Treatment Of Open Fractures Research Articles

Does mechanism of injury impact the outcome of operative fixation of geriatric proximal humerus fractures.

The purpose of this study is to determine the effects of energy mechanism on outcomes following repair of proximal humerus fractures (PHF) in the middle aged and geriatric population. Two hundred sixty-nine patients who presented to our academic medical center between 2006 and 2020, and underwent operative treatment of a proximal humerus fracture were prospectively enrolled in an IRB-approved database. Patients above 55 were divided into high energy (motor vehicle accident, pedestrian struck, or fall > 2 stairs) or low energy mechanisms (fall from standing or < 2 stairs). Of 97 patients with complete documentation and follow-up, 72 were included in the low velocity (LV) group and 25 were included in the high velocity (HV) group. Demographic information, primary injury details, healing and time to union, range of motion (ROM), complications, and need for reoperation were assessed at initial presentation and subsequent follow-up appointments. Mean age, BMI, and gender were significantly different between the LV and HV cohorts (p = 0.01, 0.04, 0.01). OTA/AO fracture patterns were similar between the groups. (p = 0.14). Bony healing and complications occurred with similar frequency between groups (p = 1.00, 0.062). The most common complications in the LV and HV groups included avascular necrosis (9.7%, 16.0%), and screw penetration (4.2%, 12.0%), while the HV group also had rotator cuff issues including weakness and tendonitis (12.0%). There was no significant difference in need for reoperation between cohorts (p = 0.45). Time to healing, shoulder ROM, and DASH scores did not differ between each group. Energy and mechanism demonstrates similar outcomes in operatively treated proximal humerus fractures. These factors should not play a role in decisions for surgery in these patients and can help guide patient expectations.

Comparative Outcome of Hybrid External Fixator Versus Primary Ilizarov Fixator in the Treatment of Open Distal Tibia Extra-Articular Fractures.

Because one-third of the tibia is subcutaneous throughout most of its length and its location, it is more prone to open fractures. Open distal tibia fractures are mostly due to RTA and sports injuries. The goal of treatment is to obtain a healed, well-aligned fracture; pain-free weight-bearing; and functional range of motion of the knee and ankle. 33 patients of the 18-60-year age group with open distal tibia extra-articular fractures (without vascular injury), less than 3weeks old trauma were included in the prospective study for 1year period (1st June 2019 to 31st May 2020). 17 cases were treated with the Hybrid external fixator (HEF) and 16 cases were treated with the Ilizarov fixator (IF). Significantly (P < 0.05), the mean duration of surgery was less in the HEF group (67.6min), faster union of open type-II fractures in the HEF group (16.4weeks), and also a higher AOFAS score at 6months in open type-II fractures in the HEF group (84.4). There were two cases of equinus deformity in the IF group and one case of valgus deformity in the HEF group. HEF and IF are both equally effective in the treatment of open distal tibia extra-articular fractures with the advantage of stable fracture fixation, early weight-bearing, preserving soft tissue, minimal periosteal stripping, and providing one-staged definitive intervention. However, HEF is preferred over IF in terms of less operating time, faster union, and a better functional outcome with minimal complications.

Rates and risk factors of complications associated with operative treatment of pelvic fractures

PurposePost-operative complications following fixation of pelvic fractures can lead to mortality and increased morbidity. Available literature regarding complications is heterogeneous and knowledge on risk factors is limited. This study aims to identify the most common post-operative complications and their possible risk factors following pelvic fracture surgery.MethodsA retrospective cohort study was performed in two level-1 trauma centers in the Netherlands between January 2015 and January 2021. Included patients were all adult patients (≥ 18 years) with an operatively treated pelvic fracture (pelvic ring and/or acetabular fractures). Post-operative complications included surgical site infections (SSI), material-related complications, neurological complications, malunion/non-union and performed reoperations. A forward stepwise multivariable logistic regression analysis was used to identify any risk factors associated with these complications.ResultsComplications occurred in 55 (24%) of the 233 included patients. SSI’s were most common, occurring in 34 (15%) patients. Duration of surgery (odds ratio 1.01 per minute, 95% confidence interval 1.00–1.01) and obesity (odds ratio 1.10 per BMI point, 95% confidence interval 1.29–7.52) were independent risk factors for development of SSI. Less common post-operative complications were material-related complications (8%) and neurological damage (5%).ConclusionLimiting operation time by using less invasive and less time-consuming surgical approaches may reduce the risk of SSI. More awareness and post-operative screening for early signs of SSI is mandatory, especially in obese patients. Future research should include large prospective patient cohorts to determine risk factors for other post-operative complications associated with pelvic fracture surgery.

