Duration Of Immobilization Research Articles

Surgical treatment of mid-shaft clavicle fractures by minimally invasive internal fixation facilitated by intra-operative external fixation: A preliminary study

BackgroundMid-shaft clavicle fractures are common and may require surgery. The objective of this study in adults with high-risk mid-shaft clavicle fractures was to evaluate the clinical and radiological outcomes of a minimally invasive surgical technique involving a minimally invasive approach, fracture reduction, temporary intra-operative external fixation, and locking plate internal fixation. HypothesisThis minimally invasive surgical technique for mid-shaft clavicle fractures ensures satisfactory radiographic fracture healing and medium-term functional outcomes, with a short immobilisation, rapid return to sports, and low complication rate. Material and methodA retrospective review was performed of patients managed using our minimally invasive surgical technique between 1 January 2012 and 31 December 2016. The primary outcome measure was the 3-month radiographic healing rate. The secondary outcome measures were duration of post-operative immobilisation, 3- and 6-month QuickDASH scores, and post-operative complications. ResultA total of 19 patients were included, 18 males and 1 female with a mean age of 37 years. Radiographic healing was consistently achieved within 3 months. Immobilisation duration was 3 weeks. The mean QuickDASH score was 23.75 after 3 months and 7.5 after 6 months. Return to sports occurred after 3 months. The only complication was transient paraesthesia in the distribution of the C8 nerve root in 1 patient. DiscussionThe management of mid-shaft clavicle fractures remains controversial. The high complication rates associated with conventional surgical techniques make treatment decisions difficult. A surgical technique characterised by temporary intra-operative external fixation to facilitate minimally invasive internal fixation may have a lower complication rate and shorter immobilisation requirements compared to conventional surgery. Level of evidenceIV, retrospective observational study.

Duration of Cast Immobilization in Distal Radial Fractures: A Systematic Review.

Objective The duration of immobilization in distal radial fractures is disputed in the current literature. There are still no long-term superior outcomes of operative treatment in comparison to nonoperative treatment. A systematic review was initiated to assess the clinical controversy on the duration of the immobilization period for nonoperatively treated distal radial fractures. Materials and Methods A comprehensive search was performed in the PubMed, Embase, and Wiley/Cochrane Library databases and a manual reference check of the identified systematic reviews and meta-analyses was executed. Eligible studies were randomized controlled trials that compared two periods of immobilization, with reported functional, patient-reported, and radiological outcomes. Two reviewers independently agreed on eligibility, and assessed methodological quality and extracted outcome data. Results The initial search yielded 3.384 studies. Twelve trials, with 1063 patients, were included in this systematic review. Grip strength and patient-reported outcome were better in patients treated by a shorter period of immobilization. There was no difference in pain, range of motion, or radiological outcome between different periods of immobilization. Owing to heterogeneity of studies, data were unsuitable for pooling. Conclusion Included studies showed that there might be a preference for a shorter period of immobilization in nonoperatively treated distal radius fractures. Therefore, shortening the period of immobilization in distal radial fractures to a maximum of three weeks should be considered. Future research should include homogeneous groups of patients to draw valid conclusions on the appropriate period of immobilization for nonoperatively treated distal radial fractures. Level of Evidence This is a Level II study. Systematic Review Registration Number PROSPERO 2018 CRD42018085524.

Dislocated distal radial fractures in adult patients: 4 weeks versus 6 weeks of cast immobilisation following reduction, a multicentre randomised controlled trial, study protocol

IntroductionUp to 30% of patients with a dislocated distal radial fracture (DRF) treated with closed reduction and cast immobilisation suffer from long-term functional restrictions. It remains unclear, whether duration of...

Clinical Characteristics Associated with the Prognosis of One-Stage Grafting for Flexor Digitorum Profundus Reconstruction in Zones I and II.

