Management Of Fractures Research Articles

Comparative Study between Percutaneous Ilioilial Fixator versus Percutaneous Iliosacral Screw in Managing Sacral Fractures

Abstract Background The sacrum is the mechanical nucleus of the axial skeleton, located at the base of the lumbar spine and acts as the keystone at the centre of the pelvic ring. Traumatic sacral fractures are an increasingly recognized diagnosis. Sacral fractures remain a relative uncommon entity in the general population. Objective The aim of this work is to compare between percutaneous iliosacral screw and ilioilial fixation in sacral fractures fixation as regard operative time, need of intraoperative fluoroscopy, blood loss & related transfusion, infection, neurovascular complication, hardware failure and screws miss- displacement, clinical and radiological outcomes, revision rate and rate of non-union. Patients and Methods After obtaining the hospitals Research/Ethics Committee approval and written informed consents from the patients. This study was carried on 51 Patients with sacral fractures injuries through the period from August 2019 to November 2021. A prospective randomized controlled clinical trial was conducted to compare the functional and radiological outcome of closed reduction and percutaneous fixation of traumatic sacral fractures using iliosacral screw or ilioilial fixator. Results There is no statistically significant difference in functional outcome, radiological outcome operative time, blood loss, postoperative complication, union rate or follow up. There is statistically significant difference in incision length between the two groups as mean length of incision in iliosacral screw and Ilioilial fixator is 1.2 cm and 4.8 cm respectively. There is statistically significant relation between number of intraoperative fluoroscopic and fixation principles (P value <0.001) with higher risk for radiation exposure in IS screw group. Conclusion Iliosacral screw and ilioilial fixator have comparable functional and radiological outcome and similar biomechanical stability .We suggest the ilioilial fixator as an alternative to IS screw in sacral fracture management. The ilioilial fixator is a useful option in patients who do not qualify for IS screw fixation.

Management of Open Fractures of the Extremities and Pediatrics.

The modern management of open fractures was established after the foundational work of Gustilo and Anderson, but we continue to strive to determine the optimal treatment of open fractures to diminish the risk of infection. The ideal timing of antibiotics, presentation to the operating room, and timing of procedures such as flap coverage continue to be investigated with incremental changes recommended over the years. This article aims to provide the most recent review of the literature regarding the timing and management of both upper and lower extremity open fractures, pediatric open fractures, current topics of controversy, and the data supporting current treatment recommendations.

Examining the role of ChatGPT in the management of distal radius fractures: insights into its accuracy and consistency.

The optimal management of distal radius fractures remains a challenge for orthopaedic surgeons. The emergence of Artificial Intelligence (AI) and Large Language Models (LLMs), especially ChatGPT, affords significant potential in improving healthcare and research. This study aims to assess the accuracy and consistency of ChatGPT's knowledge in managing distal radius fractures, with a focus on its capability to provide information for patients and assist in the decision-making processes of orthopaedic clinicians. We presented ChatGPT with seven questions on distal radius fracture management over two sessions, resulting in 14 responses. These questions covered a range of topics, including patient inquiries and orthopaedic clinical decision-making. We requested references for each response and involved two orthopaedic registrars and two senior orthopaedic surgeons to evaluate response accuracy and consistency. All 14 responses contained a mix of both correct and incorrect information. Among the 47 cited references, 13% were accurate, 28% appeared to be fabricated, 57% were incorrect, and 2% were correct but deemed inappropriate. Consistency was observed in 71% of the responses. ChatGPT demonstrates significant limitations in accuracy and consistency when providing information on distal radius fractures. In its current format, it offers limited utility for patient education and clinical decision-making.

Surgical management of combined osteoarthritis knee and proximal tibial stress fracture via long tibial stem total knee arthroplasty: assessment of medium-term results

