Fractures Of Distal End Research Articles

A prospective observational study of functional outcome of fracture distal end of Tibia, treated with minimally invasive plating osteosynthesis (Mippo) technic

Background: Distal tibia fractures including Tibia pilon fractures present a challenge as to their best method of management due to subcutaneous location of larger portion of tibia, paucity of soft tissue coverage and precarious blood supply to the distal leg. The involvement of the ankle joint and the vulnerability of the surrounding soft tissues further complicate these already complex injuries. Numerous classifications have been proposed for these fractures, however AO-OTA alphanumeric classifications the most comprehensive as well as the most commonly quoted classification. The lower end of the tibia including its medial and the lateral malleoli of the fibula form a socket (mortise) into which the body of the talus articulates, and along with capsule and ligament thus form the ankle joint. Any disruption of length, axis or rotation of the fibula or the tibia can result in an incongruent ankle joint. The lateral aspect of the distal tibia forms a triangular notch where the fibula articulates. The interosseous membrane and the anterior and posterior tibiofibular ligaments bind these bones together.Aim: To evaluate the efficiency of internal fixation for the fractures of distal tibia by using minimally invasive plating osteosynthesis [Mippo] technique. To assess the functional outcome of Mippo technique with locking compression plate and dynamic compression plate.Methods: A prospective observational study of patients above the age of 20 years with distal tibia fracture admitted in King George hospital, Visakhapatnam. Study duration 9 months.Results: There were 72 patients in the study including 50 males (69.4%) and 22 females (30.6%) of mean age 46 years. The commonest cause of injury was RTA with High energy trauma with total of 31 patients (43.06%) followed by Low energy RTA with total of 28 patients (38.89%) and the rest 28 of the patients with Low energy fall (18.06%) respectively. All fractures united at an average of 15 weeks (range 12 to 20 weeks). As regards pain, 48 patients (66.66%) were pain-free, 18 patients (25%) had only occasional pain.Conclusion: It is well accepted that the final outcome of distal tibial fractures including pilon fractures with this MIPPO technique, a single stage operative procedure. It is obvious that these are not directly influenced by this technique MIPPO, single-stage operative procedure, contributing to a favorable outcome.

Management of comminuted intra-articular fractures of distal radius by external fixator using principle of ligamentotaxis: A prospective study

Management of fracture distal end of radius is still a challenge for Orthopaedic surgeon and pose therapeutic problem in terms of reduction of fracture, maintenance of reduction till the fracture unites, mobility of the joint after fracture union. Failure in the management may cause permanent disability1. The efficacy of ligamentotaxis in neutralizing detrimental compression forces, which are likely to cause displacement of unstable fracture with radial shortening, is a significant and increasingly appealing advance in the management of distal radius fracture. The aim of our study is to evaluate the functional outcome of comminuted intra-articular distal radius fractures in 30 patients treated by External fixator using principle of Ligamentotaxis. Demerit score system modified after Gartland Werley (1951) was used to assess the functional outcome. As per scoring system 14 patients had excellent results, 12 patients had good results and 3 patients had fair results and poor result in 1 patient. Based on our study we found ligamentotaxis is a good surgical option in the management of comminuted intra- articular distal end radius fractures.

Correlation of the radial inclination angle in the distal part of the radius with the volar cortical angle and age-related changes of these angles

Background/Aim. The radial inclination (RI) and volar cortical (VC) angle values used in the treatment of radial distal end fractures may vary depending on factors such as the age and gender of the patient. That raises the question of the compatibility of the standard anatomical plates, which are frequently used in the surgical treatment of these fractures. The aim of the study was to evaluate the VC and RI angles depending on the age and gender of subjects and determine the correlation between these two angles. Methods. A total of 121 individuals (59 females and 62 males) aged 10?65 years were included in the study. The individuals were divided into two groups: a group of 60 adolescents (31 females, 29 males) 10?20 years old and a group of 61 adults (28 females, 33 males) aged 20?65 years. The subjects were also evaluated between themselves, independently, within each age group. Radiographic images were evaluated by using the 3.0.1.55 version of the KarPacsViewer application. Measurement points were determined, and angles between these points were measured. Statistical analyses were made using the SPSS 15.0 program. Results. When the correlation for 121 individuals was assessed independently of their gender, no statistically significant relationship was found between the RI angle and age (p = 0.616; r = -0.046). A statistically negative (or opposite) relationship was found between the VC angle and age (p < 0.001; r = -0.396). When women and men were compared in terms of the RI and VC angles, no statistically significant difference was found (p = 0.958, p = 0.165, respectively). The VC angle decreased as the age increased in females (p = 0.004; r = -0.365), while both the RI and VC angles decreased with increasing age in males (p = 0.032, r = -0.273; p < 0.0001, r = -0.445, respectively). Conclusion. Our findings regarding the RI and VC angles offer an advantage in terms of determining which plate designs are most appropriate for planning surgical procedures and treatment processes.

