Unilateral Fractures Research Articles

Morphometric Parameters of the Proximal Femur in Nepalese Population: A Cross-sectional Study

Background: Most of the proximal femur fractures are managed surgically by internal fiation with a variety of implants. Improperly designed or ill-fited implant may lead to a failure of fiation, breakage of implant and nonunion, thus increasing the morbidity and the cost of treatment. This study was conducted to evaluate the radiographic morphometry of the proximal femur which may be helpful in designing the implants for the Nepalese population.
 Methods: In this cross-sectional study, 84 patients aged 18 years and above with traumatic unilateral hip fracture were enrolled. Anthropometric measurements were recorded. The postoperative check X-ray in the antero-posterior view of the pelvis and bilateral hip were assessed. Various morphometric parameters of the proximal femur were measured and recorded in the radiograph of the unaffcted limb using a digital caliper.
 Results: Out of 84 patients, 47 were male. The mean ± SD femoral neck width, femoral neck length, femoral axis length, cervico-diaphyseal angle, acetabular tear-drop distance, and great trochanter-pubic symphysis distance were 36.10 ± 5.67 mm, 28.29 ± 4.18 mm, 104.51 ± 9.56 mm, 130.35 ± 8.67°, 32.56 ± 11.05 mm, and 163.07 ± 10.71 mm respectively. The femoral neck width was found to be signifiantly larger in males (39.08 ± 3.06 mm) than in females (32.32 ± 5.99 mm, p < 0.001).
 Conclusion: This study determined the radiographic measurement of the proximal femur and found that the femoral neck width of the males was larger than that of the females.

Evaluation of bilateral tibial fracture management by external and internal fixation technique in a calf

Unilateral diaphyseal tibial fractures are very common in different species of animals but the occurrence and repair of bilateral diaphyseal tibial fractures are very rare. The aim of the present study is to evaluate the efficacy of bilateral tibial fracture management in a calf. The study was performed in a 75 days old cross-bred calf weighing 42 kgs which was suffering from bilateral tibial fracture and treated by external coaptation technique on left tibia and internal fixation by retrograde intramedullary pinning on the right tibia. The patient was evaluated after treatment at different intervals by recording the lameness grade, functional limb outcome, fracture healing. Satisfactory posture (weight bearing), gait and secondary bone healing in both left and right tibia were noticed up to 93 day of post-treatment with the minor complications of swelling and stiffness of the right hock joint and hyperextension of fetlock joint of left hind limb. This technique can be used in bilateral tibial fracture management in calf in field condition with reasonable cost

Does Three-Dimensional Plate Offer Better Outcome and Reduce the Surgical Time Following Open Reduction and Internal Fixation of Adult Mandibular Unilateral Subcondylar Fractures. A Randomized Clinical Study

The management of the condyle fractures continue to be a source of perineal controversy in the field of oral and maxillofacial trauma. The aim of this study was to compare the surgical feasibility, functional outcome, and stability of fixation between the conventional miniplate and 3-dimensional plate in the management of adult mandibular unilateral subcondylar fractures. A prospective randomized clinical study with well-structured inclusion and exclusion criteria was carried out. Patients were allocated into Group A (Miniplates) and Group B (3-D Plates). The primary outcome variables were time taken for fixation, maximum mouth opening, occlusal stability, increase in angulation, and increase in the gap between fractured segments in the radiograph. The secondary outcome variables were needed for intermaxillary fixation (IMF) with guiding elastics and jaw movements. Statistical analysis was done using χ2 test and student's t test with P value less than 0.05 indicating statistical significance. Forty-four patients (40 male and 4 female) were enrolled, with 22 patients in each group. Time taken for fixation using 3-D plates was significantly lower than conventional miniplates (9.6±0.9minutes with P value 0.001). Although clinical parameters showed improved results for Group B, there was no statistical significance. Radiological parameters ie increase in angulation, and increase in the gap, showed statistically significant results. Group A had significant increases in the angulation of the fractured condyle at the end of the third and sixth months with a P value of 0.008 and 0.0001, respectively. The gap between the fractured segments was significantly increased in Group A at the end of the first and third months, with a P value of 0.022 and 0.003, respectively. Our results concluded that 3-D plate offers superior fracture fragment stability and less displacement of the fractured segments. It has an added advantage of the ease of adaptation and shorter operating time.

