OUTCOMES OF CLOSED UNSTABLE DISTAL RADIUS FRACTURES OPERATED AND FIXED WITH VARIABLE ANGLE LOCKING PLATE

INTRODUCTION AND AIM: This study aims to evaluate the functional and radiological outcomes in unstable distal end radius fractures treated with variable angle locking plates. MATERIAL AND METHODS: We reviewed 20 unstable distal end radius fractures that were operated and xed with variable-angle locking plate. RESULTS: According to Green and O'Brien Score (Cooney's modication) , excellent results were reported in 70 %,while good results were present in 20% cases, fair results were seen in 10% cases. CONCLUSION: The use of variable angle locking plates (VALP) in treating unstable distal end radius fractures is associated with excellent to good functional outcomes with minimal complications. VALP allows subchondral purchase in the articular fragments due to the exibility in the implant as far as plate positioning (that can be placed even beyond watershed line for very distal radius fractures) and as far as screw positioning in different directions (that can hold various distal fracture fragments as well as styloid process fracture). By this way, VALP helps in maintaining the reduction and predictably yields better functional outcome especially in unstable distal end radius fractures with early return to pre-injury occupation.

Biomechanical Comparison of a Novel Implant and Commercial Fixation Devices for AO/OTA 43-C1 Type Distal Tibial Fracture

This study compares the novel Asia Distal Lateral Tibial Locking Plate mechanical stability to that of the current anterolateral and medial tibial plates based on finite element analysis. Four-part fracture fragment model of the distal tibia was reconstructed using CAD software. A load was applied to simulate the swing phase of gait. The implant stress and the construct stiffness were compared. The results of the anterolateral plate and the medial plate were similar and the displacement values were determined lower than those in the medial plate. In the simulated distal tibia fracture, the Aplus Asia Distal Lateral Tibial Locking Plate and medial distal tibial plate tibia fixations will lead to a stiffer bone-implant construct compared to the anterolateral distal tibial plate. Moreover, the stress in the Aplus Asia Distal Lateral Tibial Locking Plate was lower than those for the medial distal tibial plate and anterolateral bone plates. The Aplus Asia Distal Lateral Tibial Locking Plate has better stabilization and is an anterolateral plate that avoids more soft tissue damage than other bone plates. The Aplus Asia Distal Lateral Tibial Locking Plate could be one of a suitable design in tibia distal fracture fixation.

ASSESSMENT OF RESULTS OF TREATMENT OF PAEDIATRIC FEMORAL DIAPHYSEAL FRACTURES WITH TITANIUM ELASTIC NAILS

Introduction: Femoral fractures are among the most common fractures of long bones. The management of pediatric femur fractures depends basically on the age group of the child although the age of bone and size of the child also determines the treatment choice. The choice of management may also be determined by surgical experience and local trends in practice. Study aimed to assess the results of treatment of paediatric femoral diaphyseal fractures with titanium elastic nails. Material And Methods: The study was conducted at Orthopaedics Department of PMCH, Patna, Bihar. A total of 22 patients with closed shaft femur fractures and age ranging between 5-16 years scheduled to undergo treatment with titanium elastic nails were selected for the study. Children with open fractures, outside this age group with concomitant head injury, bilateral femur fracture or associated fracture of either limb whose xation was done after 7 days were excluded from the study. No control group was used. They were treated by retrograde TENS xation using two nails of equal diameter for each fracture. Pre-operative evaluation includes full length radiograph of the fractured femur both antero–posterior (A–P) and lateral views. Results: In the present study, 22 patients with closed shaft femur fractures were treated with titanium elastic nails. The mean age of the patient was 13.23 years. We observed that in regards to fracture location, proximal fracture was seen in 5 patients, midshaft fracture in 14 patients and distal fracture in 3 patients. However, in regards to pattern of location, transverse fracture was seen in 6 patients, oblique fracture in 8 patients, spiral fracture in 5 patients and comminuted fracture in 3 patients. Conclusion: From this study we can conclude that Intramedullary nailing of the pediatric femoral diaphyseal fractures using titanium elastic nail is an effective surgical modality, with advantages of minimal incisional scar, minimal soft tissue damage, with early union time and excellent union rates, and without affecting shoulder and elbow function.

