The objective of this was to compare of traditional closedreduction and closedreduction in conjunction with osteotomy regarding patient satisfaction and complications. We performed a prospective randomized clinical trial of 80 patients with acute nasal bone fracture who underwent either traditional closedreduction (traditional CR) (n=38) or closedreduction (CR) in conjunction with osteotomy (n= 42). While patients in traditional CR group only underwent closedreduction, patients in CR in conjunction with osteotomy underwent closedreduction in conjunction with osteotomy for correcting the post reduction deformity. The study outcomes were complications, patient’s satisfaction and deformity at 4 months follow-up after intervention. The rates of complications was seen in 37% and 42% in traditional CR group and CR in conjunction with osteotomy group, respectively (P<0.03). Also, the proportion of patients with complete correction in CR in conjunction with osteotomy group and traditional CR were 69% and 52.6, respectively. The proportion of patient’s satisfaction from nose appearance in CR in conjunction with osteotomy group (35 of 42 patients (83.3%)) was significantly higher than traditional CR (24 of 38 patients (63.1%)) (P value=0.04).CR along with osteotomy is more effective than traditional CR regarding and patient’s satisfaction and corrected deformity. So, it could be used for some of patients to prevent secondary and more aggressive procedure like open septorhinoplasty.
Emergency internal fixation is one of the main options for the treatment of displaced femoral neck fractures . It contains open reduction internal fixation (ORIF) and closedreduction internal fixation (CRIF). Both of the two methods have their advantages and disadvantages . Although ORIF has advantages of direct look and restoration of normal function, its application still lim- ited by the potential negative effects of nerve damage, swelling, incomplete healing of the bone, increased pres- sure and blood clot . CRIF has advantages of avoiding injury to the medial circumflex femoral artery . How- ever, intracapsular pressure formed by CRIF compro- mised femoral head circulation, and prolonged extension and internal rotation position on the fracture table re- duced the blood supply to the femoral head, what’s more, the repeated forceful manipulation increased the risk of AVN . Thus, the optimal treatment of femoral
All patients presenting with midfacial trauma in the outpatient department of Oral and Maxillofacial surgery, Mayo hospital Lahore and fulfilling inclusion and exclusion criteria were included in the study after the approval of ethical committee. An informed consent was obtained from patient or patient’s guardian after explaining study protocol, use of data for research and risk benefit ratio. Patient's demographic data like age and gender were collected on a specially designed proforma. Patients were selected blindly via lottery method and divided into two groups. Group A, who underwent closedreduction method and group B, those treated with open reduction and fixation with mini plate osteosynthesis. All patients underwent surgical management within 1-5 days of presenting in the OPD. Paresthesia of every patient was checked by surgeon. It was determined by relief of initial complaint like tingling or numbness. Recovery was accessed by using a sterile dental needle in a quick prick fashion in sufficient intensity to be perceived by the patient. Appropriate response was perception of sharp pain and not just pressure. Follow up was done after 2 weeks, 4 weeks, 6 weeks, 12 weeks and a final evaluation was be made.
Certified that the dissertation on “Evaluation of Clinical and Functional outcome Of Open Reduction/ClosedReduction with Intra Medullary Interlocking Nailing and ‘Poller’ Blocking Screws in Tibial Metaphyseal Fractures” is a bonafide work done by Dr.K.SHANMUGANATHAN, Postgraduate, in the Department of Orthopaedic Surgery and Traumatology, Madurai Medical college. &Govt Rajaji Hospital, Madurai, under my guidance and supervision in fulfilment of the regulations of The Tamilnadu Dr. M. G. R. Medical University for the award of M.S. Degree Branch II (Orthopaedic Surgery) during the academic period of May 2010– April 2013
Abstract: Objective: To compare the efficacy of open reduction and internal fixation versus closedreduction and external fixation in treating distal radius fracture. Methods: A total of 77 patients with distal radius fracture were ret- rospectively analyzed. There were 40 patients in the open reduction and internal fixation group (observation group) and 37 patients in the closedreduction and external fixation group (control group). The fracture symptoms, healing time of fracture, postoperative evaluation of wrist function, disabilities of the arm, shoulder and hand (DASH) score and life quality for 3 months after operation were compared. Results: In terms of fracture symptoms, the patients in the observation group had better improvements in pain, swelling and ecchymosis over the patients in the control group. The differences were statistically significant (P<0.05). Healing time of the patients’ fracture in the observa- tion group was less than that of the patients in the control group (P<0.05). As for the recovery of wrist function, the observation group showed better recovery of the palmar tilt angle, ulnar deviation angle and radius height than the control group (P<0.05). What’s more, the excellent and good scores of DASH scale was higher in the observation group than in the control group (P<0.05). Lastly, with regard to postoperative life quality, physical function, physical role functioning, social functioning, emotional role functioning and bodily pain of the patients in the observation group were all significantly better than those of the patients in the control group (P<0.05). Conclusion: Open reduc- tion and internal fixation is better than closedreduction and external fixation in treating distal radius fracture. When treated by open reduction and internal fixation, patients with distal radius fracture have shorter healing time and good postoperative life quality. Therefore, it is worthwhile to popularize and apply open reduction and internal fixa- tion in clinical practice.
