ORIF Group Research Articles

Ilizarov versus ORIF for Open AO Type-C Pilon Fractures

Objective: This study aimed to evaluate the clinical effectiveness of ORIF versus Ilizarov for the management of Type C closed pilon fractures of the distal tibia at 12 months follow up. Methods: This retrospective cross sectional study was conducted at Jinnah Postgraduate Medical Center (JPMC) between 29th May 2015 and 27th November 2019 that included patients 18 years and older diagnosed with open AO type C pilon fractures. The primary outcome was the patient-reported Disability Rating Index (DRI) months. While the secondary outcomes were quality of life assessment using the patient satisfaction form (SF-12) and AOFAS-Ankle Hindfoot Score. Radiographs were assessed for fracture healing, time to healing, and malalignment. Results: Fifteen patients underwent ORIF, while 26 patients were treated with Ilizarov, there was no statistically significant difference in DRI scores at 12 months between the two groups. In terms of clinical outcomes, both groups had comparable results throughout the follow-up period. The number of unplanned surgical procedures was not statistically significant (p=0.73), 26.92% (n=7) in the Ilizarov as compared to 33.33% (n=5) in the ORIF group. Conclusion: Among patients with an acute, displaced, intra-articular fracture of the distal tibia, neither external fixation nor locking plate fixation resulted in superior disability status at 12 months. Patient factors may need to be considered in deciding the optimal approach. doi: https://doi.org/10.12669/pjms.40.10.8941 How to cite this: Shaikh SA, Tanveer MO, Tahir M, Ahmed N. Ilizarov versus ORIF for Open AO Type-C Pilon Fractures. Pak J Med Sci. 2024;40(10):2213-2218. doi: https://doi.org/10.12669/pjms.40.10.8941 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Civilian Ballistic Arthrotomies: Infection Rates and Operative Versus Nonoperative Management.

The purpose of this study was to determine whether a significant difference existed in the rate of infection after ballistic traumatic arthrotomy managed operatively compared with those managed without surgery. Retrospective cohort study. Academic Level I Trauma Center. Patients with ballistic traumatic arthrotomies of the shoulder, elbow, wrist, hip, knee, or ankle who received operative or nonoperative management. The rates of infection and septic arthritis in those who received operative or nonoperative management. One hundred ninety-five patients were studied. Eighty patients were treated nonoperatively (Non-Op group), 16 patients were treated with formal irrigation and debridement in the operating room (I&D group), and 99 patients were treated with formal I&D and open reduction and internal fixation (ORIF) (I&D + ORIF group). Patients in all 3 groups received local wound care and systemic antibiotics. No patients in the Non-Op or I&D group developed an infection. Six patients in the I&D + ORIF group developed extra-articular postoperative infections requiring additional interventions. The infection rate in the I&D + ORIF group was consistent with the infection rates reported in orthopaedic literature after fixation alone. In addition, none of the infections were cases of septic arthritis. This suggests that traumatic arthrotomy does not increase the risk for infection beyond what is expected after fixation alone. Importantly, the Non-Op group represented a series of 80 patients who were treated nonoperatively without developing an infection, indicating that I&D may not be necessary to prevent infection after ballistic arthrotomy. The results suggest that septic arthritis after civilian ballistic arthrotomy is a rare complication regardless of the choice of treatment. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Combined Hip Procedure Versus Open Reduction and Internal Fixation for Displaced Acetabular Fractures in Patients Older than 75 years: A Matched Cohort Study

Objective: To compare surgical outcomes between combined hip procedure (CHP: open reduction and internal fixation [ORIF] with total hip replacement) and ORIF alone for the treatment of displaced acetabular fractures in a geriatric population. Design: Retrospective case–control study. Setting: Academic Level 1 trauma center. Patients: Consecutive patients from 2012 till 2020 with acetabular fractures fitting inclusion criteria were enrolled. Intervention: Combined hip procedure or ORIF alone for displaced acetabular fractures. Main Outcome Measurement: Revision surgery at the latest follow-up, defined as the need for implant revision in the CHP group and conversion to total hip replacement in the ORIF group. Results: The need for revision surgery was lower in the CHP group (12.5%) compared with the ORIF alone group (25%). The median time for conversion to total hip replacement in the ORIF alone group was 2.6 years. Ten-year survivorship was significantly higher in the CHP group (85.7% vs. 45.8%, P < 0.01). Patients in the CHP group presented with higher American Society of Anesthesiologists and Charlson index scores and had more marginal impaction and concomitant femoral head fractures. Conclusions: In patients older than 75 years presenting with a displaced acetabular fracture with marginal impaction or femoral head fracture, survivorship of CHP is higher than ORIF alone. A combined hip procedure should be considered in such patients. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Comparison between primary total elbow arthroplasty versus open reduction and internal fixation in elderly patients with distal humerus fractures: a prospective study

