Stabilization Of Fractures Research Articles

Risk factors for excessive lateral migration of the blade in proximal femoral nail anti-rotation in elderly patients with intertrochanteric femur fracture.

Intertrochanteric femur fractures are prevalent among the elderly, leading to substantial morbidity. Proximal femoral nail anti-rotation (PFNA) is commonly used for internal fixation, but excessive lateral migration of the PFNA blade poses a significant complication. Understanding the risk factors for this complication is crucial for optimizing patient care. A retrospective case-control study was conducted on elderly patients with intertrochanteric femur fractures who underwent PFNA internal fixation. Patients were categorized based on the occurrence of excessive lateral migration of the blade. The differences in general information, surgical indices, imaging measures, fracture stability indicators, VAS score, Harris score, and other factors were analyzed. Single factor correlation analysis and multivariate logistic regression were utilized to identify risk factors associated with excessive blade lateral migration. Risk factors significantly associated with excessive blade lateral migration included the Singh index for osteoporosis, quality of calcar reduction, surgical indices (hospital stays, revision surgery for blade prominence), imaging measures (blade position, lateralization, and migration), fracture stability indicators (tip-apex distance, AO/OTA classification), and postoperative functional outcomes (VAS and Harris scores). Multivariate logistic regression identified these factors as independent predictors of excessive lateral migration, underlining the multifactorial nature of this complication. This study identified several significant risk factors for excessive lateral migration of the PFNA blade, including bone quality, calcar reduction, surgical indices, imaging measures, and fracture stability indicators.

Percutaneous TENS in Pediatric diaphyseal femoral fractures- Respects biology and ends happily

Femoral shaft fractures are amongst the most common major pediatric injuries treated by orthopaedic surgeons. They represent 1-2% of all fractures in the paediatric population. Paediatric males are affected more commonly than females. [1] There are various methods available for operative stabilization of paediatric femoral shaft fractures, which include external fixation, compression plating and rigid and flexible intramedullary nailing. [2] There is no uniform consensus on the treatment modality for femoral shaft fracture in school-aged children between 6 years to16 years. Titanium elastic nailing system (TENS) is a recent and widely used technique which allows stable reduction, maintenance of reduction and early mobilization. [3] American Academy of Orthopaedic Surgeons (AAOS) recommends with strong evidence based support in favour of the use of flexible intramedullary nailing for treating children age five to eleven years diagnosed with diaphyseal femur fractures. [4, 5] This device exploits a child’s denser bone, rapid healing and ability to remodel during period of bone growth. Here, we establish this axiom by a detailed case presentation, who was successfully treated with flexible intramedullary nailing for diaphyseal fracture of the femur.

Functional assessment of daily living activities following surgical management of young-burgess lateral compression type-II pelvic fractures with combined anterior and posterior internal fixation

Background: Fractures of the ischiopubic bones, S-I joint, and sacrum are among the most common bony injuries. Various procedures are available for managing this condition. Biomechanically, internal fixation of both the posterior and anterior lesions can offer complete stability to the pelvic ring. This study aimed to assess the functional assessment of daily living activities following surgical management of young-burgess lateral compression type-II pelvic fractures with combined anterior and posterior internal fixation. Methods: This descriptive observational study was conducted at the Department of Orthopedics & Traumatology, Dhaka Medical College & Hospital, Dhaka, Bangladesh from July 2016 to June 2018. A total of 44 patients with pelvic injuries admitted to the respective department were purposively enrolled as the study population. Data analysis was performed using the MS Office tools. Results: Most patients (68.18%) continued their jobs with reduced performance, while 22.72% maintained both job and performance levels. Regarding functional assessment, 54.54% could sit pain-free, with only 13.63% experiencing discomfort. None reported painful sexual intercourse. Mobility-wise, no one was bedridden or could only walk a few meters, and 0% needed walking sticks. Additionally, 18.81% could walk for one hour with a stick, while 63.63% had a normal walking distance for their age. No limitations in walking time or distance were observed in 63.63% of cases. Conclusions: This study concludes that stabilization of LC type-II pelvic ring fractures by anterior, combined, or posterior reconstruction plate provides a good result concerning daily living activities.

