Plate fixation versus titanium elastic nailing in midshaft clavicle fractures based on fracture classifications

Background: The best strategy for implant selection in midshaft clavicular fractures (MCF) remains controversial. The present study aims to determine the optimal strategy for implant selection by comparing plate and Titanium Elastic Nail (TEN) with respect to outcomes and related complications and analyze the results based on fracture patterns. Methods: A total of 97 patients with MCF who underwent plate (48 patients) or TEN (49 patients) fixation were retrospectively reviewed. Both groups were divided into three subgroups by fracture type using the AO Foundation/Orthopaedic Trauma Association classification: simple fracture (type A), wedge fracture (type B), and multi-fragmentary fracture (type C). The observed outcome measures were bone union rate, related complications, functional scores, and patient satisfaction score. These outcomes were analyzed based on the fracture classification. Results: Both groups demonstrated excellent union rates (p = 0.495) and similar functional scores (p > 0.05). Visual analog scale (VAS) for satisfaction was better in TEN than plate fixation (p < 0.001). In type A and B subgroups, there were no significant difference in functional scores between plate and TEN fixation (p > 0.05). In type C subgroup, however, both VAS for pain and DASH score in TEN fixation were significantly worse than in plate fixation at 2 and 6 weeks postoperatively (p < 0.05). The incidences of clavicle shortening and skin irritation are higher especially in type C subgroup of TEN fixation (p < 0.05). Conclusion: Patient satisfaction of TEN fixation was higher than that of plate fixation, but TEN fixation had a higher incidence of early postoperative pain and migration in type C fractures. Therefore, type A and B fractures can successfully be treated with plate or TEN fixation, but type C fractures should be treated with plate fixation.

Download Full-text

Associations Between the Fracture Type and Functional Outcomes After Distal Radial Fractures Treated With a Volar Locking Plate

Medicina ◽

10.3390/medicina49090062 ◽

2013 ◽

Vol 49 (9) ◽

pp. 62

Author(s):

Kęstutis Braziulis ◽

Rytis Rimdeika ◽

Rima Kregždytė ◽

Šarūnas Tarasevičius

Keyword(s):

Locking Plate ◽

Hand Function ◽

Linear Regression Analysis ◽

Type A ◽

Dash Score ◽

Volar Locking Plate ◽

Fracture Type ◽

Type C ◽

And Gender

Objective. The aim of this study to investigate the associations of fracture type, age, and gender with hand function after distal radius fractures treated with a volar locking plate at a 6-month follow-up. Material and Methods. A total of 120 patients with displaced distal radius fractures were included into the study. They were operated on using a volar locking plate system. All the fractures were classified according to the AO classification, and the patients were divided into 3 groups by the fracture type. The range of motion and grip strength were evaluated at the 6-month follow-up. Multivariate linear regression analysis was used to evaluate the associations of age, gender, and fracture type with the score of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The DASH questionnaire was completed as an outcome measure. Results. A total of 28 patients experienced type A fractures; 70 patients, type B fractures; and 22 patients, type C fractures. No statistically significant difference regarding age and sex among the groups was observed. At 6 months after the surgery, the mean DASH score for type A, B, and C fractures was 16, 13, and 32, respectively (P=0.01). After the surgery, the radiographic parameters such as the volar tilt and the ulnar variance were significantly worse in the patients with type C fractures. Grip strength and the range of motion of the contralateral healthy hand at the 6-month follow-up were significantly better than those of the operated hand. The linear regression analysis showed that the type C fracture was the only factor significantly associated with lower DASH score. Conclusions. The patients with type C fractures treated with a volar locking plate had a worse wrist function as compared with the patients type A and B fractures at the 6-month follow-up. The postoperative hand function was significantly associated only with the type C fracture, while age and gender had no significant impact.

Download Full-text

EXTRACORPOREAL SHOCKWAVE THERAPY IN SHOULDER INJURIES: PROSPECTIVE STUDY

Acta Ortopédica Brasileira ◽

10.1590/1413-785220212905237628 ◽

2021 ◽

Vol 29 (5) ◽

pp. 268-273

Author(s):

VICTOR OTAVIO MORAES DE OLIVEIRA ◽

JULIANA MUNHOZ VERGARA ◽

VICENTE FURQUIM DE OLIVEIRA ◽

PAULO HENRIQUE SCHMIDT LARA ◽

LUIZ CARLOS NOGUEIRA JÚNIOR ◽

...

