Distal metaphyseo-diaphyseal humeral fractures are challenging particularly if open, comminuted, or associated with nerve injury. In cases of open distal complex metaphyseo-diaphyseal humeral fractures inamenable for traditional methods of fixation, retrograde intramedullary locked humeral nail with a new lateral condylar point of entry has been proposed. Methods: Two phases of study were conducted; phase I comprised computerized tomography evaluation of right humeri of 120 adult subjects, while phase II entailed prospective analysis of 18 patients who sustained firearm injuries resulting in open distal metaphyseo-diaphyseal humeral fractures associated with radial nerve injuries. All patients were surgically managed using lateral condylar retrograde humeral nailing with primary radial nerve exploration. Results: Distal sagittal medullary diameter of the humeral medulla was the narrowest in comparison to axial and coronal medullary diameters in phase II, which matched the results of phase I. The mean postoperative disability of the arm, shoulder, and hand score was 11.2 + 6.4. Only five patients underwent subsequent successful tendon transfer. Conclusions: Lateral condylar retrograde humeral nail with early radial nerve exploration in cases of high-energy distal metaphyseo-diaphyseal humeral fractures yielded good results regarding union and spontaneous radial nerve recovery or later on reconstruction.
Background Data: Lumbar spondylolysis is often managed by conservative methods in most patients. Operative interference is indicated in symptomatic patients not responding to medical treatment or patients with multilevel pars defect. Purpose: To evaluate the clinical, functional, and radiological results of bone graft and pedicular screw fixation and rod laminar hook construct in treatment of lumbar spondylolysis. Study Design: A prospective clinical case cohort study. Patients and Methods: Between October 2017 and January 2019, fifteen patients with symptomatic lumbar spondylolysis not responding to conservative treatment for more than 6 months were treated by reconstruction of pars defect by bone block autografting and fixation using pedicular screw laminar hook construct. The mean follow-up was 9.47±3.07 months. All patients were examined pre-and postoperatively and they were followed up clinically; for measuring their pain scale, Visual Analogue Scale (VAS); functionally, Oswestry Disability Index (ODI); radiologically (pars defect healing). Perioperative outcomes and complications were documented. Results: Clinical, radiological, and functional outcomes were significantly improved. Bony union was evident in all patients (100%). Blood loss, operative time, and hospital stay were reported. Two cases reported complications in this study: misplaced pedicular screw and superficial wound infection. Conclusion: Direct reconstruction of pars defect by bone graft and fixation using pedicular screw rod laminar hook construct is an effective feasible procedure in treating lumbar spondylosis. It preserves lumbar motion and hence may decrease adjacent segment problems. (2019ESJ194)
We report outcomes of patients who were managed with two-stage tendon grafting for neglected Zone 2 flexor tendon injuries from 2012 until 2019. The patients were divided into two cohorts: recent series (Series 1) included patients treated with local anaesthesia and epinephrine (16 fingers, from 2015), and earlier series (Series 2) included patients treated with either general or local intravenous anaesthesia and tourniquet (12 fingers, before 2015). The patients in Series 1 achieved statistically better mean total active motion of the operated fingers and grip compared with the contralateral hand than the earlier series ( p = 0.03, p = 0.01, respectively). With the Tang grading system, excellent and good results were achieved in 13 and six fingers of the patients in Series 1 and Series 2, respectively. We conclude that wide-awake second stage of staged flexor tendon grafting provides fine-tuned adjustment of length and tension of the graft, but we cannot conclude about comparative outcomes between two series because the sample size is small and the earlier series was operated by the same surgeons with lower expertise level. Level of evidence: IV
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