Successful Fracture Treatment Research Articles

Clinical Observations of the Effectiveness of the Masquelet Induced Membrane Technique in the Treatment of Critical Long-Bone Defects of the Lower and Upper Extremities

Background and Objectives: Successful treatment of severe trauma and fractures of the long bones with successful healing and bone union is still a significant challenge for surgeons. Unfortunately, up to 10% of long-bone fractures develop bone healing disorders. The aim of this study was to evaluate the results of treating bone defects with different etiologies in the upper and lower extremities using the induced membrane technique. Materials and Methods: We prospectively evaluated the radiological and clinical outcomes of 45 patients with severe bone defects treated with the induced membrane technique during the period from May 2021 to October 2023. The time to bone defect regeneration, size of the bone defect, and the cost of treatment were evaluated. Functional outcomes were assessed using the Disabilities of the Arm Shoulder and Hand (DASH) scale, SF-36, and the Lower Limb Functional Index (LLFI). Results: The mean follow-up time was 31 months (12–35). There were 20 patients with upper extremity bone defects and 25 with lower extremity bone defects. The mean defect length was 7.9 cm for the upper extremity (3.5–18) and 5.3 cm for the lower extremity (3–11). The mean times to achieve bone union and remodeling were 6.0 months (3–12) and 9 months (3–13) for the upper and lower limbs, respectively. Clinical evaluation at the end of treatment (achieving bone union) showed statistically significant improvements in the DASH, SF-36, and LLFI scales for pre- and postoperative outcomes. There was no statistical significance in the SF-36 clinical scale scores after surgical treatment compared to reconstructive treatment of upper and lower extremity bone defects. Results: The presented reconstructive approach to the treatment of bone defects and healing disorders and extensive analysis demonstrate the effectiveness of the induced membrane technique in a short follow-up period, with a relatively high level of patient comfort and good clinical results in the treatment of severe bone defects with particularly infectious etiologies.

Study of clinical and functional outcome of malleoli fracture

Background: Ankle fractures are a common orthopedic injury, accounting for 9% of all fractures, with an increasing incidence among both young and elderly populations. These fractures often result from road traffic accidents, falls, and sports injuries. Malleolar fractures, involving the bony prominences of the ankle, are particularly prevalent and necessitate accurate reduction and stable internal fixation to prevent complications such as post-traumatic arthritis and restricted motion. This study aims to assess the functional outcomes and results of surgical treatment of malleolar fractures. Methods: The study utilized Lauge-Hansen’s classification to analyze the mechanism of injury in 32 patients with ankle fractures. Surgical techniques included the fixation of syndesmotic injuries with anatomical fibular plates, (AFP) posterior malleolus fractures with percutaneous screws or Ellis plates, and medial malleolus fractures with tension band wiring (TBW). The outcomes were measured in terms of union time, range of motion, and stability. Results: The most common injury mechanism was supination external rotation (SER) in 14 patients, followed by pronation external rotation (PER) in 7 patients, pronation abduction (PAB) in 6 patients, and supination adduction (SAD) in 5 patients. Syndesmotic injuries were found in 7 patients, all treated surgically except one. Posterior malleolus fractures were present in 3 patients and treated with screws or plates. Fixation of medial malleolus fractures with TBW showed better union rates and improved range of motion compared to screw fixation. Lateral malleolar fractures treated with AFP provided additional stability. The average union time was 6 to 8 weeks. Conclusions: Anatomical reduction and stable internal fixation are crucial for the successful treatment of malleolar fractures. TBW for medial malleolus fractures and AFP for lateral malleolar fractures provide favorable outcomes. However, a larger sample size and longer follow-up duration are required to further evaluate the outcomes of ankle injuries, particularly in older patients with osteoporosis and comorbidities.

The surgical management of triple mandibular fractures: A challenging task.