Background: The nasal bone is the most protruding bony structure of the facial bones. Nasal bone fracture is the most common facial bone fracture. The high rate of incidence of nasal bone fracture emphasizes the need for systematical investigation of epidemiology, surgical techniques, and complications after surgery. The objective of this study is to investigate the current trends in the treatment of nasal bone fractures and the effectiveness of closedreduction depending on the severity of the nasal bone fracture.
I declare that the dissertation entitled “ A COMPARATIVE ANALYSIS BETWEEN METHODS OF OPEN REDUCTION AND CLOSEDREDUCTION IN INTERNAL FIXATION OF PROXIMAL TIBIA FRACTURES” submitted by me for the degree of M.S is the record work carried out by me during the academic period of 2013 to 2016 under the guidance of Prof.A.PANDIASELVAN M.S.Ortho., D.Ortho., Institute of Orthopaedics and Traumatology, Madras Medical College, Chennai. This dissertation is submitted to the Tamilnadu Dr.M.G.R. Medical University, Chennai, in partial fulfillment of the University regulations for the award of degree of M.S.ORTHOPAEDICS (BRANCH-II) examination to be held in April 2016.
On functional analysis based upon Disability of Arm, Shoulder and Hand (DASH) scoring system the K wire fixation and casting group had lower mean scores compared with closedreduction and casting group both at nine (16.59 compared with 18.41 with p value 0.593) and at twelve weeks (17.24 compared with 17.76 with p value 0.877) indicating no significant difference in terms of functional outcome; though lower scores indicates better outcome considered on individual basis. At end of twelfth week post-intervention thirteen patients (76.87%) of K wire and casting group resumed to their regular work as compared to ten (58.82%) patients of closedreduction and casting group.
In the search for a less invasive alternative to open re- duction, arthroscopic reduction has been performed in several studies [12–15] to treat children with DDH. For example, McCarthy and MacEwen  reported the outcomes of three patients with hip dysplasia who received arthroscopic reduction 9 months after the pro- cedure. One patient developed residual dysplasia that required surgery. Eberhardt et al.  performed arthroscopic reduction on five very young infants and reported outcomes at a mean follow-up of 13.2 months. A later study by Eberhardt et al.  reported the expe- riences of nine walking-age children who received arthroscopic reduction and acetabuloplasty to treat dis- located hips with a mean follow-up of 15.4 months. However, patient outcomes after a longer time period remain unclear. To fill this research gap, our study assessed the medium-term outcomes of walking-age pa- tients who underwent arthroscopic reduction after an unsuccessful closedreduction.
the patients were treated surgically within 2 weeks of the injury (Fig. 1a). The operations were carried out with the patient in a modified beach-chair or supine position with the involved scapula positioned over the edge of the table. Under general anesthesia or nerve-blocking anesthesia, with fluoroscopic control, closedreduction was realized to obtain good fragment contact and alignment. Guide pins were inserted through the deltoid into the humerus towards the humeral head, or crossing from the greater tubercle to the distal fracture end.
Introduction: As the most anterior part of the face, the nose is more prone to trauma than other parts of the face, thereby making it the most common facial fracture site. Closedreduction has long been used as the standard treatment of the nasal fracture, which can be performed outpatiently or inpatiently. Bleeding due to the fracture can be minimized by adopting certain strategies before the realignment of the nasal fracture. One of these strategies is to use phenylephrine spray before surgery. This study aimed to evaluate the effect of phenylephrine spray in closedreduction of nasal fractures.
The majority of authors approximate Lisfranc fracture-dislocations by ORIF with many opting for an open approach following failed closed attempts [4,6,9,11,14,16-18,20]. Abdelgaid et al are among those with unsuccessful attempts who, consequently, have rested on recommendations from Denton et al (1980), proposing that Lisfranc fracture dislocations are irreducible by closed means alone and require open reduction . P.H. Hardcastle et al. suggest that, whenever possible, closedreduction should be attempted, and that the only absolute indication for ORIF is pre-operative vascular insufficiency not improved after closedreduction. We have demonstrated that closedreduction techniques are effective in reducing
tudinal traction, aid fractured fragment align- ment and help restore length and normal anat- omy during fracture management procedures. Comparisons of the different management te- chniques for femoral fractures have been re- ported [3-5]. However, few comparisons of traction bed assisted closedreduction (CR) and OR during intramedullary nailing of femo- ral fractures have been reported. This retro- spective study compared specific operation processes and patient outcomes associated with these techniques.
traction and reduction of the femoral shaft fracture in the side-lying position under C-arm fluoroscopy usually require a repeated operation for completion, and a lon- ger time of fluoroscopy during the operation was also re- quired. Meanwhile, physicians and nurses, as well as patients, would be exposed to the radiation of the X-ray from the C-arm for longer periods, which could lead to potential radiation injury [20–22]. However, the applica- tion of the reduction brace designed in the present study can temporarily maintain the stability of the reduced broken end of the fracture. Furthermore, physicians can enable the reduction while avoiding X-ray irradiation and saving manpower. The indications were for those young, muscular, and even overfat patients who undergo closedreduction with malposition and anterior-posterior motion. The contraindications were patients combined with already known nerve, vessel injury. The complica- tion for our device so far was unknown, perhaps the number of patients using such devices was limited.
