Close Reduction Research Articles

The Impact of the Position of the Humeral Head Relative to the Glenoid on Iatrogenic Fractures During Shoulder Dislocation Reduction

Background and Objectives: The aim of this study was to investigate the relationship between the position of the humeral head relative to the glenoid and the occurrence of iatrogenic surgical neck fractures of the humerus during anterior glenohumeral dislocation reductions. Materials and Methods: Patients with first-time anterior shoulder dislocations without generalized joint hyperlaxity were included. The humeral head displacement ratio was calculated as the distance between the medial border of the humeral head and the anterior glenoid rim divided by the diameter of the humeral head. Demographic data, concomitant tuberculum majus fractures, and the deltoid tuberosity index were recorded. Patients were divided into three groups: Group 1 (iatrogenic fracture development during closed reduction (CR)), Group 2 (failed CR), and Group 3 (successful reduction without iatrogenic fracture). Complicated dislocations were included in Groups 1 and 2, while uncomplicated dislocations were those in Group 3. Results: The study included 89 patients with a mean age of 46.44 ± 19.02 years (64 males, 25 females). Concomitant tuberculum majus fractures occurred in 37 (41.6%) cases. Iatrogenic surgical neck fractures occurred in 10 patients (Group 1), and CR was unsuccessful in 8 patients (Group 2), totaling 18 cases of complicated dislocations. Reduction without iatrogenic fracture was achieved in 71 cases (Group 3). The mean humeral head displacement ratio was higher in the complex dislocation group (92.91 ± 15.34 vs. 75.01 ± 13.80; p < 0.001). Complicated dislocations were more frequent in patients with tuberculum majus fractures (p = 0.031). Subgroup analysis showed higher humeral head displacement ratios in Groups 1 and 2 compared to Group 3 (p = 0.010 and p = 0.06, respectively). Tuberculum majus fractures were more frequent in Group 1 compared to Group 3 (p = 0.013), with no significant difference between Groups 2 and 3. Conclusions: In patients experiencing first-time traumatic anterior shoulder dislocations, a greater medial displacement of the humeral head relative to the glenoid rim significantly increases the risk of iatrogenic humeral fractures and the likelihood of unsuccessful closed reduction attempts.

Delayed fixation of distal radial fractures beyond three weeks after initial failed closed reduction increases the odds of reoperation.

We aimed to compare reoperations following distal radial fractures (DRFs) managed with early fixation versus delayed fixation following initial closed reduction (CR). We used administrative databases in Ontario, Canada, to identify DRF patients aged 18 years or older from 2003 to 2016. We used procedural and fee codes within 30 days to determine which patients underwent early fixation (≤ seven days) or delayed fixation following CR. We grouped patients in the delayed group by their time to definitive fixation (eight to 14 days, 15 to 21 days, and 22 to 30 days). We used intervention and diagnostic codes to identify reoperations within two years. We used multivariable regression to compare the association between early versus delayed fixation and reoperation for all patients and stratified by age (18 to 60 years and > 60 years). We identified 14,960 DRF patients, 8,339 (55.7%) of whom underwent early surgical fixation (mean 2.9 days (SD 1.8)). In contrast, 4,042 patients (27.0%) underwent delayed fixation between eight and 14 days (mean 10.2 days (SD 2.2)), 1,892 (12.7%) between 14 and 21 days (mean 17.5 days (SD 1.9)) and 687 (4.6%) > 21 days (mean 24.8 days (SD 2.4)) post-fracture. Patients who underwent delayed fixation > 21 days post-fracture had a higher odds of reoperation (odds ratio (OR) 1.33 (95% CI 1.11 to 1.79) vs early fixation). This worsened for patients aged > 60 years (OR 1.69 (95% CI 1.11 to 2.79)). We found no difference in the odds of reoperation for patients who underwent delayed fixation within eight to 14 or 15 to 21 days post-fracture (vs early fixation). These data suggest that DRF patients with fractures with unacceptable reduction following CR should be managed within three weeks to avoid detrimental outcomes. Prospective studies are required to confirm these findings.

