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Hollawell SM, Yancovitz S, Casciato DJ, Coleman MR. Safety and Outcome Measures of Ankle Open Reduction and Internal Fixation in an Ambulatory Surgical Center. J Foot Ankle Surg 2024; 63:376-379. [PMID: 38266809 DOI: 10.1053/j.jfas.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 12/28/2023] [Accepted: 01/13/2024] [Indexed: 01/26/2024]
Abstract
The transition of traditionally hospital-based orthopedic procedures to the ambulatory surgery center setting provides many benefits from a patient care and financial perspective. Specifically, closed ankle fractures can potentially be managed at such centers without needing hospitalization. Adding to the paucity of data, this study describes the safety, cost, and outcomes of patients undergoing ankle fracture repair in an ambulatory surgery center. A retrospective chart review of 100 patients who underwent ankle fracture open reduction and internal fixation from a single ambulatory surgery center by 1 surgeon were reviewed. Demographic data, surgical characteristics including operating time and cost were collected. Short- and long-term complications, as well as, reoperation rates were reported and functional outcomes were described. Of the 100 patients, 59% were female and the overall average age was 50 ± 16 years. The average cost per case was $8,709.63 ± 6,360.18. The short-term complication rate was 16%, with surgical site infection reported as the most common complication. No postoperative hospital admissions were reported. Planned and unplanned hardware removal was performed in 7% and 5% of patients, respectively. The delayed union rate was 13%, in which 86% shared a history of smoking. Smoking history was the only statistically significant predictor of prolonged bone healing (p = .002). This investigation demonstrates low complications rates for surgeries performed in a surgery center when compared to historical rates of those procedures performed in the hospital. These results suggest that ambulatory surgery center-based ankle fracture repair does not increase complications while may decrease overall cost when compared to ankle ORIF in a hospital setting.
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Affiliation(s)
- Shane M Hollawell
- Orthopaedic Institute Brielle Orthopedics Foot and Ankle Fellowship, Wall Township, NJ
| | - Sara Yancovitz
- Orthopaedic Institute Brielle Orthopedics Foot and Ankle Fellowship, Wall Township, NJ.
| | | | - Meagan R Coleman
- Orthopaedic Institute Brielle Orthopedics Foot and Ankle Fellowship, Wall Township, NJ
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McLaughlin K, Jabbar FAA, Kelly LJ, Jovanovic I, Gray MP, Charalambous CP, Harrison JWK. Does correction of carpal malalignment influence the union rate of scaphoid nonunion surgery? J Hand Surg Eur Vol 2024; 49:564-569. [PMID: 37987674 DOI: 10.1177/17531934231212979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
The aim of this retrospective study was to assess the relation between carpal malalignment correction and radiological union rates in surgery for scaphoid nonunions. A total of 59 scaphoid waist fracture nonunions treated with open reduction and palmar tricortical autograft were divided according to their pre- and postoperative scapholunate (SL) and radiolunate (RL) angles. We found that carpal malalignment failed to correct in 32 of 59 (54.2%) patients despite meticulous surgical technique and placement of an appropriately sized wedge-shaped graft. In total, 43 (72.9%) fractures united at a mean of 4.47 months (range 3-11). Of the 27 fractures with postoperative SL and RL angles within the normal range, 21 united, whereas 22 of the 32 remaining fractures that failed to achieve postoperative angles within the normal range went on to union. The postoperative SL and RL angles were not related to union. Our findings suggest that in scaphoid fracture nonunion surgery, carpal malalignment may not be corrected in a substantial proportion of patients, but such correction may not be essential for bony union. Our findings also show that there is no marked collapse of the scaphoid graft in the early postoperative period. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Kealan McLaughlin
- Gateshead NHS Foundation Trust, Gateshead, UK
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | | | - Luke J Kelly
- School of Mathematical Sciences, University College Cork, Cork, Ireland
| | - Iva Jovanovic
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | | | - Charalambos P Charalambous
- Blackpool teaching Hospitals NHS Foundation Trust, Blackpool, UK
- School of Medicine, University of Central Lancashire, Preston, UK
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Uslu M, Solmaz M, Daşcı MF, Beytemür O. Bilateral Flexion-Type Supracondylar Humerus Fracture. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202404000-00006. [PMID: 38547051 PMCID: PMC10980408 DOI: 10.5435/jaaosglobal-d-23-00239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 02/08/2024] [Accepted: 02/14/2024] [Indexed: 04/01/2024]
Abstract
Supracondylar humerus fractures are common in the pediatric population, but flexion fractures are very rare in this population. The need for open reduction in these fractures is high and can be challenging for orthopaedic surgeons. In this article, we report a 9-year-old patient with bilateral flexion-type humeral fracture treated with closed reduction, which, to our knowledge, is the first report in the literature. We concluded that the first step in the treatment of flexion-type supracondylar fractures should be closed reduction with the help of an experienced assistant surgeon and that successful results can be obtained even in bilateral flexion-type fractures with appropriate treatment and follow-up.
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Affiliation(s)
- Muhammed Uslu
- From the Department of Orthopedics and Traumatology, University of Health Science, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Mahsum Solmaz
- From the Department of Orthopedics and Traumatology, University of Health Science, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Fatih Daşcı
- From the Department of Orthopedics and Traumatology, University of Health Science, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Ozan Beytemür
- From the Department of Orthopedics and Traumatology, University of Health Science, Bagcilar Training and Research Hospital, Istanbul, Turkey
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Shah A, Perez-Otero S, Tran D, Aponte HA, Oh C, Agrawal N. Infection Rates of an Intraoral Versus Extraoral Approach to Mandibular Fracture Repairs are Equal: A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2024; 82:449-460. [PMID: 38336352 DOI: 10.1016/j.joms.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/06/2024] [Accepted: 01/15/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE This study investigates whether the intraoral approach to mandibular open reduction and internal fixation, through exposure to the oral cavity's microbiome, results in higher infection rates compared to the extraoral approach, thus addressing a critical public health concern, potentially offering an opportunity to reduce health-care costs, and aiming to guide effective clinical practice. METHODS In this systematic review with meta-analyses, a review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A comprehensive literature search was conducted using Embase and PubMed for articles published between 1989 and 2023. Inclusion criteria targeted studies on open reduction and internal fixation mandibular fractures comparing intraoral and extraoral approaches and reporting infection rates. Exclusion criteria eliminated non-English articles, case reports, and studies with insufficient approach-specific data. The primary outcome was the postoperative infection rate, with surgical approach as the predictor. Covariates such as age, sex, diabetes, and smoking status were included when reported. Data were analyzed using R software, employing random-effects models due to anticipated heterogeneity (I2 statistics). RESULTS From 61 studies, 11 provided direct comparisons involving 1,317 patients-937 intraoral and 380 extraoral. Infection rates were 5.9% for intraoral and 10% for extraoral approaches. Pooled relative risk was 0.94 [95% confidence interval, 0.63, 1.39], suggesting no significant risk difference. Prevalence of infections was estimated at 9% for intraoral and 6.1% for extraoral procedures, with significant heterogeneity (I2 = 84% for intraoral and 56% for extraoral). CONCLUSION Our meta-analysis found no significant difference in infection rates between the two approaches. There is opportunity to expand on reporting complication rates comparing the various approaches to mandibular fixation. Until these data are presented, surgeon preference may dictate the operative approach to expose the mandible for reduction and fixation.
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Affiliation(s)
- Alay Shah
- Post-Doctoral Research Fellow, Medical Student, Clinical Assistant Professor, Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY.
| | - Sofia Perez-Otero
- Post-Doctoral Research Fellow, Medical Student, Clinical Assistant Professor, Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
| | - David Tran
- Post-Doctoral Research Fellow, Medical Student, Clinical Assistant Professor, Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
| | - Hermes A Aponte
- Post-Doctoral Research Assistant, Department of Surgery, University of Puerto Rico School of Medicine, San Juan, PR
| | - Cheongeun Oh
- Clinical Assistant Professor, Biostatistics Division, Department of Population Health (Biostatistics), New York University Grossman School of Medicine, New York, NY
| | - Nikhil Agrawal
- Post-Doctoral Research Fellow, Medical Student, Clinical Assistant Professor, Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
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Chaudhry S. Value-Driven Pediatric Supracondylar Humerus Fracture Care: Implementing Evidence-Based Practices. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202404000-00007. [PMID: 38547045 PMCID: PMC10980363 DOI: 10.5435/jaaosglobal-d-24-00058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/15/2024] [Indexed: 04/01/2024]
Abstract
Supracondylar humerus fractures are high-volume injuries in children; therefore, value-driven treatment has far-reaching implications for patients and families as well as healthcare systems. Children younger than 5 years can remodel posterior angulation. Most Type IIa fractures will maintain alignment after closed reduction. Many patients with surgical fractures can safely wait for nonemergent fixation. Outpatient surgery is associated with shorter surgical time, lower costs, and fewer return visits to the emergency department with no increase in adverse events. Type III fractures treated the following day do not have higher rates of open reduction, and patients with associated nerve injuries have no difference in recovery time compared with those treated more urgently. Pediatric-trained surgeons generally provide more efficient care (shorter surgical time and less after-hours surgery); however, their outcomes are equivalent to non-pediatric orthopaedic surgeons. Community hospitals have lower costs compared with teaching hospitals; therefore, transferring patients should be avoided when feasible. Postoperative care can be streamlined in uncomplicated cases to minimize radiographs, therapy referrals, and multiple visits. Splinting offers safer, lower cost immobilization over casting. With staffing shortages and an increasingly burdened healthcare system, it is imperative to maximize nonsurgical care, use outpatient facilities, and minimize postoperative requirements without negatively affecting patient outcomes.
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Affiliation(s)
- Sonia Chaudhry
- From the Department of Orthopaedic Surgery, Univeristy of Connecticut School of Medicine, Pediatric Orthopaedic and Hand Surgery, Connecticut Children's Medical Center, Hartford, CT
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Ren W, Zhang K, Zhao Z, Zhang X, Lin F, Li Y, Bao K, Yang J, Chang J, Li J. Biomechanical characteristics of Sanders type II and III calcaneal fractures fixed by open reduction and internal fixation and percutaneous minimally invasive fixation. J Orthop Surg Res 2024; 19:166. [PMID: 38443993 PMCID: PMC10916136 DOI: 10.1186/s13018-024-04606-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/31/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND This work investigated the differences in the biomechanical properties of open reduction and internal fixation (ORIF) and percutaneous minimally invasive fixation (PMIF) for the fixation of calcaneal fractures (Sanders type II and III calcaneal fractures as examples) through finite element analysis. METHODS Based on CT images of the human foot and ankle, according to the principle of three-point fixation, namely the sustentaculum tali, the anterior process and the calcaneal tuberosity were fixed. Three-dimensional finite element models of Sanders type II and III calcaneal fractures fixed by ORIF and PMIF were established. The proximal surfaces of the tibia, fibula and soft tissue were constrained, and ground reaction force and Achilles tendon force loads were added to simulate balanced standing. RESULTS The maximum stress was 80.54, 211.59 and 113.88 MPa for the calcaneus, screws and plates in the ORIF group and 70.02 and 209.46 MPa for the calcaneus and screws in the PMIF group, respectively; the maximum displacement was 0.26, 0.21 and 0.12 mm for the calcaneus, screws and plates in the ORIF group and 0.20 and 0.14 mm for the calcaneus and screws in the PMIF group, respectively. The values obtained from the simulation were within the permissible stress and elastic deformation range of the materials used in the model, and there was no significant stress concentration. The maximum stress and displacement of the calcaneus and implants were slightly lower in the PMIF group than in the ORIF group when fixing Sanders type II and III calcaneal fractures. CONCLUSIONS This study may provide a reference for optimising the design of implants, the development of individualised preoperative plans and the choice of clinical surgical approach.