Comparison between open reduction and internal fixation and minimally invasive surgery in management of Sanders type II calcaneal fracture: A randomized controlled trial protocol.

Background:The minimally invasive surgery possesses an essential and growing function in treating the calcaneal fractures, but the related literature on this topic is limited. For our study, the main purpose was to compare the early prognosis of a group of the patients with Sanders type II fracture of calcaneus treated via minimally invasive surgery and open reduction and internal fixation (ORIF).Methods:This is a prospective randomized controlled trial in the patients who suffer from displaced intra-articular calcaneal fractures. This current study was carried out in accordance with the guidelines of “CONSORT statement” for the randomized controlled studies. All patients were randomly assigned into 2 groups on the basis of a random number table, namely the minimally invasive treatment group and the ORIF group using conventional methods. Inclusion criteria included the followings: aged between 18 to 59 years old; closed and unilateral fracture; patients with displaced intra-articular calcaneal fracture (>2 mm) involving Sanders Type IIC and Type IIB; and patients have enough mental capacity to understand and answer questions in the evaluation scale. In the process of outpatient follow-up, the radiographs were taken at 1, 3, 6, and 12 months. The functional results involved the American Orthopaedic Foot and Ankle Score, Foot Function Index, and the pain score.Conclusions:This protocol will give us research directions in future work.Trial registration:This study protocol was registered in Research Registry (researchregistry6261).

Evaluation of the preauricular transmassetric anterior parotid approach in the open reduction and internal fixation of condylar fractures

Numerous approaches have been described to access the fractured condyle. Unrestricted wide optical window to the fracture site and the safety of the facial nerve dictate the type of approach required. Aims: To evaluate the pre auricular transmassetric anterior parotid approach in 20 unilateral condylar fractures. Results: All the twenty cases evaluated showed adequate mouth opening, no signs of facial nerve palsy and sialocele. The transmassetric anterior parotid approach is a safe approach which can be used in the surgical management of condylar fractures and is of special value in obtaining excellent exposure in the cases of medially displaced condylar neck fractures. Keywords: Condylar fractures, Open reduction internal fixation, Preauricular, Transmassetric anterior parotid.

Comparative pattern of fracture in different animals

Incidence of bone fracture is very common in both medical and veterinary profession. There is lots of fracture management techniques applied for bone fracture. A total of 6163 clinical cases were recorded from May, 2017 to April, 2018 at the Sahidul Alam Quadery Teaching Veterinary Hospital (SAQTVH), CVASU. The objectives of the study were to find out the incidence of fracture in dogs, cats, goats and cattle and parameters were also studied for fracture occurrence in breed, age, sex and different nature and causes of fractures. A total of 6163 cases were recorded out of which 829 were surgical cases and 85 were fracture cases (dog-20, cat-19, goat-36 and cattle-10). The overall incidence of fracture was recorded as1.38% for all four species (dogs, cats, goat and cattle) of animals and 10.25% for all surgical cases of animals. Goat was the most common (42.35%) species to have a fracture among four species. Local breeds were more susceptible for fracture in dog, cat and cattle but jamunapari breeds were common in goats. Overall males were more prone for fracture and age less than six months old were also more vulnerable for fracture among four species. Closed unilateral hind limb fractures were more in all cases. Among different bones, femur fracture was the most common in dogs and cats but metacarpal bone was more common in goat and tibial bone in cattle and most of the fractures were oblique in nature. Falling from height (34.11%) was the major cause of fracture comparison to other causes but according to four species, automobile accident was common cause of fracture in dogs.

