RESUMEN
Hip joint is a ball and socket type of joint and its anatomic features makes it very stable. However, Incidence of hip dislocation has increased recently due to high energy trauma like road traffic accident, fall from height etc. It is usually associated with fracture of femoral head, neck, shaft and acetabular wall. Association of ipsilateral intertrochantric fracture is exceedingly rare and only a few case reports are available in the literature. We are presenting a rare case report of neglected anterior hip dislocation with ipsilateral comminuted intertrochanteric fracture managed with hemiarthroplasty using long cemented distal press-fit revision stem. A 66-year-old male presented to our outpatient department with history of fall from a tree 22 days back with pain in right hip and inability to bear weight on right lower limb. Radiographs were suggestive of anterior hip dislocation with fracture of ipsilateral comminuted intertrochanteric fracture of right side. Anterior hip dislocation with ipsilateral intertrochanteric fracture is a very rare entity, and only a few case reports are available in the literature. Management includes early open reduction and fixation to achieve optimal outcomes, but doing primary arthroplasty is also a viable option especially in neglected cases as there is high chances of avascular necrosis and secondary osteoarthritis of the hip joint later on.
RésuméL'articulation de la hanche est une articulation de type rotule et ses caractéristiques anatomiques la rendent très stable. Cependant, l'incidence de luxation de la hanche a récemment augmenté en raison de traumatismes à haute énergie comme un accident de la route, une chute de hauteur, etc. Elle est généralement associée à une fracture de la tête fémorale, du col, de la diaphyse et de la paroi acétabulaire. L'association de fractures intertrochantriques homolatérales est extrêmement rare et seuls quelques rapports de cas sont disponibles dans la littérature. Nous présentons un rapport de cas rare de luxation antérieure négligée de la hanche avec fracture intertrochantérienne comminutive ipsilatérale gérée par hémiarthroplastie utilisant une longue tige de révision distale cimentée à ajustement serré. Un homme de 66 ans s'est présenté à notre service ambulatoire avec des antécédents de chute d'un arbre il y a 22 jours avec des douleurs à la hanche droite et une incapacité à supporter le poids sur le membre inférieur droit. Les radiographies évoquaient une luxation antérieure de la hanche avec une fracture intertrochantérienne comminutive homolatérale du côté droit. La luxation antérieure de hanche avec fracture intertrochantérienne homolatérale est une entité très rare et seuls quelques rapports de cas sont disponibles dans la littérature. La prise en charge comprend une réduction ouverte et une fixation précoces pour obtenir des résultats optimaux, mais la réalisation d'une arthroplastie primaire est également une option viable, en particulier dans les cas négligés, car il existe un risque élevé de nécrose avasculaire et d'arthrose secondaire de l'articulation de la hanche par la suite.
Asunto(s)
Fracturas Conminutas , Luxación de la Cadera , Fracturas de Cadera , Humanos , Masculino , Anciano , Fracturas de Cadera/cirugía , Fracturas de Cadera/complicaciones , Fracturas Conminutas/cirugía , Fracturas Conminutas/complicaciones , Fracturas Conminutas/diagnóstico por imagen , Luxación de la Cadera/cirugía , Luxación de la Cadera/diagnóstico por imagen , Luxación de la Cadera/complicaciones , Resultado del Tratamiento , Hemiartroplastia/métodos , Artroplastia de Reemplazo de Cadera/métodos , Radiografía , Accidentes por Caídas , Articulación de la Cadera/cirugía , Articulación de la Cadera/diagnóstico por imagenRESUMEN
PURPOSE: Shaping and assembling contemporary external fixators rapidly for the severe mandibular fractures remains a challenge, especially in emergency circumstance. We designed a novel external fixator that incorporates universal joints to provide the stabilization for mandibular comminuted fractures. This study aims to confirm the efficacy of this novel external fixator through biomechanical tests in vitro and animal experiments. METHODS: In vitro biomechanical tests were conducted using 6 fresh canine with mandibular defect to simulate critical comminuted fractures. Three mandibles were stabilized by the novel external fixator and other mandibles were fixed by 2.5 mm reconstruction plates. All fixed mandibles were subjected to loads of 350 N on the anterior regions of teeth and 550 N on the first molar of the unaffected side. The stability was evaluated based on the maximum displacement and the slope of the load-displacement curve. In animal experiments, 9 beagles with comminuted mandibular fractures were divided into 3 groups, which were treated with the novel external fixation, reconstruction plate, and dental arch bar, respectively. The general observation, the changes in animals' weight, and the surgical duration were recorded and compared among 3 groups. The CT scans were performed at various intervals of 0 day (immediately after the surgery), 3 days, 7 days, 14 days, 21 days, and 28 days to analyze the displacement of feature points on the canine mandible and situation of fracture healing at 28 days. The statistical significance was assessed by the two-way analysis of variance test followed by the Bonferroni test, enabling multiple comparisons for all tests using GraphPad Prism10.1.0 (GraphPad Inc, USA). RESULTS: The outcomes of the biomechanical tests indicated that no statistically significant differences were found in terms of the maximum displacement (p = 0.496, 0.079) and the slope of load displacement curves (p = 0.374, 0.349) under 2 load modes between the external and internal fixation groups. The animal experiment data showed that there were minor displacements of feature points between the external and internal fixation groups without statistic difference, while the arch bar group demonstrated inferior stability. The CT analysis revealed that the best fracture healing happened in the internal fixation group, followed by the external fixation and arch baring at 28 days after fixation. The external fixation group had the shortest fixation duration (25.67 ± 3.79) min compared to internal fixation ((70.67 ± 4.51) min, p < 0.001) and arch baring ((42.00 ± 3.00) min, p = 0.046). CONCLUSION: The conclusion of this study highlighted the efficacy and reliability of this novel external fixator in managing mandibular fractures rapidly, offering a viable option for the initial stabilization of comminuted mandibular fractures in the setting of emergency rescue.
