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JBJS Case Connector Apr 2024A 34-year-old man was a restrained passenger involved in a high-speed rollover motor vehicle crash. The patient sustained a type 5 AC joint separation, severely...
CASE
A 34-year-old man was a restrained passenger involved in a high-speed rollover motor vehicle crash. The patient sustained a type 5 AC joint separation, severely comminuted intra-articular glenoid fracture with extension to the coracoid process base, displaced open scapular body fracture, a posterior shoulder dislocation of the glenohumeral joint, and a 2-part proximal humerus fracture.
CONCLUSION
To our knowledge, this is the first report describing this injury pattern involving the superior shoulder suspensory complex with an associated open proximal humerus fracture-dislocation.
Topics: Humans; Male; Adult; Shoulder Fractures; Shoulder Dislocation; Fractures, Open; Accidents, Traffic; Fractures, Comminuted
PubMed: 38788054
DOI: 10.2106/JBJS.CC.22.00615 -
Veterinary Sciences May 2024Despite recent advancements in antibiotics, hygienic measures, and peri-operative systemic antibiotics, post-operative infections in osteosynthesis remain prevalent and...
Despite recent advancements in antibiotics, hygienic measures, and peri-operative systemic antibiotics, post-operative infections in osteosynthesis remain prevalent and continue to be among the most common surgical complications, leading to delayed fracture healing, osteomyelitis, implant loosening, and loss of function. Osteosynthesis implants are routinely utilized in veterinary medicine and the current study investigates the microbial colonization of implants following osteosynthesis in small animals, along with its incidence and influencing factors. The results are analyzed in regard to correlations between infection, patient, disease progression, and radiographic images, as well as other factors that may promote infection. Seventy-one explants from sixty-five patients were examined and evaluated for microbial colonization. Factors like body weight and age, location and type of plate and additional injuries like lung lesions, the surgeon's experience, or the number of people present during the surgical procedure seem to influence the development of an infection. Of the animals, 60% showed osteolytic changes and 73.3% of those with dysfunctional mobility had an implant infection. Microorganisms were detected in almost 50% of the explants, but a clinically relevant infection was only present in five patients (7.3%), suggesting that the presence of microorganisms on an implant does not necessarily lead to treatment complications.
PubMed: 38787193
DOI: 10.3390/vetsci11050221 -
Journal of Orthopaedic Case Reports May 2024Glenoid rim fractures with Bankart lesions are called bony Bankart lesions and are associated with persistent glenohumeral joint instability. Acute bony Bankart lesions...
INTRODUCTION
Glenoid rim fractures with Bankart lesions are called bony Bankart lesions and are associated with persistent glenohumeral joint instability. Acute bony Bankart lesions can be treated by various arthroscopic techniques. Here, we present a technique of arthroscopic bony Bankart repair using suture-assisted reduction and screw fixation.
DISCUSSION
The conventional suture anchor repair does not provide compression of the fractured fragment, and the bony piece may tilt because of the single-point fixation.
CONCLUSION
This procedure can achieve firm compression between the bony fragments and prevent rotation of fragment during screw fixation to the glenoid. The capsular plication distributes the loads to the surrounding soft tissues. Hence, this procedure should be offered to all patients presenting acutely with a large bony Bankart of size >25% of glenoid width, as it is minimally invasive as well as provides excellent outcomes and anatomical union.
PubMed: 38784870
DOI: 10.13107/jocr.2024.v14.i05.4478 -
Cirugia Y Cirujanos 2024Clavicle fractures represent 2.5-4% of all fractures observed in emergency services. 80% occurs in the middle third. Treatment by plating requires a higher level of... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
Clavicle fractures represent 2.5-4% of all fractures observed in emergency services. 80% occurs in the middle third. Treatment by plating requires a higher level of evidence.
OBJECTIVE
To compare the functional outcomes of mid-shaft clavicle fractures managed with superior plating compared to anteroinferior plating.
TRIAL DESIGN
A randomized, double-blind, parallel, superiority clinical trial.
