Common Fracture Research Articles

Investigation of fatal traumatic head injuries.

Traumatic head injuries (THIs) are one of the major causes of death in forensic cases. The aim of this study was to investigate the characteristics of patients with fatal THIs. In this study, a total of 311 patients with fatal THIs, who underwent postmortem examinations and/or autopsies, were retrospectively analyzed. Cases were evaluated based on sex, age group, incident origin, cause of the incident, presence of skull fracture, type of fractured bone (if any), fracture localization and pattern, presence and type of intracranial lesion (if any), and cause of death. Out of the patients, 242 (77.8%) were male and 69 (22.2%) were female. Accidents accounted for 235 (75.6%) of the incidents, with in-vehicle traffic accidents causing 117 (37.6%). In 221 cases (71.1%), intracranial lesions and skull fractures were observed together. The most common fractures were base fractures (171 cases) and temporal bone fractures (153 cases). The rate of intracranial hemorrhage was lower in the adult age group (69.7%) compared to the older age group (92.6%). The results obtained in this study indicate that the cause of the incident, type of fracture, presence of skull base fracture, and multiple skull fractures increase the likelihood of fatalities. The occurrence of skull fractures reduces intracranial pressure, thereby decreasing the incidence of intracranial lesions. The development and effective enforcement of road traffic safety policies and regulations will reduce the incidence of fatalities.

Immobilization Period for the Non-Operative Treatment of Proximal Humerus Fractures: Systematic Review and Meta-Analysis.

Proximal humerus fractures (PHFs) are common fractures in the elderly and are typically treated conservatively with immobilization. However, there is no consensus on whether to choose early or late conventional mobilization, taking their outcomes into account. This paper reviews comparative studies on the clinical outcomes of one- and three-week immobilization periods in terms of limb function, pain intensity, and complications following the adoption of the non-surgical treatment of PHF. The current systematic review started with searching PubMed, Scopus, and Web of Science databases for randomized clinical trials (RCTs) on PHF patients to compare the clinical outcomes between patients receiving the one-week mobilization (early mobilization) and those receiving the three-week mobilization (late mobilization). We also performed a meta-analysis to compare the two groups' limb function and pain levels at three and six months of follow-up. Five of the seven RCTs had adequate data to be included in the meta-analysis. The quantitative results showed that the early mobilized patients had improved limb function at three [weighted mean difference (WMD): 5.15 (CI 95%: 0.68-9.62)] and six [WMD: 3.51 (CI 95%: 0.43-6.60)] months, but not at 12 months of follow-up. At either three, six, or 12 months, there was no difference in pain intensity between the two groups. This review supports the adoption of early mobilization at one week for the non-operative management of PHFs. However, to compare the long-term effects, more clinical trials with longer follow-ups are needed.

Distal fibula locked plate versus nonlocked plate for treatment of Danis Weber type B fracture comparative prospective study

Abstract Background Ankle fractures are one of the most common fractures affecting both the young and old. they are the third most common fracture in elderly patients. The appropriate method of fixation of those fractures is debatable especially for osteoporotic patients, osteoprosis renders commonly used internal fixation methods technically demanding and prone to failure. Aim To compare distal fibula locked plate to nonlocked plate for treatment of Danis Weber type B fracture regarding union rate, union time, operation time, failure rate, and other complications. Patients and methods This study was conducted on 100 patients classified as a Weber B traumatic fracture. Fifty patients were undergoing open reduction internal fixation (ORIF) using locking plates (group A) and patients underwent ORIF using nonlocking plates (group B). The following parameters were assessed in both groups range of motion, union rate, union time, complications, operation time, American orthopedic foot and ankle society and failure rate. Results There was no statistically significant difference between both groups in operation time and blood loss. Length of hospital stays (days) and Time to full weight bearing, union time was lower in group A than group B. American orthopedic foot and ankle society was higher in group A than in group B. There was no statistically significant difference in range of motion (extension, flexion) between both groups. The rate of loosening of the distal screw and implant removal was higher in group B than in group A. Conclusion No statistically significant difference was found between both groups regarding functional, radiological outcomes, and complications in patients less than or equal to 60 years old. Therefore, one-third plate is preferred in a young age in terms of cost-effectiveness. In patients over 60 years old, using the locking plates yields better stability, and functional and radiological outcome than non-locking plates.

