Procs III 2011.indb - Journal of Bone & Joint Surgery, British Volume ...

364 HELLENIC ASSOCIATION OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY
125 INTRAMEDULLARY NAILING OF
COMBINED / EXTENDED FRACTURES OF
THE HUMERAL HEAD AND SHAFT
C.Garnavos, N.Lasanianos, V.Lakka. M.Morakis,
G.Sinnis, K.Papagiannakos
1st & 2nd Trauma & Orthopedic surgery dept.
Athens General Infirmary “Evaggelismos”
Although intramedullary nail fi xation maybe highly
indicated for comminuted and segmental humeral fractures
that require operative treatment, the literature
lacks reviews of this content.
The aim of the present study is to prospectively evaluate
the clinical and radiographic outcomes in patients
with combined head and shaft fractures of the humerus
who were treated by antegrade locking intramedullary
nailing.
During a period of four years 21 patients (9 men &
12 women) between 36 and 82 years old, with combined
fractures of the humeral head and shaft, were operated
by one surgeon. Three types of nail implants were used
(Polarus long, Garnavos nail, True fl ex nail) and antegrade
technique was performed in all cases.
The mean operating time was 105 min (50’-140’).
The period of follow-up averaged 14.25 months (range,
9 to 18 months). Two patients were lost to follow up
and one died before the callus formation procedure
was accomplished. The functional assessment included
determination of the Constant score and documentation
of shoulder function as compared with the non injured
extremity. Radiographic control was obtained during
the follow-up intervals and at the fi nal follow up. No
neurovascular complications, deep wound infections or
non-unions were recorded and all fractures were fully
healed between 4 to 8 months post-operatively. In one
case the nail was extracted before callus formation was
achieved, because of acromion impingement.
The results are judged as very satisfying, taking into
account the comminution of the fractures. Further evaluation
of the results, with comparable methods of internal
fi xation of such fracture patterns, is needed.
126 ARTHROSCOPICALLY ASSISTED
REDUCTION AND INTERNAL FIXATION OF
TIBIAL PLATEAU FRACTURES
S.Plessas, D. Louverdis,P. Mavroeidis,A.
Bourlekas,G. Stroboulas,N. Prevezas
Orthopaedic Dpt.of General Hospital Nikaia
Peirea
During the last few years, the arthroscopically assisted
technique for reduction and internal fi xation of tibial
plateau fractures is of increasing popularity. The accumulated
surgical experience allowed the possibility of treating
type I, II, III according to Schatzker classifi cation.
During the last two years 17 patients who had suffered
a tibial plateau fracture were treated this way.
The mean age was 44 years, while the mean FU was
16 months. According to Schatzker classifi cation 8 fractures
were type I, 6 fractures type II and 3 fractures type
III. The bone reduction was achieved under arthroscopic
view and fl ouroscopy. In all cases the fracture was fi xed
by the with cannulated Herbert type screws. Meniscal
lesions were fi xed in 9 patients, while in 5 patients
ruptures of the ACL were detected, which were reconstructed
at a later stage.
Full range of motion of the knee was restored in 11
patients, while lack of full knee fl exion (mean 100) was
found in 6 patients. All patients were assessed with a
modifi ed Lyslom Knee Scale. The Knee score was 85
points to 96 points (mean 92 points), while the anterior
knee pain was the common problem especially following
increased activities.
The proposed arthroscopically assisted technique
for reduction and fi xation of certain types of tibial plateau
fractures consists a alternative minimal invasive
approach. Visualization of the whole joint is possible
and concomitant lesions can be detected and possibly
fi xed at the same time
127 A TWO STAGES TREATMENT OF HIGH
ENERGY FRACTURES OF DISTAL TIBIA.
RESULTS ESTIMATION.
G. Antypas, Ath. Konstas, G. Kontogiannis, K.
Liossis, P. Gakis, N. Prevezas
Orthopaedic Department, Nikaia, Piraeus General
Hospital “Ag. Panteleimon”
The treatment of high energy fractures of distal tibia by
internal fi xation is followed by a high rate of soft tissue
complications.
The result estimation of these fractures in a two stage
treatment, bridging the ankle by Ex-Fix with/without
internal fi xation of the fi bula and internal fi xation of the
tibia after soft tissue recovery
In a 4 year period (2005-8), 15 patients, average of 42
years were treated. The AO fracture classifi cation was
followed. The soft tissue damage estimation (Osternn-
Tscherne and Gustillo classifi cation), the fracture pattern
of the fi bula and the injury mechanism consisted of
the choice method criteria. The majority of the injuries
was classifi ed Tscherne II & III, and 3 open fractures
Gustillo II. Fracture reduction was performed by bridging
Ex-Fix of the ankle with/without plating the fi bula
with a 1/3 or DCP 3.5 mm plate. Defi nite internal fi xation
of the tibia by locking plate was performed from
8th -14th postoperative day after soft tissue recovery.
Preoperatively CT scan was performed with grate signifi
cance, defi ning the soft tissue condition, the surgical
approach and the osteosynthesis type.
Follow up average 14 months. None of the patients
developed infection. All wounds were healed in one
stage. Superfi cial skin necrosis was conservatively
treated in two patients.
Soft tissue complications, after internal fi xation of
high energy fractures of the distal tibial, usually appear.