Ipsilateral fractures of both the proximal and distal humerus; the ‘floating arm injury’ in children

<p>Proximal humerus fractures are usually associated with other injuries in and around the shoulder joint like clavicle fracture, acromion process fracture, coracoid process fracture, and dislocation of the shoulder joint or acromion-clavicular joint. Similarly, distal humerus fractures are normally associated with fractures of olecranon, radial head or dislocation of the elbow joint itself. However, simultaneous fracture of both the ends of humerus is rarely encountered. Literature search does reveal only a few cases of such type. This variety is also termed as floating arm. We are presenting here two cases of fracture of both the proximal and distal end of same humerus following fall from height, one of which the proximal humeral fracture was Gustillo-Anderson type II open fracture. The patient was managed by wound debridement and open reduction and fixation of the proximal fracture followed by closed manipulation and K wire fixation of the distal fracture. The second case was also managed by closed reduction and K wire fixation of both the fractures. </p>

Peri-implant fractures proximal to a long retrograde femoral nail – A case series

Low energy peri-trochanteric fractures may happen in the presence of a retrograde nail in the femur. The management of these peri-implant fractures are very rarely reported. This is a series of seven cases from a level one trauma centre in Hong Kong. All fractures arose from low energy falls and were either inter-trochanteric or subtrochanteric. Removal of previous implants to allow cephalo-medullary fixation of the new fracture could be considered, but this is often difficult, time-consuming, and may inflict damage to the articular cartilage. Furthermore, this is not an option if the distal fracture is not yet well healed. Six of the seven fractures presented here were treated operatively with an extra-medullary device fixed to the proximal shaft with cerclage cables. The choice of fixation implants were based on the fracture type and available space above the proximal end of the retrograde nail. All seven fractures healed with no implant failure and major complications. There were no thirty-day and one-year mortality. A treatment algorithm is proposed for the management of these uncommon but difficult cases.

Type II D Phalangeal Neck Fractures in Children: A Series of 20 Cases Treated According to a Preset Stepwise Algorithm

Introduction Type II phalangeal neck fractures are defined as displaced fractures with bone-to-bone contact at the fracture site. In the type II D subtype, the distal fracture fragment is thin. A review of the literature did not reveal any study investigating the outcome of management of these fractures. Patients and Methods This is a retrospective study of 20 consecutive children with type II D phalangeal neck fractures treated over the past 4 years. Demographic data were reviewed. All cases were managed according to the preset stepwise algorithm. The outcome of management at final follow-up was documented using Al-Qattan’s grading system. Results The mean age was 30 months (range 12–80 months). There were 12 males and 8 females. The mean follow-up was 2 years (range 7 months to 3 years). The largest two categories within the management algorithm were patients with minimally displaced fractures treated conservatively (n = 8) and those with displaced fractures treated with closed reduction and percutaneous K-wire fixation (n = 9). Fischer exact test was used to compare the outcome in these two groups and the p value was significant (p = 0.015), indicating a significantly better outcome in the former group. Conclusion Several conclusions were made from the study. Type II D of phalangeal neck fractures tend to occur in young children and the majority involve the middle phalanx. The thinness of the distal fracture fragment makes standard techniques of closed reduction more difficult. However, flexion of the proximal and distal joints appears to be effective in reducing dorsally displaced type II D fractures by closed means. Finally, a more conservative approach to minimally displaced type II D fractures results in a better outcome compared with closed reduction and percutaneous K-wire fixation.

OR13-03 Understanding Why Older People with Low Trauma Fractures Die Prematurely

There is increasing evidence that all proximal and not just hip fractures are associated with increased mortality risk. However, the cause of this increased mortality is unknown. We sought to determine the post-fracture trajectories of subsequent hospital admissions and mortality to develop an understanding of why patients with non-hip fractures die prematurely. This nationwide Danish population-based study included all individuals aged 50+ years who sustained an incident fragility fracture between 2001 and 2014. High-trauma fractures or individuals with fracture prior to 2001 were excluded. Fracture patients were matched 1:4 by sex, age and comorbidity status with non-fracture subjects alive at the time of fracture. Comorbidities included 33 unique medical conditions of the Charlson or Elixhauser comorbidity index. We modelled the contribution of specific fractures on the risk of subsequent admissions or death within the following 2 years. There were 212,498 women and 95,372 men with fracture followed by 30,677 and 19,519 deaths, respectively over 163,482 and 384,995 person-years of follow up. Mean age at fracture was 72± 11 for women and 75± 11 for men. Proximal fractures including hip, femur, pelvis, rib, clavicle and humerus had increased mortality compared with their matched non-fracture counterparts with HRs ranging from 1.5-4.0, while distal fractures such as ankle, forearm, hand or foot fractures had similar or lower mortality risk. Almost 75% of men and 60% of women had ≥1 comorbidity. For every additional comorbidity, risk of mortality increased for all fracture types. However, only for proximal fractures did the fracture itself independently increase mortality risk over and above co-morbidity status. The 2-yr post fracture admission and mortality patterns differed between proximal and distal fractures. Proximal, but not distal fracture subjects had greater risk of any major hospital admission (including cardiovascular disease, cancer, stroke, diabetes, pneumonia and pulmonary disease) within 2 years compared with their non-fracture counterparts. Distal fractures in general had similar admission patterns as their non-fractured matched counterparts. Furthermore, 2 year mortality risk was increased for proximal fractures whether or not they were admitted to hospital post fracture. By contrast, mortality risk was similar or reduced for distal fractures compared with non-fracture controls. This study has not only confirmed the increased mortality following proximal fractures but has demonstrated differing clinical trajectories between proximal and distal fractures that contribute to this increased mortality. These findings provide important insights as to why proximal fracture subjects die prematurely that may lead to specific avenues for intervention.

