Top PDF Functional outcome of communited intra articular distal radius fractures managed by fragment specific fracture fixation: A Prospective study.

Functional outcome of communited intra articular distal radius fractures managed by fragment specific fracture fixation: A Prospective study.

Functional outcome of communited intra articular distal radius fractures managed by fragment specific fracture fixation: A Prospective study.

This is to certify that this dissertation entitled ‘FUNCTIONAL OUTCOME OF COMMUNITED INTRA ARTICULAR DISTAL RADIUS FRACTURES MANAGED BY FRAGMENT SPECIFIC FRACTURE FIXATION’ is a record of bonafide research work done by Dr. M.NIRMAL, post graduate student under my guidance and supervision in fulfilment of 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 from 2014 to 2017, in the Department of Orthopaedics, Govt. Kilpauk Medical College, Kilpauk, Chennai-600010
Show more

101 Read more

Functional outcome of intra-articular fractures of distal radius using external fixator: A long term study

Functional outcome of intra-articular fractures of distal radius using external fixator: A long term study

This study was conducted in Government Hospital for Bone and Joint Surgery, Postgraduate Department of Orthopaedics, Government Medical College, Srinagar Kashmir from September 2013 to august 2016. The study was approved by the College Research Ethics Committee. This prospective randomized observational study consisted 30 cases who underwent ligmentotaxis with external fixation. Patients included in the study were adults (Age 20 – 60), patient with intra articular fractures of distal end of radius (AO Type B/C), all closed and Grade I (Gustillo and Anderson) compound fractures and presenting within 72 hours of injury. Patients with Grade II and III open fracture distal radius, pathological fractures, rheumatoid arthritis, concomitant injuries of same limb, bilateral distal end radius fractures and neurovascular injuries were excluded. The specific radiographic criterion for considering closed reduction as acceptable was more than a 2- mm step-off of the distal articular surface of the radius, The fractures were assessed preoperatively by wrist radiographs (PA and
Show more

7 Read more

Mid-term functional outcome after the internal fixation of distal radius fractures

Mid-term functional outcome after the internal fixation of distal radius fractures

Many studies reviewing various methods of fixation look at radiographic parameters that affect outcome, however few if any have looked at surgeon grade or time to surgery as we have. In a large radiographic study, Mackenney et al. showed that age over 80 years; metaphyseal comminution and positive ulna variance were the main predictors of instability. This and poor radio-carpal alignment were shown to be associated with poor outcome [7]. However this study did not look at results after fixation with a volar locking plate, which has specific design applications for use in osteo- porotic unstable fracture patterns. We chose not to assess radiographic parameters such as residual intra- articular step, correction of normal distal radial anat- omy and presence of post traumatic osteoarthritis as we were interested purely in patient centered outcome and these radiographic features have consistently been Table 3 Time to Fracture Union with varying fracture type
Show more

8 Read more

Functional recovery after treatment of extra articular distal radius fractures in the elderly using the IlluminOss® System (IO Wrist); a multicenter prospective observational study

Functional recovery after treatment of extra articular distal radius fractures in the elderly using the IlluminOss® System (IO Wrist); a multicenter prospective observational study

Background: Approximately 17 % of all fractures involve the distal radius. Two-thirds require reduction due to displacement. High redislocation rates and functional disability remain a significant problem after non-operative treatment, with up to 30 % of patients suffering long-term functional restrictions. Whether operative correction is superior to non-operative treatment with respect to functional outcome has not unequivocally been confirmed. The IlluminOss® System was introduced in 2009 as a novel, patient-specific, and minimally invasive intramedullary fracture fixation. This minimally invasive technique has a much lower risk of iatrogenic soft tissue complications. Because IlluminOss® allows for early mobilization, it may theoretically lead to earlier functional recovery and ADL independence than non-operative immobilization. The main aim of this study is to examine outcome in elderly patients who sustained a unilateral, displaced, extra-articular distal radius fracture that was treated with IlluminOss®. Methods/design: The design of the study will be a multicenter, prospective, observational study (case series). The study population comprises elderly (60 years or older; independent in activities of daily living) with a unilateral, displaced, extra-articular distal radius fracture (AO/OTA type 23-A2 and A3) that after successful closed reduction was fixed within 2 weeks after the injury with IlluminOss®. Critical elements of treatment will be registered, and outcome will be monitored until 1 year after surgery. The Disabilities of the Arm, Shoulder, and Hand score will serve as primary outcome measure. The Patient-Rated Wrist Evaluation score, level of pain, health-related quality of life (Short Form-36 and EuroQoL-5D), time to ADL independence, time to activities/work resumption, range of motion of the wrist, radiological outcome, and complications are secondary outcome measures. Health care consumption and lost productivity will be used for a cost analysis. The cost analysis will be performed from a societal perspective. Descriptive data will be reported.
Show more