Asunto(s)
Fijadores Externos , Fijación de Fractura , Fracturas Conminutas , Fracturas Mandibulares , Animales , Fracturas Mandibulares/cirugía , Fracturas Mandibulares/diagnóstico por imagen , Fracturas Conminutas/cirugía , Perros , Fijación de Fractura/métodos , Fenómenos BiomecánicosRESUMEN
Distal humerus intra-articular comminuted open fracture is a challenging injury, with nonunion, infection and stiffness considered as major concerns. We report a 58-year-old woman who was admitted to the emergency department from a car accident, sustaining an open wound with severe comminution of distal humerus and complete articular fracture, classified as AO/OTA 13C2 and Gustillo Anderson type IIIA. Debridement and external fixation was done first, followed by open reduction and internal fixation with fibular strut allograft. The patient showed excellent results in radiological and functional outcomes. Level of Evidence: Level V (Therapeutic).
Asunto(s)
Peroné , Fracturas Conminutas , Fracturas Abiertas , Fracturas del Húmero , Humanos , Femenino , Persona de Mediana Edad , Fracturas Conminutas/cirugía , Fracturas Conminutas/diagnóstico por imagen , Fracturas del Húmero/cirugía , Fracturas del Húmero/diagnóstico por imagen , Peroné/trasplante , Peroné/lesiones , Fracturas Abiertas/cirugía , Aloinjertos , Fijación Interna de Fracturas/métodos , Fracturas Intraarticulares/cirugía , Fracturas Intraarticulares/diagnóstico por imagen , Desbridamiento , Trasplante Óseo/métodosRESUMEN
PURPOSE: Comminuted coronal shear fractures of the distal humerus represent rare injuries and are difficult to treat, especially comminuted capitellum and trochlear fractures (Dubberley Type III). The on-table reconstruction technique of comminuted articular fractures may be an option, although it has not been reported in the coronal shear fracture of the distal humerus. The aim of the present case series is to determine the functional and radiological outcomes of on-table reconstructed Dubberley III fractures. METHODS: A retrospective review was conducted of 10 patients with Dubberley type III fractures in coronal shear fractures of the capitellum and trochlea who underwent an 'on-table' reconstruction technique between January 2009 and October 2019. All patients were evaluated using the disabilities of the arm, shoulder, and hand (DASH) score, American Shoulder and Elbow Surgeons(ASES) score, Mayo Elbow Score Performance Index (MEPI) score and at least 4 years later. RESULTS: All cases achieved union. At the final follow-up, the mean range of elbow motion was 11.5°of flexion contracture and 131.9° of further flexion. The mean DASH score was 21.2 (5.7) points (range 13.3-32.5). The mean ASES score was 88.6 ± 7.4 (range, 77 to 100). The mean MEPI score was 87 (10) points (range 70-100). In complication, partial osteonecrosis of capitellum is developed in one patient. One patient had heterotopic ossification without functional impairment. CONCLUSION: The on-table reconstruction technique can be a reliable option in the surgical treatment of complex distal humerus fractures. This technique allows anatomical reduction of comminuted capitellum and trochlea, with a low risk of avascular necrosis over 4 years of follow-up. LEVEL OF EVIDENCE: Level IV, retrospective case series.
Asunto(s)
Articulación del Codo , Fracturas Conminutas , Fracturas del Húmero , Rango del Movimiento Articular , Humanos , Masculino , Estudios Retrospectivos , Femenino , Fracturas del Húmero/cirugía , Fracturas del Húmero/diagnóstico por imagen , Persona de Mediana Edad , Adulto , Resultado del Tratamiento , Fracturas Conminutas/cirugía , Fracturas Conminutas/diagnóstico por imagen , Articulación del Codo/cirugía , Articulación del Codo/diagnóstico por imagen , Articulación del Codo/fisiopatología , Fijación Interna de Fracturas/métodos , Anciano , Estudios de Seguimiento , Procedimientos de Cirugía Plástica/métodos , Adulto JovenRESUMEN
BACKGROUND: For the treatment of coronoid process fractures, medial, lateral, anterior, anteromedial, and posterior approaches have been increasingly reported; however, there is no general consensus on the method of fixation of coronal fractures. Here, we present a highly-extensile minimally invasive approach to treat coronoid process fractures using a mini-plate that can achieve anatomic reduction, stable fixation, and anterior capsular repair. Further, the study aimed to determine the complication rate of the anterior minimally invasive approach and to evaluate functional and clinical patient-reported outcomes during follow-up. METHODS: Thirty-one patients diagnosed with coronoid fractures accompanied with a "terrible triad" or posteromedial rotational instability between April 2012 and October 2018 were included in the analysis. Anatomical reduction and mini-plate fixation of coronoid fractures were performed using an anterior minimally invasive approach. Patient-reported outcomes were evaluated using the Mayo Elbow Performance Index (MEPI) score, range of motion (ROM), and the visual analog score (VAS). The time of fracture healing and complications were recorded. RESULTS: The mean follow-up time was 26.7 months (range, 14-60 months). The average time to radiological union was 3.6 ± 1.3 months. During the follow-up period, the average elbow extension was 6.8 ± 2.9° while the average flexion was 129.6 ± 4.6°. According to Morrey's criteria, 26 (81%) elbows achieved a normal desired ROM. At the last follow-up, the mean MEPI score was 98 ± 3.3 points. There were no instances of elbow instability, elbow joint stiffness, subluxation or dislocation, infection, blood vessel complications, or nerve palsy. Overall, 10 elbows (31%) experienced heterotopic ossification. CONCLUSION: An anterior minimally invasive approach allows satisfactory fixation of coronoid fractures while reducing incision complications due to over-dissection of soft tissue injuries. In addition, this incision does not compromise the soft tissue stability of the elbow joint and allows the patient a more rapid return to rehabilitation exercises.
