Risk Of Soft Tissue Complications Research Articles

Esthetic Outcomes of Immediately Placed Implants with Convergent Transmucosal Profile: A Retrospective Single-Cohort Study.

Purpose: Immediate implant placement is a reliable solution to replace hopeless teeth, but this procedure may be associated to an increased risk of soft tissue complications in case of thin biotype. The use of tissue-level implants with a convergent transmucosal profile has been advocated to increase space for soft tissue, contributing to improve their stability and esthetics. The aim of this retrospective study was to evaluate the esthetic outcomes and the Patient-Reported Outcome Measures (PROMs) of immediately placed implants with a convergent transmucosal profile. Materials and methods: This single-cohort, monocentric, retrospective clinical study was conducted on patients treated with an immediately placed implant in the esthetic zone (from premolar to premolar). All the eligible patients were recalled for a clinical and radiographic follow-up visit. Results: This study included 20 patients (8 males, 12 females) with an average age of 55.5± 6.8 years, who received 20 implants, with a mean follow-up of 46.5± 15.3 months. At the time of follow-up, immediately placed implants showed a mean Marginal Bone Loss of 0.42± 0.49 mm, and a statistically significant improvement of the esthetic parameters from baseline to the last available follow-up; in particular, Pink and White esthetic scores (p=.001) and Papilla Index at mesial and distal sites (p<.001). All the patients reported a high satisfaction (VAS>9) both from esthetic and functional point of view. Conclusion: Immediately placed implants with convergent transmucosal profile in the esthetic zone showed good clinical and esthetic outcomes, with stable results over time.

Anterolateral and Medial Locking Compression Plates for the Management of Distal Tibial Fractures: A Comparative Prospective Study.

Open/close reduction (OR/CR) and internal fixation (IF) of displaced fractures of distal tibia with either a medial or anterolateral plate is a commonly performed procedure. Anterolateral plating avoids an incision along the medial subcutaneous border of tibia and has been shown to have reduced risk of wound complications. The aim of our study was to determine the functional outcome of these fractures treated with anterolateral and medial distal tibial locking compression plates. This was a prospective study that included 60 patients with distal tibial fractures (close or grade I open injury)divided into two groups with 30 patients in each where one group was treated with OR/CR and IF using an anterolateral distal tibial locking plate (Group A) and the other using a medial distal tibial locking plate (Group B). The duration of surgery and intraoperative blood loss and time to union were recorded for all the patients. Functional evaluation was done at one year in terms of pain, function and alignment using theAmerican Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, and complications, if any, were noted. Both the groups were comparable in terms of age, gender, time of presentation, AO classification and presence of wound. The mean duration of surgery as well as the intraoperative blood loss were more in the anterolateral plate group than in the medial plate group, but the difference was statistically insignificant. Ten patients (33%) with medial plates had symptomatic hardware and 7 (23.3%) underwent removal while only 3 (10%) patients in the anterolateral plate group had similar complaints and none had to undergo removal. Two patients with anterolateral plate and one with medial plate had malunion. The mean time to fracture union as well as the rate of infection was less and the functional outcome at one year was better in the group treated with anterolateral plates as compared to the one with medial plates, but the difference again was not statistically significant for all the parameters. With reduced risk of soft tissue complications and by obviating the need for implant removal, anterolateral plates can prove to be a better alternative to the medial plates especially in elderly patients in the management of these fractures.

A Staged Protocol for Treatment of High-Energy Tongue-Type Calcaneus Fractures: Surgical Technique and Case Series.

Displaced tongue-type calcaneus fractures are frequently associated with severe soft tissue injuries, and urgent relief of the displaced tongue fragment on the posterior soft tissues is essential to preventing soft tissue complications. If there is a complex articular injury, the soft tissue envelope often needs time for swelling to resolve to allow for a safe open anatomic reduction because premature open reduction internal fixation is often associated with increased complications. We have found that in high-energy tongue-type calcaneus fractures with complex articular injuries, a staged protocol consisting of initial percutaneous reduction and fixation with later definitive reconstruction is soft tissue friendly, allows early restoration of calcaneal morphology, and affords extensile approaches for eventual reconstruction. The purpose of this study was to describe our protocol of staged treatment of high-energy tongue-type calcaneus fractures, along with postoperative surgical outcomes, in a case series of 53 patients.Our series of patients had a high rate of intra-articular injury with marked initial displacement (mean Bohler angle -8.4±20.8 degrees). They were treated initially with percutaneous reduction and fixation at median 1 day postinjury (interquartile range [IQR] 0-1) and definitively at median 16 days postinjury (IQR 10-33). In this series, 2 of 53 (3.8%) patients developed a deep wound infection.In high-energy tongue-type calcaneus fractures at risk for soft tissue compromise or with a significantly displaced tongue fragment without initial soft tissue compromise, we found that staged management represents a feasible management strategy to mitigate risk of soft tissue complications and therefore helps facilitate safe definitive open treatment.

