Majority Of Fractures Research Articles

Fracture patterns in bicycle accidents: A descriptive national cohort study of fractures sustained in bicycle accidents in the Swedish Fracture Register 2015–2022

IntroductionBicycle accidents account for the majority of traffic-related accidents in Sweden. Despite the widespread everyday use of bicycles, little is known about the fracture panorama resulting from bicycle accidents. This study analysed the fracture patterns of bicycle accidents in Sweden in regard to fracture type, sex, age, and type of bicycle. Material and methodsWe retrieved data from the Swedish Fracture Register on all fractures caused by bicycle accidents between 2015 and 2022. The study population was comprised of both children and adults who had sustained one or more fractures in a bicycle accident as registered in the Swedish Fracture Register. ResultsWe included 33,384 fractures (25,960 in adults and 7424 in children) in 30,815 patients, with a dominance of fractures in men. The mean age at fracture was 41.6 years (SD 23). The majority of fractures (62.7 %, n = 20,932) were sustained via a low energy mechanism. Overall, the most commonly fractured body parts were the forearm (35.2 %, n = 11,747), the hand (15.6 %, n = 5,196) and the clavicle (13.7 %, n = 4,558). In children, fractures of the forearm (56.8 %, n = 4,215) clearly dominated, followed by the hand (11.7 %, n = 868), and the humerus (11.0 %, n = 816). In adults, the top 3 fracture locations were the forearm (29.0 %, n = 7,532), the hand (16.7 %, n = 4,328), and the clavicle (15.7 %, n = 4,086). Mountain bikes and road bikes showed a fracture panorama that was very similar with a predominance of fractures to the clavicle. Fractures were more common during the warm season. ConclusionThe main finding is that bicyclists predominantly sustained fractures of the upper limb via low energy mechanisms. The fracture panorama differed by age, sex, and type of bicycle.

RISK OF PERIPROSTHETIC FRACTURE AFTER PRIMARY TOTAL HIP ARTHROPLASTY USING A COLLARED CEMENTLESS (CC) OR TAPER-SLIP CEMENTED STEM (PTS)

A: - determine the incidence of intraoperative periprosthetic femoral fracture (PFF)B: - determine the incidence of, and the reoperation rate for postoperative PFFWhen using either CC or PTS femoral components.Retrospective review of a consecutive series of 11,018 THAs over a ten-year period. All PFFs were identified using regional radiograph archiving and electronic care systems.Of the 11,018 THAs 4,952 were CC and 6,066 were PTS. Between groups, age, sex, and BMI did not differ.A: - 55 (0.5%) had an intraoperative PFF. 44 CC and 11 PTS (p<0.001). 3 patients in each group had a femoral shaft fracture, remaining fractures were either the calcar (20 CC and 2 group) or the greater trochanter (11 CC and 6 PTS).B: - 91(0.8%) sustained a postoperative PFF. Of those 15 were managed conservatively, 15 were revised and 61 (80.3%) had an ORIF. The CC group had both a lower overall rate of postoperative PFFs (0.7% (36/4,952) vs 0.9% (55/6,066); p = 0.341), and a lower rate of return to theatre (0.4% (22/4,952) vs 0.9% (54/6,066); p = 0.005). 1.3% of male PTS (36/2,674) had a reoperation compared to 0.3% of male CC (7/2,121) (p<0.001).With regard to stem fracture there were none in the Corail group and 5 in the Exeter group. Of these 2 were sub trunnion and 3 were basal neck.A: - There were significantly more intraoperative PFFs with CC 44 (0.8%) than PTS 11 (0.2%). However, the majority of fractures were either of the calcar or greater trochanter with no impact on early recovery or one year Oxford scores.B: - Male PTS were five times more likely to have a reoperation for postoperative PFF. Females had the same incidence of reoperation with either component type.There were 5 stem fractures in the Exeter group and none in the Corail.These results represent robust estimates, which are likely to be more accurate than revision only studies typically generated from registry data.

Mid- to long-term outcomes of proximal humerus fractures treated with open reduction, plate fixation, and iliac bone autograft augmentation.

