Closed Reduction And Internal Fixation Research Articles

Correlation between Peripheric Blood Markers and Surgical Invasiveness during Humeral Shaft Fracture Osteosynthesis in Young and Middle-Aged Patients

The treatment for humeral shaft fractures (HSFs) is still controversial, consisting of a wide variety of orthopedic osteosynthesis materials that imply different grades of invasiveness. The aim of this study is to investigate the correlation between inflammatory blood-derived markers and the magnitude of the surgical procedure in young and middle-aged patients who sustained these fractures. Observational, retrospective research was conducted between January 2018 and December 2023. It followed patients diagnosed with recent HFSs (AO/OTA 12-A and B) and followed operative treatment. They were split in two groups, depending on the surgical protocol: group A, operated by closed reduction and internal fixation (CRIF) with intramedullary nails (IMNs), and group B, operated by open reduction and internal fixation (ORIF) with dynamic compression plates (DCPs). Statistically significant differences (p < 0.05) between the two groups could be observed in injury on the basis of surgery durations, surgical times, pre- and postoperative neutrophil-per-lymphocyte ratio (NLR), postoperative platelet-per-lymphocyte ratio (PLR), monocyte-per-lymphocyte ratio (MLR), systemic inflammatory index (SII), systemic inflammatory response index (SIRI) and aggregate inflammatory systemic index (AISI). The multivariate regression model proposed revealed that NLR > 7.99 (p = 0.007), AISI > 1668.58 (p = 0.008), and the surgical times (p < 0.0001) are strongly correlated to the magnitude of the surgical protocol followed. Using receiver operating characteristic (ROC) curve analysis, a balanced reliability was determined for both postoperative NLR > 7.99 (sensitivity 75.0% and specificity 75.6) and AISI > 1668.58 (sensitivity 70.6% and specificity 82.2%). Postoperative NLR and AISI as inflammatory markers are highly associated with the magnitude of surgical trauma sustained during humeral shaft fracture osteosynthesis in a younger population.

Double reverse traction repositor assisted closed reduction and internal fixation versus open reduction and internal fixation for treatment of lateral tibial plateau fractures among the elderly.

In elderly tibial plateau fractures (TPFs), the lateral condyles are involved frequently. This study aimed to compare the outcomes of open reduction and internal fixation (ORIF) and double reverse traction repositor (DRTR) assisted closed reduction and internal fixation (CRIF) in elderly patients with lateral TPFs. From January 2015 to July 2020, we retrospectively reviewed 68 patients treated surgically at our trauma center for lateral TPFs (Schatzker type I-III). 31 patients were eventually assigned to the DRTR assisted CRIF group, whereas 37 patients were assigned to the ORIF group. The primary outcomes included surgical details, radiological assessment, follow-up knee function, and complications. The DRTR assisted CRIF group experienced a 43.6mL decrease in intraoperative blood loss (161.3ml vs 204.9ml, p = 0.033), and the operation duration was 32.1min shorter than the ORIF group (83.8min vs 115.9min, p < 0.001). There was no statistically significant difference in terms of widening of the tibia plateau (WTP), depth of articular depression (DAD), medial proximal tibial angle (MPTA) and posterior tibial slope angle (PTSA) immediately after surgery and at the last follow-up. No differences in malreduction (p = 0.566) or reduction loss (p = 0.623) were observed between the groups, and Lysholm and HSS scores were similar between the two groups (83.6 ± 15.8 vs 83.4 ± 5.1, p = 0.934; 89.3 ± 7.8 vs 86.9 ± 6.2, p = 0.172; respectively). However, ORIF was associated with a greater increase in postoperative complications than DRTR assisted CRIF (3.2% vs 27%, p = 0.008). Both types of internal fixation provide good radiological outcomes and knee function in the treatment of lateral TPFs in the elderly. However, DRTR assisted CRIF has the advantage of a shorter duration of surgery, less blood loss, and fewer postoperative complications, and appears to be a better treatment option for elderly patients with lateral TPFs.

