Fracture Union Time Research Articles

Pre-operative use of CT based three-column concept for fragment specific fixation of proximal tibia fractures in a series of 84 cases

Background: It is important to classify proximal tibia fractures based on CT scan in addition to plain radiograph. The 3-column concept was introduced to classify these fractures based on a transverse CT scan. This study aimed to evaluate the surgical and functional outcomes of fragment specific fixation in proximal tibia fractures using the 3-column concept. Materials and Methods: 84 cases of proximal tibia fractures (mean age: 42.85±11.94 years, range 23-72 years; 65 males and 19 females) were classified based on the 3-column concept (24 - 1 column, 50 – 2 column, 10 – 3 column). The surgical approach was decided for fragment-specific fixation based on the column involved. The clinic-functional assessment was done using fracture union time, range of motion, Oxford Knee Score and Functional Knee Society Score. Results: The mean follow up duration was 1.2-1.5 years. The average fracture union time was 15.63±1.98 weeks (range, 12-21 weeks). The mean flexion achieved at the final follow up was 132.74±4.49 degrees (range, 130-135 degrees). The mean follow-up Oxford Knee Score was 47.98±0.109 (range, 45-48) and the mean Functional Knee Society Score was 99.88±1.09 (range, 90-100) in all patients after 1 year. 2 patients showed they delayed wound healing with superficial infection and 1 patient had a stiff knee. There was no other complication. Conclusion: Using the CT-based three-column concept for fragment-specific fixation pre-operatively helps treat a complex proximal tibia fracture with acceptable complication rates and good functional outcomes.

A functional outcome of intra articular calcaneum fracture managed surgically with plate fixation: A prospective study

Intraarticular fractures account for approximately 75% of calcaneal fractures and historically have been associated with poor functional outcomes. The management of intraarticular calcaneal fractures remains a controversy, with strong arguments supporting both conservative & operative managements. Significant controversy remains over the results of nonoperative versus operative treatment. The lack of standardization of results has made it difficult to compare studies that have evaluated outcomes [1]. Aims and Objective: To evaluate the functional and radiological outcome of intra-articular calcaneal fractures managed surgically with a plate in terms of bohler’s and gissane’s angle, rate of radiological union and AOFAS score. Methods: A prospective study including 25 patients with an intra-articular calcaneal fracture who met the inclusion criteria was conducted in SGITO, Bangalore, between November 2019 and November 2020. Patients were managed surgically with plate fixation and were followed up regularly at 6 weeks, 12 weeks, 24 weeks and 1 year. Radiological outcome and functional outcome evaluated using AOFAS score. Results: Mean age of the patients was 33.6 years. The mean time duration between injury and surgery was 7.8 days. The mean time for fracture union was 13.64 ±2.56 weeks. The difference between pre and post-operative mean bohler’s and gissane’s angle was statistically significant with a p value

TO EVALUATE RADIOLOGICAL AND FUNCTIONAL OUTCOMES OF INTRAMEDULLARY OSTEOSYNTHESIS OF SUBTROCHANTERIC FEMUR FRACTURES IN ADULTS WITH LONG PROXIMAL FEMORAL NAIL

Background: The subtrochanteric fractures accounts for 10-34% of hip fractures. Operative treatment is gold standard in adults in view of anatomical location, deforming forces & vascularity issues. Intramedullary device are less invasive, more biological & mechanically stable whereras extramedullary methods achieves better anatomical reduction but at the expense of vascularity. However, there is still no consensus over the methodology for being the best for these fractures. Objective: To evaluate clinical, functional and radiological outcomes of intramedullary osteosynthesis of subtrochanteric femur fractures in adults with long PFN. Methods: A prospective randomized control study was conducted on total 30 patients of subtrochanteric fractures and treated with long proximal femoral nail (PFN). All the patients were followed up for a maximum of 24 weeks. Outcomes were observed & analysed such as tip apex distance, duration of surgery, complications, functional and radiological outcomes. Results: The average age of patients was 43.6 years ±13.26. Left sided fracture were more than right sided fracture. The most common type of fracture as per AO-ASIF classication was 32-C3 (53.33%). In 21 patients compression screw used was 95mm or above. Derotation screw of size 85mm or above were inserted in 19 patients. Mean TAD of compression screw and derotation screw was 11.59 and 13.81 respectively. Closed reductions was achieved in 27 patients. Mean surgical time was 157 minutes. Mean radiological union time of fracture was 14.16 weeks. Mean Harris hip score at 24 weeks was 84.56. Conclusions: It is concluded that intramedullary xation by long PFN is a sound and effective modality for the subtrochanteric fractures. Subchondral xation of both proximal screws probably has led to better stable xation with hundred percent union rates and no implant failure.

