Surgical Treatment Of Unstable Fractures Research Articles

Treatment of children with fractures of the distal metaepiphysis of the radius: A literature review

BACKGROUND: Fractures of the distal metaepiphysis of the radius are among the most common injuries in pediatric patients. This results from the peculiarities of the anatomical structure and structure of the radial tissue in this area. AIM: This study aimed to analyze the literature on the treatment of children with fractures of the distal metaepiphysis of the radius. MATERIALS AND METHODS: Literatures on the treatment of children with fractures of the distal metaepiphysis of the radius were extracted from PubMed, eLibrary, and Google Scholar without language restrictions for the period from 1990 to 2024. RESULTS: In fractures of the distal metaepiphysis of the radius without displacement, the limb is immobilized. Displaced fractures require closed reduction and/or surgical treatment. For the treatment of stable fractures, specialists adhere to conservative techniques. The method of choice for the surgical treatment of unstable fractures should be minimally invasive osteosynthesis. The current gold standard for the surgical treatment of fractures of the distal metaepiphysis of the radius in children is closed reduction and intramedullary metal osteosynthesis with Kirschner wires, followed by plaster cast application. CONCLUSIONS: Currently, no consensus has been reached on the method of choice for the surgical treatment of fractures of the distal metaepiphysis of the radius in children. The results of treating children using the presented surgical techniques are contradictory, and high risks of developing intra- and postoperative complications are noted. Thus, conducting more research in this area and developing new and most effective surgical methods that can reduce the risk of complications and optimize the rehabilitation process for these patients remain relevant.

Osseous microarchitecture in frequent fracture zones of the distal clavicle.

Fracture classifications of the distal clavicle are based on ligamentous integrity. The influence of osseous microarchitecture on fracture occurrence, morphology, and the lesion's stability has not yet been investigated. We aimed to characterize osseous microarchitecture according to common fracture classification systems based on ligamentous integrity and investigated the possible effects of age, gender, and osteoporosis in distal clavicle fractures. N=20 human cadaveric distal clavicles were scanned using XtremeCT with an isometric voxel size of 82 μm. In the sagittal plane, each data set was evaluated in 11 sections of approximately 7 mm thickness. Three topographic regions were defined: the bone lateral to the trapezoid (LTR), intertubercular (ITR), and medial to the conoid (MCR) ligament. Cortical bone mineral density (BMD) [mgHA/cm3] and cortical porosity (1- (BV/TV) [%]) were determined and evaluated relative to age and gender. Along the mediolateral axis, there was an >20-fold increase in median cortical porosity (P≤.001). There were significant differences in cortical porosity between LTR and ITR (P≤.001) but not between ITR and MCR (P=.09). In ITR, cortical porosity was significantly greater in >60-year-old compared to younger donors (P=.01). For BMD, there was an >2-fold decrease toward the distal apex (P≤.001). BMD was significantly greater in ITR compared to LTR (P≤.001) and in MCR compared to ITR (P=.02). In ITR and MCR, clavicles of >60-year-old donors had significantly lower BMD values compared to younger donors (P<.01). Across all 3 regions, frequency distribution of low bone mass did not significantly differ between <60-year-olds and >60-year-olds (P>.6). The distal clavicle features a characteristic bony microarchitecture. The present study revealed a significant difference in bone quality of lateral, intertubercular, and medial zones of the distal clavicle and could specify target areas and strategies for surgical treatment of unstable fractures. Age, gender, and osteoporosis have a limited effect on bone quality and fracture genesis. In contrast, ligamentous quality is supposed to exert a substantial influence on fracture characteristics, especially in ITR. Fracture morphology of the distal clavicle is determined by a bony-ligamentous conjunction, which remains to be characterized.

История развития хирургии таза при нестабильных переломах, врожденной и приобретенной деформации тазового кольца в Республике Татарстан

The paper presents the concept of an external fixation device for the surgical treatment of unstable fractures, as well as congenital and acquired deformities of the pelvic ring. The main approaches are analyzed, which were used for the treatment of this pathology in the last 20–30 years, both by the Russian and foreign surgeons. Based on the authors’ experience, the aspects are described that need to be considered during surgical intervention carried out to restore geometry and function in the treatment of unstable fractures, congenital and acquired deformities of the pelvic ring.

