Surgical Treatment Of Fractures Research Articles

Stable elastic nail application with poller K-wire for Irreducible distal radius metaphyseal-diaphyseal Junction fractures in preadolescents: a new operative technique

BackgroundSurgical treatment of irreducible distal radius diaphyseal- metaphyseal junction fractures involves difficulties as the fracture remains too proximal for K-wire fixation and too distal for the elastic stable intramedullary nail. Our study aims to present the clinical results of applying an elastic stable intramedullary nail with a poller K-wire to achieve both reduction and stable fixation.Patients and methodsA retrospective analysis was performed on 26 patients who underwent ESIN with a poller K-wire for distal radius diaphyseal-metaphyseal region fracture. Reduction parameters such as residual angulation and alignment were evaluated on postoperative follow-up radiographs. Changes in angular and alignment parameters on follow-up radiographs were recorded. Wrist and forearm functions were evaluated at the last follow-up.ResultThere were 17 male and nine female patients with an average age of 10.9. The residual angulation in coronal and sagittal planes on immediate postoperative radiographs was 4.0 ± 1.62° and 3.0 ± 1.26°, respectively. The mean translation rate on immediate postoperative radiographs was 6.0 ± 1.98% and 5.0 ± 2.02% in the coronal and sagittal planes, respectively. No change was observed in translation rates in the last follow-ups. The mean angulation in the coronal and sagittal planes measured on 6th-week radiographs was 4.0 ± 1.72°and 3.0 ± 1.16°, respectively. No significant difference was observed in angular changes in the sagittal and coronal planes at the last follow-up (p > 0.05). No tendon injury or neurovascular injury was observed in any of the patients.ConclusionIn the surgical treatment of pediatric DRDMJ fractures, applying ESIN with poller K-wire is an effective, safe, and novel method for achieving reduction and stable fixation.

Pain Management in Surgical Treatment of Facial Fractures: Alternative Approaches to Opioid Use

Study Design Literature review. Objective This review aims to explore current opioid use trends for surgical management of facial fractures, as well as methods and alternative treatments to decrease opioid use. Methods Review of selected literature from Medline and Google Scholar. Results Despite the devastating effects of the opioid epidemic and recent policy changes aimed at reducing unnecessary opioid prescription, opioids remain commonly used for pain management after facial fracture repair. Recently, use of multimodal analgesic therapy has been suggested to decrease opioid dosage utilized for post-operative pain control. Alternatives to medication therapies have been proposed for pain management; however, standardized recommendations for pain management in facial fracture patients remain unclear. Conclusions Further research is required to establish evidence-based recommendations for pain management in craniofacial fracture repair.

The Effect of Age and Sex on Early Postoperative Outcomes after Surgical Treatment of Distal Radius Fractures.

Background: We aim to evaluate the impact of advanced age and sex on postoperative complications and radiographic outcomes after open reduction with internal fixation of distal radius fractures (DRF). Methods: We conducted a retrospective chart review, including all patients who underwent open reduction with internal fixation of a DRF between 2012 and 2018 at a single level 1 trauma centre. We recorded patient age, sex, fracture classification (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association [AO/OTA]), time from injury to surgical date, surgical duration, diabetes status, tobacco use, illicit drug use, history of osteoporosis, use of adjuvants, fixation type, postoperative radiographic restoration of normal parameters and early complications including loss of reduction within 30 days postoperatively. Advanced age was defined as age greater than 60 years. Results: A total of 521 patients underwent operative treatment - 264 males and 257 females. Males were twice as likely (23.5% vs. 10.1%; p < 0.0001) to sustain a type C3 fracture and be treated with a wrist spanning plate (5.3% vs. 0; p < 0.0001). A larger percentage of elderly patients undergoing operative treatment of DRF were female (20.2% vs. 5.7%; p < 0.0001) and females were more likely to carry a pre-injury diagnosis of osteoporosis (9.3% vs. 0%; p < 0.0001). And 100% of the elderly patients received were treated with a volar plate. The overall early loss of reduction was 7.5%. The overall complication rate was 8.2%. No differences in early postoperative complications were identified between sexes or age groups. Neither female sex nor advanced age was found to have increased risk of postoperative complications or early loss of reduction. Similar postoperative radiographic parameter measurements were obtained across groups as well. Conclusions: Our results support the idea that operative treatment of unstable DRF in elderly patients and women is a reasonable treatment option without significant increases in early postoperative complications. Level of Evidence: Level III (Therapeutic III).