Keyword(s):

Rotator Cuff ◽

Range Of Motion ◽

Case Series ◽

Post Treatment ◽

Dash Score ◽

Extracorporeal Shockwave Therapy ◽

Extracorporeal Shockwave ◽

Shockwave Therapy ◽

Significant Difference ◽

Functional Scores

ABSTRACT Objective: To evaluate the functional results after the use of extracorporeal shockwave therapy (ESWT) in four groups of patients: tendinopathy, partial rotator cuff injury, adhesive capsulitis and calcareous tendinopathy of the rotator cuff at one month and three months after the end of treatment. Methods: Case series in which patients were evaluated according to the VAS of pain, range of motion of the shoulder, and functional questionnaires DASH and modified UCLA. Results: There was a significant increase in the measure of flexion, lateral rotation and shoulder abduction in the evaluations after treatment in relation to the baseline measurement (p < 0.001) and no evidence of significant difference was found between the post-treatment evaluations at one month and three months follow-up (p > 0.05). There was a significant reduction in the VAS score, increase in the UCLA score and a significant reduction in the DASH score in the post-treatment evaluations in relation to the baseline score (p < 0.001) and a significant improvement in the three-month evaluation in relation to one month (p < 0.05). Conclusion: Extracorporeal shockwave therapy proved to be efficient and safe in the treatment of shoulder pathologies, improving pain, range of motion and functional scores in all groups of patients evaluated in the study. Level of Evidence IV, Case series.

Download Full-text

Anatomical plating versus titanium elastic nailing for displaced midshaft clavicle fractures: a prospective comparative study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20210621 ◽

2021 ◽

Vol 7 (2) ◽

pp. 278

Author(s):

Ashish Philip ◽

Shishir Murugharaj Suranigi ◽

Lingaraj . ◽

Kanagasabai Rengasamy ◽

Syed Najimudeen

Keyword(s):

Functional Outcome ◽

Plate Fixation ◽

Minimal Invasive ◽

Dash Score ◽

Randomised Study ◽

Titanium Elastic Nailing ◽

Significant Difference ◽

Prospective Comparative Study ◽

Clavicle Fractures ◽

The Mean

Background: Plate fixation has become the standard operative method for fixing displaced midshaft clavicle fractures. Over the years, TENS has also gained lot of attention due to its minimal invasive nature, smaller scar and reduced operative time. The purpose of this study was to compare the functional outcome of middle third displaced clavicle fractures treated either by plate or intra medullary TENS fixation using Constant Murley score and disability of the arm, shoulder and hand score.Methods: A prospective randomised study was conducted from January 2010 to September 2016 at our institute on patients with displaced midshaft clavicle fractures. A total of 56 patients (TENS; n=25, plating; n=31), classified according to orthopaedic trauma association classification underwent midshaft clavicle fixation. They were followed-up for a minimum period of 1 year.Results: Length of the scar in the TENS group was significantly smaller when compared to the incision in the plating group (1.86±1.23 and 11.01±3.29 cms respectively, p<0.001). The Constant shoulder score measured at the end of 1 year was 90.77±9.01 for the TENS group and 92.63±6.04 for the plating group, not significant statistically (p=0.269). The mean DASH score was also not significantly different (p=0.552) between the TENS group and the plating group, at 6.01±11.09 and 6.32±10.33 respectively.Conclusions: In comparison with plate fixation, the nailing procedure is less invasive, requires smaller incisions and has a shorter duration of hospital stay with no statistically significant difference in terms of functional outcome. Hence, TENS technique is recommended for the fixation of displaced mid-shaft non-/minimal comminuted clavicular fractures, especially for young individuals and can be used as an alternative to plate fixation.