Clinical and radiographic outcomes of a transosseous suture technique for displaced lateral clavicle fractures

The purpose of this study was to evaluate the clinical and radiographic outcomes of a transosseous suture fixation technique for the treatment of unstable lateral clavicle fractures. The appropriate treatment for lateral clavicle fractures is controversial. Many authors have argued for nonsurgical treatment of these injuries; however, recent literature has shown a role for the surgical treatment of unstable fractures. The paucity of lateral clavicular bone and the unique anatomy of this area of the shoulder makes surgical treatment of these injuries challenging. This article reports a single-surgeon experience with a transosseous suture fixation technique for the treatment of unstable lateral clavicle fractures. A retrospective review of all patients with unstable lateral clavicle fractures treated with a transosseous suture technique from 2015-2018 was performed. The indication for surgery was significant displacement between the main medial and lateral clavicle fragments. The surgical technique used was a modification of the technique as described by Levy. Patients were followed postoperatively with active and passive range of motion (ROM) measurements, strength testing, and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score, visual analog scale score, and standard radiographs. Patients were followed to radiographic union. Twelve patients underwent surgical fixation of unstable lateral clavicle fractures from 2015-2018. All patients had excellent function, full ROM, minimal pain, and improved functional scores at final follow-up. Eleven patients achieved complete union of the fracture. One patient healed with a fibrous union; however, the fracture had maintained alignment and the patient was asymptomaticand satisfied with the result. No patient required a second surgery. We found that the transosseous suture technique for fixation is an effective treatment for unstable lateral clavicle fracture. This technique is reproducible, cost effective, and limits the need for revision surgery often encountered with other techniques.

Rehabilitation of children at the inpatient stage after surgical treatment of unstable fractures of the thoracolumbar and lumbar spine

Introduction. The modern approach to the treatment of unstable fractures of the thoracolumbar and lumbar spine in children is surgical stabilization at the early stages after trauma by using metal structures that quickly restore vertical functionality to the patient and shorten the period of inpatient treatment. However, the issues related to restorative treatment have not been sufficiently addressed.&#x0D; Aim. To develop an algorithm for restorative treatment of children at the inpatient stage after surgical treatment of unstable uncomplicated fractures of the thoracolumbar and lumbar spine.&#x0D; Material and methods. Based on the results of treatment of 73 patients aged 9 to 17 years with unstable uncomplicated vertebral fractures, an algorithm of stage-by-stage rehabilitation by means of therapeutic gymnastics depending on the severity of the injury, method of surgical stabilization of the spine, physical condition of the child, and time passed after the operation was developed.&#x0D; Results and discussion. The use of differentiated groups of respiratory gymnastics and isometric and dynamic exercises for muscle groups restored vertical functionality to patients in 1–3 days after surgery, restored spine and motor functions, and shortened the duration of inpatient treatment to a range of 10–14 days.&#x0D; Conclusion. The developed algorithm for physical rehabilitation of children after surgical treatment of unstable injuries of the thoracic and lumbar spine by using metal structures at the inpatient stage contributed to the selection of the most rational and effective program of restorative treatment.

Minimally invasive surgical treatment for unstable fractures of the proximal phalanx: intramedullary screw

ObjectiveTo analyze the clinical-functional parameters and quality of life of patients undergoing minimally invasive surgical treatment for extra-articular fractures of the proximal phalanx, using an intramedullary screw (Acutrak®). MethodsBetween January 2011 and September 2014, a prospective study was conducted on 41 patients (48 fingers) with unstable extra-articular fractures of the proximal phalanx, who underwent minimally invasive surgical treatment using an intramedullary screw (Acutrak®). These patients were evaluated 12 months after the surgery by means of the DASH quality-of-life questionnaire, VAS pain scale, measurement of range of motion (ROM, in degrees) and radiographic assessment. ResultsAll the patients achieved adequate reduction and consolidation of their fractures. There were statistically significant improvements in quality of life on the DASH scale, pain on the VAS scale and range of motion. ConclusionThe minimally invasive technique for treating unstable extra-articular fractures of the proximal phalanx using an intramedullary screw (Acutrak®) is effective and safe, and it presents satisfactory clinical-functional results.

