Open Reduction Research Articles

Construction and validation of a nomogram for blood transfusion after open reduction and internal fixation (ORIF) of proximal humeral fractures in the elderly: a cross-sectional study

PurposeFew studies have focused on the risk factors leading to postoperative blood transfusion after open reduction and internal fixation (ORIF) of proximal humeral fractures (PHFs) in the elderly. Therefore, we designed this study to explore potential risk factors of blood transfusion after ORIF for PHFs. We have also established a nomogram model to integrate and quantify our research results and give feedback.MethodsIn this study, we retrospectively analyzed the clinical data of elderly PHF patients undergoing ORIF from January 2020 to December 2021. We have established a multivariate regression model and nomograph. The prediction performance and consistency of the model were evaluated by the consistency coefficient and calibration curve, respectively.Results162 patients met our inclusion criteria and were included in the final study. The following factors are related to the increased risk of transfusion after ORIF: time to surgery, fibrinogen levels, intraoperative blood loss, and surgical duration.ConclusionsOur patient-specific transfusion risk calculator uses a robust multivariable model to predict transfusion risk.The resulting nomogram can be used as a screening tool to identify patients with high transfusion risk and provide necessary interventions for these patients (such as preoperative red blood cell mobilization, intraoperative autologous blood transfusion, etc.).

Long-term operation and dynamic response of dissimilatory nitrate reduction to ammonium process under low-frequency infrared electromagnetic field

Dissimilatory nitrate reduction to ammonium (DNRA) received more attention for its ability to recover ammonium. This study investigated the possibility of low-frequency infrared electromagnetic field (IR-EMF) to improve DNRA. The optimal IR-EMF intensity of 0.04 μT could effectively improve DNRA activity of nonwoven fabric membrane bioreactors. In the long-term operation, the average ammonium conversion efficiency was enhanced by 117.7% and 62.5% under 0.04 μT and 0.06 μT IR-EMF, respectively. The highest nrfA-gene abundance and potential DNRA rate were obtained under 0.04 μT IR-EMF exposure. Bacteroidetes fragilis, Shewanelle oneidensis MR-1, and Thauera sp. RT1901 were selected to investigate the dynamic response of nitrogen transformation and energy metabolism to IR-EMF. The transcriptome sequencing and RT-qPCR results suggested that IR-EMF could enhance both denitrification and DNRA process, mainly by improving ATP synthesis to boost metabolic activity. This study provided an efficient method for the nitrogen recovery via DNRA process by applying IR-EMF.

Treatment of traumatic elbow luxation and radius fracture with non-rigid transarticular external fixation and paraosseous clamp cerclage in a cat

An 8-year-old, female, neutered mixed-breed cat presented with traumatic elbow luxation and radius fracture due to high-rise syndrome. According to the anamnesis, the trauma had occurred 10 days prior. Therefore, the patient was treated with an open reduction technique. The reduction of the elbow joint was performed with the cerclage transarticular external fixation (CTEF) method. Fixation of the radius fracture was performed using the paraosseous clamp cerclage method. The follow-up time for the patient was 1 year, and the functional outcome was considered fair due to humero-ulnar ankylosis of the elbow joint with 110° of extension. In this case report, post-operative long-term clinical and radiographic results were not as desired. This can be explained by the inability to perform surgery at the desired time, the severity of the trauma, and cartilage damage. However, further cases are required to determine whether this procedure is optimal for the treatment of traumatic elbow luxation in cats.

Radiocapitellar joint plasty for missed monteggia fracture with radial head deformity in children: a retrospective study.

The retrospective study reviewed the clinical and radiological outcomes of patients treated with radiocapitellar joint plasty. 10 children with missed Monteggia fracture (MMF) were reviewed. The average time from injury to operation was 20 months. The average age of children who underwent the operation was 10.5 years. 6 flat and 4 domed radial heads were included. 7 type I and 3 type III MMF were identified based on the Bado classification. All children with MMF were treated by open radial head reduction with radiocapitellar joint plasty and ulnar osteotomy (UO). The average union time was 4.9 ± 2.6 months. The average osteotomy angle to reduce the radial head was 15.7 ± 3.5°, and the average lengthening of the ulna was 8.2 ± 3.2 mm. The average preoperative flexion range of motion was 110.5 ± 9.1°, and the postoperative flexion range of motion was 138.8 ± 15.1° (p < 0.05). The average preoperative extension range of motion was 10.1 ± 3.2°, and the postoperative extension range of motion was 5.5 ± 3.3° (p < 0.05). The average preoperative pronation range of motion was 78.8 ± 8.7°, while the postoperative pronation range of motion was 81.1 ± 5.6° (p > 0.05). The average preoperative supination range of motion was 68.3 ± 9.7°, and the postoperative supination range of motion was 80.1 ± 7.8° (p < 0.05). The preoperative Kim score was 66.5 ± 10.9°, and the postoperative Kim score was 88.1 ± 12.6 (p < 0.05). The radial head was completely reduced in 9 patients, and subluxation in 1 patient. Osteoarthritis of the radiocapitellar joint was observed in 2 patients. Radiocapitellar joint plasty is effective surgical intervention for MMF with radial head deformity. It yields favorable functional outcomes while ensuring continued radial head reduction.

