RESUMEN
BACKGROUND: Recent literature has found a consensus in favor of conservative treatment for type II supracondylar humeral fractures (SCHF). This retrospective observational study compares the short- to medium-term functional outcomes of conservative versus surgical treatment in 31 patients with SCHF (Gartland II and III) to assess the potential superiority of one approach over the other. MATERIALS AND METHODS: Thirty-one pediatric patients treated for SCHF-19 classified as Gartland II and 12 as Gartland III-were assessed in our department. Eight patients underwent closed reduction and cast immobilization, 22 were treated with closed reduction and percutaneous pinning, and one underwent open reduction and internal fixation with plates. Clinical and functional data were collected during follow-up, including elbow and forearm range of motion (ROM), grip strength, carrying angle, Flynn's criteria, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. RESULTS: The average follow-up was 3.3 years (± 1.4 years). All patients demonstrated good functional recovery. According to Flynn's criteria, 85% and 81% of the patients achieved a satisfactory outcome in elbow flexion and carrying angle, respectively. No cases of nerve injuries were reported. Four patients developed cubitus varus in the Gartland II group, which was treated with closed reduction and casting with the initial alignment maintained (without a loss of reduction during the first week). However, compared to this group that was conservatively treated, functional and clinical outcomes were significantly better in the group with SCHF Gartland II treated with reduction and pinning (p < 0.05). CONCLUSIONS: Although some recent studies have demonstrated positive outcomes with conservative treatment for both Gartland IIA and IIB fractures, the short- to medium-term functional results in our study emphasize that superior outcomes were obtained with surgical treatment for Gartland II fractures when compared to those treated conservatively. TRIAL REGISTRATION: This study was performed in line with the principles of the Declaration of Helsinki. Ethics approval was obtained from our institute's ethics committee (registry no. 3511). LEVEL OF EVIDENCE: Therapeutic level III.
Asunto(s)
Fijación Interna de Fracturas , Fracturas del Húmero , Rango del Movimiento Articular , Humanos , Fracturas del Húmero/cirugía , Femenino , Masculino , Estudios Retrospectivos , Niño , Resultado del Tratamiento , Fijación Interna de Fracturas/métodos , Preescolar , Moldes Quirúrgicos , Tratamiento Conservador/métodos , Adolescente , Recuperación de la Función , Estudios de Seguimiento , Fuerza de la Mano , Articulación del Codo/cirugía , Articulación del Codo/fisiopatología , Reducción Cerrada/métodos , Reducción Abierta/métodosRESUMEN
Objectives: This study aimed to report the complication rate associated with open reduction and internal fixation (ORIF) of mandibular condyle fractures in Oman. Methods: This retrospective cohort study was conducted among patients who underwent ORIF of mandibular condyle fractures at Al-Nahdha Hospital and the Sultan Qaboos University Hospital in Muscat, Oman, from January 2008 to December 2020. Data collected included patient demographics, fracture aetiology, fracture side and type, surgical approach and recorded complications and outcomes. Results: A total of 68 patients (59 males and 9 females; mean age of 30.1 years) with 83 mandibular condyle fractures underwent ORIF during the study period. Subcondylar fractures were the most common type, occurring in 62.7% of patients, while bilateral fractures were observed in 21 (30.8%) patients. The most common surgical approach was retromandibular, used in 42.2% of patients. The overall complication rate was 42.6%, with the most frequently reported complications being transient facial nerve palsy (18.1%), malocclusion (14.7%) and restricted mouth opening (10.3%). Subsequent surgical interventions to correct malocclusion were performed in 6 cases. There was no statistically significant association between the overall complication rate and the patients' clinical characteristics. Conclusion: Although ORIF of mandibular condyle fractures generally offers favourable outcomes, it carries a risk of complications.
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Fijación Interna de Fracturas , Cóndilo Mandibular , Fracturas Mandibulares , Reducción Abierta , Complicaciones Posoperatorias , Humanos , Omán/epidemiología , Masculino , Femenino , Fracturas Mandibulares/cirugía , Fracturas Mandibulares/epidemiología , Estudios Retrospectivos , Adulto , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/estadística & datos numéricos , Fijación Interna de Fracturas/efectos adversos , Cóndilo Mandibular/lesiones , Cóndilo Mandibular/cirugía , Reducción Abierta/métodos , Reducción Abierta/estadística & datos numéricos , Reducción Abierta/efectos adversos , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Adolescente , Adulto Joven , Estudios de CohortesRESUMEN
BACKGROUND: Ogden type V tibial tubercle avulsion fracture is an unusual type of physial injury. Thus, little is known about its mechanism of injury and treatment. The type of osteosynthesis is variable and depends on the experience of the surgeon. We commonly used cancellous screws fixation combined with tension band wiring for displaced fracture of the anterior tibial tuberosity. CASE PRESENTATION: The present manuscript describes a case of a Han nationality 13-year-old boy who presented with severe pain of the left knee, which began after landing following a high jump. He had no significant past medical history apart from a high body mass index of 30.3. Radiographs revealed that he had an unusual Ogden type V tibial tubercle avulsion fracture. He was treated by open reduction and combined fixation with cannulated screws and tension-band wiring. After 3 months, the fracture healed without any complications or knee symptoms with full range of motion. He underwent reoperation for symptomatic hardware, which was removed at 5 months after initial surgery, and returned to his prior level of sporting activity at 1 year follow-up. CONCLUSION: Our case suggests that excellent functional outcome could be achievable by open reduction with the combination of internal fixation and tension-band wiring for Ogden type V tibial tubercle avulsion fracture. This type of osteosynthesis could not only achieve anatomical reduction and stable fixation for such fractures, but also avoid further damage to the proximal tibial epiphysis, which prevents serious complications, such difference in leg length.
