Common Cause Of Fracture Research Articles

Efficacy of Closed Reduction Perutaneous Pinning and Laeral Pinning in the Treatment of Supracndylar Fracture of Humerus in Children

Objective: Closed reduction percutaneous cross pinning vs. lateral pinning in the treatment of children's supracondylar humeral fractures is the goal of this research. Study Design: Prospective study Place and Duration: THQ hospital Jaranwala/ Punjab medical college Faisalabad. Feb 2021-Aug 2021 Methods: This research included a total of 90 patients of both sexes. After obtaining informed permission, demographic information such as gender, age, and BMI was gathered. Patients ranging in age from 2 to 15 years old were taken into consideration for treatment. Two groups of children with fractures of the supracondylar humerus were recruited and randomized. In the first group, 45 patients got percutaneous cross pinning, whereas in the second group, 45 patients had lateral pinning performed on them. Both groups' radiological and functional outcomes were evaluated using Flynn's criteria, and a high incidence of problems was noted. SPSS 24.0 was used to analyze all of the data. Results: Total 60 (66.7%) patients were males and 30 (33.3%) cases were females. There was no any significant difference of age among both groups. Most common cause of fracture was sports and road traffic accident. In group I mean surgical time was 28.12±4.04 minutes and mean time in group II was 32.21±4.31 minutes. We found mean radiation time in group I was greater 4.11±5.41 sec than in group II radiation time was 3.21±4.5 sec. According to Flynn's criteria, excellent results were found in 29 (64.4 %) cases, good results were found in 10 (22.2 %), and fair results were found in 6 (13.3 %) cases in group I, while excellent results were found in 24 (53.3 %) cases, good results were found in 13 (28.9 %), and fair results were found in 8 (17.8%) cases in group II. Conclusion: After conducting this study, we came to the conclusion that both methods for the treatment of closed reduction supracondyla fractures of the humerus are safe and effective for children; however, percutaneous pining was found to be less operative and required more radiation time than two lateral pinnings. Keywords: Two lateral pinning, Children, Supracondylar humerus fracture, Percutaneous cross pinning

Radiological Outcome of Fracture of Neck of Femur Treated with Two versus Three Cannulated Screws Fixation in Adults

Objective: Adults with neck-of-femur fractures will be compared between two and three cannulated screws for fixation in this study. Study Design: Comparative/Experimental study Place and Duration: Orthopaedics and Trauma Department of Bacha Khan Medical College, Mardan and the department of Orthopaedics, Gambat Institutes of Medical and Science, Sindh during the period from April 2021 to September 2021 Methods: There were 90 patients of both genders had garden type fractures of neck of femur with ages 15-55years were included. Age, gender, and the reason of the fracture were among the variables collected after patients provided written consent. Patients were equally segregated into two groups. Group I had 45 patients and received cannulated screws fixation and in group II 45 patients received three cannulated screws fixation. Post treatment radiological union was assessed and compared at the 14th week. We used SPSS 23.0 to analyze complete data. Results: There were majority males 75 (83.3%) and only 15 (16.7%) females in this study. Most common cause of fracture was road accidents found in 65 (72.2%) cases followed by falling from height in 18 (20%) cases and sports in 7 (7.8%) cases. In group I mean age of the patients was 34.9±7.16 years and had mean BMI 23.6±3.22 kg/m2 while in group II mean age was 35.2±3.61 years with mean BMI 24.2±2.19 kg/m2. Mean union time in group I was 9.1±3.16 weeks and in group II mean time was 13.3±4.14 weeks. Frequency of radiological union in group I was higher among 43 (95.6%) cases as compared to group II in 37 (82.2%) cases. Overall success rate of radiological union was found among 88.9% cases. Conclusion: We concluded in this study that two cannulated screws fixation was effective and useful as compared to three cannulated screws fixation in the management of fracture of neck of femur in terms of less radiological union time and higher number of success rate among all cases. Keywords: Fracture Neck of Femur, Two Cannulated Screws Fixation, Three Cannulated Screws Fixation, Radiological Outcome

Epidemiology of Traumatic Tusk Fractures of Managed Elephants in North America, South America, Europe, Asia and Australia