Comparison of surgical outcomes for hip fracture between older patients with and without cancer: a propensity score matching analysis

Research on the treatment outcomes and mortality of patients with cancer and hip fractures remains limited. We aimed to assess the treatment outcomes and mortality in older patients with cancer and hip fractures. We retrospectively reviewed the data of 1264 patients aged ≥ 60 years treated for hip fractures between January 2005 and April 2022. The operation time, blood transfusion-related indicators, postoperative complications, reoperation rate, length of hospital stay, admission to the intensive care unit, mortality rate, and clinical scores were compared. We also performed survival analysis. Subsequently, 1:1 propensity-score matching was performed. In the unmatched cohort, we compared 273 patients with cancer and 991 controls. The cancer group exhibited a higher incidence of pneumonia (P = 0.025) and higher in-hospital and 1-year follow-up mortality rates (P = 0.044 and P < 0.001, respectively). In the matched cohort, the 1-year mortality rate remained higher in the cancer group (P < 0.001). The control group showed a higher survival rate in both unmatched and matched cohorts (P < 0.001 for both). The surgical outcomes for hip fractures were comparable between patients with and without cancer. We recommend surgical treatment for hip fractures in patients with cancer.

Effectiveness of Concurrent Ankle Arthroscopy During Open Reduction and Internal Fixation of Malleolar Fractures in Prevention of Common Short-Term Complications

Rotational malleolar fractures result in a high prevalence of intra-articular pathologies; therefore, routine arthroscopic assessment may be beneficial in the surgical treatment of ankle fractures. However, the clinical studies regarding the effectiveness of arthroscopy thus far have mixed results. We investigated the efficacy of concurrent arthroscopy during the treatment of malleolar fractures using a large U.S. healthcare data set. Those who had arthroscopy were compared with those who did not, during the surgical treatment of malleolar fractures, while adjusting for covariates of clinical relevance. The analysis showed that concurrent arthroscopy is protective against postoperative repeat surgery (OR = 0.13, 95CI = 0.02-0.41) and wound dehiscence (OR = 0.18, 95CI = 0.03-0.56). The number of added arthroscopy cases needed to avoid one repeat surgery was 74, while that of wound dehiscence was 52. Further studies are needed to determine if routine use of arthroscopy is justifiable in the surgical treatment of malleolar fractures, given the additional costs and time to the healthcare system.

Sliding Osteotomy, a New Simple Technique for Olecranon Nonunion Treatment.

Nonunion is a rare complication after surgical treatment of olecranon fracture, but indeed it is a devastating one because of the high potential for elbow stiffness, pain, soft tissue and skin problems, and device complaining. To our knowledge, there is no treatment of choice for olecranon nonunion in the literature. Here we describe a unique and new technique by sliding osteotomy of the olecranon in the form of prism and refixation with tension band wiring. Then, we report the clinical results for our 2 patients operated using this technique.

Early Weight-bearing Following Surgical Treatment of Ankle Fractures Without Trans-syndesmotic Fixation Is Safe and Improves Short-term Outcomes.

