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During the last decades, effective pain reduction and early mobilization were identified as the central priorities in therapy of insufficiency fractures of the pelvis. For operative treatment minimally-invasive stabilization techniques are favored. While there is consensus on the significance of sufficient dorsal stabilization the role of additional fixation of the anterior fracture component stays under discussion. Within the present study we developed an internal ring fixator system (RingFix) with the question whether an in-itself-closed construct can improve stability of the entire ring structure. RingFix was evaluated on an osteoporotic bone model with a standardized FFP IIIc fracture within an established biomechanical setup regarding its primary stabilization potential. Further, it was compared to transiliac–transsacral screw fixation with and without stabilization of the anterior fracture component. The transiliac–transsacral fixation with separate screw fixation of the anterior fracture showed significantly higher stability than the RingFix and the transiliac–transsacral screw fixation without anterior stabilization. Our results show that stabilization of the anterior fracture component relevantly improves the stability of the entire ring construct. As a bridging stabilizer, RingFix shows biomechanical advantages over an isolated dorsal fracture fixation, but inferior results than direct stabilization of the single fracture components. [ABSTRACT FROM AUTHOR]

Background: Tibial shaft fractures (TSFs) are among the most common long bone injuries often resulting from high-energy trauma. To date, musculoskeletal complications such as fracture-related infection (FRI) and compromised fracture healing following fracture fixation of these injuries are still prevalent. The relatively high complication rates prove that, despite advances in modern fracture care, the management of TSFs remains a challenge even in the hands of experienced surgeons. Therefore, the Fracture-Related Outcome Study for operatively treated Tibia shaft fractures (F.R.O.S.T.) aims at creating a registry that enables data mining to gather detailed information to support future clinical decision-making regarding the management of TSF's.Methods: This prospective, international, multicenter, observational registry for TSFs was recently developed. Recruitment started in 2019 and is planned to take 36 months, seeking to enroll a minimum of 1000 patients. The study protocol does not influence the clinical decision-making procedure, implant choice, or surgical/imaging techniques; these are being performed as per local hospital standard of care. Data collected in this registry include injury specifics, treatment details, clinical outcomes (e.g., FRI), patient-reported outcomes, and procedure- or implant-related adverse events. The minimum follow up is 12 months.Discussion: Although over the past decades, multiple high-quality studies have addressed individual research questions related to the outcome of TSFs, knowledge gaps remain. The scarcity of data calls for an international high-quality, population-based registry. Creating such a database could optimize strategies intended to prevent severe musculoskeletal complications. The main purpose of the F.R.O.S.T registry is to evaluate the association between different treatment strategies and patient outcomes. It will address not only operative techniques and implant materials but also perioperative preventive measures. For the first time, data concerning systemic perioperative antibiotic prophylaxis, the influence of local antimicrobials, and timing of soft-tissue coverage will be collected at an international level and correlated with standardized outcome measures in a large prospective, multicenter, observational registry for global accessibility.Trial Registration: ClinicalTrials.gov : NCT03598530 . [ABSTRACT FROM AUTHOR]

Objectives: This study aims to explore the clinical efficacy of applying a new reduction brace in the closed reduction of femoral shaft fracture. Methods: A total of 18 patients with femoral shaft fracture, who were admitted to the Bone Trauma Surgery, Second Hospital of Shanxi Medical University, from September 2015 to January 2017, were chosen. A novel reduction brace combined with closed reduction intramedullary nail insertion on the traction table adopted for the orthopedic surgery was taken for the fixation. Then, surgical time, bleeding amount, and postoperational fracture healing time were recorded. Results: All 18 patients with femoral shaft fracture successfully received closed reduction femoral nail with the application of the novel reduction brace. The follow-up period was 3–18 months, with an average of 12 months, and the femoral shaft fracture was well healed with good recovery of function. Conclusions: The design of the closed reduction brace of the femoral shaft fracture was reasonable, simple, and convenient to use and has a short learning curve. Furthermore, it led to little trauma to these patients and fully played the advantages of minimally invasive therapy for femoral fractures. [ABSTRACT FROM AUTHOR]

For this study all autopsy reports of non-natural deaths performed at the Institute of Legal Medicine at the University of Cologne from a 10-year period (2008-2017) were examined in regards to the manner of non-natural death and their frequency and distribution of bone injuries (BI). 2026 cases (220 homicides, 421 suicides, 760 accidents, 393 possible suicides, 232 possible accidents) were reviewed. The highest frequency of BI was registered within homicides with 89.1%, second being accidents (79.3%), while suicides and poss. suicides were at 53.4% and 43.3%. Gunshots/explosions split between 52% for suicides and 33.6% for homicides, sharp force was to 56% found within homicides and with 29.8% in suicides. 63.7% of all blunt force was found in the accident category. The highest participation of BI and injuries across all body regions was found with gunshot homicides (100% BI, over every region). Intoxication showed the lowest BI over all with only 19.9% of all cases. Albeit several distinctive patterns were found, e.g. distinction between gunshots in suicides and homicides or high amount of BI in decayed corpses in homicides, a close examination on case by case basis, utilizing the forensic toolkit to its fullest, should always be attempted when examining decomposed or skeletal remains. [ABSTRACT FROM AUTHOR]

Purpose: Corticotomy is an integral part of the Ilizarov method on management of infected nonunited fractures that are challenging orthopaedic surgeons. However, the presence of active draining sinuses may contaminate the operative field with the potential of developing corticotomy site infection. The authors present a surgical technique aiming at minimizing or avoiding the risk of surgical site infection (SSI) in the corticotomy zone.Patients and Methods: A total of 144 cases of draining infected nonunions were treated by Ilizarov fixator using the corticotomy-first technique. The study included humeral (18 cases), femoral (52 cases), and tibial (74 cases) nonunions. The mean age was 44.48 years with 87 males and 57 females. The mean duration of nonunion was 28.69 months. After debridement, the combined shortening and nonunion gap averaged 5.98 (range 3-10) cm. Evaluation of bone and functional results was done according to Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria.Results: The follow-up period averaged 51.05 (range 36-72) months. None of the cases developed corticotomy site or distraction gap infection. Union was successfully achieved in 141 cases (97.92%). Nonunion persisted in three cases (2.08%) in the distal tibia. Infection was eventually controlled in 138 cases (95.83%). Bone grafting was not needed in any case.Conclusions: The Ilizarov fixator with the corticotomy-first technique was effective in the management of draining infected non-united fractures of long bones while avoiding the SSI in the corticotomy site in all cases. [ABSTRACT FROM AUTHOR]

Traditionally, tongue-type calcaneal fractures have been treated using internal fixation. External fixation has been described to a lesser degree in the treatment of these injuries, though not in the setting of an open fracture. We present a case of an open tongue-type calcaneal fracture treated with external fixation, utilizing a tensioned wire affixed to the frame that imparts compression across the fracture site. With this method, maximal respect to the soft tissues is rendered, and soft tissue insult is minimized. This patient achieved timely soft tissue coalescence and fracture union, with a return to pre-injury activities. To our knowledge, this technique has not been previously described in the treatment of an open calcaneal fracture of the posterior tuberosity. [ABSTRACT FROM AUTHOR]

Introduction: Distal radius fractures (DRF) are the most common fractures of the upper extremities. The incidence is expected to continue rising in the next years due to the increased life expectancy. Palmar locking plate stabilizing has since become the standard treatment for dorsally displaced DRF with a complication rate of 8-39% reported in the literature. Main aim of this study was to investigate the incidence of complications after DRF stabilization using palmar angular stable locking plate.Methods: A retrospective medical records review conducted from January 2013 to December 2016 included a total of 392 patients with DRF, that were stabilized using palmar angular stable locking plate and showed a minimum follow-up of 3 months. The group comprised 259 female and 133 male patients with a mean follow-up interval of 11 months (range 3-52 months). All recorded complications were documented. Range of motion (ROM) in extension, flexion, supination, pronation, radial- and ulnar deviation of the last follow-up was noted. Age was divided into younger than 65 years (< 65 years) and older than 65 years (≥ 65 years). The primary, immediate postoperative and final checkup radiographs were scrutinized for alignment and intra-articular step-off.Results: A total of 51 (13%) early and 17 late (4%) complications were recorded in 392 patients. The most common complications included carpal tunnel syndrome (3%), complex regional pain syndrome (3%) and loss of reduction (2%). Of the 68 complications, only 25 (6%) were directly related to the plate. 73% of all complications occurred in AO type C fractures. Patients without complications showed a significantly better ROM in extension, flexion, pronation and supination than patients with complications. No significant differences in incidence of complications, ROM or loss of reduction could be found between patients over and under 65 years of age. Gender and type of immobilization showed no significant influence on the complication rate.Conclusions: Stabilization of DRF by palmar angular stable locking plate is a safe form of treatment. In the majority of the cases a good clinical and radiological outcome with no complications was documented. Gender and type of immobilization had no impact on the complication rate and an age over 65 years is not associated with an increased risk for complications or restricted ROM. [ABSTRACT FROM AUTHOR]

