Fracture Subtypes Research Articles

SHOULDER HEMIARTHROPLASTY FOR PROXIMAL HUMERAL FRACTURES

Shoulder hemiarthroplasty is a well-accepted surgical procedure for the treatment of specific subtypes of proximal humeral fractures, including four-part fractures, three-part fractures associated with severe osteopenia, head-splitting and severe articular impression fractures. Careful patient assessment and meticulous surgical technique are essential to prevent complications. The results are satisfactory in approximately 80% of cases. The results are better in younger patients and in acute versus chronic fractures. There are a significant number of complications that are related to technical details of the procedure. Careful placement of the prosthesis and secure reattachment of the tuberosities to the shaft reduce the chance of complication following surgery. Good to excellent results in terms of range of motion and pain relief can be expected in most patients.

Fractures of the Fifth Metatarsal

To understand better the natural history of fractures of the fifth metatarsal, a fracture registry was established consisting of patients who had acute fractures of the fifth metatarsal. The first 100 patients were studied to develop data on the natural history of injuries to this bone, and on the results of standard treatment for those injuries. In this study, 3 fracture subtypes were identified: avulsion, true Jones' fracture, and shaft/neck fracture. Avulsion fractures healed without immobilization, usually in 4 weeks. Shaft/neck fractures healed in plaster casts with weight bearing as tolerated in 4 to 6 weeks. True Jones' fractures required a prolonged time to heal when treated with 8 weeks of nonweight bearing and then weight bearing as tolerated in a cast. This method was, however, successful in 72% of patients (average time until union, 21.2 weeks). For the 7 patients in whom conservative treatment failed, surgical fixation at an average of 25 weeks after injury reliably achieved bony union in half the time required with cast treatment. This low-risk procedure met with higher patient satisfaction than prolonged casting.

External fixation for type III open tibial fractures

An analysis of 51 type III open tibial fractures treated by external skeletal fixation is presented. The fractures are subdivided according to the classification of Gustilo, Mendoza and Williams (1984) into types IIIa, IIIb and IIIc. The different prognoses of these fracture subtypes is examined. The use of the Hoffmann and Hughes external fixators in the management of type III open tibial fractures is presented and it is suggested that the prognosis is independent of the type of fixator used.

Acute axis fractures: a review of 229 cases.

Eighteen percent of acute cervical spine fractures involve the C-2 vertebra. The odontoid Type II fracture is the most common axis fracture and it is also the most difficult to treat. The degree of odontoid dislocation has been identified as the single most important fracture feature that helps separate those patients who have a high likelihood of healing with nonoperative therapy from those who are likely to fail nonoperative therapy and should be offered early surgical stabilization. The difference is statistically significant (p less than 0.001, x2 = 30.20). The present series includes 229 patients with acute axis fractures. Follow-up data were available in 92% of these patients, for a median duration of 4 years 9 months. Treatment guidelines and results are offered for each subtype of axis fracture based on this experience.