Download Full-text

Utility and outcomes of locking compression plates in distal femoral fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20160343 ◽

2015 ◽

Vol 1 (1) ◽

pp. 15

Author(s):

Shriharsha R.V. ◽

Sapna M

Keyword(s):

Bone Grafting ◽

Type A ◽

Open Fractures ◽

X Rays ◽

Range Of Movement ◽

Entire Study ◽

Locking Compression Plates ◽

Significant Difference ◽

Type C ◽

Closed Fractures

Background: Supracondylar and intercondylar fractures of femur present a huge surgical challenge. The purpose of this study was to evaluate the rate of union, functional outcome and complications of these fractures treated with open reduction and internal fixation with a locking compression plate- distal femur (LCP-DF).Methods: A prospective study of 26 fractures in 25 patients was done during a period of June 2012 to July 2014. Based on clinical diagnosis and x rays, the fractures were managed by surgery and had a minimum follow up of one year. The decision to fix with Locking compression plates was taken based on extensive comminution, missing bone, poor quality of bone and a combination of these factors. Primary Bone grafting was done in cases of severe medial comminution.Results: Overall 26 fractures were studied. The mean age was 44 yrs. Out of 25 patients, 16/25(64%) were men and 36% were women. There were 10/26 type A and 16/26 type C fractures. There were 57.6% closed fractures and 42.3 % open fractures. Bone grafting was done for 13 fractures. The average time for union in open fractures was 20.60 weeks and 18.53 weeks for closed fractures. The average range of motion for closed fractures was 10- 100.330 and for open fractures was 50- 84.50The results of entire study group showed 4 excellent, 10 good, 5 fair and 6 poor. We saw that 2 of 10 (20%) open fractures had excellent or good results whereas 12 of 15(80%) closed fractures had excellent or good results (p <0.005). The 8 of 10(80%) type A fractures had excellent or good results whereas 6 of 15(40%) type C fractures had excellent or good results (p<0.058). The closed fractures united early as compared to open fractures (p <0.72). The closed fractures had a mean range of 99 degrees movement against the open fractures which had 79 degrees (p <0.36). the type A fractures had a better range of movement( 106 degrees) as compared to type C fractures(81.67 degrees) (p <0.13).Conclusions: Locking compression plates had better outcome in closed fractures than open fractures. The extra articular (type A) fractures had better outcome than intra articular (type C) fractures. The closed fractures united earlier as compared to open fractures. There was no significant difference in time of union in fractures where bone graft was used and in those where no bonegraft was used. Knee stiffness is a common complication following these fractures. Therefore the distal femoral LCP provides a stable fixation in comminuted fractures.

Download Full-text

DOZ047.19: Outcomes in the management of long-gap esophageal atresia: is the Foker technique superior?

Diseases of the Esophagus ◽

10.1093/dote/doz047.19 ◽

2019 ◽

Vol 32 (Supplement_1) ◽

Author(s):

A Wiseman ◽

J Krishnan ◽

D Wanaguru ◽

C Langusch ◽

V Varjavandi ◽

...

Keyword(s):

Esophageal Atresia ◽

Type A ◽

Small Sample ◽

Type B ◽

Repair Technique ◽

Long Gap ◽

Delayed Repair ◽

Significant Difference ◽

Long Gap Esophageal Atresia ◽

Type C

Abstract Background Long-gap esophageal atresia (LGEA) has traditionally been managed by delayed anastamosis. However, over the last 10 years the Foker technique of esophageal growth elongation has been used. There is limited data evaluating outcomes using both techniques. Aims The aim of this study was to compare the outcomes in LGEA repair using the traditional delayed repair technique versus the Foker technique. Methods A retrospective chart review was done of LGEA patients at Sydney Children's Hospital between 1997 and 2016, comparing the Foker technique with the delayed repair technique. Results There were 9 children repaired using the Foker technique, and 10 by delayed repair. There were 7 patients with Type A, 1 with Type B, and 1 with Type C in the Foker group and in the delayed repair cohort, 5 were Type A, 2 Type B, 2 Type C, and 1 Type D esophageal atresia/tracheoesophageal fistula. There were 4 males in the Foker group and 5 in the non-Foker group. Median time to join was 59 days (15–117 days) for Foker repair and 173 days (16–433 days) for delayed repair. There was no significant difference in the incidence of post-operative leak, incidence of strictures needing dilation, presence of reflux symptoms, presence of reflux esophagitis on endoscopy, proton pump inhibitor use, need for fundoplication, incidence of cyanotic spells, occurrence of recurrent fistula, and symptoms of dysphagia when comparing both groups. Data on time to oral feeds and incidence of malnutrition was incomplete. Details are shown in Table 1. Conclusions Although the time to anastamosis was shorter in the Foker group and the incidence of post-operative leak, strictures needing dilation, need for fundoplication, and dysphagia were lower in the Foker group, the difference was not significant probably secondary to the small sample size. These results require validation in larger cohorts.

