Open Anatomic Reduction Research Articles

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

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

A Staged Protocol for Treatment of High-Energy Tongue-Type Calcaneus Fractures: Surgical Technique and Case Series.

Displaced tongue-type calcaneus fractures are frequently associated with severe soft tissue injuries, and urgent relief of the displaced tongue fragment on the posterior soft tissues is essential to preventing soft tissue complications. If there is a complex articular injury, the soft tissue envelope often needs time for swelling to resolve to allow for a safe open anatomic reduction because premature open reduction internal fixation is often associated with increased complications. We have found that in high-energy tongue-type calcaneus fractures with complex articular injuries, a staged protocol consisting of initial percutaneous reduction and fixation with later definitive reconstruction is soft tissue friendly, allows early restoration of calcaneal morphology, and affords extensile approaches for eventual reconstruction. The purpose of this study was to describe our protocol of staged treatment of high-energy tongue-type calcaneus fractures, along with postoperative surgical outcomes, in a case series of 53 patients.Our series of patients had a high rate of intra-articular injury with marked initial displacement (mean Bohler angle -8.4±20.8 degrees). They were treated initially with percutaneous reduction and fixation at median 1 day postinjury (interquartile range [IQR] 0-1) and definitively at median 16 days postinjury (IQR 10-33). In this series, 2 of 53 (3.8%) patients developed a deep wound infection.In high-energy tongue-type calcaneus fractures at risk for soft tissue compromise or with a significantly displaced tongue fragment without initial soft tissue compromise, we found that staged management represents a feasible management strategy to mitigate risk of soft tissue complications and therefore helps facilitate safe definitive open treatment.

Open anatomical reduction by anterior transverse mini approach for the treatment of distal humeral epiphyseal separation in young children.

The treatment of distal humeral epiphyseal separation (DHES) in young children includes closed reduction and cast immobilization or fixation by Kirschner (K) wire with the assistance of an elbow joint arthrogram. In this study, we aimed to introduce and evaluate open reduction using an anterior transverse mini approach in the treatment of DHES in young children. We retrospectively analyzed the clinical data of patients diagnosed with DHES at our hospital between January 2015 and December 2019. After applying the inclusion and exclusion criteria, 70 patients were included in this study. The fracture type was classified using DeLee's classification. The conservative group (14 patients; group A) underwent closed reduction and cast immobilization. Open surgery was performed using an anterior mini-transverse approach, and K-wires were used for fixation in group B (56 patients). After 3-5 weeks, the K-wires were removed following radiographic confirmation of callus formation. All elbow functions were evaluated using Flynn's criteria. Complications such as cubitus varus, nerve palsies, incision infection, and K-wire skin irritation were analyzed. According to DeLee's classification, in group A, five, four, and five patients were of types A, B, and C, respectively. In group B, 11, 10, and 35 patients were of types A, B, and C, respectively. There was a significant difference in Flynn's criteria ( P = 0.0007). In groups A and B, five and four patients developed cubitus varus, respectively, with a significant difference observed in the complication rate ( P = 0.0127). Five patients developed K-wire skin irritation. Nerve injury was not observed in either group. One patient in group B had avascular necrosis of the trochlea. Open anatomic reduction via the anterior mini-transverse approach can be a choice of treatment for DHES in young children. Level of evidence: IV.

Effect of Different Reduction Intramedullary Nails on Spiral Fracture of Middle and Lower Tibia.

Objective To compare the efficacy of different reduction and intramedullary nailing in the treatment of spiral fracture of middle and lower tibia. Method A total of 96 patients with spiral fractures of middle and lower tibia treated with intramedullary nails were retrospectively analyzed. The patients were divided into closed functional reduction group, open anatomical reduction group, and closed anatomical reduction group according to different treatment methods. The operation time, intraoperative blood loss, intraoperative fluoroscopy times, fracture healing time, fracture nonunion, wound complications, and healing conditions of the three groups were compared. Results The operation time and intraoperative fluoroscopy times of patients in the closed anatomical reduction group were significantly increased compared with those in the closed functional reduction group, while the fracture healing time was significantly reduced. However, patients in the open reduction group had significantly more intraoperative blood loss than those in the closed reduction group. The mean follow-up duration of patients was 15.81 ± 3.25 months. Open anatomical reduction was found to have a higher complication rate during follow-up. Specifically, a total of 3 cases recovered after 2 times of surgical treatment. 6 cases showed a small gap at the fracture end which did not affect the function. Conclusion In the treatment of middle and lower spiral fracture of tibia, closed anatomical reduction and intramedullary nail internal fixation have shorter fracture healing time, less blood loss, and fewer complications, which can act as the first surgical choice. However, open reduction and intramedullary nailing have a high complication rate, which is not recommended.

