Short Oblique Fractures Research Articles

Imaging characteristics of irreducible tibial shaft fractures and their clinical significance

Objective To propose a concept of irreducible tibial shaft fractures and to discuss their imaging characteristics and clinical significance. Methods A retrospective study was performed in 21 patients with tibial shaft fracture who had received intraoperative intramedullary nailing after limited open reduction at Department of Orthopaedics, The Second Affiliated Hospital to Anhui Medical University from November 2013 to June 2018. They were 14 males and 7 females, aged from 2l to 66 years (average, 34.9 years). There were 15 left and 6 right sides. Firstly, closed reduction was performed followed by traction, folding and rotation, but repeated attempts failed to achieve smooth reduction or insertion of guide wire. Next, local limited open reduction had to be performed for intramedullary nailing. The X-ray and CT images of the tibial fractures were collected to analyze their imaging characteristics. The imaging manifestations were characterized into 4 types: single-segment type with intact fibula, multiple-segment type, interlocking type where the distal and proximal ends interlock commonly seen in short spiral and short oblique fractures, and incarceration type where the fracture interspace is blocked by a bone fragment. The therapeutic efficacy was evaluated at the final follow-up by knee scores of The Hospital for Special Surgery (HSS) and Kofoed ankle scores. Results Of the 21 patients, 2 were single-segment type, 4 multiple-segment type, 13 interlocking type and 2 incarceration type. They were followed up for 7 to 50 months (average, 22.7 months). The fractures united after 5 to 16 months (average, 7.3 months). Postoperative knee pain was observed in 3 cases and delayed fracture union in 2. Osteomyelitis, superficial wound infection, implant breakage or malunion occurred in none of the patients. The therapeutic efficacy evaluated at the final follow-up by HSS knee scores and Kofoed ankle scores revealed 15 excellent, 4 good and 2 fair cases, yielding an excellent to good rate of 90.5%. Conclusion The concept of irreducible tibial shaft fractures may lead to preoperative awareness on the part of the surgeons so that ineffective repeated reductions can be spared and the damage to the blood supply to the fracture ends and the operation time can be reduced. Key words: Tibia fracture; Knee joints; Ankle joints; Imaging characteristics; Irreducible

The Modified Anterolateral Approach to the Humerus

The Modified Anterolateral Approach to the Humerus

90/90 Bicortical, double-loop, interosseous wiring for fixation of transverse and short oblique metacarpal shaft fractures

Background: The purpose of this study was to determine the effectiveness of 90/90 interosseous wiring for fixation of transverse and short oblique metacarpal shaft fractures on early motion. Methods: This prospective study was conducted at an academic Level 1 trauma Center from 2015 to 2017. The study included 20 patients (16 males and 4 females). The mean age was 27.3 yr (range, 12 to 44 yr). The dominant hand was affected in 10 patients, and the nondominant hand was affected in the other 10 patients. Regarding the fracture pattern, 17 were transverse and three were short oblique fractures. The mean follow-up period was 6 mo (range, 4 to 8 mo). Patients were assessed for union (clinically and radiographically), range of motion (total active motion [TAM] and total active flexion [TAF]), hand grip strength, and patient-reported outcome using the quick-Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Results: All patients achieved union after a mean of 7 wk (range, 6 to 8 wk). The mean TAF was 246 degrees (range, 150̊ to 260 degrees). TAM was excellent in 13 digits and good in seven digits. The mean grip strength was 90.20% (range, 61.53% to 100%) of the unaffected side. The mean quick-DASH score was 2.72 (range, 0 to 20.45). Conclusions: The interosseous wiring technique is an effective method of fixation that can be used alone for transverse or short oblique fractures of the metacarpal and can permit early hand mobilization postoperatively without loss of reduction.

Lag Screw Fixation for Treatment of an Ulnar Styloid Process Fracture with Antebrachiocarpal Joint Luxation in a Cat

AbstractFracture of the ulnar styloid process can result in clinically debilitating antebrachiocarpal instability. Previously described repair methods include Kirschner wire and figure of eight tension band wire and/or intramedullary pinning. This case report describes surgical repair of a short oblique ulnar styloid process fracture in a cat using two cortical screws placed in lag fashion. Recheck evaluation confirmed lameness-free full return to function with anatomical fracture healing.

