Closed Reduction Internal Fixation Research Articles

Displaced intra-articular calcaneal fractures treated with Calcanail® and additional screw fixation of the thalamic surface through lateral subtalar arthroscopy

The treatment of displaced intra-articular calcaneal fractures is not standardized, as many surgeons prefer not to perform surgery, considering a high rate of cutaneous complications associated with the usual extensile lateral approach. The Calcanail® represents a percutaneous osteosynthesis device that is biomechanically more stable than multiple screws or locking plates. While it effectively restores the height and axis of the hindfoot, it appears to be less reliable in achieving articular reduction of the thalamic surface in cases of mixed fractures. Therefore, we developed a new technique suitable for comminuted mixed fractures, using the Calcanail® device with an arthroscopically guided closed reduction internal fixation of the thalamic surface.

Association between surgical delays for femoral neck fractures and early postoperative complications in young and middle-aged adults: A study based on the national inpatient sample database

BackgroundFemoral neck fractures (FNF) in young and middle-aged adults are primarily caused by high-energy injuries in traffic accidents. Surgical delays often occur due to transportation issues, preoperative evaluations, and economic burdens. MethodsA retrospective analysis was conducted on young and middle-aged FNF patients undergoing reduction and internal fixation surgeries from 2010 to 2019 with the use of the National Inpatient Sample database. Logistic regression analysis was used to assess the relationship between surgical delays and complications, and the independent risk factors contributing to delays. Categorical variables were investigated via a chi-square test, while continuous variables including Elixhauser Comorbidity Index (ECI) scores, length of hospital stay (LOS), and total medical costs were analyzed via t-test or rank-sum test. Results9,204 patients undergoing reduction and internal fixation surgeries were included. In the delayed group, patients had higher ECI scores, longer hospital stays, higher expenses, and increased inpatient mortality (1.61% vs. 0.28 %, P < 0.0001). Longer surgical delays were associated with higher risks of complications, including femoral head osteonecrosis, internal fixation loosening and breakage, and respiratory complications. Fluid and electrolyte disorders, metastatic cancer, pulmonary circulation disorders, and renal failure were identified as independent risk factors for surgical delays. Except for anemia (OR=2.37, P < 0.0001), no significant differences in early postoperative complications were found between open-reduction and closed-reduction internal fixation (ORIF/CRIF) surgeries. ConclusionEarly surgical intervention, within a 2-days period after injury, seems to be crucial for young adults with FNF. If CRIF is challenging in some cases, ORIF can be another choice.

Clinical study on the incidence of femoral head posterior tilt angle in non-displaced femoral neck fractures

