Open Reduction Plate Fixation Research Articles

Modified pedicle screw-rod fixation versus open reduction plate fixation for the management of pubic symphysis diastasis: A retrospective study

ObjectiveSurgical intervention and fixation is the recognized measurement to treat pubic symphysis diastasis caused by high-energy trauma. The purpose of this retrospective study was to assess the clinical application of modified pedicle screw-rod fixation (modified PSRF) and open reduction plate fixation (ORPF) for treating pubic symphysis diastasis. MethodsThe data of this retrospective analysis were collected from 32 patients with pubic symphysis diastasis managed with modified PSRF or ORPF from January 2012 to December 2017, with or without posterior fixation. Indicators of clinical assessments including operating time, intraoperative blood loss, relevant surgical complications as well as follow-up were recorded. Majeed scores were performed for functional evaluation, as well as Matta criteria were applied to evaluate the quality of reduction. ResultsThe average time from injury to operation was 2.9 days in modified PSRF group and 3.2 days in ORPF group. Significant differences regarding average operation time (41.8 min versus 64.3 min) and average intraoperative blood loss (46.6 ml versus 304.6 ml) were presented between modified PSRF groups and ORPF group. Neither Majeed scores nor Matta evaluation showed a significant difference between two groups. In ORPF group, the incision infection occurred in one patient and two patients developed loosening of screws. In modified PSRF group, loosening of screws was found in one patient during the operative procedure and one patient experienced femoral nerve palsy. Irritation to the lateral femoral cutaneous nerve (LFCN) was detected in two patients in modified PSRF group. ConclusionsSatisfactory clinical outcomes were provided with applications of both fixation methods for treating pubic symphysis diastasis. Modified PSRF, as a minimal invasive technique, could serve as an effective and reasonable option for treating pubic symphysis diastasis.Level of evidence: III: retrospective cohort study.Trial registration: researchregistry3906.

A More Conservative Approach in the Surgical Management of Pediatric Physeal Ankle Fractures Should be Preferred: Mid to Long-term Functional Outcomes of Three Different Surgical Techniques for Salter-Harris Type II and Triplane Distal Tibial Fractures.

Pediatric physeal ankle fractures carry a high risk of complications. This study aimed to (1) investigate the effect of anatomic reduction of the physis on mid to long-term functional outcomes in Salter-Harris type II and triplane distal tibial physeal fractures (DTPFs) and (2) compare the outcomes of 3 different surgical techniques applied in these fractures. The database of a single level-I trauma center was retrospectively reviewed for DTPFs between 2012 and 2022. A total of 39 eligible patients with operative Salter-Harris type II and triplane fractures between 2012 and 2022 were included. Surgical treatment methods were closed reduction-percutaneous fixation (CR-PF), open reduction-screw fixation, or open reduction-plate fixation. Patients were further divided into subgroups for fractures reduced anatomically (<1 mm) or nonanatomically (1 to 3 mm). The primary outcome measures were the American Orthopaedic Foot and Ankle Society Score, ankle range of motion, presence of premature physeal closure and angular deformities, and Takakura ankle osteoarthritis grade. A total of 39 patients were included, with an average age of 12.9 ± 2.2 years. The mean follow-up time was 68.9±38.0 months. The CR-PF group had higher postoperative fracture displacement ( P = 0.011). American Orthopaedic Foot and Ankle Society scores were excellent in all groups, statistically similar between surgical techniques, and similar between anatomic and nonanatomic reduction groups. The CR-PF group ( P =0.030) and nonanatomic reduction ( P = 0.030) provided a significantly lower ankle osteoarthritis rate. All 4 patients with premature physeal closure were observed in patients treated with open techniques. CR-PF for the treatment of DTPFs should be preferred in suitable cases as it is less invasive and provides satisfactory mid to long-term functional outcomes without increasing complications compared with anatomic reduction and open techniques. Level III.