Two Cardiac Arrests that Occurred after the Administration of Sugammadex: A Case of Kounis Syndrome

Kounis syndrome is a form of acute coronary syndrome caused by allergic reactions. No cases of cardiac arrest caused by Kounis syndrome that arose after the administration of sugammadex have been reported. A 71-year-old female suffered two cardiac arrests. The first occurred after sugammadex was administered at the end of an operation for a right radial distal fracture. The patient was resuscitated and transferred to our intensive care unit. She was subsequently discharged home. Five months later, she suffered a second cardiac arrest after sugammadex was administered at the end of an operation for a right femoral neck fracture at our hospital. Urgent coronary angiography revealed multiple coronary spasms. Kounis syndrome was diagnosed based on the patient’s elevated serum trypsin levels and a positive result in a skin allergy test of sugammadex. In cases of cardiac arrest with unclear etiologies, Kounis syndrome should be considered.

Assessing distal radius malrotation following fracture using computed tomography

Hypothesis: When the distal fracture fragment in distal radius fractures displaces, it commonly rotates as well as shortens and angulates. Aim: The aim of this study was to assess the frequency and magnitude of malrotation of the distal fracture fragment using computed tomography (CT). Methods: A retrospective radiological assessment of 85 CT scans of the distal radius, 35 following fracture and 50 normal radii, was carried out. We developed and applied a simple method for measuring rotation of the distal radius relative to the diaphysis using routine CT scans of the wrist. A Mann–Whitney analysis was used to identify differences in radial rotation between fractures and controls. Intra- and inter-observer reliability were analyzed using intra-class correlation coefficients (ICCs) and Bland–Altman plots. Results: The articular surface of the distal radius is normally rotated in the long axis of the forearm relative to the diaphysis, either into pronation or into supination. The median radial rotation angle of controls was 1° pronation (range −15° to 4°) compared to 3° pronation (range −24° to 31°) in the fracture group. The absolute rotation angle was significantly greater in the fracture group (median 10°, range 0–31° vs. 3°, range 0–15°; p < 0.001) and outside the “normal range” of controls in 26 cases indicating that 75% had rotated appreciably following injury. Intra- and inter-observer reliability of measurements were good with ICCs of 0.99 and 0.98, respectively. Conclusions: Malrotation of the distal radius appears common following distal radius fracture. Malrotation of the distal fracture fragment has been shown to affect distal radio-ulnar joint function. Despite this, rotational deformity is rarely addressed in clinical practice as it is difficult to appreciate on simple radiographs. The simplified method described here is easy to use in routine clinical practice and also appears reliable. Measuring radial rotation may be an important consideration when planning both primary treatment and corrective osteotomy for patients with distal radial malunion.

Repair of Y-T Humeral Condyle Fractures with Locking Compression Plate Fixation

Objectives The aim of this study was to describe the use of locking compression plates (LCP) in Y-T humeral condyle fractures and to evaluate their clinical outcome. Methods This study involved a retrospective review, including clinical, radiographical and canine brief pain inventory outcome evaluation. Results Eighteen consecutive dogs met the inclusion criteria, and 15/18 were considered to have humeral intracondylar fissure. Twelve of 18 dogs had simple fractures, and the remaining six had comminuted fractures. Postoperative radiographs revealed accurate intracondylar reconstruction (articular step defect [ASD] < 1 mm) in 17/18 of patients. Short-term outcome was considered fully functional in 9/13 and acceptable in 3/13 patients. Complications were diagnosed in 2/13; infection in one with resolution after antibiotic treatment, and one case of implant failure. Nine of 18 owners provided postoperative questionnaire responses (median 25; range: 14–52 months) and 8/9 clients perceived the treatment to have resulted in an excellent overall outcome. Clinical significance Repair of Y-T humeral fractures with LCP allowed for hybrid fixation and monocortical screw placement in distal fracture fragments. There was no significant ASD at the intracondylar fracture line in most cases. ASD using combined medial and lateral approaches depends upon the accuracy of supracondylar reduction, particularly on the side that is reduced and stabilized first, and the use of locking screws may have been influential in minimizing primary loss of reduction, potentially maintaining the initial fragment reduction.