Fixation In Treatment Research Articles

Primary Total Hip Arthroplasty versus Open Reduction and Internal Fixation in Displaced Fracture of Femoral Neck in Adults

Background: Femoral neck fracture as a prevalent skeletal injury accounts for 7% of orthopedic hospital admission. The aim of the present study is to evaluate the functional outcome of patients with femoral neck fracture treated with total hip arthroplasty (THA) and compare them with those undergoing fixation treatment. Methods: In this study, we reviewed patients in the age range of 45-60 years old with femoral neck fracture during 2007-2017. The subjects were assigned to either THA or fixation group. The primary outcome was hip function, evaluated with the Harris Hip Scale (HHS). Secondary outcomes included pain, local infection, avascular necrosis (AVN), thromboembolic event, loosening of the prosthetic and internal fixation device, prosthetic dislocation, non-union, and delayed-union. Results: In this study, 34 patients with displaced fracture of femoral neck were treated with acute THA and 38 patients were treated with fixation. The HHS was higher in the THA group compared to the fixation group (P < 0.050). The results of the present study indicated no significant difference in early postoperative complications over the first month between the two groups, but frequency of complications such as non-union, AVN, pain and loosening of the internal fixation device in the fixation group were significantly higher than the THA group after six months (P < 0.050). Conclusion: Over a period of six months, THA provided better hip function and significantly fewer postoperative complications compared to fixation.

Comparison of radiological and clinical outcome among Kirschner wires versus 3.5 mm diameter cannulated cancellous screw internal fixation in treatment for the displaced lateral humeral condyle fractures in children

<p><strong>Background:</strong> Lateral humeral condyle fracture, the second most common injury around the elbow, accounts for 10-20% of all fractures of the elbow in children with a high incidence between two and 14 years.</p><p><strong>Methods:</strong> This hospital based prospective randomized comparative study design was include patients of both sexes in age group of 2 to 14 years attending SMS hospital, Jaipur during April 2018 to June 2019 or till the sample size achieved, with due permission from the institutional ethic committee and review board and after taking written informed consent from the patient.</p><p><strong>Results:</strong> 40 patients out of 50 were grouped as excellent (70.1%) while 13 were found good (22.8%) and only four patients were found poor (7.01%) as per Hardacre criteria of assessment of lateral condyle treatment in k wire group while excellent, good and poor results were found 68.4, 24.5 and 7.01% respectively in CC screw groups</p><p><strong>Conclusions:</strong> The displaced fractures (displacement over 2 mm) can be treated successfully by open reduction and K-wires or screw fixation with excellent results.</p><p> </p>

Microalgal-Bacterial Consortia as Future Prospect in Wastewater Bioremediation, Environmental Management and Bioenergy Production.

In the recent years, microalgae have captured researchers' attention as the alternative feedstock for various bioenergy production such as biodiesel, biohydrogen, and bioethanol. Cultivating microalgae in wastewaters to simultaneously bioremediate the nutrient-rich wastewater and maintain a high biomass yield is a more economical and environmentally friendly approach. The incorporation of algal-bacterial interaction reveals the mutual relationship of microorganisms where algae are primary producers of organic compounds from CO2, and heterotrophic bacteria are secondary consumers decomposing the organic compounds produced from algae. This review would provide an insight on the challenges and future development of algal-bacterial consortium and its contribution in promoting a sustainable route to greener industry. It is believed that microalgal-bacterial consortia will be implemented in the near-future for sub-sequential treatment of wastewater bioremediation, bioenergy production and CO2 fixation, promoting sustainability and making extraordinary advancement in life sciences sectors.

Effectiveness of multidirectionally three-dimensional steel wire ring sleeve fixation in treatment of inferior patellar pole avulsion fractures

