Degree Of Fracture Displacement Research Articles

Prognosis of teeth in the line of jaw fractures.

The decision as to whether teeth in the line of jaw fractures should be extracted or retained remains a controversial issue. The aim of this study was to assess the prognosis of teeth directly in the line of, and adjacent to, jaw fracture sites. The study consisted of 50 patients with facial fractures in the dentate region, the diagnosis of which was made on the basis of clinical and radiographic examinations. A total of 124 teeth were present in 69 fracture sites (50 patients), of which 89 teeth were evaluated both, clinically (tooth mobility, pocket depth, pulp sensibility) and with periapical radiographs (degree of fracture displacement, marginal bone loss, root resorption). The results revealed that 61.9% of teeth in directly in the line of fractures showed no response to electric pulp testing compared with 48.9% teeth adjacent to fractures. The maximum frequency of non-responsive teeth was observed in Type I fractures followed by Type II fractures. Response to pulp tests was highly significant at postoperative 3- and 6-month periods (Wilcoxon's test). There was continuous reduction in the measurement for mean pocket depth at both test and control sites of teeth. The measurement of marginal bone levels of teeth in the line of fractures revealed a significant reduction (P < 0.01) from preoperative to postoperative 7-day period only. In teeth adjacent to fracture sites, the mean marginal bone levels of control site and test sites were not significant at any time interval. There was no difference in postoperative complications pertaining to whether the tooth at the fracture site was extracted or retained. Teeth in line of jaw fractures should not be removed on a prophylactic basis and should be followed up clinically and radiographically to determine any treatment needs.

Management of floating shoulder injury with dual surgical approach

Background: The floating shoulder is an uncommon but important injury pattern. Although it is frequently defined as an ipsilateral fracture of the clavicle and scapular neck, studies suggest that ligament disruption associated with a scapular neck fracture contributes to the functional equivalent of this injury pattern, with or without an associated clavicle fracture. Minimally displaced fractures typically do well with nonsurgical care. However, the degree of fracture displacement and ligament disruption that results in less predictable outcomes after nonsurgical treatment is uncertain. Internal fixation of a displaced clavicle fracture restores the contour of the shoulder, regulates soft-tissue tension, but it does not reduces the scapular neck fracture. Hence fixation of both fractures is recommended in certain fracture patterns. Material & Methods: This is a study of 10 cases of floating shoulder injury operated by front (ant. Approach for # clavicle) and back (modified Judets posterior approach for scapula #) from Jan 2012 to March 2016. All cases were assessed with Constant shoulder score at the end of six months. Results: Results of our study shows that majority of pt. had excellent to good results. There were complications in two cases; 1.Broken Clavicle plate which needed revision, 2.Failure to anatomically reduce scapula neck fracture and proximal screw penetration in to the joint. Conclusion: We propose the combined anterior and posterior surgical approach to be the method of choice for the treatment of unstable and displaced floating shoulder injuries.

Commentary: Dynamic hip screw fixation versus multiple screw fixation for intracapsular hip fracture.

of fragility hip fracture also increases. By 2050, the incidence is predicted to be around 4.5 million.1 Treatment of intracapsular hip fractures depends on many factors including patient age, fracture pattern, degree of fracture displacement and comorbidities. For younger patients (<65 years of age), the femoral head should be preserved using an internal fixation method, either multiple screw fixation or dynamic hip screw (DHS), to avoid any long-term complication of arthroplasty.2 For elderly patients, both internal fixation methods are suitable for nondisplaced intracapsular hip fractures. Nonetheless, arthroplasty is preferable for displaced intracapsular hip fractures because of a lower reoperation rate and better functional outcome.3 In this issue, Jettoo et al.4 compared DHS fixation with multiple screw fixation for intracapsular hip Commentary: Dynamic hip screw fixation versus multiple screw fixation for intracapsular hip fracture

The functional outcome and quality of life after treatment of isolated medial malleolar fractures.

