Or Open Reduction And Internal Fixation Research Articles

Clinical and radiographic long-term outcomes of hemiarthroplasty for complex proximal humeral fractures

Hemiarthroplasty (HA) is a treatment option for complex proximal humerus fractures not suitable for conservative treatment or open reduction and internal fixation (ORIF). Long-term outcomes using a large metaphyseal volume prosthesis in the management of fractures of the proximal humerus have not been reported thus far. Between 2006 and 2010, 41 patients with a proximal humerus fracture were treated with HA (average age: 62 years: range, 38-85) at our institution. Nine patients underwent revision surgery, three patients were lost to follow-up and seven died unrelated to the index surgery. Twenty-two patients were reviewed clinically and radiographically at a mean period of 10.4 years (range, 9-13 years). Seven out of nine failures of HA occurred within the first 2 postoperative years: 2 infections and 5 greater tuberosity non-/mal-unions. The other two patients underwent revision for rotator cuff deficiency more than 5 years after initial surgery. Of those patients available for final follow-up, the implant survival rate was 71% (22 out of 31 patients). Their mean relative Constant score was 76 % (range, 49-96), the mean active elevation was 116° (range, 60-170) and the mean external rotation was 28° (range, 0-55), at the final follow-up. The majority had a good/excellent internal rotation, with 13 patients (59%) to the 12th thoracic vertebra and 7 patients (31%) to the 8th thoracic vertebra. The mean Subjective Shoulder Value was 76% (range, 40-100). Clinical outcomes did not significantly deteriorate over a period of 10 years, except for flexion (p<0.001) and internal rotation (p=0.002). Analyzing greater tuberosity healing, one patient had a non-union, 10 (45%) had a mal-union, and in 12 patients (55%) the greater tuberosity healed in an anatomical position. Patients with a displaced mal-union of the greater tuberosity did not have inferior clinical results at last follow-up. Only two patients showed glenoid erosion and in no patient stem loosening could be identified at the final follow-up. The revision rate following large metaphyseal volume HA to treat a proximal humerus fracture was 29% after 10 years postoperatively, with failure within 2 years largely related to greater tuberosity non-/mal-union and later related to rotator cuff insufficiency. Patients with a retained implant showed good clinical and radiographic long-term results, without relevant deterioration over time even when the greater tuberosity healed in a non-anatomical position.

Does Lower Extremity Fracture Fixation Technique Influence Neurologic Outcomes in Patients with Traumatic Brain Injury? The EAST Brain vs. Bone Multicenter Trial.

To determine whether lower extremity (LE) fracture fixation technique & timing (≤ 24 vs > 24 hours) impact neurologic outcomes in TBI patients. A prospective observational study was conducted across 30 trauma centers. Inclusion criteria were age ≥ 18, head abbreviated injury scale (AIS) score > 2, and a diaphyseal femur or tibia fracture requiring external fixation (Ex-Fix), intramedullary nailing (IMN) or open reduction and internal fixation (ORIF). The analysis was conducted using ANOVA, Kruskal-Wallis, and multivariable regression models. Neurologic outcomes were measured by discharge Ranchos Los Amigos Revised Score (RLAS-R). Of the 520 patients enrolled, 358 underwent Ex-Fix, IMN or ORIF as definitive management. Head AIS was similar among cohorts. The Ex-Fix group experienced more severe LE injuries (AIS 4-5) compared to the IMN group (16% vs 3%, p = 0.01) but not the ORIF group (16% vs. 6%, p = 0.1). Time to operative intervention varied between the cohorts with the longest time to intervention for the IMN group (median hours: Ex-Fix 15 [8-24] vs. ORIF 26 [12-85] vs. IMN 31[12-70], p < 0.001). The discharge RLAS-R score distribution was similar across the groups. After adjusting for confounders, neither method nor timing of LE fixation influenced the discharge RLAS-R. Instead, increasing age and head AIS score were associated with a lower discharge RLAS-R score (OR 1.02, 95% CI 1.002-1.03 and OR 2.37, 95% CI 1.75-3.22) and a higher GCS motor score on admission (OR 0.84, 95% CI 0.73,0.97) was associated with higher RLAS-R score at discharge. Neurologic outcomes in TBI are impacted by severity of the head injury and not the fracture fixation technique or timing. Therefore, the strategy of definitive fixation of LE fractures should be dictated by patient physiology and the anatomy of the injured extremity and not by the concern for worsening neurologic outcomes in TBI patients. Level III (Prognostic/Epidemiological).