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Affiliation(s)
- Wu Ren
- The First Affiliated Hospital of Xinxiang Medical University, School of Medical Engineering, Xinxiang Medical University, Xinxiang, 453003, Henan, China
- Engineering Technology Research Center of Neurosense and Control of Henan Province, Xinxiang Engineering Technology Research Center of Intelligent Rehabilitation Equipment, Xinxiang, 453003, Henan, China
| | - Kailu Zhang
- The First Affiliated Hospital of Xinxiang Medical University, School of Medical Engineering, Xinxiang Medical University, Xinxiang, 453003, Henan, China
- Engineering Technology Research Center of Neurosense and Control of Henan Province, Xinxiang Engineering Technology Research Center of Intelligent Rehabilitation Equipment, Xinxiang, 453003, Henan, China
| | - Ziya Zhao
- The First Affiliated Hospital of Xinxiang Medical University, School of Medical Engineering, Xinxiang Medical University, Xinxiang, 453003, Henan, China
- Engineering Technology Research Center of Neurosense and Control of Henan Province, Xinxiang Engineering Technology Research Center of Intelligent Rehabilitation Equipment, Xinxiang, 453003, Henan, China
| | - Xueling Zhang
- The First Affiliated Hospital of Xinxiang Medical University, School of Medical Engineering, Xinxiang Medical University, Xinxiang, 453003, Henan, China
- Engineering Technology Research Center of Neurosense and Control of Henan Province, Xinxiang Engineering Technology Research Center of Intelligent Rehabilitation Equipment, Xinxiang, 453003, Henan, China
| | - Fei Lin
- The First Affiliated Hospital of Xinxiang Medical University, School of Medical Engineering, Xinxiang Medical University, Xinxiang, 453003, Henan, China
| | - Yawei Li
- The First Affiliated Hospital of Xinxiang Medical University, School of Medical Engineering, Xinxiang Medical University, Xinxiang, 453003, Henan, China
| | - Ke Bao
- The First Affiliated Hospital of Xinxiang Medical University, School of Medical Engineering, Xinxiang Medical University, Xinxiang, 453003, Henan, China
| | - Jun Yang
- Hunan Normal University, Changsha, 410000, Hunan, China
| | - Jinlong Chang
- The First Affiliated Hospital of Xinxiang Medical University, School of Medical Engineering, Xinxiang Medical University, Xinxiang, 453003, Henan, China.
- Engineering Technology Research Center of Neurosense and Control of Henan Province, Xinxiang Engineering Technology Research Center of Intelligent Rehabilitation Equipment, Xinxiang, 453003, Henan, China.
| | - Jia Li
- The First Affiliated Hospital of Xinxiang Medical University, School of Medical Engineering, Xinxiang Medical University, Xinxiang, 453003, Henan, China.
- Engineering Technology Research Center of Neurosense and Control of Henan Province, Xinxiang Engineering Technology Research Center of Intelligent Rehabilitation Equipment, Xinxiang, 453003, Henan, China.
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Franke A, Weiland B, Bučkova M, Bräuer C, Lauer G, Leonhardt H. Cost minimization analysis of indication-specific osteosynthesis material in oral and maxillofacial surgery. Oral Maxillofac Surg 2024; 28:179-184. [PMID: 36331629 PMCID: PMC10914910 DOI: 10.1007/s10006-022-01126-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/23/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE Following the introduction of the Regulation (EU) 2017/745 by the European Parliament, any bioactive substance or surgical implant introduced into the human body must be documented. The regulation requires any implant to be traced back to the manufacturer. Lot numbers need to be available for every single medical implant. Also, the manufacturer is required by law to provide implants individually packaged and sterilized. Previously, model tray systems (MOS tray) were used for osteosynthesis in oral and maxillofacial surgery, in which the individual implants could not be registered separately. The new regulation made it impossible to use such processes during surgery anymore and a need for a change in the medical practice surged. We examined a possible solution for the new legislation. The aim of this prospective cohort study is to analyze the MOS tray systems to osteosynthesis materials prepackaged in sets. We record and evaluate parameters such as surgical time and documentation time. We perform a short cost analysis of our clinic. The primary aim is to determine how much time is gained or lost by the mandatory increased patient safety. The secondary aim is to describe change in costs. METHODS Patients that underwent standard surgical procedures in the clinic of oral and maxillofacial surgery of the faculty hospital Carl Gustav Carus in Dresden were included. We chose open reduction and internal fixation (ORIF) of anterior mandibular corpus fractures as well as mandibular advancement by means of bilateral sagittal split osteotomies (BSSO) as standardized procedures. Both of these procedures require two osteosynthesis plates and at least four screws for each plate. MOS trays were compared to prepackaged sterilized sets. The sets include a drill bit, two plates, and eight 5-mm screws. A total number of 40 patients were examined. We allocated 20 patients to the ORIF group and the other 20 patients to the BSSO group. Each group was evenly subdivided into a MOS tray group and a prepackaged group. Parameters such as the incision-suture time (IST) as well as the documentation time (DT) by the operating room (OR) staff to complete documentation for the implants are the main focus of investigation. RESULTS For open reduction, the incision-suture time was significantly different in favor of the MOS tray (p < 0.05). There was no difference in the BSSO groups. However, we observed a significantly different (p < 0.01) documentation time advantage for the prepackaged sets in both the ORIF and BSSO groups. On top of that, we find that by using the prepackaged kits, we are able to reduce sterilization costs by €11.53 per size-reduced container. Also, there is also a total cut of costs of €38.90 and €43.70, respectively, per standardized procedure for implant material. CONCLUSIONS By law, a change in the method of approaching surgery is necessary. For standardized procedures, the right choice of implants can lead to a reduction of documentation time and costs for implant material, sterilization, as well as utilizing less instruments. This in turn leads to lower costs for perioperative processing as well as provision of state-of-the-art implant quality implementing higher patient security.
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Affiliation(s)
- Adrian Franke
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus, 01304, Dresden, Germany.
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Carl Gustav Carus, an der Technischen Universität Dresden, 01304, Dresden, Germany.
| | - Bernhard Weiland
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus, 01304, Dresden, Germany
| | - Michaela Bučkova
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus, 01304, Dresden, Germany
| | - Christian Bräuer
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus, 01304, Dresden, Germany
| | - Günter Lauer
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus, 01304, Dresden, Germany
| | - Henry Leonhardt
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus, 01304, Dresden, Germany
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Ye K, Tang J, Shen L, An Z. Open reduction and internal fixation of crescent fracture-dislocation: anterior or posterior approach? Arch Orthop Trauma Surg 2024; 144:1269-1279. [PMID: 38195950 DOI: 10.1007/s00402-023-05185-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 12/14/2023] [Indexed: 01/11/2024]
Abstract
INTRODUCTION To date, the approach that prevails in the open reduction and internal fixation of crescent fracture-dislocations (CFD) remains unknown. This study aimed to compare the outcomes of CFD treated via the anterior or posterior approach. MATERIALS AND METHODS Data from 64 cases of CFDs openly reduced through an anterior (group A, n = 31) or a posterior (group B, n = 33) approach were retrospectively analyzed. Functional results, reduction quality, residual displacements in the axial and coronal planes, pelvic asymmetry deformity, and correlations between Day's classification were compared. Complications and fracture union were also recorded. All patients were followed up for at least 12 months. RESULTS The functional scores were similar between the two groups, and all fractures achieved good or excellent reduction postoperatively. In the coronal plane, the excellent/good ratio in group B was higher than in group A. The mean residual displacement in the coronal plane was significantly higher in group A than in group B, with group A showing greater displacement in both planes for Day I fractures and in the coronal plane for Day II fractures. The residual displacement in both planes for Day III fractures was comparable between the groups. The pelvic asymmetry deformity was equal between the two groups and among the different Day's fracture types. CONCLUSIONS Open reduction and internal fixation of CFDs obtained satisfactory outcomes through an anterior or posterior approach. The posterior approach achieved a better sacroiliac joint reduction. The optimal indication for the posterior approach was a Day I fracture, followed by a Day II fracture. No correlation was found between the surgical approach and reduction quality in Day III fractures.
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Affiliation(s)
- Kai Ye
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, NO.600 Yishan Road, Shanghai, 200233, China
| | - Jianfei Tang
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, NO.600 Yishan Road, Shanghai, 200233, China
| | - Longxiang Shen
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, NO.600 Yishan Road, Shanghai, 200233, China
| | - Zhiquan An
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, NO.600 Yishan Road, Shanghai, 200233, China.
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Davey MS, O'Sullivan D, McCabe FJ, McQuail P, Kearns SR. The Use of Dorsal Bridge Plate Fixation in the Operative Management of Lisfranc Injuries - A Retrospective Cohort Study at Medium Term Follow-Up. Foot (Edinb) 2024; 58:102061. [PMID: 38064802 DOI: 10.1016/j.foot.2023.102061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/30/2023] [Accepted: 10/29/2023] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Traditionally, early surgical management of Lisfranc injuries with transarticular screws (TAS) was deemed to be the optimal treatment. However, concerns of potential iatrogenic articular cartilage disruption has led to discrepancies in opinion amongst surgeons, with many surgeons now utilizing dorsal bridge plates (DBP) for ORIF of Lisfranc injuries. OBJECTIVES This study sought to investigate the clinical outcomes at medium-term follow-up of consecutive patients in our institution who underwent ORIF with DBP for Lisfranc injuries. METHODS All consecutive patients who underwent ORIF with DBPs for Lisfranc injuries were identified. Outcomes of interest included; visual analogue scale (VAS), functional foot index (FFI), American Orthopaedic Foot & Ankle Surgeons (AOFAS) hindfoot scores, and complications. RESULTS Overall, 37 consecutive patients (24 males) with a mean age of 34.8 ± 13.0 years underwent ORIF with DBPs for lisfranc injuries. After a mean 48.3 ± 28.7 months, the mean reported AOFAS and FFI scores were 77.4 ± 23.8 and 31.9 ± 32.7 respectively, with satisfactory reported pain scores as measured by VAS post-operatively at rest and whilst walking (2.2 ± 2.5 and 3.1 ± 2.6 respectively). The reported satisfaction rate was 86.5% (32/37). Overall, 25 patients (67.6%) had subsequent removal of metal or were listed for same, 88% (22/25) of whom did so electively in the absence of broken screws or infection. CONCLUSION This study found that the use of Dorsal Bridge Plates for Open Reduction and Internal Fixation of Lisfranc Injuries resulted in satisfactory functional outcomes, high rates of patient-reported satisfaction and a low complication rate at medium-term follow-up. LEVEL OF EVIDENCE Level IV; Retrospective Series of Consecutive Patients.
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Affiliation(s)
- Martin S Davey
- Galway University Hospitals, Galway, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - David O'Sullivan
- Galway University Hospitals, Galway, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fergus J McCabe
- Galway University Hospitals, Galway, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Paula McQuail
- Galway University Hospitals, Galway, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Stephen R Kearns
- Galway University Hospitals, Galway, Ireland; University of Galway, Galway, Ireland
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Le V, Viskontas D, Lohre R, Yan J, Stone T, Perey B, Moola F, Boyer D, Lemke HM, Apostle K. Immediate Unprotected Weightbearing vs 2 Weeks Nonweightbearing After Open Reduction Internal Fixation of Ankle Fractures. Foot Ankle Int 2024; 45:103-114. [PMID: 38156640 DOI: 10.1177/10711007231217675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Postoperative care protocols for ankle fracture surgery remain controversial with variability among care providers. This prospective controlled trial compared 12-week postoperative outcomes for immediate unprotected weightbearing (IMWB) vs nonweightbearing (NWB) for 2 weeks in a splint followed by weightbearing as tolerated (WBAT) in a boot after surgical fixation of selected low-energy ankle fractures without superior articular involvement. METHODS Eighty-seven patients undergoing surgical fixation of ankle fractures at a single level 1 trauma center were recruited according to specific criteria and enrolled by presentation date. The first 43 eligible patients were allocated to the control group, with NWB in a splint for 2 weeks followed by WBAT in a walker boot. The next 44 patients recruited were allocated to the IMWB group. The primary outcome was the Olerud-Molander score (OMAS). Secondary outcome measures included the Euroquol-5D (EQ5D) score and Work Productivity and Activity Impairment: Specific Health Problem (WPAI:SHP) scores, ankle range of motion (ROM), wound complications, time to return to work, radiograph measurements, and fracture reduction loss. In this perioperative-focused study, we collected data on patients until 12 weeks postoperation. RESULTS The IMWB group had 5 superficial wound complications vs 1 in the control group. At 12 weeks, we found no difference in OMAS, EQ5D, WPAI:SHP scores, ROM, time to return to work, or radiographic measurements. CONCLUSION In this short-term and relatively small prospective trial, we found more wound complications among patients treated with immediate unprotected weightbearing compared with patients treated with 2 weeks of NWB followed by protected weightbearing. Given the low incidence and small sample size, we do not know if these observed findings are generalizable. However, we also found no difference in functional outcomes at 12 weeks postoperation between these 2 groups. In light of that, we do not recommend IMWB after open reduction internal fixation of low-energy ankle fractures with plate and/or screw fixation. LEVEL OF EVIDENCE Level II, prospective controlled trial.
