Wade Gofton

Plate fixation of olecranon osteotomies.

The management of intra-articular distal humeral fractures remains a difficult surgical problem. Although an olecranon osteotomy provides excellent exposure for management of these fractures, a number of complications can occur after the creation and repair of the osteotomy including nonunion, malunion, hardware failure, and pain secondary to prominent hardware. In an effort to reduce the incidence of these complications, the senior authors now use contoured 3.5 mm reconstruction plates for the fixation of their apex-distal chevron olecranon osteotomies. Two surgeons at a single institution used this technique of exposure on a series of 17 consecutive patients with intra-articular distal humerus fractures between 1996 and 1999. In this series, all osteotomies united. There was one complication related specifically to the osteotomy: one of the screws in the plate penetrated the proximal radioulnar joint, interfering with forearm rotation; a second procedure was required to shorten the screw. Only one of the 17 patients requested plate removal during the 32 month (average) follow-up period. Plate fixation of olecranon osteotomies using a 3.5 mm reconstruction plate provides a construct with predictable healing and few complications. The overall results using this technique are comparable with other reported methods in the literature.

A Multicenter Randomized Control Trial Comparing a Novel Intramedullary Device (InterTAN) Versus Conventional Treatment (Sliding Hip Screw) of Geriatric Hip Fractures.

Objectives: To compare outcomes in elderly patients with intertrochanteric hip fractures treated with either the sliding hip screw (SHS) or InterTAN intramedullary device (IT). Design: Prospective, randomized, multicenter clinical trial. Setting: Five level 1 trauma centers. Patients: Two hundred forty-nine patients 55 years of age or older with AO/OTA 31A1 (43) and OA/OTA 31A2 (206) fractures were prospectively enrolled and followed for 12 months. Intervention: Computer generated randomization to either IT (n = 123) or SHS (n = 126). Main Outcome Measurements: The Functional Independence Measure (FIM) and the Timed Up and Go test (TUG) were used to measure function and motor performance. Secondary outcome measures included femoral shortening, complications, and mortality. Results: Demographics, comorbidities, preinjury FIM scores and TUG scores were similar between groups. Patients (17.2%) who received an IT had limb shortening greater than 2 cm compared with 42.9% who received an SHS (P < 0.001). To determine the importance of preinjury function and fracture stability, we analyzed the subgroup of patients with the ability to walk 150 m independently preinjury and an OA/OTA 31A-2 fracture (n = 70). In this subgroup, patients treated with SHS had greater shortening and demonstrated poorer FIM and TUG scores compared with patients treated with an IT. Conclusions: Overall, most patients with intertrochanteric femur fractures can expect similar functional results whether treated with an intramedullary or extramedullary device. However, active, functional patients have an improved outcome when the InterTAN is used to treat their unstable intertrochanteric fracture. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

The Effect of Varying Tension of a Suture Button Construct in Fixation of the Tibiofibular Syndesmosis—evaluation Using Stress Computed Tomography

BACKGROUND/PURPOSE There have been no studies assessing the optimal biomechanical tension of suture button constructs. The purpose of this study was to assess optimal tensioning of suture button fixation and its ability to maintain reduction under loaded conditions using a stress computed tomography (CT) model. METHODS Ten cadaveric lower limbs disarticulated at the knee were used. The limbs were placed in a modified ankle load frame that allowed for the application of sustained torsional axial or combined torsional/axial loads. The syndesmosis and the deep deltoid ligaments complex were sectioned and the limbs were randomized to receive a suture button construct tightened at 4, 8, or 12 kg. The specimens were loaded under the 3 loading scenarios with CT scans performed after each and at the conclusion of testing. Multiple measurements of translation and rotation were compared with baseline CT scan taken before sectioning. RESULTS Significant lateral (maximum 5.26 mm) and posterior translation (maximum 6.42 mm) and external rotation (maximum 11.71 degrees) was noted with the 4 kg repair. Significant translation was also seen with both the 8 and the 12 kg repairs; however, the incidence was less than with the 4 kg repair. Significant overcompression (ML = 1.69 mm, B = 2.69 mm) was noted with the 12 kg repair and also with the 8 kg repair (B = 2.01 mm). CONCLUSION Suture button constructs must be appropriately tensioned to maintain reduction and re-approximate the degree of physiological motion at the distal tibiofibular joint. These constructs also demonstrate overcompression of the syndesmosis; however, the clinical effect of this remains to be determined.BACKGROUND/PURPOSE There have been no studies assessing the optimal biomechanical tension of suture button constructs. The purpose of this study was to assess optimal tensioning of suture button fixation and its ability to maintain reduction under loaded conditions using a stress computed tomography (CT) model. METHODS Ten cadaveric lower limbs disarticulated at the knee were used. The limbs were placed in a modified ankle load frame that allowed for the application of sustained torsional axial, or combined torsional/axial loads. The syndesmosis and the deltoid ligament complex were sectioned and the limbs were randomized to receive a suture button construct tightened at 4kg, 8kg, or 12kg. The specimens were loaded under the 3 loading scenarios with CT scans performed after each as well as at the conclusion of testing. Multiple measurements of translation and rotation were compared to baseline CT scan taken prior to sectioning. RESULTS Significant lateral (maximum 5.26mm) and posterior translation (maximum 6.42mm) as well as external rotation (maximum 11.71°) was noted with the 4kg repair. Significant translation was also seen with the both the 8kg and 12 kg repairs however the incidence was less than with the 4kg repair.Significant overcompression (ML=1.69mm, B=2.69mm) was noted with the 12kg repair and also with the 8kg repair (B=2.01mm). CONCLUSION Suture button constructs must be appropriately tensioned to maintain reduction and re-approximate the degree of physiological motion at the distal tibiofibular joint. These constructs also demonstrate overcompression of the syndesmosis however the clinical effect of this remains to be determined.