جستجوی مقالات مرتبط با کلیدواژه « fracture fixation » در نشریات گروه « پزشکی »

Dynamic nailing (IMN) by placing only one screw on one side of the nail, shortens the surgical time and reduces the complications during surgery and secondary dynamization, so we decided to investigate the healing of dynamic IMN of tibial fractures.

This cross sectional study was done on 67 patients with dynamic IMN in Fifth Azar Hospital, Gorgan in 2015-2018. Complications, union time, RUST score and Johner-Wruhs criteria were analyzed based on their grouping in AO classification.

The average age of the patients was 33.2±13 years. Most of the fractures were closed type (71.6%), type C (43.4%). The mean healing time was 14.62±4.38 weeks and RUST score was 8.9±1.26. There was no significant difference between locations of fracture and the healing time or RUST score (P> 0.05). The healing time in the comminuted fractures (e.g, type C) and open tibial fractures were statistically longer than the simpler type (e.g, type A or B) and the mean radiological score in type C fractures was significantly lower (P<0.05). The mean Johner-Wruhs Criteria score of fractures was 46.31±4.49, so that 61 patients had excellent results, four patients had good results, and two patients had fair results.

Dynamic IMN of closed and middle third tibial fractures and simpler types of fractures (e.g, type A or B) have faster healing. Anyway, it is better to be more cautious for fixation of open or comminuted fracture (e.g, type C).

As operative techniques and the quality of implants are improving, surgical management of diaphyseal fractures of forearm bones in elderly patients is gaining widespread acceptance. A combination of a better understanding of the fractures, preoperative antibiotics, properly designed newer implants, minimal soft tissue handling techniques, and C-Arm guidance have made surgical fixation practical and safe while treating these fractures. Titanium elastic nailing system (TENS) provides flexural, axial, translational, and adequate amounts of rotational stability.

The treatment of diaphyseal forearm bone fracture with TENS nail aims to regain length, axial, and adequate rotational stability without extensive soft tissue injury, neurovascular compromise, and periosteal stripping. Objective of this study is to analyze the demographic distribution, union rates, functional outcomes, cosmetic outcomes, complications, and functional rehabilitation of the upper limb.

Elderly patients admitted to the Department of Orthopedics at SRG Hospital and Medical College, Jhalawar with BBFA diaphyseal fractures during the period from JUNE 2019 TO MAY 2023 were selected and evaluated clinically and radiologically. We followed all those patients for an average of 6 months. The outcome was assessed using the Grace-Eversmann scoring system. We followed up with all 25 patients and evaluated them every 2 weeks until the fracture unites.

Our study consisted of 25 patients, 14 males, and 11 females. The mean age of distribution was 65 years. The average time to bone union was 12 (8–20) weeks, and the average surgery time was 35 (15–60) minutes. There was a superficial infection in 1 case. No one had a deep infection, mal-union, non-union, fracture, nail migration, compartment syndrome, nerve palsy, synostosis, or rupture of any tendon. Most patients had a full range of Elbow and Wrist Movements after the union.

Based on our experience and results, we conclude that the titanium elastic nailing technique is a better method for the treatment of displaced BBFA diaphyseal fractures in elderly patients also. It is easy, cheap, convenient, and gives elastic mobility promoting a rapid union of fractures and stability which is ideal for early mobilization. It provides a lower complication rate, shorter surgery time, good cosmetic outcome, and easy implant removal when compared to other methods of treatment.

We report four cases of subtrochanteric fracture in school-aged pediatrics, treated with an adult proximal humerus locking plate. The clinical outcomes were excellent. The advantage of this plate is that many screws can be inserted at appropriate positions and angles without damaging the physis. This approach is considered useful for pediatric subtrochanteric fractures.

