Effectiveness and Outcome of Early Weight Bearing in Ankle Fracture: A Systemic Review

Introduction: Ankle fractures are claimed to affect 70-185 patients out of 100,000 people each year. There is currently no unanimity among surgeons throughout the world on early versus restricted weight bearing in surgically treated trauma patients with fractures. The aim of this study was to systematically review the effectiveness and outcome of early weight bearing in ankle fracture as well as quality of life and pain. Methods: An electronic search was conducted of the databases EMBASE, PubMed, and The Cochrane Library, as well as Medline, Google Scholar to identify all articles related to the topic that have been published after 2006. Results: Initially, 2434 records were identified. Due to similarity and duplication, 1308 records were eliminated, and 1126 records were kept. Following the screening of the records and their subjects, 921 further unconnected records were eliminated. Then, 205 qualified full-text articles were selected, and 10 articles were included in qualitative analysis. Conclusion: According to the findings of this study, surgical therapy, both aggressive and minimal, appears to be a safe alternative for the elderly. Short-term advantages of early weight-bearing include a decreased incidence of thromboembolic disease. Active movement reduces joint stiffness while maintaining muscle mass. Post-operative mobility, quality of life, and post-operative early weight bearing status are considered as significant outcome indicators. Unsafe weight as tolerated after ankle surgery might be a safe and encouraging option. As a result, future research should include this possibilities.

Quality of life and complications in elderly patients after pronation rotation type III ankle fractures treated with a cast and early weight-bearing

Background Early weight-bearing is becoming increasingly common because it can positively affect the quality of life of patients. Therefore, the efficacy and safety of this conservative treatment should be assessed for different types of ankle fractures. The goal of this study was to compare early weight-bearing and non-weight-bearing in terms of effectiveness and safety in patients with pronation rotation type III ankle fractures treated nonsurgically. Methods A prospective multicenter cohort study was conducted over two years. Elderly patients with a nondisplaced pronation rotation type III ankle fracture were included. The main variables were the Barthel Index and SF-12 scores. The patients completed the questionnaires at six weeks, one year and two years. We also compared the complications associated with the two interventions. Results 30 patients were included in the weight-bearing group, while 32 patients were included in the non-weight-bearing (WB) group. The mean ages were 82.6 ± 2.6 years and 83.1 ± 2.6 years, respectively. Quality of life, measured with the SF-12 scale, increased significantly in both the short and long term in the WB group (53.5 ± 5.8 points vs 65.2 ± 4.4 points at 6 weeks and 70.1 ± 4.2 points vs. 80.9 ± 3.7 points at 2 years; p<0.001). The WB group also showed a higher quality of life, as measured by the Barthel Index (54.5 ± 5.2 points vs. 64.3 ± 4.0 points at 6 weeks and 71.0 ± 4.3 points vs. 80.7 ± 3.4 points at 2 years; p<0.001). Conclusions Elderly patients with pronation rotation type III fractures could benefit from an early weight-bearing protocol in terms of quality of life and functionality.

New option of tibial plateau plasty in total knee arthroplasty

Introduction There are several options of fixation and plasty for tibial defects. Screw and cement augmentation of the tibia is an alternative to conventional bone autograft and allograft. Although use of metal and cement augments provides reliable support for the tibial plateau and facilitates early weight-bearing on the operated limb the technique fails to maintain enough bone stock for future revisions. The purpose was to present an option of cement and metal augmentation of the tibial component in total knee arthroplasty (TKA). Material and methods The technique consists of cement and screw augmentation using three screws placed vertically as a regular triangle and being perpendicular to the tibial plateau. We describe the technique and a clinical instance of type 2A defect of the proximal tibia using the author's method. Outcome measures were goniometry and radiography. Results Goniometry examination showed positive dynamics in the first week after surgery with flexion of 110.0 degrees, extension 175.0 degrees; at 12 months with flexion of 90.0 degrees and extension of 180.0 degrees. Radiographic examination demonstrated no instability and micromobility of the cement mantle. Discussion The author's technique of screw and cement augmentation of the tibial component was practical for type 2A defects of the proximal tibia with a shortage of materials of bone autografts. This is a pilot study that requires further investigations.

