Aims. The aim of this study was to investigate the association between fracture displacement and survivorship of the native hip joint without conversion to a total hip arthroplasty (THA), and to determine predictors for conversion to THA in patients treated nonoperatively for acetabular fractures. Methods. A multicentre cross-sectional study was performed in 170 patients who were treated nonoperatively for an acetabular fracture in three level 1 trauma centres. Using the post-injury diagnostic CT scan, the maximum gap and
To investigate the effect of instability on the remodelling of a minor articular surface offset, we created a 0.5 mm coronal
Aims. The primary aim of this study was to address the hypothesis that fracture morphology might be more important than posterior malleolar fragment size in rotational type posterior malleolar ankle fractures (PMAFs). The secondary aim was to identify clinically important predictors of outcome for each respective PMAF-type, to challenge the current dogma that surgical decision-making should be based on fragment size. Methods. This observational prospective cohort study included 70 patients with operatively treated rotational type PMAFs, respectively: 23 Haraguchi Type I (large posterolateral-oblique), 22 Type II (two-part posterolateral and posteromedial), and 25 (avulsion-) Type III. There was no standardized protocol on how to address the PMAFs and CT-imaging was used to classify fracture morphology and quality of postoperative syndesmotic reduction. Quantitative 3D-CT (Q3DCT) was used to assess the quality of fracture reduction, respectively: the proportion of articular involvement; residual intra-articular: gap,
Aims. The optimal management of posterior malleolar ankle fractures, a prevalent type of ankle trauma, is essential for improved prognosis. However, there remains a debate over the most effective surgical approach, particularly between screw and plate fixation methods. This study aims to investigate the differences in outcomes associated with these fixation techniques. Methods. We conducted a comprehensive review of clinical trials comparing anteroposterior (A-P) screws, posteroanterior (P-A) screws, and plate fixation. Two investigators validated the data sourced from multiple databases (MEDLINE, EMBASE, and Web of Science). Following PRISMA guidelines, we carried out a network meta-analysis (NMA) using visual analogue scale and American Orthopaedic Foot and Ankle Score (AOFAS) as primary outcomes. Secondary outcomes included range of motion limitations, radiological outcomes, and complication rates. Results. The NMA encompassed 13 studies, consisting of four randomized trials and eight retrospective ones. According to the surface under the cumulative ranking curve-based ranking, the A-P screw was ranked highest for improvements in AOFAS and exhibited lowest in infection and peroneal nerve injury incidence. The P-A screws, on the other hand, excelled in terms of VAS score improvements. Conversely, posterior buttress plate fixation showed the least incidence of osteoarthritis grade progression, postoperative articular
Aims. Proper preoperative planning benefits fracture reduction, fixation, and stability in tibial plateau fracture surgery. We developed and clinically implemented a novel workflow for 3D surgical planning including patient-specific drilling guides in tibial plateau fracture surgery. Methods. A prospective feasibility study was performed in which consecutive tibial plateau fracture patients were treated with 3D surgical planning, including patient-specific drilling guides applied to standard off-the-shelf plates. A postoperative CT scan was obtained to assess whether the screw directions, screw lengths, and plate position were performed according the preoperative planning. Quality of the fracture reduction was assessed by measuring residual intra-articular incongruence (maximum gap and step-off) and compared to a historical matched control group. Results. A total of 15 patients were treated with 3D surgical planning in which 83 screws were placed by using drilling guides. The median deviation of the achieved screw trajectory from the planned trajectory was 3.4° (interquartile range (IQR) 2.5 to 5.4) and the difference in entry points (i.e. plate position) was 3.0 mm (IQR 2.0 to 5.5) compared to the 3D preoperative planning. The length of 72 screws (86.7%) were according to the planning. Compared to the historical cohort, 3D-guided surgery showed an improved surgical reduction in terms of median gap (3.1 vs 4.7 mm; p = 0.126) and
