scholarly journals Functional results after operative treatment of talus fractures

2021 ◽  
Vol 13 (1) ◽  
pp. 1-6
Author(s):  
Andreja Gavrilovski ◽  
Aleksandra Gavrilovska-Dimovska ◽  
Goran Aleksovski
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Functional Results ◽  
High Rate ◽  
Posttraumatic Osteoarthritis ◽  
Anatomic Reduction ◽  
Aseptic Osteonecrosis ◽  
The University ◽  
With Screws

Fractures of the talus do not occur frequently, accounting for about 0.1% of all fractures. Failure to achieve anatomic reduction, exponentially increases the risk of postoperative aseptic osteonecrosis and posttraumatic osteoarthritis. The purpose of this study was to evaluate and compare the short-term and medium-term functional outcomes in patients who underwent open reduction and internal fixation of talus fractures. Materials and methods: At the University Clinic for Traumatology in the period between 2017 to 2020, 14 patients with talus fractures were surgically treated. The inclusion and exclusion factors were determined, all patients signed the consent and the study passed the ethics committee. Results: All patients underwent open reduction and internal fixation with screws or reconstructive plate. Follow-up was done on the 14th postoperative day, 1st month, 3rd month and 6th month. At the 6th month follow-up, the functional outcome was tested using the Kitaoka score unified by the American Orthopedic Foot and Ankle Society. This injury is too rare for conclusions to be brought out of and to be compared to larger studies. However, all major studies from reference trauma centers lead to the same conclusions, that the treatment of these fractures is complex Anatomical reduction is mandatory for a better outcome. Conclusion: A protocol for the treatment of posttraumatic osteoarthritis should be introduced, given the high rate of its occurrence despite the satisfactory surgical technique.

scholarly journals Limited Open Reduction and Internal Fixation of Calcaneal Fractures

2019 ◽  
Vol 41 (1) ◽  
pp. 57-62 ◽  
Author(s):  
Anne K. Bremer ◽  
Lukas Kraler ◽  
Lars Frauchiger ◽  
Fabian G. Krause ◽  
Martin Weber
Keyword(s):  
Wound Healing ◽  
Internal Fixation ◽  
Open Reduction ◽  
Case Series ◽  
Functional Results ◽  
High Rate ◽  
Calcaneal Fractures ◽  
Retrospective Case ◽  
Level Of Evidence

Background: The treatment of displaced intra-articular calcaneal fractures remains a challenge and the optimal approach is still controversial. The main reason to avoid the extended lateral approach is the high complication rate due to wound healing problems. We report on 16 years of experience with a standardized limited open reduction and internal fixation technique. Methods: Between 2001 and 2017, we prospectively followed 240 consecutive patients operatively treated for a displaced intra-articular calcaneal fracture. Patients with open, multiple, bilateral, extra-articular, and Sanders IV fractures and those lost to follow-up were excluded. A lateral subtalar approach was used, with a cast for 8 weeks and full weightbearing allowed after 12 weeks. Follow-up examinations were scheduled until 24 months. Subjective and clinical assessment included gait abnormality, subtalar and ankle range of motion, and stability and alignment. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score was calculated. Alignment was analyzed on standard radiographs. In total, 131 patients were excluded. The remaining 109 patients were followed for a minimum of 24 months (34.4 ± 14.2 [range, 24-102] months). Results: The mean AOFAS score was 87 ± 13 (range, 32-100). “Excellent” and “good” results, as well as hindfoot motion with “normal/mild” and “moderate” restrictions, were seen in 80% of patients. Early reoperations were performed for insufficient reduction (2 patients), delayed wound healing (debridement, 3 patients), and hematoma (1 patient). Late revisions were arthrodesis (3 patients), medializing calcaneal osteotomy (1 patient), and implant removal (53 patients; 49%). Conclusion: The presented approach has remained unmodified for 16 years and resulted in consistently good functional results. The main disadvantage was the high rate of heel screw removal. Level of Evidence: Level IV, retrospective case series.