Short-oblique lumbar spine fracture in ankylosing spondylitis patient

Ankylosing spondylitis (AS) is a chronic inflammatory joint disease that mainly causes fusion of the intervertebral discs and facet joints by involving the axial skeleton that typically leads to kyphotic bamboo spine. Demineralization of vertebral bodies in AS raises the risk of spinal fracture even after a simple trauma. During the progression of the disease, the spine becomes more prone to injury, even after minor trauma. Patients with AS have a higher fracture risk during their lifetime by four times compared to the normal population. A 61-year-old male, a known case of AS, came to the emergency room complaining of back pain. His neurological examination was normal, and the images showed transverse/oblique fracture involving L2 vertebral body associated with small retropulsed fragments and bone debris. Posterior spinal fixation and fusion with a bone graft from T10 to S1 was decided to stabilize the fracture. On the 2nd postoperative day, the radiograph showed good alignment and fixation. One-year follow up showed a normal neurological exam with a stable and fused spine. In this case, we present a rare lumbar spine fracture orientation in a patient with AS, with a good outcome with 1-year follow-up. Up to our knowledge, this is the first report to presenting a short-oblique fracture in a patient with AS disease.

Effectiveness of one-stage total knee arthroplasty with tibial stem extender for knee arthritis complicated with tibial stress fracture

To evaluate the early effectiveness of one-stage total knee arthroplasty (TKA) with tibial stem extender for knee arthritis complicated with tibial stress fractures. Between January 2014 and November 2016, 12 patients (12 knees) with knee arthritis and tibial stress fractures underwent one-stage TKA with tibial stem extender. There were 5 males and 7 females with an average age of 71.5 years (range, 60-77 years). There were 8 cases with osteoarthritis and 4 cases with rheumatoid arthritis. The radiographic examination showed the 6 cases of intra-articular fractures and 6 of extra-articular fractures (including transverse fractures in 4 cases and short oblique fractures in 2 cases); 2 cases complicated with middle and upper fibular stress fractures; all patients of varus deformities. Preoperative Knee Society Score (KSS) clinical score was 31.5±8.4 and functional score was 33.3±9.0. The preoperative range of motion (ROM) of the knee was (65.6±9.6)°. All indexes healed primarily and no wound infection or skin necrosis occurred. All patients were followed up 36.5 months on average (range, 6-52 months). X-ray films showed that all fractures healed at 3-7 months (mean, 4 months); the position of the prosthesis was good, and no loosening or signs of infection occurred. At last follow-up, the KSS clinical score was 90.5±8.9 and functional score was 92.1±7.8; the ROM of the knee was (115.0±9.8)°. All indicators were significantly improved than those before operation ( t=40.340, P= 0.000; t=32.120, P=0.000; t=8.728, P=0.000). One-stage TKA with tibial stem extender for patients with knee arthritis and tibial stress fractures can restore limb alignment, facilitate fracture healing, and obtain the satisfactory early effectiveness.

