Periosteal Stripping Research Articles

Periosteal Stripping and Periosteal Division for Leg Length Discrepancy After Proximal Femoral Intertrochanteric Osteotomy for Perthes Disease.

Background and objective Periosteal stripping and periosteal division (PSPD) can help promotethe growth of the long bone in children with leg length discrepancy (LLD). We performed PSPD in a cohort of patients when LLD was observed at the time of implant removal surgery after proximal femoral osteotomy for Perthes disease. This study aimed to clarify the efficacy and safety of PSPD for acquired LLD related to Perthes disease. Methods This retrospective study enrolled 10 patients treated with PSPD and six controls who declinedPSPD for LLD associated with Perthes disease. The lengths of the femur, tibia, and entire leg were measured in the full-length standing radiographs at baseline and final follow-up. The baseline was defined as the time of the last preoperative observation. LLD and changes in LLD (ΔLLD) were measured. The correlation of ΔLLD with age at the time of surgery, follow-up period, and extent of PSPD was investigated. Results In the PSPD group, the mean age of the patients was9.4 years and the mean LLD at baseline was 20.5 ± 4.6 mm, while it was 10.2 years and 11.5 ± 10.0 mm in the control group. With a mean follow-up period of 4.3 years, the PSPD group showed a mean ΔLLD decrease of 13.9 mm, which was significantly greater than that of the control group at 3.2 mm with a mean follow-up period of 5.4 years. Logistic regression analysis revealed that age at the time of surgery was a significant factor for obtaining >10 mm ΔLLD with PSPD and the cutoff value by the receiver operating characteristic curve was 9.6 years (sensitivity: 0.83; specificity: 0.83). Conclusions PSPD seems to be a safe and effective surgical option for LLD associated with Perthes disease. The age at the time of surgery negatively correlated with the amount of LLD correction. Obtaining >10 mm LLD correction is more likely if the patients are <10 years of age.

The Role of Early Mobilization in Outcome of Proximal Tibia Fractures Treated with Dual Plating

The management of bicondylar fracture of the proximal tibia is a challenging task and the aim of management is to achieve stable, painless and mobile joint and also to prevent the secondary degeneration of the joint. Open reduction and internal fixation with dual plating in such fractures is beneficial to address fracture fragments in different planes and also to achieve anatomical reduction under direct vision. It also allows stabilizing the fracture which helps in early mobilization of the patient. Early post-op rehabilitation is one the most important factor that play a vital role in outcome of the operated knees by preventing the post- operative stiffness and achieving good range of motion. This is a retrospective study conducted in Department of Orthopedic Surgery, Kurmitola General Hospital, Dhaka, Bangladesh from July to December 2022. Total 100 patients were included in the study. The functional outcome was evaluated according to Rasmussen scoring system. Mal-reduction of the articular surface was defined as an intra- articular step-off of at least 2 mm measured on scaled radiographs. Oldest patient was 71 years and youngest patient was 20 years old. Male were 79% and female were 21%. All the patients with bicondylar fracture treated with dual plating. Data was obtained from the Medical record department, indoor ward records, OPD registers and Operation theatre records. This study analyses the outcome of bicondylar proximal tibia fracture treated with dual plating in 100 patients. In our series we found 63 % excellent results and 28 % good results, while 7 % and 2% fair and poor outcome respectively. Fractures of proximal tibia are increasing with the increase in mechanization and increased road traffic in current world today. These fractures are more in men and those who use automobiles frequently for their outdoor ventures. Better preoperative planning in selection of approach can minimize the soft tissue injury and unnecessary periosteal stripping. ......

Effectiveness of Mechanical Treatments (Periosteal Stripping VS Non-Periosteal Stripping) on Fracture Healing: In Vivo Study

Background: Periosteal stripping (PS) is a controversial technique in fracture management, with studies reporting both positive and negative effects on bone healing. This study aims to evaluate the effectiveness of PS and non-periosteal stripping (NPS) on fracture healing in the Sprague Dawley rat model. Methods: This study is an in vivo experimental research. Male Sprague Dawley rats (8-10 weeks old) were divided into four groups (n=10 per group): Group I: NPS, evaluation day 14; Group II: PS, evaluation day 14; Group III: NPS, evaluation day 28 and Group IV: PS, evaluation day 28. A standard fracture was created in the tibia, and PS or NPS was performed. Radiographic evaluation was performed on days 14 and 28, with the RUST score (Radiographic Union Score for Tibia) used to assess fracture healing. Statistical analysis was performed using the Kruskal-Wallis test. Results: The RUST score showed better fracture healing in the NPS group compared to PS on day 28 (p&lt;0.05). There was no significant difference on day 14 (p&gt;0.05). Conclusion: NPS was more effective in accelerating fracture healing in Sprague Dawley rats than PS, especially in the later stages of healing. These findings provide further evidence of the potential adverse effects of PS and highlight the importance of considering time in assessing its efficacy.

