Meta-analysis of the efficacy of volar plate internal fixation versus closed reduction and external fixation in the treatment of adult distal radius fractures

Objective:To compare the efficacy of open reduction and volar locking plate internal fixation with closed reduction and external fixation in the treatment of distal radius fractures by using meta analysis.Methods:The databases of CNKI,Wanfang,Weipu,Chinese biomedical literature,Pubmed,Embase,and Cochrane Library were retrieved,and the randomized controlled studies that directly compared the efficacy of plate internal fixation and closed reduction external fixation in the treatment of distal radius fractures published publicly from the establishment of the database to April 2023 were collected.The two researchers independently screened the retrieved literature according to the inclusion and exclusion criteria,extracted data,used Cochrane risk bias assessment tool for quality assessment,and used RevMan 5.4 software for meta analysis.Results:A total of 10 randomized controlled trials were included,all of which were in English.There were 1042 patients in total,and 9 of them were rated as low risk.Meta analysis results showed that one year after the treatment of distal radius fracture with volar locking plate internal fixation,DASH score[MD=-5.64,95%CI(-7.21,-4.06),P<0.00001];One year later,PRWE score[MD=-5.90,95%CI(-8.88,-2.92),P=0.001];Palm flexion[MD=5.92,95%CI(1.29,10.55),P=0.01];Pronation[MD=2.48,95%CI(0.59,4.36),P=0.01];Postrotation[MD=4.73,95%CI(2.15,7.31),P=0.0003];Grip strength[MD=0.61,95%CI(0.12,1.10),P=0.02];palmar tilt angle[MD=9.84,95%CI(5.66,14.02),P<0.00001];Radial inclination[MD=4.33,95%CI(2.97,5.69),P<0.00001]was superior to closed reduction plaster or splint external fixation.One year later,the European Five dimensional Health Scale(EQ-5D-5L)score[MD=0.02,95%CI(-0.01,0.05),P=0.27];Back extension[MD=2.22,95%CI(-4.15,8.59),P=0.49];Ulnar deviation[MD=3.49,95%CI(-0.80,7.78),P=0.11];Radial deviation[MD=2.05,95%CI(-2.39,6.50),P=0.37];Ulnar variance[MD=-1.14,95%CI(-3.16,0.88),P=0.27];There was no significant difference in complications[MD=0.77,95%CI(0.54,1.10),P=0.16](P>0.05).Conclusion:Based on the current clinical data,internal fixation with volar locking plate is more conducive to mid-term DASH score and grip strength recovery than closed reduction plaster or splint external fixation,but there is no significant difference in the quality of life and complications of patients.For adult distal radius fractures,surgical indications should be carefully grasped,and non operative treatment should be given priority.

Axial load-share ratio testing to assess the healing of open tibial fractures treated with the Taylor Spatial Frame

Background:The Taylor Spatial Frame(TSF)has gained popularity among orthopedic surgeons for treating open fractures.However,a key challenge is the timely and safe removal of the frame.This study assessed the efficacy and safety of axial load-share ratio(ALSR)testing to evaluate callus healing strength after TSF treatment of open tibial fractures.Methods:A retrospective case-control study was conducted,analyzing 180 adult patients with open tibial fractures treated at Tianjin Hospital’s Orthopedic Limb Correction Unit between August 2019 and August 2022.All patients underwent TSF external fixation surgery,and were divided into two groups based on ALSR testing.Group I(92 patients)underwent ALSR testing,with frame removal if the test value fell below 5%.Traditional methods were used for fixator removal guidance in Group II(88 patients).Clinical outcomes,including fixation duration,complications after fixator removal,and Johner-Wruhs functional scores,were compared between the two groups.Results:The groups showed no statistically significant differences(P>0.05)in sex,age,injury side,body mass index,surgery timing,or fracture type.Group I had a significantly shorter fixation duration(25.85±5.57 weeks)compared to Group II(31.82±6.98 weeks)(P<0.05).Following fixator removal,Group I demonstrated superior Johner-Wruhs scores compared to Group II,indicating better outcomes(P<0.05).Complication rates did not differ significantly between the groups at the last follow-up(P>0.05).Conclusion:Regular postoperative ALSR testing could safely and effectively guide TSF removal following open tibial fracture treatment.This method significantly reduced fixation duration compared to traditional guidance methods while maintaining efficacy and safety.