Background: The added value of routine radiography in the follow-up of extremity fractures is unclear. The aim of this systematic review was to create an overview of radiography use in extremity fracture care and the consequences of these radiographs for the treatment of patients with these fractures.Materials and Methods: Studies were included if they reported on the use of radiography in the follow-up of extremity fractures and on its influence on treatment strategy, clinical outcome, or complications. A comprehensive search of electronic databases (i.e., PubMed, Embase, and Cochrane) was performed to identify relevant studies. Methodological quality was assessed with the Newcastle-Ottawa scale for cohort studies. Level of evidence was assessed using GRADE. The search, quality appraisal, and data extraction were performed independently by two researchers.Results: Eleven studies were included. All studies were retrospective cohorts. Of these, only two used a comparative design. Two of the included studies described fractures of both the upper and lower extremities, four studies concerned fractures of the lower extremity only, and five studies focused on fractures of the upper extremity. Pooling of data was not performed because of clinical heterogeneity. Eight studies reported on a change in treatment strategy related to radiography. Percentages ranged from 0 to 2.6%. The overall results indicated that radiographs in the follow-up of extremity fractures seldom alter treatment strategy, that the vast majority of follow-up radiographs are obtained without a clinical indication and that detection of a complication on a radiograph, in the absence of clinical symptoms, is unlikely. All included studies were regarded of a 'very low' level using GRADE.Conclusions: Based on current literature, the added value of routine radiography in the follow-up of extremity fractures seems limited. Results, however, should be interpreted with care, considering that available evidence is of a low level. [ABSTRACT FROM AUTHOR]

Surgical approach selection and fixation of Hoffa fractures is difficult and remains controversial. Evolving trends emphasize the importance of fracture morphology, fracture location, and comminution, all of which guide decisions regarding surgical approach and implant selection. This focused review highlights factors affecting Hoffa fracture available surgical approaches, treatment outcomes, and recommendations for selecting an optimal approach. [ABSTRACT FROM AUTHOR]

Distal femoral diaphyseal fractures in six dogs about 10-22 months old with body weight ranging from 12-25 kg were stabilized with String of Pearls (SOP) (Orthomed, UK) locking plates along with standard cortical and cancellous screws following standard AO/ASIF principles. Selection of appropriate size of plate and screws was according to body weight and type of fracture (2.7mm plate for dogs below 12 kg body weight and 3.5 mm plate for dogs above 12 kg body weight) which provided good fracture stability. The outcome of fracture stabilization and healing was evaluated with lameness grading and radiography. Postoperatively, all the animals showed weight bearing with early functional limb usage of grade I lameness and good joint mobility in an average of 7 weeks. Functional outcome was excellent in good in four cases and excellent in two cases. The average overall healing time in all the cases was 7-11 weeks. The fractures showed radiographically excellent postoperative healing of cortical union, absence of fracture lines with limited and also bridging callus. Based on present study, it was concluded that, String of Pearls (SOP) locking plates were good for stabilization of distal femoral diaphyseal fractures for early limb ambulance and healing. [ABSTRACT FROM AUTHOR]

In the United States, more than 300,000 hip fractures occur annually in the elderly population with associated significant morbidity and mortality. Both intracapsular and extracapsular hip fractures have inherent treatment challenges and therefore are at risk of nonunion complications. A systematic assessment including radiographic, metabolic, and infectious evaluations should be completed for all patients suspected of nonunion. Failed internal fixation of intracapsular hip fractures is typically treated with arthroplasty, while extracapsular proximal femur nonunions may be amenable to revision internal fixation or arthroplasty. While not a classic hip fracture, bisphosphate associated subtrochanteric femur fractures affect a similar patient population and are historically difficult to treat. Atypical subtrochanteric femur fractures are at increased risk of nonunion given the altered biologic environment secondary to bisphosphonate use; therefore adjuvant therapies may be beneficial in setting of revision fixation. Having a thorough understanding of nonunion risks, recognition, evaluation, and treatment is necessary for appropriate patient care. [ABSTRACT FROM AUTHOR]

Bone fractures represent a significant medical morbidity among aged population with osteoporosis. Bone morphogenetic proteins (BMPs) are suggested to have therapeutic potential to enhance fracture healing in such patients. Though BMP-mediated fracture healing has been well-documented in preclinical models, there has been no clinical study that demonstrated unequivocally that indeed a BMP when presented with an appropriate scaffold could provide basis for robust outcome for delayed or non-union diaphyseal bone fractures. This review presents a comprehensive insight towards the existing knowledge on the role of BMP signaling in bone formation and maintenance. Also therapeutic options based on BMP biology are discussed.A novel osteoinductive autologous bone graft substitute (ABGS) aimed to accelerate bone regeneration was developed and is currently being tested in the clinical setting. It comprises of a biologically compatible autologous carrier made from the patient's peripheral blood (autologous blood coagulum, ABC) and of rhBMP6 as an active ingredient. Such formulation circumvents the use of animal-derived materials, significantly limits inflammatory processes common in commercial bone devices and renders the carrier flexible, malleable, and injectable ensuring the ease of use. The ongoing clinical trials result will provide more detailed insights into the safety, tolerability, pharmacokinetics, and bone healing effects in humans and potentially provide novel and safe therapeutic options for bone repair. [ABSTRACT FROM AUTHOR]

Intra-articular fractures of the distal humerus are complex injuries that can considerably limit elbow function if not treated appropriately. Surgical management is indicated for most intra-articular distal humerus fractures with the goal of restoring elbow range of motion and function. Open reduction and internal fixation (ORIF) with plates and screws has been the preferred surgical option. Double plating is recommended for bicolumnar fractures and plates can be applied either parallel or orthogonal to each other. Surgical approach for ORIF of the distal humerus can be performed through an olecranon osteotomy, but other approaches that preserve the olecranon are also in use, such as the triceps-reflecting, triceps-splitting, paratricipital, and triceps-reflecting anconeus pedicle approach. The ulnar nerve is identified during the approach, followed by either in situ decompression or anterior transposition. Elbow arthroplasty has also emerged as a viable alternative to ORIF for fixation of these fractures in elderly patients with poor bone quality. [ABSTRACT FROM AUTHOR]

Background: This systematic review aims to determine the effectiveness of surgical and non‐surgical management for the type B ankle fracture with minimal talar shift. Methods: Two authors independently systematically searched the following databases: MEDLINE, EMBASE and CENTRAL. Only randomized controlled trials were included that evaluated surgical versus non‐surgical management of type B ankle fracture with minimal talar shift in adults. Two authors independently performed study selection, risk of bias assessment and data extraction. Main outcomes extracted were general health and ankle function. Heterogeneity was assessed using I2 and chi‐squared statistic. Data were pooled using fixed effect where appropriate. Results: Two studies were included involving 241 patients. The pooled mean difference for the physical component score was 0.60 (95% confidence interval (CI): −1.62 to 2.82) non‐significantly favouring surgical management. One study reported no significant difference in ankle function (mean difference: 3.20; 95% CI: −6.56 to 12.96) whilst the other reported a significant difference favouring non‐surgical management (mean difference: 3.20; 95% CI: 0.44–5.96). Ankle function scores were not pooled due to heterogeneity. Meta‐analysis showed that the surgical group was more likely to develop a minor infection (odds ratio: 12.46; 95% CI: 2.29–67.78) or undergo hardware removal (odds ratio: 4.40; 95% CI: 1.09–17.84). There was no significant difference in major infection between the two groups (odds ratio: 4.03; 95% CI: 0.44–36.65; favouring non‐surgical management). Conclusion: There was no significant difference in the general health outcome or ankle function for patients treated surgically versus non‐surgically at 12 months. Further follow‐up is needed to evaluate longer‐term ankle function. [ABSTRACT FROM AUTHOR]