Treatment of posterior malleolar (PM) ankle fractures remain controversial. Despite increasing recommendation for small PM fragment fixation, high quality evidence demonstrating improved clinical outcomes over the unfixated PM is limited. We describe the medium-to-long term clinical and radiographical outcomes in younger adult patients with PM ankle fractures managed without PM fragment fixation. A retrospective cohort study of patients aged 18–55 years old admitted under our orthopaedic unit between 1st of April 2009 and 31st of October 2013 with PM ankle fractures was performed. Inclusion criteria were that all patients must mobilise independently pre-trauma, have no pre-existing ankle pathologies, and had satisfactory bimalleolar and syndesmotic stabilisation. Open fractures, talar fractures, calcaneal fractures, pilon fractures, subsequent re-injury and major complications were excluded. All PM fragments were unfixated. Clinical outcomes were evaluated using Foot and Ankle Ability Measure (FAAM) with activities of daily living (ADL) and sports subscale, visual analogue scale (VAS) and patient satisfaction ratings. Osteoarthrosis was assessed using modified Kellgren-Lawrence scale on updated weightbearing ankle radiographs. 61 participants were included. Mean follow-up was 10.26 years. Average PM size was 16.19±7.39%. All participants were evaluated for clinical outcomes, demonstrating good functional outcomes (FAAM-ADL 95.48±7.13; FAAM-Sports 86.39±15.52) and patient satisfaction (86.16±14.42%), with minimal pain (VAS 1.13±1.65). Radiographical outcomes were evaluated in 52 participants, showing no-to-minimal osteoarthrosis in 36/52 (69.23%), mild osteoarthrosis in 14/52 (26.92%) and moderate osteoarthrosis in 2/52 (3.85%). Clinical outcomes were not associated with PM fragment size, post-reduction
Despite the current trend favoring surgical treatment of displaced intra-articular calcaneal fractures (DIACFs), studies have not been able to demonstrate superior functional outcomes when compared to non-operative treatment. These fractures are notoriously difficult to reduce. Studies investigating surgical fixation often lack information about the quality of reduction even though it may play an important role in the success of this procedure. We wanted to establish if, amongst surgically treated DIACF, an anatomic reduction led to improved functional outcomes at 12 months. From July 2011 to December 2020, at a level I trauma center, 84 patients with an isolated DIACF scheduled for surgical fixation with plate and screws using a lateral extensile approach were enrolled in this prospective cohort study and followed over a 12-month period. Post-operative computed tomography (CT) imaging of bilateral feet was obtained to assess surgical reduction using a combination of pre-determined parameters: Böhler's angle, calcaneal height, congruence and articular
Despite the current trend favoring surgical treatment of displaced intra-articular calcaneal fractures (DIACFs), studies have not been able to demonstrate superior functional outcomes when compared to non-operative treatment. These fractures are notoriously difficult to reduce. Studies investigating surgical fixation often lack information about the quality of reduction even though it may play an important role in the success of this procedure. We wanted to establish if, amongst surgically treated DIACF, an anatomic reduction led to improved functional outcomes at 12 months. From July 2011 to December 2020, at a level I trauma center, 84 patients with an isolated DIACF scheduled for surgical fixation with plate and screws using a lateral extensile approach were enrolled in this prospective cohort study and followed over a 12-month period. Post-operative computed tomography (CT) imaging of bilateral feet was obtained to assess surgical reduction using a combination of pre-determined parameters: Böhler's angle, calcaneal height, congruence and articular
Aims. To assess the proportion of patients with distal radius fractures (DRFs) who were managed nonoperatively during the COVID-19 pandemic in accordance with the British Orthopaedic Association BOAST COVID-19 guidelines, who would have otherwise been considered for an operative intervention. Methods. We retrospectively reviewed the radiographs and clinical notes of all patients with DRFs managed nonoperatively, following the publication of the BOAST COVID-19 guidelines on the management of urgent trauma between 26 March and 18 May 2020. Radiological parameters including radial height, radial inclination, intra-articular
Aims. To compare operative and nonoperative treatment for displaced distal radius fractures in patients aged over 65 years. Methods. A total of 100 patients were randomized in this non-inferiority trial, comparing cast immobilization with operation with a volar locking plate. Patients with displaced AO/OTA A and C fractures were eligible if one of the following were found after initial closed reduction: 1) dorsal angulation > 10°; 2) ulnar variance > 3 mm; or 3) intra-articular
Introduction. After total knee arthroplasty (TKA) with a PCL-retaining implant the location of the tibiofemoral contact point should be restored in order to obtain normal kinematics. The difficulty during surgery is to control this location since the position of the femur on the tibia cannot easily be measured from the back of the joint. Therefore, we developed a simple “spacer technique” to check the contact point indirectly in 90° flexion after all bone cuts are made by measuring the
We performed a retrospective study to determine
the effect of osteoporosis on the functional outcome of osteoporotic
distal radial fractures treated with a volar locking plate. Between
2009 and 2012 a total of 90 postmenopausal women with an unstable
fracture of the distal radius treated with a volar locking plate
were studied. Changes in the radiological parameters of 51 patients
with osteoporosis (group 1, mean age 66.9, mean T-score –3.16 (. sd. 0.56))
were not significantly different from those in 39 patients without
osteoporosis (group 2, mean age 61.1, mean T-score –1.72 (. sd. 0.57)).