The relationship between surgical treatment results of AO type-C radius distal end fractures in adults and patient age

Aim: To evaluate the results of the locking anatomic plate fixation method with volar intervention according to age groups in the surgical treatment of unstable radius distal end fractures involving the joint. Materials and Methods: In this study, 72 adult patients with distal radius fractures who were treated with open reduction and locked volar plate fixation due to radius distal end fracture in group C according to AO classification between August 2010 and August 2018 were evaluated retrospectively. All our patients were evaluated for a post-op range of motion. We divided the age ranges into four groups: Group 1 for ages 17-30, Group 2 for ages 30-45, Group 3 for ages 45-60, and Group 4 for ages over 60. Results: The mean values of joint range of motion and grip strength in all our patients were; flexion 70.95° (Group 1 76.87°, Group 2 74.00°, Group 3 66.96°, and Group 4 64.16°), extension 67.38° (Group 1 71.87°, Group 2 68.33°, Group 3 61.15° and, Group 4 61.16°), radial deviation 27.02° (Group 1 32.50°, Group 2 29.67°, Group 3 23,08° and, Group 4 21.67°), ulnar deviation 32.86° (Group 1 38.75°, Group 2 36.33°, Group 3 28.46°, and Group 4 25.83°), supination 77.74° (Group 1 85.0°, Group 2 79.67°, Group 3 74.62°, and Group 70.0°), pronation 82.50° (Group 1 85.62°, Group 2 84.33°, Group 3 82.69°, and Group 4 73.33°). Analysis of the data revealed a negative correlation between patient age and post-operative joint range of motion. Our findings indicate a statistically significant difference in joint range of motion among Group 4, Group 1, and Group 2 patients. Conclusion: Volar locking plate surgery in AO type C radius distal fractures is suitable for all age groups thanks to rigid fixation and early mobilization.

A variable mineralization time and solution concentration intervene in the microstructure of biomimetic mineralized collagen and potential osteogenic microenvironment.

The absence of a conducive bone formation microenvironment between fractured ends poses a significant challenge in repairing large bone defects. A promising solution is to construct a bone formation microenvironment that mimics natural bone tissue. Biomimetic mineralized collagen possesses a chemical composition and microstructure highly similar to the natural bone matrix, making it an ideal biomimetic bone substitute material. The microstructure of biomimetic mineralized collagen is influenced by various factors, and its biomineralization and microstructure, in turn, affect its physicochemical properties and biological activity. We aimed to utilize mineralization time and solution concentration as variables and employed the polymer-induced liquid precursor strategy to fabricate mineralized collagen with diverse microstructures, to shed light on how mineralization parameters impact the material microstructure and physicochemical properties. We also investigated the influence of microstructure and physicochemical properties on cell biocompatibility and the bone-forming microenvironment. Through comprehensive characterization, we examined the physical and chemical properties of I-EMC under various mineralization conditions and assessed the in vitro and in vivo biocompatibility and osteogenic performance. By investigating the relationship between mineralization parameters, material physicochemical properties, and osteogenic performance, we revealed how microstructures influence cellular behaviors like biocompatibility and osteogenic microenvironment. Encouragingly, mineralization solutions with varying concentrations, stabilized by polyacrylic acid, successfully produced intrafibrillar and extrafibrillar mineralized collagen. Compared to non-mineralized collagen, all mineralized samples demonstrated improved bone-forming performance. Notably, samples prepared with a 1× mineralization solution exhibited relatively smooth surfaces with even mineralization. Extending the mineralization time enhanced the degree of mineralization and osteogenic performance. Conversely, samples prepared with a 2× mineralization solution had rough surfaces with large calcium phosphate particles, indicating non-uniform mineralization. Overall, our research advances the potential for commercial production of mineralized collagen protein products, characterized by dual biomimetic properties, and their application in treating various types of bone defects.

