Close Reduction Research Articles

The pattern of maxillofacial fractures associated with rollover accidents: A 7-year retrospective study.

This study aimed to assess the incidence and pattern of maxillofacial fractures and related demographic data in the victims of rollover crashes. This retrospective study was based on medical records of patients who sustained maxillofacial injuries following rollover accidents. Investigated data included age, gender, accident date and time, accident cause, seat belt usage, airbag deployment, road type, anatomical location of the facial fracture, and treatment approach. Among the 147 patients who met the inclusion criteria, the most prevalent age groups were 20-30 (36.7%) and 30-40 (32.7%) years, with a mean age of 33.6 ± 9.7 years. The male-to-female ratio was 6:1. Most crashes occurred in March, August, and July. These accidents involved 69.4% light vehicles and 39.6% heavy vehicles. The leading causes of rollover crashes were speeding (58.5%) followed by distracted driving (21.1%) and traffic rule violations (13.6%). The most prevalent injuries were fractures of the maxillary sinus wall (40.8%), nasal bones (39.5%), zygomaticomaxillary complex (36.1%), and the mandible (32.6%). Surgical intervention was necessary for 44.2% of patients, while 12.9% of cases underwent close reduction, and 42.9% did not require any surgical intervention. The occurrence of nasal bone fractures was significantly lower in cases where seat belts were worn and zygomatic arch fractures were less frequent in incidents with airbag deployment. In rollover crashes, the midface is the most vulnerable anatomical location. Utilization of seat belts and airbag deployment has the potential to prevent nasal bone and zygomatic arch fractures.

Comparison of Post Operative Aesthetic Outcome Between Local and General Anesthesia after Close Reduction for Nasal Bone Fracture

Background: Nasal bone fractures are commonest type of facial bone fractures and 3rd most common among all body fractures. Objective: To compare the post operative aesthetic outcome after close reduction of fractured nasal bone when performed under local anesthesia and general anesthesia. Study Design: Randomized control trial. Settings: Department of ENT, Mayo Hospital Lahore Pakistan. Duration: From September 2018 to December 2020. Methods: Seventy patients with diagnosis of nasal bone fracture were included. Patients were randomized into two groups by random number table. Close reduction of Group A was done under local anesthesia and group B under general anesthesia. Pre and post operative aesthetic outcomes were measured by Likert score and nasal angles. Results: Mean age of patients was 23.8 ± 8.59 years. 90% patients were males and 10% were females. Statistically significant difference in aesthetic outcome was present between general and local group at 1st and 3rd month of follow up. Conclusion: In patients of fractured nasal bone post operative aesthetic outcome after close reduction are better under general anesthesia at 1st and 3rd month of follow up. However, at 6th month of follow up results are not statistically significant for reduction under both types of anesthesia.

Influence of ulnar styloid fracture with concurrent extra-articulardistal radius fracture on forearm rotations

Introduction: This study was conducted to evaluate the relation between extra articular distal radius fracture associated with and without ulnar styloid fracture and the rotational movements of wrist and forearm. Materials and Methods: This retrospective study was performed on 86 unilateral, extra articular distal radius fracture, treated conservatively. Associated ulnar styloid fracture was present in 42 (48.8%) group Aand 44 (51.2%) with intact ulnar styloid group B. Men were 54 (62.8%) and women 32 (37.2%). Distal radius fracture involving right, dominant side were 56 (65.1%). All patients were treated by one surgeon with close reduction under anaesthesia with plaster immobilisation. Long arm cast was applied with forearm in supination wrist in ulnar volar flexion and after 2 weeks changed to below elbow cast with wrist in neutral rotation. Results: The mean limitation of supination was 7.82 ± 5.19 for group 1 (intact styloid) and 23.82±14.41 for group 2 (fractured styloid). The mean limitation of pronation was 4.72 ± 3.68 for group 1 (intact styloid) and 3.29 ± 2.79 for group 2 (fractured styloid). The difference between the two groups was statistically significant regarding the limitation of supination, but not about the 0 0 0 limitation of pronation. The average pronation deformity was 120 (range 60 to 190 ) in patients with dorsal malunion and 110 0 (range 50 to 210) in volar malunion. The supination deformity averaged at about 80° (range 40° to 140°) in dorsal and 120 0 0 (range 80 to 170 ) in volarly angulated distal radius malunion. Conclusion: The association of extra articular distal radius fracture with fracture ulnar styloid at two year follow up causes restriction of supination and pronation of forearm

