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Endo Y, Nwawka OK, Sneag DB. Iatrogenic "overshoot" nerve injuries: imaging features. Skeletal Radiol 2024; 53:1173-1181. [PMID: 38165469 DOI: 10.1007/s00256-023-04550-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Describe features of iatrogenic "overshoot" nerve injuries on ultrasound and MRI, which occur when an instrument passes through the bone and injures the nerve after it penetrates the opposite cortex. MATERIALS AND METHODS After a keyword search of the radiology database at a tertiary care orthopedic hospital from January 2016 to December 2022, those fulfilling the inclusion criteria of (1) instrumentation through the bone during surgery, (2) acute neuropathy immediately after surgery, (3) nerve injury confirmed on electrodiagnostics, and (4) imaging consistent with overshoot nerve injury were included. Imaging studies were retrospectively evaluated to determine primary and secondary signs of an overshoot nerve injury. RESULTS Six patients (3 females, mean age 26.7 (range 10-49) years) had nerve injury fitting the mechanism of injury: 3 injuries to the radial nerve during fixation of distal humerus fractures, 1 tibial nerve and 1 superficial peroneal nerve injury during fixation of tibial fractures, and 1 posterior interosseous nerve injury during biceps tendon repair. Ultrasounds were performed in all while 4 also had MRI. Secondary signs included (1) cortical defect adjacent to injured nerve (n=2); (2) scar extending from bone to injured nerve (n=2); (3) screw tip pointing to injured nerve (n=1, 4) tract in bone on MRI from previous instrumentation pointing to injured nerve (n=2). CONCLUSION In addition to primary signs such as laceration or neuroma, secondary signs of "overshoot" nerve injury include cortical defect, scar extending to nerve, screw tip pointing to nerve, and linear tract in the bone on MRI.
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Affiliation(s)
- Yoshimi Endo
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA.
| | - Ogonna K Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
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Ganesan V, Pandya R, Rodriguez AN, Horn AR, Abdelgawad AA, Razi AE. Comparison of patient demographics and patient-specific risk factors for readmissions following open reduction and internal fixation for acetabular fractures. Eur J Orthop Surg Traumatol 2024; 34:1911-1915. [PMID: 38459969 DOI: 10.1007/s00590-024-03862-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/16/2024] [Indexed: 03/11/2024]
Abstract
PURPOSE Acetabular fractures are highly complex injuries often resulting from high-energy trauma. The gold standard treatment for these injuries has become open reduction internal fixation (ORIF). The purpose of this study is to further this understanding and investigate how (1) patient demographics and (2) patient-specific risk factors affect 90-day readmission rates. METHODS A retrospective, nationwide query of private insurance database from January 1st, 2010 to October 31st, 2020 was performed using ICD-9, ICD-10, and CPT codes. Patients who underwent acetabular ORIF and were readmitted within 90 days following index procedure were included, patients who were not readmitted served as controls. Patients were divided by demographics and specific risk factors associated with readmission. RESULTS The query yielded a total of 3942 patients. Age and sex were found to be non-significant contributing risk factors to 90-day readmissions. Data also showed that statistically significant comorbidities included arrhythmia, cerebrovascular disease, coagulopathy, fluid and electrolyte abnormalities, and pathologic weight loss. CONCLUSION This study illustrated how several patient-specific risk factors may contribute to increased 90-day readmission risk following acetabular ORIF. A heightened awareness of these comorbidities in patients requiring acetabular ORIF is required to improve patient outcomes and minimize rates of readmission. Further investigation is needed to improve patient outcomes, and increase awareness of potential post-operative complications in these higher-risk patient populations.
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Affiliation(s)
- Vanathi Ganesan
- Department of Orthopedic Surgery, Maimonides Medical Center, 927 49th St., Brooklyn, NY, 11219, USA
- College of Medicine, State University of New York (SUNY) Downstate, Brooklyn, NY, USA
| | - Radha Pandya
- Department of Orthopedic Surgery, Maimonides Medical Center, 927 49th St., Brooklyn, NY, 11219, USA
- College of Medicine, State University of New York (SUNY) Downstate, Brooklyn, NY, USA
| | - Ariel N Rodriguez
- Department of Orthopedic Surgery, Maimonides Medical Center, 927 49th St., Brooklyn, NY, 11219, USA.
| | - Andrew R Horn
- Department of Orthopedic Surgery, Maimonides Medical Center, 927 49th St., Brooklyn, NY, 11219, USA
| | - Amr A Abdelgawad
- Department of Orthopedic Surgery, Maimonides Medical Center, 927 49th St., Brooklyn, NY, 11219, USA
| | - Afshin E Razi
- Department of Orthopedic Surgery, Maimonides Medical Center, 927 49th St., Brooklyn, NY, 11219, USA
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Abdel-Wahed M, Elmahdy Ismail M, Galal AA, Elsary AY, Abdel-Ghani H, Yasin E. Open versus closed reduction and internal fixation in children with femoral neck fractures. Systematic review and meta-analysis of the literature. J Orthop 2024; 51:157-162. [PMID: 38405127 PMCID: PMC10891281 DOI: 10.1016/j.jor.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 02/09/2024] [Indexed: 02/27/2024] Open
Abstract
Background Femoral neck fractures in children are uncommon, making up little more than 1% of all paediatric fractures. It's not apparent which type of internal fixation-closed or open-is preferable in these situations when it comes to therapeutic options. When treating children with displaced femoral neck fractures, serious problems can arise. Methods Five databases were examined: Medline Plus, PubMed, Scopus, Science Direct, and Web of Science. The outcomes that were relevant for the meta-analysis were non-union, coxa vara, and avascular necrosis. Using the RevMan file, we extracted the data and carried out the analysis (Review Manager Version 5.3). Results 294 patients had ORIF procedures and 266 patients had CRIF procedures in the included trials. Regarding the outcome of avascular necrosis, we discovered that there was no statistically significant difference between the two groups (RR = 0.84, [95% confidence range (CI) = 0.60, 1.18], P = 0.32). There was homogeneity in the data (P = 0.22, I2 = 27%). When it came to coxa vara, there was no statistically significant difference between the two groups (RR = 0.69, [95% CI = 0.30, 1.58], P = 0.38). There was homogeneity in the data (P = 0.22, I2 = 27%). Regarding non-union, the similar outcome was seen (RR = 0.45, [95% CI = 0.16, 1.14], P = 0.12). There was homogeneity in the data (P = 0.49, I2 = 0%). Conclusion Regarding reducing the risk of non-union, coxa vara, and avascular necrosis, we did not find any difference between CRIF and ORIF. To validate this outcome, however, additional research on the various variables (fracture type, age, displacement, fixation technique, and duration of surgery) is required. Sorting patients based on the kind of fracture will ensure that the right approach is used for each type.
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Affiliation(s)
- Mohamed Abdel-Wahed
- Department of Medicine Cairo University, Kasr A Ainy St, Cairo, 11562, Egypt
| | | | - Ahmed Amin Galal
- Department of Medicine Cairo University, Kasr A Ainy St, Cairo, 11562, Egypt
| | - Asmaa Younis Elsary
- Faculty of Medicine, Fayoum University, Gamma St., Keman Square, 63514, Fayoum, Egypt
| | - Hisham Abdel-Ghani
- Department of Medicine Cairo University, Kasr A Ainy St, Cairo, 11562, Egypt
| | - Ebeed Yasin
- Faculty of Medicine, Aswan University, Aswan, New Aswan City, 81528, Egypt
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Gallimore AT, Shihab Z, Platt S. Should We Fix the Fibula in Tibial Plafond Fractures? A Meta-analysis Reviewing the Evidence Base for Fibula Open Reduction and Internal Fixation in Tibial Plafond Fractures. J Foot Ankle Surg 2024; 63:414-419. [PMID: 38151112 DOI: 10.1053/j.jfas.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 12/06/2023] [Accepted: 12/20/2023] [Indexed: 12/29/2023]
Abstract
Open reduction and internal fixation are the standard of care to stabilize tibial plafond fractures. However, it remains uncertain as to whether fixation of the fibula affects the outcome. This study aimed to review the evidence base for comparable outcomes in tibial plafond fractures when undergoing open reduction and internal fixation of ipsilateral fibula fractures compared with open reduction and internal fixation of the tibia alone. A systematic review and meta-analysis of the literature was completed; 4 studies were included for analysis. This study demonstrated no statistically significant differences in the incidence of nonunion (p = .784) or mal-union (p = .416). There was a greater rate of removal of metalwork in the fibula operative group compared to the tibia alone group (p < .001). The current evidence demonstrates that open reduction and internal fixation of ipsilateral fibula fractures in tibial plafond fractures is not necessarily routinely indicated for all fractures.
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Affiliation(s)
- Arthur T Gallimore
- Department of Orthopaedic Surgery, Gold Coast University Hospital, Southport, Queensland, Australia.
| | - Zaid Shihab
- Department of Orthopaedic Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Simon Platt
- Department of Orthopaedic Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
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Ptak NA, Rigby RB, Douthett SM. Nonunion Rate Following Primary Arthrodesis for Acute Lisfranc Injuries. J Foot Ankle Surg 2024; 63:411-413. [PMID: 38346585 DOI: 10.1053/j.jfas.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/04/2023] [Accepted: 01/27/2024] [Indexed: 03/12/2024]
Abstract
Injury to the tarsometatarsal joint (TMT) results in instability throughout the midfoot that does not often improve with conservative management. If instability is identified, surgical intervention is frequently recommended, either open reduction and internal fixation (ORIF) or primary arthrodesis (PA). These 2 treatment options have been compared in the literature multiple times, often reporting similar outcomes. Due to this, as well as the need for subsequent hardware removal after ORIF has led many surgeons towards PA at the index surgery. Concern for nonunion is a leading concern with surgeons who advocate instead for ORIF. The purpose of this study is to review patients who underwent PA and observe nonunion rates. Nonunion at the TMT has been previously studied, but only in the chronic setting. We performed a retrospective study of 34 patients who had PA in the management of an acute Lisfranc injury. The average age in our study was 43.9 years old (range 19-72, SD 17.4) with an average follow-up of 9.4 months (range 4-33, SD 6.2). Radiographs were evaluated for signs of nonunion at regular postoperative intervals. Within the patients included in the study, a total of 71 TMT joints were fused. Overall successful fusion rate was 95.8% at an average of 7.9 weeks (range 6-12, SD 1.4) postoperatively. Individual nonunion rates at the first, second, and third TMT were 0%, 1.4% and 2.8% respectively. Our study demonstrates that primary arthrodesis provides a predictable outcome with low nonunion rates in the management of acute Lisfranc injury.
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Affiliation(s)
| | - Ryan B Rigby
- Logan Regional Orthopedics - Intermountain Healthcare, Logan, UT
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Flores Meca A, Ortiz Gallego Á. Treatment of supracondylar femoral fractures by minimally invasive techniques vs. exposure of the fracture site: A retrospective cohort study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00082-1. [PMID: 38677469 DOI: 10.1016/j.recot.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 04/15/2024] [Accepted: 04/21/2024] [Indexed: 04/29/2024] Open
Abstract
INTRODUCTION Fractures of the distal femoral third are an important cause of morbidity and mortality, and their treatment is currently controversial. OBJECTIVES To compare the results between minimally invasive techniques versus exposure of the fracture site. Secondly, to evaluate the relationship between demographic factors, mechanism of injury and surgical delay with patient prognosis. METHOD Retrospective cohort study carried out between 2015 and 2021 in a tertiary hospital. Data collection was performed by reviewing medical histories, measuring demographic and hospital parameters and definitive treatment strategy. One year of follow-up was completed in all patients, assessing the occurrence of surgical complications and mortality. A stratified analysis of the variables of interest was performed among patients over 65 years of age. RESULTS 128 fractures were recorded, with definitive osteosynthesis being performed in 117. Patients who underwent minimally invasive techniques required a shorter hospital stay (9 [7-12] vs. 12 [8.75-16] days) (p=0.007), with no differences in mortality or complications during follow-up. In those over 65 years of age, opening the fracture site was associated with an increased risk of infection compared to minimally invasive techniques (33.3% vs. 2%) (p=0.507). All the deceased were patients over 65 years of age (33.7% at one year). Surgical delay longer than 48hours increased mortality by 10% among those older than 65 years (p=0.3). High-energy trauma had a higher proportion of pseudarthrosis (27.6% vs. 6.1%) (p=0.011). CONCLUSIONS Minimally invasive techniques decreased hospital stay but not complications or long-term mortality. LEVEL OF EVIDENCE IIb.
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Affiliation(s)
- A Flores Meca
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen de las Nieves, Granada, España.
| | - Á Ortiz Gallego
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen de las Nieves, Granada, España
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Massari L, Saracco A, Marchesini S, Gambuti E, Delorenzi A, Caruso G. Safety of a Porous Hydroxyapatite Bone Substitute in Orthopedics and Traumatology: A Multi-Centric Clinical Study. J Funct Morphol Kinesiol 2024; 9:71. [PMID: 38651429 PMCID: PMC11036204 DOI: 10.3390/jfmk9020071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024] Open
Abstract
The development of biomaterials in recent years has made it possible to broaden their use in the surgical field. Although iliac crest bone graft harvesting currently remains the gold standard as an autograft, the properties of hydroxyapatite bone substitutes appear to be beneficial. The first fundamental step to consider is the safety of using these devices. The purpose of this retrospective cohort study is to consider all the adverse events observed in our population and assess their relationships with the bone substitute device. The population analyzed consisted of patients undergoing trauma osteosynthesis with at least one implanted porous hydroxyapatite device. We considered a court of 114 patients treated at "Azienda Ospedaliera Universitaria di Ferrara-U.O. di Ortopedia e Traumatologia" in the period from January 2015 to December 2022. Upon analyzing our population, no adverse events related to the device emerged. Taking into consideration different study groups from other National Hospital Centers, no critical issues were detected except for three cases of extrusion of the biomaterial. It is necessary to clarify that bone substitutes cannot replace compliance with the correct principles linked to the biomechanics of osteosynthesis. This report outlines a safety profile for the use of these devices as bone substitutes in trauma orthopedic surgery.
