Results Of Open Reduction Research Articles

A Clinical and Radiographical Study on Augmentation of Fracture Healing in Long Bones of Dogs Using Synthetic Nanohydroxyapatite

Long bone fractures in six dogs were stabilized with intramedullary pinning and synthetic nanohydroxyapatite (Nha) graft material was deposited at the fracture site intra-operatively. The fractures were classified according to AO ASIF method of classification and the outcome of open reduction and internal fixation was evaluated based on clinical and radiological studies, on 7th, 15th, 30th and 45th post- operative days. Post-operative weight bearing and angulation and lameness grading, radiographic evaluation for alignment and implant stability were also evaluated. The stabilization technique proved to be satisfactory in all the cases. The radiographic score indicated better long bone fracture healing with Nha alone as a graft.

Open Reduction and Fixation of Late-Presenting Pediatric Supracondylar Humeral Fractures: A Prospective Study.

Supracondylar humeral fracture (SCHF) is a common injury in children, and early treatment provides excellent results and prevents disabilities. Delayed presentation is still prevalent, mainly in developing countries, because many factors hinder the opportunity to receive appropriate treatment. Currently, there are no standard treatment protocols, and there is insufficient published literature on this topic. This study aimed to evaluate the effectiveness and outcomes of open reduction and Kirschner wire fixation using a triceps-sparing posterior approach in neglected cases with complicated fractures. This was a prospective multicenter clinical study conducted between July 2016 and June 2021, which included 28 pediatric patients with neglected SCHF who presented to the hospital for definitive treatment five days or more after initial trauma without previous surgical intervention. All the patients underwent open reduction and K-wire fixation using a posterior triceps-sparing approach. The final functional outcome was assessed using the Mayo Elbow Performance Index (MEPI) and Flynn criteria. All fractures (100%) united within 3-5.5weeks (mean 4 ± 0.7 weeks). Excellent scores observed in 67.9% (n = 19), good in 21.4% (n = 6), fair in 7.1% (n=2), and poor in 3.6% (n = 1) patients according to MEPI. Correspondingly, Flynn's criteria showed 96.4% (n = 27) satisfactory and 3.6% (n = 1) unsatisfactory outcome. Open reduction and fixation using Kirschner wires through the posterior triceps-sparing approach is an effective treatment method for late-presenting SCHF in children with consequent satisfactory results.

Operative treatment of acromial and scapular spine fracture nonunions complicating reverse total shoulder arthroplasty

BackgroundFractures of the acromion and spine can have a major impact on the outcome of reverse shoulder arthroplasty (RSA) with respect to pain, motion, and function. Reports on internal fixation for these fractures are isolated to small series or case reports with variable outcomes. The purpose of this study was to report on the outcome of open reduction and internal fixation (ORIF) of acromion or spine fractures encountered before or after RSA and describe our evolution of fixation techniques. MethodsBetween 2011 and 2023, 22 fractures or nonunions of the acromion or spine of the scapula underwent ORIF at a single institution and were followed for a minimum of 1 year. In 16 shoulders, fractures occurred after RSA, whereas 5 shoulders underwent ORIF prior to RSA. One shoulder had undergone prior failed ORIF elsewhere and revision ORIF was performed at our institution. There were 10 males and 12 females with a mean age of 67 (SD=15.1) years. Fixation strategies included single (n=11) and double plate fixation (n=11). Kruskal-Wallis one-way analyses of variance were used to analyze continuous variables and Chi-square tests employed for categorical variables. ResultsOf the 5 fractures treated with ORIF pre-RSA, 1 shoulder suffered an additional fracture medial to the hardware and 1 required additional bone grafting for incomplete union at the time of RSA. These 5 shoulders all underwent RSA uneventfully, but one fracture experienced late displacement of the scapular spine nonunion, leading to plate removal. Of the 16 post-RSA ORIF shoulders, radiographic union was confirmed in 14 and substantial residual inferior angulation identified in 3. New fractures occurred after ORIF in 5 shoulders. For patients who underwent ORIF after RSA, pain scores improved from a mean of 8 to 1.9 points, with more modest elevation gains (58.2° to 91.3° pre- and postoperatively, respectively). ConclusionsORIF of acromion and scapular spine fractures or nonunions in the setting of RSA have the potential to lead to union. When these fractures and nonunions are encountered prior to RSA, ORIF allows for uneventful RSA implantation, but secondary displacement may occur. ORIF seems to lead to improvements in pain, but more modest improvements in motion and function. Our fixation strategy has evolved to (1) dual plating, (2) spanning the whole length of the spine with one of the plates, (3) use of hook features under the acromion or os trigonum if possible, and (4) liberal use of bone graft.