Elephant tusk fractures are a management and medical challenge that can escalate into life-threatening complications. Here, an international survey was sent to elephant managers to understand the risk factors associated with tusk fractures since 2009, identifying best practices for reducing the incidence. Out of 459 elephants included in the survey, 85 elephants incurred at least one fracture. Though not statistically significant, descriptive statistics identified a trend for both Asian and African elephant males to be more likely to incur a fracture than females. Additionally, the first reported fracture occurred in males of both species approximately ten years earlier in age than females. The most common causes of fractures were conspecific interactions (44.6%), caught tusk in an enclosure or enrichment item (28.4%), and a strike by the elephant of a tusk with an object (12.2%). For social causes, unstable hierarchy (45.5%) and specific agonistic interactions (36.4%) were the most frequently cited fracture causes. Steel gates were associated with 23.8% of fractures caused by enclosure elements. Management changes including tusk trimming, enrichment, training, and re-arranging social groups were found to be important in reducing subsequent fractures, with odds ratios showing that a second tusk fracture was 6.37 times more likely to occur if no management changes occurred after the first fracture. Our data suggests that targeted management strategies in herds with maturing males, unstable social dynamics, and/or high-risk enclosure elements could reduce the frequency of tusk fractures.

Penile Fracture, Surgical Success and Complications Rate

Objective: The aim of current study is to determine the causes, symptoms of penile fracture and post-operative outcomes. Study Design: Prospective study Place and Duration: Conducted at Urology department of Miangul Abdulhaq Jehanzeb Kidney, Swat for the duration of one year from 1st January to 31st December, 2020. Methods: Total 30 patients had penile fracture were presented in this study. Included cases were aged between 20-50 years. After receiving informed written permission, detailed demographic information about the enrolled patients was compiled, including age, body mass index, place of residence, and marriage status. Causes and clinical features of fracture were assessed. Patients were undergone surgery and success rate was observed. Post-treatment rate of complications among enrolled cases were also calculated. We used SPSS 22.0 version to analyze complete data Results: Included patients had mean age 35.7±12.32 years with mean BMI 24.7±4.31 kg/m2. Majority of the cases were married 26 (86.7%) and rest were unmarried 4 (13.3%). 12 (40%) patients had urban residency and majority were had rural 18 (60%). Most common cause of fracture was coital 20 (66.7%), followed by masturbation in 6 (20%) and 4 (13.3%) patients had manipulation during sleep. Deformity, swelling, detumescence and crackling sound was the most common symptoms. Right corpus was the most common tunical tear 24 (80%) and most common site was proximal 22 (73.3%). Success rate was found among 26 (86.7%) cases. Post-operatively complications were found among 5 (16.7%) cases in which plaques/ nodules, curvature, erectile dysfunction, pain and swelling were included. Conclusion: For the purposes of this study, we found the penis fracture to be a rather simple condition to diagnose. Cavernosography may be used to confirm a diagnosis if necessary. Penile fractures may be successfully treated with immediate primary surgical repair, resulting in normal erection without substantial sequelae. Short hospital stays and fast restoration of sexual function are common outcomes of this procedure. Keywords: Surgical Outcomes, Penile Fracture, Complications, Causes

PERIODONTAL STATUS IN PATIENTS WITH MANDIBULAR FRACTURES

Purpose: The aim of the present study was to assess the gingival and periodontal status of patients with maxillofacial trauma and to determine the need for periodontal treatment after removal of the intramaxillary fixation. Material and methods: The study included 36 patients with a fracture of the lower jaw. After the clinical and radiological examination of the patients, treatment was performed on a case-by-case basis. 30 days after fixation and removal of the wire ligatures of the patients, the oral-hygienic and periodontal status was assessed using the following indices: simplified oral hygiene index, gingival bleeding index, community periodontal index of treatment needs and evaluation of oral malodour. Results: The most common cause of fractures is a traffic accident, followed by domestic injuries. The level of oral hygiene immediately after removal of the wire ligatures and intermaxillary fixation varied between relatively good and poor, with a greater number of patients having poor hygiene (OHI-S ≥5). The periodontal status of the patients, measured by CPITN, also showed a statistically significant level of clinically established periodontal destruction. Halitosis was detected in all patients. Conclusions: The course of the healing process in the alveolar bone and the functional rehabilitation of patients with mandibular fractures depends not only on the type of surgical treatment for immobilization of the fragments but also on the maintenance of optimal oral hygiene.

