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Case: A 12-year-old girl presented with significant right elbow pain following a fall during soccer which caused an osseous triceps avulsion injury and nondisplaced type II Salter-Harris radial neck fracture. The patient was treated with successful open repair utilizing suture anchor fixation, resulting in full return of function and return to previous activities. Conclusion: Timely and accurate diagnosis and treatment of displaced triceps sleeve avulsion injuries is critical and can result in excellent patient outcomes and return to previous functional level. This unique case contributes to the diagnosis and management of this rare condition in pediatric populations. [ABSTRACT FROM AUTHOR]

Background and objectives: We aimed to determine the effects of vanillic acid (VA) on fracture healing radiologically, histologically, immunohistochemically, and biomechanically using a rat femur open fracture injury model. Methods: 32 male Wistar-Albino rats were used and divided into two groups: the study group (VA) and the control group. From the time they were operated on until they were sacrificed, the rats in the study group were given 100 mg/kg/day VA by oral gavage. After sacrification, the femurs were analyzed. Results: It was observed that the Huo histological scoring was significantly higher in the VA group (p = 0.001), and the ratio of the amount of callus tissue compared to intact bone tissue was significantly higher. While no significant difference was observed in immunohistochemical H-scores in Coll antibody staining (p = 1.000), a borderline significant difference in favor of VA was observed in Colili antibody staining (p = 0.078). In biomechanical analysis, failure load (N), total energy (J), maximum stress (MPa), and stiffness (N/mm) measurements were significantly higher in the VA group (p = 0.040, p = 0.021, p = 0.015, and p = 0.035, respectively). Conclusion: It has been observed that VA, with its antioxidative properties, increases fracture healing in rats, in which an open fracture model was created. We are hopeful that such an antioxidant, which is common in nature, will increase fracture healing. Since this study is the first to examine the effect of VA on fracture healing, further studies are needed. [ABSTRACT FROM AUTHOR]

Background: Delayed union in long bone fractures poses a significant clinical challenge, necessitating effective treatment solutions. The urgency for novel and effective treatment modalities is ever-increasing, especially considering the prevalence and complications associated with delayed union. Aims and Objectives: This retrospective analysis aims to assess the safety and efficacy of autologous bone marrow injections in treating delayed union in a diverse cohort of individuals with long bone fractures. Materials and Methods: The study includes 100 individuals aged 21–69 with varying fracture types. Fracture classifications comprised 40% closed fractures (n=40) and 60% open fractures (n=60). Notably, the femur had a higher prevalence of open fractures (n=30) than closed fractures (n=20). Tibia fractures demonstrated a similar propensity, with 25 open and 15 closed cases. Humerus fractures manifested an even distribution between open and closed categories (n=5 each), indicating their relative resilience to open fractures. Results: Union was attained in 82 cases, with a mean union time of 7.4 weeks post-the-third bone marrow injection. The timeframe for the union varied widely, ranging from 4 to 17 weeks. In eight instances where bone marrow injections failed to achieve union, alternative treatment via bone grafting was necessary. No significant complications were reported; however, minor discomfort was experienced by 13% of the patients and was effectively managed with over-the-counter analgesics. Conclusion: This retrospective analysis demonstrates the high efficacy and safety of autologous bone marrow injections in treating delayed union in long bones, making them a promising alternative treatment strategy with minimal complications.

Background: Delayed union in long bone fractures poses a significant clinical challenge, necessitating effective treatment solutions. The urgency for novel and effective treatment modalities is ever-increasing, especially considering the prevalence and complications associated with delayed union. Aims and Objectives: This retrospective analysis aims to assess the safety and efficacy of autologous bone marrow injections in treating delayed union in a diverse cohort of individuals with long bone fractures. Materials and Methods: The study includes 100 individuals aged 21-69 with varying fracture types. Fracture classifications comprised 40% closed fractures (n=40) and 60% open fractures (n=60). Notably, the femur had a higher prevalence of open fractures (n=30) than closed fractures (n=20). Tibia fractures demonstrated a similar propensity, with 25 open and 15 closed cases. Humerus fractures manifested an even distribution between open and closed categories (n=5 each), indicating their relative resilience to open fractures. Results: Union was attained in 82 cases, with a mean union time of 7.4 weeks post-the-third bone marrow injection. The timeframe for the union varied widely, ranging from 4 to 17 weeks. In eight instances where bone marrow injections failed to achieve union, alternative treatment via bone grafting was necessary. No significant complications were reported; however, minor discomfort was experienced by 13% of the patients and was effectively managed with over-the-counter analgesics. Conclusion: This retrospective analysis demonstrates the high efficacy and safety of autologous bone marrow injections in treating delayed union in long bones, making them a promising alternative treatment strategy with minimal complications. [ABSTRACT FROM AUTHOR]

