Evaluation of Efficacy of Different Plating Systems in ZMC Fractures: An Original Research.

Objective: This study's objective was to assess and contrast the performance of several plating techniques in the treatment of zygomaticomaxillary complex (ZMC) fractures. Group A (Microplate System), Group B (Titanium Mesh System), and Group C (Absorbable Plate System) plating systems were the ones that were studied. Materials and Methods: With 10 patients in each group, a retrospective analysis of 30 patients with ZMC fractures was done. The following information was gathered: fracture reduction, stable fixation, complications, and patient satisfaction. Analysis was done on patient-reported outcomes, surgical outcomes, and demographic factors. Results: Group B (Titanium Mesh System) came in second with rates of 70% and 80%, respectively, while Group A (Microplate System) showed the highest rates of fracture reduction (90%) and stable fixation (100%). For fracture reduction and stable fixation, Group C (Absorbable Plate System) demonstrated rates of 80% and 90%, respectively. For Groups A, B, and C, the complication rates were 20%, 30%, and 10%, respectively. For Groups A, B, and C, the patient satisfaction levels were 90%, 80%, and 70%, respectively. Conclusion: According to the results, the Microplate System (Group A) is better than the Titanium Mesh System (Group B) and the Absorbable Plate System (Group C) in terms of fracture reduction and stable fixation when treating ZMC fractures. All plating systems had acceptable complication rates, and overall patient satisfaction ratings were high. Fracture features and patient-specific considerations should be taken into account while making individualized treatment options.

The impact of early nutritional support on postoperative wound healing in patients with complex fractures: A meta-analysis review.

Complex fractures present significant challenges in orthopaedic surgery, particularly in terms of postoperative wound healing. Nutritional status plays a crucial role in the recovery process, with early nutritional support potentially influencing wound healing outcomes. This meta-analysis aimed to assess the impact of early nutritional interventions on postoperative wound healing and scar formation in patients with complex fractures. From an initial pool of 1742 articles, 7 studies were selected for analysis. The results revealed that preoperative nutritional support significantly improved early wound healing, as indicated by lower REEDA scores (SMD = -14.06, 95% CI: [-16.79, -11.32], p < 0.01) 1 week post-surgery. Furthermore, there was a notable reduction in scar formation, as demonstrated by lower Manchester Scar Scale scores (SMD = -25.03, 95% CI: [-30.32, -19.74], p < 0.01) 3 months post-surgery. These findings highlight the importance of incorporating nutritional strategies into the management of complex fractures to optimize postoperative recovery.

Incidence of Orbital Side Effects in Zygomaticomaxillary Complex and Isolated Orbital Walls Fractures: A Retrospective Study in South Italy and a Brief Review of the Literature.

Zygomaticomaxillary complex and isolated orbital walls fractures are one of the most common fractures of the midface, often presenting orbital symptoms and complications. Our study was born with the aim of understanding the trend in the incidence of orbital presurgical symptoms, specifically diplopia, enophthalmos and exophthalmos, in the Campania Region in southern Italy. We conducted a retrospective, monocentric observational study at the Maxillofacial Surgery Unit of the Federico II University Hospital of Naples, enrolling 402 patients who reported a fracture of the zygomaticomaxillary complex and orbital floor region from 15 June 2021 to 15 June 2022. Patients were evaluated by age, gender, etiology, type of fracture, preoperative orbital side effects and symptoms. Pre-surgical side effects were studied, and 16% of patients (n = 66) developed diplopia. Diplopia was most common in patients previously operated on for orbital wall fractures (100%), and least common in patients who reported trauma after interpersonal violence (15%) and road traffic accidents (11%). Exophthalmos appeared only in 1% (six cases); whereas it did not appear in 99% (396 cases). Enophthalmos was present in 4% (sixteen cases), most commonly in interpersonal violence cases (two cases). The frequency of orbital complications in patients with zygomaticomaxillary complex and isolated orbital walls fractures suggests how diplopia remains the most common pre-surgical orbital side effect.

