Open Reduction Group Research Articles

Prediction of the possibility of laparoscopic reduction of Petersen's hernia after gastrectomy: multicenter observational cohort study.

IntroductionPetersen’s hernia (PH) is a potentially fatal complication of bowel infarction that is difficult to treat by laparoscopic reduction.AimTo define predictive computed tomography (CT) profiles to identify PH patients who would be suitable for laparoscopic reduction by a comparative analysis between patients treated by laparoscopic and open reduction.Material and methodsWe retrospectively collected the clinical data of patients (n = 28) who underwent PH reduction surgery after minimally invasive gastrectomy for gastric cancer in the period 2015–2018 at four training hospitals. We examined the preoperative CT scans to identify the indications for laparoscopic PH reduction.ResultsWe compared the laparoscopic reduction group (laparoscopic group, n = 15) and the open reduction group (open group, n = 13). Patients in the laparoscopic group were younger (55.7 ±10.4) than those in the open group (69.3 ±9.1), but there were no differences in clinical or laboratory findings. We found that there were two CT profiles with significant differences between the open and laparoscopic groups: superior mesenteric vein (SMV) narrowing and small bowel dilation. We found that small bowel dilatation was an independent factor on multivariate analysis for laparoscopic PH reduction.ConclusionsWe found that small bowel dilatation is the most important CT profile for identifying PH patients contraindicated for laparoscopic reduction. Despite the retrospective design of this study, these CT profiles are expected to define the scope of laparoscopic reduction in PH patients and to establish indications for the laparoscopic approach.

Closed Reduction for Developmental Hip Dysplasia in Lately Diagnosed Walking Age Children

Aim: The aim of the study was to assess the success and possible complications of closed reduction (CR) treatment of developmental hip dysplasia (DHD) in late-diagnosed children and explores its relation to the acetabular index (AI) measurement prior to treatment. Patients and Methods: Twenty-three consecutive patients with dislocated hips, 16 unilateral and 7 bilateral (30 hips), were retrospectively included in the study. They were admitted to the specialist pediatric orthopedic unit of the University Hospital (Tripoli Medical Center) in Tripoli, Libya. There were 21 females and 2 males with an average age at diagnosis of 17 months (range from 14 to 31 months). Their average follow-up period was 3 years (2–5 years), and none of them received treatment prior to diagnosis. All patients received prior inpatient skin traction for at least 2 weeks followed by CR with soft tissue release (adductor tenotomy), hip spica applied and maintained for an average of 3 months. Patients who had a failure of reduction or resubluxation at follow-up went for open reduction and a reconstruction procedure. Results: CR was successful in 27 hips (90%), failed in 3 (10%) other, the average age of the successful reduction group was 20.5 months, while that of the open reduction group, it was 23 months (P = 0.25). The average AI of the CR group was 39.0°, while that of the open reduction group, it was 42.7° (P = 0.15); 6.7% of patients with an AI of <40° had a failure of CR, while 16.7% of an AI of >40° had a failure of CR of the hip (P = 0.46). No complications of treatment were recorded at follow-up. Conclusion: Staged CR of DHD in older children in the hands of experienced specialists is still a valid means of their treatment, especially in developing countries with limited resources. There is a relatively higher failure rate of CR, the older the child is and the higher the AI.

Temporary Use of Skeletal Traction in Management of Pediatric Supracondylar Humeral Fractures

The paper presents a treatment algorithm for supracondylar humeral fractures in children, involving temporary use of skeletal traction following failure of primary closed reduction and percutaneous fixation (CRPF) and introducing closed reduction after management by skeletal traction. The aim of this study was to assess the outcomes of supracondylar humerus fracture treatment performed according to the algorithm. The treatment was performed in 149 children (70 girls, 79 boys) with extension-type supracondylar humeral fractures. The study group was assessed with regard to a modified Gartland classification, neurological complications (12 children, 8%) and vascular complications (8 children, 5.4%). A total of 124 (83.2%) patients underwent emergency CRPF and 24 children (16.1%) received skeletal traction after a failed CRPF. After 2-6 days, an elective repeat CRPF procedure was attempted, which was successful in 17 children. The attempt failed in the other 7 children, who received traction and underwent open reduction under a single anesthesia. One child (0.7%) with a white and pulseless hand was treated by emergency open reduction and percutaneous fixation. The study used the Flynn criteria modified by the author. After 6 months, the results in the group treated with CRPF (both primary and following skeletal traction) were good in 90.8% of patients, satisfactory in 8.5%, and poor in 0.7%, whereas in the open reduction and percutaneous fixation group, the results were good in 87.5% of cases and satisfactory in 12.5%. 1. X-ray-guided closed reduction and percutaneous K wire fixation is a method of choice in the treatment of displaced supracondylar humeral fractures in children. If closed reduction fails, the surgeon is faced with a choice between primary open reduction and the use of direct traction through the olecranon. 2. The use of skeletal traction following failure of primary emergency CRPF results in local improvement in the fracture region and allows for scheduling an elective repeat delayed closed reduction and percutaneous K wire fixation procedure. 3. The algorithm used in clinical practice, based on literature reports and the author's experience, helps achieve good treatment outcomes.

