Open Reduction Of Fractures Research Articles

Is Anterior Plating Superior to the Bilateral Use of Retrograde Transpubic Screws for Treatment of Straddle Pelvic Ring Fractures? A Biomechanical Investigation.

Background: Fractures of the four anterior pubic rami are described as “straddle fractures”. The aim of this study was to compare biomechanical anterior plating (group 1) versus the bilateral use of retrograde transpubic screws (group 2). Methods: A straddle fracture was simulated in 16 artificial pelvises. All specimens were tested under progressively increasing cyclic loading, with monitoring by means of motion tracking. Results: Axial stiffness did not differ significantly between the groups, p = 0.88. Fracture displacement after 1000–4000 cycles was not significantly different between the groups, p ≥ 0.38; however, after 5000 cycles it was significantly less in the retrograde transpubic screw group compared to the anterior plating group, p = 0.04. No significantly different flexural rotations were detected between the groups, p ≥ 0.32. Moreover, no significant differences were detected between the groups with respect to their cycles to failure and failure loads, p = 0.14. Conclusion: The results of this biomechanical study reveal less fracture displacement in the retrograde transpubic screw group after long-term testing with no further significant difference between anterior plating and bilateral use of retrograde transpubic screws. While the open approach using anterior plating allows for better visualization of the fracture site and open reduction, the use of bilateral retrograde transpubic screws, splinting the fracture, presents a minimally invasive and biomechanically stable technique.

Prolonged Operative Time Associated with Increased Healthcare Utilization after Open Reduction and Internal Fixation of Intra-Articular and Extra-Articular Distal Radial Fractures: An Analysis of 17,482 Cases.

Background The current literature does not contain a quantitative description of the associations between operative time and adverse outcomes after open reduction and internal fixation (ORIF) of distal radial fractures (DRF). Questions/Purpose We aimed to quantify associations between DRF ORIF operative time and 1) 30-day postoperative health care utilization and 2) the incidence of local wound complications. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for DRF ORIF cases (January 2012-December 2018). A total of 17,482 cases were identified. Primary outcomes included health care utilization (length of stay [LOS], discharge dispositions, 30-day readmissions, and reoperations) per operative-time category. Secondary outcome was incidence of wound complications per operative-time category. Multivariate regression was conducted to determine operative-time categories associated with increased risk while adjusting for demographics, comorbidities, and fracture type. Spline regression models were constructed to visualize associations. Results The 121 to 140-minute category was associated with significantly higher risk of a LOS > 2 days (odds ration [OR]: 1.64; 95% confidence interval [CI]:1.1-2.45; p = 0.014) and nonhome discharge (OR: 1.72; 95% CI:1.09-2.72; p = 0.02) versus 41 to 60-minute category. The ≥ 180-minute category exhibited highest odds of LOS > 2 days (OR: 2.08; 95%CI: 1.33-3.26; p = 0.001), nonhome discharge disposition (OR: 1.87; 95% CI: 1.05-3.33; p = 0.035), and 30-day reoperation occurrence (OR: 3.52; 95% CI: 1.59-7.79; p = 0.002). There was no association between operative time and 30-day readmission ( p > 0.05 each). Higher odds of any-wound complication was first detected at 81 to 100-minute category (OR: 3.02; 95% CI: 1.08-8.4; p = 0.035) and peaked ≥ 181 minutes (OR: 9.62; 95% CI: 2.57-36.0; p = 0.001). Spline regression demonstrated no increase in risk of adverse outcomes if operative times were 50 minutes or less. Conclusion Our findings demonstrate that prolonged operative time is correlated with increased odds of health care utilization and wound complications after DRF ORIF. Operative times greater than 60 minutes seem to carry higher odds of postoperative complications.

Risk Factors for Aseptic Revision of Operatively Treated Ankle Fractures.