Asunto(s)
Placas Óseas , Articulación del Codo , Fijación Interna de Fracturas , Fracturas Conminutas , Rango del Movimiento Articular , Fracturas del Cúbito , Humanos , Masculino , Femenino , Fracturas del Cúbito/cirugía , Fracturas del Cúbito/diagnóstico por imagen , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Persona de Mediana Edad , Adulto , Fracturas Conminutas/cirugía , Fracturas Conminutas/diagnóstico por imagen , Articulación del Codo/cirugía , Articulación del Codo/diagnóstico por imagen , Articulación del Codo/fisiopatología , Resultado del Tratamiento , Estudios Retrospectivos , Estudios de Seguimiento , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/instrumentación , Curación de Fractura , Anciano , Medición de Resultados Informados por el Paciente , Adulto JovenRESUMEN
CASE: A 28-year old male patient was involved in a RTA and sustained a highly comminuted L4 burst fracture with more than 90% canal compromise.Considering the complete loss of power in the respective myotomes but the preservation of sacral sparing there were controversially different surgical options. We successfully performed a posterior only surgical procedure, which applied a modified transpedicle access technique to decompress the spinal canal and to restore the anterior column, achieving full neurological recovery at the final follow-up. CONCLUSION: A well-planned and executed posterior surgery alone can achieve excellent clinical and radiological result in the treatment of severely comminuted lumbar fractures.
Asunto(s)
Fracturas Conminutas , Vértebras Lumbares , Fracturas de la Columna Vertebral , Humanos , Masculino , Adulto , Fracturas Conminutas/cirugía , Fracturas Conminutas/diagnóstico por imagen , Fracturas de la Columna Vertebral/cirugía , Fracturas de la Columna Vertebral/diagnóstico por imagen , Vértebras Lumbares/cirugía , Vértebras Lumbares/lesiones , Vértebras Lumbares/diagnóstico por imagen , Accidentes de TránsitoRESUMEN
Objective: To introduce a new fluoroscopic method for assessing the quality of medial and lateral joint surface reduction during internal fixation of patellar fractures and to summarize the clinical outcomes of patients treated using this method. Methods: A retrospective analysis was conducted on the clinical data of 52 patients with patellar fractures treated between January 2018 and January 2022 who met the inclusion criteria. There were 27 male and 25 female patients, aged 21-75 years, with an average age of 62 years. The types of patellar fractures included 9 transverse fractures, 37 comminuted fractures, and 6 longitudinal fractures. According to the AO/Orthopaedic Trauma Association (AO-OTA)-2018 fracture classification, there were 21 cases of type 34A, 6 cases of type 34B, and 25 cases of type 34C. The time from injury to operation ranged from 1 to 5 days, with an average of 2.3 days. Treatments included internal fixation with hollow screws or hollow screw tension bands, with or without anchor repair. During operation, the medial and lateral joint surfaces of the patella were observed using the tangential fluoroscopic method to assess the smoothness of reduction of the median ridge, lateral joint surface, medial joint surface, and lateral joint edge. Patients were followed up regularly, and X-ray films were taken to observe fracture healing. Knee joint range of motion, Böstman score, and Lysholm score were used to evaluate functional recovery. Results: The tangential fluoroscopic method for the medial and lateral joint surfaces of the patella during operation showed satisfactory reduction of the joint surfaces and good positioning of the implants. All patients were followed up 12-16 months, with an average of 13.4 months. During the follow-up, fracture displacement occurred in 1 case and titanium cable breakage in 1 case. All patella fractures healed successfully, with a healing time of 8-16 weeks (mean, 11.4 weeks). At last follow-up, knee joint range of motion ranged from 120° to 140°, with an average of 136°. The Böstman score ranged from 20 to 30, with an average of 28, yielding excellent results in 45 cases and good results in 7 cases. The Lysholm score ranged from 88 to 100, with an average of 93, yielding excellent results in 40 cases and good results in 12 cases. Conclusion: The intraoperative application of the tangential fluoroscopic method for the medial and lateral joint surfaces of the patella can quickly determine the fluoroscopic plane of the patella, accurately assess the quality of fracture reduction and the position of internal fixator, thereby improving effectiveness.