Background The combined osteoarthritis knee and proximal tibial stress fracture is an uncommon condition that increases the complexity of the management for both. No common consensus among surgeons regarding management guidelines. We assessed the medium-term results (minimum 5 years) of using long tibial stem total knee arthroplasty (TKA) to restore limb alignment, achieve fracture union, and resurface the arthritic joint in a single procedure. Methods Total of 23 patients with combined osteoarthritis knee and proximal tibial stress fracture were enrolled in this study. Of those 23 patients, 18 were females and five were males. All patients were managed surgically by TKA (PCL sacrificing) with a long tibial stem (straight or with offset). Assessments of union and tibiofemoral alignment were carried out using radiographs. Clinically, patients were evaluated by assessment of knee range of motion, knee society score (KSS), and knee injury and OA outcome score. Results The average follow-up period was 6.5 ± 2.3 years (range from 5 to 9 years) all fractures united in 3–8 months (average 3.2 months), and mean range of motion improved from 89°±8° to 119°±6°, mean knee society score improved from 32 ± 8 to 87 ± 5, mean knee injury osteoarthritis outcome score improved from 27 ± 6 preoperatively to 79 ± 5 after a minimum of 5 years follow-up. no complications (instability, infection, or patella mal-tracking) were reported, although 1 case had a femoral intraoperative condyle fracture which was fixed by screws with no effect on the outcome. Conclusion The use of a long tibial stem TKA is an effective and reproducible single surgical procedure in the management of combined osteoarthritis knee and proximal tibial stress fracture. Satisfactory clinical scores and radiological outcomes were achieved and proper limb alignment was restored obviating the need for further fixation or grafting.

How Effective is Fibula Pro Tibia Plating in Treatment of Distal Tibial Fractures: A Pilot Study.

Despite recent advances, management of distal tibial fractures is challenging, with high rate of complications. Fibula pro tibia plating technique fixes fibula and tibia together, via laterally placed fibular plate without disturbing the tibial soft tissue sleeve. We contemplated this pilot study to assess effectiveness of fibula pro tibia plating in management of distal tibia fibula fractures. A total of 30 patients with distal tibia fibula fractures with fracture line extending within 5cm from tibial plafond were managed with fibula pro tibia plating, with or without minimal articular fixation. Outcome evaluation was done by union, union time, alignment and functional outcome as assessed by AOFAS score. Mean age in the series was 39.4 years with male to female ratio of 3:2. Mean duration of surgery, blood loss and C arm exposure were 79 minutes (range 52 to 98min), 80ml (range 62 to 102ml) and 48 shoots (range 36 to 81 shoots), respectively. All fractures united in mean union time of 10.2 weeks (range 9 to 14 weeks) with acceptable alignment in all the patients except one. Mean AOFAS score was 86.3 (range 70 to 93) with 29 patients having good to excellent outcome. One patient had varus malunion and in one case infection was seen. Fibula pro tibia plating can be successfully used to manage complex distal tibia fractures which leaves the soft tissue and periosteal sleeve undisturbed, thus avoiding wound related problems and leading to early union.

Comparative Analysis of Infrapatellar and Suprapatellar Nailing Techniques for Tibial Shaft Fractures

Introduction: Tibial shaft fractures pose a significant challenge in orthopaedic practice, often necessitating surgical intervention for optimal recovery. The selection of the entry point for intramedullary nailing, particularly between the suprapatellar and infrapatellar approaches, remains a debated aspect in fracture management. While both approaches aim to restore stability and function, their nuances influence outcomes and patient experiences. This study aims to comprehensively compare the suprapatellar and infrapatellar approaches, analyzing surgical techniques, complications, and functional outcomes to inform clinical decision-making. Methodology: A retrospective comparative analysis was conducted on patients undergoing intramedullary nailing for tibial shaft fractures, comparing outcomes between the suprapatellar and infrapatellar approaches. Data collection included patient demographics, fracture characteristics, intraoperative details, and postoperative outcomes. Statistical analysis was performed using appropriate tests, with a significance level set at p < 0.05. Result: Operative time was longer in the infrapatellar group (137.8 minutes) compared to the suprapatellar group (114.4 minutes). The mean radiation dose was higher in the infrapatellar group (74.3 cGY/cm2) and lower in the suprapatellar group (48.5 cGY/cm2). Postoperative outcomes showed a mean Lysholm score of 74 in the infrapatellar group and 90 in the suprapatellar group. one case of infection and one case of malunion were reported in the infrapatellar group, while the suprapatellar group had one infection case but no instances of non-union or malunion. Conclusion: This study provides valuable insights into the surgical and clinical outcomes of the suprapatellar and infrapatellar approaches for tibial shaft fractures. While both techniques offer viable options, the suprapatellar approach may offer advantages in terms of operative efficiency and functional recovery.

1283 Non-Operative Management of Paediatric Orbital Fractures at a Major Trauma Centre in the UK: A 12-Year Review

1283 Non-Operative Management of Paediatric Orbital Fractures at a Major Trauma Centre in the UK: A 12-Year Review

955 Is Non-Operative Management Equal to or Superior to Operative Management of Distal Radius Fractures for Patients Over 60?

