Average Fracture Union Time Research Articles

Prospective Study of Surgical Management of Midshaft Clavicle Fractures

Introduction: Fractures of the clavicle constitute 2.6% of all fractures, account for 44% of the injuries around the shoulder girdle, approximately 70%–80% of which occur in the middle third. Even when significantly displaced, conventionally these fractures are treated without surgery. Conservative treatments either by sling/figure of eight bandage/clavicular brace are favored by patients, but the results are much inferior to what was reported previously. The present study conducted to operate fresh fracture with displacement >2 cm, nonunion by open reduction and internal fixation (ORIF) with locking plate with or without bone grafting. The objective is relief from pain, restoration of activities as far as possible and better cosmetic appearance. Materials and Methods: Twenty-eight cases of the clavicle in healthy active individuals between 18 and 65 years of age operated between December 2019 and September 2022 in Hazaribag Medical College, Hazaribag, Jharkhand. Patients with minimally displaced fracture were excluded from the study. Fracture is classified by Allman in three groups as middle 1/3rd, distal 1/3rd, and medial 1/3rd. Indications for surgery are either open fracture, vascular injuries, initial displacement >2 cm, nonunion, cosmetically conscious patients. Results: Fifteen cases of fresh, 6 cases of symptomatic delayed union, and 7 cases of nonunion operated with precontoured plate with or without bone grafting. The average hospital stay was 3–7 days. The average time of fracture union was 10 weeks (8–12 weeks). Patients were followed weekly up to 4 weeks and then after 2 and 6 months. The functional outcome according to Constant and Murley score is excellent in 17 (60.7%) patients, good in 10 (35.7%) patients and satisfactory in 1 (3.6%) case. There was no major complication, one patient had superficial infection, deep infection in 1 case, nonunion in 1 case and plate breakage in one patient. Results were compared with cases treated conservatively. Conclusion: In the present era of competition, cosmesis and advancement with least morbidity and excellent results is required. ORIF in selected cases is a very good option in comparison to accept morbidity, cosmetic disfigurement and below-average functional results.

Clinical outcome of proximal tibia plates in extra-articular proximal tibia fractures: a retrospective study

<p><strong>Background:</strong> Tibial fractures, which account for 2.2% of all intra-articular fractures, are frequent. These fractures are prevalent in two age groups: younger patients experience higher-energy fractures, whereas elderly patients experience lower-energy fractures as a result of osteopenia. These injuries are linked to a higher frequency of complications such as non-union, infection, mobility limitation, and post-traumatic arthritis in the younger population. The study's primary objective was to assess the results of proximal tibial fracture treated with a locking plate.</p><p><strong>Methods:</strong> Thirty patients with proximal tibia fractures are included in this retrospective clinical study. They are all treated with a tibia plate system made by Kaulmed private limited in Sonipat, Haryana, India. Thirty patients consisting of 18 males and 12 females, with average age of 42 years. Fractures categorized based on AO classification and type of soft tissue injury. Patients assessed clinically, radiologically, functionally using VAS, post-op radiographs and ROM.</p><p><strong>Results:</strong> All 30 cases that were chosen were monitored for 6 months. The average time for fracture union was 21 weeks, with a range of 18 to 24 weeks. No delayed union and non-union was observed. Infection, valgus, Knee stiffness were the complication that was observed. Two patients complained about the mild pain on the post-operative visit. Acceptable knee ROM of angle >120° was achieved and all patients were satisfied at their last visit based on parameters of pain, ADLs, aesthetics and full weight bearing.</p><p><strong>Conclusions:</strong> Excellent results were achieved in the surgical treatment of proximal tibia fractures by MIPO (minimal invasive plate osteosynthesis) and ORIF (Open reduction and internal fixation) using proximal tibia plate technique. Optimum knee function is achieved with reduction, rigid fixation to restore articular fragments, and early mobility. preventing osteoarthritis following trauma.</p>

Management of Clavicle Midshaft Fractures: A Comparative Prospective Study in Jammu

