Does the morphology of the posterior malleolar fragment influence clinical outcomes of trimalleolar fractures after surgical fixation? A systematic review and Meta-analysis

Background: Posterior malleolus (PM) fractures have historically been classified according to the size of the fragment, to study the need for surgical fixation and to assess clinical outcomes. Recent research has suggested that the morphology of the PM fragment is of more relevance than its size. Objectives: This systematic review aims to determine if the size of the PM fragment influences clinical outcomes of trimalleolar fractures after surgical fixation, and if so, to find out which fracture type has the best outcomes. Methods: This systematic review will be conducted according to the PRISMA guidelines. A literature search will be conducted on the electronic databases of PubMed, Embase, Scopus and Ovid with a pre-determined search strategy. A manual bibliography search of included studies will also be done. Original articles in English that have relevant data on the outcomes of PM fractures and its morphology will be included. Data will be extracted from included studies and analysis carried out with the help of appropriate software.

Analysis of Risk Factors for Non-union After Surgery for Limb Fractures: A Case-Control Study of 669 Subjects

Objective: The purpose of this study was to analyze the risk factors for limb fracture non-union in order to improve non-union prevention and early detection.Methods: A total of 223 patients with non-union after surgery for limb fractures performed at our institution from January 2005 to June 2017 were included as the case group, while a computer-generated random list was created to select 446 patients with successful bone healing after surgery for limb fractures who were treated during the same period as the control group, thus achieving a ratio of 1:2. The medical records of these patients were reviewed retrospectively. Age, sex, body mass index, obesity, smoking, alcohol, diabetes, hypertension, osteoporosis, fracture type, multiple fractures, non-steroidal anti-inflammatory drugs (NSAIDs) use, delayed weight bearing, internal fixation failure, and infection data were analyzed and compared between the two groups. A multivariate logistic regression model was constructed to determine relevant factors associated with non-union.Results: After comparison between two groups by univariate analysis and multivariate logistic regression, we found some risk factors associated that osteoporosis (odds ratio [OR] = 3.16, 95% confidence interval [CI]: 2.05–4.89, p < 0.001), open fracture (OR = 2.71, 95%CI: 1.72–4.27, p < 0.001), NSAIDs use (OR = 2.04, 95%CI: 1.24–3.37, p = 0.005), delayed weight bearing (OR = 1.72, 95%CI: 1.08–2.74, p = 0.023), failed internal fixation (OR = 5.93, 95%CI: 2.85–12.36, p < 0.001), and infection (OR = 6.77, 95%CI: 2.92–15.69, p < 0.001) were independent risk factors for non-union after surgery for limb fractures.Conclusions: Osteoporosis, open fracture type, NSAIDs use, delayed weight bearing, failed internal fixation, and infection were found to be the main causes of bone non-union; clinicians should, therefore, take targeted measures to intervene in high-risk groups early.

Fracture profiles of a 4-year cohort of 266,324 first incident upper extremity fractures from population health data in Ontario

Background Understanding the profiles of different upper extremity fractures, particularly those presenting as a 1st incident can inform prevention and management strategies. The purpose of this population-level study was to describe first incident fractures of the upper extremity in terms of fracture characteristics and demographics. Methods Cases with a first adult upper extremity (UE) fracture from the years 2013 to 2017 were extracted from administrative data in Ontario. Fracture locations (ICD-10 codes) and associated characteristics (open/closed, associated hospitalization within 1-day, associated nerve, or tendon injury) were described by fracture type, age category and sex. Standardized mean differences of at least 10% (clinical significance) and statistical significance (p < 0.01) in ANOVA were used to identify group differences (age/sex). Results We identified 266,324 first incident UE fractures occurring over 4 years. The most commonly affected regions were the hand (93 K), wrist/forearm(80 K), shoulder (48 K) or elbow (35 K). The highest number of specific fractures were: distal radius (DRF, 47.4 K), metacarpal (30.4 K), phalangeal (29.9 K), distal phalangeal (24.4 K), proximal humerus (PHF, 21.7 K), clavicle (15.1 K), radial head (13.9 K), and scaphoid fractures (13.2 K). The most prevalent multiple fractures included: multiple radius and ulna fractures (11.8 K), fractures occurring in multiple regions of the upper extremity (8.7 K), or multiple regions in the forearm (8.4 K). Tendon (0.6% overall; 8.2% in multiple finger fractures) or nerve injuries were rarely reported (0.3% overall, 1.5% in distal humerus). Fractures were reported as being open in 4.7% of cases, most commonly for distal phalanx (23%). A similar proportion of females (51.5%) and males were present in this fracture cohort, but there were highly variant age-sex profiles across fracture subtypes. Fractures most common in 18–40-year-old males included metacarpal and finger fractures. Fractures common in older females were: DRF, PHF and radial head, which exhibited a dramatic increase in the over-50 age group. Conclusions UE fracture profiles vary widely by fracture type. Fracture specific prevention and management should consider fracture profiles that are highly variable according to age and sex.

