Stable Fracture Fixation Research Articles

Evaluation the role of bone marrow aspirate on osteogenic outcome of mandibular fractures in rabbits

Purpose: The treatment of fractures involves addressing the biology of fracture repair and the mechanical stability of fracture fixation. Traditionally it has included the addition of bone graft to enhance healing. New advances in the understanding of the cellular and molecular mechanisms of fracture repair have led to the use of growth factors to accelerate bone healing. The aim of this study was to evaluate the effect of bone marrow aspirate on healing activity of rabbit mandibular fractures by histological analysis. Material and Methods :Experimental study was on 30 male rabbits, classified into Group I, normal control group. Group II, fracture control group formed of 10 rabbits in which traumatic mandibular fractures were done then fixed through wiring without application of bone marrow aspirate. Group III (Bone marrow aspirate) formed of 10 rabbits in which traumatic mandibular fractures were done then fixed through wiring with application of bone marrow aspirate.Results: Fracture site in bone marrow aspirate group showed peripheral pre-existing bony plates with formation of callus formed mainly by the more regularly arranged osteoid trabeculae rimmed by osteoblastic proliferation being more mature towards the periphery and few immature bony trabeculaeConclusions : Bone marrow aspirate as source of stem cells seem to be of clinical advantage in acceleration of bone healing.

Combined Fractures of the Scaphoid and Distal Radius: Evaluation of Early Surgical Fixation (21 Patients with 22 Wrists).

Introduction The purpose of this retrospective study, is to evaluate the clinical and functional results of early surgical fixation of the ipsilateral distal radius and scaphoid fractures in 22 of 21 patients. Patients and Methods Overall, 22 combined ipsilateral scaphoid, and distal radius fracture treatments between 2002 and 2015 were evaluated. The mean age was 34.9 (range: 19-82) years. One patient had bilateral injuries. In 17 patients the injury was due to a fall from a height, and in 4 patients due to a motorcycle accident. According to the AO classification, there were 2 type B and 20 type C fractures of the distal radius. The volar locking plate fixation technique was applied in 14 wrists, screw fixation technique in 1, external fixation combined with Kirschner wires (K-wire) stabilization technique was used in 3 wrists, and only K-wire pinning technique was used in 4 wrists. All scaphoid fractures were type B (21 type B2, 1 type B1) according to the Herbert-Fischer classification. K-wire fixation was applied in 2 and cannulated screw fixation was performed in 20 fractures. Clinical evaluation was performed with measuring the pinch power, grip power, and range of motions. Functional evaluation was performed using patient-rated wrist evaluation score (PRWE). Results The average follow-up period was 25 (range: 12-97) months. All radius and scaphoid fractures healed. The mean active wrist motions were found to be 45 degrees of flexion, 48.5 degrees of extension, 20 degrees of radial deviation, and 43 degrees ulnar deviation. Mean grip/pinch strengths were 31/8.5 kg. Mean PRWE score was 5.5 (range: 0-8.5). All patients returned to preoperative activity level and can do preinjury jobs. Conclusion Combined ipsilateral fractures of distal radius and scaphoid are complex and rare injuries due to high energy traumas. Stable early primary fracture fixation in these injuries can be expected with good functional results. Level of Evidence Level IV.

A sliding hip screw augmented with 2 screws is biomechanically similar to an inverted triad of cannulated screws in repair of a Pauwels type-III fracture

ObjectivePauwels III femoral neck fractures are highly unstable. These fractures are commonly treated with three cannulated screws or sliding hip screw (SHS) implants, however high rates of non-union persist. A hybrid SHS construct has recently been proposed. The objective of the study was to compare this construct to the familiar inverted triad of cannulated screws and to a single SHS. MethodsFourth generation biomechanical femur analogs were used to create a highly repeatable injury model. The hybrid SHS construct contained a SHS with two superior cannulated screws in an inverted triangle configuration. Eight samples for each construct were biomechanically evaluated and the results compared using ANOVA (p<0.05). ResultsThe cannulated triad and hybrid SHS provided similar stiffness and fracture gap motion. The single SHS exhibited significantly lower stiffness and larger fracture plane diastasis than either the inverted triangle of cannulated screws or hybrid SHS (p<0.05). None of the constructs exhibited catastrophic failure during cyclic loading nor under loading up to 2.5 times body weight. ConclusionsThe single SHS provided the least stable fracture fixation, while the inverted triad and hybrid SHS constructs were mechanically similar. The fracture repair simulated here illustrates how these repairs have the potential to return near pre-fracture strength in ideal conditions with young, healthy bone. However; in clinical situations where comminution impairs load transfer through the cortices the hybrid SHS may be the most favorable option.

