Cases Of Superficial Infection Research Articles

Abordaje transfibular modificado para fracturas del platillo tibial posterolateral. Serie de Casos

BackgroundFractures of the posterolateral tibial plateau require an approach that allows a good visualization of the articular surface for its anatomical restitution, restoration of height and an adequate space for the application of osteosynthesis material and stable fixation. There are several approaches described in the literature that do not provide the desired visualization or involve multiple limitations and / or complications. The purpose of this study is to describe a modification to the surgical technique of the fibula osteotomy for the management of posterolateral tibial plate fractures. MethodsWe present the clinical results of a retrospective case series of 15 patients with posterolateral tibial plate fractures that at the time of the study had an average follow-up of 6 months. ResultsFunctional results in Lysholm scale were excellent in 3 patients, good in 8 and regular in 4. Good results were obtained in all patients with a reduction of the tibia articular surface, without loss of height of the same, with alignment adequate, without symptoms of instability, all with consolidation of the fibula that did not delay rehabilitation, there were no peroneal nerve injuries or problems with the skin; There was a case of superficial infection that was managed with oral antibiotics without complications. DiscussionThe described approach facilitates a broad exposure of the articular surface, is technically easy and reproducible, allows the necessary reduction and fixation, with a lower risk of complications, with which the vascular supply of the proximal tibia is conserved, the damage is avoided to the proximal tibiofibular joint and a greater area of consolidation of the osteotomy is favored. This technique can be used alone or in combination with other approaches, for acute or chronic fractures with poor union.We consider that the approach with the described technique is an alternative for the management of posterolateral fractures, with encouraging results.Evidence Level: IV

Percutaneous Oblique Distal Osteotomy of the Fifth Metatarsal for Bunionette Correction: A Prospective Cohort Study

Category:Lesser Toes; Midfoot/ForefootIntroduction/Purpose:Bunionette is a very common foot disorder, and several kinds of corrective surgery have been described. With the popularization of minimally invasive surgeries, the forefoot region became a suitable area for this kind of technique. The aim of this study was to evaluate the results of oblique distal osteotomy of the fifth metatarsal adapted for the percutaneous approach.Methods:We prospectively evaluated 31 consecutive tailor’s bunion patients who underwent surgical correction after failure of conservative treatment between 2016 and 2019, totaling 42 feet. Clinical outcomes such as pain (VAS), function (AOFAS), criteria of personal satisfaction, and complications were evaluated. Radiographic aspects were also included. The Shapiro and Mann- Whitney statistical tests were run in the Stats package within the R environment.Results:The average age of the patients was 69.54 years, and the average follow-up was 13.14 months. There was a decrease of6.67 points in the VAS for pain (p<0.001) and an increase of 34.94 in AOFAS (p<0.001) after the surgical procedure. Radiographic correction was achieved at both the fifth metatarsophalangeal angle (p<0.001) and intermetatarsal angle (p<0.001), which showed decreased values. There was one case of superficial infection and two cases of nonconsolidation (asymptomatic). A large majority of patients considered the procedure outcome satisfactory.Conclusion:The percutaneous oblique distal osteotomy of the fifth metatarsal for bunionette deformity showed improvement in pain and function and a high rate of personal satisfaction with a low incidence of complications and high capacity to correct the deformity.

Surgical Treatment of Pediatric Proximal Humeral Fracture by Percutaneous Pinning

Background: Proximal humeral fracture pattern varies based on the mechanism of injury and the patient’s age at the time of the injury. The purpose of this study was to prove short-term clinical and radiographic results of closed reduction and percutaneous pinning in displaced proximal humeral fractures in pediatric by K-wire. Subjects and Methods: This was clinical trial study included 18 children with proximal humeral fracture; their age ranged from 8 to 15 years with mean age 11.88 ± 2.08 with closed proximal humeral fracture between November 2019 and June 2020 at Zagazig University Hospital by closed reduction and percutaneous pinning under image intensifier using Kirschner-wires. Results: This study showed that 12 cases had no complication (66.7%), 3 cases had stiffness (16.7%), 2 cases had superficial infection (11.1%) and 1 case had loss of reduction (5.6%) and treated by K-wire removal, arm sling stabilizer. Two cases of superficial infection did not necessitate early removal of K-wires. All of them were treated with oral antibiotics. Conclusions: Additional K-wires through the lateral cortex give more stability for the severely displaced fractures with rotational or angular instability mainly type 4 fractures.