Outcomes of open reduction and internal fixation of calcaneus fractures: A database study comparing patients with and without diabetes.

Treatment of calcaneal fractures in patients with diabetes mellitus (DM) is challenging. The purpose of this study was to compare post-operative outcomes after open reduction and internal fixation (ORIF) for calcaneus fracture in patients with complicated DM, uncomplicated DM, and patients without DM. A commercially available de-identified database was queried for all calcaneus fracture diagnoses undergoing ORIF from 2010 to 2021. The patients were separated into three groups for analysis: patients without DM (10,951, 82.6%), uncomplicated DM (1,500, 11.3%) and complicated DM (802, 6.1%). At 1 year, post-operative adverse events were assessed among the three groups. The odds of adverse event(s) for each group were compared between the three groups with and without characteristic matching. In the unmatched cohorts, patients with complicated DM, when compared with patients without DM and patients with uncomplicated DM, had significantly higher rates of all adverse events with exception of DVT. Rates of CNA were significantly higher in patients with complicated DM compared with no DM (OR 107.7 (CI 24.83-467.6) p < 0.0001) and uncomplicated DM (OR 44.26 (CI 3.86-507.93) p = 0.0002). After matching, non-union, AKI, sepsis, surgical site infection, and wound disruption were higher in patients with complicated DM compared with patients without DM. There were no significant differences in the three groups with regard to reoperation, DVT, MI, pneumonia, or below the knee amputation. Patients with DM who underwent ORIF for calcaneus fracture experienced higher rates of post-operative adverse events compared with those patients without DM.

Outcome of Open Reduction and Internal Fixation versus Hemiarthroplasty in Proximal Humerus Complex Fractures

Abstract Background: This study compares open reduction and internal fixation (ORIF) versus hemiarthroplasty (HA) in the management of complex proximal humerus fractures. Materials and Methods: Neer three- and four-part fracture-dislocations, surgical neck fracture-dislocations with severe articular impaction, and any head-split fracture treated surgically at our institution were studied retrospectively. Constant–Murley scores, Disability of the Arm, Shoulder, and Hand (DASH), American Shoulder and Elbow Surgeons (ASES) Shoulder, and 36-item Short-Form Health Survey (SF-36) scores were obtained and compared between ORIF versus HA treatment. Results: Thirty patients were included in the analysis: 15 treated with ORIF were compared to 15 treated with HA with an average follow-up of 60 months. The mean Constant score (72 ± 15 vs. 54 ± 19; P = 0.005), DASH score (13 ± 17 vs. 29 ± 18; P = 0.006), ASES score (87 ± 13 vs. 66 ± 22; P = 0.003), and SF-36 physical composite score (PCS) (50 ± 11 vs. 40 ± 11; P = 0.02) all favored the ORIF group. Because of the potential confounding variable posed by including younger patients, we performed a subgroup analysis of patients older than 50 years. In this group, the Constant, DASH, ASES, and PCS scores remained significantly better in the ORIF group. Conclusion: Results of this retrospective study show improved patient-reported outcomes and quality of life scores in patients undergoing ORIF for complex proximal humerus fractures as compared to patients undergoing HA, despite a higher revision rate in the ORIF cohort. When considering patients older than 50 years, outcomes after ORIF were better than HA.