Does the Treatment Approach for Mandibular Condyle Fractures Impact Self-Perceived Quality of Life?

There is no consensus in mandibular condylar fracture/s treatment. In medicine, quality of life (QOL) includes the individual's satisfaction toward their own health condition, disease, or treatment. The purpose of this study was to investigate self-perception QOL outcomes for patients who sustained mandibular condylar fracture/s. This cross-sectional study surveyed patients at Grady Memorial Hospital in Atlanta, Georgia from November 2016 to June 2020. The study included patients who were at least 16years old at the time of injury, diagnosed with mandibular condylar fracture/s, treated by close reduction or open reduction and internal fixation (ORIF), presented for 6-months post-operative follow-up, and had a valid phone number. The primary predictor variable was treatment approach. The primary outcome variable was mood. Covariates were demographics, injury details, and self-perception QOL questionnaire. Univariate, bivariate, and ordinal regression analysis were performed (P<.05 significance). A total of 108 patients met inclusion criteria. Response rate was 84.2%. Our data showed that patients who underwent ORIF treatment were statistically more likely to experience no or milder pain when chewing (tau=0.390, P=.002), to not require pain medications (tau=0.389, P=.002), to report larger maximum mouth opening (tau=0.402, P=.0003), and to report better QOL (tau=0.440, P=7.407e-05). Ordinal regression analysis showed that patients who had undergone ORIF treatment were positively associated with better mood (estimate: -0.062; OR: 0.54; P=.29) and statistically significant associated with excellent QOL (estimate: -2; OR: 0.13; P=3.99e-05). Patients who sustained class III Lindahl mandibular condyle fracture were statistically significantly associated with depressed mood (estimate: 1.46; OR: 4.33; P=.002). ORIF treatment was positively associated with better QOL when compared to closed reduction for mandibular condyle fracture.

Does Open Reduction and Internal Fixation for Condyle Fractures Deliver Better Quality of Life?

Treatment of mandible condyle fractures is one of the most controversial topics in maxillofacial trauma. The purpose of this study was to evaluate and compare quality of life (QoL) outcomes for patients who sustained condyle fractures and were treated with closed reduction (CR) or open reduction and internal fixation (ORIF). This study supplements current literature by addressing patients’ mood, which can be a product of how patients view themselves and perceive that others view them. Mood is important in assessing a mental status, social interactions, and QoL.

Treatment of displaced intra-articular calcaneal fractures: A single-center experience study with 20 years follow-up

IntroductionThis study was conducted to identify the patient characteristics, classification, treatment, complications, and functional outcomes of operatively treated displaced intra-articular calcaneal fractures (DIACFs) in a level-I trauma center over a 20-year period. MethodsPatients with a DIACF classified as Sanders ≥2 and operatively treated with percutaneous reduction and screw fixation (PSF) or open reduction and internal fixation (ORIF) between 1998 and 2017 were identified. Pre- and postoperative radiological assessments were performed. Functional outcomes were evaluated using the American Orthopaedic Foot & Ankle Society (AOFAS) score and the Maryland Foot Score (MFS). General health and patient satisfaction were assessed using the Short Form-36 Health Survey (SF-36) and the visual analog scale (VAS). ResultsIn total, 120 patients with a DIACF that were operatively treated with PSF or ORIF. Of these patients, 72 with a total of 80 DIACFs completed the questionnaires (60%). The average follow-up was 130 months. Mean scores for PSF and ORIF were 74 and 75 for AOFAS, 78 and 78 for MFS, 68 and 61 for SF–36, and 7.7 and 7.5 for VAS, respectively. An infection was the most common complication associated with ORIF (31%), and hardware removal (58%) was the most common complication in patients treated with PSF. Overall, 36 patients (68%) were able to return to work after a median time 6 months (IQR, 3–7) and 6 months (IQR, 3,25–6,75) for PSF and ORIF treated, respectively ConclusionThis long-term follow-up study reviews ORIF using ELA and PSF in the treatment of DIACFs. This study shows that both treatments are capable of restoring the Böhler angle and yield relatively good long-term functional outcomes. Differences in complication rates were apparent, infectious problems are inherent to ORIF using ELA, and hardware removal is associated with PSF.