Optimum timing of conversion from DCO to definitive fixation in closed fractures of the lower limb: When and how?

IntroductionIn damage control orthopaedics (DCO), fractures are initially stabilised with external fixation followed by delayed conversion to definitive internal fixation. The aim of this study is to determine whether the timing of the conversion influences the development of deep infection and fracture healing in a cohort of patients treated by DCO after a closed fracture of the lower limb. Furthermore, we wanted to evaluate whether the one-stage conversion procedure is always safe. Materials and methodsA retrospective cohort study was conducted at a single level 1 trauma centre. Ninety-four cases of closed fractures of lower limb treated by DCO subsequently converted to internal fixation from 2012 to 2019 were included. Development of deep infection, superficial infection, non-union and time to union were recorded. Patients were then divided into three groups according to the timing of conversion: Group A (<7 days), Group B (7-13 days), Group C (> 14 days). Comparison between groups was performed to assess intergroup variabilty. ResultsThe mean number of days between DCO and conversion was 6.7±4.52 (range 1-22). We observed one case of deep infection (1.1%), one case of non-union (1.1%), four cases of superficial infection (4.3%) and mean time to union was 4.9±1.38 months months. Comparison between groups demonstrated no significant correlation between timing of conversion and development of superficial or deep infection and non-union, while it highlighted that complexity of the fracture and longer surgical time of conversion procedure were significantly higher in Group C. ConclusionsOne-stage conversion to definitive internal fixation within 22 days from DCO is a safe and feasible procedure, which does not influence the incidence of infection or non-union.

Minimally invasive technique for stage III adult-acquired flatfoot deformity: a mid- to long-term retrospective study.

The purpose of this study was to present the functional, radiological, and quality of life outcomes of a series of stage III adult-acquired flatfoot deformity corrections using an original operative approach based on minimal incision surgery (MIS). Sixty-two patients (67feet) with a symptomatic stage III flatfoot deformity were treated using a modified double arthrodesis by MIS. The mean age was 63years (range, 50 to 81) and the mean follow-up was 6.6years (range, 3.2 to 11.5). Clinical, radiological, American Orthopaedic Foot and Ankle Society Hindfoot score (AOFAS score), quality of life (SF-36), and satisfaction scores were collected retrospectively. The mean AOFAS score improved by 54.27 (95% [CI], 57.27-51.3; P < 0.0001), and the SF-36 improved by a mean of 17.5 points (95% CI, 1.4-20.9) in the physical component summary (PCS). Deformity correction was confirmed by a significant improvement in the x-ray measurements (six angles). Bony union was observed in 89.5% of cases (60/67). In all, nine patients (13.4%) needed a secondary surgery: three for talonavicular nonunion, four for progression of the flatfoot deformity, and two for screw protrusion. No cases of superficial infection, wound dehiscence, or avascular necrosis of the talus were observed. The present series represents the largest study of stage III flatfoot correction using MIS with a mid- to long-term follow-up. Because the data showed clinical and functional improvement after surgery with fewer complications, this technique may be ideal for patients at risk of complications. Graphical abstract.