Open reduction and internal fixation (ORIF) using locking plates is a widely adopted treatment for displaced proximal humerus fractures. Various augmentation techniques have been developed to enhance the stability of plate fixation. Among these, iliac bone autograft is notable for its advantages over allografts, such as ready availability and the elimination of costs and risks associated with disease transmission. Despite its potential benefits, data on the outcomes of iliac bone autograft augmentation (IBAA) are still limited. This study aims to present the mid- to long-term results of treating proximal humerus fractures with ORIF using locking plates and IBAA. The study included 15 patients treated with ORIF and IBAA. We classified fracture patterns using the Neer classification and estimated local bone density via the deltoid tuberosity index. We measured the neck shaft angle (NSA) and humeral head height (HHH) on both immediate postoperative and most recent X-ray images to assess the maintenance of reduction. Clinical outcomes were evaluated using the DASH (Disabilities of the Arm, Shoulder, and Hand) and Constant scores. The average follow-up duration was 59.56 months, ranging from 24 to 93 months. A majority of fractures were classified as four-part (53%). The average immediate and late postoperative NSAs were 132.6±8.19 and 131.6±7.32 degrees, respectively. The average HHH on the immediate postoperative and latest follow-up images were 16.46±6.07 and 15.10±5.34, respectively. None of the patients exhibited any radiological signs of avascular necrosis or loss of reduction at the latest follow-up. The mean postoperative Constant and DASH scores at the latest follow-up were 79.6 and 11.5, respectively. Our findings suggest that ORIF with IBAA is an effective method for managing three- or four-part proximal humerus fractures, yielding excellent outcomes.

An Outcome Analysis of Pediatric Diaphyseal Fractures Treated Surgically With the Titanium Elastic Nailing System.

Introduction Pediatric fractures account for one-fourthof all pediatric injuries. Stabilizing the fracture, regulating the length and alignment, encouraging bone healing, and minimizing morbidity and problems for the child and family are the objectives of treatment for diaphyseal fractures of long bones in children. Our goal is to investigate how pediatric diaphyseal long bone fractures are treated with a titanium elastic nailing system (TENS). Methods A prospective interventional study was conducted on 24 children who had displaced diaphyseal fractures of major long bones, involving 31 diaphyseal fractures of long bones. Utilizing Flynn's grading standards, the result was examined. Results The mean age was 12.20 years. The youngest child was seven years old and the eldest child was 16 years old. There were 20 boys (83.33%) and four girls (16.67%). The male-to-female ratio was noted to be 5:1. The commonest mode of injury was road traffic accidents (12 cases, 50%), followed by falls while playing (10 cases, 41.67%). Other causes included falls from height (one case, 4.17%)and blunt trauma (one case, 4.17%). The commonest bone to get fractured was the femur (37.50%), followed by both bones of the forearm (29.17%), tibia (20.83%), humerus (8.33%), and ulna alone (4.17%). The middle third (21 fractures, 67.74%) was the most prevalent location for fractures. Five fractures each (16.13%) accounted for in the proximal and distal thirds. Twelve fractures (38.71%) were detected on the left side, while the majority of fractures (19 fractures, 61.29%) were seen on the right side. Most of the fractures in this group were transverse fractures (18 fractures, 58.06%) followed by oblique fractures (eightfractures, 25.81%). Comminuted fractures accounted for five fractures (16.13%). Of the 31 fractures, open reduction had to be done in two fractures, after unsuccessful attempts at closed reduction. Closed reduction was done in 29 fractures. There were 15.12 weeks in the average union term. The range is six weeks to 39 weeks. The most frequent side effect was discovered to be skin irritation at the entry site. The extraosseous portion of nails caused irritation at two entry sites (6.45%). A case had delayed union (3.23%) and restricted knee range of movements. Conclusion For the treatment of juvenile diaphyseal fractures of the long bones, the TENSis the best option. It is a quick, straightforward, safe, dependable, and efficient way to treat pediatric long-bone fractures in patients aged five to 16 years. The healing process takes a fair amount of time, while the surgery takes less time. It does away with the necessity for extended bed rest and significantly shortens hospital stays. It provides stability and elastic mobility, which is perfect for early mobilization and quick union at the fracture site. It has a low rate of complications and produces excellent functional results.

The Heel Complex: Anatomy, Imaging, Pathologic Conditions, and Treatment.