The authors aimed to identify clinical characteristics related to the prognosis after one-stage grafting for flexor digitorum profundus reconstruction in zones I and II. A total of 401 patients who underwent one-stage flexor digitorum profundus reconstruction after injuries in zones I and II, between January 1, 2006, and June 1, 2016, were included for analysis. The authors recorded the following clinical characteristics: duration from injury to reconstruction, graft type and length, handling (preservation or removal) of flexor digitorum superficialis, tenorrhaphy technique, and duration of postoperative immobilization. There was no significant difference in age, sex, duration between injury and reconstruction, graft type, and handling of flexor digitorum superficialis between subjects who underwent successful reconstruction and those who did not. Univariate and multivariate analyses revealed that end-to-end tenorrhaphy, immediate controlled motion, and immobilization for less than 2 weeks all independently were related to improved final outcomes. Grafting within zones I and II contributed to increased incidence of failure. In a subgroup having an injury-reconstruction duration of less than 2 weeks, the authors observed that grafting from zone III to zones I and II tended to result in better outcomes compared with grafting from zone III to the flexor digitorum profundus insertion. This, however, was not statistically significant (p = 0.11). The authors recommend end-to-end tenorrhaphy, reducing immobilization to less than 2 weeks, and avoiding grafting within zones I and II. In addition, further studies are still needed to clarify the optimal length of grafting. Therapeutic, III.

Duration and Success of Nerve Rehabilitation after Elbow Injuries in Children

AbstractNeurological complications after the supracondylar humerus fractures with a displacement of fragments result from traction, direct trauma, or nerve ischemia. The beginning of early rehabilitation, from when the arm is still immobilized, leads to complete restoration of the elbow joint, and thus any delay in starting the rehabilitation will have consequences, ranging from lighter ones to full disability. This study analyzed the impact of injured nerves, length of immobilization, and interruptions during rehabilitation on the rehabilitation duration (RD). A sample of 140 children of both genders with post-traumatic elbow injuries was considered, from the birth to 15 years. The sample was collected in cooperation with an orthopedist, pediatrician, and physiotherapist. The diagnosis was confirmed by physical and neurological examination and by radiography. The type of injury affects the RD. The supracondylar humerus fracture has a longer RD, with the average 85.45 days. We conducted the linear correlation test, between cases with injured nerves and cases without in relation to RD. The analysis provided significant statistical data (p < 0.01) proving that injured nerves are an important factor in RD. Of cases with radius nerve injury, 62.5% achieved full recovery. The analysis shows that for p < 0.01 (for cases in general) the immobilization duration has a significant impact on RD. Among patients who had no interruptions of rehabilitation, 92 achieved an excellent rehabilitation success, with an average number of 29.7 procedures and an average RD of 56 days. Injured nerves proved to have a great impact on the RD for elbow injuries, while not showing any impact on the rehabilitation success. Interruptions of rehabilitation treatments proved to have a statistical significance, meaning they have a high impact on the RD and success.

Study on risk factors affecting nonunion of fractures

INTRODUCTION: Nonunion is one of the most common complications of fracture healing. The incidence of nonunion is believed to vary from 5% to 10%. AIM: The aim of the research is to study the risk factors affecting nonunion of fractures and analyze the treatment taken, and it is bearing on nonunion. MATERIALS AND METHODS: The study is a cross-sectional observational study with purposive sampling done in the orthopedic department. A total of 71 patients were selected, and a questionnaire was filled in with data obtained from the patient and medical records. Radiological evidence was also used to confirm the nonunion. RESULTS: The sample included 48 men and 23 women. Of the females, 21 had attained menopause (91%). About 58% of the patients had taken treatment from Traditional Bone Setters (TBS), and 49% of the patients first went to a TBS before coming to the allopathic physician for fracture treatment. About 45% of the patients had a very short duration of immobilization of their fractures. A history of previous malignancy, bone cyst, or other illnesses lead to a longer time for recovery and return to work (P = 0.0339). Patients who had infected fractures had a significantly more number of surgeries than those without infection (P = 0.015). Nonsteroidal anti-inflammatory drugs use during treatment of fracture was also associated with nonunion (P = 0.0077), especially in allopathic medicine. CONCLUSION: Nonunion continues to be a significant problem for all orthopedic surgeons despite their best ability to prevent them. A complete examination of the patient with relevant investigations and selection of the most suitable and appropriate treatment for each individual should be carried out; since each person is unique, and every fracture is not alike.

Duration of postoperative immobilization affects MMP activity at the healing graft-bone interface: Evaluation in a mouse ACL reconstruction model.

