Outcomes Following Open Reduction and Internal Fixation in Proximal Phalangeal Fracture with Rotational Malalignment

2020 ◽  
Vol 25 (02) ◽  
pp. 219-225
Author(s):  
Jun-Ku Lee ◽  
In-Tae Hong ◽  
Jin Woo Cho ◽  
Cheungsoo Ha ◽  
Woo-Jin Yu ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Proximal Phalanx ◽  
Dash Score ◽  
Rotational Malalignment ◽  
Active Motion ◽  
Rotational Angle ◽  
Rotation Direction ◽  
Anatomic Reduction

Background: The rotational malalignment in proximal phalanx fracture is unacceptable. Authors attempted to describe clinical and radiographic outcomes as well as complications after open reduction and internal fixation with screw only or plate for phalangeal fractures accompanied by rotational malalignment. Methods: Authors conducted a retrospective review of 46 patients who had been treated between Jan. 2010 and Dec. 2016. The average follow-up period was 16.7 months. A total active motion (TAM), Disability of Arm, Shoulder and Hand score (DASH), and tip pinch power between thumb and fractured finger were measured at the final follow-up. Complications were investigated during the follow up. We assessed the amount of rotation by measuring angle between 3rd ray and fractured finger. The measurement was divided into two groups depending on rotation direction, divergent and convergent direction group. Results: Twenty-eight cases were fixed with mini LCP plate, 12 cases with lag screws, and rest 6 cases with combined. All patients showed solid bony union on radiographs on average follow-up of 68 days (range, 41–157 days). Average TAM of the injured finger was 244 degrees and average DASH score was 4.9 at the last follow-up. Tip pinch power was 3.2 kg, which was not significantly different from that of the contralateral side at 3.4 kg (p = 0.21). The preexisting rotational angle was significantly adjusted (overall, 11.1°). Depending on rotation direction, preoperative 21.7° to postoperative 12.1° in 27 patients of convergent group and preoperative −5.0° to postoperative 8.3° in 19 patients of divergent group were achieved. Conclusions: The rotation from proximal phalanx fractures could be corrected with anatomic reduction by open reduction. Our results showed that open reduction and rigid internal fixation after physical examination for acute proximal phalanx fractures accompanied by rotational malalignment could achieve good clinical results.

Open reduction and internal fixation of displaced head-split type humeral fractures and role of the rotator-interval approach

2021 ◽  
pp. 175857322110654
Author(s):  
E. Fleischhacker ◽  
G. Siebenbürger ◽  
J. Gleich ◽  
T. Helfen ◽  
W. Böcker ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Dash Score ◽  
Rotator Interval ◽  
Anatomic Reduction ◽  
Interval Approach ◽  
High Instability

Background Open reduction and internal fixation (ORIF) of humeral head split fractures is challenging because of high instability and limited visibility. The aim of this retrospective study was to investigate the extend of the approach through the rotator interval (RI) on the reduction quality and functional outcome. Methods 37 patients (mean age: 59  ±  16 years,16 female) treated by ORIF through a standard deltopectoral (DP) approach were evaluated. The follow-up period was at least two years. In 17 cases, the approach was extended through the RI. Evaluation was based on radiographs, Constant scores (CS) and DASH scores. Results In group DP, “anatomic” reduction was achieved in 9 cases (45%), “acceptable” in 5 cases (25%), and “malreduced” in 6 cases (30%). In group RI, “anatomic” reduction was seen in 12 cases (71%), “acceptable” in 5 cases (29%), and “malreduced” in none (p  =  0.04). In the DP group, the CS was 60.2  ±  16.2 and the %CS was 63.9  ±  22.3, while in the RI group, the CS was 74.5  ±  17.4 and the %CS was 79.1  ±  24.1 (p  =  0.07, p  =  0.08). DASH score was 22.8  ±  19.5 in DP compared to RI: 25.2  ±  20.6 (p  =  0.53). Conclusions The RI approach improves visualization as it enhances quality of fracture reduction, however functional outcomes may not differ significantly. Type of study and level of proof Retrospective, level III

scholarly journals Functional results after operative treatment of talus fractures

2021 ◽  
Vol 13 (1) ◽  
pp. 1-6
Author(s):  
Andreja Gavrilovski ◽  
Aleksandra Gavrilovska-Dimovska ◽  
Goran Aleksovski
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Functional Results ◽  
High Rate ◽  
Posttraumatic Osteoarthritis ◽  
Anatomic Reduction ◽  
Aseptic Osteonecrosis ◽  
The University ◽  
With Screws