Definitive management of open pilon fractures with fine wire fixation

IntroductionThe BOAST (British Orthopaedic Association Standards for Trauma) guidelines advise that open pilon fractures amongst other open lower limb fractures need to be treated at a specialist centre with Orthoplastic care. The purpose of this study was to determine clinical outcomes in patients with open pilon fractures treated as per BOAST guidelines alongside a treatment protocol which consisted of early wound debridement and spanning external fixation, delayed soft tissue coverage with a flap when necessary and delayed definitive fixation with the use of a Fine Wire Fixator. Material and methodsWe conducted a retrospective analysis of open pilon fractures treated between 2014 and 2019. All patients were included for the assessment of the rate of infection and fracture healing. Functional outcome assessment was performed in all patients according to the American Orthopaedic Foot and Ankle Score (AOFAS) at 12 months post injury. ResultsThere were 20 patients including 16 males and 4 females. The mean age was 50.45 years. Initial wound with bone debridement and application of a spanning external fixator was performed within an average of 13.5 hours. The mean time from primary surgery to definitive fixation was 24.5 days.There were 3 patients with Gustilo Type I injuries, 6 with Type II, 4 Type with type IIIa and 7 with Type IIIb injuries. Average time to bone union was 10.4 (Range: 2-18) months. The mean AOFAS score was 74.2 (Range: 28-97). A Taylor Spatial Frame was used on 18 patients, while 2 patients had an Ilizarov frame. A corticotomy was performed on 4 patients with critical bone defect post debridement. There was 1 case of deep infection and 9 cases of superficial infection. There were also 4 cases of delayed union which required bone grafting from their femur using a RIA (Reamer Irrigation Aspirator). ConclusionOur study suggests that the use of staged wound debridement including relatively aggressive bone debridement in conjunction with systemic and local antibiotics, external fixators and patient tailored conversion from spanning external fixator to fine wire frame achieves low rates of wound infection and complications for patients with open pilon fractures.

OUTCOME OF INTRAMEDULLARY NAILING OF PROXIMAL THIRD RADIUS FRACTURES IN ADULTS USING TALWALKAR SQUARE NAIL.

Background : In the management of Proximal Third Radius Fractures in Adults it is very important to take care of posterior Interosseous nerve, regain the length of the bones, maintaining the radial bow, good apposition, intact fracture haematoma and alignment without any malrotation, early mobilization of wrist and elbow to get good results. Intra medullary nailing of these fractures can be considered as a good alternative method. The aim of the study was to evaluate results of intramedullary nailing using Talwalkar square nails in adult forearm fractures.&#x0D; Method: It’s a prospective multicentric study where we treated 92 adult patients with Proximal Third Radius Fractures, isolated or along with ulna fracture with over the period of four years may 2013 to may 2018 with a follow up for one years.&#x0D; Result: The average time to complete union was 12.1 (SD +3.2) weeks with cast support for a mean of 8.5 weeks. Union was achieved in 88 out of 92 patients. Using the Grace and Eversmann rating system, 57 patients were excellent, 24 were good, and 7 had an acceptable result. Four patients had non-unions, 2 for the radius and two for the ulna. There were three cases of superficial infection, two had olecranon bursitis. Complication rates associated with the use of square nails were lower compared to plate osteosynthesis and locked intramedullary nails. To control rotation postoperatively, there is a need for application of an above-elbow cast after nailing. There were no incidences of Posterior Interrosseous Nerve injury&#x0D; Conclusion: Use of Talwalkar’s design of the square nail has resulted in and continues to result in predictable and good results. Complication rates are lower as compared to plate osteosynthesis, although application of above-elbow cast after nailing is a downside of the procedure. The square nail still has a future in repair of forearm fractures considering its complications rates, cost and acceptable results.&#x0D; Keywords: Proximal Radius fractures, square nail, Talwalkar Nail, closed intramedullary nailing, radius-ulna nailing

Percutaneous Oblique Distal Osteotomy of the Fifth Metatarsal for Bunionette Correction.