Purpose: Greater tuberosity fractures (GTFs) account for 17 to 21% of proximal humerus fractures, most of these fractures are treated conservatively, but treatment for displaced fractures is still controversial. The aim of this study is to compare intra-operative clinical conditions and post-operative outcomes when displaced GTFs are treated with either proximal humeral internal locking system (PHILOS) or mini locking plate with trans-osseous sutures.Methods: This is a retrospective study conducted in Shanghai Tenth People's Hospital. A total of 60 patients (22 males and 38 females) with displaced humeral GTF between May 2013 and March 2017 were included, of whom 43 underwent PHILOS implant treatment and 17 underwent titanium mini plate implant with trans-osseous suture treatment. Intra-operative (incision size, intra-operative blood loss, operative duration) and postoperative (Constant-Murley score (CMS) and implant cost) variables were recorded for the comparison.Results: Mini locking plate with trans-osseous sutures shows better results. Operative duration (PHILOS mean 77.0 minutes vs mean 63.7 minutes, p value < 0.05), blood loss during surgery (PHILOS mean 111.5 vs 66.5 ml, p value < 0.05), incision size (PHILOS mean 7.2 vs 4.6 cm, p value < 0.05), CMS (PHILOS mean 81.0 vs 87.3, p value < 0.05), and implant costs (PHILOS mean 26,192.6 renminbi (RMB) vs mean 21,358.8 RMB, p value < 0.05). On the other hand, 9.30% of impingement in the PHILOS group was observed to have no complications compared to the mini locking plate group.Conclusions: Mini locking plate with trans-osseous sutures shows better efficacy in reducing the incision size, operative duration, intraoperative blood loss, and implant cost and in improving CMS. No complication was found with its use. Our data can provide rationale and inform sample- size calculations for such studies. Larger, control studies are needed for better understanding. [ABSTRACT FROM AUTHOR]

Introduction: Zygomaticomaxillary complex (ZMC) fractures are a group of fractures that can significantly alter the structure, function, and appearance of the midface, including the globe. Like other facial fractures, the optimal management of operative ZMC fractures requires anatomic reduction of all fractures followed by rigid internal fixation. However, surgical treatment of these fractures can be quite challenging with potential for high rates of complications. Materials and Methods: A total of 84 articles were identified through the database searches. Articles which were found to be review papers, summaries of other studies, or contained no data to inform the research questions were rejected, and a total of 34 articles were included in the review. Discussion: The ZMC fracture is also known as a quadripod fracture or quadramalar fracture, and formerly referred to as a tripod fracture or trimalar fracture has four components: The lateral orbital wall, separation of the maxilla and zygoma along the anterior maxilla, the zygomatic arch and the orbital floor near the infraorbital canal. The buttress is of two types (1) horizontal buttress and (2) vertical buttress. Classification - non displaced, displaced, comminuted, orbital wall fracture, zygomatic arch fracture knight, and north classification. Clinical features (1) anesthesia/paraesthesia of that side of the face, (2) inability to open the mouth, and (3) flattening of zygomatic area. Diagnosis - (1) computed tomography scan imaging, (2) endoscopy, and (3) enophthalmos. Majority of the patients were managed conservatively or Gillie's procedure. Conclusion: The discussion about zygomatic complex fracture includes buttress system, classification, clinical features, diagnosis, and treatment. Surgical technique results in good bony alignment and esthetics. From this review, awareness on zygomatic complex fracture and treatment available for zygomatic complex fracture is known. [ABSTRACT FROM AUTHOR]

Introduction: We aim to review the incidence and risk factors for the development of intraoperative periprosthetic femur fractures while performing a bipolar hemiarthroplasty for displaced neck of femur fractures. Our secondary aim is to characterize the types of intraoperative periprosthetic fractures, the steps leading to the fractures, and the salvage treatments instituted.Materials and Methods: 271 patients treated with bipolar hemiarthroplasty after traumatic displaced femoral neck fractures were retrospectively analyzed. Demographic data, co-morbidities, vitamin D level, consumption of steroids, ASA score, surgical approach, surgeon experience, use of cemented or uncemented implants, proximal femur morphology, and types of anaesthesia were analyzed statistically.Results: There were 28 patients (10.3%) with intraoperative periprosthetic femur fractures. We found two significant independent risk factors which were the use of uncemented prosthesis (OR 4.15; 95% CI 1.65-10.46; p = 0.003) and Dorr type C proximal femurs (Dorr A OR 3.6; 95% CI 1.47-8.82; p = 0.005). In addition, patients with Dorr type C proximal femurs who underwent uncemented bipolar hemiarthroplasty were more likely to sustain an intraoperative periprosthetic fracture (14(73.7%) out of 19 patients; p = 0.002). There were no significant differences found in other risk factors. The most common location for these fractures was at the greater trochanter at 11 (39.3%) cases. Majority of them, 15 (53.6%), had intraoperative fractures during trial implant insertion and reduction.Conclusion: The overall incidence of intraoperative periprosthetic femur fractures during hemiarthroplasty for displaced neck of femur fractures was 10.3%. The incidence was significantly higher for uncemented (14.7%) when compared to cemented prosthesis (5.4%) and the greater trochanter was the commonest area for periprosthetic fractures during trial implant insertion and reduction. Uncemented prosthesis and Dorr type C proximal femurs were two significant independent risk factors contributing to intraoperative periprosthetic fractures. By identifying these risk factors, surgeons can take ample precautions to prevent complications. [ABSTRACT FROM AUTHOR]

Introduction: It is likely that posterior-wall involvement in association with two-column fractures plays a pivotal role in outcomes because of the potential for hip instability if it is not anatomically reduced and fixed. Uncertainty remains about how this fracture is best treated, especially regarding how posterior-wall involvement may affect functional results.Materials and Methods: To better understand the role that posterior-wall involvement may play in determining functional results, we compared data for outcomes for patients with posterior-wall involvement and for those without in a consecutive series of two-column fractures. Between 2000 and 2013, 42 patients who underwent surgical treatment for two-column acetabular fractures were evaluated after a minimum follow-up period of 1 year. Data were prospectively collected and retrospectively evaluated. Of the 42 patients, 25 had only a two-column fracture (group 1) and 17 had a two-column fracture with posterior-wall involvement (group 2).Results: There were no differences between groups in terms of reduction accuracy, radiographic results, clinical results, or complication rates. All hips in patients with internal fixation for the associated posterior-wall fracture had anatomical reduction. At the latest follow-up evaluation, three patients from group 1 (without posterior-wall involvement) and three patients from group 2 (with posterior-wall involvement) had undergone total hip arthroplasty.Conclusion: These results suggest that a posterior-wall fracture in a two-column fracture does not compromise functional outcomes when the treatment algorithm discussed here is followed. [ABSTRACT FROM AUTHOR]

Background: Osteochondritis dissecans (OCD) is a disorder of unknown origin that can affect knees in skeletally mature and immature patients. Surgical management is an important cornerstone of treatment for unstable OCD lesions. Purpose: To determine the (1) healing rate after internal fixation of unstable OCD between skeletally immature and mature knees, (2) risk factors for failure, and (3) patient-reported outcomes among healed patients. Study Design: Cohort study; Level of evidence, 3. Methods: A multicenter retrospective cohort study was conducted with patients who underwent internal fixation of unstable knee OCD lesions from 2000 to 2015. Skeletal immaturity was defined as open or partially open physes. Healing was assessed through clinical findings and imaging. Definitive reoperation for the same OCD lesion was classified as failure. Results: Among 87 patients included, 66 (76%) had healed lesions at ≥2 years postoperatively, while 21 (24%) failed. Skeletal maturity made no significant difference in failure rate (risk ratio, 0.68; 95% CI, 0.29-1.72; P = .40). For skeletally immature patients, lateral versus medial condylar location conferred an increased hazard of 18.2 (95% CI, 1.76-188.07; P < .01). Multivariate analysis factoring in skeletal maturity showed that lateral condylar location was an independent risk factor for failure (hazard ratio, 4.25; 95% CI, 1.47-19.85; P < .01). Mean patient-reported outcome scores (International Knee Documentation Committee [IKDC] and Knee injury and Osteoarthritis Outcome Score [KOOS]) increased significantly after surgery, except the KOOS symptoms score for the skeletally mature group. Final scores (mean ± SD) were as follows at a mean follow-up of 60 months (range, 24-166): IKDC, 83.5 ± 20.2; KOOS pain, 89.7 ± 14.1; KOOS symptoms, 87.4 ± 18.4; KOOS activities of daily living, 93.9 ± 12.7; KOOS sports, 80.7 ± 25.9; KOOS quality of life, 78.9 ± 23.1. Conclusion: Skeletally immature and mature patients heal at comparable rates after internal fixation of OCD lesions, resulting in functional and subjective improvement. Lateral femoral condylar lesion location is an independent risk factor for failure. [ABSTRACT FROM AUTHOR]