Weber C Fractures Treated with ORIF, Syndesmotic Dynamic Fixation and Open Deltoid Repair: Clinical and Radiographic Evaluation after Minimum 12 Months

Category:Trauma; AnkleIntroduction/Purpose:Ankle fractures are among the most common fractures in the body and it can affect not only professional athletes but also lower activity level and sedentary patients. The standard treatment for displaced fractures is open reduction and internal fixation. Even though the management for Weber B and C fractures is well stablished in the literature, deltoid ligament repair is still debatable. Medial ligament instability is a result of deltoid ligament failure and usually leads to valgus deformity of the ankle and severe morbidity over time. The primary objective of this study is to analyze clinically and radiographically, patients with Weber C fractures and deltoid ligament injury who were submitted to fibular fracture and syndesmotic fixation, associated with deltoid ligament repair.Methods:Forty one patients who had Weber C fractures with deltoid ligament lesion from January 2013 to December 2019 had their medical records and X-Rays reviewed by a fully trained foot and ankle surgeon. The patients were between 14 and 69 years old and had their medial clear space wider than 4mm on initial X-Rays (our criteria for deltoid ligament lesion). Patients with Weber A or B, diabetics and with previous surgeries on the ankle were excluded. Patients were submitted to open anatomic reduction and fixation of the fibula, the syndesmosis was fixed with dynamic fixation system and the deltoid was reattached to the tip of the medial malleolus with one suture anchor. Medial Clear Spcace, Tibiofiluar clear space and Tibiofibular overlap were measuresd on weight bearing X-Rays done on the last follow up visit. FAAM sports Subscale17 and VR12 were used to evaluate clinical status of our patients.Results:Forty one patients were analyzed on this series after 22 months on average. The mean age at operation was 37.7 years old. There were 32 males and 9 females. Mental and Physical VR-12 scores went from 56 and 37 pre-operatively to 57 and 50 on their final evaluation. Activity Daily Living and Sports FAAM scores improved from 27 and 7 to 19 and 88 respectively. Post- operative mean medial clear space was 3mm, and mean tibio-fibular clear space was 5mm. The average tibio-fibular overlap percentage was 46%. Patient's overall satisfaction rate was 86.7%.Conclusion:Weber C fractures with Deltoid ligament lesion can be successfully treated with anatomic reduction, syndesmotic fixation (dyanamic systems) and open deltoid repairs. Patients show excellent reduction parameters on weight-bearing X-Rays and good clinical outcomes after a minimum 12 months follow up. Comparative studies with and without deltoid ligament repair should be performed to compare two techniques. Weight-bearing CT scan could be used in future studies for more accurate evaluation of the syndesmotic reduction and medial clear space.

Medial talonavicular dislocation with nondisplaced navicular fracture: A case report.