Patterns of Ankle Fractures Based on Radiographs and CT Images of 1000 Consecutive Patients.

The knowledge of different types of ankle fractures based on plain radiographs and computed tomography (CT) images can help improve patients' management. This cross-sectional study assessed the plain radiographs and CT images of 1,000 consecutive patients observed in an emergency department between March 2015 and March 2020. Fractures were labeled as uni-, bi-, or trimalleolar. Malleolar fractures were classified into medial, lateral, and posterior ones based on Herscovici, Danis-Weber, and Mason and Molloy classifications, respectively. Bi- and trimalleolar fractures, on the other hand, were categorized according to the Lauge-Hansen classification. This study included 1,000 patients with 1,003 ankle fractures. Of them, 901 were adults (mean±SD age: 41.6±16.7, male: 567 [62.9%]) with 904 fractures. In total, 53% of adult patients were 18 to 39 years old. Considering unilateral ankle fractures, the medial malleolar fracture was the most common unimalleolar fracture (62.6%), with Herscovici C being the most frequent subtype (65.3%). On the other hand, the most common type of lateral malleolar fracture was Danis-Weber type B (65.5%). There were also 209 (23.3%) bimalleolar and 114 (12.7%) trimalleolar fractures, 5.8% (16 fractures) of which could not be classified based on the Lauge-Hansen classification. Unimalleolar fractures were also observed in 87 (87.9%) children, with the medial malleolar fracture being the most common type (89.7%). Medial malleolar fractures were the most frequent malleoli in patients observed in the emergency department under study. Among bi- and trimalleolar ankle fractures, supination-external rotation and pronation-external rotation injuries were the most common patterns. The Lauge-Hansen classification was not applicable in 5.8% of bi- and trimalleolar fractures.

Finite element analysis of vertebroplasty in the osteoporotic T11-L1 vertebral body: Effects of bone cement formulation.

Vertebral compression fractures are one of the most severe clinical consequences of osteoporosis and the most common fragility fracture afflicting 570 and 1070 out of 100,000 men and women worldwide, respectively. Vertebroplasty (VP), a minimally invasive surgical procedure that involves the percutaneous injection of bone cement, is one of the most efficacious methods to stabilise osteoporotic vertebral compression fractures. However, postoperative fracture has been observed in up to 30% of patients following VP. Therefore, this study aims to investigate the effect of different injectable bone cement formulations on the stress distribution within the vertebrae and intervertebral discs due to VP and consequently recommend the optimal cement formulation. To achieve this, a 3D finite element (FE) model of the T11-L1 vertebral body was developed from computed tomography scan data of the spine. Osteoporotic bone was modeled by reducing the Young's modulus by 20% in the cortical bone and 74% in cancellous bone. The FE model was subjected to different physiological movements, such as extension, flexion, bending, and compression. The osteoporotic model caused a reduction in the average von Mises stress compared with the normal model in the T12 cancellous bone and an increment in the average von Mises stress value at the T12 cortical bone. The effects of VP using different formulations of a novel injectable bone cement were modeled by replacing a region of T12 cancellous bone with the materials. Due to the injection of the bone cement at the T12 vertebra, the average von Mises stresses on cancellous bone increased and slightly decreased on the cortical bone under all loading conditions. The novel class of bone cements investigated herein demonstrated an effective restoration of stress distribution to physiological levels within treated vertebrae, which could offer a potential superior alternative for VP surgery as their anti-osteoclastogenic properties could further enhance the appeal of their fracture treatment and may contribute to improved patient recovery and long-term well-being.

