Functional outcome following conservative management of acetabular fractures

Background: Acetabular fractures are complex injuries caused due to high velocity injury and constitutes about 18 % of Pelvic fractures. To obtain articular congruency and anatomical reduction is the gold standard in treating these fractures. In this study we have studied about the functional outcome in acetabular fractures managed conservatively with the long-term follow.Methods: A retrospective study with prospective analysis done between 2011-2020 involved 39 patients with acetabular fractures who were treated conservatively at St John’s Medical college Hospital. Patients were followed up at 6 months, 1 year, 2 years and at the end of 5 years for functional evaluation and assessment with the clinical outcome scores with Merle d’Aubigne and Postel score & Harris Hip Score.Results: Study included 39 patients with the average age of 41.3 years with 31 male and 8 female patients. Functional outcome score showed good to excellent results in 80%, fair to satisfactory results in 18%, 0.5 to 2% had poor result in the patient analyzed with both Merle d’Aubigne and Postel score and Harris Hip Score. 80 % of the patients were able to sit cross legged, 90% had returned to regular work and 10% of the patients changed their occupation to desk jobs.Conclusions: Conservative management of acetabular fractures gives a good long-term result following congruent reduction of the fracture, good early rehabilitation and gradual weight bearing. Return to activity of daily living was good even in congruently reduced acetabular dome fractures with good to excellent functional outcome scores.

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Scaphoid Nonunion Is a Disabling Problem in a Military Population

Hand ◽

10.1177/15589447211003177 ◽

2021 ◽

pp. 155894472110031

Author(s):

Nicholas H. Lake ◽

Rafae Khan ◽

Kyle W. Mombell ◽

Mary Fergus ◽

Dominic Gomez-Leonardelli

Keyword(s):

Functional Outcome ◽

Military Service ◽

Functional Outcomes ◽

High Rate ◽

Scaphoid Nonunion ◽

Military Population ◽

Outcome Scores ◽

The Mean ◽

Return To Duty

Background Scaphoid nonunion can occur in up to 55% of displaced scaphoid fractures. Long-term functional outcomes of this injury are lacking. In addition, no study has published rate of return to active military service after this injury. Our goal was to educate providers and patients on expected functional outcomes and return to duty after treatment of scaphoid nonunion. Methods We conducted a retrospective review of patients who underwent scaphoid nonunion repair at our institution from 2008 to 2017. The primary outcome measures were union rates, return to duty rates, and functional outcome scores obtained by telephone call. A total of 144 patients were included and 40 responded to our call for long-term follow-up. Results A total of 72% of patients achieved union after surgery, 18% required revision surgery, and 74% of patients were able to return to full duty after surgery. However, this number progressively decreased at 1, 2, and 5 years after surgery. At an average of 5.9 years after surgery, the mean Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) score was 23.9. The mean qDASH for patients who achieved union (21.9) was significantly lower than those with persistent nonunion (29.2) ( P = .0115). Conclusion Scaphoid nonunion is a difficult problem in the military. We found a high rate of persistent nonunion often requiring revision to partial or full wrist arthrodesis. In addition, our long-term functional outcome scores demonstrate significant disability after this injury, even when union is achieved. This information can help us better counsel our patients and set expectations after treatment of this injury.

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LONG TERM FUNCTIONAL EVALUATION AUTOFIBULAR STRUT GRAFT IN CASE OF FRACTURES NECK FEMUR IN RSUD DR SOETOMO SURABAYA

(JOINTS) Journal Orthopaedi and Traumatology Surabaya ◽

10.20473/joints.v7i1.2018.55-64 ◽

2019 ◽

Vol 7 (1) ◽

pp. 55

Author(s):

Achmad Sjarwani ◽

OK Ilham Abdullah Irsyam

Keyword(s):