Management of fracture non-union long bones by limb reconstruction devices

Background: The limb reconstruction system (LRS), rail road fixator, and Ilizarov fixator are used to treat open fractures with bone loss and infective non-union of long bones. It benefits the fracture site by permitting distraction, compression, and further enhancing micromotion at the level of fracture site which plays an important part in healing. The LRS is a straightforward, unidirectional arrangement that provides exceptional strength and rigidity. The limb rebuilding procedure has proven to be an effective treatment option in instances of fracture infective non-union of long bones. Aims and Objectives: This study is to evaluate and to observe the use of limb reconstruction devices (such as the Ilizarov fixator and the rail road fixator) in the treatment of open fractures with bone loss and infective non-union of long bones. Materials and Methods: Twenty patients (15 males and five females) with fracture non-union of long bones were involved in this study after taking permission from ethic committee and consents from all 20 individuals. These patients then underwent thorough debridement and resection of non-viable bone ends with the application of limb reconstruction devices which were then followed by bone transport to fill the bone gap. This was done by means of Ilizarov in 13 patients and by rail road fixator in the remaining seven patients. The average time of union and complications were evaluated. Results: Mean duration of fracture union was 7.9 months. While one patient had failure resulting in non-union, other 19 patients achieved union by limb reconstruction devices. Majority of the cases had no complications. Mean period of hospital stay for Ilizarov was 68.13 days and for rail road fixator 53.17 days. After applying independent “t-test,” no statistically significant differences were observed in fracture union duration between Ilizarov and rail road fixator, since the calculated P value was observed to be &gt;0.05. Mean union of Ilizarov and rail road fixator application was found to be 7.6 months and 8.2 months, respectively. Conclusion: Limb reconstruction devices in our present study can be utilized as an effective way to tackle infective non-union of long bones and open fracture with bone loss for achieving better stabilization. Both Ilizarov and rail road fixator perform a crucial role in causing early mobilization of the patient and also in fracture union by distraction osteogenesis.

肋骨骨折観血的手術を行ったフレイルチェスト症例における呼吸理学療法の経験(The experience of respiratory physical therapy to operative treatment of rib fractures in flail chest injuries)

要旨 多発肋骨骨折を伴うフレイルチェストに対し，骨接合術を施行された患者の呼吸理学療法を3症例経験した。陽圧内固定による治療では高い確率で肺炎などの合併症を引き起こしたが，観血的内固定術後は体位ドレナージなど肺理学療法の制限が少ないため，合併症なくいずれも良好に経過した。理学療法プログラムも円滑に行われ，速やかな機能改善と社会復帰が可能であった。理学療法士は呼吸運動を評価し，異常な胸郭運動などの所見があった場合，速やかに情報共有を行う必要がある。運動療法中も胸郭運動を評価し，呼吸仕事量に着目した呼吸デバイスを選択，調整することで治療効果をより高めることができる。また，治療経過中に起こった胸郭動揺増悪の有無に着目することは，保存的治療の人工呼吸器離脱可否の判断と骨接合術の適応を検討するための一助となりうる。

Unreamed Intramedullary Nailing Versus External Fixation for the Treatment of Open Tibial Shaft Fractures in Uganda: A Randomized Clinical Trial.