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Affiliation(s)
- Leo Massari
- Department of Translational Medicine and for Romagna, University of Ferrara, c/o “S. Anna”, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Achille Saracco
- Department of Neurosciences and Rehabilitation, University of Ferrara, c/o “S. Anna”, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Sebastiano Marchesini
- Department of Neurosciences and Rehabilitation, University of Ferrara, c/o “S. Anna”, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Edoardo Gambuti
- Department of Neurosciences and Rehabilitation, University of Ferrara, c/o “S. Anna”, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Alessandro Delorenzi
- Department of Neurosciences and Rehabilitation, University of Ferrara, c/o “S. Anna”, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Gaetano Caruso
- Department of Neurosciences and Rehabilitation, University of Ferrara, c/o “S. Anna”, Via Aldo Moro 8, 44124 Ferrara, Italy
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Lecoultre Y, Beeres FJP, Link BC, Pretz F, Tillmann F, Babst R, van de Wall BJM. Cement augmentation for proximal humerus fractures: a meta-analysis of randomized trials and observational studies. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02520-z. [PMID: 38589503 DOI: 10.1007/s00068-024-02520-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/30/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION It is unclear if elderly patients treated with plate osteosynthesis for proximal humerus fractures benefit from cement augmentation. This meta-analysis aims to compare cement augmentation to no augmentation regarding healing, complications, and functional results. METHODS PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched for randomized clinical trials and observational studies. Effect estimates were pooled across studies using random effects models. The primary outcome is overall complication rate. Stratified analyses were performed for types of complication (implant-related or systemic). Secondary outcomes include re-interventions, hospital stay, operation time, functional scores, and general quality of life. RESULTS Five observational studies and one randomized controlled trial with a total of 541 patients were included. The overall complication rate was significantly lower in the augmented group (15.6% versus 25.4%, OR 0.54 (95%CI 0.33-0.87)). This was caused by a reduction of implant-related complications (10.4% vs. 19.9%, OR 0.49 (95%CI 0.28, 0.88)). No difference in humeral head necrosis was found. Data on re-intervention, hospital stay, and operation time was limited but did not show significant differences. No impact on functional scores and general quality of life was detected. CONCLUSION This meta-analysis shows that cement augmentation may reduce overall complications, mainly by preventing implant-related complications. No difference was detected regarding need for re-intervention, functional scores, general quality of life, and hospital stay. This is the first meta-analysis on this topic. It remains to be seen whether conclusions will hold when more and better-quality data becomes available.
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Affiliation(s)
- Yannic Lecoultre
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
| | - Frank J P Beeres
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Björn C Link
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Fabian Pretz
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Franz Tillmann
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Reto Babst
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Bryan J M van de Wall
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Swenson R, Paull T, Moua G, Weatherby D, Azzam K, Wojahn R, Anderson S, Cole PA, Nguyen M. Does Transparency of Ankle Implant Costs Influence Surgeon Behavior? Foot Ankle Orthop 2024; 9:24730114241247826. [PMID: 38659719 PMCID: PMC11041529 DOI: 10.1177/24730114241247826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Background Ankle fractures are a common injury treated by orthopaedic surgeons. Unstable, displaced ankle fractures are often fixed with open reduction internal fixation (ORIF) using different implant constructs at various cost. No study to date has looked at transparency in ankle implant costs to surgeon behavior. Our surgeons self-identified that the biggest barrier for lowering implant cost was the lack of cost transparency. This was a surgeon-led-study to evaluate whether increased transparency in implant costs affected surgeon behavior. Methods Monthly operative logs from December 2021 to September 2022 were reviewed at our level 1 trauma center for operative fixation of ankle fractures. The cost data of each fixation construct was reported to trauma-trained surgeons at the end of each month from March 2022 to June 2022. Average costs of implants were compared before and after education. A linear mixed model was used to explore what factors were associated with changes in costs. Surgeons also participated in a poststudy survey. Results The implant costs of 110 ankle fracture fixations were reviewed over the period before education (n = 60), during education (n = 30), and after education (n = 20). The mean implant cost difference for unimalleolar fractures was -$204.80 (P = .68), whereas the mean cost difference for bimalleolar fractures was -$9.82 (P = .98). Trimalleolar fractures had a mean cost difference of +$94.47 (P = .84). Linear mixed model demonstrated fracture pattern as the only factor significantly associated with implant costs (P < .01). Post-education surgeon survey revealed that 6 of 7 surgeons felt that monthly updates affected their implant selection. However, only 2 surgeons demonstrated a change in practice with decreased implant costs during the study. Conclusion The majority of surgeons self-reported being influenced by the implant cost education, but the detected change in implant cost was only observed in less than one-third of surgeons. Our results suggest implant selection and related costs are not influenced by increased cost transparency education alone. Level of Evidence Level III, case control study.
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Affiliation(s)
| | - Thomas Paull
- University of Minnesota, Minneapolis, MN, USA
- Regions Hospital, Saint Paul, MN, USA
| | - Gaonhia Moua
- University of Minnesota, Minneapolis, MN, USA
- Regions Hospital, Saint Paul, MN, USA
| | - David Weatherby
- University of Minnesota, Minneapolis, MN, USA
- Regions Hospital, Saint Paul, MN, USA
| | - Khalid Azzam
- University of Minnesota, Minneapolis, MN, USA
- Regions Hospital, Saint Paul, MN, USA
| | - Robert Wojahn
- University of Minnesota, Minneapolis, MN, USA
- Regions Hospital, Saint Paul, MN, USA
| | - Sarah Anderson
- University of Minnesota, Minneapolis, MN, USA
- Regions Hospital, Saint Paul, MN, USA
| | - Peter A. Cole
- University of Minnesota, Minneapolis, MN, USA
- Regions Hospital, Saint Paul, MN, USA
| | - Mai Nguyen
- University of Minnesota, Minneapolis, MN, USA
- Regions Hospital, Saint Paul, MN, USA
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Matsumoto H, Tokushige S, Takei Y, Uyama Y, Mura M, Hitomi G. [The Need for Lens Radiation Protection for Healthcare Provider in Open and Internal Fixation of the Hip Joint]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2024; 80:287-295. [PMID: 38296460 DOI: 10.6009/jjrt.2024-1422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Increased occupational exposure of radiation workers is a major problem during open reduction and internal fixation (ORIF) of the hip joint, as the surgeon's eye lens is in close proximity to the patient and the X-ray tube. The purposes of this study were to clarify the occupational exposure of radiation workers during ORIF of the hip joint and to examine the need for radiation protection measures. The radiation exposure of radiation workers was evaluated by making an airborne dose distribution map using phantom experiments. The radiation goggles attached with a small optically stimulated luminescence dosimeter were used in clinical practice to measure the lens dose received by the surgeon, and the necessity of radiation goggles was examined. The airborne dose distribution in ORIF of the hip joint showed a wider area of high dose rate during axial fluoroscopy of the femoral neck than during posterior-anterior fluoroscopy. In axial fluoroscopy of the femoral neck, the surgeon was always in the high dose rate range of 10 µGy/min or higher, the nurses were in the dose rate range of 4 to 10 µGy/min, and the radiologic technologists were in the dose rate range of 0.5 µGy/min or lower. The maximum 3 mm dose equivalent to the surgeon per case was 0.38 mSv. In contradiction, radiation goggles were useful in ORIF because they provided approximately 60% shielding. It is advisable to work with radiation goggles to avoid cataracts.
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Affiliation(s)
- Hiroki Matsumoto
- Department of Radiological Technology, Kawasaki Medical School Hospital
| | - Shoya Tokushige
- Department of Radiological Technology, Kawasaki Medical School Hospital
| | - Yasutaka Takei
- Department of Radiological Technology, Kawasaki University of Medical Welfare
| | - Yuji Uyama
- Department of Radiological Technology, Kawasaki Medical School Hospital
| | - Masakatsu Mura
- Department of Radiological Technology, Kawasaki Medical School Hospital
| | - Go Hitomi
- Department of Radiological Technology, Kawasaki Medical School Hospital
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Ahmed Kamel S, Shepherd J, Al-Shahwani A, Abourisha E, Maduka D, Singh H. Postoperative mobilization after terrible triad injury: systematic review and single-arm meta-analysis. J Shoulder Elbow Surg 2024; 33:e116-e125. [PMID: 38036253 DOI: 10.1016/j.jse.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/30/2023] [Accepted: 10/18/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Terrible triad injury is a complex injury of the elbow, involving elbow dislocation with associated fracture of the radial head, avulsion or tear of the lateral ulnar collateral ligament, and fracture of the coronoid. These injuries are commonly managed surgically with fixation or replacement of the radial head and repair of the collateral ligaments with or without fixation of the coronoid. Postoperative mobilization is a significant factor that may affect patient outcomes; however, the optimal postoperative mobilization protocol is unclear. This study aimed to systematically review the available literature regarding postoperative rehabilitation of terrible triad injuries to aid clinical decision making. METHODS We systematically reviewed the PubMed, Embase, Cochrane, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The inclusion criteria were studies with populations aged ≥16 years with terrible triad injury in which operative treatment was performed, a clear postoperative mobilization protocol was defined, and the Mayo Elbow Performance Score (MEPS) was reported. Secondary outcomes were pain, instability, and range of motion (ROM). Postoperative mobilization was classified as either "early," defined as active ROM commencement before or up to 14 days, or "late," defined as active ROM commencement after 14 days. RESULTS A total of 119 articles were identified from the initial search, of which 11 (301 patients) were included in the final review. The most common protocols (6 studies) favored early mobilization, whereas 5 studies undertook late mobilization. Meta-regression analysis including mobilization as a covariate showed an estimated mean difference in the pooled mean MEPS between early and late mobilization of 6.1 (95% confidence interval, 0.2-12) with a higher pooled mean MEPS for early mobilization (MEPS, 91.2) than for late mobilization (MEPS, 85; P = .041). Rates of instability reported ranged from 4.5% to 19% (8%-11.5% for early mobilization and 4.5%-19% for late mobilization). CONCLUSION Our findings suggest that early postoperative mobilization may confer a benefit in terms of functional outcomes following surgical management of terrible triad injuries without appearing to confer an increased instability risk. Further research in the form of randomized controlled trials between early and late mobilization is advised to provide a higher level of evidence.
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Affiliation(s)
- Sherif Ahmed Kamel
- University Hospitals of Leicester NHS Trust, Leicester, UK; Ain Shams University, Cairo, Egypt.
| | - Jenna Shepherd
- University Hospitals of Leicester NHS Trust, Leicester, UK; University of Leicester, Leicester, UK; Integrated Academic Clinical Training Pathway, Academic Foundation Programme, National Institute for Health and Care Research, UK
| | | | | | | | - Harvinder Singh
- University Hospitals of Leicester NHS Trust, Leicester, UK; University of Leicester, Leicester, UK
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Ibaseta A, Emara A, Rullán PJ, Santana DC, Ng MK, Grits D, Krebs VE, Molloy RM, Piuzzi NS. Effect of operative time in outcomes following surgical fixation of hip fractures: a multivariable regression analysis of 35,710 patients. Hip Int 2024; 34:270-280. [PMID: 37795582 DOI: 10.1177/11207000231203527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND Prolonged operative time is a risk factor for increased morbidity and mortality after open reduction and internal fixation (ORIF) of hip fractures. However, the quantitative nature of such association, including graduated risk levels, has yet to be described. This study outlines the graduated associations between operative time and (1) healthcare utilisation, and (2) 30-day complications after ORIF of hip fractures. METHODS The National Surgical Quality Improvement Program (NSQIP) database was queried (January 2016-December 2019) for all patients who underwent ORIF of hip fractures (n = 35,710). Demographics, operative time, fracture type, and comorbidities were recorded. Outcomes included healthcare utilisation (e.g., prolonged length of stay [LOS>2 days], discharge disposition, 30-day readmission, and reoperation), inability to weight-bear (ITWB) on postoperative day-1 (POD-1), and any 30-day complication. Adjusted multivariate regression models evaluated associations between operative time and measured outcomes. RESULTS Operative time <40 minutes was associated with lower odds of prolonged LOS (odds ratio [OR] 0.77), non-home discharge (OR 0.85), 30-day readmission (OR 0.85), and reoperation (OR 0.72). Operative time ⩾80 minutes was associated with higher odds of ITWB on POD-1 (OR 1.17). Operative time ⩾200 minutes was associated with higher odds of deep infection (OR 7.5) and wound complications (OR 3.2). The odds of blood transfusions were higher in cases ⩾60 minutes (OR1.3) and 5-fold in cases ⩾200 minutes (OR 5.4). The odds of venous thromboembolic complications were highest in the ⩾200-minute operative time category (OR 2.5). Operative time was not associated with mechanical ventilation, pneumonia, delirium, sepsis, urinary tract infection, or 30-day mortality. DISCUSSION Increasing operative time is associated with a progressive increase in the odds of adverse outcomes following hip fracture ORIF. While a direct cause-effect relationship cannot be established, an operative time of <60 minutes could be protective. Perioperative interventions that shorten operative time without compromising fracture reduction or fixation should be considered.
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Affiliation(s)
- Alvaro Ibaseta
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Ahmed Emara
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Pedro J Rullán
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Daniel C Santana
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Mitchell K Ng
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Daniel Grits
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Viktor E Krebs
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Robert M Molloy
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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Davey MS, O'Sullivan D, McCabe FJ, McQuail P, Kearns SR. The Use of Dorsal Bridge Plate Fixation in the Operative Management of Lisfranc Injuries - A Retrospective Cohort Study at Medium Term Follow-Up. Foot (Edinb) 2024; 58:102061. [PMID: 38064802 DOI: 10.1016/j.foot.2023.102061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/30/2023] [Accepted: 10/29/2023] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Traditionally, early surgical management of Lisfranc injuries with transarticular screws (TAS) was deemed to be the optimal treatment. However, concerns of potential iatrogenic articular cartilage disruption has led to discrepancies in opinion amongst surgeons, with many surgeons now utilizing dorsal bridge plates (DBP) for ORIF of Lisfranc injuries. OBJECTIVES This study sought to investigate the clinical outcomes at medium-term follow-up of consecutive patients in our institution who underwent ORIF with DBP for Lisfranc injuries. METHODS All consecutive patients who underwent ORIF with DBPs for Lisfranc injuries were identified. Outcomes of interest included; visual analogue scale (VAS), functional foot index (FFI), American Orthopaedic Foot & Ankle Surgeons (AOFAS) hindfoot scores, and complications. RESULTS Overall, 37 consecutive patients (24 males) with a mean age of 34.8 ± 13.0 years underwent ORIF with DBPs for lisfranc injuries. After a mean 48.3 ± 28.7 months, the mean reported AOFAS and FFI scores were 77.4 ± 23.8 and 31.9 ± 32.7 respectively, with satisfactory reported pain scores as measured by VAS post-operatively at rest and whilst walking (2.2 ± 2.5 and 3.1 ± 2.6 respectively). The reported satisfaction rate was 86.5% (32/37). Overall, 25 patients (67.6%) had subsequent removal of metal or were listed for same, 88% (22/25) of whom did so electively in the absence of broken screws or infection. CONCLUSION This study found that the use of Dorsal Bridge Plates for Open Reduction and Internal Fixation of Lisfranc Injuries resulted in satisfactory functional outcomes, high rates of patient-reported satisfaction and a low complication rate at medium-term follow-up. LEVEL OF EVIDENCE Level IV; Retrospective Series of Consecutive Patients.