The optimal treatment of isolated medial malleolar fractures is widely debated. The aim of this study is to analyse the different treatment methods. The study included 137 patients with an isolated medial malleolar fracture treated at our hospital between 2000 and 2010. Functional outcome was assessed using Olerud-Molander score and health-related quality-of-life (HRQoL) was measured with RAND36 item health survey. Patients were sent follow-up questionnaires after an average of 9.5 years (4.3-15.2) from the date of treatment. The overall improvement in function was equivalent in both operative and non-operative treatment groups. However, the outcome scores declined in both groups as the primary displacement increased, regardless of the treatment method. HRQoL was similar in both groups. If maximal fracture displacement is ≤2mm, isolated medial malleolar fractures can be treated non-operatively with good outcome, but the operative treatment may also be performed without serious complications. The degree of fracture displacement is an independent risk factor for inferior functional result, regardless of the treatment method. Therapeutic level of evidence: IV, retrospective cohort study.

Effects of fracture displacement and operation method on perioperative blood loss of femoral neck fractures

Objective To investigate the effects of fracture displacement and operation method on perioperative blood loss of femoral neck fractures. Methods From December 2013 to October 2014, 130 cases (58 males and 72 females, aged from 18 to 91 years, with an average age of 71.1±12.9 years) with femoral neck fractures were retrospectively analyzed for the perioperative blood loss. The degree of displacement was described according to Garden's grades. According to the degree of fracture displacement, the patients were divided into two groups: Garden Ⅰ-Ⅱ group and Garden Ⅲ-Ⅳ group, and patients' preoperative hidden blood loss was compared between two groups. According to the degree of fracture displacement and the method of operation, the patients were divided into four groups: Group 1 indicates the group in which patients received cannulated screws fixation for Garden gradeⅠ-Ⅱ; Group 2 in which patients received hemiarthroplasty for Garden gradeⅠ-Ⅱ; Group 3 in which patients received cannulated screws fixation for Garden grade Ⅲ-Ⅳ; Group 4 in which patients received hemiarthroplasty for Garden grade Ⅲ-Ⅳ; and variation in the following four parameters was analyzed: the dominant blood loss, postoperative hidden blood loss, total hidden blood loss, total blood loss in the four different groups. Results For the Garden grade Ⅲ-Ⅳ femoral neck fracture group, the preoperative hidden blood loss was significantly higher than that of the Garden grade Ⅰ-Ⅱ femoral neck fracture group (t=2.267,P=0.001). The dominant blood loss volume, postoperative hidden blood loss volume, total hidden blood loss volume and total blood loss volume of hemiarthroplasty groups (402.1±36.8 ml, 641.3±53.2 ml, 880.7±61.7 ml, 1 246.1±76.7 ml) were higher than those of the cannulated screws fixation group (45.8±34.9 ml, 301.9±50.6 ml, 436.6±58.6 ml, 478.5±72.9 ml). Conclusion The perioperative hidden blood loss is mainly related with the degree of fracture displacement, the greater the degree of fracture displacement, the more the preoperative hidden blood loss. While the dominant blood loss volume, postoperative hidden blood loss volume, total hidden blood loss volume and total blood loss volume are mainly related to the method of operation, the blood loss in which patients received hemiarthroplasty should be increased significantly. Key words: Femoral neck fractures; Perioperative period; Blood loss, surgical

Femoral neck fractures

Surgical interventions consisting of internal fixation (IF) or total hip replacement (THR) are required to restore patient mobility after hip fractures. Conventionally, this decision was based solely upon the degree of fracture displacement. However, in the last ten years, there has been a move to incorporate patient characteristics into the decision making process. Research demonstrating that joint replacement renders superior functional results when compared with IF, in the treatment of displaced femoral neck fractures, has swayed the pendulum in favour of THR. However, a high risk of dislocation has always been the concern. Fortunately, there are newer technologies and alternative surgical approaches that can help reduce the risk of dislocation. The authors propose an algorithm for the treatment of femoral neck fractures: if minimally displaced, in the absence of hip joint arthritis, IF should be performed; if arthritis is present, or the fracture is displaced, then THR is preferred.

Persistent diminished joint function following ankle fracture—A risk factor for posttraumatic osteoarthritis?