The Chauffeur’s Fracture: Simple or Complex?

1992 ◽  
Vol 17 (2) ◽  
pp. 156-159 ◽  
Author(s):  
R. H. HELM ◽  
M. A. TONKIN
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Functional Results ◽  
Complex Pattern ◽  
Mechanism Of Injury ◽  
Radial Styloid ◽  
Carpal Injury ◽  
Radial Styloid Fracture

14 chauffeur’s-type fractures were treated by open reduction and internal fixation, mainly with Herbert screws. At average follow-up of 18 months, all had good or excellent functional results. The presence of an associated carpal injury in four cases indicates that the mechanism of injury may not be one of simple “backfire” and that a radial styloid fracture may represent the first stage of a more complex pattern.

Open reduction and internal fixation of displaced head-split type humeral fractures and role of the rotator-interval approach

2021 ◽  
pp. 175857322110654
Author(s):  
E. Fleischhacker ◽  
G. Siebenbürger ◽  
J. Gleich ◽  
T. Helfen ◽  
W. Böcker ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Dash Score ◽  
Rotator Interval ◽  
Anatomic Reduction ◽  
Interval Approach ◽  
High Instability

Background Open reduction and internal fixation (ORIF) of humeral head split fractures is challenging because of high instability and limited visibility. The aim of this retrospective study was to investigate the extend of the approach through the rotator interval (RI) on the reduction quality and functional outcome. Methods 37 patients (mean age: 59  ±  16 years,16 female) treated by ORIF through a standard deltopectoral (DP) approach were evaluated. The follow-up period was at least two years. In 17 cases, the approach was extended through the RI. Evaluation was based on radiographs, Constant scores (CS) and DASH scores. Results In group DP, “anatomic” reduction was achieved in 9 cases (45%), “acceptable” in 5 cases (25%), and “malreduced” in 6 cases (30%). In group RI, “anatomic” reduction was seen in 12 cases (71%), “acceptable” in 5 cases (29%), and “malreduced” in none (p  =  0.04). In the DP group, the CS was 60.2  ±  16.2 and the %CS was 63.9  ±  22.3, while in the RI group, the CS was 74.5  ±  17.4 and the %CS was 79.1  ±  24.1 (p  =  0.07, p  =  0.08). DASH score was 22.8  ±  19.5 in DP compared to RI: 25.2  ±  20.6 (p  =  0.53). Conclusions The RI approach improves visualization as it enhances quality of fracture reduction, however functional outcomes may not differ significantly. Type of study and level of proof Retrospective, level III

scholarly journals Evaluation of functional and clinical outcome of open reduction and internal fixation of Barton’s fracture of the wrist in a central hospital of Kashmir

2021 ◽  
Vol 7 (5) ◽  
pp. 986
Author(s):  
Jawed A. Bhat ◽  
Faesal Khurseed ◽  
Abdul H. Javaid
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Road Traffic ◽  
Excellent Result ◽  
Functional Results ◽  
Functional Evaluation ◽  
College Hospital ◽  
Articular Fractures ◽  
Limited Range Of Motion

<p class="abstract"><strong>Background:</strong> Fractures of the distal end of radius continue to pose a management challenge. Defective alignment of extra articular as well as intra articular fractures result in a variety of complications like post traumatic arthritis, decreased in grip strength and endurance as well as limited range of motion and instability of carpus. The main aim of this study is to assess the functional results of open reduction and internal fixation in the treatment of volar Barton’s fracture.</p><p class="abstract"><strong>Methods:</strong> From December 2006 to December 2019, forty cases of volar Barton’s fracture were operated in Skims Medical College Hospital, Srinagar, Kashmir, however only 32 cases were included in the study group and 8 cases were lost to follow up. In the majority of our cases the injury was sustained as a result of road traffic accident followed by fall. Majority (24) of the cases were operated within one week of trauma, followed by six in two weeks and two in 3 weeks of time since injury.<strong></strong></p><p class="abstract"><strong>Results:</strong> Functional evaluation was done after a mean follow-up of 28.7 months. Fracture union was achieved within 8 to 12 weeks and excellent results were obtained in 18 cases and 10 cases were categorized as good followed by fair result in 4 cases. Median nerve compression was not observed in any case.</p><p class="abstract"><strong>Conclusions:</strong> Good to excellent result can be achieved after open reduction and internal fixation which restores joint congruity.</p>

scholarly journals Functional Results of Open Reduction and Internal Fixation with Primary Arthrodesis for Injuries to the Tarsometatarsal Joint Complex

