Results Of Operative Management Research Articles

Improved Outcomes in Operative Management of Concomitant Distal Radius and Scaphoid Fractures.

This study aims to investigate the characteristics of concomitant distal radius and scaphoid fractures and determine outcome differences of operative and nonoperative management. A retrospective search of a level-1 trauma center's database over a 15-year period (2007-2022) for concomitant distal radius and scaphoid fractures in adult patients was completed. In all, 31 cases were reviewed for mechanism of injury, method of fracture management, distal radius fracture AO Foundation/Orthopaedic Trauma Association classification, scaphoid fracture classification, time to radiographic scaphoid union, time to motion, and other demographics. A multivariate statistical analysis was completed comparing outcomes in operative versus conservative management of the scaphoid fracture in these patients. Outcomes were defined as time to radiographic union and time to motion. In all, 22 cases of operative fixation of the scaphoid and 9 cases of nonoperative management of the scaphoid were reviewed. One case of nonunion was identified in the operative group. Operative management of scaphoid fractures resulted in a statistically significant reduction in time to motion (2-week reduction) and time to radiographic union (8-week reduction). This study demonstrates that operative management of scaphoid fractures in the setting of a concomitant distal radius fracture reduces the time to radiographic union and time to clinical motion. This suggests that operative management is ideal in patients who are good candidates for surgery and desire earlier return of motion. However, conservative management should be considered, as nonoperative care showed no statistical difference regarding union rates of scaphoid or distal radius fractures.

Outcomes of operative management in the delayed presenting neck of femur fractures in children: A case series.

Fracture neck of femur in pediatric age group occurs due to high energy trauma and is an uncommon entity with high complication rate. No uniform guidelines are present to manage these fractures, especially in delayed presentation of fracture neck of femur as a smaller number of such cases were reported. Eight children (nine hips), five boys and three girls of age <15 years, were operated on. The mean delay in surgery time was 8.6 days (range: 5-22 days). The mean union time was 13.44 weeks. The mean follow-up was 20.88 months (range: 12-36 months). All the cases were managed with closed or open reduction followed by internal fixation with or without hip spica application and resulted in satisfactory outcomes in most of the cases. Anatomical reduction (open or closed) and fixation reduce the risk of complications even in delayed presentation if the orthopedic surgeon is familiar with the management.

Composite Criteria for Non‐Operative Management of Acute Non‐Complicated Appendicitis Result in Low Failure Rates

The aim of this study is to investigate the outcomes of conservative management of non-complicated acute appendicitis (AA) using our unique institutional protocol, and to compare between these and the outcomes of operative management. Patients admitted to our institution between March 2016 and October 2019 with non-complicated AA were grouped according to their initial management: non-operative versus surgical. Our unique protocol for non-operative management includes: pain< 3days; afebrile upon admission; non-gravid; WBC<15,000 (× 109/L); CRP< 5mg/dl; appendix diameter < 1cm; no appendicolith on imaging; no prior episode of AA; no history of Inflammatory Bowel Disease; no evidence of peritonitis on physical examination. The primary outcome measured was failure of non-surgical management during the index admission. Secondary outcomes included recurrence rate, readmissions, complications, length of antibiotic treatment and length of stay (LOS). A total of 695 patients were included, 436 in the operative group and 259 in the non-surgical treatment group. The mean follow-up time was 1004.9 ± 205.7days. Patients initially treated conservatively rarely required surgery during their index admission (6.9%). Recurrence rate was 19.1% after a mean follow up of 33.4months. The overall failure rate of conservative management was documented in 20.8% of the patients. The complication rate was higher in those treated with upfront surgery (1.6% vs. 0.4%, p < 0.001). The overall LOS was not statistically different between the groups. Our composite protocol for non-surgical management of non-complicated AA results in a low failure rate. A well calculated patient treatment allocation in non-complicated AA can advocate for wide-spread use of the conservative approach.