Objective: It aims to assess the efficacy of these treatments, specifically in the presence of osteoporotic bone conditions. The findings of this study offer insights into the suitability of TEA as an alternative treatment option in such cases. Methods: In this study, sixty patients with distal humerus fractures were divided into two groups. The first group received ORIF for fracture fixation, while the second group underwent primary TEA treatment. The study evaluated various outcomes, including elbow range of movement, elbow stability, and comparison of Mayo Elbow Performance Scores (MEPS) between the two groups at three- and twelve-month follow-up periods. Results: In the three- and twelve-month follow-up periods, noticeable differences in elbow motion range were observed between the ORIF and TEA groups. The ORIF group experienced more significant restrictions in daily activities due to stiffness and pain, unlike the TEA group. However, both groups showed improvements in elbow function after one year. Furthermore, there were significant differences in the mean MEPS between the two groups at the three- and twelve-month follow-up period. However, no considerable differences were found between these periods within either group. Conclusion: TEA is emerging as a promising option for elderly patients with comminuted distal humerus fractures, considering the osteoporotic bone condition. The results of this study hold substantial implications for the decision-making process in treatment selection.

To Compare Mean Dash Score at 12 Weeks in Distal Radius Fracture Patients Treated Operatively (ORIF Group) Versus Those Treated Non-Operatively (CAST Group)

Aim: To compare wrist function by mean of DASH score at 12 weeks in distal radial fracture patients treated operatively (ORIF group) versus those treated non-operatively (CAST group). Methodology: The randomized controlled trial was conducted at The Indus Hospital Karachi, which is a tertiary care hospital from 1st January 2017 to 30th June 2017 and the 12 weeks follow up was taken after the recruitment of the last patient and 96 patients were enrolled. Patients in the operative group were treated with a volar locking plate. Reduction and stabilization of fracture were done with the application of 2.7mm volar locking titanium distal radius anatomically contoured implants. Non-operative Treatment Protocol was that All patients were complete a six weeks immobilization in a splint. One repeated manipulation if needed was accepted in the first 3 weeks. Passive and active finger motion from the starting was encouraged. Formal physiotherapy in this group was started 6 weeks after the removal of the cast. In the twelfth week, the functional assessment was examined by a physiotherapist or orthopaedic resident in both the Cast group and ORIF. Results: Thirty (31.3%) were in operative and 66(68.8%) were in non-operative group. No significant difference were found in age, height, weight, and BMI between both the groups (Mean: 42.7 vs 41.6 years, p=0.644; 156.5 vs 156.4 cm, p=0.962, 61.0 vs 59.5 kg, p=0.557, 24.9 vs 24.5, p=0.395 respectively). Moreover, distribution of gender, dominant hand, and injured hand was also similar in both the groups (p=0.427, p=0.587, and p= 0.673). DASH score were found to be significantly lower in operative group as compared to non-operative cast group (median 17.5 vs 28.8, p<0.0001, mean 16.6 vs 27.9, p<0.0001). Conclusion: At 12 weeks volar locking plates significantly produced better clinical and functional outcomes as compared with the treatment by Cast. The significantly anatomical reduction was more possible to be conserved in the operating group, but in the operative group, early mobilization achieved is the key to better achieving functional outcomes. Keywords: Distal radius extra-articular fractures, DASH score, Wrist function

Outcome of treatment of intra-articular distal end radius fractures by volar locking plate versus bridging external fixator augmented by single K-wire through radial styloid