Evaluation of post-earthquake fractures according to anatomical body parts: A retrospective study

Bone fractures that occur in earthquakes threaten human life. The study aims to localize the fractures in earthquake victims according to anatomical regions in the earthquake centered in Kahramanmaraş 2023. The study included 137 patients aged between 1-90 years diagnosed with fractures by an orthopedic physician. Radiographs were taken of patients admitted to the emergency department after the earthquake. The fractures diagnosed patients were evaluated and classified in anatomical regions and fracture type. The fractures were observed in females with high rates of fragmented (49.6%) and s ingle fractures (75.9%). The fractures also occurred on the right side (58.4%), in the upper extremities (37.2%) and long bones (38.7%). In the specific anatomic region evaluation of fractures; high rates were observed in manus (19%), antebrachi (15.3%), crus (13.9%) and pes fractures (12.4%). In the region of the most common fragmentary fracture type (48.9%); omos (3%), brachium (1%), thorax (15%), viscerocranium (7%) and neurocranium (3%), in oblique fractures (25.5%); pes (26%), in transverse fractures (20.4%); antebrachi (21%), manus (32%) and vertebral column (4%), in spiral fractures; pelvis (14%), femur (14%) and crus (57%) region. We determined that fractures frequently occur on the right-side extremities and, besides sequentially high rates at manus, antebrachii, crus, and pes. We recommend providing information about the protection of these anatomical parts in the training given to people during the earthquake closure and post-earthquake panic times to reduce earthquake-related fractures.

Comparison of 3D-navigation and fluoroscopic guidance in percutaneous pedicle screw placement for traumatic fractures of the thoracolumbar junction

IntroductionFractures of the thoracolumbar junction are the most common vertebral fractures and can require surgical treatment. Several studies have shown that the accuracy of pedicle screw placement can be improved by the use of 3D-navigation. Still only few studies have focused on the use of navigation in traumatic spine injuries. Research questionThe aim of this study was to compare the screw placement accuracy and radiation exposure for 3D-navigated and fluoroscopy-guided percutaneous pedicle screw placement in traumatic fractures of the thoracolumbar junction. Materials and methodsIn this single-center study 25 patients undergoing 3D-navigated percutaneous pedicle screw placement for traumatic fractures of the thoracolumbar junction (T12-L2) were compared to a control group of 25 patients using fluoroscopy. Screw accuracy was determined in postoperative CT-scans using the Gertzbein-Robbins classification system. Additionally, duration of surgery, dose area product, fluoroscopy time and intraoperative complications were compared between the groups. ResultsThe accuracy of 3D-navigated percutaneous pedicle screw placement was 92.66 % while an accuracy of 88.08 % was achieved using standard fluoroscopy (p = 0.19). The fluoroscopy time was significantly less in the navigation group compared to the control group (p = 0.0002). There were no significant differences in radiation exposure, duration of surgery or intraoperative complications between the groups. Discussion and conclusionThe results suggest that 3D-navigation facilitates higher accuracy in percutaneous pedicle screw placement of traumatic fractures of the thoracolumbar junction, although limitations should be considered. In this study 3D-navigation did not increase fluoroscopy time, while radiation exposure and surgery time were comparable.

Anterior odontoid lag screw fixation in type II odontoid fractures

Abstract Background Odontoid fractures are common cervical spine fractures, lead to atlantoaxial instability, and constitute 10–20% of all cervical fractures. Almost two-thirds of all dens fractures are classified as type II according to the Anderson and D’ Alonzo classification system. An increased rate of nonunion of type II odontoid fractures with conservative measures has been reported. The technique of direct anterior screw fixation of the odontoid fracture has become increasingly popular since Bohler reported its use in 1982, and it is now widely used to treat type II. Purpose To evaluate the safety and efficacy of the anterior transodontoid screw fixation in odontoid fractures. Patients and methods Ten patients underwent anterior transodontoid single screw fixation for type II odontoid fractures according to the Anderson and D’ Alonzo classification system. All patients were operated on less than 3 months following trauma. All patients were males apart from one female with their ages ranging from 20 to 59 years with a mean age of 33.9 years. Patients were evaluated clinically and neurologically according to the American Spinal Injury Association scale, and radiologically using plain radiograph, computed tomography scan, and MRI. Results Good clinical and radiological (bony or fibrous) outcomes were achieved in all patients with no screw loosening, backing out, or proximal migration. There were no complications related to surgical procedure or neurological deterioration. Conclusion Direct single anterior screw fixation has proved to be a very successful treatment method for type II odontoid fractures.

3D PRINTING IN COMPLEX TIBIAL FRACTURE CLASSIFICATION & PLANNING.

