Functional outcome of hybrid external fixator in proximal tibial fractures Schatzker type V and VI with Gustillo grade-II

<h2>Background: Management of high energy tibial plateau fractures along with extensive soft tissue damage is still challenging to many orthopaedic surgeons. This study evaluates the purpose of hybrid external fixator intreating high energy tibial plateau fractures with minimal invasion and accurate reduction.</h2><h2>Methods: Twenty patients with high energy Schatzker type V and VI tibial plateau fractures with severe soft tissue injury were enrolled into the study in RNT medical college, Udaipur.</h2><h2>Results: The results- bony union, range of movements and associated complications were assessed. All fractures united in an average time period of 20 weeks. Ten patients developed knee stiffness, five patients developed delayed union andthreenon-union.15 patients required split skin graft. Final outcome showed excellent score in 53 patients.</h2><h2>Conclusions: Hybrid external fixation is a safe option for managing complex high energy tibial plateau fractures by simultaneously providing adequate fracture stabilization and necessary protection to soft tissue healing to achieve bony union.</h2>

Three-Dimensional Printed Models for Preoperative Planning and Surgical Treatment of Chest Wall Disease: A Systematic Review

Introduction: In chest wall reconstruction, the main objectives are the restoration of the chest wall integrity, function, and aesthetic, which is often achieved with the placement of implants. We aimed to evaluate whether 3D printed models can be useful for preoperative planning and surgical treatment in chest wall reconstruction to improve the outcome of the surgery and to reduce the rate of complications. Methods: We conducted a systematic review of literature using PubMed, Scopus, Embase, and Google Scholar databases until 8 November 2021 with the following keywords: (“3D printing” or “rapid prototyping” or “three-dimensional printing” or “bioprinting”) and (“chest wall” or “rib” or “sternum” or “ribcage” or “pectus excavatum”). Results were then manually screened by two independent authors to select studies relevant to 3D printing application in chest wall reconstruction. The primary outcome was morphological correction, and secondary outcomes were changes in operating time and procedure-related complication rate. Results: Eight articles were included in our review. Four studies were related to pectus excavatum correction, two studies were related to rib fracture stabilization, and two studies were related to chest wall tumor resection and reconstruction. Seven studies reported 3D printing of a thorax model or template implants for preoperative planning and implant modeling, and one study reported 3D printing of a PEEK prosthesis for direct implantation. Four studies reported comparison with a conventionally treated control group, and three of them detected a shorter operative time in the 3D printing model-assisted group. Satisfactory morphological correction was reported in all studies, and six studies reported a good implant fitting with minimal need for intraoperative adjustments. There were no major intraoperative or postoperative complications in any of the studies. Conclusions: The use of 3D printing models in chest wall reconstruction seems to be helpful for the production of personalized implants, reducing intraoperative adjustments. Results of morphological correction and postoperative recovery after the 3D printing-assisted surgery were satisfactory in all studies with a low rate of complication. Our literature review suggests good results regarding prosthesis fitting, accuracy of surgical planning, and reduction in operative time in 3D printing-assisted procedures, although more evidence is needed to prove this observation.

Creating and Implementing a Protocol for the Management of Patients in Skeletal Traction: A Quality Improvement Project

Introduction.Skeletal traction use generally has decreased over generations and is used most often for temporary fracture stabilization. Proper nursing management of patients in skeletal traction is crucial. A hospital protocol was created and implemented to educate and direct registered nurses (RNs) in the care of patients requiring skeletal traction. Method.A skeletal traction management protocol was drafted and implemented as hospital policy. Twenty-nine RNs from an orthopaedic unit at a level 1 trauma center attended a financially compensated, 45-minute, in-person, off-shift educational session. An anonymous pre-test utilizing a 5-point Likert scale was completed to assess RN knowledge and comfort regarding the following topics of traction care: pin care, manual traction, frame assembly, weight application and removal, skin evaluation, neurovascular checks, and reporting issues. The RNs were provided with a copy of the new hospital policy and key points were highlighted and demonstrated. After the demonstration, the RNs were given a post-test to assess their perceived knowledge and comfort with traction care. Results.Statistically significant improvements in RN knowledge and comfort were seen in six of the seven evaluated topics. The greatest increase was seen in the manual traction topic. No significant change regarding neurovascular checks was observed with this topic having the highest pre-test scores. Conclusion. A hospital protocol was created successfully and implemented that significantly improved the level of RN knowledge and comfort with the management of patients requiring skeletal traction. Future studies should assess the effectiveness of annual education regarding the traction policy.

