Fractures in older adults. A view of the future?

Changing epidemiology of lower extremity fractures in adults over a 15-year period - a National Hospital Discharge Registry study

Background

Demographic changes led to an increasingly ageing population in Germany and thus to possible changes in the frequency of fractures. The primary aim of this study was to report changes in fracture rates of the lower extremities in Germany in 2002 compared to 2017 and to evaluate those changes.

Methods

Inpatient data from the German National Hospital Discharge Registry (ICD10) for 2002 and 2017 were evaluated. Changes in total counts and incidence rates were analysed for fractures in the following locations: femoral neck, pertrochanteric, subtrochanteric, distal femur, femoral shaft, proximal and distal tibia, tibial shaft, medial and lateral malleolus, and other parts of the lower leg (including bi- and trimalleolar fractures), calcaneus, talus, other tarsal bones, metatarsal bones, greater toe, lesser toe, other fractures of foot or unspecific fractures of foot and toe. Patients were classed into age groups by sex: 15–24, 25–34,35–44, 45–54, 55–64, 65–74, 75–84, 85–90 and >  90 years.

Results

The total count for lower extremity fractures in men and women increased slightly by 4.5% from 305,764 in 2002 to 319,422 in 2017. Hip and femur fractures increased by 23.5% from 150,565 in 2002 to 185,979 in 2017. The number of these fractures among men increased by 46% and among women by 15.3%. The total count of lower leg fractures decreased by 15.4% from 131,162 in 2002 to 110,924 in 2017. Especially, younger age groups showed a decline for all tibial segments and ankle fractures. For both sexes, the number of lower leg fractures in those 75 years or older increased in all lower leg fracture locations. Most femur and lower leg fractures occurred in women. The incidence of fractures rose sharply from 2002 to 2017, especially for older cohorts.

Conclusion

The total numbers of lower extremity fractures increased slightly in 2017 compared to 2002 – especially hip and femur fractures among men. The incidence of almost all lower extremity fracture types among older people increased during this time. Women were particularly affected. Therefore, focused prevention programmes should be considered including an extended fracture spectrum in the elderly.

Clinical and radiological outcomes of reverse shoulder arthroplasty for acute fracture in the elderly

PURPOSE

The goal of this study was to assess the clinical outcomes associated with anatomic healing of the greater tuberosity in patients treated for proximal humerus fractures with reverse shoulder arthroplasty. Our hypothesis was that anatomic healing of the greater tuberosity leads to less complications and better functional outcomes.

METHODS

RESULTS: Patients from the GT+ group presented better functional outcomes than the GT- group in all evaluated outcomes. Mean constant score was 61 ± 14 versus 56 ± 15, and the subjective shoulder value (SSV) was 77 ± 14 versus 64 ± 21 (p < 0.001). Forward elevation was 128° ± 28° versus 107° ± 30° and external rotation was 23° ± 17° versus 14° ± 17° (p < 0.001). Twenty patients presented with at least one prosthetic dislocation (7 GT+ vs 13 GT-) while nine patients were revised for humeral loosening (1 GT+ vs 8 GT-). The use of a fracture specific humeral stem was associated with a higher rate of greater tuberosity healing.

CONCLUSIONS

Non-anatomic healing of the greater tuberosity was associated with a higher dislocation and humeral loosening rate. Anatomic healing of the greater tuberosity lead to better functional outcomes, less humeral-sided complications, and fewer re-operations.

Treatment of severely open tibial fractures, non-unions, and fracture-related infections with a gentamicin-coated tibial nail-clinical outcomes including quality of life analysis and psychological ICD-10-based symptom rating

BACKGROUND

Implant-associated infections depict a major challenge in orthopedics and trauma surgery putting a high burden on the patients and health care systems, strongly requiring improvement of infection prevention and of clinical outcomes. One strategy includes the usage of antimicrobial-coated implants. We evaluated outcomes after surgical treatment using a gentamicin-coated nail on (i) treatment success in terms of bone consolidation, (ii) absence of infection, and (iii) patient-reported quality of life in a patient cohort with high risk of infection/reinfection and treatment failure.

