Journal of Trauma & Treatment

Osteoporotic fragility fractures are a significant cause of morbidity for the geriatric population. One third of women and one fifth of men over 50 will sustain a fragility fracture in their lifetime [1]. In the United States alone, this adds up to an estimated 2 million fractures each year [1]. These numbers are expected to rise in future years as the baby boomer generation advances in age. Conservative estimates have the number of osteoporotic hip fractures increasing from 330,000 yearly (at present) to 550,000 by 2040 [2,3].

An article published in the New England Journal of Medicine focuses on personal responsibility for medical error, suggesting that restoring the balance between personal accountability and a ?noblame? system is the key factor in eliminating medical error [1]. The authors of this article write as if there has been a ?no-blame? system in place and that it is now time to reinstitute personal responsibility. We believe the opposite has been true. The current medical culture of blame, malpractice and reactionary punishment?all of which are based on the idea that one human or a team of humans is responsible for an error?has been in place for decades and has failed to improve safety [2]. The concept of personal responsibility and liability has been in place from before the IOM report on medical error in 1999 and things have not changed [3].

Study background: Thoracolumbar fractures are among the most common type of traumatic spine fractures. The use of minimally invasive, percutaneous pedicle screw fixation for these fractures has been limited to case reports and small case series. The efficacy of this approach remains unclear. Methods: The evaluation and management of a patient with traumatic T12 burst fracture is presented. In addition, a literature review of the Medline and PubMed databases was conducted. Results: A total of 166 patients from 8 studies were identified. Average age was 46 years. Polytrauma was reported in 27% of patients. Average surgery time was 91 minutes, with an average blood loss of 95 milliliters. Reported complications were non-healing fracture in 3(2%), infection in 1(0.6%), mal-positioned screw in 1(0.6%), and hematoma in 1(0.6%) at a median follow-up time of 26 months. Pain improved by an average of 6 points after surgery according to visual analog score, and mean kyphosis correction in these studies was 8.5°. Conclusions: This review demonstrates that minimally invasive, percutaneous pedicle screw fixation is a viable option for the management of traumatic thoracolumbar fractures in neurologically intact patients. Patients who are older and/or present with polytrauma may most benefit from this type of intervention.

Background: Tibial nailing is a standard treatment of tibial fracture. Placing the nail in the wrong position will result in poor fracture alignment and potentially damage to cortical bone. But the exactly entry point of this technique in Thai people has never been studied. In Chiang Mai University hospital, a tibial SIGN nail is commonly used in tibial shaft fracture.

Objective: To identify the accurate entry point for tibial nailing with tibial SIGN nail, defined as the point which will provide adequate fracture alignment.

Design: Cadaveric study

Methods: Twelve cadavers with attached knee joints underwent tibial nailing with tibial SIGN nails. After placement of the nail, the specimens underwent osteotomies at the level of 10 centimeters distal to the articular surface. Multiple entry points were tested to determine fracture alignment. Medial?lateral and anterior?posterior displacements from plain radiography were recorded for these various points of entry.

Results: In coronal plane, the entry point at the sixty percent from medial edge of tibial plateau was identified as minimizing the medial-lateral displacement of the tibial shaft following fracture. In sagittal plane, the entry point of 20mm posterior to the tibial tubercle resulted in the least anterior-posterior displacement.

Conclusion: When tibial nailing with tibial SIGN nail was used, the entry point of 20 mm posterior to the tibial tubercle and sixty percent of the total distance from medial tibial plateau provided the accurate balance of fracture reduction.

Background: The Comminuted subtrochanteric femoral fractures are considered as one of the most difficult fractures to treat in the orthopaedic literatures. The aim of this prospective study was to evaluate the indirect reduction and biological fixation technique with Dynamic condylar screw and plate fixation for the treatment of comminuted subtrochanteric femoral fractures.

Method: Thirty one cases suffered from comminuted subtrochanteric fractures femur, AO classification (type C), were treated by biological fixation, indirect reduction method with Dynamic condylar screw and plate fixation.

Results: The cases were followed up by clinical and radiological examination from 12 to 32 months (mean 22 months). In all cases union in acceptable alignment were achieved from 15 to 24 weeks (range from 3 to 6 months) (mean 4.5 months) in all cases except, three cases (9.7%) with failures of the fixations due to osteoporosis and early full weight bearing one week after surgery. With exception of 3 cases with fixation failures who excluded from the analysis of the functional results, all the cases had good functional outcome as regarding to Harris hip score which varying from 70 to 95 (mean 85).

Conclusion: Indirect reduction and biological fixation with Dynamic condylar screw and plate fixation is considered as a valuable cheap fixation method for the management of comminuted subtrochanteric fractures femur especially in young patients’ populations.