Video-Assisted Thoracoscopic Internal Rib Fixation

Rib fractures result in serious morbidity and mortality after trauma. Although there is ongoing debate about surgical rib fixation, it is increasingly important for some patients. Minimally invasive techniques for rib fixation are gaining traction within the trauma community. We present an observational experience at our level 1 trauma center with our first 10 cases of video-assisted thoracoscopic surgery (VATS) internal rib fixation. Video-assisted thoracoscopic surgery internal plates are especially helpful for rib fractures under the scapula, which are difficult to access traditionally. This technique is also excellent at reducing complex segmental fractures as the bridge can span across multiple fractures with a single post on either side. They also work well for posterior fractures where multiple screws cannot be placed. Video-assisted thoracoscopic surgery internal rib fixation is a viable and exciting option for surgical fixation. The plates work particularly well for certain fracture patterns.

Refracture after locking compression plate removal in displaced midshaft clavicle fractures after bony union: a retrospective study

Background: A midshaft clavicle fracture is a common fracture that typically responds well to open reduction and internal fixation (ORIF). However, refracture can occur after implant removal (IR). This study aimed to analyze the rate of refracture and related factors after removal of the locking compression plate (LCP) for displaced midshaft clavicle fractures. Methods: We retrospectively reviewed the medical records of 201 patients who had undergone ORIF with LCP for midshaft clavicle fractures after IR after bony union from January 2011 to May 2018 at our institute. We evaluated basic demographic characteristics and radiographic parameters. All patients were treated with an LCP for primary fracture. The patients were divided into two groups: a refracture group that experienced a second fracture within 1 year after IR and a no-fracture group.Results: There were four cases (1.99%) of refracture; three were treated conservatively, while one was treated surgically. All patients achieved bony union. The average interval between refracture and IR was 64 days (range, 6–210 days). There was a significant difference in classification of fractures (AO Foundation/Orthopaedic Trauma Association [AO/OTA] classification) between the two groups. However, other patient demographics and radiographic measurements between refracture and IR, such as bone diameter, showed no significant difference between the two groups. Conclusions: This study showed that one in 50 patients suffered from refracture after removal of the LCP. Thus, if patients desire IR, the surgeon should explain that there is a relatively higher possibility of refracture for cases with simple or segmental fractures than for other types of fracture.

Management of Closed Tibal Shaft Fractures with Reamed Interlocking Nail

Objective: The aim of this study is to determine the effectiveness of reamed interlocking nail in the management of closed tibal shaft fractures. Study Design: Descriptive/ Observational study Place and Duration: Study was conducted in Orthopaedic Unit Ayub Medical Teaching Institute Abbottabad and DHQ Teaching Hospital Gomal Medical College Dera Ismail Khan for nine months duration from January 2019 to September 2019. Methods: Total 80 patients of both genders were presented in this study. Age ranges of enrolled cases were 20-70 years. Demographically details of enrolled cases were recorded after taking written consent. Patients who had tibial shaft fractures were admitted in emergency ward and underwent for reamed interlocking nail. Postoperatively union time and rate of complications were assessed. Complete follow up of the patients were take place in duration of 14-months. Data was analyzed by SPSS 20.0 version. Results: Mean age of the patients was 28.65±8.77 years with mean BMI 24.16±6.23 kg/m2. Out of 80 patients, 47 (58.6%) were males and 33 (41.4%) were females. Traffic accident was the most common cause of fracture found in 60 (75%) cases, followed by fall from the height 15 (18.75%) and the rest were others 5 (6.25%). Mean united time of simple fractures were 13.14±4.14 weeks while among segmental fractures union time observed 18.13±6.17 weeks. Frequency of union fractures was 62 (77.5%), delayed unions were 13 (16.25%) and non-unions were 5 (6.25%). Satisfaction rate was 72 (90%) among all cases. Conclusion: We concluded in this study that reamed interlocking nail was an effective and safest method for the management of closed tibal shaft fractures. Overall union rate in this study was 93.75% and showed less morbidity among cases. Keywords: Interlocking nail, Tibial shaft fractures, Union

Development and Validation of a Nomogram for Predicting the Probability of Adjacent Segmental Fractures After Vertebral Augmentation of Osteoporotic Vertebral Compression Fractures

Background Adjacent segmental fractures are adverse events after vertebral augmentation of osteoporotic vertebral compression fractures(OVCFs). Predicting the risk of adjacent segmental fractures accurately after surgery is still a significant challenge for spinal surgeons. The aim of our study was to identify predictive factors of the risk of adjacent segmental fractures after vertebral augmentation of OVCFs and develop a nomogram. Methods A nomogram was compiled based on the training cohort of 403 patients, who were hospitalized for OVCFs and performed vertebral augmentation, in the People's Hospital of Ningxia Hui Autonomous Region from June 2014 to December 2016. The independent predictive factors of postoperative adjacent segmental fractures were determined by LASSO, univariate analysis and multivariate logistic regression analysis. Then, establish a nomogram based on these independent predictors. We assessed nomograme using variety methods, including area under the curve (AUC), calibration curve and decision curve analysis (DCA).The above results were verified by the validation cohort of 159 patients, who were hospitalized for OVCFs and performed vertebral augmentation between January 2017 and June 2018. Results The establishment of the nomogram was based on six independent predictors， were determined by multivariate analysis，including age, bone cement injection, bone cement leakage, contact between bone cement and vertebral endplates, bone cement dispersion, and anti-osteoporosis treatment. In the training and validation cohort, the AUC of the nomogram were 0.882 (95% confidence interval, 0.824–0.940) and 0.869 (95% confidence interval: 0.811–0.927),respectively.In the training and validation cohort, the optimal calibration curves demonstrated the coincidence between prediction and actual status, and the decision curve analysis demonstrated that the full model had the highest clinical net benefit across the entire range of threshold probabilities. Conclusion The risk prediction model shows a satisfactory prediction effect and could quantify the probability of adjacent segmental fractures after vertebral augmentation of OVCFs.