Asunto(s)
Tornillos Óseos , Fijación Interna de Fracturas , Fracturas por Avulsión , Fracturas de la Tibia , Humanos , Masculino , Adolescente , Fijación Interna de Fracturas/métodos , Fracturas de la Tibia/cirugía , Fracturas de la Tibia/diagnóstico por imagen , Fracturas por Avulsión/cirugía , Fracturas por Avulsión/diagnóstico por imagen , Resultado del Tratamiento , Radiografía , Hilos Ortopédicos , Rango del Movimiento Articular , Reoperación , Reducción Abierta/métodosRESUMEN
PURPOSE: The 5-item modified frailty index (mFI-5) has been established as a reliable indicator of poor postoperative outcomes following a variety of orthopaedic procedures. This study aims to determine whether the mFI-5 can be used by surgeons to predict the likelihood of postoperative complications in patients undergoing open reduction internal fixation (ORIF) for tibial plateau fractures. METHODS: From 2006 to 2019, patients aged 50 years or older undergoing ORIF for tibial plateau fracture were identified in the National Surgical Quality Improvement Program database. The mFI-5 was calculated based on the sum of the presence of 5 conditions: diabetes, congestive heart failure, hypertension, chronic obstructive pulmonary disease, and dependent functional status. Chi-squared tests and multivariable regression analysis were used to evaluate the association of different mFI-5 scores with postoperative complications. RESULTS: The study analyzed 2213 patients with an average age of 63 years. Multivariable regression analysis demonstrated that in comparison to patients with a mFI-5 score of 0, those with a score of 1 had an increased risk of prolonged hospital stay (OR 1.31) and discharge to a non-home location (OR 1.50) while those with a score of 2 or greater were at an increased risk of readmission (OR 2.30), wound complication (OR 5.37), pulmonary complication (OR 4.56), urinary tract infection (OR 4.79), prolonged hospital stay (OR 1.89), and discharge to a non-home location (OR 3.01). CONCLUSION: The mFI-5 is a reliable instrument for determining the likelihood of postoperative complications following ORIF for tibial plateau fracture repair. LEVEL OF EVIDENCE: III.
Asunto(s)
Fijación Interna de Fracturas , Fragilidad , Reducción Abierta , Complicaciones Posoperatorias , Fracturas de la Tibia , Humanos , Persona de Mediana Edad , Femenino , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/diagnóstico , Masculino , Fracturas de la Tibia/cirugía , Fracturas de la Tibia/complicaciones , Fragilidad/diagnóstico , Fragilidad/complicaciones , Anciano , Fijación Interna de Fracturas/efectos adversos , Reducción Abierta/efectos adversos , Reducción Abierta/métodos , Tiempo de Internación/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Mejoramiento de la Calidad , Fracturas de la Meseta TibialRESUMEN
PURPOSE: The purpose of this study was to determine the rates of compartment syndrome and other early complications following outpatient open reduction and internal fixation (ORIF) of tibial plateau fractures. METHODS: This was a retrospective cohort at a single US level I academic trauma centre of patients with tibial plateau fractures managed operatively. Inpatients received their definitive ORIF during their index hospital stay and were admitted post-operatively following ORIF. Outpatients were scheduled for ambulatory surgery during definitive ORIF. Exclusion criteria for outpatient surgery included compartment syndrome, polytrauma, open types IIIb/IIIc, and patients who received any internal fixation during index presentation. The primary outcome measure was post-operative compartment syndrome. Secondary outcomes were return to the 90-day return to the ED, 90-day readmission, surgical wound infection, thromboembolism, and 90-day mortality. An intention-to-treat (ITT) and as-treated (AT) analyses were performed. RESULTS: Totally, 71 inpatients and 47 outpatients were included. There were no cases of post-operative compartment syndrome. In the ITT analysis, there were no differences for inpatients vs outpatients for 90-day re-admission (22.5% vs 12.8%, p = 0.275), 90-day return to the ED (35.2% vs 17.0%, p = 0.052), infection (12.7% vs 2.1%, p = 0.094), DVT (7% vs 4.3%, p = 0.819), or PE 1.4% vs 0.0%, p = 1.000). The AT analysis showed a significantly higher 90-day re-admission (26.9% vs 2.5%, p = 0.003) and 90-day ED visit (38.5% vs 7.5%, p = 0.001) rate in the inpatient group. CONCLUSIONS: Appropriately selected patients with isolated tibial plateau fractures can have non-inferior rates of compartment syndrome and post-operative complications when compared to inpatients.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Síndromes Compartimentales , Fijación Interna de Fracturas , Readmisión del Paciente , Complicaciones Posoperatorias , Fracturas de la Tibia , Humanos , Fracturas de la Tibia/cirugía , Masculino , Procedimientos Quirúrgicos Ambulatorios/efectos adversos , Procedimientos Quirúrgicos Ambulatorios/estadística & datos numéricos , Femenino , Estudios Retrospectivos , Síndromes Compartimentales/etiología , Síndromes Compartimentales/cirugía , Persona de Mediana Edad , Adulto , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/métodos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Readmisión del Paciente/estadística & datos numéricos , Reducción Abierta/métodos , Reducción Abierta/efectos adversos , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/etiología , Tromboembolia/etiología , Anciano , Fracturas de la Meseta TibialRESUMEN
