Plate osteosynthesis after patellar fracture: 1-year results of a prospective study

Aims and Objectives: Tension band wiring after patellar fractures is associated to a high number of implant related complications (22-53%). Revision surgery is necessary in 10-55% of the patients with mostly unsatisfactory results. The patella plate is an alternative treatment with the advantages of a locked plating implant. Biomechanical studies have shown a significant higher stability compared to tension band wiring. Therefore an immediate full weight bearing after surgery is allowed with the prophylaxis of knee-stiffness. The purpose of this study was to evaluate the first time clinical prospective results and complications of this new implant. Materials and Methods: Between April 2013 and May 2015 all patients that were treated with locked plating for patella fractures were included in this prospective study. Patients were examined after 6 weeks, 6 and 12 months. Information about patient satisfaction, pain situation and the functional result were collected. Additionally subjective scores (Tegner activity score, Lysholm-score, Kujala-score) were determined and compared to their value before trauma. Complications and revision surgeries were recorded and analysed. Results: 17 patients, 6 women and 11 men, with a mean age of 58 (19-87) years were included in this study. The range of motion of the injured knee was 120° after 6 weeks and improved to 138° after 6 months, corresponding to 84% and 97% of the range of motion of the healthy opposite knee. The Tegner activity scale increased from 2,5 to 3,5 (initial value: 4), the Lysholm score from 78 to 92 points (initial value: 97) and the Kujala score from 72 to 88 points (initial value: 96). Two complications occurred: one patient had a reactive bursitis praepatellaris and one patient sustained a loss of reduction. Another two patients had their implants removed. Patient satisfaction reached 94% after one year. Conclusion: Locked plating of patella fractures is a reliable alternative treatment with good functional outcomes, low complication rates and high patient satisfaction. Already 6 months after surgery the functional results and subjective scores reached results as before trauma. Furthermore the aftercare with immediate full-weight bearing and motion exercise improves quality of life through an early return to daily life.

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Screw osteosynthesis of transverse fracture of the patella in children

World Journal of Pediatric Surgery ◽

10.1136/wjps-2018-000014 ◽

2019 ◽

Vol 2 (2) ◽

pp. e000014

Author(s):

Simon Oksbjerre Mortensen ◽

Anne Mette Stausholm ◽

Rikke Thorninger

Keyword(s):

Screw Fixation ◽

Weight Bearing ◽

Full Range ◽

Surgical Techniques ◽

Full Weight Bearing ◽

Transverse Fracture ◽

Excellent Outcome ◽

Fractures In Children ◽

Patella Fractures ◽

Special Surgery

ObjectivePatella fractures in children are rare, with an incidence of less than 1% of all pediatric fractures. Literature describes different surgical techniques and outcomes, but there is not a specified superior technique for children. The aim of this study is to assess the functional outcome after screw fixation of transverse patella fractures in children.MethodsTwo boys at 11 years of age were presented with a transverse fracture of the patella within the same week. Open reduction and fixation of the fractured patella with periost sutures and a 4.0 mm titanium screw inserted from the distal fragment. Afterward, the quadriceps expansion was meticulously repaired with sutures.ResultsThe patients could fully weight bear immediately on a fully extended knee in an orthosis. After 4 weeks, radiological healing was obtained. At the 8-week and 6-month follow-up, the modified Hospital of Special Surgery knee score was 100 points in both patients.ConclusionSingle screw fixation provides an excellent outcome after 8 weeks with a full range of motion and full weight bearing, providing a faster recovery.

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Functional outcome of fixation of distal femoral fractures with DF-LCP: a prospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164000 ◽

2016 ◽

Vol 2 (4) ◽

pp. 291 ◽

Cited By ~ 1

Author(s):

Shafeed T. P. ◽

Bijo Paul

Keyword(s):