Closed reduction and percutaneous pinning versus open reduction and internal fixation for Jakob type 3 lateral condyle fractures in children.

The management of type 3 lateral condyle fractures (LCFs) remains controversial. The main goal of this study was to evaluate the feasibility of closed reduction and percutaneous pinning (CRPP) in patients with type 3 LCFs and to assess the outcome of such injuries according to the type of treatment, CRPP, or open reduction and internal fixation (ORIF). This is a retrospective review of prospectively enrolled children with type 3 LCF managed by CRPP or ORIF between 2018 and 2021. All patients were followed for at least 12months. Patients were divided into two groups according to the type of treatment, CRPP or ORIF. Demographic characteristics were recorded for all patients. Standard radiographs were used to identify, evaluate, and classify each fracture and to detect the presence of other concomitant bone lesions. The clinical outcome was assessed according to the Hardacre et al. criteria. Seventy-eight children with type 3 LCF were included; 42 were treated by CRPP (53.8%) and 36 by ORIF (46.2%); the mean follow-up time was 17.7months (range, 12.3-40.9). The baseline characteristics did not differ between the two groups of patients. Overall, successful CRPP could be achieved in 39 out of 42 patients (92.9%). The mean surgical time was 63.4 and 84.5min in patients treated by CRPP and ORIF, respectively (p = 0.01). Fluoroscopy time was significantly shorter in patients managed by ORIF than in those treated by CRPP (12 versus 40s, respectively; p < 0.001). Clinical outcome according to the Hardacre et al. criteria was excellent in 37 out of 39 (94.4%) and in 35 out of 36 patients (97.2%) treated by CRPP and ORIF, respectively (p = 0.09). CRPP management of paediatric type 3 LCF has clinical and radiographic outcomes similar to ORIF; if satisfactory reduction cannot be achieved by CRPP, conversion to ORIF should be considered.

DISTAL HUMERUS FRACTURES MANAGED WITH OPEN REDUCTION AND INTERNAL FIXATION OR TOTAL ELBOW ARTHROPLASTY RESULT IN SIMILAR RANGE OF MOTION AND REOPERATION RATES

Introduction: The purpose of our study was to evaluate complications in intraarticular distal humerus fractures in patients above 50 years of age treated with either total elbow arthroplasty (TEA) or open reduction and internal fixation (ORIF). Methods: Between 1999 and 2018, 54 patients, underwent either TEA (27 patients) or ORIF (27 patients) for a distal humerus fracture at a Level 1 trauma center. Pre-operative variables, including mechanism of injury, open or closed fracture, AO/OTA fracture classification, and nerve palsy, were recorded. Main outcomes measurements included postoperative complications and reoperation. Results: Average follow up was 3.3 years for the TEA group and 1.0 year for the ORIF group. The TEA group had 28 complications in 23 total patients Fourteen complications were minor and did not require reoperations. Twelve patients had a major complication requiring reoperation. The ORIF group had 25 complications in 17 patients. Twelve complications were minor and did not require operation. Twelve patients sustained a major complication requiring reoperation. Conclusion: Patients above 50 years of age with intraarticular distal humerus fractures managed with TEA or ORIF have similar reoperation and complication rates.

Fixation and Implant Retention of Extracapsular Femoral Neck Periprosthetic Fractures Around Hip Resurfacing Arthroplasty - A Case Series.