To explore the method and effectiveness of multidirectionally three-dimensional steel wire ring sleeve fixation in the treatment of inferior patellar pole avulsion fractures. Betweern January 2015 and January 2019, 22 patients with inferior patellar pole avulsion fractures were admitted and treated. There were 12 males and 10 females. The age ranged from 20 to 69 years, with an average age of 39.4 years. The causes of injury included 9 cases of traffic accident and 13 cases of falling. All of them were unilateral closed injury of knee joint, including 7 cases of skin contusion around patella. Preoperative range of motion of the affected knee was (20.82±7.16)° (range, 10°-35°). The time from injury to operation ranged from 3 to 12 days, with an average of 5.9 days. During the operation, the inferior patellar avulsion fracture was reduced with forceps; the patella was circumferentially ligated through the distal bone surface of the fracture with 0.8 mm diameter steel wire; then 3 longitudinal bone tunnels were made in the upper patella, respectively. The 0.8 mm diameter steel wire passed through the bone tunnel, and the longitudinal ring was attached to the ring to fix the upper and inferior patellar fracture. Tighten the transverse and longitudinal rings with No.2 tendon suture line, then longitudinally ringed and sutured to strengthen the patella. The knee range of motion, fracture healing time, and complications were recorded. The functional recovery of the knee joint was evaluated by Böstman score. All incisions healed by first intention, and no incision related complications occurred. All the 22 patients were followed up 13 months to 5 years with an average of 26.7 months. The fracture healing time was 9-12 weeks (mean, 10.9 weeks). At last follow-up, the knee range of motion was (129.77±2.35)° (range, 126°-135°), showing significant difference when compared with preoperative one ( t=-67.022, P=0.000). The Böstman score ranged from 31 to 36, with an average of 34.3. No reduction loss, fracture of steel wire, failure of internal fixation, and other complications occurred during follow-up. Multidirectionally three-dimensional steel wire ring sleeve fixation in the treatment of inferior patellar pole avulsion fractures has the advantages of reliable fixation, early functional recovery, and fewer complications, so the effectiveness is satisfactory.

Clinical application of nose ring drain technique combined with Ilizarov circular external fixation for Gustilo ⅢA Pilon fractures

To investigate the effectiveness of the nose ring drain (NRD) technique combined with Ilizarov circular external fixation in treatment of Gustilo ⅢA Pilon fracture. Between March 2017 and December 2019, 17 patients with Gustilo ⅢA Pilon fractures were admitted and treated with NRD technique combined with Ilizarov circular external fixation. Among them, there were 11 males and 6 females; the age ranged from 24 to 63 years, with an average of 38.2 years. There were 3 cases of traffic accident injury, 13 cases of falling injury, and 1 case of penetrating injury. There were 13 cases of emergency admittance and 4 cases of wound infection after surgical treatment. Furthermore, there were 2 cases of fibula fractures and 3 cases of lateral malleolus fractures. All patients were followed up 8-12 months, with an average of 9.9 months. All wounds healed by first intention, and 4 patients with preoperative infection had no recurrence during the follow-up. The external fixator was removed after fracture healing in 17 patients at 3-7 months after operation (mean, 4.5 months). At last follow-up, the pain score of the ankle joint Kofoe score was 40-50, with an average of 44; the functional score was 17-27, with an average of 25; the mobility score was 8-18, with an average of 14; and the effectiveness was rated as excellent in 8 cases, good in 7 cases, and poor in 1 case. For Gustilo ⅢA Pilon fractures, the NRD technique combined with Ilizarov circular external fixation has advantages of good fracture fixation and drainage effects, which greatly reduces the complications of traditional treatment options and the number of operations.

Minimally Invasive Technique and K-Wire Fixation in Treatment of Fracture Calcaneus

Minimally Invasive Technique and K-Wire Fixation in Treatment of Fracture Calcaneus

Functional outcome of proximal femoral nailing (PFN) versus dimon hughston osteotomy with dynamic hip screw (DHS) fixation in unstable intertrochanteric femur fractures

Intertrochanteric fracture is one of the most common fractures of the hip especially in the elderly with osteoporotic bones, usually due to low energy trauma like simple falls. The goal of the treatment of these fractures is stable fixation, which allows early mobilization of the patient. This study was conducted to compare the functional and radiological outcome of proximal femoral nailing and Dimon Hughston Osteotomy with Dynamic Hip Screw (DHS) fixation in treatment of unstable intertrochanteric femur fractures amongst 60 patients, with 30 patients in each group. In our study we found that patients treated with DHS group showed better results in comparing PFN in terms of early weight bearing, functional outcome, early radiological union but had its own complications. Both are effective in the treatment of unstable intertrochanteric fractures, it is the fracture geometry and bone quality which will influence the choice of fixation.