The objective of this study was to ascertain outcome differences after fixation of unstable rotational ankle fractures allowed to weight-bear 2 weeks postoperatively compared with 6 weeks. Prospective case-control study. Academic medical center; Level 1 trauma center. Patients with unstable ankle fractures (OTA/AO:44A-C) undergoing open reduction internal fixation (ORIF) were enrolled. Patients requiring trans-syndesmotic fixation were excluded. Two surgeons allowed weight-bearing at 2 weeks postoperatively (early weight-bearing [EWB] cohort). Two other surgeons instructed standard non-weight-bearing until 6 weeks postoperatively (non-weight-bearing cohort). The main outcome measures included the Olerud-Molander questionnaire, the SF-36 questionnaire, and visual analog scale at 6 weeks, 3 months, 6 months, and 12 months postoperatively and complications, return to work, range of ankle motion, and reoperations at 12 months were compared between the 2 cohorts. One hundred seven patients were included. The 2 cohorts did not differ in demographics or preinjury scores ( P > 0.05). Six weeks postoperatively, EWB patients had improved functional outcomes as measured by the Olerud-Molander and SF-36 questionnaires. Early weight-bearing patients also had better visual analog scale scores (standardized mean difference -0.98, 95% confidence interval [CI] -1.27 to -0.70, P < 0.05) and a greater proportion returning to full capacity work at 6 weeks (odds ratio = 3.42, 95% CI, 1.08-13.07, P < 0.05). One year postoperatively, EWB patients had improved pain measured by SF-36 (standardized mean difference 6.25, 95% CI, 5.59-6.92, P < 0.01) and visual analog scale scores (standardized mean difference -0.05, 95% CI, -0.32 to 0.23, P < 0.01). There were no differences in complications or reoperation at 12 months ( P > 0.05). EWB patients had improved early function, final pain scores, and earlier return to work, without an increased complication rate compared with those kept non-weight-bearing for 6 weeks. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Surgical Treatment of Non-United Ulnar Fracture

Surgical Treatment of Non-United Ulnar Fracture

Fracture of the patella involving inferior pole is associated with postoperative patella baja - A retrospective multicenter study

BackgroundThe patella fracture involving of inferior pole fractures (IPF) may be associated with patella baja, However, the clinical impact of this condition remains unclear. This study aims to clarify 1) the incidence of patella baja following patellar fracture surgery, 2) the associated clinical outcomes with and without the presence of patella baja, and 3) the potential correlation between the detection of IPF on CT and the occurrence of patella baja. MethodsWe conducted a retrospective multicenter study involving 251 patients who underwent surgical treatment for patellar fractures. Patients were divided into the patella baja (PB; n = 49) group and patella norma (PN; n = 202) group. Data collected included demographics, radiographic findings, surgical details, and postoperative complications. We compared these items between PB group and PN group. Logistic regression analyses were used to identify risk factors for patella baja. ResultsImmediately following surgery, 36 (14.3%) patients presented with patella baja which increased to 49 cases (19.5%) at six months postoperatively. There is no statistically significant difference in the demographics, surgical details, clinical outcomes and complication between PB group and PN group. While, in the radiographical assessment, the prevalence of IPF on CT scan in the patella baja group was significantly higher than that in the patella norma group. By logistic regression analysis, IPFP on CT was identified as an independent risk factor for patella baja. (odds ratio 2.11, 95% confidence interval: 1.03–4.33, p = 0.042). ConclusionIn patients with patellar fractures, the incidence of patella baja increased from 14.3% immediately post-surgery to 19.5% at the six-month check-up. No significant differences were observed in clinical outcomes between the patella baja group and the norma group. The patella fracture involving IPF on CT emerged as a predictive factor for patella baja.

İntertrokanterik Kırıkların Tedavisinde Subkondral Pençe Yerleştirme Gecikmeli Vidanın Yanal Kayma Mesafesine ve Kesmeye Etkisi

Introduction: The incidence of intertrochanteric fractures has increased in recent years due to the growing elderly population at risk of hip fractures, primarily attributed to osteoporosis. Among hip fractures, the prevalence of intertrochanteric fractures is progressively rising. Aim: To evaluate clinical and radiological results of the lag screw that deploys the claw in the subchondral area of the femoral head in the treatment of advanced age unstable intertrochanteric fractures. Methods: We retrospectively reviewed patients with intertrochanteric fractures treated with proximal femoral nails between 2019 and 2021. A total of 107 patients were examined under two groups according to the choice of the nail (Interclaw lag screw(n=52), Proximal femoral nail anti-rotation (n=55) used in the treatment. The radiological parameters in the post-operative 1st-day radiographs of the patients were evaluated. The changes in the first month, three, six months, and one-year control radiographs of the patients were evaluated. Changes in tip apex distance and lateral sliding of the lag screw were compared between the two groups. Result: There was no statistically significant difference between the two groups regarding operation time, post-operative femoral neck/shaft angle, post-operative Calcar gap (mm), and tip-apex distance (TAD) (mm). In the last clinical follow-up, the two groups had a statistically significant difference in the femoral neck/shaft angle and TAD change. There was a significant difference in sliding distance between the two groups at the last follow-up. Conclusion: Using a subchondral claw-deploying lag screw is a reliable implant choice in the surgical treatment of geriatric intertrochanteric fractures. The claw mechanism increases fixation strength and restricts the movements of the lag screw in the femoral head.

