Extra-articular Fractures Research Articles

Combined use of minimal screw synthesis and external articulated fixation is effective for the management of supra-intercondyloid humeral fractures in the elderly? A retrospective study

BackgroundFractures of the distal humerus are relatively rare and can be a source of disabling outcomes especially if not properly treated. Therefore, the objective of the treatment must be to obtain a stable synthesis that allows early mobilization, avoiding complications such as muscular hypotonotrophy, joint rigidity or delays in consolidation that may be due to prolonged immobilization of this joint. Although ORIF treatment of these fractures may intuitively appear to be the gold standard, there is still no consensus in the literature on which type of treatment is most suitable. Patients and methodWe report in this retrospective case series analysis our experience on 31 elder patients (more than 65 years old), affected by a supra-intercondyloid humerus fracture, treated using a minimal internal fixation with cannulated screws combined with the use of an external articulated elbow fixator. This methodology is less invasive but allows a stable synthesis and an early mobilization.Clinical and radiographic examinations were performed for each patient at 1, 2, 3 and 6 months after surgery. At 6 months the residual joint excursion was evaluated and the data were collected. In addition, at 6 months, each patient underwent three different functional capacity assessment questionnaires: MAYO Elbow Performance score, The Disability of the ARM, Shoulder and Hand Score (QuickDASH) and Oxford Elbow Score. ResultsThe healing rate was 100% with no cases of non-union, despite the old age of our patients. The average range of motions obtained at 6 months from the surgery was 111° in flexion-extension and 157° in pronation-supination for the patient with an extra-articular fracture, 88° in flexion-extension and 153° in pronation-supination for the patients with a partial articular fracture and 85° in flexion-extension and 149° in pronation-supination for the patients with a complete articular fracture. Our results in the recovery of an arc of motion in flexion-extension are slightly less performing than the results obtained with an ORIF treatment. Indeed, according to literature the mean postoperative flexion arc in an ORIF treatment of distal humerus fractures in adults is 110°.The functional results obtained were satisfactory, with an average score at 6 months from the surgery of 95/100 (Mayo score) for the patients with an extra-articular fracture, 83.3/100 for the patients with a partial articular fracture and 79/100 for the patients with a complete articular fracture. ConclusionThe results obtained, in terms of range of motions, function, pain and healing and complications rate lead us to affirm that, in selected patients, this technique can represent a valid treatment and therefore a valid option that could be considered.

Treatment of Distal Radius Fractures with Bridging External Fixator with Optional Percutaneous K-Wires: What Are the Right Indications for Patient Age, Gender, Dominant Limb and Injury Pattern?

The aim of this retrospective study was to evaluate the medium-term clinical and functional outcomes of patients with closed, displaced, and unstable, simple or complex, intra- and extra-articular distal radius fractures (DRFs) treated with a bridging external fixator (BEF) and optional K-wires (KWs). AO classification was used to differentiate the injuries radiographically. Clinical-functional outcomes were evaluated using the Patient-Rated Wrist and Hand Evaluation Score (PRWHE Score) and the Quick Disabilities of the Arm Shoulder and Hand Score (QuickDASH). A total of 269 dorsally displaced fractures of 202 female (75%) and 67 male subjects (25%) were included, with a mean follow-up of 58.0 months. Seventy-five patients (28%) were treated by additional KWs. No differences were found comparing the two groups of patients (BEF vs. BEF + KWs) regarding age, sex, and fracture side (dominant vs. non-dominant). PRWHE and QuickDASH scores were lower in the BEF + KWs group compared to the BEF group (p < 0.0001 and p = 0.0007, respectively). Thus, patients treated with KWs had a better clinical outcome. Beta multivariate regression analysis confirmed that patients of the BEF + KWs group exhibited a better PRWHE score but not a better QuickDASH score. Patients treated by the BEF + KWs with the fracture on the dominant site were characterised by better clinical outcomes. Older patients had a better PRWHE score independently from the treatment. Our findings suggest that the use of BEF for DRFs with optional KWs can be indicated in both young and elderly patients of any gender, independent of limb side and fracture pattern. As the best functional results were achieved in the elderly when KWs were added, the combination of BEF and KWs seems to be mainly indicated for the treatment of DRF, also complex, in the elderly population.

