Internal Fixation Of Intra-articular Fractures Research Articles

The Impact of De-Roofing of Lateral Calcaneal wall in Open Reduction and Internal Fixation of Intra-Articular Fractures: Clinico-Radiological Outcomes of a Novel Technique and Review of Literature.

Most displaced intra-articular calcaneus fractures need to be treated surgically but postoperative soft tissue complications limit to achieve of optimal functional outcomes. Certain mini-invasive techniques lead to better soft tissue healing but anatomical reduction gets compromised. We aim to evaluate the results of lateral wall de-roofing of the calcaneum to achieve good anatomical reduction as well as to minimise soft tissue complications in the internal fixation of calcaneal fractures. Thirty-two patients (40 ft) with displaced intra-articular calcaneus fractures (10 were of Sanders type II, 16 were of type III, and 14 were of type IV) were treated between January 2018 and September 2021. All patients were managed surgically with open reduction and internal fixation using lateral extensile approach combined with de-roofing of the lateral wall. All patients were followed up for ≥1 year using functional parameters American Orthopaedic Foot and Ankle Score (AOFAS), visual analogue scale (VAS) and radiological parameters (Bohler angle, Gissane angle, height of the calcaneus, width of the calcaneus and pitch of calcaneus). Out of 32 patients, one patient lost to follow-up. At 1 year follow-up, mean AOFAS hindfoot score was 86.2 ± 5 (Sanders type II: 91.2, Sanders type III: 87.6, and Sanders type III: 81.4), mean VAS score was 91.3 ± 2.1, mean Bohler angle (°) was 27.2 ± 4.7, mean Gissane angle (°) was 136.4 ± 5.2, mean calcaneus height was 46.2 ± 2.1 mm and mean calcaneus width was 45.1 ± 3.2 mm. Patients with decreased Bohler angle between postoperative images and follow-up had lower AOFAS hindfoot scores. Complications included persistent swelling (64.10%), stiffness (33.33%), superficial infections (5.12%), and wound dehiscence (10.25%). Lateral wall de-roofing is a useful technique which allows the lateral wall to get flattened reducing soft tissue complications and providing bone graft as well. This approach also adequately exposes fracture fragments, subtalar and calcaneocuboid joints for good anatomical reduction. Hence, it can act as a useful adjunct in the internal fixation of intra-articular calcaneus fractures. III.

Functional Outcome Following Internal Fixation of Intraarticular Fractures of the Distal Humerus

Objectives: To evaluate the functional outcome following internal fixation of intraarticular fractures of the distalhumerus (AO Type C) with a minimum follow-up of twelve months.Materials and Methods: This prospective study was carried out at Orthopaedics department from December2018 to December 2022. A total of 170 consecutive patients with intraarticular fractures of the distal humerus wererecruited from Emergency and outpatient department and treated with open anatomical reduction and internalfixation with plating and lag screw. Functional evaluations of elbow joints were evaluated with Broberg andMorrey functional rating index. All patients were followed for twelve months.Results: All fractures united in average 3.2 months (range 7-19 weeks). The results were excellent in 66.47% patientsand good in 22.35% patients at final follow-up. Complications found in 22.35% patients who had insignificantdelayed unions which were united next 3 weeks, 7.05% insignificance malunion, 5.83% ulnar nerve neurapraxiaand 5.83% patients developed elbow stiffness.Conclusions: We conclude that internal fixation of intraarticular fractures of the distal humerus is an effectiveprocedure with an excellent or good functional outcome in majority of the patients. Patients have a high level ofsatisfaction and the majority returns to their previous level of activity.

Prospective Randomized Study Comparing the External Fixator and Volar Locking Plate in Intraarticular Distal Radius Fractures: Which Is Better?