Comparison of treatment methods in patients with developmental dysplasia of the hip.

This study aimed to compare the results of Pemberton osteotomy (PO), Salter innominate osteotomy (SO), open reduction (OR), and closed reduction (CR) applied in the treatment of developmental dysplasia of the hip (DDH). Included in the study were 101 hips of 82 patients treated at our orthopedic clinic between 2017 and 2023. The patients were evaluated preoperatively, postoperatively, and at the final follow-up. The results were evaluated based on Barret's clinical and Severin's radiological classifications. Those who developed avascular necrosis (AVN) were evaluated based on Bucholz-Ogden's classification. In terms of the preoperative acetabular angles (AAs), those for hips treated with PO were significantly higher than those of the other three, and those treated with SO were significantly higher than those of the other two (OR and CR) (p < 0.001). There was a significant difference in the final follow-up AAs of those treated with SO and PO compared to those treated with OR and CR (p < 0.001). The best corrections were achieved with PO (average: 27.94 ± 4.89°). There was a significant difference between PO and OR, and PO and CR in terms of the preoperative collodiaphyseal angles (CDAs) (p < 0.05). The greatest decrease was in those treated with PO (average: 22.44 ± 9.45°). AVN developed at various stages in 15 of 79 hips (14.85%) that were treated surgically. While AVN developed at a rate of 22.22% with PO, 18.18% with SO, and 17.85% with OR, no AVN developed in the 22 hips treated with CR. Understanding normal and abnormal values by age is essential for selecting appropriate treatments. Acetabulum-related surgeries should be planned for patients over 1.5 years of age with an AA above 30°. Early diagnosis and CR treatments yield excellent results and low AVN rates. Various DDH treatments in our clinic have shown low AVN rates, indicating safety and efficacy.

Does More Invasive Surgery Result in Higher Patient Satisfaction? A Long-Term Follow-Up of 136 Zygomaticomaxillary Complex Fractures.

Retrospective with follow-up. To evaluate the long-term satisfaction of surgically treated patients with zygomaticomaxillary complex (ZMC) fractures in relation to the use of internal fixation, number of fixation points, and orbital floor (OF) reconstruction. Secondary objectives were to describe the use of antibiotics and post-operative infections. Patients with unilateral ZMC fractures between 2007-2018 and treatment with either open reduction and internal fixation (ORIF) or closed reduction (CR) were identified from medical records and invited to follow-ups between 2018-2020. Patients were examined, photographed, and completed a questionnaire. A review panel of 3 experienced surgeons evaluated photographs and computed tomography (CT) scans pre- and post-surgery. The study sample consisted of 136 patients (108 ORIF, 28 CR) with a median follow-up time of 76 months. Patient satisfaction of surgical outcome was high (97.8%), with no significant differences in relation to the use of internal fixation, number of fixation points, or OF reconstruction. Dissatisfaction was primarily related to hypoesthesia. On post-operative CT scans, malar asymmetry was more often predicted in patients with 1-point fixations. On questionnaires and photographs, malar asymmetry was more common in patients with 3-point fixations. Prophylactic antibiotics had no effect on the rate of post-operative infections. Patient satisfaction was not influenced by internal fixation, number of fixation points, or OF reconstruction. Selected ZMC fractures can be treated with less invasive approaches. Caution should be observed when predicting long-term malar asymmetry on post-operative CT scans. The findings of this study highlight the importance of a rational and ethical use of surgery.

Association between ossific nucleus volume changes and postoperative avascular necrosis risk in children with developmental dysplasia of the hip

This study aimed to investigate the correlation between ossific nucleus volume and avascular necrosis (AVN) in pediatric patients diagnosed with developmental dysplasia of the hip (DDH). Analyzing 211 cases, including 119 open reduction (OR) and 92 closed reduction (CR) procedures, we quantified ossific nucleus volume using magnetic resonance imaging (MRI). Categorizing the OR group based on ossific nucleus volume revealed no statistically significant difference in AVN incidence. Similarly, in the CR cohort, there was no significant discrepancy in AVN occurrence between subgroups with or without the ossific nucleus. Logistic regression in CR identified the international hip dysplasia institute (IHDI) grade as a significant AVN risk factor (p = 0.007). IHDI grades 3 and 4 exhibited a 6.94 times higher likelihood of AVN compared to grades 1 and 2. Across CR and OR, neither initial age nor ossific nucleus volume emerged as AVN risk factors. In conclusion, ossific nucleus volume does not pose a risk for AVN in DDH children undergoing CR or OR, emphasizing the clinical significance of IHDI grading in predicting AVN risk during CR and the importance of early intervention to prevent treatment delays.