Clinical analysis of reconstruction of lateral wall and femoral moment in the treatment of Evans Jensen type V intertrochanteric fracture

To investigate the clinical effect of proximal femoral nail anti rotation (PFNA) and titanium plate in the treatment of Evans Jensen type V intertrochanteric fractures. From October 2013 to March 2016, 30 patients with Evans Jensen type V intertrochanteric fractures were analyzed. According to the operation methods, they were divided into two groups:16 cases of closed reduction and PFNA internal fixation;14 cases of small incision incision reconstruction of titanium plate reconstruction of femoral moment and lateral wall PFNA internal fixation. The operation (blood loss, operation duration), postoperative rehabilitation (postoperative ambulation time, bone healing time), operation related complications (internal fixation fracture, withdrawal, spiral blade cutting out) were observed and compared between the two groups. Harris score of hip joint function was performed 12 months after operation, and the loss degree of cervical trunk angle was observed and compared. All the 30 patients were followed up for 12 to 18 months. The blood loss and operation duration of open reduction group were significantly greater than those of closed reduction group (P<0.05). The postoperative ambulation time, bone healing time, operation related complications, Harris score of hip joint function and loss of cervical trunk angle in the open reduction group were better than those in the closed reduction group(P<0.05). Evans Jensen was treated with PFNA intramedullary fixation through reduction and fixation of femoral moment and lateral wall with reconstruction titanium plate Vtype intertrochanteric fracture can restore the support of femoral moment and lateral wall to femoral head and neck, improve the stability of fracture end and internal fixation after operation, and reduce the risk of fracture end displacement, internal fixation loosening, cutting out and even fracture after treatment with PFNA alone. To shorten the bed time of elderly patients and reduce the operation related complications, it provides a new idea and method for the treatment of Evans Jensen type V intertrochanteric fracture.

Treatment of mandibular condyle fracture - a comparison of two protocols.

Objectives: To compare the outcome of two protocols (open reduction and closed reduction) in the treatment of mandibular condyle fracture. Study Design: Comparative study. Setting: Department of Oral &amp; Maxillofacial Surgery, Institute of Dentistry, Liaquat University of Medical and Health Sciences Jamshoro. Period: January 2016 to September 2016. Material &amp; Methods: After selection of patient into either group, for closed reduction technique, maxillomandibular fixation was applied for 4-6 weeks. For open reduction, a preauricular incision was given and fracture was reduced and fixed with miniplates after achieving the normal occlusion. Post operatively, patients of both the group were recalled after one, two and three months for the assessment of the functional effects such as occlusion and range of motion in both groups. Results: Mean age of the patients was29.80+4.42 years in group 1 (open reduction group), while mean age of the group 2 (closed reduction group) was 23.95+6.63 years. Male were in the majority in both groups 17 in group 1 and 16 in group 2. Out of 20 patients in group 1, 11 patients had condylar neck fracture and 9 had subcondyle fracture. While in group 2, 13 patients had subcondyle fracture and 7 had condylar neck fracture. In both groups again no significant difference was found according to location of the fracture (p-value 0.20). Group 1 (open reduction) had better functional results in terms of occlusion and range of motion after 3 months as compared to the group 2 (closed reduction). P-value 0.19. Conclusion: In dealing with mandibular condyle fractures it was concluded that open reduction and internal fixation is a better technique as compared to the closed reduction with maxillomandibular fixation.

Calcaneus traction compression with orthopaedic reduction forceps combined with percutaneous minimally invasive treatment of intra-articular calcaneal fractures: An analysis of efficacy