Bunionette is a common foot disorder, and several types of corrective surgery have been described. With the popularization of minimally invasive surgeries, the forefoot region has become a suitable area for this type of technique. The aim of this study was to evaluate the results of oblique distal osteotomy of the fifth metatarsal adapted for a percutaneous approach. We prospectively evaluated 31 consecutive tailor's bunion patients who underwent operative correction on a total of 42 feet between 2017 and 2019 after failure of conservative treatment. Clinical outcomes such as pain (visual analog scale [VAS]), function (American Orthopaedic Foot & Ankle Society [AOFAS] Lesser Toe Metatarsophalangeal-Interphalangeal Scale scoring system), personal satisfaction, and complications were evaluated. Radiographic aspects were also examined. Shapiro and Mann-Whitney statistical tests were conducted. The average age of the patients was 69.5 years, and the average follow-up was 13.1 months. After the operative procedure, there was a decrease of 6.6 points on the VAS for pain (P < .001) and an increase of 34.9 in the AOFAS score (P < .001). Radiographic correction was achieved for both the fifth metatarsophalangeal angle (P < .001) and the intermetatarsal angle (P < .001), which showed decreased values. There was 1 case of superficial infection and 2 cases of nonunion (asymptomatic). A large majority of patients regarded the procedure outcome as satisfactory. This percutaneous oblique distal osteotomy of the fifth metatarsal for bunionette deformity produced improvements in pain and function and a high rate of satisfaction, with a low incidence of complications and a high capacity for correcting the deformity. Level II, prospective cohort study.

Induced-membrane treatment of refractory humeral non-union with or without bone defect

IntroductionTreatment of humeral non-union with or without bone defect is complex, with non-negligible rates of complication and failure. Few reports focused on management of treatment failure. ObjectiveThe study hypothesis was that the induced-membrane technique associated in a 2-stage strategy to internal fixation provides systematic bone healing in refractory humeral non-union. Material and methodsThe study included 15 patients, with a median age of 46.6 years, with humeral non-union of a mean 24 months’ progression and mean history of 3 attempted revision surgeries. Seven patients showed bone defect, exceeding 5cm in 2 cases. Six had history of radial palsy. ResultsConsolidation was achieved in all cases, at a mean 4.6 months. Ten patients underwent radial nerve transposition, 6 of whom had shown radial motor nerve palsy; all recovered within 2 to 5 months. There was 1 case of superficial infection, and 1 of seroma. DiscussionThe induced-membrane technique ensures bone healing due to the biological properties of the membrane; the main drawback is the need for 2-stage surgery. When bone defect exceeds 5cm, a multi-perforated fibula segment can be placed inside the membrane to increase primary stability and enhance bone integration. ConclusionThe induced-membrane technique is suited to humeral non-union, with or without bone defect. The 2-stage strategy is mandatory in case of suspected latent infection. In the 2-stage procedure, anteromedial radial nerve transposition facilitates the bone-graft stage. Level of evidenceIV, retrospective study.

Paediatric open tibial fractures. Do children require a modified approach to that advised by the British Orthopaedic Association and British Association of Plastic Reconstructive and Aesthetic Surgeons in the UK?

This study reviews the outcomes of paediatric open tibial fractures treated at a level 1 trauma centre using the British Orthopaedic Association/British Association of Plastic Reconstructive and Aesthetic Surgeons standards and compares the results to management in adults. This was a retrospective study of 60 consecutive cases over a 9-year period. The variables recorded include grade of injury, contamination and pattern of fracture. Other data recorded include time at which antibiotics were given, time to index surgery, type of skeletal fixation and time to definitive cover. Outcomes sought were infection rate, time to union, problems with union and any additional unplanned surgery. The mean time to administration of antibiotics was 3.4 h after injury with a range of 0.35-17 h. The mean time to debridement was 13.4 h (range 1-32 h, SD 7.7). The mean time to union was 4.3 months (range 1.3-15 months). There were five cases of deep infection (8.3%) and three cases of superficial infection (5%). There were no significant differences between timings of antibiotic administration, hours to debridement or days to definitive closure between those cases which became infected and those which did not. This retrospective review of a consecutive series of paediatric open tibial fractures shows a close parallel of outcomes to that from adult centres in the UK using the same standards of care. This strengthens the recommendation that, until the availability of data to suggest otherwise, open tibial fractures in children should follow the same recommendations as suggested for adults. The greater healing potential in children, seen in multiple examples of closed long bone fractures, appears to be attenuated in the higher grades of the open tibial fracture.