Background: Clavicle fracture, which is also commonly known as a broken collarbone, occurs mostly due to direct high impact energy over the bone due to a fall onto the lateral shoulder or on the outstretched hand. It has been seen that such types of fractures are prevalent among active and sports persons due to sporting activities. This study aimed to assess the pros and cons associated with conservative and surgical management of clavicle fractures.
 Methods: The present prospective comparative study was conducted at Government Medical College Kathua between February 2021 to January 2022. There was a total of 52 patients, with 26 patients in each group. Group A patients were given conservative management, while Group B patients were operated on for plate fixation.
 Results: The average fracture union time in group A was slightly higher compared to group B (15.9 vs. 13) weeks. And the difference was statistically significant with a p-value of 0.0483. We observed that there exists a significant difference between the two groups with respect to the total score at 24 weeks (6 months). Evidently, the average CMS score for the conservative group is smaller compared to the operated group (89.95 vs. 94.2) weeks. However, the majority of patients in group A had malaunion complications (65.4%) compared to (3.8%) in group B, and the difference was statistically significant.
 Conclusion: Evidently, post six months of displaced midshaft clavicle fracture, the rate of complications was more prevalent in group A compared to group B.

The Functional and Radiological Outcome of Hoffa's Fracture Treated With Cannulated Cancellous Screws.

Introduction: Distal femur AO type 33 B fractures consist of partial articular fractures subdivided into three types namely sagittal lateral condyle fracture, medial condyle fracture, and coronal split fracture. Coronal plane fractures of the distal femur are less frequent compared to sagittal plane fractures and are known as Hoffa fractures. The mechanism of injury is usually a direct anteroposterior force to the flexed and abducted knee for lateral condylar fractures and a direct impact on the medial side of the knee in flexion for a medial condylar fracture. Various approaches like lateral parapatellar for lateral condylar Hoffa's fixation, with or without posterior approach for open reduction of Hoffa's fracture with screw or buttress plate fixation, medial parapatellar approach for medial condylar Hoffa's fracture screw fixation are used.Materials and Methods: This study was conducted at R L Jalappa Hospital and Research Center attached to Sri Devaraj Urs Medical College, Kolar, India, from June 2017 to May 2020 with 17 patients as a sample size.Results: Seventeen patients with Hoffa's fracture were treated with cannulated cancellous screws with lag effect including 12 males and five females with a mean age of 31.1 years. The range of motion ranged from 120 to 135 degrees of flexion with a mean of 125.2 degrees. Three patients had extensor lag ranging from 5 to 10 degrees with an average of 6.3 degrees. Neer scores were excellent in 11, good in four, and fair in two patients. The average fracture union time for the lateral condyle was 16.4 months and for the medial condyle, it was 16.7 months.Conclusion: Restoration of articular anatomy and its congruence is of paramount importance for better surgical outcomes. Closed or open reduction and stable fixation with anteroposterior cannulated cancellous screws are essential. A good post-operative rehabilitation program is required for better outcomes.

Comparison between Clinico-radiological outcomes of primary closed static and dynamic interlocking nailing in transverse or short oblique diaphyseal fractures of tibia: A prospective study

Introduction and Background: The objective of the study is to evaluate the comparative efficacy in terms of clinico-radiological outcomes in primary static versus primary dynamic intramedullary interlocking nailing of tibia. The principle of fixation for a tibial middle third fracture is to stabilize at the proximal metaphyseal region, the isthmus and the distal metaphyseal region. This 3 point fixation provides adequate resistance to the deforming axial and torsional forces at the fracture site. Two types of Locking techniques exist for the intramedullary nailing, Static and Dynamic. Materials and Method: A total of 17 patients of either sex who presented with closed trauma of transverse or short oblique diaphyseal fractures of tibia, which were observed between the years 2015-2017. Randomly, static and dynamic locking was done to the equal populations presented. The aims of the study conducted were to analyze time to union, functional recovery and incidence of complications. Johner and Wruh’s Criteria was used to analyze the functional outcome. All patients were followed for a period of 18months. Results: Upon evaluation with regard to Johner and Wruh’s criteria showed Excellent results in 9 out of 17 subjects, Good results in 7 out of 17 subjects and a Fair result in 1 patient. The average time of fracture union in case of dynamically and statically interlocked nailed tibiae is 13.00 and 15.22 weeks respectively. Therefore, the difference was 2.22 weeks. In our study, the results of tibia nailing was found to be in consonance with the earlier studies. Conclusion: We conclude that Primary Dynamic locking is a better option as compared to primary static locking in simple transverse or short oblique diaphyseal fractures of tibia as it leads to faster fracture healing and early return to function.

