Reliability of a Trapezium Miniplate with Endoscope-Assisted Internal Fixation in Mandibular Subcondylar Fractures: A Three-Dimensional Analysis

This study aimed to evaluate the reliability of a trapezium plate for open reduction and internal fixation (ORIF) of mandibular subcondylar fractures with the simultaneous use of an endoscope. We selected and retrospectively studied 18 patients (12 males and 6 females) with unilateral mandibular subcondylar fractures who visited the Wonju Severance Christian Hospital. The mean age of the patients was 43.43 ± 15.76 years. Patients underwent ORIF with trapezium miniplate application through an intraoral incision under general anesthesia. The clinical and radiographic findings of the fractured side were compared with those of the non-operated side at 6 months follow-up. All occlusions became stable, and transient functional disturbances disappeared within 6 months of periodic follow-up. Functional mandibular movement recovered within the normal range, with an average mouth opening of 41.5 mm, protrusion of 7.5 mm, and lateral excursion of 7 mm at 6 months. Radiographic controls and statistical analysis confirmed a decent anatomical reduction in all 18 cases. In conclusion, the use of a trapezium miniplate with endoscope-assisted ORIF in mandibular subcondylar fractures can be useful for fixation and functional recovery.

Complications in surgical management of calcaneal fractures with anatomical plates

<p class="abstract"><span lang="EN-US">Calcaneal fractures, irrespective of their types, are treated non-operatively, one of the reasons being fear of complications. But conservatively managed fractures can result in equally problematic complications. Incidence of subtalar arthritis in such cases is reported to be 16.9% compared 3.3% in cases treated surgically. With surgical treatment aimed at achieving anatomical joint reduction, regaining calcaneal height, its length and width, successful attempts at curtailing the long-term complications can be made. This was a prospective study of 20 cases of calcaneal fractures, admitted to MNR Medical College and Hospital, Sangareddy from August 2020 to September 2021 were treated with ORIF with non-locking anatomical calcaneal plates using Fernandez’s approach, without use of bone graft. Essex Lopresti and Sander’s classification were used. Intra-operative assessment of reduction and articular surface reconstruction was done under fluoroscopic guidance. Regular follow up was done for assessment of fracture union and complications, assessment of late collapse. Among the 20 cases, 73% were men and 27% women. On typing the fractures based on Essex-Lopresti classification, intra-articular tongue type constituted 13% and 87% were of joint depression. Near normal anatomical reduction was obtained in all cases except in one where it was difficult due to comminution noted during surgery. 2 cases developed superficial skin necrosis at the surgical site, 1 case of deep infection and abscess formation and 3 cases of subtalar arthritis. This study showed that the incidence of long-term complications can probably be minimized by restoring the altered anatomy through surgical means; hence we advocate surgical management and accurate anatomical reduction in cases of displaced and comminuted calcaneal fractures with proper surgical principles. </span></p>

Neglected Scaphocapitate Syndrome

Background Scaphocapitate syndrome is a rare injury where the proximal pole of the capitate rotates 90 to 180 degrees. The proximal pole of the capitate, thought to receive its vascular supply retrograde, is rendered avascular in such cases. However, recent evidence of low rates of avascular necrosis in displaced capitate fractures, and new vascular studies of the capitate, challenge this paradigm. Case Description We report a case of a missed and neglected scaphocapitate syndrome with more than 30 years follow-up. While the patient experienced midcarpal arthritis, the injury had not resulted in capitate proximal pole avascular necrosis as per T1 magnetic resonance imaging studies. Literature Review Missed and chronic cases of scaphocapitate syndrome were reported previously. Successful outcomes were achieved with anatomical reduction in cases without midcarpal arthritis. Salvage procedures or arthroplasty procedures are recommended with the presence of midcarpal arthritis. However, there are no reports of a neglected case with more than 30 years follow-up with preserved vascularity of the proximal pole of the capitate. Clinical Relevance This case illustrates that vascularity of the proximal pole of the capitate can be preserved even in longstanding displaced fractures.

A Review on: 3D Printed Orthopaedic Cast for Improved Forearm Fracture Rehabilitation

Forearm fracture has many management related problems. In order to regain its function anatomical reduction and immobility is very necessary. Traditional cast is not a satisfactory cast as it is heavy, poorly ventilated and often causes fracture related complications. The paper deals with application of 3D printing technique for suitable cast for forearm rehabilitation. Novel 3D printed cast is light weighted, ventilated, custom fit, strong and waterproof and substantial improvement over conventional orthopaedic cast. With the development in technology, it is expected that the cost of fabrication and its manufacturing time will be greatly reduced in the coming future. Keywords: bone fracture, immobility, rehabilitation, 3D printing, orthopaedic cast

