AO Type Research Articles

Intravenous bisphosphonate therapy does not delay fracture healing in inter-trochanteric femur fractures – A randomised controlled study

Hip fractures in elderly are commonly associated with osteoporosis and surgical outcome is influenced by its concurrent management. The purpose of our study is to determine the association between timing of bisphosphonate administration in inter-trochanteric (IT) fractures and fracture healing. Patients with IT fractures (aged≥50 years) and T-score ≤ -1.5 [WHO defines osteopenia as T-score between −1 and −2.5, and osteoporosis as T-score ≤ -2.5 on DEXA scan (which was obtained post-operatively in our cohort)], who underwent proximal femoral nailing were included. Patients were divided into three groups: group 1a-intravenous bisphosphonate {ivBP [zoledronic acid (ZA)]} given within one week, group 1b-ZA at six weeks and group 2-control group. Post-operative radiographs were assessed for reduction parameters [neck-shaft angle, tip-apex distance, reduction variance]. Radiological union was determined using RUSH score and functional outcome (at one year) with Modified Harris Hip Scores. 41 (23 males), 40 (15 males) and 42 (15 males) patients were included in groups 1a, 1b and 2, respectively (no statistical difference in sex distribution among the groups; p = 0.12). Mean age in groups 1a, 1b and 2 was 71.8 ± 8.1, 75.9 ± 8.5 and 72.3 ± 10.6 years (p = 0.09). There was no significant difference in the pattern of injuries (AO classification) among the groups (p = 0.72). Mean time to union in groups 1a, 1b and 2 was 13.7,13.7 and 14.2 weeks, respectively (p = 0.69). Mean time to union in AO types A1, A2 and A3 fractures was 13.2 ± 2.1, 13.7 ± 2.8 and 16.1 ± 4.9 weeks (p = 0.01). We did not observe any association between T-scores and fracture union (hip:p = 0.52, spine:p = 0.93).The functional outcome was similar among groups (p = 0.96). Early administration of ZA did not negatively influence fracture healing in patients undergoing fixation of IT fractures. Among the various other factors analyzed, there was a statistically significant association between the fracture type (AO type A3) and longer time to fracture union.

Management of AO-type C thoracolumbar fractures during COVID-19 pandemic using distractor device: a novel technique

Study design Prospective cohort study. Introduction Management of the severe thoracolumbar (TL) spine fracture–dislocation injuries have been further complicated by the COVID-19 pandemic. The need to optimize resources and minimize the personnel in the operating room (OR) led us to develop a novel technique to reduce TL fracture–dislocations (AO type-C) using an orthopedic distractor device (ODD). Methods This prospective study was conducted at a tertiary care spine center with a study duration from March 2020 to May 2020 coinciding with the nationwide lockdown and travel restrictions imposed in view of the COVID-19 crisis. Only patients with AO type C fracture–dislocation managed using the ODD operated by a single surgeon were included in the study. Results Of 12 cases, the most commonly affected level was D12-L1. Nine patients were American Spinal Injury Association Impairment Scale (AIS) A at presentation, two patients were AIS B, and one AIS C. The mean operative time was 125 min and mean blood loss was 454 ml. Eight patients remained AIS A, one patient improved from AIS B to C. Two patients became independent walkers, one remained AIS B. The post-operative VAS score improved to a mean value of 2.33. The improvement in kyphosis was 26.24° immediate postoperatively and maintained at 25.9°, percentage height loss reduced to 2.75% immediate postoperatively and maintained at 3.16% at 3 months follow-up. Conclusions Management of TL fracture–dislocations in COVID times of health care resource scarcity can be challenging. Single surgeon with ODD is a useful technique for achieving good results in these injuries.