To investigate the occurrence of posterior femoral head tilt after clinical non-displaced femoral neck fracture, and to provide a reference basis for clinical surgery and improvement of disease prognosis. Total of 165 patients with non-displaced femoral neck fractures of Garden typeⅠandⅡfrom January 2018 to June 2022 were selected as study subjects including 48 males and 117 females, with an average age of (71.5±8.5) years old ranging from 53 to 89, involving 97 cases of typeⅠand 68 of typeⅡ. On the patient's preoperative sagittal or axial CT film of the hip, the angle formed by the radius line of the femoral head and the midline of the femoral neck was used as the posterior tilt angle of the femoral head (α), and the posterior tilt femoral head angle was measured using the method proposed by Palm. The measured data were divided into 6 groups:α<0°, 0°<α< 5°, 5°≤α<10°, 10°≤α<15°, 15°≤α<20°, α≥20°, and the incidence of different ranges of posterior tilt angle was compared. The sex composition ratio of 165 patients were analyzed and compared, and the age of 65 was used as the cut-off point to compare the incidence of fractures between genders. Patients were divided into the posterior tilt <20° group for 135 cases and the posterior tilt ≥20°group for 30 cases according to the preoperative posterior tilt angle, the differences between two groups in terms of gender and age were analyzed. Among 165 patients with non-displaced femoral neck fractures, 143 cases with poaterior tilt of the femoral head occurred with an incidence of 86.7%. Posterior tilt 0°<α<5° accounted for 36 cases with an incidence of 21.8%;5°≤α<10° accounted for 40 cases with an incidence of 24.2%;10°≤α<15° accounted for 27 cases with an incidence of 16.4%;15°≤α<20° accounted for 10 cases with an incidence of 6.1%;posterior tilt angle α≥20° accounted for 30 cases, the incidence was 18.2%, of which the maximum posterior tilt angle was 42.7°. Statistical analysis showed that the percentage of fractures in the 165 patients selected for this study was significantly higher in female than in male, and that the female group was more likely to have fractures before the age of 65 years compared to the male group. However, gender, age and fracture subtypes (GardenⅠ, Ⅱ) were not influential factors for femoral neck fractures with a preoperative posterior femoral head tilt angle >20°(P>0.05). The incidence of femoral head posterior tile in non-displaced femoral neck fractures is relatively high, in which severe posterior tile occurs, and the femoral head posterior tile angle≥20° can reach 18.2%. In patients with closed reduction internal fixation, the fracture end needs to be repositioned as much as possible to reduce the risk of postoperative avascular necrosis of the femoral head. In order to prevent femoral neck fractures, special attention should be paid to anti-osteoporosis treatment for female. Preoperative assessment of posterior tilt is critical for patients of different ages, genders and fracture subtypes (GardenⅠ, Ⅱ).

Biomechanical study of a biplanar double support screw (BDSF) technique based on Pauwels angle in femoral neck fractures: finite element analysis.

The objective of the present study is to conduct a comparative analysis of the biomechanical advantages and disadvantages associated with a biplanar double support screw (BDSF) internal fixation device. Two distinct femoral neck fracture models, one with a 30° angle and the other with a 70° angle, were created using a verified and effective finite element model. Accordingly, a total of eight groups of finite element models were utilized, each implanted with different configurations of fixation devices, including distal screw 150° BDSF, distal screw 165° BDSF, 3 CLS arranged in an inverted triangle configuration, and 4 CLS arranged in a "α" configuration. Subsequently, the displacement and distribution of Von Mises stress (VMS) in the femur and internal fixation device were assessed in each fracture group under an axial load of 2100N. At Pauwels 30° Angle, the femur with a 150°-BDSF orientation exhibited a maximum displacement of 3.17mm, while the femur with a 165°-BDSF orientation displayed a maximum displacement of 3.13mm. When compared with the femoral neck fracture model characterized by a Pauwels Angle of 70°, the shear force observed in the 70° model was significantly higher than that in the 30° model. Conversely, the stability of the 30° model was significantly superior to that of the 70° model. Furthermore, in the 70° model, the BDSF group exhibited a maximum femur displacement that was lower than both the 3CCS (3.46mm) and 4CCS (3.43mm) thresholds. The biomechanical properties of the BDSF internal fixation device are superior to the other two hollow screw internal fixation devices. Correspondingly, superior biomechanical outcomes can be achieved through the implementation of distal screw insertion at an angle of 165°. Thus, the BDSF internal fixation technique can be considered as a viable closed reduction internal fixation technique for managing femoral neck fractures at varying Pauwels angles.

A Comparative Analysis of Locking Plate versus Intramedullary Nail for Humerus Shaft Fractures

Introduction: Humerus shaft fractures pose a significant challenge in Orthopaedic practice, with various treatment approaches available, including surgical methods like conservative management, Plating and Nailing. The choice between these methods remains debatable, necessitating further comparative studies. Methods: This study compared Open Reduction Internal Fixation (ORIF) with Locking Compression Plates and Closed Reduction Internal Fixation (CRIF) with Intramedullary Interlocking nails for Humerus shaft fractures. Patients were categorized into two groups based on the intervention received. Perioperative parameters, radiological outcomes, and complications were assessed. Results: Baseline demographics were comparable between the two groups. The Plating Group had longer surgery duration and higher blood loss compared to the Nailing Group. Both groups had similar rates of union and non-union, with no significant difference in shoulder function and pain outcomes at one year post-operation. Discussion: Functional outcomes post-union remain acceptable despite notable deformities, suggesting the viability of conservative treatments. While ORIF with plating has been conventional, concerns over blood loss and nerve injury have led to exploration of CRIF with intramedullary nails. This study, consistent with previous findings, found no significant disparity in outcomes between the two methods, emphasizing the need for personalized treatment decisions. In conclusion, this study adds to the understanding of Humerus shaft fracture management, highlighting the need for individualized treatment decisions and further research in this field.

