Treatment Of Such Fractures Research Articles

Posterior-anterior versus anterior-posterior screws for posterior malleolar fractures: A meta-analysis.

The incidence of posterior malleolus fractures in ankle fractures ranges from 7% to 44%. Studies have indicated a poorer prognosis for ankle joint function when a posterior malleolar fracture is present, underscoring the significance of active intervention for optimal postoperative ankle function recovery. Hence, the selection of treatment for such fractures holds particular importance. Screw fixation is a key treatment for posterior malleolus fractures (PMFs) or Haraguchi Type 1 fractures involving less than 25% of the distal tibia's articular surface. However, the optimal screw placement direction - anteroposterior (AP) or posterior-anterior (PA) - remains debated. This meta-analysis aims to compare these two approaches for treating posterior ankle fractures, focusing on the efficacy of PA fixation. We searched the Cochrane Library, EMBASE, PubMed, SinoMed, and Web of Science databases from their inception to October 20, 2022. Methodological quality was assessed using the Cochrane Collaboration's tool for assessing bias risk in randomized controlled trials (RCTs). Stata MP17 software was used to compare the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, full weight-bearing time, and fracture healing time at the last follow-up between the two fixation methods. A total of 403 patients with posterior malleolar fractures from six RCTs met the inclusion criteria. The meta-analysis revealed a higher AOFAS score at the last follow-up for PA placement compared to AP placement [SMD = 0.512, 95% CI (0.244 to 0.780), z= 3.74, P< 0.001]. Postoperative full weight-bearing time and fracture healing time did not show statistically significant differences between the two groups. PA fixation demonstrated a superior AOFAS score compared to AP fixation for posterior malleolar fractures. PA screw placement offers advantages in restoring ankle joint stability and enhancing joint function recovery post-surgery.

Factors Associated With Adverse Radiographic Outcomes Following Operative Management of Ankle Fractures: A Single-Center Study.

Introduction Ankle fractures arecommonly encountered fractures in emergency departments worldwide. These fractures often have significant articular involvement that requires anatomic surgical reduction and stabilization. Radiographs can be used in everyday practice to evaluate ankle fractures utilizing various parameters to assess reduction quality intraoperatively and postoperatively. Several factors have been found to influence the reduction quality of fractures across body regions.This retrospective study aimed to evaluate the influence of several factors on the reduction quality of ankle fractures in a tertiary care center in the Kingdom of Bahrain. Materials and methods A total of 462 records were identified during the search, and 68 records were excluded. A total of 394 ankle fractures met the inclusion criteria for the study. Five orthopedic surgeons then evaluated the operative films in accordance with the Delphi consensus parameters for evaluating ankle fractures, and the reductions were graded as good, adequate, or poor. Results The study included 394 ankle fractures that met the inclusion criteria, and four significant associations were notedto affect the quality of reduction. Ankle fractures with posterior malleolus involvement (PMI) were significantly associated (p = 0.001) with fragments smaller than 15% and larger than 20% having decreased outcomes. The number of daysfrom admission to operation was also significant (p = 0.009), with the best reductions observed between zero and one day from admission. Operating surgeon was also a significant factor (p = 0.038), with inferior reductions noted in specialist surgeons compared to trainees. The last significant association was the number of malleoli (p = 0.001), with an inferior reduction with a larger number of malleoli involved. Conclusion Ankle fractures are a common and significant orthopedic injury. Reduction quality is important for optimal outcomes after surgical stabilization. Various factors including the number of malleoli, the grade of the operating surgeon, and the time of surgery were significantly related to the quality reduction in this single-center study. Expedited surgical management of fractures that are amenable to early fixation, careful assessment, and meticulous technique in fixation offractures with multiple fractured malleoli is indicated to reduce the chance of malreduction particularly in complex injuries.Further assessment of factors related to reduction quality with large-scale prospective studies would provide orthopedicsurgeons with insights into the identification and optimal treatment of such fractures.