Functional Outcome of Displaced Intra-articular Fractures of the Distal Radius: Comparison of Closed Reduction Percutaneous Pinning with or without External Fixation versus Open Reduction Plate Fixation

Objectives. The purpose of the study was to determine the outcomes of closed reduction percutaneous pinning (CRPP) with or without external fixation (EF) with open reduction and internal fixation (ORIF) using plate and screws. Methods. Outcomes of ORIF versus CRPP, with or without external fixation for intra-articular distal radius fractures were compared through a multicenter, non-randomized, ambispective cohort study. A validated Filipino version of the DASH score (FIL-DASH) was used as primary outcome measure.Results. The ORIF group consisted of 13 patients and the CRPP group, eight patients. Pain scores, post-operative complications and radiographic measurements were also evaluated. Mean FIL-DASH score for the ORIF group (M=26.69, SD=4.88) was significantly higher versus the CRPP group (M=14.59, SD=10.64; t(19)=3.58, p=0.002). No significant differences in radiologic parameters, pain scores, and complications were found.Conclusion. The study demonstrates that functional outcomes post-CRPP with or without external fixation compares favorably over ORIF for distal radius fractures at one-year post-surgery.

Long-term Functional Consequences of Surgically Treated Pediatric and Adolescent Olecranon Fractures: Does the Presence of Associated Fractures and Surgical Procedure Affect the Results?

Olecranon fractures are rare conditions in childhood. The aim of this study was to investigate the factors affecting the results in surgically treated pediatric and adolescent olecranon fractures. The orthopaedic trauma database of a large academic tertiary center was retrospectively searched for patients who had sustained an olecranon fracture and were treated surgically between 2005 and 2021. Data related to demographic features, additional fractures, and the presence of any disease were obtained from the patient files. Mayo elbow performance score and the Turkish-language version of the shortened version of the disabilities of arm, shoulder, and hand scale were the main functional outcome measurements. The study included 37 elbows of 34 patients with an average age at the time of surgery of 10.9±3.1 years. The mean follow-up period was 78.2±48.0 months (range, 12 to 196mo). The 1-year fracture rate of contralateral olecranon was 75% in osteogenesis imperfecta patients. Concomitant fractures were 7 proximal radius, 1 medial epicondyle, and 2 capitellum fractures. The surgical treatment methods were tension band wiring (TBW), open reduction and isolated K-wire fixation, closed reduction and percutaneous fixation (CR-PP), and open reduction-plate fixation. The mean implant removal time in patients treated with closed reduction and percutaneous fixation was 2.2 months, open reduction and isolated K-wire fixation 4.7 months, and TBW 12.7 months ( P =0.004). The mean disabilities of arm, shoulder, and hand scale was 1.9. The mean Mayo elbow performance score was 100. Grade 1 elbow arthritis was determined in 3 patients. No patient underwent revision surgery. All treatment modalities provided excellent long-term functional results and low complication rates without the need for revision. Closed reduction-percutaneous fixation and open reduction-isolated K-wire fixation were associated with shorter implant removal times compared with TBW. Level III.

External Fixation in the Treatment of Displaced Midshaft Clavicle Fractures in Adults: A Retrospective Study

The study aims to compare the clinical outcome of external fixation (EF) and plating fixation (PF) in the treatment of displaced midshaft clavicle fractures in adults. Fifty-nine patients meeting the inclusion criteria were selected; 29 cases of external fixation and 30 cases of open-reduction plate fixation. The average follow-up period was 32 months. Outcomes analysis included: satisfaction with the received treatment, local appearance and shoulder function; residual symptoms; constant shoulder score (CSS); disability of the arm, shoulder and hand score (DASH). 25 cases of EF and all patients in PF group were successfully followed up. No statistically significant differences were observed between two groups in overall satisfaction (P = 0.12), CSS (P = 0.132), DASH (P = 0.113), or healing time (P = 0.086). In the EF group, there was one case of non-union (4%) and three cases of angular deformity. PF group had one case of non-union (3%) and no malunion; hardware irritation and the need for a second surgery were the biggest complications. Compared with PF, EF provided a better treatment overall, with the advantages of simple procedure, no damage to the soft tissue and blood supply, a short healing time, and no second operation.