Trends in the surgical management of proximal humerus fractures in Ireland from 2009 to 2022: An increasing usage of reverse shoulder arthroplasty.

Proximal humeral fractures are a common injury accounting for a significant workload across orthopaedic departments. Though often managed non-operatively, surgical management is indicated for a proportion of patients. The aim of this study is to examine the trends in the management of proximal humeral fractures within Ireland over the past 13years. A retrospective review of Irish Hospital In-Patient Enquiry (HIPE) data was performed between January 2009 and December 2022. Information regarding demographics including age and gender, along with procedure type were collated after patients with proximal humerus fractures, were identified using relevant ICD 10 codes. Demographic details remained stable with females and those within the 55-69year age bracket accounting for the highest proportion of patients. The mean annual number of procedures performed across the study period was 365 (273-508), with an increase from 288 cases in 2009 to 441 in 2022. Open reduction and internal fixation were the most common procedures accounting for 76.4% of cases. There has been a rising usage of total shoulder arthroplasty for fixation with an increase from < 5 cases in 2016 to 84 in 2022. A decrease in the usage of hemiarthroplasty and closed reduction internal fixation was also observed. There has been an increasing volume of operatively managed proximal humeral fractures in Ireland, which sustained despite the 2015 publication of the highly publicised PROPHER trial. The increasing utilisation of total shoulder arthroplasty in acute trauma management is notable and necessitates appropriate training for trauma theatre personnel.

Correlation between Inflammatory Systemic Biomarkers and Surgical Trauma in Elderly Patients with Hip Fractures.

The treatment for hip fractures consists of a wide variety of orthopedic implants ranging from prosthesis to intramedullary nails. The purpose of this study is to determine the correlation between blood-count-derived biomarkers such as the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the monocyte-to-lymphocyte ratio (MLR) and the systemic immune-inflammation index (SII) and the level of aggression sustained by elderly patients during these surgical procedures. A total of 129 patients aged over 70 and diagnosed with acute hip fractures who underwent surgical treatment between November 2021 and February 2023 were included in our observational retrospective cohort study. Two groups were formed depending on the anatomic location of the fracture for statistical comparison: group 1 with extracapsular fractures, who received a closed reduction internal fixation (CRIF) with a gamma nail (GN) as treatment, and group 2 with intracapsular fractures, who received a bipolar hemiarthroplasty (BHA) as treatment. The length of hospital stay (LHS), duration of surgery, preoperative days, pre- and postoperative red blood count (RBC) and hemoglobin (HGB) levels and postoperative NLR, PLR and SII were significantly different between the two groups (p < 0.05). Furthermore, the multivariate analysis indicated that the postoperative NLR (p = 0.029), PLR (p = 0.009), SII (p = 0.001) and duration of surgery (p < 0.0001) were independently related to the invasiveness of the procedures. The ROC curve analysis demonstrated that a postoperative SII > 1564.74 is a more reliable predictor of surgical trauma in terms of specificity (58.1%) and sensitivity (56.7%). Postoperative SII as a biomarker appears to be closely correlated with surgical trauma sustained by an older population with hip fractures.

