Weight-bearing Time Research Articles

X-Ray Film under Artificial Intelligence Algorithm in the Evaluation for Nursing Effect of Gamma Nail Internal Fixation in Elderly Patients with Intertrochanteric Fracture of Femur.

The aim of this work was to explore the effects of Gamma nail internal fixation for intertrochanteric fracture of femur by X-ray film classification and recognition method based on artificial intelligence algorithm. The study subjects were 100 elderly patients with intertrochanteric fracture of femur admitted to hospital. The cases were diagnosed as elderly (over 60 years old) femoral intertrochanteric fractures by X-ray or CT. They were divided into two groups, with 50 persons in each group: one group used the X-ray film evaluation image guidance based on the artificial intelligence algorithm (research group), and the other group did not use algorithmic guidance (control group). The results showed that the segmentation effect of the proposed algorithm was similar to the gold standard segmentation result, indicating that the algorithm was effective and feasible in the segmentation of fractures and bones. The global level set algorithm was set as the control. The ultimate measurement accuracy (UMA) value of the algorithm group was (1.77 ± 0.22), and the UMA value of the global level set algorithm group was (3.42 ± 0.36), indicating that the image processed by the algorithm group had obvious numerical effect, high accuracy, and good retention of details. The operation time, intraoperative blood loss, incision length, hospital stay, weight-bearing time, and fracture healing time of the two groups were all better than those of the control group. One month after surgery, the Harris score of the algorithm group was 67, and that of the control group was 51, with a 16-point difference between the two groups (p < 0.05). The patient had less pain and fast recovery speed, indicating that it was a good way to treat elderly intertrochanteric fractures with the nursing effect of X-ray Gamma nail internal fixation based on an artificial intelligence algorithm. The artificial intelligence algorithm not only can be applied to the Gamma nail internal fixation of elderly patients with intertrochanteric fractures but also can be applied to the X-ray image processing of other fractures and other surgical methods to provide effective treatment for fracture patients.

Arthroplasty vs proximal femoral nails for unstable intertrochanteric femoral fractures in elderly patients: a systematic review and meta-analysis

BACKGROUNDProximal femoral nails (PFNs) are the most common method for the treatment of unstable intertrochanteric femoral fractures (IFFs), but postoperative bed rest is required. There is a large amount of blood loss during the operation. Osteoporosis in elderly patients may cause nonunion of fractures and other complications. Arthroplasty can give patients early weight bearing and reduce financial burden, but whether it can replace PFNs remains controversial.AIMTo compare the clinical outcomes of arthroplasty and PFNs in the treatment of unstable IFFs in elderly patients.METHODSA search was conducted in the PubMed, Embase, and Cochrane Library databases and included relevant articles comparing arthroplasty and PFN. The search time was limited from January 1, 2005 to November 1, 2020. Two investigators independently screened studies, extracted data and evaluated the quality according to the inclusion and exclusion criteria. According to the research results, the fixed effect model or random effect model were selected for analysis. The following outcomes were analyzed: Harris Hip score, mortality, complications, operation time, blood loos, hospital stay, weight-bearing time, fracture classification and type of anesthesia.RESULTSWe analyzed four randomized controlled trials that met the requirements. A total of 298 patients were included in these studies. According to the AO/OTA classification, there are 20 A1 types, 136 A2 types, 42 A3 types and 100 unrecorded types. Primary outcome: The Harris Hip Score at the final follow-up of the PFN group was higher [mean difference (MD): 9.01, 95% confidence interval (CI): 16.57 to 1.45), P = 0.02]. There was no significant difference between the two groups in the rate of overall mortality [risk ratio (RR): 1.44, P = 0.44] or the number of complications (RR: 0.77, P = 0.05). Secondary outcomes: blood loss of the arthroplasty group was higher (MD: 241.01, 95% CI: 43.06–438.96, P = 0.02); the operation time of the PFN group was shorter (MD: 23.12, 95%CI: 10.46–35.77, P = 0.0003); and the length of hospital stay of the arthroplasty group was shorter [MD: 0.97, 95% CI: 1.29 to 0.66), P < 0.00001]. There was no difference between the two groups in the type of anesthesia (RR: 0.99). There were only two studies recording the weight-bearing time, and the time of full weight bearing in the arthroplasty group was significantly earlier.CONCLUSIONCompared with PFN, arthroplasty can achieve weight bearing earlier and shorten hospital stay, but it cannot achieve a better clinical outcome. Arthroplasty cannot replace PFNs in the treatment of unstable IFFs in elderly individuals.

A STUDY ON OUTCOME OF MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS (MIPO) IN EXTRA ARTICULAR FRACTURE OF DISTAL 1/3RD TIBIA.

