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The malleoli fractures in combination with the fractures of posterior edge of the tibia are considered unstable injuries and present particular difficulties in surgical treatment. The aim of the study was to evaluate short-term and mid-term results of osteosynthesis on account of unstable fractures of malleoli and posterior edge of the tibia using posterolateral surgical approach. Materials and Methods. The analysis of short-term and mid-term results of the treatment of 29 patients with malleoli fractures types 44-B3 and 44-C1.3, C2.3 and C3.3 (according to the AO classification) with the involvement of the Volkman`s posterior tibia fragment was performed in traumatology departments of three hospitals during the period from January 2019 to September 2020. In all 29 cases the fracture of the posterior edge of the tibia was classified as type 1 according to the classification of N. Haraguchi et al. All patients underwent osteosynthesis of the posterior edge of the tibia and the lateral malleolus via posterolateral surgical approach. Combined fracture of the medial malleolus was fixed via classical medial approach. 5 patients (17.2%) with continued instability of the distal tibiofibular syndesmosis underwent fixation with positional screw. Functional results, as well as the range of motions in the ankle joint were evaluated with the use of AOFAS and Neer scales 3, 6 and 12 months after surgery. Results. Statistically significant improvement in functional outcomes over time was noted when evaluated on the AOFAS scale (p

To determine the impact of magnetic resonance imaging (MRI) on fracture classification for low lumbar fractures (LLFs) compared to CT alone. This study was a retrospective review of 41 consecutive patients with LLFs who underwent CT and MRI within 10 days of injury. Three reviewers classified all fractures according to AOSpine Classification and the Thoracolumbar Injury Classification (TLISS). Posterior ligamentous complex (PLC) injury in MRI was defined by black stripe discontinuity and in CT by the presence of: vertebral body translation, facet joint malalignment, horizontal laminar or spinous process fracture, and interspinous widening. The proportion of patients with AO type A/B/C and with TLISS

Background: Scapholunate injuries in distal radius fractures may frequently be overlooked. The aims of this study were to measure the scapholunate distance in intraarticular distal radius fractures and to find out which fracture types were associated with an increased scapholunate width. Methods: Measurements of the scapholunate distance were performed on computed tomography scans of 143 intraarticular distal radius fractures in 140 patients. The fractures were classified according to the AO classification. The morphology of AO type B fractures was further analysed according to the Bain classification. Results: In 43 AO type B fractures mean scapholunate distance measured 2.1 mm and in 100 type C fractures 1.6 mm. The difference between partial and complete intraarticular fractures was significant. A trend towards a greater scapholunate distance was found in AO type B1 and radial styloid oblique fractures. Conclusions: In this study, partial intraarticular distal radius fractures, especially with a sagittal split, had a greater scapholunate distance and may be at risk for ligamentous injury.

Objectives: Pelvis fractures (PF) and acetabular fractures (AF) are major challenges in orthopedics. Epidemiological figures are not available for Kuwait, making it difficult to evaluate the success of future plans. This study aimed to analyze the epidemiology of pelvis and AF in Kuwait. Methods: A retrospective cross-sectional design was used by reviewing the Database of PF and AF of level II trauma center, Kuwait. Results: From October 2018 to September 2019, 2046 patients were admitted to the orthopedic wards of our hospital. PF prevalence was 3.66%; mean age (standard deviation) was 37.56 (18.09) years, and 74.5% were men. AF prevalence was 1.71%; mean age was 28.08 (17.77) years, and 71.6% were men. The most frequent mechanism of injury was motor vehicle accidents. Using the OTA/AO classification, the most frequent fracture of the PF was B1.1 fractures at 60.7%, and A1 fractures for AF at 80.0%. PF and AF were associated with other injuries in 54.4% and 38.2%, respectively. In terms of management, 24.3% of the patients with PF were managed operatively and the reported complications were metal failure (2.7%), post-operative infection (1.4%), and wound dehiscence (1.4%). The management of AF was operative in 54.3%, and the identified complication was only metal failure (2.9%). The mortality of PF was 2.7% and 0.0% for AF. Variables related to the ICU length of stay, mortality, and postoperative complications were explored. Conclusion: The epidemiological figures explored could help determine PF and AF’s burden in Kuwait and direct future management and preventive plans.

Objective The objective of the present study was to identify patterns of femoral diaphyseal fractures which are associated with fractures of the ipsilateral femoral neck according to the AO classification. We propose an algorithm of investigation based on plain radiographs, recognizing cases that need additional screening with computed tomography. Patients and Methods This observational retrospective study included patients with combined diaphyseal and femoral neck fractures. These patients were retrieved from a total of 1398 patients with the diagnoses of diaphyseal fractures of the femur, who were admitted to our hospital for surgical treatment between January 2009 and October 2019. All included cases had both fractures analyzed for their geometry and were classified according to the AO Classification, seeking to find a correlation between the types of fractures. Results Sixteen diaphyseal fractures associated with ipsilateral neck fractures were detected during the period. The distribution of the diaphyseal fractures according to the AO Classification was as follows: 5 of type A3 (31,2%) 6 type B2 (37.5%), 1 type B3 (6,2%), 2 type C2 (12,5%) and 2 type C3 (12,5%). One A2 femoral fracture occurred during the surgical procedure. No type A1 fractures were detected. Conclusion The patterns of high-energy diaphyseal fractures (A3, B and C) have a higher prevalence of associated ipsilateral neck fractures. Our study suggests that routine additional methods of image investigation of femoral neck fractures may be unnecessary for diaphyseal fractures type A1 and A2.

Pilon fractures are associated with soft tissue complications such as skin necrosis, and deep infections have been reported very often. This study retrospectively compared the treatment effects of Ilizarov external fixation and of internal fixation methods in elderly patients with pilon fractures.A total of 37 patients60 years old with pilon fractures (AO classification type 43) were investigated. Patients were treated either with internal fixation (n = 15) or Ilizarov external fixation (n = 22). The patients' mean age was 74.2 (range, 60-78) years in the internal fixation group and 76.1 (range, 60-82) years in the Ilizarov external fixation group. Many patients in the internal fixation group received toe-touch to 1/3 partial weight-bearing at 2-4 weeks postoperatively and full weight-bearing by 6-8 weeks postoperatively. Many patients in the Ilizarov external fixation group received partial weight-bearing (as tolerated) 1 day postoperatively, 1/2 partial weight-bearing at 2 weeks postoperatively, and full weight-bearing at 4 weeks postoperatively.The mean duration of hospitalization was 79.1 ± 30.1 days for the internal fixation group and 29.1 ± 18.8 days for the Ilizarov external fixation group (p 0.05). Bone mineral density (T-score) was 2.6 ± 0.7 for the internal fixation group and 3.6 ± 1.2 for the Ilizarov external fixation group (p 0.05). The incidence of skin disorders that required additional surgical treatment was 33.3% (5/15 patients) in the internal fixation group and 0% (0/22 patients) in the Ilizarov external fixation group (p 0.05).In elderly patients with periarticular fractures of the ankle, those who underwent Ilizarov external fixation had a shorter duration of hospitalization and fewer complications than those who underwent internal fixation.

Supracondylar humerus fractures are the most common fractures around the elbow in children between 4 and 10 years of age. The treatment of supracondylar humerus fractures can vary from conservative treatment to operative treatment depending on the fracture type. All around the world, the most commonly used classification system is the Wilkins-modified Gartland classification of supracondylar humerus fractures. Currently, the decision to operate or conserve the fracture is taken on basis of this classification system. Non-operative treatment for type I fractures and operative treatment for type III fractures have been well-established in literature. The management of type II supracondylar humerus fracture creates confusion in the minds of numerous orthopaedic surgeons around the world. We have tried addressing this using a classification-based treatment algorithm. Other classification systems like the AO classification, Lagrange and Rigault classification and Bahk classification with special reference to special fracture patterns that require attention and pre-op planning have also been mentioned. It is important to understand that operative management of each supracondylar humerus fracture is unique as regards fixation method and it is important to consider the fracture pattern before internal fixation.

Unicondylar femoral fractures are uncommon injuries, known to occur primarily in young people, with high energy trauma. However, according to our experiences, unicondylar femoral fractures in geriatric patients generally involved the medial femoral condyle, unlike previously reported. In addition, the fractures of medial femoral condyle (FMFC) showed a characteristic fracture pattern. To date, there has been no published article focusing on the FMFC in geriatric patients. Thus, the aim of this study was to determine the characteristics of FMFC in geriatric patients and to present their outcomes. We retrospectively reviewed the medical records of 13 patients over age of 65 who underwent surgery for FMFC (AO-OTA 33B2). Of the 13, 10 patients were treated with Tomofix medial distal femoral plate (MDF) (Synthes GmbH, Switzerland) and additional screws fixation; the other three were treated with screw fixation and cast application. The mean age of patients was 76.8 years, and 10 patients were females. The fracture was due to low-energy trauma in all of the cases. Eight patients had medial knee osteoarthritis, and 2 patients were on osteoporosis treatment. A characteristic fracture pattern was observed. The fracture line extended from the lateral aspect of the intercondylar notch to the posteromedial column of the distal femur, with a characteristic medial beak. All fractures belonged to AO classification 33B2.1; there were no cases of AO classification 33B2.2 or 33B2.3. The postoperative joint function was graded according to the Kolmert functional criteria: ten cases were excellent, one case was good, one case was fair, and one case was poor. FMFC caused by low-energy trauma in geriatric patients tend to have a characteristic pattern. We believe that anatomic reduction and firm fixation with Tomofix MDF plate and cannulated screw for low-energy trauma FMFC in geriatric patients would yield good outcomes.

