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 For many years, the most common approach to a COMMINUTED patella was excision. As further research shed light on the biomechanical importance of the patella, more attention was paid to the complications of patellectomy. So far, numerous attempts have been made to introduce successful alternatives, since nearly 55% of all surgically treated patellar fractures are COMMINUTED (1). Nevertheless, COMMINUTED patellar fractures still pose a challenge to the orthopedic trauma surgeons around the world...

Background: COMMINUTED distal metaphyseal fractures of tibia, often pose major treatment problems. Closed reduction, leads to high rate of malunion, while open reduction is associated with high risk of wound problems, joint stiffness, and nonunion. Biological fixation of these fractures by locking compression plates (LCP) is another alternative for fixation of this difficult fracture.Methods: 22 patients with COMMINUTED fracture of distal metaphysic, in a two-year period were treated with percutaneous application of LCP. The cases were evaluated clinically and rediographically with an average follow-up of 11 months. Results: Union was achieved in 19.2 (15-28) weeks in all cases. No skin breakdown and no malunion were observed. Full ankle motion was observed in all but 3 patients who had restricted dorsiflexion. One case of superficial wound infection was observed. Plate prominency was seen in 3 patients that caused skin irritation in one case. All swellings subsided and blisters healed within two weeks. Conclusions: With better preservation of blood-supply in biological application of LCP plates in distal tibial metaphyseal fractures, fast healing potential with fewer complications is to be expected.