Fractures of the talus do not occur frequently, accounting for about 0.1% of all fractures. Failure to achieve anatomic reduction, exponentially increases the risk of postoperative aseptic osteonecrosis and posttraumatic osteoarthritis. The purpose of this study was to evaluate and compare the short-term and medium-term functional outcomes in patients who underwent open reduction and internal fixation of talus fractures. Materials and methods: At the University Clinic for Traumatology in the period between 2017 to 2020, 14 patients with talus fractures were surgically treated. The inclusion and exclusion factors were determined, all patients signed the consent and the study passed the ethics committee. Results: All patients underwent open reduction and internal fixation with screws or reconstructive plate. Follow-up was done on the 14th postoperative day, 1st month, 3rd month and 6th month. At the 6th month follow-up, the functional outcome was tested using the Kitaoka score unified by the American Orthopedic Foot and Ankle Society. This injury is too rare for conclusions to be brought out of and to be compared to larger studies. However, all major studies from reference trauma centers lead to the same conclusions, that the treatment of these fractures is complex Anatomical reduction is mandatory for a better outcome. Conclusion: A protocol for the treatment of posttraumatic osteoarthritis should be introduced, given the high rate of its occurrence despite the satisfactory surgical technique.

scholarly journals Correlation between functional and radiological outcome after surgical stabilization of volar Barton fracture with plating: a comparative study

2020 ◽  
Vol 6 (4) ◽  
pp. 666
Author(s):  
Vikram Goud ◽  
Manoj Kanamarlapudi
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Functional Result ◽  
Dash Score ◽  
Statistical Relationship ◽  
Radiological Outcome ◽  
Distal Extremity ◽  
The Mean ◽  
Barton Fracture

<p class="abstract"><strong>Background:</strong> The objective of the study was to evaluate the functional and radiological outcomes after open reduction with internal fixation of volar Barton’s fracture of the wrist and compare their outcomes.</p><p class="abstract"><strong>Methods:</strong> Total of 30 cases of volar Barton fractures were operated by open reduction and internal fixation with plating. Mean follow up period was 6 months. Patients were assessed both radiological and functional outcome and compare between the two outcomes.<strong></strong></p><p class="abstract"><strong>Results:</strong> All fractures were healed in a mean period of 7 weeks (range 6-9 weeks). The mean disabilities of the arm, shoulder and hand (DASH) score was 13.21 points (range: 10.3 to 30), thus confirming the patient’s good functional capacity. The higher the DASH score was (i.e. the worse the functional result), the smaller were the flexion (p=0.01), pronation (p=0.03), supination (p&lt;0.0001) and radial deviation (p=0.005) of the wrist that underwent the surgical procedure after the fracture of the distal extremity of the radius. The radiological results were evaluated by modified Lidstrom criteria.</p><p class="abstract"><strong>Conclusions:</strong> The radiographic results did not influence the DASH score. There was no statistical relationship between the DASH score and the radial height or the volar tilt or the radial tilt of the distal extremity of the operated radius.</p>

scholarly journals Open Reduction Internal Fixation of Posterior Malleolus Fractures via a Posteromedial Approach

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0004
Author(s):  
Robert Zbeda ◽  
Lon Weiner ◽  
Stuart Katchis ◽  
Steven Friedel
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Direct Reduction ◽  
Plate Fixation ◽  
Open Reduction Internal Fixation ◽  
Ankle Fractures ◽  
Posterior Malleolus ◽  
Anatomic Reduction ◽  
Surgical Methods

Category: Ankle, Trauma Introduction/Purpose: Ankle fractures with a posterior malleolus component are complex injuries to manage. Due to the heterogeneous morphology of these fractures and lack of high-quality evidence, methods of surgical fixation are controversial and highly variable. The most commonly used surgical methods include indirect reduction via a percutaneous anterior approach or direct reduction via a posterolateral approach. For large posterior malleolus fractures with medial extension, direct reduction via a posteromedial approach is an alternative surgical option. The purpose of this study was to report on a large series of posterior malleolus fractures treated via a novel posteromedial approach. The study hypothesized that fixation of large posterior malleolus fractures with medial extension via a posteromedial approach results in anatomic reduction and stable plate fixation. Methods: From 2008 to 2015, 23 of 244 (9.4%) consecutive operative ankle fractures were identified as posterior malleolus fractures treated using a posteromedial approach (Figure 1). All patients had pre-operative computed tomography scans to confirm the presence of a posterior malleolus fracture with medial extension (Figure 2-4). A posteromedial incision was made and fracture was reduced with the saphenous vein retracted anteriorly and the posterior tibial tendon retracted posteriorly. Patient charts were retrospectively reviewed for demographics, injury history, surgical details, follow-up time, and any post-operative complications. Post-operative radiographs were reviewed to ensure that anatomic reduction and stable fixation was maintained (Figure 5). Results: 73.9% (17/23) of the patients were female and the average age at the time of surgery was 54.6 years (range, 26-86 years). There were no open fractures, but 8/23 (34.7%) patients required external fixation prior to open reduction internal fixation (ORIF) for soft tissue management. The average follow-up time was 11.0 months (range, 0.3 to 41.4 months). All patients healed completely on a clinical and radiographic basis. Anatomic reduction and stable plate fixation was obtained intra-operatively in all patients and maintained at maximal follow-up. Eight (34.7%) patients underwent removal of hardware. There was a 13.0% (3/23) post-operative complication rate: 1 patient had cellulitis, 1 patient had osteomyelitis involving the fibula, and 1 patient had symptomatic heterotopic ossification. All complications resolved with appropriate management. Conclusion: ORIF of posterior malleolus fractures via a posteromedial approach achieved anatomic reduction, stable plate fixation, and complete healing in all patients. Posteromedial approach enables direct visualization and anatomic reduction of large posterior malleolus fractures. Fixation of the posteromedial tibial plafond is important because, unlike the posterolateral aspect, there are no ligamentous insertions that can provisionally reduce the fracture fragment by ligamentotaxis. In concurrence with previous literature, our study demonstrates that posteromedial approach is a reasonable alternative to other more commonly used methods for treating these fractures.

