Background: Treatment of COMMINUTED FRACTURES of long bongs has been a problem in orthopaedic surgery. Recently fixation with out opening the fracture site, known as biological fixation has been used. We performed this study to assess the results, and rate of complications of this treatment for COMMINUTED FRACTURES of the tibia and femur in our institution. Methods: Twenty patients, referred to two teaching hospitals, who has COMMINUTED FRACTURES of Femur (15 patients) or tibia (5 patients), not suitable for fixation with closed intramedullary nailing, were treated with biological fixation method. Two patients with femoral fracture, had type IIIA open FRACTURES and two patients with tibial fracture had type II open FRACTURES. The rest of the cases (16 patients) had closed FRACTURES. After biological fixation, patients started range of motion of the joints, but avoided weight bearing until radiographic evidence of union. Results: All the patients had union of FRACTURES with mean time to union of 5.5 months for femoral and 7.5 months for tibial FRACTURES. One of the femoral FRACTURES had shortening of 1 cm and another one, had implant failure due to early weight bearing. There was no infection in closed FRACTURES, but two patients with open FRACTURES developed infection. None of them had limitation in joint motion. Conclusions: Biological plating method is a safe, simple and effective method of fixation for closed COMMINUTED FRACTURES of long bones. It has a high rate of union with minimal complication. It is not recommended for open FRACTURES because of high infection rate.

BACKGROUND: The treatment of COMMINUTED FRACTURES in long bones has continued to be a problem in orthopedic surgery. Recently, fixation without exploration of the fracture site, known as "biologic fixation”, has been introduced. This study was performed to assess the results and complications of this method for the treatment of COMMINUTED FRACTURES of the tibia and femur. METHODS: The study included 41 patients with COMMINUTED FRACTURES of the tibia and femur treated with biologic plating from 2003 to 2006 (25 femur FRACTURES and 16 tibial FRACTURES). After biological fixation joint motion was started but weight bearing was avoided until radiographic evidence of union was shown. RESULTS: The mean time of union in the tibial FRACTURES was 19±2 weeks and 17±2 weeks for the femur FRACTURES. All patients had fracture union without any infection, non-union or implant failure. In one patient with a femur fracture there was a 10o internal rotation deformity. Two of the femoral FRACTURES had shortening of 1 cm, and one patient had shortening of about 2 cm. Compared to similar studies, all results were statistically significant (P<0.05). CONCLUSIONS: The biologic plating method is a safe, simple and effective method of fixation for COMMINUTED FRACTURES of long bones. It has a high rate of union with minimal complications.

Background: Distal radius FRACTURES are among the most common FRACTURES. They can happen at any age group, and there are several treatment options and several classification systems for these FRACTURES. One of these classifications is that of Fernandez. In this study, we evaluated the results of treatment of distal radius FRACTURES by bridging external fixator and percutaneous pinning. Methods: In a cross-sectional study, 72 patients with Fernandez type 3, 4 and 5 that underwent external fixation and percutaneous pinning for COMMINUTED distal radius FRACTURES were followed and assessed after 3 and 6 months. Results: The 72 patients had mean age of 44. 2 years. 55% were male. The most common cause of FRACTURES was vehicle accidents. 4 cases of malunion, 4 radial nerve injuries, 2 fixator loosening and 6 cases of infection were encountered. Conclusion: External fixator supplemented by percutaneous pinning is an efficient technique for treatment of unstable distal radius FRACTURES. It has low rate of complication and high rate of patient's satisfaction.

Background: Bridge plate osteosynthesis of FRACTURES by minimal invasion and near acceptable reduction is becoming popular and acceptable entity. Management of humeral shaft fracture has evolved a lot with their pros and cons. Anterior bridge plate osteosynthesis (ABPO) for humeral shaft fracture is pertinent to a minimal invasive procedure, and it has evolved as a new entrant in the surgical techniques. This study was designed to carry out the results and efficacy of ABPO in the COMMINUTED fracture shaft of the humerus in the manual workers. Methods: Study included the closed COMMINUTED fracture of shaft of humerus in skeletally mature patients engaged predominantly in manual works, like overhead sports activity, laborers, and industrial workers. All FRACTURES were managed by either 4. 5-mm narrow locking compression plate (LCP) or dynamic compression plate (DCP). The functional outcome for elbow was measured by Mayo's elbow performance score (MEPS) and functional outcome of shoulder was measured by UCLA (University of California at Los Angeles) shoulder score system. Results: In this study 37 patients were enrolled. Mean duration for satisfactory radiographic union was 12. 3 weeks. The mean duration of follow-up period was 14. 5 months. In respect to elbow function, the average Mayo elbow score was 92. 42 ± 2. 17 and average UCLA score of shoulder function was 34 ± 0. 34. Conclusion: The ABPO is an optimum choice for managing the COMMINUTED fracture shaft of humerus in manual labors. The outcomes are favorable and reproducible with very few risks.

