RESUMEN
BACKGROUND: Tibial plateau fractures, which are intra-articular injuries of the knee joint, are often difficult to treat and have a high complication rate, including early-onset osteoarthritis. The most common treatment for complex tibial plateau fractures is surgical fixation. Additionally, orthopaedic surgeons often use bone defect fillers to address bone defects caused by the injury. Currently, there is no consensus on the best method of fixation and on whether bone defect fillers are necessary. OBJECTIVES: To assess the benefits and harms of different surgical interventions and bone defect fillers for treating tibial plateau fractures. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, and trial registries up to March 2023. We also searched conference proceedings and the grey literature. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-RCTs comparing surgical interventions for treating tibial plateau fractures and different types of filler for bone defects. DATA COLLECTION AND ANALYSIS: Two review authors independently screened search results, selected studies, extracted data, and assessed risk of bias. We calculated risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) or standardised mean differences (SMDs) for continuous outcomes, with 95% confidence intervals (CIs). Our primary outcomes (and the specific measures we considered most relevant) were generic quality of life (general health score in the 36-item Short-Form Health Survey (SF-36)), patient-reported lower limb function (Hospital for Special Surgery (HSS) score), and adverse events (frequency of unplanned reoperation). We used GRADE to assess the certainty of evidence. MAIN RESULTS: We included 15 trials in the review, with a total of 948 adult participants. Nine trials compared different types of fixation, and six trials evaluated different types of bone graft substitutes. All 15 trials were small and at high risk of bias. We considered most available evidence to be of very low certainty, meaning we have very little confidence in the results. Only limited pooling was possible. One trial compared circular fixation combined with insertion of percutaneous screws (hybrid fixation) versus standard open reduction and internal fixation (ORIF) in 82 people with open or closed Schatzker types V or VI tibial plateau fractures. At 24 months' follow-up, hybrid fixation compared with ORIF may have little or no effect on SF-36 general health score (MD 6 points higher, 95% CI 7.7 points lower to 19.7 points higher; 66 participants), patient-reported lower limb function according to the HSS score (MD 7 points higher, 95% CI 2.4 points lower to 16.4 points higher; 66 participants), or frequency of unplanned reoperation (RR 0.78, 95% CI 0.45 to 1.32; 83 fractures (82 participants)). However, the evidence for all three outcomes is very uncertain. Three trials (with 242 participants) compared single-plating ORIF versus double-plating ORIF. There may be little to know difference in patient-reported lower limb function (HSS score) at 24 months' follow-up in people who undergo single-plating ORIF compared with those who undergo double-plating ORIF (MD 0.2 points higher, 95% CI 2.12 points lower to 2.52 points higher; 1 study, 84 participants), but the evidence is very uncertain. There were no data for quality of life or unplanned reoperation at 24 months' follow-up. Six trials (including 368 participants) compared bone substitute versus autologous bone graft (autograft) for managing bone defects. No trials reported SF-36 general health score, HSS score, or frequency of unplanned reoperation at 24 months' follow-up. AUTHORS' CONCLUSIONS: There is insufficient evidence to ascertain the best method of fixation or the best method of addressing bone defects during surgery in people with tibial plateau fractures. Further well-designed RCTs with larger sample sizes are warranted.
Asunto(s)
Fijación Interna de Fracturas , Calidad de Vida , Fracturas de la Meseta Tibial , Adulto , Humanos , Sesgo , Sustitutos de Huesos/uso terapéutico , Fijación Interna de Fracturas/métodos , Fracturas Intraarticulares/cirugía , Ensayos Clínicos Controlados Aleatorios como Asunto , Fracturas de la Meseta Tibial/cirugíaRESUMEN
PURPOSE: This study aims to (1) devise a classification system to categorize and manage ballistic fractures of the knee, hip, and shoulder; (2) assess the reliability of this classification compared to current classification schemas; and (3) determine the association of this classification with surgical management. METHODS: We performed a retrospective review of a prospectively collected trauma database at an urban level 1 trauma centre. The study included 147 patients with 169 articular fractures caused by ballistic trauma to the knee, hip, and shoulder. Injuries were selected based on radiographic criteria from plain radiographs and CT scans. The AO/OTA classification system's reliability was compared to that of the novel ballistic articular injury classification system (BASIC), developed using a nominal group approach. The BASIC system's ability to guide surgical decision-making, aiming to achieve stable fixation and minimize post-traumatic arthritis, was also evaluated. RESULTS: The BASIC system was created after analysing 73 knee, 62 hip, and 34 shoulder fractures. CT scans were used in 88% of cases, with 44% of patients receiving surgery. The BASIC classification comprises five subgroups, with a plus sign indicating the need for soft tissue intervention. Interrater reliability showed fair agreement for AO/OTA (k = 0.373) and moderate agreement for BASIC (k = 0.444). The BASIC system correlated strongly with surgical decisions, with an 83% concurrence in treatment choices based on chart reviews. CONCLUSIONS: Conventional classification systems provide limited guidance for ballistic articular injuries. The BASIC system offers a pragmatic and reproducible alternative, with potential to inform treatment decisions for knee, hip, and shoulder ballistic injuries. Further research is needed to validate this system and its correlation with patient outcomes. LEVEL OF EVIDENCE: Level III, Diagnostic Study.
