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

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370 HELLENIC ASSOCIATION OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 3 with CA. Conclusions: It appears that the immediate surgical intervention of patients with hip fracture has positive effect in the duration of hospitalization, morbidity and mortality 162 ACETABULAR FRACTURES WITH MARGINAL IMPACTION: CLINICAL RESULTS P.V. Giannoudis, N.K. Kanakaris, P. Stavlas, V.S. Nikolaou, N. Prevezas Academic Department of Trauma and Orthopaedics, Leeds Teaching Hospitals, School of Medicine, University of Leeds, UK; Orthopaedic Department of General Hospital of Nikea, Greece The purpose of this study was to investigate the outcome of acetabular fractures treated in our institution with marginal impaction. Over a 5 year period consecutive acetabular cases treated in our institution with marginal impaction were eligible for inclusion in this study. Exclusion criteria were patients lost to follow up and pathological fractures. A retrospective analysis of prospectively documented data was performed. Demographics, fracture types according to the Judet-Letournel classifi cation, radiological criteria of intra-operative reduction (Matta) and secondary collapse, complication rates, and the EuroQol-5D questionnaire were documented over a median period of follow-up of 40months (12-206). Out of 400 cases, eighty-eight acetabular fractures met the inclusion criteria. The majority (93.2%) involved males with a median age of 40.5years (16-80). Half of them were posterior-wall fractures, 21.6%bicolumn, 14.7%posterior-wall and column, 6.8%transverse, 5.7%anterior-column, 1.1%anterior-column posterior hemi-transverse. In 75% of the cases anatomical intraoperative reduction was achieved. Structural-bone-graft was used in 73.9%, and two-level reconstruction in 61%. At the last follow-up, the originally achieved anatomical reduction was lost in 17/66 (25.8%), (10 PW, 4 PC+PW, 1 PC, 1 Transverse, 1 Bicolumn fracture). Avascular necrosis developed in 9.1% and heterotopic ossifi cation in 19.3%. Full return to previous activities was documented in 48.9% of cases, the EuroQol general heath state score had a median of 80% (30-95%), full recovery was recorded as to the patients’ mobility in 51.1%, as to pain in 47.7%, as to self-care in 70.5%, as to work-related activities in 55.7%, and as to emotional parameters in 65.9%. Reoperation (heterotopicossifi cation excision, total-hip-arthroplasty, removal of metalwork) was necessary in 19.2% of cases. Utilising different techniques of elevation of the articular joint impaction leads to joint preservation with satisfactory overall functional results. Secondary collapse was noted in 25.8% of the patients predisposing to a poorer outcome 163 MEDIUM TO LONG TERM RESULTS OF ACETABULAR RECONSTRUCTION FOLLOWING ANTERIOR COLUMN & ANTERIOR WALL FRACTURES N.K. Kanakaris, R.K. Mallina, P. Stavlas, G. Kontakis, P.V. Giannoudis Academic Department of Trauma and Orthopaedics, Leeds Teaching Hospitals, NHS Trust, Leeds, UK Anterior wall and/or column acetabular fractures (AW/ C) have a low incidence rate. Paucity of information exists regarding the clinical results of these fractures. We present our experience in treating AW/C at a tertiary referral centre. Between Jan-2002 and Dec-2007, 200 consecutive patients were treated in our institution with displaced acetabular fractures. All AW/C fractures according to the Letournel classifi cation were included in the study. All patients underwent plain radiography and CT investigations. Retrospective analysis of the medical notes and radiographs was performed for type of associated injuries, operative technique, peri-operative complications. Radiological assessment of fracture healing was determined by Matta’s criteria and functional hip scores were assessed using Merle-d’-Aubigne scoring. The mean follow up was 44.5 months (28-64). 