scholarly journals Management of paediatric humeral shaft fractures and associated nerve palsy

2019 ◽  
Vol 13 (5) ◽  
pp. 508-515 ◽  
Author(s):  
M. A. O’Shaughnessy ◽  
J. A. Parry ◽  
H. Liu ◽  
A. A. Stans ◽  
A. N. Larson ◽  
...  
Keyword(s):  
Nerve Palsy ◽  
Analysis Data ◽  
High Energy ◽  
Open Fractures ◽  
Level Of Evidence ◽  
Fracture Displacement ◽  
Shaft Fractures ◽  
Diaphyseal Fractures ◽  
Full Neurological Recovery ◽  
Humerus Shaft

Purpose The aim of this study is to review the management of all paediatric humerus diaphyseal fractures treated at a single institution over a 20-year period. Methods Retrospective review from between 1996 and 2016 identified 96 humerus shaft fractures in paediatric patients (0 to 17 years). After excluding those deceased from inciting trauma, pathological and perinatal fractures, 80 patients remained for analysis. Data collected included age, fracture type, displacement, nerve palsy, treatment, complications and time to union. Radiographs were reviewed at the time of injury and at latest follow-up. Results Of 80 paediatric humeral diaphyseal fractures, 65 (81%) were treated with immobilization. In all, 15 (19%) fractures were treated with surgical stabilization. Most common indications were fracture displacement, open fractures and to improve mobilization in patients with multiple injuries. Fractures were stabilized with a plate (eight), flexible nails (five), external fixation (one) and percutaneous pinning (one). The operative group, compared with the nonoperative group, was older, had more high-energy mechanisms, more open fractures and increased fracture displacement. All patients in the nonoperative and operative groups went on to union with minimal complications. A nerve palsy was present in five patients (6%)with three of the five involving the radial nerve (4%). All nerve palsies were observed and had full neurological recovery. Conclusion Over a 20-year period nonoperative management of paediatric humerus shaft fractures was successful in the majority of patients. Operative stabilization, when rarely indicated, had a low complication rate and improved radiographic alignment. All nerve injuries fully recovered without surgical intervention. Level of evidence IV

scholarly journals EVALUATION OF RESULTS OF INTERNAL FIXATION OF CLOSED, DISPLACED, RECENT FRACTURE SHAFT OF HUMERUS BY MIPPO TECHNIQUE

2019 ◽  
Vol 3 (6) ◽  
Author(s):  
Alok Sobhan Datta ◽  
S. Velagada ◽  
A. Haque
Keyword(s):  
Road Traffic Accident ◽  
Traffic Accident ◽  
Road Traffic ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
High Energy ◽  
Time Interval ◽  
Shaft Fractures ◽  
Recent Fracture ◽  
Humerus Shaft

BACKGROUND: The humerus shaft fracture is the second most common fracture of the upper extremity. The predominant causes of humerus shaft fractures include low energy trauma such as fall from a standing height in older population, while in the younger population it is caused by high energy trauma. Aims and Objectives - To investigate the effectiveness of economical MIPPO technique and to determine the radiological and functional significance of MIPPO technique in the patients undergoing treatment for recent fracture shaft of humerus. MATERIALS AND METHODS: A prospective study had been carried out from December 2012 to August 2014 in the Orthopaedics Department of SSKM Hospital, Kolkata, West Bengal, India. Thirty three patients, who presented with fracture shaft of humerus and underwent fixation of humeral shaft fractures by MIPPO technique were included in this study. Complete history was taken and full clinical examination was carried out. RESULTS: The average age group in our study is 35.3 years. Of them 85% are male and 15% are female. In majority cases, mode of injury was road traffic accident. 85% cases had middle 1/3rd fracture shaft of humerus and the average time interval between the injury and surgery was 8.54 days. CONCLUSION: The results obtained in this study have shown that the MIPPO technique is safe, convenient and effective, since there was minimal soft tissue injury with no major complications. KEYWORDS: Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO); Road Traffic Accident (RTA).

