Degree Of Initial Displacement Research Articles

ASSESSMENT OF NEAR-REDUCTION UNION RATES WITH CONSERVATIVE HUMERUS FRACTURE TREATMENT

This study attempts to determine near-reduction union rates with non-operative treatment of humeral shaft fractures, assess alignment and functional outcomes, and compare these with historic and surgical management approaches. Methods: This was a cross-sectional study at the Department of Orthopedics, Jinnah Postgraduate Medical Centre, Karachi, from January 2024 to June 2024. Twenty patients aged between 17–72 years who suffered from humeral shaft fractures were inducted through consecutive sampling. The conservative treatment mode was applied with a "U"-shaped coaptation splint, where alignment was assessed on radiographs, and functional outcome was achieved with a grading system. Data was analyzed using SPSS-20 regarding union rates, functional recovery, and factors influencing treatment success. Results: In this study of 20 fractures, the initial angulation was 30%, while deviations in sagittal plane alignment in the anterior or posterior direction were seen in 45%. Nineteen of these fractures united within an average time of 42 days in men and 44 days in women; one case showed a delayed union of 13 weeks. Functional results were also excellent, with 60% of patients achieving Grade V function, signifying the absence of pain or limitations, and 35% reporting Grade IV, meaning minimal limitations. Comparisons with historical studies showed that conservative management was similarly successful, with a high union rate and acceptable functional outcome in most cases noted. Conclusion: The conservative approach to treating humeral shaft fractures, characterized by limited immobilization with early mobilization, had a high union rate with excellent functional outcomes equal to surgical interventions. Success with treatment was considerably influenced by patient age, type of fracture, and degree of initial displacement, thus indicating that treatment has to be individualized. This study supports a conservative approach as a modality of choice in managing humeral shaft fractures, emphasizing individuated care for optimum recovery and satisfaction of patients.

The Volar Cortical Hinge: An Independent Risk Factor for Distal Radius Fracture Displacement.

Background Displaced distal radius fractures are prone to redisplacement after manipulation. This can result in the need for delayed surgery. Several criteria have been studied to predict the likelihood of redisplacement. We hypothesized that reduction in the volar cortex would be an additional predictive factor. Purpose The aim of this study was to assess whether the quality of the volar cortex reduction predicts the subsequent need for further intervention (surgery or remanipulation). As a secondary outcome, we assessed whether the quality of the reduction predicts the rate of malunion. Methods A retrospective review was performed of displaced adult distal radius fractures over a 2-year period that had undergone closed reduction at presentation. We identified 105 patients and a review of their electronic notes and radiographs was then performed. The volar cortex reduction was defined as "anatomical," "opposed," or "displaced." We assessed the radial height, radial inclination, radial/ulnar translation, volar/dorsal angulation, teardrop angle, presence of dorsal comminution, quality of the cast (molding, cast index), and volar cortex reduction. These measurements were taken at five time points (prereduction, postreduction, 1 week, 2 weeks, and 6 weeks). All patients that subsequently required surgical fixation or repeat reduction were identified as the primary outcome measure. The 6-week radiographs were assessed for radiographic malunion as our secondary outcome measure. A statistical analysis was then performed to assess the factors that influenced a loss of position and the need for delayed surgical intervention. Results Of the 105 patients, 22 patients required delayed surgery, 3 patients underwent a repeat manipulation, and 12 patients had a radiographic malunion at 6 weeks. During the study period, the proportion of patients requiring surgery or repeat manipulation in the displaced group was 10/21 (47.6%), in the opposed group it was 11/50 (23.4%), and in the anatomic group it was 4/36 (11.1%; p = 0.008). We then included the patients with a radiographic malunion and found the proportion of patients with an adverse outcome in the displaced group was 14/21 (66.7%), in the opposed group it was 17/47 (36.2%), and in the anatomic group it was 6/36 (16.7%; p = 0.001). At the 1-week time point, this association was equally significant, as the proportion in the displaced group was 17/33 (51.5%), in the opposed group it was 15/45 (33.3%) and in the anatomic group it was 1/22 (4.5%; p = 0.001). The patients' age, quality of cast, presence of dorsal comminution, and degree of initial displacement did not predict the subsequent need for surgery or remanipulation. Conclusion The most important factor in our study for significant redisplacement of an initially dorsally displaced distal radius fracture is the association of the volar cortex. This parameter maintains significance at the 1-week time point. This data shows that volar cortex reduction is a useful clinical measurement in assessing which distal radius fractures will undergo delayed displacement requiring intervention. Level of evidence Level 3-Retrospective comparative study.