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Sean Lannon ◽  
Michael Clare
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Functional Results ◽  
High Energy ◽  
Low Energy ◽  
Lisfranc Joint ◽  
Energy Group ◽  
Energy Mechanism ◽  
Viable Treatment

Category: Midfoot/Forefoot, Trauma Introduction/Purpose: Controversy remains as to the optimal treatment of injuries to the tarsometatarsal (Lisfranc) joint complex. Recent studies have described open reduction internal fixation (ORIF) with primary arthrodesis as a viable treatment option but there is limited orthopaedic literature as to the functional results of primary arthrodesis for these injuries. The senior author began treating these injuries with primary arthrodesis in 2005. We present the functional results of a consecutive series of patients with injuries to the TMT joint complex treated by ORIF with primary arthrodesis. Methods: Sixty-eight consecutive patients underwent ORIF with primary arthrodesis from 2006 to 2015. Seventeen patients were unable to be evaluated or contacted and were therefore lost to follow up, leaving 51 patients available for follow-up evaluation. Clinical follow up and/or telephone interviews was conducted. AOFAS Midfoot scores and Foot and Ankle Ability Measure (FAAM) were collected as a measure of functional outcome at final follow up. Results: Sixty-seven of 68 patients (98.5%) went on to radiographic union following the index procedure. Among patients with a low energy mechanism (32 patients), AOFAS and FAAM were 88.7 and 94.0; among those with a high- energy mechanism (19 patients), AOFAS and FAAM were 86.9 and 89. Outcome scores were higher in the low energy group: AOFAS by 2.1(p=0.667); and FAAM by 5.0 (p=0.021). Injury to the lateral midfoot necessitating fixation was less likely in the low energy group compared to the high-energy group (7.5% versus 37.0%; p=0.0032). Eighteen of the 51 patients participated in professional, collegiate or recreational sports preoperatively. All 18 were able to return to their previous sport, with a mean FAAM sports sub scale score of 93. Conclusion: ORIF with primary arthrodesis remains a viable treatment for injuries to the tarsometatarsal (Lisfranc) joint complex, with functional results in the good to excellent range at midterm follow up. Patients with low energy mechanisms demonstrated higher functional scores compared to patients with high energy mechanisms, but outcomes remained good to excellent in both groups. Of those who participated in athletics prior to injury, all were able to return to their previous sport.

Outcomes Following Open Reduction and Internal Fixation in Proximal Phalangeal Fracture with Rotational Malalignment

2020 ◽  
Vol 25 (02) ◽  
pp. 219-225
Author(s):  
Jun-Ku Lee ◽  
In-Tae Hong ◽  
Jin Woo Cho ◽  
Cheungsoo Ha ◽  
Woo-Jin Yu ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Proximal Phalanx ◽  
Dash Score ◽  
Rotational Malalignment ◽  
Active Motion ◽  
Rotational Angle ◽  
Rotation Direction ◽  
Anatomic Reduction