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Affiliation(s)
- Martin S Davey
- Galway University Hospitals, Galway, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - David O'Sullivan
- Galway University Hospitals, Galway, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fergus J McCabe
- Galway University Hospitals, Galway, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Paula McQuail
- Galway University Hospitals, Galway, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Stephen R Kearns
- Galway University Hospitals, Galway, Ireland; University of Galway, Galway, Ireland
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Duey AH, Stern BZ, Zubizarreta N, Galatz LM, Parsons BO, Poeran J, Cagle PJ. Surgical Treatment of Displaced Proximal Humerus Fractures Is Associated With Decreased 1-Year Mortality in Patients Aged 65 and Older: A Retrospective Study of Medicare Patients. J Shoulder Elbow Surg 2024:S1058-2746(24)00154-X. [PMID: 38430980 DOI: 10.1016/j.jse.2024.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/01/2024] [Accepted: 01/18/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Proximal humerus fracture (PHF) is a risk factor for 1-year mortality. This study aimed to determine if surgery is associated with lower mortality compared to nonoperative treatment following PHF in older patients. METHODS This retrospective cohort study used the Medicare Limited Data Set. Patients aged 65+ with a PHF diagnosis in 2017-2020 were included. Treatment was classified as nonoperative, open reduction internal fixation (ORIF), total shoulder arthroplasty (TSA), or hemiarthroplasty. Multivariable logistic regression models examined (a) predictors of treatment type and (b) the association of treatment type with 1-year mortality, adjusting for patient demographics, comorbidities, frailty, and fracture severity among other variables. A subgroup analysis examined how the relationship between treatment type and 1-year mortality varied based on fracture severity. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) are reported. RESULTS In total, 49,072 patients were included (mean age = 76.6 years, 82.3% female). Most were treated nonoperatively (77.5%), 10.9% underwent ORIF, 10.6% underwent TSA, and 1.0% underwent hemiarthroplasty. Examples of factors associated with receipt of operative (versus nonoperative treatment) included worse fracture severity and lower frailty. The 1-year mortality rate after the initial PHF diagnosis was 11.0% for the nonoperative group, 4.0% for ORIF, 5.2% for TSA, and 6.0% for hemiarthroplasty. Compared to nonoperative treatment, ORIF (aOR 0.55; 95% CI [0.47, 0.64]; P<.001) and TSA (aOR 0.59; 95% CI [0.50, 0.68]; P<.001) were associated with decreased odds of 1-year mortality. In the subgroup analysis, ORIF and TSA were associated with a lower 1-year mortality risk for 2-part and 3-/4-part fractures. CONCLUSIONS Compared to nonoperative treatment, surgery (particularly TSA and ORIF) was associated with a decreased odds of 1-year mortality. This relationship remained significant for 2-part and 3-/4-part fractures after stratifying by fracture severity.
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Affiliation(s)
- Akiro H Duey
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brocha Z Stern
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nicole Zubizarreta
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Leesa M Galatz
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bradford O Parsons
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jashvant Poeran
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul J Cagle
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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15
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Okulski J, Kozakiewicz M, Krasowski M, Zieliński R, Szymor P. Optimal Plate Choice for High-Neck Mandibular Condyle Fracture: A Mechanistic Analysis of 16 Options. J Clin Med 2024; 13:905. [PMID: 38337599 PMCID: PMC10856367 DOI: 10.3390/jcm13030905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: Mandibular fractures are common, with the condylar process being a frequent site of injury, accounting for 25-45% of cases. This research aims to assess the mechanical suitability of various plates for high-neck condyle fractures. (2) Methods: Polyurethane models mimicking high-neck condyle fractures were utilized in this study. Sixteen distinct plate designs, constructed from titanium sheets, were tested. The figures underwent force assessments on a durability testing apparatus, and the relationship between used force and fracture movement was documented. (3) Results: For high-neck breaking, the two straight plates emerged as the most effective, aligning with established osteosynthesis standards. The second-best plate exhibited nearly half the strength of the gold standard. (4) Conclusions: In response to the aim of this study, considering the mechanical aspects, the double plain plate stands out as the optimal choice for osteosynthesis in cases of high-neck fractures of the mandibular condylar process. In addition, the authors propose the Mechanical Excellence Factor (MEF) as a superior metric for appraising a plate's mechanical force, surpassing the conventional Plate Design Factor (PDF).
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Affiliation(s)
- Jakub Okulski
- Department of Maxillofacial Surgery, Medical University of Lodz, 113 Żeromskiego Str., 90-549 Lodz, Poland; (J.O.); (M.K.); (R.Z.)
| | - Marcin Kozakiewicz
- Department of Maxillofacial Surgery, Medical University of Lodz, 113 Żeromskiego Str., 90-549 Lodz, Poland; (J.O.); (M.K.); (R.Z.)
| | - Michał Krasowski
- Material Science Laboratory, Medical University of Lodz, 251 Pomorska Str., 92-213 Lodz, Poland;
| | - Rafał Zieliński
- Department of Maxillofacial Surgery, Medical University of Lodz, 113 Żeromskiego Str., 90-549 Lodz, Poland; (J.O.); (M.K.); (R.Z.)
| | - Piotr Szymor
- Department of Maxillofacial Surgery, Medical University of Lodz, 113 Żeromskiego Str., 90-549 Lodz, Poland; (J.O.); (M.K.); (R.Z.)
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Papalia AG, Romeo PV, Kingery MT, Alben MG, Lin CC, Simcox TG, Zuckerman JD, Virk MS. Trends in the treatment of proximal humerus fractures from 2010 to 2020. J Shoulder Elbow Surg 2024; 33:e49-e57. [PMID: 37659703 DOI: 10.1016/j.jse.2023.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/24/2023] [Accepted: 07/29/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND The incidence of proximal humerus fractures (PHF) is continuing to rise due to shifts towards a more aged population as well as advancements in surgical treatment options. The purpose of this study is to examine and compare trends in the treatment of PHFs (nonoperative vs. operative; different surgical treatments) across different age groups over the last decade (2010-2020). METHODS The New York Statewide Planning and Research Cooperative System (SPARCS) database was queried using International Classification of Diseases and Current Procedural Terminology codes to identify all patients presenting with or undergoing surgery for PHF between 2010 and 2020. Treatment trends, demographics, and insurance information were analyzed during the study period. Comparisons were made between operative and nonoperative trends with respect to the number and type of surgeries performed among 3 age groups: ≤49 years, 50-64 years, and ≥65 years. The rate of postoperative complications and reoperations was evaluated and compared among different surgical treatments for patients with a minimum 1-year postoperative follow-up. RESULTS A total of 92,308 patients with a mean age of 67.8 ± 16.8 years were included. Over the last decade, there was no significant increase in the percentage of PHFs treated with surgery. A total of 15,523 PHFs (16.82%) were treated operatively, and these patients, compared with the nonoperative cohort, were younger (64.9 years vs. 68.4 years, P < .001), more likely to be White (80.2% vs. 74.7%, P < .001), and more likely to have private insurance (41.4% vs. 32.0%, P < .001). For patients ≤49 years old, trends in operative treatment have remained stable with internal fixation (IF) as the most used surgical modality. For patients 50-64 years old, we observed a gradual decline in the use of hemiarthroplasty (HA), with a corresponding increase in the use of reverse total shoulder arthroplasty (rTSA), but IF continued to be the most used operative modality. In patients over 65 years, a steep decline in the use of IF and HA was noted during the first half of the decade along with a significant exponential increase in the use of rTSA, which surpassed the use of IF in 2019. Despite the increase in the use of rTSA, no differences in rate of surgical complications were noted between rTSA and IF (χ2 = 0.245, P = .621) or reoperations (χ2 = 0.112, P = .730). CONCLUSION Nonsurgical treatment remains the mainstay treatment of PHFs. Although there is no increase in the prevalence of operative treatment in patients ≥50 years in the last decade, there is an exponential increase in the use of rTSA with a corresponding decrease in HA and IF, a trend more substantial in patients ≥65 years compared with patients between 50 and 64 years.
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Affiliation(s)
- Aidan G Papalia
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Paul V Romeo
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Matthew T Kingery
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Matthew G Alben
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Charles C Lin
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Trevor G Simcox
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Joseph D Zuckerman
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Mandeep S Virk
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA.
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Fahy E, Carr R, Moore E, Min A, Harrington CI, Murphy C, Ekanayake K, Kearns G. Mandibular angle fractures: a demographic review, with particular reference to post-operative complications. Ir J Med Sci 2024; 193:533-537. [PMID: 37462894 DOI: 10.1007/s11845-023-03433-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/15/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Mandibular angle fractures (MAF) have a recognized complexity of treatment and an increased risk of incurring complications. METHODS This retrospective study included 45 consecutive patients who were diagnosed with an isolated MAF and no other facial fractures. The average age was 27.3 (SD = 7.7). RESULTS A comparatively low rate of complications (11.1%) and a low rate of reoperation (1.8%) are reported, along with a significant role of smoking in complications (p = 0.022). A non-significant association was noted between complications, male gender and assault as an aetiological factor. CONCLUSIONS Review of the data from this study confirms that complication rates for patients attending the National Maxillofacial Unit are similar to or better than that of international studies. An overview of the aetiology of fracture complications is included.
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Affiliation(s)
- Edward Fahy
- National Maxillofacial Unit, St James Hospital Dublin, Dublin, Ireland.
| | - Richard Carr
- National Maxillofacial Unit, St James Hospital Dublin, Dublin, Ireland
| | - Emma Moore
- National Maxillofacial Unit, St James Hospital Dublin, Dublin, Ireland
| | - Arimie Min
- National Maxillofacial Unit, St James Hospital Dublin, Dublin, Ireland
| | | | - Colm Murphy
- National Maxillofacial Unit, St James Hospital Dublin, Dublin, Ireland
| | - Kumara Ekanayake
- National Maxillofacial Unit, St James Hospital Dublin, Dublin, Ireland
| | - Gerry Kearns
- National Maxillofacial Unit, St James Hospital Dublin, Dublin, Ireland
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Putra DP, Mustamsir E, Phatama KY, Pradana AS, Pratama YA. The effectiveness ORIF for neglected periprosthetic femoral fractures after hemiarthroplasty: A case report. Int J Surg Case Rep 2024; 115:109285. [PMID: 38266366 PMCID: PMC10832499 DOI: 10.1016/j.ijscr.2024.109285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Periprosthetic fractures are a growing concern due to the increasing frequency of primary joint replacement surgery, with total hip arthroplasty being the most common. The incidence of periprosthetic fractures after revision surgery ranges from 4 to 11 %, with up to 30 % reported after knee revision surgery. This case report aims to describe the treatment of an 81-year-old woman suffering from neglected periprosthetic femoral fracture post hemiarthroplasty. CASE PRESENTATION An 81-year-old woman with a history of hemiarthroplasty surgery and hypertension was admitted to the ER with pain in her right thigh. She had a middle shaft femoral fracture and was scheduled for open reduction and internal fixation. Despite being fully conscious and having an average pulse rate and blood pressure, she had cardiomegaly and congestive pulmonum. Unfortunately, this patient did not receive appropriate medical treatment after it occurred for 1 month. After surgery, we evaluated the implant, and the implant stabilized the fracture. After 1-3 months after surgery, the LEFS (The Lower Extremity Functional Scale) score was found that the score increase significantly after surgery. CLINICAL DISCUSSION The Vancouver classification system manages periprosthetic fractures by assessing location, stability, and bone quality. Type A fractures involve the trochanter, while type B fractures are diaphyseal and can extend distally. ORIF is used for subtype B1 fractures, but newer techniques offer shorter operating times and fewer complications. CONCLUSION From this study, we can conclude that even though neglected cases procedure with ORIF promises a good outcome based on clinical evaluation.
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Affiliation(s)
- Domy Pradana Putra
- Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya - Saiful Anwar General Hospital, Malang, East Java, Indonesia.
| | - Edi Mustamsir
- Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya - Saiful Anwar General Hospital, Malang, East Java, Indonesia
| | - Krisna Yuarno Phatama
- Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya - Saiful Anwar General Hospital, Malang, East Java, Indonesia
| | - Ananto Satya Pradana
- Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya - Saiful Anwar General Hospital, Malang, East Java, Indonesia
| | - Yudit Alfa Pratama
- Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya - Saiful Anwar General Hospital, Malang, East Java, Indonesia
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Helmstetter T, Maniglio M, Fornaciari P, Tannast M, Vial P. Open reduction and internal fixation of modified Mason type III/IV radial head fractures with more than three fragments: an analysis of the clinical outcome and reoperation rate. Eur J Orthop Surg Traumatol 2024; 34:1121-1130. [PMID: 37962633 PMCID: PMC10858131 DOI: 10.1007/s00590-023-03772-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE It is generally accepted that a radial head fracture (RHF) with more than three parts is not suitable for repair; therefore, most authors suggest straightforward radial head arthroplasty (RHA). With up to 20% risk for reoperation after RHA, improvement in reduction and fixation techniques may represent a valuable alternative before further extending the indications for arthroplasty. To determine the functional results and radiological failure rate after osteosynthesis of multi-fragmentary RHF with more than three articular fragments. We specifically determined (1) the one-year Broberg and Morrey functional elbow score, (2) duration of fracture healing, (3) complication rate, and (4) number of patients converted to RHA. METHODS This study is a retrospective single-center case series. All patients who underwent primary osteosynthesis for RHF between 2012 and 2019 were included. Nine patients with an average age of 52 years had an average clinical and/or radiological follow-up of 49 months. RESULTS The preoperative imaging identified nine fractures with four fragments. Three patients underwent osteosynthesis with plates and screws, whereas six patients underwent osteosynthesis with only screws. The mean Broberg and Morrey score was 95 points. Overall, eight of the nine patients had satisfactory results. All patients retained their radial heads and showed radiological fracture healing. Only two patients presented with low-grade complications requiring no further surgery. CONCLUSION Our study showed that osteosynthesis of RHF with up to four fragments can achieve good functional results with a low complication rate and seems to be a valid alternative to RHA.
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Affiliation(s)
- Timothée Helmstetter
- University of Fribourg Medical School, Chemin du Musée, 1700, Fribourg, Switzerland.
