RESUMEN
Objectives: This study aimed to report the complication rate associated with open reduction and internal fixation (ORIF) of mandibular condyle fractures in Oman. Methods: This retrospective cohort study was conducted among patients who underwent ORIF of mandibular condyle fractures at Al-Nahdha Hospital and the Sultan Qaboos University Hospital in Muscat, Oman, from January 2008 to December 2020. Data collected included patient demographics, fracture aetiology, fracture side and type, surgical approach and recorded complications and outcomes. Results: A total of 68 patients (59 males and 9 females; mean age of 30.1 years) with 83 mandibular condyle fractures underwent ORIF during the study period. Subcondylar fractures were the most common type, occurring in 62.7% of patients, while bilateral fractures were observed in 21 (30.8%) patients. The most common surgical approach was retromandibular, used in 42.2% of patients. The overall complication rate was 42.6%, with the most frequently reported complications being transient facial nerve palsy (18.1%), malocclusion (14.7%) and restricted mouth opening (10.3%). Subsequent surgical interventions to correct malocclusion were performed in 6 cases. There was no statistically significant association between the overall complication rate and the patients' clinical characteristics. Conclusion: Although ORIF of mandibular condyle fractures generally offers favourable outcomes, it carries a risk of complications.
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Fijación Interna de Fracturas , Cóndilo Mandibular , Fracturas Mandibulares , Reducción Abierta , Complicaciones Posoperatorias , Humanos , Omán/epidemiología , Masculino , Femenino , Fracturas Mandibulares/cirugía , Fracturas Mandibulares/epidemiología , Estudios Retrospectivos , Adulto , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/estadística & datos numéricos , Fijación Interna de Fracturas/efectos adversos , Cóndilo Mandibular/lesiones , Cóndilo Mandibular/cirugía , Reducción Abierta/métodos , Reducción Abierta/estadística & datos numéricos , Reducción Abierta/efectos adversos , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Adolescente , Adulto Joven , Estudios de CohortesRESUMEN
BACKGROUND: Distal femoral fractures account for less than 1% of all fractures. The therapy of choice is usually surgical stabilization. Despite advances in implant development over the past few years, complication rate remains comparatively high. The aim of this study is to analyze our results with plate fixation of distal femoral fractures with a focus on complication and fracture healing rates. METHODS: In this retrospective cohort study, patients (> 18 years) with distal femoral fractures treated at an urban level I trauma center between 2015 and 2022 were analyzed. RESULTS: In total, 206 patients (167 female, 39 male) with an average age of 75 (SD 16) years were diagnosed with a fracture of the distal femur. One hundred fourteen of these patients were treated surgically by means of plate osteosynthesis. In 13 cases (11.41%), a revision procedure had to be performed. The indication for surgical revision was mechanical failure in eight cases (7.02%) and septic complication in five cases (4.39%). Periprosthetic fractures were more likely to cause complications overall (19.6% versus 4.76%) and further included all documented septic complications. The analysis of modifiable surgical factors in the context of plate osteosynthesis showed higher complication rates for cerclage in the fracture area compared with plate-only stabilizations (44.44% versus 22.22%). CONCLUSIONS: The data show an increased amount of revisions and a significantly higher number of septic complications in the treatment of periprosthetic fractures of the distal femur compared with non-periprosthetic fractures. The detected combination of plates together with cerclage was associated with higher complication rates. Level of evidence Level III retrospective comparative study.
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Placas Óseas , Fracturas del Fémur , Fijación Interna de Fracturas , Fracturas Periprotésicas , Complicaciones Posoperatorias , Humanos , Femenino , Estudios Retrospectivos , Masculino , Fracturas del Fémur/cirugía , Fracturas Periprotésicas/cirugía , Fracturas Periprotésicas/etiología , Anciano , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/métodos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Persona de Mediana Edad , Anciano de 80 o más Años , Reoperación , Curación de Fractura , Fracturas Femorales DistalesRESUMEN
In this article, we attempted to identify risk factors affecting the loss of vertebral height and kyphosis correction on type A thoracolumbar fractures. Patients with type A thoracolumbar fractures who underwent short segments with intermediate screws at the fracture level management between 2017 and 2022 were included in this study. Clinical factors including patients' demographic characteristics (age, sex), history (smoking, hypertension and/or diabetes), value of height/kyphosis correction, the thoracolumbar injury classification and severity score (TLICS), the load sharing classification (LSC) scores and bone mineral density were collected. Correlation coefficient, simple linear regression analysis and multivariate regression analysis were performed to identify the clinical factors associated with the loss of vertebral height/kyphosis correction. Finally, 166 patients were included in this study. The mean height and kyphosis correction were 21.8%â ±â 7.5% and 9.9°â ±â 3.8°, respectively, the values of the loss were 6.5%â ±â 4.0% and 3.9°â ±â 1.9°, respectively. Simple linear regression analysis and multivariate regression analysis showed that age, value of height correction, LSC scores and bone mineral density were significantly associated with the loss of vertebral height and kyphosis correction (Pâ <â .01) We could draw the conclusion that patients with older age, lower bone mineral density, higher LSC scores and diabetes are at higher risk of vertebral height and kyphosis correction loss increase. For these patients, appropriate clinical measures such as long segment fixation, control of blood glucose, and increase of bone density must be taken to reduce the loss of correction.