Epidemiology of isolated olecranon fractures: a detailed survey on alarge sample of patients in a suburban area.

BackgroundLiterature lacks data concerning several epidemiologic aspects of isolated olecranon fractures (IOFs). The few studies that have analyzed this type of fracture show a low sample size and contradicting results.MethodsThis retrospective study included 165 consecutive patients (82 men and 83 women) who sustained an IOF in the past 10 years. Participants who were aged <16 years or had a previous elbow fracture or had a fracture that involved other bones of the elbow joint were excluded. Data regarding age, sex, season, date, and fracture side were collected. As per the mechanism of injury, we arbitrarily distinguished 7 subgroups. IOFs were classified as per the Mayo and AO classifications using x-ray. Statistics were performed.ResultsThe patients’ mean age was 58.5 (standard deviation [SD], 21.3) years, and men and women were aged 48.1 (SD, 19.8) years and 67.9 (SD, 18.8) years, respectively. The most frequent fracture patterns were the MAYO 2A and the AO 2U1B1(d). Low-energy mechanisms caused simple dislocated-stable fractures, whereas high-energy mechanisms caused both simple and comminuted displaced-stable fractures. Significant differences in the trauma mechanism were found between male and female patients. The former fractures showed a bimodal distribution depending on the patients’ age group, whereas in women, the traumatic event was mainly represented by a low-energy mechanism. Overall, the most common cause of fracture was a low-energy accident. The seasonal distribution of fractures was different for male and female patients being more frequent in summer among young men and more frequent in winter among the elderly, both men and women. The left side was involved in 87 patients.ConclusionIOFs occur equally in both genders, although with different age distribution. The most common fracture pattern was a simple displaced-stable fracture (MAYO 2A and AO 2U1B1[d]). Young men are more often subject to high-energy injuries that occur in road accidents, whereas with aging, they become more prone to fragility fractures as women. Female patients are usually older and are mostly affected by low-energy traumas as a fall from a standing height.

Effects of the COVID-19 Pandemic on Pediatric Nasal Fractures.

ObjectivesNasal bone fracture is a frequent entity consulted to the otolaryngologists, approximately accounting for 39% of all facial bone fractures. The most frequent mechanisms of injury consist of assault, sport-related injuries, falls, and motor vehicle accidents. In this study, we examined the effects of the COVID-19 pandemic on pediatric nasal fractures.MethodsChildren with nasal fracture who applied to Malatya Training and Research Hospital during the year before the first case and the following year were included in this study. Data of 172 patients for the pre-pandemic period and 79 patients for pandemic were available and included in the study. Demographic information, clinical features, nasal fracture etiology, nasal fracture type, type and time of intervention, and other accompanying pathologies were recorded.ResultsWhile falls was the leading cause of fracture etiology before the pandemic (64 patients [37.21%]), assault seems to be the leading cause during the pandemic period (27 children [34.18%]). In the pre-pandemic period, the intervention for patients with nasal fractures was performed on an average of 5 days, while this period was calculated as an average of 6 days during the pandemic period. When the 2 groups are compared in terms of nasal fracture intervention time, it was seen that the intervention time was statistically significantly later in the pandemic period (P < .001). According to the results of the analysis, the most cases in the pandemic period were seen in the fourth month, which indicated a-month period between 11 June and 11 July.ConclusionsIn conclusion, our number of nasal fracture cases was decreased during the pandemic period compared to the 1-year period before the pandemic. We observed the most common type IIA nasal fracture. We gave outpatient treatment to most of the patients. Our most common cause of fracture was assault. We intervened in our cases in an average of 6 days and preferred closed reduction most frequently. We could not find any study on the same subject in the literature, and we aimed to contribute to the literature with this study.

A retrospective analysis of mandibular fractures in Mewat, India.