- Department of Orthopedics and Traumatology, Fribourg Cantonal Hospital, Chemin des Pensionnats 2-6, 1752, Villars-sur-Glâne, Switzerland.
| | - Mauro Maniglio
- University of Fribourg Medical School, Chemin du Musée, 1700, Fribourg, Switzerland
- Department of Orthopedics and Traumatology, Fribourg Cantonal Hospital, Chemin des Pensionnats 2-6, 1752, Villars-sur-Glâne, Switzerland
| | - Paolo Fornaciari
- University of Fribourg Medical School, Chemin du Musée, 1700, Fribourg, Switzerland
- Department of Orthopedics and Traumatology, Fribourg Cantonal Hospital, Chemin des Pensionnats 2-6, 1752, Villars-sur-Glâne, Switzerland
| | - Moritz Tannast
- University of Fribourg Medical School, Chemin du Musée, 1700, Fribourg, Switzerland
- Department of Orthopedics and Traumatology, Fribourg Cantonal Hospital, Chemin des Pensionnats 2-6, 1752, Villars-sur-Glâne, Switzerland
| | - Philippe Vial
- University of Fribourg Medical School, Chemin du Musée, 1700, Fribourg, Switzerland
- Department of Orthopedics and Traumatology, Fribourg Cantonal Hospital, Chemin des Pensionnats 2-6, 1752, Villars-sur-Glâne, Switzerland
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Baboeram NSVL, Sanders FRK, Wellenberg RHH, Dobbe JGG, Streekstra GJ, Maas M, Schepers T. Primary arthrodesis versus open reduction and internal fixation following intra-articular calcaneal fractures: a weight-bearing CT analysis. Arch Orthop Trauma Surg 2024; 144:755-762. [PMID: 38129717 DOI: 10.1007/s00402-023-05120-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/29/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE To compare primary arthrodesis (PA) versus open reduction and internal fixation (ORIF) in displaced intra-articular calcaneal fractures (DIACFs), based on clinical outcome and 2D and 3D geometrical analyses obtained from weight-bearing (WB) cone-beam CT images. MATERIALS AND METHODS In this prospective study, 40 patients with surgically treated calcaneal fractures were included, consisting of 20 PA and 20 ORIF patients. Weight-bearing cone-beam CT-images of the left and right hindfoot and forefoot were acquired on a Planmed Verity cone-beam CT-scanner after a minimum of 1-year follow-up. Automated 2D and 3D geometric analyses, i.e., (minimal and average) talo-navicular joint space, calcaneal pitch (CP), and Meary's angle (MA), were obtained for injured and healthy feet. Clinical outcomes were measured using the EQ5D and FFI questionnaires. RESULTS Overall, there were no differences in baseline patient characteristics apart from age (p < 0.005). The calcaneal pitch in 2D after treatment by ORIF (13.8° ± 5.6) was closer to the uninjured side (18.1° ± 5.5) compared to PA (10.9° ± 4.5) (p < 0.001). Meary's angle in 2D was closer to the uninjured side (8.7° ± 6.3) after surgery in the PA cohort (7.0° ± 5.8) compared to the ORIF cohort (15.5° ± 5.9) (p = 0.046). In 3D measurements, CP was significantly decreased for both cohorts after surgery (- 4.09° ± 6.2) (p = 0.001). MA was not significantly affected overall or between cohorts in 3D. Clinical outcomes were not significantly different between the ORIF and PA cohorts. None of the radiographic measurements in 2D or 3D correlated with any of the clinical outcomes studied. CONCLUSION Three-dimensional WB CT imaging enables functional 2D and 3D analyses under natural load in patients with complex calcaneal fractures. Based on clinical outcome, both PA and ORIF appear viable treatment options. Clinical correlation with geometrical outcomes remains to be established.
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Affiliation(s)
- N S V L Baboeram
- Department of Trauma Surgery, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands.
- Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
| | - F R K Sanders
- Department of Trauma Surgery, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - R H H Wellenberg
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - J G G Dobbe
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - G J Streekstra
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - M Maas
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - T Schepers
- Department of Trauma Surgery, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Dekhne MS, Stenquist D, Suneja N, Weaver MJ, Petersen MM, Singh UM, Von Keudell A. Optimizing Outcomes after Operative Treatment Bicondylar Tibial Plateau Fractures - Time for Innovation? Arch Bone Jt Surg 2024; 12:80-91. [PMID: 38420520 PMCID: PMC10898803 DOI: 10.22038/abjs.2023.72836.3378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/30/2023] [Indexed: 03/02/2024]
Abstract
Bicondylar tibial plateau fractures are technically demanding fractures that have a high complication rate. We sought to review the recent literature with the aim to summarize the development of new classification systems that may enhance the surgeon's understanding of the fracture pattern and injury. We highlight the best methods for infection control and touch on new innovative solutions using 3D printer models and augmented mixed reality to provide potentially personalized solutions for each specific fracture configuration.
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Affiliation(s)
- Mihir S. Dekhne
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard Orthopedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts, USA
| | - Derek Stenquist
- Harvard Orthopedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts, USA
| | - Nishant Suneja
- Harvard Orthopedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael J. Weaver
- Harvard Orthopedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Moerk Petersen
- Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Upender Martin Singh
- Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Arvind Von Keudell
- Harvard Orthopedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
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22
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Factor S, Druckmann I, Kazum E, Atlan F, Tordjman D, Rosenblatt Y, Eisenberg G, Pritsch T. A novel pulsed electromagnetic field device as an adjunct therapy to surgical treatment of distal radius fractures: a prospective, double-blind, sham-controlled, randomized pilot study. Arch Orthop Trauma Surg 2024; 144:543-550. [PMID: 37971511 DOI: 10.1007/s00402-023-05117-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION The purpose of this study is to evaluate whether using a Fracture Healing Patch (FHP) device that generates pulsed electromagnetic fields (PEMF), applied at the fracture site immediately after open reduction and internal fixation surgery, can accelerate healing of acute distal radius fractures. METHODS In a prospective, double-blind, randomized, and sham-controlled study, thirty-two patients with DRFs treated with ORIF were included. Patients were allocated to a PEMF (active) group (n = 15) or a control (sham) group (n = 17). All patients were assessed with regard to functional Patient-Rated Wrist Evaluation (PRWE), SF12, and radiological union outcomes (X-rays and computed tomography (CT) scans) at 2, 4, 6, and 12 weeks postoperatively. RESULTS Patients treated with the FHP demonstrated significantly bone bridging at 4 weeks as assessed by CT (70% vs 54%, p = 0.05). Mean grip strength in the active group was significantly higher as compared to control (16 ± 9 kg vs 7 ± 3.5 kg, respectively, p = 0. 02). The function subscale of the PRWE was significantly better in PEMF-treated group at 6 weeks after surgery (27.2 VS 35.5, p = 0.04). No statistically significant differences were found in SF12. CONCLUSION PEMF application after ORIF of DRFs is safe, may accelerate bone healing which could lead to an earlier return to daily life activities and work. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Shai Factor
- Hand Surgery Unit, Division of Orthopedic Surgery, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel.
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ido Druckmann
- Division of Radiology, Tel Aviv Medical Center, 6 Weitzman St., 6423906, Tel Aviv, Israel
| | - Efi Kazum
- Hand Surgery Unit, Division of Orthopedic Surgery, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Franck Atlan
- Hand Surgery Unit, Division of Orthopedic Surgery, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Tordjman
- Hand Surgery Unit, Division of Orthopedic Surgery, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yishai Rosenblatt
- Hand Surgery Unit, Division of Orthopedic Surgery, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilad Eisenberg
- Hand Surgery Unit, Division of Orthopedic Surgery, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamir Pritsch
- Hand Surgery Unit, Division of Orthopedic Surgery, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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23
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Mallory N, Gibbs D, Belmonte A, Mallory TH, Santiago-Torres J. Utility of prophylactic closed suction drainage in open reduction and internal fixation for tibial plateau fracture. Eur J Orthop Surg Traumatol 2024; 34:271-277. [PMID: 37452136 DOI: 10.1007/s00590-023-03581-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/10/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE The usefulness of closed suction drains (CSD) after open reduction and internal fixation (ORIF) of tibial plateau fractures is a contested topic. The purpose of this study was to examine the impact of CSD in postoperative outcomes after tibial plateau fracture. METHODS Data were retrospectively collected from patients who underwent primary repair of closed tibial plateau fractures via an anterolateral approach between June 2021 to May 2022 at a single academic center. Fifty-six patients were included and 28 received CSDs at time of surgery. P values less than 0.05 were considered significant. RESULTS Fifty-six patients were included. There was no significant difference in demographics, pre- and post-op hemoglobin, estimated blood loss during surgery, length of stay, postoperative MMEs and pain at 3 month follow-up, deep vein thrombosis (DVT), compartment syndrome, flexion contracture, use of incisional vac, infection rate, wound drainage, hematoma, neurologic pain, dehiscence, additional surgery, or range of motion at 3 months follow-up. We noted a significant difference in Defense and Veterans Pain Rating Scale (DVPRS) on POD1, demonstrating greater pain in those in the CSD group. CONCLUSION Our findings suggest that the use of CSD in ORIF of tibial plateau fractures may not be of significant prophylactic benefit. CSDs in ORIF patients were associated with increased early postoperative pain and had no identifiable benefits. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Noah Mallory
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, 241 W 11th Ave, Suite 6065L, OH, 43201, Columbus, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - David Gibbs
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, 241 W 11th Ave, Suite 6065L, OH, 43201, Columbus, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Anthony Belmonte
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, 241 W 11th Ave, Suite 6065L, OH, 43201, Columbus, USA
| | - Thomas H Mallory
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Juan Santiago-Torres
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, 241 W 11th Ave, Suite 6065L, OH, 43201, Columbus, USA.
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Kalhor A. Scapular spine fracture, presentation of two cases and novel surgical treatment. JSES Int 2024; 8:1-5. [PMID: 38312276 PMCID: PMC10837727 DOI: 10.1016/j.jseint.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Affiliation(s)
- Ali Kalhor
- Mater public and private hospital Brisbane, QLD, Australia
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25
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Sherman N, Hill B, Nisbet B, Knox A, Mahoney A. Bilateral atraumatic acromial base fractures following reverse shoulder arthroplasty managed with open reduction and internal fixation: a case report. JSES Int 2024; 8:95-98. [PMID: 38312292 PMCID: PMC10837714 DOI: 10.1016/j.jseint.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Affiliation(s)
- Nathan Sherman
- Department of Orthopedic Surgery, University of Arizona, Tucson, AZ, USA
| | - Brogan Hill
- College of Osteopathic Medicine, Touro University Nevada, Henderson, NV, USA
| | - Bryn Nisbet
- Department of Orthopedic Surgery, University of Arizona, Tucson, AZ, USA
| | - Andrew Knox
- Tucson Orthopaedic Institute, Tucson, AZ, USA
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26
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Leow J, Exley R, Holmes S, Bhatti N. How good is good enough? Lessons learned from review of outcomes of 50 patients following extraoral open reduction and internal fixation of condylar neck and base fractures at a regional major trauma centre. Br J Oral Maxillofac Surg 2024; 62:83-88. [PMID: 38101970 DOI: 10.1016/j.bjoms.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/08/2023] [Indexed: 12/17/2023]
Abstract
The management of mandibular fractures is routine owing to their frequency, particularly those of the mandibular condyle, which are invariably common. Notwithstanding disparities in the literature, the international consensus towards which fractures of the mandibular condyle benefit from open surgical intervention is almost universally accepted. Closed reduction or non-operative management may be utilised in certain circumstances. Whilst outcome research has addressed complications with respect to operative side effects, outcomes related to the quality of bone repair and the setting in which this is delivered have not been universally addressed. The aim of this study was to determine the predictability of translating an indicated operative treatment plan into an acceptable functional result. We evaluated the outcomes of 59 extracapsular condylar fractures in 50 patients who were treated by extraoral open reduction and internal fixation (ORIF) between March 2021 and August 2022. We reviewed demographic data, surgical approach, and plating strategy, and critically evaluated the clinical and radiological outcomes. Whilst we found that the quality of reduction was not universally perfect, the majority were within tolerance, which we set according to the Strasbourg Osteosynthesis Research Group (SORG) definition for minimal displacement (<2 mm overlap and 10° angulation). The cohort had good functional occlusion and minimal long-term postoperative complications. Two patients required re-operation for non-union, and we discuss causality in these cases. In conclusion, we found that ORIF of condylar neck and base fractures is predictable in real-time surgical practice with respect to functional outcome. However, if imperfectly reduced, there is a small risk of non-union.
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Affiliation(s)
- Julian Leow
- Department of Oral and Maxillofacial Surgery, Royal London Hospital, London E1 1BB, United Kingdom.
| | - Rebecca Exley
- Department of Oral and Maxillofacial Surgery, Royal London Hospital, London E1 1BB, United Kingdom
| | - Simon Holmes
- Department of Oral and Maxillofacial Surgery, Royal London Hospital, London E1 1BB, United Kingdom
| | - Nabeel Bhatti
- Department of Oral and Maxillofacial Surgery, Royal London Hospital, London E1 1BB, United Kingdom
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27
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Sobel AD, Shah KN, Raducha J, Koeller E, Ibrahim LI, Paxton S. Failure of humeral shaft fixation: construct characteristics. Eur J Orthop Surg Traumatol 2023; 33:3637-3641. [PMID: 37268871 DOI: 10.1007/s00590-023-03587-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/10/2023] [Indexed: 06/04/2023]
Abstract
PURPOSE Fixation failure following open reduction and internal fixation (ORIF) of humeral shaft fractures can be a challenging complication. We aimed to identify the modes of failure and characteristics of failed fixation constructs. METHODS We queried our institutional database for patients > 18 years old with fixation failure after ORIF with single plate and screw constructs of humeral shaft fractures from 2006 to 2017. Demographics, fracture characteristics, fixation construct design and mode of failure were recorded. RESULTS Twenty-three failures were identified. Mean age was 55.9 years (SD 19.2 years) with 15 (65%) women. Twelve patients (52%) had midshaft fractures; the remainder had distal-third shaft (8 pts, 35%) or proximal-third shaft (3 pts, 13%) fractures. Midshaft fractures were most commonly fixed through an anterolateral approach with plates and all non-locking screws (83%), while distal-third shaft fractures were fixed with a combination of locking and non-locking screws from a posterior approach. Distal-third shaft fractures failed by plate breakage (63%) or screw pullout (38%) and all midshaft failures occurred by screw pullout proximal (92%) or distal (8%) to the fracture. Resultant varus deformity occurred in 20 (87%) fractures. CONCLUSION Screw pullout in midshaft fractures suggests that fixation to bone was insufficient or biomechanically disadvantageous. Varus moments contribute significantly to the failure of humeral shaft fracture ORIF. Plate breakage in distal fractures suggests high concentrations of stress over a narrow working length of constructs with inadequate plate strength. Recognizing how these constructs fail can aid proper implant selection and application for humeral shaft fracture. LEVEL OF EVIDENCE Treatment level IV.
