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Intra-Articular Distal Radius Fracture with Lunate Fossa Rotated and Associated Lesions: Radiologic Analysis

Open Journal of Orthopedics 2023年第4期13卷 123-130页

作者： issam ait hadj sliman Cesar Tommeh Frederic Desmoulin André-Pierre Uzel Department of Orthopaedics and Traumatology Pointe-à-Pitre Hospital Pointe-à-Pitre France

Introduction: Intra-articular distal radial fractures in young patients occur in high energy trauma which can lead to a combination of bone and ligaments lesions. An articular step superior to 2 mm is pejorative, for that an adequate radiologic analysis is necessary accessing to the best surgical treatment. The purpose of our study was to investigate this type of fracture and expose radiologic analysis (radiograph and CT-scan) of bone and ligamentous associated lesions of this specific twisted lunate facet fracture for recognizing it and accessing to the best surgical treatment. Patients and Methods: Seven patients with severely displaced type 4 articular fractures of the distal radius whose wrists had been exposed to violent compression are reported in our series, they are required open treatment for the reduction and fixation of disrupted articular surfaces by using an antero-medial approach which allows direct access to the fragment of the lunate facet and easier visualization of the distal radio-ulnar joint. Results: All the patients were clinically examined with antero-posterior and lateral X ray, completed by a CT scan, all the fractures were type IV according to Melone classification. In all of our seven cases there was a lesion of the distal radioulnar joint (DRUJ) identified in the CT scan. The CT scan allowed us to individualize well the void of the lunate fossa and calculate his exact degree of rotation, which is very important for planning therapeutic management. Discussion: In all of our cases the CT scan was to expose all of the osseous and ligamentous injuries;in the sagittal reconstruction we were able to objectify and calculate the exact degree of the rotation of the lunate fossa fragment;in the frontal reconstruction the void of the lunate fossa is visible and in the axial reconstruction we can determine the incongruence of the distal radio-ulnar joint (DRUJ). Intra-articular involvement has long been recognized as a poor prognostic factor in fract

关键词： Articular Fracture Lunate Facet Distal Radio-Ulnar Joint Wrist Radiograph CT-Scan

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Surgical Treatment for Proximal Humerus Fractures Comparison between Plate Fixation and Kapandji’s Pinning

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Open Journal of Orthopedics 2022年第12期12卷 474-484页

作者： issam ait hadj sliman Amine Abdelaoui Elhoussain Zim Mohamed Haddou Amine Benhima Imad Abkari Youssef Najeb Department of Orthopedic Surgery and Trauma Hopital Ibn-Tofail CHU Mohammed VI Marrakesh Morocco

Introduction: Proximal humerus fractures are common, however, there is no consensus on a decision-making algorithm for the therapeutic management of these fractures, the aim of this study is to evaluate and compare functional results between two surgical techniques and to deduce the satisfactory results of the Kapandji’s pinning which, compared to the screw plate, should keep its place in the therapeutic arsenal. Patients and Methods: It’s a retrospective study, including two groups: The first of 18 patients treated with palm-tree pinning using kapandji’s technique, the second of 16 patients treated with anatomical screw plate at the orthopedic trauma service of the Mohamed VI university hospital between July 2013 and July 2018. We compared the results of the two techniques by studying three parameters which are the healing time, the anatomical reduction, and the functional outcomes. The average age was 46 years, and the sex ratio (M/F) was 2.3. Results: The statistical analysis of functional and radiological results showed no significant difference between the two techniques, indeed the average healing time was 56.3 days in the group treated by screw plate and 55.2 days in the group treated by Kapandji’s pinning (p = 0.46), Constant’s score was 73.18 and 79.05 respectively (p = 0.27) and the average cephalodiaphyseal angle was 49.03° and 52.07°, respectively (p = 0.35). Discussion: This study has clearly shown, as reported in the literature, that there is no conclusive evidence to suggest superiority of os-teosynthesis by anatomical plate versus kapandji’s pinning. However, the simple achievement of pinning according to kapandji’s technique, the preservation of soft tissues and the low cost make us prefer this technique. Furthermore, despite the progress noted in the development of osteosynthesis means of the proximal humerus, percutaneous pinning should always keep its place.

关键词： Fracture of Proximal Humerus Osteosynthesis Humeral Anatomical Plate Kapindji’s Pinning

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