Functional Outcome of Open Reduction and Internal Fixation of Intra-articular Distal Radial Fractures by Buttress Plate

Introduction: Treatment of displaced, comminuted, intra-articular fracture of the distal end of the radius by a closed method, such as pins and plaster or external fixation, gives unsatisfactory outcome in most of the cases. The purpose of this study is to evaluate the efficacy of open reduction and internal fixation (ORIF) of intra-articular distal radial fractures by buttress plate. Materials and Methods: We conducted a prospective study from January 1, 2015, to June 30, 2016, on patients having intra-articular distal radius fractures aged above 18 years (20–58 years), who were treated by ORIF with buttress plate. Males outnumbered females by a ratio of 2.67:1. The most common mode of injury was found to be road traffic accident (68.2%). The fractures were classified as per the Frykman classification system. Type III was the most common (54.5%), followed by Type IV (27.3%). Majority of the cases (54.5%) were operated in 2–5 days following injury. The mean time for union was 8.04 weeks. Results: Functional evaluation was done according to the modified demerit point system of Gartland and Werley. Functionally, 14 patients (63.6%) had excellent, 6 had good (27.3%), and 2 had fair (9.1%) restoration of functions. Radiological assessment and the results were graded according to the Sarmiento's modification of Lindstrom criteria. Anatomically, 16 patients (72.7%) had excellent restoration, 4 (18.2%) had good restoration, and 2 had fair (9.1%) restoration. One case of superficial infection and one case of injury to the superficial branch of the radial nerve were noted. In later follow-up, two cases presented with joint stiffness, and in one case, loss of reduction was seen at final follow-up. Conclusion: Around 91% of the patients had excellent-to-good result, both anatomically and functionally. Hence, we conclude that ORIF with buttress plate is an excellent mode of treatment for displaced intra-articular distal radius fractures.

Minimally Invasive Percutaneous Plate Osteosynthesis: A Blessing for Notorious Distal Tibia Fractures

Introduction: Fractures of distal tibia are difficult to treat as they are high energy fractures, associated with extremely damaged soft tissues, poor vascularity, high incidence of compound injuries, skin complications following surgery and comminution of the metaphysis and articular surface makes anatomical reduction difficult. A mechanically stable osteosynthesis can be obtained with minimum dissection and surgical trauma by Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO). In this technique fracture is reduced indirectly, and is fixed with Locking Compression Plate (LCP). Aim: To assess functional and radiological outcomes of distal tibial fractures managed by MIPPO using LCP. Materials and Methods: In this cross-sectional study, 25 patients with distal tibia fractures were operated by LCP using MIPPO technique. Patients were followed-up at regular intervals for about one year. They were assessed clinically, functionally and with radiologically for fracture union. Functional assessment was done using American Orthopaedic Foot and Ankle Society Score (AOFAS) scoring system. Radiological outcome was evaluated using the Radiological Union Scale in Tibia Fracture (RUST) to assess union. Data was analysed using paired t-test. The chosen level of significance was p-value &lt;0.05. Statistical Package for the Social Sciences (SPSS) version 21 was used for analysis. Results: Males were more commonly affected with Road Traffic Accident (RTA) being the most common mode of injury. All fractures healed with good functional outcome. Mean union time was 20 weeks. Mean AOFAS score at the end of one year was 88.83 (SD 5.65) and mean RUST score was 11.58 (SD 0.72) at the end of one-year follow-up, indicating good outcome. There was one case of superficial infection which was managed with antibiotics, one patient had implant failure. Conclusion: LCP using MIPPO offers biological advantage by preserving periosteal blood supply, which is particularly critical with distal tibia or pilon injury. Thus, fractures heal rapidly with very few complications.