9 Read more

Functional Outcome of Distal Radius Fractures Managed by Barzullah Working Classification

Functional Outcome of Distal Radius Fractures Managed by Barzullah Working Classification

From casting to arthroscopic assisted reduction, all treatment modalities have been tried. Sir Abraham Col- les first described the deformities of distal end radius fractures many years before the advent of X-rays. Since then, a lot of modifications in the management of DRF have taken places, which include closed reduction with casting, percutaneous pinning, intrafocal pinning, external fixation with ligamentotaxis, minimal open to open reduction and internal fixation with various modern gadgets. Even the fragment specific fracture fixation has been tried with good results. Karimi et al. in his study has shown good results in torus fractures in patients less than 17 years of age using removable wrist splint. He, however, studied only the patients of less than 17 (16).Bahari-Kashani et al. (2003) studied the intra-articular distal end radius fractures managed by pin and plaster or plating. They concluded that func- tional scoring, radiological indices, grip strength, and supination pronation were better in the plating group (17). Mardani et al. compared the closed reduction with long-arm cast to closed reduction with PCP and found the latter as better option in terms of finger stiffness, but found some pin tract infections, which resolved un- eventfully (18).
Show more

6 Read more

External fixation versus volar locking plate for displaced intra-articular distal radius fractures: a prospective randomized comparative study of the functional outcomes

External fixation versus volar locking plate for displaced intra-articular distal radius fractures: a prospective randomized comparative study of the functional outcomes

Fractures of the distal radius are common [1–3]. The increasing incidence of these injuries may be attributed to an aging population (osteoporotic fractures) and the growing participation in outdoor pursuits (higher energy fractures) [4, 5]. Whereas a large number of these fractures are managed non-operatively, the number of patients who undergo surgical management is considerable. Over the past 30 years, the surgical treatment of distal radius frac- ture has shifted from cast immobilization to numerous surgical options such as the use of external fixation and volar locking plates [6–9]. There are distinctive differences in these two surgical techniques and postoperative reha- bilitation protocols. Previously some authors have com- pared volar locked plating with external fixation, but there is still insufficient evidence regarding which gives the best outcome [10–14].
Show more

6 Read more

Assessment of a novel biomechanical fracture model for distal radius fractures

Assessment of a novel biomechanical fracture model for distal radius fractures

Several limitations of the study must be discussed. First, although the fracture model proposed here more closely resembles the in vivo situation, distal radius frac- tures can theoretically take on near infinite patterns. Still, as stated above, the distal fracture line was found to be well-defined and independent of fracture complex- ity, energy of the fall or age [19]. Therefore the authors believe this model to be representative of the majority of AO-23-A3 fractures. Second, the specimens were tested only in axial loading using a rapidly increasing cyclic loading protocol. The influence of other bending models (i.e. torsion, eccentric bending, combined axial compres- sion and bending, etc.) and actual fatigue testing might provide additional information on the anchorage of the screws in the distal bone stock. However, dehydration of the specimens during long-term cyclic testing might affect the outcome. Third, specimen exposure time is a possibly limiting factor for any biomechanical test using fresh-frozen cadaveric bones. In this study, total expos- ure time for each specimen was below 24 h and the standardized preparation and testing protocol ensured a similar thawing-to-testing timing. Both parameters where shown to affect bone properties significantly [22]. Fourth, displacement was measured as actuator displace- ment, which must not necessarily reflect actual fragment displacement. As bending of the radius shaft was mini- mized by a short uncovered shaft, the authors believe actuator displacement to be sufficiently accurate. Fifth, force-displacement curves of three pairs showed no sig- nificant difference between the two fracture models. This was most probably due to early failure of the new osteotomy group specimens.
Show more