IntroductionTalonavicular dislocation is a rare injury that usually occurs following high-energy trauma. The mechanism of injury is a force of abduction or adduction applied to the forefoot. In this article, we present a rare case of medial talonavicular dislocation with a fracture of the navicular following low-energy trauma.Presentation of caseWe report a case of talonavicular dislocation with a navicular fracture in a 25-year-old male. He presented at the emergency department with a history of twisting injury to his left foot. Physical examination revealed an obvious deformity of his foot associated with tenderness. No neurological deficit was present. Radiograph and CT scan showed medial talonavicular dislocation and postero-lateral navicular fracture. Closed reduction was done followed by six weeks in a cast. The patient was followed up for six months and no complications were reported.DiscussionTalonavicular dislocation is commonly associated with ligamentous disruption and midfoot fractures. Most studies reported this type of dislocation in association with a fracture of the navicular, cuboid, talus, calcaneus or metatarsal bones as a result of high-energy trauma. However, in our case, the dislocation resulted from low-energy trauma and was associated with a nondisplaced fracture of the navicular and a minimally impacted fracture of the talus that was treated conservatively.ConclusionSince this type of dislocation is rare, it is important to recognize it early to avoid complications such as painful equinovarus deformity. Early reduction and immobilization is the ideal treatment for this injury.

The Role of Medial Buttress Plate Augmentation of Cannulated Screws in Unstable Femoral Neck Fractures: A Pilot Study

Background: About 20% of femoral neck fracture surgeries require re-operation. The use of medial buttress plate may reduce the reoperation rate. The purpose of this study is to examine the results of using the method of augmentation of the cannulated screws with medial buttress plate for treatment of unstable femoral neck fractures. Methods: This study included patients with femoral neck fractures of Pauwels type 2 and 3 in which closed reduction was not successful. The patients underwent open anatomical reduction and implantation of three screws, and then the medial placement of the buttress plate was performed. Patients were followed up after 2 weeks, 6 weeks, 3 months, and 6 months. Union and fracture healing and operative complications were assessed using plain radiography. Results: This study included 8 patients with Pauwels type 2 and 3 femoral neck fractures. All patients were men with the mean age of 38.0 ± 11.3 years. Re-hospitalization 30 days after surgery, surgical site infection, deep vein thrombosis (DVT), and deep infection were not observed in any of the patients. The angle between the neck and the femur shaft dramatically increased during the 6-month follow-up (P = 0.049). Union occurred in 6 (75%) patients after 6 months, while 2 patients were lost to follow up. Participants’ Harris Hip Score (HHS) had a significant improvement from 3 months to 6 months after surgery (P = 0.02). Conclusion: Augmentation of cannulated screws with medial buttress plate for unstable femoral neck fractures in patients has advantages in short-term clinical follow-up.

An unprecedented case: Salter Harris II Gartland modified IV fracture of the humeral palette with metaphyseal fragment olecranon fossa. Review of literature.

Background. The Salter-Harris II fracture is the most common transphyseal fracture of all types of fractures, per-total and for each bone extremity that has a growth cartilage. This type of fracture rarely occurs in the humeral palette and the metaphyseal fragment is located laterally or medially. No cases with ventral or dorsal metaphyseal fragment have been described. Purpose. To bring into notice a fracture, type Salter-Harris II, with posterior metaphyseal fragment, represented by a posterior corticospongiosis lysereum(thickening) and the olecranon fossa, associated with periosteal rupture and soft tissue interposition. Study design: Case report Methods: A 9-year-old patient shows signs of traumatic injury, as a result of a direct impact on the right elbow. After a radiological examination, the diagnosis of Gartland type III supracondylar fracture is established, a closed reduction is practiced and it is immobilized in a plaster cast. The radiological control after the orthopedic reduction highlighted an unsatisfactory reduction. A surgery and an open reduction and internal fixing in "double X" were performed. Results: The preoperative diagnosis of Salter-Harris II fracture, with posterior Holland fragment, was made with difficulty and may be a surprise on intraoperative exploration. Open anatomical reduction and the fixation in "double X" allowed a firm synthesis of the fracture, verification of stability, intraoperatively, lack of mobilization in the plaster splint, starting recovery on the first postoperative day and full recovery of elbow mobility in 32 days. Conclusions: Salter Harris type II fracture with posterior fragment dislocated by tilting, translation and asymmetric rotation, irreducible is operated by open reduction and internal fixation. The fixation in "double X" ensured a better stabilization and allowed the recovery of flexion and extension in 32 days from surgery.