Uncoated vs. Antibiotic-Coated Tibia Nail in Open Diaphyseal Tibial Fracture (42 according to AO Classification): A Single Center Experience

Implant-associated infections remain one of the main problems in the treatment of open tibia fractures. The role of systemic antibiotic prophylaxis is now agreed and accepted; nevertheless, recent literature also seems to emphasize the importance of local antibiotic therapy at the fracture site. Several therapeutic strategies have been proposed to overcome this new need. Antibiotic-coated nails play crucial role in this, allowing both infection prevention and favoring the fracture stabilization. We describe the outcome of patients with open diaphyseal tibia fracture treated either with a standard uncoated nail or a gentamicin-coated nail from January 2016 to December 2018 at our second level emergency-urgency department. Primary outcomes were infection rate and bone union rate. Other outcomes reported are reoperation rate, time between injury and nailing, and safety of antibiotic nail. Numerical variables were tabulated using mean, standard deviation, minimum, maximum, and number of observations. Categorical variables were tabulated using number of observations. 23 patients treated with uncoated nail and 23 patients treated with antibiotic-coated tibia nail were included in the study and were evaluated for a minimum follow-up of 18 months. Among the 46 patients, 9 were Gustilo-Anderson type I, 21 type II, and 16 type III open fracture. Regarding the bone healing rate at 12 months, 16 fractures in the first group and 18 in the second were completely healed. 4 infections were found in the first group (3 superficial surgical site infection and 1 osteomyelitis) and 3 superficial infections in the second one. No adverse events have been recorded with antibiotic-coated nails. In this unicentric retrospective study observed no deep wound infections and good fracture healing in the use of antibiotic-coated nails. Antibiotic nails have been shown to play a role in the treatment of fractures in critically ill patients with severe soft tissue damage.

Influence of overweight on the course of a mechanical injury

A literature review deals with the importance of overweight in victims with severe mechanical injury. Mechanical trauma remains an important medical and social problem for humanity. The course of injury and its consequences depend not only on the nature of the trauma, but also on the initial status of victim. The individual characteristics of the patient (gender, age, concomitant somatic pathology, etc.) and the treatment strategy are of great importance, in particular the timing and extent of surgical interventions. In this aspect, the role of overweight, which is a serious health problem worldwide, deserves attention. Many clinical studies and meta-analyses have shown the impact of overweight and obesity on the severity of certain injuries, the course of the post-traumatic period, the frequency of general and local complications, and mortality. Most studies have found that obesity is a marker of a negative prognosis in abdominal injury, and increases the risk of major complications and death. Obesity has been found to be a risk factor for wound complications, intra-abdominal hypertension and abdominal compartment syndrome, acute kidney injury, infectious complications, deep vein thrombosis, thromboembolism and pneumonia. Obese patients who underwent laparotomy for abdominal trauma had higher mortality, longer duration of hospital treatment, and longer duration of stay in the intensive care unit. In addition, obesity impedes interventional manipulations (the placement of the central venous catheter, tracheal intubation, ventilation) and surgical interventions (fracture stabilization, abdominal and thoracic interventions), and reduces the diagnostic value of traditional methods for examination of patients. The negative impact of overweight and obesity should be taken into account when planning diagnostic and treatment strategy, but needs to be further investigated.