Outcomes After Surgically Managed Oblique Extra-Articular Proximal Phalanx Fractures: A Comparison of Closed-Reduction Percutaneous Pinning and Open-Reduction Internal Fixation With Lag Screws

Hand ◽  
2021 ◽  
pp. 155894472110031
Author(s):  
Tyler W. Henry ◽  
Jacob E. Tulipan ◽  
Stephanie A. Kwan ◽  
Pedro K. Beredjiklian ◽  
Kevin F. Lutsky ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Closed Reduction ◽  
Open Reduction ◽  
Proximal Phalanx ◽  
Open Reduction Internal Fixation ◽  
Complication Rates ◽  
Percutaneous Pinning ◽  
Full Extension ◽  
Extensor Lag

Background Long oblique extra-articular proximal phalanx fractures are common orthopedic injuries. When unstable and without substantial comminution, treatment options include closed-reduction percutaneous pinning (CRPP) and open-reduction internal fixation using lag screws (ORIF-screws). The aims of this study are primarily to compare the functional outcomes and complication rates between these techniques and secondarily to assess potential factors affecting outcomes after surgery. Methods All patients with long oblique extra-articular proximal phalanx fractures treated surgically within a single orthopedic institution from 2010 to 2017 were identified. Outcome measures and complications were assessed at the final follow-up. Results Sixty patients were included in the study with a mean time to the final follow-up of 41 weeks (range: 12-164 weeks). Thirty-four patients (57%) were treated with CRPP and 26 patients (43%) with ORIF-screws. The mean Disabilities of the Arm, Shoulder, and Hand score across both fixation types was 8 (range: 0-43) and did not differ significantly between the 2 groups. Mean proximal interphalangeal extension at the final follow-up was 9° short of full extension after CRPP and 13° short of full extension after ORIF-screws. The rates of flexion contracture and extensor lag were 15% and 41% in the CRPP group compared with 12% and 68% in the ORIF-screws group. Reoperation rates and complication rates did not differ significantly between fixation strategies. Conclusions Acceptable outcomes can be achieved after surgical fixation of long oblique extra-articular proximal phalanx fractures using both CRPP and ORIF-screws. Extensor lag may be more common after ORIF-screws.

scholarly journals Open reduction and internal fixation of quadrilateral plate fractures in the elderly: association between initial fracture pattern and outcomes

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Haiyang Wu ◽  
Qipeng Shao ◽  
Ranran Shang ◽  
Chengjing Song ◽  
Ximing Liu ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Classification System ◽  
Functional Outcomes ◽  
Open Reduction ◽  
The Elderly ◽  
Acetabular Fractures ◽  
Quadrilateral Plate ◽  
Anatomic Reduction ◽  
Functional Scores

