Type C3 Fractures Research Articles

Preliminary application of human-computer interaction CT imaging AI recognition and positioning technology in the treatment of type C1 distal radius fractures

To explore the accuracy of human-computer interaction software in identifying and locating type C1 distal radius fractures. Based on relevant inclusion and exclusion criteria, 14 cases of type C1 distal radius fractures between September 2023 and March 2024 were retrospectively analyzed, comprising 3 males and 11 females(aged from 27 to 82 years). The data were assigned randomized identifiers. A senior orthopedic physician reviewed the films and measured the ulnar deviation angle, radial height, palmar inclination angle, intra-articular step, and intra-articular gap for each case on the hospital's imaging system. Based on the reduction standard for distal radius fractures, cases were divided into reduction group and non-reduction group. Then, the data were sequentially imported into a human-computer interaction intelligent software, where a junior orthopedic physician analyzed the same radiological parameters, categorized cases, and measured fracture details. The categorization results from the software were consistent with manual classifications (6 reduction cases and 8 non-reduction cases). For non-reduction cases, the software performed further analyses, including bone segmentation and fracture recognition, generating 8 diagnostic reports containing fracture recognition information. For the 6 reduction cases, the senior and junior orthopedic physicians independently analyzed the data on the hospital's imaging system and the AI software, respectively. Bone segments requiring reduction were identified, verified by two senior physicians, and measured for displacement and rotation along the X (inward and outward), Z (front and back), and Y (up and down) axes. The AI software generated comprehensive diagnostic reports for these cases, which included all measurements and fracture recognition details. Both the manual and AI software methods consistently categorized the 14 cases into 6 reduction and 8 non-reduction groups, with identical data distributions. A paired sample t-test revealed no statistically significant differences (P>0.05) between the manual and software-based measurements for ulnar deviation angle, radial ulnar bone height, palmar inclination angle, intra-articular step, and joint space. In fracture recognition, the AI software correctly identified 10 C-type fractures and 4 B-type fractures. For the 6 reduction cases, a total of 24 bone fragments were analyzed across both methods. After verification, it was found that the bone fragments identified by the two methods were consistent. A paired sample t-tests revealed that the identified bone fragments and measured displacement and rotation angles along the X, Y, and Z axes were consistent between the two methods. No statistically significant differences(P>0.05) were found between manual and software measurements for these parameters. Human-computer interaction software employing AI technology demonstrated comparable accuracy to manual measurement in identifying and locating type C1 distal radius fractures on CT imaging.

Incidence and risk factors of adverse events after distal radius fracture fixation with volar locking plates: retrospective analysis of 2,790 cases

Background and purpose: 12–18% of patients encounter adverse events after distal radius fracture (DRF) surgery with volar locking plates (VLPs). Risk factors for which preventive measures could be administered are currently scarce. We aimed to examine the incidence of postoperative adverse events and assess the causes and risk factors for the adverse events after VLP fixation of DRFs.Methods: We performed a single-center retrospective cohort study evaluating all adult DRF patients treated with VLP fixation between 2009 and 2019 at Helsinki University Hospital. Patients with previous disabilities or ulnar fractures, other than styloid process fractures, in the affected extremity were excluded. We examined each patient’s treatment using the electronic medical records system and identified postoperative adverse events defined as any deviation from the ordinary postoperative course, showcasing clinical symptoms. We used multivariable binary logistic regression to assess the risk for adverse events.Results: 2,790 cases of DRF were included. The incidence of adverse events was 16%. Hardware complications (8.3%), predominantly intra-articular screws (4.9%), were the most commonly encountered adverse events. Other frequent adverse events included carpal tunnel syndrome (2.8%), tendon complications (2.8%), and surgical site infections (1.5%). In the multivariable analysis, smoking, higher body mass index (BMI), alcohol abuse, C-type fractures, residual intra-articular displacement, and dorsal tilt were found as risk factors for adverse events.Conclusion: The incidence of adverse events was 16% after VLP fixation of DRFs. We identified several new risk factors for adverse events, which included residual dorsal tilt, intra-articular dislocation, insufficiently corrected inclination, smoking, alcohol abuse, and higher BMI.

