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Kabelitz M, Kabelitz N, Frima H, Stillhard PF, Sommer C, Michelitsch C. Two-staged management of ankle fracture-dislocations with a posterior fragment: computer-tomography-based classification, treatment and its outcome. Arch Orthop Trauma Surg 2023; 143:6193-6200. [PMID: 37335355 DOI: 10.1007/s00402-023-04949-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/11/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Trimalleolar fractures are difficult to treat and malreduction can lead to functional impairment. Involvement of the posterior malleolus has a poor predictive value. Current computed-tomography (CT)-based fracture classifications led to an increase in fixation of the posterior malleolus. The aim of this study was to describe the functional outcome after a two-stage stabilisation with direct fixation of the posterior fragment in trimalleolar dislocation fractures. MATERIALS AND METHODS In a retrospective study, all patients presenting with a trimalleolar dislocation fracture, an available CT scan, and a two-stage operative stabilisation including the posterior malleolus by a posterior approach were included. All fractures were treated with initial external fixator and delayed definitive stabilisation including fixation of the posterior malleolus. Next to clinical and radiological follow-up, outcome measures (Foot and Ankle Outcome Score (FAOS), Numeric Rating Scale (NRS), Activity of Daily Living (ADL), Hulsmans implant removal score) and complications were analysed. RESULTS Between 2008 and 2019, of 320 trimalleolar dislocation fractures, 39 patients were included. Mean follow-up was 49 months (standard deviation (SD) 29.7, range 16-148). Mean age was 60 years (SD 15.3, 17-84) with 69% female patients. The mean FAOS was 93/100 (SD 9.7, 57-100), NRS 2 (interquartile range (IQR) 0-3) and ADL 2 (IQR 1-2). Four patients showed a postoperative infection, three re-operations had to be performed and implants were removed in 24 individuals. CONCLUSION A two-stage procedure of trimalleolar dislocation fractures with in-direct reduction and fixation of the posterior tibial fragment through a posterior approach leads to good functional outcome scores with a low rate of complications.
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Affiliation(s)
- Method Kabelitz
- Clinic of Orthopedics, Hand and Trauma Surgery, City Hospital Zurich, Tièchestrasse 99, 8037, Zurich, Switzerland.
| | - Nina Kabelitz
- Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland
| | - Herman Frima
- Department of Trauma Surgery, Noordwest Ziekenhuisgroep, Wilhelminalaan 12, 1815 JD, Alkmaar, Netherlands
| | | | - Christoph Sommer
- Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland
| | - Christian Michelitsch
- Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland
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Haupt S, Weber S, Frima H, Hutter R, Grehn H, Sommer C. Proximal humeral fracture-dislocation: Outcome analysis in osteosynthesis and arthroplasties. Eur J Orthop Surg Traumatol 2023; 33:305-314. [PMID: 35031852 DOI: 10.1007/s00590-021-03183-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/09/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Proximal humeral fracture-dislocations (PHFD) are challenging to treat. In older patients, usually arthroplasty is performed. In younger patients, osteosynthesis is chosen. This study presents functional outcomes of these different treatment modalities. METHODS All patients operated for PHFD from 2010 until 2017 were included. Osteosynthesis was performed in younger patients and if reconstruction was possible. Either an open deltopectoral approach or a minimal invasive plate osteosynthesis (MIPO) was performed. Hemiarthroplasty (HA) was done if reconstruction of the tubercles was possible, age was below 63 years and no signs of osteoarthritis were present. In all other cases, a reverse total shoulder arthroplasty (rTSA) was done. The primary endpoint was functional outcome assessed with the QuickDASH Score (QDS). Secondary outcomes were subjective shoulder value (SSV), complications, revisions, and conversion into arthroplasty. RESULTS The mean follow-up of 40 patients was 56 ± 24 months. The mean QDS was 4.5 (0.6-9.1) and the mean SSV was 90 (80-98.6). Of these, 33 patients (mean age: 50) had an osteosynthesis, 25 were treated with MIPO. Only 18% were converted into an arthroplasty after a mean of 22 months. Among them, 7 patients received a primary arthroplasty (mean age: 68), no revisions were recorded. Subgroup analysis showed functional outcome deficits in avascular necrosis (AVN) compared to no AVN (p = 0.021), revision surgery compared to no revision (p = 0.040) and in HA compared to rTSA (p = 0.007). CONCLUSION Both osteosynthesis and primary arthroplasty after PHFD can lead to good or even excellent functional outcome. Revision rates in osteosynthesis are high. Revision procedures or secondary conversion into arthroplasty after failed osteosynthesis decrease outcome scores significantly.
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Affiliation(s)
- Samuel Haupt
- Department of Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland.
- Department of Orthopedics, Kantonsspital Graubünden, Loëstrasse 99, 7000, Chur, Switzerland.