The Fifth Metatarsal Bone Fracture In Athletes ‐ Modalities of Treatment Related to Agility In Soccer Players

The 5th metatarsal fracture is a common foot fracture which could exclude a player from competition for several months and significantly affect his or her career. This manuscript presents the treatment and rehabilitation of professional soccer players who had acute fractures of the 5th metatarsal bone and a cannulated screw fixation. The main purpose of the analysis was to determine the minimum time necessary for a permanent return to the sport after a 5th metatarsal fracture among professional soccer players. We followed the surgical and rehabilitation path of 21 professional soccer players from the Polish League (Ist and IInd divisions) who suffered from the 5th metatarsal bone fracture. All players underwent standard percutaneous internal fixation with the use of cannulated screws. The total inability to play lasted for 9.2 (± 1.86) weeks among players treated only surgically (n = 10), 17.5 (± 2.5) weeks in the conservative and later surgery group, excluding players with nonunion (n = 6), and 24.5 (± 10.5) weeks for nonunion and switch treatment (n = 4) players. Prompt fracture stabilization surgery is recommended for athletes, enabling the implementation of an aggressive rehabilitation protocol as soon as possible. Early limb loading after surgery (from week 2) does not delay fracture healing or hinder the bone union, thus rehabilitation plays a crucial role in shortening the time of RTP (return to play) and is obligatory for each athlete who undergoes surgical treatment.

Radiographic Assessment of Distal Radius Fracture Treatment Outcomes Following Various Types of Fracture Stabilization in Elderly Patients

Background: Distal radius fractures pose a serious problem due to their high incidence and can be treated with various methods. No specific distal radius fracture treatment is acknowledged to be the gold standard by orthopedic surgeons. The aim of study was to conduct a comprehensive radiographic assessment of treatment outcomes in patients with distal radius fractures following various types of stabilization in elderly patients. Methods: We retrospectively assessed 122patients who underwent treatment for distal radial fracture in the years 2017and2018.There were three study groups: closed reduction with K-wire fixation (37patients),open reduction with volar plate fixation (42 patients),and closed reduction with cast immobilization (43patients).The mean age at the beginning of treatment was 73years.The mean follow-up period was 2 years and 7months.The following radiological parameters were evaluated: union rate, time to union, time of fracture immobilization, fracture stabilization failure, and the development of adjacent-joint arthritis. Results: There were no significant differences between the study groups in terms of union rate, time to union, and the development of adjacent-joint arthritis. After treatment, the lowest rates of posttraumatic intercarpal and carpometacarpal arthritis and the lowest rates of fracture stabilization failure in our study were observed in the plaster-cast group. Volar plate fixation was associated with the shortest duration of fracture stabilization. In comparison to the status from before treatment, all study groups showed increased rates of intercarpal and carpometacarpal arthritis after treatment. Conclusions: Our radiographic assessments demonstrated similar outcomes, regardless of the stabilization method. In treating distal radius fractures, we achieved good radiographic treatment outcomes irrespective of the fracture stabilization method used.

Evaluation of functional outcome of diaphyseal fractures of shaft humerus treated with closed interlocking nail in adults

<p class="abstract"><strong>Background:</strong> Humeral shaft fractures are those fractures of the diaphysis of the midshaft that do not involve the proximal or distal articular joints. Humerus fractures have a substantial impact on personal function and well‐being and are one of the causes of excessive mortality among the elderly. The aim and objective of the study was to study the functional assessment after interlocking nailing in fractures of shaft humerus.</p><p class="abstract"><strong>Methods:</strong> A retrospective clinical study was done on 20 patients with shaft humerus fractures treated with intramedullary nailing by orthopaedic surgeons at a tertiary care centre in the Department of Orthopaedics, Indian Institute of Medical Science and Research, Noor hospital, Jalna between January 2020 to July 2020 (DASH Score being calculated till January 2021). The DASH score was assessed 6 months post-operative day of surgery.</p><p class="abstract"><strong>Results: </strong>For all the operated patients clinical, physiological and ortho-radiological assessment were performed to observe and evaluate fracture stabilization, reduction, fracture healing and callus formation, functional evaluation done with DASH scoring system.</p><p class="abstract"><strong>Conclusions:</strong> Closed intramedullary nailing is safe and reliable technique to fix humeral shaft fracture. It provides early fracture consolidation, with high union rate, with advantage of early mobilization of the involved limb.</p><p class="abstract"> </p>