To compare unreamed intramedullary nailing versus external fixation for the treatment of Gustilo-Anderson type II and IIIA open tibial fractures admitted to a hospital in rural Uganda. Randomized clinical trial. Regional referral hospital in Uganda. Fifty-five skeletally mature patients with a Gustilo-Anderson type II or IIIA open tibia shaft fracture treated within 24 hours of injury between May 2016 and December 2019. Unreamed intramedullary nailing (n = 31) versus external fixation (n = 24). The primary outcome was function within 12 months of injury, measured using the Function IndeX for Trauma (FIX-IT) score. Secondary outcomes included health-related quality of life (HRQoL) using the 3-level version of the 5-dimension EuroQol instrument (EQ-5D-3L), radiographic healing using the Radiographic Union Scale for Tibia (RUST) fractures score, and clinical complications. Treatment with an intramedullary nail resulted in a 1.0-point higher [95% credible intervals (CrI), 0.1 to 1.9] FIX-IT score compared with external fixation. Results were similar for the secondary patient-reported outcomes, EQ-5D-3L and the visual analog scale component of the EuroQol instrument (EQ-VAS). RUST scores were not different between groups at any time point. Treatment with an intramedullary nail was associated with a 22.1% (95% CrI, -42.6% to 1.7%) lower rate of malunion and a 20.8% (95% CrI, -44.0% to 2.9%) lower rate of superficial infection. In rural Uganda, treatment of open tibial shaft fractures with an unreamed intramedullary nail results in marginal clinically important improvements in functional outcomes, although there is likely an important reduction in malunion and superficial infection. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Operative treatment of hamate fractures with hamatometacarpal fracture dislocation using a self-designed dorsal buttress locking plate with trans-metacarpal pin insertion: short-term follow-up results

Purpose: Fracture and dislocation of the hamatometacarpal joint are rare; therefore, the diagnosis is frequently missed and the treatment is not clearly established. The authors performed operative treatment of hamate fractures with hamatometacarpal fracture dislocation using a self-designed dorsal buttress locking plate. Herein, we report the clinical and radiological results.Methods: From May 2016 to February 2022, we experienced 12 cases of hamatometacarpal fracture dislocation that underwent operative treatment with a self-designed dorsal buttress locking plate. All 12 patients were male, with an average age of 30.3 years and an average postoperative follow-up period of 6 months and 1 week. Open reduction and internal fixation were performed using a self-designed dorsal buttress locking plate with trans-metacarpal pin insertion according to the patient, and the results of the treatment were evaluated radiologically and clinically.Results: All cases showed bony union in radiological evaluations at the last follow-up. In functional evaluations using the modified Mayo wrist score, the results were excellent in 11 cases and good in 1 case. There were no complications such as fixation failure, nonunion, or infection.Conclusion: In cases of hamate fracture with hamatometacarpal fracture dislocation, the dorsal displaced fragment is very small, and it is often difficult to maintain reduction by direct fixation. In these fractures, operative treatment using a self-designed dorsal buttress locking plate with trans-metacarpal pin insertion can obtain good results.

Non-operative vs. operative treatment for multiple rib fractures after blunt thoracic trauma: a multicenter prospective cohort study

BackgroundPatients with multiple rib fractures without a clinical flail chest are increasingly being treated with rib fixation; however, high-quality evidence to support this development is lacking.MethodsWe conducted a prospective multicenter observational study comparing rib fixation to non-operative treatment in all patients aged 18 years and older with computed tomography confirmed multiple rib fractures without a clinical flail chest. Three centers performed rib fixation as standard of care. For adequate comparison, the other three centers performed only non-operative treatment. As such clinical equipoise formed the basis for the comparison in this study. Patients were matched using propensity score matching.ResultsIn total 927 patients with multiple rib fractures were included. In the three hospitals that performed rib fixation, 80 (14%) out of 591 patients underwent rib fixation. From the nonoperative centers, on average 71 patients were adequately matched to 71 rib fixation patients after propensity score matching. Rib fixation was associated with an increase in hospital length of stay (HLOS) of 4.9 days (95%CI 0.8–9.1, p = 0.02) and a decrease in quality of life (QoL) measured by the EQ5D questionnaire at 1 year of 0.1 (95% CI − 0.2–0.0, p = 0.035) compared to non-operative treatment. A subgroup analysis of patients who received operative care within 72 h showed a similar decrease in QoL. Up to 22 patients (28%) who underwent surgery experienced implant-related irritation.ConclusionsWe found no benefits and only detrimental effects associated with rib fixation. Based on these results, we do not recommend rib fixation as the standard of care for patients with multiple rib fractures.Trial registrationRegistered in the Netherlands Trial Register NTR6833 on 13/11/2017.