Functional Outcome after Close Reduction Internal Fixation with K Wire of Type III Supracondylar Fracture Humerus in Children under C-Arm

Functional Outcome after Close Reduction Internal Fixation with K Wire of Type III Supracondylar Fracture Humerus in Children under C-Arm

Open versus closed reduction internal fixation for lateral condyle humeral fractures in children: a systematic review and meta-analysis

ObjectiveThe objective of this meta-analysis was to illustrate the clinical outcomes and safety of two different management options for Song stage 2–4 lateral condyle humeral fractures in children.MethodIn January 2023, a systematic computer-based search was conducted. Data were retrieved for patients with two different management options for lateral condyle humeral fractures in children. The primary endpoints were clinical outcomes based on infection, avascular necrosis, and nonunion. After testing for publication bias and heterogeneity between studies, the data was aggregated for stochastic effect models when necessary.ResultsEight clinical studies with 742 patients were eventually included in the meta-analysis. There was no significant difference between the closed reduction and percutaneous pinning, and open reduction and internal fixation in terms of the clinical outcomes based on infection, avascular necrosis, and nonunion (P > 0.05).ConclusionsClosed reduction and percutaneous pinning, as well as open reduction and internal fixation of lateral condyle humeral fractures in children, resulted in similar structural stability and functional outcomes. More high-quality randomized controlled trials are needed to determine this conclusion.

Comparative Study Between Closed Reduction Internal Fixation Alone Versus Closed Reduction Internal Fixation and Addition of Muscle Pedicle Bone Graft for Prevention of Osteonecrosis in Cases of Displaced Femoral Neck Fractures.

In patients of less than 60years of age, osteosynthesis is the treatment of choice for displaced femoral neck fractures (Garden 3 and 4). Most of these fractures unite well but chances of osteonecrosis are quite high even after early operations and till date there is no well-defined method of prediction and prevention of osteonecrosis. Vascularized bone graft may prevent the development of osteonecrosis. This is a retrospective case control study done in an urban Medical College in eastern India and tried to evaluate efficacy of addition of quadratus femoris muscle pedicle bone graft in cases of osteosynthesis comparing the results of cases treated with closed reduction and internal fixation alone for femoral neck fractures We have taken into consideration 45 consecutive cases from each group with identical demographic background and of very similar age pattern of 20years to 60years.For further reference, we will describe Group I for closed reduction and CHS/DHS only, and Group II for closed reduction CHS and quadratus femoris muscle pedicle graft. Satisfactory bony union occurred in 42 out of 45 follow-up patients in Group 1 (93.3%) and 43 out of 45 patients in Group 2. (95.5%) In 2- to 10-year follow-up period, eight patients (18.6%) developed osteonecrosis in Group I, and in Group 2, in the same period, there were no cases of osteonecrosis. Addition of quadratus femoris muscle pedicle bone graft is a very effective procedure for prevention of osteonecrosis when we attempt osteosynthesis by closed reduction and internal fixation for displaced femoral neck fractures.

Does the Treatment Approach for Mandibular Condyle Fractures Impact Self-Perceived Quality of Life?

There is no consensus in mandibular condylar fracture/s treatment. In medicine, quality of life (QOL) includes the individual's satisfaction toward their own health condition, disease, or treatment. The purpose of this study was to investigate self-perception QOL outcomes for patients who sustained mandibular condylar fracture/s. This cross-sectional study surveyed patients at Grady Memorial Hospital in Atlanta, Georgia from November 2016 to June 2020. The study included patients who were at least 16years old at the time of injury, diagnosed with mandibular condylar fracture/s, treated by close reduction or open reduction and internal fixation (ORIF), presented for 6-months post-operative follow-up, and had a valid phone number. The primary predictor variable was treatment approach. The primary outcome variable was mood. Covariates were demographics, injury details, and self-perception QOL questionnaire. Univariate, bivariate, and ordinal regression analysis were performed (P<.05 significance). A total of 108 patients met inclusion criteria. Response rate was 84.2%. Our data showed that patients who underwent ORIF treatment were statistically more likely to experience no or milder pain when chewing (tau=0.390, P=.002), to not require pain medications (tau=0.389, P=.002), to report larger maximum mouth opening (tau=0.402, P=.0003), and to report better QOL (tau=0.440, P=7.407e-05). Ordinal regression analysis showed that patients who had undergone ORIF treatment were positively associated with better mood (estimate: -0.062; OR: 0.54; P=.29) and statistically significant associated with excellent QOL (estimate: -2; OR: 0.13; P=3.99e-05). Patients who sustained class III Lindahl mandibular condyle fracture were statistically significantly associated with depressed mood (estimate: 1.46; OR: 4.33; P=.002). ORIF treatment was positively associated with better QOL when compared to closed reduction for mandibular condyle fracture.