ObjectivesMandibular fractures vary significantly with respect to epidemiological and demographic parameters among populations. To date, no study has evaluated these aspects of mandibular fractures in Nuh, Mewat, Haryana, India. To retrospectively analyze the incidence, age and sex distributions, etiology, anatomic distribution, occlusal status, treatment modality provided, and their correlation in patients who suffered isolated mandibular fractures.Materials and MethodsThe records of maxillofacial injury patients who reported to the Department of Dentistry, SHKM Government Medical College from January 2013 to December 2019, were retrieved from our database, and necessary information was collected. The data collected were analyzed statistically using IBM SPSS ver. 21.ResultsTotals of 146 patients and 211 fractures were analyzed. There were 127 males and 19 females with an age range of 3-70 years (mean age, 26 years). Road traffic accident (RTA) was the most common cause of fracture (64.4%), followed by fall (19.9%), assault (15.1%), and sports injury (0.7%). Of all patients, 42.5% had bilateral fractures, 31.5% had left side fracture, 21.2% had right side fracture, 3.4% sustained midline symphyseal fracture, and 1.4% had symphyseal fracture along one side of the mandible. Site distribution was as follows parasymphysis (34.6%), angle (23.7%), condyle (20.4%), body (12.8%), symphysis (4.3%), ramus 2.4%, and dentoalveolar 1.9%. The most common facture combination was angle with parasymphysis (17.8%). Occlusion was disrupted in 69.2% patients. Closed reduction was the predominant treatment modality.ConclusionThe data obtained from retrospective analyses of maxillofacial trauma increase the understanding of variables and their outcomes among populations. The results of the present study are comparable to those of the literature in some aspects and different in others.

Outcome of Two Ring Hybrid Ilizarov Fixator in the Management of Proximal Tibial Fractures in Adults

Objective: The aim of this study is to determine the outcomes of using two ring hybrid ilizarov fixator for the management of proximal tibial fractures in adult patients. Study Design: Descriptive Study Place and Duration: Methods: There were 60 patients of both genders were presented in this study. Patients were aged between 25-65 years. Informed written consent was taken from all the patients for detailed demographics age, sex, body mass index and cause of fracture. All the patients had proximal tibial fractures were included, type of fractures were assessed by schatzker technique. Outcomes were assessed by using Rasmussen score in terms of excellent, good and fair. Radiological outcome was measured by fracture healing on radiography. Student t-test and chi square test was used. SPSS 24.0 was used to analyze all of the data. Results: There were 45 (75%) patients were males and 15 (25%) were female patients. Mean age of the patients was 42.3±7.43 years with mean BMI 25.07±6.29 kg/m2. Falling was the most common cause of fracture found in 33 (55%), followed by road traffic accidents in 17 (28.3%) and 10 (16.7%) fractures by assault. Majority of the patients were schatzker type VI fractures 34 (56.7%) followed by schatzker type V fractures in 11 (18.3%), metaphyseal fractures found in 8 (13.3%) cases and proximalone third shaft fractures in 7 (11.7%) cases. Mean surgery time was 4.2±6.17 hours and mean union time of fractures was 19.8±6.61 weeks. According to Rasmussen score 39 (65%) cases showed excellent results with knee flexion more than 90 degree, good results found in 17 (28.3%) patients and fair results in 4 (6.7%) cases. Pin tract infection was the most common complication found in 12 (20%) cases, followed by compartment syndrome in 4 (6.7%) and delayed union in 3 (5%). No any poor outcome was assessed in this study. Conclusion: We concluded in this study that the use of two ring hybrid ilizarov fixator in the management of proximal tibial fractures were effective and useful in terms of excellent and good outcomes of knee flexion. The ilizarov approach allowed for early definitive treatment with a low rate of complications and a favourable clinical outcome. Keywords: Proximal Tibial fracture, Ilizarov Fixator, Shatzker, Rasmussen score, Outcomes

Comparison of Outcome of Three Different Approaches for Supracondylar Humerus Fractures in Children

