Department Of Orthopaedic Trauma Research Articles

Clinical-radiological results of the tibial osteotomy of valgization by internal addition in Gonarthrosis.

In knee osteoarthritis, medial-opening tibial osteotomy remains a good surgical technique, and have been effective in stabilizing and even improving osteoarthritis, Our study is about 20 cases of gonarthrosis on genu varum, treated by opening wedge valgus high tibial osteotomyconducted within the orthopedic trauma department '' B'' of the University Hospital Mohamed VI of Marrakech, over a period of 4 years. The mean age of our patients was 49 years (39-60), with a sex ratio of 1M/4F. In 55% of cases (11 cases) thegonarthrosis was related to primitive genu varum, while 45% cases (9 cases) was secondary to trauma ormeniscectomy. Clinically the knee pain was the main symptom in all cases, with an intensity level 3 on the simple verbal scale. The imagery was designed to measure angular deviations and surgical correction and monitoring the evolution. Angular deviation adjusted mean was 10.3 ° (6 ° -16 °), stages II and III of Ahlback classification, represent the mostcases of tibiofemoral osteoarthritis (90%).The filling was done by autologous bone graft, and the average degree of varus correction was 9.6 °.The results evaluated by the IKS score were excellent or good in 60% of cases for the knee score and 73% for the function score.

"Survey of Knowledge about Fracture Prevention Among Patients and their Relatives at Department of Orthopaedic Trauma An Binh Hospital"

"Survey of Knowledge about Fracture Prevention Among Patients and their Relatives at Department of Orthopaedic Trauma An Binh Hospital"

Chiari Osteotomy in the Children: Mid-term Follow-Up Results.

Introduction The Chiari osteotomy enlarges the acetabulum to increase coverage of the femoral head. It is performed as a salvage procedure on a noncongruent, yet in-place, hip. This study aims to assess the clinical and radiographic outcomes of Chiari pelvic osteotomy for treating hip dysplasia in children. Methods This is acase series conducted in the pediatric orthopedic trauma department of the Centre Hospitalier Universitaire Hassan II, Fez, Morocco, over a 10-year period from January 2011 to December 2020. The study included patients who were being treated for hip dysplasia and had undergone a Chiari osteotomy. Two types of assessments were used to evaluate global hip function: a clinical assessment using the Merle d'Aubigné and Postel score, and a radiological assessment involving measurements taken from frontal pelvic radiographs. Results A total of 12 Chiari osteotomies were performed in nine patients. The mean age at surgery was 10.8 ± 1.7 years and the mean follow-up was 4.6 ± 2.78 years. The clinical assessment score improved statistically during the last follow-up compared with the preoperative measurements for pain (p<0.001), mobility (p = 0.002), walking (p<0.001), and total score (p< 0.001), for which 3.8 ± 1.9 points could be gained. Surgically, the osteotomy line height was 5.4 ± 2.6 mm, the osteotomy angle was 12.5 ± 2.2°, and the translated distance was 18.5 ± 3.2 mm.Regarding radiological evaluation, the comparison of angle measurements between preoperative and final recoil was statistically significant for both the vertical center edge (VCE) angle (p<0.001) with a mean gain of 16.33 ± 4.79° and the high transverse edge (HTE) angle (p = 0.002) with a mean loss of 12.67 ± 10.88°. Conclusion Chiari pelvic osteotomy is a complex procedure that requires very precise techniques. However, it results in remarkable relief for patients, providing an immediate impact on the Merle d'Aubigné and Postel score, particularly with regard to pain.