The optimal treatment of isolated medial malleolar fractures is widely debated. The aim of this study is to analyse the different treatment methods.The study included 137 patients with an isolated medial malleolar fracture treated at our hospital between 2000 and 2010. Functional outcome was assessed using Olerud–Molander score and health-related quality-of-life (HRQoL) was measured with RAND36 item health survey. Patients were sent follow-up questionnaires after an average of 9.5 years (4.3–15.2) from the date of treatment.The overall improvement in function was equivalent in both operative and non-operative treatment groups. However, the outcome scores declined in both groups as the primary displacement increased, regardless of the treatment method. HRQoL was similar in both groups.If maximal fracture displacement is ≤2 mm, isolated medial malleolar fractures can be treated non-operatively with good outcome, but the operative treatment may also be performed without serious complications. The degree of fracture displacement is an independent risk factor for inferior functional result, regardless of the treatment method.Therapeutic level of evidence: IV, retrospective cohort study.

MDCT and MRI for the diagnosis of complex fractures of the tibial plateau: A case control study

The aim of this study was to evaluate the clinical value of multidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI) in the diagnosis and treatment of complex fractures of the tibial plateau. A total of 71 patients with complex fractures of the tibial plateau (estimated Schatzker classifications III, V and VI) were included in this study. The X-ray, MDCT and MRI data obtained from the patients were analyzed. MDCT was the most sensitive method in the diagnosis of tibial articular surface collapse, cruciate ligament tibial avulsion fracture, degree of fracture comminution and degree of fracture displacement (P<0.01). MRI was the most sensitive method in the diagnosis of injuries of the cruciate and collateral ligaments, menisci and cartilage peeling of the articular surfaces (P<0.01). MDCT and MRI were demonstrated to be more sensitive than X-rays for the diagnosis of insidious damage around the knee.

Retrospective analysis of 73 orbital floor fractures

Methods: After confirmation of a zygomatic complex fracture the patients were divided into groups of surgically and non-surgically treated fractures, with and without fracture displacement. The groups were compared according to age, gender, degree of fracture displacement and clinical signs. Results: 283 patients were included, with a mean age of 43 years and a domination of male patients. All type C-fractures and themajority of type B-fractures were treated surgically. Except for facial swelling, the symptoms frequently found in the surgically treated patients, were found less common in the non-surgically treated patient group. Extraoral steps, intraoral steps, and malar depression were significantly related to surgical treatment. Conclusions: The clinical characteristics extraoral steps, intraoral steps, and malar depression, in contrast to paraesthesia of the infraorbital nerve, were significantly related to surgical treatment of zygomatic complex fractures. Knowledge of the differences between the surgically and non-surgically treated patients may help physicians to develop future methods in clinical decision making.

Visual recovery following emergent orbital decompression in traumatic retrobulbar haemorrhage—case report

Methods: After confirmation of a zygomatic complex fracture the patients were divided into groups of surgically and non-surgically treated fractures, with and without fracture displacement. The groups were compared according to age, gender, degree of fracture displacement and clinical signs. Results: 283 patients were included, with a mean age of 43 years and a domination of male patients. All type C-fractures and themajority of type B-fractures were treated surgically. Except for facial swelling, the symptoms frequently found in the surgically treated patients, were found less common in the non-surgically treated patient group. Extraoral steps, intraoral steps, and malar depression were significantly related to surgical treatment. Conclusions: The clinical characteristics extraoral steps, intraoral steps, and malar depression, in contrast to paraesthesia of the infraorbital nerve, were significantly related to surgical treatment of zygomatic complex fractures. Knowledge of the differences between the surgically and non-surgically treated patients may help physicians to develop future methods in clinical decision making.

Paediatric lateral humeral condyle fractures: internal oblique radiographs alter the course of conservative treatment

At first presentation of paediatric humeral lateral condyle fractures, radiological methods such as computerised tomography, ultrasonography, magnetic resonance imaging, arthrography, and internal oblique radiography are used to determine stability. Very few studies show which radiological method should be used to evaluate displacement at follow-up for conservatively treated patients. This study aimed to show that internal oblique radiography is a simple, effective method to determine the subsequent development of fracture displacement in patients with an initially non-displaced or minimally displaced fracture. In this retrospective study, 27 paediatric patients with non-displaced or minimally displaced (<2 mm) humerus lateral condyle fracture were evaluated by elbow anteroposterior radiograph. The degree of fracture displacement was evaluated by anteroposterior then by internal oblique radiographs. The first follow-up was made between the 5th and 8th day and thereafter at intervals of 7-10 days. Of the 27 patients identified with non-displaced or minimally displaced (<2 mm) fracture from the initial anteroposterior radiograph, 16 were accepted as displacement >2 mm as a result of the evaluation of the internal oblique radiography and underwent surgery. At follow-up, 2 of 11 patients were defined with displacement from anteroposterior and internal oblique radiographs and 4 from the internal oblique radiographs and underwent surgery. Conservative treatment was applied to 5 patients. Internal oblique radiography is the best imaging showing subsequent fracture displacement in initially non-displaced or minimally displaced humerus lateral condyle fractures. At the first week follow-up, anteroposterior and particularly internal oblique radiographs should be taken of conservatively treated patients.