A RARE CASE OF FEMORAL COLUMN FRACTURE IN CHILDREN WITH CLOSED REDUCTION AND SPICA CAST: A CASE REPORT

Background: Femoral column fracture is a rare case fracture in children. This is usually caused by high-energy trauma, such as falling from a height, or, in some cases, can also occur due to pathological fractures or repetitive trauma, such as running or jumping. Femoral column fractures can occure several complications, such as avascular necrosis (AVN), coxa vara, malunion, and osteonecrosis. Therefore, appropriate treatment is needed to reduce the risk of complications that may occur. Case Presentation: A 15 year old boy came to the emergency room with complaints of pain in base of his right thigh after falling while jumping over a tennis net with focus on his right leg. On examination, vital signs were normal, pain in the right groin had limited range of motion (ROM), and no other injuries or pain were found in his parts of the body. Then treatment was carried out using the closed reduction method and the installation of a spica cast without internal fixation. Conclusion: Although there is still a lot of controversy regarding the best time and method for administering therapy, determining the Delbet classification is very helpful as a consideration in choosing treatment and patient prognosis. In this case, treatment was given using close reduction and spica cast techniques with the consideration that anatomical reduction could be achieved.

Functional Outcomes of Close Reduction and Percutaneous Pinning in Proximal Humerus Fractures

INTRODUCTION Proximal humerus fractures are usually sustained from trivial fall in elderly. These fractures are usually associated with severe degree of comminution and deformity. Therefore, anatomical reduction of fracture fragments, and early mobilization are key factors for optimal outcomes of involved limb. This study was intended to evaluate the functional outcomes of proximal humer- us fractures in adults managed by closed reduction and percutaneous pinning (CRPP). MATERIAL AND METHODS This prospective and observational hospital based study was carried out in Orthopedics Department, Universal College of medical Sciences-Teaching Hospital (UCMS-TH) from July 2021 to June 2023. All patients with proximal humerus fractures who fulfilled the inclusion criteria and who underwent closed reduction and percutaneous pinning were enrolled in the study and functional outcome was assessed according to Constant murley scoring system and Visual analogue score. Post-operatively patients were regularly followed at 6 weeks, 3 months and 6 months. RESULTS In this study of 60 cases, the mean age group was 53.08±13.10 years and male patients outnumbered female patients (37 males and 23 females). Forty one cases (68.3%) were of right side and 19 (31.7%) were of the left side. Majority of the fractures were due to fall injury (53.3%), followed by road traffic accident (40%). The mean Constant Murley Score was 76.95 ± 5.53 and VAS (visual analogue score) was 1.97 ± 0.97. CONCLUSION Closed reduction and percutaneous pinning is simple, less invasive and effective procedure for proximal humerus fracture providing good functional outcome.

Comparison outcome of open and close reduction treatments for parasymphysis mandibular fractures