Recognition of the pattern of complex fractures of the elbow using 3D-printed models.

AIMS: This study aimed to answer the following questions: do 3D-printed models lead to a more accurate recognition of the pattern of complex fractures of the elbow?; do 3D-printed models lead to a more reliable recognition of the pattern of these injuries?; and do junior surgeons benefit more from 3D-printed models than senior surgeons? METHODS: A total of 15 orthopaedic trauma surgeons (seven juniors, eight seniors) evaluated 20 complex elbow fractures for their overall pattern (i.e. varus posterior medial rotational injury, terrible triad injury, radial head fracture with posterolateral dislocation, anterior (trans-)olecranon fracture-dislocation, posterior (trans-)olecranon fracture-dislocation) and their specific characteristics. First, fractures were assessed based on radiographs and 2D and 3D CT scans; and in a subsequent round, one month later, with additional 3D-printed models. Diagnostic accuracy (acc) and inter-surgeon reliability (κ) were determined for each assessment. RESULTS: Accuracy significantly improved with 3D-printed models for the whole group on pattern recognition (acc2D/3D = 0.62 vs acc3Dprint= 0.69; Δacc = 0.07 (95% confidence interval (CI) 0.00 to 0.14); p = 0.025). A significant improvement was also seen in reliability for pattern recognition with the additional 3D-printed models (κ2D/3D = 0.41 (moderate) vs κ3Dprint = 0.59 (moderate); Δκ = 0.18 (95% CI 0.14 to 0.22); p ≤ 0.001). Accuracy was comparable between junior and senior surgeons with the 3D-printed model (accjunior = 0.70 vs accsenior = 0.68; Δacc = -0.02 (95% CI -0.17 to 0.13); p = 0.904). Reliability was also comparable between junior and senior surgeons without the 3D-printed model (κjunior = 0.39 (fair) vs κsenior = 0.43 (moderate); Δκ = 0.03 (95% CI -0.03 to 0.10); p = 0.318). However, junior surgeons showed greater improvement regarding reliability than seniors with 3D-printed models (κjunior = 0.65 (substantial) vs κsenior = 0.54 (moderate); Δκ = 0.11 (95% CI 0.04 to 0.18); p = 0.002). CONCLUSION: The use of 3D-printed models significantly improved the accuracy and reliability of recognizing the pattern of complex fractures of the elbow. However, the current long printing time and non-reusable materials could limit the usefulness of 3D-printed models in clinical practice. They could be suitable as a reusable tool for teaching residents.Cite this article: Bone Joint J 2023;105-B(1):56-63.

Characteristics of Orbital Injuries Associated with Maxillofacial Trauma.

INTRODUCTION: The incidence of ocular injury associated with maxillofacial trauma remains poorly defined, with reported rates ranging from 0.8% to 92%. Our study aims to more accurately characterize ocular injuries associated with midface fractures. METHODS: We performed a retrospective review of 1677 patients from 2015 to 2020 with midface fractures at a Level I trauma center. Isolated nasal bone and frontal process of the maxilla fractures were excluded. Demographic information, mechanism of injury, need for surgery, and ophthalmologic findings were documented. Statistical analysis was conducted using SPSS. RESULTS: 773 patients between the ages of 15 and 92 were identified. Trauma most commonly resulted from assault (63.8%). The association between the mechanism of injury and ocular injury was statistically significant (p = 0.003), with 78.6% of gunshot wounds and 44.3% of assault patients having an ocular injury. The Ophthalmology service evaluated 62.6% of cases preoperatively. Minor ocular injury occurred in 36% of patients, including 46.1% of isolated orbital floor, and 28.2% of zygomaticomaxillary complex fractures. Major ocular injury occurred in 10.5% of patients. CONCLUSIONS: Over 10% of patients with midface fractures were found to have major ocular injuries. Ophthalmologic exams should be performed for all patients with midface fractures to guide clinical decision making and prevent further intraoperative ocular insults. LEVEL OF EVIDENCE: Level 4. This study represents a retrospective cohort study analyzing ocular injuries detected in patients presenting to a Level I trauma center with maxillofacial fractures between 2015 and 2020 Laryngoscope, 133:1624-1629, 2023.

