Yih-Shiunn Lee

Comparison of the efficacy of hook plate versus tension band wire in the treatment of unstable fractures of the distal clavicle

Fifty-two patients with unstable fractures of distal clavicle treated by open reduction and internal fixation with hook plates or tension band wires were retrospectively reviewed. The 52 patients were divided into two groups based on the method of treatment. The hook plate (HP) group included 32 patients and the tension band wire (TBW) group included 20 patients. Both groups were similar in respect to injury mechanisms, compounding medical conditions, and shoulder score (p > 0.1). However, hook plating had a significantly lower rate of complication (p = 0.01) and symptomatic hardware (p = 0.001). In addition, hook plating better facilitated the return to work and athletic activity (p = 0.004 and p = 0.003, respectively). In conclusion, if surgery of distal clavicular fractures is indicated, internal fixation with a hook plate has more advantages than with tension band wires.Résumé52 patients présentant une fracture instable de la clavicule ont été traités par réduction sanglante et fixation interne par plaques crochet. Les 52 patients ont été revus et ont été divisés en deux groupes en fonction de la méthode de traitement. L’ostéosynthèse par plaques crochet HP groupe 1 incluait 32 patients et le haubannage TBW 20 patients. Les deux groupes sont identiques en ce qui concerne le mécanisme des traumatismes, les problèmes médicaux, les scores épaule (p > 0,1). Cependant le traitement par crochet-plaque permet une diminution significative des complications (p = 0,01) notamment matérielles (p = 0,001). Par ailleurs cette ostéosynthèse par crochet-plaque permet une reprise plus rapide du travail et des activités sportives (p = 0,004, 0,003 respectivement). En conclusion, si il existe une indication chirurgicale dans les fractures distales de la clavicule, il est indiqué de réaliser l’ostéosynthèse par crochet-plaque. Cette ostéosynthèse présente beaucoup plus d’avantages que l’ostéosynthèse par hauban.

Stabilisation of the fractured fibula plays an important role in the treatment of pilon fractures: a retrospective comparison of fibular fixation methods

Ninety-eight pilon fractures associated with ipsilateral distal fibular fracture were included in this study. The pilon fractures were treated by open reduction and plating. The 98 fractures were divided into three groups based on the treatment method of fractured fibula. Group A was composed of 50 fibular fractures treated by open reduction and plate fixation. Group B was composed of 23 fibular fractures treated by open reduction and pin fixation. Group C was composed of 25 fibular fractures treated conservatively by closed reduction. The radiographs were reviewed for adequacy of fracture reduction and posttraumatic arthrosis. At the end of follow-up, the clinical outcomes were evaluated using a rating scale. The three groups were similar in respect to Ruedi type, open fracture grade, and demographics (all p values >0.25). Group A showed a decreasing trend of malunion and ankle arthrosis compared to group C (p = 0.091 and p = 0.099, respectively). Group A had a better clinical outcome than group C (p = 0.008). In addition, group A showed an increasing trend of satisfactory outcome compared to group B (p = 0.096). In conclusion, for pilon fractures associated with ipsilateral fibular fractures, stabilisation of the fractured fibula plays an important role in the decrease of distal tibial malunion and post-traumatic ankle arthrosis as well as improvement of clinical outcomes.Résumé98 fractures du pilon tibial avec fracture du péroné ont été inclus dans cette étude. Les fractures du pilon tibial ont été traitées par réduction sanglante et ostéosynthèse par plaque. Les 98 fractures ont été divisées en 3 groupes selon les méthodes de traitement du péroné fracturé. Le groupe A était composé de 50 fractures du péroné traitées par réduction sanglante et plaque, le groupe B de 23 fractures du péroné traitées par réduction sanglante et fixations par broches et le groupe C de 25 fractures du péroné qui ont été réduites sans fixation. Les radiographies ont été analysées afin d’évaluer la réduction de la fracture et l’évolution vers une arthrose post-traumatique. A la fin du suivi, les trois groupes étaient identiques sur le plan clinique le type de Ruedi, le stade d’ouverture et les données démographiques. Le groupe A montrait un nombre moins important de pseudarthrose et d’arthrose de la cheville comparé au groupe C (p = 0,091, p = 0,099 respectivement). Le groupe A avait un meilleur résultat clinique que le groupe C (p = 0,008). De plus, le groupe A montrait une amélioration plus satisfaisante sur le devenir clinique à long terme que le groupe B (p = 0,096). En conclusion, les fractures du pilon tibial présentant une fracture associée du péroné doivent être stabilisées au niveau du tibia et au niveau du péroné par une ostéosynthèse par plaques de façon à diminuer le nombre de cals vicieux postraumatiques et d’améliorer les résultats cliniques.