Antibiotic artificial bone implantation for the treatment of infection after internal fixation of tibial plateau fractures

ObjectiveTo explore the clinical effect of antibiotic artificial bone (Calcium phosphate) in the treatment of infection after internal fixation of tibial plateau fractures.MethodsWe retrospectively reviewed the clinical data of 32 patients with infection after internal fixation of tibial plateau fractures treating from March 2010 to October 2021. There were 18 males and 14 females, aged from 23 to 70 (average 49.66 ± 10.49), 19 cases of the left side and 13 cases of the right side. Among them, 7 cases were open fractures with initial injury and 25 cases were closed fractures. On the basis of thorough debridement and implanting antibiotic artificial bone, the internal fixation of 18 patients were tried to be preserved and the internal fixation of 14 patients were removed completely. In order to provide effective fixation, 14 patients also received external fixation. Postoperative wound healing, infection control, Hospital for Special Surgery knee scores (HSS), related inflammatory indicators and bone healing time were recorded and followed up.ResultsThirty-two patients were followed up for 12 ~ 82 months (average 36.09 ± 19.47 months). The redness, swelling and pain of pin site occurred in 2 patients, which returned to normal after applying antibiotics and continuous dressing change. One patient retained the internal fixation during the first-stage operation. Redness and swelling of incision, subcutaneous undulation occurred after two months. In order to avoid the recurrence of infection, the internal fixation was removed completely and antibiotic artificial bone was filled again. The infection was controlled and fracture healed. Four patients’ wounds could not be closed directly due to soft tissue defect and was covered with skin flap. After the first-stage operation, 12 patients received second-stage autologous iliac bone grafting due to residual bone defects and poor healing of the fracture end. The bone healing time was 4 ~ 16 months (average 7.31 ± 2.79 months). Inflammatory indicators including CRP, ESR, and WBC returned to normal levels within 2 ~ 10 weeks (average 4.97 ± 2.58 weeks). The HSS of all patients were 54 ~ 86 points (average 73.06 ± 8.44 points) at the last follow-up.ConclusionImplantation of antibiotic artificial bone, retention or removal of internal fixation according to infection and fracture healing, application of external fixation timely is an effective method to treat infection after internal fixation of tibial plateau fractures, which can control infection effectively and promote functional recovery.

Evaluation of functional outcome by modified mayo wrist score in intra- articular distal end radius fracture managed by plate osteosynthesis

<p class="abstract"><strong>Background:</strong> Fractures of distal end of radius continue to pose a therapeutic challenge. Intra articular and extra articular malalignment can lead to various complications like post traumatic osteoarthrosis, decreased grip strength and endurance, as well as limited motion and carpal instability.</p><p class="abstract"><strong>Methods:</strong> A prospective study of forty patients with intra-articular distal end radial fractures treated under the department of orthopaedics, PIMS, Udaipur, were included in this study. All patients managed by plate osteosynthesis were followed up to 9 months.<strong></strong></p><p class="abstract"><strong>Results:</strong> When outcome according to modified Mayo wrist scoring system was assessed, only one patient (2.50%) scored with poor grade. 11 (27.50%) were graded as excellent, 19 (22.50%) as grade good, 9 (22.50%) as grade fair. 32 (80%) patients had union within 2-3 months and 06 (15%) patients had union in 3-4 months. There were 2 (5%) case of delayed union.</p><p class="abstract"><strong>Conclusions:</strong> Assessment of functional outcome by modified mayo wrist score in intra-articular distal end radius fracture managed by plate osteosynthesis gives an excellent scoring system to assess outcome of communited intrarticular distal radius fractures with reference to function of the hand and wrist of the individual. Also, it will help to predict the likely functional outcome in relation to fracture pattern of distal radius.</p><p> </p>

Radiomics-Based Machine Learning for Predicting the Injury Time of Rib Fractures in Gemstone Spectral Imaging Scans.