METHODS

Thirteen patients with open tibia fractures (n = 4), non-unions (n = 2), and fracture-related infection (n = 7) treated with a gentamicin-coated intramedullary nail (ETN Protect^TM) were retrospectively reviewed. Quality of life was evaluated with the EQ-5D, SF-36, and with an ICD-10-based symptom rating (ISR).

RESULTS

At a mean follow-up of 2.8 years, 11 of the 13 patients (84.6%) achieved bone consolidation without any additional surgical intervention, whereas two patients required a revision surgery due to infection and removal of the implant. No specific implant-related side effects were noted. Quality of life scores were significantly lower compared to a German age-matched reference population. The mean ISR scores revealed mild psychological symptom burden on the scale depression.

CONCLUSION

The use of a gentamicin-coated intramedullary nail seems to be reasonable in open fractures and revision surgery for aseptic non-union or established fracture-related infection to avoid infection complications and to achieve bony union. Despite successful treatment of challenging cases with the gentamicin-treated implant, significantly reduced quality of life after treatment underlines the need of further efforts to improve surgical treatment strategies and psychological support.

An evaluation of the measurement properties of the Olerud Molander Ankle Score in adults with an ankle fracture

OBJECTIVES

The aim of this study is to evaluate the measurement properties of the Olerud Molander Ankle Score in adults with an ankle fracture.

METHODS

Patients completed outcome measure questionnaires at baseline, six, 10- and 16-weeks postinjury as part of an ongoing clinical trial on ankle fracture rehabilitation. The internal consistency, convergent validity, structural validity and interpretability of the Olerud Molander Ankle Score was assessed. This was achieved through using the respective analysis methods of Cronbach's alpha, correlation coefficients, principal component analysis, evaluation of floor and ceiling scores and estimation of the minimally important change using anchor-based methods.

RESULTS

The Olerud Molander Ankle Score showed adequate convergent validity against hypotheses set in relation to scores of comparator instruments. Principal component analysis demonstrated that the measure has two subscales: ankle function and ankle symptoms. The internal consistency of the measure and the ankle function subscale was sufficient, but inconclusive for the ankle symptoms subscale. There were no floor and ceiling effects present within the scores and the estimated minimally important change was 9.7 points.

CONCLUSION

The Olerud Molander Ankle Score demonstrates sufficient measurement properties and is likely to be primarily measuring the construct of patient reported function following ankle fracture. Further research should evaluate the relevance of other domains to individuals recovering from and ankle fracture, such as social participation and psychological wellbeing. The development of a core outcome set would be advantageous to standardise outcome measurement collection in this area.

Effect of Osteoporosis on Proximal Humerus Fractures

Introduction:

Proximal humerus fractures (PHF) constitute the majority of the most common osteoporotic fractures. Bone density measurements can affect treatment methods and outcomes. This study was aimed to investigate the effect of osteoporosis values, measured from direct radiographs, on fracture type, surgical outcomes.

Methods:

248 patients over 50 years of age who presented to Mersin City Hospital between 2017 and 2020 with proximal humeral fractures were retrospectively evaluated. The age and gender of the patients and the fracture types were evaluated according to the AO classification system from the direct radiographs obtained at the time of admission were recorded. The Tingart cortical thickness and deltoid tuberosity index (DTI) measurements were used to assess osteoporosis status in all patients. Postoperative and follow-up radiographs of 45 patients, treated with fixed-angle proximal humeral locking plate, were evaluated for radiographic results and their correlations with osteoporosis measurements were examined.

