Early Range Of Motion Exercises Research Articles

OPEN REDUCTION AND INTERNAL FIXATION WITH PLATING VERSUS EXTERNAL FIXATOR IN DISTAL END RADIUS FRACTURES: A COMPARATIVE STUDY

Objectives: The purpose of this study is to compare the external fixation and locking plate fixation of intraarticular fractures of the distal radius in terms of functional outcome and complications. The study aims to assess the patients for fracture union, wrist range of motion (ROM), grip strength, pain, and activity among the locking plate and external fixator group. Methods: This study aimed to compare distal end radius external fixator to distal end radius plating regarding functional outcomes. This is an observational type of study where 40 patients were included in the study, among them, 20 were treated with external fixator/k wire and 20 with distal radius plate. The study was conducted in a tertiary care institute during the study period. Results: The most patients were males >50 years of age, with injury caused by a fall on an outstretched hand. In the present study, we got excellent functional results according to the G and O’Brien system in 11 (55%) of patients treated with the plating group, good results in 5 (25%), fair results in 4 (20%), and poor (0%) in the plating. Conclusion: Plating provides better functional outcomes, as assessed by Green and O’Brien’s score, as compared to external fixation. It allows for an early post-operative ROM exercises compared to an external fixator and better anatomical positioning of the fracture segments.

The Results of Hook Plate Fixation for Palmar Fracture Dislocation of the Proximal Interphalangeal Joint

This study aimed to present the clinical outcomes of the dorsal plating technique for palmar fracture dislocations of the proximal interphalangeal (PIP) joint. This plating technique minimizes dissection and interference with the finger extensor mechanism. We treated seven patients (with a mean age of 39.1 years) with dorsal hook plates for palmar fracture dislocations of the PIP joint between April 2018 and August 2022. The little finger was affected in five patients, and ring finger was affected in two. The mean time to surgery was 5.6 days, and the postoperative follow-up period was seven months. On the second postoperative day, all patients were allowed active motion of both the PIP and the distal interphalangeal (DIP) joints. Simultaneously, DIP blocking exercises were started to prevent adhesion of the extensor mechanism. The mean active flexion and extension of the PIP joint was 105° and-4°, respectively, whereas those of the DIP joint were 65° and 4°. No patient experienced extension lag in the DIP joint. The mean total active motion (TAM) was 273°, and the %TAM was 96%. The grip strength of the affected hand averaged 90% of that of the unaffected hand. The mean numerical rating scale for pain was 0.3 points, and the mean Hand20 score was 5.1 points. No complications were observed; two patients underwent implant removal at their request. The present study suggests that this hook plate technique, which minimizes interference with the finger extension mechanism, is an effective surgical procedure that allows patients to tolerate early range of motion exercises and obtain satisfactory clinical outcomes in both the PIP and DIP joints. Therapeutic V.

Lack of Consensus in Rehabilitation Protocols After Posterior Shoulder Stabilization.

Posterior shoulder instability is being identified and treated more frequently by orthopaedic providers. After posterior shoulder stabilization, long-term outcomes in function and mobility are largely dependent on the postoperative rehabilitation period. Thus, it is important to assess the consistency between protocols at different institutions. The purpose of this study was to investigate the variability among rehabilitation protocols published by academic orthopaedic programs and their affiliates. It was hypothesized that there would be little consistency in the duration of immobilization, timing of functional milestones, and start dates of various exercises. Cross-sectional study. Rehabilitation protocols after posterior shoulder stabilization that were published online from Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedic surgery programs and their affiliates were evaluated for recommendations on immobilization, exercises, activities, range of motion (ROM), and return-to-sport goals. Of the 204 ACGME-accredited orthopaedic surgery programs, 22 programs and 17 program affiliates had publicly available rehabilitation protocols that were included for review. There were 37 programs (94.9%) that recommended the use of sling immobilization for a mean of 4.7 ± 1.8 weeks postoperatively. Active ROM of the elbow, wrist, and hand was the most common early ROM exercise to be recommended (36 programs; 92.3%). The goal of 90° passive external rotation demonstrated the widest range of recommended start dates (0-12 weeks postoperatively). Late ROM exercises and start dates varied between protocols, with the largest standard deviation found in achieving full active ROM (13.5 ± 3.6 weeks). Resistance exercises showed a wide range of recommended start dates. Bench presses and push-ups began, on average, at 13.1 ± 3.4 and 15.3 ± 3.2 weeks, respectively. Return to sport was recommended at 21.7 ± 3.6 weeks. There was a high level of variability in postoperative rehabilitation protocols after posterior shoulder stabilization among orthopaedic programs and their affiliates, suggesting that a standard protocol for rehabilitation has yet to be established.