Pre-operative use of CT based three-column concept for fragment specific fixation of proximal tibia fractures in a series of 84 cases

Background: It is important to classify proximal tibia fractures based on CT scan in addition to plain radiograph. The 3-column concept was introduced to classify these fractures based on a transverse CT scan. This study aimed to evaluate the surgical and functional outcomes of fragment specific fixation in proximal tibia fractures using the 3-column concept. Materials and Methods: 84 cases of proximal tibia fractures (mean age: 42.85±11.94 years, range 23-72 years; 65 males and 19 females) were classified based on the 3-column concept (24 - 1 column, 50 – 2 column, 10 – 3 column). The surgical approach was decided for fragment-specific fixation based on the column involved. The clinic-functional assessment was done using fracture union time, range of motion, Oxford Knee Score and Functional Knee Society Score. Results: The mean follow up duration was 1.2-1.5 years. The average fracture union time was 15.63±1.98 weeks (range, 12-21 weeks). The mean flexion achieved at the final follow up was 132.74±4.49 degrees (range, 130-135 degrees). The mean follow-up Oxford Knee Score was 47.98±0.109 (range, 45-48) and the mean Functional Knee Society Score was 99.88±1.09 (range, 90-100) in all patients after 1 year. 2 patients showed they delayed wound healing with superficial infection and 1 patient had a stiff knee. There was no other complication. Conclusion: Using the CT-based three-column concept for fragment-specific fixation pre-operatively helps treat a complex proximal tibia fracture with acceptable complication rates and good functional outcomes.

Extra articular metadiaphyseal fractures of distal tibia managed by tip locking intramedullary Nailing: A case series

Introduction: Distal tibial fractures are commonest, often a result of high-energy trauma causing significant soft tissue injury and comminution. Being subcutaneous with tenuous soft tissue coverage it is poorly vascularized with more risk of infections, delayed union and non-union. This study is intended to know the efficacy of closed reduction with tip locking intramedullary nail, in distal extra articular metadiaphyseal tibia fractures with at least 4-5cm of intact distal fragment. Materials and Methods: This study is conducted on 18 skeletally mature patients, 14 male and 4 female, between December 2019 to December 2020 who fulfilled the inclusion criteria, using an Expert Tibial Nail System (ETNS)/tip locking IM nail. Patients were assessed clinically and radiologically at regular intervals for fracture union, functional ROM and any residual symptoms. Results: Average time of fracture union was 15.2 weeks. The functional ROM in majority of patients was as pretrauma level at end of 15.2 weeks without any complications and residual symptoms on full weight bearing. Evaluated American Orthopaedic Foot and Ankle Society (AOFAS) ankle score was 80.Conclusion: ETNS/tip locking IM nail is an excellent option in tackling distal tibia fractures. It is a minimal invasive biomechanical procedure, giving stability even in osteoporotic bone. Minimal soft tissue complications with advantage of early fracture union and ambulation.

A prospective study of surgical management in fracture of both bone forearm shaft using titanium elastic nailing system in pediatric patients

Introduction: Both bone forearm fractures are common orthopaedic injuries in pediatric population which present significant challenges to the orthopaedic community. It is not only important to treat them adequately but also to recognize the overall impact a fracture can have on a child, possibly limiting physical activity. Forearm fractures comprise 40% or more of pediatric fractures.Majority of these fractures can be treated conservatively with closed reduction and cast immobilization. A recognized failure rate has been reported up to 7% to 32%. Commonly two operative treatment modalities are employed at present: open compression plating and flexible intramedullary nailing. Each modality has advantage and disadvantage. Objective: Assess the functional outcome and complications associated with Titanium Elastic Nailing System in fracture of both bone forearm in pediatric patients.Materials and Methods: 20 Patients with both bone forearm shaft fracture aged between 6-16 years admitted to Chigateri General Hospital and Bapuji Hospital attached to J.J.M. Medical College Davanagere in the period from September 2019 to August 2021.Results: In our study, majority of the patients were boys, with an average age of 10.5 years with mid 1/3rd shaft transverse fractures being the most common, and self-fall while playing was the most common mode of injury. The surgery required minimum dissection, short operation time with hardly any risks of intraoperative complications. The average fracture union time was 9 weeks with patients recovering near normal functions of forearm at the earliest.We didn’t encounter any major post-operative complications in our study, and 95% of the patients had excellent range of motion at wrist, elbow and radio-ulnar joints and 5% had satisfactory range of motion.Conclusion: TENS nailing in both bone forearm shaft fractures in pediatric age group provides excellent results with advantages of early union, excellent recovery of function, minimal invasive and decreased time of surgery.

