Clinical Outcomes and Return to Play in Youth Overhead Athletes After Medial Epicondyle Fractures Treated With Open Reduction and Internal Fixation

Background: There is limited literature regarding outcomes after operative treatment of displaced medial epicondyle avulsion fractures in adolescent athletes. Most studies have had a relatively small sample size and have not assessed return to play of the overhead athlete. Purpose: To examine return to play and outcomes of youth overhead athletes who underwent open reduction and internal fixation (ORIF) with screw fixation. Study Design: Case series; Level of evidence, 4. Methods: Charts and radiographs were queried between January 2003 and June 2018 for young overhead athletes (age, <17 years) who underwent ORIF for displaced medial epicondyle fracture. Patients with open fracture or concomitant injury were excluded. Radiographs from postoperative follow-up visits were examined for radiographic union. Eligible patients were asked to provide responses to the American Shoulder and Elbow Surgeons Standardized Assessment Elbow questionnaire and Kerlan-Jobe Orthopaedic Clinic questionnaires as well as questions regarding return to play. Results: Overall, 29 patients were included in the study; the mean age at surgery was 14.7 years (range, 12.9-16.5 years). There were 25 baseball players, 3 football quarterbacks, and 1 tennis player. Of the 23 patients with available images at least 3 months after surgery, 96% demonstrated radiographic union at last follow-up. Imaging for the 1 patient with nonunion was taken 3 months after ORIF, and it is unknown if he eventually had union. All patients (100%) were successfully contacted to complete questionnaires at a mean follow-up of 4.8 years (range, 1.0-13.5 years). The mean KJOC score was 93.0, and the mean scores for the American Shoulder and Elbow Surgeons Elbow questionnaire were 8.9, 35.6, and 9.8 for pain, function, and satisfaction, respectively. One overhead athlete did not return to play, while the other 28 returned at a mean 7 months after surgery. No patient underwent revision ORIF, 1 underwent hardware removal, and 1 underwent ulnar nerve transposition. No players underwent ulnar collateral ligament reconstruction after primary ORIF of the medial epicondyle. Conclusion: ORIF of displaced medial epicondyle fractures is a reliable and successful procedure in adolescent overhead athletes with high demands, with relatively low risk of major complications, reinjury, or reoperation.

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Staged Management of Severely Displaced Calcaneal Fractures With Transarticular Pinning: A Damage Control Strategy

Foot & Ankle International ◽

10.1177/10711007211013012 ◽

2021 ◽

pp. 107110072110130

Author(s):

Kyeong-Hyeon Park ◽

Chang-Wug Oh ◽

Joon-Woo Kim ◽

Hee-June Kim ◽

Dong-Hyun Kim ◽

...

Keyword(s):

Soft Tissue ◽

Internal Fixation ◽

Kirschner Wire ◽

Wound Complications ◽

Calcaneal Fractures ◽

Simple Method ◽

Wire Fixation ◽

The Mean ◽

Radiographic Union

Background: Severely displaced calcaneal fractures can result in considerable morphology derangement and may be accompanied by soft tissue compromise. Delayed operative restoration of the calcaneal morphology may result in acute retensioning of the damaged soft tissue with associated wound-related complications. In this study, we describe a staged treatment of displaced intra-articular calcaneal fractures that uses temporary transarticular Kirschner wire (K-wire) fixation and staged conversion to definite fixation. Methods: We identified all of the patients who were treated at our institution for calcaneal fractures between 2015 and 2019. A total of 17 patients with 20 calcaneal fractures were selectively treated with 2-stage management. Temporary transarticular K-wire fixation was performed 24 hours after the injury to restore calcaneal morphology and the surrounding soft tissue. After the soft tissue was considered safe, delayed open reduction and internal fixation was performed. The time to definite surgery, radiographic alignment, wound complications, time to radiographic union, and hindfoot American Orthopaedic Foot & Ankle Society (AOFAS) scores were recorded. Results: The average follow-up period was 17 months (range, 12-43). The average Böhler angle increased from a mean of −22 degrees (range, −109 to 25) to 25 degrees (range, 0 to 47) after temporary transarticular K-wire fixation. The mean time from temporary pinning to conversion to definite internal fixation was 20 (range, 10-32) days. There were no immediate postoperative complications. The average time to radiographic union was 13.7 (range, 10-16) weeks. The mean AOFAS score was 87 (range, 55-100). No infections or wound complications were reported during the follow-up period. Conclusion: Temporary transarticular pinning for staged calcaneal fracture treatment is safe and effective in restoring the calcaneal morphology. This novel and relatively simple method may facilitate delayed operation and decrease wound-related complications. Level of Evidence: Level IV, retrospective case series.

