In cases of humeral diaphyseal fractures, is lateral approach surgery without radial nerve exploration as effective and safe as conventional surgery?

BACKGROUND: This study compares the efficacy and safety of lateral approach surgery with and without radial nerve dissection in treating humeral diaphyseal fractures. It assesses clinical, radiological, and complication outcomes, providing a description of the surgical methods and perioperative benefits. METHODS: We retrospectively analyzed data from 71 patients admitted between May 2015 and December 2022 who underwent lateral approach surgery for humeral diaphyseal fractures. Group 1, consisting of 34 patients without radial nerve dissection, and Group 2, comprising 37 patients with radial nerve dissection, were compared. Parameters such as age, gender, fracture side (right/left), fracture type, follow-up time, surgical duration, blood loss, radiological and clinical evaluations (including Shoulder-Elbow range of motion [ROM] and Quick Disabilities of the Arm, Shoulder, and Hand score [Q-DASH]), and complications were examined. Surgical techniques and outcomes were documented. RESULTS: Both groups exhibited comparable distributions in age, gender, fracture types, and follow-up times (p>0.05). Group 1 demonstrated significantly lower surgical duration and blood loss compared to Group 2 (p<0.05 for both). Clinical assessment revealed satisfactory shoulder and elbow ROM within functional limits for all patients, with no instances of infection. Q-DASH scores were similar between groups. Postoperative radial nerve palsy occurred in one patient in Group 1 and three patients in Group 2, with all cases resolving uneventfully during outpatient follow-ups. Radiological assessment confirmed uneventful union in all patients. CONCLUSION: Lateral approach surgery without radial nerve dissection for humeral diaphyseal fractures offers comparable effectiveness and safety to conventional surgery, with potential perioperative advantages such as reduced operation time and blood loss.

[Research progress in the treatment of distal humeral metaphyseal-diaphyseal junction fracture in children].

Objective: To summarize the research progress in the treatment of distal humeral metaphyseal-diaphyseal junction (DHMDJ) fractures in children and to provide reference for clinical practice. Methods: The characteristics and treatment methods of transverse and comminuted DHMDJ fractures in children were summarized and analyzed by referring to relevant literature at home and abroad. Results: DHMDJ fractures in children are not uncommon clinically, with high fracture line position, multi-directional instability, difficult closed reduction in treatment, and easy to cause complications such as coronal and sagittal deformity of the elbow. The Kirschner wire technique was effective for DHMDJ fractures with the fracture line at the middle and low levels, but was prone to iatrogenic ulnar nerve injury. Elastic stable intramedullary nail is suitable for higher-position transverse DHMDJ fractures. However, this technique requires a second operation to remove the internal fixator, and may cause iatrogenic epiphysis plate injury in children. External fixator is a new way to treat DHMDJ fractures, and it can show satisfactory results for transverse and comminuted DHMDJ fractures. However, at present, there are few relevant studies, and most of them focus on biomechanical studies, and the efficacy lacks high-quality clinical research support. Conclusion: The ultimate goal of DHMDJ fracture treatment in children is to restore the anatomical alignment of the fracture and prevent the loss of reduction. The choice of internal fixator depends on the location of the fracture line and the shape of the fracture to provide personalized treatment.

Is intramedullary nailing of femoral diaphyseal fractures in the lateral decubitus position as safe and effective as on a traction table?