Growth arrest and its risk factors after physeal fracture of the distal tibia in children and adolescents.

. This study performed to investigate the incidence of growth arrest such as leg length discrepancy (LLD) and ankle joint angular deformity and its risk factors after physeal fracture of the distal tibia in children and adolescents. . Consecutive 78 patients (mean age 11.4 ± 2.0 years; mean follow-up period 2.0 ± 1.2 years) treated for the distal tibia physeal fracture were included. All patients underwent preoperative ankle radiographs, three-dimensional computed tomography (CT) scans, and postoperative follow-up teleradiogram. Patients were divided into two groups according to the LLD and the difference of lateral distal tibial angle (LDTA) with the contralateral limb as follows: Group 1 (growth arrest), patients with LLD ≥ 1cm or difference of LDTA ≥ 5°; Group 2 (normal growth), patients with LLD < 1cm and difference of LDTA < 5°. . The overall incidence of growth arrest was 12.8% (10 of 78). The mean displacement measured using CT scan was 4.4 ± 3.2 mm (range, 0.8-14.9). Of the total 78 fractures, 65 were treated surgically and 13 fractures were treated conservatively. The initial fracture displacement was significantly different between the two groups (p<0.001). However, there were no statistically significant differences between the two groups with respect to other factors. Initial displacement was the only significant risk factor for growth arrest (p<0.003). The cutoff values of initial displacement between the two groups were 5.2mm. . This study showed that degree of initial displacement was the only significant risk factor for growth arrest after physeal fracture of the distal tibia in children and adolescents. Therefore, physicians should consider the possibility of growth arrest for patients with severely displaced physeal fractures of the distal tibia.

Factors affecting early re-displacement of paediatric diaphyseal forearm fractures at Korle Bu Teaching Hospital.

Complete fractures of the forearm have the potential to displace and angulate with overriding fracture fragments. Maintaining acceptable reduction is not always possible, and re- displacement or re-angulation is the most commonly reported complication. Factors responsible for the re-displacement after an initial acceptable reduction have not been clearly defined. The study aimed to determine the factors that influence early re-displacement of paediatric diaphyseal forearm fractures in Korle-Bu Teaching Hospital. A prospective study in a cohort of 72 children below the age of 12 years with diaphyseal forearm fracture attending the Orthopaedic clinic were followed with close reduction casting from April 2017-December, 2017. Factors analysed included demographics, initial fracture features and the radiographic indices of the cast quality. 93.1% (67) of the fractures were because of the children falling on an outstretched arm. Majority of the children had a fracture of the distal 1/3 of the radius (n=38, 52.6%). The overall C.I was 0.8 (SD 0.1). The only significant predictor for predicting re-displacement was children falling on an outstretched hand (p-value=0.0). This study has shown that the degree of initial displacement and the ability to achieve good reduction with a well moulded cast, constitute the major factors for early re-displacement of paediatric forearm fractures. Personal funding.

