Distal Metaphyseal Fractures Research Articles

Result of the pin fixation with mini-open technique for irreducible distal radius diaphyseal metaphyseal junction fractures in child

Aim: Although conservative treatment remains the preferred choice for distal radius fracture in children, reduction losses and failure to achieve reduction remain the main problems at diaphyseal metaphyseal junctional fractures. There is no consensus on the surgical treatment of displaced metaphyseal-diaphyseal distal radius fractures. This study aims to evaluate the result of the crossed pin fixation applied with the mini-open technique at pediatric metaphyseal-diaphyseal distal radius fractures. 
 
 Methods: The radiological and clinical outcomes of pediatric distal metaphyseal diaphyseal distal radius fractures operated between 2018 and 2020 were retrospectively investigated. The clinical follow-ups of the patients were performed in the second, fourth, sixth weeks and the third month. Radiological recovery time, reduction losses during follow-up, complications, and forearm and wrist range of motion were examined. 
 
 Result: There were 13 boys and 6 girls with an average age of 10.1 (8-12 years). Radiographs taken immediately after the operation showed less than 5% translation in the coronal plane and less than 10% translation in the sagittal plane. An average of 4 degrees of change was observed in the lateral radiographs, and an average of 3 changes was detected in the anterior to posterior (AP) radiographs at the last follow-up. No limitation in the range of motion was observed in the patients. 
 
 Conclusion: Our data showed that the pin fixation with the mini-open technique was a suitable method to treat metaphyseal-diaphyseal distal radius fractures with a satisfactory alignment and achieving stable fixation.

Combined Intramedullary Pinning for the Stabilisation of Distal Diaphyseal and Metaphyseal Femoral Fractures in Five Skeletally Immature Dogs

AbstractThe aim of this retrospective case series was to evaluate outcomes of distal normograde intramedullary pinning combined with dynamic intramedullary pinning for the stabilisation of distal diaphyseal and metaphyseal femoral fractures in five juvenile dogs. Medical records and radiographs were reviewed to evaluate signalment, interval from injury to surgery, fracture classification, concurrent injuries, apparatus, fracture healing and any complications. Final follow-up at skeletal maturity consisted of orthopaedic examination and orthogonal radiographs of bilateral femurs. Radiographs were evaluated for osteoarthritis, femoral length and alignment. Three of four dogs that returned for short-term follow-up healed without complication at 4 weeks postoperatively. One dog experienced pin migration and delayed union, requiring pin removal. All four dogs that returned for final follow-up demonstrated excellent limb function based on owner assessment and orthopaedic examination. Radiographic evaluation revealed mild stifle osteoarthritis in two dogs. All dogs demonstrated continued growth of the affected femur with mild discrepancies in length compared with the contralateral femur at skeletal maturity. Two dogs developed subclinical femoral neck retroversion relative to the normal contralateral limb. Combined intramedullary pinning may be an appropriate treatment option for select distal femoral fractures in skeletally immature dogs; however, more rigid fixation methods should be considered when possible, to effectively counter rotational forces during fracture healing.

Fracture gap and working length are important actionable factors affecting bone union after minimally invasive plate osteosynthesis for the treatment of simple diaphyseal or distal metaphyseal tibia fractures