Research advances on atypical femoral fractures related to Bisphosphonates

Bisphosphonates have become the first-line drugs for the treatment of osteoporosis, which can reduce the risk of brittle fracture by inhibiting osteoclast activity and increasing bone density. Bisphosphonates bring benefits to osteoporosis patients, while some side effects can occur. In recent years, bisphosphonate related femoral atypical fractures (AFF) have been gradually recognized and become the focus of researches. AFF has typical clinical features and X-ray findings: Patients with long-term usage of bisphosphonate drug. AFF were defined as atraumatic or low-trauma fractures located in the subtrochanteric region or femoral shaft. X-ray showed transverse or short oblique fracture of the medial cortex which shaped like a spike, and the bone cortex at the fracture area becomes thicker because of localized or diffuse periosteal reaction. AFF pathological mechanism is not clear, mainly with long-term use of bisphosphonates which seriously inhibit bone turnover, other theories including the theory of syndrome like collagen abnormal theory, mineral abnormal theory, hypophosphatasia, precise pathological mechanism still needs further study. Although the absolute incidence of AFF is very low, the number of AFF will inevitably increase with the increasing number of aging osteoporosis patients and the widespread application of bisphosphonates, which should be paid more attention to. AFF risk factors included long-term usage history of bisphosphonate, glucocorticoid treatment history, female patients, fracture prodromal symptoms including pain, discomfort or weakness in the thighs or groin and the bowing of the femoral shaft was associated with the location of AFF fracture. At present, the point of view of AFF treatment is: complete fracture of femoral length, reamed intramedullary nail fixation. Even for incomplete fractures, preventive intramedullary nailing should also be considered. The healing time of AFF fracture increases obviously. The most common complications are delayed union and nonunion. The rate of delayed union can be as high as 26%. How to improve the curative effect of this kind of fracture needs further study. In this paper, the latest literature on the clinical features, diagnostic criteria, morbidity, risk factors, pathological mechanisms, treatment and complications of atypical fractures of the femur were reviewed.

The effect of the cerclage wire in the treatment of subtrochanteric femur fracture with the long proximal femoral nail: A review of 52 cases

IntroductionTo present the effect of the cerclage fixation, which was performed for the purpose of preserving the alignment obtained by open reduction, on the long-term clinical and radiological results of subtrochanteric fractures. Materials and methodsThe inclusion criterias were at least 2 years of follow-up, no severe cognitive impairment, and to be able to walk independently prior to fracture. Patients with transverse or short oblique subtrochanteric hip fractures (AO/OTA class 32-A3.1), patients underwent previous femoral or hip operation for the same side and those with segmental fractures, bilateral fractures and pathological fractures were not included in the study. The clinical and radiological results of the patients were evaluated. The clinical evaluations were performed with Palmer and Parker Mobility Score (PPM), Lower Extremity Functional Score (LEFS), visual analogue score (VAS) and return to pre-injury activity status.The elapsed time between the trauma and the surgery date, the duration of surgery the estimated amount of bleeding, and the length of hospital stay of patients were assessed. ResultsThirty-two of the 52 patients were female and 20 were male. The mean age of females was 77.80 ± 9.75 years and the mean age of the males was 79.18 ± 6.50 years. The mean follow-up period of the patients was 62.25 ± 34.68 months. The mean time until the patients' surgery was 6.18 ± 3.32 days. The mean duration of surgery was 52.6 ± 13.8 min. The mean amount of bleeding was 176 ± 90 ml. The mean length of patients' hospital stay was 6.2 ± 3.2 days. The postoperative mean duration of union was found to be 3.8 ± 1.6 months. The mean value of varus/valgus angulation in coronal plane measurements was 0.52°. No complication was observed in any patient during the cerclage application. The mean number of wire was 1.3. LEFS difference was statistically significant. PPM decline was not statistically significant. ConclusionOpen reduction and the use of cerclage did not produce a negative effect in terms of fracture union. The generation of medial support by anatomical reduction of the fracture prevents the implant failure and provide a basis for union.

Treatment of proximal phalanx fractures: transarticular pinning the metacarpophalangeal joint or cross pinning from the base of the proximal phalanx-a prospective study.

For extraarticular proximal phalanx fractures, two methods are employed, transarticular fixation in which the metacarpophalangeal joint is crossed and the extraarticular method in which the pins are introduced through the base of the proximal Phalanx. This study was a prospective one on patients with proximal phalanx transverse or short oblique fractures. In one of the groups we used parallel pins from metacarpal head through MCP joint to proximal phalanx. In the second, we used two cross pins from proximal phalanx the base of the proximal phalanx to fix the fracture. We evaluated metacarpophalangeal, proximal and distal interphalangeal joints active range of motion and how long it took the patient to resume their daily activities and work without difficulty, as well as post-operative complications such as wound infection, malunion, and nonunion in 3 and 6months follow-up. Ultimately, 61 people entered the study, 29 in the parallel pins and 31 in the cross pins group. There was no significant difference between the two groups, but the improvement in all of the joints range of motion showed a statistically significant difference (P < 0.0001) from the 3 to 6months follow-up. The final range of motion showed an inverse correlation with age of the patient (P < 0.05). Most of the patients were in the excellent grade of range of motion class and no serious complication was observed in any of them. The results of treatment in proximal phalangeal fractures with both methods were comparable and so the surgeon may select each based on the experience and training.

