Distal radius fractures-Regional variation in treatment regimens.

OBJECTIVES: After recent technical innovations of fracture surgery implants, treatment traditions are changing for distal radius fractures, the most common orthopaedic injury. The aim of this study was to determine if the choice of surgical method for treatment of distal radius fractures differ between healthcare regions in Sweden. METHOD: The study was based on all (n = 22 378) adult patients who were registered with a surgical procedure due to a distal radius fracture during 2010-2013 in Sweden. Consecutive data was collected from the Swedish National Patient Registry. RESULTS: The proportions of use of surgical method varied among the 21 healthcare regions between 41% and 95% for internal fixation, between 2.3% and 44% for percutaneous fixation and between 0.6% and 19% for external fixation. Differences between regions were statistically significant in all but 6 comparisons when controlled for age and gender. Incidence rates of surgical treatment of a distal radius fracture varied between 4.2 and 9.2/10 000 person-years. CONCLUSION: We conclude that there is a large variation in operative management of distal radius fractures between Swedish healthcare regions.

Review of mccormack classification for thoracolumbar segment fractures / Revisão da classificação de mccormack para fraturas do segmento toracolombar / Revisión de la clasificación de mccormack para fracturas del segmento toracolumbar

ABSTRACT Objective: The aim of this study was to evaluate the success and complications rates of thoracolumbar fractures with a score equal or superior to 7 according to the load sharing classification (McCormack), surgically treated with short posterior fixation at three points. Methods: We evaluated 40 patients with thoracolumbar fractures and score by the load sharing classification greater than or equal to 7, treated exclusively by surgery by short posterior fixation. We assessed epidemiological data, increased kyphosis, loss of vertebral body height and complications at 2-year follow-up. Results: Although there was a statistically significant increase in kyphosis and a decrease in vertebral height, there was no clinical repercussion. Conclusion: We conclude that the McCormack classification is not a fundamental predictor for indication of anterior approach complementary to the short posterior fixation.

RESUMO Objetivo: O objetivo deste estudo foi avaliar as taxas de sucesso e de complicações das fraturas toracolombares com pontuação igual ou superior a 7 segundo a classificação de load sharing (McCormack), tratadas cirurgicamente com fixação posterior curta em três pontos. Métodos: Avaliamos 40 pacientes com fraturas toracolombares e pontuação pela classificação de load sharing maior ou igual a 7, tratados exclusivamente por cirurgia por fixação via posterior curta. Avaliamos dados epidemiológicos, aumento de cifose, perda de altura do corpo vertebral e complicações em seguimento de 2 anos. Resultados: Apesar de ter havido aumento de cifose e diminuição da altura vertebral estatisticamente significativa, não houve repercussão clínica. Conclusão: Concluímos que a classificação de McCormack não é um preditor fundamental para indicação da via anterior complementar à fixação posterior curta.

RESUMEN Objetivo: El objetivo de este estudio fue evaluar las tasas de éxito y de complicaciones de las fracturas toracolumbares con puntuación igual o superior a 7, según la clasificación de load sharing (McCormack), tratadas quirúrgicamente con fijación posterior corta en tres puntos. Métodos: Evaluamos 40 pacientes con fracturas toracolumbares y puntuación por la clasificación de load sharing mayor o igual a 7, tratados exclusivamente por cirugía por fijación vía posterior corta. Evaluamos datos epidemiológicos, aumento de la cifosis, pérdida de altura del cuerpo vertebral y las complicaciones en un seguimiento de 2 años. Resultados: A pesar del aumento de la cifosis y de la disminución de la altura vertebral estadísticamente significativa, no hubo ninguna repercusión clínica. Conclusión: Concluimos que la clasificación de McCormack no es un predictor fundamental para indicar la vía anterior complementaria a la fijación posterior corta.

Asking for the 22-modifier in isolated ankle fractures: does the operative note make the case?

