Sensitivity and specificity of modified RUST score using clinical and radiographic findings as a gold standard

Aims The modified Radiological Union Scale for Tibia (mRUST) fractures score was developed in order to assess progress to union and define a numerical assessment of fracture healing of metadiaphyseal fractures. This score has been shown to be valuable in predicting radiological union; however, there is no information on the sensitivity, specificity, and accuracy of this index for various cut-off scores. The aim of this study is to evaluate sensitivity, specificity, accuracy, and cut-off points of the mRUST score for the diagnosis of metadiaphyseal fractures healing. Methods A cohort of 146 distal femur fractures were retrospectively identified at our institution. After excluding AO/OTA type B fractures, nonunions, follow-up less than 12 weeks, and patients aged less than 16 years, 104 sets of radiographs were included for analysis. Anteroposterior and lateral femur radiographs at six weeks, 12 weeks, 24 weeks, and final follow-up were separately scored by three surgeons using the mRUST score. The sensitivity and specificity of mean mRUST score were calculated using clinical and further radiological findings as a gold standard for ultimate fracture healing. A receiver operating characteristic curve was also performed to determine the cut-off points at each time point. Results The mean mRUST score of ten at 24 weeks revealed a 91.9% sensitivity, 100% specificity, and 92.6% accuracy of predicting ultimate fracture healing. A cut-off point of 13 points revealed 41.9% sensitivity, 100% specificity, and 46.9% accuracy at the same time point. Conclusion The mRUST score of ten points at 24 weeks can be used as a viable screening method with the highest sensitivity, specificity, and accuracy for healing of metadiaphyseal femur fractures. However, the cut-off point of 13 increases the specificity to 100%, but decreases sensitivity. Furthermore, the mRUST score should not be used at six weeks, as results show an inability to accurately predict eventual fracture healing at this time point. Cite this article: Bone Jt Open 2021;2(10):796–805.

Comparitive Study of Reamed vs Unreamed Interlocking Intra Medullary Nailing for Fracture Shaft of Tibia

Tibia is the commonest bone to sustain open injury because of subcutaneous position. Treatment of open fractures requires simultaneous management of both skeletal and soft tissue injury. Intramedullary nailing with reaming is generally considered to be contraindicated for open fractures tibia, because it damages the endosteal blood supply which will lead to non-union, deep infection. However, recent studies with or without reaming in open fracture tibia shows no influence in healing of fracture. Purpose: To compare the clinical and radiological results of intramedullary interlocking nailing of open fractures of the tibial shaft after reaming versus unreamed medullary canal. The aim and objective is a comparative study on the technique, outcome and time taken for clinical and radiological union in either of the reamed or unreamed interlocking nailing in tibial shaft fractures. The operative technique, advantages and disadvantages, follow up, time taken for bony and radiological union and complications if any and overall functional outcome will be evaluated in patients. The follow up of patients will be done in the immediate post operative period and subsequently at periodic intervals both clinically and radiologically and the result so obtained will be compared.

A COMPARATIVE STUDY OF PLATE OSTEOSYNTHESIS VERSUS LOCKED INTRAMEDULLARY NAILING IN DIAPHYSEAL HUMERUS FRACTURE IN ADULTS

Introduction: Nonoperative treatment of fracture of humeral diaphysis generally has provided acceptable results. However, to achieve faster union and early return to preinjury state along with preserving functionality and motion of adjacent joints, operative management is preferable. Various choices of internal xation for managing these fractures exist. However, the preferred method of internal xation for these fractures remains debatable. to compare the clinical, radiological, functional outcome Aim: of plate Osteosynthesis versus intramedullary nailing in management of diaphyseal humerus fracture in adults. a prospective, randomized study Method: including 49 patients with diaphyseal fracture of humerus randomized into two groups in which one group (n=29) was treated with internal xation with plate Osteosynthesis while the other group (n=20) was treated with antegrade intramedullary nailing. Parameters examined included shoulder and elbow range of motion and evidence of clinical and radiological union along with presence of any complication. Mean a Result: ge of the patients in the Plating group was 44.3 years while in the Nailing group, it was 42.9 years. Mean time to radiological union in the plating was 17.6 weeks compared to 15.7 weeks in the nailing group. Non union was seen in 6.8% of patients with plating as compared to 10% in patients treated with nail. Mean ASES score for plating group was 81.6 while for the nailing group it was 76.3. Conclusion: For diaphyseal fracture of humerus in adults, both the treatment modalities i.e. antegrade intramedullary nailing and internal xation with plating are almost similar with regard to functional outcome and union rate. Antegrade Intramedullary nailing has better rate of union but is associated with signicantly increased risk of shoulder complications which may adversely affect outcome. Plating isour treatment modality of choice for managing these fractures in view of minimal complications with optimal outcome.