BACKGROUND: Fractures of the distal tibia can be challenging to treat because of the limited soft tissue, the subcutaneous location, and poor vascularity. There is a considerable debate regarding the best method for treating distal tibial fractures. In present study we have treated distal tibial fractures using MIPPO technique OBJECTIVES: To evaluate the functional outcome following use of MIPO technique in lower 1/3rd fractures of tibia. MATERIAL AND METHODS: This is a longitudinal follow up study. In this study a total of 30 patients with fracture distal 1/3rd tibia admitted to CMRI hospital will be selected for treatment with MIPO technique according to inclusion and exclusion criteria. All patients were reviewed in CMRI Hospital and radiographs (Tibia AP and lateral views) obtained after surgery and then at 1 month, 3 months and nally at 6 months. From 5 weeks onwards symptoms and functions will be assessed using the scoring system of Olerud and Molander(1984). Statistical analysis of categorical variables was expressed as number of patients and percentage of patients and continuous variables are expressed as descriptive statistics. The statistical software SPSS version 20 has been used for the analysis. RESULTS: The age of patients ranged from 22-65 years. Fracture was most common in 4th and 5th decade of life. Average mean age was 44.03±10.74yrs. In this study majority of 17(56.7%) patients were male and there were 13(43.3%) were female. Road Trafc accident (RTA) was the main cause to produce lower end tibia fractures (83.3%) in our study. In this study right side (60%) was involved more than left (40%). In this study only 3 (10%) patients had open grade 1 injury. Majority of patients 27 (90%) had closed injury. In our study 66.67% (20) of patients had associated injuries and 33.33% patients had no associated injury. Average injury operation interval in this study was 3.27±1.53 days. Average no. of plate holes were 10.50±1.72. Average duration of hospital stay in this study was 10.07±2.75 days. Average duration of surgery in this study was 88.03±16.36 minutes. In this study 26 patients (86.7%) had no early post-op complications and 4 (13.3%) had complications. 3 patients (10%) had delayed wound healing and 1patient (3.3%) had supercial infection of suture lines. There was 1 non-union and majority of patients 21(70%) took 20-25 weeks for union. 7(23.4%) patients took less than 20 weeks and 1(3.33%) patient took more than 25 weeks. Average time of union in this study was 21.17±2.17 weeks. Average time of weight bearing was 17.72±1.91 weeks in this study. Most frequent late complication seen was swelling with frequency of 7 followed by stiffness and pain. 1 patient had malunion and 1 patient had non-union. In this study there were 28(93.3%) patients which showed union, 1 (3.3%) patient showed coronal malunion and 1(3.3%) had non-union. There were 21 patients (70 %) with excellent result, 7 patients (23.3%) with good result and 2 patients (6.7%) with fair result in our cases of study. Average clinical Olerud &amp; Molander score was 81.17±16.07 in this study. CONCLUSION: The satisfactory functional results and lack of soft tissue complications suggest that this method should be considered in peri-articular fractures. Biological xation of complex fractures gives stable as well as optimal internal xation and complete recovery of limb function at an early stage with minimal risk of complications.

A study on clinical outcomes of complex subtrochanteric femoral fractures with cephalomedullary nail

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The aim of the study was to evaluate the clinical outcomes of complex subtrochanteric fractures treated by using cephalomedulary nail.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a prospective observational study of 30 cases of complex subtrochanteric femoral fractures admitted to our hospital from January 2018 to June 2019. Cases were taken according to the inclusion and exclusion criteria i.e. type IV, type V Seinsheimer’s classification, above 18 years and those who are willing to participate in the study has been included and pathological fractures, open fractures were excluded. All the patients are followed up on 2 post-operative day, after 4 weeks, 8 weeks, 12 weeks and 6months. X-ray hip with thigh anteroposterior (AP) and lateral view taken during each follow up. Out comes was assessed using modified Harris hip score.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study of 30 cases there are 22 males and 8 females and the mean age of 43.7 years. 73.3% patients are due to Road traffic accidents predominance of right side. In our study 66% had type 4 Seinsheimers and 34% cases had type 5 Seinsheimers fracture. The mean duration of hospital stay was 17 days. Mean time for full weight bearing is 12 weeks. Good to excellent results are seen in 80% of type 4 subtrochanteric fractures and 75% of cases of type 5 subtrochanteric fractures. 4 cases had surgical site infection, 3 cases had varus, 1 case had developed implant failure, and 1 case had reverse Z effect.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; From this study, we conclude that proximal femoral nail is an excellent implant in the treatment of complex subtrochanteric femoral fractures the terms of successful outcome include a good understanding of fracture biomechanics, good preoperative planning and accurate instrumentation.&lt;/p&gt;

Comparative study of femoral head replacement and internal fixation in the treatment of unstable intertrochanteric fractures in the elderly