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Affiliation(s)
- Vu Le
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Darius Viskontas
- Department of Orthopaedics, University of British Columbia, BC, Canada
| | - Ryan Lohre
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - James Yan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Trevor Stone
- Department of Orthopaedics, University of British Columbia, BC, Canada
| | - Bertrand Perey
- Department of Orthopaedics, University of British Columbia, BC, Canada
| | - Farhad Moola
- Department of Orthopaedics, University of British Columbia, BC, Canada
| | - Dory Boyer
- Department of Orthopaedics, University of British Columbia, BC, Canada
| | - H Michael Lemke
- Department of Orthopaedics, University of British Columbia, BC, Canada
| | - Kelly Apostle
- Department of Orthopaedics, University of British Columbia, BC, Canada
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11
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Vesely BD, Michels L, King MA, Gangopadhyay P, Scott AT. Primary Arthrodesis versus Open Reduction and Internal Fixation for Lisfranc Joint Fracture-Dislocations in Adults: A Systematic Review. J Am Podiatr Med Assoc 2024; 114:21-232. [PMID: 38446576 DOI: 10.7547/21-232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
BACKGROUND The Lisfranc joint is an intricate podiatric medical structure that when injured can prove difficult to treat. No consensus has been established on optimal surgical management for this injury. It is widely debated whether open reduction and internal fixation or primary arthrodesis provides better outcomes for patients. Although literature has been published on this subject, no generalized guidelines have been created. The goal of this study was to analyze high-level meta-analyses to draw conclusions about surgical interventions for Lisfranc joint injuries. METHODS A literature review was conducted to analyze outcomes of meta-analyses from January 1, 2016, to August 31, 2021. Only high-level evidence that reported at least one of the following outcomes was included: American Orthopaedic Foot and Ankle Society scale score, visual analog scale score, total complication rate, hardware removal rate, revision surgery rate, and secondary procedure rate. RESULTS Six articles met the inclusion and exclusion criteria and were then analyzed. For all of the outcome measures, primary arthrodesis was equal or superior to open reduction and internal fixation. CONCLUSIONS We recommend primary arthrodesis over open reduction and internal fixation for adult Lisfranc injuries.
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Affiliation(s)
| | | | | | | | - Aaron T Scott
- *Wake Forest Baptist Medical Center, Winston Salem, NC
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12
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Ku KH, Baek JH, Lee YJ, Kim MS. Risk factors for nonunion in patients with transcondylar fracture of the distal humerus after open reduction and internal fixation. J Shoulder Elbow Surg 2024; 33:139-144. [PMID: 37633592 DOI: 10.1016/j.jse.2023.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/12/2023] [Accepted: 07/21/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Transcondylar fractures have been reported to rarely occur in the distal humerus, and stable fixation is difficult because of the unique fracture pattern. However, few studies have reported the risk factors for nonunion after open reduction and internal fixation (ORIF). This study aimed to evaluate the demographic and surgical risk factors for nonunion in patients who had undergone ORIF for transcondylar fractures. METHODS We retrospectively reviewed 68 patients who underwent ORIF for transcondylar fractures. Preoperative demographic factors, including diabetes mellitus (DM) and smoking, and operative factors, including fixation methods (eg, dual plate/single plate/tension band wiring [TBW]) were assessed as risk factors for nonunion. RESULTS Nonunion occurred in 8 out of 68 patients (11.8%). Univariate analysis revealed that among the demographic factors, DM (4/8 [50%] vs. 8/60 [13.3%], P = .028) and smoking (3/8 [37.5%] vs. 4/60 [6.7%], P = .031) were significantly different between nonunion and union patients. Regarding operative factors, the fixation method (dual plate/single plate/TBW; 2 [25.0%]/2 [25.0%]/4 [50%] vs. 29 [48.3%]/25 [41.7%]/6 [10.0%], P = .033) showed significant differences between nonunion and union patients. Multivariate regression analysis showed that DM (odds ratio [OR], 10.560; 95% confidence interval [CI], 1.308-85.247; P = .027), smoking (OR 22.371; 95% CI, 2.111-237.081; P = .010), and TBW (OR 15.390; 95% CI, 1.348-175.666; P = .028) were independent risk factors for nonunion. CONCLUSIONS Nonunion occurred in approximately 12% of the patients who underwent ORIF in the transcondylar region of the distal humerus. The risk of nonunion was higher in patients with DM than those who smoked. In addition, among the fixation methods, the TBW technique was a significant risk factor for nonunion.
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Affiliation(s)
- Ki-Hyeok Ku
- Department of Orthopaedic Surgery, Shoulder & Elbow Clinic, School of Medicine, Kyung Hee University and Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jong-Hun Baek
- Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University and Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Young-Jik Lee
- Department of Orthopaedic Surgery, Shoulder & Elbow Clinic, School of Medicine, Kyung Hee University and Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Myung-Seo Kim
- Department of Orthopaedic Surgery, Shoulder & Elbow Clinic, School of Medicine, Kyung Hee University and Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.
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13
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Guo N, Chen X, Bao G, Xiong HZ. Simultaneous open reduction with internal fixation and ligament reconstructions to treat proximal tibial fracture with ipsilateral knee dislocation: A case report. Asian J Surg 2024; 47:521-522. [PMID: 37989684 DOI: 10.1016/j.asjsur.2023.06.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/13/2023] [Indexed: 11/23/2023] Open
Affiliation(s)
- Na Guo
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, 149# Dalian Road, Zunyi, 563000, People's Republic of China.
| | - Xing Chen
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, 149# Dalian Road, Zunyi, 563000, People's Republic of China.
| | - Gang Bao
- Department of Orthopedic Surgery, People's Hospital of Yinjiang Tujia and Miao Autonomous County, Yinjiang, 555299, Guizhou, People's Republic of China.
| | - Hua-Zhang Xiong
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, 149# Dalian Road, Zunyi, 563000, People's Republic of China.
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14
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Shimizu K, Takegami Y, Tokutake K, Naruse K, Sudo Y, Matsubara Y, Imagama S. What factors are associated with loss of alignment after open reduction and internal fixation for tibial plateau fractures? A retrospective multicenter (TRON group) study. J Orthop Sci 2024; 29:286-291. [PMID: 36575098 DOI: 10.1016/j.jos.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/20/2022] [Accepted: 12/12/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Tibial plateau fractures (TPFs) are one of the most challenging intra-articular fractures to treat. Along with reconstruction of the articular surfaces, appropriate alignment of the knee joints must be obtained and maintained after open reduction and internal fixation (ORIF) for TPFs because loss of alignment (LA) is associated with worse clinical outcomes. We aimed to investigate and clarify the risk factors related to LA after ORIF for TPFs. METHODS This multicenter, retrospective cohort study used data of hospitals of the Trauma Research Group (TRON group) from January 1, 2011, to December 31, 2020. Among 293 TPFs extracted from the database, we evaluated the alignment of the articular surface to the anatomical axis of the tibia in the immediate postoperative and last follow-up radiographs. We defined a change of alignment from the immediate postoperative radiograph as LA. We evaluated the risk factors of LA using univariate and multiple logistic regression analyses. RESULTS LA was observed in 27 fractures (9.2%). In multiple logistic regression analyses, preoperative articular step-off and postoperative condylar widening were statistically associated with LA (OR = 1.1, 95% CI: 1.02-1.19 and P = 0.012; OR = 1.04, 95% CI: 1.00-1.08, P = 0.045, respectively). We calculated the threshold by drawing a receiver operating characteristic curve using the final regression model. The threshold of postoperative widening was 8.2 mm. We divided the 293 TPFs into two groups according to this threshold and determined differences between the two groups using Fisher's exact test. The two groups were statistically significantly different (P = 0.00502). CONCLUSIONS Preoperative articular step-off and postoperative condylar widening could be associated with LA after ORIF for TPFs. We suggest that intraoperative restoration of condylar widening is important for the prevention of malalignment following ORIF for TPF.
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Affiliation(s)
- Keita Shimizu
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Takegami
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Katsuhiro Tokutake
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keita Naruse
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshito Sudo
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuji Matsubara
- Department of Orthopedic Surgery, Kariya TOYOTA General Hospital, Toyota, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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15
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Khalili P, Tevell S, Fischer P, Hailer NP, Wolf O. Analysis of fracture-related infections from Swedish insurance claims between 2011 and 2021. Sci Rep 2023; 13:22662. [PMID: 38114785 PMCID: PMC10730616 DOI: 10.1038/s41598-023-50224-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/16/2023] [Indexed: 12/21/2023] Open
Abstract
Fracture-related infections (FRI) pose a serious complication with an incidence of 1-2%. This study aimed to analyze compensation claims submitted to The Swedish National Patient Insurance Company (LÖF) because of FRI after closed/open reduction and internal fixation (C/ORIF) in the four most common fracture sites (proximal humerus, distal radius, hip, ankle). Patients registered in the LÖF database with a suspected FRI between 2011 and 2021 were identified by matching International Classification of Diseases and procedural codes indicative of a combination of fractures to the proximal humerus, distal radius, hip and ankle, C/ORIF and infection. Medical records were reviewed for fracture sites, pathogens and complications. Data from the Swedish Fracture Register (SFR) were extracted to estimate the proportion of reported claims to the presumed number of FRI. Of 122 FRI identified in the LÖF database, 34 were after C/ORIF in the proximal humerus, 12 in the distal radius, 28 in the hip and 48 in the ankle. LÖF compensated 111 patients (91%). Median time from C/ORIF to an FRI was 3 weeks (interquartile range 2-6), and 95% of all FRI occurred within 1 year after C/ORIF. Staphylococcus aureus was the most common pathogen in patients with a distal radius, hip and ankle FRI. In contrast, Cutibacterium spp. were the most common aetiology in FRI of the proximal humerus. The total number of fractures treated with C/ORIF in the four fracture sites registered in the SFR during 2021 was 18,711. Most of the FRI patients were diagnosed within the first year after C/ORIF, and 91% of the patients received compensation. Given an expected FRI incidence of 1-2%, our estimates with extrapolated data from the SFR indicate that < 10% of affected patients applied for compensation.
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Affiliation(s)
- Pendar Khalili
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden.
- Department of Orthopedic Surgery, Karlstad Hospital, Rosenborgsgatan 9, 652 30, Karlstad, Sweden.
- Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden.
| | - Staffan Tevell
- Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden
- Department of Infectious Diseases, Karlstad Hospital, Karlstad, Sweden
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Per Fischer
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Nils P Hailer
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden
| | - Olof Wolf
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden
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16
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Dekker P, Callahan NF, Miloro M, Han MD. Which Factors Affect the Reduction Quality of Open Reduction Internal Fixation of Mandibular Subcondylar Fractures? J Oral Maxillofac Surg 2023; 81:1485-1494. [PMID: 37741628 DOI: 10.1016/j.joms.2023.08.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/02/2023] [Accepted: 08/26/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Open reduction internal fixation (ORIF) of mandibular subcondylar fractures (MSF) involves several variables that could affect decision making. There is insufficient data regarding factors influencing the outcomes of MSF ORIF. PURPOSE The purpose of this study was to investigate factors associated with quality of bony reduction of MSF and occlusion, after ORIF. STUDY DESIGN, SETTING, AND SAMPLE We designed a retrospective cohort study of consecutively treated subjects for MSF ORIF, ages 18 to 64 years, by University of Illinois' Department of Oral and Maxillofacial Surgery, between January 1, 2013, and January 26, 2021. PREDICTOR VARIABLE The primary predictor variable was the vertical level of MSF from the gonial angle. Secondary predictor variables included surgeon, fixation scheme (number and configuration of miniplate), surgical approach, time to surgery, mechanism of injury, vertical fragment overlap, overlying soft tissue thickness, presence of other mandibular fractures, and severity and direction of displacement. MAIN OUTCOME VARIABLES The primary outcome variable was the mean radiographic reduction score (RRS), rated by 2 blinded observers on a 1 to 5 scale. The secondary outcome variable was presence of postoperative malocclusion as documented in the medical records. COVARIATES Covariates were age and sex. ANALYSES Descriptive statistics were computed. To investigate the influence of the predictor variables on reduction quality, multifactorial analysis of variance with post hoc Tukey test was performed. For malocclusion, χ2 test was performed. The level of significance was set at P < .05. RESULTS Thirty-eight MSF in 37 subjects were included. Mean age was 32.7 years (range 18 to 64), and 83.8% were male. Mean RRS was 4.38 (standard deviation 0.77). Fixation scheme was the only variable that showed significant impact on RRS: single-straight miniplate had lower scores than double-straight (-1.50, P = .011), rhomboid (-1.29, P = .036), and ladder miniplates (-1.38, P = .048). There was 1 incidence of malocclusion (2.7%) which resolved without intervention. CONCLUSIONS AND RELEVANCE Favorable reduction (anatomic reduction to mild discrepancies) can be achieved without malocclusion using double-straight, or rhomboid-shaped or ladder-shaped miniplates, without influences from patient or injury-related factors. In contrast, single-straight miniplate fixation resulted in moderate discrepancies in reduction, although it did not lead to malocclusion.