Acute Airway Compromise After Isolated Mandibular Subcondyle Fracture in a Patient With a Hemi-Mandible: A Case Report

Evaluation of the airway is the first step in any trauma protocol, and this is particularly important in instances of facial trauma. While airway compromise is not uncommon in blunt or penetrating facial trauma, it is rarely a significant concern in instances of an isolated mandibular fracture. We report a rare case of immediate airway compromise in an elderly, edentulous female who sustained an isolated mandibular subcondyle fracture, complicated by her history of a remote hemimandibulectomy for management of her oral cancer. Initial airway management was performed conservatively with prone or lateral positioning under continuous pulse oximetry monitoring in the intensive care unit, followed promptly by open anatomic reduction and internal fixation of the fracture under more optimal operative conditions. After stabilizing the subcondylar fracture, the patient followed a mechanical soft/no-chew diet for 6 weeks until the fracture was healed. She has experienced no airway concerns since her surgery. This case report stresses the importance of a comprehensive evaluation of the airway in facial trauma patients with altered baseline anatomy, as well as highlights the considerations for emergent surgical airway versus immediate or delayed surgical fracture fixation.

A study of functional outcome of closed ankle fractures treated by open reduction and internal fixation

Background: Ankle fractures are one of the most common injuries of the lower limb 3 treated by orthopaedic surgeons, with an incidence of 107 fractures per 100000 person- years. 4 Up to 12% of emergency presentations involve an ankle injury. There has been an increase in the prevalence of ankle fractures over the past two decades both in the young, active patients and in the elderly [5, 6]. Injuries around the ankle joint cause destruction of not only the bony architecture, but also often the ligamentous and soft tissue components [7]. The anatomy of the joint makes it very unstable in cases of fractures or ligamentous injuries around the ankle. Open anatomic reduction and internal fixation are routinely advocated for displaced, unstable ankle fractures [10, 11, 12]. Functional and radiological results were analyzed using the ankle scoring system of Baird and Jackson [16]. The objective of this study is to analyse the patterns and causes of ankle fractures as well as to assess the functional outcome and results of surgically treated ankle fractures performed at our institution.

Anterior fracture dislocation of the proximal humerus

Anterior fracture dislocations are among the most severe forms of proximal humeral fractures. Because of potential devascularization of the humeral head, it is unclear whether open reduction and internal fixation (ORIF) offers superior results to primary hemiarthroplasty (HAS) or reverse shoulder arthroplasty (RSA). We retrospectively compared functional outcomes, complications, and revision surgeries after ORIF, HSA, and RSA in 81 patients with anterior fracture dislocations. Functional results were assessed with the age- and gender-normalized Constant Score (nCS). Of 81 anterior fracture dislocations, 40 (49.4%) were treated by ORIF (mean age 61.5 ± 13.9 years, range 29–89), 19 (12.3%) by HSA (mean age 71.6 ± 10.1 years, range 53–85), and 22 (27.2%) by RSA (mean age 79.8 ± 10.8 years, range 58–91). Of 81 patients (75.8% women, mean age: 67.4 ± 12.5 years, range 29–91 years), the mean nCS after 3.4 ± 2.9 years of follow-up was 63.4 ± 10.3 after ORIF, 52.4 ± 12.9 after HSA, and 74.5 ± 11.1 after RSA (ANOVA, p = 0.001). The complication rate in ORIF procedures was 22.5% (secondary displacement n = 2, avascular necrosis n = 7), in HSA, 36.8% (tubercle dislocation n = 4, tubercle resorption n = 2, septic loosening n = 1), and RSA, 13.6% (acromial fracture n = 1, tubercle displacement n = 1, tubercle resorption, n = 1; p < 0.001). Avascular necrosis was observed in 17.5% of cases following a primary head-preserving treatment. Treatment of anterior fracture dislocations is demanding. Open anatomic reduction and internal fixation can lead to good and excellent functional outcomes in young patients with good bone quality and should be performed in these patients as soon as possible. Elderly and frail patients may profit from RSA as a primary treatment. HSA should be reserved for cases where anatomic reduction and stable fixation in patients <65 years has failed; however, functional outcomes are poor.

Management of Pediatric Ankle Fractures.