7 Read more

Outcomes and financial implications of intra-articular distal radius fractures: a comparative study of open reduction internal fixation (ORIF) with volar locking plates versus nonoperative management

Outcomes and financial implications of intra-articular distal radius fractures: a comparative study of open reduction internal fixation (ORIF) with volar locking plates versus nonoperative management

Fractures of the distal radius are among the most common orthopaedic injuries, and impose a significant financial burden on healthcare [1]. However, given the prevalence of distal radius fractures, controversy remains concerning the best management. Although several surgical options are available, including percutaneous pinning, external fixa- tion, open reduction internal fixation (ORIF) techniques, intramedullary fixation, as well as arthroscopic assisted reduction and fixation, the 2009 American Academy of Orthopaedic Surgeons (AAOS) clinical practice guideline (CPG) was unable to recommend for or against any one specific surgical method [2]. Despite this lack of consensus, ORIF of distal radius fractures has become increasingly popular in recent years, particularly in relation to the use of volar locking plates [3–5]. With the rise in cost-con- sciousness in our healthcare system, it is important to
Show more

6 Read more

Prospective Study of Distal End Radius Fracture Volar Type Treated with Open Reduction Internal Fixation with Plating

Prospective Study of Distal End Radius Fracture Volar Type Treated with Open Reduction Internal Fixation with Plating

Out of 25 patients, 16 (64%) were males and 9 (36%) were females. The youngest patient in the series was of 21 years and the oldest was of 83 years. In this study 60% of the total patient had a fracture involving their right hand (dominant). Majority of the injuries (48%) were due to fall on outstretched hand, followed by those due to road traffic accident (44%), and the remaining (8%) due to fall from the height. Out of the 25 patients maximum number of patients (12) had been classified in B3.2 by the AO classification. Maximum number of patients stayed for duration of 1 to 3 days in the hospital i.e. 16 out of 25 patients. The average results of move- ments after 8 months in the present study were 68.4° palmar flexion, 70.2° dorsiflexion, 18.6° radial devi- ation, 32° ulnar deviation, 74.2° pronation and 76.6° supination (Table 2). The complications observed were postoperative stiffness in 2 (8%) patients and regional pain syndrome in 1 (4%) patient. Union occurred in all cases.
Show more

5 Read more

Study of Functional Outcome in Calcaneal Fractures, Managed Conservatively and Open Reduction and Internal Fixation with Plate

Study of Functional Outcome in Calcaneal Fractures, Managed Conservatively and Open Reduction and Internal Fixation with Plate

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 internal fixation 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 internal fixation with plating, average functional outcome score was excellent in7 Sanders Type-II fractures and good in 5 Sanders Type-III fractures.
Show more

7 Read more

Internal plate fixation versus plaster in displaced complete articular distal radius fractures, a randomised controlled trial

Internal plate fixation versus plaster in displaced complete articular distal radius fractures, a randomised controlled trial

The goal of open reduction and plate fixation is to re- store articular congruity and axial alignment to prevent post-traumatic osteoarthritis. Additionally, open reduc- tion and plate fixation allows for early mobilisation and may theoretically lead to a more rapid recovery and bet- ter functional outcome [13, 14]. Especially in the young and working population, but also in the elderly patients, this could be an advantage. Moreover, redisplacement rates up to almost 60 % are encountered in patients treated with closed reduction and plaster immobilisation, especially in those with type C fractures [15–19]. How- ever, with nonsurgical treatment the standard risks for undergoing a surgical procedure and the risk of hard- ware removal, tendon rupture and neurovascular dam- age are avoided. Moreover, we know that especially patients over 65 years of age have a lower disutility for painful malunion [20]. Though, plaster immobilisation is not without risks either. Pressure neuropathy of the superficial radial nerve, Complex Regional Pain Syn- drome and stiffness of the wrist can occur.
Show more

8 Read more

Bohler’s angle’s role in assessing the injury severity and functional outcome of internal fixation for displaced intra-articular calcaneal fractures: a retrospective study

Bohler’s angle’s role in assessing the injury severity and functional outcome of internal fixation for displaced intra-articular calcaneal fractures: a retrospective study