The clinical and radiographical characteristics of zygomatic complex fractures: A comparison between the surgically and non-surgically treated patients

BackgroundIn this retrospective study we evaluated the epidemiological data and the clinical and radiographical differences between surgically and non-surgically treated patients with zygomatic complex fractures at their initial assessment in our clinic over a period of 5 years. More knowledge of the clinical similarities and/or differences between the non-surgical and the surgical group will provide us a more complete view and may help physicians to develop any future methods in clinical decision making or even methods in distinguishing patients benefiting from a surgical treatment. MethodsSurgically and non-surgically treated patients were included in the study, if clinical and radiographical confirmation of zygomatic complex fractures were present at initial assessment. The patient groups were divided into surgically treated zygomatic complex fractures, and non-surgically treated fractures, with and without displacement. The groups were compared according to age, gender, degree of fracture displacement and clinical signs. ResultsIn total 283 patients were diagnosed with zygomatic complex fractures, with a mean age of 43 years (±20 years) and a domination of male patients. The mean age was higher in the non-surgically treated group and contained more female patients. Overall type C fractures and the majority of the type B fractures were treated surgically. Only 2.1% of the type A fractures were treated surgically. Overall facial swelling and paraesthesia of the infraorbital nerve were found as most common clinical findings. Additionally, malar depression and extraoral steps were frequently found in the surgically treated group, as in the non-surgically treated group only facial swelling was found frequently, whether there was fracture displacement or not. The clinical characteristics 'extraoral steps', 'intraoral steps', and 'malar depression' were found to be significantly related to surgical treatment. ConclusionExtraoral steps, intraoral steps, and malar depression were significantly related to surgical treatment. The group of non-surgically treated zygomatic complex fractures is a valuable group to investigate as this group also consists of patients with displaced fractures (i.e. surgical indication) and thus, could provide us more insight in future clinical decision methods. Therefore, we highly recommend more research of the non-surgically treated group.

Unusual Case of Isolated Lunate Fracture Without Ligamentous Injury

Fractures of the lunate are rare injuries that usually result from high-energy trauma and are typically associated with other carpal and ligamentous injuries. The incidence of lunate fractures has been cited as 0.5% to 6.5% of all carpal fractures. These fractures are not frequently reported in the literature, and no consensus exists on the treatment of these injuries in the acute and chronic setting. The mechanism typically producing this fracture is a loading force applied to a dorsiflexed, ulnarly deviated wrist such that the capitate is driven downward into the lunate.No prior reports exist in the literature of an isolated fracture of the lunate without perilunate dislocation or ligament disruption. This article reports a case of an isolated displaced transverse shear fracture of the lunate seen 3 months after initial injury, which was successfully treated using a volar and dorsal combined approach and open reduction and internal fixation using microscrews. Bony union across the fracture site was obtained by 7-week follow-up and continued to show improved consolidation through 10-month follow-up. The patient had decreased pain, normal range of motion, and no radiographic evidence of lunate osteonecrosis on most recent follow-up despite the delayed presentation and degree of fracture displacement. This case demonstrates a previously unreported type of wrist injury.

