Weight-bearing Time Research Articles

Retrospective study of results of closed tibial diaphyseal fractures treated by closed interlocking nail by subjective and objective parameters

Background: Intramedullary nailing of tibia fulfills the objective of stable fixation with minimal tissue damage resulting in early fracture union. However, it is accompanied by its own set of complications. Materials and Methods: Study area: Burdwan Medical College and Hospital. Study population: Patients attending emergency room and outpatient department 18 years with closed tibial diaphyseal fractures. Sample size: Fifty patients. Study Design: This study was an institution-based retrospective, observational study. Parameters to be Studied: (1) Subjective parameters: (A) resumption of activities of daily living, (B) pain-free movement and walking, and (C) squatting and sitting cross-legged. (2) Objective parameters: (A) clinical (i) weight-bearing time (partial/complete), (ii) clinical union time, (iii) range of motion of knee and ankle, (iv) limb length discrepancy, (v) neurovascular damage, (vi) infection, and (vii) need for second surgery: (a) dynamization, (b) exchange nailing, (c) bone grafting, and (d) ORIF with plate and bone grafting. (B) radiological: (i) radiological union, (ii) varus/valgus, (iii) procurvatum/recurvatum, (iv) rotational malalignment, and (v) implant failure. Results: Final outcome was measured using Johner and Wruhs' Criteria with modification, and excellent result was achieved in 48% patients, good in 34% patients, fair in 12% patients and poor in 6% patients. Conclusion: Closed interlocking nail for closed tibial diaphyseal fractures of tibia is not a “full-proof” technique. Advantages over conservative methods and it's complications, both should be explained, and an informed consent taken before “interlocking” a closed tibial diaphyseal fracture.

FUNCTIONAL OUTCOME AND ASSOCIATED COMPLICATIONS OF INTERTROCHANTERIC FRACTURE TREATED WITH TROCHANTERIC FEMORAL NAIL: A PROSPECTIVE OBSERVATIONAL STUDY

Introduction: As age increases, fall becomes more often so as intertrochanteric fracture of femur. Because of early mobilization, The Trochanteric Femoral Nail (TFN) is found effective and suitable in Indian population as it is smaller in size than Proximal Femoral Nail (PFN). AIM: To clinically evaluate the functional outcome and associated complications of intertrochanteric fracture treated with trochanteric femoral nail. Methodology: Study was done in 30 patients with intertrochanteric fractures treated with trochanteric femoral nail. Patients were followed up at 6 wks, 3months, and 6 months. The intraoperative blood loss, duration of surgery, intra operative complications, post-operative complication, duration of hospital stay were studied. Functional outcome was assessed based on Kyle criteria. Results: In our series of 30 cases there were 22 male and 8 female, maximum age of 90 yrs and minimum age of 20 yrs, most of the patients were between 60 to 70 yrs. Mean age of 58 yrs. 63.3% of cases were admitted due to Domestic fall and 36.7% due to road traffic accidents with common predominance of both sides.AO Type 31A2 fracture accounted for 40 % of cases. Mean duration of hospital stay is 14 days and mean time of full weight bearing is 6 wks. Good to excellent results are seen in 81% cases, Fair in 16%, 3% case with poor results according to kyle's criteria. Conclusion: Trochanteric femoral nail can be considered the most judicious and rational method of treating intertrochanteric fractures, especially the unstable and reverse oblique type.

Extended use of limb reconstruction system in management of compound tibia diaphyseal fracture as primary and definitive tool

<p class="abstract"><strong>Background:</strong> The fractures of the tibia are among the most difficult fractures to treat effectively. The status of the soft tissues, the degree of comminution and level of contamination sustained at the time of injury affect the long term clinical results. The goal of operative treatment is to obtain anatomic realignment of the shaft of tibia while providing enough stability to allow early motion. This should be accomplished using techniques that minimize osseous and soft tissue devascularization in the hopes of decreasing the complications result­ing from treatment.</p><p class="abstract"><strong>Methods:</strong> A prospective randomized study was conducted between 2014-2016 on 20 patients admitted with compound tibia diaphyseal fracture and treated with Limb reconstruction surgery.<strong></strong></p><p class="abstract"><strong>Results:</strong> In our study, the mean time of partial weight bearing was 3.5±2.97 weeks, full weight bearing was 8.55± 4.14 weeks and bone union time was 20.22±5.22 weeks. The pin tract infection was found in 5 (25%) cases. Delayed union was observed 06 (30%) cases. Shortening of more than 2 cm were recorded in 3 (15%) patients. Joint (knee or ankle) stiffness was observed in 6 (30%) cases. Loosening of pin was observed in 3 (15%) cases. Chronic osteomyelitis was observed in 3 (15%) cases. Secondary procedures were done in 11 (55%) cases. Bone marrow aspiration was done in 5 (25%) cases, iliac bone grafting in 5 (25%) cases.</p><p><strong>Conclusions:</strong> LRS is found to be wonderful tool in management of compound tibia fractures as primary and definitive mode because of its safety, versatile nature, patient friendly and cost effectiveness.</p>