Choosing the proper implant for extra-articular fractures of proximal phalanges: A study on 75 cases

IntroductionPhalangeal fractures are the most common fractures of the hand and in particular the proximal phalanx of the long fingers is the most involved. These fractures can ben conservatively managed but, when the fracture pattern is considered unstable, surgical treatment is recommended. However, there is no consensus in literature about the proper surgical option for extra-articular proximal phalanx fractures. Material and methodsWe compared clinical and radiographical results after treatment of 75 cases of extra-articular proximal phalanx fractures using three different surgical techniques: closed reduction and internal fixation (CRIF) with Kirschner wires (G1 group), open reduction internal fixation (ORIF) with plates and screws or lag screws (G2 group), and closed reduction and intramedullary screw fixation (CRIMEF)(G3 group). ResultsWe found no significant differences in term of union rate and time to fracture healing between the three groups. However, we found a significant reduction in time to return at work and in TAM at the final follow-up examination in G3 group (treated with CRIMEF) when compared with both G1 and G2. No differences in complications rate were found between three groups. DiscussionThe surgical variability in the management of extra-articular phalanx fractures create lacks on standard guide for treatment. ConclusionsIn conclusion, our results showed good clinical and radiographical results with all the three surgical options. However, the closed reduction and internal fixation with intramedullary screws (CRIMEF) seems to be better in terms of time to return to work and TAM at the final follow-up, probably due to good primary stability and little risk of soft tissue adherence development.

Sterile Inflammatory Response and Surgery-Related Trauma in Elderly Patients with Subtrochanteric Fractures.

Sterile inflammation is a natural response of the organism in the absence of microorganisms, which is triggered in correspondence with the degree of tissue damage sustained after a surgical procedure. The objective of this study was to explore the values of postoperative hematological-derived biomarkers in assessing the sterile inflammatory response magnitude related to the invasiveness of the surgical reduction technique used for subtrochanteric fractures (STFs) treatment. A retrospective, observational cohort research was conducted between January 2021 and October 2023 that included a total of 143 patients diagnosed with acute subtrochanteric fractures who underwent long Gamma Nail (LGN) fixation. According to the surgical reduction technique used, they were divided into two groups: group 1, which consisted of those with a closed reduction and internal fixation (CRIF); and group 2, which consisted of those with an open reduction internal fixation (ORIF). Between groups, statistically significant differences (p < 0.05) were found in relation to days to surgery, length of hospital stay (LOHS), duration of surgery, postoperative hemoglobin (HGB) levels, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), systemic inflammation index (SII), systemic inflammation response index (SIRI), and aggregate inflammation systemic index (AISI). The receiver operating characteristics (ROC) curve analysis revealed that all ratios presented a high diagnostic ability (p < 0.0001) with NLR > 6.95 being the most reliable (sensitivity 94.8% and specificity 70.6%). Moreover, the multivariate regression model confirmed that sterile immune response after orthopedic interventions can be assessed in an almost equal and non-dependent manner using these biomarkers. Postoperative NLR, PLR, MLR, SII, SIRI, and AISI ratios are closely correlated to the sterile inflammatory response magnitude, due to the extent of surgical dissection performed during internal fixation procedures of subtrochanteric femur fractures.

Percutaneous treatment of radial neck fractures in adult patients.

Radial neck fractures in adults are rare, but outcomes are often poor. Closed reduction and internal fixation (CRIF) technique has been advocated for the treatment of minimally displaced fractures in children, with a few reports on adult subjects. The aim of the present paper is to investigate mid-term results of a CRIF technique in adults with retrograde intramedullary K-wires in Mason's type II and III fractures. The proposed technique yields to good anatomical reduction of displaced neck fractures, faster rehabilitation, and easier hardware removal after fracture consolidation. A consecutive series of 17 patients were treated with closed reduction and intramedullary osteosynthesis, and outcomes were retrospectively evaluated. Elbow X-ray (XR) and CT scan were obtained preoperatively. Objective assessment before surgery and at an average 36-month follow-up included active and passive elbow range of motion (ROM). Functional evaluation was carried out through the collection of the Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder, and Hand (DASH) score, and Elbow Self-Assessment Score (ESAS). XR at last follow-up was evaluated. The cohort included 10 males and seven females, with a mean age of 32 years. Patients returned for a follow-up evaluation at a mean of 36 months (range 6-43 m) form the surgery. The DASH score revealed good to excellent outcomes with a mean of 6.32 ± 10.24 points at last follow-up. The ESAS was 98.35 ± 1.89, indicating a non-restricted elbow function. Acceptable radiographic healing was achieved in all patients. The advocated technique is promising for obtaining good reduction and stabilization, and good to excellent satisfaction for patients. Given the challenging technique, the learning curve could be long and initial results unsatisfactory. More research with larger cohorts and improved study design could be carried out, comparing the technique with the current choice of treatment (ORIF, radial head resection).