Recent Advances in the Surgical Management of Radiation-Induced Fractures following Soft Tissue Sarcomas.

Background: Post-radiation fractures are a significant complication of cancer treatment, often being challenging to manage and impacting patients' quality of life. This study systematically reviews the literature on fractures in irradiated bones, focusing on risk factors, treatment modalities, and prevention strategies. Factors increasing fracture risk include exposure to high doses of radiation of at least 50 Gy, female gender, menopausal age, and periosteal stripping. Additionally further risk factors are the size of the original tumor and osteoporosis. Methods: A search of PubMed yielded 541 articles, with 4 were ultimately included in the review. These retrospective studies focused on patients undergoing Combined Limb-Sparing Surgery and Radiation Therapy for soft tissue sarcoma. Results: Results show post-radiation fractures affect approximately 4% of patients, with the femur being the most frequently affected site. Intramedullary nailing emerges as the gold standard treatment, with prosthetic replacement or megaprostheses used in the metaepiphyseal region and as salvage procedures. Non-union and infection remain formidable complications. Conclusions: This study highlights the importance of prophylactic nailing in fracture prevention and the efficacy of free vascularized fibular flaps to achieve bone union during revision surgeries. Limited case availability and patient follow-up hinder comprehensive studies, impacting treatment outcomes.

Surgical reconstruction of medial eyelid defects using margin transposition, tarsal graft, and periosteal strip

ABSTRACT Purpose Surgical reconstruction of medially located lower eyelid defects can be challenging. The Hughes procedure, considered the standard for reconstruction in such cases, often falls short in terms of cosmetic outcomes. An alternative approach that combines medial transposition with a tarsal graft and periosteal strip has shown promise. Here, we aim to demonstrate the cosmetic advantages of medial transposition of a preserved temporal lower eyelid over other techniques. Method We conducted a retrospective study involving seven well-documented patients who underwent the procedure described below. The study was approved by the University’s Ethics Committee. Results All patients were followed up for one year. Lower eyelid defects spanned 50–80% of their total length, situated in the central third of the eyelid or the central to medial portion. Postoperative complications were minimal, with all patients exhibiting good cosmetic, functional, and anatomical outcomes at follow-up. Conclusion The absence of eyelashes is well tolerated if it is lateral, but when the defect is medial, medial transposition could be a good alternative to the familiar Hughes surgical intervention.

Functional Outcomes in Orthopaedic Open Wounds Treated With Vacuum-Assisted Closure Therapy: A Prospective Case Series.

Open fractures with extensive soft-tissue damage, significant periosteal stripping, and exposed bone ends pose a significant challenge in orthopaedics. So, we conducted a prospective study that investigated the efficacy of vacuum-assisted closure (VAC) therapy in improving functional outcomes for orthopaedic open wounds. A prospective case series was conducted for a period of 18 months at the department of orthopaedics. Seventeen patients with open wounds were included in the study after fulfilling specific criteria. The study involved 17 patients with open wounds, where VAC therapy was applied within 24 hours of admission for 14 patients, and for three patients with superficial infection, thorough wound debridement preceded VAC dressing. Follow-up with patients continued until definitive skin cover procedures were performed. The majority of cases were attributed to open compound fractures caused by road traffic accidents (82.35%), followed by train traffic accidents (11.76%) and accidental falls (5.88%). The leg (47%) was the most common location of injury, followed by the forearm (23.52%). The average treatment duration was 10.5 days, with an average of 3.3 dressing changes, indicating the efficacy and feasibility of VAC therapy in clinical practice. The average wound size reduction at completion was 15mm, and 15 out of 17 patients achieved successful wound healing. The average time required for forming a uniform granulation bed was 10.5 days, highlighting the efficiency of VAC therapy in promoting tissue regeneration. Our study findings revealed that there is a significant reduction in the rate of wound infection with the application of VAC therapy, along with a shorter duration for the formation of healthy granulation tissue, rendering the wound suitable for definitive skin cover procedures such as split skin graft and flap cover at an accelerated rate. Additionally, technical challenges associated with applying VAC dressing in the presence of an external fixator were successfully managed through realignment strategies, further underscoring the adaptability and efficacy of VAC therapy in addressing complex wound scenarios.

