Top PDF Short Term Functional Outcome Analysis of Internal Fixation of Distal Ulna Fractures with Concomitant Distal Radius Fractures

Short Term Functional Outcome Analysis of Internal Fixation of Distal Ulna Fractures with Concomitant Distal Radius Fractures

Short Term Functional Outcome Analysis of Internal Fixation of Distal Ulna Fractures with Concomitant Distal Radius Fractures

Ulnar-sided injuries of the wrist have received more attention recently for their potential negative impact on the outcome of distal radius fractures. Some studies have revealed that inappropriate treatment of distal ulna fractures with appropriately treated distal radius fractures resulted in distal radio ulnar joint instability and hence poor functional outcome at later years. There have been proponents for both operative and non-operative methods. Various studies are coming forth with various fixation techniques being described for distal ulna fractures with concomitant distal radius fractures. Good functional results were reported with either modality in low energy fractures in elderly but the ideal treatment for high energy injuries with associated distal ulna fractures is still being debated.
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Locking compression plating for distal femoral fractures: A Short Term Outcome Analysis

Locking compression plating for distal femoral fractures: A Short Term Outcome Analysis

a cleft palate and was made out of molded gold. The late 1880's brought the next major change in bone plating; surgeons began burying the bone screws below the skin. There were many designs and ideas that developed over the next 70 years. Unfortunately, malunions, nonunions and bone infections were issues due to lack of sterile techniques, and bone plates that were biomechanically unable to provide rigid fixation. Robert Danis (1880-1962) developed the ideas of compression plating and experimented with many different designs during his lifetime. Modern bone plating started in the 1950's when a group of 15 surgeons lead by Maurice Muller formed AO/ASIF (Albeitgemeinshaft fur osteosynthenfragen/ Association for the study of internal fixation) to improve the principles of bone plating. AO remains purely a medical organization to advance the study of fracture treatment while Synthes is the commercial arm of the AO.
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Functional Outcome analysis of Open reduction and internal fixation of complex acetabular fractures.

Functional Outcome analysis of Open reduction and internal fixation of complex acetabular fractures.

8) Joel m. matta, m.d.t, los angeles, california, Fractures of the Acetabulum: Accuracy of Reduction and Clinical Results in Patients managed Operatively within Three weeks after the Injury, Journal of Bone and Joint Surgery1996;78:1632-45. 9) P. K. Sancheti, Atul Patil, A.K. Shyam, Kailash Patil , Milind Merchant, Outcome of Operatively Treated Anterior Column Fracture of the Acetabulum- A Short term Prospective Cohort study. Journal of Orthopaedics 2009;6(4)e7

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Loss of correction in unstable comminuted distal radius fractures with external fixation and bone grafting -a long term followup study

Loss of correction in unstable comminuted distal radius fractures with external fixation and bone grafting -a long term followup study

Complex distal radius fractures pose a significant challenge to the practicing surgeon because of the inherent tendency to collapse resulting in malunion, deformity. loss of function and late osteoarthritis. Fair and poor results were attributed to associated injuries and extended period of application of external fixator. Lunate fragments which could not be reduced by external fixation required open reduction, fixation with K wires and bone grafting. Ulnar styloid process frac- tures were not actively treated in this study. Late col- lapse of the articular surface led to early arthritis. Bone grafting should be performed to obtain good articular congruity and to prevent deformity. Although AO external fixator provides absolute rigidity and stability, restoration of original palmar tilt could not be achieved in all cases despite maintaining radial length and radial. The restoration of palmar tilt requires mul- tiplanar ligamentotaxis or a pin in the dorsal fragment. Majority regained more than 63 percent of grip strength. It is decreased in patients with increased radial tilt, associated injuries and prolonged immobili- sation. The final outcome of functional results in complex distal radius fractures depends on patient selection, fracture morphology, obtaining accurate reduction and maintaining it by external or internal fixation, bone grafting inpatients with large
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Analysis of Factors Affecting the Functional Outcome of Intra Articular Distal Femoral Fractures

Analysis of Factors Affecting the Functional Outcome of Intra Articular Distal Femoral Fractures

