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Treatment of humeral shaft fractures or performing osteotomies in the ankle: Key procedures for shoulder or lower limb specialists
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Humeral shaft fractures are a common trauma condition that shoulder surgeons often need to treat, whereas ankle osteotomies are one the most used techniques of foot and ankle experts.
These both topics will be largely covered during two Interactive Expert Exchanges (IEE) scheduled during our upcoming 18th EFORT Congress in Vienna. Check out the detailed program of these sessions and participate to perfect your knowledge as a specialist.
Osteotomies Around the Ankle | Thursday 1 June 2017 | 10:15 to 12:30
The ankle joint is the most congruent joint of the lower limb in the human body. It has a special cartilage which is thinner than in other joints, but also stiffer. In contrast to the joints of the knee or the hip, when the ankle joint becomes stiffer, it has a high ability for self-defense against osteoarthritic changes. Therefore, osteotomies may work better for the ankle than for the knee or the hip joints.
This IEE session on ankle osteotomies will provide a deep analysis of supramaleollar, inframaleollar and fibular corrections, as well as a large discussion of how the treatment is performed in particular conditions, like varus, valgus or arthritic ankles. Any type of symptomatic misalignment or malrotation that impacts the loading pattern or impairs the ankle function may be considered as an indication for an osteotomy above or below the ankle joint. This is, analogously, the case for any kind of malposition or malrotation of fibula after malunited fractures. Osteotomies are the treatment of choice as long as motion at the ankle joint is preserved (more than 30°) and osteoarthritic changes remain low. Based on Takakura’s classification, grade 0 to 2 of ankle osteoarthritis with asymmetric load of the tibiotalar joint are an indication for osteotomies to realign the ankle joint complex, thereby normalizing joint load and joint mechanics. In some cases, grade 3 also may be considered, but risk of failure is significantly higher. If osteoarthritis has largely progressed or there is little motion left at the ankle, a total ankle replacement or ankle arthrodesis should be favored.
Smoking and bad bone healing conditions are relative contraindications for osteotomies, whereas patients with infection, severe osteoporosis or Charcot neuropathy will strictly be referred to another kind of treatment. All kind of osteotomies can be combined or be combined with other procedures, such as arthrodesis of neighboring joints, ligament reconstructions and tendon transfers. However, the key of success of any treatment, combined or not, is the correct balancing of the whole ankle joint complex. As gaining motion is normally not an issue, the main goal is to normalize the joint load and the joint mechanics and to prevent any degenerative disease.
Introduction & Moderation
Beat Hintermann (Switzerland)
Supramalleolar Corrections - Opening, Closing, Dome-Shaped or Other
Markus Knupp (Switzerland)
Inframalleolar Corrections - Sliding, Lengthening, Shortening Osteotomies?
Sjoerd Stufkens (The Netherlands)
Fibular Corrections - No or Yes? That Is the Question
Fabian Krause (Switzerland)
The Algorithm for A Varus And A Valgus Ankle
Olivier Michelsson (Finland)
What Can We Expect from Osteotomies Around the Misaligned and Arthritic Ankle?
Roxa Ruiz (Switzerland)
The availability of new ankle prostheses may lead some surgeons to consider their use more aggressively, even in cases in which joint preserving surgery would still work. However, as the patients with ankle osteoarthritis are generally younger than those with knee or hip end-stage osteoarthritis, surgeons will favor a joint preserving procedure as long as possible. Moreover, the medical knowledge around the balancing procedures to preserve the ankle joint has greatly progressed in Europe in the last years.
Humeral Shaft Fractures | Friday 2 June 2017 | 10:15 to 12:30
Humeral shaft fractures are common, at around 3% of all orthopaedic injuries, but there is no standard method of management. Although nonoperative management has a high healing rate (90%), this method has some drawbacks as immobilization of the whole limb for an extended period of time. Some fracture geometries and patient characteristics are more prevalent to nonunion, hence surgery is advocated in these cases; but each surgery school claims that its method is the best.
Also, the close relation between the humerus and radial nerve is responsible of a feared and common traumatic and iatrogenic complication — radial nerve palsy. This IEE will try to solve these differences and come to an agreement for which treatment method is favored in each specific fracture.
The surgeon’s decision between a conservative or a surgical approach to treat a humeral shaft fracture is crucial for each patient. Most surgeons have a preferred procedure which they master and tend to use in most of their patients, but often a “favorite” procedure is not the best in such particular conditions.
Despite being a safe procedure, nonoperative treatment is uncomfortable for an extended period (2 months to 3 months). Patients with a light restricted mobility can fall into a heavy dependent situation after a humeral shaft fracture. Moreover, complex cases are more common among young male patients as they represent a higher risk. Reduction of mobility in those cases can compromise the long-term functionality of an active population. Short-term mobility is great after a successful internal fixation, long-term results are equal between nonoperative and operative treatment, provided there is no complication (which is the drawback of operative treatment).
Introduction & Moderation
Josep María Muñoz Vives (Andorra)
Conservative Treatment
Peter Giannoudis (United Kingdom)
Nailing
Jochen Blum (Germany)
Plating
Michael Plecko (Austria)
Plating - Minimal Invasive
Rafael López Arévalo (Spain)
Discussion on Clinical Cases
Provocateurs: Ulrich Stöckle (Germany) and Christian Candrian (Switzerland)
As for most fractures, multiple procedures can be envisioned for humeral shaft trauma conditions and several of these can be equally successful approaches. During this Interactive Expert Exchange, we will cover nailing, plating and minimally invasive plating in addition to nonoperative treatment options that can all be combined, particularly in non-healing situations. Indeed, in some cases, healing does not occur; not only after nonoperative treatment, but also after operative treatment. If the outcome of a first treatment could be predicted, surgeons could at least prevent patients from spending long periods of immobilization.
It is important to point out the differences between plating and minimal invasive plating, as the “learning curve” of minimally invasive surgery is a big burden on the patient. Indeed, humeral shaft tolerates great deformity without significantly affecting function, but the “corridors” for safe plating are narrower than those of the lower limb.
Finally, as new plates and nails become available, new technical advantages are offered to surgeons, especially in the proximal and distal third. The decision-making can therefore be influenced by these new products which offer better fixation and shorter operative times because there is no need to adapt the implant to the patient humeral shape.
The IEEs are paid sessions and pre-registration is mandatory up to a maximum of 80 participants on a first-come, first-serve basis. IEE sessions may be attended only if the participant is already registered for the EFORT Congress. All details to sign-up for these sessions are available on the registration platform.
- For more information:
- All about 18th EFORT Congress in Vienna | 31 May-2 June 2017
- Format and programs of the 2017 Interactive Expert Exchanges sessions
- Book your seat for the Interactive Expert Exchange session