Tibial plateau fractures are common intra-articular fractures that pose classification and treatment challenges for orthopedic surgeons. This study examines the value of 3D printing for classifying and planning surgery for complex tibial plateau fractures. We reviewed 54 complex tibial plateau fractures treated at our hospital from January 2017 to January 2019. Patients underwent preoperative spiral CT scans, with DICOM data processed using Mimics software. 3D printing technology created accurate 1:1 scale models of the fractures. These models helped subdivide the fractures into seven types based on the tibial plateau's geometric planes. Surgical approaches and simulated operations, including fracture reduction and plate placement, were planned using these models. The 3D models accurately depicted the direction and extent of fracture displacement and plateau collapse. They facilitated the preoperative planning, allowing for precise reconstruction strategies and matching intraoperative details with the pre-printed models. Post-surgery, the anatomical structure of the tibial plateau was significantly improved in all 54 cases. 3D printing effectively aids in the classification and preoperative planning of complex tibial plateau fractures, enhancing surgical outcomes and anatomical restoration. Level of Evidence IV, Prospective Study.

A Cross-sectional Study on the Pattern of Skull Fractures in Fatal Two-wheeler Road Traffic Accidents at a Tertiary Care Hospital in Northeastern India

Introduction: Death due to Road Traffic Accidents (RTA) is one of the leading causes of mortality and morbidity in a developing country like India. As there is a paucity of literature on the nature and type of injuries in RTAs in the locality of Upper Assam, a retrospective study on postmortem cases of fatal two-wheeler accidents was conducted to address the magnitude of the problem. Aim: To analyse different types of skull fractures and causes of death among two-wheeler RTAs at tertiary care Hospital in Northeast India. Materials and Methods: The present cross-sectional study was conducted in the mortuary of Assam Medical College, Dibrugarh, Assam, India, for a period of one year from August 2020 to July 2021. The records of all RTA cases involving twowheeler motorcycles brought for postmortem examination during this period were studied for parameters including age, gender distribution, cause of death, type of skull fracture, intracranial haemorrhage, and time of occurrence, and analysed using descriptive statistics. Results: There were 532 fatal RTA cases recorded, out of which 292 involved two-wheelers (54.89%). Males (87.67%) outnumbered females (12.33%). The most affected age group was between 21-30 years with a total of 98 cases (33.56%), followed by 31-40 years with 68 cases (23.29%). Skull fracture was present in 103 cases (35.27%). Fissured fracture was the most common type seen in 64 cases (62.14%) followed by depressed fracture in 19 (18.45%). The most common single bone fracture was of the Temporal bone in 44 cases (42.72%), followed by frontal bone in 18 (17.48%). Coma was the most common cause of death, seen in 214 cases (73.29%), followed by haemorrhagic shock in 42 (14.38%). Subdural Haemorrhage (SDH) alone was the most common intracranial haemorrhage found in 159 cases (74.30%), followed by Extradural Haemorrhage (EDH) alone in 7 cases (3.27%). Conclusion: Injuries to the skull and brain are the leading cause of death in RTAs. Adequate measures should be taken to prevent mortality and morbidity, achievable through strict enforcement of road safety measures, awareness among the people, and improving road infrastructure along with emergency medical services.

Odontoid/Dens Fractures.

Odontoid fractures remain the most common C2 fracture and of those individuals older than 65 years. The type of optimal management remains in question given comorbidities, risk of nonunion, and limitations in mobility when surgical fusion is the treatment selected. These fractures are of particular importance, given the high incident of morbidity and mortality following an odontoid fracture. Overall quality of life remains a significant consideration when selecting the best intervention following careful examination and confirmation with radiographic imaging. The literature continues with controversies in the best treatment interventions for these fractures, resulting in a case-by-case decision-making process.

The Relationship Between Fracture and Mortality in a Chinese Maintenance Hemodialysis Patients Cohort.