Meta-analysis of the efficacy and safety of PFNA and InterTAN for the treatment of intertrochanteric fractures

To system evaluate the clinical effect and safety of PFNA and InterTAN internal fixation methods for femoral intertrochanteric fracture. According to the Cochrane systemic analysis method, randomized controlled trials and quasi-randomized controlled trials which were about the comparison of PFNA and InterTAN for intertrochanteric fracture were collected from Cochrane Library(2017, issue 4), PubMed (January, 2003-May, 2017), Wanfang Med Online (January, 2003-May, 2017) and China Academic Journals Full-text Database(January, 2003-May, 2017) by computer searching. Cross-checking was done after assessing the quality of the included trials and extracting the data by two reviewers independently. Data analysis were performed with RevMan 5.3. Two randomized controlled trials and five quasi-randomized controlled trials involving 611 cases met the inclusion criteria. The meta-analyses showed no significant differences between the two methods on Harris scores[MD=-1.00, 95%CI(-2.29, 0.28), P=0.13], union time[MD=0.04, 95%CI (-0.70, 0.77), P=0.92], full weight-bearing time[MD=1.06, 95%CI(-0.29, 2.42), P=0.13], hospital stay[MD=-0.04, 95%CI (-0.52, 0.45), P=0.89] and length of incision[MD=-1.00, 95%CI (-2.64, 0.65), P=0.23]. There were significant differences between the two methods on operative time[MD=-25.75, 95%CI (-37.47, -14.03), P<0.000 1], intraoperative blood loss[MD=-55.67, 95%CI(-108.07, -3.27), P=0.04] and the internal fixation complication rate[MD=4.17, 95%CI (1.33, 13.08), P=0.01]. Both PFNA and InterTAN could provide good effect for intertrochanteric fracture. The operation time of PFNA is shorter than that of InterTAN, and there is less blood loss during operation. PFNA may be the first choice for the treatment of patients who have many complications and can't endure long-time operation. The complications of PFNA are more than those of InterTAN. In patients with long life expectancy and high requirements, InterTAN may be preferentially selected to reduce complications. According to the patient's situation, after a comprehensive consideration, appropriate treatment can be selected.

Internal fixation for tibial plateau fractures involving anteromedial margin caused by hyperextension varus injury

Objective To report the operative procedures and clinical outcomes of open reduction and internal fixation for the treatment of tibial plateau fractures involving anteromedial margin caused by hyperextension varus injury. Methods From December 2013 to December 2015, 11 patients with tibial plateau fracture involving anteromedial margin caused by hyperextension varus injury were treated at our department. They were 6 males and 5 females with a mean age of 42.3 years (range, from 19 to 65 years). Simple medial column fracture happened in 2, fractures of medial and lateral columns in 4, fractures of medial and posterior columns in 3, and 3-column fractures in 2 cases. The cortical bone fractures of anteromedial margin were fixated by open reduction and internal fixation using self-clipped joint line plating. Bone grafting was conducted if necessary. Results The 9 patients were followed up for an average of 17.6 months (range, from 12 to 30 months). All the fractures healed. The average time for radiographic bony union and full weight bearing was 11.4 weeks (range, from 9 to 14 weeks) and 16.1 weeks (range, from 14 to 19 weeks), respectively. On average, the Rasmussen’s radiological grading scored 16.9 (range, from 14 to 18) immediately after operation; the Hospital for Special Surgery scores of all the patients at 12 months postoperatively averaged 89.1 (range, from 75 to 94), yielding an excellent to good rate of 92.3%. The average range of motion of the affected knee was from 2.3° to 125.1°. There were significant differences in both tibial plateau angle and posterior slope angle on radiography between preoperation and postoperation (P 0.05). Partial incision necrosis occurred postoperatively in one case which was uneventfully healed after wound management. One case complicated with preoperative common peroneal nerve injury reported dorsal sense of numbness which was healed after administration of neurotrophic drugs. No screw loosening, plate breakage or fixation failure was found during follow-ups. Conclusions It is difficult to treat the tibial plateau fractures involving anteromedial margin caused by hyperextension varus injury. Internal fixation with joint line plating is an appropriate treatment for this fracture pattern, leading to satisfactory clinical outcomes. Key words: Tibial fractures; Fracture fixation, internal; Bone plates; Hyperextension; Varus