Comparison between Clinico-radiological outcomes of primary closed static and dynamic interlocking nailing in transverse or short oblique diaphyseal fractures of tibia: A prospective study

Introduction and Background: The objective of the study is to evaluate the comparative efficacy in terms of clinico-radiological outcomes in primary static versus primary dynamic intramedullary interlocking nailing of tibia. The principle of fixation for a tibial middle third fracture is to stabilize at the proximal metaphyseal region, the isthmus and the distal metaphyseal region. This 3 point fixation provides adequate resistance to the deforming axial and torsional forces at the fracture site. Two types of Locking techniques exist for the intramedullary nailing, Static and Dynamic. Materials and Method: A total of 17 patients of either sex who presented with closed trauma of transverse or short oblique diaphyseal fractures of tibia, which were observed between the years 2015-2017. Randomly, static and dynamic locking was done to the equal populations presented. The aims of the study conducted were to analyze time to union, functional recovery and incidence of complications. Johner and Wruh’s Criteria was used to analyze the functional outcome. All patients were followed for a period of 18months. Results: Upon evaluation with regard to Johner and Wruh’s criteria showed Excellent results in 9 out of 17 subjects, Good results in 7 out of 17 subjects and a Fair result in 1 patient. The average time of fracture union in case of dynamically and statically interlocked nailed tibiae is 13.00 and 15.22 weeks respectively. Therefore, the difference was 2.22 weeks. In our study, the results of tibia nailing was found to be in consonance with the earlier studies. Conclusion: We conclude that Primary Dynamic locking is a better option as compared to primary static locking in simple transverse or short oblique diaphyseal fractures of tibia as it leads to faster fracture healing and early return to function.

Comparison of the Effect of Rhombic and Inverted Triangle Configurations of Cannulated Screws on Internal Fixation of Nondisplaced Femoral Neck Fractures in Elderly Patients.

ObjectiveTo investigate whether four‐screw fixation in rhombic configuration could improve the clinical outcomes and decrease the complication rate compared with three‐screw fixation in inverted triangle configuration in elderly patients with nondisplaced femoral neck fractures.MethodFrom January 2018 to January 2019, 91 elderly patients with nondisplaced femoral neck fractures who were treated with a cannulated screw system were reviewed retrospectively. The inverted triangle configuration was applied in 51 patients and rhombic configuration in 40 patients. The demographic and perioperative information of the patients were extracted from medical records and surgical records. Variables including incision size, surgical blood loss, surgical time, fluoroscopy time, hospital stays, fracture union time, postoperative visual analogue scale (VAS) scores, and complications were compared between the two groups. Also, Harris hip score at the final follow‐up was used to evaluate the functional outcomes.ResultsAll patients were followed up from 24 to 36 months, with an average of 29.75 months. The average age of patients was 72.37 ± 7.16 years. No significant differences were found between the two groups with regard to patients' age, gender, affected side, Garden classification, Pauwels classification and comminution of posterior wall (P > 0.05). We found shorter incision size (P < 0.001), less blood loss (P = 0.020), less surgical time (P = 0.026), and shorter fluoroscopy time (P < 0.001) in inverted triangle configuration group. However, shorter hospital stays (P = 0.001) and fracture union time (P = 0.002) were found in the rhombic configuration group. The VAS scores were lower in the rhombic configuration group at the first (P < 0.001) and third months (P = 0.010), but no significant difference was found at the sixth month (P = 0.075). Meanwhile, the total complication rate was relatively lower in the rhombic configuration group compared to the inverted triangle configuration group (P = 0.041). Harris hip score presented no significant difference between the two groups at final follow‐up (P = 0.078). No wound infection or cortical perforation occurred in either group.ConclusionFour‐screw fixation in rhombic configuration was superior to three‐screw fixation in inverted triangle configuration in the treatment of nondisplaced femoral neck fractures in elderly patients in terms of less early postsurgical pain, shorter fracture union time, and lower complication rate.