PURPOSE: This study aimed to compare reoperation rate and clinical outcomes between revision open reduction and internal fixation and hip arthroplasty following failed subtrochanteric fracture fixation. METHODS: A retrospective review was conducted of patients > 50 years old treated for failed fixation of subtrochanteric fractures with revision ORIF or hip arthroplasty from 2003 to 2023. Primary outcomes included rate of fracture union and reoperations after initial salvage therapy. Secondary outcomes included complications (infection, dislocation, bursitis, implant prominence, implant failure, nonunion), pain, and gait-aid requirements by final follow-up. RESULTS: Forty-four patients were identified: 34 treated with revision ORIF and 10 with hip arthroplasty. The arthroplasty cohort was older (75.4 vs. 66.0 years, p = 0.016) but did not differ from the ORIF cohort in sex, type of initial fixation, or reason for fixation failure. Patients treated with revision ORIF and patients treated with arthroplasty had similar rates of fracture union (85.3% vs. 80.0%, p = 0.772) and reoperation (35.3% vs. 30.0%, p = 0.710). There was no significant difference in rate of additional complications not requiring reoperation (0.0% vs. 40.0%, p = 0.071). The arthroplasty cohort achieved full weightbearing in significantly shorter time than the revision ORIF cohort (3.8 vs. 6.8 weeks, p = 0.005). CONCLUSION: Both revision ORIF and hip arthroplasty are acceptable options for salvage of failed subtrochanteric fracture fixation in patients greater than 50 years old, but patients should be counseled that although the rate of fracture union is high whether revision ORIF or hip arthroplasty is selected, the rate of reoperation can exceed 1-in-4 patients. LEVEL OF EVIDENCE: : Level III, Retrospective Comparative Study.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Fijación Interna de Fracturas , Fracturas de Cadera , Reoperación , Terapia Recuperativa , Humanos , Reoperación/estadística & datos numéricos , Fracturas de Cadera/cirugía , Masculino , Femenino , Anciano , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Estudios Retrospectivos , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/efectos adversos , Terapia Recuperativa/métodos , Persona de Mediana Edad , Insuficiencia del Tratamiento , Anciano de 80 o más Años , Reducción Abierta/métodos , Reducción Abierta/efectos adversos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Curación de FracturaRESUMEN
The aim of the study was to compare the efficacy and safety of robot-assisted (RA) percutaneous hollow screw fixation with traditional open reduction internal fixation (ORIF) for the treatment of calcaneal fractures through a systematic review and meta-analysis. An extensive search was conducted in the following databases-PubMed, CNKI, Embase, and the Cochrane Library-to gather research on patients with calcaneal fractures published up to July 2024. This search focuses on studies comparing the effectiveness of robot-assisted percutaneous cannulated screw fixation versus ORIF. We will include studies published in both English and Chinese. Our screening process adhered strictly to predefined inclusion and exclusion criteria, emphasizing randomized controlled trials (RCTs) and cohort studies. The ROBINS-I tool was utilized to evaluate the risk of bias in non-randomized studies. Meta-analysis was conducted using Review Manager 5.4.1. The final analysis incorporated six retrospective cohort studies comprising 247 patients-122 treated with robotic-assisted percutaneous cannulated screw fixation and 125 with conventional open reduction and internal fixation. The findings indicated that patients undergoing robotic-assisted percutaneous cannulated screw fixation experienced advantages over those receiving conventional treatment in terms of reduced hospital stay, lower estimated blood loss, and higher AOFAS scores at both 3 and 6 months. No statistically significant differences were observed between the two methods concerning operative time, fracture healing duration, or the frequency of intraoperative fluoroscopies. Robotic-assisted percutaneous cannulated screw fixation is a safe and viable treatment approach for patients with calcaneal fractures. When compared to ORIF methods, this robotic-assisted technique demonstrated significant benefits, including reduced hospital stay, lower estimated blood loss, and improved AOFAS scores at both 3 and 6 months.
