Principles Of Fracture Fixation Research Articles

What to Expect? Use of Supplemental Fixation With a Concomitant Dorsal Spanning Plate for Complex Intraarticular Distal Radius Fractures.

The dorsal spanning plate (DSP) is a versatile implant suitable for bridging severely comminuted intraarticular distal radius fractures [AO (Arbeitsgemeinschaft für Osteosynthesefragen) 23-C.1-C.3]. It may be used alone or with supplemental fixation such as a volar locking plate (VLP) or fragment-specific fixation (FSF). Outcomes following DSP fixation with additional implants have not been specifically evaluated. We retrospectively reviewed consecutive patients who underwent internal fixation of a distal radius fracture by a single surgeon from 2017 to 2021. Patients were grouped according to implants used: DSP only, DSP + FSF, and DSP + VLP. Preoperative variables, treatment times, and wrist range of motion (ROM) were assessed. Functional wrist ROM was defined as minimum 80° combined flexion and extension. One hundred fifty-two patients underwent surgery for wrist fracture, 33 of them were treated with a DSP: 8 DSP only, 6 DSP + VLP, and 19 DSP + FSF. Falls from height greater than 10 ft accounted for 52% of injuries, most of which were treated with a DSP + FSF. Treatment times and ROM were similar between subgroups. Wrist ROM did not improve significantly beyond 4 weeks following DSP removal. Overall, DSP patients recovered a mean wrist ROM of 85° (range 0°-130°) within a median 26 weeks total treatment period (range 12-68 weeks). Regardless of the construct used, if the distal radius articular surface is well reduced and other principles of fracture fixation are applied, most patients treated with a DSP can expect to regain functional wrist ROM. Level IV-Retrospective review of prospectively collected data.

Surgical fixation of ipsilateral femoral neck and shaft fractures: a matter of debate?

Segmental femoral fractures represent a rare but complex clinical challenge. They mostly result from high-energy mechanisms, dictate a careful initial assessment and are managed with various techniques. These often include an initial phase of damage control orthopaedics while the initial manoeuvres of patient and soft tissue resuscitation are employed. Definitive fixation consists of either single-implant (reconstruction femoral nails) or dual-implant constructs. There is no consensus in favour of one of these two strategies. At present, there is no high-quality comparative evidence between the various methods of treatment. The development of advanced design nailing and plating systems has offered fixation constructs with improved characteristics. A comprehensive review of the existing evidence with a step-by-step description of these different definitive fixation strategies based on three case examples was conducted. Furthermore, the rationale for using single vs dual-implant strategy in its case is presented with supportive references. The prevention of complications relies mainly on the strict adherence to basic principles of fracture fixation with an emphasis on careful preoperative planning, the quality of the reduction, and the application of soft tissue-friendly surgical methods.

Intraoperative Fractures of Acetabulum and Proximal Femur in Cementless Primary Total Hip Arthroplasty: A Systematic Review

Introduction: Cementless Total Hip Arthroplasty (THA) is generally safe, but intraoperative fractures of the acetabulum and proximal femur can occur and can have significant consequences for the patient. This systematic review aims to synthesize the available literature on intraoperative fractures of the acetabulum and proximal femur during primary uncemented THA and highlight the incidence, risk factors, and potential preventive measures for these fractures, to improve patient outcomes and reduce the incidence of this complication. Methods: We conducted a thorough review in the PUBMED, EMBASE, Cochrane database and Scopus library, and extracted the articles describing the intraoperative acetabulum and femur fractures in primary cementless THA. Results: The initial search carried out produced 1792 results. After exclusion processing, 22 articles were included for the review. Of these, 16 were intraoperative fractures of the femur and 6 were intraoperative fractures of the acetabulum. Incidence of acetabular fractures was 0.49% and 2.7% for femoral fractures with female preponderance in both groups. Time of occurrence and location of the intra-operative fractures can vary widely, with femoral fractures occurring more commonly during broaching and acetabular fractures during cup implantation. Conclusion: A plethora of management options have been utilized according to surgeon preference and the fracture pattern as well as location. Standard principles of fracture fixation and arthroplasty should be followed to achieve stable internal fixation and any unstable fracture site should be bypassed with the utilization of long-stemmed components.

