Management Of Fractures Research Articles

Trends in inpatient versus outpatient upper extremity fracture surgery from 2008 to 2021 and their implications for equitable access: a retrospective cohort study.

The aim of this study is to describe trends in inpatient and outpatient upper extremity fracture surgery between 2008 and 2021, along with identifying patient factors (age, sex, race, socioeconomic status) associated with outpatient surgery. Retrospectively, 12,593 adult patients who underwent upper extremity fracture repair from 2008 to 2021 at one of five urban hospitals in the Northeastern USA were identified. Using Distressed Communities Index (DCI), patients were divided into five quintiles based on their level of socioeconomic distress. Multivariable logistic regression was performed on patients from 2008 to 2019 to identify independent factors associated with outpatient management. From 2008 to 2019, outpatient procedures saw an average increase of 31%. The largest increases in the outpatient management were seen in humerus (132%) and forearm fractures (127%). Carpal and hand surgeries had the lowest percent increase of 8.1%. Clavicle and wrist fractures were independently associated with outpatient management. Older age, male sex, higher Elixhauser comorbidity index, DCI scores in the 4th or 5th quintile, and fractures of the scapula, humerus, elbow, and forearm were associated with inpatient management. During the onset of the COVID-19 pandemic, there was a decrease in outpatient procedures. There is a shift toward outpatient surgical management of upper extremity fractures from 2008 to 2021. Application of our findings can serve as an institutional guide to allocate patients to appropriate surgical settings. Moreover, physicians and institutions should be aware of the potential socioeconomic disparities and implement plans to allow for equal access to care.

Volar locking and angular stability plate for treatment of comminuted scaphoid fractures: a case series of 44 cases.

The primary method employed worldwide for the treatment of scaphoid fractures is screw fixation. However, in unstable and comminuted fractures, percutaneous fixation could produce complications due to technical challenges, such as improper axis positioning, inaccurate screw length measurement, intra-articular screw penetration, and impingement. Alternative open approaches for the surgical management of scaphoid fractures have been proposed, and in recent years, a new specific volar locking plate for the treatment of scaphoid fractures has been developed. This study aims to present the outcomes of this technique applied to 44 patients with unstable and comminuted fractures of the scaphoid. The purpose of the study is to verify the effectiveness of the volar plate in the treatment of comminuted scaphoid fractures and the necessity for plate removal when consolidation has occurred. Between January 2021 and March 2023, a specific volar locking plate for the treatment of scaphoid fractures was used in 44 patients. A retrospective study was conducted involving all patients, consisting of continuous clinical and radiographic assessments, functional evaluations (using QuickDASH and MHQ), and patient satisfaction surveys. All patients achieved clinical and radiographic recovery. However, the plate can impinge with nearby structures and should be removed once the fracture is consolidated. After plate removal, further improvement in range of motion was observed. The plate and screws system is a viable and appropriate method of osteosynthesis in the treatment of unstable and comminuted recent fractures occurring in the middle third of the carpal scaphoid.

Odontoid fractures in the pediatric population: a systematic review and management algorithm.

The management of odontoid fractures in adult patients has been widely described. However, there is sparse literature about this injury in the pediatric population. This study aimed to review published literature regarding the management and outcomes of pediatric odontoid fractures to develop a stepwise treatment algorithm. A literature review was conducted using PRISMA guidelines on PubMed to identify studies between 1960 and 2023 that reported on the management and outcomes of odontoid fracture in pediatric patients. Studies were included if they were published in English and if their sample included at least four patients aged 0-18, minimum follow-up of 6 weeks, and outcomes for each patient clearly differentiated. In total, 15 studies including 125 pediatric patients with odontoid fractures were included. Treatment options varied from non-operative management with immobilization in rigid collars, halo vests, cervicothoracic orthosis, or soft collars to surgical management with fixation and/or arthrodesis. There were 73 patients initially treated nonoperatively, 47 initially treated surgically, 2 who healed with observation alone, and 3 who died acutely of concomitant injuries. The nonunion rate for nonoperative management was 5.5%. Surgery was successful, demonstrating bony union at final follow-up, in 94.6% of cases treated via a posterior approach and 85.7% of cases treated with an anterior approach. Odontoid fractures must be considered in pediatric patients with cervical spine trauma. This is the largest literature review of pediatric odontoid fractures. Various management strategies exist and can be considered. The proposed algorithm offers an evidence-based framework for the management of pediatric odontoid fractures.