Factors associated with postoperative quality of life in patients with intertrochanteric fracture

Introduction: Intertrochanteric fractures, which make up the majority of hip fractures, are a common and serious injury that can greatly impact quality of life. Treatment of such fractures comprises nearly half of the costs contributed to hip fractures. Identifying the factors affecting the functional outcomes of patients after intertrochanteric fracture can help to reduce burden of disease for the patient and healthcare system. The present study investigated the factors underlying the worsening of short form-36 score (SF-36) scores for intertrochanteric fracture patients. Materials and methods: This retrospective cohort study was designed based on data from our clinic. All consecutive patients with intertrochanteric fractures from November 2016 to September 2020 were reviewed. The exclusion criteria included patients having a second injury or having had previous surgery related to the hip and those with incomplete data. Baseline characteristics of patients were extracted from annotated records. The lab data were acquired from the electronic hospital system. The outcomes were SF-36 scores obtained by phone contact with patients or their families. Statistical analysis was conducted in SPSS. Results: A total of 310 patients were included in the current study. The female gender, advanced age, history of diabetes, thyroid malfunction, cancer, osteoporosis, anticoagulant use and blood transfusion were identified as risk factors for lower SF-36 scores. Low levels of haemoglobin before surgery, blood urea nitrogen (BUN), BUN/Creatinine, and white blood count values correlated with lower SF-36 scores. Conclusion: Numerous contextual variables affected the functional outcomes of the patients. Consideration of these factors could be helpful in reducing costs and improving the quality of life for intertrochanteric fracture patients.

Treatment of 5th Metecarpal Neck Fractures with Titanium Elastic Nail Using Local Anesthesia and Hematoma Block

Objective:Surgical treatment of 5th metacarp neck fractures using titanium elastic nail (TEN) is performed under general anesthesia or axillary block. In this study, our aim is to present the clinical and radiological results of patients who underwent surgery under local anesthesia for the TEN entry site and hematoma block for fracture reduction. Methods: There were 14 patients who met the inclusion criteria in the study. Radiologically, metacarpal shortness and volar angulation angles at the time of admission, after reduction in the ER and after surgical intervention when the fusion had been achieved were evaluated. Clinically, rotational deformity, range of motion of the affected finger were evaluated according to Quick DASH scores. Results: The volar angulation before and after reduction in ER was found to be as a mean of 46.2° (33-60°) and 40.6° (30-48°) respectively. After surgical intervention a mean of 17.2° (10-22°) was achived at the final follow-up. The metecarpal shortness was determined to be mean 4.4 mm (1.8-7.3mm) on first presentation, 3 mm (2-5 mm) after reduction in ER, and 2 mm (1.2-3.3mm) at the final follow-up examination in surgically treated group compared to healthy side. Radiological bone union was observed in mean 35 days, there was no pain on palpation, and the TEN was removed. Finger flexion and extension were determined to be full at the end of the 3rd month and no rotational defomity was observed. The mean Quick DASH score of the patients was 1.5 (1.2-2). Conclusion:5. metacarpal fractures with TEN under hematoma blockage and local anesthesia and leaving the proximal end out of the skin is a safe method for the treatment of such fractures.

Antegrade vs Retrograde Intra-Medullary Nailing in Femoral Shaft Fractures: A Systematic Review and Meta-Analysis.

Femoral shaft fractures are one of the most prevalent fractures found in clinical practice. Numerous operative and non-operative options are readily available for the treatment of such fractures with intra-medullary nailing being the gold standard. To date, no consensus has been reached favoring one approach over the other. Thus, this meta-analysis aims to compare the outcomes between an antegrade and retrograde intra-medullary nailing for the treatment of femoral shaft fractures. PubMed, Cochrane, Google Scholar (page 1-20), and Embase were searched till January 2024. The clinical outcomes evaluated were the incidence of adverse events, reoperations, hip and knee pain, and surgery-related parameters. Higher rates of hip pain, and heterotopic ossification (p=0.0003, and p=0.0002 respectively) was observed with antegrade nailing. However, a higher rate of knee pain (p=0.02) was appreciated in retrograde nailing. There was no statistically significant difference in the remaining analyzed outcomes such as operative time, reoperation rate or other complications. Despite a higher rate of heterotopic ossification using the antegrade nailing technique, both the antegrade and retrograde nailing techniques yield overall similar outcomes. Therefore, the decision to choose one or the other should be based on patient-related factors, and the surgeon's experience and preference.

