228

Podium

WITH EXTERNAL FIXATOR

Marchesini Reggiani, Leonardo, MDC Istituto Ortopedico RizzoliA Antonioli, Diego, MD; Lampasi, Manuele, MD; Bettuzzi, Camilla, MD; Di Gennaro, Giovanni Luigi, MD; Donzelli, Onofrio, MDC Istituto Ortopedico RizzoliC Italy

Chronic Monteggia lesion in child are quite rare but is not uncommon the misdiagnostic of the radial head luxation in the emergency room. Many different treatment options have been proposed for the treatment of the chronic Monteggia lesions. Some authors suggest the radial shortening osteotomy with the anular ligament reconstruction but results are not always good. Exner in 2001, published the results of a 2 cases of chronic Monteggia lesions treated with ulna lengthening using an external fixator. This technique is made into two steps: the first step in which he perform ulnar osteotomy and the application of a ulnar external monoaxial fixator to progressive lengthening the ulnar bone. Then the radial head can regain enough space to reduce cruently with the reconstruction of the anular ligament or incruently with an angulation of the external fixator. We perform this technique in 5 cases with good results in 4 patiens.

In conclusion, external fixator to progressive lengthening ulna can be a valid option in the treatment of chronic Monteggia lesions.

PAPER POSTER ABSTRACTS

231

PAPERPOSTERINDEX

Paper poster 1:DOUBLE OSTEOTOMY WITH EX. FIXATION FOR CHARCOT SALVAGE RECONSTRUCTION: AN ALTERNATIVE TO TRIPLE ARTHRODESIS. . . . . . . . . . . . . . . . . . . 233

Paper poster 2:ANKLE DISTRACTION ARTHROPLASTY WITH RING FIXATION FOR THE TREATMENT OF SEVERE ANKLE ARTHRITIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233

Paper poster 3:CLINICO-RADIOLOGICAL EVALUATION OF LATE PRESENTED CTEV MANAGED BY LIGAMENTOTAXIS A LONG TERM FOLLOWUP . . . . . . . . . . . . . . . . . . . . . . . . 234

Paper poster 4:HYBRID EXTERNAL FIXATION FOR OPEN SEVERE COMMINUTED FRACTURES OF THE DISTAL FEMUR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234

Paper poster 5:IN VITRO BEHAVIOUR OF MESENCHYMAL STEM CELLS ON FIBROIN MESH FOR BONE RECONSTRUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235

Paper poster 6:TISSUE DISTRACTION COMBINED WITH LIMITED OSTEOTOMIES FOR CORRECTING POST-TRAUMATIC CLUBFOOT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235

Paper poster 7:CONTINUOUS REGIONAL ANAESTHESIA AND EXTERNAL FIXATION.OUR EXPERIENCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236

Paper poster 8:MINIMAL-INCISION OSTEOTOMY WITH EXTERNAL FIXATION FOR SLIPPED CAPITAL FEMORAL EPIPHYSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236

Paper poster 9:DISTAL FEMORAL DOME VARUS OSTEOTOMY: SURGICAL TECHNIQUE WITH MINIMAL DISSECTION AND EXTERNAL FIXATION. . . . . . . . . . . . . . . . . . . . . . . . . . 237

Paper poster 10:TREATMENT OF POSTTRAUMATIC EQUINES FOOT DEFORMITY USING ILIZAROV EXTERNAL FIXATOR OR TRIPLE ARTHRODESIS? . . . . . . . . . . . . . . . . . . . . . . 237

Paper poster 11:CASIO3-SIO2-TCP CERAMIC FOR BONE RECONSTRUCTION. STUDY IN VIVO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238

Paper poster 12:ELBOW INSTABILITY AFTER FRACTURE-DISLOCATION TREATED WITH A HINGED EXTERNAL FIXATOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238

Paper poster 13:REMOVAL OF EXTERNAL FIXATORS. WITH OR WITHOUT ANESTHESIA? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239

Paper poster 14:A BRAIN TEASING DEFORMITY, HOW WE GOT OUT OF IT? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239

Paper poster 15:INITIAL HISTOLOGICAL CHANGES OF DISTRACTION OSTEOGENESIS IN A MURINE MODEL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240

Paper poster 16:EXTERNAL FIXATORS IN TUMOR RECONSTRUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240

Paper poster 17:ACCELERATION OF BONE TRANSPORT AND BMP-2 INCREASE THE UNION RATE OF DOCKING SITE IN VIVO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241

Paper poster 18:NEW REDUCTION TECHNIQUE OF FRACTURES BY ILIZAROV APPARATUS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241

Paper poster 19:THE USE OF EXTERNAL FIXATION IN THE TREATMENT OF COMMINUTED INTRA-ARTICULAR DISTAL RADIUS FRACTURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242

Paper poster 20:ACCURACY OF SPATIAL CAD SOFTWARE IN CALCULATING MOUNTING AND DEFORMITY PARAMETERS OF TAYLOR SPATIAL FRAME . . . . . . . . . . . . . . . . . . 242

Paper poster 21:CONSERVATIVE TREATMENT OR EXTERNAL FIXATION FOR UNSTABLE DISTAL RADIAL FRACTURES IN ADULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243

232

Paper poster 22:ILIZAROV HIP RECONSTRUCTION OSTEOTOMY WITH MONOLATERAL EXTERNAL FIXATOR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243

Paper poster 23:PROXIMAL HUMERUS FRACTURES-PERCUTANEOUS K-WIRES VS EXTERNAL FIXATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244

Paper poster 24:RECONSTRUCTION USING A MEGAPROSTHESIS FOR OSTEOARTHRITIS OF THE KNEE JOINT WITH A JUXTAARTICULAR DEFORMITY . . . . . . . . . . . . . . . . . . 244

Paper poster 25:RESCUE TREATMENT TECHNIQUE INVOLVED USING GIRDLESTONE. A REPORT CASE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245

Paper poster 26:A NEW CONSTRUCT BASED IN STEM CELLS AND GLASS CERAMICS FOR BONE REPAIR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245

233

Paper poster 2:ANKLE DISTRACTION ARTHROPLASTY WITH RING FIXATION FORTHE TREATMENT OF SEVERE ANKLE ARTHRITIS

Polk, Matthew, MD Saint Joseph Hospital Rodríguez, Edgardo, MD; Bibbo, Christopher, MD

Chicago Foot and Ankle Deformity Correction Center; Marshfield Clinics

United States

Aim of study:

Surgical treatment options for severe osteoarthritis of the ankle include joint replacement, arthrodesis, and distraction arthroplasty. While arthrodesis has been shown to provide effective pain relief, it also creates a level of functional limitation while increasing the likelihood of developing arthritic changes in adjacent joints. Joint replacement maintains a level of function but has been shown to have a steep learning curve leading to a higher rate of complication or revision. This report reviews ankle distraction arthroplasty as a joint preserving alternative for the treatment of severe ankle arthritis.

Methodology:

This study represents a retrospective review of 121 subjects who underwent ankle distraction arthroplasty utilizing ring fixation. Mean age of the subjects was 49 years and 87% suffered post-traumatic arthritis. In addition to the arthroplasty and distraction, 55% underwent corrective osteotomy (Midfoot, Calcaneal, or Supramalleolar), and 28% a TAL. A static ring fixator was applied to 38 subjects while the remainder had the application of a hinged external ring fixator to allow for ankle range of motion throughout distraction period. Frame was removed at an average of 7 weeks and an ankle arthroscopy was performed concomitantly. Objective and subjective data was collected and reviewed over a minimum follow-up of 24 months.

Discussion:

Ankle arthroplasty distraction is thought to stimulate reparative changes to the joint by mechanically unloading the joint and restoring the intermittent intra-articular hydrostatic pressure. Further, ankle distraction has also reportedly allowed for fibrocartilage growth and a decrease thickness of the subchondral plate improving pain and slowing degeneration. Finally, the stretching of the periarticular nerve endings may be an additional mechanism for pain relief. Results of the Maryland Foot Score for the 121 subjects included 78.5% reporting excellent/good results, 19% reporting fair, and 2.5% reporting poor. Pain rated on the VAS scale averaged 9 pre-operatively and 2 post-operatively. Pre-operative ankle range of motion was 21 degrees while measuring 43 degrees post-operatively. 13 patients went on to ankle replacements.

Conclusion:

Ankle distraction arthroplasty with hinged external ring fixation represents a viable alternative for the treatment of severe ankle arthritis, decreasing arthritic pain while preserving joint function.

Paper poster 1:DOUBLE OSTEOTOMY WITH EX. FIXATION FOR CHARCOTSALVAGE RECONSTRUCTION: AN ALTERNATIVE TO TRIPLEARTHRODESIS

Polk, Matthew, MD Saint Joseph Hospital Rodríguez, Edgardo, MD

Chicago Foot and Ankle Deformity Correction Center United States

Aim and purpose of study:

Diabetic Charcot neuroarthropathy is a progressive, debilitating condition characterized by joint dislocation, pathological fracture, and wide-spread osseous destruction. Several recent studies have discussed the role of arthrodesis in Charcot reconstruction; however non-union in high risk diabetic patients remains a concern. This study presents a double osteotomy approach with external ring fixation as an alternative to triple arthrodesis in the diabetic Charcot reconstruction.

Materials and methodology:

This study represents a retrospective review of 43 patients who underwent Charcot reconstruction utilizing double osteotomy procedure with external ring fixation. Following evaluation of patient deformity, reconstruction was performed utilizing a medial or lateral calcaneal slide osteotomy, and a bi-correctional midfoot osteotomy (Cole/Reverse Cole) with application of a static ring fixator for a period of 12 weeks. Additional procedures included a gastroc recession, and posterior tibial tendon lengthening as needed. Objective and subjective data is reviewed over a mean follow-up of 28 months.

Discussion:

Treatment for Charcot neuroarthropathy remains a challenge to foot and ankle surgeons. The goal for reconstructive surgery is to achieve and maintain a plantigrade orientation to the foot to avoid development of ulceration, infection, and amputation. The 43 patients who underwent reconstruction with double osteotomy had a mean post-operative AOFAS score of 87. 40 of 43 midfoot osteotomies and all 43 heel osteotomies displayed bony consolidation on CT examination at 18 weeks. All patients were able to achieve assisted weight-bearing while in the ring fixator and maintained a plantigrade, braceable foot at the end of the follow-up period.

Conclusion:

Reconstruction utilizing a double osteotomy with external ring fixation represents a promising alternative to triple arthrodesis, allowing for earlier weight-bearing, quicker bone healing, and decreased patient morbidity.

234

Paper poster 4:HYBRID EXTERNAL FIXATION FOR OPEN SEVERE COMMINUTEDFRACTURES OF THE DISTAL FEMUR

Ghayem Hassankhani, Ebrahim, MD Imam Reza University Hospital Rahimi, Mohamad, MD; Birjandi Nejad, Ali, MD; Ghayem

Hassankhani, Golnaz, MDImam Reza University Hospital Iran

Background:

The treatment of open severe comminuted fractures of the distal Femur is still a major problem. The basic strategy is to assemble the condylar blocks and then fix the condyles to the femoral Shaft by minimal handling of the softtisues.

Objectives:

Evaluate the treatment of open severe comminuted fractures of the distal Femur (type C2 and C3) with hybrid external fixator.

Methods:

34 patients with open comminuted distal femur fracture (type C2 and C3) were treated by hybrid external fixator between January 2005 and December 2008. Average follow up was 36 month. All of the fractures were opened and extended to joint surface. 33 patients were male and 5 patients were female. Their average age was 30.5 years (17 to 72 y). 12 patients had isolated fracture and 26 patients had multiple fractures. The bony and functional results were evaluated by ASAMI protocol.

Results:

29 cases from 34 fractures (85%) had union without bone grafts. Average time of union was 6.1 months (4-19 m). 27 patients had union within 6 months or less. The average knee range of motion was 87.5 degrees (30-115 degrees).

According to the association for the study and application of the method of Ilizarov (ASAMI) protocol, the bony results were excellent in 24 patients (70/5%), good in 6 (17/7%), fair in 2 (5/9%), and poor in 2 (5/9%) and the functional results were excellent in 10 (29/4%) patients, good in 14 (41/2%), fair in 6 (17/6%), and poor in 4 (11/8%).

Conclusion:

Hybrid external fixator is an effective method for treatment of open severe comminuted fractures of the distal Femur (type C2 and C3) and may be considered an alternative to other conventional surgical methods in the management of these fractures.

Keywords:

Hybrid external fixator, open fractures, distal femoral fracture, type C2 & C3.

Paper poster 3:CLINICO-RADIOLOGICAL EVALUATION OF LATE PRESENTED CTEV MANAGED BY LIGAMENTOTAXIS A LONG TERM FOLLOWUP

Singh, Ajai, MD Department of Orthopaedics, CSM Medical Univerity,

Lucknow, India India

Aims & purpose of study:

Clubfoot is commonest congenital anomaly seen by a paediatric orthopaedic surgeon. We evaluated role of ligamentotaxis in management of “late presented” CTEV and compared our long term results with other workers using same principle of treatment.

Method and material:

No standard definition in literature of “late presentation” (of CTEV) could be found, but we considered any CTEV patient of more than 6 months of age, presenting first time for treatment as late presented. Total 32 feet of 24 such children of CTEV of either sex were studied. At the time of presentation all feet were assessed clinically to establish the grading of severity as per clinical parameters and Pirani score. Weight bearing foot tracings with FBM angles were taken. Then radiological assessment of these feet was done and various angles were measured as per protocol. After gradual and differential distraction (by a rate double on medial side than lateral) by external fixator (an unconstrained assembly having K wires, blocks and rods without rings), when the clinical corrections were achieved, again feet were assessed as per above-mentioned clinico-radiological parameters. After fixator removal, AKPOP was given till orthosis was available. Average time of correction was 5.3 weeks. Regular follow up 4.2 years (minimum 03 years and maximum 5 years) was done.

Discussion:

All thirty-two feet had severe clinical deformities (clinical grade III, Pirani score 5-6 and FBM angle below 66 degrees). Mean pre correction FBA (60.9 degrees) was corrected to 78.7 deg. Mean preoperative Talo-calcaneal (TC) index was 19.2, which was improved to 63.1. All other clinico-radiological parameters were also improved (statistical significant) in all patients. Only 6 (18.7%) feet developed superficial infection (not severe enough to compel any active intervention) and managed by dressing. Only 10 (31.2%) feet presented relapsed forefoot adduction which was corrected by corrective POP in all cases and then all returned to orthosis. No open correction of any component of deformity in any case at any stage was done.

Conclusions:

Differential distraction by fixator for the correction of CTEV is a cost effective and patient friendly method of manipulation.

235

Paper poster 6:TISSUE DISTRACTION COMBINED WITH LIMITED OSTEOTOMIESFOR CORRECTING POST-TRAUMATIC CLUBFOOT

Chen, Jianwen, MD Chen Jianwen China

Aim and purpose of the study:

To explore some clinical problems of severe talipes equinovarus in the adults’ post-traumatic lower extremities corrected by tissue distraction combined with the limited osteotomies.

Material and methodology:

Retrospective analysis, from May 2004 to February 2010, 17 clubfoot of 17 patients in post-traumatic lower extremities were corrected. According to the Dimeglio’s classification: thirteen feet were graded as severe (grade III), and four were very severe (grade IV). The modified apparatus was composed of tibial frame and foot frame. If the apparatus couldn’t be well attached the severe deformities foot through adjusting the frames, for correcting the foot varus and adductus easily and installing the frames conveniently, the operative procedure of limited osteotomies and triple arthrodesis should be selected. The residual deformities were gradually corrected by post-operative tissue distraction. All patients’ clubfoot were completely corrected over the treatment. 14 patients were followed up for an average of 11 months (range, 6-36). Only five feet had mild recurrent deformities with equines<20º and a plantigrade foot. Some patients obtained a more mobile foot. The final outcome was assessed by using the International Clubfoot Study Group (ICFSG) score: three feet were excellent, nine feet were good, two feet were fair, no poor.

Discussion:

After the leg suffer from serious harm, the contracture of muscles and soft tissue will give rise to the severe stiff clubfoot. The conventional surgical management can’t achieve significant correction and frequently lead to severe complications. Ilizarov’s technique with relatively few complications is a good selection. The special designed external fixator are fixed around the ankle-foot by transcutaneous wires. To perform slow mechanil distraction, the deformities of foot are gradually corrected. However, some severe clubfeet is difficult to be cured by the foot external fixator, the post-operative deformities of recurrence also can’t be completely avoided. We perform the limited osteotomies at operation and use the modified foot fixator frame and have obtained satisfactory clinical results .

Conclusions:

Tissue distraction combined with the limited osteotomies for correcting severe talipes equinovarus in the adults post-traumatic lower extremities, easy attachment of the external fixator, which can prevent the recurrence deformity. It presents the superiorities of Ilizarov’ technique.

Paper poster 5:IN VITRO BEHAVIOUR OF MESENCHYMAL STEM CELLS ONFIBROIN MESH FOR BONE RECONSTRUCTION

Meseguer, Luis, MD University Hospital V. Arrixaca/chief of section

1Aznar, Salvador, MD; 1Cenis, José Luis, MD; 2Meseguer, Clara, MD; 3Meseguer, Ana Belén, MD; 3Rodríguez, Francisco J, MD

1Imida/researcher; 2University Hospital Morales Meseguer/researcher; 3University Hospital V. Arrixaca/researcher

Spain

Aim:

Our aim was to test the adhesion and proliferation of MSCc on this new resorbable silk fibroin based biomaterial in order to use it in tissue engineering for bone reconstruction.

Material & methods:

The silk fibroin mesh was obtained by electrospinning of silk fibroin solution obtained from cocoons of silkworms. Human bone marrow MSCs (hMSCs) were obtained by direct aspiration of ileac crest from volunteer donors. The cells were isolated by gradient ficoll by mean of SEPAX™ System device and cultivated in -MEM supplemented with 10% FCS and penicillin/streptomycin. A total of 1.0 x 105 hMSC were seeded onto the material in 24-well plates and analyzed at 72 h and 1, 2, 3, and 4 weeks. The growth rate was carried out by image analysis of the cell covered surface using ImageJ™ software. Cell morphology, adherence, behaviour and growth were analyzed by phase contrast microscope and scanning electron microscope.

Results:

At 72 h, the hMSCs cultured had a flattened polygonal appearance with variable and spread cytoplasmatic extensions. Later, at 1 week, the adhesion was enhanced by means of multiple cytoplasmatic philopodia that spread across the surface. Abundant extracellular matrix was also observed at this time occupying intercellular gaps. Between 2-3 weeks, the cells became confluent forming an homogeneous monolayer almost coating the whole of the mesh. Cell proliferation was fast as is showed in the growth curve which follows a logarithmic model, with a rapid growth in the first week and a slowdown the last three weeks.

Discussion & conclusions:

This study show culture of hMSCs on silk fibroin mesh may provide a useful approach to assess the biological effects of this material on the adhesion and proliferation of hMSCs with a view to their potential application in bone reconstruction. In this sense, the cells showed a strong adhesion to the microfiber and proliferated in a short period of time (1 week). At the confluence it was observed the presence of collagen-like lattices occupying the intercellular gaps. No cytotoxicity phenomena was detected. In view of these results we can say that the material behave as a suitable substrate for hMSCs growth.

236

Paper poster 8:MINIMAL-INCISION OSTEOTOMY WITH EXTERNAL FIXATION FORSLIPPED CAPITAL FEMORAL EPIPHYSIS

Kakihana, Masataka, MD Dept. of Orthop. Surg Dokkyo Med. Univ. Koshigaya

Hospital Ozeki, Satoru, MD

Dept. of Orthop. Surg Dokkyo Med. Univ. Koshigaya Hospital

Japan

Background:

Southwick osteotomy for slipped capital femoral epiphysis (SCFE) is an established method, which involves large incisions for the use of an internal fixation device. The methods presented here offer an opportunity for intraoperative correction, as it is not easy to make fine corrections after fixation. Often it is impossible to obtain space to insert a cannulated screw to fixate a slipped femoral head. Additionally, postoperative cast immobilization is necessary, so early weight bearing is difficult.

Material and method:

After 1993, three-dimensional correction with open wedge osteotomy based on Southwick’s methods was done for 7 hips in 7 patients with a slipped capital femoral epiphysis. The mean follow-up period was 57 months (range 24-100 months). Full weight bearing was allowed 4 weeks after surgery. Osteotomy was at the lesser trochanter through a minimal anterior incision. The femur was fixed with a unilateral external fixator (Stryker Monotube TRIAX) after correction.

Before the operation, cannulated cancellous screws were inserted into the slipped femoral head using fluoroscopy for fixation.

Removal of the external fixation system was done at a mean of 10 weeks (range 7-10 weeks) after surgery. We evaluated the postoperative results using the Iowa Hip Scale. The mean Iowa Hip Rating was 96 (range, 94-97).

Discussion:

Using the external fixation system allows for easily repeatable intraoperative varus/valgus and flex/extension corrections, as compared with the use of an internal fixation device. We succeeded in performing both a Southwick osteotomy and in situ fixation with cannulated screws by using an external fixator.

Conclusion:

Minimal-incision osteotomy with external fixation is a useful method for treating pediatric hip disease.

Paper poster 7:CONTINUOUS REGIONAL ANAESTHESIA AND EXTERNAL FIXATION.OUR EXPERIENCE

Guarnerio, Chiara Paola, MD Anaesthesiology/Niguarda Hospital Milan Bassi, Gabriele, MD; Vimercati, Marco, MD; Pulido,

Johanna, MD; Arpino, Ines, MDNiguarda Hospital Milan Italy

Background:

Precocious physical therapy, after leg and femur fractures, improves in significant way the functional prognosis but also causes severe pain.

We assume that a continuous regional anaesthesia technique (CRA) done for the pain check improves the surgical outcome and the patient’s satisfaction.

Materials and methods:

In the years 2008-2009 we have submitted 52 patients to leg and femur osteosynthesis with external fixation. Our population has been divided into 4 groups:

block for EF of leg.

EF of leg.

block for EF of femur.

Pain has been evaluated using VAS scale in the immediate post-operative period, at 12, 24, 48 hours and during every physiotherapeutic session until 7 days from the intervention. The post-operative analgesia in the patients submitted to GA was assured with intravenous patient-controlled morphine (dose 1 mg; lockout interval 15 min) plus NAIDs. The post-operative analgesia in the patients submitted to CRA was assured with continuous infusion of a 2% Ropivacaine solution, administered at 0.2-0.35 mg/Kg/h plus Paracetamol as a rescue dose.The data we gathered have been analyzed with comparisons based on the analysis of variance with Mann-Whitney test.

Results:

In the A and B groups VAS scale does not have significant differences in the first 24 hours after intervention but it is significantly lower in the A during physical therapy sessions. Between C and D groups the VAS score is significantly smaller in group C. The one and biggest side effect (DVT) has happened in a group B patient. In half of the patients (A and C) we had an accidental removing of the catheter between 5th and 7th day of intervention.

Conclusions:

Although we cannot do a quantitative analysis due to the reduced number of cases, our experience confirm data presented in literature. The regional anaesthesia technique improves: early rehabilitation by controlling pain during continuous passive motion, surgical outcome and the patient’s satisfaction.

237

Paper poster 10:TREATMENT OF POSTTRAUMATIC EQUINES FOOT DEFORMITYUSING ILIZAROV EXTERNAL FIXATOR OR TRIPLE ARTHRODESIS?