The management of segmental femur fractures: the radiographic 'cover-up' test to guide decision making

BackgroundSegmental femur fractures often pose management challenges regarding the optimal fixation choice and sequence of surgical events. MethodsRetrospective review of clinical records and radiographic data of adult patients with segmental femur fractures treated by a conceptual radiographic cover-up test to determine the ideal fixation method between January 2019 and December 2020. ResultsForty patients with 84 individual fractures underwent fracture fixation. The most consistent fracture combinations were intertrochanter-diaphysis (AO31A-AO32) fractures (25%, n = 10) and femur neck-diaphysis (AO31B-AO32) fractures (20%, n = 8). Compared to evidence-based fracture management, the gold standard treatment was used for the fixation of 78 fractures (93%). One patient required revision for fixation failure of a diaphyseal fracture, and two fractures, both open diaphysis injuries, developed fracture-related infections. ConclusionAnatomical alignment and high union rates are possible for segmental femur fractures treated by evidence-based fracture fixation principles. A conceptual radiographic cover-up test assists in matching the best possible implant for each fracture.

Functional outcome of distal end femur fracture treated with locking compression plate

Aim of the study: The aim of this study is to assess the functional outcome of distal femur fracture treated with a locking compression plate. Materials and methods: The study was conducted from July 2019 to February 2021 at Dr BR Ambedkar Medical College and Hospital with follow-up period of six months. 20 skeletal mature patients fulfilling the inclusion criteria with distal end femur fractures were surgically treated with distal femoral locking compressive plate using a direct lateral approach. The clinical assessment was conducted for at least a period of 6 months postoperatively using the oxford knee scoring system. Results: At six months of follow-up, 10 patients achieved range between 120 to 140°, 9 achieved between 100 to 120 and 1 had 95° flexion. In the present study, 18 out of 20 cases (90%) showed a radiological union at 3 months’ follow-up. 2 cases (10%) had radiological union at 6 months (24 weeks) of follow-up. In the present study, 85% of cases that is 17 of 20 cases had Oxford Knee Score of more than 41, 2 cases that is 10% had a score between 34 and 40, and only 1 had a score between 27 and 33. In the present study, 17 cases, i.e., 85% showed excellent functional outcome, while 2 cases showed good and 1 case had a fair outcome. Conclusion: The use of LCP in distal femoral fracture promotes early radiological union, good knee range of movement and early recovery when fracture fixation is done following all the basic principles of fracture fixation. Finally, it can be concluded that the use of LCP provides a good functional outcome for distal femur fractures, particularly in osteoporotic bones.

Mandibular Fractures: Diagnosis and Management.

Accurate evaluation, diagnosis, and management of mandibular fractures is essential to effectively restore an individual's facial esthetics and function. Understanding of surgical anatomy, fracture fixation principles, and the nuances of specific fractures with respect to various patient populations can aid in adequately avoiding complications such as malocclusion, non-union, paresthesia, and revision procedures. This article reviews comprehensive mandibular fracture assessment, mandibular surgical anatomy, fracture fixation principles, management considerations, and commonly encountered complications. In addition, this article reviews emerging literature examining 3-dimensional printing and intraoperative imaging.

Virtual Reality and Physical Models in Undergraduate Orthopaedic Education: A Modified Randomised Crossover Trial.

BackgroundOrthopaedic surgery is underrepresented in the United Kingdom medical school curriculum, with an average of less than 3 weeks of exposure over the five-year degree. This study evaluates the effectiveness of high-fidelity virtual reality (VR) and physical model simulation in teaching undergraduate orthopaedic concepts.MethodsA modified randomised crossover trial was used. Forty-nine students were randomly allocated to two groups, with thirty-three finishing the six-week follow-up assessment. All undergraduate medical students were eligible for inclusion. Both groups were given introductory lectures, before completing a pre-test with questions on the principles of fracture fixation and osteotomy. Each group then received a lecture on these topics with the same content, but one was delivered with VR and the other with physical models. Both groups completed the post-course assessments. Knowledge was assessed by way of questionnaire immediately before, immediately after, and six-weeks after.ResultsIn the VR group, participants improved their post-training score by 192.1% (U=32; p<0.00001). In the physical models group, participants improved their post-training scores by 163.1% (U=8.5; p<0.00001). Overall, there was no statistically significant difference in the total means of post-training test scores between the VR and the physical models study groups (U=260.5; p=0.4354).ConclusionBoth VR and physical models represent valuable educational adjuncts for the undergraduate medical curriculum. Both have demonstrated improvements in immediate and long-term knowledge retention of key orthopaedic concepts.