Asunto(s)
Tomografía Computarizada por Rayos X , Humanos , Estudios Retrospectivos , Masculino , Adulto , Femenino , Tomografía Computarizada por Rayos X/métodos , Persona de Mediana Edad , Reproducibilidad de los Resultados , Traumatismos de la Rodilla/diagnóstico por imagen , Traumatismos de la Rodilla/clasificación , Traumatismos de la Rodilla/cirugía , Fracturas del Hombro/clasificación , Fracturas del Hombro/diagnóstico por imagen , Fracturas del Hombro/cirugía , Heridas por Arma de Fuego/diagnóstico por imagen , Heridas por Arma de Fuego/clasificación , Heridas por Arma de Fuego/cirugía , Adulto Joven , Anciano , Adolescente , Lesiones del Hombro/diagnóstico por imagen , Fracturas Intraarticulares/clasificación , Fracturas Intraarticulares/diagnóstico por imagen , Fracturas Intraarticulares/cirugíaRESUMEN
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
OBJECTIVES: To report a case series of extra-articular osteotomies for the management of intra-articular tibial plateau malunions and to assess the ability to correct deformity and improve knee range of motion (ROM). METHODS: . DESIGN: Retrospective case series. SETTING: Academic, tertiary, referral center. PATIENT SELECTION CRITERIA: Adult patients with tibial plateau fracture malunion treated with extra-articular osteotomy of the femur and/or tibia between 2014 and 2023. OUTCOME MEASURES AND COMPARISON: Mechanical axis deviation (MAD), medial proximal tibia angle (MPTA), lateral distal femoral angle (LDFA), and posterior proximal tibia angle (PPTA) correction; knee ROM; and time to weight bearing. RESULTS: There were 7 patients included, 6 (85.7%) were female and 1 (14.3%) were male. The median age was 43.5 years (IQR 38.5-51, range 32-62). Four (57.1%) patients were treated with a high tibial osteotomy (HTO), and 3 (42.9%) patients were treated with an HTO and distal femoral osteotomy. One patient had concomitant supramalleolar osteotomy with HTO to address distal tibia procurvatum and valgus. Four were treated with hexapod frames, and 3 were treated with plates and screws. Median follow-up was 22.5 months (IQR 10.5-107 months, range 7-148 months). Surgical intervention corrected median radiographic measures of valgus malalignment preoperatively relative to postoperative values. This included MAD (42.5 mm-0 mm), valgus angle (12.5 degrees-1.5 degrees), MPTA (95 degrees-88.0°), and LDFA (86.0°-87.3 degrees). Surgical intervention increased maximal knee range of motion preoperatively to postoperatively. Median time to full weight bearing was 81.5 days (IQR 46-57 days, range 41-184 days). Two patients were converted to total knee arthroplasty after 5 and 10 years following HTO with hexapod frame. CONCLUSIONS: Extra-articular osteotomy is an effective treatment for addressing intra-articular malunion after tibia plateau fractures. It is effective in correcting the MAD, valgus deformity, MPTA, LDFA, PPTA, and improving knee ROM (measured through knee extension and flexion). LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Asunto(s)
Fracturas Mal Unidas , Osteotomía , Rango del Movimiento Articular , Fracturas de la Tibia , Humanos , Osteotomía/métodos , Masculino , Femenino , Fracturas de la Tibia/cirugía , Fracturas de la Tibia/diagnóstico por imagen , Persona de Mediana Edad , Adulto , Estudios Retrospectivos , Fracturas Mal Unidas/cirugía , Fracturas Mal Unidas/diagnóstico por imagen , Resultado del Tratamiento , Fracturas Intraarticulares/cirugía , Fracturas Intraarticulares/diagnóstico por imagen , Fijación Interna de Fracturas/métodos , Tibia/cirugía , Tibia/diagnóstico por imagenRESUMEN
Background: Intra-articular fractures of the proximal interphalangeal joint (PIPJ) can result in poor outcomes if inadequately treated. Dynamic external fixation and internal fixation with plates and/or screws are two treatment options. The role of combining these two methods is unclear. The aim of this study is to determine the outcomes of patients with intra-articular fractures of the PIPJ treated with a combination of dynamic external fixation with a plate and/or screws. Methods: A retrospective review was conducted on 18 consecutive cases of intra-articular fractures of the PIPJ treated with pins and rubber band traction system (PRTS) combined with dorsal internal fixation with plates and/or screws. The patients' average age was 51 years (range: 20-81 years). The fracture patterns were volar-type (n = 2), dorsal-type (n = 4) and pilon-type (n = 12). Data with regard to time to surgery, interphalangeal joint range of motion, grip strength, VAS for pain, Quick DASH score, complications, duration of follow-up and return to work were collected. Results: The levels of articular involvement were stable (n = 1), tenuous (n = 5) and unstable (n = 12). The average time to surgery was 9 days, and the average follow-up period was 15 months. The fracture was fixed with a dorsal plate and screws in 10 patients and with only screws in eight patients. All patients had PRTS. All patients returned to their original occupation and the fractures united in good alignment. The average grip strength was 86% of that of the unaffected side. The average active PIPJ motion was 85° (range: 50°-106°), and the average active distal interphalangeal joint (DIPJ) motion was 48° (range: 10°-90°). Conclusions: Our results show that a combination of PRTS and open reduction and fixation with plate and/or screws achieved a good range of motion and articular reduction. Level of Evidence: Level IV (Therapeutic).