Summarize classic and recent information regarding the unique subset of ankle fractures in children with open growth plates and share the authors' decision-making and surgical techniques. Recent research on pediatric ankle fractures has centered on the accurate prediction and prevention of growth arrest following fractures of the distal tibia. Another source of discussion is the necessity and benefit of CT scanning in classification and treatment approach. Pediatric ankle fractures continue to pose clinical challenges for orthopedic surgeons. While open anatomic reduction and internal fixation continue to produce good outcomes for intra-articular fractures, outcomes of physeal injuries are more difficult to predict. More studies are needed to determine which patients may benefit more from surgical treatment of physeal injuries.

Plate and Screw Versus Intramedullary K Wire for Fixation of Unstable Metacarpal and Phalangeal Fractures

Background: Unstable metacarpal and phalangeal fracturesrepresent more than one third fractures of the hand. The severethe trauma, the more grave the fracture that herald perfectmanagement is needed.Objective: Assessment of the clinical and radiologicaloutcomes of metacarpal and proximal phalangeal fractures inpatients who underwent open anatomic reduction and fixationwith plate and screws or by intramedullary K wire fixation.Patients and Methods: Twenty five patients with unstablemetacarpal and phalangeal fractures were treated; in group I12 male patients operated by plate and screw fixation andgroup II 13 male patients operated by intramedullary K wirefixation. For the two groups total active motion TAM, DASHscore, postoperative lateral angulation, loss of reduction andradiological healing were assessed.Results: There was a non-significant difference betweengroup I (Plate and screw fixation) and group II (Intramedullarynail fixation) as regard the follow-up period or associationbetween loss of reduction and removal of hard ware (p>0.05).Group I showed a significant increase in the mean values ofsurgery duration and TAM (p<0.05), accompanied by a significantreduction in the mean values of DASH score, postoperativelateral angulation and radiological healing in comparisonto those group II (p<0.01).Conclusion: The operative duration of plates and screwsfixation was longer than that of K wire fixation, but it hadperfect stability with early mobilization, therefore, whenpossible it is preferred to be the first line of choice in managementof unstable metacarpal and proximal phalangeal bonefractures

Lussazioni del carpo

Carpal instabilities are uncommon and challenging lesions resulting from high energy traumas, often affecting young patients. They can result in significant morbidity and disability if inadequately treated. Their anatomy is complex and some aspects of their pathomechanisms still need to be clarified. The diagnosis is often difficult and can be missed in up to 25% of cases, especially in pure ligamentous lesions. Treatment must be prompt, and open anatomic reduction of any carpal malalignment is essential for a successful outcome.

A study of efficacy of locking versus dynamic compression plates for diaphyseal forearm fractures

Fractures of the forearm bones may result in severe loss of function unless adequately treated. Severe loss of function may result even though adequate healing of the fracture occurs 1, 4. Fractures of the forearm present a unique management problem for years. A forearm fracture involving both bones requires open anatomical reduction with stable fixation. 2, 3 various treatment modalities were introduced from time to time and each of them had some edge over the previous one. The forearm represents the critical anatomic unit of upper limb, permitting the effector organ of the upper limb, the hand, to perform multiaxial daily activities of living. Historically, the closed management of forearm fractures has been met with frustration in adults and resulted in poor functional outcome, hence perfect fracture reduction and rigid fixation is mandatory and achieved by plating. 3, 5, 7 The number of forearm fractures is increasing faster than the predicted rate due to increasing number of road traffic accidents, increased incidence of violence, rapid industrialization, and various sports activities. Conservative treatment has resulted in malunion, non-union, synostosis and ultimately poor functional outcome 4, 6, 7. compression techniques have a lower incidence of non-union and are found to hasten rehabilitation, with less joint stiffness.the various modalities of plating have developed each has edge over the other. there are very less studies on indian population this study has taken up to analyse the outcome between two most commonly used plates in forearm shaft fracture treatment i.e DCP (dynamic compression plate) and LCP (locking compression plate). Aims and Objectives of The Study: 1) To study and compare the functional and radiological outcome after surgical intervention by using and open reduction and internal fixation with dynamic compression plating vs locking compression plate in the treatment of closed diaphyseal fractures of forearm. 2) To study and compare the complications associated with these two modalities of the treatment. Materials And Methods: About 60 patients with both bone forearm fractures treated with LCP or DCP in RLJ hospital attached to Sri Devaraj Urs Medical College between maech 2013 to june 2017, will be taken up for the study after obtaining the informed consent. This is a retrospective study with follow up period of 6 months minimum. The functional outcome was assesed according to Anderson scoring system which included evaluation of the movements and the radiological union. Conclusions: Statistically, both LCP and DCP have similar outcomes in the treatment of diaphyseal fractures of both bones forearm. Whereas, LCP group had a faster recovery as compared to DCP group. Thus, we conclude that both LCP and DCP have similar results for the diaphyseal fractures.