IntroductionVarious treatment options for patients with an intraarticular distal radius fracture are available, but in cases of comminuted fractures, these narrow down to either a volar locking plate, an external fixator, or a combination of these two. We conducted this prospective study to compare the external fixation and internal fixation of intraarticular fractures of the distal radius in terms of clinical/functional outcome and complications and with the available literature.Material and methodThis prospective randomized study consisted of a total number of 30 patients with intraarticular fractures of the distal end of the radius divided randomly into two groups (A and B), treated by external fixation (Group A) and volar plating (Group B), in a tertiary care institute during the study period.ResultThe most patients were males >50 years of age, with injury to the right dominant hand most commonly caused by a fall on an outstretched hand. As per the modified Green & O’Brien scoring system, the volar plating group showed the final result as excellent in two (13.33%), good in seven (46.6%), fair in four (26.6%), and poor in two (13.3%) whereas an excellent outcome was seen in one (6.66%), good and fair in five patients each (33.3%), and poor in four (26.66%) patients at the six months follow-up.ConclusionOverall, both fixation techniques seem to apply sufficient stabilization to restore function and retain anatomy; however, volar locking plates have certain advantages over external fixator in the early postop period in terms of earlier recovery and mobilization.

Anatomical reduction and precise internal fixation of intra-articular fractures of the distal radius with virtual X-ray and 3D printing

To evaluate and precisely internal fix intra-articular distal radial fracture (IDRF) using the virtual X-ray and three-dimensional (3D) printing technologies. Twenty-one patients with IDRF were recruited, and the data from digital design group (DDG) and real surgery group (RSG) were collected and analyzed. In DDG, the data from thin-slice computed tomography scan, virtual X-ray measurement parameters, including volar tilt, palmar tilt, radius length (D1), ulnar variation (D2), locking plate position parameter (D3) and distance between key nail and joint surface (D4) were collected. The bone was virtually fixed with the locking plate, and the final model of radius with the screw was obtained by 3D printing. In RSG, the locking plate was precisely pre-bended and used in surgery. During the surgery, the key K-wire was accurately placed and the locking plate was adjusted with the aid of the U-shaped navigation arm. The C-arm was used to observe the positions of key K-wires and the locking plate, and the same above-mentioned parameters were measured intra- and post-operatively. The data from RSG and DDG were compared statistically by t test. This approach proved to be successful in all 21 patients, and none of the screws pierced through the wrist joint surface. All the measured parameters, including the volar tilt, palmar tilt, D1–4, in RSG were not significantly different from preoperative DDG data. Virtual X-ray measurement of anatomical reduction parameters and 3D printing can help the anatomical reduction and precise internal fixation by providing quantitative references, preoperatively, intraoperatively and postoperatively.

Arthroscopically-Assisted Reduction and Internal Fixation of Intra-Articular Fractures of the Lateral Tibial Plateau

Arthroscopically-Assisted Reduction and Internal Fixation of Intra-Articular Fractures of the Lateral Tibial Plateau

Incidence and risk factors for surgical site infection after open reduction and internal fixation of intra-articular fractures of distal femur: A multicentre study.

There remains a lack of data on the epidemiological characteristics of surgical site infection (SSI) following the open reduction and internal fixation (ORIF) of intra-articular fractures of distal femur, and the aim of this study was to solve this key clinical issue. The electronic medical records (EMRs) of patients who underwent ORIF for distal femoral fracture from January 2013 to December 2017 were reviewed to identify those who developed a SSI. Then, we conducted univariate Chi-square analyses and used a multivariate logistic regression analysis model to determine the adjusted risk factors associated with SSI. A total of 724 patients who underwent ORIF of intra-articular fractures of the distal femur were studied retrospectively, and 29 patients had postoperative SSIs. The overall incidence of SSIs was 4.0% (29/724), with deep SSIs being 1.5% (11/724), and superficial SSIs being 2.5% (18/724). Staphylococcus aureus was the most common causative pathogen (8, 42.1%), followed by mixed bacterial pathogens (5, 26.3%). Open fracture, obesity, smoking, and diabetes mellitus were identified as the adjusted risk factors associated with SSIs. Although modification of these risk factors may be difficult, patients and families should be counselled regarding their increased risk of SSI because these patients potentially benefit from focused perioperative medical optimisation.