Internal Radioulnar Fixation for Treatment of Nonunion of Proximal Radius and Ulna Fractures in a Toy Breed Dog

AbstractIn this case report, we describe an alternative surgical procedure to treat proximal radius and ulnar nonunion in a toy breed dog. A 14-month-old, Maltese cross-breed dog was referred after previous treatment with external and internal fixation had failed, resulting in a nonunion of a fracture of the proximal radius and ulna with the proximal radius fragment too small and friable to be used for fixation. A craniomedial approach was made to debride the radius nonunion site and a second approach to the lateral aspect of the ulna was made. The fracture was realigned and a titanium locking plate was applied in bridging fashion, fixed to the proximal ulnar fragment with three locking screws in the most proximal plate holes, a fourth screw was inserted in the mid-shaft of the distal ulnar fragment and three locking screws were inserted in the distal most holes of the plate through the distal ulna to engage the distal radial fragment. A recombinant bone morphogenetic protein 2 graft was inserted into the radius and ulna fracture sites. The dog had a successful clinical and radiographic outcome with bridging of the defect 4 weeks postoperatively and complete callus formation 8 weeks postoperatively. Implants have undergone dynamization and then removal. Use of a locking plate as an internal fixator achieving fixation of the proximal ulna and distal radius can be considered an option for the treatment of proximal radioulnar nonunions with a small proximal radial fragment.

CLINICAL EVALUATION OF THE TREATMENT OF CLAVICLE FRACTURES: INTRAMEDULLARY NAIL × PLATE.

ABSTRACTObjective: Studies confirm the benefit of surgical treatment for fixation of displaced midshaft clavicle fractures. Plate fixation and intramedullary nail are the two most used techniques. Our study seeks to compare these two surgical techniques. Methods: This is a retrospective study, conducted by the evaluation of patients treated for displaced midshaft clavicle fracture with intramedullary nail, and plate and screws. Socioeconomic variables were collected, a visual pain scale questionnaire was applied, the shoulder function was measured using CONSTANT and UCLA scores, and radiography was performed to verify the consolidation and evaluation of the final clavicle shortening. Results: Sixty-five patients were evaluated, 36 (55.4%) of which were subjected to clavicle fixation with plate and screws and 29 (44.6%) with intramedullary nail. The median shortening was 0.1mm for plate and 5.8mm for nail (p = 0.001). The UCLA score shows an average of 35 in the plate group and 35 in the intramedullary group. The median CONSTANT scores were 96.5 for plate and 95 for nail, without significance. In all groups, 13 (20%) complications were registered, 9 fixed with plate and 4 fixed with intramedullary nail. The most common complication was skin erosion with exposure of the synthetic material. Conclusion: The two techniques present satisfactory results for the treatment of displaced midshaft clavicle fractures. Level of Evidence III, Therapeutic Studies Investigating the Results of Treatment.

Kırk Yedi Hastada Fiksasyon veya Endoprotez ile Proksimal Femur Metastazı Tedavisi

Objective: Purpose of the present study was to compare patients with proximal femur metastasis with actual or impending fractures who were treated by fixation or prosthetic hip replacement. Method: Twenty-seven patients underwent fixation treatment (IM nail, DHS), and 20 patients prosthetic (endoprosthesis or total hip arthroplasty) replacement. Data were analyzed regarding patient demographics, cancer type, localization and type of metastasis, actual or impending fracture, number of bone metastasis, presence of spinal or visceral metastasis and treatment data (ASA class, length of hospital stay or surgery or survival, cement usage, adjuvant treatment, postoperative walking status). Results: Fixation group (63 years) was younger than prosthesis group (70 years) (p: 0.03). Fixation was more preferred at subtrochanteric area (p˂0.001). Cementation of the lesion was more preferred and surgery time was longer at fixation group (p: 0.01). Greater number of complications (mostly medical) were more likely to be seen in the fixation group (6 ‘1 loosening’ vs 3 ‘1 dislocation’). Conclusion: It is not still clear whether one implant is clearly superior to other one, however it was revealed again that nailing was mostly preferred for the subtrochanteric area and tended to have more complications although mostly medical and unrelated to implant placement as previously reported

Perbandingan Efek Samping Pemberian Ketorolac 30 mg Intravena dengan Tramadol 100 mg Intravena pada Nyeri Pasca Bedah terhadap Perubahan Kadar Hemoglobin Pasien Fraktur Shaft Femur yang Dilakukan Reduksi Terbuka dan Fiksasi Dalam di RS M. Djamil

