Secondary Displacement Research Articles

Open reduction and navigated Iliosacral screws for vertically unstable pelvic fractures

AimsTo evaluate clinical and radiological results of vertically unstable pelvic fractures managed by open reduction and navigated iliosacral screws. Patients and MethodsThe study included eleven patients with complex posterior ring fractures with vertical instability admitted to our hospital and managed with CT navigated iliosacral screws. There were 7 type C1, 2 C2 and 2 C3, according to Tile classification. Three patients presented a spino-pelvic dissociation and four a vertical sacral fracture affecting the foramina (Denis 2). Vertical displacement, pelvic deformity and asymmetry were measured. Tornetta and Matta criteria were used to assess the quality of pelvic reduction. ResultsAn excellent reduction was achieved in 9 fractures and a good reduction in two. Asymmetry index improved from 13.18 to 2.72. Deformity index improved from 0.049 to 0.010. Only two patients with a Denis 2 fracture showed secondary displacement during follow-up. Four patients presented neurological complications due to their initial injuries. Seven patients were able to resume their previous activities. ConclusionCT navigated IS screws provide enough stability after an anatomic reduction of the fracture. There was no complication related to screw insertion and adequate screw positioning was achieved in all the cases.

Long dorsal "Y-shaped" plate for distal diaphyseal humeral fractures.

Osteosynthesis of distal diaphyseal humeral fractures is challenging, especially if there is a metaphyseal extension of the fracture line with a butterfly third fragment or if the fracture is bifocal. These fractures put the radial nerve at risk at the time of the fracture and during surgery. We hypothesize that ORIF with a long dorsal Y-plate matching the dorsal aspects of the humeral diaphysis and of the two metaphyseal columns would provide a reliable method of fixation for distal diaphyseal humeral fractures even when there is a metaphyseal extension or bifocal component. Between 2015 and 2019, 17 distal diaphyseal humeral fractures in 17 consecutive patients (14 men, 3 women, mean age 38 years) were operated on with a long "Y-shaped" dorsal plate. There were two bifocal fractures and 11 diaphyso-metaphyseal fractures with butterfly fragments. All 17 patients could be retrospectively followed up clinically and radiographically at a mean follow-up of 25 months (min 4, max 40). Clinical charts included VAS pain, elbow range of motion, QuickDASH, MEPS and subjective elbow value. Bone healing was observed in all cases. Five patients (29%) had a pre-operative radial nerve palsy. All pre-operative radial nerve palsies but one recovered spontaneously. One complete radial nerve palsy that was not present before the operation was observed after surgery. It recovered spontaneously in four months. One case of post-operative elbow stiffness required a revision. Only one case (5%) showing a complication directly related to the plate (secondary displacement) required revision. Mean post-operative elbow flexion was 134°. Extension deficit averaged 13°. Subjective elbow value, QuickDASH and MEPS averaged respectively 81%, 19 points and 92 points. Currently available plates (long dorsal straight, short dorsal "Y-shaped", long lateral) may have limitations in terms of screw purchase or biomechanical efficiency when ORIF of distal diaphyseal humeral fractures is considered. A long dorsal "Y-shaped" plate is a new alternative which may be successfully used even in the most difficult cases. Our study suggests that a long dorsal "Y-shaped" plate is suitable for distal diaphyseal humeral fractures especially when there is a metaphyseal bifocal or third fragment component.

Functional and Radiological Outcome in Distal Third Humerus Fracture Treated with Extra-articular Locking Plate: A Multicentric Retrospective Study.

Introduction:The optimal method for fixation of extra-articular distal humerus fractures poses a management dilemma. Although various plate configurations have been proposed, anatomic shaped extra-articular distal humerus locking plates (EADHPs) have emerged as a viable solution for these complex injuries. We assessed functional and radiologic outcomes in our retrospective case series of extra-articular distal humerus fractures managed with these plates at different centers in Cuttack, Odisha.Materials and Methods:One hundred and ten patients of extra-articular distal humerus fractures, who were operated at various trauma centers between January 2012 and December 2020, were identified. After exclusion, 100 patients were available for the final assessment. All patients were operated with the triceps-reflecting modified posterior approach. Regular functional–radiologic follow-up was done evaluating elbow functionality, fracture union, secondary displacement, nonunion, implant failure, and any complications; Mayo Elbow Performance Score (MEPS) was used for the final functional assessment.Results:Sixty-seven percent of male and 33% of female patients constituted the study group, who had an average follow-up of 18 months. Preoperatively three patients and postoperatively one patient had radial nerve palsy; all had neurapraxia and recovered completely. Overall, 95% of patients were adjudged to have complete radiological union within 3 months; 6% of patients developed nonunion. The mean flexion achieved was 123 + 22, and the mean extension was 4.031 + 6.50; five patients with head injury developed flexion deformity of 45. The average MEPS at the final follow-up was 91 + 9.8.Conclusion:Stable reconstruction and early initiation of physiotherapy are utilitarian to envision optimal outcome; the use of precontoured EADHPs has yielded satisfactory results with minimal complications in our hands.