Abstract Background Acetabular fractures with medial displacement of the quadrilateral plate (QLP) are common in the elderly. The presence of QLP fractures greatly increase the surgical difficulty of acetabular fractures. This study aims to evaluate the clinical radiological outcomes of open reduction and internal fixation (ORIF) in QLP fractures in elderly patients and to investigate factors potentially affecting the result. Methods We conducted a retrospective study. A series of 37 consecutive patients with acetabular fracture involving the QLP aged 60 years and older who received ORIF between January 2010 and May 2019 were included. QLP fractures were classified according to Walid’s classification system. Radiological outcomes were evaluated using Matta criteria and functional outcomes were assessed using the modified Merle d’Aubigné score. The relationships between Walid’s classification and radiological or functional outcomes were analyzed. Results According to Walid’s classification, 18, 13, 6 were classified as QLP1, QLP2 and QLP3, respectively. The average follow-up was 35.5 ± 10.7 months. We obtained anatomic reduction in 48.6 % (18/37) of cases, imperfect reduction in 40.5 % (15/37) of cases, and poor reduction in 10.8 % (4/37) of cases. Excellent-good functional scores were found in 83.7 % (modified Merle d’Aubigné). There were no cases of screw entering the hip, pull-out and loosening or implant failure during the follow-up. Walid’s classification was positively correlated with radiological outcomes of reduction (r = 0.661; P < 0.001), and functional outcomes (r = 0.478; P = 0.003). Unsatisfactory reduction was demonstrated a correlation with the development of post-traumatic arthritis (r =-0.410; P = 0.012). Conclusions ORIF may be suggested for quadrilateral plate fractures in the elderly. Walid’s classification system is associated with the reduction quality and functional recovery.

scholarly journals Nascent Malunion of an Isolated Intraarticular Fracture of the Ulnar Head

2019 ◽  
Vol 09 (03) ◽  
pp. 240-243
Author(s):  
Frank Nienstedt ◽  
Markus Mariacher ◽  
Günther Stuflesser ◽  
Wilhelm Berger
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Excellent Result ◽  
Corrective Osteotomy ◽  
Fracture Dislocation ◽  
Intraarticular Fracture ◽  
Ulnar Head ◽  
Ulnar Styloid Fracture ◽  
Palmar Approach

Abstract Background Isolated fractures of the ulnar head are rare. Only few cases have been reported in literature. Case Description We report a case of a 16-year-old student who was treated for an ulnar styloid fracture conservatively. An associated displaced intraarticular fracture of the ulnar head has been overlooked. He presented late in our clinic with a symptomatic nascent malunion of the ulnar head fracture. A corrective osteotomy by a palmar approach was performed. Fixation by screws was used with an excellent result at 7-year follow-up. Literature Review The rare cases of isolated ulnar head fractures reported in literature were treated by open reduction and internal fixation only in case of fracture dislocation. Clinical Relevance The authors highlight the fact that even a nascent malunion of an isolated intraarticular fracture of the ulnar head may be treated successfully by open reduction and internal fixation.

scholarly journals Combined Ipsilateral Humeral Shaft and Galeazzi Fractures Creating a Floating Elbow Variant

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Patrick Lee ◽  
Allison Z. Piatek ◽  
Michael J. DeRogatis ◽  
Paul S. Issack
Keyword(s):  
Internal Fixation ◽  
Range Of Motion ◽  
Open Reduction ◽  
Humeral Fracture ◽  
Humeral Shaft ◽  
Proximal Ulna ◽  
Elbow Injury ◽  
Anatomic Reduction ◽  
Elbow Injuries ◽  
Floating Elbow

“Floating elbow” injuries of the arm traditionally represent a combination of humeral shaft and forearm fractures which require anatomic rigid open reduction and internal fixation of all fractures to allow for early range of motion exercises of the elbow. There are published variants of the floating elbow injury which include ipsilateral diaphyseal humeral fracture, proximal ulna fracture with proximal radioulnar joint disruption, and ipsilateral diaphyseal humeral fracture with elbow dislocation and both bones forearm fracture. We present the case of a 21-year-old woman whose left arm became caught between the side of a waterslide and adjacent rocks at a park. She sustained a torsional and axial loading injury to her left upper extremity resulting in ipsilateral humeral shaft and Galeazzi fractures. The combination of ipsilateral humeral shaft and Galeazzi fractures resulted in a rare floating elbow variant. Prompt open reduction and internal fixation of both fractures and early range of motion of the elbow and wrist resulted in an excellent clinical and radiographic result. Floating elbow injuries and their variants should be promptly recognized as early anatomic reduction, and rigid internal fixation can allow for good elbow function with minimization of stiffness.

Results of Treatment of Chronic Dorsal Fracture-Dislocations of the Proximal Interphalangeal Joints of the Fingers

1998 ◽  
Vol 23 (6) ◽  
pp. 798-801 ◽  
Author(s):  
O. ISHIDA ◽  
Y. IKUTA
Keyword(s):  
Articular Cartilage ◽  
Internal Fixation ◽  
Open Reduction ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Fracture Dislocation ◽  
Results Of Treatment ◽  
Palmar Plate ◽  
Fracture Dislocations

We reviewed 20 cases of chronic dorsal fracture-dislocation of the proximal interphalangeal joint, with a mean follow-up period of 74 months. In patients without comminuted palmar fragments, open reduction and internal fixation or osteotomy of the malunited fragment provided good results. In treating patients with damaged articular cartilage or with comminuted palmar fragments by palmar plate arthroplasty, poor results were obtained because of secondary osteoarthritic changes.

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