Comparison of Titanium Elastic Nailing and End-threaded Intramedullary Pinning for Distal Femoral Fractures in Young Dogs

Background: Femur fractures are common in immature dogs. As compared to stainless steel, titanium implants are lighter and allow controlled micro-motion at the site of fracture that stimulates early callus formation by limiting stress shielding. Cited literature reports successful clinical use of titanium elastic nails for the stabilization of long bone fractures in young human patients; however, there is paucity of information on this technique is dogs. This study was planned with an objective to compare titanium elastic nails (TENS) and single end-threaded pin for the management of femoral fractures in young dogs. Methods: The study included 20 clinical cases (10 male and 10 female) of dogs suffering from distal femoral fracture with a mean ± SD age of 5.70 ± 5.60 month, body weight 11.09 ± 4.48 Kg since 3.05 ± 2.35 days. The cases were divided into 2 groups; using TENS (n=10; group 1) and stainless steel end-threaded intramedullary pin (n=10; group 2). Result: Group 1 dogs demonstrated better fracture reduction score, early and uniform callus and better implant stability as compared to group 2, radiographically. Early weight bearing and minimum postoperative complications with better functional outcome including joint mobility was reported in group 1. In conclusions, TENS is superior fracture fixation technique for the repair of supracondylar or distal third femur fractures in young dogs with better functional outcome, minimal stiffness of stifle joint and early weight bearing, in comparison to single end threaded intramedullary pin.

An overview on the treatment and outcome factors of ankle fractures in elderly men and women aged 80 and over: a systematic review

Introduction This article is a systematic review of the literature on elderly aged 80 and over with an ankle fracture. Low energy trauma fractures are a major public health burden in developed countries that have aged populations. Ankle fractures are the third most common fractures after hip and wrist fractures. The purpose of this review is to provide an overview of the treatments and the used outcome factors. Methods PubMed, Embase, Cochrane Library, and CINAHL were searched to retrieve relevant studies. Studies published in English or Dutch concerning the treatment of ankle fractures in patients aged 80 and over were included. Results Initially 2054 studies were found in the databases. After removing duplicate entries, 1182 remained. Finally, after screening six studies were included, of which three cohorts studies and three case series. Six different treatments were identified and described; ORIF, transarticular Steinmann pin, plaster cast with or without weight-bearing, Gallagher nail and the TCC nail. Furthermore, 32 outcome factors were identified. Discussion The various studies show that practitioners are careful with early weight-bearing. However, if we look closely to the results and other literature, this seems not necessary and it could potentially be of great value to implement early weight-bearing in the treatment. Furthermore, quality of life seems underreported in this research field. Conclusions ORIF with plaster cast and permissive weight-bearing should be considered for this population since it seems to be a safe possibility for a majority of the relatively healthy patients aged 80 and over. In cases where surgery is contra-indicated and a plaster cast is the choice of treatment, early weight-bearing seems to have a positive influence on the outcome in the very old patient.

1125 Proximal Tibial Giant Cell Tumor in A 25-Year-Old Female Treated with Two Stage Extended Curettage, Cementing and Arthrodesis. Key Words: GCT, Two Stage, Curettage, Cementation, Arthrodesis

Introduction Giant cell tumor of bone is a benign but locally aggressive tumor accounting for approximately 20% of benign osseous neoplasms. Female gender predominance, common in second to third decade of life. Commonly seen around knee, with the distal femur being more frequently involved. Method Presenting a 25year old lady with history of progressive pain and swelling around right knee for 2 years and inability to walk for 6 months. Radiography and biopsy revealed giant cell tumor of the right proximal tibia involving the medial condyle. Two staged procedure planned. Stage 1 extended curettage, cementation of cavity with PMMA and a knee spanning fixator was done. In stage 2 at 12 weeks cement was removed and knee arthrodesis using allograft performed retaining the fixator in place. Results Patient was able to partially bear weight 6 weeks post 2nd stage of surgery and was able to bear full weight after 12 weeks. A solid arthrodesis was achieved at 5 months post 2nd stage, when the fixator was removed. There is no recurrence at end of one year Conclusions This is a novel method of low-cost treatment using bone cement and external fixator for stability. Cement gives immediate structural support and fixator allows ambulation and early weight-bearing. The importance of thorough curettage cannot be overemphasized in preventing recurrence. This can be a viable alternative treatment option for patients presenting with large giant cell tumors around the knee joint who cannot afford options like wide local excision and joint replacement using mega-prosthesis.