Early-onset Adjacent Vertebral Fractures after Balloon Kyphoplasty and SpineJack® Kyphoplasty for the Management of Single-level Thoracolumbar Vertebral Compression Fractures

Objective: To evaluate the risk factors contributing to early-onset adjacent level fractures (ALFs) occurring within 1 month following either balloon kyphoplasty (BKP) or SpineJack® kyphoplasty (SJ) for the treatment of thoracolumbar vertebral compression fractures (TLVCFs). Materials and methods: This retrospective analysis enrolled patients with single-level TLVCFs (T11–L2) who underwent either BKP or SJ between July 2013 and June 2019. We recorded the ALF occurrences within 1 month. Age, osteoporosis, severity and shape of TLVCFs, and surgical type were compared between patients with and without early-onset ALFs. Results: Altogether, 106 TLVCF patients were enrolled, comprising 64 BKP and 42 SJ cases. We observed 19 early-onset ALFs, with 9 and 10 cases in the BKP and SJ, respectively. Patients with early-onset ALFs have significantly more severe TLCVFs (severe versus mild, 25% versus 0%, p = 0.055) and wedge-shaped TLVCFs (26.47% versus 2.63%, p = 0.002) and older age (81.05 versus 73.34 years, p < 0.001) and kyphoplasty performed within 1 month are risk factors of early-onset ALFs (26.92% versus 9.26%, p = 0.018). Univariable analysis showed that kyphoplasty timing within 1 month (odds ratio [OR]: 0.193, p = 0.008), wedge-shaped TLVCFs (OR: 5.358, p = 0.036), and advanced age (OR: 1.119, p = 0.001) are significant risk factors of early-onset ALFs. Conclusions: The occurrence rate of early-onset ALFs between BKP or SJ techniques in treating TLVCFs does not differ. Preoperative wedge-shaped TLVCFs, advanced age, and early treatment within 1 month are the risk factors of early-onset ALFs following kyphoplasty for TLVCFs.

Treatment outcomes of concomitant ipsilateral neck and trochanteric fractures using Gamma3 nails with U-blade lag screws.

This study aimed to investigate the outcomes of Gamma3 nails fitted with U-blade lag screws in the management of combined neck and trochanter fracture of the femur. Two hundred-fifty patients with fractures in the proximal femur underwent treatment using Gamma3 nails integrated with U-blade lag screws from 2015 to 2022. Among these cases, 33 had combined neck and trochanteric fractures; 8 patients were excluded because of follow-up for <1 year. The remaining data of 25 patients (7 males and 18 females) were reviewed. Bone mineral density (BMD), body mass index (BMI), tip-apex distance (TAD), extent of lag screw migration, femoral neck-shaft angle, callus formation, fracture type, and treatment failure were analyzed. The mean patient age was 76.3 (range, 61-91) years, and the mean follow-up duration was 17.3 (range, 12.5-57.3) months. The mean BMD T-scores for the spine and femoral neck were -2.3 ± 1.0 and -2.8 ± 0.7, respectively; 18 patients had T-scores ≤-2.5, indicating osteoporosis. The mean BMI was 23.2 ± 3.8 kg/m2 , and the mean operative time was 69.8 (range, 45-90) minutes. Twenty-one patients experienced injuries from slipping, 2 sustained injuries from falling, and 2 from car traffic accidents. The mean TAD was 21.6 ± 5.9 mm, with 16 patients showing <25 mm. The mean extent of lag screw migration was 5.7 ± 5.1 mm. The mean femoral neck-shaft angle on plain radiographs was 125.1 ± 8.6 degrees immediately postoperatively and 120.3 ± 9.5 degrees at the final follow-up. During the follow-up period, the first callus formation was observed at 3.8 months (range, 1.4-7.3) on plain radiographs in the anteroposterior and axial views. Based on our fracture criteria, 4 patients had a two-part fracture type, 12 patients had three-part, and 9 patients had four-part. Out of 25 patients, 3 exhibited treatment failure. No significant differences were observed between the groups with and without bone union regarding age, BMD, BMI, operative time, TAD of the lag screw, extent of lag screw migration, and femoral neck-shaft angle. The bone union was achieved in 88% of patients who underwent treatment utilizing the U-blade Gamma3 nail for concomitant ipsilateral neck and trochanteric fractures. Level IV, Therapeutic Study.