Results:

According to the demographic characteristics of the patients, 171 patients were female and 77 patients were male (F/M: 3/1), and mean age was 69.2 ± 11.66 (50-95). Considering the bone quality parameters in all patients, the mean Tingart value was 5.8 ± 1.6 mm and the mean DTI was 1.43 ± 0.17, where there was a correlation between the Tingart value and DTI (r = 0.810 and p < 0.001). Although there was a statistically significant relationship between the osteoporosis parameters and age and gender (p < 0.001 and p = 0.023, respectively), main AO fracture types were not related to osteoporosis (p < 0.05). In the operated group (n = 48, 19%), 19 patients (42%) showed poor outcomes, which were not associated with age and osteoporosis parameters.

Conclusion:

This study was concluded that osteoporosis parameters differ between genders and age groups in patients with PHF, however osteoporosis is not the main factor affecting the fracture type and surgical outcomes.

Fracture incidence in adults in relation to age and gender: A study of 27,169 fractures in the Swedish Fracture Register in a well-defined catchment area

Studies on fracture incidence have mostly been based on retrospectively registered data from local hospital databases. The Swedish Fracture Register (SFR) is a national quality register collecting data prospectively on fractures, at the time of care-seeking. In the present study the incidence of all different fractures, regardless of location, in adults’ ≥ 16 years treated at the only care provider for patients with fractures within a catchment area of approximately 550,000 inhabitants, during 2015‒2018 are described. Age, gender, and fracture location (according to AO/OTA classification) was used for the analyses and presentation of fracture incidences. During the 4-year study period, 23,917 individuals sustained 27,169 fractures. The mean age at fracture was 57.9 years (range 16‒105 years) and 64.5% of the fractures occurred in women. The five most common fractures accounted for more than 50% of all fractures: distal radius, proximal femur, ankle, proximal humerus, and metacarpal fractures. Seven fracture incidence distribution groups were created based on age- and gender-specific incidence curves, providing visual and easily accessible information on fracture distribution. This paper reports on incidence of all fracture locations based on prospectively collected data in a quality register. The knowledge on fracture incidence related to age and gender may be of importance for the planning of orthopaedic care, involving both in- and out-patients as well as allocating surgical resources. Further, this might be useful for organizing preventive measures, especially in countries with similar socioeconomic structure and fracture burden.

Impact of coronavirus disease 2019 (COVID-19) on the epidemiology of orthopedics trauma in a region of central italy

• Italy is among the most affected countries by COVID-19. • The general lockdown significantly reduced road accident traumas, high energy traumas and sport injuries. • Domestic accidents or fall related traumas do not seem to show any variations..

Proximal humeral nail for treatment of 3- and 4-part proximal humerus fractures in the elderly population: effective and safe in experienced hands

BACKGROUND

Optimal treatment of 3- and 4-part proximal humerus fractures (PHFs) remains controversial. Although commonly recommended for less comminuted PHFs, the outcomes of treatment with proximal humerus nailing (PHN) are more equivocal. The purpose of this study was to report on radiographic and clinical outcomes of patients undergoing PHN fixation of 3- and 4-part PHFs at minimum one-year follow-up. Our hypothesis was that the findings would demonstrate satisfactory radiographic and clinical outcomes, with low rates of complications and revision surgeries.

METHODS

Between 2008 and 2016, 121 patients with comminuted, low-energy, osteoporotic, PHFs underwent fixation via Targon PHN (Aesculap, Tuttlingen, Germany). Of these, 60 patients met inclusion and exclusion criteria and were included in this analysis (mean age 72; range 65-85). All completed a minimum 1-year follow-up (range 12.5-82 months). Patients with 3-part PHFs were compared to patients with 4-part PHFs. Clinical, radiographic, and functional outcomes were assessed at postoperative visits. Patient reported outcomes included pain, the American Shoulder and Elbow Surgeons (ASES) score and the Simple Shoulder Test (SST). Radiographic union and revision and complication rates were assessed.

