Top PDF The functional outcome of surgically treated unstable pelvic ring fractures by open reduction, internal fixation

The functional outcome of surgically treated unstable pelvic ring fractures by open reduction, internal fixation

The functional outcome of surgically treated unstable pelvic ring fractures by open reduction, internal fixation

The radiological result was graded by the maximum residual displacement in the pos- terior or anterior pelvic ring injuries as; ex- cellent for 0 to 5mm, good for 6 to 10mm, fair for 11 to 15mm and poor for more than 15mm of displacement or established non union [5]. The functional result was meas- ured using the functional grading scale de- scribed by Majeed [6]. This functional scor- ing system consisted of several questions in seven items. These items included pain, work, sitting, sexual intercourse, walking aids, gait and walking distance. Each score represented a number of points, which make up the total score ranging from 0 to 100. All follow up data were collected and patients were recalled for assessment of their radio- logical and functional outcome using scoring system devised by Majeed scoring system and the current job status was also recorded. Data were subjected to one way analysis of variance (ANOVA), where P<0.05 was con- sidered significant.
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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.

This is to certify that this dissertation titled “Functional Outcome Analysis of Open reduction and internal fixation of complex Acetabular fractures” 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.
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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.
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Physical Inactivity: A Social Burden

Physical Inactivity: A Social Burden

A prospective quantitative descriptive cohort study was carried out over 2 years, from January 2016 to January 2018, in all consecutive cases of closed displaced intra-articular fractures of calcaneum in skeletally mature patients that presented to the Department of Orthopaedics at Dr. R.N. Cooper muncipal general hospital, Juhu, Mumbai.. Out of total 30 cases of calcaneal fractures that were managed during the study period, 25 cases were eligible for the study and 20 cases were available for final follow up. Open calcaneal fractures, patients unwilling for the operative management, skeletally immature patients, cases managed conservatively were excluded from the study. Written informed consent was obtained from all patients to be managed with ORIF with LBCP. The data were recorded in proforma including: epidemiological information, fracture details from X-rays and CT scans, preoperative, perioperative, and postoperative details including wound condition.Fractures classified using sanders classification. Routine investigations carried out to get fitness for surgery. Patients underwent Open reduction and internal fixation with locking branched calcaneal plate through extensile lateral approach under spinal anaesthesia. Post- operative physiotherapy followed according to protocol. Patients will be followed up at 6 weekly interval until fracture union. Clinical evaluation done by using Maryland foot scoring system. Radiological evaluation done by using Boehlers angle and Critical angle of Gissane on Lateral radiographs of calcaneum. Functional outcome was recorded at every followup after 12 wks of surgery.
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Functional Outcome of Unstable Pelvic Fractures: A Retrospective study

Functional Outcome of Unstable Pelvic Fractures: A Retrospective study

involving 53 patients. He showed the results of a protocol based treatment of selective fractures using external fixator with a 5 year follow up. He used SF36 General Health survey and Iowa pelvic scores. He concluded that the results of non operative, open reduction and internal fixation and intermittent use of external fixation to treat pelvic injuries were remarkably similar and the restoration of traumatically displaced anatomy should maximize long term results.

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Functional Outcomes of Traumatic Complex Acetabulum Fractures with Open Reduction and Internal Fixation: 200 Cases

Functional Outcomes of Traumatic Complex Acetabulum Fractures with Open Reduction and Internal Fixation: 200 Cases

We identified that the functional outcome after open reduction and internal fixation of complex acetabulum fractures depends on fracture type, on time surgery and perfect reduction and a[r]

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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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Clinical Outcome of Conservative Treatment of Displaced Mandibular Fracture in Adults

Clinical Outcome of Conservative Treatment of Displaced Mandibular Fracture in Adults

The article evaluates 12 cases of conservative treatment of displaced mandibular fractures in adults. Twelve cases of displaced mandibular fractures treated surgically, either by closed reduction (IMF) or open reduction internal fixation (ORIF) served as controls. Occlusion, maximal mouth opening, lateral jaw movements, neurological dysfunction (=sensory deficit), and bone remodeling were evaluated and scored in both groups, and results were compared. No sig- nificant differences were found between the two groups in all the evaluated parameters. It is concluded that in certain cases, with displacement of 2 - 4 mm, where a surgical approach is not feasible, reasonable spontaneous reduction and bone remodeling can occur. Meticulous follow-up is mandatory.
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OUTCOME OF OPEN REDUCTION AND INTERNAL FIXATION IN LATERAL CONDYLE HUMERAL FRACTURES IN PEDIATRICS

OUTCOME OF OPEN REDUCTION AND INTERNAL FIXATION IN LATERAL CONDYLE HUMERAL FRACTURES IN PEDIATRICS

Distal humerus fractures in children are optimally treated with open anatomic reduction and stable fixation to allow for early anatomic restoration and upper extremity ROM. While operative intervention is not without complications, detailed attention to anatomic reduction, soft-tissue handling and preservation, stable fixation, and early mobilization can reduce complications. For articular fractures and unstable nonarticular fractures, operative treatment with direct visualization of the joint surface and anatomic reduction and stabilization can prevent accelerated arthritis associated with articular incongruity [3].
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Comparision of functional and cosmetic outcome of supracondylar fractures in children treated by percutaneous pinning and open reduction and internal fixation with K-wires

Comparision of functional and cosmetic outcome of supracondylar fractures in children treated by percutaneous pinning and open reduction and internal fixation with K-wires

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.