To compare the clinical efficacy of femoral head replacement and internal fixation in the treatment of unstable intertrochanteric fractures in the elderly. Retrospective analysis of 70 cases of unstable intertrochanteric fractures treated from January 2016 to January 2019 and meeting the inclusion and exclusion criteria, 39 cases were fixed with closed reduction and new proximal femoral intramedullary nail(InterTAN), and 31 cases were treated with open trochanter reconstruction and artificial femoral head replacement. The operation time, intraoperative bleeding, hospital stay, weight bearing time, postoperative complication rate and hip function recovery (Harris score) were compared between two groups. All cases were followed up for 12 to 24 months. There were no significant differences in intraoperative bleeding and hospital stay between the two groups (P>0.05). The operation time in replacement group was longer than that in internal fixation group (P< 0.05). The postoperative weight-bearing time in replacement group was significantly earlier than that in internal fixation group (P<0.05). In the replacement group, there were 1 case of pulmonary infection, 1 case of deep venous thrombosis and 1 case of periprosthetic fracture;in the internal fixation group, there were 4 cases of pulmonary infection, 3 cases of internal fixation failure, 3 cases of cerebral infarction and 2 cases of urinary infection;there was significant difference between two groups (P< 0.05). The Harris score in replacement group was higher than that in internal fixation group one month after operation (P< 0.05), but there was no significant difference between two groups at 12 months after operation(P>0.05). InterTAN and femoral head replacement can treat unstable intertrochanteric fractures in the elderly, but femoral head replacement can move down early, improve the quality of life at the end of life, reduce postoperative complications and facilitate the treatment of coexisting diseases in internal medicine.

Comparison of femoral neck system and inverted triangle cannulated screws fixations in treatment of Pauwels typle Ⅲ femoral neck fractures

To compare the effectiveness of the femoral neck system (FNS) and inverted triangle cannulated screws (ITCS) for the treatment of Pauwels type Ⅲ femoral neck fractures. The clinical data of 59 patients with Pauwels type Ⅲ femoral neck fractures treated between May 2019 and November 2020 were retrospectively analysed. The patients were divided into FNS group (28 cases) and ITCS group (31 cases) according to the different internal fixation. There was no significant difference in gender, age, affected side, body mass index, cause of injury, smoking history, alcohol abuse history, Pauwels angle, Garden classification, AO/Orthopaedic Trauma Association (AO/OTA) classification, and time from injury to operation between the two groups ( P>0.05). The operation time, incision length, intraoperative blood loss, extra assisted reduction procedures (Kirschner wire prying reduction or open reduction), hospitalization stay, and early complications were recorded and compared between the two groups. Garden index and Haidukewych score were used to evaluate fracture reduction. Fracture healing time, lateral thigh irritation, time of partial or total weight-bearing postoperatively, shortening length and degree of femoral neck, change of caput-collum-diaphysis (CCD) angle (the difference of CCD angle between immediate after operation and last follow-up), incidence of osteonecrosis of femoral head and revision surgery were recorded and compared between the two groups. Hip joint function were evaluated by Harris score. The operation time of FNS group was significantly shorter than ITCS group, and the incision length was significantly longer than ITCS group ( P<0.05). There was no significant difference in intraoperative blood loss, assisted reduction, Garden index, Haidukewych score, and hospitalization stay between the two groups ( P>0.05). All the incisions healed by first intention. There were 2 deep vein thrombosis in the FNS group and 1 pulmonary infection and 1 deep vein thrombosis in the ITCS group. No significant difference was found in the incidence of early postoperative complications (7.1% vs. 6.5%) between the two groups ( P=1.000). Patients in both groups were followed up 3-14 months, and there was no significant difference in follow-up time between the two groups ( t=-0.553, P=0.582). The fracture healing time, Harris score, and the partial weight-bearing time after operation of the FNS group were significantly better than those of the ITCS group ( P<0.05). However, there was no significant difference in total weight-bearing time between the two groups ( Z=-1.298, P=0.194). No lateral thigh irritation was found in the FNS group, while 10 patients in the ITCS group had lateral thigh irritation, and the incidence between the two groups (0 vs. 32.3%) was significant ( P=0.001). At last follow-up, the shortening length and degree of femoral neck and the change of CCD angle in FNS group were significantly less than those in ITCS group ( P<0.05). There was no patient with osteonecrosis of femoral head or reoperation in the FNS group, while 4 patients in the ITCS group underwent reoperation (including 2 cases of osteonecrosis of the femoral head). However, the incidences (0 vs. 6.5%; 0 vs.12.9%) between the two groups were not significant ( P=0.493; P=0.114). Using FNS to treat Pauwels type Ⅲ femoral neck fracture is simple as well as able to reduce the shortening of the femoral neck and the change of the CCD angle. Also, FNS is conducive to the recovery of hip joint function, which should be considered as a new choice for the treatment of young femoral neck fracture patients.

Quel est le meilleur fixateur externe pour la fixation des fractures de la diaphyse tibiale par arme à feu ?

IntroductionThe present study aimed to evaluate the functional and radiological outcomes of AO type monolateral external fixator (AO-EF) and Ilizarov type external fixator (I-EF) in definitive fixation of tibial shaft fractures due to gunshot injury. HypothesisPatients undergoing I-EF would have faster fracture healing with the help of early weight-bearing and the functional scores would be better compared to AO-EF. Material and methodsThe study consisted of 76 (67M, 9F) patients who underwent surgery between 2010 and 2016 for tibial shaft fracture due to low-velocity gunshot injury (LVGI). The patients were divided into two groups according to the fixation method (AO-EF and I-EF) which was discussed by the surgeon team due to their experience. The average age at the time of injury was 37.8±9.8 (20 to 59 years). Groups are compared according to LEFS score, coronal-sagittal-rotational angle, Johner-Rush score, and complications such as nonunion, malunion, osteomyelitis, and pin-tract infection. The mean follow-up time 31.61±3.83 months (between 24 and 44 months). ResultsNo statistical difference was found between groups in terms of demographic characteristics. There was no statistical difference between groups regarding body mass index (BMI). LEFS score and operation duration were higher in the I-EF group (p=0.000 and p=0.006 respectively, p˂0.05). In the I-EF group, hospitalization period, full weight-bearing time, and healing time was shorter than the AO-EF group (p=0.001, p=0.000, and p=0.025 respectively, p˂0.05). DiscussionAlthough AO-EF has advantages such as ease of application and short surgery time in the definitive fixation of LVGI tibia shaft fractures, I-EF is a superior technique in terms of functional scores. However, I-EF is a surgical approach that requires relatively more experience. Therefore, the choice of fixator should be determined according to the surgeon's experience in the permanent treatment of LVGI tibial shaft fractures.Level of Evidence: IV; retrospective, case-control study.