Management of diaphyseal fractures of both bones of forearm by internal fixation using locking compression plate and screws

Background and objective: The fractures of both bones forearm are one of the commonest fractures found and can be treated by different methods. The accepted management for fractures of both bones forearm is open reduction and internal fixation using compression plating. The present study is undertaken to verify the claims made by the authors of the new design of the plate (LCP) and to learn the techniques, advantages and complication of the new method of internal fixation of forearm fractures. Materials and methods: It is a prospective study which was carried out from November 2012 to October 2014 in Karnataka Institute of Medical Sciences, Hubli. In this study period 20 cases of fractures of both bones of forearm were treated by open reduction and internal fixation using Locking Compression Plate. Results: In our series, majority of the patients were males, middle aged with road traffic accidents being the commonest mode of injury, involving middle third of forearm. Transverse or short oblique fractures were most common. All twenty ulna fractures and nineteen radius fractures united. Excellent results or full range of mobility of elbow and wrist joints were present in 15 patients(75%), 4(20%) patients having good range of movements and 1(5%) patient with failure. Conclusion: The fixation with LCP for forearm fractures produces excellent results, the advantage being early mobilization, early union but the complication, duration of surgery and surgical techniques remains unchanged.

A true silent compartment syndrome in a competent sensate patient: Case report

A true silent compartment syndrome in a competent sensate patient: Case report

Preexisting lesions associated with complete diaphyseal fractures of the third metacarpal bone in 12 Thoroughbred racehorses

We characterized features of complete diaphyseal fractures of third metacarpal bones in Thoroughbred racehorses. Given that stress fractures are known to occur in the third metacarpal bone, an additional aim was to determine if complete fractures are associated with signs of a preexisting incomplete stress fracture. Bilateral metacarpi from 12 Thoroughbred racehorses euthanized because of complete unilateral metacarpal diaphyseal fracture were examined visually and radiographically. Open, comminuted, transverse or short oblique fractures occurred in the middle of the diaphysis or supracondylar region. Periosteal surface discoloration and bone callus formation contiguous with the fracture line were present in fractured bones. All contralateral intact metacarpi had gross anatomic lesions, and 10 had radiographic abnormalities similar to those observed on fractured metacarpi. Catastrophic metacarpal fractures occurred in racehorses with bilateral evidence of preexisting bone injury.

Comparison of below knee cast and elasticated support bandage treatment foe an isolated fracture of the lateral malleolus

Introduction: Ankle fractures are the most common type of fractures treated in orthopaedics with isolated malleolar fractures, accounting for two-thirds of fractures. The most common injury mechanism is supination external rotation, which accounts for the majority of all ankle fracture patterns. Supination external rotation stage II is the classic short oblique fracture of the distal fibula without a medial side injury, which responds well to non-operative treatment as it is a stable fracture. The purpose of this study is to compare efficacy of elasticated support bandage versus plaster cast in the patient with isolated lateral malleolus fracture (Lauge-Hansen supination- eversion external stage II.)Method: A prospective comparative study was carried out in the Department of Orthopaedics in Bir Hospital from February 2007 to January 2009. Patients with ankle fracture were initially treated by below knee posterior slab for seven days to allow the swelling to subside and on seventh day follow-up they were grouped in two groups. Group A were patients with below knee cast and Group B were elasticated support bandage. Both groups were followed-up in the 5th week for cast or elasticated bandage removal and were evaluated after a week, thereafter, every monthly for 3 months and finally at 6 month.Result: Of the 48 cases enrolled, the mean age of the patients was 38.85 years. The common mode of injury was fall from height followed by road traffic accident. The modified subjective ankle score of Olerud and Molander (1984) was found more in group B in comparison to group A in all follow ups. In initial three successive follow ups at 6 week, 12 week and at 3 month subjective score was found statistically significant (p&gt; 0.05) however, it was not significant at 6 month follow up. The range of motion was significantly improved in group B in all follow ups but the difference between the two groups at 6 weeks and 10 weeks follow ups was statistically significant. Immobilized group required less analgesic but the difference was not significant statistically.Conclusion: Both below knee cast and elasticated support bandage treatment methods are safe, satisfactory and equally effective with a better early result in elasticated support bandage. Supination External Rotation stage II type fracture can be treated conservatively, if there is no medial tenderness.Journal of Society of Surgeons of NepalVol. 17, No. 2, 2014, Page: 7-11