Displaced acetabular fractures are complex injuries that necessitate precise surgical intervention. Obturator nerve injuries occur in approximately 2% of cases. The modified Stoppa approach, offering enhanced exposure of the quadrilateral plate, has gained attraction as an alternative technique for anterior acetabular fractures. However, its proximity to the obturator nerve poses a risk of iatrogenic injury. This study aimed to investigate the incidence of nerve injuries and functional outcomes in patients undergoing the modified Stoppa approach for traumatic acetabular fractures. This retrospective study involved 86 patients with anterior column fractures, whose data were prospectively collected. The fractures were treated using the modified Stoppa approach. Exclusion criteria were pathological fractures, alternative surgical approaches, prior nerve injuries, hip issues, refusal to participate, or inadequate follow-up. Data collection involved pre-operative imaging, thorough post-operative neurological assessments, and post-operative radiographic evaluation. Functional outcomes were assessed using the Harris Hip Score (HHS). Most patients were male (n=54) with a mean age of 40±17.3 years. Post-operative infection occurred in six cases, with resolution in four through antibiotics and two necessitating device removal. Obturator nerve damage was detected in 14 patients, comprising nine traumatic and five iatrogenic cases. During the follow-up, symptoms improved in all patients, except for the four patients with iatrogenic nerve damage. Traumatic nerve injuries generally heal naturally over time. In contrast, iatrogenic injuries have a less optimistic prognosis, potentially resulting in lasting neurological deficits. Level of evidence: III

Various fixation techniques have been described for osteotomy for correction of cubitus varus. Kirschner-wiring (K-wiring) was used in the past for fixation; however, rates of fixation failure and pin-track infection were high. Fixation with two screws and a figure-of-eight wiring provides a stable fixation in children younger than 15 years. Herein, we used a modified lateral approach and a figure-of-eight construct with two screws and evaluated the outcome.

A case series comprising 35 patients out of the total of 54 patients who underwent modified French osteotomy between January 2013 to December 2021 was conducted retrospectively. Functional outcomes were assessed using the modified Mayo Elbow Performance Scoring (MEPS) system.

There were 22 male and 13 female subjects in the study group. We had excellent results in 16 cases, good outcomes in 13 cases, and fair outcomes in 6 cases. Superficial infection was seen in three patients and four patients had occasional negligible pain. In addition, there was no loss of correction or fixation failures in our study.

Modified French osteotomy using two screws and figure-of-eight wiring is a simple and safe procedure that yields satisfactory outcomes. A careful preoperative planning, sufficient surgical technique, and stable fixation are key to achieving satisfactory functional outcomes.

An obese 57-year-old woman with known hypertension and diabetes mellitus sustained multiple injuries during an accident, which caused anterior-posterior fracture-dislocation of the pelvic ring. Due to the drawbacks of conventional stabilizing methods for anterior-posterior fracture-dislocations of the hip in this setting, such as the inability to visualize anatomical landmarks fluoroscopically for the iliosacral screw technique and the compromised L5 pedicle preventing lumbopelvic fixation, the patient underwent an innovative Hula Hoop technique described here. Using the Hula Hoop technique, a technique that has rarely been studied in humans, we avoided an invasive open procedure, decreased anesthesia time, reduced the size and number of incisions, and minim ized bleeding. After three months of routine physiotherapy and occupational therapy, the patient was able to walk with a walker and an ankle-foot orthosis.  

Intertrochanteric hip fractures are a common orthopaedic injury in the United States. Complications of surgical treatment include nonunion, lag screw cutout, implant failure, post -operative pain, risk of refracture or reoperation, and infection. The purpose of this study was to compare the rate of complications of sliding hip screw fixation (SHS) compared to cephalomedullary nailing (CMN) for the treatment of closed intertrochanteric femur fractures in adult patients.

PubMed, CINAHL, and Cochrane Library databases were searched for studies comparing SHS to CMN in the treatment of closed intertrochanteric femur fractures in adults. Data were compiled to observe the rate of nonunion, cutout failure, infection, refracture, perioperative blood loss, reoperation, postoperative pain, pulmonary embolism/deep venous thrombosis (DVT), length of hospital stay, and mortality.

