Open Reduction And Internal Fixation For Fractures Research Articles

Cost Effectiveness of Fixation Versus Total Hip Arthroplasty in Vancouver B2 Periprosthetic Femur Fractures: A Predictive Markov Analysis.

Although Vancouver B2 periprosthetic fractures (PPFs) have been historically managed with revision total hip arthroplasty (rTHA), open reduction and internal fixation (ORIF) has been proposed as an alternative option for reasons including lower cost and surgical time. The purpose of this study was to, therefore, create a Markov model to assess the cost effectiveness of ORIF versus rTHA for Vancouver B2 periprosthetic femur fractures and evaluate various inflection points for varying costs and outcome measures. A Markov model was built using discrete and mutually exclusive health states of the hypothetical patient with Vancouver B2 PPF. A decision tree was created on possible outcomes for each health state, using probabilities defined in the recent PPF literature. Direct costs and quality-adjusted life-years for each surgery and complication state were also collected. One-way and two-way deterministic sensitivity analyses were conducted to better understand the effect of 1 to 2 variables on the incremental cost-effectiveness ratio. The hypothetical patient with a Vancouver B2 PPF that was treated with rTHA incurred a cost of $52,559.64 with an effectiveness of 0.71. When treated with ORIF, the cost was $47,371.97 with an effectiveness of 0.38. The incremental cost and effectiveness of rTHA over ORIF were found to be $5,187.67 and 0.33, respectively. The cost of rTHA, the cost of ORIF, and the effectiveness of ORIF were the most influential variables in the model. On two-way sensitivity analysis, rTHA was more cost effective than ORIF within realistic healthcare parameters. From the payer perspective, we estimate that rTHA is more cost effective than ORIF for the treatment of Vancouver B2 PPFs within certain cost and quality-of-life parameters.

Functional Outcomes of Clavicle Open Reduction and Internal Fixation (ORIF).

The clavicle is among the most commonly fractured bones. It can be managed nonoperatively or surgically. Open reduction and internal fixation (ORIF) surgery is thetechnique to help restore the clavicle's anatomy and allow patients to rehabilitate sooner. The current study aims to assess the functional results and problems related to ORIF using plates for displaced midshaft clavicle fracture. This retrospective study was conducted in Heartlands Hospital, Birmingham, United Kingdom. A total of 60 patients who underwent ORIF for displaced midshaft clavicle fracture in Birmingham's Heartlands Hospital from 2016 to 2023 were included in this study. Selected patients were reviewed to determine demographic data, cause of injury, fracture classification, and postoperative complications. All chosen patients were assessed for functional outcomes (Disabilities of the Arm, Shoulder, and Hand Questionnaire [DASH] score-based functional outcome measures). The mean age of patients was 34.75 ± 9.787 years (20-59 years). A total of 60 participants were included in the study, with 43 (71.7%) male and 17 (28.3%) female. In the majority of patients, the left side was affected (34 patients, 56.7%). The mode of injury was a fall from a bike or road traffic accident in 47 (78.3%) patients. The DASH score was excellent (98-100) in 49 (81.7%) patients, good to excellent (93-97) in 10 (16.7%) patients, and fair to good (82-92) in one (1.7%) patient. Of the total patients,48.3% did not experience any complications. Among patients who developed complications, 20% of patients faced adhesive capsulitis or stiffness in the early postoperative period, which was treated with physiotherapy, followed by paresthesia over the surgical site, and anterior chest developed in 13.3%, followed by superficial infection in 3.3%. ORIF for clavicle fractures ensures a high rate of bone union and improved functional outcomes after six months of surgery, with early pain relief and effective anatomical restoration. While it generally offers advantages over conservative methods, it is associated with a risk of adhesive capsulitis or stiffness.

Differences in Intraoperative Fluoroscopic Radiation Exposure during Ankle Fracture ORIF between Orthopaedic Surgery and Podiatry

