CASE STUDY OF TITANIUM ELASTIC NAIL FOR FRACTURES

Mostly, clavicle fracture is treated conservatively but because of higher rates of delayed union, non-union, symptomatic, malunion cosmetic deformity and other complications, there is increased used of operative management for clavicle fracture. In this regard, plating and intramedullary nailing are common surgical options. The operative technique is also found to be producing favorable results compare to the traditional method based on recent prospective randomized studies. In this study, the objective is to make a comparison between clinical results, operative method, and resulting complications proportion. The study was conducted on 66 patients who had OTA type B DMCFs and underwent surgical fixation with antegrade TENs and 1/3rd tubular plate. The study participants were divided in to two groups based on TENS and other with plate fixation with 1/3rd tubular plate. We conducted evaluation using constant-murley shoulder outcome and dash scores at 6, 12, weeks, 3, 6, and 12 months for determining outcomes. It was observed that among TENS group, there was easier implant removal and minimal complications, less blood loss, lesser operating time, with only complication of shortening of about 0.5 cm in fewer cases. In the other group which is plate group, no major complications were observed except minor one such as deep infection, superficial infection, hypertrophied scarring without pain, and decreased shoulder motion with no case of shortening. In terms of union and stability, no significant differences were found in both groups. Based on the result, it is suggested that TENS is more preferable since it involves fewer morbidity, better cosmetic results, and easier implant removal. Fixation with plate seems to be little more stable and its implant of choice is comminuted fracture.

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Arthrodesis of First Metatarsophalangeal Joint by Plate and Screws for Treatment of Hallux Rigidus (Systematic Review and Meta-Analysis)

QJM ◽

10.1093/qjmed/hcab104.016 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Ossama Abdelraoof El Shazly ◽

Mohamed Mokhtar Abdellah ◽

Mostafa Abdelnabee Abouzaid

Keyword(s):

Systematic Review ◽

Observational Studies ◽

Plate Fixation ◽

Meta Analysis ◽

Metatarsophalangeal Joint ◽

Hallux Rigidus ◽

Superficial Infection ◽

First Metatarsophalangeal Joint ◽

Non Union ◽

Meta Analyses

Abstract Background With continued loss of dorsiflexion of the 1st MTP, degenerative changes occur within the joint with severe restriction of movement and increase in pain, which leads to the condition known as hallux rigidus. The amount of dorsiflexion may be reduced to 0-10 degrees with pain on both active and passive motion. Objectives Systematically reviewing available evidence from published articles to assess the effectiveness of arthrodesis of first metatarsophalangeal joint by plate and screws in hallux rigidus. The assessment also would encompass safety, side effects, and complications of this mode of treatment. Materials and Methods We performed this systematic review and meta-analysis in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statement. PRISMA and MOOSE are reporting checklists for Authors, Editors, and Reviewers of Meta-analyses of interventional and observational studies. According to International committee of medical journal association (ICJME), reviewers must report their findings according to each of the items listed in those checklists. Results Previous results for arthrodesis have been favourable with a union rate of almost 96%. In the present systematic review and meta-analysis, the overall effect estimates showed that the union rates after plate and screw arthrodesis for 1st MTPJ was 96.2% (95% CI 94 – 98.4%). In addition, the overall effect estimates showed that the non-union rates after plate and screw arthrodesis for 1st MTPJ was 4.2% (95% CI 2.4 – 6.1%). Moreover, the overall effect estimates showed that the satisfaction rates after plate and screw arthrodesis for 1st MTPJ was 94.5% (95% CI 90 – 99%). In the present study, the overall effect estimates showed that the overall complications rate after plate and screw arthrodesis for 1st MTPJ was 7.2% (95% CI 2.5 – 12%). The overall effect estimates showed that the malunion rates after plate and screw arthrodesis for 1st MTPJ was 2.7% (95% CI 0 – 6.4%). Additionally, the overall effect estimates showed that the hardware removal and superficial infection rates after plate and screw arthrodesis for 1st MTPJ were 2% and 2.9%, respectively. Conclusion Our analysis showed that plate and screws fixation is effective techniques that can be used for first MTPJ arthrodesis in patients with hallux rigidus. We found that the screw and plate fixation has a significantly lower rate of nonunion compared with the screw alone, as reported by the literature. However, owing to the small group sizes and methodologic shortcomings, we were unable to identify the clinically superior fixation technique for first MTPJ arthrodesis arthrodesis.