Background: Distal radius fractures are common injuries occurring more frequently than any other fracture, and remain one of the most frequent skeletal injuries treated by orthopaedic or trauma surgeons. They are considered the most common fracture of the upper extremity. The use of percutaneous pin fixation, external fixation devices that permit distraction and palmar translation, low-profile internal fixation plates and implants, arthroscopically assisted reduction, and grafting techniques including bone-graft substitutes all have contributed to improving fracture stability and outcome. Methods: This is a prospective study consisting of 30 patients, who were treated with volar locking plate or K-wire augmented external fixation for intra-articular commented distal radius fractures (AO type C) at Rajendra institute of medical sciences between November 2020 and January 2023. The 15 patients were treated with open reduction using the volar approach and locking plate were used while 15 patients were treated with closed reduction under fluoroscopy, distraction with the external fixator (Joshi type external fixator) along with K-wire fixation for additional stability used. Result: The ORIF with plating group showed better functional outcomes in Green and O'Brien compared to ex fix group. The radiographic results in the ORIF group were more favorable than in the EF group. Conclusions: We found that both ORIF with plating and external fixation represent treatment choices for distal radius fractures. ORIF had better functional and radiological outcomes according to Green and O'Brien and Sarmiento scoring systems when compared to external fixation. ORIF had less incidence of complications compared with external fixation.

Functional Outcome Of Medial Distal Tibial Locking Compression Plate Fixation In Distal Tibial Fractures-A Prospective Study.

Aim: The Study Aim To Assess The Functional Outcome Of The Fracture Of Distal Tibia Treated With Medial Distal Tibial Locking Compression Plate. Materials & Methods: In The Current Study, 30 Patients With The Distal Tibia Fractures Underwent Reduction & Internal Fixation By Open & Mippo Technique With The Medial Distal Tibial Locking Compression Plate. The Study Was Conducted From July 2018 To December 2020 At Department Of The Orthopedics In Sree Balaji Medical College & Hospital. Results: All Patients Had Excellent Clinical & Functional Outcome. The Age Of Patient Ranged From 23 - 62 Years With The Fracture     Seen Commonly In The 4th & 5th Decade Of Life. Out Of The 30 Patients, 18 (60%) Were Male & 12(40%) Were Female, Indicating Male Predominance. All The Cases Were Then Evaluated Using The Iowa Ankle Score, Aofas Scoring Periodically & Only Final Follow Up Scores Were Taken For Compilation Of Results. Functional Results Based On Iowa Ankle Score In Mippo Group Among 18 Patients, 15 Patients Had Excellent Results With 2 Good And 1 Fair Result. In Orif Group Among 12 Patients, 8 Patients Had Excellent Results With 3 Good And 1 Fair Result. Based On Aofas Score In Mippo Group Among 18 Patients, 14 Patients Had Excellent Results ,3 Had Good Result, 1 Fair Result And No Poor Result. In Orif Group Among 12 Patients, 7 Patients Had Excellent Results With 3 Good Result, 2 Fair Result And No Poor Result. Implant Failures Or Deformity Was Not Seen In Any Cases. Conclusion: The Current Study Provides Ample Stability Of The Fracture & Facilitates Early Motion. It Also Helps In Achieving The Rapid Union & Allows The Preservation Of Blood Supply To The Fragment & Achieve Fracture Reduction. The Biggest Advantage Of Fixation Of The Fracture With Distal Tibial Locking Plate Is That Anatomical Reduction Is Achieved & Added Advantage In Mippo Is Fracture Hematoma Is Not Disturbed. This Study Shows That Lcp With Mipo Technique Provides Better Healing Of Fracture With Good Recovery And Lesser Complications Of Treatment.

Comparison of the Functional Outcomes of Close Reduction Percutaneous Pinning Versus Open Reduction Internal Fixation with Pinningin Children with Gartland Type III Supracondylar Fracture of Humerus

Objective: To compare the functional outcomes of close reduction percutaneous pinning versus open reduction internal fixation with pinning in children with Gartland type-III supracondylar fracture of the humerus.
 Study Design: Quasi-experimental study
 Place and Duration of the Study: Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Center, Karachi Pakistan,from Sep 2019 to Aug 2020.
 Methodology: A total of 98 patients aged of 2 to 15 years, of either gender, with Gartland type III supracondylar fracture were included in the study. By blocked randomization, patients were randomly assigned into two groups (49 each), Group-A (CRPP) and Group-B (ORIF). All of the patients were prospectively followed up after six months, assessed for the functional outcome according to Flynn's criteria, and classified as satisfactory and unsatisfactory based on functional and cosmetic factors.
 Results: The mean age in our study population was 8.2±3.4 years and 7.1±2.3 years in ORIF and CRPP Groups, respectively.The right arm was shown to be more commonly involved than the left arm in our population demographics, and RTA was determined to be the most frequent cause of supracondylar fractures. Functional outcomes were satisfactory for 68 individuals (69.4%), out of which 40(40.8%) belonged to the ORIF Group, and 28(28.6%) belonged to the CRPP Group, respectively.
 Conclusion: It is to be concluded that a significant difference was noted in terms of satisfactory outcomes between CRPP versus ORIF in the treatment of supracondylar fracture of humerus in children and that ORIF can be considered a valid firstline treatment for Type III supracondylar humer........