Background:Extracapsular femoral neck fractures in the presence of a resurfacing hip arthroplasty (RHA) appear to be independent of suboptimal technique during the initial implantation of the RHA and present with a similar etiology as native hip fractures – that is, a fragility fracture related to pathological or age-related osteoporosis, as a consequence of trauma. In the presence of a well-fixed and previously well-functioning RHA, the options for management include revision arthroplasty or open reduction and internal fixation (ORIF). In the absence of loosening through mechanisms of wear, infection, metallosis, or suboptimal prosthesis positioning, many authors have advocated ORIF with implant retention. However, there is often debate regarding the use of total hip arthroplasty in these casesCase Series:The authors conducted a thorough assessment of the literature followed by a retrospective review of outcomes for three patients treated by ORIF with implant retention for extracapsular femoral neck fractures around a RHA, using a standardized technique. All patients were independently mobile and active with well-fixed and well-functioning RHAs before the date of injury. All patients suffered low-energy trauma resulting in the fracture. There were no intraoperative or perioperative complications. All patients achieved full weight-bearing status and independent mobility. Two patients achieved radiographic union and returned to full range of movement and independent mobilization comparable to their preoperative state. One patient was lost to follow-up.Conclusion:The authors believe that fixation of extracapsular proximal femoral fractures distal to a well-fixed, well-functioning RHA is a good management option in an independent and active patient. A higher level of evidence is needed to investigate the surgical management options of these injuries comparing osteosynthesis with revision arthroplasty.

Comparaison des taux de survie des arthroplasties et des ostéosynthèses pour le traitement des factures basi-cervicales du col fémoral chez des patients ayant des comorbidités multiples

BackgroundFemoral neck fractures (FNFs) are associated with high mortality and can be treated with arthroplasty or open reduction and internal fixation (ORIF). For basi-cervical FNFs there is no agreement on which procedure is better. Do arthroplasty and open reduction with internal fixation (ORIF) have different rate of survival? Do age and comorbidities influence survivorship? HypothesisPatients who underwent arthroplasty and patients who underwent ORIF have different rates of survival. Patients and methodsSurvivorship curves, complications, and hospitalization length were analysed in 154 patients who received hip arthroplasty and in 72 patients who received ORIF. Age and ASA score were used to divide the patients into sub-groups and perform secondary analyses. ResultsAt 4.9±2.4 years after surgery, 74 patients in the arthroplasty group (48%) and 33 in the ORIF group (45%) had died. The survivorship curves of the two groups showed a non-significant difference. The hospitalization length was 13.5±8.9 days, with a non-significant difference between groups. There were 130 complications in total: 97 in the arthroplasty patients (19 patients had multiple complications, 52 had only one), 33 in the ORIF patients (4 patients had multiple complications, 29 had only one); the odds ratio was therefore 2.1 (p=0.02). Age, ASA score, Sernbo score, Charlson Comorbidity Index, and sex (male) were the best predictors of mortality. In the ASA 3–4 sub-group, the survivorship curves showed a lower mortality in the arthroplasty group (p=0.02). DiscussionArthroplasty and ORIF are both valid procedures for the treatment of basi-cervical FNFs, but a high mortality rate is associated with either procedures. There is no difference in terms of survivorship between arthroplasty and ORIF in the overall population, but the presence of comorbidities may favour arthroplasty, which should be considered when managing patients with basi-cervical FNFs. Level of evidenceIII; retrospective, observational study.

Determining the development stage of the ossification centers around the elbow may aid in deciding whether to use ESIN or not in adolescents’ forearm shaft fractures

Background and purpose — Elastic stable intramedullary nailing (ESIN) is the preferred method of operative stabilization of unstable pediatric forearm shaft fractures. However, the decision whether to use ESIN or open reduction and internal fixation (ORIF) in older children or teenagers is not always straightforward. We hypothesized that the development stage of the elbow would aid in evaluating the eligibility of the patient for ESIN. Patients and methods — All eligible children, aged <16 years who were treated with ESIN in Oulu University Hospital, during 2010–2019 were included (N = 70). The development stages of 4 ossification centers were assessed according to the Sauvegrain and Diméglio scoring. The proportion of impaired union vs. union was analyzed according to bone maturity, by using the optimal cutoff-points determined with receiver operating characteristics (ROC). Results — Development stage ≥ 6 in the olecranon was associated with impaired union in 20% of patients, compared with none in stages 1–5 (95% CI of difference 8% to 24%). Trochlear ossification center ≥ 4 was associated with impaired union in 17% of patients (CI of difference 7% to 36%) and lateral condyle ≥ 6 in 13% of patients (CI of difference 3.4% to 30%). Proximal radial head ≥ 5.5 was associated with impaired union in 18% of patients (CI of difference 7% to 39%). Interpretation — Recognizing the rectangular or fused olecranon ossification center, referring to stage ≥ 6, was in particular associated with impaired fracture healing. This finding may aid clinicians to consider between ESIN and plating, when treating forearm shaft fracture of an older child or teenager.

