Top PDF Outcome of Infection Following Internal Fixation of Closed Fractures

The breakdown of the infected bone were 19 femur, 8 tibia, 2 radius and 1 ulna. Twenty-five infected fractures were in the diaphysis while 5 were in the metaphysis. Fourteen (47%) were simple fractures while 16 (53%) were comminuted fractures. Of the 30 cases infected, eight were associated with intramedullary nails and 22 were plates (Table Ill). Seventeen patients presented during the subacute phase as compared to 13 who presented during the acute phase. There were 8 patients with florid infection as compared to 22 who presented with low grade infection. (Table III) Staphylococcus aureus was identified in 24 (80%) patients, of which 14 (54%) were Methicillin Resistant Staphylococcus aureus (MRSA). In 3 (10%) patients the culture failed to grow any organisms. Mixed gram negative Bacillus was cultured from 2 (7%) patients which probably represented contaminated specimens. Pseudomonas aeroginosa were cultured in 3 (10%) patients. Other organisms cultured were Klebsiella species in one patient and Enterobacter species in one patient. (Table Il)

This study found a low incidence of infections following surgical management of tibia fractures in a cohort of 787 participants in India. The incidence of infection for closed and open fractures was 1.6% and 8.0%, respect- ively. These incidences are similar to those seen in the largest investigation of tibia shaft fractures in developed countries, which were 1.9% in closed fractures and 8.8% in open fractures [10]. This result is surprising, as many study participants had injuries resulting from motor ve- hicle accidents (71.4%), experienced long times to sur- gery (64 h for open and 76 for closed fractures), and did not have health insurance (<20% had insurance). The typical time between injury and surgery in developed countries for open fractures has been reported to be 9.8 h, which is drastically shorter than the mean time to surgery of 64 h for open fractures observed within this study [11]. Contributing factors may include patients liv- ing in rural areas of India unable to travel to a hospital in an appropriate time, as well as patient overcrowding in a hospital. Overcrowding can result in delayed treat- ment, long patient waiting time and stay, overburdened working staff, and poor patient outcomes [12]. Despite these factors, one possible explanation for the low inci- dence of infection seen in our study is that participants received prophylactic antibiotics for a mean of 8.3 days in closed fractures and 9.1 days in open fractures, which is much longer than North American standard practice [13–15]. The typical length of prophylactic antibiotic use for tibia fractures in the literature ranges from 1 – 5 days, demonstrating an extended length of prophylactic anti- biotic use seen within our cohort [15, 16]. However, this is specific to open fractures in India without evidence of use in closed fractures. The widespread and prolonged use of prophylactic antibiotics within this study may be Table 4 Method of Fixation for AO Fracture Types

Management of hip fractures is based on individual patient factors such as pre-injury ambulatory status, age, cognitive function, and co-morbidities, and on fracture factors including fracture type and the degree of displacement. Treatment options include nonsurgical management, percutaneous fixation, closed reduction and internal fixation, open reduction and internal fixation (ORIF), and arthroplasty (i.e, hemiarthroplasty, total hip replacement). Despite the variety of treatment options available, the question remains: What is the best treatment of intracapsular hip fractures in elderly patients? Hip fractures are probably most feared and devastating consequence of osteoporosis in elderly population and a major International Journal of Current Research

Many clinical studies have been published to report the clinical outcomes of orthopaedic surgeries in HIV-positive patients. Some authors suggest that HIV-positive patients have higher rates of wound infection and nonunion than HIV negative patients after internal fixation. [1,6] However, in a study of 42 HIV-positive patients, Hao 7 suggests that HIV infection does not correlate with a higher rate of postoperative infection and fracture nonunion. Li also advocates that the wound in HIV positive patients can be normally healed and no infection occur in most of patients. [3] In addition, some authors suggest that implant sepsis may occur after internal fixation, demonstrating that removal of implants in HIV- positive individuals should be considered, [5,8] but in another study of 91 HIV-positive patients, Graham concluded that it was safe to perform internal fixation and no increased risk of implant sepsis was detected. [9] Apparently, controversies are common.

