S. Piatek

Outcome after surgery of distal radius fractures: no differences between external fixation and ORIF

The purpose of this study was to determine the most appropriate surgical treatment from three procedures used for fractures of the distal radius. In a retrospective comparative study, 166 out of 237 patients who underwent surgery for AO/ASIF A3 or C2 distal radius fractures were evaluated. Surgical procedures were external fixation or open reduction and internal fixation with either palmar or dorsal plates. Radiological outcomes were palmar tilt, radial angle, radial length and ulnar variance. Functional outcomes were range of motion and grip strength. In addition, outcomes according to Gartland and Werley and the Disabilities of the Arm, Shoulder and Hand questionnaire were compared. Further outcome criteria were the treatment time and the number of complications. Data were analysed using an analysis of variance statistical procedure respective of the χ2-test. Open reduction and internal fixation, in particular palmar plate fixation, demonstrated the best radiological and functional results. Subjective assessment of ORIF proved better than that of external fixation as treatment time was shorter and complications were more rarely seen. However, most of the differences between groups were not significant. Although there were no significant differences between groups, our data indicates that most dorsally displaced distal radius fractures can be treated successfully by open reduction and internal fixation. Palmar plate fixation seems to have slight advantages compared to both the external fixation and dorsal plate fixation surgical procedure.

Outcome of surgically treated intraarticular calcaneus fractures—SF-36 compared with AOFAS and MFS

Background There is no consensus as to which is the best treatment for intraarticular fractures of the calcaneus. Furthermore, few studies have assessed general health after calcaneus fractures. We therefore measured the state of general health after operation of calcaneal fractures and compared these data with usual foot-scores. Patients and methods We compared the general health of 71 patients with surgically treated calcaneal fractures 2.5 years after injury, with the general health of 71 people from the standard German population (German National Health Survey, 1998) using the SF-36 form. We compared the results of the examination with results of AOFAS Ankle Hindfoot Scale and Maryland Foot Score in the treated patients. Results In patients with calcaneal fractures, there were significant limitations regarding general health in all 9 elements of the SF-36 form. Correlations between SF-36 and foot-scores were strong regarding function and pain scales, but moderate for all other scales. Interpretation Patients face significant limitations regarding general health after calcaneal fractures. The usual foot-scores measure only 2 dimensions of outcome: function and pain. To measure all dimensions of outcome, SF-36 is a better alternative.

Retrograde Marknagelung von Femurfrakturen mit dem langen Nagel

ZusammenfassungFragestellung. Die orthograde Nagelung gilt als Methode der Wahl bei Femurfrakturen. Zugangsbedingt sind Komplikationen nicht selten. Bietet die retrograde Nagelung Vorteile und kann sie das Indikationsspektrum erweitern? Methodik. Im Rahmen einer prospektiven Studie wurden 70 Femurfrakturen bei 62 Patienten mit langem retrograden Nagel stabilisiert. Ergebnisse. 50 Patienten (57 Frakturen) wurden 13,3 Monate postoperativ (3–36) nachuntersucht.Mit Ausnahme einer Infektpseudarthrose heilten alle Frakturen zeitgerecht. Die Kniebeugung war bei Schaftfrakturen (32A–C) im Zeitraum von 12 Monaten in 81% der Fälle im Normbereich, bei distalen Frakturen (33A–C) in 44%. Eine Streckhemmung bestand bei keinem Patienten. Zwei Patienten wiesen eine Beinverkürzung von 1 cm auf.Rotationsfehlstellungen über 5° bestanden nicht. Das funktionelle Ergebnis (Neer) war bei Schaftfrakturen überwiegend ausgezeichnet (89%), bei supra-/supradiakondylären Frakturen in 50% der Fälle.Bei 18 arthroskopiegestützten Materialentfernungen zeigte das Femuropatellargelenk keine pathologischen Veränderungen. Schlussfolgerung. Die retrograde Femurnagelung bietet Vorzüge gegenüber dem orthograden Vorgehen und erweitert die Palette der Behandlungsmethoden.AbstractPurpose of the study. Antegrade intramedullary nailing is seen as a most effective method in the management of femoral fractures. However, complications may arise due to the surgical approach.Can these disadvantages be avoided by using a retrograde approach? Material and methods. In a prospective study 70 femoral fractures in 62 patients were stabilised using a long intramedullary nail by a retrograde approach. Results. We were able to re-examine 50 patients (57 fractures) 13,3 (3–36) months after the operation.Apart from one non-union by infection, all fractures healed in time. Flexion of the knee joint was within a normal ROM in 81% of shaft fractures 12 months or more after the operation, as was the case in 44% of distal fractures. A inhibition of extension was not found in any patient.Two patients had a femoral shortening of up to one centimeter.We observed no rotational malalignement of more than 5°.The clinical results were excellent in 89% of shaft fractures, and in 50% of supra-/diacondylar fractures. In 18 cases a nail removal was already performed, thereby allowing an arthroscopical follow-up inspection of the knee joint.No knee pathology due to nailing was found in either case. Conclusion. Our results show the advantages of retrograde intramedullary nailing in comparison to the antegrade method.