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Minimal Invasive Hallux Valgus Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00464 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0046

Author(s):

Shay A. Tenenbaum ◽

Ran Thein ◽

Erel Ben Ari ◽

Niv Dreiangel ◽

Jason T. Bariteau ◽

...

Keyword(s):

Hallux Valgus ◽

Operating Time ◽

Clinical Results ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Minimal Invasive ◽

Published Data ◽

X Rays ◽

Non Union ◽

Patient Reported

Category: Bunion; Other Introduction/Purpose: Hallux valgus is one of the most common deformities of the adult foot, and can adversely affect quality of life, with common complaints including pain, footwear restrictions and cosmesis. Minimal Invasive Surgery (MIS) has re-emerged lately, gaining growing popularity as a surgical approach for surgical treatment of HV deformity. Advantages such as short operating time, quicker recovery, and fewer complications have attributed to MIS. However published data are still inconclusive. Methods: The study included 40 feet (33 pts) with hallux valgus treated with MIS technique, between Apr 20016 to March 2018. Patients were included only if pre- and postoperative weightbearing X-rays at final followup (min 6m) were available. The average age was 51.3 years (range, 21 to 77), with average follow-up of 12 months (range, 6 to 24). Patients’ radiographic records were studied to evaluate postoperative change in hallux valgus angle (HVA), intermetatarsal angle (IMA) and DMAA. Clinical outcome was recorded with Patient reported outcome questioners PROMS10 and MOXFQ. Results: Following surgery deformity was corrected with preoperative mean HVA of 29.8° and IMA of 14.4° compared to postoperative mean of 7.1° and 4.7°, respectively. Patient reported outcome measures recorded the efficacy of MIS for HV in terms of pain reduction and function improvement. In six feet surgery for hardware removal was performed. In one case non- union was treated with revision surgery. Conclusion: This study shows that MIS for HV is safe, effective and offers satisfactory surgical and clinical results.

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Late onset venous thoracic outlet syndrome following clavicle non-union fracture: A case report

Vascular ◽

10.1177/1708538114538253 ◽

2014 ◽

Vol 23 (2) ◽

pp. 183-187 ◽

Cited By ~ 2

Author(s):

Daniel J Wong ◽

Tammy M Holm ◽

George SM Dyer ◽

Jonathan D Gates

Keyword(s):

Case Report ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Thoracic Outlet Syndrome ◽

Late Onset ◽

Plate Fixation ◽

Clavicle Fracture ◽

Vascular Complications ◽

Non Union ◽

Clavicle Fractures

A 59-year-old woman was admitted three times over a six-month period with recurrent upper extremity deep venous thrombosis (UEDVT). It was determined that this patient was suffering from an unusual presentation of Paget-Schröetter syndrome secondary to a 20-year-old non-union of a midshaft clavicle fracture. Following thrombolysis the patient underwent resection and plate fixation of the clavicle fracture non-union. Despite the anatomic proximity of the subclavian vessels to the clavicle, vascular complications from fracture are rare. Treatment of midshaft clavicle fractures is often non-operative. Non-union rates are generally less than 10%, and easily treated secondarily without complication. Clavicular pseudo-arthroses from trauma have been implicated in the development of the thoracic outlet syndromes, however, onset 20 years after fracture has never before been reported.

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A prospective study on operative management of displaced fracture of midshaft of clavicle

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20171912 ◽

2017 ◽

Vol 3 (3) ◽

pp. 619

Author(s):

Mohammed Ismail Hathiwale ◽

Prakash A. Sasnur ◽

Md. Johorul Islam Tapadar

Keyword(s):

Plate Fixation ◽

Operative Management ◽

Delayed Union ◽

Locking Compression Plate ◽

Non Union ◽

Early Return ◽

Compression Plate ◽

Clavicle Fractures ◽

Displaced Fracture ◽

A Prospective Study

Background: Clavicle fractures had been traditionally treated non-operatively which resulted in high rates of non-union. The present study has been undertaken to study the role of precontoured locking compression plate in the fixation of mid-third clavicle fractures.Methods: We reviewed the results of 25 cases of displaced middle third clavicle fractures (Robinson type 2B) which were treated with open reduction and internal fixation with pre-contoured locking compression plate at Al-Ameen Medical College and Hospital.Results: Out of 25 patients operated with precontoured LCP, 21 were male and 4 were female patients. One patient had hypertrophic scar, one patient had plate prominence, two patients had delayed union and one patient had implant failure, none of them developed non-union. Constant Murley score was excellent in 19, good in 4 and fair in 1 patient and poor in 1 patient. Conclusions: Precontoured locking compression plate fixation has better functional outcome, immediate pain relief, early return to function and avoids complications of conservative methods.

