AO Classification System Research Articles

Benefits of Ankle Arthroscopic Debridement in Acute and Subacute in Ankle Fractures

Category:Ankle; Arthroscopy; TraumaIntroduction/Purpose:The purpose of this study was to evaluate the benefits of ankle arthroscopy at the time of ORIF or after six months in patients with residual symptoms. The hypothesis was that in patients treated arthroscopically at the time of ORIF, there were faster and better clinical results than those treated after or untreated with arthroscopy.Methods:In this retrospective study, we compared three homogeneous groups of selected patients with specific inclusion criteria (144in total, mean age 38.2 years). They have been surgically treated for an ankle fracture (bimalleolar or trimalleolar without frank syndesmotic injuries) with open technique (ORIF) or arthroscopic ORIF (AORIF), between 2016 and 2019. The AO classification system was used for each patient. The clinical assessment was based on the Foot and Ankle Outcome Score (FAOS).Results:At the final follow-up (mean 36 months), both patients treated with ankle arthroscopic debridement at the time of ORIF and patients treated with arthroscopic debridement after ORIF showed a significant improvement of the FAOS, which reported84 and 85 respectively at final follow-up.Conclusion:Through direct visualization of intra-articular structures, ankle arthroscopy can offer an essential option for patients both in acute and in sequelae after an ankle fracture. More studies are needed to understand the real effectiveness of the procedure, especially in acute at the same time of osteosynthesis.

The Effect of Bone Morphology on Fracture Type and Treatment Result in Patients with Intertrochanteric Femur Fracture Aged over 65 year.

We aimed to investigate the effect of bone morphology on fracture type and treatment result in patient with inter-trochanteric fracture (IFF) treated with intramedullary nailing (IMN) aged over 65 years. Primary outcome of study was to investigate the relationship between fracture type (stable or unstable) and bone density. This was a retrospective cohort study conducted at single trauma center which included patients aged >65 years, minimum 3 months' control postoperatively, patients with simple fall by evaluating the patient data from 2010 to 2021. All fractures were classified based on the AO classification system. Proximal femoral nail anti-rotation was used between 2010 and 2016, while InterTAN was used after 2016 in our clinic practice. For the evaluation of the bone morphology, we measured the canal-to-calcar ratio (CCR) and cortical thickness index (CTI) and classified with Dorr morphology on anteroposterior (AP) hip radiograph of both the fracture side and contralateral sides. Complications were also evaluated on radiological view. Failures were defined as non-union or failure of fixation. Excessive collapse and screw/blade prominence also evaluated by hip radiograph on the 3rd month control visit. One hundred and fifty females and 59 males were included in this study. The average age was 81.6±8.8 years. One hundred and forty-four patients were treated with InterTAN and 65 patients with helical blade type IMN (PFN-A®). There were 78 patients with stable IFF type A1 fracture and 131 patients with unstable IFF (109 patients with A2 and 22 patients with A3 AO type fracture). The mean CTI was 0.469±0.09 and 0.510±0.09 in the fracture and unaffected side femurs, respectively (p<0.001), the CCR was 0.636±0.15 and 0.568±12 in the fracture and unaffected side femurs, respectively (p<0.001). There were 36 patients with Dorr type A, 115 patients with Dorr type B, and 48 patients with Dorr type C in fracture side and 65 patients with Dorr type A, 123 patients with Dorr type B, and 21 patients with Dorr type C in non-affected side (p<0.001). There were 29 (13.9%) patients with screw (n=14) and blade (n=15) prominence. Excessive collapse was seen 30 patients (14.4%) and 16 patients (7.7) evaluated as a failure. We found a significant difference in the failure rate between unstable group than stable group which higher in unstable group according to the AO classification. In addition, the mean CTI, CCR, and Dorr index were significant difference in fractured side than unaffected side which indicated lower bone quality at fracture side.

