Description of unusual osteochondral laminar fragment patterns in Distal Radius fractures.

BACKGROUND: Distal radius fracture (DRF) is one of the most common fractures and, frequently, surgical treatment is mandatory in the presence of an intra-articular fracture. However, there are some unusual intra-articular fracture patterns, were it remains challenging to properly recognize and anatomically reconstruct the articular surface. The objective of the present study is to describe an intra-articular fracture pattern of the distal radius characterized by the presence of osteochondral laminar fragments, which could potentially require a different treatment to standard stabilization. We aim to answer the following questions: (1) What are the radiological characteristics of intra-articular DRFs with osteochondral laminar fragments (OCLF), (2) What is the prevalence of DRFs with OCLF relative to all intra-articular surgical DRFs, (3) What are the differences in epidemiological characteristics of patients with OCLF in relation to all patients with intra-articular DRFs, (4) What is the prevalence of intra-articular DRFs with OCLF in patients belonging to a closed community. PATIENTS AND METHODS: We reviewed radiological and tomographic records of all adult patients operated on distal radius fractures at our institution. We analyzed tomographic characteristics; prevalence of osteochondral laminar fragments relative to all intra-articular surgical distal radius fractures and compared clinical and demographic characteristics of patients with osteochondral laminar fragments in relation to all patients with intra-articular fractures. RESULTS: Two main groups according to the fracture pattern were described: group I, volar rim impacted OCLF (vOCLF); and group II, central impacted OCLF (cOCLF). Prevalence of OCLF relative to surgical intra-articular DRFs: 42/989 (4.2%); group I: 23/989 (2.32%); group II: 19/989 (1.92%). Characteristics of patients with OCLF compared to all patients with intra-articular DRFs: Significant differences were found in the five variables evaluated (age, less than 65 years, female, high energy fracture, and associated fractures). The global prevalence of DRFs with OCLF in patients affiliated with the medical care insurance system of our institution was 2 per 10,000 individuals (95% CI 1.4 to 2.9). DISCUSSION: Global prevalence of these fragments relative to surgical intra-articular fractures was very low. However, despite being epidemiologically rare, it is important to identify these specific fracture patterns because their treatment can be challenging. LEVEL OF EVIDENCE: IV (Observational/Descriptive); Cross sectional study.

El acortamiento del radio como factor limitante para la reducción cerrada en fracturas de antebrazo pediátrico / Radius shortening as a limiting factor for closed reduction in pediatric forearm fractures

IntroducciónLas fracturas diafisarias de antebrazo (FDA) en pacientes esqueléticamente inmaduros son lesiones comunes que representan el 30% de las fracturas de la extremidad superior en este grupo etario. Existen casos con lesiones inestables o reducciones inaceptables, en los cuales está indicada la resolución quirúrgica mediante la reducción y estabilización con clavos endomedulares elásticos (CEE) por vía percutánea. Una de las ventajas que ofrece este sistema es evitar un abordaje del foco de fractura, pudiendo realizar la reducción de forma cerrada en la gran mayoría de estas. Sin embargo, no siempre es posible lograr una aceptable reducción cerrada y entonces es necesaria la apertura del foco de fractura. El objetivo de este estudio fue determinar si existen factores preoperatorios para predecir la dificultad de efectuar una reducción cerrada en estos pacientes.MétodosSe realizó un estudio retrospectivo de pacientes esqueléticamente inmaduros con FDA agudas, tratados con CEE por el mismo cirujano pediátrico. La variable de resultado primaria se definió como la necesidad de llevar a cabo una reducción abierta; considerado como un abordaje quirúrgico directo en el sitio de fractura. Se analizaron las características demográficas de los pacientes incluidos y las radiográficas de la fractura.ResultadosEncontramos que la mediana del porcentaje del acortamiento del radio preoperatorio en los grupos de reducción cerrada y reducción abierta fue del 1 y 5%, respectivamente; resultando en una diferencia estadísticamente significativa (p = 0,04).ConclusiónEl acortamiento del radio en las radiografías preoperatorias permite predecir un aumento del riesgo de requerir una reducción abierta de la fractura (39% de asociación); por lo cual, esta variable debe ser considerada por el traumatólogo general como un factor pronóstico para definir la derivación de estos pacientes.(AU)

IntroductionDiaphyseal forearm fractures in skeletally immature patients are common injuries that account for 30% of upper extremity fractures in this age group. There are cases with unstable injuries or unacceptable reductions, in which surgical resolution by reduction and stabilisation with percutaneous elastic endomedullary nailing is indicated. One of the advantages of this system is that it avoids an approach to the fracture site, allowing closed reduction in the vast majority of fractures. However, it is not always possible to achieve an acceptable closed reduction and opening of the fracture site is necessary. The aim of this study was to determine whether there are preoperative factors to predict the difficulty of performing closed reduction in these patients.MethodsA retrospective study of skeletally immature patients with acute diaphyseal forearm fractures treated with elastic endomedullary nailing by the same paediatric surgeon was performed. The primary outcome variable was defined as the need for open reduction; considered as a direct surgical approach to the fracture site. Demographic characteristics of the included patients and radiographic characteristics of the fracture were analysed.ResultsWe found that the median percentage of preoperative radial shortening in the closed reduction and open reduction groups was 1 and 5%, respectively; resulting in a statistically significant difference (p = 0.04).ConclusionRadial shortening on preoperative radiographs predicts an increased risk of requiring an open reduction of the fracture (39% association); thus we understand that this variable should be considered by the general traumatologist as a prognostic factor in defining the referral of these patients.(AU)

Radius shortening as a limiting factor for closed reduction in pediatric forearm fractures / El acortamiento del radio como factor limitante para la reducción cerrada en fracturas de antebrazo pediátrico

