Amongst other things, the study recorded the median time to union and the number of days in hospital for both compound (open) and closed fractures. The details presented about the costing methodology are insufficient to allow detailed comments here. Although Shaw et al. 4 make a good attempt to describe the costing methodology, the figures are not presented in any depth. There would appear to be some confusion over the concept of fixed and variable costs given that the authors describe implants as fixed costs when they are clearly a variable component. Costs for first and second admissions have both been calculated at an average £120 per day (irrespective of whether the re-admission was for complications or for removal of implants). No sensitivities around these figures were presented in the paper. The results of the costing exercise were a cost per patient of £1,686 for the external fixator compared with £2,358 for nailing, and £2,022 and £3,412 for the two studies looking at plating. The results imply the relative cost-effectiveness of external fixation compared with the various forms of internalfixation. These results are dominated by the length of hospital stay costs and, as such, highlight the need for more precise attempts to model the marginal costs for hospital stays.
It should be noted that a novel Ni-Ti alloy (the ASC) was used for limited internalfixation in our study. In the past decade, ASCs have been increasingly used in the clin- ical treatment of various musculoskeletal diseases due to their excellent wear and corrosion resistance, good bio- compatibility, and shape memory effect [19 – 22]. Accord- ing to our study, we believe that this connector is also a practical internal apparatus for treating open tibial shaft fractures. It can be used in conditions that are not suitable to be enhanced with cortical screws, including transverse fractures, fragments without the enough opposite cortex, and friable fragments under twisting force. Furthermore, this connector is much more flexible, which helps find the proper placement position for sufficient soft tissue cover- age, as well as for procedures in narrow spaces, without additional damage to surrounding tissues. In addition, due to the inherent property of the shape memory alloy, the compression arms in the device provide sustained axial compression forces that can be transmitted across the fracture site to accelerate fracture healing [19 – 22, 28].
complications, including structural injuries on other elbow joints, such as coronoid process fracture compli- cated with fracture of the capitulum radii and elbow joint dislocation (terrible triad of the elbow) or coronoid pro- cess fracture complicated with fracture of the capitulum radii and olecranon fracture. Type II coronoid process fractures were replaced via hand under direct vision and were temporarily fixed with towel forceps or Kirschner needles. A 2-mm-diameter (1–3) lag screw was used to fix and repair the anterior capsule from front to back or back to front. Type III fractures were fixed with Kirsch- ner needles, or the anterior capsule was repaired with non-absorbable sutures. The radial head was resected for patients with comminuted fractures, compression fractures, severe articular cartilage injuries, or combined radial neck fractures for those who were not capable of reposition and fixation. If the elbow joint was still unsta- ble, the lateral collateral ligament was repaired. Three dif- ferent types of internalfixation methods were performed using the screw plate fixation method. The repair of the anterior bundle of the ulnar collateral ligament was explored during the operation. After the completion of the operation with perspective observation, the incision was sutured layer by layer, and a drain was placed in the wound. The elbow was held in place with a plaster cast for 2 weeks following operation. The patient’s vital signs were monitored, and routine anti-infection therapy was performed after the operation. After 48 h, passive flexion and extension of the elbow joint were performed with the guidance of doctors, and the activities of the active wrists and fingers were assessed. The wound was disassembled 14 days after operation.
This is to certify that Dr.E.R.MITHUN, post graduate student (2008-2011) in the Department of Orthopedic Surgery, Government Royapettah Hospital/ Kilpauk Medical College , has done dissertation on ‘‘COMPARISION OF FUNCTIONAL AND COSMETIC OUTCOME OF SUPRACONDYLAR FRACTURES IN CHILDREN TREATED BY PERCUTANEOUS PINNING AND OPEN REDUCTION AND INTERNALFIXATION WITH K- WIRES’’ under my guidance and supervision in partial fulfillment of the regulation laid down by the ‘THE TAMILNADU DR MGR MEDICAL UNIVERSITY, CHENNAI -32’ for M.S.(Orthopaedic Surgery) degree examination to be held in April 2011.