Yang, Sheng Song, MD Peking Jishuitan Hospital, China Huang, Lei, MD

Peking Jishuitan Hospital, China China

Objective:

There are two different way to treat traumatic equines foot deformity: triple and/or ankle osteotomy and arthrodesis, correct the deformity at once, or use Ilizarov external fixator to correct the deformity gradually. The aim of this study is to compare the operation time, blood loss, and prognosis of these two methods.

Material and method:

From 2002 to 2008, 86 patients of traumatic equines foot deformity were admitted into Beijing Jishuitan Hospital, 62 male, 24 female; age from 15-48 (average was 27), 25 patients were treated with triple and/or ankle osteotomy and arthrodesis (abbreviate as OA group), 61 patients were treated with Ilizarov external fixator (abbreviate as IEF group). AOFAS score and VASFA score were used to evaluate the outcome of treatment. The preoperative deformity, blood loss, operation time, the AOFAS and VASFA score of two groups were analysised with SPSS 10.0 Software.

Result:

The preoperative equines deformity of two group have no significant difference (IEF group was 52 degree averagely, OA group was 48 degree). The blood loss of IEF group was significant less than OA group (26.00±35.567 ml vs. 136.15±110.645 ml, P<0.01). The operative time of IEF group

were followed up for 14-65 month (average 31 month). AOFAS score was 77.85±7.32 in OA group, 80.07±7.72 in IEF group, no significance. VASFA score was 76.38±7.98 in OA group; IEF group is 78.00±10.33, no significance. There were 4 patients who loss correction after operation in IEF group and 3 patients in OA group individually.

Conclusion:

The Ilizarov external fixator and triple/four osteotomy arthrodesis are both succeful method to traumatic equines foot deformity. Although preoperative soft tissue condition may be worse in IEF group, the prognosis of both methods are comparable, the blood loss is significant lower In IEF group.

Key word:

Equines foot, Ilizarov external fixator, triple arthrodesis.

Paper poster 9:DISTAL FEMORAL DOME VARUS OSTEOTOMY: SURGICAL TECHNIQUE WITH MINIMAL DISSECTION AND EXTERNAL FIXATION

Luna Pizarro, Daniel, MD Unidad Medica de Alta Especialidad, Hospital de

Traumatología y Ortopedia De la Fuente Zuno, Juan Carlos, MD

Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia

Mexico

Introduction:

The results obtained when using the distal femoral varus osteotomy are variable. Our objetive was to describe a surgical technique involving minimal dissection, semicircular osteotomy with external fixation for valgus angular deformities and early weight bearing.

Methods:

Design: Series of cases.Setting: Orthopedic Referral and Trauma Center.Patients: Fourteen patients with valgus angular deformities >12º.Intervention: Wedge varus Osteotomy, minimal dissection with external fixation using a standard system Orthofix multi-directional Main outcome measurements: Pain, surgical time, knee flexion and extension angles and assessment of knee function based on the Special Surgery knee rating scale (SSkrs).

Results:

Of 14 patients, 12 were evaluated up to the end of the study (2 years). When we compared the preoperative values to those obtained postoperatevely at a mean of 24 ± 2.1 months, the

angle of flexion from 105.4 ± 14.6 to 104 ± 11.1 degrees

one due to an infection that developed along the trajectory of a screw and the other underwent a complete arthroplasty of the knee which was performed to combat the pain, that was not alleviating.

Conclusions:

The technique improves function and reduces pain, while facilitating the early rehabilitation although it is associated with two failures among the 14 patients.

238

Paper poster 12:ELBOW INSTABILITY AFTER FRACTURE-DISLOCATION TREATEDWITH A HINGED EXTERNAL FIXATOR

Christodoulou, Evangelos, MD General Hospital of Karpenisi

1Chrysikopoulos, Theodoros, MD; 2Saras, Emanouil, MD 1Orthopaedic Department, General Hospital of Karpenisi;

2Orthopaedic Department, “KAT” Hospital of Athens Greece

Introduction:

Instability persisting after fracture-dislocation is a very difficult problem that the surgeon has to deal with. The combination of the operative treatment with the hinged external fixator may give satisfactory results.

Method:

Sixteen patients (10 men and 6 women) with fracture-dislocation were treated with reconstruction of the olekranon, the coronoid process, the radiocapitelar joint and the lateral ligament complex. 5 patients had the terrible triad. The reconstruction was followed by the application of a hinged ex-fix due to residual instability checked intraoperatively. The mean age of the patients was 47 y.o. and the follow up was 18 months (from 6 to 48). The evaluation of the results was done according the range of motion, the persistence or not of instability, radiographic findings for arthrosis and the Mayo score.

Results:

The average Mayo score was 79. Five patients had an excellent result, 6 good and 5 fair. The patients had an average 22º extension deficits and 15º flexion deficits. The elbow was stable in all patients. In 5 patients were found radiographic signs of arthrosis.

Discussion:

Although a stable elbow can be achieved, the range of motion is always negatively affected. The use of a hinged external fixator allows early mobilization with flexion extension movements which positively influences the final result.

Paper poster 11:CASIO3-SIO2-TCP CERAMIC FOR BONE RECONSTRUCTION. STUDY IN VIVO

Meseguer, Luis, MD University Hospital V. Arrixaca/chief of section

1Clavel, Luis, MD; 1Moraleda, José María, MD; 2Vicente, Vicente, MD; 1Meseguer, Ana Belén, MD; 3Meseguer, Clara, MD

1University Hospital V. Arrixaca. Murcia; 2School of Medicine. University of Murcia; 3University Hospital Morales Meseguer

Spain

Introduction:

The “gold standard” in bone repair is spongy bone autograft, although the technique has its disadvantages (donating region, localised pain, bruising, etc). Our objective is to study the oseous response to a new material in the CaSiO3-SiO2-Ca3(PO4) system to assess its bioreactivity, bioincompatibility, reabsorption, and osteointegration for consideration as a potential bone tissue substitute.

Material & methods:

The material was implanted in an osseous defect created in the femur distal methaphysis in 16 NZ Rabbits. Four study periods (1, 3, 6 and 9 months) were established. All sixteen samples were studied by simple radiology (mammographic techniques), optical microscope (HE staining, Masson’s T. and Gordon Sweet) and SEM.

Results:

From the very first study time (one month), a rounded ostoid layer surrounded the implant with no fibrous tissue inteface or inflammatory response observable. This gradually increased until, after nine months, a large quantity of mature bone tissue was observed around the periphery and inside the implanted material. This was accompanied by gradual reabsorption of the implanted material, although this was still incomplete after the nine months.

Discussion & conclusions:

The studies made by L. Hench using Bioglass® demonstrated its high reactivity (bioactivity) to contact with the bone and gradual reabsorption. Following this, several studies have used glass-ceramics. Our study, in line with the literature shows that this new glass-ceramic is biocompatible, bioactive and slowly reabsorbed, making it a good candidate for use as bone substitute in zones of the body which demand a high mechanical resistance or as a coating in orthopaedic implants.

239

Paper poster 14:A BRAIN TEASING DEFORMITY, HOW WE GOT OUT OF IT?

Puthan Veetil Nandalan, Vasudevan, MD Rv Institute of Research in Ilizarov Technology KV, Vaidyalimgam, MD; P Nair, Bhaskaran, MD

Rv Institute of Research in Ilizarov Technology India

Introduction:

Rare problems needs high level of clinical skills for its evaluation and correction, one such problem is presented for its rarity and still more rarer correction strategies.

Case presentation:

In September 2006 a 13 yr old girl was referred to us with the following description “having a very complicated deformity of left hip, left knee and left ankle along with severe shortening and a very interesting 1800s torsional deformity just above her left knee”.

X ray was very deceptive. As she could not stand straight even on height equalizing blocks, we were not able to take standard Standing X-ray of both lower limbs with patella pointing forward.

As our conventional tools of investigations were of no help in deciphering the condition we had to fall back on our clinical skill and common sense to sort out the problem.

Ultimately we found it was nothing but a pure genu valgum to the extent of 1700s, along with severe shortening and compensatory fixed equinus of left ankle. As far as we know there is no report of such severe deformity in the literature or its correction.

Management:

The details of evaluation of this complicated deformity and its management using Ilizarov principles were presented. She finally achieved full correction of deformity and limb length disparity.

Paper poster 13:REMOVAL OF EXTERNAL FIXATORS. WITH OR WITHOUTANESTHESIA?

Christodoulou, Evangelos, MD General Hospital of Karpenisi

1Saras, Emanouil, MD; 2Papageorgiou, Evanthia, MD; 1Chrysikopoulos, Theodoros, MD

1Orthopaedic Department, “KAT” Hospital of Athens; 2General Hospital “Laiko” of Athens

Greece

Introduction:

The routine removal of the external fixators is without anesthesia. Our purpose is to evaluate the pain and discomfort that the patient feels during the removal.

Material and method:

From March 2008 until March 2009 we removed 98 external fixators from 92 patients without anesthesia. The patients evaluated the pain using the Visual Analogue Scale (VAS, 1 to 10). We also recorded the anatomical site of the ex-fix, the presence of pin track infection, the type of fracture, the period from applying to removal, the use of olive wires, the age and gender.

Results:

The mean VAS score was 4.1. It was higher when pin track infection was present (5.1) and when olive wires had been used (4.7). The highest VAS score was recorded when we removed external fixators for trochanteric fractures (5.8) and the lowest for distal radius fractures (3.2). The duration of fixation and the age doesn’t seem to influence the VAS score. Slightly higher score was recorded for the women (4.3). When finally we asked the patients if they would agree to undergo the same procedure again without anesthesia, 82% answered that they would.

Discussion:

The removal of the external fixators without anesthesia is safe and well tolerated from most patients. Maybe we should think for anesthesia only when we have to remove external fixators used for the treatment of trochanteric fractures. The pin track infection is not an indication for removing the ex-fix with under anesthesia.

240

Paper poster 16:EXTERNAL FIXATORS IN TUMOR RECONSTRUCTION

Stefano, Eduardo, MD Asami Argentina Martínez, Gabriela, MD; Saa Lucero, Francisco, MD;

Lamelas, Ana, MDAsami Argentina Argentina

Aim and purpose of the study:

A biological reconstruction after large bone resections is the gold standard and it’s possible to succed in it using bone graft or callotasis. For large bone lengthening during oncologic treatment the number of complications ussually makes surgeons select others treatments like endoprostesis.

Material and methodology:

8 patients were treated during the last 10 years using callotasis as primary reconstruction (5 cases) or after failure of other methods (3) differents sistems of compression distraction with external fixation were used, and also diferent fixators like Illizarov device or monolateral ones.

Discussion:

Pin site infections, pin loosening, slow bone formation, need of second surgery and other complications were observed during this treatment. The final result was of bone healing in all 8 patients with a healing index 30 to 50% longer than usual legnthenings.

Conclusions:

The use of callotasis with external fixation is a biological treatment for bone tumors but the complication rate and long healing index makes it neccesary to select carefully the indications.

Paper poster 15:INITIAL HISTOLOGICAL CHANGES OF DISTRACTIONOSTEOGENESIS IN A MURINE MODEL

Amano, Kuniaki, MD Department of Orthopaedic Surgery, Graduate School of

Comprehensive Human Sciences, Univ. of Tsukuba Ishii, Tomoo, MD; Nozawa, Daisuke, MD; Ochiai,

Naoyuki, MDDepartment of Orthopaedic Surgery, Graduate School of

Comprehensive Human Sciences, Univ. of Tsukuba Japan

Purpose:

Distraction osteogenesis is a surgical technique widely used. This procedure involves the creation of an osteotomy, followed by gradual and continuous distraction of the osteotomy site. But it is not yet revealed which cells sense the distraction force, or where the mesenchymal cells were delivered from. In addition, there is no research at initial histological changes. This research is aimed at clarifying this mechanism by histology of distraction sites in early-phase.

Materials and methods:

Distraction osteogenesis surgery was performed on wild type male mice of aged 2 months. The fixator consisted of two rings and two screws, and two needles in both the distal and proximal end of the tibia. After fixator setting, an osteotomy was performed at the middle of the diaphysis. After an application of the external fixator, there was a latency period of 7 days. Distraction was started at a rate of 0.25 mm every 12 h for 10 days. The mice were sacrified on alternate days between 7 and 17 days after surgery. After x-ray photographing, the frozen specimens of tibia were made by Kawamoto film method and stained by hematoxylin-eosin for histology.

Results:

At the end of the latency period (7 days), the osteotomy gaps were covered with periosteal callus. After 2 days of distraction (9 days after operation), cells in osteotomy gap was elongated. At 4 days, the gap was filled by the tissue which was longitudinally-arranged in subperioseteum. Furthermore, the intramedullary tissue was spread radially attached to endosteum. After that, those tissues became calcified gradually.

Discussion:

Morphologically, subperiosteal tissue was longitudinally arranged, and intramedullary tissue around osteotomy sites spread radially attached to the endosteum, although we have not investigated where the cells were derived from. Morphological changes of cells and tissue by mechanical stress play an important role on the distraction osteogenesis. Further detailed observation of cell reaction in the early phase is need to clarify a mechanism of the distraction osteogenesis.

Conclusions:

Subperiosteal tissue and intramedullary tissue attached to endosteum were longitudinally arranged and calcified on early phase observation of distraction osteogenesis in a murine model.

241

Paper poster 18:NEW REDUCTION TECHNIQUE OF FRACTURES BY ILIZAROVAPPARATUS

Odessky, Jacob, MD Assaf Harofeh Medical Center Israel

Aim and purpose of the study:

The classical steps of Ilizarov’s reduction technique of the fractures include skeletal traction, insertion of couple of KW in proximal and distal metaepiphysis, their fixation in basic rings, traction by Ilizarov apparatus, reduction of the fracture by olive KW, fixated to reduction rings. The purpose of this study formulates an alternative technique of reduction, enabling avoids skeletal traction, simplify and make it more accurate.

Material and method:

Our reduction technique includes application of distal ring(s) of the pre-built Ilizarov apparatus strongly perpendicular to long axis of the distal fragment, followed by the closed reduction by manual traction, and than fixation of proximal base and augmentation of each ring with KW or half pin. Reduction was controlled under fluoroscopy. We use such technique from 1993. This series includes 32 patients from 5 to 60 y.o. (31) that were treated in our institution in period 2002-2010. 6 were female, 26 male. 6 patients had fractures of distal femur, 26 - tibia. 4 fractures were open (G-1).

Discussion:

Stable fixation of distal fragments in ring of the Ilizarov apparatus, allows freely management of distal fragment in all planes and closed manual reduction. If fracture is stable after reduction, it generally is retained at the time of fixation of the proximal fragment to apparatus. If the fracture is unstable, under manual traction of distal fragment the KW inserts to the proximal fragment strongly perpendicular to long axis, and strengths to the proximal ring. Strongly perpendicular incretion of all KW to axis of each fragment allows preventing the classical maneuver in which olive KW is used.

Closed reduction with anatomic or almost anatomic position was achieved in all fractures. The overage fixation period was 3 months. All fractures were united. Superficial pin tract infection was observed in 10%. The average follow-up was 26 months in 25 patients. All patients have good functional result.

Conclusions:

These results suggest that Ilizarov apparatus allows faster anatomic reduction by manual traction of distal fragment; avoid skeletal traction before operation and prevent reduction maneuvers with KW in most of cases.

Paper poster 17:ACCELERATION OF BONE TRANSPORT AND BMP-2 INCREASE THE UNION RATE OF DOCKING SITE IN VIVO

Yoshitaka, Eguchi, MD Osaka City University Graduate School of Medicine Kunio, Takaoka, MD; Shigeyuki, Wakitani, MD; Yoshifumi,

Naka, MD; Hiroaki, Nakamura, MDOsaka City University Graduate School of Medicine Japan

Purpose:

We investigate new methods that can decrease the delayed union rate of docking site in the treatment of bone transport distraction osteogenesis.

Materials & methods:

We prepared bone transport model of rabbit (bone defect: 35 mm) and evaluated the bone formation performed by different rate (SC; 1 mm/day, RC; 4 mm/day) and different doses of bone morphogenetic protein-2 (BMP-2) in RC groups. The composite materials consisted of BMP-2 (0, and 100 μg), -tricalciumphosphate powder ( TCP, 100 mg/animal; particle size, <100 μm), and polyethylene glycol (PEG; 40 mg/animal). In RC groups, a paste of equivalent composition was percutaneously injected at the lengthening and the docking sites after surgery and after bone transport, respectively.

Results:

The radiographic, mechanical, and histological examinations at 12 postoperative weeks revealed that the generation of bridging callus with or without BMP-2 was significantly different. The bony union rate of docking site tended to increase in RC regardless to injection of BMP-2. The callus mass in the bone defect site and the bony union in the docking site were adequately and consistently developed in RC groups with BMP-2 (administered for 6 weeks), and the bones were consolidated in 12 weeks. Such an adequate callus formation and bony union at the docking site were not observed in SC groups.

Conclusion:

The result of this experimental study suggests the potential application of BMP-2 in accelerating callus formation and in enabling rapid bone transporting, thereby shortening the treatment period for the repair of diaphyseal bone defects without the problem of docking site by distraction osteogenesis.

242

Paper poster 20:ACCURACY OF SPATIAL CAD SOFTWARE IN CALCULATINGMOUNTING AND DEFORMITY PARAMETERS OF TAYLOR SPATIALFRAME

Lahoti, Om, MD Kings College Hospital Rashid, MA, MD; Shoaib, Ahmad, MD

Kings College Hospital United Kingdom

Aim:

Spatial CAD™* is a software solution for obtaining deformity and mounting parameters from orthogonal and non-orthogonal x-ray images of Taylor Spatial Frame. We conducted a study to assess the accuracy of this software against a known mounting and deformity parameters of a sawbone and Taylor Spatial Frame assembly.

Materials and methodology:

We mounted a two-ring Taylor Spatial Frame (155 mm full rings) on a sawbone tibia and fibula unit. Plaster of Paris tape was wrapped round the tibia and fibula to enhance its image on x-ray film. Two of the authors (AR and AS) mounted the frame and produced a deformity in tibia and calculated the deformity and mounting parameters accurately. Then orthogonal images based on the proximal ring and non-orthogonal Anterior-Posterior and Lateral images of the tibia and fibula unit were obtained by placing a marker sphere (25 mm diameter) at the level of the bone. One additional set of images (AP and Lateral) was obtained without a marker sphere. Senior author (OL) independently acquired deformity and mounting parameters using Spatial CAD™ software.

Results:

Spatial CAD™ software was accurate within 1 mm and 1 degree when orthogonal images with marker sphere placed at the bone level were used. Non orthogonal images with marker sphere yielded accurate axial frame offset but other mounting parameters were at least 6 mm more than the actual measurements. Understandably angular measurements were different. In the third set of films we used frame hardware -Rancho Cube width (12 mm) as a calibrator. Since the cube was not in the same plane as the bone all measurements were way off actual measurements.

Conclusions:

Spatial CAD™ software yields parameters within 1 mm of actual parameters when orthogonal images with a sphere marker placed at the level of bone are used for measurements. Non

parameters.

*Voyant Health35 Efal StreetPetach-Tikva, 49511Israel

Paper poster 19:THE USE OF EXTERNAL FIXATION IN THE TREATMENT OFCOMMINUTED INTRA-ARTICULAR DISTAL RADIUS FRACTURES

Skarakis, Ioannis, MD Genaral Hospital of Levadia Tzioupis, Chris, MD; Kakouri, Petroula, MD

Genaral Hospital of Levadia Greece

Aim and purpose:

The treatment of unstable intra-articular comminuted fractures still remains a challenge to the trauma surgeon. Despite the ongoing innovations in terms of new implants there is no consensus with regard to their management. We present the results of our prospective nonrandomized study in a cohort patient population with comminuted distal radius fractures treated with dynamic external fixation.

Materials-methods:

All comminuted intra-articular distal radius fractures were enrolled for the study from 2006 till 2009. Four different types of dynamic external fixation were used based on the severity of the injury and the surgeon’s preference. The clinical scoring chart modified by Cooney and two plane radiological imaging (ulnar variance or radial inclination) were used evaluate the functional outcome.

Results:

Eighty patients (27 males/53 females) were included. The mean age was 60 years (range 50-85). The commonest mechanism of injury was fall on a outstretched hand. All were operated within 24 hours. 18 of the fractures were complicated. All the fractures were united. Digit movement was initiated immediately postoperatively. Follow up included clinical and radiological evaluation at 1, 2, 4, 6, 12 weeks and at 6, 12 and 18 months.The external fixation was removed after 4-10 weeks. Pain lasting up to 3 postop days was recorded in 30% of our cases. Following the removal of ex-fix, 60% underwent a physiotherapy programme reaching full recovery after 4 weeks. There were (50%) excellent, (30%) good, (10%) fair and (10%) poor results.There were very few complications (3 superficial pin track infections) in our series. In 7 patients readjustment of the fixator was needed due to loss of reduction.

Conclusions:

The contemporary treatment of this demanding type of intra-articular distal radius fracture is still haunted with ongoing controversies. In our series, the use of dynamic external fixation, in combination with ligamentotaxis, has proven a reliable strategy providing very satisfactory results, given the complexity of the specific injury. Meticulous planning along with strict operative rules compliance in combination with adequate rehabilitation, ensue a successful uncomplicated outcome.

243

Paper poster 22:ILIZAROV HIP RECONSTRUCTION OSTEOTOMY WITHMONOLATERAL EXTERNAL FIXATOR

Miscione, Horacio, MD Hospital Garrahan de Pediatría Goyeneche, Rodolfo, MD; Primomo, Claudio, MD;

Masquijo, Javier, MD; Miscione, Fernando, MDHospital Garrahan Argentina

Purpose:

Patients with an unstable hip secondary to structural defects of the proximal femur usually have lower-extremity length discrepancy, abnormal gait, and pain. The Ilizarov Hip Reconstruction Osteotomy (IHRO) is a valid approach for treatment of this difficult problem. Monolateral fixation has been introduced recently as an alternative with higher comfort for patients. The aim of our study to assess the initial results of this technique using a mobile monolateral external fixator.

Methods:

We retrospectively reviewed 13 consecutive patients treated from January 2002 to December 2006. 10 patients have a Hunka Type-IV or V hip deformity, 2 Proximal Focal Femoral Deficiency and 1 have a Tönnis Type 3 dislocated hip. Mean age was 13.7 years (r, 7-17 years). Mean follow-up was 36.4 months (r, 12-61 months). Outcomes were evaluated clinically and radiographically. The Harris hip score and Trendelenburg sign were evaluated preoperatively and at follow-up. The mechanical axis deviation (MAD) and the leg length discrepancy (LLD) were radiographically analyzed.

Results:

All the patients are painless. The mean Harris hip score increased significantly from 56.6 points (r, 42-72 points) preoperatively to 85.1 points (r, 74-96 points) at last follow-up (p <0,001). Trendelenburg sign was diminished or negative in all cases. The mean lower-extremity length discrepancy had improved from 5.1 cm preoperatively to 1.3 cm. (p 0,0010). All extremities were well aligned, with a mean deviation of the mechanical axis of 1.01 cm in a medial direction.

Conclusions:

The use of monolateral external fixator for IHRO can successfully correct hip instability and simultaneously lower-extremity length discrepancy avoiding the disadvantages of a bulky frame.

Paper poster 21:CONSERVATIVE TREATMENT OR EXTERNAL FIXATION FORUNSTABLE DISTAL RADIAL FRACTURES IN ADULTS

Sarras, Emmanuil, MD Kat Hospital Athens Korres, Nectarios, MD; Christodoulou, Evagelos, MD;

Papadopoulou, Theodora, MD; Chrysikopoulos, Theodoros, MD; Baltopoylos, Panagiotis, MD

Kat Hospital Athens Greece

Aim:To evaluate the clinical and radiological outcome comparing external fixation with conservative treatment for fractures of the distal radius in adults.

