Head Fractures Research Articles

Effect of patient age on fifth metatarsal fracture pattern, management, and outcomes

Patients with 5th metatarsal (MT) fractures encompass a broad age distribution. This study evaluated the impact of age on the differences in clinical outcomes and management of these fractures. This was a retrospective cohort study of patients presenting to a single large, urban, academic hospital system with a 5th MT fracture over a 10-year period. Patients were stratified into groups of younger than 65 years old and equal to or greater than 65 years old. Initial and successive radiographs were reviewed, and fractures were categorized as Zone 1, Zone 2, Zone 3, Shaft, Neck, or Head fractures. 2,461 patients with 5th MT fractures were evaluated. Patients who did not follow up after initial evaluation in the emergency department or urgent care were excluded. Among 2,020 patients with mean follow-up of 1.03 years who met inclusion criteria, 76.2% were younger than 65 years and 23.8% were greater than or equal to 65 years. There was a significant difference in fracture type between groups as older patients were more likely to sustain metatarsal neck fractures but less likely to sustain Zone 1 base fractures (p < 0.05). There was no difference in time to clinical healing (p = 0.108) or time to radiographic union (p = 0.367) for all fractures between age groups. In conclusion, older patients sustain different 5th metatarsal fracture patterns compared to younger patients. However, despite the differences in age, there was no evidence for any difference in clinical and radiographic outcomes between groups.

Non-operative management of metacarpal II-IV fractures: A retrospective study from a tertiary hand unit

Metacarpal fractures produce significant hand disability, and non-operative management of these fractures can produce satisfactory functional outcomes with few complications. However, most studies assessing non-operative outcomes of metacarpal fractures revolves around metacarpals I and V, which possess different anatomy. Therefore, further investigation into outcomes after non-operative treatment of metacarpals II-IV is required to inform management decisions and allow modification of the rehabilitation protocols to specific fracture patterns. All records for 76 non-operative patients presenting with fractures of metacarpals II-IV to our tertiary centre in the year 2019 were retrospectively reviewed. Patients were treated with thermoplastic splinting or fibreglass casting with a rehabilitative exercise programme. Range of motion (ROM) of the Metacarpophalangeal (MCPJ), Proximal Interphalangeal (PIPJ), and Distal Interphalangeal joints (DIPJ), return to work time, and complications were assessed at 12 weeks post-treatment. Mean return to work time was 5.4 weeks, and patients did not report any serious adverse events; the main complication reported was tenderness on palpation (20%). The MCPJ exhibited the poorest ROM (9° flexion reduction relative to the healthy hand). Metacarpal II fractures were associated with significantly worse MCPJ flexion than metacarpal III (p=0.022) and metacarpal IV (p=0.049) fractures. Fractures of the metacarpal base were associated with superior MCPJ flexion (p=0.004) but longer return to work time (p=0.042) than head fractures. Spiral fractures were associated with shorter return to work time (p=0.043) and superior ROM results (p=0.041). In conclusion, outcomes of the non-operative treatment of metacarpal II-IV fractures are highly dependent on the location and pattern of the fracture, and this should be considered during clinical decision making.

Surgical fixation of distal ulna neck and head fractures.

Distal ulna plate fixation for ulnar neck and head fractures (excluding ulnar styloid fractures) aims to anatomically reduce the distal ulna fracture (DUF) by open reduction and internal fixation, while obtaining astable construct allowing functional rehabilitation without need for cast immobilization. Severe displacement, angulation or translation, as well as unstable or intra-articular fractures. Furthermore, multiple trauma or young patients in need of quick functional rehabilitation. Inability to surgically address concomitant ipsilateral extremity fractures, thus, limiting early active rehabilitation. Stable, nondisplaced fractures. Need for bridging plate or external fixator of distal radiocarpal joint. An ulnar approach, with astraight incision between the extensor and flexor carpi ulnaris. Preservation of the dorsal branch of the ulnar nerve. Reduction and plate fixation with avoidance of plate impingement in the articular zone. Postoperatively, an elastic bandage is applied for the first 24-48 h. In isolated DUF with stable fixation, apostoperative splint is often unnecessary and should be avoided. For the first fourweeks, only light weightbearing of everyday activities is allowed to protect the osteosynthesis. Thereafter, heavier weightbearing and activities are allowed and can be increased as tolerated. The best available evidence likely shows that for younger patients with aDUF, with or without concomitant distal radius fractures, open reduction and internal fixation can be safely achieved with good functional outcome and acceptable union and complication rates as long as proper technique is ensured.