Are Rush Nails Still a Good Choice for Fibula Fixation in Ankle Fractures? A Retrospective Study with Five Years Follow-Up.

The aim of this retrospective study is to evaluate if Rush nail fixation still has a role in distal fibular fractures surgery compared with locking plate in terms of fixation quality, complications, functional results and patient satisfaction level. This study included 109 patients (average age 56.05), who had undergone operative treatment for bi- or trimalleolar fractures between 2009 and 2014. The patients were evaluated retrospectively, divided in group A (57 patients treated with Rush nail) and group B (52 patients treated with locking plate). The patients were evaluated at an average 4.9 years of follow-up (SD: 1.01) with Olerud-Molander Ankle Score (OMAS), American Orthopedic Foot and Ankle Society - Ankle-Hindfoot Scale (AOFAS) and Visual Analogue Scale (VAS) for clinical outcomes. X-rays were conducted to assess ankle osteoarthritis using the classification system by Takakura and joint space symmetry using measurements in comparison with contralateral ankles. The groups were homogeneous regarding age and gender. Patients treated with Rush Nail fixation (Group A) showed statistically significant worse clinical results at functional scores (78.1 Group A versus 88.7 Group B at the OMAS (P<0.05); 83.1 Group A versus 90.1 Group B at the AOFAS (P<0.05); higher pain levels in the VAS (3.9 Group A versus 2.4 Group B) and lower satisfaction rates (52.6% Group A versus 73.1% Group B (P<0.05)) in comparison with patients treated with locking plate fixation (Group B). However, infections rate was significantly lower in Group A (1.8%) than in Group B (9.6%) (P<0.05). Radiographic evaluation showed more cases of post-traumatic osteoarthritis in Group A (35.1% Group A versus 15.4% Group B (P<0.05)) and worse results in regards to restoration of joint space symmetry (45.6% Group A versus 73.1% Group B (P<0.05)). Results of current study indicates that even though plating of lateral malleolus in bimalleolar and trimalleolar fractures is superior in fracture reduction quality, early functional recovery, reduced incidence of post-traumatic osteoarthritis and greater patient satisfaction, Rush nail fixation still provides acceptable clinical results with a lower infection rate. Therefore Rush nails could be considered as a valid choice in selected patients with high risk of soft tissue complications or low functional demand.

Use of a modified retrograde femoral rod as a custom length tibiotalocalcaneal nail.

There has been increasing interest in the use of hindfoot tibiotalocalcaneal (TTC) nails to treat ankle and distal tibia fractures in select patient populations who are at increased risk for soft tissue complications after open reduction and internal fixation with traditional plate and screw constructs. We describe a technique which uses a retrograde femoral nail as a custom length TTC nail. By using a simple modification of the insertion jig, we are able to achieve safe screw trajectories that allow for robust distal interlocking fixation. Review of implantation in multiple cadaveric specimens demonstrates safe placement of distal screw fixation in the calcaneus without risking injury to important neurovascular structures. Because of the 2-cm incremental length options of this particular device, we are able to achieve supraisthmal fixation in the tibia which may lessen the risk for fracture that may be more likely to occur at the tip of a short TTC nail option. Furthermore, a custom length TTC nail is more costly and also requires advanced notice to acquire for the case; retrograde femoral nails are readily stocked and accessible at our level 1 trauma center. This TTC technique offers anatomic restoration while also offering convenience, instrument familiarity, cost savings, and increased patient safety.

Perioperative Impact of Early Limited Surgical Intervention to Treat Pilon Fractures.

