Thirty-eight patients with nonunion of the humeral shaft underwent a comprehensive assessment including completion of three patient-based functional outcome surveys as well as the determination of the Constant shoulder and Mayo elbow scores. Treatment consisted of compression plating with or without bone grafting. Smokers were found to have significantly longer time to union as compared to nonsmokers (25.1 weeks vs. 16.2 weeks, p<
0.001). Our results also demonstrated that increased time to union had a significant negative effect on the patient-reported functional outcome scores. To evaluate the functional outcome and identify prognostic factors that influence the healing time of surgically treated humeral shaft nonunions. Time to consolidation of operatively treated humeral shaft nonunions was significantly longer in smokers versus non-smokers. Time to union was negatively associated with the patient-reported functional outcome scores. The long-term functional outcome following surgical treatment of humeral shaft nonunions is dependent upon the time to consolidation. Smoking is a significant remediable risk factor for delayed union following surgical repair of humeral shaft nonunion. We identified thirty-eight patients (mean age fifty-five years) treated surgically for nonunion of the humeral shaft at a mean follow-up of sixty months. All patients underwent a comprehensive assessment including the completion of the SF-36, the DASH, the SMFA and the determination of the Constant shoulder and Mayo elbow scores. Seventeen (44.7%) patients were classified as ‘smokers’ and twenty-one (55.3%) were ‘non-smokers’. All nonunions united with a mean time of 16.2 weeks for non-smokers and 25.1 weeks for smokers (p<
0.001). Time to union was negatively associated with the Physical Function portion of the SF-36 (p=0.01), the DASH (p=0.01), and the Arm and Hand Function part of the SMFA (p=0.005). The only other factor that had a significant negative effect on the functional outcome scores was the presence of one or more comorbid factors (SF-36, p<
0.001; DASH, p<
0.001; SMFA, p<
0.001). Patient-oriented and surgeon based scores were found to correlate well (range r=0.545 to r=0.916, p<
0.001 for all combinations).
The purpose of this study was to evaluate functional outcome in patients with combined pelvic and acetabular fractures and to identify factors associated with outcome. One hundred and fifteen patients were identified. 63% were male; mean age was thirty-seven years; mean ISS was thirty. Three patients died from their injuries. At a mean follow-up of 3.5 years, patients exhibited profound functional deficits compared to the normal population. Those with an acetabular fracture involving the posterior wall or an associated lower extremity injury have a particularly poor prognosis. Combined pelvic and acetabular injuries are associated with high mortality and functional morbidity irrespective of treatment. To evaluate functional outcome in patients with combined pelvic and acetabular fractures and to identify factors associated with outcome. Combined pelvic and acetabular injuries are associated with high mortality and functional morbidity irrespective of treatment. These results will allow us to further investigate which injury is dictating prognosis in the combined injury – the pelvic or the acetabular fracture. One-hundred and fifteen patients with combined pelvic and acetabular injuries were identified at a level One trauma centre. 63% were male; mean age was thirty-seven years (13–88); mean ISS was thirty (16–75). Three patients died from their injuries. 16% involved bilateral pelvic fractures; 7% bilateral acetabular fractures; and for 2%, both were bilateral. 64% were Tile B and 34% were Tile C. Most acetabular fractures involved the anterior column or both column. Only 18% were treated with ORIF for both injuries. 25% had ORIF of their acetabulum and 14% had ORIF on their pelvis. Sixty-five patients completed validated functional outcome questionnaires at a mean follow-up of 3.5 (one to eleven) years. Patient function was significantly compromised with a mean MFA score of 33.8 (SD 21.8). Function was worse for all 8 SF-36 domains and the two component scores compared to the health status of the Canadian normal population (p<
0.001). Those individuals with an acetabular fracture involving the posterior wall or an associated lower extremity injury have a particularly poor prognosis. There was no relationship found between treatment or the pre-defined stability groups and functional outcome.
In five teaching hospitals, seventy-two patients with seventy-three bicondylar tibial plateau fractures were prospectively randomized by envelope to treatment either by AO methods (group A) or ring fixator methods (group B). Outcome measures included clinical and radiographic parameters, &
HSS knee scores.
