Pin Track Infection Research Articles

The results of femoral lengthening using domestic unilateral external fixation and then plating: the first case series in Vietnam.

This study aimed to assess the results of femoral lengthening using an external fixator and then plating. This prospective case series study enrolled 11 patients who underwent femoral lengthening and then plating (LATP) between January 2019 and April 2023. The average age of patients was 14.45 ± 7.54 years. One patient with a femur was lengthened and plated, and one tibia was lengthened over a nail simultaneously. The average femoral lengthening was 8.41 ± 1.35cm. The femoral healing result was excellent in seven femurs and good in four femurs; the functional outcome was excellent in five patients and good in six patients. Pin-track infection occurred in all patients. A limited range of motion of knee flexion occurred in eight patients. Femoral varus and procurvatum deviation occurred during distraction in four and two patients. Femoral LATP was considered an attractive alternative to intramedullary lengthening nails in a low-income country. Our research suggests that femoral LATP was an effective method. However, the most common complications were pin-site infection and extensive knee contracture. Further research should be done with a larger sample size and longer follow-up time. Level IV-prospective observational case series study.

External Fixation as a Primary and Definitive Treatment for Complex Tibial Diaphyseal Fractures: An Underutilized and Efficacious Approach.

External fixation is one of the most often utilized treatment options for complicated tibial diaphyseal fractures (TDF). The purpose of this study was to assess the efficacy of unilateral external fixators as primary and definitive therapy for complex TDF in a resource-limited setting. A retrospective study between June 2016 and March 2021 included 110 subjects with TDF who were treated with an external fixator as definitive fixation in hospitals affiliated with Ibb University. The patient's demographic characteristics, complications, and outcomes were gathered and analyzed. Factors associated with pin site infection were also investigated. The mean age was 42.1 ± 10.1 years, with 92.7% being male. Rural residents accounted for 22.7%. Smoking and diabetes mellitus were present in 27.3% and 30.0%, respectively. General complications occurred in 12.0%, with pulmonary embolism being the most common at 4.5%. Orthopedic complications included pin-track infections in 27.3% (30) and osteomyelitis in 1.8% (2). Pin site infections required medical treatment in 21 cases and external fixator changes in five. Two cases each needed several debridements for osteomyelitis and soft tissue. Full union occurred in 79.1% (87) over 23.1 ± 3.2 weeks and final alignment in 97.3% (107) over 34.8 ± 4.8 weeks. Malunions occurred in 1.8% (2), and one case had hypertrophic nonunion. Factors like rural residency, smoking, diabetes, open fractures, worst fracture grade (Gustilo and Anderson type C), and general complications occurrence significantly correlated with pin site infection (all p-values < 0.05). A unilateral external fixator as a primary and definitive treatment is a viable, simple, and effective option for TDF with a high success rate even in a resource-limited setting. In this study, residents in rural areas, smoking, diabetes, open fracture, worst fracture grade, and general complication occurrence were associated with pin site infection occurrence.

Modified French Osteotomy for Cubitus Varus Correction: Our Experience

Background: Various fixation techniques have been described for osteotomy for correction of cubitus varus. Kirschner-wiring (K-wiring) was used in the past for fixation; however, rates of fixation failure and pin-track infection were high. Fixation with two screws and a figure-of-eight wiring provides a stable fixation in children younger than 15 years. Herein, we used a modified lateral approach and a figure-of-eight construct with two screws and evaluated the outcome.&#x0D; Methods: A case series comprising 35 patients out of the total of 54 patients who underwent modified French osteotomy between January 2013 to December 2021 was conducted retrospectively. Functional outcomes were assessed using the modified Mayo Elbow Performance Scoring (MEPS) system.&#x0D; Results: There were 22 male and 13 female subjects in the study group. We had excellent results in 16 cases, good outcomes in 13 cases, and fair outcomes in 6 cases. Superficial infection was seen in three patients and four patients had occasional negligible pain. In addition, there was no loss of correction or fixation failures in our study.&#x0D; Conclusion: Modified French osteotomy using two screws and figure-of-eight wiring is a simple and safe procedure that yields satisfactory outcomes. A careful preoperative planning, sufficient surgical technique, and stable fixation are key to achieving satisfactory functional outcomes.

