Aims

We quantitatively compared the 3D bone density distributions on CT scans performed on scaphoid waist fractures subacutely that went on to union or nonunion, and assessed whether 2D CT evaluations correlate with 3D bone density evaluations.

Objectives

To investigate the differences of open reduction and internal fixation (ORIF) of complex AO Type C distal radius fractures between two different models of a single implant type.

Introduction: The aim of this retrospective study is to identify factors that might influence the final result in the treatment of volarly displaced distal radius fractures

Material : 31 patients with an average age of 39 years and a volarly displaced distal radius fracture were treated by ORIF. According to the Comprehensive classification of fractures thee were 3 B3.1, 7 B3.2, and 21 B3.3. All the fractures approached volarly and fixed with a T plate. 3 patients required bone graft. All patients were evaluated with postop radiographs and results were assessed according to the system described by Gartland and Werley.

Results: The average follow up was 50 months. There were twenty excellent, six good and five poor results. Although all fractures healed, six patients had evidence of osteoarthrosis, and there were four early and six late complications, which adversely influenced the final result. Reversal of the volar tilt and evidence of osteoarthrosis found to have a significant association with a fair or poor outcome.

Conclusion: Treatment of such injuries require careful preoperative evaluation and identification of fracture morphology, otherwise the postoperative rate of complications can be quite high, a factor that may negatively influence the final result.

Introduction: The aim of the study was to review the treatment of twenty six patients who had non union of a fracture or osteotomy of the clavicle, with specific attention to the complications of the non union, the techniques used at operation and the outcome of treatment.

Material: There were twenty six patients with clavicular non union. Twenty two patients treated by open reduction and internal fixation, three with partial resection of the clavicle and one with total resection.

Results: The average follow up was 23.4 months. Twenty patients were led to union. Thirteen patients were pain free, whereas the rest had some mild pain. Normal shoulder mobility was noted in fourteen patients. In two patients was necessary to resect the first rib because of symptoms of thoracic outlet syndrome.

Conclusion: Clavicular non-union can cause major functional problems, requiring treatment. Careful evaluation is mandatory in order to decide if the non union is amenable to reconstruction procedure or to salvage operation or to non treatment.

Our aims were to describe the distribution of α-smooth muscle actin (SMA)-containing cells in Dupuytren’s tissue in vivo and to determine the effects of selected agents in regulating the expression of SMA in Dupuytren’s cells in vitro.

In selected hypercellular zones of Dupuytren’s nodules up to 40% of the cells contained SMA, as shown by immunohistochemistry. A lower percentage (20%) of SMA-containing cells was found in regions of lower cellularity. A notable finding was that treatment in vitro of Dupuytren’s cells with platelet-derived growth factor significantly reduced the content of SMA. Cells from the same patients showed a significant increase in expression of SMA in response to treatment with transforming growth factor, which confirmed recent findings. In addition, interferon-γ, which has been previously used as a treatment for Dupuytren’s disease in a clinical study, had no reproducible effect on the expression of this actin isoform. Our findings are of significance for the conservative management of contractures.

We treated 15 patients with atrophic nonunion of a diaphyseal fracture of the humerus with an associated bony defect using an autogenous cancellous bone graft and a plate to bridge the defect. There were nine men and six women with a mean age of 48 years. The mean length of the bony defect was 3 cm.

At a mean follow-up of 30 months only one fracture failed to unite. This suggests that, in the presence of a well-vascularised envelope of muscle, the application of an autogenous cancellous bone graft in conjunction with a bridging plate represents a good alternative to more demanding surgical techniques.

We have treated 16 patients with recurrent complex elbow instability using a hinged external fixator. All patients had instability, dislocation or subluxation of the ulnohumeral joint. The injuries were open in eight patients and were associated with 20 other fractures and five peripheral nerve injuries. Two patients had received initial treatment from us; 14 had previously had a mean of 2.1 unsuccessful surgical procedures (1 to 6). The fixator was applied at a mean of 4.8 weeks (0 to 9) after the injury and remained on the elbow for a mean of 8.5 weeks (6 to 11). After treatment we found the mean range of flexion-extension to be 105° (65 to 140). At a final follow-up of 23 months (14 to 40), the mean Morrey score was 84 (49 to 96): this translated into one poor, three fair, ten good and two excellent results.

Complications included one fractured humeral pin, one temporary palsy of the radial nerve, one recurrent instability, one wound infection, one severe pin-track infection and one patient with reflex sympathetic dystrophy. Although technically demanding, the use of the fixator is an important advance in the management of recurrent complex elbow instability after failure of conventional treatment.

We performed ulnar nerve neurolysis and transposition during reconstructive operations on 20 consecutive patients (21 elbows) with neuropathy after the failure of primary treatment of elbow fractures. There were 11 men and nine women with a mean age of 48.3 years. Preoperatively, four elbows were in McGowan stage I, seven in stage II and ten in stage III and the mean Gabel and Amadio ulnar nerve score was 3.2. At a mean follow-up of 32.1 months (24 to 67) we performed comprehensive neurological, functional, electrophysiological and outcome assessments.

Patient satisfaction was high with good pain relief and restoration of hand strength and dexterity. The mean Gabel and Amadio score had improved to 6.5, an improvement of 3.3. There were one excellent, 16 good, 2 fair and 2 poor results; both of the last were due to failure of the underlying elbow reconstruction. Even for advanced stage-II and stage-III lesions we achieved good function, return of intrinsic power, and a high rate of patient satisfaction.

We have treated 42 consecutive complex ununited fractures of the femoral shaft by wave-plate osteosynthesis at five different medical centres. There were 13 with previous infection, 12 with segmental cortical defects, and 3 were pathological fractures. In 39 cases there had been previous internal fixation and 21 patients had had more than one earlier operation.

Union was achieved in 41 patients at an average of six months, although three had required a second bone graft. Two patients had recurrence of infection and in one this resulted in the persistence of nonunion. There were no failures of the implant. All 41 patients with union are now fully weight-bearing, but four have a leg-length discrepancy, one has axial malalignment, and nine have residual stiffness of the knee. These results are surprisingly good, despite the complexity of the initial problem, and appear to confirm the biological and mechanical advantages of the wave plate over the conventional plate for such cases.