Seventeen studies were included comprising 1,500 patients treated with SHS and 1,890 patients treated with CMN. Treatment of intertrochanteric femur fractures with SHS demonstrated significantly fewer refractures and reoperations. There was no significant difference in other variables between SHS and CMN treated groups.

This meta-analysis shows that the only notable difference in outcomes is patients treated with CMN have a higher rate of refracture and reoperation. With new advances in the development of both CMNs and SHS, further studies will be required to see if these differences persist in the coming years. 

This study investigates outcomes and complications of the pin and plate fixation technique, which was suggested for distal humerus fractures. It also reports the results of its application in nonunions for the first time. Forty-nine fracture and 17 nonunion cases who underwent surgery using the technique and were followed for at least 18 months were assessed through the range of motion (ROM), Quick Disabilities of the Arm, Shoulder, and Hand Score (Quick-DASH), Mayo Elbow Performance Score (MEPS), four-category verbal rating scale (VRS4), and complications. At the last follow-up, the mean scores of flexion, extension deficit, supination, and pronation ranges in fracture cases were 116.7, 22.9, 90.0, and 90.0 degrees, respectively. These values in nonunion cases were 112.2, 26.4, 86.7, and 85.5 degrees, respectively. The average ROM in fracture cases was 93.8, while it was 85.8 degrees in nonunion cases. The mean Quick-DASH in fracture and nonunion patients were 25.2 and 31.1, respectively. According to the MEPS, 77.5% of fracture and 64.7% of nonunion patients had excellent and good results. In fracture cases, the mean scores of VRS-4 at rest, light activity, and hard activity were 1.3, 1.8, and 2.3, respectively. These values in nonunion cases were 1.8, 2.2, and 2.5, respectively. The most common complications were device prominence and ulnar neuropathy. An acceptable union rate and proper elbow function can be expected by using this technique. Owing to the promising results of this study, further high-quality studies are recommended. Hereby this technique is called Persian Fixation. Level of evidence: IV

Uncertainties remain as to which type of plate [locking compression plate (LCP) or dynamic compression plate (DCP)] is more efficient and cost-effective in fixing and stabilizing the fractures. We aimed to compare the clinical utility of the two types of plates including LCPs and 3.5-mm DCPs in the treatment of low distal fibula fracture (distal lateral malleolus fractures).

This randomized single-blinded clinical trial was performed on 54 patients with distal fibula fractures who were candidates for surgical treatment using compression plate fixation. The patients were randomly assigned into two groups scheduled for treatment with fixation of LCPs or with 3.5-mm T-plates (DCPs). The patients were finally followed-up for two years to assess the clinical outcome of the procedures.

No difference was revealed between the two groups in the prevalence of postoperative infection, nonunion, wound dehiscence, skin reactions, and local surgical pain. The mean functional score [Olerud-Molander Ankle Score (OMAS)] in the DCP and LCP groups was 85.33 ± 4.92 and 84.85 ± 5.12, respectively, indicating no difference between the groups (P = 0.726).

In the treatment of low distal fibula fractures, the use of LCPs and 3.5mm DCPs can similarly result in improving functional status with minimal postoperative complications. Due to the similarity of the consequences of using both plates and the fact that the DCP type is more cost-effective and available in remote and deprived areas, this type seems to be preferred.

The posterior cruciate ligament (PCL) presents commonly as avulsion fractures from the tibial attachment site. Isolated tears of the PCLcan be caused by a fall on the flexed knee or dashboard injury in road traffic accident. Such a mechanism (the upper tibia driven posteriorly with the knee flexed) may produce PCL disruption as the only clinically detectable instability. For the PCL avulsion fractures fixation, there are various methods available like closed reduction and internal fixation (CRIF), open reduction and internal fixation (ORIF), and arthroscopic fixation. This study was performed to assess the result of PCL avulsionfracture managed with ORIF with cannulated cancellous screw.

We performed ORIF using cannulated cancellous screws with the posterior approach in 11 patients with isolated PCL tibial avulsion injuries. The minimum follow-up period was 6 months. The results were assessed radiologically and clinically. The spectrum of outcomes following PCL tibial avulsion fracture were measureusing the Lysholm knee scoring system and range of motion (ROM) of the knee joint.

