Wednesday, November 9, 2011

Cannulated Screw and Cable vs Modified tension band wiring for Transverse Patella fracture

Cannulated Screw and Cable are Superior to Modified Tension Band in the Treatment of Transverse Patella Fractures            

Clin Orthop Relat Res. 2011 Dec;469(12):3429-35. Epub 2011 May 15.
Tian Y, Zhou F, Ji H, Zhang Z, Guo Y.
.Source: Department of Orthopaedics, Third Hospital of Peking University, Beijing, 100191, China,

Although the modified tension band technique (eg, tension band supplemented by longitudinal Kirschner wires) has long been the mainstay for fixation of transverse fractures of the patella, it has shortcomings, such as bad reduction, loosening of implants, and skin irritation.

We conducted a retrospective comparison of the modified tension band technique and the titanium cable-cannulated screw tension band technique.

We retrospectively reviewed 101 patients aged 22 to 85 years (mean, 56.6 years) with AO/OTA 34-C1 fractures (n = 68) and 34-C2 fractures (n = 33). Fifty-two patients were in the modified tension band group and 49 were in the titanium cable-cannulated screw tension band group. Followup was at least 1 year (range, 1-3 years). Comparison criteria were fracture reduction, fracture healing time, and the Iowa score for knee function.

The titanium cable-cannulated screw tension band group showed improved fracture reduction, reduced healing time, and better Iowa score, compared with the modified tension band group. In the modified tension band group, eight patients experienced wire migration, three of these requiring a second operation. There were no complications in the titanium cable-cannulated screw tension band group.

The titanium cable-cannulated screw tension band technique showed superior results and should be considered as an alternative method for treatment of transverse patellar fractures.

LEVEL OF EVIDENCE: Level III, therapeutic study. 

IORG Trauma Update

Monday, October 31, 2011

The non-operative functional management of patients with a rupture of the tendo Achillis leads to low rates of re-rupture.

J Bone Joint Surg Br. 2011 Oct;93(10):1362-6.
Wallace RGHeyes GJMichael AL.


Ulster Hospital Dundonald, Upper Newtownards Road, Dundonald, Belfast BT16 1RH, UK.


Controversy surrounds the most appropriate treatment method for patients with a rupture of the tendo Achillis. The aim of this study was to assess the long term rate of re-rupture following management with a non-operative functional protocol. 

We report the outcome of 945 consecutive patients (949 tendons) diagnosed with a rupture of the tendo Achillis managed between 1996 and 2008. There were 255 female and 690 male patients with a mean age of 48.97 years (12 to 86). Delayed presentation was defined as establishing the diagnosis and commencing treatment more than two weeks after injury. The overall rate of re-rupture was 2.8% (27 re-ruptures), with a rate of 2.9% (25 re-ruptures) for those with an acute presentation and 2.7% (two re-ruptures) for those with delayed presentation. 

This study of non-operative functional management of rupture of the tendo Achillis is the largest of its kind in the literature. Our rates of re-rupture are similar to, or better than, those published for operative treatment. We recommend our regime for patients of all ages and sporting demands, but it is essential that they adhere to the protocol.
IORG Trauma update

Friday, October 28, 2011

Subtrochanteric femoral fractures: a comparative study of the long proximal femoral nail and the long trochanteric fixation nail

E. Muñoz-MahamudE. García-OltraJ. A. Fernández-ValenciaJ. A. ZumbadoJ. RíosS. Suso and G. Bori


Subtrochanteric femoral fractures are expected to increase in the coming years. Despite the improvement of implants and surgical techniques, failures due to complications are still considerable. 

This article reports a retrospective review of patients who showed a subtrochanteric femoral fracture and who were treated consecutively with the Long Proximal Femoral Nail (LPFN) from January 2001 to August 2004, or with the Long Trochanteric Femoral Nail (LTFN) from January 2005 to January 2008. A total of 43 patients with 44 subtrochanteric femoral fractures were included in the study: 23 were treated with the LPFN and 21 with the LTFN. The number of complications related to the LPFN was eight (two re-interventions) against only one related to the LTFN (no re-interventions). haemoglobin decrease was on average higher in the group treated with the LPFN (35.5 g/L) than with the LTFN (30.4 g/L), and so was the number of patients needing for red blood cell concentrates transfusion (15 and 9, respectively). 
Mortality at the sixth-month follow up was higher in the group treated with the LTFN. The average surgery time was similar in both groups. The percentage of patients capable of walking within the first postoperative week was similar in both groups as well as time to discharge and the consolidation time. Both the LPFN and the LTFN are reliable implants for the treatment of subtrochanteric fractures of the femur.
 New features related to the LTFN might decrease the number of complications as well as the need for red blood cell concentrates transfusion.

IORG Trauma Update