جستجوی مقالات مرتبط با کلیدواژه « open reduction » در نشریات گروه « پزشکی »

The surgical management of periprosthetic fractures (PPF) and periimplant fractures (PIF) can be challenging. The locking attachment plate (LAP) was proposed in recent years for the osteosynthesis of such fractures. The aim of this study was to assess the experience of a third -level hospital with LAP for the treatment of PPF and PIF, and analyse the clinical outcomes. Data were prospectively collected and analysed from all patients whose PPF/PIF was treated surgically with LAP in a third-level hospital from June 2018 to June 2022. All fractures were postoperative low-energy femur fractures. The minimum follow-up period was six months. Thirty-eight patients (31 women) met the eligibility criteria. The mean age was 86.3 years. The median time until surgery was 4 days. A mean of 3.61 screws were used for each LAP. The mean femur plate length was 14 holes, and the mean working length 7.1 holes. The median hospital stay was nine days. The mean follow-up was 19.56 months. At one month, 12 patients tolerated partial weight-bearing. Five patients walked independently indoors. One patient had died and seven patients were readmitted. At six months, six more patients had died. Fifteen patients tolerated full weight-bearing (FWB). Nine patients walked independently indoors, six outdoors. Twenty-five patients reached fracture consolidation without malalignment. Nine patients were readmitted. At 12 months, another patient had died. Seventeen patients tolerated FWB. Eleven patients walked independently indoors, six outdoors. Twenty-five patients achieved fracture consolidation without malalignment. Five patients were readmitted. Fourteen patients crossed the two-year postoperative threshold. All achieved fracture consolidation. Two patients passed the 4-year postoperative milestone. The clinical results of patients whose PPF or PIF was treated with the LAP are promising. This fixation method is a viable option to be considered when planning surgery for such fractures. Level of evidence: III

Displaced femoral neck fractures in the young are difficult to treat. The complexity of the fractures for closed or open reduction requires careful surgical planning and experience. Acceptable reduction criteria in this fracture is crucial and should be followed strictly in order to get the favorable outcomes. Various reduction techniques have been described ranging from closed reduction by traction table or closed reduction with minimal direct manipulation with instruments to direct open reduction. This manuscript describes the mini open reduction, Watson-Jones and Smith-Petersen approaches, and some modifications in terms of indications, advantages, and disadvantages of each approach for the decision-making in these complex fractures.

Distal femur fractures are a common fracture seen in both high and low‑energy traumas in young and elderly patients. The standard of care in healthy, mobile, younger patients remains open reduction and internal fixation (ORIF) through various fixation devices. However, the standard of care for comorbid and elderly patients remains unclear. In these patients, rates of nonunion vary between 6% and 20%, requiring revision surgery. Our study sought to identify patients who have gone endoprosthesis conversion to a distal femur replacement following failed ORIF.

This descriptive study includes a total of eight patients who underwent a revision distal femoral replacement (DFR) following failure of primary distal femur ORIF and data were gathered through chart review. Patient comorbidities, demographic characteristics, hospital disposition, complications, and mortality were collected and described.

The average age of this cohort was 52.1 years, with 6 being female, and with a follow‑up mean of 3.02 years. The most common medical comorbidities present in these patients at the time of ORIF were diabetes, hypertension, obesity, smoking, and renal insufficiency. 87.5% of patients were able to tolerate weight bearing following DFR conversion, compared to 62.5% tolerating weight bearing before revision. Complications requiring revision surgery occurred in 3/8 patients, which included: aseptic loosening, prosthetic joint infection, and patellar maltracking.

DFR in a revision setting following acute distal femur ORIF can be an acceptable treatment options with outcomes similar to primary DFR. Further investigation is warranted to determine optimal timing and indications for primary DFR in a fracture setting.

There is no clear consensus on the best treatment option for scaphoid fractures. 

In this study, we aim to evaluate the short-term clinical and radiologic outcomes in patients with acute isolated scaphoid fractures treated with surgical or nonsurgical methods.

In a retrospective study, 31 patients with acute isolated scaphoid fracture (Mean±SD age: ‎28.9±9.9 ‎years) treated with open reduction and internal fixation (n=15) or cast immobilization (n=16) methods were included. The fractures were classified according to Herbert & Fishers’ classification system. Clinical outcome measures were the wrist range of motion, pinch strength, and grip strength. Radiographic outcome measures were the lunocapitate angle, scapholunate angle, and ulnar variance. The outcome were compared between the involved and uninvolved hands and between surgical or nonsurgical groups.

