Coronal Shear Fractures of the Distal Humerus

Coronal shear fractures of the distal humerus are rare, frequently comminuted, and are without consensus for treatment. The aim of this paper is to review the current concepts on the diagnosis, classification, treatment options, surgical approaches, and complications of capitellar and trochlear fractures. Computed Tomography (CT) scans, along with the Dubberley classification, are extremely helpful in the decision-making process. Most of the fractures necessitate open reduction and internal fixation, although elbow arthroplasty is an option for comminuted fractures in the elderly low-demand patient. Stiffness is the most common complication after fixation, although reoperation is infrequent.

Bone Fractures Numerical Analysis in a Femur Affected by Osteogenesis Imperfecta

This work presents a non-invasive methodology to obtain a three-dimensional femur model of three-year-old infants affected with Osteogenesis Imperfecta (OI) type III. DICOM® Files of a femur were processed to obtain a finite element model to assess the transverse, the oblique, and the comminuted fractures. The model is evaluated under a normal walking cycle. The loads applied were considered the most critical force generated on the normal walking cycle, and the analyses considered anisotropic bone conditions. The outcome shows stress concentration areas in the central zone of the diaphysis of the femur, and the highest levels of stress occur in the case of the comminuted fracture, while the transverse fracture presents the lowest values. Thus, the method can be helpful for determining the bone fracture behavior of certain pathologies, such as osteogenesis imperfecta, osteopenia, and osteoporosis.

The Use of Low-Profile Angular-Stability Plates in a “Nutcracker” Tarsal Navicular Fracture Combined with a Cuboid Fracture: ORIF Experience

Background: Clear recommendations about the optimal treatment of traumatic tarsal navicular fractures are still very debated in the literature, and this is due to several factors: navicular fractures are rare and often misdiagnosed injuries, they are frequently associated with other fractures or a dislocation of the midfoot, and the current knowledge is based on few papers mainly considering a limited number of cases and dealing with different therapeutic approaches. The treatment of navicular body fractures is controversial and burdened by a high incidence of complications; in particular, Sangeorzan type III comminuted fractures represent a real challenge for the orthopedic surgeon. An accurate preoperative planning, a scrupulous surgical technique aimed at restoring volume and bony anatomy, and the use of low-profile angular-stability plates can lead to optimal clinical and functional results, decreasing the chances of arthritic evolution of mid-foot joints.

EFFICACY OF TERIPARATIDE IN COMMINUTED FRACTURE HEALING IN LOWER LIMB: A RETROSPECTIVE STUDY

Objective: The objective of the study was to show the efficacy of teriparatide in comminuted fracture healing and improvement in overall functional recovery. Methods: A total of 30 subjects who suffered from comminuted fractures of lower limb were selected. Subjects were categorized into two groups: Group A (n=15) contained individuals with teriparatide administration and Group B (n=15) contained individuals who were not administered teriparatide. 20 mg of teriparatide was injected subcutaneously for a period of 3 months. Patients were followed up ay durations of 4, 8, and 12 weeks. Obtained data were entered into Microsoft Excel Worksheets and descriptive analysis was performed. Chi-square test was used to analyze all obtained data. Results: Among Group A patients, the fracture healing rates were found to be significantly earlier with comparison to control group (Group B). Conclusion: Teriparatide was observed to be effective in comminuted fracture healing and has demonstrated good clinical outcome.

A PROSPECTIVE STUDY TO EVALUATE THE SURGICAL MANAGEMENT OF PROXIMAL HUMERUS FRACTURES BY LOCKING PLATES

BACKGROUND: This prospective clinical study was performed to evaluate the efcacy and functional outcome in proximal humeral fractures following surgery with locking plates. MATERIAL & METHODS: from August 2013 to April 2015, 32 patients were enrolled in this study following exclusion and inclusion criteria. The evaluation parameters included Time taken for fracture union, functional scores, radiographs of the shoulder and ROM (Range of motion- exion, abduction, internal and external rotation etc.). Patients were followed up regularly at 6 weeks, 12 weeks, 24 weeks and 12 months. Functional results were evaluated using Neer's score. All data were collected and analyzed with the help of suitable statistical parameters. RESULTS: The nal results were evaluated by using NEER'S Score. In our study, the minimum score was 65 and maximum was 94. The average score was 83.9 (Mean ± S.D. : 83.875 ± 6.73). We had excellent results in 6(18.75%) patients, 19(59.375%) had satisfactory results, 7(21.875%) patients had unsatisfactory results but none of the case is failure in our study. CONCLUSION: Open reduction and internal xation with Locking Compression Plates, has given good results and it is the implant of choice now-a-days particularly in comminuted fractures and in osteoporotic bones in elderly patients.