PREOPERATIVE AND POSTOPERATIVE TOMOGRAPHIC ASPECTS OF CONDYLE FIXATION AND MANDIBULAR FRACTURE: AN INTEGRATIVE LITERATURE REVIEW

Introduction: Computed tomography (CT) is crucial for the evaluation of mandibular fractures, especially in complex areas such as the condylar region. Its ability to provide detailed images in multiple planes has improved surgical planning and post-operative monitoring, offering precise information on the location and characteristics of fractures. Objective: This integrative review aims to analyze how tomographic aspects impact surgical planning and postoperative monitoring of condylar and mandibular fractures. The study discusses the advantages and limitations of tomographic techniques in order to understand how they influence the clinical outcome and rehabilitation of patients. Materials and Methods: An integrative literature review was carried out, without the need for submission to the Ethics Committee, in accordance with the guidelines of Normative Instruction No. 510/2016. The search was conducted in databases such as PubMed, Scopus and Web of Science, and expanded with Google Scholar. Results and Discussion: The analysis revealed that cone beam computed tomography (CBCT) provides high-resolution three-dimensional images, which are essential for the accurate assessment of fractures, especially in complex anatomical areas such as the mandibular condyle. Conclusion: Cone beam computed tomography (CBCT) is an indispensable tool for the management of condyle and mandible fractures. Its use in preoperative and post-fixation monitoring facilitates detailed visualization of anatomical structures, improving the precision of surgical interventions and contributing to superior functional and aesthetic results.

The Use of Nitinol Staples as Reduction Aids in Fixation of Forearm Diaphyseal Fractures: Surgical Technique and Case Series.

Forearm diaphyseal fractures are common orthopedic injuries that typically require surgical intervention using various implants and approaches. Maintaining reduction while simultaneously achieving compression in radial and/or ulnar shaft fractures during compression plate application can be challenging, particularly with unstable segmental and/or transverse fracture patterns. Nitinol compression staples have become increasingly used as a reduction aid because of their ability to provide continuous compression between the staple legs at the fracture site, low profile, and ease of application. These staples have the potential to be an effective means of maintaining reduction and applying compression before definitive plate fixation for radial and ulnar shaft fractures. We present our surgical technique and an associated patient series detailing our institution's experience, highlighting favorable outcomes and potential considerations when using nitinol compression staples for forearm fracture management.

There is no correlation between differences in adverse events and differences in patient-reported outcome measures in orthopaedic trauma randomized controlled trials: A systematic review

IntroductionA recovery without adverse events is a top priority of orthopaedic trauma patients, however many randomized controlled trials (RCTs) are only powered to detect a difference in patient-reported outcome measures (PROMs). While it may be assumed that differences in major adverse event rates between treatment groups will result in differences in PROMs, this has not been established. The purpose of this study was to perform a systematic review of RCTs to evaluate if differences in these outcomes were correlated. MethodsA systematic search was conducted of online databases to identify RCTs in orthopaedic trauma fracture management that reported both major adverse events and PROMs. Adverse events included secondary surgeries or complications that could negatively affect long-term outcomes (nonunion, chronic regional pain syndrome, etc.). The correlation between a difference (p < 0.05) in adverse events and a difference in PROMs was assessed. ResultsThe systematic review yielded 30 RCTs involving 6,769 patients. The primary outcome was a continuous PROM in 70.0 % (21/30). A difference in major adverse events was reported in 23.3 % (7/30) and a difference in PROMs was reported in 6.7 % (2/30). Studies reporting a difference in adverse events, compared to those that did not, were not more likely to report a difference in PROMs (14.3 % (1/7) vs. 4.3 % (1/23); p = 0.42). ConclusionsThere was no correlation between differences in adverse event rates and differences in PROMs in orthopaedic trauma RCTs. Investigators should consider powering studies to detect differences in the major adverse events that both patients and surgeons wish to avoid. Level of evidenceLevel I

Minimally Invasive Plate Osteosynthesis for Comminuted Fractures of Long bones: A Prospective Study on Outcomes and Complications