Effectiveness of proximal femoral nail anti-rotation and cerclage fixation for complicated femoral subtrochanteric fractures

To investigate the effectiveness of proximal femoral nail anti-rotation (PFNA) and cerclage fixation for complicated femoral subtrochanteric fractures. A clinical data of 74 patients with complicated femoral subtrochanteric fractures, who were admitted between March 2016 and March 2019 and met the criteria, was retrospectively analyzed. Among them, 39 patients were treated with limited open reduction and PFNA combined with cerclage fixation (observation group) and 35 patients were treated with closed reduction and PFNA fixation (control group). There was no significant difference in gender, age, cause of injury, side and type of fracture, and the time from injury to operation ( P>0.05). The ratio of postoperative hemoglobin (1, 3, and 5 days) to the preoperative hemoglobin, the operation time, the first weight-bearing time after operation, and the hospital stay were recorded. X-ray films were taken to observe fracture healing in the two groups and bone resorption around the cerclage in the observation group, and the fracture healing time was recorded. Hip function was evaluated by Harris scoring. The operation time of the observation group was significantly longer than that of the control group ( P<0.05), but the first weight-bearing time and hospital stay were significantly shorter ( P<0.05). All patients were followed up 12 months. There was no significant difference in the ratios of post- to pre-operative hemoglobin (1, 3, and 5 days) between the two groups ( P>0.05). X-ray film reexamination showed that the fractures of the two groups healed smoothly, and the fracture healing time of the observation group was significantly shorter than that of the control group ( t=-12.989, P=0.000). No bone resorption around the cerclage occurred in the observation group. The Harris scores of the observation group were better than those of the control group at 7 days and 1, 2, and 3 months after operation ( P<0.05), and there was no significant difference between the two groups at 6 months after operation ( t=1.329, P=0.180). Compared with PFNA fixation, PFNA combined with cerclage fixation for the complicated femoral subtrochanteric fractures has a shorter operation time, and can obtain immediate stability after fixation, which can meet the needs of patients for early functional exercise.

Outcome of proximal femoral nail antirotation in peritrochanteric fractures: A prospective study

Background: The incidence of peritrochanteric fractures are increasing worldwide. Early mobilization in these fractures prevents from other medical complications. There are many methods of treatment but the ideal method should be less invasive procedure, intramedullary device and stable fixation of fracture. Proximal femoral nail antirotation (PFNA) is biomechanically considered one of the most effective methods of treatment with promising results.&#x0D; Aims and Objectives: The aim of our study was to evaluate the clinical and radiological outcomes in patient who were treated with PFNA in peritrochanteric fracture.&#x0D; Materials and Methods: This study was a prospective study which included 37 patients, conducted in Manipal Teaching Hospital from 1st October 2019 to 30th September 2020. All the patients were clinically evaluated and detail history was obtained. After the anaesthesia clearance the patients were operated. Operating time, intraoperative blood loss and complications were noted. Postoperatively the duration of hospital stay, time of partial and full weight bearing, time for radiological union and complications were noted. At the final follow up Harris Hip Score was used for functional outcome.&#x0D; Results: The mean age of the patient in this study was 64 years (45-88 years). The average time to complete the surgery was 62.49 minutes (45-75 minutes) and the average blood loss was 129.32 ml (65-210 ml). Partial weight bearing was started at the mean time of 8.57 weeks (6-12 weeks) whereas full weight bearing was done at the mean of 14.43 weeks (10-20 weeks). Fracture union was seen at the average of 11.41 weeks (8-18 weeks). The mean Harris Hip score at final follow up was 84.73 (65.8-95.0) with the functional status of 35.1% excellent result, 45.9% good, 13.5% fair and 5.4% poor.&#x0D; Conclusion: Proximal femoral nail antirotation in peritrochanteric fracture is a good method of fixation. The procedure is easy with reduced operative time and radiation exposure. Since this is minimally invasive procedure the blood loss is very less compared to DHS or plate fixation. The patient could be mobilized early from the bed that reduced the complication of immobilization. So we strongly recommend using PFNA for fixation of peritrochanteric fracture of hip.