Asunto(s)
Fijación Interna de Fracturas , Fracturas Óseas , Rótula , Humanos , Rótula/lesiones , Rótula/cirugía , Femenino , Masculino , Fijación Interna de Fracturas/métodos , Adulto , Fluoroscopía/métodos , Estudios Retrospectivos , Persona de Mediana Edad , Fracturas Óseas/cirugía , Fracturas Óseas/diagnóstico por imagen , Anciano , Adulto Joven , Resultado del Tratamiento , Rango del Movimiento Articular , Articulación de la Rodilla/cirugía , Articulación de la Rodilla/diagnóstico por imagen , Fracturas Conminutas/cirugía , Fracturas Conminutas/diagnóstico por imagen , Fractura de RótulaRESUMEN
Objective: To analyze the effectiveness of external fixator combined with Kirschner wire (EF-KW) fixation in the treatment of oblique and comminuted distal humeral metaphyseal-diaphyseal junction (DHMDJ) fractures in children. Methods: A clinical data of 22 children with DHMDJ fractures who met the selection criteria between April 2021 and December 2023 was retrospectively analyzed. All patients were treated with EF-KW fixation. There were 14 boys and 8 girls with an average age of 6.8 years (range, 1.5-12.0 years). The time from injury to operation was 14-38 hours (mean, 24.2 hours). There were 18 cases of comminuted fractures and 4 cases of oblique fractures; and 1 case of median nerve injury and 1 case of radial nerve injury before operation. The occurrence of postoperative complications was recorded. At last follow-up, the function of the affected elbow joint was evaluated according to the Mayo elbow joint function score, and the Baumann's angle (BA) and humero-capitellar angle (HCA) of the affected and healthy sides were recorded and compared. Results: All fractures were successfully treated with closed reduction and no complications such as nerve injury occurred. Superficial infection occurred in 4 cases after operation and healed after symptomatic treatment. The incisions of other patients healed by first intention. All patients were followed up 9-24 months (mean, 13.8 months). At last follow-up, according to the Mayo elbow joint function score, the elbow joint function was rated as excellent in 15 cases, good in 6 cases, and fair in 1 case, with an excellent and good rate of 95.5%. The neurologic injury before operation recovered gradually. X-ray films reexamination showed that all fractures healed, and the healing time of fractures ranged from 29 to 61 days, with an average of 35.6 days. At last follow-up, there was no significant difference in BA and HCA between the healthy side and the affected side ( P>0.05). During follow-up, 1 case developed mild cubitus varus, while the other patients had no serious complications. Conclusion: EF-KW fixation for oblique and comminuted DHMDJ fractures in children has the advantages of less trauma, simple operation, easy reduction, good stability after reduction, low incidence of serious complications, and good elbow functional recovery.
Asunto(s)
Hilos Ortopédicos , Fijadores Externos , Fracturas Conminutas , Fracturas del Húmero , Humanos , Masculino , Femenino , Niño , Fracturas del Húmero/cirugía , Estudios Retrospectivos , Fracturas Conminutas/cirugía , Preescolar , Lactante , Resultado del Tratamiento , Rango del Movimiento Articular , Articulación del Codo/cirugía , Fijación de Fractura/métodos , Complicaciones Posoperatorias , Curación de Fractura , Diáfisis/lesiones , Diáfisis/cirugíaRESUMEN
INTRODUCTION: The goals of surgical treatment of patellar fractures are a biomechanically stable joint and congruent restoration of the retro patellar joint surface. Surgical treatment strategies for patellar fractures have evolved from tension band in combination with wire cerclages to new devices. METHODS: The modified anterior tension band (MATB) technique for fixation of patellar fractures consists of two longitudinal 1.8 mm Kirschner wires (K-wires) and an 18-gauge stainless steel wire looped in a figure-of-8 pattern over the anterior aspect of the patella. The K-wires should be inserted 5 mm from the anterior cortical surface of the patella, parallel in the coronal and sagittal planes. For mechanical reasons, the wire should be the closest to the anterior aspect of the bone. This construct converts the anterior tensile forces generated by the extensor mechanism and knee flexion into compressive forces on the anterior aspect of the fracture site. The MATB is the most widely accepted method of internal fixation for transverse and comminuted patellar fractures. Only a careful implementation of the MATB in all its phases will provide the best mechanical construct and the least aggressive construct for the soft tissues, allowing early re-education without complications. RESULTS: Good to excellent clinical results (64-100 %) have been reported with MATB for fixation of patellar fractures. Good to excellent range of knee motion and satisfactory results have been reported despite a high percentage (up to 60 %) of secondary procedures, mainly for removal of symptomatic hardware. CONCLUSION: This article provides an overview of the use and results of the MATB technique for patellar fractures and the means to improve results with this technique.