Locking condylar plate: best device to treat supracondylar fractures of the femur

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Supracondylar fractures of the femur in adults account for only 7% of all femoral fractures. However, these fractures present with numerous complications. The purpose of this study was to assess the outcome of locking condylar plate in supracondylar fractures of femur in adults.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study was based on 25 patients of supracondylar fracture of the femur treated with locking condylar plate at Srinivas Institute of Medical Sciences and Research Centre, Mukka, Suratkal, Mangalore. The patients were followed up for 1 year.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In present study, 84% fractures were sustained due to road traffic accidents. In 23 (92%) patients, full weight bearing was achieved at 20 weeks while only 2 (8%) patients required more than 20 weeks. 80% of cases required less than 16 weeks for union while 20% required more than 16 weeks. Average injury to surgery time was 3.62 days in the present series. Superficial stitch infection occurred in two cases. Deep infection occurred in a grade 2 compound fracture in a male who was treated initially with debridement and antibiotics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Good results are seen by distal femur locking condylar plate alone. It is the main implant of choice for distal femur fractures of all varieties. Best outcome is expected if fracture fixation is done following all the basic principles of fracture fixation. Advantage of the mechanical properties of a locking plate is definitely useful. &lt;/p&gt;

Radiologic Evaluation of Lower Leg, Ankle, and Foot Fracture Fixation Hardware.

Radiologists should be familiar with basic principles of fracture fixation and the normal imaging appearances of implant constructs and their complications. The surgeon's selection of external fixation, intramedullary nail fixation, open reduction and internal fixation, or some combination depends on patient factors, fracture configuration, injury to the soft tissue envelope, and surgeon experience. Complications including loss of fixation with resultant malalignment, nonunion, infection, and posttraumatic osteoarthritis present additional challenges for the surgeon as well as the radiologist. This article reviews the rationale behind fracture fixation in fractures of the lower leg, ankle, and foot. Examples of postoperative complications are also reviewed.

Comparison of outcome in MIPO versus ORIF with plate Osteosynthesis in The Management of Fractures of the Shaft of Humerus

Background: Fractures of the humeral shaft are usually managed surgically with ORIF (open reduction with internal fixation) with PO (plate osteosynthesis) being the most commonly used modality of treatment. With the advent of biological fracture fixation principles, the trend currently is to go in for minimally invasive techniques. The aim of this study was to compare the functional outcomes of humeral shaft fractures treated by ORIF and MIPO (minimally invasive plate osteosynthesis) and to compare the results with studies of other authors as available in literature. Methods: 30 patients with diaphyseal fractures of the humerus who presented between Jan 2014 to Jan 2016 were randomly allocated into 2 groups with Group 1 treated by ORIF with PO (N=15) and Group 2 treated by MIPO (n=15) and were followed up for a minimum period of 2 years. Functional outcomes of both groups were assessed by the DASH score. Results: Both groups were comparable in terms of age, sex, side predominance and mode of injury.According to fracture classification, AO type A was the most common type seen followed by type B and C. The mean follow up in group 1 was 26 months ranging from 24 to 31 months while it was 27 months in group 2 ranging from 25 to 30 months. There was a significant statistical difference in group 2 pertaining to operative time, blood loss and radiation exposure with the P value < 0.001. The time to union was shorter in group 2 and the DASH score in both groups improved over the course of follow up upto a year. Conclusion: By this study we conclude that MIPO of humeral shaft fractures is a good viable and easily reproducible option in the management of these fractures and has advantages over conventional ORIF techniques in terms of reduced blood loss, shorter surgical times and earlier time to fracture union by employing biological principles of fracture fixation and gives good functional results.