Femoral Shaft Fracture of a Middle-aged Male Adult during Playing Baseball

In general, femur fractures in the younger patient population are the result of high energy trauma, such as motorcycle accidents or traffic accidents. A 43-year-old healthy man presented with painful swelling of his right thigh. Plane radiographs showed short oblique fracture of the femur shaft with comminution. He had no medical history such as osteoporosis or any metabolic bone disorder. He was a healthy man with no smoking and no alcohol drinking, enjoying sports activity such as baseball and football. He was injured during defense time of a baseball game by rapid turning motion to catch a ball. We performed intramedullary interlocking nailing for the femur shaft fracture and the fracture was uneventually healed with no complication. To our knowledge, femur shaft fracture which occurred during playing baseball in a healthy middle-aged man has not been reported in our country. So we report this case with a review of the literature.

Bisphosphonates Are Not Always Helpful: Commentary on an article by Hae-Seong Lim, MD, et al.: "Factors Associated with Increased Healing Time in Complete Femoral Fractures After Long-Term Bisphosphonate Therapy".

Somewhere between 20% and 33% of people will sustain an osteoporotic fracture during their lifetime1. Preventative treatment has mainly been antiresorptive therapy, such as bisphosphonates. These medications have reduced the risk of fractures in large clinical trials2,3. Unfortunately, prolonged use of bisphosphonates is associated with relatively rare but potentially troublesome atypical femur fractures (AFFs)4,5. We are just beginning to understand the clinical scenario of AFFs and develop patient treatment plans. The occurrence of AFFs is still relatively rare for bisphosphonate users6,7. Lim et al. have now evaluated 109 AFFs in 99 consecutive patients who had been operatively treated for complete AFFs. AFFs were defined by characteristic radiographic features, including a transverse or short oblique fracture line, medial spike, focal lateral cortical thickening, and no or minimal comminution, according …

Treatment of fracture shaft humerus with dynamic compression plate osteosynthesis – A prospective study

Background and Objectives: Fractures of Humeral shaft account for approximately 3% of all long bone fractures. Most will heal with appropriate conservative care, although a small but consistent number will require surgery-for optimal outcome. The aim of this study is to assess the results of humeral shaft fractures with dynamic compression plate (DCP). Methodology: This is a prospective study of 20 cases of fracture shaft of humerus admitted to Sri siddhartha Medical College & Research Center, Tumkur, between July 2005 to October 2006. Cases were taken according to inclusion and exclusion criteria. Results: In our series of 20 cases there were 18 male s and 2 females, with average age of 33.4 yrs. 16(80%) cases were admitted due to road traffic accident and with copal side affected. Out of 20 cases, 2(10%) were proximal third, 16(80%) were middle third and 3 (9%) were distal third. Transverse or short oblique fractures were most common i.e., 14(70%) patients. 7(3 5%) cases were having associated injuries. The fractures united in 19(95%) patients with 1(5%) cases going for non-union due to deep infection in one, in other case may be due to immediate weight bearing activity done by the patient. Good or full range of mobility of shoulder and elbow joints was present in 19 (95%) patients. Conclusion: Internal fixation of the humerus with DCP achieves higher union rates and comparable better results as compared to other modes of treatment.