Analysis of clinical effects of iliolumbar fixation in treating U-shaped sacral fractures

To evaluate the efficacy of iliolumbar fixation in the treatment of U-shaped sacral fractures. A retrospective study was conducted on the 14 complex U-shaped sacral fractures which had been treated from January 2014 to December 2019, involved 10 males and 4 females, aged 24 to 48 (35.4±6.5) years. Fracture healing time, nerve function, clinical function and complications were observed in the patients. All patients were followed up for 9 to 16(26.0±5.9) months. The complete weight-bearing time for bone healing was(12.4±2.0) weeks. One case of surgical incision infection occurred after operation, and one case of sacrum nailspenetrated to the outer plate of sacrum. No complications such as pressure ulcers, loosening or rupture of internal fixation occurred. According to Gibbons scoring, the neurological function recovered from preoperative 2.9±0.9 to postoperative 2.1±1.1, there were statistically significant differences between preoperative and postoperative (t=6.9, P=0.00). There was significant difference between preoperative malformation angle (41.4±11.2)° and postoperative value (28.3±7.5)° (t=4.70, P=0.00). According to Majeed scoring to evaluate the clinical function, postoperative pain, standing, sitting, sexual life, work ability, total score respectively were 23.21±3.17, 25.57± 3.94, 7.71±1.54, 2.64±0.92, 16.14±2.41, 75.30±8.10, 2 cases got excellent results, 10 good, 2 fair. Sacral lumbar fixation is an effective method for the treatment of U-shaped sacrum fractures. It has the advantages of strong internal fixation and satisfactory functional recovery.

The Clinical Efficacy of Suture-Button Fixation and Trans-Syndesmotic Screw Fixation in the Treatment of Ankle Fracture Combined With Distal Tibiofibular Syndesmosis Injury: A Retrospective Study

Twenty percent of ankle fractures present with concomitant syndesmosis injury which results in poor clinical outcomes. Surgical stabilization of the syndesmosis can be achieved with either trans-syndesmotic screws or a suture button device. The aim of this study is to investigate the clinical efficacy of suture button fixation and trans-syndesmotic screw fixation in the treatment of ankle fracture combined with distal tibiofibular syndesmosis injury. A retrospective analysis was conducted by enrolling 76 patients with ankle fractures combined with distal tibiofibular syndesmosisinjury who were admitted in our trauma center from January 2018 to January 2019, including 34 cases of suture button group and 42 cases of the syndesmotic screw group with a mean follow-up period of 16 ± 7 (range 12-21) months. The demographic data included gender, age, injury mechanism, AO classification and the operation duration were recorded, the radiographic and clinical outcomes were determined by tibiofibular clear space, tibiofibular overlap distance, complications, and the Olerud-Molander Ankle Score at the last follow-up. All the indexes were compared between the 2 groups to discover the related statistical differences. With the numbers available, no significant difference could be detected in the surgical duration, tibiofibular clear space, tibiofibular overlap distance, total complication rate, and middle-term Olerud-Molander Ankle scores between the 2 groups. However, the suture button fixation group showed higher early stage Olerud-Molander Ankle scores (p=.027) and shorter full weightbearing time (p=.018) than that of syndesmotic screw fixation group. Considering the outcomes, we conclude that the suture button fixation not only shows equivalent efficacy to the traditional syndesmotic screw, but also has advantages of allowing early weightbearing, low requirements for routine removal.

Elastic Stable Intramedullary Nailing Femoral Shaft Fractures in Children from Six to Ten Years Age

Background: Diaphyseal fractures of the femur (DFF) are common long-bone injuries in children and adolescents. DFF represent 1.5% of fractures in childhood. Objective: This study aimed to evaluate the clinical, functional and radiological outcome of femoral shaft fractures, which are managed by elastic stable intramedullary nailing (ESIN) in pediatric age 6-10 years. Patients and Methods: A prospective clinical randomized trial study was conducted on18 children underwent elastic stable intramedullary nailing (ESIN) for treating femoral shaft fractures at Orthopedic department, Zagazig University Hospitals during the period from April to December 2020. Plain X- rays of the femur Antero-posterior (AP) & Lateral (Lat.) views (from hip to the knee joint) was taken. Results: The time to surgery was 1.39 ± 1.12 days ranging from 1 to 6 days, the time till full union was 9.4 ± 1.76 weeks ranging from 7 to 12 weeks, more than half of the studied group (55.5%) ranged from 7 to 9 weeks and the time of full weight bearing was 9.6 ± 1.7 weeks ranging from 7 to 12 weeks, half of the studied group (50.0%) ranged from 7 to 9 weeks. So, the final outcome was 83.3% had excellent functional outcome, 11.1% of them had satisfactory functional outcome and 5.6% had poor functional outcome. 88.8% didn’t have any complications, 5.6% of them had irritation and 5.6% had superficial infection. Conclusion: ESIN is the choice treatment for transverse and short oblique shaft fractures in patients aging from 6 to 10 years old.

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

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

Pathoanatomy and clinical outcomes following operative treatment of supination adduction type II medial malleolus fractures-a cohort study.