Functional outcome of displaced mid shaft clavicular fractures treated by plate fixation: a prospective observational study

<p class="abstract"><strong><span lang="EN-US">Background:</span></strong><span lang="EN-US"> Clavicle fractures are one of the commonest injuries to the shoulder girdle. Traditionally these fractures are treated conservatively. This study was to assess the functional outcome of displaced mid shaft clavicular fractures treated with plate fixation.</span></p><p class="abstract"><strong><span lang="EN-US">Methods:</span></strong><span lang="EN-US"> This was a single center prospective observational study conducted at department of orthopaedics M.E.S medical college Perinthalmanna between the period January 2018 to December 2018 in patients with displaced mid shaft clavicle fractures treated by plate fixation. Out of 51 patients 35 patients were males and 16 were females with mean age of 37.7 years (range 19-59). All patients included in this study were included under Allman group 1. All Patients were treated with plate fixation. Post op follow done at 1 1/2 ,3 and 6 months. During follow up clinical and radiological union were checked. Final functional outcome was assessed at 6 months follow up by Constant-Murley Score.</span></p><p class="abstract"><strong><span lang="EN-US">Results:</span></strong><span lang="EN-US"> Out of 51 patients with displaced mid shaft clavicle fractures treated with plate fixation 43 patients (84.3%) showed excellent functional outcome 8 patients (15.7%) showed good functional outcome. None of the patients showed moderate or poor outcome. The radiological union was attained at 9.35 weeks. No complications in 83.4% of patients.</span></p><p class="abstract"><strong><span lang="EN-US">Conclusions: </span></strong><span lang="EN-US">Mid shaft clavicle fractures are more common in young males sustaining high energy trauma, and those fractures treated with plate fixation has a better functional outcome in terms of pain relief, activities of daily living and range of motion.</span></p>

Outcome of Fracture Distal Femur Treated with Intramedullary Interlocking Nailing

Objective: To evaluate the functional and radiological outcome of the distal femur fracture treated with a retrograde locking nail. Methods: This is a descriptive study conducted at the Orthopedic department Dibba Hospital Fujairah, United Arab Emirates for one-year duration from March 2019 to March 2020. All patients who met the inclusion criteria were treated with femoral retrograde nailing technique. The postoperative functional score was assessed according to Schatzker and Lambert criteria, which were rated excellent, good, and poor. Radiological union was assessed by X-rays. Results: There were 103 patients with a mean age of 35.20 ± 10.66 (range, 20 to 50 years). There were 78 men (75.72%) and 25 women (24.27%). Most of the fractures (68.9%, n = 71) were caused by car accidents. Fracture of the right side occurred in 70 (67.96%) patients, and the left side fracture in 33 (32.03%) patients. Excellent results were obtained in 75 (72.81%) patients and good results were obtained in 28 patients (28.20%). The nonunion has been documented in one patient. Conclusion: Excellent and good functional and radiological results were obtained in patients with distal femur treated with retrograde locking nails. For some distal femoral fractures, we recommend the use of a retrograde locking nail.

