C. Faymonville

[Reconstruction of shoulder-girdle symmetry after midclavicular fractures. Stable, elastic intramedullary pinning versus rucksack bandage].

ZusammenfassungDas Ziel dieser Untersuchung war der Vergleich der mittelfristigen Behandlungsergebnisse von 2 verschiedenen Behandlungsstrategien bei Klavikulafrakturen des mittleren Drittels. In Gruppe 1 wurden alle Patienten konservativ mit einem Rucksackverband behandelt. In Gruppe 2 wurde die Klavikulafraktur minimal invasiv mit einem ungebohrten elastischen Titannagel intramedullär geschient. Es konnten signifikant bessere Ergebnisse in der Gruppe der operierten Patienten hinsichtlich des Constant-Score, der Schulterfunktion und des kosmetischen Ergebnisses festgestellt werden. Die mittlere Verkürzung der Klavikula war in der konservativen Gruppe signifikant höher als in der operierten Gruppe. Der Wert des absoluten Constant-Score war in der Gruppe 1 signifikant niedriger als in Gruppe 2. Es konnte ein signifikanter Unterschied festgestellt werden zwischen Patienten, die eine Verkürzung der Klavikula von weniger als 1 cm aufwiesen, und Patienten mit einer Verkürzung von 1 cm oder mehr. In Gruppe 1 wurden 2 Pseudarthrosen beobachtet, während in Gruppe 2 alle Frakturen verheilt waren. Refrakturen wurden in beiden Gruppen nicht beobachtet. Die bisherigen Ergebnisse der elastisch stabilen intramedullären Osteosynthese bei Klavikulafrakturen des mittleren Drittels zeigen, dass dieses Verfahren sicher ist und funktionell sowie kosmetisch mittelfristig zu besseren Resultaten als die Behandlung im Rucksackverband führt.AbstractThe aim of this study was to compare the results achieved in two groups of 20 patients treated for midclavicular fracture. The first group (mean age 36 years) was treated non-operatively with a rucksack bandage, whereas the second group (mean age 37 years) underwent intramedullary fixation with a titanium pin using a minimally invasive, unreamed technique. At follow-up, which averaged 3.1±0.9 years in group 1 and 2.9±0.7 years in group 2, the result of treatment, as indicated by the Constant score, functional outcome and cosmetic outcome, was significantly better in the group undergoing operative treatment. Clavicle shortening was significantly (P=0.027) higher in patients treated with a rucksack bandage. The absolute Constant score averaged 78±23 in group 1 and 97±4 in group 2 (P=0.001). The Constant rating scale showed a significant difference between patients with clavicle shortening of less than 1 cm and 1 cm shortening or more. There were two non-unions in group 1 but none in group 2. Refractures were not observed in either group. According to these results, intramedullary fixation with a titanium pin seems to be more advantageous in midclavicular fractures than non-operative treatment. As the operation is well received by the patients, it should be offered to them as an alternative treatment to the rucksack bandage.