Intramedullary Nailing of Forearm Fractures.

The primary goal in operative fixation of forearm fractures is to restore length, rotational stability, and maintenance of the radial bow. Plate osteosynthesis is well regarded as the gold standard of treatment though often necessitates soft tissue injury, periosteal stripping, and risk of refracture after hardware removal. While intramedullary nails have been utilized for forearm fixation since the early 1900s, technological advancements including locked intramedullary nails have lead to improved outcomes in intramedullary nail forearm fixation. In select patients, intramedullary nail fixation is an appropriate treatment option. For example, patients with mangled extremities, comminuted or segmental fractures, or soft tissue injury may benefit from this approach as it allows for smaller incisions and limits further soft tissue compromise.

Successful four flap reconstruction for extensive crush injuries of bilateral lower limbs using local pedicled flaps in a 73-year-old patient: a rare case report

Extensive soft tissue defects with periosteal stripping over critical areas of tibia pose a tough challenge to the reconstructive plastic surgeon. Treatment of choice for these defects is free tissue transfer. Local pedicled fasciocutaneous or muscle flaps are used only when the free tissue transfer is not possible. The gastrocnemius and soleus flaps either used as a combined flap or as individual separate flaps can be an alternate reconstructive option for these defects in selected cases. Here we report a 73-year-old male patient a case of extensive crush injury involving both lower limbs following a motor vehicle accident (MVA) in whom we have successfully reconstructed the extensive soft tissue defects with exposed tibia with four local pedicled flaps. The purpose of writing this case report is that when free tissue transfer is not possible in such extensive crush injuries, a durable functionally and cosmetically acceptable reconstruction with pedicled hemi gastrocnemius and medial hemisoleus flaps can be done after a meticulous planning and flap design without any significant functional donor site morbidity.

Symptomatic Heterotopic Bone Formation after 1,2 ICSRA in Scaphoid Nonunions.

Background We observed several cases of heterotopic bone formation after a 1,2 intercompartmental supraretinacular artery (1,2 ICSRA) distal radius vascularized bone graft (VBG) for the treatment of scaphoid nonunion. This adverse event seems underreported. Knowledge about factors associated with the formation of heterotopic bone after VBGs might help reduce this adverse event. Purpose What factors are associated with resected heterotopic bone formation after 1,2 ICSRA distal radius graft for the treatment of scaphoid nonunion? Patients and Methods We retrospectively reviewed all patients with a scaphoid nonunion treated with a 1,2 ICSRA distal radius graft between 2008 and 2019 in an urban level 1 trauma center in the Netherlands. We included 42 scaphoid nonunions in 41 people treated with the 1,2 ICSRA graft. We assessed potential correlation with patient, fracture, and treatment demographics. Results Heterotopic bone developed in 23 VBGs (55% [23/42]), of which 5 (12% [5/42]) were resected. Heterotopic bone was located radially (at the pedicle side) in all participants. Except a longer follow-up time ( p = 0.028), we found no variables associated with the development of heterotopic bone formation. Conclusion The location of the heterotopic bone at the pedicle site in all cases suggests a potential association with the periosteal strip. Surgeons might consider not to oversize the periosteal strip as a potential method to prevent heterotopic ossification after VBG. Level of Evidence Level II, prognostic study.

A NOVEL TECHNIQUE FOR MANAGEMENT OF A CRITICALLY-SIZED BONE DEFECT IN THE OPEN PROXIMAL TIBIAL FRACTURE: EMPLOYING THE CAPANNA TECHNIQUE IN TRAUMA

A NOVEL TECHNIQUE FOR MANAGEMENT OF A CRITICALLY-SIZED BONE DEFECT IN THE OPEN PROXIMAL TIBIAL FRACTURE: EMPLOYING THE CAPANNA TECHNIQUE IN TRAUMA

Conservative Management with Functional Brace Versus Various Surgical Fixation Techniques for Humeral Shaft Fractures: A Network Meta-Analysis.

