External fixation in distal radius fractures

Background: Distal radius fractures are frequent in emergency departments, treatment is generally conservative, but there are patients who meet certain criteria of instability who need surgical treatment, including external fixation. Aim: To update on the most important elements regarding the use of external fixation in unstable fractures of the distal radius. Methods: The search and analysis of the information was carried out in a period of 30 days (from April 1 to April 30, 2021) and the following words were used: distal radius fractures, distal radius fractures and external fixation and unstable radius fractures from the information obtained, a bibliographic review of a total of 809 articles published in the PubMed databases, Hinari, SciELO and Medline was carried out using the search manager and EndNote reference manager, of which 44 selected citations were used to perform the review, 37 from the last five years. Development: The criteria to be taken into account for the instability described by various authors are indicated, as well as the imaging parameters. The two most used classification systems are mentioned. Reference is made to general surgical indications, external fixation, and placement of additional wires. Complications are discussed and a comparison is made between external fixation and blocked volar plates.

Risk decreasing of water waste through spontaneous fracturing in injectors by integrated well-testing and production logging

Background. When creating an effective reservoir pressure maintenance system, unstable spontaneous hydraulic fractures can be created in injection wells. This can both negatively and positively affect hydrocarbon production. First, fracture improves reservoir connectivity, which increases injection efficiency. On the other hand, unstable fractures can cause behind-the-casing flows and unproductive injection into off-target layers or fingering. Goal. The paper is devoted to the analysis of well testing (PTA) and production logging (PLT) improvement for the diagnosis of unstable fractures in injection wells. Materials and methods. The analysis is based on the results of modeling the pressure in the reservoir system, describing the penetration reservoirs by an unrestricted conductivity unstable fracture. It is taken into account that the fracture can cross both the perforated formation and the thickness not penetrated by the perforation, and can grow with increasing overbalance. The modeling results made it possible both to assess the potential informative capabilities of well testing and to substantiate recommendations for the practical use of the obtained results. Conclusions. The proposed approaches to the technology of well testing and production logging and the interpretation of their results make it possible to estimate the additional thicknesses of the reservoirs connected by the spontaneous hydraulic fracturing to injection, the proportion of nonproductive injection in the total volume of the well. The research technology used by the authors is based on continuous measurements of pressure and flow rate during cyclic change of pressure and assessment of the effective transmissibility of the formation system at different heights of unstable fractures. The role of the PLT is to determine the effective production thickness of the reservoirs. When assessing the injectivity profile when penetrating the injector with the spontaneous hydraulic fracturing, the key role belongs to non-stationary temperature logging. In this case, it is necessary to take into account the specific features of temperature relaxation in the wellbore after the injection cycle, related to hydraulic fracturing, primarily the increase in the relaxation rate with increasing fracture length.

Unstable Fractures Osteosynthesis of Malleoli and Posterior Edge of the Tibia Using Posterolateral Surgical Approach

The malleoli fractures in combination with the fractures of posterior edge of the tibia are considered unstable injuries and present particular difficulties in surgical treatment. The aim of the study was to evaluate short-term and mid-term results of osteosynthesis on account of unstable fractures of malleoli and posterior edge of the tibia using posterolateral surgical approach. Materials and Methods. The analysis of short-term and mid-term results of the treatment of 29 patients with malleoli fractures types 44-B3 and 44-C1.3, C2.3 and C3.3 (according to the AO classification) with the involvement of the Volkman`s posterior tibia fragment was performed in traumatology departments of three hospitals during the period from January 2019 to September 2020. In all 29 cases the fracture of the posterior edge of the tibia was classified as type 1 according to the classification of N. Haraguchi et al. All patients underwent osteosynthesis of the posterior edge of the tibia and the lateral malleolus via posterolateral surgical approach. Combined fracture of the medial malleolus was fixed via classical medial approach. 5 patients (17.2%) with continued instability of the distal tibiofibular syndesmosis underwent fixation with positional screw. Functional results, as well as the range of motions in the ankle joint were evaluated with the use of AOFAS and Neer scales 3, 6 and 12 months after surgery. Results. Statistically significant improvement in functional outcomes over time was noted when evaluated on the AOFAS scale (p0.05) and on the Neer scale (p0.01). 12 months after the surgery these points were 83.213.4 and 87.816.8 respectively. Complications were noted in 5 patients (17.24%). Deep periimplant infection was registered just in one case, another patient had marginal necrosis of the operative wound. Three patients had clinically significant post-traumatic deforming arthritis of the ankle joint. Conclusion. Posterolateral surgical approach has advantages when performing osteosynthesis in patients of the studied profile and enables anatomical reduction and stable fixation of fragments of the Volkman`s posterior edge of the tibia, which provides the possibility of early mobilization of the ankle joint and has positive effect on the results of treatment.