Introduction: Intercondylar fracture of distal humerus is one of the difficult fracture involving the humerus in adults. Intercondylar fracture distal humerus in adults are difficult to manage due to complex anatomy of elbow. We present a method of surgical treatment of intercondylar humerus fracture in adults by open reduction with JEES fixator and to evaluate functional outcome and associated complication with application of JESS fixator.Materials & Methods: It is Institutional based, prospective study carried out from June 2018 to May 2019.Twenty cases of intercondylar distal humerus fracture were reduced and fixed with K-wire and finally JESS was applied. Patient were follow up at 1week, 4weeks, 6weeks & 12weeks and clinically evaluated with Mayo’s elbow performance score. Results: According to AO classification 4 cases had C1 fractures, 14 cases had C2 fractures and and 2 cases had C3 fractures. 3 cases had open injury among which two were of C2 and 1 were C3 type. All cases were operated using paratricipital approach and average duration of JESS application was 7 week and mean follow up duration was 9 months. Irrespective of injury pattern 9(45%) cases showed excellent results, 7(35%) showed good results, 3(15%) cases showed fair results and 1(5%) case showed poor results.Discussion: The goal of intercondylar fracture management by JESS technique is to achieve early range of motion of anatomically align joint. Conclusion: This study shows comparatively good results using JESS fixator. This procedure is viable alternative option to ORIF dur to its simplicit, cost-effectiveness and easy implant removal on day care basis.

Objective The clinical and imaging data of patients diagnosed with femoral neck fractures (FNFs) in Xi 'an Honghui Hospital from 2018 to 2020.The epidemiological characteristics of these patients in different age groups were analyzed. Methods In this study, patients with femoral neck fracture hospitalized in Xi 'an Honghui Hospital from January 2018 to January 2021 were divided into four groups according to age: the young group (≤44 years old), the middle-aged group (45-59 years old),the young old group (60-74 years old), and the elderly group (≥75 years old) to analyze age,sex,side,injury mechanism,new AO classification and other features. A total of 2071 patients were included for analysis. Results There were 742 males (35.8%) and 1,329 females (64.2%).There were 1,106 patient s(53.4%) on the left side and 965 on the right side (46.6%).There were 1781 cases of low energy injury (86%) and 290 cases of high energy injury (14%), and the main injury mechanism was falling.The number of patients with femoral neck fracture in each year was 719 patients in 2018, 694 patients in 2019, and 661 patients in 2020, respectively. The number of patients showed a decreasing trend year by year, and the gender ratio and injury mechanism showed no significant trend of change. In the age group, the proportion of the young group was increasing year by year.Among the new AO classification, there were 1023 cases of B1.3, accounting for the highest proportion of 49.4%.The proportion of B2.2 was the highest in the young group (32.4%) .B1.3 and B2.2 were the main types in the middle-aged group, accounting for 31.7% and 32.0, respectively.B1.3 was dominant in the young old and elderly group (47.1% and 63.4%, respectively). Conclusion The new classification combines the classic classification, which is easier to remember. The stability of fracture is more carefully distinguished,which is conducive to guiding the surgical treatment of many stable femoral neck fractures in middle-aged and young old people. ORIF treatment can be used to delay the age of hip replacement.

Introduction In this study, we clinically and radiologically investigated whether the application of expandable nails for surgical treatment of humeral shaft fractures has an advantage over locked intramedullary nails. Methods Patients treated with intramedullary fixation due to humeral shaft fractures in our clinic were investigated retrospectively. Patients with fractures of type 12A and 12B according to the AO classification in the middle 1/3 shaft region of the humerus were divided into two groups as those receiving fixation with expandable nails and with locked intramedullary nails. The union rate, union time, Q-DASH scores, duration of surgery, and complication rates were statistically compared between the two groups. Results The study included 38 patients with clinical follow-up from among 47 patients; 20 patients received fixation with locked intramedullary nails and 18 with expandable nails. The mean age of the patients was 56.92 (19-91) years and 53% (n=20) were men while 47% (n=18) were women. During statistical evaluation, a statistically significant difference was found between the groups for union (100% and 72.2%) and complication rates (6% and 13%). More union and lower complication rates were found in patients treated with locked intramedullary nails. In comparing the mean of surgical times (71.1 and 30.2 min), expandable nails had a shorter surgical time. However, there was no statistically significant difference between the union time and Q-DASH scores between the two groups. Conclusion Locked intramedullary nails are a better fixation method than expandable nails due to the low complication rate and high rate of union. However, due to shorter surgery time, expandable nailing is an alternative method in limited cases.

Traumatic spinal cord injuries (TSCI) have devastating consequences on patients' quality of life. More specifically, TSCI with spinal fractures (TSCIF) have the most severe neurological impairment, although limited data are available. This study aimed at providing data and analyzing TSCIF in a level I trauma center in the province of Québec, Canada.Two hundred eighty-two TSCIF were reviewed. Spinal injuries and neurological impairment were assessed with AO classification and AIS, respectively. Variables included age, sex, cause, location, mechanism of injury (MOI), and severity of TSCIF. Chi-squared Pearson determined significant associations (p0.05).Male-to-female ratio was 3.21:1. Patients were 42.5 ± 18.7 years. The leading causes of TSCIF were high-energy falls (28.4%), cars (26.2%) and vehicle without restraint system (motorcycle, all-terrain vehicle, snowmobile, and bicycle) (21.3%). Vehicle collisions, pooling cars and unrestrained vehicles, mostly affected the 20-49-year population (62.2%). The main MOI was distraction in males (47.9%), and axial compression in females (44.8%). There were significant associations between causes and injured spinal level, as well as between MOI and injured spinal level, sex, and TSCIF severity. Most patients involved in unrestrained vehicle accidents sustained a thoracolumbar spine distraction with complete motor deficit. A severe neurologic deficit affected most patients following car accidents that caused cervical spine distraction or axial torsion.In Québec, most TSCIF caused by vehicle collisions affect a young population and have severe neurological impairments. Future efforts should focus on better understanding accidents involving the unrestrained vehicle category to further improve preventive measures.Des lésions traumatiques de la moelle épinière associées à des fractures dans le cadre d’un centre de traumatologie de niveau 1 du Québec Contexte: Les lésions traumatiques de la moelle épinière (LTME) ont des conséquences catastrophiques sur la qualité de vie des patients qui en sont victimes. De façon plus particulière, il faut savoir que les LTME associées à des fractures vertébrales sont celles qui entraînent, bien que les données à ce sujet soient limitées, les déficiences neurologiques les plus graves. Cette étude vise à collecter des données et à analyser les LTME associées à des fractures vertébrales dans un centre de traumatologie de niveau 1 situé au Québec (Canada). Méthodes: Au total, nous avons examiné 282 cas de LTME associés à des fractures vertébrales. Pour ce faire, nous avons évalué ces fractures au moyen de la classification Müller AO ; quant au niveau de déficience neurologique, nous l’avons évalué au moyen de l’échelle ASIA. Parmi les variables incluses dans cette étude, mentionnons l’âge, le sexe, la cause, l’endroit de l’incident, le mécanisme de blessure (mechanism of injury) ainsi que la gravité des LMTE associées à des fractures vertébrales. Enfin, c’est au moyen du test du X2 de Pearson qu’on a pu déterminer des associations statistiques valables (p0,05). Résultats: Le rapport hommes/femmes était de 3,2 :1. En moyenne, les patients étaient âgés de 42,5 ans ± 18,7 ans. Les principales causes de LMTE associées à des fractures vertébrales se sont révélées être des chutes à haut transfert d’énergie (28,4 %), des accidents de la route impliquant des automobiles (26,2 %) et des accidents impliquant des moyens de transport (motocyclettes, VTT, motoneiges et vélos) dépourvus d’un dispositif de retenue (21,3 %). Tant les collisions à bord d’une automobile que celles impliquant un moyen de transport sans dispositif de retenue ont surtout affecté la population des 20 à 49 ans (62,2 %). Chez les hommes, le principal mécanisme de blessure était la distraction de la colonne (47,9%) alors que chez la femme, c'était la compression axiale (44,8%). Des associations significatives sont apparues entre les causes énumérées ci-dessus et la gravité des blessures à la colonne vertébrale de même qu’entre le mécanisme de blessure et la gravité des blessures à la colonne vertébrale, le sexe des patients et la gravité des LMTE associées à des fractures vertébrales. La plupart des patients victimes d'un accident sur un véhicule sans dispositif de retenue ont subi une distraction thoraco-lombaire de la colonne vertébrale jumelée à un déficit moteur complet. Enfin, un déficit neurologique marqué a affecté la plupart des patients victimes d’un accident de la route ayant subi une distraction cervicale et une torsion axiale. Conclusions: Au Québec, la plupart des LMTE associées à des fractures vertébrales et causées par des accidents de la route affectent une population plus jeune et entraînent de graves déficits neurologiques. À l’avenir, on devrait tenter de mieux comprendre les accidents impliquant des moyens de transport dépourvus de dispositif de retenue afin d’améliorer davantage les mesures préventives.