Evaluation of Surgical Treatment of Distal Humeral Fractures in Adults

Introduction: Fractures of the distal end of the humerus are becoming increasingly frequent in young subjects because of the increase in road traffic accidents, and in elderly subjects because of osteoporosis related to aging populations. Materials and Methods: It was a prospective, monocentric study from January 2018 to December 2020 involving 14 patients who received and were treated surgically for distal humeral fractures and followed up. Results: We collected 14 patients, including 11 men (78.57%) and 3 women (21.43%), with a sex ratio of 3.7. The mean age was 36.41 years. The circumstances of onset were dominated by road traffic accidents, with 12 cases (85.71%). The dominant side was right-handed, with 11 cases (78.57%). Standard elbow radiography revealed 8 cases of type A fractures (57.14%), 4 cases of type B and 2 cases of type C fractures of the AO. We performed Lecestre plate osteosynthesis in 12 patients and external fixator in 2 others, using the trans-olecranial and transtricipital approaches. Elbow stiffness was the most frequent complication, with 6 cases (42.86%). After six months’ follow-up, our results were excellent and good in 78.57% of cases (MEPS). Conclusion: Surgical treatment with posterior approaches enabled us to achieve restitution of the articular surfaces, solid restraint and early mobilization of the elbow with satisfactory functional results.

Emergent and delayed hybrid external fixation management of tibial pilon fractures: A multicentric retrospective analysis of 80 patients

Objective:To report our experience with the hybrid external fixator in emergency.Methods:We assessed 80 cases of pilon fracture treated with the external fixator during the period of January 2009 and December 2016:55 men (69%) and 30 women (33%) with a mean age of 40 years (range between 16 and 70 ). About 45 occurred as isolated trauma, 35 instead were politrauma. Each patient underwent standard radiographic examination and a CT examination. There were 28 open fractures (35%), (Gustilo type 1, 2 and 3) while closed fractures showed soft tissue involvement of various grade (2-3 Tscherne classification). In all cases, the external fixation, sometimes associated with other reduction and synthesis techniques, was used. The timing of surgery was dictated by the condition of the soft tissues. For clinical evaluation, the Mazur score with mean follow-ups at 12 months was utilized.Results:The final range of ankle motion was 15 dorsal and 10 plantar flexion. In about 80 cases there was an average Mazur score of83. The mean score was 90;in open fractures 85 to 72. Radiographic healing of fractures in 60 patients occurred in 120 days (mean 105 days), at the time when the external fixator was removed.Conclusion:Pilon fractures are complex and often present complications;the definitive treatment, in emergency or delayed, with hybrid external fixator permits a stable synthesis with minimal soft tissue damage. Weight bearing maybe allowed early and functional recovery is generally good.

External fixation is more suitable for intra-articular fractures of the distal radius in elderly patients

The purpose of this study was to compare the functional outcomes, psychological impact, and complication rates associated with external fixation and volar or dorsal plating in relation to the functional parameters following treatment of intra-articular fractures of the distal radius （IFDR） in patients older than 65 years. We hypothesized that using volar or dorsal plating would improve functional outcomes, but that it would be associated with more complications and equivalent functional outcomes when compared with the external fixation group. A total of 123 consecutive patients suffering from IFDR were recruited into the study. The patients were measured for clinical, radiological, and psychosocial functioning outcomes and were followed up after I week and 3, 6 and 12 months. After 3 months, the plating group had better pronation （P = 0.001）, supination, （P = 0.047） and extension （P = 0.043） scores. These differences were somewhat attenuated by 6 months and disappeared at I year. The plating group had a greater occurrence of wound infection （P = 0.043）, tendonitis, （P = 0.024） and additional surgery compared with the external fixation group. The only TNO-AZL Adult Quality of Life scores in the plating group that were lower than those in the external fixation group were in the ＂gross motor＂ category （walking upstairs, bending over, walking 500 yards; P = 0.023）. Internal fixation was more advantageous than external fixation in the early rehabilitation period; after I year the outcomes were similar. The plating group showed significantly higher levels of wound infection and tendonitis and had a greater need for additional surgeries.