Excessive MMP activity may impair tendon-to-bone healing. However, little is known about the effect of joint motion on MMP activity after ACL reconstruction. The aim of this study was to determine the effect of different durations of knee immobilization on MMP activity in a mouse ACL reconstruction model using a fluorescent MMP probe which detects MMP 2, 3, 9, and 13 and near-infra red in vivo imaging. Sixty C57BL male mice underwent ACL reconstruction. Post-operatively, the animals were treated with free cage activity (Group 1), or with the use of an external fixator to restrict knee motion and weight bearing for 5 days (Group 2), 14 days (Group 3), and 28 days (Group 4). At days 3, 7, 16, 23, and 30, five mice underwent IVIS imaging. At days 3, 7, 16, and 30, histological analysis was also performed. Probe signal intensity in the whole limb peaked at day 7, followed by a decrease at day 16, and maintenance up to day 30. There was no significant difference among groups at any time point based on IVIS, but histologic localization of MMP probe signal showed significantly less activity in Group 2 and Group 3 compared to Group 4 in the bone tunnel at day 30. We demonstrated that short-term immobilization led to less MMP activity around the bone tunnel compared with prolonged immobilization. A short period of immobilization after ACL reconstruction might enhance graft-bone interface healing by mitigating excess MMP expression. These findings have implications for post-operative rehabilitation protocols following ACL reconstruction. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:325-334, 2019.

Range of Extension Correlates with Posterior Capsule Length after Knee Remobilization.

Knee injuries are common in sports, and postinjury immobilization is often required to protect healing tissues and alleviate pain, but both the injury and the immobilization can lead to a knee contracture. Knee flexion contractures limit performance. Previous research has identified posterior knee capsule fibrosis as a contributor to immobility-induced knee flexion contractures. This study aims to measure posterior knee capsule length at various durations of remobilization after knee immobilization and to correlate with the recovery of knee range of motion. Two hundred fifty-nine male Sprague-Dawley rats had one knee extra-articularly immobilized in flexion with a Delrin® plate at a 45° angle for one of six durations: 1, 2, 4, 8, 16, or 32 wk, followed by spontaneous remobilization after plate removal, which lasted zero, one, two, and four times the duration of immobilization. The contralateral knees served as controls. The posterior knee capsule length was measured by histomorphometry. These measures were correlated with previously published range of motion data from the same cohort of specimens. Knees immobilized for 1 and 2 wk partially recovered posterior capsule length (P > 0.05). Knees immobilized beyond 2 wk failed to recover posterior capsule length, irrespective of the duration of remobilization (P < 0.05). The residual posterior capsule shortening correlated with the lack of knee extension (P < 0.003). For knee injuries requiring more than 2 wk of immobilization, unassisted remobilization will not restore posterior knee capsule shortening and the reduction in knee extension. These results support the role of the posterior capsule in knee joint contracture and the need to minimize the duration of immobility and to assist the recovery of the range of knee extension after a sport injury.

Using a Knee Arthrometer to Evaluate Tissue-specific Contributions to Knee Flexion Contracture in the Rat.

Normal knee range of motion (ROM) is critical to well-being and allows one to perform basic activities such as walking, climbing stairs and sitting. Lost ROM is called a joint contracture and results in increased morbidity. Due to the difficulty of reversing established knee contractures, early detection is important, and hence, knowing risk factors for their development is essential. The rat represents a good model with which the effect of an intervention can be studied due to the similarity of rat knee anatomy to that of humans, the rat's ability to tolerate long durations of knee immobilization in flexion, and because mechanical data can be correlated with histologic and biochemical analysis of knee tissue. Using an automated arthrometer, we demonstrate a validated, precise, reproducible, user-independent method of measuring the extension ROM of the rat knee joint at specific torques. This arthrometer can be used to determine the effects of interventions on knee joint ROM in the rat.

Current opinions regarding the management of pyogenic flexor tenosynovitis: a survey of Pulvertaft Hand Trauma Symposium attendees.