Objective: The aim of this study is compare the outcomes among three different approaches (lateral approach, medial approach and posterior approach) for supracondylar humerus fractures in children. Study Design: Retrospective cohort study Place and Duration: The study was conducted at Orthopedics department of Ayub Teaching Hospital, Abbottabad for duration of one year from January 2020 to December 2020. Methods: There were one hundred and thirty five children had supracondylar humerus fracture were presented. Patients were aged between 3-12 years. Informed written consent was taken from authorities for detailed demographics age, sex, cause of fracture and side of fracture. Patients were categorized into three equal groups, group A had 45 patients and received lateral approach, group B had 45 patients and received medial approach and group C received posterior approach with 45 cases. Shaft Condylar Angle (SCA) and Baumann angle were used to analyze the radiological result. All children were assessed using Flynn's criteria for functional outcomes, and the results were divided into Excellent, Good, Fair and Poor. Post-operative outcomes among all the three groups were calculated and compared. SPSS 23.0 version was used to analyze complete data. Results: There were 90 (66.7%) males (30 in each group and 45 (33.3%) females (15 in each group). In group A mean age was 6.88±5.45 years, mean age in group B was 7.11±5.33 years and in group C mean age was 7.17±5.66 years. Sports 85 (62.9%) was the most common cause of fracture followed by traffic accidents 30 (22.2%) and the rest were 20 (14.8%) fall from the height. According to radiological outcomes, Mean shaft condylar Angle in group A was 41.5±6.3, in group B was 41.8±1.9 and in group C was 40.1±3.8 respectively (P&gt;0.05). Mean Bauman angle in group A was 18.8±6.11, group B was 19.4±7.5 and in group C 20.4±5.3 with (P&gt;0.05). According to Flynn’s criteria, excellent outcomes were observed in 33 (73.3%) in LA group, 24 (53.3%) in MA group and 22 (48.9%) in PA group, good results were observed in 11(24.4%), 19 (42.2%) and 21 (46.7%), fair outcomes in 1 (2.2%), 2 (4.4%) and 2 (4.4%). Conclusion: As a result of this research, we have concluded that the lateral technique for supracondylar fractures is superior to the medial or posterior approaches in terms of radiological and functional results. However, there was no statistically significant difference between the three groups. Keywords: Supracondylar fractures, Flynn’s criteria, Functional outcome, Open reduction

Delayed total hip arthroplasty in patients developing osteoarthritis following acetabular fractures

Objectives: The aim of this study is to review the short-term results of total hip arthroplasty (THA) for the management of delayed arthritis after acetabular fractures. Methods: This is a retrospective study of operated cases of THA post-acetabular fracture arthritis. Data were collected from computerized hospital records from January 2010 to December 2019. We analyzed post-operative outcomes, which included revision surgery due to any reason, post-operative infection, hip dislocation, sciatic nerve injury, and deep venous thrombosis. In addition, radiographs were evaluated for restoration of the center of rotation (COR), horizontal offset (HO), and vertical offset (VO) by an independent observer. Results: A total of 36 cases (30 males and six females) were included in the study. The average age was 55 years. Road traffic accidents were the most common cause of fractures followed by falls from height. The mean time between the fracture and the development of symptoms of arthritis was 48 months. One THA was complicated by post-operative dislocation. Infection was reported in three cases and sciatic nerve injury occurred in one patient. Heterotopic ossification was seen in four cases and thromboembolism developed in one patient. The COR, HO, and VO showed a normal pattern. Conclusion: THA after acetabular fractures is a complex surgical procedure with relatively high short-term complications. Restoring the hip biomechanics can help in achieving results that are comparable to primary total hip replacement.

Study of functional outcome of surgical management of proximal humerus fracture by various modalities

Background: Proximal humerus fractures account for nearly 6-10% and are on a rise. The management of this is controversial and is challenging task. There is a significant heterogeneity among the studies in describing the best surgical procedure in proximal humerus fracture. The objective of the study is to assess and compare the functional outcome with different modalities in fixation of proximal humerus shaft fractures.Methods: A two-year prospective study was conducted after getting ethical approval at Narayana Medical College on cases admitted with proximal humerus fractures as per the inclusion criteria based on Neer’s classification. Radiological evaluation was done, and surgery was performed. Postoperative follow-up was done at 1st, 4th, 8th and 14th week and outcome were evaluated for each case based on Neer’s shoulder score.Results: 30 cases were included with a mean age of 48.2 years. Road traffic injury was common cause of fracture. Of the total 30 cases, 23 cases had excellent results, 4 cases were satisfactory, 2 cases were unsatisfactory, and one case had a failure. The mean scores observed on Neer’s score was pain (33.5 units), Function (23.5 units), range of motion (16.55 units) and anatomy (6.9 units).Conclusions: Clinical evaluation, obtaining proper radiological views, age of the patient and activity holds the key for realistic approach and surgical management of complex humerus fractures. Proper patient selection and thorough knowledge of the anatomy and biomechanical principles are the pre-requisites for a successful surgery and good functional outcome.