The Incidence and Treatment Outcome of Atypical Triplane Fractures in Adolescents.

Atypical triplane fractures (ATFs) defined as a triplane fracture that did not involve the weight-bearing articulating surface or as an extra-articular triplane fracture. ATFs are scarcely reported and the incidence may be underestimated. Moreover, there is no consensus on treatment. This study aimed to evaluate ATFs incidence, fracture pattern, and treatment outcome, and propose treatment recommendations. Twenty-five ATFs of 46 triplane fractures were retrospectively reviewed between 2011 and 2017. ATFs were classified according to the modified ATF classification. Treatment methods were analyzed. Radiologic outcomes were measured based on fracture displacement. Clinical outcomes included the American Orthopedic Foot and Ankle Society score, visual analogue scale, ankle range of motion, and complications at final follow-up period. A total of 11 type IV, 11 type III, and three type II ATFs were identified. All type II ATFs (intra-articular fracture) were treated with operative treatment. Nine patients were treated with operative treatment and 18 patients were treated with non-operative treatment in type III or IV ATFs (extra-articular fracture). Good radiologic and clinical outcomes were observed in all patients. The residual displacement after initial trial of closed reduction was between 4 and 5mm in ten cases of type III or IV ATFs; however, no complications were observed, and all cases had good clinical results after non-operative treatment. ATFs may be under-recognized. Operative treatment and non-operative treatment showed good outcome. Non-operative closed reduction and cast immobilization can be recommended for extra-articular ATF with displacement < 4mm. Level IV, case series.

Comparative Outcome of Hybrid External Fixator Versus Primary Ilizarov Fixator in the Treatment of Open Distal Tibia Extra-Articular Fractures.

Because one-third of the tibia is subcutaneous throughout most of its length and its location, it is more prone to open fractures. Open distal tibia fractures are mostly due to RTA and sports injuries. The goal of treatment is to obtain a healed, well-aligned fracture; pain-free weight-bearing; and functional range of motion of the knee and ankle. 33 patients of the 18-60-year age group with open distal tibia extra-articular fractures (without vascular injury), less than 3weeks old trauma were included in the prospective study for 1year period (1st June 2019 to 31st May 2020). 17 cases were treated with the Hybrid external fixator (HEF) and 16 cases were treated with the Ilizarov fixator (IF). Significantly (P < 0.05), the mean duration of surgery was less in the HEF group (67.6min), faster union of open type-II fractures in the HEF group (16.4weeks), and also a higher AOFAS score at 6months in open type-II fractures in the HEF group (84.4). There were two cases of equinus deformity in the IF group and one case of valgus deformity in the HEF group. HEF and IF are both equally effective in the treatment of open distal tibia extra-articular fractures with the advantage of stable fracture fixation, early weight-bearing, preserving soft tissue, minimal periosteal stripping, and providing one-staged definitive intervention. However, HEF is preferred over IF in terms of less operating time, faster union, and a better functional outcome with minimal complications.

NLR as a Prognostic Tool in Orthopaedic Surgery in Elderly Extra-Articular Hip Fracture: A Significant Increase in NLR 24 Hours after Surgical Intervention

AbstractNeutrophil-to-lymphocyte ratio (NLR) was developed as a diagnostic and prognostic tool in many medical conditions, and its use is spreading as a predictor of postoperative outcome in orthopaedic surgery. The aim of this study is to investigate the improvement of NLR 24 hours after surgical intervention in a cohort of 91 patients (F/M = 68/23) with hip fracture who underwent femur intramedullary fixation. Patients were 84.7 ± 7.9 years old, and the mean hospital stay was 13.4 ± 4.7 days, with a mean delay to surgery of 1.9 ± 1.4 days. A significant increase in NLR between baseline (T0) and 24 hours after surgical intervention (T1) was observed in the study sample overall and on subgroup analysis by gender. Nevertheless, no significant effect of NLR on the length of hospital stay was observed.

