Surgical Management Of Fractures Research Articles

Factors Associated With Adverse Radiographic Outcomes Following Operative Management of Ankle Fractures: A Single-Center Study.

Introduction Ankle fractures arecommonly encountered fractures in emergency departments worldwide. These fractures often have significant articular involvement that requires anatomic surgical reduction and stabilization. Radiographs can be used in everyday practice to evaluate ankle fractures utilizing various parameters to assess reduction quality intraoperatively and postoperatively. Several factors have been found to influence the reduction quality of fractures across body regions.This retrospective study aimed to evaluate the influence of several factors on the reduction quality of ankle fractures in a tertiary care center in the Kingdom of Bahrain. Materials and methods A total of 462 records were identified during the search, and 68 records were excluded. A total of 394 ankle fractures met the inclusion criteria for the study. Five orthopedic surgeons then evaluated the operative films in accordance with the Delphi consensus parameters for evaluating ankle fractures, and the reductions were graded as good, adequate, or poor. Results The study included 394 ankle fractures that met the inclusion criteria, and four significant associations were notedto affect the quality of reduction. Ankle fractures with posterior malleolus involvement (PMI) were significantly associated (p = 0.001) with fragments smaller than 15% and larger than 20% having decreased outcomes. The number of daysfrom admission to operation was also significant (p = 0.009), with the best reductions observed between zero and one day from admission. Operating surgeon was also a significant factor (p = 0.038), with inferior reductions noted in specialist surgeons compared to trainees. The last significant association was the number of malleoli (p = 0.001), with an inferior reduction with a larger number of malleoli involved. Conclusion Ankle fractures are a common and significant orthopedic injury. Reduction quality is important for optimal outcomes after surgical stabilization. Various factors including the number of malleoli, the grade of the operating surgeon, and the time of surgery were significantly related to the quality reduction in this single-center study. Expedited surgical management of fractures that are amenable to early fixation, careful assessment, and meticulous technique in fixation offractures with multiple fractured malleoli is indicated to reduce the chance of malreduction particularly in complex injuries.Further assessment of factors related to reduction quality with large-scale prospective studies would provide orthopedicsurgeons with insights into the identification and optimal treatment of such fractures.

Ex vivo analysis of cortical microarchitecture of the distal clavicle: implications for surgical management of fractures.

Cortical thickness and porosity are two main determinants of cortical bone strength. Thus, mapping variations in these parameters across the full width of the distal end of the clavicle may be helpful for better understanding the basis of distal clavicle fractures and for selecting optimal surgical treatment. Distal ends of 11 clavicles (6 men, 5 women; age: 81.9 ± 15.1years) were scanned by micro-computed tomography at 10-µm resolution. We first analyzed cortical thickness and porosity of each 500-μm-wide area across the superior surface of distal clavicle at the level of conoid tubercle in an antero-posterior direction. This level was chosen for detailed evaluation because previous studies have demonstrated its superior microarchitecture relative to the rest of the distal clavicle. Subsequently, we divided the full width of distal clavicle to three subregions (anterior, middle, and posterior) and analyzed cortical porosity, pore diameter, pore separation, and cortical thickness. We found the largest number of low-thickness and high-porosity areas in the anterior subregion. Cortical porosity, pore diameter, pore separation, and cortical thickness varied significantly among the three subregions (p < 0.001 p = 0.016, p = 0.001, p < 0.001, respectively). Cortex of the anterior subregion was more porous than that of the middle subregion (p < 0.001) and more porous and thinner than that of the posterior subregion (p < 0.001, p = 0.030, respectively). Interaction of site and sex revealed higher porosity of the anterior subregion in women (p < 0.001). The anterior subregion had larger pores than the middle subregion (p = 0.019), whereas the middle subregion had greater pore separation compared with the anterior (p = 0.002) and posterior subregions (p = 0.006). In general, compared with men, women had thinner (p < 0.001) and more porous cortex (p = 0.03) with larger cortical pores (p < 0.001). Due to high cortical porosity and low thickness, the anterior conoid subregion exhibits poor bone microarchitecture, particularly in women, which may be considered in clinical practice. Level IV.