OBJECTIVES: The aim of this study was to compare the radiological and clinical results of femoral diaphyseal fractures operated in the lateral decubitus position with those operated in the supine position on a traction table and to detail the perioperative surgical technique. PATIENTS AND METHODS: Between October 2018 and January 2022, in this prospective, randomized, and single-blind comparative study, 75 patients diagnosed with adult femoral diaphyseal fractures to whom intramedullary nails were applied were operated in the lateral decubitus position without a traction table (Group 1, 37 patients) and in the supine position with a traction table (Group 2, 38 patients). Preoperative age, gender, fracture mechanism, fracture type, and surgical waiting times were determined. Perioperative anesthesia type, surgery preparation time, surgical time, number of fluoroscopy doses, amount of bleeding, and type of reduction were evaluated, and detailed observational descriptions of the surgical techniques were made. In the postoperative period, radiological evaluations were made with x-ray radiography and orthoroentgenogram, while in the clinical evaluation, hip-knee joint range of motion and rotational evaluation were made with the Craigs test. Follow-up periods were determined and complications noted. RESULTS: The average age was 32 in Group 1 and 28 in Group 2, the female/male ratio was 1:36 in Group 1 and 5:33 in Group 2, and the follow-up period was 18.2 months Group 1 and 21.7 months in Group 2. No significant difference was detected between the groups in terms of age, gender, fracture mechanism, fracture type, anesthesia type, surgical waiting time, and follow-up period (p > 0.05). Compared to Group 2, the shorter preparation time, surgical time, and number of fluoroscopy doses in Group 1 were found to be statistically significant (p < 0.05). The differences in the amount of bleeding and need for open reduction were not statistically significant between the groups (p > 0.05), and no statistical difference was found in joint range of motion and rotational evaluation in clinical evaluation in both groups (p > 0.05). There was no significant difference in terms of complications between groups. CONCLUSIONS: We found the lateral decubitus method without a traction table to be a safe and effective alternative to the supine method with a traction table in terms of the radiological and clinical results and that it also has the advantages of shortening the surgical time, reducing radiation exposure. LEVEL OF EVIDENCE: Level 1 prospective, randomized, single-blind controlled study.

Fracture pattern analysis of fractures to the diaphysis of the fifth metatarsal.

BACKGROUND: Fractures to the fifth's metatarsal (MT-V) diaphysis are common. These are inconsistently referred to as diaphyseal-, shaft-, or Dancer's fractures. A comprehensive analysis of the MT-V fracture morphology is missing. The aim was to qualitatively and quantitatively analyze fracture patterns of MT-V diaphyseal fractures. HYPOTHESIS: Fractures to the shaft of the fifth metatarsal feature specific fracture morphologies. MATERIALS AND METHODS: Retrospective, radiologic database study. Included were all acute, isolated MT-V shaft fractures (including the proximal [Lawrence and Botte (L&B) III] and distal meta-diaphysis). Demographics and fracture characteristics were assessed. Each proximal fracture line was drawn, scaled, and a qualitative and quantitative fracture line analysis was conducted. The quantitative fracture line analysis aimed at identifying dens clusters with arbitrary shape using the DBSCAN algorithm. Data are presented as mean±standard deviation. RESULTS: Out of 704 eligible MT-V fractures, 156 met the inclusion criteria. Patient's mean age was 46±19 years and 94% suffered a low energy trauma. Qualitative and quantitative fracture line analysis revealed three distinct fracture patterns. The proximal (30%) and distal (5%) meta-diaphyseal clusters showed a predominant transverse fracture pattern. The vast majority of diaphyseal fractures (56%) were spiral/oblique fractures, progressing from the proximal lateral meta-diaphyseal region in an oblique course at 61±9° to the medial distal diaphyseal cortex. Seven percent of diaphyseal fractures showed a transverse fracture pattern. DISCUSSION: Based on a qualitative and quantitative analysis of all MT-V shaft fractures, three distinct fracture clusters were identified with homogeneous fracture patterns. MT-V shaft fractures should therefore be classified as proximal meta-diaphyseal (L&B Type III), diaphyseal (oblique or transverse) and distal meta-diaphyseal. LEVEL OF PROOF: IV; retrospective database study.

Nonunion of Diaphyseal Humerus Fracture in an Infant: A Case Report.

CASE: A 9-month-old infant girl with Down syndrome presented with an atrophic nonunion of the right humerus diaphysis secondary to birth trauma. Surgical intervention included open reduction and external fixation plus cadaveric cancellous bone allograft and platelet-rich plasma and then was changed to an external fixator in axial compression. At 16 months after surgery, bone healing was achieved. CONCLUSION: Nonunions in infants are rare, and their treatment is a challenge; an adequate vascular supply with good stabilization and reduction are keys to management. We believe that the improvement in reduction and stability under axial compression were the keys to achieve consolidation.

Feline Diaphyseal Fractures: Management and treatment options.