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Affiliation(s)
| | - Nicholas F Callahan
- Associate Professor, Department of Oral and Maxillofacial Surgery, University of Illinois Chicago, Chicago, IL
| | - Michael Miloro
- Professor and Head, Department of Oral and Maxillofacial Surgery, University of Illinois Chicago, Chicago, IL
| | - Michael D Han
- Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Illinois Chicago, Chicago, IL.
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17
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Sobel AD, Shah KN, Raducha J, Koeller E, Ibrahim LI, Paxton S. Failure of humeral shaft fixation: construct characteristics. Eur J Orthop Surg Traumatol 2023; 33:3637-3641. [PMID: 37268871 DOI: 10.1007/s00590-023-03587-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/10/2023] [Indexed: 06/04/2023]
Abstract
PURPOSE Fixation failure following open reduction and internal fixation (ORIF) of humeral shaft fractures can be a challenging complication. We aimed to identify the modes of failure and characteristics of failed fixation constructs. METHODS We queried our institutional database for patients > 18 years old with fixation failure after ORIF with single plate and screw constructs of humeral shaft fractures from 2006 to 2017. Demographics, fracture characteristics, fixation construct design and mode of failure were recorded. RESULTS Twenty-three failures were identified. Mean age was 55.9 years (SD 19.2 years) with 15 (65%) women. Twelve patients (52%) had midshaft fractures; the remainder had distal-third shaft (8 pts, 35%) or proximal-third shaft (3 pts, 13%) fractures. Midshaft fractures were most commonly fixed through an anterolateral approach with plates and all non-locking screws (83%), while distal-third shaft fractures were fixed with a combination of locking and non-locking screws from a posterior approach. Distal-third shaft fractures failed by plate breakage (63%) or screw pullout (38%) and all midshaft failures occurred by screw pullout proximal (92%) or distal (8%) to the fracture. Resultant varus deformity occurred in 20 (87%) fractures. CONCLUSION Screw pullout in midshaft fractures suggests that fixation to bone was insufficient or biomechanically disadvantageous. Varus moments contribute significantly to the failure of humeral shaft fracture ORIF. Plate breakage in distal fractures suggests high concentrations of stress over a narrow working length of constructs with inadequate plate strength. Recognizing how these constructs fail can aid proper implant selection and application for humeral shaft fracture. LEVEL OF EVIDENCE Treatment level IV.
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Affiliation(s)
- Andrew D Sobel
- Department of Orthopedic Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Orthopaedic Surgery, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Kalpit N Shah
- Department of Orthopedic Surgery, Scripps Clinic, San Diego, CA, USA
| | - Jeremy Raducha
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Eva Koeller
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Lina I Ibrahim
- Department of Orthopaedic Surgery, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - Scott Paxton
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
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18
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Ripatti L, Kauko T, Kytö V, Rautava P, Sipilä J, Lastikka M, Helenius I. The incidence and management of slipped capital femoral epiphysis: a population-based study. Acta Orthop Belg 2023; 89:634-638. [PMID: 38205753 DOI: 10.52628/89.4.9832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
We aimed to investigate the national trends in the incidence and management of slipped capital femoral epiphysis (SCFE) and to report the need for reoperations. We included all <19-year-old patients hospitalised for SCFE in 2004-2014 in mainland Finland (n=159). Data from the Finnish Care Register for Health Care, Statistics Finland, and Turku University Hospital patient charts were analyse for the incidence of SCFE in 2004-2012, the length of stay, and the type of surgery with respect to age, gender, study year, and season. The reoperations and rehospitalisations in 2004-2014 for SCFE were analysed for 2-10 years after surgery. In 2004 to 2012, primary surgery for SCFE was performed for 126 children. The average annual incidence of SCFE was 1.06/100 000 (95% confidence interval [CI], 0.81-1.38) in girls and 1.35/100 000 (95% CI 1.07-1.70) in boys. The median age at surgery was lower in girls than in boys (11 and 13 years, respectively, p<0.0001). During the study period, there was no significant change in the incidence of SCFE (p=0.9330), the type of primary procedures performed (p=0.9988), or the length of stay after the primary procedure (p=0.2396). However, the length of stay after percutaneous screw fixation was shorter compared with open reduction and fixation (mean 3.4 and 7.9 days, respectively, p<0.0001). There was no significant difference in the rate of reoperations according to the type of primary surgery. In conclusion, the incidence of SCFE and the proportion of different primary surgeries have recently remained stable in Finland.
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Meurer F. [Intraoperative imaging with the mobile C-arm : Technique, image creation and radiation protection]. Unfallchirurgie (Heidelb) 2023; 126:917-920. [PMID: 37861805 DOI: 10.1007/s00113-023-01379-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/21/2023]
Abstract
Imaging techniques in the discipline of orthopedics and trauma surgery are essential not only for making a diagnosis but also play a central role in the performance, documentation and monitoring of the corresponding treatment. Procedures such as open reduction and internal fixation (ORIF) and closed reduction and internal fixation (CRIF) of fractures, kyphoplasty and vertebroplasty as well as posterior stabilization of spinal fractures are carried out under X‑ray control. In the relevant operating rooms of emergency departments and operating theaters, mobile fluoroscopy devices are available, which due to their appearance are called C‑arms. These devices can be moved horizontally, vertically, and along the pivotal axis, enabling real-time imaging of joints and bones from various angles. This imaging enables minimally invasive surgical techniques as this often eliminates the need for extensive preparation and resulting in smaller wound defects compared to open surgical preparation. Additionally, surgeons can immediately assess and, if necessary, adjust the reduction outcome to achieve the best possible care and reduce the need for corrective interventions. With current C‑arms it is also possible to generate 3‑dimensional datasets, to enhance the assessment of implant positioning, particularly in complex intra-articular fractures. This availability helps avoid subsequent corrective interventions that would otherwise only be identified through postoperative computed tomography [1].
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Affiliation(s)
- Felix Meurer
- Sektion Muskuloskelettale Radiologie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
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20
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Salman LA, Al-Ani A, Radi MFA, Abudalou AF, Baroudi OM, Ajaj AA, Alkhayarin M, Ahmed G. Open versus closed intramedullary nailing of femur shaft fractures in adults: a systematic review and meta-analysis. Int Orthop 2023; 47:3031-3041. [PMID: 36864184 PMCID: PMC10673735 DOI: 10.1007/s00264-023-05740-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/20/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE This systematic review and meta-analysis aimed to compare the outcomes of open- versus closed-reduction and intramedullary nailing (IMN) of adult femur shaft fractures. METHODS Four databases were searched from inception until July 2022 for original studies that compared the outcomes of IMN following open-reduction versus closed-reduction technique. The primary outcome was the union rate; the secondary outcomes were time to union, nonunion, malalignment, revision, and infection. This review was conducted in line with PRISMA guidelines. RESULTS A total of 12 studies with 1299 (1346 IMN cases) patients were included, with a mean age of 32.3 ± 3.25. The average follow-up was 2.3 ± 1.45 years. There was a statistically significant difference in union rate (OR, 0.66; 95% CI, 0.45-0.97; p-value, 0.0352), nonunion (OR, 2.06; 95% CI, 1.23-3.44; p-value, 0.0056), and infection rate (OR, 1.94; 95% CI, 1.16-3.25; p-value, 0.0114) between the open-reduction and closed-reduction groups in favour of the latter. However, malalignment was significantly higher in the closed-reduction group (OR, 0.32; 95% CI, 0.16-0.64; p-value, 0.0012), whereas time to union and revision rates were similar (p = NS). CONCLUSION This study showed that closed-reduction and IMN had more favourable union rate, nonunion, and infection rates than the open-reduction group, yet malalignment was significantly less in the open-reduction group. Moreover, time to union and revision rates were comparable. However, these results must be interpreted in context due to confounding effects and the lack of high-quality studies.
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Affiliation(s)
- Loay A Salman
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
| | - Abdallah Al-Ani
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Mohammed F A Radi
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Abedallah F Abudalou
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Omar M Baroudi
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Abdulla A Ajaj
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Mohamed Alkhayarin
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Ghalib Ahmed
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
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Kumar A, Barik S, Raj V, Kumar V. Comment on 'Which pediatric supracondylar humerus fractures are high risk for conversion to open reduction?'. J Pediatr Orthop B 2023; 32:621. [PMID: 37820112 DOI: 10.1097/bpb.0000000000001098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Affiliation(s)
- Aman Kumar
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), Deoghar, Jharkhand, India
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22
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Kapanci B, Zahri S, Valcarenghi J, Charles T, Jayankura M. Acute total hip replacement by direct anterior approach combined with intrapelvic fixation for geriatric acetabular fracture of the anterior column. Orthop Traumatol Surg Res 2023; 109:103617. [PMID: 37031952 DOI: 10.1016/j.otsr.2023.103617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 02/09/2023] [Accepted: 04/03/2023] [Indexed: 04/11/2023]
Abstract
Management of anterior column acetabular fracture in the elderly is challenging. Open reduction and internal fixation do not allow early weight bearing and are associated with a high risk of failure compared to younger patients. Therefore, acute fixation and total hip arthroplasty may be an option. This technical note describes a combined procedure: anterior intrapelvic approach for fracture fixation and a direct anterior approach to the hip for THR. Fracture reduction and arthroplasty were achievable in all five patients. The mean operative time was 289min, and the mean blood loss was 2120mL. At short term, no complication was noticed. Combining these two "muscle-sparing" approaches could help manage anterior column fractures in elderly patients. Level of evidence: IV.
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Affiliation(s)
- Bilal Kapanci
- Department of Orthopaedics and Traumatology, Hôpital Universitaire de Bruxelles, Route de Lennik 808, 1070 Anderlecht, Belgium.
| | - Sarah Zahri
- Department of Orthopaedics and Traumatology, Hôpital Universitaire de Bruxelles, Route de Lennik 808, 1070 Anderlecht, Belgium.
| | - Jérôme Valcarenghi
- Department of Orthopaedics and Traumatology, Hôpital Universitaire de Bruxelles, Route de Lennik 808, 1070 Anderlecht, Belgium.
| | - Tatiana Charles
- Department of Orthopaedics and Traumatology, Hôpital Universitaire de Bruxelles, Route de Lennik 808, 1070 Anderlecht, Belgium.
| | - Marc Jayankura
- Department of Orthopaedics and Traumatology, Hôpital Universitaire de Bruxelles, Route de Lennik 808, 1070 Anderlecht, Belgium.
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Abstract
Supracondylar humerus fractures are common pediatric injuries encountered by orthopedic surgeons. Displaced fractures are treated operatively with closed reduction and percutaneous pinning or open reduction of injuries that cannot be adequately closed reduced. The purpose of this study is to identify preoperative injury characteristics associated with open reduction. Retrospective chart review was performed on all AO type 13A (Gartland type) supracondylar humerus fractures in patients 2-13 years old treated surgically at a single level 1 trauma center over 6 years. Preoperative demographics and radiographic parameters were obtained for all patients. Primary outcomes were closed reduction or conversion to open reduction of fractures prior to k-wire fixation. Initial bivariate analysis was done using Chi-square tests. Final multivariate analysis with Bonferonni correction was performed using a backward, stepwise regression model including potential predictor variables identified in the bivariate analysis. A total of 211 patients received surgical treatment and 18 of those patients (8.5%) failed closed reduction and underwent open reduction. Final multivariate analysis demonstrated that only flexion type [relative risk (RR), 10.2] and coronal displacement more than 7 mm (RR, 4.49) were significant preoperative factors for conversion to open reduction. Patients with significant coronal displacement and flexion-type injuries are markers of challenging reduction and are at high risk for conversion to open reduction.