IntroductionIndirect reduction of minimally invasive plate osteosynthesis (MIPO) can often result in delayed union in tibia fractures. This study evaluated several factors in MIPO in relation to bone union. HypothesisWe hypothesized that the fracture gap, plate – tibia distance, or working length would have a substantial effect on the tibia union rate. Materials and methodsForty-one patients with simple diaphyseal or distal metaphyseal tibia fractures who underwent internal fixation surgery using the MIPO technique were divided into two groups: patients with delayed union and patients without delayed union. Non-actionable factors involving AO/OTA classification, fibula fracture and actionable factors including postoperative fracture gap, plate – tibia distance, working length in relation to parameters of bone union were compared between the two groups. Also cumulative rates of bone union and risk factors of delayed union according to variables of interest were investigated. ResultsAO/OTA classification, site of fibula fracture, postoperative fracture gap, working length, and bone union rate of the two groups significantly differed (p<0.05). The cumulative rate of bone union during 1-year follow-up according to 43A tibia fracture, distal fibula fracture, fracture gap, and working length significantly differed between the two groups (p<0.05). By univariate Cox proportional hazards model, 43A tibia fracture, distal fibula fracture, facture gap, and short working length were risk factors for delayed union (p<0.05). DiscussionNon-actionable factors involving AO/OTA classification, distal fibula fracture and actionable factors including postoperative fracture gap, working length were significant factors affecting bone union after MIPO. The present study indicated that small fracture gap and long working length during MIPO might facilitate bone healing in tibia fracture. Level of evidenceIV; single-center retrospective cohort study.

PREVALENCE OF VASCULAR INJURY IN PATIENTS WITH ORTHOPAEDIC TRAUMA OF THE KNEE AT CHRIS HANI BARAGWANATH ACADEMIC HOSPITAL

Orthopaedic injuries in the knee are often associated with vascular injury. When these vascular injuries are missed devastating there are devastating outcomes like limb ablation. Pulse examination in these patients is not sensitive to exclude vascular injuries. That often lead to clinicians opting for Computed Tomography Angiogram (CTA) to exclude vascular. this usually leads to a burden in Radiology Department. This study aimed to evaluate the prevalence of vascular injury in patient with orthopaedic injury in the knee.The computed tomography (CT) done in patients with distal femur fracture, knee dislocation and proximal tibia fractures were retrieved from the picture archiving and comunication system (PACS). The CTs were done between June 2017 and June 2022. The computed tomography angiogram (CTA) reports were reviewed to determine cases that vascular injury.A sample size of 511 cases was collected. 386 cases were done CTA and 125 cases were not done CTA. There were 218 tibial plateau fractures, 79 knee dislocations, 72 distal metaphyseal femur fractures, 61 floating knees, 55 distal femure intraarticular and 26 proximal metaphyseal tibia fractures. The mechanisms of injury in these were gunshot, fall from standing height, fall from height, MVA, MBA, PVA and sports. Prevalance was 9.17% (47) of the total injuries in the knee. Prevalance in patients who were sent for CTA was 12.08%.Routine CTA in patients with injuries in the knee is not recomended. The use of ankle brachial index may decrease the number of CTA done.

A Novel Method for Treating Distal Radius Diaphyseal Metaphyseal Junction Fracture in Children.

BACKGROUND The treatment of distal radius diaphyseal metaphyseal junction (DMJ) fracture in children is a clinical problem; several treatments are available, but none are very effective. Therefore, this study aimed to report a novel method for treating this fracture using limited open reduction and transepiphyseal intramedullary fixation with Kirschner wire. MATERIAL AND METHODS From January 2018 to December 2019, a total of 15 children (13 boys and 2 girls) with distal radius DMJ fractures with a mean age of 10 years (range: 6-14 years) were included in the study. The operation time, incision length, and X-ray radiation exposure were precisely recorded. All children were followed up regularly. At the final follow-up, clinical outcomes were evaluated according to Price criteria, and complications were recorded. RESULTS The mean operation time of the 15 children was 21.4 min, and the mean incision length was 1.9 cm. The intraoperative X-ray was performed 3.7 times on average. The mean radiographic union of fracture was 4.7 weeks, and the mean time to remove the Kirschner wire was 4.8 weeks for radial instrumentation and 4.7 months for ulnar instrumentation. According to the Price grading evaluation system, clinical outcome was excellent in 14 cases and good in 1 case. Moreover, there were no major complications related to loss of reduction, malunion, nonunion, and physeal arrest of the distal radius. CONCLUSIONS Limited open reduction and transepiphyseal intramedullary fixation with Kirschner wire are effective for treating distal radius DMJ fracture in children, which has the advantages of simple surgical procedures, short operation time, small incision, and less radiation exposure, making it an excellent choice for treating this fracture.