Short-Term Outcomes of Open Reduction and Internal Fixation for Sanders Type III Calcaneal Fractures With and Without Bone Grafts

Calcaneal fractures, often caused by a fall from a height, are the most common injuries encountered by orthopedic surgeons. Currently, open anatomic reduction and internal fixation (ORIF) is considered a valuable treatment of displaced intraarticular fractures of the calcaneus; however, the need for bone grafting in the treatment is still controversial. Therefore, in the present study, we investigated the outcomes of 2 methods (with and without bone grafting) used for the surgical treatment of Sanders type III calcaneal fractures. From January 2013 to September 2015, 57 cases (55 patients) with displaced Sanders type III calcaneal fractures (53 unilateral and 2 bilateral) were enrolled. The patients were divided into 2 groups: group I was treated by ORIF with bone grafting (n = 28) and group II was treated by ORIF without bone grafting (n = 29). The radiologic evaluation included Böhler's angle, Gissane's angle, and the height and width of the calcaneum. In addition, the American Orthopaedic Foot and Ankle Society questionnaires and visual analog scale were completed by the patients. During the follow-up period, no differences were found in the outcome measures (Böhler's angle, p = .447; Gissane's angle, p = .599; calcaneal height, p = .065; calcaneal width p = .077; and American Orthopaedic Foot and Ankle Society questionnaires, p = .282) with or without bone grafting. The only difference between the 2 groups was the occurrence of postoperative pain (p = .024 and p = ≤ .05), which was greater in the patients who had undergone bone grafting. We have provided evidence that bone grafting with internal fixation in the treatment of intraarticular calcaneal fractures failed to improve the restoration of Böhler's angle or Gissane's angle. No statistically significant difference was found in the short-term outcomes between the 2 methods used for the surgical treatment of Sanders type III calcaneal fractures.

Focal osteonecrosis in the femoral head following stable anatomic fixation of displaced femoral neck fractures.

Femoral head (FH) osteonecrosis (ON) and subsequent segmental collapse is a major concern following displaced femoral neck fractures (FNF). We aimed to quantify residual perfusion to the FH following FNF and evaluate the viability of the FH overtime after surgical fixation. Twenty-three patients with FNF underwent dynamic contrast-enhanced (DCE)-MRI to estimate bone perfusion in the FH, using the contralateral side as control. Following open anatomic reduction and a length/angle-stable fixation, a special MRI sequence evaluated the FH for ON changes over time at 3 and 12months after surgery. We found significant compromise of both arterial inflow [83.1%-initial area under the curve (IAUC) and 73.8%-peak) and venous outflow (243.2%-elimination rate (K el)] in the FH of the fractured side. The supero-medial quadrant suffered the greatest decrease in arterial inflow with a significant decrease of 71.6% (IAUC) and 68.5% (peak). Post-operative MRI revealed a high rate (87%-20/23) of small ON segments within the FH, and all developed in the anterior aspect of the supero-medial quadrants. Fracture characteristics, including subcapital FNF, varus deformity, posterior roll-off ≥20° and Pauwel's angle of 30°-50° demonstrated a greater decrease in perfusion compared to contralateral controls. FNF significantly impaired the vascular supply to the FH, resulting in high incidence of small ON segments in the supero-medial quadrant of the FH. However, maintained perfusion, probably through the inferior retinacular system, coupled with urgent open anatomic reduction and stable fixation resulted in excellent clinical and radiographic outcomes despite a high rate of small ON segments noted on MRI. Level I: Prognostic Investigation.