Asunto(s)
Hilos Ortopédicos , Fijación Interna de Fracturas , Fracturas Óseas , Rótula , Humanos , Rótula/lesiones , Rótula/cirugía , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Fracturas Óseas/cirugía , Resultado del Tratamiento , Rango del Movimiento Articular , Fenómenos Biomecánicos , Procedimientos de Cirugía Plástica/métodos , Fracturas Conminutas/cirugía , Fractura de RótulaRESUMEN
Background: Treatment of comminuted patellar fractures accompanied by coronal split articular and inferior pole fragments is a challenge. To treat this difficult fracture, we perform articular fragment detachment and separate fixation for coronal split articular and inferior pole fragments. We aimed to evaluate the radiological and clinical outcomes of our technique in comminuted patellar fractures at least 1 year after surgery. Methods: Between January 2019 and June 2022, 15 patients diagnosed with comminuted patellar fractures accompanied by coronal split articular and inferior pole fragments based on preoperative computed tomography underwent surgery using the articular detachment technique. The key point of this technique was anatomical reduction and subchondral fixation of the coronal split articular fragment to the superior main fragment after complete detachment of the coronal split fragment from the inferior pole. The remaining inferior pole was fixed using a separate construct. Postoperative articular gap, articular step-off, and complications, including resorption, reduction loss, and avascular necrosis of fixed articular fragments, were evaluated as radiological outcomes. Range of motion and the Lysholm scores were used to evaluate clinical outcomes. Results: Among the 15 patients, the coronal split articular fragments were fixed using Kirschner wires in 13 patients and headless screws in 2 patients. The inferior poles were fixed using separate vertical wiring in 13 patients and tension-band wiring in 2 patients. A postoperative articular gap was noted in 7 patients, with an average articular gap of 1.0 mm (range, 0.7-1.6 mm). No articular step-off was observed. Bone union and normal range of motion were achieved in all patients. On the 1-year postoperative lateral radiograph, resorption of the articular fracture site was seen in 5 patients. There was no loss of reduction or avascular necrosis of the coronal split articular fragments. The average postoperative Lysholm score at 1 year was 89.3 ± 4.1 (range, 82-95). Conclusions: The technique would be a reliable and safe option for the surgical treatment of comminuted patellar fractures accompanied by coronal split articular and inferior pole fragments in terms of anatomical reduction and stable fixation of articular fragments without risk of avascular necrosis.
Asunto(s)
Fijación Interna de Fracturas , Fracturas Conminutas , Rótula , Humanos , Fracturas Conminutas/cirugía , Rótula/cirugía , Rótula/lesiones , Masculino , Femenino , Adulto , Fijación Interna de Fracturas/métodos , Persona de Mediana Edad , Hilos Ortopédicos , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Adulto Joven , Tornillos Óseos , Fracturas Óseas/cirugía , Fracturas Óseas/diagnóstico por imagenRESUMEN
OBJECTIVES: To compare the clinical, radiographic, and patient-reported outcomes of nonoperative and operative treatment of adolescents with comminuted "Z-type" midshaft clavicle fractures. DESIGN: Prospective observational cohort. SETTING: Eight tertiary care pediatric centers. PATIENT SELECTION CRITERIA: Patients aged 10-18 years who were treated either operatively or nonoperatively for a diaphyseal clavicle fracture between 2013 and 2017 were screened/enrolled at the time of injury. The current subcohort analysis was derived from a larger adolescent clavicle study population of 907 patients. OUTCOME MEASUREMENTS AND COMPARISONS: Complications and validated patient-reported outcome measures (PROs):(ASES, QuickDASH, Marx Shoulder Activity Score, EQ-5D, EQ-VAS, and patient satisfaction score) were compared between operative and nonoperative cohorts. RESULTS: Eighty-one patients (69 male [85.2%], 12 female; average age 15 years [11.1-18.7]; 78 with sports participation [96.2%]) were followed through bony healing and return to sports, while 59 patients (73%) completed 2-year follow-up with PROs, 26 of whom were treated nonoperatively and 33 treated operatively. All demographic and fracture characteristics were similar (P > 0.05) between the 2-year follow-up cohorts except for fracture shortening, which was greater in the operative cohort (23 vs. 29 mm, P = 0.01). After controlling for this potential confounder through both regression and propensity matched subgroup analysis, nonoperative versus operative cohorts showed no difference in rates of nonunion (0%), delayed union (0% vs. 2.3%, P = 1.0), symptomatic malunion (2.7% vs. 0%, P = 0.4), refracture (2.7% vs. 2.2%, P = 1.0), unexpected subsequent surgery (5.4% vs. 11.4%, P = 0.45), or clinically significant complications (5.4% vs. 16%, P = 0.17). There were no differences in any PROs between cohorts, both before and after controlling for the difference in fracture shortening (all P-values >0.05). CONCLUSIONS: In this prospective comparison of complications and 2-year PROs in adolescents with comminuted Z-type clavicle fractures, nonoperative and operative treatment yielded similar outcomes. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Asunto(s)
Clavícula , Fracturas Conminutas , Humanos , Clavícula/lesiones , Clavícula/cirugía , Adolescente , Masculino , Femenino , Estudios Prospectivos , Fracturas Conminutas/cirugía , Niño , Medición de Resultados Informados por el Paciente , Resultado del Tratamiento , Curación de Fractura , Estudios de Cohortes , Tratamiento Conservador/métodos , Fijación Interna de FracturasRESUMEN
PURPOSES: Fractures of the inferior patellar pole, unlike other patellar fractures, present challenges for traditional surgical fixation methods. This article introduces the clinical technique and outcomes of using Kirschner wire tension band combined with anchor screw cross-stitch fixation for comminuted inferior patellar pole fractures. METHODS: This retrospective case series study included 14 patients with comminuted inferior patellar pole fractures treated at our institution from September 1, 2020, to April 30, 2022. All patients underwent surgery using the Kirschner wire tension band with anchor screw cross-stitch technique. Follow-up assessments involved postoperative X-rays to evaluate fracture healing, as well as clinical parameters such as healing time, Visual Analog Scale (VAS) scores, range of motion (ROM), and Bostman scores. RESULTS: All patients were followed for an average of over 12 months, with no cases of internal fixation failure. Knee joint stability and function were excellent. X-rays revealed an average healing time of approximately 10.79 ± 1.53 weeks, hospitalization lasted 5.64 ± 1.15 days, surgery took approximately 37.86 ± 5.32 minutes, and intraoperative blood loss was 33.29 ± 8.15 ml. One patient experienced irritation from the internal fixation material. At the final follow-up, the Bostman score averaged 28.29 ± 0.83, knee joint flexion reached 131.07° ± 4.88°, all patients achieved full knee extension, and the VAS score was 0.36 ± 0.63. CONCLUSION: Kirschner wire tension band with anchor screw cross-stitch fixation for comminuted inferior patellar pole fractures delivered satisfactory clinical outcomes. This surgical method, characterized by its simplicity and reliability, is a valuable addition to clinical practice.