Asunto(s)
Articulaciones de los Dedos , Fijación Interna de Fracturas , Fracturas Intraarticulares , Rango del Movimiento Articular , Tracción , Humanos , Persona de Mediana Edad , Adulto , Anciano , Estudios Retrospectivos , Masculino , Femenino , Tracción/métodos , Tracción/instrumentación , Anciano de 80 o más Años , Articulaciones de los Dedos/cirugía , Fracturas Intraarticulares/cirugía , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Adulto Joven , Clavos Ortopédicos , Resultado del Tratamiento , Traumatismos de los Dedos/cirugía , Tornillos Óseos , Fuerza de la Mano/fisiología , Placas ÓseasRESUMEN
Displaced intra-articular calcaneus fractures (DIACFs) are difficult injuries to treat and are often encountered by orthopedic surgeons. For DIACFs treated nonoperatively or with open reduction internal fixation (ORIF), a common complication is painful subtalar arthritis and the need for a secondary subtalar fusion, which prolongs the overall recovery time. One treatment option to address this sequela involves ORIF with subtalar fusion as the primary treatment. We describe a reproducible, minimally invasive surgical technique for primary ORIF with subtalar fusion when the calcaneal tuberosity is amendable to cannulated screw fixation to treat these complex calcaneal fractures. Our technique offers advantages compared to other techniques in that it avoids screw traffic, allows easy bony compression of the subtalar joint, and minimizes soft tissue damage via percutaneous screw fixation. Fourteen fractured calcanei in 12 patients underwent our technique and all achieved bony union with a median time to fusion of 107.5 days (range, 54-530 days). Eight patients returned to work with the remaining 4 patients having an unknown work status at last follow-up, although 2 of these 4 patients resumed normal activities. Only 1 patient experienced a complication, which was an infection after achieving bony union, and was treated with successful hardware removal and our infection protocol. Overall, we conclude our surgical technique offers a successful option in the treatment of DIACFs when the calcaneal tuberosity is amendable to cannulated screw fixation.
Asunto(s)
Artrodesis , Calcáneo , Fijación Interna de Fracturas , Fracturas Intraarticulares , Procedimientos Quirúrgicos Mínimamente Invasivos , Articulación Talocalcánea , Humanos , Calcáneo/lesiones , Calcáneo/cirugía , Masculino , Adulto , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/efectos adversos , Articulación Talocalcánea/cirugía , Articulación Talocalcánea/lesiones , Femenino , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Persona de Mediana Edad , Fracturas Intraarticulares/cirugía , Fracturas Intraarticulares/diagnóstico por imagen , Artrodesis/métodos , Tornillos Óseos , Adulto Joven , Reducción Abierta/métodos , Resultado del Tratamiento , Fracturas Óseas/cirugíaRESUMEN
BACKGROUND: Fixation of calcaneus through the sinus tarsi approach is increasingly popular due to the lower rate of wound complications. The use of postoperative CT provided a better evaluation tool than using plain radiography. Our objective of the present study is to evaluate the quality of fracture reductions by postoperative 3D CT scans after surgical intervention using the sinus tarsi approach and fixation with 3.5 cortical screws. METHODS: Between January 2018 and April 2020, 86 consecutive patients with 92 closed displaced intra-articular calcaneal fractures underwent ORIF with 3.5 mm screws constructed via a minimally invasive sinus tarsi approach by a single foot and ankle surgeon. RESULTS: The preoperative radiographic assessment found 36 joint depression type and 56 tongue type fractures according to the Essex-Lopresti classification. Preoperative CT assessment found 82 type II and 10 type III according to the Sander classification. Analysis of pre- and postoperative CT parameters showed that the height of the posterior facet, the length of the posterior facet, Gissane, and Bohler's angle were significantly improved. In addition, the means of posterior facet step-off in postoperative CT was 1.07, and 72% of posterior facet reductions were < 2 mm step-offs. CONCLUSION: With postoperative CT scan assessment, the treatment of displaced intra-articular calcaneal fracture with 3.5 mm screws via sinus tarsi approach has achieved good quality of reduction. Therefore, the screws-only technique is an option for treating calcaneal fracture with less soft tissue damage and implant cost.