Seasonal variation of surgically treated distal radius fracture in Japan using inpatient database: cross-sectional study.

The purpose of this study was to clarify the relationship between seasonal variation and distal radius fractures using diagnosis procedure combination data in Japan. The participants were hospitalized patients who underwent surgical treatment for distal radius fracture as the primary injury at hospitals that introduced the diagnosis procedure combination system between April 2011 and March 2016. We obtained a summary table of the month of admission, region of residence, age at admission, and sex of the patients from the Ministry of Health, Labour and Welfare and evaluated it by month, region, age group, and sex. The total number of patients for the 5years from 2011 to 2016 was 105,025. There were 29,224 male and 75,801 female participants, with a female-to-male ratio of 2.6. The mean age was 60.2 (standard deviation, 20.8) years. Distal radius fractures occurred more frequently in the winter, especially among female individuals in eastern Japan. Female participants aged ≥ 50years tended to have a higher incidence of distal radius fracture in winter. The incidence of distal radius fracture among male participants aged 0-19years was higher from spring to autumn. Surgically treated distal radius fractures occur frequently during the winter months among female individuals in eastern Japan or those aged ≥ 50years and increase from school age to adolescence, especially in male individuals from spring to autumn. We should be aware of the high incidence of distal radius fractures in winter, especially in regions with snowfall and cold temperatures.

Early Results of Surgical Treatment of Volar Barton Fractures by Plating In Adults

Early Results of Surgical Treatment of Volar Barton Fractures by Plating In Adults

The effect of the size of pedicle screw on the long-term radiological and clinical results of short-segment posterior instrumentation in the management of thoracolumbar vertebral fractures.

It was aimed at evaluating the effect of the size of the pedicle screw placed on the fractured vertebra on the long-term radiological and clinical results of short-segment posterior instrumentation applied in the surgical treatment of thoracolumbar vertebral fractures. This retrospective study included 36 patients who underwent short-segment posterior instrumentation surgery for a single-level thoracolumbar (T11-L2) fracture between January 2015 and March 2021. The patients included in the study were divided into 2 groups according to the size of the pedicle screw placed in the fractured vertebra (group A: intermediate screw 4.5 mm, ≤35 mm+less than 50% of the vertebral corpus length, m/f: 13/4, n: 17, age: 36.5; group B: intermediate screw 5.5 mm, ≥40 mm+more than 70% of the vertebral corpus length, m/f: 11/8, n: 19, age: 42.6). All patients were periodically evaluated clinically and radiologically. Vertebral compression angle (VCA), anterior and posterior vertebral body height (ABH-PBH), intraoperative parameters (instrumentation time and intraoperative fluoroscopy number), and complications were compared between the 2 groups. Both groups were comparable with respect to age, sex, level of injury, AO classification, mechanism of injury, and American Spinal Cord Injury Association impairment scale. Restoration of VCA and vertebral corpus heights was achieved sufficiently in both groups after operation (P < .0001). There was no significant difference between the 2 groups in terms of early postoperative VCA, VCA measured at final follow-up, or loss of correction in VCA. At the last follow-up, PBH was statistically significantly better preserved in group B (P=.0424). There was no difference between the 2 groups in terms of operation time and the number of intraoperative fluoroscopies. Implant failure was observed in 1 patient in group A. This study has revealed that using a long, thick pedicle screw placed in the fractured vertebra can better preserve the PBH at the final follow-up. No correlation was found between the size of the intermediate screw and the preservation of the correction in the postoperative vertebral heights and VCA during the follow-up. Level III, Therapeutic Study.