Abstract- Background: 75% of calcaneal fractures are intra articular. Treating calcaneal fractures is a challenge for orthopaedic surgeon due to the complex fracture pathology. A wide range of treatment options varying from non operative to operative methods are available. The purpose of this study is to assess the functional outcome of conservatively treated and operatively managed intra articular calcaneal fractures. Methods: 24 intra articular fractures have been classified as per Computerized Tomography based Sanders system.12 fractures were treated conservatively.12 fractures were treated with open reduction and internalfixation with plating. . Functional outcome was assessed using Modified Rowe score after following the cases over mean period of 18 months. Results: In conservatively managed 12 fractures, average functional outcome score was good in 7 Sanders Type-I fractures, average functional outcome score was satisfactory in 3 Sanders Type –II fractures and was poor in 2 Type-III Sanders fractures.. In fractures fixed with open reduction and internalfixation with plating, average functional outcome score was excellent in7 Sanders Type-II fractures and good in 5 Sanders Type-III fractures.
The present study showed that internalfixation with mini plate and hollow screw had shorter average operation time, lower average blood loss, and less postoperative pain than internalfixation with Kirschner wire and steel wire suture while treating Regan-Morrey type II and III ulna coronoid fractures. A recent study showed that mini-locking plate fixation could be employed to treat Regan-Morrey type III coronoid fractures through elbow anterior approach, for satisfactory outcomes . Another study also dem- onstrated that an anterior approach is effective for in- ternal fixation of ulnar coronoid fractures because of minimal surgical dissection damage and clear visualization of ulnar coronoid fractures for reduction and internal fix- ation . Moreover, among numerous surgical treatment techniques, mini plate and screw are superior options as they can stipulate rigid fixation important for progressive bone healing and early active finger motion . In line with our study, Hanks et al. also confirmed that internal
During the study period there were 41 patients treated for infection following internalfixation of closed fractures of long bones. However, only 30 patients fulfill the inclusion criteria (Table I). The youngest patient was 14 years of age and the oldest was 64 years. The mean and median ages of the patients were 29.5 and 21.0 years respectively. There were 28 males and 2 females with 28 Malays and 2 Chinese.
This is to certify that Dr.TRIVENI.P, Post Graduate student (2014-2017) in the Department of Oral and Maxillofacial Surgery, Tamil Nadu Government Dental College and Hospital, Chennai-600003, has done dissertation titled “EVALUATION OF 3 DIMENSIONAL PLATES IN OPEN REDUCTION AND INTERNALFIXATION OF SUBCONDYLAR FRACTURES” under our direct guidance and supervision in partial fulfillment of the regulation laid down by The Tamilnadu Dr. M.G.R. Medical University, Guindy, Chennai-32 for Master of Dental Surgery, Oral and Maxillofacial Surgery (Branch III) Degree Examination.
This is to certify that this dissertation entitled “Prospective study on the OUTCOME ANANLYSIS OF INTERNALFIXATION OF PROXIMAL HUMERUS FRACTURES.” submitted by Dr.R.ANAND KUMAR appearing for Part II, M.S. Branch II - Orthopaedics degree examination in april 2011 is a bonafide record of work done by him under my direct guidance and supervision in partial fulfilment of regulations of The Tamil Nadu Dr. M.G.R. Medical University, Chennai.
Sander’s classification system was used to study fracture patterns. Sander’s type IIB was the most common fracture pattern. Sander’s type II fractures included 63.63% of the patients while as 36.36% of the fractures were Sander’s type III. All the patients were managed with open reduction and internalfixation using calcaneum plating through an extensile lateral approach. The patients were operated once the wrinkle sign appeared. The average waiting time for surgery, from the time of injury to surgery, was 7.35 days. The average operative time was 82.32 minutes. The mean fracture
The primary goals of the surgical management of tibial plateau fractures are the anatomical reduction and fix- ation of the articular fracture and the proper treatment of associated intra-articular lesions to achieve early mobilization and reduce the risk of stiffness, instability, and post-traumatic osteoarthritis of the knee . These objectives were traditionally pursued through open re- duction and internalfixation with plate and screws, but the last decades’ literature has shown the effectiveness of the arthroscopically assisted treatment [12–18]. Our study aimed to compare the clinical and radiological re- sults of ARIF and ORIF techniques used for Schatzker type I–III fractures in two different groups of patients.