Changes in operative treatment of tibia fractures in Finland between 2000 and 2018: A nationwide study.

Incidences of different tibia fractures are not well reported. Possible changes in the operative treatment methods have also not been studied. The aim of this nationwide registry study is to determine the incidence of operatively treated tibia fractures and investigate the possible changes in treatment methods in Finland between 2000 and 2018. All patients aged 16 years or older with operatively treated tibia fractures in Finland from 2000 to 2018 were included. The incidence of operatively treated proximal, diaphyseal, and distal tibia fractures per 100,000 person years by age, sex, mechanism of injury, and study year was calculated. Data were extracted from the Finnish National Hospital Discharge Register. A total of 5996 proximal, 6874 diaphyseal, and 5658 distal tibia fractures were reported during the 18-year study period, resulting in incidences of 7.2/100,000, 8.1/100,000, and 6.9/100,000 person years for operatively treated proximal, diaphyseal, and distal tibia fractures, respectively. Over the study period, a clear change in fixation method in distal tibia fractures was found as plating became popular in the beginning of the 21st century. During the last 5 years of the study period, nailing and plating were equally used. Operatively treated proximal tibia fractures are most common among older females while diaphyseal fractures are most frequent in young male patients. Distal tibia fractures occur most often among middle-aged people.

Distal Fibula Fractures-Intramedullary Fixation Versus Plating: A Systematic Review and Meta-analysis of Randomized Control Trials.

The aim of the present study is to compare the functional scores and complications of intramedullary fixation versus plate osteosynthesis of distal fibular fractures in adults. Study was performed in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses format from MEDLINE, Embase, Ovid, and Cochrane databases. The included articles were assessed according to the risk of bias assessment tool by Cochrane collaboration. A total of 5 randomized control trials were included for quantitative review. Random sequence generation and allocation concealment of the study subjects were the strengths of all the included studies. There was high heterogeneity among the included studies (I2 > 75%). There was no significant difference between the Olerud-Molander scores in both the groups but the trend favored the intramedullary nailing of distal fibula (mean difference of 3.42, 95% confidence interval [CI] of 8.90). Complications were significantly lesser in the intramedullary group across the studies (odds ratio 0.26, 95% CI of 0.81). Intramedullary nailing of fibula with the use of modern locking fibular nails is an alternative to fibular plating for unstable distal fibular fractures in properly selected cases. There remains the need for standardizing the method of operative treatment of distal fibular fractures which can be done by a well-planned large-scale prospective study design. Level 1.

Early Knee Range of Motion Following Operative Treatment for Tibial Tubercle Avulsion Fractures Is Safe.

Tibial tubercle avulsion fractures (TTAF) often require surgical reduction and stabilization. Traditional teachings recommend postoperative knee immobilization for 4 to 6 weeks; however, the necessity of these restrictions is unclear and the actual practice varies. This study's purpose was to: (1) retrospectively review operatively managed TTAFs at a single center to examine the spectrum of postoperative rehabilitation guidelines, and (2) compare the outcomes of patients based on the timing of initiation of postoperative knee range of motion (ROM). Operatively managed TTAFs treated at a single center from 2011-2020 were identified. Patients with polytrauma, associated lower extremity compartment syndrome, or treatment other than screw fixation were excluded. Patient demographics, mechanism of injury, Ogden Classification, associated injuries, operative technique, postoperative ROM progression, and time to release to unrestricted activities were collected. Patients were grouped based on the initiation of postoperative ROM as Early (<4wk, EROM) or Late (≥4wk, LROM). Bivariate analysis was used to compare characteristics between these 2 groups. Study criteria identified 134 patients, 93.3% (n=125) of whom were male. The mean age of the cohort was 14.77 years [95% confidence interval (CI: 14.5 to 15.0]. Forty-nine patients were designated EROM; 85 patients were categorized as LROM. The groups did not differ significantly with regards to age, race, injury characteristics, or surgical technique. Both groups progressed similarly with regards to postoperative range of motion. Ultimate activity clearance was achieved at ~20 weeks postoperatively without differences between groups ( P >0.05). Four instances of postoperative complication were identified, all of which occurred in the LROM group. A broad range of postoperative immobilization protocols exists following the screw fixation of TTAFs. Across otherwise similar cohorts of patients undergoing operative treatment, initiation of knee range of motion before 4 weeks was without complication and provided equivalent outcomes to traditional immobilization practices. Given the clear benefits to patients and caregivers provided by the permission of early knee motion and the avoidance of casting, providers should consider more progressive postoperative rehab protocols following operatively treated TTAFs. Level III, Retrospective Cohort.