Treatment of complex macular holes using a large disc of trypan blue stained‐lyophilized amniotic membrane: a 10 cases series with 1‐year follow‐up

AbstractPurposeTreatment of complex macular holes (MH) is challenging. The use of amniotic membrane (AM) has been described but is not yet codified, and we need to collect more cases.AimTo describe tips and tricks for the use of a large patch of lyophilized AM (lAM) in this indication.MethodsConsecutive 10 cases series: two patients with severe MH‐induced rhegmatogenous retinal detachment (RRD), three with recurring RRD + persistant MH, five with persistant MH after inner limitant flap. Our IRB approved the study and all patients signed an informed consent. lAM (Visio Amtrix, TBF) was chosen because of its availability, easy handling, thinness and transparency. A 3‐ to 4‐mm diameter disc was trephined with a disposable punch, stained with 0.06% Trypan Blue (after a first failure due to poor visualization of an unstained lAM) and rinsed with BSS. Stained lAM were inserted through a 23G sclerotomy using a standard perfusion catheter and unfolded on top of the MH using a forceps and a backflush needle. Tamponade was done with gas (17% C2F6, Arceole; n = 6) or heavy silicone (Densiron 68, Fluoron; n = 4) depending of the case. Routine follow‐up was done for 12 months, including SD‐OCT (Spectralis, Heidelberg) and color fundus photography (CR2‐AF, Canon).ResultsTen eyes of 10 patients of 62 ± 9 years with preoperative mean BCVA 1/80 (1.9 logMAR) and a mean minimal MH diameter of 942 ± 333 μm underwent surgery. The blue staining disappeared within 15 days. Anatomic success occurred for all patients: six/10 were closed, four/10 had reduced diameter. BCVA improved in all cases. The five RRD were reattached without recurrence. Apart one failure (lAM left unfolded) with migration at day 1 and MH closed with central scar, no secondary displacement of the patch occurred.ConclusionsA large patch of lAM seems a new method to cure complex MH in different situations. Trypan blue staining is, in our hand, absolutely necessary to allow correct positioning. Complete unfolding seems also required to allow good adherence over the MH.

Clinical Results of Dual SC Screw: A Mini-Sliding Hip Screw with an Anti-rotating Screw for Femoral Neck Fractures.

BackgroudDual SC screw (DSCS) is a unique concept internal fixation device consisting of a sliding screw and barrel assembly that enables compression force to be applied to the femoral neck fracture side. There are two types of barrels: a thread barrel and a plate barrel that has a one-holed side plate to prevent varus deformity. We report clinical results of the application of a DSCS with combined use of a thread barrel screw as an anti-rotational screw and a plate barrel screw as a compression hip screw.MethodsWe used DSCS for femoral neck fractures in 196 hip joints of 190 patients between November 2005 and June 2017. Among them, 70 hips in 66 patients (13 men and 53 women; mean age, 73.2 years) were followed up for at least 24 months. There were 53 nondisplaced fractures (Garden's classification stage 1 or 2) and 17 displaced fractures (stage 3 or 4). We evaluated the postoperative walking ability of the patients who were followed up for at least 24 months and examined details of all complications.ResultsThe mean follow-up period was 37.4 months (range, 24–144 months). Forty-two (64%) out of the 66 patients who were followed up for at least 2 years were able to walk independently with or without a cane. The incidence of complications was 11.5% in nondisplaced fractures and 17.5% in displaced fractures, and arthroplasty was required in 5.8% and 5.0%, respectively. The most frequent complication was secondary displacement including cutout and shortening of the femoral neck, but no implants showed varus displacement.ConclusionsThe application of DSCS for the treatment of femoral neck fractures had satisfactory results. The complication rate was low, and there was no postoperative varus displacement of DSCS in either displaced or nondisplaced fractures. We suggest DSCS is a reliable option for both displaced and nondisplaced femoral neck fractures.