STUDY OF TENS NAIL IN PAEDIATRIC RADIUS AND ULNA FRACTURE

Introduction: Forearm is considered as a functional joint, therefore near anatomical reduction is essential to regain normal supination and pronation. In older children many forearm fractures can be treated conservatively, but failures continue to occur despite good orthopaedic intentions. The fracture which are irreducible or unstable fracture which tends to re-displace needs surgical interventions. Among various surgical treatment one is internal xation using TENS. Various studies in the recent shows excellent to good clinical outcomes using TENS. Aims: Our study is intended to evaluate the clinical and radiological outcomes in paediatric both bone forearm fracture using TENS. Materials and methods: A total of 30 patients are included in our study. All are investigated, undergone preanesthetic check-up and taken for TENS application under image intensier. Nail diameter taken as 33-40% of narrowest diameter of diaphysys were introduced proximally in ulna and distally in radius under image intensier in closed manner. Postoperatively, patients encouraged for active shoulder, elbow and nger movements and suture removal done after 2 weeks. All patients are followed up to 24 week, when implant removal was done. Results: In our study 90% patients show excellent functional results. Conclusion: We conclude that TENS in both bone forearm fractures in adolescent age group in terms of union and range of motion is a minimally invasive and effective method of xation

Mini-Open Reduction and Extension Block Pinning for Irreducible Mallet Fractures: A Minimally Invasive Technique for Anatomical Reduction

Background: Dorsal rotation or persistent displacement of the fracture fragment is frequently encountered in extension block pinning for mallet fractures. We reviewed nine irreducible mallet fracture patients treated with mini-open reduction and extension block pinning. Methods: A small V-shaped incision was made on the fracture gap when there was persistent displacement of fracture fragment despite closed maneuvers and percutaneous procedures while performing extension block pinning. Soft tissue or granulation tissue hampering reduction was removed through the incision. Anatomical reduction was guided with a freer elevator. The incision was closed by distal interphalangeal joint transfixation in extension without any suture. Pin tips were buried under the skin. The incision and pin entry sites were covered with skin adhesive, and the patients were allowed to wash their hands 1–2 days after the surgery. No splint was applied postoperatively. Mean follow-up period was 13 months. Results: Anatomical reduction was achieved in 7 out of 9 patients. In the rest 2 patients, postoperative step-off of the articular surface at the fracture site was less than 0.5 mm. Solid union was achieved in all cases. The mean extension lag at final follow-up was 0°. No patient developed postoperative external bleeding or other complications in the incision site or the pin site. Conclusions: Mini-open reduction and extension block pinning appears to be a good option for irreducible mallet fractures, which improves reduction quality and patients’ convenience.

Functional Outcome of Distal End of Radius Fractures Treated with Buttress Plating at a Tertiary Care Centre in Central Kerala, India

BACKGROUND Distal radius fractures are one of the most common injuries that orthopaedic surgeons will face during their trauma practice. Despite this, many aspects in distal radius fracture management like the definition of what constitutes an acceptable reduction and when or even whether to operate a patient with a distal radius fracture remain a poignant subject of debate even to this day. We wanted to evaluate the functional outcome of fractures of distal end of radius managed with buttress plate. The importance of anatomical reduction in attaining a good functional outcome and post-operative complications of the procedure are also studied. METHODS A prospective study of cases of distal end of radius fractures meeting the inclusion criteria who were admitted in Thrissur Government Medical College, Kerala between 1 – 01 - 2016 to 1 – 06 - 2017 was carried out. Fractures were classified according to Frykman system and anatomical reduction of fragments attempted using buttress plate and screws. After a minimum follow up period of 3 months, the anatomical and functional outcomes were standardised using Lindstorms anatomical and functional scoring system. RESULTS A series of 32 cases with distal end of radius fracture were studied comprising of 24 males and 8 females. Majority were in the age group of 20 to 29 years (50 %). Road Traffic Accidents was the commonest cause of injury (62.5 %). Type III Frykman made the largest contribution with 11 (34 %) cases. A total of 7 cases were found to develop complications including blisters, joint stiffness, infection and paraesthesia. Postoperatively, excellent anatomical reduction was achieved in 75 % of cases and good results in 12.5 % cases. Functionally 68.75 % cases had an excellent outcome and 18.75 % had a good result. CONCLUSIONS Good to excellent results were seen in majority of patients after buttress plate fixation of the distal radius, with outcomes and complications comparable to other studies in literature. This study supports the finding that precise identification of unstable lower radial fractures, and satisfactory anatomical restoration results in improved functional outcome. KEYWORDS Distal End Radius Fracture, Buttress Plating, Functional Outcome, Frykman Classification, Lindstorm Scoring System

Intramedullary Nailing of Intertrochanteric Fractures - Minimal Invasive Techniques for Reduction

Background: An intramedullary nail has become the implant of choice for intertrochanteric fractures. This paper introduced some minimal invasive techniques were used to improve quality of intertrochanteric fracture reduction. Methods: Of 119 intertrochanteric fractures treated from January 2014 to October 2019. All patients who received internal fixation on traction bed, and who could not achieve satisfactory closed reduction through the process of "external rotation, abduction, traction, adduction and internal rotation". Reductions were classified as good, acceptable, or poor. We had acceptable reduction in 83 cases and poor reduction in 37 cases though closed reduction. The displacement was reduced using some minimal invasive techniques. Results: After performing the relative techniques in these cases, no case had a poor result. 112(94.9%) cases were in a good reduction. Anatomical reduction should always be achieved in intertrochanteric fractures. Conclusion: The minimal invasive techniques could help the surgeon achieve satisfactory reduction in intertrochanteric fractures. This work had the potential to improve the cognition of reduction of intertrochanteric fractures for surgeons, especially beginners and juniors.