A prospective study to evaluate functional results of PHILOS locking plate system in management of proximal humerus fractures in adults

<p class="abstract"><strong>Background:</strong> Various management options are available for management of proximal humerus fractures where PHILOS plating is one of them. But data available in literature on its use and efficacy in management of all types of proximal humerus fractures is still dicey. So, we through our study attempted to grow our knowledge regarding its functional results, complication rates, etc. for use in coming future.</p><p class="abstract"><strong>Methods:</strong> 30 patients with proximal humerus fractures classified on the basis of Neer’s classification were included in study who were operated from 2018 to 2020 at our institute. These patients were operated by PHILOS locking plate system with either delto-pectoral or trans-deltoid approach and they are followed up at regular intervals to assess them clinicoradiologicallly and functionally by Neer’s criteria.<strong></strong></p><p class="abstract"><strong>Results:</strong> In our study we found maximum incidence of these fracture between age group of 40-80 years (66.66%) with male to female ratio of 2:1 with 19 patients having left sided and 11 patients having right sided proximal humerus fracture. Complications were found in 11 patients (36.67%). Functional evaluation was carried out using Neer’s criteria at final follow up which came to excellent results in 3, satisfactory in 18, unsatisfactory in 7 and failure in 2 patients. Average time of fracture union was 12.62 weeks.</p><p class="abstract"><strong>Conclusions:</strong> PHILOS locking plate system serves good purpose in management of fractures of proximal humerus but requires trained faculty to do this operation who has detailed knowledge about shoulder anatomy and mechanism of injury to reduce complications associated with this type of modality.</p>

Is it advantageous to use the intraoperative compression option of proximal femoral nail antirotation in the treatment of osteoporotic intertrochanteric fractures? A retrospective comparative study.

The aim of this study was to retrospectively compare the radiological and clinical results of intertrochanteric fractures treated with proximal femoral nail antirotation (PFNA) that were either intraoperatively compressed or non-compressed. Ninety-four patients (64 female, 30 male; mean age = 77.6 years; age range = 68-81) who underwent intraoperative fracture compression (IOFC) (94 hip joints, group A) and 88 patients (64 female, 24 male; mean age = 77.1 years; age range = 67- 80) who underwent postoperative impaction (POI) alone (88 hip joints, group B) from2012 to 2017 met the following six conditions were observed for over 2 years: AO Foundation/Orthopaedic Trauma Association 31-A1 and 31-A2 trochanteric fractures; Singh index grade ≥ 3; positive or neutral medial cortical support position with slightly valgus reduction; possible compression of more than one cortical bone in the anterior or medial region of the fracture site based on preoperative imaging test; blade position within the center-center; andtip-apex distance of < 25 mm. During the follow- up periods, changes of pain and time to fracture union were evaluated clinically, and the lateral extension distance (for screw back-up) was evaluated radiologically which measuredbetween the lateral end of the screw and lateral edge of the intramedullary nail. The mean follow-up was 38.4 (range = 24-48) months in Group A and 36.7 (24-48) months in Group B. The mean operation time was 68 (range = 40-100) min in group A and 71 (range = 40-105) min in Group B (P = 0.521). Intraoperative blood loss was 78 (range = 50-110) mL in Group A and 81 (range = 50-100) mL in Group B (p=0.715). The mean fluoroscopy time was 2.8 (range = 2.2-3.5) min in Group A and 2.6 (range = 2.1-3.5) min in Group B (P = 0.631). The acute phase pain scores measured by visual analog scale at postoperative 3 months were 35.5 in Group A and 37.6 in Group B (P = 0.073). The lateral extension of the PFNA blade showed significant difference at 24 months after surgery (Group A, 3.6±3.1 mm; group B, 7.8±3.7 mm, P = 0.017). Fracture gaps after surgery were 1.8 (range = 0.5-2.5)mmin Group A and 2.6 (range = 0.7-4.6)mmin Group B, showing significant difference (P = 0.001). The average fracture union time was 16.7 (range = 14-20) weeks in Group A) and 19.7 (range = 16-22) weeks in Group B (P = 0.065). The mean Harris Hip Scores at postoperative 24 months were 84.3 (range = 65-100) in Group A and 85.5 (range= 69-100) in Group B (P = 0.545).p Conclusion: If all the six conditions are met, IOFC seems to appropriate for AO/OTA 31-A1 and 31-A2 intertrochanteric fractures with the smaller postoperative fracture gap and lateral protrusion of the blade, which may contribute to the shortening of fracture union periods. Level IV, Therapeutic Study.

