Amount Of Fracture Displacement Research Articles

Increase in gap index over time after reduction of unstable paediatric both-bone forearm fracture does not cause displacement.

This study investigated the effects of changes in the gap index on fracture displacement during follow-up. Patients who underwent closed reduction and casting with a diagnosis of unstable paediatric both-bone forearm fractures and a cast index < 0.8 were retrospectively evaluated. Patients were divided into Groups 1 and 2 based on their gap index (<0.15 and >0.15, respectively). Anteroposterior and lateral displacements of the radius and ulna and the gap index of the cast were measured on the X-ray after the first reduction and on the last X-ray before plaster removal. The mean patient age (n = 94, 74 boys and 20 girls; 51 in Group 1 and 43 in Group 2) was 7.09 ± 2.66 years. Fracture union times (plaster removal) were 38.8 ± 7.1 days. The mean cast index was 0.76 ± 0.05 (0.59-0.8). Both groups had similar distributions in terms of age, sex, fracture side, anatomic location and plaster removal time (p > 0.05). No significant differences were observed in either group in any radial or ulnar angulation values at any time point or the difference between the first and last values (all p > 0.05). Moreover, the gap index difference between the first and last measurements was significantly different in both groups (p = 0.002). If the cast index remains <0.8, despite the increase in the gap index in both groups, the amount of fracture displacement was small and acceptable.

Fractures around the shoulder in the skeletally immature: A scoping review.

Fractures around the shoulder girdle in children are mainly caused by sports accidents. The clavicle and the proximal humerus are most commonly involved. Both the clavicle and the proximal humerus have a remarkable potential for remodeling, which is why most of these fractures in children can be treated conservatively. However, the key is to understand when a child benefits from surgical management. Clear indications for surgery of these fractures are lacking. This review focuses on the available evidence on the management of clavicle and proximal humerus fractures in children. The only strict indications for surgery for diaphyseal clavicle fractures in children are open fractures, tenting of the skin with necrosis, associated neurovascular injury, or a floating shoulder. There is no evidence to argue for surgery of displaced clavicle fractures to prevent malunion since most malunions are asymptomatic. In the rare case of a symptomatic malunion of the clavicle in children, corrective osteosynthesis is a viable treatment option. For proximal humerus fractures in children, treatment is dictated by the patient's age (and thus remodeling potential) and the amount of fracture displacement. Under ten years of age, even severely displaced fractures can be treated conservatively. From the age of 13 and onwards, surgery has better outcomes for severely displaced (Neer types III and IV) fractures. Between 10 and 13 years of age, the indications for surgical treatment are less clear, with varying cut-off values of angulation (30-60 degrees) or displacement (1/3 - 2/3 shaft width) in the current literature.

How do surgeons decide when to treat proximal humerus fractures with operative versus nonoperative management?

The objective of this study was to determine the underlying factors that drive the decision for surgeons to pursue operative versus nonoperative management for proximal humerus fractures (PHF) and if fellowship training had an impact on these decisions. An electronic survey was distributed to members of the Orthopaedic Trauma Association and the American Shoulder and Elbow Surgeons Society to assess differences in patient selection for operative versus nonoperative management of PHF. Descriptive statistics were reported for all respondents. A total of 250 fellowship trained Orthopaedic Surgeons responded to the online survey. A greater proportion of trauma surgeons preferred nonoperative management for displaced PHF fractures in patients over the age of 70. Operative management was preferred for older patients with fracture dislocations (98%), limited humeral head bone subchondral bone (78%), and intraarticular head split (79%). Similar proportions of trauma surgeons and shoulder surgeons cited that acquiring a CT was crucial to distinguish between operative and nonoperative management. We found that surgeons base their decisions on when to operate primarily on patient's comorbidities, age, and the amount of fracture displacement when treating younger patients. Further, we found a greater proportion of trauma surgeons elected to proceed with nonoperative management in patients older than the age of 70years old as compared to shoulder surgeons.

