OBJECTIVE: To compare the effectiveness of early versus delayed closed reduction and percutaneous Kirschner wire fixation in the treatment of pediatric supracondylar humerus fractures. METHODS: A retrospective analysis was conducted on 468 children with supracondylar humerus fractures, who were admitted between January 2020 and December 2023 and met the inclusion criteria. Among them, 187 children were treated during 12 hours after injury (early operation group) and 281 were treated after 12 hours (delayed operation group). There was no significant difference between the two groups ( P>0.05) in the gender, age, injury mechanism, fracture side and type, while there was significant difference in interval from injury to operation ( P<0.05). The operative outcomes, including the operation time, intraoperative blood loss, the length of hospital stay, fracture healing time, elbow function assessed by Flynn criteria at 3 months after operation, and complications, were compared. RESULTS: Compared to the delayed operation group, the early operation group demonstrated significantly shorter operation time and less intraoperative blood loss ( P<0.05). There was no significant difference in the length of hospital stay between the two groups ( P>0.05). All children were followed up 3-12 months. The follow-up time was (6.7±2.9) months in the early operation group and (6.9±2.8) months in the delayed operation group, showing no significant difference between the two groups ( P>0.05). There was no significant difference in the fracture healing time between the two groups ( P>0.05). At 3 months after operation, the early operation group exhibited superior Flynn elbow functional outcomes to the delayed operation group ( P<0.05). In the early operation group, there was 1 case of fracture non-union and 3 cases of cubital varus deformity after operation. In the delayed operation group, there was 1 case of nerve injury, 7 cases of fracture non-union, and 12 cases of cubital varus deformity after operation. There was significant difference in the incidence of complications between the two groups ( P<0.05). One case of the early operation group and 10 cases of the delayed operation group underwent secondary operation, showing no significant difference in the incidence of secondary operation between the two groups ( P>0.05). CONCLUSION For pediatric supracondylar humerus fractures, early closed reduction and percutaneous Kirschner wire fixation can reduce operation time, minimize intraoperative blood loss and postoperative complications, and improve the functional recovery compared to delayed operation.
Humans ; Humeral Fractures/surgery* ; Bone Wires ; Retrospective Studies ; Male ; Female ; Child ; Fracture Fixation, Internal/instrumentation* ; Child, Preschool ; Treatment Outcome ; Operative Time ; Fracture Healing ; Length of Stay ; Closed Fracture Reduction/methods* ; Blood Loss, Surgical ; Time Factors ; Time-to-Treatment ; Postoperative Complications/epidemiology*

PURPOSETo report complications in the management of complex closed proximal tibial fractures.

METHODA retrospective study was conducted to analyze the infectious and noninfectious complications encountered in the management of high-energy Schatzker type V and VI tibial plateau fractures. All patients were treated at the level 1 trauma centre between January 2011 and March 2014. Sixty two patients were included in the study. The mean patient age was (43.16 ± 11.59) years with 60 males and 2 females. Infectious complications like superficial and deep infection, wound dehiscence, malalignment in the immediate postoperative period and in follow-up period were noted.

RESULTSThe overall complication rate was 30.65% (19 out of 62). Infectious complications were noted in 20.97% cases (13/62). In majority of the cases (8/13), superficial infection was seen which managed with regular dressing and antibiotic administration. The patients (5/13) who had developed deep-seated infection were subjected to repeated debridements, flap coverage, implant removal or amputation depending upon the host response. Thirteen patients had experienced noninfectious complications. Hardware related complications were noticed in six patients and four among them received a secondary procedure. Malalignment was observed in seven patients but only single patient underwent subsequent operative intervention.

CONCLUSIONProximal tibial plateau fractures especially Shatzker type V and VI are associated with extensive soft tissue damage even in closed injuries. The complications encountered in the management of these fractures can be minimized with appropriate patient selection and minimal soft tissue dissection.

Adult ; Fasciotomy ; Female ; Fracture Fixation ; adverse effects ; Fractures, Closed ; surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications ; therapy ; Retrospective Studies ; Tibial Fractures ; surgery

PURPOSETo compare treatment outcome of screw proximal femoral nail (PFN) system with that of a helical PFN.

METHODSThe study included 77 patients with closed unstable intertrochanteric fracture classified as AO 31A2&31A3, between June 2008 to August 2011. Inclusion criteria were: all mature skeletons above 50 years of age; closed unstable trochanteric fracture classified as AO 31A2&A3. Exclusion criteria were: immature skeleton, pathological fracture of any cause other than osteoporosis, inability to walk inde- pendently prior to injury. Patients were randomized to 2 treatment groups based on admission sequence. Forty patients were treated with screw PFN and thirty seven were treated with helical PFN.