Asunto(s)
Hilos Ortopédicos , Fijación Interna de Fracturas , Fracturas Conminutas , Rótula , Humanos , Masculino , Femenino , Adulto , Rótula/cirugía , Rótula/lesiones , Fracturas Conminutas/cirugía , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Estudios Retrospectivos , Persona de Mediana Edad , Rango del Movimiento Articular , Resultado del Tratamiento , Fracturas Óseas/cirugía , Curación de Fractura , Articulación de la Rodilla/cirugía , Articulación de la Rodilla/fisiopatología , Adulto Joven , Tornillos Óseos , Anclas para SuturaRESUMEN
Background: The pins and rubber traction system (PRTS) has proven effective in managing intra-articular fractures of the proximal interphalangeal joint. However, there is scant evidence in the literature regarding its efficacy in treating distal interphalangeal joint (DIPJ). This study aims to investigate the outcomes of PRTS in the treatment of comminuted intra-articular fractures of the DIPJ. Methods: We conducted a retrospective review of patients with comminuted intra-articular fractures of the DIPJ treated with PRTS between 2017 and 2021. At the final follow-up, we measured and compared the active range of motion (ROM) in both affected and non-injured contralateral fingers. The subjective evaluation utilised the Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) questionnaire and the Visual Analogue Scale (VAS). Results: Ten patients with a mean follow-up of 13.2 months (range: 12-17) were included in the study. Fracture locations included the base of the distal phalanx in two patients, the condyle of the middle phalanx in seven and both in one patient. At the final follow-up, the average VAS score was 0.5 (range: 0-2). The average active motion of the DIPJ was 61° (range: 50°-70°) for the injured side and 76° (range: 75°-80°) for the opposite side. The mean range of DIPJ movement was 80% (range: 68%-87%) of the non-injured side. Extension deficits were observed in five patients, with a median deficit value of 10° (range: 5°-10°). The average Quick-DASH score was 2.9 (range: 0-11.3). Conclusions: The PRTS can be considered as an effective surgical technique in managing comminuted intra-articular fractures of the DIPJ. Level of Evidence: Level IV (Therapeutic).
Asunto(s)
Articulaciones de los Dedos , Fracturas Conminutas , Fracturas Intraarticulares , Rango del Movimiento Articular , Tracción , Humanos , Masculino , Femenino , Estudios Retrospectivos , Fracturas Intraarticulares/cirugía , Fracturas Intraarticulares/terapia , Adulto , Articulaciones de los Dedos/fisiopatología , Tracción/métodos , Fracturas Conminutas/cirugía , Fracturas Conminutas/terapia , Persona de Mediana Edad , Clavos Ortopédicos , Adulto Joven , Traumatismos de los Dedos/terapia , Evaluación de la DiscapacidadRESUMEN
OBJECTIVE: The treatment of talar neck and/or body fractures is known to be difficult and challenging, with significant impact on the long-term functional outcome for the patient. The optimal management, including the choice of surgical approaches and implants, are still under constant discussion. The purpose of the study was to investigate the clinical effects of lateral mini-plate combined with medial lag screws for the treatment of complicated central talar fractures. METHODS: The data of eight patients with complex central talus fractures treated between June 2019 and January 2021 were retrospectively analyzed. There were six males and two females, ranging in age from 15 to 66 years, with an average age of 37.4 years. There were three cases on the left and five cases on the right. All fractures were comminuted, including talar neck with talar body fracture in seven cases and talar body comminuted with subluxation of subtalar joint in one case. All patients were treated with the anteromedial combined anterolateral approach, lateral talar mini-plate fixation and medial lag screw fixation. Fracture reduction quality, union time, and complications were recorded, and functional outcomes were evaluated using the American Orthopedic Foot & Ankle Society (AOFAS) scoring system. RESULTS: The time from injury to surgery was 1-6 days, with an average of 3.38 days. The follow-up period was 34-53 months (mean 44.88 months). All fractures healed with a mean healing time of 16.75 weeks (13-23 weeks). Anatomical reduction was observed in six cases and near in two cases. After operation, there was no loosening or breakage of implant, loss of fracture reduction, and irritation of skin and soft tissue by internal fixation. The average AOFAS score was 87.38 (48-100), with excellent five cases, good two cases and poor one case, and the excellent and good rate was 87.5%. Superficial skin necrosis in one surgical incision healed after dressing exchange. No deep infection occurred. One case (1/8, 12.5%) developed avascular necrosis of the talus without collapse. Posttraumatic arthritis was found in four cases (4/8, 50%). CONCLUSION: The utilization of lateral mini-plates in combination with medial screws for treating complex central talar fractures results in satisfactory reduction and stable fixation, mitigating complications associated with poor reduction. However, due to the absence of an anatomical mini-plate, pre-contouring is necessary when applying the lateral plate. This demands a surgeon's thorough familiarity with the anatomical morphology of the talus and proficiency in surgical techniques. Posttraumatic arthritis is the most common complication of complex central talar fractures.