Sensitivity Analysis of C. auris, S. cerevisiae, and C. cladosporioides by Irradiation with Far-UVC, UVC, and UVB.

The World Health Organization has published a list of pathogenic fungi with prior-itizing groups and calls for research and development of antifungal measures, with Candida auris belonging to the group with high priority. The photosensitivity towards short wavelength ultraviolet irradiation (Far-UVC, UVC, and UVB) was investigated and compared to other yeasts (Saccharomyces cerevisiae) and a mold (Cladosporium cladosporioides). The observed 1-log reduction doses were compared to literature values of other representatives of the genus Candida, but also with S. cerevisiae, Aspergillus niger, and A. fumigatus. For the determined 1-log reduction doses, an increase with higher wavelengths was observed. A 1-log reduction dose of 4.3 mJ/cm2 was determined for C. auris when irradiated at 222 nm, a dose of 6.1 mJ/cm2 at 254 nm and a 1-log reduction dose of 51.3 mJ/cm2 was required when irradiated with UVB. It was observed that S. cerevisiae is a possible surrogate for C. auris for irradiation with Far-UVC and UVB due to close 1-log reduction doses. No surrogate suitability was verified for C. cladosporioides in relation to A. niger and A. fumigatus for irradiation with a wavelength of 254 nm and for A. niger at 222 nm.

An Outcome Study of DERFs Managed by Close Reduction &amp; Immobilization Vs Close Reduction by Intra Focal Pinning (Kapandji Technique)

An Outcome Study of DERFs Managed by Close Reduction &amp; Immobilization Vs Close Reduction by Intra Focal Pinning (Kapandji Technique)

Outcome of primary fixation of traumatic acetabular fractures

Objectives; Traumatic acetabular fracture is a major injury with high association of mortality, morbidity and long recovery period. Surgical management of acetabular fracture is a technical challenge needing high level of skills and vigilance because of the complex anatomy and risk to surrounding structures. We aim to look at two surgical techniques for fixation of acetabular fracture and their outcome in this study. Methods; Between April 2018 and March 2023, a total of 26 patients (15 males and 11 females) were treated for acetabular fracture fixation. 10 were treated with minima invasive technique Close reduction and per-cutaneous fixation because of good reduction was achieved under image guidance and 16 patients had ORIF with use of various recon plates, screws and wires. Results; All patients were followed up for 12 months. Among all patients, the clinical outcomes were recorded as excellent in 17 patients (17/26, 65%), good in 5 (5/26, 19%), fair in 2 (2/26, 7.7%), and poor in 2 (2/26. 7.7%), according to the modified Merle d’Aubigné-Postel score. The average modified Merle d’Aubigné-Postel score was 15 ± 2.0 points (range, 10–18 points). The radio-logical healing was assessed according to the Matta score [22] and were reported excellent in 15 patients (15/26, 57.6%), good in 7 (7/26, 26.8%), fair in 1 (1/26, 3.8%),and poor in 3 (3/26, 11.5%). Conclusion; our study shows comparable clinical outcome for acetabular fracture fixation using either ORIF or CRPF technique. Right patient choice and good knowledge of anatomy is of paramount importance.

Protective effect of modified lange "second position" for developing avascular necrosis following closed reduction for developmental dysplasia of the hip.