Reconstruction of Intercalary Bone Defects After Tumour Resection with the Use of a Free Vascularised Fibular Graft: the Concealed Advantages of the External Fixator.

The free vascularised fibular graft represents the mainstay of intercalary bone defect reconstruction after tumour resection. Different reconstruction techniques are described, favouring internal fixation and possibly overlooking potential advantages of external fixation. This series is a description of the technique performed at our institution using an external fixator for the reconstruction of segmental bone defects which enables to maintain limb length and rotational alignment after large segmental bone resection. Data collected were demographic, surgical and histological data, perioperative complications and postoperative data. Eighteen different complications were encountered in seven patients. Mean reoperation rate was 1.3 per patient but no patient required further interventions in order to correct limb length or rotational alignment. Pin-track infection rate was 6%. The limb salvage rate was 100%. Solid final bone healing was obtained in all patients. External fixation for the reconstruction of intercalary bone defects after tumour resection is a safe technique which might offer the advantage of limb length and alignment preservation.

Early complications of percutaneous K-wire fixation in pediatric distal radius fractures—a prospective cohort study

IntroductionDistal radius fractures (DRF) are the most common pediatric fractures, but the current evidence for management remains inconclusive. Closed reduction and percutaneous pinning (CRPP) provide excellent stability but are not complications-free. Therefore, a thorough evaluation of their adverse events is necessary to provide reliable information on risks and benefits in different clinical scenarios. The current literature lacks studies conducted with rigorous grading systems and uniform follow-up protocols on this topic. This prospective cohort study used a validated grading scheme to analyze complications associated with CRPP in an unselected pediatric population with displaced, unstable distal third radius fractures.Materials and methodsOne hundred and nineteen DRFs (one hundred and sixteen patients) treated with CRPP were enrolled in the study. All patients were followed 4 weeks, 5 weeks, 3 months, and 6 months after the surgery. The same protocol, comprising structured history, physical and radiological assessment, was used throughout the study. All data were prospectively abstracted. The Clavien–Dindo–Sink grading system was used to assess the complications and the Dahl score to evaluate the pin sites.ResultsForty-two wrists (35,3%) had CDS grade I or II complications, and two (1,7%) had a grade III complication. The general complication rate for the study group was 37% (44 complications). Two patients required repeated surgery—deep bone pin-track infection treated with the Masquelet technique and surgical removal of a migrated pin. Among minor complications, pin-site inflammations were the most common—40 wrists (33,6%).ConclusionsThe CRPP is a safe treatment method for DRF in pediatric patients, with a low major complication rate. However, minor adverse events are frequent and can significantly burden the patient’s postoperative well-being. The application of rigorous definitions and grading systems should not only lead to the obtainment of high-quality data but also to higher awareness of possible pin tract infections and therefore allow for better therapeutic decisions.

External fixation versus intramedullary nailing for the management of open tibial fracture: meta-analysis of randomized controlled trials.

Tibial shaft fractures are the most common type of long-bone fractures. External fixation (EF) and intramedullary nailing (IMN) are widely used surgical techniques for the definitive fixation of open tibial shaft fractures. The aim of this systematic review and meta-analysis was to compare EF to IMN for the definitive fixation of open tibial fractures. Medline, Embase, and CENTRAL databases were searched for eligible studies. We included randomized controlled trials (RCTs) that compared EF to IMN for skeletally mature adults with open tibial fracture (Gustilo I, II, and III). We evaluated the following outcomes: superficial infection, pin-track infection, deep infection, malunion, nonunion, delayed union, and implant/hardware failure. The risk ratio (RR) was used to represent the desired outcomes. The statistical analysis was performed using the random-effects model. A total of 12 RCTs that enrolled 1090 participants were deemed eligible for the analysis. EF showed a significantly higher rate of superficial infection, pin track infection, and malunion compared to IMN (RR = 2.30, 95% confidence interval (CI): 1.34 to 3.95; RR = 13.52, 95% CI: 6.16 to 29.66; RR = 2.29, 95% CI 1.41 to 3.73, respectively). No substantial difference was found between EF and IMN in terms of deep infection, nonunion, delayed union, or implant/hardware failure (RR = 1.15, 95% CI 0.67 to 1.98; RR = 0.92, 95% CI 0.77 to 1.10; RR = 1.50, 95% CI 0.98 to 3.33; RR = 0.96, 95% CI 0.36 to 2.60, respectively). The findings of our meta-analysis are consistent with the previous systematic reviews excepts for the implant/hardware failure which was found to be significant in favour of IMN by one of the previous reviews. This meta-analysis confirms that IMN is better than EF with respect to clinical outcomes and complication rate for the definitive fixation of open tibial fracture.

