1/289. A metallurgical examination of fractured stainless-steel ASIF tibial plates.Between 1970 and 1973 99 tibial fractures were treated by rigid internal fixation with ASIF plates. The fractures were all regarded as sufficiently stable for exercise without weight bearing, thus needing no additional external support during the healing period. Four of the plates broke late in the healing period, after the onset of weight bearing. These fractures had some degree of delayed union with slight resorption of the bone ends, resulting in cyclical bending of the plate. Examination of 2 of the fractured plates by scanning electron microscopy, electron microprobe analysis and optical metallography revealed that the primary cause of plate fracture was fatigue. There was no evidence that corrosion fatigue or inclusion content were factors leading to plate fracture.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
2/289. The spiral compression plate for proximal humeral shaft nonunion: a case report and description of a new technique.We present a case of humeral nonunion managed with a dynamic compression plate (DCP) contoured in a spiral fashion to preserve the deltoid muscle insertion. A forty-one-year-old woman sustained a closed proximal third humeral shaft fracture with an associated supraclavicular brachial plexus injury. She presented five months later with an atrophic nonunion of the proximal humeral shaft, inferior subluxation of the humeral head, and a resolving brachial plexopathy. Autogenous cancellous bone grafting and open reduction and internal fixation with a narrow DCP was performed. The deltoid muscle insertion was preserved by contouring the plate to fix the proximal humerus laterally over the greater tuberosity and anteriorly over the mid-humeral shaft. During the postoperative period, the humeral head reduced spontaneously. Five months after surgery, the fracture healed, and an excellent clinical result was achieved. We recommend the use of the spiral DCP for proximal shaft fractures and nonunions when preservation of the deltoid insertion is desirable.- - - - - - - - - - ranking = 0.3keywords = fracture (Clic here for more details about this article) |
3/289. Non-union of undisplaced radial neck fracture in a rheumatoid patient.Non-union of an undisplaced fracture of the radial neck in a rheumatoid patient is presented. Possible causes are discussed, and the literature reviewed.- - - - - - - - - - ranking = 0.5keywords = fracture (Clic here for more details about this article) |
4/289. Salvage of contaminated fractures of the distal humerus with thin wire external fixation.Fractures and osteotomies of the distal humerus that are contaminated or infected represent a difficult management problem. Stable anatomic fixation with plates and screws, the acknowledged key to a good result in the treatment of bicondylar fractures, may be unwise. A thin wire circular (Ilizarov) external fixator was used as salvage treatment in such complex situations in five patients. The fixator allowed functional mobilization of the elbow while allowing achievement of the primary goal of eradicating the infection or colonization. Two patients required a second operation for fixation of a fibrous union of the lateral condyle. One patient with a vascularized fibular graft later required triple plate fixation for malalignment at the distal host and graft junction. Four of five patients ultimately achieved complete union. The fracture remained ununited in one patient who has declined additional intervention. All five patients achieved at least 85 degrees ulnohumeral motion, two after a secondary elbow capsulectomy performed after healing was achieved. This experience suggested that the Ilizarov construct, although not a panacea, represents a reliable method of skeletal stabilization that allows functional mobilization while elimination of infection or colonization is ensured. If necessary, stiffness and incomplete healing can be addressed with an increased margin of safety at subsequent operations.- - - - - - - - - - ranking = 0.6keywords = fracture (Clic here for more details about this article) |
5/289. Management of nonunion below proximal humeral prosthesis.Fractures below proximal humeral prostheses are rare and their successful management presents technical difficulties. Closed treatment usually results in nonunion. A case illustrating this disabling complication is reported and a literature review is presented that summarizes the classification, treatment options, and complications of these uncommon fractures.- - - - - - - - - - ranking = 0.1keywords = fracture (Clic here for more details about this article) |