Developmental Dysplasia of the Hip (DDH) is a condition affecting hip joint development in children, presenting multiple manifestations. Immobilization methods to ensure hip concentricity, such as the human position and modified Lange position, vary in effectiveness and risks, especially avascular necrosis. The purpose of this study was to identify whether closed reduction (CR), with two different immobilization techniques, is effective in avoiding complications such as residual hip dysplasia (RHD), re-dislocation, and Avascular Necrosis (AVN). A total of 66 patients with DDH (84 hips) were treated with two different techniques of immobilization (groups A and B); the mean age at the time of reduction was 8 (6-13) months. The rates of RHD, Re-dislocation, and AVN were determined with a minimum follow-up of 48 months in both techniques. The Chi-square analysis conducted across the study groups unveiled that patients in Group B demonstrated a protective effect against AVN compared to those in Group A (OR: 0.248, 95% CI: 0.072-0.847, p = 0.026). However, no statistically significant differences were found between the groups concerning RHD (p = 0.563) and re-dislocation (p = 0.909). After the initial Human Position immobilization, the second cast with the modified Lange "second position" demonstrated a protective effect compared with maintaining the Human Position immobilization throughout the immobilization period, reducing the likelihood of AVN development in patients undergoing closed reduction for developmental dysplasia of the hip.

A Comparative Study of Electrochemical Reduction of Levulinic Acid on Various Electrodes in Organic Solvents.

Studies on the electrochemical hydrogenation (ECH) of levulinic acid (LA) to valeric acid (VA) or γ-valerolactone (GVL) have mainly focused on the electrochemical reduction of LA in acidic aqueous solutions. However, the narrow range of applied potentials has hindered understanding of some mechanistic aspects of LA electrochemical conversion. Earlier, we discovered that employing proton-deficient non-aqueous reaction media provides more comprehensive insights into the mechanism of LA electrochemical reduction. Here, we conducted further investigations into the LA electroreduction process using cyclic voltammetry in various organic solvents on a Pt electrode and on various electrode materials in acetonitrile, both with and without the addition of proton donors. The products of the ECH processes were identified using HPLC. The solvent nature, the presence of proton donors, the electrode material, and the applied potential strongly influence the LA electroreduction process. This study reveals that LA, in the presence proton donors, can undergo electrochemical reduction through different pathways, depending on the difference (ΔE1/2) between the reduction half-wave potential of protons and LA on a certain electrode. When the difference is large, the LA reduction is incomplete and the formation of GVL is observed. Under the close reduction potentials of protons and LA, LA can be completely reduced to VA.

Failure of Pavlik Harness Treatment in Infants Under 6 Months Old with Dislocated Hips: Short- and Intermediate-Term Results of Subsequent Treatment Modalities

ObjectiveThis study aimed to determine the short- and medium-term outcomes of hip dislocation in infants who failed Pavlik harness therapy and were subsequently treated with brace, closed reduction (CR) or open reduction (OR) before 6 months of age.MethodsFifty infants (66 hip dislocations) who failed Pavlik harness therapy between 2000 and 2018 and were treated with a rigid abduction brace or undergoing a CR or OR/cast were evaluated. All demographic data obtained from the medical system, developments and complications during the follow-up and treatment process were recorded and evaluated.ResultsFifty infants (66 hips) with dislocated hips failed Pavlik harness therapy. Of these, 9 infants (12 hips) underwent rigid abduction splint therapy: 9 hips were successful, 2 hips had CR and 1 had OR. Thirty-eight infants (51 hips) had index CR, of which 3 (3 hips) failed and had OR. Radiographs of 49 hips (44 patients) were normal at the final evaluation. Pavlik harness therapy starting after 3 weeks (P = 0.028) and unilateral dislocations (P = 0.028) increased the risk of needing operating room. There was an association between OR and avascular necrosis (P = 0.025), but not between OR and other complications—dysplasia and re-dislocation/subluxation (P = 0.257 and P = 0.508, respectively).ConclusionClosed treatment of hip dislocation is possible in most babies who fail Pavlik treatment. Babies who are started on Pavlik therapy after 3 weeks of age may be at increased risk of needing an operating room.Level of EvidenceIV.

