Outcome Of Fractures Research Articles

Treatment outcomes of concomitant ipsilateral neck and trochanteric fractures using Gamma3 nails with U-blade lag screws.

This study aimed to investigate the outcomes of Gamma3 nails fitted with U-blade lag screws in the management of combined neck and trochanter fracture of the femur. Two hundred-fifty patients with fractures in the proximal femur underwent treatment using Gamma3 nails integrated with U-blade lag screws from 2015 to 2022. Among these cases, 33 had combined neck and trochanteric fractures; 8 patients were excluded because of follow-up for <1 year. The remaining data of 25 patients (7 males and 18 females) were reviewed. Bone mineral density (BMD), body mass index (BMI), tip-apex distance (TAD), extent of lag screw migration, femoral neck-shaft angle, callus formation, fracture type, and treatment failure were analyzed. The mean patient age was 76.3 (range, 61-91) years, and the mean follow-up duration was 17.3 (range, 12.5-57.3) months. The mean BMD T-scores for the spine and femoral neck were -2.3 ± 1.0 and -2.8 ± 0.7, respectively; 18 patients had T-scores ≤-2.5, indicating osteoporosis. The mean BMI was 23.2 ± 3.8 kg/m2 , and the mean operative time was 69.8 (range, 45-90) minutes. Twenty-one patients experienced injuries from slipping, 2 sustained injuries from falling, and 2 from car traffic accidents. The mean TAD was 21.6 ± 5.9 mm, with 16 patients showing <25 mm. The mean extent of lag screw migration was 5.7 ± 5.1 mm. The mean femoral neck-shaft angle on plain radiographs was 125.1 ± 8.6 degrees immediately postoperatively and 120.3 ± 9.5 degrees at the final follow-up. During the follow-up period, the first callus formation was observed at 3.8 months (range, 1.4-7.3) on plain radiographs in the anteroposterior and axial views. Based on our fracture criteria, 4 patients had a two-part fracture type, 12 patients had three-part, and 9 patients had four-part. Out of 25 patients, 3 exhibited treatment failure. No significant differences were observed between the groups with and without bone union regarding age, BMD, BMI, operative time, TAD of the lag screw, extent of lag screw migration, and femoral neck-shaft angle. The bone union was achieved in 88% of patients who underwent treatment utilizing the U-blade Gamma3 nail for concomitant ipsilateral neck and trochanteric fractures. Level IV, Therapeutic Study.

Trapezial ridge nonunion treated with excision and ligamentous tissue repair.

We describe the challenge associated with obtaining an initial correct diagnosis of trapezial ridge fracture and the importance of repairing the detached ligamentous tissue after excision of the trapezial ridge fragment to obtain a favourable postoperative outcome for this rare fracture.

Incidence of deep vein thrombosis and pulmonary embolism in closed foot and ankle fractures treated with conservative versus surgical management: A nationwide analysis

ObjectivesThough there is extensive research on recovery and outcomes of proximal joint fractures, such as hip and knee, there is a paucity of such research in foot and ankle fractures and a lack of uniform data on the incidence of venous thromboembolism (VTE). This is a retrospective cohort study that seeks to investigate the incidence of VTE following surgically versus conservatively treated foot and ankle fractures MethodsThis study included all adult-patient hospitalizations with International Classification of Disease 10th Revision diagnosis codes related to closed foot and ankle fractures as a primary diagnosis in the National Inpatient Sample, an administrative database part of the Healthcare Cost and Utilization Project, for a total of 209,595 cases. Multivariate binary logistic regression was performed to determine the effect of age, gender, past medical history of venous thromboembolism (PMHVTE), Charlson Comorbidity Index, race, surgery, and transfusion of red cell products on the incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE). ResultsOur study found an overall incidence of DVT and PE to be 0.4 % and 0.3 %, respectively, following foot or ankle fracture. Conservative management was found to have an increased relative risk of DVT and PE of 2.02 and 1.15, respectively. This difference persisted on performing inverse probability treatment weighting (IPTW) analysis to account for confounders. PMHVTE and requirement of blood transfusion was associated with an increased odds ratio (OR) of 3.41 and 3.217, respectively. Cases identified as Black and Asian/Pacific Islander also had an increased OR of DVT. ConclusionsThe results of this study demonstrate that surgical management of foot and ankle fractures is associated with a lower relative risk of VTE compared to medical management. PMHVTE and transfusion of red cell products increase the odds of VTE following either form of intervention.