Intraoperative imaging with the mobile C-arm : Technique, image creation and radiation protection

Imaging techniques in the discipline of orthopedics and trauma surgery are essential not only for making a diagnosis but also play a central role in the performance, documentation and monitoring of the corresponding treatment. Procedures such as open reduction and internal fixation (ORIF) and closed reduction and internal fixation (CRIF) of fractures, kyphoplasty and vertebroplasty as well as posterior stabilization of spinal fractures are carried out under X‑ray control. In the relevant operating rooms of emergency departments and operating theaters, mobile fluoroscopy devices are available, which due to their appearance are called C‑arms. These devices can be moved horizontally, vertically, and along the pivotal axis, enabling real-time imaging of joints and bones from various angles. This imaging enables minimally invasive surgical techniques as this often eliminates the need for extensive preparation and resulting in smaller wound defects compared to open surgical preparation. Additionally, surgeons can immediately assess and, if necessary, adjust the reduction outcome to achieve the best possible care and reduce the need for corrective interventions. With current C‑arms it is also possible to generate 3‑dimensional datasets, to enhance the assessment of implant positioning, particularly in complex intra-articular fractures. This availability helps avoid subsequent corrective interventions that would otherwise only be identified through postoperative computed tomography [1].

Fixation of Tibial Shaft Fracture by Interlocking Nail without Proximal Screws

Tibia is the most commonly fractured long bone. In adults it takes 4 to 6 months to heal depending on the severity ofinjury and method of treatment. Rate of complications are also high. Locked intramedullary nailing is the preferredtreatment for tibial shaft fractures. When locked proximally and distally, removal of one set of screws, especially intransverse and short oblique fractures are required for dynamization before weight bearing. Fail to do this timely,many of these patients present with nonunion and implant failure. The purpose of the study was to enhance healing oftibial shaft fracture by early weight bearing, at the same time minimizing the complications and early return to work.Stable open type- I, II &amp; closed tibial shaft fractures from the isthmus to 4 cm above the distal articular surface of thetibia were fixed by locking nail without proximal screws. This prospective study was done from June 2009 to July2014 on 410 patients treated at several hospitals of Faridpur city. All the operations were done in closed methodwithout any C-Arm monitoring. Patients were allowed to move with crutch and controlled partial weight bearingwithin two to four weeks of operation. All patients were followed up for five years. In most cases the nail wereremoved in one to two years. Early weight bearing causes compression and intermittent micro movements at thefracture site. The fractures heal as early as in eight to twelve weeks and no nonunion or implant failure wereencountered. Knee pain was complained by 41 patients (10%), disappeared after removal of the nail. Superficialinfection developed in 8 cases (1.95%), controlled in 2 to 3 weeks and deep infections were encountered in 8 cases(1.95%) with delaying union but eradicated spontaneously as the fracture healed. Deep infection occurs only in openfractures. Although five years period is not enough to comment about development of secondary osteoarthritis, weencountered no such cases till now. So, closed reduction and internal fixation (CRIF) of stable open type-I, II &amp;closed tibial shaft fractures from the isthmus to 4 cm above the distal articular surface of the tibia by interlockingnailing with distal locking screws only, allows early controlled weight bearing, thereby early fracture healing and lesschance of implant failure.&#x0D; Bangabandhu Sheikh Mujib Med. Coll. J. 2022;1(1):33-36

Incidence of Carpal Tunnel Syndrome in Distal Radius Fractures Treated by Various Modalities in a Tertiary Care Center: A Single Center Study.