The majority of fractures were type B2 (n=14). In a Mean±SD follow-up of 15.1±3.2‎‏ months, the mean extension, flexion, pinch, and grip strength of the involved hand averaged 81.3%, 80.7%, 90%, and 87% of the uninvolved hand. Accordingly, clinical outcomes were significantly lower in the involved hand. The scapholunate angle was significantly higher in the involved hand (P=0.002). Clinical and radiographic outcomes were not significantly different between the surgical and nonsurgical groups. Radiographic malalignment was detected in 25 scaphoids. No significant correlation was found between the clinical and radiographic outcomes.

After scaphoid fracture union, the decrease in wrist range of motion (extension, flexion) and grip/pinch strength has no correlation with radiographic results.

Regarding the fact that lateral compression is usually not the underlying mechanism of fracture, Locked pubic symphysis is a very rare injury. At most times it can be managed with closed reduction method; however, open reduction with or without internal fixation may sometimes be required. In rare cases, osteotomy is the only choice. Urethral or bladder damage can occasionally be found. In this study, we presented a case of locked pubic symphysis with failed closed reduction who underwent successful open reduction with internal fixation.

The humerus shaft fracture (HSF) is a typical long bone fracture. Following non-surgical therapy, some patients experience delayed or non-union of the HSF. The most common treatment is open reduction and internal fixation (ORIF) with plate and bone graft. However, substantial tissue dissection increases radial nerve damage and delays union. Because of its minimally invasive nature, the minimally invasive plate osteosynthesis (MIPO) method may be a suitable replacement technique. MIPO helps in the protection of soft tissue and nerves in the area of the fracture. A better and faster union achieve with less tissue dissection and vascular disturbance. All patients were treated with the MIPO method using bone graft implantation. A specific six-hole locking plate was used during surgeries. Physical examinations and radiological studies were used to monitor the patients' progress. UCLA and the MEPS scoring system assessed shoulder and elbow function. The average follow-up period was six months. The mean age of patients was 39.8 years (19-73 years). The mean fracture site distance from the elbow joint was 12.1 cm. The mean maximal final rotation was 3.3 degrees. The last rotation alignment was within normal limits. No shortening was detected. Average scores were 35 for UCLA and 100 for MEPS. Radial nerve damage was not reported. Malunion delayed union, or nonunion did not occur. Mean union time was 2.8 months. MIPO technique combined with bone transplant causes micromotion at the fracture site, resulting in a better and faster union. Its minimally invasive nature also helps prevent iatrogenic injury to nerves and soft tissue. Less tissue manipulation and dissection help shoulder and elbow function progress more quickly and reduce the rate of malunion. We recommend using this method in delayed union and nonunion of the HSF patients to reach better outcomes and lesser complications.

A therapeutic challenge to maxillofacial surgeons is management of panfacial fractures, especially when treating multiple comminuted bone fractures. One of the most important goals in these fractures is achieve and stablish a correct occlusal relationship of the mandibular-maxillary unit in parallel with the proper positioning of the jaws with the skull base and other facial units. Also, it is important to prevent long-term sequelae such as facial asymmetry, enophthalmos, and malocclusion that could be caused by inadequate correction. To achieve all these goals some usual guides of management are proposed as follow: “Bottom to up”, “Top to down”, “outside to inside,” or “inside to outside”. We present 3 cases of Panfacial fracture and the proposed methods were based on different sequences of management with introducing “reference point” as the most intact area to determine the management concept & “confirming point” as the areas that should be reduced and fixed completely. These points act as an orientation aid during surgery and aid to successfully restore the entire face contour and maxillomandibular occlusion and also to improves surgical procedure.

Perilunate dislocations and perilunate fracture-dislocations (PLD/PLFD) are the second most common wrist injuries.

Given the limited available case series due to the rarity of these injuries, in this study, we report the functional outcomes of 20 patients who received surgical treatment with a mean follow-up of 28 months (range 24-36).

We retrospectively reviewed the admissions to Imam Khomeini Hospital Sari, Iran, and included patients with (PLD/PLFD) who underwent surgical treatment between January 2014 to December 2019. We included 20 patients (16 males, mean age±SD=33.6±12.4) who had received urgent surgical treatment following the initial closed reduction in the emergency department. All of the patients received surgical treatment from the same surgical team using the dorsal approach.