Advantages of Ilizarov External Fixation in an Elderly Patient with Pilon Fracture with Severe Soft Tissue Injury and Severe Osteoporosis: A Case Report

Introduction: Pilon fracture in elderly individuals is characterized by senile skin atrophy, poor dermal extensibility, and thin subcutaneous tissue. The use of bulky internal fixation material can thus cause the swelling that accompanies the fracture to induce secondary injury to skin tissue. In addition, initiation of postoperative weight-bearing is delayed due to bone fragility and difficulties with partial weight-bearing, causing a tendency toward prolonged hospitalization. Mean duration of hospitalization after pilon fracture for elderly patients in our department was 79.2 days. Case Presentation: An 80-year-old woman with pilon fracture with soft tissue injury and severe osteoporosis was transferred to our department. The fracture was treated using Ilizarov external fixation. Fourteen days postoperatively, walking with full weight-bearing was permitted. The hospital stay was 28 days. The external fixator of the ankle was removed 87 days postoperatively, at which time the patient was anatomically and functionally recovered and able to walk unaided. Conclusion: Ilizarov external fixation may represent a useful option in elderly patients with pilon fracture showing severe soft tissue injury and severe osteoporosis. The present case provides evidence that this procdure can be successfully applied to the management of such pilon fractures in elderly patients.

Early complications of preoperative external traction fixation in the staged treatment of tibial fractures:A series of 402 cases

BACKGROUND Different external skeletal fixators have been widely used in preoperative traction of high-energy tibial fractures prior to a definitive surgical treatment.However,the early complications associated with this staged treatment for traction and soft tissue injury recovery have rarely been discussed.AIM To analyze the early complications associated with preoperative external traction fixation in the staged treatment of tibial fractures.METHODS A total of 402 patients with high-energy tibial fractures treated using preoperative external traction fixation at a Level 1 trauma center from 2014 to 2018 were enrolled in this retrospective study.Data regarding the demographic information,Tscherne soft tissue injury,fracture site,entry point placement,and duration of traction were recorded.Procedure-related complications such as movement and sensation disorder,vessel injury,discharge,infection,loosening,and iatrogenic fractures were analyzed.RESULTS The mean patient age was 42.5(18-71)years,and the mean duration of traction was 7.5(0-26)d.In total,19(4.7%)patients presented with procedure-related complications,including technique-associated complications in 6 patients and nursing-associated complications in 13.Differences in the incidence of complications with respect to sex,affected side,soft tissue injury classification,and fracture sites were not observed.However,the number of complications due to hammer insertion was significantly reduced than those due to drill insertions(2.9%vs 7.4%).CONCLUSION We found a low incidence of early complications related to the fixation.Furthermore,the complications were not significantly associated with the severity of the soft tissue injury and fracture site.Although relatively rough and more likely to cause pain,the number of complications associated with hammer insertion was significantly smaller than that of complications associated with drill insertion.

Hybrid External Fixation for Open Severe Comminuted Fractures of the Distal Femur

