This is to certify that this dissertation titled “FunctionalOutcomeAnalysis of Openreduction and internalfixation of complexAcetabularfractures” is a bonafide record of work done by DR.D.KAMALASEKARAN , during the period of his Post graduate study from June 2010 to May 2013 under guidance and supervision in the INSTITUTE OF ORTHOPAEDICS AND TRAUMATOLOGY, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai-600003, in partial fulfilment of the requirement for M.S.ORTHOPAEDIC SURGERY degree Examination of The Tamilnadu Dr. M.G.R. Medical University to be held in April 2013.
In our short term study, we were able to produce satisfactory results with minimum complications in this new upcoming approach which is being widely practised throughout the world from 2010. Use of non extensile approaches have made surgery simple and reduced the complications. With improvement in surgical experience and earlier surgical intervention, we can produce better results in this new approach for anterior exposure of the acetabulum to treat complexacetabularfractures.
Bassi JL, C handarjeet Dattal, Pankaj Mahindra, Navdeep Singh retrospective study included 45 patients who had undergone openreduction and internalfixation for posterior wall fractures of the acetabulum showing the incidence of AVN after operative treatment of acetabular fracture has generally ranged from 3-9% with majority identified between three and eighteen months after surgery. Justin G. Brothers, MD; Kaan S. Irgit, MD; Raveesh D. Richard, MD; Daniel S. Horwitz, MD; James C. Widmaier Jr, MD study of 23 patients presenting with complexacetabularfractures underwent combined ORIF and primary THA Combined ORIF and THA is an acceptable treatment an option for selected patients with severe acetabularfractures. Intermediate follow up demonstrates a low rate of revision and high rates of fracture union.
Previous studies have demonstrated that post- operative clinical efficacy of ORIF in treating acetabularfractures is significantly correlated with the waiting time for surgery. The earlier the surgery is conducted, the higher rate of ana- tomic reduction will be achieved. Mears et al.  reported a rate of anatomic reduction up to 76% at 2 d after injury, 68% at 3-10 d and 54% at 11-12 d. In this investigation, the total rate of anatomic reduction was 63.6% following ORIF, which is consistent with previous findings. However, the total rate of anatomic reduction in the delayed acetabular fracture group was merely 42.8%, suggesting that it is not feasible to perform ORIF immediately after injury be- cause the acetabular fracture is caused by high-energy shock frequently accompanied by severe damages at multiple sites and unstable vital signs. Hence, simple pelvic external fixa- tion is the only choice available. Peng et al.  regarded the 1st week after injury as the opti- mal timing for performing ORIF and insisted that it was difficult to conduct reduction suc- cessfully after 10 days after fracture, especially more challenging to achieve reduction exceed- ing 3 weeks, which could be categorized into delayed fracture. Zhou et al.  have demon- strated that it is reasonable to perform ORIF within 1-2 weeks following the incidence of complexacetabularfractures, whereas should be highly alerted to conduct ORIF over 3 weeks after delayed acetabular fracture. For those patients suffering from acetabularfractures for over 3-4 months due to poor systemic condi- tion or alternative causes, other clinical thera- pies, such as THR, should be considered rather than ORIF. In this study, 55 patients diagnosed with early acetabularfractures steadily under- went reduction and exposure of the fracture ends, especially for those receiving ORIF within 1 week after fracture. Although significant frac- ture shifting may be observed, the operation time and quality of reduction could be signifi- cantly improved compared with their counter-
institution. A total of 200 patients were included and followed prospectively. Data on demographic parameters: age, gender, body mass index (BMI), types of trauma, asso- ciated injuries, fracture types, treatment methods, complications and return to normal activities were collected. However, elderly patients with severe osteoporotic bone, un- displaced or minimally displaced fractures ≤2 mm, open fracture, pathological frac- tures, fractures on top of a previous hip disease, other underlining disease and who in- volved in injuries presenting after 10 days of onset were excluded from the study. Also things that made important limitation in our study leading to incomplete data records were excluded from the study. Trauma etiology was classified as road accident, high fall, and fall from body height or sports-related. The Injury Severity Score (ISS) was de- termined from emergency medical records . Patient’s fracture type was grouped according to Letournel’s classification . We included four most common complexacetabularfractures: columns, Posterior Column & Posterior Wall, Anterior Column & Posterior Hemi transverse and T fracture by using conventional radiographs, Compu- terized Tomography (CT scan) and Magnetic Resonance Imaging (MRI). The mini- mum follow-up period for every individual case was set to be 18 months. Informed consent was taken from every patient to be involved in the study. Patients included in the study were all those who presented with complex and displaced acetabular fracture of more than 2 mm which diagnosed radiologically within 10 days of injury.
But, H.J.Kreder et al.  in their study involving 128 acetabularfractures, suggested that anatomical reduction alone was not sufficient to restore the joint function. In addition to articular reductionfunctionaloutcome was also determined by fracture pattern, marginal impaction, age of the patient and associated co- morbid conditions. They also suggest primary total hip replacement surgery in patients with age more than 50 years for fractures involving marginal impaction with posterior wall comminution.