We conclude that percutaneous Kirschner wire pinning is a minimally invasive technique that provides an effec- tive means of maintaining anatomical fracture reduction. It does not require highly skilled personnel or sophis- ticated tools for application. It is a suitable method for fixation of Colles’ fracture. Kirschner wire and cast stands an upper hand over the closedreduction and cast for Colles’ fractures with respect to the near anatomical restoration of the radial height, radial inclination, and ulnar angle.
combination of propofol and fentanyl (PF), the complications of this compound are considerable (7). First, fentanyl may exacerbate the drop in blood pressure after propofol consumption. Second, the adverse effects of propofol on the cardiovascular system may be intensified by the addition of fentanyl (8, 9). Third, the compound KP may be more suitable and might lead to more pain relief and less post-reduction respiratory suppression in comparison with PF. Nonetheless, there is little evidence on the clinical and hemodynamic benefits of KP in comparison with PF after procedures. The present study was conducted to compare KF and PF compounds in the PSA of patients undergoing closedreduction in EDs.
1994; Hogstrom et al., 1976; Hove and Brudvik, 2008; Hughston, 1962; Khosla et al., 2003; Landin, 1997; Malviya et al., 2007; Mani et al., 1993; Milleret al., 2005; Mostafa et al., 2009; Nilsson and Obrant, 1977). Fixation with percutaneous Kirschner wire (K-wire) is recommended in patients who carry high risk of reduction loss after clesed treatment in order to prevent forearm rotation loss(Gibbons et al., 1994; Hogstrom et al., 1976; Hove and Brudvik, 2008; Hughston, 1962; Khosla et al., 2003; Landin, 1997; Malviya et al., 2007; Mani et al., 1993; Miller et al., 2005; Mostafa et al., 2009; Nilsson and Obrant, 1977; Noonan and Price, 1998; Prevotet al., 1997; Proctor et al., 1993; Khosla et al., 2003; Landin, 1997; Malviya et al., 2007; Mani et al., 1993; Miller et al., 2005; Mostafa et al., 2009; Nilsson and Obrant, 1977; Noonan and Price, 1998; Prevot et al., 1997; Proctor et al., 1993; Roberts, 1986; Rodrı´guez-Mercha, 2005). Noonan et al. (1998) estimated that in children under the age of 9 years, complete displacement with 15degreee angulation and 45 degree malrotation is accepted, and in children over 9 years, 301degree malrotation and 15degree angulation in distal fractures is accepted.Fracture healing is quick after reduction and casting alone, and the fractures have an excellent capacity to spontaneously correct residual axial deformities during the growing years (Rodrı´guez-Mercha, 2005; Zamzam and Khoshhal, 2005). Nevertheless, several studies have shown that complete remodeling does not always occur; this is especially true in children who are older than 10 years (Hove and Brudvik, 2008).However, redisplacement after closedreduction is well described in the literature as the most common complication, observed in up to 25% of the cases after reduction and casting (Zamzam and Khoshhal, 2005; Voto et al., 1990; Proctor et al., 1993); some studies
Results: There were 15 girls and 9 boys with ages ranging from 1.5 to 12 years and an average age of 7.2 years. Percutaneous K-wire leverage reduction and intramedullary pinning were successfully used in an average total surgery time of 35 mins (range 15 – 80 min). In total, 2 cases (O ’ Brien type III and Judet type IVb, angulation = 90°) needed the additional maneuver. Bone union was achieved in all patients within a mean time of 4.2 weeks. The clinical results were evaluated basing on the Mayo elbow performance score, and there were 23 excellent results and one good result. There were no refractures and no incidences of nonunion, suture infection, iatrogenic radial nerve injury, asymptomatic enlargements of the radial head or growth arrest in the proximal radial epiphysis. Conclusion: Our modified percutaneous leverage technique with radial intramedullary fixation may be successfully used to avoid open reduction.
simple, minimally invasive technique to maintain the reduction in extra and intra articular fractures. Clinical guidelines from the American Academy of Orthopaedic Surgeons (AAOS) moderately recommend an anatomically stable surgical fixation, instead of cast fixation, to be followed by early wrist motion for treatment of patients with displaced distal radius fractures. 4 Radial length is a radiological parameter that
Conservative management as a treatment modality is well accepted in mandibular condylar fractures . Con- servative treatment in cases of mandibular body fractures has been reported in children in early childhood age, [7-12] and in adults with atrophic edentulous mandible [13-15]. In some reports, closedreduction with IMF was