Relevance — the need for an objective justification in choosing the type of fixation in the treatment patients with pertrochanteric hip fractures. Objective — to study the changes in the properties of a consolidating trochanteric fracture fixed by a dynamic cephalomedullary nail when subjected to cyclic dynamic loads. Materials and methods . A mathematical model was developed for trochanteric fracture of the femur (A1 according to AO classification) when fixed with a dynamic cephalomedullary nail. Then, the properties of the system were studied (pressure between fragments, mechanical stress in the bone and fixation device, displacement amplitude, neck-diaphysis angle) under a virtual load of a 80 kg body at various amount of insertion of the dynamic screw (from 10 mm to 0 mm). Results . In the process of shortening the femoral neck axis by 1 cm, the stability of the ‘bone-metal fixation device’ system increases, as indicated by a decrease in the maximum amplitude of displacements in the system under load by 16.8%, a decrease in the maximum stress in the fixation elements by 20.2%, a decrease in pressure at the site of contact of fragments by 19.8%. In addition, there was a decrease in the neck-diaphysis angle by 2.8%. Conclusion. The mathematical modeling of the ‘bone-metal fixation device’ system simulating conditions of dynamic osteosynthesis showed that there is a potential increase in the stability of the cephalomedullary system and that favorable conditions are created for the consolidation of the fracture when subjected to cyclic load of body mass.

Introduction: Ankle injuries comprise a major group of lower limb trauma. Many of these injuries can be treated by manipulative reduction and conservative treatment and some of these yield satisfactory results, so present study was undertaken to know the effectiveness of surgical management of ankle fractures. Method: 42 surgically treated displaced fractures are included and studied in detail of age, sex, occupation, type of fracture, mode of injury, type of treatment, Clinical evidence of fracture union, Radiological evidence of fracture union, Relation of talus in the ankle mortise, Range of mobility of the ankle, Residual disability and pain, Ability to walk and time of return to duty and complications were noted. Result: 42 cases were surgically treated, most of the patients were operated on an emergency basis within 24 hours of injury. Based on the mechanism of injury Pronation- External Rotation (30.9%) and Based on Ao Classification Type B - B2 (53.3%) were the major type of fractures. In the majority of cases, Malleolar screws type of implants used. In overall the final status of patients is good (ability to walk). Conclusion: Displaced ankle fractures need accurate open reduction and internal fixation and postoperative immobilization for 6 weeks. This will suffice to get good results. Post-operative rigid immobilization and protected weight bearing for 12 weeks is minimal to achieve good union followed by physiotherapy to restore the maximum range of movements Keywords: Ankle Fractures; Surgical management, Stability; Effectiveness.

Two techniques are described to treat distal radius fractures: conventional (Henry approach) and minimally invasive plate osteosynthesis. The latter technique has been described by different authors such as Imatani et al. and Zenke et al. This was a descriptive retrospective study, analyzing 26 adult patients with unstable distal radius fracture, extra-articular type A or partially intra-articular type B according to AO. The approaches used were: (i) single longitudinal palmar incision; (ii) double T-incision (horizontal and vertical) and (iii) double position II. Ages were between 21 and 78 years. Most affected hand was the right. Most common fracture was 23B2 (AO classification). In total, 84.6% of the patients did not present complications. According to the functional evaluation of the wrist by the Mayo Clinic, 31% showed excellent results, 42% showed good results, 27% showed fair results. The techniques had satisfactory results for the osteosynthesis with more aesthetic and less invasive approach.

Background: Distal tibial fractures accounts for approximately 37.8% of all tibial injuries affecting all ages. Treatment of distal tibial fractures in skeletally mature patients is challenging because of its unique anatomical characteristics of subcutaneous location with weak blood supply and proximity to the ankle joint. Objective: To compare the results of fixation of extra-articular distal tibial fractures in adults by ILN vs. distal tibial locked plate with MIPPO. Patients and methods: This study was done at Al-Azhar University Hospital, during the period of January 2020 to December 2020. 20 patients were recruited for this study to compare ILN vs. distal tibial locked plate with MIPPO technique in fixation of extra-articular distal tibial fractures. Patients were assessed clinically using Olerud and Molander score and radiologically at 6months. Results: Age range of the patients was 20-57yr. Most common mode of trauma was RTA. Associated fibula fracture was present in 9 (90%) of patients in both groups. Difference between 2 groups regarding demographic data, AO classification, operative time wasn't significant .No significant intraoperative complications were noted in both groups. The average time for union was 13.10 weeks (range, 12-16 weeks) in group 1 and 16.78 weeks (range, 12-24 weeks), Malunion was found in 20% of patients in group 1 and 10% of patients in group2. Conclusion: The overall results were comparable and most patients were satisfied with the results. These results indicate that both modalities of treatment deserve a place in treating distal Tibial fractures.

Objective. To explore the postoperative complications of distal radius fractures and analyze the related factors that affect its prognosis. Methods. The clinical data of 50 patients with distal radius fractures admitted to our hospital from October 2016 to September 2019 were retrospectively analyzed. All patients were followed up for 6–12 months, and their postoperative complications were recorded. Collect general patient information and related clinical data. During the follow-up process, Gartland and Werley wrist function scoring system was used to evaluate the prognosis of patients’ joint function. Univariate analysis and multiple logistic regression models were used to analyze the related factors that affected the prognosis of patients. Results. 15 patients with postoperative complications were found during the follow-up period, with an incidence rate of 30.00%. Univariate analysis showed that the patient’s age, cause of injury, AO classification, shortened deformity, whether it was osteoporosis, surgical method, whether it was combined with other fractures on the same side, whether it was comminuted fracture, and the time to start postoperative exercise were all related to the distal radius. The prognosis of fractures is related ( P < 0.05 ). Multivariate logistic analysis showed that age, AO classification, surgical method, whether it was combined with other fractures on the same side, whether it was comminuted fracture, and the time to start postoperative exercise were the independent factors affecting the prognosis of distal radius fractures ( P < 0.05 ). Conclusion. The postoperative complications of distal radius fractures are higher. The prognosis is related to the patient’s age, AO classification, surgical method, whether it is combined with other fractures on the same side, whether it is comminuted fracture, and the time to start postoperative exercise. Therefore, choosing an appropriate surgical method and starting exercise in time can effectively improve the recovery of the patient’s wrist function and reduce the occurrence of complications.

Background The use of smartphones and multimedia messaging service (MMS) continues to increase in day to day orthopaedic clinical practice. However, there is limited evidence to support the safe utilisation of MMS. Objectives The aim of this study was to correlate the performance of MMS imaging to picture archiving and communication systems (PACS) imaging within the setting of diagnosis and management of ankle fractures. Methods The ankle fracture radiograph series of 82 consecutive patients were evaluated by five orthopaedic consultant specialists. A questionnaire regarding diagnosis and preferred management was completed separately for each patient using smartphone and PACS images. Statistical analysis was performed using Intraclass Correlation Coefficient (ICC). Results Ankle fracture diagnosis showed strong to excellent correlation both inter- and intraobserver MMS vs PACS when using the Weber (0.815, 0.988), Anatomical (0.858, 0.988), and AO classification systems (0.855, 0.985). MMS was less reliable than PACS in determining many management options. Conclusion The reliability of ankle fracture classification using MMS image viewing was not significantly different to interpretation on PACS workstations. Smartphone use in ankle fracture classification is supported by this study. Smartphone use was less accurate than PACS in devising management plans and future use should be limited to making only initial plans that must be corroberated with PACS and intraoperative findings prior to definitive fixation.

Introduction: The study compares the results of open reduction using volar locking plates with ligamentotaxis by external fixation in fractures of distal radius type 2R3C according to AO classification. Methods: A retrospective study evaluating the results of osteosynthesis in patients with distal radius fractures type 2R3C according to AO classification, operated until December 2018. The ORIF method with volar locking plates (LCP) was used in 54 patients, and closed reduction with ligamentotaxis using external fixation (EF) was used in 33 patients. The mean age of the patients was 46.7 years in the LCP group and 59.6 years in the EF group. All were evaluated for their X-ray and functional outcomes and according to the Green and O’Brien score at 6 and 12 months after surgery. Results: According to X-rays at 12 months in the LCP group, the mean sagittal tilt was 10.13°, the mean radial inclination was 23.89°, and the mean radial length was 11.84 mm. In the EF group, the mean sagittal tilt was 6.32°, the mean radial inclination was 24.78°, and the mean radial length was 9.89 mm. According to the Green and O’Brien score, we recorded a mean score of 84.44 points in the LCP group at 12 month; we achieved good and excellent results in 83.33% of the patients and no poor result was observed. In the EF group the final mean score was 77.27; good and excellent results were achieved in 45.46% of the patients and a poor result in one patient. Conclusion: Based on the results in our group of patients, the internal type osteosynthesis using LCP implants can be recommended as a first-choice technique in the treatment of 2R3C fractures according to AO classification.

