Outcomes after fixation of rib fractures sustained during cardiopulmonary resuscitation: A retrospective single center analysis

BackgroundHistorically rib fractures have been typically treated non-operatively. Recent studies showed promising results after osteosynthesis of rib fractures in trauma patients with flail segments or multiple rib fractures. However, there is a paucity of data on rib fixation after cardiopulmonary resuscitation (CPR). This study evaluated the outcomes of patients who received rib fixation after CPR.MethodsAdult patients who received surgical fixation of rib fractures sustained during CPR between 2010 and 2020 were eligible for inclusion in this retrospective study. Outcome measures included complications, quality of life (EQ 5D 5L) and level of dyspnea.ResultsNineteen patients were included with a mean age of 66.8 years. The mean number of fractured ribs was ten, seven patients additionally had a sternum fracture. Pneumonia occurred in 15 patients (74%), of which 13 were diagnosed preoperatively and 2 post-operatively. Six patients developed a postoperative pneumothorax, none of which required revision surgery. One patient showed persistent flail chest after rib fixation and required additional fixation of a concomitant sternum fracture. One infection of the surgical site of sternal plate occurred, while no further surgery related complications were reported. Mean EQ-5D-5L was 0.908 and the average EQ VAS was 80. One patient reported persisting dyspnea.ConclusionTo date, this is the largest reported cohort of patients who received rib fixation for fractures sustained during CPR. No complications associated with rib fixation were reported whereas one infection after sternal fixation did occur. Current follow-up demonstrated a good long-term quality of life after fixation, warranting further studies on this topic. Deeper knowledge on this subject would be beneficial for a wide spectrum of physicians

Does plate position influence the outcome in midshaft clavicular fractures? A multicenter analysis

PURPOSE To date, it remains unclear whether superior or anterior plating is the best option for treating midshaft clavicular fractures. The aim of this study was to compare both techniques with regard to the incidence of implant removal due to implant irritation, risk of complications, time to union, and function. METHODS In this retrospective cohort study, all midshaft clavicular fractures treated operatively between 2017 and 2020 in two hospitals in Switzerland were analyzed. The participating hospitals differed with regard to their standard practice; one offered superior plating only, while the other predominantly employed an anterior plate. The primary outcome was the incidence of implant removal for irritation. Secondary outcomes were time to union, complications, re-interventions, and range of motion during the follow-up period of at least 6 months. RESULTS In total, 168 patients were included in the study of which 81 (48%) received anterior plating and 87 (52%) superior plating. The overall mean age was 45 years (SD 16). There was no significant difference between anterior and superior plating with regard to implant removal (58.5% versus 57.1%, p = 0.887), infection (5.7% versus 1.8%, p = 0.071), and time to union (median 48 weeks versus 52 weeks, p = 0.643). Data on range of motion were available in 71 patients. There was no significant difference in anteflexion (median 180 degrees anterior versus 180 degrees superior) and abduction (median 180 degrees anterior versus 180 degrees superior) between the two groups. CONCLUSION This retrospective cohort study did not find sufficient evidence to recommend one implant position over the other for midshaft clavicular fractures with regard to removal due to irritation. Time to union was similar and Infections were equally rare in both groups. Notably, a considerable number of patients in both groups had their implants removed due to irritation. Larger prospective studies are needed to determine how much plate position contributes to the occurrence of irritation and whether other patient or implant-related factors might play a role. Until this is clarified, implant position should be based on surgeons preference and experience

Screw-blade fixation systems for implant anchorage in the femoral head : Horizontal blade orientation provides superior stability

Objectives: Despite continual improvement in the methods and devices used for treatment of proximal femoral fractures, unacceptably high failure rates remain. Novel screw-blade implant systems, combining a lag screw with a blade – the latter adding rotational stability to the femoral head – offer improvement of osseous purchase, especially in osteoporotic bone. The aim of this study was to compare biomechanically the head element (HE) anchorage of two screw-blade implant systems differing in blade orientation in the femoral head – vertical versus horizontal. Methods: Twenty paired human cadaveric femoral heads were assigned to four groups (n = 10), implanted with either Rotationally Stable Screw-Anchor HE (RoSA-HE, vertical blade orientation) or Gamma3 Rotation Control Lag Screw (Gamma-RC, horizontal blade orientation) in center or off-center position, and biomechanically tested until failure under progressively increasing cyclic loading at 2 Hz. Results: Cycles to failure and failure load were significantly higher for Gamma-RC versus RoSA-HE in center position and not significantly different between them in off-center position, p = 0.03 and p = 0.22, respectively. In center position, the progression of both rotation around implant axis and varus deformation over time demonstrated superiority of the implant with horizontal versus vertical blade orientation. Compared with center positioning, off-center implant placement led to a significant decrease in stiffness, cycles to failure and failure load for Gamma-RC, but not for RoSA-HE, p < 0.01 and p = 0.99, respectively. Conclusion: Horizontal blade orientation of screw-blade implant systems demonstrates better anchorage in the femoral head versus vertical blade orientation in center position. As the stability of the implant system with horizontal blade orientation drops sharply in off-center position, central insertion is its placement of choice

Interobserver reliability of classification and characterization of proximal humeral fractures: a comparison of two and three-dimensional CT