Delayed Union and Nonunion: Current Concepts, Prevention, and Correction: A Review.

Surgical management of fractures has advanced with the incorporation of advanced technology, surgical techniques, and regenerative therapies, but delayed bone healing remains a clinical challenge and the prevalence of long bone nonunion ranges from 10 to 15% of surgically managed fractures. Delayed bone healing arises from a combination of mechanical, biological, and systemic factors acting on the site of tissue remodeling, and careful consideration of each case's injury-related, patient-dependent, surgical, and mechanical risk factors is key to successful bone union. In this review, we describe the biology and biomechanics of delayed bone healing, outline the known risk factors for nonunion development, and introduce modern preventative and corrective therapies targeting fracture nonunion.

Trauma Registry: Trauma Quality indicators analysis in hospitalized patients.

to consolidate a Trauma Register (TR) trough REDCap data acquisition platform and to validate, in this context, local Quality Indicators (QI) as improvement opportunities in trauma management. continuous data acquisition of all patients admitted in Irmandade da Santa Casa de Misericórdia de São Paulo adult Trauma bay and it's validation in REDCap platform; 6 months retrospective cohort of QI impact in length of hospitalar stay, complications and mortality. Fisher, Chi-squared, Wilcoxon and Kruskal-Wallis tests were used to correlate QIs fails with the endpoints, considering p<0.05 and CI <95% as statically significant. 465 were admitted in Trauma bay, with 137 patients hospitalized (29.5%); the number of QIs compromised were related with more complications (p=0.075) and increased length of stay (p=0.028), especially the delay in open fracture's surgical management, which increased the severe complications' incidence (p=0.005). the REDCap data acquisition platform is useful as a tool for multi center TR implementation, from ethical and logistical point of view; nevertheless, the proposed QIs are validated as attention points in trauma management, allowing improvements in traumatized patients treatment.

Depressed Skull Fracture Surgical Management and Outcome among Head Injury Patients: Experience at Tertiary Care Hospital

Objective: To evaluate outcomes in patients with managed depressed skull fractures operatively having head injuries. Methods: This study was conducted at Liaquat University of Medical and Health Sciences, Jamshoro. We analyzed 76 patients who underwent operative management for skull fractures. Patient selection included both children and adults with skull fractures evident on CT brain scans using bone windows. Results: Our study included 76 patients, with 48 males and 28 females, and a mean age of 28.68 ± 10.33 years. Among them, 45 (59.21%) were under 30 years old, and the highest incidence of depressed skull fractures occurred in the 21 – 30 age group. Road traffic accidents were the leading cause, accounting for 42 (55.25%) cases, while falls from heights contributed to 24 (31.57%) cases, and 7 (9.21%) resulted from objects falling on the patients. Conclusion: Patients with head injuries can be fatal if not managed promptly. Neglecting the management of a depressed fracture can also impact the outcome in these cases and lead to a series of complications.

Orthopedic hardware in trauma – A guided tour for the radiologist-Associated complications (Part 2)

With the increasing number of options available for surgical management of fractures now available, it is imperative that radiologists should familiarize themselves with the various hardwares used to provide a good support system for orthopedic surgeons. Understanding fracture union and “why a device may fail” are basic concepts that have been discussed in this review article, as their success is mutually dependent. While it may be easy to identify frank loosening, fracture, or migration of the hardware, it is more important to identify any early signs of these complications. However, before that, as a radiologist, one should be able to accurately identify the hardware type, assess their position, and then identify any potential complications. Another important aspect that is clinically important is the ability to differentiate between aseptic and septic loosening. Apart from these, avascular necrosis, pseudoaneurysms, bursitis, muscle impingement with atrophy, adverse reaction to metal debris, nerve impingements, traumatic neuroma formation, tendon impingement, snapping syndromes, and sarcoma are uncommon complications that may be rarely encountered. While conventional radiology is still the backbone of radiological evaluation, CT, MRI, and Ultrasound can be used as problem-solving tools, further aiding in the diagnosis of any hardware-related complications. In this series, we have also described a checklist based approach of reporting so that the radiologist can accurately identify the hardware, assess their position, and identify any potential complications. We hope that this learning will facilitate the interobserver consensus and standardization of reports.

