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

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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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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OUTCOME OF OPEN REDUCTION AND INTERNAL FIXATION OF DISPLACED MEDIAL EPICONDYLE HUMERUS FRACTURES IN CHILDREN

Journal of Saidu Medical College, Swat ◽

10.52206/jsmc.2015.5.1.630-634 ◽

1969 ◽

Vol 5 (1) ◽

pp. 630-634

Author(s):

WAQAR ALAM ◽

DILAWAR KHAN ◽

MUHAMMAD IDREES ◽

FAIZ ALI SHAH ◽

SHAMS UR REHMAN ◽

...

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Teaching Hospital ◽

Open Reduction ◽

Kirschner Wire ◽

Medial Epicondyle ◽

Elbow Fracture ◽

Fractures In Children ◽

Humerus Fractures

BACKGROUND: Medical epicondyle fracture is one of the commonest elbow fracture in children.Various treatment options exist inadequate treatment leads to elbow deformity. Our study will highlightone treatment option with open reduction and fixation with k-wires or one screw and one k-wire.OBJECTIVE: To determine the functional outcome of open reduction and internal fixation ofdisplaced medial epicondyle humerus fractures in children.MATERIAL AND METHODS: This Descriptive cross sectional study was conducted simultaneouslyat five orthopaedic units: Orthopaedic Unit District Headquarter Hospital Timergara Lower Dir,Orthopaedic Unit, Saidu Teaching Hospital Swat, Department of Orthopaedics and Trauma Khalifa GulNawaz Teaching Hospital Bannu, Orthopaedics and Traumatology Unit “ A” Lady Reading HospitalPeshawar and Department of Orthopaedics and Trauma, Pak International Medical College Peshawarfrom January 2012 to September 2014. Twenty one children meeting the inclusion criteria were operatedunder general anaesthesia and tourniquet control and fracture was stabilized with either two kirschnerwires or a screw and single kirschner wire. All patients were discharged on first or second postoperativeday and advised active movements of fingers. Patients were called for follow up visit after two, six andtwelve weeks and elbow functions and deformity was evaluated in each visit using modified criteria ofHardacre et al (25).RESULTS: Twenty one patients including 14 males and 7 females with mean age 12.3 years (range 6 to15 years) had displaced fracture of medial epicondyle and were operated. Two of our patients were lostin follow up and they were excluded from the final results. After evaluating our results according tomodified Hardacre et al criteria, five patients (26.32%) had excellent results, eleven (57.89%) patientshad good results and three (15.78%) patients had poor results.CONCLUSION: Early surgical stabilization of displace medial epicondyle humerus fractures inchildren results in excellent and good functional outcome in majority of patients.KEY WORDS: Medial epicondyle humerus, Open reduction and internal fixation, Kirschner wire.

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Functional outcome of Schatzker type V and VI tibial plateau fractures managed with open reduction internal fixation using dual plates

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20173215 ◽

2017 ◽

Vol 3 (5) ◽

pp. 961

Author(s):

Saranjeet Singh Jagdev ◽

Subodh Kumar Pathak ◽

Abhijeet Salunke ◽

Pritam Maheshwari ◽

Prahlad Ughareja ◽

...

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Open Reduction ◽

Tibial Plateau ◽

Oxford Knee Score ◽

Tibial Plateau Fractures ◽

Schatzker Type ◽

The Mean ◽

Type V

Background: Complex tibial plateau fractures remain a challenge to even the most experienced surgeons. These injuries usually affect the young population in their productive years thereby causing socioeconomic impact. We performed a retrospective study to evaluate the functional outcome of of Schatzker type V and VI managed through open reduction and internal fixation.Methods: 26 patients with Schatzker type V and type VI tibial plateau fractures treated with open reduction and internal fixation using plates were included in the study. Three patients were lost to follow up, 23 patients were evaluated in the final analysis. The preoperative, intraoperative data was noted from the indoor files.The final evaluation was done using Oxford knee score and VAS score.Results: There were nine Schatzker type V fractures and 14 patients with Schatzker type VI fractures. The mean duration of follow-up was 68.32 months ranging from 41 months to 126 months. The mean Oxford knee score was 39.78. Patients with Schatzker type VI had mean OKS of 37.7.The mean MPTA and mean PPTA were 88.75 degrees and 7.35 degrees respectively. Average VAS Score was 2.8 ranging from 1 to 3.9. All patients returned to their pre-injury level of activity and employment. There were no patients of deep infection. Conclusions: We conclude that open reduction and internal fixation of high-energy tibial plateau fractures gives excellent to good functional outcome with minimal soft tissue complications. The complications can be minimized with proper patient selection and soft tissue dissection.