Operative treatment of displaced lateral malleolar fractures: The Knowles Pin Technique

Objectives: To assess the use of Knowles pin fixation for isolated displaced lateral malleolar fractures and to present our surgical experience using this method. Design: Retrospective evaluation. Setting: The study was carried out at a municipal teaching hospital. The senior surgeons were all orthopedic trauma subspecialists. Patients: A total of 168 patients meeting our inclusion criteria, an isolated displaced lateral malleolar fracture surgically treated by a Knowles pin between 1995 and 2000, were studied. All the patients had a stable syndesmosis, less than 50% comminution, and had no other operations in the same extremity. Patients were assigned into 4 groups according to the Orthopedic Trauma Association classification of ankle fractures. Intervention: Open reduction and internal fixation with a Knowles pin fixation of the lateral malleolus. Main Outcome Measurements: Functional results were evaluated using the Baird and Jackson ankle scoring system. Results: There was a 100% union rate. The average satisfactory outcome of the 4 groups was 88.1%. No instrumentation problems were encountered. Three complications occurred, but resolved with nonoperative therapy. Conclusions: Knowles pin fixation for displaced lateral malleolar fractures is a useful and effective method. This implant offers several advantages, including easy application, less soft tissue dissection, less palpable instrumentation, stable fixation, and a short operating time.

Internal Fixation of Undisplaced Femoral Neck Fractures with DHS or Multiple Cannulated Screws: Outcome Comparison in the Elderly

Background and Purpose: Multiple cannulated screws or dynamic hip screw (DHS) has been commonly used to treat undisplaced femoral neck fractures. Although these two techniques advocated in the literature could achieve good results, it is unclear which one is the best. It is the purpose of our study to compare the clinical outcomes of undisplaced femoral neck fractures that were treated with DHS or multiple cannulated screws. Methods: Between 1997 and 2002, a total of 42 elderly patients (＞60 years of age) with complete followup data meeting our inclusion criteria, had an undisplaced femoral neck fracture surgically treated by either the DHS or the cannulated screws. Functional results were evaluated using the Harris hip scoring system. The incision length, surgery time, hemoglobin level drop, blood transfusion, hospital stay, and overall success rates were recorded. Results: The surgery time, hospital stay, overall success rate, and hip score were similar between the two groups (p values＞0.34). The DHS group had larger operative wound, more hemoglobin level drop and higher blood transfusion rate than cannulated screw group (p values＜0.05). Conclusion: The advantages of cannulated screwing were less invasive surgery associated with a small incision, less blood loss, and lower rate of blood transfusion. The major advantage of the DHS was stable fixation with a high rate of overall success.

Surgical Treatment of Midclavicular Fractures in the Elderly

Operative treatment of midclavicular fractures in patients older than 60 years poses an increased risk of fixation failure. Although plating of midclavicular fractures in the elderly is still a popular fixation method, osteopenic bone may result in plate loosening and fixation failure. The purpose of this study is to prospectively evaluate and compare the clinical outcomes of midclavicular fractures in patients older than 60 years who are treated with either a locking compression plate or nonlocking plate. Sixty-four elderly patients with midclavicular fractures were surgically treated with either a locking compression plate or nonlocking plate, which included dynamic compression plates and reconstruction plates. The locking compression plate group included 29 patients with an average age of 69.1 years. The nonlocking plate group included 35 patients with an average age of 66.3 years. Both groups were similar for age, gender, injury mechanism, fracture patterns, and confounding medical condition (P>.5). However, the locking compression plate group had lower complication rates compared to the nonlocking plate group (P=.087). In addition, the locking compression plate group had higher rates of return to work and exercise (P=.02, P=.016, respectively). If surgery of elderly patients with midclavicular fractures is indicated, internal fixation with a locking compression plate is preferable to a nonlocking plate.

Comparison of the Efficacy of Hook Plate Versus Kirschner Wire in the Surgical Treatment of Unstable Fractures of the Distal Clavicle

Objectives: Unstable fractures of the distal clavicle usually require surgical fixation to achieve satisfactory results. The traditional method using Kirschner-wire (K-wire) fixation has always been adopted in the past. However, complications commonly occur. Over the last two years, we have adopted a claviclular hook plate fixation method to treat such cases and the preliminary results are highly satisfactory. The purpose of this study is to review the clinical outcomes of the to techniques. Patients and Methods: Between 1999 and 2002, ten unstable fractures of the distal clavicle were operated on using K-wire fixation at our institution. During 2002-2004, eight consecutive cases were treated by hook plate fixation. The clinical results were evaluated by a popular shoulder scoring system. The Fishers exact test was used to analyze gender versus type, confounding medical conditions, complication rates, symptomatic hardware rates, elective hardware removal rates, and the ability to return to work. A Mann-Whitney U test was used to compare the shoulder scores. Results: The mean shoulder score for K-wire fixation was 80±5.3 points and for hook plate fixation was 94±4.8 points (p=0.05). Hook plating had a significantly lower rate of loss of reduction (p=0.013) and symptomatic hardware (p=0.025). In addition, hook plate fixation resulted in a higher rate of return to work (p=0.025). Conclusion: If surgery of distal clavicular fractures is indicated, internal fixation with a hook plate has distinct advantages over the K-wire method.