RESUMEN
OBJECTIVE: This study investigates if the use of calcium phosphate cement as an adjunct to internal fixation for posterior wall acetabular fracture will result in acute restoration of joint loading parameters to the intact condition. METHODS: Ten fresh-frozen cadaveric pelves were used for this investigation. Simulated abductor mechanism was used to load the hip. Pressure-sensitive film was used to measure contact area and pressure within the anterior, superior, and posterior regions of the acetabulum for all experimental conditions. The hips were loaded under the following 4 conditions: 1) intact; 2) following posterior wall osteotomy; 3) following reduction and standard internal fixation; and 4) following reduction of the posterior wall using calcium phosphate cement, as a grout, in addition to internal fixation. A posterior wall fracture was created along an arc of 40-90 degrees about the acetabular rim. Extensometers were utilized to measure posterior wall fragment micromotion under conditions 3 and 4 above. Statistical analysis was performed using multivariate analysis of variance to assess the significance of the difference among and between conditions simultaneously for each region. Fragment motion data were analyzed using a 2-tailed t test. RESULTS: Fragment micromotion was reduced to 78 microm superiorly and 46 microm inferiorly with the use of calcium phosphate cement (P < 0.05). Creation of a posterior wall defect resulted in increased load in the superior acetabulum (1201N) as compared to the intact condition (902N, P = 0.024). Following reduction and internal fixation, the load distributed to the superior acetabulum (1132N) was not statistically different from the displaced condition. Following the addition of calcium phosphate cement, the load seen at the superior region of the acetabulum (883N) was less than fixation without calcium phosphate cement and was not different from the intact state (P = 0.85). CONCLUSION: The use of calcium-phosphate cement as a fracture grout with internal fixation resulted in a partial restoration of joint loading parameters toward the intact state. Further work will be needed to determine if similar types of augmented articular fixation may result in a clinical benefit.
Asunto(s)
Acetábulo/lesiones , Cementos para Huesos , Fosfatos de Calcio , Fijación Interna de Fracturas/métodos , Fracturas Óseas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Fenómenos Biomecánicos , Articulación de la Cadera , Humanos , Persona de Mediana Edad , Rango del Movimiento Articular , Estrés MecánicoRESUMEN
PURPOSE: To review the clinical and radiographic results of scaphoid excision and four-corner arthrodesis using a circular plate and screws compared with traditional fusion techniques (wires, staples, screws). METHODS: Fifty-eight patients with four-corner arthrodesis (plate fixation, n = 27; traditional fixation, n = 31) were evaluated for radiographic and clinical success using wrist radiographs and functional assays. Patients were subjectively surveyed using the standardized Disabilities of the Arm, Shoulder, and Hand questionnaire and classification scales for pain and satisfaction. Objective measurements included grip-strength and range-of-motion measurements. RESULTS: Radiographic analysis showed 26% nonunion with loose hardware in the plate group compared with 3% in the traditional group and 22% hardware impingement in the plate group compared with 3% in the traditional group. Clinical evaluation yielded a mean grip strength of 31 kg (70% of opposite side) for plate fixation and 33 kg (79% of opposite side) for traditional fixation. The mean flexion-extension arc was 48% and 50% of the opposite wrist for plate and traditional patients, respectively. The mean adjusted Disabilities of the Arm, Shoulder, and Hand questionnaire scores were 27 out of 100 for plate patients and 8 out of 100 for traditional patients. Pain classification scores showed that only 2 patients in the plate group were pain free whereas there were 8 patients in the traditional group who were pain free. Overall patient satisfaction was 60% for the plate group whereas the traditional patient group reported 100% satisfaction. CONCLUSIONS: The rate of major complications (nonunion or impingement) was much greater with circular plate fixation (48%) versus traditional fixation techniques (6%). With the plate procedure the grip strength and arc of motion decreased approximately 30% and 52%, respectively, compared with decreases of 21% and 50%, respectively, for traditional fusion methods. Additionally, subjective patient dissatisfaction was 40% in the plate group compared with 0% in the traditional group. We postulate that the increased complication and dissatisfaction rates associated with plate fixation may be attributable to possible biomechanical imperfections or increased technical demands with this fusion system.
Asunto(s)
Artrodesis/métodos , Articulaciones del Carpo/cirugía , Dispositivos de Fijación Ortopédica , Traumatismos de la Muñeca/cirugía , Adolescente , Adulto , Anciano , Artrodesis/efectos adversos , Articulaciones del Carpo/diagnóstico por imagen , Articulaciones del Carpo/fisiopatología , Evaluación de la Discapacidad , Empleo , Femenino , Fuerza de la Mano/fisiología , Humanos , Ilion/trasplante , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Satisfacción del Paciente , Radiografía , Radio (Anatomía)/trasplante , Rango del Movimiento Articular/fisiología , Reoperación , Estudios Retrospectivos , Hueso Escafoides/trasplante , Resultado del Tratamiento , Traumatismos de la Muñeca/diagnóstico por imagen , Traumatismos de la Muñeca/fisiopatologíaRESUMEN
The treatment of tendon injury in combined complex injuries to the hand is dictated by the presence of concomitant injuries. Early range of motion is desirable. To achieve this, fractures must be stabilized and the soft tissue envelope and vascular integrity maintained or reconstituted. In those instances in which these conditions cannot be met, the surgeon and patient should be prepared for secondary surgeries, including reconstruction or tenolysis. Although nerve integrity is not necessary for early functional success following tenorrhaphy, nerve injuries should be repaired or grafted primarily as the injury permits. In cases in which vascular compromise is encountered, the options of revascularization versus primary amputation should be discussed with the patient. With an understanding of the treatment principles, the complications associated with complex tendon injuries can be minimized. It is important to stress that optimal functional outcome is multifactorial and includes a physician-therapist team-oriented approach.