Aim

The pathogenesis of non-union is multifactorial. Path biological factors, mechanical factors, and low-grade-infection contribute to impaired bone healing. Aim of this study was to determine the rate of low-grade-infection in patients with long bone non-union of the lower extremity without signs of acute infection, the influence of CRP (C-reactive protein), and the outcome.

Background

For the treatment of proximal humeral fractures two major therapeutic principles can be employed: Intramedullary nailing (PHN) or locking plate osteosynthesis. Aim of this study was to evaluate and compare clinical and radiological long-term outcome of proximal humeral fracture stabilization using PHN or angular stable plating. In addition, we discussed advantages and disadvantages of both techniques and aimed at establishing criteria which operative technique should preferentially be utilized for selected fracture configurations.

Background: To improve the primary operative treatment of complex olecranon fractures we searched for new conclusive parameters. We hypothesized that the intermediate fragment plays a critical role for precise restoration of the trochlear notch contour and good outcome of initial operative treatment.

Methods: 58 patients (26 female, 32 male; mean age 55 years) with multi-fragmentary olecranon fracture were identified in a seven-year-period from trauma unit files at two European Level 1 trauma institutions. Retrospective review of all operative reports and radiographs/computed tomography scans identified patients with an intermediate fragment.

Results: 28 patients were treated with stable internal fixation using figure-of-eight tension-band wire fixation and 30 patients using posterior plate osteosynthesis with and without intramedullary screw. An intermediate fragment was seen in 36 patients (62 %). In 17 of these 36 patients (47 %), the intermediate fragment was described in operative report. Twelve of these patients (71 %) were treated with single posterior plate with/without an intramedullary screw, and five patients (29 %) with figure-of-eight tension-band wire fixation.

Conclusion: Fracture analysis identified an intermediate fracture fragment in the majority of patients with complex olecranon fractures. In diagnostic work up a CT scan should be used to assess the fracture pattern and to detect an intermediate fragment. This study suggests that identification, desimpaction and anatomic reduction of the intermediate fragment are critical preconditions for anatomic restoration of the trochlear notch and good functional results. Precise description of the fracture pattern including presence of an intermediate fragment in the operative report is recommended.

Background: Aim of this study was to evaluate and compare clinical and radiological outcome of distal femur fracture stabilization using retrograde nailing or LISS plating.

Materials and Methods: In a retrospective study from 2003–2008 we analyzed 115 patients with distal femur fractures who had been treated by retrograde i.m. nailing (60 patients) or LISS plating (55 patients). Mean age was 55 years in the two cohort groups. Mechanism of injury was high energy impact in 57 % (SCN 53 %; LISS 76 %) and low energy injury in 43 % of all evaluated patients (SCN 47 %; LISS 33 %). Fractures were classified according to AO classification: There were 52 type A fractures (SCN 31; LISS 21) and 63 type C fractures (SCN 28; LISS 35). Interestingly severe articular fractures (type C2 and C3) were found much more often in LISS group (15 patients; 27 %) compared to 5 patients (8 %) in the SCN group.

Results: Fracture healing within 3 months was observed in type A fractures in over 90 % of the cases (SCN 29 patients, 89 %; LISS 20 patients, 95 %). A distinct diffrence was found in type C fractures. Whereas still nearly 90 % consolidation was evaluated in the SCN group (25 patients; 89 %), LISS plate group showed only 41 % (14 patients). Nonunion was found in type A fractures in only one patient per group (SCN and LISS 3 %) and in 2 patients in type C fractures treated with SCN (7 %). As expected 35 % (11 patients) nonunions were found in type C fractures treated with LISS. Both, the nail and the LISS group required additional bone grafting for successful healing (SCN 2; LISS 8). Functional outcome using the KOOS score demonstrated in type A fractures a score of 263 in the nail and 260 in the LISS plate group, and in type C fractures 257 in the nail and 218 in the LISS group. Loosening of screws without disturbing fracture healing (SCN 12 %; LISS 2 %). Deep infection (SCN 2 %; LISS 7 %), axis deviation of more than 10 degrees in the coronal or sagittal plane in 5 % in the nail and 12 % in the plate group were treated.

Conclusion: Both, retrograde i.m. nailing and LISS plating are adequate treatment options for distal femur fractures. No differences in outcome between implants regarding fracture healing, nonunion, and infection were found in type A fractures. A distinct difference occurred in type C fractures. According to high rate of severe articular and open fractures a high rate of nonunions and infections was found in the LISS group. Locked plating can be utilized for all distal femur fractures including complex type C fractures, periprosthetic fractures and osteoporotic fractures. I.m. nailing provides favorable intramedullary stability and can be successfully implanted in bilateral or multisegmental fractures of the distal femur as well as in extraarticular and type C1 to C2 fractures.