Material-methods:

52 adults with dorsally displaced and potentially or evidently unstable distal radial fractures, were included. 26 treated with close reduction and plaster cast and 26 treated with external fixator. We evaluate the clinical outcome at 1, 2, 3 months posttreatment and radiological 10 days, 1 month and 3 months posttreatment. The plaster cast was removed 5 to 6 weeks after first or final treatment and the external fixator 1 month after surgery in all cases.

Results:External fixation maintained reduced fracture positions and prevented late collapse and malunion compared with plaster cast immobilization. There was no superior overall functional or clinical result for the external fixation group. In both groups there was from one case of reflex sympathetic dystrophy and one pin track infection for the external group that was treated with antibiotics. In conservative group there was two cases with redispacement that needed new reduction after ten days in plaster cast and two cases with serial edema that needed to release the plaster after 36 hours without redisplacement.

Conclusion:There is some evidence to support the use of external fixation for unstable displaced fractures of the distal radius in adults. Though there is insufficient evidence to confirm a better functional outcome, external fixation reduces redisplacement, gives improved anatomical results and most of the excess surgically-related complications are minor.

244

Paper poster 24:RECONSTRUCTION USING A MEGAPROSTHESIS FOROSTEOARTHRITIS OF THE KNEE JOINT WITH A JUXTAARTICULARDEFORMITY

Nomura, Issei, MD Kanazawa University Watanabe, Kouji, MD; Matsubara, Hidenori, MD; Takato,

Kei, MD; Takata, Munetomo, MDKanazawa University Japan

Resume:

A 75-year-old woman presented to our hospital after four years of increasingly intense knee pain that finally had left her unable to walk. Her medical history was remarkable for osteomyelitis of her left distal femur at four years of age and a subsequent varus deformity and limb shortening which had steadily worsened during childhood. Physical examination documented a varus deformity of 32 degrees and left femur shortening of 54mm. Conventional treatment alternatives were unattractive: TKA in combination with a femoral corrective osteotomy would have left her still with a 50 mm limb length discrepancy after reconstruction. On the other hand, delaying the TKA and reconstruction until the completion of deformity correction and lengthening using an external fixator would have necessitated a lengthy treatment period whose duration was unacceptable to the patient. Instead, we reconstructed her knee joint using a modular resection megaprosthesis system (Growing Kotz), which produced 15 mm of lengthening during the first postoperative year. Her leg length discrepancy ultimately stabilized at 10 mm, at which time she was able to walk painlessly with the assistance of a cane.

The results of this case demonstrate that for patients with OA of the knee joint requiring correction of a leg length discrepancy, reconstruction with a growing megaprosthesis is a feasible treatment option.

Paper poster 23:PROXIMAL HUMERUS FRACTURES-PERCUTANEOUS K-WIRES VSEXTERNAL FIXATION

Almeida Simões, Luís, MD Hospital Garcia de Orta-Almada Carvalho, Tiago, MD; Monarca, Filipa, MD; Villacreses,

Carlo, MD; Craveiro-Lopes, Nuno, MDHospital Garcia de Orta-Almada Portugal

Introduction:

Proximal humerus fractures are the most common fractures in this bone, and when displaced, present a difficult challenge to the orthopedic surgeon, remaining a controversial matter. Numerous classifications have been proposed, yet all suffer from significant interobserver disagreement, making prognosis difficult to assess.

As in many other areas, there is a trend toward minimally invasive treatment. Percutaneous K-wire pinning and external fixators play an important role in this regard.

Material:

We present our department’s experience with this type of treatment. We do not routinely use “classic” AO-type monolateral external fixators, instead opting for two different options that have been developed in our department -TGF and spider fixator-.

Methods:

We have made a retrospective review of patients who were treated for this type of fracture by percutaneous pinning or external fixation, between January 1997 and June 2009. Polytrauma, associated fractures, and loss in follow-up were used as exclusion criteria.

Results:

During this period, a total of 50 patients matching the criteria were treated. 74% were female, average age was 64 years, average follow-up of 13 months. 26 were treated with K-wires, 16 with TGF, and 8 with “spider” fixator.

Patients were evaluated using the Constant shoulder score.K-wire treated patients had an average constant score of 70; TGF-treated patients, 68; “spider fixator” treated patients, 71.

Discussion:

Although the “spider fixator” achieved slightly superior results, this difference is not significant. In fact, all methods’ results are comparable, albeit not optimal as is usual with this type of fractures. The “spider fixator” does have the advantage that it’s cheaper than other external fixators, and is not subject to migration like the K-wires.

245

Paper poster 26:A NEW CONSTRUCT BASED IN STEM CELLS AND GLASSCERAMICS FOR BONE REPAIR

Meseguer, Luis, MD University Hospital V. Arrixaca/chief of section

1Bernabeu, Antonia, MD; 2Aznar, Salvador, MD; 3Rodríguez, Francisco, MD; 3Meseguer, Ana Belén, MD; 4Meseguer, Clara, MD

1University of Murcia/researcher; 2Imida/researcher;3University Hospital V. Arrixaca/researcher; 4University Hospital Morales Meseguer

Spain

Introduction:

Our aim is to demonstrate the efficacy of a 55S bioactive glass-ceramic as a substrate for the induction of the differentiation of human adult mesenchymal stromal cells (hMSCs) with the requirements to be considered osteoinductive and osteogenic.

Material & methods:

The glass ceramic was obtained by heat treatment of a bioactive glass by the sol-gel method. Informed consent was obtained from volunteer donor. hMSCs were cultivated from a iliac crest bone marrow aspiration in -MEM supplemented with 10% FCS and penicillin/streptomycin (100 U ml-1 and 100 μg ml-1) Ten thousand hMSC were seeded on the material. The growth rate (MTT method) and the osteodifferentiation, osteocalcin and alkaline phosphatase production and the loss of CD90 expression, were determined. The mineralization of the extracellular matrix was assessed by microanalisis-EDS. Isolated osteoblast used as control were obtained by enzymatic digestion method form patients undergoing elective hip and spine surgery. A variance analysis (ANOVA) was carried out with a minimal significance of p<0.05.

Results:

The glass ceramic was an excellent substrate for the osteoblastic differentiation of the hMSCs as assessed by the increment in the production of osteocalcin and phosphatase alkaline and the reduction in the CD90 expression. Adhesion and proliferation of the cells on the substrate was observed by scanning electron microscopy as well as their ability to produce calcified bone extracellular matrix in the intercellular spaces.

Discussion & conclusions:

This material presents a high level of in vitro bioactivity after 3 days of soaking in SBF (previous studies). With time en culture, some hMSCs developed many granular irregularities in the cell membrane, composed of Ca and P quite similar to the extracellular deposit. These finding are considered characteristic of osteoblastic cells. The results obtained allow us to assert that the material used provides the adequate microenviroment to support the adhesion, proliferation and is capable of promote the differentiation of the hMSCs to osetoblasts. Thus, it can be considered as a adecuate scaffold for tissue engineering the field of bone tissue reconstruction.

Paper poster 25:RESCUE TREATMENT TECHNIQUE INVOLVED USINGGIRDLESTONE. A REPORT CASE

Palacios Fatilli, Jesús, MD Institut Universitari Dexeus Spain

Introduction:

Girdlestone surgery is one of the treatments used as ransom for prosthetic hip infection. The hip arthrodiastasis allows us to reposition the trace as close to the center of natural head rotation.

Material and methods:

We present the case of a man, 64 years, that avascular osteonecrosis of the femoral head 34 years ago, is first treated with the technique of forage, after two years there was a total hip arthroplasty, which became infected, so surgery was performed Girlestone, which was left to develop freely, yielding a 6-cm leg length discrepancy in 30 years. We proceeded to a arthrodiastasis elongation, and finally a total hip arthroplasty.

Results:

After arthrodiastasis, and after total hip arthroplasty was achieved a lengthening of the leg of 3 cm.

Conclusion:

The case demonstrates the validity of this combination of treatments for a complex joint arthroplasty in conditions of long evolution.

Keywords:

Arthrodiastasis, infected total hip arthroplasty.

E-POSTER ABSTRACTS

249

E-POSTERINDEX

E-Poster 1:CORRECTION OF COMPLEX ADULT FOOT DEFORMITIES WITH V-OSTEOTOMY AND EXTERNAL RING FIXATION.......................................................................................253

E-Poster 2:GOLD WITH FRAGRANCE: ROTATIONPLASTY WITH STATIC INTERLOCKING INTRA-MEDULLARY NAIL AS FIXATION ...............................................................................253

E-Poster 3:ENDER NAILING FOR FEMORAL SHAFT FRACTURE IN PEDIATRICS .........................................................................................................................................................................................254

E-Poster 4:REPAIR OF SEGMENTAL BONE DEFECT BY ALLOGENEIC MSCS-CERAMICS. STUDY IN ANIMAL MODEL.......................................................................................................254

E-Poster 5:TREATMENT THE AVULSION FRACTURES OF THE DISTAL TIBIA EPIPHYSIS AT CHILDREN .......................................................................................................................................255

E-Poster 6:APLICATION OF COMPRESSION-DISTRACTION EXTERNAL FIXATOR TYPE MITKOVIC IN TREATMENT OF NONUNION AFTER OPEN TIBIA................................255

E-Poster 7:EXTERNAL FIXATION IN PERIPROSTHETIC TIBIAL FRACTURE ......................................................................................................................................................................................................256

E-Poster 8:TREATMENT FOR NONINFECTIOUS NONUNION OF TUBULAR FRACTURES WITH MONOFOCAL COMPRESSION-DISTRACTION TECHNIQUE..........................256

E-Poster 9:CASE REPORT: ARTHRODESIS AFTER PSEUDOARTHROSIS IN ANKLE FRACTURE IN A DIABETIC PATIENT....................................................................................................257

E-Poster 10:THE USE OF STIMULAN KIT IN TREATING CHRONIC OSTEOMYELITIS ....................................................................................................................................................................................257

E-Poster 11:OPEN TIBIAL SHAFT FRACTURES TREATED BY THE UNILATERAL EXTERNAL FIXATION.............................................................................................................................................258

E-Poster 12:UNUSUAL WINDSWEPT DEFORMITY IN A GIRL WITH HYPOPHOSPHATEMIC BONE DISEASE. CASE REPORT...............................................................................................258

E-Poster 13:BONE PLASTIC EXPERIENCE BY THE PATIENTS WITH THE TRAUMATIC OSTEOMALITIS ............................................................................................................................................259

E-Poster 14:TREATMENT OF CLOSED TIBIAL SHAFT FRACTURES BY EXTERNAL FIXATION................................................................................................................................................................259

E-Poster 15:PIN TRACT INFECTION: OFTEN AND SERIOUS COMPLICATION....................................................................................................................................................................................................260

E-Poster 16:TREATMENT OF COMMINUTED INTRA-ARTICULAR FRACTURES OF DISTAL RADIUS USING THE NOVEL EXTERNAL FIXATOR ........................................................260

E-Poster 17:KNEE SEPTIC ARTHRITIS FROM STREPTOCOCCUS PLURANIMALIUM IN HUMANS. FIRST CASE REPORTED IN THE LITERATURE.................................................261

E-Poster 18:EXTERNAL FIXATION IN CERVICAL FRACTURES....................................................................................................................................................................................................................................261

E-Poster 19:EXTERNAL FIXATION IN CENTRAL ACETABULAR FRACTURE DISLOCATIONS IN PATIENTS WITH MULTIPLE INJURIES ..........................................................................262

E-Poster 20:HUMERAL LENGTHENING AND DEFORMITY CORRECTION WITH THE MULTIAXIAL CORRECTION SYSTEM ...................................................................................................262

E-Poster 21:10.5-YEAR-OLD BOY WITH OPEN TIBIAL SHAFT FRACTURE AND DEFECT OF TIBIA TREATED WITH SEGMENT BONE TRANSPORT............................................263

E-Poster 22:EXTERNAL FIXATEUR IN POSTTRAUMATIC OSTEITIS AND SEPTIC NON-UNION ..............................................................................................................................................................263

250

E-Poster 23:EXTERNAL FIXATOR IN PELVIC FRACTURES.............................................................................................................................................................................................................................................264

E-Poster 24:ROLE OF A MULTIMODAL ANAESTHESIA IN PROPHYLAXIS OF PURULENT-NECROTIC COMPLICATIONS FOR PATIENTSWITH OPEN TIBIAL FRACTURES.......................................................................................................................................................................................................................................................................264

E-Poster 25:TEMPORARY JOINT DISTRACTION WITH AN EXTERNAL FIXATOR IN THE THERAPY OF SEPTIC ARTHRITIS OF FINGER JOINTS......................................................265

E-Poster 26:THUMB RECONSTRUCTION WITH USE OF TWO MINI FIXATORS IN DIFFERENT LEVELS. A CASE REPORT.....................................................................................................265

E-Poster 27:RECONSTRUCTION OF POSTRAUMATIC TIBIAL LOSS OF 13 CENTIMETER BY MEANS OF DISTRACTION OSTEOGENESIS ................................................................266

E-Poster 28:TREATMENT OF TYPE IIIB OPEN HUMERAL FRACTURE USING A FREE VASCULARIZED OSTEOSEPT CUTANEUS FIBULA GRAFT ...................................................266

E-Poster 29:DISTAL TIBIA INTRARTICULAR FRACTURE WITH INTRAMEDULLARY NAIL...........................................................................................................................................................................267

E-Poster 30:TIBIAL PILON FRACTURE: EXTERNAL FIXATION CHOICE..................................................................................................................................................................................................................267

E-Poster 31:FEMORAL SHAFT INFECTIOUS PSEUDOARTHROSIS ..........................................................................................................................................................................................................................268

E-Poster 32:KNEE ARTHRODESIS WITH EXTERNAL FIXATION, AN ALTERNATIVE TREATMENT............................................................................................................................................................268

E-Poster 33:TWO DIFFERENT SIZE RINGS (200 AND 180) WERE USEFUL FOR THE MANAGEMENT OF THE DISTAL TIBIAL COMPLEX FRACTURE........................................269

E-Poster 34:TENSION BAND WIRING IN POSTERIOR PELVIC RING FRACTURES: REPORT OF TWO CASES.................................................................................................................................269

E-Poster 35:ACUTE SHORTENING AND GRADUAL LENGTHENING OF THE TIBIA OVER INTRAMEDULLARY NAIL COMBINED WITH CIRCULAR EXTERNAL.........................270

E-Poster 36:ANKLE WITH IRREVERSIBLE ARTICULAR SYMPTOMATIC DETERIORATION. MODELING ARTHROPLASTY AND JOINT DISTRACTION............................................270

E-Poster 37:DISTRACTION OSTEOGENESIS IN A MURINE MODEL THE PROCESS AND EXPERIMENTAL PRECAUTION.......................................................................................................271

E-Poster 38:TIBIAL PLATEAU FRACTURES BY MEANS OF EXTERNAL FIXATION. OUR EXPERIENCE ...............................................................................................................................................272

E-Poster 39:TREATMENT OF CONQUASANT LOWER LEG FRACTURE AFTER BEING RUN OVER BY BUS.....................................................................................................................................272

E-Poster 40:CLOSURE OF SOFT TISSUE DEFECT IN OPEN FRACTURES OF TIBIA WITH TAYLOR SPATIAL FRAME A SUCCESSFUL STRATEGY..................................................273

E-Poster 41:COMBINATION OF SHELF ARTHROPLASTY WITH ARTICULATED HIP DISTRACTION IN PATIENTS WITH PERTHES DISEASE ...............................................................273

E-Poster 42:TREATMENT OF AN INTRARTICULAR FRACTURE OF PROXIMAL PHALANX OF THE INDEX FINGER WITH AN EXTERNAL FIXATION MINI PENNING.............274

E-Poster 43:CORRECTION OF COMPLEX FOOT DEFORMITIES OF PEV WITH ILIZAROV EXTERNAL FIXATOR IN PATIENTS ABOVE 10 YEARS OF AGE...................................274

E-Poster 44:CUBITAL PSEUDOARTHROSIS TREATED WITH EXTERNAL FIXATION........................................................................................................................................................................................275

E-Poster 45:CASE REPORT: OPEN DISLOCATION OF KNEE ASSOCIATED WITH THROMBOSIS OF THE POPLITEAL ARTERY. INITIAL MANAGEMENT......................................275

E-Poster 46:LOWER LIMB LENGTHENING BY ILIZAROV TECHNIQUE AND LENGTHENIG OVER NAIL. A COMPARATIVE STUDY......................................................................................276

E-Poster 47:SECONDARY BONE GRAFT IMPLANTATION IN GRADE IIIB TIBIAL SHAFT FRACTURE...................................................................................................................................................276

E-Poster 48:HIP ARTHRODIASTASIS: AN ALTERNATIVE FOR SEVERE COXALGIA ON YOUNG PATIENT ...........................................................................................................................................277

E-Poster 49:ADJUSTABLE BRACING TECHNIQUE FOR TREATMENT OF ELBOW CONTRACTURES DURING UPPER EXTREMITY LENGTHENING ................................................277

E-Poster 50:HOW EXTERNAL FIXATION AFFECTS IN THE QUALITY OF LIFE OF THE PATIENTS ..........................................................................................................................................................278

E-Poster 51:INTRAMEDULLARY SKELETAL KINETIC DISTRACTOR (ISKD) FOR POSTTRAUMATIC LIMB LENGTH DISCREPANCY.................................................................................278

E-Poster 52:OLLIER MAFFUCCI DISEASE: EXTREME DEFORMITY OF THE LOWER LIMB WITH VASCULAR LESIONS. SURGICAL TREATMENT...................................................279

E-Poster 53:MANAGEMENT OF CLOSED TIBIAL PILON FRACTURES TYPE C WITH EXTERNAL FIXATOR HOFFMAN II AND PERCUTANEOUS OSTEOSYNTHESIS...........279

251

E-Poster 54:PROXIMAL FEMUR CORRECTION CORTICOTOMY WITH MONOLATERAL FIXATION IN CHILDREN WITH DEVELOPMENTAL HIP DYSPLASIA.............................280

E-Poster 55:EXTERNAL FIXATION IN THE TREATMENT OF FRACTURES OF THE DISTAL END OF RADIO TYPE C3 (AO) .....................................................................................................280

E-Poster 56:FIBULAR HEMIMELIA G-III OF COVENTRY-JOHNSON: RECONSTRUCTION PLANNING..................................................................................................................................................281

E-Poster 57:CONGENITAL SYNOSTOSIS OF THE KNEE: EARLY RESULTS OF LIMB RECONSTRUCTION SURGERY.................................................................................................................281

E-Poster 58:AUTHORS TECHNIQUE OF REDUCTION OF THE TYPE III SUPRACONDYLAR FRACTURES OF HUMERUS..........................................................................................................282

E-Poster 59:TREATMENT OF THE BRACHYMETATARSIA WITH EXTERNAL FIXATION BY CALLUS DISTRACTION ....................................................................................................................282

E-Poster 60:TSF ON ILIZAROV. CORRECTION OF SECONDARY DEFORMITIES BY A COMBINATION OF A HEXAPOD AND A LIZAROV RING FIXATOR......................................283

E-Poster 61:REPARATIVE REGENERATION FOR LENGTHENING OF FRAGMENTAL ENDS WITH OSTEOPOROSES AT EXPERIMENTS .........................................................................283

E-Poster 62:PROGRESSIVE CORRECTION OF PERIARTICULAR TIBIAL RETRO-CURVATUN APPLYING PRINCIPLES OF ARTICULAR ALIGNMENT ANDORIENTATION AND MULTIPLANAR EXTERNAL FIXATION..................................................................................................................................................................................................................284

E-Poster 63:ANKLE FUSION STABILITY: A BIOMECHANICAL COMPARISON OF EXTERNAL FIXATION VERSUS INTERNAL FIXATION..........................................................................284

E-Poster 64:DISTAL OBLIQUE OSTEOTOMY (DTOO) FOR THE VARUS-TYPE OSTEOARTHRITIS OF THE ANKLE.......................................................................................................................285

E-Poster 65:THE CLINICAL RESULTS OF DISTAL TIBIAL OBLIQUE OSTEOTOMY TREATED FOR THE TRAUMATIC OSTEOARTHRITIS OF THE ANKLE JOINT ......................285

E-Poster 66:CORRECTION OF EQUINUS CONTRACTURE USING ILIZAROV APPARATUS WITHOUT HINGE SYSTEM (MATSUSHITA’S METHOD) ..................................................286

E-Poster 67:CLINICAL RESULTS OF DISTAL TBIAL OBILIQUE OSTEOTOMY (DTOO) TREATED FOR THE VALGUS TYPE OSTEOARTHRITIS OF THE ANKLE JOINT...........286

253

E-Poster 2:GOLD WITH FRAGRANCE: ROTATIONPLASTY WITH STATICINTERLOCKING INTRA-MEDULLARY NAIL AS FIXATION

Pant, Bhaskar, MD Davao Medical Center Penarada, Noelrex, MD

Davao Medial Center Philippines

Resume:

Rotationplasty remains a viable option in the management of tumors around the knee area. It provides a stable and functional extremity with a coordinated gait pattern similar to able bodied population. It also minimizes or at best, eliminates the possibility of reoperation and provides excellent control of local recurrences of the tumor.

Patients with Rotationplasty walk more efficiently than fusion or above-knee amputation. Longer residual limb is better and need for optimal long term function is vital. Post-Rotationplasty maturation of gait is cognitive rather than instinctive. It does not depend on progressive maturation of CNS. It must be learned. Role of physiotherapy and good prosthetics is vital. Availability and experience of rehabilitation services is very important.

The 6 cases of osteosarcoma of the lower extremity in adolescent patients admitted at the Department of Orthopedics in our center and underwent rotationplasty as the surgical treatment for their affectation analysed.

All patients with Osteosarcoma of tibia and femur underwent neoadjuvant chemotherapy post biopsy. Rotationplasty was done with Static Interlocking Intra-Medullary Nail as fixation. Patients had completed adjuvant chemotherapy and were fitted with long awaited prosthesis.

The golden surgery of Rotationplasty is added with fragrance of Static Interlocking IM Nail. Patient is back to his normal daily living and gaining confidence in sports activities.

E-Poster 1:CORRECTION OF COMPLEX ADULT FOOT DEFORMITIES WITHV-OSTEOTOMY AND EXTERNAL RING FIXATION

Polk, Matthew, MD Saint Joseph Hospital

1Rodríquez, Edgardo, MD; 2Bibbo, Christopher, MD1Chicago Foot and Ankle Deformity Correction Center;

2Marshfield Clinic United States

Aim and purpose of study:

Polio, recurrent clubfoot, trauma, burn contractures, neuromuscular disease, and iatrogenic conditions can lead to rigid complex foot deformities that require surgical intervention. The V-osteotomy in combination with a dynamic external ring fixator allows for multiplanar realignment and stabilization to help create a functional lower extremity.

Materials and methodology:

35 patients with complex foot deformities underwent a reconstructive surgical procedure utilizing V-osteotomy with application of external ring fixator. 17 patients had post-polio cavovarus deformity, 15 patients had a Charcot-Marie-Tooth varus deformity, and 3 patients had malalignment of a triple arthrodesis with rocker bottom foot. The V-osteotomy consists of a combination of an oblique osteotomy of the posterior calcaneus and anterior calcaneal-talar osteotomy which intersect one another at a 60-70 degree angle on the lower surface of the calcaneus. A dynamic external ring fixator was then applied and left in place for 12 weeks with distraction occurring 11 days post-operatively.