Clinical outcomes of titanium elastic nailing system for middle third clavicular fracture

Aim: Clinical outcome of displaced middle third clavicular fracture using intramedullary fixation by titanium elastic nail. Materials and Methods: 20 cases of displaced middle third clavicular fracture underwent closed reduction internal fixation with Intra medullary fixation by titanium elastic nail. The study was conducted from July 2020 to August 2022 admitted to Narayana Medical College and hospital, Nellore. We evaluated the Constant score to determine the outcomes.Results: All fractures got united in our study. Average time taken for full clinical and radiological union was 11.8 weeks (Range 10- 14 weeks).There were no major complications noted. Average Constant Score at final follow up was 95.16.Conclusion: Minimally invasive fixation with TENS is a safe method and can be performed with minimal complications. This method of fixation of displaced middle third clavicular fractures should result in less soft tissue injury, shorter operating time, satisfactory stabilization, a good cosmetic appearance, quick pain relief, early return to work and easy implant removal under local anaesthesia as an outpatient department procedure.

Outcome assessment of management of fractures of the radius and ulna in adults using two different techniques

Aim: To determine relationship between subjective, objective and radiographic outcome of two different method of treatment of fracture radius and ulna. Material &amp; Methods: The present comparative study was carried out among 30 patients in the department of Orthopaedic, Indira Gandhi Institute of Medical Science, Patna, Bihar, India, for the period of 4 years after taking the informed consent and ethical approval from the concerned ethics committee. Complete information was available for 30 patients who had sustained mid-shaft fractures of radius and ulna. Data collection and radiographic findings were standardized for all 30 patients. All 30 patients were followed for 24 months. Results: In the present study 80 percent of patients reported no pain. The union occurred in 90 percent of radius fractures and 93 percent of ulna fractures. An average time for union was 17.14 weeks for the radius and 18.2 weeks for ulna. Conclusion: Outcome of open reduction internal fixation (ORIF) with plates and screws were better than close reduction internal fixation (CRIF) with IM nail, as former minimizes malalignment and resulting loss of forearm rotation. The interpretation of radiological finding was associated with radiological alignment and functional outcomes.

A prospective study to find the functional outcome of displaced radial neck fracture among children treated with closed reduction internal fixation with intramedullary nailing

Background: Radial neck fracture among children is very common. If fractures not treated early it further leads to malunion. Number of times such malunion are irreversible and may lead to disability for lifetime. The most important set of problems that can happen in this fracture involves the blood supply to the radial head. The radial head is supplied by periosteal vessels in the neck. As a result, any trauma to the proximal end of the radius (with or without a fracture) will produce an aseptic necrosis of the radial neck and head of varying severity. This can precipitate a slight shortening of the proximal end of the radius with a propensity toward slight valgus deviation of the elbow axis. However, the concurrent widening and thickening of the radial head and neck are more significant; in extreme cases, this can restrict pronation and supination. One of the recent advances in treatment of distal radius fractures is the more frequent application of open reduction and internal fixation, especially for intra-articular fractures and other one is treated with treated with closed reduction internal fixation with intramedullary nailing.