Intramedullary fixation of metacarpal and phalangeal bone fractures with bioabsorbable Mg K-wire in 20 cases.

The treatment of irreducible or severely displaced metacarpal and phalangeal bone fractures is still much debated. The recent development of the bioabsorbable magnesium K-wire is thought to allow effective treatment upon insertion via intramedullary fixation by minimizing articular cartilage injuries without discomfort until pin removal and drawbacks, such as pin track infection and metal plate removal. Therefore, this study investigated and reported the effects of intramedullary fixation with the bioabsorbable magnesium K-wire in unstable metacarpal and phalangeal bone fractures. This study included 19 patients admitted to our clinic for metacarpal or phalangeal bone fractures from May 2019 to July 2021. As a result, 20 cases were examined among these 19 patients. Bone union was observed in all 20 cases, with a mean bone union time of 10.5 (SD 3.4) weeks. Reduction loss was observed in six cases, all showing dorsal angulation with a mean angle of 6.6° (SD 3.5°) at 4.6weeks as compared with that noted in the unaffected side. The gas cavity upon H2 gas formation was first observed approximately 2weeks postoperatively. The mean DASH score was 33.5 for instrumental activity and 9.5 for work/task performance. No patient complained of notable discomfort after surgery. Intramedullary fixation with the bioabsorbable magnesium K-wire may be used for unstable metacarpal and phalanx bone fractures. This wire is expected to be a particularly favorable indication for shaft fractures, although care should be taken due to the possibility of complications related to rigidity and deformity.

Hydroxyapatite-coated compared with stainless steel external fixation pins did not show impact in the rate of pin track infection: a multicenter prospective study.

Infection at the pin site remains the most common complication of external fixators (EFs). It is known that hydroxyapatite (HA)-coated pins increase bone adhesion and may lead to reduced rates of reported infections. The present study compares the rates of pin track infection associated with stainless steel and HA-coated pins. This is a prospective, multicenter, nonrandomized, comparative intervention study among patients undergoing surgical treatment with EFs of any type between April 2018 and October 2021. Patients were followed up until the removal of the EF, or the end of the study period (ranging from 1 to 27.6 months). The definition of pin track infection was based upon the Maz-Oxford-Nuffield (MON) pin infection grading system. Overall, 132 patients undergoing external fixation surgery were included. Of these, 94 (71.2%) were male, with a mean age of 36.9 years (SD ± 18.9). Infection of any type (score > 1) was observed in 63 (47.7%) patients. Coated and uncoated-pin track-infection occurred in 45.7% and 48.5% of patients, respectively (P= 0.0887). The probability of developing infection (defined as a score ≥ 2) adjusted for comorbidities and follow-up time was not statistically higher among those who received uncoated pins compared to those who received pins coated with HA (odds ratio (OR) = 1.56, 95% confidence interval (95% CI): 0.67-3.67, p <0.05). In the present study, the external fixator pin infection rates were similar when using HA coating and standard steel pins.