Various Management Modalities and Radiographic Outcomes of Condylar Fractures: A Single Centric Retrospective Study

Background: The mandibular condylar fracture is second most frequent maxillofacial fracture but still the management remains controversial. Aim: The purpose of the present study is to evaluate the clinical as well as radiographic outcomes of different types of management modalities in various mandibular condyle fractures during 6 months of follow-up. Material and Method: This retrospective study consisted of 17 patients of which 11 were male (65%) and 6 female (35%). These included 12 unilateral condylar fractures (70%) and 5 bilateral fractures (30%). Anatomically, these fractures were 13 condylar neck fractures (59%) while 9 were subcondylar fractures (41%). Depending on the anatomic position, type, displacement/dislocation/deviation of condyle, and associated fractures, 5 closed reduction (23%) and 17 open reduction and internal fixations (77%) were performed. Fixation was done with lag screw in 1 patient, 3-D strut plate in 2 patients, and single miniplate fixations in 14 patients. Orthopantomograms were taken preoperatively, immediate postoperatively, and at 1, 3, and 6 months postoperatively to evaluate the radiographic changes. Results: Preoperatively, the average ramus height was 62.07 ± 4.13 (in mm) while condylar angulation was 18.23 ± 4.38 (in degree) while immediate postoperatively these were 66.98 ± 5.03 (in mm) and 25.67 ± 4.07 (in degree), respectively. After 6 months, the value was 66.43 ± 4.97 (in mm) and 25.24 ± 3.94 (in degree) which is statistically significant (P < .5). Conclusion: Open reduction and internal fixation allows better maintenance in function and anatomical repositioning of condyle as compared to closed reduction.

Radiographic Assessment of Pediatric Condylar Fractures after Conservative Treatment with Functional Appliances-A Systematic Review.

Background: To evaluate the effectiveness of conservative treatment with functional appliances for condylar fractures in pediatric age. Methods: Four electronic databases (PubMed, EBSCO, Scopus, and Web of Science) were consulted with no restriction of publication status or year, up to 31 August 2020. Selection criteria: based on the PICOS criteria, the selection criteria were set for observational human studies, with at least 10 patients and six months of follow-up. The study population included pediatric patients (aged 5–16 years), with unilateral or bilateral condylar fracture, treated with functional appliances. Condylar remodeling and mandibular growth were analyzed through sequential radiographic examinations. Data collection and analysis: Two independent reviewers carried out title-abstract screening, and a senior investigator was involved to solve any disagreement. The quality of the evidence was assessed through the Canada Institute of Health Economics (IHE) quality appraisal checklist, and the National Institutes of Health (NIH) quality assessment tool. Results: A total of 971 articles were retrieved from the electronic search; among them, three studies met the eligibility criteria. A moderate risk of bias was detected in all the studies, due to common limitations (absence of multicenter studies, prospective design, blindness of the investigators, patients’ drop-out). At follow-up examinations (between 6 months and 4.9 years), the difference of condylar neck length between the “injured” and “healthy” side was approximately 2 mm, while the anteroposterior condylar width discrepancy was recorded up to 1 mm. Conclusions: Short- and long-term data revealed that conservative treatment with functional appliances led to partial or full radiological recovery of the joint morphology, along with good to excellent functional results. Patients’ age has a crucial role on the treatment choice, and the type of fracture (presence of condylar displacement, or dislocation) is also a major prognostic indicator of the radiologic outcome. Limitation: To confirm the effectiveness of functional appliances, more prospective clinical long-term follow-up studies with homogeneous samples of condylar fractures are deemed necessary. Registration: The study protocol was registered on PROSPERO (CRD42020205650).

Identifying Bone Matrix Impairments in a Mouse Model of Neurofibromatosis Type 1 (NF1) by Clinically Translatable Techniques.