955 Is Non-Operative Management Equal to or Superior to Operative Management of Distal Radius Fractures for Patients Over 60?

Diagnosis and management of orbital bone fracture: a review and update

Diagnosis and management of orbital bone fracture: a review and update

Risk Factors of Failed Conservative Treatment for Adjacent Vertebral Fractures Following Percutaneous Vertebroplasty

Study Design. A retrospective, single-center, observational study. Objective. This study investigated the risk factors associated with the failure of conservative treatment for adjacent vertebral fractures (AVFs). Summary of Background Data. Adjacent vertebral fractures following vertebroplasty for osteoporotic vertebral compression fractures are not uncommon. Presently, there is a lack of consensus regarding the management of adjacent vertebral fractures. Methods. We included patients who developed adjacent vertebral fractures within two years post single-level vertebroplasty between January 2013 and December 2020. All patients initially underwent six weeks of conservative treatment, including pain medications, bracing, and physical therapy. Surgical intervention was offered to those with intractable back pain due to AVFs. Baseline demographics, AVF characteristics, and radiological measurements were systematically collected, and sequential univariable and multivariable logistic regression analyses were conducted to explore the risk factors. Results. Of the 114 patients with a mean age of 78.6 years, two-thirds (76 patients) tolerated conservative treatment well, while 38 required surgical interventions for adjacent vertebral fractures. Both groups demonstrated similar baseline demographics and radiological parameters regarding AVFs (P>0.05). The multivariable logistic regression analyses revealed that the development of AVFs later than six months post-vertebroplasty and their caudal location to the index vertebroplasty were the independent risk factors of unsuccessful conservative treatment, with odds ratios of 3.57 (95% confidence interval [CI]: 1.14–11.1, P=0.029) and 2.50 (95% CI: 1.09–5.88, P=0.032), respectively. Conclusion. Adjacent vertebral fractures following percutaneous vertebroplasty generally have favorable outcomes under conservative treatment. However, the timing and the relative anatomical location of adjacent vertebral fractures are associated with treatment efficacy. Adjacent vertebral fractures occurring later than six months following the initial vertebroplasty or situated in the caudal location to the index vertebroplasty may exhibit reduced responsiveness to conservative treatment. These patients might benefit from a more aggressive therapeutic approach. Level of Evidence. 3

Traumatic pelvic ring fracture during pregnancy: a systematic review.

This systematic review aims to investigate the management and outcomes of pelvic ring fractures (PRFs) during pregnancy, emphasizing maternal and fetal mortality rates, mechanisms of injury, and treatment modalities. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a comprehensive search of databases from 2000 to 2023, identifying 33 relevant studies. Data extraction included demographics, fracture types, treatment methods, and outcomes. Risk of bias was assessed using the JBI criteria. Maternal mortality stood at 9.1%, with fetal mortality at 42.4%. Maternal factors impacting mortality included head trauma and hemodynamic instability. Fetal mortality correlated with mechanisms like motor vehicle accidents and maternal vital signs. Surgical and conservative treatments were applied, with a majority of pelvic surgeries performed before delivery. External fixators proved effective in fracture stabilization. Pelvic ring fractures during pregnancy present significant risks to maternal and fetal health. Early stabilization and vigilant monitoring of maternal vital signs are crucial. Vaginal bleeding/discharge serves as a critical fetal risk indicator. The choice between surgical and conservative treatment minimally influenced outcomes. Multidisciplinary collaboration and tailored interventions are essential in managing these complex cases.

Health-related quality of life after anterior-only fixation of lower cervical spine fractures: long-term follow-up

