MIPPO technique and LCP internal fixation for open tibial shaft fractures

Objective To explore the efficacy of minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and locking compression plate (LCP) for open tibial shaft fractures.Methods From March 2005 to May 2009,16 cases with open tibial

Outcomes of early versus late irrigation and debridement of pediatric open long bone fractures

BACKGROUND Open long bone fractures are a major concern for pediatric patients due to the risk of surgical site infection(SSI).Early studies have recommended irrigation and debridement of open fractures within 6 hours-8 hours for the prevention of SSI.According to the American College of Surgeons(ACS)Best Practice Guidelines,in 2015,irrigation and debridement should be done within 24 hours.AIM To identify whether early irrigation and debridement,within 8 hours,vs late,between 8 hours and 24 hours,for pediatric open long bone fractures impacts rate of SSI.METHODS Using retrospective data review from the National Trauma Data Bank,Trauma Quality Improvement Project(TQIP)of 2019.TQIP database is own by the ACS and it is the largest database for trauma quality program in the world.Propensity matching analysis was performed for the study.RESULTS There were 390 pediatric patients with open long bone fractures who were incl-uded in the study.After completing propensity score matching,we had 176 patients in each category,irrigation and debridement within 8 hours and irrigation and debridement between 8 hours and 24 hours.We found no significant differences between each group for the rate of deep SSI which was 0.6%for patients who received surgical irrigation and debridement within 8 hours and 1.1%for those who received it after 8 hours[adjusted odd ratio(AOR):0.5,95%CI:0.268-30.909,P>0.99].For the secondary outcomes studied,in terms of length of hospital stay,patients who received irrigation and debridement within 8 hours stayed for an average of 3.5 days,and those who received it after 8 hours stayed for an average of 3 days,with no significant difference found,and there were also no sig-nificant differences found between the discharge dispositions of the patients.CONCLUSION Our findings support the recommendation for managing open long bone fractures from the ACS:Complete surgical irrigation and debridement within 24 hours.

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.

Open reduction and internal fixation for radial head fractures: A prospective observational study

Objective: To evaluate the effect of open reduction and internal fixation on radial head fracture and assess the post-operative function. Methods: This prospective observational study was conducted from June 2016 to July 2017 at Liaquat National Hospital and Medical College, Karachi. Altogether, 28 patients with radial head and neck fractures were enrolled in our study. These patients were admitted to the hospital and their fractures were fixed with open reduction and internal fixation. Baseline information of the patients was collected, and patient-rated elbow evaluation scores were calculated. Results: Out of the 28 patients, 21 were male and 7 were female. Besides, 16 fractures were on the right side and 12 were on the left side and 17 involving the dominant hands. In addition, 8 patients had Mason type Ⅱ fracture and 20 had Mason type Ⅲ fracture. The mean age of patients was (31.0 ± 8.0) years, and the mean follow-up is (1.2 ± 0.5) years. The mean average patient-rated elbow evaluation scores were (27.64 ± 1.60) at 1-year follow-up. Conclusions:The majority of the patients who had radial head fractures and treated by open reduction and internal fixation have attained an excellent range of motion postoperatively.

Functional Outcomes of Traumatic Complex Acetabulum Fractures with Open Reduction and Internal Fixation: 200 Cases

Objective: Acetabular fractures are common injuries in Iran. We assess the functional outcome of open reduction and internal fixation management of displaced Complex acetabular fractures. Materials and Methods: We analyzed a case series of patients with open reduction and internal fixation (ORIF) for complex acetabular fractures. Two hundred patients (132 men, 68 women) in four age groups including with a mean age of 43.39 ± 6.18 years (range 20 - 59 years) and a mean follow-up of 82.34 ± 12.48 months (range 18 - 109 months) met the inclusion criteria. Functional outcome at final follow-up was graded assessed according to Harris score. Factors affecting were defined. Results: Anatomic reduction was achieved in 192 hips, imperfect in 8 and poor in none. Radiological outcome revealed excellent results in 128 (64%) hips, good in eight, fair in five and none in poor. Harris score were excellent in 139 (69.5%) hips, good in 43 (21.5%) and fair in 18 (9%) and poor in none. The anatomical reduction results had a favorable final functional outcome. (0.003) However, BMI (P Conclusion: Optimal functional and radiological outcomes have been achieved with anatomic postoperative reduction. Also experience of specialist, on time surgery and good recovery lead to receiving excellent functional outcome with at least complications.