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Comparative analysis between locking compression plate and Joshi's external stabilization system in the management of proximal tibial fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20205560 ◽

2020 ◽

Vol 7 (1) ◽

pp. 56

Author(s):

Amit Dwivedi ◽

Anupinder Sharma ◽

Vaibhav Ashta ◽

Robium Nairobi ◽

Sunandan Nandi

Keyword(s):

Plate Osteosynthesis ◽

Plate Fixation ◽

Deep Infection ◽

Open Reduction Internal Fixation ◽

Tibial Fractures ◽

Stabilization System ◽

Superficial Infection ◽

Bone Consolidation ◽

Proximal Tibial Fractures ◽

External Stabilization

Background: Proximal tibial fractures present with a variety of patterns. They are mostly treated using plate osteosynthesis or Joshi's external stabilization system (JESS) depending upon the injury configuration and surgeon preference. We have compared the efficacy of plate fixation to JESS in the treatment of complex proximal tibial fractures.Methods: 36 patients of proximal tibial fractures with a mean age of 47 years were included in the study, 20 were treated using plate osteosynthesis while the other 16 were treated using JESS, they were followed up at regular intervals till 24 weeks and the progress was recorded in accordance with the knee society score (KSS) parametersResults: 20 patients were treated using plate osteosynthesis, 18 of them had excellent KSS scores, 2 patients recorded good scores, average range of flexion was 126o, no incidences of superficial or deep infections were seen in any of them. Bone consolidation was achieved around 12 weeks in plate fixation group of the16 patients treated using JESS, 12 had excellent scores, 4 recorded a good score, average range of flexion was 118o, superficial infection was seen in 2 patients, with no incidence of deep infection. Bone consolidation was achieved around 16 weeks in JESS group.Conclusions: Both open reduction internal fixation (ORIF) with plating and JESS appear to be adequate fixation methods for complex proximal tibial fractures, but as per our study plate fixation resulted in earlier bone consolidation and gave a slightly better functional outcome compared to JESS.

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Comparing functional outcome in lateral end clavicle fracture after conservative and plating

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20172882 ◽

2017 ◽

Vol 3 (4) ◽

pp. 833

Author(s):

Sachin Y. Kale ◽

Prasad Chaudhari ◽

Shikhar D. Singh ◽

Sanjay B. Dhar ◽

Prakash D. Samant ◽

...

Keyword(s):

Functional Outcome ◽

Functional Outcomes ◽

Standard Treatment ◽

Clavicle Fracture ◽

Operative Management ◽

Skin Infections ◽

Non Union ◽

Medical College ◽

Clavicle Fractures ◽

Early Healing

Background: Fractures of the clavicle have been traditionally treated non- operatively but has been associated with various postoperative complications. In this study, we analyzed the outcomes of the operative management and compare its results with conservative treatment considering it as standard treatment option.Methods: The present study was carried out at the Department of Orthopedics, DY Patil Medical College and Hospital, Navi Mumbai. Open fractures, fractures associated with complication like head injury with associated other bone injuries were included in this study. We excluded patients less than 18 years of age, patients with middle third fracture of clavicle and patients with medial end clavicle fracture. The fractures were classified according to Robinson’s classification. Patients were followed up every week for 4 weeks then at 8 weeks, 12 weeks, 6 months and 1 year. The functional outcomes were assessed by Constant and Murley score.Results: We included 48 patients in the study, 34 of which were males, average age of the patients was 37.53±7.64 years. 23 injuries were on the left. There was statistically significant better union times with operative management (p=0.034). Various complications were observed like infection, implant failure, man union, non-union, deformity and skin infections, statistically seen more in patients who underwent conservative management. Overall, patients experienced excellent and good results with operative management in 6 and 12 patients respectively.Conclusions:Operative treatment gave statistically significant functional outcome and early healing compared to conservatively treated in displaced, communited lateral end clavicle fractures.

