Clinical Outcomes Of Internal Fixation Research Articles

Clinical Outcome of Internal Fixation and Fusion in the Treatment of Spinal Fractures by Paraspinal Muscular Space Approach

Clinical Outcome of Internal Fixation and Fusion in the Treatment of Spinal Fractures by Paraspinal Muscular Space Approach

Clinical outcome of internal fixation of middle third clavicle fractures using locking compression plate: comparison between conventional open plating and minimally invasive plate osteosynthesis

Objective: To compare the outcomes of conventional open plating and minimally invasive plate osteosynthesis (MIPO) for treatment of displaced middle third clavicle fractures. Methods: A retrospective cohort study. From January 2016 to December 2020, a total of 42 patients with middle third clavicle fractures treated with locking compression plates in the Department of Orthopedics, Nanping First Hospital Affiliated to Fujian Medical University were analyzed retrospectively, including 27 males and 15 females with a mean age of (36.5±8.7) years (19-61 years). According to the different treatment methods, the patients were divided into 2 groups: the traditional incision group (n=20) were treated with conventional open plating and the MIPO group (n=22) were treated with the MIPO technique. The supraclavicular nerve was preserved in those patients. The two groups were compared in terms of operation time, intraoperative blood loss, incision length, fracture healing time, and the ratio and length difference with the uninjured clavicle. The shoulder joint function was evaluated with Constant score and Disability of the Arm, Shoulder and Hand score (DASH) at the last follow-up. The incidence of numbness around the incision was evaluated at 6 weeks, 12 weeks and 1 year after operation, and the complications of the two groups were compared. Results: The patients were followed-up for an average of 16.5 months (ranged from 13 to 35 months). The operating time [(68.4±12.7) min vs (55.3±10.2) min], intraoperative blood loss[(72.5±16.9) ml vs (52.8±13.5) ml], as well as incision length [(8.7±2.3) cm vs (4.5±1.2) cm] were all significantly greater in traditional incision group than those in MIPO group (all P<0.05). There was no significant difference between the two groups in the time of fracture healing, the length of contrast with the contralateral clavicle, and the constant score and DASH score of shoulder joint function at the last follow-up (all P>0.05). The incidence of numbness around the incision after operation at 6 weeks [60.0%(12/20) vs 27.3%(6/22)] and 12 weeks [45.0%(9/20) vs 13.6%(3/22)] were obviously higher in traditional incision group than those in MIPO group (both P<0.05), but there was no significant difference between the two groups at 1 year after operation [15.0%(3/20) vs 4.5%(1/22), P=0.531]. There was no significant difference in postoperative complications incidence between the two groups (P>0.05). Conclusions: It is showed that both conventional open plating and MIPO are effective and safe treatment methods for displaced middle third clavicle fractures with locking compression plates. MIPO can reduce operating time, intraoperative blood loss and the incidence of early postoperative numbness around the incision.

Clinical Outcomes of Internal Fixation for Distal Diaphyseal Fractures of the Forearm in Pediatric Patients

Clinical Outcomes of Internal Fixation for Distal Diaphyseal Fractures of the Forearm in Pediatric Patients

Retroperitoneoscopic debridement and internal fixation for the treatment of lumbar tuberculosis.

To describe the retroperitoneoscopic debridement technique and evaluate the clinical outcome of internal fixation for the treatment of lumbar tuberculosis.Twenty-eight patients were performed conventional laparoendoscopic technique (n = 17) or laparoendoscopic single-site technique (n = 11). Antituberculosis chemotherapy and thoracolumbosacral orthosis were given to all patients. The clinical outcomes were evaluated with preoperative and postoperative Visual Analog Scale, and radiographs with respect to sagittal angle and fusion status.Average time of the 28 procedures was 220.6 ± 50.9 min (180–365 min). The average intraoperative blood loss was 108.6 ± 95.3 mL (50–400 mL). All patients showed significant improvement of their Visual Analog Scale back pain score at follow-up and were classified as having a radiographic fusion in this study. The mean sagittal angle was 11.2 ± 3.6° before operation, significantly improved to 3.7 ± 2.4° after operation. There were no recurrent infections during the follow-up period. Complications included loosening of anterior fixation and temporary deficit of the sympathetic nerve.Retroperitoneal laparoscopic approach with CO2 insufflation technique is a challenging but safe and effective procedure for lumbar spine tuberculosis. Retroperitoneal laparoendoscopic single-site can be used for anterior lumbar spine surgery, offer exposure for L1 through L5.