The differential diagnosis for heel pain is broad but primarily involves abnormalities of the Achilles tendon, calcaneus, and plantar fascia. Achilles tendon disorders include tendinosis, tendinitis, and partial or complete tears. Tendinosis refers to tendon degeneration, while tendinitis is inflammation after acute overload. Untreated tendinosis can progress to partial or complete tears. Tendon disorders can be accompanied by paratenonitis or inflammation of the loose sheath enclosing the tendon. Initial management involves rehabilitation and image-guided procedures. Operative management is reserved for tendon tears and includes direct repair, tendon transfer, and graft reconstruction. The calcaneus is the most commonly fractured tarsal bone. The majority of fractures are intra-articular; extra-articular fractures, stress or insufficiency fractures, medial process avulsion, and neuropathic avulsion can also occur. Posterosuperior calcaneal exostosis or Haglund deformity, retrocalcaneal bursitis, and insertional Achilles tendinosis form the characteristic triad of Haglund syndrome. It is initially managed with orthotics and physiotherapy. Operative management aims to correct osseous or soft-tissue derangements. The plantar fascia is a strong fibrous tissue that invests the sole of the foot and contributes to midfoot stability. Inflammation or plantar fasciitis is the most common cause of heel pain and can be related to overuse or mechanical causes. Acute rupture is less common but can occur in preexisting plantar fasciitis. Conservative treatment includes footwear modification, calf stretches, and percutaneous procedures. The main operative treatment is plantar fasciotomy. Plantar fibromatosis is a benign fibroblastic proliferation within the fascia that can be locally aggressive and is prone to recurrence. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.

Epidemiology of Stress Fracture in Police Trainees.

Military recruits and athletes have high occurrence of stress fractures, with very high incidence among military recruits. Symptomatic stress fractures can be disabling in some people. This study aims at identifying pattern and distribution of such fractures in Nepal Police trainee and assess the risk factors and demographics that may help to develop the local guidelines. This study analysed 65 police trainees who presented to the orthopaedic Out Patient Department at Nepal Police and Province Police Hospital diagnosed as a case of stress fracture from 29 December, 2020 to 29 December, 2021. Ethical approval was obtained and different variables analysed were age, sex, Body Mass Index, location of fracture, duration of pain, method of treatment, time to heal the fracture and time to pain free mobilisation of patient. There were 65 trainees with 86 sites of fracture at different bones with 50.8% (33) of male population. The majority of fracture was located at tibia (58.1%) followed by pubic rami (33.7%) with potentially debilitating fracture neck of femur seen in 4.6% subjects. Mean duration of pain was 20.7±14.2 days with mean time for pain free mobilisation 42.2±17.7 days after presentation. 96.5% of those recovered with conservative treatment (activity restriction or cast). The location of stress fracture depends upon the type of training or activities. Modification of activities in early phase of training with early visit for medical care in case of trainees with increasing pain may decrease morbidities and complications requiring operative treatment.

Changing practice to a new-generation triple-taper collared femoral component reduces periprosthetic fracture rates after primary total hip arthroplasty.

Periprosthetic femoral fracture (PPF) is a major complication following total hip arthroplasty (THA). Uncemented femoral components are widely preferred in primary THA, but are associated with higher PPF risk than cemented components. Collared components have reduced PPF rates following uncemented primary THA compared to collarless components, while maintaining similar prosthetic designs. The purpose of this study was to analyze PPF rate between collarless and collared component designs in a consecutive cohort of posterior approach THAs performed by two high-volume surgeons. This retrospective series included 1,888 uncemented primary THAs using the posterior approach performed by two surgeons (PKS, JMV) from January 2016 to December 2022. Both surgeons switched from collarless to collared components in mid-2020, which was the only change in surgical practice. Data related to component design, PPF rate, and requirement for revision surgery were collected. A total of 1,123 patients (59.5%) received a collarless femoral component and 765 (40.5%) received a collared component. PPFs were identified using medical records and radiological imaging. Fracture rates between collared and collarless components were analyzed. Power analysis confirmed 80% power of the sample to detect a significant difference in PPF rates, and a Fisher's exact test was performed to determine an association between collared and collarless component use on PPF rates. Overall, 17 PPFs occurred (0.9%). There were 16 fractures out of 1,123 collarless femoral components (1.42%) and one fracture out of 765 collared components (0.13%; p = 0.002). The majority of fractures (n = 14; 82.4%) occurred within 90 days of primary THA. There were ten reoperations for PPF with collarless components (0.89%) and one reoperation with a collared component (0.13%; p = 0.034). Collared femoral components were associated with significant decreases in PPF rate and reoperation rate for PPF compared to collarless components in uncemented primary THA. Future studies should investigate whether new-generation collared components reduce PPF rates with longer-term follow-up.