Outcome of dynamic locked plate in treatment of intracapsular femur neck fracture

Background: The ideal surgical treatment of femoral neck fractures is still debatable. When internal fixation is used, many implants are available. This study aimed to evaluate the outcome following fixation of intracapsular femur neck fractures using the Targon-FN system (B. Braun, AG. Melsungen, Germany) comparing the results with a similar study done by the manufacturer and to assess risk factors associated with complications. Methods: A prospective interventional case series involved 30 consecutive patients aged from 23 to 82 (Mean 49 years) treated at Al-Jalaa trauma hospital in Benghazi- Libya in period from January 2016 to July 2017, for an intracapsular femur neck fracture with Targon-FN system. According to Garden classification 9 fractures (30%) undisplaced and 21 (70%) were displaced fractures, with 2 patients (6.7%) had type I, 7 patients (23.3%) had type II, 7 patients (23.3%) had type III and 14 patients (46.7%) had type IV fracture. Epidemiological data were collected. Patients were followed-up for 2 years (average 16 months). Joint function was assessed clinically by using Harris hip score (HHS) and fracture healing by radiological assessment at sex weeks, 3 months, 6 months, 1 year and finally at 2 years. Complications were recorded. Statistical analysis done to predict risk factors associated with reoperation and complications. Results: Sixteen patients (53.3%) developed one or more complications. Complications were higher than those of manufacturer’s study and included avascular necrosis (53.3%, n=16), nonunion (30%, n=9), blown out implant (16.66%, n=5), loosening screw (3.3%, n=1), and deep infection (3.3%, n=1). In total, 5 patients required total hip replacements. At end of 2 years 19 patients (63%) had poor result, one patient (3.3%) had fair result, 1 patient (3.3%) had good result and 9 patients (30%) had excellent result according to HHS. Delayed surgery, fracture displacement, surgeon’s experience, age ≥40 years and time to postop weight bearing recognized as risk factors for complications. Conclusions: A minimally-invasive surgery of Targon FN justifies use of this system for the preservation of the patient’s hip joint, early rehabilitation and mobilization. Complications and re-operation could be minimized by performing surgery within 24-48 hours, provision of skillful surgeons, and proper timing of postoperative weight bearing. The main limitation is the small number of cases and short follow-up averaged at 16 months.

Analysis of complications in 97 periprosthetic Vancouver B2 fractures treated either by internal fixation or revision arthroplasty

IntroductionThe treatment of Vancouver B2 periprosthetic fractures after hip arthroplasty is still a matter of debate. Revision Arthroplasty (RA) was long thought to be the treatment of choice, however several recent papers suggested that Open Reduction and Internal Fixation (ORIF) is a viable option for selected B2 fractures. Complication rates of 14–26% have been reported following surgical treatment of B2 fractures. No significant difference between RA and ORIF in the complication rates nor in the functional outcome was observed.MethodWe conducted a retrospective analysis of 97 consecutive Vancouver B2 fractures treated according to the algorithm at our institution from 2007 to 2020 and recorded complications and patient specific data.ResultFrom the 97 patient, 45 fractures were treated with RA while 52 fractures were treated with ORIF. Thirteen patients in the RA group had a complication that needed revision (28%) and 11 patients in the ORIF group needed revision (21%). There was no significant difference between complication rates. The reason for failure in the 13 RA patients were infection (n = 4), stem subsidence (n = 1), refracture after a new fall (n = 3), secondary dislocation of the greater trochanter (n = 1) and dislocation (n = 4). The reason for failure in the 11 ORIF patients that were revised were infection (n = 5), persistent symptomatic stem loosening (n = 3) and refracture (n = 3) after a new fall.ConclusionORIF can be used to revise cemented and non-cemented shafts in more than half of Vancouver B2 fractures with no difference in complication rates when compared to RA. A periprosthetic fracture around the hip has a 21–28% risk of a re-operation after revision surgery with infection and re-fracture after a new fall being the most frequent cause of re-operation.

Intravenous tranexamic acid reduces complications following surgical treatment of pathologic fractures of the lower extremity.