Dorsal locked plate fixation in dorsally unstable distal radius fractures

Introduction: Distal radius fractures are common, and internal fixation for operative management of these injuries is widely accepted. Although use of the volar approach for plate fixation has become more popular, benefits of the dorsal surgical approach include the potential for direct reduction and assessment of articular alignment, evaluation and management of concomitant intrinsic intercarpal ligament injury, and initiation of early range of motion. For certain fracture patterns, dorsal plate fixation is the preferred surgical technique. Improvements in implant design, in particular the use of low-profile dorsal plates, has decreased the rate of complications seen previously with this technique. Purpose of the study: We are trying into evaluate the functional outcome of distal radius fractures treated by open reduction internal fixation [ORIF] with precontoured low profile dorsal locking plates. Material and Methods: We performed ORIF with dorsal plating in 40 patients (16 males and 24 females) for distal radius fractures according to our inclusion and exclusion criteria. Fractures were classified by AO classification. Patients were followed up at routine intervals and the functional outcome was evaluated by the Disabilities of the Arm, Shoulder, and Hand questionnaire, the Gartland and Werley scoring system and modified Green O’ Brien score. All plates were low profile and stainless steel. Radiographic parameters, range of motion, and strength compared with the uninjured side were recorded. Results: According to the AO classification system, there were 5 type A fractures, 6 type B fractures, and 29 type C fractures. The median preoperative dorsal angulation was 30°, and the median postoperative angulation was -4° volar. Twenty-six patients with fractures had an intra-articular step-off or gap, which were all corrected to neutral by the procedure. Seven patients with the fractures showed positive ulnar variance, all corrected to neutral at time of follow-up evaluation. The median patient age at surgery was 59 years. The median follow-up period was 18 months Compared with the contralateral side, the mean extension and flexion were 88% and 81%, respectively; pronation and supination were 89% and 87%, respectively; and grip strength and thumb pinch were 78% and 94%, respectively. The mean postoperative Disabilities of the Arm, Shoulder, and Hand questionnaire score was 15 points. 38 patients had Gartland and Werley scores of good or excellent. No patients needed to have their plates removed, and no extensor tendon rupture was reported. 1 patient lost reduction; 1 patient needed a tenolysis of the extensor pollicis longus tendon. Out of 40 patients, 31 patients had excellent results, 7 patients had good results and 1 had fair and only 1 patient had poor result, according to the modified Green O’ Brien score. Average time to clinico-radiological union was 7 weeks. Average follow up time was 18 months. Conclusion: Our study has demonstrated that dorsal plating is an effective method for management of dorsally unstable distal radius fractures.

Rotura de la sindesmosis asociada a fracturas diafisarias de tibia de alta energía: serie de casos de una lesión habitualmente inadvertida

IntroductionAnkle syndesmosis injuries can be associated with a spiral mechanism on tibial shaft fractures. We are not aware if there is evidence of the incidence of ipsilateral syndesmotic lesson associated to high-energy tibial shaft fracture mechanisms. The aim of this study was to analyze the incidence of syndesmotic injuries associated with high-energy tibial shaft fractures. Methods233 diaphyseal tibial fractures operated between January 2007 and January 2017, the fracture patterns were analyzed, they were classified according to AO, the talocrural angle was measured, they analyzed failures and reoperations and described a novel failure method. ResultsFrom a total of 234 fractures that met the inclusion criteria, 159 (64.96%) suffered closed fractures and 75 (32.05%) where open fractures. According to the AO classification system: 152 (64.10%) were simple patterns 42.A; 49 (20.94%) wedge type patterns 42.B and 33 (14.10%) complex patterns 42.C. Ten patients, a 4.27% of the sample, shown an increased talocrural angle in the postoperative radiographs, evidencing shortening of the fibula. Nine patients underwent surgery, the remaining patient was lost to follow-up. All the treated patients presented restoration of the normal talocrural angle. ConclusionThe incidence of syndesmotic injuries associated with high-energy tibial shaft fractures reaches 4.27%. We think that is necessary to evaluate the ankle and syndesmosis in all tibial shaft fractures, even with high-energy patterns, not only in spiral patterns.

Evaluation of long-term surgical treatment outcomes of thoraco-lumbar spinal fractures - follow-up period of over 10 years.