Tissue Injury ◽

Weight Bearing ◽

Soft Tissue Injury ◽

Femoral Fractures ◽

Early Mobilization ◽

Type A ◽

Full Weight Bearing ◽

Supracondylar Fractures ◽

Range Of Movement ◽

Locked Plating

Background: Management of supracondylar fractures is a real challenge to the orthopaedician due to its extensive soft tissue injury, boneloss, comminution, articular extention and instability. Open reduction and internal fixation with anatomical distal femoral locking plate permits early mobilization. Stable anatomical fixation is necessary to avoid complications and disability.Methods: 25 patients with Type A and Type C closed supracondylar femoral fractures were followed up from November 2013 to November 2015. All the patients underwent ORIF with DF-LCP. Clinical and radiological follow up were recorded for 24 months.Results: Mean time for fracture union was 4.02 months. Average duration for full weight bearing was 122 days (range 90-180days). The average range of movement for Type A fractures was 105.71 degrees, for C fractures average ROM was 93.64 degrees. Average ROM for patients <50 was 103 degree and for patients>50 ROM was 98.66 degree. Conclusions: Locked plating of DF fractures permits stable fixation and early mobilization which avoids disability and ensures good joint function.

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Comparison of intramedullary nailing fixation and percutaneous locked plating fixation for the treatment of proximal tibial fractures: A meta-analysis

Journal of Orthopaedic Surgery ◽

10.1177/23094990211024395 ◽

2021 ◽

Vol 29 (2) ◽

pp. 230949902110243

Author(s):

Cheng Ren ◽

Ming Li ◽

Liang Sun ◽

Zhong Li ◽

Yibo Xu ◽

...

Keyword(s):

Intramedullary Nailing ◽

Meta Analysis ◽

Weight Bearing ◽

Tibial Fractures ◽

Fixation Method ◽

Cochrane Library ◽

Full Weight Bearing ◽

Locked Plating ◽

Fixation Group ◽

Proximal Tibial Fractures

Objective: This meta-analysis aimed to systematically compare the clinical outcomes of intramedullary nailing (IMN) fixation and percutaneous locked plating (PLP) fixation in the treatment of proximal tibial fractures. Methods: We searched PubMed, Embase, Cochrane library, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), and Wan Fang to select relevant articles up to March 29, 2020 without language limit. Continuous variables were estimated by weighted mean difference (WMD) with a 95% confidence interval (CI) and dichotomous outcomes were calculated by relative risk (RR) with 95% CI. Moreover, heterogeneity analysis was evaluated. Furthermore, publication bias assessment and sensitivity analysis were conducted. Stata 11.0 software was used to perform the statistical analysis. Results: Ten studies involving 667 cases (321 from IMN fixation group and 346 from PLP fixation group) were included. The type of fractures involved in the included articles was extra-articular proximal tibia fractures. IMN fixation method achieved significantly shorter union time ( WMD = −2.88, 95% CI: −3.23 to −2.53, p < 0.001) and full weight-bearing time ( WMD = −2.81, 95% CI: −3.64 to −1.97, p < 0.001) than PLP fixation method. Meanwhile, IMN fixation resulted in lower risks of infection ( RR = 0.50, 95% CI: 0.27 to 0.91, p = 0.02) and total complications ( RR = 0.36, 95% CI: 0.22 to 0.60, p < 0.001) than PLP fixation. No significant differences were found in the incidence of nonunion ( p = 0.33), malunion ( p = 0.38), and osteofascial compartment syndrome (OCS, p = 0.62) between the two groups. Conclusions: Compared to PLP fixation, IMN fixation had several advantages in treating proximal tibial fractures, including the short time of union and full weight-bearing, as well as a low risk of infection and total complications.

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A Pilot Study of a Novel Fixation Technique for Fixation of Comminuted Patellar Fractures: Arthroscopic-Controlled Reduction and Circular External Fixation

The Journal of Knee Surgery ◽

10.1055/s-0040-1708830 ◽

2020 ◽

Vol 33 (09) ◽

pp. 931-937

Author(s):

Cagri Neyisci ◽

Yusuf Erdem ◽

Erden Kilic ◽

Arsen Arsenishvili ◽

Mustafa Kürklü

Keyword(s):