Operative treatment of isolated epiphyseal fracture of the distal fibula: 1 case report and literature review

Pediatric ankle injuries are common; ankle epiphyseal fractures are also common in children. But isolated distal epiphyseal fibular fractures of the distal fibula are clinically rare. We describe one unusual case of an adolescent with a completely displaced Salter-Harris type II distal fibular epiphyseal fracture. The attempt of closed reduction failed, and the patient required open reduction and internal fixation. The localized periosteum and the superior peroneal retinaculum were avulsed from the distal fibular metaphysis, with the peroneal tendons underneath exposed but no obvious subluxation. To the best of our knowledge, this combination of injuries has not been previously reported.

Operative treatment of isolated epiphyseal fracture of the distal fibula: 1 case report and literature review

Pediatric ankle injuries are common; ankle epiphyseal fractures are also common in children. But isolated distal epiphyseal fibular fractures of the distal fibula are clinically rare. We describe one unusual case of an adolescent with a completely displaced Salter-Harris type II distal fibular epiphyseal fracture. The attempt of closed reduction failed, and the patient required open reduction and internal fixation. The localized periosteum and the superior peroneal retinaculum were avulsed from the distal fibular metaphysis, with the peroneal tendons underneath exposed but no obvious subluxation. To the best of our knowledge, this combination of injuries has not been previously reported.

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

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

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

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

Reconstruction of Chronic Monteggia Fracture with Radial Head Excision: A Case Report

Introduction: Chronic Monteggia fracture is a rare and clinically challenging condition, characterized by a non-union fracture of the proximal ulna with dislocation of the radial head. This case report presents the case of a 42-year-old woman with a chronic Monteggia fracture diagnosed 21 years after the initial injury, highlighting the importance of a careful patient history and radiographic investigation. Case presentation: A 42-year-old woman presented with left elbow pain and a history of significant trauma 21 years previously. Physical examination revealed limited range of motion and radiographic examination revealed a nonfused fracture of the proximal ulna with dislocation of the radial head. The patient underwent open reduction and internal fixation (ORIF) reconstruction of the ulna and excision of the radial head. Conclusion: Successful surgical reconstruction of chronic Monteggia fractures results in significant improvements in the patient's function and quality of life. This case report emphasizes the importance of early diagnosis and timely surgical intervention to prevent long-term complications and achieve optimal functional outcomes.

Use of light activated intramedullary device for revision of a proximal humerus fracture: a case study.

Post-operative non-compliance is a risk factor for fracture fixation failure and presents a challenge for revision surgery planning. We present a patient who underwent revision surgery for a proximal humerus fracture with lateral locked plating augmented with a UV light activated intramedullary implant. A 45-year-old woman with a history of alcoholism presented with a proximal humerus fracture. After undergoing open reduction internal fixation with a lateral locking plate, the patient suffered a fall secondary to delirium tremens. New radiographs demonstrated displacement of the fracture with failure of screws. Revision surgery consisting of removal of the initial construct as well as open reduction internal fixation via lateral locking plate, augmented with a UV-activated intramedullary cement implant, was performed. This is the first case report describing the use of a UV-activated intramedullary cement implant to augment the use of lateral locked plating for proximal humerus fractures. This case illustrates the successful management using UV-activated intramedullary cement to augment fixation, specifically in a patient with risk factors and post-operative non-compliance that predispose to fixation failure.

Reamed intramedullary nailing of diaphyseal multifragmentary femur fractures (AO/OTA 32-C) without fluoroscopy guidance: prospective analysis of methods and short-term outcomes in a low-resource setting.