63.6, 27.3, and 9.1percentof the cases had excellent, good,and moderate fracture healing, respectively.

PCL tibial avulsion fractures managed with open reduction with cannulated cancellous screw fixation yields good functional outcome with less complications.

A 21-year-old male patient was admitted with a severe right thigh deformity following a car accident. He had experienced a previous history of intramedullary interlocking femoral nail 3 years ago.The neurovascular examination was normal. The radiologic evaluation revealed a bent nail with 105° angular deformity in the sagittal plane.With a lateral approach to the apex of the fracture site, the bent nail was cut by an 8mm cobalt drill, two parts of the nail were extracted; then fixation was performed by a new intramedullary interlocking nail and autogenous cancellous graft.The fracture healed properly without any complications 6 months after corrective sur-gery.

About 20% of femoral neck fracture surgeries require re-operation. The use of medial buttress plate may reduce the re-operation rate. The purpose of this study is to examine the results of using the method of augmentation of the cannulated screws with medial buttress plate for treatment of unstable femoral neck fractures.

This study included patients with femoral neck fractures of Pauwels type 2 and 3 in which closed reduction was not successful. The patients underwent open anatomical reduction andimplantation of three screws, and then the medial placement of the buttress plate was performed. Patients were followed up after 2 weeks, 6 weeks, 3 months, and 6 months. Union and fracture healing and operative complications were assessed using plain radiography.

This study included 8 patients with Pauwels type 2 and 3 femoral neck fractures. All patients were men with the mean age of 38.0 ± 11.3 years. Re-hospitalization 30 days after surgery, surgical site infection, deep vein thrombosis (DVT),and deep infection were not observed in any of the patients. The angle between the neck and the femur shaft dramatically increased during the 6-month follow-up (P = 0.049). Union occurred in 6 (75%) patients after 6 months, while 2 patients were lost to follow up. Participants’ Harris Hip Score (HHS) had a significant improvement from 3 months to 6 months after surgery (P = 0.02).

Augmentation of cannulated screws with medial buttress plate for unstable femoral neck fractures in patients has advantages in short-term clinical follow-up.

Atypical femoral fractures are the femoral fractures located anywhere between the lesser trochanterand the supracondylar flare of the femur. Long-term bisphosphonates, as the most common preventive and treatmentmedications for osteoporosis, are thought to have an important role in these fractures. Most of the fractures should betreated surgically, and the complications are considerable.

We searched Medline, CENTRAL, Embase, and DART on February 26, 2020. One author reviewed andretrieved citations from these four databases for irrelevant and duplicate studies, and two other authors independentlyextracted data from the studies and rated their quality.Patients with surgical treatment of bisphosphonate-related atypical femoral fracture, according to the American Societyfor Bone and Mineral Research definition, were included. Animal studies, case reports, studies with high-energy trauma,pathological fracture, or malignancy-related fractures were excluded.

In total, 316 patients (348 fractures) were included in this study. Mean age of patients was 70.47 years,and 97.5% of them were female. Duration of using bisphosphonates was 4.04 to 8.8 years, and Alendronate was themost common type. Moreover, 65.27% and 34.72% of the reported fractures were in diaphyseal and subtrochanteric,respectively. Moreover, the most common fixation type was intramedullary. Rate of complication was 17.52%, and themost frequent one was non-union, followed by implant failure. The main limitation of this research was that most of thestudies did not have a high level of evidence.

An increase in the rate of atypical femoral fracture with its challenging management makes it an importantissue to be noted by orthopedic surgeons. Based on the results of this study, subtrochanteric fractures might have morecomplications post-operatively and are suggested to be operated on by more experienced surgeons. It was also foundthat extra-medullary fixation increases the risk of complications. Future studies on union time, outcomes of differentsurgical methods, and teriparatide therapy may help shed more light on the surgical management of these fractures.Level of evidence: III