Management of Comminuited Intra/Juxta Articular Fracture of Distal Radius Using Bridging External Fixator

Background: Distal radius fractures are the third most common osteoporotic fractures and are frequently treated in emergency department. They have a trimodal peak of occurrence and there has been a significant increase in incidence of involvement in elderly females and young males. Management of these fractures comes with lots of treatment options and challenges to provide good functional outcome. This prospective study was done for the management of communited intra/juxta articular fractures of distal end radius using a bridging external fixator on 25 patients. The principle of ligamentotaxis was used for alignment of fracture fragments and wrist spanning external fixator was used to maintain the fracture reduction.Methods:25 patients of either sex with age group 16 to 80 years were taken from the orthopedic department. After proper primary care, cases were classified using Fernandez classification, and posted for surgery as soon as investigations and fitness were taken.Results:Patients involved in the study were in range of 16 to 78 years with 16 patients having dominant side with road traffic accident as leading cause.Radiological union was seen at an average of 7.3 weeks, 4 patients had superficial pin tract infection, 3 patients had stiffnes and a single case had malunion. Conclusions:Modified clinical scoring system of Green and O’Brien was used to evaluate the overall functional results which showed excellent to good results in 84% of cases. Hence, properly planned and executed bridging external fixator is an easy, cost-effective and reliable treatment modality through the “Principle of Ligamentotaxis”.

Functional and radiological outcomes of distal humerus fractures treated with pre-contoured locking compression plate

<p><strong>Background: </strong>Distal humerus intra-articular fractures are one of the complicated fractures managed by orthopaedic surgeons. We did a prospective and a retrospective study on 21 patients with these fractures treated with pre-contoured locking compression plate.</p><p><strong>Methods: </strong>The<strong> </strong>21 patients in this series were followed for a minimum of 1 year. The prospective study cases were followed at 3 months, 6 months and annually. The rating system of the Mayo elbow functional scoring system was used. The radiological evaluation was done using standard AP and lateral views.<strong></strong></p><p><strong>Results: </strong>We had 14 patients with range of motion of 50-100 degrees. There was only one patient with range of motion of &lt;50 degrees. 6 patients had the maximum range motion of &gt;100 degrees. We had 6 (23.57%) excellent, 9 (42.85%) good, 5 (23.80%) fair and 1 (4.7%) poor in the Mayo elbow scoring at the end of 1 year. We were able to compare our outcomes with a study done by Kumar et al done in 2017. They had 27 (89.66%) of excellent and good results as opposed to 27 (79.4%) in our study. Out of 21 patients in our study 17(80.95%) patients had good 11 (52.5%) / excellent 6 (28.5%) results. This was comparable with Jupiter et al. His study of 34 patients 26 (79.40/0) patients showed good 14 (41%) / excellent 13 (38.4%) result.<strong></strong></p><p><strong>Conclusions: </strong>Pre-contoured locking compression plate appears to be technically an ideal implant for comminuted osteoporotic bone providing an angle stable construct.</p>

Surgical treatment of patients with extra-articular fractures of the distal humerus

Background. The article deals with extra-articular fractures of the distal humerus, according to the АО/ASIF classification, which includes types 12A–C, depending on the plane of the fracture and the nature of the fragment displacement. The purpose was to study the features of the lower third humeral fractures and to conduct a comparative analysis of the outcomes of surgical treatment. Material and methods. One hundred and twenty-seven patients with extra-articular fractures of the distal humerus were under observation. For retrospective analysis, they were divided into a comparison group (n = 92) who underwent traditional bone osteosynthesis and a study group (n = 35) in whom a rod-type external fixation device developed by us was used. The short- and long-term functional results were studied using the Mayo Elbow Performance Score. Results. Various indicators, established by us for comparison, and treatment outcomes were analyzed in 101 patients (comparison group — 68 people, study group — 33). Many values of these parameters were quite comparable in terms of the age, gender, hospitalization terms, duration of surgeries, etc., but the revealed differences in indicators still did not reach the level of statistical reliability (p > 0.05). Evaluation of the clinical use of the device proposed by us showed restoration of the humeral anatomy, quite comparable to that in bone osteosynthesis, and the achievement of the final result of treatment. However, the number of complications by type and by total number was significantly higher (4.5 times; p ˂ 0.001) in the comparison group, where it accounted for the largest share of cases of neuropathies (16.18 %), nonunions (8.82 %), elbow contractures (8.82 %) and heterotopic ossification (4.42 %). The final score on the Mayo Elbow Performance Score in the comparison group was 84.9 ± 10.2 points, in the study group — 92.6 ± 3.7 points. At the same time, the total number of positive treatment outcomes after bone osteosynthesis was 66.18 %, after transosseous osteosynthesis — 81.82 %. Conclusions. The analysis of the data obtained allows us to recommend a method of minimally invasive osteosynthesis with a rod device of external controlled fixation as a method of choice for wider clinical use in the treatment of patients with lower third humeral fractures.