The surge in comminuted bone fractures, attributed to modern lifestyles and increased trauma incidents, poses significant challenges in management. Traditional open reduction and plating methods, while effective, are associated with drawbacks like delayed union and higher infection rates. The evolution of MIPO (Minimally Invasive Plate Osteosynthesis) seeks to overcome these limitations. The potential effects of MIPO in the management of severely comminuted long bone fractures are investigated in this work. The Saveetha Medical College's Department of Orthopaedics carried out a prospective study from March 2022 to March 2024. Patients aged 20 to 60 with fractures of the femur, tibia, and humerus resulting from road traffic accidents were included. The AO Fracture classification system was utilized, and MIPO techniques were employed for fixation. Clinical and radiological assessments were conducted at various follow-up intervals. Statistical analysis using IBM SPSS Version 22.0 assessed outcomes, with a P-value&lt;0.05 countedas significant. MIPO was performed on twenty-four male patients, ages averaging 34.4 years, for severely comminuted fractures. The distal 1/3 of the femur, the tibia, and the humerus shaft were among the fractures. Union was rapid in 15 cases, with delayed consolidation in two requiring secondary bone grafting. Functional outcomes assessed using the Neer–Grantham–Shelton Criteria, demonstrated excellent outcomes- 65%, good- 30%, and fair- 5% of events. Complications included infection (5%), wound gaping (5%), joint stiffness (25%), and limb length discrepancy (20%). This study reinforces MIPO as a promising approach for severely comminuted fractures, showcasing excellent union rates and functional outcomes. Studies highlight its advantages in preserving soft tissue and periosteal circulation. The shift from anatomic reduction to optimal stability in such fractures aligns with current trends. Complications, though present, are manageable. The study contributes to the growing body of evidence supporting MIPO, emphasizing its potential advantages in minimizing surgical trauma and maintaining biological stability. Further research, including comparative studies and exploration of other fixation methods, is warranted for a comprehensive understanding of MIPO's role in fracture management.

Assessing functional and radiological outcomes: open reduction and internal fixation vs. minimally invasive plate osteosynthesis for humerus shaft fractures-a prospective comparative study.

To analyse and compare the functional and radiological outcome of different methods of surgical management of humerus shaft fractures in 30 patients treated by conventional open reduction and internal fixation (ORIF) or minimally invasive plate osteosynthesis (MIPO). This prospective interventional study was conducted among 30 patients by dividing into two equal groups over oneyear and sixmonths. All patients were followed up for a minimum of at least sixmonths. Radiological outcome was assessed using fracture union in serial radiographs and functional outcome was measured using DASH scoring. The majority of patients (26.7%) were between 18 to 30years, overall mean age was 44.4years, most of the patients (50%) had 12A3 AO type fractures, and 73.3% of patients had injuries following two-wheeler road traffic accidents. On comparing multiple factors, we found a statistically significant reduction of intra-operative blood loss in MIPO compared to ORIF. Though time taken for fracture union, functional outcome and complication rate were better in MIPO when compared to ORIF, these differences were not statistically significant. two patients in the MIPO group and one patient in the ORIF group had a peri-implant fracture following slip and fall again within the study period and underwent Revision plating. Excluding cases of peri-implant fractures, out of 13 patients in the MIPO group, only one patient developed fracture non-union. Of 14 patients in the ORIF group, three developed fracture non-union. MIPO is a safe, reproducible, efficient and good if not a better alternative to ORIF as it offers good radiological and functional outcomes with advantages of minimal soft tissue damage, minimal blood loss, better cosmesis, no incidence of radial nerve palsy and with few concerns such as the need for fluoroscopy, and a learning curve.

Functional Outcome of Perpendicular Plating Versus Parallel Plating In The Management Of Distal Humerus Fractures- A Comparative Study

Distal humerus fractures are quite uncommon but pose significant challenges in management due to their complex anatomy and varied fracture patterns. Surgical intervention, particularly using plate fixation, is often necessary to achieve stable fracture union and restore functional elbow mobility. This prospective comparative study aimed to analyse the outcomes of distal humeral fracture management using perpendicular and parallel plating techniques. Thirty patients with distal humeral fractures underwent osteosynthesis with either perpendicular or parallel plating between November 2020 and October 2022 at Saveetha Medical College and Hospital in Chennai. The Mayo Elbow Performance Score has been utilized to measure the following assessment parameters: pain, radiological, stiffness and clinical union, and functional elbow ability at 6 weeks, 3 months, 6 months, and 1 year after the surgery.Both techniques yielded satisfactory outcomes in terms of fracture union and functional recovery. However, complications and biomechanical properties differed significantly between the two methods. Parallel plating demonstrated superior stability and resistance to plastic deformation, particularly in osteoporotic bone, suggesting potential advantages in managing comminuted distal humerus fractures with an intraarticular component. This study contributes valuable insights into the optimal management strategies for distal humeral fractures and highlights the importance of considering individual patient factors and fracture characteristics when selecting the most suitable surgical approach. Additional investigation is necessary to verify these results and improve methods of treatment for this difficult kind of fracture.