PFN in trochanteric fractures: Clinico radiological outcome study

Intertrochanteric fractures are common in elderly osteoporotic population. Our study aims to analyse the clinico radiological outcome in these fractures operated using Proximal Femur Nail. This is a prospective study was conducted in our department involving 52 patients between June 2014 to June 2016. All patients more than 18 years of age with intertrochanteric fractures less than 2 weeks of injury were included. Pathological fractures, patients with previous hip surgeries, polytrauma and associated neurological problems like stroke were excluded. Fractures classified by AO system and fixed using Proximal Femur Nail. Optimal position of cervical screw in immediate postop and mean lateral sliding of cervical screw during every follow up were analysed. Harris Hip Score is used to analyse the functional outcome at 1 year. Optimal Placement of screw achieved in 76% of patients with mean clinico radiological union time of 15.4 weeks. Lateral sliding of lag screw is more in unstable A3 fractures with mean lateral slide of the lag screw at the end of 1 year was 4.9mm.Proximal Femur Nail is useful impant in unstable intertrochanteric fractures. Complications can be minimised by strictly following the principles of fracture fixation.

Restoration of Humeral Bone Stock Two Years After Internal Fixation of a Periprosthetic Fracture with a Loose Stem

We describe 2 patients who sustained a periprosthetic humeral fracture with a loosened long-stemmed Coonrad-Morrey total elbow prosthesis. As noted in the literature, the success rate for a major revision with use of strut grafts is around 70%; therefore, both cases were managed without revision of the prosthesis. A submuscular locking plate was placed following typical fracture fixation principles. Screws that interfered with the humeral stem and the distal flange stabilized both the distal fragment and the humeral stem. At 2 years postoperatively, both fractures had healed, with increased endosteal bone stock. In each case, the prosthesis was successfully salvaged, and radiographic reconstitution of the implant-bone interface was noted after 2 years.

Failure of fracture fixation in osteoporotic bone

This manuscript will provide an overview of how the age and osteoporosis related changes in mechanical properties of bone affect the stability of osteosynthesis constructs, both from a mechanical as well as from a clinical perspective. The manuscript will also address some of the principles of fracture fixation for osteoporotic fractures and discuss applications of osteoporotic fracture fixation at sites typically affected by fragility fractures, namely the distal radius, the proximal humerus, the femur and the spine. The primary aim of operative treatment in elderly individuals is the avoidance of immobilization of the patient. In selected cases conservative treatment might be required. Generally, choice of treatment should be individualized and based on the evaluation of patient-specific, fracture-specific and surgeon-specific aspects. The orthopaedic surgeon plays an essential role in enabling functional recovery by providing good surgery but a multidisciplinary approach is essential in order to support the patient to regain his/her quality of life after fragility fracture. Overall, the therapy of fractures in osteoporotic bone in the elderly requires a multidisciplinary therapeutic acute care concept including treatment of co-morbidities and correct choice of timing, and technique of the operative intervention.

Distal Femur Locking Plate: The Answer to All Distal Femoral Fractures.

Good results have been published by researchers with distal femur nail, dynamic condylar screw and even addition of a medial plate to a distal femur locking plate for treating distal femur fractures. By this study, we explore the capability of a distal femur locking plate to counter distal femur fractures of extra- articular, partial or intra- articular nature. Positive results have been published by various groups from all over the world. To study the functional and radiological outcome of distal femoral fractures in skeletally mature patients treated by open reduction and internal fixation with distal femur locking plate. This was a prospective study conducted from January 2012 to March 2014 at the Government Medical College and Hospital (GMCH) with a 2 year follow-up. Twenty five skeletally mature patients with post-traumatic distal femur fractures were included. Patients with open grade 3B and 3C distal femur fractures, according to the Gustilo- Anderson classification and pathological distal femur fractures were excluded from the study. Patients with any fracture other than the distal femur in the ipsilateral limb were excluded from the study. Follow-up at 3 months, 6 months, 1 year and 2 years was carried out and evaluation was done according to the Neer scoring system. The statistical data analysis was carried out using SPSS version 20 (IBM, Chicago, USA). The p-value <0.05 was considered significant. Following all principles of fracture reduction, union was achieved in all patients with mean time to radiological union being 19 weeks. The mean Range of Motion (ROM) was 109 degrees with 20 patients having a Neer score graded as excellent to satisfactory. Our study had nine cases which required additional surgeries. Out of these, all nine cases required bone grafting, three also required antibiotic cement bead insertion initially. Three patients developed complications in the form of infection (two cases) and mal-union (one case) during the course of our study, but were completely treated by the end of the study. Positive results can be obtained by distal femur locking plate alone as it is the main implant of choice for distal femur fractures of all varieties. Best outcome is expected if fracture fixation is done following all the basic principles of fracture fixation and taking benefit of the mechanical properties of a locking plate.