Meniscus is the most vulnerable soft tissue in tibial plateau fractures. The incidence of meniscal injuries is upto 50% 12 . With the advent of arthroscope and pre-op MRI the incidence can still go high. The diagnosis is usually made during the surgery or arthroscopic examination. Meniscal injuries are not serious enough in relation to the osseous injuries to be clinically important or they healed during treatment of fractures. Only the irreparably damaged meniscus has to be excised. Routine removal of meniscus is not recommended for fracture visualization. Peripheral suturing, minor trimming can salvage most torn or displaced meniscus 16 .
Various techniques and implants have been used for treating the distal radius fractures. From the days of cast application for all the cases the era changed to pinning and casting followed by external fixator application and indirect reduction of the fracture by the principle of ligamentotaxis. Later buttress plates of various shapes were used for internalfixation 24,28 . The next breakthrough was with the Locking plates which had better anchorage and stability even in the metaphyseal bone 28 . With advancement came the fracture specific smaller plates and anchorage pins 29 . The variable angled 2.4mm locking plates are the newer choice with maximum number of screws in the metaphyseal region in the desired direction of anchorage.
The initial disrepute of bicolumn fixation of complex tibial plateau fractures owes itself to poor surgical technique practiced earlier on. The use of a single midline incision and extreme soft tissue handling led onto a high incidence of wound breakdown and infection and put the orthopaedic fraternity on guard regarding bicolumn fixation 5,6,7 . The advent of locking plates shifted the spectrum towards isolated lateral plating using locking compression plates and stabilizing medial fragment through screws passed via the locking plate 13,18.
There was neither early superficial nor deep infection. No vascular or neurological complications were noted. Mean SST score was 9.95. No differences between DCP and LCP fixation was noted (P=.27). Fixing tuberosities was not correlated with the SST (Simple Shoulder Test) score (P=.73). Latest x-ray evaluation showed 4 NHH. No correlation was found between functionaloutcome and the development of NHH (P=.18). Malunion was found in 6 patients (3 varus, 3 valgus). Perforation of the articular surface from long screws was noted in 3 patients. Intraarticular screw had no effect on functionaloutcome (P=.3).
Good functional result depends on reasonable anatomic reduction of the articular surface or acceptable reduction of shaft of the bone either by direct or indirect methods. Understand the fracture completely before planning any surgery with adequate radiographs, CT scan and radiographs of the uninjured limb. Surgical reconstruction must be tailored to the personality of each fractures and operative approaches dictated by the quality of the soft tissues.
From the structural and functional stand points the distal humerus is divided into separate medial and lateral components each containing an articular and non-articulating portion. Included in the non-articulating portion are the epicondyle which are the terminal points of the supracondylar ridges. The lateral epicondyle contains a roughened anterolateral surface from which the superficial forearm extensor muscles arise. The medial epicondyle is larger than the lateral counter part and serves as the origin of forearm flexor muscles.
Objectives: To evaluate the benefits of Cell Salvage (CS) therapy in patients with traumatic pelvis and/or acetabulum fractures. Design: Retrospective cohort study. Data collected from medical records and radiographs. Setting: Level-1 trauma center. Patients/Participants: 157 patients with traumatic pelvis and/or acetabulum fractures treated operatively under the care of one surgeon between 2008 and 2012 were included. Exclusion criteria included nonsurgical patients and those treated with percutaneous fixation. Intervention: All patients underwent openreductioninternalfixation of their pelvis and/or acetabulum fractures. The use of cell salvage therapy was randomly selected for trauma patients based on the availability of the system. Main Outcome Measurements: Volume of allogeneic blood transfused (ABT), estimated blood loss (EBL), hemoglobin (Hb) levels preoperatively and postoperatively, and blood-related costs to the patient. Results: CS was used in 89 cases (56.7%) with an average volume of 86 mL. There was a significantly higher ABT in the CS group than the no CS group (625 vs. 376 mL, p < 0.05) however this difference disappeared when controlling for blood loss with the ABT/EBL ratio (1.08 vs. 0.74, p = 0.10). Cell saver showed some benefit in patients with high blood loss (> 500 mL) in which case there was a significantly higher volume of salvaged blood than patients with low blood loss (162 vs. 27 mL, p < 0.05), and in patients with > 7 days to surgery (135 vs. 64 mL, p < 0.05). The cost difference of $1,375 was seen between the two groups, favoring the No CS group. Conclusions: Our results suggest limited overall benefit to the use of CS in patients treated with ORIF for traumatic pelvis and acetabulum fractures. Journal of Nature and Science, 1(5):e99, 2015
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
Human mandible is shown to exhibit numerous complex combination of movements and torsion patterns, which must be considered when evaluating the stability of the osteosynthesis device 77 . Also miniature osteosynthesis devices become essential for stabilization of subcondylar fractures because of the usually small size of condylar fragments. It is also mandatory to place these plates along “Ideal line of osteosynthesis’’ for dictating predictable outcome. Champy et al 1976 6 experimentally located these strain lines in the mandibular body, symphysis and angle region. Later Meyer et al 7 proposed ideal lines of osteosynthesis in condylar region.