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Affiliation(s)
- Luke D Latario
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Memorial Medical Center, Worcester
| | - Marc G Lubitz
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Memorial Medical Center, Worcester
| | - Ankur S Narain
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Memorial Medical Center, Worcester
| | - Eric F Swart
- Department of Orthopedic Surgery, Lahey Medical Center, Burlington, Massachusetts, USA
| | - Errol S Mortimer
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Memorial Medical Center, Worcester
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24
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Temporin K, Miyamura S, Oura K, Shimada K. Chronic volar dislocation of the metacarpophalangeal joint of the thumb treated with open reduction: A case report and literature review. J Orthop Sci 2023; 28:1525-1528. [PMID: 34690048 DOI: 10.1016/j.jos.2021.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/18/2021] [Accepted: 08/22/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Ko Temporin
- Department of Orthopaedic Surgery, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan.
| | - Satoshi Miyamura
- Department of Orthopaedic Surgery, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
| | - Keiichiro Oura
- Department of Orthopaedic Surgery, Osaka General Medical Center, Osaka, Japan
| | - Kozo Shimada
- Department of Orthopaedic Surgery, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
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25
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Liang C, Cao Y, Lin Z, Liu G, Zhang C, Hu Y. Open reduction and internal fixation of irreducible displaced femoral neck fracture with femoral Neck System: a preliminary study. BMC Musculoskelet Disord 2023; 24:826. [PMID: 37858123 PMCID: PMC10585802 DOI: 10.1186/s12891-023-06839-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/27/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Most displaced femoral neck fractures can achieve satisfactory anatomical reduction by closed reduction, but there are still some that cannot reset satisfactorily after closed reduction, and open reduction are required. Such fractures that cannot be repositioned successfully by closed reduction are called irreducible displaced femoral neck fractures in this study. The objective of our study was to evaluate the efficacy of direct anterior incision with the Femoral Neck System in the treatment of irreducible displaced femoral fractures. METHODS A total of 16 young and middle-aged patients with irreducible displaced femoral neck fractures involving Garden type III and IV were treated using Femoral Neck System fixation by open reduction through Direct Anterior Approach between January 2020 to September 2021. Functional outcomes and postoperative complications were assessed during follow-up. Clinical outcomes were evaluated by the Hip Harris score. The postoperative reduction was evaluated by the Garden Index. Observe postoperative complications. RESULTS All patients were followed up with a mean follow-up time of 21.1(12-30) months, and according to radiological results, all patients achieved fracture healing, with a mean healing time of 4.25 months. All 16 patients received grade Garden I and II reductions, and there was no significant difference in the anteroposterior Garden reduction index between the first day after surgery (166.13 ± 5.61) and the 12th month after surgery(164.94 ± 4.49) (P>0.05) and no significant difference in lateral Garden index between the first day after surgery(171.06 ± 4.46) and the 12th month after surgery(169.38 ± 3.98) (P<0.05). According to the Hip Harris score scale, 13 patients received excellent and 3 patients received good. The postoperative Hip Harris Score(17.19 ± 4.8) was significantly higher than the preoperative score(92.19 ± 3.4), and the difference was statistically significant (P < 0.05). No or mild femoral neck shortness occurred in 12 (75%) patients, moderate shortening occurred in 3 (18.75%) patients, and severe shortening occurred in 1 (6.25%) patient. None of the patients experienced femoral head necrosis, fracture nonunion, or incision infection. One patient developed deep venous thrombosis of the lower extremity. CONCLUSIONS The Direct Anterior Approach combined with Femoral Neck System is an excellent treatment for irreducible displaced femoral neck fracture and achieved good functional outcomes and anatomical reduction with low complications.
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Affiliation(s)
- Chengzhi Liang
- Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, Shandong, 266003, People's Republic of China
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330000, People's Republic of China
| | - Yuan Cao
- Department of Orthopedics, People's Hospital of Rizhao, Rizhao, Shandong, 276800, People's Republic of China
| | - Zhihao Lin
- Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, Shandong, 266003, People's Republic of China
| | - Guoming Liu
- Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, Shandong, 266003, People's Republic of China
| | - Chengdong Zhang
- Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, Shandong, 266003, People's Republic of China
| | - Yanling Hu
- Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, Shandong, 266003, People's Republic of China.
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26
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Trivellas M, Wittstein J. Midshaft Clavicle Fractures: When Is Surgical Management Indicated and Which Fixation Method Should Be Used? Clin Sports Med 2023; 42:633-647. [PMID: 37716727 DOI: 10.1016/j.csm.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
For displaced midshaft clavicle fractures, operative treatment either with open reduction and plate fixation or with intramedullary fixation has been shown to provide earlier return to work and sport, improved functional outcomes, greater patient-reported satisfaction with appearance, and significantly decreased incidence of nonunion and malunion when compared with conservative treatment. Operative intervention is not without risks associated with surgery. Shared decision-making with the patient and understanding patient goals allows surgeons to recommend a management option that the patient will be comfortable with and will follow to achieve a satisfactory outcome.
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Affiliation(s)
- Myra Trivellas
- Department of Orthopaedic Surgery, Duke University School of Medicine, 3475 Erwin Road, Durham, NC 27705, USA
| | - Jocelyn Wittstein
- Department of Orthopaedic Surgery, Duke University School of Medicine, 3475 Erwin Road, Durham, NC 27705, USA.
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27
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Bauder AR, Graham EM, Shubinets V, Mendenhall SD, Carrigan RB, Lin IC, Shah A, Chang B. Does Irreducibility Always Mean a Complex Dislocation? An Analysis of 33 Pediatric Metacarpophalangeal Joint Dislocations. Plast Reconstr Surg 2023; 152:662e-669e. [PMID: 36946903 DOI: 10.1097/prs.0000000000010455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Previous failed reduction and certain radiographic indicators historically have been used to differentiate simple and complex metacarpophalangeal joint (MPJ) dislocations in children, the latter of which warrants open reduction. This investigation aimed to determine the necessity for open reduction with these indicators and establish a new treatment algorithm and educational focus for these rare injuries. METHODS A 12-year retrospective study was conducted on all children with MPJ dislocations at a single pediatric hospital. The rates of successful closed reduction, number of reduction attempts, and radiographic findings were detailed. Operative details and postoperative outcomes were also gathered. RESULTS Thirty-three patients with a mean age of 11.1 years were included. Most were male [ n = 27 (82%)] and had undergone two or more previous reduction attempts at an outside facility. Stable closed reduction was then achieved outside of the operating room in five patients and in the operating room under general anesthesia in another 14, for a total of 19 of 33 patients (57.6%). The thumb was injured most often [ n = 19 (57.6%)] and more likely to undergo successful closed reduction ( P = 0.04). There was no relationship between number of previous reduction attempts and ability to achieve closed reduction ( P = 0.72). Neither joint-space widening nor proximal phalanx bayonetting was correlated radiographically with failure of closed reduction ( P = 0.22 and P = 1, respectively). CONCLUSIONS This study supports closed reduction of pediatric MPJ dislocations in the operating room under general anesthesia before conversion to open reduction, regardless of injury characteristics or previous reduction attempts. This strategy is likely to limit unnecessary open surgery and related risks. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, IV.
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Affiliation(s)
| | - Emily M Graham
- From the Divisions of Plastic and Reconstructive Surgery
| | - Valeriy Shubinets
- Orthopaedic Surgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - Shaun D Mendenhall
- From the Divisions of Plastic and Reconstructive Surgery
- Curtis National Hand Center, MedStar Union Memorial Hospital
| | | | - Ines C Lin
- From the Divisions of Plastic and Reconstructive Surgery
| | - Apurva Shah
- Curtis National Hand Center, MedStar Union Memorial Hospital
| | - Benjamin Chang
- From the Divisions of Plastic and Reconstructive Surgery
- Curtis National Hand Center, MedStar Union Memorial Hospital
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28
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Billig JI, Law JM, Brody M, Cavanaugh KE, Dy CJ. Catastrophic Health Expenditures Associated With Open Reduction Internal Fixation of Distal Radius Fractures. J Hand Surg Am 2023; 48:977-983. [PMID: 37480916 DOI: 10.1016/j.jhsa.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/17/2023] [Accepted: 06/07/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE Distal radius fracture is one of the most common upper-extremity traumatic injuries. These injuries result in time off work and potential financial consequences for patients. Therefore, we aimed to understand the risk of catastrophic health expenditures (CHEs) after open reduction and internal fixation of distal radius fractures and examine the association between patient characteristics and the risk of CHE. METHODS We used data from patients undergoing open reduction and internal fixation of a distal radius fracture from a large, urban, level I trauma center (2018-2020). The risk of CHE was defined as out-of-pocket expenses of ≥40% of postsubsistence income. We used multivariable logistic regression to assess the impact of age, sex, race, and insurance status on the risk of CHE. RESULTS In our cohort of 394 patients, 121 patients (30.7%) were at risk of CHE after their distal radius fracture. After controlling for patient characteristics and insurance status, patients aged 26-34 years were 5.7 times more likely to be at risk of CHE (odds ratio, 5.73; 95% CI, 1.81-18.13) than patients aged ≥65 years. Patients who were uninsured were six times more likely to be at risk of CHE than patients with employer-sponsored health insurance (odds ratio, 6.02; 95% CI, 1.94-18.66). Lastly, non-White patients were at a higher risk of CHE (odds ratio, 3.63; 95% CI, 1.70-7.79) than White patients. CONCLUSIONS Distal radius fractures are unexpected and place patients at risk of financial harm, with one in three patients at risk of CHEs. Policies aimed at minimizing cost-sharing after traumatic injury may help alleviate the financial consequences of health care delivery and reduce disparities. TYPE OF STUDY/LEVEL OF EVIDENCE Economic and Decision Analysis II.
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Affiliation(s)
- Jessica I Billig
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO
| | - Jody M Law
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO
| | - Madison Brody
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO
| | - Katherine E Cavanaugh
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO
| | - Christopher J Dy
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO.
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29
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Roddy E, Kandemir U. High rate of avascular necrosis but excellent patient-reported outcomes after open reduction and internal fixation (ORIF) of proximal humerus fracture dislocations: should ORIF be considered as primary treatment? J Shoulder Elbow Surg 2023; 32:2097-2104. [PMID: 37224914 DOI: 10.1016/j.jse.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 03/23/2023] [Accepted: 04/04/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Proximal humerus fracture dislocations, excluding 2-part greater tuberosity fracture dislocations, are rare injuries. Outcomes after open reduction and internal fixation (ORIF) of these injuries have not been well described in the literature. The purpose of this study was to report the radiographic and functional outcomes of patients who underwent ORIF of a proximal humerus fracture dislocation. METHODS All skeletally mature patients who underwent ORIF of a proximal humerus fracture dislocation between 2011 and 2020 were identified. Patients with isolated greater tuberosity fracture dislocations were excluded. The primary outcome was American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score at a minimum of 2 years. Secondary outcomes were the development of avascular necrosis (AVN) and reoperation rate. RESULTS Twenty-six patients met the inclusion criteria. The mean age was 45 years (standard deviation 16), and 77% were men. Median time to reduction and surgery was 1 day (interquartile range [IQR] 1-5). There were 2 (8%) Neer 2-part fractures, 7 (27%) 3-part, and 17 (65%) 4-part fractures. Fifty-four percent (54%) involved the anatomic neck and 31% included a head-split component. Thirty-nine percent (39%) were anterior dislocations. The rate of AVN was 19%. The reoperation rate was 15%. Reoperations included removal of hardware (2), subscapularis repair (1), and manipulation under anesthesia (1). No patients went on to arthroplasty. ASES scores were available for 22 patients (84%) including 4 of 5 patients with AVN. The median ASES score at a mean of 6.0 years postoperatively was 98.3 (IQR 86.7-100, range 63.3-100) and was not different in those with or without AVN (median 98.3 vs. 92.0, P = .175). Only the presence of medial comminution and nonanatomic head shaft alignment on postoperative radiographs were associated with increased risk of AVN. CONCLUSION Radiographic rates of AVN (19%) and reoperation (15%) were high in this series of patients undergoing ORIF of proximal humerus fracture dislocations. Despite this, none of the patients required arthroplasty, and patient-reported outcome scores at an average of 6 years postinjury were excellent, with a median ASES score of 98.5. ORIF should be considered as primary method of treatment in proximal humerus fracture dislocations not only in young patients but also middle-aged patients.
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Affiliation(s)
- Erika Roddy
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Utku Kandemir
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA.