Purpose: Various fixation techniques have been described for midshaft clavicle fractures in the literature. We hypothesized that use of the Rockwood pin for fixation of displaced midshaft clavicle fractures would result in favorable outcomes in a young active cohort. Methods: Patients aged 10–35 years who underwent Rockwood clavicle pin fixation at a single institution were identified. Preoperative and postoperative radiographs were reviewed and assessed for fracture characteristics, postoperative alignment, and radiographic union. Postoperative outcome scores were obtained. Results: A total of 39 patients (age 17.3 ± 3.9 years) with clavicle fracture treated with Rockwood pin were identified. Radiographic review demonstrated that 88% of fractures were 100%, or more, displaced, and surgery achieved near-anatomic reduction in 92% of cases. Average time to radiographic union was 2.3 ± 0.8 months, and average time to clinical union was 2.5 ± 0.3 months. One patient required revision for nonunion (3%). Complete outcome responses were obtained for 24 patients, with an average 40 ± 27.7 months of follow-up. Mean Total Clavicle Functional score was 2.75 ± 3.6 for minor patients. For adult patients, Nottingham Clavicle score was 90.7 ± 10.7, mean American Shoulder and Elbow Society score was 92.4 ± 11.2, and mean Single Assessment Numerical Evaluation score was 88.8 ± 21.5. 77% of adults reported no long-term functional limitation; 54% reported a bump at the prior fracture site, but 100% reported satisfaction with shoulder appearance. Conclusions: In our cohort of young active patients, treatment with Rockwood pin allowed for anatomic reduction, healing with a low nonunion rate, and favorable patient reported outcomes. [ABSTRACT FROM AUTHOR]

Background: The use of orthobiologics is expanding. However, the use of orthobiologic augmentation in primary fracture fixation surgery remains limited. Primary fracture fixation of the fifth metatarsal (Jones) in athletes is one of the rare situations where primary orthobiologic augmentation has been advocated. Purpose: To determine the effect of orthobiologic augmentation on the outcome of surgically managed Jones fractures in athletes. Study Design: Systematic review; Level of evidence, 4. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 2 independent team members searched several databases including PubMed, MEDLINE, Embase, Google Scholar, Web of Science, Cochrane Library, and ClinicalTrials.gov through March 2021 to identify studies reporting on surgically managed Jones fractures of the fifth metatarsal exclusively in athletes. The primary outcomes were the return to play (RTP) rate and time to RTP, whereas the secondary outcomes were time to union, union rate, and refractures. Data were presented by type of treatment (biologically augmented fixation or fixation alone). Results: In the biologically augmented fixation group, successful RTP was reported in 195 (98.98%) of 197 fractures (odds ratio [OR], 97.5%; 95% CI, 95.8%-100%; I 2 = 0), with a mean time to RTP of 10.3 weeks (95% CI, 9.5-11.1 weeks; I 2 = 99%). In the group that received fixation without biological augmentation, successful RTP was reported in 516 (99.04%) of 521 fractures (OR, 98.7%; 95% CI, 97.8%-99.7%; I 2 = 0], with a mean time to RTP of 9.7 weeks (95% CI, 7.84-11.53 weeks; I 2 = 98.64%]. In the biologically augmented fixation group, fracture union was achieved in 194 (98.48%) of 197 fractures (OR, 97.6%; 95% CI, 95.5%-99.7%; I 2 = 0%), with a mean time to fracture union of 9.28 weeks (95% CI, 7.23-11.34 weeks; I 2 = 98.18%). In the group that received fixation without biological augmentation, fracture union was achieved in 407 (93.78%) of 434 fractures (OR, 97.4%; 95% CI, 96%-98.9%; I 2 = 0%), with a mean time to fracture union of 8.57 weeks (95% CI, 6.82-10.32 weeks; I 2 = 98.81%). Conclusion: Orthobiologically augmented surgical fixation of Jones fractures in athletes is becoming increasingly common, despite the lack of comparative studies to support this practice. Biologically augmented fixation of Jones fractures results in higher fracture union rates than fixation alone but similar rates of RTP and time to RTP. Although the current evidence recommends primary surgical fixation for the management of Jones fractures in athletes, further high quality comparative studies are required to establish the indication for orthobiologic augmentation. [ABSTRACT FROM AUTHOR]

Assessment of scaphoid fracture union on computed tomography scans is not currently standardized. We investigated the extent of scaphoid waist fracture union required to withstand physiological loads in a finite element model, based on a high-resolution CT scan of a cadaveric forearm. For simulations, the scaphoid waist was partially fused at the radial and ulnar sides. A physiological load of 100 N was transmitted to the scaphoid and the minimal amount of union to maintain biomechanical stability was recorded. The orientation of the fracture plane was varied to analyse the effect on biomechanical stability. The results indicate that the scaphoid is more prone to re-fracture when healing occurs on the ulnar side, where at least 60% union is required. Union occurring from the radial side can withstand loads with as little as 25% union. In fractures more parallel to the radial axis, the scaphoid seems less resistant on the radial side, as at least 50% union is required. A quantitative CT scan analysis with the proposed cut-off values and a consistently applied clinical examination will guide the clinician as to whether mid-waist scaphoid fractures can be considered as truly united. [ABSTRACT FROM AUTHOR]