Treatment of Children’s Shaft Fracture of Tibia and Fibula with ESIN Fixation

The Objective is to evaluate Elastic Stable Intrame-dullary Nailing (ESIN) fixation through the treat-ment of children’s shaft fracture of tibia and fibula. From January 2007 to January 2009, 16 cases of children’s shaft fracture of tibia and fibula had been treated by ESIN. 15 cases were followed up after the surgery and the follow-up time was 4 - 12 months (4.5 in average). The results turn out that all the patients’ fractures have got healed by Phase I and the healing time is 10 weeks in average. The near joints’ activity and affected extremity completely return to normal. This group of cases doesn’t show any sign of infection, bone nonunion, malunion or epiphysis injury. And six patients have had their intramedullary nails taken out after six months. It can be concluded that ESIN is good for treating children’s long diaphysis fracture which has difficulty in closed diaplasis and is suitable for children aged 6 - 13. ESIN has the advantages of small incision, slight injury of soft tissue, short sur-gery time, rapid recovery and few complications.

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.

Strategies and outcomes in severe open tibial shaft fractures at a major trauma center: A large retrospective case-series

BACKGROUND Severe open tibia fractures are challenging to treat with a lack of published clear management strategies.Our aim was to provide an overview of the largest singlecenter experience in the literature,with minimum 1-year follow-up,of adult type 3 open tibial shaft fractures at Cambridge University Hospitals(a United Kingdom major trauma center).We sought to define patient characteristics and our main outcome measures were infection,union and re-fracture.AIM To retrospectively define patient and injury characteristics,present our surgical methods and analyze our outcomes–namely infection,union and re-fracture rates.METHODS Consecutive series of 74 patients with 75 open tibial fractures treated between 2014 and 2020(26 classified as Gustilo-Anderson 3A,47 were 3B and two were 3C).Nine patients underwent intramedullary nailing(IMN),61 underwent Taylor spatial frame(TSF)fixation and 5 were treated with Masquelet technique(IMN and subsequent bone grafting).RESULTS Mean follow-up was 16 mo(IMN)and 25 mo(TSF).We had an infection rate of 6.7%(5),non-union rate of 4%(3)and re-fracture rate of 2.7%(2).Average time to union was 22 wk for IMN and 38.6 wk for TSF.Thirty-three cases had a bone defect with a mean of 5.4 cm(2-11).Patient age,sex,diabetes,smoking status or injury severity did not have a significant effect on union time with either fixation method.Our limb salvage rate was 98.7%.CONCLUSION Grade 1 to 3A injuries can effectively be treated with reamed or unreamed IMN.Grade 3B/C injuries are best treated by circular external fixators as they provide good,reproducible outcomes and allow large bone defects to be addressed via distraction osteogenesis.

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.

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.

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.

Total knee arthroplasty and fractures of the tibial plateau

Tibial plateau fractures are common injuries that occur in a bimodal age distribution. While there are various treatment options for displaced tibial plateau fractures, the standard of care is open reduction and internal fixation(ORIF). In physiologically young patients with higher demand and better bone quality, ORIF is the preferred method of treating these fractures. However, future total knee arthroplasty(TKA) is a consideration in these patients as post-traumatic osteoarthritis is a common long-term complication of tibial plateau fractures. In older, lower demand patients, ORIF is potentially less favorable for a variety of reasons, namely fixation failure and the need for delayed weight bearing. In some of these patients, TKA can be considered as primary mode of treatment. This paper will review the literature surrounding TKA as both primary treatment and as a salvage measure in patients with fractures of the tibial plateau. The outcomes, complications, techniques and surgical challenges are also discussed.

