The aim of the study was to evaluate the efficacy custom 3D-printed osteosynthesis plates in the treatment of intercondylar humeral fractures.Thirteen patients with distal intercondylar humeral ...fractures were randomized to undergo surgery using either conventional plates (n = 7) or 3D-printed plates (n = 6) at our institution from March to October 2014. Both groups were compared in terms of operative time and elbow function at 6 month follow-up.All patients were followed-up for a mean of 10.6 months (range: 6-13 months). The 3D-printing group had a significantly shorter mean operative time (70.6 ± 12.1 min) than the conventional plates group (92.3 ± 17.4 min). At the last follow-up period, there was no significant difference between groups in the rate of patients with good or excellent elbow function, although the 3D-printing group saw a slightly higher rate of good or excellent evaluations (83.1%) compared to the conventional group (71.4%).Custom 3D printed osteosynthesis plates are safe and effective for the treatment of intercondylar humeral fractures and significantly reduce operative time.
BACKGROUND:Following internal fixation of intertrochanteric hip fractures, tip apex distance, fracture classification, position of the screw in the femoral head, and fracture reduction are known ...predictors for screw cutout, but the reliability of these measurements is unknown. We investigated the reliability of the tip apex distance measurement, the Cleveland femoral head dividing system, the three-grade classification system of Baumgaertner for fracture reduction, and the AO classification system as predictors for screw cutout.
METHODS:All patients with an intertrochanteric hip fracture who were managed with either a dynamic hip screw or a gamma nail between January 2007 and June 2010 were evaluated from our hip trauma database.
RESULTS:The tip apex distance measurement was reliable and patients with device cutout had a significantly higher tip apex distance. The agreement between observers with regard to screw position and fracture reduction was moderately reliable. After adjustment for tip apex distance and screw position, A3 fractures were at more risk of cutout compared with A1 fractures. Poor fracture reduction was significantly related with a higher incidence of cutout in univariate analysis, but not in multivariate analysis. Central-inferior and anterior-inferior positions, after adjustment for tip apex distance and screw position, were significantly protective against cutout.
CONCLUSION:To decrease probable risks of cutout, the tip apex distance needs to stay small or the screw needs to be placed central-inferiorly or anterior-inferiorly.
LEVEL OF EVIDENCE:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Plating of clavicle fracture using the wide-awake technique Ahmad, Amir Adham; Ubaidah Mustapa Kamal, Muhammad Abu; Ruslan, Shairil Rahayu ...
Journal of shoulder and elbow surgery,
November 2020, 2020-Nov, 2020-11-00, 20201101, Letnik:
29, Številka:
11
Journal Article
Recenzirano
Fixation of clavicle fractures has now become a more popular option as it provides better outcome compared with conservative management. Wide-awake local anesthesia no tourniquet (WALANT) has been ...effectively used in plating of distal radius and olecranon fractures. This paper expands the usage of WALANT into the shoulder girdle, namely plating of the clavicle that has not been described. The operation is typically performed under general anesthesia.
We report a case series of 16 patients who successfully underwent fixation of the clavicle under the wide-awake technique. The clavicle fractures were grouped under the AO Fracture Classification. The WALANT solution comprised 1% lidocaine, 1:100,000 epinephrine, and 10:1 sodium bicarbonate. A total of 40 mL was injected in each patient with 10 mL subcutaneously along the clavicle followed by 30 mL subperiosteally at multiple intervals and directions.
The Numerical Pain Rating Score was 0 during WALANT injection and during surgery except for 2 patients with Numerical Pain Rating Scores of 1 and 2, respectively, during reduction.
We conclude that clavicle plating under WALANT is a good alternative option of anesthesia.
Background
Two types of implants used for the surgical fixation of extracapsular hip fractures are cephalocondylic intramedullary nails, which are inserted into the femoral canal proximally to ...distally across the fracture, and extramedullary implants (e.g. the sliding hip screw).
Objectives
To compare cephalocondylic intramedullary nails with extramedullary implants for extracapsular hip fractures in adults.