Ceramic-on-Ceramic or Metal-on-Polyethylene: The Bearing of Choice after Ceramic Component Fracture in Total Hip Arthroplasty along with Concise Follow-Up of the Previous Cohort.

We previously reported the questionable result of reoperation using metal-on-polyethylene (MoP) bearing after the fracture of the ceramic component. After the report, we abandoned the use of MoP; instead, we used ceramic-on-ceramic (CoC) bearing. This report aimed to present the outcome of reoperation to CoC bearing after ceramic component failures along with the longer-term outcome of the previously reported cohort with an MoP bearing. The mean follow-up of the MoP cohort was extended from 4.3 years to 8.8 years. Metallosis had occurred in three of nine patients of the previous cohort, which all required re-reoperations. Two hips from 11 patients with revision to CoC had re-reoperations due to ceramic liner fracture and non-union of the osteotomized fragment, respectively. No metallosis and wear occurred in the cohort revised with CoC articulation. Otherwise, there were no adverse changes in radiographs and no impairment in functions. We conducted an extended prospective evaluation of a previous cohort consisting of six head fractures and three liner fractures. In this cohort, the patients underwent a bearing change to metal-on-polyethylene. Additionally, we retrospectively analyzed 11 cases of third-generation ceramic bearing fractures, comprising nine head fractures and two liner fractures. These cases were subsequently treated with a bearing change to fourth-generation CoC. We assessed clinical and radiological outcomes, including complication rates, in both groups. We recommend the latest CoC as the bearing of choice in reoperation after the fracture of ceramic components. In the case of an MoP bearing after the ceramic component fracture, the risk of metallosis seemed high in the early postoperative period.

Comparing Conservative Treatment of Distal Ulna Fractures with Operative treatment

Objective: To compare the outcome of conservative treatment of distal ulna fractures with operative treatment Study design: A randomized control trial Place and duration: This study was conducted at Muhammad Medical College and Hospital Mirpurkhas from September 2021 to September 2022 Methodology:Patients with different types of ulnar fractures (base fractures, head fractures, and subchondral fractures) were divided into two groups based on a systematic approach that established the course of treatment for forearm fractures. The fractures of the distal radius in Group A were treated with plating osteosynthesis, while the fractures of the distal ulna were taken care of with a surgical procedure involving the implantation of an LCP Distal Ulna Plate (De PuySynthes, USA) Results: A total of 120 patients were enrolled in the study, 8 of whom had to be excluded due to the development of carpal ligament damage symptoms. The 112 patients who remained were divided into three groups: 36 in group A, 42 in group B, and 34 in group C. The results of distal forearm fractures were initially treated with closed repositioning in local anesthesia and plaster fixation in 89 cases. In 10 cases, external fixation was primarily applied due to soft tissue conditions. The definitive surgical procedure was performed on average 10 days (3-19) from the injury. In group A, osteosynthesis of both bones was performed during one operation in 30 patients. In 7 cases, it was necessary to perform a two-phase procedure due to the state of the soft tissues. Conclusion: Based on the study's results, osteosynthesis is the more successful treatment for sub-capital fractures, as it results in better early outcomes than a conservative approach. However, due to the low number of patients with this type of fracture, it is impossible to make definitive treatment recommendations Keywords: distal ulnar fracture, osteosynthesis, conservative treatment

Management of Pipkin Type 3 Fracture-Dislocation in Young Adults: A Dilemma

Pipkin type 3 fracture-dislocation constitutes a rare subgroup of fractures involving the femoral neck and head fracture. The management is difficult and controversial, including osteosynthesis using Herbert or cancellous screws and hip replacement surgery. In this case report, a 26-year-old male suffered a road traffic accident leading to a hip fracture. Radiographs and computed tomography scan of the hip depicted three large fragments of the femur head, dislocated posteriorly along with the neck of femur fracture. Considering the needs of the patient, fracture morphology, and unpredictable results of the osteosynthesis, the patient was treated primarily with uncemented total hip replacement. The complexity of the fracture leads to more chances of malreduction and avascular necrosis of the femur head. The patient had an uneventful intra and postoperative period. At the 3-year follow-up, the patient was walking unaided, pain-free, and performing all the activities of daily living satisfactorily.

