Risk Analysis of Re-displacement After Conservative Treatment of Pediatric Unstable Fractures of Middle and Distal Forearm

Background: Fractures of the middle and distal diaphysis of the forearm are common in children. Conservative treatment is effective in this regard. Some studies have discussed the risk factors and predictive indicators of re-displacement; however, the objects of the study are all fixed with tubular plaster or double sugar splint. Objectives: This study was performed to determine the risk factors of re-displacement after closed reduction and double splint plaster fixation of unstable pediatric fractures of the middle and distal diaphysis of the forearm. Methods: This retrospective study was conducted on 57 patients undergoing closed reduction and plaster fixation after unstable diaphyseal fractures of the middle and distal forearm in Wuxi Children's Hospital of Nanjing Medical University within May 2014 to May 2020. A total of 35 male and 22 female subjects aged 6 - 9 years (average: 7.3 years) participated in this study. They were followed up for more than 6 weeks after fracture healing. According to whether experiencing a secondary displacement within 2 weeks after the fracture, the subjects were divided into two groups, namely displacement, and non-displacement. Gender, age, double fracture, reduction quality, and plaster fixation type were analyzed as relevant, effective factors. Results: All 57 patients were followed up, and all fractures reached clinical healing standards at the last follow-up. Moreover, 20 and 37 cases were in the shift and non-shift groups, respectively. No statistically significant difference was reported in gender (c2 = 0.168; P = 0.780), age (t = 1.003; P = 0.217), double fracture (c2 = 0.021; P = 1), and plaster fixation type (c2 = 0.416; P = 0.699) between the two groups. The reduction quality (c2 = 7.480; P = 0.025) showed a statistically significant difference. Binary logistic regression analysis showed that reduction quality was a risk factor for fracture relocation providing a predictive value. Conclusions: Good reduction quality can reduce the risk of fracture displacement.

1616 Antibiotic Use in The Management of Mandibular Fractures: A Survey of Current Practice in the UK

Aim Traumatic mandibular fractures account for a significant proportion of UK oral and maxillofacial trauma. Prophylactic antibiotics is standard practice for management of these patients, however evidence for this is weak and relevant RCTs are insufficiently powered or poorly designed. The Maxillofacial Trainee Research Collaborative (MTReC) aims to survey current antibiotic regimens in UK OMFS units treating mandibular trauma, Method A multicentre online survey was shared via email and social media. Questions focused on current practices regarding management of mandibular fractures during pre-, peri-, and post-operative phases. Results 89 responses from 50 UK OMFS units including 76 trainees and 4 consultants were collated over 2.5-months. 45 units routinely admitted patients; 88% clinicians starting pre-operative IV antibiotics;11 different pre-operative antibiotic regimens were identified across all surveyed clinicians, with 65% prescribing Augmentin, and remaining 35% using variable combinations of penicillins with 4 other antibiotic classifications. 5 different protocols were identified in use across the 88.8 % of respondents who chose to prescribe post-operative antibiotics. Conclusions There is inter-unit and inter-clinician variability in prophylactic antibiotic prescription in UK patients undergoing ORIF mandibles. Given antimicrobial resistance has been declared a WHO public health threat, efforts must be made to reduce antibiotic overuse and understand regional situation specific sensitivities. The survey highlights need for nationalised protocols for antibiotics use in mandibular fractures, if at all. This survey of clinician reported practice will be used to inform a prospective observational study on 30-day outcomes of ORIF mandibles taking into account patient factors, fracture pattern, fixation type and antibiotic use.

