Un-United Fracture Neck Femur Results of Treatment with Close Reduction, Cancellous Screw Fixation & Fibular Strut Graft

Background: Ununited, femur neck fractures are a common problem in the developing countries like India where medical facilities are already deficient and ignorance, illiteracy and poverty further delay the patients in seeking proper treatment. The struggle to find the best treatment continues as relentlessly as it did half a century ago. The study was undertaken to evaluate the results of close reduction, cancellous screw fixation and fibular graft in ununited fractures of femoral neck in young adults with regards to achievement of fracture union, effect of this procedure on pre-existing AVN and establishment of relatively easy new surgical technique. Materials & Methods: This study was conducted in Government hospital, Pali, Rajasthan. It includes 25 cases treated by close reduction, cancellous screw fixation and fibular strut graft who have non-united fracture. The patients are systemically interrogated for personal details, mode of injury, time elapsed after injury, complaints, any other associated injury, any previous treatment taken and other systemic illness. Grading of fracture (Garden’s classification) resorption of neck and avascular necrosis changes are based on roentgen graphic findings. Results: Our study showed that the mean age of patients was 35.19 years and maximum patients were seen in 21-40 years of age (72%), male to female ratio was 2.57:1. Average union time in our series was 19 weeks. In present series good to excellent results found in 96% of cases; in only one case (4%) result was poor that was because of failure of procedure. Conclusion: We concluded that the cancellous screws fixed in closed reduced fracture and supplemented with fibular strut graft is one of the good methods as far as union and functional results are concerned in ununited fractures of femoral neck.

Un-united Fractures of Femoral Neck Treatment Modalities in Young Adults: A Hospital Based Study in Udaipur

Background: Neglected, femur neck fractures are a common problem seen in the developing countries like India where medical facilities are still in developing stage especially in rural area, where illiteracy and poverty is predominant. The study was undertaken to evaluate the results of close reduction, cancellous srew fixation and fibular graft in ununited fractures of femoral neck in young adults with regards to achievement of fracture union, effect of this procedure on pre-existing AVN and establishment of relatively easy new surgical technique. Material & Methods: This study was conducted in Department of Orthopaedics, Pacific Medical College and Hospital, Udaipur, Rajasthan. This prospective study included 20 cases during 3 months study period (March 2016 and May 2016) treated by close reduction, cancellous screw fixation and fibular strut graft who have non- united fracture. The patients are systemically interrogated for personal details, mode of injury, time elapsed after injury, complaints, any other associated injury, any previous treatment taken and other systemic illness. Grading of fracture (Garden’s classification) resorption of neck and avascular necrosis changes are based on roentgen graphic findings. Results: Our study showed that the mean age of patients was 38.78 years and maximum patients were seen in 21-35 and 36-50 years of age (72%). Average union time in our series was 20 weeks. In present series good to excellent results found in 92% of cases; in only one case (8%) results was poor that was because of failure of procedure. Conclusion: We concluded that the cancellous screws fixed in closed reduced fracture and supplemented with fibular strut graft is one of the excellent method as far as union and functional results are concerned in ununited fractures of femoral neck.

A clinical comparative study of tibia fracture treated by intrmedullary nail using limited incision or close reduction / 西安交通大学学报(医学版)

Objective To discuss the clinical therapeutic effect of tibia fracture treated by intramedullary nail using limited incision or close reduction.Methods We treated 54 tibia transverse fracture cases,93 oblique fracture cases, 7 1 fragmental fracture cases by intramedullary nail using open with limited incision or close reduction.We then compared operation time,X-ray time,hospital stay duration,infection rate,nonunion rate, and postoperative function restoration between patients with different fractures.Results There was no different operation time in transverse fracture group,but longer for close reduction in oblique fracture group and for open reduction in fragmental fracture group.X-ray time did not differ for open or close reduction in transverse fracture group.Long X-ray time was used in close reduction in oblique and fragmental fracture groups.There was no significant difference in nonunion rate for open and close reduction in both transverse and fragmental fracture groups.The oblique fracture nonuinon rate was higher in close reduction group than in open reduction group.No difference was found in infection rate or function recovery whether for open or close reduction in all types of fractures.Conclusion Different therapy methods should be determined by different fracture types.Open reduction with minimal incision should be used for oblique fracture cases and fragmental fracture cases with reduction difficulty.

