Management of Fractures Shaft of Tibia in Adult Interlocking Nailing Versus Plating in: A Comparative Study

Background: Tibial shaft fractures are the commonest long bone fractures in adults, most commonly managed by intramedullary interlocking nailing. However, several meta-analysis show that locking plate osteosynthesis is equally effective in managing tibial diaphyseal fractures and are associated with less number of complications. Aim: To compare the results of fixation of tibial fractures followingplating and nailing in terms of union, patient satisfaction and complications. Materials and Methods: Khwaja Yunus Ali Medical College and Hospital based non randomized clinical trial was performed from September 2014 to August 2017 where closed or open diaphyseal or metaphyseo- diaphyseal fractures of the tibia (closed or open Gustilo Anderson type 1 through 3B) were included. Simple sequential allocation was used for allotting the patients to two groups, one for interlocking nailing and other for plating. The patients were followed up for clinical, radiographic and functional results. Results: Forty patients with 41 involved limbs completed followup for one year. in our study was 19.55±0.69 weeks in case of interlocking nailing and 20.38±1.39 weeks in case of plating and there was no statistically significant difference between the two. Conclusion: There was no difference between the twomodalities in terms of fracture union. Complications were lesser but more serious in case of plating. Patient satisfaction was more with plating. KYAMC Journal Vol. 10, No.-2, July 2019, Page 99-105

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Tactics of Operative Treatment for Closed Long Bone Fractures in Patients with Polytrauma in Early Period

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto20031033-9 ◽

2003 ◽

Vol 10 (3) ◽

pp. 3-9

Author(s):

V A Sokolov ◽

E I Byalik ◽

V A Sokolov ◽

E I Byalik

Keyword(s):

Soft Tissues ◽

Bone Fractures ◽

Plate Osteosynthesis ◽

Early Period ◽

Functional Results ◽

Fat Embolism ◽

Long Bone ◽

Long Bone Fractures ◽

Embolism Syndrome ◽

Urgent Operation

Results of the treatment of 218 victims with polytrauma were analyzed during the period from 1998 to 2202. There were 127 patients with one and 91 patients with several closed fractures. Authors consider osteosynthesis for closed long bone fractures to be an urgent operation of third term. Osteosynthesis is absolutely indicated to the patients with psychomotor excitation, in cases of the threat for skin perforation by bone fragments and in patients requiring intensive nursing for their life rescue. The choice of operative method depends on polytrauma severity and fracture type. When osteosynthesis is performed by urgent indications in patients with polytrauma the requirements to osteosynthesis stiffness are higher than in isolate injuries, as the rotation displacement, migration and fixator deformity frequently take place in unconscious patients who need constant intensive nursing. In patients with concomitant thorax injury urgent intramedullar osteosynthesis by nail is contraindicated due to the possibility of fat embolism syndrome development. In these patients plate osteosynthesis is preferred. If there are no absolute indications to urgent osteosynthesis this operation could be performed on 3-10 days after trauma using lightly traumatic and invasive methods not waiting for the complete normalization of homeostasis parameters and restoration of soft tissues in the fracture zone. In closed long bone fractures tactics of early osteosynthesis allows to decrease the rate of hypostatic complications and mortality by more than 10% and achieve good functional results.

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Clinical and radiological evaluation of minimally invasive intramedullary fixation by titanium elastic nails in paediatric long bone fractures of lower limb: a prospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20193592 ◽

2019 ◽

Vol 5 (5) ◽

pp. 816

Author(s):

A. Sandeep ◽

Jayant Jain

Keyword(s):