“DOUBLE X” FIXATION FOR RARE AND PARTICULAR PEDIATRIC SUPRACONDYLAR HUMERUS FRACTURES

Background Context. The presence of special, rare and various forms which we can encounter when treating supracondylar humeral fractures (SHF) in children, call into question what therapeutic methods can be used to increase the effectiveness of the treatment applied. The aim of this paper is to present the results obtained by using double cross-fixation, "in double X", by closed reduction and percutaneous pinning (CRPP) or open reduction and internal fixation (ORIF) in treating rare and particular forms. Comments and opinions on "double X" method and other cross or side configurations are presented. Patient Sample. All patients with rare and particular forms presented in this article, were operated during 2001-2020 in state and private hospitals. Fixation in "double X" was used either by CRPP and ORIF. The epitrochlear approach (EA) was performed in cases where stability by CRPP could not be ensured or when there were clear signs of ulnar nerve damage. The minimal medial-approach (mMA) highlights the epitrochlea and the fracture of the medial pylon; it has the role of anatomically reducing the medial pylon, thinner and very unstable in rare and particular forms. During 1982-2020 we consulted, treated and evaluated patients with SHF to whom all known treatment methods were applied: orthopedic reduction and immobilization in plaster cast, CRPP, ORIF, minimal-open reduction and internal fixation (mORIF) by mMA and external fixator. Internal fixation was done by the techniques of Judet, San Antonio, San Diego, Dorgan, in “X” and “double X”. In 2001, I introduced "double X" fixation to better stabilize anatomical reductions that showed signs of instability during intraoperative verification. All indications given in the study protocol have been made in accordance with the regulations mentioned in the experimental program. Results. All SHFs operated by CRPP and ORIF by “double X” were cured and satisfactory and good results were obtained in the neglected types operated between 14 and 60 days and good and excellent results were obtained in the rare forms. Conclusions. “Double X” fixation gives the best stabilization and postoperatively there is no need for immobilization in a plaster cast. Recovery may begin the day after surgery. Keywords: supracondylar fractures, child elbow pathology, cross-fixation, lateral fixation, healing and recovery after 30-45 days.

Treatment of Paediatric Supra Condylar Fracture Humerus

Introduction: One of the most frequent elbow fractures in childhood, is supracondylar fracture whichrequires rapid diagnosis and treatment. It is usually associated with neurovascular, functional problems and deformity.&#x0D; Objectives: To assess demographic, clinical features and treatment outcomes of the patients who underwent closed reduction and splinting, stabilization by percutaneous pinning or Open Reduction and Internal Fixation(ORIF).&#x0D; Materials and Methods: This retrospective study was conducted in the department of orthopedic surgery, CMH, Bogura from June 2017 to December 2018. The inclusion criteria was Gartland type I,II,III fracture who attended in emergency and casualty, between 2 to 13 years of age. Total 40 patients with the mean age 7.5 years were included in the study group.&#x0D; Results: All were closed fractures, 2flexion and 38 extension type. Two (5%) Gartland type I, 24(60%) and 14(35%) had type II and III fracture respectively. 2(5%) were treated by cast immobilization,8(20%)of type llby closed reduction &amp; splinting, 22(55%) and 8(20%) of type ll&amp;lll by crossed k-wire or by ORIF respectively. According to Flynn’s criteria our study shows 33(82.5%) excellent, 4(10%) good, 2(5%) fair and 1(2.5%) poor outcome.4(10%) had ulnar nerve neuropraxia, 1(2.5%) elbow stiffness,1(2.5%) cubitusvarus, 2(5%) experienced superficial pin tract infection.&#x0D; Conclusion: Management of supracondylar fracture should be decided according to patient’s age, fracture pattern and deformity status. Closed reduction and stabilization by percutaneous wiring provides an effective and safe treatment, when failed, open fractures or associated neurovascular complications ORIF should be preferred.&#x0D; JAFMC Bangladesh. Vol 15, No 2 (December) 2019: 171-174