6/289. Pseudo-dislocation of the sternoclavicular joint.Fractures of the medial third of the clavicle are the rarest of all clavicle fractures. We present two cases of medial clavicle fracture nonunions that were initially thought to be chronic anterior sternoclavicular dislocations and describe the entity of pseudo-dislocation of the sternoclavicular joint. Computed tomography should be performed on all patients with suspected or established injuries of the sternoclavicular region to ensure differentiation between fracture and dislocation.- - - - - - - - - - ranking = 0.3keywords = fracture (Clic here for more details about this article) |
7/289. Five case studies of soldiers with painful clavicular fracture non-union.We report a short case series of 5 servicemen who had sustained closed clavicular fractures, 4 of whom presented to our clinic with a painful non-union, and 1 required primary fixation for tenting of the skin. Our treatment consisted of open reduction and internal fixation of these non-unions. This resulted in all these men returning to duties with painfree shoulder girdles within 6 months. A complication in these cases was one of a prominent plate which rubbed on straps and required removal of the plate after union had occurred resulting once again in a painfree shoulder girdle and a return to full duties. We advocate early orthopaedic referral in cases of painful clavicular non-union and where appropriate, open reduction and internal fixation with the expectation of an early return to full duties with a pain free shoulder girdle.- - - - - - - - - - ranking = 0.5keywords = fracture (Clic here for more details about this article) |
8/289. External rotation-lateral view of the ankle in the assessment of the posterior malleolus.Demonstration of a posterior malleolar fragment on a radiograph of an ankle fracture is important in the diagnosis and evaluation of posterior malleolus fractures. The size and extent of displacement of a posterior malleolar fragment can be evaluated. The diagnosis of non-union of the posterior malleolus is also important because it can lead to failure of reduction of ankle fractures. The authors present a case in which nonunion of the posterior malleolus was diagnosed by an external-rotation lateral view of the ankle. This could not be demonstrated on the AP or the lateral views. Thirteen cadaver feet were then used to study the external-rotation lateral view. A posterior malleolar fracture was created, and the borders of the fracture line were marked with solder wire. The average external rotation angle required to best demonstrate the posterior malleolar fracture was 50 degrees (range, 43 degrees -55 degrees). The actual size of the posterior malleolus fragment was measured and compared to the x-ray measurement. There was a 0.10 correction for the determination of the actual size of the fragment. The unmarked fragment could not be demonstrated on AP and lateral views.- - - - - - - - - - ranking = 0.6keywords = fracture (Clic here for more details about this article) |
9/289. pseudarthrosis of the capitate.Nonunion of an isolated fracture of the capitate is an infrequent condition. The authors present a patient who had few symptoms. Computed tomography showed more bone destruction than the standard X-ray. The nonunion healed with the use of a cancellous bone graft.- - - - - - - - - - ranking = 0.1keywords = fracture (Clic here for more details about this article) |
10/289. Reconstruction plate fixation with bone graft for mid-shaft clavicular non-union in semi-professional athletes.From 1993 to 1997, 22 semi-professional athletes (14 men and 8 women), aged 18-33 years (mountain bike racers, soccer players, handball players, swimmers, and short distance runners) with a non-union of the middle third of the clavicle were treated operatively by reconstruction plating and bone grafting. Fourteen clavicular non-unions were caused by falls. Eight non-unions were the result of a car, motorcycle, or bicycle accident. There were 19 atrophic and 3 hypertrophic non-unions. In all patients, initially a figure-of-eight strap or a sling was used for immobilization and no radiographic union was documented within 5 months. None of the athletes had gone back to their sports and all had pain and limitation of shoulder function. For open reduction and internal fixation, an AO 3.5-mm seven-hole reconstruction plate was used. The sclerotic bone ends were freshened and a cortical bone transplant or cancellous bone from the iliac crest (depending on the shortening of the clavicle) was packed around the fracture or between the reduced fracture ends. In all athletes, radiographic consolidation was achieved after an average of 14 weeks (range, 11-16 weeks) and the average increase in the Constant and Murley Score was from 79 points preoperatively to 97 points after surgery. No operative or postoperative complications occurred and all athletes returned to their sports.- - - - - - - - - - ranking = 0.2keywords = fracture (Clic here for more details about this article) |
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