Treatment of a femoral neck fracture combined with ipsilateral femoral head and intertrochanteric fractures: A case report

BACKGROUND This article presents a rare case of a complex hip fracture involving the ipsilateral femoral neck,trochanter,and femoral head,that was accompanied by hip dislocation.Currently,there is no established standard treatment method for this specific type of fracture.Therefore,it is crucial to comprehensively consider factors such as patient age,fracture type,and degree of displacement to achieve a successful outcome.CASE SUMMARY A 38-year-old man sustained a comminuted fracture of his right hip as a result of a car accident.The injuries included a fracture of the femoral head,a fracture of the femoral neck,an intertrochanteric fracture of the femur,and a posterior dislocation of the hip on the same side.We opted for a treatment approach combining the use of a proximal femoral locking plate,cannulated screws,and Kirschner wires.Following the surgery,we developed an individualized rehabil-itation program to restore patient limb function.CONCLUSION For this complex fracture,we selected appropriate internal fixation and for-mulated individualized rehabilitation,which ultimately achieved good results.

Usage of buttress plate internal fixation associated with autografting of fibula and iliac bone for the treatment of distal femoral C_3 type fracture

To assess the effect of using buttress plate associated with antografting of fibula and iliac bone for the treatment of distal femoral C3 type fracture.Methods Seventeen cases of distal femoral C3 type fracture using buttress plate associated with antografting of fibula and iliac bone were analyzed retrospectively.Results All cases were followed up for an average of 24 months（8～55 months）.The average time of octets bridge forming were 4 months（3～5 months） while the average time for bone union were 8 months （6～14 months）.According to Shelbourne rating system,result of all 18 cases were excellent and no malunion,infection were found.Conclusion Buttress plate associated with antografting of fibula and iliac bone is an effective alternative for the treatment of distal femoral C3 type fracture.It can provide more stable fixation to the bone and earlier functional exercises can be achieved.5 refs,3 figs,1 tab.

Therapeutic effect of two methods on avulsion fracture of tibial insertion of anterior cruciate ligament

BACKGROUND The tibial stop of anterior cruciate ligament(ACL) is fan-shaped and attached to the medial groove in front of the intercondylar spine,which is located between the anterior horn of the medial and lateral meniscus.The incidence of this fracture is low previously reported,which is common in children and adolescents.With the increase of sports injury and traffic injury and the deepening of understanding,it is found that the incidence of the disease is high at present.AIM To explore the difference between open reduction and internal fixation with small incision and high-intensity non-absorbable suture under arthroscopy in the treatment of tibial avulsion fracture of ACL.METHODS Seventy-six patients with tibial avulsion fracture of anterior cruciate ligament diagnosed and treated in Guanyun County People’s Hospital from April 2018 to June 2020 were retrospectively analyzed.According to the surgical methods,they were divided into group A(40 cases) and group B(36 cases).Patients in group A were treated with arthroscopic high-strength non-absorbable suture,and patients in group B were treated with small incision open reduction and internal fixation.The operation time,fracture healing time,knee joint activity and functional score before and after operation,and surgical complications of the two groups were compared.RESULTS The operation time of group A was higher than that of group B,and the difference was statistically significant(P < 0.05);the fracture healing time of group A was compared with that of group B,and the difference was not statistically significant(P > 0.05);The knee joint function activity was compared between two groups before operation,3 mo and 6 mo after operation,and the difference was not statistically significant(P > 0.05);the knee joint function activity of group A and group B at 3 mo and 6 mo after operation was significantly higher than that before operation(P < 0.05);the limp,support,lock,instability,swelling,upstairs,squatting,pain and Lysholm score were compared between the two groups before and 6 mo after operation,and the difference was not statistically significant(P > 0.05);the scores of limp,support,lock,instability,swelling,upstairs,squatting,pain and Lysholm in group A and group B at 6 mo after operation were significantly higher than those before operation(P > 0.05);the surgical complication rate of group A was 2.63%,which was lower than 18.42% of group B,and the difference was statistically significant(P > 0.05).CONCLUSION Both small incision open reduction and internal fixation and arthroscopic high-strength nonabsorbable sutures can achieve good results in the treatment of anterior cruciate ligament tibial avulsion fractures.The operation time of arthroscopic high-strength non-absorbable sutures is slightly longer,but the complication rate is lower.