Comparison of the survivorship between arthroplasty and ORIF for basi-cervical femoral neck fractures in the overall population and in polymorbid patients

BackgroundFemoral neck fractures (FNFs) are associated with high mortality and can be treated with arthroplasty or open reduction and internal fixation (ORIF). For basi-cervical FNFs, there is no agreement on which procedure is better. Do arthroplasty and open reduction with internal fixation (ORIF) have different rates of survival? Do age and comorbidities influence survivorship? HypothesisPatients who underwent arthroplasty and patients who underwent ORIF have different rates of survival. Patients and methodsSurvivorship curves, complications, and hospitalisation length were analysed in 154 patients who received hip arthroplasty, and in 72 patients who received ORIF. Age and ASA score were used to divide the patients into sub-groups and perform secondary analyses. ResultsAt 4.9±2.4 years after surgery, 74 patients in the arthroplasty group (48%) and 33 in the ORIF group (45%) had died. The survivorship curves of the two groups showed a non-significant difference. The hospitalisation length was 13.5±8.9 days, with a non-significant difference between groups. There were 130 complications in total: 97 in the arthroplasty patients (19 patients had multiple complications, 52 had only one), 33 in the ORIF patients (4 patients had multiple complications, 29 had only one); the odds ratio was therefore 2.1 (p=0.02). Age, ASA score, Sernbo score, Charlson comorbidity index, and sex (male) were the best predictors of mortality. In the ASA 3–4 sub-group, the survivorship curves showed a lower mortality in the arthroplasty group (p=0.02). DiscussionArthroplasty and ORIF are both valid procedures for the treatment of basi-cervical FNFs, but a high mortality rate is associated with either procedures. There is no difference in terms of survivorship between arthroplasty and ORIF in the overall population, but the presence of comorbidities may favour arthroplasty, which should be considered when managing patients with basi-cervical FNFs. Level of evidenceIII; retrospective, observational study.

Functional Outcome of Distal Radial Fractures in Patients With a Mean Age of 75 Years at a Mean Follow-Up of 5.4 Years.

PurposeDistal radial fractures in the elderly are common and present in a wide spectrum of severity. Their management is varied. The aim of this retrospective case review is to evaluate the late functional outcome of surgically treated distal radial fractures in the elderly population.MethodsForty-two patients (36 female and six male) were surgically treated for an unstable distal radial fracture. The mean age of the patients was 75 years. Frykman classification was used to assess the severity of the injury. Surgical options used were reduction and K wires (19 patients) or open reduction and internal fixation (ORIF) using volar distal radial plate fixation (23 patients). At a mean follow-up of 5.4 years, a validated questionnaire (Patient Rated Wrist Evaluation-PRWE) of the functional ability was completed for each patient.ResultsThe outcome in both groups was satisfactory (PRWE 40-50) with no significant statistical difference, however, a better functional outcome (<40 PRWE) was achieved in the K wire group compared to the ORIF group. Factors such as post injury fear from fall, weakness of grip, wrist pain, and other comorbidities altered the predicted functional outcome score.ConclusionIn conclusion, surgically treated fractures in the elderly generally lead to good outcomes. However, confounding factors can contribute to unpredictable results despite good surgical reduction and fixation.

Carpometacarpal Joint Dislocations: Management and Long-Term Outcomes at a Specialized Hand Surgery Center in Latin America.