Developmental delay: is this pediatric patient population at risk for complications following open treatment of femoral shaft fracture?

Femoral shaft fractures are common in the pediatric population, accounting for over 20% of inpatient pediatric fractures. Patients with developmental delays are a population group whose medical care and recovery come with a unique set of considerations and challenges. The purpose of this study was to evaluate the impact of developmental delay on outcomes following open treatment of femoral shaft fractures in the pediatric population. Pediatric patients undergoing open treatment of femoral shaft fracture from 2012 to 2019 were identified in the National Surgical Quality Improvement Program-Pediatric database. Patients were divided into two groups: patients with developmental delay and patients without developmental delay. Patient demographics, comorbidities, and various postoperative outcomes were compared between the two groups using bivariate and multivariate analyses. Of the 5896 pediatric patients who underwent open treatment of femoral shaft fracture, 5479 patients (92.9%) did not have developmental delay whereas 417 (7.1%) had developmental delay. Patients with developmental delay were more likely to have other medical comorbidities. Following adjustment on multivariable regression analysis to control for the baseline differences between the two groups, patients with developmental delay had an increased risk of readmission to the hospital (OR 4.762; p = 0.014). Developmental delay in the pediatric population was found to be an independent risk factor for hospital readmission following open treatment of femoral shaft fractures. Taking these patients into special consideration when evaluating the optimal treatment plan can be beneficial to reduce the risks of readmission, which can decrease costs for both the patient and the hospital.

Antibiotic cement-coated intramedullary nail is cost-effective for the initial treatment of GAⅢ open tibia fractures

ObjectiveTo evaluate the cost-effectiveness of antibiotic cement-coated intramedullary nails (IMN) in the initial management of Gustilo-Anderson type Ⅲ (GAIII) open tibia fractures. MethodsA break-even equation was used to analyze the costs associated with antibiotic cement-coated IMN and postoperative infection following GAⅢ open tibia fractures. This equation produced a new infection rate, which defines what percentage the antibiotic coated IMN needs to decrease the initial infection rate for its prophylactic use to be cost-effective. The postoperative infection rate used for calculations was 30%, a value established in current literature for these fracture types (6–33%). The institutional costs associated with a single operative debridement and resultant inpatient stay and treatment were determined. A sensitivity analysis was conducted to demonstrate how various total costs of infection and different infection rates affected the break-even rate, the absolute risk reduction (ARR), and the number needed to treat (NNT). ResultsFinancial review yielded an average institutional cost of treating a postoperative infection to be $13,282.85. This number was inclusive of all procedures during an inpatient stay. The added cost of the antibiotic coated implant to the hospital is $743.42. Utilizing the break-even formula with these costs and a 30% initial infection rate, antibiotic coated IMN was economically viable if it decreased infection rate by 0.056% (NNT = 1,785.714). ConclusionThis break-even analysis model suggests the initial use of an antibiotic coated IMN in the setting of GAⅢ open tibia fractures is cost-effective.