Functional and radiological outcome of intertrochanteric fracture in patients treated with dynamic hip screw and proximal femoral nail

Background: The aim of the study was to assess the functional and radiological outcome of intertrochanteric fracture in elderly patients treated with dynamic hip screw or proximal femoral nail. Materials and Methods: The study was conducted in Government Stanley hospital, from May 2014 to December 2015. A total of 98 cases of intertrochanteric fractures in age group of 55 to 65 years admitted were included in our study. Patients with pathological fracture was excluded. The 98 patients were divided into stable and unstable groups using Evans classification. DHS was done for 56 of them and PFN for another 42 of them and results were evaluated. The mean duration of surgery, mean blood loss and mean length of incision, intraoperative complications, time of weight bearing were evaluated. The Harris hip score was used to evaluate the hip joint function. Results: Most of the patients in our age group were between 55 to 65 years around 80%. The mean duration of surgery, mean blood loss and mean length of incision was more in DHS group then PFN group. We came across more intraoperative complications in PFN group then DHS group. Time of weight bearing was more in unstable fracture in DHS group. The Harris hip score was in favour of PFN at six weeks after surgery but it became same in both groups after 20 weeks of surgery. Conclusion: PFN has advantage of smaller incision, less blood loss and less morbidity. The short lever arm and lower bending moment in PFN may add mechanical advantage to the construct which makes it the implant of choice in osteoporotic bones. Deformity and complications was less in PFN group in our study. Rate of fracture union was similar in both groups with early mobilization in PFN group, DHS found to be the implant of choice for stable fracture but for unstable fracture PFN is the better choice.

External fixation combined with delayed internal fixation in treatment of tibial plateau fractures with dislocation.

The aim of this study was to evaluate the clinical efficacy of external fixation, delayed open reduction, and internal fixation in treating tibial plateau fracture with dislocation.Clinical data of 34 patients diagnosed with tibial plateau fracture complicated with dislocation between January 2009 and May 2015 were retrospectively analyzed. Fifteen patients in group A underwent early calcaneus traction combined with open reduction and internal fixation and 19 in group B received early external fixation combined with delayed open reduction and internal fixation. Operation time, postoperative complication, bone healing time, knee joint range of motion, initial weight-bearing time, Rasmussen tibial plateau score, and knee function score (HSS) were statistically compared between 2 groups.The mean follow-up time was 18.6 months (range: 5–24 months). The mean operation time in group A was 96 minutes, significantly longer than 71 minutes in group B (P < .05). In group A, 5 cases had postoperative complications and 1 in group B (P < .05). The mean bone healing time in group A was 6.9 months (range: 5–9 months) and 6.0 months (range: 5–8 months) in group B (P > .05). In group A, initial weight-bearing time in group A was (14.0 ± 3.6) weeks, significantly differing from (12.9 ± 2.8) weeks in group B (P < 0.05). In group A, the mean knee joint range of motion was 122° (range: 95°–150°) and 135° (range: 100°–160°) in group B (P > 0.05). Rasmussen tibial plateau score in group A was slightly lower than that in group B (P > .05). The excellent rate of knee joint function in group A was 80% and 84.21% in group B (P > .05).External fixation combined with delayed open reduction and internal fixation is a safer and more efficacious therapy of tibial plateau fracture complicated with dislocation compared with early calcaneus traction and open reduction and internal fixation.