Changing Physician Behavior to be More Cost Conscious in Distal Radius Fracture Surgical Management: A Survey Study

Objectives:To evaluate six surgeons’ overall experience using cost-effective implants compared to the implants they typically use.Design:Cross-sectional SurveySetting:A Metropolitan Healthcare SystemParticipants:Six surgeons who operatively treat distal radius fractures regularly.Intervention:Surgeons were asked to alternate implant (brand name vs. generic) use in DRF fixation each month. They were then sent a 10-question survey to evaluate their experience with the generic implants. Most questions were rated on a 1-10 Likert scale (1=worst outcome, 10=best outcome). Main Outcome Measurements:Ease of Use and Continued Generic Implant UseResults:All six surgeons completed the survey (100% response rate). Most surgeons completed a hand surgery fellowship (83.3%) and performed their cases in an ambulatory surgery center (83.3%). The average rating for ease of use and how intuitive the system was were 8.8±2.2 and 8.5±1.7. Most surgeons felt that generic implants added little or no extra time to the procedure (4.5±1.0, with 5 being neutral). Most in this group would use generic implants again and recommend them to colleagues (8.2±2.9, 8.0±3.2, respectively).Conclusions:Implant preference is often driven by exposure during residency and fellowship and is minimally evidence-based by comparison. In many instances there is a belief that the value lies in the technology when, in fact, patient selection, surgical technique and post-operative management are more important in determining patient outcome. As cost containment strategies are developed and implemented, we recommend they come from physician leadership, and not top-down administrative mandates.Key Words:Surgeon Behavior, Satisfaction Survey, Implant Cost, Cost Containment Strategy, Generic Implants, Distal Radius FractureLevel of Evidence:Level V

MANAGING A PATIENT WITH RENAL OSTEODYSTROPHY AND MULTIPLE FRACTURES: A MULTIDISCIPLINARY APPROACH

Renal Osteodystrophy is a type of metabolic bone disease characterized by bone mineralization deficiency due to electrolyte and endocrine abnormalities. Patients with chronic kidney disease (CKD) are more likely to experience falls and fractures due to renal osteodystrophy and the high prevalence of risk factors for falls. Treatment involves medical management to resolve the etiology of the underlying renal condition, as well as management (and prevention) of pathological fractures.A 66-year-old female patient, with severe osteoporosis and chronic kidney disease undergoing haemodialysis, has presented with multiple fractures along the years. She was submitted to bilateral proximal femoral nailing as fracture treatment on the left and prophylactically due to pathological bone injury on the right, followed by revision of the left nail with a longer one after varus angulation and fracture distal to the nail extremity. Meanwhile, the patient suffered a pathological fracture of the radial and cubital diaphysis and was submitted to conservative treatment with cast, with consolidation of the fracture. Posteriorly, she re-fractured these bones after a fall and repeated the conservative treatment.Clinical management: There is a multidisciplinary approach to manage the chronic illness of the patient, including medical management to resolve the etiology and consequences of her chronic kidney disease, pain control, conservative or surgical fracture management and prevention of falls.The incidence of chronic renal disease is increasing and the patients with this condition live longer than previously and are more physically active. Thus, patients may experience trauma as a direct result of increased physical activity in a setting of weakened pathologic bone. Their quality of life is primarily limited by musculoskeletal problems, such as bone pain, muscle weakness, growth retardation, and skeletal deformity. A multidisciplinary approach is required to treat these patients, controlling their chronic diseases, managing fractures and preventing falls.