Profile of patients reporting with fractures in the orthopaedics department

Background: Fractures occur in individuals of all ages. The present study was conducted to record fracture reported in orthopaedics department. Materials and Methods: 148 patients with fractures reported in orthopaedics department underwent physical examination along with radiological investigation such as X- ray skull, upper limb, lower limb, CTR scan etc. was performed in each case. Etiology of fracture and associated injuries was also reported. Management of the patient was performed accordingly. Results: Out of 148 patients, males were 80 and females were 68. The most common cause of fracture among patients was road traffic accident seen in 102, fall in 40 and domestic violence in 6 cases. The difference was significant (P< 0.05). Fracture of upper limb was seen in 60, fracture of lower limb in 30, fracture of spine and trunk in 25, fracture of skull, intracranial injury in 33. Associated injuries was contusion in 12, open wound of upper limb in 24, open wound of lower limb in 54 and superficial injury in 28 patients. The difference was significant (P< 0.05). Conclusion: Common type of fractures among patients visiting orthopaedics department was fracture of upper limb, fracture of lower limb, fracture of spine and trunk.

STUDY OF INCIDENCE OF THE CORONAL APPROACH IN CRANIOFACIAL TRAUMA AND ADVANTAGEOUS OF TITANIUM MESH IN RECONSTRUCTION OF CRANIOFACIAL DEFECTS.

INTRODUCTION: The coronal approach gives a broad exposure to the frontal bone, the calvaria, the nasal bones, the orbits, the subcondylar region, the zygoma and the zygomatic arch and gives ideal aesthetic results with less complication. The common craniofacial fractures are Nasal bones (45%), cranial bones (24%), Mandible (13%), Zygoma (13%), Orbital blowout (3%), Maxilla (2%). Common causes of fractures are Road trafc accident, Assault, Industrial accidents, Recreational accidents, Frontal bone fracture. METHOD: The study was carried out for a period of one year from March 2020 to March 2021. The study conducted in St Joseph dental college ELURU in the department of Oral and Maxillofacial Surgery. The age limit for this study was below 30 years. The number of subjects involved in this study was 5. Number of females was 3 and males were 2 in this study. RESULT: Number of female participants in this study was 3 and number of male participants was 2.Number of male participants with coronal incision were 1 and number of participants with pretrichial incision were 2.Out of 2 one for male participant and one for female participant. CONCLUSION: The coronal ap has recently become a preferred approach for access to the craniofacial skeleton and orbit. This method of exposure has become particularly useful with increased indications for rigid internal xation and primary bone grafting in the management of complex facial fractures.

Compare the Functional Outcomes of Closed Reduction and Percutaneous Cross Pinning versus Lateral Pinning in Supracondylar Fracture of Humerus in Children

Objective: To determine results of treating supracondylar fracture of the humerus in children using percutaneous cross pinning versus two lateral pinning. Study Design: Prospective study Place and Duration of Study: Department of Orthopaedics, King Abdullah Teaching Hospital Mansehra from 1st November 2020 to 30th April 2021 Methodology: Eighty four patients of both genders were enrolled. Baseline demographic details of patient’s age, sex and body mass index were recorded after taking consent. Patients aged between 2-14years were included. Children with supracondylar humerus fractures were enrolled and divided equally into 2-groups. Group I had 42 patients and received percutaneous cross pinning technique and group II had 42 patients underwent lateral pinning. Radiological and functional results were assessed by Flynn’s criteria among both groups and frequency of complications was also observed. Results: There were 50 (59.5%) males (25 in each group) and 34 (40.5%) were females (17 in each group. Mean age of the patients in group I was 5.14±9.88 years and in group II mean age was 6.14±8.35 years. Sports 60 (71.43%) was the most common cause of fracture followed by traffic accidents 17 (20.24%) and the rest were 7 (8.3%) fall from the height. Mean surgical time in group I was 30.42±6.09 minutes while in group II mean time was 34.24±2.16 minutes. Mean radiation time in group I was 3.98±9.44 sec and in group II radiation time was 2.11±1.1sec. According Flynn’s criteria excellent results in group I were found in 25 (59.5%) cases, good results in 12 (28.6%) and fair results found in 5 (11.9%) while in group II excellent results were found in23 (54.8%), good results in 15 (35.7%) and fair results in 4 (9.5%). Significantly no difference in outcomes was observed among both groups. Conclusion: Both methods of treatment of supracondylar fractures of humerus are safe and successful however less operative and high time of radiation in cross percutaneous pinning compared to two lateral pinning has been found. Keywords: Percutaneous cross pinning, Two lateral pinning, Supracondylar humerus fracture