Background: Mandibular fracture is a condition of mandibular discontinuity. The treatment aims to reconstruct the appropriate anatomical position. Reduction is the process of repositioning fracture fragments to their original anatomical positions, which can be done by open and closed techniques. Open reduction is more invasive, and the possibility of nerve or blood vessel injury and infection postoperatively is greater. Closed reduction also has postoperative complications such as muscle atrophy, periodontal tissue and mucosa damage, speech disorders, and nutritional disorders. In the final determination of the treatment plan, the advantages, disadvantages, and risks of each treatment and the risk of complications should be sufficiently discussed with patients and the patient’s guardians. Purpose: This case aims to compare the outcome of open reduction and internal fixation (ORIF) with closed reduction treatment in the management of mandibular parasymphysis fractures. Cases: Two case studies of mandibular parasymphysis fractures. Clinically, each patient had mandibular displacement and occlusion disturbance before treatment. Case Management: The treatment plan is considered by the patient’s age and fracture type. One patient received ORIF, and the other received close reduction treatment with gradual repositioning. Malocclusion after treatment was absent in both cases. Conclusion: Open reduction is recommended for displaced parasymphysis fractures. In cases where the open reduction technique cannot be performed, the closed technique can be an alternative, especially on non-displaced or minimally displaced parasymphysis fractures.

Do We Need to Change Hip Spica Halfway Through Immobilization Following Closed Reduction for Developmental Dysplasia of the Hip

Objectives: Closed reduction (CR) is a well-established method for treating developmental dysplasia of the hip (DDH). Traditionally, the child is placed in a spica cast after DDH CR for three to four months and it is common practice to change the spica under general anesthesia after 6–8 weeks. To our knowledge, no previous studies have shown that changing the spica is necessary. We hypothesize that there is no need to change the spica and that it can be safely retained for three months without any significant complications.
 Methods: We used our department database to find all children who had DDH CR and a spica cast for a minimum of 90 days over a one-year period (March 2018 to March 2019) and who had at least a one year follow up after removal of the cast. We retrospectively reviewed the medical notes and radiographs, looking at complications that may be attributed to prolonged use of spica.
 Results: Thirty-nine patients (48 hips) met our criteria. None of the patients developed any cast-related complications during or after removal of the spica cast. No abdominal, joint or skin complications were reported throughout treatment. At one year follow up, there were no complications that could be attributed to using the spica for three months. 
 Conclusion: Changing the spica every 6–8 weeks after DDH CR is of no benefit and exposes the infant to an unnecessary general anesthesia, with the risk of losing the hip reduction. We conclude that it is very safe to keep the spica cast on for three months without changing after DDH CR. We recommend changing practice to reflect our findings.

The Use of a CAD/CAM Thermoformed Splints System in Closed Reduction of Condylar Fractures.

(1) Background: Mandibular fractures are very common. Common indications of closed treatment for mandibular fractures are non-displaced or minimally displaced simple fractures in adult compliant patients with good dentition, the absence of occlusal disruption, and fractures in growing children. In closed treatment, the mandible is maintained in centric occlusion with a maxillomandibular fixation (MMF) with orthodontic elastics. Many methods of MMF have been described, often using orthodontic appliances. In recent years, CAD-CAM technology has improved many procedures used in maxillofacial surgery and orthodontics. The device we present is manufactured following a digital workflow, and was designed specifically for MMF. (2) Materials: Two patients with mandibular fractures were treated with an MMF method whose procedure comprised scanning of the dental arches, followed by construction of thermoformed splints on which buttons for the elastics and retention holes are made. The splints were fixed on the dental arches with composite resin at the level of the holes, and were kept in place for the period of healing of the fracture, with the intermaxillary elastics hooked to the buttons. (3) Results: The application time of the splints was very quick. The splints remained stable for the necessary time, without causing particular discomfort to the patients. (4) Conclusions: From our experience, this technique has proved to be reliable and reproducible and could represent a valid tool in the closed treatment of mandibular fractures.

Factors influencing outcomes of pelvic osteotomy for residual acetabular dysplasia following closed reduction in patients with developmental dysplasia of the hip.

