BackgroundMultiplanar complex C3-type unstable distal femoral fractures present many challenges in terms of approach and fixation. This prospective study investigates a possible solution to these problems through double plating with autogenous bone grafting via a modified Olerud extensile approach.Materials and methodsTwelve patients with closed C3-type injuries were included; eight of them were male, and their mean age was 33.5 years (range 22–44 years). Mechanism of injury was road traffic accident (RTA) in nine patients and fall from height in the other three cases. Eight cases were operated during the first week and four cases during the second week after injury. Mean follow-up was 13.7 months (range 11–18 months).ResultsMean radiological healing time was 18.3 weeks (range 12-28 weeks), and all cases had good radiological healing without recorded nonunion or malunion. Clinically, two cases (16.7 %) had excellent results, five cases (41.7 %) had good results, three cases (25 %) had fair results, and two cases (16.7 %) had poor results. No cases developed skin necrosis, deep infection, bone collapse, or implant failure. However, two cases (16.7 %) had limited knee flexion to 90° and required subsequent quadricepsplasty.ConclusionsUse of this modified highly invasive approach facilitated anatomical reconstruction of C3-type complex distal femoral fractures with lower expected complication rate and acceptable clinical outcome, especially offering good reconstruction of the suprapatellar pouch area. It can be considered as a standby solution for managing these difficult injuries.

Open intramedullary fixation of 37 fresh midshaft clavicular fractures in 35 patients was performed using a 6.5 partially threaded cancellous screw. Mean age was 38 years (range 18-65). The screw was inserted from the medial fragment after retrograde drilling of that fragment. Average follow-up period was 21 months (range 9-36). Radiological evidence of union was apparent in all cases within six to eight weeks after surgery (mean 7.8). Two cases had intraoperative failure of fixation, nine complained of subcutaneous prominence of the screw head, five experienced decreased sensation over the site of incision, and three had symptoms of frozen shoulder. In conclusion, the technique is simple, affordable and it does not require special instrumentation or implants. It allows intramedullary compression, stability, stress sharing, minimal periosteal stripping, and early recovery after surgery.Résumé Fixation intramédullaire des fractures diaphysaires de la clavicule. 37 fractures de la partie médiophysaire de la clavicule chez 35 patients ont été traitées par une fixation intramédullaire par voie ascendante, en utilisant une vis spongieuse, de diamètre 6,5. L'âge moyen des patients était de 38 ans (entre 18 et 65). La vis a été insérée à partir du fragment interne après mêchage rétrograde. Le suivi moyen a été de 21 mois (entre 9 et 36 mois). Une consolidation radiologique a été effectuée dans tous les cas à partir de 6 à 8 semaines après l'intervention (moyenne de 7,8 semaines). 2 cas ont présenté un défaut de fixation peropératoire et 9 patients se plaignaient d'une gène secondaire à la proéminence de la vis, 5 de sensations désagréables au niveau de l'incision et 3 avaient des signes d'épaules gelées. En conclusion, cette technique simple et abordable ne nécessite pas d'instrumentation particulière, ni d'implants particuliers et permet une compression intramédullaire avec une bonne stabilité, une bonne répartition des contraintes et d'un dépériostage à minimum ainsi qu'une récupération rapide après l'intervention.

The locked compression plate withstood fixing femoral fractures in polio patients, addressing the challenges of a smaller, osteoporotic, less vascularized and sometimes deformed femur.

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Twenty-one patients having proximal ulna nonunion were treated with contoured plating. The most proximal hole received an intramedullary 6.5-mm cancellous lag screw that extends fixation of the nonunion site. Mean age of the patients was 41.7 years. Average follow-up period was 22 months. Union occurred in 19 cases after a mean of 9.6 weeks. Complications were persistent nonunion in two cases, a stiff elbow in one, hardware prominence in two, and a 1×1-cm ulcer over the curve of the plate in one case. The two unsatisfactory results were related to ulnohumeral arthritis. In conclusion, augmentation of the contoured plate with a 6.5-mm intramedullary cancellous lag screw creates a stable construct in treatment of proximal ulna nonunion. It applies axial compression, resists bending forces on the dorsal plate and allows early mobilization after surgery, regardless of the size of the proximal fragment.