Tibial Fractures Research Articles

Soft tissue defect closure using an Ilizarov frame: a case series.

The Ilizarov technique is a well-known procedure for limb deformity corrections. However, in the present study, the purpose was to examine the potential of wound closure by means of an Ilizarov frame. Two main cases are presented, a further seven were retrospectively reviewed. The first case experienced a chronic wound at the tibial tuberosity. A fistula was excised followed by antibiotic therapy, however, dehiscence at the wound occurred for which an Ilizarov procedure was used. After two weeks the frame was removed and the wound was closed. The second patient underwent osteosynthesis of a tibia and fibula fracture but was complicated by infection. An Ilizarov device was applied for bone healing as well as the skin defect. Nine patients were included in total. Four of them attained enough skin length via the Ilizarov procedure for secondary closure. Three had the frame removed before having full wound covering and needed further granulation of the wound. Finally, two more patients underwent graft reconstruction. Three patients suffered from infectious complications. The gold standard in soft tissue closure remains skin or flap reconstruction, however, this is not advisable in poor overall health and decreased local vascularity. If an Ilizarov frame is present for bone reconstruction, it can simultaneously be used for skin closure. The results shown in the current study indicate that a satisfactory outcome can be achieved.

Prevention and treatment of osteomyelitis after open tibia fractures.

Infection and chronic post-traumatic osteomyelitis of the tibia after open fracture are complex problems that cause significant morbidity and threaten the viability of a limb. Therefore, it is of utmost importance for the orthopaedic surgeon to understand both patient and treatment factors that modify the risk of developing these disastrous complications. Infection risk is largely based on severity of open injury in addition to inherent patient factors. Orthopaedic surgeons can work to mitigate this risk with prompt antibiotic administration, thorough and complete debridement, expedient fracture stabilization, and early wound closure. In the case osteomyelitis does occur, the surgeon should use a systematic multidisciplinary approach for eradication.

Soft tissue coverage for IIIB fractures: from timing to coverage options.

Open tibia fractures are the most common open long bone injury. Most of these injuries involve a high-energy mechanism. Many standards for management have been created to provide guidance and a baseline for quality. There are several factors that must be considered when determining the timing of coverage for an open fracture with soft tissue compromise. Understanding the available options for soft tissue coverage, including local/rotational flaps and free tissue transfer, will allow for a tailored approach based on the personality of the injury. The aim of this review was to characterize the critical window of treatment based on the current literature and to provide a review of the available soft tissue coverage options.

Intramedullary nailing at different distal tibial fracture levels: A biomechanical study.

Distal tibial fractures remains a significant challenge in orthopedic trauma surgery. As the fracture level approaches the joint, alternative fixation options instead of intramedullary nailing (IMN) come to the fore. The present study aimed to assess the biomechanical stability of IMN at different distal tibial fracture levels and the number of locking screws required. Using a total of 21 sawbone models, 3 different tibial fracture levels (3, 4.5, and 6 cm proximally to the talocrural joint) were created and the fractures were fixed using 2, 3, or 4 distal locking screws. A single compression force at a speed of 30 mm/min with a maximum force of 800 Newton and a cyclic compression force of 60 cycles at a speed of 60 mm/min was applied to all tibia models. The applied weight and displacements from the fracture lines were recorded and evaluated. There was no statistically significant difference in fixation with 2 distal locking screws in groups 1, 2, and 3 (single test P =.9689) (cyclic test P =.8050). Therefore, if 2 distal screws are used, the fracture level does not affect the strength of fixation. In fractures located 6 cm proximal to the talocrural joint, all 4 holes of the nail can be used to insert screws, which provides a stronger fixation. When 2 screws are used, a statistically weaker fixation is obtained than with 3 or 4 screws. However, there is no significant difference between using 3 or 4 screws. Our findings support the use of IMN with 2 distal locking screws as a viable option for the management of distal tibial fractures. We found that it provides sufficient fixation regardless of the fracture level, suggesting that there is no need to choose an alternative fixation technique due to concerns of inadequate fixation as the fracture line moves distally. In cases where more stable fixation is desired, an additional locking screw can be used, but the potential increase in procedure and fluoroscopy time should be considered.