Functional Results and Outcomes After Repair of Partial Proximal Hamstring Avulsions at Midterm Follow-up

Background: Partial avulsions of the proximal hamstring origin remain a challenging problem with nonoperative treatments frequently providing limited success. The literature is limited regarding the outcomes of operative management in the active and athletic population. Hypothesis: Surgical fixation of proximal hamstring ruptures will have favorable outcomes at midterm follow-up. Study design: Case series; Level of evidence, 4. Methods: A total of 64 patients with partial avulsions of the proximal hamstring origin treated with surgical fixation by a single surgeon were reviewed at a 2-year minimum follow-up. All patients had initially undergone failed nonoperative treatment. Patient-reported outcome scores on the Lower Extremity Functional Score (LEFS), Marx Activity Rating Scale, custom LEFS and Marx scales, and total proximal hamstring score were evaluated. Data on patient-perceived strength, return to sport, and satisfaction were also collected. Results: The cohort included 27 male and 37 female (N = 64) patients with a mean age of 47.3 years (range, 16-65 years), and all were reviewed at a mean 6.5-year (range, 2-12.5 years) follow-up. The average postoperative LEFS was 96% (range, 68%-100%), with the custom LEFS being 90% (range, 39%-100%). The mean Marx score was 12.4 (range, 4-16). The Marx custom score demonstrated no disability with activities of daily living. The mean total proximal hamstring score was 94% (range, 69%-100%). No differences in any outcome measures were seen when comparing acute versus chronic repairs. Three patients underwent further hamstring surgery. No patients reported symptoms of numbness in the operative extremity at rest, while 3 patients had a superficial stitch abscess treated with antibiotics alone. The most commonly reported difficulty was with prolonged sitting. Ninety-seven percent were satisfied with surgery, 92% reported they could participate in strenuous activity, and 97% estimated their strength to be >75%, while 64% estimated it to be 100% of their contralateral side. Patients returned to sport at an average of 11.1 months, and all that returned were satisfied with their performance. Conclusion: Both early and delayed anatomic surgical repair of partial proximal hamstring avulsions leads to successful functional outcomes, a high rate of return to athletic activity, and low complication rates at the 6.5-year follow-up. Nonoperative treatments should first be attempted.

A prospective study of the functional outcomes in operative management of intra-articular Calcaneum fractures

A prospective study of the functional outcomes in operative management of intra-articular <i>Calcaneum</i> fractures

Modalities of treatment for segmental tibia fracture

Background: Segmental tibia fractures (AO 42-C2) are defined by two or more distinct fracture lines isolating an interposed cortical segment which excludes butterfly fragmentation. Severe soft tissue defects are common due to their association with high energy trauma mechanisms of injury. Objectives: This study is an attempt to observe the various outcome of operative management of segmental tibia fracture treated by various modalities like intramedullary nailing, plating and external fixator. The results have been studied in depth to determine which modality is better for management of this type of fracture. Material & Methods: This is a prospective study of 25 cases of segmental tibia fracture treated by intra medullary nailing or plating or external fixator with minimum 6 months of follow up. All cases are evaluated according to time of union, complications, range of motion and modified knee society score. Modified knee society Score on residual effects on clinical ground at final examination. Points are given for pain, function and range of motion in modified knee society score. Result: Mean knee ROM in intramedullary nailing group is 118, while in plating group is 113.33.Average time of union in intramedullary nailing group is 18.61weeks; while in plating group is 25.33 weeks. Result according to Modified knee society score was found to be excellent to good in 18(72%) patients.11(73%) patients treated by interlocking intramedullary nailing had excellent to good knee score. Conclusion: Interlocking intramedullary nailing is a excellent method of treatment for the segmental tibia fracture as it provides rotational stability, gives excellent to good result, lower rate of complications and good knee ROM. Key words: Segmental tibia fracture, Modified knee society score, Intramedullary nailing.

