scholarly journals Open Reduction and Internal Fixation for Displaced Salter-Harris type II Fractures of the Distal Tibia: A Retrospective Study of Eighty-Five Cases in Children

2021 ◽  
Author(s):  
Quanwen Yuan ◽  
Yunfang Zhen ◽  
Zhixiong Guo ◽  
Fuyong Zhang ◽  
Jianfeng Fang ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Distal Tibia ◽  
Open Reduction Internal Fixation ◽  
Angular Deformity ◽  
Initial Displacement ◽  
Fibular Fracture ◽  
The Mean ◽  
Salter Harris ◽  
Physeal Closure

Abstract Background: The treatment for displaced Salter-Harris Ⅱ distal tibia fractures remains controversial. The purpose of this study was to evaluate the rate of premature physeal closure (PPC) and to identify the risk factors treated by open reduction and internal fixation.Methods: We reviewed the charts and radiographs of patients with Salter-Harris Ⅱ fractures of the distal tibia with displacement >3mm between 2012 and 2019. Open reduction and internal fixation was performed for all patients. Patients were followed up for a minimum of 4 months. Contralateral ankle radiograph or CT scans were obtained if there was any evidence of premature physeal closure. Any angular deformity or shortening of the involved leg was documented.Results: A total of 85 patients with a mean age of 12.3years were included in the study. The mean initial displacement was 8.5 mm. All patients but one were treated within seven days after injury and the mean interval was 3.7 days. SER injuries occurred in 65 patients (76.5%), PER in 17 (20.0%), and SPF in three (3.5%). The rate of PPC was 29.4% and two patients with PPC had varus deformities. The rate of PPC was significantly greater in patients with associated fibular fracture as compared with those with intact fibular (P=0.005). Patient age, gender, injured side, mechanism of injury (only SER vs PER), amount of initial displacement, interval from injury to surgery, or energy of injury did not affect the rate of PPC significantly. Conclusions: PPC is a common complication for displaced S-H Ⅱ distal tibia physeal fractures. We suggest that open reduction internal fixation is an effective choice to reduce the risk of PPC. The presence of concomitant fibula fracture was associated with PPC.

scholarly journals Open reduction and internal fixation for displaced Salter-Harris type II fractures of the distal tibia: a retrospective study of sixty-five cases in children

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Quanwen Yuan ◽  
Yunfang Zhen ◽  
Zhixiong Guo ◽  
Fuyong Zhang ◽  
Jianfeng Fang ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
External Rotation ◽  
Distal Tibia ◽  
Initial Displacement ◽  
Injured Side ◽  
Tibia Fractures ◽  
Distal Tibia Fractures ◽  
The Mean ◽  
Salter Harris

Abstract Background The treatment for displaced Salter-Harris II (S-H II) distal tibia fractures remains controversial. The purpose of this study was to review S-H II distal tibia fractures and evaluate the rate of premature physeal closure (PPC) treated by open reduction and internal fixation (ORIF). Methods We reviewed the charts and radiographs of S-H II fractures of the distal tibia with displacement > 3 mm between 2012 and 2019 treated by ORIF. Patients were followed up for a minimum of 6 months. CT scans of injured side or contralateral ankle radiograph were obtained if there was any evidence of PPC. Any angular deformity or shortening of the involved leg was documented. Multivariable logistic regression was performed to identify risk factors for the occurrence of PPC. Results A total of 65 patients with a mean age of 11.8 years were included in this study. The mean initial displacement was 8.0 mm. All patients but one were treated within 7 days after injury and the mean interval was 3.7 days. Supination-external rotation injuries occurred in 50 patients, pronation-eversion external rotation in 13, and supination-plantar flexion in two. The residual gap was less than 1 mm in all patients following ORIF and all fractures healed within 4–6 weeks. Superficial skin infection developed in one patient. Ten patients complained of the cosmetic scar. The rate of PPC was 29.2% and two patients with PPC developed a varus deformity of the ankle. Patients with associated fibular fracture had 7 times greater odds of developing PPC. Age, gender, injured side, mechanism of injury, amount of initial displacement, interval from injury to surgery, or energy of injury did not significantly affect the rate of PPC. Conclusions ORIF was an effective choice of treatment for S-H II distal tibia fractures with displacement > 3 mm to obtain a satisfactory reduction. PPC is a common complication following ORIF. The presence of concomitant fibula fracture was associated with PPC.