Category: Ankle; Trauma Introduction/Purpose: Operative ankle fractures pose a unique situation as both podiatrists and orthopaedic surgeons manage these injuries. Intraoperative fluoroscopy is routinely used, however, excessive radiation can be harmful to both the patient and surgical team. The primary aim of this study is to determine if there is a difference in the amount of intraoperative radiation exposure during ankle fracture open reduction and internal fixation (ORIF) when performed by orthopaedic surgeons versus podiatrists. Methods: This is a retrospective review of patients who underwent ankle fracture ORIF at an urban level I trauma center between January 1st, 2018 and April 1st, 2023. The electronic health record was queried using International Classification of Diseases nine and 10 codes associated with ankle fractures. Patients greater than 18 years of age with an ankle fracture managed operatively were included. Subjects were then stratified by procedure. Mean total radiation dose (mRad) and mean total fluoroscopic time (seconds) were then compared between those performed by orthopaedic surgeons and podiatrists. Results: Of the 333 included procedures, 186 were performed by orthopaedic surgeons and 147 were performed by podiatrists. Using multiple linear regression analysis to control for age, sex, race, ethnicity, and body mass index, patients undergoing isolated malleolus ORIF with syndesmosis repair performed by orthopaedic surgery were found to have a significantly lower mean fluoroscopic time compared those performed by podiatry (68.4s versus 104.8.s; p = 0.0280). Additionally, trimalleolar ORIF with syndesmotic repair performed by orthopaedic surgery had a significantly lower mean total radiation dose compared to those performed by podiatry (244.6 mRad v 565.6 mRad; p = 0.0090). Conclusion: Patients and surgical teams are exposed to significantly less radiation in isolated malleolar and trimalleolar fracture ORIF with syndesmosis repair when performed by an orthopaedic surgeon as compared to those performed by a podiatrist.

The Prognosis of the Posterior Malleolar Fracture in the Syndesmosis Injury

Category: Trauma; Ankle Introduction/Purpose: Syndesmosis injuries, often involving the posterior malleolus (PM), are common in rotational ankle fractures. Concomitant intra-articular involvement, along with deltoid ligament rupture and open reduction and internal fixation (ORIF) affects outcomes predisposing to postoperative complications. Our study aims to investigate the outcomes of posterior malleolar fractures with concomitant syndesmosis injuries and identify prognostic factors associated with these injuries. Methods: This retrospective study investigated posterior malleolar ankle fractures with syndesmotic injury in 71 patients between January 2004 and March 2021. Among these, there were 54 cases of trimalleolar fractures and 17 cases of trimalleolar equivalent fractures. After receiving IRB approval from a single Korean center institution, demographic data, revision surgeries, syndesmotic implant removal, deltoid ligament rupture, deltoid ligament repair, types of implants, and insurance status were evaluated by an expert surgeon affiliated with the institution. Weight-bearing plain radiographs were analyzed for various parameters including superior and medial clear space (MCS), tibiofibular overlap, tibiofibular clear space, implant height, fibular shortening, and synostosis. Radiographic parameters were recorded preoperatively, postoperatively, at 3-month follow-up, and final follow-up. CT scans were utilized to assess posterior malleolar fracture involvement and evaluated using the Haraguchi classification. The severity of ankle joint obliteration was determined. Fibular shortening and synostosis presence were assessed from follow-up radiographs. Results: All radiographic parameters showed significant improvement over time (p-=0.001). No significant differences were found between groups with and without deltoid ligament rupture, except for postoperative 3-month TFO, which showed a significantly higher value in group of the deltoid ligament rupture (p=0.001). Fixation of the posterior malleolar fracture was significantly associated with a preoperative MCS with optimal cut off value of 3.72 mm as absolute value and 84% as the percent divided by the superior clear space as in area under curve (p=0.001, AUC=0.717). Male sex was significantly associated with unexpected syndesmotic implant removal. Deltoid rupture was significantly associated with postoperative ankle osteoarthritis. Preoperative TFC and ORIF of the posterior malleolar fracture were negatively associated with postoperative ankle osteoarthritis. Conclusion: A preoperative medial clear space measurement of 3.72 mm or more in posterior malleolar fractures with syndesmotic injury may be beneficial in deciding the fixation approach for posterior malleolar fractures. Male gender is identified as a risk factor for unplanned removal of syndesmotic implants. Deltoid ligament rupture, preoperative tibiofibular clear space (TFC), and the need for posterior malleolar fixation may be regarded as risk factors for postoperative ankle osteoarthritis.

Cannabis Use and Postoperative Risks: A Comprehensive Analysis of Medical Complications Within 90 Days Following Ankle Fracture Fixation