Is implant choice associated with fixation strength for displaced radial neck fracture: a network meta-analysis of biomechanical studies

The multitude of fixation options for radial neck fractures, such as pins, screws, biodegradable pins and screws, locking plates, and blade plates, has led to a lack of consensus on the optimal implant choice and associated biomechanical properties. This study aims to evaluate the biomechanical strength of various fixation constructs in axial, sagittal, and torsional loading directions. We included biomechanical studies comparing different interventions, such as cross/parallel screws, nonlocking plates with or without augmented screws, fixed angle devices (T or anatomic locking plates or blade plates), and cross pins. A systematic search of MEDLINE (Ovid), Embase, Scopus, and CINAHL EBSCO databases was conducted on September 26th, 2022. Data extraction was carried out by one author and verified by another. A network meta-analysis (NMA) was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Primary outcomes encompassed axial, bending, and torsional stiffness, while the secondary outcome was bending load to failure. Effect sizes were calculated for continuous outcomes, and relative treatment ranking was measured using the surface under the cumulative ranking curve (SUCRA). Our analysis encompassed eight studies, incorporating 172 specimens. The findings indicated that fixed angle constructs, specifically the anatomic locking plate, demonstrated superior axial stiffness (mean difference [MD]: 23.59 N/mm; 95% CI 8.12–39.06) in comparison to the cross screw. Additionally, the blade plate construct excelled in bending stiffness (MD: 32.37 N/mm; 95% CI − 47.37 to 112.11) relative to the cross screw construct, while the cross-screw construct proved to be the most robust in terms of bending load failure. The parallel screw construct performed optimally in torsional stiffness (MD: 139.39 Nm/degree; 95% CI 0.79–277.98) when compared to the cross screw construct. Lastly, the nonlocking plate, locking T plate, and cross-pin constructs were found to be inferior in most respects to alternative interventions. The NMA indicated that fixed angle devices (blade plate and anatomic locking plate) and screw fixations may exhibit enhanced biomechanical strength in axial and bending directions, whereas cross screws demonstrated reduced torsional stability in comparison to parallel screws. It is imperative for clinicians to consider the application of these findings in constraining forces across various directions during early range of motion exercises, taking into account the distinct biomechanical properties of the respective implants.

Early versus delayed rehabilitation protocol after arthroscopic rotator cuff repair

Objective: To assess the effect of immobilization versus early range of motion exercises in treating primary arthroscopic rotator cuff repair secondary to full-thickness tear. Design: Parallel group randomized clinical trial. Participants: 30 patients with primary arthroscopic rotator cuff repair secondary to full-thickness tear participated in the study. Interventions: Patients were divided into two groups, 15 in each group. The first group (A) received early range of motion (ROM) exercises started 2 weeks post-operative; and the second group (B) immobilized immediately post operative and received delayed range of motion exercises started 6 weeks post-operative. Main outcomes: Shoulder pain and function were assessed by shoulder pain and disability index (SPADI). ROM of shoulder flexion, abduction, and internal rotation were assessed by standard goniometer. Scapular protraction was assessed by digital caliper and scapular upward rotation was assessed by bubble inclinometer. All outcomes were assessed in both groups 6 weeks, 3 months and 6 months postoperative. Results: A significant increase in flexion, abduction and internal rotation ROM at 6 weeks, 3 months and 6 months was observed between groups in favor of Group A.