Outcome of treatment of Gartland type lll supracondylar humerus fractures in children by closed reduction and percutaneous pinning vs. open reduction and internal fixation by K-wires

Background: Extension fractures are more common than flexion fractures, and were classified into three subgroups by Gartland: type I, with no displacement; type II, with moderate displacement and intact posterior cortex and type III, with complete displacement. According to many authors, the ideal treatment for type 3 supracondylar humerus fractures is closed reduction and percutaneous pinning. Methods: This study was conducted in the department of orthopaedics, Rajendra institute of medical sciences, Ranchi during the period from December 2020 to December 2022. Both male and female patients were included in the study. Implant used are K wires of various diameter ranging from 1.5 to 2 mm. Results: The results with CRPCP are better than ORIF method as far as range of motion of elbow is concerned. Baumann angle were also comparable in both the groups. Conclusions: In our study, in the ORIF group, the ROM of the elbow treated improved with time. There was improvement in the range of motion at the 6-months follow-up as compared to the 3-months follow-up.

Effectiveness of Early Versus Delayed Open Reduction and Internal Fixation for Isolated Mandibular Fractures

Introduction: Mandibular fractures are common maxillofacial injuries that can cause significant functional and esthetic impairments. Objectives: The main objective of the study is to find the effectiveness of early versus delayed open reduction and internal fixation for isolated mandibular fractures. Material and methods: This study is a retrospective analysis of patient conducted in Govt Lady Reading Hospital, Medical Teaching Institution, Peshawar, during January 2022 till December 2022 and data collected from medical records. The study compares the outcomes of early and delayed ORIF for isolated mandibular fractures. All patients who underwent ORIF for isolated mandibular fractures at a single institution over a two-year period were included in the study. Patients were excluded if they had associated injuries or comorbidities that could affect their outcomes or if they underwent surgery at another institution. Results: A total of 150 patients who underwent ORIF for isolated mandibular fractures were included in the study. Of these, 75 patients underwent early ORIF (within 72 hours of injury), and 75 patients underwent delayed ORIF (more than 72 hours after injury). The two groups were similar in terms of age, sex, and fracture type. Functional and esthetic outcomes were assessed using the Facial Disability Index and the Glasgow Benefit Inventory. The early ORIF group had a mean score of 75.2 on the Facial Disability Index, while the delayed ORIF group had a mean score of 68.9 (p < 0.05). Conclusion: In conclusion, this study suggests that early ORIF for isolated mandibular fractures may lead to better functional and esthetic outcomes compared to delayed ORIF, without increasing the risk of complications or healthcare costs.

Comparison of open reduction and internal fixation and radial head resection for treatment of Mason type 2 and 3 fractures in young and active patients: our experience

Objective. The management of Mason type II and III radial head fractures (RHF) is still a debated topic. In the past, the only treatment of choice was radial head resection (RHR) but, as surgical techniques and instrumentation have advanced, internal screw fixation (ORIF) has gained popularity. The aim of this paper is to compare in a retrospective analysis the outcomes of ORIF and RHR in these fracture patterns in young patients. Methods. A total of 37 patients (age between 20 and 60 years old) affected by Mason type 2 and 3 RHF and surgically treated were collected by means of our electronic hospital database. Sixteen patients underwent RHR, and 21 patients underwent ORIF with mini screws. Functional outcomes and scores as well as the radiographs were recorded during follow-up. Results. After 22.17 months (range 12-45) of mean follow-up, the mean DASH, UCLA and MEPS scores showed no significant differences between groups (p: 0.26; 0.21; 0.23). The VAS score was unfavorable in the ORIF group compared to the RHR group (p: 0.43) although not statistically significant. Conclusions. The gold standard in the management of these fractures is not universally recognized. The advantages and complications of both techniques as well as of the RH arthroplasty are abundantly described. Our outcomes support RHR as a possible treatment choice in multi-fragmentary fractures of RH in young patients while minimizing complications.

A comparison of early fixation of distal radius fractures versus late corrective osteotomy of distal radius malunion.

