ABSTRACT
@#Introduction: Clavicle fractures are frequently encountered by orthopaedic surgeons. Though multiple treatment techniques have been described in literature, open reduction and internal fixation with plating and intramedullary nailing are preferred in adults. This study analyses the functional outcome, complications, duration of bony union of mid-shaft clavicle fractures treated with plate fixation versus intramedullary fixation. Materials and methods: A quasi- experimental study was conducted on 38 patients with mid-shaft clavicle fracture aged between 18 to 60 years at a tertiary care centre in South India. Nineteen patients were treated by plate fixation and 19 patients underwent intramedullary nail fixation. Every alternate patient with mid-shaft fracture clavicle was treated with plate osteosyntheses or nailing. Results: The average age of presentation was 42 years in plate fixation and 31 years in nail fixation group. Robinson’s classification type 2B1 was the most common type of fracture in both groups. The Visual Analogue Scale (VAS) score reduced significantly from pre-operative to postoperative day 1 in both the groups but there was no significant difference between the two groups. The Disabilities of the Arm, Shoulder and Hand (DASH) score at 6, 12 and 24 weeks reduced significantly in both the groups but showed no statistically significant difference between the two groups. However, intramedullary nail fixation group had a shorter duration of hospital stay and showed an earlier improvement in the DASH score during the first six months after surgery. Complications included implant loosening (three patients) in plating group and implant failures (two cases) in nailing group. Conclusion: There is a role for surgical intervention for certain cases of displaced and comminuted clavicle fracture in order to avoid malunion or non-union and their potential long-term sequelae. Both the surgical modalities of plating, and nailing provide good functional outcome and allow early return to occupational activities.
ABSTRACT
Introducción El presente estudio de casos revela los avances tecnológicos en el tratamiento de las fracturas de mano realizados por el grupo de investigación F-CIBER-HAND en Manizales, Colombia; integra la intervención quirúrgica practicada por el cirujano ortopedista de mano, la movilización temprana indicada por Fisiatría, la rehabilitación convencional por fisioterapeuta especializada en Ortopedia y Traumatología, y la terapia de movilización pasiva mediante ortesis robóticas. Materiales y métodos Se seleccionaron cuatro pacientes: paciente con fractura intraarticular compleja de la cabeza del quinto metacarpiano de la mano derecha; paciente con fractura conminuta de la base del cuarto metacarpiano de la mano izquierda; paciente con fractura diafisiaria del quinto metacarpiano de la mano derecha, y paciente con fractura subcapital del segundo metacarpiano de la mano izquierda, los cuales fueron tratados de acuerdo con los cuatro momentos terapéuticos descritos, con seguimiento de su evolución clínica individual. Resultados En todos los pacientes se ponen de manifiesto la recuperación funcional de la mano según la Escala de Discapacidades del Hombro, el Codo y la Mano (DASH), la disminución de la intensidad del dolor según la Escala Visual Análoga del Dolor (EVA) y la recuperación del arco de movilidad articular; además, todos los pacientes retornaron a las actividades de la vida diaria y laborales. Discusión Se concluye que con el manejo quirúrgico especializado y la rehabilitación temprana complementada con ortesis robóticas, se mejoró la funcionalidad de la mano, disminuyó el dolor, hubo ganancia del arco articular y reinserción a las actividades cotidianas. El propósito del estudio es generar evidencia clínica de que el manejo interdisciplinario especializado y el uso de ortesis robóticas mejora la condición clínica de los pacientes con fracturas de la mano. Nivel de evidencia clínica nivel IV.
Background The present cases study reveals technological advances in the treatment of hand fractures performed by the F-CIBER-HAND research group in Manizales - Colombia, integrating the surgical intervention by Hand Orthopedic Surgeon, early mobilization Indicated by Physiatry, the conventional rehabilitation by Physiotherapist specialized in Orthopedics and Traumatology, and passive mobilization therapy whit robotic orthoses. Materials and methods Four patients were selected: patient with complex intra-articular fracture in the head of the 5th right metacarpal, patient with a fracture in the base of the 4th left metacarpal, patient with diaphyseal fracture of the 5th right metacarpal, and patient with subcapital fracture of the 2nd left metacarpal, who were treated according to the four therapeutic moments described, with follow-up of their individual clinical evolution. Results In all patients was evident functional recovery of the hand according to the DASH scale, decrease of pain intensity according to analogous visual scale, and recovery of the joint mobility arc. In addition, all the patients returned satisfactorily to the daily life activities and jobs. Discussion It was concluded that with specialized surgical management and early rehabilitation complemented with robotic orthoses, the functionality of the hand was improved, pain decreased, there was gain of the articular arch and reinsertion to daily activities. The purpose of the study is to generate clinical evidence that specialized interdisciplinary management and the use of robotic orthoses improve the clinical condition of patients with hand fractures. Evidence level IV.
Subject(s)
Orthotic Devices , Upper Extremity , Animal Shells , HandABSTRACT
@#plate osteosynthesis depends on the quality of the bone,design of the fixation devices and intra-operative soft tissuedissection. This study evaluates the functional outcome ofminimally invasive percutaneous plate osteosynthesis usinglocking compression plate in proximal humerus fracturetreatment. MaterialsandMethods:The study was conducted on 30patients with complex proximal humerus fractures treated byminimally invasive percutaneous plate osteosynthesis usinglocking compression plate (PHILOS). There were 21 malesand 9 females. The average age of our study group was 58.8years. All the patients were evaluated at six weeks, threemonths, four months, six months and 12 months followingsurgery. Results:All patients had fracture union at an average of 13.2weeks. The mean DASH score at the follow-up was 8.69 (2.5to 17.16), the average range of flexion was 143.83 degrees(100 to 170 degrees) and abduction was 121.49 degrees (90to 160 degrees). We had superficial infection in three patientswhich resolved with a short course of antibiotics. There wasexcellent outcome in 26 patients, good and fair in twopatients each. Conclusion:Proximal humerus fractures treated withminimally invasive percutaneous plate osteosynthesis usinglocking compression plate with minimal soft tissuedissection, provides good functional outcome and earlyreturn of shoulder function.
ABSTRACT
One of the points made against nailing in radius and ulna shaft fractures has been the loss of radial bow and its impact on function. The aims of the study were to assess the change in magnitude and location of the radial bow in radius and ulna shaft fractures treated with intramedullary square nails and to assess the impact of this change on functional outcome, patient reported disability and the range of motion of the forearm. We measured the magnitude of radial bow and its location in the operated extremity and compared it to the uninjured side in 32 adult patients treated with intramedullary square nailing for radius and ulna shaft fractures at our institute. The mean loss of magnitude of maximum radial bow was 2.18 mm which was statistically significant by both student-T test and Mann-Whitney U test with p value less than 0.01. The location of maximum radial bow shifted distally but was statistically insignificant. The magnitude of maximum radial bow had a negative correlation with DASH score that was statistically insignificant (R=- 0.22, p=0.21). It had a positive, statistically significant correlation to the extent of supination in the operated extremity (R = 0.66, p = 0.0004). A loss of up to 2mm of radial bow did not influence the functional outcome as assessed by criteria reported by Anderson et al. The magnitude of radial bow influenced the supination of the forearm but not the final disability as measured by DASH score. Intramedullary nailing did decrease the magnitude of radial bow but a reduction of up to 2mm did not influence the functional outcome.