Management of Tibial Metaphyseal Fractures Using JESS Fixator

Introduction: The management of proximal and distal tibia fractures remains challenging due to associated soft tissue injuries. The use of wire fixators for the definitive treatment of such fractures entails a minimally invasive technique of insertion that gives good fracture reduction and stability combined with minimal postoperative complications. Aim: To assess the outcome of treatment of such fractures by the use of Joshi’s external stabilization system (JESS), which is a simple wire based, circular external fixator system. Materials and Methods: A prospective, uncontrolled study was done using JESS on 30 consecutive patients (20 patients of proximal tibial metaphyseal fractures and 10 of distal tibial metaphyseal fractures). Results: In our study, the most common mode of injury was road traffic accidents (21 cases), fall from height (6 cases) and slip injury (3 cases). The patients were operated at a mean interval of 3.2 days (range 1-6 days) due to associated poor soft tissue conditions. The patients were followed up for 24 weeks. Full weight bearing was allowed at 10 to 14 weeks. JESS frame was removed at mean duration of 13 weeks (range 12-16 weeks). According to knee society score (KSS), excellent result (score 80- 100) was seen in 12 patients (60%), good result (score 70-79) was seen in 4 patients (20%), fair result (score 60-69) in 3 patients (15%) and poor result (score <60) in 1 patient (5%) of proximal tibial metaphyseal fracture. According to Olerud and Molander score (OAMS), excellent result (score 91-100) was seen in 5 patients (50%), good result (score 61-90) in 3 patients (30%) and fair result (score 31-60) in 2 patients (20%) of distal tibial metaphyseal fracture. The complication seen was superficial pin tract infection in 4 patients, which was managed by regular pin tract dressing and oral antibiotics. Delayed union (mean at 15.3 weeks) was seen in 2 patients with Schatzker type VI fracture and 1 patient with severe comminuted distal metaphyseal fracture. Conclusion: JESS is a simple, light, effective and cheap method and can be used as a definitive procedure to treat these fractures even with soft tissue compromise.

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Non-locking buttress plate in distal tibial metaphyseal fractures

Medical Journal of Pokhara Academy of Health Sciences ◽

10.3126/mjpahs.v1i2.23401 ◽

2018 ◽

Vol 1 (2) ◽

pp. 87-91

Author(s):

Norman Lamichhane ◽

Bhogendra Bahadur KC ◽

Chandra Bahadur Mishra ◽

Sabita Dhakal

Keyword(s):

Soft Tissue ◽

Weight Bearing ◽

Delayed Union ◽

Full Weight Bearing ◽

Distal Fibula ◽

Fibula Fracture ◽

Group A ◽

The Mean ◽

Group B ◽

Metaphyseal Fractures

Background: Treatment of distal tibial metaphyseal fractures is often challenging and no single technique has been unanimously advocated. Open reduction and internal fixation with plates and screws allows better restoration of anatomical alignment but with more soft tissue complication. Simultaneous fixation of the fibula is not universally carried out. This study aims at evaluation of the outcome of plating technique and the effect of fixation of fibula fracture in treatment of distal tibial metaphyseal fractures. Material and methods: Thirty-one cases (14 cases in Group A with concomitant distal fibula fracture and 17 cases in Group B without distal fibula fracture) were analyzed retrospectively for the mean duration of full weight bearing, mean union time and complications, and compared. Results: The mean time for full weight bearing and radiological union in our study was 14.2 weeks (15.9 in Group A and 13.1 in Group B) and 23.8 weeks (26.6 in Group A and 21.5 in Group B) respectively. 16.1% of cases had post-operative complications including one case of deep infection and malalignment of 6 degree varus (following delayed union) was seen in one case of Group A. Range of motion (ROM) at ankle was not problem in any of the cases except the one delayed union which had 5 degrees of dorsiflexion and 15 degrees of plantiflexion. Conclusion: Open reduction and internal fixation with plate and screws in distal tibial metaphyseal fracture is more economic means of treatment modality with comparable incidence of post-union malalignment and union time,though more soft tissue complications compared to other modalities. Fixation of fibula fracture aids in reducing the incidence of malalignment.