A STUDY ON STABILIZATION OF COMPOUND SMALL BONE FRACTURES OF HAND AND FOOT WITH JESS FIXATOR

Background : The fractures of small bones of hand and foot should not be more complicated and damaging compared to the damage caused by the injury itself. The goal is to achieve good stability of the bone and joint, which allows early motion without resulting in the residual instability and malunion. These fractures of small bones of hand and foot can be treated with an external xator that allows fracture reduction attaining normal alignment. we took up the study with an aim to access the overall function and complications in treating open small bones of hand and foot with JESS xator. Methods: We performed a prospective study on 20 adult patients (14 males and 6 females) with small bone fractures of hand and foot, who attended outpatient or admitted in inpatient in the department of orthopaedics, government general hospital, Kakinada from October 2017 to august 2019. We excluded closed fractures and severely crushed fractures with neurovascular and tendon injuries. Results: 5 Results are recorded based on Duncan et al. criteria for ngers. For toes, the results are graded based on a total active range of movements. Most of the cases (n=17) showed radiological union within 12 weeks. Two cases took more than 20 weeks to heal. Whatever be the radiological union, the frame is removed mostly by 15 days postop (n=18) and by a maximum period of 21 days (n=6). the results are found to be excellent in 40% of cases, good in 44% cases, fair in 8% and poor results are seen in 8% cases. We had extensor lag as the most common complication (60%, n=15), 2 cases with malunion (8%) and one case (4%) with supercial infection. Conclusion: Hand serves many functions of precise movement, grip, grasp, touch etc. though these are small bones their fracture are not to be neglected and should be managed with utmost care. Jess is simple to operate, cheap, easily available, and has less complication rate. It makes the postoperative management simple and effective. It allows early mobilization, which prevents joint stiffness. Removing the frame at end of second postoperative week allows good functional results and doesn't compromise the stability of fracture.

Functional and Radiological Outcome Analysis of Osteoperiosteal Decortication Flap in Nonunion of Tibia

Introduction. The treatment of long bone shaft nonunions is challenging. The technique of osteoperiosteal decortications flap for approaching the nonunion site coupled with fixation modalities was first described by Judet in 1963. Despite promising clinical and radiological union, this technique is not popular among orthopaedic surgeons. Our study aimed to evaluate the radiological union and functional results of shaft tibia nonunions treated by the osteoperiosteal decortication approach. Methods. This retrospective study included all the cases with established tibial shaft nonunion following stringent inclusion and exclusion criteria and operated upon by following the principle of osteoperiosteal flap technique from April 2015 to July 2019. Further subgroups were made based on nonunions complexity based on nonunion scoring system (NUSS) score. The outcome measures included radiological union scale in tibial fractures (RUST) and lower extremity functional scale (LEFS). The preoperative scores for union and function were recorded, and the subsequent scores were obtained at three, six, and nine months and one year. Appropriate statistical analysis of the data was done. Results. Thirty-four cases were shortlisted for analysis, fulfilling our inclusion and exclusion criteria. There were 22 males (64.7%) and 12 females (35.3%) with a mean age of 34.17 ± 10.3 years. Subgroup analysis based on the complexity of nonunion (NUSS score) revealed 14 cases in group A, 10 cases in group B, 10 cases in group C, and 0 cases in group D. The average time from fracture to surgery in these cases was 14.6 months. The average time to achieve union was 9.6 months, with patients in groups A, B, and C, having a mean duration of 9, 10.5, and 12 months, respectively. Statistically, significant improvement was seen in both RUST scores and LEFS score. Complications included infection in seven cases, wound dehiscence in two cases, and four cases of persistent nonunion. Conclusion. Osteoperiosteal decortication remains a highly effective surgical technique in the management of nonunion of long bones. NUSS scoring is an essential tool for prognosticating nonunion cases. This score is inversely related to the radiological union (RUST score) of the bone and functional recovery (LEFS score) of the patient.