Outcome of Unstable Pertrochanteric Fractures in High-Risk Geriatric Treated with External Fixators

Background: To review the outcome of high-risk geriatrics with unstable pertrochanteric fractures treated with external fixator. Methods: Eighteen consecutive patients with pertrochanteric fractures were operated with external fixator by using closed reduction technique. AO type, accompanying diseases, operating time, transfused blood units, duration of hospitalization, complications, healing time and mortality were recorded. Patients were followed clinically and radiologically for two years at least. The Harris Hip Score was used to document hip function at each regular follow-up. Results: Fifteen patients with average age of 71.5 years were available for final evaluation. The mean operating time was 41.1 min and union was achieved in all cases with an average time of 16 weeks. The mean Harris Hip Score at one, three, six, twelve and twenty-four months postoperatively was 42.07 ± 8.55; 55.07 ± 11.62; 70.07 ± 10.32; 86.27 ± 9.06 and 89.27 ± 8.81 respectively. Complications included all the patients undergoing loss of some motion in the knee and four of them had to experience revision surgery because of knee stiffness, ten cases of pin-tract infections, seven cases of deep venous thrombosis, two cases of migration of the screws and two cases limb shortening Conclusions: The use of external fixator in high-risk geriatric provided a satisfactory long term efficacy, but the short term functional results were quite unsatisfactory owing to high complication rate. Therefore, the advantages and disadvantages should be fully weighed when using external fixators, which was especially suitable for those patients who could not tolerate prolonged operative time and open surgery.

Treatment of irreducible intertrochanteric femoral fracture with minimally invasive clamp reduction technique via anterior approach

To explore the effectiveness of minimally invasive clamp reduction technique via anterior approach in treatment of irreducible intertrochanteric femoral fractures. Between January 2015 and January 2019, 59 patients with irreducible intertrochanteric femoral fractures were treated with minimally invasive clamp reduction technique via anterior approach. There were 29 males and 30 females with an average age of 77.9 years (range, 45-100 years). The causes of injury included falling in 46 cases, traffic accident in 6 cases, smashing in 2 cases, and falling from height in 5 cases. The time from injury to operation was 1-14 days (mean, 3.8 days). The fractures were classified as AO type 31-A1 in 12 cases, type 31-A2 in 25 cases, type 31-A3 in 22 cases. All fractures were reduced well and the fracture reduction took 10 to 30 minutes, with an average of 19 minutes. All patients were followed up 13-25 months, with an average of 17.6 months. Among them, 2 cases of pronation displacement of proximal fracture segment died for infection or falling pneumonia after internal fixation failed. Six patients with reversed intertrochanteric femoral fractures experienced re-pronation and abduction displacement of the lateral wall after internal fixation, but the fractures all healed. The rest of the patients had no fracture reduction loss, and the fractures healed with an average healing time of 5.9 months (range, 3-9 months). Except for 2 patients who died, the Harris score of hip joint function of the remaining 57 patients was excellent in 49 cases and good in 8 cases at last follow-up. The minimally invasive clamp reduction technique via anterior approach for irreducible intertrochanteric femoral fractures is simple and effective. For irreducible intertrochanteric femoral fractures related to lateral wall displacement, after clamp reduction and intramedullary nail fixation, the lateral wall should be reinforced in order to avoid reduction loss and internal fixation failure.

Possible Correlation Between Kyphosis of Lumbar Osteoporosis Fractures and the Spinal Signal Intensity Ratio (SSIR).

The aim of this study was to examine the correlation between the risk of increasing kyphosis as well as collapse of the osteoporotic vertebral body fractures and the intensity of the bone edema in magnetic resonance imaging (MRI) scans. Inclusion criteria included the following: age >18 years and osteoporotic vertebral body fracture grade I-IV according to OF classification. Exclusion criteria included the following: other pathological fractures due to primary tumors or metastasis, OF grade V fractures, and AO type B or C fractures. This was a retrospective study from pseudonymized data of a tertiary spine center. No additional imaging were performed. Measurements of bisegmental kyphosis angle of the fracture for involvement of both endplates and monosegmental angle for involvement of 1 endplate, as well as vertebral body height loss in initial radiographs and at follow-ups after 3 and 6 months have been performed. Also, the initial signal intensity of the vertebral body edema was measured using integrated tool of the DICOM viewer (Impax V6.5 Agfa, Brentford, UK) in addition to the signal intensity of the cerebrospinal fluid (CSF) as reference for T1, T2, and separate target illumination radar (STIR) sequences of the MRI scans. A quotient from the signal intensity of the vertebral body edema and the reference (CSF) has been generated. Patients have been divided to 4 groups according to the ratio (<1, 1-2, 2-3, >3) and compared in regards to the results of the degree of kyphosis and vertebral collapse at follow-ups and final examination. The statistical analysis was performed using linear regression using statistic software SPSS version 26. Forty-four patients have been included: 9 males and 35 females with an average age of 71.5 years. The analysis showed a significant correlation between the increasing kyphosis at follow-ups and the quotient of the signal intensity for STIR and T2 weighing with P = .002 (SD ±2.664) for STIR and P = .001 (SD ±1.616) for T2 sequences. Furthermore, there was only a correlation between the intensity ratio and kyphosis for STIR weighting at last examination (P = .017; SD ±1.360). There was no correlation between the height loss and the signal intensity. Level 2.