Epidemiology of distal radius fractures: a detailed survey on a large sample of patients in a suburban area

BackgroundLiterature lacks data on correlations between epidemiology and clinical data of patients with distal radius fractures (DRFs).AimThe aim of this study was to present a detailed epidemiologic survey of a large consecutive series of patient with DRFs.Materials and MethodsThis retrospective study included 827 consecutive patients (579 females, 248 men) who sustained a DRFs in the last 5 years. All fractures were radiographically evaluated. DRFs were classified according to Association of Osteosynthesis classification. Data on age, gender, side, period in which fracture occurred, and fracture mechanism were collected. Statistical analysis was performed.ResultsThe patients’ mean age was 60.23 [standard deviation (SD) 16.65] years, with the left side being most frequently involved (56.1%). The mean age of females at the time of fracture was significantly higher than that of males.The most frequent pattern of fracture was the complete articular fracture (64.3%), while the most represented fracture type was 2R3A2.2 (21.5%). Regarding the period in which the fracture occurred, 305 DRFs (37.5%) were observed in the warmer months and 272 (33.4%) in the colder months. Low-energy trauma occurring outside home was found to be the major cause of DRF throughout the year.In both genders, trauma mechanism 2 was more frequent (59.4% F; 31.9% M; p < 0.01).A bimodal distribution of fracture mechanisms was found in males when considering the patient’s age with a high-energy mechanism of fracture (3 and 4), identified in 21% (n = 52) of males aged 18–45 years, and a low-energy mechanism (1 and 2) was observed in 39.9% (n = 99) of males aged > 45 years. A significant correlation between all trauma mechanisms (from 1 to 6) and different fracture patterns (complete, partial, and extraarticular) was found (p value < 0.001). The mean age of patients with extraarticular fractures (mean age 61.75 years; SD 18.18 years) was higher than that of those with complete (mean age 59.84 years; SD 15.67 years) and partial fractures (mean age 55.26 years; SD 18.31 years). Furthermore, considering different fracture patterns and patient age groups, a statistically significant difference was found (p < 0.001).ConclusionsDRFs have a higher prevalence in females, an increase in incidence with older age, and no seasonal predisposition. Low-energy trauma occurring at home is the main cause of fracture among younger males sustaining fractures after sports trauma; Complete articular is the most frequent fracture pattern, while 2R3A2.2 is most frequent fracture type.Level of evidenceLevel IV; case series; descriptive epidemiology study.

Distal radius fractures: a prospective study of the clinical and radiological outcomes in surgically managed patients

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Objective of the research was to evaluate radiological and functional outcome in fractures of the distal radius treated by various surgical methods.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 89 patients with distal radius fractures were randomly divided into three groups according to a computer-generated table of randomization. 40 patients were managed by K wire fixation. 22 patients were managed by external fixator. 27 patients were managed by volar plating technique. Anatomical restoration was evaluated by posterior-anterior and lateral radiographs obtained preoperatively and at 09 months of follow up to evaluate radial height (RH), radial inclination (RI) and volar tilt (VT). Functional outcome was evaluated using Mayo scoring system.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; According to Mayo score, in K-wire group 72.5% (n=29) patients had excellent to good outcome, 17.5% (n=7) had fair outcome while as 10% (n=4) patients had poor outcome. In external fixator group 72.7% (n=16) patients had excellent to good outcome while as 27.3% (n=6) had fair outcome. In volar plating group 81.5% (n=22) patients had excellent to good outcome while as 18.5% (n=5) had fair outcome.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; In our study we found that volar locked plating provides advantage in dorsally or volarly displaced intra-articular fractures with excellent to good radiological outcome. However, in type B (partial intra-articular fractures) fractures, volar locking compression plate (LCP) and external fixator provide almost equivocal results. Percutaneous pinning can be recommended for extra-articular or simple intra-articular fracture patterns, with a loss of volar and/or RI but without significant radial shortening.&lt;/p&gt;

Risk Factors for Failure of Closed Forearm Fracture Reduction in the Pediatric Emergency Department.