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A Prospective Study on Functional Outcome of Open Reduction and Internal Fixation of Acetabular Fractures

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2020/v32i1330597 ◽

2020 ◽

pp. 174-183

Author(s):

Venkata Kiran Pillella ◽

J. Lionel John

Keyword(s):

Prospective Study ◽

Internal Fixation ◽

Functional Outcome ◽

Open Reduction ◽

Acetabular Fractures ◽

Medical College ◽

The Mean ◽

One Year ◽

A Prospective Study

The current study is a prospective study on the functional outcome of open reduction and internal fixation of acetabular fractures. About 30 patients were analyzed for the functional outcome of acetabular fractures treated by open reduction and internal fixation over a period of one year and eight months from March 2017 to October 2018 with a minimum follow up period of 9 months at Sree Balaji Medical College & Hospital, Chromepet, Chennai. The mean age of the patient was 37.96 year ranging from 20 - 60 years. The Joel Matta score was used for calculation of radiological outcome of 30 patients. The results were excellent in 19 (66.3%), good in 8 (26.6%), fair in 3 (10%), and poor in 0 (0%) patients. Functional outcome of displaced acetabular fractures more than 2 mm displacement was found to have excellent results on open reduction and internal fixation.

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FUNCTIONAL OUTCOME OF PROXIMAL HUMERUS FRACTURES TREATED WITH OPEN REDUCTION AND INTERNAL FIXATION WITH A LOCKING COMPRESSION PLATE: A CROSS SECTIONAL STUDY

Journal of medical pharmaceutical and allied sciences ◽

10.22270/jmpas.v10i4.1407 ◽

2021 ◽

Vol 10 (4) ◽

pp. 3266-3269

Author(s):

Abhishek Patil

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Open Reduction ◽

Proximal Humerus ◽

Constant Score ◽

Locking Compression Plate ◽

Proximal Humerus Fractures ◽

Compression Plate ◽

Humerus Fractures ◽

The Mean

Proximal humerus fractures account for about 4% to 5% of all fractures. Following distal forearm fracture, proximal humeral fracture is the second most common upper extremity fracture. Kirschner (K)-Wires, external fixation, tension band wiring, and rush pins, intramedullary nails, ORIF with plates, and shoulder hemiarthroplasty have all been offered as therapeutic options. The purpose of this study was to assess the functional outcome and complication rates following internal fixation of proximal humerus fractures using a locking compression plate. Patients over the age of 18 with closed proximal humerus fractures or open proximal humerus fractures (Gustilo and Anderson type I, Type II) received open reduction and internal fixation with locking compression plate in the current study. The participants in this study were 60 people who had a proximal humerus fracture and were treated with open reduction and a proximal humerus locking compression plate. Patients ranged in age from 20 to 85 years old, with a mean age of 51.14 +/- 17.30 years. The age group 36–55 years (37 percent) was the most prevalent, followed by 56–75 years (30 %). The majority of patients (76.7 %) were men who had been in automobile accidents on the right side (83 %) (63 %). According to the Neer classification, the most prevalent type of fracture was a three-part fracture (53 %). The maximum union time observed in this study was 16 weeks, with a minimum of 10 weeks. The average time to union is 12.52 +/- 1.14 weeks. The mean flexion at the end of six months was 121.660 +/- 19.84. The mean internal rotation was 57.330 +/- 8.48, the mean external rotation was 530 +/- 11.98, and the mean abduction was 1180 +/- 19.36. 75.28 +/- 9.66 [Mean +/- SD] is the Mean Constant score. Pain 14.10, ADL 18.26, range of motion 22.46, and power 20 were the mean scores observed on Constant Score for its various aspects. According to the Constant score, the functional outcome of the 60 patients was as follows: 8 patients had excellent outcomes (13%), 34 patients had good outcomes (56.7%), 16 patients had moderate outcomes (26.7%), and two patients had poor outcomes (26.7%) and (3 %). Internal fixation of proximal humerus fractures with a locking compression plate results in anatomical reduction and secure fixation, resulting in a favorable functional outcome.

