The aim of this study was to report a complete overview of both incidence, fracture distribution, mode of injury, and patient baseline demographics of paediatric distal forearm fractures to identify age of risk and types of activities leading to injury. Population-based cohort study with manual review of radiographs and charts. The primary outcome measure was incidence of paediatric distal forearm fractures. The study was based on an average at-risk population of 116,950. A total number of 4,316 patients sustained a distal forearm fracture in the study period. Females accounted for 1,910 of the fractures (44%) and males accounted for 2,406 (56%).Aims
Methods
Aims. Distal third clavicle (DTC) fractures are increasing in incidence. Due to their instability and nonunion risk, they prove difficult to treat. Several different operative options for DTC fixation are reported but current evidence suggests variability in operative fixation. Given the lack of consensus, our objective was to determine the current epidemiological trends in DTC as well as their management within the UK. Methods. A multicentre retrospective cohort collaborative study was conducted. All patients over the age of 18 with an isolated DTC fracture in 2019 were included. Demographic variables were recorded: age; sex; side of injury; mechanism of injury; modified Neer classification grading; operative technique; fracture union; complications; and subsequent procedures. Baseline characteristics were described for demographic variables. Categorical variables were expressed as frequencies and percentages. Results. A total of 859 patients from 18 different NHS trusts (15 trauma units and three major trauma centres) were included. The mean age was 57 years (18 to 99). Overall, 56% of patients (n = 481) were male. The most common mechanisms of injury were simple fall (57%; n = 487) and high-energy fall (29%; n = 248); 87% (n = 748) were treated conservatively and 54% (n = 463) were Neer
Introduction: Throughout known medical literature the proximal humeral fracture is mentioned with an approximately 5% contribution to all fractures. The optimal operative strategy regarding proximal humeral fractures is still being discussed controversely. This study was conducted to show implant associated problems and their clinical relevance. Materials and methods: Of a total 198 patients with proximal humeral fractures 166 patients, 98 females and 68 males at a mean age of 74,7 years were treated operatively from 2000 to 2004 in our clinic with an angle-stabile plate osteosynthesis and underwent a clinical and radiological follow-up. Retrospectively we characterised the fractures by using the most common classification of NEER and assessed the functional results with the CONSTANT score. Results: The 166 evaluated patients with 8 cases of a
Currently, the optimal treatment of pipkin fractures remains controversial. To rovide guidance on the management of these challenging injuries, we systematically viewed the available literature on outcomes following presentation with pipkin fracture dislocations and meta analysis was applied where applicable. Material and Methods: Electronic databases were searched for studies on “Pipkin fractures”. Thompson &
Epstein scale used as primary outcome measure and Merle’d Aubgine score, AVN, Nerve injuries, Heterotrophic ossification used as secondary outcome measures. Results: This metaanalysis included 242 cases from 13 studies. Mean age of patients is 41.2 (sex ratio 7:3 male to female). Motor vehicle accidents contributes to 93% of cases, followed by fall from height in 6% cases. Patients were divided in to two groups, one with hip reduction with in 6 hours and second group more than 6 hours. ‘P’ value calculated using CMA software has shown no statistical advantage of reducing hip in less than six hours (p – 0.87). Majority of Type I cases treated by excision, type II cases were treated by ORIF. Type III cases predominantly treated by arthroplasty, where as type IV cases mainly treated by open reduction and internal fixation. Thompson &
Epstein results were excellent in 13% of cases, 47% good, 16% fair to satisfactory and 24 % cases reported poor results. Incidence of good results descended from Type I to Type IV, where as incidence of poor results increased. Meta analysis of TE results and surgical approach has not shown any advantage of anterior or posterior approach in producing better TE outcomes. Similarly early time to reduction or surgery also failed to show any statistical advantage over delayed reduction or surgery. Analysis of the outcomes treated by non operative and operative methods in type I cases has shown operative methods producing less favourable outcomes in
Patella fracture after total knee arthroplasty has a variety of etiologies and has been reported to occur with an incidence ranging from 3% to 21%. Heavy patients with full flexion are at greatest risk for sustaining patella fracture. Overstuffing the patellofemoral joint with an oversized femoral component, an anteriorised femoral component or a femoral component placed in excessive extension can also overload the underlying patella. A similar phenomenon may be seen with underrsection of the patella or use of a thick button. Excessive patellar resection can predispose to patellar fracture as well. It has been demonstrated that a residual patella thickness of less than 15 mm can substantially increase anterior patellar strain. Asymmetric patellar resection can also critically alter the mechanical strength of the patella making it vulnerable to failure. Elevation of the tibiofemoral joint line, from excessive femoral resection and hastened by posterior cruciate ligament release, will result in a relative patella baja. This can cause early patellofemoral articulation, which may result in patellar impingement on the tibial insert in late flexion and ultimately predispose the patella to fracture. Surgical approach and soft tissue dissection should be as atraumatic to the patellar blood supply as possible to preserve the superolateral geniculate artery when performing a lateral retinacular release. The classification used by Goldberg, et al is helpful for planning appropriate intervention:.
