Aged ; Bone Wires ; adverse effects ; Clavicle ; injuries ; surgery ; Fracture Fixation, Internal ; adverse effects ; Humans ; Male ; Neck

PURPOSETibial pilon fractures remain challenging for an orthopaedic surgeon to repair. External fixation (ExFix) and open reduction and internal fixation (ORIF) are two widely used methods for repairing tibial pilon fractures. However, conclusions of comparative studies regarding which method is superior are controversial. Our aim is to compare ORIF and ExFix and clarify which method is better in terms of reduction and union results and major complications.

METHODSA computerized research of MEDLINE, EMBASE, Springer, and Cochrane Library (before December 2014) for studies of any design comparing ORIF and ExFix was conducted. Weighted mean difference (WMD), risk ratio (RR) and corresponding 95% confidence intervals (CI) were used for esti- mating the effects of the two methods. Statistical analyses were done using Review Manager Version 5.2.

RESULTSTen cohort studies and one randomized clinical trial were included in our ultimate analysis. And the analysis found no significant difference between the two methods in deep infection (p = 0.13), reduction (p = 0.11), clinical evaluation (p = 0.82), post-traumatic arthrosis (p = 0.87), and union time (p = 0.35). Besides, ExFix group was found to have a higher rate of superficial infection (p =0.001), malunion (p = 0.01) and nonunion (p = 0.02), but have a lower risk of unplanned hardware removal (p = 0.0002).

CONCLUSIONSWe suggest that ORIF has a relatively lower incidence rate of superficial infection, malunion and nonunion, but a higher rate of unplanned hardware removal. No difference was found in deep infection, reduction, clinical evaluation, post-traumatic arthrosis and union time.

External Fixators ; adverse effects ; Fracture Fixation, Internal ; adverse effects ; methods ; Humans ; Tibial Fractures ; surgery

PURPOSE: Treatment of distal tibia fractures poses significant challenge to orthopedic surgeon because of poor blood supply and paucity of soft tissue coverage. There is considerable controversy regarding the superior option of treatment for distal tibia fracture between the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and intramedullary interlocking (IMIL) nailing for extra-articular distal tibia fractures. The aim of our study is to compare the functional outcome between the two treatment methods. METHODS: This was the prospective comparative study of 100 patients with distal third tibia fractures divided into two groups. The first group of patients were treated with MIPPO technique while the second group of patients were managed by IMIL nailing. Patients were followed up in outpatient department to assess the functional outcomes, malunion, delayed union, nonunion, superficial and deep infection between the two groups. Statistical analyses were performed using the SPSS software (version 16.0). RESULTS: Average malunion (degrees) in the MIPPO group was 5 (3-7) ± 1.41 vs. 10.22 (8-14) ± 2.04 in the IMIL group (p = 0.001). Similarly postoperative knee pain in the IMIL group was 10% vs. 2% in the MIPPO group (p = 0.001). In terms of superficial infection and nonunion, the results were 8% vs. 4% and 2% vs. 6% for the MIPPO and IMIL group, respectively (p = 0.001). CONCLUSION Both procedures have shown the reliable method of fixation for distal extra-articular tibia fractures preserving the soft tissue, bony vascularity and fracture hematoma that provide a favourable biological environment for fracture healing. Considering the results of the study, we have slightly more preference for the MIPPO technique.
Bone Plates/adverse effects* ; Fracture Fixation, Internal/methods* ; Fracture Fixation, Intramedullary/methods* ; Fracture Healing ; Humans ; Minimally Invasive Surgical Procedures/methods* ; Prospective Studies ; Tibia/surgery* ; Tibial Fractures ; Treatment Outcome

PURPOSETo compare the clinical efficacy and complications of limited internal fixation combined with external fixation (LIFEF) and open reduction and internal fixation (ORIF) in the treatment of Pilon fracture.

METHODSWe searched databases including Pubmed, Embase, Web of science, Cochrane Library and China Biology Medicine disc for the studies comparing clinical efficacy and complications of LIFEF and ORIF in the treatment of Pilon fracture. The clinical efficacy was evaluated by the rate of nonunion, malunion/delayed union and the excellent/good rate assessed by Mazur ankle score. The complications including infections and arthritis symptoms after surgery were also investigated.

RESULTSNine trials including 498 pilon fractures of 494 patients were identified. The meta-analysis found no significant differences in nonunion rate (RR = 1.60, 95% CI: 0.66 to 3.86, p = 0.30), and the excellent/good rate (RR = 0.95, 95% CI: 0.86 to 1.04, p = 0.28) between LIFEF group and ORIF group. For assessment of infections, there were significant differences in the rate of deep infection (RR = 2.18, 95% CI: 1.34 to 3.55, p = 0.002), and the rate of arthritis (RR = 1.26, 95% CI: 1.03 to 1.53, p = 0.02) between LIFEF group and ORIF group.

CONCLUSIONLIFEF has similar effect as ORIF in the treatment of pilon fractures, however, LIFEF group has significantly higher risk of complications than ORIF group does. So LIFEF is not recommended in the treatment of pilon fracture.