Discussion:

The V-osteotomy is a double bone cut that separates the forefoot from the hindfoot allowing for independent correction. The V-osteotomy combined with a dynamic external ring fixator allows for the gradual correction of complex deformities. The 35 patients who underwent the corrective procedures had a mean post-operative AOFAS score of 95. 32 of 35 patients maintained correction with stable plantigrade foot through follow-up period (mean follow-up 24 months). 3 patients required revision of initial procedure, 2 to correct hindfoot varus, and 1 for midfoot adduction.

Conclusion:

In combination with a dynamic external ring fixator, the V-osteotmy provides powerful correction for both the equinovarus and valgus-pronated foot types.

254

E-Poster 4:REPAIR OF SEGMENTAL BONE DEFECT BY ALLOGENEICMSCS-CERAMICS. STUDY IN ANIMAL MODEL

Meseguer, Luis, MD University Hospital V. Arrixaca/chief of section

1Bernabeu, Antonia, MD; 2Aznar, Salvador, MD; 3Meseguer, Clara, MD; 4Rodríguez, Francisco, MD; 5Vicente, Vicente, MD

1Tissue Culture Unit-University of Murcia; 2Imida;3University Hospital Morales Meseguer; 4University Hospital V. Arrixaca/rechercher; 5University of Murcia/prof

Spain

Introduction:

Repair of long bone segmental defect as a result of trauma, bone tumors, bone infections, etc. is one of the challenging in reconstructive orthopaedic surgery. Current treatment options include the use of different types of auto and allo bone grafts, but all of them have well-known disadvantages.

Methods:

A critical-sized segmental bone defect, 15 mm in length, was created in femora diaphysis of ten both sexs adult rabbits (weight: 3.5-4 K) and stabilized with mini-external fixator. The defect was filled with a hybrid construct (allogeneic mesenchymal stem cells loaded onto a glass-ceramic cylinder).

Results:

The CT analysis showed, at the end of this study, union at the proximal and distal host bone implant interfaces by mean a callus, while the specimen control (untrated defect) little or no bone was present. Histologically, lamellar bone ingrowth the pores of the implant and a callus occupied the length of the defect. Slight reactiva adenitis in paraaortic ganglia was observed. Inespecific fibrous tissue was observed at the control defects.

Discussion & conclusions:

The inductive effect of GC on MSCs differentiation into osteoblast could to favour the fast bone defect healing, so, this hybrid construct based on A-MSCs-GC could be considered a adecuate material for enhanced the repair a critical-sized bone defect in rabbit without evident adverse immune response.

E-Poster 3:ENDER NAILING FOR FEMORAL SHAFT FRACTURE IN PEDIATRICS

Pant, Bhaskar, MD Davao Medical Center Reyes, Esperidion, MD

Davao Medical Center Philippines

Resume:

Femoral shaft fractures are a common and temporarily disabling injury in children. The age distribution is bimodal, with peaks in the younger than 5 years and mid-teenage groups. This distribution is attributed to the relative weakness of woven bone in the young child and the increased incidence of high energy trauma in teenage children.

Age, fracture pattern, fracture location, soft-tissue injury, the presence of other fractures, physician and family preference, and the social situation all affect the treatment of a child with a femoral shaft fracture. Treatment modalities include the Pavlik harness, traction, immediate spica casting, traction followed by spica casting, external fixation, plating, flexible nailing, and intramedullary nailing.

Flexible Intramedullary Nailing seems to be a safe and effective method of treatment of femoral fractures for patients between 6 and 11 years of age.

The cases of pediatrics femoral shaft fractures managed by Ender Nailing in our institution have been analysed. Except for one case of implant failure in series of 18 cases, all healed well. The broken implant was removed and the fracture was managed with IM Nailing SI with entry through trochanteric tip.

Elastic nailing can be used in 11-year-old to skeletally mature age group with caution, particularly if the fracture is a length stable transverse fracture in a relatively small patient in this age group.

Skeletally mature adolescents are treated with solid antegrade or retrograde interlocking nails.

255

E-Poster 6:APLICATION OF COMPRESSION-DISTRACTION EXTERNALFIXATOR TYPE MITKOVIC IN TREATMENT OF NONUNION AFTEROPEN TIBIA

Stojiljkovic, Predtag, MD Clinic for Orthopaedic Surgery and Traumatology, Clinical

Center Nis, Serbia Golubovic, Zoran, MD; Micic, Ivan, MD; Karalejic, Sasa,

MD; Golubovic, Ivan, MD; Mladenovic, Marko, MD Clinic for Orthopaedic Surgery and Traumatology, Clinical

Center Nis, Serbia Serbia

Resume:

The open fracture of tibia shaft is one of the most common open fractures. Contamination of the fracture and devitalization of the soft-tissue envelope increase the risk of infection and nonunion.We report a two cases of aseptic nonunion after open tibial fracture treated with compression-distraction external fixator type Mitkovic.

Bouth patients (tirty-five and forty years old) with open tibial fracture (gradus II and grdus III A) were primary treated with external fixation without union in eight mounths. In bouth patients after osteotomy of fibula we placed a compression-distraction external fixator type Mitkovic and starting with compression and distraction in fracture focus on five days. We recorded satisfactory fracture healing in bouth patients aftre four mounths.

The use of compression-distraction external fixator type Mitkovic may be an effective method in nonunions of the tibia.

E-Poster 5:TREATMENT THE AVULSION FRACTURES OF THE DISTAL TIBIA EPIPHYSIS AT CHILDREN

Kuksov, Vitaly, MD Pirogov Clinical City Hospital Russian Federation

Resume:

Category of high-gravity intra-articular injuries. Thus, the teenage zones are always involving in pathological process. These comes acute instability of an ankle-anatomical and functional.

Purpose:

To find adequate methods of treatment for elimination acute instability ankle joint.

Materials & methods:

At clinical practice always were applying Salter a. Harris classification. According to this classification avulsion fractures of the distal tibia epiphysis with fragment displacement are concerning to 3-4th types. Surgical treatment was providing at 117 patients. The boys were 90, the girls 27. The age was from 10 till 14 years old. At X-ray examination were founding intra-articular injuries: separation of the internal part of the distal tibia epiphysis -at 100 patients; external -at 17. Combined injuries were taking place: fractures of distal epiphysis of both tibias -at 39, foot subluxation -at 21 patients. We are consider, that the adequate treatment is the surgical treatment at early periods (at first 3 days after trauma). Surgical treatment was providing at such way-required removal of the haematoma, ideal comparison of the fragments and internal fixation it’s by 2-3 Kirshner wires. At foot subluxation were reconstructing the full congruence articular surfaces of the ankle. Plaster was putting from ends of the foot fingers till proximal metaepiphysis tibia. The sutures were taking away on 10th day, then - the round bandage from polyurethanes at the terms of 2 months. The wires were extracting through 2, 5-3 months. To all patients with acute ankle injuries were providing at full volume medical and sport rehabilitation.

Results:

The far distant results were examined at all 117 patients in terms from 2 till 10 years after provided surgical treatment. Anatomic indices at all observed are excellent -true union of the fragments, full congruence articular surfaces, acceleration synostosis of the distal tibia epiphysis. There is a full volume of the moving at the ankle.

Conclusions:

The adequate treatment at children with avulsion fractures of the distal tibia epiphysis must be only early surgical treatment- Percutaneous osteosynthesis. The excellent anatomic and functional indexes, favorable sport prognosis are the evidence of it.

256

E-Poster 8:TREATMENT FOR NONINFECTIOUS NONUNION OF TUBULARFRACTURES WITH MONOFOCAL COMPRESSION-DISTRACTIONTECHNIQUE

Teng, Xing, MD Jishuitan Hospital, Beijing Huang, Lei, MD; Yang, Shengsong, MD; Zhao, Gang, MD;

Wang, Manyi, MD Jishuitan Hospital, Beijing China

Aim and purpose of the study:

Treating noninfectious nonunion of tubular bone fractures with monofocal compression-distraction-compression technique without grafting.

Material and methodology:

5 noninfectious nonunions (4 femurs and 1 tibiofibule) were stabilized with external fixators with distraction device. Nonunions were compressed for 2 weeks, followed by distraction with 1 mm per day divided by 4 times until 10-14 mm separation was available. After 2 weeks at the maximal distraction, shortening with the same speed and rhythm was performed until a second compression. Then the nonunion site was compressed till union if osteogenic activity was present radiographically. One or two more compression-distraction cycles (so-called “ccordion technique”) were needed with poor osteogenic response in X ray until union. Pin-tract infection and loosening happened in a tibiofibular nonunion and led to malapposition. Varus and recurvatum deformity was present in a femal nonunion at the time of the 2nd compression. No other complications were noticed except pin tract problems. After corresponding treatment, all five nonunions healed with average healing time of 7.6 months (6-10 months). No refractures were found with average following-up of 5.8 months (1-10 months) after fixator removal.

Discussion:

Necrosis and inflammation led by compression will increase osteogenic activity. Tension stress caused by gradual distraction to living fibril tissue and fibrocartilage will stimulate bone regeneration. Consecutive compression-distraction-compression works with combination of such two different kinds of mechanical principles. This technique is indicated to those without obvious leg length discrepancy, with good contact area and optimal configuration for efficient compression.

Conclusions:

Noninfectious nonunions of tulular bone fractures can be treated successfully with monofocal compression-distraction-compression technique. By this technique we can decrease hemorrhage and soft tissue stripping during operation, as well as avoid grafting.

E-Poster 7:EXTERNAL FIXATION IN PERIPROSTHETIC TIBIAL FRACTURE

Soria Villegas, Laura, MD Hospital de Sant Pau, Barcelona Gómez Masdeu, Mireia, MD; González Rodríguez, José

Carlos, MD; Natera Cisneros, Luis, MD; Álvarez Gómez, Carlos, MD Hospital de Sant Pau, Barcelona Spain

Resume:

The incidence of periprosthetic tibial fractures associated with a TKA is 0,1-0,4%; however, they are about to become an emerging fracture due to the increase of total knee replacements, longevity of patients and improvement of the implant survival. There is no consensus on the treatment of such fractures. The authors report a case of a periprosthetic tibial fracture treated with external fixation, although some authors claim they should be avoided.

Methods:

82 year old woman with a revision TKA diagnosed of open tibia fracture IIIB distal to the tibial stem. The patient had skin grafts on the affected knee 2 years before, 6 months before had a fibula fracture treated with osteosynthesis which had to be removed because of a MRSA infection with a 20 degrees valgus sequelae as a result of fibula shortening.

Results:

As conventional monolateral frame was not appropriate owing to the proximity of tibial stem, the elected treatment applied at the emergency service was a circular external frame. Partial to total bearing was allowed two days after the surgery. Soft tissues healed properly and the circular frame allowed an easy access to them. Bone formation and proper alignment was checked every 15 days. 8 months later the frame was removed with bone consolidation achieved and no need of further treatment or bone graft. The patient walks with crutches as she previously did.

Conclusions:

Although external fixation may seem inadequate in periprosthetic tibial fractures associated with a TKA due to the proximity of the pins to the prosthesis, it can be the most suitable choice in some cases like those with important damage of soft tissues and risk of infection.

257

E-Poster 10:THE USE OF STIMULAN KIT IN TREATING CHRONICOSTEOMYELITIS

Saghieh, Said, MD AUBMC Taha, Abdel Majid, MD; Masrouha, Karim, MD

AUBMC Lebanon

Resume:

Osteomyelitis is a pivotal issue to handle especially in the 3rd

World. Where availability of treatment is not that optimal. Also where risk factors are not controlled .In this paper We aimed at evaluating the use of Stimulan Kit (Calcium sulfate impregnated with antibiotics) in the treatment of patients with infected non-union. We reviewed the treatment of 12 patients with infected non-union at the American University of Beirut-Medical Center between March 2002 and May 2007. 11 out of 12 patients had culture positive long bone infections. All patients underwent surgical debridement followed by application of Stimulan-K bone graft substitute impregnated with antibiotics to fill in the gap resulting from debridement. Infection resolved in 12 out of 12 patients as witnessed by a drop in ESR, decreased pain at the site of infection and resolution of draining sinuses. Union was achieved in all patients as documented by follow-up radiographs. All our 12 patients were interviewed using the SF-36 health survey to capture valid information about functional health and well being from the patient`s point of view. The use of antibiotic impregnated bone graft substitute was effective in treating infected non-union of bone and achieving union in all the patients of the study. We recommend the use of porous pieces of Calcium sulfate impregnated with antibiotics (SK) as a new system for drug delivery in the treatment of chronic Osteomyelitis 100% success rate (12 out of 12). Because of its re-absorbability and osteoconductive properties, it promoted bone growth and subsequently bone union. It provided a matrix to deliver good concentrations of antibiotics locally and thus better eradication of infection keeping out all the systemic harmful effects of systemic toxicity of antibiotics.

E-Poster 9:CASE REPORT: ARTHRODESIS AFTER PSEUDOARTHROSIS IN ANKLE FRACTURE IN A DIABETIC PATIENT

Gómez Masdeu, Mireia, MD Hospital de la Santa Creu i Sant Pau. Universitat

Autònoma de Barcelona Soria Villegas, Laura, MD; Moya Gómez, Esther, MD;

Natera Cisneros, Luis Gerardo, MD; Álvarez Gómez, Carlos, MD; Buezo Ribero, Óscar, MD

Hospital de la Santa Creu i Sant Pau. Universitat Autònoma de Barcelona

Spain

Introduction:

Diabetic patients have a higher mortality and infection rate, skin damage and malunion than general population after bone fractures. In the case of ankle fractures, malunion or infection could require an arthrodesis.

Material and methods:

We report the case of a 60 years old woman with poorly controlled insulinodepenent diabetes with cronic renal failure associated who presented a medial and lateral malleolus fracture after entorses. It was treated with open reduction and internal fixation. In the postoperative period showed an anterior tibial-talus subluxation which was reduced after a new surgery. 4 months after, it showed another asymptomatic anterior subluxation which was treated with the withdrawal of the osteosynthesis. 11 months after the first surgery, the patient suffered a septic arthritis by Pseudomona aeruginosa treated with a cleansing in the operating room and a Gentamicin impregnated string of beads in a first stage, the second stage consisted in a tibiotalocalcaneal arthrodesis. 2 months after the arthrodesis, the patient shows a Staphyloccus epidermidis septic arthritis wich required the screws withdrawal, a debridement and a Gentamicin impregnated string of beads. When we evaluated the patient, she had a tibiotalocalcaneal arthrodesis failed, an absence of distal tibia and talus in the radiological study and the presence of Gentamicin beads. We decided to use a circular external fixation Ilizarov type to achieve the arthrodesis.

Results:One month after the surgery, the patient had no inflammatory signs, the analytical parameters were correct, the arthrodesis was achieved without malunion signs.

Conclusion:

Postoperative complications in diabetic patients are closely related to the degree of vasculopathy and neuropathy injury and glycemic control among other factors, that is why we need a preoperative evaluation of these parameters. In many of these patients, the arthrodesis is a rescue therapy although some authors suggest it as the initial treatment due to the high rate of complications.

258

E-Poster 12:UNUSUAL WINDSWEPT DEFORMITY IN A GIRL WITH HYPOPHOSPHATEMIC BONE DISEASE. CASE REPORT

Colak, Mehmet, MD University of Mersin Eskandari, Metin Manouchehr, MD

University of Mersin Turkey

Aim:

Hypophosphatemic bone disease (HBD) usually causes limb deformities. These can be either as long bowings or acute angulations less frequently. We represent a patient with HBD who had an unusual windswept deformity of lower extremities.

Case:

Thirteen years old girl admitted to our department with complaint of lower limb deformities. She had a history of right femoral varus osteotomy fixed with monolateral external fixator 3 years ago. On physical examination she had a short stature; bilateral femoral bowing marked on right side, right tibia valga and left tibia vara (Figure-1). After serum and urine analyses she received a diagnosis of autosomal inherited HBD and vitamin D treatment was initiated. Orthopaedic management included staged multi-level osteomies and intramedullary fixation of both femora, varus osteotomy of right tibia with plate fixation and acute valgization osteotomy of left tibia with external fixator guidance. Last control was done after 18 months of last surgery when the patient reached 16 years old. Both lower extremities had an acceptable alignment with full range of motion (Figure-2).

Discussion:

Slight medial bowing of femur may contribute to valgus deformity in genu valgum. When indicated a varus osteotomy is performed in supracondylar region. Our patient had an unusual anterolateral femoral bowing with genu valgum and previous varus osteotomy worsened her deformity. Limb deformities caused by metabolic bone disease often require multi level osteotomies in late childhood and adolescents. We performed osteotomies in three level for left (genu valgum) and two level for right (genu varum) femur which were stabilized by intramedullary nailing. With correction of accompanying tibia deformities satisfactory mechanical axis of both sides were achieved.

Conclusion:

Limb deformities in patients with metabolic bone disease needs further attention during preoperative planning. As presented in this report unusual combinations may exist and standard procedures may worsen the deformity anyway unsuitable to philosophy of deformity correction.

E-Poster 11:OPEN TIBIAL SHAFT FRACTURES TREATED BY THE UNILATERAL EXTERNAL FIXATION

Milenkovic, Sasa, MD University Orthopaedic & Traumatology Clinic Nis Mitkovic, Milorad, MD; Vidic, Goran, MD

University Orthopaedic & Traumatology Clinic Nis Serbia

Introduction:

Tibial shaft fractures are one of the most common shaft fractures of long bones. Severe open tibial fractures are the result of high energy injury. The external fixation of the open tibial shaft fractures with external fixator is a simple and effective method for everyday traumatology praxis. The fixation is unilateral with convergent pins orientation, which allows three-dimensional stability of the fixed bone and there is also possibility for compression and distraction. Pins are placed without any guidance.

Material & methods:

The retrospective study shows the results of treating 59 patients with open tibial shaft fractures. The fractures were fixed with Mitkovic’s external fixators, types M 20, M 20 CD, M 20 CD-V. The follow-up was 16- 24 months postinjury.

Results:

The result of external fixation in 59 patients with open (Gustilo type IIIA,B) tibial shaft fractures, 30 (61,22%) men and 19 (38,77%) women, average age 43,92 years old (16-84), are presented in this work. The results applied external fixation method are excellent and good. Union rate was 83,68%. Pin tract infection appeared in 4 (8,16%) patients. Nonunion rate was in 6 (12,24%) patients, of which 4 with opened fractures (two Gustilo type IIIA, AO 42 B3, two Gustilo type IIIB, AO 42A2,AO 42 B2) and 2 with the segment open fractures (Gustilo type IIIB, AO 42C2,AO 42C3). Compartment syndrome was observed in 1 (2,04%) patient with closed fracture. Malunion rate was in 2 (4,08%).

Discusion:

The most common methods used in treating tibial shaft fractures are intramedullary nail, conventional, AO compression plates and external fixator. Application of external fixator enables an almost perfect control of the fracture, owing to a possibility of intraoperative and postoperative reduction of the fracture. During the healing of the fracture treated with the external fixation method there is a possibility of adapting biomechanical condition of healing-dynamization of the external fixator.

Conclusion:

External fixation of the open tibial shaft fractures is a simple and effective method that enables the safe healing of the fractures, early mobilization of a patients, early weight-bearing, as well as early rehabilitation.

259

E-Poster 14:TREATMENT OF CLOSED TIBIAL SHAFT FRACTURES BYEXTERNAL FIXATION

Mladenovic, Marko, MD Clinic of Orthopedics and Traumatology of the Clinical

Center Nis Stojiljkovic, Predrag, MD; Mladenovic, Desimir, MD;

Karalejic, Sasa, MD; Micic, Ivan, MD; Micic, Nevenka, MD Clinic of Orthopedics and Traumatology of the Clinical

Center Nis Serbia

Resume:

Closed tibial shaft fractures are usually formed under the influence of the strong trauma that severely damages all structures of the lower leg. They most frequently occur as a result of traffic accidents or fall from the heights. The fracture of tibia shaft is one of the most common fracture of long bones.

Within the period from 1.1.2008. to 31.12.2009 at the Orthopaedics and Traumatology Clinic, Clinical Center Nis, 49 patients with closed tibial shaft fractures were treated. Within the analyzed group there were 37 (75.5%) males and 12 (24.5%) females. In the analyzed group, a dominant etiological factor of sustaining an injury was traffic traumatism reported in 32 (65.3%) patients. All the patients were treated by Mitkovic external fixator, with convergent orientation of pins. Closed repositon of the fragment is performed in 41 (83.6%) and open reposition of the fragment is performed by small incision in 8 (16.4%).

Excellent result in treatment of closed tibial shaft fractures with external fixation were achieved in 36 (73.6%) patients.The healing time of the fractures in that group was 3.5 months. With 3 (6.12%) patients pseudoarthrosis was formed.

External fixation by the use of Mitkovic external fixation can be method of choose in the treatment of unstable and comminutive closed tibial fractures, providing dynamic and balanced biomehanical conditions for fracture healing.

E-Poster 13:BONE PLASTIC EXPERIENCE BY THE PATIENTS WITH THETRAUMATIC OSTEOMALITIS

Rushay, Anatoliy, MD R&d Institute of Traumatology and Orthopedy of Donetsk

State Medical University Named After M. Gorky Ukraine

Actuality:

Replacement of the bone defects occurs in the conditions of the purulent infection, neurothrophical changes that makes this problem difficult.

Purpose:

The improvement of the results of traumatic osteomyelitis patients bone plastic.

Aims:

To reveal requirements to plastic intervention; to specify the optimal way of a bone plastic.

Materials and methods:

In work experience of treatment of 470 patients from 2000 for 2010 is presented.

Results and discussion:

The major factors defining volume of a resection and a way of the kind bone plastic were: the activity of process; degree of defeat of a bone; a condition of the reparative processes; localisation of the process and a condition of surrounding fabrics.

In the presence of the consolidation at defeat less than 1/3 diameters of bone the basic maintenance of intervention was the partial resection of the injured parts. Presence of bone cavities or absence of the bony union demanded their autoplastyc or a plastic by allograft. The features of surgical tactics were the following. A plastic was made in 2 stages. Intervention was maximum atraumatical, it was made through the small cuts. Fragments were fixed by external devices of the spoke rod type.

At a further bone plastic by Ilizarovu we received a high-functional bone, the renew function of the extrimities was restored reliably. If the defect was more than 5 sm the adaptable resection came to the end with a neutral osteosynthesis with the subsequent osteotomy by the technique offered by us and the replacement of the defects by Ilizarov.

Conclusions:

Essential factor defining volume of a resection and then the choice of way of bone plastic is degree of injury of a bone fabric by inflammatory process.

Plastic of the bone defects by Ilizarov is the most radical and reliable way at a traumatic osteomyelitis of long bones.

Performance of an optimal bone plastic has allowed to achieve good anatomo-functional results at 446 (94,9%) patients with a traumatic osteomyelitis.

260

E-Poster 16:TREATMENT OF COMMINUTED INTRA-ARTICULAR FRACTURES OFDISTAL RADIUS USING THE NOVEL EXTERNAL FIXATOR

Iwabu, Shohei, MD Keiyu Orthopaedic Hospital

1Kozo, Morita, MD; 2Norikazu, Ota, MD1Kawasaki Municipal Hospital; 2Shizuoka Red-Cross

Hospital Japan

Purpose:

Novel non-bridging fixtor was developed to use thin distal fixation pins, 1.8 mm or 2.0 mm in diameter, which were inserted to distal radial fragments in multi-directional fashion. The pins placed in multiple directions meant to keep the comminuted distal fragments. The objective is to assess the ability of the fixator to maintain fracture reduction when used to treat comminuted intra-articular distal radial fractures (AO: type C3).