ThP7.13 - A systematic review of the perioperative outcomes of surgical fixation versus conservative approach for severe rib fractures

Abstract Objective The objective of this meta-analysis is to compare the patient outcomes for severe rib fractures being managed by operative or non-operative treatment. Methods Studies reporting patient outcomes in patients undergoing surgical fixation or conservative approach were selected from medical electronic databases and meta-analysis was conducted by following the guidelines of the Cochrane Collaboration using statistical software RevMan version 5. Results Three studies on 258 patients reporting patient outcomes were included. In the random effect model analysis, the total hospital stay [mean difference -1.44, 95%, CI (-2.88, 0.00), Z = 1.96, p = 0.05] was comparable between the two groups with no heterogeneity among included studies. The intensive care stay [mean difference -2.36, 95%, CI (-5.92, 1.21), Z = 1.30, p = 0.20] and mortality [odds ratio 1.08, 95%, CI (0.11, 10.31), Z = 0.07, p = 0.94] was comparable between the two groups but with moderate heterogeneity among included studies. Pneumonia was more common in patients of the non-operative group [odds ratio 0.35, 95%, CI (0.15, 0.82), Z = 2.41, p = 0.02] with no heterogeneity among included studies. Conclusion Pneumonia was more common in patients in the patients managed with the conservative approach. Other patient outcomes were comparable between the two groups. Due to the paucity of data, multiple other crucial variables could not be assessed and a major multi-centre randomised control trial is needed to confirm the findings of this meta-analysis.

Closed reduction followed by percutaneous fixation of acute femoral neck fractures in young adults: a retrospective cohort study

OBJECTIVES: To evaluate the surgical outcomes of femoral neck fractures (FNF) in young adults treated with a closed reduction technique as it pertains to reduction quality, rates of union and risk factors for complication. METHODS: Design: Retrospective cohort study with radiograph and electronic medical record review. Setting: Level 1 Swiss Trauma center. Patient Selection Criteria: Between 2012 and 2021, young adults with isolated FNF (AO/OTA 31-B1) treated with percutaneous screw fixation were selected. Exclusion criteria were open reduction technique, age over 65 or under 16, pathologic fractures, associated femoral head or shaft fractures. Outcome Measures and Comparisons: Primary outcome was quality of reduction, as assessed by three experienced trauma surgeons’ evaluation of, intraoperative and/or first postoperative radiographs using the overall impression, the Garden’s alignment index, and Lowell`s criteria. Additionally, clinical outcomes, conversion to arthroplasty and complications following closed reduction and fixation of femoral neck fractures was reviewed. RESULTS: A total of 54 patients with a median (IQR) age of 57.5 (48-60) years were included. Among them, 22 (41%) were female and 32 (59%) were male. The closed reduction technique demonstrated satisfactory reduction results in up to 87% of cases. Major complications occurred in 19%, with 17% requiring conversion to total hip arthroplasty. Unacceptable or borderline acceptable reduction quality correlated significantly with the need for later conversion (p=0.03). CONCLUSIONS: The study supported the use of the closed reduction technique for acute FNF in patients under 65, achieving satisfactory reduction results in up to 87% of cases with comparable complication rates to treatment of young femoral neck fractures with open reduction. Furthermore, it underscored the significance of the surgeon's overall impression of reduction quality, alongside the established reduction criteria, the Garden alignment index and Lowell’s criteria, in evaluating the quality of the reduction. Additionally, risk of conversion to total hip arthroplasty was associated with worse closed reduction quality. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Related factors of severe osteoporotic vertebral compression fracture and clinical outcomes of percutaneous kyphoplasty: A retrospective study.