A COMPARATIVE STUDY ON NASAL BONE FRACTURE ASSOCIATED WITH SEPTAL DEVIATION CORRECTED WITH SEPTOPLASTY VERSUS CLOSED REDUCTION

Objective: The dorsum of the nose formed by nasal bones helps to maintain the airway and esthetic appearance of the nose. Faciomaxillary trauma is associated with a nasal bone fracture with or without nasal septal fractures. Nasal bone fractures can lead to deviation of the external nose and nasal obstruction. The management includes correction of nasal bone deformity with either septoplasty or reduction of nasal septal deviation by the non-surgical method. A study was conducted to compare the results of septal deviation corrected by septoplasty and non-surgical reduction of septal deviation combined with nasal bone fracture reduction.The aim of this study was to compare the results of septal deviation corrected by septoplasty and non-surgical reduction of septal deviation combined with nasal bone fracture reduction. Materials: Sixty-two patients with nasal bone fractures with varying degrees of external nose deformity and nasal septal deviation were divided into two groups. Group A consisted of patients treated with septoplasty and nasal bone fracture correction and Group B consisted of patients treated with non-surgical reduction of septal deviation and nasal bone fracture correction. Type I, II, and II nasal bone fractures were included with all types of septal deviations. The subjective improvement in nasal obstruction was assessed using the visual analog scale in both groups. Results: There were 26 males (81.25%) and 06 (18.75%) females in Group A and 25 (83.33%) males and 05 (16.67%) females in Group B. In Group A, 12 (37.5%) patients were aged between 18 and 27 years, 10 (31.25%) patients were aged between 28 and 27 years, 07 (21.87%) patients were aged between 38 and 47 years, and 03 (09.37%) patients were aged between 48 and 57 years. The mean age was 23.54±2.30 years. Conclusion: Nasal bone fractures cause not only esthetic facial deformity but also functional airway obstruction. A thorough clinical examination, computed tomography scan, and patient counseling are necessary. There is no statistically significant difference in the final outcome between the septoplasty and closed reduction of the septal deviation undertaken to relieve nasal obstruction in patients with associated nasal bone fractures.

Treatment and Outcome of Supracondylar Humeral Fractures in Children Over 10 Years of Age at the Time of Injury: A Review of 60 Cases.

To assess the treatment and outcomes of supracondylar humeral fractures (SHFs) in children older than 10 years of age at the time of injury. The study analyzed clinical data from 60 patients who sustained SHF, all over the age of 10 years, were analyzed. The patients included 49 males and 11 females with a mean age of 10.9 ± 0.9 years (range, 10 to 14.5). All patients underwent surgical treatment under general anesthesia. Closed reduction (CR) and percutaneous fixation were the primary treatment, with open reduction and internal fixation being employed only in cases CR was unsuccessful. The study assessed the healing of fractures by measuring the radiographic angles, including the carrying angle (RCA), Baumann's angle (BA), and metaphyseal-diaphyseal angle (MDA) on anteroposterior radiographs of the elbow joint. In addition, the study evaluated whether the anterior humeral line (AHL) appropriately passed through the middle third of the capitellum. The final follow-up visit used the Mayo Elbow Performance Index score (MEPI) and Flynn's criteria to analyze the recovery of elbow function. There were 15 (25%) SHF type II, 17 (28.3%) type III and 28 (46.7%) type IV. Of the 60 patients, 56 (93.3%) underwent successful CR, whereas 4 (6.7%) required open reduction and internal fixation because of an unsuccessful CR. The final follow-up showed the average BA as 72° ± 5.3°, the average MDA as 88.3° ± 2.8°, and the average RCA as 9.6° ± 3.9°. The AHL bisected accurately the capitellum in 59 cases (98.3%). The average range of elbow flexion-extension was 146.6° ± 8.6°, whereas the average MEPI score was 99.9 ± 0.6; 98.3% (n=59) were rated as excellent and 1.7% (n=1) were rated as good. According to Flynn's criteria, 86.7% had an excellent outcome (n=52), 10% had a good outcome (n=6), and 3.3% had a poor outcome (n=2). Only 1 patient (1.7%) experienced redisplacement. Eight cases of nerve injury were reported, with 7 involving the radial nerve and 1 involving the ulnar nerve; all resolved spontaneously. CR and percutaneous fixation have been shown to be effective in treating SHF in 93.3% of children aged 10 years old and older at the time of injury, with favorable radiographic and functional outcomes and a low risk of secondary displacement. Open reduction should only be considered when CR is ineffective.