Surgical outcome of proximal tibial fractures treated with locking compression plate: A prospective study

Background: The knee joint is one of the major weight bearing joints in the lower extremity. Generally, these injuries fall into two broad categories, high energy fractures and low energy fractures. Fractures of the proximal tibia are the result of high energy injuries and because of lack of soft tissue coverage in this region. The majority of tibial plateau fractures are secondary to high speed velocity accidents and fall from height. Fractures result from direct axial compression usually with a valgus or varus moment and indirect shear forces. Materials and Methods: The study was conducted between the period of November 2017 to April 2019 includes at Department of Orthopaedics, Bowring hospital,Bangalore.20 patients with diagnosis of proximal tibial fractures were treated with locking compression plate. All Schatzker’s classification type 1-6 proximal tibial fractures in adults aged 18 years and above of either sex were included in the study. All patients were followed up. With each follow up, clinical and radiological examinations were performed at 6 weeks, 3 months and 6 months. Results: The study included 20 patients, 18 males and 2 female aged from 21-80 years with mean age of 40.02 years. The average time for fracture union in our series was 15.52 weeks. In present study, knee stiffness was observed in 2 patients. Our study yielded excellent to good results in 80% of cases. Conclusion: Displaced tibial plateau fractures are best managed operatively. Optimal knee function is achieved by accurate anatomical reduction and secure fixation followed by early mobilization to attain functional arc of motion. For minimally-displaced fractures with minimal bone defects percutaneous fixation suffices, whereas for comminuted fractures, open reduction and internal fixation is mandatory. In our study, we found that proximal tibial locking plate provides complete union and early mobilization to attain better functional outcome.

Concomitant intramedullary nailing and plate augmentation as a single-stage procedure in treating complicated nonunited femoral shaft fractures

Background and Purpose: Complicated femur fracture represents a major challenge for the orthopedic surgeon, with failed internal fixation, nonunion with broken intramedullary nail (IMN), and infected nonunion among the complications. Mechanical instability, as well as the poor biological environment, is considered as a concern when treating these cases. The purpose of this study was to evaluate concomitant IMN and plate augmentation as a single-stage procedure for the management of multiply operated nonunited femoral shaft fractures. Materials and Methods: Between January 2015 and May 2018, nine patients (eight men) with an average age of 40.8 years (range 25–70) diagnosed as nonunion femoral fractures after an average of four previous surgeries (range 2–6). All patients were available for follow-up with an average of 22 months (range 12–36). Results: The average time for fracture union was 6.7 months (range 3–12); five patients needed bone grafting to compensate for the bone defect encountered during the initial procedure, and two patients required secondary bone grafting after 6 months follow-up. Two patients presented with surgical site infection which was treated by antibiotics and daily dressing. The average leg length discrepancy at last follow-up was 1 cm (range 0.5–1.5). No patient had a metalwork failure or needed removal of the implants. Conclusion: In treating complicated multiply operated nonunited femoral shaft fractures, we believe that this technique can provide a robust mechanical foundation as well as an improved biological environment for such nonunited fractures to heal.

Functional outcome analysis in floating knee injury

Introduction: The term floating knee is defined as simultaneous ipsilateral fracture of femur and tibia that disconnect the knee from the rest of the limb. Due to the complexity of injury and associated complications such as compartment syndrome, vascular injury, collateral and meniscal injuries they remain as great challenge to the treating orthopaedician. Materials and Methods: Study includes 25 cases of floating knee injuries done at our institution from June 2013 to December 2016, McBryde and Blake classification was used and intramedullary interlocking nailing was done in majority of cases. All the patients were followed up for clinical, radiological outcome and complications. Functional outcome was assessed by using Karlstrom Olerud criteria. Results: In our study, mean age is 43.5 years, predominantly males (96%). McBryde and Blake type I (52%) was common. The average hospitalization period is 45 days. Minimum follow up period was 4 months. The average fracture union time was 24 weeks for tibia and 25 weeks for femur. The most common complications noted was shock (68%), knee stiffness (44%),chronic osteomyelitis (20 %), malunion (16%), non union (16%),vascular injury with amputation(4%). Functional outcome based on above criteria is excellent in 40%, good in20%, acceptable in 20% and poor in 28%. Conclusion: Each fracture in floating knee is unique and treatment should be individualized. In compound fractures early stabilization with external fixator followed later by definitive fixation avoid the late complication. In closed fractures early internal fixation and rehabilitation will give a good functional outcome. Keywords: Floating knee, Management, Complications, Functional outcomes.