The mean Disabilities of the Arm, Shoulder and Hand (DASH) score
at final follow-up was 11.5 (. sd. 12.2) in group 1 and 10.5
(. sd. 13.25) in group 2. The mean modified Mayo wrist score
at final follow-up was 79.0 (. sd. 14.04) in group 1 and 82.6
(. sd. 13.1) in group 2. However, this difference was not
statistically significant (p = 0.35 for DASH score, p = 0.2 for
modified Mayo wrist score). Univariable and multivariable logistic regression
analysis showed that only the
Introduction: The magnitude of the initial chondral injury and the residual articular
The fracture most commonly treated by orthopaedic surgeons is that of the distal radius. However, as yet there is no consensus on what constitutes an ‘acceptable’ radiological position before or after treatment. This should be defined as the position that will predict good function in the majority of cases. In this paper we review the radiological indices that can be measured in fractures of the distal radius and try to identify potential predictors of functional outcome. In patients likely to have high functional demands, we recommend that the articular reconstruction be achieved with less than 2 mm of gap or
Introduction: Outcome following intra-articular fractures is dependent on a myriad of variables, including the extent of the initial osteochondral and soft tissue injury. In the clinical setting it is impossible to control such variables, and studies are largely confined to radiographic and outcome based assessments. Therefore the effect of fracture line orientation has not been widely examined. Theoretically an incongruent intra-articular fracture results in a “low” side that is relatively unloaded, at the expense of a “high” side exposed to increased loads. Furthermore the orientation of the fracture may give rise to a narrow or broad swathe of wear on the opposing articular surface. Aim: To evaluate the effect of an incongruent intra-articular fracture of the medial femoral condyle on subsequent loading and wear patterns, using an in vitro model. Materials and Methods: 15 porcine stifle (knee) joints were harvested within three hours of death. Three groups of five joints were evaluated. Group S underwent a sagittal osteotomy of the medical femoral condyle that was then fixed in an incongruent position. In Group C the osteotomy was performed in the coronal plane. The third group acted as a control group and had no oseotomy performed. In all cases great care was taken to prevent injury to the menisci, articular surfaces and Ligamentous structures. The size of the
A new anterior intrapelvic approach for the surgical
management of displaced acetabular fractures involving predominantly
the anterior column and the quadrilateral plate is described. In
order to establish five ‘windows’ for instrumentation, the extraperitoneal
space is entered along the lateral border of the rectus abdominis
muscle. This is the so-called ‘Pararectus’ approach. The feasibility
of safe dissection and optimal instrumentation of the pelvis was
assessed in five cadavers (ten hemipelves) before implementation
in a series of 20 patients with a mean age of 59 years (17 to 90),
of whom 17 were male. The clinical evaluation was undertaken between
December 2009 and December 2010. The quality of reduction was assessed
with post-operative CT scans and the occurrence of intra-operative
complications was noted. In cadavers, sufficient extraperitoneal
access and safe instrumentation of the pelvis were accomplished.
In the patients, there was a statistically significant improvement
in the reduction of the fracture (pre- versus post-operative:
mean
The December 2023 Trauma Roundup360 looks at: Distal femoral arthroplasty: medical risks under the spotlight; Quads repair: tunnels or anchors?; Complex trade-offs in treating severe tibial fractures: limb salvage versus primary amputation; Middle-sized posterior malleolus fractures – to fix?; Bone transport through induced membrane: a randomized controlled trial; Displaced geriatric femoral neck fractures; Risk factors for reoperation to promote union in 1,111 distal femur fractures; New versus old – reliability of the OTA/AO classification for trochanteric hip fractures; Risk factors for fracture-related infection after ankle fracture surgery.