Diagnosis,treatment and complications of radial head and neck fractures in the pediatric patient

Radial head and neck fractures represent up to 14%of all pediatric elbow fractures and can be a difficult challenge in the pediatric patient.In up to 39%of proximal radius fractures,there is a concomitant fracture,which can easily be overlooked on the initial standard radiographs.The treatment options for proximal radius fractures in children range from non-surgical treatment,such as immobilization alone and closed reduction followed by immobilization,to more invasive options,including closed reduction with percutaneous pinning and open reduction with internal fixation.The choice of treatment depends on the degree of angulation and displacement of the fracture and the age of the patient;an angulation of less than 30 degrees and translation of less than 50%is generally accepted,whereas a higher degree of displacement is considered an indication for surgical intervention.Fractures with limited displacement and non-surgical treatment generally result in superior outcomes in terms of patient-reported outcome measures,range of motion and complications compared to severely displaced fractures requiring surgical intervention.With proper management,good to excellent results are achieved in most cases,and long-term sequelae are rare.However,severe complications do occur,including radio-ulnar synostosis,osteonecrosis,rotational impairment,and premature physeal closure with a malformation of the radial head as a result,especially after more invasive procedures.Adequate follow-up is therefore warranted.

Managing extremely distal periprosthetic femoral supracondylar fractures of total knee replacements-a new PHILOS-ophy

We report two cases where a proximal humeral locking plate was used for the fixation of an extremely distal, type Ⅲ peri-prosthetic femoral fractures in relation to a total knee replacement(TKR). In each case there was concern regarding the fixation that could be achieved using the available anatomic distal femoral plates due to the size and bone quality of distal fragment. The design of the Proximal Humeral Internal Locking System(PHILOS) allows nine 3.5-mm locking screws to be placed over a small area in multiple directions. This allowed a greater number of fixation points to be achieved in the distal fragment. Clinical and radiological short-term follow-up(6-12 mo) has been satisfactory in both cases with no complications. We suggest the use of this implant for extremely distal femoral fractures arising in relation to the femoral component of a TKR.

Pulmonary thromboembolism after distal ulna and radius fractures surgery: A case report and a literature review

BACKGROUND Pulmonary thromboembolism(PTE)is a serious postoperative complication that can occur after a fracture.Generally,PTE is caused by the falling off of lower extremity deep vein thrombosis(LEDVT)after lower limb fracture surgery.LEDVT and PTE after upper extremity fracture surgery are very rare.PTE is one of the most common clinical causes of sudden death.Venous thromboembolism includes PTE and DVT.We experienced one case of LEDVT and PTE after distal ulna and radius fracture surgery.The purpose of our report is to raise awareness for orthopedic surgeons that PTE can occur after distal ulna and radius fracture surgery,and patients with high risk factors should be considered for prevention and treatment of thrombosis in a timely manner.CASE SUMMARY We report a 51-year-old Chinese male who had severe fractures of the left distal ulna,radius and little finger after a motorcycle accident.The patient underwent external fixation,open reduction and internal fixation.On the third post-operative day,computed tomographic pulmonary angiography showed PTE.Doppler ultrasonography showed thrombus formation in the bilateral posterior tibial veins.After a period of anticoagulation therapy,on the 25th d after the PTE,computed tomographic pulmonary angiography showed that thrombus in both sides of the pulmonary artery disappeared.Furthermore,about 4 mo after the PTE,thrombosis in the deep veins of the lower limbs disappeared.About 1 year after the surgery,X-rays showed good fracture healing,and the function of the wrist joint recovered well.CONCLUSION Though rare,PTE can occur after distal ulna and radius fracture surgery and patients with high risk factors should be considered for prevention and treatment of thrombosis in a timely manner.

Floating elbow combining ipsilateral distal multiple segmental forearm fractures: A case report

BACKGROUND Floating elbow along with ipsilateral multiple segmental forearm fracture is a rare and high-energy injury,although elbow dislocation or fracture of the ulna and radius may occur separately.CASE SUMMARY We report the case of a 37-year-old woman with open(IIIA)fracture of the right distal humerus with multiple shaft fractures of the ipsilateral radius and ulna with a history of falling from a height of almost 20 m from a balcony.After providing advanced trauma life support,damage control surgery was performed to debride the arm wound and temporarily stabilize the right upper limb with external fixators in the emergency operating room.Subsequently,one-stage internal fixation of multiple fractures was performed with normal values of biochemical indicators and reduction in limb swelling.The patient achieved good outcome at the 7 mo follow-up.CONCLUSION One-or two-stage treatment must be performed according to the type of injury;we efficiently used the“damage control principle.”