Surgical Treatment of Talar Neck and Body Fractures: Mid-Term Results of 24 Cases.

Talar neck and body fractures are rare. Major posttraumatic complications with a potential reduction in the quality of life are arthrosis and necrosis due to the specific vascular supply. The aim of the study was to evaluate mid-term results of surgery for talar fractures of neck and body. Parameters that potentially affected/influenced treatment outcomes were analysed exploratively. 24 patients with 24 talar neck and body fractures (Marti type II n = 9, type III n = 12, type IV n = 3) were retrospectively examined for radiological and clinical functional outcomes. The independent parameters evaluated included age (< 40, ≥ 40 years), sex (male, female), general overall extent of injury (polytrauma/multiple injuries/multiple fractures of the extremities, additional injuries to the same foot, isolated talus fracture), soft tissue damage (open, closed), surgical latency (< 6, ≥ 6 h), fracture classification/displacement (undisplaced [= Marti II], displaced [= Marti III, IV]) and fracture type (talar body, neck fracture). The potential influencing parameters were analysed by univariate analyses. With an average follow-up of 8.7 years (1,25 - 16 years) the AOFAS score was 71.4 ± 22.9 points, the Foot Function Index score 35.9 ± 28.3 points; the physical and mental component summary scores of the Short Form 36, version 2, was 43.8 ± 10.9 and 47.4 ± 13.6 points (mean ± standard deviation), respectively. Thus, the patient reported physical health of the patients was slightly reduced compared to the German population, while the mental health remained largely unaffected. Two patients developed partial avascular necrosis (8%), 10 patients developed osteoarthritis (42%). Of the independent parameters, only the general overall extent of injury showed a significant influence on osteoarthritis (p = 0.002). In the evaluation of undisplaced (n = 9) and displaced (n = 15) fractures, surgical treatment after more than 6 hours did not result in a worse outcome. The clinical outcome of internal fixation of talar neck and body fractures can be classified as good. In the study group, there was no correlation between the occurrence of arthrosis and the Marti fracture classification.

Three-column Internal Fixation System for Comminuted Fracture of the Tibial Plateau

Background: the tibia is the major weight-bearing bone of the lower leg. The proximal portion of the bone, the tibial plateau, forms the lower surface of the knee joint and it consists of two condyles – medial and lateral – separated by the tibial spines, The articular surface of the medial plateau is concave, whereas that of the lateral plateau is convex. The knee is a complex dynamic joint that is subjected to many forces during normal activities, so intact articular surface of tibial plateau is one of important factors to keep the geometry and alignment of the knee joint to act in harmony to perform its crucial function as a flexible weight bearing joint. Objective: the aim was to describe the operative procedures and clinical outcomes of internal fixation of tibial plateau to treat comminuted fractures of the tibial plateau according a new three-column classification. Conclusion: using anatomical locking plates on tibial plateau is an effective and safe tool to treat complex three-column fractures of tibial plateau and is more convenient than common plate.

Three-column Internal Fixation System for Comminuted Fracture of the Tibial Plateau

Background: the tibia is the major weight-bearing bone of the lower leg. The proximal portion of the bone, the tibial plateau, forms the lower surface of the knee joint and it consists of two condyles – medial and lateral – separated by the tibial spines, The articular surface of the medial plateau is concave, whereas that of the lateral plateau is convex. The knee is a complex dynamic joint that is subjected to many forces during normal activities, so intact articular surface of tibial plateau is one of important factors to keep the geometry and alignment of the knee joint to act in harmony to perform its crucial function as a flexible weight bearing joint. Objective: the aim was to describe the operative procedures and clinical outcomes of internal fixation of tibial plateau to treat comminuted fractures of the tibial plateau according a new three-column classification. Conclusion: using anatomical locking plates on tibial plateau is an effective and safe tool to treat complex three-column fractures of tibial plateau and is more convenient than common plate.