Outcome of Open Reduction and Internal Fixation with Interlocking Intra-Medullary Nail in the Treatment of Fracture of Shaft of Femur without Fluoroscopy

Introduction: Femoral shaft fractures are among the common fractures generally managed by close reduction and internal fixation (CRIF) with interlocking intramedullary nailing (ILIMN) as the nail provides the rotational as well as longitudinal stability along with good clinical and functional outcomes but requiring fluoroscopy guidance. Also, in delayed cases, the close reduction might not be possible intimidating the need of open reduction.&#x0D; Objective: To assess the clinical outcome of the treatment from Open Reduction and Internal Fixation (ORIF) technique as well as placement tricks of locking screws in the absence of a traction table and fluoroscopy.&#x0D; Methodology: Fourteen cases of close femur fractures with transverse and oblique type in the middle 1/3 shaft coming to Koshi Hospital, Nepal, from June 2019 to December 2021 were included in this study. All patients were treated with ORIF with ILIMN technique without the use of a traction table and fluoroscopy. Data collection included demography, mechanism of injury, mobilization time, union rate, infection, and complication. The study was also designed to evaluate the method of our technique which could be helpful in case of dysfunction of fluoroscopy during intra-operative of CRIF in a resource-limited setting.&#x0D; Results: The average age of patients was 39.86±14.93, the average hospital stay duration was 12 ± 8.60 days, full weight-bearing walking was around 11.64 ± 3.15 weeks and the average union time was observed to be 14.54 ± 3.36 weeks.&#x0D; Conclusion: This technique was successful with an efficient duration of the surgery and satisfactory results in early mobilization and fracture union time. Thus, concluding it to be a safe procedure in situations like old fracture (more than 3 weeks), pelvic injury with urethral injury, lack of traction table, and dysfunction of fluoroscopy.

Children’s orthopaedics

The October 2023 Children’s orthopaedics Roundup360 looks at: Outcomes of open reduction in children with developmental hip dislocation: a multicentre experience over a decade; A torn discoid lateral meniscus impacts lower-limb alignment regardless of age; Who benefits from allowing the physis to grow in slipped capital femoral epiphysis?; Consensus guidelines on the management of musculoskeletal infection affecting children in the UK; Diagnosis of developmental dysplasia of the hip by ultrasound imaging using deep learning; Outcomes at a mean of 13 years after proximal humeral fracture during adolescence; Clubfeet treated according to Ponseti at four years; Controlled ankle movement boot provides improved outcomes with lower complications than short leg walking cast.

Time-to-Surgery and Short-Term Outcomes of Trimalleolar Ankle Fracture During the COVID-19 Pandemic.

Introduction During the coronavirus disease 2019 (COVID-19) pandemic, a rapid and significant transformation in patient management occurred across the healthcare system in order to mitigate the spread of the disease and address resource constraints. Numerous surgical cases were either postponed or canceled, permitting only the most critical and emergent cases to proceed. The impact of these modifications on patient outcomes remains uncertain.The purpose of this study was to compare time-to-surgery and outcomes of open reduction and internal fixation for trimalleolar ankle fractures during the pandemic to a pre-pandemic group.We hypothesized that the pandemic group would have a prolonged time-to-surgery and worse outcomes compared to the pre-pandemic cohort. Materials and methods This retrospective cohort study was conducted within a single healthcare system, examining the treatment of trimalleolar ankle fractures during two distinct periods: April to July 2020 (COVID-19 group) and January to December 2018 (2018 group). Cases were identified usingCurrent Procedural Terminologycode 27822. Information on demographics, fracture characteristics, and outcomes was obtained through chart review. Outcomes analyzed included time-to-surgery, mean visual analog scale scores, ankle strength and range of motion, and complications. Results COVID-19 and 2018 groups consisted of 32 and 100 patients, respectively. No significant difference was observed in group demographics and comorbidities (p > 0.05). Fracture characteristics were similar between groups apart from tibiofibular syndesmosis injury, 62.5% (20/32) in COVID-19 vs 42.0% (42/100) in 2018 (p = 0.03). Time-to-surgery was not significantly different between the two groups (8.84 ± 6.78 days in COVID-19 vs 8.61 ± 6.02 days in 2018, p = 0.85). Mean visual analog scale scores, ankle strength, and ankle range of motion in plantarflexion were not significantly different between the two groups at three and six months postoperatively (p > 0.05). Dorsiflexion was significantly higher in the COVID-19 group at three months (p = 0.03), but not six months (p = 0.94) postoperatively.No significant difference in postoperative complication was seen between groups, 25.0% (8/32) COVID-19 group compared to 15.0% (15/100) 2018 group (p = 0.11). Conclusions Patients who underwent surgery during the early months of the COVID-19 pandemic did not experience prolonged time-to-surgery and had similar outcomes compared to patients treated prior to the pandemic.