The treatment of multiple mandibular fractures may often be challenging. The aim of this study was to evaluate the characteristics and outcomes of multiple mandibular fractures, with a focus on triple mandibular fractures. Patients with multiple (triple) mandibular fractures were included. The following data were recorded for each patient: age; gender; cause of injury; sites of mandibular fractures; presence of complications. Facial width was esthetically evaluated through a clinical examination considering the inferior facial width, postoperative asymmetries, and facial esthetic harmony. From January 1, 2010, to December 31, 2018, 25 patients (15 men, 10 women) underwent surgery for triple mandibular fractures and were included in the study. A predominance of symphysis/parasymphysis fracture associated with bilateral condylar/ramus fractures was observed, followed by symphysis/ parasymphysis fracture combined with mandibular angle fracture and condyle fracture. Most patients did not show any type of complications. An optimal esthetic outcome was obtained in 20 patients. A successful treatment of trifocal mandibular fractures may be achieved by different techniques, although it remains challenging. The re-establishment of the transversal bigonial dimension by a correct reconstruction of the mandibular arch should guide surgeons. The aim of the treatment should always be the successful rehabilitation of patients' pretraumatic occlusion and function. Key words:Mandibular fractures, multiple, treatment, management, mandible.

Značaj odabira dijagnostičkih i terapijskih modaliteta na ishod lečenja preloma dijafize tibije

Fractures of the tibial shaft are the most common fractures of long bones. Open fractures of the tibial shaft often lead to simultaneous severe soft tissue and bone damage. The absence of adequate soft tissue coverage, together with the specific blood supply to this region, makes these fractures susceptible to infection and non-healing. A thorough patient evaluation, including diagnosis of soft tissue and bone damage, is essential for the successful treatment of tibial diaphysis fractures. The medical importance of tibial diaphyseal fracture on the one hand, and the uncertainties that exist when it comes to treatment, on the other hand, impose the need to examine the best therapeutic modalities in patients with tibial diaphyseal fracture. In addition to conservative treatment, which is reserved for fractures without dislocation of fracture fragments, the most common approach is surgical treatment - with external fixators or intramedullary fixation with nails. Today, intramedullary fixation takes precedence in the treatment of most fracture types. Ilizarov external fixator is still the method of choice in patients with multiple traumas. Most studies did not observe a significant difference in the frequency of postoperative complications between the two methods, such as delayed healing and fracture nonunion, however, numerous studies indicate more frequent superficial infections in patients treated with an external fixator, or deep infections in patients treated with intramedullary pins. Each of the mentioned complications additionally burdens both the surgical team and the patient, i.e. the success of the treatment and functionality, together with the quality of life after the treatment is completed. Therefore, it is necessary to conduct larger, prospective, and multicenter studies on complication rates, which will help in choosing the most adequate treatment method for tibial diaphysis fractures.

УСПЕШНЫЙ ОПЫТ ЛЕЧЕНИЯ ЗАКРЫТОГО ДИАФИЗАРНОГО ПЕРЕЛОМА КОСТЕЙ ЛЕВОЙ ГОЛЕНИ СО СМЕЩЕНИЕМ ОТЛОМКОВ

Among all fractures of the bones of the lower extremities, fractures of the bones of the lower leg occur in 65 % of cases, and fractures of the middle (diaphyseal) part are recorded, on average, in 29 out of 100000 people of the population per year. The time of incapacity for work for fractures of the bones of the lower leg can vary depending on the severity of the damage and can reach 10-12 months. Purpose . Demonstrate successful experience in the treatment of a patient with a closed fracture of the diaphyses of both bones of the left lower leg, with displacement of bone fragments. Materials and methods . We carried out the search in open electronic scientific databases PubMed and databases of the Russian scientific electronic library eLibrary. Results . We performed open reposition of tibia diaphysis fracture of left tibia and osteosynthesis with titanium plate and screws. On the 5th day after the osteosynthesis, the patient was discharged in a satisfactory condition for further observation and treatment on an outpatient basis by a traumatologist at the place of residence. Discussion . Analyzing the results of surgical treatment in the described clinical case, it can be concluded that effective treatment with the method of osteosynthesis with a titanium plate and screws is possible with a closed fracture of the diaphysis of both bones of the lower leg with displacement of fragments. Conclusion . For successful treatment of fractures of the diaphyseal part of the lower leg bones, it is a prerequisite to accurately compare the fragments and ensure complete immobilization of the damaged area, followed by complex therapy. Our experience suggests that treatment with the method of osteosynthesis with a titanium plate and screws for a closed fracture of the diaphysis of both bones of the lower leg with displacement of fragments is effective in terms of consolidation and restoration of limb function.