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Affiliation(s)
- Andrew D Sobel
- Department of Orthopedic Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Orthopaedic Surgery, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Kalpit N Shah
- Department of Orthopedic Surgery, Scripps Clinic, San Diego, CA, USA
| | - Jeremy Raducha
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Eva Koeller
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Lina I Ibrahim
- Department of Orthopaedic Surgery, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - Scott Paxton
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Tsotsolis S, Ha J, Fernandes ARC, Park JY, Dewhurst M, Walker T, Ilo K, Park SR, Patel A, Hester T, Poutoglidou F. To plate, or not to plate? A systematic review of functional outcomes and complications of plate fixation in patellar fractures. Eur J Orthop Surg Traumatol 2023; 33:3287-3297. [PMID: 37286819 DOI: 10.1007/s00590-023-03597-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/17/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE Poor outcomes and high complication and reoperation rates have been reported with tension-band wiring (TBW) in the management of patellar fractures and particularly the comminuted ones. The purpose of this study was to investigate the functional outcomes and complication rates of patellar fractures managed with open reduction and internal fixation (ORIF) with a plate. METHODS MEDLINE, EMCare, CINAHL, AMED and HMIC were searched, and the PRISMA guidelines were followed. Two independent reviewers extracted the data from the included studies and assessed them for the risk of bias. RESULTS Plating of patellar fractures is associated with satisfactory range of movement (ROM) and postoperative function and low pain levels. We found a 10.44% complication rate and a low reoperation rate. Reoperations were mainly performed for metalwork removal. CONCLUSION ORIF with plating of patellar fractures is a safe alternative in the management of patellar fractures and may be associated with a lower complication and reoperation rate compared to TBW. Future randomized prospective studies are needed to validated the results of the present systematic review.
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Affiliation(s)
- Stavros Tsotsolis
- Department of Trauma and Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Joon Ha
- Department of Trauma and Orthopaedics, Barts Health NHS Trust, Royal London Hospital, Whitechapel Road, London, E1 1FR, UK
| | | | - Jae Yong Park
- Faculty of Medicine, Imperial College London, London, UK
| | - Maximilian Dewhurst
- Department of Trauma and Orthopaedics, Barts Health NHS Trust, Royal London Hospital, Whitechapel Road, London, E1 1FR, UK
| | - Thomas Walker
- Department of Trauma and Orthopaedics, Barts Health NHS Trust, Royal London Hospital, Whitechapel Road, London, E1 1FR, UK
| | - Kevin Ilo
- University Hospitals of Derby and Burton NHS Trust, Royal Derby Hospital, Derby, UK
| | - Se Ri Park
- Faculty of Medicine, Imperial College London, London, UK
| | - Amit Patel
- Department of Trauma and Orthopaedics, Barts Health NHS Trust, Royal London Hospital, Whitechapel Road, London, E1 1FR, UK
| | - Thomas Hester
- Kings College Hospital NHS Foundation Trust, London, UK
| | - Freideriki Poutoglidou
- Department of Trauma and Orthopaedics, Barts Health NHS Trust, Royal London Hospital, Whitechapel Road, London, E1 1FR, UK.
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Tanpure S, Chaughule C, Date J, Sonawane A, Lohiya M. How we do it? Trimalleolar Fractures: Posterolateral Approach for Fixing the Syndesmotic Ligament, Posterior Malleolus, and Fibula. J Orthop Case Rep 2023; 13:153-158. [PMID: 38162351 PMCID: PMC10753668 DOI: 10.13107/jocr.2023.v13.i12.4116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/10/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Syndesmotic injury in trimalleolar fracture is necessary to address intraoperatively by stability test, as it affects post-operative functional outcomes. Most of syndesmotic injuries are stable after fixation of the posterior malleolus, but in rare cases, syndesmosis is not stable after adequate fixation. In those rare conditions, we have to fix syndesmosis by corticocancellous (CC) screw throw lateral fibula plate. We emphasize this complex problem and offer solutions to overcome it. Case Report Case 1: A 45-year-old male suffered significant trauma to his right ankle from a slip and fall, resulting in a trimalleolar fracture. The open reduction and internal fixation (ORIF) throw posterolateral approach was performed after wrinkles were seen on the ankle. A four-hole Ellis plate was used in antiglide mode to reduce posterior malleolar fragments. The lateral malleolus is fixed with a 7-hole, 1/3-locking tubular plate with a tricortical syndesmotic CC screw. The medial malleolus was internally fixed by a 6-hole LC-DCP. Case 2: A 49-year-old female suffered significant trauma to her right ankle from a domestic fall, resulting in a trimalleolar fracture. The ORIF throw posterolateral approach was performed after wrinkles were seen on the ankle. A four-hole Ellis plate was used in antiglide mode to reduce posterior malleolar fragments. The lateral malleolus is fixed with an 8-hole, 1/3-locking tubular plate with a tricortical syndesmotic CC screw. The medial malleolus was internally fixed by a 2 CC screw with an 8-hole LC-DCP. The anterior distal tibia fragment was fixed with a 16-mm anteroposterior CC screw. Conclusion In a trimalleolar ankle fracture, fixation of the posterior malleolus is important for a better post-operative functional outcome, irrespective of the size of the posterior malleolus. The author recommends lateral fibula plate fixation by creating a window between the skin and the peroneus longus and brevis tendon, so we have a chance to put a syndesmotic screw into the lateral plate if syndesmosis is not stable.
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Affiliation(s)
- Sanket Tanpure
- Department of Orthopaedics, Dr Vithalrao Vikhe Patil Medical College, Ahmednagar, Maharashtra, India
| | - Chandrasen Chaughule
- Department of Orthopaedics, Dr Vithalrao Vikhe Patil Medical College, Ahmednagar, Maharashtra, India
| | - Jay Date
- Department of Orthopaedics, Dr Vithalrao Vikhe Patil Medical College, Ahmednagar, Maharashtra, India
| | - Akash Sonawane
- Department of Orthopaedics, Dr Vithalrao Vikhe Patil Medical College, Ahmednagar, Maharashtra, India
| | - Mayur Lohiya
- Department of Orthopaedics, Dr Vithalrao Vikhe Patil Medical College, Ahmednagar, Maharashtra, India
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Hochreiter B, Saager LV, Zindel C, Calek AK, Stern C, Wieser K, Gerber C. Computer-assisted planning vs. conventional surgery for the correction of symptomatic mid-shaft clavicular nonunion and malunion. JSES Int 2023; 7:2321-2329. [PMID: 37969529 PMCID: PMC10638583 DOI: 10.1016/j.jseint.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background The aim of this study was to compare the clinical and radiographic outcomes of treatment of symptomatic mal- and/or nonunion of midshaft clavicle fractures using radiographically based free-hand open reduction and internal fixation (ORIF) or computer-assisted 3D-planned, personalized corrective osteotomies performed using patient-specific instrumentation (PSI) and ORIF. The hypotheses were that (1) patients treated with computer-assisted planning and PSI would have a better clinical outcome, and (2) computer-assisted surgical planning would achieve a more accurate restoration of anatomy compared to the free-hand technique. Methods Between 1998 and 2020, 13 patients underwent PSI, and 34 patients underwent free-hand ORIF and/or corrective osteotomy. After application of exclusion criteria, 12/13 and 11/34 patients were included in the study. The clinical examination included measurement of the active range of motion and assessment of the absolute and relative Constant-Murley Scores and the subjective shoulder value. Subjective satisfaction with the cosmetic result was assessed on a Likert scale from 0 to 100 (subjective aesthetic value). 11/13 and 6/11 patients underwent postoperative computed tomography evaluation of both clavicles. Computed tomography scans were segmented to generate 3D surface models. After projection onto the mirrored contralateral side, displacement analysis was performed. Finally, bony union was documented. The average follow-up time was 43 months in the PSI and 50 months in the free-hand cohort. Results The clinical outcomes of both groups did not differ significantly. Median subjective shoulder value was 97.5% (70; 100) in the PSI group vs. 90% (0; 100) in the free-hand group; subjective aesthetic value was 86.4% (±10.7) vs. 75% (±18.7); aCS was 82.3 (±10.3) points vs. 74.9 (±26) points; and rCS was 86.7 (±11.3) points vs. 81.9 (±28.1) points. In the free-hand group, 2/11 patients had a postoperative neurological complication. In the PSI cohort, the 3D angle deviation was significantly smaller (PSI/planned vs. free-hand/contralateral: 10.8° (3.1; 23.8) vs. 17.4° (11.6; 42.4); P = .020)). There was also a trend toward a smaller 3D shift, which was not statistically significant (PSI/planned vs. free-hand/contralateral: 6 mm (3.4; 18.3) vs. 9.3 mm (5.1; 18.1); P = .342). There were no other significant differences. A bony union was achieved in all cases. Conclusion Surgical treatment of nonunion and malunions of the clavicle was associated with very good clinical results and a 100% union rate. This study, albeit in a relatively small cohort with a follow-up of 4 years, could not document any clinically relevant advantage of 3D planning and personalized operative templating over conventional radiographic planning and free-hand surgical fixation performed by experienced surgeons.
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Affiliation(s)
- Bettina Hochreiter
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Laura Victoria Saager
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christoph Zindel
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Anna-Katharina Calek
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christoph Stern
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Karl Wieser
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christian Gerber
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Balgrist Campus, Orthopaedic Research Center, Zürich, Switzerland
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Bastías GF, Sepúlveda S, Bruna S, Contreras M, Hube M, Cuchacovich N, Bergeret JP, Fuentes P. Comparison of complications and reoperations in AO/OTA 43.C3 pilon fractures treated with conventional ORIF versus minimally invasive hexapod ring fixation. Injury 2023; 54 Suppl 6:110884. [PMID: 38143151 DOI: 10.1016/j.injury.2023.110884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/04/2023] [Accepted: 06/04/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION Controversy exists regarding the optimal management of AO/OTA 43. C3 pilon fractures. Open reduction and internal fixation (ORIF) is the gold standard treatment, but serious soft tissue and infectious complications have been previously reported. Minimally invasive strategies using hexapod ring fixation (HRF) with supplemental limited internal fixation have been used to reduce the incidence of complications. Previous studies have included heterogeneous types of pilon fractures, with non-comminuted injuries being more likely to be treated with ORIF and complex fractures receiving HRF treatment. To our knowledge, no studies have compared the complications and reoperation rates between ORIF and HRF exclusively for C3 fractures. METHODS Retrospective study comparing 53 patients treated for AO/OTA 43.C3 pilon fracture with ORIF or HRF in a trauma level I center with at least a two-year follow-up. Patients treated between January 2015 and January 2019 received ORIF and those treated between January 2019 and January 2021 received HRF. Complications were divided into two groups: minor (superficial infection and malalignment) and major (non-union, deep infection, and amputation). Reoperations, prevalence of ankle osteoarthritis, and requirement for ankle arthrodesis/total ankle replacement were registered. RESULTS We included 30 and 23 patients in the ORIF and HRF groups, respectively. The overall complication rate was similar in both groups, with 50% and 56,5% of the patients having complications in the ORIF and HRF groups, respectively (p:0,63). Minor complications were significantly more prevalent in the HRF group (p<0,001) whilst the ORIF group had a significantly higher rate of major complications (p<0,01). Superficial infections were highly prevalent in the HRF group (47,8%), as they were related to half-pin or K-wire infections. Deep infection was present only in the ORIF group, with 20% of the patients developing this major complication (p:0,03). Non-union rate, reoperations, ankle osteoarthritis, and the need for arthrodesis or ankle replacement showed no significant differences. CONCLUSION In AO/OTA 43.C3 fractures, HRF is safe and effective, achieving high union rates with a significantly lower rate of major complications compared to ORIF. According to our results, ORIF should be used cautiously for these types of fractures, considering the increased risk of deep infection.
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Affiliation(s)
- Gonzalo F Bastías
- Department of Orthopedic Surgery, Foot and Ankle Unit, Hospital del Trabajador, Santiago, Chile; Centro de Excelencia en Reconstrucción Ósea, Santiago, Chile.
| | - Sebastián Sepúlveda
- Department of Orthopedic Surgery, Foot and Ankle Unit, Hospital de Puerto Montt; Clínica Andes Salud Puerto Montt, Puerto Montt, Chile
| | - Sergio Bruna
- Department of Orthopedic Surgery, Hospital del Trabajador, Santiago, Chile
| | - Martin Contreras
- Department of Orthopedic Surgery, Hospital del Trabajador, Santiago, Chile
| | - Maximiliano Hube
- Department of Orthopedic Surgery, Foot and Ankle Unit, Hospital del Trabajador, Santiago, Chile; Centro de Excelencia en Reconstrucción Ósea, Santiago, Chile
| | - Natalio Cuchacovich
- Department of Orthopedic Surgery, Foot and Ankle Unit, Hospital del Trabajador, Santiago, Chile; Centro de Excelencia en Reconstrucción Ósea, Santiago, Chile
| | - Juan Pedro Bergeret
- Department of Orthopedic Surgery, Foot and Ankle Unit, Hospital del Trabajador, Santiago, Chile
| | - Patricio Fuentes
- Department of Orthopedic Surgery, Foot and Ankle Unit, Hospital del Trabajador, Santiago, Chile; Centro de Excelencia en Reconstrucción Ósea, Santiago, Chile
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Roddy E, Kandemir U. High rate of avascular necrosis but excellent patient-reported outcomes after open reduction and internal fixation ( ORIF) of proximal humerus fracture dislocations: should ORIF be considered as primary treatment? J Shoulder Elbow Surg 2023; 32:2097-2104. [PMID: 37224914 DOI: 10.1016/j.jse.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 03/23/2023] [Accepted: 04/04/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Proximal humerus fracture dislocations, excluding 2-part greater tuberosity fracture dislocations, are rare injuries. Outcomes after open reduction and internal fixation (ORIF) of these injuries have not been well described in the literature. The purpose of this study was to report the radiographic and functional outcomes of patients who underwent ORIF of a proximal humerus fracture dislocation. METHODS All skeletally mature patients who underwent ORIF of a proximal humerus fracture dislocation between 2011 and 2020 were identified. Patients with isolated greater tuberosity fracture dislocations were excluded. The primary outcome was American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score at a minimum of 2 years. Secondary outcomes were the development of avascular necrosis (AVN) and reoperation rate. RESULTS Twenty-six patients met the inclusion criteria. The mean age was 45 years (standard deviation 16), and 77% were men. Median time to reduction and surgery was 1 day (interquartile range [IQR] 1-5). There were 2 (8%) Neer 2-part fractures, 7 (27%) 3-part, and 17 (65%) 4-part fractures. Fifty-four percent (54%) involved the anatomic neck and 31% included a head-split component. Thirty-nine percent (39%) were anterior dislocations. The rate of AVN was 19%. The reoperation rate was 15%. Reoperations included removal of hardware (2), subscapularis repair (1), and manipulation under anesthesia (1). No patients went on to arthroplasty. ASES scores were available for 22 patients (84%) including 4 of 5 patients with AVN. The median ASES score at a mean of 6.0 years postoperatively was 98.3 (IQR 86.7-100, range 63.3-100) and was not different in those with or without AVN (median 98.3 vs. 92.0, P = .175). Only the presence of medial comminution and nonanatomic head shaft alignment on postoperative radiographs were associated with increased risk of AVN. CONCLUSION Radiographic rates of AVN (19%) and reoperation (15%) were high in this series of patients undergoing ORIF of proximal humerus fracture dislocations. Despite this, none of the patients required arthroplasty, and patient-reported outcome scores at an average of 6 years postinjury were excellent, with a median ASES score of 98.5. ORIF should be considered as primary method of treatment in proximal humerus fracture dislocations not only in young patients but also middle-aged patients.