Outcomes of Open Reduction and Internal Fixation for Supracondylar Humeral Fractures in Children

Objectives: The aim of this study was to evaluate the results of open reduction and internal fixation of humeral supracondylar fractures in pediatric patients. Patients and methods: A retrospective descriptive study conducted from 2006 to 2016, including 24 patients who underwent open reduction and internal fixation for the treatment of condylar fractures, adjusted by the closed method. The patients were clinically and radiographically evaluated according to the Gartland’s classification. Data collection also included postoperative radiological assessment, range of motion, presence of postoperative complications, and satisfaction questionnaire with treatment received. Results: Patient’s age: Mean 9.46 ± 2.07; Males : 15 (62.5%), Femeals: 9 (37.5%); Injured elbow: Left 17 (70.8%), Right 07 (29,2%); Injury/Sugery Interval (days): 2.2 ± 0.78; Gartland’s classification: Type II: 6 (25%), Type III: 17 (70.8%), Type IV: 1 (4.2%); Foll-up Period (months): 44. 08 ± 5.78; Baumann angle: 16.12° ± 2.23°; Final loss of flexion: averaged 5.9°; loss of extension: 0.73°. The KW was removed was 4.2 months (range: 3 - months). Complications: KW Pierce through brachial artery (intra - Operatively) 1 (4.2%), Iatrogemic ulnar injury 1 (4.2%), Cubitus varus 1 (4.2%). Evaluation: Satisfactory 22 (91.7%), Unsatisfactory 02 (8.3%). Conclusions: Conservative treatment is recommended for Gartland type I and nondisplaced type II fractures. Open reduction with two or three pins is the preferred treatment option for most supracondylar fractures. The use of appropriate criteria is wise in managing these cracks; Prognosis in the event of complications or possible complications should be explained.

Dumontier group 2 radiocarpal fracture-dislocation: The results of open reduction and fixation without volar ligament repair

IntroductionThe radiocarpal fracture-dislocations are a spectrum of severe injury involving both the bony and ligamentous structures that stabilise the wrist joint. The aim of this study was to analyse the outcome of open reduction and fixation without volar ligament repair for Dumontier group 2 radiocarpal fracture-dislocation and to evaluate the incidence and clinical relevance of ulnar translation and advanced osteoarthritis. Patients and methodsWe retrospectively reviewed 22 patients with Dumontier group 2 radiocarpal fracture-dislocation treated in our institute. Clinical and radiological outcomes were recorded. Postoperative visual analogue scale (VAS) score for pain, Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH), and Mayo modified wrist scores (MMWS) were collected. Furthermore, extension‒flexion and supination‒pronation arcs were collected by reviewing chart, either. We divided the patients into two groups according to the presence or absence of advanced osteoarthritis, and presented the differences in the pain, disability, wrist performance, and range of motion between the two groups. We performed the same comparison between the patients with and those without the ulnar translation of the carpus. ResultsThere were sixteen men and six women with a median age of 23 years (range, 20‒48 years). The median follow-up period was 33 months (range, 12–149 months). The median VAS, DASH and MMWS were 0 (range 0–2), 9.1 (range, 0–65.9) and 80 (range, 45–90), respectively. The median flexion‒extension and pronation‒supination arcs were 142.5° (range, 20°‒170°) and 147.5° (range, 70°‒175°), respectively. Ulnar translation was recognised in four patients and the development of advanced osteoarthritis was noted in 13 patients during the follow-up period. However, neither was highly correlated with functional outcomes. ConclusionThe current study postulated that ulnar translation might occur following treatment for Dumontier group 2 lesions, whereas injury was predominantly caused by rotational force. Therefore, radiocarpal instability should be recognized during the operation. However, the clinical relevance of ulnar translation and wrist osteoarthritis needs to be assessed in further comparison studies.

