Common Fracture Type Research Articles

Epidemiology of more than 50,000 ankle fractures in the Swedish Fracture Register during a period of 10 years

BackgroundDespite being one of the most common types of fracture, there is a lack of epidemiological studies involving ankle fractures of all kinds. Since 2012, the Swedish Fracture Register (SFR) has prospectively collected data on surgically and non-surgically treated ankle fractures. The aim of this study is to describe the epidemiology of ankle fractures between 2012 and 2022.MethodsAll ankle fractures registered in the SFR between 1 April 2012 and 31 March 2022 in patients aged 16 years or older were included. Information on age, sex, mechanism of injury, fracture classification according to AO/OTA and high- or low-energy trauma was retrieved from the SFR.ResultsDuring the study period, 56,439 patients sustained 57,443 ankle fractures. Women (61%) were more commonly affected than men (39%). The mean age at the time of injury was 55 years. Men were found to be younger at the time of injury compared with women. Women were found to sustain open fractures more frequently, whereas the men more frequently sustained high-energy trauma. The most common mechanism of injury for all ankle fractures and for each AO/OTA44 fracture group separately was a simple fall. A seasonal variation in ankle fractures was found, where the number of ankle fractures peaked during the between November and March.ConclusionsThis study presents the epidemiology of all AO/OTA types of ankle fractures. We have demonstrated that most ankle fractures are caused by a simple fall and occur during wintertime. Women are more commonly affected than men and are older at the time of injury. These findings indicate that age-related skeletal fragility, as well as an increasing risk of simple falls in the elderly, may be risk factors for ankle fractures. This study will contribute to the planning of primary prevention for ankle fractures.

ANATOMY, EPIDEMIOLOGY, DIAGNOSIS, MANAGEMENT AND TREATMENT OF THE METACARPAL FRACTURES

Introduction: The fracture of the neck of the fifth metacarpal, also known as boxers fracture, is one of the most frequent traumatic pathologies seen in the emergency department and is usually treated with conservative measures. The fifth metacarpal is the most frequently fractured, representing almost 25% of all metacarpal fractures and 10% of all fractures. Objective: to define and explore the anatomy, epidemiology, approach, diagnosis, management and treatment of metacarpal fractures. Methodology: a total of 40 articles were analyzed in this review, including review and original articles, as well as cases and clinical trials, of which 26 bibliographies were used because the information collected was not important enough to be included in this study. The sources of information were Cochrane, PubMed and Google Scholar, SciElo; the terms used to search for information in Spanish, Portuguese and English were: fractura del boxeador, fratura do metacarpo, fracture of the fifth metacarpal and boxers fractures. Results: About 30% of all hand fractures and 18% of all below-elbow fractures are metacarpal fractures. Small-finger neck fractures and ring-finger shaft fractures are among the most frequent metacarpal fractures.To diagnose the boxers fracture and evaluate the degree of angulation, plain radiographs are the gold standard. Fractures with significant angulation require closed reduction and splinting. Surgical management can result in hardware-related issues such as adhesions, infection, and tendon rupture, whereas a more conservative approach may result in malunion or stiffness due to immobilization. Conclusions: Uncomplicated fractures of the fifth metacarpal are usually treated with immobilization and splinting or neighboring strapping, with a comparable degree of functional outcome. In Metacarpal head fractures nonoperative treatment options include immobilization in the intrinsic plus position. Small finger metacarpal neck fractures are the most typical and are frequently referred to as boxers fractures. Metacarpal fractures that have no associated rotational deformity can typically be managed conservatively with immobilization and serial radiographs. The use of the Jahss maneuver can result in reduction of fractures with rotational deformity or pseudoclawing. The most common types of metacarpal shaft fractures are transverse fractures, oblique fractures, and comminuted fractures. Operative intervention should be taken into consideration if there is pseudoclawing, rotational deformity, significant metacarpal shortening, or a noticeable dorsal deformity. Despite being a rare injury, intra-articular base fractures of the index- through ring-finger metacarpals have been suggested to be an underreported and misdiagnosed condition. Complications related to these injuries are prevalent and may result from surgical or non-surgical treatment of the initial injury. KEYWORDS: fracture of the fifth metatarsal, Boxers Fracture, hand injury.