Search methods
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (April 2010), The Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 1), MEDLINE (1950 to March 2010), EMBASE (1980 to 2010 Week 13), and other sources.
Selection criteria
All randomised and quasi‐randomised controlled trials comparing cephalocondylic nails with extramedullary implants for extracapsular hip fractures.
Data collection and analysis
Both authors independently assessed trial quality and extracted data. Wherever appropriate, results were pooled.
Main results
We included 43 trials containing predominantly older people with mainly trochanteric fractures.
Twenty‐two trials (3749 participants) compared the Gamma nail with the sliding hip screw (SHS). The Gamma nail was associated with increased risk of operative and later fracture of the femur and increased reoperation rate. There were no major differences between implants in wound infection, mortality or medical complications.
Five trials (623 participants) compared the intramedullary hip screw (IMHS) with the SHS. Fracture fixation complications were more common in the IMHS group. Results for post‐operative complications, mortality and functional outcomes were similar in both groups.
Three trials (394 participants) showed no difference in fracture fixation complications, reoperation, wound infection and length of hospital stay for proximal femoral nail (PFN) versus the SHS.
None of the 10 trials (1491 participants) of other nail versus extramedullary implant comparisons for trochanteric fractures provided sufficient evidence to establish definite differences between the implants under test.
Two trials (65 participants) found intramedullary nails were associated with fewer fracture fixation complications than fixed nail plates for unstable fractures at the level of the lesser trochanter.
Two trials (124 participants) found a tendency to less fracture healing complications with the intramedullary nails compared with fixed nail plates for subtrochanteric fractures.
Authors' conclusions
With its lower complication rate in comparison with intramedullary nails, and absence of functional outcome data to the contrary, the SHS appears superior for trochanteric fractures. Further studies are required to confirm whether more recently developed designs of intramedullary nail avoid the complications of previous nails. Intramedullary nails may have advantages over fixed angle plates for subtrochanteric and some unstable trochanteric fractures, but further studies are required.
OBJECTIVES:To examine one health systemʼs response to the essential care of its hip fracture population during the COVID-19 pandemic and report on its effect on patient outcomes.
DESIGN:Prospective ...cohort study.
SETTING:Seven musculoskeletal care centers within New York City and Long Island.
PATIENTS/PARTICIPANTS:One hundred thirty-eight recent and 115 historical hip fracture patients.
INTERVENTION:Patients with hip fractures occurring between February 1, 2020, and April 15, 2020, or between February 1, 2019, and April 15, 2019, were prospectively enrolled in an orthopaedic trauma registry and chart reviewed for demographic and hospital quality measures. Patients with recent hip fractures were identified as COVID positive (C+), COVID suspected (Cs), or COVID negative (C−).
MAIN OUTCOME MEASUREMENTS:Hospital quality measures, inpatient complications, and mortality rates.
RESULTS:Seventeen (12.2%) patients were confirmed C+ by testing, and another 14 (10.1%) were suspected (Cs) of having had the virus but were never tested. The C+ cohort, when compared with Cs and C− cohorts, had an increased mortality rate (35.3% vs. 7.1% vs. 0.9%), increased length of hospital stay, a greater major complication rate, and a greater incidence of ventilator need postoperatively.
CONCLUSIONS:COVID-19 had a devastating effect on the care of patients with hip fracture during the pandemic. Although practice patterns generally remained unchanged, treating physicians need to understand the increased morbidity and mortality in patients with hip fracture complicated by COVID-19.
LEVEL OF EVIDENCE:Prognostic Level III. See Instructions for Authors for a complete description of Levels of Evidence.
Percutaneous sacroiliac (SI) screw fixation is indicated for unstable posterior pelvic ring injuries, sacral fractures, and SI joint dislocations. This article provides a review of indications and ...contraindications, preoperative planning, imaging techniques and relevant anatomy, surgical technique, complications and their management, and outcomes after SI screw insertion.
The recommendation on whether to bury or expose the Kirschner wire (K-wire) for the management of fractures has still been controversial with inconsistent results in the published studies due to the ...potential issue associated with exposed K-wire is the heightened risk of infection, as it comes into direct contact with the external environment and air. This study aims to summarize the specific outcomes between buried and exposed K-wire for the management of hand and forearm fractures.
