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.

Three predictive scores compared in a retrospective multicenter study of nonunion tibial shaft fracture

BACKGROUND Delayed union,malunion,and nonunion are serious complications in the healing of fractures.Predicting the risk of nonunion before or after surgery is challenging.AIM To compare the most prevalent predictive scores of nonunion used in clinical practice to determine the most accurate score for predicting nonunion.METHODS We collected data from patients with tibial shaft fractures undergoing surgery from January 2016 to December 2020 in three different trauma hospitals.In this retrospective multicenter study,we considered only fractures treated with intramedullary nailing.We calculated the tibia FRACTure prediction healING days(FRACTING)score,Nonunion Risk Determination score,and Leeds-Genoa Nonunion Index(LEG-NUI)score at the time of definitive fixation.RESULTS Of the 130 patients enrolled,89(68.4%)healed within 9 months and were classified as union.The remaining patients(n=41,31.5%)healed after more than 9 months or underwent other surgical procedures and were classified as nonunion.After calculation of the three scores,LEG-NUI and FRACTING were the most accurate at predicting healing.CONCLUSION LEG-NUI and FRACTING showed the best performances by accurately predicting union and nonunion.

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.

Exclusive Fibula Osteosynthesis for Treating Open Fractures Gustillo I-III B of the Distal Half of the Leg Bones in a Resources-Limited Setting

Introduction: Management of open leg bones fractures is a challenging health issue for the surgeon, particularly true in resource-limited settings. In this study, we evaluate exclusive fibular osteosynthesis in the treatment of open fractures of the distal half of the leg bones as a therapeutic option in our context. Methods: This is a prospective, experimental, multicenter study of 30 open fractures of the distal half of the leg bones treated with exclusive fibula osteosynthesis, conducted in 3 hospitals in the DRC from January 1, 2013 to September 30, 2016. Results: The age range of 20 to 40 years grouped 22 (73.4%) patients, the sex ratio was 1:1 and the unemployed were the most involved with 16 (53.3%) cases. The Gustilo II, I, III B and III A types represented 40%, 33.3%, 20% and 6.7%, respectively. The fractures were located in the distal third in 12 (40%) cases, in the middle third in 11 (36.7%) cases, and in both malleoli in 7 cases (23.3%). Osteosynthesis of the fibula by screw plate was applied in 22 (73.3%) patients and pinning in 8 (26.7%). Satisfactory reduction of the tibial fracture site was achieved in 29 (96.7%) cases and 100% bone healing was achieved within an average of 10 weeks. Four (13.3%) loss of alignment, 1 (3.3%) infection, 1 (3.3%) skin necrosis and 2 (6.7%) ankle stiffness complicated our fractures. Conclusion: Exclusive osteosynthesis of the fibula as a common technique for fractures of the distal half of the leg bones allowed us to reduce, immobilize and consolidate the tibial fracture in the required time and to preserve the mobility of the ankle.

Locking compression plate+T-type steel plate for postoperative weight bearing and functional recovery in complex tibial plateau fractures

Complex tibial plateau fractures can seriously affect quality of life and physical and mental health of patients.The anatomical relationship between the proximal tibial bone and soft tissue is complex,resulting in different types of tibial plateau fractures.Violent trauma can lead to displaced fracture,serious soft tissue injury,and potentially,dislocation of the knee joint.Therefore,tibial plateau fractures are extremely unstable.AIM To assess the use of locking compression plate(LCP)+T-type steel plate for postoperative weight bearing and functional recovery of complex tibial plateau fractures.METHODS Ninety-seven patients with complex tibial plateau fractures who underwent surgery at our hospital were selected for retrospective study.Forty-nine patients had been treated with LCP+T-type steel plate limited internal fixation(study group),and 48 patients with bilateral ordinary steel plate support(control group).The operation process index,postoperative rehabilitation related index,Rasmussen score of the knee joint,tibial plateau varus angle(TPA),tibial plateau retroversion angle(PA),and surgical complications of the two groups were compared.RESULTS The operation time and intraoperative bone graft volume in the study group were lower than those in the control group(P<0.05).There were no significant differences in surgical bleeding,anterior external incision length,postoperative drainage,hospital stay duration,and fracture healing time between the groups(P>0.05).There was no significant difference in the TPA and PA angle between the groups immediately and 18 mo after surgery(P>0.05).At 12 mo after surgery,the Rasmussen scale score was higher in the study group than in the control group(P<0.05).There was no significant difference in the Rasmussen scale score at 18 mo after surgery,and the radiology score at 12 and 18 mo after surgery,between the two groups(P>0.05).The postoperative complication rate in the study group(3.77%)was lower than that in the control group(15.09%;P<0.05).CONCLUSION LCP+T-type steel plate internal fixation has advantages in terms of minimizing trauma and enabling early postoperative functional exercise,promoting functional recovery and lower limb weight-bearing,and reducing postoperative complications.