Treatment of High Energy Tibial Plateau Fractures with Hybrid External Fixation

Objective: The current study aimed to assess the treatment results of high energy tibial plateau fractures with hybrid external fixation. Methodology: It included 20 adult patients (17 males and 13 females). At emergency rooms, patients were clinically and radiologically evaluated according to standard protocols, then the assessment was completed and treatment was started in the inpatient department. Preoperative preparation was completed according to standard protocols. Then, the surgical fixation was performed and the patient scheduled for postoperative evaluation. Radiological evaluation had been achieved by anteroposterior and lateral X-ray of the knee and leg. Computed tomography and Doppler ultrasound were requested for specific patients when indicated. Routine laboratory investigations were carried out. All operations carried out under spinal anesthesia. The 1st follow up visit was at the 2nd week postoperative, and follow up was done every 2 weeks. In each visit, patient was assessed clinically and by radiological investigations. Results: Five patients (25 %) had excellent, 8 patients (40%) had good, 2 patients (10 %) had fair, 5 patients (25%) had poor final result. In addition, 13 patients (65%) had no varus or valgus angulation, 18 patients (90 %) had 0-5mm limb shortening, 14 patients (70 %) had normal knee range of motion, 12 patients (60 %) had no pain and 14 patients (70 %) had normal gait. Two patients had non-union treated by removal of Ilizarov, proximal tibial locked plate, autologous iliac bone graft. 6 patients had multiple degrees of stiffness treated by physiotherapy and had fair, good outcomes, 3 patient had Pin track infection treated by surgical debridement with good outcome, 1 patient had deep vein thrombosis DVT treated by anticoagulant medication. Conclusion: Hybrid external fixation is a safe and effective treatment modality for tibial plateau fractures.

Pitfalls and suggestions for the treatment of open, comminuted fractures of the middle phalanx using custom-made dynamic external fixators: a retrospective case series

Background: The proximal interphalangeal joint (PIPJ) is a synovial joint prone to injury encompassing a wide spectrum of severity. In the setting of complicated injuries, dynamic external traction systems are considered to be the optimal treatment modality with numerous different Kirschner-wire configurations combined with rubber bands, springs, pulleys, or hinges being described. However, many of these pose significant technical challenges for the surgeon or are unwieldy to the patient emphasizing the need for simple, easy to construct, and well-tolerated modifications, which are equally effective in reducing the fracture and allowing early motion. Methods: The authors retrospectively analyzed prospectively collected data of 12 patients with open complex PIPJ fracture dislocations treated with a custom-made external fixator based on the one that was originally suggested by Suzuki et al. All patients were men with an average age of 55.1 yr (23 to 81). Injured digits involved four index, five middle, and three ring fingers. Results: The mean follow-up was 54.36 mo, and all patients healed without a second operation and returned to their jobs and preinjury level of activity. The average active range of motion of the PIPJ was 75.16±3.18 degrees, DIPJ was 69.33±14.7 degrees, and MCPJ was 88.75±1.97 degrees. Mean Quick Disabilities of Arm, Shoulder, and Hand (DASH)-Japan Society for Surgery of the Hand (JSSH) score at the final examination was 4.33±1.38 (range 2.3 to 6.8). The authors recorded five complications involving two rubber bands breaking, one pin-track infection, one rubber band-axial traction pin malposition, and one swan neck deformity, which were treated accordingly. Conclusions: One of the most crucial factors affecting outcome in this kind of injury is the appearance of the digit and functional results. None of the participants in this series had any complaint about the appearance of their fingers in the final examination, and 10 out of 12 judged the cosmetic result as very good. To the authors' knowledge, this report is one of the few that describes the functional outcome of pins and rubbers traction system (PRTS) application in complex fracture and fractures-dislocations with severe comminution of the middle phalanx and not only fractures related to the PIP joint. Level of Evidence: Level V.

Distraction osteogenesis at the proximal third of the ulna for the treatment of Masada type I/IIb deformities in children with hereditary multiple exostoses: a retrospective review of twenty cases.