Operative Management of Spinal Infection Among Intravenous Drug Abusers

Recent population-level increases in intravenous drug abuse (IVDA) may contribute to incidence of spinal infection. The aim of this study was to evaluate national trends of spinal infections and evaluate effect of IVDA on outcomes in operative management of spinal infection. Using the National (Nationwide) Inpatient Sample database for 2002-2014, all patients undergoing spinal decompression or fusion for treatment of spinal infection were evaluated. Inpatient outcomes included length of stay, total cost, complications, discharge to facility, reoperations, and inpatient mortality. Bivariate and multivariate logistic regression analyses were performed to compare patients with IVDA and patients without IVDA. A total of 60,964 patients undergoing surgical management of spinal infection were identified. Number of surgically managed spine infections increased from 2002 to 2014 (P < 0.0001). Proportion of surgically managed spine infections associated with IVDA increased from 3.3% in 2002 to 14.0% in 2014 (P < 0.0001). IVDA was associated with increased hospital length of stay (odds ratio= 1.38; 95% confidence interval, 1.32-1.45; P < 0.0001) and greater total charges (odds ratio= 1.23; 95% confidence interval, 1.17-1.29; P < 0.0001). No other significant differences between groups were noted. From 2002 to 2014 in the United States, the incidence of operatively treated spine infections increased 227.9%, and the proportion of cases associated with IVDA significantly increased. Patients with IVDA had a longer mean length of stay and increased inpatient cost of care but were not at increased risk for complication, reoperation, or mortality. These findings are important for surgeons, internists, hospitals, and insurers to ensure proper resource allocation in treating these at-risk patients.

AO type C distal femur fracture: results of operative management in 52 patients

Background: Intraarticular distal femur fractures are severe injuries posses many challenges in management and associated large number of complications like infection, knee stiffness, delayed union, nonunion, instability, and post-traumatic arthritis. The advent of distal femur locking plate has improved the operative outcome of these fractures. Aim and Objectives: This retrospective study aimed to determine the functional, clinical and radiological outcome of AO type C distal femur fractures treated with distal femur locking plate. Level and type of study: Level 4, A retrospective study. Methods: We retrospectively reviewed 52 patients with AO type C distal femur fracture in our hospital between January 2010 to December 2017. Patients were selected according to strict inclusions criteria and operated distal femur locking plate through medial parapatellar or modified swashbuckler approach. The functional and radiological outcome were studied using NEER knee score. Results: Total 52 patients in which 38 males and 14 females with a mean age of 41.77 years, a mean follow up of 14.56 months were included in our study. According to AO classification, 12 patients of type C1 fracture, 14 of C2 fracture and 26 of type C3 fracture were included. Average time of union was 18.4 weeks and average NEER score at final follow up was 77.68 with 18 patients had excellent, 22 patients had satisfactory results, 7 were had fair results and 5 had poor results. The average range of flexion was 95.860. Conclusion: Distal femur locking plate is better to provide angular stability, multiple options to secure fracture fragments both metaphyseal and articular to restore limb length, joint congruity, and varus-valgus alignment. Along with the anatomical reduction of joint surface and rigid fixation, early mobilization and proper physiotherapy are mandatory to get the optimum outcome.

Outcome of operative management of displaced acetabular fracture: A retrospective analysis of a tertiary care center of a developing country

Introduction: Displaced acetabular fracture is a consequence of high energy trauma and commonly seen in young population. There has been increasing trend towards operative management of these injuries to provide early mobilisation and prevent complication of incongruent reduction.&#x0D; Methods: A retrospective analysis on clinical outcome of operative management of 16 displaced acetabular fracture using Merle d’Aubigne hip score carried out at university teaching hospital carried out between 2015 to 2017 AD&#x0D; Result: The Merle d’Aubigné hip score at final follow of 3 to 30 months period ranged from 7 to 17. The average score was 13.8. Very good result was seen in 68.75%, fair result in 12.5%.&#x0D; Conclusion: Operative management of displaced acetabular fracture gives excellent to good short term outcome in most of the cases.

Operative Management of late Presented Displaced Lateral Condyle Fracture of Humerus in Children

Management of late presented displaced fracture of lateral condyle of humerus in children is controversial, many recommend conservative management due to fear of complications like avascular necrosis but recently many are advocating for operative management with good results hence we studied the outcome of operative management in late presented displaced lateral condyle fracture of humerus in children. We studied 22 children aged between 4 to 11 years, presenting 3 to 16 weeks from injury. All underwent open reduction and internal fixation with Kirschner wires with or without additional screw and followed up for average 18.05 months. Elbow range of motion, angular or local deformity, premature fusion of physis, avascular necrosis and fracture union were noted and analyzed using modified Aggarwal et al criteria. We had 9 (40.91%) excellent, 5 (22.73%) good, 5 (22.73%) fair, 3 (13.63%) poor result. Overall satisfactory results were seen in 19 (86.37%); 3 (13.63%) had poor result , one due to AVN, two due to premature fusion of physis and visible local deformity. All poor result were seen among delay of operation 6 weeks or later. There was significant improvement of elbow range of motion and all fracture united. Outcome of operation without bone grafting on lateral condyle fracture of humerus in children who presents late up to 5 weeks are excellent; whereas outcome of delayed operation up to 16 weeks also gives good functional recovery and union.

