The aim of this study was to evaluate the mid-term results of surgically treated scaphoid fractures since we were concerned that good results might deteriorate over time due to osteoarthritis or functional impairment. Thirty-three out of 121 surgically treated patients (isolated scaphoid fractures n = 23; scaphoid fractures with concomitant injuries n = 10) were evaluated retrospectively (47–138 months). Five patients (4%) had a non-union after internal fixation and were excluded because of additional treatment. The remaining 83 patients were not available for a follow-up examination. Patients with an isolated scaphoid fracture had a mean extension-flexion of 68°–0°–64°, a radial-ulnar deviation of 27°–0°–41° and a grip strength of 39 kg (corresponding to 87–98% of the uninjured contralateral wrist), while patients with concomitant injuries had a mean extension-flexion of 60°–0°–44°, radial-ulnar deviation of 22°–0°–38° and a grip strength of 42 kg (corresponding to 73–98% of the uninjured contralateral wrist). The Michigan Hand Questionnaire score was 85 and 75 and the Patient-Rated Wrist Evaluation score was 8 and 21, respectively. Fifteen patients had radiological signs of radiocarpal osteoarthritis with a significantly higher occurrence in those who had concomitant injuries compared to those with isolated scaphoid fractures (p < 0.01). There was no significant group difference in scaphotrapeziotrapezoid (STT) osteoarthritis (p = 0.968). One STT osteoarthritis case occurred after plate fixation, one after antegrade screw fixation and 10 after retrograde screw fixation. Surgical treatment of an acute isolated scaphoid fracture has excellent clinical, functional, and radiologic mid-term results, while scaphoid fractures with concomitant wrist injuries have slightly inferior results. Le but de cette étude était d'évaluer les résultats à moyen terme des fractures du scaphoïde traitées chirurgicalement parce qu'un bon résultat clinique initial peut se détériorer à cause d'arthrose ou de troubles fonctionnels. Trente-trois parmi 121 patients traitées chirurgicalement ont été évalués rétrospectivement (47–138 mois, 23 fractures scaphoïdiennes isolées; 10 fractures scaphoïdiennes avec lésions associées). Cinq patients (4%) ont présenté une pseudarthrose après ostéosynthèse et ont été exclus en raison d'un traitement supplémentaire. Les 83 patients restants n'étaient pas disponibles pour un examen de suivi. Les patients présentant une fracture du scaphoïde isolée présentaient une flexion-extension moyenne de 68°–0°–64°, une déviation radio-ulnaire moyenne de 27°–0°–41° et une force de poigne moyenne de 39 kg (correspondant à 87 à 98% par rapport au poignet controlatéral non blessé), tandis que les patients présentant des lésions associées présentaient une flexion-extension moyenne de 60°–0°–44°, une déviation radio-ulnaire moyenne de 22°–0°–38° et une force de poigne de 42 kg (correspondant à 73 à 98% par rapport au poignet controlatéral non blessé). Le score au Michigan Hand Questionnaire était de 85 et 75 et le Patient-Rated Wrist Evaluation score 8 et 21, respectivement. Quinze patients présentaient des signes radiologiques d'arthrose radio-carpienne avec une fréquence significativement plus élevée parmi les fractures scaphoïdiennes avec lésions associées par rapport aux fractures scaphoïdiennes isolées (p < 0,01). Il n'y avait pas de différence significative entre les deux groupes concernant l'arthrose scapho-trapézo-trapézoïdienne (STT) (p = 0,968). Un cas d'arthrose STT été constaté après ostéosynthèse par plaque, un autre avec une fixation par vis antérograde et dix avec une fixation par vis rétrograde. Le traitement chirurgical d'une fracture isolée récente du scaphoïde aboutit à d'excellents résultats cliniques, fonctionnels et radiologiques à moyen terme, tandis que les fractures scaphoïdiennes avec lésions associées au poignet donnent des résultats légèrement inférieurs.
Background: This study evaluates the results of ulnar shortening using the ulna osteotomy locking plate system (UOL; I.T.S. GmbH, Graz, Austria) with special regard to the time-dependent recovery of subjective and objective outcome parameters and surgeons’ experiences. Methods: Ulnar shortening using the UOL was performed on 11 patients (3 men, 8 women) with an average age of 47 ± 19.6 years. Range of motion (ROM) and grip strength were compared with the contralateral hand. Patient-rated outcomes were measured using a visual analogue scale (VAS) for pain and the Disability of the Arm, Shoulder and Hand (DASH) and the Patient Rated Wrist Evaluation (PRWE) survey for subjective outcomes. Ulnar variance and bony union were assessed using conventional wrist radiographs. The surgeons evaluated intraoperative handling through a standardized feedback form. Results: ROM improved and grip strength increased significantly between preoperative values and final follow-up. Flexion and supination improved significantly between weeks 8 and 12 and grip strength from week 8 onward. Patient-rated outcomes changed significantly with a final DASH score of 14.2 ± 12.4 and a PRWE score of 24.3 ± 17.0. Pain levels improved significantly with no pain at rest and a mean VAS of 0.8 ± 1.2 during activity. The average amount of shortening was 4.0 ± 1.9 mm with a final ulnar variance of 0.2 ± 1.8 mm. All osteotomies healed with 2 cases of delayed union. Conclusions: In ulnar shortening with the UOL, wrist function recovered after an initial decrease from week 8 onward. Subjective outcome parameters showed early recovery and improved continuously over time.