Features and results of knee arthroplasty after osteosynthesis of intra-articular fractures forming its bones

The purpose of the study - to find out surgical intervention features, the function restoration dynamics and clinical results after primary total knee replacement (TKA) in patients with a history of osteosynthesis of intra-articular fractures, to assess the risk of complications and to suggest measures for their prevention. Material and methods. The study includes a retrospective (100 observations) and prospective (40 observations) comparative analysis of the results of primary TKA in patients with a history of osteosynthesis of intra-articular fractures (MOS) of the bones forming the knee joint (main group) and without them (comparison group). Adapted Russian-language versions of the KSS, WOMAC and FJS-12 score scales were used to study the clinical and functional results of the TKA, the incidence of any complications after arthroplasty and the X-ray position of the endoprosthesis components on the KRESS scale were evaluated. Statistical analysis of the data obtained was carried out in accordance with generally accepted methods. Results. Statistically significant differences were revealed between the patients of the main and the comparison groups according to the following indicators: the patients of the main group were 8 years younger, the duration of the operation time, the volume of intraoperative blood loss, the need for implantation of structures with an increased degree of mechanical coupling between the components of the endoprosthesis, the number of postoperative complications were greater in the patients of the main group. Functional results on the KSS and WOMAC scales did not have statistically significant and clinically differences, when assessing the satisfaction of TKA on the FJS-12 scale, statistically significantly worse results were obtained in the main group. TKA in patients with a history of MOS for intraarticular fractures of the knee joint area statistically and clinically significantly increased the amplitude of movements in the knee joint - from 89 to 108 , that is, by 19 , the function recovery dynamics according to the KSS, WOMAC and FJS-12 scales was slowed down at 3 and 6 months, and according to the WOMAC and FJS-12 scales and by 12 months after surgery. Conclusion. The trauma and subsequent surgical treatment of intra-articular fractures of the knee joint leads to an earlier development of posttraumatic arthritis of the 3rd degree, functional results have no statistically significant differences, satisfaction with the results of TKA in this category of patients is less, and the number of postoperative complications, are greater. A history of MOS significantly slows down the dynamics and degree of recovery of function in the early postoperative period.

Factors Associated with Timely Surgery for Semi-elective Distal Radius Fracture Fixation

Background In the United Kingdom, national guidance recommends intra-articular distal radius fractures should undergo surgery within 72 hours and extra-articular fractures within 7 days. Purpose We investigated if hospitals can provide timely surgery and meet national guidelines in patients who are sent home following distal radius fracture (DRF) to return for planned surgery. The influence of patient, hospital, and seasonal factors on wait to surgery are investigated. Patients and Methods We reviewed Hospital Episode Statistics (HES) data between April 2009 and March 2013. Proportion of procedures being performed within 3 and 7 days was calculated. A linear regression model was created to investigate the relationship between wait for surgery and patient and hospital factors. Results A total of 9,318 patients were sent home to return for planned acute DRF surgery during the 4-year study period. Mean time to surgery was 3.04 days (range 1–days, standard deviation [SD] 3.14). A total of 6,538 patients underwent surgery within 3 days (70.2%) and 8,747 within 7 days (93.9%). Patients listed for surgery and sent home to return waited longer if listed toward the end of the week. Less surgery was performed at weekends, and patients were less likely to be listed for semielective trauma surgery. Conclusions Acute semielective DRF fixation is generally performed within targets for extra-articular fractures but there is scope for improvement for intra-articular fractures. Day of presentation and increasing number of comorbidities increase wait for surgery. Hospital trusts should focus on improving pathways for patients with multiple comorbidities and strategies to improve accessibility of these services at weekends.

A STUDY ON OUTCOME OF MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS (MIPO) IN EXTRA ARTICULAR FRACTURE OF DISTAL 1/3RD TIBIA.