Early revision rates within 12 months after ankle fracture open reduction internal fixation (AF-ORIF) are fairly low; however, they remain relevant given the volume of ankle fractures occurring annually. Understanding these rates is complex because reoperation due to technical or mechanical complications is typically reported alongside soft tissue-related problems such as symptomatic hardware, wound dehiscence, or infection. There are limited data identifying risk factors specifically for revision of ankle fracture fixation in the absence of soft tissue complications. Understanding variables that predispose to aseptic technical and mechanical failure without this confounder may provide insight and improve patient care. A retrospective cohort study was performed at 2 large academic medical centers. Research Patient Data Registry (RPDR) data available from 2002 to 2019 were used to identify patients who underwent aseptic revision of AF-ORIF within 12 months (n = 33). A control group (n = 100) was selected by identifying sequential patients who underwent AF-ORIF not requiring revision within 12 months. Multiple factors were recorded for all patients in both cohorts. Each fracture was also evaluated according to the Ankle Reduction Classification System (ARCS) of Chien et al,8 which categorizes biplanar talar displacement in relation to a central tibial plumb line into 1 of 3 grades: A (0-2 mm), B (3-10 mm), and C (>10 mm). Adapted from its original purpose of grading reduction quality, we applied ARCS to pre-reduction radiographs to assess initial fracture displacement. All variables collected were compared in univariate analysis. Variables that achieved significance in univariate comparisons were included as candidates for multivariable analysis. Final multivariable logistic regression modeling demonstrated the following factors to independently predict the need for aseptic revision surgery: documented falls in the early postoperative period (aOR, 298; 95% CI, 15.4, 5759; P < .001), movement-altering disorders (aOR, 81.7; 95% CI, 4.12, 1620; P = .004), a nonanatomic mortise (medial clear space [MCS] > superior clear space [SCS]) on immediate postoperative imaging (aOR, 38.4; 95% CI, 5.53, 267; P < .001), initial coronal plane tibiotalar displacement >10 mm and sagittal plane tibiotalar dislocation (ARCS-C) (aOR vs ARCS-A, 25.8; 95% CI, 2.81, 237; P = .004), substance abuse (aOR, 15.7; 95% CI, 2.66, 92.8; P = .002), and polytrauma (aOR, 12.3; 95% CI, 2.02, 74.8; P = .006). In this investigation we found a notable increase in risk for revision surgery after AF-ORIF for patients who had one of the following: (1) falls in the early postoperative period, (2) movement-altering disorders, (3) a nonanatomic mortise (MCS > SCS) on immediate postoperative imaging, (4) more severe initial fracture displacement, (5) substance abuse, or (6) polytrauma. Identifying these factors may allow surgeons to better understand risk and counsel patients, and may serve as future targets for intervention aimed at improving patient safety and outcomes after ankle fracture ORIF. Level III, retrospective cohort study.

"Open Reduction of Medial Epicondyle Fractures in the Pediatric Population: Supine Versus Prone Position".

"Open Reduction of Medial Epicondyle Fractures in the Pediatric Population: Supine Versus Prone Position".

1224 Effect of Distal Brachioradialis Release During Open Reduction and Internal Fixation of Distal Radius Fractures

Abstract Aim The study aim is to determine the impact of the brachioradialis release during the open reduction and internal fixation of distal radius fractures using a volar approach Method Total of 40 patients was treated with Open reduction and internal fixation of intra articular distal radius fractures. Distal release of Brachioradialis was performed to 19 patients, while 21 patients had no release of BR during surgery. Radiological parameters including Radial height, Inclination and volar tilt were measured 1 month post-operatively, while functional outcomes assessed with modified mayo wrist scores and Quick-dash scores Results There is no significant difference between age, gender and pre-operative conditions indicating that both the groups (BR release and without BR release) have similar demographic characteristics. Pre-operatively both groups had disturbed values for radial height, inclination, and volar tilt. Postoperatively, the mean of both groups was closer to normal ranges for radial inclination and volar tilt; however, radial height was the least adequately restored radiological parameter for both study group (11.54 ± 1.35 for BR group versus 10.21 ± 2.29 for Non-BR group). Pain, functional status, and grip strength had similar values in both groups whereas BR group showed higher ROM and DASH scores with P values of 0.048 and 0.025 respectively. Conclusions Brachioradialis release enhances the reduction and operative fixation, restoring the necessary radiological and subsequent functional parameters in distal radius fractures with reported no complications.