Complication Rates and Short-Term Outcomes After Operative Hammertoe Correction in Older Patients.

Hammertoe deformities are the most common lesser toe deformity. To date, no studies have looked at outcomes of operative management in the geriatric population, which may be at greater risk for complications or functional compromise because of comorbidities. Data on 58 patients undergoing operative correction of hammertoe deformities were prospectively collected. Clinical outcomes were assessed using preoperative and postoperative visual analogue scale (VAS) and Short Form Health Survey (SF-36) scores with a minimum of 6-month follow-up. Patients were divided into 2 groups on the basis of age at the time of surgery: younger than 65 and 65 and older. Complication rates and mean VAS and SF-36 improvement were compared. Forty-seven patients met inclusion criteria (7 men, 40 women), with 26 patients (37 toes) in the younger cohort and 21 patients (39 toes) in the older cohort. Overall, patients demonstrated significant improvement from baseline to 6 and 12 months postoperatively in VAS ( P < .001 and P < .001) and SF-36 ( P < .001 and P < .001) scores. Mean improvement in VAS and SF-36 scores was not significantly different between the groups at 6 and 12 months postoperatively. Complications occurred in 13.5% and 10.3% of patients in the younger and older cohorts, respectively. Outcomes of operative correction of hammertoe deformities in older patients were similar to outcomes in younger patients after greater than 6 months of follow-up. Overall improvement in VAS and SF-36 was statistically significant for both cohorts. There was no associated increase in complications for older patients. Level, III comparative series.

To Evaluate Results of Operative Management of Tibial Plateau Fractures

To Evaluate Results of Operative Management of Tibial Plateau Fractures

Functional Outcome of Unstable Intertrochanteric femur fracture treated with intramedullary nailing

Background: Femoral pertrochanteric fracture is one of the most frequently occurring fractures in the elderly, usually following trivial trauma. In the younger age group of people, it occurs almost always due to high velocity trauma. Objectives: This study aimed to study the functional outcome of operative management of unstable intertrochanteric fracture treated by intra medullary nailing. The results have been studied in depth with a view to outline guideline for better management of this fracture. Material & Methods: A prospective study of 75 cases of unstable intertrochanteric femur fracture treated by intra medullary nailing, minimum 6 months of follow up. All cases are evaluated according to Modified Harris Hip Score on residual effects on clinical ground at final examination. Pain & functional capacity are the two basic considerations for this scoring system. Points are given for pain, function, range of motion & absence of deformity. Result: Functional result according to Modified Harris Hip score was found to be excellent in 43(57.33%) patients, good in 19(25.33%) patients, fair in 3(44%) patients & poor in 10(13.33%) patients. poor outcome occurs due to development of complications and old age & medical illness. Conclusion: Modified Harris Hip Score is good score to evaluate functional outcome of the unstable intertrochanteric fracture treated with intramedullary nailing. Unstable intertrochanteric fracture treated with intramedullary nailing gives Excellent to Good (82.66%) functional results. Key words: Unstable intertrochanteric fracture, Modified Harris Hip score, Proximal Femoral Nail.