BACKGROUND: Unilateral external fixators are widely used in orthopedics to stabilize fractured bones and in the treatment of limb deformities. The main value for evaluation of mechanical stability of the external fixator is fixator stiffness. The fixator stiffness is an important factor as it will influence the biomechanical environment to which fixator and regenerating tissues are exposed. OBJECTIVE: The main objective of this work was to monitor the transmission of stress and the change of displacement generated in fixator-bone system under three loading conditions during healing process. METHODS: In this study, a finite element model with changing Young's modulus of the callus is established, finite element analysis was used to investigating stress and deformation of fixator-bone system caused by axial load, torsional load and bending load during three healing stages. RESULTS: The results reveal that at different healing stages, stress distribution between the fixator and fractured bone is different, the position of displacement is mainly concentrated in the fracture site and proximal bone and with the increase of healing time, the deformation decreased. CONCLUSIONS: This work helps orthopedic doctors to monitor the progression of fracture healing and determine the appropriate time for removal of a fixation device and provide useful information. [ABSTRACT FROM AUTHOR]

Background: Triplane ankle fractures are complex transitional fractures that often necessitate surgical treatment. Axial fracture lines determine optimal screw trajectories for fixation. The purpose of our study was to identify fracture patterns in triplane fractures by illustrating fracture lines in the axial plane of the distal tibial metaphysis and epiphysis.Methods: We retrospectively reviewed records of children presenting with ankle fractures at 1 center from January 2007 through June 2017. Thirty-three cases of triplane fractures with available computed tomographic (CT) scans were identified. Fractures in the axial plane of the metaphysis were identified 10 mm proximal to the physis, and fractures in the epiphysis were identified midway between the physis and distal tibial articular surface. Fracture lines were drawn and were superimposed on unfractured bone templates to generate fracture maps, and heat maps were then created to show areas of high and low fracture densities.Results: In the metaphysis, the most common fracture pattern was medial-lateral lines in the posterior metaphysis. This metaphyseal pattern was consistent across 2, 3, 4, and 5-part fractures. There were clear zones of rare fracture involvement in the anterior and anterolateral metaphysis. In the epiphysis, anterior-to-posterior fracture lines were common in the anterior epiphysis. All cases had an epiphyseal fracture exit through the anterior epiphysis. Fracture extension into the posteromedial epiphysis was a feature of all fracture classes.Conclusions: Fracture mapping of triplane fractures suggests consistent axial fracture patterns in the metaphysis and epiphysis with additional class-dependent fractures in the epiphysis. This study provides visual guidelines to assist surgeons in understanding the axial fracture patterns of individual triplane fractures for surgical planning. [ABSTRACT FROM AUTHOR]

Purpose: Floating knee injuries are relatively uncommon injuries. We report the prevalence, location, and severity of heterotopic ossification (HO) around the knee in patients treated with antegrade tibial intramedullary nailing and ipsilateral antegrade versus retrograde femoral intramedullary nailing as well as how the severity of HO around the knee affects knee range of motion (ROM).Methods: From 2004 to 2014, 26 floating knee injuries were included. Radiographs were reviewed to determine presence, location, and severity of HO. Post-operative knee ROM was determined.Results: A significantly higher prevalence of HO around the knee was detected in the retrograde group (90%) compared to the antegrade group (43%) (p = 0.028). There was a trend for more HO into the patellar tendon occurring in 29% of patients in the antegrade group and 74% in the retrograde group (p = 0.069). The severity of HO was higher for the retrograde group 1.6 ± 1.0 compared to the antegrade group 0.4 ± 0.5 (p = 0.004). There was poor correlation between HO severity and knee ROM.Conclusions: Treatment of floating knee injuries with a retrograde femoral nail was demonstrated to result in a greater likelihood of developing HO and a greater severity of HO around the knee than if treated with an antegrade femoral nail. However, this increased severity of HO is unlikely to affect ROM.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to identify independent risk factors for surgical site infection (SSI) and quantify the incidence of SSI in tibial plateau fractures after open reduction and internal fixation (ORIF).Methods: This retrospective study was performed at a level 1 trauma centre from January 2015 to June 2016. Data of adult patients with tibial plateau fractures treated by ORIF were extracted from the electronic medical records. A total of 370 patients were collected. We reviewed the patients' demographics, characteristics of fracture, treatment-related variables, and indexes of laboratory examination. Multivariate logistic analysis models were performed respectively to determine independent predictors of SSI.Results: Twenty-one patients developed SSI in this study. The overall incidence of SSI after ORIF of tibial fracture was 5.7%, with six (1.6%) for deep infection and 15 (4.1%) for superficial SSI. Independent predictors of SSI identified by multivariate analysis were open fracture (odds ratio=4.53; 95% CI=1.64-15.26; p=0.000), intra-operative duration (odds ratio=2.72; 95% CI=1.17-6.29; p=0.020), and smoking (odds ratio=4.79; 95% CI=1.46-15.73; p=0.010).Conclusions: The SSI incidence was high (5.7%) after surgical tibial plateau fractures by ORIF and open fracture, operative time, and smoking were identified as independent related risk factors. Therefore, we recommend that a smoking cessation program is introduced immediately at the time of admission to hospital. More reasonable management strategies on open injury should be utilized to reduce the SSI rate. [ABSTRACT FROM AUTHOR]

Objective: To assess the results of open reduction and internal fixation with K-wires for displaced Supracondylar humerus fractures in children in an isolated forward treatment centre (FTC) in Neelum valley. Study Design: Cross-sectional descriptive series. Place and Duration of Study: This study was carried out at a FTC which is located in Tehsil Headquarters Hospital Kel valley from Dec 2013 to Feb 2015. Material and Methods: It was a cross sectional descriptive study. Data was collected form 24 patients who came to FTC Kel with displaced supracondylar fracture from Dec 2013 to Feb 2015. They were assessed for age, sex, etiology, time of surgery, pattern of fracture, hospital stay, infection and range of motion. Results: In our study majority of patients were found to be between 5-6 years of age (66%). The majority of the patients were males (83%). The commonest cause was fall from mountain tracks (62%). In our study we had twenty (83%) patients who had grade III displaced fracture. Ninety one percent underwent operation on the same day as the occurrence of injury (91%) patients were discharged on 3rd post op day. Twelve percent Patients had pin track infection and (4%) patients had iatrogenic nerve palsy which recovered spontaneously. Four percent patients developed superficial wound infection. There was loss of range of motion in six patients ranging from 0-5 degrees. Functional results based upon Flynn's grading system showed that we had 75% satisfactory result. Conclusion: We concluded that open reduction and internal fixation with k-wires at a remote station without the facility of image intensifier was safe and effective provided that the surgeon is confident in this procedure. [ABSTRACT FROM AUTHOR]

Background: Proximal humeral fracture is the 3rdmost common fracture among the elderly population account for approximately 5% of all fractures. More than 70% of patients with these fractures are of sixty years of age above of age out of them 75% are women3. Significant controversy present regarding the best methods of treating displaced proximal humerus fractures, which recently moved towards internal fixation by locking plates. Given study is related to evaluation of functional outcome of the surgical management of proximal humerus fractures by using proximal humeral locking compression plate. Methods: This prospective study had been conducted on 35 Patients with proximal humerus fractures treated with a proximal humeral locking compression plate at Dr. S.N. Medical college, Jodhpur from August 2016 to December 2018. Results: Our study is male predominant with high incidence in the 40 to 60 age group involving both shoulders almost equally. Majority of patient were having RTA (68.6%) followed by fall from height (20%). According to Neer's classification majority were 3-part fractures - 58%. In our series excellent results were noted in 7 patients (20%), good results in 14 (40%), moderate results in 11 (32%) and poor results in only 3 patients (8%), by Constant-Murley Scoring system.Mean time taken for fracture union in our study was 9weeks (with range of 6 to 12 week). Conclusion: Internal fixation with PHILOS plate is well founded operative option for displaced proximal humerus fracture which provides stable fixation, particularly in comminuted fractures that allows early mobilization in postoperative period. [ABSTRACT FROM AUTHOR]

