Method Of Fixation For Fractures Research Articles

Complication rates, fluoroscopy exposure time, and functional outcomes of the two K-wire fixation methods for distal radius fractures in pediatric patients; mini-incision as a feasible surgical option

Objectives. In this study, we aimed to compare complication rates and fluoroscopy exposure time, as well as to analyze the functional results of percutaneous K-wire fixation and K-wire fixation with mini-open techniques in pediatric distal radius fractures. Materials and Methods. In this retrospective design study, one-hundred patients with completely displaced fracture of the distal radius were evaluated in terms of demographic data, radiological and functional evaluations, fluoroscopy exposure time, and complications. In Group 1, 50 patients were treated by closed reduction and percutaneous K wire application. In Group 2, 50 patients were treated with close reduction and K-wire fixation using a mini-incision. Results. There were no statistically significant differences between the two groups in terms of age, fracture degree, reduction degree, and follow-up duration. We found the fluoroscopy time and redisplacement rate were significantly lower in group 2. We did not notice tendon irritation and neuropraxia complications in any of the patients in group 2. We observed good functional results and no malalignment in both groups. Conclusions. The mini-open incision technique had lower complication rates and fluoroscopy durations. Based on the results of this study, K-wire fixation with the mini-open technique may be recommended as an alternative method for pediatric distal radius fractures.

Computer-aided automatic planning and biomechanical analysis of a novel arc screw for pelvic fracture internal fixation

Background and ObjectiveThe sacroiliac joint screw is a common fixation method for pelvic posterior ring fractures. The complex anatomical structure around the pelvis makes it impossible to find a suitable fixed path, which increases the difficulty of surgical operation. In this paper, we propose an automatic planning algorithm based on a computer-aided internal arc fixation channel for pelvic fractures for the first time. MethodsA channel generation algorithm based on seed derived points was designed, and the optimal channel was selected by scoring rules based on 3D erode algorithm for the generated channel. The biomechanical properties of the internal arc fixation screw and traditional internal straight fixation screw in three postures were compared using biomechanical finite element analysis. ResultsThe proposed algorithm verified the existence of a more adaptable internal arc fixation channel and can quantitatively plan a relatively optimal constant-curvature internal arc fixation channel in pelvises of ten adults. Significantly high stresses concentrated around the interaction region between the screws and bone may increase the risk of bone fractures and screw loosening in the long term. The experimental results show that the internal arc fixation screw has better strain and deformation performance than the internal straight fixation screw. ConclusionsA novel arc internal fixation method for pelvic fractures was proposed to improve the safety and stability of screw fixation of pelvic fracture. The nonparametric test proved that the sacroiliac dislocation model repaired by internal arc fixation screw was significantly different from that repaired by internal straight fixation screw. The computer-aided automatic planning algorithm provides the possibility of robot-assisted pelvic fracture fixation.

Arthroscopically Assisted Percutaneous Screw Fixation of Tibial Plateau Fractures.