Background Distal end radius fractures (DRF), which account for 17.5% of all fractures, are the most frequent fracture seen in emergency rooms. In patients with DRFs, delayed carpal tunnel syndrome (CTS) occurs in about 20% of cases. When patients are treated with DRFs using different modalities, CTS results in poor functional outcomes. Our study aims to identify the prevalence of CTS in DRF patients receiving treatment with various modalities. Materials and methods Two hundred twenty patients with a history of DRFs who were treated by a variety of modalities at R.L. Jalappa Hospital and Research Center between January 2013 and January 2018 are included in this retrospective analysis. The medical records from the department of the hospital's paperwork were used to gather the patient's information and radiographs. The information was gathered, tabulated, and examined. Results In our study, the incidence of CTS in DRF was calculated using a sample size of 220 and found to be 32.73%. The incidence of CTS was shown to be higher in groups with more comminution than less comminution when treatment modalities were analyzed. These groups included closed reduction and internal fixation (CRIF)/open reduction and internal fixation (ORIF) with K wire, external fixation, conservative with the cast, ORIF with variable angle volar locking plate (VAVLP), and ORIF with volar T locking plates (VTLP). Conclusions After DRFs, carpal tunnel syndrome is the most significant consequence limiting functional results, hence preventing it requires considerably more attention and care.

Does the Method of Fixation Affect the Risk of Complications in Patients with Pauwels Type 3, Displaced Intracapsular Femoral Fractures

Background: Patients with Pauwels type III displaced intracapsular femoral fractures (DICFF) are at a high risk of developing avascular necrosis (AVN) and non-union following closed reduction and internal fixation (CRIF). We compared the complications between the Targon femoral neck (TFN) plate and the cannulated cancellous screws (CCS). Methods: This retrospective study reviewed the records of 34 patients younger than 65 years of age who underwent CRIF of Pauwels type III DICFF from January 2007 to January 2018. Patients were evaluated for demographic data as well as the fixation method. Subsequent postoperative radiographs were obtained to assess the incidence of AVN and nonunion. Results: 34 patients were included in the study, of which, 18 (53%) and 16 (47%) were treated using TFN and CCS, respectively There were no significant differences observed between the CCS and TFN cohorts in terms of age (p = 0.90), gender (p = 0.27), time to surgery (p = 0.36), and duration of surgery (p = 0.99). The incidence of AVN and non-union did not significantly differ between the groups, with rates of 38.9% and 43.8%, respectively (p = 0.083) Conclusions: The type of fixation utilized, whether CCS or TFN, did not have a significant impact on the incidence of treatment failure in patients with Pauwels type III fractures treated via CRIF

Randomized clinical trial to assess functional outcome and complication of surgical neck humerus fracture (two part and three part) treated by percutaneous K-wire fixation and Philos plating

Background: Proximal humeral fracture, whether caused by trauma or osteoporosis, requires meticulously planned individual treatment. The technique and devices used are determined by the quality of bone and soft tissue, age, and reliability of the patients. The purpose of this study is to evaluate the functional outcomes and complications of surgical neck humerus fractures (two part and three part) treated by percutaneous K-wire fixation and PHILOS plating. Methodology: The study includes patients with proximal neck humerus fractures (two-part and three-part) according to Neer's classification who underwent open reduction and internal fixation with a PHILOS locking plate and percutaneous K-wire fixation. Functional outcomes and complications were evaluated by the Shoulder Constant score (SCS). Patients were followed up at 1, 3, and 6 month intervals until fracture union. In this study, a total of 76 patients were chosen and divided into two groups, i.e., Group A and Group B, each comprising 38 patients. Patients of Group A were treated with ORIF PHILOS plating and patients of Group B were treated with closed reduction and internal fixation (CRIF) percutaneous K-wire fixation. Results: ORIF PHILOS plating was used on 20 (26%) of patients who had an excellent SCS. 10 (13%) patients exhibited a good grade, 5 (6%) patients had a fair grade, and the remaining 3 (4%) patients displayed a poor grade. In Group B, 12 (16%) of patients treated with closed reduction with K-wire fixation had excellent grades, 7 (9%) patients had good grades, 16 (21%) received fair grades, and the remaining 3 (4%) received poor grades. After comparing both treatments, a P value was found to be 0.0403, which shows Group A was more efficient than Group B. Conclusion: The results of our study concluded that, as compared to ORIFPHILOS plating treatment with the CRIF K-wire fixation treatment has poor functional outcomes and a high failure rate. In addition, the surgical treatment of proximal neck humerus fractures (two part and three part) in both groups showed that the PHILOS plating provides an excellent way to achieve the goal, including time of union, fewer complications, and good functional outcomes as compared to percutaneous K-wire.