Exchange Nailing vs Plate over Nail and Graft in the Management of Non-United Proximal Tibial Fractures after Interlocking Nail Fixation in Proximal Tibial Fractures

Exchange Nailing vs Plate over Nail and Graft in the Management of Non-United Proximal Tibial Fractures after Interlocking Nail Fixation in Proximal Tibial Fractures

Design and Testing of a Pressure Measurement and Adjustment Device for Fracture Ends

To design and test a device which is capable of accurately measuring and dynamically adjusting the axial pressure at the fracture end in real-time. Upon completion of the design, the pressure measurement and adjustment device was implemented in a canine tibial fracture external fixation model. A pressure sensor was mounted at the fracture end, and the displayed values of the pressure sensor were used as the standard for comparison. The relationship between the displayed values of the measurement and adjustment device and the pressure sensor under identical conditions was examined. The device was utilized in external fixation models of tibial fractures in five beagles. A linear correlation was observed between the displayed values of the device and the pressure sensor at the fracture end. The measurement values from the device could be transformed into fracture end pressure through the application of coefficients, thereby facilitating accurate measurement and dynamic adjustment of the fracture end pressure. The pressure measurement and adjustment device at the fracture end is easy to operate, enabling precise measurement and dynamic regulation of the pressure at the fracture end. It is well-suited for animal experiments aimed at investigating the impact of axial compression on fracture healing, demonstrating promising potential for experimental applications.

Right Distal Tibial Oblique Fracture Open Reduction and Internal Fixation (ORIF) with Medial Neutralization Non-locking Plate

Right Distal Tibial Oblique Fracture Open Reduction and Internal Fixation (ORIF) with Medial Neutralization Non-locking Plate

Regional anesthesia is safe for use in intramedullary nailing of low-energy tibial shaft fractures

The purpose was to compare perioperative outcomes of patients who underwent general or regional anesthesia for intramedullary (IM) nailing of tibial shaft fractures (TSFs). Retrospective chart review was performed on a consecutive series of low-energy TSF patients who presented to a single academic medical center and a level 1 trauma center who underwent operative repair with a reamed IM nail. Collected information included demographics, injury information, anesthesia type (general or regional i.e. peripheral nerve block), intra-operative opiate consumption (converted to morphine milliequivalents [MME], and post-operative pain visual-analog scale [VAS] pain scores. Patients were divided into 3 groups based on the type of anesthesia received and univariate analysis was performed to compare the 3 groups. Seventy-six patients were included, with an average age of 44.47±16.0 years. There were 38 (50 %) who were administered general anesthesia and 38 (50 %) who were administered regional anesthesia in the form of a peripheral nerve block. There were no differences between the groups with respect to demographics, medical co-morbidities, rate of open fractures or AO/OTA fracture classification. Regional anesthesia patients received less intra-operative MME than general anesthesia patients (17.57±10.6, 28.96±13.8, p < 0.001). Patients who received regional anesthesia also spent less time in the operating room, received less MME on post-operative day 1, and ambulated further on post-operative day 1, however none of these differences were statistically significant. There were no cases of missed post-operative compartment syndrome or complications related to the administration of the peripheral nerve block. Regional anesthesia in TSF surgery received less intra-operative opioid requirements, without any untoward effects. Therapeutic Level III.

Preliminary results of stabilization of far distal tibia fractures with the distal tibial nail: A prospective, multicenter case series study