Fractures of the distal radius are common. Closed reduction and moulded casting is often the first line treatment. Malunion after casting is not uncommon and can lead to discussion on acute surgical fixation versus delayed corrective osteotomy if symptomatic. However, it is unclear if late surgery will provide similar outcomes as early intervention. We performed a single centre, age matched, case series comparison study, comparing outcomes of patients who had undergone early fixation (ORIF) versus those who had undergone late corrective osteotomy (CO) following distal radius fracture. Twenty-six patients were available for review, 13 in each group. Fracture patterns were similar. Reviewing CO versus ORIF; patients achieved a mean DASH; 22 versus 18 (P= 0.355), PRWE; 35 versus 26 (P= 0.237), and VAS 2 versus 2 (P= 0.490). Grip strength was significantly better in those who had undergone ORIF; 2% versus -22% (P ≤ 0.001). Range of motion was generally better with primary fixation but of doubtful clinical importance, reviewing CO versus ORIF; Flexion 46° versus 60° (P= 0.045), extension 55° versus 64° (P= 0.137), pronation 73° versus 85° (P= 0.078), supination 84° versus 84° (P= 0.747), flexion/extension arc 101 versus 124 (P= 0.017), ulnar/radial deviation arc 42° versus 59° (P= 0.01), pronation/supination arc 157° versus 168° (P= 0.118). Ulnar variance was significantly improved in the ORIF group; +0.5 mm versus +2 mm in the CO group (P= 0.023). Radial inclination, radial height and volar tilt were not significantly different between either group. Our findings suggest that patient measured outcome of corrective osteotomy is not inferior to early internal fixation. III (Case Series Comparison).

Osteosynthesis versus revision arthroplasty in Vancouver B2 periprosthetic hip fractures: a systematic review and meta-analysis.

Several studies comparing osteosynthesis and stem revision in Vancouver B2 (VB2) periprosthetic hip fractures (PPHF) have been published. This work aims to be the first systematic review and meta-analysis to include only studies involving statistical comparison between the two techniques. MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were systematically searched from inception to October 2021 for studies involving a comparison between VB2 treated by osteosynthesis versus revision arthroplasty. The effect size (ES) was calculated using Cohen´s d index. From 17 published studies selected, a total of 856 patients were recruited (363 osteosynthesis / 493 revision arthroplasty). The pooled ES estimates for the Parker mobility score were 1.03 (95% CI, 0.22-1.84; I2 = 87.7%) for ORIF surgery, and 0.54 (95% CI, -0.10-1.17; I2 = 83%) for revision surgery. The pooled ES estimates for the operative time, reintervention, complications, hospital stay and needing for blood transfusion were significant lower in ORIF than in revision surgery. There were no differences in first-year mortality between groups. There was a higher proportion of ASA > 3 patients in the ORIF group. Osteosynthesis versus revision arthroplasty has a shorter operative time, less need for blood transfusion, fewer complications and reoperation rate and shorter hospital stay. Nonetheless, similar results were found for functional tests and first-year mortality. These results support the use of osteosynthesis in selected patients (low functional demand, multiple comorbidities, and high anesthetic risk). III.

Distal humerus fractures: closed reduction and percutaneous pinning versus open reduction and internal fixation

Introduction Distal humerus fractures are relatively rare and being intra-articular are difficult to manage. As the number of elderly people grows steadily and also with increasing use of motor vehicles in the developing countries, it can be said that the frequency of intraarticular fractures of the distal humerus will increase similar to the fractures of the distal end of the radius, hip, and spine. There are several treatment plans for managing intraarticular fractures of the distal humerus depending on fracture anatomy. We conducted this study to assess which approach is superior, closed percutaneous reduction with K-wires or ORIF. Methods A total of 30 patients who satisfied the inclusion criteria were included, out of which 16 patients underwent ORIF and 14 patients underwent closed reduction and percutaneous pinning (СRPP). Patients included were between 21–50 years of age with intraarticular nonpathological closed distal humerus fractures without preoperative neurovascular deficit and presented less than 10 days between the fracture event and treatment. Results In our study, mean age of patients undergoing CRPP was 28.1 years while the mean age of patients undergoing ORIF was 30.1 years. This study showed that distal humerus fractures are more common in younger age groups. In our study, mean arc of motion at 6 months postoperatively in patients which underwent CRPP was 106.07 degrees while the mean arc of motion in patients which underwent ORIF was 80.94 degrees. In patients who underwent ORIF, only 6.2 % (1/16) had excellent outcome, 56.3 % (9/16) patients had good outcomes, 31.3 % (5/16) patients had fair outcomes, and 6.2 % (1/16) had poor outcome. It was found that out of a total of 14 patients which underwent CRPP, only 7.1 % (1/14) had cutaneous impingement. Fracture union occurred in 100 % of patients except 3 patients in ORIF group; however, they had partial union up till 6 months of follow-up. Conclusion Our study concludes that even displaced intra-articular fractures of the distal humerus can be satisfactorily treated with closed reductions and percutaneous pinning.