BackgroundRib fractures are the most common injuries in chest trauma. Compared with younger patients, elderly patients with rib fracture have a higher incidence of complications and mortality. A retrospective study was conducted to investigate the effect of internal fixation compared with conservative treatment on the outcome of rib fracture in elderly patients.Material and methodsWe used a 1:1 propensity score matching method to perform a retrospective analysis of 703 elderly patients with rib fractures treated in the Thoracic Surgery Department of Beijing Jishuitan Hospital between 2013 and 2020. After matching, the length of hospital stay, death, symptom relief and rib fracture healing were compared between the surgery and the control group.ResultsThe study included 121 patients receiving SSRF in the surgery group and 121 patients receiving conservative treatment in the control group. The length of hospital stay in the surgery group was significantly longer than that in the conservative group (11.39d vs. 9.48d, p = 0.000). After 9 months of follow-up, the fracture healing rate in the surgery group was significantly higher than that in the control group (96.67% vs. 88.89%, p = 0.020). The fracture healing time (p = 0.000), improvement in pain score (p = 0.000) and duration of pain medication use (p = 0.000) were also significantly better in the surgery group than in the control group.ConclusionCompared with conservative treatment, surgical treatment can prolong hospital stay to some extent. However, it has the advantages of more rapid healing and lessened pain. For rib fractures in elderly individuals, surgical treatment is a safe and effective option under strict surgical indications and is recommended.

Purpose: Early weight bearing (EWB) is often recommended after intramedullary nailing of tibial shaft fractures, however, the risks and benefits have not been critically evaluated in a systematic review or meta-analysis. Therefore, the aims of this study were to perform a systematic review and meta-analysis comparing EWB and delayed weight-bearing (DWB) after intramedullary nailing of tibial shaft fractures and assess the relationship between weight-bearing, fracture union and healing. Method: This review included studies comparing the effects of EWB, defined as weight-bearing before 6 weeks, and DWB on fracture union and healing. PubMed, Embase, CINAHL, and the Cochrane Library were searched from inception to 9 May 2021. Risk of bias was assessed using the Down's and Black Checklist and Cochrane Risk of Bias Tool 2.0. Data were synthesised in a meta-analysis, as well as narrative and tabular synthesis. Results: Eight studies were included for data extraction and meta-analysis. The analysis produced mixed results and found a significant decrease in mean union time (−2.41 weeks, 95% confidence interval: −4.77, −0.05) with EWB and a significant Odd's Ratio (OR) for complications with DWB (OR: 2.93, 95% CI: 1.40, 6.16). There was no significant difference in rates of delayed union, non-union, re-operation and malunion. Conclusion: The included studies were of moderate risk of bias and demonstrated shorter union time and fewer complications with EWB. However, current evidence is minimal and has significant limitations. The role of EWB in high-risk patients is yet to be examined. Further well-designed, randomised studies are required on the topic. [ABSTRACT FROM AUTHOR]

Introduction: Injuries resulting from traffic accidents, industrial accidents, natural disasters, and assault are the cause of most fractures of the forearm and it is very important to regain the length, apposition, axial alignment, and rotational alignment of the radius and ulna while treating diaphyseal fractures to achieve a good range of motion. In such cases, open reduction and internal fixation are recommended. Aim: To determine the effectiveness of Locking Compression Plates (LCP) and Dynamic Compression Plates (DCP) in treating adult forearm fractures. Materials and Methods: A prospective interventional study was conducted from September 2020 to September 2021 in which 30 patients with both bone forearm fractures underwent open reduction and internal fixation with a Locking Compression Plate(n=15) or a Dynamic Compression Plate(n=15) at the Dr.D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, India. For each LCP and DCP operated patient, radiographic findings regarding fracture union and functional outcomes regarding elbow joint range of motion was evaluated. Appropriate parametric tests (Chi-square test, Independent t-test) were conducted to identify significant differences in functional outcomes between the two interventions. Results: Out of total, 13 patients (86.7%) each who underwent both the DCP and LCP fixation had excellent outcomes, though the results were not significant according to Anderson LD et al., grading system. Although it was statistically insignificant (p-value= 0.18), patients who received LCP took less time to heal their fractures than those who received DCP. There was no significant difference between patients treated with DCP and those treated with LCP when it comes to achieving a complete range of motion (p-value=0.99). Conclusion: In terms of functional outcome, both the patient groups who were operated on with DCP as well as LCP had no significant difference. Proper preoperative planning, good patient care, proper surgical technique with minimal adjacent soft tissue damage, strict aseptic conditions, proper follow-up, and rehabilitation along with patient education are all required for good functional outcomes. [ABSTRACT FROM AUTHOR]

Purpose: In cases of closed tibia fractures with acute compartment syndrome (ACS), there is no established agreement on whether performing internal fixation at the time of closure or after healing of the fasciotomy wounds would affect the likelihood of non-union or infection risk. The study aims to compare fracture union rates, incidence of infection, and overall outcomes between early and delayed definitive fixation., Methods: Retrospective analysis of closed tibia fractures (AO/OTA 41, 42) with ACS between 2010 and 2019 with a minimum two years follow-up. The patients were grouped into group-1 (early-definitive fixation group) and group-2 (delayed-definitive fixation group). The patients were further subdivided into - 1 A(early-plate osteosynthesis), 1B(early-intramedullary nail fixation), 2 A(delayed-plate osteosynthesis), and 2B(delayed-intramedullary nail fixation)., Results: Incidence of ACS in closed tibia fractures was 3.85%. Of the 103 patients included, the patients with plate fixation had a significantly higher union rate in the delayed group (100% vs. 91.66%; P = 0.0001). Similarly, among patients with nail fixation, a significantly higher union rate was seen in the delayed group (96.30% vs. 85.19%; P = 0.0016). The overall incidence of infection was 22.3% (23/103). Moreover, infection was higher in the early definitive fixation group (30.16% vs. 10%; P = 0.016)., Conclusion: With a lower incidence of infection and higher union rate among the delayed definitive fixation group, we propose to postpone the definitive fixation of closed tibia fractures complicated by ACS till the complete healing of fasciotomy wounds. This allows for adequate soft tissue healing and improvement in the biological environment of fracture, which boosts the chances of successful union and reduces infection risks., (© 2024. The Author(s) under exclusive licence to SICOT aisbl.)