Pyogenic flexor tenosynovitis (PFT) is recognized as a severe infection of the hand with potentially disastrous outcomes. The mainstay of treatment has been emergent surgical washout. Recent evidence suggests potential for conservative management with a combination of intravenous antibiotics, elevation and splinting. We aim to determine current management of PFT to guide further education and research. An electronic survey was distributed to attendees at the Pulvertaft Hand Trauma Symposium in May 2017. The survey was also sent to previous attendees. The survey was compiled by hand surgeons and piloted within a tertiary centre prior to dissemination. Questions focused on three clinical vignettes describing PFT of increasing severity. Responses were analyzed using Surveymonkey. A total of 91 clinicians responded. Almost 50% would proceed to surgical decompression and washout even in patients diagnosed early. This increased to 88% when treating a patient whose diagnosis was delayed. The majority of those advising surgery felt this should be within 24h. More than 50% advocate active mobilization either immediately or as soon as possible regardless of severity. Almost all would use either general or regional anaesthesia and a two-incision technique with catheter irrigation. Our survey demonstrates large variation in the management of PFT. Advice from the pre-antibiotic era continues to be followed with some clinicians continuing to advocate open surgery. There is substantial discrepancy regarding duration of immobilization. Further investigation into the management and outcomes of PFT is required to establish best practice guidelines for this rare but potentially devastating condition.

Antidepressant activity of 4-amino-5-(alkyl-, aryl-, heteryl)-1,2,4-triazole-3-thione benzylidene derivatives

The current market for antidepressants has a number of limitations, they have a high probability of development of adverse reactions, have low latitude and stability of the therapeutic effect, and also have a long latent period of action. Therefore, it seems obvious that there is a need to create new drugs that improve the quality of life, affect the mood and are safe. An analysis of literary sources has shown that derivatives of 1,2,4-triazole have a pronounced antidepressant effect and drugs such as Trazodone and Alprozalam are widely used in medical practice. The purpose of this work was to study antidepressant effects of 1,2,4-triazole derivatives and to make analysis of the dependence between chemical structure and pharmacological activity. Materials and methods. The search of antidepressants in the series of 1,2,4-triazole derivatives was performed on the basis of the classical model of R.D. Porsolt in the modification of E.V. Schetynin. Each animal was immersed for 6 minutes in a vessel filled with water at a temperature of 27 °C. The duration of active swimming was fixed (vigorous movements of all paws with active movement), passive swimming (weak bends of the paws necessary to support the body to swim) and immobilization (no swimming motions). In addition, the number of active swimming periods of different lengths and the number of very short immobilization periods of up to 6 seconds were counted. The index of depression (ID) was calculated due to the ratio of the very short periods number of immobilization to the total number of active swimming periods. The research results are processed by modern statistical methods of analysis using personal computer, including the standard program package Microsoft Office 2013 (Microsoft Excel) and Statistica ® for Windows 6.0. The average arithmetic mean (M) and standard mean errors (±m) were calculated. The statistical significance of intergroup differences according to the experimental data was established using Student's t-criterion. To study the dependence of the influence of benzylidene derivatives of 4-amino-5-(alkyl-, aryl-, heteryl)-2,4-dihydro-3H-1,2,4-triazole-3-thione on the duration of passive swimming and the duration of immobilization was carried out by correlation analysis. Results. Benzylidene derivatives of 4-amino-5-(alkyl-, aryl-, heteryl)-1,2,4-triazole-3-thione were used as test substances. The index of depression in the use of fluoxetine decreased to 70.92 % (P < 0.05), and with the use of trazodone to 76.95 % (P < 0.05). Compounds 26 and 32 statistically significantly lowered the index of depression to 86.66 and 81.24 %, respectively, which was higher than the activity of the used comparison drugs. The main indicator of rats despair was the duration of immobilization, decreased to 73.53 % (P < 0.05) and trazodone to 79.55 (P < 0.05) when administered with fluoxetine. When applying 1,2,4-triazole derivatives, the duration of immobilization of compound 32 was reduced to 89.53 % (P < 0.05), and compounds 23 to 87.05 % (P < 0.05). Conclusions. The most active compound according to the results of the study was compound 32, which reduced the average duration of immobilization in the experimental group to 89.53 % and had a rather low index of depression (0.34 ± 0.08, P < 0.05).

A Review of the Historical Evolution, Biomechanical Advantage, Clinical Applications, and Safe Insertion Techniques of Cervical Pedicle Screw Fixation.