862 A Retrospective Audit on Management of Ankle fracture In a District General Hospital in South east England

Abstract Aim Ankle fractures are common injuries encountered by orthopaedic surgeons on a daily basis. Primary aim of the audit is to compare management of ankle fracture in Ashford and St Peter’s Hospital under NHS trust with the BOAST guidelines. As a secondary objective, quality of life of patients less than 60 years of age is assessed in order to review the specificity of timing of surgery as mentioned in the guidelines. Method An audit was conducted among patients who have undergone open reduction and internal fixation for ankle fracture during a period of one year in Ashford and St. Peter’s hospital. BOAST guidelines was kept as a standard to compare the management practice in the trust. Quality of life is assessed with the help of COST (Chertsey Outcome Scoring for Trauma) scoring method. Results Trust showed good compliance with the guidelines regarding documentation and reviewing patients within 6 weeks’ time. Only 45% of the patients, less than 60 years old had surgery within 24 hours. The average COST score does not show any significant difference between those who had surgery within 24 hours and after that. Conclusions To conclude, trust showed good compliance in certain aspects like documentation and reviewing patients, but the surgery was delayed up to 19 days for patients less than 60 years of age. The average COST score showed that there are no functional benefits for patients who had surgery on an early date. So, the specificity of timing in the BOAST guideline is questionable.

A prospective study of functional and radiological outcome of open reduction and internal fixation of malleolar fracture and associated complications

Background: Malleolar fractures are a kind of regularly seen fractures in orthopedic department. As with all intra articular fractures, malleolar fractures necessitate anatomical reduction and stable internal fixation.Objective: To study functional and radiological outcome of open reduction and internal fixation of malleolar fracture and associated complications and to study role of early mobilization and graded weight bearing.Materials and Method: This study prospectively evaluated clinical, radiological and functional outcome of 39 patients of malleolar fracture treated with open reduction and internal fixation at Madras institute of orthopaedics and traumatology, Chennai from May 2016 to May 2017. After open reduction, patients were followed clinically and radio logically at 6 weeks, 3 months and 6 months. After operative procedure, functional and radiological outcome was assessed using Baird and Jackson score system.Results: Majority were Supination-External Rotation injuries 19 cases. Most common implant used for medial malleolus fracture was 3.5mm cortical screw (84.6%) cases and for lateral malleolus semi tubular plate (64.1%). According to Baird and Jackson scoring system our results were excellent in 6 cases (15.4%), good in 22 cases (56.4%), fair in 8 cases (20.5%), poor in 3 cases (7.7%). Good results were observed in maximum patients, one patient developed infection and two patients developed ankle stiffness.Conclusion: Open reduction and internal fixation of malleolar fracture is necessary to achieve anatomical reduction of the fracture fragments, ankle mortise congruity, restoration of the length of the fibula and restoration of syndesmotic integrity. We recommend to apply POP cast to prevent equines deformity and to start early range of motion of ankle as early as possible in cast after making dorsal window cut for 1 month.

Open Reduction and Internal Screw Fixation of Transitional Ankle Fractures in Adolescents.