This technique involves the use of both arthroscopy and fluoroscopy to facilitate reduction and fixation of the tibial plateau fracture. Through a minimally invasive technique, the depressed articular joint surface is targeted with use of preoperative computed tomography (CT) scans and intraoperative biplanar fluoroscopy. Reduction is then directly visualized with arthroscopy and fixation is performed with use of fluoroscopy. Lastly, restoration of the articular surface is confirmed with use of arthroscopy after definitive fixation. Modifications can be made as needed. The traditional method for fixation of displaced tibial plateau fractures is open reduction and internal fixation. Articular reduction can be visualized directly with an open submeniscal arthrotomy and an ipsilateral femoral distractor or indirectly with fluoroscopy. Visualization of the articular surface is essential to achieve anatomic reduction of the joint line. Inspection of the posterior plateau is difficult with an open surgical approach. Arthroscopically assisted percutaneous screw fixation of a tibial plateau fracture may allow for improved restoration of articular surfaces through enhanced visualization. Less soft-tissue dissection is associated with lower morbidity and may result in less damage to the blood supply, lower rates of infection and wound complications, faster healing, and better mobility for patients. In our experience, this technique has been successful in patients with severe osteoporosis and comminution of depressed fragments. If total knee arthroplasty is required, we have also observed less damage to the blood supply and fewer surgical scars with use of this surgical technique. Arthroscopically assisted percutaneous screw fixation of a tibial plateau fracture facilitates anatomical reduction through a less invasive approach. Patients undergoing this method of tibial plateau fracture fixation are able to engage earlier in rehabilitation2. Studies have shown early postoperative range of motion, excellent patient-reported outcomes, and minimal complications7,8. Arthroscopically assisted fixation can be applied to a variety of tibial plateau fractures; however, the minimally invasive approach is best suited for patients with isolated lateral tibial plateau fractures (Schatzker I to III) and a cortical envelope that can be easily restored. The cortical envelope refers to the outer rim of the tibial plateau. Fracture pattern and ligamentotaxis determine the cortical envelope, which can be evaluated on preoperative CT scans. In our experience, even depressed segments with a high degree of comminution may be treated with use of this technique with satisfactory results.Articular depression should be targeted with use of a preoperative CT scan and intraoperative fluoroscopy and arthroscopy.The surgeon should be careful not to "push up" in 1 small area; rather, a "joker" elevator or bone tamp should be utilized, moving anterior to posterior, which can be frequently assessed with arthroscopy.The intra-articular pressure of the arthroscopy irrigation fluid should be low (≤45 mm Hg or gravity flow), and the operative extremity should be monitored for compartment syndrome throughout the procedure. ACL = anterior cruciate ligamentK-wires = Kirschner wiresORIF = open reduction and internal fixationAP = anteroposteriorCR = computed radiography.

Arterial injury in tibial fracture correlates with trauma severity and orthopaedic outcomes

Tibia fractures are a common fracture of the lower extremity that pose increased risk for vascular injury. The clinical relevance of vascular injury, including particular vessel and number of vessels injured, remains ambiguous. In this study, we evaluate the effect of arterial injury on orthopaedic outcomes for patients with tibia fractures, while identifying trends in fracture characteristics, fixation, and plastic surgery intervention. This single-center retrospective cohort study performed at an academic level I trauma center included 61 patients with 62 tibia fractures undergoing computed tomography angiography (CTA) from 2010 to 2019. Patients were stratified by presence (n = 26) and absence of arterial injury (n = 36) with an average age of 43.6 years (74.2% male) and no differences in patient demographics or comorbidities. Primary outcome measures included delayed- or non-union, amputation, compartment syndrome, infection, revision fixation, and time to full weight bearing (FWB). Fracture characteristics, fixation methods, and plastics interventions were also recorded. Patients with arterial injury had higher rates of open fracture (73.1% vs 44.4%, p = 0.025), infection (46.2% vs 25%, p = 0.042), and delayed- or non-union (42.3% vs 13.9%, p = 0.012). No differences were identified for revision fixation (p = 0.233), compartment syndrome (p = 0.196), amputation (p = 0.093), time to FWB (143.4 vs 109.4 days, p = 0.911) or plastic surgery intervention (p = 0.05). Arterial injury in patients with tibia fractures is associated with higher rates of open fractures and increased risk of infection and delayed- or non-union. Higher-powered studies are required to better characterize the association between arterial injury in tibial fracture and clinical outcomes. • Vascular injury in tibial fracture correlates with increased trauma severity. • Concomitant vascular injury increases risk of infection and delayed- or non-union. • Vascular injury does not increase time to full weight bearing.

Low profile external fixation using locking compression plate as treatment option for management of soft tissue problem in open tibia fracture grade IIIA: A case series.

IntroductionExternal fixators are the most common fixation method for fractures with substantial soft tissue compromise. Nonetheless, the frames used are bulky, uncomfortable, and cumbersome to patients. Using locking compression plate (LCP) as an external fixator (low profile external fixation/LPEF) owns the same properties as standard external fixators but may overcome disadvantages because of its low-profile frame. This case series aims to evaluate the results of LPEF for the management of tibia fracture with soft tissue compromise.Presentation of casesWe reviewed five patients at our centers who underwent surgery in 2020 with the application of LPEF. These patients had grade IIIA open tibia fracture with respective complications. The follow-up duration was 6 months post-operative in which we assessed Southampton Wound Assessment Scale (SWAS), laboratory infection markers, radiographic evaluation, and the Lower Extremity Functional Scale (LEFS). The results showed all wounds healed and cases with infection showed tendency of resolving, alongside varying degree of bone healing. The implant was well tolerated for patients and the functional outcome was overall good (mean LEFS: 71.26%).DiscussionThe LPEF is fortuitously lightweight and more convenient for patients to ambulate, thus the compliance of early functional exercise is more likely to happen.ConclusionApplication of LPEF can be considered as an option for treating soft tissue compromised tibia fracture. In our experience, it is low profile, more acceptable to the patients, and displayed favorable outcomes especially in terms of soft tissue or skin healing and infection resolution.