Математичне моделювання остеосинтезу черезвертлюгових переломів типу А1 із застосуванням різних металевих фіксаторів

Із метою визначення оптимального виду остеосинтезу при оперативному лікуванні черезвертлюгових переломів типу А1 проведено комп’ютерне моделювання напружень на металеві фіксатори (пластина DHS та PFN-стрижень). Визначено, що найбільш біомеханічно обґрунтованою при черезвертлюгових переломах типу А1 є модель PFN-стрижня у варіанті без застосування гвинтів для дистального блокування, про що свідчать мінімальне напруження на металевому фіксаторі та наявність оптимальної мікрорухливості між кістковими відламками. Проведене дослідження дозволить визначити диференційований підхід до лікування хворих із черезвертлюговими переломами стегнової кістки, покращить ефективність надання медичної допомоги цій категорії тяжких хворих.

CONSERVATIVE VERSUS OPERATIVE MANAGEMENT OF MID-CLAVICULAR FRACTURES

Background: Mid-clavicle fractures were traditionally managed by non-operative means which led to stiffness and painful shoulder. Surgical treatment on the other hand had the advantage of reducing malunion and allowing early shoulder movements, but also had incidences of infection. This study was carried out with the objectives of comparing functional outcome, fracture union rates, patient satisfaction rates and complications of both treatments. Methods: In this observational study done from October 2020 to September 2021 in the Orthopedics and Emergency department of KIST Medical College Teaching Hospital, Lalitpur, Nepal, 40 patients with mid-clavicle fractures were treated either conservatively or operatively according to their choice. 20 patients in each group were assessed functionally in each follow-up using the Constant and Murley score and union and complications were also assessed. Data collection and entry was done using the statistical package for social science version 22 and analyzed by using statistical tools like mean, frequency and Independent samples t-test. Results: At 6 months, there was no statistical difference in the Constant and Murley score between the two groups, but the scores were statistically better in the operative group at 6 weeks. Mean fracture union time in operative group (12.67 weeks) was statistically better than that in conservative group (14.89 weeks). Complications in operative group were mainly hardware related while stiffness was more common in conservative group. Conclusions: Operative treatment led to earlier fracture union, regain of shoulder function and return to work, but had the disadvantage of high cost and risk of infection as compared to conservative treatment.

Ultrasound-guided preoperative localization of radial nerve in the treatment of extra-articular distal humeral shaft fractures

BackgroundThe aim of this study was to discuss the treatment of extra-articular distal humeral shaft fractures using ultrasound-guided preoperative localization of radial nerve.MethodsBetween May 2010 and December 2019, 56 patients with extra-articular distal humeral shaft fractures were retrospectively reviewed. Twenty eight patients were received examination by using preoperative localization of radial nerve guided by ultrasound-guided preoperative localization (group A) and 28 control patients without ultrasound-guided (group B). All patients were treated surgically for distal humeral shaft fractures by posterior approach techniques. Operative time, radial nerve exposure time, intraoperative bleeding volume, union time and iatrogenic radial nerve palsy rate were compared between the two groups. Elbow function was also evaluated using the Mayo Elbow Performance Score (MEPS).ResultsA significant difference was observed between the two groups, Operative time (113.25 min vs 135.86 min) (P < 0.001), radial nerve exposure time (20.82 min vs 32.53 min) (P < 0.001), intraoperative bleeding volume (246.80 ml vs 335.52 ml) (P < 0.001). However, iatrogenic radial nerve palsy rate (3.6% vs 7.1%) (P = 0.129), the fracture union time (13.52 months vs 12.96 months) (P = 0.796) and the MEPS score (87.56 vs 86.38) (P = 0.594) were no significantly different in both groups.ConclusionsThe study demonstrates that ultrasound-guided preoperative localization is an effective approach in the treatment of extra-articular distal humeral shaft fracture by revealing radial nerve, which may help reduce the operative time, radial nerve exposure time and the intraoperative bleeding volume.

