Isolated capitellum humeri fractures in adults

From 2003 through 2009 we treated 35 patients who suffered from an isolated capitellum humerus fracture whom we treated with osteosynthesis. Patients who presented with concomitant fractures were not included. Thirty-four patients were categorized as Type I (Hahn-Steinthal) while one patient was Type IV (McKee). We describe the mechanism of injury and compared our results with works available in the literature. The average age of our patients was 38.6 years which was much younger than many articles about this type of injury found in the literature. The ratio of women to men in our study was 20:15. The surgical treatment was performed with various methods including: Kirschner wires, AO screws, Herbert screws and TwinFix screws. We discuss type of injury, days after injury operative treatment is performed, type of osteosynthesis used, the surgical approaches used for our treatment of capitellum humeri fractures, possible complications and our postoperative treatment. Results at the conclusion of treatment were excellent. Range of motion, shown in detail for each patient, was measured preoperatively, 1 month and 3 months postoperatively. We concluded that the major factors in successful treatment are how quickly the surgical treatment is performed after injury and early postoperative rehabilitation.     

Injuries of the tarsometatarsal joints: treatment and outcome

Between January 2005 and May 2009, a total of 26 patients, 21 males and 5 females, were admitted for treatment of Lisfranc lesion. All patients were radiologically evaluated and classified according to the criteria proposed by Myerson: 5 (19.2%) patients had a type A injury, 2 patients (7.7%) presented with a type B1 injury, 17 (65.4%) sustained the most common type B2 injury and 1 (3.8%) patient suffered from a type C1 and C2 injury. Taking radiological and clinical findings in account, fifteen patients were elected for operative treatment and eleven patients were treated conservatively. According to type of fracture we established three groups; in group I metatarsal fracture was found in fourteen (53.9%) patients, group II with phalangeal fracture in three (11.5%) cases, whereas in group III nine (34.6%) patients sustained combined metatarsal, navicular and, most commonly, a cuneiform fracture. Using the American Orthopedic Foot and Ankle Society (AOFAS) midfoot scoring scale and SF-36 questionnaire, the functional outcome was assessed. The mean value for age distribution was 42.7 +/- 13.2 years and the mean follow up was 27.9 +/- 12.4 months. A p value < 0.005 was regarded as statistically significant for the analysis of the results. We found by means of SF 36 questionnaire a statistically significant difference in the role limitation due to existence of pain (p = 0.04) and poor general health (p = 0.013) in the group of patients that sustained combined foot fracture. The purpose of this study is to assess the treatment of Lisfranc injuries in our patients, according to SF36 and AOFAS criteria, clinical outcome was evaluated. In the group I the mean AOFAS score was 74.0 +/- 9.1 and in the group II it reached 72.0 +/- 5.2 signifying fair outcome! Poor outcome was present in the group III with mean AOFAS score 67.1 +/- 9.0. All unstable injuries require surgery. Clinical outcome is highly dependent on the restoration of normal anatomic alignment.