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A prospective study of distal radius fracture management by close reduction, percutaneous Kirschner wire fixation and plaster immobilization

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20171898 ◽

2017 ◽

Vol 3 (3) ◽

pp. 537

Author(s):

Abhishek Chattopadhyay ◽

Upal Banerjee ◽

Prashant Kumar Sinha ◽

Subarna Misra ◽

Ananya Chattopadhyay ◽

...

Keyword(s):

Distal Radius Fracture ◽

Distal Radius ◽

Excellent Result ◽

Kirschner Wire ◽

Radius Fracture ◽

Invasive Technique ◽

Fair Result ◽

Kirschner Wire Fixation ◽

Wire Fixation ◽

Plaster Immobilization

Background: Distal radius fracture is one of the most common fractures. It may be sustained due to low-energy trauma or high-energy trauma. Objectives: To compare the clinical effectiveness of Kirschner wire fixation with and plaster immobilization for patients with fracture of the distal radius.Methods: Interventions Kirschner wire fixation: wires are passed through the skin over the dorsal aspect of the distal radius and into the bone to hold the fracture in the correct anatomical position. About 79 patients with Distal Radial Fractures presented to MGM Medical College and LSK Hospital, Kishanganj between November 2012 and June 2014 were included in the study.Results: The majority were men (60.4%). Majority of the patients (69.8%) sustained the injury due to fall. The side of involvement was nearly equal and that there was no predominance of the either sides. In our study, according to AO classification, 31 cases were of Type A, 17 were of Type B and 5 were of Type C. The Anatomical evaluation by Sarmiento’s Criteria showed 33 patients with excellent result, 15 patients with good result and 5 with a fair result. At final follow-up by ‘The Gartland and Werley criteria for functional outcome’ 37 patients had excellent result, 13 had good result, 2 had fair result and 1 had a poor result. Conclusions: This study demonstrates that percutaneous Kirschner wire pinning is a minimally invasive technique that provides an effective means of maintaining the anatomical fracture reduction. It does not required highly skilled personnel or sophisticated tools for application. It is a suitable method for fixation of displaced Colles fracture with minimal intra-articular involvement. The technique involves a minimal procedure that provides anatomic reduction, fracture fixation, and maintenance of reduction with an adequate method of immobilization.

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Comparative study between intramedullary interlocking nailing and minimally invasive percutaneous plate osteosynthesis for distal tibia extra-articular fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20214185 ◽

2021 ◽

Vol 7 (6) ◽

pp. 1177

Author(s):

Anil Sharan ◽

Johney Juneja ◽

Raghvendra Choubisa ◽

Nitin Jeenjwadia ◽

A. K. Mehra ◽

...

Keyword(s):

Soft Tissue ◽

Minimally Invasive ◽

Comparative Study ◽

Plate Osteosynthesis ◽

Weight Bearing ◽

Distal Tibia ◽

Tibia Fractures ◽

Group A ◽

Distal Tibia Fractures ◽

Group B

Background: Treatment of distal tibia fractures poses significant challenge to orthopedic surgeon because of poor blood supply and paucity of soft tissue coverage. There is considerable controversy regarding the superior option of treatment for distal tibia fracture between the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and intramedullary interlocking (IMIL) nailing for extra-articular distal tibia fractures. The aim of our study is to compare the functional outcome between the two treatment methods.Methods: This was the prospective comparative study of 50 patients with distal third tibia fractures divided into two groups. First group of patients were treated with MIPPO technique while second group of patients were managed by IMIL nailing. Patients were followed up in outpatient department to assess the functional outcomes, malunion, delayed union, non-union, superficial and deep infection between the two groups.Results: Average time taken by patients for full weight bearing in group A was 17.6 weeks as compared to 16.7 weeks in group B. All patients were able to bear weight prior to complete union of fracture. By the process of weight bearing, we believed that it would promote secondary bone healing. On taking X-rays during follow up of included patients starting of radiological union was observed carefully by looking for bridging callus, haziness of fracture line. Appearance of callus was taken average time of 12.5 weeks in group A and 12.1 weeks in group B.Conclusions: Both procedures have shown the reliable method of fixation for distal extra-articular tibia fractures preserving the soft tissue, bony vascularity and fracture hematoma that provide a favourable biological environment for fracture healing. Considering the results of the study, we have slightly more preference for the MIPPO technique.