Background: Postoperative evaluation of wrist joint trauma is divided into patient-reported outcomes (PROs) and clinician-reported outcomes (CROs). We investigated the association of the Q-DASH score as the postoperative PROs and the Mayo wrist score as the postoperative CROs with clinical evaluation in patients with distal radius fractures surgically treated using a volar locking plate (VLP). Moreover, whether PROs and CROs are correlated to the clinical evaluation was investigated.Methods: The subjects were 109 patients surgically treated for distal radius fractures at our hospital between June 2013 and May 2017. Forty-one patients were male, 68 patients were female, and the mean age was 61.4 (19–86) years old. The fracture type was AO classification A type in 30 patients (A2: 25, A3: 5), B type in 5 (B2: 1, B3: 4), and C type in 74 (C1: 50, C2: 11, C3: 13). All patients were surgically treated using VLP. The range of motion of the wrist, grip strength the Visual Analog Scale (VAS), the Q-DASH score (PROs), and the Mayo wrist score (CROs) were investigated. Each evaluation was compared as the clinical outcome between at 3 months after surgery and the final follow-up. In addition, the correlations of the postoperative PROs and CROs with the clinical evaluation were analyzed.Results: Each evaluation was significantly improved compared with that at 3 months after surgery. There was a significant correlation between PROs and CROs at 3 months after surgery and the final follow-up. However, the range of motion of the wrists was not significantly correlated with PROs or CROs at 3 months after surgery or at the final follow-up.Conclusions: On evaluation after surgery for distal radius fractures, PROs and CROs improved early after surgery (3 months after surgery) before the final follow-up, and an inverse correlation was present between these scores.

Ankle malleolar fractures are one of the most common surgical fractures. The literature about ankle fracture sport related is reduced. Severe fractures, fractures–dislocations, syndesmosis lesions, associated osteochondral lesions, postoperative complications, as well as age are associated in several studies with worse functional results and may, therefore, also be associated with a lower rate of sports return. This study aims to retrospectively assess the return to physical activity at the level prior to injury in individuals undergoing surgical treatment of unstable malleolar ankle injuries and to identify risk factors associated with a non-return. We retrospectively evaluated between January 2008 and December 2017, patients with an unstable malleolar fracture of the ankle surgically treated, recreational or competitive sportsman with a minimum follow-up of one year. Demographic data, fracture classification according to AO classification, presence/absence of osteochondral lesion, presence/absence of unstable syndesmosis lesion, associated dislocation, type of surgery, postoperative complications, functional outcome evaluation with the AOFAS score and sports return. 92 patients met the inclusion criteria. The mean AOFAS score observed was 90.93 (67–100). 69.7% of patients returned without limitations in performing physical activity. 21.75% returned with limitations and 8.7% did not return to physical activity. No association was observed between age, sex, syndesmosis lesion and greater risk of not returning to physical activity. Patients with bimalleolar or trimalleolar fractures, osteochondral injury, or associated dislocation presented an increased risk of inferior functional score and non-return sporting activity. Bimalleolar and trimalleolar fractures, associated presence of dislocation and osteochondral lesions are associated with worse clinical outcome and lower return onset.

Background To compare the efficacy of three-point locating versus routine locating techniques for implanting helical blades for proximal femoral nail anti-rotation-II in the treatment of trochanteric fractures. Methods From January 2010 to June 2013, 90 patients with intertrochanteric fractures were surgically treated, including 48 males and 42 females with an average age of 70.5 ± 7.2 years. According to the AO classification, there were 45 cases of A2.1, 35 cases of A2.2, and 10 cases of A2.3. Based on locating techniques, the 90 patients were divided into two groups: the three-point group and the routine group, with 45 patients in each group. All operations were performed by the same group of surgeons using proximal femoral nail anti-rotation (PFNA); the helical blade was inserted into the femoral neck with the three-point locating technique or by the usual method according to treatment group. Several figures including total operation time, elapsed time for implanting the helical blade, intraoperative blood loss, X-ray exposure time, and tip-apex distance (TAD) were measured and compared. Results The three-point group was significantly superior as compared to the routine group in terms of total operation time [(59.34 ± 9.42) min vs (67.61 ± 12.63) min, P P P P P Conclusion The three-point locating method is faster and more accurate than the routine locating method.

Surgical treatment of patients with thoracolumbar vertebral fracture without neurological deficit is still controversial. Management of vertebral fracture with percutaneous fixation was first reported in 2004. Advantages of percutaneous fixation are: less tissue dissection; decreased post-operative pain; decreased bleeding and operative time (depending on the steep learning curve); better screw positioning with fluoroscopy compared with an open freehand technique; and a decreased infection rate. The limitations of percutaneous fixation of vertebral fractures include increased radiation exposure to the patient and the surgeon, together with the steep learning curve for this technique. Adding a screw at the level of the fractured vertebra has the advantages of incorporating fewer motion segments with less operative time and bleeding. This also increases the axial, sagittal and torsional stiffness of the construct. Percutaneous fixation alone without grafting is sufficient for treating type A and B1 (AO classification) thoracolumbar fractures with satisfactory results concerning kyphosis reduction when compared with open instrumentation and fusion and with open fixation. Type C and B2 fractures (ligamentous injuries) should undergo fusion since the ligamentous healing is mechanically weak, increasing the risk of instability. This review offers a detailed description of percutaneous screw insertion and discusses the advantages and disadvantages. Cite this article: EFORT Open Rev 2018;3:604-613. DOI: 10.1302/2058-5241.3.170026.

The present study investigated the factors influencing the early clinical outcomes after ankle fracture surgery. We included 88 patients, who had undergone implant removal surgery at 1 year after ankle fracture surgery, with ankle computed tomographic (CT) scans obtained before ankle fracture surgery and at implant removal available. We collected demographic information, including age, sex, the presence of diabetes mellitus, level of trauma energy, and fracture classification from the medical records. We also recorded the fracture height using the radiographs and CT images. The medial joint space and articular incongruity were assessed on the follow-up radiographs and CT scans. Bone attenuation was measured by placing a circular region of interest around the ankle joint on the preoperative CT image. The postimplant removal outcomes were assessed using 2 functional questionnaires, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and Foot and Ankle Outcome Score (FAOS). Significant factors related to the AOFAS ankle-hindfoot scale scores and FAOS were identified through univariate analysis using age, sex, radiographic measurements, and CT findings as explanatory variables, followed by multiple regression analysis. On multiple regression analysis, the total FAOS was independently related to the AO classification (p = .003) and Lauge-Hansen classification (p = .003). The total AOFAS ankle-hindfoot scale score was related to articular incongruity (p = .044). The early clinical outcomes after ankle fracture surgery were affected by involvement of the ankle joint fracture rather than the lateral malleolus fracture height. Female sex and the presence of postoperative articular incongruity correlated with inferior early clinical outcomes.

Background: Distal radius fractures are one of the commonest injuries only after clavicle fractures. These fractures poses challenges to the treating surgeons as a result of which these fractures are sometime treated unacceptably and leads to poor outcome. Among various treatment options for these fractures wrist sparing Cobra external fixator is one of the options with an impressive stability and outstanding functional outcomes.Aims and Objectives: To determine whether this system can achieve adequate reduction of a variety of DRF, is able to maintain reduction despite hand and wrist movements, whether it compromises hand and wrist functions and leads to long term problems.Materials and Methods: From July 1, 2016 - June 30, 2017, all skeletally matured patients with acute distal radius fractures (AO-A2, B1, C1, C2) were adequately reduced and fixed with Cobra ex-fix. Immediately post-op patients were encouraged to start range of motion of the wrist as the pain decreased. The patients were followed up in 2,4 and 8 weeks and were analyzed clinically, radiologically, their functional outcomes and any complications.Results: Twenty-two patients were included in our study. Nine were males and 13 were females. Using the AO classification, 15 were classified as A2, 2 were B1, 3 were C1, and 2 were C2. The mean number of weeks the cobra fixator was maintained was 5.3 weeks. The Cobra ex-fix was able to achieve excellent maintenance of radial height and radial inclination and good maintenance of dorsal tilt. Recovery of functional activities according to Gartland and Werley’s functional scoring system was good to excellent in all patients at 8 weeks follow-up.Conclusion: The Cobra external fixation system is an outstanding device for use in fractures of the distal radius. It achieves superior anatomic correction and is dependable in maintaining fracture reduction even with hand and wrist use.Asian Journal of Medical Sciences Vol.9(6) 2018 84-89

