Results Of Percutaneous Fixation Research Articles

Results of percutaneous fixation and distal radius core decompression in scaphoid waist non-unions treated without grafting

Scaphoid non-union management is still a challenge in clinical practice for orthopaedic surgeons. Though several treatment methods have been described, there is an ongoing debate about optimum management. Based on new concepts about avascular conditions, promising results were reported with metaphyseal decompression of the distal radius by increasing the vascularization of the radial column of the carpus. We aimed to evaluate the clinical, radiological, and functional outcomes of distal radius core decompression and fixation with palmar percutaneous cannulated compression screws without grafting in patients with scaphoid waist fracture non-union. Twenty-nine patients with scaphoid non-union were included in this prospective study. There were 27 male and 2 female patients with an average age of 29 years (range 18–45 years). Mean time from the injury to surgery was 18.3 months. The Slade and Geissler classification was used to classify the non-unions. Wrist range of motion (ROM), pain based on a visual analog scale (VAS), and the Mayo wrist score were used to assess the clinical outcomes. Postoperative radiographs and CT-scans were reviewed to assess fracture union, carpal alignment and screw position. The average clinical follow-up was 76 weeks (range: 74–87 weeks) postoperatively. Mean time to union was 11 weeks (range: 7–18 weeks). There was no humpback/no DISI in any of the cases. Twenty-six patients healed successfully with no additional procedures. Three patients with failed union underwent revision surgery with grafting. At the final follow-up, average wrist ROM was 61° (range: 30–80) in extension and 61° (range: 35–80) in flexion, the average Mayo wrist score was 66±20 (range: 20–90), and the mean VAS was 2±2 (range: 0–7). Percutaneous fixation without grafting associated with distal radius core decompression can provide satisfactory outcomes in surgical management of scaphoid non-unions. Level of evidenceII.

Acetabular fractures in patients aged > 55 years

The increasing prevalence of osteoporosis in an ageing population has contributed to older patients becoming the fastest-growing group presenting with acetabular fractures. We performed a systematic review of the literature involving a number of databases to identify studies that included the treatment outcome of acetabular fractures in patients aged > 55 years. An initial search identified 61 studies; after exclusion by two independent reviewers, 15 studies were considered to meet the inclusion criteria. All were case series. The mean Coleman score for methodological quality assessment was 37 (25 to 49). There were 415 fractures in 414 patients. Pooled analysis revealed a mean age of 71.8 years (55 to 96) and a mean follow-up of 47.3 months (1 to 210). In seven studies the results of open reduction and internal fixation (ORIF) were presented: this was combined with simultaneous hip replacement (THR) in four, and one study had a mixture of these strategies. The results of percutaneous fixation were presented in two studies, and a single study revealed the results of non-operative treatment. With fixation of the fracture, the overall mean rate of conversion to THR was 23.1% (0% to 45.5%). The mean rate of non-fatal complications was 39.8% (0% to 64%), and the mean mortality rate was 19.1% (5% to 50%) at a mean of 64 months (95% confidence interval 59.4 to 68.6; range 12 to 143). Further data dealing with the classification of the fracture, the surgical approach used, operative time, blood loss, functional and radiological outcomes were also analysed. This study highlights that, of the many forms of treatment available for this group of patients, there is a trend to higher complication rates and the need for further surgery compared with the results of the treatment of acetabular fractures in younger patients.

Functional results of percutaneous fixation of displaced tibial plateau fractures assisted by arthroscopy

Background Tibial plateau fractures are a common injury that require anatomic reduction to obtain the best functional results. Assisted arthroscopy seems to be more satisfactory in reducing the risks of open reduction and internal fixation. Aim of the study This study evaluated the functional results of percutaneous fixation of displaced tibial plateau fractures assisted by arthroscopy. Patients and methods The study was carried out between July 2012 and June 2013 in Suez Canal University Hospitals. This was a prospective study and 20 patients were included, 16 men and four women, mean age 40 years (range 21-72 years) at the time of surgery. Patients with closed tibial plateau fractures type I-IV according to the Schatzker classification were included in the study with step-off of the articular surface more than 3 mm and condylar widening more than 5 mm. All patients underwent preoperative and postoperative clinical and radiological assessment, and the outcomes were scored by the Rasmussen system. Results The results of the current study showed a significant difference between preoperative and postoperative Rasmussen scores. For the postoperative Rasmussen score, the median clinical score at the 1-year follow-up was 28 (range 22-30) and the median radiological score was 9 (range 6-10). According to clinical and radiological assessments, we found that 95% of the patients had satisfactory results. All fractures were united and no permanent complications developed. Conclusion Percutaneous fixation of displaced tibial plateau fractures with assisted arthroscopy is a safe and effective procedure with excellent results and early mobilization.

Percutaneous Fixation of Displaced Calcaneal Fracture

Purpose To review the techniques and outcomes of percutaneous fixation, with the modified Essex-Lopresti technique, in isolated, displaced tongue-type calcaneal fractures. Methods This is a retrospective review of 24 patients who received percutaneous calcaneal screw fixation in our hospital, from April 2003 to June 2009. One patient had bilateral fixation performed. All patients had a serial of X-rays of the injured foot, which included anteroposterior, axial, lateral, and Broden’s views. Preoperative and post-operative Bohler’s and Gissane’s angles were measured. The patients’ conditions were continuously assessed in serial follow-ups, and the Maryland Foot Score was used to evaluate the clinical outcome. Results Bohler’s and Gissane’s angles were fully restored in 13 and 17 out of 25 fractures, respectively. The mean duration of post-operative hospital stay was 4 days. There were no major post-operative complications. Sixteen patients were able to resume their original jobs. The Maryland Foot Score rated 13 out of 25 injured limbs (52%) as excellent, 9 (36%) as good, and 3 (12%) as fair. There were no patients rated as poor. The three patients with fair results complained of pain and stiffness at the subtalar joint. Conclusion Percutaneous fixation of displaced tongue-type calcaneal fractures is an effective treatment with acceptable clinical outcome, short hospital stay, minimal skin complications, and quick recovery.