Interlocking Nailing In Adult Femoral Shaft Fractures

Fractures of femur in adult age groups above 18 years treatment mainly by internal fixation by inter locking nailing in present days . in the pas it is by cast, traction followed by casting, external fixation ,plating, enders nailing, intra medullary nailing ( k nail ) But presently by more advanced interlocking nailing , by closed method, fracture hematoma and periosteum are not disturbed, with minimal incision for entry point of nail , nail and bone are locked by locking screws proximally and distally, so it gives rigid fixation and accurate anatomical alignment, that leads to early mobilization, early fracture healing ,less complications and high patient satisfactory rate 1 . This is prospective study of 28 patients with isolated femoral diaphyseal fractures in above 18 years age group with transverse ,short oblique and minimal comminuted fractures are treated . results are evaluated by radiological union, time of weight bearing and return to work ,complication rate, patient satisfaction, and scoring by klemms criteria.

Comparison of 2 Methods of Percutaneous Fixation of Proximal Phalanx Fractures

Purpose: Short oblique or transverse extra-articular fractures at the proximal phalanx are very common. Stabilization and early motion are critical to support good results. No single operative method has been shown to be superior in clinical studies. Traditionally, these fractures were treated with percutaneous pinning. Latter intramedullary nailing (IMN) became popular. During the past years, a new technique using intramedullary placed Herbert screws (HSs) showed satisfactory outcome. The aim of this study is to assess the complications and outcomes of these last 2 techniques performing postoperative early digital motion. Our hypothesis is that HSs have less complications rates and better outcomes than IMN. Methods: Over a 2-year period, a prospective study was conducted at our service. Radiological (reduction, consolidation time, secondary displacement) and clinical (Visual Analogue Scale [VAS]-Total Active Motion [TAM]-Quick Disabilities of Arm, Shoulder and Hand [QuickDASH]) results of 20 patients having 25 displaced extra-articular fractures of the proximal phalanges were recorded through a minimum follow-up of 3 months. Short oblique or transverse types were included. Intra-articular fractures, thumb fractures, and concomitant injuries of the tendons or collateral ligaments were excluded from this study. All fractures were reduced closed and fixed. Aggressive active full range of motion was encouraged 48 hours after surgery. Surgical Techniques: We performed percutaneous IMN with 2 crossed 1-mm rods in Eiffel tower configuration using 2 portals at the base of the phalange in 12 fractures; we left the rods outside the skin, and they were removed at consolidation time. We placed percutaneous 3-mm HSs, 1 in each fracture inserted in antegrade fashion in 13 cases. For statistical analysis, the quantitative variables were reported as mean values. The Student t test was used for continuous data. For all analyses, P &lt; .05 was considered statistically significant. Results: Radiographically there was a statistically significance ( P = .01) in the average consolidation time between the 2 groups—IMN: 107 (±60) days; HS: 63 (±10) days. We got anatomical reduction and no secondary displacement in both groups. The mean TAM for the IMN and HS groups was 161 (±36) and 218 (±27), respectively ( P = .001). Average VAS was similar at discharge in both groups, but during the first postoperative month, patients with HS referred less pain. Mean final QuickDASH was 18 (±12) for IMN group and 15 (±14) for HS group. Regarding complications, we recorded a mild superficial infection at the entrance of the wires in 1 patient that healed with oral antibiotics (ATB). The volar cortex in shaft fractures treated with IMN showed a delayed union in 48% of cases. No complications were recorded in HS group. Conclusions: It is generally agreed that closed fixation minimizes additional soft tissue injury and allows for early motion. Percutaneous intramedullary placed HS was a superior method compared with IMN in terms of the measured parameters.