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Affiliation(s)
- Erika Roddy
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Utku Kandemir
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA.
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Contreras ES, Lynch DJ, Hatef S, Speeckaert AL, Goyal KS. Risk Factors for Loss of Reduction After Open Reduction and Internal Fixation of Isolated Olecranon Fractures in Adults. Hand (N Y) 2023; 18:1169-1176. [PMID: 35264046 PMCID: PMC10798208 DOI: 10.1177/15589447221075667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND We sought to determine whether any relevant patient, fracture, surgical, or postoperative characteristics are associated with loss of reduction after plate fixation of isolated olecranon fractures in adults. METHODS Patients who underwent open reduction and internal fixation of an olecranon fracture at our institution over an 11-year period were analyzed. Electronic patient charts and radiographic images were reviewed to gather patient, fracture, surgical, and postoperative data. Statistical analysis to explore the differences between groups was performed. RESULTS Seven of 96 patients experienced a loss of fracture reduction diagnosed at a median of 19 days after their initial surgery (range: 4-116 days). The radiographic mode of failure of all patients who lost reduction was proximal migration of the proximal fracture fragment with or without implant failure. The group that lost reduction had a significantly smaller proximal fragment (14.2 vs 18.6 mm), a higher incidence of malreduction with a persistent articular step-off greater than 2 mm (6/7 vs 14/89), a greater distance between the most proximal screw and the olecranon tip (19.8 vs 13.5 mm), a higher proportion of constructs with screws placed outside of the primary plate (4/7 vs 14/89), and a higher proportion of patients that were not immobilized postoperatively (3/7 vs 8/89). CONCLUSIONS Our results suggest anatomical reduction at the articular surface and adequate fixation of the proximal fragment are key factors in maintenance of reduction, with smaller proximal fragments being at higher risk for failure. A period of postoperative immobilization may decrease the risk of loss of reduction.
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Affiliation(s)
| | - Daniel J. Lynch
- The Ohio State University Wexner Medical Center, Columbus, USA
| | - Sarah Hatef
- The Ohio State University Wexner Medical Center, Columbus, USA
| | | | - Kanu S. Goyal
- The Ohio State University Wexner Medical Center, Columbus, USA
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Caterini A, Luciano C, Rovere G, Ziranu A, Farsetti P, De Maio F. Periprosthetic distal femoral fractures after total knee replacement treated by ORIF. Mid to long-term follow-up study in 12 patients. Orthop Rev (Pavia) 2023; 15:87871. [PMID: 37786428 PMCID: PMC10542000 DOI: 10.52965/001c.87871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
Periprosthetic fractures following total knee arthroplasty are a quite uncommon traumatic lesion that often are present in elderly patients with osteoporosis and comorbidities. The most common periprosthetic fracture affects the distal femur. The main internal fixation techniques are ORIF with a locking plate and retrograde intramedullary nailing. In the present study, we report the medium-long term results in 12 patients with a distal femoral periprosthetic fracture stabilized with a locking plate. We reviewed 12 patients affected by a periprosthetic distal femur fracture surgically treated between 2010 and 2016 by ORIF using a locking compression plate after an average follow-up of 5.75 years. The average age of the patients at diagnosis was 78 years. The mean interval time between knee arthroplasty and distal femoral fracture was 8.25 years. Clinical results were assessed using the WOMAC score, while radiographic results according to Beals and Tower's criteria. All fractures of our series were type II according to the Rorabeck and Taylor classification. At follow-up, the WOMAC score ranged from 40.5 to 76.5 points (average 53.92). Radiographic results, according to Beals and Tower's criteria, were excellent in 5 patients and good in 7. All patients returned to their previous daily activities. We believe that reduction and internal fixation with a locking plate is a surgical option of treatment that provides satisfactory clinical and radiological results in Rorabeck type II periprosthetic distal femoral fractures.
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Affiliation(s)
- Alessandro Caterini
- Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology University of Rome Tor Vergata, Italy
| | - Claudia Luciano
- Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology University of Rome Tor Vergata, Italy
| | - Giuseppe Rovere
- Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology University of Rome Tor Vergata, Italy
| | - Antonio Ziranu
- Orthopaedics Catholic University of the Sacred Heart, Rome, Italy
| | - Pasquale Farsetti
- Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology University of Rome Tor Vergata, Italy
| | - Fernando De Maio
- Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology University of Rome Tor Vergata, Italy
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Pesch S, Greve F, Zyskowski M, Müller M, Crönlein M, Biberthaler P, Kirchhoff C, Wurm M. High return to sports rates after operative treatment of patella fractures. Eur J Med Res 2023; 28:366. [PMID: 37736742 PMCID: PMC10514948 DOI: 10.1186/s40001-023-01359-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 09/10/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Patella fractures are relatively rare fractures and only little is known about the postoperative return to sports after patella fractures. METHODS This retrospective study presents information on functional outcome after operative treatment of patella fractures as well as time until return to sports and patients' complaints after open-reduction internal-fixation (ORIF) of patella fractures. RESULTS Overall, 39 patients after ORIF of patella fractures were evaluated at our Level-I trauma center with a mean follow-up of 42 months. The mean time until return to sports was 7 ± 3.9 months. No significant difference was found for functional outcome with respect to body mass index (BMI) or age. Fracture consolidation was accomplished after a mean of 6.9 ± 2.9 months besides a relatively low complication rate of 5.1% (n = 2). CONCLUSION The results demonstrate a high return to sports rate of 90.3%. However, only 51.6% were able to perform sports on their pre-injury level or above. Trial Registration The study was retrospectively registered at DRKS (No: DRKS00031146).
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Affiliation(s)
- Sebastian Pesch
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- Department of Trauma Surgery, AUVA Trauma Center Meidling, Kundratstrasse 37, 1120, Vienna, Austria
| | - Frederik Greve
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Michael Zyskowski
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Michael Müller
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Moritz Crönlein
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Peter Biberthaler
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Chlodwig Kirchhoff
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Markus Wurm
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
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Bhatnagar A, Rao SS. Mid-facial soft tissue re-suspension following skeletal fixation after maxillofacial trauma-a prospective case series study. Oral Maxillofac Surg 2023; 27:445-457. [PMID: 35672481 DOI: 10.1007/s10006-022-01083-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/27/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Open reduction and internal fixation (ORIF) is used for reduction and stabilization of facial fractures. Despite perfect anatomic skeletal reduction, subtle asymmetries are seen in facial appearance as mid-facial soft tissue often reattaches to the respective facial bones in an aberrant, mostly lower in position. Thus, the present study evaluates the effectiveness of mid-facial soft tissue re-suspension procedure to prevent changes in mid-facial soft tissue profile after ORIF of maxillo-facial fractures. METHODS Fifteen patients with maxillo-facial fractures requiring ORIF were included. After ORIF, mid-facial soft tissue resuspension (STRP) was done by suspending the soft tissue and periosteum over cheek region from temporal fascia by polydioxanone suture material. The results were analyzed by patient satisfaction survey and doctor perspective form on photographs by three surgeons 6 months postoperatively. RESULTS All patients were male in the age range of 18-60 years. STRP was done unilaterally in 7 cases and bilaterally in 8 cases, with average time ranging from 10.6 to 20.5 min. The patient satisfaction survey revealed that 86.6% were pleased with their appearance and 93% said that there was no abnormal change in the esthetics postoperatively. The doctor perception form revealed almost 80% agreement, that there was minimal change in the appearance of cheek mound, nasolabial fold, corner of the mouth, and lateral canthus postoperatively. CONCLUSION STRP is a simple technique to perform with fewer complications, and helps in restoring facial esthetics, same as prior to facial trauma; as it prevents soft tissue sagging after degloving incisions for fracture reduction and fixation.
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Affiliation(s)
- Abhinav Bhatnagar
- Department of Oral and Maxillofacial Surgery, KLEVK Institute of Dental Sciences and Hospital, KLE Academy of Higher Education and Research, Belgaum, 590010, Karnataka, India
| | - Sanjay S Rao
- Department of Oral and Maxillofacial Surgery, KLEVK Institute of Dental Sciences and Hospital, KLE Academy of Higher Education and Research, Belgaum, 590010, Karnataka, India.
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Tuaño KR, Fisher MH, Lee N, Khatter NJ, Le E, Washington KM, Iorio ML. Analysis of Postoperative Distal Radius Fracture Outcomes in the Setting of Osteopenia and Osteoporosis for Patients with Comorbid Conditions. J Hand Surg Glob Online 2023; 5:601-605. [PMID: 37790836 PMCID: PMC10543796 DOI: 10.1016/j.jhsg.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/13/2023] [Indexed: 10/05/2023] Open
Abstract
Purpose Distal radius fractures (DRFs) are among the most common orthopedic injuries, especially in the elderly. A wide variety of approaches have been advocated as successful treatment modalities; yet, there remains variability in practice patterns of DRF in patients with osteoporosis and osteopenia. Using large data set analysis, we sought to determine the risk profile of operative fixation of DRF in patients with low bone mineral density. Methods A commercially available health care database, PearlDiver, was queried for all patients who underwent open reduction internal fixation of DRFs between 2010 and 2020. The study population was divided into groups based on the presence or absence of osteopenia or osteoporosis and was further classified by patients who were receiving bisphosphonate therapy. Complication rates were calculated, including rates of malunion, surgical site infection, osteomyelitis, hardware failure, and hardware removal. Five-year future fragility fractures were defined in hip, vertebrae, humerus, and wrist fractures. Chi-square analysis and logistic regression were performed to determine an association between these comorbidities and various postoperative complications. Results A total of 152,926 patients underwent open reduction internal fixation of a DRF during the study period. Chi-square analysis of major complications at 3 months showed a statistically significant increase in malunion in patients with osteopenia (P = .05) and patients with osteoporosis (P = .05) who underwent open reduction internal fixation. Logistic regression analysis at 12 months after surgery demonstrated that osteopenia was associated with an increased risk of hardware failure (P < .0001), hardware removal (P < .0001), surgical site infection (P < .0001), and malunion (P = .004). Osteoporosis was associated with a significantly increased risk of hardware failure (P = .01), surgical site infection (P < .0001), and malunion (P < .0001). Conclusions We demonstrated, using large data set analysis, that DRF patients with osteopenia and osteoporosis are predicted to be at increased risk of multiple postoperative complications, and thus, bone density should be strongly considered in treatment planning for these patients. Type of study/level of evidence Prognostic III.
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Affiliation(s)
- Krystle R. Tuaño
- Division of Plastic and Reconstructive Surgery, University of Colorado Hospital, Denver, CO
| | - Marlie H. Fisher
- Medical Scientist Training Program, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Nayun Lee
- University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO
| | - Neil J. Khatter
- University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO
| | - Elliot Le
- Division of Plastic and Reconstructive Surgery, University of Colorado Hospital, Denver, CO
| | - Kia M. Washington
- Division of Plastic and Reconstructive Surgery, University of Colorado Hospital, Denver, CO
| | - Matthew L. Iorio
- Division of Plastic and Reconstructive Surgery, University of Colorado Hospital, Denver, CO
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Orapiriyakul W, Apivatthakakul V, Theppariyapol B, Apivatthakakul T. Humerus shaft fractures, approaches and management. J Clin Orthop Trauma 2023; 43:102230. [PMID: 37588079 PMCID: PMC10425411 DOI: 10.1016/j.jcot.2023.102230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/30/2023] [Accepted: 08/03/2023] [Indexed: 08/18/2023] Open
Abstract
Humeral shaft fracture is a common injury which can be treated either conservatively with functional bracing or with surgical fixation. Current evidence shows an increase in the rate of nonunion after conservative treatment, suggesting that indications for conservative treatment may need to be re-examined. This article updates trends in treatment for humeral shaft fracture. Indications for surgery, both for plate osteosynthesis with open reduction and internal fixation (ORIF) as well as for minimally invasive plate osteosynthesis (MIPO) and intramedullary nailing (IMN) are described. Recognition of the advantages and disadvantages of each technique can better define the role of the plate or nail and can aid in the selection of an appropriate surgical approach. ORIF with compression plate continues to have a role in the treatment of simple or AO/OTA type A fractures. The primary goal of minimal invasive osteosynthesis, a surgical technique involving small incisions, closed reduction or mini-open reduction that minimizes soft tissue dissection and helps preserve the periosteal blood supply, is to achieve bone union and the best possible functional outcomes. MIPO of the humerus is now well accepted as being less invasive and providing relative stability to allow indirect (secondary) bone healing with callus formation. MIPO approaches can be performed circumferentially to the humerus, including the proximal, middle and distal shaft. The classic MIPO approach is anterior MIPO, followed by posterior, anterolateral and anteromedial MIPO. IMN is also an option for treating humerus fractures. In the past, IMN was not widely used due to the potential for complications such as shoulder impingement and elbow problems as well as the limited availability of implants and the steep learning curve of this surgical technique. Over the past decade, the launch of a new design of straight antegrade and retrograde IMN with established techniques has encouraged more surgeons to use IMN as an alternative option. Methods of dealing with concomitant and post-treatment radial nerve palsy have also been evolving, including the use of ultrasound for diagnosis of radial nerve conditions. Radial nerves with contusion, entrapment or laceration can be detected using ultrasound with reliability comparable to intraoperative findings. Trends in treatment of radial nerve palsy are described below. Future larger randomized controlled trials comparing conservative and operative management are necessary to further develop appropriate guidelines.