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A Prospective Study on Treatment of Distal Radial Fractures Using Volar Locking Plate

10.33140/ijor.03.01.07 ◽

2020 ◽

Vol 3 (1) ◽

Keyword(s):

Internal Fixation ◽

Distal Radius ◽

Open Reduction ◽

Locking Plate ◽

Small Sample ◽

Care Hospital ◽

Volar Locking Plate ◽

Distal Radial Fractures ◽

Compression Plating

Introduction: Distal radius fractures are one of the most common injuries which come to the orthopaedic surgeons. Displaced extra-or intra-articular fractures require anatomical reduction for a good outcome. Historically, these fractures were treated with manipulation and casting, with or without Kirschner (K) wire fixation. Modern plating techniques have been advocated to restore anatomical alignment and allow early mobilisation. Despite the wide variety of treatment options available there is still debate about the best way to treat these fractures. The aim of this study was to evaluate fifty cases of fracture distal end radius treated by open reduction and internal fixation using locking compression plating (LCP). Methods: The present study was carried out on 50 cases of acute fracture distal radius admitted at a tertiary care hospital treated by open reduction and internal fixation using locking compression plating (LCP) between January 2018 and December 2018. Functional results were rated at the end of the study as excellent, good or poor as criteria laid down by Gartland and Werley’s combined subjective and objective criteria. Results: 50 cases of fracture distal radius were selected for study that fulfill the inclusion criteria, were operated and studied. 10 fractures were fixed using Extra-articular Locking Compression T-Plates, 40 fractures were fixed using Juxtaarticular Locking Compression T-Plates. According to the Gartland and Werley’s rating scale, 20 had excellent results, 23 good results, and 07 fair results during latest follow up. Conclusion: Notwithstanding a very small sample size and a short follow up, Volar locking plate osteosynthesis at the distal radius signifies a significant improvement in the treatment of distal radial fractures in terms of restoration of the shape and function of the wrist.

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Nightstick Fractures, Outcomes of Operative and Non-Operative Treatment

Acta Medica (Hradec Kralove Czech Republic) ◽

10.14712/18059694.2019.41 ◽

2019 ◽

Vol 62 (1) ◽

pp. 19-23

Author(s):

Mohammed Ali ◽

D. I. Clark ◽

Amole Tambe

Keyword(s):

Internal Fixation ◽

Functional Status ◽

Operative Treatment ◽

Open Reduction ◽

Associated Injuries ◽

Clinical Notes ◽

Satisfactory Outcome ◽

Isolated Fracture ◽

The Mean

Introduction: A nightstick fracture is an isolated fracture of the ulnar shaft. Although operative and non-operative treatments have been commonly decided by the degree of displacement of the fracture, still there is a controversy specially in those moderately displaced. Herein we report our experience with nightstick fractures. Objective: To evaluate operative and non-operative treatment of nightstick fracture. Materials and methods: We retrospectively reviewed the clinical notes, physiotherapy letters and radiographs of 52 patients with isolated ulnar shaft fractures. Outcome Measurements included radiographic healing, post-operative range of motion and complications. Results: The study included 13 females and 39 males, with a mean age of 26 years [range, 18–93 years]. The mean Follow-up period was 32 months ranged from 12 to 54 months. Ten patients were treated non-operatively; forty-two patients had open reduction and internal fixation including six open fractures. The average wait for surgery was 2.5 days. Mobilisation was commenced immediately after the surgeries non-load bearing. 40 patients had no complications post-operatively with good outcome and average of four visits follow-up. In the non-operative group, five out ten failed and had a mean follow-up of nine visits. Conclusion: Satisfactory outcome is to be expected with open reduction and internal fixation. Fractures with less than 50% displacement should be treated on individual bases, considering; age, pre-morbid functional status, co-morbidities, compliance and associated injuries.