RESULTSBoth groups were similar in respect of time of surgery, blood loss and functional assessment and duration of hospitalization. In screw PFN group 2 patients had superficial wound infection, 1 patient had persistent hip pain and 1 patient had shortening>1 cm but<2 cm, while in helical PFN group 1 patient had superficial wound infection.

CONCLUSIONBoth screw and helical PFN are very effective implants in osteoporotic and unstable trochanteric fractures even in Indian patients where the bones are narrow and neck diameter is small. It is an implant of choice for osteoporotic and unstable trochanteric fractures.

Aged ; Bone Screws ; Female ; Fracture Fixation, Internal ; instrumentation ; Fractures, Closed ; surgery ; Hip Fractures ; surgery ; Humans ; Male ; Middle Aged ; Operative Time ; Postoperative Complications ; Prospective Studies ; Treatment Outcome

Ulnar nerve palsy subsequent to a fracture of the distal radius is extremely rare compared to a median nerve injury. The lesion tends to occur in younger patents with a high-energy mechanism of injury and a severe injury pattern consisting of wide displacement, comminution, combined distal ulnar fracture and open fracture. The mechanism of injury can contribute to a direct contusion and traction, compression secondary to prolonged edema and tissue fibrosis, intraneural fibrosis and laceration. We report 2 cases of progressive ulnar nerve palsy subsequent to closed fractures of the distal radius. The neurological symptoms recovered in all cases who underwent nerve decompression and neurolysis at 2 or 3 months after the trauma. It is recommended that cases with high-energy, widely displaced or comminuted fractures of the distal radius be evaluated carefully for ulnar nerve as well as median nerve injury.
Adult ; Fracture Fixation, Internal ; Fractures, Closed/*complications/surgery ; Fractures, Comminuted/*complications/surgery ; Humans ; Male ; Radius Fractures/*complications/surgery ; Ulnar Neuropathies/*etiology/surgery ; Young Adult

OBJECTIVETo study the instance of deep venous thrombosis(DVT) complicated by preoperative lower extremity close fracture.

METHODSRetrospectively analyzed the clinical data of 54 patients with DVT (through color Doppler to final diagnosis) complicated by preoperative lower extremity close fracture from March 2008 to February 2009, and explored the concomitant reason of DVT. There were 23 males and 31 females with age for 23-95 years old.

RESULTSDVT including thrombus of ilio-venae external, thrombus of femoral vein, thrombus of popliteal vein, thrombus of posterior tibial veins and thrombus of soleus venae. The instance of DVT complicated by preoperative lower extremity close fracture: (1) The age of 23 cases (42.59%) more than 70 years. (2) 11 cases (20.37%) combined with syndrome, 2 cases had hypertension, 3 cases had hypertension and diabetes, 2 cases hypertension and cerbral infarction, 4 cases had hypertension, diabetes and coronary heart disease. (3) 10 cases (18.51%) were multi-fractures. (4) 28 cases (51.85%) occurred DVT at 7-14 days after lower extremity close fracture.

CONCLUSIONAdvanced age, complicating hypertension, diabetes, coronary heart disease, cerbral infarction, multi-fractures may be lead to DVT. Multitudinous DVT occurred at 7-14 days after fracture, as early as possible operation has important significance on prevention DVT to decrease risk of pulmonary embolism.

Adult ; Aged ; Aged, 80 and over ; Female ; Fractures, Closed ; complications ; diagnostic imaging ; surgery ; Humans ; Leg ; blood supply ; Leg Bones ; injuries ; Male ; Middle Aged ; Preoperative Period ; Retrospective Studies ; Ultrasonography ; Venous Thrombosis ; complications ; Young Adult

OBJECTIVETo analyze the reasons on complications of treatment with elastic nail in children's long bone fracture.

METHODSSixty-six cases (75 parts of long bone fratures) were treated by elastic nail including 49 male and 17 female. The age ranged from 3 to 17 years, mean 7.8 years. There were 35 femur fractures (2 cases were hibateral), 20 tibia and fibula fractures (12 cases were tibia fractures), 8 radial fractures (1 case was ulna fracture) and 3 humerus fractures. The cases included 4 open fractures and 62 closed fractures. All cases were fresh fractures, no multi-segmental fractures. Three cases associated with brain and chest injuries. These cases were treated by open or closed reduction and internal fixaion with elastic nail. A cast or brace had been used after operation for a month. Following-up included the function of the joint,the bottom of the nail and the callus. Complications were timely recorded.