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Cell Salvage Transfusion Therapy for Open Reduction and Internal Fixation of Traumatic Pelvic and Acetabulum Fractures: An Analysis of Costs and Outcomes

Cell Salvage Transfusion Therapy for Open Reduction and Internal Fixation of Traumatic Pelvic and Acetabulum Fractures: An Analysis of Costs and Outcomes

The study was retrospective in design. Patients who underwent ORIF for traumatic pelvis and/or acetabulum fractures at our institution between 2008 and 2012 were included. All patients were cared for by one surgeon (DZ) to minimize potential bias. Patients excluded from the study included those who did not suffer pelvis/acetabulum fractures, and those who were not treated with ORIF, including patients treated with conservative management and percutaneous fixation. The Cell Salvage system used was Fresenius Continuous AutoTransfusion System (Fresenius Medical Care Waltham, MA. This is a two suction line system, where one line is designated for “old” hematoma and irrigation fluid and the other for intraoperative blood loss that is later processed for retransfusion. We compared patients for which a CS system was used to those where only ABT was used to meet hematologic needs. The outcome measures included intraoperative allogeneic blood transfusion, length of hospital stay, days to surgery, changes in hemoglobin (Hb) levels preoperatively and postoperatively, total intraoperative blood loss, and amount of allogeneic blood required intraoperatively. We also identified the costs associated with perioperative use of the CS system and compared them to the costs experienced by patients receiving only ABT. Further, subanalyses were performed on the CS and no CS group separated by surgical approach. Approval was obtained from the Institutional Review Board and all patients provided informed consent.
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Outcome of closed ipsilateral metacarpal fractures treated with mini fragment plates and screws: a prospective study

Outcome of closed ipsilateral metacarpal fractures treated with mini fragment plates and screws: a prospective study

In closed multiple metacarpal fractures, plate fixation is a good option for several reasons. These fractures are highly unstable, and stable fixation is required in these fractures [9]. Metacarpal length is very likely to be short- ened in multiple metacarpal fractures, causing instability [6, 7]. This effect is greater in internal metacarpals (third and fourth metacarpals) than in border metacarpals (second and fifth metacarpals), because the latter are anchored on both sides of the metacarpal head [8]. Closed ipsilateral multiple metacarpal fractures are frequently associated with more soft tissue injury as compared with single fracture, making them more susceptible to stiffness and poor functional results. Osteosynthesis using miniature plates and screws in these unstable fractures produces anatomical reduction of fractures with stabilization that is rigid enough to allow early mobilization of adjacent joints without allowing loss of reduction, thereby preventing stiffness and hence good functional results.
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A retrospective and prospective analysis of functional and radiological outcome in acetabular fractures treated with open reduction and internal fixation

A retrospective and prospective analysis of functional and radiological outcome in acetabular fractures treated with open reduction and internal fixation

When further evaluating the acetabulum using plain x-rays oblique views (Judet views) can be indispensable in showing the anterior and posterior columns and walls. Oblique views, coupled with the AP view, must be obtained and understood, even with the advent of computed tomography, so that the surgeon may assess them intraoperatively. The internal oblique (or obturator oblique) view brings the anterior column and posterior wall into profile. This view is obtained by rotating the pelvis 45° away from the side of interest. The external oblique (or iliac oblique) view brings the posterior column and the anterior wall into profile. This view is obtained by rotating the pelvis 45° toward the side of interest.
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Case Report Fixation of unstable pelvic fractures with minimally invasive adjustable plate

Case Report Fixation of unstable pelvic fractures with minimally invasive adjustable plate

Abstract: Objective: Unstable pelvic fractures are relatively rare injuries usually requiring reduction and internal fixation. Selecting appropriate methods for unstable pelvic fractures remains a challenging problem for orthopaedic surgeons. The aim of this study was to present the techniques and outcomes of MIAP for unstable pelvic fractures. Methods: We performed a retrospective analysis of patients with unstable pelvic ring fractures treated with mini- mally invasive adjustable plate at a level I trauma centre. Outcome evaluation was assessed using Majeed score standard, duration of surgery, blood loss, radiation exposure and size of incision. Results: Twenty-one patients were available for follow-up after at least 12 months. The main findings were as follows: the average duration of surgery was 67.5 min, the intraoperative blood loss was 204 ml on average, the average radiation exposure was 8 s, and the size of incision was 8.8 cm on average. The mean Majeed functional evaluation score was 85.3 points. Conclusion: Minimally invasive adjustable plate may be a good alternative for treating unstable pelvic fractures. It has the ad- vantages of technically safe, minimally invasive, less radiation exposure and time saving.
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Role of locking compression plate for Distal Radius Fractures in Postmenopausal Women