Asunto(s)
Tornillos Óseos , Calcáneo , Fijación Interna de Fracturas , Imagenología Tridimensional , Fracturas Intraarticulares , Tomografía Computarizada por Rayos X , Humanos , Calcáneo/lesiones , Calcáneo/cirugía , Calcáneo/diagnóstico por imagen , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Tomografía Computarizada por Rayos X/métodos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Imagenología Tridimensional/métodos , Fracturas Intraarticulares/cirugía , Fracturas Intraarticulares/diagnóstico por imagen , Anciano , Fracturas Óseas/cirugía , Fracturas Óseas/diagnóstico por imagen , Adulto Joven , Estudios RetrospectivosRESUMEN
OBJECTIVES: To present a review of the clinical characteristics, preoperative and surgical management, and outcomes of patients with intra-articular calcaneal fractures who had open reduction and internal fixation (ORIF) and to offer some comments on and research ideas for the preoperative management of patients with these fractures. PATIENTS AND METHODS: We studied consecutive patients who had ORIF performed by a single surgeon for closed, intra-articular calcaneal fractures at our level-1 trauma center between 5/29/2012 and 3/20/2018. All inpatients were treated with a preoperative soft tissue management protocol, whereas outpatients were not. Data were obtained about demographic and clinical characteristics, times from injury to surgery, quality of fracture reductions, and complication rates. RESULTS: Mean follow-up for the 72 patients with 77 calcaneal fractures was 8.5 (range: 1-43) months, and 21 (27.3%) fractures received inpatient preoperative care with a soft tissue management protocol, while 56 (72.7%) received outpatient preoperative management. More of the fractures treated preoperatively as inpatients versus outpatients were classified as Sanders type III (66.7% vs. 32.1%) and type IV (8.9% vs. 4.8%) fractures and were associated with polytrauma (38.1% vs. 7.1%) and diabetes mellitus (9.5% vs. 5.4%), respectively. For all patients, the mean time from injury to surgery was 12.2 (range: 2.7-19.4) days, and the time was 6.3 days for inpatients and 14.4 days for outpatients, but the quality of fracture reductions and complication rates did not differ between these two groups. CONCLUSIONS: Patients with intra-articular calcaneal fractures treated as inpatients and receiving a preoperative soft tissue management protocol had outcomes after ORIF that were not inferior to those experienced by patients treated preoperatively as outpatients, despite a greater proportion of the inpatients having severe fractures, polytrauma, and diabetes mellitus. Dedicated preoperative soft tissue management protocols may be beneficial for patients with calcaneal fractures and warrant further study.
Asunto(s)
Calcáneo , Fijación Interna de Fracturas , Humanos , Calcáneo/lesiones , Calcáneo/cirugía , Femenino , Masculino , Adulto , Persona de Mediana Edad , Fijación Interna de Fracturas/métodos , Fracturas Intraarticulares/cirugía , Resultado del Tratamiento , Cuidados Preoperatorios/métodos , Anciano , Estudios Retrospectivos , Adulto Joven , Fracturas Óseas/cirugía , Adolescente , Reducción Abierta/métodosRESUMEN
PURPOSE: There are still controversies on the effect of grafting during open reduction and internal fixation of calcaneal fractures. The aim of this study was to compare the radiological and functional outcomes in patients with or without intraoperative grafting. METHODS: In a comparative retrospective study, among 442 operatively-treated calcaneal fractures, 60 patients with unilateral closed sanders type II intraarticular calcaneal fracture who underwent ORIF via lateral extensile approach using locking anatomical plates with at least 1 year follow-up without any postoperative wound complication were enrolled. The patients were separated into 2 groups: with bone allograft and without bone allograft. The functional outcome of the patients was assessed using visual analog scale (VAS) for pain, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, foot function index (FFI), and short-form (SF-36) health survey. Radiographic variables included Böhler angle, Gissane angle, calcaneal width, calcaneal height, and talar declination angle. Also, the differences (delta) of these values in comparison to the uninjured foot were calculated. RESULTS: The mean age was 39.1 ± 12.7 (range, 13-67) years with 54 males, 90.0%. No statistically significant differences were detected in age, gender, affected side, and subtypes of calcaneal fractures between the two groups (p > 0.05). The average follow-up was 25.1 (range, 12-48) months. The differences for all radiographic measurements and also, the delta values between the groups were not statistically significant, except talar declination angle which was more in cases without grafting (p = 0.007). Although the differences between the two groups regarding AOFAS ankle-hindfoot scale (p = 0.257), VAS for pain (p = 0.645), and FFI (p = 0.261) were not statistically significant; the group with bone graft experienced less pain (19.7 ± 22.0) than the other group (26.7 ± 22.8). The difference between the groups was not statistically significant (p = 0.87) according to the SF-36 questionnaire. CONCLUSIONS: Incorporating allografts into the void defects during ORIF of displaced intraarticular calcaneal fractures may not improve functional outcomes and recover postoperative radiological parameters. Therefore, routine use of allograft to fill the defects during ORIF of calcaneus may not be recommended. Of note, that these findings solely relate to the treatment of Sanders type II fractures. LEVEL OF EVIDENCE III: Comparative retrospective study.