Introduction: Clinical manifestation of fractured femur are deformity, severe pain and sometimes shock as a result of bleeding. Thrombocytes dysfunction is one of the cause of bleeding during surgery or major injury such as fractured femur. Drug interactions that cause thrombocytes dysfunction are hazardous.5 Meanwhile, major injury like fractured femur and surgery always need analgesic. Ketorolac and tramadol become the choices in M. Djamil Hospital for analgesic therapy of fracture cases because they are the hospital formularies. Although they are from different classes, these medicine both have coagulation effect, that is interrupting thrombocytes aggregation through different channels. There are still no experiment about the effect of hemoglobin level change towards the using of those two analgesics. Aims: of this study is to know the comparison between the effect of using 30 mg ketorolac intravenous and 100 mg tramadol intravenous for post surgical pain towards hemoglobin level change of patient with shaft fracture femur who got open reduction and internal fixation treatment at M. Djamil Hospital. Method: This study used double-blind randomized clinical trial method and was held between September-December 2015. The collected data are primary data of hemoglobin levels measurement before and after the treatment given. The subjects of this study are the patients who have undergoing surgery in department of orthopedic surgery chosen based on inclusion criteria and divided into ketorolac group and tramadol group. The difference between hemoglobin level of these two groups were analyzed using independent two sample Wilcoxon-Rank test and Mann-Whitney test. Results: there is differences between hemoglobin level before and after surgery, before and after the given of analgesic in both tramadol group and ketorolac group. But, there is no significant change of hemoglobin levels after the surgery and after the given of analgesic, in both tramadol or ketorolac group. There is no difference between hemoglobin levels after the given of tramadol or ketorolac. Conclusion: there is no significant change between the average hemoglobin level after the surgery and after the given of analgesic in both tramadol and ketorolac groups. Based on statistical test, there is no difference between the hemoglobin level after the given of analgesic in both tramadol and ketorolac group.

Is Dynamic Condylar Screw Better Than (95°) Blade Plate in Management of Subtrochanteric Fracture of Femur?

Background: Subtrochanteric fractures account for approximately 10-30% of all hip fractures, affecting persons of all ages and should be internally fixed to reduce the morbidity and mortality by early rehabilitation and mobilization. A dynamic condylar screw (DCS) and a 95° angle blade plate (BP) provide a good choice for fixation of subtrochanteric fractures so it is a matter of debate that which one is the best fixation in such fractures. Objective: To evaluate the surgical treatment of subtrochanteric fracture of femur using DCS versus a 95° BP. Methods: Prospective comparative study of 40 patients conducted in Al-Imamein Al-Kadhimein Medical City from November 2015 to November 2017. Twenty patients treated with open reduction and internal fixation by using DCS and other twenty patients treated with open reduction and internal fixation by using a 95° BP. The mode of injury, site and type of fracture, age of patients, operating time, and blood loss, union rate, complication of implants, functional results were compared between the groups. Results: Out of 40 patients, there were 26 (65%) male, right side affected in 24 (60%) patients. Mechanism of injury was trivial trauma observed in 28 (70%) patients. According to a Russell-Taylors classification, majority of fractures are type IB that observed in 16 (40%) patients. Majority of the patients, 27 (67.5%), started full weight bearing at 14 weeks. There was no significant mean age difference between the two groups (p=0.7). The mean operation time of DCS (83±4.3 min) was lower significantly than of 95° BP (p<0.001). Mean blood loss from DCS variety (365±63 cc) was lower significantly than of 95° BP (p=0007). Infection occurred less frequently significantly in patients who treated by DCS than those treated by 95° BP (p=0.03). There was no association between types of open reduction and internal fixation treatment variety and functional result according to the modified Harris hip score (p=0.52). Conclusion: DCS better than 95ᵒ BP because of its technically easier, possibility to correct reduction even after insertion, less perioperative complication and earlier weight bearing. Keywords: Subtrochanteric fractures of femur, dynamic condylar screw, 95ᵒ BP Citation: Joda AI, Chhaily ZA, Abd Ali AS, Rahee LS. Is dynamic condylar screw better than (95°) blade plate in management of subtrochanteric fracture of femur? Iraqi JMS. 2020; 18(2): 123-129. doi: 10.22578/IJMS.18.2.6

Comparison of effectiveness of anterior subcutaneous internal fixator and plate internal fixation for unstable anterior pelvic ring fractures

