Functional outcome of resection versus reconstruction in mason II-III radial head fractures; a short-term prospective study

Objective: to compare the short-term functional outcome between resection and reconstruction in Mason Type II and Type III radial head fractures using Broberg and Morrey score

Methods: a prospective cohort study was conducted in the Department of Orthopedic Surgery of SMS Medical College and attached Hospitals. A total of 29 patients [15 in resection group, 14 in reconstruction group] between the age group of 20-60 years with Mason Type II and Type III fresh closed radial head fractures were included in the study. The functional outcome including the range of motion, extension lag and Broberg Morrey score were determined and compared between two groups

Results: the mean age of resection group was 44.5+/-6.6 years and mean age of reconstruction group was 37.1+/-6.2 years. The baseline characteristics . At 12-months follow-up, in Mason type II fracture, radial head reconstruction group with mean extension lag of 9.4+/-4.1 and mean Broberg Morrey score of 94.9+/-5.1 showed better results compared to radial head resection group with mean extension lag of 15.7+/-4.1 [p=0.022] and mean Broberg Morrey score of 88.3+/-5.1 [p=0.045] respectively. In Mason type III fractures, radial head resection with mean supination of 79.4+/-4.7, mean pronation of 74.4+/-4.1 and mean Broberg Morrey score of 89.8+/-6 showed better results when compared with radial head reconstruction group with mean supination of 64.2+/-4 [p<0.001], mean pronation of 59.2+/-8.4 [p=0.003] and mean Broberg Morrey score of 81.9+/-5 [p=0.031]

Conclusion: the procedure suggested in Mason type II, is reconstruction of radial head. In Mason type III due to difficulty in achieving anatomical reduction results were not good with reconstruction when compared with resection. We recommend radial head excision in Mason type III fractures where anatomical and stable fixation is not possible

Role of Joshi's external stabilization system with percutaneous screw fixation in high-energy tibial condylar fractures associated with severe soft tissue injuries / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>The treatment of high-energy tibial condylar fractures which are associated with severe soft tissue injuries remains contentious and challenging. In this study, we assessed the results of Joshi's external stabilization system (JESS) by using the principle of ligamentotaxis and percutaneous screw fixation for managing high-energy tibial condylar fractures associated with severe soft tissue injuries.</p><p><b>METHODS</b>Between June 2008 and June 2010, 25 consecutive patients who were 17e71 years (mean, 39.7), underwent the JESS fixation for high-energy tibial condylar fractures associated with severe soft tissue injuries. Out of 25 patients, 2 were lost during follow-up and in 1 case early removal of frame was done, leaving 22 cases for final follow-up. Among them, 11 had poor skin condition with abrasions and blisters and 2 were open injuries (Gustilo-Anderson grade I&II). The injury mechanisms were motor vehicle accidents (n=19), fall from a height (n=2) and assault (n=1). The fractures were classified according to Schatzker classification system.</p><p><b>RESULTS</b>There were 7 type-V, 14 type-VI and 1 type-lV Schatzker's tibial plateau fractures. The average interval between the injury and surgery was 6.8 days (range 2-13). The average hospital stay was 13 days (range, 7-22). The average interval between the surgery and full weight bearing was 13.6 weeks (range 11-20). The average range of knee flexion was 121°(range 105°-135°). The normal extension of the knee was observed in 20 patients, and an extensor lag of 5°-8° was noted in 2 patients. The complications included superficial pin tract infections (n=4) with no knee stiffness.</p><p><b>CONCLUSION</b>JESS with lag screw fixation combines the benefit of traction, external fixation, and limited internal fixation, at the same time as allowing the ease of access to the soft tissue for wound checks, pin care, dressing changes, measurement of compartment pressure, and the monitoring of the neurovascular status. In a nutshell, JESS along with screw fixation offers a promising alternative treatment for high- energy tibial condylar fractures associated with severe soft tissue injuries.</p>

Management of neglected femoral neck fracture in above knee amputated limb: A case report / 中华创伤杂志(英文版)

The treatment of an above knee amputee who has sustained a fracture of the femoral neck is a chal- lenging situation for both the orthopedic surgeon and the rehabilitation team. These fractures may be managed acutely either by reduction and internal fixation or by endoprosthetic replacement based on the same criteria as in any other patient with otherwise intact limbs.We present a neglected case treated successfully with valgus osteotomy. We conclude that these fractures should be treated with the same urgency and expertise as similar fractures in non-amputees as long-term survival and good quality of life can be expected.

A bony foreign body found in a patient with no bony injury: a case report / 中华创伤杂志(英文版)

Open fractures with bone loss are a common occurrence following high energy trauma. But usually the bone fragments are lost on the roadside and are not usable. We report a patient who was involved in a head-on collision between two wheelers and presented with a bone fragment embedded in his thigh. Radiological survey revealed no bony injury in that patient. Another patient, who presented at the same time, sustained a segmental fracture of shaft femur and was found to have lost a bone fragment that was similar to the one found in previous patient. CT scan with 3D reconstruction revealed this missing fragment to be the same as that found in previous patient. Both patients had a history of head-on collision while travelling on a two-wheeler. Present case report throws some highlights on the probable mechanism of injury.