An Alternative Approach Using Circummandibular Wiring for Treatment of Dentoalveolar Fractures in Children: A Case Report

The prevalence of dentoalveolar injuries in children is approximately 25%, with falls from own height being one of the main etiologies. Diagnosis is based on the clinical evaluation associated with complementary imaging tests. The treatment of choice depends on the type of damage and structure affected. For alveolar process fractures, closed reduction and semi-rigid dental splinting for 4 to 6 weeks is generally satisfactory. However, some cases, such as severe segmental fractures, require open treatment to ensure adequate reduction and stabilization of the displaced alveolar segment, which is usually achieved by titanium miniplates and screws. Nevertheless, there are situations where this type of fixation is not possible, requiring alternative methods. Therefore, this article describes a surgical technique performed by open reduction, associating semi-rigid dental splint and circummandibular wiring in pediatric patient diagnosed with dentoalveolar fracture through clinical examination (with bone fracture displacement) and tomography. The technique promoted a good prognostic to the patient, proving to be a viable alternative for treating dentoalveolar fractures.

Tratamento cirúrgico de fraturas Le Fort I e Le Fort II em vítima de trauma por acidente motociclístico: relato de caso

O terço médio da face é funcional e esteticamente importante. De acordo com a classificação Le Fort, existem três níveis mais fracos desta região da face quando traumatizados a partir de uma direção frontal, sendo que os acidentes motociclísticos, atualmente, correspondem a causa de aproximadamente 29% destes traumas. O presente trabalho tem como objetivo relatar um caso clínico de tratamento cirúrgico de fraturas do tipo Le Fort I e Le Fort II em um paciente de 29 anos de idade, sexo masculino, vítima de acidente motociclístico, atendido no Hospital de Emergência e Trauma Senador Humberto Lucena (João Pessoa – PB). Ao exame físico observou-se mobilidade de maxila, degrau palpável em pilar zigomático e pilar canino, alteração oclusal com leve mordida aberta e degrau em rebordo infraorbitário direito, entretanto o paciente não apresentava nenhuma alteração ocular. Foi solicitada tomografia computadorizada como exame complementar para confirmação do diagnóstico e planejamento cirúrgico, o qual se deu como fratura Le Fort I e Le Fort II no lado direito. O paciente foi submetido à cirurgia sob anestesia geral para fixação dos pilares zigomático e canino através do acesso vestibular maxilar e rebordo infraorbitário através do acesso subciliar. Inicialmente foi feito o bloqueio maxilo – mandibular para a utilização da oclusão como ponto de referência, seguido da redução das fraturas e fixação com placas e parafusos do sistema 2.0. Sob acompanhamento pós – operatório o paciente apresentou retorno da oclusão dentro dos padrões de normalidade, recuperou a projeção da região zigomática fraturada e então recebeu alta. Descritores: Fraturas Ósseas; Fixação de Fratura; Traumatismos Faciais. Referências Organização das Nações Unidas no Brasil. Traumas matam mais que malária, tuberculose e AIDS, alerta OMS. Disponível em: <http://www.onu.org.br/traumas-matam-mais-que-malaria-tuberculose-e-aids-alerta-oms/>. Acesso em: 22 julho 2019 Ansari MH. Maxillofacial fractures in Hamedan province, Iran: a retrospective study (1987-2001). J Craniomaxillofac Surg. 2004;32(1):28-34. Kostakis G, Stathopoulos P, Dais P, Gkinis G, Igoumenakis D, Mezitis M, Rallis G. An epidemiologic analysis of 1,142 maxillofacial fractures and concomitant injuries. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;114(5 Suppl):S69-73. Li Z, Li ZB. Characteristic changes of pediatric maxillofacial fractures in China during the past 20 years. J Oral Maxillofac Surg 2008;66:2239-42. Fonseca RJ. Trauma Bucomaxilofacial 4. ed. Rio de Janeiro : Elsevier; 2015. Wulkan M, Parreira Junior JG, Botter DA. Epidemiologia do trauma facial. Rev Assoc Med Bras. 2005;51(5):290-95. Scherer M, Sullivan WG, Smith DJ Jr, Phillips LG, Robson MC. An analysis of 1,423 facial fractures in 788 patients at an urban trauma center. J Trauma. 1989;29(3):388-90. Cohen RS, Pacios AR. Facial and cranio-facial trauma: epidemiology, experience and treatment. F Med. 1995;111(suppl):111-16. de Birolini D, Utiyama E, Steinman E. Cirurgia de Emergência. São Paulo: Atheneu; 1997. Tessier P. The classic reprint: experimental study of fractures of the upper jaw. 3. René Le Fort, M.D., Lille, France. Plast Reconstr Surg. 1972;50(6):600-7. Buehler JA, Tannyhill RJ 3rd. Complications in the treatment of midfacial fractures. Oral Maxillofac Surg Clin North Am. 2003;15(2):195-212. Manson PN, Clark N, Robertson B, Slezak S, Wheatly M, Vander Kolk C, Iliff N. Subunit principles in midface fractures: the importance of sagittal buttresses, soft-tissue reductions, and sequencing treatment of segmental fractures. Plast Reconstr Surg. 1999;103(4):1287-306; Carr RM, Mathog RH. Early and delayed repair of orbitozygomatic complex fractures. J Oral Maxillofac Surg. 1997;55(3):253-8; 258-9.