Cervical spine instrumentation is evolving with an aim of stabilizing traumatic and non-traumatic cases of the cervical spine with a beneficial reduction, better biomechanical strength, and a strong construct with minimal intraoperative, as well as immediate and late postoperative complications. The evolution from interspinous wiring till cervical pedicle screws has changed the outlook in treating the cervical spine pathologies with maximum 3D stability, decreasing the duration of postoperative immobilization and hospital stay. Some complications associated with the use of cervical pedicle screw can be catastrophic. This review article discusses the morphometry of cervical pedicle; indications, biomechanical superiority, tricks, and pitfalls of cervical pedicle screw; complications and technical advancements in targeting safe surgery; and future directions of cervical pedicle screw instrumentation.

Antidepressant-like action of diacamphe against the background stress-induced behavioral depression

Background. It was find out the cerebroprotective properties of diacamphe – (±)-cis-3-(2’-benzimidazolyl)-1,2,2-trimethylcyclopentan-carbonic acid hydrochloride in vivo experiments in the some models of brain injury.&#x0D; Aim. To investigate the neuroprotective and antidepressant-like activities of diacamphe.&#x0D; Materials and Methods. It was investigated an impact of diacamphe on inhibition of the pyramidal neurons field synaptic potentials evoked by N-methyl-D-aspartate, procedure anoxia/neuroaglicemia, and H2O2 in the electrophysiological experiments on hippocampal slices for evaluating of diacamphe neuroprotective activity. It was explored in behavioral experiments the impacts of diacamphe and antidepressant imipramine on basic manifestations of behavioral depression evoked by five-days swimming stress – helplessness and anhedonia.&#x0D; Results. It was ascertained in experiments on the hippocampal slices that diacamphe especially at conditions of systemic administration diminished of injury of the pyramidal neurons synapses induced by procedure anoxya/aglicemia, oxidative stress, but not N-methyl-D-aspartate action. The chronic administration of diacamphe in dose 10 mg/kg reduced the manifestations of induced by swimming stress behavioral depression, decrease duration of immobility in forced swimming test (helplessness) and increase preference of intake of sweet solution comparably with water (dilution of anhedonia). Antidepressant-like action of diacamphe differences from action of traditional antidepressant imipramine so far as diacamphe did not diminishes immobilization duration in swimming test after single administration and by more slow developing of action.&#x0D; Conclusions. Diacamphe possesses neuroprotective action and therefore manifests antidepressant-like action against the background behavioral depression evoked by swimming stress.

Antidepressant-like action of diacamphe against the background stress-induced behavioral depression

Background. It was find out the cerebroprotective properties of diacamphe – (±)-cis-3-(2’-benzimidazolyl)-1,2,2-trimethylcyclopentan-carbonic acid hydrochloride in vivo experiments in the some models of brain injury.&#x0D; Aim. To investigate the neuroprotective and antidepressant-like activities of diacamphe.&#x0D; Materials and Methods. It was investigated an impact of diacamphe on inhibition of the pyramidal neurons field synaptic potentials evoked by N-methyl-D-aspartate, procedure anoxia/neuroaglicemia, and H2O2 in the electrophysiological experiments on hippocampal slices for evaluating of diacamphe neuroprotective activity. It was explored in behavioral experiments the impacts of diacamphe and antidepressant imipramine on basic manifestations of behavioral depression evoked by five-days swimming stress – helplessness and anhedonia.&#x0D; Results. It was ascertained in experiments on the hippocampal slices that diacamphe especially at conditions of systemic administration diminished of injury of the pyramidal neurons synapses induced by procedure anoxya/aglicemia, oxidative stress, but not N-methyl-D-aspartate action. The chronic administration of diacamphe in dose 10 mg/kg reduced the manifestations of induced by swimming stress behavioral depression, decrease duration of immobility in forced swimming test (helplessness) and increase preference of intake of sweet solution comparably with water (dilution of anhedonia). Antidepressant-like action of diacamphe differences from action of traditional antidepressant imipramine so far as diacamphe did not diminishes immobilization duration in swimming test after single administration and by more slow developing of action.&#x0D; Conclusions. Diacamphe possesses neuroprotective action and therefore manifests antidepressant-like action against the background behavioral depression evoked by swimming stress.