RESULTS

Overall, 37 (62%) fractures were classified as Neer 3 and 23 (38%) were classified as Neer 4. Both groups achieved similar postoperative range of motion. Patients with 3-part fractures reported significantly lower postoperative pain (0.76 ± 1.8 vs. 1.65 ± 2.2, p = 0.0047). Patients with 3-part fractures reported significantly better ASES scores (82.4 ± 19.2 vs. 70.8 ± 21.9, p = 0.02) and non-statistically significant higher SST scores (8.4 ± 3.2 vs. 7.43 ± 3.8, p = 0.14). Adequate fracture union was achieved in 53 fractures (88.3%). Three patients (5%) had varus malunion or greater tuberosity displacement, one (1.7%) had mechanical failure, and three (5%) had radiographic evidence of avascular necrosis. Between groups, there was no difference in failure rates.

CONCLUSION

Proximal humeral nails can successfully be used by experienced surgeons in fixation of comminuted and displaced proximal humeral fractures in selected patients with osteoporosis. While patients with both 3- and 4-part fractures demonstrate fracture union with satisfactory outcomes, patients with 3-part fractures demonstrate significantly higher postoperative functional scores.

Fractures of the proximal- and middle-thirds of the humeral shaft should be considered as fragility fractures

Aims

The aim of this study was to determine the current incidence and epidemiology of humeral diaphyseal fractures. The secondary aim was to explore variation in patient and injury characteristics by fracture location within the humeral diaphysis.

Methods

Over ten years (2008 to 2017), all adult patients (aged ≥ 16 years) sustaining an acute fracture of the humeral diaphysis managed at the study centre were retrospectively identified from a trauma database. Patient age, sex, medical/social background, injury mechanism, fracture classification, and associated injuries were recorded and analyzed.

Results

A total of 900 fractures (typical 88.9%, n = 800/900; pathological 8.3%, n = 75/900; periprosthetic 2.8%, n = 25/900) were identified in 898 patients (mean age 57 years (16 to 97), 55.5% (n = 498/898) female). Overall fracture incidence was 12.6/100,000/year. For patients with a typical fracture (n = 798, mean age 56 years (16 to 96), 55.1% (n = 440/798) female), there was a bimodal distribution in men and unimodal distribution in older women (Type G). A fall from standing was the most common injury mechanism (72.6%, n = 581/800). The majority of fractures involved the middle-third of the diaphysis (47.6%, n = 381/800) followed by the proximal- (30.5%, n = 244/800) and distal-thirds (n = 175/800, 21.9%). In all, 18 injuries (2.3%) were open and a radial nerve palsy occurred in 6.7% (n = 53/795). Fractures involving the proximal- and middle-thirds were more likely to occur in older (p < 0.001), female patients (p < 0.001) with comorbidities (p < 0.001) after a fall from standing (p < 0.001). Proximal-third fractures were also more likely to occur in patients with alcohol excess (p = 0.003) and to be classified as AO-Orthopaedic Trauma Association type B or C injuries (p < 0.001).

Conclusion

This study updates the incidence and epidemiology of humeral diaphyseal fractures. Important differences in patient and injury characteristics were observed based upon fracture location. Injuries involving the proximal- and middle-thirds of the humeral diaphysis should be considered as fragility fractures. Cite this article: Bone Joint J 2020;102-B(11):1475–1483.

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

Osteoporosis (OP) and osteoporotic fractures (OFs) are common multifactorial and heterogenic disorders of increasing incidence. Helicobacter pylori (H.p.) colonizes the stomach approximately in half of the world's population, causes gastroduodenal diseases and is prevalent in numerous extra-digestive diseases known to be associated with OP/OF. The studies regarding relationship between H.p. infection (HPI) and OP/OFs are inconsistent. The current review summarizes the relevant literature on the potential role of HPI in OP, falls and OFs and highlights the reasons for controversies in the publications. In the first section, after a brief overview of HPI biological features, we analyze the studies evaluating the association of HPI and bone status. The second part includes data on the prevalence of OP/OFs in HPI-induced gastroduodenal diseases (peptic ulcer, chronic/atrophic gastritis and cancer) and the effects of acid-suppressive drugs. In the next section, we discuss the possible contribution of HPI-associated extra-digestive diseases and medications to OP/OF, focusing on conditions affecting both bone homeostasis and predisposing to falls. In the last section, we describe clinical implications of accumulated data on HPI as a co-factor of OP/OF and present a feasible five-step algorithm for OP/OF risk assessment and management in regard to HPI, emphasizing the importance of an integrative (but differentiated) holistic approach. Increased awareness about the consequences of HPI linked to OP/OF can aid early detection and management. Further research on the HPI-OP/OF relationship is needed to close current knowledge gaps and improve clinical management of both OP/OF and HPI-related disorders.