Introduction: Several reconstructive procedures have been used in management of large tibial bone defects including bone graft, bone transport (distraction osteogenesis) using various external fixators, and vascularized bone graft. Each of these procedures has its limitations and complications. The study describes gradual medial fibular transfer using Ilizarov external fixators in management of patients with large tibial defect, either following infection or trauma.Patients and Methods: Between May 2011 and June 2013, 14 patients were prospectively included in the current study. The inclusion criteria were large tibial defect due to trauma or infection with severe soft tissue compromise, and small or poor tibial bone remnants making bone lengthening difficult. Exclusion criteria were patients with vascular or nerve injuries. The average age of the patients was 31.64 (± 6.5) years. Medial fibular transfer was done for all patients using Ilizarov at a rate of 0.5 mm twice daily. Iliac bone graft was used in all patients after the transfer.Results: The average segmental bone defect of the tibia was (13.2 ± 2.6), ranging between 8 and 18.6 cm. Union was achieved in all patients with average fixator time was 32.42 (± 4.32) weeks. Average follow-up after removal of the fixator was 40.5 (± 6.9) months.Conclusion: Gradual fibular transfer by Ilizarov external fixator is a reliable technique in management of post-traumatic and post-infection large tibial bone defects with good clinical outcome, and with few complications. [ABSTRACT FROM AUTHOR]

The articleoffers information on the pipkin classification of femoral head fractures. Topics discussed include management challenged posed by femoral head; subclassification of the Grade IV fracture-dislocations of the hip; and hip dislocation with a femoral head fracture caudad to the fovea capitis femoris.

Fractures of the rostral mandible in horses are the most common type of jaw fractures. The present study was performed for stabilization of rostral mandibular fracture with cerclage wire. In a retrospective case series, six client-owned horses with unilateral mandibular fractures were admitted to our clinic and suffered from a major gingival wound at rostral part of mandible. Rostral mandibular fracture was diagnosed through clinical examination and radiography. Fractured region was repaired by cerclage wire under the effect of general anesthesia and wires were maintained for 6-12 weeks. The repair of mandibular fracture by cerclage wiring exhibited good fracture reduction and fixation in five horses and fair results in one horse. After twelve weeks, the fracture healing was excellent practically and cosmetically. Furthermore, the horses appeared normal without any evidence of teeth-related mastication problems, obstinate fracture-site fistula, or extreme callus formation. Radiographically, cerclage wire achieved good fracture fixation and fracture gap closure. Moreover, the formation of uniting callus was noticed at 6-12 weeks post-operatively. It was concluded that, unilateral mandibular fracture in horses can successfully be repaired by interdental wiring (IDW). All horses were returned to their usual activities without any fracture healing-related masticatory problems at the time of follow-up. [ABSTRACT FROM AUTHOR]

Introduction: Distal femur fractures are one of the most common fractures encountered in high velocity trauma which are associated with high morbidity and mortality. The incidence of distal femoral fractures is approximately 37 per 100000 person per year. Fixation of intra-articular fractures is a challenge even to most experienced surgeons. The ideal treatment plan of intraarticular distal femur fracture is still open for debate. Aim: The aim of the present study was to determine the best functional outcome for distal third femur fracture treated by closed/open reduction using retrograde nailing or locked compression plating in respect to knee-flexion, early mobilisation and fracture union. Materials and Methods: A prospective study was carried out at KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, Karnataka, India, in which 40 patients with age >18 years were operated with either Retrograde nailing (20) or locked compression plating (20) for intra-articular and extra-articular distal femur fractures (July 2015 to June 2017). Patients with Grade 1 and 2 fractures (Gustillo-Anderson classification), who were medically fit, both males and females in the age group of 18 years and above were included in the study. Exclusion criteria included, patients having pathological fractures, who were not fit for surgery, was not willing for surgery, lost in follow up and distal femoral fractures with neurovascular compromise. We use chi-square test and fisher's exact test to find the p-value. Results: Patients who underwent retrograde nailing, showed average radiological union time of 14.6 weeks, average full weight bearing time of 12.4 weeks, average knee flexion of 113.4 degree with an extensor lag of 3 degree. Patients who underwent locked compression plating showed average radiological union time of 16.2 weeks, average full weight bearing time of 14.4 weeks, average knee flexion 106.3 degree with an extensor lag of 4.5 degree. According to Modified Neer's criteria 70% excellent results were found in Retrograde nailing and 65% excellent results were found in Locked compression plating. Conclusion: Retrograde nailing is a good fixation system for fractures of distal femur with better outcome in terms of range of movements, early mobilisation, less operative time and blood loss. [ABSTRACT FROM AUTHOR]

Introduction: The intact lateral wall plays a key role in stabilization of trochanteric fracture. Hence extreme precaution should be taken to prevent lateral wall damage during DHS fixation. Present study is aimed at evaluating the determinants of lateral wall fracture and its effect on outcome in intertrochanteric fracture femur treated with DHS.Material and Methods: This is a prospective study involving intertrochanteric fractures treated with DHS fixation from July 2013 to June 2014. Out of 135 patients 49(36.3%) had stable fractures and 86(63.7%) unstable fractures. Cortical thickness index (CTI) was measured to evaluate osteoporosis. Lateral wall thickness in anteroposterior radiograph was also measured.All patients underwent 135° DHS fixation.Postoperative x-rays are assessed for implant position, intactness of the lateral wall, tip apex distance (TAD) and medialization. Functional outcome was measured at the end of fracture union by modified Harris hip score and Parkers mobility score. Clinical information including age, gender, fracture classification, TAD, lateral wall thickness and functional outcome of the patients were subjected to statistical analysis.Results: 34 (19.5%) patients had lateral wall fractures. Medialization was found in 22 out of these 34 (64.7%) patients. The mean preoperative lateral wall thickness of these patients is 19.2mm, compared with 26.8mm in patients with intact lateral wall (p<0.001). The mean values of CTI and TAD are comparable in both the groups. In patients with intact lateral wall, mean Harris hip score is 73.1 compared to 65.5 in lateral wall fracture group (p<0.001). Preinjury mobility status was achieved in 70.2% of intact lateral wall patients, whereas only 32.3% (11) achieved that in lateral wall fracture group. Threshold for lateral wall thickness that could predict lateral wall fracture was found to be 21mm with 95% sensitivity and 88.2% specificity.Conclusion: Lateral wall fractures during DHS fixation are not uncommon and osteoporosis has no bearing on its occurrence. It alone can lead to poor radiological and functional outcome independent of TAD. Lateral wall thickness is a reliable predictor of intra operative lateral wall fracture during DHS fixation and nailing is a good option especially when lateral wall thickness is <21mm. [ABSTRACT FROM AUTHOR]

Acute compartment syndrome (ACS) after tibial fracture carries a risk of various complications, including infection, delayed union, nonunion, nerve damage, and poor prognosis. For the treatment of fractures with ACS, fasciotomy is conducted, and the method to stabilise the fracture has to be considered. Thirty-five patients who underwent surgery for ACS with tibial shaft fractures were evaluated, and the results of initial internal fixation (Group I, 20 patients) and initial external fixation (Group II, 15 patients) were analysed. The mean age was 41 years. Five patients needed additional surgery for bone union. Complications occurred in 4 cases, but no deep infection was reported. The time to bone union, the need for additional surgery, and the incidence of complications in Group I and Group II were not statistically different. For the treatment of ACS with tibial fracture, immediate internal fixation and changing from external fixation to internal fixation did not affect the clinical course. [ABSTRACT FROM AUTHOR]