Отличительные особенности результатов оперативного лечения внутрисуставных и внесуставных переломов у ВИЧ-инфицированных пациентов

The purpose — to evaluate the effectiveness of the developed algorithm for determining the tactics and methods of treating intraarticular fractures in HIV-infected patients. Material and methods. From 2016 to 2020, 56 HIV-infected patients with intra-articular fractures underwent surgical treatment. In the course of treatment, an algorithm developed in the clinic for determining the tactics and method of treating HIV-infected patients was used, which proved effective in treating extra-articular fractures. Results. The results were evaluated in the average expected time of the fracture consolidation of the selected location, as well as 6 and 12 months from the moment of surgery using the algorithm developed by us for determining the tactics and method of treating fractures in HIV-infected patients. Good results (according to the Luboschitz — Mattis scale) were noted in 16 (30,8%), satisfactory — in 27 (51,9%) and unsatisfactory — in 9 (17,3%) cases. For patients of this category, the most typical complications were the rapid progression of deforming arthrosis of the joints, the secondary displacement of bone fragments against the background of bone resorption, and the development of an inflammatory process of predominantly non-infectious etiology. Conclusion. The use of the developed algorithm for determining the tactics and method of treatment in HIV-infected patients with extra-articular fractures, taking into account the effect of HIV infection and antiretroviral therapy on the processes of bone remodeling and soft tissue regeneration, can significantly reduce the number of unsatisfactory treatment results. At the same time, the peculiarities of the effect of HIV infection on the state of cartilage, subchondral bone and synovial fluid determine the nature and risks of postoperative complications in HIV-infected patients. In the future, it is planned to correct the developed algorithm taking into account the data obtained and to carry out a comparative analysis of the treatment results.

Intertrochanteric Hip Fracture in a 4-year child: A Case Report

Hip fractures are rare in children and are less than 1% of all pediatric fractures and less than 1% of all cases of hip fracture. The literature agrees that early treatment, whether surgical or conservative, reduces the risk of complications. The clinical case we present concerns a pertrochanteric fracture with displacement of the greater trochanter in a 4-year-old child. The fracture was a type 4 according to Delbet classification. Clinical evaluation was carried out using the Ratliff scheme. Clinical criteria include pain, movement, activity and X-ray evaluation of the fracture both from the point of view of the formation of the bone callus, and the alteration of the diaphyseal cervical angle (DCA). It was surgically treated with three cannulated screws and a hip spica plaster cast immobilization with a Kirschner wire to avoid secondary displacement. The cast was maintained during the 6 weeks healing period of the fracture. After plaster cast removal, the child begins physiotherapy with an experienced physio in pediatric trauma. The child healed without complications.

A Systematic Review on Management of Anterior Column Acetabular Fracture

Acetabular fractures are potentially severe fractures associated with high morbidity and disability. Although open reduction and internal fixation are the standard methods of treating displaced acetabular fractures, open reduction has substantial morbidity, such as blood loss, neurovascular injury, wound infection, wound healing problems and heterotopic bone formation. With the development of advanced radiologic technology and new techniques and approaches for reduction and internal fixation, a percutaneous approach for internal fixation has become possible. Percutaneous approach is associated with fewer complications related to surgical exposure. It is a possible treatment option with no or minimal displaced, but instable acetabular fractures with a risk of secondary displacement, and displaced acetabular fractures which can be reduced by cannulate screw.

Iliac intramedullary stabilization for Type IIIA fragility fractures of the pelvis

There have been few reports on fixation of Rommens classification Type IIIA fragility fractures of the pelvis (FFPs). Here, we present our less invasive surgical technique, called iliac intramedullary stabilization (ILIS), for the internal fixation of Type IIIA FFPs. The technique involves a closed reduction, termed the femur internal rotation reduction method (FIRM), whereby the fracture fragments are repositioned using lateral rotators by internally rotating the femur while the patient is in the prone position. Two iliac screws are inserted on the ilium bilaterally via the supra-acetabular bone canal during FIRM and connected with two transverse rods and two cross connectors. We refer to this internal fixation procedure as ILIS. We retrospectively recruited patients with Type IIIA fractures, treated using this procedure, at our institute between October 2017 and October 2019. We evaluated operative and post-operative outcomes. We enrolled 10 patients (9 women and 1 man; mean age, 85.2 years) who were followed up for over 6 months. All patients suffered FFPs after falling from a standing position. The mean operative time was 145.1 (range, 94–217) minutes, and the mean blood loss was 258.5 (range, 100–684) ml. All patients were allowed full weight bearing from post-operative day 1. All patients achieved bone union and regained their pre-injury walking ability at 6 months after surgery without evident secondary displacement. In conclusion, our ILIS technique allows less invasive internal fixation of Type IIIA FFPs with adequate stability for full weight bearing from post-operative day 1.