BackgroundThe treatment of displaced calcaneal fractures is controversial.Open reduction and internal fixation are widely described as the gold standard in the literature,but these technique shave many complications,including skin necrosis,internal fixation leakage and deep infection and wound healing problems.Percutaneous reduction and unilateral external fixation have received increasing attention because they can provide a good, stable reduction and reduce the soft tissue complications caused by open surgery(such as deep infection and delayed wound healing).The purpose of this retrospective study was to evaluate the reduction imaging and clinical results of calcaneus traction compressionwith orthopaedic compression reduction forceps combined with percutaneous minimally invasive external fixation for intra-articular calcaneal fractures. MethodsThis was a retrospective analysis. A total of 35 patients with unilateral calcaneal fractures were divided into two groups: 1) the open reduction, internal fixation group (19 feet)and 2) the percutaneous minimally invasive, closed reduction external fixation group (16 feet).Evaluation of the reduction include dimaging measurements of the calcaneus length,width,and height,and the Bohler angle and Gissane angle before and after surgery.Clinical outcomes included the time of surgery,length of hospital stay,operation time,wound-related complications,the American Orthopaedic Foot and Ankle Society hindfoot score,the visual analogue score for pain, and the SF-36 score. ResultsThe average follow-up time was 25.52 ± 1.68 months.There was no significant difference in reduction between the open group and the closed group (P > 0.05).The operation time of the open group was significantly longer than that of the closed group(P = 0.0001).The length of hospitalization and waiting time for surgery in the open reduction group were significantly longer than those in the closed reduction group (P < 0.05).Incidence-related complications in the open group and closed group were 21.1 %(4/19) and 6.3 %(1/16),respectively (P = 0.0001).The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scores in the open and closed groups were 81.35 ± 5.25 and 82.52 ± 4.78, respectively (P = 0.0875). The visual analogues cale (VAS) scores of the open group and the closed group were 1.81 ± 1.32 and 0.78 ± 0.91, respectively (P = 0.0412).The SF-36 scores were 80 ± 4.5 and 79 ± 4.2, respectively. ConclusionOur research shows that for various types of intra-articular calcaneal fractures compared with open reduction,internal plate fixation,calcaneus traction compression with orthopaedic reduction forceps combined with percutaneous minimally invasive external fixation is a simple and effective method for treating calcaneal fractures; not only can the calcaneus be corrected, but it can also provide notable imaging and clinical results.

Does Open Reduction in Intramedullary Nailing of Femur Shaft Fractures Adversely Affect the Outcome? A Retrospective Study.

Aim This study aims to assess the results of open versus closed reduction in intramedullary nailing for femoral fractures and whether it delays union, predisposes to nonunion, or increases the rate of infection. Materials and Methods A retrospective review of all adult patients with isolated femoral shaft fractures treated by intramedullary nailing was done. The primary outcome is union rate, and the secondary outcomes are operation time and the infection rate. Results 110 isolated femoral shaft fractures, with 73 (66.4%) in the closed reduction group and 37 (33.6%) in the open reduction group, 90.4% males and 9.6% females, and the average age was 32.6 years. RTA is the most common cause of these injuries followed by the fall from height. The delayed union rate was 20% (22/110) with no difference between the two groups, p value 0.480, and the nonunion rate was 5.5% (6/110), and no statistical difference was observed between the two groups. The operation time was shorter in the closed groups, and no difference in the time to union was observed between two groups. No infection was found in the two groups. Conclusions There is no statistical difference between the healing rates in closed and open reduction in femoral shaft fractures. In cases where closed reduction is difficult, it is better to open reduce the fracture if closed reduction cannot be achieved in 15 minutes, especially in polytrauma.

Management of Gunshot Injuries of Mandible with Open Reduction and Internal Fixation versus Closed Reduction and Maxillo-mandibular Fixation.

Background/objectivesGunshot injuries are known to cause severe morbidity and mortality when facial regions are involved. Management of the gunshot wounds of the face comprises of securing an airway, controlling hemorrhage, identifying other injuries and definite repair of the traumatic facial deformities. The objective of the present study was to compare the clinical outcome (infection and nonunion) of open reduction and internal fixation versus closed reduction and maxillo-mandibular fixation (CR-MMF) in the treatment of gunshot injuries of the mandible.Materials & methodsThis study was conducted at Oral and Maxillofacial Surgery Department of Shaheed Zulfiqar Ali Bhutto Medical University/Pakistan Institute of Medical Sciences Islamabad, Pakistan. Ninety gunshot mandibular fractures were randomly allocated in two equal groups. In group-A, 45 patients were treated by open reduction and internal fixation while in group-B, 45 patients were also managed by closed reduction and maxillo-mandibular fixation. Post-operative complications (infection, non-union) were evaluated clinically and radiographically in both groups.ResultsPatients treated by open reduction and internal fixation were having more complications in terms of infection (17.8%) as compared to closed reduction (4.4%) with a p-value 0.044. Whereas non-union was more in closed reduction (15.6%) as compared to open reduction and internal fixation group (2.2%) with a significant p-value 0.026.ConclusionBoth the treatment modalities can be used in the management of gunshot injuries of mandible and there is need for further studies to have clear guideline in this regard in best interest of patients, community and health care providers.