The operative treatment of pilon fractures is classically treated with a staged protocol with ankle spanning external fixator, followed by definitive open reduction and internal fixation in order to decrease risk of soft tissue complications and infection. However, treatment of pilon fractures with patrial tibial fixation in addition to ankle spanning external fixation at the time of index procedure may facilitate final fixation while avoiding complications that were associated with acute definitive fixation. Retrospective cohort series of 113 patients treated for pilon fractures from September 2012 to November 2018 at a single level 1 trauma center. Charts were reviewed to compare patients who underwent traditional management with a staged protocol and those who had a limited tibial reduction and fixation (LTRF) during the index procedure. The main outcome measurement was time to definitive fixation. Twenty-six percent of patients (29 of 113) had limited tibial reduction and fixation (LTRF) during index surgery. Mean time between index procedure and definitive ORIF was 4.75 days less for LTRF cohort compared to standard stage cohort (10.86 ± 7.44 vs. 15.61 ± 8.59 days, P = .009). The index procedure took on average 51 minutes longer in the LTRF cohort (P < .001), yet definitive procedure operative time was decreased by an average of 98 minutes (P < .001), and overall (index plus definitive) operative duration was shortened by an average of 50 minutes (P = .044). There was no difference in rate of infection between LTRF (3.1%) and traditional treatment (2.5%) (P = .86) or reduction quality (P = .270). There were no nonunions in either treatment group. Patients who had LTRF had quicker time to definitive ORIF and decreased operative time for definitive ORIF. There was no difference in infection rate, reduction quality, or nonunion rate between groups. Level IV, Retrospective Cohort Study.

Myofascial Flap Closure Decreases Complications in Complex Surgery of the Craniocervical Junction in Ehlers-Danlos Patients.

Patients with Ehlers-Danlos syndrome (EDS) are at elevated risk for soft tissue complications when undergoing decompression with or without fusion of the craniocervical junction. We have previously shown that muscle flap closure can decrease reoperative rates. This study investigated whether myofascial flap closure improved clinical outcomes after simple or complex surgery of the craniocervical junction in EDS patients specifically. We performed a retrospective chart review of EDS patients who had undergone surgery for Chiari malformation at the Weill Cornell Medical Center between 2013 and 2020. Postoperative complications were recorded, including infection, wound dehiscence, seroma, hematoma, hardware removal, cerebrospinal fluid (CSF) leak, reoperation, and pseudomeningocele. Patients were stratified by type of closure and type of surgery. Fisher exact test was used for statistical comparison. Between 2013 and 2020, 62 EDS patients who had surgery of the cervicocranial junction were reviewed. Of these, 31 patients had complex surgery with myofascial flap closure and 22 had simple surgery with traditional closure. The mean age at the time of surgery was 21.3 years. There were no significant differences in wound complications or reoperation rates between the simple surgery and complex surgery groups. In addition, there were no significant differences in complications between complex surgery with flap closure and simple surgery with traditional closure. Our CSF cutaneous fistula rate was 0%, considerably lower than rates reported in the literature, and, in one case, a patient developed a postoperative pseudomeningocele secondary to a dural leak, but the myofascial flap closure prevented its progression. Patients with EDS undergoing surgery of the cervicocranial junction may benefit from myofascial flap closure. Flap closure reduced complications after complex surgery of the craniocervical junction to the level of simple surgery. Our CSF leak rate was exceptionally low and only one patient experienced pseudomeningocele. Myofascial flaps are safe to perform in the EDS cohort and prevented CSF cutaneous fistula formation.

A Novel Technique of Biological Osteosynthesis in a Bicondylar Tibial Fracture

Purpose: To evaluate the biological treatment outcomes for tibial plateau fractures. Methods: 8 men and 4 women aged 21 to 54 (mean, 36) years with closed tibial plateau fractures were enrolled for the study. According to the Schatzker classification, patients were classified into type I (n=1), type II (n=2), type IV (n=4), and type V (n=5). After closed reduction the fracture was fixed with two to three 6.5 mm cannulated cancellous screws and crossed K wires.The functional outcome was evaluated using the Rasmussen score. A total score of 28 to 36 was considered as excellent, 20 to 27 as good, and less than 10 as poor. Results: Patients were followed up for a mean of 2.2 (range, 1-3.4) years. All the fracture united radiographically after a mean of 3 (range, 2.3-4.3) months. Respectively in Schatzker types-I, II, IV, and V fractures, outcomes were excellent in 1, 2, 3, and 3 patients, It was good in 0, 0, 1, and 1 patients, fair in 0, 0, 0, and 1 patient, and poor in 0, 0, 0, and 0 patients. Outcome was satisfactory (good-to-excellent) in 85%, 86%, 100%, and 80% of the respective fracture types of patients. The mean Rasmussen score was 26.7 for all patients; it was 27.7 for type I, 26.5 for type II, 28.9 for type IV, and 24.4 for type V fractures. No infection, wound dehiscence or hardware issues were noted. Conclusion: This technique offers improved fracture healing without any risk of soft tissue complications, minimising the hospital stay and expenditure.