Third-generation intramedullary nailing for displaced proximal humeral fractures in the elderly: quality of life, clinical results, and complications.

Antegrade insertion of third-generation intramedullary nail (IMN) has been shown to provide excellent results in young patients for treatment of displaced two-part surgical neck fracture. In elderly patients, osteoporosis makes internal fixation problematic and frequently contributes to failed fixation and poor clinical results. The purpose of this study was to report the health-related quality of life (HRQoL), functional results, and postoperative complications obtained with straight third-generation antegrade nailing of proximal humerus fractures (PHFs) in elderly patients. A retrospective review of 32 patients aged 80 y.o. or older presenting a two-part or three-part PHFs treated with a straight IMN with a minimum follow-up of 12months. Results assessed included 1) radiographic measures 2) clinical data: Charlson Comorbidity Index (CCI), VAS, range of motion (ROM), Individual Relative Constant score (IRC), Simple Shoulder Test (SST) and 3) Health-related Quality of life (HRQoL) with the EQ-5D index/EQ-VAS. Mean age was 82.1 (range 80-90) and mean follow-up was 45.6months (range 16-53months) with 91% of female patients and a mean CCI 4.6. 81% were two-part surgical neck fractures and 19% were three-part greater tuberosity fractures. The mean neck-shaft angle (NSA) at final follow-up was 132º ± 17.9º. 15.6% underwent hardware removal because of subacromial impingement and one patient (3%) was revised to RSA because of severe secondary fracture displacement. Mean IRC was 67,7 ± 30, the mean SST and VAS-Pain were 8.1 ± 3.1 and 3.2 ± 3.2, respectively, and the mean EQ-5D/EQ-VAS were 0.40 ± 0.33/64.2 ± 8.9. At last review, mean active forward flexion, abduction, and external rotation were 115º ± 35º, 100º ± 35º, and 20º ± 15º, respectively. Appropriate selection of fracture and proper operative technique with a third-generation nail result in good functional results and good HRQol with a low complication rate in elderly population.

Minimally invasive anterior plate osteosynthesis of the distal radius: A 710 case-series

IntroductionSince the 2000s, internal fixation of distal radius fracture by volar locking plate on an extended flexor carpi radialis (FCR) approach has become the gold standard. ObjectiveThe present study aimed to assess medium-term results of minimally invasive plate osteosynthesis (MIPO) in distal radius fracture. Material and methodsThe series comprised of 710 cases (512 female; mean age, 58 years). The 15mm approach was on the lateral edge of the FCR. The plate was slipped under the pronator quadratus. Closure used intradermal running suture without drain or orthosis. ResultsAt a mean 7 months’ follow-up, mean scar length was 17mm (range, 10–40mm), pain 1.13/10 (0–8), Quick-DASH 13.28 (0–86.36), and patient-rated wrist evaluation (PRWE) 11.48 (0–91). Compared to contralateral values, mean flexion was 87.23%, extension 88.52%, pronation 96.17%, supination 93.41%, and grip strength 79.68%. Hardware was removed in 45.92% of cases. There were 16 cases of secondary displacement, with 4 revision procedures, one of sepsis at 6 months, 10 of complex regional pain syndrome, and 14 of median nerve paresthesia, with 4 carpal tunnel release procedures. DiscussionThe minimally invasive FCR approach can be used for volar plate fixation of distal radial fracture. It has the advantage of conserving ligamentotaxis, facilitating reduction and improving scar esthetics. The incision can be extended if need be. Level of evidenceIII; single-centre retrospective study.