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Outcome of locking plate fixation for proximal humerus fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20160712 ◽

2016 ◽

Vol 2 (1) ◽

pp. 25

Author(s):

Neil Rohra ◽

Jimmy Chokshi ◽

Rishi Sanghavi

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Proximal Humerus ◽

Evaluation Criteria ◽

Proximal Humerus Fractures ◽

Age Group ◽

Philos Plate ◽

Humerus Fractures ◽

The Mean

Background: The objective of the study was to evaluate functional outcome of open reduction and internal fixation with proximal humeral internal locking system (PHILOS) plate for proximal humerus fractures.Methods: We reviewed 30 patients who underwent open reduction and internal fixation with PHILOS plate between the years 2010 to 2015. There were 23 men and7 women with a mean age of 36 years (range 20-64).There were 22 patients in the age group of <60 years and 8 patients in the age group of >60 years. According to Neer classification system, 12, 11 and 4 patients had2-part, 3-part, and 4-part fractures, respectively and 2 patients had 4-part fracture dislocation. All surgeries were carried out at our tertiary care trauma center. Functional evaluation of the shoulder at final follow-up was done using Neer’s Evaluation Criteria.Results: The mean follow-up period was 20 months (range 14-40 months). All fractures united clinically and radio logically. The mean time for radiological union was 13.2 weeks (range 9-26 weeks).At the final follow-up the mean Neer’s Evaluation Criteria was 90 (range 76-100). The results were excellent in 17patients, Satisfactory in 8 patients, Unsatisfactory in 4 patients and Failure in 1 patient. During the follow-up, 3 cases of varus malunion, 1 case of failure of fixation were noted. No cases of AVN, hardware failure, locking screw loosening, infection or nonunion were noted.Conclusions: PHILOS provides stable fixation in proximal humerus fractures. In order to prevent the complications like avascular necrosis, knowledge of anatomy and vascular supply of head of humerus and good surgical dissection to preserve vascularity of humeral head is important.

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

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20202050 ◽

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

Background: 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.Methods: 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.Results: 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<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.Conclusions: 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.

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Treatment of Tibial Avulsion Fracture of Posterior Cruciate Ligament by Open Reduction and Internal Fixation

Journal of Nobel Medical College ◽

10.3126/jonmc.v9i1.29419 ◽

2020 ◽

Vol 9 (1) ◽

pp. 17-21

Author(s):

Ranjib Kumar Jha ◽

Santosh Thapa

Keyword(s):

Clinical Outcome ◽

Internal Fixation ◽

Functional Outcome ◽

Posterior Cruciate Ligament ◽

Open Reduction ◽

Avulsion Fracture ◽

Cruciate Ligament ◽

Avulsion Injury ◽

The Mean

Background: An avulsion fracture of posterior cruciate ligament from tibial attachment is more common in younger age group. It should be fixed otherwise it may lead to secondary changes in knee. Various techniques and approaches are available to fix posterior cruciate ligament avulsion. Different biomechanical studies have shown that, results both open and arthroscopic methods of fixation of posterior cruciate ligament avulsion by screws are comparable. The purpose of study is to evaluate functional and clinical outcome of open reduction and fixation of posterior cruciate ligament avulsion injury through posteromedial approach. Materials and Methods: The study enrolled 19 cases of isolated posterior cruciate ligament avulsion injury with mean age of 33.21±9.07 year. All cases were treated by open reduction and internal fixation through modified posterior approach. The patients having duration of injury more than 12 weeks were excluded. The minimum follow up duration was 12 months. Results were assessed clinically and radiologically. Final functional outcome was assessed using the Lysholm scoring for knee. Results: The mean duration of follow up was 14±1.85 months. All patients achieved union at 3months. At final follow up the mean range of motion was 125.42±6.37 degree (range 110 to 135 degree) without any extensor lag. The functional outcome assessed by Lysholm scoring system was excellent in 15 cases and good in 4 cases. Conclusion: Open reduction and internal fixation with early range of motion exercises provides good clinical outcome and stable knee.