Introduction: Injuries resulting from traffic accidents, industrial accidents, natural disasters and assault are the cause of most fractures of the forearm and it is very important to regain the length, apposition, axial alignment and rotational alignment of the radius and ulna while treating diaphyseal fractures to achieve a good range of motion. In such cases, open reduction and internal fixation are recommended. Aim: To determine the effectiveness of Locking Compression Plates (LCP) and Dynamic Compression Plates (DCP) in treating adult forearm fractures. Materials and Methods: A prospective interventional study was conducted from September 2020 to September 2021 in which 30 patients with both bone forearm fractures underwent open reduction and internal fixation with a LCP (n=15) or a DCP (n=15) at the Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, India. For each LCP and DCP operated patient, radiographic findings regarding fracture union and functional outcomes regarding elbow joint range of motion was evaluated. Appropriate parametric tests (Chi-square test, Independent t-test) were conducted to identify significant differences in functional outcomes between the two interventions. Results: Out of total, 13 (86.7%) patients each who underwent both the DCP and LCP fixation had excellent outcomes, though the results were not significant according to Anderson LD et al., grading system. Although, it was statistically insignificant (p-value=0.18), patients who received LCP took less time to heal their fractures than those who received DCP. There was no significant difference between patients treated with DCP and those treated with LCP when it comes to achieving a complete range of motion (p-value=0.99). Conclusion: In terms of functional outcome, both the patient groups who were operated on with DCP as well as LCP had no significant difference. Proper preoperative planning, good patient care, proper surgical technique with minimal adjacent soft tissue damage, strict aseptic conditions, proper follow-up, and rehabilitation along with patient education are all required for good functional outcomes.

Introduction: Extra-articular diaphyseal tibial fractures are a common injury and are often treated with intramedullary nailing (IMN). Weight-bearing (WB) of simple tibial fractures treated with an IMN immediately as pain allows is now standard practice. Our aim was to assess the impact of varied WB on fracture union following IMN of diaphyseal tibia fractures. Methods: We conducted a retrospective cohort study of tibial fractures treated with IMN in our department between 2012-2017. WB status was recorded in the post-operative note and subsequently reviewed in the patients' follow-up appointments. Patients were divided in three groups; Group I: immediate full-WB, Group II: non-WB for 6 weeks and Group III: 2 weeks non-WB, 4 weeks increasing partial-WB and full-WB at 6 weeks. Radiographic union score for tibial fractures (RUST) of ≥10 at a painless fracture site was considered as evidence of fracture union. Results: 92 patients with comparable pre-operative demographics [mean age 40 y (16-88)] were included. The median union time in weeks for each group was: Group I 17.3, Group II 21.7 and Group III 19.5 (F 1.09, p 0.34). Survival analysis and log rank test did not show any difference in union times between the three groups (x2 1.1, p 0.57). 12 delayed unions were identified across all groups. Multiple logistic regression identified three factors that could increase the rate of delayed union – non-WB, smoking and IMN size 11/12 mm - however the results were not statistically significant. Conclusion: Immediate post-operative WB does not adversely affect union time in statically locked IMNs. In fact, although our data show no statistically significant difference in fracture healing between the three groups, full WB seems to decrease overall time to union. In conclusion, we could suggest that full WB after IMN in patients with AO 42-A/B type fractures is safe practice. [ABSTRACT FROM AUTHOR]