A Comparative Study on Internal Fixation Using Long Proximal Intramedullary Nail for the Treatment of Humeral Shaft Fracture according to Fracture Types.

BackgroundThis study was conducted to compare the radiological and clinical outcomes of internal fixation using a Polarus humeral nail for treatment of a humeral shaft fracture according to fracture types.MethodsFrom 43 patients, 13 were excluded and 30 patients were included. The 30 patients were divided into 2 groups: 15 in group I (Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen classification type A and B) and 15 in group II (type C). The mean age was 63.1 years (range, 20–87 years), and mean follow-up period was 2.3 years (range, 1.0–6.1 years). The causes of injuries were as follows: 12, traffic accidents; 14, simple slips; 2, simple falls; 2, contusions after lower energy trauma. Radiological and clinical evaluations were performed.ResultsRadiological union was confirmed by plain anteroposterior and lateral radiographs on average of 5.0 months in group I, and 8.4 months in group II, respectively. Differences between the two groups were statistically significant (p<0.01). The clinical union value was 1.6 in group I, and 2.0 months in group II, but these values did not differ significantly (p=0.441). The mean Korean shoulder scoring system scores were 89.7 and 90.6, which did not differ significantly (p=0.352).ConclusionsIntramedullary nailing using the Polarus humeral nail is considered to be a good treatment modality for all types of humeral shaft fractures. Additionally, the Polarus humeral nail can be an optimal choice for the treatment of complex type fractures such as segmental or comminuted humeral shaft fractures.

Clinical outcome of internal fixation of middle third clavicle fractures using locking compression plate: Comparison between open plating and MIPO

Clinical outcome of internal fixation of middle third clavicle fractures using locking compression plate: Comparison between open plating and MIPO

Surgical treatment of lateral and posterior process fractures of the talus: Mid-term results of 15 cases after 7 years

BackgroundWe retrospectively evaluated the mid-term results of surgery for talar process fractures (lateral and posterior processes) and exploratively analyzed parameters that potentially impact treatment outcomes. MethodsFifteen patients who underwent internal fixation (January 2000 to December 2015) were examined for radiological and clinical functional outcomes. The independent parameters evaluated were age, sex, extent of general injury, soft-tissue damage, surgical latency, and fracture type. ResultsAll fractures healed completely. Three patients developed osteoarthritis. The American Orthopaedic Foot and Ankle Society Ankle/Hindfoot Scale score was 79.5±18.6, the Functional Foot Index score was 31.1±31.4, and the physical and mental component summary scores of the Short Form 36, version 2, were 46.6±11.8 and 50.3±9.1, respectively. No influence on the above scores was determined. ConclusionsThe clinical outcomes of internal fixation of talar process fractures were good. Delayed surgical treatment (≥14days) did not significantly lead to poorer outcomes in our patients.

Plate versus Kirschner wire fixation in treatment of fourth and fifth carpometacarpal fracture-dislocations: A retrospective cohort study

BackgroundFourth and fifth carpometacarpal fracture-dislocations with unsatisfactory closed reduction commonly require later open reduction and internal fixation. However, the optimal method of internal fixation for these is unknown. The purpose of this study was to determine through objective clinical measures which method is superior for fourth and fifth carpometacarpal fracture-dislocations: a K-wire or a plate. MethodsWe conducted a retrospective review of hospital records of patients who had received treatment for fourth and fifth carpometacarpal fracture-dislocations at one hospital between May 2007 and May 2015. A total of 86 patients who had received open reduction either with plate or K-wire fixation were included. Demographic and clinical characteristics of the two groups of patients were collected. Patients received standardised clinical tests one year after fixation. Clinical outcomes included tests of grip strength and scores on the Michigan Hand Outcomes Questionnaire and Disabilities of Arm, Shoulder, and Hand. Student's t tests and Chi-square tests were used to statistically evaluate whether plate or K-wire fixation was superior on the clinical variables. ResultsThe two groups were statistically indistinguishable on their demographic and clinical characteristics. Generally, the clinical outcomes of internal fixation were satisfactory. The average DASH and MHQ scores of the K-wire group were superior to those of the plate group (DASH 2.3 versus 9.8, P = 0.01; MHQ 96.7 versus 86.6, P = 0.02). Grip strength was not significantly different between the two groups (89.5 ± 5.8% versus 90.1 ± 4.9%, P = 0.36). ConclusionsThis non-randomly controlled, retrospective study suggests that clinical outcomes after K-wire fixation is superior to plate fixation for fourth and fifth carpometacarpal fracture-dislocations. This is especially the case for hand functions related to work. The present results suggest that K-wire fixation is the gold-standard technique for the treatment of fourth and fifth CMC fracture-dislocations.