Surgical treatment of a triplane fracture is indicated if there is >2 mm articular displacement of the distal aspect of the tibia or if the fracture pattern is deemed unstable following closed reduction and casting. Preoperative planning (Step 1) involves the use of radiographs and computed tomography scans to determine accurate fracture classification, the intended reduction maneuver, possible blocks to reduction, and screw trajectory and length. Room setup and patient positioning (Step 2) include placing the patient in the supine position with a bump under the hip, as well as the placement of a ramp or stack of blankets under the affected limb and adequate general anesthesia with muscle relaxation to facilitate reduction. Incision and surgical exposure (Step 3) is performed with use of an anterior ankle incision at the anatomic plane between the extensor hallucis longus and extensor digitorum longus, protecting the neurovascular bundle (i.e., the anterior tibial artery and deep peroneal nerve). Open reduction and assessment of reduction (Step 4) begins by removing any soft tissue, such as the periosteum, that may be interposed in the fracture site precluding a reduction. The ankle is then put through internal rotation and dorsiflexion in order to reduce the fracture, utilizing direct visualization through the incision and fluoroscopy to verify reduction with <2 mm articular step-off. Screw placement (Step 5) typically involves a 2-screw construct, with 1 screw starting at the anterolateral distal tibial epiphysis aiming medially (and staying within the epiphysis) and a metaphyseal screw aiming from the anterior metaphysis to the posterior Thurston-Holland fragment. Closure and immobilization (Step 6) usually involve a layered skin closure, as no deep closure is necessary in most cases. A below-the-knee cast is applied with the ankle in neutral dorsiflexion. Nonoperative treatment typically involves closed reduction and long-leg cast immobilization. Surgical treatment with reduction and screw fixation of triplane fractures is indicated for patients with >2 mm articular displacement or >3 mm physeal displacement of the distal aspect of the tibia. Achieving and maintaining reduction with screw fixation within these tolerances helps decrease the chance of arthritis development by 5 to 13 years postoperatively5,7. Following treatment of a triplane fracture with reduction and screw fixation, full ankle range of motion and normal growth are anticipated. Postoperative follow-up continues until skeletal maturity or until 1 year postoperatively with evidence of continued growth by Park-Harris lines on sequential radiographs. Short-term recovery is expected to be excellent, and long-term results are expected to be good as long as <2 mm articular reduction is achieved and maintained5,7. General anesthesia with muscle relaxation helps with closed or open reduction.Computed tomography is valuable for determining the maximum articular displacement and for 3D surgical planning for screw trajectories.Be aware of the periosteum and perichondrial ring as possible soft-tissue blocks to reduction, and do not hesitate to visualize the periosteum with an open technique to achieve anatomic reduction. AITFL = anterior inferior tibiofibular ligamentAP = anteroposteriorCT = computed tomography.

The outcome of Endoscopic Assisted versus Conventional transbuccal approach for Open Reduction and Internal Fixation of Mandibular angles Fractures using two miniplates osteosynthesis. Comparative study

The outcome of Endoscopic Assisted versus Conventional transbuccal approach for Open Reduction and Internal Fixation of Mandibular angles Fractures using two miniplates osteosynthesis. Comparative study

Efficacy of dynamic compression plating (DCP) in treating adults with humerus shaft fractures

Introduction: Fractures of the humerus shaft accounts about 3 to 6% of all fractures of which majority can be managed by conservative management but some will require surgery. The objective and aim were to determine the efficacy of dynamic compression plate (DCP) in the treatment of humeral shaft fractures in adults. Materials and Methods: This was a prospective study of 20 cases of fracture shaft of humerus admitted to Navodaya Medical Hospital and Research Centre, Raichur between December 2019 and October 2021. Cases were taken according to inclusion and exclusion criteria, with written informed consent. The study was approved by the Ethical committee of the institute.Results: Out of 20 cases, there were 14 (70%) men and 6 (30%) women. 15 (75%) cases were admitted due to Road Traffic Accident and 5(25%) had fall at home. Of 20 cases, 2 cases (10%) were proximal third, 14 (73%) were middle third, and 4 (20%) were distal third. Short oblique fractures or Transverse were commonly found. The fractures united in 18 (90%) patients, with 2 (10%) cases showed delayed union due to deep infection. Good range of mobility of shoulder and elbow joints was present in 18 (90%) patients, with 2 (10%) patients having poor mobility.Conclusion: Open reduction and Internal fixation of the humerus shaft fractures treated with dynamic compression plate provides higher union rates as compared to other modes of treatment available.

Evaluation of the functional outcome of surgical management of both bones forearm fracture with locking compression plate: A prospective study

Objective: The objective of the study is to evaluate the functional outcome of both bone forearm fractures with locking compression plate.Methods: This prospective study was conducted in the department of orthopedics, MVJ Medical College and Research hospital, Bengaluru from June 2019 to January 2021. The patient’s age group ranging from 18-60 years with closed both bone forearm fractures treated with locking compression plate for radius and ulna. Post operatively patients were evaluated using the Criteria of Anderson et al.Results: A total of twenty patients were evaluated in our study of which there were 14 males and 6 females. Nineteen patients had complete fracture union and one patient had non-union. 17 patients showed excellent results, 2 patients had satisfactory results and 1 patient had a failure of the procedure.Conclusion: Open Reduction and Internal Fixation of both bones forearm fracture with Locking Compression Plate is a safe and effective option in the fixation of closed both bone forearm fractures.