The February 2024 Trauma Roundup360 looks at: Posterior malleolus fractures: what about medium-sized fragments?; Acute or delayed total hip arthroplasty after acetabular fracture fixation?; Intrawound antibiotics reduce the risk of deep infections in fracture fixation; Does the VANCO trial represent real world patients?; Can a restrictive transfusion protocol be effective beyond initial resuscitation?; What risk factors result in avascular necrosis of the talus?; Pre-existing anxiety and mood disorders have a role to play in complex regional pain syndrome; Three- and four-part proximal humeral fractures at ten years.
It is not clear which type of casting provides the best initial treatment in adults with a distal radial fracture. Given that between 32% and 64% of adequately reduced fractures redisplace during immobilization in a cast, preventing redisplacement and a disabling malunion or secondary surgery is an aim of treatment. In this study, we investigated whether circumferential casting leads to fewer fracture redisplacements and better one-year outcomes compared to plaster splinting. In a pragmatic, open-label, multicentre, two-period cluster-randomized superiority trial, we compared these two types of casting. Recruitment took place in ten hospitals. Eligible patients aged ≥ 18 years with a displaced distal radial fracture, which was acceptably aligned after closed reduction, were included. The primary outcome measure was the rate of redisplacement within five weeks of immobilization. Secondary outcomes were the rate of complaints relating to the cast, clinical outcomes at three months, patient-reported outcome measures (PROMs) (using the numerical rating scale (NRS), the abbreviated version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Patient-Rated Wrist/Hand Evaluation (PRWHE) scores), and adverse events such as the development of compartment syndrome during one year of follow-up. We used multivariable mixed-effects logistic regression for the analysis of the primary outcome measure.Aims
Methods
Introduction:. Bicondylar tibial plateau fractures are serious periarticular injuries. We investigated outcomes in injuries managed with Ilizarov external fixators. Methods:. We retrospectively reviewed bicondylar tibial plateau fractures treated with Ilizarov fixators in a major trauma centre from 2008–2012. Radiological parameters were measured from standardised weight-bearing radiographs. A subset (n=34) had patient-related outcome measures. Results:. Of 80 injuries, all fractures united. Two developed septic arthritis and one osteomyelitis. 76.3% were graded a good-excellent outcome (Rasmussen radiological score). 30.3% had evidence of osteoarthritis (Kellgren Lawrence>1). Neither parameter correlated significantly with lower functional scores. Referrals from neighbouring hospitals had longer times to surgery, which associated with increased condylar widening (p=0.0214) and posterior tibial slope (p=0.0332). Risk of developing osteoarthritis correlated with lower joint line congruency angle (JLCA) (p=0.0017) and increased articular
The December 2023 Wrist & Hand Roundup360 looks at: Volar locking plate for distal radius fractures with patient-reported outcomes in older adults; Total joint replacement or trapeziectomy?; Replantation better than revision amputation in traumatic amputation?; What factors are associated with revision cubital tunnel release within three years?; Use of nerve conduction studies in carpal tunnel syndrome; Surgical site infection following surgery for hand trauma: a systematic review and meta-analysis; Association between radiological and clinical outcomes following distal radial fractures; Reducing the carbon footprint in carpal tunnel surgery inside the operating room with a lean and green model: a comparative study.