MINIMAL INVASIVE FOR MAXIMAL RECOVERY IN DENTAL TRAUMA : A CASE REPORT

Introduction: Dentoalveolar fractures can be treated in a simple non-surgical procedure by repositioning the fractured fragments and immobilizing them. One of the factors affecting the success of dentoalveolar fracture treatment is the choice of material and immobilization technique. Case: A 16-year-old girl came to the Emergency Department with complaints of bleeding from the mouth due to a traffic accident 5 hours ago. Her lip hit the handlebar of a motorcycle. There was no history of fainting, vomiting, and bleeding from the ears and nose. Extraoral examination revealed an asymmetrical face. Edema and laceration on the upper lip. Intraoral examination revealed gingival laceration of teeth 12-22 and avulsion of teeth 12,22. Panoramic x-ray revealed supra position of teeth 11, 21 and avulsion of teeth 12, 22. Case Management: Wound debridement, indirect root canal treatment of teeth 12, 22, repositioning of teeth 12-22, fixation with wire and composite splinting, selective grinding, antibiotics, and analgesics were performed. Post-operative instructions included maintaining oral hygiene, a soft diet, and a return for splinting control. Discussion: The goal of dentoalveolar trauma treatment is to restore the normal function and shape of the masticatory organs. The treatment in this case uses flexible splinting because it has ability to resemble the physiological mobility condition of the teeth which can help the healing of the periodontal ligament. The treatment results showed soft and hard tissue healing after one month of treatment. Conclusion: Successful treatment of dentoalveolar fractures will be achieved if performed promptly and if accurate immobilization and accurate tools are used. Simple tools and techniques make flexible splinting a good treatment for simple dentoalveolar fractures.

SURGICAL MANAGEMENT OF UNSTABLE SACRAL FRACTURES

Sacral fractures are often underdiagnosed, but are frequent in the setting of pelvic ring injuries. They are mostly caused by high velocity injuries or they can be pathological in aetiology. We sought to assess the clinical outcomes of the surgically treated unstable sacral fractures, with or without neurological deficits. unstable sacral fractures were included in the study.Single centre, prospectively collected data, retrospective review of patients who sustained vertically unstable fractures of the sacrum who underwent surgical fixation. out of a total of 432 patients with pelvis and acetabulum injuries. fifty six patients met the inclusion criteria. 18 patients had sustained zone one injuries. 14 patients had zone 2 injuries and 10 patients had zone 3 injurie. Operative fixation was performed percutaneously using cannulated screws in 18 patients.. Open fixation of the sacrum using the anterior approach in 6 patients. Posterior approach was indicates in all 10 of the zone 3 injuries of the sacrum. While in 4 patients, combined approaches were used. 3 patients had decompression and spinopelvic fixation.Neurological deficits were present in 16% of the patients. 2 patients presented with neurgenic bladder. Of the 4 patients who had neurological fall out, 3 resolved with posterior decompression and posterior fixation. All 4 neurological deficits were due to taction or compression of the nerve roots. No hardware failures or non unions observed.The rate of neurological deficit was related more to the degree of pelvic ring instability than to a particular fracture pattern. Low rates of complications and successful surgical treatment of sacral fractures is achiavable. Timeous accurate diagnosis mandatory

Computed Tomography Provides Improved Quantification of Trabecular Lumbar Spine Bone Loss Compared to Dual-Energy X-Ray Absorptiometry in Ovariectomized Sheep.

Early detection of osteoporosis using advanced imaging is imperative to the successful treatment and prevention of high morbidity fractures in aging patients. In this preclinical study, we aimed to compare dual-energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT) to quantify bone mineral density (BMD) changes in the sheep lumbar spine. We also aimed to determine the relationship of BMD to microarchitecture in the same animals as an estimate of imaging modality precision. Osteoporosis was induced in 10 ewes via laparoscopic ovariectomy and administration of high-dose corticosteroids. We performed DXA and QCT imaging to measure areal BMD (aBMD) and trabecular volumetric BMD (Tb.vBMD)/cortical vBMD (Ct.vBMD), respectively, at baseline (before ovariectomy) and at 3, 6, 9, and 12 months after ovariectomy. Iliac crest bone biopsies were collected at each time point for micro-computed tomography (microCT) analysis; bone volume fraction (BV/TV), trabecular number (Tb.N), thickness (Tb.Th), and spacing (Tb.Sp) were reported. aBMD and Tb.vBMD both decreased significantly by 3 and 6 months (p < 0.05) compared with baseline, whereas no changes to Ct.vBMD were observed. Combined (Tb. and Ct.) vBMD was significantly correlated with aBMD at all time points (all p < 0.05). Additionally, greater significant correlations were found between BV/TV and Tb.vBMD at all five time points (R 2 = 0.54, 0.57, 0.66, 0.46, and 0.56, respectively) than with aBMD values (R 2 = 0.23, 0.55, 0.41, 0.20, and 0.19, respectively). The higher correlation of microCT values with QCT than with DXA indicates that QCT provides additional detailed information regarding bone mineral density changes in preclinical settings. Because trabecular bone is susceptible to rapid density loss and structural changes during osteoporosis, QCT can capture these subtle changes more precisely than DXA in a large animal preclinical model. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Successful Primary Treatment of Ankle Fractures in Diabetic Patients with Peripheral Neuropathy Using a Tibiotalocalcaneal Nail: A Case Series.