Posterior Temporary C1-2 Pedicle Screws Fixation for the Treatment of Unstable C1-2 Complex Fractures: Minimum of 2-Year Follow-Up.

STUDY DESIGN: Retrospective. OBJECTIVES: To present rarely reported complex fractures of the upper cervical spine (C1-C2) and discuss the clinical results of the posterior temporary C1-2 pedicle screws fixation for C1-C2 stabilization. METHODS: A total of 19 patients were included in the study (18 males and 1 female). Their age ranged from 23 to 66 years (mean age of 39.6 years). The patients were diagnosed with complex fractures of the atlas and the axis of the upper cervical spine and underwent posterior temporary C1-2 pedicle screws fixation. The patients underwent a serial postoperative clinical examination at approximately 3, 6, 9 months, and annually thereafter. The neck disability index (NDI) and the range of neck rotary motion were used to evaluate the postoperative clinical efficacy of the patients. RESULTS: The average operation time and blood loss were 110 ± 25 min and 50 ± 12 ml, respectively. The mean follow-up was 38 ± 11 months (range 22 to 60 months). The neck rotary motion before removal, immediately after removal, and the last follow-up were 68.7 ± 7.1°, 115.1 ± 11.7°, and 149.3 ± 8.9° (P < 0.01). The NDI scores before and after the operation were 42.7 ± 4.3, 11.1 ± 4.0 (P < 0.01), and the NDI score 2 days after the internal fixation was removed was 7.3 ± 2.9, which was better than immediately after the operation (P < 0.01), and 2 years after the internal fixation was removed. The NDI score was 2.0 ± 0.8, which was significantly better than 2 days after the internal fixation was taken out (P < 0.001). CONCLUSIONS: Posterior temporary screw fixation is a good alternative surgical treatment for unstable C1-C2 complex fractures.

Management of zygomatic fractures using different surgical approaches.

Management of zygomatic complex fractures using closed reduction, two point open reduction with internal fixation (ORIF), closed reduction with three point ORIF and two point ORIF is of interest to dentist. 150 patients with zygomatic bone fractures between the ages of 14-60 years were included in the study. At final assessment, the percentage of stable condition was greater in closed reduction + two point ORIF and closed reduction + three point ORIF when compared to two point ORIF alone and three point ORIF alone and closed reduction alone. It was observed that stable condition was lowest in closed reduction alone. It was also observed that stable condition was lower in closed reduction + two point ORIF as compared to closed reduction + three point ORIF. It was also further noticed that stable condition was lower in two point ORIF alone as compared to three point ORIF alone. The treatment approach involving closed reduction and three point ORIF had better outcomes for management of zygomatic complex fractures.

Preliminary reports of augmented-reality assisted craniofacial bone fracture reduction.

BACKGROUND: Zygomaticomaxillary complex fractures involve four fracture ends. It is difficult to fully expose the operative area through a main coronal incision, an intraoral incision, and an eyelid incision. To address the partial visual field loss in craniofacial fracture reduction, we attempted to use an augmented reality (AR) navigation system. METHODS: Patients with zygomaticomaxillary complex fractures underwent three-dimensional (3D) computed tomography (CT) modeling before surgery, and preoperative plans were designed. The control team used traditional optical navigation to perform the surgery. The experimental team used an AR navigation system. From May 2019 to December 2019, 10 patients with zygomaticomaxillary complex fractures were included in this study. Data were collected after surgery and analyzed. RESULTS: There was a significant difference between the two groups in the fracture point error (1.35 vs. 1.61, P = 0.02) and fracture reduction time (15.40 vs. 20.40, P = 0.03). However, there was no difference in the operative duration (6.60 vs. 6.65, P = 0.92), blood loss volume (620.00 vs. 580.00, P = 0.83), or incidence of complications. CONCLUSIONS: The AR navigation system used by the research team has good auxiliary effects for reducing zygomaticomaxillary complex fractures. The new surgical method has better accuracy and a shorter reduction time than the traditional surgical method.