Category: Ankle; Trauma Introduction/Purpose: As medical and recreational cannabis use continues to increase in prevalence across the United States, it is important to understand how cannabis can impact health. Though prior studies have shown that cannabis use can result in delayed bone healing, there is a paucity of literature examining the relationship between cannabis use and postoperative medical outcomes following fracture fixation. Therefore, the purpose of this study was to investigate the relationship between cannabis use and the incidence of medical complications within 90 days of surgical fixation of ankle fractures. Methods: A retrospective review of a national insurance claims database was performed from 2010 to 2022. Patients who underwent open reduction and internal fixation (ORIF) procedures for medial malleolus fractures, lateral malleolus fractures, distal fibula fractures, bimalleolar fractures, and trimalleolar fractures were identified using CPT codes. Of those patients, those with established diagnoses of cannabis use disorder, cannabis dependency, or cannabis addiction were identified using ICD-9 and -10 codes. This cannabis cohort was matched 1:4 on the basis of age, sex, and Charlson Comorbidity Index (CCI) to a control cohort without a history of cannabis use to remove potential confounding upon comparison. Demographic and comorbidity profiles, as well as medical and surgical post-operative outcomes were compared using Chi-square tests. Results: Out of 788,702 patients undergoing ankle fracture open reduction and internal fixation (ORIF) during the study period, 46,105 had documented cannabis use. Cannabis cohort, compared to controls, exhibited significant differences: younger age (mean 38.8 vs. 52.7 years; p< 0.001), lower comorbidity-burden (mean CCI 1.58 vs. 1.68; p< 0.001), and a higher proportion of male patients (51.1% vs. 33.2%; p< 0.001). Following age, CCI, and sex matching, patients with cannabis use histories showed a significantly increased incidence of medical complications within 90 days post ankle fracture ORIF. Cannabis users displayed elevated rates of various complications compared to matched controls, including pneumonia, deep venous thrombosis, pulmonary embolism, myocardial infarction, stroke, surgical site infection, cardiac arrest, acute kidney injury, urinary tract infection, sepsis, and hypoglycemia (all p< 0.001). Conclusion: Cannabis use is associated with increased incidences of many serious medical complications within 90 days of ankle fracture fixation procedures. These results underscore the importance of eliciting cannabis use history during preoperative patient evaluations so that physicians and patients can be better informed about the increased postoperative risks they may face, and so tailored perioperative care can be appropriately implemented. Further, these results emphasize the need for further research on the molecular mechanisms of cannabis to explain interactions that may predispose heavy cannabis users to this profile of adverse surgical outcomes.

5-Item Modified Frailty Index Score is Associated with Increased Postoperative Complications Following Ankle Fracture ORIF

Category: Trauma; Ankle Introduction/Purpose: Ankle fractures are among the most common injuries in orthopaedics and often require surgical management to obtain a stable mortice. It is essential to quantify preoperative risk for patients undergoing ankle fracture repair, but a consensus regarding an optimal risk stratification model does not currently exist. The 5-factor modified frailty index (mFI-5) has been found to be an independent predictor of postoperative complications following numerous orthopaedic procedures, but its efficacy has not been evaluated in patients undergoing ankle fracture open reduction and internal fixation (ORIF). This study aims to analyze the effect of preoperative mFI-5 on 30-day complication, readmission, reoperation, and mortality rates following ankle fracture procedures. Methods: The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried from 2005-2019 to identify 44,755 patients undergoing ankle fracture ORIF using Current Procedural Terminology (CPT) codes 27766, 27792, 27814, 27822, and 27823. Patients were stratified into groups based on preoperative mFI-5 scores, which incorporate the presence of chronic obstructive pulmonary disease, pneumonia, congestive heart failure, non-independent functional status, and diabetes into a composite risk index. Demographics, hospital length of stay (LOS), and 30-day complication, surgical site infection (SSI), Clavien-Dindo grade IV (CDIV) complication, readmission, reoperation, and mortality rates were compared between groups. The cohort was predominantly male (59.0%) and the mean age was 49.52 (range, 16-89) years. Preoperative mFI-5 was also used as a categorical variable when analyzing postoperative outcomes. Results: A total of 44,838 patients met criteria for inclusion, with the majority of patients having an mFI-5 score of 0 (mFI-5:0=65.1%, mFI-5:1=27.0%, mFI-5:2=6.5%, mFI-5:3=1.1%, mFI-5:4=0.2%). The mFI-5 score was a predictor of serious medical complications (myocardial infarction, sepsis, pulmonary embolism, postoperative dialysis, prolonged ventilator requirement, SSI, blood transfusion, DVT/thrombophlebitis, and pneumonia), adverse discharge to a facility, readmission, and reoperation. (Table 1) Mortality was strongly predicted by mFI-5 with the risk more than tripling for each point increase in mFI-5 score (odds ratio (OR)=3.639, 95% CI= 3.038-4.360). Lastly, LOS was also found to increase with mFI-5 with the average length of stay increasing by 1.44 days per increase in mFI-5 score. Conclusion: Our results indicate that mFI-5 score is useful as a predictive measure for postoperative complications, adverse discharge, readmission, reoperation, mortality, and length of stay for patients undergoing ankle ORIF. The variables considered by mFI-5 are easily obtained through a patient history, making this scale a practical measure to identify patients at increased risk for postoperative outcomes.

