The August 2024 Trauma Roundup³⁶⁰ looks at: Does topical vancomycin prevent fracture-related infections in closed fractures undergoing open reduction and internal fixation? A randomized controlled trial; Is postoperative splinting advantageous after upper limb fracture surgery?; Does suprapatellar nailing resolve knee pain?; Locking versus non-locking plate fixation in comminuted talar neck fractures: a biomechanical study using cadaveric specimens; Revolutionizing recovery metrics: PROMIS versus SMFA in orthopaedic trauma care; Dorsal hook plating of patella fractures: reliable fixation and satisfactory outcomes; The impact of obesity on subtrochanteric femur fracture outcomes; Low-dose NSAIDs (ketorolac) and cytokine modulation in orthopaedic polytrauma: a detailed analysis.

Aims

Accurate skeletal age and final adult height prediction methods in paediatric orthopaedics are crucial for determining optimal timing of growth-guiding interventions and minimizing complications in treatments of various conditions. This study aimed to evaluate the accuracy of final adult height predictions using the central peak height (CPH) method with long leg X-rays and four different multiplier tables.

We describe the technique and results of medial submuscular plating of the femur in paediatric patients and discuss its indications and limitations. Specifically, the technique is used as part of a plate-after-lengthening strategy, where the period of external fixation is reduced and the plate introduced by avoiding direct contact with the lateral entry wounds of the external fixator pins. The technique emphasises that vastus medialis is interposed between the plate and the vascular structures.

A total of 16 patients (11 male and five female, mean age 9.6 years (5 to 17)), had medial submuscular plating of the femur. All underwent distraction osteogenesis of the femur with a mean lengthening of 4.99 cm (3.2 to 12) prior to plating. All patients achieved consolidation of the regenerate without deformity. The mean follow-up was 10.5 months (7 to 15) after plating for those with plates still in situ, and 16.3 months (1 to 39) for those who subsequently had their plates removed. None developed a deep infection. In two patients a proximal screw fractured without loss of alignment; one patient sustained a traumatic fracture six months after removal of the plate.

Placing the plate on the medial side is advantageous when the external fixator is present on the lateral side, and is biomechanically optimal in the presence of a femoral defect. We conclude that medial femoral submuscular plating is a useful technique for specific indications and can be performed safely with a prior understanding of the regional anatomy.

Cite this article: Bone Joint J 2014;96-B:137–42.

Permanent growth arrest of the longer bone is an option in the treatment of minor leg-length discrepancies. The use of a tension band plating technique to produce a temporary epiphysiodesis is appealing as it avoids the need for accurate timing of the procedure in relation to remaining growth. We performed an animal study to establish if control of growth in a long bone is possible with tension band plating. Animals (pigs) were randomised to temporary epiphysiodesis on either the right or left tibia. Implants were removed after ten weeks. Both tibiae were examined using MRI at baseline, and after ten and 15 weeks. The median interphyseal distance was significantly shorter on the treated tibiae after both ten weeks (p = 0.04) and 15 weeks (p = 0.04). On T. 1. -weighted images the metaphyseal water content was significantly reduced after ten weeks on the treated side (p = 0.04) but returned to values comparable with the untreated side at 15 weeks (p = 0.14). Return of growth was observed in all animals after removal of implants. Temporary epiphysiodesis can be obtained using tension band plating. The technique is not yet in common clinical practice but might avoid the need for the accurate timing of epiphysiodesis. Cite this article: Bone Joint J 2013;95-B:855–60

Purpose: Management of unstable or comminuted displaced fractures of the distal radius is difficult. We report our experience treating these fractures with AO volar plate fixation applying the principle of a volarulnar tension band platting. An attempt to introduce a new radiological classification for the accuracy of reduction is made. The classification includes 10 criteria.

Materials and Method: We reviewed clinically and radiologically 99 patients (101 fractures); 60 were type C and 41 were type A. The average follow up was 37 months (24 – 57). The average age was 46 years (19 – 81). Sarmiento’s modification of Gartland and Werley and Cooney’s modification of Green and O’Brien were used for clinical assessment. Lidstorm and Frykman used for radiological assessment.

Results: At final follow up the means of distal radius parameters were: volar tilt of 9°, radial inclination of 22°, radial height of 11mm and palmer cortical angle of 32°. The mean dorsiflexion was 61°, palmer flexion was 59°, pronation was 80° and supination was 76°. Grip strength was 86% of the opposite side. The average DASH score was 13.6. There was 13 poor results, 6 of them had a significant loss the initial reduction. There was significant correlation between our classification outcome and the clinical outcome.