This study aimed to explore risk factors for failure of forearm fracture closed reduction in the pediatric emergency department (ED) and to suggest indications for initial surgery. This retrospective cohort study included all patients aged 0 to 18 years who presented to our pediatric ED with an extraarticular forearm fracture treated with closed reduction between May 2017 and April 2021. We explored risk factors for procedural failure, defined as a need for surgical intervention within 6 weeks of the closed reduction attempt. Of 375 patients (median age 8.1 years, 294 [78.2%] boys), 44 (11.7%) patients sustained a reduction failure, of whom 42 (95.5%) had both radius and ulna fractures. Of the 259 patients with fractures of both bones, the following parameters were independent predictors for reduction failure: refracture (adjusted odds ratio [aOR] 17.6, P < 0.001), open fracture (aOR 10.1, P = 0.007), midshaft fracture (aOR 2.6, P = 0.004), radial translation rate 37% and higher in either plane (aOR 5.1, P = 0.004), and age of 10 years and older (aOR 2.9, P = 0.01). Most pediatric forearm fractures can be successfully managed by closed reduction in the ED. Two-bone fractures had the strongest association with reduction failure. Refracture, open fracture, midshaft location, initial radius bone translation of 37% and higher (and not initial angulation), and patient age of 10 years and older are independent risk factors for reduction failure in two-bone fractures. We propose a risk score for reduction failure that can serve as a decision-making tool.

Evaluation of Treatment of Unstable Distal Radial Fractures by External Fixator

Background: Distal radial fractures are very common in Orthopaedic practice but still there is no unanimity about its treatment. Objective: To evaluate the external fixator for the treatment of unstable distal radius fractures. Methods: This prospective observational study was carried out from January 2018 to December 2019 over a period of two years. Twenty-five consecutive patients of both sexes between the ages of 18 to 60 years with closed or open unstable distal radius fractures with or without intraarticular extension admitted in the Department of Orthopaedic Surgery, 250 Bedded General Hospital, Tangail &amp; several private hospitals in Tangail &amp; Dhaka city were selected. Patients with diabetes mellitus or chronic renal or hepatic disorder or extra-articular fractures or volar &amp; dorsal shear injuries (Barton fractures) were excluded from this study. All the patients were evaluated thoroughly including distal neurovascular status and any associated injuries ruled out. Patients were operated as early as possible. But 4 cases were lost to follow up. Remaining 21 patients were followed up for at least 6 months and a maximum period of 12 months. Results: In this series mean age of the patient was 35.71±11.65 years and males (66.7%) were predominant than females (33.3%). In this series right side was involved in 13 patients (61.9%) and left side in 8 patients (38.1%). The mechanism of injury included road traffic accident 13 (61.9%), fall on slippery ground 7 (33.3%) and occupational accident 1 (4.8%). Six patients of this study (28.6%) had associated injury other than the local soft tissue injury. Most of the patients (66.7%) were operated on the day of admission, 2 patients (9.5%) were operated within 3 days and 5 patients (23.8%) were operated within 7 days. As per AO classification, majority (38.1%) injury was type C3 fracture followed by C1 (33.3%), C2 (14.3%), B1 (9.5%) and A3 (4.8%). According to functional outcome, satisfactory was 76.2% and according to anatomical outcome, satisfactory was 85.7%. Conclusion: According to this study finding satisfactory outcome was 76.2% (functional) and 85.7% (anatomical). J Shaheed Suhrawardy Med Coll 2021; 13(1): 20-25

A Critical Analysis of Lateral Versus Central Endpoint in Distal Tibia Nailing: Does It Affect Alignment?