Agricultural accidents often result in spinal injuries, particularly in fractures of the thoraco-lumbar spine. Surgical treatment of thoraco-lumbar fractures continues to comprise a major medical problem. The aim of this study was to assess and compare the long-term effects of surgical treatments of thoracic and lumbar spinal fractures treated with transpedicular stabilization, combined with posterior interbody spinal fusion (PLIF, also known as spondylodesis) or Daniaux reconstruction. A retrospective analysis was conducted on 66 patients with a thoracic or lumbar spinal fracture (Th10-L3) type A in the AO classification system, operated in 2000-2005. All patients underwent a short segment transpedicular stabilization, which in 36 patients was combined with posterior interbody spinal fusion, and in 30 other patients combined with Daniaux reconstruction. Radiological assessment was performed based on X-ray imaging. A lateral X-ray image of the spine was used to measure the vertebral wedging angle of the fractured vertebrae, the height ratio of the anterior to posterior vertebral body, and the angle of segmental kyphotic deformation. Subjective long-term assessment of the patient was conducted using the Oswestry Instability Score. The results were analyzed for statistical significance. In both groups, similar improvements in all measured parameters were observed. Despite all patients losing some of the correction in the long-term, this loss was significantly smaller following Daniaux reconstruction. Spinal stabilization combined with vertebral reconstruction allows for long-term and improved treatment results for thoraco-lumbar fracture than posterior interbody spinal fusion (spondylodesis).

Patient-Reported Outcome Following Operative and Conservative Treatment of Calcaneal Fractures: A Retrospective Analysis of 79 Patients at Short- to Midterm Follow-Up.

Background: Fractures of the calcaneus are severe injuries of the hindfoot, mostly resulting from high-energy axial loads, which still present enormous challenges to modern trauma surgery. Possible variables influencing the outcome are the type of fracture, age, and quality of fracture reduction. These might also be factors affecting the self-reported patient outcome, but large studies are still lacking. Therefore, the aim of this study was to analyze the patient-reported outcome of calcaneal fractures following operative and conservative treatment.Methods: All patients suffering from calcaneal fractures between 2002 and 2015 were enrolled in this retrospective analysis. The calcaneal fractures were classified according to Sanders and the AO classification system. For further analysis, two groups were formed: group I involved complex intra-articular fractures defined by the involvement of the posterior calcaneal facet, while group II consisted of extra-articular and process calcaneal fractures. Data were collected via the patient registry, radiographs, and a standardized questionnaire (Foot and Ankle Outcome Score, FAOS). For outcome analysis, non-parametric Mann–Whitney U-test was performed, and Spearman's rank correlation coefficient was calculated.Results: In total, the functional outcome of 79 patients with calcaneal fractures was analyzed. In group 1 (n = 43), the mean FAOS score was 65.5 ± 18.9. The surgically treated patients with a Sanders type II calcaneal fracture had a mean FAOS score of 72.9 ± 17.2, type III fractures had 65.6 ± 20.8, and type IV had 61.1 ± 19 (p = 0.15). The reoperation rate was 22%, most frequently caused by wound complications (10%). The mean follow-up time was 64.5 ± 44 months. The mean FAOS score of group 2 (n = 36) was 75.2 ± 18.4, and 83% of the patients (=30) were managed conservatively. Only one out of six operatively managed patients had a reoperation due to regular implant removal. The mean follow-up time was 31 ± 25.9 months.Conclusion: Intra-articular calcaneal fractures are severe injuries of the hindfoot leading to a fair to poor functional outcome in the majority of the patients. Complications regarding wound healing are the most common causes for revisional surgery. Extra-articular calcaneal fractures are a heterogenous entity commonly managed non-operatively. Overall, they show a better functional outcome in comparison to intra-articular calcaneal fractures.

'Absolute' inter-observer classifications agreement for proximal humeral fractures with a single shoulder anteroposterior X-ray.