Prospective Evaluation of a New Classification System for the Management of Mandibular Subcondylar Fractures

We propose a new classification of subcondylar fractures of the mandible based on ramal height shortening and degree of fracture angulation and present our treatment experience using this classification system. Eighty patients with subcondylar fractures of the mandible were evaluated. We categorized the fractures into 3 classes: Class 1 (minimally displaced), fracture with ramal height shortening: <2 mm and/or degree of fracture displacement: <10°; Class 2 (moderately displaced), fracture with ramal height shortening: 2 to 15 mm and/or degree of fracture displacement: 10 to 35°; Class 3 (severely displaced), fracture with ramal height shortening: >15 mm and/or degree of fracture displacement: >35°. Our treatment protocol is closed treatment for Class 1 fractures; either closed or open treatment for Class 2 fractures; and open treatment for Class 3 fractures. Among 80 patients, 20 had Class 1 fractures (25%), 40 had Class 2 fractures (50%), and 20 had Class 3 fractures (25%). In Class 2 fractures, 22 patients were managed by closed treatment (Class 2a) and 18 by open treatment (Class 2b). No statistically significant differences were found between the 3 classes in terms of functional outcome, while, within Class 2 patients, significantly (P = .00) better functional results were observed in open (Class 2b) group compared with closed group (Class 2a). Our new classification based on ramal height shortening and degree of fracture displacement can better guide clinical treatment. Class 1 fractures are treated by closed method, while open reduction is recommended in Class 2 and Class 3 cases.

Teeth in the Line of Fracture: To Retain or Remove?

The purpose of this study was to analyze mandibular fracture site, relationship of the fracture line to the periodontium, vitality of teeth, displacement of the fracture segments and their implications, and determine whether to retain or remove the teeth in the fracture line. Fifty patients with 62 fractures were involved in this study. An electric pulp tester was used to measure the pulpal response. The degree of fracture displacement and the relationship of the fracture line to the periodontium were evaluated using panoramic radiographs. Fractures of the parasymphysis region constituted a majority of 60.87% in the gross displacement category. Four of 50 patients showed no response presurgically and minimal response postoperatively on pulp vitality testing. Patients with teeth in the fracture line showing no response on pulp vitality testing should be advised extraction to avoid further complications.

Clinical Results of Femoral Subtrochanteric Fractures

Purpose: This study examined the clinical course of subtrochanteric fractures of the femur as well as the risk factors of complications. Materials and Methods: A retrospective study was performed on 56 patients with femoral subtrochanteric fractures who were treated at our hospital from 2004 to 2008. Risk factors, such as the type of fracture, type of implant, soft tissue dissection at the fracture site, communition of the medial cortex and degree of fracture displacement after the reduction, were compared to determine their effect on the rate of complications, such as nonunion and implant failure. Open reduction with a soft tissue dissection at the fracture site was performed in 34 cases, and a closed reduction was performed in 22 cases. Thirty five cases had medial cortex communition and 21 cases did not. Results: There were 8 cases of nonunion(14.3%). There was a positive correlation between the degree of fracture displacement after the reduction and the union time (P=0.017). The union time was longer when there was communition of the medial cortex. A subtrochanteric fracture using an open reduction tended to have a long union time but this was not statistically significant. There was no correlation between the type of implant and union time. Conclusion: The union time is longer in subtrochanteric fractures with communition of the medial cortex. Therefore, it is important to preserve the blood supply at the fracture site using a closed reduction and restore the fracture reduction accurately.

Selective Kirschner wiring for displaced distal radial fractures in children

This study was designed to evaluate our departmental policy of plaster immobilization and selective Kirschner (K) wiring for the management of displaced distal radius fractures in children. On a retrospective basis, we evaluated a consecutive series of 112 childhood displaced distal radius fractures (108 patients; 77 boys, 31 girls; mean age 10.5+/-2.6 years; range 5 to 16 years) presenting with clinical deformity during a two-year period. There were 97 incompletely displaced (86.6%), and 15 completely displaced (13.4%) fractures. All the fractures were managed with manipulation under general anesthesia and plaster immobilization. Additionally, K-wire fixation was performed following manipulation in seven (46.7%) of the completely displaced fractures. The mean follow-up period was 1.1 years (range 10 weeks to 2 years). The mean angulation of fractures prior to manipulation was 21.5+/-10.1 degrees, it decreased to 2.4+/-4.8 degrees following manipulation. Remanipulation was required in 11 fractures (9.8%) based on clinical and radiographic findings of redisplacement. Of these, eight fractures (8.3%) were incompletely displaced, and three fractures (20%) were completely displaced. All completely displaced fractures that required remanipulation had been additionally treated with K-wire fixation. Fractures requiring further treatment had a mean angulation of 17.1+/-5.8 degrees prior to remanipulation, and a mean residual angulation of 4.7+/-6.0 degrees at final radiographic assessment. A perfect fracture reduction was achieved in all the patients with a Salter-Harris II injury (n=22), and none of these patients required remanipulation. However, the quality of initial reduction was not associated with the development of redisplacement. There was no significant difference between isolated distal radius fractures (n=58) and combined radius and ulna fractures (n=32) with respect to remanipulation rate and final angulation (p>0.05). Final radiographs showed a significantly greater angulation in fractures which were initially completely displaced in comparison with those that were incompletely displaced (8.2+/-7.1 degrees vs. 4.2+/-5.7 degrees; p=0.024), but this was not of clinical significance. None of the patients had radial shortening and no K-wire related complications were encountered. Our data suggest that there should be other factors involved in the development of redisplacement and the need for remanipulation other than the degree of fracture displacement and the quality of initial reduction. Selective K-wire fixation in displaced fractures does not seem to decrease redisplacement and remanipulation rates.