Summary Statement. Objectifying postoperative recovery of patients with comminuted tibial plateau fractures treated with a unilateral plate trough the use of a gait analysis system. Introduction. Gait analysis has been a proved method for assessing postoperative results in patients with different orthopedic afflictions of the lower limb such as hallux valgus, ankle instabilities, knee osteoarthritis and arthroplasties but it has rarely been used for postoperative assessment of proximal tibial fractures. The more traditional means of quantifying postoperative articular
This study investigates the efficacy of the AO Pi-plate in the treatment of complex, unstable, intra-articular fractures of the distal radius. A retrospective study of 17 patients was carried out who underwent open reduction and internal fixation for dorsally displaced, intra-articular fractures of the distal radius using the AO Pi-plate. All patients were assessed clinically and radiologically post-operatively. The final functional outcome was assessed using the Gartland &
Werley scoring system. The average follow-up period was 34.3 months. 94% (16 patients) of the fractures were classified as AO type C fractures. The wrist movement was restored to a near normal range in all cases. The mean grip strength was 67% of the uninjured hand. The functional outcome as measured by the Gartland &
Werley scoring system showed excellent and good results in 88% of the patients. Radiographic assessment revealed an average articular
Introduction and purpose: Distal radius fractures often affect the joint surface; their reduction is difficult and may be incomplete. In these cases the use of an arthroscope may help reconstruct the joint surface of the radius and allow the diagnosis of ligament injuries. The purpose of this study is to analyze the results of this type of fractures by means of this technique. Materials and methods: Between November 2001 and January 2007 we reduced 24 fractures of the distal extremity of the radius that involved the joint surface with arthroscopic control. The mean age of the patients was 36 years (range: 21–55). We used Barbieri and Geissler’s classification. We recorded the approach route, arthroscopic ports, ligament injuries observed and complications. Also both radiological and functional results were assessed. Results: In 18 of the 24 patients some sort of ligamentous or osteochondral lesion was found (lunate-pisiform ligament, scaphoid-lunate ligament or triangular cartilage). All achieved union after a mean period of 8 weeks. By means of x-rays we measured a mean intraarticular
There has been a marked increase in the number of hip arthroscopies performed over the past 16 years, primarily in the management of femoroacetabular impingement (FAI). Insights into the pathoanatomy of FAI, and high-level evidence supporting the clinical effectiveness of arthroscopy in the management of FAI, have fuelled this trend. Arthroscopic management of labral tears with repair may have superior results compared with debridement, and there is now emerging evidence to support reconstructive options where repair is not possible. In situations where an interportal capsulotomy is performed to facilitate access, data now support closure of the capsule in selective cases where there is an increased risk of postoperative instability. Preoperative planning is an integral component of bony corrective surgery in FAI, and this has evolved to include computer-planned resection. However, the benefit of this remains controversial. Hip instability is now widely accepted, and diagnostic criteria and treatment are becoming increasingly refined. Instability can also be present with FAI or develop as a result of FAI treatment. In this annotation, we outline major current controversies relating to decision-making in hip arthroscopy for FAI. Cite this article:
We treated 24 patients with high-energy fractures of the tibial plateau by the Ilizarov fixator and transfixion wires. Eleven fractures were open, and 20 patients had complex injuries. Twelve were treated by ligamentotaxis and percutaneous fixation, seven by limited open reduction and five by extensive open reduction. All were followed for at least 24 months. All the fractures united, with an average time to healing of 14.4 weeks. Thirteen patients achieved full extension and 13 more than 110° of flexion. Twenty-two knees were stable. Fifteen patients walked normally and the rest with only a slight limp. All but two knees had an articular