Historically, humeral shaft fractures have been successfully treated with nonoperative management and functional bracing; however, various surgical options are also available. In the present study, we compared the outcomes of nonoperative versus operative interventions for the treatment of extra-articular humeral shaft fractures. This study was a network meta-analysis of prospective randomized controlled trials (RCTs) in which functional bracing was compared with surgical techniques (including open reduction and internal fixation [ORIF], minimally invasive plate osteosynthesis [MIPO], and intramedullary nailing in both antegrade [aIMN] and retrograde [rIMN] directions) for the treatment of humeral shaft fractures. The outcomes that were assessed included time to union and the rates of nonunion, malunion, delayed union, secondary surgical intervention, iatrogenic radial nerve palsy, and infection. Mean differences and log odds ratios (ORs) were used to analyze continuous and categorical data, respectively. Twenty-one RCTs evaluating the outcomes for 1,203 patients who had been treated with functional bracing (n = 190), ORIF (n = 479), MIPO (n = 177), aIMN (n = 312), or rIMN (n = 45) were included. Functional bracing yielded significantly higher odds of nonunion and significantly longer time to union than ORIF, MIPO, and aIMN (p < 0.05). Comparison of surgical fixation techniques demonstrated significantly faster time to union with MIPO than with ORIF (p = 0.043). Significantly higher odds of malunion were observed with functional bracing than with ORIF (p = 0.047). Significantly higher odds of delayed union were observed with aIMN than with ORIF (p = 0.036). Significantly higher odds of secondary surgical intervention were observed with functional bracing than with ORIF (p = 0.001), MIPO (p = 0.007), and aIMN (p = 0.004). However, ORIF was associated with significantly higher odds of iatrogenic radial nerve injury and superficial infection than both functional bracing and MIPO (p < 0.05). Compared with functional bracing, most operative interventions demonstrated lower rates of reoperation. MIPO demonstrated significantly faster time to union while limiting periosteal stripping, whereas ORIF was associated with significantly higher rates of radial nerve palsy. Nonoperative management with functional bracing demonstrated higher nonunion rates than most surgical techniques, often requiring conversion to surgical fixation. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Incidence and Risk Factors for Extremity Osteoradionecrosis after Limb-Sparing Surgery and Adjuvant Radiotherapy

Osteoradionecrosis (ORN) is a major complication after radiotherapy. Most studies on ORN have focused on patients with mandibular lesions, with few studies including patients with extremity soft tissue sarcoma (STS). We included 198 patients with extremity STS who underwent limb-sparing surgery and adjuvant radiotherapy between 2004 and 2017. The incidence rate of extremity ORN was 3.5% (7/198), with most lesions (6/7) located in the lower extremities. The mean follow-up time was 62 months. Clinical presentations included chronic ulcers, soft tissue necrosis, sinus discharge, bone nonunion, and pathological fractures. Compared with the non-ORN group, the ORN group had a significantly higher total radiation dose (68 Gy vs. 64 Gy, p = 0.048) and greater use of intraoperative periosteal stripping (p = 0.008). Repeat surgeries and subsequent soft tissue reconstruction or limb amputation were performed as treatments. The risk and management of ORN in patients with extremity STS was ignored previously. Because the disease is complex and affects both clinicians and patients, careful surveillance should be undertaken.

Length Unstable Pediatric Tibial Shaft Fracture Treated With Cerclage Augmented Elastic Intramedullary Nails: A Novel Technique

Introduction: Tibial shaft fractures are common injuries in the pediatric population that can reliably be treated with conservative treatment. However, unstable tibial shaft fractures in the pediatric population have limited operative treatment options because the skeletal immaturity of these patients makes rigid intramedullary devices contraindicated in this population, and external fixation strategies are associated with a high complication rates. Elastic nailing with cerclage is a minimally invasive, and relatively soft tissue sparing technique that can decrease wide dissection and periosteal stripping associated with plating. However, treating long oblique length unstable femur fractures with elastic nails has been shown yield good result; EIN in length unstable tibia shaft fractures with elastic nails has not been explored. Materials and Methods: Review of 2 patients receiving novel cerclage augmented elastic nailing technique. Results: Patients included had complete follow-up to fracture union, had no surgical complications postoperatively, and no failure of fixation. Patients achieved full range of motion and strength compared with the contralateral uninjured limb. Both patients returned to preinjury activity levels with no limitations. Discussion: We present a novel technique using elastic nails in unstable long oblique tibia fractures with a cerclage augment. This can expand EIN indications to provide a load-sharing construct with relative stability to length unstable tibia fractures that EIN use would typically be contraindicated. This in turn affords the benefits of EIN such as reliable fracture healing, excellent functional and cosmetic results with a safe and reproducible surgical technique.