Functional and Radiological Results of Phalanx Fractures Fixation with Intramedullary Cannulated Headless Compressive Screws

Objective: Unstable phalanx fractures are an indication for reduction and fixation. Classic fixation techniques include Kirschner wires (K wires) or plates for osteosynthesis. This investigation has an objective to compare functional and radiological results of patients operated with intramedullary cannulated no head compressive screw (IMS) with a control group of osteosynthesis with dorsal plate or K wire. Materials and Methods: A prospective follow-up of 15 patients operated with IMS between September 2014 and November 2015, with a mean follow-up of 5 months (range, 3-8 months). Patients included were between 18 and 70 years old and had diaphyseal or distal metaphyseal fractures of Proximal or Middle Phalanx; fracture lines transverse or short oblique; unique lesions, without other structure harmed. Those patients where compared with a control group of 15 patients operated with dorsal locking plate in diaphyseal fractures, or with K wire in cases with distal metaphyseal fractures. The final range of movement, immediate postoperative pain and pain at discharge, radiological consolidation, time of labor leave, complications, and satisfaction index at discharge were evaluated. The IMS group corresponded to 16 fractures: 6 diaphyseal and 3 of the distal metaphysis of the Middle Phalanx (P2). 16 fractures of the control group: 8 diaphyseal (treated with plate) and 2 of the distal metaphysis of the Proximal Phalanx (P1, treated with K wires); 3 diaphyseal (treated with plate ) and 3 of the distal metaphysis of the Middle Phalanx (P2, treated with K wires). Results: Total active range of movement of the IMS group P1 was 249° (240°-260°) and 225° (190°-240°) ( P = .01). Total active range of movement of the IMS group P2 was 240° (231-255) and 228° (190-250) ( P = .05). The mean return to work was 50 days (range, 15-64 days) for the IMS group and 60 days for the control group ( P = .1). All fractures of the IMS group had radiological consolidation at discharge, and there were no difference in the time of consolidation with the control group. There were no cases with secondary arthrosis at final follow up. Immediate postoperative pain (0/10) of IMS group was 3 and 0 at discharge and 100% of the IMS classified as “satisfied.” Conclusions: Transverse and short oblique fractures of P1 or P2 may fixate satisfactory with compressive cannulated intramedullary screw. They present a better functional result, less time of labor leave, and same consolidation rate as that of the control group. The index of satisfaction was outstanding. The presence of arthrosis should be evaluated with longer follow up where the screw site of entrance to the bone.

Optimizing compression: Comparing eccentric plate holes and external tensioning devices

ObjectiveElimination of interfragmentary motion in fracture fixation using plates to impart compression and promote primary bone healing through absolute stability has been well described as a reliable and successful method to treat simple transverse and short oblique fracture morphologies. Our hypothesis is that dynamic compression plating augmented by external compression techniques would produce and maintain a significantly greater amount of compression than using the plate alone. MethodsSimple transverse diayphyseal fractures were simulated in nine 4th generation composite bone models. A load cell was placed within the transverse fracture osteotomy and stabilized and compressed using either eccentric screw placement in a dynamic compression plate alone or augmented with an opposite segment Verbrugge clamp or articulated tensioning device (ATD) compressing using a screw outside of the plate. Dynamic plate compression was evaluated independently and in conjunction with the external compression techniques. Statistical analyses were carried out using a linear mixed effects model and pairwise comparisons between conditions with a significance set at a P-value <0.05. ResultsBoth of the external compression techniques (Verbrugge and ATD) achieved significantly higher compression than the plate compression technique alone with 78% (P<0.001) and 134% (P<0.001) more compression respectively. The measured compression across the osteotomy after screw application and removal of external compression decreases by 17% for the Verbrugge device (P=0.215) and by 22%, after removal of the ATD device (P=0.038). For both techniques, adding additional screws in eccentric (load) position further increases compression. ConclusionPlate compression is a reliable method for inducing compression across transverse and short oblique fractures. Augmenting plate compression technique with external compression techniques (Verbrugge clamp or ATD) allows for a significantly greater compressive load to be achieved. Compression lost after removal of the external compression device indicates that the maximal compression attainable across a fracture may not be reliably maintained with standard dynamic compression plating techniques.