Surgical Management of Metastatic Long Bone Fractures: Principles and Techniques

Management of metastatic long bone fractures requires identification of the lesion and the use of sound fracture fixation principles to relieve pain and restore function. The treating surgeon must understand the principles of pathologic fracture fixation before initiating treatment. Because these fractures occur in the context of a progressive systemic disease, management typically involves a multidisciplinary approach. When considering surgical stabilization of these fractures, the abnormal (or absent) healing environment associated with diseased bone and the overall condition of the patient must be taken into account. The goal of surgery is to obtain a rigid mechanical construct, which allows for early mobility and weight bearing. This can be achieved using internal fixation with polymethyl methacrylate cement or segmental resection and joint reconstruction. Prosthetic joint arthroplasty is a more reliable means of fracture management when insufficient bone is present for fixation. Prophylactic stabilization of impending pathologic fractures can reduce the morbidity associated with metastatic lesions.

Scapula fractures.

Over the past decade, there has been an increased interest in understanding the operative indications and techniques in treating scapular fractures and tracking their outcomes. Multiple studies have documented poor functional outcomes following nonoperative management of displaced scapular fractures. There is a groundswell of recognition that severe deformity from scapular malunion is associated with functional consequences for patients. This has led to a growing recognition that scapular fractures should be held to the same standards as other bodily fractures with regard to fracture fixation principles, including anatomic articular reduction, proper alignment, and stable internal fixation. Through research, there has been an improved understanding of scapular fracture patterns and the relevant surgical approaches and exposures used for fracture fixation. As with many bones, however, there still remains the absence of a compelling study that defines thresholds for surgical indication based on degrees of deformity and amounts of displacement.

Complex and open fractures: a straightforward approach to management in the cat.

Cats often present with traumatic injuries of the limbs, including complex and open fractures, frequently as a result of road traffic accidents. On initial assessment, complex and open fractures may appear to require expertise beyond the experience of the general practitioner and, in some cases, referral to a specialist may be indicated or amputation should be considered. Many cases, however, can be managed using straightforward principles. This review describes a logical and practical approach to treating such injuries. It discusses general principles of fracture management, highlights the treatment of open fractures, and describes the use of external skeletal fixation for stabilisation of both open and complex fractures. Most fractures can be stabilised using equipment and expertise available in general practice if the basic principles of fracture fixation are understood and rigorously applied. Many textbooks and journal articles have been published on the management of fractures in companion animals, presenting case studies, case series and original biomechanical research. The simple strategy for managing complex injuries that is provided in this review is based on the published literature and the author's clinical experience.

Evidence for success with locking plates for fragility fractures.

Fixation of fragility fractures with plates and screws often results in loss of fixation and need for revision surgery. Locking plates and screw were introduced to improve fixation of fragility fractures and have been in use for a decade. This review was conducted to compile evidence that locking plates and screws improve fixation of fragility fractures. A search of PubMed was performed to identify biomechanical studies as well as clinical series of fragility fractures treated with locking plates. Biomechanics papers had to use models of osteoporotic bone and had to directly compare locking plates with traditional plates. Clinical studies included case series in which locking plates were applied to elderly patients with fractures of the proximal humerus and periprosthetic distal femur fractures. Most studies are retrospective case series. Locking plates lead to greater stability and higher loads to failure than traditional plates. When applied to proximal humerus fractures, uncomplicated healing occurs in 85% of patients. Constant and Dash scores approach normal values. For distal femoral periprosthetic fractures, union rates of 75% are reported with a malunion rate of 10%. Early evidence suggests that locking plates improve results of treatment of proximal humerus fractures and distal femoral periprosthetic fractures in the elderly. Loss of fixation is associated with failure to achieve stability at the fracture site. Principles of fracture fixation in osteoporotic bone defined prior to the introduction of locking plates should still be applied.