Application of Finite Element Analysis Combined With Virtual Computer in Preoperative Planning of Distal Femoral Fracture.

BackgroundDistal femoral fractures are increasing with an aging population. The computer-assisted preoperative planning has great potential, but there are no preoperative plans to determine appropriate fixation methods for distal femoral fractures on an individual basis. The aims of this study are: (1) to describe the technique of finite element analysis combined with computer-assisted preoperative planning to determine a fixation method for distal femoral fractures and (2) to evaluate the intra-operative realization of this technology and the clinical outcomes based on it for distal femoral fractures.Materials and MethodsBetween January 2017 and January 2020, 31 patients with distal femoral fractures treated by open reduction and internal fixation were included and randomly divided into two groups based on preoperative planning methods: conventional group (n = 15) and computer-assisted group (n = 16). Firstly, how to determine the most appropriate plate and screw length and placement in the preoperative planning of distal femoral fractures was described. The time taken for preoperative planning for different fracture types in the computer-assisted group was then analyzed. Finally, intraoperative and postoperative parameters were compared between the conventional and computer-assisted groups, assessing operative time, intraoperative blood loss, number of intraoperative fluoroscopies, days of hospital stay, Visual Analog Scale for Pain Score (VAS), and Knee Society Score (KSS).ResultsMean total planning time for 33-A, 33-B, and 33-C fractures in computer-assisted group were 194.8 ± 6.49, 163.71 ± 9.22, and 237 ± 5.33 min, respectively. Compared with the conventional group, the patients in the computer-assisted group had less blood loss, fewer fluoroscopic images, and shorter operation time (p < 0.05). However, there was no significant difference in the hospitalization days, KSS score and VAS score between the two groups (p > 0.05).ConclusionsThe results of this study show that finite element combined with computer-assisted preoperative planning can effectively help surgeons to make accurate and clinically relevant preoperative planning for distal femoral fractures, especially in the selection of appropriate plate length and screw positioning.

Biomechanical comparison of different fixation methods in metatarsal shaft fractures: A cadaver study

BackgroundVarious fixation methods are available for the operative treatment of metatarsal shaft fractures: Kirschner wire, Titanium elastic nail, plate, or an intramedullary bone stabilization system within a balloon catheter. The aim of this study was to compare the stability of these techniques. Methods72 metatarsals II to V from fresh frozen human cadaver feet were used. A shaft fracture was performed and fixed with a 1.6-mm Kirschner wire, a 1.5-mm Titanium elastic nail, a locking 6-hole-plate, or an intramedullary bone stabilization system. In a cantilever configuration, the head of the metatarsals was loaded statically (2 mm/min until failure; all groups) or cyclically (0 to 20 N for 1000 cycles with 10 mm/s, after 1000 cycles 2 mm/min until failure; plate and bone stabilization system). FindingsThe mean failure strength for static loading was 17 N for Kirschner wire, 13 N for Titanium elastic nail, 73 N for plate and 34 N for the bone stabilization system (P < .01). For cyclic loading, the mean cycle of failure was 1000 for plate and 961 for the bone stabilization system (P = .76). The mean failure strength after cyclic loading was 73 N for plate and 48 N for the bone stabilization system (P = .03). InterpretationStability differs depending on the fixation method, with a plate showing the greatest stability and Kirschner wire or Titanium elastic nail the least. The stability of the bone stabilization system for fixing metatarsal shaft fractures is intermediate.