Trends in the Characterization of the Proximal Humerus in Biomechanical Studies: A Review

Proximal humerus fractures are becoming more common due to the aging of the population, and more related scientific research is also emerging. Biomechanical studies attempt to optimize treatments, taking into consideration the factors involved, to obtain the best possible treatment scenario. To achieve this, the use of finite element analysis (FEA) is necessary, to experiment with situations that are difficult to replicate, and which are sometimes unethical. Furthermore, low costs and time requirements make FEA the perfect choice for biomechanical studies. Part of the complete process of an FEA involves three-dimensional (3D) bone modeling, mechanical properties assignment, and meshing the bone model to be analyzed. Due to the lack of standardization for bone modeling, properties assignment, and the meshing processes, this article aims to review the most widely used techniques to model the proximal humerus bone, according to its anatomy, for FEA. This study also seeks to understand the knowledge and bias behind mechanical properties assignment for bone, and the similarities/differences in mesh properties used in previous FEA studies of the proximal humerus. The best ways to achieve these processes, according to the evidence, will be analyzed and discussed, seeking to obtain the most accurate results for FEA simulations.

Management of Lower Extremity Fractures in the Elderly: A Focus on Post-Operative Rehabilitation

Fractures in the elderly population are increasing in incidence and represent a rising burden of disease. It is difficult for the elderly population to adhere to restricted weight bearing, and immobility poses significant risks and increased morbidity. Therefore, a primary goal of fracture management in the elderly population is early post-operative weight bearing. This review examines published literature regarding lower extremity fracture management in the elderly, with a focus on post-operative rehabilitation. While extensive literature supports early weight bearing after hip fractures in the elderly, further research is warranted to provide guidelines for management of other lower extremity fractures in this population.

Reverse Shoulder Arthroplasty for Proximal Humerus Fracture

PURPOSE OF REVIEW

The purpose of this review is to examine trends, outcomes, and principles in treatment of proximal humerus fractures in the elderly with a critical focus on reverse shoulder arthroplasty as a developing treatment option.

RECENT FINDINGS

Recent literature shows an increase in reverse shoulder arthroplasty and a decrease in hemiarthroplasty performed for proximal humerus fractures. More predictable outcomes and lower revision rates are seen in older individuals treated primarily or secondarily with reverse shoulder arthroplasty compared to those treated with hemiarthroplasty. We report current and historical treatments, outcomes, and principles in reverse shoulder arthroplasty for treatment of complex, displaced proximal humerus fractures in older individuals (≥ 65 years old).

Trends in fracture development of the upper extremity in Germany-a population-based description of the past 15 years

Background

Recent studies investigating fracture development in Germany are not available especially with regard to demographic change. The primary aim of this study was to report trends in fracture development of the upper extremity in Germany between 2002 and 2017 and to evaluate changes over time.

Methods

Evaluating inpatient data from the German National Hospital Discharge Registry (International Classification of Diseases, ICD-10) between 2002 and 2017. Total count, incidences and percentage changes of the following fracture localizations were analysed: proximal humerus, distal humerus, proximal ulna, proximal radius, ulna diaphysis (including Monteggia lesion) and distal radius. Ten age groups for men and women were formed: 35–44, 45–54, 55–64, 65–74; 75–84; 85–90, and > 90 (years).