The Prevalence of maxillary fractures in trauma patients referred to Shahid Rajaei Hospital in Shiraz from 2011 to 2021

Introduction: Maxillofacial fractures are one of the most common fractures in the body due to trauma. Maxillary fractures, especially Lefort fractures, are common fractures. The aim of this study is to evaluate the prevalence and etiology of Lefort fractures in patients referred to Shahid Rajaei Hospital during 2011 to 2021.
 Materials and Method: In this cross-sectional study, 2700 patients who referred to the maxillofacial surgery department of Shahid Rajaei Hospital in Shiraz between 2011 to 2021 due to trauma and fractures of the jaw and face were examined. 903 cases were related to patients with upper jaw fracture and were included in the study. The demographic information of the patients, including age, sex, cause of trauma, and also the type of fracture, were extracted from their records. The etiology of maxilla fracture was divided into three groups: vehicle accidents, violence and interpersonal conflict, and accidents during work and sports. Finally, in order to analyze the data, it was done through statistical tests.
 Results: 65% of patients were male and 35% were female. The average age of people was 38.5 years. Lefort I fracture was reported in 25% of patients, Lefort II fracture in 31% and Lefort III fracture in 11% of patients. 46% of patients had fractured maxilla due to vehicle accidents, 26% of patients due to interpersonal violence, and 27% of patients due to accidents during work and sports.
 Conclusion: The prevalence of Lefort fracture in men is significantly higher than in women. In our society, injuries caused by road accidents, especially car accidents, are the most common causes of Lefort fractures. The most common type of Lefort fracture is Lefort II fracture. Of course, the cause of injury has an important effect on the pattern of injury.

Epidemiological study of zygomatic bone fractures: A five-year retrospective analysis of a single-center experience

Introduction. Zygomatic bone fractures are prevalent in the maxillofacial region. This study aims at analyzing the epidemiology and clinical presentation of isolated zygomatic bone fractures. Material and Methods. The retrospective study, conducted at the Clinic of Maxillofacial Surgery of the University Clinical Center of Vojvodina, included 128 patients diagnosed with isolated zygomatic bone fractures. The following parameters were taken into consideration: gender, age, trauma etiology, clinical presentation, computed tomography analysis of the fracture localization and pattern. The fractures were classified into five groups according to Zingg classification system. Results. The study included patients aged 10-82 divided into four groups, with the most affected group being 30-49 years old. Men were more often treated for zygomatic bone fractures (male: female ratio 3:1). Left-sided fractures of the zygomatic bone occurred more often (55.2%) than the right-sided ones. Type B was the most common type of fracture, while the zygomaticomaxillary buttress fracture was the most common injury. Early treatment was administered in 78 patients (60.94%), while 50 patients (39.06%) underwent delayed reconstruction. The analysis of complications concerning the time of surgical intervention revealed a higher incidence of ectropion in cases treated early, while infraorbital paresthesia and facial asymmetry were more prevalent in cases treated late. Conclusion. Zygomatic bone fractures have high morbidity risk, and may cause temporary incapacity to work, and potentially permanent and functional damage.

Characteristics of Plate and Screw Fixation in Tibial Shaft Fracture at Sanjiwani General Hospital Gianyar in 2021: A Retrospective Descriptive Study

Tibial shaft fracture is the most common fracture condition since the position of the tibia bone is close to the subcutaneous tissue. The incidence of tibial shaft fractures is 16.9/100,000 per year, with males between 10-20 years of age having the highest incidence. The operative procedure for it is closed intramedullary nailing as the gold standard in this case, and plate fixation as an alternative procedure. This study aims to determine the characteristics and complications of the ORIF P/S procedure, considering that the gold standard, in this case, is the intramedullary nail. This research is a descriptive-retrospective study. The sample of this study was obtained from secondary data from medical records of patients with tibial shaft fractures in adults at Sanjiwani Gianyar Hospital from January 2021-December 2021. Data collection was taken using the Total Sampling method. The research variables were age, gender, fracture type, fracture location, surgery method, and complications. The results showed 16 patients with tibial shaft fractures in adults. Males were the most common sex, with a percentage of 68%; the highest age was in the 18-59 years old category, with a rate of 69%, and the most common type of fracture was closed fracture, with a percentage of 56%. Most fracture locations are on the right side, with a rate of 62.2%. All surgery used the ORIF P/S method with a percentage of 100%. Complications obtained were infection, with a percentage of 6.2%, and delayed union, with a rate of 6.2%.