Background and Objective: Today the COMMINUTED femoral FRACTURES are very common because increment of vehicles traffic and accident. These FRACTURES can lead to long-term disabilities. This type of fracture has always been a problem for the society of orthopedic surgeons, and various methods of treatment have been suggested in the literature and references.The goal of the study was to determine the outcomes of using minimal invasive technique, which is referred to a new method and technique.Materials and Methods: This study is a prospective one, which was carried out on 36 patients with COMMINUTED femoral FRACTURES who had not suffered burning, open fracture, head injuries. The patients had referred to the Shohada hospital in the course of six months (From 23 October 2004 to 20 April 2005), and undergone plating surgery with minimum manipulation, and followed up from 6 to 12 months. Follow up evaluation study were include the time of union and the status of the extremities from the view point of rotation, shortening and lengthening.Results: The results showed that complete union rate was 77.8% (24 out of 36 patients) with the delayed union were seen in 22.7% (7 out of 36 patients) in six months. There was no serious complication in the follow- up period other than a few superficial infections. There was no significant correlation between the union rate and sex. However, there was a statistically significant correction between age and union. Lengthening of the extremities ranging from 1-2 cm was observed in 10 patients, while shortening of lower than 1cm was also observed in 4 patients. Rotation disorder existed in 8 patients with internal rotation and in 2 patients with external rotation.Conclusion: The new plating technique with minimum manipulation can be regarded as a suitable substitute for the previous ones. The basic principle of this method is not damaging the soft tissue at the fracture site which leads to faster healing of the bone. This technique is, in fact, a biologically stabilizing method similar to the closed intramedullary nailing technique.

Background: COMMINUTED radial head FRACTURES are often associated with secondary injuries and elbow instability.Objectives: The aim of this retrospective study was to evaluate how well the modular metallic radial head implant EVOLVEÒ prosthesis restores functional range of motion (ROM) and stability of the elbow in acute care.Patients and Methods: Eighty-five patients with COMMINUTED radial head FRACTURES and associated injuries received treatment with an EVOLVEÒ prosthesis between May 2001 and November 2009. Seventy-five patients were available for follow-up. On average, patients were followed for 41.5 months (33.0: 4.0 - 93.0). Outcome assessment was done on the basis of pain, ROM, strength, radiographic findings, and functional rating scores such as Broberg and Morrey, the Mayo elbow performance index (MEPI), and disabilities of the arm, shoulder and hand (DASH). Our study is currently the largest analysis of clinical outcome of a modular radial head replacement in the literature.Results: Overall, there were 2 (2.7%) Mason II FRACTURES, 21 (28%) Mason III FRACTURES, and 52 (69.3%) Mason IV FRACTURES. Arbeitsgemeinschaft fur osteosynthesefragen (AO) classification was also determined. Of the 85 patients in our study, 75 were available for follow-up. Follow-up averaged 41.5 months (range, 4 - 93 months). Average scores for the cohort were as follows: Morrey, 85.7 (median 90.2; range 44.4 - 100); MEPI, 83.3 (85.0; 40.0 - 100); and DASH 26.1 points (22.5; 0.0 - 75.8). Mean flexion/extension in the affected joint was 125.7o/16.5o/0o in comparison to the noninjured side 138.5°/0°/1.2°. Mean pronation/supination was 70.5o/0o/67.1o in comparison to the noninjured side 83.6°/0°/84.3°. Handgrip strength of the injured compared to the non-injured arm was 78.8%. The following complications were also documented: 58 patients had periprosthetic radioluceny shown to be neither clinically significant nor relevant according to evaluated scores; 26 patients had moderate or severe periarticular ossification, and scored substantially worse according to MEPI and Morrey. Four patients required revisional surgery due to loosening of the prosthesis and chronic pain. In addition, one patient required a neurolysis of the ulnaris nerve, one developed a neobursa, and one had extensive swelling and blistering. The time interval between injury and treatment appeared to have an effect on results. Thirty-five patients were treated within the first 5 days after accident and showed better results than the 40 patients who were treated after 5 days.Conclusions: COMMINUTED radial head FRACTURES with elbow instability can be treated well with a modular radial head prosthesis, which restores stability in acute treatment. The modular radial head arthroplasty used in this study showed promising findings in short to midterm results.