PRACTICAL RELEVANCE: Cats frequently present with diaphyseal fractures, which require treatment in order to achieve a good return to function. These fractures often occur due to significant trauma; for example, as a result of road traffic accidents, high-rise syndrome and dog bite wounds. The first priority is to ensure the patient is systemically well before embarking on any specific surgical treatment of a fracture. CLINICAL CHALLENGES: Surgical management of diaphyseal fractures can be challenging due to the surgical approach for some bones being technically demanding, for example because of the presence of important neurovascular structures, and the small size of feline bones, which limits the choice of implant size and strength. Further, it may be difficult to visualise fracture alignment when using minimally invasive techniques, although the use of intraoperative fluoroscopy can aid with this, and malalignment can be common for some fracture repairs, particularly in cases where anatomical reconstruction is not possible. AIMS: This review focuses on diaphyseal long bone fractures and aims to assist decision-making, with an overview of the management and treatment options available. EVIDENCE BASE: Many textbooks and original articles have been published on aspects of managing fractures in small animals. The authors also provide recommendations based upon their own clinical experience.

Fractura compleja del húmero asociada a parálisis radial / Complex Fracture of the Humerus Associated with Radial Paralysis

Las fracturas de la diáfisis humeral son lesiones que se producen con frecuencia como parte de caídas o de accidentes de alta energía y se asocian con parálisis del nervio radial. Se presenta paciente de 43 años de edad, masculino, que sufre accidente automovilístico que le produce fractura diafisaria del húmero derecho multifragmentaria, por lo cual se le realiza reducción cerrada y osteosíntesis con clavo intramedular acerrojado y tratamiento conservador para la parálisis radial. La evolución fue satisfactoria, el paciente se recuperó de la parálisis a los 4 meses y logró la consolidación completa a los 5 meses. Tras un año de evolución no presenta dolor en el hombro, y tiene movilidad completa del hombro, muñeca y dedos a la extensión(AU)

Diaphyseal fracture of humerus are frequent lesions, resulting from falls or high energy accidents; they are associated to radial nerve palsy. We report the case of a 43 years old male patient, who suffered a multifragment diaphyseal fracture of his right humerus, as a result of a car accident. He underwent a closed reduction and osteosynthesis using a locking intramedullary nail for the radial paralysis. His evolution was satisfactory; this patient recovered from the paralysis after four months and he managed full consolidation five months later. After a year, he did not have any pain in his shoulder, he has full mobility of his shoulder, wrist and fingers when extendind(AU)

Analysis of feline humeral fracture morphology and a comparison of fracture repair stabilisation methods: 101 cases (2009-2020).

OBJECTIVES: The aims of this study were to describe the type, presentation and prognostic factors of feline humeral fractures over a 10-year period and to compare three stabilisation systems for feline humeral diaphyseal fractures. METHODS: In total, 101 cats with humeral fractures presenting to seven UK referral centres between 2009 and 2020 were reviewed. Data collected included signalment, weight at the time of surgery, fracture aetiology, preoperative presentation, fixation method, surgical details, perioperative management and follow-up examinations. Of these cases, 57 cats with humeral diaphyseal fractures stabilised using three different fixation methods were compared, with outcome parameters including the time to radiographic healing, time to function and complication rate. RESULTS: The majority of the fractures were diaphyseal (71%), with only 10% condylar. Of the known causes of fracture, road traffic accidents (RTAs) were the most common. Neutered males were over-represented in having a fracture caused by an RTA (P = 0.001) and diaphyseal fractures were significantly more likely to result from an RTA (P = 0.01). Body weight had a positive correlation (r = 0.398) with time to radiographic healing and time to acceptable function (r = 0.315), and was significant (P = 0.014 and P = 0.037, respectively). Of the 57 humeral diaphyseal fractures; 16 (28%) were stabilised using a plate-rod construct, 31 (54%) using external skeletal fixation and 10 (18%) using bone plating and screws only. Open diaphyseal fractures were associated with more minor complications (P = 0.048). There was a significant difference between fixation groups in terms of overall complication rate between groups (P = 0.012). There was no significant difference between fixation groups in time to radiographic union (P = 0.145) or time to acceptable function (P = 0.306). CONCLUSIONS AND RELEVANCE: All three fixation systems were successful in healing a wide variety of humeral diaphyseal fractures. There was a significantly higher overall complication rate with external skeletal fixators compared with bone plating; however, the clinical impact of these is likely low.