Assessment of Clinical Outcomes in Open Reduction and Internal Fixation of Mandibular Condyle Fractures Compared to Closed Treatment

Statement of the problemThe clinical decision to pursue open reduction and internal fixation (ORIF) vs. closed treatment (CT) to treat mandibular condyle fractures has been long contested but predicated on understanding of absolute and relative indications and contraindications. This meta-analysis critically appraised the literature to compare and contrast clinical outcomes following these interventions. Materials and methodsA systematic review and meta-analysis were performed to test the null hypothesis of no difference in clinical outcomes in ORIF vs. CT of mandibular condyle fractures. ORIF also was compared to endoscopically assisted open treatment. The PubMed, EMBASE, Cochrane Library, Elsevier text mining tool database and ClinicalTrials.gov trial registries were accessed from 1946 to 2020. The quality of evidence was determined using Grading of Recommendations Assessment, Development and Evaluation methodology. No pediatric studies were included. The quality of evidence was downgraded due to risk of bias and imprecision in specific outcomes in observational studies. Data analysisTwo authors extracted the following data from included studies: country of origin, study design, study period, number of patients, patient characteristics (i.e., age range, gender, ethnicity), fracture laterality (unilateral vs. bilateral), treatment used (CT vs. ORIF), and clinical outcomes. The study analyzed the data separately according to fracture location and study design (e.g., RCTs and observational studies). An experienced medical librarian was consulted on methodology and ran a medical subject heading (MeSH) analysis of known key articles provided by the research team to ensure complete capture of all articles pertaining to management of condylar fractures. In each database, the study ran scoping searches and used an iterative process to translate and refine the searches. Results and outcomes dataOf 1507 screened articles, 14 met the inclusion criteria. There were 4 meta-analyses that were included, examining 7 randomized controlled (RCTs) trials and 31 non-randomized studies. Primary studies enrolled adults with displaced uni- or bilateral condylar fractures and did not report the results by fracture location (e.g., subcondylar or condylar) except with 2 RCTs that included all adults with subcondylar fractures. Primary studies compared the outcomes after open surgical procedure with those of fixation using 1 or 2 miniplates with various diameters. Open reduction and internal fixation were favored significantly when evaluating temporomandibular joint pain (RR 0.3; 95% CI 0.1-0.7) (NNTp 3; 2-6), laterotrusive movements of the mandible (MD 2.3; 1.7-3.0) (SMD 0.9; 0.4-1.3), and malocclusion (RR 0.5; 0.4-0.7) (NNTp 19; 10-200). However, open treatment yielded higher incidence of postoperative infection (RR 3.6; 95% CI 0.9-13.8). With respect to ORIF versus endoscopically assisted open treatment, no difference was seen in overall patient satisfaction with postoperative mandibular movement, disturbance to articulation, or occlusion. ConclusionMeta-analysis of high-level evidence in randomized controlled trial data suggests ORIF yields significantly superior clinical outcomes when evaluating restoration of translational and rotational mandibular movement, alleviation of pain, and restoration of occlusion and symmetry, although it is associated with higher risk of postoperative infection and facial nerve injury. These long-term benefits must be weighed against the increased risk of postoperative infection in ORIF; thus, treatment should be patient-specific. Future investigations with high-level evidence may further elucidate the relative effectiveness and safety of various open, endoscopic, and closed techniques in patients with facial trauma.