To investigate the factors influencing outcome of pelvic osteotomy (PO) for residual acetabular dysplasia (RAD) following closed reduction (CR) in patients with developmental dysplasia of the hip (DDH). We retrospectively reviewed 91 patients (95 hips) with DDH who underwent PO for RAD. Tönnis grade, Acetabular index, Center Edge Angle, Reimer's Index (RI), and avascular necrosis of the femoral head (AVN) were assessed. Hips were divided into satisfactory (Severin I/II) and unsatisfactory group (Severin III/IV). Finally, 87 hips (91.5%) had satisfactory and 8 (8.5%) unsatisfactory outcomes. The RI before PO was significantly higher in unsatisfactory (49.6 ± 9%) than in satisfactory group (30.6%±11.8%). All patients without AVN had satisfactory outcome, while it was 78.9% of patients with AVN. Logistic regression analysis showed that higher AVN grade and RI before PO were risk factors for unsatisfactory outcome. Satisfactory outcome was obtained in all hips with RI < 33% before PO, while it was 79.5% if RI > 33% before PO (79.5%). There was no difference in the satisfactory rate between patients undergoing open reduction (66.7%) and those not undergoing (83.3%). The rate of satisfactory outcome in patients undergoing femoral osteotomy (63.6%) was lower than those without it (100%). In patients with RAD following CR, good outcome can be expected after PO alone. AVN and preoperative RI > 33% are risk factors for poor outcome. Additional open reduction and femoral osteotomy do not significantly improve outcome of PO in patients with preoperative RI > 33%.

A Modified Technique of Percutaneous Fixation of Displaced Pediatric Lateral Humeral Condyle Elbow Fractures (aka the Martini Technique): A Brief Case Series.

Displaced lateral humeral condyle (LHC) fractures have routinely been treated with open reduction, which has known postoperative complications. Recent reports show that closed reduction and percutaneous pinning (CRPP) is a valid treatment. Five pediatric patients with displaced LHC fractures were included in a retrospective case series. Closed reductions (CRs) were facilitated by Kirschner wire placement into the capitellum through a toothed drill guide. The Kirschner wire and drill guide were used like a joystick to manipulate the fragment and maintain reduction for placement of additional Kirschner wires. Patient records were used to determine the number of patients diagnosed with LHC fractures between 2011 to 2022 among six pediatric orthopaedic surgeons at one institution along with the treatment and associated complications. Satisfactory reduction of displaced LHC fractures was achieved with CRPP in all patients with no complications using the "martini" modification. Of 26 LHC fractures, 16 were treated with CRPP/CRPS and 10 with open reduction and percutaneous pinning/open reduction and internal fixation, with four converted from CR to OR. Complications included one superficial infection in the CR group and four stiff elbows and one nonunion in the OR group option for LHC fractures. CRPP is an effective treatment option with a decreased risk of complications. Our modified reduction technique may help improve the success and results of closed treatment of LHC fractures.

Clinical effect of Kirschner wire intramedullary fixation in the treatment of pediatric both-bone forearm fractures at high altitude area

To explore the clinical effect of Kirschner wire intramedullary fixation in the treatment of both-bone forearm fractures in children of high altitude area. From August 2020 to December 2021, 19 children were treated with Kirschner wire intramedullary fixation including 11 males and 8 females, aged from 4 to 13 years old with an average of (8.16±2.71) years old. The course of disease was 1 to 10 days, with a mean of (4.11±2.51) d. First, close reduction was performed. If the reduction was unsuccessful, limited open reduction was performed, followed by Kirschner wire intramedullary fixation of the radius and ulna. The fracture healing was evaluated by X-ray after operation, and the curative effect was evaluated by Anderson forearm function score standard. The wound healed well after operation, 2 cases had clinical manifestations of needle tail irritation after operation, and the symptoms disappeared after removing the internal fixation. The average follow-up time was(7.68±3.50) months (3 to 14 months). X-ray showed that all fracture healing in follow-up, Anderson forearm function score showed excellent in 16 cases, good in 2 cases and fair in 1 case at the final follow-up. Children with fractures in plateau areas often have delayed medical treatment, lack of medical conditions and insufficient compliance. Based on these characteristics, Kirschner wire intramedullary fixation for the treatment of children's double forearm fractures has the advantages of small injury and rapid recovery. It is a kind of operation method that can be popularized.