Study of intertrochenteric fracture treated by bipolar hip replacement

Introduction: Unstable intertrochanteric fractures in osteoporotic bones are difficult to treat. Conservative treatment with traction and prolonged immobilization lands up with many complications and often fatality. Rate of failure in internal fixation, with dynamic hip screws or intramedullary nail has been found high, especially in osteoporotic bones. The weak and porotic bone tolerates screws poorly so cut out is the major problem in internal fixation. The purpose of this study was to determine whether hemiarthroplasty is a reasonable alternative method of treatment for elderly patients in intertrochanteric fracture with osteoporosis to reduce mortality and morbidity in terms of full weight bearing and complications related to prolonged bed rest. Material and methods: 15 patients (6 males and 9 females) above 60 years of age with unstable intertrochanteric fractures who underwent bipolar arthroplasty were prospectively evaluated. Transtrochanteric approach was used in all patients. Greater trochanter tension band wiring was done in some patients. Harris hip score was used for the clinical evaluation. The minimum follow up period was one year. Results: In our study 15 cases were taken, which had a mean age 75years. The mean Harris hip score at one year was 85. Excellent to good results were obtained at one year in 12 cases and fair in 2 cases, poor in 1. Death of two patients occurs due to age related factors. There was one case of superficial infection. Radiological follow-up showed no case with loosening of the prosthesis, break in the cement or sinking of the prosthesis. Conclusion: In conclusion we state that hemireplacement arthroplasty is a valid treatment option for mobile and mentally healthy patients. This procedure offers quick recovery with little risk of mechanical failure, avoids the risks associated with internal fixation and enables the patients to maintain a good level of function beginning in the immediate post-operative period. But the follow up period in our study is not enough to make any clinical recommendations though it can serve as a critical analysis to stimulate future research. Further long-term studies are required.

Safety of Arthroscopic Versus Open or Combined Heterotopic Ossification Removal Around the Elbow

To analyze the complications of arthroscopic heterotopic ossification (HO) excision and compare them with those of open removal of HO or a combined open-arthroscopic approach. We performed a retrospective review of elbow HO removal cases performed by a single surgeon from 1997 to 2014. In all cases studied, the intention was to restore range of motion owing to the presence of HO causing functional impairment. The arthroscopic, open, and combined treatment groups were compared. The study cohort consisted of 223 surgical procedures performed on 213 elbows in 211 patients. Fifty major complications occurred in 46 cases (21%): 17 hematomas (8%) treated by irrigation and debridement, 8 cases of HO requiring reoperation (4%), 7 deep infections (3%), 4 contractures (2%), 3 cases of delayed-onset ulnar neuritis (1%), 2 cases of distal humeral avascular necrosis (1%), 2 tendon ruptures (1%), 2 cases of instability requiring reconstruction (1%), 2 postoperative fractures (1%), 1 intraoperative fracture (<0.5%), 1 case of worsening of pre-existing neuropathic pain (<0.5%), and 1 permanent partial posterior interosseous nerve injury (<0.5%). Of these 46 cases, the major complications occurred in 6 of the 41 (15%) performed arthroscopically, in 36 of the 158 (23%) performed open and in 4 of the 21 (17%) with combined (i.e. open + arthroscopic) HO removal. Preventive strategies, introduced to prevent hematomas and delayed-onset ulnar neuritis, reduced the rate of major complications from 35% during the period from 1997 to 2005 to 10% during the period from 2006 to 2014 (P < .0001). Moreover, the rate of reoperations was reduced from 34% to 10% in the same periods (P < .0001). Minor complications occurred in 36 cases (16%), including 17 cases of transient nerve palsy, 9 cases of superficial infection or delayed wound healing, 6 cases of mild instability, and 4 cases of hematoma resolved by aspiration. The use of arthroscopy-or a combination of arthroscopic and open techniques-to remove HO around the elbow by a surgeon skilled in both arthroscopic and open elbow surgery does not increase the risk of major complications or need for reoperation compared with traditional open surgery. Preventive strategies, such as avoiding raising skin flaps by using multiple separate incisions for open and prophylactic ulnar nerve decompression in arthroscopic cases, were developed during the study period. These strategies were monitored prospectively and found to be effective in preventing two-thirds of the major complications needing reoperation with both open and arthroscopic HO removal. Level III, retrospective comparative study of prospectively collected data.