31. de Boer as, Van lieshout em, den hartog d, et al. Functionaloutcome and patient satisfaction after displaced intra-articular calcaneal fractures: a comparison among open, percutaneous, and nonoperative treatment. J Foot Ankle Surg 2015;54(3):298-305. 32. Wu Z, su Y, Chen W, et al. Functionaloutcome of displaced intra-articular calcaneal fractures: a comparison between openreduction/internalfixation and a minimally invasive approach featured an anatomical plate and compression bolts. J Trauma Acute Care Surg 2012;73(3):743-751.
A thorough preoperative evaluation should be performed, including patient history and physical examination, radiographic evaluation, and surgical planning. Key components of the history include the mechanism of injury as well as the patient’s age, handedness, preinjury shoulder function, functional demands, and comorbidities. Physical examination of the shoulder should evaluate for the presence of an open or closed fracture, the location of tenderness and amount of localized swelling, the position of the humeral head on palpation (ie, located, subluxated, dislocated), active and passive shoulder range of motion (ROM), neurovascular status of the extremity, and associated cervical spine or other distracting injuries.
Background: Although fracture mid shaft clavicle always united with a good functionaloutcome, nonunion of fracture clavicle always leads to impaired shoulder joint functions with a significant disability that can cause poor functionaloutcome and limitations of shoulder joint activities due to pain and stiffness. Materials and Methods: From July 2005 through October 2011, twenty (20) patients (13 males and 7 females) were suffering from symptomatic nonunion of the mid-shaft clavicle (no union for more than three months). They had treated operatively in 14 patients who had suffered from the atrophic nonunion by using a curved reconstruction plate and autologous iliac bone grafting and in six patients with hypertrophic nonunion of mid-shaft clavicle fracture by using a curved reconstruction plate and “local bone grafting” from local callus, bone chips. The American Academy of Orthopedic Surgeons (AAOS) disabilities of the arm, shoulder and hand (DASH) questionnaire was used for the outcome results evaluation. Results: The patients were followed-up for an average of 15 months (range from one year to four years). All fractures were united within three months. The preoperative DASH score was varied from 80 to 70, mean (75). The postoperative DASH score was varied from, 10 to 25, mean (12.7) in our series. Functionally, this was very much acceptable. Conclusion: Based on the results of our and other studies, we recommended openreduction and internalfixation with using a curved reconstruction plate and autologous iliac bone grafting in patients whom suffering from the atrophic nonunion. For treating patients whom suffering from hypertrophic nonunion of mid-shaft clavicle fracture we recommended using a curved reconstruction plate and local bone graft as a sufficient procedure to achieve necessary union, and autologous bone graft from other sites of the body appears to be unnecessary. This successful procedure had a good functionaloutcome and most of the patients had promising results, as regard to return to a near normal level of function.
Beingessner et al. showed that the changes in elbow stability and kinematic caused by type I coronoid process fractures cannot be correct- ed with suture repair . On the other hand, fixation with 1 or 2 lag screws was performed by some surgeons recently, nevertheless the screw fixation is not only difficult to perform , but also maybe not reliable to resist the compressive forces pulling the fragment off coronoid’s base. And the internalfixation may be failed because it is difficult to position screwsin the appropriate place of the fragment. In current studies, mini-plate fixation was pro- moted for achievement of stability and com- pression in type II and type III patients.Rigid fixationcould be achieved in intra-articulation fractures due to thatmini-plate could be easily shaped according to the bone configuration, fixed fragmentsintegrately and reliably, and made less impact on the motion of articulation and surrounding tissue, especially tendon ac- tivities. Moreover, functional exercise could be given earlier after surgery. In our study, we fixed all the patients by mini-plate and achieved sat- isfactory clinical outcomes. Our study has some limitations including that not only it was a retro- spective analysis, but also it has no control group inwhich the patients were treated by other fixation methods to prove the advantag- es. However, we believe that openreduction and internalfixation with mini-plate is a valid method for coronoid process fractures of ulna with the advantages of rigid internalfixation and early functional exercise.
Thirty patients with zygomatic complexfractures with or without other fractures of the facial skeleton who reported to Tamilnadu Government Dental College were included in the study. It was a prospective study. The patients were randomly divided into three groups with each group having ten patients. In Group I patients were treated with subciliary incision, Group II patients were treated with subtarsal incision and in Group III patients were treated with infraorbital incision. The parameters assessed and documented were average time from incision to the fracture exposure, surgical exposure of the operative field attained, aesthetic appearance of the scars, scleral show, chronic lid edema and ectropion. All the patients in the study were reviewed at regular intervals of first, third and sixth month postoperatively and evaluated functional and esthetic outcomes and the findings were evaluated by a single member blinded to the procedure. Ethical approval was obtained for the study from the institutional ethical committee.