OUTCOMES OF OPEN REDUCTION AND INTERNAL FIXATION OF FRACTURE OF NECK OF TALUS

Background: Talus is the second largest tarsal bone with unique importance regarding its location and anatomy . It is an osseous link between foot and the leg and has got a pivotal role in overall foot function . It has got three important articulations at tibiotalar , talocalcaneal and talonavicular joint . It is divided into body , neck and posterior facets. Almost 70% surface of talus is covered with articular cartilage . Its blood supply is predominantly extraosseous and is at risk during fractures .&#x0D; Objectives : The aim of our study is to observe the long term outcomes after surgical treatment of fracture neck of talus .&#x0D; Study design : Prospective cross sectional study .&#x0D; Study setting : Department of Orthopedic Surgery Services hospital , Lahore&#x0D; Study duration : From Dec 2017 – Feb 2020&#x0D; Methodology: After approval from hospital ethical review board , total number of 30 patients with fracture neck of talus , both males ( 20 patients ) and females ( 10 patients ) were included in the study . Each patient underwent X-rays of ankle joint AP , LAT and ankle mortis views .. All these fractures were fixed with 4 mm cannulated screw by using combined anterolateral and anteromedial approach.&#x0D; Results: Post-traumatic arthritis was observed in 15 patients (50.0%) out of the 30 patients with 10 (75.0 %) patients at subtalar joint and 5 (25.0 %) patients at ankle joint. Among these 30 patients , 8 (26.7%) patients were having Hawkins type 2 , 14 (46.6%) with Hawkins type 3 and remaining 8 (26.7%) patients with were having Hawkins type 4 fractures. Osteonecrosis was mostly observed in Hawkins type 3 fractures 6 (42.8%) in Hawkins type 3, 2 (25.0%) patients in Hawkins type 2 fractures and 1 (12.5%) patient in Hawkins type 4 fractures. 1 (3.3 %) patient developed non-union and 1 (3.3 %) patient developed delayed union. 4(13.3 %) patients developed the superficial infection which was treated with IV antibiotics and wound irrigation .&#x0D; Conclusion: We concluded from our study that familiarity with the complex vascular , bony , surgical anatomy and techniques for rigid fixation of fractures is of utmost importance for fracture neck of talus . Rate of osteonecrosis , arthritis , mal-union and non-union are still high even in the presence of rigid internal fixation of these fractures

Outcome of Open Reduction Alone or with Concomitant Bony Procedures for Developmental Dysplasia of the Hip (DDH).