We evaluated the operative notes for justification on the use of the 22-modifier in ankle fracture cases and compared the differences in physician billing and reimbursement. A total of 265 patients who had undergone operative management of isolated ankle fractures across a 10-year period were identified at a level I trauma center through a retrospective chart review. Of the 265 patients, 61 (23.0%) had been billed with the 22-modifier. The radiographs were reviewed by 3 surgeons to determine the complexity of the case. The amount of the professional fees and payments was obtained from the financial services department. Operative reports were reviewed for inclusion of eight 22-modifier criteria and word count. Mann-Whitney U tests of means were used to compare cases with and without the 22-modifier. From our analysis of preoperative radiographs, 37 (60%) showed evidence of a significantly complex fracture that justified the use of the 22-modifier. A review of the operative reports showed that 42 (68%) did not identify 2 or more reasons for requesting the 22-modifier in the report. Overall, the 22-modifier cases were not always reimbursed significantly greater amounts than the nonmodifier cases. No significant difference in the average word count of the operative notes was found. We have concluded that orthopedic trauma surgeons do not appropriately justify the use of the 22-modifier within their operative report. Further education on modifiers and the use of the operative report as billing documentation is required to ensure surgeons are adequately reimbursed for difficult trauma cases.

Fracturas del complejo orbitomalar. Reporte de casos / Management of Zygomatic Bone fractures and orbital fractures: Report of cases

Las fracturas de malar representan el 78% del total y afectan al suelo de la orbita, seno maxilar y sutura cigomático malar. El hueso malar o cigomático, es el acolchado principal del esqueleto en la zona media de la cara, sus fracturas representan el 13 % de las fracturas cráneo faciales. Las fracturas del hueso cigomático se acompañan frecuentemente de fracturas de la órbita o de fracturas de la apófisis cigomética del temporal, por lo que algunos autores prefieren hablar de fracturas del complejo cigomático, abarcando otros huesos. Alrededor del 15% de los casos se asocian con lesiones oculares. Parestesias secundarias a fracturas se presentan en un 70% y 90% de los casos, de ellos el 25% persistirán por largo tiempo. Se presentan dos casos que concurrieron al servicio del Hospital, con fractura orbito-malar, por traumatismos deportivos. Se procedió a la reducción y fijación abierta con osteosíntesis

Malar bone fractures represent 78% of the total amount of fractures that affect the orbit floor, maxillary sinus and malar zygomatic suture. The malar and zygomatic bone, are those which constitute the primary padding in the center of the face, their fractures represent 13% of the craniofacial fractures. Zygoma fractures usually go along with orbit fractures or zygomatic process of temporal fractures, so that some authors prefer to talk about zygomatic complex, including others bones. Almost 15% of the cases are associated with ocular lesions. Secondary paresthesia and fractures represents 70% to 90% of the cases, 25% of them will persist during a long time. We'll show you two cases from our surgery department, the patient present orbitomalar fracture, due to sports trauma, the interventions consists in open reduction and fixation with osteosynthesis

Fracturas del complejo orbitomalar. Reporte de casos / Management of Zygomatic Bone fractures and orbital fractures: Report of cases

Las fracturas de malar representan el 78% del total y afectan al suelo de la orbita, seno maxilar y sutura cigomático malar. El hueso malar o cigomático, es el acolchado principal del esqueleto en la zona media de la cara, sus fracturas representan el 13 % de las fracturas cráneo faciales. Las fracturas del hueso cigomático se acompañan frecuentemente de fracturas de la órbita o de fracturas de la apófisis cigomética del temporal, por lo que algunos autores prefieren hablar de fracturas del complejo cigomático, abarcando otros huesos. Alrededor del 15% de los casos se asocian con lesiones oculares. Parestesias secundarias a fracturas se presentan en un 70% y 90% de los casos, de ellos el 25% persistirán por largo tiempo. Se presentan dos casos que concurrieron al servicio del Hospital, con fractura orbito-malar, por traumatismos deportivos. Se procedió a la reducción y fijación abierta con osteosíntesis AU)