To describe the methods and outcomes of reamed intramedullary nailing (IMN) of diaphyseal multifragmentary femur (AO/OTA C2 and C3) fractures (DMFFs) in a low-resource setting without fluoroscopy and fracture table. The prospective study involved 35 DMFFs among 318 femur fractures treated ≤ 3weeks post-injury with SIGN nails. The fractures were fixed without fluoroscopy, fracture table and power reaming. Closed, mini-open or open reduction was done. Anatomical length and alignment were ensured using a surgical support triangle during retrograde nailing, and by an assistant during antegrade nailing. Follow-ups were done at 6weeks, 12weeks and 6months. DMFFs constituted 11.0% of the 318 fractures. Twenty-four (68.6%) were males. The mean age was 39.0years (range 17-75years). About 94.3% were injured in road traffic accidents. Fracture reduction was closed in 18, mini-open in 8 and full-open in 9. The operative times were significantly shorter for closed than open reduction (p = 0.001). Five fractures received a supplemental fixation with plate or lag screws. By the 12th post-operative week, 97.1% demonstrated continuing radiographic healing, 94.1% tolerated painless weight-bearing and 91.2% could squat & smile. There was no infection or noticeable rotational malunion. Five fractures healed with a limb-length discrepancy of < 2cm. The study demonstrates the feasibility of reamed IMN of DMFFs without fluoroscopy. The outcomes were satisfactory. Although the small sample size and short follow-up period are limitations, the study could serve as a basis for future larger studies in low-resource settings.

Clinical and radiographic results of internal fixation of quadrilateral plate fractures of acetabulum.

Quadrilateral plate (QLP) is a relatively thin bony structure located below the pelvic brim proximal to the hip joint, so management of its fractures is challenging. Evaluation of the functional and radiological outcomes of internal fixation of quadrilateral plate acetabular fractures; comparison of two methods of fracture fixation. A prospective multicentric study including 30 patients who underwent open reduction and internal fixation of QLP fractures through modified Stoppa approach. Patients were divided into two groups according to the method of fixation (anatomical QLP plate vs suprapectineal and infrapectineal plates). Post-operative quality of reduction was evaluated using Matta score. Radiographical assessment according Matta's grading criteria and clinical outcome assessment using the Harris Hip Score (HHS) were repeated at follow-up and at one year to assess displacement. Mean age of patients was 34.9 ± 12.1years. After one year follow-up, clinically mean HHS was 88. ± 5.74. Radiologically post-operative reduction quality was anatomical in 21 (70%) patients, satisfactory in eight (26.7%) patients and unsatisfactory in one (3.3%) patient. Matta's grading at the last follow-up was excellent in 21 (70%) patients, good in six (20%), fair in two (6.7%) patients and poor in one (3.3%) patient. No significant difference was recorded between the two groups in terms of radiographical and clinical results and rate of complications. Accurate reduction of quadrilateral plate fracture with secure fixation through modified Stoppa approach provides good and reproducible outcomes with few complications regardless the type of the implant.

Minimally Invasive Sinus Tarsi Approach versus Extensile Lateral Approach for Sanders Type II &amp; III Calcaneal Fractures (Systematic Review &amp; Meta-analysis)

Abstract Background Open reduction and internal fixation (ORIF) is becoming more common in Calcaneal fractures of Sanders types II and III. The extensile lateral approach (ELA) appears to be the gold standard. Aim of the Work We aimed to compare the clinical outcomes of intra- articular calcaneus fractures treated with open reduction and internal fixation with via Extensile lateral approach (routine treatment) versus those via a sinus tarsi approach (minimally invasive treatment). Materials and Methods This systematic review conducted on 7 studies enrolled 734 patients with Sanders type II &amp; III calcaneal fractures comparing he clinical outcomes of intra-articular calcaneus fractures treated with open reduction and internal fixation (ORIF) via Extensile lateral approach (routine treatment). The outcome measures considered: Postoperative wound complications, AOFAS score, Time to surgery, Surgical operative time, 24 hours Postoperative VAS score, Bohler's angle improvement, Gissane's angle improvement, Calcaneus width reduction, Recovery of calcaneus length, Length of hospital stay. Results Regarding postoperative wound complication, minimal invasive procedure significantly reduced the rate of wound complications other than open reduction. Concerning American Orthopedic Foot and Ankle Society score (AOFAS) score, there was no significant difference between ORIF and minimally invasive (MI) method. With reference to time to surgery, there was a significant difference between ORIF and minimally invasive (MI) method. As regard surgical operative time, MI had a significant reduction in operative time. According 24 hours Post operative VAS score, there was no significant difference between ORIF and minimally invasive (MI) method. Concerning Bohler's and Gissane's angles improvement, there was no significant difference between ORIF and minimally invasive (MI) method. With reference to calcaneus width reduction, there was no significant difference between ORIF and minimally invasive (MI) method. According recovery of calcaneus length, the current study showed no significant difference between ORIF and minimally invasive (MI) method. Concerning length of hospital stay, the ORIF consume more hospital stay than minimally invasive methods. Conclusion In contrast to ELA, minimal invasive procedure (STA) reduced the rate of wound complication. There was no significant difference between ELA and STA regarding the anatomical and functional outcome. The STA showed significant reduction in time to surgery and operative time.