Volar plating in distal end radius fractures and its clinical and radiological outcome as compared to other methods of treatment

Background: Fracture of the distal end radius constitutes one of the most common skeletal injuries treated by the orthopedic surgeon. Wide arrays of techniques have been described including closed reduction, percutaneous fixation and open methods of reduction, and stabilization. Displaced extra- or intra-articular distal radius fractures require accurate reduction to allow a good outcome. We assessed the outcome of volar plate osteosynthesis and compared its outcome with other methods of treatment to confirm satisfactory reduction and functional outcomes. Materials and Methods: Prospective study conducted in our medical institution between 2012 and 2013. Inclusion criteria included skeletally mature patients who presented to casualty with fractures of the distal radius. Closed reduction cast application/K-wire fixation/open reduction and internal fixation with a volar plate was done under general anesthesia in 60 patients (20 cases each). During the follow-up, radiological and functional parameters were assessed and Gartland and Werley scoring was done. Results: Patients with volar plate fixation had a better outcome than the K-wire fixation and cast application. Radiological parameters were well-maintained, and functional parameters showed a significant improvement during the follow-up period. The complication rate was less and insignificant. Conclusion: Primary volar plate fixation of unstable distal radius fracture provides a stable construct that helps in early mobilization, thereby better functional outcomes and minimizes chances of delayed/malunion and, thereby is an upcoming method of choice for fracture distal end of radius. The present study comprised of 60 patients of distal radius fractures in 20 patients treated by plating, 20 by cast application and 20 by K-wire application. The minimum follow-up was 8 weeks, and the maximum was 36 weeks. This study was undertaken to assess the functional outcome of operative management of distal radial fractures and the following conclusions were drawn - male patients predominated female patients (36 males to 24 females) and average age of patients is 46.01 years. Left sided fractures were more common (61.6%). Road traffic accident was the commonest cause of the trauma (73.3%). AO 23 A-2 was the most common type of fracture, accounting for (26.6%) with Associated injuries seen in 4 patients (6.6%). Functional outcome as per Gartland and Werley was 3.75 for plating, 8.6 for cast application, and 7.55 for K-wire fixation. About 90% excellent to good results were observed in plating group as compared to 55% in cast and 65% in K-wire fixation in demerit score. Complication such as irregular articular surface, wrist pain, finger stiffness, K-wire loosening was observed. Thus, based on this study, we conclude that volar plating has relatively better outcome for distal end fractures of radius particularly volar Barton fractures, with minimum chance of loosening of implant even in highly comminuted cases and cases having osteoporosis.

Midterm functional outcome after operative management of midfoot injuries.

Background. Injuries of the midfoot are often missed and therefore underestimated. Early diagnosis and treatment are crucial for the final outcome. The primary aim of this study was to assess the pattern and results of early operative management of mid-foot injuries after a midterm follow up. Material and methods. This study was conducted on 25 patients (19 Males, 6 Females ) with mean age of 34.6 years (range 18-60 years) with mid-foot fracture dislocations who were admitted consecutively at our centre from May 2008 through November 2010. 25 patients fulfilling our inclusion criteria with mid-foot fracture dislocations were included in this study. Mechanism of injury, its pattern and results of operative management of midfoot injuries were assessed after acute management of these fractures on urgent basis. Evaluation of results was done by AOFAS Score. Results. Most common mode of injury was indirect trauma due to fall (n=12) followed by road traffic accident (n=9). Males (n=19) outnumbered females (n=6). The pattern of injuries requiring operative treatment as per our criteria were Lisfranc fracture dislocations (n=22) and navicular fractures (n=3). The mean follow up was 3.2 years and mean AOFAS score at 3.2 years was 78.36, with most patients losing points to pain and decreased recreational function. Conclusion. The Lisfranc fracture dislocations are the most common injuries around midfoot requiring operative treatment, and we believe that operative treatment considerably improves functional outcome in these injuries.

Hyperparathyroidism-jaw tumor syndrome: Results of operative management

Hyperparathyroidism-jaw tumor syndrome (HPT-JT) is a rare, autosomal-dominant disease secondary to germline-inactivating mutations of the tumor suppressor gene HRPT2/CDC73. The aim of the present study was to determine the optimal operative approach to parathyroid disease in patients with HPT-JT. A retrospective analysis of clinical and genetic features, parathyroid operative outcomes, and disease outcomes in 7 unrelated HPT-JT families. Seven families had 5 distinct germline HRPT2/CDC73 mutations. Sixteen affected family members (median age, 30.7 years) were diagnosed with primary hyperparathyroidism (PHPT). Fifteen of the 16 patients underwent preoperative tumor localization studies and uncomplicated bilateral neck exploration at initial operation; all were in biochemical remission at most recent follow-up. Of these patients, 31% had multiglandular involvement; 37.5% of the patients developed parathyroid carcinoma (median overall survival, 8.9 years; median follow-up, 7.4 years). Long-term follow-up showed that 20% of patients had recurrent PHPT. Given the high risk of malignancy and multiglandular involvement in our cohort, we recommend bilateral neck exploration and en bloc resection of parathyroid tumors suspicious for cancer and life-long postoperative follow-up.