A Word of Caution: Success May Be Limited to 2 Years and Highly Displaced OTA/AO B2 and C2 Injuries: Commentary on an article by Alexander Nilsskog Fraser, MD, et al.: "Reverse Total Shoulder Arthroplasty Is Superior to Plate Fixation at 2 Years for Displaced Proximal Humeral Fractures in the Elderly. A Multicenter Randomized Controlled Trial".

Commentary I would like to congratulate Fraser et al. on a well-conducted study from which we are able to draw a narrow but strong conclusion: for the displaced anatomic neck fracture with involvement of the lesser and greater tuberosities, a reverse total shoulder arthroplasty (TSA) yields improved outcome at a 2-year follow-up across a population of patients. It is important to acknowledge that results are superior at 2 years and superior in this injury pattern, not generally superior postoperatively or for other broad definitions of proximal humeral fracture. There was a mean difference in the Constant score of 13.4 points overall and 18.7 points for C2 fractures for this modest timeframe and in these fracture patterns. Both exceeded the minimal clinically important difference of 10 points, according to the article by Fraser et al. This article is well organized and written, easy to understand, and comprehensive. The strengths of the investigation include a well-powered cohort for the primary outcome variable, the Constant score, although it was underpowered for secondary outcomes and subgroup analysis. Additionally, the inclusion and exclusion criteria were well established, and I like that Fraser et al. stuck to the controversial treatment groups of the OTA B2 and C2 fractures and, at that, only those with severely angulated and displaced parameters of >45° valgus or >30° varus on an anteroposterior radiographic view or >45° angulation on a scapular Y radiographic view. Although there was a high percentage of excluded patients (54% [146 of 270 patients] with OTA/AO B2 and C2 fractures), most exclusions were due to the patients not meeting displacement criteria, ultimately leaving 60 patients in the open reduction and internal fixation (ORIF) group and 64 patients in the reverse TSA group. It was outstanding that the physiotherapists performing measurements were blinded to the procedure during the measurement of outcome parameters and were different from those physiotherapists rendering treatment. Further, in this study, the same surgeons performed the arthroplasties and ORIF, which has the advantage of consistency of technique and protocol in each treatment arm. However, the possible downside is that this circumstance may also introduce bias for 1 treatment arm given that the operating surgeons were likely shoulder surgeons by training. We should not conclude that, for every patient and every surgeon, improved results can be expected with one modality over another. The randomized controlled trial (RCT) helps to give us a guideline for a population of patients treated by a population of surgeons; therefore, it should be obvious that within those populations there exist patients who will outperform the mean in both treatment groups, and the same is true for the surgeon. This RCT does not tell us what the optimal outcome is at the onset of treatment for any individual patient, nor even whether optimal reverse TSA is better than optimal ORIF; therefore, we must be circumspect in counseling our patients, taking into consideration variables that could make them better candidates for a particular technique or that may make the surgeon more facile with another technique. What would not be appropriate is to conclude that reverse TSA is better than ORIF for proximal humeral fractures. We must beware; it is only a 2-year study. If there was a 25% revision rate for reverse TSA at 5 to 10 years, then the superior results would be reversed, and we would be reinventing another wheel in orthopaedics again. I commend the authors for an excellent study, and I am pleased to learn that this study group is in the midst of mining longer-term results that would elevate our understanding further regarding this very important fracture for which excellent treatment results have been hard to find.

Predictors of Open Reduction in Pediatric Femur Fractures Treated With Flexible Nails

Closed reduction (CR) is sufficient to reduce the majority of femur fractures treated with flexible intramedullary nailing (FIN). No previous study has examined factors associated with failed CR of pediatric femoral shaft fractures treated with FIN. We sought to determine preoperative factors associated with failed CR. We hypothesized that fracture, patient, and surgeon characteristics would impact the need for open reduction (OR). A retrospective review of children treated for femur fracture between 2012 and 2017 at a tertiary pediatric hospital was performed. Comparisons were made between 2 groups: FIN with CR group and FIN that required OR group. Demographic and baseline characteristics were compared between treatment groups using either χ tests or Fisher exact tests for categorical variables and general linear models for continuous variables. Odds ratios with 95% confidence intervals were calculated using univariate logistic regression tests. Of 449 consecutive pediatric femur fractures treated at our center, 85 children were treated with FIN and constituted the study cohort. CR failed in 14 patients (16.5%) necessitating OR of the fracture site. Significant differences between study groups were found in fracture location (P=0.018), the mechanism (P=0.003), and displacement on the anteroposterior radiograph (P=0.027). Surgical time was found to be longer in the OR group (P=0.010). We identified 3 preoperative predictors of OR for FIN including fractures caused by high energy mechanisms (odds ratio=7.5), distal third fractures (odds ratio=15.3), and fracture displacement on the anteroposterior view (odds ratio=1.06). Surgeon years in practice, patient weight, age, and time from injury to surgery were not associated with OR. This study presents 3 preoperative risk factors that predict the need for OR of femur fractures treated with FIN. Surgical time was longer in cases that required OR. Our findings suggest that surgeons should avoid lengthy attempts at CR and consider a lower threshold for OR of at-risk fractures or use another technique other than flexible nails. Level III-prognostic.