RESULTSAll the patients were followed-up for 12 to 29 months, averaged 17 months. The cases occurrenced compilications including 2 cases of nonunion, 2 of new fracture, 1 of displacment, 4 of joint dysfunction, 3 of irritation of the bottom of the nail and 1 malunion.

CONCLUSIONStrict indication, well design,canonical operation is a good way to avoid compliacations. At the same time,early treatment can reduce the sequela.

Adolescent ; Bone Nails ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; Fractures, Bone ; complications ; surgery ; Fractures, Closed ; complications ; surgery ; Fractures, Open ; complications ; surgery ; Humans ; Leg Bones ; injuries ; surgery ; Male ; Postoperative Complications ; etiology ; prevention & control ; therapy

OBJECTIVEEvaluation of two different methods of treatment of distal tibial fractures of the clinical indications, complications and efficacy.

METHODSForty-five cases of closed distal tibial fractures were assigned to two groups, 25 cases in group A included 18 males and 7 females, according to the AO/ASIF classification: 4 cases of type A, 14 cases of B, 7 cases of C, open reduction and anatomic plate fixation were used. Twenty cases in group B included 12 males and 8 females, 5 of type A, 9 of B, 6 of C, minimally invasive percutaneous locking compression plate osteosynthesis were used. Observed on the postoperative pain, skin necrosis of the incision, the incidence of deep infection and other complications, as well as the healing of fractures, ankle motor function for comparative study.

RESULTSAll patients were followed up 10 to 15 months, according to the visual analogue scale (VAS) score, group A were moderate to severe in, group B were mild to moderate between. Bone healing time: group A averaged (16.0+/-4.2) weeks, group B averaged (13.0+/-3.2) weeks, the difference was significant (P<0.01). Postoperative complications of group A was more than that of group B (P<0.05), there were significant differences. Ankle function in accordance with the assessment criteria Kofoed, the good and excellent rate of group B was higher than that of group A (P<0.05), there were significant differences.

CONCLUSIONMinimally invasive percutaneous locking compression plate osteosynthesis compared open reduction and anatomic plate fixation for distal tibial fractures with less trauma surgery, bone blood supply to the affected small, fracture healing faster, less complications, and ankle function better advantage of. It is consistent with the biomechanics of internal fixation, and is the treatment of tibial fractures ideal method.

Adult ; Ankle Injuries ; complications ; surgery ; Bone Plates ; Female ; Fracture Fixation, Internal ; methods ; Fracture Healing ; physiology ; Fractures, Closed ; complications ; surgery ; Humans ; Knee Injuries ; complications ; surgery ; Male ; Middle Aged ; Postoperative Complications ; Tibial Fractures ; complications ; surgery ; Treatment Outcome ; Young Adult

OBJECTIVETo investigate the rate of systemic inflammatory response syndrome (SIRS) among patients treated by intramedullary nail (IMN) for femoral shaft fracture right after the operation, the effect of femoral nailing on SIRS and sought to differentiate any differences between reamed and unreamed IMN.

METHODSThree hundred and twenty-four patients presenting with acute femoral fractured from April 1997 to April 2005, divided into 2 group depending on ISS. Group 1 had 179 patients (ISS < 16, AIS < 2) including 64 reamed cases and 115 unreamed cases; group 2 had 145 patients (ISS >or= 16, AIS >or= 2) including 51 reamed patients and 94 unreamed. All patients were treated by close reduction and intramedullary nail for fixation. The heart rate, breath rate, temperatures were recorded every 6 h before and after operation. If any of the life sign was above normal, then venous blood samples were taken at once to make sure whether SIRS occurred or not. All data were crosstabs analysis by SPSS 10.0.

RESULTSOne hundred and twenty-four patients suffered from SIRS postoperation. In group 1, 24 reamed and 37 unreamed, in group 2, 27 reamed and 36 unreamed. Among those SIRS, 119 cases healed evenly and 5 patients developed further complication. Between reamed and unreamed patients both in group 1 and group 2, there was no significant difference found. The Chi-Square value were 0.159 and 2.885 respectively, total value was 3.467, which P was 0.325, 0.089 and 0.471, all greater than 0.05.

CONCLUSIONSAlthough SIRS will result from IMN, there is no significant different effect on the rate of SIRS found between reamed and unreamed nail in both group.

Adult ; Bone Nails ; adverse effects ; Female ; Femoral Fractures ; surgery ; Fracture Fixation, Intramedullary ; adverse effects ; methods ; Fractures, Closed ; surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Retrospective Studies ; Systemic Inflammatory Response Syndrome ; etiology ; Time Factors