This retrospective study aimed to predict the injury time of rib fractures in distinguishing fresh (30 days) or old (90 days) rib fractures. We enrolled 111 patients with chest trauma who had been scanned for rib fractures at our hospital between January 2018 and December 2018 using gemstone spectral imaging (GSI). The volume of interest of each broken end of the rib fractures was segmented using calcium-based material decomposition images derived from the GSI scans. The training and testing sets were randomly assigned in a 7:3 ratio. All cases were divided into groups distinguishing the injury time at 30 and 90 days. We constructed radiomics-based models to predict the injury time of rib fractures. The model performance was assessed by the area under the curve (AUC) obtained by the receiver operating characteristic analysis. We included 54 patients with 259 rib fracture segmentations (34 men; mean age, 52 years ± 12.02; and range, 19-72 years). Nine features were excluded by the least absolute shrinkage and selection operator logistic regression to build the radiomics signature. For distinguishing the injury time at 30 days, the Support Vector Machine (SVM) model and human-model collaboration resulted in an accuracy and AUC of 0.85 and 0.871 and 0.91 and 0.912, respectively, and 0.81 and 0.804 and 0.83 and 0.85, respectively, at 90 days in the testing set. The radiomics-based model displayed good accuracy in differentiating between the injury time of rib fractures at 30 and 90 days, and the human-model collaboration generated more accurate outcomes, which may help to add value to clinical practice and distinguish artificial injury in forensic medicine.

Problem of Blocking a Technogenic Fracture in the Reservoir Using a Suspension Mixture

The solution of the problem of blocking a technogenic fracture in the reservoir by a suspension mixture is considered. The mathematical model based on the mass conservation laws for the disperse particles and carrier fluid is used. The flow velocity of disperse particles through the fracture is calculated from the Poiseuille law and the carrier fluid outflow to the reservoir is described by Darcy’s law. It is found that the leading front of suspension slug corresponds to a contact discontinuity. It is shown that a reflected wave in the form of a discontinuity of the volume fraction of disperse particles begins to move counter the flow when the front of suspension slug reaches the fracture end and the fracture begins to be blocked up from this end. It is established that the movement of the reverse wave is gradually slowing down; therefore, blocking the entire fracture is turned out to be problematic.

Finite element comparative analysis of three different internal fixation methods in the treatment of Pauwels type III femoral neck fractures

BackgroundComparison of 4 cannulated lag screws (3 inverted triangular cannulated screws + anti-rotating screws;4 CLS), dynamic hip screws + derotational screws (DHS + DS), and femoral neck fixation system (FNS) in the treatment of Biomechanical properties of middle-aged Pauwels type III femoral neck fractures.MethodsThe femur CT data of a healthy young volunteer was selected and imported into Mimics software to construct a three-dimensional model of a normal femur. Pauwels type III femoral neck fractures were simulated according to the 70° fracture line. Use Geomagic and SolidWorks software to optimize and build CLS, DHS + DS, and FNS fracture internal fixation models. Finally, Ansys software was used to analyze the stress distribution, peak value, and maximum displacement of the proximal fracture fragment and internal fixation; the displacement distribution, and peak value of the fracture surface at the fracture end.Results① The stress peaks of the proximal fracture fragments in the three groups were concentrated near the femoral calcar. The peak stress of the FNS group was the largest, and the DHS + DS group was the smallest. ②The displacement of the fracture fragments was all located at the top of the femur. The peak displacement of the FNS group was the largest, and the DHS + DS group was the smallest. ③ The internal fixation stress of the three groups is concentrated in the middle part of the device. The stress distribution of the first two groups of models is more uniform than that of FNS. The peak stress of FNS is the largest and the CLS is the smallest. ④ The internal fixed displacements are all located at the top of the model. The peak displacement of the CLS is the largest, and the DHS + DS is the smallest. ⑤ The displacement of the fracture surface is in the upper part of the fractured end. The peak displacement of the FNS group was the largest, and the DHS + DS group was the smallest.ConclusionCompared with the other two internal fixation methods, dynamic hip screw + derotational screw (DHS + DS) showed good biomechanical stability. When Pauwels type III femoral neck fracture occurs in young adults, DHS + DS can be given priority as the preferred treatment for this type of fracture.