Classification of Proximal Tibial Fractures and Algorithm of Intramedullary Nailing: Efficacy Evaluation

Background. Intramedullary nailing of proximal tibial fractures is challenging due to difficulties with fracture reduction and achievement of stable fixation. Preoperative planning based on proximal fragment length, fracture pattern and bone quality evaluation is a prerequisite for a successful operation. However, there is no classification that could adequately access these factors and guide us towards the most effective methods of fracture reduction and fixation with intramedullary nail. The purpose of this study was to evaluate a classification of extra-articular proximal tibial fractures and algorithm for intramedullary nailing in clinical conditions. Materials and Methods. We compared the treatment outcomes before (Group 1) and after (Group 2) the introduction of the new PFL-TN classification algorithm of intramedullary nailing of proxamal tibial fractures. The group 1 included 43 patients from 18 to 71 years old (males 28; females 15; average age 44.52.0 years). The group 2 included 42 patients from 18 to 72 years old (males 30; females 12; average age 46.12.0 years). The data analysis was carried out after a minimum follow-up period of 12 months. The results were analyzed by the following criteria: reduction quality assesed with reduction quality scale, number of complications, quality of life with SF-36 questionnaire and leg function with LEFS scale. Results. The introduction of the proposed algorithm allowed to reduce the number of late complications by more than 5 times, and the number of required additional surgical interventions by more than 4 times compared to with a control group. The introduction of the proposed algorithm made it possible to improve the functional outcomes 1 year after surgery from 83.58 to 93.29% (p = 0.00002) by the LEFS scale, and the patients quality of life from the 77.501.88 to 86.712.03 points (p = 0.00072) and from the 81.251.88 to 86.842.26 points (p = 0.00116) by the physical and role functioning scales SF-36 questionnaire. Conclusion. The proposed algorithm, based on the new classification, allows to optimize the surgical technique of intramedullary nailing of proximal tibial fractures.

Treatment of open fracture of lower limb in high altitude area

To explore the treatment methods and experience of open fracture of lower limb in high altitude area. From January 2016 to January 2021, 62 patients with open fractures of lower limbs were treated by staged surgery with the concept of injury control orthopedics, emphasizing wound treatment and combining various fracture fixation methods. There were 51 males and 11 females, ranging in age from 14 to 59 years old, with a mean of (37.2±12.3) years old; and the course of disease ranged from 7 to 59 days, with a mean of (23.7±15.5) days. According to Gustilo Anderson classification, there were 14 cases of typeⅠ, 24 cases of typeⅡ, 14 cases of typeⅢA, 8 cases of typeⅢB and 2 cases of typeⅢC. The fracture repair and wound healing were observed, and the clinical efficacy was evaluated by Johner-Wruhs evaluation standard. Fifty-five patients were followed up, and the duration ranged from 4 to 36 months, with a mean of (14.7±8.5) months, and 7 cases were lost to follow-up. According to Johner-Wruhs evaluation criteria, 33 cases got an excellent result, 16 good, 4 poor and 2 bad. The wound healing was poor in 2 cases, partial necrosis of Achilles tendon in 1 case, nonunion of fracture in 1 case and delayed healing of fracture in 2 cases. It is an effective method to treat the open fracture of lower extremity in high altitude area to pay attention to the management of soft tissue injury, the management of wound moisturizing, staged operation of fracture and full protection of blood supply at the fracture end. Paying attention to the treatment of soft tissue injury and the management of wound moisturizing, staged operation of fracture and full protection of blood supply at the fracture end are effective methods for the treatment of open fracture of lower limbs in high altitude areas.

Biomechanical Comparison of a Closed-Loop Double Endobutton to a Lag Screw in Fixation of Posterior Malleolar Fractures

Anteroposterior (AP) lag screw, posteroanterior (PA) lag screw, or posterior buttress plate are usually performed for posterior malleolar fixation, but the biomechanically strongest technique is unclear. The aim of our study was to biomechanically compare 3 different fixation methods for posterior malleolar fractures; AP lag screw, PA lag screw, and closed-loop double endobutton. Fracture models were created using a thin blade power saw after drawing the fracture line. The resultant fracture involved 30% of the joint on the distal tibial joint surface and extends with an angulation of approximately 50 degrees using 15 tibia composite bone samples. After anatomical reduction, fixation was achieved with 3.5 mm cortical screw in PA direction and in AP direction for group PA and AP, respectively. In Group DL, fixation was achieved with a closed-loop double endobutton (double lift loop, Orthomed, Turkey). The highest compression force to generate all displacement amounts was required for the double loop group (Group DL). The strongest fixation against compression was a double loop. The PA group was the second strongest fixation, and the AP group was the biomechanically weakest among these 3 fixation techniques. The closed-loop double endobutton technique was found biomechanically superior to anterior to posterior or posterior to anterior screw fixation techniques for posterior malleolar fracture.