Introduction: The value of arthroscopy, fluoroscopy, and e-learning courses (focusing on minimally invasive surgical techniques) for the treatment of intra-articular distal radius fractures (I-ADRF), remains controversial. This study compares the outcomes after fluoroscopically assisted (FA) reduction and external fixation of distal radius fractures, with or without concomitant arthroscopic evaluation. Materials and Methods: Forty-seven patients with I-ADRF underwent FA external fixation and percutaneous pinning. Among them 23 had additional arthroscopic evaluation of their wrist. For teaching purposes procedures with the use of fluoroscopy and arthroscopy were recorded and adapted as a course for the On-line Performance Support Environment for Minimally Invasive Orthopaedic Surgery (“OnLineOrtho” EU- sponsored project). The context of these courses was incorporated in an intelligent medical performance support environment. The duration of the procedure, the surgical findings and the outcomes were recorded. Results: The follow-up period ranged from 24 to 62 months and the patients were evaluated at 3, 6, 12 and 24 months. The addition of arthroscopy prolonged the procedure by 25 minutes but diminished the number of images obtained by the image intensifier by 5. After arthroscopic evaluation the placement of subchon-dral pins was changed, because of
Aims: To simulate intra-articular fracture healing, this study investigated the regeneration of identical osteochondral gaps within step-offs or on congruous articular surfaces. Methods: Twenty-nine rabbits received either half-millimetre coronal step-offs separated by 0.5X2mm osteochondral gaps (n=16) or identical osteochondral defects alone (n=13) on the medial femoral condyles. After 6, 12 and 24 weeks survival, subchondral bone density about the lesion was measured by pQCT. Cartilage regeneration/degeneration was evaluated with histology and immunostaining for collagen type I and II. Results: Subchondral bone re-establishment was complete in gaps within step-offs by 24 weeks however, showed delayed restoration in defects on congruent surfaces. Repair cartilage quality showed some differences in the two groups producing better results on the low side of
Liquiband is a new tissue adhesive: It works like super glue – it is attached to the wound edges, it sets within seconds and lasts for about two weeks. The glue then flakes off automatically as the skin regenerates. There is no need for suture removal. A second step forms a waterproof layer over the wound. We compared in a prospective randomized trial the Liquiband glue to skin staples. Over a 9 month period (May 2005 to January 2006) we enrolled a total of 80 patients, 40 in each group. The patients were booked for elective limb surgery and agreed to participate in the study. The surgical wounds were closed in layers. The skin was then either closed with Liquiband or skin staples. A follow up was a weeks 2, 6 and 18. The wound healing was photographically documented. The wounds were assessed according to the Hollander wound scoring system and a patient satisfaction score. Ethical approval was obtained. The two groups were matched for sex, age, body-mass index and smoking. There was a similar total wound length in both groups. All wounds healed. In the Liquiband group 4 superficial infections occurred, one dehiscence due to glue removal by the patient. In the skin staples group we had 6 superficial infections. The patient satisfaction score was lower in the skin staple group (7.0 compared to 8.3 in the Liquiband group) and on the Hollander wound scoring system there were 10% more
Aims: In prospective study the author asked, what are the results of ORIF (open reduction, internal fixation) in displaced intraarticular fractures of the calcaneus, and whether type of fracture and/or congruity in the sub-talar joint influence these results. Methods: Forty-three displaced intraarticular fractures of the calcaneus (30 Type II, 10 Type III and 3 Type IV; Sanders) were operated through extensile lateral approach. After reduction of the subtalar joint and restoration of the calcaneus shape, the fracture was fixed with the calcaneal plate. Mostly, surgery was delayed (median: day 7). Motion was encouraged immediately, partial weight-bearing after 5–6 weeks, and full weight-bearing after 3–4 month. Following surgery subtalar joint was congruent in 33 (77%) and non-congruent (within 2mm) in ten fractures. Results: Thirtysix fractures were evaluated 12 to 61 months postinjury. Functional results were satisfactory in 31 fractures (86%) and not satisfactory in five. All fractures with unsatisfactory results were comminutive (Type III or IV). Four fractures with congruent subtalar joint had unsatisfactory, whereas eight of nine fractures with uncongruent joint had satisfactory result. Statistically, functional results of the comminuted fractures were significantly worse (p=0,002). However, functional results of fractures with non-congruent joint were comparable to the results of fractures with congruent joint. Conclusions: ORIF enables satisfactory results in majority of displaced intraarticular fractures of the calcaneus. Comminution in the subtalar joint is a negative prognostic factor; furthermore, comminution is a negative prognostic factor irrespectless of the postreduction congruity in the subtalar joint, if