Outcome analysis of patients with proximal humerus fractures treated with locking plates

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Fracture of proximal humerus incidence has been reported to be 73 cases per 100,000 individuals per year. There are different methods of treatment of proximal humeral fractures. The aim of our study is to analyse the functional outcome of proximal humerus fractures treated with proximal humerus locking plates and to analyse the possible benefits and complications of the procedure&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a retrospective study of 34 patients with proximal humeral fractures treated with ORIF using Proximal humeral locking plates from October 2010 to November 2012 at Saifee Hospital, Mumbai. The cases are evaluated as regards to functional outcome using constant score, fracture healing clinically, radiologically and complications if any and reason for them.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Our study shows that proximal humerus fractures are now increasingly seen in younger population with good bone stock following high energy trauma. In elderly it was low energy trauma. The average time of radiological fracture union in our study was 10 weeks (8-16 weeks). The mean constant score at final follow up was 66.7 (35-90). A total of 17 patients (51%) had excellent or good results, but in 9 (27%) the outcome was poor. Eight (23%) complications were noted resulting in poor functional outcome&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Proximal humeral locking plate is a good method of osteosynthesis for complex proximal humerus fractures allowing early mobilization, good functional outcome. A reproducible standard surgical technique is absolutely necessary for improved patient outcome. Most of the complications in our study were related to the surgical technique. The precise surgical technique, stable fracture fixation and restoration of correct neck shaft angle are absolutely necessary for improved outcome&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;

Humeral Tip-apex-distance as a Prognostic Marker for Proximal Humeral Fractures in 203 Patients.

Background:Humeral head fractures and their postoperative outcome remain a challenging problem in surgical daily routine. Predictive factors for loss of fixation are rare.Objective:Determination of predictive factors for the failure of osteosynthesis with the loss of fixation or migration of screws in humeral head fractures.Method:From 1995 to 2011, 408 patients with proximal humeral fractures [mean age 66.6 years, 50.9-82.3 years] and osteosynthesis were analyzed. Two hundred and three received open reduction internal fixation (ORIF) with the PHILOS® plate. The non-locking plate was used in 80, the locking plate in 16 and humeral head prosthesis in 26 patients, in addition to 23 patients undergoing other procedures. Intraoperative reduction that achieved an anatomical alignment of the medial aspect of the humerus (humeral calcar) was assessed in 94 patients by postoperative X-ray analysis. The loss of fixation was evaluated by a follow-up of three to five X-rays and measurement of the humeral tip-apex-distance (HTAD).Results:For stable fixed fractures with an intact calcar, percentual HTAD was significantly higher than for unstable fixed fractures (p=0.04). Morbidity, such as hypertension, orthopedic operations or diabetes, strongly influenced the HTAD, while postoperative passive motion treatment modestly affected the HTAD over time.Conclusion:The anatomic reconstruction of the calcar, leading to stable fixation of humeral head fractures, can significantly prevent an overproportioned decrease in the HTAD in postoperative X-rays and seems to be vital in multimorbid patients. Measurement of the HTAD over time delivers a tool for early detection of secondary loss of fixation.