To evaluate the effect of a traditional "center-center" end point for distal tibia nailing in comparison with a lateral-of-center end point on fracture malalignment in a cadaver model. Nine matched pairs of human cadaveric lower-extremity specimens were used to model the effect of nail end point on fracture alignment in extra-articular distal tibia fractures. After simulation of the fracture through a standardized osteotomy, 1 member of each pair was fixed with an intramedullary nail using a "center-center" end point, whereas a lateral-of-center end point was used for the other member of the pair. Specimens were stripped of soft tissue, and digital calipers were used to measure fracture translation and gap medially, laterally, anteriorly, and posteriorly. Coronal plane angulation at each fracture was measured on the final mortise image. The average coronal angulation was 7.0 degrees of valgus (with a SD of 4.1) in central-end point specimens versus 0.2 degrees of valgus (SD = 1.5) in lateral-end point specimens ( P < 0.001). Lateral-end point specimens also demonstrated significantly less fracture gap medially (mean 0.2 vs. 3.1 mm for central-end point specimens, P < 0.001), anteriorly (mean 0.1 vs. 1.3 mm, P = 0.003), and posteriorly (mean 0.3 vs. 2.2 mm, P = 0.003). Lateral-end point specimens also showed less lateral translation (mean 0.6 vs. 1.6 mm, P = 0.006). Lateral-of-center nail end points may help surgeons restore native alignment in extra-articular distal tibia fractures and avoid valgus malalignment.

Risk factors for hardware-related complications after extra-articular distal humerus fracture fixation using an anatomical locking plate.

We aimed to identify the incidence and risk factors of hardware-related complications in patients treated with anatomical locking plate fixation for extra-articular distal humerus fractures. From 2013 to 2020, patients with extra-articular distal humerus fractures who underwent open reduction and internal fixation with an extra-articular distal humerus locking plate (EADHP) were retrospectively reviewed and categorized according to the presence/absence of hardware-related complications. Hardware-related complications were defined as the occurrence of skin prominence on the plate and discomfort in activities of daily living. Patient demographics, the lateral condylar angle, lateral body length, shaft-condylar angle of the humerus, and plate length were analyzed. Of the 29 patients, 10 (34%) did not develop hardware-related complications (group A), whereas 19 (66%) did (group B). Patient demographics did not differ between the groups. However, the number of patients who underwent hardware removal was significantly greater in group B (16/19) than in group A (4/10; p = 0.032). Radiologic assessment revealed no significant difference in the lateral condylar or shaft-condylar angle. However, the lateral body length was greater in group A than in group B (44.5 ± 4.8 vs. 39.5 ± 3.7, p = 0.007). The plate length significantly differed between the groups. Twelve of 19 (63%) patients in group B received short-hole plates (six holes), while nine of ten (90%) patients in group A received long-hole plates (eight holes). In the multivariable analysis, the lateral body length of the distal humerus (p = 0.047, odds ratio = 0.734, 95% confidence interval: 0.542-0.996) and plate length (p = 0.036, odds ratio = 0.076, 95% confidence interval: 0.542-0.996) were associated with hardware-related complications. Most patients developed hardware-related complications, particularly with short plates, mainly because of the narrow lateral body length of the distal humerus. Surgeons should be careful to secure EADHP in the appropriate position, especially when short plates are used in patients with narrow lateral body length.

Determinants of Lack of Recovery from Dependency and Walking Ability Six Months after Hip Fracture in a Population of People Aged 65 Years and Over.