Intramedullary Nailing ◽

Complication Rate ◽

Bone Fractures ◽

Full Range ◽

Elastic Stable Intramedullary Nailing ◽

Long Bone ◽

Ankle Motion ◽

Soft Tissue Envelope ◽

Internal Support ◽

Diaphyseal Fractures

Background: Elastic stable intramedullary nailing for the treatment of paediatric femur and tibial diaphyseal fractures was introduced by Prevot and colleagues in 1979. It follows three-point fixation principle that provides internal support in presence of cortical contact and an intact soft-tissue envelope. This technique has many advantages, including better reduction, dynamic axial stabilization, shorter hospitalization with early rehabilitation and low complication rate.Methods: This is a prospective observational study done at Kauvery Medical Centre, Trichy between May 2017 to May 2018 consisting of 39 children between age 5 to 16 years with diaphyseal fractures of femur and tibia. The fractures were treated by closed reduction and internal fixation with titanium elastic intramedullary nailing. The patients were evaluated clinically and radiologically and followed for an average of 6 months. Outcome was assessed using transcutaneous electrical nerve stimulation (TENS) scoring system used by Flynn et al.Results: Our series consisted of 39 patients (22 cases with fracture shaft of femur and 17 cases with fracture shaft of tibia), 33 males and only 6 females. Average time for radiological union was 9.89 weeks. All patients had full range of hip and ankle motion and 2 (5.1%) patients had mild restriction in knee flexion at 12 weeks.Conclusions: Elastic stable intramedullary nailing is an ideal method for treatment of paediatric femoral and tibial diaphyseal fractures due to lower complication rate and good functional outcome in comparison to other methods of treatment.

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Outcome of tibial diaphyseal fracture fixation with Surgical Implant Generation Network (SIGN) nail

Journal of Patan Academy of Health Sciences ◽

10.3126/jpahs.v6i2.27206 ◽

2019 ◽

Vol 6 (2) ◽

pp. 5-11

Author(s):

Balakrishnan M. Acharya ◽

Rojan Tamrakar ◽

Pramod Devkota ◽

Abhishek K. Thakur ◽

Suman K. Shrestha

Keyword(s):

Road Traffic ◽

Bone Fractures ◽

Long Bone ◽

Fracture Union ◽

Surgical Implant ◽

Non Union ◽

Generation Network ◽

Diaphyseal Fractures ◽

The Mean

Introductions: Fractures of diaphyseal region of the tibial bone are amongst the most commonly seen extremity injuries in the developing countries. The surgical implant generation network (SIGN) intramedullary (IM) nail was designed for the treatment of long bone fractures in the developing nations. Methods: From March 2008 to December 2018, a total of 104 patients with 104 tibial diaphyseal fractures were treated with SIGN IM nail. The follow-up visits were arranged at 6, 12, 24 weeks and one-year post operatively. During follow-up visits, the signs of fracture union clinically as well as radiologically and the presence of complications any were recorded and analyzed. Results: The mean age of the patients was 32.81 (16 – 65) years, male 74 (71.2%) and female 30 (28.8%). Majority of the patients 70 (67.3%) had fractures after road traffic accidents. The mean time of surgery was 13.58 (1 – 463) days. Six (5.8%) patients had delayed union and no non-union was detected. We had 10 cases (9.6%) of mal-alignment but were on acceptable range. Conclusions: In the developing country like Nepal, the SIGN nail is an effective surgical implant for the management of the tibial diaphyseal fractures with good result of fracture union and low rates of nonunion, mal-alignment and manageable complications.

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Outcomes of Concurrent Functional Endoscopic Sinus Surgery and Rhinoplasty: A Meta-analysis

American Journal of Rhinology and Allergy ◽

10.1177/1945892420980673 ◽

2020 ◽

pp. 194589242098067

Author(s):

Benjamin F. Bitner ◽

Karthik R. Prasad ◽

Khodayar Goshtasbi ◽

Brandyn S. Dunn ◽

Edward C. Kuan

Keyword(s):

Patient Satisfaction ◽

Endoscopic Sinus Surgery ◽

Meta Analysis ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Complication Rates ◽

Medical Problems ◽

Random Effects Models ◽

Ovid Medline ◽

Significant Difference

Introduction Chronic rhinosinusitis (CRS) and functional nasal airway obstruction are common but distinct medical problems which affect quality of life. In certain instances, patients often benefit from concomitant functional septorhinoplasty, or elect for cosmetic rhinoplasty, in addition to functional endoscopic sinus surgery (FESS) and prefer combining procedures. Determining outcomes of combined surgery is important when discussing risks and benefits with patients. Methods A thorough literature search of articles published in PubMed, Ovid MEDLINE, and Cochrane databases. Patients were categorized as either having FESS or rhinoplasty alone or combined. Binary random-effects models were applied to calculate odds ratios (ORs) for outcomes including complications, recurrence, and satisfaction. Results Of the 55 screened articles, 6 were included in the analysis, and of these, 6 (405 patients), 2 (90 patients), 4 (290 patients), and 3 (190 patients) provided data for postoperative complications, recurrence of CRS symptoms, revision rates, and patient satisfaction, respectively. Major complications were observed in 11 (5.8%) total combined cases, 0 (0%) FESS cases, and 6 (3.5%) rhinoplasty cases with no statistical difference between combined cases and rhinoplasties (OR 1.37, 95% CI 0.45–4.16, p = 0.58). Recurrence of CRS symptoms was noted in 35.6% combined cases and 28.9% FESS cases (OR 1.42, 95% CI 0.55–3.64, p = 0.47). There was no observed difference in revision rates between combined and isolated rhinoplasties (OR 1.00, 95% CI 0.43–2.32, p = 1). Lastly, 91.6% of patients were satisfied with results of combined cases compared to 87.4% of patients in standalone cases (OR 1.57, 95% CI 0.61–4.03, p = 0.35). Conclusion Aggregate evidence demonstrates similar risk in complication rates in combined surgical cases compared to stand-alone rhinoplasty. There appears to be no significant difference in recurrence of symptoms, revision rates or patient satisfaction.