Comparison of conservative and operative management for unstable extra articular proximal phalanx fracture of hand: A prospective study

BACKGROUND: Hand injuries are often overlooked and are not given the importance that they deserve. Decision-making in the management of phalangeal fractures is crucial rather more difficult than long bone fractures; as no treatment will lead to deformity and over treatment will cause stiffness. AIM OF THE STUDY: Compare the results of both conservative and operative managements of proximal phalangeal fractures for decision making while dealing with these innocent looking injuries. SUBJECTS AND METHODS: This was a prospective study of 60 patients of unstable extra articular proximal phalangeal fractures over 2 years. Fifty percent of the patients managed conservatively and 50% surgically. Results were analyzed by the assessment of total range of movements (TROM); functional score of Belesky et al.; grip strength; time of return to work and complications associated with each methods. RESULTS: There was no statistically significant difference between conservative and operative group (TROM P 0.063; Belesky score P = 0.135). Among all modalities best results was achieved with Close Reduction and Internal Fixation (CRIF) with percutaneous k wires which was statistically and clinically significant as compared to conservative and Open Reduction and Internal Fixation (ORIF) group (TROM P = 0.012; Belesky score P = 0.024]. Complications were mostly malunion with conservative methods and infection; implant failure; CRPS were more common in operative methods. CONCLUSION: Conservative management is preferred over surgery for unstable proximal phalangeal fractures. If surgery is needed for stability than close reduction (CRIF) with percutaneous k wire is preferred over open techniques (ORIF).

Efficacy and complications after delayed fixation of femoral neck fractures in children

This study evaluated the efficacy of surgery for femoral neck fractures in children after a 24-h delay and the factors affecting the risk of complications. The study included 16 children who underwent surgery after the first 24 h for femoral neck fractures. According to Delbet's classification, there were 2 type I, 11 type II, and 3 (four hips) type III cases. The mean time from injury to surgery was 85 h (range 27-240 h). According to Garden's classification, there were 1 type II, 14 type III, and 1 type IV (two hips) cases. Initial surgery consisted of closed reduction and hematocele drainage with a 20-mL needle tube. If the procedure failed, open reduction was performed. Internal fixation (K-wire pinning, screw) was performed after closed (n = 9) or open (n = 8) reduction. The results were assessed using the Ratliff criteria after a mean follow-up of 23.2 months. Patient age, type of fracture, complications, treatment, and avascular necrosis (AVN) were evaluated. The results were good in 15 hips (88.2%) and fair in 2 hips (11.8%, one type II case with closed reduction and one type I case with open reduction). The most frequent complication was AVN (4 of 17; 23.5%; three Ratliff good and one fair), which was significantly related to poor outcomes. AVN occurred in one hip in the closed reduction group (Delbet's type II, 12.5%) and in three in the open reduction group (one Delbet's type I, 50%; two Delbet's type II, 66.7%). There were no significant differences in the time from injury to operation (27, 54, 64, and 116 h) and AVN incidence or Ratliff criteria. The efficacy of delayed reduction fixation of the femoral neck was better in the closed reduction group than in the open reduction group. Fracture location closer to the femoral head and older age affected the incidence of AVN.

Outcome of fracture calcaneum managed by conservative versus operative methods a randomized comparative study

Background: Calcaneal fracture is a complex injury that represents 1%–2% of all fractures. However, they make up 60% fractures of the midfoot bones. Due to challenging management of calcaneal fractures, we decided to evaluate the long term outcome of the same. Method: In this series of 61 calcaneal fractures 11 fractures were treated by open reduction and internal fixation method, 16 fractures by percutaneous reduction technique and 34 were treated conservatively, Creighton-Nebraska scoringhas been chosen, being based on results rather than radiographic criteria. Our average duration of follow is 18 months.Results: In this study total 61 feets of 50 patients. Com90. 9%) had excellent results with 1 fair result in open reduction group with internal fixation group. 5 excellent (31. 2%) with 10 good (62. 5%) and 1 fair (6. 3%) result were obtained in percutaneous reduction group. No patient from operative group and percutaneous reduction group showed poor result. There were Only 3 excellent (8. 8%) results with 10 good (29. 5%), 13 fair (38. 3%), and 8 poor (23. 5%) results in conservative group of patients plication included infection, plantar fascitis, subtalar arthritis.Conclusion: our conclusion is that intra articular fractures of calcaneum should be approached in more practical and scientific manner so that normal anatomy of the subtalar joint and overall shape of the calcaneum can be restored with early range of motion.