scholarly journals Are Orthopaedic Surgeons Being Adequately Compensated for Ankle Fractures? An Analysis of Relative Value Units (RVUs)

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0005
Author(s):  
Azeem Tariq Malik ◽  
Safdar N. Khan ◽  
Laura Phieffer ◽  
Thuan V. Ly ◽  
Carmen E. Quatman
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Operative Time ◽  
Open Reduction Internal Fixation ◽  
Ankle Fractures ◽  
Reimbursement Rate ◽  
Total Operative Time ◽  
Orthopaedic Surgeons ◽  
Malleolar Fractures ◽  
The Mean

Category: Ankle, Trauma Introduction/Purpose: Tri-malleolar fractures, as compared to simple uni-malleolar fractures, are technically more challenging cases, have longer operative times and require a higher effort. The current RVU-based system is built to reflect the varying presentation of ankle fractures (uni-malleolar vs. bi-malleolar vs. tri-malleolar) by assigning individual RVUs to different fracture complexities. However, no study has evaluated whether the current RVUs reflect an appropriate compensation per unit time following open reduction internal fixation (ORIF) for uni-malleolar vs. bi-malleolar vs. tri-malleolar ankle fractures. Methods: The 2012-2017 American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) files were queried using CPT codes for patients undergoing open reduction internal fixation (ORIF) for uni-malleolar (CPT-27766, CPT- 27769, CPT-27792), bi-malleolar (CPT-27814) and tri-malleolar (CPT-27822, CPT-27823) ankle fractures. A total of 7,830 (37.2%) uni-malleolar, 7,826 (37.2%) bi-malleolar and 5,391 (25.6%) tri-malleolar ankle fractures were retrieved. Total RVUs were calculated for each case. Mean RVU/minute was derived by dividing the total RVU of each case by the total operative time. Reimbursement rate ($/min) was calculated by multiplying the mean RVU/min of each procedure by a preset CMS-defined rate of $35.8887/RVU. Mean Reimbursement/case was calculated by multiplying the reimbursement rate by the operative time of each procedure. Kruskal-Wallis tests were used to compare RVUs, operative time and reimbursements between the three fracture groups. Results: The mean total RVU for each fracture type was as follows:- 1) Uni-malleolar: 9.99, 2) Bi-malleolar=11.71 and 3) Tri- malleolar=12.87 (p<0.001). A statistically significant difference was noted in mean operative time (uni-malleolar=63.2 vs. bi- malleolar=78.6 vs. tri-malleolar=95.5; p<0.001) between the two groups. Reimbursement rates ($/min) decreased significantly as fracture complexity increased (uni-malleolar=$7.21/min vs. bi-malleolar=$6.75/min vs. tri-malleolar=$6.10; p<0.001). The average reimbursement/case was $358, $420 and $462 for uni-malleolar, bi-malleolar and tri-malleolar fractures respectively. Based on a hypothetical scenario, an orthopaedic surgeon spent 190 minutes fixing two tri-malleolar fractures and earning $924 in the process. Within a total operative time of 190 minutes, three uni-malleolar ankle fractures and two bi-malleolar ankle fractures could be managed completely with an associated earning of $1,074 and $840 respectively. Conclusion: Orthopaedic surgeons are reimbursed at a higher rate ($/min) for treating a simple uni-malleolar fracture as compared to bi-malleolar and tri-malleolar fractures, despite the higher complexity and longer operative times seen in the latter. The study highlights the need of a change in the RVUs for bi-malleolar and tri-malleolar ankle fractures to ensure that surgeons are adequately reimbursed per unit time for treating a more complex fracture case.

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

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.

scholarly journals Open reduction internal fixation with triceps-sparing approach in distal humerus fracture: an experience from a tertiary level hospital in Mangalore

2019 ◽  
Vol 5 (2) ◽  
pp. 345
Author(s):  
Bhaskar Bhandary ◽  
Sachin Shetty ◽  
Mohammed Shabir Kassim ◽  
Amlan Mohapatra
Keyword(s):  
Internal Fixation ◽  
Range Of Motion ◽  
Open Reduction ◽  
Final Analysis ◽  
Distal Humerus ◽  
Open Reduction Internal Fixation ◽  
Range Of Movement ◽  
Humerus Fractures ◽  
The Mean ◽  
Distal Humerus Fractures

