ABSTRACT
The current treatment of distal femur fractures includes locking plating and retrograde intramedullary nailing. These fractures are difficult to manage also for experienced surgeons, with results not always satisfactory. Reported nonunion rates now range from 0 to 34%. Factors associated with nonunion include comorbidities, such as obesity and diabetes, as well as the presence of open fractures, medial bone defects and comminuted fractures. This case report summarizes all of these assumptions and it concerns a 58 years old patient who underwent to 6 surgical procedures before to arrive to bone healing.
Subject(s)
Femoral Fractures/surgery , Fracture Fixation, Intramedullary , Fractures, Ununited/surgery , Fracture Fixation, Intramedullary/methods , Humans , Male , Middle Aged , Orthopedic Procedures/methodsABSTRACT
BACKGROUND AND AIM: Pelvic ring fractures represent a challenge for orthopaedic surgeon. Their management depends on patient's condition, pattern of fracture and associated injuries. Optimal timing for synthesis is not yet clear. The aim of this study was to define if surgical timing influenced clinic and radiographic outcomes following open reduction and internal fixation for Tile B and C fractures. MATERIALS AND METHODS: 38 patients were included. Patients underwent a clinical examination with the Majeed Score, Iowa Pelvic Score and Orlando Pelvic Score. The radiographic assessment was performed according to Matta Pelvic Score. A statistical analysis of the data compared patients who were operated within 3 weeks (group 1) and those operated later (group 2). RESULTS: Both clinical and radiological outcomes were influenced by timing of surgery. CONCLUSION: Pelvic ring fractures interest many polytrauma patients and, therefore, their surgical orthopedic approach is frequently delayed as consequence of the severity of the associated clinical conditions. An early surgery of pelvic rong fractures allows a better quality of reduction and osteosynthesis.
Subject(s)
Fracture Fixation, Internal , Fractures, Bone/surgery , Open Fracture Reduction , Pelvic Bones/injuries , Pelvic Bones/surgery , Adult , Female , Fractures, Bone/diagnostic imaging , Humans , Male , Middle Aged , Pelvic Bones/diagnostic imaging , Radiography , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND AND AIM: There is a wide debate about the number, diameter and length of the syndesmotic screw and necessity and timing for its removal. The aim of this study is to determine whether functional and radiological outcomes differ in patients operated for Weber type B and C ankle fractures who had syndesmotic screws removed (group 1) compared to those who did not (group 2). Furthermore, authors want to define if it is really necessary to remove this device and its correct timing. MATERIALS AND METHODS: 90 patients were eligible for the study. The functional outcomes were analyzed 1 year after surgery using OMAS and AOFAS scores. Radiographic evaluation assessed the tibiofibular distance immediately and 12 months after surgery and fracture's healing. RESULTS: Clinical and x-rays results were similar in both groups at follow-up. DISCUSSION: Fractures with interruption of syndesmosis are lesions that, if not well treated, are complicated by joint stiffness, residual pain and post-traumatic osteoarthritis. Syndesmotic screw removal is not routinely performed, thus accepting the risk of rupture but avoiding a new surgery. CONCLUSIONS: Results observed suggest that syndesmotic screw removal is not necessary. If surgeon decide to remove this device correct timing is mandatory in order to obtain satisfactory long-term results.