Recent Advances in Rib Plating.

Rib fractures are a common injury in blunt trauma and are associated with high morbidity and mortality. Recent advances in surgical stabilization of rib fractures (SSRF) have led to better patient outcomes for those with highly unstable complex rib fractures, as well as those with less severe injuries. This result has been due in part to the expansion of indications for repair, as well as the development of new hardware systems to address a variety of fracture patterns and injuries. This joint advancement of operator techniques, outcomes research, and industry development has brought SSRF to the forefront of rib fracture management and challenged non-operative paradigms. The future of repair is now shifting focus, as surgeons develop minimally invasive approaches and challenge manufacturers to develop new systems, instruments, and materials to address increasingly complex fracture patterns. These expansions promise to make SSRF an increasingly effective form of management for traumatic rib fractures.

Functional Outcome of Inter-Trochanteric and Sub-Trochanteric Fracture Femur Treated with Proximal Femur Nail Antirotation-II

Intertrochanteric femoral fractures are of great interest all around the world. They are the most often performed fracture type, and the high expense of treatment required following injury has made them a critical health resource concern. A higher predisposition towards Intertrochanteric fracture is observed in females than males due to osteoporosis A substantial demand is placed on the implanted hardware, as the subtrochanteric region of the femur experiences mechanical forces several multiples of the patient’s weight.The primary objective of this study was to evaluate the functional result of inter- and sub-trochanteric femur fractures treated with Proximal Femur Nail Antirotation-II. To improve the rotational stability of the proximal fracture fragment, the trochanteric fixation nail (TFN) was designed. To lessen bone tension at the isthmus, the diameter of the distal tip of the nail was lowered. The research was carried out in the Department of Orthopaedics, Krishna Institute of Medical Sciences, Karad. The research was carried out between June 2019 and June 2021. The Department of Ethics of Krishna Institute of Medical Sciences, Deemed to be University Karad, granted the ethics committee permission. There were 60 individuals in the research who had intertrochanteric and subtrochanteric femur fractures. After receiving informed written consent in the specified way, all participants were included. In summary, PFN A-II is a stable, biomechanically acceptable implant with a clear advantage over other implants for treating stable and unstable intertrochanteric fractures, particularly those in the elderly, and linked with osteoporotic bone. The benefits of the PFN A-II are noticeable with the right surgical approach, with a bare minimum complication rate.

Comparative study of radiological outcomes of intertrochanteric fractures managed with intra medullary nailing with or without intraoperative temporary K-wire’s stabilization

Background: Inter-trochanteric fractures are one of the most common hip fractures, occurring in both young adults and the elderly, as a result of high-energy trauma or low-energy trauma. These fractures are three to four times more common in elderly women with osteoporosis. The primary concern with Intertrochanteric fractures is the 20% to 30% mortality risk in the first year after the fracture. Methods: Various methods of fracture fixation have been used in treating this fracture with intramedullary nailing has been the most favoured. In this modality maintenance of reduction during and after fixation remains a concern. The temporary stabilization of fracture with K-wires for minimally invasive fixation of Intertrochanteric fracture with an intramedullary nail is advocated and aids in keeping the fracture reduction in place while proximal reaming and nail introduction. Results: In this study a total of 80 patients with intertrochanteric fractures were included, of which 45 patients operated with temporary K-wire, 43 patients reduction was maintained and loss of reduction was noted in 2 patients (4.4%) and 35 patients operated without K-wire, 29 patients reduction maintained and lost in 6 patients (17.1%). Conclusions: There was no statistically significant, difference in the 2 groups with respect to intra/post-operative loss of reduction. Having a larger study group the results may have a statistically significant outcome.