Background: Atypical subtrochanteric fracture and femoral fracture have been considered to be rare complications related to long-term bisphosphonates use. A reduced bone turnover rate may lead to delayed bone healing. Limited data have revealed that teriparatide treatment may reverse the effect of bisphosphonates and be effective in bone healing.Methods: We reviewed patients with atypical subtrochanteric and femoral fracture related to bisphosphonates use between January 2008 and December 2014. Thirteen female patients were enrolled. Radiographic findings were compatible with the characteristics of atypical fracture. Surgical intervention was performed for all, and teriparatide use was advised postoperatively. Outcome measures included perioperative results, and clinical and radiographic outcome.Results: Of the 13 female patients enrolled, 10 had subtrochanteric and 6 had proximal femoral fracture; 3 had bilateral fractures. The mean age of the patients at surgery was 70.15±6.36 years. Most fractures (68.8%) presented prodromal thigh pain. All patients were treated with an intramedullary fixation system without severe complications. The patients were divided into 2 groups based on whether they had received treatment with teriparatide or not. The mean time to bone union was 4.4 months in the teriparatide-treated group, and 6.2 months in the non-teriparatide-treated group (p=0.116). Six patients (75%) in the teriparatide-treated group and 4 (50%) in the non-teriparatide-treated group (p= 0.3) achieved bone union within 6 months. The means of the modified Harris Hip Score and Numerical Rating Scale were significantly better in the teriparatide-treated group at postoperative 6 months. Seven patients had the same ability to walk at the 1-year follow-up as they did before the atypical fracture.Conclusions: Teriparatide treatment in patients with atypical fracture may help in fracture healing, hip function recovery, and pain relief in this reduced bone turnover patient group. [ABSTRACT FROM AUTHOR]

Metatarsal fractures represent a common fracture type accounting for 35% of all fractures within the foot and 5% of total skeletal fractures annually. Central metatarsal fractures are caused by excess torsional force applied to the bone or direct trauma, with most fractures being attributed to the latter. As with most fractures, minimally displaced fractures of the central metatarsals are amenable to conservative treatment including protected immobilization and RICE therapy. In general, physicians may be accepting of subtle displacement of central metatarsal fractures accepting up to 10 degrees of displacement and 3mm of translation in any direction. When displacement is too great, metatarsal fractures are treated with closed reduction with percutaneous pin fixation or ORIF with pin or single plate fixation. This case report presents a case of a gentleman who suffered from a comminuted metatarsal with a unique fracture pattern that required dual plating technique for proper reduction of the fracture. With this unique fracture type, dual plate technique optimized fixation in order to stabilize an unstable fracture of a second metatarsal in an obese patient with diabetes. [ABSTRACT FROM AUTHOR]

Purpose Fractures of the lateral condyle of the humerus in children are a common injury. If displaced or unstable they may require surgical reduction and fixation with Kirschner wires (K-wires). K-wires are placed using either an open or closed technique. The decision to bury or leave the ends extending through the skin is surgeon-dependent and based on factors including post-operative infection risk, bony union and ease of wire removal. Methods We performed a systematic review and meta-analysis of non-buried versus buried K-wires for lateral condyle elbow fractures in children in accordance with the Preferred Reporting Items for Systematic Reviews and Meta- Analyses methodology. A comprehensive search strategy included Medline, Embase and CINAHL via NICE Evidence from database inception to June 2017. Two authors independently reviewed, included or excluded articles, extracted data and assessed for quality with the ROBINS-I tool. We performed direct comparison meta-analysis for all adverse events, post-operative infection and failure of bony union. Results Three studies were analysed comprising of 434 participants. There was a significantly reduced relative risk of adverse events in the non-buried group, equating to approximately 45% reduced risk (RR 0.55, 95% confidence interval 0.34 to 0.88). There were no significant differences in risk of post-operative infection or failure of bony union. All three cost-analyses in the included studies observed savings with non-buried K-wires. [ABSTRACT FROM AUTHOR]

Background: Supracondylar humeral fracture in children is the most frequent one in the first decade of life. Closed reduction and percutaneous pinning has been adopted as the treatment of choice, and the outcome has relied mainly upon the perfection of reduction and the stability of fixation .Many configurations of pinning has been used. Objective: To evaluate the efficacy and safety of the closed reduction and lateral pinning in treating displaced supracondylar humeral fracture. Patients and Methods: Thirty-eight patients of extension type Gartland class III displaced SCHF in children aged (1.5-13) years had been included in this study in the period from April 2014 to July 2016 all of them had been treated by closed reduction and lateral percutaneous pinning .They were (26) males (68.4%) and (12) females (31.6%) and the mean age was( 5.8 ) years. The left side was injured in (25) patients (65.8%) and the right side was involved in (13)patients (34.2%). All cases had been operated within the first 24 hours of injury. Results: Stable and satisfactory reduction had been obtained in all cases except one, in whom failure of reduction occurred postoperatively. Allcases regained full-range of extension and flexion of elbow movement after about 3-4 months .Baumann's angle was( 76± 2.5) and (74±0.5) on the injured and normal sides respectively . In all cases the carrying angle of elbow was within normal limit .No neurovascular complication had been noted in the all cases. Conclusion: Percutaneous pinning using the lateral configuration technique found to be stable and safe method. [ABSTRACT FROM AUTHOR]

Objective Elderly patients suffer fractures through low-energy mechanisms. The distal radius is the most frequent fracture localization. Insulin-like growth factor-1 ( IGF1) plays an important role in the maintenance of bone mass and its levels decline with advancing age and in states of malnutrition. Our aim was to investigate the association of IGF1 levels, bone mass, nutritional status, and inflammation to low-energy distal radius fractures and also study if fracture healing is influenced by IGF1, nutritional status, and inflammation. Methods Postmenopausal women, 55 years or older, with low-energy distal radius fractures occurring due to falling on slippery ground, indoors or outdoors, were recruited in the emergency department ( ED) and followed 1 and 5 weeks after the initial trauma with biomarkers for nutritional status and inflammation. Fractures were diagnosed according to standard procedure by physical examination and X-ray. All patients were conservatively treated with plaster casts in the ED. Patients who needed interventions were excluded from our study. Fracture healing was evaluated from radiographs. Fracture healing assessment was made with a five-point scale where the radiological assessment included callus formation, fracture line, and stage of union. Blood samples were taken within 24 h after fracture and analyzed in the routine laboratory. Bone mineral density ( BMD) was measured by dual-energy X-ray absorptiometry ( DXA). Results Thirty-eight Caucasian women, aged 70.5 ± 8.9 years (mean ± SD) old, were recruited. Nutritional status, as evaluated by albumin (40.3 ± 3.1 g/L), IGF1 (125.3 ± 39.9 μg/L), body mass index (26.9 ± 3.6 kg/m2), arm diameter (28.9 ± 8.9 cm), and arm skinfold (2.5 ± 0.7 cm), was normal. A positive correlation was found between IGF1 at visit 1 and the lowest BMD for hip, spine, or radius ( r = 0.39, P = 0.04). High sensitive C-reactive protein (hs CRP) and leukocytes were higher at the fracture event compared to 5 weeks later ( P = 0.07 and P < 0.001, respectively). Fracture healing parameters (i.e. callus formation, fracture line, and stage of union) were positively correlated with the initial leukocyte count and to difference in thrombocyte count between visit 1 and 3. Conclusions In elderly women with low-energy distal radius fractures, an association between IGF1 and lowest measures of BMD was found, indicating that low IGF1 could be an indirect risk factor for fractures. Fracture healing was associated with initial leukocytosis and a lower thrombocyte count, suggesting that inflammation and thrombocytes are important components in fracture healing. [ABSTRACT FROM AUTHOR]

Background: Hoffa fractures, coronal-plane fractures involving the distal femoral condyles, are unstable, intra-articular fractures. The aim of this study was to define the location and frequency of fracture lines and comminution zones in Hoffa fractures using computed tomography (CT) mapping in both 2-dimensional and 3-dimensional contexts.Methods: Seventy-five Hoffa fractures (OTA/AO types 33B3.2 and 33B3.3) were retrospectively reviewed. The directions of fracture lines were characterized in the axial and sagittal CT planes. CT images for all fractures were superimposed on one another and oriented to fit a standard template. Mapping of fracture lines and comminution zones in both the axial and sagittal planes was performed. A 3-dimensional map was created by reducing reconstructed fracture fragments to fit to a model of the distal aspect of the femur.Results: This study included 1 bicondylar and 74 unicondylar (26 medial and 48 lateral) Hoffa fractures. Comminuted fractures accounted for 35.5% of all fractures and 44.9% of lateral fractures. Axial fracture mapping demonstrated that fracture lines were concentrated in the middle-third area of the lateral condyle but were less concentrated and with greater variation in the medial condyle. The mean angle of fracture lines with respect to the posterior condylar axis was 34.4° and 29.0° in the lateral and medial femoral condyles, respectively. Sagittal fracture mapping also demonstrated that fracture lines were concentrated in the middle third of the lateral condyle but were less concentrated in the medial condyle. The mean angle of fracture lines with respect to the posterior cortex of the distal femoral shaft was 23.1° and 19.3° in the lateral and medial condyles, respectively. Three-dimensional mapping demonstrated comminution zones commonly occurring in the weight-bearing zone of the lateral condylar articular surface.Conclusions: Hoffa fractures occurred more frequently in the lateral femoral condyle. In the axial plane, fractures commonly extended from anterolateral to posteromedial in the lateral condyle and from anteromedial to posterolateral in the medial femoral condyle. In the sagittal plane, fractures traversed from anteroinferior to posterosuperior. Articular comminution was more commonly seen in lateral condylar fractures and concentrated in the weight-bearing zone of the articular surface.Clinical Relevance: Research in this area is imperative for optimal preoperative planning, such as for the selection of surgical approach and fixation constructs. Our findings lend insight into fracture morphology, which can assist with fracture classification and the design of biomechanical studies, ultimately aiding in treatment. [ABSTRACT FROM AUTHOR]