Management of distal tibial metaphyseal fracture by expert tibial nail using suprapatellar approach

Background: Distal tibial metaphyseal fractures are common lower limb injuries and results in extensive musculoskeletal damage due to paucity of soft tissue coverage. Fixation methods include open reduction and internal fixation (ORIF) with plates, minimally invasive percutaneous plate osteosynthesis (MIPPO) and intrameduallary nailing. Extensive exposure for ORIF leads to wound complications,nonunion and infection. Intramedullary nailing is the preferred for diaphyseal tibial fracture however conventional nailing is less suited for distal tibial metaphysis due to diameter mismatch between the nail and the bone leading to very little nail effect and impaired stability. Expert tibial nail with multiplanar locking options at the proximal and distal end allows for secure stabilization of the metaphyseal fragments. Infrapatellar approach is traditionally used for tibial nailing however suprapatellar approach is emerging as an alternative as semi-extended positioning makes it technically easier to nail the proximal and distal fractures. Materials and Methods: This is a prospective study conducted from February 2019 to February 2020. 14 patients fulfilling the inclusion criteria underwent intramedullary nailing using the suprapatellar approach. The functional outcomes were measured at 6 months using the Lysholm knee score and the SF-36 physical and mental score. The obtained data was analyzed using SPSSv16. Result: The average time of fracture union was 17.8 weeks. The mean SF-36 physical and mental score were 42.4 and 44.5 respectively. The average Lysholm score was 84. The mean arc of motion in the involved knee was 110ᵒ. Secondary procedure in the form of dynamization was done in 2 cases. Anterior knee pain was observed in 3 patients.Conclusion: Expert tibial nailing using suprapatellar approach appears to be a suitable fixation method for distal tibial metaphyseal injuries as it provides good functional and clinical outcome at the same time minimizing the violation of delicate soft tissue structures.

Surgical Treatment of Comminuted Coronal Shear Fracture of Distal Humerus.

ObjectiveTo investigate the surgical approach, fixation, and clinical effect of comminuted coronal shear fracture of distal humerus.MethodsFrom March 2017 to February 2019, we had used open reduction and internal fixation to treat 19 cases of comminuted distal humeral coronal shear fracture. There were 8 males and 11 females, with an average age of 44.6 years (19–72 years). There were 10 cases on left side and 9 cases on right side. All cases were closed fractures. According to Dubberley's classification, there were six cases of type 1, six cases of type 2, and seven cases of type 3. The lateral Kocher approach, extended Kocher approach, extended Kocher approach combined with a medial incision and the olecranon osteotomy approach were used for exposure. Headless screw, Kirschner wire, and suture were used to fix the fractures. Two cases were fixed with hinged elbow fixators additionally. The follow‐up was evaluated by Mayo Elbow Performance Score (MEPS).ResultsAll patients were followed up for an average of 17.1 months (range, 12 to 30 months). The average time of fracture union was 8.8 ± 1.9 weeks. There were three cases of degenerative osteoarthritis of elbow and one case of heterotopic ossification after operation. A total of 10 patients underwent removal of implants. At the last follow‐up, the elbow flexion‐extension arc was 130.5° ± 10.5°. The forearm rotation arc was 167.4° ± 6.1°. The MEPS was 85.8 ± 8.5, the results were classified as excellent in nine cases, good in eight, and fair in two. The excellent and good rate was 89.5%. The time of fracture union of type 1 was shorter than type 3 (P = 0.024), the elbow flexion‐ extension arc of type 1 fracture was better than type 2 (P = 0.043) and type 3 (P = 0.012), the forearm rotation arc of type 1 fracture was better than type 3 (P = 0.006), the MEPS of type 1 fracture was better than type 2 (P = 0.009) and type 3 (P = 0.002).ConclusionOpen reduction and internal fixation with headless screw, Kirschner wire, and suture can be used for the treatment of comminuted distal humeral coronal shear fractures. The elbow joint function can be restored satisfactorily.