Population characteristics, outcomes, and centerwide insights of the Zimbabwe national experience with the SIGN intramedullary nail (2013-2020).

SIGN Fracture international is a non-profit organization that provides intramedullary nails to SIGN centres at no cost for intra-operative fracture fixation in exchange for cases being uploaded to the SIGN Online Surgical Database (SOSD). The SIGN program was introduced in Zimbabwe in 2013 and had expanded to nine hospitals at the end of 2020. This study aimed to evaluate the population characteristics and clinical outcomes of patients who received the SIGN nail in Zimbabwe as well as intranational trends across SIGN centres. We conducted a retrospective review of the SOSD for all cases carried out in Zimbabwe between 2013 and 2020. A total of 1764 patients received operative fixation over the period. The majority were young (36.83 ± 15.13) years and male (74%). The average time to surgery was 22 ± 20.5days with over 69% of patients getting surgery after more than tendays. Femur fracture fixation (72%) was the most common procedure with road traffic accidents (RTAs) being the most common cause of fractures (73%). The majority of patients had no follow-up (61%). Of patients with follow-up, 4% reported infection, 2% deformity, and 78% with healing X-rays. There were large differences in volume of patients at different centres with no significant trends in outcomes. The SIGN program allows for safe surgery in Zimbabwe. There are large intranational differences of no particular trend across SIGN centres which may be improved through more intranational knowledge sharing. Improved follow-up would allow for more insights to be gleaned from the database.

Microstructured titanium functionalized by naringin inserted multilayers for promoting osteogenesis and inhibiting osteoclastogenesis

Osteoporosis is the most common cause of fractures in middle-aged and elderly people. Fracture repair can be difficult due to the decreased bone volume in osteoporosis patients and implants are often required. In this study, a slow-release system for microstructured titanium (Micro-Ti) was designed to promote osteogenesis and inhibit osteoclastogenesis. Firstly, Micro-Ti was prepared on titanium surfaces by dual acid etching. Micro-Ti was covered with naringin (NA), chitosan (CHI) and gelatin (GEL) multilayers through layer by layer technique, which is denoted as LBL (NA) coated-Ti. Osteoblasts (ME3T3-E1) and macrophages (RAW 264.7) were cultured on untreated and treated titanium surfaces in vitro. Osteoblasts grown on LBL (NA) coated-Ti showed higher alkaline phosphatase (ALP) and mineralization, consistent with qRT-PCR analysis of osteoblast genes including runt-related transcription factor 2 (Runx2), ALP, collagen I (Col I), osteocalcin (OCN), osteopontin (OPN), and osteoprotegerin (OPG). In contrast, acid tartarate-resistant phosphatase activity and the expression of osteoclastic differentiation related genes comprising of cathepsin K (CTSK), nuclear factor of activated T cells (NFAT), tartrate resistant acid phosphatase (TRAP) and V-ATPase (VATP) in osteoclasts were significantly reduced on LBL (NA) coated-Ti surfaces compared with other groups. These results indicate that microstructured titanium functionalized by naringin inserted multilayers enhanced the differentiation of osteoblasts and inhibited osteoclast formation. The proposed approach in this research provides a novel way to modify titanium-based implants for fracture repair in osteoporosis patients.