Ulna distraction by monolateral external fixator (MEFix) is a good option for the treatment of Masada type I and IIb deformities in children with hereditary multiple exostoses (HMEs). However, there is no consensus regarding where to perform ulnar osteotomy. Our hypothesis is that osteotomy at the proximal third of the ulna and progressive distraction with MEFix can simultaneously correct elbow and wrist deformities in patients with HME. We retrospectively reviewed patients with HME who underwent ulna distraction osteogenesis from June 2014 to March 2019. The carrying angle (CA), radial articular angle (RAA), ulnar variance (UV), radial variance (RV) and range of motion (ROM) of the affected forearm and elbow were clinically assessed before lengthening and at the last follow-up visit. The total ulna lengthening distance (LD) and radiographic outcome were also recorded. Nineteen patients (20 forearms) with HME aged 9.1 ± 2.4years at the time of surgery were retrospectively reviewed. The mean follow-up period was 26.1 ± 5.6months. There were 11 patients (12 forearms) with Masada type I deformities and eight patients (8 forearms) with Masada type IIb deformities. Patients with type IIb deformity had higher RV, lower CA values, less elbow flexion and forearm pronosupination than those with type I deformity (p < 0.05); RV was an independent risk factor for radial head dislocation, with the cut off at RV > 15.5mm. The mean LDs in patients with type I and type IIb deformities were 33.6 ± 6.6mm and 41.4 ± 5.4mm, respectively. The mean CA, UV, RV, forearm pronation and ulna deviation at the wrist improved significantly following surgery in all patients. In particular, five of eight patients (62.5%) with type IIb deformities had concentric reduction of the radiocapitellar joint, while no radial head subluxation was detected in patients with type I deformities at the last follow-up. Three complications were recorded: two pin-track infections and one delayed union. Distraction osteogenesis at the proximal third of the ulna provides satisfactory clinical and radiological outcomes in patients with Masada type I and IIb deformities. Early treatment of Masada type I deformities is indicated before progression to more complex type IIb deformities.

TO EVALUATE THE OUTCOME OF ELASTIC NAILING ALONG WITH EXTERNAL FIXATOR IN OPEN TIBIA FRACTURES

Background: Open tibial fractures account for over 40% of all open fractures and are frequently accompanied by significant damage to soft tissues, including skin, muscle, and neurovascular structures . This article presents a intramedullary(TENS)- and external fixator technique. The purpose of this study is TO EVALUATE THE OUTCOME OF ELASTIC NAILING ALONG WITH EXTERNAL FIXATOR IN OPEN TIBIA FRACTURES . Materials and Methods: Following ethical approval, thirty patients with tibial fractures were treated by the EF-TENs system between NOVEMBER 2019 and SEPTEMBER 2021. The follow-up studies included clinical and radiographic examinations. All relevant outcomes were recorded during follow-up. Results: All 30 patients were assessed by follow-ups. According to the Anderson-Gustilo classification, there were 19 Type Grade II, 6 Type Grade IIIA and 5 Type Grade IIIB. All thirty patients were achieved follow-ups. All follow-up fractures united at last, but delayed union was observed in 5/30 patients. The average union time is 23.83+_4.47 weeks (range, 18–32 weeks). The main complication mentioned in this study was pin track infection, which occupied 6/30 cases. According to Johner–Wruhscriteriaof tibial shaft fractures, 19 fractures had excellent, 5 had good, 5 had fair and 1 had poor results. Conclusion: This study indicated that the outcome of elastic nailing along with external fixator , as a definitive intra- and extramedullary fixation technique, which was effective in treatment of open tibial fractures.

Gradual Deformity Correction with a Computer-assisted Hexapod External Fixator in Blount's Disease.