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A Novel Minimally Invasive Reduction Technique by Balloon and Distractor for Intra-Articular Calcaneal Fractures: A Report of 2 Cases

Case Reports in Orthopedics ◽

10.1155/2018/7909184 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8

Author(s):

M. Prod’homme ◽

S. Pour Jafar ◽

P. Zogakis ◽

P. Stutz

Keyword(s):

Soft Tissue ◽

Minimally Invasive ◽

Soft Tissues ◽

Weight Bearing ◽

Calcaneal Fracture ◽

Invasive Technique ◽

Calcaneal Fractures ◽

Early Weight Bearing ◽

Articular Fractures ◽

Minimally Invasive Reduction

Treatment of displaced intra-articular fractures of the calcaneus remains a challenge for the orthopaedic surgeon. Conservative therapy is known to produce functional impairment. Surgical approach is plagued by soft-tissue complications and insufficient fracture reduction. We describe a minimally invasive technique that will hopefully improve these issues. We want to present our first experience through two cases. The first was a 46-year-old man who presented with a Sanders type IIBC calcaneal fracture, and the second was a 86-year-old woman with a type IIIBC calcaneal fracture. We introduced 2 Schanz screws in the talus and the calcaneus. After distraction, we introduced an inflatable balloon inside the calcaneus. By inflating the balloon, the articular surface was reduced by lifting it up. Then bone cement was injected in order to maintain the reduction. Additional screw fixation was used in the young patient. Postoperative imaging showed good congruence of the subtalar joint without leakage of cement, for the two cases. After 2 months, the patients had no pain and were without soft-tissue complications. We advocate this technique to perform a minimally invasive reduction and fixation of intra-articular calcaneal fractures because it preserves soft-tissues and provides good clinical results with early weight-bearing.

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Outcome of the Treatment of Distal Tibia Fractures by Minimal Invasive Locked Plate – A Short Term Study

Journal of Nobel Medical College ◽

10.3126/jonmc.v6i1.18081 ◽

2017 ◽

Vol 6 (1) ◽

pp. 12-19

Author(s):

Ranjib Kumar Jha ◽

Yogendra Gupta ◽

Navin Karn

Keyword(s):

Soft Tissue ◽

Minimally Invasive ◽

Plate Fixation ◽

Distal Tibia ◽

Invasive Technique ◽

Type I ◽

Short Term ◽

Plate Interface ◽

Locked Plating ◽

Soft Tissue Dissection

Background :Treatment of fracture distal tibia is challenging. Classic open reduction and internal plate fixation requires extensive soft tissue dissection and causes periosteal injury. The locking screw-plate interface allows fracture fixation without plate–bone adherence, thus preserving the fracture hematoma, and reduces the risk of nonunion by maintaining microvascular circulation within the cortex and its investing tissues.Material & Methods: This study included 33 patients of age between 18 to 62 years with extra-articular and simple intra-articular fracture of distal tibia. All fractures were fixed by minimally invasive technique with pre-countered distal tibia locking plate under image intensifier control. The American Orthopaedic Foot and Ankle Society (AOFAS) scale was used for functional assessment.Results: Out of 33 there were twelve 43-A1, five A2, five A3, five B1, three B2, two C, one C2 fractures. There were 29 closed fracture and four open fracture (three type I and one type II). The overall mean time of union was 16.3 weeks. The mean AOFAS score was 93 points. In all 30 cases there were no wound problems, whereas three cases had superficial wound infection. No any cases needed secondary procedure for healing of bone.Conclusion: The short-term results shows that minimally invasive locked plating is good solution for the challenging distal tibia fracture. This technique minimizes soft tissue complication and provides good union and functional outcome.Journal of Nobel Medical CollegeVolume 6, Number 1, Issue 10 (January-June, 2017), page: 12-19