Role of locking compression plate for Distal Radius Fractures in Postmenopausal Women

A common obstacle while dealing with osteoporotic patients is fixation of the device to the bone which occurs as a result of a higher frequency of bone failure which is attributed to reduced bone mass resulting in brittle bones and altered bone structure which may even include medullary expansion. The above characteristics must hence be taken into consideration while planning lines of management. It must also be duly noted that patients with osteoporotic bones generally have proportionately lower physical demands. Also there is a documented reduction in the life expectancy amongst individuals with osteoporosis.
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Anterior subcutaneous internal fixation for treatment of unstable pelvic fractures

Anterior subcutaneous internal fixation for treatment of unstable pelvic fractures

report lethality as high as 60% [4-8]. The reason for this is attributed to the high level of blood loss, which leads to hemodynamic shock and multi- organ failure [8]. Be- side the fracture plain itself, the main source of bleeding is also due to lesions of the pelvic venous plexus. In up to 25% per cent of the cases, arterial haemorrhaging can be noted, especially from branches of the A. iliaca interna [9,10]. An injury to the pelvic ring not only leads to a loss of stability, but also increases the volume of the intra-pelvic compartment. This impedes spontaneous tamponade of bleeding. Frequent associated ruptures of the musculature of the pelvic floor may further contrib- ute to this [11]. Beside general measures of circulatory stabilisation, reconstruction of pelvic anatomy and thereby restoration of a stable, non-expandable compartment is a main goal in patient management. Especially the recon- struction of the posterior pelvic ring is hereby of great im- portance. On the other hand, biomechanical studies have also shown that additional osteosynthesis of anterior le- sions significantly improves stability [12,13]. It seems that
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“Iliosacral bridging” - A new alternative minimal invasive fixation of unstable pelvic ring fractures

“Iliosacral bridging” - A new alternative minimal invasive fixation of unstable pelvic ring fractures

In order to analyze outcomes and recognize the extent of clinical symptoms as well as evaluating social factors, a detailed examination of the body took place and standardized questionnaires were applied. Corresponding symptoms of pain of the distal lumbar spine and the pelvis were found, functional impairments, neurological- sensomotorical de icits and additional urological and sexual dysfunction (pre- and postoperative). In addition restrictions in profession, sport and leisure activities as well as social reintegration after the operative treatment were documented. Implementation of x-ray then was performed during follow-up making an a.p.– radiograph of the pelvis as well as inlet and outlet images of the pelvis. The diagnosis was done by an independent investigator with the focus on dislocation of the posterior pelvis as well as dislocation of the ischiopubic bone and also of the anterior pelvis ring. The gained results were validated against the pelvis-outcome-scores.
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Functional and Radiological Outcome of Schatzker type V and VI Tibial Plateau Fracture Treatment with Dual Plates with Minimum 3 years follow-up: A Prospective Study

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reduction and internal fixation, especially done through injured soft tissues have been associated major wound complications [2]. Various other methods of treatment have been described by various authors, each with its own merits and demerits [7]. The use of external fixators as mode of treatment often leads to joint stiffness because of delayed mobilization of knee joint [7]. Treatment by open reduction and internal fixation either with a single or dual plates through a single mid line incision causes extensive soft tissue injury of the proximal tibia, causing de-vascularization of the fracture fragments, thereby decreasing fracture healing and leading to risks of wound complications [8]. In order to improve outcome of high-energy tibial plateau fractures treatment, fixation using double buttress plates via a medial and a lateral incisions is been widely used. This technique leads to anatomic joint reduction and minimal soft tissue dissection and its associated complications and therefore adequate fixation of the fracture fragments, hence allowing early mobilization of knee joint [6].
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A Study of Functional Outcome of Proximal Tibial Fractures Treated by Internal Fixation using Plateosteosynthesis

A Study of Functional Outcome of Proximal Tibial Fractures Treated by Internal Fixation using Plateosteosynthesis

The proximal tibial plateau fractures with extension into articular surfaces are difficult to treat. Factors like Skin conditions, age, osteoporosis and compartment syndrome are of important concern to surgeon as it determines the wound healing process. Most of the proximal tibial fractures are due to fall from height and high speed velocity road traffic accidents. It results from direct axial compression, usually with a varus and valgus moment and also indirect shear forces 1 .

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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

Fixation of the ulnar column was stressed for better function of the wrist and to avoid late distal radio ulnar instability 31,32 . Many studies revealed negative outcomes of distal radius fixation with untreated distal ulna fractures. Hence the classification of the distal ulna fractures came to vogue. Even separate classification for ulnar styloid fractures were proposed by Fernandez et al. The level of fracture has implications for management. The ulnar styloid fracture at the tip can be treated conservatively as only few ulnotriquetralfibres would be disrupted. The base of the styloid fractures with greater displacement along the line of the distal radius are to primarily fixed to achieve osteosynthesis to prevent later complications.
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