Management and Complications of Condylar Fractures

Mandibular condylar fractures are frequently encountered maxillofacial traumatic injuries, representing a significant proportion of all fractures of the lower jaw. They are more common in young males and are typically caused by trauma to the face or jaw. The diagnosis begins with a thorough medical and dental history, followed by a clinical examination and radiographic imaging. With both surgical and nonsurgical methods available, there are differences in opinion regarding condylar fracture repair. Surgical options include open reduction and internal fixation (ORIF), closed reduction and internal fixation (CRIF), percutaneous reduction and internal fixation (PRIF), arthroscopy-assisted reduction and internal fixation (ARIF), and endoscopic-assisted reduction and internal fixation (ERIF). Non-surgical options include closed reduction, immobilization, and functional therapy. Complications can occur with both surgical and non-surgical approaches, and the timing of treatment should be based on the severity and complexity of the fracture, as well as the patient's overall health and individual circumstances. The longterm outcomes of mandibular condylar fracture management are generally favorable, but certain factors can influence the prognosis. Further research is needed to better understand how to optimally manage these injuries and improve clinical and surgical outcomes.

Outcomes of TFN-Advanced™ Proximal Nail System (TFNA) for AO Type 31-A1/A2/A3 Intertrochanteric Fractures: A Retrospective Review of 100 Cases with Minimum 2-Year Follow-Up

Purpose: Hip fractures are a growing concern for healthy systems worldwide. Several fixation modalities have been developed for the fixation of AO type 31-A1/A2/A3 fractures. The TFN-AdvancedTM Proximal Nail System (TFNA) is a novel fixation device that aims to build on success of previous generation nails. Currently, there is a paucity of literature regarding the outcomes of this implant. The aim of this study was to present our experience using the TFNA implant over a 2-year minimum follow-up. Methods: We retrospectively reviewed patients above the age of 65 who underwent closed reduction and internal fixation (CRIF) for AO type 31-A1/A2/A3 intertrochanteric fractures, with the TFNA nail between January 2017 and June 2018. The minimum follow-up time in our study was 2 years. Radiological evaluation was performed during follow up visits to evaluate for post-operative complications. Results: Following exclusions, the final study population consisted of 100 patients. The mean follow-up was 30.8 months (range 24–44, SD 5.1). During the follow-up period, 6% of the patients (n=6) experienced orthopedic complications. The rate of peri-prosthetic fracture in our study was 2% (n=2), the rate of peri-prosthetic infection was 2% (n=2) and the cut-out rate was 1% (n=1). No cases of mal-union or non-union were observed. Revisions were required in 4% of patients (n=4). Conclusion: The low rates of complications reported in our study support the implementation of TFN-A as a fixation device for AO type 31-A1/A2/A3 intertrochanteric fractures undergoing CRIF. Additional follow-up is required in the long-term.