Intramedullary Fibular Strut Allograft and a Small Fragment Nonlocking T-plate for Periprosthetic Lateral Femoral Condyle Fracture: A Case Report

Intramedullary Fibular Strut Allograft and a Small Fragment Nonlocking T-plate for Periprosthetic Lateral Femoral Condyle Fracture: A Case Report

Dynamic condylar screw functional outcome in the treatment of unstable proximal femoral fractures in adult patients

Objective: The purpose of this study was to assess the functional outcome of dynamic condylar screw (DCS) fixation in the treatment of unstable proximal femoral fractures in adults. Study Place and Duration: This descriptive study was done from March 2021 to November 2022 at MTI Lady Reading Hospital Peshawar. Methods: A descriptive study, employing dynamic condylar screws to treat proximal femur fractures in all adult patients who met the inclusion criteria, was utilized in this in-depth examination (DCS). The Harris Hip Score was used to determine post-surgery mobility. Results: The average age of patients was 63 having standard deviation of 14. Fracture union took 14.3 +/- 3.8 weeks on the average. At 24 months, the typical HHS was 85.2 +/-12.3, and 78.1% of patients reported adequate or outstanding functional performance. Nonunion, malunion, or hardware failure occurred in 13.3% of patients. Complications were unaffected by age, gender, or fracture type. Conclusion: Dynamic condylar screw therapy has demonstrated promising functional and radiological benefits with few adverse effects in people with unstable proximal femoral fractures. DCS fixation, an efficient treatment for such fractures, is one of the best treatment for such fractures.

Surgical treatment for ipsilateral femoral neck and shaft fracture

To retrospectively analyze efficacy of single structure internal fixation and double structure internal fixation in the treatment of ipsilateral femoral shaft and neck fracture, and analyze their indications. From June 2015 to December 2020, 21 patients with ipsilateral femoral shaft and femoral neck fracture were treated, including 14 males and 7 females, aged 23 to 69 years old with an average of(38.1±12.9) years old. According to different femoral shaft fracture sites, some patients were fixed with cephalomedullary implant for both femoral neck and the femoral shaft(single structure, InterTan or PFNA Ⅱ), some patients were fixed with cannulated screws for the femoral neck and a retrograde locking nail for the femoral shaft (dual structure), and postoperative function and complications were recorded during follow-up. In 10 cases of single-structure fixation, the femoral necks were all basicervical fractures, and the femoral shaft fractures were located in the proximal isthmus;11 cases were double-structure fixation, 9 cases in 11 were basal type of femoral neck, 2 cases in 11 were neck type, and the femoral shaft fractures were located in the isthmus and the distal isthmus. All patients were followed up for 12 to 27 months. No femoral head necrosis, deformity, delay or nonunion occurred in the patients with single-structure fixation, and no delayed union or nonunion occurred in femoral shaft fractures;At the final follow-up, Harris score of patients with single-structure fixation was 91.8±4.1, with 8 cases were excellent and 2 cases were good. The fractures of patients with dual-structure fixation achieved good union without femoral head necrosis, except 1 case of femoral shaft fracture had delayed union;At the final follow-up, Harris score of patients with dual-structure fixation was 92.4±5.9, 7 cases were excellent, 3 cases were good, and 1 case was fair. Good reduction and fixation is the key to the treatment of such fractures. Both the single-structure fixation and the dual-structure fixation are good methods, and it should be selected according to the locations of femoral shaft and femoral neck fractures. Single-structure fixation is a good choice for femoral shaft fractures located at the proximal isthmus and basal femoral neck fractures. For isthmus and distal femoral shaft fractures combined with ipsilateral femoral neck fractures, dual-structure fixation is recommended.

Bridge Plating Versus Hybrid External Fixation in the Management of Proximal Tibia Metaphyseal Fractures.