Outcomes at mean follow-up of four years following AO type-C distal humerus fractures managed with fixation or arthroplasty.

To compare outcomes between open reduction internal fixation (ORIF), total elbow replacement (TER) and distal humerus hemiarthroplasty (DHH) for AO type-C (AOC) fractures of the distal humerus in patients aged 50 years or older. A retrospective analysis of acute AOC distal humerus fractures in patients aged 50 years or older between 2016 and 2022. Outcomes measured: Oxford Elbow Score (OES), Mayo Elbow Performance Score (MEPS), complication rate, re-operation rate and range of movement (ROM). Sixty-five patients met the inclusion criteria (20 males, 45 females). Mean age was 64.4, 77.1 and 61.3 years old for ORIF, TER and DHH respectively. Logistic model analysis revealed a statistically significant increased complication rate in the ORIF group compared to the TER and DHH groups (ORIF vs TER p = 0.01; ORIF vs DHH p = 0.048). There was a higher re-operation rate in the ORIF group compared to the DHH group (p = 0.03). There were no differences in OES, MEPS or ROM between groups. This supports the use of TER in elderly patients with AOC distal humerus fractures. In the younger patient, DHH may have lower rates of complications and re-operations compared to ORIF, but function remains similar. We propose a prospective randomised control trial.

Study on automatic and rapid diagnosis of distal radius fracture by X-ray

This article aims to combine deep learning with image analysis technology and propose an effective classification method for distal radius fracture types. Firstly, an extended U-Net three-layer cascaded segmentation network was used to accurately segment the most important joint surface and non joint surface areas for identifying fractures. Then, the images of the joint surface area and non joint surface area separately were classified and trained to distinguish fractures. Finally, based on the classification results of the two images, the normal or ABC fracture classification results could be comprehensively determined. The accuracy rates of normal, A-type, B-type, and C-type fracture on the test set were 0.99, 0.92, 0.91, and 0.82, respectively. For orthopedic medical experts, the average recognition accuracy rates were 0.98, 0.90, 0.87, and 0.81, respectively. The proposed automatic recognition method is generally better than experts, and can be used for preliminary auxiliary diagnosis of distal radius fractures in scenarios without expert participation.

Medial plating of distal femur: which pre-contoured angular stable plate fits best?

Distal femur fractures comprise approximately 4% of all femoral fractures, with lateral plating being a common fixation technique. In recent years, dual plating with an additional medial plate has shown added benefit for Arbeitsgemeinschaft für Osteosynthesefragen C-type fractures, comminuted, osteoporotic distal femur fractures and non-union or malunion complications postsingle lateral plating. However, to our knowledge, there is no commercially available distal femur medial plate for fracture fixation. The aim of our study was to determine which of our current commercially available pre-contoured plates fit the medial distal femur best in an Asian population. We evaluated 13 different pre-contoured angular plates on standardized sawbone models. The plates were first applied onto the medial distal femur and subsequent anterior-posterior and lateral radiographs were taken postapplication. The appropriateness of the fit of each plate was objectively compared using a scoring system derived from pre-determined plate- and screw-related factors. The proximal humerus internal locking system plate had the best anatomical fit with the highest 'best fit score,' followed by the variable angle proximal tibia plate. While non-anatomical plates may be successfully utilized, in view of the anatomical variations of the femur, ultimately an anatomical plate for the medial distal medial femur should be developed for ease of fixation.