Outcomes of Primary Volar Locking Plate Fixation of Open Distal Radius Fractures.

Background: Few studies have reported the outcomes of primary volar locking plate fixation in Gustilo and Anderson type II and IIIA open distal radius fractures. We report the outcomes of treatment of Gustilo and Anderson type II and IIIA open distal radius fractures using primary volar locking plate fixation. Methods: We retrospectively reviewed 24 patients with open distal radius fractures who were treated using primary volar locking plate fixation. The range of motion (ROM) and modified Mayo wrist scores were measured to assess functional outcomes. Radiological outcomes included the bone union period, radial inclination, volar tilt, radial length and ulnar variance. Results: Functional outcomes, including mean ROM in flexion (39.1°) and extension (52.5°), improved following primary volar locking plate treatment. Radiological outcomes were as follows. Mean bone union period, radial length and ulnar variance were 7.8 months, 10.4 and 0.7 mm, respectively. Two patients had superficial wound infection 2 weeks after surgery and one patient had non-union of the radius that required implant removal, autologous iliac crest bone graft and plate re-fixation. Conclusions: Primary volar locking plate fixation is a safe and reliable treatment option for Gustilo and Anderson type II and IIIA open distal radius fractures. By providing firm stabilisation and allowing early ROM exercise, primary volar locking plate fixation resulted in good functional and radiological outcomes. Level of Evidence: Level IV (Therapeutic).

Is early mobilization after volar locking plate fixation in distal radius fractures really beneficial? A meta-analysis of prospective randomized studies

This was a systematic review with a meta-analysis. Despite rising trends toward surgical treatment of distal radius fractures (DRF) with volar locking plate (VLP) fixation, there is a lack of consensus on when to start vigorous wrist range of motion (ROM) exercises after surgery. We performed a meta-analysis to compare early and late mobilization after VLP fixation in patients with DRF. Four prospective randomized controlled trials with a minimum of 6 months of follow-up were retrieved through MEDLINE (PubMed), EMBASE, Web of Science, the Cochrane Library, and the KoreaMed databases in March 2021. We divided patients into an early group (patients who started ROM exercises of the wrist within 2 weeks after surgery), and a late group (patients who started ROM exercises 5 or 6 weeks after surgery). The primary outcome was treatment efficacy which was measured through improvement in pain score, function score, ROM, and grip power. The secondary outcome was the incidence of postoperative complications. This meta-analysis included 127 patients in the early group and 131 patients in the late group. The outcomes were compared at 6 weeks, 3 months, and 6 months postoperatively. There was no significant difference in pain score, though the early group had a lower average visual analog scale score. The early group had a lower arm, shoulder, and hand disability score than the late group (95 % CI, -16.25 to -8.35 points; P < .001) at 6 weeks postoperatively, suggesting significantly superior outcomes. A similar trend persisted at 3 (n=74 in the early group and n=77 in the late group; 95% CI, -5.45 to -0.30; P=.029) and 6 months (n=102 in the early group and n=100 in the late group; 95% CI, -4.81 to 0.21; P=.073), but the differences were smaller. The early group had a higher grip power at all follow-up periods, but the difference was only significant at 6 months postoperatively (n=88 in the early group and n=83 in the late group; 95% CI, 0.50 to 6.99; P=0.024). The early group also had more favorable ROM in all directions at 6 weeks, but only in supination at 6 months. The complication rate was not significantly different between the 2 groups. There were no differences in the rates of secondary operation and reduction loss. Early ROM exercise after VLP in DRF resulted in superior functional scores and grip power until 6 months postoperatively. The dominance of the joint ROM, which was seen at 6 weeks after surgery in the early exercise group, decreased with time and ultimately showed little difference at 6 months. Early exercise is safe and did not increase complication rates.

Phalangeal and Metacarpal Fractures of the Hand: Preventing Stiffness.