Self-made dentation hook plate associated with hot-air balloon technique on treatment of Mutch Ⅰ or Ⅱ type isolated greater tuberosity fractures of humerus

To observe effectivness and safeness of self-made dentation hook plate associated with hot-air balloon technique in treating Mutch Ⅰ or Ⅱ type isolated greater tuberosity fractures of humerus. Between January 2016 and December 2018, 15 patients with Mutch Ⅰ or Ⅱ type greater tuberosity fractures were treated with self-made dentation hook plate associated with hot-air balloon technique. There were 9 males and 6 females with an average age of 45.1 years (range, 29-62 years). The injury causes included falling injury in 9 patients and traffic accident injury in 6 patients. According to Mutch classification, 4 cases were MutchⅠ type and 11 cases were Mutch Ⅱ type. There were 7 cases with anterior dislocation of shoulder. The time from injury to operation was 2-10 days (mean, 4.5 days). All 15 patients were followed up 8-16 months, with an average of 13.5 months. There was no infection of incision, loss of reduction of fracture block, delayed union or nonunion. The average time of fracture union was 6.5 months (range, 4-8 months). One patient had axillary paralysis at 1 day after operation, and was treated with nutritional nerve therapy, the symptoms disappeared after 2.5 months. Three patients had slight subacromial impingement. After fracture healing, the hook plate was taken out in advance, and the pain and abnormal noise disappeared during shoulder abduction. At last follow-up, Costant-Murley score used to evaluate shoulder joint function was 88-100, with an average of 96.8; 8 cases were excellent, 7 cases were good, and the excellent and good rate was 100%. The internal fixator was removed after 8-16 months after the secondary operation with no re-fracture occurred. The self-made dentation hook plate associated with hot-air balloon technique is a safe and reliable method for the treatment of Mutch Ⅰ or Ⅱ type isolated greater tuberosity fracture of humerus.

Posteromedial versus direct posterior approach for posterior cruciate ligament avulsion – A comparative study

Background/Purpose:Open reduction of acute avulsion of posterior cruciate ligament (PCL) fragment may be achieved through direct posterior approach or posteromedial approach. The aim of our study was to compare these two techniques for fixation of avulsed PCL fragment. Our primary study objective was to study that which of the above techniques provides a better screw placement on post-operative radiographs. The secondary objectives were to study any statistically significant differences in surgical time, blood loss, incidence of neurovascular injury, bone union and functional knee scores in the above two techniques.Materials and methods:This is a prospective, comparative, interventional, single tertiary referral centre-based study from November 2014 to May 2019. Patients in the direct posterior group were treated with the approach described by Abbott and Carpenter, and patients in the posteromedial group were treated with the approach described by Burks and Schaffer. Screw placement was assessed on anteroposterior (AP) and lateral knee X-rays. Blood loss was studied using haemoglobin balance method. Functional scores were recorded preoperatively and at 1-year follow up using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee scores.Results:The posterior group showed better screw placement angle compared to the posteromedial group. In the AP plane, the mean angle of screw placement and fracture line was 83° compared to 59° in the posteromedial group. Average fracture union time, post-operative range of motion and post-operative WOMAC scores were not statistically different in both groups. There were no cases of neurovascular complication, deep vein thrombosis and superficial or deep surgical site infection in any group.Conclusion:Direct posterior approach to PCL avulsion provides better screw placement angle compared to the posteromedial approach, which might result in better interfragmentary compression at the avulsion site. However, the two approaches did not differ statistically in terms of functional scores of patients reported at 1 year.

Minimally invasive medial plate osteosynthesis in tibial pilon fractures: Longterm functional and radiological outcomes.