Brittle Crack Arrest Temperature Estimation Method Utilizing a Small-Scale Test with a Thick Steel Plate for Shipbuilding

As the shipbuilding industry has emerged from an extended recession, orders for high-value-added ships, such as LNG and ultra-large container ships, are increasing. For ultra-large container ships, high-strength, thick materials are applied. Because the possibility of brittle fracture increases owing to the application of thick steel plates, the related regulations of the International Association of Classification Societies have been strengthened to prevent brittle fracture. To secure brittle fracture stability, it is necessary to secure crack arrest toughness (Kca) through large ESSO experiments or to secure a crack arrest temperature (CAT) value. Because large-scale experiments require considerable costs and efforts, efforts have increased to examine brittle fracture stability through small-scale tests. In the present study, a technology was developed to predict CAT with small specimens. The CAT prediction formula developed with small specimens makes it possible to accurately predict CAT using data obtained through large-scale experiments.

Potential problem and solution of lateral plate postposition for the posterolateral tibial plateau fracture

BackgroundThere has been controversial for the treatment of the posterolateral tibial plateau fractures (PTPF). This study aimed to evaluate clinic outcomes of the lateral locking compression plate (LCP) postposition, analyze the feasibility of LCP postposition through anatomical measurement, and address the potential problems of LCP postposition through the biomechanical assessment.Methods39 patients with PTPF undergoing LCP fixation between June 2019 and June 2022 were retrospectively evaluated. All cases were divided into two group: Group A (15 cases) employed plate transverse arm postpositioning with posterolateral (PL) fracture fixation using two raft screws, while Group B (24 cases) utilized non-postpositioning with fixation by a single raft screw. Surgical duration, intraoperative blood loss, the change of lateral tibial plateau angle (LTPA), lateral tibial plateau posterior slope angle (LPSA) and fracture collapse between immediate postoperative and last follow up, range of motion (ROM), HSS knee score, and Lysholm knee score were recorded. CT measurements of the fibular head superior space and LCP transverse arm were taken in 50 healthy adult knees to assess postposition feasibility. Finally, three fracture models were established using finite element analysis: Model A with plate postposition and PL split fracture fixed by two raft screws of transverse arm, Model B with plate non-postposition and PL split fracture fixed by one raft screw, and Model C with plate non-postposition and PL split fracture fixed by one raft screw and anterior–posterior tension screws. Loadings of 250N, 500N, and 750N were applied for the analysis of the displacement degree, von Mises stress distribution.ResultsResults indicate comparable operative duration and intraoperative hemorrhage between groups. Complications were minimal in both groups. Group A demonstrated superior outcomes in terms of radiographic parameters, functional scores, and fracture collapse prevention. CT measurements revealed compatibility in 72% of healthy knees with the postpositioning technique. Finite element analysis indicated favorable biomechanical stability.ConclusionNot all patients with PTPF were applicable to the management of the plate postposition and two raft screws fixation, even though this technique exerted good biomechanical stability and achieved satisfactory clinic outcomes. When the PL fracture was fixed by only raft screw through LCP owing to various reasons, two anterior–posterior tension screws might be necessitated to maintain the fracture stability.

Finite element analysis and a pilot study of different fixation constructs for Danis-Weber A and B lateral malleolus fractures