A clinical prospective study on the surgical management of zygomatico-maxillary complex fractures using two-point fixation

The ZMC fractures are one of the most frequently occurring maxillofacial injuries due to its prominence and facial contour. The ZMC forms a principle buttress of face and helps transmit occlusal forces to skull base. Fracture of zygomatic bone leads aesthetic and functional deformity. Restoration to premorbid condition is most predictable by ORIF. In this study was to evaluate efficacy of two-point internal fixation using conventional miniplates and screws for ZMC fractures. 35 patients with established unilateral isolated ZMC fractures were operated using two-point fixation method i.e. the maxillary buttress and the fronto-zygomatic suture, followed up for 3 months. Patients were assessed clinically and radiographically at different follow up intervals. Charts of patients were reviewed for age, gender, etiology, malar height analysis and vertical dystopia. 35 patients in this study, underwent ORIF under GA with two-point fixation. Preoperatively, mean malar height of the patients recorded was 66.55 ± 3.02. There was a significant increase in malar height postoperatively (P &amp;#60; 0.0001). 70.24 ± 2.05, at 1st week, and 69.87 ± 1.98. in 3rd and 6th weeks. Preoperatively, mean vertical dystopia of patients was 2.24 ± 0.71. Postoperative resolution of vertical dystopia was statistically significant (P&amp;#60;0.0001), with value of 0.52 ± 0.52.Integrity of ZMC is important in maintenance of normal facial width and prominence of cheek. Two‑point fixation shows satisfactory results functionally, esthetically and also provides additional advantage by eliminating another surgical site. Thus we conclude that our study provides a basis for further research.

Management of Mandibular Condyle Fractures in Pediatric Patients: A Multicentric Retrospective Study with 180 Children and Adolescents.

Background: Mandibular condyle fractures in pediatric patients can lead to crippling sequelae such as ankylosis, pain and facial deformity if not managed properly. However, there is no consensus on the best approach for treating these fractures in children. Objective: This study aimed to describe the management of mandibular condyle fractures in growing patients across 14 maxillofacial departments worldwide. Methods: A retrospective multicenter study was conducted on children and adolescents aged 0 to 16 who had at least one mandibular condyle fracture. This study included patients who underwent expectant, closed, or open management and were treated over an 11-year period. Results: 180 patients had at least one mandibular condyle fracture, and 37 had a second condylar fracture. One hundred sixteen patients (65%) were males, and 64 (35%) were females (ratio 1.8:1). An expectant strategy was chosen in 51 (28%) patients, a closed treatment-stand-alone maxillomandibular fixation (MMF)-in 47 (26%), and open reduction and internal fixation (ORIF) was performed in 82 (46%) patients. The management varied significantly between the different departments (p < 0.0001). Significant differences were also identified between the fracture type (non-displaced, displaced or comminuted) and the management of the 180 patients with a single condylar fracture. Out of 50 non-displaced fractures, only 3 (6%) had ORIF, 25 (50%) had expectant management, and 22 (44%) had MMF. Out of 129 displaced fractures, 79 (62%) had ORIF, 25 (19%) had a soft diet, and 25 (19%) had MMF. Conclusions: Expectative management, MMF, and ORIF were all effective in treating pediatric mandibular condyle fractures, with a low incidence of complications and asymmetry.

Incidence of deep vein thrombosis and pulmonary embolism in closed foot and ankle fractures treated with conservative versus surgical management: A nationwide analysis