Does Surgeon Experience Affect the Risk of Post-Op Complications for Patients Undergoing Fixation for Intertrochanteric Fractures

Background: Intertrochanteric fractures compromise approximately one half of all hip fractures. Common complications following fixation of these fractures include cut-out, non-union and avascular necrosis (AVN). It is unclear what effect surgeon experience has on the risk of developing these complications following fracture fixation. The purpose of this study was to compare the post-surgical outcomes for patients treated with TFNA nail for intertrochanteric fractures between residents and fellow trained orthopedic surgeons. Methods: Data was retrieved from the medical records of patients that underwent closed reduction and internal fixation (CRIF) for type 31A1, 31A2 and 31A3 (AO classification) fractures of the proximal femur. All of the fractures were treated with the Trochanteric Fixation Nail Advanced (TFN-A) nail between January 2017 and June 2018. Surgery was performed by either a fellowship-trained trauma surgeon or a resident who had completed his third year of residency. Data such as the duration of surgery, decreased hemoglobin levels, together with data on other hospitalization characteristics and any intraoperative and postoperative complications were retrieved from the medical files. Results: The final study population consisted of 100 patients. Forty-nine patients were operated upon by a senior surgeon, while 51 were operated upon by a resident surgeon. No significant difference was noted between cohorts for the duration of surgery (p = 0.66), blood loss (p = 0.13), orthopedic complications (p = 1) or rates of re-operation (p = 0.35). Conclusion: Residents may perform CRIF for intertrochanteric fractures without placing patients at an increased risk for post-surgical complications.

Causes of Increased Use of Closed Reduction and Internal Fixation for High-Energy-Related Traumatic Sacral Fractures

BackgroundReasons for the increased use of closed reduction and internal fixation (CRIF) for traumatic sacral fractures (SFs) are unclear in the literature. Therefore, we aimed to report the annual changes in the number of patients, mechanisms of injury, fracture patterns, and fixation methods.MethodsIn this retrospective study, we extracted data of 271 patients (mean age, 37.5 years) from the trauma register over an 8-year period. Annual records regarding the number of patients, injury mechanisms, fracture types, and treatment options were statistically analyzed to examine the interactions among these factors.ResultsThe number of patients with SFs increased significantly each year. The rate of admission to the intensive care unit after resuscitation was high (64.9%). Arbeitsgemeinschaft für Osteosynthesefragen (AO) type C pelvic ring injury (PRI), Dennis zone II injury, Roy-Camille type 2 injury, and U/H-type injury were the most common fracture types. Trans-iliac trans-sacral screws were mainly used in AO type B PRI, and their use significantly increased each year. For AO type C PRI, open reduction and internal fixation (ORIF) with rigid fixation was the main treatment, and the use of CRIF with iliosacral screws decreased each year. Stepwise statistical analysis revealed that the increase in AO type B PRI and ORIF for anterior PRI were the factors contributing to the increased use of CRIF for SFs.ConclusionsWhile the use of osteosynthesis for SFs is increasing, an increased use of CRIF for traumatic SFs has also been observed in clinical practice. This increase can be attributed to the increase in AO type B PRIs and ORIF for anterior PRIs.

Outcomes of Closed Reduction and Internal Fixation (CRIF) by Cannulated Cancellous Hip Screw in Transcervical Fracture Neck of Femur in Children

Introduction: Fracture of the neck of the femur is one of the most common and difficult problems all over the world, for all ages. As the femur is the weight-bearing bone in the lower limbs, fracture of the neck femur creates severe problems like shortening, limping, and a painful unstable hip. The incidence of pediatric neck fractures is highest in children above the age of eleven. The most common cause is high-energy trauma such as motor vehicle accidents and falls from height, also osteogenesis imperfecta, and myelomeningocele. This study aimed to analyze the outcomes of closed reduction and internal fixation (CRIF) by the cannulated cancellous hip screw in the transcervical fracture neck of the femur in children. Methods: This prospective interventional study was conducted at the National Institute of Traumatology &amp; Orthopedic Rehabilitation (NITOR), Dhaka, from July 2011 to June 2013. A total of 16 patients were selected for this study as per inclusion criteria. All statistical analysis of different variables was analyzed according to the standard statistical method by using SPSS. Result: In this study, the age of the patients ranged from 5-18 years with an average age of 11.25 years. The majority of the patients (56.25%) belonged to the age group 10-14 years, followed by 31.25% in the age group 5-9 years, and the rest 12.50% in the 15-18 years age group. Out of 16 patients, 10 patients (62.50%) were male and 06 patients (37.50%) were female. In the present study, the anatomical reduction was achieved in 07 (43.75%), the acceptable reduction was achieved in 05 (31.25%), and the unacceptable reduction in 04 (25.0%). The average time interval between injury and operation was 7.3 days, out of 16 study cases, 10 cases operated within 7 days of which 9 were united (90.0%), and 6 cases were operated after 7 days, of which 4 (66.66%) were united. Out of 16 patients, 12 (75.0%) regained full range of hip movement and 04 (25.0%) patients had limited range of motion. ...