Among diabetics, patients with peripheral neuropathy are at increased risk of developing complications following an ankle fracture. While the outcomes in these patients treated nonoperatively have been poor, the outcomes in those undergoing open reduction and internal fixation are at the best modest. We hypothesize that closed reduction and internal fixation with tibiotalocalcaneal nail is an effective primary procedure in this complication prone patient group. A retrospective review of diabetic patients with peripheral neuropathy who underwent acute treatment of an ankle fracture with closed reduction and internal fixation with a tibiotalocalcaneal nail at two Level 1 trauma centers was performed. 30 patients were identified and divided into 2 groups with respect to their postoperative weight bearing protocol: 20 patients in the early weight bearing (EWB) group and 10 patients in the touch-down weight bearing (TDWB). The primary outcome was the rate of return to baseline function and the secondary outcomes included the incidence of wound dehiscence, wound infection, implant failure, loss of fixation, loss of reduction and amputation. In the EWB group, 15/20 patients returned to their baseline function, 5/20 had wound dehiscence and infection, 2/20 had implant failure, 5/20 had loss of fixation, 4/20 had loss of reduction, and 4/20 underwent amputation. In the TDWB group, 9/10 patients returned to their baseline function, 1/10 had implant failure, 1/10 had loss of fixation. No patients from this group had loss of reduction or underwent amputation. Treatment with tibiotalocalcaneal nail is an effective primary procedure in this complication prone group of patients, assuming that weight bearing is delayed for six weeks to protect soft tissues and surgical incisions. Level IV, retrospective case series.

Optimizing Delivery of Therapeutic Growth Factors for Bone and Cartilage Regeneration

Bone- and cartilage-related diseases, such as osteoporosis and osteoarthritis, affect millions of people worldwide, impairing their quality of life and increasing mortality. Osteoporosis significantly increases the bone fracture risk of the spine, hip, and wrist. For successful fracture treatment and to facilitate proper healing in the most complicated cases, one of the most promising methods is to deliver a therapeutic protein to accelerate bone regeneration. Similarly, in the setting of osteoarthritis, where degraded cartilage does not regenerate, therapeutic proteins hold great promise to promote new cartilage formation. For both osteoporosis and osteoarthritis treatments, targeted delivery of therapeutic growth factors, with the aid of hydrogels, to bone and cartilage is a key to advance the field of regenerative medicine. In this review article, we propose five important aspects of therapeutic growth factor delivery for bone and cartilage regeneration: (1) protection of protein growth factors from physical and enzymatic degradation, (2) targeted growth factor delivery, (3) controlling GF release kinetics, (4) long-term stability of regenerated tissues, and (5) osteoimmunomodulatory effects of therapeutic growth factors and carriers/scaffolds.

Robot–patient registration for optical tracker-free robotic fracture reduction surgery

Background and objectiveImage-guided robotic surgery for fracture reduction is a medical procedure in which surgeons control a surgical robot to align the fractured bones by using a navigation system that shows the rotation and distance of bone movement. In such robotic surgeries, it is necessary to estimate the relationship between the robot and patient (bone), a task known as robot–patient registration, to realize the navigation. Through the registration, a fracture state in real-world can be simulated in virtual space of the navigation system. MethodsThis paper proposes an approach to realize robot–patient registration for an optical-tracker-free robotic fracture-reduction system. Instead of the optical tracker which is a three-dimensional position localizer, X-ray images are used to realize the robot–patient registration, combining the relationship of both the robot and patient with regards to C-arm. The proposed method consists of two steps of registration, where initial registration is followed by refined registration which adopts particle swarm optimization with the minimum cross-reprojection error based on bidirectional X-ray images. To address the unrecognizable features due to interference between the robot and bone, we also developed attachable robot features. The allocated robot features could be clearly extracted from the X-ray images, and precise registration could be realized through the particle swarm optimization. ResultsThe proposed method was evaluated in phantom and ex-vivo experiments involving a caprine cadaver. For the phantom experiments, the average translational and rotational errors were 1.88 mm and 2.45°, respectively, and the corresponding errors in the ex vivo experiments were 2.64 mm and 3.32° The results demonstrated the effectiveness of the proposed robot–patient registration. ConclusionsThe proposed method enable to estimate the three-dimensional relationship between fractured bones in real-world by using only two-dimensional images, and the relationship is accurately simulated in virtual reality for the navigation. Therefore, a reduction procedure for successful treatment of bone fractures in image-guided robotic surgery can be expected with the aid of the proposed registration method.