Download Full-text

Factors Influencing Patient Satisfaction after Microvascular Decompression for Hemifacial Spasm: A Focus on Residual Spasms

Stereotactic and Functional Neurosurgery ◽

10.1159/000517954 ◽

2021 ◽

pp. 1-9

Author(s):

Jeong-A Lee ◽

Doo-Sik Kong ◽

Soo Jung Kim ◽

Seunghoon Lee ◽

Sang-Ku Park ◽

...

Keyword(s):

Patient Satisfaction ◽

Hemifacial Spasm ◽

Microvascular Decompression ◽

Surgical Outcomes ◽

Social Life ◽

Interpersonal Relationship ◽

Psychological Problem ◽

Satisfaction Score ◽

Patient Satisfaction Score ◽

Significant Difference

Introduction: Patients with hemifacial spasm (HFS) experience improvement in symptoms after microvascular decompression (MVD); however, patient satisfaction is sometimes low. This study aimed to analyze the relationship between residual spasms and patient satisfaction, identify factors affecting satisfaction, and investigate the degree of improvement in spasms which result in patient satisfaction after surgery. Methods: 297 patients who completed a questionnaire after MVD for HFS between March 2020 and June 2020 were included. Information on surgical outcomes and patient satisfaction was collected using the questionnaire, and their relationships were analyzed. Results: Among the 297 patients, the mean residual spasm percentage and patient satisfaction score were negatively correlated with 14.0% and 8.8 points, respectively. In addition to residual spasms, discomfort caused by persistent spasms, psychological problem-solving, better social life, and interpersonal relationship improvement were associated with satisfaction. There was no significant association between the presence of complications and satisfaction. There was no significant difference in the satisfaction score at up to 30% residual spasm, and the patients with 0–30% residual spasm had a satisfaction score of 7 points or higher. Conclusion: Residual spasms and discomfort from residual spasms decreased patient satisfaction after MVD for HFS. It is then necessary to perform accurate surgical resolution to improve surgical outcomes and provide adequate management to reduce postoperative discomfort and anxiety, and ultimately to enhance satisfaction. Residual spasms of up to 30% compared with the preoperative severity can be considered a good outcome when evaluating surgical outcomes.

Download Full-text

Posterior Meniscal Root Repairs: Outcomes of an Anatomic Transtibial Pull-Out Technique

The American Journal of Sports Medicine ◽

10.1177/0363546516673996 ◽

2016 ◽

Vol 45 (4) ◽

pp. 884-891 ◽

Cited By ~ 69

Author(s):

Robert F. LaPrade ◽

Lauren M. Matheny ◽

Samuel G. Moulton ◽

Evan W. James ◽

Chase S. Dean

Keyword(s):