Background: The treatment of distal femoral open comminuted fractures is a major problem for orthopedic surgeon. The basic and important aim in treatment of these fractures is to assemble the condylar fragments and then fix the condyles to the femoral shaft by minimum handling of the bone and soft tissues. Objectives: To evaluate the treatment of distal femoral open comminuted fractures (type C2 and C3) with hybrid external fixator. Methods: Thirty-four patients with distal femur open comminuted fracture (type C2 and C3) were treated by hybrid external fixator between January 2005 and December 2008. All of the fractures were opened with extension to joint surface. 30 patients were male and 4 were female. Their average age was 30.5 years (17 to 72 years). Average follow up period was 36 months. 12 patients had isolated fracture and 22 patients had multiple fractures. The bony and functional results were evaluated by the association for the study and application of the method of Ilizarov (ASAMI) protocol and knee society score. Results: 29 out of 34 fractures (85%) had union without bone grafts. Average time of union was 6.1 months (4 - 19 ms). The average knee range of motion was 87.5 degrees (30 - 115 degrees). The bony results were excellent in 24 patients (70.5%), good in 6 (17.7%), fair in 2 (5.9%), and poor in 2 (5.9%), and the functional results were excellent in 10 (29.4%) patients, good in 14 (41.2%), fair in 6 (17.6%), and poor in 4 (11.8%), and the functional results were excellent in 10 (29.4%) patients, good in 14 (41.2%), fair in 6 (17.6%), and poor in 4 (11.8%) according to ASAMI protocol. According to the knee society score the functional results were excellent in 9 (26.44%) patients, good in 13 (38.26%), fair in 7 (20.6%), and poor in 5 (14.7%). Conclusion: Hybrid external fixator is an effective method for treatment of distal femoral open comminuted fractures (type C2 and C3) and may be considered as an alternative surgical methods in the management of these fractures.

Treatment of Vertically Unstable Sacral Fractures with Pelvic External Fixation and Skeletal Traction

Objective: To determine the efficacy in treatment of vertically unstable sacral fractures with pelvic external fixation and skeletal traction. Patients and Methods: The pelvic external fixation and skeletal traction were applied on 12 cases of vertically unstable sacral fracture (eight males and four females, at age of 19 - 52 years, mean 35.2 years) including two cases of Denis Zone I, nine of Zone II, and one of Zone III. All patients were treated with the pelvic external fixation, and pre- and post-operational longitudinal skeletal traction. Results: The mean operation time, skeletal traction time, skeletal traction removal time and full weight bearing time were 38 min, 4.5 weeks, 8.5 weeks, and 10.3 weeks respectively. All these patients were followed up for 12 - 36 months (average, 22.5 months), which showed no associated complication. The function results were rated as excellent in four cases, good in six and fair in two, with a mean score of 84.4 points, according to Majeed scoring system. Conclusion: The anterior pelvic external fixation with continuous skeletal traction can reliably restore and stabilize the vertically unstable sacrum fracture with excellent functional and radiographic outcomes. It is an ideal method to treat unstably vertical sacral fracture.

Assessment of the trauma degree and bone metabolism after external fixation combined with vacuum sealing drainage treatment of open tibiofibula fracture

Objective: To evaluate the effect of external fixation combined with vacuum sealing drainage on the trauma degree and bone metabolism in patients with open tibiofibula fracture. Methods:A total of 116 patients with open tibiofibula fracture who received surgical treatment in Luzhou People's Hospital between February 2015 and January 2017 were divided into control group (n=58) and study group (n=58) by random number table. Control group received debridement + external fixation, and study group received debridement + external fixation +vacuum sealing drainage. The differences in the levels of trauma indexes and bone metabolism indexes were compared between the two groups before and after treatment. Results: Before surgery, there was no statistically significant difference in serum levels of trauma indexes and bone metabolism indexes between the two groups. 1 week after surgery, serum acute phase protein Tf level of study group was higher than that of control group whereas CER, Hp and CRP levels were lower than those of control group;stress indexes NE and Cor levels were lower than those of control group;bone metabolism indexes P1NP, BGP and BALP levels were higher than those of control group whereas β-CTX level was lower than that of control group. Conclusion: External fixation combined with vacuum sealing drainage can effectively reduce fracture trauma and promote fracture end healing in patients with open tibiofibula fracture.