A PROSPECTIVE OBSERVATIONAL STUDY ON FUNCTIONAL OUTCOME OF PROXIMAL HUMERUS FRACTURES FIXED SURGICALLY WITH PHILOS

Proximal humerus fractures are common injuries that can result in signicant functional disability. The use of the PHILOS plate in surgical management of these fractures has gained popularity due to its ease of use and favourable biomechanical properties. This paper aims to assess the functional outcomes of surgical management of proximal humerus fractures xed with the PHILOS plate. The methodology involved studying patient demographics, fracture classication, surgical technique, postoperative protocol, and complications. The study found that surgical management of proximal humerus fractures with the PHILOS plate results in good functional outcomes, with a low complication rate.

Functional and radiological outcome of volar plate fixation in intra articular distal radius fractures

Introduction: Fractures of lower end radius are most common fractures of the upper extremity encountered in practice and constitute 17% of all fractures and 75% of all forearm fractures. These injuries account for approximately one sixth of all fractures seen and treated. In the words of Dr. Abraham Colles “this fracture takes place about an inch and a half above the carpal extremity of the radius and there is a 17% lifetime probability for distal radius fractures”. The majority of these injuries are 'closed', with no evidence of breach of the surrounding skin. Materials and Methods: A prospective study on cases of the fractures of the distal end of the radius, attending the Orthopaedics outdoor and the emergency services of Vinayaka Mission's Kirupananda Variyar Medical College and Hospital, Salem. The fractures were classified according to Modified AO Classification. 25 cases were followed at regular intervals and final assessment was done at 3 months (photographic plate 2). This study was conducted with detailed clinical and radiological analysis after surgical management of fractures of distal end of radius.

Factors associated with delays in medical and surgical open facial fracture management

ObjectivesOpen fractures are at risk of infection because of exposure of bone and tissue to the environment. Facial fractures are often accompanied by other severe injuries, and therefore fracture management...

Does delayed weight bearing in the surgical management of fractures of the upper end of the femur in the elderly lead to more complications? A prospective study

IntroductionFractures of the upper end of the femur (FUEF) lead to increased mortality and dependence in the elderly. However, mechanical complications after surgery persist in up to 20% of cases, which may justify a delayed resumption of full weight bearing to protect the osteosynthesis during consolidation. HypothesisOur hypothesis was that the late resumption of weight bearing in an elderly population after a FUEF would be limited by a higher frequency of medical complications. MethodsThis was a prospective monocentric study including patients aged 80 or over with an isolated FUEF requiring osteosynthesis. The operator decided on the discharge. The primary endpoint was to show a difference in a medical complication score created for this study (APRETAR), between a group with, and a group without, weight bearing delayed by 45 days. ResultsBetween 2016 and 2019, 254 patients (88±5.6 years, 77.6% women) were included, and of these, 70 (27.6%) had delayed weight bearing. The mean APRETAR at 45 days was greater in the delayed weight bearing group (5.9±8.6 vs. 5.7±11.0; p<0.001). One-year mortality was 12.6% (32 patients), with no difference between the two groups (p=0.51). The level of dependence was significant (IADL at 2.2±1.7), with some comorbidities (Charlson at 2.9±2.2 and CIRS-G at 6.5±4.3) and all comparable across the two groups but with low cognitive levels, especially in the group with delayed weight bearing (MMSE 15.9±10.7 vs. 21±6.9; p<0.001). ConclusionThis prospective study shows that delaying weight bearing in the elderly population, even for mechanical problems with FUEF, statistically increases medical complications but in a clinically acceptable manner. Level of evidenceII, Prospective cohort study.