Distal femoral fractures are difficult to treat because they are often unstable and comminuted and have a potential for long term disability. Varus collapse, malunion and nonunion were the problems before fixed angle plates and indirect reduction techniques were introduced. In principle, therefore, all intra – articular distal femoral fractures should be treated surgically. Successful treatments of distal femoral fractures require surgery and maintenance of the congruence of the articular surfaces. The prognostic factor for supracondylar fracture includes age, intra articular involvement, method of treatment, timing of joint mobilization etc. Comparison of results with other studies is often difficult because of difference in the classifications schemes and the use of different methods of treatment [5-7] . Some articles have been published documenting superior functional results using internal fixation [8, 9] . Rigid fixation has also enabled earlier knee motion and weight bearing, which help prevent some of the serious complication attributed to prolonged bed rest and traction [5, 6] . In our study an attempt was made to assess the factors affecting functional outcome of distal femoral fractures with intra articular extension, treated by various surgical methods. The present study was conducted on 25 patients with supracondylar fracture with intra articular extension admitted in department of Orthopedics, in MGM Warangal, Hospital.
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Comparative analysis of functional outcome of distal femur fractures treated with Locking Compression Plate fixation and Dynamic Condylar Screw fixation

Comparative analysis of functional outcome of distal femur fractures treated with Locking Compression Plate fixation and Dynamic Condylar Screw fixation

Our study is short term prospective and retrospective study conducted in Institute of orthopedics and traumatology, Madras medical college, Rajiv Gandhi Govt. General Hospital. Chennai. Tamil Nadu. Patients admitted with distal femur fractures are selected on the basis of inclusion and exclusion criteria. We have followed Muller Classification for distal femur fractures, based on which treatment modalities determined. Adult age group with Type A and C Muller included and Type B and skeletal immature patients and Gr III compound excluded in this study. Our study sample size is 25 patients, of which 10 patients treated with dynamic condylar screw and 15 patients with distal femur locking compression plate. They were processed as per protocol, traction of extremity till the patient get fit for surgery. We have used Extensile Lateral approach to fix the fracture with patient supine with sand bag underneath knee. Fractures treated with either LCP and DCS followed in standard protocol and evaluated in serial follow up. Functional outcome analyzed using standard scoring system called Hospital for Special Surgery.
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Short term comparative study of external fixation versus volar locking compression plate in the treatment of unstable distal radius fractures

Short term comparative study of external fixation versus volar locking compression plate in the treatment of unstable distal radius fractures

In our study , Although the External fixation group regain the movements a after vigorous physiotherapy ,the early recovery and movement in volar locked plating group gives better working capacity and yielded good functional outcome. Although Two groups in our study have shown similar radiological and clinical outcome, the functional outcome which was evaluated by DASH scoring system is better in volar plated group patients than in external fixator group.

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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

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 internal fixation, 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.
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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
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Functional Outcome of Distal Radius Fractures Managed by Barzullah Working Classification

Functional Outcome of Distal Radius Fractures Managed by Barzullah Working Classification

Various classifications of DRFs have been proposed in the past two centuries. Fracture eponyms pay tribute to those who initiated the process, including Pouteau, Col- les, Barton, Goyrand, and Smith. With this foundation, many investigators progressively contributed to the breadth and depth of understanding of DRFs based on fracture attributes and severity. Each method of classifi- cation had its champions, who touted its strengths, but there were always critics who identified weaknesses as well. The present study is in continuity to evaluate and understand further the comprehensive management of distal fractures in more global and simple way. This study investigated the functional outcome of 310 DRFs man- aged in line with standard treatment but in a new and simple way. Small sample size and short follow-up are the limitations of this study to draw any definite conclusion. Further studies are needed to check credibility of the new classification in orthopedic practices. Various modalities of treatment used differentially in different types of DRFs based on the Barzullah Working Classification give good results in spite of conflicting literature.
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Hybrid external fixation for neglected fractures of the distal radius: results after one year

Hybrid external fixation for neglected fractures of the distal radius: results after one year