Comparison between computed tomography and magnetic resonance imaging in clinical diagnosis and treatment of tibial platform fractures

BACKGROUND Tibial plateau fracture is one of the common fracture types.It occurs mainly in teenagers and is usually caused by a fall.After the occurrence of fracture,knee swelling,pain,limited activity,etc.greatly affect the patient’s exercise habits and lifestyle.X-ray,computed tomography(CT)and magnetic resonance imaging(MRI)were used in this examination.X-rays are relatively new and easy to operate.However,there are some errors in the observation of fracture collapse and fracture displacement.In recent years,CT and MRI have been actively used to diagnose various types of clinical fractures.They have more diagnostic power than X-ray film.However,some scholars believe that CT is also prone to errors in clinical application.The volume effect leads to missed diagnosis and misdiagnosis in some cases,while the multidirection scanning of MRI technology can effectively overcome the shortcomings of CT.To facilitate the selection of clinical examination regimens,this study further observed the diagnostic ability of these two regimens in the diagnosis of tibial plateau fractures.AIM To explore the value of nuclear MRI and CT in the clinical diagnosis of tibial plateau fractures.METHODS A total of 120 patients with tibial plateau fractures admitted from September 2017 to August 2019 were included.All patients were examined by nuclear MRI and CT scanning.The results were sent to senior physicians in our hospital to complete the diagnosis.RESULTS Nuclear magnetic resonance showed the same effects as CT in four aspects:fracture displacement,bone defect,fracture site and fracture comminution.There was no significant difference in the score data(P>0.05).Nuclear magnetic resonance and CT tended to be consistent in the B3,C2 and C3 fracture diagnosis coincidence rate,combined injury detection rate and fracture detection rate.The diagnostic coincidence rate of type B1,B2 and C1 fractures and the accuracy rate of overall fracture classification indicated that the MRI technique was significantly better than that of CT(P>0.05).CONCLUSION MRI and CT have good diagnostic typing in the diagnosis of tibial plateau fractures,but MRI is more accurate and may be preferred.

Correlative Factors Research of Tibial Shaft Fracture with Ipsilateral Posterior Malleolar Crack Fractures

Background:Missed diagnosis rate of spiral tibia shaft fracture with posterior malleolus crack fracture(PMCF)is high in the clinical.However,the mechanism and related factors of fracture are still unclear.Moreover,PMCF has been observed in other types of tibial shaft fractures.Objective:To explore the correlative factors of tibial shaft fracture with ipsilateral PMCF,decrease the rate of clinical missed diagnosis,strengthen the effective fixation of PMCF,and reduce the incidence of traumatic arthritis.Methods:From September 2014 to May 2019,we collected 137 tibiofibular fracture.Only 68 cases involved in ankle joint CT examination and were retrospectively analyzed.The patients were divided into posterior malleolus group(30 cases)and non-posterior malleolus group(38 cases)according to whether come up PMCF or not.The posterior malleolus group contained 24 males and 6 females,27-77(47.57±11.79)years old,the non-posterior malleolus group contained 23 males and 15 females,18-85(48.71±13.84)years old.The gender,age,location,fibula fracture and tibial shaft fracture classification were observed for univariate and multivariate analysis.Results:The probability of PMCF was higher with right tibial shaft fracture(OR=3.6995%CI:1.13-12.08 P<0.05);the probability of PMCF following distal fibular fracture was higher than that without fibular fracture(OR=11.3695%CI:1.72-75.05 P<0.05);the probability of PMCF with type A tibial shaft fracture was higher than type C(OR=4.8295%CI:1.19-19.58 P<0.05).Conclusion:Right type A tibial shaft fracture accompanied by distal fibular fracture are very important factors related to PMCF,which needs highly attention to avoid clinical missed diagnosis.

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

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.