Background: Proximal fifth metatarsal fractures are among the most common forefoot injuries in athletes. The management of this injury can be challenging because of delayed union and refractures. Intramedullary (IM) screw fixation rather than nonoperative management has been recommended in the athletic population. Purpose: To provide an updated summary of the return-to-play (RTP) rate and time to RTP after Jones fractures in athletes with regard to their management, whether operative or nonoperative, and to explore the union rate and time to union as well as the rate of complications such as refractures. Study Design: Meta-analysis. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 2 independent team members searched several databases including PubMed, MEDLINE, Embase, Google Scholar, Web of Science, Cochrane Library, and ClinicalTrials.gov through November 2019 to identify studies reporting on Jones fractures of the fifth metatarsal exclusively in athletes. The primary outcomes were the RTP rate and time to RTP, whereas the secondary outcomes were the number of games missed, time to union, and union rate as well as the rates of nonunion, delayed union, and refractures. Results: Of 168 studies identified, 22 studies were eligible for meta-analysis with a total of 646 Jones fractures. The overall RTP rate was 98.4% (95% CI, 97.3%-99.4%) in 626 of 646 Jones fractures. The RTP rate with IM screw fixation only was 98.8% (95% CI, 97.8%-99.7%), with other surgical fixation methods (plate, Minifix) was 98.4% (95% CI, 95.8%-100.0%), and with nonoperative management was 71.6% (95% CI, 45.6%-97.6%). There were 3 studies directly comparing RTP rates with surgical versus nonoperative management, which showed significant superiority in favor of surgery (odds ratio, 0.033 [95% CI, 0.005-0.215]; P <.001). The RTP rate according to type of sport was 99.0% (95% CI, 97.5%-100.0%) in football, 91.1% (95% CI, 82.2%-99.4%) in basketball, and 96.6% (95% CI, 92.6%-100.0%) in soccer. The overall time to RTP was 9.6 weeks (95% CI, 8.5-10.7 weeks). The time to RTP in the surgical group (IM screw fixation) was 9.6 weeks (95% CI, 8.3-10.9 weeks), which was significantly less than that in the nonoperative group of 13.1 weeks (95% CI, 8.2-18.0 weeks). The pooled union rate in the operative group (excluding refractures) was 97.3% (95% CI, 95.1%-99.4%), whereas the pooled union rate in the nonoperative group was 71.4% (95% CI, 49.1%-93.7%). The overall time to union was 9.1 weeks (95% CI, 7.7-10.4 weeks). The time to union with IM screw fixation (8.2 weeks [95% CI, 7.5-9.0 weeks]) was shorter than that with nonoperative treatment (13.7 weeks [95% CI, 12.7-14.6 weeks]). The rate of delayed union was 2.5% (95% CI, 1.2%-3.7%), and the overall refracture rate was 10.2% (95% CI, 5.9%-14.5%). Conclusion: The RTP rate and time to RTP after the surgical management of Jones fractures in athletes were excellent, regardless of the implant used and type of sport. IM screw fixation was superior to nonoperative management, as it led to a higher rate of RTP, shorter time to RTP, higher rate of union, shorter time to union, and improved functional outcomes. We recommend surgical fixation for all Jones fractures in athletes. [ABSTRACT FROM AUTHOR]

Open reduction and internal fixation (ORIF) of displaced midshaft clavicle fractures is associated with higher union rates and earlier functional recovery. However, ORIF with plate fixation is associated with complications including implant irritation and implant failure. Dual plate fixation provides fixation in orthogonal planes, and uses a lower profile fixation technique in comparison to pre-contoured and surgeon-contoured small-fragment locking plates, which may be more prominent. The objective of this study was to conduct a systematic review to summarize outcomes and complications associated with surgical fixation of displaced acute midshaft clavicle fractures with dual plate fixation. Using a predetermined study protocol in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, the databases MEDLINE, EMBASE, and CENTRAL were searched from inception to 2020 to identify studies reporting outcomes in acute midshaft clavicle fractures treated with dual plate fixation. All clinical studies which reported on outcomes of dual plating in patients with acute midshaft clavicle fractures were included. Baseline demographics, plate fixation constructs, fracture union rates, implant removal rates, maintenance of reduction, symptomatic implant rates, wound complications, and functional outcomes were extracted. All extracted data were recorded, and descriptive statistics were summarized. Meta-analysis was performed on fracture union rates and implant removal rates using random-effects modeling using Mantel-Haenszel weighting. Our literature search identified 2226 unique abstracts, of which eight studies met our study inclusion criteria following review. A total of 278 patients made up of 79.8% male with an average age of 36.0 years were included. The overall dual plate implant removal rate was 4.2% with excellent rates of union reported. Moreover, single plate fixation was associated with a 3.9-fold increased implant removal rate compared to dual plate fixation. Results from this systematic review demonstrate that ORIF of displaced midshaft clavicle fractures using a dual plate fixation technique is a viable option to reduce the incidence of implant removal, without negatively impacting the rate of fracture union. Therapeutic Level III. [ABSTRACT FROM AUTHOR]

Introduction: Despite recent evolution in the operating techniques and surgical implants, debate continues around the choice of implant for the management of intertrochanteric fractures of femur bone. There is a paucity of clinical data on the results with Proximal Femoral Nail Antirotation (PFNA). Aim: To evaluate the functional and radiological outcome of reduction and fixation of these fractures with PFNA. Materials and Methods: This prospective interventional study was conducted from december 2015 to november 2018. A total of 62 patients of more than 50 years of age with intertrochanteric fracture were managed with internal fixation using PFNA. All the pateints were evaluated with respect to the mean operative time, blood loss. Fluoroscopy exposure, time to union and development of any complication. The statistical analysis involved calculation of the mean and Standard Deviations (SD) of above parameters which was done using the Microsoft excel chart sheet. Functional evaluation was done using the Harris Hip Score (HHS). Results: A total of 62 patients with age ranging from 54 to 94 years (mean 78.2, SD 09.11) were evaluated. The mean duration of follow-up was 14.3 months. The average operative time, the mean blood loss and the average fluoroscopy time were 61.4 (range 45-90 minutes, SD 11.6) minutes, 103.9 (range 60-200 mL, SD 36.4) mL and 74.0 (range 41 to 98, SD 13.5) seconds respectively. About 100% union rate with the average time to union being 16.1 (SD 3.3) weeks and ranging from 12 weeks to 24 weeks was reported. Varus collapse and limb shortening >1 cm were observed in 3 patients. The average HHS at the end of study showed a mean value of 82.8 (SD 8.6) and ranged from 65 to 94 with 46 (74.2%) patients having excellent to good outcome. Conclusion: Owing to easy insertion, reduced operative time and blood loss, stable fixation, less complications and good functional and radiological outcome, PFNA can prove to be an implant of choice for the management of intertrochantric fractures of the femur.