Spontaneous Calcaneal Fracture of Charcot Neuroarthropathy in Diabetic Patients-Three Case Reports and Literature Review

Background: Charcot neuroarthropathy is one of the low extremity complications in diabetes mellitus peripheral neuropathy. It is a progressive destruction of foot and ankle joint, which may cause bony fracture or dislocation. In its late stage, amputation may be needed to control infection or provide limbs stability. The prevalence of Charcot neuroarthropathy is low, and its diagnosis needs high index of suspicion. Aim and Objectives: To report three cases of spontaneous calcaneal fracture of Charcot neuroarthropathy in our institution and review previous articles. Materials and Methods: From 2003 February to 2008 February, three diabetic patients with spontaneous calcaneal farcture of Charcot neuroarthropathy were collected in a retrospective chart review. Results: All cases were the least common type in Brodsky’s classification (Type IIIB). The treatment of each case is variable according to the degree of fracture displacement and associated symptoms. Two cases underwent open reduction and internal fixation while one received below knee amputation. Conclusion: Charcot neuroarthropathy is a progressive destructive process. If diabetic patients with this complication are treated cautiously from the beginning, such as nonweightbearing and early immobilization, surgical reduction or limbs amputation can be avoided.

The functional outcome of the fractured clavicle

The severity of symptoms, rate and completeness of recovery after closed treatment of the fractured clavicle has not been fully explored. The severity and duration of pain, analgesic requirements, ability to perform daily activities, return to work, driving and sport along with appearance of the shoulder were recorded in 56 patients between 1 and 2 years after fracture. Radiographs were assessed by Robinson's classification [8]. Twenty-two out of 56 patients described functional restriction 1-2 years after injury. The majority of patients ceased to experience pain (34/56) and returned to work (19/46) within 3 months. Thirty-eight out of 56 patients noted cosmetic deformity, the severity of which was associated with worse functional outcome (p = 0.002). The degree of fracture displacement was associated with cosmetic deformity (p = 0.02) and functional outcome (p = 0.015). The majority of patients perceive a cosmetic deformity and 22/56 impaired function after clavicular fracture.

Femoral Neck Fractures: Evidence Versus Beliefs About Predictors of Outcome

It is unclear whether current practice reflects current evidence on predictors of clinically important outcomes like mortality and fixation failure. Knowledge of predictors of outcome can and should influence treatment decisions and can subsequently improve outcomes. We hypothesized that there is evidence about the significance of predictors of outcome not being considered in the decision making process in the treatment of hip fractures because many surgeons are unaware of it. We surveyed 298 North American and European orthopedic surgeons to examine their training and experience and their opinion on the relative importance of predictors of outcome of femoral neck fracture treatment. We compared the results with the highest level of therapeutic and prognostic evidence currently available. Surgeons' perceptions about the importance of the quality of fracture reduction, patient comorbidities, degree of fracture displacement, dementia, and prefracture walking ability were justified by the current literature. However, we further identified a number of variables deemed unimportant to surgeons that have evidence to support their use in managing patients with hip fractures, including the type of anesthesia as a modifiable variable. In contrast to surgeons' perceptions, the available evidence suggests regional anesthesia is associated with a lower mortality risk than general anesthesia.