Osteoporosis is the most common disease in postmenopausal women and the elderly, which can lead to vertebral compression fracture. To investigate the related factors of severe osteoporotic vertebral compression fracture (SOVCF) and evaluate the long-term outcomes of percutaneous kyphoplasty (PKP) for treating SOVCF through comparison with mild OVCF (MOVCF). From September 2015 to March 2019, 294 osteoporotic vertebral compression fracture (OVCF) patients treated with PKP were analyzed. Compression of the anterior margin of the fractured vertebral body beyond 2/3 of the original height was defined as SOVCF. Baseline data, clinical and imaging findings before and after surgery and at the last follow-up were recorded. Numerical Rating Scale (NRS) was used to evaluate low back pain, the Oswestry Disability Index (ODI) was used to evaluate activity of daily life. Anterior vertebral height (AVH) and local kyphosis angle (LKA) was used to evaluate radiographic outcomes. During the follow-up, patients with recurrent back pain were examined by MRI to identify new fractures and the incidence of adjacent vertebral fracture (AVF) was recorded. Age, sex, body mass index (BMI), dual energy X-ray absorptiometry based T value, duration of symptom, history of trauma, steroid use, and fracture site were collected for univariate logistic regression analysis Variables with a P-value of less than 0.05 were then included in multivariate analysis to determine the related factors for SOVCF. Logistic regression analysis indicated that longer duration of symptom (OR = 1.109, 95%CI: 1.038-1.185, P= 0.002), lower T value (OR = 0.332, 95%CI: 0.139-0.763, P= 0.001), and steroid use (OR = 31.294, 95%CI: 1.020-960.449, P= 0.049) were related factors of SOVCF. Compared with the MOVCF group, the SOVCF group had longer operation time (57.3 ± 13.51 minutes vs 44.9 ± 8.13 minutes, P< 0.001), more radiation exposure (39.9 ± 7.98 times vs 25.5 ± 4.01 times, P< 0.001), and higher cement leakage rate (55.81% vs 18.73%, P< 0.001). At the last follow-up, the SOVCF group had higher NRS (2.28 ± 0.85 vs 1.30 ± 0.71, P< 0.001), and ODI (16.23 ± 4.43 vs 12.88 ± 3.34, P< 0.001). After operation and at the last follow-up, the SOVCF group had higher LKA and lower AVH (all P< 0.05). The AVF rate at the last follow-up was higher in the SOVCF group at the last follow-up (4.78% vs 18.60%, P< 0.001). Lower T value, longer duration of disease, and steroid use were related factors of SOVCF. Compared with MOVCF, PKP for SOVCF had longer operation time, more radiation exposure, and higher cement leakage rate, and the long-term outcomes were worsen.

Intraoperative Acetabular Fractures in Primary Total Hip Arthroplasty Management and Functional Outcomes.

Intraoperative acetabular fracture (IAF) is a non-common complication of primary total hip arthroplasty (THA). Despite the prevalence of intraoperative periprosthetic fractures are increasing, little has been written about this type of fracture. The main objective is to analyze possible risk factors, treatment options and functional outcomes associated with IAF. Between 2006 and 2020, 4 senior arthroplasty surgeons performed 5540 uncemented primary THA. We reviewed our Total Joint Registry and found 18 cases with an IAF. We analyzed demographic factors, medical history, preoperative diagnose, acetabular cups designs, anatomic location of the fracture, treatment, associated complications and functional outcomes. The minimum duration of follow-up was 12 months. The prevalence of an IAF was 0,3%. All the acetabular cups were hemispherical modular. The most frequent acetabular cup associated with an IAF was the CSF Plus (JRI). In two cases the acetabular components were judged to be stable and no additional treatment was done. In the other sixteen patients, various surgical procedures were carried out. Almost 30% of patients that sustained an IAF had some complication during their follow up. Moreover, poor functionality outcomes were obtained (12.1 ± 4.1). in the final follow up accordance to Postel Merle d'Aubingé score. Although IAF is a rare complication of THA, maintaining a high index of suspicion is important as they can be difficult to identify. Still with an adequate early treatment they have poor functionality and high risk of associated complications.