Association of secondary displacement of distal radius fractures with cortical bone quality at the distal radius

IntroductionThe aim of this study was to investigate the associations of patient characteristics, bone mineral density (BMD), bone microarchitecture and calculated bone strength with secondary displacement of a DRF based on radiographic alignment parameters.Materials and methodsDorsal angulation, radial inclination and ulnar variance were assessed on conventional radiographs of a cohort of 251 patients, 38 men and 213 women, to determine the anatomic position of the DRF at presentation (primary position) and during follow-up.Secondary fracture displacement was assessed in the non-operatively treated patients (N = 154) with an acceptable position, preceded (N = 97) or not preceded (N = 57) by primary reduction (baseline position). Additionally, bone microarchitecture and calculated bone strength at the contralateral distal radius and tibia were assessed by HR-pQCT in a subset of, respectively, 63 and 71 patients.OutcomeCharacteristics of patients with and without secondary fracture displacement did not differ. In the model with adjustment for primary reduction [OR 22.00 (2.27–212.86), p = 0.008], total [OR 0.16 (95% CI 0.04–0.68), p = 0.013] and cortical [OR 0.19 (95% CI 0.05–0.80], p = 0.024] volumetric BMD (vBMD) and cortical thickness [OR 0.13 (95% CI 0.02–0.74), p = 0.021] at the distal radius were associated with secondary DRF displacement. No associations were found for other patient characteristics, such as age gender, BMD or prevalent vertebral fractures.ConclusionsIn conclusion, our study indicates that besides primary reduction, cortical bone quality may be important for the risk of secondary displacement of DRFs.

A study on functional outcome of osteosynthesis for fracture proximal tibia

Background: The ultimate objective in the management of tibial plateau fracture is to ensure anatomic reduction, restore the axial alignment and maintain a stable fixation such a way to prevent the secondary displacement of fracture fragment. The various type of managing the tibial plateau fractures apart from conservative management are open reduction and internal fixation, closed reduction and percutaneous fixation and hybrid type of external fixation. Aim: To evaluate the functional outcome of osteosynthesis of tibial plateau fractures using different surgical techniques after a minimum period of 6 months by using Rasmussen scoring system. Methodology: All patients with proximal tibial fracture in the age group between 20 and 60 years were included as our study subjects. A total of 38 patients were taken as our study subjects. The tibial fractures were classified based on schatzker type of fracture classification. Fracture reduction was done under C-arm guidance by closed methods using ligamentotaxis. After confirming the reduction under C-arm guidance fixation of the fracture was done with locking plate. Functional outcome assessment of knee joint was done after six months post-operatively by using Rasmuseen score, which includes pain perception, walking capacity, extension at knee joint, range of movements and stability.Results: Majority of the patients who had undergone closed reduction with cancellous screw procedure or open reduction and internal fixation with buttress plate and bone graft had the functional outcome between excellent and good whereas patients who had underwent dual plating had a fair to poor outcome and this difference was found to be statistically significant. Pain and knee stiffness were reported in very few patients at the end of 6 months.Conclusion: In the management of tibial plateau fractures, open reduction with internal fixation using plate screws with lesser soft tissue dissection would lead to excellent functional outcome.

Clinical Efficacy of Patient-specific Implants Manufactured using Direct Metal Laser Sintering (DMLS) Technology in Patients with Mandibular Defects

Purpose: The purpose of this study was to compare the clinical efficacy of patient-specific implants (PSIs) in patients with mandibular defects in the early and distant postoperative period. Materials and Methods: The surgical results in 60 patients with postoperative and posttraumatic mandibular discontinuous defects were analyzed. The patients were treated at the Center of Maxillofacial Surgery and Dentistry, Kyiv Regional Clinical Hospital in the period from 2015 to 2020. Results: Despite certain functional limitations and residual aesthetic deficiency, 34 patients (85%) of the main group and 9 (45 percent) of the control group noted an improvement in their quality of life and were satisfied with the results of the operation (р < 0.05). Conclusions: The use of PSIs, compared to traditional methods of bone grafting, allow to achieve a more accurate restoration of the anatomical shape of the mandible in areas with complex geometry and probably better aesthetic results, and significantly reduces the frequency of secondary displacement of bone fragments due to plastic deformation and destruction of fixation elements (p < 0.05). At the same time, it probably does not affect the frequency of purulent-inflammatory complications, unsatisfactory clinical results and the effectiveness of the restoration of masticatory function in patients with mandibular defects.

Surgical comfort and clinical outcomes of MIPO with an extra-short plate designed for distal radius fractures.