145 Outcomes of Unstable Distal Radius Fractures – A Meta-Analysis of Bridging External Fixation Versus Volar Plating

Abstract Introduction Distal radius fractures are common and trends for fixation have changed with increased use of volar locking plates in recent time. A meta-analysis will summarise the best evidence for treatment. Method A systematic review was conducted using PRISMA methodology to identify studies that reported clinical and/or radiological outcomes in patients with AO type C distal radius fractures when treated with external fixation versus ORIF. Results 10 randomised trials were included in this review, reporting on 967 patients. Clinical outcomes are in favour of volar plating at 3 months post-operation, but no difference between the two groups is seen at 6 or 12 months. Analysis of complication rates shows a minute increase in risk-ratio for volar plating versus external fixation. Subgroup analysis showed significantly higher re-operations after plate fixation and significantly higher infection after external fixation. Conclusions Internal fixation of complex distal radius fractures confers an improved clinical outcome at early follow up only and a minimally increased risk of complications. The improved grip strength with volar plating is only superior at early follow up and no long-term superiority is seen with either intervention. The type of surgery in this injury type therefore remains at the surgeon’s consideration on a case-by-case basis.

Quality of life after distal radius fractures

Introduction: Distal radius fractures (DRFs) are among the most commonly seen types of fractures worldwide. Numerous studies suggested that surgical treatment of DRFs results in better quality of life. Objectives: The aim of this study was to assess long-term quality of life after operative and nonoperative treatment of distal radius fractures among adults. Material and methods: We retrospectively studied 207 patients with isolated DRF (mean age 64 ±17.9 years, women comprised 150 (72.5%), men 57 (27.5%). There were no significant differences in sex, age, hand dominancy, energy of trauma, AO type fracture and comorbidities between patients treated operatively (n=101) and nonoperatively (n=106). After 3.9 ±1.6 years (mean ±SD) quality of life assessment was conducted using Short Form Health Survey (SF-36) and International Osteoporosis Foundation Quality of Life Questionnaire (IOF QLQ). Functional outcomes were evaluated using Disabilities of the Arm, Shoulder and Hand (DASH) and Patient Rated Wrist Evaluation (PRWE) questionnaires. Results: Quality of life in operatively treated distal radius fracture patients was better than amongst those treated nonsurgically. However, after subdivision of cohorts we observed no such differences regardless of treatment method in patients aged ≥ 50 years. SF-36 and IOF QLQ scores were correlated with DASH and PRWE results. Conclusions: Quality of life questionnaires are useful tools for determining outcomes after distal radius fractures. Operative treatment may not always be superior to nonoperative management especially in patients aged 50 years or above with distal radius fractures.