Circular External Fixator Assisted Open Reduction Combined With Locking Plate Fixation for Intra-articular Comminuted Fractures of the Calcaneus

Comminuted fractures of the calcaneus are relatively common and generally require surgical treatment. The quality of fracture reduction is crucial. The extended lateral approach (ELA) can better expose the fracture end and facilitate the reduction of the fracture, while it has a higher risk of postoperative skin complications. In this study, the ELA was adopted, and the calcaneal comminuted fractures were treated with circular external fixator assisted reduction to achieve the purpose of good reduction of the fracture and fewer skin complications. During 64 months, a total of 61 cases of unilateral calcaneal fractures were treated by the same surgeon and followed up for 19.28 ± 5.28 months. During the operation, a circular external fixator was employed to fix the midfoot and the distal end of the tibia, and the calcaneal tubercle; then, the calcaneal tubercle was distracted to restore the 3-dimensional structure of the calcaneus. The ELA was utilized to reduce the articular surface fracture. The fracture was fixated with a locking plate. Postoperative radiographs were regularly reviewed. Meanwhile, Böhler's angle and Gissane's angle were measured. Visual analogue scale and American Orthopedic Foot and Ankle Society Score assessments were performed at the final follow-up. All fractures healed. The mean preoperative Böhler's angle was 9.3 ± 10.1 degrees; the mean Gissane's angle was 110.5 ± 14.7 degrees; the immediate postoperative mean Böhler's angle was 31.3 ± 5.5 degrees; mean Gissane's angle was 110.9 ± 5.9 degrees. Local superficial necrosis of surgical incision occurred in 2 cases, which healed well after dressing changes. Skin necrosis appeared in 1 case, where debridement and local flap transfer were performed. At the final follow-up, the mean visual analogue scale score was 1.48 ± 1.30, and the mean American Orthopedic Foot and Ankle Society Score was 90.16 ± 7.19. The ELA combined with a circular external fixator to assist in the reduction of calcaneal fractures achieved good reduction quality and effectively reduced postoperative complications.

OR01-1 Proximal Femur Fracture Incidence by Sex among Older US Asian/Pacific Islander Adults and non-Hispanic White Adults

Abstract Background The burden of proximal femur (hip) fractures is high in older adults and contributes to substantial mortality. Numerous studies also document racial/ethnic differences in hip fracture incidence, lower among US Asian compared to non-Hispanic White (NH-White) adults. These data have informed base population factors used for fracture risk calculation; for US Asian compared to NH-White populations, ratios of 0.50 and 0.64 have been used for women and men, respectively. In this study, we examined age-adjusted and age-specific incidences of hip fracture in a contemporary population of older US adults and compared findings in Asian and NH-White women and men. Methods Among adults age ≥50 years who were members of a large US healthcare system during 2010-2019, we identified Asian/Pacific Islander (Asian/PI) and NH-White adults based on self-reported race/ethnicity data. Incident hip fractures were identified during follow-up from 2010 to 2021 (censoring at hip fracture, death, or membership end) based on (1) initial principal/primary hospital diagnosis of femoral neck or pertrochanteric fracture or (2) secondary hospital diagnosis with hip fracture repair procedure(s). The incidence of hip fracture (per 100,000 person-years) by sex and age and overall age-standardized incidence (using the 2010 US Census) were reported with [95% confidence intervals]. To compare sex-specific fracture rates between Asian/PI and NH-White adults, Poisson models were fitted, adjusting for age (5-year age categories). Results Among 203,116 Asian/PI and 645,384 NH-White women, we identified 1,436 and 15,214 hip fractures, and among 174,594 Asian/PI and 573,693 NH-White men, we identified 582 and 7051 hip fractures during follow-up, respectively. The age-adjusted incidence of hip fracture was 136 [129-143] and 297 [292-302] per 100,000 person-years for Asian/PI and NH-White women and 54 [49-58] and 149 [145-153] per 100,000 person-years for Asian/PI and NH-White men, respectively. By 5-year age group, hip fracture incidence increased from 4, 40, to 1113 per 100,000 person-years for Asian/PI women and 7, 29, to 528 per 100,000 person-years for Asian/PI men ages 50-54, 65-69, to 85+ years, respectively. These estimates were lower than that observed in respective NH-White women (range 19, 140, to 2068 per 100,000 person-years) and NH-White men (range 22, 85, and 1381 per 100,000 person-years). The age-adjusted relative risk (risk ratio) of fracture comparing Asian/PI to NH-White women was 0.44 [0.41-0.46] and comparing Asian/PI to NH-White men was 0.35 [0.33-0.39]. Conclusion Hip fracture incidence in Asian/PI women and men is 56% and 65% lower than that observed in NH-White women and men. These findings indicate that racial/ethnic differences in proximal femur fracture persist in contemporary aggregate populations of older US Asian/PI adults compared to NH-White adults. However, given the known and increasing heterogeneity of the US Asian/PI population, future studies should examine whether these risk ratios vary by Asian/PI ethnic subgroups. Presentation: Saturday, June 11, 2022 11:30 a.m. - 11:45 a.m.