Asunto(s)
Trasplante Óseo , Calcáneo , Fijación Interna de Fracturas , Fracturas Óseas , Reducción Abierta , Humanos , Calcáneo/lesiones , Calcáneo/diagnóstico por imagen , Masculino , Fijación Interna de Fracturas/métodos , Persona de Mediana Edad , Femenino , Estudios Retrospectivos , Adulto , Trasplante Óseo/métodos , Anciano , Reducción Abierta/métodos , Fracturas Óseas/cirugía , Fracturas Óseas/diagnóstico por imagen , Adolescente , Adulto Joven , Resultado del Tratamiento , Estudios de Seguimiento , Placas Óseas , Fracturas Intraarticulares/cirugía , Fracturas Intraarticulares/diagnóstico por imagenRESUMEN
BACKGROUND: People with achondroplasia exhibit distinct physical characteristics, but their cognitive abilities remain within the normal range. The challenges encountered during surgical procedures and perioperative care for achondroplastic individuals, are underrepresented in the existing literature. CASE PRESENTATION: In this report, the management of a 26-year-old North-African achondroplastic male is highlighted. The patient suffered a complete intra-articular distal femur fracture (AO/OTA 33-C1) and an ipsilateral patella fracture (AO/OTA 34-C1). The patient's unusual anatomical variations and the lack of suitable orthopedic implants posed significant surgical challenges, particularly in the context of a resource-limited developing country. Facial and spinal deformities, which are common in patients with achondroplasia, further complicated the anesthetic approach. CONCLUSIONS: The limited information on operative management of fractures in achondroplastic patients necessitated independent decision-making and diverging from the convenient approach where clear guidance is available in the literature.
Asunto(s)
Acondroplasia , Fracturas del Fémur , Rótula , Humanos , Adulto , Masculino , Acondroplasia/complicaciones , Fracturas del Fémur/cirugía , Fracturas del Fémur/diagnóstico por imagen , Rótula/lesiones , Rótula/cirugía , Rótula/diagnóstico por imagen , Fracturas Intraarticulares/cirugía , Fracturas Intraarticulares/diagnóstico por imagen , Fijación Interna de Fracturas/métodosRESUMEN
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
Tension band wiring (TBW) is one of the most commonly used fixation techniques to fix olecranon osteotomies. Hardware prominence has been the most commonly reported complication of TBW. However, distal migration of Kirschner (K)-wire after TBW fixation for olecranon osteotomy has not been reported. In this case report, we presented distal migration of K-wire detected nine months after initial surgery in a 46-year-old male patient. The patient was operated on for an intraarticular distal humerus fracture using an olecranon osteotomy. The osteotomy was fixed with TBW fixation. The patient missed routine follow-ups and presented to the outpatient clinic with a complaint of skin irritation at the elbow nine months after the surgery. On radiological examination, distal migration of one K-wire was detected. The K-wire was surgically removed without any complication. Physicians should be aware of possible complications of TBW and remove fixation after fracture union to avoid unexpected complications.