[Quality of life after calcaneal fractures. A matched-pairs trial with a standardised German control group].

ZusammenfassungZiel der vorliegenden Studie war die Beurteilung von Einschränkungen der gesundheitsbezogenen Lebensqualität nach operativer Behandlung von Kalkaneusfrakturen und der Vergleich dieser Ergebnisse mit denen gebräuchlicher Fußscores. 55 Patienten mit einseitiger Kalkaneusfraktur und operativer Versorgung durch Plattenosteosynthese wurden 2,9 Jahre nach Unfall mit 55 Probanden der deutschen Normpopulation des Bundes-Gesundheits-Surveys 1998 bezüglich der Lebensqualität durch Befragung mit dem SF-36 verglichen (Wilcoxon-Test). Die Daten des SF-36 der Patienten wurden mit dem Kalkaneusscore nach Zwipp und der AOFAS Ankle Hindfoot Scale korreliert (Spearman-Korrelationskoeffizient). Die Patienten mit Kalkaneusfrakturen zeigten in 9 von 10 Skalen des SF-36 eine signifikante Beeinträchtigung der gesundheitsbezogenen Lebensqualität.Die Daten der untersuchten Fußscores korrelierten lediglich mit den Skalen Schmerz und Körperliche Funktion stark, in allen anderen Fällen fanden sich schwache Korrelationen.Kalkaneusfrakturen hinterlassen messbare Beeinträchtigungen der gesundheitsbezogenen Lebensqualität. Gebräuchliche Fußscores erfassen vorwiegend die Dimensionen “Körperliche Funktion” und “Schmerz”. Für eine umfassende Outcomebewertung ist die Ergänzung durch den SF-36 empfehlenswert. Internationale Vergleiche sowie Vergleiche mit der deutschen Normalbevölkerung sind möglich.AbstractThe purpose of the study was the assessment of the limitations of health related quality of life after open reduction and internal fixation (ORIF) of calcaneal fractures and the comparison of these results with those of normal foot-scores.The quality of life of 55 patients with calcaneal fractures treated by ORIF was compared 2.9 years after injury with that of 55 people from the standardised German population of the German-Health-Survey 1998 using the Short Form 36 (SF-36) (Wilcoxon test).The results of SF-36 of patients were correlated with results of the calcaneus score according to Zwipp and AOFAS Ankle Hindfoot Scale (Spearmans correlation coefficient). Health related quality of life showed significant limitations in patients with calcaneal fractures in 9 of 10 scales of the SF-36.Correlations between SF-36 and foot-scores were strong in the function and pain scale and moderate in all other scales.The quality of life of shows significant limitations after calcaneal fractures. Usual foot-scores measure only the function and pain dimension of the outcome.To measure all dimensions, application of the SF-36 can be recommended. International comparisons of results and comparison with a standardised German population is possible.