Introduction: Developmental dysplasia of the hip (DDH) is commonly managed in a tertiary centre and regularly involves surgical treatment. The aim of this study is to determine the surgical outcome of DDH patient treated with either open reduction alone or combined with bony procedures in our institution. Methods: Medical records of DDH patients treated surgically were reviewed. Patients were divided into two groups: Group A: underwent open reduction (OR) only; and Group B: underwent open reduction with additional bony procedures (ORB), such as pelvic or femoral osteotomy. Modified McKay classification was used to evaluate the clinical outcome, and Severin classification for the radiological outcome. Presence of avascular necrosis and other post-operative complications were recorded. Results: A total of 66 patients (76 hips) were reviewed with the mean age of 11.9 ± 4.8 years. Mean duration of follow up was 8.6 ± 4.7 years (ranged 2 to 23 years). From our sample, 50/66 patients (75.8%) achieved satisfactory clinical outcome, whereas 48/66 patients (72.7%) had satisfactory radiological outcome. A higher proportion of patients achieved satisfactory outcomes in the OR group compared to the ORB group (p < 0.05), but no difference was seen in terms of radiological outcome (p = 0.80). Overall, 23 hips (34.8%) developed radiographic evidence of avascular necrosis (AVN). Nineteen hips had undergone ORB, although they were mainly (63.2%) Grade I AVN. Incidence of AVN was comparable in both groups (p = 0.63), but presence of AVN led to a higher proportion of unsatisfactory clinical and radiological outcome (p < 0.05). Other complications included redislocation/subluxation (13.6%) and bleeding (0.1%). Conclusions: Good overall outcome of DDH surgery was achieved in our centre. The OR group may produce a better clinical outcome, but with similar radiological results and AVN rate with the ORB group. The presence of AVN is associated with unsatisfactory clinical and radiological outcomes.

Results of Open Reduction and Internal Fixation of Proximal Third Both Bones of Forearm Fractures in Adults

Results of Open Reduction and Internal Fixation of Proximal Third Both Bones of Forearm Fractures in Adults

Excision Versus Replacement in Unrepairable Comminuted Fractures of the Radial Head: A Systematic Review of Outcomes and Complications.

The radial head fractures comprise approximately 4% of all fractures around the elbow. The outcomes of open reduction and internal fixation are poor in fractures with more than three fragments, and the excision of radial head is considered a viable surgical treatment option. However, it is associated with its own set of complications. The radial head prosthetic replacement has emerged as an alternative in management of these fractures with constraints of cost and related complications. Hence, the treatment for the unrepairable comminuted radial head fractures still remains controversial. This systematic review and meta-analysis was conducted to compare the post-operative outcomes of the radial head excision versus prosthetic replacement in comminuted Mason type-III fractures of radial head. Three databases of Medline (PubMed), Scopus, and Embase were searched for comparative studies on the study question and relevant studies which mentioned at least one of the outcomes of interest (functional outcome scores and number of complications) were included. Six studies were part of this review with 82 excisions and 99 prosthetic replacements. There was no significant difference between the two groups in terms of number of complications (OR 0.65; 0.08-5.07); and measures of functional outcomes; Mayo elbow performance score or MEPS (mean difference - 6.56; - 23.45 to 10.33). The incidence of elbow osteoarthritis, heterotrophic ossification, stiffness, and instability were similar in both groups. The flexion extension arc in degrees was better in excision group (mean difference 9.93; 1.31-18.55; p = .02). Excision is a reasonable surgical option for isolated comminuted radial head fractures with similar results of function and associated rates of complications as prosthetic replacements. The arc of motion is also better with excisions. There have been reports of more osteoarthritis with excision and arthroplasty has been advised in younger patients; however, we had no quantitative proof of that in this review.

Comparison of open reduction and fixation with hook plate and modified closed reduction and fixation with tightrope loop plate for treatment of rockwood type III acromioclavicular joint dislocation