Summary:Fractures of the phalangeal or metacarpal bones of the hand are common. Many of these fractures are treated without surgery. However, both conservative and operative management of fractures of the hand can result in stiffness. Stiffness is the most common complication in the management of hand fractures. The key to preventing stiffness is early range of motion exercises. This article challenges many of the current treatment regimens offered to patients with the so-called unstable fractures. The evaluation of the patients’ function is the primary factor that should determine the course of conservation versus operative management. X-rays do not demonstrate function and therefore act as an adjunct only to the care of the patient. The goal of treating hand fractures is to restore function. Early motion may not only improve healing but may also hasten the return to normal hand function. The tenets of how to prevent stiffness are described in this review.

Acute Achilles tendon ruptures: Surgical versus non-surgical treatment using early functional rehabilitation: A randomized controlled study

Patients were randomized to surgical or non-surgical treatment for acute Achilles tendon rupture. All patients in both the groups underwent functional [bracing] treatment that includes early weight bearing and early range of motion exercises. The primary outcomes included calf circumference, range of motion, calf muscle strength and functional evaluation by Achilles tendon total rupture [ATRS] score at 6 and 12 months after injury. The secondary outcome is re-rupture rates and other complications.Results: A total of 30 patients [15 patients treated operatively and 15 patients treated non-operatively] were randomized. There were 19 men and 11 women. Mean age 49.5 ± 11.5 years. Re-ruptures occurred in 1 patient [7%] in the surgical group and 2 patients [13%] in the non-surgical group [P=0.368]. The mean ATRS Score at 6 months and 12 months was 74 and 86 in the surgical group and 69 and 84 in the non-surgical group respectively. There was no statistically significant difference between 2 groups with regard to calf circumference ROM, Plantar flexion strength and ATRS Score [p=0.713, p=0.412]. More complications occurred in the operative group, mainly related to wound and soft tissues, compared to non-operative group [15 vs 8].Conclusion: The results of this study demonstrates no significant differences between operative and non-operative functional treatment with regard to re-rupture rates and functional results. Early weight bearing and early ROM exercises are beneficial whether treated by surgical or non-surgical treatment. Addition of functional [Brace] rehabilitation to non-operative treatment avoids wound complications associated with surgery and is a valid alternative to surgical treatment.

Short term functional outcome of jess (Joshi’s external stabilisation system) in proximal humours fractures in adults: A prospective study

Background and Objective: In patients older than 65 years of age, fractures of the Proximal humerus are the second most common in incidence pertaining upper extremity fracture and are only the third most overall common fracture, after hip fractures and the distal radial fractures. It is well known that Most of the minimally displaced fractures of proximal humerus can be treated conservatively. For displaced fractures, many surgical techniques have been described but no single technique is considered to be the standard care. Optimal reduction and fixation of three and four part fractures of proximal humerus remains a challenge well known. Also in most of the surgical techniques and conservative treatments of proximal humerus fractures, post-operative stiffness due to long periods of immobilization remains a challenging issue, even after fruitful union of the fractures. Our study was undertaken to evaluate the functional outcome of the proximal humerus fractures treated with JESS fixators followed by early range of motion exercises post operatively, to curtail the occurrence of stiff shoulder due to longer immobilization periods of other fixation modalities. The final results of the study was then compared to the data of retrospective studies of different modalities of treating proximal humerus fractures and the incidence of frozen shoulder in their studies. Method: It was a Prospective study of 12months duration including 50 adult patients (>18 yrs) with fractures of the proximal humerus admitted to Hospital, and treated by Joshi’s External Stabilization System(JESS) with early mobilization and start of range of motion and pendulum exercises, from post op day 3. Consequently the patients were evaluated till 2 month post-pin removal period, using Murley shoulder score at the time of Pin removal followed by a gap of two months and were followed up at the outpatient clinic. Results: 50 patients were included in the study. The study had 15 (30%) females and 35 (70%) males. out of total 50 cases 18 (36%) patients had left side involvement and 32 (64%) had right side involvement. In 20 (40%) patients the injury to surgery interval was 1-3 days, in 15 (30%) patients the injury to surgery interval was 4-7 days and in 15 (30%) patients the injury to surgery interval was more than 7 days. Neer’s classification was used for classifying the proximal humerus fractures in our study and 3 part fracture was the most common followed by 2 part fracture. Murley score 2 months after implant removal in relation to final outcome was 50.50 ± 5.62 days in excellent outcome group, 55.65 ± 5.69 days in good outcome group, 64.27 ± 7.93 days in fair outcome group and 71.00 ± 11.27 days in poor outcome group. As the duration of complete pin removal increased the final outcome shifted from excellent to poor. Conclusion: In our study we found that proximal humeral fractures can be satisfactorily treated with JESS fixator which is a simpler and affordable method of proximal humerus fracture fixation, which also provides easy early shoulder mobilization and good gain of functionality in about four months since injury. Early mobilization and proper follow-ups with scheduled exercise regimes are of pivotal importance in bringing a better functionality and to decrease the post-operative incidence of frozen shoulder and these factors can be achieved by our modality.