Clinical outcomes for linked fixation of distal humerus fractures: a multicenter study

BackgroundO’Driscoll popularized the principle of linked column fixation for distal humerus fractures. Despite the linked column concept being widely accepted, there are few reported techniques to accomplish this goal. A novel device was designed based on the principles of linked columns. An interlocking beam is used to connect the medial and lateral plates, creating a unified fixed angle construct. Our primary objective was to report clinical outcomes across multiple institutions for a linking beam used in distal humerus fracture fixation. MethodsA retrospective series was collected from five institutions for the TiBeam (Skeletal Dynamics, Miami, FL, USA) with a minimum follow-up of six months. Acute and chronic treatment of distal humerus fracture patterns, and all plate configurations were included for analysis. ResultsA total of 36 cases were collected at a mean age of 52 years and a mean follow-up of 19.3 months. AO C-type fractures were 56% of the series. The median MEPS was 85 (IQR 76.3 to 90), the median DASH was 21.4 (IQR 15.9 to 30), and the median VASa was 3.5 (IQR 2 to 5). An olecranon osteotomy was used in 86% of cases and an anatomic plate was used for fixation of the osteotomy in 94% of those cases. There were three cases of olecranon plate removal for a rate across the series of 13.7%. DiscussionOur short-term results demonstrate satisfactory clinical outcomes with low rates of revision for distal humerus fracture fixed with a linking beam. Further, the rate of removal for the olecranon osteotomy plate was lower than historical reports for aggregate methods of osteotomy fixation.

Low risk of early conversion to surgery in non-surgically treated proximal humeral fractures - An observational cohort study of 31,761 fractures from the Swedish Fracture Register

IntroductionThe majority of all proximal humeral fractures (PHFs) are treated non-surgically. Due to the risk of early secondary fracture displacement patients with non-surgically treated PHFs routinely undergo serial clinical and radiological evaluations. However, the value of these routine follow-up visits is unclear. This study aimed to examine the rate of early conversion to surgery in non-surgically treated PHFs. Moreover, the associations between patient and fracture characteristics and the risk of conversion to surgery were explored in order to assess the need for routine follow-ups. MethodsData on all patients aged ≥18 years with a non-surgically treated PHF registered between 2013 and 2021 were extracted from the Swedish Fracture Register. Early change of treatment from non-surgical to surgical is an optional treatment modality in the SFR. The rate of early conversion to surgery within 60 days from injury was analyzed in relation to age and sex of the patient, energy level at injury and fracture morphology according to the AO/OTA classification. ResultsA total of 31,761 primarily non-surgically treated PHFs (mean age 70 years: 76 % female) were included in the study. The overall rate of early conversion to surgery was 3.7 %. Younger age and increasing fracture severity were associated with a higher conversion rate to surgery. Patients ≥80 years and those with the three most common fracture types (A1, A2, and B1) had <2 % early conversion to surgery. In contrast, patients with C-type fractures, unstable/displaced fractures (A3, B2, and C2), or fracture dislocations (A1.3, B3, and C3) had a substantially higher risk (5.0–20 %) of early conversion. ConclusionThe overall risk of early conversion to surgery in non-surgically treated PHFs is low and can be further predicted based on patient age and fracture morphology. These results could have implications regarding which patients are in need of routine follow-ups. Level of evidenceLevel II; Retrospective design; Prognosis study

The Effect of Age and Sex on Early Postoperative Outcomes after Surgical Treatment of Distal Radius Fractures.

Background: We aim to evaluate the impact of advanced age and sex on postoperative complications and radiographic outcomes after open reduction with internal fixation of distal radius fractures (DRF). Methods: We conducted a retrospective chart review, including all patients who underwent open reduction with internal fixation of a DRF between 2012 and 2018 at a single level 1 trauma centre. We recorded patient age, sex, fracture classification (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association [AO/OTA]), time from injury to surgical date, surgical duration, diabetes status, tobacco use, illicit drug use, history of osteoporosis, use of adjuvants, fixation type, postoperative radiographic restoration of normal parameters and early complications including loss of reduction within 30 days postoperatively. Advanced age was defined as age greater than 60 years. Results: A total of 521 patients underwent operative treatment - 264 males and 257 females. Males were twice as likely (23.5% vs. 10.1%; p < 0.0001) to sustain a type C3 fracture and be treated with a wrist spanning plate (5.3% vs. 0; p < 0.0001). A larger percentage of elderly patients undergoing operative treatment of DRF were female (20.2% vs. 5.7%; p < 0.0001) and females were more likely to carry a pre-injury diagnosis of osteoporosis (9.3% vs. 0%; p < 0.0001). And 100% of the elderly patients received were treated with a volar plate. The overall early loss of reduction was 7.5%. The overall complication rate was 8.2%. No differences in early postoperative complications were identified between sexes or age groups. Neither female sex nor advanced age was found to have increased risk of postoperative complications or early loss of reduction. Similar postoperative radiographic parameter measurements were obtained across groups as well. Conclusions: Our results support the idea that operative treatment of unstable DRF in elderly patients and women is a reasonable treatment option without significant increases in early postoperative complications. Level of Evidence: Level III (Therapeutic III).