Results

The total count of proximal humeral fractures increased from 40,839 (2002, men/women 9967/30,872) to 59,545 (2017, men/women 14,484/45,061). Distal humeral fractures increased from 5912 (2002, men/women 1559/4353) to 6493 (2017, men/women1840/4653). The total count of forearm fractures increased from 68,636 (2002, men/women 17,186/51,450) to 89,040 (2017, men/women 20,185/68,855). Women were affected in 70–75% of all cases with rising incidences among nearly every age group in female patients.

Conclusion

Total count of nearly every evaluated fracture increased. Also, incidences increased especially in the older female age groups. Fracture development already seems to reflect demographic changes in Germany.

Patient experiences of an ankle fracture and the most important factors in their recovery: a qualitative interview study

OBJECTIVE

The objective of this qualitative research study is to explore patient experiences of ankle fracture and the factors most important to them in recovery.

DESIGN

Semistructured interviews exploring patient experiences of ankle fracture recovery at 16-23 weeks following injury. Interviews followed a topic guide and were recorded with an encrypted audio recorder and then transcribed verbatim. Thematic content analysis was used to identify themes in the data.

SETTING

Individuals were recruited from a sample of participants of a UK-based clinical trial of immobilisation methods for ankle fracture (ISRCTN15537280 at the pre-results stage at time of writing). Interviews were conducted at the participants' own homes or on a university campus setting.

PARTICIPANTS

A purposive sample was used to account for key variables of age, gender and fracture management. Participants recruited from the clinical trial sample were adults aged 18 years or over with a closed ankle fracture.

RESULTS

Ten participants were interviewed, five of whom were female and six of whom needed an operation to fix their ankle fracture. The age range of participants was 21-75 years with a mean of 51.6 years. Eight themes emerged from the data during analysis; mobility, loss of independence, healthcare, psychological effects, social and family life, ankle symptoms, sleep disturbance and fatigue, and activities of daily living. Factors of importance to participants included regaining their independence, sleep quality and quantity, ability to drive, ability to walk without walking aids or weight-bearing restrictions, and radiological union.

CONCLUSIONS

The results of this research demonstrates the extensive impact of ankle fracture on individuals' lives, including social and family life, sleep, their sense of independence and psychological well-being. The results of this study will enable an increased understanding of the factors of relevance to individuals with ankle fracture, allowing collection of appropriate outcomes in clinical studies for this condition. Ultimately these results will help formulate appropriate patient-centred rehabilitation plans for these patients.

TRIAL REGISTRATION NUMBER

ISRCTN15537280; Pre-results.

A systematic review of the measurement properties of patient reported outcome measures used for adults with an ankle fracture

BACKGROUND

Ankle fractures are painful and debilitating injuries that pose a significant burden to society and healthcare systems. Patient reported outcome measures (PROMs) are commonly used outcome measures in clinical trials of interventions for ankle fracture but there is little evidence on their validity and reliability. This systematic review aims to identify and appraise evidence for the measurement properties of ankle specific PROMs used in adults with an ankle fracture using Consensus Based Standards for the Selection of Health Measurement Instrument (COSMIN) methodology.

METHODS

We searched MEDLINE, Embase and CINAHL online databases for evidence of measurement properties of ankle specific PROMs. Articles were included if they assessed or described the development of the PROM in adults with ankle fracture. Articles were ineligible if they used the PROM to assess the measurement properties of another instrument. Abstracts without full articles and conference proceedings were ineligible, as were articles that adapted the PROM under evaluation without any formal justification of the changes as part of a cross-cultural validation or translation process. Two reviewers completed the screening. To assess methodological quality we used COSMIN risk of bias checklist and summarised evidence using COSMIN quality criteria and a modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Two reviewers assessed the methodological quality and extracted the data for a sample of articles.

RESULTS

The searches returned a total of 377 articles. From these, six articles were included after application of eligibility criteria. These articles evaluated three PROMs: A-FORM, OMAS and AAOS. The A-FORM had evidence of a robust development process within the patient population, however lacks post-formulation testing. The OMAS showed sufficient levels of reliability, internal consistency and construct validity. The AAOS showed low quality evidence of sufficient construct validity.