Professional Reintegration after Pelvic and Acetabular Trauma

Introduction: Pelvic ring and acetabulum injuries are complex injuries varying in severity and complications resulting in serious morbidity in surviving individuals which as a result can be a major contributor to reintegration of patients in professional services. Therefore its important to evaluate to what extent affected patients can return to pre injury work status and how their quality of life is affected. The objective of this study is to evaluate reintegration of affected patients in profession in a two year follow up after acetabular and pelvic ring injuries Material and Methods: Using local Trauma Registry of Orthopedic Trauma department in Shaheed Mohtarma Benazir Bhutto Institute of Trauma (SMBBIT) a retrospective Cohort study was conducted. All patients between age 18 to 60 who had a Acetabulum or Pelvic Ring fracture presented in SMBBIT during July 2017 to July 2019 and were treated by Orthopedic Trauma department were included in study. Multivariate logistic regression analysis was used to model reintegration to profession. Affected patients were classified as “Reintegrated to profession” if they have earned a month salary after 13 to 24 months rehabilitation post treatment. For unemployed patients along with majority of women who were domestic home makers, reciprocate basic household chores to pre injury injury level were classified as “ Reintegrated “ Fracture classification, Age, Gender, Fracture of Spine , Nerve Injuries of Lumbo Sacral Spine and/or lower limb and work status before injury were considered prognostic covarities. Results: Almost 70 percent of 180 researched patients were classified reintegrated. This means a reduction of 20 percent in employment for Pelvic ring injuries and 10 percent reduction in employment for acetabular fractures post treatment. Employment status before injury was the main predictor for reintegration. Older patients had a less chance to return to work in comparison to young individuals. Patients with Nerve injuries and fracture of spine had almost 80 percent higher risk for not being reintegrated. Conclusion: Acetabular fractures and Pelvic ring injuries currently lead to greater loss of reintegration to profession or domestic work. Trauma to Pelvis and Acetabulum threatens the social security of patients. Therefor rehabilitation and follow up care should be optimized to reduce post traumatic disability and reduce the economic burden of work disability.

Observation on the Effect of Minimally Invasive Technique in Clinical Treatment of Orthopaedic Trauma

Objective To observe, analyze and study the application and value of minimally invasive technique in orthopaedic trauma. Methods thirty-eight patients admitted to the Department of Orthopaedic Trauma of Jilin Provincial People’s Hospital in the past one year were selected as observation objects, and they were divided into two groups: control group and observation group, with 19 patients in each group. The control group received conventional treatment, while the observation group received minimally invasive treatment. The control subjects included clinical treatment effect, pain score, quality of life score, incidence of clinical complications and treatment indicators. Results through observation, analysis and research we found that the comprehensive clinical effect and index to observe group was obviously superior to observe group (p &lt; 0.05), and the observation group of intraoperative blood loss, operating time, postoperative wound healing, switching frequency effect is better than that in control group (p &lt; 0.05), at the same time, the probability of complications to observation group was obviously lower than the control group.

Patella baja after intramedullary nailing of tibial fractures, using an infrapatellar/transtendinous approach, predicts worse patient reported outcome

PurposeAfter intramedullary nailing of tibial shaft fractures using an infrapatellar/transtendinous approach, several patients suffer anterior knee pain. We suspect that the approach is associated with soft tissue scars and the development of a postoperative patella baja. The goal of the study is to investigate whether the development of patella baja is associated with worse subjective outcomes.MethodsWe retrospectively analyzed all patients in our orthopedic trauma department between 2011 and 2020 who underwent tibial fracture fixation via intramedullary nailing via an infrapatellar/transtendinous approach. Pre- and postoperative lateral knee x-rays were evaluated by measurement of the Insall-Salvati Index, and nail tip position. All patients were asked to answer the self-assessment Kujala questionnaire and Lysholm questionnaire.ResultsWe included 78 patients (age: 44 ± 18 years) with a minimum follow-up of 12 months. Mean follow up was 59 ± 25 months. We included 50 male and 28 female patients. Patella baja detected by Insall-Salvati Index could be observed in 8 (10.3%) patients. Patients with patella baja showed significant worse function measured by the Kujala score 54 ± 18 vs. 80 ± 14 (p < 0.01). Likewise, Lysholm score did show significant differences between both groups (60 ± 24 vs. 86 ± 11; p < 0.01). Nail tip position was not associated with worse subjective function.ConclusionsPatella baja in patients after tibial intramedullary nailing via an infrapatellar/transtendinous approach, is associated with worse subjective function and increased pain.

Construction and efficiency analysis of prediction model for venous thromboembolism risk in the elderly after hip fracture.