The purpose of the current study was to retrospectively clarify the anatomic character and evaluate the mid-term operative outcomes for vertical medial malleolar fractures (MMFs). A total of 53 patients with supination adduction (SAD) type II MMFs treated with open reduction and internal fixation (ORIF) between March 2009 and June 2013 were included. We reviewed the patients' preoperative X-ray and computed tomography (CT) to determine the pathoanatomic characteristics of medial malleolus fractures. Buttress plate lag screws fixation had been applied. Complications and treatment failures were recorded; the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analogue scale (VAS) were used to evaluate the functional outcomes. For the 53 patients, only 39.6% cases with simple vertical MMFs. The mean distal tibial articular surface (DTAS) involvement in the MMF was 16.5%±11.6% (range, 0-47%). The mean follow up time was 62.4±14.1 [44-91] months. There were 7 cases of traumatic osteoarthritis (TOA), and 3 cases of failure were reported in the screw fixation group. The mean AOFAS score was 80.6±15.8 points, and the mean VAS score was 2.1±1.7 points, with a good to excellent rate (GTE) of 81.1%. No significant difference was found in comparing the AOFAS, VAS, GTE, incision relative complication rate, infection rate, loss of reduction (LoR) rate, and TOA rate between groups (P>0.05). The participants in the buttress plate group reached a shorter mean full weight-bearing (FWB) time (P=0.04). More than 60% vertical MMFs are with one or more characteristics of medial cortex comminuted fractures, or die-punch fragments, or medial joint compression. And patients with die-punch fragment, medial joint compression, LoR, large DTAS involvement and small fracture line angle (FLA) were positively correlated with the fair to poor results. Lag screw fixation should be cautiously used in vertical MMF patients with comminuted medial cortex.

Comparison of the results of expert tibial nailing with results of distal tibial plating in patients with distal 1/3rd extraarticular tibial fractures

Background: The tibia constitutes one of two bones of the leg. Recently, minimally invasive percutaneous medial locked plating has been described in the literature with promising results. Expert Tibial Nail currently represents an effective approach to the treatment of complex extraarticular distal tibial fractures. Hence; the present study was undertaken for comparing the results of Expert Tibial nailing with results of Distal Tibial Plating in patients with Distal 1/3rd extraarticular Tibial Fractures. Materials & Methods: The study was conducted on 40 patients with extraarticular distal 1/3rd tibia fractures. All the patients were divided into two study groups randomly with 20 patients in each group as follows: Expert Tibial Nailing group, & Distal Tibial Plating group. All the patients underwent procedures according to their respective study groups. During the postoperative phase, static quadriceps exercises & toe movements, as tolerated were started from 1st postoperative day. Full weight-bearing was allowed after 10 to 12 weeks, depending on the radiographic signs of fracture healing. Patients were followed up for 6 months after operation and evaluated as per Johner and Wruss Criteria. Results: The mean age of the patients of the expert tibial nailing group and distal tibial plating group was 48.12 years and 49.71 years respectively.Mean operative time among the patients of the expert tibial nailing group was 83.15 minutes and was significantly lower in comparison to the patients of the distal tibial plating group (101.2 minutes). Mean intraoperative blood loss was compared between expert tibial nailing and distal tibial plating. Torniquet was used in all the cases. Mean intraoperative blood loss among the patients of the expert tibial nailing group was 51.6 ml and was significantly lower in comparison to the patients of the distal tibial plating group (89.1 ml). Mean postoperative weight-bearing time among the patients of expert tibial nailing was 8.95 weeks and was significantly lower in comparison to the patients of the distal tibial plating (14.35 weeks). Mean fracture union time among the patients of the expert tibial nailing group was 18.6 weeks and was significantly lower in comparison to the patients of the distal tibial plating group (25.84 weeks). Excellent results were obtained in 80 percent of the patients of the expert tibial nailing group and 55 percent of the patients of the distal tibial plating group respectively. Conclusion: The results of present study with expert tibial interlocking nailing are encouraging and demonstrate the benefits of new nailing system. Changes in the design of the nail for improved proximal and distal locking enable it to use in proximal and distal metaphyseal fractures of tibia.

Comparison of the effectiveness of the posterior malleolus fixed or not on treatment of different Haraguchi's classification of posterior malleolus fractures