Anterolateral minimally invasive plate osteosynthesis technique for distal humeral shaft fracture / 中南大学学报(医学版)

Objective: To evaluate the clinical effcacy of the modiifed anterolateral minimally invasive plate osteosynthesis technique for distal humeral shaft fracture, and to explore its feasibility, security, advantage and disadvantage. Methods: hTe clinical effcacy of 17 patients with distal humeral shatf fracture, who were treated with the anterolateral humerus minimally invasive plate osteosynthesis during 2009 to 2012, were retrospectively analyzed. hTe operative time, bleeding volume, complications, esseous union time and range of motion (ROM) of elbow were recorded, and the functional outcome of elbow joint was evaluated by Mayo elbow performance score (MEPs). The varus angle was measured in the malunion patients atfer the distal humeral shatf fracture healed. Results: All of the 17 patients obtained bony union at an average of 19.2 weeks postoperatively, an average of 4.5 screwes were inserted in distal humerus. hTe mean ROM of elbows was 133° and the MEPS were 98.2. Seven patients suffered humeral malalignment and the mean varus degrees were 8.3°. Conclusion: hTe technique of anterolateral humerus minimally invasive plate osteosynthesis is safe and feasible for distal humeral shatf, and the satisfactory clinical outcomes can be obtained by this modiifed technique. However, some of the patients may appear malunion with varus angulation of humerus.

Analysis of Surgical Treatment and Factor Related to Closed Reduction Failure for Patients with Traumatically Locked Facets of the Subaxial Cervical Spine

PURPOSE: Cervical dislocations with locked facets account for more than 50% of all cervical injuries. Thus, investigating a suitable management of cervical locked facets is important. This study examined factors of close reduction failure in traumatically locked facets of the subaxial cervical spine patients to determine suitable surgical management. METHODS: We retrospectively analyzed of the case histories of 28 patients with unilateral/bilateral cervical locked facets from Nov. 2004 to Dec. 2010. Based on MRI evaluation of disc status at the injury level, we found unilateral dislocations in 9 cases, and bilateral dislocations in 19 cases, The patients were investigated for neurologic recovery, closed reduction rate, factors of the close reduction barrier, fusion rate and period, spinal alignment, and complications. RESULTS: The closed reduction failed in 23(82%) patients. Disc herniation was an obstacle to closed reduction (p=0.015) and was more frequent in cases involving a unilateral dislocation (p=0.041). The pedicle or facet fracture was another factor, although some patients showed aggravation of neurologic symptoms, most patients had improved by the last follow up. The kyphotic angle were statistically significant (p=0.043). Sixs patient underwent anterior decompression/fusion, and 15 patients underwent circumferential fusion, and 7 patients underwent posterior fusion. All patients were fused at 3 months after surgery. The complications were 1 case of CSF leakage and 1 case of esphageal fistula, 1 case of infection. CONCLUSION: We recommend closed reduction be performed as soon as possible after injury to maximize the potential for neurological recovery. Patients fot whom closed reduction of the cervical locked facets have a higher incidence of anatomic obstacles to reduction, including facet fractures and disc herniation. Immediate direct open anterior reduction or circumferential fixation/fusion of locked cervical facets is recommended as a treatment of choice for traumatic locked cervical facet patients after closed reduction failure.

Open versus closed reduction of mandibular condyle fractures: A systematic review of comparative studies

Objective: The objective of this review was to provide reliable comparative results regarding the effectiveness of any interventions either open or closed that can be used in the management of fractured mandibular condyle PATIENTS AND METHODS: Research of studies from MEDLINE and Cochrane since 1990 was done. Controlled vocabulary terms were used. MeSH Terms were "Mandibular condyle" AND "Fractures, bone". Only comparative study were considered in this review using the "limit" function. According to the criteria, two review authors independently assessed the abstracts of studies resulting from the searches. The studies were divided according to some criteria, and following were measured: Ramus height, condyle sagittal displacement, condyle Towns's image displacement, Maximum open length, Protrusion & Lateral excursion, TMJ pain, Malocclusion, and TMJ disorder. RESULTS: Many studies were analyzed to review the post-operative result of the two methods of treatment. Ramus height decreased more in when treated by closed reduction as opposed to open reduction. Sagittal condyle displacement was shown to be greater in closed reduction. Condyle Town's image condyle displacement had greater values in closed reduction. Maximum open length showed lower values in closed reduction. In protrusive and lateral movement, closed reduction was less than ORIF. Closed reduction showed greater occurrence of malocclusion than ORIF. However, post-operative pain and discomfort was greater in ORIF. CONCLUSION: In almost all categories, ORIF showed better results than CRIF. However, the use of the open reduction method should be considered due to the potential surgical morbidity and increased hospitalization time and cost. To these days, Endoscopic surgical techniques for ORIF (EORIF) are now in their infancy with the specific aims of eliminating concern for damage to the facial nerve and of reducing or eliminating facial scars. Before performing any types of treatment, patients must be understood of both of the treatment methods, and the best treatment method should be taken on permission.