Single-Plate versus Dual-Plate Utilization for Treatment of Humeral Shaft Fractures: A Retrospective Clinical Series

Objectives Dual plating is the current standard of care for displaced distal humerus fractures and even some metadiaphyseal humeral fractures. Single plate fixation is the current standard of care for humeral shaft fractures when performing open reduction and internal fixation (ORIF). A role may exist for dual plating of humeral shaft fractures. This study aims to compare clinical outcomes of single versus dual-plating when performing ORIF procedures on humeral shaft fractures. Methods A retrospective study of 143 patients (81 females, 62 males; mean age 47.3) who sustained humeral shaft fractures (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (AO/OTA) type 12A, B, and C) and received either dual or single plating via ORIF between March 2010 and May 2022. Of the 143 patients, 79 (55%) received single plating, while 64 (45%) received dual plating. To account for possible confounders, we collected data on patient characteristics, mechanism of injury, and intra-surgical variables. Primary outcome measurements compared radiographical x-ray imaging (3-months, 6-months, and 12-months), complications, and visual analog scale (VAS) score. Results There was no statistically significant difference between VAS scores, union rates, post operative radial nerve injury, infections, or hardware failure for primary surgical outcomes. Patients were allowed to bear weight as tolerated more quickly in the dual-plating group. An association was observed between the usage of dual plates and osteoporosis. Conclusion In conclusion, we found dual-plate fixation for ORIF of humerus fractures to be not statistically significantly different compared to single plate fixation. Dual-plating has satisfactory radiograph and clinical outcomes compared to conventional single-plate fixation. While we are not advocating for the routine use of dual-plating, the results of our study suggest that the use of dual-plating produces similar outcomes when compared to single-plating for ORIF of a humerus shaft fracture.

Evaluation of the efficacy of perioperative tranexamic acid in patients with pelvic and acetabular fractures: A systematic review and meta-analysis.

Tranexamic acid (TXA) is commonly used to reduce perioperative bleeding in various surgeries, including acetabular and pelvic fractures treated with open reduction and internal fixation (ORIF). However, research on TXA's effectiveness and safety in this context is conflicting. To address this, we conducted a systematic review and meta-analysis on TXA's efficacy and safety in patients with acetabular and pelvic fractures undergoing ORIF. We systematically searched Cochrane, PubMed, and EMBASE databases until August 30, 2023. Our evaluation of TXA focused on 6 domains: estimated blood loss (EBL), blood transfusion units, transfusion rates, thromboembolic events, other complications, and surgery duration. Data from these studies were analyzed using RevMan Manager 5.4. This study included 4 randomized controlled trials with 179 patients with acetabular and pelvic fractures treated with TXA. The analysis showed that TXA did not significantly reduce EBL, packed red blood cell transfusion units, blood transfusion rates, or surgery duration. There was no significant difference in thromboembolic events or other postoperative complications, like surgical wound issues, pneumonia, heterotopic ossification, and sciatic nerve injuries, between the TXA and control groups. TXA did not demonstrate a significant benefit in reducing perioperative bleeding or complications in patients treated with ORIF for acetabular and pelvic fractures. The utilization of TXA in such clinical scenarios remains a topic necessitating further rigorous investigation to delineate its role in this clinical setting.

Comprehensive analysis of risk factors for postoperative wound infection following open reduction and internal fixation of Rib fractures

BackgroundPostoperative wound infections (PWIs) significantly impact patient outcomes following open reduction and internal fixation (ORIF) of rib fractures. Identifying and understanding risk factors associated with these infections are crucial for improving surgical outcomes and patient care.MethodsThis retrospective study, conducted from January 2020 to October 2023 at our institution, aimed to analyze the risk factors for PWIs in patients undergoing ORIF for rib fractures. A total of 150 patients were included, with 50 in the infected group and 100 in the non-infected control group, matched for demographic and clinical characteristics. Data on variables such as intraoperative blood loss, hospital stay duration, body mass index (BMI), operation time, presence of anemia, drainage time, diabetes mellitus status, smoking habits, and age were collected. Statistical analysis involved univariate and multivariate logistic regression using SPSS software (Version 27.0), with p-values < 0.05 considered statistically significant.ResultsUnivariate analysis revealed no significant association between intraoperative blood loss or hospital stay duration and PWIs. However, operation time ≥ 5 h, anemia, drainage time ≥ 7 days, diabetes mellitus, smoking, and age ≥ 60 years were significantly associated with higher PWI rates. Multivariate logistic regression confirmed these factors as independent predictors of PWIs, with operation time and diabetes mellitus showing particularly strong associations.ConclusionsProlonged operation time, anemia, extended drainage, diabetes mellitus, smoking, and advanced age significantly increase the risk of PWIs following ORIF for rib fractures. Early identification and targeted management of these risk factors are essential to reduce the incidence of infections and improve postoperative outcomes.