Treatment of intraarticular calcaneal fractures by reconstruction plate. Results and complications of 86 fractures

ObjectiveTo evaluate the results of surgical treatment of intraarticular calcaneal fractures, and also to analyse the variables that influence the final clinical and radiological outcomes as well as the complications. Material and methodsWe retrospectively analysed 86 intraarticular calcaneal fractures in 78 patients, who underwent surgery with an extended lateral approach and reconstruction plate. The mean age was 48 years (16–74 years) and the mean follow-up was 4.6 years (9–99 months); 54 patients (69.2%) suffered falls from less than 3m in height or banal injuries and 24 patients (30.8%) falls from more than 3m in height or high energy-accidents. According to the Sanders classification we operated 12 (15%) type II, 54 (62.8%) type III and 20 (23.2%) type IV fractures. ResultsThe postoperative mean AOFAS score was 73.9 points, with good or excellent results in 57% of the patients. Twelve cases (14%) suffered surgical wound complications and 11 (12.8%) required subtalar arthrodesis. Significantly better results were obtained in the patients younger than 30 years old, patients that fell from less than 3m in height and patients with Sanders fractures types II and III compared to type IV, which were associated with higher rate of subtalar arthrodesis. ConclusionsWe consider that open reduction and internal fixation of intraarticular fractures of the calcaneus with reconstruction plate is a valid treatment alternative. Given the complications described and the secondary subtalar arthrodesis rate, we recommend a meticulous technique carried out by experienced surgeons.

Tratamiento de las fracturas intraarticulares de calcáneo mediante placa de reconstrucción. Resultados y complicaciones de 86 fracturas

ObjectiveTo evaluate the results of surgical treatment of intraarticular calcaneal fractures, and also to analyze the variables that influence the final clinical and radiological outcomes as well as the complications. Material and methodsWe retrospectively analyzed 86 intraarticular calcaneal fractures in 78 patients, who underwent surgery with an extended lateral approach and reconstruction plate. The mean age was 48 years (16-74 years) and the mean follow-up was 4.6 years (9-99 months); 54 patients (69.2%) suffered falls from less than 3m in height or banal injuries and 24 patients (30.8%) falls from more than 3m in height or high energy-accidents. According to the Sanders classification we operated 12 (15%) typeII, 54 (62.8%) typeIII and 20 (23.2%) typeIV fractures. ResultsThe postoperative mean AOFAS score was 73.9 points, with good or excellent results in 57% of the patients. Twelve cases (14%) suffered surgical wound complications and 11 (12.8%) required subtalar arthrodesis. Significantly better results were obtained in the patients younger than 30 years old, patients that fell from less than 3m in height and patients with Sanders fractures types II and III compared to typeIV, which were associated with higher rate of subtalar arthrodesis. ConclusionsWe consider that open reduction and internal fixation of intraarticular fractures of the calcaneus with reconstruction plate is a valid treatment alternative. Given the complications described and the secondary subtalar arthrodesis rate, we recommend a meticulous technique carried out by experienced surgeons.

Open Reduction and Internal Fixation of Displaced Calcaneum, Intra-Articular Fractures by Locking Calcaneal Plate.

Calcaneal fractures constitute the most common fractures in hindfoot. Lots of controversies exist in the management of calcaneal fractures but now-a-days, it is preferable to perform open reduction and internal fixation and early mobilizatation. To evaluate the functional outcome after open reduction and internal fixation of displaced intra-articular fractures of the calcaneum by locking calcaneal plate. The study was conducted in the Department of Orthopaedic Surgery from September 2013 to April 2016. Thirty intra-articular fractures of the calcaneum were treated by locking calcaneal plate. Patients were followed up for a period of 24 months. Bohler's angle was measured in preoperative, immediate Post-operative period and after 2 years, follow-up was compared. Results were evaluated according to American Orthopaedic Foot and Ankle Society (AOFAS) Score. After 24 months of follow-up, all 24 patients were available for evaluation. Radiological union was achieved in a mean time of 12.5 weeks. Mean duration of hospital stay was 21 days. Bohler's angle was significantly higher after 2 years of follow-up when compared with preoperative x-ray. According to the AOFAS, Ankle-Hind foot Scale outcome score results were excellent in 43.3% of the patients, good in 33.3%, fair in 10%, and poor in 13.3% of patients. The mean AOFAS score was 79.9 (Range 49-96). Open reduction and internal fixation of intra-articular fractures of the calcaneum with locking calcaneal plate gives good results. Maintenance of calcaneal height and Bohler's angle helps to decrease the incidence of subtalar arthritis.