Asunto(s)
Calcáneo , Fijación Interna de Fracturas , Fracturas Óseas , Reducción Abierta , Procedimientos Quirúrgicos Robotizados , Humanos , Calcáneo/cirugía , Calcáneo/lesiones , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Procedimientos Quirúrgicos Robotizados/métodos , Fracturas Óseas/cirugía , Reducción Abierta/métodos , Tornillos Óseos , Resultado del Tratamiento , Tiempo de Internación , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Masculino , Tempo OperativoRESUMEN
OBJECTIVES: The aim of this study was to investigate the efficacy of three-dimensional (3D) printing-assisted treatment for acetabular fractures (AFs) and to compare with conventional surgical methods. PATIENTS AND METHODS: Between May 2019 and May 2022, a total of 44 patients (33 males, 11 females; mean age: 40.6±11.8 years; range, 20 to 68 years) who were diagnosed with AFs based on clinical symptoms, X-ray and computed tomography (CT) and underwent open reduction and internal fixation in Hospital of Xinjiang Production and Construction Corps were retrospectively analyzed. The patients were divided into two groups based on whether 3D printing was applied as the experimental group (n=24) and control group (n=20). In the experimental group, pelvic and acetabular data were imported into a 3D printer, and an equal-scale highly simulated model was printed using photosensitive resin as the 3D printing material. The model was used to develop more specific personalized surgical plans, to determine the optimal sequence of surgical procedures for fracture reduction, and simulate surgery in vitro. RESULTS: In the experimental group, the mean surgical duration was shorter (123.57±22.05 vs. 163.57±26.20 min, p<0.001), the mean intraoperative bleeding loss was lower (557.14±174.15 vs. 885.71±203.27 mL, p<0.001), and the frequency of intraoperative fluoroscopy was lower (8.64±1.65 vs. 12.07±2.76, p<0.001) than in the control group. No statistically significant differences were found between the two groups in the Visual Analog Scale scores after surgery or the hip function score after treatment (p>0.05). No major postoperative complications were observed in any of the patients. CONCLUSION: Compared to conventional surgical treatment, preoperative 3D printing-assisted treatment for adult patients with AFs can significantly reduce surgical duration, intraoperative bleeding loss and frequency of intraoperative C-arm fluoroscopy, reducing surgical difficulty and improving surgical safety.
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Acetábulo , Fijación Interna de Fracturas , Fracturas Óseas , Impresión Tridimensional , Humanos , Masculino , Acetábulo/lesiones , Acetábulo/cirugía , Acetábulo/diagnóstico por imagen , Femenino , Persona de Mediana Edad , Adulto , Estudios Retrospectivos , Fracturas Óseas/cirugía , Fracturas Óseas/diagnóstico por imagen , Anciano , Fijación Interna de Fracturas/métodos , Adulto Joven , Resultado del Tratamiento , Cirugía Asistida por Computador/métodos , Tomografía Computarizada por Rayos X , Tempo Operativo , Reducción Abierta/métodosRESUMEN
Aims: Pneumatic tourniquets are often used during the surgical treatment of unstable traumatic ankle fractures. The aim of this study was to assess the risk of reoperation after open reduction and internal fixation of ankle fractures with and without the use of pneumatic tourniquets. Methods: This was a population-based cohort study using data from the Danish Fracture Database with a follow-up period of 24 months. Data were linked to the Danish National Patient Registry to ensure complete information regarding reoperations due to complications, which were divided into major and minor. The relative risk of reoperations for the tourniquet group compared with the non-tourniquet group was estimated using Cox proportional hazards modelling. Results: A total of 4,050 ankle fractures treated with open reduction and internal fixation between 15 March 2012 and 31 December 2016 were included, with 669 (16.5%) undergoing surgery with a tourniquet and 3,381 (83.5%) without a tourniquet. The overall reoperation risk was 28.2% with an adjusted relative risk of 1.46 (95% CI 0.91 to 2.32) for group comparison. The reoperation risk due to major complications was 3.1% with a tourniquet and 4.4% without a tourniquet, resulting in an adjusted relative risk of 1.45 (95% CI 0.91 to 2.32). For minor complications, there were 24.7% and 23.9% reoperations, resulting in an adjusted relative risk of 0.99 (95% CI 0.84 to 1.17). Conclusion: We found no significant difference in the reoperation rate when comparing ankle fractures treated surgically with and without the use of pneumatic tourniquets.