Clinical and Radiographical Evaluation of Displaced Supracondylar Humerus Fractures in Children with Open Reduction and Internal Fixation from Lateral Approach at Dr. Soedirman Hospital in Kebumen

ABSTRACT Supracondylar humerus fracture is the most common elbow fractur in children. This fracture requires proper diagnosis and treatment, otherwise it can cause functional impairment and complications. This study aims to assess outcome of displaced supracondylar humerus fracture in children by open reduction and pining from lateral approach. This research was descriptive quantitative using a retrospective method. All cases Gartland type III of supracondylar humerus fractures in children at Dr. Soedirman Hospital in Kebumen for 2015-2020, treated with open reduction and internal fixation from lateral approach. Outcomes were assessed according to the Flynn’s criteria and Mayo Elbow Performance Score. There were 59 patients, the age 3-15 years and the mean age 6.8 years. More cases were found in boys (59.3%) than girls (40.7%). The most common type of fracture was extension (98.3%). The side of fracture was more the left and was the non-dominant extremity (56%). No infection, vascular and nerve injuries. According to Flynn's criteria, cosmetic outcome in 55 of the 59 patients (93.2%) was excellent, in 4 patients (6.8%) good (P=0.051). Also, the functional outcome in 59 patiens (100%) were excellent. According to MEPS scoring, functional outcome in 58 patients (98.3%) was excellent and 1 patient (1.7%) had good. Overall, all cases were judged satisfactory (P=0.043). Treatment of supracondylar humerus fractures in children with open reduction and internal fixation from lateral approach is a safe with good clinical and radiographic results and can be applied. Keywords: Supracondylar Fractures, Open Reduction, Lateral Approach, Children.

Radiological measurement parameters of distal radius and wrist measured on X-rays in the Turkish population.

The aim of our study was to analyze the radiologic morphometry of the distal radius and wrist to assess acceptable limits for restoring normal wrist function after fracture. Radiological measurement parameters were measured retrospectively on anteroposterior and lateral (LAT) wrist radiographs (n=981). Radiological measurement parameters were volar tilt, radial inclination, radial height, ulnar variance, radiocarpal angle, and volar angulation angle. The patients' age, gender, and side of the radiograph were recorded as demographic data. The mean volar tilt angle was 15.4±4.3 degrees. The mean radial inclination angle in males was 26.8±3.6 degrees. The mean radial height was 13.6±2.1 mm. The mean ulnar variance was 0.8±1.9 mm. One hundred and eighty-nine patients had negative ulnar variances. The mean radiocarpal angle was 12.3±2.7. The mean volar angulation angle was 32.1±6.9 degrees. Radial height was found to be positively correlated with radial inclination (p<0.001; r: 601), but it was not significantly correlated with ulnar variance (p=0.14). Distal radius fractures are one of the most common types of fractures. Radiological measurement parameters were used in the determination and follow-up of the treatment. The values obtained in this study belong to the Turkish population. These values may be used as reference values in determining the quality of reduction after fracture and in the design of suitable implants for fracture treatment.

Does posterior approach always lead to poor functional and cosmetic outcomes in displaced pediatric supracondylar humeral fractures?

Supracondylar humerus fractures (SCHFs) are the most common types of elbow fractures in children. Closed reduction percutaneous pinning (CRPP) is the primary surgical treatment of SCHFs. In cases that cannot be managed with closed reduction, treatment with open reduction and internal fixation (ORIF) is necessary. We aimed to compare CRPP and ORIF through a posterior approach regarding clinical and functional outcomes in pediatric SCHF cases. Patients with Gartland type III SCHF who underwent CRPP or ORIF with posterior approach at our clinic between January 2013 and December 2016 were included in this retrospective study. A total of 60 patients who underwent surgical treatment and had available data on our hospital database and no additional injuries were included in the study. We analyzed their data concerning age, gender, fracture type, neurovascular damage, and surgical treatment. In addition, we inspected the patients' anteroposterior and lateral radiographs at 1-year follow-up visits for Baumann (humerocapitellar) angle (BA) and carrying angle (CA) and checked their go-niometer assessments of elbow range of motion (ROM). The cosmetic and functional outcomes were determined using Flynn's criteria. Demographic, preoperative, and post-operative data of 60 patients between the ages of 2-15 were analyzed. 46 of these patients had CRPP, and 14 had posterior ORIF. CA, Baumann angle, and lateral capitello-humeral angle were measured for fractured elbow and contralateral elbow and compared statistically. There was no statistically significant difference between the two surgical ap-proaches in terms of CA (p=0.288), Baumann's angle (p=0.951) and LHCA (p=0.578). At the end of 1-year follow-up, elbow ROM was measured, and there was no statistically significant difference between the two groups (p=0.190). Furthermore, there is no statistically significant difference between the two surgical approaches in terms of both cosmetic (p=0.814) and functional (p=0.319) outcomes. A comprehensive literature review of pediatric SCHF shows that surgeons do not frequently prefer posterior incisions in Gartland type III fracture that cannot be managed with closed reduction. However, posterior open reduction is a safe and effective method since it provides more control over the distal humerus, allows for a complete anatomical reduction involving both cortices, reduces the risk of ulnar nerve injury, thanks to the nerve exploration, and yields positive cosmetic and functional outcomes.