Patient Satisfaction ◽

Lateral Root ◽

Activity Level ◽

Consecutive Series ◽

Age Cohorts ◽

Pull Out ◽

Meniscal Root ◽

Root Repair ◽

Significant Difference ◽

Functional Scores

Background: Outcomes after transtibial pull-out repair for posterior meniscal root tears remain underreported, and factors that may affect outcomes are unknown. Purpose/Hypothesis: The purpose of this study was to compare patient-centered outcomes after transtibial pull-out repair for posterior root tears in patients <50 and ≥50 years of age. We hypothesized that improvement in function and activity level at minimum 2-year follow-up would be similar among patients <50 years of age compared with patients ≥50 years and among patients undergoing medial versus lateral root repairs. Study Design: Cohort study; Level of evidence, 3. Methods: Inclusion criteria were patients aged 18 years or older who underwent anatomic transtibial pull-out repair of the medial or lateral posterior meniscus root by a single surgeon. All patients were identified from a data registry consisting of prospectively collected data in a consecutive series. Cohorts were analyzed by age (<50 years [n = 35] vs ≥50 years [n = 15]) and laterality (lateral [n = 15] vs medial [n = 35]). Patients completed a subjective questionnaire preoperatively and at minimum of 2 years postoperatively (Lysholm, Tegner, Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], 12-Item Short Form Health Survey [SF-12], and patient satisfaction with outcome). Failure was defined as revision meniscal root repair or partial meniscectomy. Results: The analysis included 50 knees in 49 patients (16 females, 33 males; mean age, 38.3 years; mean body mass index, 26.6). Of the 50 knees, 45 were available for analysis. Three of 45 (6.7%) required revision surgery. All failures were in patients <50 years old, and all failures underwent medial root repair. No significant difference in failure was found based on age ( P=.541) or laterality ( P = .544). For age cohorts, Lysholm and WOMAC scores demonstrated significant postoperative improvement. For laterality cohorts, all functional scores significantly improved postoperatively. No significant difference was noted in postoperative Lysholm, WOMAC, SF-12, Tegner, or patient satisfaction scores for the age cohort or the laterality cohort. Conclusion: Outcomes after posterior meniscal root repair significantly improved postoperatively and patient satisfaction was high, regardless of age or meniscal laterality. Patients <50 years had outcomes similar to those of patients ≥50 years, as did patients who underwent medial versus lateral root repair. Transtibial double-tunnel pull-out meniscal root repair provided improvement in function, pain, and activity level, which may aid in delayed progression of knee osteoarthritis.

Download Full-text

The Effect of Eutectic Mixture of Local Anesthesia Cream (EMLA) on Satisfaction, Pain, and Nausea/Vomiting of Patients Undergoing Gastro-intestinal Endoscopy-A Randomized Clinical Trial Comparing EMLA Cream and Gel, Lidocaine Gel and Spray, and Placebo

Global Journal of Health Science ◽

10.5539/gjhs.v9n1p273 ◽

2016 ◽

Vol 9 (1) ◽

pp. 273

Author(s):

Jafar Nasiri ◽

Amin Ahmadi ◽

Forouzan Ganji

Keyword(s):

Clinical Trial ◽

Patient Satisfaction ◽

Randomized Clinical Trial ◽

Local Anesthesia ◽

Eutectic Mixture ◽

Double Blind ◽

Patient Satisfaction Score ◽

Emla Cream ◽

Significant Difference ◽

Lidocaine Gel

BACKGROUND & OBJECTIVES: Esophagogastroduodenoscopy is a valuable diagnostic method for the treatment of various diseases that has found a wonderful application in recent years. Yet, controlling patients’ pain and nausea is a fundamental factor to increase patient satisfaction, reduce patients’ discomfort, and increase the patient’s cooperation. Therefore, this study aimed to assess the efficacy of Eutectic Mixture of Local Anesthesia (EMLA) cream and gel, as a topical pharyngeal anesthetic on patients’ pharyngeal pain, nausea/vomiting, and satisfaction, in comparison with lidocaine gel and spray and placebo.METHODS: This double-blind randomized clinical trial was conducted to assess patient satisfaction, nausea/vomiting, throat and pharyngeal pain during and after endoscopy by different methods of local anesthesia. Thus, 150 patients were randomly divided into 5 groups of 30 receiving placebo, lidocaine gel, lidocaine spray, EMLA gel and cream 5 to 10 minutes before endoscopy. Then patient satisfaction (measured by GHAA-9 questionnaire), pain or discomfort in the throat, and nausea/vomiting were evaluated half an hour after endoscopy.RESULTS: Patient satisfaction score was not statistically different between the test groups (P>0.05), but the throat pain and discomfort and nausea/vomiting during and after endoscopy was statistically different between groups (P<0.05) and the lowest nausea/vomiting was in the group using EMLA cream.CONCLUSION: Different methods of throat anesthesia had no significant difference on patient satisfaction but EMLA cream and gel caused less nausea/vomiting than lidocaine gel or spray during and after endoscopy.