Enhanced interfragmentary stability and improved clinical prognosis with use of the off-axis screw technique to treat vertical femoral neck fractures in nongeriatric patients

Background The optimal internal fixation strategy for vertical femoral neck fractures (VFNFs) in nongeriatric patients remains uncertain. Therefore, the purpose of this study was to compare the clinical prognoses and underlying mechanical characteristics of a novel off-axis screw technique with dynamic hip screws (DHSs) and three traditional parallel screws. Methods This study included a clinical investigation and a patient-specific finite element analysis (FEA). In the clinical investigation, VFNF patients were grouped by fixation type: (1) use of three parallel screws (G-TRI); (2) augmentation with an off-axis screw (G-ALP); and (3) DHS with an anti-rotational screw (G-DHS). Fixation failures (nonunion, femoral neck shortening (FNS), varus deformation, screw cut-out) and avascular necrosis (AVN) consequent to the three types of fixations were compared. In the FEA, twenty-four fixation models with the three fixation types were created based on the data of eight healthy volunteers. Models were assessed under walking conditions. Stiffness, interfragmentary motion (IFM), and implant stress were evaluated. Results In the clinical investigation, the fixation failure rate was significantly (p < 0.05) lower in G-ALP (18.5%) than in G-DHS (37.5%) and G-TRI (39.3%). No significant difference in AVN was observed among the three fixation groups. In the FEA, stiffness and implant stress in the G-DHS models were significantly (p < 0.05) higher, and the IFM of G-ALP was significantly (p < 0.05) lower among the groups. Conclusions Among fixation types for VFNFs, the off-axis screw technique exhibited better interfragmentary stability (lowest IFM) and a lower fixation failure rate (especially FNS). Analyzing interfragmentary stability in biomechanical experiments is more consistent with clinical prognosis than construct stability for VFNFs, suggesting that internal fixations should aim for this outcome.

P25 AVN and complication rate following Intracapsular fracture Neck of Femur fixation in the under 60s. – Derby experience

Introduction Neck of femur fractures (NOF#) are common in Trauma and Orthopaedics and Avascular necrosis (AVN) is a major complication. Guidance advises fixation within 48 hours, with no separate guidance for under 60 years of age. We reviewed factors affecting the complication rate in intracapsular NOF#’s undergoing fixation under the age of 60. Methodology We retrospectively reviewed a 5 year cohort (2013-2017) of intracapsular NOF#’s with native femoral head retention. 49 patients were identified. The following were determined: • Time to fixation from presentation in ED - 0-6hrs, 6-12hrs, 12-18hrs, 18-24hrs, 24-48hrs, 48+hrs: • Fixation type - Cannulated screw (CS), Dynamic Hip Screw (DHS), DHS + CS: • Complications – AVN, Non-union: • Displaced/Undisplaced Results 31 were undisplaced, 18 displaced. 82% (N = 40) were treated with CS, 10% (N = 5) with DHS and 8% (N = 4) with DHS + CS. Overall 21% developed AVN and 10% developed non-union. After undisplaced fractures 19% developed AVN and 10% developed non-union. After displaced fractures 22% developed AVN and 11% developed non-union. 40 patients were fixed using CS, 20% developed AVN and 12.5% had non-union. AVN occurred in 20% of those fixed with a DHS and 25% fixed with DHS and CS. No AVN was identified in the 0-6 hr fracture fixation time range. Conclusion No patients receiving fixation in less than 6 hours went on to have AVN or non-union, with higher rates after this time. There was no difference in outcome regarding AVN when looking at different fixation methods. There was no difference in complications when comparing fracture displacement.

Tibial-graft fixation methods on anterior cruciate ligament reconstructions: a literature review

Introduction Anterior cruciate ligament (ACL) reconstruction is the most performed orthopedic surgical procedure. The result of ACL reconstructions depends on multiple technical variables, including tension to be applied to the graft for fixation, knee-flexion angle during fixation and the type of fixation to the bone. Objective To carry out a survey of the literature with the best evidence on these themes. Methods Literature review about methods of tibial-graft fixation in ACL reconstructions – tension applied at the time of fixation, type of graft fixation, and knee-flexion degree during tibial fixation. Results Thirty studies on the selected topics were found. Most studies point to graft-tension levels close to 90 N to obtain the best results. Regarding the knee-flexion angle, multiple studies suggest that fixation at a 30° angle would bring superior biomechanical advantages. Regarding the type of implant for fixation, it is not possible to affirm the superiority of one method over another in clinical outcomes. Conclusions There is no consensus on the best method for tibial fixation of the grafts in ACL reconstructions regarding tension, type of implant and knee-flexion angle. However, the analysis of the studies pointed to certain trends and allowed the drawing of specific conclusions.