Asunto(s)
Placas Óseas , Tornillos Óseos , Fijación Interna de Fracturas , Fracturas Óseas , Astrágalo , Humanos , Masculino , Femenino , Adulto , Astrágalo/lesiones , Astrágalo/cirugía , Persona de Mediana Edad , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Estudios Retrospectivos , Adolescente , Anciano , Adulto Joven , Fracturas Óseas/cirugía , Fracturas Conminutas/cirugíaRESUMEN
PURPOSE OF THE STUDY: This manuscript aims to identify an indication algorithm for the surgical treatment of radial head fractures associated with elbow dislocation. The study compares the mid-term functional outcomes of patients with multifragment radial head fracture treated by resection with the outcomes of patients treated with radial head replacement. MATERIAL AND METHODS: The cohort of 34 patients who sustained a radial head fracture at the mean age of 42.5 years (age range 20-81 years) was broken down into two groups by type of surgery. The EXT group consists of 20 patients with the radial head fracture treated by radial head resection. The END group includes 14 patients treated with the radial head replacement. In all patients, the radial head fracture was associated with elbow dislocation (type IV fracture according to the Mason-Johnston classification). The modified Kocher's surgical approach was used in all patients of both the groups. In the EXT group, resection of the fragmented radial head was performed. In the END group, the ExploR® Modular Radial Head System (Zimmer, Biomet, USA) was used, consisting of a CoCr (cobalt chromium) alloy head and a titanium stem. The pain and the range of motion of the elbow and forearm were evaluated after the completion of the outpatient rehabilitation (the mean follow-up period was 2.4 years). Simultaneously, the elbow joint stability was assessed. Radiographs were taken to detect heterotopic ossifications, proximalization of the radius, and any signs of prosthesis loosening. The frequency of reoperations was followed-up. The MEPS (Mayo Elbow Performance Score) was calculated. RESULTS: In the EXT group, the mean elbow flexion was 117.5° and the mean pronation/supination was 166.9°. In 50% of patients, the MEPS obtained was greater than 90 points, which means an excellent functional outcome. In 1 patient (5%), recurrent elbow dislocation occurred which was the reason for revision surgery (elbow transfixation with the Kirschner wires and medial collateral ligament suture). Revision surgery was also performed in 2 patients (10%) in whom not all the radial head fragments were removed. Moreover, also observed was elbow joint instability (2 patients) and temporary radial nerve paralysis (1 patient). In 1 case discrete proximalization of the radius developed. The patients in the END group showed the mean elbow flexion of 112° and the mean pronation/supination of 135°. The MEPS obtained from 69% of patients was greater than 90 points, which means an excellent outcome. The pain under load was reported by 3 patients (21%). In 5 patients (35%), the X-rays showed radiolucent zone around the stem of the prosthesis. Neither revision surgery, nor prosthesis removal has been performed yet in any patient. No instability, neurological complications or infections have been reported. In both EXT and END group heterotopic ossifications have developed in 4 patients. CONCLUSIONS: Radial head replacement compared to the radial head resection in the management of multifragment fractures associated with elbow dislocations increase the elbow and forearm stability. The group of patients with an implanted radial head prosthesis shows a higher percentage of patients achieving excellent functional outcome than the group of patients with radial head resection. KEY WORDS: radial head, elbow, fracture, dislocation, resection, prosthesis.
Asunto(s)
Articulación del Codo , Fracturas Conminutas , Luxaciones Articulares , Inestabilidad de la Articulación , Fracturas del Radio , Humanos , Fracturas del Radio/cirugía , Adulto , Luxaciones Articulares/cirugía , Articulación del Codo/cirugía , Articulación del Codo/fisiopatología , Persona de Mediana Edad , Masculino , Fracturas Conminutas/cirugía , Anciano , Femenino , Inestabilidad de la Articulación/cirugía , Inestabilidad de la Articulación/etiología , Lesiones de Codo , Anciano de 80 o más Años , Rango del Movimiento Articular , Resultado del Tratamiento , Adulto Joven , Fracturas Radiales de Cabeza y CuelloRESUMEN
Objective: To summarize the research progress in the treatment of distal humeral metaphyseal-diaphyseal junction (DHMDJ) fractures in children and to provide reference for clinical practice. Methods: The characteristics and treatment methods of transverse and comminuted DHMDJ fractures in children were summarized and analyzed by referring to relevant literature at home and abroad. Results: DHMDJ fractures in children are not uncommon clinically, with high fracture line position, multi-directional instability, difficult closed reduction in treatment, and easy to cause complications such as coronal and sagittal deformity of the elbow. The Kirschner wire technique was effective for DHMDJ fractures with the fracture line at the middle and low levels, but was prone to iatrogenic ulnar nerve injury. Elastic stable intramedullary nail is suitable for higher-position transverse DHMDJ fractures. However, this technique requires a second operation to remove the internal fixator, and may cause iatrogenic epiphysis plate injury in children. External fixator is a new way to treat DHMDJ fractures, and it can show satisfactory results for transverse and comminuted DHMDJ fractures. However, at present, there are few relevant studies, and most of them focus on biomechanical studies, and the efficacy lacks high-quality clinical research support. Conclusion: The ultimate goal of DHMDJ fracture treatment in children is to restore the anatomical alignment of the fracture and prevent the loss of reduction. The choice of internal fixator depends on the location of the fracture line and the shape of the fracture to provide personalized treatment.