CONCLUSIONS

There is insufficient evidence to support the recommendation of a particular PROM for use in adult ankle fracture research based on COSMIN methodology. Further validation of these outcome measures is required in order to ensure PROMs used in this area are sufficiently valid and reliable to assess treatment effects. This would enable high quality, evidenced-based management of adults with ankle fracture.

Primary outcome measures used in interventional trials for ankle fractures: a systematic review

Background

Ankle fractures cause considerable pain, loss of function and healthcare resource use. High quality randomised controlled trials are required to evaluate the optimal management protocols for ankle fracture. However, there is debate regarding the most appropriate outcome measure to use when assessing patients with ankle fractures. The aim of this systematic review is to identify and summarise primary outcome measure use in clinical trials of non-pharmacological interventions for adults with an ankle fracture.

Methods

We performed comprehensive searches of the Medline, Embase, CINAHL, AMED and Cochrane CENTRAL databases, as well as ISRCTN and ClinicalTrials.gov online clinical trial registries on 19/06/2019 with no date limits applied. The titles and abstracts were initially screened to identify randomised or quasi-randomised clinical trials of non-pharmacological interventions for ankle fracture in adults. Two authors independently screened the full text of any articles which could potentially be eligible. Descriptive statistics we used to summarise the outcome measures collected in these articles including an assessment of trends over time. Secondary analysis included a descriptive summary of the multi-item patient reported outcome measures used in this study type.

Results

The searches returned a total of 3380 records. Following application of the eligibility criteria, 121 records were eligible for inclusion in this review. The most frequently collected primary outcome measures in this type of publication was the Olerud Molander Ankle Score, followed by radiographic and range of movement assessments. There was a total of 28 different outcome measures collected and five different multi-item, patient reported outcome measures collected as the primary outcome measure. There was a sequential increase in the number of this type of study published per decade since the 1980’s.

Conclusion

This review demonstrates the wide range of measurement methods used to assess outcome in adults with an ankle fracture. Future research should focus on establishing the validity and reliability of the outcome measures used in this patient population. Formulation of a consensus based core outcome set for adults with an ankle fracture would be advantageous for ensuring homogeneity across studies in order to meta-analyse trial results.

Electronic supplementary material

The online version of this article (10.1186/s12891-019-2770-2) contains supplementary material, which is available to authorized users.

Locking plate fixation versus antegrade intramedullary nailing for the treatment of extra-articular distal femoral fractures

INTRODUCTION

The current study aimed to retrospectively analyze locked plating (LP) and antegrade intramedullary nailing (AIN) for the treatment of extra-articular distal femoral fractures.

PATIENTS AND METHODS

Between January 2000 and March 2015, 97 patients (49 male, 48 female) underwent surgery for extra-articular distal femoral fractures in our clinic. Patients were grouped based on their method of treatment (69 (71.1%) with locked plate (LP group) and 28 (28.9%) with antegrade intramedullary nailing (AIN group)), and the groups were analyzed with regards to fracture types, associated trauma, hospital stay, Injury Severity Score (ISS), nonunion, reoperation rate and Lysholm Functional Knee Score.

RESULTS

The LP and AIN groups had no significant differences with regards to age and gender. Sixteen patients (16.4%) experienced nonunion; all of these (5 (5.1%) in the AIN group and 11 (11.3%) in the LP group) required a secondary procedure (p = 0.773). ISS was significantly higher in the AIN group (p = 0.033). There were no significant differences between the two groups with regards to hardware failure, postoperative malreduction, reoperation rate, deep infection, and nonunion. However, the AIN group (mean 88) had a significantly higher Lysholm Functional Knee Score than the LP group (mean 75.9) (p = 0.019).

CONCLUSION

In our study we encountered less nonunion in AIN group. Both fixation methods offer good results; however, functional outcomes in the AIN group were significantly better than those in the LP group.