As described in previous reports [15,16], this mini- mally invasive procedure started with transverse in- sertion of one or two Steinmann pins into calcaneal tuberosity, followed by distraction of pins to restore primarily the length and height of the calcaneus. An- other one or two Steinmann pins were introduced for- ward across the fracture line for repeated percutaneous leverage to reduce the articular surface and the height of the calcaneus, which can help restore Böhler angle to normal range. If satisfactory reduction was obtained, the Steinmann pins were drilled forward to the ante- rior part of calcaneus for provisional fixation. Then, a 3.5-cm longitudinal incision was made on the posterior part of lateral hindfoot, and a subcutaneous tunnel was created with a periosteal elevator. The anatomical plate of appropriate size was inserted into the tunnel, and then fixed with two to four (usually three) compression bolts under intraoperative fluoroscopic control. The nut was tightened on each screw, and integrated with the anatomical plate as a whole, which produced tre- mendous compressive force to reduce the width and height of the calcaneus to the utmost extent. The distal part of the compression bolt was broken off at the constricted area. In cases of severe collapse, or dis- placed, involving the center of articular surface, a small lateral incision through the sinus tarsal could be made to get direct access to the articular surface for an anatomical reduction. Sometimes, additional cancel- lous screws were used to secure the multi-fragment fractures.
Show more

8 Read more

Operative Treatment of Intra Articular Distal Radius Fractures With versus Without Arthroscopy: study protocol for a randomised controlled trial

Operative Treatment of Intra Articular Distal Radius Fractures With versus Without Arthroscopy: study protocol for a randomised controlled trial

During wrist arthroscopy, the forearm will be positioned upright and in neutral position, the elbow flexed by 90° and axial traction of 4–6 kg will be performed. Four portals are created dorsally by superficial stab incisions and blunt prep- aration through the joint capsule; one midcarpal radial (MCR) and ulnar (MCU) portal and one radiocarpal 3-4 and 6-R portal (Fig. 1). Portals may be changed to improve visualisation. A shaver or mini grasper is used for removal of fracture haematoma and osteocartilaginous debris. Car- tilage damage will be graded using the Outerbridge classifi- cation system [22] (Additional file 3). With the 1-mm hook probe, assessment of the quality of reduction and ligament- ous injuries will be performed. Step-off and gaps will be measured with a calibrated 1-mm probe at the point of maximum displacement and recorded. The trampoline and hook test are performed to demonstrate a triangular fibro- cartilage complex (TFCC) tear. TFCC tears will be classi- fied according to Palmer [23] (Additional file 4). All scapholunate ligament injuries will be noted and graded ac- cording to the Geissler classification [11] (Additional file 5).
Show more

8 Read more

Functional Outcome of Displaced Fractures of the Proximal Humerus managed surgically: A Prospective study

Functional Outcome of Displaced Fractures of the Proximal Humerus managed surgically: A Prospective study

with greater tuberosity. The LCP is placed on the lateral side of humerus, approximately 5 mm below the tip of greater tuberosity. Temporary fixation of plate with 1.8 Kirschner wires is done. The proximal locking screws were inserted into the humerus head before the distal screws were inserted into the humeral metaphysis or diaphysis. The screws alternatively diverge and converge gaining great purchase and superior screw pullout strength. Standard AO cortical screws were used to fix the plate to the shaft. Instead cancellous screws were used in severely osteoporotic bone. In Koukakis et al 78 study mean Constant shoulder score was 76.1%. Only
Show more

154 Read more

Internal Fixation of Fractures of the Shaft of the Tibia and of the Distal Radius
in Adults

Internal Fixation of Fractures of the Shaft of the Tibia and of the Distal Radius in Adults

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 internal fixation. 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.
Show more

46 Read more

Functional Outcome of Closed Subtrochanteric Fractures Managed by Various Surgical Methods: A Prospective study

Functional Outcome of Closed Subtrochanteric Fractures Managed by Various Surgical Methods: A Prospective study

The pre-requisite for the inclusion in the study was a minimum of 6 months follow-up evaluation period. Reduction was considered acceptable when the anatomic configuration of the hip was restored and continuation of the medial cortex was re- established. If neither of these were achieved, the reduction was deemed unacceptable. Union was defined by radiographic criteria consistent with clinical examination or both. The majority of the patients were operated when their general condition was stable, mostly within a week. Few were postponed for their medical problems or associated injuries. Prophylactic antibiotics were given at the time of skin incision.
Show more