Orthopedic Traumatology – A Resident's Guide

According to Dr Ip's preface, his book is aimed at doctors in training and, where appropriate, paramedical staff who regularly deal with trauma victims. With relevance to the UK, this will mainly mean FY2, ST1 and ST2 doctors. It has forewords and is essentially endorsed by two eminent trauma professors, namely Charles Court-Brown from Edinburgh and John Wedge from Toronto. The book is divided into 12 chapters discussing important areas of trauma management. It is written in the style of a thesis, with nearly every paragraph numbered and subdivided so that a detailed index is given at the beginning of each chapter. I felt that this division for a textbook was too detailed as the point of an index at the start of a chapter is to give an at-a-glance guide to what is in it. This was not possible here as some chapter indices are many pages long. The main index at the end of the book is in a standard format and is accurate. Most topics are easy to find using the index. However, some are mentioned on many different pages and it is not clear in the index where the main narrative is located. For example, compartment syndrome has 16 entries, none of which are highlighted for ease of access. Each topic is presented in bullet-point format with any necessary subdivisions and the topics covered are accurate and current. Some of the basics like requesting appropriate radiographs, the management of major trauma and the principles of fracture fixation are described well. The current issues in fracture management and the ideas put forward are clearly contemporary and, overall, the material covered is relevant with no serious omissions. Illustrations are lacking in number and do not always appear close to the relevant text. I felt some of the text used was difficult to understand and a single diagram with a few words would have got the message across. On occasion, I felt the illustrations were not the best examples to go with the text. For example, in the section on periprosthetic fractures in the lower limb, major osteolysis around a complex knee implant is shown. A simpler example of, say, a fracture adjacent to a total knee prosthesis, which is seen much more commonly would have illustrated the point better. Compared with the competition designed for residents or similar grades, I thought that although this book was pocket-sized and to the point, it was neither detailed enough to cover the topic in depth, nor readable enough for revision purposes. It scored well in terms of portability and relevance of topics but was not as easy to read, nor did it have enough good quality illustrations for my liking. Faced with fierce competition from other authors on this subject matter, I felt that a resident or equivalent could do better in terms of a choice of text to acquire.

Recombinant Human Bone Morphogenetic Protein‐2 in Absorbable Collagen Sponge Enhances Bone Healing of Tibial Osteotomies in Dogs

To compare the efficacy of 2 doses of recombinant human bone morphogenetic protein-2 (rhBMP-2) on tibial osteotomy healing in dogs. Experimental, randomized complete block (n=7). Adult female dogs (n=21). Right midshaft tibial osteotomies were created and stabilized with a 1-mm gap using type I external fixators. Seven dogs were untreated controls and 14 with osteotomies were treated with either 0.05 or 0.2 mg/mL rhBMP-2 delivered in an absorbable collagen sponge (ACS). At 8 weeks, dogs were euthanatized and bones were mechanically tested and examined by microscopy. Bone healing based on radiographic scoring, was significantly improved in dogs treated with 0.2 mg/mL of rhBMP-2 compared with the other groups; these tibiae were also significantly stronger and stiffer than 0.05 mg/mL rhBMP-2 and control osteotomized tibiae. Histologic scores were significantly better for 0.2 mg/mL rhBMP-2 group than 0.05 mg/mL rhBMP-2 group, but neither was significantly different from control. rhBMP-2 in ACS at a concentration of 0.2 mg/mL improves healing of tibial osteotomies in dogs compared with untreated controls and 0.05 mg/mL rhBMP-2 based on force plate analysis and radiographic evaluation. This was not confirmed histologically but treated bones had improved mechanical properties at 8 weeks. After a long bone fracture, dogs may face a long recovery period before full return of limb function. rhBMP-2, in association with good fracture fixation principles, may enhance bone healing in dogs with diaphyseal fractures.