Asunto(s)
Hilos Ortopédicos , Migración de Cuerpo Extraño , Olécranon , Osteotomía , Humanos , Hilos Ortopédicos/efectos adversos , Masculino , Persona de Mediana Edad , Olécranon/lesiones , Olécranon/cirugía , Olécranon/diagnóstico por imagen , Osteotomía/efectos adversos , Osteotomía/métodos , Osteotomía/instrumentación , Migración de Cuerpo Extraño/cirugía , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/etiología , Fracturas del Húmero/cirugía , Fracturas del Húmero/diagnóstico por imagen , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Remoción de Dispositivos/métodos , Articulación del Codo/cirugía , Articulación del Codo/diagnóstico por imagen , Fracturas Intraarticulares/cirugía , Fracturas Intraarticulares/diagnóstico por imagenRESUMEN
INTRODUCTION: To analyze recent literature comparing clinical outcomes of displaced intra-articular calcaneal fractures (DIACF) treated with open reduction and internal fixation using the extensile lateral approach (ELA) vs the minimally invasive sinus tarsi approach (STA), with a focus on wound complications. MATERIALS AND METHODS: A comprehensive literature search was conducted utilizing PubMed, EMBASE, and Cochrane Library databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published between 2013 and 2022, level of evidence (LOE) I-III, head-to-head comparative studies reporting on clinical outcomes after DIACFs treated with ORIF using ELA versus STA, and literature with full-text written in English were included. Data collection included: publication year, study design, number of surgeons, number of participants, demographic data (mean age at time of surgery, percent male, body mass index, medical co-morbidities), preoperative data (mechanism of injury, Sanders classification, time from injury to surgical fixation), intraoperative data, and postoperative clinical and radiographic outcomes (Böhler angle, angle of Gissane, calcaneal height/length/width). RESULTS: A total of 21 articles (4 randomized control trials, 17 cohort studies) comprising of 2086 patients with calcaneal fractures, treated with either ELA (n = 1129) or STA (n = 957) met inclusion criteria. The risk of postoperative wound-related complications (RR 2.82, 95 % CI: 2.00-3.98, I2=27 %) and the risk of reoperation (RR 1.85, 95 % CI: 0.69-5.00, I2=67 %) was higher in ELA patients comparted to STA patients. However, the increased risk of postoperative wound-related complications with an ELA vs. STA was shown to be trending downward in recent publications. The ELA group also experienced longer time to surgery, extended operative times, and prolonged hospital stays when compared to the STA group. Radiographic measurements at final follow-up, including Böhler angle, angle of Gissane, as well as calcaneal height, length, and width, showed no statistically significant differences between the two groups. CONCLUSION: Surgical treatment of calcaneal fractures utilizing the ELA continues to have an increased rate of complications and reoperation when compared to the less invasive STA, yet recent trends in the literature show that this rate is decreasing. Operative treatment of calcaneal fractures via either an ELA or STA can both achieve comparable postoperative radiographic outcomes. LEVEL OF EVIDENCE: Therapeutic Level III.
Asunto(s)
Calcáneo , Fijación Interna de Fracturas , Humanos , Calcáneo/lesiones , Calcáneo/cirugía , Calcáneo/diagnóstico por imagen , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/efectos adversos , Complicaciones Posoperatorias/etiología , Resultado del Tratamiento , Infección de la Herida Quirúrgica/etiología , Fracturas Intraarticulares/cirugía , Fracturas Intraarticulares/diagnóstico por imagen , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Reducción Abierta/métodos , Reducción Abierta/efectos adversos , Fracturas Óseas/cirugíaRESUMEN
Intra-articular calcaneal fractures are debilitating injuries that can result in a dramatic effect on quality of life post-injury. Surgical intervention is generally advised when significant displacement or comminution is present but can present a host of complications secondary to the limited blood supply and fragility to the soft tissues following injury. Surgical approaches to calcaneal fractures generally include the lateral extensile approach, minimal incision (sinus tarsi approach), or percutaneous approach. Each approach presents risks and benefits; therefore, determining the optimal incisional approach should be based on patient comorbidities, fracture pathoanatomy, soft tissue envelope concerns, and patient pre-injury functional status.
Asunto(s)
Calcáneo , Fijación Interna de Fracturas , Fracturas Intraarticulares , Humanos , Calcáneo/lesiones , Calcáneo/cirugía , Fracturas Intraarticulares/cirugía , Fracturas Intraarticulares/diagnóstico por imagen , Fijación Interna de Fracturas/métodos , Masculino , Fracturas Óseas/cirugíaAsunto(s)
Placas Óseas , Fracturas del Fémur , Fijación Interna de Fracturas , Fracturas Osteoporóticas , Humanos , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Fracturas del Fémur/cirugía , Fracturas Osteoporóticas/cirugía , Resultado del Tratamiento , Fracturas Intraarticulares/cirugía , Fracturas Intraarticulares/diagnóstico por imagen , Femenino , Curación de Fractura/fisiología , Fracturas Femorales DistalesRESUMEN
OBJECTIVES: This study aimed to compare the efficacy and safety of the intramedullary nail and conventional plate for the treatment of displaced intra-articular calcaneal fractures from clinical comparative trials. MATERIALS AND METHODS: A comprehensive search of English databases was carried out in the Springer, PubMed, ScienceDirect, Web of Science, and Cochrane Library databases until September 2023. Studies on calcaneal fractures treated by an intramedullary nail or a plate were considered for inclusion. Endpoints included duration of operation, length of hospital stay, the Visual Analog Scale (VAS) score, postoperative functional score, radiological parameters, and complications. The mean difference (MD) and risk difference (RD) as the combined variables, as well as the 95% confidence intervals, (CIs) were calculated. RESULTS: Five retrospective controlled studies covering 473 feet at the one-year follow-up met the inclusion criteria. The meta-analysis demonstrated that there were significant differences in the duration of operation (MD: -10.81; 95% CI: -16.32, -5.31; p=0.0001), length of hospital stay (MD: -3.65; 95% CI: -4.35, -2.95; p<0.00001). No significant differences were found regarding postoperative American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale (MD: 0.36; 95% CI: -3.89, 4.61; p=0.87), VAS (MD: 1.95; 95% CI: -0.30, 4.21; p=0.09), or postoperative Böhler angle (MD: 0.94; 95% CI: -0.04, 1.92; p=0.06) between the two groups. The incidence of total complications (RD: -0.31; 95% CI: -0.46, -0.17; p<0.0001) and wound-healing complications (RD: -0.16; 95% CI: -0.30, -0.03; p=0.02) were lower in the intramedullary nail group. There were no significant differences in the incidences of revision surgery, implant removal, superficial wound infection, deep infection, and nonunion. CONCLUSION: Compared to conventional plates, the intramedullary nail showed a shorter duration of operation, reduced length of hospital stay, and fewer postoperative total complications and wound-healing complications in treating displaced intra-articular calcaneal fractures.