Medical Record ◽

Operating Room ◽

Femur Fracture ◽

Primary Data ◽

Harris Hip Score ◽

Functional Evaluation ◽

Medical Record Data ◽

Strut Graft ◽

Record Data

Background: Neck femur fracture has a poor prognosis due to its anatomical structure. Fractures that occur in the elderly often have a heavy comorbid so that the mortality rate in 1 year in this case reaches 30-50%. The techniques that have been developed at this time are not satisfactory results with non-union rate of about 30%.Purpose: Assessing the long-term effectiveness of fibular auto strut graft techniques for neck femoral fracture therapy.Methods: The study was conducted retrospectively using primary data in the form of clinical evaluation and secondary data in the form of medical record data and questionnaires of neck femur fracture patients who performed non-vascularized autofibular strutgraft therapy in the period January 2005 to August 2015 in operating room IRD RSUD Dr. Soetomo Surabaya. Patients were evaluated with Harris Hip Score.Result: Medical record data shows that surgery was performed in January 2005 until August 2015 in the IRD hospital operating room. Soetomo Surabaya with 15 patients that fit criteris inclusion. The final result of Harris Hip Score is excellent in 66.66% of patients, good in 20% of patients, and poor on 13.33% of patients. It can be seen that in large part, the technique of autofibular strutgraft (Surabaya Technique) gives good results to the sufferer.Conclusion: Autofibular strutgraft and reinforcement with cancellous lag screw on neck femur fracture can generally provide good functional results in long term evaluation. From the assessment of functional aspects, abnormal anatomical conditions, and Range of Motion (ROM), obtained satisfactory results. This supports autofibular strutgraft as a neck femur fracture therapy as a major therapeutic option at a young age.

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Posteromedial fragment fixation through Lobenhoffer approach in tibial plateau fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20171891 ◽

2017 ◽

Vol 3 (3) ◽

pp. 497

Author(s):

Vijaysing S. Chandele ◽

Abhishek P. Bhalotia ◽

Milind V. Ingle ◽

Maroti R. Koichade

Keyword(s):

Functional Outcome ◽

Tibial Plateau ◽

Weight Bearing ◽

Oxford Knee Score ◽

Tibial Plateau Fractures ◽

Knee Score ◽

Early Weight Bearing ◽

Non Union ◽

Approach Time

Background: Management of tibial plateau fractures with coronal fractures especially posteromedial fragment is frequent and challenging. This study was conducted to evaluate the functional outcome of patients with tibial plateau fractures having posteromedial fragment treated with open reduction and internal fixation (ORIF) using Lobenhoffer approach.Methods: Thirty two patients with tibial plateau fractures having posteromedial fracture alone or part of bicondylar fracture was operated with ORIF using Lobenhoffer approach. Time to union, maintenance of alignment, rate of complications and functional outcome was assessed using Oxford knee score.Results: The mean time to healing was 16.4 weeks, without any complication in the form of non-union and infection. Malunion with secondary loss of alignment was seen in only one case due to fracture comminution and early weight bearing. Oxford knee score was good to excellent in all the cases. Conclusions: With recent development in understanding these fractures, ORIF gives excellent to good outcome in all patients operated through Lobenhoffer approach. Long term disability can be prevented by maintenance of adequate alignment and reduction through direct visualization of fracture.

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Functional and radiological outcome in surgically managed posterior wall and column fractures of acetabulum

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20214179 ◽

2021 ◽

Vol 7 (6) ◽

pp. 1139

Author(s):

K. Nageswara Rao ◽

Ronak Dinesh Soni ◽

C. Nagesh ◽

P. A. Shravan Kumar ◽

B. Arvind Kumar

Keyword(s):