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Cifosis , Vértebras Lumbares , Fracturas de la Columna Vertebral , Vértebras Torácicas , Humanos , Masculino , Femenino , Estudios Retrospectivos , Vértebras Torácicas/lesiones , Vértebras Torácicas/cirugía , Persona de Mediana Edad , Fracturas de la Columna Vertebral/cirugía , Fracturas de la Columna Vertebral/etiología , Vértebras Lumbares/lesiones , Vértebras Lumbares/cirugía , Cifosis/cirugía , Cifosis/etiología , Adulto , Tornillos Óseos , Factores de Riesgo , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/instrumentación , Anciano , Densidad ÓseaRESUMEN
To investigate the treatment outcomes of combined internal and external fixation surgery for patients with posterior lateral tibial plateau fractures and explore its safety. The study was conducted from February 2020 to February 2023 and included a total of 77 patients with Schatzker IV and Schatzker V type posterior lateral tibial plateau fractures. Patients were divided into control group and treatment group according to different treatment methods: the control group with 38 cases received treatment with dual-support plates, and the study group with 39 cases received treatment with internal fixation using medial plates combined with lateral locking plates. Clinical indicators during treatment, immediate postoperative and 12-month postoperative radiographic indicators, Rasmussen knee joint function scores before and 3 months after surgery, knee joint function recovery, quality of life, and postoperative complications were recorded and compared between the 2 groups. The inter-group comparisons were made for intraoperative blood loss, surgical duration, and the time to start weight-bearing postoperatively (Pâ >â .05). The study group had shorter postoperative hospital stays and fracture healing times compared to the control group (Pâ <â .05). Immediately postoperatively, the medial tilt angle and posterior tilt angle in both groups were compared (Pâ >â .05). At 12 months postoperatively, the medial tilt angle decreased and the posterior tilt angle increased in both groups compared to immediately postoperative values (Pâ <â .05), with no significant difference between the groups (Pâ >â .05). However, at 3 months postoperatively, the scores for various dimensions in both groups increased compared to preoperative values, and the study group had higher scores than the control group (Pâ <â .05). However, at 3 months postoperatively, the quality of life scores were higher than preoperative values in both groups, with the study group having higher scores (Pâ <â .05). The occurrence of complications during the treatment period was compared between the 2 groups (Pâ >â .05). The medial and lateral combined plate fixation has a good clinical effect in the treatment of posterolateral tibial plateau fractures, which can shorten the fracture healing time, help the recovery of knee joint function and improve the quality of life of patients after operation, and has high safety in the treatment process.
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Placas Óseas , Fijación Interna de Fracturas , Fracturas de la Tibia , Humanos , Fracturas de la Tibia/cirugía , Masculino , Femenino , Persona de Mediana Edad , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/efectos adversos , Adulto , Resultado del Tratamiento , Fijación de Fractura/métodos , Fijación de Fractura/efectos adversos , Complicaciones Posoperatorias/epidemiología , Calidad de Vida , Curación de Fractura , Fijadores Externos , Fracturas de la Meseta TibialRESUMEN
PURPOSE: The radial nerve may be painfully irritated or damaged by open reduction and internal fixation (ORIF) of humeral fractures. Secondary radial nerve lesions after ORIF of humeral shaft fractures are described in up to 16%. Not only peripheral nerves but also orthopaedic instruments and osteosynthesis material are well visible by ultrasound. The aim of this study was to evaluate the accuracy of ultrasound in assessing the relation between the bone overlapping screw tips and the radial nerve close to the humeral bone. METHODS: Ultrasound-guided drilling was used to place screws as close as possible to the radial nerve in 8 humeral bones of four cadavers. The relation between the radial nerve and the screw tips was assessed by high-resolution ultrasound, and the overlap of all screw tips over the bone was measured by ultrasound and fluoroscopy. Thereafter, the findings were validated by anatomical dissection. RESULTS: We could correctly identify all screw tips and their relation to the radial nerve by ultrasound. In 7 of 8 cases, the screw tip had direct contact with the radial nerve. The overlaying length of the screw tip was accurately measured by using ultrasound in all cases. In contrast fluoroscopy underestimated this length in 50% of cases. CONCLUSION: With this study, we show that ultrasound can reliable visualize the screw tips and its relation to the radial nerve. Ultrasound is a promising diagnostic tool to evaluate patients with radial nerve irritations or lesions after ORIF of humeral fractures. Furthermore, ultrasound could be an adequate tool to guide drilling.