We conducted relevant literature searches on Europe PMC, Medline, Scopus, and Cochrane Library databases using specific keywords. This investigation focuses on individuals of any age diagnosed with hand or forearm fractures who underwent surgery involving Kirschner wire (K-wire) fixation. It examines the comparison between buried and exposed K-wire fixation, emphasizing primary outcome pin infection, along with secondary outcomes such as early pin removal, days to pin removal, and surgical duration. The study includes observational studies (cohort/case-control) or randomized clinical trials (RCTs). The results of continuous variables were pooled into the standardized mean difference (SMD), while dichotomous variables were pooled into odds ratio (OR) along with 95% confidence intervals using random-effect models. The quality of included studies was assessed with Cochrane Collaborations, Risk of Bias version 2 (RoB v2).
A total of 11 studies were included. Our pooled analysis revealed that buried K-wire was associated with a lower risk of pin site infection RR 0.49 (95% CI 0.36-0.67), p < 0.00001, I2 = 0% and 33.85 days longer duration until pin removal MD 33.85 days (95% CI 18.68-49.02), p < 0.0001, I2 = 99% when compared with exposed K-wire. However, the duration of surgery was 9.98 minutes significantly longer in the buried K-wire MD 6.98 minutes (95% CI 2.19-11.76), p = 0.004, I2 = 42% with no significant difference in the early pin removal rate RR 0.73 (95% CI 0.36-1.45), p = 0.37, I2 = 0%. Further regression analysis revealed that sample size, age, sex, and duration of follow-up did not affect those relationships.
Buried K-wire may offer benefits in reducing the infection rate with a longer duration until pin removal. However, further RCTs with larger sample sizes are still needed to confirm the results of our study.
Summary
There is ongoing effort to discharge patients early after hip fracture surgery to reduce the medical and economic burden. We tried to find whether there is any related side effect, and ...discovered that early discharge, especially before 10 days after surgery, is associated with higher mortality.
Introduction
The aim of this study was to analyze the association between the length of hospital stay after hip fracture and 1-year mortality in older adults aged ≥ 65 years old.
Methods
We conducted a retrospective cohort study using the Korean National Health Insurance Service data to identify patients who were discharged after hip fracture surgery from 2007 to 2009 among 487,460 older adults of age ≥ 65 years. The lengths of stay involving hip fracture surgery were categorized at 10-day interval, and analyzed in relation to 1-year mortality from the date of hospital discharge.
Results
A total of 4213 patients were discharged after hip fracture surgery, of whom 604 (14.3%) died within 1 year of discharge. The average length of stay was 30.7 days (standard deviation 24.5 days). The 1-year mortality was the highest for the length of stay ≤ 10 days group at 21.7%, followed by 15.2%, 14.3%, 13.3%, and 12.4% for > 40, 21–30, 31–40, and 11–20 days groups, respectively (
p
value 0.05). On Cox proportional hazard regression, the adjusted hazard ratio for length of stay ≤ 10 days group was 1.56 (95% confidence interval 1.14–2.12) against the reference group (11–20 days), while other groups did not show statistical significance. Higher risk of death was associated with increasing age, male gender, Charlson comorbidity index ≥3, subtrochanteric fracture, and discharge to tertiary care hospitals and long-term care hospitals.
Conclusion
Older adults discharged within 10 days of hospital admission for hip fracture surgery have higher 1-year mortality after discharge.
Two types of implants used for the surgical fixation of extracapsular hip fractures are cephalocondylic intramedullary nails, which are inserted into the femoral canal proximally to distally across ...the fracture, and extramedullary implants (e.g. the sliding hip screw).
To compare cephalocondylic intramedullary nails with extramedullary implants for extracapsular hip fractures in adults.
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (June 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 2), MEDLINE (1966 to June week 3 2007), EMBASE (1988 to 2007 Week 27), the UK National Research Register, orthopaedic journals, conference proceedings and reference lists of articles.
All randomised and quasi-randomised controlled trials comparing cephalocondylic nails with extramedullary implants for extracapsular hip fractures.