Does Computed Tomography Provide an Advantage over X-ray in the Treatment of Intertrochanteric Fractures?

Objective: Successful treatment of intertrochanteric fractures depends on an appropriate implant and is decided according to fracture classification and stability. In the present study, the purpose was to investigate the interobserver and intraobserver consistency of x-ray and/or Computed Tomography (CT) in fracture classification and implant preference for treatment in intertrochanteric fractures. Materials and Methods: The patients who were diagnosed with 80 intertrochanteric fractures by two orthopedists with 5 or more years of trauma experience and who had pelvic CT scans for suspected accompanying fractures were evaluated in the study. AO/OTA classification and implant preference for treatment were based on x-ray and/or CT. Second evaluations were made two weeks later. Cohen’s Kappa was calculated for interobserver reliability in the first evaluation and intraobserver reliability in the first and second evaluations. Results: Intra-observer ICC ranged between 0.861 and 0.973 for Observer-1 and between 0.893 and 0.993 for Observer-2 in all evaluations. Inter-observer ICC was within the range of 0.865-0.961 based on primary evaluations. These data represented excellent intra- and inter-observer consistency for both observers (P

A review of equine tibial fractures.

Equine tibial fractures are relatively infrequent in racing and non-racing sport horses, but limitations in successful treatment of tibial fractures in adult horses result in relatively high mortality compared with other musculoskeletal injuries. The aetiology of tibial fracture can be classified into two general categories: traumatic impact or fatigue failure. Tibial stress fractures, also known as fatigue fractures, are often rated as the second most common stress fracture in racing Thoroughbreds; young age, early stage in race training, and initiation of training after a period of rest are the reported risk factors. Both impact and fatigue fracture propagation are dependent on the magnitude of force applied and on the local composition/alignment of mineralised collagen in the tibial lamella. Extensive research has characterised the pattern of strain distribution and stress remodelling within the equine tibia, but in vivo measurement of load and angular moments are currently not feasible. Further research is warranted to correlate biomechanical theory of tibia fatigue fracture propagation with current histopathological data. Preventative measures for fatigue fractures aim to optimise diagnostic efficiency, reduce the interval between injury and diagnosis and modify racing and training conditions to reduce non-specific fracture risk. Treatment options for complete tibial fractures in adult horses are limited, but with careful case selection, successful outcomes have been reported after open reduction and internal fixation. On the other hand, tibial stress fractures and minimally displaced incomplete fractures are typically treated conservatively and have good prognosis for athletic recovery. This review aims to describe the current literature regarding tibial fracture aetiology, prevalence, risk factors, fracture biomechanics, treatment, prognosis and prevention.

The Clinical Efficacy of Minimally Invasive Clamp-Assisted Reduction and Open Reduction with Wire Cerclage for Unstable Subtrochanteric Fractures.

The purpose of this study was to compare the clinical effectiveness of minimally invasive clamp-assisted reduction and open reduction with wire cerclage and intramedullary nails for unstable subtrochanteric fractures. Between January 2016 and October 2019, 68 patients who had unstable subtrochanteric fractures experienced intramedullary nail surgery in this retrospective study. There were 41 cases in the minimally invasive clamp or closed reduction group (group A) and 27 cases in the open reduction with wire cerclage group (group B). There were 3 cases of complications in group A and 2 cases of complications in group B. Remarkable distinction was observed between the two groups in the operation time (p < 0.05), quality of reduction (p < 0.05), and union time (p < 0.05). For the successful surgical treatment of unstable femoral subtrochanteric fractures, an anatomical reduction is crucial. Reduction and wire cerclage are cut to give medial support for the anatomical reduction, which has a positive effect on fracture healing.

