Between November 1981 and November 1984, eight patients with comminuted radial head fractures were treated with open reduction and internal fixation. The recommended treatment for these fractures has been early motion, with or without radial head excision. According to the AO classification all were B3-1 or B3-2 fractures. All fractures were fixed through Kocher incisions using Kirschner wires and AO small fragment screws. All patients began motion 7 to 10 days following surgery. In a retrospective study, clinical results were reviewed in six patients with an average followup of 12 months (range, 4 to 40 months). Three patients had associated elbow dislocations, one requiring internal fixation of the coronoid process. Loss of range of motion averaged 3 degrees of flexion, 10 degrees of extension, 3 degrees of pronation, and 20 degrees of supination. Cybex testing demonstrated no significant difference in strength between injured and uninjured extremities. The only complication was a transient posterior interosseous nerve palsy. No patient had evidence of any radial shortening. Our findings suggest that open reduction and internal fixation gives satisfactory elbow function and avoids complications of radial shortening, loss of motion, and wrist symptoms that may subsequently occur following radial head excision.

No abstract

Concomitant ipsilateral femoral neck and shaft fractures are uncommon, occurring in 1-9% of femoral shaft fractures. While this injury typically occurs in young patients following high-energy trauma, little consensus has been established regarding the optimal fixation approach. A multitude of treatment strategies exist, with limited evidence as to which is more favorable. The aim of this study was to appraise current evidence, comparing management with either one single or separate devices for both fractures. A systematic review was undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published between 1992 and 2018 comparing the rate of postoperative nonunion, malunion, delayed union, avascular necrosis, infection or reoperation between at least one method of single device fixation and one method of separate device fixation were included. Six non-randomized cohort studies assessing 173 patients were suitable for inclusion, each comparing single device cephalomedullary nail fixation of both fractures with a combination of devices. All patients presented following high-energy trauma, at a median age of 32 years. While low complication rate and favorable outcomes were found across both groups, no significant difference could be inferred between either treatment strategy. This injury continues to occur in the traditionally described patient group, and results in acceptable postoperative outcomes. A paucity of randomized studies limits the ability to recommend a single or separate device treatment approach, and as such prospective, randomized trials with adequately powered sample sizes are required to definitively compare surgical management strategies in this rare but complex injury.

No abstract

Ultra low temperature isotropic (ULTI) carbon-coated polyester suture material was evaluated histologically and mechanically in dogs. These results were compared to those obtained for uncoated polyester and polybutylate coated polyester. The suture materials were used in the repair of the surgically incised medial collateral ligament and subcutaneous tissues to evaluate the potential of the carbon-coated system for ligamentous repairs. Following surgery, the dogs were sacrificed at periods of 1-48 weeks postoperatively for evaluation of tissue biocompatibility and mechanical strength of the materials. The polybutylate-coated polyester suture broke at lower force levels than did comparable sizes of uncoated or carbon-coated polyester. All three types showed a high retention (greater than 98%) of mechanical strength at 48 weeks, often exhibiting an increase in tensile strength due to tissue ingrowth. The histologic response to carbon-coated polyester was equal to or better than the response to either the uncoated polyester or polybutylate-coated polyester. A greater degree of tissue growth into the carbon-coated material was evident at most time periods following an initial acute inflammatory response which was also present in the other materials.