The most common instrumentation used, restores the anatomy of the distal forearm by continuous ligamentotaxis across the radiocarpal joint. It is also effective in simple intraarticular fractures without additional manipulation [18, 21–23]. Various designs of transarticular (‘‘bridging’’) fixators have been invented; they are easy to apply, allowing some postoperative adjustments, and are fairly well tolerated by patients [1, 4, 5, 7–9, 13, 24]. The classic transarticular external fixation may cause serious problems associated with its design. The most common, such as hand and finger stiffness (‘‘claw hand’’) or reflex sympathetic dystrophy, are probably caused by prolonged excessive ligamentotaxis with distraction of the carpus; positioning of distal Shantz screws into the II and III metacarpals can cause serious hand problems like infection and bone frac- ture [1, 4–7, 9, 13, 14, 25, 26]. In addition, the restoration of an important anatomic feature of the distal radius—the palmar tilt—is difficult or sometimes impossible without an additional approach to the distal radius [1, 4, 8, 9, 13, 14, 18, 20, 25–27].
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Reliability of radiographic measurements for acute distal radius fractures

Reliability of radiographic measurements for acute distal radius fractures

Posteroanterior (PA) and lateral wrist radiographs of all patients with distal radius fractures presenting to a large outer metropolitan ED in Victoria, Australia during the period July 2009 to January 2010 were retrospectively selected for review. Standardised positioning of neutral forearm rotation was adopted for the PA and lateral views. Inclusion criteria for radiographs were skeletal maturity, fracture within 3 cm of the distal end of the radius, and presenting to the ED within seven days of fracture. Exclu- sion criteria were pathological fracture and evidence of previous distal radius fracture on the affected side. Radio- graphs meeting the inclusion/exclusion criteria were as- sembled and stratified by fracture deformity to either Group A (mild deformity) or Group B (severe deformity) based on decision rules defining estimates of severity (Table 1). In the absence of guidelines, decisions regarding cut points separating mild from severe were arbitrary and intended only to enable the spectrum of injury to be ap- propriately represented in the assembled targets. Fifteen ra- diographs from each group were randomly selected based on a computer generated sequence. The sample size of 30
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New classification of lunate fossa fractures of the distal radius

New classification of lunate fossa fractures of the distal radius

For a type I center depression fracture, the reset should be achieved with a small window via a volar or dorsal approach combined with bone grafting. In addition, if the collapse is >5 mm or osteoporosis is present, the joint surface should be buttressed with a steel plate. For type II vertical depression fractures, the use of a volar plate could obtain satisfactory results. For type III volar depression frac- tures, a modified Henry volar approach can be applied, fix- ing a steel plate on the palm side. A volar incision could be less affected upon tendon. For type IV dorsal depression fractures, a dorsal approach with fixing a steel plate at the back side is suggested. The multi-angle stability of a locked steel plate makes it possible to achieve fixation of the back side of the bone using a steel plate on the palm side. For type V double die-punch fractures, if fixation of a steel plate on the palm side cannot reset the bone on the back side, the dorsal approach should be applied. To obtain max- imum holding force, distal screws placed under the sub- chondral bone can enhance the stability of the fixation, especially in osteoporotic patients. Type I and V fractures are difficult to treat surgically as they are prone to poor resolution on the joint surface, followed by emergence of traumatic arthritis of the wrist. Hence, it is essential to re- store the flatness of the joint surface to the extent possible. Table 1 Demographics of the patients (n = 112)
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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.
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Functional Outcome of treatment of distal humerus fractures using distal humeral locking plates

Functional Outcome of treatment of distal humerus fractures using distal humeral locking plates

joint reconstruction more problematic. The anatomically preshaped locking plates allow angular stable fixation for these complex fractures. We evaluated functional results of patients treated with open reduction and internal fixation with distal humerus locking plates for complex distal humerus fractures. Methods: Thirty consecutive patients with articular fractures of the distal humerus were treated by open reduction and internal fixation with AO distal humerus plate system and locking reconstruction plates. According to AO/ASIF classification, there were 2 cases of type A2, 4 cases of type A3, 1 case of type B1, 1 case of type B2, 11 cases of type C1, 4 cases of type C2 and 7 cases of type C3. Open reduction with triceps splitting technique was used in all patients. The clinical and radiographic follow-up was performed and outcome measures included pain assessment, range of motion, and Mayo elbow performance score.
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Functional Outcome of the Distal Femur Locking Compression Plates in the Treatment of Fractures of Distal Femur