Posterior malleolus fractures and their role in prognosis of malleolar fractures

Introduction: The treatment of ankle fractures with involvement of the posterior tibial margin remains a subject of debate. We have evaluated the clinical, radiological, and functional outcome of such fractures in 25 patients, all of which were managed surgically over an average follow- up period of 6 months. The treatment options available for malleolar fractures, to attain a proper anatomical alignment and stability of ankle joint, can lead to rewarding outcome for the patient.Materials and Methods: 25 patients with posterior malleolus fractures were managed surgically between June 2019 to November2021 were included in this series. The mean age, gender ratio, mode of trauma, fracture union time, and complications were noted. The AOFAS Hindfoot scores were used for assessing the Ankle function.Results: Of the 25 patients in the study, 21 were males and 4 were females. The mean age was 38.12 years. The mean fracture union (radiological) time was 14.04 weeks (range: 10–18 weeks). However Ankle function was excellent in 17 cases (68%) on the AOFAS hindfoot score with a average AOFAS score of 94.8. Also platting gives a better result than using cannulated cancellous screws. Better syndesmotic stability is observed after surgically treating posterior malleolus fractures.Conclusion: Fixation of the posterior malleolus to reduce persistent fragment displacement, regardless of size, as well as to restore syndesmotic stability, may lead to improved outcomes. We conclude that posterior malleolar fractures encountered in clinical practice need thorough assessment and meticulous surgical intervention. We achieved stable fixation and performed early mobilization of the ankle joint, which limits the complications of mainly ankle stiffness and have achieved excellent clinical and functional outcomes of surgically fixing the posterior malleolus fractures.

Cephalomedullary Nailing versus Dynamic Hip Screw Fixation in Basicervical Femoral Neck Fracture: A Systematic Review and Meta-Analysis.

PurposeAlthough many studies have reported the use of dynamic hip screws (DHS) and cephalomedullary nailing (CMN) for basicervical femoral neck fracture (BFNF), no clear treatment protocols have been recommended. The present study aimed to compare the surgical outcomes associated with DHS and CMN to determine the appropriate fixation method for BFNF.Materials and MethodsWe systematically searched MEDLINE, Embase, and the Cochrane Library for studies published up to January 9, 2021 that compared the treatment outcomes between CMN and DHS in BFNF. The primary outcomes of the present meta-analysis were fracture union time, postoperative cut-out rate, and reoperation rate.ResultsWe included seven studies involving 353 cases of BFNF in our review. Of these, 206 patients were treated using CMN, and DHS were utilized in 147 patients. In a pooled analysis, the DHS group required a longer time to achieve fracture union compared to the CMN group [mean difference (MD): -0.41; 95% confidence interval (CI): -0.70, -0.12; p=0.006; I2=0%]. However, the cut-out and reoperation rates exhibited no statistically significant differences between the DHS and CMN groups [cut-out odds ratio (OR): 0.54; 95% CI: 0.10, 2.82; p=0.47; I2=24%, reoperation rate OR: 0.65; 95% CI: 0.15, 2.86; p=0.57; I2=19%, respectively].ConclusionStable fixation using DHS and CMN does not show a significant clinical or radiographical difference in BFNF, and the implant can be selected based on the surgeon’s preference.

Functional outcome of midshaft humerus fracture treated with minimally invasive anterior plate osteosynthesis