BackgroundDisplaced lateral malleolus fractures are typically stabilised through open reduction and internal fixation. The biomechanically and clinically efficacy of locking plates and lag screws, particularly in Weber A and B distal fibular fractures remains a subject of contention. This study examines two locking plate designs for lateral malleolus fractures, evaluating their performance with and without interfragmentary screws using finite element models.MethodsUtilising CT images of a healthy adult male volunteer, a three-dimensional finite element model was constructed. The Fibula-specific Flank Multiaxial Locking Anatomic Plate (FMLP) and the Conventional Locking Plate (CLP) were subjected to stabilisation, both with and without an interfragmentary screw, mimicking the Danis-Weber A and B lateral malleolus oblique fracture fixation. Loads of 140 N and 70 N, equivalent to 20% of the body weight, were applied to simulate the single-leg and two-leg standing conditions in the axial direction. The von Mises stress (VMS) distributions and element displacements were subsequently analyzed.ResultsIn the Danis-Weber A fracture model group, the FMLP with an interfragmentary screw fixation exhibited the lowest peak VMS values: 51.9 MPa in the fibula, 89.0 MPa in the plate, and 61.3 MPa in the screws for simulating single-leg conditions. Under two-leg standing conditions, these peak VMS values decreased to 25.9 MPa in the fibula, 44.5 MPa in the plate, and 30.6 MPa in the screws, respectively. Furthermore, the overall structural peak displacements during single-leg standing for both Weber-A and B fractures with different implants ranged from 1.61 to 2.54 mm. While standing on two feet, the ranged was from 0.80 to 1.27 mm. An interfragmentary screw at the oblique fracture site resulted in reduced the peak value of VMS in the fibula, plate, screws, consequently decreased the overall structural displacement for FMLP and CLP fixation in lateral malleolus fractures.ConclusionsThe current finite element analysis (FEA) demonstrates that FMLP exhibits superior mechanical characteristics in Danis-Weber A and B lateral malleolus fractures compared to CLP. The inclusion of an interfragmentary screw, combined with locking plate design, enhances stability for simple oblique distal fibular fractures. The FMLP presents itself as potential as an alternative for lateral malleolus fractures from a biomechanical perspective. Nevertheless, further verification of these results is imperative through subsequent clinical studies.

Evolving trends in hip fracture patterns among the elderly from 2001 to 2022

IntroductionHip fractures among the elderly exhibit diverse patterns. Differences regarding treatment and prognosis of displaced versus undisplaced intracapsular fractures are well established. Unstable extracapsular fractures are associated with considerably higher rates of complications than stable fractures, including cutout failures, non-unions, wound complications and hardware related problems.The purpose of this study was to identify trends in the distribution of various types of hip fractures and their complexity between 2001 and 2022. MethodsThis retrospective study compared hip fractures treated in the years 2001, 2006, 2010, 2014, 2018, and 2022, excluding patients under 60 years old and those with pathological or peri‑prosthetic fractures. Radiographs were reviewed and fracture patterns were categorized as stable extracapsular, unstable extracapsular, subtrochanteric or intracapsular. ResultsOut of 2646 patients admitted with proximal femoral fractures during these years, 2277 patients (69.5 % women) were available for analysis. Over the initial decade, the mean patient age gradually increased from 80 to 82, subsequently stabilizing. Gender distribution remained consistent, and the proportion of intracapsular fractures showed minimal variation (36–38 %). The most significant finding was the marked decrease in the proportion of stable-to-unstable extracapsular fractures during the first decade from 51 % to 31 %, followed by stabilization after 2010. Subgroup analysis by age revealed that while the proportion change between stable and unstable fractures remained insignificant in younger age groups (p = 0.41 for sexagenarians and 0.12 for septuagenarians), a significant change was observed in older patients (p = 0.002 for octogenarians and 0.04 for nonagenarians and older patients). DiscussionThis study reveals a surge in unstable peritrochanteric fractures between 2001 and 2010, particularly pronounced in patients over 80. This trend plateaued in the following decade, aligning with the stabilization of the cohort's mean age at 82. Numerous factors, from bone morphology to systemic markers, influence hip fracture types. Evolutions in osteoporosis screening and treatment over the last three decades may have contributed to the observed shifts in fracture pattern distribution. Conclusion: Understanding these trends enriches treatment strategies and underscores the need for further exploration of the interplay between demographic and anatomical factors in the etiology of specific fracture patterns.