Wiederherstellung der Symmetrie des Schultergürtels bei Klavikulafrakturen

ZusammenfassungDas Ziel dieser Untersuchung war der Vergleich der mittelfristigen Behandlungsergebnisse von 2 verschiedenen Behandlungsstrategien bei Klavikulafrakturen des mittleren Drittels. In Gruppe 1 wurden alle Patienten konservativ mit einem Rucksackverband behandelt. In Gruppe 2 wurde die Klavikulafraktur minimal invasiv mit einem ungebohrten elastischen Titannagel intramedullär geschient. Es konnten signifikant bessere Ergebnisse in der Gruppe der operierten Patienten hinsichtlich des Constant-Score, der Schulterfunktion und des kosmetischen Ergebnisses festgestellt werden. Die mittlere Verkürzung der Klavikula war in der konservativen Gruppe signifikant höher als in der operierten Gruppe. Der Wert des absoluten Constant-Score war in der Gruppe 1 signifikant niedriger als in Gruppe 2. Es konnte ein signifikanter Unterschied festgestellt werden zwischen Patienten, die eine Verkürzung der Klavikula von weniger als 1 cm aufwiesen, und Patienten mit einer Verkürzung von 1 cm oder mehr. In Gruppe 1 wurden 2 Pseudarthrosen beobachtet, während in Gruppe 2 alle Frakturen verheilt waren. Refrakturen wurden in beiden Gruppen nicht beobachtet. Die bisherigen Ergebnisse der elastisch stabilen intramedullären Osteosynthese bei Klavikulafrakturen des mittleren Drittels zeigen, dass dieses Verfahren sicher ist und funktionell sowie kosmetisch mittelfristig zu besseren Resultaten als die Behandlung im Rucksackverband führt.AbstractThe aim of this study was to compare the results achieved in two groups of 20 patients treated for midclavicular fracture. The first group (mean age 36 years) was treated non-operatively with a rucksack bandage, whereas the second group (mean age 37 years) underwent intramedullary fixation with a titanium pin using a minimally invasive, unreamed technique. At follow-up, which averaged 3.1±0.9 years in group 1 and 2.9±0.7 years in group 2, the result of treatment, as indicated by the Constant score, functional outcome and cosmetic outcome, was significantly better in the group undergoing operative treatment. Clavicle shortening was significantly (P=0.027) higher in patients treated with a rucksack bandage. The absolute Constant score averaged 78±23 in group 1 and 97±4 in group 2 (P=0.001). The Constant rating scale showed a significant difference between patients with clavicle shortening of less than 1 cm and 1 cm shortening or more. There were two non-unions in group 1 but none in group 2. Refractures were not observed in either group. According to these results, intramedullary fixation with a titanium pin seems to be more advantageous in midclavicular fractures than non-operative treatment. As the operation is well received by the patients, it should be offered to them as an alternative treatment to the rucksack bandage.

Die perkutane Plattenosteosynthese der Klavikula

ZusammenfassungEine Applikation des Titannagels bei A- und B-Frakturen scheitert perioperativ bisweilen aufgrund eines zu kleinen oder verlegten Markraums, was bis dato zu einer offenen Plattenosteosynthese geführt hat. Bei C-Frakturen beobachtet man ein Telescoping-Effekt, sodass diese Fraktur – neben der konservativen Therapie – ausschließlich für eine Plattenosteosynthese geeignet ist. Die minimal-invasive Lösung für C-Frakturen (Stückfrakturen) und als Salvageprozedur für intraoperativ gescheiterte Markraumschienungen mit Hilfe eines Titannagels von A- und B-Frakturen ist die hier erstmals publizierte perkutane LC-Plattenosteosynthese der Klavikula.AbstractInsertion of titanium nails for type A and B clavicular fractures can fail intraoperatively due to the small diameter or irregular nature of the medullary canal. At present, such failures lead to open reduction and fixation (ORIF) with plates. In type C fractures (comminuted fractures), a telescoping effect is observed so that ORIF is the only suitable alternative besides nonoperative therapy. A suitable minimally invasive solution for type C fractures and as a salvage procedure for failed intramedullary nailing of type A and B fractures is presented here for the first time with a percutaneous application of an LC plate to the clavicle.Insertion of titanium nails for type A and B clavicular fractures can fail intraoperatively due to the small diameter or irregular nature of the medullary canal. At present, such failures lead to open reduction and fixation (ORIF) with plates. In type C fractures (comminuted fractures), a telescoping effect is observed so that ORIF is the only suitable alternative besides nonoperative therapy. A suitable minimally invasive solution for type C fractures and as a salvage procedure for failed intramedullary nailing of type A and B fractures is presented here for the first time with a percutaneous application of an LC plate to the clavicle.

Midclavicular fracture: not just a trivial injury: current treatment options.