Risk factors for adverse events after clavicle fracture open reduction and internal fixation: A NSQIP study

BackgroundMidshaft clavicle fractures are often subject to increased complications when treated nonoperatively, so surgical treatment with open reduction and internal fixation (ORIF) is a favored alternative. Despite safer outcomes, adverse events such as surgical site infections may still persist, particularly in the presence of certain patient characteristics. The objective of this study was to determine risk factors for and the frequency of adverse events following ORIF for clavicle fractures. MethodsA retrospective review of the National Surgical Quality Improvement Program (NSQIP) database from 2012 to 2021 identified patients undergoing isolated ORIF for clavicle fractures. Patient demographics and 30-day complications were collected. Bivariate analyses with a student's t-test or chi-square test were used to identify possible predictor variables for either AAE or SSI, and demographic metrics with P < 0.2 were included in a multivariable regression model. Multivariable analyses identified significant independent patient risk factors for any adverse event (AAE) or SSI within 30-days of surgery. Adjusted odds ratios were reported for each variable included in the model. Statistical significance was set a prior at P < 0.05. ResultsThe 6,753 selected patients who underwent ORIF for clavicle fractures between 2012 and 2021 were 38.1 ± 15.3 years of age, BMI 26.2 ± 4.9 kg m-12, and 77.3 % male. Of this cohort, 88.4 % received treatment on an outpatient basis. Postoperative adverse events were experienced by 128 (1.9 %) patients within 30 days of surgery, and SSI were prevalent in 0.77 % of patients, followed by wound dehiscence in 0.12 % of patients. After controlling for patient demographics and comorbidities, notable risk factors for adverse events included current smoking status (OR=2.036; P < 0.001) and patient age (OR=1.025; P < 0.001). Outpatient status (OR=0.528; P = 0.004) was protective. ConclusionThe present study noted significantly increased risk of postoperative adverse events in older patients, as well as patients who smoke. Outpatient setting was significantly protective for adverse events. These findings help to provide further clinical context to guide surgical decision making and inform surgeons on current risks and outcomes.

Assessing the Need for Imaging after Distal Radius Fracture Fixation

Abstract Background Distal radius fractures are extremely common. Patients routinely undergo early imaging (around 2 weeks) after open reduction and internal fixation (ORIF) of distal radius fractures despite no clinical concerns. We analyzed the need for these radiographs by evaluating when imaging identifies complications after surgery. Methods All distal radius fractures treated with ORIF via a volar approach by the senior surgeon were included. Intraoperative and postoperative images were analyzed for maintenance of reduction and complications. Demographic data, fracture characteristics, and postoperative complications were also recorded. Results A total of 342 patients were identified. Postoperative images were obtained from 0 to 14, 15 to 90, 91 to 180, 181 to 365, or greater than 365 days after surgery. Some patients had multiple images. Measurements on postoperative images were statistically equivalent across all time points. Complications mostly occurred &gt;90 days after surgery. Of the 26 patients with complications, 5 had a failure of reduction or plating seen on postoperative imaging. Two occurred after unrelated trauma; only three patients had unanticipated complications caught on routine imaging within 3 months after surgery. These patients had extraordinarily complex fractures in poor bone stock. Conclusion Early postoperative imaging is not necessary after ORIF for distal radius fractures unless the patient is elderly, or the fracture is severely comminuted with ulnar column or die-punch components. Thus, we suggest that patients have imaging only in the 3- to 6-month period to determine if the union has been achieved, which could provide cost savings to both surgeon and patient.

Predictors of Extended Length of Stay Following Open Reduction and Internal Fixation for Distal Radius Fractures