Analysis of risk factors for femoral head necrosis after internal fixation of femoral neck fractures with dynamic hip screw and anti-rotation screw

Objective To explore the influence factors for femoral head necrosis after treatment of femoral neck fractures with dynamic hip screw (DHS) and anti-rotation screw. Methods A retrospective case series analysis was made on the clinical data of 106 cases of femoral neck fractures who had undergone fixation with DHS and anti-rotation screw between May 2010 and May 2015. There were 59 males and 47 females, with an average age of 57.0 years (range, 27-76 years). By Garden classification, there were 27 cases of type Ⅱ, 51 cases of type Ⅲ and 28 cases of type Ⅳ. All cases were divided into femoral head necrosis group (18 cases) and none-necrosis group (88 cases) according to the radiographs of the fractured hip at the follow-up. Univariate analyses and a multivariate logistic regression analysis were made to test whether the following factors were significantly associated with femoral neck necrosis: sex, age, Garden classification, Pauwels classification, Singh index, injury-to-surgery time interval, reduction methods, reduction quality, complete weight-bearing time, implant removal and the time cost of implant removal surgery. Results All the 106 patients obtained a mean follow-up of 49 months (range, 26-76 months). Femoral head necrosis occurred in 18 cases (17.0%). In univariate analyses, Garden classification, reduction quality, implant removal and long time of the implant removal surgery were significantly associated with femoral head necrosis(P<0.01). In multivariate logistic regression analysis, high level of Garden classification(95%CI 0.008, 0.998, P<0.05), implant removal and long time of the implant removal surgery(95%CI 0.000, 0.143, P<0.01) were found to have a significant effect on femoral head necrosis development. Conclusions Fracture displacement, removal of internal fixation and broadening the screw canal, which cand hinder the blood supply of femoral head, will enhance the rate of femoral head necrosis. As a result, it needs prudent consideration to remove internal fixation after internal fixation with DHS combined with anti-rotation screw for femoral neck fractures. When it is difficult to remove the anti-rotation screw, it is better to give up, rather than to force a removal. Key words: Femoral neck necrosis; Femoral neck fractures; Fracture fixation, internal; Bone nails

Comparison of the effect of proximal femoral nail anti-rotation and dynamic hip screw internal fixation in the treatment of intertrochanteric fracture

Objective To compare the clinical effect of proximal femoral nail anti-rotation(PFNA) and dynamic hip screw(DHS) internal fixation in the treatment of femoral intertrochanteric fracture. Methods 80 patients with femoral intertrochanteric fracture were selected as research subjects.They were divided into PFNA group and DHS group by random number table, 40 cases in each group.The operation time, intraoperative blood loss, postoperative wound drainage, postoperative weight-bearing time, healing time, complication rate, Harris hip function score between two groups were compared. Results The operation time of the PFNA group was lower than that of DHS group(t=22.66, P<0.05), the amount of bleeding in operation was less than that in the DHS group(t=54.85, P<0.05), the postoperative wound drainage volume was less than that of the DHS group(t=16.85, P<0.05), the weight-bearing time after operation was shorter than that in the DHS group(t=20.18, P<0.05), and the healing time was shorter than that in the DHS group(t=22.00, P<0.05). The excellence rate of Harris hip function score in the PFNA group was 95.00%, which was significantly higher than 80.00% in the DHS group, the difference was statistically significant(χ2=4.11, P<0.05). The incidence rate of complication of the PFNA group was 7.50%, which was significantly lower than 25.00% of the DHS group(χ2=4.50, P<0.05). Conclusion Compared with DHS, PFNA internal fixation has the advantages of less operation time, less intraoperative blood loss, shorter healing time and low complication rate in the treatment of femoral intertrochanteric fracture.It is worthy to be promoted clinically. Key words: Femoral fractures; Fracture fixation, internal; Fracture fixation, intramedullary; Bone wires

Effect of axial stress stimulation on tibial and fibular open fractures healing after Taylor space stent fixation