To compare the effectiveness of anterior subcutaneous pelvic internal fixator (INFIX) and plate internal fixation in treatment of unstable anterior pelvic ring fractures. The clinical data of 48 patients with unstable anterior pelvic ring fractures who met the selection criteria between June 2014 and December 2019 were retrospectively analyzed. Among them, 21 cases were treated with INFIX (INFIX group), and 27 cases were treated with plate (plate group). There was no significant difference in gender, age, body mass index, cause of injury, time from injury to operation, Injury Severity Score (ISS), and fracture type between the two groups ( P>0.05). The operation time, intraoperative blood loss, fracture healing time, partial weight-bearing time, and complete weight-bearing time were recorded and compared between the two groups. Matta standard was used to evaluate the quality of fracture reduction, and Majeed score system was used to evaluate the functional recovery of pelvic fracture after operation. The patients in both groups were followed up for an average of 12.5 months (range, 6-16 months). The operation time and intraoperative blood loss in INFIX group were significantly lower than those in plate group ( t=-11.965, P=0.000; t=-20.105, P=0.000). There was no significant difference in the quality of fracture reduction, fracture healing time, partial weight-bearing time, and complete weight-bearing time between the two groups ( P>0.05). At 14 weeks after operation, there was no significant difference in the scores of pain, working, standing and walking, and total scores between INFIX group and plate group ( P>0.05), but there were significant differences in sitting and sexual intercourse scores ( t=-4.250, P=0.003; t=-6.135, P=0.006). The incidences of lateral femoral cutaneous nerve injury, femoral nerve injury, and heterotopic ossification were significantly higher in INFIX group than in plate group ( P<0.05), while the incidence of incision infection was lower in INFIX group than in plate group ( P<0.05). Compared with the plate internal fixation, the INFIX internal fixation can obtain the similar effectiveness for the unstable anterior pelvic ring fracture and has the advantages of shorter operation time, less blood loss, and lower risk of infection.

Polymethylmethacrylate-augmented screw fixation in treatment of senile thoracolumbar tuberculosis combined with severe osteoporosis

To explore the safety and effectiveness of polymethylmethacrylate-augmented screw fixation (PASF) in the treatment of elderly thoracolumbar tuberculosis combined with severe osteoporosis. The clinical data of 20 elderly patients with thoracolumbar tuberculosis and severe osteoporosis who underwent PASF after anterior or posterior debridement and bone grafting and met the selection criteria between December 2012 and December 2014 were retrospectively analyzed. There were 8 males and 12 females with an average age of 68.5 years (range, 65-72 years). T value of bone mineral density was -4.2 to -3.6, with an average of -3.9. There were 12 cases of thoracic tuberculosis, 3 cases of thoracolumbar tuberculosis, and 5 cases of lumbar tuberculosis. The diseased segments involved T 3-L 4, including 11 cases of single-segment disease, 6 cases of double-segment disease, and 3 cases of multi-segment disease. The disease duration was 3-9 months, with an average of 6 months. The preoperative spinal nerve function of the patients was evaluated by the American Spinal Injury Association (ASIA) grading. There were 2 cases of grade A, 5 cases of grade B, 6 cases of grade C, 4 cases of grade D, and 3 cases of grade E. Postoperative imaging examination was used to evaluate the bone graft fusion and paravertebral abscess absorption, and to measure the Cobb angle of the segment to evaluate the improvement of kyphosis. The levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were tested. The visual analogue scale (VAS) score, Oswestry disability index (ODI), and ASIA grading were used to evaluate the effectivreness before operation, at 1 month after operation, and at last follow-up. The clinical cure of tuberculosis was also evaluated. All operation successfully completed. The operation time was 154-250 minutes, with an average of 202 minutes; the intraoperative blood loss was 368-656 mL, with an average of 512 mL. All 20 patients were followed up 18-42 months, with an average of 26.8 months. The postoperative pain and symptoms of tuberculosis in all patients relieved, and the paravertebral abscess was absorbed, reaching the cure standard for spinal tuberculosis. All bone grafts fusion achieved within 1 year after operation. Only 1 case had asymptomatic bone cement leakage into the paravertebral veins, and the remaining patients had no serious complications such as bone cement leakage in the spinal canal, pulmonary embolism, and neurovascular injury. At last follow-up, spinal cord nerve function significantly improved when compared with preoperative one. Among them, ASIA grading were 7 cases of grade C, 8 cases of grade D, and 5 cases of grade E, showing significant difference when compared with preoperative one ( Z=2.139, P=0.000). VAS score, ODI score, segmental Cobb angle, ESR, and CRP at 1 month after operation and at last follow-up were significantly improved when compared with preoperative ones ( P<0.05); there was no significant difference between 1 month after operation and last follow-up ( P>0.05). During the follow-up, no complications such as failure of internal fixation, proximal junctional kyphosis, or tuberculosis recurrence occurred. For elderly patients with thoracolumbar tuberculosis and severe osteoporosis, PASF treatment is safe and effective.