Functional outcome of surgical management of fracture of proximal humerus treated with proximal humerus internal locking operative system plating

Purpose: To study the functional outcome of proximal humerus internal locking system plating in displaced proximal humerus fractures.Materials and Methods: Prospective interventional study a total of 30 patients admitted in VIMS, Ballari with displaced proximal humerus fractures between August 2020 and August 2022 were included in the study. Patients were treated with proximal internal locking system plating and followed up at 6 weeks, 12 weeks and 6 months and were evaluated for functional outcome using Constant and Murley shoulder scoring system.Results: Excellent outcome was noted in 20%, Good in 47%, fair in 23% and poor in 10% cases. 90% of patients had clinical and radiological union in 3 months. The range of motion showed gradual improvement in successive follow ups.Conclusion: PHILOS plate provides a high degree of angular and axial stability eliminating screw loosening and backout. PHILOS plate showed significantly less plastic deformation subsequent to torsional and axial forces.

Surgical Management of Extremity Fractures in COVID-19 Patients

Background: COVID-19 is spreading rapidly and potentially affects every person, including fracture patients. This study was conducted with the aim to evaluate our primary months’ experience of surgical treatment of fractures in COVID-19 infected patients in order to assist in better decision-making in the next waves of the infection. Methods: In this cross-sectional study, 15 patients with orthopedic trauma and COVID-19 infection were included from 2 trauma centers during February and March 2020 Results: Most of the patients were younger than 40 year of age. The most common COVID-19 related symptom at presentation was malaise, and a hypoxia rate of 85.7% was detected among the patients. Two-thirds of the fractures were in the lower extremities. One patient expired, but all others were discharged with no follow-up complications. Conclusion: Surgical management of fractures in COVID-19 patients is inevitable. To achieve this, sensitive screening techniques and standard protection measures are essential.

Surgical Management of Fracture Both Bone Forearm in Pediatric Using Elastic Stable Intramedullary Nail

Surgical Management of Fracture Both Bone Forearm in Pediatric Using Elastic Stable Intramedullary Nail

Surgical management of fractures of distal end radius with open reduction and internal fixation using volar locking compression plate

Backgrounds and Objectives: Fractures of distal end of the radius are one of the most common injuries which lead to approximately 1/6th of all fractures which are observed and treated.Failure to achieve and also to maintain anatomic restoration may lead to various deformities and disabilities, poor functional outcome (usually seen with cast immobilization of intraarticular fractures)Later studies have advised operative intervention with conventional T buttress plates, and more recently volar locking compression plates whose mechanical advantage justifies its vast usage. The principle of the Locking Compression Plate is to have rigid fixation close to the bone and under the soft tissue envelope. Locking Compression Plates are anatomically designed plates to maintain alignment and to prevent collapse of the fracture fragment.Methods: This study is a prospective, time bound, hospital based study that was conducted in kempegowda institute of medical sciences and research centre, Bangalore between October 2018 and May 2020. The study included a total of 30 cases of distal end radius fractures that were operated with open reduction and internal fixation with volar Locking Compression Plate (volar LCP).The fractures were classified according to Frykmann classification and were followed up at regular intervals. Functional outcome was assessed using the Gartland and Werley demerit scoring at each follow up visit.Results: Our study revealed nearly half of the study population with excellent outcome (47%), good and fair outcomes were noted among 40% and 13% respectively while none of the patients had poor outcome.Most fractures united by 12 weeks. Complications associated were stiffness, arthritis and EPL tendon irritation.Conclusion: The present study demonstrates well to excellent results in the majority of patients based on G&W functional outcome evaluation after locking plate fixation of the lower end distal radius with lower rate of complications.