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Tornillos Óseos , Cadáver , Fijación Interna de Fracturas , Fracturas del Húmero , Nervio Radial , Humanos , Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/efectos adversos , Nervio Radial/lesiones , Nervio Radial/diagnóstico por imagen , Fracturas del Húmero/cirugía , Fracturas del Húmero/diagnóstico por imagen , Tornillos Óseos/efectos adversos , Fluoroscopía/métodos , Ultrasonografía Intervencional/métodos , Ultrasonografía/métodosRESUMEN
BACKGROUND: The Internal Fixator (INFIX) is a popular method, known for its minimal invasiveness and short operation time, for treating anterior pelvic ring fractures. Studies have shown that postoperative complications may occur, including anterolateral femoral cutaneous nerve injury, the femoral nerve paralysis, and delayed fracture healing. These complications are believed to be related to surgical stimulation, an excessively long lateral end of the connecting rod, a small distance between the screw and bone surface, insufficient pre-bending of the connecting rod, and difficulties in fracture reduction. CASE PRESENTATION: We report two unique cases of lower abdominal pseudocyst complicated with suspected infection after INFIX treatment of pelvic fractures at our trauma center. Following surgical removal of the internal fixation, resolution of the cysts was observed in both patients, and subsequent postoperative follow-up revealed the absence of any residual sequelae. These cases have not been reported in previous literature reviews. DISCUSSION: The lower abdominal cysts, potentially arising from the dead space created during intraoperative placement of the INFIX rod, may increase infection risk. The etiology remains uncertain, despite the presence of abnormal inflammation markers in both cases, and staphylococcus aureus found in one. These cysts were confined to the lower abdomen, not involving the internal fixation, and hence, only the INFIX was removed. Postoperative oral cefazolin treatment was successful, with resolved pseudocysts and no subsequent discomfort. CONCLUSION: We report two unprecedented cases of post-INFIX abdominal cysts, with a suspected link to intraoperative dead space. Despite uncertain etiology, successful management involved INFIX removal and oral cefixime therapy. These findings necessitate further exploration into the causes and management of such complications.
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Quistes , Fijación Interna de Fracturas , Fracturas Óseas , Huesos Pélvicos , Humanos , Antibacterianos/uso terapéutico , Quistes/etiología , Quistes/cirugía , Fijación Interna de Fracturas/efectos adversos , Fracturas Óseas/cirugía , Fracturas Óseas/complicaciones , Huesos Pélvicos/lesiones , Huesos Pélvicos/cirugía , Huesos Pélvicos/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/diagnóstico , Infecciones Estafilocócicas/etiología , Infecciones Estafilocócicas/diagnósticoRESUMEN
This systematic review and meta-analysis compare the incidences of complications, reoperations and hardware removal between anterior and dorsal plating after corrective osteotomy for dorsally angulated distal radial malunions. A total of 403 patients were included; 253 patients underwent anterior corrective osteotomy and 150 underwent dorsal corrective osteotomy. Mean follow-up was 30 months. Anterior plating was associated with fewer reoperations (9% vs. 28%), less hardware removal (3% vs. 18%) and comparable major complications (5% vs. 6%) compared to dorsal plating. The adjusted model showed a significant reduction (approximately 85%) in the odds of reoperation and hardware removal in the anterior group. There was no difference in major or minor complications between the groups. Surgeons should be fully aware of the increased risks when using dorsal plate fixation after corrective osteotomy for dorsally angulated distal radial malunions.
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Placas Óseas , Fracturas Mal Unidas , Osteotomía , Complicaciones Posoperatorias , Fracturas del Radio , Reoperación , Humanos , Fracturas Mal Unidas/cirugía , Osteotomía/efectos adversos , Fracturas del Radio/cirugía , Complicaciones Posoperatorias/etiología , Fijación Interna de Fracturas/efectos adversos , Remoción de DispositivosRESUMEN
BACKGROUND: The optimal treatment of open fractures complicated by soft tissue loss of pediatric tibial fractures remains inconclusive. The author described a protocol of concurrent plate fixation and pedicled flap coverage and retrospectively reviewed the outcomes of such injuries. METHODS: A total of 25 pediatric cases with Gustilo lllB open tibial fracture were treated by single-stage plate fixation and pedicled flap reconstruction. The reviewed information consisted of time to fix and flap, type of plate, type of pedicled flap, fracture union time, postoperative complication and the clinical outcomes by objective scoring system. RESULTS: Fix and flap was undergone between 7 and 12 days after injury with the average time of 8.2 days. Regarding the type of plate, narrow LCP was applied in 8, 3.5 mm precontoured LCP in 10, 5.0 mm precontoured in 2 and double LCP in 5. According to soft tissue reconstruction, the medial gastrocnemius flap was selected in 6 cases, myocutaneous medial gastrocnemius flap in 2, soleus flap in 3, hemisoleus flap in 5, reverse sural flap in 6 and combined medial gastrocnemius and hemisoleus flaps in 3. No flap-related complication was demonstrated. All cases established fracture union in between 12 and 24 weeks with an average time to union of 17.7 weeks. According to postoperative complications, infected plate occurred in 2 cases and implant irritation in 5. According to Puno functional score, excellent results were presented in 7 cases and good results in 18 cases. CONCLUSION: Single-stage plate fixation and pedicled flap coverage are a reliable regimen for pediatric open fractures complicated by soft tissue loss of the tibia.