Early Clinical Result of Computerized Navigated Screw Fixation in Treatment of Fragility Pelvic Fracture

Introduction:Minimal invasive fixation of fragility pelvic fracture is feasible with advancement of computerized navigation. However, the clinical outcomes compared with conservative care were seldom mentioned.Method:This is a retrospective study comparing the outcomes of elderly with stable pelvic fracture treated conservatively or operatively using computerized navigation. Outcome parameters included pain score, analgesics requirement, length of hospital stay and complication(s), if any.Result:Operations were performed in 15 patients from July 2017 to November 2018. A retrospective cohort of 37 patients who were treated conservatively was recruited. In the operative group, it showed a statistically significant reduction in analgesics consumption at 4-week time only. There was significant improvement in pain score at 1-week, 4-week and 3-month time. Patients showed earlier return to premorbid walking status. No major surgical complication was noted.Conclusion:Treating fragility pelvic fracture with computerized navigated screw fixation achieve better pain control, reduction in analgesics requirement and earlier mobilization.

Primary treatment of atlantoaxial rotatory fixation in children: a multicenter, retrospective series of 125 cases.

The primary treatment for atlantoaxial rotatory fixation (AARF) remains controversial. The aim of this study was to investigate the primary treatment for AARF and create an algorithm for primary treatment. The authors analyzed the data of 125 pediatric patients at four medical institutions from April 1989 to December 2018. The patients were reported to have neck pain, torticollis, and restricted neck range of motion and were diagnosed according to the Fielding classification as type I or II. As a primary treatment, 88 patients received neck collar fixation, and 28 of these patients did not show symptom relief and required Glisson traction. Thirty-seven patients were primarily treated with Glisson traction. In total, 65 patients, including neck collar treatment failure patients, underwent Glisson traction in hospitals. The success rate of treatment was significantly higher in the Glisson traction group (97.3%) than in the neck collar fixation group (68.2%) (p = 0.0001, Wilcoxon test). In the neck collar effective group, Fielding type I was more predominant (p = 0.0002, Wilcoxon test) and the duration from onset to the first visit was shorter (p = 0.02, Wilcoxon test) than that in the neck collar ineffective group. Using multivariate logistic regression analysis with the above items, the authors generalized from the estimated formula: logit [p(success group by neck collar fixation group)|duration from onset to the first visit (x1), Fielding type (x2)] = 0.4(intercept) - 0.15x1 + 1.06x2, where x1 is the number of days and x2 = 1 (for Fielding type I) or -1 (for Fielding type II). In cases for which the score is a positive value, the neck collar should be chosen. Conversely, in cases for which the score is a negative value, Glisson traction should be the first choice. According to this formula, in patients with Fielding type I AARF, neck collar fixation should be allowed only if the duration from onset is ≤ 10 days. In patients with Fielding type II, because the score would be a negative value, Glisson traction should be performed as the primary treatment.

Wrist arthroscopy combined with 2.7 mm titanium osteotomy plate fixation in treatment of ulnar impaction syndrome

Wrist arthroscopy combined with 2.7 mm titanium osteotomy plate fixation in treatment of ulnar impaction syndrome

The midterm outcomes of ankle Dias-Tachdjian pronation-eversion external rotation physeal fracture in children treated by open reduction internal fixation with one-stage medial-lateral combined incision.