AimTo evaluate the results in terms of correction and complications from gradual correction with a computer-assisted hexapod circular external fixator in a mixed cohort of children with Blount's disease.Materials and methodsA retrospective review was performed of the correction and complications of 19 children (25 limbs) with recurrent infantile (IBD) and late-onset Blount's disease (LOBD) treated by gradual correction with a hexapod external fixator. The correction was measured by the medial proximal tibial angle (MPTA), anatomic posterior proximal tibial angle (aPPTA) and anatomic tibio-femoral angle (TFA). Obesity was present in 76% (19/25) of cases. Fifteen limbs were classified as infantile Blount's disease and 10 limbs as late-onset Blount's disease. The mean age was 12.5 years (range 7–17 years).ResultsThe mean pre-operative MPTA of 59° (SD 13°, range 33–79°) was corrected to a mean of 86° (SD 5°, range 77–93°). The mean pre-operative aPPTA of 64° (SD 14°, range 33–84°) was corrected to 79° (SD 6°, range 70–90°). The median pre-operative rotation of 15° internal rotation was corrected to normal (0–15° of external rotation). Eight out of 25 limbs had severe deformities with varus or procurvatum greater than 40° or both. The mean pre-operative TFA of 28° varus (SD 13°, range 4–53°) was corrected to 1.8° valgus (SD 6°, range 14° varus to 13° valgus). The median follow-up was 19 months (range 6–67 months). The alignment after correction was “good” in 55% (11/20), “acceptable” in 35% (7/20) and “poor” in 10% (2/20).The median duration for correction was 16 days (IQR 11–31 days, range 7–71 days). The median number of prescribed correction programmes was 1 (IQR 1–2, range 1–5). The mean total time in the frame was 136 days (SD 34 days, range 85–201 days).All patients developed minor pin track infections that resolved with oral antibiotics (Category 1 complications). Four patients developed complications that necessitated modification of the treatment plan (Category 2 complications). In two cases, treatment objectives could not be achieved (Category 3 complications). Two patients treated before skeletal maturity developed recurrent genu varum.ConclusionGradual correction with a computer-assisted hexapod external fixator may be a useful technique for correcting recurrent IBD or LOBD even in children with severe deformities. The results of gradual correction were similar in the two groups. While complications occur, most can be mitigated by timely intervention during the correction phase of treatment. Recurrence remains a concern if correction is performed before skeletal maturity.Level of evidence4.How to cite this articleMare PH, Marais LC. Gradual Deformity Correction with a Computer-assisted Hexapod External Fixator in Blount's Disease. Strategies Trauma Limb Reconstr 2022;17(1):32–37.

Prospective Comparison of the Early Outcomes of Headless Compression Screw and Percutaneous K-Wire Fixation in Metacarpal Fractures

The study aimed to assess early clinical outcomes achieved by headless compression screws (HCS) in fixation of metacarpal fractures, and to compare them with outcomes of percutaneous K-wire fixation. The hypothesis was that HCS would show better arc of motion and superior early clinical outcomes. This was a randomized study of nonthumb metacarpal neck and shaft fractures. To compare the 2 surgical techniques, 23 patients treated for metacarpal neck and shaft fractures were divided into 2 groups: 11 treated with K-wire fixation and the other 12 with HCS fixation. We followed the patients for 12 weeks. The primary objective was to compare metacarpophalangeal arc of motion, and the secondary aim was to determine clinical union, radiographic union, and recovery time before returning to employment in the 2 groups. At each follow-up visit, patients in the group treated with HCS had better metacarpophalangeal arc of motion than those treated with K-wire fixation. The HCS group showed a shorter time interval to return to work (at 3 weeks) and no complications, while the K-wire group had 1 pin track infection, which was treated with oral antibiotics and pin removal. Compared with K-wire fixation, limited-open HCS fixation for metacarpal neck and shaft fractures was superior in terms of the early postoperative metacarpophalangeal arc of motion and return to work. Therapeutic II.

Study of soft tissue cover in compound lower limb trauma

: Early vascularized soft tissue closure has long been recognized to be essential in achieving eventual infection free union. The question of whether muscle or fasciocutaneous tissue is superior in terms of promoting fracture healing remains unresolved.: To study options of different flaps in compound lower limb trauma and to know the pattern of providing flap cover in our setup. This was prospective observational study conducted in all the cases admitted under orthopaedics department who are hemodynamically stabilised, later referred to our department of plastic surgery for the flap cover. Isolated compound lower limb injuries with or without fractures were included in study.: Among 45 cases one patient (2.2%) had defect in the thigh, two patients had defect around knee (6.6%), nine cases had defect in upper third leg (20%), thirteen patients had defect in middle third leg (28.8%), seventeen patients have defect in lower third leg (37.7%) and three patients had in the foot (6.6%). Cross leg flap were used in 11 cases (24.4%) Gastrocnemius myo-cutaneous flap were used in 9 cases (20%). Fascio-cutaneous flaps superiorly based were used in three cases (6.6%) and Inferiorly based Fasciocutaneous flaps were used in 6 cases (13.3%), Reverse sural artery flap were used in six cases (13.3%) and Lateral premalleolar flap were used in 8 cases (17.7) and Advancement flap done in one case over defect of the thigh (2.2%). In a case with defect over thigh (2.2%). Complications like total flap loss was noted in one case (2.2%) marginal necrosis noted in five cases (11.1%) and pin track infection in three cases (6.6%).In Grade IIIB fractures external fixator was the choice of skeletal stabilisation. Delayed flap cover gave good results but it increases duration of hospital stay.