Download Full-text

Feasibility of Nasogastric Tube Insertion in Conscious Patients: Conventional Method vs. SORT Method

Anesthesiology and Pain Medicine ◽

10.5812/aapm.103747 ◽

2020 ◽

Vol 10 (3) ◽

Author(s):

Hamed Afsharjoo ◽

Ata Mahmoodpoor ◽

Kavous Shahsavarinia ◽

Farzad Rahmani

Keyword(s):

Patient Satisfaction ◽

Conventional Method ◽

Nasogastric Tube ◽

University Hospital ◽

Tube Insertion ◽

Patient Satisfaction Score ◽

Significant Difference ◽

History Of ◽

The Mean ◽

Nasogastric Tube Insertion

Background: Nasogastric tube (NGT) insertion is one of the most common procedures in the Emergency Department (EDs). Objectives: This study aimed to evaluate the ease of NGT installation using the conventional method and the SORT method. Methods: We conducted a randomized clinical trial in a university hospital on 200 patients who required NGT insertion during Mar-Sep, 2019. The patients were randomly divided into two groups of 100 patients each, receiving the SORT and conventional methods. Finally, the feasibility of NGT insertion was examined in the two groups using the frequency of NGT insertion attempts, pain during insertion (based on the VAS score of 1 - 10), patient satisfaction with the procedure (rating of 1 - 10), and incidence of complications. Results: There was no significant difference between the two groups in terms of age, body mass index, sex, and history of NGT use. However, the mean patient satisfaction score was higher (P < 0.05), whereas the mean pain score was lower (P < 0.05) in the group receiving the conventional method compared to the other group. Moreover, there was no statistically significant difference in complications (P > 0.05). Conclusions: The study showed that using the conventional method in comparison with the SORT method was significantly better for NGT insertion in conscious patients in terms of patient satisfaction and pain relief. Therefore, it is recommended not to use the SORT method in conscious patients.

Download Full-text

Plate Fixation versus Percutaneous Pinning for Unstable Metacarpal Fractures: A Meta-analysis

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s0218810417500058 ◽

2017 ◽

Vol 22 (01) ◽

pp. 29-34 ◽

Cited By ~ 5

Author(s):

Eitan Melamed ◽

LiJin Joo ◽

Edward Lin ◽

Donato Perretta ◽

John T. Capo

Keyword(s):

Fixed Effects ◽

Plate Fixation ◽

Meta Analysis ◽

Fixation Method ◽

Cochrane Library ◽

Dash Score ◽

Percutaneous Pinning ◽

Metacarpal Fractures ◽

Functional Scores

Background: Whether percutaneous pinning or plate fixation is more appropriate for metacarpal fractures is still open to debate. Our study purpose was to review the current literature in an attempt to determine the optimal treatment modality for metacarpal fractures on the basis of functional outcomes, radiographic outcome and rates of complications.Methods: We selected Pubmed, Cochrane library, EMBASE and the relevant English orthopedic journals and pooled data from eligible trials including four comparative studies and one retrospective review. Overall, the studies contained 222 patients with 231 fractures, 143 treated with pinning and 88 treated with plates and screws. Mean follow up was 7.5 months (4-12 months). Data were analyzed and the fixed effects are assumed for meta-analysis.Results: Patients undergoing pinning for metacarpal fractures have higher motion scores when compared to open reduction and internal fixation with plate and screws. Functional scores, grip strength, radiographic parameters, time to union and complications were found not to be significantly different between the two groups.Conclusions: There is evidence to support the use of pins over ORIF with plates and screws in the treatment of metacarpal fractures. This may have practical advantages, including minimal dissection, easier insertion and availability of the pins. The limitations of this study include the small number of eligible studies, lack of reporting of standard deviation value, and the lack of DASH score assessments at follow up. Further randomized controlled trials that include a larger patient numbers with longer follow up are needed to substantiate the superiority of one fixation method over another.

Download Full-text