Ophthalmic Complications Associated with Zygomatic Complex Fractures: A Randomised Descriptive Clinical Study.

Background and Objectives: Trauma to the maxillofacial region is usually associated with varying degrees of disruption of the soft and hard tissues in the region and injuries to the neighbouring structures such as eyes, brain, nasal apparatus and paranasal sinuses. Injuries to the middle third of the face commonly destroys the integrity of the orbital skeleton, and are frequently complicated by injury to the eye, ranging between 2.7 and 67% as reported in the literature. These injuries may result in loss of vision or compromised ocular function. When these injuries are severe, they may be detected with ease by any medical or maxillofacial surgeon but many injuries appear minimal and may be missed by the non-ophthalmologist. Methods: A total of thirty patients were selected who were diagnosed with a zygomatic complex fracture, irrespective of sex predilection and in the age group of 18-70 years. All patients underwent a thorough ophthalmic examination by an Oral and Maxillofacial Surgeon and an Ophthalmologist preoperatively and on postoperative day 2, and 7 and all findings were documented separately by the surgeon and the ophthalmologist and the findings were later compared. Results: The statistical analysis was performed using SPSS VERSION 21.0, Shapiro-Wilk test which was used to assess the normality. Descriptive analysis was done for age and gender distribution of study subjects, which are expressed as number and frequency. Cochran's q test was used to determine if there are differences in various study factors among OMFS and ophthalmologists at three time intervals which are expressed as number and frequency. Kappa agreement was used to assess the measurement of agreement between OMFS and ophthalmologists for each factor at each time interval and these are expressed as number and frequency, and p ≤ 0.05 is considered as statistically significant. Upon examination by an OMFS periorbital oedema (p = 0.000), periorbital ecchymosis (p = 0.002), chemosis (p = 0.02) and exophthalmos (p = 0.03) were considered clinically significant. Upon examination by an ophthalmologist subconjunctival haemorrhage (p = 0.05), periorbital oedema (p = 0.05), periorbital ecchymosis (p = 0.00), ptosis (p = 0.006), enopthalmos (p = 0.05) and diplopia (p = 0.05) were considered to be clinically significant. Upon correlation of the findings of the surgeon and the ophthalmologist it was seen that certain parameters like corneal injury, Phthisis bulbing, examination of posterior segment can be better done by the ophthalmologist. Interpretation and Conclusion: In conclusion, it was determined that there is a significant correlation between ophthalmic injuries caused by zygomatic complex fractures. There are a wide array of injuries affecting the eye due to trauma to the middle third of the face, and the superficial injury can be well evaluated and documented by a surgeon; however due to the extensive nature of the injuries in trauma and the importance of the eye, an ophthalmic examination cannot be ruled out. The need for evaluation of such injures deem it pertinent for observation by an ophthalmologist.

Ramal bone graft for management of infra-orbital rim fractures with defects - Technical note and a series of 16 cases.

The purpose is to describe a technique of using ramal bone graft for reconstructing defects of the infra-orbital rim (IOR), assess outcomes and complications. This was a retrospective chart review of 16 patients who underwent ramal bone grafting for IOR fractures. Outcomes evaluated were improvement in clinical findings (lid/globe malposition, tethering of facial skin and implant extrusion) and complications. Data analysis included descriptive statistics. The sample included 15 males and 1 female, with a mean age of 31.6 years. Lid malposition, globe malposition and tethering of facial skin was seen in 16, 13 and 6 patients, respectively. One patient demonstrated extrusion of implant. The mean size of bone harvested was 14 × 7 mm. All patients demonstrated improved globe position post-treatment, while 3 had residual lid retraction. Two patients demonstrated wound dehiscence in the donor site. In conclusion ramal bone graft was found to be a viable alternative for IOR reconstruction.

Application of customized integration titanium mesh in the treatment of complicated zygomatic complex fractures: A prospective randomized clinical study.