Design and use of an instrument for video-assisted surgical treatment of unstable fractures of the zygomatic arch: the Z instrument

T ractures of the zygomatic arch often result from zygoaticomaxillary fractures, but they can be isolated, which ecessitates aesthetic or functional compromise, or both.1 Numerous techniques for treatment have been described ncluding the Gillies procedure, which has been widely recmmended because of its low postoperative morbidity and inimal aesthetic compromise.1 However, it is used only hen the fracture does not require fixation to stabilise it. or those that require fixation, it should be rigid, and inserted hrough a coronal or hemicoronal approach. However, the echnique has been associated with appreciable aesthetic and unctional consequences. During the past decade some authors have reported excelent results with endoscopic support for reduction and rigid xation. This technique, which has been studied since 1995, hows that it is possible to reduce and fix fractures of the ygomatic arch under direct vision.2–4 The main advantages nclude minimal scars and less risk of undesirable side effects han the traditional method.5 We report an instrument that has been designed to faciltate the manipulation of rigid osteosynthesis material for roper fixation of an unstable fracture of the zygomatic arch. t consists of a handle about 15 cm long at an angle of 90o o its active part. The active end is 8 cm long and follows the

OSTEOTOMY OF THE DISTAL RADIUS USING A FIXED-ANGLE VOLAR PLATE

Objective: Skewed consolidation of the distal radius, due to sequelae of fractures, may cause functional incapacity, thus leading such patients to present pain, loss of strength and diminished mobility. Based on the excellent results obtained from surgical treatment of unstable fractures of the distal radius through a volar approach and use of rigid fixation with a fixed-angle volar plate, we started to use the same method for osteotomy of the distal radius. Methods: A retrospective review was conducted, and 20 patients treated between February 2002 and October 2009 were found. The mean length of follow-up was 43.9 months (range: 12 to 96 months). The surgical indications were persistent pain, deformity and functional limitation subsequent to a dorsally displaced fracture. Results: The mean preoperative deformity was 27° of dorsal tilt of the distal radius, 87° of ulnar tilt, and 7.3 mm of shortening of the radius. All the osteotomies consolidated and the final mean volar tilt was 6.2°, with ulnar tilt of 69.3° and shortening of 1 mm. The mean mobility of the wrist increased by 19.9° (flexion) and by 24° (extension). Mean forearm supination increased by 23.5° and pronation by 21.7°. Grip strength increased from 13.4 to 34.5 pounds. Conclusion: Use of a fixed-angle volar plate for a volar approach towards osteotomy of the distal radius enables satisfactory correction of the deformities and eliminates the need for removal of the synthesis material caused by tendon complications

SURGICAL TREATMENT OF UNSTABLE PELVIC RING FRACTURE IN SKELETALLY IMMATURE PATIENTS

Objectives: To present the outcomes from definitive surgical treatment for unstable fractures of the pelvic ring in children undergoing surgical reduction and stabilization. Methods: We studied 10 patients with immature skeletons who suffered unstable fractures of the pelvic ring and were treated between March 2004 and January 2008. The study was retrospective, based on clinical and radiographic evaluations. Results: The mean age at the time of the trauma was 8.8 years (2 to 13 years). Seven patients were female and three was male. There were eight cases of trauma caused by being run over, and one case each of a motorcycle accident and falling from a height. Five patients had other associated injuries such as fractures of the clavicle, femoral diaphysis, proximal humerus, lower leg bones, olecranon and bladder injury. All the patients evaluated showed an excellent clinical outcome. The pelvic asymmetry before surgery ranged from 0.7 to 2.9 cm (mean 1.45 cm), and dropped to values between 0.2 and 0.9 cm (mean 0.39 cm) after reduction. In no case was any change observed in pelvic asymmetry measured in the immediate postoperative period and at the end of follow-up. Conclusion: Pelvic ring fractures in skeletally immature patients are rare and surgical treatment is unusual. Several authors have questioned conservative treatment because of the complications encountered. Bone remodeling does not seem enough to cause an improvement in pelvic asymmetry, and this justifies the choice of surgical treatment for reduction and correction of pelvic ring deformities.