| | - Sabrina Weber
- Department of Orthopedics, Kantonsspital Graubünden, Loëstrasse 99, 7000, Chur, Switzerland
| | - Herman Frima
- Department of Trauma Surgery, Northwest Hospitalgroup, Wilhelminalaan 12, 1815 JD, Alkmaar, Netherlands
| | - René Hutter
- Department of Orthopedics, Kantonsspital Graubünden, Loëstrasse 99, 7000, Chur, Switzerland
| | - Holger Grehn
- Department of Orthopedics, Kantonsspital Graubünden, Loëstrasse 99, 7000, Chur, Switzerland
| | - Christoph Sommer
- Department of Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland
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Michelitsch C, Kabelitz N, Frima H, Kabelitz M, Beks R, Stillhard PF, Sommer C. Osteosynthesis of scapular fractures: a retrospective cohort study. Arch Orthop Trauma Surg 2022; 142:3845-3852. [PMID: 34993604 DOI: 10.1007/s00402-021-04283-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/27/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE In recent years a trend from conservative to operative treatment of displaced scapula fractures has evolved. The aim of this study was to assess surgical and patient-based radiological and functional outcome after open reduction and internal fixation (ORIF) of displaced scapula fractures following predefined operative indications. METHODS We retrospectively analyzed data of a consecutive series of patients with displaced scapula fractures following operative fixation at our institution between 06/2010 and 02/2020. The primary endpoint was a functional outcome using the QuickDASH score. Secondary outcomes were the Subjective Shoulder Value (SSV), numeric rating scale (NRS) for pain, Activities of Daily Living score (ADL) and complications. RESULTS Twenty-six male patients were treated operatively. Twenty-three of whom were available for follow-up after a median follow-up time of 33 months (interquartile range [IQR] 8-70 months). In 18 (69%) cases a standard open approach and in 8 (31%) cases a minimal invasive (MI) approach was used. The median QuickDASH was 0 (IQR 0-0) with a median SSV of 95 (IQR 90-98). Patients reported a median NRS of 0 (IQR 0-1) and a median ADL score of 1 (IQR 1-1). Radiological fracture union was 100% without the occurrence of implant failure or mal-union. Two patients (7.7%) required early correction osteosynthesis, one patient (3.8%) developed a frozen shoulder 3 months postoperatively, and one patient (3.8%) presented with a superficial wound infection. CONCLUSION Following previously published indications for ORIF of displaced scapula body and neck fractures a good functional outcome and a low rate of complications could be achieved.
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Affiliation(s)
- Christian Michelitsch
- Department of Surgery, Division of Trauma Surgery, Cantonal Hospital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland.
| | - Nina Kabelitz
- Department of Surgery, Division of Trauma Surgery, Cantonal Hospital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland
| | - Herman Frima
- Department of Trauma Surgery, Northwest Hospital Group, Alkmaar, Netherlands
| | | | - Reinier Beks
- Department of Trauma Surgery, Northwest Hospital Group, Alkmaar, Netherlands
| | - Philipp F Stillhard
- Department of Surgery, Division of Trauma Surgery, Cantonal Hospital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland
| | - Christoph Sommer
- Department of Surgery, Division of Trauma Surgery, Cantonal Hospital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland
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Hoepelman RJ, Ochen Y, Beeres FJP, Frima H, Sommer C, Michelitsch C, Babst R, Buenter IR, van der Velde D, Verleisdonk EJMM, Groenwold RHH, Houwert RM, van Heijl M. Let’s Agree to Disagree on Operative versus Nonoperative (LADON) treatment for proximal humerus fractures: Study protocol for an international multicenter prospective cohort study. PLoS One 2022; 17:e0264477. [PMID: 35213647 PMCID: PMC8880817 DOI: 10.1371/journal.pone.0264477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/09/2022] [Indexed: 12/01/2022] Open
Abstract
Background The proximal humerus fracture is a common injury, but the optimal management is much debated. The decision for operative or nonoperative treatment is strongly influenced by patient specific factors, regional and cultural differences and the preference of the patient and treating surgeon. The aim of this study is to compare operative and nonoperative treatment of proximal humerus fractures for those patients for whom there is disagreement about optimal management. Methods and analysis This protocol describes an international multicenter prospective cohort study, in which all patients of 18 years and older presenting within three weeks after injury with a radiographically diagnosed displaced proximal humerus fracture can be included. Based on patient characteristics and radiographic images several clinical experts advise on the preferred treatment option. In case of disagreement among the experts, the patient can be included in the study. The actual treatment that will be delivered is at the discretion of the treating physician. The primary outcome is the QuickDash score at 12 months. Propensity score matching will be used to control for potential confounding of the relation between treatment modality and QuickDash scores. Discussion The LADON study is an international multicenter prospective cohort study with a relatively new methodological study design. This study is a “natural experiment” meaning patients receive standard local treatment and surgeons perform standard local procedures, therefore high participation rates of patients and surgeons are expected. Patients are only included after expert panel evaluation, when there is proven disagreement between experts, which makes this a unique study design. Through this inclusion process, we create two comparable groups whom received different treatments and where expert disagree about the already initiated treatment. Since we are zooming in on this particular patient group, confounding will be largely mitigated. Internationally the treatment of proximal humerus fractures are still much debated and differs much per country and hospital. This observational study with a natural experiment design will create insight into which treatment modality is to be preferred for patients in whom there is disagreement about the optimal treatment strategy. Trial registration Registered in Netherlands trial register NL9357 and Swiss trial register CH 2020–00961; https://clinicaltrials.gov/.