PATIENTS AND METHODS
Patients with fractures of the clavicles AO15B1 and AO15B2 were studied. Patients were randomized to be treated with either 3.5 mm superior or anteroinferior plating. A rehabilitation program was designed for both groups. The primary outcome measure was the Disability of Arm, Shoulder, and Hand (DASH) score; secondary outcomes included pain, union rate, and complication rates.
RESULTS
Twenty-eight patients were studied and were eligible for analysis. Significant differences were found in the function assessed with the DASH score at 30 days for the superior plating compared with anteroinferior (43.74 vs. 29.26, respectively, p = 0.027), 60 days (23.97 vs. 11.18, p = 0.021), and 90 days (9.52 vs. 3.5, p = 0.016). One loosening with superficial infection was found with superior plating.
CONCLUSIONS
Using an anteroinferior reconstruction plate in diaphyseal fractures offers better functional results than the upper plate in patients with fractures of the middle third of the clavicle.
Topics: Humans; Clavicle; Bone Plates; Male; Female; Fractures, Bone; Fracture Fixation, Internal; Adult; Double-Blind Method; Middle Aged; Treatment Outcome; Postoperative Complications; Young Adult
PubMed: 38782391
DOI: 10.24875/CIRU.22000562 -
Cureus Apr 2024There are several operative modes to address hand fractures to gain better anatomical and functional results including external fixator, percutaneous K-wire fixation,...
INTRODUCTION
There are several operative modes to address hand fractures to gain better anatomical and functional results including external fixator, percutaneous K-wire fixation, lag screw fixation, tension band wiring, intra-medullary nails or wires, and plate-screw fixation. We evaluated the results of plate osteosynthesis in fractures of metacarpals and phalanges in a prospective manner.
MATERIAL AND METHODS
A total 50 adults (19-60 years) of either sex having 58 fractures managed by miniature plate osteosynthesis and followed for a minimum six months (6-19), including metacarpal and phalangeal fractures (unstable or serial fractures), intra-articular fractures, fracture-dislocation of proximal interphalangeal and distal interphalangeal joints with joint incongruity or subluxation were enrolled while contaminated compound fractures, pathological fractures and cases of reimplantation were excluded from study. Clinical assessment was done using the American Society for Surgery of the Hand (ASSH), total active flexion (TAF), total active range of motion (TAM) score, and the Disabilities of the Arm, Shoulder, and Hand (quick DASH) score while sequential radiographs were done at each follow-up.
RESULT
All the fractures had perfect union clinically as well as radiologically with a mean duration of six weeks while functional outcomes in reference to clinical scores were observed excellent and fair in all cases. None of the cases had any loss of reduction, loosening of the implant, or other major complications.
CONCLUSIONS
Miniature plate fixation provides enough stability in metacarpal and phalanges fractures, thereby allowing immediate active movements, which leads to excellent functional outcomes and early return to normal activities.
PubMed: 38779225
DOI: 10.7759/cureus.58759 -
Cureus Apr 2024Humeral shaft fractures are common orthopedic injuries, representing 1-5% of all fractures. There is conflicting literature regarding the superiority of operative versus...
PURPOSE
Humeral shaft fractures are common orthopedic injuries, representing 1-5% of all fractures. There is conflicting literature regarding the superiority of operative versus nonoperative treatment of these fractures. The purpose of this study was to examine functional outcomes and time to radiographic union in humeral shaft fractures with the hypothesis that both would be improved in patients treated operatively relative to those treated nonoperatively.
METHODS
This retrospective cohort study examined patients with humeral shaft fractures treated at a single large healthcare system between 2010 and 2020. A chart and radiograph review were performed to collect information on demographics, fracture, treatment, and outcome information. These measures were compared between patients treated operatively and nonoperatively.