Prognostic factors for surgical site infection following intramedullary nailing of diaphyseal fractures of the femur and tibia in adult patients at a tertiary hospital in Lusaka, Zambia.

Our study aimed to identify prognostic factors for surgical site infection following long bone fracture intramedullary nailing at a tertiary hospital in a low-resource setting. This was a longitudinal observational study involving 132 participants enrolled over a one-year period with femoral and tibial diaphyseal fractures scheduled for ORIF. Participant median age was 30 years (range: 26 - 42). The prevalence of surgical site infection was 16%. Male sex (AOR=0.26, 95% CI [0.70-0.98]; p = 0.047) was associated with lower odds of surgical site infection while associated non-musculoskeletal injuries were associated with higher odds of developing surgical site infection. Our study confirms a higher surgical site infection rate than normally accepted. However, intramedullary nailing in our setting is justified as it allows an early return to a pre-injury state. These interventions must be carried out in the best possible circumstances. Future studies could explore alternative methods of fracture fixation.

A review of outcomes after operative fixation of clavicular fractures over a 10-year period-a single tertiary trauma unit experience.

BackgroundEarly definitive fixation of clavicular fractures is rising in popularity when compared with conservative management. Despite this, the relative risk of subsequent hardware removal or revision surgery is relatively undocumented in the literature. The aim of this study was to review all clavicle fractures treated operatively in a single tertiary referral trauma unit and determine the true incidence of hardware removal and revision rates among this cohort.MethodsA retrospective electronic review was performed in a single tertiary trauma unit for all open reduction internal fixation of clavicle fractures over 10 years (2010-2019 inclusive). All patients were cross referenced for hardware removal during the same period. Patients identified as having undergone ORIF clavicle were reviewed via the National Integrated Medical Imaging System to identify the fracture pattern, fixation method, radiographic nonunion, or radiographic malunion. Age, gender, time from injury to fixation, and time from insertion to removal of hardware where relevant were also collected.ResultsOver the 10-year period from 2010 to 2019, 352 patients underwent ORIF of clavicular fractures. After application of inclusion and exclusion criteria, 346 patients (76% male and 24% female) were analyzed with a mean age of 34.46 years old (95% confidence interval [33.02-35.91]). In total, 54 (15.6%) patients underwent removal of hardware. When fracture type and fixation method were accounted for, only 11% of plate fixations for mid-shaft fractures (n = 29) were removed, whereas 76% of clavicular hook plates for distal fractures (n = 25) underwent removal (P < .001). No distal clavicle fractures treated with locking plates underwent removal (n = 23). Women were almost 3 times more likely to undergo removal of hardware than men (28.6% vs. 11.5%, P < .001). Seven patients (2%) underwent revision ORIF in the 10-year period for nonunion (n = 3), malunion (n = 2), and failure of fixation (n = 2). The mean follow-up time was 1 year (366 days) for those who underwent subsequent surgery and 5.7 years (2087 days) for those who did not.ConclusionClavicular fracture fixation using either locking or hook plates is a safe method of treatment with a very low reoperation rate for either hardware removal or revision. Women are more likely to request plate removal. Distal locking plates are a safe alternative to hook plates for distal one-third clavicle fractures with lower reoperation rates. Newer techniques are emerging for the management of distal fractures such as tight rope fixation and locking plates which also appear to be successful.

Firearm Injuries to the Wrist and Hand in Children and Adults: An Epidemiologic Study.

Gunshot wounds (GSWs) to the wrist and hand are a major health and economic burden in the United States. There are few studies examining the circumstances and epidemiological factors surrounding these injuries. This study assesses the epidemiological factors, as well as the shooting circumstances, injury details, and surgical management of wrist and hand GSWs in children and adults. Medical records and radiographs were reviewed for all patients with ballistic injury to the wrist or hand treated at an urban academic level 1 trauma center from 2016 to 2019. Fisher exact and Pearson χ2 tests were used to assess differences between groups. Two hundred forty-nine victims (29 children, 220 adults) with complete documentation were identified. Among 180 victims with known shooting circumstances, 132 (70%) were shot by another person and 110 (65%) were injured by intentional gunfire. Eighty-seven victims (35%) suffered a concurrent GSW to another body region. Metacarpal fracture was the most commonly diagnosed bony injury (37%), followed by proximal phalanx fracture (25%). One hundred twenty-nine victims (52%) underwent surgery following their injuries. Nerve discontinuity was diagnosed in 27 victims (11%), while 20 victims (8%) had vascular disruption. There was no significant difference between children and adult victims' type of fracture, concurrent injuries, rates of surgery, or in the most common fracture fixation method. Most wrist and hand GSW victims were injured due to intentional, non-self-inflicted gunfire. Most patients present with hand fractures, and fortunately, nerve and vascular disruptions are uncommon.