Three-to-four percent of children with neurofibromatosis type 1 (NF1) present with unilateral tibia bowing, fracture, and recalcitrant healing. Alkaline phosphatase (ALP) enzyme therapy prevented poor bone mineralization and poor mechanical properties in mouse models of NF1 skeletal dysplasia; but transition to clinical trials is hampered by the lack of a technique that (i) identifies NF1 patients at risk of tibia bowing and fracture making them eligible for trial enrollment and (ii) monitors treatment effects on matrix characteristics related to bone strength. Therefore, we assessed the ability of matrix-sensitive techniques to provide characteristics that differentiate between cortical bone from mice characterized by postnatal loss of Nf1 in Osx-creTet-Off ;Nf1flox/flox osteoprogenitors (cKO) and from wild-type (WT) mice. Following euthanasia at two time points of bone disease progression, femur and tibia were harvested from both genotypes (n ≥ 8/age/sex/genotype). A reduction in the mid-diaphysis ultimate force during three-point bending at 20 weeks confirmed deleterious changes in bone induced by Nf1 deficiency, regardless of sex. Pooling females and males, low bound water (BW), and low cortical volumetric bone mineral density (Ct.vBMD) were the most accurate outcomes in distinguishing cKO from WT femurs with accuracy improving with age. Ct.vBMD and the average unloading slope (Avg-US) from cyclic reference point indentation tests were the most sensitive in differentiating WT from cKO tibias. Mineral-to-matrix ratio and carbonate substitution from Raman spectroscopy were not good classifiers. However, when combined with Ct.vBMD and BW (femur), they helped predict bending strength. Nf1 deficiency in osteoprogenitors negatively affected bone microstructure and matrix quality with deficits in properties becoming more pronounced with duration of Nf1 deficiency. Clinically measurable without ionizing radiation, BW and Avg-US are sensitive to deleterious changes in bone matrix in a preclinical model of NF1 bone dysplasia and require further clinical investigation as potential indicators of an onset of bone weakness in children with NF1. © 2022 American Society for Bone and Mineral Research (ASBMR).

Development and application of the average pelvic shape in virtual pelvic fracture reconstruction.

With unilateral pelvic fractures, the contralateral hemipelvis can be used as a template in virtual reconstruction; however, this cannot be applied for bilateral fractures. Therefore, statistical shape modelling was used to build average pelvic shapes that can serve as templates when reconstructing bilaterally fractured pelvises. Four average shape models were created for male and female, left and right hemipelves from 20 male and 20 female subjects. They were used as templates to reconstruct eight unilaterally fractured pelvises. The average root-mean-square of deviations between the reconstructed and intact hemipelves was 1.46 ± 0.32 mm, which is less than the 2 mm threshold for causing hip joint complications. This indicates that the reconstructions are reliable and the average shape models can be used to reconstruct bilaterally fractured pelvises. The proposed technique can potentially provide quick and accurate treatment plans for pelvic fracture patients, which is necessary for recovery.

Time-Lapse Between Presentation and Treatment of Mandibular Fractures: Is There a Correlation With Sensory Loss Recovery or No Recovery?

A prospective cohort study composed of 43 patients treated for unilateral mandibular fracture. The primary study variables were the post-traumatic IAN neurosensory score and the score after fracture reduction in two different groups on the basis of time lapse between presentation and treatment and displacement of mandible fracture. Appropriate descriptive and bivariate statistics were computed. The sample was analyzed over a one year period. It was observed that the recovery percentage (80%) was good in Group-A (n = 20) patients as compared to Group-B (n = 23) patients (43.47%) with significant P value of 0.015. Patients with displacement of ≥9 mm have neurosensory deficit of 80% while fracture displacement ≥ 5 mm to 8 mm have the neurosensory deficit of 34.21% which is significant with P value of 0.049. With each millimeter increase of displacement of fracture segments, more neurosensory deficit will be manifested. Delay in seeking in the treatment increases the risk because of continued movement. Where the injury is more severe, excessive displacement with increased time lapse from injury to surgical intervention, there is a higher possibility neurosensory deficit or no recovery. Early management can reduce the risk of permanent neurosensory deficits.