Comparison of the functional outcomes after treatment of periprosthetic hip fractures with femoral stem loosening: Locking plate fixation with or without femoral stem revision

IntroductionPeriprosthetic fractures have become one of the main reasons for revision of total hip arthroplasty, with the treatment strategy guided by the Vancouver and SOFCOT classification systems. The main objective of this work was to compare the functional outcomes and mortality rate in patients who suffered a periprosthetic hip fracture with femoral stem loosening and who were treated either by internal fixation with locking plate only, or in combination with revision of the existing femoral stem with a cemented stem. The secondary objective was to compare the blood loss, procedure duration, length of hospital stay, living arrangements, time to weight bearing and major complications between these two treatment strategies. The starting hypothesis was that there is no difference in the functional outcomes between these two groups. Materials and methodsThis was a single center, retrospective study of patients treated between 2013 and 2019. Thirty-six patients (54%) underwent femoral stem revision (FSR group) and 31 patients (46%) were treated by locking plate fixation only (ORIF group). In this population, 19 of the patients had been residing at a nursing home before the surgical treatment: 12 (33%) in the FSR group and 7 (23%) in the ORIF group (p=0.33). The mean preoperative Parker score was 7.03 (± 1.48) in the FSR group versus 5.19 (± 1.92) in the ORIF group. The functional outcomes at the final review were evaluated using the Parker score, HHS (Harris Hip score), WOMAC (Western Ontario and McMaster Arthritis Index) and Oxford score. Fracture healing was determined on radiographs centered over the hip joint with the entire femur visible on AP and lateral views. All patients were reviewed at a minimum of 1 year for clinical and radiological assessments. ResultsAt a mean follow-up of 28 months [12–85], the Oxford score was 40.4 (± 10.6) in the FSR group versus 37.1 (± 13.5) in the ORIF group (p=0.34), WOMAC of 45.5 (± 26.9) versus 50.5 (± 32.4) (p=0.56), and HHS of 62.7 (± 25.5) versus 60.3 (± 28.6) (p=0.79). The Parker score at the final assessment was 5.14 (± 1.96) in the FSR group versus 4.64 (± 2.17) in the ORIF group (p=0.33). In the FSR group, 10 patients were at a nursing home (34%), 6 of whom were not there initially, versus 6 in the ORIF group (43%), 5 of whom were not there initially (p=0.59). The mean operating time was 152±41.4 minutes (minimum: 85; maximum: 254) in the FSR group versus 89.2 (± 44.1) minutes (minimum: 39; maximum: 280) in the ORIF group (p<0.001). Resumption of full weight bearing occurred at 6 weeks in 21 patients (58%) in the FSR group versus 14 patients (47%) in the ORIF group (p=0.023). There were 5 major complications (14%) in the FSR group versus 7 (23%) in the ORIF group (p=0.35). Among the reviewed patients, the union rate was 86% on the latest radiographs in the FSR group versus 78% in the ORIF group. DiscussionThere was no statistically significant difference between groups in the various functional scores, confirming our study hypothesis. Internal fixation with a locking plate appears to be an acceptable solution for treating periprosthetic hip fractures in which the femoral stem has loosened. Level of evidenceIII, comparative retrospective study.

Does Surgical Repair Benefit Pipkin Type I Femoral Head Fractures?: A Systematic Review and Meta-Analysis.