Functional Outcome of the Distal Femur Locking Compression Plates in the Treatment of Fractures of Distal Femur

be utilized for all distal femur fractures including complex type C fractures, periprosthetic fractures, as well as osteoporotic fractures. IM nailing may provide favorable IM stability, may promote formation of circular and stable callus, and may be successfully implanted in bilateral or multisegmental fractures of the lower extremity as well as in extra- articular and type C1 fractures. However, both systems require precise preoperative planning and advanced surgical experience to reduce the risk of revision surgery. Clinical outcome may largely depend on surgical technique and rather than on the choice of implant and multicenter studies with high numbers of patients are required to draw useful conclusions.
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Functional Outcome of various modalities of management of Distal Tibial Fractures

Functional Outcome of various modalities of management of Distal Tibial Fractures

This is to certify that Dr. E.S.ARIVAZHAGAN Post-Graduate student (2004 – 2007) in the Department of orthopaedics; Govt. Kilpauk Medical College Chennai has done this dissertation on “FUNCTIONAL OUTCOME OF VARIOUS MODALITIES OF MANAGEMENT OF DISTAL TIBIAL FRACTURES” under my guidance and supervision in partial fulfillment of the regulations laid down by The Tamil Nadu Dr. M.G.R Medical University, Chennai for M.S (Orthopaedics) degree examination to be held on March 2007.

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NON-OSSEOUS COMPLICATIONS FOLLOWING DISTAL RADIUS FRACTURES

NON-OSSEOUS COMPLICATIONS FOLLOWING DISTAL RADIUS FRACTURES

Causes of nerve dysfunction include hematoma within the carpal tunnel or beneath the deep forearm fascia at the fracture site, wrist hyperextension at the time of injury causing nerve st[r]

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Original Article Volar locking plate fixation versus Kirschner wire fixation in distal radius fractures: a meta-analysis

Original Article Volar locking plate fixation versus Kirschner wire fixation in distal radius fractures: a meta-analysis

Abstract: Objective: The superiority of volar locking plate fixation and K-wire fixation on treatment of distal radius fractures was controversial. Thus, we performed a meta-analysis to compare the efficacy of volar locking plate and K-wires for distal radius fracture. Methods: We searched Embase, Medline and PubMed for randomized controlled trials which compare the effects of volar locking plate and K-wire on treatment of distal radius fracture. Data analy- sis was performed by using the RevMan5. Results: Six studies met the inclusion criteria. The meta-analysis results showed volar locking plate fixation led to better DASH scores at 3 and 12 months, faster recovery of grip strength, extension and supination at 3 months. But there was no significant difference at 12 months in term of functions and motions recovery. Complications of the two methods were similar. Conclusion: The patients receiving fixation with volar locking plate for the treatment of distal radius fracture achieved an early recovery of function compared to those with K-wire.
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Analysis of functional outcome for unstable distal radius fractures treated with closed reduction and percutaneous ‘K’ wire fixation with casting and closed reduction with casting: A comparative study

Analysis of functional outcome for unstable distal radius fractures treated with closed reduction and percutaneous ‘K’ wire fixation with casting and closed reduction with casting: A comparative study

Displaced fractures reduced by longitudinal traction and gentle manipulation. Traction is applied for disimpaction of the bone surfaces; holding the thumb, index finger, and middle finger. Counter-traction applied at arm with flexed elbow of patient by an assistant. Translation reduction manoeuvres are used. With maintained traction at the fracture site, flexion and ulnar deviation manoeuvres were applied to reduce the distal fragment. Finally the fracture was locked in reduced position by applying slight pronation, flexion and ulnar deviation forces.
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