748 Case Series: Experience of Using External Fixation as An Adjunct in The Management of MRONJ Affecting the Mandible

Introduction External fixation was first described by Malgaigne and Rigaud in 1870 for use on long bones, then adapted for OMFS in 1934 and used for treating comminuted fractures. In recent times, popularity of external fixators has decreased with the use of mini-plates, often only used in major trauma, for example gunshot wounds. This is a case series of patients who have been treated by external fixation for medication related osteonecrosis (MRONJ) of the jaw and could be a fairly simple alternative to major reconstructive surgery in such cases. This method of treatment has been particularly useful during the Covid-19 pandemic as a non-aerosol generating procedure. Method A single centre, retrospective study of 5 cases between December 2018 - December 2020. The MRONJ cases were graded using the AAOMS classification. All cases treated with external fixation of mandible were included. Pre-operative condition, medical history, treatment complications, pain management, length of treatment and follow-up results were recorded. Results Of the 5 cases treated for MRONJ, 4 of these had pathological fractures. All were AAOMS stage 3. The mean duration of treatment was 78 days, with regular clinical reviews monitoring progress. Of these cases, 4 cases healed well with significant improvement or closure of intraoral and extra-oral wounds. Conclusions In this small case series the technique has shown positive results; being well received by patients and allowing function while in situ. It allows treatment of pathological fractures as well as stabilising the mandible as a preventative measure whilst debriding severely atrophic mandibles.

Treatment of Comminuted Proximal Humeral Fractures with Fibular Autografts

Background: For severe proximal humerus comminuted fractures, which are often accompanied by a large number of fracture defects, there are many cavities left at the fracture end after reconstruction, which is one of the important factors leading to the failure of internal fixation. At present, the appropriate treatment of these proximal humerus comminuted fractures has not been identified. The purpose of this study used locking plates combined with fibular autografts was increased fixed strength for the treatment of severe comminution fractures of the proximal humerus with bone defects. Methods: 10 cases of comminuted fracture of proximal humerus with bone defect were treated with open reduction and plate internal fixation combined with autologous fibular segment structural bone grafting. The postoperative follow-up was summarized and statistically analyzed by a paired sample t test.Results: There was a total of 10 cases, including 7 cases that had full follow up data. The constant Murley score of the shoulder joint was 88.57±4.28 points at 12 months after the operation. The preoperative HSS score of the knee joint was 90.14±4.95 points. The HSS score of the knee at 12 months after the operation was 90.5±5.47 points. The preoperative HSS score and the postoperative 12-month score had P=0.088 (>0.05). The shoulder function score at 12 months was defined as excellent in 2 cases, good in 5 case, and 100% of the patients had excellent or good scores.Conclusions: Locking plates combined with autogenous fibula segment transplantation may be an effective treatment for severe comminution fractures of the proximal humerus with bone defects.

Management of Unilateral Zygomaticomaxillary Complex Fracture - A Case Report

Zygomaticomaxillary complex (ZMC) fractures are relatively common. Zygomatic complex fractures with functional or aesthetic impairments often require surgical intervention. Treatment of ZMC fractures consists of reduction and fixation of the dislocated bone fragments to their original location. The zygomaticomaxillary complex functions as a major buttress for the face and because of its prominent convex shape, is frequently involved in facial trauma.1 ZMC fractures are also called tripod, tetrapod, quadripod, malar or trimalar fractures. They account for approximately 15 % - 23.5 % of maxillofacial fractures.2,3 The aetiology of zygomatic complex fractures primarily includes road traffic accidents (RTA), violent assaults, falls and sports injuries. They are the second most common facial fracture after nasal bone fractures.3-6 ZMC fractures are more common in men than women, and most commonly occur in the third decade of life.7-10 The main clinical features of zygomatic complex fractures include diplopia, enophthalmos, subconjunctival ecchymosis, extraocular muscle entrapment, cosmetic deformity, malocclusion and neurosensory disturbances of the infra-orbital nerve.10 The gold standard radiological investigation for evaluation of ZMC fractures is computed tomography (CT) scan. Surgical intervention is effective in cases of displaced and comminuted fractures involving functional and aesthetic defects, whereas a nonsurgical approach is often used for non-displaced fractures.11 Various surgical approaches and treatment strategies have been proposed to obtain a successful treatment outcome. Based on review of literature, it has been observed that the open reduction with internal fixation using mini plates and screws is the most commonly preferred treatment for displaced and comminuted fractures.10-12 Here, we report a clinical case of right zygomaticomaxillary complex fracture and its management.

Favorable and unfavorable maxillofacial comminuted fractures

Many maxillofacial injuries were reported with the most common ones being nasal bone injuries. In another context, injuries occurring to the mandible followed by the malar bone and axilla are the most common injuries that require surgical interventions. However, favorable outcomes regarding the management of these injuries are associated with many factors. Such factors include the severity of the fracture and the presence of associated morbidities and other fractures, which might lead to unwanted complications and complex management plans. In this study, we aim to discuss the most reported maxillofacial fractures, elaborating when favorable and unfavorable events can be detected. Moreover, this literature review discusses some challenges that might be present in some cases, requiring the integration of certain management skills and techniques. Providing adequate examination is essential to conduct better management. Caring for the associated fractures with the main event is also important, and should be considered to intervene against the development of any adverse events.