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Introduction: Prevention of infection remains the critical goals in open fracture treatment. This study reports the epidemiological, clinical and therapeutics features at Lubumbashi teaching hospital.Methods: the study covers a three-year period, including retrospective study from January 2018 to December 2020. Data collection was performed through a standardized survey form included many parameters.Results: 44 cases of open leg fractures were registered in 42 patients, this represented 2.46% in orthopedics and traumatology department and 5.92% in surgery. The most common age brackets were 20- 29 years (65.91%). The mean age (33.41years) ranging from 8 to 80 years. Males accounted for 73.80% with a ratio sex M/F of 2.81. The most common etiology was traffic accidents (88.64%). Mostly the mechanism was direct (81.82%); 73.80% of patients arrived within 6 hours. Clinical sign mostly represented were deformation of the leg (95.46%). Most of fracture was classified in Cauchoix 2 (45.45%) with head injury like most associated injury (34.10%). Radiologically, the fracture line through the bone was oblique in 38.64% of cases and transverse in 29.55%. 38.64 % of open leg fractures occur in the middle third of the bone in our study. Definitive treatment consisting in putting a plaster window (18.18%) and external fixation (40.90% of cases).Conclusion: open leg fracture is an almost daily practice which the management must be delicate.Mots clés: fracture ouverte – jambe – épidémiologie - prise en charge.

Risk Factors for Infection and Subsequent Adverse Clinical Results in the Setting of Operatively Treated Pilon Fractures.

To determine patient-specific and injury-specific factors that may predict infection and other adverse clinical results in the setting of tibial pilon fractures. Retrospective chart review. Level 1 academic trauma center. Two hundred forty-eight patients who underwent operative treatment for tibial pilon fractures between 2010 and 2020. External fixation and/or open reduction and internal fixation. Fracture-related infection rates and specific bacteriology, risk factors associated with development of a fracture-related infection, and predictors of adverse clinical results. Two hundred forty-eight patients were enrolled. There was an infection rate of 21%. The 3 most common pathogens cultured were methicillin-resistant Staphylococcus aureus (20.3%), Enterobacter cloacae (16.7%), and methicillin-resistant Staphylococcus aureus (15.5%). There was no significant difference in age, sex, race, body mass index, or smoking status between those who developed an infection and those who did not. Patients with diabetes mellitus ( P = 0.0001), open fractures ( P = 0.0043), and comminuted fractures (OTA/AO 43C2 and 43C3) ( P = 0.0065) were more likely to develop a fracture-related infection. The presence of a polymicrobial infection was positively associated with adverse clinical results ( P = 0.006). History of diabetes was also positively associated with adverse results ( P = 0.019). History of diabetes and severe fractures, such as those that were open or comminuted fractures, were positively associated with developing a fracture-related infection after the operative fixation of tibial pilon fractures. History of diabetes and presence of a polymicrobial infection were independently associated with adverse clinical results. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

The Conservative Treatment of Some Hand and Carpal Fractures.

In recent decades, there has been a trend toward increased use of operative treatment of hand fractures. However, internal stabilization with wires or open reduction and internal fixation of the phalanges and the metacarpals carries a risk of surgical complications that can be avoided by using appropriate conservative treatment. In this article, some hand fractures that can be managed safely without surgery are discussed. In conclusion, when facing a fracture in the hand, the first consideration is whether the fracture can be treated nonoperatively and not which operative treatment is most appropriate. This applies to both displaced and undisplaced fractures.

Decreasing Rate of Operative Management of Proximal Humerus Fractures in Adolescents: A National Database Study

Background: There is no consensus on the operative treatment of adolescent proximal humerus fractures. The purpose of this study was to investigate the trends in treatment of proximal humerus fractures in adolescents and identify predictors of operative management. Methods: The Pediatric Health Information System database was used to identify patients ages 10 to 18 diagnosed with proximal humerus fractures between 2004 to 2019. Open fractures were excluded from the analysis. Descriptive, univariate, and multivariate analyses were used to determine trends and predictors of operative management. Results: A total of 17,515 proximal humerus fracture admissions were identified and 2081 (11.9%) were treated operatively. The mean age was 12.5 years and 37.5% of patients were female. The rate of operative management decreased from 15.1% to 8.9 during the study period (p&lt;0.01). There was a higher rate of operative management in boys (13.4% vs. 9.4%, p&lt; 0.01). The operative cohort was older (13.4 years vs. 12.4 years, p&lt;0.01), and patients who lived in rural areas had twice the rate of operative management (20.7% vs. 10.8%, p&lt;0.01). Operative patients had higher billed charges and longer hospital stay (p &lt; 0.05), but there was no significant difference in mean estimated household income between operative and nonoperative groups (p &gt; 0.05). A multivariate analysis showed increased odds of operative management with older age (OR 1.32, 1.29-1.36), and residence in the South (OR 1.19, 1.05-1.34). The odds of operative management were lower in more recent years (OR 0.94, 0.93-0.95) and in urban settings (OR 0.41, 0.35-0.47). Conclusion: From 2004 to 2019, there has been a significant decrease in the rate of operative management of adolescent proximal humerus fractures at children’s hospitals. Patients who are older, male, or reside in rural areas or the South are more likely to be treated operatively.