BACKGROUND: Fractures of the distal tibia can be challenging to treat because of the limited soft tissue, the subcutaneous location, and poor vascularity. There is a considerable debate regarding the best method for treating distal tibial fractures. In present study we have treated distal tibial fractures using MIPPO technique OBJECTIVES: To evaluate the functional outcome following use of MIPO technique in lower 1/3rd fractures of tibia. MATERIAL AND METHODS: This is a longitudinal follow up study. In this study a total of 30 patients with fracture distal 1/3rd tibia admitted to CMRI hospital will be selected for treatment with MIPO technique according to inclusion and exclusion criteria. All patients were reviewed in CMRI Hospital and radiographs (Tibia AP and lateral views) obtained after surgery and then at 1 month, 3 months and nally at 6 months. From 5 weeks onwards symptoms and functions will be assessed using the scoring system of Olerud and Molander(1984). Statistical analysis of categorical variables was expressed as number of patients and percentage of patients and continuous variables are expressed as descriptive statistics. The statistical software SPSS version 20 has been used for the analysis. RESULTS: The age of patients ranged from 22-65 years. Fracture was most common in 4th and 5th decade of life. Average mean age was 44.03±10.74yrs. In this study majority of 17(56.7%) patients were male and there were 13(43.3%) were female. Road Trafc accident (RTA) was the main cause to produce lower end tibia fractures (83.3%) in our study. In this study right side (60%) was involved more than left (40%). In this study only 3 (10%) patients had open grade 1 injury. Majority of patients 27 (90%) had closed injury. In our study 66.67% (20) of patients had associated injuries and 33.33% patients had no associated injury. Average injury operation interval in this study was 3.27±1.53 days. Average no. of plate holes were 10.50±1.72. Average duration of hospital stay in this study was 10.07±2.75 days. Average duration of surgery in this study was 88.03±16.36 minutes. In this study 26 patients (86.7%) had no early post-op complications and 4 (13.3%) had complications. 3 patients (10%) had delayed wound healing and 1patient (3.3%) had supercial infection of suture lines. There was 1 non-union and majority of patients 21(70%) took 20-25 weeks for union. 7(23.4%) patients took less than 20 weeks and 1(3.33%) patient took more than 25 weeks. Average time of union in this study was 21.17±2.17 weeks. Average time of weight bearing was 17.72±1.91 weeks in this study. Most frequent late complication seen was swelling with frequency of 7 followed by stiffness and pain. 1 patient had malunion and 1 patient had non-union. In this study there were 28(93.3%) patients which showed union, 1 (3.3%) patient showed coronal malunion and 1(3.3%) had non-union. There were 21 patients (70 %) with excellent result, 7 patients (23.3%) with good result and 2 patients (6.7%) with fair result in our cases of study. Average clinical Olerud & Molander score was 81.17±16.07 in this study. CONCLUSION: The satisfactory functional results and lack of soft tissue complications suggest that this method should be considered in peri-articular fractures. Biological xation of complex fractures gives stable as well as optimal internal xation and complete recovery of limb function at an early stage with minimal risk of complications.

Application of Biological Glue in Orthopedics and Traumatology

The purpose of the study was to investigate the method of osteosynthesis using glues. Materials and methods. The simplest and most effective method in the treatment of traumatological patients is a plaster fixing bandage of different variations. This is a conservative type of treatment. Also, a very common method in the treatment of orthopedic and traumatological patients is the surgical method. Modern high-tech methods of osteosynthesis require a thorough preoperative examination of the patient, conducting a 3D tomographic examination for intra-articular fractures, clear planning of the course of surgical intervention, electro optical probing techniques during the operation, the availability of tool kits for installing retainers, the ability to choose a retainer intraoperative in the size range. An orthopedic-traumatologist and the entire operating team need appropriate training. All operational fixation methods must provide adequate stability to maintain axis length and rotation. Results and discussion. In the world practice, biological glues are used in such areas as abdominal surgery, neuro- and cardiac surgery, plastic and pediatric surgery, orthopedics and traumatology. Cyanocrylate glues have undergone extensive experimental clinical testing. Positive characteristics of cyanoacrylate glues are the ability to glue living tissues in a humid environment, polymerization rate, autosterility, bactericidal, absence of histotoxicity, hemostatic effect. Another glue in the review is sulfacrylate. It can be used in patients of any age, starting from newborns, regardless of the pathogenesis of the disease. Venaseal glue, used by many authors to treat fistulas of the gastrointestinal tract. Widely used fibrin glues, such as Evicel, are used to achieve hemostasis and sealing in surgery, for example, in vascular operations, kidney resection and neurosurgical interventions, in the surgical treatment of distal hypospadias in children. BioGlue glue is designed to seal surgical sutures, thereby preventing fluids (exudate, lymph, urine, gastric juice) and / or air from leaking through them. It is also used in liver surgery. At the moment, the use of bone cement is the most common auxiliary method for surgical interventions. But its side effects are very clear. Bone cement can cause the patient to die on the operating table or, in the postoperative period, in intensive care. This is due to an immediate or rapid allergic reaction. This situation is dangerous for humans. Biological glues are not so toxic and do not cause such allergic reactions Conclusion. The search for new materials and techniques for consolidating bone fragments is one of the most important problems of modern medical science, namely orthopedics and traumatology. Substances that are included in the biological glue must be bioinert, contain elements of strength (for holding fragments), looseness of the structure (for germination of capillaries between fragments), natural antibiotic (for antibiotic prevention), activators of hematopoiesis processes (for the fastest callus), organic and inorganic substances (for the building material of bone tissue). Therefore, the desire to improve treatment and improve its results, in particular in orthopedics and traumatology, is the key to the development of modern medicine