A retrospective study to compare the treatment outcomes with and without surgical navigation for fracture of the orbital wall

PurposeTo evaluate the outcomes with and without aid of a computer-assisted surgical navigation system (CASNS) for treatment of unilateral orbital wall fracture (OWF). MethodsPatients who came to our hospital for repairing unilateral traumatic OWF from 2014 to 2017 were included in this study. The patients were divided into the navigation group who accepted orbital wall reconstruction aided by CASNS and the conventional group. We evaluated the surgical precision in the navigation group by analyzing the difference between actual postoperative computed tomography data and preoperative virtual surgical plan through color order ratios. We also compared the duration of surgery, enophthalmos correction, restoration of orbital volumes, and improvement of clinical symptoms in both groups systemically. Quantitative data were presented as mean ± SD. Significance was determined by the two-sample t-test using SPSS Version 19.0 A p < 0.05 was considered statistically significant. ResultsSeventy patients with unilateral OWF were included in the study cohort. The mean difference between preoperative virtual planning and actual reconstruction outcome was (0.869 ± 0.472) mm, which means the reconstruction result could match the navigation planning accurately. The mean duration of surgery in the navigation group was shorter than it is in the control group, but not significantly. Discrepancies between the reconstructed and unaffected orbital-cavity volume and eyeball projection in the navigation group were significantly less than that in the conventional group. One patient had remnant diplopia and two patients had enophthalmos after surgery in the navigation group; two patients had postoperative diplopia and four patients had postoperative enophthalmos in the conventional group. ConclusionCompare with the conventional treatment for OWF, the use of CASNS can provide a significantly better surgical precision, greater improvements in orbital-cavity volume and eyeball projection, and better clinical results, without increasing the duration of surgery.

Early Hypoglobus in Orbital Floor Reconstruction With Resorbable Implants.

Among the variety of materials developed for facial bone surgery, resorbable implants are widely used in orbital wall reconstruction. There are many advantages in selecting resorbable implants, such as minimal foreign body reaction and adjustability within the damaged orbital floor. Resorbable implants are supposed to remain in place over 1 to 2 years to hold the structure of immature healing tissue surrounding the bony defects. However, some patients who have undergone orbital wall reconstruction surgery with resorbable implants suffer from early hypoglobus. This retrospective study was performed from January 2014 to August 2019 and follows 39 patients with unilateral pure orbital floor fractures. All orbital floor reconstruction was performed using resorbable implants via the transconjunctival approach. Exophthalmometer measurements and CT scans showing the degree of implant sagging were used to provide an index of hypoglobus. Most patients showed hypoglobus over 3 to 4 months follow-up. The size of bony defect in the orbital floor showed positive correlation with follow-up exophthalmometer measurement and degree of implant sagging. Orbital floor reconstructed with resorbable implant tends to lose load-bearing strength gradually, especially in large bony defects. Therefore, surgeons should be cautious about using resorbable implants for the maintenance of reconstructed orbital floor, especially in large bony defects.

Longitudinal changes in physical activity levels and fear of falling after hip fracture.

Due to global ageing, more people will suffer from hip fracture in the future, and many will be left with permanent physical impairments. The care burden for people post hip fracture is high. The aim of this study is to measure longitudinal changes in physical activity levels and fear of falling in people after hip fracture who return home after inpatient rehabilitation. Longitudinal observational study. Participants were recruited from three rehabilitation centres in Victoria, Australia. Self-reported fear of falling (Short Falls Efficacy Scale - International) and physical activity levels (Human Activity Profile - Adjusted Activity Score and Frenchay Activity Index) were assessed at 2 weeks, 3 and 6 months after discharge. Mobility (walking speed) and balance (Timed Up-and-Go test and Step Test) were measured at discharge from rehabilitation. Thirty-four participants (mean age: 82 years [SD 8]; 62% female) with unilateral hip fracture were recruited. Participants had moderately impaired balance and mobility at discharge compared to age-matched normative data; they were all discharged with a walking aid and were 40% slower in their walking speed. Participants had increased fear of falling and reduced physical activity 2 weeks after discharge, which improved significantly (p < 0.01) over the following 6 months, but scores were still lower than the normative values. At 6 months, participants also had moderate to high levels of fear of falling and were less active than the general population of similar age. Although fear of falling and physical activity improved in the 6 months following discharge, both remained negatively affected compared to normative data. Rehabilitation post hip fracture should include routine assessment of fear of falling as a potential barrier for return of physical activities.