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Sialendoscopy With Intraductal Steroid Irrigation in Patients With Sialadenitis Without Sialoliths

Ear Nose & Throat Journal ◽

10.1177/0145561319841207 ◽

2019 ◽

Vol 98 (5) ◽

pp. 291-294 ◽

Cited By ~ 4

Author(s):

Saudamini J. Lele ◽

Mickie Hamiter ◽

Torrey Louise Fourrier ◽

Cherie-Ann Nathan

Keyword(s):

Treatment Option ◽

Case Series ◽

Complete Response ◽

Definitive Treatment ◽

Invasive Technique ◽

Effective Treatment Option ◽

Patient Reported ◽

History Of ◽

The Mean

Sialendoscopy has emerged as a safe, effective and minimally invasive technique for management of obstructive and inflammatory salivary gland disease. The aim of our study was to analyze outcomes of sialendoscopy and steroid irrigation in patients with sialadenitis without sialoliths. We performed a retrospective analysis of patients who underwent interventional sialendoscopy with steroid irrigation from 2013 to 2016, for the treatment of sialadenitis without sialolithiasis. Twenty-two patients underwent interventional sialendoscopy with ductal dilation and steroid irrigation for the treatment of sialadenitis without any evidence of sialolithiasis. Conservative measures had failed in all. Eleven patients had symptoms arising from the parotid gland, 4 patients had symptoms arising from the submandibular gland, while 6 patients had symptoms in both parotid and submandibular glands. One patient complained of only xerostomia without glandular symptoms. The mean age of the study group which included 1 male and 21 females was 44.6 years (range: 3-86 years). Four patients had autoimmune disease, while 7 patients had a history of radioactive iodine therapy. No identifiable cause for sialadenitis was found in the remaining 11 patients. The mean follow-up period was 378.9 days (range: 16-1143 days). All patients underwent sialendoscopy with ductal dilation and steroid irrigation. Twelve patients showed a complete response and 9 patients had a partial response, while 1 patient reported no response. Only 3 patients required repeat sialendoscopy. The combination of sialendoscopy with ductal dilation and steroid irrigation is a safe and effective treatment option for patients with sialadenitis without sialoliths refractory to conservative measures. Prospective studies with a larger case series are needed to establish its role as a definitive treatment option.

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Stress Fractures in Royal Marine Recruits

Journal of The Royal Naval Medical Service ◽

10.1136/jrnms-56-78 ◽

1970 ◽

Vol 56 (1) ◽

pp. 78-91

Author(s):

J. Bertram

Keyword(s):

Soft Tissue ◽

Weight Bearing ◽

Fracture Site ◽

Stress Fractures ◽

Vigorous Activity ◽

Main Symptom ◽

Soft Tissue Swelling ◽

History Of ◽

Radiological Changes

AbstractThe main features of stress fractures in Royal Marine recruits are that they occur in normal bones, most often those that are weight bearing. There is no history of injury, but there is usually a history of unaccustomed or more vigorous activity for some weeks before onset. The main symptom is pain on use of the affected part and this pain is relieved by rest. Localised tenderness and soft tissue swelling are present at the fracture site when the affected bone is readily palpable. Radiological changes are absent in the first seven to ten days, but become visible within two months, unless treatment starts or stress ceases early.