Volar locking plates (VLPs) are increasingly used for distal radius fractures (DRFs) with minimally invasive plate osteosynthesis (MIPO), but surgery learning curves could be long. The purpose of this study was to assess a new extra-short plate with two locking diaphyseal divergent screws, specifically designed for MIPO, preserving the pronator quadratus muscle. This retrospective study consisted of three phases: (i) the evaluation of surgical comfort with the incision size and the duration of 59 consecutive surgeries using the extra-short plate in DRFs; (ii) the verification of the implant ability to maintain radiographic indices compared immediately postoperatively and at consolidation. They included radial inclination (RI), volar tilt (VT) and ulnar variance (UV); (iii) the assessment of clinical outcomes at last follow-up through: pain measured on the visual analogue scale (VAS), QuickDASH score, patient-rated wrist evaluation (PRWE) score, grip strength, range of motion and complications. In the first phase: mean incision size was 32mm, and mean operative time was 28.5min. In the second phase, there was no statistical difference between the two measures of the indices studied. In the third phase, mean follow-up time was 14.2months, VAS score was 1.1, QuickDASH score was 11.4/100, and PRWE score was 9.5/100. Flexion was 91%, extension was 94%, and grip strength was 86% compared to the contralateral side. The surgical comfort may be related to short operative time and incision. The implant allowed maintaining the radiographic indices without secondary displacement. Functional clinical outcomes were satisfactory. This extra-short plate design belongs to a novel generation of VLPs.

Symbols of Gentrification? Narrating Displacement in Los Angeles Chinatown

Los Angeles Chinatown is one of the oldest North American urban Chinatowns and experiencing changes that are redefining the neighborhood. Yet, not all community leaders label these changes as gentrification that directly displaces the community. This article examines how community leaders representing business, residential, and cultural interests engage in the politics of placemaking through their narratives of a new development, Blossom Plaza. Community leaders do not always view gentrification as a primary direct displacement, and instead emphasize how a secondary and symbolic displacement is happening historically, physically, economically, and politically in Chinatown. However, they also vary in whether they see these changes as ultimately reshaping the neighborhood to maintain its unique identity, which is linked to how they envision Chinatown as an ethnic space. The findings highlight the importance of considering symbolic displacement in gentrification studies about historic ethnic enclaves.

Treatment of dorsally dislocated distal radius fractures with individualized 3D printed bracing:\xa0an exploratory study

BackgroundThe aim of this work was to develop a three-dimensionally (3D) printed brace for the acute treatment of dorsally dislocated and correctly reduced distal radius fractures (DRF). The hypothesis was that a brace shaped to the mirror image of the contralateral (non-fractured) wrist will have an optimal anatomical fit, resulting in improved comfort and lower rates of secondary fracture displacement.MethodValidation: the circumference of both wrists and comfort of the brace were studied in healthy volunteers and effectiveness of the brace was evaluated in an ex vivo fracture model.Clinical study: the brace was tested for comfort and effectiveness in patients with a well reduced unstable DRF.ResultsValidation: the circumference of both wrists may be different, the brace retained the reduction in the ex vivo fracture model and was well tolerated in the volunteers.Clinical study: in DRF patients comfort scores were lower and pain scores higher compared to the healthy volunteers. After 3 and 5 weeks all patients were independent in ADL according to the Katz-index. Posttraumatic swelling subsided in the first week. In two of the five patients secondary fracture dislocation occurred.ConclusionsTreatment of a dislocated DRF in the acute setting (day one) with a custom-made 3D printed brace, anatomically modelled from a 3D scan of the contralateral wrist, is possible. Difference between both wrists and posttraumatic swelling must be adapted for. The high rate of secondary fracture displacement led to early discontinuation of the study and a small sample size.Trial registrationName of the registry: ClinicalTrials.GovTrial registration number: NCT03848702Date of registration: 02/21/2019, retrospectively registered

Prevention of secondary displacement and reoperation of distal metaphyseal forearm fractures in children

