scholarly journals Complex Ankle Fractures, Presentation of 3 Cases and Review of the Literature

2020 ◽  
pp. 1-6
Author(s):  
Montoya Saenz Rocio ◽  
Montoya Saenz Rocio ◽  
Carlos Cano ◽  
Marques Parrilla Carlos
Keyword(s):  
Soft Tissue ◽  
Elderly Population ◽  
Young Patients ◽  
Soft Tissue Injuries ◽  
The Elderly ◽  
High Energy ◽  
Ankle Fractures ◽  
Inherent Risk ◽  
Fixation Devices ◽  
Main Complication

Ankle fractures represent a significant percentage of all fractures, and there is currently an increased incidence, both among the elderly population with associated comorbidities and among young patients with high-energy traumas. These fractures have an inherent risk of complications. In this connection, it is crucial that we turn our attention to soft tissue injuries, with wound infection as the main complication in this category. The last objective of this study is to highlight the possible derived complications in complex ankle fractures, and to explain the advantages of the use of different fixation devices, through the presentation of three clinical cases treated in our center. We conclude in order to prevent or reduce the complications resulting from the direct surgical treatment of high-energy trauma in the distal end of the tibia, it is essential to properly manage the soft tissue based on the type of lesion and the characteristics of the patient.

scholarly journals Evaluation of results of three and four-part fracture dislocations of proximal humerus in young adults using philos (proximal humerus internal locking system)

2018 ◽  
Vol 6 (2) ◽  
pp. 585
Author(s):  
Amit Thakur ◽  
Khalid Muzzafar ◽  
Sumeet Singh Charak ◽  
Bias Dev ◽  
Abdul Ghani
Keyword(s):  
Proximal Humerus ◽  
Young Patients ◽  
Soft Tissue Injuries ◽  
Functional Results ◽  
High Energy ◽  
High Rate ◽  
Fracture Dislocation ◽  
Rotator Cuff Insufficiency ◽  
Fracture Dislocations ◽  
Adequate Management

Background: The fractures of proximal humerus constitute about 5% of fractures in adults third in number to fracture colles and hip usually in elderly patients due to a low energy trauma. In young patients the fractures are mostly due to high energy trauma and as such are associate with other soft tissue injuries. A sub group of young patients have a three or four fracture dislocation of shoulder joint. The aim of this study was to find the results of fixation by PHILOS in these young patients.Methods: This study was done in a teritiary referral centre over a period of about 1 year. All patients were operated within three weeks. Open fractures, patients with age more than 50 years were excluded from the study. All patients underwent open reduction and fixation using commercially available PHILOS. A minimum of 6 months follows up was essential for inclusion into the study. Final functional results were evaluated by Constant Murley scoring.Results: 14 patients were included in the study. The average age of patients was 38.42years. All fractures united. We had 71.4% excellent or good results. The complications noted were shoulder stiffness in 3, inadequate post op reduction, rotator cuff insufficiency, head necrosis, secondary osteo arthritis 1 each.Conclusions: Despite the relatively high rate of complications encountered in the management of these complicated high-energy fractures, the PHILOS plating system could be considered an adequate management of these patients.

scholarly journals Functional outcome following external fixator (JESS) application for proximal humeral fractures

2016 ◽  
Vol 2 (4) ◽  
pp. 303
Author(s):  
Om P. Gupta ◽  
Arun Vashisht ◽  
Avinash Rastogi ◽  
Naman Gupta ◽  
Utkarsh Shahi ◽  
...  
Keyword(s):  
Soft Tissue ◽  
External Fixator ◽  
Scoring System ◽  
Young Patients ◽  
High Energy ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Average Score ◽  
Soft Tissue Dissection ◽  
Tissue Dissection