Open Reduction and Internal Fixation versus Minimally Invasive Plate Osteosynthesis in Management of Distal Tibia Extra-Articular Fracture (Mini Thesis)

Abstract Background Extra-articular distal tibia fracture is one of the difficult fractures to treat and the optimal treatment remains controversial, however plates seem to be the obvious choice for treating this type of fractures. The mechanism on how to achieve the balance between anatomic reduction and indirect reduction as well as direct and indirect healing remains unclear. Thus, the key point is whether to use ORIF or MIPO in treating fractures. Aim of the Work to provide a complete overview of the optimal plating technique for distal tibia fractures by evaluating and comparing the clinical and functional outcomes of minimally invasive plate osteosynthesis (MIPO) vs Open reduction and internal fixation (ORIF) for treating extra- articular distal tibial fractures. Outcomes of interest include operation time, time to union, non-union, mal-union, infection, secondary operations, and functional outcomes (AOFAS score). Patients and Methods From August 2020 to August 2021, a prospective randomized study was conducted at the department of orthopedic surgery of Ain-shams University Hospital including 36 patients to compare MIPO vs. ORIF in fixation of extra-articular distal tibial fractures. The patients were allotted to the MIPO or ORIF group with the flip of a coin. Results Regarding complications rate, no cases developed infection in MIPO technique. On the other hand, the ORIF technique had an infection incidence of 16.6% overall, with two cases (11.11 %) developing superficial infection and one case (5.56 %) developing deep infection. There was no significant difference in the incidence of mal-union between both techniques with no cases of non-union in both groups. The MIPO group had only one case of sagittal plane malunion (5.56%), compared with no cases in the ORIF group. There was no significant difference between both groups in secondary operations rate, with one case in each group. Conclusion Both MIPO and ORIF have similar therapeutic efficacy regarding the functional outcome and can be used safely in distal tibial extra-articular fractures. Although MIPO is advantageous over ORIF with earlier weight-bearing, earlier union, and clinical lower incidence of infection, it has delayed operation time.

Total Knee Replacement as Primary Management in Comminuted Tibial Plateau Fracture in Elderly Patients: A Systematic Review and Meta-Analysis

Abstract Background Fracture of the tibial plateau represents approximately 8% of fractures in elderly patients. These injuries occur with an estimated incidence of 13.3 per 100,000 adults annually, with nearly a quarter of these occurring in elderly patients with concomitant osteoporosis. In young patients, the mainstay treatment for displaced tibial plateau fracture is open reduction and internal fixation (ORIF). However, in elderly patients with periarticular fracture, the combination of poor bone quality, metaphyseal bone comminution, and friable soft tissue envelope creates unique challenges to traditional ORIF. Aim of the Work To evaluate the perioperative complication rates and clinical outcomes in patients following TKA for primary treatment of tibial plateau fracture and to establish whether TKA can be considered a reliable primary treatment option in selected individuals. Patients and Methods The present systematic review will be performed in accordance with the preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search for all level I–IV evidence published articles using the online databases MEDLINE, Embase, and PubMed will be performed. The purpose of this search is to identify all eligible studies featuring perioperative complications or clinical outcomes in patients following TKA for primary treatment of tibial plateau fracture. Results The immediate management of acute tibial plateau fracture in elderly patients continues to be controversial. Although there is emerging evidence showing positive results for primary TKA for tibial plateau fracture, it is paramount to appreciate that performing TKA in the context of acute tibial plateau fracture is not a straightforward attempt. Many of these patients have notable loss of the articular surface, which disrupts normal anatomic references, and compromised soft tissue due to possible coexisting ligamentous injury. Conclusion Total knee arthroplasty for treatment of acute tibial plateau fracture is an enticing alternative to ORIF to allow early weight bearing, especially in elderly patients with poor bone quality and a friable soft tissue envelope. Our systematic review shows that functional scores are only average.