Functional Outcome ◽

Weight Bearing ◽

Posterior Wall ◽

Joint Surface ◽

Acetabular Fractures ◽

P Value ◽

Radiological Outcome ◽

Anatomic Reduction ◽

Joint Reduction

Background: The incidence of acetabular fractures has increased following road traffic accidents. The aim of the study is to evaluate functional and radiological outcome in surgically managed posterior wall and column fractures of acetabulum.Methods: This is a prospective study done at Nizam’s Institute of Medical Sciences, Hyderabad between May 2018 and May 2020. The sample size is 20 patients between the age group 18-60 years who presented to the hospital with closed posterior wall and/or column fractures of acetabulum with or without posterior dislocation of hip joint. Functional outcome is assessed by using the modified Merle D’ Aubigne Postel clinical grading system, radiological outcome by Matta et al and perioperative complication are assessed by retrospectively analyzing medical records and radiographics examination.Results: Functional outcome according to Merle D’ Aubigne and Postel score 16 patients (75%) showed good, 3 patients (20%) showed fair, 1 patient (5%) showed poor outcome. Radiological outcome according to Matta criteria, 16 patients (75%) showed excellent quality of joint reduction, 4 patients (25%) showed good quality of reduction of joint. There was significant correlation between anatomic reduction of the joint surface and functional outcome of the patient in our study (p value <0.05).Conclusions: Accurate joint reduction is of utmost importance in reduction of posterior wall or column fractures of acetabulum as posterior wall is the weight bearing zone. Functional outcome depends on fracture type, associated injuries, selection of patient, time between injury and surgery and postoperative rehabilitation.

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Complications and Short-Term Patient Outcomes of Periacetabular Osteotomy for Symptomatic Mild Hip Dysplasia

Hip International ◽

10.5301/hipint.5000420 ◽

2016 ◽

Vol 27 (1) ◽

pp. 42-48 ◽

Cited By ~ 18

Author(s):

Benjamin F. Ricciardi ◽

Kara G. Fields ◽

Catherine Wentzel ◽

Danyal H. Nawabi ◽

Bryan T. Kelly ◽

...

Keyword(s):

Functional Outcome ◽

Acetabular Dysplasia ◽

Periacetabular Osteotomy ◽

Harris Hip Score ◽

Severe Dysplasia ◽

Complication Rates ◽

Radiographic Findings ◽

Mild Dysplasia ◽

Early Functional Outcome ◽

Outcome Scores

Introduction The purpose of our study is to identify complications and early functional outcome scores in patients treated with periacetabular osteotomy (PAO) for mild acetabular dysplasia. Methods The study population consisted of patients from a single centre prospective hip registry undergoing PAO with mild acetabular dysplasia (LCEA ≥18° and ≤25°; n = 27 patients; Mild Dysplasia group). A comparison group of patients undergoing PAO with more severe acetabular dysplasia (lateral centre-edge angle [LCEA] ≤17°; n = 50 patients; Severe Dysplasia group) were included as a comparison cohort. Demographics, radiographic findings, complications, and functional outcome scores were recorded at 6 months, 1 year, and 2 years postoperatively (mean 15 months [range 6-30]). Results Demographic characteristics were similar in patients with mild dysplasia undergoing PAO compared with more severe dysplasia. Achievement of radiological correction and complication rates were not different between the 2 groups. Functional outcome scores showed similar improvements in modified Harris Hip Score (mHHS), hip outcome score (HOS) activities of daily living (ADL), HOS Sport, and the international Hip Outcome Tool-33 (iHOT-33) at all time points between the 2 groups with over 90% of patients in the mild dysplasia group achieving a minimum important change (MIC) in functional outcome scores at final follow-up. Discussion Patients with symptomatic mild acetabular dysplasia undergoing PAO have similar complication rates and functional outcomes as a cohort of patients with more severe dysplasia.

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Use of circular external skeletal fixator constructs to stabilize tarsometatarsal arthrodeses in three dogs

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1633409 ◽

2004 ◽

Vol 17 (04) ◽

pp. 204-209 ◽

Cited By ~ 15

Author(s):

D. D. Lewis ◽

R. W. Jones ◽

R. C. Hill ◽

G. M. Anderson ◽

K. B. Halling

Keyword(s):

Functional Outcome ◽

Weight Bearing ◽

Antibiotic Administration ◽

Systemic Antibiotic ◽

The Mean ◽

Mean Time

SummaryThis report describes the use of circular external skeletal fixator (CESF) constructs for the stabilization of unilateral tarsometatarsal arthrodeses in three dogs with traumatic intertarsal or tarsometatarsal fracture/luxation injuries. The application of the CESF was performed following a limited approach to the intertarsal and tarsometatarsal joints. All three of the dogs developed post-operative wire tract inflammation with drainage and two dogs developed osteomyelitis. These complications resolved with systemic antibiotic administration, debridement, and/or wire removal, after which all of the dogs tolerated the CESF well and resumed weight-bearing on the affected limb. The mean time to CESF removal was 16 weeks. The CESF construct provided sufficient stabilization for progressive union of the tarsometatarsal arthrodeses with a good long-term functional outcome in all three of the dogs.