How bone quality may influence intraoperative and early postoperative problems after angular stable open reduction–internal fixation of proximal humeral fractures

With the introduction of the deltoid tuberosity index (DTI), a simple radiographic tool has become available to measure bone mineral density of the proximal humerus. The aim of this study was to assess the influence of local bone mineral density on the early failure rate after angular stable open reduction-internal fixation of proximal humeral fractures (PHFs). We retrospectively followed up all patients treated with angular stable implants for PHFs from 2007 to 2014. The fractures were classified according to Neer, and the DTI, metaphyseal head extension (MHE), medial hinge displacement, and quality of reduction were assessed. Failures were defined as head screw cutouts. The study included 146 patients (mean age, 66 years; range, 20-94 years). The mean follow-up period was 11 months (range, 3-94 months). Of the fractures, 91% were classified as 2- or 3-part fractures and 9% as 4-part fractures. The mean DTI was 1.44 (range, 1.19-2.11), and the mean MHE was 12 mm (range, 0-48 mm). The reduction result was at least acceptable in 80% of fractures. Screw cutouts were found in 23%. The DTI and MHE were the most significant preoperative predictors for the reduction result. The DTI (P = .036) and age (P = .02) were independent preoperative factors, and a good reduction (P = .001) was the only intraoperative factor influencing cutout. This study proves that good bone quality and a long MHE are helpful for the reduction. Furthermore, good bone quality, a younger age, and a good reduction prevent later cutout. We conclude that local bone quality is a relevant factor in the treatment plan for PHFs.

Biomechanical analysis of anterior ring fixation of the ramus in type C pelvis fractures

This biomechanical study compared the stability of four different ramus fracture fixation methods for Type C pelvic ring injuries in the absence of posterior fixation. A 5-mm vertical osteotomy of the mid-superior and inferior pubic ramus was created in 12 synthetic pelvic models. Four surgical constructs were compared: (1) two-pin AIIS external fixation, (2) 3.5-mm reconstruction plating, (3) bicortical, fully threaded 3.5-mm, and (4) 6.5-mm pubic ramus screws. Specimens were tested in a simulated one-legged stance on a hemiarthroplasty implant in three stages: (1) no applied load, (2) application of the loading fixture preload to the sacrum (6N), and (3) following six cycles of a 250N load. Stability was assessed based on resultant displacement of the fracture sites at the superior ramus and the anterior sacroiliac joint. The bicortical, fully threaded 6.5-mm pubic ramus screw provided the most stable ramus fracture fixation (0.5 ± 0.4mm) displacement under load and was the only construct to finish testing without gross posterior pelvic disruption. Plate constructs finished the final loading stage with only a small increase (3.1 ± 2.3mm) in ramus fracture gap size, but had significant displacement at the SI joint (>20mm). 3.5-mm screw constructs had 1.6 ± 0.7mm of ramus displacement in the preload stage, but had complete posterior pelvic disruption (>20mm) that prevented further testing. External fixation was unstable at the ramus and sacroiliac sites in the initial setup. The bicortical, fully threaded 6.5-mm pubic ramus screw was the only anterior fixation construct tested that controlled motion at both the anterior and posterior pelvic rings in the absence of posterior fixation.

Evaluation of surgical management of metacarpal fractures – A prospective clinical study

Introduction: Metacarpal fractures constitutes between 14-28% of all visits to the hospital following trauma. Too often these metacarpal fractures are neglected or treated as minor injuries and results in major disability and deformity with permanent crippling of fine movements. A stable fracture fixation helps in restoring early mobilization. Early mobilization can prevent adhesions and is the key to good clinical outcome. Materials and Methods: Thirty patients with metacarpal fractures were surgically fixed with k-wire or plate and screw in our trauma centre. 24 males and 6 female patients were part of the study. The mean age was 38 years. Radiographs of affected hand, both AP & Lateral views were obtained before surgery, post- surgery, and at follow-ups. Results: Male patients in their 3rd decade following a road traffic accident fracturing right hand 4th metacarpal shaft was the common presentation. Transverse fracture pattern was most common. 70% of cases had excellent result, 20% patients with good results and 10% had fair result. Finger stiffness was the most frequently encountered complication. Conclusion: Displaced metacarpal fractures treated surgically by plate and screw or k-wire gives good result in terms of union, functional recovery and prevent stiffness. CRIF with k-wire shows faster union, faster recovery and lesser stiffness compared to ORIF with k-wire and plates and screws. Multiple metacarpal fractures in same hand treated surgically gives better results than those treated conservatively. Metacarpal fractures fixed rigidly with plate and screw can be mobilized much earlier then those with k wire fixation.

Management of Interprosthetic Femur Fractures.