Due to the surge in high-speed road traffic accidents during the past few years, extra-articular proximal tibia fractures have also risen in number. For the treatment of such fractures, various options are available like conservative treatment with casting, surgical treatment with plate osteosynthesis, or a hybrid external fixator. Exposure of the bone surface and extensive soft tissue dissection is needed in bridge plating, posing a risk of bleeding, infection, and soft-tissue healing issues, and the blood supply of the fractured area is also hampered as the periosteum is also destroyed. To avoid these complications, a hybrid external fixator can be used but it has its own risks of malunion, non-union, and pin-tract infections; another drawback is patient compliance. In this study, we compare the clinical and functional outcomes of two treatment modalities, i.e., bridge plating and hybrid external fixator, in the treatment of proximal tibia metaphyseal fractures. This prospective randomized study was conducted from February 2021 to June 2022 on 46 adult patients diagnosed with proximal tibia metaphyseal fracture and willing to participate. An odd number of patients were treated with a bridge plate and even with a hybrid external fixator. A total of 46 patients were included in the study, sustaining proximal tibia metaphyseal fracture, out of which23 patients underwent hybrid external fixation with an outcome of 69.43 ± 8.11 according to the Knee Society Score (KSS) and 23 for bridge plating which showed better results as their score at final follow-up was 75.00 ± 8.22. According to our study, we found that bridge plating is a better treatment modality than the hybrid external fixator as the former showed better postoperative knee range of motion and functional outcome and led to a smaller number of complications. But the clinical outcome would also be influenced by the type of fracture, degree of comminution, type of injury, i.e., open or closed, and quality of bone.

Results of surgical treatment of the mandible body fractures with own designedexternal fixator in two horses

Mandibular fractures are the most common among all skull fractures. Most of them are the result of blunt trauma resulting from hitting an obstacle, kicking by another horse, or falling after a jump. The majority of fractures are open and infected. Some of them are complicated, involving the molar or premolar teeth. Treatment of such fractures is challenging because results depend on stable bony union and functional integrity of the occlusal surface. Osteosyntheses were performed under general anesthesia. Complications included infection around one implant close to the fracture line and fistulation in case 2 created by a fractured tooth which had to be extracted. In spite of the mentioned problems, good results were achieved in both cases. Stabilization of unilateral mandibular fractures with our own design fixator which is minimally invasive and provides sufficient fixation to obtain good results. The use of the fixator has proved to be beneficial and has a number of advantages in the treatment of this kind of fracture.

Improved Calculation Method of TAD for Intertrochanteric Fractures.

To investigate the relative position of femur fixed screws using intramedullary systems for intertrochanteric fractures and to improve the accurate measurement method of the tip-to-apex distance (TAD) while providing a theoretical basis for the clinical treatment of such fractures. In the anteroposterior (AP) radiographs of the hip joint, the femoral neck axis through the femoral head geometry point was designated as the X-axis, while the line perpendicular to the X-axis passing through the femoral head geometry point was designated as the Y-axis. In the lateral radiographs of the hip joint, the line perpendicular to the X-axis passing through the femoral head geometry point was identified as the Z-axis. The head of the nail tip's location projected on the three axes was described as A AP, B in the AP radiographs; and A LAT, C in the lateral radiograph. The TAD was described as X AP and X LAT. The radius of the femoral head was D. All distance units were expressed in mm. When the lateral projection angle was standardized, the A AP was equal to the A LAT, while the X AP 2=B 2+(D - A AP)2 and X LAT 2=C 2+(D - A LAT)2. When the lateral projection angle was not standardized, the value of C had no significant change; however, the (D - A LAT) value changed. The measurement value did not match the actual values of TAD when the lateral projection angle was not standardized, possibly leading to a misinterpretation during clinical work. The X LAT should be amended using the formula X LAT 2=C 2+(D - A AP)2.

Хирургическое лечение импрессионного перелома наружного мыщелка большеберцовой кости (клинический случай)