A Retrospective Study on Management of the Distal End of the Radius Fractures

Introduction: The distal end radius fracture is a common fracture type and represents about one sixth of all skeletal fractures. They commonly occur in young males and older females. In young adults it is more common to see a fracture of the Intra-articular component in distal radius, probably due to high-energy trauma such as road traffic accidents. The patient may come with symptoms of pain and swelling around the wrist, sometimes with deformity around the wrist or tenderness at an area with no obvious deformity. Objectives: To analyse the various treatment methods and their outcomes. Materials and Methods: It is a retrospective study conducted on the distal end of radius fractures by the orthopedic department of Saveetha Medical College and Hospital in the years 2018, 2019 and 2020. All the patients were examined both clinically and radiologically. Anteroposterior (AP) and lateral views of the wrist joint on both sides were obtained at the time of injury presentation. Fractures were classified according to the AO classification and anatomical features like the presence of dorsal tilt, radial shortening and loss of radial inclination are also assessed using the Sarmiento’s modification of Lindstrom Criteria. Results: Anatomical results evaluated according to Sarmiento’s modification of Lindstrom criteria showed excellent results were more frequent with open reduction and internal fixation techniques but the most frequently used treatment modality is closed reduction and cast immobilisation. Conclusion: There is no customised treatment for all distal end of radius fractures hence the treatment depends on various factors like the fracture type, characters, patient’s demands and the surgeon’s preference.

Clinical examination of various jaw fractures and evaluation of open and closed reductions: Six case reports

Aim: This study aims to present the fracture types and treatment methods of jaw fracture cases that presented at our center. Methodology: Of six presenting cases, two were angulus, one was parasymphysis, three were subcondylar, and one was a medial condyle fracture only. All patients were evaluated both clinically and radiologically by CT of the atlanto-occipital joint. We managed two of the mandibular fractures with open and closed reduction (mixed) and four with closed reduction only. Dislocation was observed in only two patients. Internal fixation was performed using either mini plates (Medartis, Basel, Switzerland) or mini-screws. All cases united within three weeks to three months. Results: After analyzing the epidemiology of six fractures and the outcomes of the surgical treatment, as well as assessing the complications related to the surgical procedures, it was determined that in cases with dislocation, bimaxillary fixation should be applied as a maintenance to open reduction therapy. In cases without dislocation, bimaxillary fixation only is sufficient. Conclusion: An analysis of dislocation conditions according to fracture type supports that the incidence of dislocation is low in condyle fractures. Conclusion: An analysis of dislocation conditions according to fracture type supports that the incidence of dislocation is low in condyle fractures. How to cite this article: Özüdoğru S, Başaran MM, Ataözden T. Clinical examination of various jaw fractures and evaluation of open and closed reductions: Six case reports. Int Dent Res 2021;11(Suppl.1):274-8. https://doi.org/10.5577/intdentres.2021.vol11.suppl1.40 Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

The pattern of orthopedic fractures and visceral injury in road traffic crash victims, Addis Ababa, Ethiopia

Background Road Traffic crash injury is one of the main public health problems resulting in premature death and disability particularly in low-income countries. However, there is limited evidence on the crash fractures in Ethiopia. Objective The study was conducted to assess the magnitude of road traffic crash fractures and visceral injuries. Methods A hospital-based cross-sectional study was conducted on 420 fracture patients. Participants were randomly selected from Addis Ababa City hospitals. The study was carried out between November 2019 and February 2020. Data were collected using a questionnaire and record of medical findings. Multilevel logistic regression analysis was carried out. Ethical clearance was obtained from the Addis Ababa University, College of Health Sciences Institutional Review Board. Confidentiality of participants’ information was maintained. Results The study found out that the majority 265 (63. 1%) of fracture cases were younger in the age group of 18 to 34 years. Males were more affected—311(74.0%). The mortality rate was 59(14.1%), of those 50(85.0%) participants were males. The major road traffic victims were pedestrians—220(52.4%), mainly affected by simple fracture type -105(53.3%) and compound fracture type—92(46. 7%). Drivers mainly suffered from compound fracture type -23 (59.0%). One hundred eighty-two (43.3%) of fracture patients had a visceral injury. Homeless persons who sit or sleep on the roadside had a higher risk of thoracic visceral injury compared to traveler pedestrians (AOR = 4.600(95%CI: 1.215–17.417)); P = 0.025. Conclusion Visceral injury, simple and compound fractures were the common orthopedic injury types reported among crash victims. Males, pedestrians, and young age groups were largely affected by orthopedic fracture cases. Homeless persons who sited or slept on the roadside were significant factors for visceral injury. Therefore, preventing a harmful crash and growing fracture care should be considered to reduce the burden of crash fracture.