External coaptation for mandibular fractures in bearded dragons (Pogona vitticeps): 2 cases

Mandibular fractures are a common presentation in reptiles, and most often occur from fighting with cage mates, falls, or iatrogenic trauma from improper handling or getting caught in cage doors/lids. Two cases of a simple, complete, open fracture of the right mandible in bearded dragons are described. In Case 1, a 2.5-year-old female intact bearded dragon presented with a right mandibular fracture after being bitten by a blue tongued skink. In Case 2, 10-month-old, female intact 259-g bearded dragon presented with an iatrogenic right mandibular fracture. External coaptation was applied with a metal wire and dental acrylic molded to the ventral mandible in both cases. A modified tape muzzle was used to reduce movement of the mandible. External coaptation was removed in the Case 1 at 7 weeks and in Case 2 at 9 weeks, with radiographic evidence of calcification at the fracture site. External coaptation with a dental acrylic and a modified tape bandage healed simple, complete, open unilateral mandibular fractures in 2 bearded dragons. The use of this external coaptation allowed the animals to continue with normal activity and did not require esophageal feeding tubes for nutritional support.

Femoral neck shaft angle in relation to the location of femoral stress fracture in young military recruits: femoral head versus femoral neck stress fracture

ObjectiveTo evaluate the influences of the femoral neck shaft angle (FNSA) on the location of the femoral stress fracture and to assess the potential differences in FNSA between fractured and normal femurs.Materials and methodsThirty-seven patients with femoral stress fractures who underwent both plain hip radiographs and MRI, from January 2016 to September 2019, were retrospectively included. Patients were classified as having either femoral head stress fracture (group A, n = 26) or femoral neck stress fracture (group B, n = 11). The FNSA was measured in anteroposterior (AP) hip radiograph. The Mann-Whitney U testing was used to compare the continuous values between the two groups. A receiver operating characteristic (ROC) analysis was used to evaluate the value of FNSA for predicting the risk of femoral stress fracture.ResultsThe FNSA was significantly higher in group A (median 135.9°, range 129.5–138.6°) than group B (median 124.3°, range 119.5–129.0°) (p < 0.001), but there were no significant differences in other clinical factors. Furthermore, the FNSA was significantly higher at the fractured femurs (median 135.9°, range 129.9–138.6°) than contralateral normal femurs (median 127.9°, range 123.8–132.1°) in the patients with unilateral femoral head stress fracture (n = 22) (p < 0.001). The ROC analysis revealed that the area under curve (AUC), sensitivity, and specificity for predicting the risk of femoral head stress fracture were 0.807, 72.7%, and 68.2%, respectively, at a FNSA cutoff of 131.0°.ConclusionFNSA was associated with the location of the femoral stress fracture. In addition, FNSA could serve as a predictive factor for the risk of femoral head stress fractures.

Analysis of Frontal Sinus Fracture Management and Resource Utilization.

Frontal sinus fractures require a large amount of force and often occur in the context of a major trauma. Many patients with these fractures are assessed in an emergent setting where stabilization takes precedence. Delayed diagnosis and treatment of a sinus fracture can result in life-threatening conditions, such as a cerebrospinal fluid (CSF) leak. A number of different treatment algorithms have been proposed, highlighting the complexity of frontal sinus fracture management. The goal of this study is to determine how patients with frontal sinus fractures were treated at Texas Tech University Health Sciences Center and what complications arose as a result of the fracture and subsequent management strategy. Over 9 years, there were 69 reported cases. A total of 63 of these occurred in males (91.3%) versus 6 (8.7%) in females. The majority occurred after a motor vehicle collision (MVC) or a motorcycle collision (MCC). A total of 51 cases were unilateral fractures and 18 were bilateral fractures. Five patients (7.2%) had CSF leakage and 64 (92.8%) did not have CSF leakage. One patient with CSF leakage (20.0%) was managed operatively. Of the 64 patients without CSF leakage, 4 (6.3%) were managed operatively. All operative patients were managed by cranialization. Complications included vision changes, facial pressure, anosmia, facial paresthesia, pneumocephalus, and mucus retention cysts. Vision changes were the most common complication. There did not appear to be any significant difference in complications between the CSF leakage groups, indicating that non-operative management remains a viable option in the management of frontal sinus fractures.