<p class="abstract"><strong>Background:</strong> Proximal humeral fractures account for 5% of all fractures. Observed frequently in older osteoporotic patients but found in young patients with high-energy trauma.About 80% of these fractures are undisplaced or minimally displaced. Non-operative method requiring immobilization of shoulder often leads to a stiff shoulder, whereas surgical procedures such as plating need excessive soft tissue dissection. It was overcome in this study by less soft tissue dissection by use of external fixator application and early mobilization.</p><p class="abstract"><strong>Methods:</strong> Total of 18 patients mean age 40.5 years, predominantly male (16/18) treated with external fixator - JESS (Joshi’s external immobilization system) for Neer’s two, three and four part proximal humeral fractures. Vehicular accidents were the most common mode of injury followed by fall. There were 8 cases each of Neer's two and three part fractures. Shoulder mobilization started within a week as postoperativelyas pain allowed. Patients followed up at 3, 6, 12 and 18 weeks for pain, function, range of motion and anatomy with check X-ray. After radiological union at 8-10 weeks JESS was removed. Cases were evaluated for functional result by constant scoring system.<strong></strong></p><p class="abstract"><strong>Results:</strong> Average score on constant scoring system was 72 after a mean follow-up of 6 months. All fractures united in mean duration of 9.33 weeks. The complications included shoulder stiffness in one case and pin tract infection in two cases.</p><strong>Conclusions:</strong> Early shoulder mobilization a prerequisite for good results can be achieved without compromising fracture union. Less soft tissue dissection required and significant cost effective.

scholarly journals Laparoscopic Cholecystectomy in the Elderly: An Experience at a Tertiary Care Hospital in Western Nepal

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Tika Ram Bhandari ◽  
Sudha Shahi ◽  
Rajeev Bhandari ◽  
Rajesh Poudel
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Elderly Patients ◽  
Medical Records ◽  
Elderly Population ◽  
Tertiary Care ◽  
Young Patients ◽  
The Elderly ◽  
Young Group ◽  
Perioperative Outcomes ◽  
Care Hospital

Background. The incidence of gallstone increases with increasing age. No studies have been reported in the elderly population with laparoscopic cholecystectomy from developing nations. The aim of this study was to compare perioperative outcomes of laparoscopic cholecystectomy between the elderly (≥60 years old) and the young (<60 years old).Methods. From July 2015 to June 2016, a retrospective review of medical records of 78 elderly patients (≥60 years old) and 164 young patients (<60 years old) who underwent laparoscopic cholecystectomy was done. The patients’ demographics and perioperative outcomes were analyzed.Results. Median ages were 65 years (range: 60–80) and 45 years (range: 21–59) for the elderly group and the young group. The majority of patients were female (62.8 and 72%). There were no significant differences in the conversion rate (9 and 7.9%,P=0.78), postoperative complications (17.9 and 14.6%,P=0.50), and length of stay in the hospital (4 days for both groups,P=0.35) between the two groups. There was no mortality in either of the groups.Conclusion. Our results of laparoscopic cholecystectomy in elderly patients are comparable with those in young patients. Therefore, laparoscopic cholecystectomy is safe even in the elderly population.

scholarly journals Acetabular fractures in the elderly: modern challenges and the role of conservative management

2021 ◽  
Author(s):  
Kunal Mohan ◽  
James M. Broderick ◽  
Hasnain Raza ◽  
Brendan O’Daly ◽  
Michael Leonard
Keyword(s):  
Conservative Management ◽  
Young Patients ◽  
Treatment Strategies ◽  
The Elderly ◽  
High Energy ◽  
Acetabular Fractures ◽  
Individualized Approach ◽  
Vulnerable Patient ◽  
Vulnerable Patient Group

Abstract Introduction  The incidence of acetabular fractures in the elderly population is ever increasing. While management of acetabular fractures in young patients following high-energy trauma is well described, treatment of the elderly patient subgroup is complex and requires a unique, individualized approach. A variety of treatment strategies including operative and non-operative approaches exists to manage this vulnerable patient group. Conservative management of acetabular fractures in the elderly continues to play an important role in treatment of both stable fracture patterns and those medically unfit for surgery. Aim  This review assessing the current literature was undertaken with the purpose of summarising the challenges of management in this at-risk cohort as well as quantifying the role and outcomes following conservative management in the elderly.  Conclusion Our recommendation is that conservative management of acetabular fractures in the elderly can be considered as a treatment option on a case-by-case basis accounting for patient, injury, and surgical factors. If it is to be pursued, we advise a multidisciplinary approach focused on early mobility, minimisation of risk and regular follow-up to optimise patient outcomes.

scholarly journals Transarticular tibiotalocalcaneal nailing versus open reduction and internal fixation for treatment of the elderly ankle fracture: protocol for a multicentre, prospective, randomised controlled trial

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e026360
Author(s):  
Paul Tuckett ◽  
Matthew Hope ◽  
Kevin Tetsworth ◽  
Jerry Van De Pol ◽  
Catherine McDougall
Keyword(s):  
Randomised Controlled Trial ◽  
Elderly Population ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Controlled Trial ◽  
Weight Bearing ◽  
The Elderly ◽  
Primary Outcome Measure ◽  
Ankle Fractures ◽  
Randomised Controlled