Several studies have been carried out, and there is no classification for proximal humeral fractures (PHF) exempted from variability in interpretation and with questioned reliability. In the present study, we investigated the 'absolute diagnostic reliability' of the most currently used classifications for PHFs on a single anterior-posterior X-ray shoulder image. Six orthopaedic surgeons, with varying levels of experience in shoulder pathology, evaluated radiographs from 30 proximal humeral fractures, according to the 'absolute reliability' criteria. Each of the observers rated each fracture according to Neer, Müller/AO and Codman-Hertel's classification systems. The overall inter-observer agreement (κ) has been 0.297 (CI95% 0.280 to 0.314) for the Neer's classification system, 0.206 (CI95% 0.193 to 0.218) for the Müller/AO classification system, and 0.315 (CI95% 0.334 to 0.368) for the Codman-Hertel classification system. We found loss of agreement in Neer's classification as the study progressed, low agreement in the AO classification, and stable values in the different evaluations with the best degree of agreement for Codman-Hertel classification, with a moderate agreement in the second evaluation among the six evaluators. The Neer, AO, and Hertel-Codman classification systems for PHF with a single radiographic projection have a difficult interpretation for orthopaedic surgeons of varying levels of experience, and therefore substantial agreements are not obtained.

Ankle fracture management using smartphone multimedia messaging service (MMS) imaging — How reliable and to what point?

BackgroundThe use of smartphones and multimedia messaging service (MMS) continues to increase in day to day orthopaedic clinical practice. However, there is limited evidence to support the safe utilisation of MMS. ObjectivesThe aim of this study was to correlate the performance of MMS imaging to picture archiving and communication systems (PACS) imaging within the setting of diagnosis and management of ankle fractures. MethodsThe ankle fracture radiograph series of 82 consecutive patients were evaluated by five orthopaedic consultant specialists. A questionnaire regarding diagnosis and preferred management was completed separately for each patient using smartphone and PACS images. Statistical analysis was performed using Intraclass Correlation Coefficient (ICC). ResultsAnkle fracture diagnosis showed strong to excellent correlation both inter- and intraobserver MMS vs PACS when using the Weber (0.815, 0.988), Anatomical (0.858, 0.988), and AO classification systems (0.855, 0.985). MMS was less reliable than PACS in determining many management options. ConclusionThe reliability of ankle fracture classification using MMS image viewing was not significantly different to interpretation on PACS workstations. Smartphone use in ankle fracture classification is supported by this study. Smartphone use was less accurate than PACS in devising management plans and future use should be limited to making only initial plans that must be corroberated with PACS and intraoperative findings prior to definitive fixation.

Effectiveness of ankle arthroscopic debridement in acute, subacute ankle- bimalleolar, and trimalleolar fractures.

The purpose of this retrospective study was to evaluate the usefulness of ankle arthroscopy at the time of ORIF or after sixmonths in patients with residual symptoms. The hypothesis was that in patients treated arthroscopically at the time of ORIF, there were faster and better clinical results than those treated after or untreated with arthroscopy. In this retrospective study, we compared three homogeneous groups of selected patients with specific inclusion criteria (144 in total, mean age 38.2years). They have been surgically treated for an ankle fracture (bimalleolar or trimalleolar without frank syndesmotic injuries) with open technique (ORIF) or arthroscopic ORIF (AORIF), between 2013 and 2017. The AO classification system was used for each patient. The clinical assessment was based on the Foot and Ankle Outcome Score (FAOS). At the final follow-up (mean 38months), both patients treated with ankle arthroscopic debridement at the time of ORIF and patients treated with arthroscopic debridement after ORIF showed a significant improvement of the FAOS, which reported 84 and 85 respectively at final follow-up. Through minimally invasive visualization of intra-articular structures, ankle arthroscopy can offer an essential option for selected patients both in acute and in sequelae after an ankle fracture. More studies are needed to understand the real effectiveness of the procedure, especially in acute at the same time of osteosynthesis.