This study aimed to evaluate the postoperative complications associated with administering intravenous (IV) tranexamic acid (TXA) in patients undergoing surgical fixation for neoplastic pathologic fractures of the lower extremities. Patients ≥18 years old who underwent surgical intervention for neoplastic pathologic lower extremity fractures from 2015 to 2021 were identified using the Premier Healthcare Database. This cohort was divided by TXA receipt on the index surgery day. Patient demographics, hospital factors, patient comorbidities, and 90-day complications were assessed and compared between the cohorts. From 2015 to 2021, 4497 patients met inclusion criteria (769 TXA[+] and 3728 TXA[-]). Following propensity score matching, patients who received TXA had a significantly shorter length of stay than those who did not (7.6 ± 7.3 days vs. 9.0 ± 15.2, p = 0.036). Between the two cohorts, there were no significant differences in comorbidities. Regarding differences in postoperative complications, TXA(+) patients had significantly decreased odds of deep vein thrombosis (DVT) (1.87% vs. 5.46%; odds ratio [OR]:0.33; 95% confidence interval: 0.17-0.62; p = 0.001). Administration of IV TXA may be associated with a decreased risk of postoperative DVT without an increased risk of other complications. Orthopedic surgeons should consider the utilization of IV TXA in patients treated surgically for neoplastic pathologic fractures of the lower extremity.

Isometry as a predictor of osteosynthesis result in fractures of the posterior acetabulum

Introduction More than 80% of injuries to the acetabulum involve its posterior parts or injuries associated with their destruction. Most poor outcomes of surgical treatment of acetabular fractures manifest themselves in the first 24 months. Surgeons consider accurate anatomical reduction of fragments to be the main predictor of good results. A number of researchers showed good results of its surgical treatment, including those with inaccurate reduction. Poor results also occur in patients with no risk factors and ideal reduction. Thus, inaccurate reduction does not always lead to poor results; the reasons for positive results have not been discussed.Purpose To evaluate the effect of maintaining hip joint isometry in surgical approach on the outcome of reconstructive operations in the treatment of traumatic destruction of the posterior parts of the acetabulum.Materials and methods From 2005 to 2021, surgeons from the Moscow Regional Research and Clinical Institute performed 120 reconstructive operations on 120 patients with fractures of the posterior structures of the acetabulum. Of these, 84 patients followed the recommended monitoring regimen, completed the Harris Questionnaire, and had radiographs taken within the specified time frame. From the 84 patients, two groups of 42 patients each were formed that differed in the method of treating the external rotators.Results During two years of follow-up after reconstructive surgery on the acetabulum, clinical indications for hip replacement were identified or hip replacement was performed in 5 patients in the first group and in 25 patients in the second (11.9 and 59.5%, respectively).Discussion Accurate reduction of fragments is considered to be the main condition for good results after reconstructive operations for fractures of the posterior part of the acetabulum.Maintaining the isometry in the joint, namely, cutting off and then reinserting external rotators while preserving the attachment sites and length of the muscles, can have a significant impact on the outcome of reconstructive operations for traumatic injuries of the posterior parts of the acetabulum due to maintaining isometry of the hip joint. It seems that the preservation of force vectors centering the femoral head in the acetabulum causes the growth of ossification that forms secondary congruence.Conclusions Maintaining hip joint isometry in surgical treatment of fractures of the posterior acetabulum by changing the method of treating the external rotators provides significantly better clinical outcomes.

The association of ICUC trauma score and quick DASH in a distal radius fracture cohort