15 patients (10 males) met the inclusion criteria (mean age 55.5years). Four had associated anterior dislocation. Associated injuries included pneumothorax, splenic rupture, tibial and distal radius fractures. Five were treated by percutaneous methods, 8 with platescrew fi xation, and 2 with circlage wire, (10 ilioinguinal approaches). Mean time-to-surgery was 14days(10- 21days). The average operative time for the percutaneous group was 75min vs. 190min in the orif group. Mean postoperative-in-patient-stay was 4 days(3- 7days), and 21days(14-37days). One patient developed chest infection post-operatively, two loss of sensation over the distribution of lateral cutaneous nerve. None of them developed incisional hernia, deep venous thrombosis and pulmonary embolism. At the last follow-up radiological outcome was excellent in 11 and good in 4 patients; clinical outcome was excellent in 12 and good in 3 patients, and none of the patients has developed heterotopic calcifi cation or early osteoarthritis. Our results on management of these fractures are comparable to the early results reported by Letournel. Operative treatment for the rare anterior wall and anterior column fractures yields a favourable outcome resulting in early mobilization with limited patient morbidity 164 EFFECTIVENESS OF PHILOS PLATE IN TREATMENT OF HUMERUS PROXIMAL END FRACTURES E. Athanaselis, I. Gliatis, P. Bougas, M. Tyllianakis Orthopaedic Department, University Hospital of Patras The study of effectiveness of PHILOS plate in the internal osteosynthesis of humeral head fractures. Since 2006 23 patients with 24 humeral head fractures ere treated in our clinic. 10 of them were men (43,48%) and 13 women (56,52%). The average age was 50,4 years (range 16-89 years). Fractures of the surgical neck of humerus were 8 of these (33,33%), 12 were 3 parts fractures according to Neer classifi cation (50%) and fi nally in 3 cases there was a 4 part fracture (16,66%). Shoulder of dominant upper limb was injured in most of the cases (68%). 19 patients (82,6%) were examined periodically in an average follow-up period of 19 months (range 13- 26 months). All the fractures were healed. In 4 cases (16,66%) insuffi cient reduction was detected postoperatively. Constant score was calculated 12 months post-operatively up to 82,05 by mean (range 62-100). Differentiation was observed between the patients of age less than 60 years (12 patients with average constant score 91,25 with range from 78 until 100) and these of age of 60 years or more (7 patients with average constant score 71,43 with range from 62 until 81). Internal osteosynthesis humeral head fractures with PHILOS plate is a reliable method of treatment not only for simple head fractures but also for them of 3 or even 4 parts, without complications and with very good functional results 165 ATLS AND PELVIC RADIOGRAPHY GUIDELINES. HOW GOOD IS CLINICAL EXAMINATION COMPARED TO CONVENTIONAL RADIOGRAPHY? D.S. Evangelopoulos, M. Hilty, L.M. Benneker, H. Zimmermann and A.K. Exadaktylos Department of Orthopaedic Surgery, Inselspital, University of Bern, Switzerland; Department of Emergency Medicine, Inselspital, University of Bern, Switzerland Pelvic x-ray is a routine part of the primary survey of Advanced Trauma Life Support (ATLS) guidelines. However, pelvic CT is the gold standard in the diagnosis of pelvic fractures. This study aims to confi rm the safety of a modifi ed ATLS algorithm omitting pelvic x-ray in hemodynamically stable polytraumatized patients with clinically stable pelvis, in favour of later pelvic CT scan. A retrospective analysis of polytraumatized patients in our emergency room was conducted between 2005 and 2006. Inclusion criteria were blunt abdominal trauma, initial hemodynamic stability and clinically stable pelvis. We excluded patients requiring immediate intervention. We reviewed the records of 452 patients. 91 fulfi lled inclusion criteria (56% male, mean age 45 years). 43% were road traffi c accidents and 47% falls. In 68/91 (75%) patients, both pelvic x-ray and CT examination were performed; the remainder had only pelvic CT. In 6/68 (9%) patients, pelvic fracture was diagnosed by pelvic x-ray. None false positive pelvic x-ray was detected. In 3/68 (4%) cases a fracture was missed in the pelvic x-ray, but confi rmed on CT. 5 (56%) were classifi ed type A fractures, and another 4 (44%) B 2.1 in computed tomography (AO classifi cation). One A 2.1 fracture was found in a clinically stable patient who only received CT scan (1/23). In hemodynamically stable patients with clinically stable pelvis, x-ray sensitivity is only 67% and it may safely be omitted in favor of a pelvic CT examination. The results support the safety and utility of our modifi ed ATLS algorithm 166 QUALITY OF LIFE AFTER TIBIAL PLATEAU FRACTURES E. Myriokefalitakis, K. Papanastasopoulos, Th. Krithymos, I. Giannoulias, K. Kateros, K. Sarantos A’ Orthopaedic Department, General Hospital of Athens “G. Gennimatas” Tibial plateau fractures are common fractures which most of the times require surgery. Recovery can take several months. The aim of our study was to estimate the effect of tibial