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Fracturas de Tobillo , Fijación Interna de Fracturas , Reoperación , Torniquetes , Humanos , Reoperación/estadística & datos numéricos , Fracturas de Tobillo/cirugía , Masculino , Femenino , Persona de Mediana Edad , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/efectos adversos , Adulto , Anciano , Dinamarca/epidemiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Reducción Abierta/métodos , Sistema de Registros , Adulto Joven , AdolescenteRESUMEN
The objective of this descriptive cross-sectional study was to assess the functional outcomes of adolescents who had undergone internal fixation for patellar post-traumatic OCD fracture from 2019-2021. The injury mechanism was divided into two categories: a) torsional mechanism and b) direct contact injury. All candidates underwent X-ray and MRI/CT scan prior to the surgery to confirm the diagnosis. Operative treatment was open reduction and internal fixation (ORIF) of osteochondral fragment using headless screws. All patients were assessed pre-operatively with knee-ROM/IKDC (International Knee Documentation committee) score and satisfaction score, and postoperatively at one year follow-up. Fourteen patients were selected, with the mean age of 16.1±3.2 years. On one-year follow-up, no difference was noted in ROM when compared to the unaffected limb. The mean satisfaction score was 86±6.3 %. The mean pre-operative-IKDC score was 47.6±5.8 out of 100, whereas on one-year follow-up it was 88.6±2.2 which was statistically significant (p<0.05). Excellent outcomes can be achieved with headless screws for urgent ORIF (next elective list) of the osteochondral fragment.
Asunto(s)
Fijación Interna de Fracturas , Rótula , Humanos , Adolescente , Masculino , Rótula/lesiones , Rótula/cirugía , Rótula/diagnóstico por imagen , Femenino , Fijación Interna de Fracturas/métodos , Estudios Transversales , Rango del Movimiento Articular , Resultado del Tratamiento , Adulto Joven , Reducción Abierta/métodos , Tornillos Óseos , Fracturas del Cartílago/cirugía , Fracturas del Cartílago/diagnóstico por imagen , Satisfacción del Paciente , Fracturas Óseas/cirugíaRESUMEN
Objective: To compare the effectiveness of open reduction and hook plate fixation versus closed indirect reduction and dorsal extension blocking Kirschner wire fixation for bony mallet fingers. Methods: The clinical data of 68 patients with bony mallet finger who admitted between May 2019 and June 2022 were retrospectively analyzed. Among them, 33 cases were in the open group (treated with open reduction and hook plate fixation) and 35 cases were in the closed group (treated with closed indirect reduction and dorsal extension blocking Kirschner wire fixation). There was no significant difference between the two groups in terms of gender, age, the affected side, the affected finger, cause of injury, time from injury to operation, and Wehbé-Schneider classification ( P>0.05). The operation time, intraoperative fluoroscopy frequency, fracture healing time, time of returning to work, and postoperative complications were recorded and compared between the two groups. At 12 months after operation, visual analogue scale (VAS) score was used to assess the pain of the injured finger, active flexion range of motion and extension deficit of the distal interphalangeal joint (DIP) were measured by goniometer, and the effectiveness was assessed by Crawford criteria. Results: All patients in the two groups were followed up 12-26 months, with an average of 15 months. There was no significant difference in the follow-up time between the closed group and the open group ( P>0.05). The operation time in the closed group was shorter than that in the open group, and the intraoperative fluoroscopy times, the fracture healing time, and the time of returning to work in the closed group were more than those in the open group, and the differences were significant ( P<0.05). In the closed group, there were 5 cases of pinning tract infection and 3 cases of small area pressure ulcer skin necrosis on the dorsal side of the finger, which were cured after intensive nursing and dressing change. Local nail depression deformity occurred in 7 cases in the open group, and the deformity disappeared after removal of plate. The incisions of the other patients healed uneventfully without complications such as infection, skin necrosis, exposure of the internal fixation, or nail deformity. There was no significant difference in the incidence of skin necrosis between the two groups ( P>0.05), but the differences in the incidence of infection and nail deformity between the two groups were significant ( P<0.05). There was no significant difference in VAS score, DIP active flexion range of motion, DIP extension deficiency, or Crawford criteria evaluation between the two groups at 12 months after operation ( P>0.05). At last follow-up, there was no DIP osteoarthritis and joint degeneration in both groups. Conclusion: Open reduction and hook plate fixation versus closed indirect reduction and dorsal extension blocking Kirschner wire fixation have their own advantages and disadvantages, but both of them have good results in the treatment of bony mallet fingers. Open reduction and hook plate fixation is recommended for young patients with bony mallet fingers who are eager to return to work.