Impact of Preoperative Neuropraxia on Surgical Duration Following Pediatric Supracondylar Fracture of the Humerus: A Retrospective Cohort Study

Abstract Background Supracondylar fractures of the humerus (SCFHs) are the most common type of elbow fracture in children. Because of the influence on functional outcome, neuropraxia is one of the most common concerns at presentation. The impact of preoperative neuropraxia on surgery duration is not extensively probed. The clinical implications of several other risk factors associated with preoperative neuropraxia at presentation may contribute to longer surgical duration of SCFH. Hypothesis Preoperative neuropraxia is likely to increase surgery duration in patients who sustained SCFH. Patients and Methods This is a retrospective cohort analysis. Sixty-six patients who sustained surgical pediatric supracondylar humerus fracture were included in the study. Baseline characteristics including age, gender, the type of fracture according to Gartland classification, mechanism of injury, patient weight, side of injury, and associated nerve injury were included in the study. Logistic regression analysis was performed using mean surgery duration as the main dependent variable and age, gender, fracture type according to the mechanism of injury, Gartland classification, injured arm, vascular status, time from presentation to surgery, weight, type of surgery, medial K-wire use, and afterhours surgery as the independent variables. A follow-up of 1 year was implemented. Result The overall preoperative neuropraxia rate was 9.1%. The mean surgery duration was 57.6 ± 5.6 minutes. The mean duration of closed reduction and percutaneous pinning surgeries was 48.5 ± 5.3 minutes, whereas the mean duration of open reduction and internal fixation (ORIF) surgeries was 129.3 ± 15.1 minutes. Preoperative neuropraxia was associated with an overall increase in the surgery duration (p &lt; 0.017). Bivariate binary regression analysis showed a significant correlation between the increase of surgery duration and flexion-type fracture (odds ratio = 11, p &lt; 0.038) as well as ORIF (odds ratio = 26.2, p &lt; 0.001). Conclusion Preoperative neuropraxia and flexion-type fractures convey a potential longer surgical duration in pediatric supracondylar fracture. Level of Evidence Prognostic III.

Management of extra-articular distal radius fracture treated with plaster and percutaneous pinning

A break in the distal radius is among the most common types of bone fractures. These fractures manifest themselves at the wrist, which is where the radius bone comes to an end. However, there has been no consensus reached regarding the proper manner in which these injuries should be defined, treated, or evaluated (1). An effective method to restore articular congruity following a distal radius fracture was to use a volar approach, indirect reduction, and locked plate fixation. Methods: An extensive search of all materials related to the topic was carried out in the PubMed and Google Scholar search engines. Relevant research articles focusing on “Management Of Extra -Articular Distal Radius Fracture Treated With Plaster And Percutaneous Pinning” published in the period 1999–2019 were included in the review. A total of 11 studies similar to the current study objectives were included in the study and analyzed. Conclusion: As reviewed the literature, Patient has better outcome in range of motion and less stiffness in percutaneous pinning compared to plaster immobilization group. Functional outcome and radiological outcome is better in percutaneous pinning compared to plaster immobilization.

Our clinical experiences in the earthquake victims who came to our university after the 2020 Aegean Sea earthquake during the COVID-19 pandemic.