Background The management of lower cervical spine fractures at the cervicothoracic junction is challenging and the selection of suitable approach is a matter of debate. The results of anterior fixation of those injuries in the available literatures are ambiguous due to the heterogeneity of the studied groups and lacking long-term follow-up. Moreover, the assessment of patients’ quality of life was not taken into consideration. Our aim was to assess the health-related quality of life and long-term follow-up of a homogenous group of patients of unstable lower cervical spine fractures managed by anterior-only fixation and iliac autograft. Patients and methods Data from hospital records of 13 cases of lower cervical spine fracture managed by anterior fixation and graft were examined and analyzed. All cases were operated as the Subaxial Injury Classification (SLIC) score was greater than or equal to 5. The International Standards for Neurological Classification of Spinal Cord Injury and American Spinal Injury Association (ASIA) scores were used to assess patients’ neurologic status; segmental kyphosis angle for cervical kyphosis and short-Form 36-item was used for health-related quality of life assessment. Results Thirteen cases were included in this series with a mean age of 36.15 ± 7.82 years. C6 was fractured in 3 cases (24%), C7 in 5 cases (38%) and both C6 and C7 in 5 cases (38%). All cases have a SLIC score more than 5 with a mean of 7.0 ± 1.53 (range 5:9). The mean follow-up was 75.54 ± 22.33 months. The operative time was 90.62 ± 20.67 min The total motor score was improved from 72 ± 33.44 preoperatively to 76.92 ± 31.80 at the final follow-up. The segmental kyphosis angle was improved from 15.62 ± 3.25° preoperatively to −9.84 ± 1.77° directly postoperative and −1.30 ± 2.32° at the final follow-up and the short-Form 36-item total score was 75.04 ± 24.26. Conclusion The procedure proved to be safe and has yielded excellent results. The late patient outcome from the quality-of-life perspectives was not affected by loss of cervical lordosis, but on the contrary improved significantly in correlation with improvement of patients’ motor power.

Odontoid Fracture with Locked Posterolateral Atlantoaxial Dislocation: A Case Report and Review of Literature.

Odontoid fractures with atlantoaxial dislocations are rare injuries. We report a case of a 41-year-old man with a Type 2 odontoid fracture with locket facet and posterolateral dislocation. He underwent single-stage C1-C4 posterior fixation and fusion, and at 2-year follow-up, he is symptom-free without any residual pain. Follow-up radiograph and CT scan show healed odontoid fracture with posterior fusion. This case highlights successful management of a complex odontoid fracture by a single-stage posterior surgery. Closed reduction is usually unsuccessful, and open reduction using posterior approach is preferable.

External skeletal fixation for the treatment of pelvic fractures in cats.

To report the technique and the outcome for the repair of pelvic fractures in cats using external skeletal fixation (ESF). Retrospective case series. Client-owned cats (n = 125). Medical records of cats with pelvic fractures, treated with an ESF between June 2001 and June 2009, were reviewed. Preoperative, immediate postoperative, and more than 4 weeks' postoperative radiographs were compared. Clinical examination was performed 4 to 9 weeks following surgery. Longer term follow up (4 to 80 months) was conducted by client questionnaire. No intraoperative complications occurred. There was no change in the pelvic canal width observed on follow-up radiographs (p = .16). Implant loosening was noted on follow-up radiographs in 16/125 (13%) of cases, and 67/803 (8%) pins were palpably loose at the time of frame removal. The mean time to frame removal was 37 ± 9 days. No long-term complications were reported. Long-term mean mobility score was 95 ± 5 and median lameness was 0 (range: 0-2). An ESF may be successfully applied for the stabilization of various pelvic fractures in cats. The application of an ESF for the management of pelvic fractures in cats provides good outcomes.

Nonoperative Treatment of Humeral Shaft Fractures With Immediate Functional Bracing Versus Coaptation Splinting and Delayed Functional Bracing: A Retrospective Study.

To compare radiographic and clinical outcomes in nonoperative management of humeral shaft fractures treated initially with coaptation splinting (CS) followed by delayed functional bracing (FB) versus treatment with immediate FB. Retrospective cohort study. Academic Level 1 Trauma Center. Patients with closed humeral shaft fractures managed nonoperatively with initial CS followed by delayed FB or with immediate FB from 2016 to 2022. Patients younger than 18 years and/or with less than 3 months of follow-up were excluded. The primary outcome was coronal and sagittal radiographic alignment assessed at the final follow-up. Secondary outcomes included rate of failure of nonoperative management (defined as surgical conversion and/or fracture nonunion), fracture union, and skin complications secondary to splint/brace wear. Ninety-seven patients were managed nonoperatively with delayed FB (n = 58) or immediate FB (n = 39). Overall, the mean age was 49.9 years (range 18-94 years), and 64 (66%) patients were female. The immediate FB group had less smokers ( P = 0.003) and lower incidence of radial nerve palsy ( P = 0.025), with more proximal third humeral shaft fractures ( P = 0.001). There were no other significant differences in demographic or clinical characteristics ( P > 0.05). There were no significant differences in coronal ( P = 0.144) or sagittal ( P = 0.763) radiographic alignment between the groups. In total, 33 (34.0%) humeral shaft fractures failed nonoperative management, with 11 (28.2%) in the immediate FB group and 22 (37.9%) in the delayed FB group ( P = 0.322). There were no significant differences in fracture union ( P = 0.074) or skin complications ( P = 0.259) between the groups. This study demonstrated that nonoperative treatment of humeral shaft fractures with immediate functional bracing did not result in significantly different radiographic or clinical outcomes compared to treatment with CS followed by delayed functional bracing. Future prospective studies assessing patient-reported outcomes will further guide clinical decision making. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