Strain-controlled creep-fatigue interaction property of Nb521 refractory alloy: Hold time effect and life prediction

Strain-controlled creep-fatigue interaction (CFI) tests were conducted for NbW alloy, i.e., Nb521 alloy, at 900 °C with a strain amplitude of ±0.3% under atmospheric conditions to study the effect of hold time on the CFI failure behaviour, with the results indicating that the creep-fatigue life of the Nb521 alloy decreased with an increase in the hold time. The decline rate gradually flattened, with no saturation effect observed. Furthermore, with an increase in the hold time, the hardening rate of the Nb521 alloy gradually decreased, but the softening rate remained high. Fatigue fractures can be divided into stable propagation, rapid propagation, and final fracture zones according to their morphological characteristics. Compared with the stable propagation zone of the pure fatigue fracture surface, the creep damage caused by the hold time resulted in numerous intergranular fracture features in the stable propagation zone of the CFI fracture surface, indicating that the crack propagation mode changed from a transgranular fracture to a mixed transgranular–intergranular fracture. The strain energy density exhaustion model under nonlinear damage summation better reflects the CFI damage behaviour, with the creep-fatigue life prediction result considered acceptable.

Self locking zip ties temporary displaced mandibular fracture reduction

The article addresses mandibular fractures, which are common today, often resulting from traffic accidents, violence and falls. Surgical management is crucial to avoid future complications. The work describes a specific case in which Nylon tape (clip) was used to reduce a mandibular fracture in a male patient who was a victim of physical aggression. The patient, a homeless individual involved with narcotic substances, was treated by neurosurgery and trauma surgery teams. The fracture was initially reduced with nylon tape during primary care. The patient was subsequently transferred to the oral and maxillofacial surgery (BMF) team for definitive treatment. The treatment involved several steps, including nasotracheal intubation, antisepsis, local anesthesia, submandibular surgical access, removal of nylon tape, tooth extraction, cleaning of the fracture, manual reduction, plate fixation and occlusion review. The patient received conventional clinical support and was released on the second postoperative day for outpatient follow-up. The choice of fixation with replaced load of the 2.4 mm system (load bearing) stands out due to the need for high rigidity in contaminated fractures. The extraction of teeth 43 and 44 was carried out to avoid risks of contamination. The article concludes by highlighting the effectiveness and accessibility of using nylon tape for the temporary stabilization of mandibular fractures, providing local pain relief and reducing the distress associated with bone movement.

Defects-Driven Plasticity: Rationalization Based on Notch Strengthening and Continuous Damage Mechanics

A novel procedure for material quality assessment developed for castings like ductile irons and Al alloys, is based on the analysis of tensile strain hardening through dislocation-density-related constitutive equation, and consists of plotting the Voce equation parameters found through modeling the tensile flow curves with the Voce constitutive equation. In sound materials the Voce parameters have a regular trend, consistent with the physical meaning of the dislocation-density-related Voce constitutive equation. The Voce parameters identify a regular trend also in defective materials, even if defects and metallurgical discontinuities might be expected to add a random and unpredictable component to the plastic behavior. This unexpected regular behavior in defective materials has been called as Defects-Driven Plasticity (DDP), and its rationalization seems to be possible by coupling the concepts of Notch Strengthening (NS) of defects, and stable ductile fracture propagation of the Continuous Damage Mechanics (CDM). The rationalization of DDP and the experimental findings to support, are here reported in high Silicon strengthened ductile irons.

3D numerical analysis of stability and onset of hydraulic fracture in the vertical‐oblique‐horizontal wells under wide range of in situ stresses

AbstractInfluence of the depth and location of perforation, direction and magnitudes of in situ stresses, wellbore angle, and pumping pressure is investigated numerically for the hydraulic fracture. 3D models of rock formation with vertical, inclined or horizontal wells containing semi‐circular crack are analyzed to obtain both KI and the minimum pumping pressure. By computing the magnitude and sign of the T‐stress it is demonstrated that hydraulic fracture path is generally stable except for a very limited situations in which the vertical well is subjected to the lowest in situ stresses. The minimum horizontal in situ stress has the most dominant role in controlling the hydraulic fracture. A direct relationship between KI and T was obtained for different ranges of in situ stresses and some relations were presented for estimating the critical stress intensity factor at the onset of hydraulic fracture and minimum injection pressure in terms of the applied in situ stresses.