Around one third of humeral fractures and 2-6% of all fractures occur to the distal part of the humerus. There is a bimodal distribution differentiating between young male patients with high-energy and elderly female patients with low-energy trauma related to osteoporosis. The AO classification and Dubberley subclassification are used in daily routine. Most fractures are diagnosed on radiographs. For further evaluation, three-dimensional computed tomography is recommended, especially for comminuted or complex fractures. Owing to the long immobilization and resultant poor functional outcome, conservative treatment is followed for inoperable patients. The operative approach and osteosynthesis depend on the fracture pattern. In A1 avulsion fractures, open reduction and screw fixation are recommended. In A2/A3 fractures, a triceps-sparing approach following a 90° double-plate construction (radial dorsal/ulnar lateral) with locking plates is favored. Partial articular B1/B2 fractures are exposed via a medial or lateral approach using unilateral locking plates to stabilize the medial/lateral column. Coronal shear fractures (B3) are classified after Dubberley and are treated via an extended Kocher approach and headless compression screws in anteroposterior direction. If there is a further posterior comminution or a lateral column fragment, stabilization is needed for the lateral/medial column with a precontoured locking plate. In solely articular fracture patterns, a dorsal approach with either a 90° or 180° double-plate construction is advised. If a reconstruction is not possible owing to fracture complexity or bone quality, total elbow arthroplasty is a viable option. However, lifelong limitation in weight-bearing up to 5 kg, limited longevity, and the potential for complicated revision surgery should be considered.Die distale Humerusfraktur stellt ein Drittel aller Humerusfrakturen und 2–6 % aller Frakturen dar. Dabei sind primär 2 Patientenkollektive zu unterscheiden: Männer zwischen 12–19 Jahren durch Hochrasanztraumata und Frauen über 80 Jahre mit osteoporotischer Knochenstruktur durch Niedrigenergietraumata. Im klinischen Alltag hat sich neben der AO-Klassifikation die Subklassifikation von frontalen Abscherfrakturen nach Dubberley als praktikabel erwiesen. Bereits im konventionellen Röntgenbild lässt sich ein Großteil der Frakturen erkennen. Zur exakten Klassifikation und Therapieplanung hat sich die Computertomographie mit dreidimensionaler Rekonstruktion insbesondere bei mehrfragmentären und komplexen Frakturen bewährt. Aufgrund längerer Immobilisation und häufig hieraus resultierenden deutlichen funktionellen Einbußen bleibt die konservative Therapie inoperablen Patienten vorbehalten. Der operative Zugangsweg und das jeweilige Osteosyntheseverfahren sind frakturspezifisch zu wählen. Dabei haben sich neben der mono-/bikondylären winkelstabilen Plattenosteosynthese die Schraubenosteosynthese und neuerdings kopflose Kompressionsschrauben mit Doppelgewinde durchgesetzt. Epikondyläre A1-Frakturen werden mittels Schraubenosteosynthese versorgt. Für metaphysäre A2-/A3-Frakturen wird ein den Streckapparat schonender paratrizipitaler Zugang und eine Doppelplattenosteosynthese in 90°-Technik favorisiert. Partiell artikuläre B1- und B2-Frakturen können entsprechend ihrer Lage entweder über einen radialen oder medialen Zugang erreicht und mittels einseitiger winkelstabiler Plattenosteosynthese versorgt werden. Frontale Abscherfrakturen (B3) werden mit einem erweiterten lateralen Zugang nach Kocher, mittels kopfloser Doppelgewindekompressionsschrauben und bei radialem/ulnarem Pfeiler mit additiver winkelstabiler Plattenosteosynthese fixiert. Vollständige artikuläre Frakturen (C1–C3) werden von dorsal dargestellt und je nach Wahl des Operateurs in winkelstabiler 90°-/180°-Doppelplattenosteosynthese fixiert. Ist eine Rekonstruktion unmöglich, stellt eine prothetische Versorgung des Ellenbogens eine Alternative da, wobei die lebenslange Limitierung der Belastbarkeit von 5 kg und limitierte Standzeiten sowie mögliche komplizierte Revisionsoperationen zu berücksichtigen sind.

Introduction: The following study was conducted to examine the short term clinical and radiological results particularly early complications and healing rate of distal tibia fracture treated by MIPPO using LCP. Methodology: The study was conducted in patients treated for distal tibia fracture (type A, B & C – AO classification) at Adichunchanagiri Institute of Medical Science, BG Nagar from the month of Nov 2013 to Nov 2015. Twenty distal tibia fracture patients were taken into the study, all were fixed with LCP by mippo, some with Bone grafting where the distal tibia fractures were associated with bone loss and communition. Patients’ age ranged from 27 to 68 years with a mean of 50. Results: The sample consisted of twenty patients with 11 males and 09 were female. The patients’ ages ranged from 27-68 years with a mean age of 50 years. The causes of fractures were motorvehicle accident in 13 patients and fall in 07 patients. There were no sports or industrial accidents. 12 fractures involved the right side and 08 involved the left. The average length of hospitalisation was 15 days with a range of 10 to 20 days. The average number of days from injury to surgery was 5 days with a range of 2 to 10 days. The operative time ranged from 45 minutes to 120 minutes. Patients were followed up from 01 to 24 months. Functional outcome was rated as per The modified ankle score of Olerud and Molander, we got excellent results in 10 cases, good in 07, fair in 02 and poor in one patient. Conclusion: The LCP is a good implant to use for fractures of the distal tibia by mippo method. However, accurate positioning and fixation are required to produce satisfactory results. We recommend use of this implant in Type A, B and C, osteoporotic fractures. Our early results were encouraging but long term studies are needed to prove definitively acceptable outcomes so that the technique can become part of the armamentarium of the orthopaedic trauma surgeon.

Introduction The purpose of this retrospective study, is to evaluate the clinical and functional results of early surgical fixation of the ipsilateral distal radius and scaphoid fractures in 22 of 21 patients. Patients and Methods Overall, 22 combined ipsilateral scaphoid, and distal radius fracture treatments between 2002 and 2015 were evaluated. The mean age was 34.9 (range: 19–82) years. One patient had bilateral injuries. In 17 patients the injury was due to a fall from a height, and in 4 patients due to a motorcycle accident. According to the AO classification, there were 2 type B and 20 type C fractures of the distal radius. The volar locking plate fixation technique was applied in 14 wrists, screw fixation technique in 1, external fixation combined with Kirschner wires (K-wire) stabilization technique was used in 3 wrists, and only K-wire pinning technique was used in 4 wrists. All scaphoid fractures were type B (21 type B2, 1 type B1) according to the Herbert–Fischer classification. K-wire fixation was applied in 2 and cannulated screw fixation was performed in 20 fractures. Clinical evaluation was performed with measuring the pinch power, grip power, and range of motions. Functional evaluation was performed using patient-rated wrist evaluation score (PRWE). Results The average follow-up period was 25 (range: 12–97) months. All radius and scaphoid fractures healed. The mean active wrist motions were found to be 45 degrees of flexion, 48.5 degrees of extension, 20 degrees of radial deviation, and 43 degrees ulnar deviation. Mean grip/pinch strengths were 31/8.5 kg. Mean PRWE score was 5.5 (range: 0–8.5). All patients returned to preoperative activity level and can do preinjury jobs. Conclusion Combined ipsilateral fractures of distal radius and scaphoid are complex and rare injuries due to high energy traumas. Stable early primary fracture fixation in these injuries can be expected with good functional results. Level of Evidence Level IV.

Study design Retrospective data analysis. Objective The aim of this study was to analyze correlations between spinopelvic configuration and fracture pattern or location in traumatic vertebral fractures. Summary of background data The spinopelvic configuration represented by the pelvic incidence (PI) angle showed to have a strong correlation with the occurrence of degenerative diseases of the thoracolumbar spine. No data are available on whether there is an influence of the PI angle on traumatic vertebral lesions as well. Materials and methods In a consecutive series of patients sustaining traumatic vertebral fractures, we retrospectively analyzed spinopelvic computed tomography data sets of 197 patients (121 male and 76 female patients; mean age, 51 years). Measurements included the PI angle, level of fracture(s), and fracture type according to the AO classification. Statistical analysis was performed to calculate correlation between PI and fracture level and between PI and fracture type. Results An average of 1.6 fractures per patient was found in the 197 individuals included in our study. PI angle showed a mean of 50.6 degrees for the left hip and a mean of 49.9 degrees for the right hip. There were no significant differences of the PI angle between male and female patients as well. Neither a significant effect of the PI angle on the vertebral fracture level (P=0.64) nor a significant relationship between the PI angle and the fracture type according to the AO classification (P=0.52) was found. Conclusions The spinopelvic configuration represented by PI angle seems to influence neither the level nor the type of vertebral fractures in trauma patients.