FUNCTIONAL OUTCOME OF DISTAL HUMERUS FRACTURE BY PARATRICEPITAL TWO WINDOW APPROACH

Background-Most of distal humerus fractures are dealt with olecranon osteotomy approach which stand as cumbersome process resulting in excessive soft tissue damage and excess hardware interposition. Alternate paratricepital two window approach has been advocated by many authors as better approach to deal with AO type A, B, and C1 type distal humerus fractures. AIM -To evaluate functional outcome of distal humerus fracture xation through paratricepital two window approach Materials &amp; Methods – A complete of 30 patients of closed fracture distal humerus fracture underwent open fracture xation through paratricepital approach. Average age of patient was 35yr .Regular follow up and physiotherapy sessions were carried out. Average period of follow up was 12 month. Results – Out of 30 patients 28 were nally followed up till 1 year, one patient died in between while another one undergoes implant removal due to infection. From 28, 20 patients has excellent functional outcome, 3 has good, 4 has fair outcome and one patient has poor results in terms of MEPS and DASH score. Conclusion – Based on present study and data analysis we conclude that distal humerus fracture treated through paratricepital two window approach results in excellent functional outcome which is evident from ability to early start various day to day to day activities like performing st nd personal hygiene, combing hairs ,putting shirt- shoes themselves and starts eating themselves by 1 or 2 week of surgery .Unlike traditional approach like Olecranon osteotomy , it maintains adequate Tricep extensor mechanism ,does minimal soft tissue damage ,minimal post op pain ,promote early wound healing and avoid excessive hardware transposition

Which external fixation method is better for the treatment of tibial shaft fractures due to gunshot injury?

IntroductionThe present study aimed to evaluate the functional and radiological outcomes of AO type monolateral external fixator (AO-EF) and Ilizarov type external fixator (I-EF) in definitive fixation of tibial shaft fractures due to gunshot injury. HypothesisPatients undergoing I-EF would have faster fracture healing with the help of early weight-bearing and the functional scores would be better compared to AO-EF. Material and methodsThe study consisted of 76 (67M, 9F) patients who underwent surgery between 2010 and 2016 for tibial shaft fracture due to low-velocity gunshot injury (LVGI). The patients were divided into two groups according to the fixation method (AO-EF and I-EF) which was discussed by the surgeon team due to their experience. The average age at the time of injury was 37.8±9.8 (20 to 59 years). Groups are compared according to LEFS score, coronal-sagittal-rotational angle, Johner-Rush score, and complications such as nonunion, malunion, osteomyelitis, and pin-tract infection. The mean follow-up time 31.61±3.83 months (between 24 and 44 months). ResultsNo statistical difference was found between groups in terms of demographic characteristics. There was no statistical difference between groups regarding body mass index (BMI). LEFS score and operation duration were higher in the I-EF group (p=0.000 and p=0.006 respectively, p˂0.05). In the I-EF group, hospitalization period, full weight-bearing time, and healing time was shorter than the AO-EF group (p=0.001, p=0.000, and p=0.025 respectively, p˂0.05). DiscussionAlthough AO-EF has advantages such as ease of application and short surgery time in the definitive fixation of LVGI tibia shaft fractures, I-EF is a superior technique in terms of functional scores. However, I-EF is a surgical approach that requires relatively more experience. Therefore, the choice of fixator should be determined according to the surgeon's experience in the permanent treatment of LVGI tibial shaft fractures. Level of evidenceIV; retrospective, case-control study.

A prospective study on functional and radiological outcome of distal femur fracture treated with distal femur locking compression plate (DF-LCP) in adults

Introduction: Distal femur fractures are one of the most fractures encountered by orthopaedic surgeons in routine practice. These fractures pose therapeutic challenges of fracture treatment because they are usually compound, comminuted, readily deformed because of muscle forces acting on the distal fragment, prone to result in functional impairment of the knee joint because of the injury to quadriceps system. There is no single implant that can be used for all distal femoral fractures. The introduction of DF-LCP is a welcome change that has brought a drastic change in management of these fractures due to its contouring to the distal femur with combiholes in proximal pattern.Aim: Evaluation of the functional and radiological outcome of Distal femoral fractures treated with DF-LCP.Materials and Methods: This prospective study was carried out at orthopaedics department of a tertiary care teaching hospital of Southern Rajasthan from January 2019 to June 2020. A total 30 patients of AO Type A and Type C distal femur fractures were included in the study. The method used for fixation was closed or open reduction and internal fixation with DF- LCP. All the patients were followed up for a period at the end of 6 months and functional outcome was assessed according to Knee Society Scoring System.Results: Fracture union was seen in all patients. On evaluation according to Knee’s criteria mean score were 73.76. Out of 30 patients excellent in 19 patients (63.33%), good in 09(26.67%), fair in 02(6.67%) and poor in 01(3.33%).Conclusion: DF-LCP is effective and reliable implant in treating distal femoral fractures AO type A and type C with minimal complications. However careful understanding of basic principles and identification of appropriate fracture pattern are essential to produce excellent result.