Manejo de fracturas abiertas de tibia en Cuba / Management of Open Tibial Fractures in Cuba

Introducción: Las fracturas abiertas de tibia son un subconjunto de la carga de traumatismos en América Latina. Se examinaron cuestiones relacionadas con el tratamiento potencialmente críticas en Cuba, país con recursos limitados, pero con un programa nacional de salud estandarizado, coherencia en educación y similitudes de programas de posgrado. Objetivos: Describir los patrones de tratamiento de la fractura abierta de tibia en Cuba, y comparar las características del manejo agudo y tardío en siete provincias del país. Métodos: Se encuestaron 67 cirujanos ortopédicos para evaluar cuatro aspectos en el tratamiento de la fractura abierta: profilaxis antibiótica, irrigación y desbridamiento, estabilización y tratamiento de heridas. Se utilizó el método de muestreo por conveniencia para identificar a los cirujanos y el análisis se realizó mediante la prueba exacta de Fisher (p < 0,05). Resultados: Se administraron antibióticos posoperatorios durante más de 72 horas para las fracturas GA-I/II (49 por ciento) y las fracturas GA-III (70 por ciento). Los cirujanos de La Habana (n= 32) utilizaron con más frecuencia la fijación interna primaria para las fracturas GA-I/II, que los cirujanos en las restantes provincias (n= 35) (64,3 porciento vs. 30,3 por ciento, p= 0,008). Los cirujanos de otras provincias realizaron cierre primario en el momento de la fijación definitiva de fracturas GA-I /II con más frecuencia que los de La Habana (62,9 por ciento vs. 32,3 por ciento, p= 0,013). Para fracturas GA-III, la mayoría de los cirujanos habaneros (88,6 %), al igual que los de las restantes provincias (96,8 por ciento) prefirieron realizar cierre diferido.Conclusiones: El tratamiento de fracturas abiertas de tibia en Cuba es generalmente consistente con otros países de América Latina. Se describen las características del manejo de fracturas abiertas de tibia en Cuba y se comparan las diferencias en los métodos de estabilización y tratamiento de heridas entre provincias, lo cual resulta útil para evaluar si son resultado de diferencias en la práctica quirúrgica, o en la disponibilidad de recursos. Esto representa una ayuda al abordar las formas de optimizar la atención al paciente, a través de la capacitación especializada y la asignación de los recursos(AU)

Introduction: Open tibia fractures are a significant subset of the overall trauma burden in Latin America. Latin American countries vary in their access to orthopaedic care resources, and country-specific orthopaedic recommendations are necessary. Cuba, a country with limited resources, has a standardized national health program, consistencies in education, and similarities across post-graduate training programs. This study aimed to identify management preferences for open tibia factures in Cuba. Objectives: To describe the treatment of open tibial fractures in Cuba, and to compare the characteristics of acute and delayed management across seven Cuban provinces. Methods: Sixty-seven orthopaedic surgeons were surveyed to evaluate four aspects of open fracture management, regarding antibiotic prophylaxis, irrigation and debridement, stabilization, and wound management. The convenience sampling method was used to identify surgeons and the analysis was performed using Fisher's exact test (p <0.05). Results: Postoperative antibiotics were administered for more than 72 hours for GA-I / II fractures (49 pecent) and GA-III fractures (70 percent). Surgeons in Havana (n = 32) used primary internal fixation for GA-I / II fractures more frequently than surgeons in the remaining provinces (n = 35) (64.3 pecent vs. 30.3 percent p = 0.008). Surgeons from other provinces performed primary closure at the time of definitive fixation of GA-I / II fractures more frequently than those from Havana (62.9 percent vs. 32.3 percent, p = 0.013). For GA-III fractures, the majority of Havana surgeons (88.6 percent), as well as those of the remaining provinces (96.8 percent) preferred to perform deferred closure. Conclusions: The treatment of open tibial fractures in Cuba is generally consistent with other Latin American countries. The characteristics of the management of open tibial fractures in Cuba are described and differences in wound stabilization and treatment methods between provinces are compared, which is useful to assess whether they are the result of differences in surgical practice, or in availability of resources. This is helpful in addressing ways to optimize patient care through specialized training and resource allocation(AU)

Can fracture healing be accelerated by serum transfer in head trauma cases? An experimental head trauma model in rats.