Earthquakes are natural disasters that threaten human life and cause loss of life and property in a very short time. In our study, we aim to carry out the medical analysis of the earthquake victims who came to our hospital after the Earthquake in the Aegean Sea and to share our clinical experiences. We retrospectively analyzed patients the medical data records of earthquake victims brought to our hospital or the injured who applied due to the Aegean Sea earthquake. Patients demographic data, their complaints and diagnoses, hour of admission, their clinical courses, hospital arrangements (admission, discharge, and transfer), time spent until the operation, anesthesia methods, surgical intervantions, intensive care needs, crush syndrome, presence of acute renal failure, number of dialysis, mortality, and mor-bidity were reviewed. A total of 152 patients were brought to our hospital due to the earthquake. The most intense period of admission to the emergency department was the 1st 24-36 h. Mortality rate was found to be higher depending on the increase of age. While the most common cause of admission for the mortal earthquake survivors was to be trapped in the wreckage, the survivors applied for other reasons as well such as falling down. The most common type of fracture observed in survivors was the lower extremity fractures. Epidemiological studies can make an important contribution to the management and organization of the future earthquake-related injuries by healthcare institutions.

Surgical Results of Anteromedial Plate Osteosynthesis for Diaphyseal Humerus Fracture

Background: Humeral shaft fracture management has always been controversial. There are proponents for both conservative and operative management with intramedullary nailing as well as plate osteosynthesis. Anteromedial plating of shaft fractures has not been regularly described. This study was conducted to evaluate the viability of anteromedial plating as an alternative to anterolateral and posterior plating for diaphyseal humerus fractures. Materials and Methods: The study was conducted at a tertiary care center. Inclusion criteria comprised: age more than 18 years, and diaphyseal humerus fracture treated with anteromedial plating using the anterolateral approach with a minimum follow-up of 6 months. Exclusion criteria included: pathological fracture, grade open III fractures, nonunion, intra-articular fractures, preoperative radial nerve palsy, nonconsent, and loss to follow-up. Functional outcome was evaluated at 6 months using the QuickDASH score. Results: Out of 44 volunteers, 28 (64%) were male and 16 (36%) were female. The mean age of the volunteers was 36 ± 13 years. The most common fracture type encountered was 12-A2 (41%). The mean operative time was 61.27 ± 10.3 min, and the mean perioperative blood loss was 308 cm3. The mean time for the radiological union was 13.9 weeks. One patient developed postoperative radial nerve palsy. The mean DASH score at 6 months was 13.5 ± 3.2. Conclusion: Anteromedial plating humerus using anterolateral approach provides a safe and viable alternative to lateral and posterior plating with regard to operative time, perioperative blood loss, complications, and functional recovery.

Clinical outcomes of the intramedullary femoral nailing system in the treatment of femoral fractures

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Femoral fractures are a common type of fracture brought on by large force impaction. This study's objective was to clinically assess the results of using an intramedullary femoral nailing system to treat femoral fractures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 32 patients with femoral fractures are included in this retrospective clinical trial. They are all treated with an intramedullary femoral nailing system made by Kaulmed private limited in Sonipat, Haryana, India. This system includes KN-1 advance nails (PFNA), KN-6 femur nails (retrograde Nails), KN-3 nails type II (gamma nails), KN-2F femur nails (expert femoral nails), and KN-5F universal intramedullary cannulated femoral nails. There were 32 patients, with 15 from one hospital and 17 from the other. The first hospital group consisted of 8 men and 7 women, with an average age of 32 years and the second hospital group consisted of 9 male and 8 female with mean age of 40.5 years. The fractures were categorized based on AO classification and pre-operative fitness was assessed using American society of anaesthesiologist (ASA Grade). The clinical effectiveness was evaluated using the VAS score and anatomical results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Surgery was performed on 32 patients with at-least three post-operative follow-up visits in 180 days. No patient in any group complained after the final follow up about complications or hardware problems, and every patient's bone union was achieved successfully. Radiological outcomes also showed proper union at 6 months. &lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; In femoral fractures, the intramedullary femoral nail provides better results with a high rate of union and postoperative composure.&lt;/p&gt;

Management of Osteoporotic Vertebral Fracture: Review Update 2022.