Clinical, functional and radiological outcomes of volar locked plating of distal radius fracture: A prospective study

Background: The fracture of lower end radius is the most common fracture of the upper extremity encountered in practice and constitutes 10 to 20% of all the fractures and 75% of all forearm fractures. In spite of various new advances, closed reduction and cast immobilization has been the mainstay of treatment of these fractures, but malunion of fracture and subluxation /dislocation of distal radioulnar joint resulting in poor functional and cosmetic results is the usual outcome. Recently, the volar locked plate osteosynthesis is considered as the “gold standard” in treatment of ‘unstable’ distal radius fractures. The present study proposed to evaluate the role of volar locking plate fixation in the management of intra-articular and extra-articular volar fractures of distal end radius and to evaluate the clinical, functional and radiological outcomes.Aim and Objectives: To study the improvement in clinical, functional and radiological outcomes of volar locked plate fixation in a distal end radius fracture.Materials and Methods: A prospective study was undertaken in a Tertiary Hospital from September 2016 to September 2018, 30 patients (age >20 yrs) with volar fracture of lower end of radius i.e. AO types A 2.3, B 3.1, B 3.2, B 3.3 operated with volar locked plating. The patients were followed up at 2nd, 6th, 12th and 24th postoperative weeks. Radiological & clinical, functional outcomes were assessed by using Stewart score & PRWE (Patient–rated wrist evaluation questionnaire) score respectively. Data collected of these 30 patients were statistically analysed using ANOVA chi – square test.Results: Clinical and Functional outcome by Patient Rated Wrist Evaluation scoring system shows maximum no. of patients come in Good and Excellent grading i.e. 17(56.7%) and 8(26.7%) out of 30 patients, along with this 1(3.3%) Fair and 4(13.3%) Poor result. Radiological outcome by Stewart I scoring system is Maximum no. of cases shows Good and Excellent results i.e. 20(66.7%) and 6(20%) out of 30 patients. With this 1(3.3%) Fair and 3(10%) Poor result.Conclusion: Open reduction and internal fixation with volar locked plating has satisfactory functional and radiological outcome with minimal complications and thus it is an excellent modality to treat volar fractures of distal end radius.

A prospective study on functional outcome of distal tibial fracture fixation with locking compression plate using minimally invasive percutaneous osteosynthesis technique

Introduction: Treatment of distal tibia fractures is challenging because of its subcutaneous location, poor vascularity and limited soft tissue envelope. Various modalities of surgical treatment such as Intramedullary nailing, Open reduction and internal fixation with conventional plate osteosynthesis and external fixation have reported good functional outcome but had high complication rate. The newer technique of distal tibia fracture fixation with Minimally invasive plate osteosynthesis (MIPO) using Locking compressing Plates (LCP) has emerged as an alternative treatment option because it involves less soft tissue handling, minimal periosteal stripping resulting in low infection rate, faster healing and it respects biology of distal tibia and also provides biomechanically stable construct.Aim: To assess the functional role of locking compression plates in treatment of distal tibial fractures using minimally invasive percutaneous osteosynthesis technique.Materials and Methods: In this study, 30 patients with distal 1/3rd tibia extra articular fractures (AO type 43A1, 43A2, 43A3) with or without associated fibula fractures were treated with LCPs using MIPO technique. The present prospective study was conducted in Department of Orthopaedics, Geetanjali medical college and hospital, Udaipur between January 2019- May 2020.Results: All fractures had excellent clinical and functional outcome, the fractures were stabilized by LCP using MIPO technique with an average operative time of 48.16 minutes. The age of the patients ranged from 20 to 76 years with the fracture being most common in the 3rd and 4th decade. Out of 30 patients, 21 (70%) patients were males and 9 (30%) patients were females showing male preponderance. Functional outcome evaluation was done using American Orthopaedic Foot and Ankle Society (AOFAS) score. At the end of this study, 21 (70%) patients had excellent outcome, 08 (26.66%) had good results, 01 (3.33%) had fair outcome and no patient had poor functional outcome. None of the cases had implant failure or any significant deformity.Conclusion: The present study shows that MIPO technique using LCP proves to be most effective and safer technique in the management of distal tibial fractures with or without intra-articular comminution by providing good fracture healing, enabling rapid functional recovery and avoiding major complications.