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Minimally Invasive Plate Osteosynthesis Using Locking Plates for AO 43–Type Fractures: Lessons Learnt From a Prospective Study

Foot & Ankle Specialist ◽

10.1177/1938640017726134 ◽

2017 ◽

Vol 11 (3) ◽

pp. 236-241 ◽

Cited By ~ 1

Author(s):

Rajeev Shukla ◽

Nikhil Jain ◽

Ravi Kant Jain ◽

Shravan Patidar ◽

Vivek Kiyawat

Keyword(s):

Soft Tissue ◽

Minimally Invasive ◽

Plate Osteosynthesis ◽

Distal Tibia ◽

Minimally Invasive Plate Osteosynthesis ◽

Surgical Trauma ◽

Locking Plates ◽

Soft Tissue Dissection ◽

Tibia Fractures ◽

Radiological Union

Introduction. Managing fractures of distal tibia is still a subject of debate for orthopaedic surgeons in terms of both, reduction and fixation. Subcutaneous location and soft tissue anatomy predisposes it to angular and rotational instability as well as other bony and soft tissue complexities. Minimally invasive plating offers many advantages over conventional open techniques. It causes minimal soft tissue dissection and surgical trauma to the bone. Minimally invasive plate osteosynthesis(MIPO) maintains biological configuration of distal tibia and fracture hematoma and also provides a construct, which is biomechanically more stable. Objectives. Evaluation of results of MIPO in management of distal tibia fractures considering radiological union, ankle function restoration, and complications. Materials and Methods. In our study, 25 closed distal one-third tibia fracture with/without articular extension were taken, fulfilling the inclusion criteria (AO classification: 10, 43A1; 3, 43A2; 2, 43B1; 4, 43B2; and 6, 43C1). MIPO with locking plates was the treatment undertaken. Patients were followed up for 18 months prospectively. Results. Average injury-hospital interval was 11.16 hours and average injury-operation interval was 2.44 days. All fractures showed radiological union at an average duration of 20.5 weeks (14-28 weeks). Olerud and Molander score was used for evaluation at 3, 6, and 18 months. One patient had union with valgus angulation >5° but there was no nonunion. There was 1 superficial postoperative wound infection. Conclusion. Our study shows that plating with MIPO is an effective treatment for closed distal one-third tibia fractures, considering union time and complications rate. Younger age promotes early union and functional recovery. Levels of Evidence: Therapeutic, Level II: Prospective

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Treatment of distal tibia metaphyseal fractures by percutaneous plate osteosynthesis

Journal of the Korean Fracture Society ◽

10.12671/jksf.2002.15.2.185 ◽

2002 ◽

Vol 15 (2) ◽

pp. 185

Author(s):

Chang Wug Oh ◽

Joo Chul In ◽

Seong Man Lee

Keyword(s):

Plate Osteosynthesis ◽

Distal Tibia ◽

Metaphyseal Fractures

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The ICEROSS concept: A discussion of a philosophy

Prosthetics and Orthotics International ◽

10.3109/03093649309164354 ◽

1993 ◽

Vol 17 (1) ◽

pp. 49-55 ◽

Cited By ~ 85

Author(s):

Ö. Kristinsson

Keyword(s):

Soft Tissue ◽

Weight Bearing ◽

Skin Care ◽

Custom Made ◽

The Subject ◽

Distal Direction ◽

Inside Out

Prefabricated ICEROSS (Icelandic Roll On Silicone Socket) sockets have been in use in Iceland since early 1986. Use of custom-made silicone sockets began several years earlier, and a paper devoted to the subject was presented at the 1984 AOPA Assembly by the author of this article. The ICEROSS system is primarily used for suspension. At the same time the author believes it considerably improves the weight-bearing capability of the prosthesis and the interface between prosthesis and user. After being turned inside out and rolled over the stump, the silicone sleeve forces skin in a distal direction, stabilising soft tissue and minimising pistoning. Both prosthetist and user may experience some problems initially, although most can be overcome by careful socket design and skin care.

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