IntroductionThe distal tibial nail (DTN) is a novel retrograde intramedullary nail used for distal tibial fracture stabilization. We investigated the clinical results of DTN use for distal tibial fractures and compared them with those reported in the literature on locking plates and antegrade intramedullary nails. Materials and methodsThis multicenter, prospective, observational cohort study examined distal tibial fractures with AO/OTA classification 43 types: A1, A2, A3 or C1. The primary outcomes included bone union rate, soft tissue problems, and surgical complications. Secondary outcomes were EuroQol-5 Dimension-5 Level (EQ-5D-5L), Self-Administered Foot Evaluation Questionnaire (SAFE-Q), and American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot clinical scores 1 year postoperatively. Incidence of varus or valgus/anterior-posterior flexion deformity with a difference of ≥5° and postoperative reduction loss rate were evaluated. ResultsFive men and five women were enrolled (mean age, 69 years [range, 30–77 years]), including one open-fracture-type Gustilo type IIIB case. Bone union was observed in all patients at 6 months postoperatively. Delayed union, leg edema, and guide pin breakage were observed in three, one, and one cases, respectively. No soft tissue or surgical complications were observed. During the final follow-up, the EQ-5D-5L, SAFE-Q, and AOFAS hindfoot scores were 0.876 (0.665–1.0), 83–92, and AOFAS 92.6 (76–100), respectively. Varus and retroflexion deformities were observed in one case each. DiscussionDTN has been reported to have biomechanically equivalent or stronger fixation strength than locking plates or antegrade intramedullary nails. In addition, while DTN was thought to be less invasive for soft tissue and can avoid injury to the knee, it was thought that care should be taken to avoid medial malleolus fractures and posterior tibialis tendon injuries. Comparisons with literature treatment results for locking plates and antegrade intramedullary nails showed comparable to advantageous results. ConclusionsDTN treatment results for distal tibial fractures were as good as those for locking plates and antegrade intramedullary nails. DTN is useful for stabilization and does not compromise the surrounding soft tissues.

Neuromuscular and trunk control mediate factors associated with injury in fatigued runners

This study aimed to determine how fatigue affects factors associated with injury, neuromuscular activity, and control in recreational runners. Previously identified injury risk factors were defined as peak vertical instantaneous loading rates (pVILR) for tibial stress fracture (TSF) and peak hip adduction (pHADD) for patellofemoral pain syndrome and iliotibial band syndrome. Kinematics, kinetics, and electromyography data were collected from 11 recreational runners throughout a fatiguing run. Three trials were collected in the first and final minutes of the run. Coactivation was quantified about the knee and ankle for the entire stance phase and anticipatory, weight acceptance (WA), and propulsion sub-phases of stance. Trunk control was quantified by the peak mediolateral lean, peak forward lean, and flexion range of motion (ROM). There were significant increases in pHADD and pVILR when fatigued. Significant decreases in coactivation around the knee were found over the entire stance phase, in the anticipatory phase, and WA phase. Coactivation decreased about the ankle during WA. Lateral trunk lean significantly increased when fatigued, but no significant changes were found in flexion ROM or lean. Mediation analyses showed changes in ankle coactivation during WA, and lateral trunk lean are significant influences on pVILR, a measure associated with TSF. Fatigue-induced adaptations of decreasing ankle coactivation during WA and increased lateral trunk lean may increase the likelihood of TSF. In this study, a fatiguing run influenced changes in control in recreational runners. Further investigation of causal fatigue-induced injuries is necessary to better understand the effects of coactivation and trunk control.

Treatment of Tile type C pelvic ring fracture using orthopedic robot combined with Starr pelvis reduction frame

To investigate the clinical effect of orthopedic robot combined with Starr pelvic reduction frame in the treatment of Tile type C pelvic ring fracture. From October 2019 to May 2021, 14 patients with type C pelvic ring fracture were treated with robotic combined with Starr pelvic reduction frame, including 9 males and 5 females. The age ranged from 33 to 69 years. All the 14 patients had fresh closed fractures without femur, tibia and fibula fracture. Surgery was completed from 4 to 7 d after hospital admission. During the operation, the X-ray carbon bed was used, the pelvic ring was reduced by Starr pelvis reduction frame, and pelvic ring fracture was treated by orthopedic robot. Operation time, bleeding volume, fluoroscopy times of single screw placement, fracture reduction quality, affected limb function and complications were observed. Radiological reduction was evaluated using Matta scoring standard, and clinical efficacy was evaluated by Majeed pelvic function scoring system at the final follow-up. All of 14 patients successfully completed the operation, the operation time was 84 to 141 min, the bleeding volume was 20 to 50 ml, and the fluoroscopy times of single screw insertion was 4 to 9 times. All of 14 patients were followed up for 12 to 24 months. The healing time was 3 to 7 months. No complications such as fracture of internal fixation, screw loosening, infection and nerve injury were found. According to the evaluation criteria of Matta imaging reduction, 9 cases were excellent, 4 cases were good, and 1 case was fair. At the final follow-up, Majeed pelvic function scoring system was used:10 cases were excellent, 4 cases were good. The treatment of type C pelvic ring fracture with robotic combined Starr pelvis reduction frame is simple, time-saving, less trauma, less complications and effective.