Method:

The patients who had sustained a type C3 distal radial fracture, treated using the non-bridging fixator were included in the study. Radial inclination, palmar tilt, ulnar variance, intra-articular step-off and gap were measured from radiographs taken soon after fixation and at 3 months after surgery (bone union). Range of motion, grip strength, pain, complications and the Mayo wrist score modified by Cooney were recorded in the patients who had followed up more than 12 months.

Results:

30 patients were included in the study. There were 18 women and 12 men. The mean age was 53.6 years (range, 21-83 years). Five patients had remaining joint step-off (more than 2 mm) and seven patients had remaining joint gap (more than 2 mm) at bone union. In one patient, distal fragments displaced after fixation, which made gaps and a step-offs. The mean radial inclination was 24.9 degree at bone union with mean reduction loss of 1.2 degree from fixation to bone union. The mean palmar tilt was 12.3 degree at bone union with mean reduction loss of 1.5 degree. The mean ulnar valiance was plus 1.3 mm at bone union with mean reduction loss of 0.65 mm. The number of patients who followed up more than 12 months was 26. The mean flexion-extension arc is 137 degree (range, 125-175 degree), the mean supination-flexion arc is 165 degree (range, 140-180 degree) and the mean grip strength is 74% compared to uninjured site (range, 50-134%).

The Modified Mayo wrist score was excellent in 10 patients, good in 9, fair in 4 and poor in 1 patient.

Conclusion:

Using the novel non-bridging external fixator is a good treatment for restoring and maintaining the anatomy of displaced intra-articular distal radial fractures.

E-Poster 15:PIN TRACT INFECTION: OFTEN AND SERIOUS COMPLICATION

Christodoulou, Evangelos, MD Orthopaedic Department, General Hospital Karpenisi

1Saras, Emanouil, MD; 2Papageorgiou, Evanthia, MD; 1Chrysikopoulos, Theodoros, MD

1A’ Orthopaedic Department, “KAT” Hospital, Athens; 2General Hospital “Laiko”, Athens

Greece

Purpose:

The purpose of this study is to find the incidence of this complication during the treatment of fractures with external fixators (ring fixators, unilateral and hybrid fixators).

Method and material:

164 fractures (152 patients) were treated with en external fixator between April 2007 and February 2008. The mean age was 39.5 years old (range 21 to 66). We treated 64 fractures of the upper limb, 94 lower limb fractures and 6 pelvic fractures. The mean follow up was 5.6 months.

Results:

24 (14.6%) fractures were complicated with pin tract infection. The highest incidence was found at the unilateral fixator’s group (19%), followed closely of the hybrid fixator’s group (17%) and finally at the ring fixators group there was only a 6% incidence of pin tract infection. We also noticed a significant difference on the incidence according the anatomical site of application (4 out of 6 pelvic fractures were complicated with pin tract infection).

Discussion and conclusion:

There is a significant difference between the unilateral and the ring fixators. The anatomical site, the Intensive Care Unit admission and the patient’s cooperation seems to be also factors that influence the final incidence of pin tract infection.

261

E-Poster 18:EXTERNAL FIXATION IN CERVICAL FRACTURES

Mihaljevic, Slavisa, MD General and Teaching Hospital Celje/General Surgeon Cetina, Dimitrij, MD; Vlaovic, Miodrag, MD; Rusek,

Radoslav, MD General and Teaching Hospital Celje/General Surgeon Slovenia

Resume:

The authors discuss about the Halo jacket as an intermediate method between operative C II (dens) fracture stabilization and conservative treatment with collars or orthosis. Good experience and good results with Halo jacket treatment of C II dens are presented.

Results of 12 patients treated with Halo jacket from 2003-2008 are presented. The displacement was 3-7 mm and was always reduced on less than 2 mm. The procedure was done under imagine intensifier and stabilized by Halo jacket for 8-12 weeks.

In 8 patients the fracture was rentgenologically consolidated. One patient died because of bronchopneumonia (aged 78). Three patients with neurologic deficit fully recovered. Six patients are without subjective and objective consequences, 5 are with reduce range of motion, 3 with painful motion. Pseudoarthrosis was shown in 3 patients with reduced and painful motion. Recommended operative therapy for further stabilization was rejected by all three patients.

Treatment of C II dens fractures remains controversial. The authors recommend method for treatment of majority of odontoid displaced fracture. Open reduction and internal fixation is necessary in selected cases.

E-Poster 17:KNEE SEPTIC ARTHRITIS FROM STREPTOCOCCUSPLURANIMALIUM IN HUMANS. FIRST CASE REPORTED IN THELITERATURE

Tilkeridis, Konstantinos, MD Alexandroupolis University Hospital of Thrace, Sheffield

Teaching Hospitals Kotzamitelos, Dimitrios, MD; Ververidis, Athanasios, MD;

Hatzigiannakis, Athanasios, MD; Panagiotakopoulos, George, MD Alexandroupolis University Hospital of Thrace; University

of Patras Greece

Purpose:

We first report a case of an infection in humans by streptococcus pluranimalium, a new streptococcal species that has been isolated in the genital tract and tonsils of cattle, tonsils of a goat and a cat, and from the crop and the respiratory tract of canaries. According our knowledge there are a few reports in the literature reporting infections by this strain of streptococcus in animals, but never since now in humans.

Material:

A 57 years old farmer, fit and well, non-immunocompromised has been treated in our department, for a close tibial plateau fracture (Schatzker VI), with a circular external fixator. Postoperatively, i.v antibiotics-cefuroxime 1500 mg every 8 h was administrated for 24 hours. Radiological and clinical healing of the fracture achieved successfully within 11 weeks of the fracture. The frame removed and the patient was followed up as an outpatient. Six days after the removal of the frame, the patient turned up to the A&E department, systematically unwell, complaining for a swollen painful knee, and a discharging abscess in one of the proximal pin sites near by the joint line. Fluid samples from the abscess and the knee aspiration, obtained and revealed streptococcus pluranimalium in all samples. Debridement of the abscess and an arthroscopic wash out was performed twice, followed by i.v antibiotics according to the sensitivity test (Levofloxacin (500 mgx2) Ceftriaxone (2 grx2)) for six weeks, and p.o antibiotics (clarithromycin 500 mg every 12h and Levofloxacin 500 mg every 12) for another two weeks. Symptoms were settled and the patient is free of infection for the last 12 months.

We hypothesized that the bacterium was settled on the wires of the circular fixator and was inoculated in the patient during the removal of the frame. According our knowledge, it is the first case of infection in a human individual by this specific strain of streptococcus.

262

E-Poster 20:HUMERAL LENGTHENING AND DEFORMITY CORRECTION WITH THE MULTIAXIAL CORRECTION SYSTEM

Widmann, Roger, MD Hospital for Special Surgery Mclawhorn, Alexander, MD; Sherman, Seth, MD;

Blyakher, Arkady, MDHospital for Special Surgery United States

Background:

Limb lengthening for humeral length discrepancy is typically accomplished using a traditional monolateral external fixator frame or an Ilizarov-type device, which have distinct shortcomings for the correction of concomitant deformity and application to the upper extremity, respectively. A new monolateral frame, the multiaxial correction (MAC) system, provides advantages over other monolateral frames and Ilizarov-type devices for humeral lengthening and may achieve similar outcomes. The purpose of this study was to report on the use of the MAC system for limb lengthening in pediatric patients, each with humeral length discrepancy and deformity. Surgical technique for applying the frame to the humerus is described briefly.

Methods:

A retrospective review of all pediatric patients with humeral length discrepancy treated with the MAC system by one orthopedic surgeon at a major teaching hospital was performed. Clinical data, operative records and radiographs were reviewed for each patient.

Results:

A total of 3 humeri in 3 children were lengthened over a 3-year

1.9 years. Etiologies for their discrepancies were osteomyelitis and posttraumatic physeal arrest. Mean initial humeral length

deformities, which were corrected during treatment. Mean

were no major complications.

Conclusion:The clinical data and results of our 3-patient series are comparable to those achieved with alternative treatment systems. The MAC system is well suited to the correction of humeral length discrepancies and associated humeral deformities in children. Our experience suggests that the MAC system maintains the ease of application and relative comfort that other monolateral frames enjoy over Ilizarov-type systems without sacrificing the ability to correct for deformities, for which circular devices are traditionally employed.

Significance:

The MAC system may offer distinct advantages over traditional frames for treating humeral length discrepancy and deformity.

E-Poster 19:EXTERNAL FIXATION IN CENTRAL ACETABULAR FRACTURE DISLOCATIONS IN PATIENTS WITH MULTIPLE INJURIES

Mihaljevic, Slavisa, MD General and Teaching Hospital Celje/General Surgeon Cetina, Dimitrij, MD; Krusic, Dejan, MD; Vlaovic,

Miodrag, MD; Brilej, Drago, MD General and Teaching Hospital Celje Slovenia

Resume:

Despite the great number of publications advocating the operative treatment of dislocated acetabular fractures, conservative treatment still has an important role in selected cases. Central acetabular fracture dislocations are crippling injuries with poor prognosis. Grossly displaced fractures should be reduced as a surgical emergency. Occasionally a patient’s general state does not allow the major operative procedure required to fix the acetabulum. In such cases external fixator can replace prolonged pin traction.

The results of treatment of 6 multiple injured patients with central acetabular fracture dislocations treated with external fixation are presented. All were men with an average age of 46 years (22-65). Average Injury Severity Score (ISS) was 22 (17-34). All patients had type 62B fractures according to AO classification. Following closed reduction an external fixator by means of ligamentotaxis was applied.

On the follow up at least two years after the injury a modified grading system proposed by d’Aubigne and Postel was used to evaluate results. The results were excellent and good in 4 patients and poor in one patient. One patient died due to pulmonary embolism.

We feel it is important to look at conservative treatment of acetabular fractures as valuable method for highly comminuted central acetabular fracture dislocations in multiple injured patients. We believe that external fixation is superior to skeletal traction in initial phase of treatment in ICU and can lead to good long-term results in selected cases.

263

E-Poster 22:EXTERNAL FIXATEUR IN POSTTRAUMATIC OSTEITIS AND SEPTIC NON-UNION

Cetina, Dimitrij, MD General and Teaching Hospital Celje/General Surgeon Mihaljevic, Slavisa, MD; Vlaovic, Miodrag, MD; Rusek,

Radoslav, MD General and Teaching Hospital Celje Slovenia

Resume:

Osteitis as a result of bone fracture can be found on each trauma department. Incidence varies from 1.1-16% for closed fracture to 7.2-20% for open fracture.

Osteitis demands a thorough surgical treatment: implant removal, sequestrectomy, fracture stabilization, full thickness skin coverage, antibiotic therapy. Stabilization of fracture has to be achieved for the purpose of fracture healing and iradication of infection. Stabilization can be achieved also by a means of using of external fixateur. External fixateur must have low complication rate, it has to achieve enough stability, it must be easy to apply and it has to be multipurposeal.

On Trauma Dept. Celje, Slovenia, the number of osteitis in years 1974-2009 is 2.1% for for all osteosynthesis including closed and open fractures. If we expose only crural fracture which are with osteitis most loaded fractures, the rate was 7.2%.

Osteitis treatment is long and hard work with long term good results and restitution. The invalidity is high (only 25% was healed without invalidity). Half of patients were treated 8-12 months, others more. Average age of patient was 40. The costs were extremely high.

E-Poster 21:10.5-YEAR-OLD BOY WITH OPEN TIBIAL SHAFT FRACTURE AND DEFECT OF TIBIA TREATED WITH SEGMENT BONE TRANSPORT

Vindisar, Franci, MD General and Teaching Hospital Celje/General Surgeon Mihaljevic, Slavisa, MD; Buhanec, Bozidar, MD

General and Teaching Hospital Celje Slovenia

Resume:

A 10.5-year-old boy was injured in October 2008 in a traffic accident as a co-driver on a motor bicycle that crashed into a car. The boy sustained an isolated injury of his right cruris -an open fracture stage III B according to Gustillo-Andersen classification, with a 7-centimetre-long defect of tibia in the middle third, paresis of peroneal nerve and occlusion of anterior tibial artery. We performed a radical necrectomy, fasciotomy of all compartments, application of thick skin transplant on defects and stabilisation with an external fixator of Ortofix type. After 4 weeks, osteotomy on proximal part was performed and we replaced the fixator with a type for segmental transport. 6 weeks after the injury, the transport started, with transport for 1 millimetre per day. After 2 months, the segmented part reached the distal part of tibia and we replaced the fixator with STAR 90 and at the same time correction of 10 degrees of valgus deformation was done. In April 2004 a tomography was done and both parts of transported segment were bone healed, but we put on a bellow knee cast for an additional month. 5 days after removing the cast, the boy sustained a refracture on a lower part of transported segment. The next day we performed a plate osteosinthesis with autologic bone transplant.

After one year we have a 1-centimetre-shorter leg, 4 degrees of valgus deformity, 6 degrees of external rotation deformity, full range of motion in ankle and knee joint and a full weight bearing.

264

E-Poster 24:ROLE OF A MULTIMODAL ANAESTHESIA IN PROPHYLAXIS OFPURULENT-NECROTIC COMPLICATIONS FOR PATIENTS WITHOPEN TIBIAL FRACTURES

Rushay, Anatoliy, MD R&d Institute of Traumatology and Orthopedy of Donetsk

State Medical University Named After M. Gorky Ukraine

Background:

The treatment of open tibial fractures is accompanied by the development of purulent-necrotic complications. Pain in the early period leads to violation of the microcirculation in the injured extremity and the pathologic metabolic disease and immunity. Treatment of a pain in the postoperative period contributes in prophylaxis or decrease of a degree of manifestation of pathological displays.

Methods:

Under our observation there are 24 patients with the open tibial fractures. In pre-operative period the patients gaine Dinastat (Parekoksib), Promedolum. The surgical intervention is carried out with application spinal anaesthesia by solution bupivacaine. In the postoperative period Dinastat and Promedolum are syringed again. The efficacy of an anaesthesia is determined by evaluation of the patients (visually-analogue scale) and by dynamics of the reovasography of extremities, the dose of narcotics is taken into account.

Results:

The quality of an anaesthesia is rated by the patients by 2,2.

data reovasography is evidence of the small violation of venous drainage in the injured extremity. The quantity of Promedolum is

complications are marked only for 2 patients from the whole amount of 24.

Conclusion.

Thus, multimodal anaesthesia for patients with the open tibial fractures is rated by the patients as adequate. The quantity of Promedolum is managed to be lowered. The low level of complications shows the high efficacy of multimodal anaesthesia for patients with the open tibial fractures.

E-Poster 23:EXTERNAL FIXATOR IN PELVIC FRACTURES

Cetina, Dimitrij, MD General and Teaching Hospital Celje/General Surgeon Mihaljevic, Slavisa, MD; Vlaovic, Miodrag, MD; Brilej,

Drago, MD General and Teaching Hospital Celje Slovenia

Resume:

The unstable pelvis is one of the trauma treatment priorities. In the acute phase an external skeletal fixation controls bleeding and stabilizes the patient. External fixation has also an important role in definitive treatment of disruption of pelvic ring by adding percutaneus internal fixation techniques, sometimes also in the acute phase and in polytrauma patient. In the majority of patients with unstable pelvic ring the haemodinamic stability and mobilization to upright position can be achieved with an external fixation. By adding minimally invasive methods of internal fixation in C type fracture, adequate stability to allow full mobilization can be achieved. Other major injuries have important influence on the method of stabilization and the outcome of the patient. In the different types of the fracture (A, B, C) we use follow tactics:

a) Single-phase treatmentb) Double-phase treatmentc) Stage treatment

In polytrauma patients the use of external fixation is rational, fast and effective. In 90% the blood lose is from cancelous bone and the stabilization provides effective results and the blood stop. Ventral fixation is most effective and allows solving problems in abdomen and other regions. Percotaneous fixation of sacroiliacal joint in the same act is effective and easy procedure in well-trained hands of traumatologists.

265

E-Poster 26:THUMB RECONSTRUCTION WITH USE OF TWO MINI FIXATORS INDIFFERENT LEVELS. A CASE REPORT

Roumeliotis, George, MD General Hospital of Kimi <george Papanikolaou> Ioannou, Markos, MD

General Hospital of Kimi Greece

Aim:

We present a rare case of thumb reconstruction with use of two mini fixators in different levels.

Case presentation:

We report a case of a 42 old male with a non functional right hand (amputation of all fingers in the past) and a amputation at the middle of the basic phalanx of his left thumb. The patient was treated immediately with an osteotomy at the basic phalanx and distraction osteogenesis via an mini external fixator and a second osteotomy-distraction osteogenesis at the 1st metacarpi with a second mini external fixator. Postoperative course was uneventful. External fixators were removed after the completion of the radiographic consolidation. The healing time was 14 weeks for the basic phalnx and 16 weeks for the 1st metacarpi. The lengthening achieved was 31 mm and the patient was able to pinch.

Discussion:

The reconstruction of posttraumatic thumb defects is a challenging. The value of a functioning thumb is immense, and its reconstruction is worthy of considerable effort. In this case we achieved to have a functional thumb with a very simple technique using 2 mini fixators in different levels, in order to achieve thumb lengthening.

E-Poster 25:TEMPORARY JOINT DISTRACTION WITH AN EXTERNAL FIXATORIN THE THERAPY OF SEPTIC ARTHRITIS OF FINGER JOINTS

Ioannou, Markos, MD General Hospital of Kimi Roumeliotis, George, MD

General Hospital of Kimi Greece

Aim:

Purpose of the study is to analyze the outcome of eight patients with septic arthritis of finger joints treated with surgery, antibiotics and joint distraction.

Materials and methods:

Eight patients with septic arthritis of finger joints were included in this study. All patients were primarily treated with surgery, antibiotics and joint distraction with a mini external fixator. The mini fixator was removed 3 weeks p.op. All patients were retrospectively analyzed. The median follow up of the 8 patients was 2,1 years (14 months-3 years).

Results:

Overall 6/8 of the patients had a good result regarding healing of infection and functional outcome. Cartilage damage was detected during surgery in 2 patients. Secondary arthrodesis was performed only in one patient.

Discussion:

Chondrolysis and destruction of the cartilage is the main complication of septic arthritis of the finger joints. Joint distraction aims to prevent the cartilage. In this study, patients without cartilage damage and treated with joint distraction had a good result.

Conclusion:

Septic arthritis of the finger joints should be immediately treated with surgey and antibiotics. In order to avoid cartilage damage joint distraction with a mini external fixator seems to be an efficient and reliable method. Once the cartilage is damaged, arthrodesis is indicated.

E-Poster 28:TREATMENT OF TYPE IIIB OPEN HUMERAL FRACTURE USING A FREE VASCULARIZED OSTEOSEPT CUTANEUS FIBULA GRAFT

Cabo Cabo, Javier, MD Hospital de Bellvitge Pedrero Elsuso, Salvador, MD; Moranas Barrero, José,

MD; Portabella Blavia, Federico, MD; Pérez Fernández, Albert, MD Hospital de Bellvitge Spain

Resume:

A vascularized fibula graft with skin flap is an effective treatment in patients presenting open humeral fractures with bone lost an in the need of skin coverage. If the patient is affected by an infectious process this should be treated and resolven first, the bone can be stabilized by external fixation.

69 yrs old female patient affected by a grade IIIB open fractura of the right humerus. She was initially treated with a Hoffman II osteotaxis. In this case, using a combine microvascularized fibula plasty with a skin fraft and externan fixation, in a patient affected by an grade IIIB open humeral fracture infected by pseudomonas aeruginosa and enterobacter cloacae.

By the tiume the patient was released from the hospital the flap was correctly integrated, good bone consolidation, and good range of movement.

E-Poster 27:RECONSTRUCTION OF POSTRAUMATIC TIBIAL LOSS OF 13 CENTIMETER BY MEANS OF DISTRACTION OSTEOGENESIS

Cabo Cabo, Javier, MD Hospital de Bellvitge Pedrero Elsuso, Salvador, MD; Moranas Barrero, José,

MD; Portabella Blavia, Federico, MD; Pérez Fernández, Albert, MD Hospital de Bellvitge Spain

Resume:

We present a case of massive bone postraumatic defect of the tibia treated by means of a procedure of distraction osteogenesis. The used methodology, the arisen complications, and the final result are shown.

Man of 27 years of age that undergoes bifocal fracture of left tibia and fibula opened IIIb of the classification of Gustilo. He was treated initially with cleaning of the wound, biplane external fixator and skin graft after granulation tissue appeared over exposed bone. The patient developed a polimicrobian infection and necrosis of the intermediate fragment that mesure 12 cm being a tibial bone defect of 13 cm. A proximal tibil corticotomy and a bone transport was done using a transportation external guide. At the end of the phase of transportation there was a skin necrosis over the transported segment with bone exposition that was managed with bone perforations, VAC therapy and laminar skin graft.

Distraction osteogenesis is a good technique for the treatment of massive postraumatic defects of the bone in the adult.

267

E-Poster 30:TIBIAL PILON FRACTURE: EXTERNAL FIXATION CHOICE

Argüelles Linares, Francisco, MD Hospital Clínico Universitario, Valencia Puig Abbs, Carlos, MD; Gil Albarova, Raúl, MD; Martín de

Arriba, Juan María, MD; Pérez del Valle, José Ramón, MD Centro de Recuperación y Rehabilitación de Levante Spain

Background:

Tibial pilon fractures are complex injuries to treat and final results are not always satisfactory for patient and surgeon.

External fixation can achieve good results in the management of these lesions, being a versatile and modifiable with the evolution of a fracture.

Methods:

37 year old patient that suffered a pilon open fracture Gustilo grade IIIb with fracture of the fibula and a contaminated medial side wound.

Initial treatment was performed with external fixator Xcaliber rocker type and screw plate fixation in the fibula, providing local antibiotic treatment with gentamicin beads.

After a good evolution of soft tissue injury without initial appearance of infectious complications, the Xcaliber ex fix was changed, two weeks after the initial surgery, for a hybrid external fixation system with Orthofix distal halo, achieving a better reduction and stabilization of the fracture.

Weight-bearing was allowed since the 2nd month after fracture.

External fixation was removed 4 months after implantation with complete fracture healing.

There were no relevant complications during the postoperative follow-up.

Results:

No wound complications after removal of the external fixator and full range of motion with fracture healing after 6 months.

Conclusions:

External fixation is useful in the treatment of tibial pilon fractures. Allows the initial stabilization of this type of fracture and can be the definitive treatment method. Good reduction of the fracture can be achieved using minimum approaches, reducing the added surgical injury to the skin. External fixation permits variations in the assembly and secondary reductions to achieve a satisfactory outcome.

E-Poster 29:DISTAL TIBIA INTRARTICULAR FRACTUREWITH INTRAMEDULLARY NAIL

Gil Albarova, Raúl, MD Centro de Recuperación y Rehabilitación de Levante Argüelles Linares, Francisco, MD1; Puig Abbs, Carlos,

MD2; Martín de Arriba, Juan María, MD2; Pérez del Valle, José Ramón, MD2

1Hospital Clínico Universitario, Valencia; 2Centro de Recuperación y Rehabilitación de Levante, Valencia

Spain

Background:

Tibial pilon fractures owing to their complex treatment and their important sequelae represent one of the most serious fractures of the lower limb. High rates of these are open fractures, particularly in the occupational accident field, fact that complicates even more the treatment.