Short term outcome of treatment with percutaneous cross Kirschner wires in paediatric distal humeral metaphyseal diaphyseal junction fractures

Background: Soft tissue sarcomas (STS) are malignant tumours arising from mesenchymal tissue, comprising &lt;1% of all the tumours of the human body and represent the second most common type of solid tumours in children and adolescents. Surgical resection is considered the mainstay of treatment, supported by multimodal therapies including chemotherapy and radiotherapy. Resource-limited countries, like Pakistan, face additional challenges due to inadequate resources. This study presents the experience of management of soft tissue sarcomas presenting to a tertiary care hospital in Central Lahore.&#x0D; Patients and Methods: This was an observational study conducted in Surgical Unit I of Sir Ganga Ram Hospital Lahore from January 2017 till June 2022. American Joint Committee on Cancer (AJCC) staging system and Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) resection classification was applied. Surgical treatment including R0, R1 and R2 resections were carried out. SPSS 23 version was used for statistical analysis of collected data.&#x0D; Results: A total of 36 patients; 24 male (66.7%) and 12 females (33.3%) were included. Anatomical site involvement was observed as 23 (63.8%) limb sarcomas and 13 (36.1%) trunk sarcomas. Out of 36 patients, 20 (55.6%) patients were staged as stage II, 11 (30.5%) patients as stage III and 5 (13.9%) as stage I. Total 17 (47.2%) patients underwent wide excision, 13 (36.1%) patients underwent limited excision, 4 (11.1%) patients underwent compartmental excision and 2 (5.6%) patients underwent palliative excision. &#x0D; Conclusion: Thigh was the commonest site of involvement in extremity sarcomas. Retroperitoneal sarcomas were most frequent among trunk tumours. Leiomyosarcoma was the most common histopathological diagnosis followed by malignant peripheral nerve sheath tumours. Most of the patients presented with stage II disease.&#x0D; Keywords: Soft Tissue Sarcoma, Presentation, Resection, Histology, Outcome

Distal femur nonunion: Risk factors and validation of RUST scores

Abstract Objectives: (1) The purpose of this study was to investigate immediate postoperative weight-bearing status and other potential risk factors for nonunion after locked plating of distal femur fractures and (2) to compare clinical and radiographic union using the previously validated Radiographic Union Scale for Tibia (RUST) and modified RUST scores. Design: This is a retrospective cohort analysis. Setting: Academic Level-1 trauma center. Patients/Participants: Ninety patients with distal femur fractures (OTA/AO 33-A, including periprosthetic) treated with lateral locked plating over a 10-year period. Intervention: Distal femur fracture fixation with lateral locked plating; surgical intervention to facilitate bone healing in cases of nonunion. Main Outcome Measurements: Nonunion rate, construct rigidity scores, RUST, and modified RUST scores. Results: Seventy-eight of 90 patients (87%) achieved clinical union (13% nonunion rate). Rigidity score was significantly associated with risk of nonunion (P = 0.003). No significant association was detected between nonunion and postoperative weight-bearing status (P = 0.77) or other previously identified risk factors. Patients who achieved fracture union had significantly higher mean (SD) RUST (10.67 [1.37] vs. 6.53 [1.48], P &lt; 0.001) and modified RUST (13.47 [2.20] vs. 6.94 [1.79], P &lt; 0.001) scores than patients who developed nonunion. Sensitivity (Sn) analyses identified a RUST score threshold of 9 for diagnosing clinical union (Sn 93.6% and specificity [Sp] 91.7%) and a modified RUST score threshold of 8 (Sn 93.6%, Sp 91.7%). Conclusions: Immediate postoperative weight-bearing status does not seem to affect nonunion rates. We observed a statistically significant association between rigidity score and nonunion. This study supports the utility of the RUST and modified RUST scores in distal femur metaphyseal fractures. Level of Evidence: Therapeutic Level IV.