Provisional fixation of unstable femoral neck basicervical fractures: A web-based survey and biomechanical assessment using a sliding hip screw construct

Objectives:Many hip fractures are considered rotationally unstable, especially during lag screw insertion. To counteract this instability, multiple provisional fixation constructs have been used to maintain the fracture reduction. This study aimed to compare the methods of provisional fixation biomechanically in ba sicervical femoral neck fractures.Methods:A web-based survey was sent by e-mail to members of three orthopedic assocations with questions concerning used techniques for provisional fixation of unstable basicervical femoral neck fractures and these results were used to guide our biomechanical assessment. Twenty, fourth-generation composite proximal femurs were osteotomized in the basicervical region to simulate a basicervical fracture. These fractures were anatomically reduced and one of the four provisional fixation constructs was applied. A sliding hip screw was then inserted with a torque limiter to the appropriate depth. The amount of fracture displacement during screw insertion was collected and analyzed.Results:Of the 142 respondents, 79.6% apply some form of provisional fixation. Derotational screw was the most commonly used provisional fixation (43.4%), followed by one superior Kirschner wire (K-wire) (39.8%). Biomechanically, the single derotation screw construct showed significantly less displacement (0.92 mm) than the one superior K-wire construct (3.09 mm). No other significant differences in fracture displacement were found between the groups.Conclusion:This study highlights that the majority of surgeons apply a form of provisional fixation during the surgical management of unstable basicervical femoral neck fractures. We have shown biomechanically that the single derotation screw had superior rotational stability when compared to the one superior K-wire.

Hook Plate Fixation of Medial Malleolar Fractures

Ankle fractures are common injuries treated by orthopedic surgeons. Medial malleolar fractures, occurring in isolation or in combination with lateral or posterior malleolar fractures, usually require surgical fixation if there is any amount of fracture displacement. With the recent advancement in surgical techniques, many different methods of fixation have been described in the literature from cannulated screws to sled devices. The objective of this study is to describe the hook plate technique for open reduction and internal fixation of medial malleolar fractures and present outcomes in 2 patients who underwent this procedure. Hook plate fixation of medial malleolar fractures results in acceptable outcomes and is be a good alternative to traditional methods of fixation in patients.

Viability and long-term survival of short-segment posterior fixation in thoracolumbar burst fractures

Background contextShort-segment pedicle screw instrumentation constructs for the treatment of thoracolumbar fractures gained popularity in the 1980s. The load-sharing classification (LSC) is a straightforward way to describe the extent of bony comminution, amount of fracture displacement, and amount of correction of kyphotic deformity in a spinal fracture. There are no studies evaluating the relevance of fracture comminution/traumatic kyphosis on the long-term radiologic outcome of burst fractures treated by short-segment instrumentation with screw insertion in the fractured level. PurposeTo evaluate the efficacy of the six-screw construct in the treatment of thoracolumbar junction burst fractures and the influence of the LSC score on the 2-year radiologic outcome. Study designCase series of consecutive patients of a single university hospital. Patient sampleConsecutive patients from one university hospital with nonosteoporotic thoracolumbar burst fractures. Outcome measuresBeing a radiology-based study, the outcome measures are radiologic parameters (regional kyphosis [RK], local kyphosis, and thoracolumbar kyphosis [TLK]) that evaluate the degree and loss of correction. MethodsRetrospective analysis of all consecutive patients with nonosteoporotic thoracolumbar burst fractures managed with a six-screw construct in a single university hospital, with more than 2 years' postoperative follow-up. ResultsEighty-six patients met the inclusion criteria, and 72 (83.7%) with available data were ultimately included in the study. The sample included 53 men and 19 women, with a mean (standard deviation [SD]) age of 35.6 years (14.4 years) at the time of surgery. Mean LSC score was 6.3 (SD 1.6, range 3–9). Forty-four of 62 (70.9) fractures had a score greater than 6. Mean (SD) RK and TLK deteriorated significantly during the first 6 months of follow-up: 2.90° (4.54°) p=.005 and 2.78° (6.45°) p=.069, respectively. Surgical correction correlated significantly (r=0.521, p<.0001) with the time elapsed until surgery. Loss of surgical correction (postoperative to 6-month RK and TLK increase) correlated significantly with the LSC score (r=0.57, p=.004; r=0.51, p=.022, respectively). Further surgery because of correction loss was not required in any case. ConclusionsThe six-screw construct is effective for treating thoracolumbar junction burst fractures. The medium-to-long-term loss of correction is affected by the amount of bony comminution of the fracture, objectified through the LSC score.