Prelom vrata talusa - pregled kliničkih karakteristika i metoda lečenja

The talus transfers the weight of the whole body onto the foot and is therefore an important factor of stability and posture. The prerequisite for successful treatment of talus neck fractures is knowledge of anatomy, understanding of the mechanisms that lead to fractures of the talus neck, knowledge of the potential complications of all treatment methods, as well as knowledge of indications for surgical treatment. About 55% of the talus surface is covered with articular cartilage, and displaced fractures lead to the destabilization of several joints. Since fractures are caused by high energy trauma, the result can easily be comminution and/or dislocation (displacement). Fractures of the talus neck can occur as an isolated injury, as well as part of polytrauma (falls from height, traffic accidents). The X-ray is the basic diagnostic tool for making an accurate diagnosis, in case of suspect talus fracture. Multi-slice computerized tomography is the most useful method for studying fracture patterns and is indispensable in planning surgical treatment. The Hawkins classification of talus neck fractures, from 1970, has remained in use to this day, while recommended treatment methods vary depending on the type of fracture. The main goal of treatment is anatomical reduction. The anatomical characteristics of the talus, the particular blood supply, as well as the "high energy" mechanism of fracture, pose a challenge for clinical evaluation and optimal treatment of talus fractures. This paper highlights the necessity of the knowledge of surgical techniques for the selection of an adequate method of treatment, in order to prevent unwanted consequences for the patient, which in the case of suboptimal treatment can be severe.

Primary cemented bipolar hemiarthroplasty by transtrochanteric approach in unstable intertrochanteric fractures

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; The successful treatment of unstable intertrochanteric fractures of the femur in elderly patients is a challenge. Due to complications associated with internal fixation, primary hemiarthroplasty is increasingly becoming an alternative treatment to achieve early mobilisation. A transtrochanteric approach could potentially decrease the complications associated with primary hemiarthroplasty. Aim of the study is to document the postoperative outcome and complications associated with this treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In this retrospective study, all elderly patients with unstable trochanteric fractures, treated by primary hemiarthroplasty through a transtrochanteric approach, in a tertiary care centre, from September 2017 to December 2019, were enrolled. Their data from hospital records were analysed and results compared to literature.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; 48 patients underwent the procedure. Average age was 85 years. One year mortality was 31.25%. Average duration of surgery is 85 min. 58.3% were ambulant at one year. One case of dislocation secondary to surgical site infection was present.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Primary hemiarthroplasty as a primary treatment in this group of patients enables early mobilization and prevents complications associated with prolonged immobilization. Transtrochanteric approach reduces the duration of surgery. Achieving early ambulation is the key to successful treatment.&lt;/p&gt;

Fine wire versus locking plate fixation of type C pilon fractures.

The successful treatment of high energy pilon fractures (AO-OTA 43C) can be achieved with a fine wire circular external fixator (CEF) or locking plate construct (ORIF). There is no consensus on whether ORIF or CEF achieves superior outcomes, and both have unique complications. We report early to mid-term outcomes comparing type C pilon fractures treated with ORIF and CEF. An 8-year retrospective review was performed on all patients who underwent ORIF or CEF for closed 43C fractures in a tertiary orthoplastic centre. Outcomes included unplanned return to theatre prior to union including superficial and deep surgical site infections (SSI), non-union and post-traumatic osteoarthritis (PTOA) needing fusion. 76 patients underwent ORIF and 59 patients had CEF, with a mean follow-up of 2years. 7/76 (9.2%) patients who underwent ORIF had a superficial SSI; 2 patients (2.6%) required a formal debridement for deep SSI; none required a flap. 13/59 patients (22%) had a pin track infection following CEF. With the numbers available, there was no significant difference in rates of unplanned return to theatre before bone healing (ORIF 7/76, 9.2%, CEF 9/59, 15.2%, p = 0.7), rates of mal-union (1.7% CEF, 3.9% ORIF, p = 0.7), deep SSI (p = 0.9), time to union (ORIF: 8.1months v CEF 10.8months, p = 0.51), non-union (p = 0.24) and fusion for PTOA (ORIF: 6/76, CEF 2/59, p = 0.46). With correct patient selection, both ORIF and CEF offer equivalent and favourable early to mid-term outcomes with regard to deep SSI, non-union, mal-union and PTOA. Although statistically insignificant, ORIF with more than 2 plates carries a risk of superficial and deep SSI, whilst CEF is associated with a 22% pin track infection rate. These unique risks must be discussed with the patient as part of a shared decision-making process.