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Placas Óseas , Fijación Interna de Fracturas , Fracturas Abiertas , Traumatismos de los Tejidos Blandos , Colgajos Quirúrgicos , Fracturas de la Tibia , Humanos , Fracturas de la Tibia/cirugía , Fracturas de la Tibia/complicaciones , Fracturas Abiertas/cirugía , Masculino , Femenino , Niño , Estudios Retrospectivos , Traumatismos de los Tejidos Blandos/cirugía , Traumatismos de los Tejidos Blandos/etiología , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/efectos adversos , Adolescente , Resultado del Tratamiento , Complicaciones Posoperatorias/etiología , Procedimientos de Cirugía Plástica/métodos , PreescolarRESUMEN
PURPOSE: The 5-item modified frailty index (mFI-5) has been established as a reliable indicator of poor postoperative outcomes following a variety of orthopaedic procedures. This study aims to determine whether the mFI-5 can be used by surgeons to predict the likelihood of postoperative complications in patients undergoing open reduction internal fixation (ORIF) for tibial plateau fractures. METHODS: From 2006 to 2019, patients aged 50 years or older undergoing ORIF for tibial plateau fracture were identified in the National Surgical Quality Improvement Program database. The mFI-5 was calculated based on the sum of the presence of 5 conditions: diabetes, congestive heart failure, hypertension, chronic obstructive pulmonary disease, and dependent functional status. Chi-squared tests and multivariable regression analysis were used to evaluate the association of different mFI-5 scores with postoperative complications. RESULTS: The study analyzed 2213 patients with an average age of 63 years. Multivariable regression analysis demonstrated that in comparison to patients with a mFI-5 score of 0, those with a score of 1 had an increased risk of prolonged hospital stay (OR 1.31) and discharge to a non-home location (OR 1.50) while those with a score of 2 or greater were at an increased risk of readmission (OR 2.30), wound complication (OR 5.37), pulmonary complication (OR 4.56), urinary tract infection (OR 4.79), prolonged hospital stay (OR 1.89), and discharge to a non-home location (OR 3.01). CONCLUSION: The mFI-5 is a reliable instrument for determining the likelihood of postoperative complications following ORIF for tibial plateau fracture repair. LEVEL OF EVIDENCE: III.
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Fijación Interna de Fracturas , Fragilidad , Reducción Abierta , Complicaciones Posoperatorias , Fracturas de la Tibia , Humanos , Persona de Mediana Edad , Femenino , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/diagnóstico , Masculino , Fracturas de la Tibia/cirugía , Fracturas de la Tibia/complicaciones , Fragilidad/diagnóstico , Fragilidad/complicaciones , Anciano , Fijación Interna de Fracturas/efectos adversos , Reducción Abierta/efectos adversos , Reducción Abierta/métodos , Tiempo de Internación/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Mejoramiento de la Calidad , Fracturas de la Meseta TibialRESUMEN
PURPOSE: The purpose of this study was to determine the rates of compartment syndrome and other early complications following outpatient open reduction and internal fixation (ORIF) of tibial plateau fractures. METHODS: This was a retrospective cohort at a single US level I academic trauma centre of patients with tibial plateau fractures managed operatively. Inpatients received their definitive ORIF during their index hospital stay and were admitted post-operatively following ORIF. Outpatients were scheduled for ambulatory surgery during definitive ORIF. Exclusion criteria for outpatient surgery included compartment syndrome, polytrauma, open types IIIb/IIIc, and patients who received any internal fixation during index presentation. The primary outcome measure was post-operative compartment syndrome. Secondary outcomes were return to the 90-day return to the ED, 90-day readmission, surgical wound infection, thromboembolism, and 90-day mortality. An intention-to-treat (ITT) and as-treated (AT) analyses were performed. RESULTS: Totally, 71 inpatients and 47 outpatients were included. There were no cases of post-operative compartment syndrome. In the ITT analysis, there were no differences for inpatients vs outpatients for 90-day re-admission (22.5% vs 12.8%, p = 0.275), 90-day return to the ED (35.2% vs 17.0%, p = 0.052), infection (12.7% vs 2.1%, p = 0.094), DVT (7% vs 4.3%, p = 0.819), or PE 1.4% vs 0.0%, p = 1.000). The AT analysis showed a significantly higher 90-day re-admission (26.9% vs 2.5%, p = 0.003) and 90-day ED visit (38.5% vs 7.5%, p = 0.001) rate in the inpatient group. CONCLUSIONS: Appropriately selected patients with isolated tibial plateau fractures can have non-inferior rates of compartment syndrome and post-operative complications when compared to inpatients.
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Procedimientos Quirúrgicos Ambulatorios , Síndromes Compartimentales , Fijación Interna de Fracturas , Readmisión del Paciente , Complicaciones Posoperatorias , Fracturas de la Tibia , Humanos , Fracturas de la Tibia/cirugía , Masculino , Procedimientos Quirúrgicos Ambulatorios/efectos adversos , Procedimientos Quirúrgicos Ambulatorios/estadística & datos numéricos , Femenino , Estudios Retrospectivos , Síndromes Compartimentales/etiología , Síndromes Compartimentales/cirugía , Persona de Mediana Edad , Adulto , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/métodos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Readmisión del Paciente/estadística & datos numéricos , Reducción Abierta/métodos , Reducción Abierta/efectos adversos , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/etiología , Tromboembolia/etiología , Anciano , Fracturas de la Meseta TibialRESUMEN
PURPOSE: The present retrospective study aimed to analyze patient characteristics, perioperative complications, and short-term outcomes of surgery for fragility fractures of the pelvis (FFP). METHODS: We selected 42 patients who underwent surgery for FFP between October 2019 and October 2022 and could be followed for more than 6 months postoperatively, including one male patient and 41 female patients with an average age of 83.5 (65-96) years. The following demographic data were collected: Rommens classification, surgical method, reoperation rate, implant loosening, perioperative complications, interventional radiology (IVR) indication rate, perioperative blood transfusion indication rate, Parker Mobility Score (PMS) before surgery and at final follow-up, and numerical rating scale (NRS) score before surgery and on day 3 postoperatively. RESULTS: Rommens classification was as follows: type IIa (n = 2), type IIb (n = 13), type IIIa (n = 8), type IIIc (n = 3), type IVb (n = 13), and type IVc (n = 3). For surgical procedure, 35 patients (83.3%) were successfully stabilized with percutaneous screw fixation alone, and 7 patients further required open plate fixation. Implant loosening was observed in 16 patients (38.1%), including minor cases, and implant removal was required in 1 patient. Minor perforation of the screw was observed as an intraoperative complication in 6 patients; there were no patients with neurological symptoms. At the time of injury, IVR was indicated in 3 patients (7.1%) because of hemorrhage. Thirty patients (71.4%) had medical complications at the time of admission. One patient died due to postoperative pneumonia. Mean PMS before injury and at final follow-up were 6.51 points and 5.38 points, respectively. Mean NRS scores before surgery and on day 3 postoperatively were 5.26 and 3.49, respectively, showing a significant improvement (p < 0.01). CONCLUSION: We retrospectively reviewed 42 patients who required surgery for FFP. More than 80% of cases could be treated with percutaneous screw fixation, but it is always important to consider hemorrhagic shock at the time of injury and indications for IVR. Implant loosening was observed in 38.1% of patients, including minor cases, and was considered an issue to be improved on in the future, such as by using cement augmentation. A significant improvement in mean NRS score on day 3 postoperatively relative to the mean preoperative score was observed, suggesting that surgery may contribute to early mobilization.