IntroductionAnkle fractures are common in the elderly population. Surgical fixation is technically challenging and often results in complications due to high rates of osteoporosis and vascular disease. Open reduction and internal fixation (ORIF) often requires prolonged periods of non-weight bearing increasing the risks of complications. Tibiotalocalcaneal (TTC) nailing has been suggested as an alternative to ORIF which allows immediate weight bearing, and is suggested to result in fewer complications. This study aims to compare the two surgical techniques in the elderly population with ankle fractures.Methods and analysisThe study will be a multicentre, prospective, randomised controlled trial comparing ORIF to TTC nailing in 110 patients with ankle fractures aged 50 or above with a Charlson Comorbidity Index of greater than or equal to four. Participants and assessors will not be blinded to intervention. The primary outcome measure will be overall complication rate. Secondary outcomes include length of hospital stay, mobility at discharge, discharge destination, the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot score, the Olerud-Molander Ankle Score, mortality rate, rate of secondary surgical interventions and number of blood transfusions required postoperatively. Our null hypothesis is that there is no clinically significant difference in the primary outcome measure between the two treatment groups.Ethics and disseminationThe study has been approved by Metro South Hospital and Health Services Human Research Ethics Committee (EC00167) (reference number HREC/17/QPAH/351).DiscussionCompletion of this trial will provide evidence on the effectiveness of TTC nailing versus ORIF in treatment of the elderly ankle fracture. If TTC nailing is found to result in superior outcomes, this trial has the capacity to change current clinical practice.Trial registration numberACTRN12617001588381;Pre-results andU1111-1203-1704.

scholarly journals Perilunate Dislocation Above the Age of 65 Years: Case Series and Review of Literature

2021 ◽  
Vol 12 ◽  
pp. 215145932110362
Author(s):  
Guy Rubin ◽  
Amir Eliyahu ◽  
Erez Grinbaum ◽  
Nimrod Rozen
Keyword(s):  
Literature Review ◽  
Elderly Population ◽  
Case Series ◽  
The Elderly ◽  
High Energy ◽  
Perilunate Dislocation ◽  
Energy Mechanism ◽  
Fracture Dislocations ◽  
Missed Diagnosis

Introduction Perilunate and fracture dislocations predominantly follow a high-energy mechanism. Perilunate dislocations have an incidence of 0.5/105 individuals/year, occurring at a mean age of 26 years and are frequently seen in men. This study aimed to describe the characteristics of this injury in elderly population of patients using literature review and our experience with four cases aged >65 years. Materials and Methods We treated four patients with perilunate dislocation aged >65 years. All the patients’ medical records were reviewed retrospectively. A literature review for case studies of perilunate dislocation was conducted with the purpose of finding cases including patients aged >65 years. Results Three of our patients had injuries that were missed in the first visit in the emergency department. The mechanism of injury was high energy in only two patients. Two patients had posterior perilunate dislocation, while the other two had transradial perilunate dislocation. Three patients were available for follow-up. The overall outcome was satisfaction according the Mayo wrist score and minimal disability according to the Disabilities of the Arm, Shoulder and Hand score. All patients reported that pain was absent and they were able to return to their regular activities. The literature review found only seven papers documenting treatment of patients aged >65 years. Discussion Perilunate dislocation is extremely rare in the population aged >65 years. Although the rate of missed diagnosis in our cohort was extremely high, the overall satisfaction and return to function was high. Conclusions This case series and literature review highlight the unique characteristics of this injury in the age group of patients aged >65 years. Although perilunate dislocation in patients aged >65 years is rare, clinicians should be aware of the presentation of this condition in the elderly.

Vacuum-Assisted Wound Closure (VAC Therapy) for the Management of Patients With High-Energy Soft Tissue Injuries

2003 ◽  
Vol 17 (10) ◽  
pp. 683-688 ◽  
Author(s):  
Dolfi Herscovici, ◽  
Roy W. Sanders ◽  
Julia M. Scaduto ◽  
Anthony Infante ◽  
Thomas DiPasquale
Keyword(s):  
Soft Tissue ◽  
Wound Closure ◽  
Soft Tissue Injuries ◽  
High Energy ◽  
Vac Therapy ◽  
Tissue Injuries
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