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Operative versus Conservative Treatment for the Management of Displaced Midshaft Clavicle Fractures in Adults

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v13i1.41030 ◽

2017 ◽

Vol 13 (1) ◽

pp. 81-85

Author(s):

Md Maksudul Haque ◽

Masud Ahmed ◽

Md Zakir Hossain ◽

Md Ali Faisal ◽

Mohammad Saiful Islam ◽

...

Keyword(s):

Conservative Treatment ◽

Functional Outcome ◽

Open Reduction ◽

Plate Fixation ◽

Major Complication ◽

Armed Forces ◽

Operative Management ◽

Cross Sectional Study ◽

Cross Sectional ◽

Non Union

Introduction: Displaced fractures of mid third clavicle are common in young athletic population and choice of management is still controversial. Recent studies have shown that these fractures do not have favourable outcomes with non-operative management and nonunion rates could be as high as 20%, in addition, there is symptomatic malunion with shortening. Objective: To compare the results of the operative versus that of conservative treatment for the management of displaced midshaft clavicular fractures. Materials and Methods: This prospective cross-sectional study was carried out in Orthopaedic and Trauma center, CMH, Dhaka, from the period of January 2014 to December 2016 to compare results of open reduction and internal fixation by plating with that of conservative management. Total 60 patients (30 in each group) were analyzed in terms of fracture union and functional outcome. Patients in the non-operative group were managed by triangular sling with or without strapping whereas in the operative group fractures were reduced and fixed with a contoured reconstruction plate. Patients were actively followed up for 12 months and functional outcome was measured by Rowe and Oxford shoulder scoring system. Complications were monitored clinically and radiologically. Results: All fractures in the operated group united compared with thirteen cases of symptomatic malunion (43.33%) in the non-operated group which is statistically significant. Rowe and Oxford scores was significantly higher in the operated group than the non-operated group in every occasion of follow-up. There was no major complication of surgery. In one patient (3.33%) plate had to be removed for hardware irritation and prominence. Conclusion: Open reduction and internal plate fixation in acute displaced midshaft clavicular fractures resulted in improved outcome decreased rate of non-union and symptomatic mal-union compared with non-operative treatment Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 81-85

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Evaluation of results of fracture Clavicle by Reconstruction Plate

VIMS Health Science Journal ◽

10.46858/vimshsj.7408 ◽

2020 ◽

Vol 7 (4) ◽

pp. 133-136

Author(s):

Dr. Vijay Patil

Keyword(s):

Clavicle Fracture ◽

Locking Compression Plate ◽

Reconstruction Plate ◽

Superficial Infection ◽

Non Union ◽

Fracture Clavicle ◽

Study Results ◽

Compression Plate ◽

Clavicle Fractures ◽

K Wires

Background: Clavicle being most common fracture in human. It is mainly managed conservatively. The results are further improved surgically. Most common surgical treatment is locking compression plating. The aim of the present study is to compare results of reconstruction plating for mid shaft clavicle fractures over locking compression plate. Material & method: The study was conducted on the patients of clavicle fractures coming to Patil hospital Ahmednagar. Total 69 patients were operated with 3.5 millimeter reconstruction plate in this study, during the period of 3 years 2016-2019. Total 63 were male and 6 were females. All fractures were fixed with reconstruction plating and the butterfly fragments were stabilized with k-wires. The functional outcome was measured by the constant and murely score [17] at the end of 3 months from the injury. The fracture union time and associated problems are also compared. Results: Out of 69 patients, 61 patients (88.41%) had excellent results. 5 patient (7.25%) had good result and 8 patients (11.60%) had poor functional out come. 5 patients (7.25%) had complications out of which 1 patient (1.45%) had plate breakage, 2 patients (2.9%) had migration of pin. There was superficial infection in 2 patients (2.9%). The study shows excellent results with simple effective economical reconstruction plates with k-wires. The complications were minimal, mainly in the form of pin migration which was only subcutaneous, removed at the time of implant removal. Conclusion: In these study results of reconstruction plating for mid shaft clavicle fracture was studied. It was found that results were improved, in patient’s oriented outcome, earlier return to the function, reduced non union and mal union and was more effective and economical. For management of mid shaft fracture clavicle. The locking compression plate was not found any superior to reconstruction plate.

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Surgical Site Infection Following Intramedullary Nailing of Subtrochanteric Femoral Fractures

Journal of Clinical Medicine ◽

10.3390/jcm10153331 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3331

Author(s):

Michalis Panteli ◽

James S. H. Vun ◽

Robert M. West ◽

Anthony Howard ◽

Ippokratis Pountos ◽

...