We observed the average Mayo Wrist Score (MWS) of 73.8±8.4 (range 65-100) with excellent or good outcomes in 40% of patients. The MWS was slightly higher in patients with the non-dominant injured side, yet it did not significantly differ with those with a dominant hand injury (75.4±9.6 vs. 71.2±5.8, P=0.29). Furthermore, we did not find a significant difference in MWS between the lesser and greater arc injuries (76.5±10.1 vs. 71.1±5.7, P=0.15). The observed flexion and extension ROM were significantly lower than the contralateral side (P<0.001). Similar patterns of lower grip and pinch strength were observed on the injured side, which was significantly lower than the contralateral hand; 38.4±8.6 (74±14% of the contralateral) and 9.9±2.4 (81±15% of the contralateral), respectively (P<0.001).

In line with other cohorts, the present case series demonstrates relatively good functional postoperative outcomes in PLD/PLFD. Our findings are comparable with prior reports concerning reasonably satisfactory MWS, ROM relative to the contralateral side and reported occasional mild pain with activity. Future studies should be directed to investigate long-term complications associated with these injuries, particularly the development of wrist osteoarthritis.

Type III Monteggia equivalent fracture is a rare injury, and its optimal diagnosis and management are still unclear. Reporting two cases of type III Monteggia equivalent fracture in two boys who were surgically treated the day after the presentation.This study presents two cases of type III Monteggia equivalent fracture in two boys who were surgically treated the day after the presentation. These observations suggest that the timely surgical treatment of type III Monteggia equivalent fracture results in acceptable outcomes. However, the lack of a universal classification system limits the generalization of the results

Patella alta is an extremely rare condition, refers to an abnormally high position of the patella. Surgical treatment of habitual dislocation of the patella aims at a step-by-step correction of the abnormality.

A 4-year-old boy presented with a rare superior dislocation of the patella. Clinical examination and radiographs confirmed the dislocation of the patella. The patella was reduced with proper reduction technique under sedation, resulting in the improvement of active range of motion.

Congenital patella alta is a rare deformity in children. Treatment and diagnosis in the early stages are of our priority in the treatment. Our non-surgical treatment is our preferred treatment in this patient. The surgical treatment approach is performed in patients that have no response to non-surgical treatments.

The ideal position of the plates and the need for additional plates are discussed continuously. In mandible, the tensile forces at the fracture line should be neutralized with a tension band. This study evaluated the role of the mandibular arch bar as a tension band eliminating the need for an upper miniplate (tension band plate) in cases of parasymphysis fractures. In this randomized control trial, a total of 90 patients with mandibular parasymphysis fractures underwent treatment in two groups. Group A was treated with one titanium miniplate along with Erich’s arch bar. In Group B, two titanium miniplates were placed across the fracture site along with Erich’s arch bar. Then, the complications and duration of the operation time were compared between two groups. The results were considered statistically significant when the P < 0.05. No significant difference was observed between the groups regarding postoperative complication rate. 1 month after surgery in Group A, number of patients with sensory impairment (17%) was significantly lower than Group B (37%) (P = 0.029). Furthermore, the operation time of Group A was significantly shorter than Group B (P < 0.001). In the presence of arch bar, placing one miniplate instead of the routine technique of placing two, do not increase complication rates. Furthermore, it reduces the operation time and costs and results in a better neurosensory recovery outcome in short time.

Recent evidence supports the superiority of surgery over conservative treatment in the management of medial humeral epicondylar fractures (MHEF) with the displacement of more than 2 mm, regardless of other indications for surgical intervention. We evaluate this strategy in a cohort of pediatric MHEF with more than 2 mm displacement. A total of 10 pediatric patients with MHEF and more than 2 mm displacement were included in the study. Relative and absolute indications for surgical intervention were present in five and one patient, respectively. No surgical indication was present in the other four cases. Elbow dislocation had occurred in three cases. All the patients were treated with open reduction and internal fixation (ORIF). The outcome measures included: Radiographic union, elbow range of motion, and Mayo elbow performance score (MEPS). At the final follow-up session, the mean flexion was 129° ± 6.1°. Flexion contracture and hyperextension were seen in three (30%) and one (10%) patient, respectively. The mean supination and pronation were 81° ± 3.2° and 80.5° ± 1.6°, respectively. MEPS was 100 (excellent) in nine patients and 55 (poor) in one patient. Radiographic union was observed in all the patients. In one patient, ulnar nerve neurolysis was performed 23 months after the initial surgery due to severe tenderness around the medial epicondyle. ORIF management of MHEF is an easy procedure with a low complication rate and satisfactory outcomes. Thus, we suggest the surgical approach for all pediatric patients with MHEF and displacement of > 2 mm, regardless of the presence of other indications for surgery.