Closed vs open reduction in developmental dysplasia of the hip: The short-term effect on acetabular remodeling

BackgroundThis study aims to assess acetabular remodeling following closed vs, open hip reduction in children younger than 2 years of age. MethodsRecords of children with DDH, who underwent closed or open reduction, were reviewed. Acetabular index (AI) was measured on radiographs taken prior to reduction and on outcome radiographs taken at age 4 years. Radiographic outcomes were analyzed and residual dysplasia (outcome AI ≥ 30) degrees recorded. Results42 hips had closed reduction; and 26 hips had open reduction. A higher percentage of hips treated with successful closed reduction, had outcome AI ≥ 30° (29% vs. 19% p = 0.387). Residual dysplasia was more common in IHDI-IV hips than IHDI-III hips for both groups. A higher incidence of AVN was seen in the open reduction group (13% vs. 7%; p = 0.43). ConclusionIn children with DDH under the age of two, open reduction with capsulorrhaphy may benefit acetabular remodeling more so than closed reduction despite maintenance of reduction. Although AVN remains a risk, higher remodeling might be expected with open reduction.

Complications in Minimally Invasive Versus Open Surgery for Intermediate- to High-Grade Spondylolisthesis: A 10-Year Retrospective, Multicenter Experience

Abstract INTRODUCTION High-grade spondylolisthesis is a relatively uncommon condition. The optimal surgical approach for management remains debatable. Although in-situ fusion is preferred due to its lower risk of neural injury, it does not correct spinal alignment. In contrast, reduction corrects the deformity and provides a high rate of fusion, but has the potential for high rates of neural injury. We herein report our experience and surgical outcomes following minimally invasive versus open management of intermediate- to high-grade spondylolisthesis. METHODS A multicenter, retrospective cohort analysis of adult patients aged more than 18 yr with grade II or higher spondylolisthesis, who underwent surgery from January 2008 until February 2019, was performed. RESULTS Sixty-two patients were included in the final analysis. A total of 41 patients were treated with an open approach and 21 with a minimally invasive surgical approach (MIS). More specifically, 18 patients underwent in-situ fusion, 11 underwent MIS reduction, and 33 had an open reduction. The total rate of complications was 40.3%. The rate of complications in the MIS group was 52.3% compared to 34.1% in the open surgery group (P = .166). The rate of complications was 27.8% in the in-situ fusion group, 72.7% in the MIS-reduction group, and 36.4% in the open-reduction group. Our comparisons of the rate of complications in the no-reduction group vs the MIS-reduction group, and the MIS-reduction group vs the open-reduction group were statistically significant (P = .027 and P = .07, respectively). However, there was no statistically significant difference between the rate of complications in the no-reduction group vs the open-reduction group (P = .757), nor between the rate of complications in the MIS group vs the open surgery group (P = .166). CONCLUSION MIS reduction is associated with a high rate of complications in the management of high-grade spondylolisthesis.

Should I Plan to Open? Predicting the Need for Open Reduction in the Treatment of Developmental Dysplasia of the Hip.

Closed reduction is generally attempted on children under 18 months of age who present as older infants or who fail nonoperative management for developmental dysplasia of the hip (DDH). However, many of these patients will not achieve concentric reduction by closed means and will ultimately require open reduction (OR). Limited evidence exists to predict which patients can be adequately closed reduced versus those who will need open treatment. Prospectively collected data from 4 select centers of an international multicenter study group sharing a common treatment approach were reviewed for all DDH infants under 18 months old that required operative management. Patients were categorized into 2 groups: those whose hips were successfully closed reduced or those who ultimately required OR. Factors were compared between the closed reduction and OR groups for 2 separate cohorts-those presenting early in life with ultrasound (US) data, and those presenting later with radiographic data. A total of 154 patients (166 hips) were included in the analysis. Overall, 87.3% were female. In the early-presenting cohort, purposeful entry multivariate regression revealed that patients with Graf IV hips on US had 3.8 times higher odds of requiring an OR. For the later cohort, hips that were clinically irreducible (ie, negative Ortolani sign) had 3.3 times higher odds of requiring OR. Patients with International Hip Dysplasia Institute (IHDI) grade IV hips had 2.5 times higher odds of needing an OR versus those with grade III hips and 15.4 times higher odds than those with grade II hips. Children with an IHDI grade IV hip and a negative Ortolani sign had 4.4 times higher odds of needing OR. Children younger than 18 months with dislocated hips who require OR are more likely to have a high-grade radiographic dislocation (IHDI grade IV), negative preoperative Ortolani sign, and a Graf IV classification on initial US. This information may help surgeons budget the use of operating room time and better counsel parents about intraoperative expectations. Level III-Prognostic.