Displacement of mandibular fractures: is there a correlation with sensory loss and recovery?

Fractures of the mandible are common. However, the correlation between the severity of the fracture and the recovery of any associated inferior dental (ID) nerve injury is still poorly understood. We aimed to examine the relationship between the amount of fracture displacement and how it relates to the recovery of sensation to the lower lip. One hundred and fifty patients requiring treatment of a mandibular fracture (where the fracture passed across the ID canal) were assessed. One hundred were initially assessed in a retrospective double-blinded study. A further 50 patients were then followed up prospectively. Both the maximal displacement of the fracture and the displacement specifically at the ID canal were measured. Sensory recovery, or persistence of numbness, was also recorded for each patient. Although there appeared to be a correlation between increasing displacement at the ID canal and a poorer recovery, there was not a clear relationship between the two, and there were many exceptions. Persistent numbness (>1 year) still occurred in fractures with relatively minimal displacement (≤3mm). Possible reasons for persistent numbness are discussed.

Periprosthetic fractures around total knee arthroplasty.

The number of total knee arthroplasties performed continues to rise annually and it would be expected that complications, which include periprosthetic fractures, will also therefore become more commonplace. This article reviews the current literature regarding this injury and identifies the treatment principles that enable patients to regain optimal function. A comprehensive search of the Pubmed and Embase™ databases was performed to identify relevant articles. Keywords and MeSH (Medical Subject Headings) terms included in the search strategy were 'periprosthetic fracture(s)', 'femur', 'tibia', 'patella(r)', 'complication(s)', 'failure(s)', 'risk(s)', 'prevalence', 'incidence', 'epidemiology' and 'classification(s)'. The search was limited to all articles published in English and reference lists from the original articles were reviewed to identify pertinent articles to include in this review. A total number of 43 studies were identified. Common treatment aims have been identified when managing patients with a periprosthetic fracture around total knee arthoplasty. The main criterion that determines which option to choose is the degree of remaining bone stock and the amount of fracture displacement. Treatment of a periprosthetic fracture around total knee arthroplasty will either be non-operative, osteosynthesis or revision arthroplasty. It is imperative that a suitable option is chosen and based on the published literature, pathways are outlined to aid the surgeon.

Management of Distal Clavicle Fractures

Most clavicle fractures heal without difficulty. However, radiographic nonunion after distal clavicle fracture has been reported in 10% to 44% of patients. Type II distal clavicle fractures, which involve displacement, are associated with the highest incidence of nonunion. Several studies have questioned the clinical relevance of distal clavicle nonunion, however. Nonsurgical and surgical management provide similar results. The decision whether to operate may be influenced by the amount of fracture displacement and the individual demands of the patient. Surgical options to achieve bony union include transacromial wire fixation, a modified Weaver-Dunn procedure, use of a tension band, screw fixation, plating, and arthroscopy. Each technique has advantages and disadvantages; insufficient evidence exists to demonstrate that any one technique consistently provides the best results.

Pediatric femur neck fractures: A retrospective analysis of 39 hips

The aim of this retrospective study was to analyze the radiological and clinical results of pediatric femur neck fractures. This study included 39 children (mean age 11.1, range 4 to 16 years) who had a femur neck fracture and had at least one year of complete follow-up. The most common etiological factor was traffic accident and the most common associated skeletal injury was pelvis fracture. According to Delbet's classification system, there were no type I (transepiphyseal) fractures and 21 type II (transcervical), 14 type III (cervicotrochanteric), and four type IV (intertrochanteric) fractures. The mean follow-up was 3.4 (1-9.5) years. A satisfactory outcome according to Ratliff's radiological and clinical criteria was obtained in 28 (72%) hips. Avascular necrosis (AVN) of the femoral head was seen in 11 (28%) hips and the rate of satisfactory outcome was significantly higher in hips without AVN than in hips with AVN (P < 0.001). Transcervical fractures had the worst outcome (P = 0.014) and the highest rate of AVN (P = 0.077) when compared with cervicotrochanteric and intertrochanteric fractures. No significant correlation was found between both the outcome and development of AVN and age, gender, laterality, amount of fracture displacement, treatment time, and the type of reduction (open/closed) (P > 0.05). It has been concluded that the development of AVN primarily influences the outcome in pediatric femur neck fractures and that fracture type is essentially correlated with the development of AVN and outcome.