Staged surgery of Sanders type Ⅳ calcaneal fractures with soft tissue three-degree swelling

To compare the clinical efficacy of staged surgery on Sanders Ⅳ calcaneal fractures with soft tissue Ⅲ swelling. The clinical data of 76 patients with Sanders type Ⅳ closed calcaneal fracture with soft tissue three-degree swelling treated from June 2017 to May 2020 was retrospectively analyzed, including 54 males and 22 females, aged from 25 to 50 (38.16±10.24) years. The patients were divided into observation group and control group according to different treatment methods. Twenty-four patients in the observation group were treated by staged surgery stageⅠclosed prying traction reduction and Kirschner wire fixation, stageⅡopen reduction and internal fixation with titanium plate, including 17 males and 7 females, aged from 25 to 50 (36.12±9.56) years. There were 52 patients in the control group, including 37 males and 15 females, aged from 25 to 50 (38.32±10.67) years, these patients were treated with open reduction and internal fixation with titanium plate after the dermatoglyphic signs appeared. The swelling subsidence time, the length of hospitalization days, and the incidence of postoperative incision complications were compared between two groups. The Bhler angle, Gissane angle, and calcaneal varus angle were measured by X-ray before and 6 months after operation. American Orthopedic Foot and Ankle Society (AOFAS) about the ankle hindfoot score was used to evaluate the clinical efficacy. All 76 patients were followed up for 8 to 12 (9.52±2.01) months. The swelling subsidence time and hospitalization days in observation group were (12.12± 3.24) d and (24.53±6.44) d, respectively, which in control group were (15.16±4.16) d and (29.46±9.61) d, with statistical difference between two groups (P<0.05). Postoperative 6 months, Bhler angle, Gissane angle and calcaneal varus angle were (31.33±10.15)°, (145.34±8.04) ° and (10.31±3.23) ° in observation group, while those in control group were (20.24±8.23) °, (165.28±10.29) °and (21.24±5.27) °, with statistical difference between two groups (P<0.05). And there was significant difference in all patients between before and 6 months after operation (P<0.05). The AOFAS score of the observation group and control group were 71.76±9.84 and 57.23±10.76 at 6 months after operation, with significant different between two groups (P< 0.05). The excellent rate of observation group was significantly higher than that of control group (P<0.05). Compared with open reduction and internal fixation with titanium plate after the appearance of dermatoglyphic signs, staged surgery for Sanders type Ⅳ calcaneal fractures with soft tissue three-swelling does not increase the risk of soft tissue complications, and can significantly shorten the patient's swelling subsidence time and hospitalization days, improve the quality of fracture reduction and short term function, and relieve pain.

Double hindfoot arthrodesis using a single-incision medial approach in the correction of adult-acquired flatfoot deformity: a case series.

Hindfoot arthrodesis is used in patients with advanced-stage acquired flatfoot, usually associated with degenerative joint disease. The objective of the present study was to evaluate the clinical and radiographic results of hindfoot arthrodesis using the single-incision medial approach. A case series of 18 consecutive patients undergoing surgical correction between 2015 and 2018 with hindfoot arthrodesis using the medial approach was evaluated. The clinical assessment used the visual analog pain scale, AOFAS hindfoot score, SF-36, and foot function index. Radiographs and personal satisfaction criteria were also analyzed. All radiographic parameters evaluated showed a significant improvement (p < .05), except the calcaneal pitch. Pain decreased by 5.1 points (p < .001), and the mean final AOFAS score was 72.6. In three feet, a new surgery was required. Two feet developed talar necrosis. None of the cases presented surgical wound dehiscence, and two presented with superficial infection, which was resolved with the use of oral antibiotics. Double arthrodesis (subtalar and talonavicular) to correct adult-acquired valgus flatfoot using a medial approach has a low risk of soft tissue complications and presents satisfactory functional results. Avascular necrosis is a serious complication that was present in 11% of cases.