Does Dynamic Anterior Plate Fixation Provide Adequate Stability for Traumatic Subaxial Cervical Spine Fractures at Mid-Term Follow-Up?

Background: It remains questionable if the treatment of cervical fractures with dynamic plates in trauma surgery provides adequate stability for unstable fractures with disco-ligamentous injuries. The primary goal of this study was to assess the radiological and mid-term patient-reported outcome of traumatic subaxial cervical fractures treated with different plate systems. Patients and Methods: Patients, treated with anterior cervical discectomy and fusion (ACDF) between 2001 and 2015, using either a dynamic plate (DP: Mambo™, Ulrich, Germany) or a rigid locking plate (RP: CSLP™, Depuy Synthes, USA), were identified. For radiological evaluation, the sagittal alignment, the sagittal anterior translation and the bony consolidation were evaluated. After at least two years, the patient-reported outcome measures (PROM) were evaluated using the German Short-Form 36 (SF-36), Neck Disability Index (NDI) and the EuroQol in 5 Dimensions (EQ-5D) scores. Results: 33 patients met the inclusion criteria (DP: 13; RP:20). Twenty-six patients suffered from AO Type B or C fractures. Both the sagittal alignment and the sagittal translation could be sufficiently improved in both groups (p ≥ 0.05). No significant loss of reduction could be observed at the follow-up in both groups (p ≥ 0.05). Bony consolidation could be observed in 30 patients (DP: 12/13 (92%); RP: 18/20 (90%); (p ≥ 0.05)). In 20 patients, PROMs could be evaluated (follow-up: 71.2 ± 25.5 months). The whole cohort showed satisfactory PROM results (EQ-5D: 72.0 ± 4.9; SF-36 PCS: 41.9 ± 16.2, MCS: 45.4 ± 14.9; NDI: 11.0 ± 9.1). without significant differences between the DP and RP group (p ≥ 0.05) Conclusion: The dynamic plate concept provides enough stability without a difference in fusion rates in comparison to rigid locking plates in a population that mostly suffered fragile fractures.

Functional outcome of distal femoral fractures managed surgically using locking compression plate laterally and augmented with titanium elastic nail system medially

Background: Distal femur fractures are generally due to high velocity trauma particularly form road traffic accidents and fall from height. The treatment of distal femur fractures has evolved from conservative to operative to fixation of both lateral and medial columns of femur.&#x0D; Aims and Objective: The aim of this study was to evaluate the functional outcome of operated cases of comminuted fracture of lower end of femur fixed with locking compression plate laterally and augmented with titanium elastic nail system medially.&#x0D; Materials and Methods: The present study was a prospective study carried out in Bharati Vidyapeeth Medical College and Hospital, Sangli after approval from institutional ethical committee. In this study, 20 patients with communited fracture of lower end of femur were included on the basis of a predefined inclusion and exclusion criteria. Detailed history was taken and clinical examination was done in all cases. After preanesthetic evaluation and relevant investigations patients were treated by reduction (close or open) and fixation was done by locking compression plate laterally and augmented with titanium elastic nail system medially. Patients were followed up at 6, 10 and 14 weeks for functional outcome by Neer’s scoring system and degree of flexion at knee joint.&#x0D; Results: Out of 20 studied cases there were 16 (80%) males and 4 (20%) were females with a M:F ratio of 4:1. The mean age of male patients was found to be 42.81+/-14.79 whereas mean age of female patients was 40.5 +/- 14.36. The mean age of male and female patients was found to be comparable with no statistically significant difference (P=0.78). Most of the patient were diagnosed with the fracture of AO TYPE C3 (7 cases), followed by AO TYPE C1 (4 cases). Full weight bearing was achieved in 8 (40%) patients within 18 weeks whereas remaining 12 (60%) patients required more than 20 weeks for full weight bearing. 14 (70%) patients had excellent outcome whereas, Good, Fair and poor outcomes were seen in 4 (20%), 1 (5%) and 1 (5%) patient. On one-way ANOVA analysis, showed that the flexion was significantly higher in 12 weeks as that of the 6 weeks (P =&lt;0.0001). Further the flexion was significantly higher in 24 weeks as that of the 6 and 12 weeks (P =&lt;0.0001).&#x0D; Conclusion: Our study found that locking compression plating laterally augmented with titanium elastic nail system medially for comminuted distal femoral fractures is a good fixation system and provides good angular stability.