The present study aimed to quantitatively evaluate the outcomes of the application of customized integration titanium mesh (CITM) in treating unilateral complicated zygomatic complex fractures. A prospective, randomized, controlled clinical study was conducted. Patients were randomly divided into the experimental group who underwent treatment with CITM, and the control group who underwent treatment just with traditional titanium plates. The X2 test and student t-test were used for statistical analyses. Twenty patients who required surgery for unilateral complicated zygomatic complex fracture were included in this study. The results showed that the mean of average distance (AD) between pre- and postoperative CT measurements was 0.487 mm in the experimental group and 1.173 mm in the control group (P < 0.001). Compared with the control group, the experimental group had superior zygomatico-facial symmetry (P＜0.05), a shorter average operation time (150 min versus 229 min; P < 0.001), and a higher rate of anatomic reduction (80.0% versus 30.0%; P＜0.05). In conclusion, CITM deserves to be promoted for the treatment of complicated zygomatic complex fractures. TRIAL REGISTRATION: www.chictr.org.cn (ChiCTR1800016818).

The application of augmented reality in craniofacial bone fracture reduction: study protocol for a randomized controlled trial.

BACKGROUND: Augmented reality (AR) is a new technology that increases users' perception of the real world. The purpose of this study is to evaluate the efficacy and safety of augmented reality navigation system in treatment with craniofacial fracture reduction. METHODS: This will be a single-center prospective randomized controlled trial. Twenty-two patients will be assigned to two groups of 11, and those with zygomaticomaxillary complex fractures will undergo preoperative three-dimensional CT modeling and have operational plans designed. The control team will use traditional optical navigation to perform the surgery, and the experimental team will use an AR navigation system. The primary outcome measures will be the accuracy of the key points of surgical area between the preoperational surgical plan and post-operation. The secondary outcome measures will be the blood loss, operation time, bone reduction time, hospital time, and complication rate. The findings obtained through this study are expected to evaluate efficacy and safety of the augmented reality navigation system in the treatment of zygomaticomaxillary complex fractures. DISCUSSION: This controlled trial of augmented reality navigation system in treatment with zygomaticomaxillary complex fracture reduction will clarify the efficacy and safety of this technology by measuring the accuracy of the key points of surgical area and blood loss, operation and bone reduction times, hospital stay duration, and complication rates. This is a single-center study, and the results are expected to promote the application of augmented reality in craniofacial fracture reduction to improve surgery accuracy and efficacy. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1900022626 . Registered on April 19, 2019.

Association between the Orthopaedic Trauma Society classification of open fractures and economic costs.

AIMS: The aim of this study was to investigate the relationship between the Orthopaedic Trauma Society (OTS) classification of open fractures and economic costs. METHODS: Resource use was measured during the six months that followed open fractures of the lower limb in 748 adults recruited as part of two large clinical trials within the UK Major Trauma Research Network. Resource inputs were valued using unit costs drawn from primary and secondary sources. Economic costs (GBP sterling, 2017 to 2018 prices), estimated from both a NHS and Personal Social Services (PSS) perspective, were related to the degree of complexity of the open fracture based on the OTS classification. RESULTS: Adjusted mean total NHS and PSS costs were £13,785 following treatment of complex fractures and £3,550 following treatment of simple fractures, where the open fracture wound is closed at the end of the first wound debridement, generating a mean difference of £10,235 (95% confidence interval £8,074 to £12,396). CONCLUSION: Following previous work correlating clinical outcomes with the OTS classification of open fractures, this study suggests that the new OTS classification also correlates with economic costs estimated from alternative study perspectives. Cite this article: Bone Joint J 2022;104-B(3):408-412.

Osteochondral allograft transplantation for complex distal humeral fractures assisted by 3D computer planning and printing technology: technical note.