Introduction: Despite recent evolution in the operating techniques and surgical implants, debate continues around the choice of implant for the management of intertrochanteric fractures of femur bone. There is a paucity of clinical data on the results with Proximal Femoral Nail Antirotation (PFNA). Aim: To evaluate the functional and radiological outcome of reduction and fixation of these fractures with PFNA. Materials and Methods: This prospective interventional study was conducted from december 2015 to november 2018. A total of 62 patients of more than 50 years of age with intertrochanteric fracture were managed with internal fixation using PFNA. All the pateints were evaluated with respect to the mean operative time, blood loss. Fluoroscopy exposure, time to union and development of any complication. The statistical analysis involved calculation of the mean and Standard Deviations (SD) of above parameters which was done using the Microsoft excel chart sheet. Functional evaluation was done using the Harris Hip Score (HHS). Results: A total of 62 patients with age ranging from 54 to 94 years (mean 78.2, SD 09.11) were evaluated. The mean duration of follow-up was 14.3 months. The average operative time, the mean blood loss and the average fluoroscopy time were 61.4 (range 45-90 minutes, SD 11.6) minutes, 103.9 (range 60-200 mL, SD 36.4) mL and 74.0 (range 41 to 98, SD 13.5) seconds respectively. About 100% union rate with the average time to union being 16.1 (SD 3.3) weeks and ranging from 12 weeks to 24 weeks was reported. Varus collapse and limb shortening >1 cm were observed in 3 patients. The average HHS at the end of study showed a mean value of 82.8 (SD 8.6) and ranged from 65 to 94 with 46 (74.2%) patients having excellent to good outcome. Conclusion: Owing to easy insertion, reduced operative time and blood loss, stable fixation, less complications and good functional and radiological outcome, PFNA can prove to be an implant of choice for the management of intertrochantric fractures of the femur. [ABSTRACT FROM AUTHOR]

Orthopaedic surgeons routinely assess the biomechanical environment of a fracture to create a fixation construct that provides the appropriate amount of stability in efforts to optimize fracture healing. Emerging concepts and technologies including reverse dynamization, "smart plates" that measure construct strain, and FractSim software that models fracture strain represent recent developments in optimizing construct biomechanics to accelerate bone healing and minimize construct failure., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Orthopaedic Trauma Association.)

Aim. To carry out literature analysis devoted to pathological mechanisms of delayed union and nonunion of limb fractures and the influence of various osteosynthesis strategies on bone healing in polytrauma. The risk of bone fractures nonunion in polytrauma increases with high-energy complex comminuted and open fractures with severe injuries of soft tissues and bones, bruised lung, shock and severe massive blood loss. The development of a systemic inflammatory response affects local immune responses in the fracture zone to the early inflammatory phase of bone healing and disrupts subsequent osteogenesis and angiogenesis processes. Early stable-functional osteosynthesis using minimally invasive techniques creates optimal conditions for bone healing. When following the tactics of the stepwise treatment of Damage Control Orthopedics, the risk of infectious complications and fracture nonunion increases with the duration of treatment in the apparatus of external fixation. Conclusion. In polytrauma a violation of consolidation of bone fractures of the extremities occurs more often than in isolated trauma. Risk factors of fracture nonunion in polytrauma are the severity of bone and soft tissue damage, shock, acute blood loss and systemic inflammatory response, as well as unjustified delay in the final stable fixation of long bones fragments or using traumatic methods of their early osteosynthesis without taking into account the severity of the condition of the injured.

Background: To present the inherent and unique challenges associated with utilizing fracture healing as an outcome measure in foot and ankle orthopedics, specifically the statistical methods used in assessing time to union. Methods: In a previously published manuscript assessing the effect of delayed weightbearing on time to union following intramedullary (IM) screw fixation of Jones (Zone 2 fifth metatarsal base) fractures, patients were divided into early weightbearing (EWB, n=20) and delayed weightbearing (DWB, n=21) cohorts (within or beyond 2 weeks, respectively). Time to union was determined and compared between the 2 cohorts using cumulative link model analysis, with delayed union (12.5 weeks) defined from established literature. Results: Cumulative link model analysis demonstrated no significant differences in time to union (EWB: 25% by 6th week, 55% by 12th week; DWB: 33% by 6th week, 43% by 12th week; P =.819) or delayed unions (EWB, 20% vs DWB, 24%; P >.999). Conclusion: Our analysis using cumulative link models, or ordinal regression, in the statistical analysis of time to union, determined that that early weightbearing following IM screw fixation in Jones fractures appeared to be safe without delaying fracture healing. This statistical approach can be considered when describing a continuous outcome captured by infrequent observations. [ABSTRACT FROM AUTHOR]