RESULTS
Five hundred seventeen adult patients meeting inclusion criteria were identified; 233 were treated nonoperatively, and 284 were treated operatively. The mean patient age was 50.2 years in those who underwent surgery relative to 59.9 years in those treated without surgery (P<0.001). Operatively-treated patients had significantly faster time to radiographic union at a median of 113 days compared to a median of 161 days in nonoperatively-treated patients (P=0.001). The operative group was made weight-bearing as tolerated significantly faster than the nonoperative group (84 days versus 98 days, respectively, P=0.002). No statistically significant difference was seen between the two treatment groups in rates of complications or range of motion at the time of radiographic union. However, patients who underwent surgery were found to be up to two times more likely to achieve full shoulder forward elevation by the time of their final follow-up than those treated without surgery (P=0.011).
CONCLUSION
Patients with humeral shaft fractures treated operatively have faster time to union, earlier weight bearing, and no change in the rate of complications compared to patients treated nonoperatively.
PubMed: 38770447
DOI: 10.7759/cureus.58658 -
Bone & Joint Open May 2024Isolated fractures of the ulnar diaphysis are uncommon, occurring at a rate of 0.02 to 0.04 per 1,000 cases. Despite their infrequency, these fractures commonly give...
AIMS
Isolated fractures of the ulnar diaphysis are uncommon, occurring at a rate of 0.02 to 0.04 per 1,000 cases. Despite their infrequency, these fractures commonly give rise to complications, such as nonunion, limited forearm pronation and supination, restricted elbow range of motion, radioulnar synostosis, and prolonged pain. Treatment options for this injury remain a topic of debate, with limited research available and no consensus on the optimal approach. Therefore, this trial aims to compare clinical, radiological, and functional outcomes of two treatment methods: open reduction and internal fixation (ORIF) versus nonoperative treatment in patients with isolated ulnar diaphyseal fractures.
METHODS
This will be a multicentre, open-label, parallel randomized clinical trial (under National Clinical Trial number NCT01123447), accompanied by a parallel prospective cohort group for patients who meet the inclusion criteria, but decline randomization. Eligible patients will be randomized to one of the two treatment groups: 1) nonoperative treatment with closed reduction and below-elbow casting; or 2) surgical treatment with ORIF utilizing a limited contact dynamic compression plate and screw construct. The primary outcome measured will be the Disabilities of the Arm, Shoulder and Hand questionnaire score at 12 months post-injury. Additionally, functional outcomes will be assessed using the 36-Item Short Form Health Survey and pain visual analogue scale, allowing for a comparison of outcomes between groups. Secondary outcome measures will encompass clinical outcomes such as range of motion and grip strength, radiological parameters including time to union, as well as economic outcomes assessed from enrolment to 12 months post-injury.
ETHICS AND DISSEMINATION
This trial has been approved by the lead site Conjoint Health Research Ethics Board (CHREB; REB14-2004) and local ethics boards at each participating site. Findings from the trial will be disseminated through presentations at regional, national, and international scientific conferences and public forums. The primary results and secondary findings will be submitted for peer-reviewed publication.
PubMed: 38767222
DOI: 10.1302/2633-1462.55.BJO-2023-0123.R1 -
Cureus Apr 2024Background The advantage of pronator quadratus (PQ) repair following internal fixation via the volar approach in distal radius fracture (DRF) surgery remains unconfirmed...
Impact of Pronator Quadratus Muscle Tear in Distal Radius Fractures on Patient Outcomes: Analyses of 55 Patients in a Volar Locking Plate Arm of a Randomized Clinical Trial.