Functional and radiological outcomes following plating for displaced fractures of patella: A pilot study

Introduction: Patellar fractures constitute almost 1% of total skeletal injuries. Existing common operative methods include the use of different types of Tension band wiring techniques like cannulated screws and K-wires. The Patellar plating construct is a relatively newer operative method for patellar fracture fixation with promising outcomes with fewer complications.Method: We conducted a pilot prospective study at our Apex Trauma center in twenty patients aged 18–65years with displaced patellar fractures, AO type A2, A3, B2, B3, C1, C2, C3. Fractures were fixed with low profile patellar plates (1.8 mm). Radiological and functional follow-up was done using X-rays, CT scans and BKS scoring (Bostman-Knee-Scale), Knee Society Score(KSS), and Tegner Lysholm knee scores respectively for two years.Result: Mean functional outcome scores at 6 weeks, 3 months, 6 months and 2 years was 25.5, 28.3, 29.05 and 29.9 for BKS; 64.62, 84.12, 90.6, and 97.5 for KSS; 73.75, 89.7,94.8, and 99.3 for Tegner Lysholm knee score respectively. Radiological union, confirmed by CT scan, was observed in all patients at 3 months. Two patients had superficial surgical site infection (SSI) at 2 weeks. Implant impingement was also found in 2 patients at 3 months. None of the patients had a failure of fixation at the end of the study.Conclusion: Patients with low profile patellar plate constructs have favorable clinical and radiological outcomes with minimal non-specific complications.

S2-alar-iliac screw and S1 pedicle screw fixation for the treatment of non-osteoporotic sacral fractures: a finite element study

BackgroundFive different sacral fracture fixation methods were compared using finite element (FE) analysis to study their biomechanical characteristics.MethodsDenis type I sacral fractures were created by FE modeling. Five different fixation methods for the posterior pelvic ring were simulated: sacroiliac screw (SIS), lumbopelvic fixation (LPF), transiliac internal fixator (TIFI), S2-alar-iliac (S2AI) screw and S1 pedicle screw fixation (S2AI-S1) and S2AI screw and contralateral S1 pedicle screw fixation (S2AI-CS1). Four different loading methods were implemented in sequence to simulate the force in standing, flexion, right bending and left twisting, respectively. Vertical stiffness, relative displacement and change in relative displacement were recorded and analyzed.ResultsAs predicted by the FE model, the vertical stiffness of the five groups in descending order was S2AI-S1, SIS, S2AI-CS1, LPF and TIFI. In terms of relative displacement, groups S2AI-S1 and S2AI-CS1 displayed a lower mean relative displacement, although group S2AI-CS1 exhibited greater displacement in the upper sacrum than group S2AI-S1. Group SIS displayed a moderate mean relative displacement, although the displacement of the upper sacrum was smaller than the corresponding displacement in group S2AI-CS1, while groups LPF and TIFI displayed larger mean relative displacements. Finally, in terms of change in relative displacement, groups TIFI and LPF displayed the greatest fluctuations in their motion, while groups SIS, S2AI-S1 and S2AI-CS1 displayed smaller fluctuations.ConclusionCompared with SIS, unilateral LPF and TIFI, group S2AI-S1 displayed the greatest biomechanical stability of the Denis type I sacral fracture FE models. When the S1 pedicle screw insertion point on the affected side is damaged, S2AI-CS1 can be used as an appropriate alternative to S2AI-S1.

Comparative study between intramedullary interlocking nailing and minimally invasive percutaneous plate osteosynthesis for distal tibia extra-articular fractures

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;Treatment of distal tibia fractures poses significant challenge to orthopedic surgeon because of poor blood supply and paucity of soft tissue coverage. There is considerable controversy regarding the superior option of treatment for distal tibia fracture between the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and intramedullary interlocking (IMIL) nailing for extra-articular distal tibia fractures. The aim of our study is to compare the functional outcome between the two treatment methods.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was the prospective comparative study of 50 patients with distal third tibia fractures divided into two groups. First group of patients were treated with MIPPO technique while second group of patients were managed by IMIL nailing. Patients were followed up in outpatient department to assess the functional outcomes, malunion, delayed union, non-union, superficial and deep infection between the two groups.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;Average time taken by patients for full weight bearing in group A was 17.6 weeks as compared to 16.7 weeks in group B. All patients were able to bear weight prior to complete union of fracture. By the process of weight bearing, we believed that it would promote secondary bone healing. On taking X-rays during follow up of included patients starting of radiological union was observed carefully by looking for bridging callus, haziness of fracture line. Appearance of callus was taken average time of 12.5 weeks in group A and 12.1 weeks in group B.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Both procedures have shown the reliable method of fixation for distal extra-articular tibia fractures preserving the soft tissue, bony vascularity and fracture hematoma that provide a favourable biological environment for fracture healing. Considering the results of the study, we have slightly more preference for the MIPPO technique.&lt;/p&gt;

345 A Novel Fixation Method for Unstable Ankle Fractures in The Elderly with Poor Quality Skin, Via Dual Percutaneous Tibiotalar Cannulated Screws

Abstract Introduction The incidence of ankle fractures is highest in the elderly population due to poor bone quality. Osteoporosis and poor overlying skin increase risk of infection, wound breakdown, and fixation failure. This ultimately results in worse functional outcomes. This retrospective case-series describes a novel dual percutaneous tibiotalar cannulated screw fixation method, for managing unstable ankle fractures, in high-risk elderly patient with low functional demand. Method Six elderly patients were identified between January 2019-2020 who underwent dual tibiotalar cannulated screw fixation for unstable ankle fractures. Pre-operative and post-operative pain and mobility scores were obtained via telephone consultation and case-note review. Radiographs were analysed pre-operatively for fracture type and post-operatively for complications such as, talar shift. Wound Infection post-operatively was monitored. Results The mean age was 86.8 with an average ASA grade of three. Functional outcomes were excellent with 83.3% of patients remaining ambulatory with no post-operative pain at an average follow-up of 10.25 months. Three patients (50%) had excellent post-operative radiographs with evidence of union and no talar shift. Two patients (33.3%) had either non-union or minor talar shift, and one patient (16.7%) had multiple radiological complications likely due to delayed fixation. All three patients remained ambulatory and had minimal post-operative pain. There were no reports of soft tissue injury or infection due to the surgery. Conclusions Dual percutaneous tibiotalar cannulated screws can be used to manage unstable ankle fractures in the low demand elderly patient, with poor skin quality. Function outcomes were good with satisfactory post-operative mobility and minimal pain in the majority of cases.

A review of biomechanical studies for mandibular angle fracture internal fixation

Mandible fractures correspond to 19-40% of all facial fractures. Among all mandible fractures, 12-30% are fractures of the mandibular angle. These fractures are mainly caused by sports activities, interpersonal violence and car accidents. The presence of the third molar and the thin transverse bone area seem to be responsible for the frequent involvement of the mandibular angle in facial fractures. Before the advent of antibiotics, a high frequency of infection was always associated after an open reduction in mandibular angle fractures. Wired osteosynthesis and maxillomandibular fixation (MMF) were traditional methods for fixing mandibular angle fractures. The limitation of both methods has influenced the development of new approaches for the treatment of mandibular angle fractures. Currently, osteosynthesis of mandibular angle fractures with plates and screws has become an effective treatment option. Several forms are described in the literature as: fixation of bone segments with a miniplate on the upper edge of the mandible, fixation with two miniplates, lag screw or by a single rigid plate on the lower edge of the mandible. The purpose of this study was to summarize the main characteristics of biomechanical studies such as the type of mandible source used, the plating techniques employed, the plate material, and the loading protocols used to evaluate the stability of the fixation methods. The Medline (PubMed) database was searched combining relevant terms and pertinent articles in English were included. Articles had to meet the following inclusion criteria: be in vitro biomechanical studies evaluating fixation methods for mandibular angle fractures. A total of 27 articles fulfilled the inclusion criteria. Synthetic mandibles (n=12), animal mandibles (n=9), and human cadaveric mandibles (n=5) were used as the sample source to perform the biomechanical analysis. One article used both synthetic and human cadaveric mandibles. Also, a variety of fixation techniques was described such as mini-plates, lag-screws, reconstruction plates, and three-dimensional plates. The materials of the bone plates used were: stainless steel, commercially pure titanium, titanium alloy or bioresorbable. However, there was inconsistency in reporting the materials and not all studies clearly stated the material of the bone plates. For the biomechanical analysis, there was a high variation among all studies regarding the loading protocols used. The same side of fixation, the anterior part of the mandible (central incisors) or the contralateral side were reported as the dentate regions in which the force was applied. For more than 2 decades, in vitro biomechanical studies have been used to help researchers and clinicians in the field of Oral and Maxillofacial Surgery to properly evaluate and compare the different devices and techniques available for the treatment of mandibular angle fractures. Also, biomechanical studies are important to answer questions on fatigue performance and fracture strength on the gross level.

Description of and complications associated with reinforced, free-form external skeletal fixation for treatment of appendicular fractures in cats: 46 cases (2010-2019).

To describe a modified technique for reinforced, free-form external skeletal fixation (rFF-ESF) of appendicular fractures in cats and identify factors associated with development of complications. 46 cats with fractures repaired with rFF-ESF at Angell Animal Medical Center between 2010 and 2019. Medical records were reviewed for information on signalment, affected bone, fracture location and orientation, degree of comminution, severity (open vs closed), fixator type, number of fixation pins, use of an intramedullary pin (yes vs no), surgeon experience (staff surgeon vs surgical resident), anesthesia time, surgery time, perioperative antimicrobial administration, concurrent surgical procedures, intraoperative complications, postoperative alignment, whether fixator destabilization was performed, and time to complete fixator removal. Postoperative complications were recorded. 43 of the 46 (93%) cats had a successful outcome, with a median time to complete fixator removal of 8 weeks (range, 3 to 61 weeks). Twelve of the 46 (26%) cats had major (n = 3) or minor (9) complications. In univariable analyses, 4 factors were significantly associated with development of postoperative complications: body weight (OR for each 1-kg increase in weight, 1.8), tibial fracture (vs fracture of any other long bone; OR, 16), use of a type 2 fixator (vs a type 1 fixator; OR, 11), and use of destabilization (vs no destabilization; 7). Results indicated that rFF-ESF can be successfully used to stabilize a variety of appendicular fractures in cats. Further studies are required to compare rFF-ESF with other fracture fixation methods.

Comparative study between intramedullary interlocking nailing and minimally invasive percutaneous plate osteosynthesis for distal tibia extra-articular fractures

PurposeTreatment of distal tibia fractures poses significant challenge to orthopedic surgeon because of poor blood supply and paucity of soft tissue coverage. There is considerable controversy regarding the superior option of treatment for distal tibia fracture between the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and intramedullary interlocking (IMIL) nailing for extra-articular distal tibia fractures. The aim of our study is to compare the functional outcome between the two treatment methods. MethodsThis was the prospective comparative study of 100 patients with distal third tibia fractures divided into two groups. The first group of patients were treated with MIPPO technique while the second group of patients were managed by IMIL nailing. Patients were followed up in outpatient department to assess the functional outcomes, malunion, delayed union, nonunion, superficial and deep infection between the two groups. Statistical analyses were performed using the SPSS software (version 16.0). ResultsAverage malunion (degrees) in the MIPPO group was 5 (3–7) ± 1.41 vs. 10.22 (8–14) ± 2.04 in the IMIL group (p = 0.001). Similarly postoperative knee pain in the IMIL group was 10% vs. 2% in the MIPPO group (p = 0.001). In terms of superficial infection and nonunion, the results were 8% vs. 4% and 2% vs. 6% for the MIPPO and IMIL group, respectively (p = 0.001). ConclusionBoth procedures have shown the reliable method of fixation for distal extra-articular tibia fractures preserving the soft tissue, bony vascularity and fracture hematoma that provide a favourable biological environment for fracture healing. Considering the results of the study, we have slightly more preference for the MIPPO technique.