Complications after talus fractures: A trauma centre experience

BackgroundTalus fractures are anatomically complex, high-energy injuries that can be associated with poor outcomes and high complication rates. Complications include non-union, avascular necrosis (AVN) and post-traumatic osteoarthritis (OA). The aim of this study was to analyse the outcomes of these injuries in a large series. MethodsWe retrospectively collected data on 100 consecutive patients presenting to a single high volume major trauma centre with a talus fracture between March 2012 and March 2020. All patients were over the age of 18 with a minimum of 12 months follow up post injury. Retrospective review of case notes and imaging was conducted to collate demographic data and to classify fracture morphology. Whether patients were managed non-operatively or operatively was noted and where used, the type of operative fixation, outcomes and complications were recorded. ResultsThe mean age was 35 years (range: 18–76 years). Open injuries accounted for 22% of patients. An isolated talar body fracture was the most frequent fracture (47%), followed by neck fractures (20%). The overall non-union rate was 2% with both cases occurring in patients with open fractures. The AVN rate was 6%, with the highest prevalence in talar neck fractures. Overall rates of post-traumatic OA of the tibio-talar, sub-talar and talo-navicular joints were 12%, 8%, and 6%, respectively. These were higher after a joint dislocation, and higher in neck or head fractures. The postoperative infection rate was 6%. The overall secondary surgery rate was 9%. There were 2% of patients who subsequently underwent a joint arthrodesis. ConclusionOur study found that talar body fractures are more common than previously reported; however, talar neck fractures cause the highest rates of AVN and post-traumatic arthritis. Open fractures also carry a greater risk of complications. This information is useful during consenting and preoperatively when planning these cases to ensure adverse outcomes may be anticipated.

Monteggia fractures: analysis of patient-reported outcome measurements in correlation with ulnar fracture localization

BackgroundMonteggia fractures and Monteggia-like lesions result after severe trauma and have high complication rates. Preliminary biomechanical studies suggested a correlation between ulnar fracture localization and clinical result.ObjectivesKey objective was to evaluate whether the site of the ulnar fracture can be correlated to clinical outcome after open reduction and internal stabilization.MethodsIn a retrospective, monocentric study 35 patients who underwent surgical treatment after suffering a Monteggia injury or Monteggia-like lesion were included. Fractures were classified according to Bado and Jupiter, the site of the fracture location at the proximal ulna and regarding the potential accompanying ligamentary injury. In a follow-up examination validated patient-reported outcome measures and functional parameters were evaluated. Furthermore, treatment strategy and complications were analysed.ResultsMean patient age was 51.9 years (± 18.0). 69% were females (n = 24). Follow-up took place after 50.5 months (± 22.1). Fractures were classified according to Bado (I:2, II:27, III:4, IV:2). Bado II-fractures were further classified according to Jupiter (A:7, B:16, C:3, D:1). Cases were divided into subgroups depending upon the distance of the ulnar fracture site in respect to its distal endpoint (A: < 7 cm and B: > 7 cm). Average overall MEPS was 84.1 (± 19.0). Oxford elbow score and DASH were 37.2 (± 10.5) and 20.4 (± 20.5). Average extension capability reached − 7° (± 7.5). Mean flexion was 134.8° (± 19.7). Average pain according to visual analogue scale was 1.6 (± 1.9). We found no differences between the subgroups regarding the PROMs. Subgroup A displayed a worse extension capability (p = 0.027) and patients were significantly older (p < 0.01). Comparing patients with and without fracture of the radial head, we observed no differences. Patients with an accompanying injury of the coronoid process displayed higher pain levels (p = 0.011), a worse functionality (p = 0.027) and overall lower scoring in PROM.ConclusionThe presented results suggest that in Monteggia fractures and Monteggia-like lesions, the localization of the ulna fracture can give a hint for its postoperative outcome. However, we could not confirm the hypothesis of an increasing instability in ulnar fractures located further distally (high severity of the potential ligamentous injury). Intraarticular fractures or injuries with a close relation to the joint have a worse prognosis, especially if the coronoid process is injured.Trial registration Registration was done with ClinicalTrials.gov under NCT05325268.