Prospective study of fluoroscopy guided cannulated screw fixation in pelvic ring and acetabulum fractures through percutaneous or mini incision technique

Open reduction and Internal fixation of pelvis and acetabulum fractures have required extensive surgical exposure of the deep structures of the pelvis, with problems of wound healing, damage to major vessels or nerves and infection. To overcome this percutaneous fixation of the pelvic and acetabulum fracture receiving increasing attention. Percutaneous techniques may offer advantage of soft tissue planes remain intact, which ease later arthroplasty of the hip if necessary. Percutaneous techniques may be an ideal treatment for pelvic and acetabulum in polytrauma. Advantages for percutaneous screw fixation of pelvic and acetabular fractures in these studies include less soft tissue injury, less blood loss, and a lower rate of infection. Furthermore, early weight bearing ambulation will be possible with percutaneous screw fixation. Neurovascular injuries, internal organ injuries, screw misplacement, and screw fracture are some potential complications of this technique. Aim: To investigates the clinical and radiological outcomes and complications of percutaneous screw fixation of Pelvic ring fracture and acetabulum fracture. Study design: Hospital based prospective type of observational study. Materials and Methods: After taking clearance from ethical committee a total 54 patient operated for 62 fractures and 95 cc screw were inserted through different percutaneous and mini incision (windows) approach for fracture of pelvis and acetabulum were operated based on preoperative CT SCAN in between January 2019 to November 2020. The pelvis and acetabulum fractures were classified based on young - burgess and judet-letournel classification system. The outcome variables for radiological outcome was evaluated by matta radiological score and functional outcome were evaluated by Harris hip score and Majeed pelvis score at 6 and 12 months follow up. Results: In post-operative follow up patient were started with active range of motion without weight bearing for 3 months then partially weight bear as tolerated after 3 months the respective functional Harris hip score, Majeed score were obtained at 6 and 12 months of follow up with p value of

Smith-Petersen Versus Watson-Jones Approach Does Not Affect Quality of Open Reduction of Femoral Neck Fracture.

To compare immediate quality of open reduction of femoral neck fractures by alternative surgical approaches. Retrospective cohort study. Twelve Level 1 North American trauma centers. Eighty adults 18-65 years of age with isolated, displaced, OTA/AO type 31-B2 or -B3 femoral neck fractures treated with internal fixation. Thirty-two modified Smith-Petersen anterior approaches versus 48 Watson-Jones anterolateral approaches for open reduction performed by fellowship-trained orthopaedic trauma surgeons. Reduction quality as assessed by 3 senior orthopaedic traumatologists as "acceptable" or "unacceptable" on AP and lateral postoperative radiographs. No difference was observed in the rate of acceptable reduction by modified Smith-Petersen (81%) versus Watson-Jones (81%) approach (risk difference null, 95% confidence interval -17.4% to 17.4%, P = 1.00) with 90.4% panel agreement (Fleiss' weighted κ = 0.63, P < 0.01). Stratified analyses did not identify a significant difference in the rate of acceptable reduction between approaches when stratified by Pauwels angle, basicervical or transcervical fracture location, or posterior comminution. The Smith-Petersen approach afforded a better reduction when preoperative skeletal traction was not applied (RR = 1.67 [95% CI 1.10-2.52] vs. RR = 0.87 [95% CI 0.70-1.08], P = 0.006). No difference was observed in the quality of open reduction of displaced femoral neck fractures in young adults when a Watson-Jones anterolateral approach versus a modified Smith-Petersen anterior approach was performed by orthopaedic trauma surgeons. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Anterior bridge plating with mini incision MIPO technique for type a humerus diaphyseal fractures