To screen the risk factors for predicting venous thromboembolism (VTE) risk after hip fracture in the elderly, to establish a prediction model based on these factors, and to analyze its prediction efficacy. A total of 52 hip fracture patients over 60 years old with VTE admitted to the Department of Orthopaedic Trauma, Xiangya Hospital, Central South University from March 2017 to April 2019 were selected as a thrombus group, and another 52 hip fracture patients over 60 years old without VTE were selected as a control group. The differences of hospitalization data and examination results between the 2 groups were compared. Logistic regression model was used to explore the influence of risk factors on VTE risk after hip fracture in the elderly and construct the prediction model based on these factors. The receiver operating characteristic curve was used to analyze the predictive effectiveness of model, Hosmer-lemeshow goodness of fit test was used to evaluate the fitting degree of prediction model. Univariate analysis showed that injury-admission interval, Caprini score, WBC count, platelet count, neutrophil count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic immune-inflammatory index (SII), and fibrinogen in the thrombus group were higher than those in the control group (all P<0.05). Logistic regression analysis showed that injury-admission interval, Caprini score, and SII were independent predictors of VTE risk after hip fracture in the elderly. The AUC was 0.949 (95% CI 0.901 to 0.996) when the sensitivity and specificity were 82.70% and 96.20%, respectively, which were significantly higher than each single index, and the prediction model had perfect fitting degree (Hosmer-lemeshow χ2=14.078, P>0.05). SII, Caprini score, and injury-admission interval are independent predictors of VTE after hip fracture in the elderly. The prediction model based on these 3 factors has a good efficacy on the prediction of VTE risk, and could provide important reference for the prevention, management, and treatment of VTE after hip fracture in the elderly.

Fractures of the proximal femur in the elderly in a sub-Saharan country

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The aim of this study was to describe the epidemiological, radiographic and therapeutic profile of the fractures of the proximal femur in the elderly in a sub-Saharan country.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A retrospective longitudinal study was carried out at the orthopedic trauma department of Idrissa Pouye Hospital in Senegal. Sixty-six patients recruited were aged at least 90 years; and treated for proximal femur fracture between 2008 and 2017.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The median age of the patients was 91 years (90-107). Females represented 54.5%. The fracture was located in the right 65.2%. Femoral neck fractures were 53% predominant with 94.3% type IV according to Garden’s classification. Concerning the 31 patients with a pertrochanteric fractures, 61.3% were stable and 38.7% unstable. The time taken for seeking hospital care was an average of 5.8±9.7 days. All patients had a preoperative anesthesic score less than 4 according to the American society of anesthesiologists (ASA). The therapeutic indication was functional in 15.1% of cases, surgical by internal fixation in 39.2% and by arthroplasty in 45.7% of cases. Pertrochanteric fractures were managed by a dynamic hip screw (DHS) in 68.2% and by gamma nail in 18.2%. Femoral neck fractures were managed by Moore's arthroplasty in 93.3% and by bipolar hip prothesis (BHP) in 6.7%.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Fractures of the proximal femur represent a growing problem in sub-Saharan Africa. For patients above 90 years, the management remains essentially surgical by internal fixation in pertrochanteric fractures or by arthroplasty in cervical fractures.&lt;/p&gt;

Surgical treatment of thalamic fractures treated by anatomic plate with survevent