Closed reduction and percutaneous screw fixation (CRIF) of iliac crescent fractures and fractures of the anterior column of the acetabulum has become an established method in the treatment of these injuries. After reduction, safe insertion of a guide wire is a key step during this procedure. We present a technique that can facilitate introducing the guide wire under fluoroscopic guidance and allow for decreased radiation exposure. [ABSTRACT FROM AUTHOR]

Background: Approximately one-third of reduced pediatric distal radius fractures redisplace, resulting in further treatment. Two major modifiable risk factors for loss of reduction are reduction adequacy and cast quality. Closed reduction and immobilization of distal radius fractures is an Accreditation Council for Graduate Medical Education residency milestone. Teaching and assessing competency could be improved with a life-like simulation training tool.Questions/purposes: Our goal was to develop and validate a realistic distal radius fracture reduction and casting simulator as determined by (1) a questionnaire regarding the "realism" of the model and (2) the quantitative assessments of reduction time, residual angulation, and displacement.Methods: A distal radius fracture model was created with radiopaque bony segments and articulating elbows and shoulders. Simulated periosteum and internal deforming forces required proper reduction and casting techniques to achieve and maintain reduction. The forces required were estimated through an iterative process through feedback from experienced clinicians. Embedded monofilaments allowed for quantitative assessment of residual displacement and angulation through the use of fluoroscopy. Subjects were asked to perform closed reduction and apply a long arm fiberglass cast. Primary performance variables assessed included reduction time, residual angulation, and displacement. Secondary performance variables consisted of number of fluoroscopic images, casting time, and cast index (defined as the ratio of the internal width of the forearm cast in the sagittal plane to the internal width in the coronal plane at the fracture site). Subject grading was performed by two blinded reviewers. Interrater reliability was nearly perfect across all measurements (intraclass correlation coefficient range, 0.94-0.99), thus disagreements in measurements were handled by averaging the assessed values. After completion the participants answered a Likert-based questionnaire regarding the realism of simulation. Eighteen participants consented to participate in the study (eight attending pediatric orthopaedic surgeons, six junior residents, four senior residents). The performances of junior residents (Postgraduate Year [PGY] 1-2), senior residents (PGY 3-5), and attending surgeons were compared using one-way ANOVA with Tukey's-adjusted pairwise comparisons.Results: The majority of participants (15 of 18) felt that the model looked, felt, and moved like a human forearm. All participants strongly agreed that the model taught the basic steps of fracture reduction and should be implemented in orthopaedic training. Attending surgeons reduced fractures in less time than junior residents (60 ± 27 seconds versus 460 ± 62 seconds; mean difference, 400 seconds; 95% CI, 335-465 seconds; p < 0.001). Residual angulation was greater for junior residents when compared with attending surgeons on AP (7° ± 5° versus 0.7° ± 0.9°; mean difference, 6.3°; 95% CI, 3°-11°; p = 0.003) and lateral (27° ± 7° versus 7° ± 5°; mean difference, 20°; 95% CI, 13°-27°; p = 0.001) radiographs. Similarly, residual displacement was greater for junior residents than either senior residents (mean difference, 16 mm; 95% CI, 2-34 mm; p = 0.05) or attending surgeons (mean difference, 15 mm; 95% CI, 3-27 mm; p = 0.02) on lateral images. There were no differences identified in secondary performance variables (number of fluoroscopic images, casting time, and cast index) between groups.Conclusions: This is the first distal radius fracture reduction model to incorporate an elbow and shoulder and allow quantitative assessment of the fracture reduction. This simulator may be useful in an orthopaedic resident training program to help them reach a defined minimum level of competency. This simulator also could easily be integrated in other accreditation and training programs, including emergency medicine.Level Of Evidence: Level II, therapeutic study. [ABSTRACT FROM AUTHOR]

Introduction: Isolated greater tuberosity (GT) fractures (AO 11-A1) tend to occur in the younger patient population and are poorly managed by most precontoured proximal humerus locking plates. The goal of this study was to identify and assess an alternative treatment strategy for greater tuberosity fractures.Materials and Methods: A retrospective review of all cases of isolated greater tuberosity fractures treated with a 2.4/2.7 mesh plate (Synthes) between 2010 and 2015 was conducted. Patient demographics, operative reports, and clinical notes were reviewed. The time to radiographic union was assessed. Clinical outcomes were retrieved from patients at their follow-up visits or via mailed Disabilities of the Arm, Shoulder, Hand (DASH) questionnaires.Results: Ten patients with isolated GT fractures treated with mesh plating were identified with an average age of 47.1 years. The average radiographic follow-up was 7.2 months and the average clinical follow-up was 8.0 months. The mean time to union was 8.5 weeks. Two patients underwent elective hardware removal. The mean DASH at final follow-up was 28.2 (±22.4), while the mean DASH work was 13.6 (±19.1).Conclusion: We have identified a viable alternative treatment option for the surgical management of isolated greater tuberosity fractures using a mesh plate that can be contoured to the patient's anatomy. Surgeons should be aware of this option for select patients. [ABSTRACT FROM AUTHOR]

Study Design: An experimental biomechanical study. Purpose: This study aims to investigate the behavior of a lamina injury in lumbar burst fractures during reduction maneuvers. Overview of Literature: Lumbar burst fractures are frequently accompanied by a lamina fracture. Many researchers concluded that any reduction maneuver will close the fractured lamina edges and possibly crush the entrapped neural elements. This conclusion did not rely on solid biomechanical trials and was based primarily on clinical experience. Methods: Eighteen fresh-frozen lamb spines were randomly divided into three groups. Using the preinjury and the dropped-mass technique, a burst fracture model was developed. A central laminectomy of 5 mm of the L3 lumbar spine was created to mimic a complete type of lamina fracture. To measure the movement of the fractured laminar edges, two holes were drilled on both sides of the upper and lower regions of the lamina to allow for optic marker placement. A single specific spine movement was applied to each group: traction, flexion, and extension. Gap changes were measured by camera extensometers. Results: After traction, the average values of the upper and lower aspects of the lamina interval showed narrowing of 1.65±0.82 mm and 1.97±1.14 mm, respectively. No statistical significance was detected between the two aspects. The upper and lower regions of the lamina gap behaved differently during extension. At 10°, 20°, and 30°, the upper part of the lamina interval was widened by an average of 0.016±0.024, 0.29±0.32, and 1.73±1.45 mm, respectively, whereas the lower part was narrowed by an average of 0.023±0.012, 0.47±0.038, and 1.94±1.46 mm, respectively. Conclusions: Neural element crushing may take place, particularly at the lower aspect of the fractured lamina gap during extension and throughout the whole lamina gap during traction. The lamina gap widens during flexion. Reduction maneuvers should be attempted after exploring the fractured lamina to prevent further neurological compromise. [ABSTRACT FROM AUTHOR]

Metacarpal fractures related to excessive and/or inaccurately traction during delivery has been encountered in large animal livestock. The purpose of this study is presented of clinical features of metacarpal fractures in calves by regarding different applications and bone's biophysical risk factors. Medical records of metacarpal fractured calves between January 2006 and January 2013 were evaluated. After clinical and radiographically examinations, the types and localization of fractures were recorded. Regarding to the individual condition of calves and also attitude of owner, several treatment procedures were performed. Thirty-two metacarpal fractures in Holstein-Friesian calves related to extraction force were studied. All fractures were observed around that the place of the rope application. Most of the fractures [22 of 32 cases (68.75%)] were located distal 1/3 part (distal 33.3%) of the bone. Total 19 oblique, 10 transversal, 3 transversal comminuted fractures were determined. Soft tissue lesions (edema, subcutaneous and/or petechial hemorrhage) on the skin recorded concomitantly. By improving the design of fetal extraction tools and alternative applications for extraction, incidence of this complication may be reduced in the future. [ABSTRACT FROM AUTHOR]