Close Reduction of Supracondylar fracture of humerus in children by Gravity Method

Objective: To evaluate the outcomes of employing a new technique, the gravity method, for the closed reduction of supracondylar humerus fractures (Gartland’s type II and III) in pediatric patients treated at the Trauma Center of Aziz Bhatti Shaheed Hospital Gujrat. Methodology: This descriptive cross-sectional study was conducted at Aziz Bhatti Shaheed Hospital's Trauma Center from August 2022 to April 2023. Children under 12 years old, presenting within 48 hours of injury with closed supracondylar humerus fractures (Gartland’s Extension type II and III), were included. All patients underwent closed reduction and percutaneous pinning. Data analysis was performed using SPSS, employing means and standard deviations for quantitative variables, and frequency and percentage for qualitative variables. Results: The mean age was 5.5 years (±1.5). Among 65 patients, there were 45 males and 20 females, with a male-to-female ratio of 1:0.4. The right humerus was affected in 28 patients (43%), while the left humerus was affected in 37 patients (57%). The gravity method successfully reduced 90% of fractures without the need for an assistant surgeon, resulting in a zero percent incidence of iatrogenic neurovascular injury. The average surgical duration was 20 minutes (ranging from 16 to 24 minutes), with an average of 7 images captured using the image intensifier. In cases where the gravity method failed, alternative closed reduction methods were employed for 10% of fractures; no open reduction was necessary. Conclusion: The gravity method demonstrates safety and efficacy by providing accurate traction for reducing displaced supracondylar fractures without causing damage to the overlying skin or neurovascular structures around the elbow. Its applicability is particularly noteworthy in settings with a shortage of trained medical personnel and limited expertise in managing neurovascular complications.

Radiographic and clinical outcomes of muenster and sugar tong splints for distal radius fractures: a comparative study

BackgroundNon-operative management is typically indicated for extra-articular distal radius fractures. Conservative treatments such as Sugar tong splints (STs) and Muenster splints (MUs) are commonly used. However, there is limited research and outcome data comparing the two splint types. Therefore, this study aimed to investigate and compare the radiographic and clinical outcomes of treatment using STs and MUs.MethodsIn this retrospective comparative study, we aimed to evaluate and compare the radiographic and clinical outcomes of STs and MUs for the treatment of distal radius fractures. The study included 64 patients who underwent closed reduction (CR) in the emergency room and were treated with either STs or MUs splints (STs group: n = 38, MUs group: n = 26). Initial X-rays, post-CR X-rays, and last outpatient follow-up X-rays were evaluated. Radial height (RH), ulnar variance (UV), radial inclination (RI), and volar tilt (VT) were measured by a blinded investigator. The Quick DASH form was applied to measure patients’ satisfaction after treatments.ResultsThere were no significant differences in baseline characteristics, initial radiographic measurements, or radiographic measurements immediately after CR between the two groups. However, the overall radiological values deteriorated to some degree in both groups compared to the post-CR images. Furthermore, using a paired test, the STs group showed significant differences in RH and RI, and the MUs group showed significant differences in RH and UV between the last follow-up and post-CR images.ConclusionsThe study concluded that there was no difference in clinical outcomes between the two splint types. However, both STs and MUs groups showed reduced radiographic parameters, and the MUs group showed a significant reduction of RH and UV in the treatment of distal radius fractures.Level of evidenceLevel IV; Retrospective Comparison; Treatment Study.