Functional Outcomes of Clavicular Fractures Fixation in Adolescent Children

Background: Fractures of the clavicle are common in both adults and children. Recent studies in the treatment of adult fractures have indicated that improved outcomes are achieved after open reduction and internal fixation. The aim of this study was to conduct a retrospective study of the functional outcomes after open reduction and internal fixation of displaced clavicle fractures in adolescent children. Material and Methods: We analysed a retrospective case series of 28 adolescent children who had displaced fractures of the clavicle which were treated with open reduction and internal fixation. The rate of healing, radiographic outcomes, functional outcomes, and complications were looked at. Results: There were 28 children with an average age of 13.8 years (range 13-16 years) had their closed unilateral clavicle fractures treated with open reduction and internal fixation. All the patients were boys. The right side was affected in 14 patients and the left in 14. There were 26 mid-shaft fractures and two lateral-end fracture. Patients were followed for an average of 12 months. There were no superficial or deep infections and all cases went on to clinical and radiological union. Twenty-four (86%) of children returned to unrestricted sporting activity. The mean QuickDASH score at 12 months was 3.24. Four patients had scar sensitivity, and four had plate prominence. Ten patients required metalwork removal. Conclusion: Historically, almost all clavicle fractures in children were treated non-operatively regardless of the displacement and the location of fractures, with variable outcomes. We conclude that open reduction and internal fixation of displaced clavicle shaft fractures in older children can be performed safely and gives predictable results especially with healing periods and functional outcomes.

Comparison of functional outcome after open and closed reduction of mandibular subcondylar fracture.

To compare open reduction with internal fixation of mandibular subcondylar fracture with closed reduction in terms of adequate mouth opening. The randomised clinical trial was conducted from March 2014 to February 2015 at the Oral and Maxillofacial Surgery Department, King Edward Medical University and Allied Hospitals, Lahore, Pakistan, and comprised patients who presented with unilateral subcondylar fractures. The patients were randomly divided into 2 groups. Group-A patients were treated with closed reduction and immobilisation and were discharged the same day, while Group-B patients were treated by open reduction with internal fixation and retained in ward for 1 day. Both were recalled for periodic follow-ups, and were compared in terms of achieving adequate mouth opening. Data was analysed using SPSS 20. Of the 70 patients, 35(50%) were in each of the two groups. The mean age in Group-A was 28.88±11.86 years compared to 28.22±10.80 years in Group-B (p>0.05). Mean mouth opening in the two groups were consistently positive, and significant at the last two follow ups(p<0.001). The difference in results of both treatment modalities was significant, indicating that open reduction and internal fixation should be the preferred treatment.

The Efficacy of Fixation of Unilateral Mandibular Angle Fracture with Single 3D Plate vs Single Miniplate Using Transbuccal Approach.

The management of mandibular angle fractures is often challenging and results in the highest rate of complications. The optimal treatment modality still remains controversial. This study was done to compare the treatment outcomes of single 3D plate versus single miniplate. The objective was to compare and evaluate the clinical and radiological outcome in patients who underwent treatment with single 3D plate versus single miniplate using transbuccal approach for unilateral angle fractures with other associated mandibular fractures. A randomized control study was done in 12 patients with unilateral angle fracture who were divided into two groups. Group A patients were treated using single 3D plates, and Group B patients were treated using single miniplates. Study parameters were evaluated at different time intervals. The results of the study showed that postoperatively in Group A, fracture reduction, occlusion and mouth opening were comparatively better than Group B. Hardware failure was seen in one patient in Group B. Postoperative morbidities showed no statistical difference. The single 3D plates showed a statistically insignificant advantage over single miniplates, although clinically Group A proved better than Group B with respect to the study parameters. Therefore, we recommend the use of single 3D plates for effective unilateral angle fracture treatment. More studies are required to prove the significant statistical significance.