A Prospective Study to Analyse the Functional and Radiological Outcome of Intertrochanteric Femur Fractures Treated with Cemented Bipolar Hemiarthroplasty

A Prospective Study to Analyse the Functional and Radiological Outcome of Intertrochanteric Femur Fractures Treated with Cemented Bipolar Hemiarthroplasty

Surgical outcomes in penile fractures: A single center experience in China

IntroductionPenile fracture is an uncommon urological emergency resulting from tunica albuginea rupture during penile erection. It is a rare condition requiring urgent surgery. Despite immediate surgical repair, the patients' erectile functions may still be impacted by penile fracture. This study aims to investigate the efficacy of surgical repair in penile fractures and its impact on erectile function. MethodsOur cohort was composed of patients diagnosed with penile fractures and received surgical repair from September 2014 to August 2022 in Peking University First Hospital. Penile color Doppler ultrasound confirmed the diagnosis. Surgical exploration was conducted, and postoperative complications were evaluated during follow-up. Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5) score. Univariate analysis was conducted employing the chi-square test, t-test, and Mann-Whitney U test to identify factors that may impact postoperative erectile function. Furthermore, multivariate analysis was conducted using logistic regression and linear regression to determine the independent risk factors influencing postoperative erectile function. ResultsA total of 58 patients were enrolled in our study. The majority of injuries (69.0 %, 40/58) resulted from vigorous sexual intercourse. Most of the patients (69.0 %, 40/58) presented within 24 h. Sixteen patients (27.6 %) presented with concomitant urethral injury. The median size of the tunical tear was 1.5 (IQR, 1.0–2.0) cm. Presentation delay correlated significantly with the difference in IIEF-5 score before and after surgery, with corresponding p values of 0.028. Urethral injury correlated significantly with postoperative erectile dysfunction (ED), postoperative IIEF-5 score, and the difference in IIEF-5 score before and after surgery, with corresponding p values of 0.002, 0.004, and 0.002, respectively. ConclusionsTo conclude, surgical repair of penile fracture provides good functional results with few morbidities and urethral injury may adversely affect postoperative erectile function after penile fracture repair.

Functional Outcomes of Gap Non-Union Humerus Fractures Treated with Fibular Strut Graft, Iliac Crest Graft, and Locking Compression Plate.

The humeral shaft gap non-union treatment surgically after unsuccessful fixation is difficult. In this study, the functional outcome of unsuccessful fixation of humeral shaft gap non-unions using a locking compression plate (LCP), fibular strut graft, and iliac bone graft was evaluated. After taking ethical approval, we studied 10 patients with humeral shaft gap non-unions with unsuccessful surgical fixation treated with open reduction and internal fixation using LCP with fibular strut graft and iliac cancellous bone graft. The study duration was from January 2022-January 2024. The mean time from non-union was 7 months. Disabilities of the arm, shoulder, and hand (DASH) scores improved significantly from a pre-operative average of 59.2 ± 7.3 to a mean final score of 24.6 ± 4.8 reflecting a mean improvement of 34.6 with no complications. This study shows that LCP with fibular strut graft and iliac bone grafts is a good alternative for diaphyseal humerus gap non-union along with statistically significant improvement in functional outcome, with union seen in all cases. This construct augments biomechanical stability and good biological healing in these gap non-unions.

Maximizing Learning in Caring for Older Patients Through a Multi-Specialty Simulation Approach

Background: Simulation-based learning has been utilized in medical education and studied to enhance its educational impact since the 1960s (Hallinger, &amp; Wang, 2020). However, there is a lack of multispecialty simulations in the literature (Fisher, &amp; Walker, 2014; Age UK. 2023; NHS England, 2021; Romero-Ortuno, Stuck, &amp; Masud, 2022; Keijsers, et al., 2016). We developed and delivered simulations on Orthopaedics and Geriatric topics. Simulation mannequins, role players, imaging, and simulated clinical documentation were incorporated into scenarios. We evaluated the effectiveness of this approach on students’ knowledge and confidence when caring for older patients. Methods: Fourth-year medical students at the University of Nottingham received simulation-based teaching during their Geriatrics placement at Queens Medical Centre. Their knowledge and confidence levels were assessed before and after the simulations. We utilized six knowledge-based and six confidence-level questions mapped to their learning outcomes for hip fractures, pressure ulcers, and discharge planning stations. In addition, we asked students to provide scenario-specific feedback and their thoughts on whether the simulation workshop was pitched at the right level. Results: Students’ knowledge and confidence levels improved significantly following the simulation workshop. About 75% of the students displayed enhanced results in the knowledge-based category. In terms of their confidence level, there was improvement seen across all simulation stations, with most learners feeling four times more confident when comparing proportions pre and post-simulation. Furthermore, 99% of the students thought the simulations had positively impacted their learning. Conclusion: Our findings demonstrate the effectiveness of the multispecialty simulation approach in undergraduate geriatrics teaching. Given significant improvements in students’ knowledge, confidence levels, and positive feedback, we aim to continue delivering this multispecialty simulation-based teaching to our students. To measure the long-term efficacy of this approach, we can perhaps re-evaluate students learning after a month to assess the efficacy of this simulation workshop.