STUDY OF FUNCTIONALAND RADIOLOGICAL OUTCOME OF ILIZAROV FIXATION IN MANAGEMENT OF GAP NON UNION OF LONG BONES

Due to increasing motor vehicular accidents, there is high incidence of compound fractures of long bones particularly Gustillo type 3a or 3b with extensive soft tissue damage and periosteal stripping. These type of injuries have decreased vascularity of the tissues around the fracture site and increased probability of complications. In these injuries Ilizarov xator provides single step denitive xation method that deals with gap nonunion and bone infection simultaneously. This study aims to assess functional and radiological outcome using ASAMI criteria of Ilizarov xation in gap nonunion of long bones. a total of 30 patients were included in the study suffering from gap nonunion which fullled inclusion and exclusion criteria. Patients underwent Ilizarov xation and were followed up for a period of minimum 6 months and assessed using ASAMI functional and radiological criteria. radiological results: 12 patients (40%) had excellent, 15 patients (50%) had good, 2 patients (6%) had fair and 1 (4%) had poor results. Union was achieved in all 30 patients. Functional results: 09 patients (30%) had excellent, 18 patients (60%) had good and 2 patients (6%) had fair results and 1 (4%) patients had poor results: Ilizarov ring xation is a versatile approach for patients with gap nonunion as it provides excellent results and aid in early weight bearing, decreased dependency, and increased quality of living.

The multi-ligament ankle fracture: Epidemiology, key anatomical findings and fixation strategies in unstable open injuries

BackgroundAnkle fracture surgery has traditionally focussed on restoration of bony anatomy, with fixation of the malleoli and syndesmotic stabilisation where applicable. However, high energy open fracture-dislocations can also result in periosteal stripping of the stabilising capsuloligamentous attachments. As such, restoration of osseous anatomy alone may not result in sufficient articular stability. ObjectivesIn this series from a level 1 trauma centre, we report a subset of highly unstable open ankle fractures with combined capsuloligamentous injuries, in which restoration of osseous anatomy did not result in a stable joint. Supplementary soft tissue reconstruction and other stabilisation techniques were required. MethodsRetrospective case series of eligible patients from a level 1 trauma centre. Inclusion criteria were open ankle fractures with tibial extrusion (AO 44) and persistent instability post-bony fixation, age over 18 years and non-diabetic. Analysis of injury pattern, mechanism, pathological anatomy, soft tissue and orthopaedic reconstruction methods was performed. Results16 patients were identified during the study period who met the eligibility criteria, out of 95 open ankle fractures treated between January 2017–December 2020. Most patients were under 65 (n = 13; 81.3%) and sustained combined or isolated injuries of the deltoid ligament, anterior capsule, lateral ligament complex (ATFL±CFL) and tibialis posterior retinaculum. The commonest injury pattern was tibial extrusion via a medial soft tissue defect with deltoid ligament and anteromedial capsule rupture. Associated syndesmotic instability and fixation was common (n = 10; 62.5%). Supplementary stabilisation methods to standard bony fixation included capsuloligamentous reconstruction or repair, “ORIF+” external fixation, or conversion to primary fusion or hindfoot nail. Six patients required either local or free flap soft tissue coverage. ConclusionsA subset of up to 20% of open ankle fractures require supplementary fixation beyond anatomical restoration of the bony anatomy due to persistent ligamentous instability. They are associated with capsuloligamentous and syndesmotic disruption, more commonly affecting the medial structures. These rare injuries can be defined as multi-ligament ankle fractures. Surgeons should be aware of this subset and be able to recognise where supplementary stabilisation strategies are required.