An innovative technique - Axial Loading and Compression Fixation (ALCF Technique) of scaphoid fracture by percutaneous K-wire

Backgrounds Surgical fixation techniques used for the treatment of scaphoid fracture is still a topic of discussion among hand surgeons especially in terms of approach, implants and surgical techniques. We present an innovative technique of scaphoid fracture fixation by K-wire, which we accidentally encountered when the guide wire broke while doing a cannulated screw for the scaphoid. This technique of axial aligning, compression loading over a bent tip of K-wire across the fracture fragments of scaphoid is innovative. Materials The study included 16 patients operated for Scaphoid fracture between January-2017 to January-2020 by ALCF Technique. the patient age ranged from 18 to 69 years,M:F12:4, 13 fractures on dominant hand,10 fracture presented within 2 weeks, 7 were trans-scaphoid displaced fractures sustained in RTA, 3 proximal pole fractures sustained after a fall, 6 were delayed presentation more than 3 months. Method The technique used to pass a K wire from dorsally in ante grade fashion to align the fracture fragments along the anatomical axis of the scaphoid then bend the K wire at the proximal end so as to hook the proximal fragment. The distal end of the K wire is then applied manual traction load with gentle rotation to achieve compression at the fracture ends with rotational alignment on the distal fragment. The distal fragment is anvil on the proximal fragment by a K-wire binder before distally binding to achieve compression & relative stable fixation. Conclusion It is a simple, easy to reproduce, economic method to achieve reduction, compression using axial traction and union in all types of scaphoid fractures.

Early Results of Internal Fixation with Femoral Neck System in Young Patients with Femoral Neck Fracture

Femoral neck fractures are intracapsular hip fractures. There are several surgical implants that have been used to treat femoral neck fractures. Depuy Synthes Products and the lower extremity expert group have developed an innovative femoral neck system (FNS) for fixing femoral neck fractures. With minimally invasive procedures, FNS can provide angular stability. A non-randomized single centre prospective study was conducted in 30 patients of less than 60 years of age at Maharishi Markandeshwar Institute of Medical Sciences and Research between August 2020 to May 2022. All patients underwent internal fixation with FNS within 48 hours of presentation. Although blood loss and operative time in our operated group was more than that in conventional fixation by cannulated screws, our group had better VAS scores, better Harris scores and lower complication rates. 1. The Femoral Neck System resulted in better biomechanical properties and good early results in femoral neck fractures. FNS gives both angular stability and rotational stability. The last follow-up in our study showed Harris score to be significantly higher, and the incidence of complications were lower. 2. The combination of FNS bolts with anti-rotation screws avoids the "Z" effect and improves the overall stability and anti-rotation effect. 3. In addition, the novel sliding compression mechanism of FNS allows the fracture ends to come in close contact with each other, benefitting fracture healing.

COMPARATIVE STUDY OF FUNCTIONAL AND RADIOLOGICAL OUTCOME OF AUGMENTED EXTERNAL FIXATOR VERSUS VOLAR LOCKING PLATE IN INTRAARTICULAR FRACTURES OF DISTAL END RADIUS.