ISOLATED FRACTURE OF TROCHLEA: A RARE CASE ENTITY

Isolated fracture of the trochlea is a rare variety of partial articular fracture of the distal humerus. A 32 year old gentleman presented with trauma to the left elbow sustained due to fall from height. Radiographs revealed an isolated fracture of the trochlea. CT Scan was done to better evaluate the fracture geometry. An ORIF(Open reduction internal fixation) was done through medial approach and fracture was fixed with Herbert and Cancellous cannulated screws. Post operatively early range of motion exercises of the elbow was commenced. Patient regained nearly full elbow range of movements.

Surgical Management of Intra-articular Fracture Distal Radius by Multi axial Locked Plate

Background: Early wrist motion and adequate reduction and fixation of fracture fragments including radial styloid process achieved with volar multi axial locked plate have the advantage of minimizing the risk of joint stiffness and radio carpal joint incongruity present in other treatment modalities of distal radius fractures. The aim of this work was evaluation of surgical management of intra-articular fractures of distal end of radius with volar multi axial locked plate. Objective: To compare the radiological and clinical outcomes with volar multi-axial locked plate and other treatment modalities of multi-fragmentary and intra-articular distal radius fractures Patients and methods: This was a prospective study on 20 patients with intra-articular distal radius fractures operated with open reduction and internal fixation with volar multi axial locked plates from February 2018 to March 2020 via trans flexor carpi radialis tendon sheath (modified Henry approach) in 12 patients with radial column involvement, and ulnar (extensile carpal tunnel release approach) in 8 patients with ulnar column involvement. Follow up was carried out for six months. Results: The mean DASH score at 3rd month was 20.5 ± 6.9, while the mean DASH score at 6th month was 7.25 ± 4.1. The mean 3 months Modified MAYO Wrist Score was 81 ± 9.8 (median = 85), while the mean 6 months MMWS was 85.8 ± 12.5 (median = 90) which indicated a good ability of the patient to perform daily activities with minimal difficulty. At six months follow up 12 patients had excellent results, 6 patients had good results, one patient had fair result, and one patient had poor result. Conclusion: Multi axial locked plate has the advantage of purchasing small fracture fragments including radial styloid process, and also allowing for early range of motion exercises which prevent the occurrence of radio carpal joint arthritis or stiffness.

Treatment of Tibial Avulsion Fracture of Posterior Cruciate Ligament by Open Reduction and Internal Fixation