Isolated, periosteal stripping injuries of the Flexor Retinaculum: Case series of 3 patients with clinico-radiological review

Isolated periosteal avulsion injuries of the flexor retinaculum on the medial side of the ankle are rare and may mimic osseous injuries or deltoid ligament tears. We describe a case series of 3 individuals with isolated, stripping injuries of the tibial attachment of the flexor retinaculum without underlying fracture or deltoid ligament disruption. A new classification system of flexor retinaculum periosteal stripping injuries of the ankle is proposed with clinico-radiological features.

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

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

FUNCTIONAL OUTCOME OF DISPLACED CLAVICLE FRACTURE TREATED BY INTRAMEDULLARY NAILING: A PROSPECTIVE STUDY

Background:Clavicle fracture is one of the most common injury.Despite the high incidence, the choice of proper treatment is still controversial. This prospective study was done to evaluate functional outcome of displaced clavicle fracture treated by intramedullary nailing. Material and methods:The study was conducted on 30 patients(25 males and 5 females) with displaced/comminuted clavicle fracture treated by either elastic intramedullary nails or elastic intramedullary nails with endcap.Followupexamination for functional and radiological evaluationwas done at 1 month,3 months and 6 months. Results: Mean duration of clinical union in comminuted and transverse/oblique fracture was 6.41 weeks and 6.89 weeks respectively while the mean duration of radiological union in comminuted and transverse/oblique fracture was 8 weeks and 8.5 weeks respectively.In co-relation between functional outcome and fracture pattern we obtained P-value 0.418,0.842 and 0.453 for Constant shoulder,DASH and VAS scores respectively which was statically not significant that means there was no relation between fracture pattern and functional outcome. Conclusion:- The intramedullary fixation of displaced clavicle fracture is a safe minimally invasive technique. The intramedullary nailing holds advantages of high union rate, minimal periosteal stripping and soft tissue damage, minimal blood loss and relatively less complications. This technique provides faster return to daily and professional activities with excellent functional results. Implant removal is easier and can be done as day care procedure under local anesthesia.

Functional outcome of minimally invasive plate osteosynthesis using anatomical locking compression plate for distal tibia fractures: A prospective study

Background: Distal tibia fracture is a therapeutic challenge in modern orthopaedics. Due to fracture pattern, periarticular location, minimal soft tissue coverage, the surgical treatment is complex one. Various modality of surgical treatment such as closed intramedullary nailing, The newer technique of fixation of distal tibia fractures - minimally invasive percutaneous plate osteosynthesis involves less soft tissue handling and the minimal periosteal stripping resulting in low infection rate and faster healing.Materials and Methods: The prospective study was done at a tertiary care centre on 18 patients from June 2017 to June 2019. The functional outcome is evaluated by clinical and radiological (AP/LATERAL) aspects at 6th, 12th weeks, 3rd, 6th months and one year interval using Olerud-Molander Ankle Questionnaire/ Score (OMAS).Results: The results were excellent in 54%, good in 29% and fair in 17% of patients. The post-operative pain was minimal and the post-operative ankle function was very good.Conclusion: Minimally invasive plate osteosynthesis using LCP proves to be a safer technique in the management of distal tibial fractures without intra-articular comminution by providing good fracture healing, enabling rapid functional recovery and avoiding major skin complications.

Reconstruction of Half of the Forehead Traumatic Defect with Single Rotation Flap and Hemi-Brow Transposition in a Resource Constrained Setting: A Case Report

Forehead reconstruction is very challenging due to limited availability of matching skin for coverage. This is even more challenging in acute traumatic events characterized by gross contamination, presence of open wounds and injury to surrounding tissues. The use of loco-regional flap option may be the only available resort where facility and expertise for free flaps are not adequate. We present a 50 year old lady that had traumatic avulsion of slightly over half of the forehead with an extension wound to the ipsi-lateral temporal region following road traffic accident. There were crushing of ipsi-lateral eye and periosteal stripping of the underlying bone. She had an immediate flap cover after resuscitation using a single rotation scalp flap based on the ipsi-lateral occipital, posterior auricular and superficial temporal arteries. The adjoining temporal region wound was covered with split-thickness skin graft. She had excellent flap survival and satisfactory graft take. We observed that this flap could be successfully used in the setting of trauma to transfer a like for skin in the setting of trauma. This is especially useful in resource constrained setting where free tissue transfer is still insufficiently used. Keywords: Periosteal stripping, Rotational scalp flap reconstruction, Traumatic forehead avulsion