Introduction: Calcaneus fractures are frequent and serious injuries. They represent 65% of tarsal trauma and 2% of all fractures. The thalamic fractures constitute a particular entity by their mechanism of occurrence, by their treatment and by their prognosis much less favorable than the extra-articular fractures.1 Materials and methods: Our series spanning a period of 7 years from January 2011 to November 2018 focused on 12 patients with a thalamic fracture of the calcaneus treated by anatomical plate with bearing, collected in the Orthopedic Trauma Department A of the Hassan II Fez University Hospital. All adult patients with a thalamic calcaneal fracture who had undergone an osteosynthesis using an anatomical plate were included and extra-thalamic fractures and thalamic fractures treated by other therapeutic means or other types of screw plates were excluded. All patients underwent an urgent general systematic examination and a regional examination. On the neurological level, the majority of patients were admitted with a GCS at 15. Results: Our focused on 12 operated patients between the ages of 17 and 53 with an average of 35 years. Our series includes 12 patients including 17 calacneum fractures which are divided into 10 men and 2 women; the male sex represents 83.3%. The preoperative delay was on average 9.25 days with extremes between 03 and 20 days. No thromboembolic complications or algodystrophy were noted in our series. According to Kitaoka's rating, the average score was 73.5%. The functional results were excellent in 47.06% of the cases, good in 23.53% of the cases, average in 23.53% of the cases and poor in 5.88% of the cases. In post-operative the average Bohler angle was 26.5° (15° to 35°) against a pre-operative Bohler angle varying between -7° to 15°. On revision, the average recoil from Bohler's angle finds it to be 21.5°. Conclusion: In the light of all those preceding the surgical treatment of articular fractures of the calcaneus displaced by anatomical plate, despite the risks associated with this technique provides a certain superiority if you are sure you can get a perfect reduction.

Pain relief during wound care for patients with a deep open wound in an orthopedic trauma department: a best practice implementation project.

The aim of this project was to implement best practice in pain relief during wound care for patients with deep open wounds in the orthopedic trauma department of a tertiary teaching hospital in China. Patients with deep open wounds often suffer from severe pain during wound care. Inadequate pain relief for these patients calls for evidence-based changes to close the gap between current and best practice. The current quality improvement project was carried out over six months using the JBI Practical Application of Clinical Evidence System (JBI PACES). A baseline and two follow-up audits of wound pain management practice were conducted to identify practice gaps and post implementation compliance in pain management in wound care. The sample comprised 20 patients and two dressing nurses. The Getting Research into Practice tool identified barriers to and strategies for improvement in practice. The patients' pain experiences were measured following the implementation of changes. The baseline audit identified poor compliance with best practice. Following implementation of the recommended changes, some significant improvements in practice were made by the dressing nurses; however, these were inadequately maintained at the second post implementation audit. Patients' pain scores improved following the nurses' practice changes (t = 2.272, P > 0.05). The implementation of best practice in pain relief during wound care for patients with deep open wounds has led to significant improvement in nurses' performance in the orthopedic trauma department. The most challenging barriers involved interdisciplinary collaborations and organizational structure.

Enhanced Recovery After Surgery used in close reduction of distal radius fracture in emergency traumatic patients: a prospective cohort study

Objective To compare the therapeutic effects between the anesthetic and non-anesthetic closed reduction protocols for distal radius fractures based on the concept of Enhanced Recovery After Surgery (ERAS). Methods A prospective study was conducted in a cohort of 186 patients with distal radius fracture who had been admitted to the Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from September 2018 to January 2019. The patients were divided into 2 groups depending on the choice by themselves. Of them, 72 (intervention group) underwent the standardized closed reduction under brachial block anesthesia based on the concept of ERAS while the other 114 (control group) conventional closed reduction under no anesthesia. The 2 groups were compared in terms of emergency reduction times, swelling scores, reoperation rate, splint removal time, functional outcomes by the Patient-Rated Wrist Evaluation (PRWE) and radiographic outcomes by the Lidstrom criteria. Results The patients in both groups were followed up for 6 months. The reduction times were fewer in the intervention group than in the control group (1.1±0.1 versus 1.6±0.1, P 0.05). Conclusion Compared with conventional closed reduction, the closed reduction under anesthesia based on the ERAS concept is an effective method for the emergency treatment of distal radius fracture, because it may minimize the patients’ pain experience, increase the rate of successful reduction, decrease the rate of reoperation, shorten the splint fixation time and gain better functional outcomes. Key words: Radius fractures; Anesthesia; Ultrasonography; Brachial plexus; Closed reduction

Incidence and risk factors of deep venous thrombosis in lower extremity in patients with tibial plateau fracture