GENERATION AND SIMULATION OF BIOMECHANICAL MODELS OF BONE-PROSTHESIS SETS IN REVERSE TOTAL SHOULDER ARTHROPLASTY SURGERIES

ABSTRACT: In last years, biomechanical investigations have led to a better understanding of the biomechanics of the glenohumeral joint, and this development, has allowed the development of a new prosthesis design named reverse shoulder prosthesis in which the hemisphere is placed in the glenoid cavity, favoring the function of the deltoid and helping in this way to reduce some post-surgery complications in patients with damage in their rotor cuff, fractures or degenerative problems. When this implant is placed to replace the shoulder joint, a loss in bone density can occur due to changes in the internal tensions generated by the bone-prosthesis system. In this context, a new methodology had been created to be able to generate a digital twin from computed tomography (CT) scan to use in a CAD-FEM environment with the mechanical properties of the bones and where a virtual surgery can be made and then simulate the performance of the implant. These models allow the simulation of different scenarios after the virtual surgery is performed. A case study of a patient with four fragment fracture of the humeral head has been developed with the new methodology. The results suggest that in certain fragments, the internal stresses vary in a significative way according with the force applied on the sutures. Keywords: 3D biomechanical models, Finite Element Simulation, Reverse shoulder prosthesis, Biomechanics, Digital Twin

A case of heterotopic ossification of the elbow joint

Patients who have undergone severe elbow trauma often develop various complications. Heterotopic ossification is considered to be the most severe complication, which leads to severe impairment of upper limb function due to the formation of severe contractures and ankylosis in the elbow joint. The paper presents the results of surgical treatment of the elbow joint in a patient with «immature» ossification against the background of aged dislocation of the forearm, non-unionized fracture of the radial head, and stage II osteoarthritis. Analysis of the outpatient follow-up of the patient after injury revealed gross diagnostic and treatment errors. As a result of medical errors, inadequate treatment of injuries in the early stages after injury was prescribed, which contributed to the formation of heterotopic ossification and resulted in functional failure of the joint. During surgery, the ossification located in the ulnar fossa was removed via a small posterior access to the elbow joint, the remaining tissues of the joint were not affected, thorough hemostasis was performed, and a Volkov-Oganesian joint-distraction device was applied to provide a physiological range of motion in the elbow joint. Postoperative long-term rehabilitation ensured restoration of the elbow joint function with the patient's return to professional activities.

Differentiated approach in the treatment of fractures of the distal humerus in children based on the use of bioabsorbable implants