Two stages treatment allows better preoperative planning,
immediate patient mobilization and reduce complication
rate
128 TREATMENT OF COMPLEX TIBIAL
SHAFT FRACTURES USING ILIZAROV
EXTERNAL FIXATION
M. Beltsios, O. Savvidou, E. Papavasiliou G.
Giourmetakis, A. Kaspiris, J. Mpesiris
Orthopaedic Department, General Hospital of
Elefsis, «Thriassio» Athens, Greece
The frequent choice of treatment for tibial shaft fractures
is intramedullary nailing. However there are cases
where this treatment is problematic and alternative
treatments are chosen with satisfi ed results.
Twenty-nine patients with complex, unstable tibial
shaft fractures (13 males and 16 females) aged 18 to 76
years (mean age 49 years) were treated using Ilizarov
external fi xation, the last decade in our Department by
the same surgeon. The indications were open Gustillo
III fractures, comminuted fractures of the proximal or
distal third tibia near metaphysis, concomitant plateau
or pillon fractures and fractures after total knee arthroplasty
(TKA). All frames were applied the fi rst day of
injury. Patients without concomitant intraarticular
fracture or bone defi cit allowed to full weight bearing
within2 weeks after surgery.
Union and good to excellent alignment with full range
of motion in the knee and ankle joints was obtained
in all patients. Three patients needed bone lengthening
using the initial applied frame after corticotomy in
second operation. There were 7 delayed unions in fractures
without bone defi cit, 10 superfi cial pin tract infection
treated with antibiotics and local care and 1 deep
infection which needed surgical intervention.
Ilizarov external fi xation gives the solution in diffi cult
and problematic tibial shaft fractures and allows early
weight bearing
129 CIRCULAR EXTERNAL FIXATION
AND CLOSED REDUCTION FOR THE
TREATMENT OF TIBIAL PLATEAU
FRACTURES
M. Beltsios, O. Savvidou, G. Giourmetakis, E.
Papavasiliou, J. Dimoulias,
Orthopaedic Department, General Hospital of
Elefsis «Thriassio» Athens, Greece
Treatment of tibial plateau fractures Schatzker type V and
VI or with soft tissues injuries is still remains under discussion.
The purpose of this study is to evaluate the results of
treatment with circular frame and closed reduction in 25
patients (15 males and 10 females) with tibial plateau fractures,
with a mean age of 42 years old (20 – 76 years).
Five fractures were classifi ed as Schatzker type II and
III and 20 as type V and VI. Reduction was obtained in
22 cases under foot traction and in 3 arthroscopically.
Bone grafts inserted through a hole (≤ 1 cm) in the inner
cortex of the tibia metaphysis under fl uoroscopy. Eight
unstable knees needed bridging the joint for 4 weeks. In
2 cases a cannulated interfragmentary screw was used.
Full weight bearing was allowed 3 months after injury
when the device was removed.
Follow up ranged from 1 to 10 years (mean 5 years).
All fractures were united and there was no infection.
Full range of the knee motion was achieved in 23
patients while 2 needed an open arthrolysis. There were
2 malunions which were treated with one valgus osteotomy
and one TKR. Asymptomatic arthritis appeared
in 6 patients. According to Knee Society Score (KSS) the
results were classifi ed as excellent in 12, good in 8, fair
in 3 and poor in 2 patients.
Circular frames are a satisfactory alternative method
for the treatment of tibial plateau fractures either in
severe soft tissues injuries or in very complex cases
130 TREATMENT OF OPEN TIBIA SHAFT
FRACTURES WITH SIMULTANEOUS
EXTERNAL FIXATION AND ALLOGRAFT
APPLICATION
I. Nikolopoulos, S. Kalos, G. Krinas, D.
Kypriadis, A. Elias, G. Skouteris
2nd Orthopaedic Department G.H. “Asclepeion
Voulas”
The use of external fi xation in open tibia fractures with
severe soft tissue injury is the most preferred and safe
treatment. The primary allograft application is doubtful
due to high infection risk.
The evaluation of the results of open tibia fractures
type II and III according Gustillo-Anderson that were
treated with simultaneous external fi xation and allograft
application.
From 2005-2007, twenty nine open tibia shaft fractures
in 27 patients (2 bilateral) with mean age of 35
years-old were treated.
According Gustillo-Anderson classifi cation, there
were 20 GII, 6GIIIa and 3GIIIb open tibia shaft fractures
without severe bone loss. All patients were treated
with thorough and extensive surgical debridment, external
fi xation and simultaneous application of allograft
and double antibiotic scheme. The patients were followed
up initially weekly till stitches removal and every
second week till the external fi xation removal without
developing any signs of infection.
Overall, there were uncomplicated union in 23 cases
(18 GII, 3GIIIa and 2GIIIb) whereas in 5 cases we had
to change method of treatment (3 GII and 2GIIIa) due
to union delay or non acceptable fracture angulations.
There were also a case that developed deep infection
and septic pseudarthrosis.
The simultaneous external fi xation and allograft
application seems to provide a small advantage in open
fracture consolidation despite the established wisdom
for allograft use on a later stage. The proper initial
open fracture estimation, the right surgical treatment,
the surgeon’s experience and a strict patient’s follow up
schedule are fundamental for a good fi nal outcome
J BONE JOINT SURG [BR] 2011; 93-B:SUPP III