IntroductionDiaphyseal forearm fractures in skeletally immature patients are common injuries that account for 30% of upper extremity fractures in this age group. There are cases with unstable injuries or unacceptable reductions, in which surgical resolution by reduction and stabilisation with percutaneous elastic endomedullary nailing is indicated. One of the advantages of this system is that it avoids an approach to the fracture site, allowing closed reduction in the vast majority of fractures. However, it is not always possible to achieve an acceptable closed reduction and opening of the fracture site is necessary. The aim of this study was to determine whether there are preoperative factors to predict the difficulty of performing closed reduction in these patients.MethodsA retrospective study of skeletally immature patients with acute diaphyseal forearm fractures treated with elastic endomedullary nailing by the same paediatric surgeon was performed. The primary outcome variable was defined as the need for open reduction; considered as a direct surgical approach to the fracture site. Demographic characteristics of the included patients and radiographic characteristics of the fracture were analysed.ResultsWe found that the median percentage of preoperative radial shortening in the closed reduction and open reduction groups was 1 and 5%, respectively; resulting in a statistically significant difference (p = 0.04).ConclusionRadial shortening on preoperative radiographs predicts an increased risk of requiring an open reduction of the fracture (39% association); thus we understand that this variable should be considered by the general traumatologist as a prognostic factor in defining the referral of these patients.(AU)

IntroducciónLas fracturas diafisarias de antebrazo (FDA) en pacientes esqueléticamente inmaduros son lesiones comunes que representan el 30% de las fracturas de la extremidad superior en este grupo etario. Existen casos con lesiones inestables o reducciones inaceptables, en los cuales está indicada la resolución quirúrgica mediante la reducción y estabilización con clavos endomedulares elásticos (CEE) por vía percutánea. Una de las ventajas que ofrece este sistema es evitar un abordaje del foco de fractura, pudiendo realizar la reducción de forma cerrada en la gran mayoría de estas. Sin embargo, no siempre es posible lograr una aceptable reducción cerrada y entonces es necesaria la apertura del foco de fractura. El objetivo de este estudio fue determinar si existen factores preoperatorios para predecir la dificultad de efectuar una reducción cerrada en estos pacientes.MétodosSe realizó un estudio retrospectivo de pacientes esqueléticamente inmaduros con FDA agudas, tratados con CEE por el mismo cirujano pediátrico. La variable de resultado primaria se definió como la necesidad de llevar a cabo una reducción abierta; considerado como un abordaje quirúrgico directo en el sitio de fractura. Se analizaron las características demográficas de los pacientes incluidos y las radiográficas de la fractura.ResultadosEncontramos que la mediana del porcentaje del acortamiento del radio preoperatorio en los grupos de reducción cerrada y reducción abierta fue del 1 y 5%, respectivamente; resultando en una diferencia estadísticamente significativa (p = 0,04).ConclusiónEl acortamiento del radio en las radiografías preoperatorias permite predecir un aumento del riesgo de requerir una reducción abierta de la fractura (39% de asociación); por lo cual, esta variable debe ser considerada por el traumatólogo general como un factor pronóstico para definir la derivación de estos pacientes.(AU)

Radius shortening as a limiting factor for closed reduction in pediatric forearm fractures. / El acortamiento del radio como factor limitante para la reducción cerrada en fracturas de antebrazo pediátrico.

INTRODUCTION: Diaphyseal forearm fractures in skeletally immature patients are common injuries that account for 30% of upper extremity fractures in this age group. There are cases with unstable injuries or unacceptable reductions, in which surgical resolution by reduction and stabilisation with percutaneous elastic endomedullary nailing is indicated. One of the advantages of this system is that it avoids an approach to the fracture site, allowing closed reduction in the vast majority of fractures. However, it is not always possible to achieve an acceptable closed reduction and opening of the fracture site is necessary. The aim of this study was to determine whether there are preoperative factors to predict the difficulty of performing closed reduction in these patients. METHODS: A retrospective study of skeletally immature patients with acute diaphyseal forearm fractures treated with elastic endomedullary nailing by the same paediatric surgeon was performed. The primary outcome variable was defined as the need for open reduction; considered as a direct surgical approach to the fracture site. Demographic characteristics of the included patients and radiographic characteristics of the fracture were analysed. RESULTS: We found that the median percentage of preoperative radial shortening in the closed reduction and open reduction groups was 1 and 5%, respectively; resulting in a statistically significant difference (p = 0.04). CONCLUSION: Radial shortening on preoperative radiographs predicts an increased risk of requiring an open reduction of the fracture (39% association); thus we understand that this variable should be considered by the general traumatologist as a prognostic factor in defining the referral of these patients.

Is obesity a risk factor in percutaneous hallux valgus surgery?

BACKGROUND: Obesity and its relationship with higher rate of complications in orthopedic surgeries have been reported. There is no evidence of the relation between obesity and percutaneous foot surgery. Our objective was to evaluate obesity as a risk factor for complications and reoperations in percutaneous surgery of the hallux valgus. METHODS: A total 532 feet were retrospectively reviewed in which a percutaneous hallux valgus correction was performed. Complications and surgical reoperations were recorded. Patients were divided into 2 groups: BMI less and greater than 30kg/m2. RESULTS: There were no differences in the rate of complications or reoperations. The total complication rate was 8%. Obesity as an isolated risk factor, presented aOR=1.14 (95%CI 0.54-2.4, p=.714). The overall rate of reoperations was 9%. Obesity presented an aOR=0.64 (95%CI 0.27-1.49, p=.31). CONCLUSION: Obesity has not been associated with a higher rate of complications and reoperations in percutaneous hallux valgus surgery. It is a safe procedure and BMI should not influence in the prognosis. LEVEL OF EVIDENCE: Level III, retrospective comparative study.