Interobserver reliability for the classification of proximal humeral fractures is limited. The aim of this study was to test the null hypothesis that interobserver reliability of the AO classification of proximal humeral fractures, the preferred treatment, and fracture characteristics is the same for two-dimensional (2-D) and three-dimensional (3-D) computed tomography (CT). Members of the Science of Variation Group--fully trained practicing orthopaedic and trauma surgeons from around the world--were randomized to evaluate radiographs and either 2-D CT or 3-D CT images of fifteen proximal humeral fractures via a web-based survey and respond to the following four questions: (1) Is the greater tuberosity displaced? (2) Is the humeral head split? (3) Is the arterial supply compromised? (4) Is the glenohumeral joint dislocated? They also classified the fracture according to the AO system and indicated their preferred treatment of the fracture (operative or nonoperative). Agreement among observers was assessed with use of the multirater kappa (&kappa;) measure. Interobserver reliability of the AO classification, fracture characteristics, and preferred treatment generally ranged from &quot;slight&quot; to &quot;fair.&quot; A few small but statistically significant differences were found. Observers randomized to the 2-D CT group had slightly but significantly better agreement on displacement of the greater tuberosity (&kappa; = 0.35 compared with 0.30, p &lt; 0.001) and on the AO classification (&kappa; = 0.18 compared with 0.17, p = 0.018). A subgroup analysis of the AO classification results revealed that shoulder and elbow surgeons, orthopaedic trauma surgeons, and surgeons in the United States had slightly greater reliability on 2-D CT, whereas surgeons in practice for ten years or less and surgeons from other subspecialties had slightly greater reliability on 3-D CT. Proximal humeral fracture classifications may be helpful conceptually, but they have poor interobserver reliability even when 3-D rather than 2-D CT is utilized. This may contribute to the similarly poor interobserver reliability that was observed for selection of the treatment for proximal humeral fractures. The lack of a reliable classification confounds efforts to compare the outcomes of treatment methods among different clinical trials and reports

Fixation failure of the LCP proximal femoral plate 4.5/5.0 in patients with missing posteromedial support in unstable per-, inter-, and subtrochanteric fractures of the proximal femur

The LCP proximal femoral plate 4.5/5.0 (PF-LCP) represents a new generation of extramedullary fixation devices for stable and unstable trochanteric and/or subtrochanteric fractures. We report four cases of secondary varus collapse of the fracture with hardware failure of the implant

Technique for intraoperative determination of femoral rotation with a lateral femur nail (LFN, Synthes, Oberdorf, Switzerland)

Endomedullary femur nails with a head-neck implant offer an up to now unused point of reference for the determination of rotation during osteosynthesis. The lateral femur nail (LFN) or the long Proximal Femur Nail (long PFNA), for example, have recon screws or a blade placed at a 10° angle to the distal locking screw in the transversal plane. If the head-neck implant is inserted properly, the rotation of the femur can be measured with the C-arm taking the hole of the distal locking screw and the posterior condylar tangential line as reference lines. If the posterior condylar tangential line is parallel to the axes of the hole of the distal locking screw, then the rotation or anteversion of the femur is equal to the angle between the head-neck implant and the distal locking screw which is 10° with LFN or long PFNA. Differing rotation angles can be made visible by rotating the C-arm from the axial projection of the distal locking screw up to the posterior condylar tangential line. Three exemplary cases are presented. The recommended method was effective. The rotation of the femur can be measured intraoperatively with this technique and many revisions can be avoided

Open reduction and fixation of medial Moore type II fractures of the tibial plateau by a direct dorsal approach

INTRODUCTION: Moore type II Entire Condyle fractures of the tibia plateau represent a rare and highly unstable fracture pattern that usually results from high impact traumas. Specific recommendations regarding the surgical treatment of these fractures are sparse. We present a series of Moore type II fractures treated by open reduction and internal fixation through a direct dorsal approach. PATIENTS AND METHODS: Five patients (3 females, 2 males) with Entire Condyle fractures were retrospectively analyzed after a mean follow-up period of 39 months (range 12-61 months). Patient mean age at the time of operation was 36 years (range 26-43 years). Follow-up included clinical and radiological examination. Furthermore, all patient finished a SF36 and Lysholm knee score questionnaire. RESULTS: Average range of motion was 127/0/1 degrees with all patients reaching full extension at the time of last follow up. Patients reached a mean Lysholm score of 81.2 points (range 61-100 points) and an average SF36 of 82.36 points (range 53.75-98.88 points). One patient sustained deep wound infection after elective implant removal 1 year after the initial surgery. Overall all patients were highly satisfied with the postoperative result. CONCLUSION: The direct dorsal approach to the tibial plateau represents an adequate method to enable direct fracture exposure, open reduction, and internal fixation in posterior shearing medial Entire Condyle fractures and is especially valuable when also the dorso-lateral plateau is depressed

Elastic stabilisation of proximal humeral fractures with a new percutaneous angular stable fixation device (ButtonFix(®)) : a preliminary report

The ButtonFix(®) system represents a new angular stable percutaneous fixation device for stabilisation of fractures of the proximal humerus. The purpose of this study was to present a preliminary report of the radiological and clinical outcome after minimally invasive stabilisation of selected proximal humerus fractures with the ButtonFix(®)