Femoral fractures between a total hip arthroplasty prosthesis and total knee arthroplasty prosthesis, also called interprosthetic fractures, are challenging clinical problems. The number of patients who have undergone ipsilateral primary or revision joint arthroplasty procedures in both the hip and the knee continues to rise, and the number of interprosthetic fractures is increasing, as well. The growing body of biomechanical and clinical literature on interprosthetic fractures reflects the increased frequency of and interest in these injuries. Similar to the management of periprosthetic fractures, the management of interprosthetic fractures depends on the location of the fracture, the stability of the implant, and the ability to achieve stable fracture fixation. These factors are the basis of recently described classification systems and treatment strategies. In patients with stable implants, fracture fixation alone is performed. When the implant is loose, both revision arthroplasty and fracture fixation may be required to provide stability of the limb.

Clinical outcome after alternative treatment of scaphoid fractures and nonunions.

Achieving stable fixation of scaphoid fractures and nonunions continues to be a challenge. Compression screw fixation has been the current standard surgical procedure. However, in some cases, bone healing cannot be achieved and requires further revision. Recent series reintroduced volar plating as valid option for stable fixation. The aim of the study was to review clinical outcome of alternative scaphoid treatment. From 2011 to 2014, nine patients with scaphoid fracture were treated by Headless Compression Screw (HCS) and seven patients with scaphoid nonunion by HCS or volar mini condylar plate with bone graft. The average age was 34.4 years and the average time to follow-up was 19.3 months. From 1996 to 1998, 38 patients with scaphoid nonunion were treated using compression screw (S-group) or volar mini condylar plate (P-group) with bone graft. The average age was 39.6 years and the average time to follow-up was 26.2 months. The union rate was 100%. For scaphoid fractures, the mean Modified Mayo Wrist Score (MMWS) was 94.1 and the DASH score 7.4. From 2011 to 2014, the MMWS was 87.9 and the DASH score 7 in scaphoid nonunions. In the period between 1996 and 1998, the MMWS was 67.2 in the P-group and 58.6 in the S-group, and the DASH score 16.8 and 28.2. Our study demonstrated that appropriate application of the HCS was able to produce very satisfactory results in scaphoid fractures and nonunions. In our opinion, however, the method of scaphoid plate osteosynthesis can achieve a higher degree of stability, particularly rotational stability, in case of multifragmentary avascular scaphoid nonunions.

A study of surgical management of distal femoral fractures in adults using locking compression plate

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The introduction of locking compression plates with option of locked screws has provided the means to increase the stability of fracture fixation.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In this study, 30 distal femoral fractures were treated using the distal femoral locking compression plate. All fractures were fresh, closed and operated within 12 days. Follow up duration ranged from 6 to 18 months.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In this study, 20 patients were males and 10 were females. The 23 of the fractures (76.66%), were caused by road traffic accidents, 3 were due to accidental falls (10%), one was due to assault and 3 were due to fall from height.9 patients had associated injuries. All patients were treated with open reduction and internal fixation using Locking Compression Plate. 6 to 9 holed plates were used. Out of 30 patients 2 went for delayed union and 3 went for non-union. Average knee flexion was 109&lt;sup&gt;o&lt;/sup&gt; having knee range of motion more than 100 with 50% patients. Average knee extensor lag was 2.4 degrees with only 4 patients with lag more than 5. 2 patients developed 2 cm shortening. 4 patients had less than 5 degrees of malalignment. 2 patients had deep infection. Functional outcome was measured using NEER's scoring system and was done at the end of 5- 7 months (average of 6 months). Excellent results- 17 (56.66%) good results-8 (26.66%) fair results-2 (6.66%) poor results-3 (10%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; LCP condylar plate represents an evolutionary approach to the surgical management and is an important armamentarium in distal femur fracture fixation, especially when fracture is severely comminuted and in situations of osteoporosis. &lt;/p&gt;

Osteosynthesis using cannulated headless Herbert screws in mandibular angle fracture treatment: A new approach?

