re-establishment of clavicular horizontal stability are key elements in avoiding residual instability of the acromioclavicular joint. MethodsA total of 14 patients diagnosed with acute types III, IV and V acromioclavicular dislocations were evaluated after a double fixation technique using coracoclavicular suture anchors and a hook plate with the use of an acromioclavicular reductor to obtain anatomical reduction of the dislocated acromioclavicular joint between February 2011 and February 2012. The Constant-Murley score and simple X-ray evaluations were performed at 4, 8 and 12 weeks after surgical treatment. All hook plates were removed 12 weeks after surgery, and three weeks after this procedure, coracoclavicular and acromioclavicular healing was evaluated by using magnetic resonance imaging to finally complete a 6 month follow-up for each patient. ResultsThe 14 patients, with a mean age of 26 years, included in the study had an overall follow-up of 6 months. The mean Constant-Murley score was 97 points at twelve weeks follow-up. No complications were observed, and all the patients had mild sub-acromial impingement symptoms that subsided once the hook plate was removed at 12 weeks follow-up. DiscussionThe results support that the acromioclavicular reduction tool helps to obtain anatomical reduction of the joint during the coracoclavicular reconstruction, while the hook plate holds this joint reduction in place, and allows an early start of physiotherapy, with no associated complications.

Parallel versus perpendicular anatomic double plating for intercondylar humerus fractures

Objective To retrospectively compare the clinical effect of anatomically designed perpendicular and parallel double plates in fixation of intercondylar humerus fractures.Methods A complete follow-up was made on 45 patients treated with anatonic locking plates for intercondylar humerus fractures.Among them,26 underwent perpendicular double plate fixation (perpendicular group) and 19 parallel double plate fixation (parallel group).Mayo elbow performance score (MEPS)was performed at the last follow-up.All postoperative complications were documented as well.Results All fractures were healed without joint pain in the elbow.Arc of elbow flexion and extension,arc of forearm rotation,MEPS and rate of excellent/good outcomes between parallel and perpendicular groups were (100 ± 21) °vs (99 ±34)°,(164± 12)° vs (171 ± 16)°,(91 ± 6) points vs (91 ± 10) points,100％ vs 92％,respectively (P ＞ 0.05).Conclusions Both fixation methods are effective in treatment of intercondylar humerus fractures.Additionally,the surgeons can make a choice about fixation methods based on fracture pattern and individual condition of the patients. Key words: Humeral fractures; Intra-articular fractures; Fractures,comminuted; Fracture fixation,internal

Sa1.2 Implant related blocking of impaction – a possible cause of trochanteric non-union. The therapeutical role of lateral cortical notching (LCN)

Introduction: Clinical Problem: the proximal femur ist he highest loaded part of the skeleton. On the other side the bone density is reduced in elderly patients so that these fractures occur mainly in elderly people. Therefore the cut out of the femur head and neck component is the most severe complication in the management of these fractures. The effect of an i beam shaped Neck component in a locked nail system (the Gliding Nail) was analysed. Material and Methods: In a five-year period 03.1996–03.2001 501 patients all patients with trochanteric and subtrochanteric fractures were evaluated. Re-examination was performed at least 6 months after therapy. All patients with no additional injury of the same leg were allowed full weight bearing immediately (98%). An experimental cut out test of Double T-Plate, single and double neck screw fixation was performed in sowbone and cadaver femora. Results: Early local complications occurred in 2.5%. Only wound revisions for haematoma (11 caseswith 5 times positive bacteriology) occurred but the general rate of complications was 28.5% especially urinary and pulmonary infections. Hospital mortality was 3.9%. Local complications were 3.3%, but in no case cut out was observed. In all cases joint preserving reosteosynthesis was possible. Central impaction of the blade was minimal with 0.24mm, varus displacement. The mean fracture impaction was only 2.2mm due to the rotation stability of the blade so that the neck could not rotate to dorsal located bone defect. The 3 months mortality was 14.9%. 15.3% were living in a nursing home. The experimental test showed 100% higher cut through in single and 400% in double screw fixation as compared to the double T plate. Conclusion: The results show that the event of a trochanteric fracture is still a serious risk but local complications especially cut out can be avoided by using the GN.

Paper 136: Mini-Open Assisted Arthroscopic Rotator Cuff Repair in Patients with Large and Massive Tears Using a Double Row Fixation Technique

Paper 136: Mini-Open Assisted Arthroscopic Rotator Cuff Repair in Patients with Large and Massive Tears Using a Double Row Fixation Technique