Adverse Outcomes of Internal Fixation Using Cannulated Screws or Dynamic Hip Screw in Stable Intracapsular Femoral Neck Fractures

Adverse Outcomes of Internal Fixation Using Cannulated Screws or Dynamic Hip Screw in Stable Intracapsular Femoral Neck Fractures

Characteristics of orthopaedic implants damage and mechanisms of its initiation

Implant fractures complicate orthopaedic procedures requiring secondary surgeries. However, it is not exactly known when the damage initiation starts and which factors predispose them to the highest degree. Thus, the aim of the study was to characterize changes observed in orthopaedic implants after their removal from the bone. Particular efforts were made to determine, which of them occur during the process of its production, installation, usage and removal. Such identification enabled to specify the role of lesions emerging during each period and their role in the implant’s deformation or fracture. The paper was focused on implants dedicated to the stabilization of the femur fractures since the bone transfers the highest loads. External surface and geometric features of eight representative implants were observed under standard and stereoscopic cameras, as well as under light and scanning electron microscopes. Macroscopic analysis of the investigated implants exhibited a number of defects in the form of scratches, abrasions, deformations and chipping. The wear degree of each implant was different and strictly depended on how it was implanted in the patient's body, as well as on how the patient exploited it through his mobility. Four different sources of implant integrity changes were identified: manufacturing-related changes, implant application-related changes, daily life-related changes and implant removal-related changes.

Intramedullary implant stability affects patterns of fracture healing in mice with morphologically different bone phenotypes

Almost all prior mouse fracture healing models have used needles or K-wires for fixation, unwittingly providing inadequate mechanical stability during the healing process. Our contention is that the reported outcomes have predominantly reflected this instability, rather than the impact of diverse biological conditions, pharmacologic interventions, exogenous growth factors, or genetic considerations. This important issue becomes obvious upon a critical review of the literature. Therefore, the primary aim of this study was to demonstrate the significance of mouse-specific implants designed to provide both axial and torsional stability (Screw and IM Nail) compared to conventional pins (Needle and K-wires), even when used in mice with differently sized marrow canals and diverse genetic backgrounds. B6 (large medullary canal), DBA, and C3H (smaller medullary canals) mice were employed, all of which have different bone morphologies. Closed femoral fractures were created and stabilized with intramedullary implants that provide different mechanical conditions during the healing process. The most important finding of this study was that appropriately designed mouse-specific implants, providing both axial and torsional stability, had the greatest influence on bone healing outcomes regardless of the different bone morphologies encountered. For instance, unstable implants in the B6 strain (largest medullary canal) resulted in significantly greater callus, with a fracture region mainly comprising trabecular bone along with the presence of cartilage 28 days after surgery. The DBA and C3H strains (with smaller medullary canals) instead formed significantly less callus, and only had a small amount of intracortical trabeculation remaining. Moreover, with more stable fracture fixation a higher BV/TV was observed and cortices were largely restored to their original dimensions and structure, indicating an accelerated healing and remodeling process. These observations reveal that the diaphyseal cortical thickness, influenced by the genetic background of each strain, played a pivotal role in determining the amount of bone formation in response to the fracture. These findings are highly important, indicating the rate and type of tissue formed is a direct result of mechanical instability, and this most likely would mask the true contribution of the tested genes, genetic backgrounds, or various therapeutic agents administered during the bone healing process.

Fracture properties evaluation of structural adhesives using the dual actuator test frame and digital image correlation technique

ABSTRACT This paper implements a dual actuator testing protocol to evaluate the fracture behavior of a toughened epoxy adhesive under mode I and mixed mode I+II loading conditions. Digital image correlation is used to monitor crack propagation and assess adherend and adhesive deformations. A good repeatability between the test results is observed for both failure modes (I and I+II). The constitutive law is obtained by evaluating the J-integral while measuring the crack tip opening displacement. Different mixed mode test strategies are developed in this work. First, an actuator load control protocol is implemented so as to propagate the crack under constant mixed mode I+II ratio and evaluate the fracture envelope of the studied adhesive, which turns out to be adequately described by the Gong-Benzeggagh failure criterion. A second strategy is proposed with a variable mixed mode ratio during the experiment for faster investigation. Using this technique, stable fracture energy values are recorded along the crack propagation path, thus leading to very fast and accurate results.