IntroductionFractures of the mandibular angle are a common type of facial skull fracture. Although operative treatment includes a wide range of fixation techniques, a definite gold standard method has yet to be established. Headless, cannulated Herbert screws, often used in many forms of minimally invasive trauma surgery, provide functional and stable fracture fixation. Materials and methodsIn a prospective, double-randomised, controlled, parallel-group – designed, in vitro trial, the biomechanical behaviour of the Herbert bone screw system was compared to that of a conventional locking plate system in 40 mandibular angle fractures of human mandible cadaver phantoms. ResultsThe mean stress values were 250 (±68.0) N in the plate subgroup and 200 (±61.0) N in the screw subgroup. The respective mean strain values were 7.90 (±2.7) mm and 6.90 (±2.2) mm, and the respective mean stiffness were values 1.10 (±0.61) N/m and 0.78 (±0.40) N/m. The differences in the results obtained using the two treatments were not significant (p = 0.55). ConclusionsThe biomechanical behaviour of the two fixation systems within the tested loads did not significantly differ with respect to postoperative parameters clinically relevant in osteosynthesis. Both systems met the mandibular angle assessment criterion, which is considered to be sufficient for clinical use. The results indicate the potential clinical utility of these two systems, and recommend further testing.

The cost of screening radiographs after stable fracture fixation

Currently up to 58% of Canadian surgeons would forego screening radiographs after stable fracture fixation. It is therefore expected that reducing screening radiographs will be well accepted, provided that patient safety is not compromised, resulting in a cost reduction. The study objective was to measure the savings of a simplified radiographic protocol for well-fixed fractures and establish feasibility for a noninferiority trial that proves patient safety. Patients were randomized after fixation. The control group received screening radiographs immediately after fixation and at 2 weeks. The experimental group received radiographs only when clinically indicated. At 6 weeks all patients received radiographs. The cost of imaging, time spent in clinic and patient satisfaction was measured. A blinded reviewer documented adverse events, either detected or missed. Of the 90 patients screened, 39 were randomized and 26 had complete follow-up. The mean cost of radiographs over the first 6 weeks was $44.51 (95% confidence interval [CI] 38.64-50.38) per patient in the experimental group, and $129.23 (95% CI 120.23-138.23) in the control group (p < 0.001). The mean time spent in clinic at 2 weeks was 46 min (95% CI 32-60) per patient for the experimental group and 68 min (95% CI 55-81) for the control group (p = 0.018). Two complications occurred in the experimental group. Both were detected clinically and did not qualify as missed events. Implementing a simplified radiography protocol after stable fracture fixation saves time and money. Additionally, no adverse events were missed with the study protocol. Recommendations are made toward a noninferiority trial to establish protocol safety.

The role of bone marrow aspirate cells in the management of atrophic mandibular fractures by mini-invasive surgical approach: Single-institution experience

PurposeThe treatment of fractures involves addressing the biology of fracture repair and the mechanical stability of fracture fixation. Traditionally it has included the addition of bone graft to enhance healing. New advances in the understanding of the cellular and molecular mechanisms of fracture repair have led to the use of growth factors to accelerate bone healing. This study aimed to assess the advantages of autologous stem cell use for atrophic mandibular fracture treatment in comparison to standard technique. Materials and methodsA total of 35 patients (14 male and 21 female) were treated for fractures of atrophic mandibles between January 2011 and December 2014. Surgical technique provided mini-invasive open reduction with or without immediate homologous bone graft, while selected patients received autologous bone marrow aspirate cell grafts in addition to the standard treatment. Demographic data and details of treatment and outcomes were recorded. ResultsPatients were categorized according to the use of autologous stem cells, leaving 17 patients treated with standard technique and autologous stem cells (Group A) and 18 treated with standard osteosynthesis only (Group B). Of the 35 patients, 26 had bilateral fractures; most patients had significant medical co-morbidities. Immediate bone graft was used in 37.1% of patients (7 in group A and 6 in group B). Complications occurred in 5 patients (14.3%). Two patients in group B (11.1%) showed non-union of the fracture. One patient in group A (5.8%) and one patient in group B (5.5%) showed wound dehiscence and were treated conservatively; one patient in group B had a local infection (5.5%), one out of 35 (2.8%), that was managed by prolonged antibiotic treatment. ConclusionsDespite the advanced age and medical co-morbidities of the vast majority of patients, mini-invasive open approach with autologous bone graft ensures a fast and excellent recovery. Moreover, the management of atrophic mandibular fractures by bone marrow aspirate cells is a safe and useful procedure which has a lower complication rate when compared to standard technique.