Methods:

41 year old patient, operated on 10 years earlier of a right tibial shaft fracture with an intramedullary nail, presents a gustilo IIIB open tibial pilon fracture with the intramedullary nail bent 90 degrees at its end.

Nail extraction and stabilization with external fixator was performed allowing the assessment of soft tissue damage with skin necrosis in the medial aspect of the ankle.

8 weeks later an ankle arthrodesis was performed with an arthrodesis nail. No fracture healing was obtained after 11 months, with x-ray images showing osteolysis around the nail. Further surgery was performed to treat this aseptic pseudoarthrosis by replacing the nail for a larger one and providing cortico-cancellous autograft bone from the iliac crest. Radiographic healing was obtained 8 months after this second surgery.

Results:

Neither infectious complications nor skin necrosis was observed during the follow up after external fixator removal. Radiographic healing was achieved 20 months after the initial injury.

Conclusions:

External fixation provides a solution for the initial stabilization of these fractures and the management of soft tissue injury until definitive treatment, minimizing the risk of infectious complications. Intramedullary nail arthrodesis has been described to be successful for the definitive treatment of some complex intrarticular tibial pilon fractures.

268

E-Poster 32:KNEE ARTHRODESIS WITH EXTERNAL FIXATION, AN ALTERNATIVETREATMENT

Mateu Vicent, David, MD Hospital Universitario Mutua Terrassa Matamala Pérez, Alfredo, MD; Sabatés Mallorques,

Santiago, MD; Anglés Crespo, Francesc, MD; Torrent Gómez, Josep, MD; Cabré Serres, Josep Lluis, MD

Hospital Universitario Mutua Terrassa Spain

Introduction:

Knee arthrodesis is a still a good treatment when knee function can not be restored. There are several reasons like poor bone stock, extensor mechanism disruption, tumor or infection. Different methods like external fixation, compression plates or endomedulary nails have been reported.

Material and methods:

We have done a retrospective study of all knee arthrodesis practiced in our hospital since 1995 to 2008. We have revised 13 arthrodesis with external fixation of a total number of 42 arthrodesis. The average age was 60,23 years (range 17-82 y), there were 6 women and 7 men. The previous diagnosis for arthrodesis was 5 knee arthroplasty infection, 2 extensor mechanism disruption, 3 open supracondylar femur fractures, 1 haematogenous arthritis, 1 open patella fracture infection and 1 Ni allergie in a TKA. In 3 cases a monoloateral external fixator (Orthofix) was used and in 10 a quadrilateral external fixation (Hoffmann I & II).

Results:

The average time to achive the arthrodesis was 5,4 months (9-3,5 months) and the average limb shortening was 3,58 cm (7-2 cm). In all cases more than one surgery was needed with an average of 3,3 surgeries per patient since the indication of arthrodesis was made, however, all of them had previous surgeries not included in this study. In three of the 10 patients treated with quadrilateral external fixation the treatment had to be transformed to a monolateral due to pin loosening.

Discussion:

External fixation used to be a good treatment and it is still a good option even though to many complications have been described like pin problems or the great number of re-operations. There is also an important limb shortening after this technique. For these reasons we currently prefer another knee arthrodesis system like intramedullary nailing although a individually indication for each case is mandatory.

E-Poster 31:FEMORAL SHAFT INFECTIOUS PSEUDOARTHROSIS

Puig Abbs, Carlos, MD Centro de Recuperación y Rehabilitación de Levante

1 Gil Albarova, Raúl, MD; 2 Argüelles Linares, Francisco, MD; 1 Martín de Arriba, Juan María, MD; 1 Pérez del Valle, José Ramón, MD

1Centro de Recuperación y Rehabilitación de Levante; 2Hospital Clínico Universitario, Valencia

Spain

Background:

The nonunion is a dreaded complication in the treatment of fractures, especially if it is infectious. The infection rate after use of techniques in intramedullary nailing of femoral shaft fractures is about 1%, according to the revised series. External fixation is a useful alternative for the treatment and final resolution of these situations.

Methods:

Were treated two cases of infectious pseudarthrosis of the femur that had been previously synthesized with intramedullary nailing.

In both cases underwent removal of intramedullary nail, making culture (S. aureus), debridement, reaming and washing the canal. Monolateral external fixator (Orthofix) was placed with focus on compression, leaving intramedullary plates with gentamicin impregnated collagen as a reservoir (Callotan ®).

We proceeded to specific intravenous antibiotic therapy for 2 weeks. Radiographic controls were performed (RX simple and TAC) and analytical.

In both cases the external fixators were kept until the 16th

week of their implant, radiographic healing was assessed. No complications of relevance in the monitoring of both patients. After fracture healing external fixation was removed and patients underwent rehabilitation program. Both patients achieved full knee mobility. The shortening of the contralateral femur was compared to 1 and 1.3 cm.

Discussion:

External fixation is a less bloody than open surgery in this type of complication. Following the withdrawal of the previous fixation, allows for correction of misalignment and focus intraoperative compression under fluoroscopic control in a single surgical procedure. However, require a helpful and disciplined patient, in order to minimize the disadvantages inherent external fixation system (cleaning and care of external fixator) to get a good result.

Conclusion:

External fixation is presented as a useful option in the definitive treatment of infectious nonunion in shaft fractures initially treated with intramedullary nail.

269

E-Poster 34:TENSION BAND WIRING IN POSTERIOR PELVIC RING FRACTURES: REPORT OF TWO CASES

Colak, Mehmet, MD University of Mersin Ayan, Irfan, MD; Eskandari, Metin Manouchehr, MD

University of Mersin Turkey

Introduction:

Unstable pelvic fracture represents a severe injury associated with high mortality and morbidity. With the development of fixation techniques external fixators have been widely used especially in the acute treatment of pelvic ring fractures. Fixators alone are ineffective in the definitive treatment of both anterior and posterior instability. Previous studies have emphasized the importance of the fixation of posterior structures in pelvic ring disruptions. Surgical methods to stabilize unstable posterior pelvic ring include open or percutaneous iliosacral screw fixation, anterior plate fixation, dorsal plate or transiliac bar fixation. Although percutaneuous iliosacral screw fixation has been a popular procedure recently, this method carries some serious complications and has a long learning curve. Plate fixation provides sufficient stability together with low complication risk.

Patients and method:

Two patients with AO type C1.3 pelvic fractures were treated with posterior tension band wiring. Briefly, with the patients in prone position short vertical incisions were made just lateral to both posterior iliac wings. Closed reduction was done under the control of image intensifier. While maintaining reduction, we applied two parallel K wires between posterior iliac wings. And then we applied tension band around K wires with circlage wire in first and cable in second patient. Tensioning was done through a short separate midline incision. Anterior stability was achieved with plate fixation in one patient. Stability was checked and the wounds were closed. We started passive exercises in early postoperative period. Partial and full weight bearing was permitted in sixth week and third month respectively.

Results:

There were no wound problems. First postoperative control x-rays revealed 1 cm of vertical displacement in both and 1 cm of lateral displacement in one patient. No additional loss of reduction was seen until the last control on first year of each patient. Male patient with transforaminal sacral fracture had a fair result because of urogenital complications.

Conclusion:

Transiliac posterior tension band technique is an easy, safe, and cheap method for posterior pelvic fixation. Although we had only two cases, encouraging results regarding efficient stability throughout healing is achieved. Further biomechanical and clinical studies are needed before strict comments.

E-Poster 33:TWO DIFFERENT SIZE RINGS (200 AND 180) WERE USEFUL FORTHE MANAGEMENT OF THE DISTAL TIBIAL COMPLEX FRACTURE

Hiroyuki, Kaneko, MD Noguchi Hospital Japan

Purpose:

The distal tibial fracture is difficult to manage.

The Ilizarov external fixation system is useful in the management of the distal tibial fracture. But the reduction of the fracture fragments is sometimes difficult in the distal tibial complex facture. I will represent the usefulness of two different size rings for the reduction of fracture fragments.

Method:

A patient was 15 years-old boy. He had a distal tibial fracture of his right leg. His fracture was managed by the Ilizarov external fixator. Two proximal tibial full rings (180) and 2 foot half rings (200) were applied, and both rings were connected by the telescopic rods. His fracture area was distracted using the connecting telescopic rods. Most of all fracture fragments were reduced by the effect of the ligamentotaxis. Then, most of all fracture fragments were fixed to the distal tibial full ring (180) by Ilizarov smooth and olive wires. This process leaded the complex fracture to the simple one. The distal fragments group was reduced manually by the distal tibial ring in the X-ray image. Finally, Ilizarov olive wires were inserted for the accurate reduction. The weight bearing was recommended as soon as possible. 14 days after the operation, foot rings were removed, and the ROM exercise of his ankle was started. The Ilizarov fixator was removed in 100 days. The union of the fracture was obtained, and his ankle ROM was almost same. He enjoys his daily life. The superficial pin tract infection was seen as a minor complication, and it was solved by a sterilization and an oral antibiotics.

Discussion:

In the complex distal tibial fracture, the accurate reduction is not obtained with the distraction of the fracture area during the operation. And it is possible to reduce the fragments gradually, after the operation. A larger foot ring leads easily to the accurate reduction during the operation.

Conclusion:

This report suggests that two different size rings are seemed useful for the management of the distal tibial fracture.

270

E-Poster 36:ANKLE WITH IRREVERSIBLE ARTICULAR SYMPTOMATIC DETERIORATION. MODELING ARTHROPLASTY AND JOINT DISTRACTION

Autorino, Carlos María, MD Hospital Universitario Austral Raimondi, Nicolás, MD; Del Vecchio, Javier Jorge, MD;

Codesido, Mariano, MDHospital Universitario Austral Argentina

Aim and purpose of the study:

The prevalence of the articular degenerative disease of the tibio-peroneal-talar joint has been estimated as 10%.

The therapeutic options available for a patient with irreversible structural articular symptomatic deterioration of the ankle joint are varied.

Prosthetic arthroplasty and arthrodeses are considered as the “gold standard” indications in advanced stages of ankle articular deterioration. Surgeon and patient must agree on the impossibility of achieving the ideal results expected on a reconstructive articular surgery: the preservation of the mobility and the expectation of a definitive acceptable result in the long term. At the same time, the high costs and the prolonged learning curve must be considered as limitations in the access to the prosthetic arthroplasty.

The aim of this work is to present the experience observed using a combined reconstructive procedure for the treatment of the ankle articular degenerative disease.

Material and methodology:

Six patients with severe morphological and functional deterioration of the tibio-peroneal-talar joint have been treated with a combined reconstructive procedure, which consisted in the association of:

a) Modelling resection arthroplasty and interposition of a heat-treated adhesive hemostatic sealant.

b) Joint distraction (“functional arthodiastasis”) with an external fixator.

Four were male and two female. The age range was between 35 and 73 years old. There was no loss to follow-up. The patients were followed for five years in four cases and for three years in two cases.

The patient´s evaluation was performed according to the “AOFAS Clinical Rating system for ankle and hindfoot”.

Discussion:

The average of AOFAS score was 16 in the preoperative and 71 in the postoperative. All patient’s expressed their conformity with the procedure and the satisfaction of their pre-surgical expectation.

E-Poster 35:ACUTE SHORTENING AND GRADUAL LENGTHENING OF THETIBIA OVER INTRAMEDULLARY NAIL COMBINED WITH CIRCULAREXTERNAL

Erdem, Mehmet, MD Gaziosmanpasa University Sen, Cengiz, MD; Gunes, Taner, MD; Bostan, Bora, MD;

Asci, Murat, MDGaziosmanpasa University Turkey

Case report:

The present case reports a 27 years old male patient with pseudoarthrosis of distal 1/3 of tibia occurred after plate and screw fixation and describes the surgical treatment. There was two cm shortening preoperatively. During surgery six cm resection was performed through the pseudoarthrosis until the viable and bleeding bone was observed. Thereby eight cm shortening occurred. Preoperative planning was made; length and width of the intramedullary nail was determined. Intramedullary nailing of the tibia was performed. Distal locking screws was placed and eight cm of the nail was left above the entrance hole and under the skin. Percutaneous corticotomy was performed and circular external fixator was placed (Combined technique). Three and a half cm acute compression intraoperatively and 2x1 mm/day gradual compression postoperatively (started postoperative day one) was made across the resection site. Distraction from the proximal corticotomy site was started with a rate of 4x0,25 mm/day on postoperative day seven. Docking site was grafted with autologous bone graft on 18th day postoperatively. After the completion of eight cm lengthening, locking screws were placed through the nail at the proximal of the corticotomy and external fixator was removed. Fixator was removed at the end of three months. Fixator index was 11.25 day/cm and consolidation index was 33.75 day/cm.

This technique provides early docking, early removal of the external fixator without waiting for the consolidation of the distraction site leading to decrement of pin tract infection, prevention of malunion and malalignment. Patient comfort, rapid rehabilitation are the other advantages of this technique.

271

E-Poster 37:DISTRACTION OSTEOGENESIS IN A MURINE MODEL THEPROCESS AND EXPERIMENTAL PRECAUTION

Nozawa, Daisuke, MD Department of Orthopaedic Surgery, Tsukuba Central

Hospital1Ishii, Tomoo, MD; 1Amano, Kuniaki, MD; 2Kobayashi,

Kouzou, MD; 1Ochiai, Naoyuki, MD1Department of Orthopaedic Surgery, Graduate School

of Comprehensive Human Sciences, Univ. of Tsukuba; 2MedicalBranch, Academic Service Office for Comprehensive Human Sciences, Univ. of Tsukuba

Japan

Purpose:

To clarify a mechanism of distraction osteogenesis, mice model is very useful for using molecular biological technique, and some models had be reported. However, we experienced sometimes troubles such as fractures and deviation of fixator pins as the mouse’s bone is very thin and small. We reported a murine external fixator with new guide device for insertion of needles and setting the external fixator in the 4th ASAMI International. In this study, we show the process of distraction osteogenesis on x-ray pictures and experimental precaution on the murine model.

Materials and methods

Ring fixators were applied to tibia of adult male mice. Mice are fixed by new device, 30 G needles are inserted to tibia through slit of device, and fixed by cyanoacrylate glue. Then mice are removed from device, and osteotomy was made in the diaphysis of the tibia. After an application of the external fixator, there was a latency period of 7 days before distraction. Distraction was started at a rate of 0.25 mm every 12 h for 10 days. We evaluated an appropriate position for needle insertion in this external fixation system by CT (computed tomography) axial views.

Results and discussion:

At the end of the latency period, no calcified areas were visible in or near the osteotomy site. At the end of 10-day distraction, tiny calcified areas were visible at the end of the preexisting bone fragments. Twenty-eight days after the end of distraction, bone formation was apparent in the distraction gap. Fourty-two days after the end of distraction, the regenerated bone areas were fused. In CT observation, the proximal tibia locates at the anteromedial site of the ring, though the distal tibia locates at the center of the ring. When we do animal experiment using this model, we should insert needles considering the position of tibia.

Conclusion:

We have improved the external fixator and produced a new guide device for insertion of needles and setting the external fixator. The device is quite helpful in studying murine distraction osteogenesis.

In the present series and according to the short and mid-term evaluation, the following data has been documented: a) pain reduction, b) the preservation of a range of functional mobility appropriate for daily activities and c) the preservation of articular stability.

Conclusions:

There are objective arguments on favor of considering the described procedure as a valid alternative (either substitutive or previous) to arthrodeses and TAA.

Key words:

Ankle; Articular distraction; Artrodiastasis; Arthrosis.

272

E-Poster 39:TREATMENT OF CONQUASANT LOWER LEG FRACTURE AFTER BEING RUN OVER BY BUS

Kutlesic-Stojanovic, Katarina, MD University Orthopaedic and Traumatology Clinic of the

Clinical Centre of NisZoran Golubovic, MD; Danilo Stoiljkovic, MD; Bascarevic

Vera, MD; Ivan Golubovic, MD; Igor Kostic, MD; Predrag Stoiljkovic, Vladimir Jovanovic, MD

University Orthopaedic and Traumatology Clinic of the Clinical Centre of Nis

Serbia

Aim:

Conquasant fractures of the lower leg are considered the most severe fractures of the lower leg segment.

Methodology:

A seventy-three year old patient got the right lower leg conquasant fracture being run over by the rear wheel of a bus. Instantly, the patient was transferred to the Clinical Centre of Nis. After the clinical examination, it was explained to the patient that due to the great damage of all the structures of the lower leg segment, limb amputation may be considered as the outcome if the measures of treatment do not give good results. Upon the admission to the University Orthopaedic and Traumatology clinic of the Clinical Centre of Nis and after the brief resuscitation, the angiography of the lower leg blood vessels was performed. The spasm of the lower leg segment blood vessels was observed with the weakened but present foot vascularization. Instant primary treatment of the wound, which stretched from the foot to the knee joint with the soft tissues detached from the bone, was done. The fracture of the tibial diaphysis was stabilized by the Mitkovic type external fixator, with the convergent orientation of pins. The wound of the compound fracture was left open. Due to the great soft tissue damage caused by the mechanism of pressure and diabetic angiopathy which the patient had, the patient was sent for further treatment and hyperbaric oxygen therapy to the Special Orthopaedic Surgery Hospital “Banjica”, Beograd. After the repeated wound debridements, the external skeletal fixator was replaced by the Ilizarov Apparatus. During further treatment, the reconstruction of the soft tissue defects initiated by the compression at the fracture site was done. Eight months after the serious conquasant injury, occurred when the bus ran over the patient’s tibia, the fracture healed and the Ilizarov Apparatus was removed.

Discussion:

Primary wound treatment,external skeletal fixation and AT protection are considered the basic principles in treating conquasant lower leg fractures.

Conclusion:

After the treatment the patient walks well and has completely returned to her daily activities.

E-Poster 38:TIBIAL PLATEAU FRACTURES BY MEANS OF EXTERNAL FIXATION. OUR EXPERIENCE

Igado Insa, Pilar, MD Hospital Txagorritxu Alfonso Lerga, José Miguel, MD; Ruiz Sánchez, Anibal,

MD; Mendieta Axpe, Leyre, MD; Argoitia Ituarte, Ane, MDHospital Txagorritxu Spain

Introduction:

The tibial plateau fractures are serious injuries which affect a load joint. In their treatment, which nowadays is still controversial, we must try to recover the complete mobility and a good joint stability; this may be complex if there is a great affectation of soft parts.

Objetives:

To put forward our experience in the treatment of tibial plateau fractures by means of EF.

Twenty cases of high-energy tibial plateau fractures were monitored for a minimum of one year. These fractures were treated by means of EF for an average time of 20 weeks, with rehabilitation treatment and premature loading.

After the orthopaedic and rehabilitation treatments, an acceptable reduction was obtained by good clinical and radiological consolidation in most cases, as well as a functional acceptable result by minimal flexion of 90º. There were some complications in a TVP’s case and two pines infections.

The EF is a method with technical difficulty; the obtained information supports its use in the treatment of high-energy tibial plateau fractures due to its minor complications risk, early beginning of joint mobilization and minor surgical morbidity. In addition, it does not present differences with the ORIF as for the development of degenerative osteoarthritis, reason why we consider the EF a tool to bearing in mind for the treatment of high-energy tibial plateau fractures.

273

E-Poster 41:COMBINATION OF SHELF ARTHROPLASTY WITH ARTICULATED HIPDISTRACTION IN PATIENTS WITH PERTHES DISEASE

Senaran, Hakan, MD Selcuk University

1Inan, Muharrem, MD; 2Kalenderer, Onder, MD; 3Erkocak, Omer Faruk, MD; 3Tuncay, Ibrahim, MD

1Istanbul University; 2Ministyr of Health; 3SelcukUniversity

Turkey

Aim and purpose of the study:

Shelf arthroplasty and articulated hip distraction are two seperate techniques that can be choosen in treatment of Perthes disease. Shelf arthroplasty or labral support osteotomy, supplies good coverage to coxa manga, however hip spica shall be applied in the postoperative period. Articulated hip distraction releives the pressure over femoral head while preserving the motion of the hip joint. The aim of our study is to report the clinical and functional results of the combination of shelf arthroplasty and articulated hip distraction in patients with Perthes disease.

Material and methodology:

Nine male patients who had the diagnosis of Perthes disease had undergone the combined surgery. They were clinically followed until the fragmentation stage and the decision for surgery was given when the lateral migration of the femoral head was above 50%. The mean age and the mean time for follow up was 6.5 years and 3.2 years respectively. The patients were able to full weight bearing a few days after the operation, able to flex their hips at average of 70 degrees. The external fixator was remained at an average of 2 months. At the latest follow up, there were no differance in terms of flexion and extension of the hip joint compared with the contralateral normal hip. Abduction was 10 degrees less and there was 1.2 cm leg length discrepancy at the involved side. All patients had type 1 pin tract infection at the proximal pins and were treated by oral antibiotics. All patients but one were satisfied from the treatment.

Discussion:

Shelf arthroplasty came out with good coverage of the femoral head, however hip spica application to the patients at this age group causes caring problems, decreased life quality, cast complications and break up of the school. Combination of articulated hip distraction with the shelf osteotomy relieves many of these complications with good care of the pin tracts.

Conclusions:

Articulated hip distraction after shelf osteotomy in treatment of Perthes disease preserves hip motion, relieves many complications associated with spica application, and have good functional outcome.

E-Poster 40:CLOSURE OF SOFT TISSUE DEFECT IN OPEN FRACTURES OFTIBIA WITH TAYLOR SPATIAL FRAME A SUCCESSFUL STRATEGY

Lahoti, Om, MD Kings College Hospital Abhishetty, Naveen, MD

Kings College Hospital United Kingdom

Aim:

To explore the use of Taylor Spatial Frame to close soft tissue defects in Gustillo 3B open tibial fractures.

Materials and methodology:

We treated three cases of Gustillo 3 B open fractures of tibia and fibula between 2005 and 2010. There were two male and one female patient. Age ranged from 17 years to 52 years. All the cases had significant soft tissue injury and tibia was exposed. We applied two-ring Taylor Spatial frame construct and deformed the fracture site to produce concavity towards the soft tissue defect and approximated the skin edges to obtain full thickness cover over the tibia. After 7-10 days we initiated gradual correction of deformity to realign the limb using direct scheduler available on Taylor Spatial Frame web site. We have successfully closed the soft tissue defects in all three cases. The skin and soft tissue loss ranged from 5 cm x 3 cm to 10 cm x 5 cm. One case needed additional split skin graft to cover large raw area.

Discussion:

Method of closing soft tissue defects by deforming the fracture site has been described by Ilizarov but it is not very widely practiced because of difficulty in achieving limb alignment with hinges. Two-ring Taylor Spatial Frame with its web based software allows six-axis deformity correction with great accuracy. We used the direct scheduler utility to achieve anatomical correction. After application of TSF, we initially anatomically reduced the open fracture on table and made a note of readings on all six struts (reduced frame). Then we deformed the fracture to close the soft tissue defect and noted down the strut readings (deformed frame). After 7-10 day lag period we produced a prescription using Direct Scheduler Utility on the web site. We were able to achieve anatomical alignment of the limb in all three cases.

Conclusion:

We successfully used Taylor Spatial Frame to close the soft tissue defects in Gustillo 3B open tibial fractures using Direct Scheduler Utility software program.