Preliminary application of Starr reduction framecombined with O-arm navigation systemin the treatment ofcomplex pelvic fractures

Objective To investigate the feasibility and short term clinical efficacy of early minimally invasive treatment of complex pelvic trauma with Starr reduction frame combined with O-arm navigation system. Methods From June 2017 to December 2018, thirty two patients with Tile C complex pelvic fractures were prospectively divided into two groups according to the random number table. The open treatment group included 17 cases (open reduction and internal fixation group; 10 males and 7 females, age 24-60 years, average 37±6.5 years; according to Tile classification, 8 cases of C1 type, 8 cases of C2 type and 1 case of C3 type; according to the Denis classification of sacral fractures, 9 cases in zone I, 6 cases in zone II and 2 cases in zone III). The combined treatment group included 15 cases (Starr reduction frame group combined with O-arm navigation system, 8 males and 7 females, age 32-57 years, average 40±5.2 years; according to Tile classification, 8 cases of C1 type, 6 cases of C2 type and 1 case of C3 type; according to the Denis classification of sacral fractures, 8 cases in zone I, 5 cases in zone II and 2 cases in zone III). The ilioinguinal and Stoppa approaches were used in the open treatment group, and the anterior and posterior ring injuries were fixed with reconstruction plate screws and hollow screws, respectively. In the combined treatment group, starr frame was used to assist reduction, combined with O arm navigation technique, infix internal fixation frame, superior pubic branch screw, sacroilium screw were used to fix the anterior and posterior ring injury. The quality of pelvic fracture reduction was evaluated by the Matta scoring system, and the Majeed score was used to evaluate the clinical efficacy. Results All patients were followed up for 6 to 12 months. The hospitalization time (45±11 d), operation time (220.0±49.4 min) and fracture healing time (24.0±5.6 weeks) in the open treatment group were longer than those in the combined treatment group (21±9 d, 180.0±24.2 min, 16.1±3.8 weeks), and the intraoperative blood loss (820.0±140.4 ml) was significantly higher than that in the combined treatment group (24.0±10.4 ml)(t=6.651, 2.772, 6.128, 22.874; all P< 0.05). According to Matta scoring system, in the open treatment group, there are 8 excellent cases, 6 good cases, 2 fair cases, 1 poor case, thus the excellent and good rate was 82.4%(14/17). While 9 cases were excellent, 5 good, 1 fair, and the excellent and good rate was 93.3% (14/15) in the combined treatment group. At the latest follow-up, Majeed score was 51-85 points in the open treatment group, including excellent in 8 cases, good in 6 cases, fair in 2 cases, poor in 1 case, thus the excellent and good rate 82.4% (14/17), and the Majeed score was 75-95 points in the combined treatment group, including excellent in 9 cases, good in 5 cases, fair in 1 case, thus excellent and good rate 93.3% (14/15). There was a statistically significant difference between the two groups of Matta score and Majeed score (χ2=0.034, 0.040; P< 0.05). Surgical infection occurred in 4 cases in the open treatment group and healed after debridement and treatment with sensitive antibiotics. The incidence of complications was 23.5% (4/17). In the combined treatment group, 2 cases had anterolateral thigh skin sensory loss after operation, and the symptoms were relieved after mannitol, mecobalamine treatment and removal of internal fixations. One patient had hematoma of the gluteus maximus muscle after operation. The result of angiography showed that the INFIX screw was too long and perforated near the foramen of the ischium, resulting from the injury of the superior gluteal artery. After stopping the use of anticoagulant, intravenous infusion of tranexamic acid, blood transfusion, etc., the patient was cured and discharged from hospital. The incidence of complications was 20.0% (3/15). There was no significant difference in the incidence of complications between the two groups. Conclusion With the help of starr reduction frame, the early reduction and minimally invasive treatment of pelvic fracture can be realized, and the amount of intraoperative bleeding can be reduced. The combined application of o arm navigation can improve the accuracy and safety of sacroiliac screw and anterior column screw placement, reduce the radiation dose and frequency of operators and patients, shorten the operation time and improve the curative effect. Key words: Pelvis; Fractures, bone; Fracture fixation, internal; Surgery, computer-assisted

Bilateral Developmental Dysplasia of the Hip: Does Closed Reduction Have a Role in Management? Outcome of Closed and Open Reduction in 92 Hips.