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Affiliation(s)
- Ruben J. Hoepelman
- Department of Trauma Surgery, UMC Utrecht, Utrecht, The Netherlands
- Department of Trauma Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
- * E-mail:
| | - Yassine Ochen
- Department of Trauma Surgery, UMC Utrecht, Utrecht, The Netherlands
- Department of Trauma Surgery St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - Frank J. P. Beeres
- Department of Trauma Surgery, Cantonal Hospital of Lucerne, Luzerne, Switzerland
| | - Herman Frima
- Department of Trauma Surgery, Noordwest Ziekenhuisgroep Alkmaar, Alkmaar, The Netherlands
| | - Christoph Sommer
- Department of Trauma Surgery, Kantonsspital Graubünden, Chur, Switzerland
| | | | - Reto Babst
- Department of Trauma Surgery, Cantonal Hospital of Lucerne, Luzerne, Switzerland
- Department of Health Science and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Isabelle R. Buenter
- Department of Trauma Surgery, Cantonal Hospital of Lucerne, Luzerne, Switzerland
| | - Detlef van der Velde
- Department of Trauma Surgery St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | | | - Rolf H. H. Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Mark van Heijl
- Department of Trauma Surgery, UMC Utrecht, Utrecht, The Netherlands
- Department of Trauma Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
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Bretschneider T, Michelitsch C, Frima H, Furrer M, Sommer C. Pathologic femur fractures following surgery and radiotherapy for soft tissue sarcomas: A case series. Int J Surg Case Rep 2021; 84:106062. [PMID: 34139424 PMCID: PMC8219744 DOI: 10.1016/j.ijscr.2021.106062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/30/2021] [Accepted: 06/03/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Combined limb-sparing surgery and radiation therapy are considered the standard of care for higher grade soft tissue sarcomas (STS) of the extremities. The risk of post-radiation fracture after this treatment modality is well known, but still underestimated, and can end in serious long-term secondary problems years later. Presentation of case We reviewed the records of three patients with pathological femur fractures years after wide local excision of an STS of the proximal lower extremity. All patients received more than 50 Gy (Gy) to the entire femur circumference. During surgery, all patients had bone exposure, and in two patients with stripping of the periosteum. The median time from surgery to fracture was 116 months (range from 84 to 156 months). The median age at the time of diagnosis was 66 years old. Despite standard operative fracture treatment, all three patients developed a non-union. One patient later died due to uncontrolled pulmonary metastasis independent from the femoral non-union. In the second case, an exarticulation at hip level due to an uncontrolled infected non-union had to be performed. The third patient finally achieved fracture union after two years of treatment. Discussion Our study confirms the high occurrence rate of postoperative complications and difficulties one encounters in treating these pathologic fractures. Only in one patient, following several revisions with intramedullary nailing, the fracture healed. In pathologic femur shaft fractures we recommend a minimal invasive procedure using intramedullary nailing devices. Conclusion The risk of pathological fractures at the former treatment site is high, even years later. The rate of non-unions after a difficult fracture treatment in this particular clinical situation seems to be very high and may be associated with severe complications. 3 patients with pathological femur fractures after excision of sarcoma are reviewed. Risk of post-radiation fracture after this treatment modality is underestimated. Despite standard operative fracture treatment, rate of non-unions is very high. We recommend a minimal invasive procedure using intramedullary nailing devices.
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Affiliation(s)
- Tobias Bretschneider
- Department of Surgery, Cantonal Hospital Graubünden, Loestrasse 170, 7000 Chur, Switzerland.
| | - Christian Michelitsch
- Department of Surgery, Cantonal Hospital Graubünden, Loestrasse 170, 7000 Chur, Switzerland
| | - Herman Frima
- Department of Trauma Surgery, Northwest Hospitalgroup, Wilhelminalaan 12, 1815 JD Alkmaar, the Netherlands
| | - Markus Furrer
- Department of Surgery, Cantonal Hospital Graubünden, Loestrasse 170, 7000 Chur, Switzerland
| | - Christoph Sommer
- Department of Surgery, Cantonal Hospital Graubünden, Loestrasse 170, 7000 Chur, Switzerland
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Beeres FJ, Diwersi N, Houwert MR, Link BC, Heng M, Knobe M, Groenwold RH, Frima H, Babst R, Jm van de Wall B. ORIF versus MIPO for humeral shaft fractures: a meta-analysis and systematic review of randomized clinical trials and observational studies. Injury 2021; 52:653-663. [PMID: 33223254 DOI: 10.1016/j.injury.2020.11.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is no consensus on the optimal operative technique for humeral shaft fractures. This meta-analysis aims to compare minimal-invasive plate osteosynthesis (MIPO) with open reduction internal fixation (ORIF) for humeral shaft fractures regarding non-union, re-intervention, radial nerve palsy, time to union, operation duration and functional outcomes. METHODS PubMed/Medline/Embase/CENTRAL/CINAHL were searched for both randomized clinical trials (RCT) and observational studies comparing MIPO with ORIF for humeral shaft fractures. Effect estimates were pooled across studies using random effects models and presented as weighted odds ratio (OR), risk difference (RD), mean difference (MD) and standardized mean difference (SMD) with corresponding 95% confidence interval (95%CI). Subgroup analysis was performed stratified by study design (RCTs and observational studies). RESULTS A total of two RCT's (98 patients) and seven observational studies (263 patients) were included. The effect estimates obtained from observational studies and RCT's were similar in direction and magnitude. MIPO carries a lower risk for non-union (RD: 5%; OR 0.3, 95% CI 0.1-0.9) and secondary radial nerve palsy (RD 5%; OR 0.3, 95%CI 0.1- 0.9). Nerve function eventually restored spontaneously in all patients in both groups. Results were inconclusive regarding re-intervention (RD 7%; OR: 0.7, 95%CI 0.2-1.9), infection (RD 4%; OR 0.4, 95%CI 0.1-1.5), time to union (MD -1 week, 95%CI -3 - 1) and operation duration (MD -13 minutes, 95%CI -38.9 - 11.9). Functional shoulder scores (SMD 0.01, 95%CI -0.3 - 0.3) and elbow scores (SMD 0.01, 95%CI -0.3 - 0.3) were similar for the different operative techniques. CONCLUSION MIPO has a lower risk for non-union than ORIF for the treatment of humeral shaft fractures. Radial nerve palsy secondary to operation is a temporary issue resolving in all patients in both treatment groups. Although both treatment options are viable, the general balance leans towards MIPO having more favorable outcomes.