Objective To investigate the incidence and risk factors of deep venous thrombosis (DVT) in lower extremity in patients with tibial plateau fracture. Methods The data from 148 patients with tibial plateau fracture were retrospectively analyzed who had been admitted to the Department of Orthopaedic Trauma, Honghui Hospital between September 2014 and December 2017. They were 90 males and 58 females, aged from 19 to 83 years (average, 47.2±13.1 years). According to the Schatzker classification of tibial plateau fractures, 24 cases belonged to type Ⅰ, 17 to type Ⅱ, 25 to type Ⅲ, 29 to type Ⅳ, 34 to type Ⅴ, and 19 to type Ⅵ. The incidence of DVT was detected by venous ultrasound of bilateral lower extremities before and after surgery. The factors related to the occurrence of DVT were statistically analyzed. Univariate analysis was used to determine risk factors, and multivariate logistic regression analysis was used to identify the primary independent risk factors. Results The preoperative DVT incidence was 43.92% (65/148) and the postoperative DVT incidence 52.70% (78/148). Distal thrombus predominated both preoperatively and postoperatively. Age (OR=1.043, 95%CI 1.015~1.072, P=0.002) and D-dimer level upon admission(OR=1.219, 95%CI 1.009~1.473, P=0.040) were independent risk factors for preoperative DVT formation; age (OR=1.075, 95%CI 1.042~1.110, P=0.000), operative time (OR=0.994, 95%CI 0.989~0.999, P=0.016), D-dimer level at 1 day postoperatively (OR=1.135, 95%CI 1.025~1.258, P=0.015) and at 3 days postoperatively (OR=1.366, 95%CI 1.008~1.853, P=0.044) were independent risk factors for postoperative DVT. Conclusions The incidence of DVT in the lower ex-tremity may be high in patients with tibial plateau fracture. Distal thrombus is the main manifestation. In fracture patients, especially the middle-aged and elderly ones, dynamic monitoring of D-dimer level should be combined with lower extremity venous ultrasound for early diagnosis of DVT. In patients with lower extremity DVT, surgical progress should be accelerated on the basis of good surgical quality to reduce the incidence of postoperative lower extremity DVT. Key words: Venous thrombosis; Risk factors; Age factors; D-dimer; Tibial plateau fracture

Treatment of distal radius fractures with dorsal dislocation of Fernandez type IV by open reduction and internal fixation

Objective To report the treatment of distal radius fractures with dorsal dislocation of Fernandez type Ⅳ by open reduction and internal fixation via a combined dorsal and volar approach. Methods A retrospective analysis was conducted of the 14 cases of fresh distal radius fracture with dorsal dislocation of Fernandez type Ⅳ which had been treated by open reduction and internal fixation via a combined dorsal and volar approach at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from July 2010 to June 2016. All the patients were male, with an average age of 38.4 years (from 27 to 52 years). The time from injury to surgery averaged 6.9 days (from 4 to 10 days). Their injury involved 5 left and 9 right wrists. Follow-up was performed at 1, 2, 3, 6 and 12 months after operation when anteroposterior and lateral X-ray films were taken and functional exercise guidance was provided. At 6 and 12 months after operation, all the patients were evaluated using modified Garland-Werley scoring and Patient Rated Wrist Evaluation (PRWE). Results The patients were followed up for an average of 19.4 months (from 15 to 26 months). Their fractures healed well. Their fracture healing time averaged 3.1 months (from 2 to 4 months). Their modified Garland-Werley scores at 6 and 12 months after surgery were 8.9 points (from 6 to 13 points) and 7.3 points (from 4 to 11 points), respectively; their PRWE scores were 17.9 points (from 12 to 25 points) and 16.5 points (from 11 to 23 points), respectively. None of the patients was inflicted by infection, vascular injury or internal fixation failure. Conclusion The open reduction and internal fixation via a combined dorsal and volar approach can restore the stability of both the dorsal osseous structure of the distal radius and the volar ligament structure of the wrist, facilitating postoperative maintenance of the radiocarpal joint stability, improving the wrist function and leading to satisfactory outcomes. Key words: Radius fractures; Fracture fixation, internal; Ligaments; Surgical approach