ObjectiveTo compare the outcomes of open reduction and hook plate fixation (ORHPF) and modified TightRope loop plate fixation (MTRLPF) in the treatment of Rockwood type III acromioclavicular joint dislocation.MethodsThis was a retrospective study. Data on 71 patients with Rockwood type III acromioclavicular joint dislocation who underwent either ORHPF (n = 39) or MTRLPF (n = 32) between January 2016 and October 2019 were extracted and analyzed. Baseline data at injury were compared to evaluate the balance. The disabilities of the arm, shoulder, and hand (DASH) score, Constant-Murley score and visual analog scores (VAS) score at 1 month, 3 months, 6 months and 12 months after operation were compared; further, at 12 months coracoclavicular distance and related complications were evaluated and compared.ResultsBoth groups did not differ for any baseline data. At 1 and 3 months after operation, MTRLPF group exhibited a significantly better performance than the ORHPF group in VAS (1 month: 2.4 ± 1.8 vs 3.0 ± 1.7; 3 months: 1.2 ± 1.4 vs 1.8 ± 1.6), Constant-Murley (1 month: 75.2 ± 11.2 vs 63.8 ± 13.7; 3 months: 81.4 ± 9.8 vs 75.8 ± 10.6), DASH (1 month: 33.6 ± 6.8 vs 40.6 ± 6.1; 3 months: 21.2 ± 7.4 vs 25.6 ± 6.6). At 6 months, only Constant-Murley remained marginally significant (p = 0.048). At 12 months, no statistical difference was observed for any outcome variable (all P > 0.05 for VAS, Constant-Murley and DASH), coracoclavicular distance (12.7 ± 1.6 mm vs 12.2 ± 1.6 mm; P = 0.374), or overall complication rate (P = 0.763).ConclusionsFor Rockwood type III acromioclavicular joint dislocation, both methods can achieve satisfactory 1-year results, but modified minimally invasive TightRope treatment is more advantageous in early functional recovery at 1 and 3-month follow-ups.

Outcome of open reduction and Kirschner wire fixation in pediatric radial neck fracture.

BackgroundRadial neck fracture in children is rare. This study attempted to evaluate the outcome of surgically treated patients and any associated complications.MethodsThis study evaluated 23 children under 15 years of age with radial neck fracture who were treated with open reduction between 2006 and 2016 to determine their range of motion, postoperative complications, and radiographic outcomes. The results were assessed clinically using the Mayo clinic elbow performance score.ResultsThe mean follow-up duration for patients was 34.6 months. The average postoperative angulation was 3.6º. Hypoesthesia was reported in only 9% of patients, and none of the patients complained of postoperative pain. The postoperative X-ray results were excellent in 60% and good in 40%. No radiographic complications were identified. The elbow score was excellent in 87% and good in 13% (mean score, 96.74). There was a statistical relationship between range of motion limitations and age, degree of fracture, initial displacement, and surgical pin removal time.ConclusionsAlthough most patients accept the closed reduction method as a primary treatment, the present study suggests that an open-reduction approach has been associated with optimal therapeutic outcomes for patients in whom closed reduction was not satisfactory or indicated.

Result of Ankle Fracture Fixation, Our Hospital Experience

Aims and Objectives: The goal of this study was to see the outcome of open reduction and internal fixation for ankle fractures.&#x0D; Methods: A prospective analysis of 40 ankle fractures of adult patients handled surgically using diverse approaches in the period from January 2019 to January 2020 at the Orthopedic department of SMBBIT, Dow University of Medical and Health Sciences. Karachi Pakistan. The ankle grading system developed by Baird and Jackson was used to assess the functional result.&#x0D; Results: We achieved 87.5 percent outstanding to good outcomes, 6.3 percent fair outcomes, and 6.2 percent bad outcomes in our study. The findings were comparable to those of other researchers around the world.&#x0D; Interpretation and Conclusion: In 87.5 percent of patients, the operational results were satisfactory, with good to outstanding functional outcomes. With stable fracture fixation, excellent outcomes are attained. Cancellous screws are better for internal fixation of the medial malleolus, while Malleolar screws are superior for that task. For ankle fractures treated surgically, patients may expect to have satisfactory function thereafter.