Open reduction and internal fixation for capitellum fractures in adolescents

Objective To report the clinical outcomes of open reduction and internal fixation for capitellum fractures in adolescents. Methods From January 2010 to January 2015, 14 adolescents with capitellum fracture were admitted to our department. They were 12 males and 2 females, aged from 12 to 16 years (13.7 years). By the Dubberley classification, we had 2 cases of type ⅠA, 8 cases of type ⅡA, 3 cases of type ⅢA and one of type ⅢB. We summarized their clinical characteristics and injury mechanisms. At the last follow-up, the therapeutic efficacy was assessed by the Mayo elbow function scores, and the ranges of motion of the elbow and forearm on the affected side were recorded. Results The 14 patients obtained an average follow-up of 12 months (from 6 to 18 months). All the cases achieved fracture union within 3 months, but malunion appeared in one. At the last follow-up, the ranges of flexion and extension of the affected elbow averaged 120.6° (from 110° to 135°), and the ranges of lateral rotation of the affected forearm averaged 160.3° (from 150° to 175°). According to the Mayo scores at the last follow-up, the elbow function was rated as ex-cellent in 12 and as good in one. Mild traumatic arthritis occurred in 3 cases. Conclusions Capitellum fractures in adolescents are often Dubberley type A ones without a complicated fracture of the posterior condyle. Usually, the capitellum is impacted by the radial head in the process of elbow extension with valgus stress. After definite diagnosis, open anatomical reduction and reasonable and reliable internal fixation can result in good clinical results. Key words: Elbow joint; Fracture fixation, internal; Adolescent; Injury mechanism

Does intra-articular load distribution change after lateral malleolar fractures? An in vivo study comparing operative and non-operative treatment

PurposeThe impact of isolated malleolar fractures on the intra-articular load distribution within the ankle joint has been studied in several biomechanical cadaver studies during the last decades. Recently, computed tomography osteoabsorptiometry (CT-OAM) has been proposed as a valuable tool to assess intra-articular joint load distribution in vivo. The purpose of this retrospective matched pair analysis was to apply CT-OAM to evaluate in vivo changes of talar load distribution after lateral malleolar fractures in patients treated with open anatomic reduction and internal fixation (ORIF) compared to patients treated non-operatively. MethodsTen matched pairs of patients with isolated lateral malleolar fractures with a maximum fracture dislocation of 3mm and a median follow-up of 42 month were included into the study. Patients were matched for age, gender, and fracture dislocation. Range of ankle motion (ROM), the AOFAS hindfoot score and the Short Form 36 (SF-36) were evaluated.CT-OAM analysis of the injured and the uninjured contralateral ankles were performed. ResultsPatients treated with ORIF showed a significant lower ROM compared to the uninjured contralateral ankle. No differences were found regarding clinical scores between patients treated by ORIF and those treated non-operatively.CT-OAM analysis showed symmetrical distribution of subchondral bone mineralization in comparison to the uninjured contralateral ankles for both groups of patients. ConclusionsThe data of this study suggest that isolated lateral malleolar fractures with fracture gaps up to 3mm are not associated with a change of the tibio-talar joint load distribution in vivo. Therefore, patients with isolated minimally displaced lateral malleolar fractures may achieve good clinical long-term outcome following non-operative treatment.Level of Evidence: Level III, retrospective cohort study

Protesi di anca su frattura acetabolare in acuto

Acetabular fractures need open anatomical reduction and stable internal fixation. In few cases some authors have suggested total hip replacement to solve complications that may occur in fracture dislocation. We analysed our experience and we concluded that in elderly patients with hip arthritis and fracture dislocation with comminution of the posterior wall there is indication for primary total hip replacement. In order to perform this kind of surgery, surgeons should make comprehensive preoperative planning, considering either trauma principles (reduction and osteosynthesis of the posterior column and wall is always compulsory) or arthroplasty principles (primary and revision devices).