Asunto(s)
Placas Óseas , Hilos Ortopédicos , Traumatismos de los Dedos , Fijación Interna de Fracturas , Curación de Fractura , Humanos , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Masculino , Femenino , Traumatismos de los Dedos/cirugía , Resultado del Tratamiento , Rango del Movimiento Articular , Fracturas Óseas/cirugía , Adulto , Tempo Operativo , Reducción Abierta/métodosRESUMEN
OBJECTIVE: This study aims to evaluate the outcomes of open reduction and internal fixation (ORIF) for chronic perilunate dislocations using single-stage, two-stage, and salvage procedures. The study also compares these approaches with each other and with results from existing literature. METHODS: A total of 15 patients with chronic perilunate injuries from 2013 to 2019 were included in the study. Pre-operative and post-operative assessments were conducted using plain radiographs, with CT scans performed selectively for detailed morphology and fracture pattern analysis. Among the patients, 13 underwent ORIF, while 2 underwent salvage procedures. Among the ORIF cases, single-stage procedures were performed in 4 patients, and two-stage procedures in 9 patients. External fixators, including unilateral uniplanar external fixators (UUEF) and bilateral uniplanar external fixators (BUEF), were applied in 5 and 4 patients, respectively. Our methodology of treating chronic perilunate injuries has evolved over the years. We started with single stage ORIF then graduated to a two staged procedure initially using a external fixator as a carpal distractor applied only on the radial side and finally settling down with bilateral carpal distraction using external fixators both on the radial and ulnar sides. RESULTS: Among the 15 patients, 3 were lost to follow-up. Of these, one underwent four-corner fusion, while the remaining two had UUEF. The mean time interval between injury and surgery was 3.60 months. The post-operative mean scapholunate angle measured 52.46°, with a negative radio-lunate angle (indicating flexion) observed in two patients, while others showed a positive angle (indicating extension). Two cases exhibited nonunion and avascular necrosis (AVN) of the scaphoid, while one case presented with lunate AVN. Mid-carpal and radio-carpal arthritis was observed in 4 and 2 patients, respectively. Functional outcomes were evaluated using Mayo's wrist score categorized as good for two-stage BUEF cases and satisfactory for UUEF and single-stage procedures. CONCLUSION: Staged reduction utilizing the BUEF followed by open reduction has demonstrated superior outcomes when compared to UUEF, single-stage open reduction and salvage procedures. LEVEL OF EVIDENCE: 4.
Asunto(s)
Fijación Interna de Fracturas , Luxaciones Articulares , Hueso Semilunar , Terapia Recuperativa , Humanos , Masculino , Adulto , Hueso Semilunar/cirugía , Hueso Semilunar/lesiones , Hueso Semilunar/diagnóstico por imagen , Femenino , Terapia Recuperativa/métodos , Resultado del Tratamiento , Luxaciones Articulares/cirugía , Luxaciones Articulares/diagnóstico por imagen , Fijación Interna de Fracturas/métodos , Persona de Mediana Edad , Fijadores Externos , Adulto Joven , Reducción Abierta/métodos , Estudios Retrospectivos , Traumatismos de la Muñeca/cirugía , Traumatismos de la Muñeca/diagnóstico por imagen , Rango del Movimiento Articular , Enfermedad CrónicaRESUMEN
PURPOSE: To determine the short-term complication rates following open reduction and internal fixation of scapula fractures, factors affecting the development of adverse events, and complication rates based on the anatomic location of the fracture. METHODS: Thirty-day complication rates for patients who underwent open reduction and internal fixation of the scapula were compared between glenoid, body, coracoid, and acromion fracture locations, as identified by International Classification of Disease codes. Possible adverse events included postoperative surgical site infection, renal insufficiency, intubation, pneumonia, deep vein thrombosis, pulmonary embolism, urinary tract infection, wound dehiscence, stroke, and blood transfusion. RESULTS: A total of 251 scapula fractures were identified, with 161 having known fracture locations: 105 glenoid, 20 body, 9 coracoid, and 27 acromial fractures. The rate of any adverse event for all scapular fractures was 2.0%, with no significant difference between anatomic locations (p = 0.79). The overall rates of transfusion, surgical site infection, and return to OR were 0.4%, 0.8%, and 3.98%. Steroid use associated with a significantly increased risk of any adverse event (OR: 55.57, p = 0.038) and outpatient status demonstrated a protective effect on reoperation (OR: 0.11, p = 0.014). There were no significant differences in the rates between groups [transfusion (p = 0.91); surgical site infection (p = 0.17); reoperation (p = 0.85)]. CONCLUSION: Complication rates within thirty days of ORIF for scapula fracture were low. Reoperation was the most common complication, followed by surgical site infection, wound dehiscence, stroke, transfusion, and pneumonia. Steroid use was a risk factor for developing any adverse event, and outpatient status was protective against reoperation. The 30-day complication profile of glenoid, body, coracoid, and acromial fractures was not significantly different. The low complication rates support the relative short-term safety of operative intervention with internal fixation. LEVEL OF EVIDENCE: Level III.
Asunto(s)
Fijación Interna de Fracturas , Fracturas Óseas , Reducción Abierta , Complicaciones Posoperatorias , Escápula , Humanos , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/métodos , Fracturas Óseas/cirugía , Escápula/lesiones , Masculino , Factores de Riesgo , Femenino , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Reducción Abierta/efectos adversos , Reducción Abierta/métodos , Persona de Mediana Edad , Adulto , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/etiología , Incidencia , Anciano , Estudios Retrospectivos , Transfusión Sanguínea/estadística & datos numéricos , Neumonía/etiología , Neumonía/epidemiología , Dehiscencia de la Herida Operatoria/etiología , Dehiscencia de la Herida Operatoria/epidemiologíaRESUMEN
BACKGROUND: Post-operative non-compliance is a risk factor for fracture fixation failure and presents a challenge for revision surgery planning. We present a patient who underwent revision surgery for a proximal humerus fracture with lateral locked plating augmented with a UV light activated intramedullary implant. CASE: A 45-year-old woman with a history of alcoholism presented with a proximal humerus fracture. After undergoing open reduction internal fixation with a lateral locking plate, the patient suffered a fall secondary to delirium tremens. New radiographs demonstrated displacement of the fracture with failure of screws. Revision surgery consisting of removal of the initial construct as well as open reduction internal fixation via lateral locking plate, augmented with a UV-activated intramedullary cement implant, was performed. CONCLUSION: This is the first case report describing the use of a UV-activated intramedullary cement implant to augment the use of lateral locked plating for proximal humerus fractures. This case illustrates the successful management using UV-activated intramedullary cement to augment fixation, specifically in a patient with risk factors and post-operative non-compliance that predispose to fixation failure.