Biomechanical Comparison of Gourd-shaped LCP versus LCP for Fixation of Comminuted Tibial Shaft Fracture

The purpose of this study was to compare monotonic biomechanical properties of gourd-shaped LCP fixation with LCP fixation of human tibial shaft in gap fracture mode. Twenty paired fresh cadaveric human tibias were randomly divided into 4 groups （5 pairs each）： （1） axial loading sin- gle cycle to failure testing, （2） torsion single cycle to failure testing, （3） 4-point bending single cycle to failure testing, and （4） dynamic 4-point bending testing. A 7-hole 4.5 mm gourd-shaped LCP was se- cured on the anteromedial surface of 1 randomly selected bone from each pair, respectively, using 6 locking screws in the 1st, 2nd, 3rd, 5th, 6th and 7th hole with the middle hole unfilled and just located at the mid-diaphysis of the tibia. A 7-hole 4.5 mm LCP was secured on the other bone with the same method. Standard AO/ASIF techniques were used. After fixation finished, a 10 mm gap in the mid-diaphysis of tibia was created, centrally located at the unfilled hole. The axial, torsional, and bending stiffness and failure strengths were calculated from the collected data in static testings and statisti- cally compared using paired Student＇s t-test. The 4-point bending fatigue lives of the two constructs were calculated from the dynamic testing data and also statistically compared using paired Student＇s t-test. Failure modes were recorded and visually analyzed. P〈0.05 was considered significant. Results showed that the axial, torsional and bending stiffness of gourd-shaped LCP construct was greater （4%, 19%, 12%, respectively, P〈0.05） than that of the LCP construct, and the axial, torsional and bending failure strengths of gourd-shaped LCP construct were stronger （10%, 46%, 29%, respectively, P〈0.05） than those of the LCP construct. Both constructs failed as a result of plate plastic torsional deformation. After axial loading and 4-point bending testings, LCP failed in term of an obvious deformation of bent apex just at the unfilled plate hole, while the gourd-shaped LCP failed in term of a deformation of bent arc between the 3rd and 5th holes, which indicated a more consistent stress distribution on gourd-shaped LCP. Fatigue life of gourd-shaped LCP construct was significantly greater than LCP construct （153 836±2 228 vs. 132 471±6 460 cycles, P〈0.01）. All constructs failed as a result of fracture of the plate through the compression hole of the unfilled combination screw hole. The biomechanical testing showed that gourd-shaped LCP can provide greater stiffness and strength, and longer fatigue life than LCP. The gourd-shaped LCP may be more advantageous mechanically and may reduce the plate breakage rate clinically.

Management of proximal tibial stress fracture associated with advanced knee osteoarthritis:A systematic review

Purpose:Tibial stress fracture associated with knee osteoarthritis is an unusual and difficult clinical scenario.There is no clear existing treatment guideline for this uncommon clinical disease.The aim of this study is to review the impact of various treatment options for patients with advanced knee osteoarthritis associated with proximal tibial stress fracture.Methods:The study was performed using the databases of PubMed and Scopus.Methodological index for non-randomized studies score was used to evaluate the included studies’bias.The concluded data included the treatment approach,reported outcome measure,and time to fracture union.The literature search was started in December 2021 and accomplished in January 2022.A narrative description of the different methods and comparison of their results were done.Results:Out of total assessed 69 studies,9 studies were included in our review.The commonest treatment approach used was total knee arthroplasty by long tibial stem extension.The mean preoperative knee society score and knee functional score were 30.62 and 23.17,respectively.The mean postoperative knee society knee score was 86.87,while the functional score was 83.52.The average reported time to achieve fracture union was 4 months(a range of 2.07-5.50 months).Conclusion:The optimal clinical outcome for treating either acute or mobile tibial stress fracture in patients with advanced knee osteoarthritis can be achieved with long stem total knee arthroplasty.However,due to heterogeneity of data,comparison of different treatment options for chronic proximal tibial stress fracture mal-union/non-union coexisting with knee osteoarthritic and such inferences need to be judged cautiously.

Simultaneous bilateral floating knee:A case report

BACKGROUND The phrase “floating knee is a flail knee joint,” referring to ipsilateral femoral and tibial fractures,was first used by Blake and Mc Bryde in 1975.This condition is often caused by a high-energy trauma with often extensive injury to the soft tissues,and is accompanied by life-threatening systemic complications,including head,chest or abdominal injuries and a high incidence of fat embolism.Floating knee is a severe and uncommon injury pattern.CASE SUMMARY A 27-year-old man sustained multiple injuries when the electric motorcycle he was riding was hit by a van.His injuries included traumatic hypovolemic shock,comminuted and open type II fractures of the left femoral shaft,fracture of the right femoral shaft,comminuted fracture of the bilateral tibial and fibular shaft,and multiple lacerations and abrasions on his forehead,lower lip,neck and limbs.The diagnosis was simultaneous bilateral floating knee complicated with soft tissue injuries.After emergency treatment and the exclusion of life-threating complications,open reduction and internal fixation were successfully performed using plates and screws in the bilateral femoral and tibial shafts.CONCLUSION Simultaneous bilateral floating knee is a rare and severe injury pattern.The treatment is challenging,and complications.We present a case report of a young adult who suffered from bilateral floating knees during road traffic accident.We also offer our treatment experience of this complex injury and review past literature.