To investigate the effect of axial stress stimulation on tibial and fibular open fractures healing after Taylor space stent fixation. The data of 45 cases with tibial and fibular open fractures treated by Taylor space stent fixation who meet the selection criteria between January 2015 and June 2016 were retrospectively analysed. The patients were divided into trial group (23 cases) and control group (22 cases) according to whether the axial stress stimulation was performed after operation. There was no significant difference in gender, age, affected side, cause of injury, type of fracture, and interval time from injury to operation between 2 groups ( P>0.05). The axial stress stimulation was performed in trial group after operation. The axial load sharing ratio was tested, and when the value was less than 10%, the external fixator was removed. The fracture healing time, full weight-bearing time, and external fixator removal time were recorded and compared. After 6 months of external fixator removal, the function of the limb was assessed by Johner-Wruhs criteria for evaluation of final effectiveness of treatment of tibial shaft fractures. There were 2 and 3 cases of needle foreign body reaction in trial group and control group, respectively, and healed after symptomatic anti allergic treatment. All the patients were followed up 8-12 months with an average of 10 months. All the fractures reached clinical healing, no complication such as delayed union, nonunion, or osteomyelitis occurred. The fracture healing time, full weight-bearing time, and external fixator removal time in trial group were significantly shorter than those in control group ( P<0.05). After 6 months of external fixator removal, the function of the limb was excellent in 13 cases, good in 6 cases, fair in 3 cases, and poor in 1 case in trial group, with an excellent and good rate of 82.6%; and was excellent in 5 cases, good in 10 cases, fair in 4 cases, and poor in 3 cases in control group, with an excellent and good rate of 68.2%, showing significant difference between 2 groups ( Z=-2.146, P=0.032). The axial stress stimulation of Taylor space stent fixation can promote the healing of tibial and fibular open fractures and promote local bone formation at fracture site.

Clinical outcome of dynamic hip locking plates and proximal femoral nails anti-rotation-Asia for treating intertrochanteric femur fracture with lateral wall fractures in the elder patients.

PurposeTo compare the clinical results of DHLP (Dynamic hip locking plates) and PFNA-IIs (proximal femoral nails anti-rotation-Asia) for treating intertrochanteric femur fracture (IFF) with lateral wall fractures in the elder patients and provide a rationale for the clinical practice.MethodsA retrospective analysis of 43 patients of IFF with lateral wall fractures was performed from December 2009 to April 2015. Intraoperative variables and postoperative complications and function were compared between the two groups.Results17 cases were treated by DHLPs, and 26 treated by PFNA-IIs. Patients were followed up from 6 to 16 months with an average of 11 months. Both the groups were comparable for demographic data before surgery. The PFNA-II group had less operation time, time of full weight bearing and healing time of fracture, but larger blood loss in comparison with the DHLP group (p<0.05). Additionally, internal fixation failure was significantly more in the DHLP group than in the PFNA-II group. The mean HHS and the rate of good-to-excellent in the PFNA-II group was significantly higher than that in the DHLP group both in third month after surgery (p<0.05).ConclusionsPFNA-IIs treatment should be recommended for the elderly patients of IFF with lateral wall fractures, because of its shorter operation time, faster full weight bearing, faster function recovery, and lower failure rate. However, more attention should be payed to its larger blood loss.

Comparative study of static versus dynamic intramedullary nailing of tibia

Materials & Methods: This was a retrospective case–control study of closed or type I open tibial diaphyseal fractures (types A and B according to the AO classification) treated with dynamic nailing (30 cases) or static nailing (30 cases). The type of intramedullary nail, the surgical technique and the postoperative protocol were similar for both groups, with the exception of the locking mode and the time of weight bearing. Time to union, mechanical and biological complications, and the number and type of re-operations needed until union were recorded and analysed. Conclusions: Dynamic nailing assembly in intramedullary nailing in closed or type I open tibial diaphyseal fractures with limited comminution (types A and B according to the AO classification) is safe when used for these fracture types.

Study of unstable intertrochanteric fractures treated by cemented bipolar hemiarthroplasty in elderly patients