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Affiliation(s)
- Frank Jp Beeres
- Lucerne Cantonal Hospital, Department of Orthopedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Nadine Diwersi
- Lucerne Cantonal Hospital, Department of Orthopedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Marijn R Houwert
- University Medical Center Utrecht, Department of Trauma Surgery, Heidelberglaan 100, 3584CX, Utrecht, the Netherlands
| | - Björn C Link
- Lucerne Cantonal Hospital, Department of Orthopedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Marilyn Heng
- Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital Boston, Department of Orthopedic Surgery, Boston, USA
| | - Matthias Knobe
- Lucerne Cantonal Hospital, Department of Orthopedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Rolf Hh Groenwold
- Leiden University Medical Center, Department of Clinical Epidemiology, Leiden, the Netherlands
| | - Herman Frima
- Northwest Hospital group, Department of Trauma Surgery, Wendelaarstraat 58, 1814 GS Alkmaar, the Netherlands
| | - Reto Babst
- Lucerne Cantonal Hospital, Department of Orthopedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Bryan Jm van de Wall
- Lucerne Cantonal Hospital, Department of Orthopedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland.
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Kabelitz N, Kabelitz M, Frima H, Rehm A, Sommer C, Michelitsch C. Lateral approach for intramedullary nailing of displaced midshaft clavicle fractures; a retrospective cohort study. Eur J Trauma Emerg Surg 2021; 48:1263-1270. [PMID: 33656616 DOI: 10.1007/s00068-021-01620-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/09/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Midshaft clavicle fractures represent about 4% of all fractures in the emergency department. Non-operative treatment of displaced midshaft clavicle fractures (DMCF) can result in a relatively high non-union rate. Several operative techniques, including intramedullary fixation (IMF) using elastic stable intramedullary nailing (ESIN), have therefore been established. IMF through the medial approach is less suitable for fractures of the lateral diaphysis. IMF of DMCF of the lateral diaphysis through a lateral approach can be an alternative approach for these fractures. The aim of this study is to describe the technique of IMF from the lateral side and to present the functional outcome and complications. METHODS A retrospective cohort study was performed. All patients with a traumatic DMCF treated with IMF using ESIN through a lateral approach between 2014 and 2019 were included. Endpoints were the functional outcome (QuickDASH, Subjective Shoulder Value (SSV)), pain (numeric rating scale (NRS)), daily impairment (activities of daily living (ADL)), complications and implant removal. RESULTS Forty out of 43 patients were available for follow-up. Mean follow-up was 37 months. Mean age was 24 years (range 13-70). The median QuickDASH score was 0 (IQR 0.0-0.0) and the median SSV was 100 (95-100). The median ADL score was 1 (1-4) and the median NRS was 0 (0-0). No non-union occurred. Implant related irritation occurred in 11 patients (27.5%). Implants were removed in a total of 38 (95%) patients; in 10 cases due to irritation, in 28 cases routinely or on patient's request. CONCLUSION IMF of DMCF of the lateral diaphysis through a lateral approach leads to excellent functional results and seems to be a suitable option for internal fixation. However, as with IMF from the medial side, it is not without complications and implant-related irritation.
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Affiliation(s)
- Nina Kabelitz
- Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland.
| | - Method Kabelitz
- Department of Orthopaedic Surgery, Spitalregion Rheintal Werdenberg Sarganserland, Spitalstrasse 44, 9472, Grabs, Switzerland
| | - Herman Frima
- Department of Trauma Surgery, Noordwest Hospital Group, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
| | - Alexandra Rehm
- Department of Endocrinology and Diabetes, University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany
| | - Christoph Sommer
- Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland
| | - Christian Michelitsch
- Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland
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Haupt S, Frima H, Sommer C. Operative Treatment of Proximal Humeral Fracture-dislocations Through an Anterolateral Deltoid Split Approach. Arch Bone Jt Surg 2020; 8:589-597. [PMID: 33088860 DOI: 10.22038/abjs.2020.42728.2162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Proximal humeral fracture-dislocations (PHFD) are a special entity in proximal humeral fracture treatment. The aim of this study is to present our minimally invasive plate osteosynthesis (MIPO) technique through an anterolateral deltoid split approach. In addition, we performed a retrospective cohort study analyzing the patient reported functional outcome and complications. Methods A single center cohort study was performed. All patients operated through a deltoid split approach for PHFD between 2009 and 2016 were eligible for inclusion. The primary endpoint was subjective shoulder function measured with QuickDASH and subjective shoulder value (SSV). Secondary endpoints were complications and implant-related irritation. Results 28 patients were included. The mean age was 49 (SD ± 10.3). The mean follow-up was 48 months (SD ± 23.7). The mean QuickDASH score was 6.8 (SD ±7.8) and the mean SSV was 86 (SD ±14.6). Four patients had a conversion into a reversed arthroplasty (14%), one patient (4%) a shortening of secondary perforated screws, four patients an early re-osteosynthesis (14%), four patients (14%) developed an AVN and in one patient damage of the axillary nerve was observed. 21 patients (75%) had their implant removed. Conclusion Patient reported functional results after humeral head preservation and internal fixation of PHFDs through an anterolateral deltoid spilt approach are promising. However, there is a high rate of re-operations either because of complications or for implant removal. Comparing our data to literature these rates are not depending on the approach chosen.
