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The objective of this study is to evaluate clinical and radiological outcomes of unstable or intra-articular Colles' fractures using the Pennig model of external fixation. The Pennig model of dynamic external fixation was used on 88 patients with 92 Colles' fractures. In 35 wrists, exercise was not performed during external fixation. In 57 wrists, exercise was initiated three weeks after surgery. Regarding radiological measurements, the degrees of volar tilt (VT), radial inclination (RI), radial length (RL) and ulnar variance (UV) were serially measured and evaluated. The clinical results were evaluated according to Sarminento's criteria. Favourable therapeutic outcomes (excellent and good) were obtained in 95.6% of the cases. However, when complicated by die-punch fractures, the outcome tended to be poorer. Postoperative re-displacement was often observed in patients over 50 years old. UV tended to increase and RL tended to decrease in the early motion group after the initiation of exercise. Neither VT nor RI significantly changed in either group during the postoperative observation period. Of patients in whom bone union of ulnar styloid fractures was not achieved, 32.2% complained of ulnar pain. Moreover, osteoarthritic changes were observed in two of 11 wrists with a step off of 1 to 2 mm or larger. In order to maintain the reduction position, it was important to determine the appropriate time for initiating exercise depending on the degree of fixation in each individual patients. The step off of the articular surface should be reduced to less than 1 mm and reductive fixation has to be performed additionally when complicated by ulnar styloid fractures.

Twenty-eight patients older than 70 years with AO type C fracture of the distal radius were treated with arthroscopically assisted reduction combined with volar plating or external fixation. The patients were followed up for an average of 24.9 ± 16.1 months. The average score was 80.1 ± 10.5 according to the modified system of Green and O'Brien. Eight patients had an excellent result, 11 had a good result, seven had a fair result, and two had a poor result. Twenty-three patients were able to return to their previous activities level or occupation without any restriction. On the basis of these results, we concluded that arthroscopically assisted reduction combined with volar plating or external fixation is one of the useful options for the treatment of a displaced intra-articular fracture of the distal radius in elderly patients who are physiologically young or active.

Proximal interphalangeal joint (PIPJ) fractures are a treatment challenge for hand surgeons. Poor treatment options may lead to stiffness, non-union and markedly reduced range of movement (ROM). We describe our experience using the Hoffman-2 micro static external fixation device (Stryker) in a case series of ten patients with closed comminuted intra-articular PIPJ fractures. The use of this device in the management of these fractures has not previously been described. The mean total active motion (TAM) of the injured joint had recovered to 80% of normal at the six-month follow up.

Wrist arthrodesis is exceptionally performed in children. The main indication is severe wrist flexion contracture resulting from Volkmann's ischaemia or spasticity. In such cases, a proximal row carpectomy is usually necessary to allow the wrist to be positioned in neutral position. In young children, it is essential to preserve the distal radius growth plate, to prevent physeal closure. In these very particular indications, with high stresses along the stretched palmar soft-tissues, Kirschner wire fixation provides poor stability, and plate fixation is contra-indicated. Radio-metacarpal external fixation is an excellent alternative, preserving the distal radius growth plate and offering sufficient stability. This technique was used in a seven-year-old girl suffering from Volkmann's ischaemic contracture, treated by first carpal bone resection and subsequent arthrodesis with radio-metacarpal external fixation. Bone healing was achieved in three months, with a five years follow-up preservation of the distal radius growth plate.

A 13-year-old girl sustained epiphyseal fractures of the proximal phalanges of the left index, middle, and ring fingers. Though manual reduction of the 3 fingers was possible, it was difficult to maintain the reduction due to severe instability of the middle and ring fingers, and closed reduction with external fixation was performed. At 4 years post-injury, the patient had no impairment of daily activities. The use of external fixation (1) causes no injury to the epiphyseal cartilage, (2) enables accurate reduction and maintenance of reduction, (3) is technically easier than pinning, (4) enables earlier range of motion (ROM) exercises of the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints of the externally fixated and other fingers, and (5) allows repeated fine adjustments after reduction. External fixation is an option for the treatment of children with highly unstable epiphyseal fractures of the proximal phalanges.

Background: Acromioclavicular joint (ACJ) dislocations are among one of the most common injuries of the shoulder and still a challenge for surgeons. We propose a technique that combines the advantages of external fixation (to obtain a stable reduction of ACJ) and a modified suspension device system (for minimally invasive ACJ reconstruction) in acute dislocations. We tend to add associate augmentation of autologous semitendinosus graft to supply a biological reconstruction of the coracoclavicular (CC) ligaments in chronic dislocations.

Material and Methods: We enrolled 8 patients, 6 with acute and 2 with chronic injuries. Inclusion criteria were the following: types IV, V, and VI ACJ dislocations; type III ACJ dislocations in high-demand patients. Exclusion criteria were the following: asymptomatic chronic ACJ dislocation without functional impairment, previous coracoid or clavicle fracture, nonparticipating patients, alcohol abusers, previous infection, and neurological problems. The external fixator was removed at 40 days after surgery and patients were followed up clinically (through Constant Score and Simple Shoulder Test Questionnaires) and radiologically for the first three months, at six months and one year after surgery.

Results: In all cases, radiographic ACJ reduction was maintained at a minimum one-year follow-up. Steel wire breakage occurred in one patient but the retained tip in the clavicle was asymptomatic; we report no further complications. Shoulder active and passive range of motion was painless in all patients; the Constant score (CS) was 85/100 and the Simple Shoulder Test (SST) score was 9/10 on average at one year of follow-up.

Conclusions: Our technique demonstrated stable joint reduction and good functional outcomes at one-year follow-up and it seems to be promising, but more clinical and biomechanical studies are required to confirm these encouraging results.

Most distal radius fractures are the result of low-energy mechanisms that can be successfully treated either non-operatively or with a variety of operative techniques if indicated. Complex distal radius fractures occur most commonly in high-energy injuries with extensive comminution or bone loss and associated soft tissue or vascular injuries. These high-energy fractures can present many challenges in reconstructing the distal radius. Effective restoration of the bony architecture requires a thorough knowledge of distal radius anatomy, understanding of the goals of treatment, versatility in surgical approaches, and familiarity with multiple fixation options.

Background: Most unstable hand fractures in children are treated by closed methods. If osteosynthesis is required, Kirschner (K)-wires are commonly used, though they carry a risk of injury to the physis. We have been using a mini external fixator system (MEFS) for the treatment of unstable periphyseal fractures of the hand. The aim of this study is to describe the application and report the outcomes of MEFS for the treatment of periphyseal fractures of the hand.

Methods: We retrospectively reviewed all the patients with periphyseal fracture of the hand treated with MEFS from March 2010 to December 2019. Data with regard to age, sex, hand dominance, digit and bone injured, mechanism of injury, medical records and related radiographs were collected. Salter–Harris classification was used to classify epiphyseal fractures and the Al-Qattan classification for categorising neck fractures. Range of motion and residual deformity of the affected fingers were evaluated during follow-up and at 3 months postoperatively.

Results: Fourteen periphyseal unstable fractures were treated using closed reduction and MEFS. Only one patient with a fracture of the neck of the proximal phalanx of the little finger required revision surgery. No patient had pin site infection or pin loosening and the device was well tolerated by all patients. All fractures united and all the patients recovered a full range of motion at final follow-up.

Conclusions: The MEFS is a reasonable alternative for unstable periphyseal fractures with good outcomes and avoids the risk of iatrogenic physeal injury from K-wire fixation.

Level of Evidence: Level IV (Therapeutic)