Radial head fractures commonly occur during elbow traumas. Among those, treatment of Mason type III fractures is still under controversy. Common treatment methods for these fractures include open reduction and internal fixation (ORIF) as well as radial head excision. In this study, we compared long-term outcomes of both methods in treatment of patients with Mason type III fractures of radial head. Fifteen men and five women with Mason type III radial head fractures were evaluated retrospectively. Ten patients had undergone excision whereas the other ten patients had been treated with ORIF. Outcomes were assessed based on stability and range of motion of the elbow joint, grip strength, and pain. Data were gathered using Mayo elbow performance index (MEPI), Oxford elbow score, and disability of arm-shoulder-hand (DASH), along with the short form (SF)-36 questionnaire. The mean age of the subjects was 36.25±9.22 years and the mean follow-up time was 25.05±11.43 months. The ranges of extension and supination, and frequency of pain reporting was significantly different between the groups. The average grip strength in the operated side was significantly higher in the ORIF group, compared with the excision (P= 0.03). Ten (100%) patients of ORIF group and 5 (50%) patients of excision group had elbow joint stability (P=0.01). Mean MEPI and DASH scores were significantly higher in ORIF group (Prespectively). The results are in favor of ORIF method. Therefore, this method is recommended and preferred over excision in treating radial heads with Mason type III frac ture.

While there is consensus about the treatment of acutely presented displaced lateral condyle fracture (LCF) of distal humerus in children by open reduction and internal fixation, treatment for lately presented LCF remained challenging due to contradictory results of treatments and paucity of studies in this field.
The aim of this study was to report the clinical and radiological results of open reduction and internal fixation for the treatment of lately presented LCF of distal humerus in children.
Prospectively we studied the clinical and radiographical results of open reduction and internal fixation of 8 patients from 12 cases. These cases had a delayed presentation of more than 3 weeks from injury among those who were referred to our center from 2011 to 2017. We evaluated the range of motion, alterations in carrying angle, presence of prominent deformity, presence of arthritic or neurological symptoms, and finally nonunion or avascular necrosis of the lateral condyle. For assessment of the treatment results we used the Hardacre criteria.
A total of 8 patients, including 7 males and 1 female with mean age of 5.2 years (2.5 - 8) bearing time delay from injury to the surgery of 32.4 days (22 - 48), underwent surgical treatment. The mean follow up was 21 months (8 - 54). The main reason for referring to the clinic consisted of palpable mass followed by decreased range of motion. All patients achieved satisfactory union. Of the patients, 2 suffered from complications; 1 patient experienced avascular necrosis of the lateral condyle and the other was complicated by carrying angle abnormality. According to the Hardacre criteria, 6 patients achieved excellent results and 2 patients, with mentioned major complications, obtained fair results.
Open reduction and internal fixation of lately presented lateral condyle fracture of distal humerus can result in excellent functional and radiological results in most of the patients.

There is an ongoing debate if bone graft substitutes (BGSs) are beneficial in the treatment of displaced intra-articular calcaneal fractures (DIACFs). The purpose of this study was to evaluate the effect of an injectable calcium sulfate/hydroxyapatite BGS (CERAMENTTM iBONE VOID FILLER, BONESUPPORT AB, Lund, Sweden) in internal fixation of calcaneal fractures.
The records of patients presenting with calcaneal fractures type Sanders III and IV and treated with internal fixation plus BGS were reviewed. Radiographs were analyzed using different measurements (including Böhler's angle and calcaneal facet height). The clinical outcome was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale.
A total of 20 fractures were available for radiographic and clinical examination at a minimum follow-up of 12 months. No decrease in Böhler's angle was recorded in six fractures, a reduction of The study results support the use of an injectable, in situ hardening calcium sulfate/hydroxyapatite BGS in DIACFs. The BGS is easy and safe to use as an augment to open reduction and internal fixation.