There is a concern that bisphosphonates may impair fracture healing because of their inhibitory effects on bone turnover. Here we evaluated the effects of early bisphosphonate therapy on fracture healing and functional outcome following a fracture of the distal radius. The fracture and bisphosphonates (FAB) trial was a double‐blind, randomized, placebo‐controlled trial involving 15 trauma centers in the United Kingdom. We enrolled 421 bisphosphonate‐naive patients aged ≥50 years with a radiographically confirmed fracture of the distal radius and randomized them in a 1:1 ratio to receive alendronic acid 70 mg once weekly (n = 215) or placebo (n = 206) within 14 days of the fracture. The primary outcome measure was the proportion of fractures that had radiologically united at 4 weeks as assessed by an observer, blinded to treatment allocation. Secondary outcomes included the Disabilities of the Arm Shoulder and Hand (DASH) questionnaire, range of wrist movement and grip strength, pain and analgesia requirements, and the rate of malunion. The mean ± SD age of participants was 63 ± 8.5 years and 362 (86%) were female. At 4 weeks, 48 of 202 (23.8%) fractures had united in the alendronic acid group compared with 52 of 187 (27.8%) in the placebo group (observed absolute proportion difference 4.0%; 95% CI, –4.7% to 12.8%; p = 0.36). The absolute proportion difference between groups based on imputed data was 4.5% (95% CI, –4.7% to 13.8%; p = 0.30). There was no significant difference in the proportion of fractures that had united at any other time point and no differences in the DASH score, pain at the fracture site, grip strength, or any other clinical outcome. We conclude that among patients aged 50 years and above with a distal radius fracture, early administration of alendronic acid does not adversely affect fracture union or clinical outcome. These findings suggest bisphosphonate therapy can be safely commenced early after fracture if clinically indicated. © 2019 American Society for Bone and Mineral Research. [ABSTRACT FROM AUTHOR]

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Background This study assessed whether treating medial end clavicular fractures using an inverted distal clavicle locking plate, twisted through 90° around its axis, would allow for a less invasive surgical approach and improve screw trajectory insertion. Materials and methods We searched the databases of the 2 senior authors for patients who had sustained an acute, displaced fracture of the medial end of the clavicle and had undergone operative fixation using an inverted distal clavicle plate contoured through 90°. Through an inferior incision, a contoured locking plate was positioned on the anterior surface of the medial end of the clavicle. Up to 8 unicortical screws were inserted from anterior to posterior through the medial end of the plate. The lateral end was contoured and fixed to the superior clavicular surface. The patients were assessed preoperatively and at 1 month, 4 months, and final follow-up. Preoperative and postoperative plain x-ray images and computed tomography scans were reviewed. Results The study included 8 patients (average age, 31.3 years; range, 15-59 years) with displaced fractures who underwent fixation. The median follow-up time was 30.5 months (range, 24-45 months). All patients reached clinical and radiographic union at 4 months. The mean 11-item version of the Disabilities of the Arm, Shoulder, and Hand score was 0.6 (range, 0-2.3). All of the patients had returned to their preinjury level of sport and activity. None of the patients had a complication. Conclusion Contouring an inverted distal clavicle plate through 90° may improve fixation options by allowing access to the anterior clavicle when treating medial clavicular fractures. [ABSTRACT FROM AUTHOR]

Introduction: Clinical and radiographic examinations detect delayed or nonunion only after the event has occurred. Biochemical markers of bone turnover (BTMs) are promising laboratory tools that offer an early insight into the likelihood of delayed union. We hypothesized that BTMs display temporal variations following fractures and the behavior of BTMs differ between normal and delayed union of fractures.Methods: This was a prospective study of patients with closed fracture of tibia treated with intramedullary, interlocking nailing. BTM assays (NTX, BSAP, P1NP and osteocalcin) and clinical and radiographic assessments were obtained preoperatively and postoperatively at 8,12, 24, 36 and 72 weeks. Temporal trend of elevation of serum levels of BTMs post-fracture was the primary assessment criterion and radiographic and clinical assessment of fracture union were the secondary assessment criteria.Results: The average time for fracture union was 15.24 weeks (range 15-19 weeks). The values of both bone formation and resorption markers peaked at the eighth week following the fracture. Resorption markers returned to baseline by 36 weeks. Among the formation markers, BSAP levels showed the smallest increase and returned to baseline earlier (36 weeks) than P1NP and osteocalcin (72 weeks). P1NP showed the most dramatic change, increasing to 2.5 times the mean baseline level at 8 weeks in normal union of fractures. The levels of bone formation markers (BSAP, OC, PINP) were significantly lower in patients with delayed union. There was no significant difference in the levels of the resorption marker (NTX) between normal and delayed union patients.Conclusion: Serial monitoring of biochemical markers of bone turnover can be used as an adjunct to clinical and radiological observations to predict delayed unionLevel of evidence: Level 2 (prospective observational study). [ABSTRACT FROM AUTHOR]

Background: Antegrade reamed interlocked intramedullary nailing is the treatment of choice forfemoral diaphyseal fractures. More recently, retrograde intramedullary nailing of the femur has been seen as a viable alternative to the antegrade nail. Methods: This was a prospective comparative study. Consecutive patients were placed alternately into a study group (retrograde nailing) and a control group (antegrade nailing) in a ratio of 2:1 i.e two retrograde nailing for every antegrade nailing. Forty one fractures had interlocking intramedullary fixation via the retrograde approach (study group), while the control group consisted of twenty fractures that had fixation via the antegrade approach. All were followed up for a minimum period of nine months (range of nine to twenty-four months). Results: The mean duration of surgery in the retrograde group was 157.07minutes and 137.40 minutes in the antegrade group (p=0.093). The mean duration to fracture union was 16.98±4.71 weeks in the retrograde group and 15.80±5.43 weeks in the antegrade group (p = 0.388). There was no incidence of non-union in the two groups. Conclusion: Retrograde approach compares favourably with antegrade approach for intramedullary interlocking nail fixation of diaphyseal femoral fracture in adults with respect to time of fracture healing.