A PROSPECTIVE FOLLOW UP STUDY OF EVALUATION OF SHOULDER FUNCTION AFTER ANTEGRADE INTERLOCKING NAILING IN HUMERUS SHAFT FRACTURES IN ADULTS

2021 ◽  
pp. 39-41
Author(s):  
Jayesh Chouhan ◽  
Deepak Kumar Yadav ◽  
Mahesh Bhati ◽  
Aditya Shrimal ◽  
Pradeep Choudhary
Keyword(s):  
Functional Outcomes ◽  
Constant Score ◽  
Shoulder Function ◽  
Fracture Union ◽  
Follow Up Study ◽  
Novel Treatment ◽  
Shaft Fractures ◽  
Diaphyseal Fractures ◽  
Humerus Shaft

INTRODUCTION: This study was conducted to assess the shoulder function after antegrade interlocking humerus nailing in humerus shaft fractures, duration of union, complications (immediate and late) of this xation. METHODS: In this prospective study 40 cases with humerus shaft fractures were treated with antegrade interlocking humerus nailing and followed up for functional outcomes and complications. RESULTS: The age of patients ranged from 18 to 57 years. The assessment of shoulder function was made according to CONSTANT score. Out of 40 patients shoulder function was excellent in 35 cases (87.5%), very good in 3 cases (7.5%) and fair in 1 case (2.5%). Period of fracture union ranged from 12 to 18 weeks, average period being 13.7 weeks. None had iatrogenic radial nerve injury and/or infection. CONCLUSION: We concluded that Locked intramedullary nailing is a novel treatment option for diaphyseal fractures of the humerus. By making correct entry, repairing rotator cuff, placing the nail inside proximal end and proper physiotherapy; shoulder function outcome can be improved to excellent in cases of humerus diaphyseal fractures treated with antegrade interlocking humerus nailing.

scholarly journals Peripheral talus fractures

2021 ◽  
Vol 15 (1) ◽  
pp. 26-30
Author(s):  
Marcos Sakaki ◽  
Jordanna Bergamasco ◽  
Lais Pinheiro ◽  
Caio Rosa e Silva ◽  
Kenji Missima
Keyword(s):  
Case Series ◽  
High Energy ◽  
Open Fractures ◽  
Short Term ◽  
Triple Arthrodesis ◽  
Level Of Evidence ◽  
The Mean ◽  
Secondary Hospital ◽  
American Orthopaedic ◽  
The Moment

Objective: To present the epidemiology and assess short-term clinical and radiological outcomes of peripheral talus fractures treated between 2013 and 2019 at a secondary hospital. Methods: This is a retrospective study based on a series of 21 cases of peripheral talus fractures. Out of these 21 cases, 11 underwent functional assessment using the ankle-hindfoot scale of the American Orthopaedic Foot and Ankle Society (AOFAS) and radiological assessment after a mean period of 24.5 months. Results: Regarding the epidemiology of the 21 reported cases, the mean age was 28.7 years and 76.2% of the patients were male. The left foot was affected in 71.4% of the cases, and the most frequent type of trauma was motorcycle accident (47.6%); 23.8% of the cases had open fractures. Complete peritalar dislocation occurred in 38.0% of the cases and the most common fracture was that of the lateral process of the talus, in 42.8% of the cases. Eleven patients returned for reassessment and presented a mean AOFAS score of 80.9 points. All fractures were consolidated at the moment of assessment, and one of them progressed to subtalar and talonavicular osteoarthritis, requiring triple arthrodesis. Conclusion: The peripheral fractures studied here were caused by high-energy traumas with open fractures in one-quarter of the cases and were frequently associated with other fractures. The short-term functional outcome is good but has potential for severe complications such as stiffness and persistent pain. Level of Evidence IV, Therapeutic Studies; Case Series.

scholarly journals Risk factors associated with delayed and aseptic nonunion following tibial diaphyseal fractures managed with intramedullary nailing

2021 ◽  
Vol 2 (4) ◽  
pp. 227-235
Author(s):  
Navnit S. Makaram ◽  
Jun Min Leow ◽  
Nicholas D. Clement ◽  
William M. Oliver ◽  
Zhan H. Ng ◽  
...  
Keyword(s):  
Intramedullary Nailing ◽  
Smoking Status ◽  
Demographic Data ◽  
High Energy ◽  
Delayed Union ◽  
Open Fractures ◽  
Consecutive Series ◽  
Superficial Infection ◽  
Energy Mechanism ◽  
Diaphyseal Fractures