Carpometacarpal joint dislocations are uncommon hand injuries. These dislocations are usually misdiagnosed due to their non-specific clinical signs and tend to be difficult to identify in simple X-rays. We report our experience in the management of carpometacarpal bone dislocations at a specialized hand surgery center. Patients with carpometacarpal dislocations seen at the emergency department between 2013 and 2017 were included. All patients were treated with either closed reduction and percutaneous pinning (CRPP) or open reduction and internal fixation (ORIF). Postoperative functional assessment was performed at 6 and 18 months using the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Eleven patients were included, 8 (72%) were managed with CRPP and the rest required ORIF (28%). For the functional outcome, we found an average DASH score of 27.9 at the 6 months threshold and of 1.5 at the 18 months threshold. Carpometacarpal dislocations are uncommon and easy to misdiagnose; the hand surgeon should have a high clinical suspicion in patients who sustained high-energy trauma, and imaging studies should be thoroughly evaluated. Closed reduction and percutaneous pinning is a safe and effective treatment option, with long-term good functional results.

Internal fixation of metacarpal fractures using wide awake local anesthesia and no tourniquet

We sought to report on the use of wide-awake local anesthesia and no tourniquet (WALANT) for internal fixation of metacarpal fractures. We retrospectively examined 10 patients with metacarpal fractures that required either closed reduction and internal fixation (CRIF) or open reduction and internal fixation (ORIF). WALANT was administered 20minutes before the surgery outside the operating room. Once the area was numb, an open or closed reduction was made followed by internal fixation of the fracture using plating, intramedullary screws or Kirshner wires (K-wires). We used intraoperative X-ray to confirm anatomic reduction and correct internal fixation. After proper reduction and fixation, the active range of motion (AROM) was assessed while the patient was awake. Patients were discharged the next day after evaluating their neurovascular status and establishing pain control. Follow-up evaluations were carried out at 2, 6 and 12 weeks postoperatively. All individuals underwent uneventful operations. No significant pain or bleeding was recorded during the operation. Nine out of ten patients regained full AROM at the 12-week follow-up visit in the outpatient clinic. One patient still had slight reduction of range of motion (ROM) of the 5th metacarpophalangeal joint. No neurovascular damage or surgical site morbidity was recorded. CRIF and ORIF of simple metacarpal fractures can be executed successfully using WALANT with good functional results without increased morbidity compared to monitored anesthesia care.

Surgical outcomes of elderly patients aged more than 80\u2009years with distal radius fracture: comparison of external fixation and locking plate

BackgroundTo compare the outcomes after surgical intervention, including external fixation (EF) with the optional addition of K-pins or open reduction and internal fixation (ORIF) with a volar locking plate (VLP), in patients with distal radius fracture aged > 80 years.MethodsWe reviewed 69 patients with a distal radius fracture aged > 80 years who treated under surgical intervention from 2011 to 2017 retrospectively. Their demographic data and complications were recorded. Preoperative, postoperative, and last follow-up plain films were analyzed. The functional outcomes of wrist range of motion were also evaluated.Results41 patients were treated with EF with the optional addition of K-pins, while 28 patients were treated with ORIF with a VLP. The radiological parameters, including ulnar variance and radial inclination, at the last follow-up were significantly more acceptable in the VLP group (p = 0.01, p = 0.03, respectively). The forearm supination was significantly better in patients treated with VLP (p = 0.002). The overall incidence of complications was lower in the VLP group (p = 0.003).ConclusionVLP provides better radiological outcomes, wrist supination and lower complication rates than EF. Therefore, although EF is still widely used because of its acceptable results and easy application, we recommend VLP as a suitable treatment option for distal radius fracture in the geriatric population aged > 80 years.

Percutaneous reduction and screw fixation for all types of intra-articular calcaneal fractures.