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30
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Dhodapkar MM, Oghenesume OP, Halperin SJ, Modrak M, Yoo BJ, Grauer JN. Adverse Events After Ankle Fracture Open Reduction Internal Fixation Among Patients With and Without Documented Cannabis and Tobacco Use. Foot Ankle Int 2023; 44:941-948. [PMID: 37698277 DOI: 10.1177/10711007231189698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
BACKGROUND Ankle fractures are common orthopaedic injuries that may be indicated for open reduction internal fixation (ORIF). Although the negative impact of tobacco use on perioperative outcomes of ankle fracture ORIF has been described, the potential impact of cannabis use on related outcomes is not as well established. METHODS Retrospective database study of adult patients undergoing ankle ORIF for closed, isolated, ankle fractures from the 2010-2021 Q1 PearlDiver M151 data set. Subcohorts without and with cannabis and/or tobacco use were identified based on coding and matched based on patient age, sex, and Elixhauser Comorbidity Index (ECI) scores to yield groups of nonusers, tobacco users, tobacco and cannabis users, and cannabis users. Ninety-day adverse events were assessed between matched subcohorts with multivariable logistic regression controlling for age, sex, and ECI. RESULTS A total of 149 289 patients met study inclusion criteria for whom tobacco only use was documented for 14 989 (10.0%), tobacco and cannabis use for 2726 (1.8%), and cannabis only use for 867 (0.6%). Matching yielded 823 for each group. On multivariable analyses, isolated tobacco users were at higher odds of 90-day urinary tract infections (UTIs) (odds ratio [OR] 2.64), minor adverse events (OR 2.33), all-cause adverse events (OR 2.17), readmissions (OR 1.85), and severe adverse events (OR 1.84). Tobacco and cannabis comorbid users were at a marginally higher odds of 90-day UTI (OR 2.82), minor adverse events (OR 2.51), readmissions (OR 2.39), and any adverse events (OR 2.22). Cannabis only users were not at greater odds of 90-day adverse events relative to nonusers. CONCLUSION Patients with tobacco use (alone or with cannabis) were at greater odds of 90-day adverse events following ankle fracture ORIF, but cannabis only users were not. LEVEL OF EVIDENCE Level III, Retrospective database study.
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Affiliation(s)
- Meera M Dhodapkar
- Department of Orthopedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | | | - Scott J Halperin
- Department of Orthopedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Maxwell Modrak
- Department of Orthopedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Brad J Yoo
- Department of Orthopedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Jonathan N Grauer
- Department of Orthopedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
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31
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Tseng HP, Hoekstra H. Pediatric proximal tibial fractures: How does the trauma mechanism guide the operative strategy? Injury 2023; 54:110969. [PMID: 37542789 DOI: 10.1016/j.injury.2023.110969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE Pediatric proximal tibial fractures (PTF) are rare but potentially debilitating. So far, no system for guiding surgical treatment based on injury-force mechanism has been documented, while adult tibial plateau fractures have benefited greatly from such an approach. This study reviews the diagnosis and treatment experience at a tertiary trauma center and introduces the reduction-traction method. METHODS Pediatric patients (0-17 years old) diagnosed with PTF were identified in the hospital database from 2017 to 2021. Their injury mechanism, injury location, treatment type, and treatment outcomes were recorded. Images were reviewed to establish an injury-force classification according to Mubarak et al., 2009. When appropriate, patients were treated using a "reduction-traction" approach. RESULTS Twenty-nine patients were identified, and followed-up for a mean of 6.8 months. The most common cause of injury was falling from height < 2 m, often from a trampoline. The tibial plateau and proximal tibial metaphysis were most commonly involved. Thirteen patients were treated non-operatively, 10 with open reduction and internal fixation, and six with arthroscopic surgery. A bimodal distribution according to age was noted in the injury mechanism, injury site, and treatment type. No adverse outcomes were recorded, and all patients resumed sports activities. The "reduction-traction" technique produced favorable outcomes in three patients. CONCLUSIONS Pediatric PTF has a bimodal distribution with high risk before three years and after 15 years. The injury-force classification can supplement the Salter-Harris classification in guiding surgical treatment. The "reduction-traction" approach in children differs from adults, and results in good outcomes.
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Affiliation(s)
- Han-Po Tseng
- University Hospitals Leuven, Department of Trauma Surgery, B-3000 Leuven, Belgium
| | - Harm Hoekstra
- University Hospitals Leuven, Department of Trauma Surgery, B-3000 Leuven, Belgium; KU Leuven - University of Leuven, Department of Development and Regeneration, B-3000 Leuven, Belgium.
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32
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Pesch S, Greve F, Zyskowski M, Müller M, Crönlein M, Biberthaler P, Kirchhoff C, Wurm M. High return to sports rates after operative treatment of patella fractures. Eur J Med Res 2023; 28:366. [PMID: 37736742 PMCID: PMC10514948 DOI: 10.1186/s40001-023-01359-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 09/10/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Patella fractures are relatively rare fractures and only little is known about the postoperative return to sports after patella fractures. METHODS This retrospective study presents information on functional outcome after operative treatment of patella fractures as well as time until return to sports and patients' complaints after open-reduction internal-fixation (ORIF) of patella fractures. RESULTS Overall, 39 patients after ORIF of patella fractures were evaluated at our Level-I trauma center with a mean follow-up of 42 months. The mean time until return to sports was 7 ± 3.9 months. No significant difference was found for functional outcome with respect to body mass index (BMI) or age. Fracture consolidation was accomplished after a mean of 6.9 ± 2.9 months besides a relatively low complication rate of 5.1% (n = 2). CONCLUSION The results demonstrate a high return to sports rate of 90.3%. However, only 51.6% were able to perform sports on their pre-injury level or above. Trial Registration The study was retrospectively registered at DRKS (No: DRKS00031146).
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Affiliation(s)
- Sebastian Pesch
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- Department of Trauma Surgery, AUVA Trauma Center Meidling, Kundratstrasse 37, 1120, Vienna, Austria
| | - Frederik Greve
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Michael Zyskowski
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Michael Müller
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Moritz Crönlein
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Peter Biberthaler
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Chlodwig Kirchhoff
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Markus Wurm
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
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Chauhan DK, Dadra A. Irreducible Shoulder Dislocation: A subtle X-ray feature mandating open reduction. BMJ Case Rep 2023; 16:e255678. [PMID: 37673464 PMCID: PMC10496699 DOI: 10.1136/bcr-2023-255678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Affiliation(s)
- Devendra Kumar Chauhan
- Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankit Dadra
- Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Lambi AG, Rowland RJ, Brady NW, Rodriguez DE, Mercer DM. Metacarpal fractures. J Hand Surg Eur Vol 2023; 48:42S-50S. [PMID: 37704027 DOI: 10.1177/17531934231184119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Metacarpal fractures are common and can be functionally disabling. The majority are managed non-operatively. When surgical intervention is indicated, various methods of fixation are available with the utility of each being based on injury pattern, patient function and surgeon preference. Early mobilization, especially in case of open reduction and internal fixation, is a critical component of treatment to prevent stiffness and restore function. When possible, a fixation construct that can withstand the applied forces of early postoperative motion is chosen. We provide an updated description for diagnosis, treatment options and operative fixation for metacarpal fractures.
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Affiliation(s)
- Alex G Lambi
- University of New Mexico Department of Orthopaedics and Rehabilitation, Albuquerque, NM, USA
| | - Robert J Rowland
- Larkin Hospital Department of Orthopaedic Surgery, Coral Gables, FL, USA
| | - Nicholas W Brady
- University of New Mexico Department of Orthopaedics and Rehabilitation, Albuquerque, NM, USA
| | - Diego E Rodriguez
- University of New Mexico Department of Orthopaedics and Rehabilitation, Albuquerque, NM, USA
| | - Deana M Mercer
- University of New Mexico Department of Orthopaedics and Rehabilitation, Albuquerque, NM, USA
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Park JJ, Perry LD, Tamburrini D, Kumar S. Successful Coil Embolization of a Large Anterior Tibial Artery Pseudoaneurysm After Open Reduction Internal Fixation of a Bi-condylar Tibial Plateau Fracture. Am Surg 2023; 89:3886-3888. [PMID: 37159921 DOI: 10.1177/00031348231175460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Pseudoaneurysms are false aneurysms that consist of turbulent blood flow between the outside layers of the arterial wall, the tunica media and tunica adventitia. Typically, pseudoaneurysms develop after injury to an artery, most often as a result of blunt trauma. Femoral pseudoaneurysms can also develop after catheter-based vascular interventions due to laceration of the artery from access needles, insufficient time or pressure held at the access site after the procedure, amongst other causes. Rarely, arterial injury during orthopedic pinning procedures has been known to cause pseudoaneurysms. There are only two documented cases within the literature in which a patient underwent closed intermedullary nailing of a proximal tibia fracture after trauma and developed an anterior tibial artery pseudoaneurysm. There are few reports of pseudoaneurysm development as the result of external fixation device placement presumably caused by the inability to directly visualize internal anatomy.
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Affiliation(s)
- Jasmine J Park
- Department of General Surgery Inspira Health Network, Vineland, NJ, USA
| | - Luke D Perry
- Department of General Surgery Inspira Health Network, Vineland, NJ, USA
| | | | - Sanjay Kumar
- Department of General Surgery Inspira Health Network, Vineland, NJ, USA
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Arteaga A, Biguetti CC, Chandrashekar BL, Mora J, Qureshi A, Rios E, La Fontaine J, Rodrigues DC. A Model Study to Evaluate Osseointegration and Fracture Healing Following Open Reduction and Internal Fixation (ORIF) in Diabetic Lewis Rats. J Foot Ankle Surg 2023; 62:832-839. [PMID: 37169119 DOI: 10.1053/j.jfas.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/24/2023] [Accepted: 04/30/2023] [Indexed: 05/13/2023]
Abstract
There is a higher risk of implant osseointegration failure after open reduction and internal fixation (ORIF) in patients with diabetes due to increased inflammatory conditions, associated metallic corrosion and infection. While it is possible to avoid elective osseous surgery in patients with diabetes, it may not be the case in nonelective cases, such as ORIF ankle fractures. A total of 30 male Lewis rats (12-15 weeks old) were distributed into diabetic (D) and nondiabetic (ND) groups. Fracture healing and osseointegration were evaluated at 2-, 10-, and 21-day time points. Microtomographic and histological analysis depicted distinct differences in fracture healing and osseointegration between D and ND animals. Immunohistochemical analysis exhibited elevated proliferation (PCNA) and osteogenic (Runx2) cells for ND animals, while HMGB1 (inflammatory marker) was elevated for D animals during healing. Bone resorption marker CTX-1 was elevated in the plasma of D animals at 2 days, while bone formation marker P1NP was higher for ND animals at 10 days. Overall, this model resulted in delayed implant osseointegration and fracture healing in diabetic animals, highlighting the importance of developing new biomaterials or implant coatings that can improve bone healing outcomes in this patient population.
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Affiliation(s)
- Alexandra Arteaga
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX
| | - Claudia Cristina Biguetti
- Department of Surgery and Biomechanics, School of Podiatric Medicine, The University of Texas Rio Grande Valley, Harlingen, TX
| | | | - Jimena Mora
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX
| | - Adeena Qureshi
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX
| | - Evelin Rios
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX
| | - Javier La Fontaine
- Department of Surgery and Biomechanics, School of Podiatric Medicine, The University of Texas Rio Grande Valley, Harlingen, TX
| | - Danieli C Rodrigues
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX.
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He Y, Liu Q, Gao B, Tian H. Efficacy of open reduction plate fixation versus external fixation in the treatment of distal radius type C fracture. Asian J Surg 2023; 46:3858-3859. [PMID: 37031082 DOI: 10.1016/j.asjsur.2023.03.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 03/26/2023] [Indexed: 04/08/2023] Open
Affiliation(s)
- Yongrui He
- Inner Mongolia Medical University, Affiliated Hospital of Inner Mongolia Medical University, Hohhot North Street, Inner Mongolia, 010050, China
| | - Qingliang Liu
- Department 2 of Bone, Zhoukou Central Hospital, Chuanhui District, Zhoukou City, Henan Province, 26 Renmin Road East Section, 466000, China
| | - Binli Gao
- Inner Mongolia Medical University, Department of Orthopedics, Affiliated Hospital of Inner Mongolia Medical University, Hohhot North Street, Inner Mongolia, 010050, China.
| | - Haizhen Tian
- Inner Mongolia Medical University, Affiliated Hospital of Inner Mongolia Medical University, Department of Anesthesiology, Huhehot Tongdao North Street, Inner Mongolia, 010050, China.