Conclusion: AO volar plate fixation of unstable distal radius fractures provides a strong fixation that maintains reduction and allows early mobilisation.

Displaced comminuted intra-and extra-articular fractures of distal radius require anatomical reduction for optimum results. To assess clinical, functional and radiological results of volar-ulnar tension band plating of dorsally displaced comminuted fractures of distal radius, we used volar-ulnar tension band plating technique (without bone grafting) and early mobilisation to treat dorsally displaced and comminuted fractures of distal radius in 47 patients with an average age of 48 years (range, 19–76 years). Volar tilt, radial height, ulnar inclination and volar cortical angles were measured on the unaffected side. AO volar plate was pre-contoured to match the volar cortical angle of the unaffected side. The horizontal arm of the plate was fixed to the distal fragment first. When the longitudinal arm of the plate was brought onto the radial shaft, the displaced distal fragment was levered out anteriorly to restore the normal volar tilt. Adjustment in ulnar inclination and radial height can be made by medio-lateral and cephalo-caudal movement of the longitudinal arm of the plate. The average follow-up was 26 months (range 12–41 months). According to Gartland and Werley’s system 25 patients had excellent, 15 had good, 7 had fair functional results. The median Disability of Arm, Shoulder and Hand (DASH) score was 10 (range 0–60). Average grip strength as percentage of the unaffected side was 80 %. Average Palmarflexion was 61 degrees, Dorsiflexion 66 degrees, Ulnar deviation 34 degrees, Radial deviation 19 degrees, Supination 74 degrees and Pronation 80 degrees. According to Lidstrom and Frykman’s radiological scoring system 39 patients had excellent and 8 had good anatomical results. Conclusion: This relatively new technique has given good results in majority of patients. We recommend its use in displaced and comminuted fractures of distal radius in physiologically young patients with high need and demand

Introduction We present prospective and retrospective reviews of sacral nonunions treated with posterior tension band plate and iliosacral screws at Frenchay Hospital from 1994. Methods Using the pelvis data base at Frenchay (Bristol, UK) Hospital six patients were identified. A further two patients were followed prospectively. Clinical outcome was measured using a visual analogue score ( VAS ) for pain. Radiological analysis was done using pre-injury x-ray and CT when available, pre-revision and post-operative CT. Eight patients were reviewed. Average follow-up was two years (range 6 months to 5.5 years). The average time from initial injury and surgery to diagnosis of sacral nonunion was 7.5 months (range 3 to 18). Six patients had been treated previously with sacro-iliac screws and an anterior external fixator. Results Pre-operative VAS scores averaged 9.2, postoperatively they averaged 3.4. All nonunions fused radiologically post-operatively. Anterior posterior displacement was able to be corrected by an average of five millimetres. The three fractures that were vertically displaced were not corrected because of coexisting neurological injury. Conclusions Posterior tension band plating and iliosacral screw fixation reliably allows union to be obtained in sacral nonunions

Introduction: Displaced intra and extra-articular fractures of distal radius require anatomical reduction in physiologically young patients. Material and methods: We used volarulnar tension band plating technique (without bone grafting) and early mobilisation to treat dorsally displaced and comminuted fractures of distal radius in 47 physiologically young patients with an average age of 48 years (range, 19–76 years). Volar tilt, radial height, ulnar inclination and volar cortical angles were measured on the unaffected side. AO volar plate was pre-contoured to match the volar cortical angle of the unaffected side. Horizontal arm of the plate was þxed to distal fragment þrst. When the longitudinal arm of the plate was brought onto the radial shaft, the displaced distal fragment was levered out anteriorly to restore the normal volar tilt, ulnar inclination and radial height. Results: The average follow-up was 26 months. According to Gartland and Worleyñs system 26 patients had excellent, 14 had good, 6 had fair and 1 had poor results. The median Disability of arm, shoulder and hand (DASH) score was 10 (range, 0–60). According to Lidstrom and Frykmanñs radiological scoring system 39 patients had excellent and 8 had good anatomical results. Conclusion:We believe this technique is technically demanding and requires good understanding of anatomy and force transmission in an intact and fractured distal radius. This relatively new technique of volarulnar tension band plating of distal radius has given good results in majority of patients. We recommend its use in displaced and comminuted fractures in physiologically young patients with high need and demand