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Fijación Interna de Fracturas , Huesos Pélvicos , Complicaciones Posoperatorias , Reoperación , Humanos , Masculino , Femenino , Anciano , Estudios Retrospectivos , Anciano de 80 o más Años , Huesos Pélvicos/lesiones , Huesos Pélvicos/cirugía , Huesos Pélvicos/diagnóstico por imagen , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/efectos adversos , Complicaciones Posoperatorias/etiología , Reoperación/estadística & datos numéricos , Fracturas Osteoporóticas/cirugía , Fracturas Osteoporóticas/diagnóstico por imagen , Resultado del Tratamiento , Tornillos Óseos , Placas Óseas , Transfusión Sanguínea/estadística & datos numéricosRESUMEN
PURPOSE: This study aimed to compare reoperation rate and clinical outcomes between revision open reduction and internal fixation and hip arthroplasty following failed subtrochanteric fracture fixation. METHODS: A retrospective review was conducted of patients > 50 years old treated for failed fixation of subtrochanteric fractures with revision ORIF or hip arthroplasty from 2003 to 2023. Primary outcomes included rate of fracture union and reoperations after initial salvage therapy. Secondary outcomes included complications (infection, dislocation, bursitis, implant prominence, implant failure, nonunion), pain, and gait-aid requirements by final follow-up. RESULTS: Forty-four patients were identified: 34 treated with revision ORIF and 10 with hip arthroplasty. The arthroplasty cohort was older (75.4 vs. 66.0 years, p = 0.016) but did not differ from the ORIF cohort in sex, type of initial fixation, or reason for fixation failure. Patients treated with revision ORIF and patients treated with arthroplasty had similar rates of fracture union (85.3% vs. 80.0%, p = 0.772) and reoperation (35.3% vs. 30.0%, p = 0.710). There was no significant difference in rate of additional complications not requiring reoperation (0.0% vs. 40.0%, p = 0.071). The arthroplasty cohort achieved full weightbearing in significantly shorter time than the revision ORIF cohort (3.8 vs. 6.8 weeks, p = 0.005). CONCLUSION: Both revision ORIF and hip arthroplasty are acceptable options for salvage of failed subtrochanteric fracture fixation in patients greater than 50 years old, but patients should be counseled that although the rate of fracture union is high whether revision ORIF or hip arthroplasty is selected, the rate of reoperation can exceed 1-in-4 patients. LEVEL OF EVIDENCE: : Level III, Retrospective Comparative Study.
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Artroplastia de Reemplazo de Cadera , Fijación Interna de Fracturas , Fracturas de Cadera , Reoperación , Terapia Recuperativa , Humanos , Reoperación/estadística & datos numéricos , Fracturas de Cadera/cirugía , Masculino , Femenino , Anciano , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Estudios Retrospectivos , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/efectos adversos , Terapia Recuperativa/métodos , Persona de Mediana Edad , Insuficiencia del Tratamiento , Anciano de 80 o más Años , Reducción Abierta/métodos , Reducción Abierta/efectos adversos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Curación de FracturaRESUMEN
Aims: Pneumatic tourniquets are often used during the surgical treatment of unstable traumatic ankle fractures. The aim of this study was to assess the risk of reoperation after open reduction and internal fixation of ankle fractures with and without the use of pneumatic tourniquets. Methods: This was a population-based cohort study using data from the Danish Fracture Database with a follow-up period of 24 months. Data were linked to the Danish National Patient Registry to ensure complete information regarding reoperations due to complications, which were divided into major and minor. The relative risk of reoperations for the tourniquet group compared with the non-tourniquet group was estimated using Cox proportional hazards modelling. Results: A total of 4,050 ankle fractures treated with open reduction and internal fixation between 15 March 2012 and 31 December 2016 were included, with 669 (16.5%) undergoing surgery with a tourniquet and 3,381 (83.5%) without a tourniquet. The overall reoperation risk was 28.2% with an adjusted relative risk of 1.46 (95% CI 0.91 to 2.32) for group comparison. The reoperation risk due to major complications was 3.1% with a tourniquet and 4.4% without a tourniquet, resulting in an adjusted relative risk of 1.45 (95% CI 0.91 to 2.32). For minor complications, there were 24.7% and 23.9% reoperations, resulting in an adjusted relative risk of 0.99 (95% CI 0.84 to 1.17). Conclusion: We found no significant difference in the reoperation rate when comparing ankle fractures treated surgically with and without the use of pneumatic tourniquets.