Comparison of the results of percutaneous and open screw fixation in the treatment of scaphoid nonunion fractures.

Our study aims to compare the clinical results of percutaneous screw fixation and non-vascularized bone grafting with open screw fixation in patients who did not achieve union due to failure in diagnosis and treatment after a scaphoid fracture. Forty-three patients with scaphoid nonunion fractures corresponding to the first three Slade and Dodds classification were divided into two groups. Non-vascularized bone grafting with open reduction and internal fixation (ORIF) was applied to 24 patients in the first group, and 19 patients in the second group were treated with a closed reduction and internal fixation (CRIF) (percutaneous screw fixation). The patients were followed up for preoperative and postoperative functional scores and time to union. Our study found that the scaphoid was most commonly fractured in the waist of the scaphoid. In our study, we found that distal scaphoid fractures had the highest union rate (100%), followed by the waist fractures (93.2%) and the weakest union (50%) in the proximal pole fractures. We observed that the fastest union had occurred in the fractures of the waist. We also observed that the union was completed earlier in patients who operated with ORIF than those with CRIF. We found union in 87.5% of patients who underwent ORIF, in 84.2% of patients who underwent CRIF. CRIF operation duration was shorter than expected from ORIF operation duration. We found that similar union rates could be achieved in the patient groups who underwent percutaneous and open screw fixation by selecting the appropriate patient in scaphoid nonunion fractures. Union was faster and functional results were more satisfactory in the ORIF group. The operation time was shorter in the CRIF group.

Predictive factors for open reduction of flexion-type supracondylar fracture of humerus in children

ObjectiveThe incidence of open reduction and internal fixation (ORIF) in flexion-type supracondylar humerus fractures (SCHF) in children is significantly higher than that of extension-type fractures. This study aimed to identify risk factors for ORIF in flexion-type SCHF.MethodsOne hundred seventy-one patients with Wilkins type III flexion-type SCHF from January 2012 to December 2021 were retrospectively enrolled in a tertiary paediatric hospital. Patients were divided into ORIF group versus closed reduction and internal fixation (CRIF) group. Then, patients data of age, sex, injury side, obesity, deviation of displacement, fracture level, rotation, nerve injury, and delay from injury to surgery were reviewed. Univariate analysis and multivariate logistic regression were used to identify independent risk factors and odds ratios (OR) of ORIF.ResultsOverall, 171 children with type III flexion-type SCHF were analyzed (average aged 7.9 ± 2.8 years). Displacement was lateral in 151 cases, medial in 20. 20 cases had combined ulnar nerve injury. The failed closed reduction rate was 20%. Univariate analysis indicated age, distal fracture fragment rotation, and ulnar nerve injury were significantly associated with ORIF. (P = 0.047, P = 0.009, and P = 0.001, respectively). Multivariate logistic regression analysis showed that distal fracture fragment rotation (OR, 3.3; 95%CI:1.1–9.5; P = 0.028) and ulnar nerve injury (OR, 6.4; 95%CI:2.3–18.3; P = 0.001) were independent risk factors; however, the age was not an independent one (OR, 1.5; 95%CI:0.6–3.5; P = 0.397) for ORIF in the Wilkins type III flexion-type SCHF.ConclusionDistal fracture fragment malrotation on initial x-rays and ulnar nerve injury were significant risk factors for ORIF in Wilkins type III flexion-type SCHF. Surgeons should prepare tourniquets or other open reduction instruments when treating these types of fractures.Level of evidenceLevel IV

Outcome of Isolated PCL Tibial Avulsion Fractures Treated with Cannulated Cancellous Screw Fixation