Early posterior column internal fixation: A staged treatment of type C3 tibial pilon fracture

Pilon fractures represent a challenging subset of tibial fractures. The management of AO/OTA Type C3 fractures remains complex due to associated complications and lack of clear guidelines for surgical timing and methods. A prospective cohort study was conducted to evaluate two staged treatment strategies for AO/OTA Type C3 tibial pilon fractures. The study focused on assessing surgical difficulty, complications, and patient prognosis. One group of patients received early internal fixation of the fibula and tibial posterior column combined with external fixation, while the other group received external fixation alone in the first stage. Patients who received early internal fixation of the fibula and tibial posterior column combined with external fixation had better outcomes, including lower rate of allogeneic bone grafting (67.74 % versus 94.64 %), reduced incidence of wound delay and skin necrosis (3.23 % versus 21.43 %), shorter surgical time (133.06 ± 23.99 min versus 163.04 ± 26.83 min), shorter hospital stay (13.77 ± 2.53 days versus 18.25 ± 3.67 days), and higher AOFAS (83.05 ± 8.68 versus 79.36 ± 8.92). Additionally, avoiding fibular shortening was shown to be crucial in preventing prolonged surgery and improving patient function. The study demonstrated that the staged treatment approach with early internal fixation led to shorter operative times, improved ankle function, and reduced complications, including a lower risk of infection. The findings support the use of this treatment to optimize outcomes in AO/OTA Type C3 pilon fractures.

Open Reduction and Internal Fixation of Distal Radius Fractures with Complete Intra-articular Involvement and Diaphyseal Extension.

Distal radius fractures with complete intra-articular involvement and diaphyseal extension pose significant challenges for stable fixation. Treatment options vary, with no single method demonstrating superiority. This study analyzed the outcomes of fixing these type of fractures with volar locking plates, which are widely used worldwide, and the fracture length according to plate type to determine when an extra-long plate should be used. This retrospective review analyzed 89 consecutive patients surgically treated for Association of Osteosynthesis (AO) classification type C distal radius fractures with diaphyseal extension, excluding open fractures. The plate length was determined to be long enough accordingly to avoid placing screws in the fracture site. Radiographic evaluation and clinical outcomes were analyzed. According to the AO system, C3 type fractures comprised 50%, C1 type 28%, and C2 type 22%. The average distance from the radiocarpal joint to the most proximal fracture line was 41.1 mm, with articular step off and gap of 1.7 mm and 3.7 mm, respectively. Concomitant distal ulna fractures were present in 81%. At final follow-up, the mean radial height was 10.9 mm, radial inclination was 22.8°, volar tilt was 5.7°, and ulnar variance was 0.6 mm. Fracture union occurred on average at 2.6 months. The average Disabilities of the Arm, Shoulder, and Hand score was 12.0 and the average Modified Mayo Wrist Score was 83.6. Regarding the average wrist range of motion, extension was 63.8°, flexion was 53.7°, ulnar deviation was 25.1°, and radial deviation was 16.7°. Complications included delayed wound healing in 3% and delayed union in 1 patient, who eventually achieved union at 10 months after surgery. APTUS Wrist Distal Radius Plates XL 2.5 and 2.4-mm Variable Angle LCP Two-Column Volar Distal Radius Plates showed a statistically significant difference in fracture length, with the former being longer than the latter (62 mm vs. 35 mm, p < 0.001). If the fracture length from the articular surface to the diaphysis exceeds 60 mm, we recommend preparing an extra-long distal radius plate. Volar plate fixation with appropriate length selection has yielded favorable functional outcomes and few minor complications in distal radius fractures with complete intra-articular involvement and diaphyseal extension.