OBJECTIVES: In this study, we aimed to investigate whether the positive union effect caused by head trauma could be transferred between individuals. MATERIALS AND METHODS: Seventy-two male rats with an average weight of 375 g were used in this study and divided into four groups including 18 in each group. Group 1 consisted of serum donor rats that were exposed to head trauma, while Group 2 consisted of study rats with long bone fractures that were given the serum obtained from the rats in Group 1, Group 3 included control rats with isolated long bone fractures, and Group 4 included control rats with both head trauma and long bone fractures. For radiological evaluation, the ratio of the width of the callus to the width of the neighboring diaphysis was considered as the callus-to-diaphyseal ratio in the study and control groups. Histopathological and radiological evaluations was made on Days 10, 20, and 30. RESULTS: In evaluation of the radiological data regarding the callus-to-diaphyseal ratio, Group 3 was found to have significantly lower radiological values than Group 4 on Day 10 (p=0.006). Group 2 had significantly higher values than Group 3 (p=0.02). On Day 20, Group 2 exhibited significantly higher radiological values than Group 3 (p=0.004), but lower than Group 4 (p=0.032). As for Day 30, Group 2 exhibited significantly higher radiological values than Group 3, but lower than Group 4 (p=0.001). In the evaluation of the Huo scores obtained for histopathological evaluation, there was no significant difference among the groups on Days 10, 20, and 30 (p=0.295, p=0.569, and p=0.729, respectively). CONCLUSION: Our study results suggest that the osteoinductive effect after head trauma can be transmitted between individuals by means of serum transfer.

Long-term Functional Outcomes and Complications in Operative Versus Nonoperative Treatment for Displaced Midshaft Clavicle Fractures in Adolescents: A Retrospective Comparative Study.

INTRODUCTION: Traditionally, midshaft clavicular fractures in adolescents are treated nonoperatively. In later years, a trend toward operative treatment can be observed. Documentation of the benefit of surgery in this group is scarce. The purpose of this study is to evaluate the long-term patient reported functional outcomes and complications for patients treated operatively and nonoperatively for displaced midshaft clavicular fractures. Using the same outcomes we also compared the operative methods. METHODS: One hundred nine adolescents aged 12 to 18 years sustaining displaced midshaft clavicular fractures in the period 2010 to 2016 were identified in our computerized files. Sixty-one were treated nonoperatively, 48 operatively (22 plate and 26 intramedullary nail). Their radiographs and patient journals were examined for fracture classification, wound infection, sensory affection, surgery duration, hardware removal, and nonunion (n=109). Long-term function, pain, and satisfaction were measured with Quick Disability of Arm, Shoulder, and Hand (QuickDASH), Oxford Shoulder Score and Visual Analogue Scale (n=87). RESULTS: Operative treatment: We could find no difference in functional score outcomes. The main outcome QuickDASH was excellent in both groups (median 0 nail vs. 2.26 plate). Surgery duration was shorter with intramedullary nail. We found 2 infections and 2 sensory affections in the plate group, and 1 infection and 1 sensory affection in the intramedullary nail group. There were 2 refractures in the nail group. Operative versus nonoperative treatment: there were no differences in functional outcomes between the operative and nonoperative groups. For the main outcome QuickDASH both groups scored excellently (median 1.12 operative vs. 0 nonoperative). The nonoperative group was more satisfied with the cosmetic result. There was 1 nonunion in the nonoperative group that later was operated. CONCLUSIONS: Adolescents aged 12 to 18 years with displaced midshaft clavicular fractures show good long-term functional results after plate fixation, intramedullary nail, and nonoperative treatment. No additional benefit is demonstrated for surgery in our material. Nonoperatively treated patients are more satisfied with the cosmetic results. Little difference is seen between the operative methods in our study. We conclude that surgery should rarely be the choice of treatment for displaced midshaft clavicular fractures in adolescents. LEVEL OF EVIDENCE: Level III study-retrospective comparative study.

Intramedullary injury combined with osteoporosis therapeutics regulates targeted local osteogenesis.