A Comparative Study of Management of Colles Fracture by Closed Reduction with Cast versus Closed Reduction with Internal Fixation

Background: In this study we did a prospective study in 40 patients with extra articular distal radius fracture treated by both closed reduction with cast and closed reduction internal fixation (PKW/CC screws).&#x0D; Methods: There were 30 patients with Colles fractures treated by closed reduction with cast and 30 patients treated with closed reduction internal fixation (PKW/CC screws). We compared both the managements together. The functional outcomes and radiological results were compared between the two groups.&#x0D; Results: Functionally, for CRIF 11 patients had excellent hand function; 4 patients had good results; 11patients had a fair outcome, and 4 patients had poor outcome. Functionally, for cast immobilization patients 13 patients had poor outcome, 10 patients had fair outcome, 4 patients had good outcome and 3 patients had excellent outcome.&#x0D; Conclusions: The percutaneous pinning/cc screws and immobilization in neutral position for 3 weeks followed by physiotherapy proved to be better and simple procedure for extra articular non comminuted distal radius fractures.&#x0D; Keywords: Fracture radius distal 1/3rd, Cast, Pinning, CC screws, Immobilization

Red cell distribution width–A mortality predictor in older adults with proximal femoral fracture

Background: Identifying elderly patients with proximal femoral fractures (PFF) who are at risk of postoperative mortality may influence the treatment decision-making process. The purpose of this study was to examine whether red blood cell distribution width (RDW) can serve as a predictor of postoperative mortality in these patients. Methods: A retrospective cohort study of electronic medical records at a single tertiary care hospital over a 3-year period between 2015 and 2018. We reviewed the records of 1574 patients aged > 65 years who underwent surgical treatment for PFF and who's preoperative RDW levels were available. Data collected consisted of patient demographics, underlying illnesses at the time of admission, type of procedure performed as well as postoperative mortality and complications over the course of a 1-year follow-up period. The cohort was then divided into two groups based on their RDW levels at the time of admission: low (<14.5%) and high (>14.5%). Results: The mean age was 90.77±1.87 years; 68.7% were women. Majority of patients (69.1%) underwent closed reduction internal fixation; 414 (26.4%) underwent hemiarthroplasty, and 71 (4.5%) had total hip arthroplasty. At admission, 576 patients (36.6%) had high RDW levels and 998 (63.4%) had low RDW levels. There were no statistically significant differences between the groups with regard to age, gender, type of surgery, or duration. Patients with high RDW had more co-morbidities (p<0.001) and more abnormal laboratory test results when compared to patients with low RDW. Overall mortality rate within 1-year post-surgery was 17.5% (276 patients). All-cause mortality was greater for patients with high baseline RDW, at 3 months (p = 0.001), 6 months (p<0.0001), and 1-year post-surgery (p<0.0001). Forty-four (2.8%) patients had surgical site infection (SSI) without any significant association to baseline RDW levels. Conclusions: Preoperative RDW levels, when combined with clinical and laboratory findings, may help to improve the risk stratification of older patients who are candidates for PFF. With further research, a treatment algorithm could be developed to potentially identify patients at high risk of preoperative mortality, allowing for more conservative management.

A clinical study of functional outcome of unstable intertrochanteric fractures treated with proximal femur nail anti rotation system II

Introduction: Unstable, Comminuted intertrochanteric fractures continue to pose a challenge to the orthopaedic surgeon because of severe osteoporosis and medical disorders that increase the risks associated with surgery and anaesthesia. To overcome problems like lateral wall impingement and prominence of the proximal end of the nail, the PFNA-II was introduced in 2008. The PFNA II design modifications include the flat lateral shape of the proximal portion and a decrease in the mediolateral bending angle from 60 to 50. The purpose of the study is to confirm that the PFNA II eliminates the problem of lateral wall impingement experienced with previous intramedullary nailing systems and provides stable fracture fixation with positive functional outcome.Materials and methods: This study was conducted on 52 patient of which 32 were available till follow up of 6 months. All patients we were diagnosed with unstable intertrochanteric fracture of femur and underwent closed reduction internal fixation with proximal femoral nail anti-rotation system II. Functional outcome was assessed with Modified Haris Hip Score and radiological outcome was assessed with TAD score and implant related complications. Results: Fracture union was appreciated on an average 4 months of postoperative period. 4 patient had superficial infection while 1 patient had deep infection. Only 1 patient had cut off of helical blade. According to modified Harris hip score, excellent to good outcome was noted in more than 80% of patient. Conclusion: From our study, we conclude that PFNA II can be a reliable and implant of choice for the management of unstable intertrochanteric fracture with high rates of union, restoring the anatomical alignment with less chances of implant failure and reduced chance of implant failure.