Avulsion Fractures of the Fifth Metatarsal Base: A Prospective Outcome Study

This prospective study was done to evaluate functional outcomes after acute avulsion fractures of the fifth metatarsal base. Fifty-two patients who sustained an avulsion fracture of the fifth metatarsal base and presented to the outpatient clinic of our hospital system were treated according to a standardized protocol. A total of 49 patients (50 fractures) were available for 1-year followup. There were eight men and 41 women with an average age of 41.9 (range 17 to 81) years. The lower extremity was placed in a hard-soled shoe, and patients were allowed to bear weight as tolerated. Baseline data collection consisted of demographic information, and radiographic, and functional evaluation. Patients were seen at regularly scheduled visits for 6 months and then contacted at 1 year to obtain followup information. A Short Musculoskeletal Function Assessment (SMFA) questionnaire was obtained at 6 months and 1 year. Analyses were performed to determine differences in outcome based on demographics and injury information. A p value of less than 0.05 was considered significant. An average of 22 days were lost from work, with 23 patients (46.9%) taking up to 10 days, 18 (36.7%) taking 10 days or longer off work, and eight patients (16.4%) losing no days of work. Based on self-reports, 10 patients (20.4%) had returned to pre-injury functional status by 3 months, 42 patients (85.7%) by 6 months, and all 49 patients by 1 year. At six and 12 months, no differences in SFMA were found based on gender, fracture type, or amount of fracture displacement. Fracture of the fifth metatarsal base often is a source of lost work productivity. Although patients can be expected to return to their preinjury level of function, recovery may take 6 months or longer.

A Biomechanical Comparison of Two Volar Locked Plates in a Dorsally Unstable Distal Radius Fracture Model

This study compares the biomechanical stability of two volar locked plate systems for fixation of unstable, extra-articular distal radius fractures. In six matched pairs of fresh frozen cadaveric specimens, a simulated unstable, extra-articular distal radius fracture was created. The fractures were stabilized with one of two types of volar locked plates. Specimens were axially loaded at five different positions: central, volar, dorsal, radial, and ulnar. Initial (precyclic loading) stiffness of each locked plate system was calculated. Each specimen was then loaded for 5,000 cycles with an 80 N central load. Finally, specimens were axially loaded at the same five positions to calculate the postcyclic loading stiffness of each volar locked plate system. Main outcome measurements were precyclic loading stiffness, postcyclic loading stiffness, maintenance of stiffness after cyclic loading, and amount of fracture displacement between the two volar locked plate systems. There were no differences in maintenance of stiffness and fracture displacement following cyclical loading between the two volar plate systems. After cyclic loading, the distal volar radius (DVR) locked plate was significantly stiffer than the Synthes volar locked plate in volar loading only (p < 0.01). Materials properties and design differences between these systems did not provide enough biomechanical difference to support use of either implant over the other. With this in vitro model, both implants provided adequate stability to resist physiologic loads expected during therapy in the initial postoperative period.