Predictive factors for re-displacement in diaphyseal forearm fractures in children—role of radiographic indices

Background and purpose — Manipulation and cast immobilization is the primary management for diaphyseal forearm fractures in children, and re-displacement is the most common complication. We wanted (1) to analyze the incidence of re-displacement in a group of children treated with close reduction and casting; (2) to determine predictive factors such as demographics, mechanism of injury, affected bone, fracture pattern, degree of initial displacement and angulation, and reduction accuracy; and (3) to determine the prognostic effect of previously defined radiographic indices.Patients and methods — We prospectively studied 269 consecutive children with closed and complete middle-third diaphyseal fractures treated with close reduction and casting from October 2014 to April 2015. Factors analyzed included demographics, initial fracture features, having a non-anatomical reduction, and the radiographic indices of cast quality.Results — There were 189 fractures of both bones (70%) and 80 solitary fractures (30%). The overall re-displacement rate was 11%. According to multivariable analysis, independent predictors of re-displacement were initial angulation >10° (RR =5) and failure to achieve an anatomical reduction (RR =2). Statistically significant radiographic indices regarding increased rate of re-displacement included cast index ≥0.7 (RR =5), Canterbury index ≥1.1 (RR =3), and 3-point index ≥0.8 (RR =6).Interpretation — Our results suggested that fractures with a higher degree of initial angulation and non-anatomical reduction more often result in re-displacement. Moreover, the casting quality examined with the radiographic indices played an important role in the success of a non-operative management.

Early prediction of outcomes in hip fractures: initial fracture displacement.

We retrospectively analyzed the surgical treatment of 28 pediatric hip fractures. The majority of cases were Delbet type 2 (57%) and type 3 (29%). The average age of the patients was 10.8 years (range: 2-16 years). The mean follow-up period was 91 months. Displaced fractures were found in 18 cases (64%). The major factor in the development of avascular necrosis was the degree of displacement at the time of initial presentation (P<0.05), irrespective of fracture type. Although the degree of initial displacement cannot be prevented, careful exposure of soft tissue during open reduction will reduce avascular necrosis.

Secondary displacement of distal radius fractures treated by bridging external fixation

Loss of reduction remains an important problem after treatment of distal radius fractures, whatever the type of bone fixation. We assessed retrospectively the rate of secondary displacement after external fixation of distal radius fractures in order to identify possible risk factors for instability. We reviewed the pre-operative and serial post-operative radiographs of a retrospective series of 35 distal radius fractures treated by bridging external fixation. When classified according to the Société Française d'Orthopédie et Traumatologie (SOFCOT) criteria, the rate of secondary displacement was 48.5%. At final follow up, the reduction was anatomical in 12% and acceptable in 83%. There was malunion in 5%. The loss of reduction concerned primarily the distal radius palmar tilt and was moderate. No correlation was found with age, gender, type of fracture, degree of initial displacement, associated ulnar fracture, or seniority of the treating surgeon.

Dorsal cortical comminution as a predictor of redisplacement of distal radius fractures in children

Background The purpose of this study was to evaluate the various factors, which could contribute towards redisplacement of distal radius fractures, including comminution of the dorsal cortex of the distal radius, treated in our department. Methods In this retrospective study, we evaluated the risk of redisplacement of distal radius fractures in our department and also looked at the probable factors predisposing to this risk. A total of 134 fractures (129 children) were included in the study after exclusions. The variables that were assessed as possible causes of redisplacement were age, gender, fracture pattern (apex), degree of initial displacement, presence/absence of comminution, presence/absence of ulnar fracture, grade of surgeon, quality of initial reduction and Cast index. Results After excluding the fractures without a known outcome, 124 fractures (120 children) were available for analysis. The average age of children was 10.6 years (range 2–16 years) with more boys (89) than girls (31). Redisplacement after an initial reduction occurred in 30 children (24%). Six of these children (4.8% of the entire study group) required further intervention. The factors associated with an increased risk of redisplacement were complete initial displacement of fracture ( p = 0.02), dorsal bayonet fracture pattern ( p = 0.007), presence of comminution ( p = 0.001) and the quality of the initial reduction ( p = 0.002). Forward stepwise logistic regression analysis revealed comminution at the fracture site to be the most significant factor associated with redisplacement, increasing the odds of redisplacement by 5.82 (95% confidence interval (CI): 2.08–16.22, p = 0.001). There seemed to be a trend towards a reduced risk of redisplacement when K-wiring was done in the presence of comminution ( p = 0.12). Conclusion The presence of dorsal cortical comminution at the fracture site on initial radiographs should alert the treating surgeon to a significantly higher risk of redisplacement and supplemental K-wiring should be considered in this situation.