Feline radial and ulnar diaphyseal fractures: a retrospective study of 49 cases comparing single bone fixation and dual bone fixation.

The objectives of this study were to report the complications in radial and ulnar diaphyseal fractures in cats and to compare the differences in outcome between single and dual bone internal fixation. Medical records between 2004 and 2022 were searched retrospectively for cats with antebrachial diaphyseal fractures treated with internal bone-plate fixation. In total, 49 cases were included from six referral hospitals, including one teaching hospital. Patient information was collated, including fracture configuration, location, repair method and clinical outcome as assessed by veterinary physical examination, radiography and owner questionnaire. A total of 47 cats (mean age 4.2 years) were included. Fractures were located distally (24/49, 49%), proximally (13/49, 26.5%) and mid-diaphyseally (12/49, 24.5%). Dual bone fixation was used in 13/49 (26.5%) cases, with only 1/13 (7.7%) having major complications. By comparison, 4/36 (11.1%) of single plated fractures had major complications. Single bone fixation was 14.25 times more likely (95% confidence interval [CI] 2.07-97.99) to have a successful outcome (veterinarian-assigned score of 0) compared with dual bone fixation (P = 0.007). When evaluating owner-assessed outcomes, single bone fixation was 9.4 times more likely (95% CI 1.4-61.96) to have a successful outcome (owner score of 0) compared with dual bone fixation (P = 0.019). Fractures that were repaired with single bone fixation had a greater chance of a better outcome. Although the difference was not significant, there was a higher major complication rate and a lower minor complication rate for cases treated with single bone fixation compared with dual bone fixation. The majority of fractures were located in the distal diaphysis. Comminution of the fracture and concurrent orthopaedic issues did not significantly affect the outcome. Further prospective studies with standardised follow-up, radiographic assessment, surgeon and implants are required to truly assess the difference between dual and single bone fixation.

Epidemiological Characteristics of Pediatric Supracondylar of Humerus Fractures in a Tertiary Hospital in Iran.

Supracondylar humerus fracture (SHF) is the most common fracture observed in children. The present study aimed to assess the characteristic parameters in one of the most extensive available pediatric SHF series referred to a tertiary hospital in Iran. The medical profiles of the SHF patients who were referred to our tertiary hospital between January 2017 and January 2022 were retrospectively reviewed. The inclusion criteria entailed age < 14 years and a radiographically confirmed diagnosis of SHF. The collected data included age, gender, side of injury, mechanism of injury, season of the injury, concurrent complications, type of fracture, and treatment. A total of 1,309 patients with a mean age of 7.7±2.7 years were included in this study. The incidence of SHF was 1.8-fold higher in males, while the mean age of incidence was significantly lower in female patients (7.2 vs. 8 years; P<0.001). Falling was the most frequent mechanism of injury (97%). Gartland type I was the most prevalent type of injury (n=482; 36.8%). Moreover, the majority of fractures were extension-type (n=1,249; 95.4%). Most patients were managed conservatively (n=785; 60%). Concurrent fractures as well as neuralgic, vascular, and muscular complications were present in 3%, 1.45%, 1.22%, and 0.5% of patients, respectively. As evidenced by the results of this study, SHF is prevalent among the Iranian pediatric population. Therefore, greater awareness is required regarding the high incidence of this fracture in this population and its adequate management with respect to concurrent complications, particularly neurovascular compromise.