Comparison of Upper Limb Function after Management of Intraarticular Distal Radius Metaphyseal Fracture between Operative and Non-Operative Procedure with Clinical Assessment of the QuickDASH Score

Introduction: Distal radius fracture is the most common fracture in an orthopedic emergency involving the upper limb. Management of patients with distal radius metaphyseal fractures greatly affects the function of the upper limb during recovery. Then the right choice of type of procedure will affect the function of the upper limb. This study aimed to compare the function of the upper limb in intraarticular distal radius metaphyseal fracture between operative and non-operative procedures with the clinical assessment of the QuickDASH score at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.&#x0D; Methods: This study was an analytic observational study with a retrospective cohort approach. A total of 55 research subjects consisting of 38 subjects belonging to the operative group and 17 subjects belonging to the non-operative group, participated in this study. Data analysis was carried out using univariate and bivariate to find out the differences between operative and non-operative procedures related to post-fracture upper limb performance.&#x0D; Results: Operative procedure are proven to improve upper limb performance better than non-operative procedure based on the QuickDASH score. Operative procedures provide improved upper limb performance 2.65 times better than non-operative procedure.&#x0D; Conclusion: Operative procedure that are better in maintaining upper limb performance after intraarticular radius distal metaphyseal fractures based on the QuickDASH score compared to non-operative procedure at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.

PROXIMAL HUMERAL LOCKING PLATE: A VIABLE ALTERNATIVE FOR FIXATION OF DISTAL FEMORAL FRACTURES IN CHILDREN.

Evaluate outcomes and complications of treatment of distal femoral metaphyseal fractures in children with proximal humeral locking plates. Retrospective study between 2018 and 2021, including seven patients. The analysis included general characteristics, trauma mechanism, classification, clinical and radiographic outcomes, and complications. The mean follow-up was 20 months, the average age was nine years, five patients were boys, and six fractured on the right side. Five fractures were caused by car accidents, one by falling from their own height and one by playing soccer. Five fractures were classified as 33-M/3.2 and two as 33-M/3.1. Three fractures were open, Gustilo IIIA. All seven patients recovered mobility and resumed their pre-trauma activities. All seven healed, and one fracture was reduced to 5 degrees valgus, without any other complications. Six patients had the implant removed and did not present refracture. Treatment of distal femoral metaphyseal fractures with proximal humeral locking plates is a viable option that offers good results and fewer complications, saving the epiphyseal cartilage. Level of Evidence II; Controlled study without randomization.

Results of Antegrade Intramedullary Elastic Wires for Severely Displaced Distal Radial Fractures in Children

Objective: The objective of this study is to present a new method of Antegrade elastic wires, which is a minimally invasive surgical approach to treat displaced fractures in the distal radial metaphyseal and dia-metaphyseal fractures in children. Materials and Methods: We conducted a retrospective analysis of 18 patients who received antegrade elastic wires treatment for distal radial fractures from January 2019 to January 2023. The surgical indications encompassed closed, significantly displaced, and unstable fractures located in the metaphysis or diaphyseo-metaphyseal region of the radius. The fractures were stabilized using two prebent short elastic nails that were introduced from the diaphysis to the metaphysis. In instances when an ulnar fracture was present, a traditional anterograde nailing procedure was also carried out. A long or short arm plaster cast was administered for a duration of 3 weeks. Results: The group consisted of 15 boys and 3 girls, with an average age of 10.8 years (ranging from 7 to 16 years). The right hand was implicated in 12 instances, whereas the left hand was implicated in 6 instances. The mean duration of follow-up was 7.8 months, with a range of 4 to 28 months. Out of the 18 patients, 2 individuals experienced skin irritations, which were resolved after the removal of the radial nails. All patients had complete restoration of their range of motion and experienced successful bone healing without any problems. Conclusions: An antegrade elastic wire fixation is a very efficient, secure, and readily replicable technique for treating unstable fractures of the distal radius, while also preventing harm to the physeal plate. It successfully attains favorable functional and radiological outcomes and allows early mobilization. Keywords: Distal radius, Metaphyseal fracture, dia-metaphyseal fractures, Elastic wires, Antegrade.