Abstract Background An extended length of stay (eLOS) following open reduction and internal fixation (ORIF) for distal radius fractures has been associated with increased patient morbidity and health care costs. The primary objective of this study was to identify risk factors, including patient characteristics, comorbidities, and postoperative complications, which are associated with an eLOS following ORIF for distal radius fractures. Methods All patients who underwent ORIF for distal radius fractures between 2015 and 2021 were queried from the American College of Surgeons National Surgical Quality Improvement Program database. Postoperative complications were reported within 30 days of procedure. eLOS was defined by ≥3 days from operation to discharge. We identified a total of 26,138 patients and 5.1% (1,323) of patients had an eLOS. Multivariate logistic regression, adjusted for all significantly associated variables, was employed to identify predictors of eLOS following ORIF. Results Characteristics of patients significantly associated with eLOS were age ≥ 75 (p &lt; 0.001), male gender (p = 0.006), body mass index &lt; 18.5 (p &lt; 0.001), American Society of Anesthesiologists (ASA) ≥ 3 (p &lt; 0.001), dependent functional status (p &lt; 0.001), noninsulin-dependent diabetes (p &lt; 0.001), chronic obstructive pulmonary disorder (COPD) (p &lt; 0.001), ascites (p = 0.005), congestive heart failure (CHF) (p &lt; 0.001), hypertension (p &lt; 0.001), chronic steroid use (p = 0.004), bleeding disorder (p &lt; 0.001), and transfusion ≥ packed red blood cell (pRBC) 72 hours before surgery (p &lt; 0.001). After controlling for significantly associated variables, predictors of eLOS were age ≥ 75 (reference &lt; 65; odds ratio [OR]: 1.34, 95% confidence interval [CI]: 1.24–1.46; p &lt; 0.001), ASA ≥ 3 (OR: 1.79, 95% CI: 1.54–2.01; p &lt; 0.001), male gender (OR: 1.32, 95% CI: 1.13–1.54; p &lt; 0.001), COPD (OR: 1.48, 95% CI: 1.15–1.91; p = 0.003), CHF (OR: 1.94, 95% CI: 1.10–3.42; p = 0.022), bleeding disorder (OR: 1.93, 95% CI: 1.45–2.58; p &lt; 0.001), transfusion ≥ 1 pRBC before surgery (OR: 27.65 95% CI: 58.22–93.02; p &lt; 0.001), bleeding transfusion (OR: 76.70, 95% CI: 15.13–388.81; p &lt; 0.001), septic shock (OR: 13.31, 95% CI: 1.99–88.97; p = 0.008), and nonhome discharge (OR: 34.31, 95% CI: 28.21–41.72; p &lt; 0.001). Clinical Relevance Age ≥ 75, ASA ≥ 3, male gender, COPD, CHF, bleeding disorder, transfusion pRBC, bleeding transfusion, septic shock, and nonhome discharge were associated with eLOS following ORIF for distal radius fractures. Level of Evidence Level III; retrospective cohort comparison; prognosis study

A New Method in Dealing With Children's Condylar Fracture by Botulinum Toxin A Injection in Lateral Pterygoid Muscle.

Condylar is one of the most vulnerable sites to be traumatized in pediatric mandible fracture, while temporomandibular joint ankylosis might be the most severe complication of condylar fracture in children. There exists a long-time controversy on the treatment of condylar fractures in children. Considering the risk of facial nerve injury and a certain probability of absorption or even ankylosis after open reduction and internal fixation (ORIF) of condylar fractures, a series of nonsurgical approaches are preferred in cases without severe malocclusion or shortening of the ramus. Our treatment plan was carried out through combining procedures of Botulinum toxin A injection in lateral pterygoid muscle with ORIF of para symphyseal fracture; subsequently, a conservative way of the occlusal splint with elastic traction was performed. Three patients of bilateral or unilateral condylar fractures, aged between 2y and 6y, were involved in this treatment. After more than 1 year's follow-up, the occlusion was satisfactory in all patients. Condylar remodeling was approximately complete in 3 months, and no unwanted complications were observed. We may expect this method to offer a new idea when dealing with children's condylar fracture.

Differences in Intraoperative Fluoroscopic Radiation Exposure During Ankle Fracture Open Reduction and Internal Fixation Between Orthopaedic Surgery and Podiatry.

Surgical ankle fractures pose a unique situation because both podiatrists and orthopaedic surgeons manage these injuries. Intraoperative fluoroscopy is routinely used; however, excessive radiation can be harmful to both the patient and the surgical team. The primary goal of this study was to determine whether there is a difference in the amount of intraoperative radiation exposure during ankle fracture open reduction and internal fixation (ORIF) when performed by orthopaedic surgeons versus podiatrists. This is a retrospective review of patients who underwent ankle fracture ORIF at an urban level I trauma center between January 1st, 2018, and April 1st, 2023. The electronic health record was queried using International Classification of Diseases nine and 10 codes associated with ankle fractures. Patients aged older than 18 years with an ankle fracture managed surgically were included. Subjects were then stratified by procedure. The mean total radiation dose (mRad) and mean total fluoroscopic time (seconds) were then compared between those performed by orthopaedic surgeons and podiatrists. Of the 333 included procedures, 186 were done by orthopaedic surgeons and 147 were done by podiatrists. Using multiple linear regression analysis to control for age, sex, race, ethnicity, and body mass index, patients undergoing isolated malleolus ORIF with syndesmosis repair performed by orthopaedic surgery were found to have a significantly lower mean fluoroscopic time compared with those performed by podiatry (68.4 s versus 104.8 s; P = 0.028). In addition, trimalleolar ORIF with syndesmotic repair performed by orthopaedic surgery had a significantly lower mean total radiation dose compared with those performed by podiatry (244.6 mRad v 565.6 mRad; P = 0.009). Patients and surgical teams are exposed to markedly less radiation in isolated malleolar and trimalleolar fracture ORIF with syndesmosis repair when performed by an orthopaedic surgeon as compared with those performed by a podiatrist.

To cast or not to cast? Postoperative care of ankle fractures: a meta-analysis of randomized controlled trials.