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PROXIMAL HUMERUS FRACTURES;

The Professional Medical Journal ◽

10.29309/tpmj/2017.24.12.571 ◽

2017 ◽

Vol 24 (12) ◽

pp. 1788-1793

Author(s):

Faisal Abdul Jabbar ◽

Rehana Ali Shah

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Avascular Necrosis ◽

Open Reduction ◽

Proximal Humerus ◽

Case Series ◽

Proximal Humerus Fractures ◽

Humerus Fractures ◽

The Mean

Objectives: The aim of our study is to study the radiological and functionaloutcome of proximal humerus fractures treated via open reduction and internal fixation usingthe proximal humerus internal locking system or PHILOS. Study Design: Case series study.Period 05 years duration from January 2011 to December 2015. Setting: Large tertiary carecentre in Karachi, Pakistan. Materials and methods: The study population consisted of n=50patients all of whom underwent open reduction and internal fixation utilizing the proximalhumeral internal locking system or PHILOS for fractures of the proximal humerus. The inclusioncriterion was all the patients with closed fractures of the proximal humerus and were belongingto 2,3 and 4 part of the Neer system of classification. Physiotherapy was started as soon aspossible for the patients. Serial radiographic imaging in two views was done at 6, 12, 24 and52 weeks postoperatively. For the functional outcome of the procedure Constant and Murleyscoring system was used. Data was analyzed using IBM SPSS version 21. Results: The studypopulation consisted of n= 50 patients of which n= 35 were males and n= 15 were femaleshaving a mean age of 38.50 years. The mean duration of follow up was 24 months. All thepatients in the study had union of fracture both radiographically and clinically, the mean timeduration for the radiographically evident union of the humerus bone was 12 weeks with a rangeof 8 to 20 weeks, the mean Constant Murley score for the functional outcome of the shoulderjoint was 79 at the final follow up with a range of 50 to 100. Complications were found in n= 9patients and varus malunion was the most common complication. In our case series we did notobserve complications such as avascular necrosis, non union or implant failure. Conclusion:According to the results of our study the proximal humerus internal locking system or PHILOSis a good method for open reduction and internal fixation of the proximal humerus fractures andprovides a stable fixation, and has lower incidence of complications such as avascular necrosis.

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Timing of Open Reduction and Internal Fixation of Ankle Fractures

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000388 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0003

Author(s):

Direk Tantigate ◽

J. Turner Vosseller ◽

Justin Greisberg ◽

Benjamin Ascherman ◽

Christina Freibott ◽

...

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Functional Outcomes ◽

Ankle Fracture ◽

Open Reduction ◽

Demographic Variables ◽

Ankle Fractures ◽

Significant Difference ◽

The Mean

Category: Ankle, Trauma Introduction/Purpose: Unstable ankle fractures are typically treated with open reduction and internal fixation (ORIF) for stabilization in an effort to ultimately prevent post-traumatic arthritis. It is not uncommon for operative treatment to be performed as an outpatient in the ambulatory surgery setting several days to a couple weeks after the injury to facilitate things from a scheduling perspective. It is unclear what effect this delay has on functional outcome. The purpose of this study is to assess the impact of delayed operative treatment by comparing the functional outcomes for groups of patients based on the amount of time between the injury and surgery. Methods: A retrospective chart review of 122 ankle fracture patients who were surgically treated by ORIF over a three year period was performed. All ankle fracture patients older than 18 years with a minimum of 24 months of follow-up were included. A total of 61 patients were included for this study. Three patients were excluded; 2 patients had an open injury and 1 patient presented with a delayed union. Demographic data, comorbidities, injury characteristics, duration from injury to surgery, operative time, length of postoperative stay, complications and functional outcomes were recorded. Functional outcome was determined by Foot and Ankle Outcome Score (FAOS) at the latest follow-up visit. Comparison of demographic variables and the subcategory of FAOS including symptoms, pain, activities of daily living (ADL), sport activity and quality of life (QOL) was performed between patient underwent ORIF less than 14 days after injury and 14 days or greater. Results: A total of 58 patients were included in this study. Thirty-six patients (62.1%) were female. The mean age of patients was 48.14 ± 16.84 years (19-84 years). The mean follow-up time was 41.48 ± 12.25 months (24-76 months). The duration between injury and operative fixation in the two groups was 7 ± 3 days (<14 days) and 18 ± 3 days (>14 days), respectively. There was no statistically significant difference in demographic variables, comorbidities, injury characteristics, or length of operation. Each subcategory of FAOS demonstrated no statistically significant difference between these two groups. (Table 1) Additionally, further analysis for the delayed fixation more than 7 days and 10 days also revealed no significant difference of FAOS. Conclusion: Open reduction and internal fixation of ankle fracture more than 14 days does not significantly diminish functional outcome according to FAOS. Delay of ORIF for ankle fractures does not play a significant role in the long-term functional outcome.