A prospective study to analyse the surgical outcome of posterior acetabular fractures

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Fractures of acetabulum are relatively uncommon, but because they involve major weight bearing joint in the lower extremity, they assume great clinical importance. Acetabular fractures are still difficult fractures to manage and are a major challenge to treating orthopaedic surgeon. The present study was aimed to study the surgical outcome of posterior acetabulum fractures and postoperative complications and failures.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A one year prospective study was done after ethical approval. Patients with traumatic injury and posterior acetabular fracture was included and categorized according to the Letournel-Judet classification. Kocher-Langenbeck approach was used for all the cases and clinical follow-up and radiological evaluation was done up to 12 months. Evaluation of different demographic elements with reference to Harris hip score was also carried out. Statistical analysis was performed using the Statistical Package for the Social Sciences software.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Twenty cases with mean age 42.6 years and males 65% were included. Road traffic accident was cause in 65% of cases.50% of the cases had good, 20% excellent, 25% fair and 5% poor outcome in our study by Harris Hip scoring. Two cases of superficial infection, one deep infection, iatrogenic sciatic nerve injury in one, heterotopic ossification in one and one case of intra-articular screw penetration was observed.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Operative treatment of displaced acetabular fractures gives satisfactory functional results. Thorough evaluation of radiograph/ CT scan and a proper pre-operative planning is necessary for decision making regarding an appropriate surgical approach, the appropriate type of implant and fixation.&lt;/p&gt;

Transglabellar approach for surgical management of unruptured anterior cerebral artery aneurysms: A set of 8 patients

ObjectivesUnruptured anterior cerebral artery aneurysms (ACAA) management is not standardized, since the decision to intervene can lead to unnecessary surgical aftermaths. One of the key issues could be to decrease the surgical consequences. We describe herein an original minimally invasive transglabellar approach in the management of ACAA. Patients and MethodsWe report our experience with the transglabellar approach which is used for two years in our centre. With an inter-eyebrow skin incision, a trans sinusal approach gives direct access to the anterior midline skull base. Aneurysm clipping is carried out. The closure requires obstruction of nasofrontal ducts and sinus mucosa removal. ResultsWe operated 8 patients using this approach. The aneurysms were clipped successfully in every case.One case of cerebrospinal fluid leak and two cases of superficial infection were observed. All the patients were satisfied with the aesthetic results. ConclusionThe transglabellar approach is an effective, safe and minimally invasive procedure for the treatment of ACAA.

Intraoperative Ultrasound Guided Percutaneous Repair of Ruptured Achilles Tendon: A Comparative Study with Open Repair

Category:Ankle, TraumaIntroduction/Purpose:To compare and analyze the clinical outcomes between ultrasound guided percutaneous repair(USPR) and open repair in ruptured Achilles tendon.Methods:We retrospectively analyzed the outcomes between 12 patients with USPR (group A) and 18 patients with open repair (group B), from January 2015 to February 2018. The postoperative clinical evaluations were done by Arner-Lindholm scale, American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Achilles tendon Total Rupture score (ATRS), visual analogue scale (VAS) for overall satisfaction and cosmetic satisfaction of scar, and starting time of single heel raise. And we evaluated complications.Results:There was no statistical difference between two groups in Arner-Lindholm scale, AOFAS score, ATRS, starting time of single heel raise (all p>.05). There was statistically higher overall patient’s satisfaction and cosmetic satisfaction in group A than group B (all p<.05). There were 2 cases of Achilles tendon elongation in group A, and 1 case of re-rupture with deep infection and 1 case of superficial infection in group B.Conclusion:The USPR showed not only good clinical outcomes but also high satisfaction and low rate of complications like sural nerve injury. Thus, it is thought that USPR can be considered as an effective surgical treatment options for Achilles tendon ruptures.

Open reduction and fixation of capitellum fractures of the elbow using anterolateral approach…A prospective study

The objective of this work is to present a functional evaluation of patients treated with open reduction and internal fixation of capitellum fractures using anterolateral approach. We studied the outcome of 20 consecutive patients with capitellum fractures, with one year of follow-up. Mean age in our study was 44 (range 25-60) years. 60% of patients were females in our study and non-dominant side was involved in 70% of patients. All the patients reported normal elbow function prior to trauma. RTA was the cause of injury in majority of patients and non-dominant side was injured in majority of patients. The patients were evaluated with Mayo Elbow Performance Index. All the fractures united at an average duration of 18 weeks. Mean Mayo score was 93. Mean pronation and supination were 83 and 85 degrees respectively. There were two cases of superficial infection, however got resolved uneventfully. One case of delayed union, one case of implant failure (needed revision surgery) and four cases of stiffness. We conclude that open reduction and internal fixation of coronal shear fractures of capitellum using headless screw compression via the antero-lateral approach is a reliable treatment modality and results in stable fixation with restoration of a functional arc of motion.