Risk Factors for Penile Fracture After Intralesional Collagenase Clostridium histolyticum in Peyronie’s Disease

ObjectivesTo evaluate risk factors leading to corporal rupture after Collagenase Clostridium histolyticum (CCh). Peyronie's disease (PD) is a fibrotic condition of the penis characterized by abnormal plaque formation. Intralesional CCh is the only FDA approved medication for PD, however it can lead to corporal rupture, a potential surgical emergency. MethodsWe retrospectively reviewed medical records from Veterans diagnosed with PD who were under treatment with CCh using the Veterans Administration Informatics and Computing Infrastructure (VINCI). Using International Classification of Diseases and Current Procedural Terminology codes, we identified men who suffered a corporal rupture after CCh. Individual charts were reviewed to determine potential risk factors and events leading to corporal rupture. ResultsWe identified 17,647 veterans who were diagnosed with PD, of which 8.7% (1,541) received at least one injection of CCh for PD. Of them, 0.7% (11/1,541) veterans suffered corporal rupture. Within these 11 patients, the median number of CCH injections was 6 with a median initial curvature of 35º. Fracture occurred at a median of 8 days after CCH injection. The majority of fractures were secondary to spontaneous erections or sexual intercourse. Finally, six patients had their fracture repaired surgically while the remaining were managed conservatively. ConclusionsMost fractures occurred within 2 weeks of CCh injections and were associated with sexual intercourse and spontaneous morning erections.

Retrospective Analysis of Pelvic Limb Fracture Management in Companion Psittacine Birds (60 Cases).

Pelvic limb fractures carry significant morbidity in avian patients, and although management options are well researched, published data on long-term complication rates and mortality outcomes are limited. Here, we present a cross-sectional study evaluating pelvic limb long bone fractures in companion psittacine birds presenting to an exotic-only veterinary hospital in the United Kingdom between 2005 and 2020, focusing on fixation techniques and long-term outcomes. Of the 60 cases that met the inclusion criteria, 22 separate species were represented, with an age range of 8 weeks to 25 years and an even distribution of sexes, among those that had been sexed. The majority of fractures (71.7%) were tibiotarsal; femoral (15%) and tarsometatarsal (13.3%) bones represented the other fracture sites. Several different fracture management methods were used, including external coaptation, surgery, or cage rest. Average time from fracture identification to healing was 33 days, with a median of 31 days and a range of 11-121 days. Satisfactory resolution of fracture repair was achieved in 85.5% (47/55) of cases that were able to be followed to conclusion. Complications were identified in 41.7% (25/60) of fractures of all pelvic long bones. Complications during fracture management were more common in cases treated with external coaptation. The most common complication reported was patient interference with bandages, splints, or both. This study provides an overview of pelvic limb long bone fracture management outcomes, which should prove useful for avian practitioners in clinical practice.

Natural fracture patterns at Swift Reservoir anticline, NW Montana: the influence of structural position and lithology from multiple observation scales

Abstract. Subsurface datasets typically lack the resolution or coverage to adequately sample fracture networks in 3D, and fracture properties are typically extrapolated from available data (e.g. seismic data or wellbore image logs). Here we assess the applicability of extrapolating fracture properties (orientation, length, and intensity) across observation scales in deformed, mechanically layered carbonate rocks. Data derived from high-resolution field images, medium-resolution digital outcrop data, and relatively low-resolution satellite imagery at Swift Reservoir anticline, NW Montana are leveraged to (i) assess interacting structural and stratigraphic controls on fracture development, and (ii) compare estimated fracture properties derived from multiple observation scales. We show that hinge-parallel and hinge-perpendicular fractures (i) make up the majority of fractures at the site; (ii) are consistently oriented with respect to the fold hinge, despite along-strike variability in the fold hinge orientation; and (iii) exhibit systematic increases in intensity towards the anticline hinge. These fractures are interpreted as having formed during folding. Other fractures recorded at the site exhibit inconsistent orientations, show no systematic trends in fracture intensity, and are interpreted as being unrelated to fold formation. Fracture orientation data exhibit the greatest agreement across observation scales at hinge and forelimb positions, where hinge-parallel and hinge-perpendicular fracture sets are well developed, and little agreement on the anticline backlimb, where fracture orientations are less predictable and more dispersed. This indicates that the scaling of fracture properties at Swift Reservoir anticline is spatially variable and partly dependent on structural position. Our results suggest that accurate prediction and extrapolation of natural fracture properties in contractional settings requires the assessment of structural position, lithologic variability, and spatially variable fracture scaling relationships, as well as consideration of the deformation history before and after folding.