An Unusual Case of Brachial Artery Thrombosis in a Neonate Following Humerus fracture at Birth

A female infant of a diabetic mother born through LSCS at 39 weeks of gestation with a birth weight of 2908 grams was noted to have a paucity of movement of the left upper limb soon after birth. The extremity was pale, had markedly deranged perfusion, and was cold to touch with absent brachial, radial, and ulnar arterial pulsations. There was a swelling noted over the middle of the left arm, which was tender and associated with crepitus suspicious of a fracture. The right upper limb and lower limbs were normal. An urgent X-ray of the left upper limb showed a displaced fracture of the left humerus fracture and the Doppler study revealed absent flow in the brachial artery distal to the fracture site without thrombus. Urgent close reduction of the fracture following which the doppler showed a thrombus in the brachial artery extending up to its bifurcation. The thrombosis was managed medically with low molecular weight heparin and aspirin. There was a gradual improvement of limb perfusion with normalcy achieved on day 3 of life with no residual complications even on follow-up. The workup of neonatal thrombosis, its immediate management and current evidence for the same have been discussed in detail.

Hematoma Block Verses General Anesthesia For Close Reduction And Percutaneous Pinning Of Distal Radius Fractures In Elderly Patients

Objective: The objective of our study is to compare two techniques used for analgesia, hematoma block and general anaesthesia, in patients presented with a fracture of the distal radius in the trauma centre of Aziz Bhatti Shaheed Hospital Gujrat. Methods: Our study was conducted at the Trauma Centre of Aziz Bhatti Shaheed Hospital Gujrat from January 2021 to April 2023. All the patients having distal radius fractures who met the inclusion criteria were included in our study. The patients were placed into two groups, A and B. All the patients were treated by close reduction and percutaneous pinning. The analgesia method used in group A was Hematoma block while in group B was general anesthesia. Data was analyzed using SPSS. Results: 156 patients met the inclusion criteria. The mean age was 61.3 ± 6.6 years. These patients were placed in two groups, A and B, of 78 patients each. There was significantly less pain intensity at 2 and 6 hours after the procedure in the hematoma block group (P &lt; 0.001). Duration for manipulation did not differ significantly between the two groups. Duration for surgery was significantly shorter for the hematoma block group (P 0.02). In 100 per cent of cases, anatomical reduction was achieved in both groups. Conclusion: Hematoma block used as analgesia for the management of fractures of the distal radius in elderly patients is a more effective and safe method than general anaesthesia in emergency trauma centres. Keywords: Hematoma block, distal radius fracture, elderly.

Evaluation of the treatment outcome of tibia shaft fracture by close reduction and internal fixation with interlocking intramedullary nail, Freetown, Sierra Leone, 2023

Introduction: The tibia shaft is a common site for bone fractures and open fractures. Tibia shaft fracture is mostly caused by high-energy trauma such as a fall from a height or a road traffic accident. The objective of this study was to evaluate the treatment outcome of tibia shaft fracture managed by close reduction and internal fixation with interlocking Intramedullary Nails (IMN) and to determine factors that are associated with tibia fracture infection. Methods: This retrospective study was conducted at the Emergency Trauma Hospital, Freetown, Sierra Leone. We analyzed the medical records of a mixed cohort of patients who were treated for, tibia shaft fracture by closed reduction and internal fixation with interlocking intramedullary nails for the period January 2020 to January 2022; with at least 15 months of follow-up. We later used both bivariate and multivariate logistic regressions to determine the factors that are associated with wound infection post-internal fixation. Results: A total of Ninety (n = 90) patients’ medical records were reviewed of which 79 were included for analysis. The median age was 30 years (Inter Quartile Range: 16-67 years). The average hospital stay was 20 days (Inter Quartile Range: 6-156 days). The mean fracture nailing time was 11 days. Infection and non-union rates were at 18.99% and 3.8% respectively. Type of tibia shaft fracture (AOR = 25.51, 95% CI = 2.06-422.75,) and characteristics of wound (AOR = 29.51, 95% CI = 2.06-422.75) were significantly associated with wound infection. The treatment outcome categorization of IMN was successful in 88.61% of the patients. Conclusion: This study concludes that the type of tibia shaft fracture and characteristics of the wound are major predictors of wound infection. The findings of this study suggest that IMN fixation of closed and Gustilo type 1 Tibia shaft fracture led to successful healing in the majority of the cases with a low non-union rate.