Combined Modality Therapy ; External Fixators ; Fracture Fixation, Internal ; adverse effects ; methods ; Humans ; Tibial Fractures ; surgery

Retrieval of a broken guide wire transfixing the acetabulum or with intrapelvic migration is challenging and frustrating for surgeons. We here present a case report on a method to remove a broken guide wire transfixing the acetabulum through the proximal hole of recon nail using a grasping forceps. This method is little invasive, easy, time-saving and without need for changing the inital fixation.
Adult ; Bone Wires ; adverse effects ; Fracture Fixation, Internal ; instrumentation ; Hip Fractures ; surgery ; Humans ; Male ; Prosthesis Failure

Compared with hip replacement, internal fixation in the treatment of the elderly femoral neck fracture, especially the application of cannulated screws, is minimally invasive, easy to operate and economical. In recent years, it becomes the research focus in the field of orthopedic clinical research. However, configuration of cannulated screws is still controversial. Most clinicians believe that three cannulated screws being placed in parallel in an inverted triangle configuration is better than that in a triangular configuration in biomechanics and clinical effect. Nonparallel strong oblique nailing technique allows the screws to share more weight to reduce postoperative complications, so that it is more suitable for elderly patients with osteoporosis. However, the related complications of internal fixation such as nonunion, femoral neck shortening and other problems are still the focus of domestic and foreign scholars. Issues about how to control the indication of internal fixation surgery, understand related factors of the complications, and prevent complications are required to be further explored.
Aged ; Bone Nails ; Femoral Neck Fractures ; surgery ; Fracture Fixation, Internal ; adverse effects ; methods ; Humans ; Internal Fixators

PURPOSETo describe our clinical experience with a system named SureShot? Distal Targeting (Smith & Nephew, Memphis, USA) based on magnetic field presence and discuss our suggestions on this technique.

METHODSWe analysed prospectively 47 patients affected by humeral, tibial or femoral fractures, treated in our institution during a 3-year period of time (August 2010 to September 2013). We considered the following parameters: the time to set up, the time to position a single screw, the effectiveness of the system (drilling ad screwing), the irradiation exposure time during distal locking procedure and surgical complications.

RESULTSA total number of 96 screws were inserted. The mean preparation time of the device was 5.1 min ± 2 min (range 3-10 min). The mean time for single screw targeting was 5.8 min ± 2.3 min (range 4-18 min). No major complications occurred. Only a few locking procedures were needed to be practiced in order to obtain the required expertise with this targeting device.

CONCLUSIONAccording to our results, this device is reliable and valid whenever the correct technique is followed. It is also user friendly, exposes to lower radiation and needs less surgical time compared to relative data from the literature. However, the surgeon should always be aware of how to use the free hand technique in case of malfunctioning of the system.

Bone Screws ; Fracture Fixation, Intramedullary ; adverse effects ; instrumentation ; methods ; Humans ; Magnetic Fields ; Prospective Studies

Aged, 80 and over ; Female ; Fracture Fixation ; adverse effects ; Humans ; Male ; Postoperative Complications ; etiology ; Radius Fractures ; surgery

OBJECTIVETo compare the differences of the efficacy between the conservative treatment and surgical treatment for unstable distal radius fractures with surgical indications.

METHODSFrom March 2008 to July 2011, the patients with unstable distal radius fractures were devided into the surgical treatment group and the conservative treatment group in a non randomized manner. In the surgical group,there were 16 males and 32 females with an average age of 50.26 years old ranging from 22 to 76 years; in the conservative treatment group there were 10 males and 27 females with an average age of 51.12 years old ranging from 42 to 79 years. The patients of two groups were almost all with falling damage trauma,which accounting for 92.94% (79/85), all the patients were closed injury, 41 cases were in the left side, and 44 cases in the right. Fracture in accordance with AO classification: C1 in 12 cases, C2 in 32 cases, C3 in 38 cases, B3 in 3 cases. Patients in the surgical treatment group were treated with volar locking compression plate (LCP) fixation and patients in the conservative were treated with manual reduction and plaster external fixation. The active wrist range of motion, pain assessment, subjective evaluation, Gartland and Werley score, Batra radiology score and complications were observed in the last follow-up.

RESULTSForty-three patients in the surgical treatment group were followed up for an average time of 8.03 months (4 to 15 months); 33 paitents in the conservative group were followed up for an average time of 6.54 months (2 to 9 months). The difference of the wrist joint active dorsiflexion and supination rotation range in the two groups were statistically significant (t = 2.212, P < 0.05; t = 2.392, P < 0.05); the difference of the proportion of patients with ulnar wrist pain in the two groups was statistically significant (chi2 = 5.71, P < 0.05); the difference of patients' subjective evaluation score of two groups was statistically significant (Z = 2.13, P < 0.05); the difference of Gartland and Werley score between the two groups was statistically significant (Z = 2.36, P < 0.05); the difference of Batra radiology score in the two groups was statistically significant (Z = 2.58, P < 0.05); the differences in the X-ray measurement of the proportion of distal radial shortening > or = 5 mm, the radial height (shortening) was statistically significant (for the correction chi2 = 7.57, P < 0.05; t = 2.016, P < 0.05); the differences of malunion rate, ulnar impaction syndrome, the incidence rate of ulnar styloid fracture nonunion of two groups was statistically significant (adjusted chi2 = 10.05, P < 0.05; chi2 = 8.39, P < 0.05; chi2 = 5.51, P < 0.05).

CONCLUSIONFor patients with surgical indications for unstable distal radius fractures, every indicator of the outcome after surgery in the treatment is better than that of the manipulative reduction and plaster fixation.

Adult ; Aged ; Casts, Surgical ; Female ; Fracture Fixation ; adverse effects ; Humans ; Male ; Middle Aged ; Radius Fractures ; surgery

Humans ; Lidocaine ; Anesthesia, Local ; Radius Fractures/surgery* ; Anesthetics, Local/adverse effects* ; Bone Plates ; Fracture Fixation, Internal