Acute correction of severe complex adolescent late-onset tibia vara by minimally invasive osteotomy and simple circular fixation: a case series with 2-year minimum follow-up

Background Despite multiple published reviews, the optimum method of correction and stabilisation of Blount’s disease remains controversial. The purpose of this study is to evaluate the clinical and radiological outcomes of acute correction of late-onset tibial vara by percutaneous proximal tibial osteotomy with circular external fixation using two simple rings. Weighing up the pros and cons and to establish if this method would be the method of choice in similar severe cases especially in a context of limited resources. Methods This study was conducted between November 2016 and July 2020. We retrospectively reviewed the clinical notes and radiographs of 30 patients (32 tibiae) who had correction of severe late-onset tibia vara by proximal tibial osteotomy and Ilizarov external fixator. The mean age at the time of the operation was 16.6 (± 2.7) years (range 13–22). Results The mean proximal tibial angle was 65.7° (± 7.8) preoperatively and 89.8° (± 1.7) postoperatively (p < 0.001). The mean mechanical axis deviation improved from 56.2 (± 8.3) preoperatively to 2.8 (± 1.6) mm postoperatively (p < 0.001). The mean femoral-tibial shaft angle was changed from –34.3° (± 6.7) preoperatively to 5.7° (± 2.8) after correction, with degree of correction ranging from 25° to 45°. Complications included overcorrection (three cases 9%) and pin tract infection (eight cases 25%). The mean Hospital for Special Surgery knee scoring system (HSS) improved from 51.03 (± 11.24) preoperatively to 94.2 (± 6.8) postoperatively (p < 0.001). The mean length of follow up period 33.22 (± 6.77) months, (rang: 25–46 months). At final follow up, all patients had full knee range of motion and normal function. All cases progressed to union and there were no cases of recurrence of deformity. Conclusion This simple procedure provides secure fixation allowing early weight bearing and early return to function. It can be used in the context of health care systems with limited resources. It has a relatively low complication rate. Our results suggest that acute correction and simple circular frame fixation is an excellent treatment choice for cases of late-onset tibia vara, especially in severe deformities.

Management of LC Type I (LC-1) Pelvic Injuries with Complete Sacral Fracture : Is there a Role for Solitary Anterior Fixation?

Background: Management of LC-1 type pelvic injuries, particularly in patients with complete sacral fracture (LC-1 PICSF, OTA type 61-B2.1) remains controversial. Specific indications for solitary fixation remain unclear, and there is a paucity of outcomes data in comparison to combined fixation. We undertook a retrospective study in patients with LC-1 PICSFs to compare outcomes between solitary anterior fixation and combined anterior-posterior fixation.Methods: A retrospective cohort study was conducted with enrollment from 2014 to 2015 at a single tertiary-referral center in China. Adults with operatively managed LC-1 PICSFs were enrolled. Patients with sacral displacement <1 cm as assessed by axial CT received solitary anterior ring fixation (Group A); patients with displacement ≥1 cm received combined fixation of both the anterior and posterior rings (Group B). Reduction was confirmed by manipulation under anesthesia. Patients followed up for at least 24 months post-operatively. Primary outcome was function (Majeed score). Secondary outcomes included intraoperative characteristics, pain (VAS score), quality of fracture reduction (Tornetta and Matta radiographic grading), rate of non-union, early weight-bearing status, and complication rate.Results: 68 (89%) of 76 enrolled patients completed follow-up. Patients in Group A exhibited improved operative times, less time under fluoroscopy, and less blood loss as compared to Group B. There were no significant differences between Groups A and B regarding quality of fracture reduction, rate of union, functional outcomes, or rate of complications. Notably, Group B patients were more likely to achieve full early weight-bearing.Conclusion: LC-1 PFCSFs can get benefits from ORIF; the treatment algorithm should be differently made following the degree of the sacral fractures displacement. Less than 1cm sacral fracture displacement may get good functional outcomes from solitary anterior fixation. However, for the sacral fractures displacement greater or equal to 1cm, both the anterior and posterior pelvic ring should be surgical stabilization.