Background: The posterior cruciate ligament (PCL) presents commonly as avulsion fractures from the tibial attachment site. Isolated tears of the PCL can be caused by a fall on the flexed knee or dashboard injury in road traffic accident. Such a mechanism (the upper tibia driven posteriorly with the knee flexed) may produce PCL disruption as the only clinically detectable instability. For the PCL avulsion fractures fixation, there are various methods available like closed reduction and internal fixation (CRIF), open reduction and internal fixation (ORIF), and arthroscopic fixation. This study was performed to assess the result of PCL avulsion fracture managed with ORIF with cannulated cancellous screw.&#x0D; Methods: We performed ORIF using cannulated cancellous screws with the posterior approach in 11 patients with isolated PCL tibial avulsion injuries. The minimum follow-up period was 6 months. The results were assessed radiologically and clinically. The spectrum of outcomes following PCL tibial avulsion fracture were measure using the Lysholm knee scoring system and range of motion (ROM) of the knee joint.&#x0D; Results: 63.6, 27.3, and 9.1 percent of the cases had excellent, good, and moderate fracture healing, respectively.&#x0D; Conclusion: PCL tibial avulsion fractures managed with open reduction with cannulated cancellous screw fixation yields good functional outcome with less complications.

Comparison of Midterm Outcomes Between the Intramedullary Fibular Nail and the Locking Plate for the Treatment of Unstable Ankle Fractures in Active Young Patients

Category:Trauma; AnkleIntroduction/Purpose:We aimed to compare the midterm radiological and clinical outcomes between closed reduction and internal fixation (CRIF) using the fibular intramedullary nail (IMN) and open reduction and internal fixation (ORIF) using plates for the treatment of unstable ankle fractures in active young patients.Methods:In this retrospective cohort study, 204 patients treated with CRIF using the fibular IMN (94 patients) or ORIF using the locking plate (110 patients) were included after at least 3 years of follow-up. The mean patient age was 41.4 years. Radiographic evaluation included the quality of reduction assessed by plain radiography and the three-dimensional (3D) reconstruction model using the CT scan images as well as the development of posttraumatic ankle osteoarthritis (PTOA) assessed by weightbearing plain radiography. Clinical evaluation included the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, Olerud and Molander score (OMAS), the Foot and Ankle Outcome Score (FAOS) and visual analog scale (VAS) pain score as well as complications.Results:In an assessment by both plain radiography and the 3D reconstruction model, the fair or poor reduction was more observed in the IMN group than in the ORIF group at final follow-up (P <.001). Poor reduction in the IMN group was significantly related to Weber type C, pronation type injury, and comminuted fibular and trimalleolar fractures (P <.001). PTOA was observed in 21.3% in the IMN group compared to 9.1% in the ORIF group (P =.024). There were no significant differences in clinical outcomes between the 2 groups. There were significantly fewer postoperative complications in the IMN group than in the ORIF group (9.5% vs 39%, P <.001).Conclusion:Surgeons should consider ORIF for unstable ankle fractures in active young patients with Weber type C, pronation type injury, and comminuted fibular and trimalleolar fractures.

Displaced femoral neck fracture in a pregnant patient diagnosed with transient osteoporosis of the hip.

Transient osteoporosis of pregnancy (TOP) is a self-limiting pathology with unspecified etiology. It is typically found in women in late pregnancy or early postpartum. A femoral neck fracture is an infrequent complication. Herein, we describe a TOP case in a 38-year-old female who suffered a displaced sub-capital femoral neck fracture without obvious trauma at 28weeks of gestation. The patient underwent operative treatment using closed reduction and internal fixation (CRIF), using cannulated screws, with no intraoperative complications. The postoperative radiograph revealed a collapse and further displacement of the femoral neck. A decision was made to postpone a definitive treatment to a postpartum date. The patient underwent a cesarean section at 38-week of gestation with no complications. At her latest follow-up, 24months postoperatively, the patient was asymptomatic. Pelvic and hip radiographs demonstrated consolidation of the fracture. Level of evidence: IV.