Weight Bearing ◽

Skin Irritation ◽

Full Weight Bearing ◽

Consecutive Series ◽

Patella Fractures ◽

Circular External Fixator ◽

Surgical Methods ◽

The Mean ◽

Pin Tract Infection ◽

Patellar Fractures

AbstractPatella fractures represent for 0.5 to 1.5% of all bony injuries in adults. Open reduction and the modified tension-band technique is the most common surgical technique used for patellar fractures. The purpose of this study is to present the outcomes of 26 comminuted patellar fractures treated with circular external fixator (CEF) under arthroscopic control and discuss its potential advantages over conventional surgical methods. This retrospective study included 26 patients who had closed comminuted patellar fractures and treated by CEF under arthroscopic control between January 2002 and March 2016. All patients treated with this technique were involved to the study as a consecutive series. Patients with noncomminuted transverse fractures were excluded, because they were treated with a different technique. Of the 26 patients 22 were male, 4 were female with the mean age of 33.5 years (range, 16–56 years). Patients were followed for 20 to 28 months (mean, 22 months). The mean time to union and the duration of fixation with the CEF ring was 12 weeks (range, 6–15 weeks). The mean Lysholm's score was 45 (range, 35–58) at the 10th postoperative day, which increased to 51 (range, 40–68) at the end of the first postoperative month and increased to 95 (range, 90–100) 1 month after CEF ring removal. Minor pin tract infection by pin-skin irritation was observed in nine patients. In one patient, refracture occurred due to a fall 19 days after CEF removal. CEF appears to be a safe and effective treatment for comminuted patellar fractures with a high union rate and minimal complications. It is safe and effective, as it allows short hospital stay and avoids a second surgery for removal of the instrument. Early rehabilitation with full weight-bearing promotes rapid recovery and quick return to work. Patients do not have a large unaesthetic scar on the anterior of the knee.

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TENS for the surgical management of femoral shaft fractures in 6-14 years age group children

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors5213-21 ◽

2017 ◽

Vol 5 (2) ◽

pp. 13-21

Author(s):

Mohit Khanna ◽

Jitendra Wadhwani ◽

Amit Batra ◽

Sidharth Yadav ◽

Sarfraz Iman ◽

...

Keyword(s):

Prospective Study ◽

Weight Bearing ◽

Femoral Shaft ◽

Full Weight Bearing ◽

External Fixators ◽

Age Group ◽

Femoral Shaft Fractures ◽

Femur Fractures ◽

Shaft Fractures ◽

Fractures In Children

Background. Fracture shaft of femur in pediatric age group is one of the most common leading emergencies. Children in the age group of 6-14 years are treated with either traction, hip spica, flexible/elastic stable retrograde intramedullary nail, or external fixators. We conducted a clinical prospective study on the use of Titanium Elastic Nailing System (TENS) for the treatment of femoral shaft fractures in children. Methods. The prospective study included 45 cases of fresh femoral shaft fractures. The Inclusion Criteria were a) Age group of 6-14 years, b) Recent fracture of femur shaft c) Transverse, short oblique, minimally comminuted fractures. Results. The clinical results were evaluated using Flynn’s criteria of scoring as, Excellent in 40 patients (88.89 %), Satisfactory in 5 patients (11.12 %) and poor in none. Radiological criteria for fracture union were assessed by using Anthony et al scale. Nine patients developed bursitis at entry point of the nail. Three patients had superficial infection due to bursitis. Full weight bearing was possible in mean time of 8.7 weeks (range; 7-12 weeks). Conclusion. TENS is very effective in management of paediatric shaft femur fractures in the age group of 6-14 years with advantages of early union, early mobilization and manageable complications.

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Clinical effects of dynamic stabilization with far cortical locking system in the treatment of simple distal-third tibia fractures: A cohort study

10.21203/rs.2.20315/v1 ◽

2020 ◽

Author(s):

Jing Peng ◽

Jun Fan ◽

Yang Li ◽

Xiaotao Long ◽

Shiyang Chen ◽

...

Keyword(s):