Background The advantage of pronator quadratus (PQ) repair following internal fixation via the volar approach in distal radius fracture (DRF) surgery remains unconfirmed in the literature. The aim of this study was to compare grip strength, patient-reported outcomes, and functional results between patients with an intact PQ and those with a ruptured PQ before undergoing surgery with a volar locking plate for dorsally displaced unstable extra-articular DRFs. Methods A total of 120 patients aged 55 years and older were included in a randomized controlled trial comparing a volar locking plate with a dorsal nail plate. Of the 60 patients randomized to the volar plate group, the integrity of the PQ muscle was recorded during surgery for 55 patients, who were included in this study. The outcomes measured were the Quick Disabilities of the Arm, Shoulder, and Hand Outcome Measure (QuickDASH) score, the Patient-Rated Wrist Evaluation (PRWE) score, the EQ-5D index, the visual analog scale (VAS) score, grip strength, and range of motion (ROM). Results The median age was 67 years (range 55 to 88), and the one-year follow-up rate was 98%. Patients with an identified intact PQ (28/55) before surgical release had better QuickDASH scores after one year (2.5 vs 8.0, mean difference 5.5, 95% CI: 1.3 to 9.8, p=0.028). Patients in the intact group also had better EQ-5D Index scores after one year (0.94 vs 0.85, mean difference 0.089, 95% CI: 0.004 to 0.174, p=0.031), and demonstrated better grip strength throughout the trial; after one year: 24 kg vs 20 kg (mean difference 3.9; 95% CI: 0.3 to 7.6, p=0.016). After one year, the intact group had regained 96% of their grip strength and the nonintact group had regained 93% of their grip strength compared to the uninjured side. The observed differences may be of questionable clinical importance, as they were lower than those of previously proposed minimal clinically important differences (MCIDs). Conclusions Patients with a DRF and a ruptured PQ prior to surgery exhibited higher QuickDASH scores and lower EQ-5D index scores after one year. The integrity of the PQ should be reported in future studies.
PubMed: 38765412
DOI: 10.7759/cureus.58576 -
Cureus Apr 2024A Segond fracture is a specific type of avulsion fracture involving the lateral aspect of the proximal tibia adjacent to the tibial plateau. Segond fractures are...
A Segond fracture is a specific type of avulsion fracture involving the lateral aspect of the proximal tibia adjacent to the tibial plateau. Segond fractures are indicative of ligamentous injury in the knee. In this case report, a 29-year-old male delivery driver presented to the ED with acute onset right knee pain after losing control of his motorbike at low speed. Examination revealed significant effusion and medial and lateral joint line tenderness. An anterior-posterior radiograph of the knee showed a Segond fracture. Subsequent MRI confirmed a full-thickness anterior cruciate ligament (ACL) rupture and medial collateral ligament (MCL) tear. Despite surgical reconstruction options, the patient chose conservative management. At eight-week follow-up, he demonstrated satisfactory progress. This case highlights the diagnostic significance of Segond fractures in identifying ligamentous damage in the knee without the availability of MRI. It also highlights the feasibility of non-operative management in some instances.
PubMed: 38765369
DOI: 10.7759/cureus.58588 -
Orthopedic Reviews 2024One of complications of the reverse shoulder arthroplasty is acromion fractures, and its therapy is controversial. The aim of the study was to investigate the...
BACKGROUND
One of complications of the reverse shoulder arthroplasty is acromion fractures, and its therapy is controversial. The aim of the study was to investigate the double-plate osteosynthesis for these fractures.
METHODS
An acromion type III fracture according to classification of Levy was simulated in 16 human shoulder cadavers, and the specimens were randomly divided into two groups. Single-plate osteosynthesis was performed in the first group (locking compression plate) and double-plate osteosynthesis (locking compression plate and one-third tubular locking plate) in the second group. Biomechanical testing included cycling load and load at failure on a material testing machine. During the test, the translation was measured using an optical tracking system.
RESULTS
The load at failure for the single-plate osteosynthesis was 167 N and for the double-osteosynthesis 233.7 N ( = 0.328). The average translation was 11.1 mm for the single-plate osteosynthesis and 16.4 mm for the double-plate osteosynthesis ( = 0.753). The resulting stiffness resulted in 74.7 N/mm for the single-plate osteosynthesis and 327.9 N/mm for the double-plate osteosynthesis ( = 0.141).
DISCUSSION
Results of the biomechanical study showed that double-plate osteosynthesis had biomechanical properties similar to those of single-plate osteosynthesis for an acromion type III fracture at time point zero. The missing advantages of double-plate osteosynthesis can be explained by the choice of plate configuration.
PubMed: 38765296
DOI: 10.52965/001c.88396