Maintenance of joint reduction and allograft incorporation in treating tibial plateau fractures. Retrospective case series using cortico-cancellous, non-irradiated, bone allograft

BackgroundRestoring joint congruence and maintaining reduction until healing is imperative in treating tibial plateau fractures (TPF). The main objective of this study was to evaluate the feasibility of augmentation with impacted bone allograft (IBA) to prevent loss of reduction in tibial plateau fractures during healing and to evaluate its incorporation. MethodsWe retrospectively analyzed all patients with an acute, closed tibial plateau fracture (Schatzker II, III, IV) treated between 2010 and 2019 with open reduction and internal fixation (ORIF) and impacted bone allograft (IBA), with a minimum follow-up of 24 months. We evaluated the postoperative radiographs by drawing a line along the tibial axis and another perpendicular to the healthy plateau to measure the reduction and subsequent behavior. The incorporation of the allograft was evaluated by radiological analysis assessing its integration, non-union, resorption, or sclerosis. We used the clinical-radiological Rasmussen system and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) to objectify the outcomes. Results78 TPFs were included, with a median age of 51.5 (40.7–62.2) years and a median follow-up of 66 (24–89) months. Two (2.5 %) patients presented loss of joint reduction (subsidence) during the follow-up regarding the achieved in the surgery. Seventy-six (94.7 %) patients presented integration, two (2.5 %) resorption, and one (1.3 %) sclerosis. Seventy-two (92.3 %) patients presented excellent and good results in the Rasmussen radiological score, and 72 (92.3 %) patients presented excellent or good clinical scores. The mean WOMAC at two years postoperatively was 15 ± 6.5. ConclusionOur results demonstrate that allograft is an adjuvant in maintaining a reduction in type II, III, and IV Schatzker's tibial plateau fractures. Low rates of loss of reduction during follow-up can be expected with its use.

Functional Outcomes of Primary Subtalar Arthrodesis versus Late Subtalar Arthrodesis in Sanders Type IV Calcaneal Fractures

Abstract Background Sanders type IV calcaneal fractures are challenging. They are more likely to result in painful subtalar arthritis and subsequent subtalar arthrodesis. There is no consensus about the best management, so our study was conducted to compare the functional outcomes of primary subtalar arthrodesis with those of late subtalar arthrodesis. Methods From 2019 till 2022, 34 patients with Sanders type IV calcaneal fractures were included. Seventeen patients were managed by open reduction and internal fixation plus primary subtalar arthrodesis, while the other seventeen patients were treated conservatively followed by calcaneoplasty and late subtalar arthrodesis. Outcomes were measured by two scores: (1) the American Orthopaedic Foot and Ankle Society’s Ankle-Hindfoot scale (AOFAS-AHS) and (2)Foot and Ankle Ability Measure - Activities of Daily Living sub scale (FAAM-ADL). We also documented the union rate at one year, the wound complications and the need for second surgeries. Results Twenty-nine patients were followed for at least two years. At one-year follow up, the mean AOFAS-AHS for group A and group B were 72.86 (SD 3.13) and 70.80 (SD 3.63) (P = .12) respectively, while the mean FAAM score for group A and B were, respectively, 57.29/84 (68.20%) (SD 2.27) and 55.27/84 (65.80%) (SD 2.74) (P = .04). At two-year follow up, the mean AOFAS-AHS for group A and group B were 74.42 (SD 1.95) and 73.80 (SD 1.9) (P = .88) respectively, while the mean FAAM score for group A and B were, respectively, 59.21/84 (70.49%) (SD 1.6) and 58.73/84 (69.92%) (SD 1.7) (P = .44). The complications were comparable. Conclusion Primary subtalar arthrodesis is a successful treatment option for these severe life-changing fractures. It may reduce the overall disability time. Level of Evidence Level II

503 An Audit of the Management of Ankle Fractures Undergoing Open Reduction Internal Fixation (ORIF) Against the British Orthopaedic Association (BOA) Standards for Trauma