BackgroundThis study evaluates the association between ICUC trauma and short-form Disabilities of the Arm, Shoulder, and Hand Questionnaire (Quick DASH) scores among patients who underwent surgery for distal radius fractures.MethodsThis research gathered patient-reported outcomes (PROs) from patients registered in the ICUC database at a single trauma center. The study involved 76 adult patients who underwent surgical treatment for distal radius fractures before 2023. These patients received a volar locking plate for their distal radius fracture. The research utilized two different PROs to evaluate the patients’ conditions. The ICUC trauma score measures functional impairment and pain through two 5-point scale questions, allowing patients to self-assess these aspects. The Quick DASH, comprising 11 questions, was used to evaluate symptoms and functionality of the upper extremity.ResultsFor patients aged 55.9 ± 15.3 years and 4.6 ± 3.9 years post-op follow-up, the ICUC trauma score was 0.70 ± 0.95, and Quick DASH was 6.07 ± 10.35. A strong correlation between ICUC and Quick DASH was identified (r = 0.71, P < 0.01). The interaction between the ICUC trauma score and age at the surgery to Quick DASH revealed a significant unstandardized partial regression coefficient of 0.19 (95% confidence interval 0.08–0.31; P < 0.01).ConclusionThis study demonstrated a strong correlation between the ICUC trauma score and the Quick DASH among patients, especially the elderly. It was noted that an elevation in the ICUC trauma score is linked to a more marked increase in the Quick DASH score, particularly in older patients. Given its simplicity and efficacy, the ICUC trauma score may be a viable alternative to the Quick DASH for assessing the patient’s clinical outcomes.

INFLUENCE OF THE ERGON TECHNIQUE ON THE PROPRIOCEPTION OF A PATIENT WITH A BIMALLEOLAR FRACTURE

Purpose: The aim of the study was to follow the influence of the Ergon Technique on proprioception in patients after surgical treatment of bimalleolar ankle fracture. Material/Methods: 30 patients with a bimalleolar fracture in the subacute postoperative period were studied, divided as follows: control group (CG) - 15 patients and experimental group (EG) - 15 patients. In CG, a traditional model of kinesitherapy is applied, and in EG, an experimental model is applied, which includes twice a week and Ergon Technique. To monitor changes in proprioception, a test was conducted: a balanced stance on the injured leg on a hard and flat surface was performed, and the time the patient maintained balance (in seconds) was recorded. Results: The mean values (±SD) after one month of kinesitherapy application are as follows: in the control group 0,9333+0,88 sec. and 3,0 sec. in the experimental group. After three months of treatment, the results are as follows: in the control group, 3,93+2,49 sec. And 9,2+4,19 sec. in the experimental group. The values of P show that the established difference in the mean values ​​of the indicator in the two groups after three months of kinesitherapy is statistically significant and proves a higher efficiency of the experimental model compared to the traditional one applied in the control group at P&lt;0.05. Conclusion: In the conducted study, we found that there were statistically significant differences in both groups. In EG, we found that Ergon Tehnique has a better effect on proprioception in patients with bimalleolar fracture of the ankle joint compared to the applied traditional model of kinesitherapy in CG.

Surgical Treatment of Scaphoid Fractures: Recommendations for Management.

Background: Several operative treatments exist for scaphoid fractures, varying by approach (e.g., ercutaneous, volar, or dorsal), implant type (e.g., screw or Kirschner wire), and bone raft choice (e.g., none, nonvascularized, or vascularized). Many previous systematic eviews and meta-analyses have investigated outcomes following different surgicalÚpproaches, the use of vascularized versus nonvascularized bone graft for scaphoidßracture nonunions, and treatment for specific fracture patterns. However, given the advancements n scaphoid fracture treatment in recent years, there is a need for updated treatment recommendations hat would be beneficial to hand surgeons. Purpose: We present a comprehensive review of the operative treatment of scaphoid fractures based on recent literature and propose a unified treatment algorithm for managing these fractures. Methods: The English-language literature was searched from 2002 to 2023 for high evidence level (e.g., randomized trials), review, and meta-analysis articles with the following search terms: "scaphoid, "u8220"scaphoid" AND "nonunion, " and "scaphoid" AND "malunion. " Each article was creened by the authors to determine the scaphoid fracture scenario addressed and ubsequent treatment recommendations. The findings from article reviews were then rganized by scaphoid fracture types in this manuscript. Results: A total of 95 pertinent articles were ultimately selected and used as the basis for reviewing different scaphoid fracture scenarios. A treatment algorithm was then proposed based on literature review. Conclusion: This summary of the recent literature can guide hand surgeons in addressing scaphoidßractures. Future research in scaphoid fracture treatment, particularly for nonunions, would be most beneficial n the form of systematic review, meta-analysis, or multicenter prospective randomized clinical trials. Level of Evidence: IV.