Bone marrow ablation prompts transient bone formation in nearly the entire medullary cavity before marrow regeneration occurs. Here, we establish a procedure to direct bone formation in a desired particular site within the medullary cavity for support of biomedical devices. Local intramedullary injury was performed in the tibiae of rats and parathyroid hormone (PTH), alendronate, or saline was administered. Newly generated bone in the medulla was assessed by micro-CT and histology. To evaluate the function of newly generated bone, animals received intramedullary injury in tibiae followed by daily PTH. At day-14, implants were placed in the endocortical bone and the bone response to the implants was assessed. The fate of newly generated bone was compared with and without implants. We found that neither intramedullary injury nor medication alone resulted in bone formation. However, when combined, substantial bone was generated locally inside the diaphyseal medulla. Newly formed bone disappeared without implant placement but was retained with implants. Bone was especially retained around and between the implants. This study found that local bone marrow disruption followed by PTH or alendronate generated substantial cancellous bone locally in the diaphyseal medulla. This approach offers promise as a tissue engineering tool in medicine and dentistry.

Management of Gustilo type IIIB open tibial shaft fractures with limited resources: experience from an African trauma center.

PURPOSE: We sought to evaluate the management of Gustilo type IIIB open tibia diaphyseal fractures in an African trauma center with respect to soft tissue defect management and bone union achievement. Functional outcome assessment was the secondary objective. METHODS: A retrospective review was conducted including patients treated for open tibia fractures requiring flap coverage between 2007 and 2011. As plastic surgeons were lacking in availability, all procedures were performed by orthopedic surgeons trained in completing nonmicrosurgical flap transfers. RESULTS: Twenty-seven patients with a mean age of 36 years were included. Although the mean time to debridement was 11 h, early infection occurred in 16 (59%) patients. The mean time to flap coverage was 27 days. Among the 29 primary local flap transfers performed, only 4 failed. Secondary amputation was required in one patient after flap failure. Bone reconstruction procedures were required in nine patients and were performed after a mean period of 97 days. At the mean follow-up time of 13 months, 23 (88%) of the 26 remaining fractures had united. There were three septic nonunions and two cases of chronic osteomyelitis. Functional result was negatively influenced by the soft tissue defect area and low-quality flap coverage. CONCLUSIONS: To our knowledge, this is the first series reporting flap reconstructions performed by orthopedic surgeons for Gustilo type IIIB tibia fractures in an African hospital. Local pedicled flap transfers permitted the achievement of soft tissue coverage and bone union in most cases. Subsequent bone grafting was required in one-third of the cases.

Precontoured Plate Fixation for Incomplete Atypical Diaphyseal Fracture of Femur using Three-Dimensional Printing Rapid Prototyping: Two Cases Reports.

BACKGROUND: Reconstruction intramedullary nail spanning the whole length of the femur has been the gold standard treatment for complete atypical diaphyseal fractures of the femur (ADF). However, in cases of incomplete ADF combined with severe bowing, this approach might have complications and lead to iatrogenic complete fracture. We report two cases of incomplete ADF with severe bowing using a precontoured plate (PCP) after rapid prototyping (RP) of the deformed femurs with three-dimensional printing (3DP) technology. CASE PRESENTATION: Two patients presented with gradually worsening thigh pain, especially during walking. The patients had been using bisphosphonates for 4 and 10 years, respectively. Radiography showed an incomplete fracture in the lateral cortex of the right femur shaft. The lateral bowing angles measured in the affected femurs were 15° and 14°, and the anterior bowing angles were 20° and 16°, respectively. In bone scans, both patients showed hot uptake in the right mid-shaft of the femur. Preoperatively, the affected femur of the patient was reconstructed by 3DP RP using CT, and the plate was bent to the shape of the bone model. The ADF was fixed with a PCP using the minimally invasive plate osteosynthesis technique. Both patients were encouraged to start full weight-bearing and return to their preinjury activity level in daily life immediately after surgery. At 2 years postoperatively, radiography showed healing of the fracture site without recurrence of thigh pain and implant-related problems. CONCLUSION: Although intramedullary nailing is the standard surgical treatment for complete ADF, PCP using 3DP RP could be an effective treatment option for incomplete ADF with severely curved femur.

Outcome Of Open Interlocking Nailing In Closed Fracture Shaft Of Femur.