Background: Hip fracture in the elderly means that between a quarter and a half of patients do not regain the levels of independence and walking ability that they previously had, according to the literature, after the fracture. Material and methods: Retrospective study of 537 patients aged ≥65 years who survived at the sixth month after fracturing their hip, of which the age, sex, type of fracture, surgical risk, independence (BI), walking ability, cognitive level (PS), comorbidities, indicated drugs, complications, surgical delay, hospital stay, and surgical technique are known. Using Pearson’s χ2 test, all the variables were contrasted with respect to the limitation or not, at the sixth month of the recovery of both independence and pre-admission walking ability. Multivariate analysis provides the necessary adjustment to the previous contrast. Results: We have found that age and PS ≥ 5 at admission limit recovery from both dependency and walking ability. Surgical risk, independence (BI) upon admission, anemia, and constipation during the hospital stay limit the recovery of the BI. Worsening of walking ability during the hospital stay and the type of extra-articular fracture, which was surgically treated by osteosynthesis, limit the recovery of walking ability. Conclusions: The factors previously exposed, and perhaps the fact that patients with hip fractures are not routinely referred to rehabilitation, explain the high proportion of patients who do not recover their previous independency (36%) or walking ability (45%) to the fact of fracturing.

Comparison of Intramedullary Interlocking Nailing (IMLNG) and Minimally Invasive Plate Osteosynthesis (MIPO) in Treating Extra Articular Distal Tibial Fractures

Background: Due to limited blood flow and sparse soft tissue coverage, treating distal tibia fractures presents a considerable challenge for orthopaedic surgeons. Objective: Our study's objectives were to compare the outcomes of the two treatment modalities of minimally invasive plate osteosynthesis (MIPO) and intramedullary nailing (IMN) for extraarticular distal tibia fractures. Study Design: Randomized Controlled Trial Place and Duration of the Study: This study was conducted at Department of Orthopedic and Spine Surgery Sughra Shafi Medical Complex, Narowal from March 2021 to March 2022. Material Methods: During A total of 59 patients ( 30 in IMLN group and 29 in MIPO group), both male and female, with AO Type A, b and C distal tibial fractures lasting less than three days and ages ranging from 20 to 60, were enrolled for this research. At the most recent follow-up, clinical and radiological data were assessed. Results: The average duration to union was 21.9 weeks in the IMN group and 19.9 weeks in the MIPO group, and all of the examined patients eventually recovered. In the IMN group, the time to union was substantially greater (p= 0.001). Conclusion: Low operating, union, and hospitalisation times make MIPO advantageous. In order to lessen the morbidity of these patients, we advise using the minimally invasive plate osteosynthesis (MIPO) procedure as the first line of treatment for distal tibia fractures.. Keywords: Distal tibia fracture, minimally invasive plate osteosynthesis, intramedullary nailing,

Comparative study of a Y- anatomical and innovative locking plate versus double plate for supracondylar humeral fracture

IntroductionThere is no “gold standard” for the type of plate to be used for distal extra-articular humeral fractures; the most used is plating of each column. The objective was to evaluate the short-term clinical and radiological results of a Y- anatomical and innovative locking plate (YALP). HypothesisThe hypothesis is: this anatomical and innovative locking plate will produce satisfactory and reliable results on extra-articular distal humerus fracture superior to double plate fixation. Materials and methodsIn a retrospective observational multicenter study, all patients with a distal humerus fracture type 13 A2.2 according to AO classification fixed with a new Y-plate (YALP) were compared to the results of double plate fixation for the same type of fracture. With a follow-up of more than 12 months, the objective and subjective clinical elbow criteria as well as the overall function of the upper limb and radiological assessment were collected. ResultsWith an average follow up of 24±11 months, 26 patients met the inclusion criteria and received a YALP and 24 patients received double plate. All patients whose fracture had healed except one were pain-free (mean VAS 0.3±0.6). All patients had good subjective results (mean SEV 96%±4). Elbow function was excellent (mean total MEPS 96±4) with normal triceps strength (23/24 patients had a triceps strength graded 5/5 and one patient 4/5) and range of motion (flexion 139±8, extension −7±8 and pronosupination greater than 155 degrees). The operating time was shorter in the YALP group (84 ± 23minutes versus 97 ± 28minutes, p=0.03). The double plate group had more complications; the overall complication rate was significantly higher (p=0.02) in the double 90-degree plate group (12/24, 50%) with four nonunions, four symptomatic ulnar nerves, three hardware removals for pain and one radial nerve injury versus 5/26 complications (19%, p=0.02) in the Y-plate group: one iliac graft for nonunion, 1 plate removal due to functional discomfort, 1 twisted YALP, 1 broke interfragmentary screw and one symptomatic ulnar nerve. DASH, SEV, MEPS scores and flexion-extension range were better in the YALP group. DiscussionYALP produces satisfactory results in supracondylar fractures of the distal humerus. The results of YALP appear to be better than the results with two 90° plates for the same fracture type with a shorter operative time and easier management of fractures with proximal diaphyseal extension. Level of evidenceIII; case control study.