Introduction: Humeral shaft fractures make up approximately 1% of all fractures. Typically, they are the result of direct trauma. Though open reduction and plating technique of humerus shaft fracture is prevailing, Minimally invasive plate osteosynthesis technique also gives favorable outcome. This techniques are challenging and have the benefitof reducing soft- tissue damage.Materials and Methods: Twenty two patients with humerus shaft fractures were managed by anterior bridge plating using MIPO technique between March 2017 to November 2019 were included in this series. All cases were treated with locking compression plate fixation in bridging mode using the MIPO technique. The dominant side, gender ratio, surgery time, radiation exposure, and fracture union time were noted. The constant Murley score for shoulder and Mayo elbow performance score for elbow were used for assessing the shoulder and elbow function.Results: Of the twenty two patients in the study, 54.4% were males and 45.5% were females. The mean age was 45.8 years (range 21 to 85 years). 59.1% patients had the left side fractured. RTA was most common mode of injury. Mean surgical time in minutes was 71.36 mins. The mean fracture union time was 12.82 weeks. At the end of 1-year follow-up, mean constant score was 87.9 and mean Mayo score was 97. 20 patients had no post-op complications and 2 had delayed union.Conclusion: This study confirmed a high overall rate of union and excellent functional outcomes. Mini incision anterior bridge technique should be considered as an effective, cosmetically advanced surgical option. It is a safe and less time consuming method for simple types of humeral shaft fracture.

Intramedullary Nail Supplemented with Poller Screws for Proximal and Distal 1/3rd Shaft Tibial Fracture: A Prospective Interventional Study from North India

Introduction: The shaft of the tibia is the most common long bone fracture. The treatment goal for shaft tibial fracture is to achieve union with correction of both axial and rotational alignment and, maintain initial fracture length. Higher malunion rates are seen in fractures of the proximal and distal 1/3rd of the shaft of the tibia. However, Intramedullary (IM) nailing is the preferred choice of operative management of diaphyseal fractures of the lower limb. Aim: To evaluate the functional and radiological outcomes of IM nail supplemented with poller screws for proximal and distal 1/3rd shaft tibial fractures. Materials and Methods: A prospective, interventional study was conducted in the Government Medical College, Patiala, Punjab, India from May 2020 to November 2021. A total of 30 fracture patients in the age group of 18 to 60 years were included in the study. All the subjects were treated with IM nail supplemented with poller screws for proximal and distal 1/3rd shaft tibial fractures. Twenty cases were closed fractures and 10 were open (grade I or II according to Gustilo Anderson’s classification of compound tibia fracture). Patients were followed-up at 3 weeks, then 6 weekly till union. Patients were evaluated by KarlströmOlerud’s functional evaluation criteria.The data was statistically analysed using IBM Statistical Package for the Social Sciences (SPSS) software version 23.0. Results: The mean time of fracture union was 17.33±2.59 weeks with a maximum (n=19) patients in ≤15 weeks, followed by 15- 20 weeks (n=10) and only one patient had delayed union (&gt;20 weeks). According to Karlström-Olerud’s functional evaluation scale 18 (60%) patients had excellent outcome followed by good outcome in 8 (26.7%) patients, while 2 (6.7%) patients had satisfactory and 2 (6.7%) patients moderate outcomes. The total mean varus/valgus deformity preoperatively was 10.17±4.15° while postoperatively it was 1.63±2.3°. The total mean antecurvatum /recurvatum deformity preoperatively was 6.47±5.97° while postoperatively it was 0.20±0.61°. Postoperative complications were observed such as shortening of the leg (n=2), movement loss in the ankle (n=4), movement loss in the knees (n=3), muscle wasting (n=6) and subtalar movement loss (n=6). One patient had a superficial skin infection (oozing of purulent discharge from distal locking skin suture site), which was treated with prolonged antibiotics. Conclusion: Poller screws were found to be effective in achieving fracture alignment and hence, serve as a effective fracture reduction tool. Also helps to maintain the fracture aligned until it healed, preventing the loss of the initial reduction.

Evaluation of the results of anterior minimally invasive plate osteosynthesis in treating humeral shaft fractures