1.1 Aims and Objectives: To study the functional outcome of unstable intertrochanteric fracture treated with bipolar cemented prosthesis and complications associated with it. Also to facilitate early mobilization, early weight bearing with rapid rehabilitation in elderly patient with unstable intertrochanteric fractures 1.2 Material and methods: Prospective study of 20 cases presenting with unstable intertrochanteric fractures which satisfy inclusion and exclusion criteria admitted in Vijayanagar Institute of Medical Sciences, Ballari from year 2013- 2016 who are treated with Cemented Bipolar Prosthesis. 1.3 Results: In our study of 20 cases, there were 9 male and 11 female patients with mean age of 77.3 years. 75% of the cases admitted were due to trivial trauma, 25% due to RTA with left side being more common side affected. Boyd & Griffin’s Type II fractures accounted for 75% of cases. Mean duration of hospital stay was 12.6 days and mean time of full weight bearing was 3.9 days in our patients. 1 patient died on Postoperative day 5. 25% excellent, 30% good, 30% fair results obtained in our study according to Harris Hip Score. 1.4 Conclusion: Our study concludes that Cemented Bipolar Hemiarthroplasty in elderly patient with unstable intertrochanteric fracture reduces complications of prolonged immobilization, prolonged rehabilitation which are associated with internal fixation. Also reduces need for secondary surgery which required in cases of malunited fractures, non-union and implant failure. The procedure offered rapid mobilization, rapid return to pre injury level and improved quality of life.

Efficacy comparison of different methods to treat femoral intertrochanteric fracture in aged patients

To compare the efficacy of proximal femoral nail anti-rotation (PFNA), locking compression plate (LCP), and artificial femoral head replacement for femoral intertrochanteric fracture in aged patients so as to provide reference for clinical treatment. A retrospective analysis was made on the clinical data of 150 aged patients with femoral intertrochanteric fracture treated between September 2009 and March 2016. PFNA was used in 51 cases (group A), LCP in 53 cases (group B), and artificial femoral head replacement in 46 cases (group C). There was no significant difference in sex, age, side, cause of injury, injury to operation time, type of fracture, and combined medical diseases between groups ( P>0.05). The incision length, operation time, intraoperative blood loss, time for full weight bearing, hip Harris score, and complications were recorded and compared between groups. The patients were followed up 12-23 months (mean, 18.6 months) in group A, 12-25 months (mean, 19.0 months) in group B, and 12-24 months (mean, 18.9 months) in group C. The incision length, operation time, and intraoperative blood loss of group A were significantly less than those of groups B and C ( P<0.05); the operation time of group C was significantly shorter than that of group B ( P<0.05), but there was no significant difference in incision length and intraoperative blood loss ( P>0.05). The time for full weight bearing was significantly shorter in group C than groups A and B, and in group A than group B ( P<0.05). Postoperative complications occurred in 11 patients of group A (21.6%), 14 patients of group B (26.4%), and 2 patients of group C (4.3%), showing significant difference between group C and group A or group B ( P<0.05), but no significant difference was found between groups A and B ( P>0.05). Hip Harris score at 12 months after operation had no significant difference between groups ( P>0.05). PFNA, LCP, and artificial femoral head replacement are all effective methods to treat femoral intertrochanteric fracture in aged patients. PFNA has the advantages of small incision, short operation time, less bleeding and simple procedure, and artificial femoral head replacement has the advantages of early time for full weight bearing, less bed rest time, and less complications. For these patients, PFNA and artificial femoral head replacement are appropriate.

To Study the Functional Outcome of Primary Cemented Bipolar Hemiarthroplasty in the Management of Unstable Inter-Trochanteric Fracture of Femur among Elderly

Aims and Objectives: To evaluate the results with regard to function, to restoring proper limb length after surgery and to study the associated complications in intertrochanteric fractures treated by cemented bipolar hemiarthroplasty in elderly. Methodology: This is a prospective study of 25 cases of Intertrochanteric fractures admitted to a tertiary care center between August 2013 and November 2015 treated with Cemented Bipolar Hemiarthroplasty for intertrochanteric fractures. Cases were taken according to inclusion and exclusion criteria. Results: In our study of 25 cases, there were 14 male and 11 female patients with mean age of 72.8 years. 80% of the cases admitted were due to trivial trauma, 20% due to RTA with left side being more common side affected. According to OTA classification Type 31A2.2 fractures accounted for 60% of cases &amp;amp; Type 31A2.3 accounted for 40 %.. Mean duration of hospital stay was 13.2 days and mean time of full weight bearing was 4.7days in our patients. Excellent was seen in 24% cases Fair to Good results were seen in 72% of cases in our study according to Harris Hip Score. Conclusion: From our study we conclude that Cemented Bipolar Hemiarthroplasty for intertrochanteric fractures in elderly reduced the complications of prolonged immobilisation, prolonged rehabilitation, marked residual deformities and need for revision surgeries. The procedure offered, faster mobilization, rapid return to pre injury level, improved the quality of life.