To Study Functional Outcome for Upper Limb Phalanx Fracture Treated by JESS Fixator

Purpose: To study functional outcome for upper limb phalanx fracture treated by Joshi’s External Stabilizing System (JESS) fixator. Material and Methods: 68 patients were operated for Upper limb phalynx fracture in a tertiary health care setup with JESS fixator and were reviewed at 3 weeks, 6 weeks and 3months. After the procedure, the patients were assessed for the functional outcome using DASH (Disabilities or Arm, Shoulder and Hand) scoring scale. Results: Mean Adjusted DASH scores of the operated finger over consequent visits at 3 weeks, 6 weeks, and 3 months. We found that the mean adjusted DASH score improved in each consequent visit as compared to the first visit for all the joints (p&lt;0.001). Out of the total 68 study participants, 63 had no complications (92.65%). Only 5 study participants had complications, out of which 2 each had joint stiffness (2.94%) and superficial pin track infection (2.94%) while 1 had pin loosening (1.47%). Conclusion: From the results, we can safely conclude that JESS is an effective alternative treatment for fractures of the phalanges. It is cheap and easily available. Technically, also it is less demanding. Also there is a good functional outcome as suggested by our study findings in terms of improvement in the range of motion as well as the mean adjusted DASH scores over a period of three follow up visits planned at 3 weeks, 6 weeks and 3 months with very few complications.

Functional and radiological outcome of gartland type 2 and 3 supracondylar fracture humerus in children treated by percutaneous pinning

Supracondylar fracture of Humerus is the commonest injury around the Elbow in children. It constitutes about 60% of all the fractures about the Elbow in children. The aim of the present study is to evaluate the results of percutaneous pinning of unstable or irreducible Type II and III Supracondylar Humeral fractures in children. A prospective study was conducted on 30 children, taking into consideration age, gender, affected side, mode of injury, type of fracture, Gartland classification of fractures, time duration between injury and surgery, postoperative complications and radiographic and clinic variables.: The median loss of motion was 5 degrees and the median change in carrying angle was 4 degrees. All patients had satisfactory results in terms of Loss of Carrying angle, Limitation of Elbow flexion and Flynn’s grading. There were 19 patients that had excellent ratings, 9 patients had good ratings and lastly only 2 patients had fair Flynn’s ratings. There was only 01 patient suffering from neurological deficit and only 01 patient from pin track infection. Percutaneous fixation with two crossed Kirschner wires leads to good functional and radiological outcome of Gartland type 2 and 3 supracondylar fracture humerus in children.

Off-Label Treatment for Severe Craniomaxillofacial Fractures in Low-Income Countries-A Novel Operation Method with the External Face Fixator.

Introduction: Craniomaxillofacial fractures (CMF) are common in low-income countries (LIC). Due to limited resources, treatment of these fractures usually consists of interdental wiring or immobilization with a Barton bandage to maintain the reduction by permanent occlusion. These non-surgical treatment methods often lead to unsatisfactory results, such as a disturbed dental occlusion and lockjaw. The aim of this study is to present an off-label treatment option for CMF by applying a hand fixator as external face fixator (EFF) and to demonstrate the surgical method in detail. Materials and Methods: The feasibility and postoperative outcomes of this new off-label operation technique were evaluated by analyzing patients with CMF (n = 13) treated at an NGO hospital in Sierra Leone between 2015 and 2019. Results: The application of the EFF was feasible. The biggest advantage compared to the conventional non-operative methods was, that a dynamic occlusion was still possible during the 6 weeks healing period. Hence, patients could eat and drink almost normally and perform dental hygiene with the EFF in place. We did not discover pintrack infections or other complications. Three patients developed an oronasal fistula due to traumatic a palatal bone loss of about 7–8 mm which was treated by a palatal mucoperiosteal flap 15–20 days after the first operation. Discussion and Conclusions: In LIC, where plate osteosynthesis for CMF cannot be performed due to limited resources the application of an EFF is a promising alternative for a better outcome and an improved quality of life for the patients.