Background: The rotational malalignment in proximal phalanx fracture is unacceptable. Authors attempted to describe clinical and radiographic outcomes as well as complications after open reduction and internal fixation with screw only or plate for phalangeal fractures accompanied by rotational malalignment. Methods: Authors conducted a retrospective review of 46 patients who had been treated between Jan. 2010 and Dec. 2016. The average follow-up period was 16.7 months. A total active motion (TAM), Disability of Arm, Shoulder and Hand score (DASH), and tip pinch power between thumb and fractured finger were measured at the final follow-up. Complications were investigated during the follow up. We assessed the amount of rotation by measuring angle between 3rd ray and fractured finger. The measurement was divided into two groups depending on rotation direction, divergent and convergent direction group. Results: Twenty-eight cases were fixed with mini LCP plate, 12 cases with lag screws, and rest 6 cases with combined. All patients showed solid bony union on radiographs on average follow-up of 68 days (range, 41–157 days). Average TAM of the injured finger was 244 degrees and average DASH score was 4.9 at the last follow-up. Tip pinch power was 3.2 kg, which was not significantly different from that of the contralateral side at 3.4 kg (p = 0.21). The preexisting rotational angle was significantly adjusted (overall, 11.1°). Depending on rotation direction, preoperative 21.7° to postoperative 12.1° in 27 patients of convergent group and preoperative −5.0° to postoperative 8.3° in 19 patients of divergent group were achieved. Conclusions: The rotation from proximal phalanx fractures could be corrected with anatomic reduction by open reduction. Our results showed that open reduction and rigid internal fixation after physical examination for acute proximal phalanx fractures accompanied by rotational malalignment could achieve good clinical results.

scholarly journals Open Reduction Internal Fixation of Posterior Malleolus Fractures via a Posteromedial Approach

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0004
Author(s):  
Robert Zbeda ◽  
Lon Weiner ◽  
Stuart Katchis ◽  
Steven Friedel
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Direct Reduction ◽  
Plate Fixation ◽  
Open Reduction Internal Fixation ◽  
Ankle Fractures ◽  
Posterior Malleolus ◽  
Anatomic Reduction ◽  
Surgical Methods

Category: Ankle, Trauma Introduction/Purpose: Ankle fractures with a posterior malleolus component are complex injuries to manage. Due to the heterogeneous morphology of these fractures and lack of high-quality evidence, methods of surgical fixation are controversial and highly variable. The most commonly used surgical methods include indirect reduction via a percutaneous anterior approach or direct reduction via a posterolateral approach. For large posterior malleolus fractures with medial extension, direct reduction via a posteromedial approach is an alternative surgical option. The purpose of this study was to report on a large series of posterior malleolus fractures treated via a novel posteromedial approach. The study hypothesized that fixation of large posterior malleolus fractures with medial extension via a posteromedial approach results in anatomic reduction and stable plate fixation. Methods: From 2008 to 2015, 23 of 244 (9.4%) consecutive operative ankle fractures were identified as posterior malleolus fractures treated using a posteromedial approach (Figure 1). All patients had pre-operative computed tomography scans to confirm the presence of a posterior malleolus fracture with medial extension (Figure 2-4). A posteromedial incision was made and fracture was reduced with the saphenous vein retracted anteriorly and the posterior tibial tendon retracted posteriorly. Patient charts were retrospectively reviewed for demographics, injury history, surgical details, follow-up time, and any post-operative complications. Post-operative radiographs were reviewed to ensure that anatomic reduction and stable fixation was maintained (Figure 5). Results: 73.9% (17/23) of the patients were female and the average age at the time of surgery was 54.6 years (range, 26-86 years). There were no open fractures, but 8/23 (34.7%) patients required external fixation prior to open reduction internal fixation (ORIF) for soft tissue management. The average follow-up time was 11.0 months (range, 0.3 to 41.4 months). All patients healed completely on a clinical and radiographic basis. Anatomic reduction and stable plate fixation was obtained intra-operatively in all patients and maintained at maximal follow-up. Eight (34.7%) patients underwent removal of hardware. There was a 13.0% (3/23) post-operative complication rate: 1 patient had cellulitis, 1 patient had osteomyelitis involving the fibula, and 1 patient had symptomatic heterotopic ossification. All complications resolved with appropriate management. Conclusion: ORIF of posterior malleolus fractures via a posteromedial approach achieved anatomic reduction, stable plate fixation, and complete healing in all patients. Posteromedial approach enables direct visualization and anatomic reduction of large posterior malleolus fractures. Fixation of the posteromedial tibial plafond is important because, unlike the posterolateral aspect, there are no ligamentous insertions that can provisionally reduce the fracture fragment by ligamentotaxis. In concurrence with previous literature, our study demonstrates that posteromedial approach is a reasonable alternative to other more commonly used methods for treating these fractures.