Management of complex wrist fractures with volar and dorsal locked (double-locked) K-lock.

This article is a technical note to outline a novel technique of fixation in complex, comminuted distal radius fractures using a double-locked K-wire construct using a new implant called K-lock. In these (AO) C-type fractures, with significant dorsal comminution, it is often difficult to attain stable and secure fixation of the dorsal rim fragments, especially the dorsal lunate fossa fragment. This often results in patients being treated by temporary spanning devices or asking to have a restricted use of the hand during a given period to avoid loss of position. If dorsal plating is necessary, because of the severity of the comminution, a double-locked K-wire (locked in both the dorsal and volar plates) offers a fixation option and may create a significantly stronger construct and allow confident early mobilization. The K-lock was recently launched by Newclip Technics as an adjunct to the Xpert Wrist 2.4 set as a fragment-specific fixation option. The wire has less chance of displacing or fracturing the fragment and has a smooth surface compared with a screw; this wire would be safer close to the joint in severe distal intra-articular comminution. Of the 9 cases performed so far (as is our usual practice), despite the complexity of the fractures, none were immobilized postoperatively and all started hand therapy in the first week. Most were driving by 2 weeks and returned to light work at 4 weeks and heavy work or sports at 6 to 8 weeks. This principle of fixation may also be extended to other fractures where dual plating is used.

COMPLEX DISTAL HUMERUS FRACTURES TREATED WITH OSTEOSYNTHESIS, ARTHROPLASTY, OR MANAGED CONSERVATIVELY

AbstractIntroductionIntra-articular distal humerus OTA type C fractures are challenging to treat. When osteosynthesis is not feasible one can choose to do a primary arthroplasty of elbow or manage non-operatively. The indications for treatment of this fracture pattern are evolving.ObjectivesWe present our outcomes and complications when this cohort of patients was managed with either open reduction internal fixator (ORIF), elbow arthroplasty or non-operatively.MethodsRetrospective study to include OTA type C2 and C3 fracture distal humerus of 36 patients over the age of 50 years managed with all the three modalities. Patient's clinical notes and radiographs were reviewed.ResultsBetween 2016 and 2022, 21 patients underwent ORIF – group 1, 10 patients were treated with arthroplasty – group 2 and 5 were managed conservatively- group 3. The mean age of patients was 62 years in group 1, 70 years in group 2 and 76 years in group 3. The mean range of movement (ROM) arc achieved in the group 1 &amp; 2 was 103 while group 3 was 68. At least follow up was 6 months. 5 patients in group 1 underwent metalwork removal and 2 patients in group 3 under arthroplasty.ConclusionThe outcomes of arthroplasty and ORIF are comparable, but reoperation rates and stiffness were higher in ORIF and conservative group. Surgeon choice and patient factors play important role in decision towards choosing treatment modality.Declaration of Interest(b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Study of functional outcome of muller type C distal femur fracture treated with locking compression plate

Background: To evaluate the functional outcome of Muller type C distal femur fracture treated with locking compression plate (LCP). Methods: This prospective study was carried out at Al-Ameen medical college and hospital, Vijayapura. Forty patients (24 males and 16 females) with Muller type C distal femur fractures were enrolled in our study. Patients were treated with open reduction and internal fixation with LCP. They were followed up for 9 months with clinical examination and serial x-rays. The functional outcome was evaluated using Neer’s scoring system. Results: Forty patients who completed follow up of 9 months were included. There were 18 muller type C1, 14 muller type C2 and 8 Muller type C3 fractures. The functional evaluation with Neer’s scoring system was excellent in 8 patients, good in 20 patients, fair in 8 patients and poor in 4 patients. Complications observed were difficulty in reduction, superficial infections, knee stiffness and limb length discrepancy. Conclusions: The LCP is a safe and effective tool to manage these difficult fractures as we had no incidence of implant failure, delayed union, non-union and revision surgery except that we had knee stiffness as commonest complication which can be tackled by early surgery, surgical expertise, meticulous soft tissue handling and vigorous early knee mobilisation.