Age- and dose-dependent effect of statin use on the risk of osteoporotic fracture in older adults.

Previous studies have revealed the protective effects of statins on bone but the association of statins use with osteoporotic fractures has shown controversial results. In this study with Korean National Health Insurance Service-Senior cohort database, a total of 365,656 elderly without previous history of osteoporosis and who were started on statin since January 1 2004 were included and observed until December 31 2012. Hazard rations (HR) for major osteoporotic fractures were calculated using the weighted Cox proportional hazards model with inverse-probability of treatment weighting method. During 6.27years of follow-up period, 54,959 osteoporotic fractures occurred and the majority of fractures (69.5%) were vertebral fractures. Compared with non-users, statin use was associated with a decreased risk of all outcomes with adjusted HR (95% CI) of 0.77 (0.72-0.83; P < 0.001) for major osteoporotic fractures, 0.49 (0.38-0.62; P < 0.001) for hip fractures, and 0.70 (0.64-0.77; P < 0.001) for vertebral fractures. When outcomes were examined separately by sex, the results were broadly comparable in terms of patterns of risk reduction by statin use. The patients with statin initiated at age≥ 80years had the highest risk reduction for most outcomes relative to non-users. Higher cumulative dose of statin was negatively associated with the osteoporotic fracture risk; 0.97 (0.91-1.02) for 30-364 cumulative daily defined dose (cDDD), 0.45 (0.40-0.51) for 365-1,094 cDDD, and 0.22 (0.15-0.33) for ≥ 1,095 cDDD. Our results showed that statin use was associated with significant reduction in the risk of osteoporotic fractures in general older population.

Combined approach versus single Henry approach for fixation of die-punch distal radius fractures: a retrospective study

BackgroundDistal radius fracture (DRF) is one of the most common orthopaedic-related traumas. DRF patients with die-punch fractures have a higher risk of loss of reduction, poorer functional outcomes, and increased risk of complications even after open reduction and internal fixation (ORIF). According to the three-column theory, the lunate fossa is an important part of the intermediate column for load bearing. When the distal radius fracture involves the lunate fossa, adequate anatomical reduction can have an important impact on the prognosis of wrist function. Herein, we used the combined volar and dorsal approach, and the dorsal approach was used to assist in bone grafting or dorsal plate fixation in reducing fractures. We compare the combined approach versus the Henry approach for the fixation of die-punch distal radius fractures.MethodsWe reviewed patients who were admitted for surgery for die-punch fractures from January 2016 to June 2021. The patients were followed-up after surgery to measure and evaluate their Gartland–Werley wrist score, wrist range of motion (ROM), and follow-up imaging data.ResultsThere were 21 patients in the volar locking plate (VLP) group and 10 patients in the combined approach group. The majority of fractures in the VLP and combined approach groups were AO B and C fractures, respectively. The cause of injury and AO fracture classification showed significant differences between the two groups, and there was no difference in age or sex between the two groups. There was no significant difference in ROM between the two groups, but the VLP group presented a better Gartland–Werley score and volar tilt angle, and the combined group presented better maintenance in radial height and articular congruity.ConclusionsReduction through the combined palmar and dorsal approach supplemented by bone grafting or dorsal plate fixation is an effective method for the treatment of die-punch distal radius fractures, which provides a new option for the treatment of die-punch fractures.

Fatigue fracture characterization of chemically post-processed electron beam powder bed fusion Ti–6Al–4V

The fatigue behavior of additively manufactured (AM) structural parts is sensitive to the surface and near-surface material conditions. Chemical post-processing surface treatments can be used to improve the surface condition of AM components, including complex geometries with surfaces difficult to access. In this work, surfaces of electron beam powder bed fusion (EB-PBF) produced Ti–6Al–4V were subject to two different chemical post-processing surface treatments, chemical milling and Hirtisation. As-built and machined surfaces, as well as hot isostatic pressing (HIP), treated conditions were also investigated. Fatigue testing was carried out in four-point bending. The investigation focused on the relationship between fracture mechanisms and fatigue life through fractographic study. It was found that a majority of fractures were initiated at internal surface-near defects or defects on the surface. Chemical post-processing was found to smoothen the surface but to leave a surface waviness. Material removal during post-processing could open up internal defects to the treated surface. In HIP-treated specimens, fractures initiated at defects open to the surface. Despite post-processing increasing the mean life of fatigue specimens, no significant improvements in the lowest tested life were observed for any specimen condition.