Clavicular hook plates have been used over the last decade in the treatment of lateral clavicular fractures with good rates of union reported throughout the literature. Fewer studies have reported the functional outcome of these patients and some have reported potential soft tissue damage post plate removal. We aimed to review the functional outcomes alongside union rates in patients treated with hook plates for lateral clavicular fractures. In this retrospective case series, 21 patients with traumatic lateral third clavicular fractures were included. 15 had Neer type II fractures, 4 Neer type III fractures, 1 patient had a Neer
Objective. To investigate the relationship between the pattern of pelvic or acetabular fracture, and bladder injuries. Methods. A total of 173 patients admitted at our Academic Hospital from January 2006 to March 2012 with cystograms done for pelvic or acetabular fractures were studied retrospectively. Records of pelvic X-Rays, CT scans and cystograms were reviewed. Tile's classification and Young & Burgess classification were used for pelvic fractures and Judet & Letournel classification system for acetabular fractures. Results. Out of 173 patients 16% had bladder injuries of which 22% were intra-peritoneal and 70% were extra-peritoneal. The bladder injuries mostly occurred among male patients; 16 males compared to 9 female patients. Out of the 21 fractures of the acetabulum only 2 sustained bladder injury and they were secondary to gunshot wounds. Lateral compression fractures accounted for 67% of bladder injuries. Motor vehicle accidents were the leading mechanism of injury accounting for 117 patients in total and 81% of those with bladder injuries. Among the patients with bladder rupture 55% had at least 3 rami involved and only one patient (4%) with 1 ramus involved had a bladder injury. Overall 44 (34%) of patients with 3 or more rami fractured had bladder injury. Conclusion. Bladder injury appears to be related to the mechanism of injury. We recommend that a cystogram be done routinely when a patient presents with a type III lateral compression fracture. In isolated acetabulum fractures, single ramus fractures and lateral compression
To analyze the results in proportion to the type of talar fracture. Eighteeen talar fractures(8 of the body and 20 of the neck)in 28 patients(24 men and 4 women, between 22 and 60 years, of average age 42 years) were treated in our department in the period 1981–2007. 24 fractures were closed and 4 were open (2 B and 2 C1 grade). The Hawkins classification for the fractures of the neck is: 10 type I, 6 type II, 4 type III. The fractures of the body were: 1 type A, 4 type B, 3 type E. The most common mechanism of injury was fall from a height in 16 cases and car accidents in 12 cases. 18 patients had associated injuries. The fractures managed within 6 hours. Time of follow up ranged between 2 and 9 years. All
It is generally accepted that urgent debridement and fixation of open tibial fractures minimizes the risk of infection. Traditionally surgeons follow the unwritten six hour rule. The purpose of this study was to determine the association between time to definite surgical management and rates of infection in open fractures of the tibia. One hundred and twenty-seven patients with one hundred and twenty-eight open tibia fractures were retrospectively reviewed. Of these ninety patients with ninety-one one fractures were available for this study. All patients were followed up to clinical and radiological fracture union or until a definitive procedure for infection or non-union had been carried out. The time from injury to surgery ranged from 2 hours 35 minutes to 12 hours with an average time of 5 hours 40 minutes. There were 24 Gustillo
Objective: 57 open tibia fractures treated with external fixation during the period 1996–2001 are presented. Material and Methods: 57 open tibia fractures concerning 52 patients (45 males, 12 females) were treated with external fixation during the period 1996–2001. Fracture classification according Gustilo included 5
To evaluate whether low-intensity pulsed ultrasound (LIPUS) accelerates bone healing at osteotomy sites and promotes functional recovery after open-wedge high tibial osteotomy (OWHTO). Overall, 90 patients who underwent OWHTO without bone grafting were enrolled in this nonrandomized retrospective study, and 45 patients treated with LIPUS were compared with 45 patients without LIPUS treatment in terms of bone healing and functional recovery postoperatively. Clinical evaluations, including the pain visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) score, were performed preoperatively as well as six weeks and three, six, and 12 months postoperatively. The progression rate of gap filling was evaluated using anteroposterior radiographs at six weeks and three, six, and 12 months postoperatively.Aims