External Fixation in the Treatment of Displaced Midshaft Clavicle Fractures in Adults: A Retrospective Study

The study aims to compare the clinical outcome of External Fixation (EF) and Plating Fixation (PF) in the treatment of displaced midshaft clavicle fractures in adults. Fifty-nine patients meeting the inclusion criteria were selected; 29 cases of external fixation and 30 cases of open-reduction plate fixation. The average follow-up period was 32 months. Outcomes analysis included: satisfaction with the received treatment, local appearance and shoulder function; residual symptoms; Constant Shoulder Score (CSS); Disability of the Arm, Shoulder and Hand Score (DASH). 25 cases of EF and all patients in PF group were successfully followed up. No statistically significant differences were observed between two groups in overall satisfaction (P=0.12), CSS (P=0.132), DASH (P=0.113), or healing time (P=0.086). In the EF group, there was one case of nonunion (4%) and three cases of angular deformity. PF group had one case of nonunion (3%) and no malunion; hardware irritation and the need for a second surgery were the biggest complications. Compared with PF, EF provided a better treatment overall, with the advantages of simple procedure, no damage to the soft tissue and blood supply, a short healing time, and no second operation.

Antegrade intramedullary nail versus plate fixation in the treatment of humeral shaft fractures: An update meta-analysis.

There is no consensus regarding the surgical treatment of humeral shaft fracture. The present meta-analysis was performed to compare the efficacy and safety between antegrade intramedullary nailing (IMN) and plating for humeral shaft fracture. PubMed, MEDLINE, Cochrane Library, EMBASE, Clinical Trails, Ovid, ISI Web of Science, and Chinese databases including WanFang Data, China National Knowledge Infrastructure were searched through March 10, 2019. The Review Manager software was adapted to perform statistical analysis and relative risk (RR) were used for the binary variables, and weighted mean difference and standardized mean difference (SMD) were used to measure the continuous variables. Each variable included its 95% confidence interval (CI). A total of 15 trials with 839 patients were included in the analysis. There was significant difference between IMN group and plate group in blood loss (SMD = 3.49, 95% CI: 1.19, 5.79, P = .003) and postoperative infections (RR = 3.04, 95% CI: 1.49, 6.24, P = .002). Additionally, significant difference was observed between minimally invasive plate osteosynthesis (MIPO) group and IMN group in nonunion rate (RR = 3.20, 95% CI: 0.12, 0.84, P = .02). Statistical significance was also observed between the open reduction plate fixation group and IMN group in restriction of shoulder and elbow joints results (RR = 0.49, 95% CI: 0.26, 0.96, P < .05). No significant difference was observed for the operation time, American Shoulder and Elbow Surgeons score, nerve injury, delayed union, reoperation in either group. IMN may be superior to plate in reducing blood loss and postoperative infections for the treatment of humeral shaft fracture. However, MIPO was superior to IMN group in nonunion and equal to IMN in other parameters. Further research is required and future studies should include analysis of assessments at different stages and follow-up after removal of the implants.

Hyaluronic Acid-Based Mesh Add-On Iliac Autograft Improves Bone Healing and Functional Outcomes in Atrophic Nonunion of Clavicular Midshaft: A 2-Year Followup.