A vertebral fracture is the most common type of osteoporotic fracture. Osteoporotic vertebral fractures (OVFs) cause a variety of morbidities and deaths. There are currently few "gold standard treatments" outlined for the management of OVFs in terms of quantity and quality. Conservative treatment is the primary treatment option for OVFs. The treatment of pain includes short-term bed rest, analgesic medication, anti-osteoporotic medications, exercise, and a brace. Numerous reports have been made on studies for vertebral augmentation (VA), including vertebroplasty and kyphoplasty. There is still debate and controversy about the effectiveness of VA in comparison with conservative treatment. Until more robust data are available, current evidence does not support the routine use of VA for OVF. Despite the fact that the majority of OVFs heal without surgery, 15%-35% of patients with an unstable fracture, persistent intractable back pain, or severely collapsed vertebra that causes a neurologic deficit, kyphosis, or chronic pseudarthrosis frequently require surgery. Because no single approach can guarantee the best surgical outcomes, customized surgical techniques are required. Surgeons must stay current on developments in the osteoporotic spine field and be open to new treatment options. Osteoporosis management and prevention are critical to lowering the risk of future OVFs. Clinical studies on bisphosphonate's effects on fracture healing are lacking. Teriparatide was intermittently administered, which dramatically improved spinal fusion and fracture healing while lowering mortality risk. According to the available literature, there are no standard management methods for OVFs. More multimodal approaches, including conservative and surgical treatment, VA, and medications that treat osteoporosis and promote fracture healing, are required to improve the quality of the majority of guidelines.

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

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

Traumatic dental injuries in adults attending a London-based trauma clinic in the UK: a seven-year survey

Introduction This survey reports the incidence of traumatic dental injuries in an adult population attending an adult dental trauma clinic in a London teaching hospital.Materials and methods Retrospective data were collected from patients attending an adult dental trauma clinic between 2012 and 2018.Results In total, 1,769 patients attended, with more men seen (1,030; 58.2%) compared to women (739; 41.8%) and this was statistically significant (p <0.05). The most common aetiological factor was an accidental fall (728; 41.15%), followed by assaults (413; 23.35%), bicycle accidents (253; 14.3%), sports injuries (132; 7.46%) and road traffic accidents (84; 4.75%). Lateral luxation (833) was the most common traumatic injury and this was followed by avulsions (362; 17%). Enamel-dentine fractures were the most common type of fracture injury (1,273; 64%).Discussion This retrospective survey attempts to report on the incidence of traumatic dental injuries in a London-based cohort of patients attending a specialised dental trauma clinic. In line with other reports, there were more men than women affected, which is probably attributed to behavioural activities.Conclusion(s) Accidental falls are the most common cause of a traumatic dental injury, lateral luxation was the most common type of displacement injury and enamel-dentine fractures were the most common type of fracture injury.

Current Evidence for the Management of Edentulous Atrophic Mandible Fractures: A PRISMA-SWiM Guided Review.

PRISMA-SWiM guided systematic review. 1. Provide consistent evidence regarding the management of atrophic mandible fractures; 2. To search, evaluate and validate existing guidelines if any for the management; 3. Provide evidence regarding specific management of condylar fractures in the atrophic mandible; 4. To address the clinical applicability of bone grafts. A systematic review was conducted using the PRISMA-SWiM protocol. PROSPERO ID: CRD42021235111. Studies with adequate data on outcome, treatment methods were selected. Isolated case reports, case series, and non-human studies were excluded. Quality assessment was done using Newcastle -Ottawa scale. The level of evidence was assessed using Oxford Level of Evidence. Mandibular body was the most common type of fracture. Self falls and RTA were the most common etiologies. Condylar fracture was most commonly managed conservatively with ORIF employed in few studies. For the mandible compression and non-compression osteosynthesis were used. Bone grafts were used in cases with segmental defects or cases requiring augmentation. There is lack of proper evidence to definitely conclude any single treatment modality. However, the consensus is towards ORIF. Reconstruction plates are preferred by many authors. However, unilateral fractures may be managed by miniplates. Bilateral fractures require more rigid fixations. Open reduction and internal fixation of condylar fracture is indicated in cases with displacement or low-level fractures.

Effectiveness of Absorbable Plates for the Treatment of Nasal Septal Cartilage Fractures.