A prospective randomised study in assessing functional and radiological outcomes of Dr. Joshirsquo;s External Stabilization System [JESS] vs Kirschner - Wire [K - Wire] fixation in management of hand fractures

A prospective randomised study in assessing functional and radiological outcomes of Dr. Joshirsquo;s External Stabilization System [JESS] vs Kirschner - Wire [K - Wire] fixation in management of hand fractures

Superior versus anterior plating of midshaft clavicle fractures: 6 months follow up (union rates, risks, and complications: hardware irritation and need for removal)

Background Operative management of midshaft clavicle fractures is gaining popularity. The clavicle is a tubular bone with a flat lateral end. Open reduction and internal fixation could be achieved by the application of plates and screws either to the superior or anterior surface of the clavicle. However, there is no consensus in the literature to support one technique over the other. This study aims to compare the early functional and radiographic outcomes of anterior versus superior plating for the treatment of midshaft clavicle fractures. Patients and methods From March 2021 to November 2022, a prospective randomized clinical trial was conducted at our institute. We included all patients with isolated midshaft clavicle fractures. Thirty-six patients were randomized by the closed envelope technique, 18 were managed with superior plating (superior group), and the other 18 patients were managed using anterior plating (anterior group). All patients were followed up for 6 months. All patients were assessed clinically for union, range of motion, and functional scores. The secondary outcome measures included operative time, complications, hardware irritation, and the need for hardware removal or secondary procedure. Results The mean time to full union was 11.28 weeks in the anterior group and 11.72 weeks in the superior group. Mean constant shoulder score for the anterior group was 84.11 while for the superior group it was 82.67. No patients had skin and wound complications in the anterior group versus one patient in the superior group that got superficial infection successfully managed by repeated dressing and antibiotics. There was no statistically significant difference between superior and anterior plating regarding union, functional scores, return to ADLs, hardware problems, or complications. Conclusion Both superior and anterior plating of the clavicle fractures are safe treatment options for displaced midshaft clavicle fractures, and they lead to similar functional outcomes, functional scores, and complication rates. Moreover, the selection of the technique of plating depends on surgeon preferences.

Management of complicated crown-root fracture in a paediatric patient: A case report

Management of complicated crown-root fracture in a paediatric patient: A case report

Management of periprosthetic fractures of the femur: a comprehensive review

Management of periprosthetic fractures of the femur: a comprehensive review

Epidemiology and Management of Pediatric Fractures in Malawi.

Pediatric fractures are common in Malawi, and surgical care, when needed, remains inaccessible to many. Understanding which children in Malawi receive surgery or nonsurgical treatment would help set priorities for trauma system development. We used multivariate logistic regression to evaluate associations between surgical treatment and age, sex, school enrollment, injury mechanism, fracture type, open fracture, referral status, hospital of presentation, delayed presentation (≥2 days), healthcare provider, and inpatient vs outpatient treatment. From 2016 to 2020, 10,400 pediatric fractures were recorded in the Malawi Fracture Registry. Fractures were most commonly of the wrist (26%), forearm (17%), and elbow (14%). Surgical fixation was performed on 4.0% of patients, and 24 (13.0%) open fractures were treated nonsurgically, without débridement or fixation. Fractures of the proximal and diaphyseal humerus (odds ratio [OR], 3.72; 95% confidence interval [CI], 2.36 to 5.87), knee (OR, 3.16; 95% CI, 1.68 to 5.95), and ankle (OR, 2.63; 95% CI, 1.49 to 4.63) had highest odds of surgery. Odds of surgical treatment were lower for children referred from another facility (OR, 0.62; 95% CI, 0.49 to 0.77). Most Malawian children with fractures are treated nonsurgically, including many who may benefit from surgery. There is a need to increase surgical capacity, optimize referral patterns, and standardize fracture management in Malawi.