BACKGROUND: Various treatment modalities have been used in treating femoral shaft fractures, i.e., open intramedullary nailing, plating and external fixators but these does not always produce stable fixation and there is increased risk of infection, closed locked intramedullary nailing technique has being the gold standard and is a routine procedure but it requires proper orthopedic operation table with traction apparatus and the use of image intensifier. The use of open interlocking nailing technique doesn't require any special orthopaedic table nor it requires use of Image intensifier. The objective of this study is to find out and determine the frequency of fracture union and wound infection in open reamed interlocking nailing of close fractures of shaft of femur. METHODS: This study included fifty-eight patients from either gender, above 14 years of age with closed femoral shaft fracture presenting within 2 weeks. Data was collected on Performa about gender, age, address, date of fracture, date of operation and discharge, type of fracture and follow-up visits. RESULTS: Mean age of the patients were 31.24±8.662. According to Winquist & Hansen, femur shaft fractures were divided into four types. Type I were found in the 16(27.6%), Type II in 21 (36.2%), Type III in 12 (20.7%) and Type IV in 9 (15.5%). Total number of fracture union with regard to Winquist & Hensen Classification of fracture shaft femur were, Type I, 14 (24.1%), Type II, 21 (36.2%), Type III, 12 (20.7%), Type IV, 8 (13.8%) respectively while the rest 3 (5.2%) were found in non-union. Total number of fracture union with regard to gender of the patients were, 41 (70.7%) males and 14 (24.1%) were females while the rest 3 (5.2%) patients fracture union has not occurred. Fracture union was found in 55 (94.8%) out of 58 patients; while fracture union had not occurred in 3 (5.2%) out of 58 patients. The total number of patients who developed wound infection following surgery were 5 (8.6%) out of 58 patients; while the non-infected patients were 53 (91.4%) out of 58 patients. CONCLUSIONS: The open interlocking nailing technique for close fractures shaft of femur without the use of image intensifier achieved excellent results in terms of fracture union. Results obtained are mostly similar to the results of close interlocking nailing and it also requires less expertise, recourses and without the use of image intensifier.

Biomechanical study of a low-cost external fixator for diaphyseal fractures of long bones.

BACKGROUND: External fixation improves open fracture management in emerging countries. However, sophisticated models are often expensive and unavailable. We assessed the biomechanical properties of a low-cost external fixation system in comparison with the Hoffmann® 3 system, as a reference. METHODS: Transversal, oblique, and comminuted fractures were created in the diaphysis of tibia sawbones. Six external fixators were tested in three modes of loading-axial compression, medio-lateral (ML) bending, and torsion-in order to determine construction stiffness. The fixator construct implies two uniplanar (UUEF1, UUEF2) depending the pin-rods fixation system and two biplanar (UBEF1, UBEF2) designs based on different bar to bar connections. The designed low-cost fixators were compared to a Hoffmann® 3 fixator single rod (H3-SR) and double rod (H3-DR). Twenty-seven constructs were stabilized with UUEF1, UUEF2, and H3-SR (nine constructs each). Nine constructs were stabilized with UBEF1, UBEF2, and H3-DR (three constructs each). RESULTS: UUEF2 was significantly stiffer than H3-SR (p < 0.001) in axial compression for oblique fractures and UUEF1 was significantly stiffer than H3-SR (p = 0.009) in ML bending for transversal fractures. Both UUEFs were significantly stiffer than H3-SR in axial compression and torsion (p < 0.05), and inferior to H3-SR in ML bending, for comminuted fractures. In the same fracture pattern, UBEFs were significantly stiffer than H3-DR (p = 0.001) in axial compression and torsion, while only UBEF1 was significantly stiffer than H3-DR in ML bending (p = 0.013). CONCLUSIONS: The results demonstrated that the stiffness of the UUEF and UBEF device compares to the reference fixator and may be helpful in maintaining fracture reduction. Fatigue testing and clinical assessment must be conducted to ensure that the objective of bone healing is achievable with such low-cost devices.

Nailing of diaphyseal ulna fractures in adults-biomechanical evaluation of a novel implant in comparison with locked plating.