BackgroundMetaphyseal distal forearm fractures are common in paediatric patients and treating these fractures by reduction and cast immobilization alone is under debate, since secondary displacement is a frequent complication that often warrants re-intervention. This study was conducted to invest the incidence of secondary displacement and re-intervention for non-displaced and displaced fractures, with or without fixation. Material and methodsA retrospective cohort study was conducted analysing all consecutive paediatric patients under the age of 16 with distal metaphyseal forearm fractures throughout a 2-year period. Data were recorded on radiographic characteristics, OTC/AO-classification, type of treatment, reduction technique, surgical interventions and removal of hardware and complications. Results200 Patients with displaced metaphyseal forearm fractures were included of which 139 were primarily treated in the emergency room, the other 61 patients were primarily treated in the operating room. 83% Of the patients had a satisfactory reduction in the emergency room and 94% of these patients were treated successfully with casting alone. A total of 84 patients were treated in the operating room of whom 30% underwent reduction and K-wire fixation, and 70% underwent reduction and casting only. 47% Of the patients treated with closed reduction without K-wire fixation in the operating room suffered from secondary displacement, of which 80% needed re-intervention. ConclusionMetaphyseal forearm fractures can be treated with a very high success rate by closed reduction and casting alone in the emergency room. Reduction and casting of displaced metaphyseal forearm fractures in children that needed treatment in the operating room however, resulted in unacceptable high rate of secondary displacement and commonly required re-intervention. Those patients should therefore be treated by reduction and K-wire fixation.

Features and results of treatment of rotationally unstable pelvic injuries of the «open book» type

The treatment of pelvic bones injuries is one of the most difficult problems in traumatology. Objective: to analyze the results of surgical treatment of patients with pelvic fractures of the «open book» type and to determine the most effective methods of its stabilization. Methods: a retrospective analysis of the results of treatment of 61 patients with «open book» type pelvic fractures (age from 16 to 64 years) in two groups was carried out. Patients of the first group (24 patients, 39.3 %) were made osteosynthesis the anterior part of the pelvic bones only with an external fixation device — 20 and with a plate — 4. In the second group (37 patients, 60.7 %), anterior and posterior osteosynthesis was made. To assess fractures, the Tile classification with the additions of AO was used. X-rays and CT of the pelvic bones was used in all cases. Fractures of type B1.1 were detected in 32 (52.5 %) cases, B1.2 — 29 (47.5 %). Surgery was planned according to the developed local protocol. The results were analyzed according to the system of functional assessment S. A. Majed. The follow-up period was from 6 to 12 months after the surgery. Results: early complications were found in 4 (6.5 %) patients: infection — 3, secondary displacement of bone fragments — 1. There was no significant difference between the groups in terms of treatment outcomes. Conclusions: in case of pelvic injury as an «open book», accurate diagnosis of injuries with assessment of sacroiliac connection using x-ray of the pelvis in three planes and CT are important. In case of injuries of type B1 and differences in the pubic joint up to 2.5 cm, conservative treatment is recommended, more than 2.5 cm — internal fixation of the anterior section by one or two plates, and in the case of suspected injury of sacroiliac joint, additional fixation of the sacroiliac joint with ileosacral screws.

Outcome analysis of extraarticular distal humerus locking plate for fresh fractures of humerus shaft

Background: The complex anatomy of distal humerus with proximity of radial nerve make the exposure and fixation of these fractures difficult. The standard technique of plate osteosynthesis consider at least eight cortices hold in both distal and proximal ends. Obeying these principles becomes difficult in distal humerus fractures. These difficulties have been overcome with the use of anatomical extra-articular distal humerus plate which has more hole density in the distal part with 3.5 mm screws for greater hold in distal part.Methods: A prospective study was carried out at Institute of Medical Sciences BHU Trauma Centre for 19 cases of distal third fracture excluding open fractures of patients between 18-68 years who attended our OPD or Emergency from June 2017 to July 2019. All patients were operated with the triceps-reflecting modified posterior approach. Regular follow-up was done to evaluate elbow functionality, fracture union, secondary displacement, non-union, implant failure and any complications; Mayo Elbow Performance score (MEPS) was used for the final functional assessment.Results: Fourteen 73.6% male and 5 (26.3%) female patients with mean age 41 years constituted the study group, who had an average follow-up of 17.1 months. Preoperatively one patient had radial nerve palsy (neuropraxia) who recovered completely 3 months after surgery. Overall, 18 (94.7%) patients were adjudged to have complete radiological union within 14 weeks; Mean flexion achieved was 134±11.5 (range 90–140). Average MEPS at the latest follow-up was 94.7±7.5.Conclusions: Extra-articular fractures of distal humerus can be satisfactorily treated with the use of single anatomically pre-contoured locking compression plate with excellent elbow functional range of motion and union rates.