CASE In this case report, we present a novel stabilization technique of the pubic symphysis using an internal spinal fixator in a 78-year-old morbidly obese woman having a pelvic disruption type B1.1 (AO classification). We treated the disruption using an internal fixator to reduce the extent of the incision and soft-tissue damage. CONCLUSIONS The use of an internal fixator, known from percutaneous spinal fixation, for the stabilization of the pubic symphysis in cases of disruption ("open book" injuries) may be an alternative to the standard plate fixation as a novel minimally invasive stabilization technique.

The current techniques used to lock distal screws for the nailing of long bone fractures expose the surgeons, radiologists and patients to a hearty dose of ionizing radiation. The Sureshot™ Distal Targeting System is a new technique that, with the same results, allows for shorter surgery times and, consequently, less exposure to radiation. The study was performed on 59 patients (34 males and 25 females) with a simple humerus fracture diagnosis, type 1.2.A according to the AO classification, who were divided into two groups. Group 1 was treated with ante-grade intramedullary nailing with distal locking screws inserted with a freehand technique. Group 2 was treated with the intramedullary nail using the Sureshot™ Distal Targeting System. Two intra-operative time parameters were evaluated in both groups: the time needed for the positioning of the distal locking screws and the time of exposure to ionizing radiations during this procedure. Group 2 showed a lower average distal locking time compared to group 1 (645.48″ vs. 1023.57″) and also a lower average time of exposure to ionizing radiation than in group 1 (4.35″ vs. 28.96″). The Sureshot™ Distal Targeting System has proven to be equally effective when compared to the traditional techniques, with the added benefits of a significant reduction in both surgical time and risk factors related to the exposure to ionizing radiation for all the operating room staff and the patient.

The purpose of this study was to assess, by the mean apparent diffusion coefficient (ADC), if a relationship exists between disc ADC and MR findings of adjacent disc degeneration after thoracolumbar fractures treated by anatomic reduction using vertebral augmentation (VAP). Twenty non-consecutive patients (mean age 50.7 years; range 45–56) treated because of vertebral fractures, were included in this study. There were 10 A3.1 and 10 A1.2 fractures (AO classification). Surgical treatment using VAP was applied in 14 cases, and conservative in 6 patients. MRI T2-weighted images and mapping of apparent diffusion coefficient (ADC) of the intervertebral disc adjacent to the fractured segment were performed after a mean follow-up of 32 months. A total of 60 discs, 3 per patient, were analysed: infra-adjacent, supra-adjacent and a control disc one level above the supra-adjacent. No differences between patients surgically treated and those following a conservative protocol regarding the average ADC values obtained in the 20 control discs analysed were found. Considering all discs, average ADC in the supra-adjacent level was lower than in the infra-adjacent (1.35 ± 0.12 vs. 1.53 ± 0.06; p

Objective To report the clinical–functional outcomes of the treatment of humeral distal fractures with a total elbow prosthesis. Material and methods This retrospective study was performed in two surgical centres. A total of 23 patients were included, with a mean age of 79 years, and of which 21 were women. The inclusion criteria were: patients with humeral distal fractures, operated on using a Coonrad–Morrey prosthesis, and with a follow-up of more than one year. According to AO classification, 15 fractures were type C3, 7 C2 and 1 A2. All patients were operated on without de-insertion of the extensor mechanism. The mean follow-up was 40 months. Results Flexor-extension was 123–17°, with a total mobility arc of 106° (80% of the contralateral side). Pain, according to a visual analogue scale was 1. The Mayo elbow performance index (MEPI) was 83 points. Excellent results were obtained in 8 patients, good in 13, medium in 1, and poor in 1. The mean DASH (disability) score was 24 points. Conclusion Treatment of humeral distal fractures with total elbow arthroplasty could be a good treatment option, but indications must be limited to patients with complex fractures, poor bone quality, with osteoporosis and low functional demands. In younger patients, the use is limited to serious cases where there is no other treatment option. Level of Evidence Level of Evidence IV.

Background The classification of proximal humeral fractures remains challenging. The two main classification systems used, the Neer and the AO classification, have both been shown to have less than ideal interobserver agreement. Agreement in classification is required, however, to guide fracture management. Method Data from the Victorian Orthopaedic Trauma Outcomes Registry were collected and the X-rays of 104 proximal humeral fractures were reviewed by three orthopaedic consultants. They classified the fractures according to the Neer and AO classifications, as well as their simplified versions. Interobserver agreement was then assessed using kappa statistics. Results Interobserver agreement was better overall in the Neer classification, which was moderate (kappa = 0.40–0.58), than the AO classification, which was fair to moderate (kappa = 0.31–0.54). When simplified, the Neer and AO classification interobserver agreement remained similar. Conclusion The classification of proximal humeral fractures with both the Neer and the AO systems remains difficult with minimal improvements seen when reducing the number of categories in each classification system. From these results, the Neer classification system would appear slightly more useful in clinical practice to guide treatment.

IntroducciónLas fracturas de tobillo son lesiones traumáticas frecuentes. El tratamiento, en general, es quirúrgico. La cirugía puede ser abierta o percutánea. El objetivo de este estudio es comparar el método mínimamente invasivo y el de la cirugía convencional abierta en el tratamiento de las fracturas de tobillo AO B.Materiales y MétodosEstudio prospectivo comparativo de 75 casos de fracturas AO B operados con MIPO y 58 casos operados por vía convencional. Se agruparon según a la clasificación AO. Se evaluaron las características durante el período intraoperatorio y la hospitalización, los resultados funcionales, según los puntajes de la AOFAS y de Weber, y los resultados radiológicos El seguimiento promedio de ambos grupos fue de 20.4 meses.ResultadosSe mencionan los resultados comparativos del tiempo quirúrgico, la estadía hospitalaria, el tiempo de fluoroscopia, la carga del peso. El puntaje de la AOFAS a los 3 meses: grupo A: 96,5 y grupo B: 99. Reducción radiológica: 97,4% con MIPO y 98,3% de los casos convencionales. Retorno a la actividad laboral: grupo A, 3.6 meses promedio, grupo B: 2.5 meses promedio. Retorno a la actividad deportiva: grupo A: media 4.8 meses; grupo B: media 3.7 meses.ConclusionesDe este estudio, se desprende que la MIPO para tratar las fracturas transindesmales es una buena opción, la evolución y la recuperación son más rápidas que con la técnica abierta, y el índice de complicaciones es bajo.

Objectives: In this study, our aim was to evaluate the functional, radiological and clinical results of the patients which treated with a volar anatomical locking plate due to distal radius fractures retrospectively. Methods: Patients operated with distal radius fracture between 2014-2016 were screened retrospectively. Fractures were classified according to the AO classification. Radiological values for radial height, radial inclination, radial volar tilt and ulnar variance were measured according to the radiological key points described by Medoff. The Stewart scoring form was used to evaluate the radiological results. Flexion-extension, pronation-supination was measured using with a goniometer. Grip strength was measured using a hand dynamometer. Clinical results were evaluated according to the Mayo wrist system. Results: The average age of 60 patients included in this study was 45 and average follow-up period was 13 month. Mean grip strength value was 18.33, the contralateral side was 25.33. The distribution of the Stewart radiological assessment score were 16 (27%) patients excellent, 36 (60%) good, and 8 (13%) moderate results. When evaluated clinically with the Mayo wrist score, the results were excellent in 20 (33%) patients, good in 35 (58%) patients, and moderate in 5 (9%) patients. Statistically significant differences were found in all radiological parameters. (p < 0.05) Conclusion: Surgery using a volar anatomical locking plate is an effective treatment method for distal radius fractures. Joint range of motion can be achieved early with correct fixation of the plate and by beginning joint movement as soon as possible. [Hand Microsurg 2020; 9(1.000): 27-31]

Rationale Tibial tuberosity fractures most often occur in the adolescents. Fracture of tibial tuberosity in adults is extremely rare with only 5 reported cases till date. Tibial plateau fractures combined with tibial tubercle fractures are not common. Patient concerns We report here a type B3 tibial plateau fracture (AO classification) with a concomitant fracture of tibial tuberosity. Diagnoses Anteroposterior and lateral knee view radiographs revealed a complex comminuted fracture of the right tibial plateau (AO Type B3; Schatzker Type IV) with tibial tubercle fracture. Three-dimensional computed tomography (CT) showed that the tibial media plateau was split into 2 pieces in the sagittal plane, along with the isolated tibial tubercle. Interventions The open procedure was performed first and a standard posteromedial approach for medial and posteromedial tibial plateau fracture was used with double locking plate fixation. The tibial tuberosity was fixed with a cortical screw. Outcomes The patient showed full range of motion in right knee after 8 weeks. The patient was allowed full weight bearing at 4 months. Eight months after operation, he was asymptomatic, showed a full range of motion and good strength. He had returned to work with no limitations. Lessons Fractures of the partial tibial plateau combined with tibial tubercle are present and should not be ignored. Accurate diagnosis and proper treatment will help achieve favorable outcomes in these patients.