Operative strategy and clinical results of complex four part distal radius fractures by combined palmar and dorsal internal fixation

Objective: To explore a standard procedure for the treatment of combined dorsal and palmar internal fixation for complex four part distal radius fractures and assess its clinical results. Methods: From May 2009 to October 2016, 38 patients(39 sides)who suffered from complex four part distal radius fractures were performed operatively with open reduction and internal fixation via combined dorsal and palmar approach in Department of Orthopaedic Trauma, Qilu Hospital of Shandong University(Qingdao). The series included 22 males(22 sides) and 16 females(17 sides). Age of the patients was 53.5 years ranging from 25 to 79 years.According to Melone classification, there were 34 sides of type of Ⅳ, 5 of type Ⅴ.According to Frykman classification, there were 15 sides of type Ⅶ, 24 sides of type Ⅷ, and all the cases were type C3 according to AO/OTA classification.Preoperatively, the key articular fragments in four part distal radius fractures were identified and the individual fracture patterns from conventional X-ray and CT-scan were analyzed. All the patients were performed combined volar and dorsal fixation.Firstly, a palmar approach which gave access to and fix the palmar-ulnar fragment and the radial styloid fragment was performed.Then a limited dorsal approach across the third extensor compartment which gave access to the dorso-ulnar fragment and a limited dorsal arthrotomy to visualize the radiocarpal joint when necessary were performed.Through dorsal approach, we can address the dorso-ulnar fragment, free intra-articular fragment and direct visualize the joint.Use of a retinacular flap was routinely advocated to help prevent against tendon irritation and rupture.The follow-up control included conventional X-ray, range of motion(ROM), grip strength, and the disabilities of the arm, shoulder and hand index(DASH), as well as the patient-rated wrist evaluation(PRWE) score for functional outcome at 6 and 12 months. Results: Thirty-three patients(34 sides) were followed up for at least 12 months.The would healed well in all cases 2 weeks postoperatively, and no soft tissue infections, necrosis or neurovascular complications occurred.All the fractures of 38 cases(39 sides)healed averaged 3.6 months(ranging from 2.5-5.7 months), and no loss of reduction occurred postoperatively.Anatomic reconstruction with a step or gap of <1 mm was achieved in 37 cases(38 sides), Whereas 5 patients were lost to follow-up at 12 months postoperatively.ROM and grip strength were all recovered to over 85% of the unaffected side(exception of the bilateral patient). Median DASH-index and PRWE were 6.5(0-17) and 9.3(0-20)respectively. Conclusion: Combined volar and dorsal approaches allow achieving anatomic reconstruction in complex four part intra-articular distal radius fractures and reveal good functional outcomes at intermediate follow-up.

FRACTURES OF VERTEBRAL BODIES IN THE STRUCTURE OF CHILDREN’S TRAUMATISM

The aim of the study was to establish the frequency and features of uncomplicated compression fractures of vertebral bodies in children and to determine its place in the rank structure of children’s injuries. In order to achieve this goal in 2011 the medical records were studied studied: case register of emergency trauma care, hospital records, medical records, X-ray archive. The authors have found that fractures of vertebral bodies took place XVIII ranking in the structure of child’s injury, which accounted for 0.55% of traumatic injuries. Frequently the fractures of vertebral bodies occur in children aged 8-12 years. Mainly the vertebra ThVIII was injured - 11.44% of cases. Children with fractures of vertebral bodies constitute 15.66% of inpatient emergency trauma patients in a specialized children’s orthopedic trauma department

Application of bilingual case discussion in clinical teaching of orthopedic trauma

The practice of daily case discussion in the morning using slice show has been cartied out since orthopedic trauma department of Nanfang Hospital was set up.Bilingual ( Chinese and Englisl) discussion was hold in the department before and after the operation on the cases requiring three-level or higher level operation and those of special diseases.The bilingual case discussions will greatly improve the clinical thinking and accumulate the clinical experiences for doctors.The professional English proficiency of all doctors in the department have been improved because of the bilingual case discussions and the most effective treatment for patients was provided at the same time. Key words: Case discussion; Orthopedic trauma; Bilingual