Tibia Fractures in Children: A Single-Centre 11-Year Retrospective Study for Evaluating the Management and Outcomes in an Acute General Orthopaedic Hospital.

Introduction Tibia fractures are children's most typical lower limb fractures affecting their general and mental well-being. This study aims to evaluate the management and outcomes of displaced tibia fractures. Methods A retrospective study was conducted to review children up to 16 years of age with displaced tibia shaft fractures who received treatment in our department from January 2011 to December 2021. Fractures managed in the operating theatre and patients who completed follow-up until fracture healing were included in the study. Treatment procedures were assessed, and outcome was measured by hospital stays, complications and revision procedure incidences. Results The study included 74 patients (75 fractures, including one re-fracture). The patient's ages ranged from 2 to 16 years (median age: 11 years). Seven patients sustained open fractures (Gustilo I, II). Tibia diaphysis was the most common site of involvement. A total of 43 patients were treated by manipulation under anaesthesia and cast. Surgical fixation was directly proportional to increasing age (p<0.05). Overall, 74% of patients were treated by fixation when age was >10 years. Three patients needed conversion of casting to surgical fixation. One patient had re-fracture following a secondary injury after six months of initial tibia shaft fracture treated by casting. Five patients had complications, including delayed union, pin site and surgical site infections. Antibiotics were adequate to manage infections except in one patient who needed debridement. The average hospital stay was three days. The median number of follow-up X-rays was 4. The planned removal of all flexible nails, and the circular frame was done between 2 and 15 months, except for one that had delayed union. All the patients underwent clinical and radiological union at the end of the follow-up. Conclusion The treatment plan was dependent on the individual need of the patient and the fracture pattern. Children older than 10 years were more likely to undergo surgical fixation. The majority of fractures were treated by manipulation and cast in operating theatres. Better logistic support in the emergency department could reduce the burden on the operating theatre.

Results of surgical treatment of the mandible body fractures with own designedexternal fixator in two horses

Mandibular fractures are the most common among all skull fractures. Most of them are the result of blunt trauma resulting from hitting an obstacle, kicking by another horse, or falling after a jump. The majority of fractures are open and infected. Some of them are complicated, involving the molar or premolar teeth. Treatment of such fractures is challenging because results depend on stable bony union and functional integrity of the occlusal surface. Osteosyntheses were performed under general anesthesia. Complications included infection around one implant close to the fracture line and fistulation in case 2 created by a fractured tooth which had to be extracted. In spite of the mentioned problems, good results were achieved in both cases. Stabilization of unilateral mandibular fractures with our own design fixator which is minimally invasive and provides sufficient fixation to obtain good results. The use of the fixator has proved to be beneficial and has a number of advantages in the treatment of this kind of fracture.

The Pattern of Midface Fractures in Jordan: A Retrospective Review of Medical Records.

Midface fracture incidence and trauma patterns vary across countries, due to socioeconomic, environmental, and cultural factors. The aim of this retrospective study was to assess the etiology, pattern, and treatment of midface fractures in North of Jordan during 2018-2021. This single-center retrospective study was based on the review of the medical records of patients who had suffered midface fractures and were treated at the Department of Oral and Maxillofacial Surgery at the King Abdullah University Hospital. The dataset for this investigation spanned the 4-year period from January 2018 to December 2021. During the 4-year period, 267 patients presented with 376 different maxillofacial fractures. Of those, 140 patients had 250 midface fractures, with a mean of 1.79 per patient. Their age ranged from 2 to 68 years (mean [standard deviation] = 25.8 [12.0] years). The most frequent injury cause was road traffic accidents (RTA) (n = 72, 51.3%), followed by falls (n = 27, 19.3%). Among midface fractures, the most frequent were orbit fractures (42.4%), followed by zygomatic fractures (31.6%) and maxillary fractures (26%). The majority of fractures (77.9%) were treated through open reduction and internal fixation (ORIF), while the remaining (15.7%) required closed reduction and conservative treatment was sufficient in 6.43% of fractures. Midface fractures were more common among males, and primarily occurred in the orbital floor due to the high incidence of RTAs. Maxillary fractures were mostly of the LeFort I Type and ORIF was the most common treatment modality.