Background The advantages of minimally invasive plate osteosynthesis (MIPO) are less soft tissue dissection and less blood loss with excellent results. This study aims to assess the outcomes of MIPO in treating humeral shaft fractures. Patients and methods Anterior MIPO was performed on 30 patients from March 2017 to January 2019. The inclusion criteria for this prospective study included a fracture located at the middle third of the humeral shaft, a fracture with polytrauma, and fractures with early conservative treatment failure. Type A fracture was the most common according to the AO-OTA classification (13 cases), followed by type B (11 cases) and type C (six cases). The space between biceps and brachialis was identified, and a locking compression plate or limited contact dynamic compression plate was used. The minimum follow-up period was 1 year. The outcome measurements included fracture union, alignment, infection, range of motion, functional assessment as per the University of California at Los Angeles shoulder score, and elbow function as evaluated using the Mayo elbow performance index. Results The mean operation time was 90.30 min (range, 80–180 min), and mean radiation exposure was 204 s (range, 110—420 s). All fractures united. The mean fracture union time was 15.3 weeks (range, 10–18 weeks). There was no incidence of implant failures. The mean University of California at Los Angeles end-result score was 34 points (range, 32–35). The mean Mayo elbow performance index was 98 points (range, 90–100). The mean range of motion was 135° (range, 100–140°). The functional outcome was satisfactory. Conclusion MIPO is an excellent method for treating humeral shaft fractures. It might decrease the perioperative complications with a reduced operation time.

RETROGRADE INTRAMEDULLARY SUPRACONDYLAR NAILING AND DISTAL FEMORAL LOCKING COMPRESSION PLATE IN THE MANAGEMENT OF DISTAL FEMUR FRACTURES – A COMPARATIVE STUDY

Objectives: The objective of the study is to assess the efficacy of retrograde intramedullary interlocking supracondylar nailing and distal femoral locking compression plate in the management of distal femur fractures. Methods: The present prospective study consists of a total of 36 cases with extra-articular supracondylar fractures of the femur between the age group of 21–70 years. Participants were randomly allocated to group 1 treated with distal femoral locking compression plate fixation and group 2 treated with retrograde intramedullary interlocking supracondylar nailing technique. Post-operatively, all the cases were followed up in regular intervals to assess the functional outcome using the American Knee Society score. Results: Road traffic accidents (80.56%) were the most common cause of injury. The average surgical duration (108 min and 90.14 min), duration of fracture union (12.48 weeks and 11.08 weeks), and blood loss (339.8 ml and 236.6 ml) was better in the nailing group than the plating group, respectively. The overall outcome was comparable between the two study groups. Conclusion: The supracondylar nailing technique has better functional outcomes in terms of less fracture union time, less operative duration, and minimal operative blood loss. Supracondylar nailing technique was effective and better in soft tissue damage control.

Comparison of complications of early and delayed open reduction and internal fixation for treating pilon fracture: A protocol of systematic review and meta-analysis.

BackgroundTibial Pilon fractures are severe fractures accompanied by soft tissue injury. Although open reduction and internal fixation (ORIF) are effective in treating Pilon fractures, there is a controversy over time to surgery due to reported postoperative complications. However, there is no systematic review evaluating the difference of postoperative complications between early and delayed ORIF for treating pilon fractures.MethodsRelevant literature written in English will be searched through PubMed, Cochrane Library, Embase, MEDLINE, and Web of Science. The study aims to compare the effects and complications of early and delayed ORIF for treating fresh pilon fractures in adult patients. The primary outcome will be infection rate, fracture union time, nonunion and malunion rate. And the secondary outcome will be metalwork removal, amputation, and ankle function grade. Two reviewers will independently assess the eligibility of the studies according to the pre-defined inclusion and exclusion criteria. A meta-analysis for the available data will be conducted using Revman 5.3. To measure effect size, odds ratios (ORs) and mean difference will be used for dichotomous and continuous data, respectively. Statistical heterogeneity will be explored. And a random-effects model or a fixed-effects will be used in pooled data on the basis of the existence or absence of heterogeneity. Subgroup analysis will be conducted to identify sources of heterogeneity and sensitivity analysis to test the results’ robustness. We will assess the risk of bias by four different quality assessment tools according to the study design. Publication bias will be evaluated by funnel plot. The study data will be stored in the Open Science Framework website.PROSPERO registration number CRD42020207465

Comparative Study of the Management of Intertrochanteric Fracture Femur With Proximal Femoral Nail vs. the Dynamic Hipscrew With Derotation Screw in Elderly Population.