Patients on maintenance hemodialysis have an increased risk of fracture. However, the relationship between fracture and poor prognosis is not clear. A total of 182 maintenance hemodialysis patients were enrolled in the study. The relationship between fracture and poor prognosis (cardiovascular events, stroke, malignancy and 5-year all-cause mortality) were analyzed. 21 of 182 patients had a history of fracture at the time of enrollment. 26 patients had a new fracture after enrollment. A total of 57 fractures occurred in 47 patients, the most common fracture site was the rib. Patients with fracture group had a higher proportion of elderly and female, higher serum phosphorus and B-type natriuretic peptide and lower hemoglobin, albumin, and potassium compared with those without fracture. Age (OR=3.809, 95% CI: 1.064-8.966, p=0.038), hemoglobin (OR=0.961, 95% CI: 0.925-0.997, p=0.035), and serum phosphorus (OR=3.325, 95% CI:1.104-10.019, p=0.033) were the independent risk factors of new fractures in MHD patients. The incidence of malignancy and 5-year all-cause mortality in patients with fracture was higher than those without fracture (p<0.05). But there was no significant difference in the incidence of acute myocardial infarction or stroke. 25.8% of maintenance hemodialysis patients had at least one fracture, with rib fractures accounting for the highest proportion. Age, hemoglobin and serum phosphorus were the independent risk factors of new fractures. The incidence of malignancy and 5-year all-cause mortality in patients with fracture was higher than those without fracture, but there was no significant difference in the incidence of acute myocardial infarction and stroke.

Results of fixation in the treatment of calcaneus fracture: a cross-sectional study

The calcaneus bone is the largest ankle bone and calcaneal fractures are the most common fracture of the tarsal bones and represent 1% to 2% of all fractures. Roughly 75% of these fractures are intra-articular, which despite the therapeutic interventions is still known as a fracture with poor therapeutic outcomes. This study investigated the results of fixation in the treatment of calcaneus fracture among patients referred to Shahid Sadoughi and Shahid Rahmonun hospitals in Yazd during 2017-2018. This is a cross-sectional study and the data obtained from the patients with intra-articular calcaneus fracture -diagnosed by simple x-ray and CT scan- was analyzed using SPSS and statistical tests. The fractures involving the subtalar joint were included in the study. Demographic information, postoperative complications, infection, and duration of treatment and recovery were also investigated. Thirty two patients were included in the study; 28 of them (87.5%) were males and 4 patients (12.5%) were females. 93.8% of the participants suffered from postoperative chronic pain, which was the most common complication in this study. 7 patients (21.9%) had an infection, 2 of them (6.3%) had sudeck’s atrophy, 2 patients (6.3%) had peroneal tendon pain, and one of them (3.1%) had calcaneocuboid. For 19 patients, the average pre and postoperative Bahler angle was 28.96±9.60 and 20.84±11.22, respectively (p-value=0.016, r=0.544), the average pre and postoperative Gissane was 136.15±10.54 and 142.93±16.60, respectively (p-value&lt;0.001), the average pre and postoperative calcaneal pitch angle was 24.44±6.02 and 23.36±5.11, respectively (p-value=0.023), the average pre and postoperative talocalcaneal angle was 43.20 ± 6.80 and 42.25 ± 6.19, respectively (p-value &lt; 0.001), the average pre and postoperative tibiotalar angle was 26.30±4.56 and 24.87±5.35, respectively (p-value=0.69), and the average pre and postoperative posterior surface slope was 28.96±9.60 and 20.84±11.22, respectively (p-value=0.016). The results showed that chronic pain is the most important postoperative complication in patients with calcaneus fractures, and surgery is somewhat effective in patients with calcaneus fractures.

Non-operative versus operative treatment of suprasyndesmotic ankle fractures: protocol for a prospective, multicentre, randomised controlled trial

IntroductionSurgery is widely recognised as the treatment of choice for suprasyndesmotic ankle fractures, because of the assumption that these injuries yield instability of the ankle joint. Stability assessment of ankle...

Epidemiological Characteristics of Pediatric Supracondylar of Humerus Fractures in a Tertiary Hospital in Iran.