Outcome of Dynamic Condylar Screw with Plate versus Distal Femoral Lock Compression Plate Fixation in Fracture of Distal Femur

Introduction: The dynamic compression screw with plate implant used to treat fractures of the distal femur. The distal femoral lock compression plate fixation is designed as an alternative surgical option to treat these fractures. The objective of this study was to assess the comparative endurance of both devices. The objective of the study is to compare the outcome of DF-LCP and DCS fixation in distal femoral fractures.&#x0D; Materials and Methods: This prospective comparative study was conducted in the Department of Orthopaedics, Sylhet MAG Osmani Medical College Hospital, Sylhet between January 2011 and December 2012. Thirty patients with AO type 33-B and 33-C fracture were selected and were divided randomly into group-A and group-B by odd and even number. Dynamic condylar screw (DCS) fixation was used in group-A and distal femoral locking compression plate (DF-LCP) fixation in group-B.&#x0D; Results: DCS group [9 male, 6 female; mean age, 44.9 ± 12.9 years] and DF-LCP group [10 male, 5 female; mean age, 42.6 ± 15.7) years] were similar in age (p=0.660) and sex (p=0.705). The total operation (minutes) [92.3 ± 7.5 versus 90.4 ± 6.9; p=0.484], length of postoperative hospital stay (days) [6.0 ± 0.9 versus 5.9 ± 0.9; p=0.695] and union time (weeks) [20.6 ± 5.0 versus 18.7 ±3.3 weeks; p=0.238] did not differ significantly between two groups. Total complications [6 (40.0%) versus 4 (26.7%); p=0.439] was also similar in both groups. Functional outcome was excellent in 13.3%, good in 33.3%, fair in 33.3% and poor in 20.0% cases in DCS group; while excellent in 53.3%, good in 20.0% fair in 6.7% and poor in 20.0% of cases in DF-LCP group; different was not significant (p=0.080).&#x0D; Conclusion: Dynamic condylar screw with plate and distal femoral locking compression plate fixation are equally effective for achieving satisfactory union and functional outcome in AO type 33-B, 33-C fracture distal femur.&#x0D; Medicine Today 2021 Vol.33(1): 45-49

Comparison of Fluoroscopically and Arthroscopically Assisted Volar Plating of Articular Distal Radius Fractures

Abstract The article presents the results of a retrospective study that included 70 patients with intraarticular (AO Type C [Arbeitsgemeinschaft für Osteosynthesefragen]) distal radius fractures, who were treated using an arthroscopically assisted approach with volar locking plates or just a fluoroscopically assisted surgery. Thirty-seven of them were treated using volar locking plates using only fluoroscopically guided surgery and 33 patients were treated with the arthroscopically assisted fracture fixation method. Data of the patients who attended a full cycle of the postoperative observation within the first year after the surgery and postponed to the last visit 1 to 5 years after the surgery were included in the analysis for both groups. Postoperative analysis was carried out using X-ray assessment, clinical data, patient-rated wrist evaluation score, Gartland and Werley score, Modern Activity Subjective Survey of 2007 score, range of motion, grip, pinch and tripod pinch assessment at 1, 3, 6 and 12 months postoperatively. Despite the statistically significant differences found in a number of parameters during the follow-up period, there were no clinically relevant differences determined between the two methods in the long-term period. There was a greater arch of motions in extension and radial deviation in the arthroscopic surgery group. Duration of the surgery was longer in the arthroscopic surgery group, but comminuted or AO-C3 type fractures also were more often presented in this group. One complex regional pain syndrome occurred in the arthroscopic surgery group and two in the control group. None of patients suffered tendon ruptures, hardware migration or infections.