Background: Intertrochanteric fractures can be treated, both by conservative and operative methods depending upon the status of the patient. The purpose of this study was to assess the functional outcome of intertrochanteric fracture of femur treated with dynamic hip screw (DHS) with de-rotation screw comparing and proximal femoral nail (PFN).Methodology: We compared 30 (male: 23, female: seven) cases of intertrochanteric fractures with a mean age of the population was 65 years and male to female ratio in was 2.75:1. Patients were recruited in this study having inclusion criteria of adults above 50 years of age, isolated intertrochanteric fractures of the AO Foundation/Orthopaedic Trauma Association (AO/OTA) type A1 and A2, fracture less than two weeks, and intertrochanteric fracture with or without distal extension.Results: Post-operatively, patients treated by either of these two methods were statistically analyzed in terms of comparing advantages and disadvantages in terms of the time of fracture union and outcome of both above-mentioned procedures using Harris hip score.Conclusion: PFN gives better results than DHS with De-Rotation Screw-in intertrochanteric fractures in terms of the amount of blood loss during surgery, duration of surgery, early toe-touch weight-bearing, and Harris hip scores. There is no difference between the two modalities in terms of duration of hospitalization, fracture union, mortality and morbidity, and postoperative complications.

Comparative Analysis of Single Lateral Locked Plate and Double Locked Plate Application in the Treatment of Bicondylar Tibial Plateau Fractures.

Background and objectiveBicondylar tibial plateau fractures (BTPFs) have been controversial in terms of surgery planning, due to articular joint surface comminution, severe soft tissue injury, and the risk of complications. The aim of this study was to conduct a clinical, functional, and radiologic comparison of the dual locked plate (DLP) and single lateral locked plate (SLLP) techniques.MethodsRetrospectively analysed were 54 patients who underwent surgical treatment with DLP or SLLP due to the diagnosis of BTPFs, between January 2018 and June 2020. Patients were evaluated in the clinic with regard to their demographic characteristics, mechanisms of injury, follow-up periods, measurement of the range of motion degrees, functional scores, and radiographic parameters. The Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm Knee Score (Lysholm) and Oxford Knee Score (OKS) were chosen as the functional scores. The condylar width, medial proximal tibial angle (MPTA), posterior tibial slope (PTS) and fracture union time were calculated radiographically.ResultsThe patients in the DLP group achieved significantly higher scores for all three scales when the KOOS, Lysholm, and OKS, respectively (P = 0.008, P = 0.048, P = 0.006), were compared. Radiographically, the mean increase in the condylar width of 1.72 mm in the DLP group and 2.59 mm in the SLLP group was measured (P = 0.010, P = 0.010, respectively). The mean decrease in MPTA was 1.75° in the DLP group and 3.54° in the SLLP group, which was statistically significant (P = 0.005, P = 0.001, respectively). An increase in the posterior tibial slope was measured at a mean of 1.8° in the DLP group and 1.4° in the SLLP group (P = 0.001, P = 0.008, respectively). On the other hand, when the condylar width, MPTA and PTS between the DLP and SLLP groups were compared, no significant difference was found (P = 0.179, P = 0.247, P = 0.611, respectively).ConclusionBetter results were obtained in patients who underwent the DLP procedure when compared to those who had the SLLP. There was no radiographic difference between the two surgical procedures. Although DLP is an effective and reliable method in the treatment of BTPFs, the SLLP procedure also provides satisfactory results in patients with appropriate indications.

Reduction and fixation of proximal humeral fracture with severe medial instability using a small locking plate

BackgroundCurrently, the reduction and support of comminuted medial cortex of humeral fracture remains a challenge, Therefore, a novel reduction and fixation technique that employs an anteromedial small locking plate was explored in this study, and its viability and the associated complications were assessed.MethodsFifteen cases of proximal humeral fractures with medial instability (five cases were classified as three-part and ten as four-part by Neer classification) were treated by the proposed reduction technique using an anteromedial small locking plate. Subsequently, the radiological and clinical outcomes were evaluated over an average follow-up period of 18.53 months.ResultsThe average operation time was 108 min (range, 70–130 min), and the mean fracture union time in all patients was 12.13 weeks (range, 8–16 weeks). Complications such as infection and neurovascular injury were not observed. Postoperative X-ray showed avascular necrosis and screw penetration in one patient, while screw penetration, varus malunion, or significant reduction loss was not found in the other cases. The mean Constant score was 79.8 (range, 68–92) during the final visit.ConclusionsThe use of an anteromedial small locking plate improved the reduction efficiency, reconstructed the medial support, and alleviated the occurrence of complications in proximal humeral fractures with medial instability.