Nasal bone fractures are the most common type of facial fracture. Nasal bone fractures often occur in combination with septal cartilage fractures, because the nasal septal cartilage acts as a vertical strut and provides structural support for the nose and bilateral nasal airway. However, the treatment for nasal septal cartilage fracture remains controversial, and if untreated, nasal septal cartilage fracture can lead to various complications, such as nasal obstruction and posttraumatic nasal and septal deformity. This study aimed to evaluate the effectiveness and safety of our procedure in which septal cartilage fractures were treated with septoplasty using an absorbable plate as an internal splint. Between January 2017 and November 2020, 21 patients with nasal septal cartilage fractures were treated with septoplasty using an absorbable plate as an internal splint. The severity of the septal cartilage fracture was graded from 0 to 3 according to the computed tomography septal grading system. The numeric graded scale of nasal septal cartilage fracture was evaluated preoperatively and 6 months postoperatively using a computed tomography scan. Of 21 patients with septal cartilage fractures, 12 were treated with a polycaprolactone (PCL) mesh plate, and 9 were treated with a polydioxanone (PDS) plate. In the PDS plate group, the preoperative numeric scale of nasal septal cartilage fracture was 2.50 (2.00-3.00), whereas the postoperative numeric scale was 1.00 (1.00-1.25, P = 0.023). In the PCL mesh plate group, the preoperative numeric scale of nasal septal cartilage fracture was 2.00 (2.00-3.00), whereas the postoperative numeric scale was 1.00 (1.00-1.50, P = 0.034). The effectiveness of the PCL mesh plate and that of the PDS plate group according to the septal grading scale were 1.45 (SD, 0.522) and 1.18 (SD, 0.603), respectively. However, these differences were not statistically significant. Our study shows that septoplasty using absorbable plates provides satisfactory and safe clinical outcomes in patients with nasal septal cartilage fractures.

Closed reduction with percutaneous Kirschner wire drill-and-pry for pediatric supracondylar humeral fractures with bony callus formation and delayed presentation

BackgroundSupracondylar humeral fractures are the most common type of pediatric elbow fractures, and are primarily treated using closed reduction and percutaneous pinning. For patients who are treated ≥14 days after the injury, after callus formation has occurred, closed reduction is usually not possible. The purpose of this study is to report the clinical outcomes of closed reduction with percutaneous Kirschner wire (K-wire) drill-and-pry for the delayed treatment of pediatric supracondylar humeral fractures with bony callus formation. MethodsWe retrospectively reviewed the data of 16 patients who underwent percutaneous K-wire drill-and-pry between November 2019 and August 2021 for the treatment of supracondylar humeral fractures with bony callus formation ≥14 days after the injury. Clinical outcomes were assessed using the Flynn criteria. The postoperative Baumann angle and pin configuration were evaluated using x-ray examinations. ResultsAll patients were followed up for 8–28 months (average, 16.63 months). The fractures healed in 4–6 weeks (average, 4.38 weeks). The operative time ranged from 10 to 124 min (average, 35.12 min). No iatrogenic vascular or nerve injury occurred. No patient developed cubitus varus. According to the Flynn criteria, 12 patients had excellent outcomes, 2 patients had good outcomes, 1 patient had a fair outcome and 1 patient had a poor outcome. ConclusionClosed reduction with percutaneous K-wire drill-and-pry is a mini invasive technique for supracondylar humeral fractures with bony callus formation in children. Most patients had a good clinical and cosmetic outcomes without scarring.

Efficacy of closed reduction of nasal fractures—a retrospective analysis with focus on factors affecting functional and aesthetic outcomes

Nasal bone fractures are the most common type of facial bone fractures. While the nasal anatomy and closed reduction techniques of nasal fractures are well described, there is a paucity of data reporting on the need for revision rhinoplasty. The objective of this study is to analyze the factors affecting the outcome and need for revision rhinoplasty in patients who underwent closed reduction for nasal bone fracture. From 2010 to 2020, a total of 417 consecutive patients underwent closed nasal reduction. Medical files of the patients were reviewed retrospectively. The rate of rhinoplasty after fracture consolidation was determined. Factors influencing the need for revision rhinoplasty were assessed using univariable and multivariable logistic regression analyses. Forty-seven patients (11.3%) required revision rhinoplasty after fracture healing. Patients who had suffered an additional septum fracture were more likely to undergo rhinoplasty. The risk of the need for open revision rhinoplasty after fracture healing was increased for patients complaining of airway obstruction at the time of cast removal after closed reduction. A certain number of patients will require secondary revision rhinoplasty after closed reduction of a nasal fracture. Subjective airway obstruction at the time of cast removal after closed reduction is a predictor for revision rhinoplasty. Prospective studies are required to support the findings of this investigation.