Intramedullary nail with integrated cephalocervical screws in the intertrochanteric fractures treatment: Position of screws in fracture stability.

Stable fracture fixation is important in the treatment of intertrochanteric femur (ITF) fractures in the elderly population to prevent the loss of reduction, achieve early mobility, and restore independence. The aim of this study was to present the results of surgical treatment of stable and unstable ITF fractures using a trochanteric antegrade intramedullary nail with two cephalocervical screws in an integrated mechanism (Intertan®; Smith & Nephew, Memphis, TN) and evaluate the relationship between the loss of reduction and screw position in the femoral neck in two planes. The authors investigated all varus misalignments and losses of reduction in 57 patients (22 males, 35 females) treated for ITF fractures with the Intertan® between 2010 and 2011. Two indices (screw alignment index in the frontal projection [SAIcoronal] and screw alignment index in the lateral projection [SAIsagittal]) were defined to evaluate the loss of reduction. Patients were also evaluated according to the Harris hip score and Barthel independence index. The mean patient age was 77.1 years. The mean follow-up period was 21.7 months. All patients achieved complete union. We did not detect any varus collapse or loss of reduction. At the end of the follow-up period, the mean Barthel independence index was 90.7, and the mean Harris hip score was 83.7. The use of a trochanteric antegrade intramedullary nail with two cephalocervical screws allows for linear intraoperative compression and rotational stability of the head/neck fragment, prevents reduction loss, and has a wide application area in the femoral head. Its inherent continuous stability permits early weight-bearing and mobilization. It is a safe and an efficient option for the treatment of ITF fractures.

A comparative study of proximal femoral fracture fixation with proximal femoral nail and Dynamic hip screw &amp; plating

Introduction: Trochanteric fractures are one of the commonest injuries sustained predominantly in patients over sixty years of age. They are three to four times more common in women than in men. These usually occur through bone affected by osteoporosis; trivial fall being the most common mechanism of injury [1]. Discussion: The goal of this study was to compare the functional outcomes of patients with intertrochanteric fractures treated by two different fixation devices, the extramedullary dynamic hip screw and the intramedullary proximal femoral nail. Our study consisted of 30 patients with 30 intertrochanteric fractures out of which 15 were treated with DHS and 15 with PFN. Conclusion: We conclude that in stable intertrochanteric fractures, both the PFN and DHS have similar outcomes. However, in unstable intertrochanteric fractures the PFN has significantly better outcomes in terms of earlier restoration of walking ability as it is an intramedullary implant which can tolerate higher cylindrical loading when compared to DHS type of implants. Bibliography 1. Kaufer H. Mechanics of the Treatment of Hip Injuries. Clin Orthop. 1980; 146:53-61. 2. Kyle RF, Gustilo RB, Premer RF. Analysis of six hundred and twenty-two intertrochanteric hip fractures. A retrospective and prospective study. J Bone Joint Surg. 1979; 61A:216-21. 3. Kaufer H, Mathews LS, Sonstegard D. Stable Fixation of Intertrochanteric Fractures. J Bone Joint Surg. 1974; 56A:899-907. 4. Jewett EL. One-piece angle nail for trochanteric fractures. J Bone Joint Surg. 1941; 23:803-10. Larsson S, Elloy M, Hansson LI. Stability of Osteosynthesis in Trochanteric Fractures. Comparison of three fixation devices in cadavers. Acta Orthop Scand. 1988; 59:386-90.