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Affiliation(s)
- Samuel Haupt
- Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse, Chur, Switzerland.,Samuel Haupt and Herman Frima have contributed equally to this manuscript and therefore share first authorship
| | - Herman Frima
- Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse, Chur, Switzerland.,Samuel Haupt and Herman Frima have contributed equally to this manuscript and therefore share first authorship
| | - Christoph Sommer
- Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse, Chur, Switzerland
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Oehme F, Schütze K, Link BC, Frima H, Schepers T, Rhemrev S, Rickman M, Babst R, Beeres FJP. Perception of quality of intraoperative fluoroscopy and the influence on postoperative management: an international survey. Eur J Trauma Emerg Surg 2019; 47:1073-1079. [PMID: 31863134 DOI: 10.1007/s00068-019-01286-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 12/11/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Intraoperative precise visualization of fractures and assessment of the quality of reduction is essential in orthopedic trauma surgery. Fluoroscopic skills will lead to an increased detection rate of minimal abnormalities needing revision intraoperatively. The definition of fluoroscopic skills and the interpretation of acceptable "minimal abnormalities" remains somehow unclear. The purpose of this study was to analyze the subjective quality assessment of intraoperative radiographs (IR) and whether they are influenced by cultural and demographic factors. Furthermore, we aimed to answer the question whether the indication for revision surgery is international comparable or rather influenceable by cultural aspects. METHODS Intraoperative radiographs of 30 patients operated for an ankle or radius fracture were selected for an international survey. In total, 22 patients were randomly selected from an already existing database and eligible for inclusion if reduction was accomplished during initial operation without planed revision. Eight patients of this group had undergone an unplanned revision surgery (26.6%). Fifteen orthopedic trauma surgeons from three different countries answered this survey. All raters were senior consultants. RESULTS The quality of reduction was rated as good in both the AP (7.95 of 10) and lateral (7.84 of 10) views. The inter-observer reliability was substantially weaker in Country B (kappa of 0.23) compared to Countries A (p value < 0.05) and C (range 0.33-0.43). In only 33% of the cases the raters requested a postoperative radiograph. This was significantly fewer (p value < 0.001) in Country A. The frequency of postoperative requested CT's was comparable between the countries. CONCLUSION This study showed acceptable IR assessment in terms of quality rating. Furthermore, it revealed substantial differences in the postoperative decision-making process in different countries, especially regarding the necessity for postoperative radiographs. This suggests that definition for indication of revision surgery is culturally influenced.
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Affiliation(s)
- Florian Oehme
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, P.O. Box 6000, Spitalstrasse 16, CH-6000, Luzern, Switzerland. .,Department for Visceral, Thoracic and Vascular surgery, University Hospital Carl Gustav Carus, Dresden, Germany.
| | - Konrad Schütze
- Department of Trauma Surgery, University Hospital Ulm, P.O. Box 89081, Albert-Einstein-Allee 23, D-89081, Ulm, Germany
| | - Björn Christian Link
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, P.O. Box 6000, Spitalstrasse 16, CH-6000, Luzern, Switzerland
| | - Herman Frima
- Department of Surgery, Cantonal Hospital Graubünden, P.O.Box 170, Loëstrasse 170, CH-7000, Chur, Switzerland
| | - Tim Schepers
- Department of Surgery-Traumatology, Amsterdam Medical Centre, Meibergdreef 9, 1105, Amsterdam, AZ, The Netherlands
| | - Steven Rhemrev
- Department of Surgery, Medical Center Haaglanden, Lijnbaan 32, 2512, The Hague, VA, The Netherlands
| | - Mark Rickman
- Centre for Orthopaedic and Trauma Research, University of Adelaide & Royal Adelaide Hospital, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Reto Babst
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, P.O. Box 6000, Spitalstrasse 16, CH-6000, Luzern, Switzerland
| | - Frank Joseph Paulus Beeres
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, P.O. Box 6000, Spitalstrasse 16, CH-6000, Luzern, Switzerland
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Kalberer N, Frima H, Michelitsch C, Kloka J, Sommer C. Osteosynthesis of sternal fractures with double locking compression plate fixation: a retrospective cohort study. Eur J Orthop Surg Traumatol 2019; 30:75-81. [PMID: 31456035 DOI: 10.1007/s00590-019-02526-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 08/02/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE Sternal fractures are rare injuries and mostly treated non-operatively. In selected cases, internal fixation becomes necessary. No standard operative approach has been determined yet among experts. The aim of this study is to describe our treatment algorithm and results after operative stabilisation of sternal fractures with locking compression plates (LCP), mainly focusing on the functional outcome. METHODS A retrospective cohort study was conducted. We included all patients after operative stabilisation of a sternal fracture between 2008 and 2016. Endpoints were the functional outcome using the Activities of Daily Living (ADL) score, pain analysed by the numeric rating scale (NRS), breathing ability, complications and implant removal. RESULTS Eighteen out of 153 (12%) patients with a sternal fracture underwent operation. Three patients were lost to follow-up. Eleven out of 15 (73%) patients were treated with double straight LCP 3.5 mm implants and 4 (27%) patients with pre-countered LCP 3.5 mm implants. Mean follow-up was 57 months. The median ADL score was 1 (1-4), the median NRS was 0 (0-9), and respiratory complaints scored a median of 1 (1-4). No non-union, hardware failure or implant-related complication occurred. Post-operative complications were pneumonia (20%) and respiratory insufficiency (20%). Implants were removed in 4/15 (27%) patients; three times due to implant-related irritation, once on patient's request. CONCLUSION Operative stabilisation of sternal fractures with double LCP 3.5 mm provides excellent long-term functional results and seems to be an appropriate option for internal fixation. The rate of post-operative complications is low; however, 27% had a second operation for implant removal.