The objective of this study was to report the midterm outcomes and complications of ankle Dias-Tachdjian pronation-eversion external rotation (PEER) physeal fracture in children treated by ORIF with combined medial and lateral incision. A total of 21 children with ankle Dias-Tachdjian PEER physeal fracture underwent open reduction internal fixation treatment with combined medial and lateral incision between January 2015 and October 2017. The lateral distal tibia angle (LDTA) was measured to evaluate angular deformity and the X-rays were taken to evaluate the premature physeal arrest. All patients were followed up for an average time of 20.1 months (ranging from 17 to 25 months). Bone healing was achieved in all cases. American Orthopedic Foot and Ankle Society-Ankle and Hindfoot (AOFAS-AH) score of the patients improved from median 31 (11, 38) preoperation to median 68 (63, 73) postoperation to median score 91 (87, 96) at last follow-up. LDTA of the patients improved from 70.5 ± 4.9 preoperation to 90.0 ± 1.2 postoperation, to measure 90.6 ± 3.7 at last follow-up. The differences were statistically significant (P < 0.05). There is no premature physeal closure, ankle deformity in 19 cases. They could normally exercise and take part in normal sport activities. The remaining two cases had physeal bone bridge and premature physeal closure but could still carry on daily activities and thus were categorized as good. ORIF with one-stage medial-lateral combined incision for ankle Dias-Tachdjian PEER physeal fracture can decrease the rate of premature physeal closure and should be a treatment choice.

Initial assessment of treatment of talar posterior process fractures with open reduction and percutaneous fixation

The purpose of this study was to provide an initial assessment of treatment for talar posterior process fractures using open reduction and internal fixation (ORIF) through posteromedial approach and percutaneous screw fixation. From January 2014 to December 2018, 12 cases with displaced fracture of talar posterior process were treated in our department. The clinical and radiological results were assessed after 4 and 12 months of operation with Visual Analog Scale (VAS) pain and American Orthopedic Foot and Ankle Society (AOFAS) scores. ORIF was performed in four of the cases and percutaneous screw fixation was performed in eight of the cases. The average follow-up period was 13 months. Complications such as wound infection, nerve injury, screw loosening, malunion or nonunion of fracture were absent. For clinical assessment, considerable mprovements were observed for the AOFAS and VAS scores at 4 and 12 months postoperatively for both techniques. There was no significant difference for AOFAS scores and VAS scores between the two techniques (p > 0.05). Both techniques showed good functional outcome and were performed for posterior talar process fracture following the fracture displacement guidelines. Percutaneous screw fixation treatment with computer-assisted three-dimensional evaluation shortened the operation time and reduced incidences of surgical complications.

Low cost 3D printed clamps for external fixator for developing countries: a biomechanical study

BackgroundExternal fixation is a mainstream limb reconstruction technique, most often used after a traumatic injury. Due to the high rates of trauma in developing countries, external fixation devices are often utilized for immediate fracture stabilization and soft tissue repair. Proper external fixation treatment too often still fails to be adopted in these regions due to the high cost and trauma complexity. A novel, inexpensive, unilateral fixator was constructed using 3D printed clamps and other readily available supporting components. ASTM standard F1541 tests were used to assess the biomechanical properties of this novel external fixator.MethodsApplicable sections of ASTM standard F1541 were used to determine the biomechanical properties of the novel external fixator. 3D printed clamps modeled using SolidWorks and printed with chopped carbon fibers using a fuse deposition modeling (FDM) based 3D printer by Markforged (Boston, MA) were used. This study included 3 different testing configurations: axial compression, anterior-posterior (AP) bending, and medial-lateral (ML) bending. Using the novel unilateral fixator with 3D printed clamps previously sterilized by autoclave, an input load was applied at a rate of 20 N/s, starting at 0 N via a hydraulic MTS tester Model 359. Force and deformation data were collected at a sampling rate of 30 Hz. There was a load limit of 750 N, or until there was a maximum vertical deformation of 6 mm. Also, 4 key dimensions of the 3D printed clamps were measured pre and post autoclave: diameter, width, height and length.ResultsThe novel external fixator had axial compression, AP and ML bending rigidities of 246.12 N/mm (σ = 8.87 N/mm), 35.98 N/mm (σ = 2.11 N/mm) and 39.60 N/mm (σ =2.60 N/mm), respectively. The 3D printed clamps shrunk unproportionally due to the autoclaving process, with the diameter, width, height and length dimensions shrinking by 2.6%, 0.2%, 1.7% and 0.3%, respectively.ConclusionOverall, the biomechanical properties of the novel fixator with 3D printed clamps assessed in this study were comparable to external fixators that are currently being used in clinical settings. While the biomechanics were comparable, the low cost and readily available components of this design meets the need for low cost external fixators in developing countries that current clinical options could not satisfy. However, further verification and validation routines to determine efficacy and safety must be conducted before this novel fixator can be clinically deployed. Also, the material composition allowed for the clamps to maintain the appropriate shape with minimal dimensional shrinkage that can be accounted for in clamp design.