ObjectivesThough there is extensive research on recovery and outcomes of proximal joint fractures, such as hip and knee, there is a paucity of such research in foot and ankle fractures and a lack of uniform data on the incidence of venous thromboembolism (VTE). This is a retrospective cohort study that seeks to investigate the incidence of VTE following surgically versus conservatively treated foot and ankle fractures MethodsThis study included all adult-patient hospitalizations with International Classification of Disease 10th Revision diagnosis codes related to closed foot and ankle fractures as a primary diagnosis in the National Inpatient Sample, an administrative database part of the Healthcare Cost and Utilization Project, for a total of 209,595 cases. Multivariate binary logistic regression was performed to determine the effect of age, gender, past medical history of venous thromboembolism (PMHVTE), Charlson Comorbidity Index, race, surgery, and transfusion of red cell products on the incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE). ResultsOur study found an overall incidence of DVT and PE to be 0.4 % and 0.3 %, respectively, following foot or ankle fracture. Conservative management was found to have an increased relative risk of DVT and PE of 2.02 and 1.15, respectively. This difference persisted on performing inverse probability treatment weighting (IPTW) analysis to account for confounders. PMHVTE and requirement of blood transfusion was associated with an increased odds ratio (OR) of 3.41 and 3.217, respectively. Cases identified as Black and Asian/Pacific Islander also had an increased OR of DVT. ConclusionsThe results of this study demonstrate that surgical management of foot and ankle fractures is associated with a lower relative risk of VTE compared to medical management. PMHVTE and transfusion of red cell products increase the odds of VTE following either form of intervention.

A retrospective study to assess the complications associated with surgical management of distal radius fracture by ligamentotaxis

Background: Fractures of the distal radius are the most common upper limb fractures encountered by orthopedic surgeons. It constitutes about 75% of all the forearm fractures. There is steady increase in this type of fracture in all age groups but is the highest in children and elderly. There are multiple modalities of treatment available for distal end radius fractures, among which ligamentotaxis is one of the modalities, where the ligaments, retinaculum, tendons and periosteum that envelope the fracture serves as barrier during open reduction, helps achieve the reduction of the fracture. The objective is to study the most common complication associated with distal radius fractures treated by ligamentotaxis in this institution. Methods: This hospital based retrospective study was conducted at MVJMC and RH after receiving ethical clearance from the institutional ethical committee. The study population contained 50 patients that met the inclusion criteria over a period of 4 years from March 2019 to March 2024.The administrative health data was collected from OPD and OT registers, and the collected data was entered in Microsoft excel and results were calculated and tabulated at the end of the period. All the patients with distal end radius fractures treated by ligamentotaxis over a period of 4 years were included Results: According to the study distal end radius fracture was more prevalent among males than females and the highest percentage with 30% was seen among the age group of 31-40 years. The most common complication encountered was neuropathy and residual wrist pain which accounted for 14%. Conclusions: The study concludes that most of the fractures and its complications are note among the active age group. The study helps understand the complications and find strategies to reduce the complication percentage.

Manejo da fratura de fêmur e as principais complicações: Uma revisão sistemática

Objective: The general objective of the present study is to analyze the scientific literature on hip fractures in the elderly, seeking to identify the main risk factors, surgical treatment options and their complications, as well as long-term functional outcomes. Methodology: This is a systematic review focused on understanding the main aspects of the management of femoral neck fractures in the elderly. The research was guided by the question: "What is the best way to manage femoral neck fractures?". To find answers, searches were performed in the PubMed database using three descriptors combined with the Boolean term "AND". This resulted in 115 articles. 27 articles were selected for analysis and 19 articles used to compose the collection. The searches used were: (Femoral Neck Fractures) AND (Surgical Procedures, Operative) AND (Orthopedic Procedures); (Femoral Neck Fractures) AND (Postoperative Care); (Femoral Neck Fractures) AND (Intraoperative Complications). Results: Hemiarthroplasty and total hip arthroplasty (THA) are viable options, each with its advantages and disadvantages. Internal fixation with cannulated screws has a high complication rate, while the femoral neck fixation system shows promising results. The choice between cemented and uncemented prostheses continues to be debated. Conclusion: The choice of treatment should be individualized, considering factors such as age, comorbidities, and type of fracture. Early interventions are crucial to minimize complications and improve functional outcomes.