[Results after Judet radial head prosthesis for non-reconstructable radial head fractures].

BACKGROUND With regard to the treatment of non-reconstructable radial head fractures, both the resection and the implantation of a prosthesis are considered. Various studies have shown poor results concerning the resection of the radial head with accompanying osteoligamentous injuries. Due to these experiences, different types of prosthesis have been developed. However, the majority of them were not convincing. Judet developed a type of a bipolar prosthesis which had been modeled on the anatomy of the radial head. The aim of our retrospective study consists in examining the results of the Judet prosthesis. PATIENTS AND METHODS Between 1995 and 2007, 50 patients were treated with an arthroplasty. These were, corresponding to the classification by McKee and Jupiter, 19 type III and 31 type IV fractures. Thirty patients were available for a follow-up after 2.5 years on average. RESULTS According to the Morrey Score, 16 very good, 7 good, 3 fair and 4 bad results could be obtained. Following the criteria of Radin and Riseborough, 17 patients achieved a good, 9 a fair and 4 a bad result. The complications which appeared were: one patient with aseptic loosening, one patient with luxation of a prosthesis, one persistent radial joint instability, three patients with heterotopic ossification and four patients with protrusion relative to the capitulum humeri.

Ergebnisse der Radiusköpfchenprothese von Judet bei nicht rekonstruierbaren Radiusköpfchenfrakturen

BACKGROUND With regard to the treatment of non-reconstructable radial head fractures, both the resection and the implantation of a prosthesis are considered. Various studies have shown poor results concerning the resection of the radial head with accompanying osteoligamentous injuries. Due to these experiences, different types of prosthesis have been developed. However, the majority of them were not convincing. Judet developed a type of a bipolar prosthesis which had been modeled on the anatomy of the radial head. The aim of our retrospective study consists in examining the results of the Judet prosthesis. PATIENTS AND METHODS Between 1995 and 2007, 50 patients were treated with an arthroplasty. These were, corresponding to the classification by McKee and Jupiter, 19 type III and 31 type IV fractures. Thirty patients were available for a follow-up after 2.5 years on average. RESULTS According to the Morrey Score, 16 very good, 7 good, 3 fair and 4 bad results could be obtained. Following the criteria of Radin and Riseborough, 17 patients achieved a good, 9 a fair and 4 a bad result. The complications which appeared were: one patient with aseptic loosening, one patient with luxation of a prosthesis, one persistent radial joint instability, three patients with heterotopic ossification and four patients with protrusion relative to the capitulum humeri.

Serum cathepsin K levels are not suitable to differentiate women with chronic bone disorders such as osteopenia and osteoporosis from healthy pre- and postmenopausal women.

OBJECTIVES Cathepsin K (CatK) is expressed in high levels in osteoplasts and therefore plays an important role in bone resorption. Thus CatK serum levels may be useful in the diagnosis of chronic bone disorders such as osteopenia and osteoporosis. Therefore we aimed at studying CatK levels in women putatively free of known skeletal disorders. STUDY DESIGN In total, 121 voluntary women, 27 premenopausal women aged between 20 and 45 years, and 94 postmenopausal women aged 59-81 years, all free of known skeletal disorders were included. All women underwent bone density measurement, routine labor parameter and measurement of serum CatK levels. MAIN OUTCOME MEASURES Based on WHO criteria, women were stratified in four groups (premenopausal: healthy; postmenopausal: healthy, osteopenia, osteoporosis), and their CatK levels were statistically analyzed. RESULTS Using WHO criteria 21 postmenopausal women had normal bone mineral density (BMD), 49 had osteopenia and 24 had osteoporosis. All 27 premenopausal women had normal BMD. There were no significant differences in CatK between these groups. ROC analysis resulted in poor diagnostic validity of CatK, where the area under curve was 0.544. There was no correlation neither between CatK and other biomarkers as C-telopeptide crosslaps (CTX) or bone-specific alkaline phosphatase (BAP) nor between CatK and age. CONCLUSIONS Serum levels of CatK are not suitable to differentiate women with osteoporosis from healthy subjects.