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Our experience with percutaneous autologous bone marrow injection in the management of delayed and nonunion of long bone fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20180682 ◽

2018 ◽

Vol 4 (2) ◽

pp. 291

Author(s):

Yeshwanth Subash

Keyword(s):

Bone Marrow ◽

Bone Fractures ◽

Autologous Bone Marrow ◽

Functional Results ◽

Long Bone ◽

Female Ratio ◽

Long Bone Fractures ◽

The Mean ◽

Autologous Bone ◽

Mean Time

Background: Various modalities of treatment are available for the management of delayed and nonunion of long bone fractures. The aim of this study was to evaluate the role of percutaneous autologous bone marrow injection in the management of these fractures and to compare the results with studies of other authors as available in literature.Methods: 15 patients with delayed and nonunion of long bone fractures were studied between January 2013 to January 2015 and were followed up for a period of 1 year. The patients were clinically and radiologically evaluated at regular time intervals at follow up.Results: The age of the patients ranged from 28 to 60 years with the mean age being 44.2 years. There was a male preponderance in our study with the male to female ratio being 2:1. The left side was more commonly affected as compared to the right. The mean time to radiological appearance of callus was 6.4 weeks. The mean time to clinical union was 7.33 weeks while the mean time to radiologic union was 13.4 weeks. We had a union rate of 93.3% in our series with one fracture going in for failure of union. Conclusions: Percutaneous autologous bone marrow injection is a minimally invasive, safe and cost effective option in the management of delayed and nonunion of long bone fractures and gives good functional results.

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Abstract 1122‐000132: Fuoxetine for Recovery After Stroke: A Pooled Analysis of 7165 Patients

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000132 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Mohamed Fahmy Doheim ◽

Ahmed Elsnhory ◽

Mohammed Elgammal ◽

Abdulrahman Ibrahim Hagrass ◽

Ahmed Hanbal ◽

...

Keyword(s):

Randomized Clinical Trials ◽

Bone Fractures ◽

Meta Analysis ◽

Cochrane Library ◽

Stroke Patients ◽

Permanent Disability ◽

Safety And Efficacy ◽

Nihss Score ◽

Significant Difference

Introduction : Stroke is one of the predominant causes of permanent disability, mortality, significant cognitive, physical, and psychosocial morbidity in the world. We conducted this systematic review and meta‐analysis to assess the safety and efficacy of fluoxetine for recovery stroke patients through different time points of follow up. Methods : We searched in PubMed, Cochrane Library, Scopus, and Web of Science databases/ search engines until June 2021. Mean difference (MD) with 95% confidence interval (CI) was applied for continuous data, while risk ratio (RR) with 95% CI was used for dichotomous data. Results : Seventeen randomized clinical trials were identified which assessed the safety and efficacy of fluoxetine compared to placebo for stroke patients. Fluoxetine enhances the National Institutes of Health Stroke Scale (NIHSS) score [MD = ‐0.67, 95 % CI (‐1.19 to ‐0.15), P = 0.01] and the Fugl‐Meyer Motor Scale (FMMS) score [MD = 17.36, 95 % CI (12.12 to 22.61), P <0.00001] at three months follow up. However, the NIHSS score showed no significant difference between the two groups at two weeks [MD = ‐0.32, 95% CI (‐0.72 to 0.07), p = 0.11] or at six months [MD = ‐0.17,95% CI (‐0.47 to 0.14), p = 0.29]. Fluoxetine and placebo‐treated patients had the same overall impact on FMMS scores at one month [MD = 7.77, 95 % CI (‐10.57 to 26.11), P = 0.41]. The fluoxetine arm had a higher risk of broken bone (RR = 2.30, 95% CI [1.59, 3.32], p < 0.001) and hyponatremia (RR = 2.12, 95% CI [1.19, 3.76], p = 0.01) with lower risk of new depression (RR = 0.72, 95% CI [0.61, 0.84], p< 0.001) in comparison to the placebo arm. Conclusions : The efficacy of fluoxetine is likely to take time to emerge, and is expected to be transient. The use of fluoxetine increased the incidence of hyponatremia and bone fractures while decreasing the risk of new‐onset depression.

