Heterotopic Ossification after Open Anchor Fixation of the Posterior Cruciate Ligament Avulsion in a Multiligament Injury of the Knee: A Case Report

Introduction: Heterotopic ossifications (HO) are a well-recognized but infrequently encountered condition. In the lower limb, the literature commonly reports the formation of HO around the hip after surgeries. However, HO is uncommon around the knee and a rare complication after open fixation of posterior cruciate ligament (PCL) avulsion fracture. Case Report:Here, we describe a case of HO in a 42-year-old patient with multiligament injury, including PCL and arcuate ligament avulsion, partial ACL tear, and medial meniscus root tear with suspected vascular compromise. He underwent open reduction and internal fixation of PCL avulsion fracture and medial meniscus root repair after the injury. At a 6-week follow-up, a plain radiograph revealed posterior capsule HO which kept increasing over successive follow-ups compromising his knee function. The patient was not willing for any mode of intervention for the same at any given time. Conclusion:HO after open PCL avulsion fixation is an uncommon entity. This article sheds light on how open fixation of PCL bony avulsion in a multiligament injured knee could result in a HO. Keywords: Posterior cruciate ligament avulsion, multiligament injury, open fixation, suture anchor, heterotopic ossification, posterior capsule.

Diagnostic Reference Levels for Common Orthopedic Hand and Wrist Procedures Using Intraoperative mini C-arm Fluoroscopy

Background: Diagnostic reference levels are radiation dose levels in medical radiodiagnostic practices for typical examinations for groups of standard-sized individuals for broadly defined types of equipment. This study aimed to contribute to national diagnostic reference levels for common hand and wrist procedures using mini C-arm fluoroscopy. Small joint and digital fracture procedure diagnostic reference levels have not been reported in significant numbers previously with procedure-level stratification. Methods: Data were collected from fluoroscopy logbooks and were cross-referenced against the audit log kept on fluoroscopy machines. A total of 603 procedures were included. Results: The median radiation dose for wrist fracture open fixation was 2.73 cGycm2, Kirschner wiring (K-wiring) procedures was 2.36 cGycm2, small joint arthrodesis was 1.20 cGycm2, small joint injections was 0.58 cGycm2, and phalangeal fracture fixation was 1.05 cGycm2. Conclusions: Wrist fracture fixation used higher radiation doses than phalangeal fracture fixation, arthrodeses, and injections. Injections used significantly less radiation than the other procedures. There are significant differences in total radiation doses when comparing these procedures in hand and wrist surgery. National and international recommendations are that institutional audit data should be collected regularly and should be stratified by procedure type. This study helps to define standards for this activity by adding to the data available for wrist fracture diagnostic reference levels and defining standards for digital and injection procedures.

CLINICAL PERFORMANCE OF LAMBDA PLATES IN THE MANAGEMENT OF SUBCONDYLAR FRACTURES

Background and Aim: Several options are available for open fixation of sub-condylar fractures. The seven-hole lambda plate is believed to demonstrate favorable outcomes for sub-condylar fractures, more so in cases with limited available bone surface. The study aimed to evaluate the outcome of sub-condylar fractures managed using lambda plates. Method: The study comprised on 10 diagnosed cases of sub-condylar fracture indicated for open fixation and were managed using the seven-hole lambda plate. Surgery was carried out under general anesthesia following standard surgical procedure. Post surgery, the cases were evaluated for immediate post-operative complications and followed up for 6 months for delayed complications. Results and Conclusion: All 10 cases showed excellent outcomes post fracture fixation using the lambda plate. Significant improvement in mouth opening was noted in all the cases at 6 weeks and 6 months follow up. No significant post surgical complications were noted in the cases except one where post operative pain persisted for a week. Lambda plates provide an attractive option for the management of sub-condylar fractures with minimal complications.

A Review on Outcomes of Distal Radius Fracture Treated With Different Modes of Treatment and Rehabilitation

Fractures around wrist joint are common complication happening after fall on an outstretched hand. It is more common in female, and mostly in age above 55 years. Different methods of treatment has been established such as surgical and conservative management, each mode of treatment has its own complication such as, pain, stiffness, swelling, deformity, infection. Non operative treatment include splinting or casting with or without reduction, operative treatment includes percutaneous k-wiring, external fixator for complex fracture or fracture with open wound, open fixation with volar or dorsal plate. Still there is controversy that what method is better in getting the good functional outcome, minimizing the duration of cast immobilization, early fixation, and early start of rehabilitation. All of them play part in better functional outcome. In the past manipulation and fixation without opening the fracture site has been the choice of treatment, comparatively in recent advances fixation with plate through anterior approach is a preferred option because it has less complication rate, plays better role in early range of movement. The information was retrieved from reliable search engines e.g. PubMed, Medline, Google scholar and others, through original research papers and reviews from2003 to 2019. Purpose of this study is to know which method of management has better outcome and its role in early rehabilitation.