INTRODUCTION: Treatment of intra-articular fractures of the proximal tibial metaepiphysis can often cause difficulties in accurate restoring of the congruence of the articular surfaces of the knee joint. Such fractures may be accompanied by subsidence of the articular surface and the formation of a subchondral defect. In the absence of displacement of bone fragments and preservation of congruence of the articular surfaces of the knee joint, such fractures can be treated conservatively. In the opposite case, there is a need for a complete restoration of the articular surface of the tibia. It should be noted that among all fractures of the tibial plateau, more than half are fractures of the lateral condyle, also accompanied by the presence of an impression. A clinical case of surgical treatment of a 62-year-old patient, BMI (body mass index) 39, with an intra-articular multi-comminuted impression fracture of the lateral condyle of the tibia with displacement of bone fragments is presented. The patient gave her written consent to the use of her clinical data for scientific purposes. Upon admission to hospital, a closed intra-articular fracture of the external condyle (Schatzker II) was diagnosed with fragmentation and articular surface impression of more than 5 mm, and the presence of a spongy bone defect with a volume of about 4 cm3 as a result of the impression. Surgical treatment was performed that consisted of open reposition and restoration of the congruence of the articular surface, with simultaneous plasty of the defect of the external condyle with an autograft taken from the iliac crest, followed by osteosynthesis of the external condyle with a plate and screws. On the follow up examination 9 months after the surgical treatment, the patient developed post-traumatic osteoarthrosis of the knee joint with severe pain. Some probable errors in the preparation of the patient for surgical treatment, preoperative planning, surgical treatment, recovery in the postoperative period, as well as functional and radiological results of treatment are presented for discussion. CONCLUSION: The development of post-traumatic osteoarthrosis in the treatment of tibial condylar fractures still remains an important problem in modern traumatology. Special attention in the treatment of such fractures should be given to preoperative planning, surgical technique and implant selection. It is important not to lose communication between the patient and the surgeon throughout the entire recovery period.

Functional Outcome of Distal Femur Fracture Treated with Retrograde Nailing Technique

Background: Management of distal femur fractures is always challenging for the surgeons. Retrograde interlocking nailing is one of the effective methods with minimal complications for treatment of such fractures. The objective of the study was to evaluate the functional outcome of retrograde interlocking nailing technique in patients with distal femur fractures.&#x0D; Methodology: This interventional study was conducted at the department of orthopedic surgery, Liaquat University Hospital, Hyderabad from March 2017 to December 2019. Patients of either gender, between 30 to 65 years age, who presented with acute fracture of distal femur, as a result of trauma within 12-96 hours, requiring surgical intervention were included. Lysholm Scoring System was used to evaluate the functional outcome of patients treated with retrograde interlocking nailing technique. Data was analyzed using SPSS version 24.&#x0D; Results: Total 102 patients gave consent of participation. The mean age of study participants was 43.50±7.26 with the age range from 40-65 years. Male patients were 76.47% and female 23.53%. In majority (63.73%) of cases, mode of injury was road traffic accidents. Statistically significant difference in functional mobility score between the age groups and gender (p &lt; 0.05) was found. Statistically significant (p &lt; 0.05) decline in mean Lysholm score was observed in participants who had been bearing full weight for 3 months. Excellent functional outcome was achieved by 49.02% patients while 34.31% patients achieved good functional outcome.&#x0D; Conclusion: Retrograde interlocking nailing for fracture of distal femur is an effective fixation surgical technique with minimal complications and excellent to good functional outcome.&#x0D; Key words: Accidents, Femur Fractures, Fracture Fixation, Functional Performance

A comparative study to assess the effect of multiple Kirschner wiring versus plating in the management and functional outcome of proximal humerus fractures

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Proximal humerus fractures constitute 5% of all appendicular skeletal injuries and are mainly a menace of the elderly, after hip fractures and distal radial fractures. According to the NEER’S classification, the decision regarding the treatment of such fractures is dependent on whether the four anatomical segments of the proximal humerus are fractured or displaced.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 50 patients admitted in orthopaedics ward satisfying the inclusion criteria were randomly divided in 2 groups with 25 patients in each group for PHILOS plating and Kirschner wiring management. Groups were compared with respect to their improvement in physical function, pain, quality of life, complications and re-operation rates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Out of the total 50 cases, 20% were type I, 22% type II, 36% were type III fractures while 22% were type IV fractures. Mean DASH questionnaire was comparable between two groups at 1 month after surgery (p=0.56). During immediate post-op period and at subsequent follow ups, DASH questionnaire was better in plating group as compared to K-wiring. At 3 months and 6 months follow up, functional outcome as calculated by DASH questionnaire was comparable between two groups (p=0.17 and 0.45). Excellent to good outcome was seen in all cases of either group. No difference was observed between study groups with respect to associated complications. K-wire loosening was observed in 2 cases (8%). Plating was associated with infections (8%) and screw break out (4%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; After comparing both the techniques, we recommend PHILOS plating for young adults and percutaneous K wire fixation for the elderly age group.&lt;/p&gt;