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Affiliation(s)
- Nina Kalberer
- Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland
| | - Herman Frima
- Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland.
| | - Christian Michelitsch
- Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland
| | - Jan Kloka
- Department of Anaesthesiology, Universitätsklinikum Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Christoph Sommer
- Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland
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Frima H, van Heijl M, Michelitsch C, van der Meijden O, Beeres FJP, Houwert RM, Sommer C. Clavicle fractures in adults; current concepts. Eur J Trauma Emerg Surg 2019; 46:519-529. [PMID: 30944950 DOI: 10.1007/s00068-019-01122-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 03/27/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND For decades, clavicle fractures have been treated conservatively. In the last 20 years, however, non-union rates after conservative treatment appear higher than previously reported and more evidence regarding operative treatment has become available. This has led to a paradigm shift towards an increase in operative treatment. The aim of this review is to present the current concepts and available evidence regarding clavicle fracture treatment. METHODS Conservative and operative treatment options together with their indications for medial, shaft and lateral clavicle fractures are discussed. For all three anatomical locations, a treatment algorithm is proposed. CONCLUSION In general, non-displaced fractures are treated conservatively. Operative treatment has to be discussed with patients with displaced clavicle fractures, especially in the young and active patient.
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Affiliation(s)
- Herman Frima
- Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland.
| | - Mark van Heijl
- Department of Surgery, Diakonessenhuis, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands
| | - Christian Michelitsch
- Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland
| | - Olivier van der Meijden
- Institut Universitaire de Locomotion et du Sport, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Frank J P Beeres
- Department of Trauma Surgery, Luzerner Kantonsspital, Spitalstrasse 16, 6000, Lucerne, Switzerland
| | - Roderick M Houwert
- Utrecht Traumacenter, Universitair Medisch Centrum Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Christoph Sommer
- Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland
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Ochen Y, Frima H, Houwert RM, Heng M, van Heijl M, Verleisdonk EJMM, van der Velde D. Surgical treatment of Neer type II and type V lateral clavicular fractures: comparison of hook plate versus superior plate with lateral extension: a retrospective cohort study. Eur J Orthop Surg Traumatol 2019; 29:989-997. [PMID: 30847678 PMCID: PMC6570672 DOI: 10.1007/s00590-019-02411-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 03/01/2019] [Indexed: 11/30/2022]
Abstract
Purpose Different fixation methods are used for treatment of unstable lateral clavicle fractures (LCF). Definitive consensus and guidelines for the surgical fixation of LCF have not been established. The aim of this study was to compare patient-reported functional outcome after open reduction and internal fixation with the clavicle hook plate (CHP) and the superior clavicle plate with lateral extension (SCPLE). Methods A dual-center retrospective cohort study was performed. All patients operatively treated for unstable Neer type II and type V LCF between 2011 and 2016, with the CHP (n = 23) or SCPLE (n = 53), were eligible for inclusion. The primary outcome was the QuickDASH score. Secondary outcomes were the numerical rating scale (NRS) pain score, complications, and implant removal. Results A total of 67 patients (88%) were available for the final follow-up. There was a significant difference in bicortical lateral fragment size, 15 mm (± 4, range 6–21) in the CPH group compared to 20 mm (± 8, range 8–43) in the SCPLE group (p ≤ 0.001). There was no significant difference in median QuickDASH score (CHP; 0.00 [IQR 0.0–0.0], SCPLE; 0.00 [IQR 0.0–4.5]; p = 0.073) or other functional outcome scores (NRS at rest; p = 0.373, NRS during activity; p = 0.559). There was no significant difference in median QuickDASH score or other functional outcome scores between Neer type II and type V fractures. There was no significant difference in complication rate, CHP 11% and SCPLE 8% (relative risk 1.26; [95% CI 0.25–6.33; p = 0.777]). The implant removal rate was 100% in the CHP group compared to 42% in the SCPLE group (relative risk 2.40; [95% CI 1.72–3.35; p ≤ 0.001]). Conclusion Both the CHP and SCPLE are effective fixation methods for the treatment of unstable LCF, resulting in excellent patient-reported functional outcome and similar complication rates. SCPLE fixation is an effective fixation method for the treatment of both Neer type II and type V LCF. The SCPLE has a lower implant removal rate. Therefore, if technically feasible, we recommend SCPLE fixation for the treatment of unstable LCF.
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Affiliation(s)
- Yassine Ochen
- Department of Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands. .,Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands. .,Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston, USA.
| | - Herman Frima
- Department of Surgery, Kantonsspital Graubünden, Chur, Switzerland
| | - R Marijn Houwert
- Department of Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Marilyn Heng
- Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston, USA
| | - Mark van Heijl
- Department of Surgery, Diakonessenhuis Hospital, Utrecht, The Netherlands.,Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
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Frima H, Michelitsch C, Beks RB, Houwert RM, Acklin YP, Sommer C. Long-term follow-up after MIPO Philos plating for proximal humerus fractures. Arch Orthop Trauma Surg 2019; 139:203-209. [PMID: 30421113 DOI: 10.1007/s00402-018-3063-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Minimally invasive plate osteosynthesis (MIPO) has been described as a suitable technique for the treatment of proximal humerus fractures, but long-term functional results have never been reported. The aim of this study was to describe the long-term functional outcome and implant-related irritation after MIPO for proximal humerus fractures. METHODS A long-term prospective cohort analysis was performed on all patients treated for a proximal humerus fracture using MIPO with a Philos plate (Synthes, Switzerland) between December 2007 and October 2010. The primary outcome was the QuickDASH score. Secondary outcome measures were the subjective shoulder value (SSV), implant related irritation and implant removal. RESULTS Seventy-nine out of 97 patients (81%) with a mean age of 59 years were available for follow-up. The mean follow-up was 8.3 years (SD 0.8). The mean QuickDASH score was 5.6 (SD 14). The mean SSV was 92 (SD 11). Forty out of 79 patients (50.6%) had implant removal, and of those, 27/40 (67.5%) were due to implant-related irritation. On average, the implant was removed after 1.2 years (SD 0.5). In bivariate analysis, there was an association between the AO classification and the QuickDASH (p = 0.008). CONCLUSION Treatment of proximal humerus fractures using MIPO with Philos through a deltoid split approach showed promising results. A good function can be assumed due to the excellent scores of patient oriented questionnaires. However, about one-third of the patients will have a second operation for implant removal due to implant-related irritation.