Extreme nailing and immediate weight bearing constructs in fractures of the distal tibia.

Extraarticular fractures of the distal tibia can present as difficult but manageable lower extremity injuries. Historically, these injuries have been fixed in a myriad of ways. Early management with intramedullary nailing had higher complication rates due to the unique anatomical and biomechanical features of the distal tibia. Modern improvements in intramedullary nailing surgical techniques and implant design have significantly decreased complication rates and led to improvement in patient outcomes. Many surgeons protect weight bearing postoperatively, but recent literature suggests that patients may safely weight bear immediately following intramedullary fixation. This article reviews technique and implant design changes that have facilitated immediate safe weight bearing following intramedullary nailing of extraarticular distal tibia fractures.

Extra-articular Unstable Iliac Fractures: Associated Injuries, Fixation Strategies, and Outcomes.

To characterize the associated injuries, fixation constructs, and outcomes of extra-articular unstable iliac fractures. Retrospective cohort study. Level I trauma center. Thirty-three extra-articular unstable iliac fractures treated over a 20-year period. Percutaneous or open fixation of iliac fractures at the pelvic brim AND/OR iliac crest. Incidence of union, fixation failure, and angiography at the time of injury. Twenty-five patients were treated operatively with appropriate follow-up. Four patients had fixation failure with displacement, all in the group with only brim OR crest fixation (4/8 patients, 50% rate). In patients with both crest AND brim fixation (n = 17), there were no cases of implant failure or late displacement. In displaced fractures (n = 22), 4 patients (18%) required embolization by interventional radiology. In all 4 cases, the superior gluteal artery was embolized. In patients with both crest AND brim fixation, all went on to uneventful union with an average Visual Analog Scale (VAS) pain score of 0.9 (range, 0-5) at final follow-up. Extra-articular unstable iliac fractures are high-energy injuries that demonstrate a high rate of union when both pelvic brim AND iliac crest fixation is used. Approximately 1 in 5 patients with a displaced iliac fracture presented with a superior gluteal artery disruption requiring embolization. Pelvic brim OR iliac crest fixation used in isolation was associated with a fixation failure rate of 50%, supporting previous biomechanical work. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

STUDY OF CLINICAL AND RADIOLOGICAL OUTCOME OF EXTRA-ARTICULAR PROXIMAL TIBIA FRACTURE TREATED WITH MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS (MIPO) TECHNIQUE

Background: Proximal extra articular tibia fractures management is challenging to surgeon because of its complex fracture pattern and anatomic location. Our aim of this study is to assess the functional, clinical, radiological outcome of MIPO in extra articular proximal tibia fractures. Materials and methods: Prospective study of 43 closed extra articular proximal tibia fracture patients. Study was done in between July 2017 to September 2019 at tertiary care centre in India. The mean age was 32.5 years (range 31-65). Primary bony union was achieved average ofResults: 16.32 weeks (range 14 to 24 weeks). According to modied Rasmussen's criteria 23 patients (53.48%) had excellent outcome, 12 patients (27.90%) had good outcome and 8 patients (18.60%) had fair outcome. mean knee range of motion is 124.23° (Range 10-150°). Complication includes Infection rate (9.3%) and varus malunion (18.60%). Minimally invasive plate ostosyntesis technique offers biological advantagesConclusion: with minimal complication. It fullls the demands of fast implantation, soft tissue protection and high biomechanical stability