To determine the functional and radiologic results of surgical treatment in patients with acetabular fractures.
This was a retrospective cross-sectional study. We retrospectively reviewed medical records of patients operatively treated acute acetabular fractures at a level I trauma center (Shahid Rajaee) and an orthopedic center (Shahid Chamran) both in southern Iran (Shiraz) with minimally 1 year follow up over a period of 7 years from April 2009 to March 2016. Functional and radiographic outcomes, and complication were considered as main outcomes.
A total number of 79 patients completed the study. Fifty-five patients were operated through Kocher–Langenbeck approach, and 18 were operated through the standard ilioinguinal approach, and 6 patients were operated through the standard ilioinguinal approach combined with Kocher–Langenbeck approach. The mean follow-up of patients was 45.6 months. The average operative time was 162.4±78.5 min, and the median blood loss was 500 ml. Functional results were excellent in 41 patients (51.9%), good in 12 (15.2%), fair in 13 (16.5%), and poor in 13 patients (16.5%). Radiologic results were excellent in 27 cases (34.2%), good in 17 cases (21.5%), fair in 18 cases (22.8%), and poor in 16 (16.5%). Osteoarthritis of hip (60.8%) and AVN of head of femur (22.8%) were two most common complications. In addition, there wasn’t any significant difference between surgical approaches regarding clinical and radiographic outcomes.
The operative treatment for acetabular fractures gives universally satisfactory results. Thereafter, this study provides evidence that ilioinguinal approach is a good choice for anterior fractures, Kocher–Langenbeck is a good choice for posteriors fractures, and combined approach may be a good choice in the management of acetabular fractures involving two columns.

Perilunate fracture dislocation (PLFD) and perilunate dislocation (PLD) are wrist injuries, which are commonly missed. Meanwhile, the delay in the treatment of these injuries is leading to a more complicated situation. One of the acceptable treatments for old cases is open reduction and internal fixation.
The purpose of this study was to determine the mid-term results of open reduction and internal fixation (ORIF) treatment for old unreduced perilunate injury that had been unreduced and untreated for a minimum of 6 weeks after injury.
Between 2011 and 2016, 12 patients with old PLFD and PLD, untreated for a minimum of 6 weeks after injury, were treated by ORIF. A retrospective review was performed with a minimum 12 months of follow-up. During the final follow up visit, the patients were evaluated for pain, range of motion, and grip strength. The MAYO wrist score was used for functional assessment. The patients were assessed using a validated Persian questionnaire Quick DASH score. Radiological outcomes were classified using the Herzberg classification.
All of patients were males with a mean age of 25 years (18 to 32 years). Perilunate Fracture Dislocation injury was found in 7 cases and PLD in 5 cases. Mean time from injury to surgery was 14.3 weeks (6 to 26 weeks) and mean follow-up after the surgery was 33.5 months (12 to 60 months). The mean MAYO wrist score was 77.5 (55 to 85). According to the Mayo wrist score, 42% of patients (5 patients) had good, 50% (6 patients) had satisfactory, and 8% (1 patient) had poor results. The active range of flexion-extension averaged 107.5° (range 80 to 155°), and grip strength averaged 84% (range 53% to 100%) of the intact extremity. According to the Herzberg classification, 5 (42%) patients were radiologically located in group A and 7 (58%) in group B. Patients’ satisfaction rate based on the Persian Quick DASH score had an average of 12.5.
Open reduction and internal fixation is an appropriate treatment with acceptable functional and clinical results in old unreduced perilunate injuries up to 6 months after trauma.

To determine the effects of platelet rich plasma PRP on healing rates of long bone non-union fracture.
This was a randomized double-blind placebo controlled clinical trial being performed in a 12-month period. We included 75 adult (>18 years) patients suffering from long bone (Femur, Tibia, Humerus and Ulna) non-union fracture who were randomly assigned to receive 5mL PRP (n=37) or 5mL normal saline as placebo (n=38) in the site of fracture after intramedullary nailing or open reduction and internal fixation (ORIF) along with autologous bone graft. Patients were followed each 45 days till 9 months and were evaluated both clinically and radiologically in each visit. The healing rate, failure rate, incidence of infection, mal-union and limb shortening were recorded and compared between groups after 9 months of follow-up.
The healing rate was significantly higher in PRP group compared to placebo (81.1% vs. 55.3%; p=0.025). The limb shortening was significantly higher in those who received placebo (2.61±1.5 vs. 1.88±1.2mm; p=0.030). Injection of PRP was also associated with lower pain scores (p=0.003) and shorter healing duration (p=0.046). The surgical site infection (p=0.262) and mal-union rate (p=0.736) were comparable between groups.
Application of PRP along with autologous bone graft in the site of non-union of long bone after intramedullary nailing or ORIF results in higher cure rate, shorter healing duration, lower limb shortening and less postoperative pain. Higher infection rate might be a complication of PRP application.