Comparison of cranial versus medial minimally invasive plate osteosynthesis applications for the stabilization of simulated radius and ulna fractures in dog cadavers.

Minimally invasive plate osteosynthesis (MIPO) is an emerging fracture management modality in small animal orthopedics. Although cranial plate application has been consistently advocated when performing radial MIPO, medial plating affords several purported advantages including improved screw purchase through the wider medial-to-lateral dimension of the radius, the potential to use smaller plates allowing more screws per unit length, and avoidance of extensor tendons which can complicate cranial plate placement in distal diaphyseal or metaphyseal fractures. To compare cranial versus medial MIPO applications for the stabilization of diaphyseal radius and ulna fractures in dog cadavers. Simulated bilateral antebrachial fractures were stabilized with cranial MIPO on one forelimb and medial MIPO on the contralateral limb, facilitated by a two-ring circular fixator construct. Procedure times and ease, number of fluoroscopic images obtained, and post-procedural frontal and sagittal alignment and radial length were compared between plating groups. The ease of construct placement, fracture reduction, radial approach, and plate application, were subjectively scored 1-5 for each procedure. Paired t-tests were performed to identify significant differences (p < 0.05) between the two plating groups. There was no difference in total or incremental procedural times, subjective ease scores, or the number of fluoroscopic images obtained between plating groups. Both plating groups had comparable post-procedural frontal and sagittal plane alignment. There was a significant difference between plating groups for final radial length (p = 0.004) and change in radial length compared to the intact radii, (p = 0.002). Medial-plated radii measured longer than cranial-plated radii. The only outcome measure significantly different between plating groups was the post-procedural radial length. The change in length compared to intact radii was <1%, regardless of the plating group, and unlikely to be clinically relevant.

Use of poller screw in proximal and distal metaphyseal fractures of tibia treated with intra-medullary inter-locking nail: A prospective study of 25 patients

Introduction: Treatment of tibia metaphyseal fractures is still difficult. Interlocking tibial fractures is preferred because it allows for some load sharing, preserves extraosseous blood flow, avoids major soft tissue dissection, and is well-known by most surgeons. Nailing of metaphyseal fractures with a short proximal or distal fragment is linked to increased malalignment, especially in the coronal plane, non-union, and the necessity for subsequent treatments to accomplish union. Blocking screws (poller screws), temporary unicortical plating, alternative nail designs with variable proximal bends (proximal third fractures), and fibular plating have all been proposed to better nailing metaphyseal fractures (distal third fractures).''The study's goal was to see if poller screws might be used as a supplement to stability in tibia metaphyseal fractures treated with a statically locked intramedullary nail. Materials and Methods: It was a prospective trial in which 25 patients with extraarticular Tibia metaphyseal fractures presented between July 2020 and December 2021 were treated with an Intra-Medullary Inter-Locking nail augmented with Poller screws and observed for six months. Results: The average age was 45.92 years, with a male majority.

Is three-point index reliable in the follow-up of the distal radius metaphys fractures in the pediatric age group?