A retrospective comparison of olecranon osteotomy and paratricipital approach in treatment of distal humerus intra-articular fractures

Aim: Paratricipital approach and Olecranon osteotomy are most commonly used to treat intra-articular distal humerus fractures in adults. In this study we have analysed the patients in whom we performed open reduction and internal fixation with and withoutolecranon osteotomy and evaluated the advantages and disadvantages of both methods.Materials and Methods: Between 2014 and 2018, 36 adult patients with intra-articular distal humerus fracture were retrospectively analysed. According to AO classification system 9, patient has Type B2, 1 Type B3, 7 Type C1, 10 Type C2 and 9 Type C3 fractures. Mayo Elbow Performance Score for evaluation of the elbow joint stability and Disabilities of Arm, Shoulder and Hand score to evaluate the functionality of shoulder, arm and hand was used.Results: Paratricipital approach was used in 12 patients (8 male , 4 female) and olecranon osteotomy in 24 patients. Mayo Elbow Performance Score and Disabilities of Arm, Shoulder and Hand scores were found respectively 15.808 and 81.25 in the Paratricipital group whereas those values were determined as 17.37 and 79.17, respectively. No statistically significant difference was found between two groups in terms of these two scorings (p=0.147 and p=0.244, respectively) A statistically significant difference was detected between the groups in terms of heterotopic ossification ( p=0.008). In the paratricipital group; no heterotopic ossification was found in 7 (58.3%) patients whereas Type 1 heterotopic ossification was detected in 5 (41.7%) patients. In the olecranon osteotomy group; no heterotopic ossification was found in 4 (16.7%) patients whereas Type 1 and Type 2 heterotopic ossification were detected in 16 (66.7%) and 4 (17.7%) patients, respectively (p=0.008). A statistically significantly higher rate of elbow degeneration and heterotopic ossification was observed in the patients who underwent osteotomy compared with those who were not performed osteotomy (p=0.008)Conclusions: Paratricipital approach can be performed as an alternative treatment option in the distal humerus fractures to reduce the postoperative complications even though it does not allow to perform a comprehensive preoperative evaluation of the joint as well as olecranon osteotomy approach.

No association between osteoporosis and AO classification of distal radius fractures: an observational study of 289 patients

BackgroundIt is mechanically plausible that osteoporosis leads to more severe peripheral fractures, but studies investigating associations between BMD and radiographically verified complexity of distal radius fractures are scarce. This study aims to study the association between osteoporosis, as well as other risk factors for fracture, and the AO classification of distal radius fractures.MethodsIn this observational study, 289 consecutive patients aged ≥40 years with a distal radius fracture were included. Bone mineral density (BMD) of the hips and spine was measured by dual-energy x-ray absorptiometry (DXA), and comorbidities, medication, physical activity, smoking habits, body mass index (BMI), and history of previous fracture were registered. The distal radius fractures were classified according to the Müller AO system (AO) (type B and C regarded as most complex).ResultsPatients with osteoporosis (n = 130) did not have increased odds of a more complex distal radius fracture (type B + C, n = 192)) (n = vs type A (n = 92) (OR 1.1 [95% CI 0.5 to 2.3]) compared to those with osteopenia /normal BMD (n = 159). Patients with AO fracture types A or C had a higher prevalence of osteoporosis than patients with type B fracture.ConclusionsDistal radius fracture patients with osteoporosis did not sustain more complex fractures than those with osteopenia/normal BMD according to the AO classification system. The AO classification of distal radius fracture cannot be used to decide which patients should be referred to DXA scan and considered for secondary fracture prevention.

The new AO classification system for intertrochanteric fractures allows better agreement than the original AO classification. An inter- and intra-observer agreement evaluation