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Treatment of the overriding fifth toe: Butler’s arthroplasty is a good option

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.12.170099 ◽

2018 ◽

Vol 12 (1) ◽

pp. 36-41 ◽

Cited By ~ 2

Author(s):

R. Simões ◽

C. Alves ◽

L. Tavares ◽

I. Balacó ◽

P. Sá Cardoso ◽

...

Keyword(s):

Patient Satisfaction ◽

Telephone Interview ◽

Deformity Correction ◽

Functional Results ◽

Level Of Evidence ◽

Forefoot Deformity ◽

Significant Difference ◽

Fifth Toe ◽

Clinical Records

Purpose The overriding fifth toe is a congenital triplane deformity that may cause aesthetic and functional concerns in children and adolescents. This study aims to evaluate the results obtained when using Butler’s arthroplasty to treat this forefoot deformity. Methods We performed a retrospective study, including all patients undergoing Butler’s arthroplasty from January 1995 to December 2012. Clinical records were reviewed to determine age at date of surgery, gender, laterality, preoperative symptoms, success of deformity correction, postoperative pain, scarring, need for adapted shoe, rates of complications and recurrence. Patient satisfaction was evaluated through a telephone interview. All p-values < 0.05 were considered statistically significant. Results A total of 21 patients were included in this study, the majority of which were male (57%), with a mean follow-up of 12 months (1 to 52). In the evaluation of the residual deformity (18 patients), 72% had excellent results, 17% good and 11% poor results. One patient had a keloid scar, three patients reported pain and three patients required adapted footwear. There was a partial recurrence of the deformity in three cases. The majority of patients (78%) were satisfied with the surgery. There was no statistically significant difference in terms of results, when comparing patients older and younger than seven years of age (p = 0.46). Conclusions Butler’s operation is effective and safe in the treatment of the overriding fifth toe, yielding good functional results and patient satisfaction, with low rate of complications. Level of Evidence IV

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Cerebral fat embolism syndrome (FES): similar cases with different outcomes

BMJ Case Reports ◽

10.1136/bcr-2018-225261 ◽

2018 ◽

pp. bcr-2018-225261

Author(s):

Alexis Jorgensen ◽

Azhar Bashir ◽

Jibanananda Satpathy

Keyword(s):

Bone Fractures ◽

Plate Osteosynthesis ◽

Neurological Impairment ◽

Fat Embolism ◽

Sudden Onset ◽

Clinical Syndrome ◽

Long Bone ◽

Fat Embolism Syndrome ◽

Long Bone Fractures ◽

Embolism Syndrome

Fat embolism syndrome (FES) is a rare multisystem, clinical syndrome occurring in 0.9%–2.2% of long-bone fractures. The severity of FES can vary from subclinical with mild respiratory changes and haematological aberrations to a fulminant state characterised by sudden onset of severe respiratory and neurological impairment. Here we present two patients with cerebral FES secondary to femur fracture. Both patients exhibited profound neurological impairment with varied outcomes. Our cases highlight the importance of a high clinical suspicion of FES in patients with long-bone fractures and neurological deterioration. We recommend early plate osteosynthesis to prevent additional emboli in patients with FES and situational placement of intracranial pressure monitoring. Finally, cerebral FES has low mortality even in a patient with tentorial herniation and fixed, dilated pupils.

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Fracture Repair in Cats Using a Conical Coupling Mini 1.9 to 2.5 mm Locking Plate System

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0040-1713005 ◽

2020 ◽

Vol 33 (06) ◽

pp. 443-450

Author(s):

Francesca C. Ferrero ◽

Alessandro Boero Baroncelli ◽

Caleb C. Hudson ◽

Bruno Peirone ◽

Ullrich Reif ◽

...