Bilateral developmental dysplasia of the hip (DDH) is believed to have a worse outcome than unilateral DDH with the optimal treatment unclear. To define indications for treatment we report a retrospective series of 92 hips (46 patients) who underwent closed reduction (CR) and/or open reduction (OR). A total of 58 hips in 29 patients underwent attempted CR using our standardized protocol. In the same 12 year time period, 54 hips in 27 patients underwent an OR. Outcome measures included resolution of acetabular dysplasia, need for further surgery, development of osteonecrosis (ON), and modified Severin Grade. CR was successful in 57% of hips; in this group secondary surgery was required in 15% and ON was seen in 12%. In the OR group, 11% failed to stabilize and required further early surgery: ON rate was 15% overall, and secondary surgery was required in 5%. In Tonnis 2/3 hips younger than 2 years, Severin grading was comparable following CR and OR, with 92% and 90% graded as Severin 1, respectively. The rate of significant ON was higher after CR in Tonnis 2/3 hips (12%) than after OR (0%). Overall, Tonnis 4 hips did badly: 94% failed CR and following OR, further surgery for redislocation/residual dysplasia was required in 21%. CR can be successful in Tonnis 2/3 bilateral hips, with acceptable rates of secondary surgery, ON, and Severin grading, the latter equivalent to open reduction. Importantly, persisting with casting of a unilateral dislocation, to allow the contra-lateral hip to stabilize, does not have an adverse effect. CR is not advised in Tonnis 4 bilateral hips. Parents should be counseled that the outcome of surgery for bilateral hips is not as good as for unilateral DDH, particularly for Tonnis 4 hips which are more difficult to stabilize and more likely to require supplementary surgery even after open reduction. Level IV-Therapeutic Study.

Intra-articular fracture distal end radius external fixation versus locking volar radius plate: A comparative study

Introduction: The purpose of the present study was to compare the results obtained by management of intra-articular fractures of distal end radius with closed reduction and external fixation versus open reduction and internal fixation with locking distal radius volar plate. Material and Method: The present study included 60 patients of distal intra-articular radius fractures. Patients were randomly divided into two groups: group I (close reduction and external fixator) and group II (open reduction and internal fixation with volar plating). Periodic clinical examination and x-ray review was carried out to find out functional outcome,range of motion, radiological outcome and complication. Patients were followed up for 6 month. Mean of all the quantitative variables was compared between two groups by unpaired 'T' test. Functional outcome was measured with Quick DASH score. Result: In present study palmer tilt,radial length and radial inclination was significantly greater in volar plate group.ulnar varience was more(-1.18mm) in volar plate group than external fixator group(-1.28mm). The mean QuickDASH scores and time to return to work were similar in patients treated with a locking plate and external fixator (QuickDASH score 2.4 ± 3.0 and 2.9 ± 5.4; 1.9 ± 0.5 months and 2.1 ± 0.7 months, respectively; P > 0.05).In present study Quick DASH score in ext fix group was 9.71 compaired to volar plating group 6.79 at the final followup. Complication rate were higher in close reduction and external fixation group as compared to open reduction and volar plating group. Conclusion: Open reduction and internal fixation with plate fixation had better functional outcome with less complication rate than close reduction and external fixation in management of intra-articular fractures distal end radius.

Functional outcome of calcaneal fractures treated by various methods

Introduction: Calcaneal fractures make up about 2% of all fractures. They account for 60% of major tarsal injuries. Anatomic restoration of the three-dimensional anatomy of the calcaneum and restoration of weight-bearing function is the goal of surgical management of calcaneal fractures. Over the years, various techniques have been developed to accomplish this goal. All these techniques have certain steps in common including disimpaction of the fragments, reduction of the displaced fragments either manually or percutaneously and protection of reduction with plaster pins and plaster, external fixation and open reduction and internal fixation. Materials and Methods: This is a retrospective study of 41 patients (50 fractures) with calcaneum fractures from 15 to 60 years of age, managed either conservatively or operated at our institution between 2012 and 2017, with regular detailed clinical and radiological follow-up for minimum of 6 months. Results: In this series, we have used American Orthopaedic Foot and Ankle Society score for assessment of our result. Ninety-three per cent fractures had good to excellent result in non-operative group and 77% fracture had good to excellent result in the operative group. In intra-articular fractures with joint depression pattern, 9 (69%) of the percutaneously fixed fractures had good to excellent results and 8 (66%) of the Open reduction and internal fixation (ORIF) group had good to excellent results. Eight (33%) with fair result had persistent heel widening and pain. One patient had loss of reduction, but all of them have returned to their original occupation. In intra-articular fractures with Tongue type fracture, all 7 (100%) fractures had good to excellent results, whether they were fixed percutaneously or via open fixation. Conclusion: In this retrospective study, we observe that there was no significant difference noted, with respect to the functional outcome, between the operated and non-operated group.