Clinical outcome analysis on using extensor digitorum communis splitting approach for the treatment of radial head fractures

To explore the clinical outcomes of internal fixation or replacement for the treatment of radial head fractures through the extensor digitorum communis splitting approach. From July 2012 to May 2015, 25 patients with radial head fractures were reviewed. There were 17 males and 8 females, ranging in age from 20 to 67 years old, with a mean age of 39 years old. Twenty-one patients were treated with reconstruction of plate internal fixation, and 4 patients were treated with radial head replacement. According to Mason classification, 19 cases were type II and 6 cases were type III. All the patients underwent internal fixation or replacement through the extensor digitorum communis splitting approach. The patients were followed up clinically and radiographically until the beginning of fracture union and the entrance of function recovery of elbow motion into a plateau. The functional status of the elbow was evaluated using the Mayo Elbow Performance Index(MEPI). Radiographic signs of post-traumatic arthritis were rated according to the Broberg and Morrey system. All the patients were followed up, and the average duration was 29 months (ranged, 12 to 56 months). The average range of flexion and extension was 120°, the extension was limited by 10°, and the flexion was 135°. The average forearm rotation range was 142°, pronation was 75°, supination was 67°. The mean MEPI was 93±7(ranged, 80 to 100 scores); according to the MEPI scoring criceria, 19 patients got an excellent functional result, 6 good. According to the Broberg and Morrey systems of traumatic arthritis, 19 patients were in grade 0, 6 in grade 1, and no patients in grade 2 or 3. No patients with nonunion of the radial head and failure of internal fixation were found. There were no complications of nerve or vascular injuries, and obvious limitation of elbow rotation. Heterotopic ossification around the elbow occurred in 4 cases, but the motion was not significantly limited. There were no complications such as prosthesis loosening and infection in 4 cases after radial head prosthesis replacement. The extensor digitorum communis splitting approach is an effective exposure method for internal fixation or replacement in the treatment of radial head fractures.

Osteosynthesis of mid-distal humeral diaphyseal fracture with an anatomically precontoured extra-articular distal plate system

Objective To evaluate the clinical outcomes of internal fixation with extra-articular distal humerus locking compression plate (LCP) for the treatment of mid-distal humerus diaphyseal fracture. Methods From December 2012 to December 2016, a cohort of 22 patients with mid-distal humerus shaft fracture were treated by open reduction and internal fixation using extra-articular distal humerus LCP. They were 14 males and 8 females with an average age of 42.7 years (range, from 18 to 86 years). According to AO classification, there were 13 cases of type 12-A, 7 cases of type 12-B, and 2 cases of type 12-C. The surgical time, intra-operative blood loss and hospital stay were recorded. The clinical outcomes were evaluated by the Mayo elbow performance score (MEPS) at the last follow-ups. Results Surgical time ranged from 46 to 95 minutes with an average of 57 minutes. The average blood loss was 220 mL (range, from 150 to 400 mL). The average hospital stay was 10.5 days (range, from 9 to 13 days). The mean follow-up was 23.8 months (range, from 6 to 48 months). Bone union was achieved in 21 cases after an average of 4.6 months (range, from 3 to 9 months), and one patient experienced bone non-union which was uneventfully healed after secondary auto platelet rich plasma (PRP) graft management. The average MEPS elbow performance score was 88.2, resulting in 16 excellent, 4 fine and 2 fair cases (excellent and fine rate: 90.9%). Conclusions Since extra-articular distal humerus LCP can provide stable internal fixation, facilitating early postoperative rehabilitation, it may be considered an effective alternative osteosynthesis for mid-distal comminuted humeral diaphyseal fractures. Key words: Elbow joint; Humeral fractures; Fracture fixation, internal; Treatment outcome