Supracondylar humerus fracture (SHF) is the most common fracture observed in children. The present study aimed to assess the characteristic parameters in one of the most extensive available pediatric SHF series referred to a tertiary hospital in Iran. The medical profiles of the SHF patients who were referred to our tertiary hospital between January 2017 and January 2022 were retrospectively reviewed. The inclusion criteria entailed age < 14 years and a radiographically confirmed diagnosis of SHF. The collected data included age, gender, side of injury, mechanism of injury, season of the injury, concurrent complications, type of fracture, and treatment. A total of 1,309 patients with a mean age of 7.7±2.7 years were included in this study. The incidence of SHF was 1.8-fold higher in males, while the mean age of incidence was significantly lower in female patients (7.2 vs. 8 years; P<0.001). Falling was the most frequent mechanism of injury (97%). Gartland type I was the most prevalent type of injury (n=482; 36.8%). Moreover, the majority of fractures were extension-type (n=1,249; 95.4%). Most patients were managed conservatively (n=785; 60%). Concurrent fractures as well as neuralgic, vascular, and muscular complications were present in 3%, 1.45%, 1.22%, and 0.5% of patients, respectively. As evidenced by the results of this study, SHF is prevalent among the Iranian pediatric population. Therefore, greater awareness is required regarding the high incidence of this fracture in this population and its adequate management with respect to concurrent complications, particularly neurovascular compromise.

FUNCTIONAL OUTCOME OF INTRAARTICULAR DISTAL RADIUS FRACTURE TREATED WITH OPEN REDUCTION AND INTERNAL FIXATION WITH DORSAL PLATE

Background: Distal radius fractures are among the most common fractures and there is considerable disparity among surgeons regarding the best way to treat these patients. Intraarticular fractures are treated with open reduction and internal fixation with either dorsal or volar plates. Dorsal plating is not much popular due to its reported complications of extensor tendon irritation and rupture. We conducted this study to assess the functional outcome of dorsal plating in intraarticular distal radius fractures. Methods: A clinical prospective observational study was conducted at Kathmandu Medical College,Sinamangal. A total of 26 patients (male: 14; female: 12) of intraarticular distal radius fractures were enrolled and underwent open reduction and internal fixation using the dorsal plate. The functional outcome of dorsal plating was measured at 3 weeks,3 months and 6 months follow up. Results: All patients achieved a functional range of motion, with greater than 50 degrees of wrist flexion, 25 degrees of wrist extension, and 60 degree arc of pronation and supination. The functional outcome measured was found to be good to excellent with a mean Mayo Wrist score of 89.23(75-100) and Quick Dash-9 score of 9.20(2.75 to 22). There were 3 cases of extensor tendon irritation, which completely resolved and no cases of extensor tendon irritation at final follow up. Conclusions: Dorsal plating is a safe and effective way of treating intra articular distal radius fracture with good functional outcome.

Study of Prevalence, Clinical Pattern and Management of Maxillo-Facial Fractures in a Tertiary Care Centre

Introduction: Maxillofacial injuries are one of the most common injuries prevailing in society because of the strong reliance on road transportation. Road traffic accidents being the most common cause, affecting more than 20 million people worldwide. Multiple modality treatment is often required for the management of maxillofacial fractures, including clinical examination, radio-diagnosis and surgical intervention. 3-D CT face has helped in the reconstruction and reformation of fractures with some limitations to the same. Surgical management still holds a good approach towards the definitive management of maxillofacial fractures. Material and methods: Prospective observational study from 1st February 2021 to 31st July 2022. The parameters used were age, sex, time of incident, etiology, type of vehicle used with preventive measures, type of fractures, and treatment received. All patients underwent proper history taking, clinical examination, radiographic evaluation, and 3-D CT face reconstruction. Results: About 104 patients of maxillo-facial fractures presented to the emergency room of SRMS-IMS, Bareilly, out of which 63 patients were treated with surgical management Conclusion: The study concluded that RTAs were the major cause of maxillofacial trauma with the mandible being the most common bone fracture. ORIF with mini-plate fixation as treatment. lack of helmet and seat belt use, alcohol abuse, over-speeding and failure to follow traffic rules and regulations were the contributing factors

Comparative study of radiological outcomes of intertrochanteric fractures managed with intra medullary nailing with or without intraoperative temporary K-wire’s stabilization