The objective of this study is to determine the reproducibility and feasibility of using 3-dimensional (3-D) computer simulation of proximal humerus fracture computed tomography (CT) scans for fracture reduction. We hypothesized that anatomic reconstruction with 3-D models would be anatomically accurate and reproducible. Preoperative CT scans of 28 patients with 3- and 4-part (AO classification 11-B1, 11-B2, 11-C1, 11-C2) proximal humerus fractures who were treated by hemiarthroplasty were converted into 3-D computer models. The displaced fractured fragments were anatomically reduced with computer simulation by 2 fellowship-trained shoulder surgeons, and measurements were made of the reconstructed proximal humerus. The measurements of the reconstructed models had very good to excellent interobserver and intraobserver reliability. The reconstructions of these humerus fractures showed interclass correlation coefficients ranging from 0.71 to 0.93 between 1 observer and from 0.82 to 0.98 between 2 different observers. The fracture reduction was judged against normal proximal humerus geometry to determine reduction accuracy. The 3-D modeling techniques used to reconstruct 3- and 4-part proximal humerus fractures were reliable and accurate. This technique of modeling and reconstructing proximal humerus fractures could be used to enhance the preoperative planning of open reduction and internal fixation or hemiarthroplasty for 3- and 4-part proximal humerus fractures.

In 1924, Speed first classified radial head fractures [1]. Currently, over ten classifications have been reported in relation to proximal radius and ulna fractures [2]. According to the reports published in resent 5 years, AO classification is the most commonly used system in scientific research [3]. In clinical practice, Morrey classification is the most commonly used system for olecranon fractures, and Mason and modified Mason classifications for radial head fractures [4–6].

The incidence of trochanteric fractures has increased significantly during the last few decades, especially in elderly patients with osteoporosis. The dynamic/sliding hip screw and the cephalomedullary nail are the most commonly used fixation methods to treat trochanteric fractures. The improvements in the Gamma Nail System (GNS) associated with a correct surgical technique reduced the postoperative orthopedic complications. The purpose of this study was to compare the results of the different Gamma Nails. The present study is a retrospective analysis of 2144 patients treated with GNS between January 1997 and December 2011 for trochanteric fractures, classified according to AO classification method. The patients were divided into three groups according to the nailing system: 525 were treated with Standard Gamma Nail (SGN), 422 with Trochanteric Gamma Nail (TGN) and 1197 with Gamma3 Nail. The overall incidence of intra-operative complications was 1.21 %; the incidence of intra-operative complications for each group was 1.71 % for SGN group, 0.47 % for TGN group and 1.25 % for Gamma3 Nail group. The overall incidence of postoperative complications was 5.48 %, and the incidence for each group was 10.73 % for SGN group, 9.92 % for TGN group and 2.92 % for Gamma3 Nail group. The GNS is a safe device with a low rate of intra-operative complications. The evolution of this nail system reduces postoperative complications, thus improving the results at follow-up and confirming that the Gamma3 Nail is a safe and predictable device to fix trochanteric fracture.

The AO classification system, used as a guide for modern fracture care and fixation, follows a basic philosophy of care that emphasizes early mobility and return to function. Lower extremity long-bone fractures in patients with spinal cord injury often are pathologic injuries that present unique challenges, to which the AO principles may not be entirely applicable. Optimal treatment achieves healing without affecting the functional level of the patient. These injuries often result from low-energy mechanisms in nonambulatory patients with osteopenic bone and a thin, insensate soft-tissue envelope. The complication rate can be high, and the outcomes can be catastrophic without proper care. Satisfactory results can be obtained through various methods of immobilization. Less frequently, internal fixation is applied. In certain cases, after discussion with the patient, amputation may be suitable. Prevention strategies aim to minimize bone loss and muscle atrophy.

The aim of this study was to evaluate nonunion causes of surgically treated humeral shaft fractures in two different trauma centers. A total of 327 cases of humeral shaft fractures were treated in 11 years in two trauma centers. We retrospectively reviewed in detail some factors in order to understand the reasons for nonunion: (1) fracture type, according to the AO classification, (2) grade of open fracture, according to Gustilo–Anderson, (3) timing, (4) reduction and (5) fixation. We observed 19 nonunions, 10 women and 9 men, with an average age of 57 years. Fractures were 1 A1 case, 2 A2 cases, 4 B2 cases, 6 B3 cases, 2 C1 cases, 1 C2 case and 3 C3 cases. Three cases had a simple fracture with two fragments; all the other were comminuted. Fifteen cases were closed, four open. The major criticalities observed were fracture comminution, exposure, unstable fixation and bone resorption. All 19 patients with nonunion underwent surgical fixation with compression plate and frozen cortical bone graft. A 4.5 LCP plate was used in 17 cases. The remaining 2 cases had an anatomical site-specific proximal humeral 3.5-mm LCP plate (Synthes, Paoli, PA, USA). In 17 patients, the nonunion healed: 15 cases treated with a 4.5 straight plate, and 2 cases with an anatomical site-specific proximal humeral 3.5 mm LCP plate, at a mean of 5 months. In 2 cases, consolidation was not reached. We believe that humeral diaphyseal fractures should be treated surgically to avoid many complications. Our retrospective analysis indicates that factors that lead to a fixation failure are fracture comminution, open fracture, unstable fixation. The 19 nonunions treated with compression plating and frozen bone graft demonstrated consolidation in almost 90% of the cases.

During the last few decades, traumatic injuries of the hip joint have significantly increased in number, and traffic accidents have also increased. Depending on the speed, direction of the forces and the position of the femur at the moment of impact, different patterns of injury occur. Basically, they are classified as hip dislocations, dislocation fractures and acetabular fractures. These injuries have in common a high rate of concomitant lesions. Several classification systems have been developed for these injuries. Commonly, Stewart and Milford's or Levin's classification is used for dislocations and dislocation fractures. For acetabular fractures, Judet and Letournel's classification and its newer version developed by Helfet (AO classification) are generally accepted. Fractures of the femoral head, though included in these classifications, are typically described by separate classifications like the one presented in 1957 by Pipkin. The multitude of injuries occuring in the hip joint requires vast knowledge of various operative approaches. No single approach exists that would permit the treatment of all injuries in an ideal fashion. Approaches are either considered limited (Kocher-Langenbeck, ilioinguinal iliofemoral) when they permit access only to a restricted segment of the joint, or extended (extended iliofemoral, Maryland, Ruedi) when they allow all-around visualization of the hip joint. The choice of the best approach for an individual patient depends on the type of injury and also on patient variables like age, preexisting disease, and concomitant injuries. The decision is further influenced by the timing of surgery, the kind of fracture stabilization intended and by complications typically seen with certain approaches. The indication for extended procedures is only seen in patients with complex injury patterns involving both the anterior and the posterior column or in delayed cases undergoing surgery more than 3 weeks after trauma. Extended approaches permit excellent visualization of the fracture, but the extent of the soft tissue trauma is reflected in a high rate of postoperative complications. After a phase in which extended procedures were favored, recently a trend towards more limited approaches can be recognized because of their lower complication rate. This is facilitated by modern fracture-reduction methods using indirect techniques.

Background: Surgical reconstruction of intra-articular distal humerus fractures imposes a challenge to even experienced surgeons as it is complicated by anatomy of elbow, small area of fixation, associated comminution, and osteopenia of articular surfaces. Single-column plating does not provide stable construct for comminuted distal humerus fractures as compared to the double-column plating methods. The purpose of this study is to evaluate the functional outcomes, technical difficulties, complications, and patients' satisfactions after orthogonal double plating. Materials and Methods: This was a retrospective analytical study of 54 patients with Type C distal humerus fractures fixed with orthogonal plating from 2012 to 2016. Time to unite the fractures and functional outcomes along with other major and minor complications were noted. Results: Seven (13%) fractures were C1, 12 (22.2%) were C2, and 35 (64.8%) were C3 types according to the AO classification. Major complications were noted in 5 patients and minor complications in 19 patients. Eleven (20.4%) patients were rated as excellent, 33 (61.1%) rated as good, 7 (12.9%) rated as fair, and 3 (5.6%) rated as poor. Mayo Elbow Performance Score in overall patients (n = 54) was 81.62 ± 10.28, C1/C2 subgroup (n = 19) was 89.05 ± 60, and C3 subgroup was 77.60 ± 9.91 (P = 0.627). Similarly, the Disabilities of the Arm Shoulder and Hand Score in overall patients was 17.96 ± 15.67, C1/C2 subgroup was 8.78 ± 7.07, and C3 subgroup was 22.82 ± 16.78 (P = 0.285). Conclusion: Orthogonal dual-plate configurations can provide anatomical reconstruction and stable fixation of Type C intra-articular distal humeral fractures and allow early mobilization of the elbow after surgery; however, a significant number of patients do not satisfy after surgery.