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Affiliation(s)
- H Frima
- Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland.
| | - C Michelitsch
- Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland
| | - R B Beks
- Utrecht Traumacenter, Universitair Medisch Centrum Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - R M Houwert
- Utrecht Traumacenter, Universitair Medisch Centrum Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Y P Acklin
- Department of Orthopaedic Surgery, Kantonsspital Baselland, 4101, Bruderholz, Switzerland
| | - C Sommer
- Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland
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Frima H, Houwert RM, Beks RB, van Heijl M, van der Velde D, Beeres FJP. [Proximal humerus fractures; conservative or surgical treatment?]. Ned Tijdschr Geneeskd 2019; 163:D3096. [PMID: 30638000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
There is an increasing incidence of proximal humerus fractures. Patients with proximal humerus fractures have traditionally been treated conservatively. During the past decades, however, various new osteosynthetic and prosthetic implants have been developed for the shoulder and surgical treatment of proximal humerus fractures has increased. However, recent literature in which conservative and surgical treatment of proximal humerus fractures is compared has shown no difference in functional outcome. The trend towards more frequent surgical treatment is thus not based on scientific evidence. In this article, we present the current state of affairs and attempt to give a nuanced picture of who will not, but also who might profit from surgical treatment of a proximal humerus fracture.
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Affiliation(s)
- Herman Frima
- Kantonsspital Graubünden, afd. Traumachirurgie, Chur, Zwitserland
- Contact: H. Frima
| | | | | | | | | | - Frank J P Beeres
- Luzerner Kantonsspital, afd. Traumachirurgie, Luzern, Zwitserland
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Hulsmans M, van Heijl M, Houwert R, Verleisdonk EJ, Frima H. Intramedullary nailing of displaced midshaft clavicle fractures using a TEN with end cap: issues encountered. Acta Orthop Belg 2018; 84:479-484. [PMID: 30879453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The purpose of this study was to describe our experience with a possible solution for implant- related irritation after intramedullary nailing of displaced midshaft clavicle fractures: the end cap. Ten patients with a displaced midshaft clavicle fracture were treated with intramedullary nailing and an end cap in 2013. Patients were followed in the outpatient clinic until fracture union. In 2015 patients were contacted again. Prospectively collected data included shoulder function and complications. The median follow-up time was 28.5 months (between 27 and 30 months). No patients were lost to follow- up. QuickDASH scores were 18.2, 9.1 and 2.3 after 6 weeks, 3 month and latest follow-up respectively. Nine patients (90%) had some type of implant-related complication. In three of these patients implant removal was required before union. One implant failure occurred which required major revision surgery using plate fixation. In conclusion, because in 70% of the patients the implant-related irritation was directly caused by the end cap, we believe end caps should not be used after intramedullary nailing for displaced midshaft clavicle fractures.
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Beks RB, Ochen Y, Frima H, Smeeing DPJ, van der Meijden O, Timmers TK, van der Velde D, van Heijl M, Leenen LPH, Groenwold RHH, Houwert RM. Operative versus nonoperative treatment of proximal humeral fractures: a systematic review, meta-analysis, and comparison of observational studies and randomized controlled trials. J Shoulder Elbow Surg 2018; 27:1526-1534. [PMID: 29735376 DOI: 10.1016/j.jse.2018.03.009] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/06/2018] [Accepted: 03/11/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is no consensus on the choice of treatment for displaced proximal humeral fractures in older patients (aged > 65 years). The aims of this systematic review and meta-analysis were (1) to compare operative with nonoperative management of displaced proximal humeral fractures and (2) to compare effect estimates obtained from randomized controlled trials (RCTs) and observational studies. METHODS The databases of MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) were searched on September 5, 2017, for studies comparing operative versus nonoperative treatment of proximal humeral fractures; both RCTs and observational studies were included. The criteria of the Methodological Index for Non-Randomized Studies, a validated instrument for methodologic quality assessment, were used to assess study quality. The primary outcome measure was physical function as measured by the absolute Constant-Murley score after operative or nonoperative treatment. Secondary outcome measures were major reinterventions, nonunion, and avascular necrosis. RESULTS We included 22 studies, comprising 7 RCTs and 15 observational studies, resulting in 1743 patients in total: 910 treated operatively and 833 nonoperatively. The average age was 68.3 years, and 75% of patients were women. There was no difference in functional outcome between operative and nonoperative treatment, with a mean difference of -0.87 (95% confidence interval, -5.13 to 3.38; P = .69; I2 = 69%). Major reinterventions occurred more often in the operative group. Pooled effects of RCTs were similar to pooled effects of observational studies for all outcome measures. CONCLUSIONS We recommend nonoperative treatment for the average elderly patient (aged > 65 years) with a displaced proximal humeral fracture. Pooled effects of observational studies were similar to those of RCTs, and including observational studies led to more generalizable conclusions.