Aims The primary aim of this study was to identify independent predictors associated with nonunion and delayed union of tibial diaphyseal fractures treated with intramedullary nailing. The secondary aim was to assess the Radiological Union Scale for Tibial fractures (RUST) score as an early predictor of tibial fracture nonunion. Methods A consecutive series of 647 patients who underwent intramedullary nailing for tibial diaphyseal fractures were identified from a trauma database. Demographic data, comorbidities, smoking status, alcohol consumption, use of non-steroidal anti-inflammatory drugs (NSAIDs), and steroid use were documented. Details regarding mechanism of injury, fracture classification, complications, and further surgery were recorded. Nonunion was defined as the requirement for revision surgery to achieve union. Delayed union was defined as a RUST score < 10 at six months postoperatively. Results There were 41 nonunions (6.3%), of which 13 were infected (31.7%), and 77 delayed unions (11.9%). There were 127 open fractures (19.6%). Adjusting for confounding variables, NSAID use (odds ratio (OR) 3.50; p = 0.042), superficial infection (OR 3.00; p = 0.026), open fractures (OR 5.44; p < 0.001), and high-energy mechanism (OR 2.51; p = 0.040) were independently associated with nonunion. Smoking (OR 1.76; p = 0.034), open fracture (OR 2.82; p = 0.001), and high-energy mechanism (OR 1.81; p = 0.030) were independent predictors associated with delayed union. The RUST score at six-week follow-up was highly predictive of nonunion (sensitivity and specificity of 75%). Conclusion NSAID use, high-energy mechanisms, open fractures, and superficial infection were independently associated with nonunion in patients with tibial diaphyseal fractures treated with intramedullary nailing. The six-week RUST score may be useful in identifying patients at risk of nonunion. Cite this article: Bone Jt Open 2021;2(4):227–235.

scholarly journals Management of high-energy tibial shaft fractures using the hexapod circular external fixator

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yanshi Liu ◽  
Jialin Liu ◽  
Maimaiaili Yushan ◽  
Zhenhui Liu ◽  
Tao Zhang ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
External Fixator ◽  
High Energy ◽  
Bone Union ◽  
Tibial Shaft Fracture ◽  
Tibial Shaft ◽  
Clinical Visit ◽  
Shaft Fractures ◽  
Definitive Management ◽  
Tibial Shaft Fractures

Abstract Background The hexapod external fixator (HEF) is increasingly used for high-energy tibial shaft fracture care as more general orthopedic surgeons are gaining expertise of this versatile device. The purpose of this study was to evaluate the clinical effectiveness of the HEF for definitive management in patients with high-energy tibial shaft fractures. Methods The study was conducted on 34 patients with tibial shaft fractures who were admitted or referred to our institution and consented to HEF treatment from Jan 2016 to June 2019, including 27 males and 7 females with a mean age of 39 years (range 18 to 65 years). Patients' clinical and radiological data, and the final clinical outcomes at a minimum of 12 months follow-up were collected and retrospectively analyzed. All complications were documented according to Paley’s classification. The clinical outcomes were evaluated using the Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) at the last clinical visit. Results All patients remained in the HEF for a mean of 26 weeks (range 15 to 52 weeks) and acquired complete bone union. The satisfactory alignment was achieved in all patients, and all the patients were able to perform daily activities with no difficulty at the last clinical visit. Complications included pin tract infection (44%), delayed union (6%), nonunion (3%), and joint stiffness (3%). The ASAMI bony result was excellent in 31 patients and good in 3. The ASAMI functional result was excellent in 27 patients, good in 6, and fair in 1. Conclusions Definitive management using the hexapod external fixator is an alternative and effective method for high-energy tibial shaft fractures, including technical advantages of early trauma-control, the versatility of achieving excellent alignment, and the continuity of device until bone union.

Plafond Malreduction and Talar Dome Impaction Accelerates Arthrosis After Supination-Adduction Ankle Fracture

2021 ◽  
pp. 107110072110060
Author(s):  
Michael F. Githens ◽  
Malcolm R. DeBaun ◽  
Kimberly A Jacobsen ◽  
Hunter Ross ◽  
Reza Firoozabadi ◽  
...  
Keyword(s):  
Case Series ◽  
High Energy ◽  
Ankle Fractures ◽  
Posttraumatic Arthritis ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Radiographic Findings ◽  
Posttraumatic Arthrosis ◽  
Patient Reported

Background: Supination-adduction (SAD) type II ankle fractures can have medial tibial plafond and talar body impaction. Factors associated with the development of posttraumatic arthritis can be intrinsic to the injury pattern or mitigated by the surgeon. We hypothesize that plafond malreducton and talar body impaction is associated with early posttraumatic arthrosis. Methods: A retrospective cohort of skeletally mature patients with SAD ankle fractures at 2 level 1 academic trauma centers who underwent operative fixation were identified. Patients with a minimum of 1-year follow-up were included. The presence of articular impaction identified on CT scan was recorded and the quality of reduction on final intraoperative radiographs was assessed. The primary outcome was radiographic ankle arthrosis (Kellgren-Lawrence 3 or 4), and postoperative complications were documented. Results: A total of 175 SAD ankle fractures were identified during a 10-year period; 79 patients with 1-year follow-up met inclusion criteria. The majority of injuries resulted from a high-energy mechanism. Articular impaction was present in 73% of injuries, and 23% of all patients had radiographic arthrosis (Kellgren-Lawrence 3 or 4) at final follow-up. Articular malreduction, defined by either a gap or step >2 mm, was significantly associated with development of arthrosis. Early treatment failure, infection, and nonunion was rare in this series. Conclusion: Malreduction of articular impaction in SAD ankle fractures is associated with early posttraumatic arthrosis. Recognition and anatomic restoration with stable fixation of articular impaction appears to mitigate risk of posttraumatic arthrosis. Investigations correlating postoperative and long-term radiographic findings to patient-reported outcomes after operative treatment of SAD ankle fractures are warranted. Level of Evidence: Level IV, retrospective case series.