Operative versus non operative treatment for displaced intra articular fracture of calcaneus: A prospective study 58 patients

Background: Calcaneus fractures are the most common tarsal bone fractures, and displaced intra articular fractures account for 60% to &75% of all calcaneal fractures. Fractures of the calcaneus remain among the most challenging for the orthopedic surgeon to manage effectively as these injuries are more destructing and devastating. The management dilemma is still going on regarding conservative or operative treatment for such fractures as there is no clear evidence to delineate the gold standard treatment method, which is superior in every aspect. Material and Method: We have done a prospective study of 58 patients (2 had bilateral fracture) with displaced intra-articular calcaneus fracture after applying strict inclusion and exclusion criteria. We have randomly allocated patients into operative (A, n-30) and non-operative groups (B, n-30). We compared the clinical, functional and radiological outcomes of both groups. Results: The mean age in the operative group is 34.7 years and in the non-operative group is 36.03 years. The average follow-up is 12.4 months and the average time of union was 10.1 weeks in the operative group, while in a non-operative group it is 11.03 month and 10.6 weeks, respectively. The mean AOFAS score at the final follow up of the operative group is 84.2 and in the other group it is 79.4. Total of 8(39%) patients undergoing operative management have an excellent result, 15(50%) have good results,3(10%) have fair and 4(1%) have poor results as compared to the other group 4 (13%), 9 (30%), 8(27%), 9(30%) respectively. Conclusion: Operative management has a better radiological, clinical and functional score in comparison with conservatively managed patients of displaced intra articular calcaneal fracture. However, operative management is also associated with an increased number of surgery-related complications like long hospital stay, cost effectiveness, local wound healing problems, superficial and deep infection, implant related problems as compared to another group.

Are Intertrochanteric Fractures Evolving? Trends in the Elderly Population over a 10-Year Period.

BackgroundIntramedullary devices for the fixation of intertrochanteric fractures are increasing in usage and popularity. This reflects either a shift in adoption of new technology or intertrochanteric fractures becoming more complex or unstable. This trend was observed in our institution, hence we set out to investigate if this was concordant with an associated change in the demographics of the patients or in the morphology of the intertrochanteric fracture pattern over a 10-year period.MethodsThis is a retrospective cross-sectional comparison undertaken for the first 100 consecutive elderly patients with intertrochanteric fractures admitted to our tertiary institution over 3 yearly intervals, in each of the years 2004, 2007, 2010, and 2013. Fractures were radiologically classified via the Evans and AO classifications. Patient demographics such as age, ethnicity, and comorbidities and surgical data including time, type of fixation, time to surgery, and length of stay were collected via case note reviews to identify possible trends.ResultsThe overall mean age was 80.5 years, with no statistically significant trend among age, sex, ethnicity, and comorbidities over the 10-year period. The main finding was a rise in the proportion of unstable intertrochanteric fractures. The proportion of such fractures was 30% in 2004, 42% in 2007, 47% in 2010, and 62% in 2013 (p < 0.001). Patients admitted for intertrochanteric fractures also experienced a shorter hospital length of stay and an increasing trend towards early fracture fixation (p < 0.001), with a greater usage of intramedullary nails in the treatment of such fractures (p < 0.001).ConclusionsIntertrochanteric fractures in elderly patients have evolved into more complex fractures over the past ten years, despite there being no change in the age of the patients over the same duration. This increasing proportion of unstable intertrochanteric fractures has brought about a greater tendency to fix these fractures with intramedullary implants.