Anterior approach versus posterior approach for the open reduction of displaced pediatric supracondylar humerus fracture

BackgroundThis study's objective was to compare the results and adverse outcomes of the anterior approach and posterior approach in patients with a type 3 Gartland pediatric supracondylar fracture who failed close treatment and indicated open reduction. Methodsin this retrospective study patients with Gartland type 3 fracture who failed close reduction and required open reduction were enrolled in the study. Eligible patients underwent open reduction via anterior and posterior triceps sparing approaches. Patients were followed up 3, 6, and 12 months after the surgery. Study variables included age, sex, Bauman's angle, pin site infection, nerve injury, osteonecrosis, and elbow arc of motion. ResultsThe study included a total of 83 patients. Surgery was performed on 49 patients using the posterior technique and 34 patients using the anterior approach. The mean age of patients was 6.78 ± 1.40 years. The mean age and the relative frequency of sex didn't differ significantly between study groups (P > 0.05). Two-way repeated measures ANOVA test showed that there was a statistically significant difference in elbow arc of motion in the anterior approach in comparison with the posterior approach, however, this increase was not clinically significant. In terms of adverse events including pin site infection, nerve injury, osteonecrosis, and cubitus varus, there was no statistically significant difference between the two approaches. ConclusionThere was no clinically significant difference in elbow arc of motion and adverse events between the anterior approach and the posterior approach. Therefore, surgeons should choose the approach with which they are more familiar and comfortable.

Effect of reverse hammering on fracture union in transverse fracture of long bone nailing

Reverse hammering is the method applied during nailing of transverse long bone fracture to decrease the gap between fracture ends to ensure healing. This study aims to asses the effectiveness of reverse hammering on fracture union in transverse fracture of long bone nailing as well as possible complications of this method. Seventy six patients with transverse fracture of long bone (femur, tibia, &amp; humerus) treated with close reduction and internal fixation with interlocking nailing were enrolled in a prospective study conducted at the department of orthopaedics, BMC Sagar from Dec. 2012 to March 2021. Union grading was done to asses union as per Hammer criteria. Mean time to achieve bony union was 4.5 months. In our study seven out of seventy six patient at the end of three month were having radiological grade three or less union which at the end of nine month only two patient out of seventy six patient were having nonunion. Our results have been encouraging. The operation is technically demanding but provides an excellent method to achieve union in intramedullary nailing of long bones. This method to reduce fracture gap should be considered for patients requiring a faster return to function after the injury.

A Comparison of Clinical Outcomes in Patients of Mandibular Condyles Fractures Treated with Open Versus Close Reduction

Aim: The absence of a widely acknowledged and conclusive therapy for condylar fractures is a matter of contemporary debate and contention, with the issue of whether surgical or conservative approaches are better suitable for managing such fractures being unresolved. This study investigates several methodologies pertaining to the conservative, closed, and open surgical interventions for the treatment of condylar fractures. The standardization of fracture classification systems and treatment techniques is necessary to provide a clear and optimum strategy for individual individuals and their respective fractures. Objectives: The objectives of the study are to compare clinical outcomes in patients of mandibular condyles fractures treated with open versus close reduction. Method: A total of 84 individuals diagnosed with subcondylar fractures of the mandible were assessed. All fractures seen in the study exhibited displacement, with either angulation ranging from 10° to 35° or a reduction in length of the ascending ramus by more than 2 mm. A comprehensive assessment, including both clinical and radiographic examination, was conducted at the 6-month mark after the occurrence of the trauma. The clinical criteria assessed in this study included mouth opening, temporomandibular joint (TMJ) discomfort, mandibular deviation, malocclusion, facial damage, and scar formation. Results: The findings indicated a statistically significant difference between the two groups, with a p-value of less than 0.05. The findings suggest that open reduction was found to be more efficacious than closed reduction in enhancing mouth opening, mandibular deviation, TMJ discomfort, and malocclusion. Conversely, closed reduction was shown to be more beneficial than open reduction. Conclusion: The study findings indicate that the open treatment approach yields superior progress compared to closed techniques, and these differences are statistically significant. Patients who had open reduction demonstrated considerably superior results in all functional measures, with the exception of facial nerve damage and scar formation, when compared to those who underwent closed reduction. Keyword: Mandibular fracture, open reduction, closed reduction, clinical outcome