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: Lateral condyle fractures of the distal humerus are the second most common fractures at the elbow in the paediatric population usually between the ages of 6-10 years old making up 5-20% of fractures in children. The aim of the present study was to assess the early results of patients with a displaced lateral humeral condyle fracture treated with open reduction and internal fixation. Methods: Our clinical trial was conducted involving 12 patients treated with open reduction and internal fixation (ORIF). Preoperative stage included clinical evaluation, routine investigations and radiological evaluation. Fractures were classified using the Milch. Patients were followed up weekly until radiological union of the fracture was evident. Results: 83.3% of our patients were males, while 16.7% were females. According to mechanism of injury, falling down continues to play a major role in causing disability. At (3-5) weeks all cases were with soft callus remove K wire; at 8 weeks, all cases were with union fracture; but at 12 weeks, one case (8.3%) was with mild stiffness and the rest was with full range of motion. As regards the carrying angle in our study, only 16.7% were with abnormal carrying angle. 33.3% were complicated; one case with mild limitation of motion and valgus; one case with varus and two cases with superficial infection. Conclusions: The open reduction and internal fixation of lateral humeral condyle fracture is the ideal treatment and it has a rate of complications.

There was evidence that the LEFS might be bi- dimensional in this group of patients which contrasts with it is use in applications as a unidimensional measure of lower extremity function. Exploratory factor analysis (data not shown) showed that the items loaded onto two clearly discernible factors relating to easier and more difficult aspects of function which gave better results in the CFA. The LEFS with 20 items, is a good deal longer than the OMAS and SEFAS and such a lengthy instrument that assesses one aspect of health is unusual for PROMs. The OMAS and SEFAS are shorter, have acceptable levels of internal consistency, test-retest reliability and the SEFAS has a lower SEM and hence is more capable of measuring change in individuals and groups of patients.

In this series of prospective study, 20 cases of supracondylar fractures Type II and Type III were managed out of which 10 cases were treated by Open Reduction and Internal Fixation, and the other 10 cases were treated by Percutaneous pinning. The study was carried out from June 2008 to October 2010, at the Department of Orthopaedic Surgery and Traumatology, Government Royapettah Hospital, Chennai. The cases were included in the study, depending on the following inclusion and exclusion criterias.

This is to certify that this dissertation in “PROSPECTIVE STUDY OF FUNCTIONAL OUTCOME OF CLOSED SCHATZKER TYPE V AND TYPE VI TIBIAL PLATEAU FRACTURES MANAGED BY OPEN REDUCTION AND INTERNAL FIXATION” is a bonafide work done by Dr. K. R. KANNAN under my guidance during the period June 2006 – November 2008. This has been submitted in partial fulfillment of the award of M.S. Degree in Orthopedic Surgery (Branch – II) by the Tamilnadu Dr. M.G.R. Medical University, Chennai.

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.

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.

Methods/Design: This multicentre randomised controlled trial will randomise between open reduction and internal plate fixation (intervention group) and closed reduction and plaster immobilisation (control group). All consecutive adult patients from 18 to 65 years with a displaced intra-articular distal radius fracture (AO/OTA type C), which has been adequately reduced at the Emergency Department according to the Dutch National Guidelines, are eligible for inclusion in this study. The primary outcome is function and pain of the wrist assessed with the Patient-Rated Wrist Evaluation score (PRWE). Secondary outcomes are the Disability of the Arm, Shoulder and Hand score (DASH), pain, quality of life (SF-36), range of motion, grip strength, radiological parameters, complications, crossovers and cost-effectiveness of both treatments. A total of 90 patients will be included in this study.