Background: An avulsion fracture of posterior cruciate ligament from tibial attachment is more common in younger age group. It should be fixed otherwise it may lead to secondary changes in knee. Various techniques and approaches are available to fix posterior cruciate ligament avulsion. Different biomechanical studies have shown that, results both open and arthroscopic methods of fixation of posterior cruciate ligament avulsion by screws are comparable. The purpose of study is to evaluate functional and clinical outcome of open reduction and fixation of posterior cruciate ligament avulsion injury through posteromedial approach.&#x0D; Materials and Methods: The study enrolled 19 cases of isolated posterior cruciate ligament avulsion injury with mean age of 33.21±9.07 year. All cases were treated by open reduction and internal fixation through modified posterior approach. The patients having duration of injury more than 12 weeks were excluded. The minimum follow up duration was 12 months. Results were assessed clinically and radiologically. Final functional outcome was assessed using the Lysholm scoring for knee.&#x0D; Results: The mean duration of follow up was 14±1.85 months. All patients achieved union at 3months. At final follow up the mean range of motion was 125.42±6.37 degree (range 110 to 135 degree) without any extensor lag. The functional outcome assessed by Lysholm scoring system was excellent in 15 cases and good in 4 cases.&#x0D; Conclusion: Open reduction and internal fixation with early range of motion exercises provides good clinical outcome and stable knee.

Open Reduction and Internal Fixation for Dorsal Fracture-dislocation of the Proximal Interphalangeal Joint.

The purpose of this study was to investigate and compare the clinical and radiological results of ORIF with inter-fragment screw or buttress plate fixation of acute PIP joint fracture dorsal dislocation. Between January 2007 to December 2016, nineteen patients-14 men and 5 women with an average age of 40.9 (19 to 64) years-were included in this study; 9 patients underwent small sized interfragmentary screw fixation and 10 patients underwent small buttress plating. The average follow-up period was 45.1 (13 to 78) months. Clinical assessment included measurement of range of motion (ROM) of the proximal and distal interphalangeal joint (PIP, DIP), grip and pinch strength, and pain with use of the Visual Analog Scale (VAS). At the postoperative X-ray, articular step off, gap, and degree of dorsal subluxation was measured, and maintenance of the reduction, fracture union, and the presence of degenerative changes were assessed. All patients achieved solid unions without instability. The overall average range of motion of PIP joint were from 9° to 85° (10-83° in the screw group, 8-87° in the plate group without significant difference). However, the screw group (average: 53°) presented more flexion in the distal interphalangeal joint than the plate group (average: 34°). Plate fixation can cause limited DIP flexion. Six of the ten patients from the plate group, underwent implant removal and two of these patients required PIP joint arthrolysis due to the PIP flexion contracture of more than 30°. Three of the nine patients in screw group underwent implant removal and two of the three patients required PIP joint arthrolysis. Mini plate and screw fixation of acute PIP joint fracture dorsal dislocation can achieve comparable favorable clinical and radiographic outcomes through stable fixation and early range of motion exercise. Screw fixation, if possible, is probably preferable to plate fixation because of better DIP joint ROM and lower incidence of hardware removal. If there is a need for plate fixation the use of a short plate is recommended to avoid joint stiffness.

Physiotherapy after tibial plateau fracture fixation: A systematic review of the literature.

Background:Tibial plateau fractures are frequent injuries that orthopaedic surgeons face. It has been reported that they have a significant negative impact on the patients’ lives, decreasing their quality of live, keeping them of work for long periods of time and reducing their activity levels.Aim:Interestingly, there is not enough focus in the literature about the post-operative rehabilitation of these patients. The aim of the present review is to investigate this field of the literature and try to give answers in four main questions: the range of motion exercises post-surgery, the immobilisation, the weight-bearing status and the ongoing rehabilitation.Materials and Methods:A literature search was conducted using the PubMed and the Google Scholar search engines. A total of 39 articles met the criteria to be included in the study.Results:The literature about this subject is scarce and controversial. Early range of motion exercises should be encouraged as soon as possible after the procedure. The immobilisation after plate fixation does not seem to be correlated with any benefits to the patients. The weight-bearing status of the patients was the most controversial in the literature with the early weight-bearing gaining ground at the most recent studies. Tibia plateau fractures can have significant impact on the patients’ lives, so ongoing rehabilitation with focus on quadriceps strengthening and proprioception exercises is recommended.Conclusion:The present literature review illuminates the controversy that exists in the literature about the physiotherapy following tibia plateau fracture fixation. Early range of motion exercises and early weight bearing should be encouraged. Immobilisation does not seem to provide any benefit. Ongoing rehabilitation should be considered with the view of better clinical outcomes.