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Yao LW, Mao HJ, Dong WW, Wu ZT, Liu Q. Comparison of a minimally invasive osteosynthesis technique with conventional open surgery for transverse patellar fractures. Chin J Traumatol 2023; 26:261-266. [PMID: 37198050 PMCID: PMC10533542 DOI: 10.1016/j.cjtee.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/31/2023] [Accepted: 03/19/2023] [Indexed: 05/19/2023] Open
Abstract
PURPOSE The study aims to compare the efficacy and safety of a new minimally invasive osteosynthesis technique with those of conventional open surgery for transverse patellar fractures. METHODS It was a retrospective study. Adult patients with closed transverse patellar fracture were included, and with open comminuted patellar fracture were excluded. These patients were divided into minimally invasive osteosynthesis technique (MIOT) group and open reduction and internal fixation (ORIF) group. Surgical time, frequency of intraoperative fluoroscopy, visual analogue scale score, flexion, extension, Lysholm knee score, infection, malreduction, implant migration and implant irritation in two groups were recorded and compared. Statistical analysis was performed by the SPSS software package (version 19). A p < 0.05 indicated statistical significance. RESULTS A total of 55 patients with transverse patellar fractures enrolled in this study, the minimally invasive technique was performed in 27 cases, and open reduction was performed in 28 cases. The surgical time in the ORIF group was shorter than that in the MIOT group (p = 0.033). The visual analogue scale scores in the MIOT group were significantly lower than those in the ORIF group only in the first month after surgery (p = 0.015). Flexion was restored faster in the MIOT group than that in the ORIF group at one month (p = 0.001) and three months (p = 0.015). Extension was recovered faster in the MIOT group than that in the ORIF group at one month (p = 0.031) and three months (p = 0.023). The recorded Lysholm knee scores in the MIOT group were always greater than those in the ORIF group. Complications, such as infection, malreduction, implant migration, and implant irritation, occurred more frequently in the ORIF group. CONCLUSION Compared with the ORIF group, the MIOT group reduced postoperative pain and had less complications and better exercise rehabilitation. Although it requires a long operation time, MIOT may be a wise choice for transverse patellar fractures.
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Affiliation(s)
- Li-Wei Yao
- Department of Orthopaedic Surgery, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, 315020, Zhejiang province, China
| | - Hai-Jiao Mao
- Department of Orthopaedic Surgery, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, 315020, Zhejiang province, China
| | - Wen-Wei Dong
- Department of Orthopaedic Surgery, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, 315020, Zhejiang province, China
| | - Ze-Ting Wu
- Department of Orthopaedic Surgery, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, 315020, Zhejiang province, China
| | - Qing Liu
- Department of General Practice, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, 315020, Zhejiang province, China.
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Miksch RC, Herterich V, Barg A, Böcker W, Polzer H, Baumbach SF. Open Reduction and Internal Fixation of the Posterior Malleolus Fragment in Ankle Fractures Improves the Patient-Rated Outcome: A Systematic Review. Foot Ankle Int 2023; 44:727-737. [PMID: 37125766 PMCID: PMC10394961 DOI: 10.1177/10711007231165771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND The best treatment strategy for fractures to the posterior malleolus (PM) is still intensively debated. The aim of this systematic review was to compare the patient-rated outcome following open reduction and internal fixation (ORIF) for fractures of the PM to either closed reduction using AP screws (CRIF) or no treatment in bi- or trimalleolar ankle fractures. METHODS Systematic literature research (MEDLINE (PubMed), CINAHL, Scopus, Central and EMBASE) according to the PICOS and PRISMA guidelines. Eligible were studies comparing the outcome following ORIF to any other treatment strategy for fractures to the posterior malleolus in isolated bi- or trimalleolar ankle fractures. RESULTS Twelve studies were eligible for a qualitative analysis and 6 for a quantitative analysis. Overall, a considerable heterogeneity among the studies was observed. The most commonly used outcome score was the American Orthopaedic Foot & Ankle Society ankle-hindfoot score (AOFAS). The final follow-up ranged from 12 to 160 months. Four studies compared ORIF to CRIF of the PM. The quantitative analysis revealed significantly better AOFAS scores for ORIF (90.9 vs 83.4 points; P < .001; I2 = 0%). Three studies compared ORIF to untreated PM fragment. The quantitative analysis again revealed superior AOFAS scores for ORIF (92.0 vs 82.5 points; P < .001; I2 = 99%). A similar trend was observed for the Ankle Fracture Scoring System and American Academy of Orthopaedic Surgeons Foot and Ankle Questionnaire scores as well as the quality of reduction. CONCLUSION Despite a considerable heterogeneity, the data available point to a superior outcome following ORIF for fractures to the PM when compared to CRIF or no treatment.
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Affiliation(s)
- Rainer Christoph Miksch
- Musculoskeletal University Centre Munich (MUM), University Hospital, Ludwig-Maximilians-University Munich (LMU), Germany
| | - Viktoria Herterich
- Musculoskeletal University Centre Munich (MUM), University Hospital, Ludwig-Maximilians-University Munich (LMU), Germany
| | - Alexej Barg
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Böcker
- Musculoskeletal University Centre Munich (MUM), University Hospital, Ludwig-Maximilians-University Munich (LMU), Germany
| | - Hans Polzer
- Musculoskeletal University Centre Munich (MUM), University Hospital, Ludwig-Maximilians-University Munich (LMU), Germany
| | - Sebastian Felix Baumbach
- Musculoskeletal University Centre Munich (MUM), University Hospital, Ludwig-Maximilians-University Munich (LMU), Germany
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Velmurugesan PS, Nagashree V, Devendra A, Dheenadhayalan J, Rajasekaran S. Should ulnar styloid be fixed following fixation of a distal radius fracture? . Injury 2023; 54:110768. [PMID: 37210301 DOI: 10.1016/j.injury.2023.04.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/27/2023] [Accepted: 04/30/2023] [Indexed: 05/22/2023]
Abstract
INTRODUCTION Fracture of the base of the ulnar styloid has shown to have higher incidence of TFCC tears and DRUJ instability leading to nonunion and impaired function. Poorer functional outcomes of the distal radius fracture have been attributed to the untreated associated ulnar styloid fractures while some studies have shown no difference. Thus, the treatment remains controversial. However, it has been shown that fractures at the base of the ulnar styloid have a higher incidence of tears in the triangular fibrocartilage complex (TFCC) and instability in the distal radioulnar joint (DRUJ), which can lead to nonunion and impaired function. Despite this, there are currently no studies comparing the outcomes of surgically and conservatively treated patients. METHODS A retrospective study was conducted to analyze the outcomes of intra-articular distal radius fractures associated with base of ulnar fracture treated with distal radius LCP fixation. The study included 14 patients who were treated surgically and 49 patients who were treated conservatively, with a minimum follow-up of 2 years. Radiological parameters such as union and amount of displacement, VAS score for ulnar-sided wrist pain, functional assessment using the modified Mayo score and the quick DASH questionnaire and complications were analyzed. RESULTS At the final follow-up, the mean scores for pain (VAS), functional outcomes (modified Mayo score), disability (QuickDASH score), range of motion, and non-union rate were found to be statistically insignificant (p > 0.05) between the surgically treated and conservatively treated groups. However, patients with non-union had statistically significant higher scores for pain (VAS), greater post-operative displacement of the styloid, poorer functional outcomes, and higher disability (p < 0.05). CONCLUSION While there was no significant difference in ulnar-sided wrist pain and functional outcomes between the surgically treated and conservatively treated groups, the conservatively treated cases had a higher risk of non-union, which can negatively impact functional outcomes. The amount of pre-operative displacement was found to be a key factor in predicting non-union and can be used as a guide for determining the management of this type of fracture.
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Affiliation(s)
| | - Vasudeva Nagashree
- Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India.
| | - Agraharam Devendra
- Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Jayaramaraju Dheenadhayalan
- Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Shanmuganathan Rajasekaran
- Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
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41
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Nguyen MP. CORR Insights®: What Factors Are Associated With Delayed Wound Closure in Open Reduction and Internal Fixation of Adult Both-bone Forearm Fractures? Clin Orthop Relat Res 2023; 481:1396-1398. [PMID: 36752767 PMCID: PMC10263242 DOI: 10.1097/corr.0000000000002577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 01/06/2023] [Indexed: 02/09/2023]
Affiliation(s)
- Mai P Nguyen
- Assistant Professor, University of Minnesota Medical Center: University of Minnesota Health, Orthopaedic Surgery and Rehabilitation, Minneapolis, MN, USA
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42
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Moran J, Homan MD, LaPrade CM, Kennedy NI, LaPrade RF. Treatment of a Failed Posterior Cruciate Ligament Avulsion Fracture Fixation in a Skeletally Immature Patient: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00045. [PMID: 37556573 DOI: 10.2106/jbjs.cc.23.00165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
CASE A 12-year-old skeletally immature girl presented with 1 year of persistent instability after an open reduction and internal fixation (ORIF) for a posterior cruciate ligament (PCL) avulsion fracture. With a period of nonoperative management, her PCL stress radiographic measurements significantly decreased and her posterior tibial slope increased because the primary ORIF effectively led to growth arrest with an early fusion of the posterior tibial physis. At age 13 years when she was skeletally mature, revision PCL and fibular collateral ligament (FCL) reconstructions were performed. Promising clinical outcomes were observed at age 17 years. CONCLUSION Pediatric patients with a failed PCL ORIF can successfully be managed with a period of nonoperative bracing and a revision PCL reconstruction once skeletally mature.
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Affiliation(s)
- Jay Moran
- Yale School of Medicine, New Haven, Connecticut
| | | | - Christopher M LaPrade
- Stanford Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
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Vaslow AS, Deal JB, Ho CA. Operative Fractures of the Phalangeal Head and Neck in Children-Does Open Reduction Affect Outcomes? J Pediatr Orthop 2023; 43:311-316. [PMID: 36863778 PMCID: PMC10082043 DOI: 10.1097/bpo.0000000000002364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Closed reduction percutaneous pinning of displaced pediatric phalangeal head and neck fractures is preferred to prevent malunion and loss of motion and function. However, open reduction is required for irreducible fractures and open injuries. We hypothesize that osteonecrosis is more common in open injuries than closed injuries that require either open reduction or closed reduction percutaneous pinning. METHODS Retrospective chart review of 165 phalangeal head and neck fractures treated surgically with pin fixation at a single tertiary pediatric trauma center from 2007 to 2017. Fractures were stratified as open injuries (OI), closed injuries undergoing open reduction (COR), or closed injuries treated with closed reduction (CCR). The groups were compared using Pearson χ 2 tests and ANOVA. Two group comparisons were made with Student t test. RESULTS There were 17 OI fractures, 14 COR fractures, and 136 CCR fractures. Crush injury was the predominant mechanism in OI versus COR and CCR groups. The average time from injury to surgery was 1.6 days for OI, 20.4 days for COR, and 10.4 days for CCR. The average follow-up was 86.5 days (range, 0 to 1204). The osteonecrosis rate differed between the OI versus COR and OI versus CCR groups (71% for OI, 7.1% for COR, and 1.5% for CCR). Rates of coronal malangulation >15 degrees differed between the OI and COR or CCR groups, but the 2 closed groups did not differ. Outcomes were defined using Al-Qattan's system; CCR had the most excellent and fewest poor outcomes. One OI patient underwent partial finger amputation. One CCR patient had rotational malunion but declined derotational osteotomy. CONCLUSIONS Open phalangeal head and neck fractures have more concomitant digital injuries and postoperative complications compared with injuries closed on presentation, regardless of whether the fracture underwent open or closed reduction. Although osteonecrosis occurred in all 3 cohorts, it was most frequent in open injuries. This study allows surgeons to discuss rates of osteonecrosis and resultant complications with families whose child presents with phalangeal head and neck fractures that are indicated for surgical treatment. LEVEL OF EVIDENCE Therapeutic, Level III.