Open reduction and internal fixation in close middle third fracture clavicle by pre-contoured anatomical clavicle plate: A study of 125 cases

Introduction: The concept of treating displaced, middle third fractures of clavicle by open reduction and stable fixation thereby restoring the clavicular length is gaining more and more acceptance amongst trauma surgeons. The aim of our study was to analyze the clinical outcome of internal fixation of middle third clavicle fracture by anatomical pre-contoured plate. Method: 125 patients with isolated displaced middle third clavicle fractures were treated by open reduction and anatomical pre-contoured locking compression plate and followed prospectively till six months after union. All patients were assessed radiologically, clinically and according to disability of arm, shoulder and hand scoring system (DASH). Results: Average time of union was 8 weeks. Union rate in our study was 97.6%. Most of the patients returned to pre-injury working status by the end of 10 weeks. Average DASH score at the end of 6 months was 12. Conclusion: Superiorly placed anatomical pre-contoured locking plate for operative treatment of displaced middle third fractures is a safe and effective option with early return to pre injury working level and at the same time avoiding potential complications of delayed union, non-union and mal-union.

Internal Fixation Using Clavicle Hook Plates for Distal Clavicle Fractures

Background: To report the radiological and clinical outcomes of internal fixation using distal clavicle hook plates for distal clavicle fractures. Methods: From April 2008 to December 2012, 32 patients with distal clavicle fractures underwent surgery using an AO hook plate. The reduction was qualified and evaluated according to the radiological findings. The evaluation of the clinical outcomes was performed with the University of California at Los Angeles (UCLA) score, the Korean Shoulder score, and the visual analogue scale (VAS) pain score. Results: By radiological evaluation, we found that 31 of 32 patients showed anatomical reduction and solid bone union. Although we obtained satisfactory UCLA scores, Korean Shoulder Scale scores, and VAS pain scores, 12 cases of complications were present. We found 4 cases of osteolysis of the acromion, 1 case of nonunion, 3 cases of periprosthetic fractures, 3 cases of subacromial pain, and 1 case of skin irritation. We performed re-operations in 2 patients. Conclusions: To avoid complications associated with clavicle hook plates, choosing the appropriate hook size and bending of the hook according to the slope of the acromion undersurface is critical. Also, we believe that early removal of clavicle plates may help reduce complications.

Internal fixation vs conservative treatment for displaced distal radius fractures: a meta-analysis of randomized controlled trials.

The aim of the present study was to compare clinical outcomes of internal fixation and conservative approach in the treatment of displaced distal radius fractures. Reports of studies were retrieved from the PubMed, Cochrane Library, EMBASE, BIOSIS, Ovid, CNKI, and Wanfang Data databases, as well as other sources. Methodological quality of the trials was critically assessed, and relevant data were extracted. Review Manager (RevMan) meta-analysis software (version 5.0; Cochrane Collaboration, London, UK) was used for data analysis. A total of 10 randomized controlled trials, which included 653 patients, were eligible for inclusion in the present meta-analysis, 7 of which were in English, and 3 of which were in Chinese. The trials had medium risk of bias. Results of meta-analysis showed that patients undergoing conservative treatment for distal radius fractures had better restoration of pronation (MD=1.80, 95% confidence interval [CI]=0.18-3.42, p=0.03; heterogeneity p=0.17, I2=43%), but shorter restoration of radial length (MD=2.62, 95% CI=1.47-3.76, p<0.00001; heterogeneity p=0.02, I2=73%). Wrist range of motion other than pronation, grip strength, radiographic parameters other than radial length, and rates of complications were not significantly different between the 2 treatments. Very few clinical differences were found between results of internal fixation and conservative treatment for displaced distal radius fractures. Best course of of treatment must be determined based on concrete conditions.