An analysis of surgical management of acetabular fractures

With increase in number of high-speed road traffic accidents the incidence of acetabular fracture is increasing. Historically satisfactory results after non operative treatment of acetabular fractures were obtained only in a minority of cases (13-30%). Non operative treatment options include traction and early mobilization with progressive weight bearing. Unsuccessful outcomes after non operative treatment were mostly related to early posttraumatic arthritis likely due to articular incongruity, hip joint instability, and muscle dysfunction. In our study, all the acetabular fractures are classified using standard investigations, operatively managed in indicated cases and followed up post-operatively with regards to improvement in clinical and radiological outcome. Out of 50 patients, 12 patients had excellent result, 24 patients had good result, 9 patients had fair result, and 5 patients had a poor result. Aims and Objectives 1. To study and analyze the outcomes of open reduction and internal fixation in patients with acetabular fractures in terms of radiology, clinical and functional outcomes. 2. To study the role of early range of motion exercises in the functional outcome.3. To study the complications associated with the surgical approaches. Materials and Methods 1. Type of study: Descriptive, case series, comparison study, partly retrospective and prospective. 2. The study was done to assess the clinical, radiological and functional outcome of patients with acetabular fractures treated with open reduction and internal fixation at Goa Medical College. 3. Study setting: Inpatient ward no 103,104,105, under Department of Orthopaedics, Goa Medical College. 4. Methods: All fractures have been classified using the Letournel and Judet classification. All the cases were followed up post operatively and were analyzed for radiological, functional and clinical outcome. The radiological outcome was evaluated with radiograph pelvis AP view, Obturator oblique view and Iliac oblique views. The functional outcome was evaluated with Merle d’Aubigne and Postel modified clinical grading system and Harris hip score.

Arch-shaped approach : New modified medial approach for the treatment of talus fractures

Anatomical reduction and fixation of complex talar fractures (Hawkins typeIII andIV, Marti typeIII andIV) using amedial approach. Displaced talar fractures (Hawkins typeIII andIV, Marti typeIII andIV) with the need for amedial malleolar osteotomy or the simultaneous treatment of amedial malleolus fracture. High perioperative risk, severe soft tissue injuries in the medial approach area, infected soft tissues. Medial arch-shaped approach about 12 cm in length over the medial malleolus using asimultaneous medial malleolus fracture or via an additional medial malleolar osteotomy. Dissection and retraction of the terminal branches of the saphenous vein and the saphenous nerve. Protection of the blood supply in the area of the medial talus and in the sinus tarsi. Reduction of the talar joint surfaces and reconstruction of the anatomical axes according to the preoperative planning by means of native radiological and computed tomographic imaging. Osteosynthesis adapted to the fracture type using Kirschner wires, conventional screws, cannulated screws, double-threaded screws, resorbable pins, magnesium screws, small fragment plates. Lower leg splint or orthesis for 6weeks, partial weight-bearing with 20 kg for 10-12weeks. Early range of motion exercise of the ankle, subtalar and mid-tarsal joints. In the past 5years, 11patients with either Hawkins typeIII andIV or Marti typeIII andIV fractures were treated operatively using the arch-shaped approach. No soft tissue problems were seen related to the arch-shaped approach. Of the 7patients who could be followed up after an average of 2years, the mean American Orthopedic Foot and Ankle Score was73. Avascular necrosis occurred in 3cases (43%). These were partial necroses of less than one third of the talar body with asymptomatic course at the time of examination. In 4patients (57%) radiographic signs of osteoarthritis occurred within 2years, whereby in two of those cases (29%) an arthrodesis of the upper ankle was performed.