Surgical management of intra-atricular fractures of the calcaneum

Objective: To study the results of internal fixation of intra-articular fractures of calcaneum, specifically Type II and TypeIII fractures, as classified by Sanders et al. Methods: Thirty patients with displaced intra-articular fractures of calcaneum were treated with open reduction and internal fixation from September 2004 to July 2008. We used CT classification as proposed by Sanders et al to classify these fractures. Surgery was performed using the standard extended lateral approach. Fractures were reduced and fixed with y-plate and screws without bone grafting. All patients were started on early motion and maintained on non weight bearing for 10 months. Average follow up was 18 months (8 to 30months). The Creighton – Nebraska Heath Foundation Assessment Scale for fractures of the calcaneum was used to evaluate the results. Results: There were 12 excellent, 12 good, 6 fair results. All TypeII fractures had excellent results. The average value of restoration of Bholer’s angle was 5.2 degree. No significant complications noted. Conclusion: We recommend TypeII and TypeIII fractures of calcaneum to be treated with open reduction and internal fixation. Minimal complications were associated with this procedure.

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BACKGROUND: Seventy five patients who sustained simple intra articular fractures of distal end of the radius treated by open reduction and internal fixation and closed reduction and k - wire fixation during 2years. To assess the functional outcome of the wrist joint in intra-articular fractures of distal end of radius AIMS: To assess the functional outcome of the wrist joint in intra- articular fractures of distal end of radius by opting surgical intervention. METHODS AND MATERIALS: A total of 75 cases of intraarticular fractures of distal end of the radius were operated on by open reduction and internal fixation, closed reduction and k - wire fixation, at KIMS hospital. Records of 75 cases were available for study. The mean age of the 54 males and 21 females was 35.4 years (range, 20-72 years) Special care was taken during surgery to achieve articular congruity. The injury was caused by fall in 32patients, RTA in 37 patients and fall from height in 6 patients. All cases were Gartland and Werely type III. All cases were operated on within 7days from the day of injury. RESULTS: All patients were assessed clinically and radiographically after a follow-up duration of 6 months. The radiological union was acceptable. Result were evaluated according to modified Green O'Brein Score were excellent in 55 cases (73.3%), good in 13 (17.4%), and fair in 7(9.3%). CONCLUSION: Open reduction and internal fixation of intraarticular fractures of distal end of the radius can restore articular congruity and result in good to excellent results.

Open Reduction and Internal Fixation of Intraarticular Fractures of the Humerus: Evaluation of 33 Cases

BackgroundStandard treatment of type C elbow fractures is open reduction and internal fixation using reconstruction plates and pins.ObjectivesThe aim of this study was to evaluate the functional outcome following internal fixation of intraarticular fractures of the distal humerus (AO Type C) with a minimum follow-up of three years. A retrospective evaluation was undertaken.Patients and MethodsThirty-three patients (28 males, 5 females; mean age 34.3years) type C elbow fractures were treated and observed over a period of three years. Six fractures were open and 27 closed; causes were falls (7 cases), traffic accidents (22 cases) and altercation (4 cases). All operations were performed using a posterior approach with an olecranon osteotomy. Mean duration of follow-up was 18 months (range 6–36). Mean duration of fracture healing was 2.3 months (range 2–4). Functional outcomes were assessed by Jupiter criteria.ResultsExcellent results were found in 69.7% (23 cases), very good reaults and good results were found in the remaining 30.3% (10 cases). Three of 33 patients 9% (3 cases) presented postoperative complications. No patient exhibited symptoms of ulnar nerve injury following surgery. One patient had cubitusvarus deformities and one case had heterotopic ossification. One patient had malunion and one case had deep infection.ConclusionsComplications were minimal and outcomes were satisfactory in patients with type C distal humerus fractures who underwent bilateral plate fixation via a posterior approach.