Plate and screw fixation of arthroscopically assisted tibial tuberosity osteotomy: technique and results.

We describe a fixation technique for tibial tuberosity osteotomies (TTO) utilising a plate and screw construct which adheres to established principles of bone healing. We record and discuss the complication profile and benefits of this technique. The technique is outlined, and thirty consecutive case of TTO fixed with this combination of plate and screws were analysed during a study period from January 2018 to October 2018. All patients were followed up clinically to 3months post-operation for the purpose of identifying early complications of surgery. Radiographic series were reviewed at 2, 6 and 12weeks post-operation for evidence of fracture, loss of position, hardware failure and union. All cases went on to clinical and radiographic union by 12weeks. We identified one case of hardware failure, one case of superficial infection and one case of stiffness requiring manipulation. We have found this technique of plate and screw construct to be effective in arthroscopically assisted TTO fixation leading to consistent union without loss of position with a low complication profile.

Reoperation strategy of malunited tibial plateau fracture

Objective To explore the revision strategy of the malunited tibial plateau fracture and to analysis the main points of four common revision operations and the clinical effect. Methods From January 2012 to December 2016, 18 patients (5 males and 13 females) aged 35-60 years (average 49.7 years) underwent tibial plateau revision surgery in our hospital were collected. The time from the second revision operation to the first operation was 2-24 months (average 10.4 months). Our revision strategies were as follows: Firstly, to determine whether there is an infection or not. If there was infection, we changed the original internal fixation to external fixator to control infection. Secondly, todetermine whether the patient could suffer re-reduction and internal fixation. If the patient was older (>65 years old) or with severe local bone defect, total knee arthroplasty should be performed. Thirdly, patients were divided into four operation modes according to the tibial plateau fracture malunion type: 1. the original fracture line osteotomy; 2. the tibial tubercle + original fracture line osteotomy; 3. tibial metaphyseal window-rod reduction; 4. the osteotomy of fibula head and original fracture line osteotomy. Results All patients were followed up for 12-30 months (average 16.8 months), and the operation time was 120-300 min (average 185 min). 2 cases were infected before operation and the original internal fixation were removed to instead of external fixator;1 patient underwent total knee arthroplasty; 3 cases were treated with metaphyseal open window-rod reduction and internal fixation; 6 cases were operated with the original fracture line osteotomy and internal fixation; 4 cases were treated with tibial tubercle osteotomy+original fracture line osteotomy and internal fixation; 2 patients underwent fibular head osteotomy+ original fracture line osteotomy and internal fixation. All patients achieved bony union at the last follow-up. The healing time was 3-6 months (mean 3.6 months). The postoperative knee Rasmussen score was 19-29 (average 22.9), compared with average 14.4 points before operation (t=-10.169, P=0.001). The postoperative range of motion of knee joint was 60-110 degrees (mean 94.5 degrees), compared with average 55 degrees before operation (t=-5.773, P=0.001). The post-operative VAS pain score was average 1.1 points, compared with average 4.2 points before operation (t=8.960, P=0.001). Fracture reduction was excellent in 12 cases and good in 5 cases, with the excellent and good rate of 100%. 3 patients still had 2mm collapse on the articular surface, while 3 patients still had mild valgus (less than 5 degrees). There were 2 cases of superficial infection of the wound surface after operation. Conclusion It was difficult to revise the malunion of tibial plateau fracture and it was necessary to make a detailed operation plan before the operation. Satisfactory clinical effects could be obtained for the patients by correct revision strategy. The key to success was the proper revision strategy which was adopted according to the different characteristics of the tibial plateau fracture malunion of the patients. Key words: Tibial fracture; Intra-articular fractures; Osteotomy; Joint deformities, acquired; Reoperation