APACHE—Anterior Plating of the Acetabulum in Hemi-Endoscopic Technique: An Alternative Method for Internal Fixation of the Acetabulum

Injuries of the acetabulum are often challenging in treatment and aftercare. One reason is the required surgical approach, which has high complication rates, including vascular lesion, hernias, and wound infection. We present an alternative endoscopic-assisted approach for the internal fixation of acetabular fractures to avoid the Pfannenstiel incision. An endoscopic approach similar to that used for endoscopic hernia surgery was used. The ilioinguinal approach’s lateral window was used to achieve reduction and insertion of a reconstruction plate. The purpose of this study is to describe a minimally invasive technique as a possible method to reduce hospitalization and complications. Another goal is to give detailed technical recommendations and to assess the potential pitfalls of this surgical approach. The APACHE technique is a safe and suitable minimally-invasive approach for the successful treatment of complex acetabular fractures and can be considered in similar cases.

Functional Outcomes of Pediatric Both Bone Fractures Fixed with Titanium Elastic Nails: : A Hospital Based Study

Background: Successful treatment of both bone fractures depends on the restoration of normal alignment and full recovery of range of motion that can be achieved by either closed reduction and casting or surgical intervention. Number of surgical treatment modalities have been mentioned for unstable pediatric both bone fractures that includes Kirschner wire fixation, plating, external fixation and elastic intramedullary nailing&#x0D; Methods: This was descriptive cross-sectional study performed from January 2016 to December 2019. A total of 85 diaphyseal pediatric forearm fractures were treated surgically with TENs during this period. Functional outcomes and complications were analysed 6 months after surgery.&#x0D; Results: The mean age of patients in our study was 10.67±1.88. There were 50 (64.1%) male and 28 (35.9%) female. Incidence of fracture is higher in left side 47 (60.2%) in comparison to right side 31 (39.8%). Thirteen (16.7%) fractures were in proximal third, 50 (64.1%) in middle third and 15 (19.2%) in distal third of both bone forearm.There were excellent outcomes in 91%, good outcomes in 6.4% and fair results in only 2.6% of patients.Seven different types of complications were noted including skin irritation 8 (10.2%), cortex perforation in 2 (2.5%) and iatrogenic fracture in 1 (1.3%) case.&#x0D; Conclusions: Titanium elastic nailing is excellent treatment option for displaced unstable pediatric both bone fractures especially in elderly children. This is technically easy, minimally invasive procedure where bone healing is relatively fast, implant removal is easy with excellent cosmesis of skin without long ugly scar in forearm.

Management of mandibular angle fractures through single and two mini-plate fixation systems: Retrospective study of 112 cases

IntroductionThe aim of this paper is to compare the clinical results between the different methods of fixation of standard mini-plates for the management of mandibular angle fractures. Study designThis was a retrospective analysis study of 196 patients with mandibular angle fractures divided into 3 groups at our hospital 20 august 1953 specialist hospital, which is a referral center between January 2015 and January 2020. The patients were assessed for malocclusion, infection, wound dehiscence, neuro-sensory deficit, mouth opening, stability, operating time, blood loss, and hardware failure. Group (I) comprised 72 men and 40 women with a mean age of 43 years. Group (II) comprised 36 men and 12 women with a mean age of 47 years. Group (II) comprised 29 men and 7 women with a mean age of 33 years. The assessment of surgical outcomes after the last follow-up visit clearly showed a lack of stability in patients group II compared to the other groups. The operating time was reduced in group I compared to Group II/ III. (P = 0.03) The wound dehiscence occurred mostly in Group III unless it was statistically no significant. The infection events occurred in 36 patients of the sample, which was not statistically significant (Table 4). DiscussionFractures of the mandibular angle represent 23–42% of all mandibular fractures, in our context road accidents followed by aggression are the most frequent mechanisms found. A various types of treatment approaches for the treatment of angular fractures have been described. Our analysis revealed that surgical time and complication rate has been reduced when using the Group I technique compared to the other groups. ConclusionThe use of the monocortical external oblique miniplate provides the best results. Successful treatment of mandibular fractures depends on stability in the ideal anatomical position since abnormal mobility at the fracture site will lead to non-union, malocclusion, and infection.