The anatomic features of proximal radius and their implication for osteosynthesis with plate
Relazione: 1.1 – Congresso: ICSES 2010 – Anno: 2010
relatori: G. Giannicola, E. Manauzzi, A. Greco, F.M. Sacchetti, G. Bullitta, F. Postacchini
speaker: A. Greco – lingua: ENG
Background: Several studies analyzed the anatomical landmarks of the safe zone for a correct placement of proximal radial plate in complex radial head and neck fractures. However, no study analyzed whether currently used plates match adequately the profile of the proximal radius in the “safe zone”. In the present investigation, a morphometric study of the proximal radius was conducted to evaluate the morphologic aspects of the “safe-zone” and the congruence between the proximal radius and a currently used plate.
Material and methods: Forty-four radial dried cadaveric bone were analysed. Whole length of the radius, height of the neck and head, minimum and maximum diameter of radial head were measured. The morphologic aspect of the cervicocephalic curvature of safe-zone and the plate-congruence was evaluated qualitatively and quantitatively.
Results: Three different morphologic variations of the safe zone with significant differences in the radius of bending were found: type A, B and C showing a flat profile (25%), a low concave (64%) and a marked concave (11%) curvature, respectively. The congruency of the tested plate with the proximal radius was good in 42,9% of morphologic type B, scarce or absent in all radii with type A and C, respectively. A plate applied to radii with type A morphology caused the most severe angular deformity at the cervico-cephalic junction (mean 11°), while the most severe translatory deformity was found when the plate was applied to morphologic type C radii (mean translation 0,98 mm).
Conclusions: The profile of the proximal radius in the “safe zone” shows substantial morphologic variations which should be taken into account to avoid a malunion of the proximal radius. A preoperative radiograph of the contralateral uninjured radius may be helpful, in order to select the most appropriate plate profile in comminuted radial head and neck fractures
Middle-term Results of Surgical Treatment in Complex Elbow Instability: A Prospective Study in 47 Cases
Introduction: Complex elbow instability consist of one o more osteo-articular fractures associated with capsule-ligaments tears and muscle-tendinous lesions that determinate a loss of elbow stability. The surgical treatment of these complex injuries is one of the most challenging in traumatic conditions. Recent investigations reported unsatisfactory results in 30%-40% of cases. X-Rays, CT scan with 2D and 3D reconstruction and assessment of elbow stability under fluoroscopy are essential to evaluate this complex injury and to plan the appropriate surgical treatment. Materials and methods: From 2005 to 2009, 47 patients, with a mean age of 53, underwent surgical treatment and were studied prospectively. 5 patients had a radial head fracture associated with elbow dislocation or MCL tear, 11 had a terrible triad injury, 2 had an anteromedial coronoid fracture associated with elbow dislocation or LCL tear, 20 had a complex fracture-dislocation of the proximal ulna and radius, 9 had a capitulum humeri and trochlea fracture associated with elbow dislocation or MCL tear. The proximal ulna was anatomically reduced and fixed; the radial head was repaired or replaced and the coronoid fractures was repaired or reconstructed. The LUCL was reattached with suture anchors or trans-osseous suture. If the elbow remains unstable, MCL was repaired and/or an hinged external fixator was applied. The patients were examined every 3 weeks in the first 3 months and every 3 months in the first year. The results were evaluated using the MEPS. Results: The results of treatment was excellent in 29 patients, good in 10, fair in 3 and poor in 5.
Conclusion: Complex elbow instability is a challenging injury even for expert elbow surgeons. We believe that definite treatment protocols may improve the clinical results of such complex injuries and that Level I or II prospective studies are needed to further clarify the most appropriate treatment