This study compares the outcomes of consecutive of patients with Sanders II and III and IV calcaneal fractures that were stabilized by either close reduction and internal fixation (CRIF) or open reduction and internal fixation (ORIF). Group I (N = 49) underwent close reduction internal fixation (CRIF). Group II (N = 39) underwent open reduction internal fixation (ORIF). The clinical outcomes included time to operation, operative duration, visual analog score (VAS), length of hospital stay, wound-related complications and AOFAS SF-36 score. Preoperative and postoperative radiographic measures also were compared. The duration of operation in the CRIF group was considerably shorter than in ORIF group (P = 0.0001). Postoperatively, at seventh day, the VAS in the CRIF group (4.2 ± 1.1) was meaningfully lower than those of the ORIF patients group (4.7 ± 1.2, P = 0.04). Totally, the prevalence of wound complications in CRIF group was significantly lower than in ORIF group. In final follow-up visit after one year, AOFAS scores and SF-36 scores between groups were comparable. Comparable radiographic measures were found in both groups. There was no significant difference between groups regarding preoperative radiographic measures (P > 0.05), while in postoperative imaging acceptable calcaneal fracture reduction was found in both groups. We believed that for treatment of various types of calcaneal fracture compared with ORIF the percutaneous reduction and screw fixation may lead to shorter hospital stay, decreased subtalar joint stiffness and earlier weight bearing along with much favorable patients' satisfaction.

Variation Among Pediatric Orthopaedic Surgeons When Treating Medial Epicondyle Fractures.

Medial epicondyle fractures are a common pediatric and adolescent injury accounting for 11% to 20% of elbow fractures in this population. This purpose of this study was to determine the variability among pediatric orthopaedic surgeons when treating pediatric medial epicondyle fractures. A discrete choice experiment was conducted to determine which patient and injury attributes influence the management of medial epicondyle fractures by pediatric orthopaedic surgeons. A convenience sample of 13 pediatric orthopaedic surgeons reviewed 60 case vignettes of medial epicondyle fractures that included elbow radiographs and patient/injury characteristics. Displacement was incorporated into the study model as a fixed effect. Surgeons were queried if they would treat the injury with immobilization alone or open reduction and internal fixation (ORIF). Statistical analysis was performed using a mixed effect regression model. In addition, surgeons filled out a demographic questionnaire and a risk assessment to determine if these factors affected clinical decision-making. Elbow dislocation and fracture displacement were the only attributes that significantly influenced surgeons to perform surgery (P<0.05). The presence of an elbow dislocation had the largest impact on surgeons when choosing operative care (β=-0.14; P=0.02). In addition, for every 1 mm increase in displacement, surgeons tended to favor ORIF by a factor of 0.09 (P<0.01). Sex, mechanism of injury, and sport participation did not influence decision-making. In total, 54% of the surgeons demonstrated a preference for ORIF for the included scenarios. On the basis of the personality Likert scale, participants were neither high-risk takers nor extremely risk adverse with an average-risk score of 2.24. Participant demographics did not influence decision-making. There is substantial variation among pediatric orthopaedic surgeons when treating medial epicondyle fractures. The decision to operate is significantly based on the degree of fracture displacement and if there is a concomitant elbow dislocation. There is no standardization regarding how to treat medial epicondyle fractures and better treatment algorithms are needed to provide better patient outcomes. Level V.

A cost minimization analysis comparing minimally-invasive with open reduction surgical techniques for pelvic ring fracture.

The aim of the present study was to compare the in-hospital direct medical costs of patients with pelvic fracture treated with minimally invasive surgery (MIS) or open reduction and internal fixation (ORIF). A retrospective, single-center, cohort, and comparative study was performed. Administrative information and clinical results, in addition to cost data, were collected and analyzed. A cost minimization analysis method was used to evaluate the costs of two different surgical techniques. A total of 128 patients diagnosed with pelvic fracture were included in this study; 62 were treated with MIS and 66 underwent ORIF. No significant difference was observed between the 2 groups in terms of patients' clinical baseline characteristics. The operative time, length of incision, intra-operative blood loss, and post-operative length of stay in the MIS group were significantly different compared with those in the ORIF group. The cost-minimization analysis demonstrated that the cost effectiveness of MIS was better than ORIF as the MIS was associated with a significantly lower total in-hospital direct medical cost ($8,900 vs. $5,786, P=0.032), compared with ORIF. The cost-minimization analysis demonstrated that for similar clinical baseline characteristics as well as outcomes, there were differences in direct hospitalization cost of two surgical techniques, and MIS had a lower cost on average than ORIF.