Study of prevalence and operative results of fracture shaft femur in adults

Background: Being the principal weight bearing of the lower limb, fractures related to the femur pose a threat to humans and affect the overall quality of life. Conservative management is no longer preferred, and stable internal fixation is the modality of treatment these days. Aims and Objectives: The aim of this article is to study the operative outcomes of fixation of fracture shaft femur in terms of union, stability, functional outcomes, and complications. Materials and Methods: This study is a retrospective study of 35 patients with proximal, mid-shaft, and extra-articular distal shaft femur fractures admitted to Smt. SCL Municipal Hospital for 3 years from May 2019 to May 2022. Results: The results showed improvement in all the functional and radiological outcomes. More than 70% of the patients achieved greater than 125° of knee flexion. The radiological union of fractures was 4.4 months in our study. According to Neer’s score, 33 patients scored excellent to satisfactory. Conclusion: Internal fixation of fractures in the femoral shaft is an absolute must and has gained widespread acceptance as implants and technology have improved. The rationale for internal fixation is that it restores anatomical alignment and allows early mobilization of the patient and limb.

Combined Medial Plate and Intramedullary Nailing for the Fixation of Extra-Articular Proximal Tibial Fractures: a Biomechanics Study.

Purpose: The extra-articular proximal tibial fractures continue to have high malunion rates despite development in intramedullary nailing (IMN) technology. Combined plate and IMN fixation can increase mechanical stability. The purpose of this study was to investigate combined plate and IMN for the treatment of extra-articular proximal tibial fracture using a biomechanical model. Methods: A 10-mm defective osteotomy was created in the fourth-generation composite tibia to simulate extra-articular proximal tibial fractures (AO/OTA 41A2). The fractures were stabilized with IMN alone (IMN group), IMN with supplementary medial plate (M-IMN group), and IMN with supplementary lateral plate (L-IMN group). The biomechanical properties of each specimen were tested under axial compression loading, bending stress, and cyclic loading. The maximum displacement of the fragments and implant-bone construct failure was recorded. Results: The maximum displacement of the M-IMN group was significantly less than either the L-IMN or IMN group in both axial compression loading and bending stress (p < 0.05 for both comparisons). All specimens in the three groups survived in 10,000 cyclic loading without hardware deformation. The maximum stiffness of failure was similar between the M-IMN and L-IMN groups, but the IMN group was statistically lower than either the L-IMN or the IMN group (p < 0.05). Conclusion: The results indicated that combined medial plate and IMN fixation could effectively increase the mechanical stability of proximal tibial fractures.

Functional Outcome Of Extra-Articular Distal Humerus Fracture Fixation Using A Lateral Column Locking Compression Plate.

: A host of different methodologies have been implemented in the management of distal humerus fractures, including conservative measures and surgical fixation with a variety of plates. This study was conducted to evaluate the functional outcome of open reduction and internal fixation of extra articular distal humerus fractures with distal humerus locking compression plate. This is a retrospective cohort study of patients with close extra articular distal humerus fractures who underwent open reduction and internal fixation with a distal humerus locking compression plate at Ghurki Trust Teaching Hospital from July 2017 to December 2019. Various demographic indicators were used for data analysis and radiological union was assessed in serial follow-ups. Functional outcome was evaluated using the Mayo Performance Elbow Score at the final follow-up. Thirty-one patients presented with extra-articular fracture of humerus (N=31) with average age 33.5±9.90 years. The average follow-up period was 13.8 months. Radiological union was achieved in 14.8 weeks (range 12-20 weeks). Out of 31 patients, 28 had excellent results with mean Mayo Elbow Performance Score of 94.8. Two patients (6.5%) had radial nerve palsy post-operatively. This study shows that open reduction and internal fixation of extra-articular distal humerus fractures with distal humerus locking compression plates allows for stable fixation, good functional outcome, and low complication rates.