Incidence and Risk Factors Associated with Post Tibial Plateau Fracture Deep Venous Thrombosis: A Prospective Cohort Study

Objective: The purpose behind this study was to determine the incidence and risk factors associated with post tibial plateau fracture deep venous thrombosis (DVT)&#x0D; Materials and Methods: A prospective study was conducted in a tertiary care hospital, Indus Medical College &amp; Hospital, Tando Muhammad Khan to recruit those patients who were undergoing orthopedic surgeries during the periods of eighteen months. All the adult patients of both gender planned for surgery due to tibial plateau fracture were enrolled under this study. Duplex ultrasound was performed to detect the presence of underlying postoperative DVT. Post-operatively patients were assessed for potential risk factors associated with higher incidence of DVT. &#x0D; Results: For the final analysis, 344 patients were included among them majority were males (n = 219, 63.66%) with overall mean age and SD was 47.52±12.02 years. The most common cause of fracture was road traffic accident (n = 178, 51.74%). The overall incidence of post-operative DVT observed in our study was 9.30% (n = 32). Mean age 40.19±6.10 years, increased mean duration of operation 3.01±.078 hours, increased mean duration of post-hospitalization 18.49±7.37 days, raised mean WBC counts 20.12±5.64, and increased mean D-dimer levels 3.24±3.09 (laboratory cut off value 0.5mg/L) were significantly associated with higher incidence of DVT in patients operated for tibial plateau fractures.&#x0D; Conclusion: This prospective analysis has identified the potential modifiable risk factors associated with DVT. Consideration should be given to the preventable and treatable risk factors to prevent from the DVT associated complications.

Characteristics of Fall-Related Fractures in Older Adults with Cerebrovascular Disease: A Cross-Sectional Study.

PurposeLimited information exists on fall-related fractures in older adults with cerebrovascular disease. This study aimed to determine the characteristics of older adults with cerebrovascular disease who sustained fall-related fractures and identify the associated risk factors for perioperative complications.Patients and MethodsThis was a cross-sectional study, which included patients with cerebrovascular disease who sustained fractures between Jan. 2017 and Dec. 2019. The collected data included demographics (age and gender), time and place of fracture occurrence, mechanism of injury, fracture location, type of cerebrovascular disease, complications, and comorbidities.ResultsA total of 768 patients with 815 fractures were included; there were 253 males and 515 females, with an average age of 78.3 years. For either males or females, 80–84 years was the most commonly involved age group. Most (61.0%) patients had their fractures occurring at home and most fractures (70.7%) occurred during the daytime. Most were hip fractures and limb weakness; instability-related falls were the most common cause of fracture, making a proportion of 34.5%. Patients who suffered falls were mainly combining ischemic cerebrovascular disease. Most (85.9%) patients presented with at least one comorbid disease and the perioperative complication rate was 76.9% in total cases. Age≥80 (OR: 1.772, 95% CI: 1.236–2.540) and the number of comorbidities≥3 (OR: 1.606, 95% CI: 1.035–2.494) were found independently associated with complications, while the type of cerebrovascular disease, fracture location, and comorbidities of prior fragility fracture and respiratory disease were not significantly correlated with complications.ConclusionOur findings highlighted that more focus on improved physical function explored in intervention setting and the importance of primary home prevention measures seems justified in China and maybe other countries as well. It is the first study that presented the epidemiological characteristics of older adults with cerebrovascular disease who later experienced a fracture.

A Ten-year Retrospective Study of Nasal Bone Fractures at a Tertiary Care Hospital of Nepal

Introduction: Nasal bone fracture occurs due to its vulnerable position and reduced biomechanical resistance to traumas. If not timely treated, it can result in permanent functional and esthetic damage. Methods: A retrospective and cross-sectional study conducted on 91 patients above 17 years of age with nasal bone fractures in the Department of Otorhinolaryngology and Head and Neck surgery of a tertiary care hospital in Kavre. Results: Road traffic accident was the most common cause of fracture (45.1%) followed by fall (36.3%), violence (13.2%), sports-related accidents (4.4%) and occupational accidents (1.1%). Class I fracture was seen in 70 (76.9%), Class II in 17 (18.7%), and Class III in 4 (4.4%). A closed reduction procedure was performed in 74 (81.30%) of the cases, closed reduction with septoplasty was done in 10 (11%), closed reduction with augmentation rhinoplasty was performed for 3 (3.3%), closed reduction with inferior turbinoplasty was required in 3 (3.3%) whereas closed reduction with debridement was done in 1(1.1%). Conclusion: Nasal bone fracture is a complex clinical issue which needs to be addressed early. Violence prevention programs along with drinking and driving campaigns need to be more strengthened to decrease the alarmingly high frequency of nasal bone fracture in the current scenario.