In the practice of pediatric traumatologists there are a number of complex problems in the treatment of fractures of the distal humerus, which require a differentiated approach: atraumatic anatomical reposition with minimal damage to active growth zones, minimal damage to articular cartilage during surgery, stable fixation and early rehabilitation. At present, the generally accepted methods of osteosynthesis (fixation with K - wires, metal screws, etc.) do not fully meet the requirements of modern pediatric traumatology. One of the newest methods of fixation in the treatment of fractures of this localization, which have significant advantages is the use of bioabsorbable implants (BAI). Purpose - to present a differential approach to the treatment of distal fractures of the humerus in children based on the use of bioabsorbable implants. Materials and methods. During the period from 2015 to 2021, 15 children aged 5 to 17 were treated at the Chernihiv Regional Children’s Hospital. Distribution by type of pathology: epiphyseal fracture of the humeral condyle head - 5, osteoepiphyseolysis of the lateral humerus condyle - 2, fracture of the medial epicondyle of the humerus - 8 cases. Damage to nerve and vascular structures was never diagnosed in this group of patients. At the preoperative stage, radiography of the elbow joint in standard projections for such injuries was used to diagnose the above injuries. In the course of surgery, bioabsorbable cannulated screws and Bioretec pins were used to fix the repositioned fragments. Results. In the process of surgery, standard approaches and repositioning techniques were used, according to the anatomical features of each fracture. The differentiated approach was to use cannulated screws in the case of osteosynthesis of extra-articular fractures (osteoepiphyseolysis of the medial epicondyle of the humerus) in older children (12 to 17 years), which allowed to create dosed compression of fragments and bioabsorbable perfect anatomical reposition. In 1 case there was a combined osteosynthesis: fixation of the metaphyseal fragment with a K - wires and synthesis of the intra-articular epiphyseal fragment with a bioabsorbent pin. Advantages of BAI: minimal damage to articular cartilage, preservation of congruence and anatomical shape of the articular surface at the site of implant placement (Pin), stable fixation and interfragmentary compression (autocompression property), intraoperatively received full range of motion in the joint. All patients received full consolidation in time according to the age of the injured child. The range of motion and function of the limb is completely restored. The children did not need repeated surgery. Conclusions. 1. The advantages of using bioabsorbable implants in cases of treatment of fractures of the distal humerus in children are demonstrated. 2. The use of BAI allows to minimize damage to the growth zones and joint surface during osteosynthesis, provides stable fixation and interfragmentary compression, creates conditions for optimal fracture fusion and further rehabilitation. 3. Due to the properties of bioabsorption there is no need to remove the implant, ie re-trauma to the structures of the elbow joint of the growing organism, no need for re-hospitalization, anesthesia and surgery, re-rehabilitation, reduces the likelihood of psychological trauma in children. 4. As a result, all of the above improves the anatomical and functional results of treatment of these injuries, saves financial costs of both the medical institution and the state, and reduces the stress on family budgets. The research was carried out in accordance with the principles of the Helsinki declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Key words: children, bioabsorbable implants, fractures of the distal humerus, trauma in children, growth zones, osteosynthesis.

FREQUENCY OF INTRACRANIAL HEMATOMAS RELATED TO TRAUMATIC SKULL OR FACIAL INJURIES EVALUATED ON COMPUTED TOMOGRAPHY

Patients sustaining maxillofacial fractures are at risk of accompanying traumatic intracranial hematomas, which are a major cause of morbidity and mortality. Prompt recognition of the clinical signs, followed by a neurosurgical inspection and diagnosis, is crucial for improving patient survival and recovery. Objective: To determine frequency of intracranial hematoma related to traumatic skull and facial injuries evaluated on Computed Tomography. Methods: This study was conducted on 195 patients from radiological department of Lahore General hospital who had road traffic accident. In this Cross-sectional study conduction advance 16 multislice CT device which shows advanced desire 3D and was used to assess intracranial hematoma in patients with skull and facial fractures. All patients with intracranial hematomas related to skull and facial injuries in trauma center and all age groups without any gender specificity were included in this study. All patients having bleeding disorders or using anti-coagulant were excluded. Results: Out of 195 patients in which 48 (24.6%) were females and 147 (75.4%) were males. 132 (67.7%) patients out of 195 patients had headache, 64 (32.8%) patients had nausea, 116 (59.5%) patients had vomiting, 149 (76.4%) patients had speaking difficulty, 71 (36.4%) patients had External bleeding and 133 (68.2%) had consciousness. Total number of 195 patients out of which 179 (91.8%) had Intracranial hematoma. Conclusion: On the basis of the results it was concluded that head and facial injury had increase prevalence rate in people with road traffic accident but no significant difference was observed between head and facial fracture cases with ICH.