Unbehandelter Abriss des Processus styloideus ulnae

BACKGROUND There are well-defined criteria for the treatment of distal radius fractures but the impact of an unrepaired fracture of the styloid process of the ulnar on recovery after operative treatment is uncertain. This study evaluated radiological and functional results after different operative treatment procedures of distal radius fractures in patients with an untreated fracture of the styloid process of the ulna and those without such a fracture. METHODS Out of 480 patients with operatively treated distal radius fractures 238 were examined at least 1 year after injury. The fracture of the styloid process of the ulna was not repaired. Three groups (patients without a fracture of the styloid process of the ulna, patients with a tip fracture and those with a basal fracture) were evaluated by multivariate analysis (MANOVA) in order to detect influences of the fracture of the styloid process of the ulna on the radiological and functional results. RESULTS Neither the existence nor the location of the fracture of the styloid process of the ulna had a significant effect on the radiological and functional results (p(function)=0,849, p(radiology)=0,330, p(scores)=0,426, MANOVA). CONCLUSIONS The repair of a fracture of the styloid process of the ulna is not necessary if reduction and fixation of the distal radius fracture is anatomical and stable.

Axillary nerve lesions after open reduction and internal fixation of proximal humeral fractures through an extended lateral deltoid-split approach: electrophysiological findings

BACKGROUND Axillary nerve injuries after shoulder surgery are rare. In most studies, the frequency of injury is usually determined using clinical examinations, but results from intraoperative neuromonitoring studies have revealed higher than expected rates. Few studies have investigated this topic. Our aim was to determine the frequency of axillary nerve lesions after open reduction and internal fixation of proximal humeral fractures by using electrophysiological assessments and to provide a review of the relevant literature. METHODS This was a retrospective cohort study of 76 consecutive patients who received open reduction and internal fixation of a proximal humeral fracture using a locking plate through a deltoid-splitting approach. We performed a clinical and electrophysiological examination at a minimum follow-up time of 12 months. Functional results were assessed according to the Constant-Murley and Disabilities of the Arm, Shoulder and Hand scores. Electrophysiological examinations comprised electromyography, electroneurography, and motor and somatosensory evoked potentials. The main outcome was the frequency of axillary nerve lesions. RESULTS Forty patients were monitored for an average of 28 months. The mean raw Constant-Murley score was 61 points, the age- and gender-adjusted score was 71%, and the mean Disabilities of the Arm, Shoulder and Hand score was 33 points. Neurapraxia occurred in 1 patient, axonotmesis with incomplete reinnervation occurred in 3, and complete reinnervation occurred in 3. The latter group was classified as having a temporary axillary nerve lesion. CONCLUSIONS The 10% rate of permanent axillary nerve lesions in our cohort is higher than expected based on the clinical examination. Electrophysiological assessment is therefore more appropriate to detect axillary nerve injuries.

Solid pseudopapillary tumor of the pancreas.

SummaryBackground. Its considerable size at the time of diagnosis and low grade of malignancy are typical features of the solid-pseudopapillary tumor, which has a tendency to predominantly affect young females. A relationship to the long-term intake of oral contraceptives is discussed. Invasive tumor growth or metastases have been observed only rarely until now.Methods. The 53-yr-old female patient we report on here was treated by radical partial pancreatoduo-denectomy for a nonmetastasizing solid-pseudopapillary tumor of the pancreatic head (T1bN0M0) 19 mo ago.Results. Histopathological studies made a definitive diagnosis of solid-pseudopapillary tumor. The patient is recurrence-free, and there are no signs of metastases at present. Since a microscopically invasive tumor growth is assumed, oncologically curative resection should be preferred vs the less radical enucleation. Conclusion. In this report, a case of the rare solid-pseudopapillary tumor of the pancreas is described. In contrast to other pancreatic tumors, the semimalignant solid-pseudopapillary tumor has a favorable prognosis.