BackgroundA new AO classification for intertrochanteric fractures was recently published; no studies have evaluated its inter- and intra-observer agreement. MethodsSix evaluators (three hip subspecialists and three residents) assessed radiographs of 68 intertrochanteric fractures; fractures were classified using the original and the new AO classifications. The cases were displayed in a random sequence after a six-week interval for repeat evaluation. We used the Kappa coefficient (k) to determine inter- and intra-observer agreement. ResultsInter-observer agreement was slight (k = 0.128 [0.092–0.170]) using the original and fair (k = 0.250 [0.186–0.327]), with the new AO classification. Orthopedic residents exhibited better agreement than hip surgeons using the original classification (k = 0.302 [0.210–0.416] and k= -0.018 [-0.058–0.029], respectively) and the new classification (k = 0.388 [0.294–0.514] and k = 0.109 [0.031–0.192], respectively). Using both classifications as dichotomous variables (stable or unstable patterns), the agreement was slight (k = 0.158 [0.074–0.246]) using the original classification and moderate (k = 0.425 [0.308–0.550]) with the new AO classification. Intra-observerThe agreement was fair using the original (k = 0.350 [0.278–0.424]) and the new (k = 0.295 [0.239 to 0.353]) AO classifications, respectively. Residents had better agreement than hip specialists using the original (k = 0.405 [0.303–0.512]) versus (k = 0.292 [0.193–0.293]) and the new classification (k = 0.449 [0.370 to 0.528] versus k = 0.129 [0.064 to 0.208]). ConclusionThe inter-observer agreement using the new AO classification was significantly better than using its original version. Also, the new AO classification system allowed better agreement when distinguishing stable from unstable patterns.

POSTERO-MEDIAL TIBIAL PLATEAU (MOORE’S TYPE) FRACTURE AND THE IMPORTANCE OF COMPUTER TOMOGRAPHY IN DIAGNOSIS: A CASE REPORT

Moore type I posteromedial split fracturedislocation of proximal tibia are relatively uncommon. It is a specific fracture pattern that is not well described by the AO (41B2.2/B3.2) or Schatzker (IV) classification system because these systems do not differentiate when the medial fragment is primarily posterior and associated with a dislocation as the Moore system does. 1The additional use of computed tomography scans in the assessment of tibial plateau fracture may improve surgeon’s agreement that lead to the final decision and optimization of treatment. 2Galla and Lobenhoffer described a direct posteromedial approach for managing Moore type I tibial plateau fracture1.Report:A 48 years old malay gentlemen was alleged motor-vehicle accident, sustained closed fracture tibial plateau of right knee. Initially patient was diagnosed with right tibial fracture schatzker IV based on right knee anterior-posterior and lateral view xray. But CT scan had done, show the proximal tibial fracture transversing medial aspect with coronal spliting. Patient was treated with posteromedial locking compression plate with Lobenhoffer approach. Intraoperatively, diagnosis was confirmed with Hohl & Moore classification type I, there is coronal split fracture extending to posteromedially. The importance of computerised tomography scans when dealing with intra-articular fracture of tibial plateau may improve regarding localisation of fracture lines, depression zone, comminution, and the surgical treatment plan. 2Alexander et al. reported after addition of computerised tomography scans significantly improved to “good” in all classification. The features of Moore’s type I fracture which is coronal split fracture dominantly posterior column, coronal view from CT scans is more useful compare than sagital view. Galla and Lobenhoffer have introduce a direct postero-medial approach that minimizes soft tissue injury while allowing excellent fracture visualization, reduction, and fixations. 1This technique protect the neurovascular bundle and requires only suboeriosteal elevation of the popliteus to obtain full exposure. Furthermore, because of the protecting posterior soft tissues, skin closure and wound healing are reliable.Conclusion:Moore’s type I fracture managed with postero-medial approach has better post operative outcome, improved reliability and shows good reproducibility when classified with computerised tomography scans.

Functional outcome of locking compression plate in the management of proximal tibia fracture

Background: The proximal tibia fractures are one of the commonest intra-articular fractures. These injuries fall into two broad categories, high energy fractures and low energy fractures. The majority of tibial plateau fractures are secondary to high velocity accidents and fall from height where fractures result from direct axial compression, usually with a valgus (more common) or varus movement and indirect shear forces. Proximal tibial fractures present a spectrum of soft tissue and bony injuries that can produce permanent disabilities.Objective: This study evaluates the effectiveness of LCP (locking compression plate) in the management of proximal tibia fractures based on clinio-radiological assessment.Methods: It is a prospective observational study with sample size of 30 and all patients having intraarticular and or juxtaarticular fracture of proximal part of tibia, using AO classification system. Post operatively patients were followed up after 2 weeks, 6 weeks and at 3 month then monthly till union.Results: Fair to good functional results were correlated with associated injury whereas excellent results were obtained with those who did not sustained other associated injury.Conclusion: locking compression plate offers a good treatment option for intraarticular and juxtaarticular fractures of proximal part of tibia without the need for additional medial stabilization.Level of evidence: prospective level III follow up study.