Arthroscopically Assisted Reduction and Internal Fixation of Intra-Articular Fractures of Tibial Plateau

Arthroscopically Assisted Reduction and Internal Fixation of Intra-Articular Fractures of Tibial Plateau

Functional Outcome After Open Reduction Internal Fixation of Intra-articular Fractures of the Distal Humerus in the Elderly

We conducted a study to evaluate the functional outcomes of elderly patients after open reduction internal fixation of intra-articular distal humerus fractures. Retrospective clinical and radiographic evaluation. A Level I trauma and tertiary referral center. We identified 23 eligible patients aged older than 65 years from the center's orthopaedic trauma registry between 1997 and 2005. Fourteen patients were available for follow-up. We had a mean follow-up of 51 months with a range of 20 to 99 months. All enrolled patients were acutely treated with open reduction internal fixation of their distal humerus. All enrolled patients were contacted and evaluated radiographically and with physical examination. Functional outcome was assessed with the Mayo Elbow Performance, Disabilities of Arm and Shoulder and Hand, and Musculoskeletal Functional Assessment functional questionnaires. All 14 fractures united. The mean Mayo Elbow Performance score was 83. The mean elbow flexion-extension arc was 20° to 120°. There was no significant loss of forearm pronation-supination (P > 0.05) or grip strength (32.6 versus 34.0 lbs, P > 0.05) compared with the contralateral arm. The mean Disabilities of Arm and Shoulder and Hand score was 37.6. Musculoskeletal Functional Assessment scores demonstrated disability with a mean total score of 33.4 (normative 9.3), hand score of 34.7 (normative 3.7), and self-care score of 31.8 (normative 1.7). One patient required reoperation for a disabling flexion contracture. Intra-articular distal humerus fractures are severely disabling injuries, particularly in the elderly population. Good results can be achieved with stable fixation and fracture union. Despite reasonable range of motion, patient-directed questionnaires revealed persistent pain and functional limitations.

Comparison of Surgical Outcomes of Intra-Articular Calcaneal Fractures by Age

Internal fixation is an accepted treatment for displaced fractures of the calcaneus. Operative intervention in older patients, however, is traditionally discouraged in the literature. The purpose of this study was to compare the outcomes of internal fixation of intra-articular fractures of the calcaneus on the basis of patient age. One hundred and seventy-five patients (191 fractures) who underwent internal fixation between 1992 and 2007 for a displaced, intra-articular calcaneal fracture were identified. The American Society of Anesthesiologists score, the fracture pattern, and the mechanism of injury were recorded. Each patient was contacted to complete a follow-up survey from which clinical outcome scores were calculated. One hundred and forty-six patients with 158 fractures were available for follow-up and were divided into two groups for comparison. Group I consisted of 108 fractures in patients who were less than fifty years old. Group II was composed of fractures in fifty patients who were fifty years of age or older. The mean duration of follow-up was 8.98 years. The average patient age was thirty-six years for Group I and fifty-eight years for Group II. The average adjusted American Orthopaedic Foot & Ankle Society score was 64 for Group I and 75 for Group II. The mean calcaneal fracture scoring system score was 66 for Group I, and 76 for Group II. Similarly, the average Foot Function Index was 24 and 15 for Groups I and II, respectively. Each clinical outcome measure suggests significantly better outcomes for Group II as compared with Group I (all p < 0.05). Overall, the complication rates were similar between groups. Conversion to subtalar fusion was 15% for Group I and 8% for Group II. In this series, outcomes of older patients are at least equivalent to those of younger patients undergoing internal fixation for an intra-articular calcaneal fracture. Operative intervention appears to be a reasonable option for displaced calcaneal fractures in older patients. Physiologic age should be considered when evaluating older patients, and individualized treatment plans remain critical because patients with low physical demands or who have medical complications may be better candidates for nonoperative treatment. Prospective studies are needed in this area.

Treatment of ipsilateral high energy tibial plateau and calcaneal fractures by a circular wire fixator: a case report

IntroductionHigh energy tibial plateau fractures along with calcaneal fractures individually produce several challenges for the orthopaedic surgeon. The principles of bony reconstruction include anatomic reduction and rigid internal fixation of intra-articular fractures and accurate restoration of the coronal, sagittal and transverse mechanical axes. Due to the tenuous nature of the soft tissue and devitalisation of the comminuted fragments with open reduction, external fixation of type 6 tibial plateau fractures is recommended. We report a case with ipsilateral high energy tibial plateau and calcaneal fractures both of which were managed with an ilizarov ring fixator.Case presentationA 55-year-old Kashmiri female presented to our department with an ipsilateral fracture of the tibial plateau and the calcaneum. Both were closed reduced and stabilized with an ilizarov ring fixator.ConclusionThe circular wire fixator provides a viable method to manage such fractures especially if they are co existent. This is especially true in situations where the soft tissue is compromised.