Comparative Evaluation of Open Reduction with Internal Fixation Against Closed Reduction Methods for Condylar Fracture Management: A Systematic Review and Meta- analysis.

Mandibular fractures are frequent in facial trauma. Management of mandibular condylar fractures (MCF) remains an ongoing matter of controversy in maxillofacial injury. A number of techniques, from closed reduction (CR) to open reduction and internal fixation (ORIF), can be effectively used to manage these fractures. The best treatment strategy, that is, closed reduction or open reduction with internal fixation, remains controversial. The aim of this study is to systematically review the existing scientific literature to determine whether open reduction with internal fixation or closed reduction is a better treatment alternative for the patients with condylar fractures through a meta-analysis. A systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Electronic databases like PubMed, google scholar and Ebsco Host were searched from 2000 to December 2021 for studies reporting management of condylar fractures through open reduction with internal fixation against closed reduction and reporting the outcome in terms of mean and standard deviation (SD). Quality assessment of included case control and cohort studies was performed using Newcastle-Ottawa Scale, and randomized studies were evaluated using Cochrane risk-of-bias (ROB)-2 tool through its domains. The risk of bias summary graph and risk of bias summary applicability concern was plotted using RevMan software version 5.3. The standardized mean difference (SDM) was used as summary statistic measure with random effect model and p value <0.05 as statistically significant. Seventeen studies fulfilled the eligibility criteria and were included in qualitative synthesis, of which only nine studies were suitable for meta-analysis. The pooled estimate through the Standardized Mean Difference (SMD) of 0.80, 0.36 and 0.42 for maximum inter incisal opening, laterotrusion and protrusion favours CR compared to ORIF for condylar fracture management. Also, most results of heterogeneity tests were poor and most of the funnel plots showed asymmetry, indicating the presence of possible publication bias. The results of our meta-analysis suggest that CR provides superior outcomes in terms of maximum inter incisal opening, laterotrusion and protrusion compared to ORIF in condylar fractures management. It is necessary to conduct more prospective randomized studies and properly control confounding factors to achieve effective results and gradually unify clinical guidelines.

Outcomes of Pediatric Proximal Phalanx Base Fractures.

Extra-articular juxtaphyseal fractures of the proximal phalanx are among the most common finger fractures in children. Immobilization of the digit for 3 to 4 weeks after reduction of the fracture is the current standard of care. The purpose of this retrospective study was to evaluate outcomes after intervention among pediatric proximal phalanx base fractures and establish radiographic criteria to guide management. A multi-institutional retrospective review of skeletally immature patients treated for proximal phalanx juxtaphyseal fractures between 2002 and 2019 was conducted. Variables collected included Salter-Harris classification; initial, postreduction, early follow-up, and final angulation and displacement on the posterior-anterior and lateral radiographs; clinical rotational deformity at final follow-up; and method of treatment. Exclusion criteria included less than 3 weeks of follow-up; Salter-Harris III, IV, and V fractures; inadequate medical record details; and missing radiographs. Six hundred thirty-four fractures meeting the inclusion criteria were categorized into no reduction, closed reduction (CR), and surgical (OP) groups. Only CR and OP groups saw large decreases in angulation by 11.8° CR (95% confidence interval, 10.1 to 13.6) and 19.0° OP (95% confidence interval, 8.7 to 29.3). Closed reduction patients had a mean coronal angulation value of 6.1° at post-reduction, which was maintained with immobilization to 5.8° at final follow-up. At final follow-up, scissoring was noted, three in the no reduction and three in the CR group for an overall 0.93% rotational malalignment rate. Extra-articular proximal phalanx juxtaphyseal fractures rarely require surgical management and can typically be treated with or without CR, based on the degree of deformity, in the emergency department or clinical setting. Low rates of documented sequelae after nonsurgical management were seen in this cohort, allowing for establishment of treatment parameters that can result in clinically insignificant angular and rotational deformity. Therapeutic IV.