A Comparison of Quality of life in Patients of Mandibular Condyles Fractures Treated with Open Versus Close Reduction

Aim: The notion of quality of life pertains to the subjective assessment made by people on their overall well-being, taking into account their cultural and value orientations, as well as their goals, expectations, standards, and concerns. The notion of quality of life (QoL) within the medical field is often denoted as Health-Related Quality of Life (HR-QoL) or subjective health status. The primary objective of research on quality of life (QoL) is to evaluate the influence of sickness, disease, and their corresponding therapies on the holistic welfare of individuals. Objectives: The objectives of the study are to compare quality of life in patients of mandibular condylar fractures treated with open versus close reduction. Method: A total of 84 individuals diagnosed with subcondylar fractures of the mandible were subjected to evaluation. All fractures seen in the study exhibited displacement, either in the form of angulation ranging from 10° to 35° or a shortening of the ascending ramus by more than 2 mm. A comprehensive assessment, including both clinical and radiographic examination, was conducted at the 6-month mark after the occurrence of the trauma. The clinical characteristics assessed in this study included oral pain, difficulty in chewing, discomfort, cosmetic deformity, impact on daily routine, and symptoms of sadness. Results: The findings of the study indicate a statistically significant difference between the two groups, with a p-value of less than 0.05. The findings suggest that open reduction had superior outcomes compared to closed reduction in terms of alleviating oral pain, enhancing chewing ability, reducing discomfort, addressing cosmetic deformities, minimising disruptions to daily activities, and mitigating depressive symptoms. Conclusion: The study has determined that open therapy yields a better improvement in quality of life compared to closed treatments, and these differences are statistically significant. Keyword: Mandibular condylar fracture, open reduction, closed reduction, Quality of life

A Comparison between Open Versus Closed Reduction in the Treatment of Fractures of the Base of the First Metacarpal Bone

A Comparison between Open Versus Closed Reduction in the Treatment of Fractures of the Base of the First Metacarpal Bone

Open Reduction and Internal Fixation of Purely Ligamentous Lisfranc Injury in a Rugby Player: A Case Report

Objective: Lisfranc injuries are found in various injury patterns, especially in athletes. These injuries are the second most common type of foot injuries in athletes. However, the treatment decision differs and is essential in athletes for a good outcome. The main controversies in surgical management include whether to execute open or close reduction, fixation technique, and arthrodesis’ role in athletes. Case Report: A previously healthy 21 Years Old Malay gentleman sustained a sports injury diagnosed with pure ligamentous Lisfranc injury with an incomplete, partial lateral dislocation. The patient was treated with Open Reduction and Internal Fixation (ORIF) using a dorsal bridge Lisfranc locking plate. Conclusion: Early diagnosis and appropriate treatment are crucial to achieving stability in unstable Lisfranc injuries. Anatomical reduction and Lisfranc joint restoration are the keys to a good outcome. Open reduction and internal fixation are preferred methods where most athletes can return to their previous level of sports.

WHICH IS THE BEST PATIENT-REPORTED OUTCOME MEASURE TO EVALUATE YOUNG PATIENTS UNDERGOING HIP SURGERY?