scholarly journals Open reduction and internal fixation of quadrilateral plate fractures in the elderly: association between initial fracture pattern and outcomes

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Haiyang Wu ◽  
Qipeng Shao ◽  
Ranran Shang ◽  
Chengjing Song ◽  
Ximing Liu ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Classification System ◽  
Functional Outcomes ◽  
Open Reduction ◽  
The Elderly ◽  
Acetabular Fractures ◽  
Quadrilateral Plate ◽  
Anatomic Reduction ◽  
Functional Scores

Abstract Background Acetabular fractures with medial displacement of the quadrilateral plate (QLP) are common in the elderly. The presence of QLP fractures greatly increase the surgical difficulty of acetabular fractures. This study aims to evaluate the clinical radiological outcomes of open reduction and internal fixation (ORIF) in QLP fractures in elderly patients and to investigate factors potentially affecting the result. Methods We conducted a retrospective study. A series of 37 consecutive patients with acetabular fracture involving the QLP aged 60 years and older who received ORIF between January 2010 and May 2019 were included. QLP fractures were classified according to Walid’s classification system. Radiological outcomes were evaluated using Matta criteria and functional outcomes were assessed using the modified Merle d’Aubigné score. The relationships between Walid’s classification and radiological or functional outcomes were analyzed. Results According to Walid’s classification, 18, 13, 6 were classified as QLP1, QLP2 and QLP3, respectively. The average follow-up was 35.5 ± 10.7 months. We obtained anatomic reduction in 48.6 % (18/37) of cases, imperfect reduction in 40.5 % (15/37) of cases, and poor reduction in 10.8 % (4/37) of cases. Excellent-good functional scores were found in 83.7 % (modified Merle d’Aubigné). There were no cases of screw entering the hip, pull-out and loosening or implant failure during the follow-up. Walid’s classification was positively correlated with radiological outcomes of reduction (r = 0.661; P < 0.001), and functional outcomes (r = 0.478; P = 0.003). Unsatisfactory reduction was demonstrated a correlation with the development of post-traumatic arthritis (r =-0.410; P = 0.012). Conclusions ORIF may be suggested for quadrilateral plate fractures in the elderly. Walid’s classification system is associated with the reduction quality and functional recovery.

scholarly journals Nascent Malunion of an Isolated Intraarticular Fracture of the Ulnar Head

2019 ◽  
Vol 09 (03) ◽  
pp. 240-243
Author(s):  
Frank Nienstedt ◽  
Markus Mariacher ◽  
Günther Stuflesser ◽  
Wilhelm Berger
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Excellent Result ◽  
Corrective Osteotomy ◽  
Fracture Dislocation ◽  
Intraarticular Fracture ◽  
Ulnar Head ◽  
Ulnar Styloid Fracture ◽  
Palmar Approach

Abstract Background Isolated fractures of the ulnar head are rare. Only few cases have been reported in literature. Case Description We report a case of a 16-year-old student who was treated for an ulnar styloid fracture conservatively. An associated displaced intraarticular fracture of the ulnar head has been overlooked. He presented late in our clinic with a symptomatic nascent malunion of the ulnar head fracture. A corrective osteotomy by a palmar approach was performed. Fixation by screws was used with an excellent result at 7-year follow-up. Literature Review The rare cases of isolated ulnar head fractures reported in literature were treated by open reduction and internal fixation only in case of fracture dislocation. Clinical Relevance The authors highlight the fact that even a nascent malunion of an isolated intraarticular fracture of the ulnar head may be treated successfully by open reduction and internal fixation.

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