FTP1.6 Epidemiology of Medial Tibial Plateau Fractures and Factors Associated with its Outcomes

Abstract Background Medial tibial plateau fractures (TPFs) are reported to be difficult to treat and are subject to higher levels of postoperative complications. The aim of the study was to evaluate the results of management of medial and bicondylar TPFs and determine the factors influencing its outcomes. Method 143 patients with TPFs were included in this study during a total period of 6 years. The groups were divided into medial TPFs (B-type) and bicondylar TPFs (Ctype), according to the AO/OTA Classification and Schatzker Type IV, V and VI classification. Patient information including basic demographics, duration of followup, mechanism of injury, comorbidities, management, and post-operative complications were included in this study. Analysis of this data was done to determine a correlation between the outcomes of both fracture groups. Results The mechanism of injury profile showed no significant difference with high energy trauma seen in 48% of B-type and 59% in C-type fractures. Age has no influence on the fracture outcomes. Most patients in both groups were mainly treated with ORIF. The incidence of infection, compartment syndrome and post-traumatic arthritis are higher in bicondylar TPFs compared to medial TPFs, with a similar number of patients with CPN Palsy in both groups. No significant difference was found between both fracture types in every aspect of patient information that was compared in this study. Conclusion The outcomes of medial TPFs are similar to bicondylar TPFs in terms of complication rates, even though one would generally assume medial TPFs to be less severe than bicondylar TPFs

How does trauma secondary to unexpected extreme weather affect orthopaedic surgery departments? An epidemiological study on the Filomena snowstorm.

Trauma secondary to extreme weather events may heavily impact the normal activity of orthopaedic surgery departments, especially in places not prepared to deal with them. The Filomena snowstorm, which happened in January 2021, has been one of the greatest snowstorms ever in Spain. During it, the constant influx of trauma patients made the Orthopaedic Emergencies Department (OED) to collapse. The primary objective of this study was to describe the orthopaedic injuries and changes in fracture's epidemiology observed during this exceptional period. Secondary objectives were to analyse the collected variables in order to minimize the future impact of these unexpected extreme weather events. Retrospective cohort study between patients that came to the OED during the snowstorm (Filomena group) and those who came on the same period of the previous year (Control group). The following data were collected: age, sex, injury location, injury mechanism, diagnosis, AO/OTA fracture classification, treatment type (conservative vs surgical) and delay to surgical treatment. A total of 1237 patients were included in total, 655 patients from the Filomena group and 582 from the Control group. One in two patients in the Filomena group sustained a fracture (50.7% vs 23.2%). The most frequent diagnosis on the Filomena group was distal radius fracture (16.2%), five times more frequent than in the Control group (3.4%). A significant increment was also observed in the incidence of ankle (21.7%) and proximal humerus (33%) fractures. In Filomena, surgically treated fractures increased by 168%, being more severe, as C-type fractures were more prevalent (23% vs 13%). Mean delay to surgery was 6.78days during the snowstorm. Unexpected snowstorms entail an exponential rise in orthopaedic care demand and OED pressures. A significant increment in orthopaedic trauma surgery, up to 168% more, particularly distal radius, proximal humerus and ankle fractures it is to be expected, which will imply elective surgery cancellation, damaging patients and increasing costs.