The article titled mini open approach for open reduction and internalfixation of radial head fractures, describes a technique which is different from the traditional Kocher’s approach used for this procedure. The technique involves an incision <5cm and minimises the dissection of the lateral collateral ligament of the elbow and the annular ligament is not divided, thus preserving the stability of the elbow.
Methods: From July 2010 to July 2014, 20 consecutive patients who underwent open reduction and internalfixation for a closed Mason type II radial head fracture were retrospectively reviewed. Patients with Mason type I, III, simple type II, and comminuted type II fractures treated without bone grafting were excluded. A clinical examination and radiographic evaluation were performed. The overall functional result was evaluated using the Mayo Elbow Performance Score (MEPS). The Broberg and Morrey classification was used to evaluate traumatic arthritis. Results: The average follow-up duration was 31 months (range, 24 – 50 months). Bone union of the radial head fracture was achieved in all patients at an average of 13.5 weeks (range, 12 – 17 weeks). Postoperative radiographs showed no cases of postsurgical ligamentous instability, necrosis of the radial head, or internalfixation failure. The mean range of motion of the affected elbow was 128° ± 8.4° in flexion, 14.5° ± 11.1° in extension, 68.7° ± 14.1° in pronation, and 65.2° ± 18.2° in supination. The mean MEPS was 92 ± 7.9 points (range, 80 – 100); the outcome was excellent (90 – 100 points) in 13 patients and good (75 – 89 points) in 7 patients. The MEPS tended to be higher in patients with an isolated fracture ( p = 0.016). Based on the Broberg and Morrey classification for radiographic assessment of post-traumatic arthritis, 15 elbows had no evidence of degenerative changes (grade 0), and 5 elbows had grade 1 changes.
Background: The use of minimally invasive plate osteosynthesis (MIPO) via anterolateral deltoid splitting has good outcomes in the management of proximal humerus fractures. While using this approach has several advantages, including minimal soft tissue disruption, preservation of natural biology and minimal blood loss, there is an increased risk for axillary nerve damage. This study compared the advantages and clinical and radiological outcomes of MIPO or open reduction and internalfixation (ORIF) in patients with proximal humerus fractures. Methods: A matched-pair analysis was performed, and patient groups were matched according to age (±3 years), sex and fracture type. Forty-three pairs of patients (average age: MIPO, 63 and ORIF, 61) with a minimum follow-up of 12 months were enrolled in the study group. The patients were investigated radiographically and clinically using the Constant score.
unstable fracture patterns. Deneka et al. reported that a sliding hip screw with a de-rotation screw provides superior outcomes for unstable fractures, compared to parallel cancellous screws . In contrast, Clark et al. did not detect any difference between cases of subcapital fractures that were treated using a sliding hip screw or three cancellous screws in a triangular configuration . A more recent study revealed inconclusive results regarding the “gold standard” of internalfixation for displaced FNFs, and the authors noted that fixation strength did not appear to be affected by subcapital or transervical patterns for the parallel cancellous screws or the sliding hip screw . In the present study, all patients received parallel cancellous screws, and none received sliding hip screws. Nevertheless, we observed an extremely high complication rate for Pauwels’ type III fractures (16/17, 94.2%), even when acceptable reduction was achieved. The choice of the implant device depends on multiple factors and is not always clear; however, in hindsight, sliding hip screws and an additional de-rotation may provide more biomechanical stability to overcome vertical shearing force.
