Fractures of proximal humerus account for nearly 5% of all fractures. Majority of these fractures are minimally displaced and can be treated non-operatively with good functional results. However, treatment of unstable, displaced and comminuted fractures remains a challenge and optimal treatment continues to be controversial. This study was undertaken to evaluate the results of proximal humeral internal locking system (PHILOS) plating done for treatment of displaced three- and four-part fractures of the proximal humerus. Between November 2003 and February 2008, a total of 36 patients with displaced three- and four-part fractures of the proximal humerus had an open reduction and internal fixation using a PHILOS plate. Data was collected retrospectively and clinical and radiological outcomes were assessed. The mean follow up was 18 months. 35 (97.2%) united clinically and radiologically, with a mean neck/shaft angle of 127.1 degrees. One patient (2.8%) had revision procedure for implant failure, with a longer PHILOS plate and bone graft. The mean time to union was 9 weeks (7 to 20). The mean Constant score at final review was 72.1 (36 to 96). A total of 16 patients (44.4%) had excellent outcome, 16 (44.4%) had satisfactory outcome, but in four (11.2%) the outcome was poor. The PHILOS plate provides good fracture stability early-on allowing early mobilisation without compromising fracture union. It requires minimal soft tissue dissection, does not need contouring and angular screw fixation gives good stability. We stress the importance of minimal soft tissue dissection to preserve the vascularity of the head, indirect methods of reduction and early mobilization.
Authors have been using kinematic computer navigation for a total knee replacement surgery since 2003. A contribution and advantage of computer navigation is well recognized. Exact guidance of both tibial and femoral osteotomy along with precise soft tissue balance respecting individual anatomic constitution is achieved by exact collection and computer evaluation of data by a use of special sensors and probes. Use of kinematic navigation in experienced hands minimizes deviation from physiological mechanical Mikulicz axis. This is considered the most important step to achieve a good long term outcome after total knee arthroplasty. We have been recently using Brain Lab kinematic navigation system in both primary and revision knee arthroplasties. 200 primary and 20 revision knee arthroplasties are included in the retrospective 3 year follow up study. A navigated revision surgery is recently performed only in cases where the axial deformity does not exceed 10 degrees and where no significant bone loss is presented (bone defects less that ½ cm). Standard cemented components are used in both primary and revision cases. A primary navigated knee arthroplasty had no exclusion criteria in the above study.
No need for conversion to a revision knee system using stem and wedges was noticed in the above series. Following the above inclusion criteria standard cemented implants were used only. We conclude that the use of navigation in cases of relatively uncomplicated knee revision arthroplasty guaranties good mid term outcome, good soft tissue balance, saves money on expensive knee revision systems and guaranties an alternative of second stage revision surgery with a use of extensive revision systems. Standard implant selection does not apply for those with deep bone defects and axial deformation higher than 10 degrees.
Authors in the presentation document the arthroscopic method of treatment of tibial intercondylar eminence fractures in children age. They follow up the short-time and middle-time results after using this method in 20 patients. Method consists in early arthroscopic revision of traumatized knee joint in children with avulsion of intercondylar eminence, haematoma irrigation and the management of the eminence avulsion depending on the size of the tibial bone fragment. Because of bleeding and fat release from traumatized bone is recommended using the water pressure pump. The reposition of the bone fragment to the original position is made after the fracture bed revision and inverted soft tissues removal. The reposition is recommended to do in 30 grade flection of the knee when LCA is maximally relaxed and fragment retention is optimal. After the reposition of the bone fragment we fix it by 2 crossed Ki wires inserted or percutaneously parapatellarly or by the arthroscopic portal using method outside-inside-out.. Immobilization is recommended in 30 grade flection position. The evaluation of 20 patients after arthroscopic surgery shows on the x-ray excellent and very good results in all patients. In 16 cases the clinical examination result is excellent with no instability of the knee, stable LCA and no front shift sign. In 4 cases was found front shift sign without clinically significant anteromedial stress instability of the knee. In 1 case there was made conversion to open revision with suturing of the fragment by PDS suture. Because the bony fragment was 1cm2 large only the closed reposition and retention was not sufficient. The method appears certainly gentle with minimal traumatization of the joint capsule. The above all advantage is in non traumatic metals replacement without second stage surgery and anesthesia. In 4 cases we saw temporary LCA hyperlaxity. We prerequisite passive tonization of the ligament while skeleton growth. Clinical results of the method are satisfactory comparable to the open reduction and fixation by suture or cerclage. The method is not recommended in cases with bony fragment smaller then 1cm2 for not sufficient retention. In these cases we do an arthroscopic verification followed by open reduction.