Comparative Study of Open Reduction Internal Fixation with Proximal Humerus Interlocking System and Closed Reduction and Pinning with K –Wire in Proximal Humeral Fracture

Background: Treatment of proximal humerus fractures may be conservative or operative. Each procedure has some limitations and complications. A major disadvantage of conservative treatment is failure to obtain early mobilization, which results in a high rate of shoulder stiffness and pain and malunion or nonunion is likely with certain fracture types. Objective: To compare functional outcomes and complications after open reduction and internal fixation of proximal humerus fractures (type 2 and 3 Neer classification) by proximal humeral internal locking osteosynthesis system (PHILOS) versus percutaneous fixation with K- wires.Patients and methods: Our study was conducted upon 20 Patients (M=7, F=13) in elderly group with two parts (10 patients) and three parts (10 patients) proximal humerus fractures according to Neer's classification patients was randomized to either (group 1) who were treated by open reduction and internal fixation with PHILOS plate and (group 2) who were treated with percutenous K- wire fixation. Results: The mean follow up UCLA score was 30 points (range from 26 to 34) points in (group 1) and 31 points (range from 27 to 35) points in (group 2), values varied depending upon the fracture type with worst in 3 parts fractures. Conclusion: we obtained satisfactory results in both groups with each procedure having its advantages and short comings. We found that fixation with percutaneous K-wires presented an efficient treatment option with the advantages of minimal invasions and soft tissue dissection and PHILO'S plate fixation provided stable fixation with minimal implants problems and enabled early range of motion exercise to achieve acceptable functional results.

Comparative Study of Open Reduction Internal Fixation with Proximal Humerus Interlocking System and Closed Reduction and Pinning with K –Wire in Proximal Humeral Fracture

Background: Treatment of proximal humerus fractures may be conservative or operative. Each procedure has some limitations and complications. A major disadvantage of conservative treatment is failure to obtain early mobilization, which results in a high rate of shoulder stiffness and pain and malunion or nonunion is likely with certain fracture types. Objective: To compare functional outcomes and complications after open reduction and internal fixation of proximal humerus fractures (type 2 and 3 Neer classification) by proximal humeral internal locking osteosynthesis system (PHILOS) versus percutaneous fixation with K- wires.Patients and methods: Our study was conducted upon 20 Patients (M=7, F=13) in elderly group with two parts (10 patients) and three parts (10 patients) proximal humerus fractures according to Neer's classification patients was randomized to either (group 1) who were treated by open reduction and internal fixation with PHILOS plate and (group 2) who were treated with percutenous K- wire fixation. Results: The mean follow up UCLA score was 30 points (range from 26 to 34) points in (group 1) and 31 points (range from 27 to 35) points in (group 2), values varied depending upon the fracture type with worst in 3 parts fractures. Conclusion: we obtained satisfactory results in both groups with each procedure having its advantages and short comings. We found that fixation with percutaneous K-wires presented an efficient treatment option with the advantages of minimal invasions and soft tissue dissection and PHILO'S plate fixation provided stable fixation with minimal implants problems and enabled early range of motion exercise to achieve acceptable functional results.

Arthroscopic-Assisted Suspensionplasty Using the Palmaris Longus Tendon for Osteoarthritis of the Thumb Carpometacarpal Joint

Osteoarthritis of the thumb carpometacarpal joint is common, especially in postmenopausal women. Numerous surgical techniques, including ligament reconstruction, partial or complete trapeziectomy, arthrodesis, and arthroplasty have been introduced. Suspensionplasty combined with trapeziectomy has been introduced to prevent proximal subsidence of the first metacarpal. To prevent excessive release of periarticular capsuloligamentous tissues, resection of the proximal part of the trapezium, and the cosmetically unappealing bump, arthroscopic partial trapeziectomy has been used as a less-invasive treatment option. With advanced techniques and devices, arthroscopic suspensionplasty with the autograft can be performed; thus far, there have been no series reporting on arthroscopic treatment options for this common condition. The purpose of this article is to present a technique for arthroscopic-assisted suspensionplasty using the palmaris longus tendon to reinforce the graft–bone interface, based on the concept of the tension slide technique to treat thumb carpometacarpal osteoarthritis.