Outcomes in operative management of pancreatic cancer.

Pancreatic cancer is a highly lethal malignancy that often presents at an advanced stage. Surgical resection can prolong survival and offers the only potential for cure. However, pancreatectomy is associated with significant morbidity and mortality. This article reviews perioperative outcomes, post-resection long-term survival, and innovations in the surgical management of pancreatic cancer.

Good outcomes in operative management of acquired prothrombin complex deficiency: a serial case report

Background Acquired prothrombin complex deficiency (APCD) is a serious bleeding disorder in infants caused by idiopathic vitamin K deficiency. This disorder has a high mortality rate and sequelae are often seen in those that survive. The principal treatments are giving vitamin K and evacuating hemorrhages.Objective To report the outcome of surgical and non-surgical management in several cases of APCD.Method Eighteen infants diagnosed with APCD had similar histories: all were less than 4 months of age as well as exclusively breastfed, and none received vitamin K injections after birth. The diagnosis of APCD was made based on prolonged prothrombin times and proven intracranial hemorrhage on brain CT-scan. All subjects were treated with vitamin K injections for 5 days and offered craniotomy procedures.Results Out of 18 subjects, 10 underwent craniotomies, 9 within 48 hours of diagnosis and 1 on the fifth day of hospitalization. Two patients with small subdural hematomas were treated conservatively. Four subjects refused hospitalization. Two refused the craniotomy and died. All patients treated (12 cases), with both surgical and conservative treatment, were survived. Survivors were followed for 6 months and 10 of whom returned to the hospital for follow-up (9 patients who had operative procedures and 1 who did not). One patient who with craniotomy on the fifth day hospitalization had hydrocephalus as a sequela.Conclusion Operative procedure was needed for treatment of APCD in some cases with moderate until severe intracranial bleeding, while vitamin K injection only stop the progress of intracranial bleeding not as currable treatment of massive intracranial bleeding. [Paediatr Indones. 2011;51:298-302].

Outcome of operative management of extra-articular mid-shaft and distal tibial fractures in a district general hospital

Outcome of operative management of extra-articular mid-shaft and distal tibial fractures in a district general hospital

Surgical management of groin pain of neural origin

Background: An approach to surgical management of the patient with groin pain is described based on our experience with 54 patients, six of whom had bilateral symptoms. History and physical examination are sufficient to relate the pain to one or more of the lateral femoral cutaneous (LFC), ilioinguinal (II), iliohypogastric (IH), or genitofemoral (GF) nerves. Study Design: Retrospective analysis of patients with groin pain is reported, with emphasis on cause, involved nerves, and outcomes of operative management. The LFC was decompressed. The II, IH, and GF nerves were resected. Outcomes were graded as excellent, good, and poor in terms of pain relief and functional restoration. Results: For the entire series of patients with painful groins, excellent relief of pain was achieved in 68% and restoration of function achieved in 72%. Ten percent had a poor result. The best results were for II and IH, which were 78% and 83% excellent for both pain relief and restoration of function, with 11% and 17% having a poor result, respectively. The worst results were for the small group of patients with a GF problem, 50% of whom had an excellent and 25% a poor result. Patients who were likely to get an LFC entrapment were those with a nerve located above or within the inguinal ligament. Complications included bruising and cautery injury to the LFC. Conclusions: Groin pain of neural origin can be relieved with a high degree of patient satisfaction by considering whether one or more of four different nerves are the source of that pain, by realizing that symptoms can be referred to regions other than the groin, such as the pelvic viscera (IH), the knee (LFC), and the testicle (GF), and by treating the appropriate nerve(s) by either neurolysis (LFC) or resection.