Surgical Management of Clavicle Fracture with Precontoured Locking Plate

Surgical Management of Clavicle Fracture with Precontoured Locking Plate

TIBIAL DIAPHYSEAL FRACTURE, PANORAMIC REVISION

Introduction: Tibial fractures are quite common injuries. Since the tibia has a subcutaneous location, it is more likely to show exposed fractures. Exposed fractures of the tibial diaphysis are serious injuries that can result in significant long-term disability if not managed correctly. Objective: to detail current information related to tibial diaphysis fractures, etiology, epidemiology, anamnesis, physical examination, assessment, treatment, differential diagnosis, prognosis and complications. Methodology: a total of 29 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 17 bibliographies were used because the other articles were not relevant for this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: tibia fractures, osteosynthesis, tibia fracture, intramedullary nails, leg trauma, exposed fractures. Results: tibial diaphysis fractures present an incidence of 16.9 per 100,000 individuals per year, being more common in the male sex, with 21.5 per 100,000 individuals per year, compared to 12.3 per 100,000 in the female sex. The most common triggers in males of tibial diaphysis fractures are motor vehicle accident injuries and sports. Conclusions: It is important to recognize the management of tibial fractures since they have a relatively high incidence. It is not uncommon to encounter an exposed tibial diaphysis fracture, so it is essential to identify, as well as perform damage control and appropriate management. The individual should undergo a complete examination and it may be necessary to implement the trauma life support protocol. In this type of fracture it is crucial to assess the neurovascular situation. In addition, complementary examinations should be requested to allow the best diagnosis, classification and treatment of the injuries. The treatment of tibia diaphysis fractures will depend on the specific situation and the patient's condition; however, external fixators are usually used for damage control and later intramedullary nails are used. Tibial diaphysis fractures may be accompanied by compartment syndrome and other complications. KEY WORDS: trauma, fractures, tibia, treatment.

Patellar Sleeve Fracture: An Update of Literature

Patellar sleeve fractures, though relatively rare, present unique challenges in diagnosis and management. This review aims to provide a comprehensive overview of the current understanding of patellar sleeve fractures, focusing on their epidemiology, clinical presentation, imaging, and management strategies. Epidemiologically, these fractures are uncommon, representing approximately 1% of all fractures in pediatric patients, yet they account for 50% of all patella fractures in this population. They predominantly affect adolescents, with a peak incidence around 12.7 years of age, and are more common in boys, occurring at a ratio of 3 to 5:1. Understanding these demographic patterns is crucial for early recognition and appropriate management. Clinically, patellar sleeve fractures typically present with the sudden onset of severe pain, often associated with explosive activities such as jumping. However, diagnosis can be challenging, particularly in cases with minimal displacement or where alternative muscle groups compensate for the injury. Differential diagnosis is essential, and clinicians should be vigilant for signs such as palpable gaps at the lower pole of the patella and patella alta. Imaging modalities play a vital role in diagnosis, with plain X-rays often revealing no bony damage. Ultrasonography may offer a cost-effective alternative, especially in cases where radiographic findings are inconclusive. Advanced imaging techniques such as MRI can assist in characterizing the extent of the injury and assessing for associated complications. Management strategies encompass a spectrum of approaches, ranging from conservative measures such as immobilization and physical therapy to surgical interventions, including open reduction and internal fixation or arthroscopic surgery. The choice of treatment depends on various factors, including the fracture pattern, displacement, patient age, activity level, and associated injuries. Despite advancements in diagnosis and treatment, the optimal management of patellar sleeve fractures remains a clinical challenge. Further research is warranted to elucidate optimal algorithms for diagnosis and treatment, with the ultimate goal of improving outcomes and reducing the risk of long-term complications associated with this rare but clinically significant knee injury.

A Scoping Review on the Management of Open Fractures in African Trauma and Orthopaedics Centres.

An open fracture is when the fractured part of a bone is exposed to the external environment by breaching the overlying soft tissue and skin.Open fractures often arise from high-energy injuries, and the risk of microbial contamination is high. There is a need to understand the management of open fractures in Africa by assessing the overall prevalence of open fractures, the mechanisms of injury, management approaches and outcomes. A literature search was conducted using PubMed, African Journal Online, and Google Scholar regarding open fracture management in Africa from inception till date. Thirty-nine (39) studies were included in this review. Road traffic accidents represented the majority of all mechanisms of open fractures, with the Tibia being the most affected bone. 320 cases were classified as Gustilo Anderson Type 1, with 487 classified as Type 2. Type 3 was divided into 3A (330), 3B (248), and 3C (34). Most studies recorded the immediate administration of intravenous antibiotics, but tetanus prophylaxis was only given in 13 studies, while initial debridement and washout were done in 35 studies. External fixators and Kirschner wires were most used for initial fixation. Follow-up for patients was between six weeks to 50 months. There were 645 cases of malunion, 83 cases of non-union, and 88 patients who had delayed union. There were 147 cases of wound infection and 119 cases of pin tract infections. Our findings emphasize the need for standardized protocols and robust emergency services to manage open fractures within Africa.