Efficacy of a “provisional incision” for longitudinal flap division after free-flap surgery

SummaryFix and flap surgery for severe open limb fractures is already a standard treatment. In cases where the fracture is complicated or accompanied by bone defects, secondary surgery is required for fracture sites covered with a myocutaneous flap after the soft tissue condition has stabilized. We applied the delayed procedure concept used for distant flaps and attempted to prevent postoperative myocutaneous flap necrosis by performing a provisional incision prior to the longitudinal incision of the flap. We report the course of five cases of the longitudinal division of the myocutaneous flap using “provisional incision” after free-flap surgery for severe open fracture and verify its usefulness. In this case series, five patients with severe open limb fractures treated from 2020 to 2021 who underwent longitudinal incision of the myocutaneous flap using provisional incision after free-flap surgery were included. The types of flaps used for soft tissue reconstruction in the acute phase, the reasons for the need for secondary surgery, the period from soft tissue reconstruction to additional surgery, and the healing status of soft tissue after secondary surgery were all investigated retrospectively. The types of flaps used for soft tissue reconstruction were latissimus dorsi myocutaneous flap in four cases and anterolateral thigh flap in one case. The breakdown of secondary surgery was osteosynthesis in one case, plate removal in one case, and bone cement removal and autologous bone grafting in three cases. The period from soft tissue reconstruction to secondary surgery ranged from 6 weeks to 4 months. In all cases, the wound healed without necrosis of the myocutaneous flap. For the treatment of severe open limb fractures, longitudinal division of the myocutaneous flap using “provisional incision” is a safer approach to the necessary secondary surgery and reduces the possibility of necrosis of the flap.

Compare the functional and surgical outcomes of operative treatment of unicondylar and bicondylar tibia fractures

Background &amp; Method: The aim of this study is to compare the functional and surgical outcomes of operative treatment of unicondylar and bicondylar fractures. During this period 50 patients were treated for tibial plateau fractures. All patients are selected on the basis of history, clinical examination and radiography. The Schatzker’s classification was used to classify these fractures. The patients were followed up for an average period of 6 to 12 months. Result: In group 1 mean injury to surgery time (in days) was 1.24 ± 0.831 and in group 2 was 2.08 ± 1.115, p value was (0.0042)&lt;0.05, therefore there is significant difference in group 1 and group 2 with respect to injury to surgery time (in days). In group 1 mean range of motion (ROM) was 131.2 ± 6.337 and in group 2 was 130.4 ± 7.059, p value was (0.675)&gt;0.05, therefore there is no significant difference in group 1 and group 2 with respect to range of motion (ROM) (in degree). Conclusion: Comparing the functional results of this study with those reported in the recent literature is complicated by the use of differing classification schemes, outcome measures, and treatment techniques.

Arthroscopic Internal Fixation of Coracoid Fractures: Surgical Technique Guide

Fractures of the coracoid process are uncommon injuries and are usually the result of high-energy trauma or avulsion-type injuries. Typically coracoid fractures treated with nonoperative management have yielded good results. Operative treatment of coracoid fractures is reserved for a subset of clinical situations, including fracture nonunion. We detail our technique for arthroscopic debridement of a Type II coracoid fracture nonunion, as well as the use of arthroscopic-assisted percutaneous fixation for a Type II coracoid fracture.