We utilized a dry-bone model of the pelvis and proximal femur, set upon transparent Lucite plates with four mounting screws and adjustable struts, allowing measurable and reproducible pelvic tilt and rotation. Our protocol for osteotome placement at each of the osteotomy sites strictly followed the technique described by Ganz. A 30°, 15 mm bifid osteotome was used for imaging at the initial ischial osteotomy at the infracotyloid groove. A 30°, 2 cm straightedge osteotome was placed 4 cm below the pelvic brim to image the retroacetabular osteotomy on the quadrilateral plate. Various osteotome placements were imaged with the C-arm image intensifier to better define the risks of inferior and posterosuperior intraarticular osteotomies at each of these sites, respectively. A 600 osteotome oriented at 500 to the quadrilateral plate was also utilized. In addition, violation of the inferior quadrant of the joint as well as posterolateral slipping of the osteotome blade along the posterior column, were appreciated on all images of pelvic flexion and rotation. The false-profile view always confirmed the perpendicular orientation of the osteotome blade. The false-profile view allowed for accurate evaluation of the positioning of the 30°, 2-cm straightedge osteotome along the retro-acetabular osteotomy site. In the views obtained, the blade could be seen aligned parallel to the posterior surface of the acetabulum, while respecting the posterosuperior joint space with optimal
Aim: To evaluate the long term results of the combined treatment of hybrid external fixator and limited internal fixation along with the advantages using pre-operative and post-operative computed tomography scan in these cases. Material and Methods: During a period of 12 months, 16 fractures of tibial plateau, were treated in 16 patients. Fractures were classified according to Schatzker’s staging system as type II 2 cases, type III 4 cases, type IV 3 cases, type V 4 cases, type VI 3 cases. Eleven patients were men and 5 women with a mean age of 42 years old (27–67 years). In all cases pre-operatively were programmed coronal and saggital reconstructed CT-Scan, revealed the precise location and degree of articular comminution and joint depression. The principles of ligamentotaxis was used to achieve the closed indirect reduction, and limited open reduction with internal fixation was performed in 9 patients. All cases were treated with hybrid external fixators. After the removal of the plants, CT-Scan was programmed for all the cases. Results: All patients were evaluated with a mean period of follow up 1.9 years. Healing was achieved in all 16 cases with a mean period of 16 weeks. There was no non-union. Pin tract infection occurred in two cases. Two fractures developed a malunion (1 valgus deformity and 1 anterior angular deformity). Radiographic evidence of arthritis appeared in 2 patients during follow up. CT-Scan offer us the possibility to measure precious the sinking of the tibia plateau in degrees, the condylar widening in mm, the degeneration of joint space, the varus-valgus tilt in degrees, the articular
OBJECTIVES: To review the short-term functional results of the surgical treatment of tibial plateau fractures using low profile peri-articular plates. METHODS: Forty-nine displaced fractures of the tibial plateau in forty-nine patients were treated with open reduction and buttress plate fixation using low profile plate between 2002–2006. All aspects of their care, including tibial plateau fracture type, operative management and associated injuries, were documented. Preoperative and postoperative follow-up radiographs were analyzed for fracture classification and adequacy of reduction. All patients were followed up with clinical assessment and given Iowa knee functional outcome questionnaires. Data were also collected regarding return to work and sporting activities. The average age of the patients was thirty-eight years and the mean follow-up was 25 months, with a range of 12 to 52 months.. Of the forty-nine fractures studied, twenty-six were classified as Schatzker types I, II, or III, and the remaining twenty-three were types IV, V, or VI. Forty-six patients had closed injury while three had open fractures. RESULTS: 48 of the fractures healed without additional surgical intervention or bone grafting except for one bicondylar fracture which needed amputation because of deep infection and soft tissue problem. Thirty eight patients had follow-up of greater than 1 year. The average time to radiographic callus was 6.2 weeks, and the average time to complete union was 16 weeks. The articular
The aim of this study was to identify the origin and development of the threshold for surgical intervention, highlight the consequences of residual displacement, and justify the importance of accurate measurement. A systematic review of three databases was performed to establish the origin and adaptations of the threshold, with papers screened and relevant citations reviewed. This search identified papers investigating functional outcome, including presence of arthritis, following injury. Orthopaedic textbooks were reviewed to ensure no earlier mention of the threshold was present.Aims
Methods
No randomized comparative study has compared the extensile lateral approach (ELA) and sinus tarsi approach (STA) for Sanders type 2 calcaneal fractures. This randomized comparative study was conducted to confirm whether the STA was prone to fewer wound complications than the ELA. Between August 2013 and August 2018, 64 patients with Sanders type 2 calcaneus fractures were randomly assigned to receive surgical treatment by the ELA (32 patients) and STA (32 patients). The primary outcome was development of wound complications. The secondary outcomes were postoperative complications, pain scored of a visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, 36-item Short Form health survey, operative duration, subtalar joint range of motion (ROM), Böhler’s angle and calcaneal width, and posterior facet reduction.Aims