Objective: To find the results of unreamed interlocking nail in the diaphyseal fracture of humerus in our setup with studying wound infection and union after fixation. Material and Methods: We applied this prospective study in Orthopaedic and Trauma Unit Khyber Teaching Hospital Peshawar-Pakistan from Feb 2014 to August 2016. We included 75 patients with diaphyseal fractures of humerus shaft. All these patients were treated with unreamed interlocking nail. All these patients were examined Two weeks and Four weeks postoperatively for infection and at 20th weeks for union in the OPD. Results: In our study male patients were 57(76%) and females were 18(24%).The mean age of all patients were 40.50years ± 14.89SD. At two weeks,97.33% patients i.e 73 were having no wound infection and 2.66% patients i.e 2 were having wound infection. These 02(2.66%) patients were again examined at further two(four) weeks, where 1(1.33%) patients got infection free and 1(1.33%) were still having infection. 74(98.66%) patients achieved union at 20 weeks while 1(1.33%) were not able to achieve solid unions when examined in OPD at this time period. Conclusion: In humerus diaphyseal fractures Unreamed interlocking nailing has good outcomes in terms of wound infection and union of fracture. [ABSTRACT FROM AUTHOR]

Background The study purpose is to evaluate the working length, proximal screw density, and diaphyseal fixation mode and the correlation to fracture union after locking plate osteosynthesis of distal femoral fractures using bridge-plating technique. Methods A four-year retrospective review was performed to identify patients undergoing operative fixation of distal femur fractures with a distal femoral locking plate using bridge-plating technique for the metadiaphyseal region. Primary variables included fracture union, secondary surgery for union, plate working length, and diaphyseal screw technique and configuration. Multiple secondary variables including plate metallurgy and coronal plane fracture alignment were also collected. Results Ninety-six patients with distal femur fractures with a mean age 60 years met inclusion criteria. None of the clinical parameters were statistically significant indicators of union. Likewise, none of the following surgical technique parameters were associated with fracture union: plate metallurgy, the mean working length, screw density and number of proximal screws and screw cortices. However, diaphyseal screw technique did show statistical significance. Hybrid technique had a statistically significant higher chance of union when compared to locking (p = 0.02). All proximal locking screw constructs were 2.9 times more likely to lead to nonunion. Conclusions Plating constructs with all locking screws used in the diaphysis when bridge-plating distal femur locking plates were 2.9 times more likely to incur a nonunion. However, other factors associated with more flexible fixation constructs such as increased working length, decreased proximal screw number, and decreased proximal screw density were not significantly associated with union in this study. [ABSTRACT FROM AUTHOR]

Purpose: Inter-fragmentary rotational and axial instabilities are major challenges in nailing of complex or comminuted fractures. We aimed to compare the inter-fragmentary rotational and axial stability of novel anti-rotation interlocking nail and the conventional interlocking nail in complex or comminuted femur shaft fractures. Methods: Twenty composite femurs were divided into two groups, 30 mm was resected from the mid-portion of all composite femurs. The inter-fragmentary rotational and axial stabilities were assessed. Results: Between 10-N m external and 6-N m internal rotation torques, mean maximum inter-fragmentary rotational arc motion in the novel nails was 1.63 mm and 291 % less than that of the conventional nails (6.38 mm, P = 0.000). Between 150 N distraction and 2300 N compression, mean axial motion in the novel nails was 0.8 mm and 257 % less than that of the conventional nails (2.86 mm, p = 0.000). Conclusion: An anti-rotational novel nail is superior to the conventional interlocking nail in terms of maximum inter-fragmentary rotational and axial stabilities in complex and comminuted femur shaft fractures. [ABSTRACT FROM AUTHOR]

Assessment of scaphoid fracture union on computed tomography scans is not currently standardized. We investigated the extent of scaphoid waist fracture union required to withstand physiological loads in a finite element model, based on a high-resolution CT scan of a cadaveric forearm. For simulations, the scaphoid waist was partially fused at the radial and ulnar sides. A physiological load of 100 N was transmitted to the scaphoid and the minimal amount of union to maintain biomechanical stability was recorded. The orientation of the fracture plane was varied to analyse the effect on biomechanical stability. The results indicate that the scaphoid is more prone to re-fracture when healing occurs on the ulnar side, where at least 60% union is required. Union occurring from the radial side can withstand loads with as little as 25% union. In fractures more parallel to the radial axis, the scaphoid seems less resistant on the radial side, as at least 50% union is required. A quantitative CT scan analysis with the proposed cut-off values and a consistently applied clinical examination will guide the clinician as to whether mid-waist scaphoid fractures can be considered as truly united.