FREQUENCY OF INTRACRANIAL HEMATOMAS RELATED TO TRAUMATIC SKULL OR FACIAL INJURIES EVALUATED ON COMPUTED TOMOGRAPHY

Patients sustaining maxillofacial fractures are at risk of accompanying traumatic intracranial hematomas, which are a major cause of morbidity and mortality. Prompt recognition of the clinical signs, followed by a neurosurgical inspection and diagnosis, is crucial for improving patient survival and recovery. Objective: To determine frequency of intracranial hematoma related to traumatic skull and facial injuries evaluated on Computed Tomography. Methods: This study was conducted on 195 patients from radiological department of Lahore General hospital who had road traffic accident. In this Cross-sectional study conduction advance 16 multislice CT device which shows advanced desire 3D and was used to assess intracranial hematoma in patients with skull and facial fractures. All patients with intracranial hematomas related to skull and facial injuries in trauma center and all age groups without any gender specificity were included in this study. All patients having bleeding disorders or using anti-coagulant were excluded. Results: Out of 195 patients in which 48 (24.6%) were females and 147 (75.4%) were males. 132 (67.7%) patients out of 195 patients had headache, 64 (32.8%) patients had nausea, 116 (59.5%) patients had vomiting, 149 (76.4%) patients had speaking difficulty, 71 (36.4%) patients had External bleeding and 133 (68.2%) had consciousness. Total number of 195 patients out of which 179 (91.8%) had Intracranial hematoma. Conclusion: On the basis of the results it was concluded that head and facial injury had increase prevalence rate in people with road traffic accident but no significant difference was observed between head and facial fracture cases with ICH.

Comparison of Questionnaire Scales to Assess the Function of the Shoulder Joint in Patients after Unipolar Arthroplasty

Summary. Unipolar shoulder arthroplasty is the method of choice for multifragmental fractures of the humeral head, aseptic necrosis of the humeral head, and deforming arthrosis of the humeral joint grade 3-4 by Kellgren and Lawrence. There are many rating scales for monitoring the recovery of shoulder joint function after unipolar arthroplasty during the rehabilitation stages. Common and most popular are: UCLA (University of California, Los Angeles) Shoulder Rating; Constant-Murley Score; DASH (Disabilities of the Arm, Shoulder and Hand); ASES (American Shoulder and Elbow Surgeons) Score; Oxford Shoulder Score, Constant Shoulder Score, and others. Each of them has its advantages and disadvantages.&#x0D; Objective: to conduct a comparative analysis of modern assessment scales for assessing the function of the shoulder joint in patients after unipolar arthroplasty.&#x0D; Materials and Methods. Comparative analysis was performed in 50 patients after unipolar arthroplasty with the consequences of injuries of the shoulder joint of varying severity. Patients filled in the answers to the questions of four proposed rating scales before treatment and further in dynamics 6 and 12 months after the surgical intervention. The share of males in the cohort of respondents was 40.5%; females were 59.5%. Four most common scales in the world practice were chosen. The average age of male patients was 62±11.4 years; the average age of female patients was 66±10.1 years. The patients underwent unipolar prosthesis of the shoulder joint: 30 patients (60%) after traumatic injuries of the proximal epimetaphysis of the humerus, 9 patients (18%) after deforming osteoarthritis, and 11 patients (22%) after aseptic osteonecrosis.&#x0D; Results and Conclusions. We analyzed the results of treatment of 50 patients at different times after unipolar arthroplasty using four assessment systems (Oxford Shoulder Score, Constant Shoulder Score, ASES, and SPADI) of shoulder function. According to the results of the analysis, in our opinion, the Constant Shoulder Score was the most informative system, as it includes both subjective and objective parts and not only quantitative characteristics, but also qualitative criteria for evaluating the results of treatment. Other rating scales turned out to be less objective.

Läsionen der Trizepssehne

The triceps brachii muscle is the main extender of the elbow joint. Triceps tendon rupture or tearing presents arare injury pattern in general. Distal tendon ruptures occur most commonly in the area of the insertion of the olecranon. Fractures of the radial head are reported as the most common concomitant injury. In many cases, pre-existing degenerative damage predisposes for tendon injury. These include local steroid injections, anabolic steroid abuse, renal insufficiency requiring dialysis, hyperparathyroidism, lupus erythematosus and Marfan's syndrome. However, the most frequent trauma mechanism is adirect fall onto the extended forearm or ablow to the elbow. Beside clinical examination and sonography, magnetic resonance imaging is the diagnostic gold standard. The treatment of triceps tendon injuries includes conservative as well as operative approaches, whereby the indications for surgical treatment must be generously considered depending on the patient's age, functional demands of the patient, involvement of the dominant extremity as well as on the extent of the tendon rupture.