Outcome of Open Reduction and Internal Fixation of Posterior Acetabular Fractures

Background:Acetabular fractures are a common clinical challenge. The posterior wall fractures represented 35% of all acetabular fractures and usually complexed. The curative treatment is surgical and depends on the fracture anatomy and surgeon preferences. Aim of the Work:The current study aimed to assess the short term results of posterior acetabular fractures management by open reduction and internal fixation. Patients and Methods:Thirty patients with displaced posterior wall acetabular fractures were included. They were treated by open reduction and internal fixation using neutralizing plates and screws. All patients were assessed by a pre-prepared trauma assessment sheet. Post-operative, active assisted and pain free passive range of motion exercises in all planes was advised. Functional outcome was evaluated using the Merle D'Aubinge and Postel score. Patients were followed up initially at 3 weeks intervals for first 2 months and thereafter at 6 weekly intervals for the next 6 months. Result:Patients were classified to two groups: Group [A] “70%” patients with isolated posterior wall fracture, and Group [B] “30%” of patients with posterior column plus posterior wall acetabular fracture. Both groups were comparable regarding age, gender, side and mode of trauma. The double plating fixation method was significantly increased in group B when compared to group A [77.8% vs. 0.0% respectively]. Group B was associated with significant increase of operative time than group A [164.44±13.33 vs. 128.57±27.80 minutes, respectively]. Blood loss significantly increased in group B than group A [1422.22±376.76 vs. 780.95±437.46 ml, respectively]. The excellent outcome was significantly associated with younger age, lower or absent complications, and anatomical [good quality] of direct postoperative radiological outcome. Conclusion: Most of our patients had an excellent and good outcome as a result to application of more strict selection criteria of patients and pattern.

Osteosynthesis for Geriatric Acetabular Fractures: An Epidemiological and Clinico-Radiological Study Related to Marginal or Roof Impaction.

This retrospective study sought to elucidate the incidence rates of roof impaction (RI) and marginal impaction (MI) and radiological and clinical outcomes of open reduction and internal fixation (ORIF) for RI and MI in geriatric acetabular fractures. The cases of 68 patients aged ≥ 65 years (mean 71 years) treated with ORIF were analyzed. MI was present in 12 fractures (67%) and an RI of the weight-bearing surface was present in 24 (46%) of the potential fracture types. Regarding the reduction quality, 54% of the reductions were graded as anatomical, 37% as imperfect, and 9% as poor. In the clinical evaluations of the 45 patients who had > 1-year follow-up (follow-up rate: 66.2%), 18% were graded as excellent, 53% as good, 16% as fair, and 13% as poor. An anatomic reduction was strongly associated with good or excellent clinical and radiological outcomes. CT was superior to radiographs for detecting the residual displacement postoperatively. Postoperative deep infection occurred in four patients. Three patients (6.7%) underwent a total hip arthroplasty conversion due to secondary osteoarthritis of the hip. We recommend ORIF as the preferred surgical treatment option for displaced acetabular fractures in elderly patients.

Outcomes of open reduction and internal fixation of proximal humerus fracture dislocations.

Proximal humeral fracture with associated glenohumeral dislocation (PHFD) is a challenging clinical problem. Outcomes of open reduction and internal fixation (ORIF) of these injuries have not been widely reported. The purpose of this analysis is to report our experience with ORIF of PHFD. A retrospective review of our 2 institutions' shoulder surgery databases was conducted to identify all PHFDs that were treated with ORIF from 2008 through 2017. Radiographs were reviewed for fracture healing by 12 weeks postoperatively. All reoperations were recorded. Patient-reported outcomes using Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores at a minimum 2-year follow-up were recorded. There were 20 PHFDs identified: they were 50% male, 55.8 ± 10.3 years old (range 31.3-66.3), and had a body mass index of 29.3 ± 8.2 (15.2-47.8). Seven (35%) patients experienced varus collapse, nonunion, or avascular necrosis and 6 (30%) patients underwent reoperation. Of the 17 patients who did not go on to revision or arthroplasty, 14 (82.3%) had patient-reported outcomes at a mean follow-up of 4.9 ± 2.2 years (2.3-8.8). These patients had an average SST 8.0±4.0 yes responses (0-12) and ASES scores of 71.6 ± 20.4 (20.2-94.9). ORIF of PHFD carries a high rate of reoperation. In patients who achieve healing, functional scores are satisfactory. This information is important for proper patient counseling prior to surgery.