Objective

A clinical investigation into a new bone void filler is giving first data on systemic and local exposure to the anti-infective substance after implantation.

Introduction: Percutaneous iliosacral screws are commonly used for the fixation of the posterior pelvis. The procedure is technically demanding because of the limitations of radiological visualisation of the relevant landmarks. There have been several reports of misplaced screws and other complications, occasionally with serious consequences. To achieve a secure surgical procedure we routinely use a CT-guided technique for percutaneous pelvic screw fixation since 2004.

Methods: Between September 2004 and January 2009, 39 patients were treated using CT-guided screw fixation. Under general anaesthesia patients were placed on a vacuum mattress in a stable lateral position within the CT gantry (Siemens SOMATOM definition; i-Fluoro: 20mAs; Hand CARE mode). The scanner bed was on a calibrated track so the same images could be used and repeated throughout the procedure. Gantry and patient were draped under sterile conditions. The laser sights of the CT indicated the cutaneous site which corresponded to the underlying osseous level (first or second sacral pedicle). At this the CT scan trajectory in the CT-fluoro mode indicated the extrapolated position of the guide-wire. A 3.2mm guide-wire was inserted using battery-powered equipment or hammer blows. When the guide-wire was in a correct position a self-drilling cannulated lag screw was placed (6.5mm DePuy). Two screws were inserted in sacral fractures, one screw in sacroiliac ligament ruptures.

Results: 19 of 39 patients were polytraumatized. In 10 cases there were both side injures. Overall 71 screws were placed. Median time for the procedure was 36 minutes in unilateral lesions and 48 min in bilateral lesions. There were no cases of infection, non-union or neurological deficit. Postoperative CT revealed correct screw positions in all cases. Screw removal was done routinely in the patients younger than sixty years to resolve the blocked sacroiliac joint.

Conclusions: CT-guided is a safe and feasible treatment option in patient with instable pelvic ring lesions. A close collaboration between interventional radiologist and surgeon is essential. Compared to other procedures g.e. internal plate fixation or fluoroscopic guided procedures CT-guided screw insertion seems to be more secure and could strongly be advocated.

Patients and Methods: Between December 2005 until January 2008 34 distal humerus fractures in 33 patients were prospectively documented and treated using the angular-stable LCP distal humerus plate system from Synthes/Switzerland. Patient median age was 54 (min 14/ max 88). Fracture types were classified according to the AO classification. Extraarticular A fractures were documented in 3 (9%) cases, partial intra-articular fractures (type B) were seen in 4 (12%) patients. Complete intraarticular fractures were found in 27 (79%) cases. Three fractures were grade I° open, 6 fractures were grade II° open according to the Gustilo classification. In median after 10 months (min 8/ max 20) follow up was performed. Due to lost to follow up in one patient functional outcome was measured in 32 patients. Functional results were evaluated using the Mayo Elbow Performence Score (MEPS).

Results: According to MEPS, predominantly excellent and good results were achieved. The intent of stable fracture fixation to allow early physical therapy was reached in 31 patients. Failure of osteosynthesis making operative revision necessary occurred in 3 patients (1x implant failure, 2x loss of reduction). Mean Mayo Elbow Performance Score was 91 points (min 88.5/ max 100). Mean range of motion for extension/flexion was 110° (min 80/ max 140) and 170° (min 125/max 180) for pronation/supination. Only one patient regained unrestricted extension, mean loss of extension was 21° (min 10/ max 40). Mean Flexion up to 131° was achieved (min 125/ max 140).

Postoperative complications were seen in eight cases (implant breakage, delayed union, lost of reduction).

Conclusion: Despite postoperative complications and revision surgery, functional results achieved using the angular-stable LCP distal Humerus system are good or excellent in the majority of patients. Through angular-stable and multidirectional screw options fixation of the distal fragment is sufficient and periostal blood supply could be protected. Especially in combination of intraarticular fractures and osteoporotic bone stock the use of the LCP distal Humerus plate system is suitable and permits early physical therapy, promising a benefit for the elbow function.