Background: Femoral head fractures are rare injuries with or without traumatic dislocations. The management of these fractures is crucial to prevent the development of severe complications and to achieve optimal functional outcomes. Wide treatment options for Pipkin 1 femoral head fractures range from fragment excision, fixation following open reduction with internal fixation, or conservative treatment such as close reduction alone after fracture dislocation. However, the best decision making remains controversial not only due to lack of large trials, but also inconsistent results reported. Therefore, we aim to compare the operative with nonoperative outcomes of Pipkin type 1 patients. Patients and Methods: We systemically searched MEDLINE, EMBASE, Cochrane library, In-Process & Other Non-Indexed Citations to identify studies assessing outcomes of Pipkin type 1 patients after conservative treatment, and open reduction with excision or fixation. Data on comparison of clinical outcomes of each management were extracted including arthritis, heterotopic ossification (HO), avascular necrosis (AVN), and functional scores (Thompson Epstein, Merle’ d Augine and Postel Score). We performed a meta-analysis with the available data. Results: Eight studies (7 case series and 1 RCT) were included in this study. In a pooled analysis, the overall rate of arthritis was 37% (95% CI, 2–79%), HO was 20% (95% CI, 2–45%), and AVN was 3% (95% CI, 0–16%). In comparison of management types, the excision group reached the best functional outcomes including Thompson Epstein Score (poor to worse, 9%; 95% CI, 0–27%) and Merle d’ Aubigne and Postel Score (poor to worse, 18%; 95% CI, 3–38%); ORIF group had the highest AVN rate (11%; 95% CI, 0–92%); conservative treatment had the highest arthritis rate (67%; 95% CI: 0–100%) and lowest HO rate (2%; 95% CI, 0–28%). Discussion: This meta-analysis demonstrates that different procedures lead to various clinical outcomes: fragment excision may achieve better function, conservative treatment may result in a higher arthritis rate, while ORIFs may have a higher AVN rate. These findings may assist surgeons in tailoring their decision-making to specific patient profiles. Future RCTs with multicenter efforts are needed to validate associations found in this study. Level of Evidence: II, systematic review and meta-analysis.

Primary fusion versus open reduction internal fixation for purely ligamentous lisfranc injuries: A Prospective comparative study and analysis of factors affecting the outcomes

BackgroundThe studies evaluating the outcomes of treatment of purely ligamentous unstable Lisfranc injuries are scarce. This study aimed at comparing outcomes of primary tarso-metatarsal joints fusion versus open reduction and internal fixation in treatment of such condition and determining the possible factors that may alter the outcomes. MethodsThis study comprised 30 patients; 16 in fusion group and 14 in ORIF group. One column was operated on in 2 patients, two columns in 21, and three columns in 7. The mean follow-up period was 36 months. ResultsThere was no statistically significant difference between both groups regarding patients or injury characteristics. The mean AOFAS and FFI-Rs scores were 88.9 and 22.7 in the fusion group, compared to 61.7 and 34.5 in the ORIF group (P = .03,.04 respectively). At final follow-up all patients in the primary arthrodesis group were maintaining an anatomical reduction versus 71.5% in the ORIF group. Sixteen patients (53%) reported prominent hardware troubles that required removal. Five patients in ORIF group developed osteoarthritis, and four of them underwent secondary fusion. There was significantly higher incidence of posttraumatic osteoarthritis in patients with non-anatomical reduction and complete injuries. Better mean AOFAS and FFI-Rs scores occurred with non-smokers and with anatomical reduction. ConclusionBased on this limited case series, purely ligamentous Lisfranc injuries were found to have better outcomes when managed with a primary fusion as compared to ORIF.Achieving and maintaining anatomical reduction was the most important factor that is significantly attributed to improved outcomes. Possible arthritic changes and additional surgeries apart from implant removal could be avoided by primary fusion. Level of evidencelevel I- prospective comparative case study.

A comparison of clinical, radiological, and quality-of-life outcomes of double-plate internal and Ilizarov external fixations for Schatzker type 5 and 6 tibia plateau fractures.

To compare clinical, functional, and radiological outcomes in patients with bicondylar tibial fractures treated with either double-plate or Ilizarov external fixation. Patients with Schatzker type 5 and 6 tibial plateau fractures who were treated with double-plate (Group O) and Ilizarov external fixations (Group E) between March 2012 and April 2018 were selected. Demographic data and preoperative, intraoperative, and postoperative variables were analyzed and compared. In the last follow-up, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Knee Score (OKS), Knee Society Score-Knee (KSS-Knee), KSS-Function (KSS-F), and Short-Form Health Survey (SF-36) were used to measure clinical and functional outcomes. Treatment costs and complication rates were also recorded and compared. A total of 64 patients (43 men and 21 women) were included in the study (group O: 36, group E: 28). WOMAC, KSS-F, KSS-Knee, and OKS scores were similar between the two groups (P > 0.05). The role limitations due to emotional problems, emotional well-being, and social functioning domains of SF-36 were higher in group O (P < 0.001). Three (8.3%) deep infections occurred in group O, whereas no deep infection was observed in group E (P = 0.035). The treatment cost was higher in group O (P < 0.001). In bicondylar tibial plateau fractures, functional outcomes of ORIF and Ilizarov method milar were sibut, role limitations due to emotional problems, emotional well-being and social functioning domains of SF-36 score were higher in ORIF group. However, Ilizarov method is more cost-effective and related with lesser complications.