Three-point index (TPI), which can be used in the follow-up of conservative treatment, is an important indicator and reveals objective results about the fracture redisplacement. The hypothesis of the current study was that an initial TPI value of 0.6-0.8 may also be dangerous as it has the potential to exceed over 0.8 before a sufficient consolidation occurs and a prompt revision of the cast may prevent an upcoming displacement. This prospective controlled study 84 patients between 4 and 16 years of age, with radius distal metaphyseal fractures with more than 30% displacement or more than 15° initial angulation, were included. All of the patients in the groups had no redisplacement at 5-7 days and had TPI between 0.6 and 0.8. The patients who had cast replacement and adjusted TPI below 0.6 were included Group 1. The patients who had no cast replacement were included in Group 2. Redisplacement was observed in 8 of 38 (21%) patients in the Group 1 and in 27 of 46 (58%) patients in the Group 2 ( P value 0.001). Redisplacement with cast revision was 2.8 times less ( P < 0.005). The first reduction quality, fracture obliquity, renewed TPI values were found to be statistically significant for the prediction of redisplacement ( P < 0.005). We recommend that the follow-up of the TPI is an important predictive factor in the conservative treatment of pediatric metaphyseal radius fractures. TPI may be renewed for protection of the fracture reduction when calculated in the gray zone which is 0.6-0.08.

Functional Outcome of Closed Static Intramedullary Nailing with Distal two Plane Locking Versus Percutaneous Mippo Distal Tibial Locking Plate in Distal 3rd Tibia Metaphyseal Fractures

Objective: Aim of current study was to determine the functional outcomes of closed static intramedullary nailing with distal two plane locking versus percutaneous MIPPO distal tibial locking plate in distal 3rd tibia metaphyseal fractures. Study Design: Randomized clinical trial Place and Duration: Nishtar Hospital Multan/Qaisrani Medical Center Multan. Jan 2021-March 2022 Methods: There were 76 patients of both genders with age 15-60 years presented. All the patients had 3rd tibia metaphyseal fracture were admitted to hospital for surgery. Following the collection of informed written consent from enrolled patients, complete demographic information was gathered. Patients were equally divided into two groups. Group I received intramedullary nailing with distal two plane locking and group II received percutaneous MIPPO distal locking plate. Favorable and unfavorable outcomes among enrolled cases were compared. SPSS 22.0 was used to analyze all data. Results: There were majority males 22 (60.5%) in group I and 20 (52.6%) in group II. In group I mean age was 30.8±6.42 years with mean BMI 24.71±3.19 kg/m2 and in group II mean age was 31.14±3.58 years and had mean BMI 25.7±7.17 kg/m2. Falling, accidents, sports and lifting of heavy object was the most common cause of fractures. We found that intramedullary nailing was more effective as compared to MIPPO distal locking plate in terms of functional outcomes but difference was insignificant. Frequency of complications were higher in group II found in 14 (36.8%) as compared to group I in 4 (10.4%) cases. Conclusion: We concluded in this study that distal third tibial metaphyseal fractures were effectively operated by intramedullary nailing distal two plane locking and MIPPO distal locking plate but frequency of complications were higher in MIPPO group as compared to intramedullary nailing. Keywords: Metaphyseal Fractures, MIPPO Distal Platting, Intramedullary Nailling, Functional Outcomes, Complications

Fixed-angle plate fixation and autogenous iliac crest graft for repair of distal metaphyseal femoral nonunion.

To analyze clinical, radiographic and patient-reported outcomes of distal metaphyseal femoral nonunions treated with fixed-angle plates and screws. All patients presenting with a distal metaphyseal femoral fracture nonunion repaired with fixed-angle plating from one urban level 1 trauma center and an orthopedic specialty hospital were identified. Baseline demographic, injury information, and outcomes (healing rates, Short Musculoskeletal Function Assessment, range of motion, and post-operative pain levels) at 12months following nonunion repair were collected. Outcomes were evaluated between patients fixed with a blade plate and with a locking plate. Of these 31 patients, 27 (87.1%) healed after their index nonunion surgery, 2 (6.5%) healed after one reoperation, 1 (3.2%) healed after 2 reoperations, and 1 (3.2%) had a persistent nonunion but did not want further treatment. At one-year follow-up, the group demonstrated a significant improvement in functional recovery with a mean difference of 14.5 points (p = 0.007) when compared to status before fixed-angle fixation of the nonunion. There was also a significant change in patient-reported pain levels using the VAS scale with a mean difference of 2.0 points (p = 0.009). At one-year follow-up, 11 (39.3%) had full knee range of motion (0-130), 11 (39.3%) had flexion greater than 90 and less than 120°, and 6 (21.4%) had range of motion less than 90°. Patients who undergo fixed angle plating and autogenous bone grafting for distal femoral metapyseal nonunionsdemonstrate improved functional outcomes and VAS pain score at one year follow up.