Functional outcomes and complications of tibial lengthening using unilateral external fixation and then plating. A prospective case series

Introductionand Importance: The purpose of this study was to assess the functional outcomes and complications of tibial lengthening using unilateral external fixation and then plating. Material and methodsThis was a prospective case series study that enrolled people of short stature or leg length discrepancy of more than 3 cm from January 2019 to January 2021. A total of 11 patients (one male and 10 females) were recruited for the study, including seven short statures and four patients with leg length discrepancies. The external fixaters in this study were Muller's frame or Nhan's frame. ResultsThe average age of patients at the time of surgery was 25.89 years (range: 13–41 years). The study included 18 tibias that were lengthened and then plated. Average tibial lengthening was 6.89 ± 1.25 cm (21.87 ± 6.59%). The functional result was excellent in seven patients and good in four patients. Pin-track infection occurred in three tibias. There was one case of superficial infection. 12 legs (66.7%) developed ankle equinus after removing the external fixator. Four legs with severe equinus deformity were treated with percutaneous tendo-Achilles lengthening. Valgus deviation occurred in eight tibias. Peroneal nerve neuropraxia occurred in two legs during distraction. Distal migration of the fibula head occurred in four legs. ConclusionOur study suggested that tibial lengthening using Nhan's external fixater or Muller frame then plating was safe and effective provided complications were looked for and kept in check. Equinus contracture, pin-site infection, and valgus alignment were the most common complications. Level of evidenceLevel IV, prospective case series study.

Functional Outcome of Monorail Fixator as a Primary and Definitive Mode of Fixation in Open Fractures of Tibia- An Interventional Study

Introduction: Open fractures of the tibia are associated with massive soft tissue injury and bone loss with high rates of infection and non union resulting in poor treatment outcome. The treatment goals include prevention of infection, soft tissue coverage, and fracture stabilisation with simultaneous mobilisation of nearby joints, enabling early return to function. The management in open fractures continues to be a topic of debate in orthopaedic traumatology with various treatment options, having their own set of complications. Aim: To assess the functional outcome of open tibial fractures with a monorail fixator using Radiographic Union Scale in Tibial fracture (RUST) score and modified Johner and Wruh’s criteria. Materials and Methods: This prospective interventional study of 30 cases was conducted from November 2018-October 2020 in Government Medical College, Patiala, Punjab, India. The patients of open tibial fractures of type 2, type 3A, 3B (male=27, female=3) as classified by Gustilo-Anderson were included in this study. Patients were operated for monorail system to assess the stability of monorail fixator, total time taken in fracture union and compliance with range of motion of joints. On follow-up patients were also assessed for pin track infection and postoperative surgical site infection by taking swab for culture and antibiotic sensitivity. Statistical analysis was performed using the statistical software Statistical Package for the Social Sciences (SPSS) 25.0 (SPSS 25.0). In this study, quantitative data was expressed as mean values with Standard Deviation (SD) and categorical data were expressed as frequencies with percentages. Results: Present study had shown excellent to good results in 27 cases (90%) with minimum surgery time of 52.17±14.24 minutes. Full weight bearing with fixator was allowed in 5.37 days and fracture union occurred at 31.8±5.8 weeks. RUST score of 2 was seen in 33.33% and score 3 in 63.33% of patients respectively. Only one patient (3.33%) had shown score 1, which was treated with removal of fixator, debridement, sequestrectromy and fracture fixation with ring fixator and bone grafting. The bacteriology positivity was seen in six cases (n=2 was positive for Escherichia coli and n=4 was positive for Staphylococcus aureus). Conclusion: Present study demonstrated the benefits of monorail fixator as a primary and definitive mode of fixation in open tibial fractures with early full weight bearing over a stable construct and minimal complications.