Perioperative Morbidities in Distal Radius Fractures Treated Using Locking Plates in the Super-Elderly Population: A Retrospective Study

Currently, there is no consensus on the treatment of distal radius fractures in the super-elderly population. The aim of this study was to evaluate the perioperative morbidities and the need for rehabilitation care after a distal radius fracture treated with locking plates among patients aged 85 years or older. A retrospective study was conducted in all patients aged 85 years or older who underwent open surgical treatment using a locking plate for an isolated distal radius fracture from January 2013 to December 2018 at a level 1 trauma center. The occurrence of minor complications (tendinopathy, neuropathy, carpal tunnel syndrome, and infection), major complications (complex regional pain syndrome, nonunion, loss of reduction, intra-articular screw, and hardware failure), and the need for revision surgery were recorded. The need and timing of rehabilitation were also documented. A nested case-control study was performed to evaluate predictive factors associated with the need for inpatient rehabilitation. The majority of fractures were AO type A, numbering 88 (55.7%), followed by 64 type C (40.5%), and then 6 type B (3.8%). The overall complication rate among the 158 included patients was 17% (n= 26), with 12 (7.6%) having minor complications and 14 (8.9%) having major complications. Inpatient rehabilitation was required for one-third of the patients (n= 59), and 11 (7%) were definitively discharged to a nursing home. The place of residence before the fracture, American Society of Anesthesiologist score, and the type of anesthesia were associated with a need for inpatient rehabilitation. Overall, this study suggests that perioperative morbidity of distal radius fractures treated using a locking plate is acceptable even in the super-elderly population. Nevertheless, given the frequent requirement for rehabilitation, the impact of age cannot be ignored. Therapeutic IV.

Thoracolumbar vertebral fracture in unoperated idiopathic scoliosis

IntroductionTraumatic fractures of the thoracolumbar spine are common. Their management considers the fracture type according to the various classifications in existence, as well as the patient's background and age. In some cases, the occurrence of a fracture on a spine with an unoperated scoliotic deformity can be observed. This entity, not described in the literature, can pose a therapeutic challenge and is not present in any existing treatment algorithm. The main objective of this work was to describe the characteristics and management of vertebral fractures in patients with unoperated idiopathic scoliosis. Material and methodsWe carried out a monocentric retrospective study in all patients operated on for a spinal fracture between May 2011 and August 2020, with a history of unoperated adolescent idiopathic scoliosis. We collected epidemiological data including the surgical course of each patient and the final result. The patients were categorized according to the surgical strategy (extensive fusion and correction of the deformity, short osteosynthesis without considering the scoliosis, vertebroplasty and orthopedic treatment) and the final clinical and radiological result evaluated at the last follow-up. ResultsTen patients were included in this study with a total number of 16 fractured vertebrae. The population was 80% female, with an average age of 36.3 years. The majority of fractures were type A, at the thoracolumbar junction. The curves were classified as Lenke 1A in 5 cases, 1B in 2 cases, 1C in 1 case and 5C for 2 patients. Ultimately, 3 patients underwent extended fusion with correction of scoliosis, 6 localized osteosynthesis and 1 percutaneous vertebroplasty. In 50% of cases, a change of surgical strategy had to be made, due to worsening of the deformity or hyperalgesia. The last follow-up was at 19.7 months on average. Five patients had a good final clinical result, 5 patients had persistence of significant pain (lower back pain or cruralgia). ConclusionThis is the first study investigating the association of vertebral fractures and the presence of unoperated idiopathic scoliosis. The results of our study highlight the management challenges and difficulties in therapeutic decision-making. The presence of a pre-existing curve is thus an important parameter to consider and should lead to the discussion of performing an extended fusion secondarily in view of the risk of poor results from localized surgery. Level of EvidenceIV.