Scaphoid Fractures: A Comparison of Two Surgical Methods for Internal Fixation Using Either Herbert Screws or Multiple Pins

Abstract: Background and Aims: Scaphoid fractures are the most common fractures of the wrist. This study compared the outcomes of two surgical internal fixation techniques, using either Herbert screws (HS group) or multiple pins (MP group), in the treatment of scaphoid fractures. Methods: This cross-sectional study was performed on 41 patients (23 in HS and 18 in MP groups) with unilateral scaphoid fractures from September 2009 to September 2011. All patients were followed-up two weeks post-surgery, every month for six months, and then every year after one year. Degree of fracture healing, measured level of pain using Visual Analog Scale (VAS), range of motion, hand grip strength of affected limb vs. healthy limb, Quick DASH score (QD) and also Mayo Modified Wrist Score (MMWS) were recorded. In December 2012, all patients presented to the Orthopedic Clinic for their final follow-up visit where all data was recorded once more. Results: Mean patient follow-up time was 24.34 ± 8.70 months (range: 11-34). Mean scaphoid fracture healing times for the HS and MP group were 14.61 ± 3.88 and 14.39 ± 4.27 weeks, respectively. No statistically significant difference was found between both groups after comparing mean levels of pain using VAS, ROM of wrist during flexion and extension, hand grip strength expressed as percentage of normal, QD, and MMWS. The level of patients' content using VAS was 9.5 for HS and 9.0 for MP groups. Conclusion: The use of multiple pins for the internal fixation of scaphoid fractures proves to be a viable treatment option compared to Herbert Screws, due to decreased cost and increased availability. Keywords: Scaphoid bone, Bone screw, Bone wire, Internal fixation, Closed fracture, Treatment outcom

Proximal crescentic osteotomy versus proximal opening wedge osteotomy of the first metatarsal bone in the treatment of moderate to severe hallux valgus

Objectives: To compare the therapeutic outcomes of proximal crescentic osteotomy (PCO) versus proximal opening wedge osteotomy (POWO). Methods: In this retrospective analytical study, 88 patients with moderate to severe unilateral hallux valgus (HV) were enrolled. HV severity and angle, intermetatarsal angle, MTPJ status, and AOFAS score were collected. Results: The AOFAS score, HV and intermetatarsal angles, and MTPJ status improved in all patients with no significant differences between the two groups. The POWO group showed significantly higher satisfaction score at the 3rd month post-operation. Conclusions: Both osteotomies demonstrated acceptable outcomes; however, short term patient satisfaction was greater in the POWO technique. © 2020, Author(s)

Scaphoid Fractures: A Comparison of Two Surgical Methods for Internal Fixation Using Either Herbert Screws or Multiple Pins

Abstract: Background and Aims: Scaphoid fractures are the most common fractures of the wrist. This study compared the outcomes of two surgical internal fixation techniques, using either Herbert screws (HS group) or multiple pins (MP group), in the treatment of scaphoid fractures. Methods: This cross-sectional study was performed on 41 patients (23 in HS and 18 in MP groups) with unilateral scaphoid fractures from September 2009 to September 2011. All patients were followed-up two weeks post-surgery, every month for six months, and then every year after one year. Degree of fracture healing, measured level of pain using Visual Analog Scale (VAS), range of motion, hand grip strength of affected limb vs. healthy limb, Quick DASH score (QD) and also Mayo Modified Wrist Score (MMWS) were recorded. In December 2012, all patients presented to the Orthopedic Clinic for their final follow-up visit where all data was recorded once more. Results: Mean patient follow-up time was 24.34 ± 8.70 months (range: 11-34). Mean scaphoid fracture healing times for the HS and MP group were 14.61 ± 3.88 and 14.39 ± 4.27 weeks, respectively. No statistically significant difference was found between both groups after comparing mean levels of pain using VAS, ROM of wrist during flexion and extension, hand grip strength expressed as percentage of normal, QD, and MMWS. The level of patients' content using VAS was 9.5 for HS and 9.0 for MP groups. Conclusion: The use of multiple pins for the internal fixation of scaphoid fractures proves to be a viable treatment option compared to Herbert Screws, due to decreased cost and increased availability. Keywords: Scaphoid bone, Bone screw, Bone wire, Internal fixation, Closed fracture, Treatment outco

Double-plate fixation together with bridging bone grafting in nonunion of femoral supracondylar, subtrochanteric, and shaft fractures is an effective technique

Purpose: The aims of the present study were to evaluate and report the therapeutic outcomes of double-plate fixation in combination with autogenous bridging bone grafting in treatment of nonunion fractures of femur. Methods: In this retrospective case series study, 41 patients with nonunion fracture of femur who underwent surgery by double-plate fixation and autogenous bridging bone grafting in academic referral center from July 2010 to July 2015 were enrolled. Totally, 32 males and 9 females with mean age of 35 years were evaluated. They were evaluated for related risk factors, previous therapeutic methods, time interval between injury to nonunion surgery and surgery to full clinical and radiological union, duration of follow-up, levels of postoperative limb shortening, and movement limitations. Results: Ten patients had open fractures and eight patients had infected nonunion in the femoral supracondylar, subtrochanteric, and shaft fractures. Nailing was the most common used method as the primary treatment of femoral shaft fractures. In addition, the mean follow-up time was 37 months. Full union was obtained even in infected cases. Deep vein thrombosis was found in one patient and pulmonary thromboembolism in another patient, and both patients were treated successfully. Moreover, limitations of articular movements were seen in seven patients. Conclusion: Double-plate fixation in combination with bridging bone grafting is an effective method in the treatment of nonunion of femoral supracondylar, subtrochanteric, and shaft fractures even in the infected cases. © 2019, Istituto Ortopedico Rizzoli

Contralateral and siblings� knees are at higher risk of ACL tear for patients with a positive history of ACL tear

Purpose: Recent studies have shown that several genetic factors can cause susceptibility to anterior cruciate ligament (ACL) rupture. The aim of the present study was to evaluate certain underlying factors that increase the risk of ACL rupture. Methods: Eight hundred thirty-six patients with ACL rupture who underwent ACL reconstructive surgery from 2010 to 2013 at an academic center completed a minimum of 5 years post-operation follow-up. The collected variables included sex, age, height, weight, exercise level, time interval between ACL rupture in the first knee and contralateral ACL rupture, dominant leg, side of the involved knee and sibling history of ACL rupture. Results: The median follow-up duration was 6.5 (range: 5�8) years. Eighty-three patients (9.9) had a contralateral ACL rupture, and 155 patients (18.5) had siblings with a history of ACL rupture. The rate of contralateral ACL rupture was three times higher in women than in men and in patients with siblings with a history of ACL rupture than in those without such history. In addition, the risk of contralateral ACL rupture was higher in those younger than 30 years of age, those with a BMI of 20�25 kg/m2 and those who participated in regular sports activity. However, whether the involved knee was on the dominant or nondominant side had no effect on the incidence of contralateral ACL rupture. The results of the study showed that 69 (83.1) of the contralateral ACL ruptures occurred within the first 2 years after the primary operation. Conclusion: In a 5- to 8-year follow-up, one out of every ten patients had a contralateral ACL rupture, and two out of every ten patients had siblings with a history of ACL rupture. The findings suggest that having a sibling with a history of ACL rupture and being female are important risk factors for ACL rupture of the contralateral knee. Level of evidence: III. © 2019, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA)