Pin Fixation Research Articles

Late-onset pseudoaneurysms of lower limb arteries following late complications of orthopaedic constructs - Two cases and review of literature.

Introduction & importanceDamage to the adventitial layer of an artery leads to pseudoaneurysm formation. Pseudoaneurysms caused by complications of orthopaedic constructs are rare.Case presentation & clinical discussionCase report 01. A 27-year-old male presented with acute bleeding from an external fixator pin site. He had defaulted follow-up due to covid pandemic and presented with malunited distal tibia fracture and loosened Schanz pins. CT angiogram revealed a pseudoaneurysm of the peroneal artery over the loosened pin site. The patient underwent exploration and ligation of the peroneal artery.Case report 02. 86-year-old female presented with a gradually enlarging lump on her left anteromedial thigh for three months duration. She underwent open reduction and internal fixation of ipsilateral femur fracture 17 months back. She was found to have a pseudoaneurysm of the superficial femoral artery caused by exposed screws following bony erosion. Exploration and repair of “neck” the pseudoaneurysm was performed and the recovery was uneventful.ConclusionPseudoaneurysms are rare but carry devastating complications following various orthopaedic procedures. The common cause for the formation of pseudoaneurysms is trauma during surgery. But loosened Schanz screws and screws are also can be the cause. Early identification of a pseudoaneurysm and proper intervention will reduce morbidities.

Effect of Bidirectional Insertion of External Skeletal Fixation Pins on Axial Pullout Strength in Canine Cadaveric Bone.

The aim of this study was to evaluate the effect of bidirectional insertion on axial pullout strength of tapered run out (TRO), traditional negative profile (TNP) and positive profile (PP) pins. Cadaveric adult canine tibiae were harvested. Tapered run out pins (Group 1) were inserted unidirectionally to the desired position; bidirectionally past the desired position, then withdrawn to the desired position (Group 2); and bidirectionally as described for Group 2, repeated twice (Group 3). Traditional negative profile pins (Group 4-6) and PP pins (Group 9-11) were placed in the same manner. Tapered run out (Group 7), TNP (Group 8) and PP pins (Group 12) were driven unidirectionally such that the shaft of the pin violated the cis-cortex. A servohydraulic testing machine extracted the pins and measured axial peak pullout strength. Positive profile pins had significantly greater pullout strength than TRO and TNP pins placed unidirectionally to the desired position. Method of insertion had no effect on peak pullout strength of TNP pins. TRO and PP pins inserted unidirectionally to the desired position had significantly greater peak pullout strengths than insertion bidirectionally or if the shaft of the pin violated the cis-cortex. The authors recommend that pins used for external skeletal fixation should be placed unidirectionally to the desired position with fluoroscopic guidance, intra-operative depth gauge measurements or measurements from preoperative radiographs. Repositioning pins results in loss of peak pullout strength with TRO and PP pins.

C4-T3 Replacement Laminoplasty and Microsurgical Resection of Ependymoma: 2-Dimensional Operative Video.

Spinal ependymomas are the most common intramedullary spinal cord tumors in adults.1-4 They are benign histologically, and maximum safe surgical resection should be pursued with the goal of maintaining neurological integrity.4 Spinal ependymoma resections have been described in the operative video literature, including those using techniques of laminoplasty to prevent postlaminectomy kyphosis.1-3,5 Defining the planes between tumor and normal spinal cord is critical to achieving safe maximum resection.3 This video will illustrate the microsurgical techniques used in the resection of a large spinal cord ependymoma in a patient who presented with progressive lower extremity paraparesis and incontinence and was found to have a large intradural, intramedullary C4-T3 lesion with a rostral glial tumor cyst. The patient consented to surgical intervention. The patient was placed prone in MAYFIELD 3-point pin fixation (Integra LifeSciences, Plainsboro Township, New Jersey). Intraoperative neurophysiological electrodes were placed for somatosensory evoked potentials, motor evoked potentials, and D-wave monitoring of corticospinal tracts.6,7 C3-T4 replacement laminoplasties were performed. A midline dural incision spanning C4-T4 was made. A midline myelotomy preserving the pial venous plexus was performed with a 69 Beaver blade.2 The attachments of the tumor to the normal white matter of the spinal cord were microsurgically defined, coagulated, and divided. Tumor debulking was performed with an ultrasonic aspirator. Once gross total resection was achieved, the pial edges of the spinal cord were reapproximated. The dura was closed in a watertight fashion. The patient recovered from surgery well with preservation of her motor function with a continued T7 sensory level.

Locking Compression Plate as an External Fixator for the Treatment of Tibia Infected Bone Defects.

This study was designed to observe the medium-term efficacy of an induced membrane technique combined with a locking compression plate as an external fixator for the treatment of tibia infected bone defects. Patients with a tibial infection were admitted to our department between January 2013 and November 2014. All patients were treated with the induced membrane technique. In the first stage, polymethyl methacrylate (PMMA) cement was implanted in the defects after debridement and then fixed with a locking compression plate (LCP) as an external fixator. In the second stage, bone grafts were implanted to rebuild the defects. The external plates were replaced with nails in 57 patients (internal group), and the remaining 30 patients were not exchanged with fixation (external group). The infection control rate, bone union rate, and complications of the two groups were compared. Eighty-seven patients were enrolled in this study, and all patients had a minimum follow-up of 5 years (average 62.8 months) after grafting. Eighty-three patients (95.4%) achieved bone union, and the average union time was 6.77 months. Five patients (5.7%) experienced recurrence of infection. Complications included pin tract infection, fixation loosening, deformity connection, and limitation of joint range of motion (ROM). No significant differences in the infection control rate or bone defect union rate were noted between the two groups. The overall rate of complications in the external group was 50%, which was greater than that noted in the internal group (21.1%). Locking compression plates are external fixators with smaller sizes that are easier to operate than conventional annular fixators or assembled external fixators. The use of locking compression plates in combination with the induced membrane technique in the treatment of tibia infected bone defects can achieve good clinical efficacy after medium-term follow-up.

Extension Block Pinning versus percutaneous Fragment Reduction with a Towel Clip and extension Block Pinning with direct Pin Fixation for Treatment of Mallet Fracture.

This study compared the clinical and radiographic results between extension block pinning (Group A) and percutaneous reduction of the dorsal fragment with a towel clip followed by extension block pinning with direct pin fixation (Group B) for the treatment of mallet fractures. A total of 69 patients (group A = 34 patients, group B = 35 patients) who underwent operative treatment for mallet fractures from June 2008 to November 2017 with ≥ 6 months post-surgical follow-up were analysed retrospectively. The extent of subluxation of the distal interphalangeal joint, articular involvement of fracture fragment, fracture gap, and articular step-off were examined on plain radiographs before and after surgery. The functional outcomes were evaluated with the Crawford rating system. The postoperative step-offs were 0.16 mm in group A and 0.01 mm in group B. Group B had a significantly better anatomical outcome than group A. Five patients in group A had a loss of reduction. Among them, two had malunion and post-traumatic arthritis. Meanwhile, no patients in group B presented with loss of reduction and nonunion. The mean extension lags were 4.2° in group A and 1.6° in group B. However, functional outcome did not differ between the two groups at the final follow-up. Fracture reduction using a towel clip and extension block pinning with direct pin insertion for mallet fracture facilitated the anatomical reduction of fragments, and allowed for stable fixation of fragments. Compared with extension block pinning technique, this technique has shown better anatomical results and stability, but not better clinical results.

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.

Management of Salter-Harris II distal femur fractures - what is the state of practice? A survey of Pediatric Orthopaedic Society of North America membership.

Level V Expert Opinion.

Comparative study between conservative treatment and percutaneous pinning of non displaced lateral condyle Humeral Fractures in young children

Objective: To compare the results of above-elbow cast conservative treatment and surgical percutaneous pinning of nondisplaced (grade1) lateral condyle humerus fractures in young children. Patients and Methods: This is a prospective study held on twenty patients at Samannoud general hospital, Gharbiae, Egypt. Ten patients underwent conservative treatment in the form of above-elbow cast, and ten patients underwent surgical treatment in the form of percutaneous pinning fixation. Results: One patient (10%) had a secondary displacement in the conservative treatment group after a week and needed surgical intervention. No other complications were reported in this group. One patient (10%) had a mild pin tract infection in the pinning group, which resolved after removal. All patients in the study restored elbow full range of motion one week from plaster removal. Sixteen patients (6 conservative and ten pinnings) had overgrowth after the procedure with no statistical difference between the two groups, that was not also clinically evident. No significant difference in any outcome was detected between the groups.Conclusion: Lateral condyle humerus fractures need proper radiological evaluation on initial presentation after trauma and close follow-up. The present study demonstrated no significant difference in outcomes on the short term scale between conservative versus surgical treatment for grade 1 fractures, except for the possible re-displacement (10%) comparable to the literature. Patients’ parents/guardians would be offered conservative treatment as a first option if good compliance and close follow-up in the first few weeks are possible, which would avoid the potential complications of anaesthetics and surgical risks.

New Linked-Wire-Type External Fixator (the Ichi-Fixator System) for Metacarpal Fractures: Case Series and Literature Review.

Background: External fixator is an effective treatment option in the comminuted or unstable metacarpal fractures. The new linked-wire type of external fixator (the Ichi-Fixator System) developed for hand and wrist fractures enables fine adjustment of the fixation under fluoroscopic inspection through small screws inside the fixator fitted externally. This technique is designed to reinforce the stability and rigidity of conventional percutaneous Kirchner wire fixation. The aim of this study is to assess the effectiveness of the fixator for comminuted or unstable metacarpal fractures through the evaluation of short-term results in ten cases. Methods: Patients were fixated with fixator pins and metal clamps using the Ichi-Fixator System. All patients were then examined for post-operative complications, functional recovery, visual analogue scale (VAS) score, and the Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score at the end of the final follow-up consultation. Results: Operative treatment using the Ichi-Fixator System facilitates anatomical reduction and allows immediate full mobilization, producing good outcomes. No infections were observed in all cases, including those at pin insertion sites. There were no implant failure and nonunion. Patients could perform all routine activities with normal grip strength and retained a full range of hand motion without pain. This treatment method with improved postoperative comfort would allow immediate return to work, which would clearly boost patient satisfaction. Conclusions: Ichi-Fixator System is considered to be useful for the treatment of metacarpal fractures, and this will provide a new surgical option for all hand fractures.

Addition of autogenous bone chips to deproteinized bovine bone mineral does not have additional benefit in lateral ridge augmentation-A preclinical in vivo experimental study.

To compare the outcome after extensive lateral guided bone regeneration using deproteinized bovine bone mineral (DBBM) with or without autogenous bone chips in a canine model of chronic horizontal alveolar ridge defect. The second, third and fourth lower premolars of both sides were extracted, and the buccal bone walls were completely removed in five beagle dogs. After 4weeks, DBBM particles mixed with autogenous bone chips at a ratio of 1:1 were grafted at one side (DBBM/Auto group), while DBBM particles alone were grafted at the contralateral side (DBBM group). The graft materials on both sides were covered by a resorbable collagen membrane and fixation pins. Microcomputed tomographic volume and histomorphometric analyses were performed at 16weeks post-surgery. The ridges of both groups were recovered horizontally, but new bone formation beyond the original ridge contour at the defect site was not found. The DBBM group exhibited a larger total radiographic augmented volume and new bone volume compared with the DBBM/Auto group, but the differences were minimal (p>.05). Histologically, the regenerated area and new bone area were also slightly larger without any statistical significance in the DBBM group than in the DBBM/Auto group (p>.05). The addition of autogenous bone chips to DBBM for lateral ridge augmentation may confer no advantage over grafting DBBM alone with respect to both space maintenance and de novo bone formation in dogs.

The Stress Concentration and Biomechanical Properties of the Intraoral Distractors and the Extraoral Distractors Used in Treatment of Hemifacial Microsomia Patients: A Simulation Finite Element Analysis Study.

Finite element analysis of the stresses subjected to both the intraoral and the extraoral distractors devices used in the mandibular distraction of hemifacial microsomia patients. Two models were included in the current study. The first model was an extraoral distractor and the second model was an intraoral distractor model. To generate the results in the simulated models; 2 vertical loads were applied (222.7 and 137.78 N) on the defective and normal side, respectively. The intraoral system observed lower stress (6.85 MPa) in the mandibular bone compared to the extraoral system (13.21 MPa). The intraoral distractor had a higher stress concentration on the distractor fixing screws (352 MPa) compared to the extraoral distractor fixing pins (15 MPa). The extraoral distractor had a higher displacement effect on the mandibular bone around the pins of 263.35 μm in comparison to the intraoral distractor effect which was 77.87 μm. Internal oral distractor provides a sort of stress shielding to the distracted bone and less displacement, so it is more advisable to be used in general. The external devices are advised only in extralong distraction distance because the distractor is subjected to lower stresses compared to intraoral counterparts.

MRI-guided laser interstitial thermal therapy using the Visualase system and Navigus frameless stereotaxy in an infant: technical case report.

Laser interstitial thermal therapy (LITT) is increasingly used as a surgical option for the treatment of epilepsy. Placement of the laser fibers relies on stereotactic navigation with cranial fixation pins. In addition, the laser fiber is stabilized in the cranium during the ablation using a cranial bolt that assumes maturity of the skull. Therefore, younger infants (< 2 years of age) have traditionally not been considered as candidates for LITT. However, LITT is an appealing option for patients with familial epilepsy syndromes, such as tuberous sclerosis complex (TSC), due to the multiplicity of lesions and the likely need for multiple procedures. A 4-month-old infant with TSC presented with refractory focal seizures despite receiving escalating doses of 5 antiepileptic medications. Electrographic and clinical seizures occurred numerous times daily. Noninvasive evaluations, including MRI, magnetoencephalography, scalp EEG, and SPECT, localized the ictal onset to a left frontal cortical tuber in the premotor area. In this paper, the authors report a novel technique to overcome the challenges of performing LITT in an infant with an immature skull by repurposing the Navigus biopsy skull mount for stereotactic placement of a laser fiber using electromagnetic-based navigation. The patient underwent successful ablation of the tuber and remained seizure free 4 months postoperatively. To the authors' knowledge, this is the youngest reported patient to undergo LITT. A safe method is described to perform LITT in an infant using commonly available tools without dedicated instrumentation beyond standard stereotactic navigation, a biopsy platform, and the Visualase system.

English

BACKGROUND Supracondylar fracture of humerus is a common fracture in children. Closed manipulative reduction and percutaneous K-wire fixation is the most widely recognized treatment method for displaced supracondylar humerus fracture in children but controversy persists regarding the ideal pin fixation technique. The purpose of this study was to compare the radiological and functional outcome of lateral entry pinning with that of crossed pinning fixation for Gartland type III supracondylar humerus fractures in children. METHODS This prospective cohort study was conducted in Govt. Medical College Hospital, Thiruvananthapuram from February, 2015 to September, 2016. A total of 54 patients who satisfied the inclusion and exclusion criteria were enrolled in the study. They were allocated to Group A (crossed pin fixation) and Group B (lateral pin) fixation with 27 patients in each. All the cases of percutaneous pinning were done according to a uniform standardized technique. The patients were reevaluated at post-operative day, three weeks, and three months after the surgery. Following information were recorded as outcome measures: (i) carrying angle (ii) range of motion (iii) modified Flynn’s criteria. (v) Baumann’s angle (vi) neurovascular injury. RESULTS There was no statistically significant difference between crossed and lateral pinning with regard to mean Baumann's angle, carrying angle, complication rate, stability and functional outcome, but there was evidence of iatrogenic ulnar nerve injury (3.7 %) in crossed pinning group. There was one case of pin tract infection. CONCLUSIONS There is no statistically significant difference between the radiological and functional outcome provided by crossed pin fixation method and lateral pin fixation methods. Closed reduction and percutaneous pin fixation are safe and efficient methods for fixation of displaced supracondylar fractures of the humerus. Closed reduction and percutaneous pin fixation for displaced supracondylar factures of the humerus in children gives good functional and cosmetic results. KEYWORDS Humerus, Percutaneous Pinning, Supracondylar Fracture

Threaded Pin and Volar Plate Fixation of Distal Radius Fractures: Early Functional Recovery

PurposeTo assess the results of threaded pin fixation and volar plate fixation of extra-articular distal radius fractures.MethodsA retrospective case comparison study of patients undergoing operative fixation of distal radius fracture and postoperative therapy at 1 hand clinic was performed. Clinical variables included implant type along with the assessment of the volar tilt; radial height; postoperative wrist flexion, extension, pronation, and supination; key pinch; and grip strength. The duration of postoperative hand therapy was recorded. An independent Student t test was used to compare the 2 groups.ResultsForty-three patients were identified (21 threaded pin and 22 volar plate). The mean ages were 46 years and 54 years for the threaded pin and the volar plate groups, respectively. Preoperative and postoperative radiographic parameters were similar for both the groups. No loss of reduction was observed. There were no statistically significant differences for postoperative range of motion or pinch and grip strength at the time of discharge from therapy. The threaded pin group had a mean duration of 65 days of therapy, and the volar plate group had a mean duration of 132 days of therapy.ConclusionsBoth groups achieved equivalent range of motion and functional recovery; however, the threaded pin group required significantly less therapy than the volar plate group. At the time of discharge from therapy, radiographic and clinical outcomes were similar for both types of implants, but the patients treated with a threaded pin required significantly less therapy and were discharged from therapy an average of 67 days sooner than the patients undergoing volar plate fixation.Type of study/level of evidenceTherapeutic IV.

A novel retractor-assisted closed reduction combined with percutaneous pinning fixation for the treatment of elderly distal radius fractures: a retrospective cohort study

BackgroundPercutaneous pinning fixation (PCP) has been used for the treatment of distal radius fractures for decades, especially in the elderly with fragile soft tissue. However, achieving and maintaining a sound anatomic reduction before PCP is difficult if we use the manipulative reduction method alone. Our study innovatively applied the Steinmann pin retractor for closed reduction combined with PCP, to provide a new protocol for the treatment of distal radius fractures.MethodsFrom March 2017 to July 2018, 49 patients out of 57 that met the inclusion criteria but not the exclusion criteria were included in our retrospective cohort study. Sixteen patients were treated with Steinmann pin retractor-assisted closed reduction combined with PCP (S-PCP), and 19 patients were treated with the manipulative reduction combined with PCP (M-PCP), and 14 patients were treated with the manipulative reduction combined with cast splint (M-C). All these patients received a positive postoperative radiological and clinical evaluation.ResultsAll the patients were followed up for a minimum of 2 years. The radiological parameters in each group improved significantly postoperative (posttreatment). In the S-PCP group, the values of radial height (postoperative, 13.33±1.74 mm; the first follow-up, 13.27±1.81mm; last follow-up, 13.16±1.76mm) and ulnar variance (postoperative, −0.10±1.29mm; the first follow-up, −0.05±1.27mm; last follow-up, −0.12±1.09mm) significantly improved as compared to the M-PCP and M-C groups. While the patients in the M-C group experienced significant re-displacement at the first and last follow-ups, in the S-PCP group, the range of wrist motion including extension (89.94±5.21%), radial deviation (90.69±6.01%), and supination (90.25±5.87%); ulnar deviation (89.81±5.82%) and QuickDASH score (2.70±3.64); and grip strength (92.50±5.59%), pronation (90.50±6.04%), and modified Mayo wrist score (90.94±4.17, the excellent rate reached up to 75%) also improved as compared to the M-PCP group, M-C group, or both groups at the last follow-up.ConclusionS-PCP improves fracture reduction and wrist function and can serve as an effective method for A2(AO/OTA) and A3 type of distal radius fractures in the elderly with limited dorsal comminution, including intra-articular fractures with displacement less than 2mm.

REMOTE RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH PROXIMAL HUMERAL FRACTURES

Proximal humeral fractures constitute 5-8% of all the fractures of the limbs and 80% of fractures of the upper arm. To report about remote results of the suggested tactics of surgical treatment of proximal humeral fractures. Satisfactory results of treatment were found in 21 (80,7%) patients out of 26 (72%), who underwent closed reduction of fractures with pin fixation. This group of patients achieved consolidation in optimal terms, and the function of the shoulder joint was satisfactory with abduction angle of 90°. 2 (7,7%) patients experienced secondary dislocation of fragments and their QuickDASH score was 38.4. 3 (11,6%) patients achieved consolidation of fracture, but stable contracture of the shoulder joint occurred. Their QuickDASH score was 38.4. Osteosynthesis with plates was performed in 10 patients. 3 (30%) of them developed aseptic necrosis of the humeral bone head, 2 (20%) patients developed suppuration of the soft tissues which produced a negative effect of the patients’ ability to work ‒ QuickDASH score 42,7, 5 (50%) patients admitted satisfactory results of treatment ‒ QuickDASH score 21,5. Osteosynthesis with plates was performed in 10 patients. 3 (30%) of them developed aseptic necrosis of the humeral bone head, 2 (20%) patients developed suppuration of the soft tissues which produced a negative effect of the patients’ ability to work ‒ QuickDASH score 42,7, 5 (50%) patients admitted satisfactory results of treatment ‒ QuickDASH score 21,5. The tactics of surgical treatment of patients with proximal humeral fracturesdepends on the following: type of a fracture, patient’s age, concomitant pathology and osteoporosis available, and patient’s social needs.

Comparison of lateral entry and crossed entry pinning for pediatric supracondylar humeral fractures: a meta-analysis of randomized controlled trials

BackgroundClosed reduction and pinning entry fixation have been proposed as treatment strategies for displaced supracondylar humeral fractures (SCHFs) in children. However, controversy exists regarding the selection of the appropriate procedure. Hence, this meta-analysis was conducted to compare the effect of lateral and crossed pin fixation for pediatric SCHFs, providing a reference for clinical treatment.MethodsOnline databases were systematically searched for randomized controlled trials (RCTs) comparing lateral pinning entry and crossed pinning entry for children with SCHFs. The primary endpoints were iatrogenic ulnar nerve injuries, complications, and radiographic and functional outcomes.ResultsOur results showed that iatrogenic ulnar nerve injuries occurred more commonly in the crossed pinning entry group than in the lateral pinning entry group (RR = 4.41, 95% CI 1.97–9.86, P < 0.05). However, its risk between the crossed pinning with mini-open incisions group and the lateral pinning entry group was not significantly different (RR = 1.58, 95% CI 0.008–29.57, P = 0.76). The loss of reduction risk was higher in the lateral pinning entry group than in the crossed pinning entry group (RR = 0.66; 95% CI 0.49–0.89, P < 0.05). There were no significant differences in the carry angle, Baumann angle, Flynn scores, infections, and other complications between these two groups.ConclusionsThe crossed pinning entry with mini-open incision technique reduced the loss of reduction risk, and the risk of iatrogenic ulnar nerve injury was lower than in the lateral pinning entry group. The crossed pinning entry with mini-open incision technique is an effective therapeutic strategy for managing displaced supracondylar humeral fractures in children.

Quality of Life and Clinical Evaluation of Calcaneoplasty with a Balloon System for Calcaneal Fracture at 5 Years of Follow-Up.

Calcaneal fractures are a challenging clinical problem. Management of this type of injury remains controversial, especially in the context of intra-articular fractures. Surgical treatment with open reduction and internal synthesis (ORIF) is considered the standard treatment for CF, but it is associated with many complications. Several minimally invasive techniques such as balloon-assisted reduction, pin fixation, and tricalcium phosphate augmentation have been proposed to avoid the frequent and recurrent postoperative problems related to these fractures. We retrospectively examined 20 patients (mean age was 54.5), all undergoing minimally invasive calcaneoplasty surgery at our Department of Orthopaedics and Traumatology between 2012 and 2016. X-ray and CT scan were performed preoperatively and at 5 years of follow-up (57.9 ± 6 months). The American Orthopaedic Foot and Ankle Society (AOFAS) score was used for clinical examination, and the Short-Form (36) Health Survey (SF-36) score and Visual Analogue Scale (VAS) were used to assess the Health-Related Quality of Life (HRQoL). All 20 patients were available at the final follow-up. The mean AOFAS score was 82.25/100. The VAS results attest an overall average of 2.7/10 (0–9). The average of the parameters “Physical Health” and “Mental Health” was, respectively, 81.25 and 83.55. In terms of postoperative complications, we observed no cases of superficial or deep infections. Clinical response after balloon-assisted reduction, pin fixation, and tricalcium phosphate augmentation has shown a comparable or better outcome according to the AOFAS and VAS score. Quality-of-life scores, obtained according to the SF-36 questionnaire, are considered high. From both a clinical and quality-of-life point of view, our study highlights that there is not gender distinction. Further comparative studies with a higher number of patients are needed which assess the quality of life in the various techniques used to treat calcaneal fractures.

Management of Distal Radius Fractures in Adolescent Patients.

While management recommendations for distal radius fractures in both young and skeletally mature patients have been generally well-established, controversy still exists regarding optimal management in adolescent patients approaching skeletal maturity. Thus, the goal of this review is to analyze relevant literature and provide expert recommendations regarding the management of distal radius fractures in this patient population. A PubMed search was performed to identify literature pertaining to distal radius fractures in adolescent patients, defined as 11 to 14 years in girls and 13 to 15 years in boys. Relevant articles were selected and summarized. Distal radius fractures demonstrate significant potential for remodeling of angular deformity and bayonet apposition, even in patients older than 12 years of age. Rotational forearm range of motion and functional outcomes are acceptable with up to 15 degrees of residual angulation. Closed reduction and percutaneous pinning reduces fracture redisplacement but has a high associated complication rate. There is no literature comparing plate versus pin fixation of distal radius fractures in the pediatric population, but in adults plate fixation is associated with higher cost with no improvement in long-term functional outcomes. Remodeling can still be expected to occur in adolescent patients, and even with residual deformity functional outcomes after distal radius fractures are excellent. Up to 15 degrees of residual angulation can be accepted before considering operative management. Smooth pins should be considered over plates as first-line operative management for unstable fractures that fail nonoperative treatment.

Intramedullary Steinmann pin nailing of the ulna: an option for the damage control orthopedics treatment of forearm fractures in open injuries in polytraumatized patients – A description of the technique and presentation of a case series

IntroductionForearm shaft fracture is common in young adult patients and associated with soft tissue and organ injuries. In open fractures in polytrauma patients, damage control orthopaedics (DCO) is well indicated. The aim of this study is to describe intramedullary Steinmann pin fixation of the ulna as a DCO procedure for the forearm and present a case series. Description of the techniqueA 3.0 mm Steinmann pin is inserted retrograde in the ulna proximal fragment through the fracture site using the open wound as the approach. With direct visualization of the reduction, the pin is advanced into the distal fragment. The reduction of the longitudinal axis and shortening is thus achieved. Patients and methodsThis method was used for all open fractures of forearm both-bone fractures in polytrauma patients undergoing DCO from 2014 to 2019. The alignment and length of the ulna were evaluated radiographically after pin fixation and before and after definitive fixation. Differences in the need for secondary procedures and infection rate between DCO and definitive fixation were also evaluated. ResultsThere were 30 males (85.7%) with an average age of 32.9 ± 12.0 years and a mean ISS (Injury Severity Score) of 29.4 (range, 18.0-41.0). The most common associated injuries were thoracic trauma (62.8%) and head trauma (45.7%). In the radius and ulna, 51.4% and 60.0% of fractures, respectively, were multifragmentary (types B and C). Gustilo type IIIA represented 77.1% of the injuries. Pin fixation achieved good alignment and length in all cases. The mean time between DCO and definitive fixation was 12.0 days, and no secondary procedure was needed, nor any case developed either superficial or deep infection. The conversion from DCO to definitive fixation was considered easy in all cases. ConclusionIntramedullary Steinmann pin fixation of the ulna is a viable option for DCO for forearm both-bone fractures in open fractures in polytrauma patients.