Acta Orthop Belg
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Comparative Study
Operative treatment of humeral shaft fractures. Comparison of plating and intramedullary nailing.
Plate and screw fixation (PSF) has always been the more common surgical treatment of humeral shaft fractures. However, intramedullary nailing (IMN) of the humerus has gained in popularity over the last two decades. The purpose of this retrospective study was to evaluate the clinical outcome of plate fixation versus intramedullary nailing of midshaft humeral fractures. ⋯ A reoperation was necessary in 143% of the PSF patients and 163% of the IMN patients (non significant difference). In this retrospective study, IMN did not achieve better results than PSF of humeral midshaft fractures and was associated with more postoperative complications. Based on these findings, we suggest that plating of humeral shaft fractures should be considered as the primary treatment for all surgical indications, except for some open fractures requiring temporary external fixation, pathological fractures, humeral shaft fractures in morbidly obese and osteopenic patients, and large segmental fractures of the humerus.
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Cannulated screw fixation is a minimal invasive technique to treat undisplaced femoral neck fractures. It is the preferred method in elderly patients who often suffer co-morbidities. There is scarce literature on subtrochanteric femoral fracture as a complication of cannulated screw fixation of a femoral neck fracture. ⋯ The overall incidence reported in literature is 2.4-4.4% (mean: 2.97%). Despite a broad use of this type of osteosynthesis, the literature does not provide clear biomechanical or clinical indications for optimal screw placement to avoid this complication. Considering the literature and our personal results, surgeons should be aware of this severe complication; they may opt for a different implant in the very old, osteoporotic patient with an undisplaced femoral neck fracture.
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Osteosarcoma of the proximal fibula is a rare entity that poses a surgical challenge. Limb salvage is the goal of treatment, and this entails sacrifice of the common peroneal nerve as well as the anterior tibial artery. Also the loss of the lateral collateral ligament and biceps attachment leads to unavoidable knee instability which requires special reconstructive procedures. ⋯ Seven of these patients are still alive without evidence of disease. Our results indicate that the sacrifice of the common peroneal nerve ensures a wide margin of resection which in turn correlates with long-term survival. Furthermore, our technique of reconstruction of lateral knee structures has produced good functional outcome without significant postoperative knee instability.