Double reverse traction repositor assisted closed reduction and internal fixation versus open reduction and internal fixation for treatment of lateral tibial plateau fractures among the elderly.

In elderly tibial plateau fractures (TPFs), the lateral condyles are involved frequently. This study aimed to compare the outcomes of open reduction and internal fixation (ORIF) and double reverse traction repositor (DRTR) assisted closed reduction and internal fixation (CRIF) in elderly patients with lateral TPFs. From January 2015 to July 2020, we retrospectively reviewed 68 patients treated surgically at our trauma center for lateral TPFs (Schatzker type I-III). 31 patients were eventually assigned to the DRTR assisted CRIF group, whereas 37 patients were assigned to the ORIF group. The primary outcomes included surgical details, radiological assessment, follow-up knee function, and complications. The DRTR assisted CRIF group experienced a 43.6mL decrease in intraoperative blood loss (161.3ml vs 204.9ml, p = 0.033), and the operation duration was 32.1min shorter than the ORIF group (83.8min vs 115.9min, p < 0.001). There was no statistically significant difference in terms of widening of the tibia plateau (WTP), depth of articular depression (DAD), medial proximal tibial angle (MPTA) and posterior tibial slope angle (PTSA) immediately after surgery and at the last follow-up. No differences in malreduction (p = 0.566) or reduction loss (p = 0.623) were observed between the groups, and Lysholm and HSS scores were similar between the two groups (83.6 ± 15.8 vs 83.4 ± 5.1, p = 0.934; 89.3 ± 7.8 vs 86.9 ± 6.2, p = 0.172; respectively). However, ORIF was associated with a greater increase in postoperative complications than DRTR assisted CRIF (3.2% vs 27%, p = 0.008). Both types of internal fixation provide good radiological outcomes and knee function in the treatment of lateral TPFs in the elderly. However, DRTR assisted CRIF has the advantage of a shorter duration of surgery, less blood loss, and fewer postoperative complications, and appears to be a better treatment option for elderly patients with lateral TPFs.

Total Knee Arthroplasty in Patients Who Have Skeletal Dysplasia: A Center’s Experience With a Mean 9-Year Follow-Up

BackgroundTotal knee arthroplasty (TKA) in patients who have skeletal dysplasia (SD) is a technically challenging surgery due to deformity, joint contracture, and associated comorbidities. Patients presenting with this condition have traditionally been treated with conservative measures, leading to poor outcomes. The aim of this study was to follow-up on patients who had SD following TKA, specifically with regards to clinical outcomes. MethodsA total of 31 knees (22 patients) with SD that had undergone TKA in our institution were included in our study. The mean follow-up from index surgery was 110.3 months (range: 20 to 291). The type of dysplasia, implant used, and clinical outcomes with patient-reported outcome measures are presented. ResultsThere were 8 patients (36.3%) who had a diagnosis of achondroplasia, followed by multiple epiphyseal dysplasia (31.8%) and spondyloepiphyseal dysplasia (22.7%). There were 14 men and 8 women who had a mean age of 51 years (range: 28 to 73). Custom implants were required in 12 cases (38.7%), custom jigs were used in 6 cases (19.4%), and robotic-assisted surgery was used in 2 (6.5%) TKAs. Hinged prostheses were used in 17 cases (54.8%), posterior-stabilized in 9 (29.0%), and cruciate-retaining implants in 5 (16.1%). There was 1 patient who sustained an intraoperative medial tibial plateau fracture treated with concomitant open reduction and internal fixation. There was 1 revision that occurred during the follow-up period with a patella resurfacing for continued anterior knee pain. Postoperatively, Oxford Knee Scores improved on average by 12.2 points. The 10-year and 20-year all-cause revision-free survival was 96.8, respectively. ConclusionsDespite the technical challenges and complexity associated with this unique patient cohort, we demonstrated excellent implant survivorship and clinical outcomes post-TKA with mid-term to long-term follow-up of more than 20 years. We recommend preoperative cross-sectional imaging for precise planning and implant templating with multidisciplinary team decision-making. Despite our results, functional outcomes remain inferior to primary arthroplasty within the general population, although we still recommend this treatment modality to appropriately counseled patients. Level of EvidenceIII.