82 Read more

Open reduction and internal fixation versus casting for highly comminuted and intra articular fractures of the distal radius (ORCHID): protocol for a randomized clinical multi center trial

Open reduction and internal fixation versus casting for highly comminuted and intra articular fractures of the distal radius (ORCHID): protocol for a randomized clinical multi center trial

To ensure patients’ safety and integrity of clinical data, e.g., correct informed consent procedure and primary endpoint evaluation in adherence to the study protocol, continuous clinical monitoring procedures are set in place. Clinical monitors from the Coordination Centre for Clinical Trials (KKS), Heidelberg, Germany, will introduce all sites to study procedures and documenta- tion before beginning of the trial. Onsite monitoring during the study will be done by personal visits accord- ing to the standard operating procedures of the KKS. The monitors review amongst others the entries into case report forms on the basis of source documents. Therefore, each investigator must allow monitors full access to all essential documents, and must provide necessary support to the monitors. In addition to regu- lar site visits, continuous support is guaranteed through email- and phone communication between monitor and trial site.
Show more

12 Read more

Inflation osteoplasty: in vitro evaluation of a new technique for reducing depressed intra-articular fractures of the tibial plateau and distal radius

Inflation osteoplasty: in vitro evaluation of a new technique for reducing depressed intra-articular fractures of the tibial plateau and distal radius

The inflatable bone tamp appears promising in treating depressed intra-articular fractures of the tibial plateau and distal radius. It appears safe, as no instances of joint pen- etration, over-reduction, or balloon breakage occurred. In these regions, the balloon appears superior to conventional methods of reducing comminuted intra-articular fracture depressions and equivalent when elevating broad, mini- mally displaced, fragments. It offers the advantage of being minimally invasive and leaving behind a void of known size and volume. Many isolated joint depression fractures now treated nonoperatively could thus undergo a simple, minimally invasive procedure that would restore articular congruency with minimal morbidity. Caution should be
Show more

7 Read more

Functional outcomes of extra-articular scapula fracture fixation with distal humeral Y-type locking plate: a retrospective study

Functional outcomes of extra-articular scapula fracture fixation with distal humeral Y-type locking plate: a retrospective study

Evaluation of the scapular fracture and 3D modeling The preoperative radiographic evaluation included antero- posterior (Fig. 1a) and lateral (Fig. 1b) X-rays. Computed tomography (SOMATOM Definition Flash, scan thickness 1.0 mm, 128 rows) scans with three-dimensional recon- structions (3D-CT scans) were ordered when a displaced scapular fracture was diagnosed. The 3D-CT data were en- tered in the 3D printing software studio (Xijin Zhenwo 3D printing cloud terminal, reconstruction software: Mimics 17.0). The 3D fracture model of the scapula with the same size and the mirror model of the contralateral scapula were printed for all patients. The reduction and fixation strategy were designed according to the 3D fracture and mirror model. The Y-type locking plate (Fig. 1c) or straight reconstruction locking plate was pre-bent according to the 3D mirror model. 3D printing was carried out using poly- lactic acid (PLA) (Weinan Dingxin Chuangxin Zhizao Technology Co., Ltd., Beijing, China).
Show more

8 Read more

Functional Outcome of closed metacarpal fractures treated with mini fragment plates and screws: A Prospective study

Functional Outcome of closed metacarpal fractures treated with mini fragment plates and screws: A Prospective study

Nowhere in the body are form and function more closely related than in the hand. Often these metacarpal fractures are treated as minor injuries causing major functional disability. In order to maintain hand function man’s most important tool, the treatment of choice in recent years has shifted from predominantly conservative measures to more surgical procedures. Unstable metacarpal fractures require internal fixation. Long term follow up depends upon fracture angulation & rotation .Rotation of the digit impairs- functional grip and can be a source of chronic pain. Metacarpal shortening affects interosseous function with a 10mm loss of length corresponding up to 55% muscle power loss.
Show more

129 Read more

Show all 10000 documents...

Related subjects