Comparison of biodegradable and metallic tension-band fixation for paediatric lateral condyle fracture of the elbow

IntroductionIn our retrospective study we compared the outcomes of paediatric lateral condyle fractures of the elbow fixed by bioabsorbable pins and tension-band sutures or by metallic tension-band with K-wires. Materials and methodsWe reviewed the data of children operated on for lateral condyle fractures between 2010 and 2020. Patients were classified as follows: 1. fractures treated with metallic (KW group), 2. fractures treated with resorbable implants (BR group). We compared the distribution of age, sex and fracture type in each group. Operative times of the two techniques were also recorded and compared. We analysed the X-rays taken one year after the injury and measured the following parameters: presence of possible non-union, varus or valgus deviation, lateral spur formation. Patients whose follow-up period was less than one year were excluded. For categorical data, group comparisons were performed with Chi-square test or Fisher's exact test, depending on the sample size. The evaluation of discrete variables was performed with Mann-Whitney U test. Results42 patients met the above criteria. We found 19 children in the Kirschner -wire + tansion band wire (KW) group and 23 in the Bioresorbable pin + tension band suture (BR) group. There were no significant differences between the study groups in terms of age, sex, left-right ratio, number of complications, operation time, number of Jacobs II and III cases or follow-up time. The operation time was on average 5 min longer in the bioresorbable group (K-wire mean = 62.1 min, Bioresorbable mean = 67 min), this difference, however, is not statistically significant (P = 0.177). In terms of minor and major complications, there was no statistically significant difference between the two groups. (P = 0.729). ConclusionsWe did not notice any difference between the complication rates of the two methods, so the real advantage of the absorbable implant technique is that no second intervention is necessary.The benefits of using biodegradable implants in various osteosynthesis techniques need further confirmation by randomised trials.

Fragment Reattachment For Complicated Crown Root Fracture – A Case Report

Complicated crown-root fractures are challenging dental injuries that involve both enamel and dentin structures and extend into the root. They often necessitate a multifaceted approach to achieve successful reattachment and functional restoration. This case report describes the management and outcomes of a complicated crown-root fracture using a reattachment technique

Computed tomography-derived structural analysis for the likelihood of pathologic fracture in canine antebrachial osteosarcoma.

Determining the risk of pathologic fracture in dogs with a primary bone tumor would aid in case selection for in-situ treatment options. Prior research found strong relationships between in vitro strength of canine antebrachii with primary bone tumors and CT-derived metrics. This study assesses the prognosis for pathologic fracture in dogs with distal radial bone tumors using CT-derived structural analysis metrics. CT images of the antebrachium in dogs with aggressive osseous lesions of the radius were used to calculate structural rigidity and failure forces, including axial rigidity (AR), craniocaudal bending rigidity (BR), torsional rigidity (TR), and failure forces for a slightly-curved/asymmetric beam (Fs) or a curved beam (Fc). Metrics were compared with the clinical outcome of radial fracture. Eight of 19 dogs with CT-derived metrics developed a radial fracture. The prognostic potential of the metrics to discriminate fractured and nonfractured bones was analyzed using receiver operating characteristic curves (area under the curve), stepwise logistic regression, and classification regression (CART) analyses. Fc was the most sensitive and specific metric for prognosing fracture occurrence (AUC=0.864). When dog body weight (BW) was included, all five metrics had AUC>0.705. Fc was the best predictor of fracture using stepwise logistic regression and CART analysis, followed by BR. An indication of fracture probability can be determined by normalizing Fc or BR with dog BW or by using the logistic regression equation of either metric with dog BW. Results warrant further analysis of a larger cohort to evaluate fracture likelihood in dogs with antebrachial bone neoplasia.