Clinico-radiological and functional outcomes of bicolumnar plating in schatzker type 5 and type 6 fractures of proximal tibia in tertiary care hospital in North India: a series of 26 patients

<p class="abstract"><strong>Background:</strong> Ideal mode of treatment is always debatable for Schatzker type 5 and type 6 fractures in proximal tibia. The aim of the study was management in tibial plateau fracture are to obtain anatomic reduction of the articular surface, restoration of axial alignment, and achieve stable fixation which can be done by open reduction and internal fixation (ORIF) using bicolumnar plating.</p><p class="abstract"><strong>Methods:</strong> 26 patients with Schatzker type 5 and type 6 fractures were managed by bicolumnar plating. They were followed up to six months in terms of radiological union, functional outcomes and complications. Functional outcome at the end of follow up was assessed using knee society scoring system.<strong></strong></p><p class="abstract"><strong>Results:</strong> Good to excellent results were obtained in almost all the patients using knee society scoring system, mean knee ROM achieved was 114.5 degree. Average time to achieve radiological union was 14.4 weeks. These results were in comparison with the studies done earlier.</p><p class="abstract"><strong>Conclusions:</strong> Bicolumnar plating is an effective method of treatment of Schatzker type 5 and type 6 fractures and provide excellent result in expert hands. Rehabilitation using early CPM (continuous passive movement) is very effective in reducing the post-operative complications like knee stiffness.</p><p> </p>

Comparison of locking compression plating vs retrograde intramedullary nailing in distal femur extra-articular fractures

<p><strong>Background</strong>: The purpose of the study was to compare the outcome of distal femur extra articular fractures treated with locking plate and retrograde intramedullary nail.</p><p><strong>Methods: </strong>86 patients’ distal femur extra-articular fractures were included in the study. 44 patients were operated with intramedullary nailing; 42 patients were operated with locking plate. Results of the 2 groups were compared with regards to clinical and radiological outcome, intraoperative timing and blood loss. Post-operative status of the patients was evaluated using the visual analogue scale, neer score, knee range of motion and radiological union on plain radiographs. Patients were followed-up at 4 weekly intervals from 8 to 28 weeks and then at 1 year.</p><p><strong>Results</strong>: Mean operative time and blood loss was less in intramedullary nailing group whereas intraoperative blood loss was less in the plating group. 6 patients developed surgical site infection in the plating group. Mean-time till radiological union was significantly better in intramedullary nailing group. 7 patients in plating group had issues with union (5 non-union, 2 delayed union) whereas 1 patient in IMN group had nonunion. 93% of intramedullary nailing cases were able to bear full weight at 12 weeks compared to 66% cases in plate group. Knee pain at 6 months was more in intramedullary nailing group.</p><p><strong>Conclusions:</strong> IMN proved to be a better modality of fixation of distal femur fracture fixation in our study in terms of operative time, union rates, infection rates and overall patient outcome if done with proper principles and techniques of intramedullary fixation.</p>

COMPARATIVE STUDY BETWEEN THE DYNAMIC COMPRESSION PLATING (DCP) AND THE INTRAMEDULLARY INTERLOCKING NAILING IN DIAPHYSEAL FRACTURES OF THE HUMERUS IN ADULTS

AIMS: The aim of our study was to nd the difference between the mean duration of union and functional outcome between the dynamic compression plating (DCP) and the intramedullary interlocking nailing in diaphyseal fractures of the humerus in adults. MATERIALS AND METHODS: From May 2019 to October 2019, 34 patients with diaphyseal fractures of the humerus were treated with compression plating using dynamic compression plate or with intramedullary interlocking nail. The time taken for radiological union in the two groups was compared. After satisfactory radiological union, the functional outcome was assessed by the “Disabilities of Hand, Shoulder and Elbow (DASH) Questionnaire”. RESULTS: All fractures united and a marginal difference was noted in the time taken for union. The functional outcome was better in DCP group compared to interlocking nailing group which was statistically signicant (P= 0.010). The complication associated with interlocking group was more than the DCP group. We are of the opinion that when surgery is opted as a choic CONCLUSION: e of treatment, both the modalities of treatment i.e. dynamic compression plating and interlocking nailing are good as far as union of the fracture is concerned, but considering the number of complications and functional outcome, we opine that dynamic compression plating offers better result than antegrade interlocking nailing with respect to pain and function of the shoulder joint.