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Affiliation(s)
- Aaron S. Vaslow
- T Brian D. Allgood Army Community Hospital, Camp Humpreys, Pyeongtaek, South Korea
| | - James Banks Deal
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD
| | - Christine A. Ho
- Department of Orthopaedic Surgery, Children’s Health Dallas
- Scottish Rite for Children
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX
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Caines A, Adamczyk A, Mahaffey R, Pickell M. Open Reduction Internal Fixation Versus Distal Femoral Replacement (DFR) for Treatment of OTA/AO 33C Fractures in the Elderly: A Review of Functional Outcomes and Cost Analysis. J Orthop Trauma 2023; 37:14-18. [PMID: 36518063 DOI: 10.1097/bot.0000000000002455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine the economic cost associated with the treatment of OTA/AO 33C fractures in patients older than 65 years of age using open reduction internal fixation (ORIF) or DFR and to assess the perioperative outcomes of elderly patients treated surgically following OTA/AO 33C fractures. DESIGN Retrospective cohort over a 10-year period. SETTING A single level-1 trauma center. PARTICIPANTS AND INTERVENTION Thirty-nine patients 65 or older with OTA/AO 33C fractures who underwent treatment with ORIF (n = 27) or DFR (n = 12) were included. MAIN OUTCOME MEASUREMENTS Direct cost associated with surgical treatment along with LOS, functional outcomes, patient-reported outcomes, and all-cause reoperation. RESULTS Index procedure costs were as follows: DFR: $ 61,259 vs. ORIF: $44,490 (P = 0.056). Five (20%) ORIF patients required revision versus one (8%) in the DFR group. Total cost when including reoperation resulted in DFR being $14,805 more costly, which was not significant. Hospital LOS was similar between groups; however, convalescent LOS was longer in ORIF patients (43.2 vs. 23.1 days, P = 0.02). CONCLUSION This study demonstrates that there is no significant difference in overall cost between ORIF and DFR when all costs are considered. A larger portion of DFR patients were able to mobilize postoperatively, with subacute length of stay being longer in ORIF patients. A multicenter trial is warranted to determine optimal treatment for this complex problem. LEVEL OF EVIDENCE Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Andrew Caines
- Division of Orthopaedic Surgery, The University of Ottawa, The Ottawa Hospital, Ottawa, ON
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Selim A, Naqvi AZ, Magill H, Smith J. Fracture neck of the talus with isolated talonavicular dislocation: A case report. Medicine (Baltimore) 2022; 101:e28073. [PMID: 36343062 PMCID: PMC9646572 DOI: 10.1097/md.0000000000028073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Talar neck fractures are injuries which frequently result in adverse outcomes or impairment of functional activity. Four groups were identified according to Hawkins classification and Canale modification. We present a female patient with a fractured neck of the talus associated with talonavicular dislocation, but intact tibiotalar and subtalar joints; an injury pattern not fulfilling the criteria described in the Hawkins classification. PATIENT CONCERNS A 46-year-old woman missed a step and fell down stairs with an immediate painful right ankle and inability to bear weight. DIAGNOSIS Talar neck fracture with an unusual isolated talonavicular dislocation. INTERVENTIONS Temporary closed reduction followed by open reduction and internal fixation were performed. OUTCOMES The patient had excellent functional and radiological outcomes following surgical management. CONCLUSION We discuss the management of this rare case in addition to a review of the current literature to provide the best evidence-based recommendations for this injury pattern.
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Affiliation(s)
- Amr Selim
- Cairo University Hospitals, Cairo, Egypt
- Homerton Hospital, London, UK
- *Correspondence: Amr Selim, Homerton Hospital, London, United Kingdom, E9 6SR (e-mail: )
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Klahs KJ, Fitzpatrick KV, Blair JA, Parnes N, Nesti LJ, Dunn JC. Treatment patterns of ABOS part II candidates: A decline of operative management among geriatric proximal humerus fractures over the decade (2010-2020). Injury 2022; 53:3742-3747. [PMID: 36104254 DOI: 10.1016/j.injury.2022.08.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/25/2022] [Accepted: 08/28/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to assess trends in ABOS part II candidate's operative management of geriatric (≥65 years) proximal humerus fractures over the 2010-2020 decade. METHODS This retrospective database cohort study utilized the American Board of Orthopaedic Surgery (ABOS) database for candidates taking Part II of their boards. Surgical coding was reviewed and the ICD10 data was correlated to the CPT code for shoulder arthroplasty or open reduction internal fixation. We investigated the number of proximal humerus fracture operative cases per year, the percent arthroplasty used per year, the stratification of percent arthroplasty per orthopaedic fellowship subspecialty and geographic region. RESULTS A total of 2,409 operative cases for proximal humerus fractures in patients 65 years of age and older were submitted by 1,420 ABOS candidates. There was a 37% reduction in operatively managed proximal humerus fractures among ABOS part II candidates between the first half of the decade (2010-2015, 263.2 +/- 13.4) and the second half of the decade (2016-2020, 166 +/- 31.2; p<.05). There also was a downward trend with a 53% reduction in percent treated with arthroplasty as compared to ORIF during those same windows (2010-2015, 34.4 +/-11.7) and (2016-2020, 16.2 +/- 6.4; p<.5). Partitioned by single fellowship training, Shoulder and Elbow (S&E) surgeons performed the highest percent arthroplasty at 25.2%, followed by Sports at 23.1% and the lowest percent arthroplasty was Trauma at 11.7%. The Southeast United States had the lowest percentage arthroplasty at 15.8% as compared to the Midwest (23.8%) and Northeast (25.8%). CONCLUSION Despite the rapid growth of both the elderly population and related geriatric proximal humerus fractures, ABOS candidates are treating less with surgery. There has been approximately a 37% decrease in the total number of operatively treated proximal humerus fractures between the first and second half 2010-2020 decade. When operative treatment is performed, there is a trend towards ORIF over an arthroplasty. Trauma fellowship trained surgeons are less likely to perform an arthroplasty as compared to other subspecialties. The Southeast region is least likely to perform an arthroplasty as compared to the Midwest or Northeast.
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Affiliation(s)
- Kyle J Klahs
- William Beaumont Army Medical Center, Fort Bliss, El Paso, TX, USA; Texas Tech University Health Science Center, El Paso, TX, USA.
| | | | - James A Blair
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Nata Parnes
- Department of Orthopaedic Surgery and Rehabilitation, Carthage Area Hospital, Carthage, NY, USA
| | | | - John C Dunn
- William Beaumont Army Medical Center, Fort Bliss, El Paso, TX, USA; Texas Tech University Health Science Center, El Paso, TX, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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47
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Fitch AA, Terhune EB, Cohn MR, Wright-Chisem J, Weatherford BM, Williams JC. Periprosthetic Tibial Plateau Fractures After Unicompartmental Knee Arthroplasty Are Successfully Treated With Open Reduction and Internal Fixation. Orthopedics 2022; 45:287-292. [PMID: 35485885 DOI: 10.3928/01477447-20220425-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Periprosthetic tibial fractures after unicompartmental knee arthroplasty (UKA) are rare but devastating events. Given the relative infrequency of these injuries, treatment strategies are not well defined. The goal of this retrospective case series is to report the findings for a series of patients who underwent open reduction and internal fixation (ORIF) of periprosthetic fracture after UKA, including radiographic alignment, Knee Society Score (KSS), and failure rate. Patients were identified by the International Classification of Diseases code for periprosthetic tibial plateau fractures. Electronic medical records and radiographs were retrospectively reviewed. Fracture patterns and coronal and sagittal alignment of UKA components were measured on radiographs. Clinical outcomes, including range of motion assessment, visual analog scale pain score, and KSS, were collected at final follow-up. Eight patients satisfied the inclusion criteria for this study. Fractures occurred at a median of 14 days (range, 5-52 days) after UKA, and all showed a vertical shear pattern that exited at the meta-diaphyseal junction. Of the 8 fractures, 7 (87.5%) healed to radiographic and clinical union after the initial ORIF. One patient required reoperation for hardware failure. Mean visual analog scale pain score and KSS at final follow-up were 3 and 85±14, respectively. Periprosthetic tibial plateau fractures after UKA commonly occur as a vertical shear fracture exiting at the metadiaphyseal junction. The use of ORIF with a 3.5-mm plate in buttress mode is a reliable method for treatment of these fractures. Restoration of alignment and motion is achievable, but residual pain may affect patient-reported outcome scores. [Orthopedics. 2022;45(5):287-292.].
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Abstract
BACKGROUND Type I open distal radius fractures treated with open reduction internal fixation (ORIF) have demonstrated minimal risk of infection. For this reason, they may not require urgent surgical treatment. The purpose of this study was to evaluate the outcomes of patients with type I open distal radius fractures treated with delayed ORIF compared with urgent ORIF. METHODS We identified all Gustilo-Anderson type I open distal radius fractures that had undergone ORIF using volar plating over a 5-year period. Patients were stratified into those treated urgently within 24 hours and those scheduled for delayed surgery. Outcomes including functional scores, complications, reoperations, and radiographic measures were compared. RESULTS Twenty-four patients (17 treated urgently and 7 treated delayed) had open type I distal radius fractures. All patients were started on empiric antibiotics at initial presentation-patients in the delayed treatment group were prescribed oral antibiotics, whereas those admitted for urgent treatment received intravenous antibiotics. There were no infections in either group and a single reoperation in each group. The mean postoperative Quick Disabilities of the Arm, Shoulder, and Hand score was 29 (range = 0-77) and did not differ significantly between delayed (mean = 19) and urgent (mean = 38) treatment. Rate of complications and radiographic measures did not differ significantly between the groups. CONCLUSIONS Type I open distal radius fractures appear amenable to delayed outpatient ORIF provided that the wound is clean at the time of initial presentation and that antibiotics are initiated appropriately. Further prospective studies comparing delayed and urgent treatment strategies are warranted.
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Aravind P, Frost C, Javia V, Cooney DS, Brandacher G, Shores JT, Cooney CM. Special Considerations for Secondary Surgery After Upper Extremity Transplantation. Hand (N Y) 2022; 17:969-974. [PMID: 33190550 PMCID: PMC9465781 DOI: 10.1177/1558944720966723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Upper extremity (UE) transplantation is a complex undertaking that may require emergent or elective secondary surgery (SS) days to years following transplant. Various patient and transplantation may help determine what SS is needed. In this study, we characterize the SS needed by our UE transplant patients. METHODS We retrospectively reviewed 6 patients who underwent hand and UE transplantation by one of the authors. Transplantation and SS details were obtained from medical records. Hand and arm function was quantified both subjectively (patient-reports) and objectively (Disabilities of the Arm, Shoulder, and Hand Score; Carroll test; Action Research Arm Tests; Box and Block test). RESULTS Six patients underwent transplantation for a total of 10 transplanted limbs. Five transplants were performed below and 5 above the elbow. Mean time post-transplantation at last follow-up was 5 years (range: 1-9 years). In all, 66.7% of the patients required SS: total 7 surgeries comprising 13 procedures. The most common procedures were to improve hand function-nerve decompressions and tendon transfer, both in above-elbow transplant. Both patients showed a mean improvement of 15 points on Carroll scores. One above-elbow transplant had a brachioplasty for excess skin and another had a hematoma evacuation immediately after transplantation. Procedures in the below-elbow transplants included multiple incision and drainages for a septic wrist and an open reduction and internal fixation for a forearm fracture. CONCLUSION Patients receiving UE transplantation often require one or more secondary procedures which may vary with level of transplantation. Secondary surgery should be an important aspect of pretransplant planning and cost-effectiveness determinations. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Pathik Aravind
- Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | | | - Vidhi Javia
- Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - Damon S. Cooney
- Johns Hopkins University School of
Medicine, Baltimore, MD, USA
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Pfister G, Murison JC, Sabate-Ferris A, Danis J, De l'Escalopier N, Mathieu L. Open Screw Fixation of Large Anterior Glenoid Rim Fractures Using a Deltopectoral Approach With Subscapularis Splitting. Tech Hand Up Extrem Surg 2022; 26:188-192. [PMID: 35288523 DOI: 10.1097/bth.0000000000000383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Anterior glenoid rim fracture is a consequence of the humeral head impacting the glenoid fossa. The management of large glenoid fractures involving more than 20% of the articulating glenoid requires surgical treatment. The 2 main techniques are open reduction internal fixation (ORIF) by screws and arthroscopic treatment using suture anchors or transcutaneous screws. Next to the technical equipment, a surgeon requires extensive experience to achieve good results with the arthroscopic technique. The main disadvantage using the ORIF technique is the detachment of the subscapularis muscle, which is often criticized for causing functional deficits of the subscapularis. Our study demonstrates the feasibility of the ORIF technique through a deltopectoral approach and splitting of the subscapularis. To our knowledge, subscapularis splitting has never been described to treat glenoid fractures.
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Affiliation(s)
- Georges Pfister
- Service de chirurgie orthopédique et traumatologie, Hôpital d'Instruction des Armées Percy, Henri Barbusse, Clamart, France
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