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Andrew R Evans,
Julie Agel,
Gregory L Desilva,
Thomas A Decoster,
Douglas R Dirschl,
Clifford B Jones,
James F Kellam,
Douglas W Lundy,
J Lawrence Marsh,
Debra L Sietsema, Milan K Sen
Journal of orthopaedic trauma 06/2011; 25(6):e59-60. · 1.78 Impact Factor
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ABSTRACT: Percutaneous fixation of fractures of the scaphoid is well documented in the acute setting by both dorsal and volar methods. What is not commonly discussed is the use of this method for delayed unions and nonunions of the scaphoid. The authors present their case series of patients who underwent dorsal percutaneous fixation for delayed union or nonunion of the scaphoid.
This study retrospectively reviewed eight consecutive patients (six male patients and two female patients) with a delayed union (8 to 12 weeks) or nonunion (≥13 weeks) of the scaphoid waist treated with dorsal percutaneous cannulated screw fixation. The indications for surgery included failure of conservative treatment, pain with loss of wrist mobility, and prevention of long-term osteoarthritis. Exclusion criteria included previous surgery, dorsal intercalated segmental instability, fracture displacement of more than 1.0 mm, osteoarthritis, avascular necrosis, and proximal pole nonunion.
The union rate was 100 percent, with an average time to union of 7 weeks for the delayed union group (three of eight) and 13 weeks for the nonunion group (five of eight). No statistically significant difference was found between the preoperative and postoperative radiolunate angles, scapholunate angles, and height-to-length scaphoid ratio. All patients were able to return to their preinjury employment after an average of 10 weeks.
This pilot study demonstrates that the dorsal percutaneous approach to treatment of delayed union and nonunion of stable scaphoid waist fractures can result in predictable union, with minimal morbidity and complications.
Therapeutic, IV.
Plastic and reconstructive surgery 04/2011; 128(2):467-73. · 2.74 Impact Factor
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Andrew R Evans,
Julie Agel,
Gregory L Desilva,
Thomas A Decoster,
Douglas R Dirschl,
Clifford B Jones,
James F Kellam,
Douglas W Lundy,
J Lawrence Marsh,
Debra L Sietsema, Milan K Sen
Journal of orthopaedic trauma 03/2011; 25(3):e30. · 1.78 Impact Factor
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ABSTRACT: This study reviews the second case in the literature involving the use of frozen osteochondral allograft to reconstruct a femoral head fracture-dislocation. The case involved significant, unreconstructable damage to the weightbearing area of the femoral head in an 18-year-old male. Clinical and diagnostic imaging follow up at 46 months revealed that despite magnetic resonance imaging and radiographic evidence of progressive arthrosis in the hip, including subchondral cystic change in the femoral head and localized cartilage loss in the acetabulum and femoral head, the patient had excellent function with no complications (Harris hip score 100, hip dysfunction and osteoarthritis outcome score 62, musculoskeletal function assesment score 22, SF-36 score 81). The use of osteochondral allograft may serve as a useful tool for the orthopaedic surgeon faced with an unreconstructable femoral head fracture-dislocation in a young patient.
Journal of orthopaedic trauma 02/2010; 24(2):120-4. · 1.78 Impact Factor
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ABSTRACT: Volar locking plates for fractures of the distal radius are a common option of care in many centers. Currently, these plates are placed through a standard approach, such as the flexor carpi radialis interval. However, in our opinion, the use of conventional plate application techniques is associated with more soft tissue dissection than is necessary for these new plates. This may contribute to postoperative pain and also to scarring, which may impede the range of motion. To avoid this, dorsal plates have been developed that can be inserted percutaneously. Historically, dorsal plating of the distal radius has been associated with increased morbidity relative to volar plates due to soft tissue depth. This article discusses a single surgeon's technique for insertion of volar locking plates through minimal incisions with sparing of the soft tissues.
Techniques in Hand and Upper Extremity Surgery 04/2008; 12(1):2-6.
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ABSTRACT: In this article, we describe a technique for internal fixation of coronal shear fractures of the distal humerus. It follows basic AO principles utilizing lag screw fixation combined with an antiglide plate to neutralize shearing forces. We have used this technique successfully for the treatment of isolated shear fractures of the capitellum, including those with extension into the trochlea.
The Journal Of Hand Surgery 12/2007; 32(9):1462-5. · 1.35 Impact Factor
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ABSTRACT: Stress fracture of the anterior tibial cortex is an extremely challenging fracture to treat, especially in the high-performance female athlete who requires rapid return to competition. Previous reports have not addressed treating these fractures in the world-class athlete with anterior plating. We hypothesize that anterior plating is a biomechanically sound approach to treatment of these fractures, and will lead to an earlier return to full activity than either nonoperative treatment or intramedullary nailing. We present a retrospective series of 4 case reports of 4 world-class female athletes with stress fractures of the anterior tibial cortex treated by anterior plating between 2001 and 2004. Average follow-up was 15 months (range 12 to 48 mo). Anterior tension band plating resulted in fracture healing in all 4 cases and return to full activity at a mean of 10 weeks. All patients returned to preinjury competitive levels. There were no complications of infection, nonunion, or malunion. Anterior tension-band plating of an anterior tibial stress fracture leads to rapid fracture healing and return to competition for high-performance female athletes. This approach should be considered in those athletes who wish to avoid the more prolonged convalescence associated with nonoperative treatment, or the problems, especially of the knee, associated with intramedullary nailing.
Journal of Orthopaedic Trauma 08/2006; 20(6):425-30. · 2.13 Impact Factor
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ABSTRACT: This study is an attempt to describe a new technique for anterior transarticular screw fixation of the atlantoaxial joints, and to compare the stability of this construct to posterior transarticular screw fixation with and without laminar cerclage wiring. Nine human cadaveric specimens were included in this study. The C1-C2 motion segment was instrumented using either anterior transarticular screws (group 1), posterior transarticular screws alone (group 2), or posterior screws with interlaminar cerclage wires (group 3). Using an unconstrained mechanical testing machine, the specimens were tested in rotation, lateral bending, and flexion-extension using nondestructive loads of +/-2 N m. The specimens were also tested in translation using nondestructive loads of +/-100 N. All values for the three groups with regards to anterior-posterior displacement, rotation, and lateral bending were similar as determined using a Kruskal-Wallis rank sum test with a significance level of p<0.05. The only significant difference was registered in flexion-extension where the cerclage wire added some strength to the construct. Anterior transarticular screw fixation of the atlantoaxial spine has several advantages over posterior fixation techniques, and is as stable as posterior transarticular fixation in all clinically significant planes of motion. The addition of posterior interlaminar cerclage wiring further improves resistance to flexion-extension forces. Anterior transarticular screw fixation of the atlantoaxial joint is a useful technique for achieving C1-C2 stabilization.
European Spine Journal 07/2005; 14(5):512-8. · 1.97 Impact Factor
