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      Retrospective analysis of open reduction and internal fixation of coronal plane fractures of the capitellum and trochlea using the anterolateral approach

      1 , * , 1 , 2 , 1 , 1
      EDP Sciences
      Capitellum Fracture, Trochlear fracture, Herbert screw, Anterolateral approach elbow

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          Introduction: Coronal plane distal humeral injuries are relatively rare. Numerous classification systems have been proposed as the complexity of these fractures has been realized. We in the present series of ten patients describe the surgical technique of Open Reduction and Internal Fixation of Coronal plane fractures of the distal humerus with headless compression screws performed using the anterolateral approach.

          Material and method: It was a retrospective study, the data collected from March 2010 to 2015 was analysed and the final outcome was assessed using the DASH score. Out of a total of 13 patients with distal humerus coronal plane fractures, 10 patients were available for follow up. The X-rays and CT scans were reviewed and the fractures were classified according to Dubberley and Bryan and Morrey classification. Radiographic were evaluated for presence of union or nonunion, avascular necrosis, joint line step-off (none/1-mm/>1-mm), hardware failure and instability.

          Results: The average age was 41 years. The average DASH score in our study was around 24. The time to union ranged between 8–12 weeks with the average time being around 10 weeks. One patient had post traumatic Arthritis radiologically classified as Broberg and Morrey Type 2 and one patient had Heterotrophic ossification Brooker Grade 1.

          Conclusion: Open reduction and internal fixation of coronal shear fractures of capitellum and trochlea using headless screw compression via the antero-lateral approach is a reliable treatment modality and results in stable fixation with restoration of a functional arc of motion.

          Level of evidence: IV

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          Most cited references24

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          Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee.

          The purpose of this new classification compendium is to republish the Orthopaedic Trauma Association's (OTA) classification. The OTA classification was originally published in a compendium of the Journal of Orthopaedic Trauma in 1996. It adopted The Comprehensive Classification of the Long Bones developed by Müller and colleagues and classified the remaining bones. In this compendium, the introductory chapter reviews new scientific information about classifying fractures that has been published in the last 11 years. The classification is presented in a revised format that is easier to follow. The OTA and AO classification will now have a unified alpha-numeric code eliminating the differences that have existed between the 2 codes. The code was significantly revised for the clavicle and scapula, foot and hand, and patella. Dislocations have been expanded on an anatomic basis and for most joints will be coded separately. This publication should stimulate new developments and interest in a unified language to code and classify fractures. Further improvements in classification will result in better patient care and clinical research.
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            Ectopic ossification following total hip replacement. Incidence and a method of classification.

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              Results of delayed excision of the radial head after fracture.

              Twenty-one patients had a delayed excision of a previously fractured radial head (range, one month to more than twenty years). There were four Mason type-II and seventeen Mason type-III fractures. Five fractures had been associated with a concomitant dislocation of the elbow and four, with an ulnar fracture. All of the patients were evaluated for pain, motion, strength, stability, and function by personal interview, examination, and testing in an upper-extremity-biomechanics laboratory. The average length of follow-up was fifteen years (range, three to thirty-two years). Postoperatively, pain was less severe in 76 per cent of the patients and motion was improved in both flexion and rotation in 81 per cent. An objective functional index showed that 77 per cent of the patients had a good or excellent result while 23 per cent had a fair or poor result. This study demonstrates the effectiveness of delayed excision after failure of closed management of fractures of the radial head. Thus, some justification is offered for the initial closed treatment of these fractures, with delayed excision of the radial head to be considered as needed.

                Author and article information

                SICOT J
                SICOT J
                EDP Sciences
                16 March 2018
                : 4
                : ( publisher-idID: sicotj/2018/01 )
                : 8
                [1 ] Department of Orthopedics, Apollo Hospital, Sarita Vihar, Delhi 110076 India
                [2 ] Maya Hospital, Farrukhabad, Uttar Pradesh India
                Author notes
                [* ]Corresponding author: tanwar_yashwant@ 123456yahoo.co.in
                sicotj170074 10.1051/sicotj/2017063
                © The Authors, published by EDP Sciences, 2018

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                : 14 June 2017
                : 15 December 2017
                Page count
                Figures: 10, Tables: 2, Equations: 0, References: 24, Pages: 10
                Original Article

                capitellum fracture,trochlear fracture,herbert screw,anterolateral approach elbow


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