plateau fractures in quality of life of patients one year after the surgery. During the time period 2004-2007 we treated 86 patients, with a mean age of 44 years (23-68). Fracture classifi cation was according to Schatzker, hence, there were 9 patients with type I, 14 with type II, 20 with type III, 22 with type IV, 13 with type V and 8 with type VI. In 45 (52.3%) patients the articular surface was reduced with limited use of internal fi xation and bone grafts, whereas the remaining patients had syndesmotaxis performed. In all patients stabilization was achieved with hybrid external fi xators. Sixty four patients returned in one year postoperative for the study, at which time they completed the Short Form-36 (SF-36) general health surveys. Compared to the standardized SF-36 categorical and aggregate scores there was no statistically signifi cant difference between the healthy age-matched population and young patients with Schatzker I, II, III and IV fractures. But in 16 patients over 40 years old with Schatzker V and VI fracture, SF-36 score was lower in all categories, despite that 13 of them had full or partial return to pre-injury levels of functioning We conclude that the age of patients and the complexity of tibial plateau fractures infl uence the quality of their life one year post-operative 167 USE OF ILIZAROV TYPE FIXATOR FOR SEVERELY COMMINUTED INTRA- ARTICULAR CALCANEAL FRACTURES. PRELIMINARY RESULTS Ch. Konstantoulakis, G. Grigorakis, C. Manimanakis, G. Poulios, V. Petroulakis Orthopaedic Department, Chania General Hospital We reviewed in retrospect the preliminary results of ilizarov type fi xator for the treatment of severely comminuted calcaneal fractures. Between February 2006 and December 2008 we dealt with six severely comminuted calcaneal fractures in six patients. Two of which were open type Gustillo IIIa. Mean age was 43 years old(28-56 years old) two of which were female and four male. Preoperatively all fractures were checked by x-ray and computed tomography and were all rated as Sanders type IV. The open fractures were treated within 6 hours and the closed J BONE JOINT SURG [BR] 2011; 93-B:SUPP III
ones the following day. After the positioning of the ilizarov tibial and foot frame, an indirect reduction was achieved using the Ilizarov olive wires. Mean follow up was 20 months (9 to 36 months). Results were rated as very good in two patients (33%), good in three patients (50%) and fair in one (17%). So far no re-operation has been required and four of the patients are back to work. We conclude that the ilizarov system, even with indirect reduction can give very promising results in severely comminuted and complex calcaneal fractures whereas internal fi xation has questionable success and many complications 168 OPERATIVE TREATMENT OF BLOUNT DISEASE WITH TSF (TAYLOR SPATIAL FRAME) EXTERNAL FIXATOR Xh. Tsibidakis, V.I. Sakellariou, G. Karaliotas, V. Tsouparopoulos, G. Mazis, A. Kanellopoulos 1st Orthopaedic Department, University of Athens, ATTIKON University General Hospital, Greece To evaluate the operative treatment of Blount disease using the TSF external fi xator and to evaluate the system. During January 2004 and August 2008, 8 males and 2 females with Blount disease (16 limbs) were treated using TSF system. For the radiological assessment we obtained standard long-leg standing radiographs and we measured the anatomic medial proximal tibial angle (aMPTA), the diaphyseal-metaphyseal tibial angle (Drennan), and the femoro-tibial angle. The mean follow-up was 29 months (15 to 45). No patient had pain around the knee, medial or lateral instability. The range motion of the knee immediately after frame removal was 10° to 90° of fl exion in two patients while in the other it was from 0° to 110°.The mean leg-length discrepancy was reduced postoperatively from mean 1,9 cm (1,7-3,2) to 0,9 cm (0- +1,5). The aMPTA angle increased from mean 73° (59°- 83°) to 94° (107°- 90°), Drennan angle from 17° (14°- 22°) to 3° (0°- 7°), and femoro-tibial angle from 17° (10°- 30°) varus to 7° (2°- 10°) valgus. The frame was removed at mean 9 weeks (7- 14). Two patients had delayed union, two presented with loss of correction (due to dissociation of struts and secondary to medial physeal bar), two patients had pin track infection. No neurologic complications were referred. Accurate corrections of multiplanar deformities as varus, internal rotation and shortening of the limb that coexist in Blount disease may be accomplished using TSF system 169 TREATMENT OF PILON FRACTURES WITH