Introduction: Anterior bridge plating with minimally invasive technique for type A shaft humeral fractures is reported as an acceptable less traumatic and reproducible procedure by several authors. We have evaluated the clinical, radiological, and functional outcome of such fractures in twenty patients, all of which were managed with dynamic compression plate over an average follow- up period of 12 months. Though open reduction and plating technique of humerus shaft fracture is prevailing, this technique also gives favorable outcome.Materials and Methods: Twenty patients with type a humerus shaft fractures were managed by anterior bridge plating using MIPO technique between March 2017 to November 2019 were included in this series. All cases were treated with closed reduction and 10-12 whole 4.5mm dynamic compression plate fixation over anterior aspect in bridging mode using the MIPO technique. The dominant side, gender ratio, surgery time, and fracture union time, and complications were noted. The UCLA shoulder and Mayo elbow performance scores were used for assessing the shoulder and elbow function.Results: Of the Twenty patients in the study, ten were males and ten were females. The mean age was 34.3 years (range 18 to 85 years) twelve out of twenty patients (60%) had the dominant side fractured. Mean surgical time in minutes was 88.98 (range: 50 to 150 minutes). The mean fracture union (radiological) time was 14.3 weeks (range: 10–16 weeks) and clinical union time was 10.4 week. However Shoulder function was excellent in 20 cases (100%) on the UCLA score.Conclusion: This study confirmed a high overall rate of union and excellent functional outcomes. Mini incision anterior bridge technique for type A fracture shaft humerus gives good functional results and should be considered as an effective, cosmetically advanced surgical option in the treatment of type A humeral shaft fractures. It is a safe and less time consuming method for type a humeral shaft fractures when the surgeon is experienced in the technique.

Хирургические доступы при лечении пациентов со свежими переломами вертлужной впадины

Abstract. Introduction According to the overwhelming majority of Russian and foreign authors, orthopedic traumatologists have been striving to improve the results of surgical treatment of acetabular (AC) fractures over the past decades. First of all, this is due to an increase in the number and severity of this injury, persisting complications and dissatisfaction of researchers with their own results of surgical treatment. Purpose Study of the rationale used by traumatologists for certain surgical approaches in the treatment of acute acetabular fractures. Materials and methods Literature sources were searched for information in the systems and databases Pubmed, Embase, Scopus, Medline, Cochran Library, eLibrary, Wiley Online Library using the keywords: acetabular fractures, surgical treatment, acetabular approach, open reduction and fixation of acetabular fractures, duration and blood loss, hip arthroplasty. Results The incidence of AC fractures, according to different authors, ranges from 2 to 23.4 %. The cause of this injury is road traffic accidents in up to 83 % of all cases. A significant increase in the number of AC fractures was noted. AC fractures in the vast majority of cases are classified according to AO/ASIF. Displaced AC fractures and multiplanar fractures are subject to surgical treatment. Open reduction and internal fixation still remain the standard treatment for AC fractures. The choice of the surgical approach is carried out more often taking into account the classification of AC fractures, and the type of fracture dictates the choice of approach to the acetabulum. It was found that the authors are forced to use surgical approaches taking into account the fractures of the AC columns. Discussion Adherence of traumatologists to the standards regarding indications for the choice of surgical approaches for complex AC fractures was noted. Surgical approaches for the treatment of two-column acetabular fractures are still often extended and traumatic, prolonged and accompanied by blood loss. Conclusion In the surgical treatment of pelvic and AC fractures, most authors adhere to standards in the choice of approach and fixation of columns and AC fragments. There is unanimity in the recognition of the trauma and "expansion" of the approaches used, accompanied by blood loss reaching up to 2000 ml and more, and the duration of the operation is on average 3 hours 50 minutes. For the surgical treatment of acute AC fractures, the researchers used both classical and modified anterior and posterior surgical approaches with the obligatory consideration of the classification of AC fractures. The rationale for choosing an operative approach, as a rule, was the determination of the type of AC fracture according to the AO/ASIF classification. The most effective approach in the surgical treatment of AC fractures is the combined anterior and posterior approach.

Geriatric Ankle Fracture: Robust Fixation Versus Hindfoot Nail.

The incidence of geriatric ankle fractures is increasing in step with the current aging population. Special considerations must be taken into account when treating geriatric patients due to increased medical comorbidities, worse soft tissue envelope, poor bone quality, and the needs for early mobilization. The orthopaedic surgeon must have a variety of surgical options to treat fractures in the elderly population based on patient-specific needs. This article uses a case-based approach to discuss relevant considerations when selecting between hindfoot fusion nail and robust open reduction and internal fixation for geriatric ankle fractures.