Changes of bioelectric potentials of experimental fracture healed under compressive external fixation

Experimental fracture was inflicted to the Junction of the upper and middle thirds of the tibia of 50 rabbits and the fracture was fixed with a half-ring sulcated external fixator to exert axial compression on the 2 fragments of the fracture. The changes

Dynamic External Fixator Combined with Volar Locking Plate Fixation for the Treatment of AO Type C3 Distal Radius Fractures

Background: AO type C3 distal radius fracture (DRF) is the most difficult-to-treat fracture type because of a tendency to shorten and collapse. The purpose of this study is to investigate the clinical and radiographic outcomes of comminuted intra-articular DRFs treated with a dynamic external fixator combined with a volar locking plate (VLP). Methods: Eleven patients (mean age, 61 years) with comminuted intra-articular DRFs were treated with a dynamic type of external fixator combined with a VLP. Following reduction and fixation with a VLP, the dynamic external fixator was applied and the distal ball joint of the fixator was aligned with the lunate-capitate line. The ball joint was unlocked approximately 2 weeks after surgery to allow wrist mobilization. The fixator was removed 3 - 6 weeks (mean, 5 weeks) after surgery. Consequently, clinical and radiographic assessments were carried out at the final follow-up. Results: At the final follow-up, the mean range values of wrist extension and flexion were 76&deg;and 64&deg;, respectively. Compared with the contralateral side, the mean grip strength was 84%. The mean Modified Mayo Wrist Score and the Disabilities of the Arm, Shoulder and Hand score were 88 and 9, respectively. No significant differences in the radiographic parameters exist between after surgery and final follow-up. Conclusions: This study indicated that the dynamic wrist fixator combined with a VLP is effective for the treatment of AO type C3 DRFs.

Management of Tibial Metaphyseal Fractures by Hybrid External Fixator

Introduction: The Hybrid External Fixator combines the advantages of the monolateral pin fixators and the circular Ilizarov wire fixators. Principle of early motion has been touted as the functional savior of major intra articular injuries in application of hybrid external fixation. Materials & Methodology: 48 patients were considered for the study with tibial fractures admitted in Mamata General Hospital from May 2011 to May 2013. Results: The union and functional outcome of hybrid external fixator in simple and complex proximal and distal metaphyseal fractures of tibia in adults was evaluated at our centre. The fractures of the proximal tibia united with an average of 13.3 weeks (12 - 16 weeks). The fractures of the distal tibia united with an average of 14.42 weeks (13 - 22 weeks) with minimal complications. Conclusion: Our study shows high satisfaction rate after fixation, provides adequate stability and allows early motion of the joint. It is also effective in extra articular fractures occurring within 5 cm of the joint as the IM nails often do not provide enough stability and plating requires extensive soft tissue dissection.

HYBRID EXTERNAL FIXATOR FOR THE TREATMENT OF UNICAMERAL BONE CYSTS WITH PATHOLOGICAL FRACTURE IN THE PROXIMAL HUMERUS

Objective: Unicameral bone cyst is a nonneoplasticbone lesion characterized by its tenacity and risk ofrecurrence. Pathological fracture is common and is often the presenting symptom. The objective of the present study was to evaluate the results of hybrid external fixator for thetreatment of a unicameral bone cyst with a pathologicalfracture. Methods: Hybrid external fixator for thetreatment of a unicameral bone cyst was performed intwelve patients. These patients presented with a pathological fracture and were managed immediately with hybridexternal fixator, of whom four had been managedconservatively at other clinics before they were referred toour department. The cyst was located in the proximalhumerus in all patients. The mean age of the patients at the time of surgery was 8.7 years, and the mean duration offollow-up was 32.6 months. Radiographic evaluation wasperformed according to the criteria of Capanna et al., andthe cyst was classified as completely healed, healed withresidual radiolucency (osteolysis), recurred, or having noresponse. Results: The healing period ranged from three to eight months. Eight cysts healed completely, and threehealed with residual radiolucent areas visible onradiographs. There was recurrence of one cyst that hadhealed with residual radiolucency. All of the cysts in thepresent study responded to treatment. A modulation ofhybrid external fixator was necessary in three patients, asthe bars had become too short after bone growth or the pins had been loose. No major complications were observed.Conclusion: Hybrid external fixator provides earlystability, which allows early mobilization and thus obviates the need for a plaster cast. This method of treatment alsoallows for an early return to normal activity.