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Functional Outcome of Traumatic Acetabulum Fractures : A 6 Months Comprehensive Follow Up Following Open Reduction Internal Fixation Surgery at Saiful Anwar General Hospital Malang

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00031 ◽

2020 ◽

Vol 8 (5_suppl5) ◽

pp. 2325967120S0003

Author(s):

DP Putra ◽

AS Pradana ◽

KY Phatama ◽

E Mustamsir ◽

M Hidayat

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

General Hospital ◽

Open Reduction ◽

Open Reduction Internal Fixation ◽

Harris Hip Score ◽

Acetabular Fractures ◽

Acetabulum Fractures ◽

Harris Score ◽

The Mean

Acetabular fractures commonly occurred in young adult patient who suffered from high impact trauma which often associated with life threatening injuries. Displaced acetabular fractures lead to abnormal distribution on joint cartilage pressures. It produces early cartilage disruption and development of premature osteoarthritis at the hip. Anatomical reduction and fixation operation in acetabulum fractures still a major challenges due to its complications such as poor functional outcome after surgery. Despite its difficulty to predict the outcomes of acetabular fractures surgeries, functional outcomes scoring such as Oxford Hip Score (OHS) and Harris score may help surgeon to measure long term outcome following acetabular fractures. A total of 13 patients were treated over period of January 2018 until March 2019 in Saiful Anwar General Hospital Malang. The mean age of patients in this serial case is 37 years old and were operated within 2 weeks of injury. All the patients undergone an ORIF (Open Reduction Internal Fixation) operation and observed for the OHS and also Harris score 6 months following surgeries to measure functional outcome of the patients. The mean score of OHS in this serial case is 41 (satisfactory joint function) and the mean score of harris hip score is 91 (excellent). Some patients experience pain during activities, tingling sensation after standing in some periods of time, and heaviness when taking stairs 6 months after operation. This results conclude that the preoperative, operative and post operative management of patient with acetabular fracture in Saiful Anwar Hospital has satisfactory results.

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Computer-Navigated versus Conventional Total Knee Arthroplasty: A Meta-Analysis of Functional Outcomes from Level I and II Randomized Controlled Trials

The Journal of Knee Surgery ◽

10.1055/s-0039-1700494 ◽

2019 ◽

Author(s):

Brian Zhaojie Chin ◽

Victor Mun Hin Seck ◽

Nicholas Li-Xun Syn ◽

Ian Jun Yan Wee ◽

Sharon Si Heng Tan ◽

...

Keyword(s):

Functional Outcome ◽

Functional Outcomes ◽

Meta Analysis ◽

Change Scores ◽

Outcome Scores ◽

Long Term Follow Up ◽

Level I ◽

Quality Evidence

AbstractThe main purpose of this article is to provide an up-to-date systematic review and meta-analysis comparing functional outcomes of total knee arthroplasty using either computer navigation (NAV-TKA) or conventional methods (CON-TKA) from the latest assemblage of evidence. This study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-Analysis of Observational Studies in Epidemiology guidelines. All Level I and II randomized controlled trials (RCTs) in PubMed, EMBASE, and Cochrane that compared functional outcomes after NAV- and CON-TKA were included in the review. Selected end points for random effects, pairwise meta-analysis included Knee Society Knee Score (KSKS), KS Function Score (KSFS), KS Total Score (KSTS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and range of motion at three arbitrary follow-up times. A total of 24 prospective RCTs comprising 3,778 knees were included from the initial search. At long-term follow-up (>5 years), NAV-TKA exhibited significantly better raw KSKS (p = 0.001) (low-quality evidence), contrary to CON-TKA, which reflected significantly better raw KSTS (p = 0.004) (high-quality evidence). While change scores (KSKS, WOMAC) from preoperative values favor CON-TKA at short-term (<6 months) and medium-term follow-up (6–60 months), long-term follow-up change scores in KSKS suggest the superiority of NAV-TKA over CON-TKA (p = 0.02) (very low-quality evidence). Overall, sizeable dispersion of nonstatistically significant functional outcomes in the medium term was observed to eventually converge in the long term, with less differences in functional outcome scores between the two treatment methods in short- and long-term follow-up. While raw functional outcome scores reflect no differences between NAV and CON-TKA, long-term follow-up change scores in KSKS suggest superiority of NAV-TKA over its conventional counterpart. Prospective studies with larger power are required to support the pattern of diminishing differences in functional outcome scores from medium- to long-term follow-up between the two modalities.