Postoperative care of ankle fractures treated with open reduction and internal fixation (ORIF) is a debated topic. A meta-analysis of Randomized Controlled Trials was conducted with the aim of comparing early mobilization and weightbearing to traditional postoperative protocols. A systematic search of electronic databases was conducted according to the PRISMA guidelines. Only randomized clinical trials were included. Data about clinical outcome, time to return to work and complications were extracted and summarized. Meta-analyses were performed. Twenty studies for a total of 1328 patients were included. Early mobilization was compared to immobilization in 724 patients: the two groups did not significantly differ in terms of short- and long-term clinical outcome (p = 0.08 and p = 0.41, respectively). However, early mobilization resulted to be significantly associated with faster return to work (p = 0.047). Early weightbearing was compared to nonweightbearing in 1088 patients. While the clinical difference between the two groups was not significant at short term (p = 0.08), it was significant at long term (p = 0.002). No other significant differences, in particular regarding complications, were highlighted between different groups. Early motion, early weightbearing and traditional postoperative protocols are all safe strategies after ORIF for unstable ankle fractures. Early mobilization is significantly associated with faster return to work and early weightbearing improves long term clinical outcome.Level of evidence: I.

Ankle fracture open reduction and internal fixation in patients with cerebral palsy.

To examine patients with cerebral palsy (CP) undergoing open reduction and internal fixation (ORIF) for ankle fractures. This was a retrospective study of adult patients undergoing ankle fracture ORIF for closed, isolated ankle fractures identified in between 2010 and 2021 in the Q1 PearlDiver M151 database. Patients with CP were identified with International Classification of Diseases (ICD)-9 and ICD-10 codes, and were matched to those without 1:10 on age, sex, and Elixhauser comorbidity index (ECI). Ninety-day adverse events were assessed with multivariable logistic regression. A total of 148 993 patients with isolated ankle fracture ORIF were identified, of whom 407 (0.27%) had CP. After matching, 3863 without CP were compared to 389 with CP. Patients with CP were at increased odds of: 90-day urinary tract infection (odds ratios [OR] 6.26), pneumonia (OR 3.50), minor adverse events (OR 3.46), sepsis (OR 3.30), any adverse events (OR 3.04), emergency department visits (OR 2.28), serious adverse events (OR 1.77), and prolonged length of stay more than 4 days (OR 22.44) (p < 0.001 for all). Patients with CP undergoing ORIF for isolated, closed ankle fractures are at increased odds of several 90-day adverse events and prolonged length of stay compared to matched patients without CP.

Current Strategies for Treatment of Mandibular Fractures With Plate Osteosynthesis: A European Prospective Study.

The training and preferences of surgeons influence the type of surgical treatment for mandibular fractures. This multicentre prospective study analyzed the current treatment strategies and outcomes for mandibular fractures with open reduction and internal fixation (ORIF). This prospective study included patients aged ≥16 years who underwent ORIF for mandibular fractures in 12 European maxillofacial centers. Age, sex, pretrauma dental status, fracture cause, site and type, associated facial fractures, surgical approach, plate number and thickness (≤1.4 or ≥1.5mm), duration of postoperative maxillomandibular fixation, occlusal and infective complications at 6 weeks and 3 months, and revision surgeries were recorded. Between May 1, 2021 and April 30, 2022, 425 patients (194 single, 182 double, and 49 triple mandibular fractures) underwent ORIF for 1 or more fractures. Rigid osteosynthesis was performed for 74% of fractures and was significantly associated with displaced ( P =0.01) and comminuted ( P =0.03) fractures and with the number of nonsurgically treated fracture sites ( P =0.002). The angle was the only site associated with nonrigid osteosynthesis ( P <0.001). Malocclusions (5.6%) and infective complications (5.4%) were not associated with osteosynthesis type. Rigid osteosynthesis was the most frequently performed treatment at all fracture sites, except the mandibular angle, and was significantly associated with displaced and comminuted fractures and the number of nonsurgically treated fracture sites. No significant differences were observed regarding postoperative malocclusion or infections among osteosynthesis types.

Comparison of Patient Demographics and Risk of Surgical Site Infections Following Open Reduction and Internal Fixation of Trimalleolar Ankle Fractures: A Nationwide Analysis of a Private Payor