Background: Inter-trochanteric fractures are one of the most common hip fractures, occurring in both young adults and the elderly, as a result of high-energy trauma or low-energy trauma. These fractures are three to four times more common in elderly women with osteoporosis. The primary concern with Intertrochanteric fractures is the 20% to 30% mortality risk in the first year after the fracture. Methods: Various methods of fracture fixation have been used in treating this fracture with intramedullary nailing has been the most favoured. In this modality maintenance of reduction during and after fixation remains a concern. The temporary stabilization of fracture with K-wires for minimally invasive fixation of Intertrochanteric fracture with an intramedullary nail is advocated and aids in keeping the fracture reduction in place while proximal reaming and nail introduction. Results: In this study a total of 80 patients with intertrochanteric fractures were included, of which 45 patients operated with temporary K-wire, 43 patients reduction was maintained and loss of reduction was noted in 2 patients (4.4%) and 35 patients operated without K-wire, 29 patients reduction maintained and lost in 6 patients (17.1%). Conclusions: There was no statistically significant, difference in the 2 groups with respect to intra/post-operative loss of reduction. Having a larger study group the results may have a statistically significant outcome.

Prospective study of surgical management of femoral shaft fractures in children using tens nail

Background: Pediatric femoral shaft fractures are uncommon, constituting less than 2% of all fractures in children; yet they are a significant burden on healthcare systems and families as they are the most common fractures requiring hospitalization in children. In the recent studies, technique of flexible stable intra medullary pinning using titanium pins which is now popularly known as TENS has become the choice of operative management for pediatric femoral shaft fractures. We conducted a clinical prospective study on the use of Titanium Elastic Nailing System (TENS) for the treatment of femoral shaft fractures in children. Methods: This prospective study was carried out at Al-Ameen Medical College and Hospital, Vijayapura. Forty patients (32 males and 8 females) aged between 5-15 years with diaphyseal femur fracture were included in our study. Patients were treated with closed reduction and internal fixation with TENS. They were followed up for 6 months both clinically and radiologically. The functional outcome was evaluated using Flynn’s scoring criteria. Results: Forty patients were followed up for 6 months and their results were evaluated. The functional outcome using Flynn’s criteria was excellent in 24 patients, satisfactory in 14 patients and poor in 2 patients. Complications observed were limb length discrepancy, knee stiffness, superficial infection and nail protrusion. Conclusions: TENS has the advantages of early union, early mobilization, and manageable complications, making it an excellent choice for treating paediatric shaft femur fractures in patients aged 5 to 15 years.

Effect of a Multicomponent Intervention with Tele-Rehabilitation and the Vivifrail© Exercise Programme on Functional Capacity after Hip Fracture: Study Protocol for the ActiveFLS Randomized Controlled Trial.

Hip fractures are the most common fracture leading to hospitalization and are associated with high costs, mortality rates and functional decline. Although several guidelines exist for preventing new fractures and promoting functional recovery, they tend to focus on osteoporosis treatment and do not take into account the complexity of frailty in older adults and geriatric syndromes, which are important factors in individuals at risk of suffering from frailty fractures. Moreover, most health systems are fragmented and are incapable of providing appropriate management for frail and vulnerable individuals who are at risk of experiencing fragility fractures. Multicomponent interventions and physical exercise using tele-rehabilitation could play a role in the management of hip fracture recovery. However, the effectiveness of exercise prescription and its combination with a comprehensive geriatric assessment (CGA) is still unclear. This randomized clinical trial will be conducted at the Hospital Universitario de Navarra (Pamplona, Spain). A total of 174 older adults who have suffered a hip fracture and fulfil the criteria for inclusion will be randomly allocated to either the intervention group or the control group. The intervention group will receive a multicomponent intervention consisting of individualized home-based exercise using the @ctive hip app for three months, followed by nine months of exercise using Vivifrail. Additionally, the intervention group will receive nutrition intervention, osteoporosis treatment, polypharmacy adjustment and evaluation of patient mood, cognitive impairment and fear of falling. The control group will receive standard outpatient care according to local guidelines. This research aims to evaluate the impact of the intervention on primary outcome measures, which include changes in functional status during the study period based on the Short Physical Performance Battery. The findings of this study will offer valuable insights into the efficacy of a comprehensive approach that considers the complexity of frailty in older adults and geriatric syndromes, which are important factors in individuals at risk of suffering from frailty fractures. This study's findings will contribute to the creation of more effective strategies tailored to the requirements of these at-risk groups.