Long term curative effect for DDH treatment by combined close-reduction in children between 18~36 months old / 中国矫形外科杂志

[Objective]To evaluate long term curative effect on treatment of developmental dislocation of hip(DDH) in children between 18~36 months old by combined close-reduction method of adductor-cut,close-reduction and frog type plaster fixation.[Method]One hundred and fifty-six children(232 hips) treated by combined close-reduction method in 1993 to 2001 were followed-up with mean follow-up time of 9.2(5.5~14.5) years.There were 77 hips of grade Ⅰ dislocation,95 hips of grade Ⅱ,and 60 hips of grade Ⅲ according to Zhou Yongde grading criteria.Periodical imaginological and hip joint function examinations were evaluated and analyzed.[Result]One hundred and ninety-five hips obtained satisfactory concentric reduction with excellent and good rate of 84.05% according to Zhou Yongde criteria.There were 9 hips with femoral head necrosis at follow-up.Mean preoperative acetabular index(AI) of successful reduction hips was(35.34?5.96)%,and that of failure reduction hips was(44.51?5.32)%.The excellent and good rate were 84.41% in cases of grade Ⅰ hips,85.21% in grade Ⅱ hips,and 81.67% in grade Ⅲ hips.[Conclusion]Combined method of adductor-cut,close-reduction and frog type plaster fixation is an effective way for treatment of DDH of children between 18~36 months old.Preoperative AI but not degree of dislocation is the criteria to determine whether close-reduction is necessary or not.

Treatment of Lisfrance injuries by close reduction and percutaneous screw fixation / 中华创伤骨科杂志

Objective To report the clinical results of treatment of tarsometatarsal joint injuries by close reduction and percutaneous screw fixation. Methods From January 2003 to June 2005, 26 cases of tarsometatarsal joint injuries were treated with close reduction and percutaneous screw fixation. They were 13 cases of middle column injury, seven cases of medial-middle column injury and six cases of three-column injury according to Myerson’ s classification. Results In this series all the wounds healed primarily with a mean operative time of 40 min ( 30 to 70 min) and a mean incision length of 5 mm. A mean follow-up of 11.4 months (ranging from 6 to 17 months) revealed a mean score of 87 according to American Orthopaedic Foot & Ankle Society (AOFAS) midfoot scoring system. All the patients returned to normal daily life after a mean time of 5.3 months (3 to 11 months). Conclusions Tarsometatarsal joint injuries can be treated well by close reduction and percutaneous screw fixation with less operative lesion and lower incidence of soft tissue complications. Reduction of the middle column with screw insertion along the direction of the Lisfranc ligament is the key to reestablishment of the stability of the tarsometatarsal joint complex.

Close-reduction and percutaneous fixation of pelvi-acetabular fractures with fluoro-navigation / 中华创伤骨科杂志

Objective To explore the application of fluoro-navigation in close reduction and fixation of pelvi-acetabular fractures. Methods After imaging reconstruction from plan X-rays and CT tomographs, close reduction and fixation of pelvi-acetabular fractures were conducted under fluoro-navigation based on the indications. If the reduction was found satisfactory, surgical planning was discussed together with the patients. Results No complications occurred among patients with pelvi-acetabular dislocation. Apart from few cases postoperative CT scan showed satisfactory crew fixation. Conclusion The current experiences suggest that the fluoro-navigation is indicated for fixation of pelvi-acetabular fractures with close reduction.

Is closed reduction and interlocking intramedullary nailing fit for the treatment of fractures of humeral shaft with radial nerve injury? / 中华创伤骨科杂志

Objective To study whether closed reduction and interlocking intramedullary nailing will worsen the injured radial nerve associated with the fracture of humeral shaft.Methods Of the 353 patients with fracture of humeral shaft who received operation from January 2002 to January 2005,63 ones were complicated with preoperative injury to their radial nerve.A retrospective analysis was done of their physical examination records, operative records,X-ray films and results of the treatment.Eleven cases were treated with closed reduction and interlocking intramedullary nailing,and 52 cases with open reduction and internal fixation of plates and screws fol- lowed by exploration to the radial nerve.Chisquare test of PEMS 3.1 system was adopted to analyze the clinical data. Results The radial nerve was embedded by the fracture ends in nine cases(17.3%)of the 52 cases,and con- tused in the other 43 ones.In the 63 cases,The injured nerves recovered spontaneously 2 to 12 weeks postoperatively except in twn cases.All the eases got bony union 3 to 4 months after operation.Closed reduction and interlocking intramedullary nailing has hardly more harmful effects on the injured radial nerve assoeiated with the fracture of humeral shaft than open reduction and internal fixation of plates and screws followed by neural exploration.Con- clusion Closed reduction and interlocking intramedullary nailing is fit for the freatment of fractures of humeral shaft with radial nerve injury.

Effect of Treatment of Tibia and Fibula Fracture with internal Fixation of Fibula / 中华创伤骨科杂志

Objective To study the effect of internal fixation of fibula on treatment of tibia and fibula unstable fractures. Methods 50 cases with middle and lower 1/3 fractures of tibia and fibula were treated with internal fixation of fibula and close reduction and external stabilization of tibia. Fibula was stabilized with plate and screw or intramedullary nail. Results All the 50 cases of the fracture achieved clinic union, reduction was satisfactory, and the average time of clinical union was 5 months. The functions of the joint were normal. No skin necrosis or infection occurred. Conclusion Fixation of fibula is suitable for treatment of close fracture combined with local skin injury or open fractures of tibia and fibula and lower 1/3 comminuted fracture of tibia combined with fibula fracture.