Does a staged treatment of high energy tibial plateau fractures affect functional results and bony union?A case series

Purpose:Tibial plateau fracture(TPF)is a devastating injury as it shatters lower articular surface of the largest joint.Apart from bony injury,TPF can lead to great soft tissue envelope compromise which affects the treatment plan and outcome.In the present study,clinical results were assessed in cases of high energy TPFs treated in staged manner.Methods:Twenty-three(20 males and 3 females)patients of high energy communited TPFs(Schatzker typeⅤandⅥ)were consecutively treated.1 All the patient had compromise of overlying skin conditions.They were all successively scheduled for staged treatment plan which comprised of application of bridging knee external fixator on the first day of admission and definitive internal fixation after skin and soft tissue overlying the fracture were healed.Schatzker typeⅠ,Ⅱ,ⅢandⅣwere excluded from the study.Primary survey was done and patient who had head injury,chest and abdominal injury,pelvic injury and contralateral limb injury and open fractures were excluded from the study.The patients were also evaluated in terms of wound complications,axial and rotary alignment of limb,fixation failure,articular congruity and range of motion of the knees and post injury employment.Statistical analysis was done using SPSS software.Results:Maximum follow-up period was 13 months.All the fractures were united at final follow-up.Clinical evaluation was done with the Tegner Lysholm knee scoring scale.2 Excellent results were found in 78%cases and good and fair results in 22%cases.There was significant correlation between range of motion and the Tegner Lysholm knee score(p<0.001,Pearson correlation coefficient=0.741).The correlation between the score and the radiographical union duration was significant(p=0.006,Pearson correlation coefficient=-0.554).Conclusion:A staged treatment plan allows healing of soft tissue envelope,with avoidance of dreadful complications such as compartment syndrome and chronic infection.In addition,a staged treatment strategy does not hamper the fracture reduction,bony union and the functional results.

New Developments in Treatments of Tibial Plateau Fractures

Tibial plateau fractures account for 1.66–2.0% of all fractures in adults and about 8% of fractures in the elderly.[1] Tibial plateau fractures should be considered as complex injuries representing a wide fracture spectrum： soft-tissue compromise, neurovascular damage, compartment syndrome, and ligament and meniscus tears, which remain a big challenge, even for experienced orthopedic trauma surgeons. Although the best treatment modality remains controversial, we aimed to present new developments in the treatment of tibial plateau fractures for reference.

Intravenous Mannitol reduces intracompartmental pressure following tibia fractures: A randomized controlled trial

Purpose:Impending compartment syndrome is a common event following closed tibia fractures,which can progress to sinister compartment syndrome.Fasciotomy is the only definitive treatment available,though it has its own drawbacks and complications.Medical management at present consists of limb elevation and adequate hydration.This study aims at determining whether intravenous administration of Mannitol reduced the intracompartmental pressure in patients with closed tibial fractures.Methods:This is a double blinded,randomized control trial done in a single tertiary care center in India.Forty-five patients were recruited between February 2012 and October 2012.Forty patients who presented to the emergency department with isolated,closed,high velocity,and proximal 2/3 tibia fractures were included in this study.Patients with contraindication to Mannitol were excluded.They were allocated into 2 groups by the investigator using computer generated randomization.The pressure in the anterior compartment of the leg was measured with a handheld Stryker pressure monitor.Then either 20%Mannitol or 0.9%normal saline as given intravenously in a blinded manner,based on the randomization.The intracompartmental pressure was measured at 0,1 and 3 h after the infusion.The participant,investigator and statistician were masked to the group assessment.Results:There was no difference in intracompartmental pressures at 1 or 3 h,between the groups.However,in patients with the baseline of compartmental pressures30 mmHg,Mannitol showed a marked reduction in pressure of 8.5 mmHg at 1 h compared to almost no change in pressure in the saline group.There were no adverse events with the use of Mannitol.Conclusions:This preliminary study appears to show that Mannitol is useful in the management of the increased compartment pressure.The limitations of this study were that it only involved a small group of patients and the baseline pressures in both the groups were not comparable.More studies are required before the use of Mannitol as a standard of care in the management of compartment syndrome can be established.