Young patients undergoing THA or hip used. HOS and iHOT33 have demonstrated to be useful in hip preservation surgery but never used in THA.The aim of the study was to evaluate long-term clinical outcomes with HOS and iHOT33 in hip arthroscopy and THAWe conducted a retrospective study with prospective data collection of 118 consecutive young patients (&lt;65 y.o.) between 2008 to 2012 who underwent hip arthroscopy or THA. The mean follow-up was 12.05 years. All surgeries were done by the same senior surgeon. PROMs used were iHOT-33 and HOS preoperatively, at one year and 10 years. SPSS Statistics Grad Pack 28.0 software was used for statistical analysisArthroscopy Group (57 patients): Mean age 35.36 years. 55.93% were male. iHOT33 mean differential improvement was 24.43 at 1 year, 70,17% exceed MCID and 49,1% SCB. HOS mean differential improvement was 16.26 at one year. 54,38 % patients exceed MCID and 49,36% SCB. At 10 years, iHOT33 mean differential improvement was 14,36 and 12.56 for HOS. Regarding complications, 3 patients underwent THA (5.26%) and 10 (17.54%) continued with groin pain.THA Group (61 patients): Mean age 52,54 years. 55.73% were male. Cementless THA was used in all patients with ceramic on ceramic used in 77%. iHOT33 mean differential improvement was 41,57 at 1 year. 95,08% patients exceed MCID and 85,25% SCB. HOS mean differential improvement was 16.57 points at one year. 85,25% patients exceed MCID and 81,97% SCB. At 10 years, iHOT33 mean differential improvement was 20,15 and 14.12 for HOS. Regarding complications, 1 patient underwent DAIR for infection (1.64%) and 1 dislocation with close reduction (1.64%).iHOT33 or HOS scores should be considered to be used in young active patients after hip preserving surgery or THA, with more predictable results at long-term in THA group.

Hoarseness and arytenoid dislocation: A rare complication after facial bony contouring surgery

Arytenoid dislocation is a rare complication after endotracheal intubation and may result in permanent hoarseness, which cannot be tolerated during cosmetic surgeries, such as facial bony contouring surgery. This study aimed to identify the clinical characteristics of this patient subgroup and share the process of diagnosis and treatment. We retrospectively collected the medical records of patients who underwent facial bony contouring surgery under general anesthesia with endotracheal intubation from September 2017 to July 2022. We divided the patients into a nondislocation group and a dislocation group. Demographic, anesthetic, and surgical characteristics were collected and compared. 441 patients were enrolled, and 5 (1.1%) were diagnosed with arytenoid dislocation. The patients in the dislocation group were more likely to be intubated with the video laryngoscope (P=0.049), and head-neck movement during surgery may predispose patients to arytenoid dislocation (P=0.019). The patients in the dislocation group were diagnosed around 5-37 days after surgery. Three of them regained their normal voice after close reduction, and two recovered with speech therapy. Arytenoid dislocation may result from multiple factors instead of one high-risk factor. Head-neck movement, the skills and experience of anesthetists, the time of intubation, and the use of intubation tools may all predispose patients to arytenoid dislocation. To acquire timely diagnosis and treatment, patients should be fully informed of this complication before surgery and observed closely afterward. Any postoperative voice or laryngeal symptoms lasting more than 7 days need a specialist evaluation.

Comparison of hand grip strength in patients with distal radius fracture that are treated by closed reduction with cast versus open reduction and internal fixation

Distal radius fracture are one of the most common fractures presenting at emergency rooms. It has bimodal age distribution. Historically, fractures were treated by manipulation and casting with or without K-wire. Modern techniques of JESS fixation and volar plating have been advocated to restore anatomical alignment and allow early mobilization. There is still debate on, which is the best method to manage these fractures. Grip strength is most used as an outcome measure of functional recovery of patients with distal radius fracture of which the most common tool is hand dynamometer. The study was observational study, which aimed to analyse the comparison of hand grip strength in patients with distal radius fractures that were treated by closed reduction and casting to open reduction and internal fixation twelve months post action. The result of this study indicates that the assessment of handgrip from open reduction internal fixation in the case of distal radius fracture with the results of statistical tests (P&amp;#62; 0.05), which mean there is no significant difference in the strength of hand between the internal fixation and casts after twelve months of action. Grip strength was found to be consistent and reliable outcome measure. It was found by evaluation of grip strength that the outcome of close reduction and casting, and open reduction internal fixation of distal radius fracture are equal and comparable.