<p class="abstract"><strong>Background:</strong> Fractures of the distal humerus represent challenging problems to an orthopaedic surgeon. The present study aimed to assess the range of movement after performing open reduction and internal fixation of distal humerus fractures treated with triceps sparing approach.</p><p class="abstract"><strong>Methods:</strong> This prospective study included all skeletally mature patients with distal humerus fractures and operated at our center with open reduction and internal fixation of distal humerus with triceps on or triceps sparing approach were included in the study. During the study period 30 cases underwent surgery and were included in the final analysis. Fractures were classified according to the AO/OTA classification. Patients will be followed up at 6 weeks, 12 weeks and at 6 months. Mean range of motion of the fractured elbow at different follow up points were compared.<strong></strong></p><p class="abstract"><strong>Results: </strong>The mean age of the total population was 37.7±13.8 years, 57% males and left side was affected in 60% of the patients. Majority of the patients had a range of motion in normal elbow in the range 0 to 140 degrees. There was an increase in the mean range of movement from 63.4±14.2 at 6<sup>th</sup> week to 120±6 at 24<sup>th</sup> week, and this change was statistically significant (p&lt;0.001).</p><p class="abstract"><strong>Conclusions:</strong> Future multicentric randomized studies, specially comparing triceps-sparing with olecranon osteotomy, are needed to support the results of our study.</p>

scholarly journals Salter-Harris type II fracture of the middle phalanx with concomitant central slip injury in an 11 years old: a case report

2020 ◽  
Vol 6 (5) ◽  
pp. 1130
Author(s):  
Devan O. Higginbotham ◽  
Andrew G. Tsai
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Proximal Interphalangeal Joint ◽  
Open Reduction Internal Fixation ◽  
Interphalangeal Joint ◽  
Clinical Indication ◽  
Type Ii ◽  
Middle Phalanx ◽  
Central Slip ◽  
Salter Harris

<p>An 11-year-old male sustained an irreducible, completely displaced epiphyseal fracture of the proximal interphalangeal joint (PIPJ) of the middle finger with an associated central slip injury. Central slip injuries occurring in conjunction with Salter-Harris type II middle phalanx fracture are rare entities, with no previously documented case. Our patient underwent open reduction, internal fixation through crossed-pins to achieve reduction and fixation. He was then splinted in extension for six weeks to allow healing of the central slip injury. At 1-year follow-up, the patient had full range-of-motion with no clinical indication of physeal disruption or growth arrest of the repaired digit. We demonstrate a case in which ephiphyseal fractures of the proximal interphalangeal joint with a concomitant central slip injury can safely be treated with open reduction internal fixation combined with a period of immobilization. We characterize a surgical method of reduction and fixation with splinted immobilization and describe lessons learned from this previously unreported case.</p>

scholarly journals EVALUATION OF FUNCTIONAL OUTCOME OF DISTAL TIBIAL FRACTURES STABILIZED WITH DISTAL TIBIAL LOCKING PLATE

2021 ◽  
Vol 5 (12) ◽  
Author(s):  
Sumeet Verma ◽  
Rakesh Thakur
Keyword(s):  
Internal Fixation ◽  
Functional Outcome ◽  
Open Reduction ◽  
Plate Osteosynthesis ◽  
Distal Tibia ◽  
Open Reduction Internal Fixation ◽  
Tibial Fractures ◽  
P Value ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Distal Tibial Fractures

Background: The present study is an attempt to evaluate the results of locking compression plate for distal tibia in lower tibial fractures using open reduction internal fixation and minimally invasive plate osteosynthesis technique. Methods: The patients attending the OPD/Emergency OPD in post graduate institute of medical education and research, chandigarh during September 2018 to August 2019 with distal tibial fractures. The patients treated with locking compression plates using MIPO or ORIF are reviewed for inclusion and exclusion criteria’s. Patients fitting into inclusion criteria has formed the study group. Results: Out of 52 patients, 48.4% patients undergo open reduction internal fixation had excellent results and 28.6% patients undergo MIPPO technique had excellent results. p value is 0.352 which is not significant. Overall 40.4% patients had excellent results. Conclusion: We observed excellent/ good functional outcome in 65.3% of patients. Keywords: Functional outcome, MIPPO, Tibia

scholarly journals Evaluation of Factors Driving Cost Variation for Distal Humerus Open Reduction Internal Fixation

2020 ◽  
Author(s):  
Michelle Zeidan ◽  
Andrew R. Stephens ◽  
Chong Zhang ◽  
Angela P. Presson ◽  
Andrew R. Tyser ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Distal Humerus ◽  
Open Reduction Internal Fixation ◽  
Cost Variation
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