274

E-Poster 43:CORRECTION OF COMPLEX FOOT DEFORMITIES OF PEV WITH ILIZAROV EXTERNAL FIXATOR IN PATIENTSABOVE 10 YEARS OF AGE

Senaran, Hakan, MD Selcuk University

1Erkocak, Omer Faruk, MD; 2Acar, Mehmet Ali, MD; 1Tuncay, Ibrahim, MD

1Selcuk University; 2Ministry of Health Turkey

Aim of the study:

Inappropriately treated feet with pesequinovarus (PEV) come up with complex deformities, rigit feet with pressure wounds. Correction of the complex feet deformities is impossible with soft tissue procedures after 5 years of age and requires osteotomies. Multiple tarsal osteotomies and gradual correction of the complex bony deformities with ilizarov external fixator is a surgical method in PEV sequela. Tha aim of our study is to present the clinical results of the surgical technique which is multiple tarsal osteotomies and gradual correction of complex foot deformities in PEV sequela patients above 10 years of age.

Materials and methods:

Two patients (4 feet) at ages of 10 and 11 who had previous mutiple inappropriate soft tissue procedures for PEV treatment and came up with complex and rigid foot deformities (heel varus and equinus, cavus, metatarsus adductus) had undergone the index procedure. Calcaneal osteomy and midtarsal osteotomy were performed. Forefoot and rearfoot were fixed with seperate ilizarov carbon circles and gradual correction of the cavus was initially performed by distracting between forefoot and rearfoot. After correction of the cavus and metatarsus adductus, heel varus and equinus were correcte gradually with ilizarov external fixator. The mean time with the fixator was 2.5 months. No seriour complications were obsered except type 1 pin tract infection. Both patients had plantigrade feet with normal heel alignment and were capable of 15 degrees of ankle dorsiflexion. None of the patients had plantar sores or shoe problems at 2 years follow up.

Discussion:

Treatment of complex and rigid foot problems of PEV sequela patients is always troublesome. The main aim of the treatment is to have a mobile and plantigrade feet without pressure sores and shoe fitting problems.

Conclusion:

Double osteotomies initially performed at calcaneus and mid tarsal region let the surgeon correct the cavus and adductus deformities followed by correction of rearfoot deformities with ilizarov external fixator is an effective method for correction of rigid foot deformities of patients with PEV sequela above 10 years of age.

E-Poster 42:TREATMENT OF AN INTRARTICULAR FRACTURE OF PROXIMALPHALANX OF THE INDEX FINGER WITH AN EXTERNAL FIXATIONMINI PENNING

Correa Vázquez, Eva, MDIcatme-IU Dexeus Font Segura, Jordi, MD; Mir Bullo, Xavier, MD

Icatme-IU Dexeus Spain

Introduction:

External fixation is useful in the treatment of comminuted fractures of the hand bones although it is not so frequently used.

Material and method:

46 years old male patient who suffers a traumatism on his index finger as a result of a traffic accident. There was no external wound. The radiographic images show a fracture on the base of the proximal phalanx. In the TC scan it can be observed a comminuted fracture of the articular phalangeal surface of the metacarpophalangeal joint.

The fracture is reducted and the stabilization is achieved by means of the Mini-Penning external fixation. Two pins are placed on the metacarpal diaphysis and the other two on the phalageal diaphysis with a central joint which allows the movement of metacarpophalangeal joint.

Results:

After five weeks the external fixation is removed and a radiological control shows signs of correct consolidation.

Conclusion:

The use of external fixation for the treatment of intra-articular fractures of the fingers is a treatment option which must be taken into account when there is a great comminution in the articular surface and the internal fixation is not able to stabilize the fracture.

275

E-Poster 45:CASE REPORT: OPEN DISLOCATION OF KNEE ASSOCIATED WITH THROMBOSIS OF THE POPLITEAL ARTERY. INITIAL MANAGEMENT

Tornero Dacasa, Eduardo, MD Hospital Clínic i Universitari de Barcelona García Elvira, Rubén, MD; Zumbado Dijeres, José

Alonso, MD; Sandoval Martínez, Elena, MD; García Oltra, Ester, MD; Prat Fabregat, Salvio, MD

Hospital Clínic i Universitari de Barcelona Spain

Introduction:

The knee dislocation is a serious injury that usually affects the ligamentous and cartilaginous structures of the knee and often is accompanied by vascular compromise of the extremity, caused mainly by the popliteal artery injury. Based on a clinical case we will review the clinical presentation of these lesions, the diagnostic and therapeutic options.

Material and methods:Case report; a 49 year old man who presented after motorcycle accident deformity and loss of function in his left knee and a wound on the posterior aspect of the knee of 10 cm. In the initial exploration were absence of distal pulses and X-ray showed an open anterior dislocation of the knee.

After reduction of the dislocation and stabilization with external fixator remained the absence of distal pulses. Intraoperative arteriography showed a “stop” at the level of the first portion of the popliteal artery. Was then carried out a popliteal-popliteal bypass with saphenous vein recovering pedis pulse. Subsequently underwent debridement and thorough cleaning of the wound.

Results:The immediate postoperative results were satisfactory, without requiring vasoactive support or blood transfusion. The patient recovered mobility and normal perfusion of the limb. 4 weeks later the patient tolerated aided walking without load.

Discussion and conclusions:Open knee dislocations are high energy injuries that frequently engage in capsuloligamentous structures and at risk of neurovascular compromise. If foot injuries go unnoticed or are not properly evaluated and treated, often lead to high rates of morbidity and eventual loss of the limb. There are lots of complications in the short to medium term (residual instability, or osteoarthritis, articular fibrosis), so these patients have a high failure rate after some years of the injury.

E-Poster 44:CUBITAL PSEUDOARTHROSIS TREATED WITH EXTERNAL FIXATION

Correa Vázquez, Eva, MD Icatme-IU Dexeus Font Segura, Jordi, MD; Ginebreda Martí, Ignacio, MD;

Mir Bullo, Xavier, MD Icatme-IU Dexeus Spain

Introduction:

In cases of pseudoarthrosis of diaphyseal bones the use of external fixation is a succesful procedure to achieve consolidation.

Material and methods:

37 years old woman who suffers a traffic accident on June 2007. She presents a diaphyseal fracture of both right cubitus and radius in the union of proximal and medial third, AO classification 22.A3.

On July 07 both fractures are treated by open reduction and internal fixation. After two months the radial fracture is consolidated but the cubital one shows a delay in the consolidation. Three months postoperative, the patient has high fever and arm pain. All laboratory analysis and gammagraphy are negative to prove the presence of infection. The plate is removed and changed for a new one and empirical antibiotic treatment is set up.

Eight months after the first surgery there is no sign of consolidation. The actual internal fixation is removed and an autologous bone graft is placed and fixed by a longer DCP plate. During the following controls it is found ostheolysis of the bone graft and pseudoarthrosis.

On February 2010 the internal fixation is removed. Bone graft and grown factors are placed and stabilized by a Triax external fixation. In case of consolidation failure, the external fixation system is prepared for becoming into a compression-distraction procedure.

Results:

The radiological control shows consolidation of the cubital fracture and there is a clinical improvement with absence of pain.

Conclusion:

External fixation is an optimal treatment option for diaphyseal pseudoarthrosis. It allows to change the stabilization process in case of failure for a compression-distraction procedure.

276

E-Poster 47:SECONDARY BONE GRAFT IMPLANTATION IN GRADE IIIB TIBIALSHAFT FRACTURE

García Elvira, Rubén, MD Hospital Clinic Barcelona Tornero Dacasa, Eduardo, MD; López Zabala, Ibon, MD;

Muñoz Mahmud, Ernesto, MD; Prat Fabregat, Salvio, MD Hospital Clínic Barcelona Spain

Objective and purpose of work:The use of external fixaton in the treatment of open fractures of tibia grade IIIB is applied, mainly, as initial treatment and sometimes as definitive. The main complications associated with these fractures are soft tissue involvement and the possible presence of bone defects.

Material and methods:A case report, a 24-years-old-man, after a traffic accident, had a tibial shaft fracture grade IIIB with trifocal fragment partern and bone loss of 6-cm in anterolateral position. At first, it proceeded to stabilization with external fixator, with inability to close this wound in antero due to soft tissue edema. Two weeks later the external fixator was removed and underwent intramedullary nailing of the tibia, being possible at this time the complete skin closure. Ten weeks later the bone defect remained in anterolateral, so we decided to make an approach on the defect and implementation of iliac crest homograft.

Discussion:

One of the most common complications in open shaft fractures of the tibia Grade IIIB is the important involvement of soft tissue. Where it is not possible primary closure, one possibility is the primary stabilization of the fracture and delayed wound closure at a second time. If that is not possible, another possibility is to make a flap coverage. Some authors argue for making a fix and

within the first 72 h.

In partial bone defects we recommend implant of bonegraft in those over 4 cm. We also recommend leaving a minimum of six weeks between stabilization and the supply of graft, and after confirming the absence of infection.

Conclusions:In grade IIIB open shaft fractures of the tibia is crucial both to stabilize the fracture and the coverage of skin defects. We emphasize the technical fix and flap described as due to the good results published.

E-Poster 46:LOWER LIMB LENGTHENING BY ILIZAROV TECHNIQUE AND LENGTHENIG OVER NAIL. A COMPARATIVE STUDY

Botter Montenegro, Nei, MD Sao Paulo University Medical School Hamilton de Castro Targa, Walter, MD; Guarniero,

Roberto, MD Sao Paulo University Medical School Brazil

Resume:

The authors studied one hundred and two lower limb lengthenings, in adults and children, from 1988 to 2008; 51 patients were treated by the Ilizarov apparatus, with leg length discrepancy -LLD- do to congenital (34) and acquired (17) pathologies, with 34 femora (average about 5.6 cm, from 3 to 14 cm) and 17 tibiae lengthening (average 4.7 cm; 2.5 to 11 cm). The lengthenig index average was 1.77 month/cm. The difficulties found were 45 problems (24 superficial infection, 11 with delayed union, 9 articular stiffness and 1 fibular neuropraxis), 24 obstacles (14 articular deformities, 11 knee flexion and 3 ankle equinus, 3 early bone healing and 4 abscesses, and 3 delayed union. The complications (27) found were 12 definitive knee stiffness, 6 definitive ankle stiffness, 3 knee subluxations, 3 lengthening interruption by pain and 2 blood hemorrhage (Paley classification, 1990). The average external fixation time were about 9 months.

The other 51 patients were submitted to lengthening over nail, done with monolateral external fixator. There were 39 femora and 12 tibiae, with follow-up time about 1 to 11 years p.o. (average: 6.5 y.), LLD do to adquired (29) and congenital (22) patologies. The bone lengthening were from 3.5 to 9.5 cm (average: 5.6 cm) and the external fixation average time were 2.5 months. The lengthenig index average was 1.6 month/cm and the difficulties observed were 9 problems (9 superfficial infections), 5 obstacles (2 calcaneus tendon lengthening, 1 premature consolidation, 1 delayed union and 1 deep infection) and 3 complications (2 knee deformities and 1 lengthening interruption. The authors conclusions were that lengthening over nail with monolateral external fixation, reducing external fixation time, was able to keep articular range of motion, bone alignement and decreases fracture risk after bone lengthening and is a good option for bone lengthening in adults and children.

277

E-Poster 49:ADJUSTABLE BRACING TECHNIQUE FOR TREATMENT OF ELBOWCONTRACTURES DURING UPPER EXTREMITY LENGTHENING

Herzenberg, John E, MD International Center for Limb Lengthening, Rubin Institute

for Advanced Orthopedics, Sinai Hospital Bardakos, Nikolaos V, MD; Bhave, Anil, MD

International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital

United States

Purpose:

Flexion contracture of the elbow joint can compromise the final outcome of upper extremity lengthening. We developed a simple method for early treatment of resistant flexion contractures.

Methods:

If no progress was observed after 2 weeks of daily physical therapy, a custom elbow device (CED) was applied that consisted of a fiberglass cylindrical cast applied to upper arm or forearm (for forearm or humeral lengthening, respectively) with a Taylor spatial frame (TSF) ring or anchor points incorporated into it. Ring was connected to external fixation by two TSF struts that symmetrically spanned medial and lateral aspects of the elbow joint. Patients distracted struts at a rate of at least four turns (4 mm) daily. Patients disconnected the struts during daily physical therapy. Patient discomfort indicated when treatment should be terminated.

Results:

Case 1: Sixteen-year-old boy with Ollier disease who previously underwent 8 cm of humeral lengthening at the deltoid tuberosity presented for a second 2.5 cm of lengthening and valgus correction in the supracondylar level with the TSF. At the end of the distraction period, he had a 35º flexion contracture. After a month of CED treatment, the residual contracture measured 5º. Sixteen-year-old girl with Ollier disease had 9 cm of humeral shortening and a 60º oblique plane deformity. After 6 weeks of treatment with the TSF, she had a 90º flexion contracture. Four weeks after CED application, flexion contracture improved to 50º. Frame was removed 5 months after its application (flexion contracture, 40º; lengthening, 7 cm). Nine months postoperatively, flexion contracture was 25º.

Eighteen-year-old girl with radial clubhand underwent right ulnar osteotomy for lengthening with a TSF. Three months postoperatively, delayed union was treated with iliac crest bone graft and healed uneventfully. Preoperative flexion contracture was 35º. After lengthening, flexion contracture was 65º. Approximately 1 month after CED application, flexion contracture was reduced to 25º.

Conclusions:

Our technique offers distinct advantages, including ease of application, low cost, and patient compliance, over traditional physical therapy methods. We consider the ability to address contracture early with the fixator still in place to be key to the technique’s success.

E-Poster 48:HIP ARTHRODIASTASIS: AN ALTERNATIVE FOR SEVERE COXALGIAON YOUNG PATIENT

Valverde Retana, Alexander, MD Orthopedics and Traumatology Group, Hospital Calderón

Guardia Castro Rivera, Luis Alfonso, MD

Clinic Hospital Calderón Guardia Costa Rica

Resume:

It’s a restrospective study that took place at Hospital Calderón Guardia, which belongs to the Caja Costarricense de Seguro Social in San José, Costa Rica. 12 cases were compiled and were followed for 2 years (medical file) and the age range was between 20 and 32 years old with pain according to the analog visual scale of 10 and with previous pathologies of evolutionary hip dysplasia, Perthes disease and luxations of the hip or fractures. A Girdlestone procedure was performed on them (redirection of the femoral head) and placement of a hip arthrodiastasador (Orthofix) for 12 weeks, allowing support on the third day and following the progress every 15 days evaluating the arcs of movement and the pain as the patient evolves with time.

The results presented in these cases: pain, hip movement, complications, etc.

278

E-Poster 51:INTRAMEDULLARY SKELETAL KINETIC DISTRACTOR (ISKD) FORPOSTTRAUMATIC LIMB LENGTH DISCREPANCY

Herzenberg, John E, MD International Center for Limb Lengthening, Rubin Institute

for Advanced Orthopedics, Sinai Hospital1Jindal, Gaurav, MD; 2Belthur, Mohan V, MD; 3Paley, Dror,

MD; 4Specht, Stacy C, MD1Pushpanjali Crosslay Hospital; 2Texas Childrens

Hospital and Shriners Hospital for Children; 3St. Mary’s Hospital; 4International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital

United States

Purpose:

Limb lengthening with external fixation can cause scarring, pin-site infections, and pain. Lengthening with an internal device is an alternative to external fixation and can be used to correct posttraumatic limb length discrepancy (LLD). The purpose of this study was to determine whether lengthening with the Intramedullary Skeletal Kinetic Distractor (ISKD) (Orthofix, McKinney, TX) is safe and effective.

Methods:

Prospective study was conducted of 28 patients with posttraumatic LLD who underwent 23 femoral and five tibial lengthening procedures with the ISKD.

Results:

Average age at surgery was 35 years (range, 13-55 years). Average follow-up was 18 months (range, 6-40 months). Average length obtained was 32 mm (range, 6-58 mm). Eighteen of 28 devices have been electively removed. Seven additional procedures were required (average, 0.25 per patient). Complications included one premature consolidation, two partial unions, and two nonunions. Reosteotomy was required for premature consolidation. Both patients with partial union healed after undergoing percutaneous marrow grafting; one also underwent exchange nailing. All patients achieved desired amount of lengthening except two patients whose limbs failed to lengthen postoperatively (one with a stiff oblique hypertrophic nonunion and one with acute correction of varus malunion). These two patients had a final LLD of 11 mm and 20 mm. Both patients experienced nonunion but the limb eventually healed after exchange nailing. There were no infections, nerve injuries, soft tissue contractures, stress fractures after nail removal, or mechanical failures of the device. Quality of life questionnaire (Enneking score, maximum of 30 points) was administered preoperatively and at 6-months post-distraction; the scores of 17 patients who completed the postoperative questionnaire improved by an average of 4 points.

Conclusion:

The ISKD is a safe and effective device for limb lengthening in cases of posttraumatic LLD. We recommend that for most cases, angular malunions and nonunions be treated first, with ISKD lengthening as a secondary, staged procedure.

E-Poster 50:HOW EXTERNAL FIXATION AFFECTS IN THE QUALITY OF LIFE OF THE PATIENTS

Sarras, Emmanuil, MD Kat Hospital Athens Christodoulou, Evagelos, MD; Korres, Nectarios, MD;

Papadopoulou, Theodora, MD; Chrysikopoulos, Theodoros, MDKat Hospital Athens Greece

Aim:

Is to evaluate the problems that occur within the treatment of a lower limb fragment or arthritis with external fixation method.

Material-methods:85 patients,17 with femoral fractures, 58 with tibial fractures and 10 patients with secondary arthritis of the hind foot that sustained a treatment with external fixation either unilateral or circular. We evaluate the patients every month until the removal of the external fixator and one month after. All the patients fulfill a questionnaire about a quality of life scale.

Results:

The most common problems that the patients believe that affects in the quality of life during the treatment with an external fixator are about physical mobility, pain, sleeping problems, sexual life problems, friendship problems and in some cases even agoraphobia with all these to leed in emotional instability.

Conclusion:

Although the treatment with external fixation in many cases provide very good stability and in a little time full weight bearing for the patients and improve the physical mobility, there are problems that affects decreasing the quality of life level for the patients.

279

E-Poster 53:MANAGEMENT OF CLOSED TIBIAL PILON FRACTURES TYPE C WITH EXTERNAL FIXATOR HOFFMAN II AND PERCUTANEOUS OSTEOSYNTHESIS

Elgueta Ruiz, Aníbal, MD Hospital Traumatológico de Concepción, Universidad de

ConcepciónArévalo, R, MD; Rivera, R, MD; Mercado, E, MD

Hospital Traumatológico de Concepción, Universidad de Concepción

Chile

Objective:A retrospective study of 30 patients with closed pilon fractures type C according to the classification Ruedi and Algöwer, managed with percutaneous fixation more external fixator, evaluating results and complications of this alternative treatment during the period January 2005 to January 2009.

Methods:

We evaluated 30 patients who presented closed pilon fractures type C according to the classification Ruedi and Algöwer and measurement scale AOFAS ankle and hindfoot, objective assessment parameters and update radiographs.

Results:

We evaluated 30 patients with pilon fractures closed tibial type C according to Ruedi and Algöwer. All patients were evaluated with objective assessment parameters clinical and radiological 1 month, 3 months, 6 months and 12 months. Also at 6 and 12 months is evaluated with AOFAS functional scale. The average period between injury and surgery was 5 days. Average time 12 weeks of consolidation. Time whithout load 8 weeks. Removal of external fixator was at 10 weeks. Early Physiotherapy postoperative 1 week. The results included a 3% infections, skin necrosis 0%, 0% malunion, consolidation delay 3%, no case of no union, sudeck sindrome in 3%, 6% post-traumatic osteoarthritis. At years post surgery, 90% of patients had 85 points in the AOFAS scale.

Conclusions:

The management of closed tibial pilon fractures type C of Ruedi and Algöwer with percutaneous osteosynthesis and external fixator is a viable alternative for these patients, compared with ORIF methods, we obtain similar results in consolidation time and functional results and lower complication rates.

E-Poster 52:OLLIER MAFFUCCI DISEASE: EXTREME DEFORMITY OF THELOWER LIMB WITH VASCULAR LESIONS. SURGICAL TREATMENT

Loayza Obando, Luis Alberto, MD Institut Universitari Dexeus

1Ginebreda Martí, Ignacio, MD; 2Rodríguez Miralles, Joaquín, MD; 2Cots Pons, Marc, MD

1Institut Universitari Dexeus; 2Capio Hospital General de Catalunya

Spain

Objective:Planning and surgical correction of the extreme deformity in lower limb and its usefulness for the funtional recovery of the limb with normal walk.

Materials and methods:Presents the case of a 19 year old woman with the diagnosis of Ollier-Maffucci disease, with important right lower limb affectation and deformity of the third distal femoral lower limb and a big encondroma in that zone, presents more than 90º of curvature, combined with bad rotation and shortening of the whole limb associated with multiples cutaneous vascular lesions in the same limb.

After the completion of adequate test (Radiology, Arteriography and CAT) is performed the planning of the correction. Localization of the osteotomy zone at the double femoral level to perform resection of the encondroma and the line up of the limb, stabilizing it with external monolateral fixation bypassing the knee.

Discussion:

Preoperative planning is important in the cases of axial corrections but there is the difficulty of the application in cases with combined deviations. In this case we prefer to make a first time axial correction and in the second time an elongation of the bone after the consolidation of the osteotomy resection.

Conclusions:

In these extreme cases is essential to ensure the vascular and neurological viability of the limb prior than mechanical function, the initial subtraction osteotomy and second time elongation of the bone seems the most appropriate solution in this case, ensuring the functional recovery of the limb although it presents extreme maximum deformities listed as tax of amputation.

280

E-Poster 55:EXTERNAL FIXATION IN THE TREATMENT OF FRACTURES OF THE DISTAL END OF RADIO TYPE C3 (AO)

Elgueta Ruiz, Aníbal, MD Hospital Traumatológico, Concepción Chile

Background and objectives:

Fractures of the distal end of radius are very common injury. The best method of treatment remains controversial. The overall rate of complications has been reported from as low as 9.6% to as high as 61%. Such complications include infection of the path of pins, pin loosening, neuropathy involving the median and radial nerve, tendinous rupture, metacarpal fractures, DSR and malunion. Our goal is to retrospectively analyze the results of surgical treatment of fractures of the distal radius with external fixation associated with threaded needles K made in the Trauma Hospital of Concepción in the period 2006-2009.

Materials and methods:

We reviewed the medical records of 30 patients with fracture of the distal radius AO Type C surgically treated with external fixation associated with K needles treated between January 2006 and April 2009, evaluating postoperative radial height, volar tilt, radial inclination, range of motion, strength of grip and complications at 3, 6 and 12 months postoperatively with DASH and PRWE scales.

Results:

K needles were removed from 6 to 8 weeks (average 7.5 weeks) and the fixator was removed between 7 and 10 weeks (mean 8 weeks). Range of motion exercises in the fingers began the day after surgery. Immediately after reduction and fixation, there was a significant improvement in height and radial inclination and in the volar tilt. There was no deep infection or Malunion. The grip strength compared with the contralateral side was 80%. There was no loss of reduction. As complications, superficial infection was presented by 5% of patients without pin loosening and one case of transitional DSR. The functional results after one year control was excellent or good in 90% of patients according to the scales PRWE and DASH.

Conclusions:

Management of fractures of the distal end of radius AO type C3 treated with external fixator associated with K wire is a valid alternative for surgical treatment, obtaining similar results to those described in the literature but with a lower rate of complications. The poor outcome would be associated more with the type of fracture than to the use of external fixation.