Late Manipulation under Anesthesia after Total Knee Arthroplasty: Improved Range of Motion and a Low Complication Rate.

The purpose of this study was to evaluate outcomes of late manipulation under anesthesia (MUA) for stiffness performed from ≥12 weeks to more than a year after primary total knee arthroplasty (TKA). A total of 152 patients receiving MUA ≥12 weeks after primary TKA from 2014 to 2021 were reviewed. The primary outcome measured was change in range of motion (ROM). We tracked intraoperative complications and the need for repeat MUA or open procedure for continued stiffness after initial MUA. Three subgroups were analyzed: Group 1 included 58 knees between 12 weeks and 6 months after TKA, Group 2 included 44 knees between 6 and 12 months after TKA, and Group 3 included 50 knees ≥12 months after TKA. Analysis included descriptive statistics and univariate analysis, with α <0.05. Groups 1 to 3 all significantly increased their overall ROM by 20.9, 19.2, and 22.0 degrees, respectively. All groups significantly increased their flexion and extension from preoperatively. Group 1 had one intraoperative supracondylar femur fracture (1.7%) requiring open reduction and internal fixation, and five patients required repeat MUA or open procedure (8.6%). Group 2 had no intraoperative fractures, and five patients required repeat MUA or open procedure (11.4%). Group 3 had one intraoperative tibial tubercle avulsion fracture managed conservatively (2.0%) and one repeat MUA (2.0%). Late MUA resulted in significantly improved ROM in all groups. ROM improved more as the time from index TKA increased, although statistically insignificant. Repeat MUA or open procedure rate decreased with MUA ≥12 months from TKA, although statistically insignificant. The overall intraoperative fracture risk was 1.3%.

Comparing the effects of pre-emptive oxycodone, diclofenac, and gabapentin on postoperative pain after tibia fracture surgery: A randomized clinical trail.

Postoperative pain (POP) is one of the most common and most important types of pain. The aim of this study was to compare the effects of pre-emptive oxycodone, diclofenac, and gabapentin on postoperative pain (POP) among patients with tibia fracture surgery. This double-blind three-group randomised controlled trial was conducted in 2023. Participants were 111 candidates for tibia fracture surgery under general anaesthesia. They were randomly allocated to oxycodone, gabapentin, and diclofenac groups through block randomisation. Baseline arterial oxygen saturation, heart rate, and blood pressure were documented before surgery and POP and sedation status were measured during postoperative recovery and 2, 4, 6, 12, and 24 h after surgery. Postoperative opioid analgesic use was also documented. The data were analysed using the SPSS software (v. 20.0) at a significance level of less than 0.05. Groups did not significantly differ from each other respecting participants' baseline age, gender, body mass index, arterial oxygen saturation, heart rate, blood pressure, and surgery duration (P > 0.05). Moreover, there were no significant differences among the groups respecting POP and sedation status at different measurement time points (P > 0.05), except for six hours after surgery at which the POP mean score in the gabapentin group was significantly less than the other two groups (P = 0.001). Among-group differences respecting postoperative use of opioid analgesics and medication side effects were also insignificant (P > 0.05). Pre-emptive oxycodone, diclofenac, and gabapentin significantly reduce POP among patients with tibia fracture surgery, though gabapentin may produce more significant analgesic effects. All these three medications can be used for pre-emptive analgesia. Of course, the best pre-emptive analgesic agent is determined based on the opinion of the treating physician.

Risk factors for delayed return to work following tibial shaft fracture surgery.

To determine when patients return to work following operative repair of tibial shaft fractures (TSF) and what risk factors are associated with a delayed return to work (RTW), defined as greater than 180days after operative repair. Retrospective chart review was performed on a consecutive series of TSF patients who underwent operative repair. Time to RTW was based on documented work-clearance communications from the operating surgeon. Patients were divided into 3 groups based on when they returned to work: early (≤ 90days), average (91-80days), and late (≥ 180days). Univariate analysis was performed, and significant variables were included in multinomial logistic regression. There were 168 patients identified. Eighteen were excluded (retired, unemployed, or never returned to work) leaving 150 patients. The average time to RTW for the overall study population was 4.17 ± 2.06months. There were 39 (26.0%) patients in the early RTW group, 85 (56.7%) in the average RTW group, and 26 (17.3%) in the late RTW group. Patient with high-energy injuries (p = 0.024), open fractures (p = 0.001), initial external-fixation (p = 0.036), labor-intensive job (p = 0.018) and post-operative non-weight bearing status (p = 0.023) all had significantly longer RTW. Multinomial logistic regression including these parameters found a closed fracture was associated with a 1.9 decreased risk of delayed RTW (p = 0.004, 95% CI 0.039-0.533). Open fractures, initial external-fixation, restricted post-operative weight-bearing and labor-intensive jobs are associated with a delayed RTW following operative repair of TSFs. Therapeutic Level III.