Linking the distal humerus columns in articular fracture fixation

IntroductionConcerning rates of nonunion in articular distal humerus fractures indicate an unsolved problem. The fixation principles of O'Driscoll describe linking the fractured articular segment to the distal humerus columns with compression screws which creates a stable fixed angle construct. A novel device has been introduced which utilizes an interlocking beam through the articular segment to connect the distal aspect of the medial and lateral plates, creating a linked construct. We sought to evaluate the stability of this linked construct using an articular model of distal humerus fracture. Materials and methodsTen matched pair specimens of 65 years of age or older were randomized to the use (LB group) or non-use (NLB group) of an interlocking beam to link the medial and lateral locking plates in fixation of an AO Type C3 fracture model. Outside of the linking beam, fixation between the matched pairs was consistent using 2.7 mm locking screws distally with fixed trajectories and +/- 2 mm lengths. ResultsMean stiffness was 273 Newtons/mm in the LB group and 225 Newtons/mm in the NLB group (p = 0.001). Mean maximum displacement was 0.28 in the LB group and 0.93 mm in the NLB group (p = 0.006). Mean load to failure was 277 pounds in the LB group and 280 pounds in the NLB group (p = 0.94). DiscussionOur results indicate that an interlocking beam which links the medial and lateral plates provides greater stability compared to a similar construct without an interlocking beam. We attribute this finding to the beam's double supported design which resists cantilever bending and provides robust compression of the fractured fragments.

Arthroscopic-assisted reduction and internal fixation for complex tibial plateau fracture: radiographic and clinical outcomes with 2- to 15-year follow-up

BackgroundTo investigate the radiologic and prognostic outcomes after using arthroscopic-assisted reduction and internal fixation (ARIF) in complex tibial plateau fractures with mid- to long-term follow-up.MethodsThis retrospective study reviewed complex tibial plateau fractures that underwent ARIF from 1999 to 2019. Radiologic outcomes, including tibial plateau angle (TPA), posterior slope angle (PSA), Kellgren–Lawrence classification and Rasmussen radiologic assessment, were measured and evaluated. The prognosis and complications were assessed by the Rasmussen clinical assessment with a minimum follow-up of 2 years.ResultsNinety-two consecutive patients (mean age: 46.9 years) with a mean follow-up of 74.8 months (24–180) were included in our series. Using AO classification, there were 20 type C1 fractures, 21 type C2 fractures, and 51 type C3 fractures. All the fractures achieved solid union. TPA was maintained well on average at the last follow-up and showed no significant difference compared to postoperatively (p = 0.208). In the sagittal plane, the mean PSA increased from 9.3 ± 2.9° to 9.6 ± 3.1° (p = 0.092). A statistically significant increase in PSA was also noted in the C3 group (p = 0.044). Superficial or deep infection was noted in 4 cases (4.3%), and total knee arthroplasty (TKA) was performed in 2 cases (2.2%) due to grade 4 osteoarthritis (OA). Ninety (97.8%) and 89 (96.7%) patients had good or excellent results in the Rasmussen radiologic assessment and Rasmussen clinical assessment, respectively.ConclusionsThe complex tibial plateau fracture could be treated successfully using arthroscopy-assisted reduction and internal fixation. Most patients achieve excellent and good clinical outcomes with low complication rates. In our experience, a higher incidence of increased slope was noted, especially in type C3 fractures. Reduction of the posterior fragment should be done cautiously during the operation.Levels of evidenceLevel III.

The double-plate fixation technique prevents varus collapse in AO type C3 supra-intercondylar fracture of the distal femur