In Relation to Morbidity, Mortality, and Hospital Stay, Determine the Predictive Value of Injury Severity Scores in Road Traffic Accidents

Objective: The purpose of this study is to calculate the predictive value of injury severity score in relation to morbidity; mortality and hospital stay of patients following road traffic accidents. Study Design: Retrospective cohort study Place and Duration: Study was conducted at the department of General Surgery, Saidu Teaching hospital Swat, Jinnah Hospital Lahore and Bakhtawar Amin Memorial Trust Hospital Multan for duration six months from June 2020 to December 2020. Methods: Total eighty patients of both genders were presented in this study. Patients with ages 18-70 years had injury because of road traffic accidents were included. Informed written consent was taken from all the patients for detailed demographics included age, sex, body mass index and type of injury. Patients were admitted in emergency ward for initial treatment. Outcomes were calculated in terms of predictive value of injury severity score in relation to morbidity, mortality and hospital stay of patients. Abbreviated injury scale (AIS) score was used to analyze severity score. SPSS 20.0 version was used to analyze complete data. Results: Majority of the patients 55 (68.8%) were males and 25 (31.2%) were females. Mean age of the patients was 30.17±3.55 years with mean BMI 24.13±6.71 kg/m2. 45 (56.3%) patients were literate and 60 (75%) cases were from urban areas. Motorcycle was the most common cause of trauma found in 48 (60%) patients followed by car accidents in 18 (22.5%) and 14 (17.5%) trauma were because of cycle or other traffic. Legs and arms fractures were the most common injuries found in 32 (40%) and 25 (31.3%) followed by head fractures in 23 (28.8%) cases. Mean injury severity score was 54.07±3.64. Mean hospital stay was 3.12±4.37 days. Rate of mortality was high found in 19 (23.8%) cases. Conclusion: We concluded in this study that the injury severity score among traumatic patients were significantly high with rate of mortality and limb fractures were the most common injury found. Injury severity score is becoming more widely accepted as a predictor of mortality. Keywords: Road Traffic Accident, Injury Severity Score, Mortality, Limb Fracture

Fracture profiles of a 4-year cohort of 266,324 first incident upper extremity fractures from population health data in Ontario

BackgroundUnderstanding the profiles of different upper extremity fractures, particularly those presenting as a 1st incident can inform prevention and management strategies. The purpose of this population-level study was to describe first incident fractures of the upper extremity in terms of fracture characteristics and demographics.MethodsCases with a first adult upper extremity (UE) fracture from the years 2013 to 2017 were extracted from administrative data in Ontario. Fracture locations (ICD-10 codes) and associated characteristics (open/closed, associated hospitalization within 1-day, associated nerve, or tendon injury) were described by fracture type, age category and sex. Standardized mean differences of at least 10% (clinical significance) and statistical significance (p < 0.01) in ANOVA were used to identify group differences (age/sex).ResultsWe identified 266,324 first incident UE fractures occurring over 4 years. The most commonly affected regions were the hand (93 K), wrist/forearm(80 K), shoulder (48 K) or elbow (35 K). The highest number of specific fractures were: distal radius (DRF, 47.4 K), metacarpal (30.4 K), phalangeal (29.9 K), distal phalangeal (24.4 K), proximal humerus (PHF, 21.7 K), clavicle (15.1 K), radial head (13.9 K), and scaphoid fractures (13.2 K). The most prevalent multiple fractures included: multiple radius and ulna fractures (11.8 K), fractures occurring in multiple regions of the upper extremity (8.7 K), or multiple regions in the forearm (8.4 K). Tendon (0.6% overall; 8.2% in multiple finger fractures) or nerve injuries were rarely reported (0.3% overall, 1.5% in distal humerus). Fractures were reported as being open in 4.7% of cases, most commonly for distal phalanx (23%). A similar proportion of females (51.5%) and males were present in this fracture cohort, but there were highly variant age-sex profiles across fracture subtypes. Fractures most common in 18–40-year-old males included metacarpal and finger fractures. Fractures common in older females were: DRF, PHF and radial head, which exhibited a dramatic increase in the over-50 age group.ConclusionsUE fracture profiles vary widely by fracture type. Fracture specific prevention and management should consider fracture profiles that are highly variable according to age and sex.