BACKGROUND: Adult forearm fractures require surgical treatment in most cases. Open reduction and internal fixation with plate osteosynthesis is the therapy of choice. Intramedullary fixation offers several advantages compared to plate fixation but is not routinely used. The aim of our study was to compare a newly designed ulna nail with angular stable plating in a biomechanical testing setup of an ulna shaft fracture with a diaphyseal defect. METHODS: Ten pairs of sawbones with a defect osteotomy of the ulna shaft (OTA 2U2C3) were fixed with an interlocked nail or locked plate osteosynthesis. The constructs were tested under four-point bending, torsional loading and axial loading in a servo-pneumatic testing machine to compare the stiffness of both stabilization methods. RESULTS: The nail constructs show lower yet sufficient bending stiffness (62.25 ± 6.64 N/mm) compared to the plate constructs (71.2 ± 5.98 N/mm, p = 0.005). The torsional loading test shows superior stiffness of the plate constructs (0.24 ± 0.03 Nm/deg vs. 0.1 ± 0.01 Nm/deg; p < 0.001), while the axial loading shows superior stiffness of the nail constructs (1028.9 ± 402.1 N/mm vs. 343.9 ± 112.6 N/mm; p < 0.001). CONCLUSIONS: Intramedullary nailing of ulna shaft fractures obtains sufficient but lower stability in bending and torsional loading when compared to rigid angular stable plating and could be an alternative technique to plate fixation. The lower stability and the closed stabilization technique allow for a rapid periosteal healing, which is not present in stiffer constructs.

Conservative vs. operative treatment for humeral shaft fractures: a meta-analysis and systematic review of randomized clinical trials and observational studies.

BACKGROUND: This meta-analysis aimed to compare conservative vs. operative treatment for humeral shaft fractures in terms of the nonunion rate, reintervention rate, permanent radial nerve palsy rate, and functional outcomes. Secondarily, effect estimates from observational studies were compared with estimates of randomized clinical trials (RCTs). METHODS: The PubMed/Medline, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases were searched for both RCTs and observational studies comparing conservative with operative treatment for humeral shaft fractures. RESULTS: A total of 2 RCTs (150 patients) and 10 observational studies (1262 patients) were included. The pooled nonunion rate of all studies was higher in patients treated conservatively (15.3%) vs. operatively (6.4%) (risk difference, 8%; odds ratio [OR], 2.9; 95% confidence interval [CI], 1.8-4.5; I2 = 0%). The reintervention rate was also higher for conservative treatment (14.3%) than for operative treatment (8.9%) (risk difference, 6%; OR, 1.9; 95% CI, 1.1-3.5; I2 = 30%). The higher reintervention rate was predominantly attributable to the higher nonunion rate in patients treated conservatively. The permanent radial nerve palsy rate was equal in both groups (OR, 0.6; 95% CI, 0.2-1.9; I2 = 18%). There appeared to be no difference in mean time to union and mean Disabilities of the Arm, Shoulder and Hand scores between the treatment groups. No difference was found between effect estimates form observational studies and RCTs. CONCLUSION: This systematic review shows that satisfactory results can be achieved with both conservative and operative management; however, operative treatment reduces the risk of nonunion compared with conservative treatment, with comparable reintervention rates (for indications other than nonunion). Furthermore, operative treatment results in a similar permanent radial nerve palsy rate, despite its inherent additional surgery-related risks. No difference in mean time-to-union and short-term functional results was detected.

Factors affecting re-displacement in pediatric forearm fractures and the role of cast indices.

OBJECTIVES: This study aims to investigate the factors affecting the loss of reduction in pediatric diaphyseal forearm fractures and to compare the three-point index (TPI) with the cast index, padding index, Canterbury index, and gap index. PATIENTS AND METHODS: This retrospective study, which was conducted between January 2016 and December 2016, included 159 patients (134 males, 25 females; mean age 8.1±2.8 years; range, 3 to 13 years) with diaphyseal forearm fracture. Patients' age, gender, and the level, displacement, and location of the fractures were recorded. The presence of anatomic reduction, a straight ulnar border, and the cast type (banana or box type) were checked after the reduction. The TPI, cast index, padding index, Canterbury index, and gap index were measured. RESULTS: Fifty-two patients (32.7%) experienced loss of reduction during the follow-up. Displaced fractures of both the radius and the ulna, cast type-banana, anatomical reduction, straight ulnar border, TPI, cast index, padding index, and Canterbury index were found to be associated with re-displacement. CONCLUSION: Although cast indices can be used as a beneficial clinical tool in predicting the loss of reduction in the treatment of pediatric forearm fractures, they may not be sufficient when used alone. Obtaining a more accurate result may be possible by assessing several parameters such as the presence of an anatomic reduction, box-type casting, and TPI together.