Keyword(s):

Complication Rate ◽

Bone Fractures ◽

Plate Osteosynthesis ◽

Healing Time ◽

Fracture Repair ◽

Long Bone ◽

Minimally Invasive Plate Osteosynthesis ◽

Long Bone Fractures ◽

Size Number ◽

Plate Size

Abstract Objective The aim of this study was to retrospectively evaluate the clinical application of the Fixin mini 1.9 to 2.5 system for the treatment of long bone fractures in cats. We proposed that the Fixin mini system would successfully stabilize long bone fractures in cats with a healing time and complication rate similar to those previously reported for feline fractures using other locking bone plate systems. Materials and Methods Medical records and radiographs of cats with long bone fractures stabilized with the Fixin mini 1.9 to 2.5 system were retrospectively reviewed. Signalment, body weight, bone(s) fractured, region of bone fractured, fracture classification, concurrent orthopaedic injuries, complications, time to functional union, if minimally invasive plate osteosynthesis techniques were used, plate size, number of plates, bone graft use and ancillary methods of fixation were recorded. Results Fifty-six fractures in 54 cats were included. Mean time to radiographic union was 8.8 weeks. Complications were recorded in 8 out of 56 fractures. Major complications occurred in 4 of 56 fractures and minor complications occurred in 4 of 56 fractures. Conclusion The Fixin mini 1.9 to 2.5 system had an overall complication rate and time to functional union similar to that of other implant systems used to treat feline long bone fractures and it appears suitable for repair of a wide variety of long bone fracture configurations in cats.

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Open Versus Endoscopic Surgical Treatment of Posterior Ankle Impingement: A Meta-analysis

The American Journal of Sports Medicine ◽

10.1177/03635465211004977 ◽

2021 ◽

pp. 036354652110049

Author(s):

Ruben Zwiers ◽

Thymen Miedema ◽

Johannes I. Wiegerinck ◽

Leendert Blankevoort ◽

C. Niek van Dijk

Keyword(s):

Patient Satisfaction ◽

Endoscopic Surgery ◽

Open Surgery ◽

Meta Analysis ◽

Aofas Score ◽

Endoscopic Techniques ◽

Full Activity ◽

Ankle Impingement ◽

Significant Difference ◽

Posterior Ankle Impingement

Background: Surgical treatment of symptomatic posterior ankle impingement consists of resection of the bony impediment and/or debridement of soft tissue. Historically, open techniques were used to perform surgery with good results. However, since the introduction of endoscopic techniques, advantages attributed to these techniques are shorter recovery time, fewer complications, and less pain. Purpose: The primary purpose was to determine whether endoscopic surgery for posterior ankle impingement was superior to open surgery in terms of functional outcome (American Orthopaedic Foot & Ankle Society [AOFAS] score). The secondary aim was to determine differences in return to full activity, patient satisfaction, and complications. Study Design: Systematic review and meta-analysis. Methods: MEDLINE, EMBASE (Classic), and CINAHL databases were searched. Publication characteristics, patient characteristics, surgical techniques, AOFAS scores, time to return to full activity, patient satisfaction, and complication rates were extracted. The AOFAS score was the primary outcome measure. Data were synthesized, and continuous outcome measures (postoperative AOFAS score and time to return to full activity) were pooled using a random-effects inverse variance method. Random-effects meta-analysis of proportions using continuity correction methods was performed to determine the proportion of patients who were satisfied and who experienced complications. Results: A total of 32 studies were included in this review. No statistically significant difference was found in postoperative AOFAS scores between open surgery (88.0; 95% CI, 82.1-94.4) and endoscopic surgery (94.4; 95% CI, 93.1-95.7). There was no difference in the proportion of patients who rated their satisfaction as good or excellent, 0.91 (95% CI, 0.86-0.96) versus 0.86 (95% CI, 0.79-0.94), respectively. No significant difference in time to return to activity was found, 10.8 weeks (95% CI, 7.4-15.9 weeks) versus 8.9 weeks (95% CI, 7.6-10.4 weeks), respectively. Pooled proportions of patients with postoperative complications were 0.15 (95% CI, 0.11-0.19) for open surgery versus 0.08 (95% CI, 0.05-0.14) for endoscopic surgery. Without the poor-quality studies, this difference was statistically significant for both total and minor complications, 0.24 (95% CI, 0.14-0.35) versus 0.02 (95% CI, 0.00-0.06) and 0.14 (95% CI, 0.09-0.20) versus 0.03 (95% CI, 0.01-0.05), respectively. Conclusion: We found no statistically significant difference in postoperative AOFAS scores, patient satisfaction, and return to preinjury level of activity between open and endoscopic techniques. The proportion of patients who experienced a minor complication was significantly lower with endoscopic treatment when studies of poor methodological quality were excluded.

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