Cohort Study ◽

Fracture Healing ◽

Operative Time ◽

Callus Formation ◽

Weight Bearing ◽

Full Weight Bearing ◽

Control Group ◽

Fracture Union ◽

Locked Plating ◽

Tibia Fractures

Abstract Background: Locked plating constructs provided rigid fixation and may suppress callus formation at the fracture site, while far cortical locking (FCL) constructs have been shown to reduce the stiffness, thereby promoting fracture healing. A few publications have demonstrated that FCL construct increased axial dynamization and improved fracture healing. However, it is unclear whether the FCL construct was superior over locked plating construct for treating simple tibia fractures. Thus, we aimed to compare the clinical effect of FCL construct and locked plating construct for these fracture types.Methods: We retrospectively analyzed 18 patients treated with locked plating (control group) and 22 patients treated with the FCL construct (FCL group) from January 2016 to January 2018; the simple distal-third tibia fractures were included (AO/OTA classification: 42A1-A3 or 43A1). Patients were followed up regularly at 1, 2, 3, 6, and 12 months postoperatively, and data from clinical and radiological examinations were obtained. Patients’ demographics, operative time, time to radiological fracture union, time to full weight bearing, callus index, radiographic union score in tibia (RUST), and surgery-related complications were analyzed between the two groups.Results: The baseline patients’ demographics were similar between the two groups (P>0.05). There were no significant differences in of the operative time, time to radiological fracture union, or time to full weight bearing (P>0.05). However, the median callus index was 1.15 (IQR=1.08–1.25) in the FCL group and 1.09 (IQR=1.00–1.14) in the control group, showing a significant difference between the two groups (Z=-2.35, P<0.05), and the RUST was significantly higher at 2 months postoperatively (6.50±0.92 vs 7.59±1.37, P =0.006). Seven out of 18 patients in the control group and 2 out of 22 patients in the FCL group had no callus formation (callus index=1.0). All patients ultimately healed, and the complication rates were similar between the two groups.Conclusions : The FCL construct could promote fracture healing and was superior to locked bridge plating, as it did not lead to more surgery-related complications. Level of Evidence : Ⅲ, retrospective cohort study

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72: Quality of Life and Patient Satisfaction of Care Among Women with Urinary Incontinence: A Prospective Study

The Journal of Urology ◽

10.1016/s0022-5347(18)30337-9 ◽

2007 ◽

Vol 177 (4S) ◽

pp. 25-26

Author(s):

Simon Kim ◽

Rodney L. Dunn ◽

Edward J. McGuire ◽

John O.L. DeLancey ◽

John T. Wei

Keyword(s):

Quality Of Life ◽

Urinary Incontinence ◽

Patient Satisfaction ◽

Prospective Study ◽

A Prospective Study

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FULL WEIGHT BEARING KINEMATIC MRI STUDY OF TT-TG DISTANCE: COMPARING PATIENTS WITH PATELLOFEMORAL PAIN TO HEALTHY INDIVIDUALS

Medicinos teorija ir praktika ◽

10.15591/mtp.2015.100 ◽

2015 ◽

Vol 21 (4.1) ◽

pp. 638-642

Author(s):

Andrius Brazaitis ◽

Algirdas Tamosiunas ◽

Janina Tutkuviene

Keyword(s):

Patellar Instability ◽

Weight Bearing ◽

Patellofemoral Pain ◽

Full Weight Bearing ◽

Trochlear Groove ◽

Patellar Tilt ◽

Full Extension ◽

Low Degrees ◽

Mri Study ◽

Kinematic Magnetic Resonance Imaging

Purpose. The aim of the present study was to investigate tibial tuberosity-trochlear groove (TT-TG) distance dynamics in patients with patellofemoral pain (PFP) and pain free individuals by using full weight bearing kinematic magnetic resonance imaging (MRI) And correlation with patellar instability. Materials and methods. 51 female individuals with PFP and 26 pain free female individuals participated in the study. The kinematic MRI was performed with 1,5 T MRI unit and full-weight bearing. TT-TG distance, bissect offset (BSO) and patellar tilt angle (PTA) were measured in steps of 10° between 50° of flexion to full extension. Results. The TT–TG was higher in PFP patients compared to volunteers’ from 40° to full extension. This difference was statistically significant (p<0.01). PFP patients demonstrated statistically significantly greater TT-TG distance increase from 30° to full extension. BSO and PTA were moderately correlated to TT-TG from 20° of flexion to full extension. Conclusion. TT-TG distance is dynamic and increases significantly during extension in patients with PFP and pain free individuals, depending on knee flexion angle. It shows different pattern of dynamics in PFP group. TT-TG distance is associated with patellar instability (BSO and PTA) at low degrees of flexion.

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ROLE OF PHYSICAL THERAPY IN THE TREATMENT OF POSTERIOR ANKLE IMPINGEMENT IN PEDIATRIC ATHLETES - A PROSPECTIVE STUDY

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00082 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0008

Author(s):

Adam Saloom ◽

Nick Purcell ◽

Matthew Ruhe ◽

Jorge Gomez ◽

Jonathan Santana ◽

...