Introduction: Augmented external fixation and Open reduction with volar locking plate are two frequently used modalities in the management of intraarticular fractures of distal end radius. However, there is still controversy regarding the optimal surgical modality. The present study was performed to compare the functional and radiological outcomes of augmented external fixation (AEF) versus volar plate fixation (VPF) in the management of patients with intraarticular fractures of distal end of radius. This prospective study was done between December 2019 Materials and Methods: and December 2021. This study included 40 patients with intraarticular fractures of distal end of radius. All patients fulfilling inclusion criteria were randomly allocated into two groups. Group A was treated with an AEF and Group B with VPF. Functional assessment was done by measuring the wrist range of motion, hand grip strength and Mayo Wrist Score. The radiographic parameters included radial height, radial inclination, and volar tilt. Follow-up was done at 6 weeks, 3 months, and 6 months post-operatively. In our study at all follow-ups, the VPF group had a significa Results: ntly better Mayo wrist score and wrist flexion, wrist extension, forearm supination and pronation compared to the AEF group (p < 0.05). There were no significant differences in terms of hand grip strength and postoperative radiologic parameters (p > 0.05). VPF is a better surgical option as compared to AEF based on our short-term functional outcome Conclusion: in the management of patients with intraarticular fractures of the distal end of radius, on account of better wrist flexion and extension, forearm rotation and Mayo wrist scores, and fewer complication rates.

Functional and radiological outcome of volar plate fixation in intra articular distal radius fractures

Introduction: Fractures of lower end radius are most common fractures of the upper extremity encountered in practice and constitute 17% of all fractures and 75% of all forearm fractures. These injuries account for approximately one sixth of all fractures seen and treated. In the words of Dr. Abraham Colles “this fracture takes place about an inch and a half above the carpal extremity of the radius and there is a 17% lifetime probability for distal radius fractures”. The majority of these injuries are 'closed', with no evidence of breach of the surrounding skin. Materials and Methods: A prospective study on cases of the fractures of the distal end of the radius, attending the Orthopaedics outdoor and the emergency services of Vinayaka Mission's Kirupananda Variyar Medical College and Hospital, Salem. The fractures were classified according to Modified AO Classification. 25 cases were followed at regular intervals and final assessment was done at 3 months (photographic plate 2). This study was conducted with detailed clinical and radiological analysis after surgical management of fractures of distal end of radius.

Treatment of the Hoffa fracture of the lateral femoral condyle with cannulated screws in combination with an anti-gliding steel plate, a retrospective observational study

BackgroundThe stability of the Hoffa fracture fixed with a cannulated screw is limited. In the present work, we adopted two cannulated screws from anterior to posterior and posteriorly anti-gliding plate to treat 12 cases with Hoffa fracture of the lateral femoral condyle.MethodsOpen reduction and internal fixation were performed in 12 patients with Hoffa fractures of the lateral femoral condyle. The Hoffa fracture end was fixed with an anti-gliding steel plate based on cannulated screw fixation in the rear of the distal femur. All patients were followed for 12–24 months, with a median of 15.3 ± 4.6 months.ResultsAll fractures were bony union, with a healing time of 3–6 months (median, 4.5 months). The Letenneur evaluation system was used to assess efficacy. Four indexes were observed, including knee range of motion (ROM), stability, pain, and dependent ambulation. The results revealed that eight cases were excellent and four cases good, with a good rate of 100%.ConclusionThe surgical treatment with cannulated screws in combination with an anti-gliding steel plate could fix the end of the Hoffa fracture, which could acquire strong internal fixation and a good curative effect.

Characteristics of femoral neck fractures in young and middle-aged adults based on fracture mapping technology