To investigate the effectiveness of fixation the posterior malleolus or not to treat different Haraguchi's classification of posterior malleolus fractures. The clinical data of 86 trimalleolar fracture patients who were admitted between January 2015 and September 2019 and met the selection criteria were retrospectively reviewed. There were 29 males and 57 females; the age ranged from 26 to 82 years with a mean age of 55.2 years. According to Haraguchi's classification, 38 patients were in type Ⅰ group, 30 patients in type Ⅱ group, and 18 patients in type Ⅲ group. There was no significant difference in the general data such as gender, age, and fracture location among the 3 groups ( P>0.05). The fixation of the posterior malleolus was performed in 23, 21, and 5 patients in type Ⅰ, Ⅱ, and Ⅲ groups, respectively. The operation time, fracture healing time, full weight-bearing time, postoperative joint flatness, and joint degeneration degree of the patients in each group were recorded and compared. The American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot score was used to evaluate ankle function, including pain, quality of daily life, joint range of motion, and joint stability. The AOFAS scores were compared between fixation and non-fixation groups in each group. The procedure was successfully completed by all patients in each group, and there was no significant difference in operation time ( F=3.677, P=0.159). All patients were followed up 12-36 months with a mean time of 16.8 months. At last follow-up, 6 patients were found to have suboptimal ankle planarity, including 2 patients (5.3%) in the type Ⅰ group and 4 patients (13.3%) in the type Ⅱ group, with no significant difference between groups ( χ 2=6.566, P=0.161). The ankle joints of all the patients in each group showed mild degeneration; the fractures all healed well and no delayed union or nonunion occurred. There was no significant difference in the fracture healing time and full weight-bearing time between groups ( P>0.05). No complications such as incision infection, fracture displacement, or plate screw loosening and fracture occurred during follow-up. At last follow-up, the total scores and pain scores of the AOFAS scores in the type Ⅱ group were significantly lower than those in the type Ⅰand Ⅲ groups ( P<0.05), there was no significant difference between groups in the scores for the quality of daily life, joint range of motion, and joint stability between groups ( P>0.05). There was no significant difference in any of the scores between the unfixed and fixed groups, except for the pain and quality of daily life scores, which were significantly lower ( P<0.05) in the unfixed group of type Ⅱ group than the fixed group. Haraguchi type Ⅱ posterior malleolus fractures have a worse prognosis than types Ⅰ and Ⅲ fractures, especially in terms of postoperative pain, which can be significantly improved by fixing the posterior malleolus; the presence or absence of posterior malleolus fixation in types Ⅰ and Ⅲ has less influence on prognosis.

Locking plate external fixation combined with membrane induction technology for the treatment of open and comminuted tibial fractures with bone defects

To explore clinical effect of locking plate external fixation combined with membrane induction technology in treating open and comminuted tibial fractures with bone defects. Totally 92 patients of open and comminuted tibial fractures with bone defects were chosen form January 2018 to July 2019, and randomly divided into external fixation group and internal fixation group, 46 patients in each group. In external fixation group, there were 29 males and 17 females, aged from 25 to 62 years old, with an average of (37.45±10.92) years old;according to AO classification, 15 patients were type A, 22 patients were type B and 9 patients were type C;according to Gustilo classification, 21 patients were typeⅡ, 10 patients were type ⅢA, 10 patients were type ⅢB, 5 patients were type Ⅲ C;treated by fracture reduction with locking plate external fixation. In internal fixation group, there were 31 males and 15 females, aged from 23 to 60 years old, with an average of(36.88±10.64) years old;according to AO classification, 18 patients were type A, 20 patients were type B and 8 patients were type C; according to Gustilo classification, 22 patients were typeⅡ, 11 patients were type ⅢA, 7 patients were type ⅢB, 6 patients were type Ⅲ C;treated by traditional open reduction with plate internal fixation. Operation time, intraoperative blood loss, incision length, hospital stay, fracture healing time and lower limb full weight-bearing time and postoperative complications between two groups were observed and compared, bone mineral density, osteocalcin, blood calcium and phosphorus before operation and 1 month after operation. All patients were followed up from 12 to 18 months with an average of (14.92±2.46) months. Operation time, intraoperative blood loss, incision length, hospital stay, fracture healing time and lower limb full weight-bearing time of external fixation group were significantly better than that of internal fixation group(P<0.05). Postoperative bone mineral density, osteocalcin, blood calcium and phosphorus at 1 month in external group were higher than that of internal fixation group (P<0.05). Four patients in external fixation group occurred complications, 13 patients in internal fixtaion group, and occurrence rate of complications in external fixation group (8.70%) was lower than that of internal fixtaion group (28.26%)(χ2=4.618, P=0.032). Locking plate external fixation combined with membrane induction technology in treating open and comminuted tibial fractures with severe post-traumatic bone defects has advantages of less trauma, reliable fixation, shorter fracture healing time, and could improve bone metabolic activity with less postoperative complications.

Clinical study of calcium phosphate cement loaded with recombinant human bone morphogenetic protein 2 combined with calcium phosphate cement loaded with antibiotic for chronic osteomyelitis with bone defect