BACKGROUND Conservative treatment was long recommended for midclavicular fractures because of the excellent results that were reported in the 1960s and 70s. Recently, however, the rucksack bandage has received competition from surgical treatment. The spectrum of operations ranges from classic plate osteosynthesis to intramedullary techniques and angle-stable implants. METHODS We present and evaluate the current treatment options on the basis of a selective review of the literature. RESULTS Recent studies have confirmed some long-held concepts and refuted others. The risk of non-union after conservative treatment was previously reported as 1% to 2% but has turned out to be much higher in selected subgroups such as in patients with severe displacement, female patients, and patients of advanced age. Furthermore, new implants and techniques have made surgery safer and more likely to result in bony union. CONCLUSION In any case of midclavicular fracture, the type of fracture should be precisely analyzed and an individual treatment strategy should be developed in view of the patients particular situation. Current studies show with a high level of evidence (level 1) that patients with dislocated fractures benefit from surgery.

Percutaneous plate osteosynthesis for clavicular fractures. Initial description

ZusammenfassungEine Applikation des Titannagels bei A- und B-Frakturen scheitert perioperativ bisweilen aufgrund eines zu kleinen oder verlegten Markraums, was bis dato zu einer offenen Plattenosteosynthese geführt hat. Bei C-Frakturen beobachtet man ein Telescoping-Effekt, sodass diese Fraktur – neben der konservativen Therapie – ausschließlich für eine Plattenosteosynthese geeignet ist. Die minimal-invasive Lösung für C-Frakturen (Stückfrakturen) und als Salvageprozedur für intraoperativ gescheiterte Markraumschienungen mit Hilfe eines Titannagels von A- und B-Frakturen ist die hier erstmals publizierte perkutane LC-Plattenosteosynthese der Klavikula.AbstractInsertion of titanium nails for type A and B clavicular fractures can fail intraoperatively due to the small diameter or irregular nature of the medullary canal. At present, such failures lead to open reduction and fixation (ORIF) with plates. In type C fractures (comminuted fractures), a telescoping effect is observed so that ORIF is the only suitable alternative besides nonoperative therapy. A suitable minimally invasive solution for type C fractures and as a salvage procedure for failed intramedullary nailing of type A and B fractures is presented here for the first time with a percutaneous application of an LC plate to the clavicle.Insertion of titanium nails for type A and B clavicular fractures can fail intraoperatively due to the small diameter or irregular nature of the medullary canal. At present, such failures lead to open reduction and fixation (ORIF) with plates. In type C fractures (comminuted fractures), a telescoping effect is observed so that ORIF is the only suitable alternative besides nonoperative therapy. A suitable minimally invasive solution for type C fractures and as a salvage procedure for failed intramedullary nailing of type A and B fractures is presented here for the first time with a percutaneous application of an LC plate to the clavicle.

[Type 2 dens fracture in the elderly and therapy-linked mortality : Conservative or operative treatment].

BACKGROUND Type II fractures of the odontoid process of the axis are the most common injury of the cervical spine in elderly patients. Only little evidence exists on whether elderly patients should be treated conservatively or surgically. MATERIAL AND METHODS The mortality and survival probability of 51 patients were determined in a retrospective study. The range of motion, pain and the neck disability index were clinically investigated. RESULTS Of the 51 patients 37 were treated surgically and 14 conservatively. The conservatively treated group showed a higher mortality (64 % vs. 32 %). Kaplan-Meier analysis revealed a median survival of the conservatively treated group of 29 months, whereby during the first 3 months of treatment this group showed a higher survival probability and afterwards the surgically treated group showed a higher survival probability. The clinical examination of 20 patients revealed limited range of motion of the cervical spine. Additionally, moderate levels of pain and complaints were recorded using the neck disability index. CONCLUSION Fractures of the odontoid process pose a far-reaching danger for elderly patients. A balanced assessment of the general condition should be carried out at the beginning of treatment of these patients. In the early phase following trauma no differences were found with respect to survival rates but for long-term survival the operatively treated group showed advantages; however, these advantages cannot be causally attributed to the choice of therapy.