To analyze the characteristics of femoral neck fractures in young and middle-aged adults by means of medical image analysis and fracture mapping technology to provide reference for fracture treatment. A clinical data of 159 young and middle-aged patients with femoral neck fractures who were admitted between December 2018 and July 2019 was analyzed. Among them, 99 patients were male and 60 were female. The age ranged from 18 to 60 years, with an average age of 47.9 years. There were 77 cases of left femoral neck fractures and 82 cases of right sides. Based on preoperative X-ray film and CT, the fracture morphology was observed and classified according to the Garden classification standard and Pauwels' angle, respectively. Mimics19.0 software was used to reconstruct the three-dimensional models of femoral neck fracture, measure the angle between the fracture plane and the sagittal plane of the human body, and observe whether there was any defect at the fracture end and its position on the fracture surface. Through reconstruction, virtual reduction, and image overlay, the fracture map was established to observe the fracture line and distribution. According to Garden classification standard, there were 6 cases of type Ⅰ, 61 cases of type Ⅱ, 54 cases of type Ⅲ, and 38 cases of type Ⅳ. According to the Pauwels' angle, there were 12 cases of abduction type, 78 cases of intermediate type, and 69 cases of adduction type. The angle between fracture plane and sagittal plane of the human body ranged from -39° to +30°. Most of them were Garden type Ⅱ, Ⅳ and Pauwels intermediate type. The fracture blocks were mainly in the form of a triangle with a long base and mainly distributed below the femoral head and neck junction area. Twenty-six cases (16.35%) were complicated with bone defects, which were mostly found in Garden type Ⅲ, Ⅳ, and Pauwels intermediate type, located at the back of femoral neck and mostly involved 2-4 quadrants. The fracture map showed that the fracture line of the femoral neck was distributed annularly along the femoral head and neck junction. The fracture line was dense above the femoral neck and scattered below, involving the femoral calcar. The proportion of displaced fractures (Garden type Ⅲ, Ⅳ) and unstable fractures (Pauwels intermediate type, adduction type) is high in femoral neck fractures in young and middle-aged adults, and comminuted fractures and bone defects further increase the difficulty of treatment. In clinical practice, it is necessary to choose treatment plan according to fracture characteristics. Anatomic reduction and effective fixation are the primary principles for the treatment of femoral neck fracture in young and middle-aged adults.

Temporary spacer rod and plate technique: a novel intraoperative technical tip for minimizing the docking site malalignment during bone transport for bone loss in Gustilo IIIb open tibial fractures.

Distraction osteogenesis is a safe and reliable option for managing bone defects of the tibia following major open fractures. Even though the Limb Reconstruction System (LRS) is a popular option, it may result in malalignment, necessitating an additional procedure to correct the alignment. The objective of the study is to assess the efficacy of a novel surgical technique in minimising malalignment. This was a retrospective cohort study conducted at a level 1 tertiary trauma centre consisting of 35 patients with primary bone loss following open tibia fractures. A uniplanar LRS frame was applied using a combined spacer rod with plate technique. Radiological assessment of docking site characteristics (translation, angulation) and functional assessment using ASAMI score was done. The mean distraction regenerate length was 8.4 ± 3.45cm. At the docking site, 18 patients did not have any deformity, 13 had a minor deformity of ≤ 5°, 2 had a moderate deformity of 6°-10° and 2 with a severe deformity > 10°. Circumferential docking was seen in 88.5% (31/35). According to the ASAMI functional scoring, 13 patients had excellent outcomes, 19 had good, one had fair, and two had poor outcomes. Six patients had pin tract infections, three had deep infections, and 17 had a delayed union. Our study had a lower incidence of malalignment compared to similar studies in the literature. The use of this simple and economical intra-operative technique allowed for much higher precision in aligning the fracture ends, thus minimising the docking site malalignment. III. Level I Tertiary trauma centre.

Numerical simulation of proppant directly entering complex fractures in shale gas

Large-scale slickwater fracturing is an important technical method for the effective development of shale gas, which generates complex fractures with fracture width of millimeters in the reservoir. It is known that the transport law of proppant in complex fractures is the premise for realizing effective propping. Taking the behavior of 70/140 mesh proppant particles commonly used in shale gas fracturing as the object，a numerical model based on the computational fluid dynamics-discrete element method (CFD-DEM) and the geometric model of the intersection of the main and secondary fractures are established. It is used to study the two-phase flow law under the conditions of different fracture widths and angles, pump displacements, and fluid viscosities. The results show that the proppant enters the secondary fracture in two ways: carried by the fluid in a suspended manner and rolling into the fracture from the sand bank surface. Particles suspended in the fracture can be transported to the distal end of the secondary fracture. Owing to the influence of the inertia force of particles, the particle flow rate entering the secondary fracture is much smaller than the fluid flow rate in the secondary fracture. As the included angle between the secondary and main fractures decreases, the fluid and particle flow rate increase, and particles can easily enter the secondary fracture. As the displacement, secondary fracture width and fracturing fluid viscosity increase, proppant particles are easier to enter secondary fractures. The absolute values of the main and secondary fracture widths become smaller, and the relative value remains the same, making it more difficult for proppant particles to enter the fractures.