A Study to evaluate the Functional Outcomes after the Surgical Management of Intra Articular Fracture of Distal Humerus

Introduction: The primary goal in management of intra articular fractures of distal humerus is to achieve stable and mobile elbow. The chances of functional impairment and deformities are very high following conservative treatment of such distal intra-articular fractures of humerus. Objectives of the study were to assess the functional outcome and to compare the results after surgical management of intra articular fracture of distal humerus using Mayo elbow performance index. &amp; to assess the range of movements, pain and union. Methods: Retrospective Evaluation study with Review and Reports of 50 cases / patients, who were diagnosed &amp; surgically managed. Fractures were classified as per AO type A to C (except C3 comminuted) and were included in this study in whom internal fixation was done using triceps reflecting Bryan Morrey approach with some modification in few cases. Results: No patient achieved complete extension. No limitation in the pronation-supination was detected. Radiographic assessment Postoperative and follow up radiographs showed adequate fracture reduction and fracture healing in all patients. No step off more than one mm was seen. All patients had completed postoperative physical therapy at the time of the study and had achieved maximum function of elbow. Conclusion: Triceps reflecting Bryan Morrey approach is a simple and effective approach that can be used in management of the majority of the distal humeral fractures as it provides adequate visualization and reduction fracture fragments with no adverse effect on triceps muscle strength

Clinical outcome after open reduction and internal fixation for distal humeral fractures (AO type C)

Clinical outcome after open reduction and internal fixation for distal humeral fractures (AO type C)

Number of screws in the articular segment of distal humerus AO/OTA C-type fractures treated with open reduction internal fixation is associated with complication rate.

Introduction: Surgical treatment of distal humerus fractures can lead to numerous complications. Data suggest that the number of screws in the distal (articular) segment may be associated with complication rate. The purpose of this study is to evaluate the association between a number of screws in the distal segment and complication rate for surgical treatment of distal humerus fractures. We hypothesize that the number of screws in the articular segment of distal humerus AO/OTA C-type fractures treated with open reduction internal fixation (ORIF) will be inversely proportional to the complication rate. Methods: We performed a single-center retrospective cohort study of 27 patients who underwent ORIF of distal humerus fractures C-type with at least six months of radiographic and clinical follow-up. Clinical outcomes including a range of motion, pain, revision surgery for stiffness and/or heterotopic ossification (HO), nonunion, and persistent ulnar nerve symptoms requiring revision neurolysis were recorded. Results: In C-type fractures, the use of three or fewer articular screws was significantly associated with nonunion or loss of fixation (RR 17, p = 0.006). Nineteen of 36 (53%) patients experienced at least one complication. The surgical approach, plate configuration, age, and ulnar nerve treatment (none, in situ release, transposition) were not associated with the need for revision surgery. Men had a higher risk of requiring surgical contracture release due to improving post-operative stiffness (RR 12, p = 0.02). Conclusion: In this retrospective study, the use of three or fewer screws to fix articular fragments in AO type C fractures was a significant risk for nonunion or loss of fixation. Plate configuration and surgical approach did not correlate with outcomes. Men had higher rates of complications and required more frequent revision surgery compared to women.

Comparison of clinical results between the olecranon osteotomy and the lateral para-olecranon approach for AO type C distal humeral fracture

Comparison of clinical results between the olecranon osteotomy and the lateral para-olecranon approach for AO type C distal humeral fracture