Introduction and objectives

Intramedullary nailing is indicated to stabilization of tibia shaft fractures. Intramedullary nailing through an infra-patellar incision is commonly the technique of choice. While intramedullary nailing of simple diaphyseal fracture patterns is relatively easy, proximal tibia fractures, extremely comminuted/segmental tibia fractures, politrauma with multiple fractures in both extremities and reconstruction of bone loss segment with stiffness of the knee joint can be very challenging to treat.

A novel technique for intramedullary tibia nailing through the patella-femoral joint is described. This technique allow extension tibia during intervention time and it supplies easier reduction of the pattern of fracture above. The purpose of our investigation was to evaluate the use of this new technique in described above pattern fracture and patient situation; because we have thought that new technique can perform better outcomes in this situations.

Objective: To present the experience of a Deparment of Neuroorthopedics in treatment of the severe deformities of the wrist using the technique of the wrist arthrodesis very often associated to other surgical procedures such as musculotendinous lengthenings and transfers.

Materials and Methods: 20 patients with neurological sequelae of cerebral palsy, head trauma, stroke and other neurological disorders of the first motoneuron were retrospectively studied. Fusion of the wrist with an specific plate was performed on these patients.

Results: We reached the consolidation of the arthrodesis in a 100% of the cases between 8 and 12 weeks. We had some complications such as 3 cases of phlictenae and edema and 4 cases needed reoperations because of the appearance of secondary deformities previously not seen. 95% of the patient were satisfied and only one wouldn’t go under the same operation again.

Discusion: Despite many text books contraindicate wrist arthrodesis in patients with neurological sequelae because of the remote possibility that they may need the flexoextensiòn for the use of walker or crutches or manual or electric wheel-chairs, in our experience many patients benefit from this procedure to correct severe deformities that make their hands absolutely dysfunctional. Besides, the intervention provides the patients and their family with benefits in terms of hygiene, dressing, very often improvement of the pain and, why not, of the aesthetics. Some patients have also gained function, passing from a dysfunctional hand to a useful hand for the basic functions of life. Nowadays, for these kind of patients to be able to move one or two fingers, if they are correctly positioned, can be useful to manage a walker, a computer or a motorized wheel-chair.