The goals of the treatment should be anatomic reconstruction of articular surface and early mobilisation. This goal can be achieved only when acetabulum is adequately exposed and rigid internal fixation is done. Displaced fractures of the pelvis that involve the acetabulum are difficult to treat. With closed methods, it is difficult, if not impossible, to restore the art icular surfaces completely and obtain sufficient stability for early motion of the hip.

The operative treatment of bone fractures using plates and screws is a standard successful technique. Internal fixation with plates and screws leads to additional trauma and disturbance of the bone blood supply, which increases the risk of delayed union and infection. However, problems also are encountered in the fixation of osteoporotic bone. The locked internal fixator technique is an approach to optimize internal fixation. It aims at flexible elastic fixation to imitate spontaneous healing, including induction of callus formation. The technology supports what is currently called "minimally invasive plate osteosynthesis" (MIPO), which provides priority to biology over mechanics. An implant system called "Locking Compression Plate (LCP)" was developed, 7 based on many years

During 12 months from June 2010 through May 2011 adult patients between 18 and 70 years, presenting with acute, closed and unstable proximal tibial fractures which required both grafting and internal fixation, were included in a prospective study with percutaneous or open reduction and internal fixation (ORIF) augmented with an injectable ceramic biphasic bone substitute CER- AMENT™|BONE VOID FILLER (BONESUPPORT™, Lund, Sweden) to fill residual gaps. Excluded from the study were patients with metabolic bone disease, type 1 diabetes or uncontrolled type 2 diabetes, malignancy or on treatment with systemic steroids or immunosuppres- sive therapy, infection at the operative site, concurrent treatment with other bone substitutes including auto- graft, peripheral vascular disease, alcoholism, substance abuse, correlated peripheral nerve damage, pregnancy or breast feeding or fertile women not on routine contra- ceptive control, a history of anaphylactic reaction to

fracture line, and we believe that the compression force from parallel screws in Pauwels’ type II fractures pro- vides optimum efficiency (vs. type I and type III cases), which can promote fracture healing and bone consolida- tion. Furthermore, excessive alcohol consumption has been identified as a risk factor for suboptimal outcomes in previous reports [6], and our findings support this re- lationship among middle-aged patients. For example, 28% of the patients with complications in the acceptable reduction group reported excessive alcohol consump- tion, and none of the patients who achieved optimal out- comes reported excessive alcohol consumption. We believed that the concurrent physiological and psycho- logical problems associated with alcohol abuse may lead to poor compliance and a high failure rate. Therefore, it is essential to consider the high risk in these patients, and other treatment options should be considered if sur- gery is indicated in these patients.

In our series we studied 26 cases out of them most of patients fall into type II, type V, and Type VI schatzker classification. Different authors use different criteria for the operative management of proximal tibial plateau fractures. SEPPO E. Honkonen conducted 131 tibial plateau plateau fractures taking into following consideration of all medial condylar fracture, lateral condyle step up off more than 3mm, Condylar widening of more than 5mm.

The distal third of the fibula has a major role in the structural integrity of the ankle joint. It is securely attached to the distal end of tibia through the ligaments of the anklesyndesmosis- the anterior and posterior distal tibiofibular ligaments, the inferior transverse ligament, and the interosseous ligament – as well as through the distal interosseous membrane. Disruption of these ligaments 19,38 , with resultant loss of fibular support for the talus, may occur in association with tibial shaft fractures. Therefore the integrity of the ankle joint should always be assessed in patients with tibial fractures.

Attempts at internal fixation date back to isolated cases as early as 1850 12 . Senn made a plea for internal fixation of femoral neck fractures when reporting his results from canine trials in 1877 19 , but after his argument was largely rejected by the surgical community, he reverted to advocating closed reduction and impaction. In 1916 Hey Groves initiated use of his quadra- flanged nail the results of which were published in 1926 20 . Despite the publicity this received, the most widely used internal fixation through the early part of the 20th century were “bone pegs”—crude intra- medullary devices of ivory or beef bone used to keep the fracture ends roughly aligned 3 .

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.