Background:Atrophic nonunion may frequently be seen after clavicular midshaft fractures. Despite a variety of surgical options, clavicular nonunion cases are associated with impaired bone healing. The aim of current study was to evaluate efficacy of perioperatively administered hyaluronic acid (HA)-based mesh in patients with atrophic midshaft clavicular nonunion managed with iliac wing autograft and plate fixation.Materials and Methods:This retrospective clinical study investigated 44 patients with atrophic midclavicular nonunion who underwent open reduction plate fixation with iliac wing autografts. Patients were divided into two groups as those managed with iliac wing autograft and anatomical locking plate (ALP) fixation alone and those managed with add-on perioperative HA-based mesh, i.e., Group 1 (n = 24) and Group 2 (n = 20), respectively. Age, duration till to surgery, fracture healing time, length of gap, and length of injured and contralateral clavicle were also invastigated. The 2-year Disabilities of the Arm, Shoulder and Hand (DASH) and Constant scores were evaluated. Kolmogorov–Smirnov test, Mann–Whitney U-test, and Spearman's correlation test were used to assess variables.Results:Patients’ age, followup time, and duration till surgery were similar between two groups. The study groups did not significantly differ in terms of postoperative clavicular length, as measured relative to unaffected side. Mean duration of the fracture healing was significantly shorter in Group 2 compared to that in Group 1. Mean postoperative 2-year Constant score was statistically higher in Group 2 compared to that of Group 1. In addition, Group 2 had also significantly higher DASH score than that of Group 1.Conclusions:HA-based mesh application added on the iliac wing autografting with ALP fixation may be an efficacious alternative for atrophic nonunion of clavicular midshaft.

Reduction and functional outcome of open reduction plate fixation versus minimally invasive reduction with percutaneous screw fixation for displaced calcaneus fracture: a retrospective study

BackgroundMinimally invasive surgery has become popular because of the lower incidence of wound complications. However, achieving an anatomic reduction that provides a satisfactory outcome is difficult using minimally invasive surgery. Our study aimed to evaluate the reduction and clinical outcomes of closed reduction and percutaneous fixation treatment using a closed reduction traction device for displaced intra-articular calcaneal fractures compared with traditional open reduction plate fixation using an extended lateral approach.MethodsA total of 40 patients and 45 feet with calcaneus fractures from 2012 to 2016 were studied. The open reduction plate fixation group (24 feet) was compared to the closed reduction percutaneous fixation group (21 feet) with a traction device. The reduction assessments included length, width, height, Bohler’s angle, Gissane’s angle, and varus or valgus angle before and after surgery. The clinical outcomes included the American Orthopaedic Foot and Ankle Society hindfoot score and the visual analog score for pain, length of stay, and complication rate.ResultsThe patients were followed up for an average of 16.53 ± 3.95 months. No significant differences in reduction were observed between the open and closed groups (P > 0.05). The American Orthopaedic Foot and Ankle Society scores of the two groups were 80.29 ± 6.15 and 83.62 ± 6.95 (open versus closed) (P = 0.0957). The visual analog scores of the open and closed groups were 1.50 ± 1.22 and 0.81 ± 0.87 (P = 0.0364). The lengths of stay in the open and closed groups were 9.63 ± 2.72 days and 6.71 ± 1.85 days (P = 0.0002). The complication rates of the open and closed groups were 20.8% (5/24) and 4.8% (1/21) (P < 0.0001).ConclusionsThe closed reduction percutaneous fixation with traction device method may provide equivalent reduction results and superior outcomes for the length of stay, VAS score, and complication rate for displaced intra-articular calcaneal fractures.

Tibial pilon fractures: Which method of treatment?

A comprehensive review of the existing literature, related to treatment options and management principles of pilon fractures was performed, and its results are presented. The identified series advocate in favour of a number of different treatment strategies and fixation methods. Decision making was mostly dependent on the severity of the local injury, the fracture pattern, the condition of the soft tissues, patient's profile and surgical expertise. External fixation and conservative treatment did not provide sufficient articular congruence in many cases. Internal fixation allowed excellent restoration of joint congruity in Rüedi type I and II fractures. A staged approach, consisting of fibular plating and temporary bridging external fixation, later substituted by an internal minimal invasive osteosynthesis or by a definitive external fixation, was favourable for Rüedi type III fractures. Closed pilon fractures with bad soft tissue conditions (Tscherne ≥ 3) or open pilon fractures are regarded as contraindication of open reduction plate fixation. Anatomic reduction of the fracture, restoration of joint's congruence, reconstruction of the posterior column, with minimal soft tissue insult, were all highlighted as of paramount importance.