Both authors independently assessed trial quality and extracted data. Wherever appropriate, results were pooled.
Predominantly older people with mainly trochanteric fractures were treated in the 36 included trials.Twenty-two trials (3871 participants) compared the Gamma nail with the sliding hip screw (SHS). The Gamma nail was associated with an increased risk of operative and later fracture of the femur and an increased reoperation rate. There were no major differences between implants in the wound infection, mortality or medical complications.Five trials (623 participants) compared the intramedullary hip screw (IMHS) with the SHS. Fracture fixation complications were more common in the IMHS group; all cases of operative and later fracture of the femur occurred in this group. Results for post-operative complications, mortality and functional outcomes were similar in the two groups. Three trials (394 participants) showed no difference in fracture fixation complications, reoperation, wound infection and length of hospital stay for proximal femoral nail (PFN) compared with the SHS. Single trials compared the Targon PF nail versus SHS (60 participants); experimental mini-invasive static intramedullary nail versus SHS (60 participants); Kuntscher-Y nail versus SHS (230 participants); Gamma nail versus Medoff sliding plate (217 participants); and PFN versus Medoff sliding plate (203 participants). These trials provided insufficient evidence to establish differences between these implants. Two trials (65 participants with reverse and transverse fractures at the level of the lesser trochanter) found intramedullary nails (Gamma nail or PFN) were associated with better intra-operative results and fewer fracture fixation complications than extramedullary implants (a 90-degree blade plate or dynamic condylar screw) for these fractures.
Given the lower complication rate of the SHS in comparison with intramedullary nails, SHS appears superior for trochanteric fractures. Further studies are required to determine if different types of intramedullary nail produce similar results, or if intramedullary nails have advantages for selected fracture types (for example, subtrochanteric fractures).
Purpose
To compare the outcomes of type II pediatric phalangeal neck fractures (PPNFs) treated with closed reduction and cast immobilization (CRCI) versus closed reduction percutaneous pinning ...(CRPP), and evaluated the clinical efficacy of conservative versus surgical treatment of type II PPNFs via meta-analysis.
Methods
Patients aged ≤ 14 years with type II PPNFs were divided into conservative (CRCI) and operative (CRPP) groups. Radiographs measured angulation and translation; hand function was assessed with total active range of motion (TAM) and Quick-DASH. Complication rates were also compared between the groups. A meta-analysis of conservative versus operative treatment confirmed the clinical results. Statistical analysis was performed using SPSS 26.0 and R studio 3.0 with two-tailed, chi-squared, and Mann–Whitney
U
or
t
-tests,
P
< 0.05. Meta-analysis used fixed or random effects models, calculating mean differences and odds ratios for outcomes, and assessing heterogeneity with
I
2
and
Q
tests.
Results
Final angulation (3.4° ± 3.7° and 4.9° ± 5.4° vs. 3.6° ± 3.7° and 4.2° ± 4.3°) and displacement (6.3% ± 5.8% and 5.7% ± 4.7% vs. 5.8% ± 5.5% and 3.2% ± 4.2%) in the coronal and sagittal planes were not different statistically between the conservative and surgical groups (
P
> 0.05), but improved significantly compared to preoperative values (
P
< 0.05). Although Quick-DASH scores were comparable in both groups (
P
= 0.105), conservatively treated patients had a significantly better TAM at the last follow-up visit (
P
= 0.005). The complication rates were 24.2% and 41.7% in the surgical and conservatively treated groups respectively (
P
= 0.162). However, the latter primarily experienced imaging-related complications, whereas the former experienced functional complications (
P
= 0.046). Our meta-analysis (
n
= 181 patients) also showed comparable functional (
P
= 0.49) and radiographic (
P
= 0.59) outcomes and complication rates (
P
= 0.21) between the surgical (94 patients) and conservative (87 patients) groups.
Conclusions
Conservative and surgical treatments are both reliable and safe approaches for managing type II PPNF in children. However, conservatively treated patients generally experience similar radiographic outcomes, lower complication rates, and better functional outcomes than surgically treated ones.
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