patients gave informed consent to be enrolled. From January 2001 to April 2006, 54 patients with displaced proximal humeral fractures (44 females and 10 males, mean 66 years old (range 39–89), 24 right and 30 left side) were treated by open reduction and internalfixation (Table 1). The mechanisms of injury included 39 pedes- trian stumbles, 5 automobile clashes, 4 severe falls, 3 bicycle accidents and 3 pedestrian-versus-automobile impacts. A fracture was considered to be displaced if the fracture fragment had a displacement more than 1 cm or an angulation more than 45° in at least one view of the trauma-series radiographs . On radiographs and com- puted tomography, the fractures were classified using the Neer system ; 29 were 2-part surgical neck fractures, 22 were 3-part fractures and 3 were 4-part fractures. The time between injury and surgery averaged 9 days (range, 2–28 days). The proximal humeral fracture with poor bone stock, non-union, and fracture-dislocation of the glenohu- meral joint were contraindicated for this study.
It is important that a distance of roughly 2 cm is kept be- tween the bone and screw head in order to avoid later ves- sel compression following introduction of the transfixation rod (Figure 8). The flexible test rod is used to define the desired length of the Longitude rod. For easier fixation, the rod is mounted to the Longitude rod holder before bend- ing the rod. Bending instruments are used to mould the rod accordingly (Figure 9). The rod is inserted through one of the supra-acetabular incisions and gently advanced in the subcutaneous layer (Figure 10). The risk of rod mal- positioning can be minimized as correct rod advancement is ensured by placing one hand on the patient’s abdominal wall for palpation. When the rod has reached the contra- lateral side, it can be grasped with the rod grasping forceps and is then guided through the hole in the iliac screw. Correct rod positioning is then verified and documented fluoroscopically and femoral as well as epifascial vessels are checked for any possible compression with a sterile Doppler ultrasound device [18,19].
In two recent reviews, Clement and Gosler et al. dem- onstrated a deficiency in the current literature of level one evidence for the treatment of humeral shaft frac- tures [3, 5]. Papasoulis et al. reviewed the available litera- ture in 2010 and stated that the union rate ranged from 77 to 100% and good functional results were achieved after the nonsurgical treatment of humeral shaft frac- tures [24–26]. Nevertheless, a recent prospective ran- domized trial, published by Matsunaga et al. in 2017, provided level one evidence comparing functional bra- cing and bridge plating for humeral shaft fractures and showed that nonsurgical treatment was associated with a significantly higher rate of nonunion and angular dis- placement (anteroposterior) than bridge plating . According to the current literature, there is no strong evidence to support the use of ORIF or minimally inva- sive procedures (MIPO) for primary fracture treatment. Xuqi Hu et al. presented the results of a systematic review and meta-analysis of eight studies, including four
Fracture was reduced and alignment was checked under fluoroscopy. Fracture fixed along intercuneiform, medial cuneiform to base of 2nd metatarsal and base of 1 st metatarsal to medial cuneiform with 3.5mm cortical/cancellous screws after stabilizing using 1.8 mm Kwires. The 3rd, 4th and 5th TMT joints assessed under fluoroscope and if found to be unstable stabilized with 1.8mm Kwires percutaneously or through another longitudinal incision along the 4th metatarsal. Fixation checked under fluroscope in anteroposterior, lateral and oblique views. After attaining hemostasis, a good washing was given with sterile normal saline. Skin closed in layers. Dressings given. Limb immobilized in below knee plaster slab with lower limb elevation. Length of incision, amount of blood lost, operation time and intraoperative findings were recorded.
Among various classification systems, the AO classification system is the most suitable one because it reflects the severity of the fracture and helps the surgeon and the patient to know the possible outcomes. The use of an external fixator alone or in conjunction with percutaneous or limited internalfixation, for unstable fractures of the distal end of the radius has produced good or excellent results. We attribute to these good or excellent results to the early removal of the fixator that allows early range-of-motion exercises and to avoid complications commonly associated with the prolonged use of external fixators.