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Affiliation(s)
- Wich Orapiriyakul
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand
| | - Varat Apivatthakakul
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Bodin Theppariyapol
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
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Miksch RC, Herterich V, Barg A, Böcker W, Polzer H, Baumbach SF. Open Reduction and Internal Fixation of the Posterior Malleolus Fragment in Ankle Fractures Improves the Patient-Rated Outcome: A Systematic Review. Foot Ankle Int 2023; 44:727-737. [PMID: 37125766 PMCID: PMC10394961 DOI: 10.1177/10711007231165771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND The best treatment strategy for fractures to the posterior malleolus (PM) is still intensively debated. The aim of this systematic review was to compare the patient-rated outcome following open reduction and internal fixation (ORIF) for fractures of the PM to either closed reduction using AP screws (CRIF) or no treatment in bi- or trimalleolar ankle fractures. METHODS Systematic literature research (MEDLINE (PubMed), CINAHL, Scopus, Central and EMBASE) according to the PICOS and PRISMA guidelines. Eligible were studies comparing the outcome following ORIF to any other treatment strategy for fractures to the posterior malleolus in isolated bi- or trimalleolar ankle fractures. RESULTS Twelve studies were eligible for a qualitative analysis and 6 for a quantitative analysis. Overall, a considerable heterogeneity among the studies was observed. The most commonly used outcome score was the American Orthopaedic Foot & Ankle Society ankle-hindfoot score (AOFAS). The final follow-up ranged from 12 to 160 months. Four studies compared ORIF to CRIF of the PM. The quantitative analysis revealed significantly better AOFAS scores for ORIF (90.9 vs 83.4 points; P < .001; I2 = 0%). Three studies compared ORIF to untreated PM fragment. The quantitative analysis again revealed superior AOFAS scores for ORIF (92.0 vs 82.5 points; P < .001; I2 = 99%). A similar trend was observed for the Ankle Fracture Scoring System and American Academy of Orthopaedic Surgeons Foot and Ankle Questionnaire scores as well as the quality of reduction. CONCLUSION Despite a considerable heterogeneity, the data available point to a superior outcome following ORIF for fractures to the PM when compared to CRIF or no treatment.
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Affiliation(s)
- Rainer Christoph Miksch
- Musculoskeletal University Centre Munich (MUM), University Hospital, Ludwig-Maximilians-University Munich (LMU), Germany
| | - Viktoria Herterich
- Musculoskeletal University Centre Munich (MUM), University Hospital, Ludwig-Maximilians-University Munich (LMU), Germany
| | - Alexej Barg
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Böcker
- Musculoskeletal University Centre Munich (MUM), University Hospital, Ludwig-Maximilians-University Munich (LMU), Germany
| | - Hans Polzer
- Musculoskeletal University Centre Munich (MUM), University Hospital, Ludwig-Maximilians-University Munich (LMU), Germany
| | - Sebastian Felix Baumbach
- Musculoskeletal University Centre Munich (MUM), University Hospital, Ludwig-Maximilians-University Munich (LMU), Germany
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Oldrini LM, Sangiorgio A, Feltri P, Marbach F, Filardo G, Candrian C. Proximal humerus fractures: deltopectoral open reduction and internal fixation vs deltosplit minimally invasive plate osteosynthesis: which surgical approach provides superior results? EFORT Open Rev 2023; 8:662-671. [PMID: 37526265 PMCID: PMC10441256 DOI: 10.1530/eor-22-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
Purpose To compare the two main surgical approaches to address proximal humerus fractures (PHFs) stratified for Neer fracture types, to demonstrate which approach gives the best result for each fracture type. Methods A literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in PubMed, Web of Science, and Cochrane databases up to 4 January 2022. Inclusion criteria were studies comparing open reduction and internal fixation (ORIF) with deltopectoral (DP) approach and minimally invasive plate osteosynthesis (MIPO) with deltosplit (DS) approach of PHFs. Patient's demographic data, fracture type, Constant-Murley Score (CMS), operation time, blood loss, length of hospital stay, complications, fluoroscopy time, and radiological outcomes were extracted. Results were stratified for each type of Neer fracture. Results Eleven studies (798 patients) were included in the meta-analysis. No functional difference was found in the CMS between the two groups for each type of Neer (P = n.s.): for PHFs Neer II, the mean CMS was 72.5 (s.e. 5.9) points in the ORIF group and 79.6 (s.e. 2.5) points in the MIPO group; for Neer III, 77.8 (s.e. 2.0) in the ORIF and 76.4 (se 3.0) in the MIPO; and for Neer IV, 70.6 (s.e. 2.7) in the ORIF and 60.9 (s.e. 6.3) in the MIPO. The operation time in the MIPO group was significantly lower than in the ORIF group for both Neer II (P = 0.0461) and Neer III (P = 0.0037) fractures. Conclusion The MIPO with DS approach demonstrated no significant differences in the results to the ORIF with DP approach for the different Neer fractures in terms of functional results, with a similar outcome, especially for the Neer II and III fracture types. The MIPO technique proved to be as safe and effective as the ORIF approach.
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Affiliation(s)
| | - Alessandro Sangiorgio
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Pietro Feltri
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Francesco Marbach
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Christian Candrian
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
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Beckwitt CH, Monaco SJ, Gruen GS. Republication of "Primary Ankle Arthrodesis vs ORIF for Severely Comminuted Pilon Fractures: A Comparative Retrospective Study". Foot Ankle Orthop 2023; 8:24730114231193391. [PMID: 37566683 PMCID: PMC10408335 DOI: 10.1177/24730114231193391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
Abstract
Background The treatment for highly comminuted pilon fractures remains controversial. The goal of this retrospective cohort study was to compare functional outcomes of primary arthrodesis of the tibiotalar joint (fusion) and open reduction internal fixation (ORIF). Methods Patients who underwent primary ORIF or fusion for pilon fractures at our institution since 2000 were identified by Current Procedural Terminology (CPT) code. Inclusion criteria for the ORIF cohort were patients with an AO/Orthopaedic Trauma Association type C3 pilon fracture. Additional inclusion criteria for the fusion cohort were patients whose fractures were deemed non-reconstructable by the treating surgeon. Outcome assessment was determined by the Foot and Ankle Outcome Score (FAOS) and Short Form 36-item health survey (SF-36), time to radiographic union or fusion, and wound-healing complications at a minimum of 2 years after their surgery. Results Nineteen ORIF and 16 fusion patients completed the study's outcome assessments. A higher rate of nonunion was observed in patients treated by primary ORIF than primary fusion (5/19 vs 1/16). Posttraumatic arthritis was observed in 11 of 19 primary ORIF patients. Primary fusion patients exhibited increased symptoms, pain, and physical role limits but were equivalent to primary ORIF patients on all other functional metrics examined. Conclusions Primary ankle arthrodesis achieves a lower rate of nonunion and comparable functional outcomes to ORIF in patients with severely comminuted pilon fractures. The higher rate of nonunion observed in the primary ORIF group suggests that primary fusion should be considered an effective procedure for severe injuries to decrease the need for further operative intervention. Level of Evidence Therapeutic Level III, retrospective cohort.
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Affiliation(s)
- Colin H Beckwitt
- Department of Pathology, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | | | - Gary S Gruen
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Okulski J, Kozakiewicz M, Zieliński R, Krasowski M, Konieczny B. Evaluation of the Relationship of Screw Pullout and Plate Fracutre in Fixation of Mandible Condyle Fractures: A Mechanistic Study. J Clin Med 2023; 12:4380. [PMID: 37445415 DOI: 10.3390/jcm12134380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/24/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The mandible is the most injured part of the facial skeleton, and 25-40% of mandibular fractures involve the condyle process. The aim of this study is to answer the question of the relationship between screw pullout and/or plate fracture during osteosynthesis. METHODS We tested polyurethane models of mandibles whose condylar process was cut (simulating a fracture) and fused using plates and screws. RESULTS A total of 672 plates were tested. A total of 25.6% of them were fractured during the test, with most being fractures of the base of the condyle. More screws (81.97%) are pulled out from the ramus than from the condyle-69.15%. CONCLUSIONS The gold standard in the osteosynthesis of condylar fractures is two straight plates. Other than these, there is no one-size-fits-all plate for every type of fracture. Plates fixed with fewer screws (smaller plates used in higher-lying fractures) are more likely to result in screw pullout. On the other hand, in plates fixed with more screws, plate fracture is more common.
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Affiliation(s)
- Jakub Okulski
- Department of Maxillofacial Surgery, Medical University of Lodz, 113st Zeromskiego, 90-001 Lodz, Poland
| | - Marcin Kozakiewicz
- Department of Maxillofacial Surgery, Medical University of Lodz, 113st Zeromskiego, 90-001 Lodz, Poland
| | - Rafał Zieliński
- Department of Maxillofacial Surgery, Medical University of Lodz, 113st Zeromskiego, 90-001 Lodz, Poland
| | - Michał Krasowski
- Material Science Laboratory, Medical University of Lodz, 251st Pomorska, 92-213 Lodz, Poland
| | - Bartłomiej Konieczny
- Material Science Laboratory, Medical University of Lodz, 251st Pomorska, 92-213 Lodz, Poland
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Cievet M, Buffard M, Kumble A, Ramos-Pascual S, Locquet V, Burnier M. Outcomes of arthroscopic versus open reduction and internal fixation for the treatment of acute traumatic lunate fractures: a systematic review. Hand Surg Rehabil 2023:S2468-1229(23)00114-7. [PMID: 37364729 DOI: 10.1016/j.hansur.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023]
Abstract
The purpose of the study was to compare outcomes of fully-arthroscopic reduction and internal fixation (ARIF) versus open reduction and internal fixation (ORIF) to treat acute traumatic lunate fractures. A literature search was conducted using Medline and Embase. Demographic data and outcomes were extracted for included studies. The search identified 2,146 references: 17 articles were included, reporting on 20 cases (4 ARIF and 16 ORIF). No differences between ARIF and ORIF were found in rate of union (100% vs 93%, P = 1.000), grip strength (mean difference, 8%; 95%CI, -16-31; P = 0.592), rate of return to work (100% vs 100%, P = 1.000), or range of motion (mean difference, 28°; 95%CI, -25-80; P = 0.426). Lunate fractures were not identified in 6 of the 19 radiographs, but were identified in all CT scans. There were no differences in outcome between ARIF and ORIF for the treatment of fresh lunate fracture. The authors recommend surgeons to perform CT scans when diagnosing high-energy wrist trauma so as not to overlook lunate fractures. LEVEL OF EVIDENCE: Level IV.
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Affiliation(s)
- Maxime Cievet
- Institut Chirurgical de la Main et du Membre Supérieur, 17 Avenue Condorcet, 69100, Villeurbanne, France; Clinique Trenel, 575 Rue du Dr Trenel, 69560, Sainte-Colombe, France.
| | - Marius Buffard
- Institut Chirurgical de la Main et du Membre Supérieur, 17 Avenue Condorcet, 69100, Villeurbanne, France; Hôpital Edouard Herriot, CHU Lyon, Service de Chirurgie Orthopédique Main et Membre Supérieur, 5 Place d'Arsonval, 69003, Lyon, France.
| | - Ankitha Kumble
- Hôpital Edouard Herriot, CHU Lyon, Service de Chirurgie Orthopédique Main et Membre Supérieur, 5 Place d'Arsonval, 69003, Lyon, France.
| | - Sonia Ramos-Pascual
- Hôpital Edouard Herriot, CHU Lyon, Service de Chirurgie Orthopédique Main et Membre Supérieur, 5 Place d'Arsonval, 69003, Lyon, France.
| | - Vincent Locquet
- Institut Chirurgical de la Main et du Membre Supérieur, 17 Avenue Condorcet, 69100, Villeurbanne, France.
| | - Marion Burnier
- Institut Chirurgical de la Main et du Membre Supérieur, 17 Avenue Condorcet, 69100, Villeurbanne, France.
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Sakellariou E, Galanis A, Vavourakis M, Papagrigorakis E, Vlachos C, Zachariou D, Vasiliadis E, Pneumaticos S. Peri-implant proximal femur fracture in a poliomyelitis survivor: A surgical and medical challenge. Clin Case Rep 2023; 11:e7465. [PMID: 37287621 PMCID: PMC10242085 DOI: 10.1002/ccr3.7465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/13/2023] [Accepted: 05/23/2023] [Indexed: 06/09/2023] Open
Abstract
Key Clinical Message The treatment of long bone fractures in post-polio survivors is indubitably an exacting task. Out of this complicated case presented in this paper, it can be deduced that it is attainable to repair a peri-implant subtrochanteric refracture or a complex non-union of the proximal femur with plate and screws with grafting. Abstract Post-polio survivors are prone to low-energy bone fractures. The management of such cases is exigent, as no literature data indicate the best surgical approach. This paper presents an intricate peri-implant proximal femoral fracture in a polio survivor treated in our institution and accentuates the various challenges we encountered.
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Affiliation(s)
- Evangelos Sakellariou
- 3rd Department of Orthopaedic SurgeryNational & Kapodistrian University of AthensKAT General HospitalAthensGreece
| | - Athanasios Galanis
- 3rd Department of Orthopaedic SurgeryNational & Kapodistrian University of AthensKAT General HospitalAthensGreece
| | - Michail Vavourakis
- 3rd Department of Orthopaedic SurgeryNational & Kapodistrian University of AthensKAT General HospitalAthensGreece
| | - Eftychios Papagrigorakis
- 3rd Department of Orthopaedic SurgeryNational & Kapodistrian University of AthensKAT General HospitalAthensGreece
| | - Christos Vlachos
- 3rd Department of Orthopaedic SurgeryNational & Kapodistrian University of AthensKAT General HospitalAthensGreece
| | - Dimitrios Zachariou
- 3rd Department of Orthopaedic SurgeryNational & Kapodistrian University of AthensKAT General HospitalAthensGreece
| | - Elias Vasiliadis
- 3rd Department of Orthopaedic SurgeryNational & Kapodistrian University of AthensKAT General HospitalAthensGreece
| | - Spiros Pneumaticos
- 3rd Department of Orthopaedic SurgeryNational & Kapodistrian University of AthensKAT General HospitalAthensGreece
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Fung M, Sivakumar B, Jiang E, Suthersan M, Wines A, Mittal R, Symes M. Trends in management of adult tarsometatarsal joint injuries in a contemporary Australian context: a nationwide study of claims data over 20 years. ANZ J Surg 2023; 93:1214-1219. [PMID: 37027316 DOI: 10.1111/ans.18456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/16/2023] [Accepted: 03/29/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Traumatic tarsometatarsal joint (TMTJ) injuries are uncommon, but can cause significant morbidity due to delayed or missed diagnosis. Recent evidence highlights the importance of achieving anatomical reduction via operative management. This study aims to analyse trends in rates of open reduction internal fixation (ORIF) for Lisfranc injuries in Australia according to Nationwide claims data. METHODS Claims according to the Medicare Benefits Schedule (MBS) on ORIF of traumatic TMTJ injuries were collated for the period from January 2000 to December 2020. Paediatric patients were excluded. Two negative binomial models were utilized to analyse the trends in TMTJ injuries over time after controlling for sex, age group and population changes. Results were absolute and per 100 000 population. RESULTS 7840 patients underwent TMTJ ORIF over the period studied. There was a mean yearly increase of 12% (P < 0.001). Age group (P < 0.001) and year (P < 0.001) were significant predictors for TMTJ fixation, whilst sex was not (P = 0.48). Patients older than 65 years were noted to have a 53% lower rate of TMTJ ORIF per person, when compared to the reference group of 25-34 year-olds (P < 0.001). Five-year block analysis revealed increases in rate of fixation for all age groups. CONCLUSION Rates of operative fixation for TMTJ injuries are increasing in Australia. This is likely due to improved diagnostics, understanding of optimal treatment goals, and increased orthopaedic subspecialisation. Further studies with clinical and patient reported outcomes, as well as comparing rates of operative intervention to incidence, will be useful.