Fractures of the proximal radius in children: management and results of 100 consecutive cases

IntroductionPediatric radial neck and head fractures are rare, accounting for only 1% of all fractures in children. The aim of this study is to describe the management and results of the respective fracture types and different injury characteristics.Materials and methodsThis study performs a retrospective data analysis of 100 consecutive patients with a fracture of the proximal radius treated in a single high-volume pediatric trauma center.ResultsOne hundred patients [mean age 7.5 years (1–15)] were documented with a fracture of the proximal radius between 3/2011 and 12/2019. The gender distribution was 62 girls and 38 boys. Twenty-seven patients had concomitant injuries. Conservative treatment was performed in 63 patients (Judet I = 27; II = 30; III = 6; Mason I = 2) using an above-the-elbow cast for 21 days (6–35). Surgical treatment was performed in 37 patients (Judet II = 3; III = 22; IV = 5; V = 7) using elastic stable intramedullary nailing (ESIN). Open reduction was necessary in five cases, and additional immobilization was performed in 32 cases. Six complications occurred: loss of implant stability (n = 2), healing in malalignment, pseudarthrosis, radioulnar synostosis, and a persisting hypoesthesia at the thumb. As a result, two ESIN osteosynthesis were revised, and one radial head resection was performed. Loss of movement was seen in 11% of cases, overall Mayo elbow performance index (MEPI) was 99.8 (90–100), and none of the patients experienced negative impacts on activities of daily life.ConclusionsProximal radial fractures occur predominately without dislocation. Good results are obtained with conservative treatment throughout. In cases with displacement exceeding growth-related correction, ESIN is the undisputed treatment of choice. Open surgery and long immobilization periods should be avoided whenever possible.

Fixation of Distal Ulna Fractures by Distal Ulnar Locked Hook Plate

Background: Distal ulna fractures are often found in conjunction with distal radius fractures, and the complexity of the interaction of the distal ulna with the radio-ulnar joint and triangular fibrocartilage complex makes understanding and treatment of distal ulna fractures challenging. Objective: To determine the efficacy and analyze the results of Locking Compression Distal Ulna Hook Plate (LC-DUP) in patients suffering from distal ulnar fracture (either isolated or associated with distal radius fractures). Patients and methods: This prospective clinical trial study included 18 patients. The age of the studied group ranged from 22 to 58 years; half of the group had age ranged from 30 to 40 years. They were suffering from distal ulna fractures and were treated by locked compression distal ulnar hook plates during the period from November 2019 to July 2020. Results: All patients eventually achieved full union. Only two of them had delayed union. The radiological and clinical assessment of fracture site and DRUJ was promising. More than three quarters of patients had excellent outcome, while the rest quarter; half of them had good, and the other half had satisfactory outcome according to the Modified MAYO Score, which had mean of 90.5 ± 14.6. While, the mean of the Quick DASH score was 9.8 ± 5.8. Conclusion: The good outcomes achieved in this study suggest that the use of the distal ulna hook plate could be an alternative treatment method for intra-articular ulna neck or head fractures, as well as basal oblique ulnar styloid fractures.

Capital femoral physeal dysplasia in cats submited to ostectomy of the femoral head and neck

ABSTRACT: This report described pathological fracture of the femoral head (physeal dysplasia) in four male cats (three mixed breed and one Bengal), with an average age of 16 months, treated by an ostectomy of the femoral head and neck. Three cats were neutered and one entire. All presented with mild intermittent lameness in the pelvic limbs. Displacement of the femoral epiphysis and resorption of the femoral neck were present and excision of the femoral head and remaining neck was performed in all cases. Hstological examination showed mild foci of compaction and trabecular fibrosis with deposition of fibrous connective tissue, permeated by granulation tissues, consistent with the original diagosis. Limb function improved in all patients from 2 to 4 weeks postoperatively. Diagnosis of physeal dysplasia is challenging and treatment is different from acute traumatic fractures. Femoral head and neck excision was considered a good alternative in these patients.