Methods
Aim. Infection rates after management of open fractures are still high. Existing guidelines regarding prevention of this complication are inhomogeneous. A survey directed to orthopaedic trauma surgeons worldwide aims to give an overview of current practices in the management of open fractures. Method. An international group of trauma surgeons and infection specialists with experience in the field of musculoskeletal infections developed a questionnaire that was distributed via email to all AOTrauma members worldwide. Descriptive statistical analysis was performed. Results. 1197 orthopaedic trauma surgeons answered the survey (response rate: 4,9% of all opened emails). Cephalosporins are the most commonly used antibiotics for systemic prophylaxis in open fractures (cefazolin: 51,46% cefuroxime: 23,6%, ceftriaxone: 14,54%). In Gustilo type III open fractures gentamicin (49,12%) and metronidazole (33,58%) are often added. 86% (n=1033) reported to give the first dosage of systemic antibiotics in the emergency department as soon as the patient arrives. Only 3% (n=34) reported pre-hospital administration at the scene of the accident or during transport to the hospital. While most respondents administer antibiotics over 24h in
Summary Statement. This study examined the fixation stiffness of 13 tibial and 12 femoral Salter-Harris fracture fixation methods, and determined that screws and screws+ k-wires methods provided the highest stability. In situations where k-wire use is unavoidable, threaded k-wires are preferable. Introduction. Salter-Harris fractures of the proximal tibia and distal femur are common in pediatric patients that present to orthopedic surgeons. Salter-Harris
Introduction: Talus fractures are rare, but because of its peculiar anatomy the complications rate is high. Its arterial vascularisation can be compromised by trauma in displaced fractures or by the surgical approaches. Material and methods: Between 2001 and 2005, 30 patients with talus fractures were surgically treated in the Department of Orthopedics and Traumatology of Bucharest University Hospital. Sex ratio was 3 men/27 men. 27 fractures were closed. The mean age was 37 years (extremes: 17 – 54 years). Fractures were classified according to Hawkins classification: type I – 9 cases, type II – 13 cases, type III – 8 cases. All patients underwent clinical and radiological examinations at 3, 6 and 12 months and every year after this interval. Results: Hawkins
Fracture of the lateral humeral condyle accounts for approximately 15% of all elbow fractures in children. We studied 68 fractures of the lateral humeral condyle, which were treated surgically over a period of six years during 1994 to 2000. There were 49 boys and 19 girls. The average age was 6,5 years (2,5 – 13 years). All cases were treated with open reduction and internal fixation with two divergent K-wires for safer stabilisation of the fracture. Subsequently a cast was applied for 4–6 weeks to the radiological union of the fracture, where the K-wires were removed. The patients were evaluated with clinical and radiological criteria. Sixty-five cases were classified as Milch type II fractures and three were Milch
Periprosthetic fractures are becoming an increasing problem because of the number of total joint replacements that are performed yearly as well as the increase in longevity of the patients that receive total joint replacement. the risk factors for intraoperative fracture are rheumatoid arthritis, cementless arthroplasty, metabolic bone disease, Paget’s Disease, complex deformities, and revisions. The risk factors for post-operative fracture are weakened bone secondary to stress risers, screw holes, cortical perforations and stem tip protrusion, loose implants, and osteolysis. As a general rule the surgeon should make sure that all stress risers such as cortical windows and holes in the diaphysis should be bypassed at least two times the shaft diameter with a longer stem which restores the strength of the shaft to approximately 80%. Areas of transition between stem tips and plates or stem tips and stem tips should be avoided. Cortical strut grafts over holes, windows, and in areas of transition are of value. Johannsen’s Classification with a