Antidepressant-like action of diacamphe against the background stress-induced behavioral depression

Background . It was find out the cerebroprotective properties of diacamphe – (±)-cis-3-(2’-benzimidazolyl)-1,2,2-trimethylcyclopentan-carbonic acid hydrochloride in vivo experiments in the some models of brain injury. Aim . To investigate the neuroprotective and antidepressant-like activities of diacamphe. Materials and Methods. It was investigated an impact of diacamphe on inhibition of the pyramidal neurons field synaptic potentials evoked by N-methyl-D-aspartate, procedure anoxia/neuroaglicemia, and H 2 O 2 in the electrophysiological experiments on hippocampal slices for evaluating of diacamphe neuroprotective activity. It was explored in behavioral experiments the impacts of diacamphe and antidepressant imipramine on basic manifestations of behavioral depression evoked by five-days swimming stress – helplessness and anhedonia. Results. It was ascertained in experiments on the hippocampal slices that diacamphe especially at conditions of systemic administration diminished of injury of the pyramidal neurons synapses induced by procedure anoxya/aglicemia, oxidative stress, but not N-methyl-D-aspartate action. The chronic administration of diacamphe in dose 10 mg/kg reduced the manifestations of induced by swimming stress behavioral depression, decrease duration of immobility in forced swimming test (helplessness) and increase preference of intake of sweet solution comparably with water (dilution of anhedonia). Antidepressant-like action of diacamphe differences from action of traditional antidepressant imipramine so far as diacamphe did not diminishes immobilization duration in swimming test after single administration and by more slow developing of action. Conclusions. Diacamphe possesses neuroprotective action and therefore manifests antidepressant-like action against the background behavioral depression evoked by swimming stress.

Pulmonary Thromboembolism during Acetabular Fracture Operation

Acetabular and Pelvic ring fractures are major high-energy trauma injuries and are often combined with other injuries. In particular, cause of long duration of immobilization and combined injuries, venous thromboembolism is a common complication in trauma patients with pelvic or acetabular fractures. We report a case of a fatal pulmonary thromboembolism during the acetabulum fracture operation in a 62-year-old male patient.

Duration of wrist immobilization is associated with shoulder pain in patients with after wrist immobilization: an observational study.

The main goal of this study was to determinate the extent of the relationship between shoulder pain and time of wrist and thumb immobilization required after injury. One hundred twenty-three consecutive subjects presenting to the practice of different Orthopedic Specialist hospitals with a diagnosis of distal radius or scaphoid fracture that required wrist and thumb immobilization were screened for eligibility criteria. Upper extremity pain and the need for shoulder rehabilitation were assessed using the visual analogue scale (VAS) at baseline after immobilization period (T0) 1- and 3-month follow-up (1-FU/2-FU). More than 35% patients had shoulder pain (VAS>40 mm) after immobilization of the wrist. Shoulder pain intensity after immobilization and at follow-up (1 and 3 months) was strongly correlated with the duration of the immobilization. Immobilization for 3.5 weeks or longer was the strongest predictor for the need of subsequent shoulder rehabilitation. An increased the time of immobilization of the wrist is associated with an increase in shoulder pain and need for shoulder rehabilitation in patients after wrist fracture.

Non- or Minimally Displaced Distal Radial Fractures in Adult Patients: Three Weeks versus Five Weeks of Cast Immobilization-A Randomized Controlled Trial.

Background Patients with non- or minimally displaced distal radial fractures, that do not need repositioning, are mostly treated by a short-arm cast for a period of 4 to 6 weeks. A shorter period of immobilization may lead to a better functional outcome. Purpose We conducted a randomized controlled trial to evaluate whether the duration of cast immobilization for patients with non- or minimally displaced distal radial fractures can be safely shortened toward 3 weeks. Materials and Methods The primary outcomes were patient-reported outcomes measured by the Patient-Related Wrist Evaluation (PRWE) and Quick Disability of Arm, Shoulder and Hand (QuickDASH) score after 1-year follow-up. Secondary outcome measures were: PRWE and QuickDASH earlier in follow-up, pain (Visual Analog Scale), and complications like secondary displacement. Results Seventy-two patients (male/female, 23/49; median age, 55 years) were included and randomized. Sixty-five patients completed the 1-year follow-up. After 1-year follow up, patients in the 3 weeks immobilization group had significantly better PRWE (5.0 vs. 8.8 points, p = 0.045) and QuickDASH scores (0.0 vs. 12.5, p = 0.026). Secondary displacement occurred once in each group. Pain did not differ between groups ( p = 0.46). Conclusion Shortening the period of immobilization in adult patients with a non- or minimally displaced distal radial fractures seems to lead to equal patient-reported outcomes for both the cast immobilization groups. Also, there are no negative side effects of a shorter period of cast immobilization. Therefore, we recommend a period of 3 weeks of immobilization in patients with distal radial fractures that do not need repositioning.