Typ-II-Densfrakturen des alten Menschen und therapiebedingte Mortalität

BACKGROUND Type II fractures of the odontoid process of the axis are the most common injury of the cervical spine in elderly patients. Only little evidence exists on whether elderly patients should be treated conservatively or surgically. MATERIAL AND METHODS The mortality and survival probability of 51 patients were determined in a retrospective study. The range of motion, pain and the neck disability index were clinically investigated. RESULTS Of the 51 patients 37 were treated surgically and 14 conservatively. The conservatively treated group showed a higher mortality (64 % vs. 32 %). Kaplan-Meier analysis revealed a median survival of the conservatively treated group of 29 months, whereby during the first 3 months of treatment this group showed a higher survival probability and afterwards the surgically treated group showed a higher survival probability. The clinical examination of 20 patients revealed limited range of motion of the cervical spine. Additionally, moderate levels of pain and complaints were recorded using the neck disability index. CONCLUSION Fractures of the odontoid process pose a far-reaching danger for elderly patients. A balanced assessment of the general condition should be carried out at the beginning of treatment of these patients. In the early phase following trauma no differences were found with respect to survival rates but for long-term survival the operatively treated group showed advantages; however, these advantages cannot be causally attributed to the choice of therapy.

Compartments of the foot: topographic anatomy

Recent publications have renewed the debate regarding the number of foot compartments. There is also no consensus regarding allocation of individual muscles and communication between compartments. The current study examines the anatomic topography of the foot compartments anew using 32 injections of epoxy-resin and subsequent sheet plastination in 12 cadaveric foot specimens. Six compartments were identified: dorsal, medial, lateral, superficial central, deep forefoot, and deep hindfoot compartments. Communication was evident between the deep hindfoot compartment and the superficial central and deep central forefoot compartments. In the hindfoot, the neurovascular bundles were located in separate tissue sheaths between the central hindfoot compartment and the medial compartment. In the forefoot, the medial and lateral bundles entered the deep central forefoot compartment. The deep central hindfoot compartment housed the quadratus plantae muscle, and after calcaneus fracture could develop an isolated compartment syndrome.

Pseudarthrose nach intramedullärer Nagelung der Klavikula mit einem Stahl-Kirschner-Draht

Elastically stable intramedullary nailing is a safe surgical procedure used to treat mid-shaft clavicular fractures of types A and B according to the Orthopaedic Trauma Association (OTA) classification. In the case reported intramedullary fixation with a Kirschner wire and an incorrectly performed surgical technique led to pseudoarthrosis (non-union). After revision surgery with an elastically stable titanium nail and a correct surgical technique, fracture healing was achieved.

Typ-II-Densfrakturen des alten Menschen und therapiebedingte Mortalität@@@Type 2 dens fracture in the elderly and therapy-linked mortality: Konservative oder operative Behandlung@@@Conservative or operative treatment

BACKGROUND Type II fractures of the odontoid process of the axis are the most common injury of the cervical spine in elderly patients. Only little evidence exists on whether elderly patients should be treated conservatively or surgically. MATERIAL AND METHODS The mortality and survival probability of 51 patients were determined in a retrospective study. The range of motion, pain and the neck disability index were clinically investigated. RESULTS Of the 51 patients 37 were treated surgically and 14 conservatively. The conservatively treated group showed a higher mortality (64 % vs. 32 %). Kaplan-Meier analysis revealed a median survival of the conservatively treated group of 29 months, whereby during the first 3 months of treatment this group showed a higher survival probability and afterwards the surgically treated group showed a higher survival probability. The clinical examination of 20 patients revealed limited range of motion of the cervical spine. Additionally, moderate levels of pain and complaints were recorded using the neck disability index. CONCLUSION Fractures of the odontoid process pose a far-reaching danger for elderly patients. A balanced assessment of the general condition should be carried out at the beginning of treatment of these patients. In the early phase following trauma no differences were found with respect to survival rates but for long-term survival the operatively treated group showed advantages; however, these advantages cannot be causally attributed to the choice of therapy.