IntroductionVarus collapse followed by osteosynthesis for distal femoral fractures with conventional implants has been well documented but is seldom mentioned in fractures managed with locking plates. The purpose of this study was to assess the incidence of varus collapse after treating complex supra-intercondylar fractures of the distal femur (AO type C3) using a Single Plate (SP) or Double Plate (DP) fixation technique.Materials and methodsWe retrospectively reviewed 357 patients with distal femoral fractures who were treated at our hospital between 2006 and 2017. After excluding cases of infection, malignancy, periprosthetic fracture, revision surgery, pediatric fracture, and extra-articular fracture, 54 patients were included in the study. All demographic data and radiological and clinical outcomes were reviewed and analyzed.ResultsThere were 54 patients enrolled into this study with age from 15 to 85 years old (mean 41.6, SD = 19.9), and 32 of them were open fractures (59%). The patients were further divided into either an SP (n = 15) or a DP group (n = 39). Demographics, including age, sex, injury severity score, and open fracture type, were all compatible between the two groups. The overall nonunion rate was 25.9% (n = 14; 6 from the SP and 8 from the DP group; p = 0.175). The varus collapse rate was 9.3% (n = 5; 4 from the SP and 1 from the DP group (p = 0.018).ConclusionsThe varus collapse rate after osteosynthesis with a single lateral locking plate could be as high as 26.7% in AO type C3 fractures of the distal femur, which would be decreased to 2.6% by adding a medial buttress plate. Surgeons should consider DP fixation to avoid varus collapse in severely comminuted complete intra-articular fractures of the distal femur.

Treatment and outcome of AO/OTA type C distal radius fractures: 12 199 fractures from the Swedish Fracture Register.

The aim of this study was to examine the epidemiology, treatment, and patient-reported outcome of AO/OTA type C distal radius fractures (DRF) using data from a large national fracture register. We used prospectively collected data from the Swedish Fracture Register covering all AO/OTA type C DRFs registered between April 2012 and December 2018. Data on fracture type, epidemiology, trauma-mechanism, and treatment had been recorded by the treating physician. Patients had been sent an outcome questionnaire including EQ-VAS, EQ-5D, and the SMFA at the time of injury and 12 months after. A total of 12 199 cases with AO/OTA type C fracture were identified. AO/OTA type C1 fracture was most common, with 5400 cases, followed by AO type C2 with 4304 and AO/OTA type C3 with 2495. Cast treatment and surgical treatment with volar locking plate fixation were the most common treatments. Patient-reported outcome measures worsened significantly one year after the fracture, and 56% reported moderate problems with pain and discomfort one year after the fracture. Patients treated with a volar plate reported a significantly larger deterioration in EQ-5D outcome compared to patients treated with a cast. No treatment method was found to be superior. A good outcome after a type C fracture is possible, but many patients do not recover completely. Our findings indicate a relatively better self-reported outcome for patients treated with a cast, but as treatment was not randomized the clinical relevance is unclear.

Distal Radius Eklem İçi Kırıklarının El Bilek Fiksatörü ile Tedavisinde Radio-Ulnar Açıdaki Değişikliklerin El Bilek Skorlamasına Etkisi

Aim: This study was aimed to evaluate the effect of radial inclination (RI) angle, assessed with radiological measurement, on the clinical outcomes of intra-articular fractures of the distal radius (IFDR) treated with closed reduction and penning type dynamic wrist fixator. Material and Methods: A total of 120 patients who underwent closed reduction and dynamic wrist fixation due to IFDR between 2012 and 2020 were retrospectively reviewed. The effects of the changes in RI on clinical outcomes according to Mayo wrist scoring (MWS) criteria were investigated by measuring the RI angles in anteroposterior wrist radiographs of the patients at postoperative 2nd, 6th, and 10th weeks. Results: According to the AO fracture classification, 77 (64.2%) of the patients had type C1 and 43 (35.8%) of the patients had type C2 fracture. The patients comprised 69 (57.7%) females and 51 (42.3%) males, and the mean age was 50.08±15.36 years. Fixators were removed at six weeks. RI angles measured at post-op week 10 were 20°-30° in 83 (69.1%) patients, 10°-19° in 32 (26.6%) patients, and 0°-9° in 5 (4.3%) patients. According to MWS, 39 (32.5%) patients were evaluated as excellent, 76 (63.3%) patients as good, and 5 (4.2%) patients as moderate. A statistically significant positive correlation was observed between RI values and MWS (r=0.369, p&amp;lt;0.001). Conclusion: Dynamic wrist fixation with closed reduction is a simple and minimally invasive method, and provides successful clinical and functional results in the treatment of IFDR. We consider that optimal RI angles are effective in clinical and functional outcomes.