A Prospective, Randomized Trial of Mobilization Protocols Following Ligament Reconstruction and Tendon Interposition.

The purpose of this study was to evaluate the hypothesis that an increased duration of immobilization following trapeziectomy with ligament reconstruction and tendon interposition (LRTI) leads to improved patient-reported outcomes compared with an early mobilization protocol. At 2 institutions, we prospectively randomized 223 patients (238 thumbs) undergoing LRTI to receive 1 of 2 postoperative rehabilitation protocols. The immobilization protocol consisted of use of a postoperative forearm-based thumb-spica splint for 7 days followed by a forearm-based thumb-spica cast for 5 weeks and then by a custom forearm-based thermoplastic thumb-spica splint for an additional 6 weeks. An active range of motion (ROM) was started 6 weeks postoperatively. The early mobilization protocol consisted of the same postoperative splint for 7 days followed by use of a forearm-based thermoplastic thumb-spica splint for 3 weeks and then by a hand-based thumb-spica splint for 4 weeks. An active ROM was started 4 weeks postoperatively. The outcome measures included the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire; pinch and grip strength; 9-hole peg test (NHP); visual analog scale (VAS) for pain; VAS for patient satisfaction; and wrist and thumb ROM. These were measured preoperatively and at 6, 12, 26, 52, and 104 weeks postoperatively. Differences in continuous and categorical variables were assessed with use of Tukey multiple comparisons following 1-way analysis of variance and Fisher exact tests, respectively. A minimum follow-up of 1 year (mean, 1.7 years) was achieved for 71% (169) of the 238 randomized thumbs (157 of the 223 patients): 74 patients (80 thumbs) treated with the immobilization protocol and 83 patients (89 thumbs) treated with the early mobilization protocol. DASH scores, VAS pain scores, VAS patient satisfaction scores, and strength all improved similarly with no significant differences between groups at any time point. Wrist and thumb ROM and NHP outcomes were significantly worse for the immobilization group at 6 weeks postoperatively, with no differences observed between groups at 12 weeks and beyond. A conservative immobilization protocol does not improve functional outcomes, satisfaction, strength, or ROM following LRTI compared with an early mobilization protocol. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Management of Neglected Lateral Condyle Fracture of Humerus: A Comparison between Two Modalities of Fixation.

Background:Implant for fixation of neglected fracture lateral condyle humerus remains an issue of controversy. This study compares the clinical and radiological outcome of fixation with Kirschner wire (K-wire) and with cancellous screw (CS) in neglected fracture lateral condyle humerus.Materials and Methods:42 patients of neglected lateral condyle humerus fracture, treated either by open reduction and internal fixation (ORIF) with K-wire or ORIF with CS were included in study. The comparisons were made in term of slab immobilization time, union time, improved range of motion (ROM), final achieved carrying angle, and functional outcome measured by Liverpool Elbow Score (LES).Results:There were 22 patients in Group I with mean age 7.8 years and 20 patients in Group II with mean age 7.3 years. Mean delay in presentation was 12.9 versus 15.6 weeks (P > 0.05). Mean followup was 26.9 versus 26.7 months. Mean duration of immobilization was 11.6 versus 9.4 weeks (P < 0.001). Improved carrying angle was 6.8° versus 9.7° (P < 0.05). Mean gain in ROM was 17.7° versus 27.5° (P < 0.05). Mean LES was 8.15 versus 8.18 (P > 0.05). Premature closure of physis was observed in two patients. Pin tract infection was seen in three of Group I (P > 0.05).Conclusion:There was no difference in LES, irrespective of implant used. Screw was better in terms of duration of slab, improvement in carrying angle and ROM.