Comparison of Closed Intramedullary Nailing and Percutaneous Plating in Distal Tibia Metaphyseal Fractures

Objective: To compare the closed intramedullary nailing and percutaneous plating in distal tibial metaphyseal fractures. Study Design: Retrospective study Place and Duration of Study: Department of Orthopaedics, Sialkot Medical College, Sialkot from 1st July 2019 to 31st December 2021. Methodology: One hundred patients who were suffering from distal metaphyseal fractures of the tibia bone were enrolled. Group A patients underwent closed intramedullary nails while group B were those who were treated through percutaneous plating. Prophylactic antibiotics were given to all enrolled patients until 24 hours’ completion of the surgery. Follow-up of the wound was done from day fifth of the surgery and removal of sutures was performed by 15th day of surgery. Patients were followed up for one and a half year for their AOFAS scoring. Results: There were 58.3% males in Group A presenting a majority while in Group B females were having a majority with 47.5%. There were more left side fractures such as 53% and treated with closed intramedullary nails than through percutaneous plating. There was not a significant difference in the pain, function or alignment in both groups. There were 87% patients in group A which requested implant removal after 15.5 months while 92% of patients from Group B demanded the same. Conclusion: Intramedullary nailing is slightly superior that have reduced post-operative wound complications as compared to plate fixation. Keywords: Nailing, Plating, Fractures, Surgical procedures

Functional outcomes of distal tibia fractures treated using the minimally invasive percutaneous plate osteosynthesis technique with a locking compression plate

Background: Distal metaphyseal tibia fractures are difficult to treat owing to their limited blood supply, subcutaneous location, and inadequate soft tissue blanket. Minimally invasive percutaneous plate Osteosynthesis (MIPPO) using a locking compression plate (LCP) is a widely used surgical treatment. It is beneficial for the management of distal tibia fractures. This study aimed to assess the functional outcomes of distal tibia fractures treated with the MIPPO technique with an LCP. Methods: The investigators have conducted this prospective study with thirty patients who presented with distal tibia fractures over 8 months. All patients fulfilling the inclusion criteria and exclusion criteria took part in the study. All the patients were surgically managed by the MIPPO technique with LCP under spinal or general anesthesia. The functional and radiological outcomes were evaluated with the American Orthopedic Foot &amp; Ankle Society (AOFAS) scale. Results: A sizable number of the patients were aged 40–60 years, with a mean age of 49.8 years. Most participants were male (66.67%). The mean duration of surgery was 72.60 ± 5.35minutes. The mean length of hospital stay was 7.22 ± 1.45 days.

Immediate Short-term Outcomes of Distal Radius Metaphyseal Fractures in Children

Immediate Short-term Outcomes of Distal Radius Metaphyseal Fractures in Children

Bioresorbable implants vs. Kirschner-wires in the treatment of severely displaced distal paediatric radius and forearm fractures \u2013 a retrospective multicentre study