Malar bone fractures represent 78% of the total amount of fractures that affect the orbit floor, maxillary sinus and malar zygomatic suture. The malar and zygomatic bone, are those which constitute the primary padding in the center of the face, their fractures represent 13% of the craniofacial fractures. Zygoma fractures usually go along with orbit fractures or zygomatic process of temporal fractures, so that some authors prefer to talk about zygomatic complex, including others bones. Almost 15% of the cases are associated with ocular lesions. Secondary paresthesia and fractures represents 70% to 90% of the cases, 25% of them will persist during a long time. Well show you two cases from our surgery department, the patient present orbitomalar fracture, due to sports trauma, the interventions consists in open reduction and fixation with osteosynthesis(AU)

Distal tibia fractures: management and complications of 101 cases.

Distal tibia fractures are complex injuries with a high complication rate. In this retrospective and multicentre study we attempted to detail complications and outcomes of this type of injury in order to determine predictive factors of poor results. Between 2002 and 2004, 104 patients were admitted for 105 distal tibia fractures. One hundred patients (101 fractures) were reviewed with an average follow-up of 19 months (range, 12-46). Internal fixation, external fixation, limited internal fixation (K-wires or screws), intramedullary nailing and conservative treatment were used. Outcome parameters included occurrence of complications, radiographic analysis, evaluation of the American Orthopaedic Foot and Ankle Society (AOFAS) ankle score and measures of the ankle range of motion. The average functional score was 76 points (range, 30-100 points), and complications occurred in 30 patients. Predictive factors of poor results were fracture severity, complications, malunion and the use of external fixation. We believe that external fixation must be reserved for trauma with severe skin injury, as a temporary solution in a two-staged protocol. For other cases, we recommend ORIF with early mobilisation.

Analysis of 115 mandibular angle fractures.

PURPOSE: This retrospective study reviewed cases of fractures of the mandibular angle to identify personal data, social traits, fracture characteristics, treatment modalities, and postoperative complications. PATIENTS AND METHODS: From April 1999 until July 2004, 114 patients were treated for 115 fractures of the mandibular angle by the Division of Oral and Maxillofacial Surgery at Piracicaba Dental School-Unicamp, in Brazil. RESULTS: More angle fractures were observed in Caucasian (55%) men (89%) with some kind of drug addiction (62%). Patient mean age was 27 years. The majority of fractures in this study were sustained in altercations, including gunshot wounds (43%), followed by vehicle accidents, including bicycles and being struck by a car (39%). Open fractures were the most frequent (90%), with prevalence of the left side (57%). Only 1 patient sustained bilateral angle fractures. Ninety-seven patients (85%) underwent open reduction. Complications occurred in 19 patients (17%); 10 (9%) were infections. Of the total number of complications, 3 underwent another surgical intervention for refixation. The factors that contributed to the development of postoperative complications were social risks that included alcohol abuse, smoking, and intravenous and nonintravenous drug abuse. CONCLUSIONS: Angle fracture management outcomes are affected by many factors beyond method of fixation.

Resultados de las fracturas diafisiarias de fémur y tibia, abiertas, tratadas con fijación externa. Servicio de Ortopedía y Traumatología. HEALF 1 de enero de 2001 al 1 de enero de 2004 / Results of the fractures femur diafisiarias and lukewarm, open, tried with external fixation. Service of Ortopedía and Traumatología. HEALF January 1 of 2001 at January 1 2004