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Treatment of Osteonecrosis: Treatment by Femoral Osteotomy

Hip International ◽

10.1177/112070009800800305 ◽

1998 ◽

Vol 8 (3) ◽

pp. 154-158 ◽

Cited By ~ 1

Author(s):

F. Menschik ◽

K.D. Schatz ◽

R. Kotz

Keyword(s):

Femoral Head ◽

Survival Curve ◽

Weight Bearing ◽

Harris Hip Score ◽

Term Outcome ◽

Long Term Outcome ◽

Total Hip ◽

Special Cases ◽

Hip Arthroplasties

The purpose of the use of an osteotomy for the treatment of osteonecrosis (ON) of the femoral head is to move the necrotic segment away from the major load-transmitting area of the acetabulum and to redistribute the weight-bearing forces to articular cartilage that is supported by healthy bone. The most common osteotomies are the varus, valgus, flexion, rotational (Sugioka), and combined osteotomies. Their long term outcome, reported in the literature, is quite controversial. We found a decreasing frequency of flexion osteotomies between 1986 and 1996 performed at our department. In 1977 we started with the Sugioka osteotomy in special cases of femoral head ON (necrotic angle in the AP-view about 90 degree) resulting in a total of 51 cases. Forty-one of them have been analyzed regarding complications, reoperations and Harris Hip Scores. Seventeen of 41 patients developed complications and underwent reoperation. Nevertheless the results according to the Harris Hip Score were satisfactoy (excellent and good in 24 patients fair in 10 and poor only in 7 cases). Independently from the size of the necrosis total hip arthroplasties have been performed in 8 cases. The survival curve of 41 Sugioka osteotomies shows a 50% decrease at 6 years. Due to this fact and the regression in the number of osteotomies of the femur in cases of ON of the hip joint we find in our material that the importance of osteotomies has dramatically decreased in contrast to the excellent results of total hip arthroplasty.

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Traumatic obturator–anterior type dislocation of the hip with an ipsilateral ischial tuberosity and greater trochanter fractures: Case report

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1177/2210491720978985 ◽

2020 ◽

pp. 221049172097898

Author(s):

Juan Manuel Concha ◽

Humberto Gonzalez ◽

Andrea C Montero ◽

Nelsy B Mueses ◽

Heydy Y Muñoz ◽

...

Keyword(s):

Hip Dislocation ◽

Femoral Fractures ◽

High Energy ◽

Ischial Tuberosity ◽

Harris Hip Score ◽

Acetabular Fractures ◽

Functional Evaluation ◽

Greater Trochanter ◽

Anterior Hip Dislocation ◽

Trochanter Fracture

Anterior hip dislocation is a rare orthopedic emergency, usually following high-energy trauma. This injury is occasionally associated with acetabular fractures, femoral head fractures, or diaphyseal femoral fractures. However, the combination between the anterior hip dislocation and the ipsilateral ischial tuberosity and greater trochanter fractures is extremely rare, and very sparsely reported in the literature. This paper reports a case of an obturator type of anterior hip dislocation associated with a concomitant ipsilateral ischial tuberosity and greater trochanter fracture. The hip dislocation was reduced by closed means under general anesthesia, and the greater trochanter fracture was reduced and internally fixed with tension band in a second stage. Radiological and functional evaluation at 12 months after surgery, using the Harris Hip Score (HHS), was good.

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