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Fractures of the calcaneum are frequent lesions, regarding about 60% of all tarsal injuries and occurring, usually, after a fall from a height: this means that most of the affected patients are young and active, which results in long non-working periods and, often, in compensation claims for permanent inability to return to their previous occupation. These lesions are either intra-articular, involving the posterior facet, or extra-articular, located in the body or tuberosities: around 70% are intra-articular, resulting from axial loading during falls from a height or motor vehicle crashes, where the talus acts as a wedge to create a shearing force, dividing the sustentaculum from the great tuberosity. The optimal treatment is still under debate because poor results can be expected despite conservative or surgical treatment, owing to complications related to poor reduction, immobilization, algodystrophy and secondary osteopenia, late arthritis, skin healing and infection. New surgical techniques and technologies (CT scan for preoperative planning, pre-contoured low profile plates and supportive osteointegrative materials), however, have improved the outcomes of operative treatment, but still problems arise from high energy fractures because of soft tissues damage, and of predisposing factors such diabetes, vasculopathy, neurologic disease and immuno-compromission. Looking at these aspects, and at other previous experiences with minimally invasive techniques for fracture treatment, we developed a technique combining percutaneous reduction and stabilization using the kyphoplasty tool (Kyphon) for vertebral fractures. This article presents this new MIPO technique in the treatment of intra-articular fractures of the calcaneum. [ABSTRACT FROM AUTHOR]

Successful treatment of displaced humeral fracture can be difficult to achieve because of osteopenia of proximal humerus. One of the new options for humeral internal fixation is the minimally invasive intramedullary nail. We retrospectively reviewed 31 consecutive proximal humeral fractures treated with Sirus and T2 antegrade intramedullary nail (20 Sirus; 11 T2 Proximal) from January 2005 to December 2007. Time to union, level of pain, recovery of shoulder function according to Neer score, level of patients satisfaction and complications were recorded. All of the fractures proceeded to union in an average time of 3 months. An unsatisfactory result was obtained in two patients. Mobilization of proximal screws was seen in 3 patients (Sirus nail) and subacromial impingement of nail in 2. Antegrade intramedullary nail is an acceptable alternative for the treatment of proximal humeral fractures, especially in osteoporotic bone, allowing satisfactory functional recovery. [ABSTRACT FROM AUTHOR]

There are many biomechanical advantages in using an intramedullary implant to fix a long bone fracture: placing a nail in the medullary canal provides a strong fixation with the lowest “shield effect” on the bone. From a mechanical point of view, this is explained by the nail being within the neutral bone’s axis, acting like a central tutor which allows an optimal share of the load along the bone, preserving the obtained reduction and allowing early function. With the new developments in closed tecniques, it’s no necessary to open the fracture site, thus respecting the biology of fracture healing. [ABSTRACT FROM AUTHOR]

Surgical indications for the treatment of distal radial fractures are evolving and becoming more common among surgeons, but, as shown in many studies, these fractures can be successfully managed by a range of methods and techniques, including conservative treatment based on closed reduction by manipulation and cast. The keys to a successful outcome appear to be understanding the patient’s needs and expectations; adequate imaging to enable identification of displacement of key bony and soft-tissue components; adequate reduction and stabilization of these critical fragments. Looking at these common fractures, several studies have raised additional questions about the optimal treatment, particularly in children and older patients where conservative treatment still plays an important role. [ABSTRACT FROM AUTHOR]