Zusammenfassung Ziel der vorliegenden Arbeit ist es, eine Übersicht über die Möglichkeiten der 3D-Bildgebung bei der Analyse von Frakturen und Pseudarthrosen des Kahnbeins zu geben und anhand von Fallbeispielen und der Literatur zu diskutieren.
Several methods treating proximal interphalangeal joint (PIP) fracture dislocations have been established providing early joint mobilization. The aim of this study was to evaluate the clinical and radiological outcome of unstable fracture dislocations of the PIP treated with a parabolic dynamic external fixator consisting of two Kirschner (K)-wires.Twenty-one patients who sustained a pilonoidal fracture of the PIP joint and were treated with a dynamic external fixator were evaluated retrospectively. The active range of motion, pain level, DASH score, Buck Gramcko Score, and the patient's satisfaction and acceptance were assessed. X-ray images were evaluated for bone healing, joint alignment, and signs of osteoarthritis.Mean PIP joint range of motion was 76°. Patients showed very mild discomfort (mean 0.7), high patient satisfaction (mean 1.9), and a moderate acceptance (mean 2.7). The mean DASH score was 11.6 and the Buck Gramcko score 13. All patients showed bone healing. One patient suffered from a recurrent dislocation, and another a subluxation of the PIP joint while wearing the fixator. Both joints could be corrected by modifying the fixator under image intensifier. Twenty patients (95%) showed a concentric and stable aligned joint. Three patients showed an osteoarthritis stage 0, five stage 1, nine stage 2, three stage 3, and one stage 4 according to the Kellgran-Lawrence Score.The use of a parabolic dynamic external fixator constructed from two K-wires restores joint alignment and stability in unstable pilonoidal PIP joint disclocation fractures. It allows immediate PIP joint mobilization to avoid adhesions. Modifications of the radius of the parabolic construct within cases of postoperative malalignment, without anesthesia, can restore joint axis and malalignment. This fixator is a cost-effective alternative, showing a good clinical outcome.
Given the absence of a satisfying plate system to deal with multifragmentary or subcapital distal ulnar fractures, the Distal Ulna Locking Plate (DUL, I.T.S. GmbH, Graz, Austria) could become a useful treatment option. This study aimed to evaluate the results of this anatomically pre-contoured plate regarding patients with unstable or displaced distal ulnar fractures.In a prospective clinical trial, 20 patients (18 female, two male; mean age 70 years (24-91 years)) with unstable or displaced distal ulna fractures between December 2010 and August 2015 were analyzed. All patients were treated with open reduction and internal fixation using the DUL. They were evaluated at three follow-up appointments at 3, 6 and 12 months postoperatively regarding their bone healing, ulnar variance (UV), range of motion (ROM) and grip strength. Patient related outcomes were measured using the Disability of the Arm, Shoulder and Hand (DASH), the Patient Rated Wrist Evaluation (PRWE) questionnaires, and the Visual Analogue Scale (VAS). The results after one year were compared to the outcome of the healthy contralateral side.All fractures treated with open reduction and internal fixation using the Distal Ulna Locking Plate healed within 6 months and showed stable ulnar variances after surgery. ROM (rotational plane 81.1 ± 9.0°, sagittal plane 55.1 ± 14.6°, frontal plane 33.0 ± 9.4°) and grip strength (18.7 ± 7.1 N) at the follow-up after 12 month had similar values compared with the uninjured side. The mean DASH score (36.4 ± 29.0), the PRWE-score (14.5 ± 27.0), and the VAS (at rest 0.5 ± 1.1, during activity 1.2 ± 2.4) after one year had no significant difference to the uninjured side. The surgeon's overall satisfaction rate regarding plate handling reached 81.8%.Stabilization of unstable distal ulna fractures using the DUL restores nearly normal anatomy and function. Its pre-countered design, volar placement, and enhanced stability present a satisfying plate system. The trial was retrospectively Registered at www.gov on 16 December 2021 (Trial Registration Number: NCT05329012).