scholarly journals Metacarpal shaft fixation: a biomechanical comparison of dorsal plating, lag screws, and headless compression screws

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Felix G. E. Dyrna ◽  
Daniel M. Avery ◽  
Ryu Yoshida ◽  
David Lam ◽  
Simon Oeckenpöhler ◽  
...  
Keyword(s):  
Peak Load ◽  
Rigid Fixation ◽  
Advantages And Disadvantages ◽  
Shaft Fractures ◽  
Metacarpal Shaft ◽  
Significant Difference ◽  
Load To Failure ◽  
Headless Compression Screws ◽  
Diaphyseal Fractures ◽  
Dorsal Plating

Abstract Background Metacarpal shaft fractures are common and can be treated nonoperatively. Shortening, angulation, and rotational deformity are indications for surgical treatment. Various forms of treatment with advantages and disadvantages have been documented. The purpose of the study was to determine the stability of fracture fixation with intramedullary headless compression screws in two types of metacarpal shaft fractures and compare them to other common forms of rigid fixation: dorsal plating and lag screw fixation. It was hypothesized that headless compression screws would demonstrate a biomechanical stronger construct. Methods Five matched paired hands (age 60.9 ± 4.6 years), utilizing non-thumb metacarpals, were used for comparative fixation in two fracture types created by an osteotomy. In transverse diaphyseal fractures, fixation by headless compression screws (n = 7) and plating (n = 8) were compared. In long oblique diaphyseal fractures, headless compression screws (n = 8) were compared with plating (n = 8) and lag screws (n = 7). Testing was performed using an MTS frame producing an apex dorsal, three point bending force. Peak load to failure and stiffness were calculated from the load-displacement curve generated. Results For transverse fractures, headless compression screws had a significantly higher stiffness and peak load to failure, means 249.4 N/mm and 584.8 N, than plates, means 129.02 N/mm and 303.9 N (both p < 0.001). For long oblique fractures, stiffness and peak load to failure for headless compression screws were means 209 N/mm and 758.4 N, for plates 258.7 N/mm and 518.5 N, and for lag screws 172.18 N/mm and 234.11 N. There was significance in peak load to failure for headless compression screws vs plates (p = 0.023), headless compression screws vs lag screws (p < 0.001), and plates vs lag screws (p = 0.009). There was no significant difference in stiffness between groups. Conclusion Intramedullary fixation of diaphyseal metacarpal fractures with a headless compression screw provides excellent biomechanical stability. Coupled with lower risks for adverse effects, headless compression screws may be a preferable option for those requiring rapid return to sport or work. Level of evidence Basic Science Study, Biomechanics.

A comparison of intramedullary cannulated screws versus miniplates for fixation of unstable metacarpal diaphyseal fractures

2021 ◽  
pp. 175319342110215
Author(s):  
Birkan Kibar ◽  
Ali Cavit ◽  
Abdullah Örs
Keyword(s):  
Plate Fixation ◽  
Randomized Study ◽  
Good Alternative ◽  
Active Movement ◽  
Cannulated Screws ◽  
Level Of Evidence ◽  
Visual Analogue Pain ◽  
Plate Group ◽  
Significant Difference ◽  
Diaphyseal Fractures

We carried out a prospective randomized study to compare the clinical and radiological results of metacarpal diaphyseal fractures treated with retrograde intramedullary headless cannulated screws (IHCS) and plates. Fractures were fixed with IHCS in 34 patients (37 metacarpals) and locked miniplates in 35 patients (40 metacarpals). The mean age was 33 years (range 18–61) in the IHCS group and 32 years (range 17–68) in plate group. All patients were followed up for 1 year. All fractures in the IHCS group united but there was one nonunion in the plate group. At final follow-up, there was no significant difference between the groups in total active movement, visual analogue pain score, Disabilities of the Arm, Shoulder, and Hand score and grip strength, although the study was not sufficiently powered to exclude differences with certainty. IHCS is a safe and fast technique that is a good alternative to plate fixation in metacarpal diaphyseal fractures. Level of evidence: I

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