BackgroundDistal radius fractures are very common in paediatric patients. Severely displaced fractures may require surgical intervention. The gold standard surgical method is percutaneous K-wire osteosynthesis followed by immobilisation. Metal implants can be removed with a second intervention; however, these extra procedures can cause further complications. Several studies confirm the benefits of bioabsorbable implants for paediatric patients. The aim of this retrospective study was to compare the complication rates of displaced distal metaphyseal radius (AO 23r-M/3.1) and forearm (AO 23-M/3.1) fractures in children operated on with K-wires versus a novel technique with bioresorbable implants.MethodsWe retrospectively reviewed 94 patients in three paediatric trauma centres who underwent operations due to severely displaced distal forearm or metaphyseal radial fractures between January 2019 and January 2020. The mean age was 8.23 (ranging from 5–12). 30 patients (bioresorbable group, BR-group) were treated with biodegradable PLGA implants (Bioretec®, ActivaPin®), 40 patients with one or two stainless steel Kirschner-wires (K-wires, Sanatmetal®) which were buried under the skin (KW I-group) and 24 children with K-wires left outside the skin. (KWII. Group). We examined the number of minor and major complications as well as the need for repeated interventions. Follow-up was at least one and half year.ResultsThere was no significant difference between the complication rates at the two KW groups (p = 0.241; Cramer’s V = 0.211), while the complication rate of the BR group was significantly lower. (p = 0.049; Cramer’s V = 0.293 and p = 0.002; Cramer’s V = 0.418 respectively). No later than half a year after the injury, no difference was observed between the functional outcomes of the patients in each group. One and a half years after the injury, no signs of growth disturbance were found in any of the children. No second surgical intervention was required in the BR group.ConclusionsSurgeries with bioresorbable intramedullary implants may have fewer complications than K- wire osteosynthesis in the treatment of severely displaced distal forearm fractures. The benefits are most pronounced in the first six weeks after surgery, reducing the number of outpatient visits and increasing the child's sense of comfort. As no second intervention is required, this can lead to significant cost savings. After half a year, there is no difference in the outcomes between the different surgical treatment strategies.

ESIN in femur fractures in children under 3: is it safe?

BackgroundPediatric femur fractures are a major trauma in children. Different treatment algorithms have been developed but indications for surgical treatment, especially in very young patients, are still controversial. Literature recommends surgical stabilization with elastic-stable intramedullary nailing (ESIN) starting at the age of 3 and non-operative treatment in younger patients. This study sought to present the outcome of patients younger than 3 years of age treated with ESIN for femur fractures.Materials and methodsInclusion criteria were patients younger than 3 treated with ESIN in femur fractures. Patient demographics, fracture characteristics, mechanism of injury, outcomes and complications were recorded using charts and X-rays. Primary outcome measures were time to mobility, fracture consolidation and surgical-related complications.ResultsBetween 2010 and 2020, 159 patients were treated with ESIN in femur fractures in our institution. A total of 30 patients met the criteria. The mean age was 2.1 ± 0.7 years (13 months–2.9 years). Most common mechanism was fall from standing height (60%). Other mechanisms were motor vehicle accidents as a pedestrian (10%) or as a passenger (10%) as well as direct blow trauma (20%). Femoral shaft fracture was the most common injury (80%). 5 subtrochanteric and one distal metaphyseal femur fractures were found. Mean length of stay was 2.0 ± 1.3 days. Radiographic controls were performed on day 1, 14 and 6 weeks after surgery if not otherwise specified or if complications occurred. 4.6 ± 1.2 (n 2–7) X-rays were performed on average after surgery. First radiographic consolidation signs were seen after 2.4 ± 0.6 weeks. Only one child showed surgical-related complication with a leg length discrepancy of 1 cm. In 10% of the patients, shortening after surgery of 1.7 ± 1.4 mm (0.3–3.1 mm) occurred. One child initially treated with traction therapy showed skin irritations and was operated with ESIN. No non-union or ESIN-related complications were found. Mean follow-up was 5.1 ± 4.4 months (4–24 months). First independent mobilization was seen at an average of 3.4 ± 1.1 weeks (2–6 weeks) after surgery. Implant removal was performed after 3.2 ± 1.3 months (2–8 months). No refracture after implant removal occurred.ConclusionEarly results with ESIN show a reasonable and safe treatment option for femur fractures in toddlers and young children under the age of 3 with easy postoperative care, fast fracture union and early independent mobilization.