The olecranon sled—a new device for fixation of fractures of the olecranon: A mechanical comparison of two fixation methods in cadaver elbows

Background Tension band wiring is the most common surgical procedure for fixation of fractures of the olecranon, but symptomatic hardware prominence and migration of K-wires can cause a high re-operation rate. The olecranon sled has been designed to minimize some of these problems.Material and methods Simulated olecranon fractures were created in 6 matched pairs of cadaver arms. Each pair was fixed with tension band wiring used on the one arm and the olecranon sled being used on the other. Mechanical testing was done with the humerus rigidly fixed in a vertical position while the forearm was held at 1 of 3 angles of elbow fixation, 45°, 90° and 135°, respectively. For each angle, the triceps and the brachialis muscles were sequentially loaded with 5 kg (50 N) for 20 cycles and the amount of fracture displacement measured.Results Loading of the brachialis muscle produced no increase in the fracture gap for either of the two fixation techniques. However, an increase in the fracture gap of up to 0.23 mm was found after cyclic loading of the triceps muscle for both techniques. The amount of increase was not significantly different between the two techniques.Interpretation The olecranon sled appears to provide as stable fixation as tension band wiring for olecranon fractures.

Excision of comminuted distal humeral lateral condyle fractures: A report of two cases

F ractures of the distal humeral lateral condyle are rare injuries in the adult, accounting for approximately 5% of fractures of the distal humerus.6 The lateral condyle is defined by both the articular and nonarticular supports of the lateral column. The capitellum, comprising only a portion of the lateral distal humeral column, is entirely intra-articular and does not include the metaphysis, epicondyle, or posterior nonarticular surface of the distal humerus.3 The mechanism of injury producing lateral condylar fractures is variable, ranging from indirect to direct trauma forces.6 However, the amount of fracture displacement and comminution is dependent on the level of energy producing the fracture. For displaced fractures, especially those involving the articular surface, reduction and internal fixation remain the goal in order to allow early motion while ensuring stability.8,12 Unfortunately, some fractures are not amenable to internal fixation. The following case presentations depict two lateral column injuries not believed to be reconstructable that were treated with excision of the lateral condyle.

Clinician variability in characterizing mandible fractures

Purpose: This study evaluated variability in the clinical parameters commonly used to characterize mandible fractures. Patients and Methods: Inter-rater reliability of 18 oral and maxillofacial surgeons was assessed using radiographs of 22 cases of mandible fractures. Raters were asked to evaluate each case based on several parameters including number, location, and displacement of the individual fractures and severity of the composite injury. To evaluate intra-rater reliability, selected cases were reviewed at a second session by a subgroup of these surgeons. Tests of concordance used to quantify measurement reliability included the interclass correlation coefficient and multiple-rater kappa statistics. Results: Inter-rater agreement on the number of constituent fractures ranged from excellent for simpler fractures to poor for complex gunshot injuries. Even within raters, the range of interclass correlation for complex injuries was only 0.33 to 0.42 between the 2 assessments. Clinicians appeared to be better at delineating coronoid, condyle, ramus, and angle fractures; symphyseal and canine region fractures had lower inter- and intrarater agreement. Tests of concordance showed moderate to excellent reliability when fracture displacements were expressed in millimeters, but only fair reliability when displacements were expressed as categories. Even when the clinicians concurred on displacement measurements, a large overlap was observed in their categorization of these displacements. Despite the differences in the assessment of individual parameters, the high intrarater reliability coefficient (0.78) indicated that the individual clinicians had a high internal consistency in their assignment of summary severity scores. Multiple regression analysis revealed the number of constituent fractures, the type of fracture, and amount of fracture displacement (millimeters) to be significant predictors of clinician ratings of injury severity. Conclusions: The clinician variability underscores the difficulties involved in trauma description and scoring. The study identifies some sources of clinician variability and emphasizes the need to standardize the characterization of mandible fractures by using explicit guidelines. © 2001 American Association of Oral and Maxillofacial Surgeons

Pin breakage in trapezio-lunate external fixation of scaphoid fractures

The treatment of scaphoid fracture is determined by the amount of fracture displacement and stability. All acceptable closed or open methods consist of long term immobilisation and secondary tissue damage. The trapezio-lunate mini external fixation for acute scaphoid fracture is a novel method which does not require any extra immobilization or secondary tissue damage. Two cases of trapezial-pin breakage in trapezio-lunate external fixation of scaphoid fractures which resulted in non-union are described. Careful manufacturing and clinical application are mandatory to avoid this previously undescribed complication.