Intramedullary Fixation of Distal Fibula Fractures

Category:Ankle; TraumaIntroduction/Purpose:For unstable ankle fractures, surgeons typically employ the long-time standard of care; that is, open reduction and internal fixation with plate and screws. For patients with increased risk of soft tissue complications, a relatively newer construct includes intramedullary distal fibula fixation offering a viable option providing similar union rates, fracture alignment, and theoretical lower infection rate. Our study examines an intramedullary system with a novel design featuring fixation by proximal talons ensuring maintenance of alignment, rotation, and prevention of fracture settling. Our research builds on recent published work evaluating this intramedullary device. However, our study is the largest case-series, to our knowledge to assess time to weightbearing, fracture union and union rate as well as the first to assess safety and reproducibility of percutaneous reduction.Methods:A retrospective case-series was conducted on all skeletally mature patients with unstable ankle fractures treated with the same intramedullary distal fibular fixation. Surgeries were performed by a single surgeon between September 2015 and August 2019. Patient post-operative imaging was carefully assessed for quality of reduction, classifying reductions as ‘good,’ ‘acceptable,’ or ‘poor,’ also assessing for union and fracture settling. Patient charts were also assessed for comorbidities, injury pattern, fracture classification, associated injuries, fracture reduction method, perioperative complications, tourniquet time, characteristics of fracture union, time to weight bearing, and need for additional surgery.Results:Fifty-one patients were included in the study. Mean follow-up time was 32.2 weeks. Four fractures were bimalleolar (7.8%), 44 were isolated distal fibula fractures (86.3%), and 3 were trimalleolar fractures (5.9%). Two percent were Weber A, 77% Weber B, and 11% Weber C. Thirty-five (69%) reductions were achieved closed or percutaneously without complications. Based on reduction classification system, 47 fracture reductions (92%) were classified as ‘good’ and 4 (8%) were ‘acceptable’. All but one fracture (98%) went on to union. Average time to union was 10.3 weeks. Average weightbearing in a walking boot was at 6.8 weeks and 11.2 weeks without immobilization. One patient (2%) had a superficial wound infection, and there were no deep infections. Diabetes, smoking, and neuropathy were not predictive of complications.Conclusion:Our study strengthens the growing body of evidence supporting the safety and efficacy for a novel intramedullary device with unique proximal fixation. To our knowledge, this is currently the largest retrospective case-series in the literature evaluating this device. Fracture union and union rates were found to be acceptable for unstable ankle fracture patterns and infections rates were found to be very low, consistent with previous research. Percutaneous reduction of the lateral malleolus did not result in any injury to nearby anatomic structures or unsatisfactory fracture alignment. Lastly, consistent time to weight bearing following surgery could safely be achieved without consequence.

Osseous and Soft Tissue Complications Associated With Foot and Ankle Surgery in Patients With Rheumatoid Arthritis Taking a Variety of Antirheumatic Medications

There are multiple antirheumatic drug modalities available to patients with symptomatic rheumatoid arthritis (RA) that function to suppress the overactive immune system, but the inflammatory and immune suppression may contribute to postoperative complications. The purpose of this study was to determine if antirheumatic medications increased the risk of both soft tissue and osseous postoperative complications in patients with RA who underwent foot and ankle surgery. We reviewed patients with RA, aged 18years and older, who underwent either an elective or a nonelective foot or ankle surgery involving an osseous procedure between 2009 and 2014. Chart review was conducted to document procedure type, active medications, and postoperative complications. Of the final 110 subjects meeting inclusion criteria, 31 (28%) patients had a postoperative complication (13 soft tissue, 9 osseous, and 9 both soft tissue and osseous). There was no statistically significant association between taking antirheumatic medications in the perioperative period and postoperative complications. Increased surgery duration and peripheral neuropathy were associated with a statistically significant increase in postoperative complications. Every 15 minutes of increased surgery time led to a 1.2-fold increase in complication risk. Nonelective procedures had a higher risk of soft tissue complications than did elective procedures (odds ratio 4.2, 95% confidence interval 1.1 to 16.0). Although there was no statistically significant association between the specific medication and complications, some medications trended toward statistical significance. When working with patients with RA, our findings suggest the importance of considering the risk of surgery duration and the potential risk of antirheumatic medications in the perioperative period.

Endoscopic Revision Subtalar Arthrodesis

Varus malunion after subtalar arthrodesis is considered to be the worst deformity in hindfoot alignment. Poor clinical outcome is expected if there is more than 10° of varus malunion with lateral column overload. Open revision subtalar arthrodesis is associated with high rates of complications, especially involving soft tissue and nonunion. The purpose of this Technical Note is to describe the technical details of endoscopic revision subtalar arthrodesis in which the correction of varus malunion is performed with a minimally invasive technique, which may reduce the risk of soft tissue complications and nonunion.