Comparison of vacuum sealing drainage and conventional drainage for postoperative drainage in closed calcaneal fracture: A randomized controlled trial

BackgroundThe objective of this study was to compare the outcomes of vacuum sealing drainage (VSD) and conventional drainage after surgery in the treatment of closed calcaneal fracture. We hypothesize that VSD is superior to conventional drainage in reducing volume of drainage, time of wound drying, time of skin fold, time of wound healing, VAS at day 3 postoperatively, wound complications and increasing wound healing grade. Methods120 patients with closed calcaneal fractures from January 2016 to December 2018 were enrolled in our study. They were divided randomly into VSD group (n = 60) and conventional (n = 60). The volume of drainage, duration of drainage, time of wound drying, time of skin fold, time of wound healing and VAS at day 3 postoperatively were recorded. Furthermore, the wound complications of the two groups were also evaluated. Besides, wound healing grade was used to assess the degree of wound healing. The functional outcome American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scores and visual analog scale (VAS) pain scores was also evaluated. ResultsA total of 10 patients were lost to follow-up for various reasons, VSD group remained 55 cases while conventional group remained 53 cases. Our results showed that VSD group exhibited significantly more volume of drainage (P< 0.0001), longer duration of drainage (P< 0.0001), shorter time of wound drying (P = 0.0086), shorter time of skin fold (P = 0.0158), shorter time of wound healing (P = 0.0240) and lower VAS at day 3 postoperatively (P = 0.0019) compared with conventional group. Moreover, VSD group was demonstrated to have significantly lower wound complications (P = 0.025) and higher rate grade A of wound healing (P = 0.031). However, no significant difference was noted in time of fracture union (P = 0.754), VAS (P = 0.407) and AOFAS score (P = 0.512) at final follow-up between the two groups. ConclusionsOur hypothesis was confirmed that VSD was superior in terms of some aspects than conventional drainage. Therefore, VSD is a safe and effective postoperative wound drainage method in the treatment of closed calcaneal fracture. However, more and higher evidence needs to be carried to demonstrate the results.

Anterior bridge plating with mini incision MIPO technique for type a humerus diaphyseal fractures

Introduction: Anterior bridge plating with minimally invasive technique for type A shaft humeral fractures is reported as an acceptable less traumatic and reproducible procedure by several authors. We have evaluated the clinical, radiological, and functional outcome of such fractures in twenty patients, all of which were managed with dynamic compression plate over an average follow- up period of 12 months. Though open reduction and plating technique of humerus shaft fracture is prevailing, this technique also gives favorable outcome.Materials and Methods: Twenty patients with type a humerus shaft fractures were managed by anterior bridge plating using MIPO technique between March 2017 to November 2019 were included in this series. All cases were treated with closed reduction and 10-12 whole 4.5mm dynamic compression plate fixation over anterior aspect in bridging mode using the MIPO technique. The dominant side, gender ratio, surgery time, and fracture union time, and complications were noted. The UCLA shoulder and Mayo elbow performance scores were used for assessing the shoulder and elbow function.Results: Of the Twenty patients in the study, ten were males and ten were females. The mean age was 34.3 years (range 18 to 85 years) twelve out of twenty patients (60%) had the dominant side fractured. Mean surgical time in minutes was 88.98 (range: 50 to 150 minutes). The mean fracture union (radiological) time was 14.3 weeks (range: 10–16 weeks) and clinical union time was 10.4 week. However Shoulder function was excellent in 20 cases (100%) on the UCLA score.Conclusion: This study confirmed a high overall rate of union and excellent functional outcomes. Mini incision anterior bridge technique for type A fracture shaft humerus gives good functional results and should be considered as an effective, cosmetically advanced surgical option in the treatment of type A humeral shaft fractures. It is a safe and less time consuming method for type a humeral shaft fractures when the surgeon is experienced in the technique.