Abstract Aim To assess compliance of the management of ankle fractures with ORIF at Aberdeen Royal Infirmary and Woodend Hospital against the management of ankle fractures guidelines in the BOA standards for trauma. Method A retrospective analysis of patients who underwent ORIF of ankle fractures from 12/06/2022 to 06/06/2023 was conducted. Pilon fractures and open fractures were excluded. Operations notes, admissions, discharge and clinic letters, and imaging were used. Results 201 patients met the inclusion criteria. 155 patients had complex fractures (posterior malleolus involvement, Maisonneuve, or syndesmotic injury); 46 had non-complex fractures. Only 47.74% of the complex fractures underwent CT imaging. Post-operation, only 14.43% and 12.45% of patients were full weight-bearing and partially weight-bearing, respectively. 97.01% of all patients had a follow-up clinic within 6 weeks post-operation. However, following the first clinic follow-up, only 24.88% and 25.87% were full weight-bearing and partially weight-bearing, respectively. The remaining patients were classified as non-weight-bearing. Conclusions Most of the patients were managed according to the guidelines. However, greater use of CT imaging for complex fractures can be done for defining fracture configurations. Additionally, more patients need to be allowed weight-bearing immediately post-operation and after their first follow-up clinic, as promoted by the BOA. Results were presented at the 21/11/23 mortality and morbidity meeting, and this issue was acknowledged by the orthopaedic surgeons. The post-operation note template will be revised, and a poster including the BOA guidelines on weight-bearing and imaging will be introduced in the department. A re-audit will be done in 2024 to assess any changes.

Emergency Management Patient with Multiple Mid-Lower Face Fracture and Tissue Avulsion of 1/3 Mid Face : A Case Report

Introduction : Facial trauma can be defined as bone and or soft tissue damage in the face region. Severe facial trauma might cause life threatening and permanent damage such as vision loss, unable to speak, swallows and chews because there are many bones, blood vessels, nerves, muscles and sensory organs at the face region. The facial damage could be a facial bone fracture with severe avulsion of facial tissue so two-dimensional and three-dimensional measurement of the wound is taken to assess the size of tissue to be covered. The aim of this case report was to give an explanation regarding the emergency management patient with multiple mid-lower face fracture and tissue avulsion of 1/3 mid face. Case Report : A 46 years old male traffic accident patient came to Emergency Department Hasan Sadikin General Hospital with facial fracture and had a severe avulsion of facial tissue. He also had an active bleeding from his face and based on immediate examination the airway was not clear. The patient has been diagnosed with Le Fort I, right orbital rim inferior aspect, nasal, right zygoma and parasymphisis of mandible bone fracture and Tissue loss at upper lip, nasolabial, left nose, left buccal and Multiple lacerated wound at facial region. He was treated with tracheostomy to clear the airway continued with open reduction internal fixation at right orbital rim inferior aspect, nasal, right zygoma, bilateral maxilla bone and parasymphisis of mandible bone with wound closing using rotational and sliding loco regional flap technique. Conclusion : Emergency treatment on multiple facial fracture with severe avulsion of facial tissue must be done to prevent life threatening condition, permanent damage and also to support the secondary reconstruction. Keywords : Severe avulsion of facial tissue, Mid lower face fracture, Open reduction internal fixation, Rotational flap, Sliding loco regional flap

Does Marijuana Smoking Increase the Odds of Surgical Site Infection after Orthopaedic Surgery? A Retrospective Cohort Study

OBJECTIVES: Does marijuana smoking increase the risk of surgical site infection (SSI) after open reduction and internal fixation of fractures? METHODS: Design: Retrospective Setting: Single academic level 1 trauma center in Southern California Patient Selection Criteria: Adult patients who underwent open treatment for closed fractures between January 2009 and December 2021, had hardware placed, and had at least 6 months of postoperative follow up. Outcome Measures and Comparisons: Risk factors associated with the development of SSI were compared between current inhalational marijuana users and non-marijuana users. RESULTS: Complete data was available on 4,802 patients after exclusion of 82 who did not have a complete variable set. At the time of surgery 24% (1,133 patients) were current users of marijuana. At final follow up (minimum 6 months), there was a 1.6% infection rate (75 patients). The average age of the infection free group was 46.1 ± 23.1 and the average age of the SSI group was 47.0 ± 20.3 (p=0.73). 2,703 (57%) in the infection free group were male compared to 48 (64%) in the SSI group (p=0.49). On multivariate analysis, longer operative times (OR 1.002 [95% CI: 1.001-1.004]), diabetic status (OR 2.084 [95% CI: 1.225-3.547]), and current tobacco use (OR 2.493 [95% CI: 1.514-4.106]) (p&lt;0.01 for all) were associated with an increased risk of SSI; however, current marijuana use was not (OR 0.678 [95% CI: 0.228-2.013], p=0.48). CONCLUSIONS: Tobacco use, diabetes, and longer operative times were associated with the development of SSI after open reduction and internal fixation of fractures; however, marijuana smoking was not shown to be associated with the development of SSI. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.