Internal fixation of radiation-induced pathological fractures of the femur has a high rate of failure

We investigated the clinical outcome of internal fixation for pathological fracture of the femur after primary excision of a soft-tissue sarcoma that had been treated with adjuvant radiotherapy. A review of our database identified 22 radiation-induced fractures of the femur in 22 patients (seven men, 15 women). We noted the mechanism of injury, fracture pattern and any complications after internal fixation, including nonunion, hardware failure, secondary fracture or deep infection. The mean age of the patients at primary excision of the tumour was 58.3 years (39 to 86). The mean time from primary excision to fracture was 73.2 months (2 to 195). The mean follow-up after fracture fixation was 65.9 months (12 to 205). Complications occurred in 19 patients (86%). Nonunion developed in 18 patients (82%), of whom 11 had a radiological nonunion at 12 months, five a nonunion and hardware failure and two an infected nonunion. One patient developed a second radiation-associated fracture of the femur after internal fixation and union of the initial fracture. A total of 13 patients (59%) underwent 24 revision operations. Internal fixation of a pathological fracture of the femur after radiotherapy for a soft-tissue sarcoma has an extremely high rate of complication and requires specialist attention.

Absorbable PDLLA screw for metacarpal fracture fixation

目的 评价国产聚-DL-乳酸(PDLLA)可吸收定位螺钉治疗手部掌骨骨折的临床效果.方法 对36例掌骨干骨折,其中掌骨干骨折19例,掌骨基底部骨折11例,掌骨头骨折6例的患者,采用国产PDLLA可吸收定位螺钉进行内固定治疗.结果 术后伤口均Ⅰ期愈合,随访时间为6～12个月.术后未发生骨折再移位及伤口红肿、渗液等,骨折均获得骨性愈合,愈合时间为6～8周.手功能恢复满意.结论 国产PDLLA可吸收定位螺钉治疗掌骨骨折疗效可靠,值得临床推广使用。

Rating of Internal Fixation and Clinical Outcome in Displaced Femoral Neck Fractures

The influence of precise surgical technique on the clinical outcome of internal fixation for displaced femoral neck fractures is an under-reported and potential confounding factor in randomized studies involving internal fixation as a treatment modality. Two experienced surgeons blindly rated internal fixation techniques on the perioperative radiographs of 102 patients selected for internal fixation in a prospective multicenter 2-year followup study. Overall technical, fracture reduction, and implant positioning ratings were given according to instruction. One or both raters assigned an inadequate overall rating in 25% of patients. There was a correlation with 2-year clinical internal fixation failure for overall technique and fracture reduction rating. Implant positioning did not correlate with 2-year internal fixation failure. Correlation increased if both raters agreed on inadequate technique. One inadequate rating indicated a problem could arise, whereas two inadequate ratings strengthened this problem likelihood. Adjudication of technique by independent rater(s) is useful, may have clinical implications, and should be performed routinely in future studies involving internal fixation in patients with displaced femoral neck fractures.

Internal fixation for displaced fractures of the femoral neck

The results of meta-analysis show a revision rate of 33% for internal fixation of displaced fractures of the femoral neck, mostly because of nonunion. Osteopenia and osteoporosis are highly prevalent in elderly patients. Bone density has been shown to correlate with the intrinsic stability of the fixation of the fracture in cadaver and retrospective studies. We aimed to confirm or refute this finding in a clinical setting. We performed a prospective, multicentre study of 111 active patients over 60 years of age with a displaced fracture of the femoral neck which was eligible for internal fixation. The bone density of the femoral neck was measured pre-operatively by dual-energy x-ray absorptiometry (DEXA). The patients were divided into two groups namely, those with osteopenia (66%, mean T-score -1.6) and those with osteoporosis (34%, mean T-score -3.0). Age (p = 0.47), gender (p = 0.67), delay to surgery (p = 0.07), the angle of the fracture (p = 0.33) and the type of implant (p = 0.48) were similar in both groups. Revision to arthroplasty was performed in 41% of osteopenic and 42% of osteoporotic patients (p = 0.87). Morbidity (p = 0.60) and mortality were similar in both groups (p = 0.65). Our findings show that the clinical outcome of internal fixation for displaced fractures of the femoral neck does not depend on bone density and that pre-operative DEXA is not useful.