Effect of patient age on fifth metatarsal fracture pattern, management, and outcomes

Patients with 5th metatarsal (MT) fractures encompass a broad age distribution. This study evaluated the impact of age on the differences in clinical outcomes and management of these fractures. This was a retrospective cohort study of patients presenting to a single large, urban, academic hospital system with a 5th MT fracture over a 10-year period. Patients were stratified into groups of younger than 65 years old and equal to or greater than 65 years old. Initial and successive radiographs were reviewed, and fractures were categorized as Zone 1, Zone 2, Zone 3, Shaft, Neck, or Head fractures. 2,461 patients with 5th MT fractures were evaluated. Patients who did not follow up after initial evaluation in the emergency department or urgent care were excluded. Among 2,020 patients with mean follow-up of 1.03 years who met inclusion criteria, 76.2% were younger than 65 years and 23.8% were greater than or equal to 65 years. There was a significant difference in fracture type between groups as older patients were more likely to sustain metatarsal neck fractures but less likely to sustain Zone 1 base fractures (p < 0.05). There was no difference in time to clinical healing (p = 0.108) or time to radiographic union (p = 0.367) for all fractures between age groups. In conclusion, older patients sustain different 5th metatarsal fracture patterns compared to younger patients. However, despite the differences in age, there was no evidence for any difference in clinical and radiographic outcomes between groups.

Bone Mineral Density and Clinical Outcome after Ankle Fracture.

No gold standard exists for bone mineral density (BMD) measurement of the ankle. This study aimed to determine the correlation between bone density using Hounsfield units (HU) based on computed tomography (CT) and BMD using dual energy X-ray absorptiometry (DXA) as well as to evaluate the correlation between HU and clinical outcome of ankle fracture. Fifty-one patients aged ≥65 years who underwent surgical treatment for trimalleolus or bimalleolus ankle fractures were included. The HU were measured at the distal tibia metaphyseal region approximately 1 cm proximal to the plafond on the axial images of preoperative CT. BMD was measured using DXA within one year before the injury. The clinical outcome was evaluated according to the Foot and Ankle Outcome Score (FAOS). Although the HU of an osteoporosis group was lower than that of a non-osteoporosis group, we observed no significant difference between the two groups. The mean HU significantly correlated with the lumbar and total lumbar spine BMD using DXA. Increased HU significantly correlated with improved clinical outcomes in three of five FAOS subscales: symptoms, pain, activity of daily living (ADL), and quality of life (QOL). In a linear regression analysis adjusted for age and body mass index, increased HU significantly correlated with improved clinical outcomes in three of five FAOS subscales: symptoms, pain, ADL, and QOL. The correlations between bone density using HU and BMD and those between HU and the clinical outcome were confirmed in ankle fractures. The HU of preoperative CT might provide valuable information for predicting postoperative clinical outcomes.

Clinical and radiological outcome of proximal third tibia fractures treated with intramedullary nailing

Introduction. Extra articular proximal tibia fractures represent about 5-11% of all tibia fractures, and usually exhibit complex fracture patterns with moderate to severe soft tissue damage and deforming forces. No fracture arose more controversy regarding the best method of treatment, common methods of fixation of proximal tibia fractures with intramedullary nailing and minimally invasive plating widely in these fractures. The open reduction or minimally invasive plating of these fractures is widely used plates do not provide axial and varus stability and nail being load sharing device can provide both axial and varus stability, while the nail being a load sharing device can provide both axial and varus stability with minimal soft tissue handling. However, the nailing of extraarticular proximal tibia fractures is associated with malunion. This current study aims to analyse the outcome of proximal third fractures treated with nailing. Material and methods. Thirty consecutive patients with fracture of the proximal third of the tibia shaft underwent nailing and were followed for up to 2 years. The clinical and radiological outcome of these cases and the complications encountered were analysed according to modified Klemm and Borner scoring system. Results. Our study comprised of patients in the age group 19-80 years, average being 40.5 years. Average time of partial weight bearing in the present study was 7.9 weeks (range 6-18 weeks). The average time for full weight bearing was 13 weeks (range 10-24 weeks). The mean time for radiological union was 24.6 weeks (range 20-32 weeks). Fourteen had excellent result, 10 patients had good, 4 patients had fair results and 2 patients had poor results according to Klemm and Borner functional criteria. Conclusions. Intramedullary nailing of proximal third tibia fractures when used with proper reduction technique using reduction clamps, k-wires, poller screws or unicortical plating in semi extended position for nailing is an effective, stable and successful method of treatment for proximal third fractures of tibia.