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Paratricepital approach for open reduction and internal fixation of delayed presentation of pediatric supracondylar humerus fracture

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20195802 ◽

2019 ◽

Vol 6 (1) ◽

pp. 107

Author(s):

Ramachandra Subbasetty ◽

Dayanand Manjunath ◽

Deepak Shivanna ◽

Narasimha Murthy

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Open Reduction ◽

Perioperative Complications ◽

Humerus Fracture ◽

Delayed Presentation ◽

Supracondylar Humerus Fracture ◽

Fractures In Children ◽

The Mean

Background: Delayed presentation of pediatric displaced supracondylar humerus fracture is relatively common. Management of such cases have higher incidence of perioperative complications and usually require open reduction and pinning. Open reduction can be done by various approaches, each having its own advantage and disadvantages.Methods: A prospective study was done comprising 20 children with displaced Supracondylar fracture presented 2-14 days of injury, Mean patient age was 6 years. 15 were boys and 5 were girls. Children in whom closed reduction and percutaneous pinning was achieved, vascular injury and more than 2 weeks old fracture cases were excluded. Paratricepital approach was used for Open reduction and pinning for all the cases. The functional outcome was assessed using Flynn criteria.Results: In all cases the fracture had united at complete follow-up and the mean follow-up period was 16 months. The outcome was excellent in 15 (75%), good in 3 (15%), fair in 1 (5%), and poor in 1 (5%) patients. The mean Baumann angle was 76º in the affected elbow and 73º in the normal elbow. Average time for complete union in the current study was 7 weeks. Pin tract infection was seen in 2, stiffness in 2 patients, cubitus varus in 1 patient. No case of compartment syndrome or iatrogenic nerve injury was seen was recorded.Conclusions: Finally, we concluded that triceps sparing paratricepital approach is an easy, simple and safe approach for exposure and internal fixation of supracondylar humeral fractures in children with excellent functional outcome.

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Comparative Study of Open Reduction and Internal Fixation and Primary Subtalar Arthrodesis for Sanders Type IV Intra-articular Calcaneal Fractures

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000411 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0004

Author(s):

Seunghun Woo ◽

Hyung Jin Chung ◽

Su-Young Bae ◽

Tae Sik Goh

Keyword(s):

Patient Satisfaction ◽

Internal Fixation ◽

Clinical Outcomes ◽

Open Reduction ◽

Calcaneal Fractures ◽

Subtalar Arthrodesis ◽

Type Iv ◽

Significant Difference ◽

The Mean

Category: Trauma Introduction/Purpose: To compare clinical outcome of Sanders type IV intra-articular calcaneal fracture treated with open reduction and internal fixation (ORIF) versus ORIF and primary subtalar arthrodesis (PSTA). Methods: Between March 2003 and November 2013, 22 patients with 22 Sanders type IV intra-articular calcaneal fractures were included in this study. Of these, 11 feet were treated with ORIF (ORIF group), 11 feet were treated with ORIF and PSTA (PSTA group). The mean follow-up periods was 34.6 months (range, 18-72 months). Clinical outcomes were assessed along with the American Orthopaedic Foot and Ankle Society’s Ankle-Hindfoot Scale (AOFAS score), the Visual Analog Scale Pain score (VAS score) at 6-, 12 month, and last follow-up. The patient satisfaction, returning to previous occupation and postoperative complications were also investigated. Results: Complete bone union were achieved in all patients. No statistical difference was found between the results for ORIF compared with PSTA: the mean preoperative Bohler angle were, respectively, -3.2±9.2 and -6.6±12.7 degrees (p=0.475); the mean last follow-up AOFAS scores were 73.8±14.9 and 80.5±4.6 (p=0.795); the mean VAS last follow-up VAS scores were 29.7±20.6 and 23.4±10.0 (p=0.986). Secondary subtalar arthrodesis were conducted in 5 patients (45.5%) of ORIF group due to subtalar osteoarthritis symptom within 2 years, postoperatively. Conclusion: We were unable to demonstrate a significant difference of clinical outcomes between ORIF and PSTA however, the patient satisfaction was higher in the PSTA group. PSTA may be considerable choice for patients who need fast recovery to daily activity and to prevent the need for secondary subtalar arthrodesis.

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