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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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Internal Fixation of Proximal Humerus Fracture with Polyaxial Angular Stable Locking Compression Plate in Patients Older Than 65 Years

Clinics in Shoulder and Elbow ◽

10.5397/cise.2012.15.1.25 ◽

2012 ◽

Vol 15 (1) ◽

pp. 25-31 ◽

Cited By ~ 2

Author(s):

Ki Won Lee ◽

Young Joon Choi ◽

Hyung Sun Ahn ◽

Chung Hwan Kim ◽

Jae Kwang Hwang ◽

...

Keyword(s):

Internal Fixation ◽

Proximal Humerus Fracture ◽

Proximal Humerus ◽

Constant Score ◽

Locking Compression Plate ◽

Humerus Fracture ◽

Vas Score ◽

Compression Plate ◽

The Mean

PURPOSE: The clinical and radiographic outcomes of the internal fixation, which were executed on patients over the age of 65 with proximal humerus fracture by using a polyaxial angular stable locking compression plate (Non-Contact-Bridging proximal humerus plate, Zimmer, Switzerland, NCB), were evaluated.MATERIALS AND METHODS: Thirty two patients over the age of 65 among the proximal humerus fracture treated with NCB plate, between August 2007 and January 2011, were chosen as the subjects. The average age of patients was 71 years, and the average postoperative follow-up period was 11.5 months. The fractures included 14 two-part and 18 three-part fractures. The clinical results were evaluated, using the visual analog scale (VAS) score and the Constant score. The radiological results were evaluated by time to union and Paavolainen method, which measures the neck shaft angle.RESULTS: At the last follow-up examination, the mean VAS score was 3 points and the mean Constant score was 64.5 points, with bone union achieved after the average of 16.2 weeks following the surgery in all the cases. The mean neck shaft angle was 125.9 and 24 cases had good results, while 8 cases had fair results by Paavolainen method, at the last follow-up. There were 1 case of delayed union and cerclage wire failure, and 3 cases of subacromial impingement. There were no complications, such as loss of reduction, nonunion, screw loosening, or avascular necrosis of the humeral head.CONCLUSION: Internal fixation, using a NCB plate, was considered to be an effective surgical method in treating proximal humerus fracture in the elderly patients, on whom the fixation of the fracture and maintenance of reduction are difficult.

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Functional outcome after open reduction and internal fixation for traumatic diastasis of the pubic symphysis a one year follow-up study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20163548 ◽

2016 ◽

Vol 2 (4) ◽

pp. 256

Author(s):

B. L. S. Kumar Babu ◽

Biju Ravindran

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Open Reduction ◽

High Energy ◽

Walking Distance ◽

Early Weight Bearing ◽

Dual Plating ◽

Pubic Diastasis ◽

One Year

Background: Pubic diastasis often results in anteroposterior compression (APC) injuries based on Young and Burgess classification. It is caused due to high-energy trauma and of much clinical importance is given when coexists with urogenital and neurological complications with hemodynamic instability. Open reduction and internal fixation with plating facilitates early mobilisation with better results and is the preferable mode of stabilisation. We evaluated the clinical and functional outcome of such patients in a one-year follow-up period.Methods: In our study, we included 20 patients with APC II injuries who underwent an open reduction by single or dual plating technique by the Pfannenstiel approach, were followed for one year.Results: Among 20 patients, 14 patients (70%) were operated with single superior plating, six patients (30%) were performed with dual plating, i.e., both superior and anterior plating. Among 20 patients, two patients (10%) were operated for primary arthrodesis with double plating. Only one among 20 (5%) had implant failure due to early weight bearing and were re-operated with primary arthrodesis with plating. Results were analysed based on a scoring system which includes five criteria such as anterior pelvic pain, dyspareunia and sexual dysfunction, ability to sit, gait abnormalities and walking distance. Among 20 patients ten patients (50%) had excellent results, six patients (30%) had good results, two patients (10%) had fair results, two patients (10%) had poor results.Conclusions: Open reduction and internal fixation of traumatic pubic diastasis in type II APC injuries with single or dual plating had given better results and early functional recovery.

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