E-Poster 54:PROXIMAL FEMUR CORRECTION CORTICOTOMY WITHMONOLATERAL FIXATION IN CHILDREN WITH DEVELOPMENTALHIP DYSPLASIA

Vvedenskiy, Petr, MD Nizhny Novgorod Research Institute of Traumatology and

Orthopaedics1Bogosyan, Alexander, MD; 1Musikhina, Irina, MD;

1Tenilin, Nikolay, MD; 1Permiakov, Mikhail, MD; 2Mikheev, Konstantin, MD

1Nizhny Novgorod Research Institute of Traumatology and Orthopaedics 2New Orthopaedic Instruments

Russian Federation

Aim:

There is a significant number of patients with developmental hip dysplasia who require a proximal correction osteotomy of femur to be performed. A conventional technique with plate fixation means a relatively wide access to proximal femur with a significant damage of soft tissues and periosteum. In the most cases this technique requires plaster cast immobilization in children of 2-3 years old. The aim of the present work is the substantiation of the advantages of proximal correction corticotomy with monolateral external fixation.

Methods:

The proximal correction corticotomy was performed in six patients at the age from 2 to 3 years with excessive parameters of antetorsion (more than 45º) and coax valga (CDA more than 145º) due to developmental hip dysplasia. The corticotomy was performed with a narrow chisel though a skin incision of 1.0-1.5 cm. The new model of monolateral fixator with four 3.5 mm in diameter half-pins was used. The major part of correction was performed manually and then a final correction was made using adjusting mechanism with hemispherical locking pairs in the attached frame. All the manipulations were done under C-arm control.

Results and discussion:

In all the cases the desired correction was achieved. The patients sustained surgery much better in comparison with the open approach and plate fixation technique. The monolateral frame provided the stable fixation of the bone fragments so there was no need in additional immobilization with plaster cast. Due to absence of significant soft tissue damage, especially muscles, patients maintained a full range of motions in the hip and knee joints and felt comfortable during fixation. The healing time (fixation period) was ranged from 33 to 38 days. There was no infection of soft tissues around pins that could require their removal.

Conclusion:

The proximal correction corticotomy of femur in children of 2-3 years old with monolateral fixation in cases of developmental hip dysplasia is the most sparing technique for such young patients.

281

E-Poster 57:CONGENITAL SYNOSTOSIS OF THE KNEE: EARLY RESULTS OFLIMB RECONSTRUCTION SURGERY

Belthur, Mohan V, MD Shriners Hospital for Children

1Burghardt, Rolf D, MD; 2Herzenberg, John E, MD; 3Paley, Dror, MD

1Technical University of Munich; 2International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital; 3St. Mary’s Hospital

United States

Purpose:

Congenital synostosis of the knee joint is rare. Recommended treatment options include observation, knee disarticulation, femoral supracondylar extension osteotomy, and realignment through the fusion mass. We present the early results of five patients who underwent limb reconstruction surgery.

Methods:

We conducted an IRB-approved retrospective review of the records of five patients (seven knees) who presented to our institution between 2000 and 2007. Clinical data collected included clinical features, position of knee fusion, limb length discrepancy, laterality, ambulatory capacity, associated manifestations, associated syndromes, intellectual development, and operative procedures. Radiographs were reviewed to describe the position and type of fusion, presence of patella, the quadriceps’ shadow, limb alignment, and associated features. Outcomes reviewed included final limb alignment, equalization of leg length discrepancy, ambulatory capacity at final follow-up, and complications.

Results:

Average age at presentation was 2.5 years (range, 0.9-5.2 years). All patients presented with knee flexion deformity, limb length discrepancy, and delayed walking ability. Average knee flexion deformity was 94 degrees (range, 60-120 degrees). Patients were either walking on their knees or bottom shuffling. Intellectual development was considered to be normal in all patients. All patients had associated hypoplasia of lower and/or upper extremity long bones. Average age at surgery was 5.9 years (range, 3.6-9.2 years). Average follow-up was 2.0 years (range, 0.5-3.5 years). In all patients, we were able to realign the knee and place it in a more functional position of full extension, neutral rotation, and neutral varus/valgus. Ambulatory capacity was improved in all patients. No major complications occurred. Limb length was equalized in one patient. All other patients will require limb length equalization procedures in the future. Three patients had pin site infection, one had premature consolidation, and one patient had transient loss of pulses during acute correction. No deformity recurrence was observed at last follow-up.

Conclusions:

Careful evaluation to assess prognosis and associated features involving the other extremities is important in the decision making process. Limb reconstruction surgery allows for reliable realignment of the lower limb, improves walking ability, and improves overall function.

E-Poster 56:FIBULAR HEMIMELIA G-III OF COVENTRY-JOHNSON: RECONSTRUCTION PLANNING

Loayza Obando, Luis Alberto, MD Institut Universitari Dexeus Ginebreda Martí, Ignacio, MD

Institut Universitari Dexeus Spain

Objective:

Schedule the early correction of the left lower limb of a fibular hemimelia Coventry-Johnson G-III associated with equinus valgus foot, femoral hypoplasia, tibial antecurvatum 33º and dismetry of 92,57 mm with a final dismetry prognostic of bone growing of 160,24 mm (Paley Multiplayer method).

Materials and methods:

Presents the case of a 4 year old male with the postnatal diagnostic of fibular hemimelia G-III schedule the deformity correction with tibia elongation, and placement of the foot in the tibia fibular shroud warm. It is stabilized by external monolateral fixation with 5 anchor points, wedge resection of the anterior base and proximal transverse osteotomy for wedge resection proximal to bone elongation, associated with open elongation of the Achilles tendon and resection of the fibula fibrotic band. It is made a 75 mm lengthening of the tibia through the proximal osteotomy to maintain the line up of the tibia and the foot. Get an appropiate consolidation of the outbreaks in 4 months 18 days with proper tibia line up and good function joint of the knee.

Discussion:

Early correction of deformity, restitution of the foot and simultaneous elongation allows to give the patient the possibility of plantigrade deambulation as well as lower percentage of final dismetry, leaving the limb line up for subsequent elongations.

Conclusion:

The early treatment of these major deformities is the most effective method to get a functional limb at the end of the growing, minimizing the definitive orthotics.

282

E-Poster 59:TREATMENT OF THE BRACHYMETATARSIA WITH EXTERNALFIXATION BY CALLUS DISTRACTION

Albarracín, Juan Pablo, MD Complejo Médico de la Policia Federal Argentina Maiaru, Ariel, MD; Zapozko, Daniel, MD; Canale, Carlos,

MD; Varas, Gabriel, MDComplejo Médico de la Policia Federal Argentina Argentina

Resume:

Brachymetatarsia is an abnormal shortness of the metatarsal bone due to premature closures of the epiphyseal plate. The cause may be congenital, post-traumatic or iatrogenic. This condition affects one, usually the fourth, or more metatarsals, unilaterally or bilaterally. The purpose of this study was to review the results for nine patients with 12 congenital brachymetatarsia made with the callus distraction using an external fixation.

In the period between 2000 and 2009 at the Complejo Medico de la Policia Federal Argentina “Churruca Visca”, 9 girls underwent 12 metatarsal lengthening by callus distraction (of the fourth metatarsal in ten, of the third metatarsal in one and the third and fourth metatarsal that was causing a Hallux Valgus in one patient). Three patients were bilateral. The reason for the surgery was cosmetic in 6 patients and plantar calluses in 3 patients. The mean age at the time of the surgery was 13 years (range 6-19 years). The mean duration of the follow-up was 5.6 years (range 1.5-9.6 years). The distraction rate was 0.5 mm/day. The metatarsal bones were lengthened by a mean of 18 mm (range 15-25 mm). The mean healing time was 135 days (range, 85-215 days). There was one case with fracture and residual angulations of 5º in the lengthening callus. One patient presented early consolidation underwent a new osteotomy in the lengthening callus percutaneously twice. Hypertrophic callus in the metatarsal lengthening was due to making compression at the beginning made by mistake instead of distraction requiring a new lengthening years later. Non union, neurovascular complication, dislocation of the metatarsophalangeal joint and pin-tract infection were not observed in any patients. Because callostasis is done by the patient or the family of this, we believe it is of great importance to good communication with them to avoid falling into technical errors. Due to the few complications with the technique of lengthening by callostasis with external fixation, we recommend this technique for the treatment of the brachymetatarsia.

E-Poster 58:AUTHORS TECHNIQUE OF REDUCTION OF THE TYPE III SUPRACONDYLAR FRACTURES OF HUMERUS

Odessky, Jacob, MD Assaf Harofeh Medical Center Israel

Aim and purpose of the study:

The purpose of this study is developing technique allows closed reduction of type III supracondylar fractures of humerus.

Material and method:

This series includes 10 patients; aged 8-12 that were treated between 1997-2003. 7 of them were boys and 3 -girls. All patients suffered from type III supracondylar fractures; distinctive futures of which were, that all attempts of closed manual reduction were unsuccessful. 8 fracture were extension type and 2 -flexion. 1 patient had ipsilateral fracture distal radius. 3 patients before definitive treatment had skeletal traction for 5-7 days. 2 patients underwent second procedure 2-6 days after closed reduction and cross KW fixation due to unacceptable reduction. 5 patients had definitive reduction at day of injury. For closed reduction we insert KW through olecranon that was attached to half ring of Ilizarov apparatus in a tight condition. Second KW inserts to mid/3 of humerus. Than by traction and rotation movement of distal fragment by half ring, the reduction was achieved. The second hand held the proximal fragment. The fixation of fractures in 6 cases was by Ilizarov apparatus from 2 KW in proximal fragment attached to the ring and 1 KW placed trough epicondyles and attached to the ring by standard particles of Ilizarov apparatus. 4 patients had standard cross KW fixation and above elbow POP. The olecranon KW was removed in all patients before the operation has been finished and the KW from mid/3 of humerus was removed as well in patients that were fixated by POP. The average fixation period in group of external fixation was 4 weeks, and 6 weeks in POP patients. All fractures were reduced anatomically and united with good functional result. No ulnar nerve palsy was notice.

Discussion:

This technique allows preventing the open reduction in difficult supracondylar fractures; reduce number of attempts of closed reduction and eliminate distal ischemia due to overflexion of the elbow.

Conclusions:

Offered technique permits anatomic reduction of type III supracondylar fractures of humerus and may be good alternative to open reduction.

283

E-Poster 61:REPARATIVE REGENERATION FOR LENGTHENING OFFRAGMENTAL ENDS WITH OSTEOPOROSES AT EXPERIMENTS

S V Gyulnazarova, MD Federal State Institution “The Urals Chaklin Scientific

Research Institute of Traumatology and Orthopaedics of Russian Medical Technologies”, Ekaterinburg

Russia

Resume:

Pseudoarthroses of long bone are characterized by pathological reorganization of fragmental ends as osteoporosis or osteosclerosis. Features of distractional osteogenesis under conditions have not been investigated well enough.

An experimental study was performed on dogs in which pseudoarthroses of leg bones with osteoporosis were modeled. Osteogenesis in these cases was investigated during lengthening and subsequent bone reorganization. In osteoporosis under distraction by 1 mm per day typical regenerated bone was formed with central zone of growth. The zone was functioning actively the whole distraction period.

The experiments have demonstrated that reparative bone osteogenesis complicated by osteoporosis is analogous to the osteogenesis for intact bone lengthening healthy animals. It provides normalization of length and wholeness of damaged bone segment in long bone pseudoaethrosis in all cases successfully irrespective of osteoporosis severity.

E-Poster 60:TSF ON ILIZAROV. CORRECTION OF SECONDARY DEFORMITIES BYA COMBINATION OF A HEXAPOD AND A LIZAROV RING FIXATOR

Baecker, Hinnerk, MD Department of Traumatology, University Hospital

Bergmannsheil, Bochum Gessmann, Jan, MD; Graf, Markus, MD; Muhr, Gert, MD;

Seybold, Dominik, MD Department of Traumatology, University Hospital

Bergmannsheil, Bochum Germany

Introduction:

Bone defects of various origins can be treated by a segmental transport by means of external fixator. Using an extraosseous transportation unit can lead to multidirectional deformities in the docking area with the need of secondary correction.

Three cases with a secondary deformity of the transportation segment are described. The required gradual correction prior to the distal docking was achieved by assembling a Taylor Spatial Frame with the standard Ilizarov ring fixator.

Method:

Three patients suffered a secondary deformity during a segmental transport of the tibia with an Ilizarov ring fixator. Two cases showed a translational deformity of the distal segment while a valgus deformity was seen in one case. To correct the segmental deformity a Hexapod fixator (TSF) was attached to the Ilizarov fixator above the docking zone. Afterwards the longitudinal threaded rods of the Ilizarov fixator were dismantled between the concerning rings. The Taylor Spatial Frame deformity correction software was used in the Total Residual Mode to calculate the prescription. All patients achieved a correction by self-adjusting the struts.

To increase the mechanical stability after the distal docking four longitudinal rods were added.

Results:

All patients achieved anatomical positioning in the docking zone after a mean average correction time of 11 days (min. 8 d, max. 13 d) and a transportation speed of 1 mm/d. In two cases a bone grafting in the docking area was necessary to achieve complete consolidation.

Conclusion:

Secondary deformities in segmental transport by means of external fixator occur if the orientation of the extraosseous transport system does not exactly correspond to the transport direction of the segment.

By assembling a TSF on an Ilizarov ring fixator secondary deformities can be corrected prior to the distal docking and without the necessity of repositioning the Ilizarov fixator. With this method an alternative treatment for the complex reconstruction of the standard Ilizarov ring fixator is available. It requires experience in dealing with a Hexapod fixator but gives the possibility of gradual correction of secondary deformities in outpatient surgery.

284

E-Poster 63:ANKLE FUSION STABILITY: A BIOMECHANICAL COMPARISON OFEXTERNAL FIXATION VERSUS INTERNAL FIXATION

Hoover, Justin, MD University of South Carolina/palmetto Health Richland Santrock, Robert, MD; James, William, MDMidlands Orthopaedics, PaUnited States

Aim and purpose of the study:

Rigid fixation and adequate compression are necessary during ankle arthrodesis to establish fusion. Our study compared bimalleolar external fixation to conventional crossed screw construct in terms of stability and compression for ankle fusion. The goals of this study were to determine which construct is more stable with bending (dorsiflexion) and torsional forces, and to determine which construct achieves more compression.

Material and methodology:

Fourth generation bone composite tibia and talocalcaneal models were made to 50th percentile anatomic specifications. Fourteen total ankle fusion constructs were created with bimalleolar external fixators and fourteen constructs were created with crossed screw construct. Ultimate bend testing was completed on four bimalleolar external fixators constructs and four crossed screw constructs using a multidirectional MTS machine. Likewise, ultimate torque testing was completed on four external fixator constructs and four crossed screw constructs using a multidirectional MTS machine. Five external fixator constructs and six crossed screw constructs were used to test compression using a transducer placed in the tibiotalar space. The external fixator construct was compared directly to the crossed screw construct with regards to failure in bending, torsion, and compression.

Discussion:

Ultimate bend testing revealed the mean peak load to failure for the bimalleolar external fixator construct was 973.2 N and 612.5 N for the crossed screw construct. This was a statistically

testing revealed the mean peak torque to failure for the external fixator construct was 80.2 N-m and 28.1 N-m for the crossed screw construct. This was also a statistically significant

the average failure force of the external fixator construct (182.7lbs) and the crossed screw construct (179.5lbs).

Conclusions:

The bimalleolar external fixator construct is a more rigid construct in both bending and torsion as compared to the conventional crossed screw construct for ankle fusion. Compressive forces for the two constructs were found to be approximately equivalent. With increased stiffness in both bending and torsion and comparable compressive strengths; bimalleolar external fixation is an excellent option for tibiotalar ankle arthrodesis.

E-Poster 62:PROGRESSIVE CORRECTION OF PERIARTICULAR TIBIALRETRO-CURVATUN APPLYING PRINCIPLES OF ARTICULARALIGNMENT AND ORIENTATION AND MULTIPLANAR EXTERNALFIXATION

Casas Placer, José, MD Hospital Central de Maracay Aragua

Rodríguez de Casas, Verónica, MD; Mendoza, Daniel, MD Hospital Central de Maracay Aragua Venezuela

Resume:

“Concerning to a case” CENTRAL HOSPITAL DE MARACAY-VENEZUELA

Objective:

To establish the effectiveness and precision of the Multiplanar External Fixation for correction of tibial peri-articular deformity in retro-curvatun, applying principles of articular alignment and orientation.

Materials and methods:

Prospective-descriptive study based on analysis, treatment and pursuit of male patient of 18 years with retro-curvatun accquired deformity sequel of postraumatics arrest of the proximal tibial physis. It was carried out percutaneous infra-tuberosity osteotomy with drill of 4,5 mm, previous placement of external multiplanar tutor with two hoops of 150 mm of diameter, 6 pines of 5.0 and 2 olive wires.

Results:

The initial deformity consisted on retro-curvatun of 35° (aptsa 20°) with supra-tuberosity CORA (center of rotation of angulation) in a sagittal plane, moderate shortening of 2.5 cm also existed in affected tibia. Two aligned hinges were used in the ACA (axis of correction of angulation) and mounted on the external fixator. The osteotomy was carried out distal to the CORA (infra-tuberosity). The correction beginning at 7 days carrying out first lengthening and then correction of the angulación in progressive form in a lapse of 8 weeks. The total correction of the shortening and retro-curvatun was achieved with consolidation in 18 weeks. The aptsa (anatomical sagittal proximal tibial angle) stayed in 10°, the anatomical sagittal axis of the tibia projected on the articular surface stayed in the anterior 1/5, similar to that of the healthy extremity. There were not complications. After 24 months of pursuit the correction of the deformity its stay, without pain and with normal articular mobility.

Conclusions:

The principles of alignment and orientation for the correction of deformities of the inferior extremity are necessaries for specific and correct result. The multiplanar external fixation is like it is evidenced in the present case an effective, specify method, with a low index of complications and reproducible.

Words Key:

Articular alignment and orientation, articular fixation, tibial retro-curvatun.

285

E-Poster 65:THE CLINICAL RESULTS OF DISTAL TIBIAL OBLIQUEOSTEOTOMY TREATED FOR THE TRAUMATIC OSTEOARTHRITISOF THE ANKLE JOINT

Motoyuki, Takaki, MD Oita Prefectual Hospital

1Teramoto, Tsukasa, MD; 2Makino, Yosiaki, MD; 3Takenaka, Nobuyuki, MD; 4Tasiro, Kouitirou, MD; 5Otuka, Kazutaka, MD; 6Asahara, Tomohiko, MD

1Nagasaki Yuai Hospital; 2Sasebo General Hospital; 3Teikyo University Hospital; 4Nagasaki Memorial Hospital; 5OmuraMunicipal Hospital; 6Nagasaki University Hospital

Purpose:

Distal tibial oblique osteotomy (DTOO) was designed by Tsukasa Teramoto for treatment of the primary osteoarthritis (OA) of the ankle joint. The purpose of this study was to evaluate the clinical result of the DTOO treated for the posttraumatic OA of the ankle joint.

Materials and methods:

The subjects were 3 patients (2 males and a female) of the traumatic OA of the ankle joint. The age of the patients ranged from 46 to 57 years. The follow up period ranged from 6 months to a year. Each cause of the OA of the ankle joint was ankle fracture 20 years before, the calcaneal fracture 40 years before and the malunion of the lower leg fracture. Elongation of the Achilles tendon was performed who had occurred equinus deformity after DTOO. Two patients required the osteotomy of the fibula. We evaluated each case about pain, gait and ROM of the ankle joint.

Results:

No patient had the equinus deformity. All patients had less pain and was able to walk without limping.

Conclusion:

DTOO seems to be useful method for treatment of the post-traumatic OA, though it is sometimes necessary for the elongation of the Achilles tendon and the osteotomy of the fibula.

E-Poster 64:DISTAL OBLIQUE OSTEOTOMY (DTOO) FOR THE VARUS-TYPE OSTEOARTHRITIS OF THE ANKLE

Asahara, Tomohiko, MD Dept. of Orthopaedic Surg, Nagasaki Univ

1Teramoto, Tsukasa, MD; 2 Makino, Yoshiaki, MD; 3Motoyuki, Takaki, MD

1Dept. of Orthopaedic Surg, Nagasaki Yuai Hospital; 2Dept. of Orthopaedic Surg, Sasebo Municipal Hospital; 3Dept. of Orthopaedic Surg, Oita Prefectual Hospital

Introduction:

Osteoartritis of the ankle have been performed arthrodesis, total ankle arthroprasty, low tibial osteotomy and so on. In Japan, the progressed osteoarthritis of the anke is often performed arthrodesis. We think that it is better the moving joint than fixed joint, so we chose the joint preservation procedure that called Distal Tibial Oblique Ostetomy for the osteoarthritis of the ankle. This method is performed using Ilizarov external fixator. We introducethe surgical method and clinical results.

Materials and method:

The study population comprised 7 patients with the varus-type OA of the ankle. Before surgery, all patients had severe pain and limping.

Surgical method is performed as follows. The medeial side of the lower leg is incised at the 5 cm proximal to the ankle joint. The distal tibia is osteotomized obliquely toward the distal tibiofibukar joint. Then the ostetomized site is spred and in adequate position, fixed with Ilizarov external fixator. Spreading site is defect, so we fill up the defext with auto iliac bone fraft.

Results:

After surgery, all patients pain had decreased and some of them could run and jump. None of them had surgical complications such as deep infection, pseudarthrosis.

Conclusion:

Distal tibial oblique osteotomy using the Ilizarov external fixator is very useful for varus-type osteoarthritis of the ankle.

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E-Poster 67:CLINICAL RESULTS OF DISTAL TBIAL OBILIQUE OSTEOTOMY(DTOO) TREATED FOR THE VALGUS TYPE OSTEOARTHRITIS OFTHE ANKLE JOINT

Teramoto, Tsukasa, MD Nagasaki Yuai Hospital

Author: 1Makino, Yosiaki, MD; 2 Asahara, Tomohiko, MD; 3Motoyuki, Takaki, MD

1Sasebo Municipal Hospital; 2Nagasaki University Hospital; 3Oita Prefectual Hospital

Resume:

We already reported that distal tibial oblique osteotomy (DTOO) is useful for the treatment of the varus type osteoarthritis of ankle joint. The aim of this operation is to improve the alignment of ankle joint and to achieve the stability of ankle joint again. The purpose of this study is to examine the usefulness of DTOO for the treatment of the valgus type osteoarthritis of ankle joint. Materials were 2 patients suffered from the valgus type osteoarthritis of ankle joint treated by DTOO. We estimated the ankle function and also analysed radiographically before and after operation. The ankle function and the radiogram of the two patient were improved after operation. The conclusion was that DTOO was also useful for the surgical treatments of the valgus type osteoarthritis of the ankle joint.

E-Poster 66:CORRECTION OF EQUINUS CONTRACTURE USING ILIZAROVAPPARATUS WITHOUT HINGE SYSTEM (MATSUSHITA’S METHOD)

Minai, Takayuki, MD Department of Orthopaedic Surgery Teikyo University

School of MedicineTakenaka, N, MD; Maruishi, M, MD; Nishizawa, Y, MD;

Watanabe, Y, MD; Katoh, N, MD; Matsushita, T, MD Department of Orthopaedic Surgery Teikyo University

School of Medicine

Purpose:

To determine effectiveness of Matsushita’s method for Equinus contracture correction through retrospective study of results.

Patients:

10 patients, 10 feet (7 men, 3 women). Age 7-62 (median 33). Etiology-Post trauma: 7 patients. Poliomyelitis: 1 patient. Hemiplegia after SAH: 1 patient. Congenital clubfoot: 1 patient.

Resume:

Equinus contracture could be corrected gradually with Matsushita’s method.

Angle could be improved, but ROM could not be increased

In order to maintain correction, some tendon elongation or arthrodesis was needed in some cases.