Dual split and dislocation——a variant of Schatzker type-I tibial plateau fracture: A case report

Schatzkter type-I tibial plateau fracture is a split fracture of the lateral tibial plateau in sagittal plane,consequent to valgus impaction caused by low velocity of trauma.However,a deep understanding of the different columns of the tibial plateau and patho-mechanisms of the injury led to the unmasking of atypical fractures around the tibial plateau.We have encountered 2 cases with unusual fracture pattern of the lateral tibial condyle caused by road traffic accidents.The fracture pattern and severity of injury deviate from the original description of Schatzker type 1;in view of dual plane split,there is rotation of the posterolateral column fragment along its sagittal plane plus grade-III medial collateral ligament injury.The patients were initially treated with knee spanning external fixator and after a latency of 5 days,definitive fracture specific fixation was done,combined with repair of grade-III medial collateral ligament injury.At the 6 months follow-up both the patients achieved satisfactory knee functions(knee society score case 1:100 and case 2:92)and returned to their jobs.The severity of fracture pattern and displacement as described should prompt for examination of associated ligament injury.Because of timely diagnosis,early and appropriate care promised an excellent function outcome even in such a severe nature of knee injury.To prompt the description of injury pattern we coined the name"dual split and dislocation"of lateral tibial plateau,as a complex injury variant of split fracture of lateral tibial plateau fracture.

Electric scooter injuries:Incidence and injury patterns at a level I trauma center

Purpose:Electric scooters(e-scooters)have become an increasingly popular mode of public transportation in recent years.As the incidence of related injuries rises,it is important to understand specific fracture patterns unique to e-scooters and electric bikes(e-bikes)to help guide management.The purpose of this study was to review the prevalence and describe specific fracture patterns of e-scooter and ebike related injuries at the busiest level 1 trauma center in the borough of Manhattan.Methods:Chart review to determine mechanism of injury was performed on all patients for whom an orthopedic consult was requested from 1/1/2021 to 12/31/2021.All patients whose injuries were sustained due to an e-scooter or e-bike were further reviewed for demographics,injury characteristics including fracture pattern,and definitive injury management.Any patients who had an orthopedic consult placed for a reason other than an acute injury were excluded.Descriptive statistics are reported as frequency(percentage)for categorical variables and means for continuous variables.Results:Of the 1815 orthopedic consults requested,1357(74.8%)were for acute injury management.Of those with acute injuries,119(8.8%)sustained 136 e-scooter or e-bike related injuries.There were 92(77.3%)males at an average age of(33.8±15.7)years.Approximately one-fifth of all patients presented in June 2021(26,21.8%).There was a 9.2%rate of open fractures.The 136 injuries were evenly split between the upper and lower extremities,with 57(47.9%)upper extremity,57(47.9%)lower extremity injuries,and 5(4.2%)concomitant upper and lower extremity injuries.The most common fracture patterns were ankle fractures(16,11.7%),followed by tibial shaft(14,10.2%),tibial plateau(13,9.5%),and radial head fractures(11,8.0%).There was a 33.3%incidence of associated posterior malleolar fractures in the spiral tibial shaft fractures,31.0%of posterior malleolar involvement and 18.8%of isolated vertical medial malleolar fractures in the ankle fractures,and 61.5%of posterior comminution in the tibial plateau fractures.Conclusion:E-scooter and e-bike related injuries have a high incidence of tibial shaft fractures,ankle fractures,tibial plateau fractures,and radial head fractures.There should be a high index of suspicion for posterior and medial involvement in lower extremity fractures sustained due to e-scooter or e-bikes.Identifying specific fracture patterns seen in e-scooter and e-bike related mechanisms will help guide management of these injuries.

Preventable iatrogenic cause of foot-drop in knee injuries with literature review

Purpose Common peroneal nerve palsy is quite disabling and every effort should be made to prevent its injury during the treatment.Methods We retrospectively reviewed the prospectively collected data of 7 cases of tibial plateau fractures in association with proximal fibula fracture from January 2019 to September 2019 who presented to emergency room of our hospital.Results In addition to fibular neck fracture,the first case had type 6 tibial plateau displaced fracture and the second case had displaced acetabular fracture with instability of knee with tibial tuberosity avulsion.common peroneal nerve palsy developed following application of distal tibial skeletal traction in both the cases.Other 6 such cases remained neurologically intact as traction was not applied to them.Conclusion Such iatrogenic complication could have been prevented if the injury pattern of"concomitant medial and lateral columns"of the proximal leg is kept in mind by the treating surgeon before applying skeletal traction.