Surgical site infections (SSIs) are a notable complication following open reduction and internal fixation (ORIF) for ankle fractures. The purpose of this study was to (1) compare baseline demographics of patients who did and did not develop SSIs within 90 days following ORIF for trimalleolar ankle fractures and (2) identify risk factors associated with SSIs in this setting. A retrospective analysis from 2010 to 2020 was completed using a national administrative database. The study group consisted of patients who underwent ORIF for trimalleolar ankle fractures and developed SSIs within 90 days postoperatively. Patients without SSIs served as the comparison cohort. Baseline demographics of the two cohorts were compared utilizing Pearson's Chi-Square Analyses. A multivariate binomial logistic regression model determined the association of various comorbidities on developing SSIs in this setting. Out of a total sample of 22,118 patients, 1000 individuals (4.52%) developed SSIs. The study revealed that the SSI cohort exhibited a greater burden of comorbidities, as evidenced by significant differences in various individual comorbidities and average Elixhauser-Comorbidity Indices scores. The most strongly associated risk factors for the development of SSIs following ORIF for trimalleolar ankle fractures were peripheral vascular disease (OR: 1.53, p < .0001), diabetes mellitus (OR: 1.26, p = .0010), iron deficiency anemia (OR: 1.24, p = .0010), male sex (OR: 1.22, p = .0010), and tobacco use (OR: 1.15, p = .0010). This study identified several patient risk factors that were associated with developing SSIs after ORIF for trimalleolar ankle fractures, recognizing potential patient-directed interventions that may reduce the rate of SSIs in this setting.

Similar Medium-Term Revision Rates Following Acute Total Hip Arthroplasty Versus Open Reduction and Internal Fixation for Acetabular Fractures in the Elderly.

The management of elderly acetabular fractures is complex, with high rates of conversion total hip arthroplasty (THA) after open reduction and internal fixation (ORIF), but potentially higher rates of complications after acute THA. The California Office of Statewide Health Planning and Development database was queried between 2010 and 2017 for all patients aged 60 years or older who sustained a closed, isolated acetabular fracture and underwent ORIF, THA, or a combination. Chi-square tests and Student t tests were used to identify demographic differences between groups. Multivariate regression was used to evaluate predictors of 30-day readmission and 90-day complications. Kaplan-Meier (KM) survival analysis and Cox proportional hazards model were used to estimate the revision surgery-free survival (revision-free survival [RFS]), with revision surgery defined as conversion THA, revision ORIF, or revision THA. A total of 2,184 surgically managed acetabular fractures in elderly patients were identified, with 1,637 (75.0%) undergoing ORIF and 547 (25.0%) undergoing THA with or without ORIF. Median follow-up was 295 days (interquartile range, 13 to 1720 days). 99.4% of revisions following ORIF were for conversion arthroplasty. Unadjusted KM analysis showed no difference in RFS between ORIF and THA (log-rank test P = 0.27). RFS for ORIF patients was 95.1%, 85.8%, 78.3%, and 71.4% at 6, 12, 24 and 60 months, respectively. RFS for THA patients was 91.6%, 88.9%, 87.2%, and 78.8% at 6, 12, 24 and 60 months, respectively. Roughly 50% of revisions occurred within the first year postoperatively (49% for ORIF, 52% for THA). In propensity score-matched analysis, there was no difference between RFS on KM analysis ( P = 0.22). No difference was observed in medium-term RFS between acute THA and ORIF for elderly acetabular fractures in California. Revision surgeries for either conversion or revision THA were relatively common in both groups, with roughly half of all revisions occurring within the first year postoperatively. III.

Outcome of Open Reduction and Internal Fixation versus Hemiarthroplasty in Proximal Humerus Complex Fractures

Abstract Background: This study compares open reduction and internal fixation (ORIF) versus hemiarthroplasty (HA) in the management of complex proximal humerus fractures. Materials and Methods: Neer three- and four-part fracture-dislocations, surgical neck fracture-dislocations with severe articular impaction, and any head-split fracture treated surgically at our institution were studied retrospectively. Constant–Murley scores, Disability of the Arm, Shoulder, and Hand (DASH), American Shoulder and Elbow Surgeons (ASES) Shoulder, and 36-item Short-Form Health Survey (SF-36) scores were obtained and compared between ORIF versus HA treatment. Results: Thirty patients were included in the analysis: 15 treated with ORIF were compared to 15 treated with HA with an average follow-up of 60 months. The mean Constant score (72 ± 15 vs. 54 ± 19; P = 0.005), DASH score (13 ± 17 vs. 29 ± 18; P = 0.006), ASES score (87 ± 13 vs. 66 ± 22; P = 0.003), and SF-36 physical composite score (PCS) (50 ± 11 vs. 40 ± 11; P = 0.02) all favored the ORIF group. Because of the potential confounding variable posed by including younger patients, we performed a subgroup analysis of patients older than 50 years. In this group, the Constant, DASH, ASES, and PCS scores remained significantly better in the ORIF group. Conclusion: Results of this retrospective study show improved patient-reported outcomes and quality of life scores in patients undergoing ORIF for complex proximal humerus fractures as compared to patients undergoing HA, despite a higher revision rate in the ORIF cohort. When considering patients older than 50 years, outcomes after ORIF were better than HA.