Asunto(s)
Fijación Intramedular de Fracturas , Reoperación , Fracturas del Hombro , Humanos , Femenino , Persona de Mediana Edad , Fracturas del Hombro/cirugía , Fijación Intramedular de Fracturas/efectos adversos , Fijación Intramedular de Fracturas/instrumentación , Fijación Intramedular de Fracturas/métodos , Placas Óseas/efectos adversos , Rayos Ultravioleta/efectos adversos , Cementos para Huesos/efectos adversos , Reducción Abierta/efectos adversos , Reducción Abierta/métodos , Accidentes por Caídas , Alcoholismo/complicacionesRESUMEN
PURPOSE: To describe the methods and outcomes of reamed intramedullary nailing (IMN) of diaphyseal multifragmentary femur (AO/OTA C2 and C3) fractures (DMFFs) in a low-resource setting without fluoroscopy and fracture table. METHODS: The prospective study involved 35 DMFFs among 318 femur fractures treated ≤ 3 weeks post-injury with SIGN nails. The fractures were fixed without fluoroscopy, fracture table and power reaming. Closed, mini-open or open reduction was done. Anatomical length and alignment were ensured using a surgical support triangle during retrograde nailing, and by an assistant during antegrade nailing. Follow-ups were done at 6 weeks, 12 weeks and 6 months. RESULTS: DMFFs constituted 11.0% of the 318 fractures. Twenty-four (68.6%) were males. The mean age was 39.0 years (range 17-75 years). About 94.3% were injured in road traffic accidents. Fracture reduction was closed in 18, mini-open in 8 and full-open in 9. The operative times were significantly shorter for closed than open reduction (p = 0.001). Five fractures received a supplemental fixation with plate or lag screws. By the 12th post-operative week, 97.1% demonstrated continuing radiographic healing, 94.1% tolerated painless weight-bearing and 91.2% could squat & smile. There was no infection or noticeable rotational malunion. Five fractures healed with a limb-length discrepancy of < 2 cm. CONCLUSION: The study demonstrates the feasibility of reamed IMN of DMFFs without fluoroscopy. The outcomes were satisfactory. Although the small sample size and short follow-up period are limitations, the study could serve as a basis for future larger studies in low-resource settings.
Asunto(s)
Diáfisis , Fracturas del Fémur , Fijación Intramedular de Fracturas , Humanos , Fijación Intramedular de Fracturas/métodos , Fijación Intramedular de Fracturas/instrumentación , Fijación Intramedular de Fracturas/efectos adversos , Fracturas del Fémur/cirugía , Fracturas del Fémur/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Femenino , Adulto , Estudios Prospectivos , Anciano , Adolescente , Adulto Joven , Diáfisis/cirugía , Diáfisis/lesiones , Resultado del Tratamiento , Tempo Operativo , Fluoroscopía , Clavos Ortopédicos , Curación de Fractura , Reducción Cerrada/métodos , Reducción Abierta/métodos , Países en DesarrolloRESUMEN
PURPOSE: The primary objective of this study was to investigate the association between preoperative chronic steroid use and postoperative complications following open reduction internal fixation (ORIF) for proximal humerus fractures (PHF). METHODS: The American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) database was queried for all patients who underwent PHF ORIF between 2015 and 2021. A total of 6,273 patients were included in this study, of which 3.4% (n = 212) were in the chronic steroid use cohort. Patient characteristics including demographics, comorbidities, and 30-day postoperative complications after PHF ORIF were collected. Bivariate logistic regression and multivariate logistic regression analysis, adjusted for all significantly associated variables, was conducted to investigate the relationship between preoperative chronic steroid use and postoperative complications. RESULTS: Chronic steroid use was significantly associated with age ≥ 75 (p < 0.001), male gender (p =0.006), dependent functional status (p = 0.008), American Society of Anesthesiologist (ASA) ≥ 3 (p < 0.001), CHF (p = 0.007), hypertension (p < 0.001), COPD (p < 0.001), bleeding disorder (p = 0.007), ascites (p = 0.040), disseminated cancer (p< 0.001), and systemic sepsis (p < 0.001). After adjusting for all significantly associated variables, chronic steroid use was independently associated with major complication (OR 1.60, 95% CI 1.06-2.43; p = 0.026), and non-home discharge (OR 1.05, 95% CI 1.01-1.08; p = 0.014). CONCLUSION: Preoperative chronic steroid use is associated with increasing rate of postoperative complications following PHF ORIF. Better understanding and characterizing chronic steroid use as a preoperative risk factor can aid physicians in risk stratification to reduce rates of postoperative complications following PHF ORIF. LEVEL OF EVIDENCE: III. Retrospective Cohort Comparison; Prognosis Study.