Impaired synaptic plasticity and decreased glutamatergic neuron excitability induced by SIRT1/BDNF downregulation in the hippocampal CA1 region are involved in postoperative cognitive dysfunction

BackgroundPostoperative cognitive dysfunction (POCD) is a common complication after anesthesia/surgery, especially among elderly patients, and poses a significant threat to their postoperative quality of life and overall well-being. While it is widely accepted that elderly patients may experience POCD following anesthesia/surgery, the exact mechanism behind this phenomenon remains unclear. Several studies have indicated that the interaction between silent mating type information regulation 2 homologue 1 (SIRT1) and brain-derived neurotrophic factor (BDNF) is crucial in controlling cognitive function and is strongly linked to neurodegenerative disorders. Hence, this research aims to explore how SIRT1/BDNF impacts cognitive decline caused by anesthesia/surgery in aged mice.MethodsOpen field test (OFT) was used to determine whether anesthesia/surgery affected the motor ability of mice, while the postoperative cognitive function of 18 months old mice was evaluated with Novel object recognition test (NORT), Object location test (OLT) and Fear condition test (FC). The expressions of SIRT1 and other molecules were analyzed by western blot and immunofluorescence staining. The hippocampal synaptic plasticity was detected by Golgi staining and Long-term potentiation (LTP). The effects of SIRT1 and BDNF overexpression as well as chemogenetic activation of glutamatergic neurons in hippocampal CA1 region of 18 months old vesicular glutamate transporter 1 (VGLUT1) mice on POCD were further investigated.ResultsThe research results revealed that older mice exhibited cognitive impairment following intramedullary fixation of tibial fracture. Additionally, a notable decrease in the expression of SIRT1/BDNF and neuronal excitability in hippocampal CA1 glutamatergic neurons was observed. By increasing levels of SIRT1/BDNF or enhancing glutamatergic neuron excitability in the CA1 region, it was possible to effectively mitigate synaptic plasticity impairment and ameliorate postoperative cognitive dysfunction.ConclusionsThe decline in SIRT1/BDNF levels leading to changes in synaptic plasticity and neuronal excitability in older mice could be a significant factor contributing to cognitive impairment after anesthesia/surgery.Graphical

HINDFOOT ANKLE RECONSTRUCTION NAIL TRIAL (HARNT): POPULATION ANALYSIS OF SURGICAL TREATMENT OF COMPLEX ANKLE FRACTURES IN THE UNITED KINGDOM

IntroductionThe management of open or unstable ankle and distal tibial fractures pose many challenges. In certain situations, hindfoot nailing (HFN) is indicated, however this depends on surgeon preference and regional variations exist. This study sought to establish the current management and outcomes of complex ankle fractures in the UK.MethodsA National collaborative study in affiliation with BOTA was conducted and data retrospectively collected between January 1st – June 30th 2019. Adult patients with open and closed complex ankle fractures (AO43/44) were included. Complex fractures included the following patient characteristics: diabetes ± neuropathy, rheumatoid arthritis, alcoholism, polytrauma and cognitive impairment. We obtained data on fixation choice and patient outcomes. Institutional approval was obtained by all centres, and statistical analysis was performed including propensity matching.ResultsFifty-six centres provided data for 1360 patients. The average age of the cohort was 53.9 years ±19 (SD) with a male/female ratio of 1:1.3. 920 patients were ASA 1/2, 440 were ASA 3/4; 316 had diabetes, and 275 were open fractures. Most fractures were AO44 (71.2%) and more commonly associated with diabetes (P&lt;0.001), alcoholism (P&lt;0.007), open (P&lt;0.013), and advanced age (55.7 vs. 46.3). 1227 patients underwent primary-fixation (111 HFN), with the remainder treated with external-fixation (84 definitive). Of the 111 HFN, 35% underwent primary fusion. Wound complication and thromboembolic rates were greater in the HFN group compared to ORIF groups (P&lt;0.003), being more evident in the HFN group with primary fusion even after propensity matching. However, 1081 patients were non-weightbearing post-op contrary to the BOAST guidance.ConclusionThis is the first National collaborative audit of complex ankle fractures. Hindfoot nails were used in 9% of patients and we observed more complications in this group when compared to other cohorts. Despite BOAST guidance, only 21% of patients undergoing operative management were instructed to fully weightbear post-operatively.