Risk factors related to failure of internal fixation for intertrochanteric fracture in Chinese patients: a meta analysis and review

Objective To evaluate the risk factors related to the failure of internal fixation for intertrochanteric fracture in Chinese patients. Methods A comprehensive Meta analysis of the clinical research from January 2005 to August 2016 on the failure of internal fixation for intertrochanteric fracture in Chinese patients was conducted after Pubmed, CNKI, Wanfang Data, et al., had been searched. Revman5.0 was used to perform the heterogeneity test and calculate the OR value and 95%CI after quality assessment and retrieval of the qualified data. Results Included for this analysis were 23 studies involving 4,031 pa-tients of whom 588 failed. The factors related to the failure of internal fixation for intertrochanteric fracture included patient age [OR=0.51, 95%CI (0.30, 0.90), P 0.05], injury cause [OR=1.68, 95%CI (0.66, 4.25), P >0.05] or type of internal fixation [OR=0.37, 95%CI (0.06, 2.14), P >0.05]. Conclusions High age, concomitant osteoporosis, complicated fracture pattern, unsatisfactory fracture reduc-tion, TAD≥25 mm, time for full weight bearing < 6 weeks, and concomitant internal diseases may be the risk factors closely related to the failure of internal fixation for intertrochanteric fracture in Chinese patients. There has been no sufficient evidence to show that gender, injury cause or type of internal fixation may be associated with the failed internal fixation for intertrochanteric fracture. Key words: Hip fractures; Fracture fixation, internal; Treatment failure; Meta-analysis

Comparative study on screw or buttress plate for fixation of supination-adduction type-II medial malleolar fracture

To investigate the functional outcomes of buttress plate fixation and simple screws fixation for the treatment of supination-adduction type-II medial malleolar fractures so as to provide reference for selection of internal fixation. Between March 2009 and December 2012, 53 patients with supination-adduction type-II medial malleolar fractures were treated with open reduction and internal fixation. Of them, buttress plate fixation was used in 30 cases (buttress plate fixation group), and screws fixation was used in 23 cases (screw fixation group). There was no significant difference in age, gender, injury cause, injury side, disease duration, and combined injuries between 2 groups ( P>0.05). Complications and full weight-bearing time were recorded; the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analogue scale (VAS) were used to evaluate the functional outcomes. Post-operative anteroposterior and lateral X-ray films were taken to evaluate fracture reduction and union condition. And the treatment failures were recorded. There was no significant difference in incision related complication rate and infection rate between 2 groups ( P>0.05). The patients were followed up 46-91 months (mean, 64.5 months) in buttress plate fixation group and 44-86 months (mean, 59.5 months) in screw fixation group. The full weight-bearing time of the buttress plate fixation group was significantly shorter than that of screw fixation group ( t=2.05, P=0.04). During follow-up time, malunion and nonunion occurred in 2 cases and 1 case of screw fixation group; anatomic reduction and bony union were observed in the other patients of 2 groups. The union time showed no significant difference between 2 groups ( t=1.06, P=0.30). No significant difference was found in AOFAS score and good and excellent rate, VAS score, operation failure rate, and traumatic osteoarthritis rate between groups ( P>0.05). For patients with supination-adduction type-II medial malleolar fracture, the angle between fracture line and tibial axial line is too small to be fixed firmly with simple screws fixation, with a relatively higher failure rate. And buttress plate fixation can reach rigid fixation, and has better functional outcomes.

Anew continuous gait analysis system for ankle fracture aftercare

Correct aftercare following lower extremity fractures remains acontroversial issue. Reliable, clinically applicable weight-bearing recommendations have not yet been defined. The aim of the current study was to establish anew gait analysis insole during physical therapy aftercare of ankle fractures to test patients' continuous, long-term compliance to partial weight-bearing restrictions and investigate whether patients can estimate their weight-bearing compliance. The postoperative gait of 14patients after operative treatment of WeberB-type ankle fractures was monitored continuously for six weeks (OpenGO, Moticon GmbH, Munich). All patients were instructed and trained by physical therapists on how to maintain partial weight-bearing for this time. Discontinuous (three, six and twelve weeks) clinical (patient questionnaire, visual analogue pain score [VAS]) and radiographic controls were performed. Despite the set weight-bearing limits, individual ranges for overall weight-bearing (range 5-107% of the contralateral side) and patient activity (range 0-366 min/day) could be shown. Agood correlation between weight-bearing and pain was seen (rs= -0.68; p= <0.0001). Patients significantly underestimated their weight-bearing time over the set limit (2.3± 1.4 min/day vs. real: 12.6± 5.9 min/day; p< 0.01). Standardized aftercare protocols and repeated training alone cannot ensure compliance to postoperative partial weight-bearing. Patients unconsciously increased weight-bearing based on their pain level. This study shows that new, individual and possibly technology-assisted weight-bearing regimes are needed. The introduced measuring device is feasible to monitor and steer patient weight-bearing during future studies.