In the last years we observed an increased number of patients with multiple lesions after high energy accidents. Type C injuries of the thoracic spine are the most severe lesions, with the worse prognosis. The study analyzes the injury profile, management and outcome of all patients with thoracic spine, from T1- to T10, type C injuries treated in the Spinal Surgery Department of “Bagdsar- Arseni” Emergency Hospital, in the last 5 years. There were 26 patients admitted in the study, mostly male, 77%, with a mean age of 33.8 years. All of them were victims of high energy accidents, and all had spine injury associated with multiple lesions (head, thoracic, abdominal and limbs). We have chosen a posterior approach in all cases, with laminectomy or hemilaminectomy, permitting us to achieve all the major objectives of surgery, with the advantage of lower blood loss and a reduced operating time. The purpose of surgery was to achieve decompression of the spinal cord and stability of the thoracic spine. We treated 19 patient surgically and 4 patient conservative. Thoracic spine type C fractures remain a challenge for the spinal surgeon. These lesions require a multidisciplinary team approach for the treatment of associated lesions. The main goal of surgery is to achieve stability of the fractured segments. The timing for surgery is indicated mainly by associated respiratory problems.

BACKGROUND Evaluate the functional results and determine the complications after treating distal humerus fractures with an anatomically pre-contoured double plate system. MATERIAL AND METHODS Twenty-five patients with distal humeral fractures were treated with a pre-contoured double plate system. There were 18 males (72%), 7 females (28%), with an average age of 39.68 years (22-70years). As per the AO classification, there were 4 type A fractures (16%) and 21 type C fractures (84%). In addition to clinical examination, functional results were evaluated using the Mayo elbow performance score (MEPS). RESULTS Using the Mayo elbow performance score, the results obtained were graded as excellent or good results in 22 patients (88%), fair in 2 (8%) and poor in 1 (4%) of cases. Average time interval between admission and surgery was 3.8 days (average 1-9 days). All the fractures as well as the olecranon osteotomies united by 10-16 weeks (12.56 weeks). No patient had deep infection, implant failure, non-union of fracture site or olecranon osteotomy site. Superficial wound infection, which occurred in 4 (16%) patients, resolved with oral antibiotics. Transient ulnar nerve palsy developed in 1(4%) case. However, the patient recovered with conservative treatment. CONCLUSIONS 1. An anatomically pre-shaped distal humerus locking plate system is useful in providing stable fixation of distal humerus fractures, thereby facilitating early postoperative rehabilitation. 2. In contrast to conventional plating, we did not observe any case of secondary fracture displacement, non-union or implant failure even in elderly patients with potentially reduced bone mass. 3. The multiple angular stable point fixation seems to be effective in the application of this system.

Background: The distal radius fractures are complex injuries. There are many treatment options for these fractures. The benefits of external fixation with mini fixator have been seen in many studies. In our study, the distal radius fracture belonging to type B and C of AO classification were treated with wrist spaning mini extrernal fixator with/without additional k wires. We wish to analyse the functional outcome and to determine any complications of this procedure.Methods: 20 patients were included in this study and were followed up for up to 6 months postoperatively. We assessed pain using VAS score at 6 weeks follow-up and the outcome of each patient was assessed using Mayo wrist score post-operatively on follow-up at 3 months and 6 months.Results: Predominance towards males and left upper limb was observed in our study. At the end of six months, the range of motion as assessed according to the criteria given by Mayo wrist score, excellent results (MWS>=90) were seen in 4 patients (20%), good results (MWS 80-89) were seen in 12 patients (60%),and fair (MWS 70-79) in 4 patient (20%). At the end of result, significant reduction in terms of pain, wellbeing, personal life, social life, lifting, travelling and sleeping was seen.Conclusions: Predominance towards males and left upper limb was observed in our study. At the end of six months, the range of motion as assessed according to the criteria given by Mayo Wrist Score, excellent results (MWS>=90) were seen in 4 patients (20%), good results (MWS 80-89) were seen in 12 patients (60%),and fair (MWS 70-79) in 4 patient (20%). At the end of result, significant reduction in terms of pain, wellbeing, personal life, social life, lifting, travelling and sleeping was seen.

Objective: To evaluate the incidence of union, nonunion, deep infection and factors influencing the time of bone healing in the treatment of open tibial shaft fractures Gustilo and Anderson types I and II initially treated with a non penetrating external fixator (Pinless(r)) followed by an unreamed intramedullary locked nail (UTN(r)). Methods: It is a prospective study of 39 open tibial shaft fractures. According to the AO classification, 16 patients (41.0%) were type A, 17 (43.6%) were type B and six (15.4%) were type C. According to the Gustilo and Anderson classification, 14 patients (35.9%) were type I and 25 (64.1%) were type II. For the definitive stabilization of the fracture were used an unreamed intramedulary locked nail (UTN(r)). Results: Bone healing was achieved in 97.4% of the cases, with a mean time of 21.2 weeks, ranging from 12 to 104 weeks. Deep infection was seen in 2.6% patients and malunion were seen in 5.1%. Only the presence of complications were statistically significant to the time of bone healing, with a risk of faster healing in patients without complications of 4.29 times (CI 95%: 1.25 -14.71) comparing to patients with complications. Conclusion: The treatment of open tibial shaft fractures with unreamed intramedullary locked nail allows high rates of bone healing, low rates of nonunion and deep infection, and only the presence of complications is statistically significant to the time of bone healing. Objetivo: Avaliar as taxas de consolidação, não consolidação e infecção profunda e quais fatores podem influenciar o tempo de consolidação nos pacientes com fraturas expostas da diáfise da tíbia grausIeIIde Gustilo e Anderson, tratadas segundo um protocolo sequencial inicialmente com fixador externo não transfixante Pinless(r), seguido por osteossíntese com haste intramedular maciça bloqueada não fresada (UTN(r)). Métodos: Em estudo prospectivo, 39 fraturas expostas da diáfise da tíbia foram acompanhadas. Segundo a classificação AO, 16 pacientes (41%) sofreram fraturas do tipo A, 17 (43,6%) dotipoB e seis(15,4%) dotipoC. SegundoaclassificaçãodeGustiloeAnderson, 14pacientes (35,9%) sofreram fraturas expostas grau I e 25 (64,1%) fraturas grau II. Para fixação interna foi usada haste intramedular maciça bloqueada não fresada (UTN(r)). Resultados: Consolidação ocorreu em 97,4% dos casos com tempo médio de 21,2 semanas, variação de 12 até 104 semanas. Infecção profunda ocorreu em 2,6% dos casos e consolidação viciosa ocorreu em 5,1%. Da análise estatística observamos que apenas a presença de complicações é estatisticamente significativa para explicar o tempo de consolidação. O risco de consolidação mais rápida em pacientes sem complicações é de 4,29 vezes (IC 95%: 1,25-14,71) em relação a pacientes com complicações. Conclusão: O tratamento das fraturas expostas da diáfise da tíbia com osteossíntese intramedular maciça bloqueada não fresada apresenta taxa alta de consolidação, baixas taxas de não consolidação e de infecçãoprofunda eapenas a presençade complicações apresenta relação estatisticamente significante com o tempo de consolidação.

Treatment options for displaced distal radial fractures are still a controversial topic of discussion. Although good results for the palmar plating of high-volume centers have been published, evidence of its successful use in smaller institutions is still lacking. We report the clinical and radiological results of the treatment for 84 distal radial fractures with a single 2.4-mm T-miniplate in an institution performing

Background: Our aim was to assess whether the Lauge-Hansen (LH) and the Muller AO classification systems for ankle fractures radiographically correlate with in vivo injuries based on observed mechanism of injury. Methods: Videos of potential study candidates were reviewed on YouTube.com . Individuals were recruited for participation if the video could be classified by injury mechanism with a high likelihood of sustaining an ankle fracture. Corresponding injury radiographs were obtained. Injury mechanism was classified using the LH system as supination/external rotation (SER), supination/adduction (SAD), pronation/external rotation (PER), or pronation/abduction (PAB). Corresponding radiographs were classified by the LH system and the AO system. Results: Thirty injury videos with their corresponding radiographs were collected. Of the video clips reviewed, 16 had SAD mechanisms and 14 had PER mechanisms. There were 26 ankle fractures, 3 nonfractures, and 1 subtalar dislocation. Twelve fractures with SAD mechanisms had corresponding SAD fracture patterns. Five PER mechanisms had PER fracture patterns. Eight PER mechanisms had SER fracture patterns and 1 had SAD fracture pattern. When the AO classification was used, all 12 SAD type injuries had a 44A type fracture, whereas the 14 PER injuries resulted in nine 44B fractures, two 44C fractures, and three 43A fractures. Conclusion: When injury video clips of ankle fractures were matched to their corresponding radiographs, the LH system was 65% (17/26) consistent in predicting fracture patterns from the deforming injury mechanism. When the AO classification system was used, consistency was 81% (21/26). The AO classification, despite its development as a purely radiographic system, correlated with in vivo injuries, as based on observed mechanism of injury, more closely than did the LH system. Level of Evidence: Level IV, case series.