Surgical treatment of unstable fractures of distal radius

Objective To explore the surgical methods for unstable fractures of distal radius and evaluate the clinical results. Methods A retrospective analysis was conducted on 87 patients with unstable fractures of distal radius treated surgically from May 2001 to June 2008. According to AO classification and comminution severity, three methods including plate fixation, external fixation and Kirschner' s pins and plate fixation plus external fixation were employed accordingly. Results Of all, 78 patients were followed up for average 18 months. The result of Cooney's assessment of the wrist was excellent in 44 patients, good in 21, fair in 11 and poor in 2, with excellence rate of 83%. Conclusions The surgical methods should be selected based on different types of unstable distal radius fractures. In the meantime, maximal recovery of the relative length of the radius and ulna, formation of articular surface, volar tilting angle and ulnar inclination angle and reasonable rehabilitation exercises are helpful for the functional recovery of the wrist to a largest extent. Key words: Radius fractures; Fracture fixation, internal

ABO plate for treatment of unstable clavicular fractures

Objective To explorethe clinical effect of the track-type compression plate fixation of clavicular fractures. Methods Since December 2004 to December 2008,185 cases of unstable clavicular fractures use track-type compression plate treatment,Made a retrospective analysis of the current. Results The group followed up for 6 ～23 months( average 15 months) ,fracture healing 100%, according to Never score criteria:excellent 159 cases(85.9% ), good in 26 cases ( 14. 1% ). Conclusion Track-type compression plate with the surgical treatment of unstable fractures of clavicle is simple, reliable fixation, less bleeding, faster healing time, less complications and conducive to the advantages of early functional exercise, so this therapy is a simple and effective. Key words: Track-type compression plate; Internal fixation; Clavicle fracture

Eine vergleichende Untersuchung der Versorgung instabiler per- und intertrochantärer Femurfrakturen mittels DHS-Osteosynthese unter Verwendung der Trochanterabstützplatte und dem Proximalen Femurnagel (PFN)

The aim of the present paper is to compare the results obtained using two osteosynthesis systems developed for the surgical treatment of unstable fractures of the trochanteric region of the femur: the proximal femoral nail (PFN) and the dynamic hip screw (DHS) with trochanteric butt-press plate (TBPP). From December 1997 to November 2000, 173 patients with instable trochanteric fractures (type 31 A-2 and A-3 according to the AO-classification) had osteosynthesis by PFN (n = 122) or DHS/TBPP (n = 51). The average patient age was 74 years (range 27 to 98). No significant differences between the two study groups were observed with regard to age, sex, and rate of fracture types. At an average follow-up of 17 months the radiological and clinical outcome according to the score of "Merle d'Aubigné" was analysed in 61 % of all patients. All fractures were healed with no difference in functional outcome between the two groups. In the case of PFN 17.2 % revisions were necessary and in the case of DHS with TBPP 21.6 %. A shorter operation time (43 vs. 61 min) and a considerable shorter in-patient stay (20 vs. 24 days) were common with PFN. Full-weight-bearing immediately after the osteosynthesis was possible for 98 % of the PFN patients and 81 % of the DHS/TBPP patients. The DHS/TBPP osteosynthesis in instable trochanteric fractures is associated with a higher incidence of complications. Therefore we recommend to treat instable fractures of the trochanteric region with the PFN.