Outcome of precontoured locking plate fixation in distal humerus fractures

Aim: Outcome of precontoured locking plates fixation in Distal Humerus Fractures. Material and methods: Twenty-five patients with distal humerus fractures were treated with ORIF with pre-contoured locking plates. There were 16 males, 9 females, with an average age of 42.8 years (21-59years). As per the AO classification performance score, the results obtained were graded as excellent or good results in 24 patients (96%), fair in 1 (4%) and poor in 0 (0%) of cases. Average time interval between admission and surgery was 3.8 days (average 1, there were 3 type A fractures(12%),1 type B(4%) and 21 type C fractures (84%).In addition to clinical examination, functional results were evaluated using the Mayo elbow performance score (MEPS). Results: Using the Mayo elbow -9 days). All the fractures as well as the olecranon osteotomies united by 10-16 weeks (13.76 weeks). No patient had deep infection, implant failure, non-union of fracture site or olecranon osteotomy site. Superficial wound infection, which occurred in 2 (8%) patients, resolved with oral antibiotics. Transient ulnar nerve palsy developed in 1(4%) case. However, the patient recovered with conservative treatment. Conclusions: An anatomically precontoured distal humerus locking plates are useful in providing stable fixation of distal humerus fractures, thereby facilitating early postoperative rehabilitation.

Endobutton Fixation Technique for Multifragmented Coronoid Fractures.

Coronoid fractures commonly occur in a part of unstable elbow fractures. Stable coronoid fracture fixation is important for early elbow motion. It may be difficult to fix multifragmented coronoid process fractures with loose capsular attachment. Thus, we demonstrated the endobutton suspensory technique to fix the anterior coronoidal fragments due to its suspensory effect providing capsular attachment. This technique allows stable fixation to the small multifragmented coronoid fractures with early range of motion.

Functional outcome in surgical management of Bi- malleolar fractures in adults

Background: Malleolar injuries are the most common significant lower extremity fractures. These injuries gain importance, because the whole body weight is transmitted through the ankle, and locomotion depends on the stability of the ankle. Open reduction and internal fixation have become the mainstay of treatment for most of the unstable bimalleolar fractures, as these operative methods restores the anatomy, biomechanics and contact loading characteristics of the ankle. Objectives: To study the functional outcome of surgically managed bimalleolar fractures of ankle in adults. Methods: A prospective study of 30 cases of bimalleolar fractures of ankle in adults, managed surgically by various techniques in During the period from December 2014 to May 2016 were studied, satisfying the inclusion and exclusion criteria were studied. The functional outcome was evaluated using the Biard and Jackson’s ankle scoring system. Results: In our study we achieved 86.6% excellent to good results, 6.6% fair results, 6.6% poor results. The results were comparable to other studies. Interpretation & Conclusion: The operative results were satisfactory in 86.6% cases, with good to excellent functional outcome. Excellent results are obtained with stable fixation of fracture. Cancellous screws or malleolar screws are far better in internal fixation of medial malleolus compared to Kirschner -wire fixation and lateral plating was the best for fibular fractures. Good functional results are obtained by surgical management of bimalleolar ankle fractures. Early weight bearing and mobilisation is achieved in these patients. Anatomical reduction with restoration of the articular congruence is essential in all intra articular fractures, more so, if a weight bearing joint like ankle is involved. Open reduction and internal fixation restores the articular congruity of the ankle joint. TBW done for many PER and PA injuries showed promising results comparable to that with screw fixation and also lesser reports of skin irritation at the wound site. It is the method preferred for small transverse fragments and osteoporotic bones of both malleoli especially in the elderly.

Randomized comparative study to evaluate the role of proximal femoral nail and dynamic hip screw in unstable trochanteric fractures

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Treatment of unstable trochanteric fracture is much more challenging than stable fracture. These fractures require stable fixation to minimize the fracture and implant related complications. Need of this study is to assess the suitable implant for stable fixation of unstable trochanteric fracture with less intra and postoperative complications and good functional outcome.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In this prospective randomized comparative study, 64 patients were distributed into two groups. Group A consisted of patients treated by proximal femoral nail (PFN) (n=32) and group B treated by dynamic hip screw (DHS) (n=32). All the patients were evaluated preoperatively and surgery was done according to the group they were allotted. Post-operative follow up was done at 6 weeks, 3, 6 and 12 months.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Average age of the patients in this study was 51.26±10.24 year. In this study patients were followed up for an average of 10.87±2.61 month. The duration of surgery was shorter in PFN group. Weight bearing was earlier in PFN group than DHS group. Mean functional ability score was better in PFN group with significant gain in function earlier as compared to DHS group.&lt;/p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; PFN is a better implant for internal fixation of unstable trochanteric fractures which allows early mobilization and has got better functional outcome score in early postoperative period than DHS