Comparative study between proximal femoral nailing versus dynamic hip screw in unstable inter-trochanteric fractures of the femur in adults

Background: Hip fractures are more common in elderly among them intertrochanteric fractures are most common, more than 50% fractures are unstable. The proximal femoral nailing (PFN) and dynamic hip screw (DHS) are frequently used modalities from last two decades in both stable and unstable fractures. The DHS has been shown to produce good results but complications are frequent, particularly in unstable inter-trochanteric fracture. The advantage of PFN fixation is that it provides a more biomechanically stable construct with good collapse control. The goal of this study was to compare the clinical and radiographical results of the DHS and PFN for the treatment of inter-trochanteric hip fractures as one is load bearing another is load shearing.Methods: In our study we included 70 inter-trochanteric fractures, out of which 40 were treated with DHS fixation and 30 were treated with PFN, and were followed up at regular intervals of 2 weeks, 8 weeks, 12 weeks, 6 months and annually thereafter.Results: The functional results were assessed with Harris hip score and observed 35% excellent results in DHS group and 63.3% excellent results in PFN group. We observed no statistically significant difference between two groups in view of late and early complications and time to union. We observed significantly better outcomes in PFN group for unstable inter-trochanteric fractures and in unstable fractures reduction loss was significantly lower in PFN group. We observed total duration of surgery was significantly lower in PFN group.Conclusions: We concluded that PFN may be the better fixation device for most unstable inter-trochanteric fractures.

A PROSPECTIVE STUDY OF A MODIFIED PIN-IN-PLASTER METHOD FOR THE TREATMENT OF FRACTURES OF THE DISTAL RADIUS

Introduction:- The motive of this study is to introduce a modied technique of 'pin in plaster.' that is a favourable treatment option for unstable fractures of the distal radius. This study was shown to narrated a modied technique using 'pin in plaster' that is a favorable treatment option for unstable fractures of the distal radius. A fracture of the distal radius is one of the most customary types of fracture, in the pediatric population fracture was 24% and up to 20% in the elderly, male-to-female ratio of one to four in older age groups. Methods:- 54 patients with fractures of the distal radius were followed for one year postoperatively. Patients were debarred if they had type B fractures according to AO classication, multiple injuries, or pathological fractures and were treated more than seven days after injury. Radiographic parameters, tilt and height including radial inclination, were measured pre-and postoperatively. Results:- The radial height was 10.2 mm at the sixth month postoperatively, and the average radial tilt was 10.6° of volar. Three patients of pin tract infection were recorded. There were no cases of pin loosening. Total 73 patients underwent surgery, and three cases of radial nerve irritation were recorded at the time of cast removal. All radial nerve palsies resolved at the six-month follow-up. Conclusion:- Our modied technique is successfully restoring anatomic congruity and maintaining the reduction in fractures of the distal radius.

A comparative study on the functional outcome of intertrochanteric fractures treated by proximal femoral nailing or dynamic hip screw fixation

<p class="abstract"><strong>Background:</strong> Intertrochanteric fractures are one of the commonly occurring injuries in elderly patients and are high among females and those with osteoporosis. They were treated with either dynamic hip screw (DHS) fixation or proximal femoral nailing (PFNA2) here at our institution. The study was conducted in order to find which method of surgical fixation has better functional outcome. </p><p class="abstract"><strong>Methods:</strong> Total 96 patients of intertrochanteric fractures admitted during the study period of November 2017 to April 2019 were included for the study. These patients were randomly divided into two groups; DHS was used as implant in group1 and PFNA2 in group 2. Postoperatively patients were followed up after 1 month, 3months and 6 months of the surgery and were assessed using Harris hip score.<strong></strong></p><p class="abstract"><strong>Results:</strong> Harris hip score was higher with PFNA2 group compared to DHS group in all follow-ups. In unstable fractures DHS group had poor outcome compared to PFNA2. Radiological union occurred in 27.1 % cases by 3 months and 72.9% cases by 6 months with DHS whereas 70.8% and 97.9% respectively with PFNA2. </p><p class="abstract"><strong>Conclusions:</strong> PFNA2 gives a better functional outcome when compared to DHS. Even though DHS gives good functional outcome in stable fractures it is not so in the case of unstable fractures. The radiological union also is faster with proximal femoral nailing. Hence in our opinion PFNA2 can be the better fixation device compared to DHS especially in unstable fractures. </p>

Effects of High Toughness and Welding Residual Stress for Unstable Fracture Prevention

Unstable fractures generally occur in brittle materials under low-temperature service conditions. Toughness and welding residual stress are the main factors that should be evaluated when defining a brittle crack propagation path. In this study, a rainbow welding technique was proposed and confirmed as being significantly useful in preventing unstable fractures in weld joints. The residual compressive stress in the crack front was particularly useful for decreasing the possibility of brittle fracture. The objective was to examine the effect of high welding consumable toughness welding residual stress, especially for avoiding brittle fracture through welding residual compressive stress.