Volar Plating for Intra-Articular Fracture of the Base of the Proximal Phalanx

Comminuted fractures involving the articular surface of the base of the proximal phalanx are relatively rare and pose a challenging problem for hand surgeons because of the difficulty in achieving an accurate reduction and secure fixation of the articular surface. These fractures usually comprise a volar base fracture associated with a central depression of the articular surface. We describe a technique for open reduction and plate fixation of intra-articular fractures of the base of the proximal phalanx through a volar A1 pulley approach. Compared with the dorsal approach, this technique offers the advantages of direct visualization of the volar base fragment and the depressed central fragment, allowing for a more accurate reduction and rigid internal fixation using a volar buttress plate. In addition, there is no interference with extensor apparatus. Although our experience is limited to 4 patients, we have had a positive experience with this technique. The technique is useful for internal fixation of intra-articular fractures of the base of the proximal phalanx.

Outcome after open reduction and internal fixation of intraarticular fractures of the calcaneum without the use of bone grafts

Background: Intraarticular fractures of calcaneum are commenest type of calcaneal fractures. Lots of controversies exist about the ideal management for them. The focus is now shifting on operative management by open reduction and internal fixation for these fractures with or without the use of bone grafts. Method: Thirty intraarticular fractures classified by Essex Lopresti radiological classification, were treated by open reduction and fixation. The patients were followed over a mean period of 30 months (25-40 months). Results: All the fractures united at a mean duration of 14 weeks. 86% patients had excellent functional outcome with one patient having fair and one having poor functional outcome. Conclusion: Open reduction and internal fixation with plate is a good method for treatment of intraarticular fractures of calcaneum to achieve anatomical restoration of articular surface under vision, stable fixation, early mobilization and an option for primary subtalar arthrodesis if deemed necessary.

Intra-articular Fractures of the Hand

This study was designed to evaluate the results of open reduction and internal fixation of intra-articular fractures of the hand. Retrospective review. Patients were treated at 2 university hospital settings by 2 hand surgeons. Twenty-eight patients with displaced intra-articular fractures of the hand treated with mini-screw/plate fixation were identified from databases maintained by two hand surgeons. There were 23 men and 5 women, with an average age of 35 (range, 18-68) years. Titanium mini-plate and screw set was used in all cases. Total active motion of the digit scored according to the Belsky and Gingrass systems. Twenty-two patients (79%) had excellent or good results, and 6 patients (21%) had poor results. All 5 thumb fractures healed without complication and had excellent results. For the lesser digits, 9 had excellent, 8 had good, and 6 had poor clinical outcomes. Poor outcomes were identified in patients with comminuted (P = 0.01) or open (P < 0.001) fractures. Other complications included superficial infection and hardware prominence, both of which occurred in patients with distal phalanx dorsal lip fractures (P = 0.01). Open reduction and internal fixation of articular fractures of the joints of the hand seems to be an effective treatment method for these difficult fracture patterns. We identified excellent or good outcomes in 79% of our patient group. Patients with open or comminuted fractures were found to have poor results.

Modified obtuse-angled lateral exposure of the calcaneum

Objective: The objective of this study is to compare the incidence of post-operative skin healing problems between the classic extensile lateral calcaneal approach and a modified obtuse-angle lateral exposure during the period 1994–2003. Methods: The classic extensile lateral calcaneal approach as described in the literature was (used in 55 cases of calcaneal fractures), while the obtuse-angled approach (used in other 39 cases). The latter needs a short vertical limb with maximal posterior shift of its proximal end, in addition to an obtuse angle (about 120 degrees) between the vertical and horizontal limbs. Results: Sixteen percent of skins healing complications with variable degrees of severity were seen with the classic extensile lateral exposure, while none was ecountered with the modified obtuse-angled lateral exposure ( p 0.02). Conclusion: The obtuse-angle lateral exposure of the heel can reduce the incidence of post-operative skin problems during open reduction and internal fixation of intra-articular fractures of os-calcis fractures.