Asunto(s)
Clavos Ortopédicos , Placas Óseas , Calcáneo , Fijación Intramedular de Fracturas , Humanos , Calcáneo/lesiones , Calcáneo/cirugía , Fijación Intramedular de Fracturas/métodos , Fijación Intramedular de Fracturas/instrumentación , Fijación Intramedular de Fracturas/efectos adversos , Fracturas Intraarticulares/cirugía , Tiempo de Internación , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Resultado del TratamientoRESUMEN
The aim of the study was to evaluate the results of Dorsal Wrist Plating in intra-articular distal radius fractures with a dorsal displacement. In this prospective study, a single surgeon treated 20 patients with a (partially) intra-articular distal radius fracture with a dorsal rim avulsion or a dorsal Barton's type fragment. They all underwent an open reduction and internal fixation by Dorsal Wrist Plating. A total of 17 patients had a follow-up period of at least 12 months (mean follow- up of 17 months) and these patients were included in the study. Both functional and radiological outcome parameters were measured. The total range of motion was 92 % of the contralateral side. The mean grip strength and key pinch were 24.6 kg and 6.9kg respectively compared to 29.5 kg and 7.4 kg on the non-operated side. The average Mayo Wrist Score was 89.7 (range 80-100) and the mean Disability of the Arm, Shoulder and Hand score was 4.5 (range 0-9.2). An articular step-off was only noted in 2 patients (1 and 2 mm respectively). Radial inclination was restored in all patients. Palmar tilt was anatomically restored in five patients. In all other patients, the palmar tilt was acceptably restored. There was no significant radial shortening in any of the patients. No infections, no tendon ruptures, no Complex Regional Pain Syndrome, or union problems were observed. Dorsal wrist plating seems to be a safe and reliable procedure in the treatment of intra-articular distal radius fractures with dorsal displacement.
Asunto(s)
Placas Óseas , Fijación Interna de Fracturas , Fracturas Intraarticulares , Fracturas del Radio , Rango del Movimiento Articular , Humanos , Fracturas del Radio/cirugía , Masculino , Femenino , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Persona de Mediana Edad , Adulto , Anciano , Estudios Prospectivos , Fracturas Intraarticulares/cirugía , Fuerza de la Mano , Articulación de la Muñeca/cirugía , Articulación de la Muñeca/fisiopatología , Resultado del Tratamiento , Adulto Joven , Fracturas de la MuñecaRESUMEN
PURPOSE: To study the clinical, radiological, and functional outcomes after of radioscapholunate (RSL) fusion for intra-articular malunion of the distal radius. METHODS: This retrospective study included 26 patients (17 males and 9 females) with intra-articular malunion of distal radius fractures who underwent RSL arthrodesis using locked miniplates (without distal scaphoid excision) between 2012 and 2020. Their mean age was 43 years (range, 32-56). Patients were assessed radiographically for union and clinically for range of motion, grip strength, and pain (assessed by Visual Analogue Scale (VAS) for pain). Functional evaluation was performed by using the Mayo modified wrist score (MMWS) and the Disabilities for the Arm, Shoulder, and Hand (DASH) questionnaire. RESULTS: All patients showed complete healing at the fusion site after a mean of 8.7 weeks (range, 8-12). The mean follow-up period was 72 months (range, 60-84). The pinch strength improved from a mean of 6.2 kg (range, 3-12) to a mean of 9.8 kg (range, 5-18) which represents 80% of the contralateral side. The mean pinch strength was 7 kg (range, 5-18) which presents 80% of the other side. VAS for pain showed a mean improvement of 72.6%. The DASH score improved to a mean of 19.2 (range, 14-24). The MMWS improved to a mean of 68 (range, 45-86). At the final follow-up period, no degenerative changes were detected in the midcarpal joint. CONCLUSION: RSL arthrodesis (using locked miniplates without distal scaphoid excision) is a reliable surgical procedure to manage cases of radiocarpal OA after intra-articular malunion of distal radius fractures with good clinical and radiological outcomes. LEVEL OF EVIDENCE: Level IV- therapeutic.