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Femoral Fractures ◽

Deep Infection ◽

P Value ◽

Superficial Infection ◽

Revision Operation ◽

Non Union ◽

Prolonged Length ◽

Micro Organisms

Aim: To investigate the incidence, risk factors and pathogenic micro-organisms causing superficial and deep infection in subtrochanteric femoral fractures managed with an intramedullary nail. Materials and Methods: Following institutional board approval, all consecutive patients presenting with a subtrochanteric fracture were retrospectively identified, over an 8-year period. Basic demographics, fracture characteristics, fracture union, revision operation, mortality and other complications were reported and analysed. Variables deemed statistically significant (p-value < 0.05) were then included into a revised adjusted model of logistic regression analysis, where we reported on the odds ratio (OR). Results: The overall incidence of infection was 6.4% (n = 36/561; superficial: 3.7%; deep: 2.7%). Associations with deep infection included: non-union (OR 9.29 (2.56–3.38)), the presence of an open fracture (OR 4.23 (3.18–5.61)), the need for massive transfusion (OR 1.42 (2.39–8.39)), post-operative transfusion (OR 1.40 (1.10–1.79)) and prolonged length of stay (OR 1.04 (1.02–1.06)). The Commonest causes of superficial infection were Staphylococcus aureus (28.5%), enteric flora (23.8%) and mixed flora (23.8%); whereas coliforms (60%) and Staphylococcus aureus (26.7%) were the commonest micro-organisms isolated in deep infection. Polymicrobial infection was identified in 38.5% and 80% of superficial and deep infections, respectively. Conclusion: Causative micro-organisms identified in both superficial and deep infection were similar to those reported in post-traumatic osteomyelitis. In an attempt to minimise infection, the treating clinician should focus on modifiable risk factors with adequate patient optimisation, prompt surgical treatment, adequate antibiotic coverage and wound care when treating patients with subtrochanteric femur fracture.

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DYNAMIC HIP SCREW (DHS)

The Professional Medical Journal ◽

10.29309/tpmj/2016.23.01.800 ◽

2016 ◽

Vol 23 (01) ◽

pp. 076-080

Author(s):

Mehtab Pirwani ◽

Abbas Memon ◽

Shakeel Ahmed Memon

Keyword(s):

Deep Infection ◽

Lateral Approach ◽

Gender Ratio ◽

Superficial Infection ◽

Non Union ◽

Fracture Table ◽

Group A ◽

Hip Screw ◽

Comparative Results ◽

Group B

Objectives: To analyze the comparative results of dynamic DHS fixation in stableand the unstable intertrochanteric fractures at LUH. Study Design: Comparative study. Setting:Orthopedic unit I of LUH Jamshoro. Period: 26th May 2010 – 25th August 2011. Methodology:All 40 patients with femur intertrochanteric fracture were enlisted. All cases isolated in 2 groupsevery having 20 patients, group A stable fracture and group B unstable fractures. After completephysical examination, examinations and fracture arrangement evaluation, patients were readiedfor operation. Fracture table was used in each operation. Fracture reduction was initiallyattempted by close manipulation and was successful in 30 (75%) cases. Lateral approach forproximal femur was used in every case. All fractures, whether stable or unstable, were reducedanatomically without any type of osteotomy and then fixed with 135o dynamic hip screw.Results: Mean age was 62.8.2 years of the cases. Gender ratio was 3:1. According to modeof injury were found RTA in 21 (70%) patients. Postoperative complications were recorded as;superficial infection noted in 2 (5%) patients and there was no case of deep infection. Averagestay of hospital found 16.5 days in 17 (42.5%) patients belongs to stable group and 06 (15%)patients belong to unstable group. All (n=40) patients were pain free on their discharge fromhospital. In all (n=40) patients we achieved union and there was no case of delayed unionor non-union. We assessed functional outcome of our patients on the base of Stinchfield HipAssessment system. According to SHAS 28 (70%) patients were excellent, 05 (12.5%) patientswere good, 04 (10%) were fair and 03 (7.5) were poor. We had not found mortality in our patients.Conclusions: According to our conclusion DHS is the best implant for intertrochanteric fracturefixation. No matter; whether fracture is stable, unstable and fresh or old.

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