A Minimally Invasive, Dual-incision (Medial and Lateral) Approach: An Alternative Technique for Reduction and Fixation of Intra-Articular Calcaneus Fractures

Calcaneus fractures are severe injuries that historically have been associated with poor outcomes and debilitating consequences. To maximize functional outcome, the literature in favor of operative management encourages anatomic reduction and alignment of displaced, intra-articular calcaneus fractures, while minimizing risk to soft tissues. Because of the increased risk of soft tissue complications with extensile approaches, minimally invasive techniques have continued to gain popularity. The current technique aims to describe a minimally invasive approach to calcaneus fractures through a dual-incision, lateral (sinus tarsi) and medial, approach. This approach facilitates anatomic reduction of the calcaneal tubercle to restore calcaneal tuberosity height and length, thus facilitating anatomic reduction of the posterior facet and realignment of the anterior calcaneus while minimizing risk of soft tissue complications. The authors’ results support this technique and we recommend it as a safe and effective method for open reduction and internal fixation of displaced, intra-articular calcaneal fractures. Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.

Percutaneous screw fixation for painful non-union of lateral malleolus ankle fractures

IntroductionLateral malleolus non-union can cause pain and loss of function. Standard treatment involves open approach with debridement, bone-grafting and plate stabilisation, with published surgical site infection rates to 17%. To minimise the risk of soft tissue complications and allow early mobilisation, we describe a technique for percutaneous cannulated screw stabilisation. Materials and methodsRetrospective case review for all percutaneous lateral malleolus non-union stabilisation procedures undertaken in our hospital between 2011 and 2017 was performed. Fracture union was diagnosed by resolution of pain and swelling, with a return to full weight-bearing mobilisation and two-view radiographs consistent with union. ResultsTwelve cases were reviewed. All fractures united. There was one superficial wound infection treated with oral antibiotics, and one early case with drill-piece fracture requiring conversion to open procedure with plate stabilisation. ConclusionWe believe this to be the first report of percutaneous stabilisation for non-union of lateral malleolus fractures. We demonstrate this to be a safe and effective technique.

Short term outcome analysis of proximal tibia fractures treated with minimally invasive plate osteosynthesis

Introduction: Proximal tibial fractures caused by high-energy mechanisms are associated with neurovascular injuries, compartment syndrome, deep vein thrombosis, contusion, crush injury to the soft tissues and open wounds. Management of proximal tibia fractures are difficult considering the limited soft tissue cover over the shin of tibia and vascular compromise following injury. Open reduction and internal fixation in oedematous vascular compromised skin will end up in complications like infection and wound dehiscence. Management of proximal tibia fractures using minimally invasive plate osteosynthesis reduces damage to surrounding soft tissues and helps in improved fracture healing without complications. Analysis of functional and radiological outcome along with the complications of proximal tibial fractures treated by minimally invasive plate osteosynthesis using Knee Society Score. Materials & Methods: We have analysed 20 cases of proximal tibial fractures treated surgically using minimally invasive plate osteosynthesis admitted in our Institute between January 2016 and December 2017. All patients were preoperatively assessed radiologically and classified and managed by MIPO technique and outcome was analysed by Knee Society score. Results: Majority of injured patients were male (90%) and the highest number of patients were in their 4th decade (60%). Road traffic accidents was the most common mode of injury (80%). Type VI fracture is the most common type in 60% patients. Early complications like wound gaping, skin necrosis were treated. Average time from injury to surgery was 10 days. All of our patient’s results were excellent and good. The average knee society score in our study with 20 patients was 81. All fractures united after an average of 20 weeks. The mean time to full, unprotected weight bearing was 16 weeks. Conclusion: Proximal Tibial fractures treated surgically using minimally invasive plate osteosynthesis technique gives early functional ability and early mobilisation of knee joint. Minimally invasive plate osteosynthesis technique offers improved fracture healing without any risk of soft tissue complications when compared to conventional plating by open reduction and internal fixation.