Physeal Acetabular Fracture in a Dog Treated with External Fixation

ABSTRACT An acetabular physeal fracture in a 13 wk old dog was treated with open fixation using Kirschner wire cross pins and a four-pin Type 1A external fixator, resulting in successful healing of the fracture. Three years following the surgery, marked osteoarthrosis of the affected hip was noted, although clinical function of the hip was good. The authors suggest this fixation method be considered a viable option for fixation of acetabular physeal fractures in dogs.

Staple versus Suture Closure for Ankle Fracture Fixation

Category: Trauma Introduction/Purpose: Ankle fractures are commonly treated fractures by orthopaedic surgeons with unique challenges to skin closure due to the lack of subcutaneous support. Metallic staples are a commonly accepted method of skin closure in other specialties, though the use of staples in orthopaedics, and more specifically in foot and ankle surgery, remains a topic of debate. Proponents of staples report several potential advantages to using staples instead of sutures, including reduced closure time, faster and less painful removal, or improved cosmetic appearance. This study aimed to compare outcomes of suture versus staple closure as well as to evaluate the safety of staple closure after open fixation of acute traumatic ankle fractures. Methods: The medical records of 94 patients treated at our institution with open fixation of an acute traumatic ankle fracture by a single surgeon between January 2011 and June 2017 were retrospectively reviewed. Demographics, preoperative characteristics, relevant comorbidities, operative characteristics, and postoperative outcomes were compared between patients who received superficial skin closure using staples versus suture techniques. Statistical analysis was performed using chi-squared test and Fisher’s exact test. Results: The staple and suture group patients were demographically similar at baseline. Of the 94 patients included in this study, 10 patients developed local wound related complications postoperatively, including 5 with wound dehiscence, 4 with superficial wound infections, and 1 deep infection . Eight patients required revision surgery due to infection or wound dehiscence. Four patients in the suture group developed superficial wound infections, compared with zero in the staple group. One patient in the staple group developed a deep infection. With the numbers available, no significant differences could be detected in the incidence of postoperative infections, local wound related complications and revision surgeries between two wound closure groups. Conclusion: Our data suggests that there is no statistical difference in outcomes between staple and suture closure after open fixation of acute ankle fractures. Because there was no difference in morbidity with possible benefits of reduced closure time, faster removal, and improved cosmetic appearance, we conclude that staple closure may be a safe alternative to sutures for superficial skin closure. This study adds evidence to a growing body of literature and suggests that staples can be used in some instances, clinical decision making, surgeon preference, and technique proficiency should remain the cornerstone of closure in ankle fracture surgery.

Spinopelvic Dissociation: Comparison of Outcomes of Percutaneous versus Open Fixation Strategies

Introduction. Spinopelvic dissociation injuries are historically treated with open reduction with or without decompressive laminectomy. Recent technological advances have allowed for percutaneous fixation with indirect reduction. Herein, we evaluate outcomes and complications between patients treated with open reduction versus percutaneous spinopelvic fixation. Methods. Retrospective review of patients undergoing spinopelvic fixation from a single, level one trauma center from 2012 to 2017. Patient information regarding demographics, associated injuries, and treatment outcome measures was recorded and analyzed. All fractures were classified via the AO Spine classification system. Results. Thirty-one spinopelvic dissociations were identified: 15 treated with open and 16 with percutaneous techniques. The two treatment groups had similar preoperative characteristics including spinopelvic parameters (pelvic incidence and lumbar lordosis). Compared to open reduction internal fixation, percutaneous fixation of spinopelvic dissociation resulted in statistically significantly lower blood loss (171 cc versus 538 cc; p=0.0013). There were no significant differences in surgical site infections (p=0.48) or operating room time (p=0.66). Conclusion. Percutaneous fixation of spinopelvic dissociation is associated with significantly less blood loss. Treatment outcomes in terms of infection, length of stay, operative cost, and final alignment between the open and percutaneous group were similar.