Se realizó un estudio descriptivo en 81 pacientes tratados mediante la fijación externa en el Hospital Escuela ôDr. Antonio Lenín Fonsecaö, para la solución de sus Fracturas Abiertas, en el período comprendido desde el 1 de enero de 2001 hasta el 1 de enero de 2004. Se emplearon 6 modelos de fijadores externos. Hubo una significativa incidencia del sexo masculino con 82.9 porciento, se afecto mas el grupo de 21 a 30 años con 36.6 porciento, 58.5 porciento era de procedencia urbana. La fractura abierta que predomino fue el tipo III en 65 pacientes para un 79.80 porciento. La tibia fue la más afectada en 67 casos, para 8 1.70 porciento, el fémur se afecto en 18.30 porciento. Predominó la fractura abierta en el tercio medio con 47.60 porciento de la serie. El objetivo para el cual se empleó el fijador se logró con Resultados excelentes y satisfactorios en un total de 70.70 porciento de los casos. Las secuelas funcionales no impidieron la reincorporación laboral en la mayoría de los pacientes. Se muestran las bondades del método y se analizan de manera exhaustiva las complicaciones...

The use of upper limb external fixation in paediatric trauma.

External fixation is an alternative method of treatment for paediatric fractures of the upper extremity. We report our experience of the management of 23 children with an average age of 10 years 1 month and review the literature. The method is indicated for second and third degree open fractures, open multiply injured patients and severely comminuted fractures. External fixation has proved unequalled for correction of limb deformities and lengthening procedures.

Resultados anatómicos y funcionales del manejo quirúrgico y conservador de los pacientes con fracturas distales de radio atendidos enel Hospital Antonio Lenín Fonseca en el período de julio de 1998 a junio de 1999 / Anatomic and functional results of the surgical and conservative management of patients with distal radius fractures attended in the Hospital Antonio Lenín Fonseca in the period from july 1998 to june 999

El presente estudio, realizado en el Hospital Antonio Lenín Fonseca (H.A.L.F) en el período de julio 1998 a junio de 1999 es de tipo observacional, descriptivo, transversal y prospectivo acerca de los resultados de manejo de las fracturas distales de radio que según la clasificación utilizada en nuestro servicio deberan ser manejadas quirúrgicamente y se decidieron manejar conservadoras y quirúrgicas. Se estudiaron un total de 49 pacientes con diagnóstico de fracturas Distal de Radio atendidos en el servicios de Ortopedia del Hospital antes mencionado y que cumplían con los criterios diagnósticos para ser manejados quirúrgicamente. Se utilizó como fuente de información, expedientes clínicos y libros de registros del departamento de estadísticas del H.A.L.F. El grupo etáreo mas afectado fueron los mayores de 61 años con 24.5 porciento y 31 - 40 años con 20.4 porciento, el sexo masculino fue el más afectado pero su frecuenciadisminuyó con el aumento de la edad, al contrario ocurrió con el sexo femenino que a mayor edad incremento su frecuencia. El manejo conservador fue el más utilizado con 59.1 porciento y quirúrgico es 40.8 porciento, el miembro toráxico izquierdo fue el mas afectado 59.1 porcienot y las acaídas con apoyo en flexión dorsal fue el principal mecanismo de producción de la fractura. Según la clasificación de Hasting de las fracturas la tipo IIB fue la mas frecuente cn 55 porciento y la complejidad de las fracturas no tuvo relación con le edad...

Closed reduction/percutaneous fixation of tibial plateau fractures: arthroscopic versus fluoroscopic control of reduction.