A newly designed anatomical plate for the therapy of posterolateral tibial plateau fracture via a supra-fibular-head approach: a retrospective study.

The posterolateral tibial plateau fracture is a special type of intra-articular fracture, for which there is no simple, safe, and effective standardized procedure. In this paper, we evaluate the clinical efficacy and the advantages of the treatment of posterolateral tibial plateau fracture by using our designed proximal lateral tibial rim plate for the posterolateral condyle of the tibial plateau via the space above the fibula head. Thirty-eight patients with posterolateral tibial plateau fractures from June 2018 to June 2021 were retrospectively analyzed. CT scans were used to classify the degree of injury in the included patients. All of them were fixed with reduction using an approach above the fibula head combined with a homemade anatomical plate. The regular postoperative review was performed to instruct functional knee exercises. Postoperative complications were observed and follow-up visits were performed to assess the functional outcome. A total of 38 patients with posterolateral tibial plateau fractures, 13 males and 25 females were included in the study. All patients were followed up for 13-26months, with a mean of 15.3months. There were no postoperative complications such as numbness of the limb, knee joint instability, etc. X-ray review showed that the fractures were all healed, and the healing time was 10-16weeks, with an average of 12.1weeks; none of the internal fixation loosening and loss of articular surface occurred during the follow-up period. At the last follow-up, according to the HSS knee function score criteria, the scores were 79-98, with an average of 91.3. The HSS score presented excellent in 34 cases (89%) and good in 4 cases (11%). The Rasmussen score was graded as excellent in 29 cases (76%) and good in 9 cases (24%). In conclusion, The treatment of posterolateral tibial plateau fractures by an approach above the fibula head has the advantages of simplicity and safety, small trauma, and no risk of vascular and nerve injuries, and the anatomical proximal lateral tibial rim plate can play a direct and effective supporting role for the bone fragments of the posterolateral condyle, and the combination of both of them has obvious advantages in the treatment of posterolateral condylar fracture of the tibial plateau, and it is a method worth borrowing and popularizing.

Study of the Healing of Tibial Fractures Treated with Dynamic Intramedullary Nailing

Background: Dynamic nailing by placing only one screw on one side of the nail shortens the surgical time and reduces the complications during surgery and secondary dynamization. This study aimed to investigate the healing of dynamic intramedullary nailing (IMN) of tibial fractures. Methods: This cross-sectional study was done on 67 patients with dynamic IMN in 5th Azar Hospital, Gorgan, Iran, in 2015-2018. Complications, union time, Radiographic Union Score of Tibia Fracture (RUST) score, and Johner-Wruhs criteria were analyzed based on their grouping in AO classification. Results: The average age of the patients was 33.2 ± 13.0 years. Most of the fractures were closed type (71.6%), type C (43.4%). The mean healing time was 14.62 ± 4.38 weeks and RUST score was 8.90 ± 1.26. There was no significant difference between locations of fracture and the healing time or RUST score (P &gt; 0.05). The healing time in the comminuted fractures (e.g., type C) and open tibial fractures was statistically longer than the simpler type (e.g., type A or B) and the mean radiological score in type C fractures was significantly lower (P &lt; 0.05). The mean Johner-Wruhs criteria score of fractures was 46.31 ± 4.49, so that 61 patients had excellent results, four patients had good results, and two patients had fair results. Conclusion: Dynamic IMN of closed and middle third tibial fractures and simpler types of fractures (e.g., type A or B) have faster healing. Nevertheless, it is better to be more cautious for fixation of open or comminuted fracture (e.g., type C).