Methods
Tibial plateau fractures are serious injuries about the knee that have the potential to affect patients’ long-term function. To our knowledge, this is the first study to use patient-reported outcomes (PROs) with a musculoskeletal focus to assess the long-term outcome, as compared to a short-term outcome baseline, of tibial plateau fractures treated using modern techniques. In total, 102 patients who sustained a displaced tibial plateau fracture and underwent operative repair by one of three orthopaedic traumatologists at a large, academic medical centre and had a minimum of five-year follow-up were identified. Breakdown of patients by Schatzker classification is as follows: two (1.9%) Schatzker I, 54 (50.9%) Schatzker II, two (1.9%) Schatzker III, 13 (12.3%) Schatzker IV, nine (8.5%) Schatzker V, and 26 (24.5%) Schatzker VI. Follow-up data obtained included: Visual Analogue Scale (VAS) or Numeric Rating Scale (NRS) pain scores, Short Musculoskeletal Functional Assessment (SMFA), and knee range of movement (ROM). Data at latest follow-up were then compared to 12-month data using a paired Aims
Methods
The aims of this study were to review the surgical technique for a combined femoral head reduction osteotomy (FHRO) and periacetabular osteotomy (PAO), and to report the short-term clinical and radiological results of a combined FHRO/PAO for the treatment of selected severe femoral head deformities. Between 2011 and 2016, six female patients were treated with a combined FHRO and PAO. The mean patient age was 13.6 years (12.6 to 15.7). Clinical data, including patient demographics and patient-reported outcome scores, were collected prospectively. Radiologicalally, hip morphology was assessed evaluating the Tönnis angle, the lateral centre to edge angle, the medial offset distance, the extrusion index, and the alpha angle.Aims
Patients and Methods
Arthroscopically controlled fracture reduction in combination
with percutaneous screw fixation may be an alternative approach
to open surgery to treat talar neck fractures. The purpose of this
study was thus to present preliminary results on arthroscopically
reduced talar neck fractures. A total of seven consecutive patients (four women and three men,
mean age 39 years (19 to 61)) underwent attempted surgical treatment
of a closed Hawkins type II talar neck fracture using arthroscopically
assisted reduction and percutaneous screw fixation. Functional and
radiological outcome were assessed using plain radiographs, as well
as weight-bearing and non-weight-bearing CT scans as tolerated.
Patient satisfaction and pain sensation were also recorded.Aims
Patients and Methods
The degree of displacement of a fracture of the distal radius
is an important factor which can be assessed using simple radiographic
measurements. Our aim was to investigate the reliability and reproducibility
of these measurements and to determine if they should be used clinically. A 10% sample was randomly generated from 3670 consecutive adult
patients who had presented to University Hospitals of Leicester
NHS Trust between 2007 and 2010 with a fracture of the distal radius.
Radiographs of the 367 patients were assessed by two independent
reviewers. Four measurements of displacement of the fracture were recorded
and the inter-observer correlation assessed using the intra-class
correlation coefficient.Aims
Patients and Methods
The posterior malleolus component of a fracture
of the ankle is important, yet often overlooked. Pre-operative CT scans
to identify and classify the pattern of the fracture are not used
enough. Posterior malleolus fractures are not difficult to fix.
After reduction and fixation of the posterior malleolus, the articular
surface of the tibia is restored; the fibula is out to length; the
syndesmosis is more stable and the patient can rehabilitate faster.
There is therefore considerable merit in fixing most posterior malleolus
fractures. An early post-operative CT scan to ensure that accurate
reduction has been achieved should also be considered. Cite this article:
To investigate the differences of open reduction and internal
fixation (ORIF) of complex AO Type C distal radius fractures between
two different models of a single implant type. A total of 136 patients who received either a 2.4 mm (n = 61)
or 3.5 mm (n = 75) distal radius locking compression plate (LCP
DR) using a volar approach were followed over two years. The main
outcome measurements included motion, grip strength, pain, and the
scores of Gartland and Werley, the Short-Form 36 (SF-36) and the
Disabilities of the Arm, Shoulder, and Hand (DASH). Differences
between the treatment groups were evaluated using regression analysis
and the likelihood ratio test with significance based on the Bonferroni
corrected p-value of <
0.003.Objectives
Methods