ILIZAROV FRAME K. Tilkeridis, A. Khaleel, D. Kotzamitelos, A. Hadzigiannakis, D. Elliott, R. B. Simonis University Hospital of Alexandroupolis; St. Peter’s Hospital, Chertsey, Surrey We treated 60 patients with type III Pilon fractures (Ruedi and Allgower Classifi cation) between 1996 and 2005. The fractures were distracted and then fi xed with an Ilizarov circular ring fi xator, without the use of open surgery. No internal fi xation was used for the tibia or fi bula. No bone grafting was performed. The average time from injury to frame application was four days. The patient stayed ib frame for a mean time of 15 weeks. No second operative procedure was needed. All cases united in good alignment. The patients were reviewed from ten years to nine months after frame removal. Four separate evaluations were performed (functional, objective, radiological and an SF-36). The function and the range of movement were better than the radiological assessment suggested. This method of treatment gives better results with fewer complications than open surgery with internal fi xation J BONE JOINT SURG [BR] 2011; 93-B:SUPP III HELLENIC ASSOCIATION OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 371 170 THE ILIZAROV METHOD FOR THE TREATMENT OF COMPLEX TIBIAL FRACTURES AND NON-UNIONS IN A MASS CASUALTY SETTING: THE 2005 EARTHQUAKE IN PAKISTAN K. Tilkeridis, N. Cheema, A. Khaleel Rowley Bristow Orthopaedic Unit, St. Peter’s Hospital, Chertsey, Surrey We report our experience in treating victims of the recent Earthquake Disaster in Pakistan. Our experience was based on 2 humanitarian missions to Islamabad. First in October 2005, 16 days after the earthquake and the second in January 2006, three months later. The mission consisted of a team of orthopaedic and a second team of plastic surgeons. The orthopaedic team bought all the equipment for application of Ilizarov External Fixators (IEF). We treated patients who had already received basic treatment in the region of the disaster and subsequently had been evacuated to Islamabad. During the fi rst visit we treated 12 injured limbs in 11 patients. 7 of these were children (ages 6 – 14). All the cases were complex and severe multifragmentary fractures associated with crush injuries. All of the fractures involved the tibia, which were treated with IEF. Nine fractures were type 3b open injuries. Eight were infected requiring debridement of infected bone and acute shortening of the limb segment. After stabilization, the plastic surgeons provided soft tissue cover. During the second, we reviewed all patients treated during our fi rst mission. In addition we treated 13 new patients [Table 3] with complex non – unions. Eight out of 13 non-unions were deemed to be infected. All patients had previous treatment with monolateral fi xators (AO type) as well as soft tissue coverage procedures, except one patient who had had a circular fi xator (Ilizarov) applied by another team. All these patients had revision surgery with circular frames 171 DELAYED TREATMENT OF LONG BONE FRACTURES IN POLYTRAUMA PATIENTS WITH THE USE OF RING TYPE EXTERNAL FIXATOR D. Louverdis, S. cPlessas, P. Kontos, N. Baxevanos, V. Petroulias, N. Prevezas Orthopaedic Depart.of General Hospital Nikaia Peirea The defi nite treatment of closed or compound fractures of the long bones in polytrauma patients, who had been treated by bridging external fi xation during the damage control phase is challenging, especially if it is performed delayed when the risk of infection is increased. In such cases the use of ring type external fi xators seems to be a good choice. During the last two years (mean FU 16 months), 22 Polytrauma patients with fractures of the long bones were treated with the use of ring type external fi xators as the defi nite method. Multiplanar reduction at the fracture site could be achieved with this method. 14 patients had a high ISS score in the emergency department. 