Asunto(s)
Artrodesis , Fracturas Mal Unidas , Fuerza de la Mano , Fracturas del Radio , Rango del Movimiento Articular , Humanos , Artrodesis/métodos , Artrodesis/instrumentación , Masculino , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto , Fracturas del Radio/cirugía , Fracturas del Radio/diagnóstico por imagen , Fracturas Mal Unidas/cirugía , Fracturas Mal Unidas/diagnóstico por imagen , Resultado del Tratamiento , Fracturas Intraarticulares/cirugía , Fracturas Intraarticulares/diagnóstico por imagen , Dimensión del Dolor , Hueso Semilunar/cirugía , Hueso Semilunar/lesiones , Hueso Escafoides/cirugía , Hueso Escafoides/lesiones , Placas Óseas , Evaluación de la Discapacidad , Fracturas de la MuñecaRESUMEN
Intra-articular distal humerus fractures present various challenges with a wide array of treatment options. Open reduction internal fixation remains the treatment of choice. In older patient populations with poor bone quality and short-end segment fractures with articular comminution, open reduction internal fixation, however, may bring on unsurmountable technical challenges. Total elbow arthroplasty and elbow hemiarthroplasty (EHA) may offer superior functional outcomes in these cases. During EHA for fractures, the medial and lateral columns are reconstructed with the collateral ligaments to restore elbow stability. We hypothesize that in coronal sheer fracture patterns where the columns are intact, maintaining the native collateral ligaments and columns will provide both an anatomic and stable elbow joint. We introduce the ligament sparing EHA technique for unreconstructible coronal shear fractures. We describe this novel technique and compare our postoperative outcomes in 2 patients who underwent this surgery to those described in the literature. The postoperative Disabilities of the Arm, Shoulder, and Hand scores for the 2 patients were 13.8 and 10.3, respectively. The Mayo Elbow Performance Score for the 2 patients were 80 and 85, respectively. The operative arm presented a grip strength of 82% and 89% when compared with the contralateral arm, for the patients respectively. The range of motion varied between 78% and 100% of the contralateral arm for both patients. Although our results are promising and the ligament sparing EHA technique may be a more anatomic option in certain fracture patterns, further research with larger cohorts and multiple surgeons is needed to reinforce our results.
Asunto(s)
Articulación del Codo , Hemiartroplastia , Fracturas del Húmero , Humanos , Fracturas del Húmero/cirugía , Hemiartroplastia/métodos , Articulación del Codo/cirugía , Femenino , Anciano , Rango del Movimiento Articular/fisiología , Masculino , Artroplastia de Reemplazo de Codo/métodos , Ligamentos Colaterales/cirugía , Ligamentos Colaterales/lesiones , Fuerza de la Mano , Fracturas Intraarticulares/cirugía , Fracturas Humerales DistalesRESUMEN
INTRODUCTION: Fractures of the distal femur with metaphyseal comminution and complete intra-articular involvement (AO/OTA classifications 33C2 and 33C3) present challenges for reduction and fixation. However, an optimal fixation method remains unknown. This study aimed to compare the clinical and radiographic outcomes of locking extramedullary plating (LEP) and retrograde intramedullary nailing (RIN) for complete distal femoral intra-articular fractures with metaphyseal comminution. MATERIALS AND METHODS: Between January 2016 and May 2022, 80 patients (45 men and 35 women; average age, 56.7 years) diagnosed with AO/OTA 33C2 and 33C3 were treated with either LEP or RIN and followed up for at least one year. Post-operative evaluations included radiographic assessments of bone union rate, timing, and alignment. Clinically, the knee joint range of motion (ROM), lower extremity functional scale (LEFS), and Kellgren and Lawrence (KL) grade were analyzed. The complications were also compared. RESULTS: 36 underwent LEP and 44 underwent RIN. Bone union was observed in 69.4% and 63.6% of the patients in the LEP and RIN groups, respectively (p = 0.64). The average union time was 6.9 months for the LEP group and 6.6 months for the RIN group (p = 0.51). A tendency toward varus deformity was observed in the RIN group, although the difference was not statistically significant. No significant differences were observed in knee ROM, LEFS, or KL grade. Complications included non-union (33.8%; RIN, 11; LEP, 16), varus deformity (5%; RIN, 4; LEP, 0), infection (1.3%; RIN, 0; LEP, 1), heterotrophic ossification (1.3%; RIN, 0; LEP, 1), and wound dehiscence (2.5%; RIN, 2; LEP, 0). CONCLUSIONS: The surgical fixation methods, RIN and LEP, for complete distal femoral intra-articular fractures with metaphyseal comminution showed similar clinical and radiological outcomes. However, regardless of the type of fixation device used, there was a reduced rate of bone union owing to high energy and a less favorable prognosis.