Keyword(s):

Physical Therapy ◽

Prospective Study ◽

Conservative Management ◽

Pediatric Patients ◽

Weight Bearing ◽

Return To Sport ◽

Time To Surgery ◽

Ankle Impingement ◽

Posterior Ankle Impingement

Background: Posterior ankle impingement (PAI) is a known cause of posterior ankle pain in athletes performing repetitive plantarflexion motion. Even though empirically recommended in adult PAI, there is minimal literature related to the role of conservative physical therapy (PT) in pediatric patients. Purpose: To identify patient characteristics and determine if there is a difference in pediatric patients with PAI who were successful with conservative PT and those who were unsuccessful, requiring surgical intervention. Methods: Prospective study at a tertiary children’s hospital included patients <18 years diagnosed with PAI and underwent PT. Patients who received PT at an external facility were excluded. Collected data included demographics, initial presentation at PT evaluation, treatment throughout PT, patient presentation at PT discharge, time to return to sport (RTS) from initial PT evaluation (if successful), time to surgery from initial PT evaluation (if unsuccessful). Visual Analogue Scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were collected. Group comparisons were conducted using independent t-tests or chi-square analyses (alpha level set at .05). Results: 31 (12 males, 19 females) patients diagnosed with PAI were enrolled with a mean age 12.61 years (range: 8-17). Gymnastics, football, and basketball were the most commonly implicated sports (42% patients). All patients underwent initial conservative PT for an average of 16.24 weeks (9.23 visits ±7.73). 20/31(64.5%) patients failed conservative management and underwent arthroscopic debridement. PAI pathology was predominantly bony in 61.3% and soft tissue 38.7%. Between the successful PT group and unsuccessful PT group, there was no difference in the proportion of athletes/non-athletes (p=.643). Average RTS time for successful group was 11.47 weeks and average time to surgery for unsuccessful group was 17.82 weeks. There were no significant differences in sex (p=.332), age (p=.674), number of PT visits (p=.945), initial weight-bearing status (p=.367), use of manual therapy (p=.074) including manipulation (p=.172) and mobilization (p=.507), sport (p=.272), initial evaluation ankle ROM (p>.05). Initial AOFAS scores for pain, function, alignment, or total were not significantly different (p=.551, .998, .555, .964 respectively). Conclusion: The first prospective study in pediatric patients with PAI demonstrates that even though success of PT is not dependent on age, sex, sport or PAI pathology, a notable proportion of patients who undergo PT do not need surgery. Conservative management including PT should be the initial line of management for PAI. PT treatment and surgery (if unsuccessful with PT) allowed patients to return to prior level of activity/sports. Tables/Figures: [Table: see text]

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907 Reduction of Nasal Fractures During COVID-19: A Single-Centre Experience

British Journal of Surgery ◽

10.1093/bjs/znab134.096 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

T Crotty ◽

M Corbett ◽

T Hussain ◽

A Diaconescu ◽

N Patil

Keyword(s):

Patient Satisfaction ◽

Prospective Study ◽

Local Anaesthetic ◽

Regional Anaesthesia ◽

Effective Alternative ◽

General Anaesthetic ◽

Single Centre ◽

Pain Scores ◽

Single Centre Experience ◽

Nasal Fractures

Abstract Introduction The utilization of local or regional anaesthesia for manipulation of nasal fractures (MNF) avoids the need for general anaesthetic (GA), and the risk associated with instrumentation of the airway during the COVID-19 pandemic. Furthermore, MNF under local anaesthetic (LA) provides similar results with regards to cosmesis and patient satisfaction. We present our experience of performing MNF under LA during the COVID-19 pandemic. Method A single-centre, prospective study of all patients undergoing MNF under LA was conducted (13th July/20–11thSeptember/20). Following reduction, pain scores and patient satisfaction surveys were administered. Results A total of 25 patients (M/F:16/9, median age, 25.6yr (14-52yr)) were enrolled. The majority of patients received either one or two instillations of LA (n = 19, 76%). Pain reported during the MNF procedure was 4.4/10, whilst pain during LA administration was reported as 3.2/10. 80% of patients felt instillation of LA was less painful than expected. 88% of respondents tolerated the LA well, and only 8% would have opted for general anaesthetic. 24 (96%) participants were happy with the cosmetic result. Discussion MNF under LA is a safe and effective alternative to MNF under GA. More literature is needed to define the best method of administering LA prior to performing MNF.

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