CIVILIAN GUNSHOT FRACTURES OF THE ACETABULUM

Acetabulum fractures caused by civilian firearms represent a unique challenge for orthopaedic surgeons. Treatment strategies should include the assessment of infection risk due to frequently associated abdominal injuries and maintenance of joint function. Still, internationally accepted treatment algorithms are not available. The aim of the study was to increase knowledge about civilian gunshot fractures of the acetabulum by describing their characteristics and management at a high-volume tertiary hospital.All adult patients admitted to our hospital between January 2009 and December 2022 with civilian gunshot fractures of the acetabulum were included in this descriptive retrospective study.In total our institution treated 301 patients with civilian gunshot fractures of the hip joint and pelvis during the observation period, of which 54 involved the acetabulum. Most patients were young males (88,9%) with a mean age of 29 years. Thirty patients (55,6%) had associated intraabdominal or urological injuries. Fracture patterns were mostly stable fractures with minor joint destruction amenable to conservative fracture treatment (n=48, 88,9%). Orthopaedic surgical interventions were performed in 21 patients (38,9%) with removal of bullets in contact with the hip joint via arthrotomy or surgical hip dislocation as most frequent procedures. Most patients received antibiotics on admission (n=49, 90,7%). Fracture related infections of the acetabulum were noted in six patients (11,1%) while the mortality in the study population was low with one demised patient (1,9%) due to the trauma burden.Most civilian acetabulum gunshot fractures are associated with intraabdominal or urological injuries. In comparison to the literature on extremity gunshot fractures, there is an increased risk of infection in our study population. The decision for surgical wash-out and bullet removal should be based on contamination and anticipated joint destruction, while osteosynthesis or primary arthroplasty are rarely necessary for these injuries.

MEDIUM-TERM OUTCOMES FOR SURGICAL VERSUS NONOPERATIVE TREATMENT FOR BENNETT'S FRACTURES OF THE THUMB METACARPAL: A MATCHED COHORT STUDY

There is no agreement as to the superiority or specific indications for cast treatment, percutaneous pinning or open fracture fixation for Bennett's fractures of the thumb metacarpal. We undertook this study to compare the outcomes of treatment for patients treated for Bennett's fracture in the medium term.We reviewed 33 patients treated in our unit for a bennett's fracture to the thumb metacarpal with closed reduction and casting. Each patient was matched with a patient treated surgically. Patients were matched for sex, age, Gedda grade of injury and hand dominance. Patients were reviewed at a minimum of 5-years and 66-patients were reviewed in total. Patients were examined clinically and also asked to complete a DASH questionnaire score and the brief Michigan hand questionnaire. Follow up plain radiographs were taken of the thumb and these were reviewed and graded for degenerative change using the Eaton-Littler score.Sixty-six patients were included in the study, with 33 in the surgical and non-surgical cohorts respectively. The average age was 39 years old. In each cohort, 12/33 were female, 19/33 were right-handed with 25% of individuals injuring their dominant hand. In each coort there were 16 Grade 1 fractures, 4 Grade 2 and 13 Grade 3 fractures. There was no difference between the surgically treated and cast-treatment cohorts of patients when radiographic arthritis, pinch grip, the brief Michigan Hand Questionnaire and pain were assessed at final review. The surgical cohort had significantly lower DASH scores at final follow-up. There was no significant difference in the normalised bMHQ scores.Our study was unable to demonstrate superiority of either operative or non-operative fracture stabilization. Patients in the surgical cohort reported superior satisfaction and DASH scores but did not demonstrate any superiority in any other objectively measured domain.