Biomechanical analysis of the closed reduction internal fixation with cannulated screw of femoral neck fractures.

The influencing factors in closed reduction internal fixation with cannulated screw of femoral neck fractures have not been well investigated. This study evaluated these factors in patients with femoral neck fractures.Fifty-seven patients (36 males and 21 females) diagnosed with femoral neck fracture with the average age of 52.44 ± 15.04 years who underwent closed reduction internal fixation with cannulated screw were included in this study. Data were collected through case report reviews, phone call follow-ups, and outpatient follow-ups to evaluate pre- and postoperative radiograph images. Statistical analysis was performed using Garden classification, binary and multinomial logistic regression analysis by including factors such as patient's age, gender, fracture type, time to fixation, reduction quality, functional recovery period, removal of cannulated screw, and preoperative traction. Logistic regression analysis revealed that age and reduction quality was statistically significant (P < .05) to clinical outcome and other factors were not statistically significant.The main factors affecting clinical outcomes were functional recovery and reduction quality. The biomechanical effects of fixation provide a good foundation for fracture healing. Patient's conditions should be carefully evaluated before selecting reduction procedures to reach an optimal surgical outcome.

Adolescent Tillaux Fractures: A Systematic Review of the Literature.

The Tillaux fracture is an uncommon injury to the anterolateral distal tibial epiphysis. It occurs during a distinct time period when adolescent patients are transitioning to skeletal maturity. Owing to its rarity, the optimal management strategy for this fracture is not well-described. The aim of this review was to assess the outcomes of operatively and nonoperatively managed displaced adolescent Tillaux fractures. We analysed articles from The Cochrane Library, PubMed, MEDLINE, and EMBASE databases that met our predetermined inclusion and exclusion criteria according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statements. A descriptive data analysis was performed. A total of 461 articles were identified from the data search, of which 13 articles were included for full-text analysis. Five of these studies reported recognised patient outcome measures and the remaining eight reported on radiographic follow-up. The reported studies included a total of 114 patients with Tillaux fractures; 58.8% of patients were female and 34.2% were male. Mean ages ranged from 12.5 to 15 years, with the youngest patient being 12 years old and the oldest 17 years old. Overall mean follow-up was 42.8 months. Of the patients, 40.4% were treated with open reduction internal fixation (ORIF), 14.9% with closed reduction internal fixation (CRIF), and 1.8% arthroscopically. The remainder were treated nonoperatively. Outcome measures were excellent for all patients irrespective of operative management choice. Follow-up radiographic deformity was only evident in Tillaux fractures that were managed nonoperatively; deformity included poor joint congruity, angular deformity, and tibial shortening. These nonoperative patients have a residual fracture displacement of 2 mm. There were no reported instances of premature physeal closure for any patient. This review shows that excellent patient outcomes have been reported for different methods of operative fixation, however, study sizes are small and data is sparse. Further robust comparative studies are required to identify definitive conclusions. The use of established clinical and radiographic outcome measures will help improve the quality of future studies for this relatively rare injury.

Comparative study between close reduction internal fixation and open reduction internal fixation in lower fibula with medial mallolus fracture

Comparative study between close reduction internal fixation and open reduction internal fixation in lower fibula with medial mallolus fracture - IJOS- Print ISSN No: - 2395-1354 Online ISSN No:- 2395-1362 Article DOI No:- 10.18231/j.ijos.2020.055, Indian Journal of Orthopaedics Surgery-Indian J Orthop Surg