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replacement of bone graft for non-union surgery.

doi:10.1016/j.injury.2011.06.272

20 Abstracts / Injury

he optimal pin position is not established from clinical trials. Theim of this study was to evaluate the radiological outcome of distaladius fractures after extra-focal k-wire fixation and to compare 3ire with 2 wire technique.

Methods: All distal radius fractures treated extra focal k-wirexation with available digital radiographs were reviewed betweenugust 2007 and February 2010, yielding 70 cases. 52 patients hadeen treated with 2 wire technique and 18 with 3 wire technique.re-operative, post fixation and follow up radiographs were eval-ated and radial inclination, volar/dorsal tilt and ulnar varianceeasured. The radius was defined as short with a positive ulnar

ariance >2 mm. Radial inclination and volar tilt angle were com-ared between the 2 groups using Student’s t-tests.

Results: Mean ages in the 2 wire and 3 wire groups were 59.4nd 64.8 respectively (p = 0.15) and time for injury to fixationas 5.9–8.3 days. Initial volar tilt was −15.9 in the 2 wire group

ersus −11.6 in the 3 wire group (p = 0.048) and after fixationere −0.6 versus +4.5 respectively (p = 0.034). There was no sig-ificant difference in the improvement in volar tilt between the 2roups (15.3 versus 16.1). Final volar tilt measurement (−3.4 versus0.4) demonstrated no significant difference between the 2 groups.here were no significant differences in terms of radial inclinationetween the 2 groups initially, after reduction and at follow up17.5 versus 15.3, 20.6 versus 21.5, 20.9 versus 19.9). In the 2 wireroup 22 out of 52 patients gained more than 2 mm of radial lengthfter reduction and fixation. 12 out of 22 (54.5%) patients subse-uently lost this reduction, falling back to their initial lengths. Inhe 3 wire group 13 out of 18 patients gained more than 2 mmf radial length after reduction and fixation. 7 out of 13 (53.8%)atients subsequently lost this reduction, falling back to their initial

engths.Conclusions: This study has not been able to show any differ-

nces in the radiological outcomes between 2 wire and 3 wireinning techniques. Percutaneous pinning does appear to be ableo hold the improvements made in radial inclination and volar tiltngle after MUA. Percutaneous pinning appears to be an unreliableethod of maintaining improvements in radial length, with more

han 50% of patients’ who had improvement falling back to theirriginal lengths at follow up.

oi:10.1016/j.injury.2011.06.270

B.19

eview of proximal humeral fracture fixation with the PHILOS®

late System in a District General Hospital

. Murugesan, G. Pavlou, J. Stevenson ∗, D. Giebaly, I.G. Bhoora

Stafford Hospital, Mid Staffordshire NHS Foundation Trust, Stafford,K

Proximal humeral fractures present a challenge to therthopaedic surgeon and the use of the Proximal Humeral Inter-ocked Osteosynthesis (PHILOS®) plate as a means to facilitateecure internal fixation has been retrospectively reviewed in a Dis-rict General Hospital.

Methods: 38 patients underwent internal fixation for displacedractures of the proximal humerus between 2007 and 2010. Thereere 23 two part, 9 three part and 5 four part Neer classification

ractures. 3 cases were lost to follow up. 28 women and 7 menith a mean age of 64.9 years (range 41–96 years) were available

or follow up (mean: 12 months; range 6–33 weeks). Clinical notes

nd radiographs were reviewed and functional assessments wereecorded using the Disabilities of Arm, Shoulder and Hand (DASH)coring system.

2 (2011) 95–169

Results: In 32 patients (91%), the fracture united clinically andradiologically at a mean of 5.6 weeks (4.5–24 weeks). There were2 cases of fibrous non-union and 1 case of non-union secondary todeep infection which required revision to excision arthroplasty, andall were 2 part fractures. Complications related to wound infection,nerve injury, screw perforation and avascular necrosis were notfound in our case series. The mean DASH score at final review wasfound to be 36.7 (range 0–88).

Conclusion: In our series, non-union has been the principal com-plication with a single case requiring revision in the short term.Fixation with PHILOS® plate seems to be acceptable for all types ofproximal humeral fractures otherwise, with satisfactory functionaloutcome and no other complications.

doi:10.1016/j.injury.2011.06.271

1B.20

Clavicle midshaft fracture non-union treated surgically, withbone grafting or demineralised bone matrix: A comparative out-come analysis

A.K. Singh, P. Mestha, A. Tavakkolizadeh, J. Sinha

King’s College Hospital, London, United Kingdom

The study compares the result of mid-shaft fracture non-unionstreated with open reduction and internal fixation (ORIF) and auto-genous bone grafting or demineralised bone matrix (DBX). It isbased on our hypothesis that demineralised bone matrix providesthe same osteoinductive and osteoconductive environment as thebone graft for fracture healing.

This is a retrospective study of 30 patients with mid shaft claviclefracture non-union treated with ORIF and bone grafting or DBXfrom 2000 to 2010. Of these, 20 were in bone graft group while10 belonged to the DBX group. Most fractures, 27 out of 30 wereinitially managed conservatively, while three had primary fixation.

Two belonged to the bone graft group and one to the DBX group.The median age for the bone graft group was 44.5 years (range30–74 yeas), and DBX group was 35.5 years (range 24–78 years).There were 23 male and 7 female patients. Seventeen fractureswere left sided. The exclusion criteria were open fracture, fracturewith neurovascular deficits or septic non-unions. The results werecompared clinically, radiologically and through DASH (Disabilitiesof Arm, Shoulder and Hand) questionnaire at the time of follow up.

The union rate in both the groups were comparable with 18 outof 20 in bone graft group, and 9 out of 10 in DBX group achiev-ing union. One of the non-unions in the bone graft group requiredre-plating, leading to union. The other two, one belonging to eachgroup, were asymptomatic with fibrous union and full range ofshoulder movement. They decided not to opt for any further surgi-cal intervention. The median radiological union time was 6 monthsin both groups.

To conclude, DBX obviates the need for an additional surgeryand associated morbidities, and hence should be considered as a