Asunto(s)
Fijación Interna de Fracturas , Fracturas del Húmero , Humanos , Niño , Fracturas del Húmero/cirugía , Fijación Interna de Fracturas/métodos , Hilos Ortopédicos , Fijadores Externos , Diáfisis/lesiones , Fracturas Conminutas/cirugía , Fijación Intramedular de Fracturas/métodos , Resultado del Tratamiento , Placas Óseas , Clavos Ortopédicos , Fijadores Internos , Preescolar , Articulación del Codo/cirugía , Curación de FracturaRESUMEN
CASES: Two competitive athletes with isolated comminuted trapezium fractures, sustained during American football and rugby, presented with pain and swelling of the first metacarpal base. Computed tomography confirmed isolated comminuted trapezium fractures. Arthroscopic reduction of displacement with screw fixation below the articular surface was performed through a small incision. Both patients returned to their preinjury sports levels within 2 months postoperatively. CONCLUSION: Arthroscopic treatment of isolated comminuted trapezium fractures achieved accurate reduction of articular surface displacement and preserved trapeziometacarpal joint stability with minimal soft-tissue invasion. This facilitated an early return to contact sports for the affected athletes.
Asunto(s)
Artroscopía , Fracturas Conminutas , Hueso Trapecio , Humanos , Masculino , Artroscopía/métodos , Traumatismos en Atletas/cirugía , Traumatismos en Atletas/diagnóstico por imagen , Fijación Interna de Fracturas/métodos , Fracturas Conminutas/cirugía , Fracturas Conminutas/diagnóstico por imagen , Hueso Trapecio/cirugía , Hueso Trapecio/diagnóstico por imagen , Hueso Trapecio/lesionesRESUMEN
Complex comminuted hand injuries are an urgent medical and social problem of national health systems, which is especially sensitive for countries with a low level of socio-economic development. The work aims to substantiate the effectiveness and safety of the shoelace method of hand bone osteosynthesis in complex comminuted fractures (a clinical case study). Clinical case: A 42-year-old female patient was admitted to the clinic with complaints of the presence of a crushed wound on the 2nd finger of the left hand. The shoelace method was applied for hand bone osteosynthesis. The surgical intervention time was 24 minutes, and the time before returning to work or daily activities equaled 7.1 weeks. The time to bone fusion was less than 45 days. The shoelace osteosynthesis method in complex comminuted fractures of the hand bones has prospects for modern clinical practice with the possibility of improving the performance and safety indicators.
Asunto(s)
Fijación Interna de Fracturas , Fracturas Conminutas , Humanos , Femenino , Adulto , Fracturas Conminutas/cirugía , Fracturas Conminutas/diagnóstico por imagen , Fijación Interna de Fracturas/métodos , Traumatismos de la Mano/cirugía , Huesos de la Mano/cirugía , Huesos de la Mano/lesiones , Huesos de la Mano/diagnóstico por imagenRESUMEN
The management of comminuted quadrilateral fractures remains challenging, and treatment options are constantly evolving. The purpose of the present study was to examine the outcomes of 2 different fixation techniques in the management of comminuted quadrilateral fractures. Twenty-two patients with comminuted quadrilateral acetabular fractures were surgically treated with interfragmentary lag screw (group 1) and square bracket-shaped tubular (SBST) plate technique (group 2), in addition to suprapectineal and infrapectineal pelvic reconstruction plate fixation between January 2016 and July 2019 at our clinic. 2 years follow-up control data of each group were compared in terms of radiological and functional results, and complications. According to the functional score comparison, the mean Merle d'Aubigne Postel scoring system (MAP) score was 15.2/15.6 (Pâ =â .632), and the mean Harris hip scoring (HHS) system score was 74.65/77.3 (Pâ =â .664) in groups 1 and 2, respectively. Radiological comparison was performed according to matta radiological criteria (MRC), and 2 excellent, 6 good, 2 poor, 4 excellent, 4 good, and 4 poor radiological results were observed in groups 1 and 2, respectively. intraarticular screw penetration was detected in 3 patients in group 1, while there was no articular implant penetration in group 2 (Pâ =â .001). We believe that satisfactory results can be obtained with the SBST plate technique, offering functional and clinical outcomes that are similar to those of the interfragmentary screw technique. The SBST plate technique is superior in terms of avoiding intraarticular screw penetration and related revision surgery.