Treatment of Diaphyseal Tibial Non-unions After Open Fracture: A Retrospective Observational Study on Characteristics and Outcomes

Abstract Purpose Non-union is a significant complication following open diaphyseal tibia fractures. Management can be complex and unpredictable. Several principles must be addressed often in combination to achieve union. The aim of this study is to report on the characteristics, management and eventual outcome of non-united open tibial fractures over a 12-year period from a level I trauma centre. Methods This is a retrospective observational study of all adults (age 18 years and older) presenting to a level 1 trauma centre with a diaphyseal tibia fracture. Non-union was diagnosed using the standard FDA definition of incomplete union by 9 months or no progress to union in the preceding 3 months. Injury and patient demographics in addition to all interventions and complications were recorded for each patient. Results Forty three cases of diaphyseal non-union were identified from 2008 to 2019. Only the presence of peripheral vascular disease demonstrated a statistically significant association with the development of non-union. In 44% of cases, more than one additional operation was required to achieve union. Successful union was achieved in 90% of cases with 74% of patients returning to full pre-injury function without complication. Conclusion Management of non-union is a complex problem which requires a multifaceted and bespoke approach. We have included an algorithm to help guide decision making based on our institutional experience. A satisfactory result is achievable in the majority of patients.

Management of Open Tibia Shaft Fractures in Ghana: A Prospective Longitudinal Study

Objective To evaluate patient and injury characteristics and functional outcomes of open tibial shaft fractures among patients treated at a tertiary hospital in Ghana. Methods We recruited consenting patients with open tibial shaft fractures over a 3-month period and followed-up each participant for at least 2 years. The functional status of each enrolled patient was assessed at 2 years following injury, using Short Form 36. Results Over the 3-month inclusive period of the study, a total of 55 open fractures of the tibia and fibula diaphysis were recorded in 55 patients. Most (52.7%) had Gustillo-Anderson grade III injury. External fixation was the mode of stabilisation (65.5%) At 2 years, 51.9% (28 of 54) had excellent functional outcome. In total, 52.7% of the participants were able to use the affected limb as before the injury, and 92.6% (50 of 54) had returned to their previous work. Conclusion The outcome of open tibial shaft fractures at the study site is good-to-excellent in most (92.6%) patients, with a return-to-previous occupation rate of 92.6%. Gustillo-Anderson grade III injury was the most predominant (52.7%) and sub-type IIIB, the most common among the grade III injuries. External fixation was the most common mode of stabilization of open tibial diaphyseal fractures.

Impact of Teriparatide and Denosumab on Clinical and Radiographic Outcomes in Osteoporotic Vertebral Compression Fractures.

Background and Objectives: Osteoporotic vertebral compression fractures (OVCFs) are prevalent among the elderly, often leading to significant pain, morbidity, and mortality. Effective management of underlying osteoporosis is essential to prevent subsequent fractures. This study aimed to compare the clinical and radiographic outcomes of teriparatide and denosumab treatments in patients with OVCFs to determine their relative effectiveness in improving patient outcomes. Materials and Methods: This retrospective study included 78 patients diagnosed with an acute thoracolumbar OVCF who received either teriparatide (35 patients) or denosumab (43 patients) within three months of a fracture. Clinical outcomes were assessed using the visual analog scale (VAS) for back pain, Oswestry disability index (ODI), and EQ-5D quality of life scores at baseline, 6 months, and 12 months. Bone mineral density (BMD) and radiographic outcomes were evaluated initially and at 12 months post-treatment. Results: Both treatment groups demonstrated significant improvements in VAS, ODI, and EQ-5D scores over 12 months. No significant differences were observed between the teriparatide and denosumab groups in terms of clinical outcomes or radiographic measurements at any time point. Fracture union and BMD improvements were similarly observed in both groups. The teriparatide group had a lower baseline BMD, but this did not affect the overall outcomes. Conclusions: Both teriparatide and denosumab are effective in improving clinical and radiographic outcomes in patients with OVCFs. Despite concerns about denosumab's potential to hinder fracture healing, our study found no significant differences between the two treatments. These findings support the use of denosumab for early treatment of OVCFs to prevent subsequent fractures without compromising fracture healing. Further prospective studies are needed to confirm these results.