Assessment of operative outcome of ankle fractures: A clinical study

Background: Ankle fractures are one of the most common fractures presenting in public hospitals. Most of the studies report the short term functional outcome post-ankle fracture surgery. Hence; the present study was undertaken for assessing operative outcome of ankle fractures. Materials and methods: A total of 40 patients operatively treated for an unstable ankle fracture were entered into a database and prospectively followed. The postoperative protocol was standardized for all patients. Complete demographic and clinical details of all the patients were obtained. Baseline characteristics, complications, additional surgery, functional status and the American Orthopaedic Foot and Ankle Society score (AOFAS) were assessed. The intervention chosen was open reduction and internal fixation of unstable ankle fractures. Functional outcome was evaluated.Results: Level of pain decreased consistently over the 3-, 6-, and 12-month follow-up periods in both study groups as measured by the AOFAS questionnaire. At 3 months, 6 months and 12 months follow-up, mean AOFAS score was 75.5, 80.3 and 85.3 respectively. Conclusion: Patients undergoing operative fixation of unstable ankle fractures showed reasonable functional result at the 1-year follow-up.

Evaluation of functional outcome after open reduction and internal fixation of distal femur fractures by locking compression plate

Background: In the supra and intercondylar fractures of femur particularly with intra articular extension, patient may develop stiffness of knee, shortening, rotational deformities, internal derangement of knee with instability, varus and valgus deformities which affect patient’s routine lifestyle. If these cases were treated with locking compression plate, the results obtained were successful, superior, timesaving providing early ambulation and least disability improving the functional outcome. Materials and Methods: This is a prospective interventional study. This study includes 25 supracondylar and intercondylar fractures of femur (both Muller’s Type ‘A’, Type B and Type ‘C’ fractures) treated with open reduction and internal fixation by Locking Compression Plate in the Department of Orthopaedics, Narayana Medical College and Hospital, Nellore from October 2019 to August 2021. There are 16 males and 9 females with age ranging from 20 to 80 years with an average of 44.6 years. Average age for males is 28.9 years and average age for females is 25 years. 18 fractures were due to road traffic accidents and 6 cases are due to fall from significant heights, 1 case due to simple fall from standing (osteoporosis). 15 cases were in right femur (60%) and 10 cases were in left femur (40%). Results: 25 cases were included in the study. There is an increase in the rate of union, decreased time taken for union, increased knee range of motion, decreased time for weight-bearing, postoperative complications and duration for hospital stay. Conclusion: LCP proved to be a good implant which could take the challenges like poor bone stock, severe comminution both metaphyseal and articular and prove successful. The locking head screws distally have prevented varus collapse, even in cases of osteoporosis. The Condylar LCP can be used in either an open or a minimally invasive manner.

Retrospective study about the postoperative stability of zygomaticomaxillary complex fracture

BackgroundThe aim of this study is to evaluate the postoperative stability of zygomaticomaxillary complex (ZMC) fractures according to the number of fixation sites and to investigate the direction of postoperative displacement of the unfixed part of the fractured segment.MethodsThis study was retrospectively performed on 38 patients who were treated by open reduction and internal fixation of ZMC fractures and were taken postoperative computed tomography (CT) between February 2012 and July 2019. The patients were classified into 3 groups: 1-point fixation, 2-point fixation, 3-point fixation according to the number of fixations. The postoperative displacement of the fractured segment was evaluated by the superimposition between postoperative CT and follow-up CT, and the postoperative stability according to the fixation sites was investigated through the amount of postoperative displacement. In addition, it was investigated in which direction the location of the fractured segment was changed in the unfixed fractured segment according to the fixation sites.ResultsThe amount of postoperative displacement of the fractured segment was 0.75 ± 1.18 mm on average.In the postoperative displacement of the distal area according to the number of fixation of the fracture, there was no statistically significant difference in the amount of displacement of the fracture (p = 0.574).As for the direction of the change in the location of the fractured segment, 12 patients among 38 patients with the change in the location of the fractured segment were investigated, and the displacement in the medial direction (n = 11, 91.67%) was the most common in all three fixation methods.ConclusionIn patients with a ZMC fracture who were treated by open reduction and internal fixation, the number of fixations did not make the difference in the postoperative displacement of the fracture. In addition, the fractured segment mainly changes in the medial direction after surgery, and this fact can be used as a reference for the reduction direction during surgery for the stable prognosis.