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Affiliation(s)
- Reinier B Beks
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Utrecht Traumacenter, Utrecht, The Netherlands.
| | - Yassine Ochen
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Utrecht Traumacenter, Utrecht, The Netherlands
| | - Herman Frima
- Department of Surgery, Kantonsspital Graubünden, Chur, Switzerland
| | | | | | - Tim K Timmers
- Department of Surgery, Meander Medisch Centrum, Amersfoort, The Netherlands
| | | | - Mark van Heijl
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands; Department of Surgery, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Luke P H Leenen
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rolf H H Groenwold
- Julius Center for Health Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R Marijn Houwert
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Utrecht Traumacenter, Utrecht, The Netherlands
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Hulsmans MHJ, van Heijl M, Frima H, van der Meijden OAJ, van den Berg HR, van der Veen AH, Gunning AC, Houwert RM, Verleisdonk EJMM. Predicting suitability of intramedullary fixation for displaced midshaft clavicle fractures. Eur J Trauma Emerg Surg 2017; 44:581-587. [PMID: 28993839 DOI: 10.1007/s00068-017-0848-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 09/25/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Implant-related irritation is a technique-specific complication seen in a substantial number of patients treated with intramedullary nailing for clavicle fractures. The purpose of this study was to identify predictors for developing implant-related irritation in patients with displaced midshaft clavicle fractures treated with elastic stable intramedullary nailing. METHODS A retrospective analysis of the surgical database in two level 2 trauma centers was performed. Patients who underwent intramedullary nailing for displaced midshaft clavicle fractures between 2005 and 2012 in the first hospital were included. Age, gender, fracture comminution and fracture location were assessed as possible predictors for developing irritation using multivariate logistic regression analysis. These predictors were externally validated using data of patients treated in another hospital. RESULTS Eighty-one patients were included in initial analysis. In the multivariate analysis, comminuted fractures in comparison to non-comminuted fractures (72 vs. 38%, p = 0.027) and fracture location (p < 0.001) were significantly associated with the development of implant-related irritation. In particular, lateral diaphyseal fractures caused irritation compared to fractures on the medial side of the cut-off point (88 vs. 26%). External validation of these predictors in 48 additional patients treated in another hospital showed a similar predictive value of the model and a good fit. CONCLUSION Comminuted and lateral diaphyseal fractures were found to be statistically significant and independent predictors for developing implant-related irritation. We, therefore, believe that intramedullary nailing might not be suitable for these types of fractures. Future studies are needed to determine whether alternative surgical techniques or implants would be more suitable for these specific types of fractures.
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Affiliation(s)
| | - M van Heijl
- Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - H Frima
- Kantonsspital Graubünden, Chur, Switzerland
| | | | | | | | - A C Gunning
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - R M Houwert
- Utrecht Traumacenter, Utrecht, The Netherlands
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Frima H, Eshuis R, Mulder P, Leenen L. The ICI classification for calcaneal injuries: a validation study. Injury 2012; 43:784-7. [PMID: 21975555 DOI: 10.1016/j.injury.2011.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Revised: 08/27/2011] [Accepted: 09/08/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The integral classification of injuries (ICI), by Zwipp et al. has been developed as a classification system for injuries of the bones, joints, cartilage and ligaments of the foot. It follows the principles of the comprehensive classification of fractures by Müller et al. The ICI was developed for 'everyday use' and scientific purposes. Our aim was to perform a validation study for this classification system applied to the calcaneal injuries. METHODS A panel of five experienced trauma and orthopaedic surgeons evaluated the ICI score in 20 calcaneal injuries. After 2 months, a second classification was performed in a different order. Inter- and intra-observer variability were evaluated by kappa statistics. RESULTS Panel members were not able to evaluate capsule and ligamental injuries based on X-ray and computed tomography (CT) films. Two injuries were excluded for logistical reasons. The inter-observer agreement based on 18 injuries of bone and joints was slight; kappa 0.14 (90% confidence interval (CI): 0.05-0.22). The intra-observer agreement was fair; kappa 0.31 (90% CI: 0.22-0.41). Overall, the panel rated the system as very complicated and not practical. CONCLUSION The ICI is a complicated classification system with slight to fair inter- and intra-observer variabilities. It might not be a practical classification system for calcaneal injuries in 'everyday use' or scientific purposes.
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Affiliation(s)
- Herman Frima
- Department of Surgery, Amphia Hospital, P.O. Box 90158, 4800 RK Breda, The Netherlands.
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Berendsen RR, Kolfschoten NE, de Jong VM, Frima H, Daanen HAM, Anema HA. [Treating frostbite injuries]. Ned Tijdschr Geneeskd 2012; 156:A4702. [PMID: 22748369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Frostbite injuries rarely occur in healthy Dutch persons. However, as the number of people engaging in winter and outdoor activities and travelling to high altitudes increases, the risk of frostbite also increases. Frostbite is a cold-induced injury which results from two processes: freezing and microvascular occlusion. Adequate first aid, which focuses on the prevention of refreezing and mechanical injury, and rapid rewarming together with the administration of ibuprofen, are of the greatest importance for limiting eventual tissue damage. Iloprost infusion and possibly (r)tPA are indicated if a patient presents within 24 hours after the tissue has thawed and the injury is such that severe morbidity can be expected. If the patient presents after this time period, hyperbaric oxygen therapy may be considered; however, the evidence available on this type of treatment is limited.
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