The aim of this study was to evaluate the long-term follow-up and functional and radiological outcomes of minimally invasive medial plate osteosynthesis in distal tibia fractures. From January 2011 to November 2015, we reviewed the medical records of 60 patients with 62 tibia fractures (41 men and 19 women; mean age: 45.3±14.9 years) who were treated with open reduction and internal fixation for distal tibia pilon fractures. The mean follow-up time after surgery was 42.7±4.6 months. Union time, coronal plan deformity, complication rates and AOFAS and Olerud-Molander functional outcome scores were evaluated. According to the AO/OTA classification, there were thirty four (54.8%) type 43-A fracture, eight (12.9%) type 43-B fractures, twenty (32.3%) type 43-C fractures. The average time for fracture union was 16.1 weeks. The mean AOFAS score was 86.6±9.1. The mean Olerud-Molander score was 85.6±9.8. There were four patients (6.5%) with a varus of less than 5°, two patients (3.2%) with a valgus of less than 5°, 39 patients (62.9%) with recurvatum (34 of them less than 5°; five of them less than 10°), and 14 patients (22.6%) with procurvatum (12 of them less than 5°; two of them less than 10°). The AOFAS and Olerud-Molander scores in the smoker and diabetic patients were significantly lower than the non-smoker (p=0.002; p=0.005) and non-diabetic patients (p=0.022, p=0.002). The duration of union was significantly higher in both diabetic (p=0.025) and smoker patients (p=0.041). There was no association between the fracture type and the presence of varus, valgus, recurvatum and rotation deformity. The AOFAS score, Olerud-Molander score and plantar-flexion were significantly higher in type A fractures than in type C fractures (p=0.021; p=0.030, and p=0.033, respectively). AOFAS score, Olerud-Molander score, plantar-flexion value did not differ between type B and type C fractures. There was no significant difference among the dorsi-flexion (p=0.211), the follow-up time (p=0.531) and duration of union (p=0.908) of type A, type B and type C fractures. Three patients with open fracture had delayed wound healing. One patient developed skin necrosis. They were treated by local wound care. Minimally invasive medial plate osteosynthesis is a reliable method of treatment for tibial pilon fractures. This technique provides a high fracture healing rate and satisfying functional outcome with minimal wound healing complications. Sagittal plan deformity remains a common complication with minimally invasive medial plate osteosynthesis. Level IV, Therapeutic Study.

A comparative study of intramedullary interlocking nailing and minimally invasive plate osteosynthesis in extraarticular distal tibia fractures

Introduction: Distal tibial fractures are very commonly encountered by orthopaedic surgeons. They are one of the perplexing injuries encountered due to its poor blood supply and limited soft tissue cover. Our aim is to study and compare clinical and radiological outcome in extra articular fractures of distal tibia treated by IMILN and MIPPO locking compression plates with reference to rate of healing, functional outcome, and complications. Material and Methods: This was a prospective observational study, with a sample size of 30, 15 randomly assigned to MIPPO group and the remaining to the IM nailing group. The patients one year with clinical and radiological assessment. The data was then recorded in a semi-structured pro forma and entered in an MS Excel Spreadsheet. Statistical analysis was performed using SPSS v20. Results: Most of the population was over the age of 55 years for IMILN group, but younger in MIPPO i.e. 30-55 years. The most common mode of injury was RTA in both the study groups. 80% cases of IMILN had associated fibular fracture compared to 46.7% in the MIPPO group. Average time for fracture union was 5.4 months in IMILN group vs 65.3 months in the MIPPO group, which was not statistically significant. We observed fewer complications in terms of implant irritation, ankle stiffness and infection (superficial and deep) were seen in interlocking group as compared to plating group. Conclusion: MIPPO with a medial distal tibial locking plate and closed reduction with intramedullary nailing are equally viable options for management of extra-articular fractures of the distal tibia.

Study of enders nailing in tibia shaft fracture in paediatric patient

Background and Aim: The exposed anatomical location of the tibia makes it vulnerable to the direct blow and high energy trauma as a result of motor vehicle accidents, thus resulting in comminuted fractures which are frequently open with significant loss of skin and soft tissues. The purpose of our study was to present results of fixation of unstable tibial shaft fractures in children with Ender’s nailing.Material and Methods: This is a study of 30 patients of unstable tibial shaft fractures in children treated with Ender’s nailing. 24 were closed fractures & 6 were open grade one fractures with only punctured wounds. Twenty patients had concomitant fibula fractures. In 26 patients tibia fracture was an isolated injury, one had associated same side clavicle fracture and one had associated same side lower end radius fracture.Results: Average time for fracture union was 9 weeks (range 6 to 15 weeks). All fractures united without 2nd operative intervention. Slight nail back out occurred in many patients, but only in 2 patients significant proximal migration of nails occurred causing some knee irritation, but not requiring any operative intervention before fracture union. In all patients implant removed 6 to 7 months after surgery. There was some restriction of knee movements in 4 patients in which nails were significantly backed out, but after implant removal full knee movements achieved in all patients there was full ankle movements in all patients at final follow-up. Conclusion: Based on our results, Ender’s nailing is an effective method of treatment in these cases, which allows rapid healing of tibial shaft fractures with an acceptable rate of complications.