OBJECTIVE: To evaluate arthroscopic versus fluoroscopic reduction and percutaneous fixation of lateral tibial plateau fractures of AO/OTA Types 41.B1 to 41.B3. DESIGN: Prospective study. SETTING: University hospital. PATIENTS AND INTERVENTION: One hundred sixty-eight patients underwent operative treatment for a tibial plateau fracture from 1988 to 1995. Thirty-three of these patients had monocondylar fractures of the lateral plateau that were treated by percutaneous reduction and fixation techniques. In the first ten cases, arthroscopic control of reduction was used. The following twenty-three consecutive cases were treated by reduction and fixation solely under fluoroscopic control. The arthroscopy group was followed for a mean of fifty-two months and the fluoroscopy group for thirty-eight months. RESULTS: Nine of ten cases of the arthroscopy group had an excellent or good result in Rasmussen's knee score at follow-up. One patient with an unreduced anterolateral depression zone despite arthroscopic surgery required a total knee prosthesis after eighteen months. Sixteen cases in the fluoroscopy group met the follow-up criteria. Fifteen were graded good or excellent in Rasmussen's clinical score; sixteen were excellent or good in the radiological score. One patient claimed chronic medial joint line pain after a lateral split fracture and had arthroscopy revealing chondral degeneration on the medial side but had no pathological findings in the lateral compartment. No secondary meniscus or ligament surgery was performed in the follow-up period. CONCLUSIONS: Percutaneous treatment of fractures of the tibial plateau can be performed using arthroscopy as well as image intensification to control reduction of the joint surface. We were not able to demonstrate any significant benefit from arthroscopy compared with fluoroscopic reduction. Reduction under image intensification is technically easier in our practice, especially in serial fractures and multiply injured patients. We reserve arthroscopy for cases with significant ligament injuries and for children with fractures of the median eminence.

Rank order analysis of tibial plafond fractures: does injury or reduction predict outcome?

We investigated the effects of severity of initial injury pattern and the quality of the articular reduction on outcome of displaced intra-articular distal tibial fractures, using a series of 25 patients who were treated with articulated external fixation and limited internal fixation, which provided a spectrum of reduction quality. Outcome was assessed by clinical ankle scores and radiographic arthrosis. The results demonstrate the rank order method to be a reliable means of stratifying severity of injury and quality of reduction. Neither injury nor reduction correlated with clinical ankle score. Reduction had a significant correlation with radiographic arthrosis. We conclude that the rank order method is useful in stratification of fracture patients, and that factors other than injury pattern and quality of articular reduction are important in determining outcome of patients with this severe articular injury.

Placa-tornillo deslizante utilizada para el tratamiento de las fracturas intertrocantéreas. Estudio mécanico comparativo de tres distintas fabricaciones / Sliding screw and plating for treatment of intertrochanteric fractures. Comparative trial of three different trading marks of fabrication

En este estudio se determina la resistencia mecánica de tres distintos modelos de placastornillo deslizante que se emplean en la cirugía ortopédica para el tratamiento de las fracturas intertrocantéreas. Dos de ellas son de importación y una de fabricación nacional. Dichos implantes son ensayados a flexión estática siguiendo los parámetros establecidos en la norma ASTM F 384-73, tanto para el montaje de los implantes, como para la realización de las pruebas mismas. Los resultados obtenidos se comparan con trabajos previos de la literatura internacional, los cuales relacionan las cargas fisiológicas encontradas para la cadera, con la resistencia de los implantes ensayados. Se concluye que a pesar de mostrar una marca de implante una resistencia mecánica adecuada para emplearse aún para el tratamiento de las fracturas intertrocantéreas inestables. Por otra parte, los resultados muestran un elevado grado de variabilidad en el comportamiento mecánico de la placa-tornillo de origen nacional, lo cual es indicio de un deficiente control de calidad, mientras que los implantes de importación mostraron un menor grado de variabilidad

Fracturas de clavícula. indicaciones y resultados funcionales del tratamiento quirúrgico / Clavicle fractures. Indications and functional results of the treatment with type Neer II prosthetic replacement

Las fracturas de clavícula son lesiones que afectan a personas jóvenes en edad productiva y ocupan el 35 por ciento de las fracturas de hombro. La deformidad producto del tratamiento inadecuado, interfiere en el buen funcionamiento de la articulación del hombro, dejando secuelas que van desde la subluxación recurrente de la articulación esternoclavicular hasta la compresión del plexo braquial por la formación exuberante de callo óseo. Tratamiento efectivo aunque no siempre los resultados son buenos por lo que la cirugía confiere además de una mejor solución funcional la estética postoperatoria. Por otro lado, la evolución de esta cirugía, es en un 69 por ciento, rápida y satisfactoria, y la clasificación del Dr. Iñárritu nos permite establecer los criterios para elegir este tratamiento del conservador