Aims: The primary aim of this study was to determine whether orthopaedic trauma patients receive appropriate antibiotic prophylaxis keeping in view the results of their MRSA screening. The secondary aim was to analyse the risk of developing MRSA surgical site infection with and without appropriate antibiotic prophylaxis in those colonized with MRSA.Patients and Methods: We reviewed 400 consecutive orthopaedic trauma patient episodes. Preoperative MRSA screening results, operative procedures, prophylactic antibiotics and postoperative course were explored. In addition to these consecutive patients, the hospital MRSA database over the previous 5 years identified 27 MRSA colonized acute trauma patients requiring surgery.Results: Of the 400 consecutive patient episodes, 395(98.7%) had MRSA screening performed on admission. However, in 236 (59.0%) cases, the results were not available before the surgery. Seven patient episodes (1.8%) had positive MRSA colonization. Analysis of 27 MRSA colonized patients revealed that 20(74%) patients did not have the screening results available before the surgery. Only 5(18.5%) received Teicoplanin and 22(81.4%) received cefuroxime for antibiotic prophylaxis before their surgery. Of those receiving cefuroxime, five (22.73%) patients developed postoperative MRSA surgical site infection (SSI) but none of those (0%) receiving Teicoplanin had MRSA SSI. The absolute risk reduction for SSI with Teicoplanin as antibiotic prophylaxis was 22.73% (CI=5.22%-40.24%) and NNT (Number Needed to Treat) was 5 (CI=2.5-19.2) CONCLUSION: Lack of available screening results before the surgery may lead to inadequate antibiotic prophylaxis increasing the risk of MRSA surgical site infection. Glycopeptide (e.g.Teicoplanin) prophylaxis should be considered when there is history of MRSA colonization or MRSA screening results are not available before the surgery. [ABSTRACT FROM AUTHOR]

Introduction: Bone segment transport leads to new bone formation (distraction osteogenesis). It is a type of bone healing in which regeneration process fills the bone defects. These long bone defects are produced either by bone loss during high energy trauma, sequestrectomy in chronic osteomyelitis or after excision of bone tumors. There are many external fixators which are designed to achieve the surgical objective of managing bone defects using the principles of distraction osteogenesis. Objective: The objective of Segmental Tibial defects treated by distraction osteogenesis with the help of Naseer Awais (NA) external fixator. Methodology: This quasi experimental study was done on forty four patients with tibial defects at department of Orthopedics surgery and Traumatology Mayo Hospital Lahore from May 2010 to June 2013. NA fixator was applied to in all cases and patients were followed up monthly basis and radiographs were assessed to see the bone healing process. Full weight bearing advised after 8-10 weeks according to the bone healing seen in x-rays. After complete healing and consolidation, fixator dynamization was performed for one month then the fixator was removed. Results: A total of 44 subjects were included in this study with a mean age of 33 ± 4.3 year. Among them forty (90.9%) male and four (9.1%) females had segment transport with NA external fixator, and male and female ratio was 10:1. Out of forty four patients, seven were lost to follow-up. So out of this thirty seven patients, the healing time was 369 ± 56.2 days (median-333).Pin loosening was in nineteen (44.2 %), clamp loosening in ten (23.3%) and pin break in one (2.3%) cases.In four (10.5%) cases knees had to be arthrodesed due to defect in the joint, sixteen (42.1%) cases had flexion in the range of 121-130º, six (15.8%) had flexion <100. Conclusion: NA external fixator is a useful device for segment transport and hence can be used in future for better outcome of segmental tibial defects treated by distraction osteogenesis. [ABSTRACT FROM AUTHOR]

The thoracolumbar junction and lumbosacral segment are the portions of the spinal column most prone to acute traumatic fractures. Multiple classifications and injury severity score systems have been published to standardize the management of patients, establishing stable/unstable and surgical/nonsurgical fractures. In the past, patients could be treated only by surgical stabilization or conservative methods. The latter implied bed rest, long immobilization periods, prolonged drugs therapies, and, at worst, the evolution of kyphosis. Percutaneous mini-invasive treatments have been developed to improve the quality of life of patients affected by stable fractures, by rapidly recovering mobility and preventing deformity of the spinal column. These approaches, based on assisted techniques, imply the placement of different types of expandable bone implant systems. We discuss the treatment of vertebral fractures, focusing on percutaneous procedures and analyzing indications, contraindications, and outcomes of patients affected by vertebral nonosteoporotic/nonneoplastic but traumatic fractures. [ABSTRACT FROM AUTHOR]

Surgery in the first half of the nineteenth century was primarily dominated by pain and fear of lethal infections. Therefore, the absolute majority of fractures and dislocations were treated non-operatively. Development of operative treatment of fractures was influenced by three major inventions: anaesthesia (1846), antisepsis (1865) and X-rays (1895). The first to use external fixation is traditionally considered to be Malgaigne (1843). However, his devices cannot be really considered as external fixation. The external fixation device invented by Lambotte in 1902 is generally thought to be the first "real fixator". In America it was Clayton Parkhill, in 1897, with his "bone clamp" who started the process. Both Parkhill and Lambotte observed that metal pins inserted into bone were tolerated extremely well by the body. Mainly on the basis of their research findings, many external fixation devices have been and are being developed. [ABSTRACT FROM AUTHOR]

Objective: To "determine functional outcome of open reduction and internal fixation of displaced proximal humerus fractures with PHILOS Plate using ASES score." Methods: This study "was carried out at the department of orthopedics surgery, Liaquat National Hospital, Karachi from August 2015 to February 2016. Total 219 patients of proximal humeral fractures required surgical treatment were included in the study. Patients were operated using a standard prescribed surgical technique. On follow up after 12 weeks, ASES Score was calculated. The quantitative variables were described by mean±SD. The qualitative variables were presented by frequency and percentage. Effect modifiers were controlled by stratification." Chi-square test was applied post stratification and p-value d''0.05 was considered as significant. Results: The overall mean ASES score of study subjects was 72.22±10.00, with range of 46(53-99). Outcome was excellent in 14 patients, good in 37 patients, fair in 63 patients, and 105 were poor. Acceptable outcome was observed in 51 cases and not acceptable was observed in 168 cases. The association of final outcomes and ASES categories was found not significant with gender and age." Conclusion: "In conclusion with the findings of this study, PHILOS provides stable fixation in proximal humerus fractures." [ABSTRACT FROM AUTHOR]

Introduction: Tibial diaphyseal fractures are the commonest long bone fractures in adults, most commonly managed by intramedullary interlocking nailing. However, several metaanalysis show that locking plate osteosynthesis is equally effective in managing tibial diaphyseal fractures and are associated with less number of complications. Aim: To compare the results of fixation of tibial fractures following plating and nailing in terms of union, patient satisfaction and complications. Materials and Methods: A hospital based non randomized clinical trial was performed from September 2013 to August 2016 where closed or open diaphyseal or metaphyseo-diaphyseal fractures of the tibia (closed or open Gustilo Anderson type 1 through 3B) were included. Simple sequential allocation was used for allotting the patients to two groups, one for interlocking nailing and other for plating. The patients were followed up for clinical, radiographic and functional results. Results: Forty patients with forty one involved limbs completed follow up for one year. The duration of surgery and average blood loss during surgery was 75.45±3.03 minutes and 165.00±5.31 ml respectively in case of nailing and 85.05±2.54 minutes and184.29±5.33 ml respectively in case of plating and their difference was statistically significant. In our study union was achieved in less than 20 weeks in 29 (70.8%) of the patients and 25-30 weeks in nine (22%) cases. The average time of union in our study was 19.55±0.69 weeks in case of interlocking nailing and 20.38±1.39 weeks in case of plating and there was no statistically significant difference between the two. However, there is statistically significant difference in the functional score in between the two groups in terms of Lower Extremity Functional Score (LEFS). Delayed union in one case of nailing and two cases of plating, valgus malunion in one case of nailing and joint stiffness in two cases each of nailing and plating were the major complications observed. Conclusion: There was no difference between the two modalities in terms of fracture union. Complications were lesser but more serious in case of plating. Patient satisfaction was more with plating. [ABSTRACT FROM AUTHOR]