Treatment of in extra-articular distal tibia fracture Open vs Mippo which is better?

Objective: Study was done to compare results between the Mippo and ORIF in extra articular distal tibia fracture. Hypothesis was made that outcome of MIPPO technique is comparable to ORIF. Methodology: 30 patients were included in study out of which 15 patients were treated by Mippo technique and remaining 15 patients ORIF technique was used. Outcome was evaluated on basis of time of injury to surgery, operation time, blood loss, healing time, hospital stay, blood transfusion, implant related complication, radiation exposure, AOFAS grading. Results: there was no remarkable difference in AOFS score, fracture union, hospital stay, mean operative time or wound healing. Blood loss was higher in ORIF group but radiation exposure was slightly more in MIPPO group, 1 case of malunion found in MIPPO group. Conclusion: functional outcome of MIPPO technique are comparable with ORIF technique.

Comparison of Open Reduction and Internal Fixation with Plate and Titanium Elastic Intramedullary Nail in Treating Pediatric Humeral Fracture

ObjectiveTo investigate the therapeutic efficacy of titanium elastic intramedullary nail (TEN) and open reduction and internal fixation with plate (ORIF) in the treatment of humeral fracture in children.MethodsA retrospective study was carried out in a total of 69 patients who were admitted to the hospital from January 2013 to December 2018. These patients, including 41 males and 28 females, were aged from 6 to 12 years old with a median of 8 years. These patients were diagnosed with humeral fracture and underwent the surgery of ORIF (n = 22) or TEN (n = 47). The intraoperative bleeding, operation time, length of stay (LOS), and fracture healing time were compared between the two groups. The therapeutic effect was assessed by the shoulder range of motion, the elbow range of motion, the UCLA shoulder function score, and the Mayo elbow performance score (MEPS) 6 months after the surgery.ResultsThe intraoperative bleeding (97.20 ± 27.83 mL vs 185.60 ± 37.50 mL, P < 0.05), the operation time (53.70 ± 11.87 min vs 73.50 ± 13.33 min, P < 0.05), and the fracture healing time (9.30 ± 4.23 weeks vs 13.45 ± 3.67 weeks, P < 0.05) in the TEN group was significantly decreased than those in the ORIF group. There was no significant difference in the LOS between the two groups. The length of follow‐up is 3 and 6 months. The shoulder range of motion (110.88° ± 15.82° vs 98.37° ± 16.22° at 3 months and 162.88° ± 17.29° vs 117.65° ± 19.38° at 6 months, both P < 0.05), the elbow range of motion (105.23° ± 2.81° vs 87.12° ± 4.73° at 3 months and 137.47° ± 4.82° vs 109.67° ± 5.83° at 6 months, both P < 0.05), and the UCLA shoulder function score (28.58 ± 4.74 vs 21.64 ± 7.23 at 3 months and 33.05 ± 3.27 vs 25.78 ± 3.87 at 6 months, both P < 0.05), and the MEPS (80.76 ± 3.53 vs 65.33 ± 9.43 at 3 months and 97.48 ± 1.23 vs 88.22 ± 3.65 at 6 months, both P < 0.05) in the TEN group were greater than those in the ORIF group. In the TEN group, complications occurred in three of 47 cases (6.38%), including one case (2.13%) of bone nonunion and two cases (4.25%) of irritation response around the nail. In the ORIF group, complications occurred in four of 22 cases (18.18%), including one case (4.55%) of delayed healing, one case (4.55%) of deep infection, and two cases (9.08%) of radial nerve injury. The complication rate was not significantly different between the two groups.ConclusionTEN can be a good technique for the treatment of humeral fracture in children, with the advantages of less intraoperative bleeding, shorter operative time, quicker healing, and better recovery of shoulder range of motion and elbow range of motion.