14 had sustained fracture of the femur while the remaining 8 patients had suffered a tibial fracture. In all but one patient the bone union was achieved in a mean time of 19 months. In a patient with a tibial fracture where a bone defect the bone union was accomplished with bone grafting and the use of growth factors. No complications or loss of reduction were seen, while local signs of infection at the site of half pins insertion in three patients were subsided with administration of local antibiotics. The defi nite treatment with ring type external fi xators of long bone fractures in polytrauma patients seems to be a very good choice. Bone consolidation with no evidence of bone infection was achieved in all patients. while low rate of complications were seen 172 MANAGEMENT OF INTRAARTICULAR CALCANEAL FRACTURES WITH ILIZAROV EXTERNAL FIXATOR A. Saridis, C. Matzaroglou, A. Kallivokas, M. Tyllianakis, P. Dimakopoulos Orthopaedic Department, Medical School, University Hospital of Patras Our purpose was to evaluate the use of indirect and closed reduction with Ilizarov external fi xator in intraarticular calcaneal fractures. In a period of 3 years, 16 patients with 18 intra-articular fractures of calcaneus (eleven type III and seven type IV according to Sanders classifi cation) were treated with the Ilizarov fi xator. Twelve patients were male and four female. The average age was 42 years (range 25 – 63 years). Three fractures were open. Fractures were evaluated by preoperative radiographs and CT scans. Restoration of the calcaneal bone anatomy was obtained by closed means using minimally invasive reduction technique by Ilizarov fi xator. Arthrodiatasis and ligamentotaxis, and closed reduction of the subtalar joint were performed in 14 cases. In 4 cases the depressed posterior calcaneal facet was elevated by small lateral incision and stabilized in frame by wires. Postoperatively, partial, early weight bearing was encouraged in all patients. The mean follow-up period was 1,5 years (range 1 – 3 years). The AOFAS Ankle – Hindfoot Score, and physical examination were used in functional evaluation. The average score was 79,8 (range 72 – 90). Six patients had limited degenerative radiological fi ndings of osteoarthrosis about the subtalar joint and three of them had painful subtalar movement. One of the patients complained of heel pad pain. Nine (6.25%) grade II pin tract infections were detected from a total of 144 wires. No secondary reconstructive procedures, including osteotomies, subtalar fusions, or amputations, have been done. Indirect closed reduction of calcaneal bone anatomy and arthrodiatasis of subtalar joint with Ilizarov external fi xator is a viable surgical alternative for intra-articular calcaneal fractures 173 PITFALLS, OBSTACLES AND COMPLICATIONS DURING DISTRACTION HISTOGENESIS P. Liantis, AF. Mavrogenis, AD. Kanellopoulos, G. Babis, PN. Soucacos 1st Department of Orthopaedics, University of Athens Medical School, “ATtIKON” The purpose of this study is to classify the pitfalls, obstacles and complications that occur during distraction histogenesis and also to evaluate the risk factors likely to lead to these problems. In this study we have retrospectively and prospectively studied the diffi culties occurring during distraction histogenesis since 2003. We studied 74 patients (mean age 19,2 years, age range 11-60yrs) whose 97 limbs segments were lengthened. 21 patients underwent angular correction, 42 patients limb lengthening, 17 patients both angular correction and limb lengthening and 14 non-union correction. In 46 cases, we used the Ilizarov fi xator, in 38 the Taylor Spatial Frame and in 10 cases the monolateral external fi xator Orthofi x LRS. Diffi culties that occured during limb lengthening were subclassifi ed into pitfalls, obstacles, and complications. For all cases we have recorded the time of appearance of all these diffi culties and have associated them with the severity of the initial deformity. The total number of diffi culties in distraction histogenesis was 20%. The number of presenting problems was estimated 5.4% and involved knee subluxation, pin breakage and malalignments. Obstacles presented in 9.5% and included cases with poor bone regeneration, peroneal nerve palsy, premature consolidation and heel cord lengthening. Finally complications were noted in 5.4% of the cases. These consisted of infection, fracture, non-union and loss of range of knee motion. The problems, obstacles and complications that occur during distraction histogenesis can all impact on the optimal therapeutic target. Extensive surgical experience, and optimal pre-operative planning in conjunction with the type of the original deformity may all contribute in minimising these diffi culties
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Page 5 and 6: 024 ARTHROSCOPIC REPAIR OF ACETABUL
Page 7 and 8: 036 ENDOSCOPIC VERSUS OPEN CARPAL T
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Page 11 and 12: 060 COMBINING BIGGER FEMORAL HEADS
Page 13 and 14: 072 THE USE OF VAC SYSTEM IN ORTHOP
Page 15 and 16: 084 THE ROTAGLIDE MOBILE BEARING TO
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