Study on the correlative factors of the pain under the second metatarsal in patients with hallux valgus

To analyze the correlation between the hallux valgus angle and arch X-ray parameters change, plantar pressure by measuring the X-ray indexes and foot-pressure indexes in patients with hallux valgus, as well as to study the main cause factors for the pain under the second metatarsal head. A retrospective study of 254 patients(477 feet) treated in Wangjing Hospital from January 2012 to June 2013 was performed. The pain under the second metatarsal head and age distribution were recorded. All the patients were divided into two groups according to the second plantar bone pain: pain group and no pain group. The following indexes were measured and compared: HAVA(hallux abductor valgus angle), IMA1-2(the inter-metatarsal angle between the first and second metatarsals), IMA1-5(the inter-metatarsal angle between the first and fifth metatarsals), TAOTMLA (top angle of the medial longitudinal arch), AAOTMLA (anterior angle of the medial longitudinal arch), SMRL (the second metatarsal relative length than the first), and the plantar pressure indicators including TPUM (touch the ground time percentage under the second metatarsal head), PPUM (peak pressure under the second metatarsal head), and IUM(impulse under the second metatarsal head). All the factors were evaluated by Logistic regression analysis. Spearman rank correlation test showed that there were statistical significance in correlation between HAVA and IMA1-2, IMA1-5, TAOTMLA, AAOTMLA, TPUM(P<0.05, r=0.647, 0.553, 0.127, -0.165, 0.158). Factors including the HAVA, SMRL and the TPUM were the risks for the pain under the second metatarsal head in patients with hallux valgus(P<0.05, ORj=1.030, 1.069, 1.060). Increase of the hallux valgus angle causes the collapse of hallux valgus arch, extending the weight bearing time of the second metatarsal and increasing the possibility of the pain under the second metatarsal.

LOCKING INTRAMEDULLARY NAIL VERSUS PLATE AND SCREWS FOR FIXATION IN TIBIAL DIAPHYSEAL FRACTURE

Diaphyseal tibial fracture is the most common fractured long bone because of it is subcutaneous position anteromedially and thinner diaphysis distally. Tibial diaphysis has poor blood supply and poor soft tissue envelope around it so it is more susceptible to infection, delay union, and non-union. For these reasons many modalities including cast and brace, external fixation, plate and screws, and locking intramedullary nail were used for treating diaphyseal tibial fracture. The aim of this study is to compare the outcome of locking intramedullary nail(LIMN) fixation versus plate and screws fixation in treating diaphyseal tibial fracture in term of operation time, early weight bearing, time to union, and complications. The study was carried out in Sulaimaniyah Teaching Hospital, Department of Orthopedics prospectively from May 2010 to July 2014 on 74 patients, 40 of them underwent surgical fixation by locking intramedullary nail (26 close method and 14 by open method), and 34 of them underwent open reduction and internal fixation by plate and screws. The outcome was assessed by clinical and radiological evaluation. The results show that young male are more affected by trauma, and the main mechanism of injury was Road Traffic Accident. Operation time was shorter among plate and screws group with a mean of 51.4±4.9 minutes, than locking intramedullary nail group with a mean of 88.5±12.5 minutes. Weight bearing(WB) time achieved earlier in the locking intramedullary nail group with a mean of 2.6±0.8 weeks than the plate and screws group with a mean of 4.2±1.4 weeks. There were no significant difference between the two groups regarding time to full weight bearing(FWB), time to union, and complications. In conclusion, Locking intramedullary nail and plate fixation are ideal option for treatment of diaphyseal tibial fractures since there were no significant differences between them in time of union and the post-operative complications.