Background:Minimally invasive plate osteosynthesis (MIPO) technique is reported as a satisfactory procedure for the treatment of humeral shaft fractures by the anterior approach by several authors. However, none of the published reports had a significant follow-up nor have they reported patient outcomes. We evaluated the clinical, radiographic, and functional outcome over a minimum follow-up of 2 years using the same MIPO technique to humeral shaft fracture.Materials and Methods:32 adult patients with diaphyseal fractures of the humerus treated with MIPO between June 2007 and October 2008 were included in the study. Patients with metabolic bone disease, polytrauma, and Gustilo and Anderson type 3 open fractures with injury severity score >16 were excluded from the study. All cases were treated with closed indirect reduction and locking plate fixation using the MIPO technique. The surgery time, radiation exposure, and time for union was noted. The shoulder and elbow function was assessed using the UCLA shoulder and Mayo elbow performance scores, respectively.Results:Of the 32 patients in the study, 19 were males and 13 were females. The mean age was 39 years (range: 22–70 years). Twenty-seven of the thirty-two patients (84.3%) had the dominant side fractured. We had eight cases of C2 type; five cases of C1 and A2 type; four cases of B2 type; three cases each of B3, B1, and A1 type; and one case of A3 type of fracture. The mean surgical time was 91.5 minutes (range: 70–120 minutes) and mean radiation exposure was 160.3 seconds (range: 100–220 seconds). The mean radiological fracture union time was 12.9 weeks (range: 10–20 weeks). Shoulder function was excellent in 27 cases (84.3%) and good in remaining 5 cases (15.6%) on the UCLA score. Elbow function was excellent in 26 cases (81.2%), good in 5 cases (15.6%), and fair in 1 case (3.1%) who had an associated olecranon fracture that was fixed by tension band wire in the same sitting.Conclusion:MIPO of the humerus gives good functional and cosmetic results and should be considered one of the management options in the treatment of humeral diaphyseal fractures.
This study retrospectively analysed 34 patients with ipsilateral hip and femoral shaft fractures treated over a period of 10 years between January 1995 and January 2005. They had an average age of 35 years. Twenty-six (76.47%) of these cases suffered high-velocity trauma (RTA); six others had fallen from a height (17.65%), and two had suffered only minimal trauma (5.88%). Twenty were extracapsular (58.82%) and 14 were intracapsular. They were evaluated with an average follow-up of 28 months, both clinically and radiologically; 26 patients (76.47%) had a good result (Friedman and Wyman score). When the intracapsular fracture was detected postperatively, there was one delayed union and one non-union. When the fracture is diagnosed preoperatively, we recommend reconstruction nail fixation. If the hip fracture is diagnosed intra-or postoperatively following nailing of the shaft, we propose the miss-a-nail technique as an option. Résumé
Purpose Computer navigation has the potential to provide precise intraoperative knowledge to the surgeon. Previous studies with navigation have confirmed its function for improved component position but few studies have reported the accuracy and precision of navigation system in clinical use. With this study we propose to evaluate the efficacy of navigation in guiding cup placement. Methods Fifty-six patients undergoing primary total hip arthroplasty were prospectively included in this study. Stryker imageless navigation system which is accurate to 0.5°was used in all cases. Intraoperative data was collected for the acetabular component position using navigation for the freehand cup placement and the final cup placement done using navigation. Postoperative evaluation of component position was done with computed tomography (CT) and the deviation from intraoperative freehand and navigation values were calculated. Results The mean inclination of the freehand reading was 39.5°(range, 20°-58°), mean version of freehand reading was 10.7°(−6°-27°), and the mean navigation reading was 43.2°(37°-49°) for inclination and 13.0°(−8°-24°) for version. On postoperative CT scan analysis the mean inclination was 45.3°(34°-56°) and mean version was 15.1°(4°-25°). The deviation of the freehand inclination from the post operative CT scan reading was 11.4°(1°-30°) and the version deviated by a mean of 10.8°(2°-26°). The deviation of the navigation reading from the CT scan reading had a mean of 5.3°(1°-13°) for inclination and 5.6°( 1°-17°) for version. Conclusion The accuracy of the navigation system over conventional freehand cup placement is validated by this study.
Volar locking plate is a viable option for treating intra-articular distal radius fractures.
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