Effect of Osteoporosis on Proximal Humerus Fractures.

Introduction:Proximal humerus fractures (PHF) constitute the majority of the most common osteoporotic fractures. Bone density measurements can affect treatment methods and outcomes. This study was aimed to investigate the effect of osteoporosis values, measured from direct radiographs, on fracture type, surgical outcomes.Methods:248 patients over 50 years of age who presented to Mersin City Hospital between 2017 and 2020 with proximal humeral fractures were retrospectively evaluated. The age and gender of the patients and the fracture types were evaluated according to the AO classification system from the direct radiographs obtained at the time of admission were recorded. The Tingart cortical thickness and deltoid tuberosity index (DTI) measurements were used to assess osteoporosis status in all patients. Postoperative and follow-up radiographs of 45 patients, treated with fixed-angle proximal humeral locking plate, were evaluated for radiographic results and their correlations with osteoporosis measurements were examined.Results:According to the demographic characteristics of the patients, 171 patients were female and 77 patients were male (F/M: 3/1), and mean age was 69.2 ± 11.66 (50-95). Considering the bone quality parameters in all patients, the mean Tingart value was 5.8 ± 1.6 mm and the mean DTI was 1.43 ± 0.17, where there was a correlation between the Tingart value and DTI (r = 0.810 and p < 0.001). Although there was a statistically significant relationship between the osteoporosis parameters and age and gender (p < 0.001 and p = 0.023, respectively), main AO fracture types were not related to osteoporosis (p < 0.05). In the operated group (n = 48, 19%), 19 patients (42%) showed poor outcomes, which were not associated with age and osteoporosis parameters.Conclusion:This study was concluded that osteoporosis parameters differ between genders and age groups in patients with PHF, however osteoporosis is not the main factor affecting the fracture type and surgical outcomes.

Clinical results of volar locking plate fixation in radius distal fractures

Aim: This study aimed to evaluate the results of 41 surgically treated radius distal fracture patients. Average follow-up time was 9.8 months (6-19) and mean age was 44.04 (20-81). All patients treated surgically with volar locking plate between the dates October 2010 and November 2018. Material and Methods: There were 11 type A2 (26%), 10 type C2 (24%), 4 type A3 (9%), 3 type B1 (7%), 3 type B3 (8%), 6 type C3 (14%) and 4 type C1 (9%) fractures, respectively according to the AO Classification System. Stewart’s radiological criteria and range of motion were used in clinical and radiological evaluation. QuickDASH-T and Gartland-Werley scores were used for functional assessment.Results: Twenty-three patients (56%) had excellent, 14 patients (34%) had good and 4 patients (9%), respectively had moderate functional scores according to Gartland-Werley scoring scale. Thirty-four patients (83%) were excellent and 7 patients (17%) were good, respectively according to Stewart’s radiological criteria. Average QuickDASH-T score was 5.92 (0-22.7) and average Gartland-Werley score was 3.26 (0-13). Two patients suffered reflex sympathetic dystrophy as a complication.Conclusion: Volar locking plating in distal radius fractures is a reliable treatment method with successful results with careful preoperative planning, attentive surgical approach and systematical rehabilitation. It should be considered as treatment of choice for all but especially active and demanding patients.

What Is the Most Reliable Classification System to Assess Tibial Pilon Fractures?