Introduction: Pediatric radial neck fractures account for 5 to 10 % of all elbow fractures. Depending on the degree of radial head displacement either operative intervention or conservative treatment is recommended. Open reduction offers anatomic fracture fixation but compromises the vulnerable blood supply. Intramedullary nailing combines the advantages of closed reduction and stable internal fracture fixation. The purpose of the presented study was to evaluate the outcome of treatment of a series of pediatric radial neck fractures. Special contributions in our algorithm were made to the age dependant capacity for spontaneous fracture remodelling. Materials and Methods: The medical data of all children with fractures of the radial head between 1999 and 2008 were retrospectively analyzed. Fractures were classified according to the classification system described by Judet et al. Depending on the angulation of the fracture and on the age of the patient the treatment algorithm was defined.
Background. As the number of primary or revision TKA with stem extension cases are growing simultaneously, the number of periprosthetic fracture in these cases has also increased accordingly. However, there have been few reports on the classification and treatment of periprosthetic fracture following stemmed TKA and lack of information about the treatment outcome. The purposes of this study were 1) to demonstrate classification and management of periprosthetic fractures after stemmed TKA and 2) to report treatment outcome after the periprosthetic fractures. Materials and Methods. This retrospective study included 17 knees (15 patients) with an average age of 69.7 years. All cases were revision TKA cases, and there were 13 female and 2 male patients. The patients were treated nonoperatively or underwent operation by orthopedic principle. The period of union was evaluated by confirming the formation of callus crossing fragments in radiographs. We reviewed the complications and functional outcomes after treatment of periprosthetic fracture following revision TKA by assessing FF, FC and scoring WOMAC and KSS. Results. The classification of periprosthetic fractures of stemmed TKA was based on location of fracture and stability of implant. They were classified as follows:
Purpose: Publications reporting compression flexion fractures are rather old and rarely individualise this type of fracture. There is a consensus on anterior plate fixation which generally provides good outcome. We propose a retrospective analysis of our series to revisit the classification system and analyse outcome after surgical treatment. Material and methods: From January 1983 to November 2001, 96 fractures of the lower extremity of the radius with anterior displacement were treated in our unit. There were 95 patients (50 men and 45 women), mean age 42.7 years (15–88). The fracture resulted from a traffic accident in 52 patients. Twenty-seven patients had associated injuries. For lateral simple or complex anterior marginal fractures, the Castaing and Cauchoix classification was modified to take into account the importance of the fragment, relative to the middle of the radial glenoid, with or without associated lesion of the radial borders on the lateral and AP views (types I and II fractures). Type III factures were Goyrand fractures and type IV associated Goyrand fractures with one or more joint fracture lines. Our series thus included 43 anterior marginal fractures including 27 type II fractures where more than 50% of the joint surface was displaced, 53 Goyrand fractures (25 type III and 28 type IV). Plate fixation was used for 90 wrists, associated with complementary fixation in 17. Outcome was assessed with Laulan clinical criteria and Mouilleron radiological criteria. Results: Bone healing was achieved in all cases, without changing the initial fixation in 85 wrists. There were 49 men and 35 women, mean age 40.7 years (20–87).
During the last few years, the arthroscopically assisted technique for reduction and internal fixation of tibial plateau fractures is of increasing popularity. The accumulated surgical experience allowed the possibility of treating type I, II, III according to Schatzker classification. During the last two years 17 patients who had suffered a tibial plateau fracture were treated this way. The mean age was 44 years, while the mean FU was 16 months. According to Schatzker classification 8