Relationship between ankle arthroscopic findings of the lateral malleolus and the ATFL attachment

Ankle fractures are amongst the most common surgically treated musculoskeletal injuries. Intramedullary (IM) fixation of the lateral malleolus had been attempted as early as the 1990s. In recent years, dedicated implants have emerged. This review evaluates the design characteristics of the technology used to perform IM fixation of distal fibular fractures.A search of electronic databases was performed. Medical subject headings (MeSH) and free-text terms were used to optimise search sensitivity and specificity.We identified 10 different surgical technologies for IM fixation of lateral malleolar fractures reported across 12 articles, including both improvised and custom-designed Orthopaedic implants. Most implants were inserted through percutaneous surgical techniques.Advances in technology have improved the feasibility of intramedullary fixation as a treatment option for lateral malleolus fractures. The implants we reviewed had very diverse morphological and mechanical properties. Intra-medullary fixation may outperform extra-medullary fixation of the lateral malleolus, particularly in patients at high risk of soft tissue complications. Robust scientific evidence is awaited. Level of evidence: Level IV evidence.

Plate Osteosynthesis of Proximal Ulna Fractures—A Biomechanical Micromotion Analysis

Double plating has been promoted, in recent years, as an alternative treatment method for proximal ulna fractures. This study aimed to compare the biomechanical properties of double-plate osteosynthesis with posterior plate fixation using a novel investigational design utilizing a 3-dimensional camera system to analyze fracture micromotion. Fourteen fresh-frozen specimens were available for this study. Mayo type IIA fractures of the olecranon were created and internal fixation was performed with either an angular stable posterior plate or angular stable double plates. Fracture micromotion was evaluated by means of digital image correlation with a 3-dimensional camera system before and after dynamic cyclic loading from 15° to 90° of elbow flexion with a pulling force of 25 N to 80 N. Micromotion of fragments was less pronounced in double-plate osteosynthesis when compared with single plates before and after cyclic loading. However, overall results were similar. Two of the single plates failed during cyclic loading but there were no failures in the double plates. This biomechanical analysis shows that single and double plating results in comparable stability of fixation. Although the double-plating technique tends to provide more stable fixation, relevant differences were not observed. Double plating potentially represents an efficient option for fixation of proximal ulna fractures. It could decrease the risk of soft tissue complications owing to their low profile and the superior soft tissue coverage.

Intramedullary Tibial Nail Fixation of Simple Intraarticular Distal Tibia Fractures.

The optimal treatment strategy for distal tibia fractures, especially those with intraarticular extension, remains controversial. Although open reduction and internal fixation with a plate and screw device is commonly performed for these injuries, the risk of soft tissue complications using this approach is significant. Staged treatment protocols and alternative means of fixation have been proposed to address these undesired events. Although potentially more technically demanding than fixation of diaphyseal or extraarticular tibial fractures, intramedullary nail (IMN) fixation of simple intraarticular distal tibia fractures is a viable treatment alternative with unique advantages. This article presents a review of the literature and rationale for intramedullary tibial nail fixation of simple intraarticular distal tibia fractures and a surgical approach commonly utilized for successful implementation.

Is buccolingual angulation of maxillary anterior implants associated with the crestal labial soft tissue thickness?

We aimed to examine the relationship between crestal labial soft tissue thickness (CLSTT, measured with a digital calliper at the crestal level of casts) and implant buccolingual angulation (IBLA). The records of 22 females and 10 males treated with two bone-level implants (3.3–4.6mm) between the maxillary canines were evaluated. IBLA was recorded as cingulum, incisal, or labial based on the screw access hole position on provisional restorations. Postoperative implant labial bone thickness (ILBT) at the crestal (2mm from crest) and mid-implant levels were measured on sectional cone beam computed tomography scans. The mean (SD) ridge width at the crestal level was 6.81 (0.98) mm. Mean (SD) CLSTT for implants with cingulum, incisal, and labial angulations were 2.98 (0.84), 2.24 (0.51), and 1.71 (0.72) mm, respectively. Significant differences were detected between CLSTT of implants with cingulum and incisal, as well as cingulum and labial angulations (P<0.01). Of implants with cingulum, incisal, and labial angulations, 3.4%, 20%, and 53.3%, respectively, had a CLSTT<2mm. Overall, 74.2% of CLSTT variance could be predicted by IBLA and ILBT at the crestal and mid-implant levels. A significant association between CLSTT and IBLA was noted when ILBT (crestal level) was <2mm (P<0.01). Implants with labial angulations carry a higher risk of soft tissue complications when the crestal implant labial bone thickness is <2mm.