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Fracturas de Tobillo , Fijación Interna de Fracturas , Reoperación , Torniquetes , Humanos , Reoperación/estadística & datos numéricos , Fracturas de Tobillo/cirugía , Masculino , Femenino , Persona de Mediana Edad , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/efectos adversos , Adulto , Anciano , Dinamarca/epidemiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Reducción Abierta/métodos , Sistema de Registros , Adulto Joven , AdolescenteRESUMEN
Checkrein deformity of the hallux is commonly characterized by rigid flexion of the interphalangeal joint in ankle dorsiflexion but with flexibility in ankle plantarflexion which can be named as flexion checkrein deformity and as rare condition, extension checkrein deformity, characterized by rigid extension of the first metatarsophalangeal joint in ankle plantarflexion and flexibility in ankle dorsiflexion, has been reported. However, there has not reported coexistence of flexion and extension checkrein deformity. The patient, a 27-year-old male, was referred to our department 3 years after tibial and fibular fractures which was treated by open reduction and internal fixation at a previous hospital. His chief complaint was pain and impaired plantarflexion of the affected great toe. The diagnosis was double checkrein deformity characterized by simultaneous rigidity in both flexion and extension of the hallux due to the adhesion of the flexor hallucis longus (FHL) muscle and the extensor hallucis longus (EHL) tendon after a fracture. Surgical intervention was performed, which involved the transection of the FHL tendon using hindfoot endoscopy and transfer of the EHL to the extensor digitorum longus, resulting in a successful outcome with no postoperative complications. The patient demonstrated a favorable prognosis 2 years after the procedure. This report represents the first documented case of double checkrein deformity and underscores the importance of considering this condition and the potential advantages of surgical intervention.
Asunto(s)
Peroné , Fijación Interna de Fracturas , Rango del Movimiento Articular , Fracturas de la Tibia , Humanos , Masculino , Adulto , Peroné/cirugía , Peroné/lesiones , Fracturas de la Tibia/cirugía , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/efectos adversos , Hallux/cirugía , Transferencia Tendinosa/métodos , Fracturas Óseas/cirugía , Fracturas Óseas/complicaciones , Resultado del Tratamiento , Radiografía/métodos , Deformidades Adquiridas del Pie/cirugía , Deformidades Adquiridas del Pie/etiologíaRESUMEN
OBJECTIVES: To identify the infection rate in patients with combined pelvic ring and bladder injuries. Secondary aims included identifying treatment and injury factors associated with infection. DESIGN: Retrospective review. SETTING: Single Level I Tertiary Academic Center. PATIENTS SELECTION CRITERIA: All patients over a 12-year period with combined pelvic ring and bladder injuries were evaluated. Exclusion criteria were nonoperative management of the pelvic ring, isolated posterior fixation, and follow-up <90 days. OUTCOME MEASURE AND COMPARISONS: Primary outcome measured was deep infection of the anterior pelvis requiring surgical irrigation and debridement. RESULTS: In total, 106 patients with anterior stabilization of the pelvis in the setting of a bladder injury were included. Seven patients (6.6%) developed a deep infection and required surgical debridement within 90 days. Patients undergoing open reduction and internal fixation with plating of the anterior pelvis and acute concomitant bladder repair had an infection rate of 2.2% (1/43). Patients undergoing closed reduction and anterior fixation with either external fixation or percutaneous rami screw after bladder repair had an infection rate of 17.6% (3/17). There was a higher infection rate among patients with combined intraperitoneal (IP) and extraperitoneal (EP) bladder injuries (23%) when compared with those with isolated EP (3.8%) or IP (9.1%) bladder injuries (P = 0.029). CONCLUSIONS: Acute open reduction and internal fixation of the anterior pelvis in patients with combined pelvic ring and bladder injuries has a low infection rate. Patients with combined IP and EP bladder injuries are at increased risk of infection compared with those with isolated IP and EP injuries. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Asunto(s)
Fracturas Óseas , Huesos Pélvicos , Vejiga Urinaria , Humanos , Masculino , Huesos Pélvicos/lesiones , Estudios Retrospectivos , Femenino , Vejiga Urinaria/lesiones , Vejiga Urinaria/cirugía , Adulto , Persona de Mediana Edad , Fracturas Óseas/cirugía , Fracturas Óseas/complicaciones , Fijación Interna de Fracturas/efectos adversos , Factores de Riesgo , Adulto Joven , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/etiología , Desbridamiento , Anciano , Traumatismo Múltiple/cirugía , Resultado del TratamientoRESUMEN
