Date: 2017-11-30 Session: Upper Limb Trauma Free Papers Time: 08:00 - 10:00 Room: 01. Auditorium II Abstract no.: 48755 FRACTURE BOTH BONE FOREARM IN ADULTS: MANAGEMENT BY NAILING COMPARED WITH PLATING Amiya BERA Murshidabad Medical College & Hospitals, Berhampore (INDIA) Out of 500 cases of nailing both bone fracture forearm in adults, we studied 200 cases and compared it with 110 cases of plating both bone fracture forearm in a retrospective study – to evaluate usefulness of nailing in day-to-day practice. Clinical, radiological, objective and subjective assessments were done. Earlier open nailing changed to closed nailing with availability of c-arm, has improved results, and in spite of anatomical alteration biological nailing has several advantages with less complications compared to plating. Nailing, a cheap option still has a role in third world countries with poor economic condition, while plating is gold standard. Date: 2017-11-30 Session: Upper Limb Trauma Free Papers Time: 08:00 - 10:00 Room: 01. Auditorium II Abstract no.: 48777 UPPER LIMB GUNSHOT INJURIES: THE CAPE TOWN EXPERIENCE Esmee ENGELMANN1, Sithombo MAQUNGO2, Stephen ROCHE2, M HELD2 1Groote Schuur Hospital, Amsterdam (NETHERLANDS), 2Groote Schuur Hospital, Cape Town (SOUTH AFRICA) Background: Upper extremity gunshot fractures are generally treated conservatively or surgically using open reduction and internal fixation (ORIF), intramedullary nails (IM) or external fixators. However, there is no gold standard for the management of these complex, multi-fragmentary upper extremity fractures. Aim: To describe and identify the injury patterns, management, complications and associated risk factors for upper extremity gunshot fractures. Methods: Data of patients with upper extremity gunshot injuries that presented to a Level I Trauma Unit in Cape Town, South Africa was collected prospectively over a ten-month period from June 2014 to April 2015. Clinical notes and radiographs were reviewed retrospectively. Results: Fifty percent of patients had fractures, most were diaphyseal, multifragmentary and extra-articular. 30% Had neurovascular injuries and 75% were associated with non-orthopaedic injuries. Fractures were treated conservatively in more than half of the cases; when surgically treated ORIF was most common, followed by intramedullary nailing and external fixation. Median fracture length was 5.5 centimetres. A longer fracture zone was statistically associated with surgical treatment (p<0.01). Median hospital stay was 6 days; infection and injury severity prolonged hospital stay (p<0.01). Five patients had ten re-operations; two were unplanned due to sepsis. Six cases of secondary infections were seen in 51 patients without identifiable. Discussion: In contrast to studies from the USA and Europe, most fractures were managed conservatively. Most fractures were diaphyseal and multifragmented, one third had neurovascular injuries and the majority had other additional injuries. Hospital stay was prolonged by infection and a higher injury severity score. Date: 2017-11-30 Session: Upper Limb Trauma Free Papers Time: 08:00 - 10:00 Room: 01. Auditorium II Abstract no.: 48800 SCAPULA FRACTURES: PLANNING OSTEOSYNTHESIS USING 3D PRINTED ANATOMICAL MODELS Johan CHARILAOU1, Steven ROCHE1, Dey ROOPAM1, Sudesh SIVARASU1, Frida HANSSON2, Ruan VAN STADEN3, Sithombo MAQUNGO1, Carey LINDEN1 1Groote Schuur Hospital, University of Cape Town, Cape Town (SOUTH AFRICA),2Karolinska Institutet, Stockholm (SWEDEN), 3Tygerberg Hospital, University of Stellenbosch, Cape Town (SOUTH AFRICA) Background: Scapula fractures are challenging to treat surgically. Bony anatomy, uncommonly used approaches, implant limitations and morphological variance of fracture patterns may lead to difficulty achieving favorable outcomes. Three-dimensional (3D) models can help with a better understanding of fracture patterns and reduction maneuvers required to achieve anatomical congruence. Our hypothesis is that preoperative planning of acromion fracture fixation by means of a tactile and visual 3D experience is beneficial. Methodology: Patients sustaining scapula fractures following blunt trauma presenting to a tertiary academic hospital from 2012 to 2016 were identified (n=41). Computed tomogram (CT) scans of acromion fractures (n=15) were converted to real size 3D models using Materialise Mimics. Three categories of fit between plate and model interface were used as a grading system. A quantitative fit analysis of available implants on the reconstructed 3D models was done. Two separate assessments of each acromion were performed by five different observers. Results: An inter-observer Intraclass Correlation Coefficient (ICC) of 0,95 was obtained. Clavicle plates had the best overall anatomical fit (n=13, 86.7%). The 6-hole anterior clavicle plate had the highest (23.2) cumulative grading. The 3D models were adequate and anatomically representative in all fractures (n=15, 100%). Minor debridement around the fracture site to obtain anatomic reduction was needed (n=6, 40%). Conclusion: Clavicle plates are superior for acromion fracture osteosynthesis. There is a need for a more anatomical and versatile plating system. Simulating fracture fixation using 3D models is a good preoperative planning tool. Date: 2017-11-30 Session: Upper Limb Trauma Free Papers Time: 08:00 - 10:00 Room: 01. Auditorium II Abstract no.: 48783 AUGMENTATION PLATE FIXATION AND BONE AUTOGRAFTING IN HUMERAL NONUNION WITH CORTICAL THINNING AFTER INTRAMEDULLARY NAILING Pavel VOLOTOVSKI1, Aleh KORZUN2 1RSPC Traumatology and Ortopaedics, Minsk (BELARUS), 2National Research and Clinical Center Of Trauma and Orthopaedic Surgery, Minsk (BELARUS) Background: Intramedullary nailing is safe and efficient choice of surgery in humeral fractures, but nonunions is quite often till nowadays. Osteoporosis with cortical thinning makes the salvage procedure more difficult and often lead to fixation failure. Materials & Methods: We retrospectively analyzed 14 patients with humeral nonunion whith cortical thinning after anterograde intramedullary nailing underwent augmentation plate fixation (with nail in situ) and bone autografting between Nov 2010 and Feb 2015. Lateral or antero-lateral approach and 3,5 mm locked-compression plate was utilized in all cases. In 10 cases addition interfragmentary lag screw or wire serclage were used. Proximal tibia bone grafting was performed in all 14 patients. Outcomes analyzed were: nonunion rate, reoperations. The mean term of final outcome assessment was 4,2±1,8years (2-7 yrs). Results: 12 of 14 pseudoarthrosis were united. Secondary surgeries – 2\14 (14,2%) - included plate exchange and repeated bone autografting. Conclusion: Augmentation plate fixation and bone autografting in humeral nonunion with cortical thinning after intramedullary nailing is reliable procedure with quite high union rate. Date: 2017-11-30 Session: Upper Limb Trauma Free Papers Time: 08:00 - 10:00 Room: 01. Auditorium II Abstract no.: 48745 CLINICAL OUTCOMES IN MANAGEMENT OF UNSTABLE DISTAL RADIUS FRACTURES TREATED WITH EXTERNAL FIXATION AND INTERNAL FIXATION - A PROSPECTIVE COMPARATIVE STUDY Manish Kumar SHARMA1, Sunil Kumar DASH1, Sanket MISHRA1, Aurobinda DAS1, Deepankar SATHAPATHY2, Syed Shahruq AHMED1, Anmol Shiv ARORA1 1Hi Tech Medical College, Bhubaneshwar (INDIA), 2IMS SUM, Bhubaneshwar (INDIA) Background: Management of Distal Radius fracture that are inherently unstable is still a matter of debate. There is no conclusive evidence that support one surgical fixation method over another. An analysis patients treated with ExFix and Internal-Fixation for unstable distal radius fractures and evaluate the clinical efficacy of Exfix using principles of ligamentotaxis and Internal-fixation and compare functional recovery, fracture healing time and complications.Method: A prospective trial was undertaken at our hospital with 35 patients, all aged >20 yrs with closed distal radius fracture and divided into two groups: group I (Exfix- with or without percutaneous k wire, and JESS) and group II (Int-Fixation) including 14 and 21 patients, respectively. Periodic clinical examination and x-ray review was carried out to find out fracture union, and functional assessment. Patients were followed up for 1 year,6 months average.Results: Exfix consumed significant less operative time, fluoroscopic exposure, reduced hospital stay and quicker post-operative pain relief. Quick DASH score were significantly high in elderly treated with ExFix in comparison to young in which DASH score was higher with internal-fixator. Functional recovery was early with int-fixation but post-operative wrist stiffness was also higher. 2 cases of delayed wound healing &1 case of pin track infection with exfix application was observed.Conclusion: Internal-fixation remains the treatment of choice for unstable distal radius fracture involving the articular surface and in the young, while ext fixation can be considered as a primary treatment modality in the extraarticular fractures in young or even intraarticular fractures in the elderly. Date: 2017-11-30 Session: Upper Limb Trauma Free Papers Time: 08:00 - 10:00 Room: 01. Auditorium II Abstract no.: 48792 THE MANAGEMENT OF ADULT OLECRANON FRACTURES Hammad PARWAIZ1, Sherif KAMEL2, Richard MURPHY2, Tristan BARTON2 1Royal United Hospital Bath, Bristol (UNITED KINGDOM), 2Royal United Hospital Bath, Bath (UNITED KINGDOM) Introduction: There is variation in practice when dealing with adult olecranon fractures. We aimed to assess the literature