Treating unstable distal radius fractures with volar locking plate—Functional and radiological outcomes

Abstract

Purpose: Clavicle fracture is a common orthopaedic injury. Recent studies suggest a better outcome following open reduction and internal fixation for displaced midshaft clavicle fractures. Standard AP view is used in most hospitals to diagnose and treat midshaft clavicle fracture. The aim of our study was to identify if the second view (30 • caudal tilt) changes the treatment of clavicle fractures.Methods: A prospective study was conducted between March and June 2009. 17 patients attending the fracture clinic with midshaft clavicle fracture were reviewed by 5 orthopaedic trainees with X-rays. The fractures were classified according to Edinburgh Classification and treatment plan was decided after reviewing 1 and 2 views of the clavicle.Results: 84 treatment responses were available for 17 patients with midshaft clavicle fractures. 66 responses (79%) decided conservative treatment and 18 (21%) operative treatment after reviewing 1 view of the clavicle fracture. 34 responses (41%) were changed after reviewing the 2nd view and operative treatment was offered to 47 patients (56%). Fracture classification was also changed for 45 (54%) responses after the 2nd view. 84% responses preferred 2 views of the clavicle for diagnosis and treatment of midshaft clavicle fractures.Conclusions: We looked at the treatment offered to the patients with midshaft clavicle fractures by orthopaedic trainees in the fracture clinic of a teaching hospital after reviewing 1 and 2 views of clavicle X-rays.We found that the treatment changed significantly after reviewing the 2 views. We strongly recommend 2 views of the clavicle to decide the treatment of midshaft clavicle fractures.Proximal humeral fractures previously had been relegated to surgical scrap heap. Over the last two decades, significant interest has been evolved in the surgical fixation of unstable and displaced fractures of the proximal humerus. PHILOS plate fixation is relatively new and effective way to treat these complex fractures.Aim of study: To asses the radiological outcome following fixation of proximal humeral fracture using PHILOS plate.Method: Retrospective review of X-ray from patient with proximal humeral fracture treated with PHILOS plate. Thirty nine (39) patients were reviewed from 2007 to 2010. Patient age, sex, medical background information gathered. Mean follow up time was (6 months). Initial and follow up X-ray reviewed and complications such as screw penetration, avascular necrosis (AVN), non union and malunion were looked at.Outcome: Female to male ratio was 3:1. Majority of the fracture was three part (24, 61.5%) with two cases of fracture dislocation (5.1%).Screw penetration was the main complication following this surgery (8, 20.5%). There were two cases of AVN and (20.3%) malunion (Varus). Majority of complication happened when the fracture was not satisfactory reduced intraoperatively.Conclusion: Fracture proximal humerus can be challenging and there is still controversy regarding optimal management of these injuries. PHILOS plating is relatively new ...