Surgical treatment of unstable fractures of the distal clavicle

Surgical treatment of unstable fractures of the distal clavicle

Modified Tenson Band Fixation for Unstable Fracture of the Distal Clavicle

Purpose : The aims of this study were to introduce a new surgical technique for unstable fracture of the distal clavicle, and to evaluate the clinical results. Materials and Methods : The clinical results of nineteen patients who underwent surgical treatment for unstable fracture of the distal clavicle, during the period from March 1995 to December 1999, using a modified tension band fixation with follow up over one year were reviewed. Outcome was analyzed in terms of pain, function, radiologic result and union time. Results : All cases showed satisfactory results; eighteen cases (95%) were excellent, and one case (5%) was good. Radiologic union was achieved on average at eight weeks (six-tweleve) after operation. No complications such as pin migration, metal breakage and nonunion were seen. Conclusion : Modified tension band fixation for unstable fracture of the distal clavicle was found to be a useful method, which is easy and induces no injury of the acromioclavicular joint, and provides enough stability for postoperative rehabilitation.

Treatment of the unstable distal radius fracture with external fixation and a hydroxyapatite spacer.

A prospective study was performed on 25 patients (15 women, 10 men) with unstable fractures of the distal radius selectively treated with a dynamic type of external fixation combined with a hydroxyapatite spacer. The fractures ranged from type VI to type VIII according to Frykman's classification. The patients' mean age at surgery was 49 years (range, 19-75 years). The mean follow-up period was 2.5 years, and overall outcome was assessed using Gartland and Werley's demerit point system as modified by Sarmiento. Radial inclination was 26 degrees +/- 4 degrees at the time of reduction and 26 degrees +/- 5 degrees at follow-up, palmar tilt was 9 degrees +/- 2 degrees at reduction and 8 degrees +/- 3 degrees at follow-up, and ulnar variance was 1.4 +/- 0.6 mm at reduction and 2.1 +/- 0.9 mm at follow-up. The mean range of motion at follow-up was 80 degrees +/- 10 degrees in flexion, 80 degrees +/- 10 degrees in extension, 85 degrees +/- 10 degrees in supination, and 80 degrees +/- 5 degrees in pronation. The outcome in 24 of 25 patients was evaluated as excellent. In the surgical treatment of unstable fractures of the distal radius using external fixator, the fracture reduction should be supported with bone graft or a bone substitute, and a hydroxyapatite spacer was considered to be a useful substitute for a bone graft.

Unconventional Fixation of Thoracolumbar Fractures using Round Hole Bone Plates and Transpedicular Screws

In an attempt to contain the high cost of commercially available pedicle screw systems, several authors have used unconventional alternatives such as locally made plates or dynamic compression plates (DCP) along with cancellous screws for transpedicular fixation of the thoracolumbar spine. These plates, however, allow for a wide range of motion at the plate-screw interphase and the construct does not provide stability in the sagittal plane. Round hole bone plates, on the other hand, allow much less mobility at the plate-screw interphase and the final construct offers better stability in the sagittal plane. Our objective was to determine the clinical, radiologic, and functional status of patients who underwent posterior fracture fixation using round hole bone plates and cancellous screws, and evaluate the construct's ability to maintain reduction of the fracture. This was a prospective follow-up of patients with fractures around the thoracolumbar junction fixed using round hole bone plates and cancellous transpedicular screws. Round hole bone plates along with 6.5 mm transpedicular cancellous screws were used for posterior spinal instrumentation in neurologically intact patients with isolated unstable fractures of the last thoracic or first lumbar vertebra. Seventeen patients were included in this study. Their mean follow-up was 10 months (range 5 to 12). All had evidence of fusion at a mean of 5 months (range 4 to 7). No patient had breakage or loosening of the screws and none had breakage of the plate. The mean kyphosis angle at the fracture site was 34 degrees preoperatively, --4 degrees in the immediate postoperative period, and 3 degrees on final follow-up radiographs. The percentage loss of anterior vertebral body height was 51% preoperatively, 15% in the immediate postoperative period, and 16% on final follow-up radiographs. The use of round hole bone plates along with 6.5 mm cancellous screws inserted into the pedicles provides an angle-stable construct that allows for better stability in the sagittal plane. It is effective in the surgical treatment of unstable fractures around the thoracolumbar junction. Because of their low cost and ease of insertion, round hole bone plates are an excellent choice for short arthrodesis and instrumentation of such fractures.