Ilizarov external fixators for maluninon of obsolete calcaneal fracture of Stephen Type Ⅲ

Objective To evaluate the clinical effects of Ilizarov external fixator for maluninon of obsolete calcaneal fracture of Stephen Type Ⅲ.Methods From July 2006 to February 2009,25 patients suffering from maluninon of obsolete calcaneal

Pelvic fractures in blunt trauma patients:A comparative study

BACKGROUND Pelvic fractures(PF)with concomitant injuries are on the rise due to an increase of high-energy trauma.Increase of the elderly population with age related comorbidities further complicates the management.Abdominal organ injuries are kindred with PF due to the proximity to pelvic bones.Presence of contrast blush(CB)on computed tomography in patients with PF is considered a sign of active bleeding,however,its clinical significance and association with outcomes is debatable.AIM To analyze polytrauma patients with PF with a focus on the geriatric population,co-injuries and the value of contrast blush.METHODS This retrospective cohort study included 558 patients with PF admitted to level 1 trauma center(01/2017-01/2023).Analyzed variables included:Age,sex,mechanism of injury(MOI),injury severity score(ISS),Glasgow coma scale(GCS),abbreviated injury scale(AIS),co-injuries,transfusion requirements,pelvic angiography,embolization,laparotomy,orthopedic pelvic surgery,intensive care unit and hospital lengths of stay,discharge disposition and mortality.The study compared geriatric and non-geriatric patients,patients with and without CB and abdominal co-injuries.Propensity score matching was implemented in comparison groups.RESULTS PF comprised 4%of all trauma admissions.89 patients had CB.286(52%)patients had concomitant injuries including 93(17%)patients with abdominal co-injuries.Geriatric patients compared to non-geriatric had more falls as MOI,lower ISS and AIS pelvis,higher GCS,less abdominal co-injuries,similar CB and angio-embolization rates,less orthopedic pelvic surgeries,shorter lengths of stay and higher mortality.After propensity matching,orthopedic pelvic surgery rates remained lower(8%vs 19%,P<0.001),hospital length of stay shorter,and mortality higher(13%vs 4%,P<0.001)in geriatric patients.Out of 89 patients with CB,45(51%)were embolized.After propensity matching,patients with CB compared to without CB had more pelvic angiography(71%vs 12%,P<0.001),higher embolization rates(64%vs 22%,P=0.02)and comparable mortality.CONCLUSION Half of the patients with PF had concomitant co-injuries,including abdominal co-injuries in 17%.Similarly injured geriatric patients had higher mortality.Half of the patients with CB required an embolization.

Missed diagnosis of femoral deep artery rupture after femoral shaft fracture: A case report

BACKGROUND Vascular injury is a rare complication of femoral shaft fractures,and rupture of the deep femoral artery is more difficult to diagnose because of its anatomical location and symptoms.Despite its low incidence,deep femoral artery rupture can lead to life-threatening outcomes,such as compartment syndrome,making early identification and diagnosis critical.CASE SUMMARY A 45-year-old male patient was admitted to our hospital due to right lower limb trauma in a car accident,with complaints of severe pain and swelling on his right thigh.X-ray demonstrated a right femoral shaft fracture.During preparation for emergency surgery,his blood pressure and blood oxygen saturation dropped,and sensorimotor function was lost.Computed tomography angiography was performed immediately to confirm the diagnosis of rupture of the deep femoral artery and compartment syndrome,so fasciotomy and vacuum-assisted closure were performed.Rhabdomyolysis took place after the operation and the patient was treated with appropriate electrolyte correction and diuretic therapy.Twenty days after the fasciotomy,treatment with the Hoffman Type II External Fixation System was planned,but it was unable to be immobilized internally based on a new esophageal cancer diagnosis.We kept the external fixation for 1 year,and 3 years of follow-up showed improvement of the patient’s overall conditions and muscle strength.CONCLUSION For patients with thigh swelling,pain,anemia,and unstable vital signs,anterior femoral artery injury should be highly suspected.Once diagnosed,surgical treatment should be performed immediately and complications of artery rupture must be suspected and addressed in time.