OBJECTIVES: To identify factors that contribute to iatrogenic sciatic nerve palsy during acetabular surgery through a Kocher-Langenbeck approach and to evaluate if variation among individual surgeons exists. DESIGN: Retrospective cohort. SETTING: Level I trauma center. PATIENT SELECTION CRITERIA: Adults undergoing fixation of acetabular fractures (AO/OTA 62) through a posterior approach by 9 orthopaedic traumatologists between November 2010 and November 2022. OUTCOME MEASURES AND COMPARISONS: The prevalence of iatrogenic sciatic nerve palsy and comparison of the prevalence and risk of palsy between prone and lateral positions before and after adjusting for individual surgeon and the presence of transverse fracture patterns in logistic regression. Comparison of the prevalence of palsy between high-volume (>1 patient/month) and low-volume surgeons. RESULTS: A total of 644 acetabular fractures repaired through a posterior approach were included (median age 39 years, 72% male). Twenty of 644 surgeries (3.1%) resulted in iatrogenic sciatic nerve palsy with no significant difference between the prone (3.1%, 95% confidence interval [CI], 1.9%-4.9%) and lateral (3.3%, 95% CI, 1.3%-8.1%) positions (P = 0.64). Logistic regression adjusting for surgeon and transverse fracture pattern demonstrated no significant effect for positions (odds ratio 1.0, 95% CI, 0.3-3.9). Transverse fracture pattern was associated with increased palsy risk (odds ratio 3.0, 95% CI, 1.1-7.9). Individual surgeon was significantly associated with iatrogenic palsy (P < 0.02). CONCLUSIONS: Surgeon and the presence of a transverse fracture line predicted iatrogenic nerve palsy after a posterior approach to the acetabulum in this single-center cohort. Surgeons should perform the Kocher-Langenbeck approach for acetabular fixation in the position they deem most appropriate, as the position was not associated with the rate of iatrogenic palsy in this series. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Asunto(s)
Acetábulo , Fracturas Óseas , Enfermedad Iatrogénica , Neuropatía Ciática , Humanos , Acetábulo/lesiones , Acetábulo/cirugía , Masculino , Femenino , Enfermedad Iatrogénica/epidemiología , Adulto , Estudios Retrospectivos , Fracturas Óseas/cirugía , Neuropatía Ciática/etiología , Neuropatía Ciática/epidemiología , Persona de Mediana Edad , Posicionamiento del Paciente/métodos , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/métodos , Nervio Ciático/lesiones , PrevalenciaRESUMEN
OBJECTIVES: To determine the effect of obesity on systemic complications after operative pelvic ring injuries. DESIGN: Retrospective cohort study. SETTING: Single level 1 trauma center. PATIENT SELECTION CRITERIA: All patients at a level 1 trauma center who underwent operative fixation of a pelvic ring injury from 2015 to 2022 were included. Patients were grouped based on body mass index (BMI) into 4 categories (normal = BMI <25, overweight = BMI 25-30, obese = BMI 30-40, and morbidly obese BMI >40). OUTCOME MEASURES AND COMPARISONS: Systemic complications including acute respiratory distress syndrome, pneumonia, sepsis, deep venous thrombosis (DVT), pulmonary embolism, ileus, acute kidney injury (AKI), myocardial infarction, and mortality were recorded. Patients who developed a complication were compared with those who did not regarding demographic and clinical parameters to determine risk factors for each complication. RESULTS: A total of 1056 patients underwent pelvic ring fixation including 388 normal BMI, 267 overweight, 289 obese, and 112 morbidly obese patients. The average age of all patients was 36.9 years, with a range from 16 to 85 years. Overall, 631 patients (59.8%) were male. The overall complication and mortality rates were 23.2% and 1.4%, respectively. BMI was a significant independent risk factor for all-cause complication with an odds ratio of 1.67 for overweight, 2.30 for obese, and 2.45 for morbidly obese patients. The risk of DVT and AKI was also significantly increased with every weight class above normal with ORs of 5.06 and 3.02, respectively, for morbidly obese patients (BMI >40). CONCLUSIONS: This study demonstrated that among patients undergoing pelvic ring fixation, higher BMI was associated with increased risks of overall complication, specifically DVT and AKI. As the prevalence of obesity continues to increase in the population, surgeons should be cognizant that these patients may be at higher risk of certain postoperative complications during the initial trauma admission. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Asunto(s)
Fracturas Óseas , Obesidad , Huesos Pélvicos , Complicaciones Posoperatorias , Humanos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Huesos Pélvicos/lesiones , Estudios Retrospectivos , Fracturas Óseas/cirugía , Fracturas Óseas/complicaciones , Anciano , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Obesidad/complicaciones , Anciano de 80 o más Años , Adulto Joven , Adolescente , Factores de Riesgo , Índice de Masa Corporal , Fijación Interna de Fracturas/efectos adversos , Estudios de CohortesRESUMEN
OBJECTIVES: This study evaluated the relationship between obesity and postoperative complications in patients undergoing ankle open reduction internal fixation (ORIF). DESIGN: Retrospective cohort study. SETTING: PearlDiver-Mariner All-Payor Database. PATIENT SELECTION CRITERIA: Patients who underwent ankle ORIF from 2010 to 2021 and had a minimum of 2 years of follow-up were identified using Current Procedural Terminology, ICD-9, and ICD-10 codes. OUTCOME MEASURES AND OUTCOMES: Patients were stratified by body mass index into nonobese, obese, morbidly obese, and super-obese groups. Complication rates, including 90-day readmissions, infection, and post-traumatic osteoarthritis, were compared between obesity groups. Patients were additionally compared with a 1:1 matched analysis that controlled for demographics and comorbidities. RESULTS: A total of 160,415 patients undergoing ankle ORIF from 2010 to 2021 were