Short-term functional results of surgical management of fractures of olecranon process of ulna by locking hook plate

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The aim was to study functional results of fixation of fractures of olecranon process of ulna by locking hook plate.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The study was conducted on 30 patients who underwent fixation of olecranon fracture by locking hook plate in department of orthopaedics, GMCH Aurangabad from September 2018 to September 2020. Patients were assessed functionally using Mayo elbow performance score and radiologically using serial follow up radiographs of elbow.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; At 2 year follow up of 30 patients of all types of olecranon fracture treated by locking hook plate, no patient had evidence of non-union or loss of reduction or any other major complications. In our study 21 patients (70%) showed excellent results, 6 patients (20%) showed good results and 3 patients (10%) showed fair results. None of the patients in our study showed poor results. 3 patients (10%) had superficial infection which were treated by adequate antibiotics after doing culture and sensitivity testing and 4 patients (13.33%) had symptomatic metal prominence which underwent implant removal after union of fracture.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Fixation of all types of fractures of olecranon by locking hook plate is good alternative to other methods of fixation like tension band wiring, intramedullary fixation using screw tension band wiring which are used only in selected cases. In our study we conclude that locking hook plate is excellent modality of treatment for all types of fractures of olecranon, it gives excellent functional and radiological outcome with minimal complication and stable fixation of all types of fractures including transverse as well as comminuted fractures.&lt;/p&gt;

A prospective study of surgical management of fractures of proximal femur using proximal femoral nail

Background and Objectives: Proximal third fractures of femur like intertrochanteric and subtrochanteric fractures, are a leading cause of hospital admissions in elderly people. The number of such admissions is on a raise because of increasing life span and sedentary habits. Conservative methods of treatment results in malunion with shortening and limitation of hip movement as well as complications of prolonged immobilization like bed sores, deep vein thrombosis and respiratory infections. This study is done to analyze the surgical management of proximal third fractures of femur using Proximal Femoral Nail. Methods: This is a prospective study of 30 cases of fresh trochanteric and subtrochanteric fractures admitted to Vijayanagar institute of medical sciences Ballari From september 2015 to august 2017. Cases were taken according to inclusion and exclusion criteria i.e., patients with Proximal third fracture femur above the age of 18yrs. Medically unsuitable and patients not willing for surgery were excluded from the study. Results: In our series of 30 cases there were 19 males and 11 females, maximum age of 81 and minimum age of 21 years most of the patients were between 61-80 years. Mean age of 57.4 years. 80% cases were admitted due to slip and fall and with slight predominance of right side. Out of 30 cases, 19 were trochanteric and 11 were subtrochanteric. In trochanteric fractures 36.84% were Boyd and Griffin type 2, in subtrochanteric fractures 27.27% were Seinsheimer type 3a. Mean duration of hospital stay is 15 days and mean time of full weight bearing is 15 weeks. 30 case were followed up. Out 30 cases 19 trochanteric and were 11 subtrochanteric. Good to excellent results are seen in 89.47% of trochanteric fractures and 81.81% subtrochanteric fractures. Overall, we had good to excellent results in 86.66%, fair in 13.33%, we had no case with poor results. Conclusion: From this sample study, we consider that PFN is an excellent implant for the treatment of Peritrochanteric fractures. The terms of successful outcome include a good understanding of fracture biomechanics, proper patient selection, good preoperative planning, accurate instrumentation, good image intensifier and exactly performed osteosynthesis.

Ex vivo analysis of cortical microarchitecture of the distal clavicle: Implications for surgical management of fractures

Ex vivo analysis of cortical microarchitecture of the distal clavicle: Implications for surgical management of fractures

Study of open reduction and internal fixation with medial plating of fracture shaft humerus

Background: Humerus shaft Fracture Surgical management (Open reduction and internal fixation) is a choice of treatment for early mobilisation and rehabilitation. In this series ORIF with Medial side plating of Shaft Humerus was done. Materials and Methods: A retrospective study of 30 Patients Operated with ORIF and medial side plating was carried out for fracture shaft of Humerus.The patients were evaluated at a mean of 39 months (Range of 12 to 66 months) for union time and clinical outcomes.Results: Mean time of Union was 24 weeks ranging from 16 weeks to 32 weeks. There was no case of non-Union in this study.Conclusions: Medial side Plating of Fracture shaft humerus has given excellent results in this study.