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Affiliation(s)
- Mitchell Fung
- Department of Orthopaedics and Trauma Surgery, Royal North Shore Hospital, Reserve Rd, St Leonards, New South Wales, Australia
| | - Brahman Sivakumar
- Department of Hand and Peripheral Nerve Surgery, Department of Orthopaedic Surgery, Royal North Shore Hospital, Hornsby Ku-ring-gai Hospital & Nepean Hospital, Sydney, New South Wales, Australia
| | - Eric Jiang
- Department of Surgery and Surgical Education Research and Training Institute, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Mayuran Suthersan
- Department of Orthopaedic Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Andrew Wines
- Department of Orthopaedic and Trauma Surgery, North Sydney Orthopaedic and Sports Medicine Centre, Sydney Orthopaedic Foot and Ankle Research Institute, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Rajat Mittal
- South West Sydney Clinical School, UNSW Medicine, Sydney, New South Wales, Australia
| | - Michael Symes
- Department of Orthopaedics and Trauma Surgery, St. George and Sutherland Clinical School, Royal North Shore Hospital, UNSW Medicine, Sydney, New South Wales, Australia
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Lu V, Jegatheesan V, Patel D, Domos P. Outcomes of Acute versus Delayed Reverse Shoulder Arthroplasty for Proximal Humerus Fractures in the Elderly: A Systematic Review and Meta-Analysis. J Shoulder Elbow Surg 2023:S1058-2746(23)00303-8. [PMID: 37024039 DOI: 10.1016/j.jse.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/17/2023] [Accepted: 03/01/2023] [Indexed: 04/08/2023]
Abstract
INTRODUCTION Reverse shoulder arthroplasty (RSA) has become an increasingly popular treatment option for proximal humerus fractures (PHFs) in the elderly. There is however contradictory evidence on the impact of timing of RSA on patient outcomes. It remains unclear if poor results after initial non-surgical or surgical management can be improved with delayed RSA. The aim of this systematic review and meta-analysis is to compare the outcomes of acute RSA and delayed RSA for the treatment of PHFs in the elderly. METHODS A systematic search was performed on four databases for studies that compared acute RSA with RSA used after prior non-operative or operative treatment. Studies with a mean cohort age <65 years old were excluded. Demographical data, clinical outcome scores, range of motion measurements, and postoperative complications were collected from included studies. RESULTS Sixteen studies were included for data analysis. Compared with delayed RSA cohorts, acute RSA cohorts had higher forward flexion (124.3o vs 114.9o; p=0.019), external rotation (24.7o vs 20.2o; p=0.041), and abduction (113.2o vs 99.8o; p=0.03). Compared to RSA after conservative management, acute RSA had greater external rotation (29.9o vs 21.4o; p=0.043). The acute RSA cohort had significantly higher ASES (76.4 vs 68.2; p=0.025) and Constant-Murley scores (65.6 vs 57.3; p=0.002) compared to the delayed RSA cohort. Subgroup analyses showed significantly greater Constant-Murley (64.9 vs 56.9; p=0.020) and SST scores (8.8 vs 6.8; p=0.031) with acute RSA compared to RSA after conservative treatment. ASES score was higher in the acute RSA cohort compared to RSA after open reduction internal fixation (ORIF) (77.9 vs 63.5; p=0.008). The overall complication rate per 100 patient-years was 11.7 for the acute RSA cohort, and 18.5 for the delayed RSA cohort (RR: 0.55; p=0.015). CONCLUSION Based on the current evidence, acute RSA presents better clinical outcome measures and range of motion measurements, with decreased complication rates than RSA performed after prior non-operative or operative treatment.
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Affiliation(s)
- Victor Lu
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom.
| | | | - Dhruv Patel
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Peter Domos
- Department of Trauma and Orthopaedics, Barnet and Chase Farm Hospital, Royal Free NHS Foundation Trust, London, United Kingdom
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Barghi A, Hanna P, Merchan N, Weaver MJ, Wixted J, Appleton P, Rodriguez E. Outcomes of fixation of Vancouver B periprosthetic fractures around cemented versus uncemented stems. BMC Musculoskelet Disord 2023; 24:263. [PMID: 37016368 PMCID: PMC10071713 DOI: 10.1186/s12891-023-06359-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/22/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND The incidence of periprosthetic femur fracture (PPFF) in the setting of total hip arthroplasty (THA) is steadily increasing. We seek to address whether there is a difference in outcomes between Vancouver B fracture types managed with ORIF when the original stem was a press-fit stem versus a cemented stem. METHODS In this retrospective cohort study at a level 1 trauma center, we identified 136 patients over 65 years-of-age with Vancouver B-type fractures sustained between 2005 and 2019. Patients were treated by ORIF and had either cemented or press-fit stems prior to their injury. Outcomes were subsidence of the femoral implant, time to full weight bearing, rate of the hip implant revision, estimated blood loss (EBL), postoperative complications, and the one-year mortality rate. RESULTS A total of 103 (75.7%) press-fit and 33 (24.3%) cemented patients were reviewed. Patient baseline characteristics, Vancouver fracture sub-types, and implant characteristics were not found to be significantly different between groups. The difference in subsidence rates, postoperative complications, and time to weight bearing were not significantly different between groups. EBL and one-year mortality rate were significantly higher in the cemented group. CONCLUSIONS In geriatric patients with Vancouver B type periprosthetic fractures managed with ORIF, patients with an originally press fit stem may have lower mortality, lower estimated blood loss, and similar subsidence and hospital length of stays when compared to those with a cemented stem.
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Affiliation(s)
- Ameen Barghi
- Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
| | - Philip Hanna
- Department of Orthopaedics, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Stoneman 10, Boston, MA, 02215, USA
- Harvard Medical School Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA, USA
| | - Nelson Merchan
- Department of Orthopaedics, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Stoneman 10, Boston, MA, 02215, USA
- Harvard Medical School Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA, USA
| | - Michael J Weaver
- Harvard Medical School Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - John Wixted
- Department of Orthopaedics, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Stoneman 10, Boston, MA, 02215, USA
- Harvard Medical School Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA, USA
| | - Paul Appleton
- Department of Orthopaedics, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Stoneman 10, Boston, MA, 02215, USA
- Harvard Medical School Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA, USA
| | - Edward Rodriguez
- Department of Orthopaedics, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Stoneman 10, Boston, MA, 02215, USA.
- Harvard Medical School Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA, USA.
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Pearce RJ, Cazzulino A, Swarup I. Rates and Factors Associated With Hardware Removal in Physeal Ankle Fractures: Analysis of the Pediatric Health Information System. Foot Ankle Orthop 2023; 8:24730114231182396. [PMID: 37425339 PMCID: PMC10328018 DOI: 10.1177/24730114231182396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Background Ankle fractures are among the most common physeal fractures in children. When surgical management is warranted, subsequent hardware removal remains controversial. This study was designed to determine rates of hardware removal in patients with physeal ankle fractures and identify risk factors for removal. Procedure data was utilized to compare rates of subsequent ankle procedures in patients with hardware removed and hardware retained. Methods We conducted a retrospective cohort study utilizing data from the Pediatric Health Information System (PHIS) for the years 2015 through 2021. We longitudinally followed patients treated for distal tibia physeal fractures to determine the rates of hardware removal and subsequent ankle procedures. Patients with open fractures or polytrauma were excluded. We used univariate, multivariate, and descriptive statistics to characterize the rates of hardware removal, identify factors associated with removal, and assess the rates of subsequent procedures. Results This study included 1008 patients who underwent surgical management of a physeal ankle fracture. The mean age at index surgery was 12.6 years with an SD of 2.2 years, and 60% of patients identified as male. Two hundred forty-two patients (24%) had their hardware removed at an average time of 276 days (range, 21-1435 days) following index surgery. Patients with Salter Harris III (SH-III) or Salter Harris IV (SH-IV) fractures had hardware removed more often than patients with Salter-Harris II (SH-II) fractures (28.9% vs 11.7%, P < .01). Four-year rates of subsequent ankle procedures are similar between patients with hardware removed and hardware retained. Conclusion The rate of hardware removal in children with physeal ankle fractures is higher than previously reported. Patients of younger age, higher income, and with fractures involving the epiphysis (SH-III and SH-IV) are more likely to undergo hardware removal. Level of Evidence Level III, retrospective study.
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Affiliation(s)
- Robert J. Pearce
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Alejandro Cazzulino
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Ishaan Swarup
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
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Kellam PJ, Cutshall ZA, Dekeyser GJ, Rothberg DL, Higgins TF, Haller JM, Marchand LS. Recovery Curve for Patients With Pilon Fractures Using Patient-Reported Outcome Measurement Information System. Foot Ankle Int 2023; 44:317-321. [PMID: 36932665 DOI: 10.1177/10711007231156424] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
BACKGROUND The time frame in which patients can expect functional improvement after open reduction internal fixation (ORIF) of pilon fractures is unclear. The purpose of this study was to determine the trajectory and rate at which patients' physical function improves up to 2 years postinjury. METHODS The patients studied sustained a unilateral, isolated pilon fractures (AO/OTA 43B/C) and followed at a level 1 trauma center over a 5-year period (2015-2020). Patient-Reported Outcomes Measurement Information Systems (PROMIS) Physical Function (PF) scores from these patients at defined follow-up times of immediately, 6 weeks, 3 months, 6 months, 1 year, and 2 years after surgery defined the cohorts and were retrospectively studied. RESULTS There were 160 patients with PROMIS scores immediately postoperatively, 143 patients at 6 weeks, 146 patients at 12 weeks, 97 at 24 weeks, 84 at 1 year, and 45 at 2 years postoperatively. The average PROMIS PF score was 28 immediately postoperatively, 30 at 6 weeks, 36 at 3 months, 40 at 6 months, 41 at 1 year, and 39 at 2 years. There was a significant difference between PROMIS PF scores between 6 weeks and 3 months (P < .001), and between 3 and 6 months (P < .001). Otherwise, no significant differences were detected between consecutive time points. CONCLUSION Patients with isolated pilon fractures demonstrate the majority of their improvement in terms of physical function between 6 weeks and 6 months postoperatively. No significant difference was detected in PF scores after 6 months postoperatively up to 2 years. Furthermore, the mean PROMIS PF score of patients 2 years after recovery was approximately 1 SD below the population average. This information is helpful in counseling patients and setting expectations for recovery after pilon fractures. LEVEL OF EVIDENCE Level III, prognostic.
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Affiliation(s)
- Patrick J Kellam
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Zachary A Cutshall
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Graham J Dekeyser
- Department of Orthopaedic Surgery, Oregon Health Sciences University, Portland, Oregon, USA
| | - David L Rothberg
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Thomas F Higgins
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Justin M Haller
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Lucas S Marchand
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
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Delmon R, Vendeuvre T, Pries P, Aubert K, Germaneau A, Severyns M. Percutaneous balloon calcaneoplasty versus open reduction and internal fixation ( ORIF) for intraarticular SANDERS 2B calcaneal fracture: Comparison of primary stability using a finite element method. Injury 2023:S0020-1383(23)00272-3. [PMID: 36997362 DOI: 10.1016/j.injury.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/25/2023] [Accepted: 03/13/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION Fractures of the calcaneus are common, with 65% being intra-articular, which can lead to a major impairment of the patient's quality of life. Open reduction and internal fixation with locking plates can be considered as gold-standard technique but has a high rate of post-operative complications. Minimally invasive calcaneoplasty combined with minimally invasive screw osteosynthesis is largely drawn from the management of depressed lumbar or tibial plateau fractures. The hypothesis of this study is that calcaneoplasty associated with minimally invasive percutaneous screw osteosynthesis presents biomechanical characteristics comparable with conventional osteosynthesis. MATERIALS AND METHODS Eight hind feet were collected. A SANDERS 2B fracture was reproduced on each specimen, while four calcanei were reduced by a balloon calcaneoplasty method and fixed with a lateral screw, four others were manually reduced and fixed with conventional osteosynthesis. Each calcaneus was then segmented for 3D finite element modeling. A vertical load was applied to the joint surface in order to measure the displacement fields and the stress distribution according to the type of osteosynthesis. RESULTS Analyses of the intra-articular displacement fields showed lower overall displacements in calcaneal joints treated with calcaneoplasty and lateral screw fixation. Better stress distribution was found in the calcaneoplasty group with lower equivalent joint stresses. These results could be explained by the role of the PMMA cement as a strut, enabling better load transfer. CONCLUSION Balloon Calcaneoplasty combined with lateral screw osteosynthesis has biomechanical characteristics at least comparable to locking plate fixation in the treatment of SANDERS 2B calcaneal joint fractures in terms of displacement fields and stress distribution under the premise of anatomical reduction.
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Affiliation(s)
- Romain Delmon
- Orthopedic and Traumatology department, University Hospital of Poitiers, Poitiers, France
| | - Tanguy Vendeuvre
- Orthopedic and Traumatology department, University Hospital of Poitiers, Poitiers, France; Pprime Institut UPR 3346, CNRS - University of Poitiers - ENSMA, Poitiers, France
| | - Pierre Pries
- Orthopedic and Traumatology department, University Hospital of Poitiers, Poitiers, France
| | - Kevin Aubert
- Pprime Institut UPR 3346, CNRS - University of Poitiers - ENSMA, Poitiers, France
| | - Arnaud Germaneau
- Pprime Institut UPR 3346, CNRS - University of Poitiers - ENSMA, Poitiers, France
| | - Mathieu Severyns
- Orthopedic and traumatology department, Clinique Porte Océane, Les Sables d'Olonne, France.
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