The problem of osteoporotic fractures of the femur in children with cerebral palsy

The problem of osteoporotic fractures of the femur in children with cerebral palsy

The Management of Distal Radius Fracture for Adult Patients in Bangladesh

Background: Distal radius fractures are one of the most common fractures patients experience. Although there are a variety of treatments, there is a lack of standardization as it relates to treatment of such fractures. Objective: In this study our main goal is to evaluate the management of distal radius fracture for adult patients in Bangladesh. Method: This observational prospective study was carried out at Chittagong Medical College Hospital and private hospitals in Chittagong from May 2015 to November 2020. Where a total of 30 Patients with unstable distal radial fracture attending at the emergency and outpatient department of Chittagong Medical College Hospital and Private Hospitals in Chittagong were included in this study. Results: During the study, according to mechanism of injury 60% patients fall on out stretched hand followed by 33.3% injuries responsible from MVA and 6.7% cases were occupational. most of the injuries belong to type II Fernandez classification, 33%. Followed by 30% injury cases belong to type II Fernandez classification, 23.3% cases belong to type I Fernandez classification, 6.7% cases belong to type IV and V classification. 86.7% cases need physiotherapy for &lt;6 weeks followed by 13.3% cases need physiotherapy for &gt;6 weeks. Also, according to distribution of overall assessment of anatomical outcome 80%cases were satisfactory and 20% cases unsatisfactory. Conclusion: Distal radius fractures are a common orthopedic injury. Advanced nursing practice providers either directly or indirectly participate in the care of these patients. Also, management of distal radius fracture for adult patients with volar locking plating system results in satisfactory results.

A comparative study of the clinical efficacy of supination-adduction type II ankle fracture surgery based on the medial pilon fracture concept versus the ankle fracture concept

BackgroundA supination-adduction (SAD) ankle fracture is a special type of ankle fracture that results in collapse of the distal tibial articular surface; as such, orthopaedic surgeons require greater awareness of this type of fracture. The severity of this injury lies between that of an ordinary ankle fracture and a pilon fracture, and the treatment of such fractures based on the ankle fracture concept leads to extremely high rates of postoperative complications and a poor prognosis. In this retrospective study, we aimed to explore the treatment of SAD fractures based on the pilon fracture concept.MethodsWe retrospectively analysed the clinical data of 67 patients with Lauge-Hansen supination-adduction type II (SAD-II) ankle fractures, most of whom had a 44-A AO classification. Patients underwent surgical treatment at the Second Affiliated Hospital of Anhui Medical University from January 2009 to June 2019. The patients were divided into two groups based on the surgical concept employed: 43 patients were included in the ankle fracture surgical concept group, and 24 patients were included in the medial pilon fracture surgical concept group. The therapeutic effect was evaluated based on the Burwell-Charnley radiological reduction standard, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and postoperative visual analogue scale (VAS) pain score 1 year after surgery using regression with adjustment for confounding factors.ResultsAll 67 patients were followed up. Twenty-four patients were treated according to the medial pilon fracture concept, and forty-three patients were treated according to the ankle fracture concept. The AOFAS score 1 year after surgery in the medial pilon group (89.83 ± 2.77) was higher than that in the ankle fracture group (83.63 ± 7.97) (p < 0.05). The VAS score 1 year after surgery in the medial pilon fracture group (1.17 ± 0.96) was significantly better than that in the ankle fracture group (2.28 ± 0.96) (p < 0.05).ConclusionPatients with Lauge-Hansen SAD-II ankle fractures treated based on the medial pilon fracture surgical concept had better postoperative outcomes than those treated based on the ankle fracture surgical concept.Level of evidenceLevel III, retrospective cohort study.

EVALUATION OF SCREWING CONFIGURATIONS IN CONVENTIONAL PLATING OF FEMORAL SHAFT FRACTURES USING FINITE ELEMENT ANALYSIS

Several fractures that occur in the human body depend on trauma or as a result of hormonal and bone fatigue. Fracture types that take place out of the neck area of the femoral bone are named femoral shaft fractures. Femoral shaft fractures are frequent conditions in orthopedics. Conventional plating method is a method that necessitates the fixation of the contact surface by contacting the epiphyses used in the treatment of such fractures. This method is known to be efficent in speeding up the healing process by reducing the movement between the epiphyses. In this study, femur models which are plated in various forms with fractures were analyzed with computer-aided finite element software and stresses on bone surfaces and fracture surfaces were determined. It is aimed to determine the best result by examining the relationship between the inputs such as the number of screws used during plating, the fixation area and material selection and the outputs obtained by finding the stresses on the bone surface and stresses on the broken surfaces.