To compare the effectiveness of calcium phosphate cement (CPC) loaded with recombinant human bone morphogenetic protein 2 (rhBMP-2) combined with CPC loaded with antibiotic versus CPC loaded with antibiotic alone in one stage for chronic osteomyelitis with bone defect. A single-blind prospective randomized controlled clinical trial was conducted. Between April 2018 and April 2019, 80 patients of chronic osteomyelitis with bone defect in accordance with the random number table were randomly divided into two groups, 40 in the trial group (CPC loaded with rhBMP-2 combined with CPC loaded with antibiotic) and 40 in the control group (CPC loaded with antibiotic). There was no significant difference in gender, age, disease duration, lesion, and preoperative white blood cells (WBC) count, platelet count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) between the two groups ( P>0.05). All patients were implanted the corresponding CPC and external fixator after lesion clearance in the two groups. The postoperative WBC count, platelet count, ESR, CRP, hospital stay, cure rate of osteomyelitis, repaired bone defect volume, the time of external fixator removal, and the time of full weight-bearing of the affected limb were compared between the two groups. All patients were followed up 12-24 months, with an average of 18.4 months. There was no significant difference in WBC count, platelet count, ESR, and CRP between the two groups at 4 weeks after operation ( P>0.05). There were significant differences in WBC count, platelet count, and CRP in the two groups between 1 week before operation and 4 weeks after operation ( P<0.05). And the ESR showed no significant difference between pre- and post-operation in the two groups ( P>0.05). In the trial group, the anaphylactic exudate occurred in 1 patient with tibial osteomyelitis and the incision healed after oral administration of loratadine. The incisions of other patients healed by first intention in the two groups. One case of distal tibial osteomyelitis recurred in each group, and 1 case of humeral osteomyelitis recurred in the control group. The cure rates of osteomyelitis were 97.5% (39/40) in the trial group and 95% (38/40) in the control group, showing no significant difference between the two groups ( χ 2 =0.000, P=1.000). There was no significant difference in the repaired bone defect volume and hospital stay between the two groups ( P>0.05). X-ray film and CT showed that the bone defects were repaired in the two groups. The time of external fixator removal and the time of full weight-bearing of the affected limb were significantly shorter in the trial group than in the control group ( P<0.05). Application of CPC loaded with rhBMP-2 and antibiotic in one stage is effective for the chronic osteomyelitis with bone defect, which can accelerate the bone regeneration in situ to repair bone defect, reduce the trauma, shorten the course of treatment, and obtain good function of the affected limb.

Comparison of intramedullary nailing fixation and percutaneous locked plating fixation for the treatment of proximal tibial fractures: A meta-analysis.

This meta-analysis aimed to systematically compare the clinical outcomes of intramedullary nailing (IMN) fixation and percutaneous locked plating (PLP) fixation in the treatment of proximal tibial fractures. We searched PubMed, Embase, Cochrane library, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), and Wan Fang to select relevant articles up to March 29, 2020 without language limit. Continuous variables were estimated by weighted mean difference (WMD) with a 95% confidence interval (CI) and dichotomous outcomes were calculated by relative risk (RR) with 95% CI. Moreover, heterogeneity analysis was evaluated. Furthermore, publication bias assessment and sensitivity analysis were conducted. Stata 11.0 software was used to perform the statistical analysis. Ten studies involving 667 cases (321 from IMN fixation group and 346 from PLP fixation group) were included. The type of fractures involved in the included articles was extra-articular proximal tibia fractures. IMN fixation method achieved significantly shorter union time (WMD = -2.88, 95% CI: -3.23 to -2.53, p < 0.001) and full weight-bearing time (WMD = -2.81, 95% CI: -3.64 to -1.97, p < 0.001) than PLP fixation method. Meanwhile, IMN fixation resulted in lower risks of infection (RR = 0.50, 95% CI: 0.27 to 0.91, p = 0.02) and total complications (RR = 0.36, 95% CI: 0.22 to 0.60, p < 0.001) than PLP fixation. No significant differences were found in the incidence of nonunion (p = 0.33), malunion (p = 0.38), and osteofascial compartment syndrome (OCS, p = 0.62) between the two groups. Compared to PLP fixation, IMN fixation had several advantages in treating proximal tibial fractures, including the short time of union and full weight-bearing, as well as a low risk of infection and total complications.

Which external fixation method is better for the treatment of tibial shaft fractures due to gunshot injury?

IntroductionThe present study aimed to evaluate the functional and radiological outcomes of AO type monolateral external fixator (AO-EF) and Ilizarov type external fixator (I-EF) in definitive fixation of tibial shaft fractures due to gunshot injury. HypothesisPatients undergoing I-EF would have faster fracture healing with the help of early weight-bearing and the functional scores would be better compared to AO-EF. Material and methodsThe study consisted of 76 (67M, 9F) patients who underwent surgery between 2010 and 2016 for tibial shaft fracture due to low-velocity gunshot injury (LVGI). The patients were divided into two groups according to the fixation method (AO-EF and I-EF) which was discussed by the surgeon team due to their experience. The average age at the time of injury was 37.8±9.8 (20 to 59 years). Groups are compared according to LEFS score, coronal-sagittal-rotational angle, Johner-Rush score, and complications such as nonunion, malunion, osteomyelitis, and pin-tract infection. The mean follow-up time 31.61±3.83 months (between 24 and 44 months). ResultsNo statistical difference was found between groups in terms of demographic characteristics. There was no statistical difference between groups regarding body mass index (BMI). LEFS score and operation duration were higher in the I-EF group (p=0.000 and p=0.006 respectively, p˂0.05). In the I-EF group, hospitalization period, full weight-bearing time, and healing time was shorter than the AO-EF group (p=0.001, p=0.000, and p=0.025 respectively, p˂0.05). DiscussionAlthough AO-EF has advantages such as ease of application and short surgery time in the definitive fixation of LVGI tibia shaft fractures, I-EF is a superior technique in terms of functional scores. However, I-EF is a surgical approach that requires relatively more experience. Therefore, the choice of fixator should be determined according to the surgeon's experience in the permanent treatment of LVGI tibial shaft fractures. Level of evidenceIV; retrospective, case-control study.