Asunto(s)
Fijación Interna de Fracturas , Reducción Abierta , Complicaciones Posoperatorias , Fracturas del Hombro , Humanos , Masculino , Femenino , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Anciano , Factores de Riesgo , Reducción Abierta/efectos adversos , Reducción Abierta/métodos , Fracturas del Hombro/cirugía , Fijación Interna de Fracturas/efectos adversos , Persona de Mediana Edad , Estudios Retrospectivos , Esteroides/efectos adversos , Esteroides/administración & dosificación , Factores Sexuales , Factores de Edad , Comorbilidad , Periodo Preoperatorio , Anciano de 80 o más AñosRESUMEN
BACKGROUND: Open reduction and internal fixation (ORIF) using locking plates is a widely adopted treatment for displaced proximal humerus fractures. Various augmentation techniques have been developed to enhance the stability of plate fixation. Among these, iliac bone autograft is notable for its advantages over allografts, such as ready availability and the elimination of costs and risks associated with disease transmission. Despite its potential benefits, data on the outcomes of iliac bone autograft augmentation (IBAA) are still limited. This study aims to present the mid- to long-term results of treating proximal humerus fractures with ORIF using locking plates and IBAA. METHODS: The study included 15 patients treated with ORIF and IBAA. We classified fracture patterns using the Neer classification and estimated local bone density via the deltoid tuberosity index. We measured the neck shaft angle (NSA) and humeral head height (HHH) on both immediate postoperative and most recent X-ray images to assess the maintenance of reduction. Clinical outcomes were evaluated using the DASH (Disabilities of the Arm, Shoulder, and Hand) and Constant scores. RESULTS: The average follow-up duration was 59.56 months, ranging from 24 to 93 months. A majority of fractures were classified as four-part (53%). The average immediate and late postoperative NSAs were 132.6±8.19 and 131.6±7.32 degrees, respectively. The average HHH on the immediate postoperative and latest follow-up images were 16.46±6.07 and 15.10±5.34, respectively. None of the patients exhibited any radiological signs of avascular necrosis or loss of reduction at the latest follow-up. The mean postoperative Constant and DASH scores at the latest follow-up were 79.6 and 11.5, respectively. CONCLUSION: Our findings suggest that ORIF with IBAA is an effective method for managing three- or four-part proximal humerus fractures, yielding excellent outcomes.
Asunto(s)
Placas Óseas , Fijación Interna de Fracturas , Ilion , Reducción Abierta , Fracturas del Hombro , Humanos , Fracturas del Hombro/cirugía , Masculino , Femenino , Persona de Mediana Edad , Ilion/trasplante , Fijación Interna de Fracturas/métodos , Reducción Abierta/métodos , Adulto , Resultado del Tratamiento , Anciano , Trasplante Óseo/métodos , Autoinjertos , Trasplante Autólogo/métodos , Estudios RetrospectivosRESUMEN
Pediatric ankle injuries are common; ankle epiphyseal fractures are also common in children. But isolated distal epiphyseal fibular fractures of the distal fibula are clinically rare. We describe one unusual case of an adolescent with a completely displaced Salter-Harris type II distal fibular epiphyseal fracture. The attempt of closed reduction failed, and the patient required open reduction and internal fixation. The localized periosteum and the superior peroneal retinaculum were avulsed from the distal fibular metaphysis, with the peroneal tendons underneath exposed but no obvious subluxation. To the best of our knowledge, this combination of injuries has not been previously reported.
Asunto(s)
Epífisis , Peroné , Fijación Interna de Fracturas , Humanos , Peroné/lesiones , Peroné/cirugía , Peroné/diagnóstico por imagen , Adolescente , Fijación Interna de Fracturas/métodos , Epífisis/lesiones , Epífisis/cirugía , Epífisis/diagnóstico por imagen , Masculino , Resultado del Tratamiento , Fracturas Óseas/cirugía , Fracturas Óseas/diagnóstico por imagen , Fracturas de Tobillo/cirugía , Fracturas de Tobillo/diagnóstico por imagen , Reducción Abierta/métodos , FemeninoRESUMEN
Radial neck fractures with radial head rotation are very rare and extremely difficult to manage. We present the case of an 11-year-old girl who fell on her outstretched left upper extremity and damaged her left elbow in a road traffic accident. An arthrotomy was performed under a C-Arm fluoroscope, which confirmed the radial head displacement of 180° along with the fracture. The fracture site was reduced and fixed with two Kirschner wires, cutting the wire short at its distal end for a complete closure. Open reduction and internal fixation were followed by casting for five weeks. After two years of follow-up, she had complete pain free range of motion of the affected limb. No post-operative complications have been observed till date. Open reduction and internal fixation with two Kwires is a viable option for such complex injuries. However, further evaluation of outcomes and post-operative complications are required.