More patients had more septic and wound complications resulting in more need for re-intervention following ORIF.
We have conducted a prospective randomized trial to determine the outcomes of treatment by
Open reduction and internal fixation or Closed reduction and ring fixation for the treatment of bi-condylar tibial plateau fractures (OTA 41.C) We report our early findings on re-intervention rates for complications. In five teaching hospitals, seventy-two patients with seventy-three bi-condylar tibial plateau fractures were prospectively randomized by envelope to treatment either by AO methods (group A) or ring fixator methods (group B). Outcome measures included clinical and radiographic parameters, &
HSS knee scores. Randomization gave the following demographics Re-intervention was necessary within six months in ten group A &
seven Group B patients. Forty-three procedures were performed (thirty-three Group A-ten Group B) I&
D 12- 3: STSG 3-0: Quadricepsplasty 1-0; Manipulation 2-4; Muscle flap 2-0; Above knee amputation 1-0; Revision ORIF 5-1; Revision Rings 0-1; Bone graft 2-1; Bead pouch 3-0; Synovectomy 1-0; Sequestrectomy 1-0. More patients had more septic and wound complications resulting in more need for re-intervention following ORIF. For bi-condylar tibial plateau fractures (OTA 41.C) six-month HSS scores are significantly higher after treatment with Ring Fixator methods. Reintervention rates for deep sepsis/wound problems are higher with AO methods. Wound and infection complications occurring after AO treatment are more severe and require multiple procedures for control. Please contact author for pictures and/or diagrams.
A total of 179 adult patients with displaced intra-articular fractures of the distal radius was randomised to receive indirect percutaneous reduction and external fixation (n = 88) or open reduction and internal fixation (n = 91). Patients were followed up for two years. During the first year the upper limb musculoskeletal function assessment score, the SF-36 bodily pain sub-scale score, the overall Jebsen score, pinch strength and grip strength improved significantly in all patients. There was no statistically significant difference in the radiological restoration of anatomical features or the range of movement between the groups. During the period of two years, patients who underwent indirect reduction and percutaneous fixation had a more rapid return of function and a better functional outcome than those who underwent open reduction and internal fixation, provided that the intra-articular step and gap deformity were minimised.
We sought to quantify agreement by different assessors of the AO classification for distal fractures of the radius. Thirty radiographs of acute distal radial fractures were evaluated by 36 assessors of varying clinical experience. Our findings suggest that AO ‘type’ and the presence or absence of articular displacement are measured with high consistency when classification of distal radial fractures is undertaken by experienced observers. Assessors at all experience levels had difficulty agreeing on AO ‘group’ and especially AO ‘subgroup’. To categorise distal radial fractures according to joint displacement and AO type is simple and reproducible. Our study examined only whether distal radial fractures could be consistently classified according to the AO system. Validation of the classification as a predictor of outcome will require a prospective clinical study.
We reviewed the results of 13 adults of secondary reconstruction of malunited and ununited intraarticular distal humeral fractures. Their average age was 39.7 years, and preoperatively all had pain, loss of motion and functional disability; the average arc of motion was only 43 degrees and the average flexion contracture was 45 degrees. Nine patients had ulnar neuropathy. Elbow reconstruction, at an average of 13.4 months after the original injury, included osteotomy for malunion or debridement for nonunion, realignment with stable fixation and autogenous bone grafts, anterior and posterior capsulectomy and ulnar neurolysis. The elbows were mobilised 24 hours postoperatively. There were no early complications and all nonunions and intra-articular osteotomies healed. After a mean follow-up of 25 months, the average arc of motion was 97 degrees with no progressive radiographic degeneration. Ulnar nerve function improved in all cases and clinical assessment using the Morrey score showed two excellent, eight good and three fair results. Reconstruction of intra-articular malunion and nonunion of the distal humerus in young active adults is technically challenging, but can improve function by restoring the intrinsic anatomy of the elbow.