identified. The cohort consisted mostly of females (64.8%) and the average age was 52.5 (SD 18.4) years. There were higher rates of 90-day readmissions, UTIs, DVT/PE, pneumonia, superficial infections, and acute kidney injuries in patients with increasing levels of obesity (P < 0.001). There were increased odds of nonunion and post-traumatic arthritis in the matched analysis at 2 years in the obesity group [OR: 2.36, 95% confidence interval (CI): 1.68-3.31, P < 0.001; OR: 2.18, 95% CI: 1.77-2.68, P < 0.001, respectively]. CONCLUSIONS: Postoperative medical complication rates in patients undergoing ankle ORIF, including infection, are higher in obese patients, even in the 1:1 matched analysis that controlled for demographic and comorbidity factors. Rates of nonunion and post-traumatic arthritis were higher in obese patients, as well. As such, it is important for surgeons to provide appropriate education regarding the risks after ankle ORIF in patients with obesity. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Asunto(s)
Fracturas de Tobillo , Fijación Interna de Fracturas , Obesidad , Complicaciones Posoperatorias , Humanos , Masculino , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Fracturas de Tobillo/cirugía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Obesidad/complicaciones , Adulto , Fijación Interna de Fracturas/efectos adversos , Anciano , Reducción Abierta , Estudios de CohortesRESUMEN
INTRODUCTION: The dynamic hip screw (DHS) and cannulated compression screws (CCS) have been the two implants most frequently employed for the fixation of femoral neck fractures. The objective of this study is to compare clinical and radiographic outcomes between patients treated with the FNS and those treated with CCS. MATERIAL AND METHODS: We conducted a retrospective analysis of a consecutive series of femoral neck fractures treated with FNS or CCS between May 2019 and June 2022. The study included 144 patients who met the inclusion criteria. Collected data encompassed age, sex, Garden fracture classification, Pauwels classification, duration of surgery, length of hospital stays, Harris Hip Score (HHS), complications, and injured side. RESULTS: The FNS group comprised 70 patients, while the CCS group consisted of 74 patients. The operation time was 43.6 ± 12.09 min for the FNS group and 56.47 ± 22.42 min for the CCS group. At the end of the follow-up, the mean HHS was 87.07 ± 11.77 for the FNS group and 76.20 ± 13.64 for the CCS group. The mean reduction in hemoglobin levels from pre- to post-surgery was 1.05 mg/dl in the FNS group and 0.87 mg/dl in the CCS group. The reintervention rate was 8.1% for the CCS group and 2.85% for the FNS group. CONCLUSION: The FNS does not demonstrate superiority over CCS regarding femoral neck shortening, complication rate, and reduction in hemoglobin levels. However, FNS does appear superior to CCS in terms HHS, operation time, and reoperation rate.
Asunto(s)
Tornillos Óseos , Fracturas del Cuello Femoral , Fijación Interna de Fracturas , Tempo Operativo , Humanos , Fracturas del Cuello Femoral/cirugía , Masculino , Femenino , Estudios Retrospectivos , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/efectos adversos , Persona de Mediana Edad , Anciano , Tiempo de Internación/estadística & datos numéricos , Adulto , Complicaciones Posoperatorias/etiología , Resultado del TratamientoRESUMEN
PURPOSE: To determine the short-term complication rates following open reduction and internal fixation of scapula fractures, factors affecting the development of adverse events, and complication rates based on the anatomic location of the fracture. METHODS: Thirty-day complication rates for patients who underwent open reduction and internal fixation of the scapula were compared between glenoid, body, coracoid, and acromion fracture locations, as identified by International Classification of Disease codes. Possible adverse events included postoperative surgical site infection, renal insufficiency, intubation, pneumonia, deep vein thrombosis, pulmonary embolism, urinary tract infection, wound dehiscence, stroke, and blood transfusion. RESULTS: A total of 251 scapula fractures were identified, with 161 having known fracture locations: 105 glenoid, 20 body, 9 coracoid, and 27 acromial fractures. The rate of any adverse event for all scapular fractures was 2.0%, with no significant difference between anatomic locations (p = 0.79). The overall rates of transfusion, surgical site infection, and return to OR were 0.4%, 0.8%, and 3.98%. Steroid use associated with a significantly increased risk of any adverse event (OR: 55.57, p = 0.038) and outpatient status demonstrated a protective effect on reoperation (OR: 0.11, p = 0.014). There were no significant differences in the rates between groups [transfusion (p = 0.91); surgical site infection (p = 0.17); reoperation (p = 0.85)]. CONCLUSION: Complication rates within thirty days of ORIF for scapula fracture were low. Reoperation was the most common complication, followed by surgical site infection, wound dehiscence, stroke, transfusion, and pneumonia. Steroid use was a risk factor for developing any adverse event, and outpatient status was protective against reoperation. The 30-day complication profile of glenoid, body, coracoid, and acromial fractures was not significantly different. The low complication rates support the relative short-term safety of operative intervention with internal fixation. LEVEL OF EVIDENCE: Level III.