Outcome of application of primary versus secondary Illizarov＇s fixator in open tibial shaft fractures

BACKGROUND: The present study aimed to compare outcome of primary and secondary Illizarov's fi xator application as a treatment method for type III open tibial fractures in terms of nonunion and wound infection.METHODS: This prospective study was done in a tertiary care center. Forty-eight type III tibial fractures were treated with Illizarov's apparatus between 2008 and 2011. The patients were divided into two groups depending on the treatment protocol, timing of wound closure and Illizarov's application, primary(n=28) and secondary(n=20).RESULTS: In the primary group, healing was achieved in all 28 patients. The median time to recovery was 24 weeks, and the median number of operations was 3. There were 6 patients with a bone defect. In the secondary group, complete recovery was achieved in 18 out of 20 patients. The median time to recovery was 30 weeks, and the median number of operations 5. There were 9 patients with a bone defect. The median time to recovery and the number of operations were signifi cantly smaller in patients undergoing primary operation. Union was 100% in the primary group and more than 95% in the secondary group. Chronic osteomyelitis persisted in one patient and below amputation was done in one patient in the secondary group.CONCLUSION: Primary wound closure and Illizarov's fixation required a smaller number of operations and shorter time to recovery than secondary wound closure and Illizarov's fi xation, mostly due to a signifi cantly less number of patients with a bone defect in the primary group.

The damage control in tibial pilon open fractures with a new external fixator delta frame

Objective: To evaluate the effectiveness of the damage control, in emergency to treat the open tibial pilon fractures with Dolphix? External Fixator Frame(CITIEFFE?, Calderara di Reno, Bologna, Italy). Methods: From January 2017 to August 2017, at the Department of Orthopedics and Traumatology of Vito Fazzi Hospital Lecce, we treated 23 open tibial pilon fractures with Dolphix? External Fixator Frame(CITIEFFE?, Calderara di Reno, Bologna, Italy). The evaluation criteria of the case series were: the time needed to assemble the external fixator;the time taked to treat the ankle associated lesions;the time of skin healing;the ankle alignment;the subjective/objective Ovadia and Beals score;and complications. The Endpoint assessment was set at the days of the definitive surgery. Results: The results in terms of alignment, biomechanical stability of the frame, healing of soft tissue, complications were as good as the objective and subjective results according Ovadia and Beals score. Conclusion:Pilon fractures are complex and often present complications;the damage control treatment, in emergency, with Dolphix? External Fixator Frame(CITIEFFE?, Calderara di Reno, Bologna, Italy) permits a stable osteotaxis with minimal soft tissue damage and permit the repair of muscles, blood vessels and nerves with a stable bone and the soft tissue healing with vaccum therapy.

Ligamentotaxis versus Open Reduction and Internal Fixation for Distal Radius Intra-Articular Fractures

Objectives: This study compared the clinical and radiological outcomes of two different methods for the treatment of distal radial intra-articular fractures. Patients and Methods: Forty-six patients with distal radius intra-arti-cular fractures were divided into two groups. Group I included 24 patients with type C fracture treated by external fixator augmented by percutaneous K-wires. Group II included 22 patients with type C fracture treated by volar locked distal radial plate augmented by K-wires. Two patients had complex injuries necessitating double plating (sandwich). All patients were evaluated clinically by Mayo Wrist Score and radiologically by Sarmiento’s radiological score. Results: Both groups reported good personal satisfaction according to Mayo Wrist Score, and the results were not statistically different between the two groups. In Group I, 19 patients (79.2%) had excellent radiological outcome and five patients (20.9%) had good radiological outcome according to Sarmiento’s radiological score. In Group II, 20 patients (90.9%) had excellent outcome, and two (9.1%) had good radiological outcome;there was no or insignificant deformity. Conclusions: Complex distal radial fractures can be treated either by external fixation (ligamentotaxis) or by locked pre-contoured plating. The clinical outcome of plating and external fixator in our study did not show any statistically significant difference. The radiological outcome had no correlation with the clinical outcome.