The aim of this study was to assess inter- and intraobserver agreement of the traditional systems (Ruedi-Allgower, AO [Arbeitsgemeinschaft für Osteosynthesefragen], and Topliss) and the newly proposed Leonetti classification system of pilon fractures. We studied all patients at our center who underwent pilon fracture surgery over a 2-year period: 68 patients (70 legs) were included. Four observers independently classified each pilon fracture according to the Ruedi-Allgower, AO, Topliss, and Leonetti systems by evaluating radiographs and computed tomography images on 2 occasions. The inter- and intraobserver agreements were calculated using the Fleiss kappa test. Interobserver reliability was good for AO types (A, B, and C) and Ruedi-Allgower (κ = 0.71 and 0.61, respectively), whereas the interobserver reliability was moderate for AO groups (A1, A2, A3, B1, B2, B3, C1, C2, and C3), Topliss families, Topliss subfamilies, Leonetti types, and Leonetti subtypes. Intraobserver reproducibility was excellent for the Ruedi-Allgower classification, AO types, and Topliss families and good for AO groups, Topliss subfamilies, and Leonetti types and subtypes. Ruedi-Allgower and AO classification systems are the most reliable among those currently used for pilon fractures, but with lower agreement at the AO group level. The use of Topliss and Leonetti classification systems is not recommended because of less favorable results.

Classifications in Brief: AO Thoracolumbar Classification System.

Classifications in Brief: AO Thoracolumbar Classification System.

Predictives of Poor Outcomes after Volar Plating an Unstable Distal Radius Fracture; A Retrospective Clinical Analysis

Aim: We aimed to evaluate the functional and radiological outcomes and complications after an unstable distal radius fracture that was treated with a volar locked plate in adults and to find out the predictive factors of poor outcomes. Patients and Method: 91 patients (55 male / 36 female) that were operated for distal radius fractures with a volar locked plate between May 2006 and August 2016 were included in this retrospective study. All fractures were classified by AO classification system. Mayo Wrist score and Quick DASH-T measure were used to quantify the functional and Steawart scores for radiological outcomes. Varying factors were evaluated for predicting the poor radiological and functional outcomes. Results: Mean age of the patients was 46.9 years (23-72 min-max) and mean follow-up was 29.6 months (12-39 min-max) in this study. Mean union time was 7.3 weeks (6-11 min-max) for all patients. Mean Quick DASH-T score was 7.1 (0-65.9) and mean Mayo Wrist score was 85.8 (55-100) at the follow-up. There were 10 patients with various complications as; 8 patients had wound infections and 2 patients had hypertrophic scars. The strongest predictive factors of poor outcomes were the type of fracture and wound complications. Conclusion: Volar locked plates are useful for treatment of displaced unstable distal radius fractures with acceptable complication rate and any attempt should be considered to avoid wound complications.

Tibial Plateau Fracture Following Low Energy Fall in the Rocky Mountains

Tibial plateau fractures are debilitating injuries. They can occurin younger individuals who sustain a high energy trauma or, withincreasing age, lesser degrees of trauma and underlying bone pathology such as osteoporosis, metabolic bone disease, and malignancy.1Outside these cases, tibial plateau fractures are relatively uncommon.However, these fractures can occur in healthy patients who have sustained direct trauma to the knee.Fractures of the tibial plateau often are classified according to theSchatzker or AO classification systems.2,3 These systems evaluate theinvolvement of both the medial and lateral plateaus, degree of comminution, extension into the joint, and displacement (both articularsurfaces and the relationship of the diaphysis to the metaphysis).Most tibial plateau fractures occur in the lateral aspect of the tibialplateau.1 The increased frequency of lateral fractures is due to themedial tibial plateau being able to resist higher weight-bearing loaddue to the presence of more cancellous bone. More importantly, thelateral plateau has more articular surface exposed during extensioncompared to the medial plateau, which increases likelihood of injury.4The standard of care for most displaced tibial plateau fracturesis surgical management with open reduction and internal fixation(ORIF).5 Conservative management, such as leg bracing, is an optionfor fractures that are nondisplaced or in patients too fragile for surgical intervention. In the senior population, a total knee arthroplasty(TKA) is a less common option. Tibial plateau fractures, particularlymedial tibial plateau fractures, caused by direct trauma in the elderly,non-osteoporotic population are uncommon.We present the case of an active male without overt risk for severefracture (10-year fracture risk of 10% via FRAX score) who wasworking to repair a trail in the Rocky Mountains. While other injurieswere more likely given the mechanism of injury and patient risk, thiscase highlighted the importance of considering tibial plateau fracture,even in atypical settings without significant risk. Improved awarenessof this mechanism of injury will lead to more accurate diagnosis andgreater post-injury management.