Hemiarthroplasty in worst cases is better than internal fixation in best cases of displaced femoral neck fractures: A prospective study of 683 patients treated with hemiarthroplasty or internal fixation

Background Studies have shown that the degree of initial displacement and also comminution of the femoral calcar, size of the head and varus angulation are prognostic of failure in displaced femoral neck fracture. We have applied these radiographic criteria in order to select patients who would benefit from internal fixation as opposed to primary hemiarthroplasty, and this prospective study was conducted in order to monitor the results of this strategy.Methods 683 displaced fractures of the femoral neck were treated with internal fixation or primary hemiarthroplasty based on the proposed radiographic criteria in a prospective consecutive study, and the patients were followed for 1–6 years. We treated 228 fractures with internal fixation and 455 by bipolar hemiprosthesis. The choice of operation was based on clinical evaluation of the patient and assessment of the assumed healing potential of the fracture, as determined by radiographic evaluation. Revision and mortality were primary endpoints.Results 54 (24%) of the patients originally treated by osteosynthesis were revised, whereas 9 (2%) of the patients treated with hemiarthroplasty had revision surgery. There were no significant differences in mortality between the groups at 30, 120 or 365 days.Interpretation Even when treating only the fractures with the assumed best healing potential with internal fixation, the results are inferior to hemiarthroplasty.

Refractures After Forearm Plate Removal

Debate continues over the need for removal of internal fixation devices. Nowhere has this been more intense than in the area of forearm fractures. Although basic biologic principles would dictate that fixation interferes with bone physiology, clinical experience has taught surgeons that every reoperation has potential complications. We therefore retrospectively reviewed all patients undergoing forearm plate removal during a 5 1/2-year period. There were four subsequent refractures in 63 patients, for an incidence of 6%. Factors that appeared to influence the refracture rate were degree of initial displacement and comminution, physical characteristics of the plate, early removal, and lack of postremoval protection.

T-condylar fractures of the distal humeral condyles during childhood: an analysis of six cases.

Six cases of T-condylar fractures in children less than or equal to 14 years of age were reviewed. Satisfactory results were achieved in all cases. Those who were approached surgically with a posterior triceps splitting approach seemed to have uniformly good results. However, other factors such as accuracy of reduction, development of avascular necrosis of the trochlea, and degree of initial displacement may have a bearing on the final outcome. The posterior approach appeared to provide the best visualization for reduction.

THE TREATMENT OF DISPLACED FRACTURES AT THE ANKLE BY RIGID INTERNAL FIXATION AND EARLY JOINT MOVEMENT

1. This paper presents a series of 135 patients with displaced ankle fractures treated by rigid internal fixation followed by early joint exercises in bed until movements were restored and followed then by full weight bearing in a plaster. 2. The advantages obtained are as follows: A high standard of reduction can be achieved and maintained. The joint movements are established before organisation of the traumatic exudate. Weight bearing in a plaster reduces the degree of disability and prevents osteoporosis. Further remedial treatment after removal of the plaster is usually unnecessary. 3. All but five of the fractures (3·7 per cent) could be classified in the manner described by Lauge-Hansen. 4. This classification is the most satisfactory of those available and is recommended for general use. 5. Anatomical reduction was obtained in 102 patients (77 per cent), with good objective clinical results in 108 patients (82 per cent). 6. The quality of the clinical result depends mostly on the accuracy of the reduction, to a lesser extent on the degree of initial displacement, and least on the type of fracture. 7. It is considered that the traditional concept of diastasis requires modification; it is felt that the term lateral ankle instability, which includes low fracture of the fibula (intraosseous diastasis) is preferable. 8. Internal fixation of the syndesmosis is to be avoided except in rare instances. 9. The incidence of arthritis is shown to depend mostly upon the accuracy of reduction; the initial degree of displacement is also of importance.