PURPOSE: The surgical treatment of comminuted distal humeral articular fractures (DHF) is challenging and is jeopardized by the high rate of complications. The study aims to describe the application of osteochondral allograft (OCA) transplantation for the treatment of complex DHF assisted with a 3D printed specific instrumentation. METHODS: Retrospective study. Inclusion criteria were the presence of an articular multi-fragmented DHF treated with frozen OCA. Clinical, self-reported and radiographic outcomes were collected every 6 months. CT were performed at 2 years FU. RESULTS: Four patients were included. At a mean follow-up of 37.3 months (24-49) MEPS, DASH and VAS were 90 (80-100), 11.8 (0-25) and 1 (0-3) points, respectively. Not significant complication or reoperation was recorded. Graft healing was observed in 3 cases. In all cases, we observed arthritic progression after 2 years of follow-up. CONCLUSION: OCA transplantation can be considered a reliable and safe procedure in patients affected by a complex DHF. LEVEL OF EVIDENCE: Level V. Technical Notes.

Research priorities for the management of complex fractures: a UK priority setting partnership with the James Lind Alliance.

OBJECTIVE: To determine research priorities for the management of complex fractures, which represent the shared priorities of patients, their families, carers and healthcare professionals. DESIGN/SETTING: A national (UK) research priority setting partnership. PARTICIPANTS: People who have experienced a complex fracture, their carers and relatives, and relevant healthcare professionals and clinical academics involved in treating patients with complex fractures. The scope includes open fractures, fractures to joints broken into multiple pieces, multiple concomitant fractures and fractures involving the pelvis and acetabulum. METHODS: A multiphase priority setting exercise was conducted in partnership with the James Lind Alliance over 21 months (October 2019 to June 2021). A national survey asked respondents to submit their research uncertainties which were then combined into several indicative questions. The existing evidence was searched to ensure that the questions had not already been sufficiently answered. A second national survey asked respondents to prioritise the research questions. A final shortlist of 18 questions was taken to a stakeholder workshop, where a consensus was reached on the top 10 priorities. RESULTS: A total of 532 uncertainties, submitted by 158 respondents (including 33 patients/carers) were received during the initial survey. These were refined into 58 unique indicative questions, of which all 58 were judged to be true uncertainties after review of the existing evidence. 136 people (including 56 patients/carers) responded to the interim prioritisation survey and 18 questions were taken to a final consensus workshop between patients, carers and healthcare professionals. At the final workshop, a consensus was reached for the ranking of the top 10 questions. CONCLUSIONS: The top 10 research priorities for complex fracture include questions regarding rehabilitation, complications, psychological support and return to life-roles. These shared priorities will now be used to guide funders and teams wishing to research complex fractures over the coming decade.

Evaluation of Panfacial Fractures in a German Supraregional Trauma Center between 2015 and 2017 - A Retrospective Study.

INTRODUCTION: Panfacial fractures represent the most severe injuries to the face. The combination of these fractures determines the treatment strategy. This study aims to retrospectively review the data of adult patients treated for complex facial skull fractures in a hospital in Dortmund, Germany from 2015-2017. MATERIALS AND METHODS: We extracted related patient data from the hospital electronic repository and reviewed the patient files and radiological images. The fractures were classified based on the AO-Classification. The statistical analysis was performed by descriptive statistical methods. The main goal was to determine the most common fracture combinations. RESULTS: A total of 188 patients with panfacial fractures were identified (181 adults, 7 children and adolescents). The gender and age distribution corresponded to the international literature (male-to-female ratio: 3.1:1, most common injuries among young men). 2-9 fracture sites were identified per patient, resulting in a fracture frequency of 3.13 per patient. 69 different fracture combinations have been identified. The most common ones were combinations of lateral and central mid-face fractures, and combinations of nasal bone fractures with lateral midface fractures or nasal bone fractures combined with mandibular fractures. Between 1 and 13 osteosynthesis implants per patient were used for osteosynthesis; the most commonly used plates were 2.0 mm and 1.5 mm straight plates. The average inpatient stay was 3 days (standard deviation [SD] = 3.0 days), and the average operation time (incision to suture) was 39.5 min (SD = 53.5 min). DISCUSSION: Panfacial fractures are the most complex maxillofacial injuries. The complication rate in this study (4.5%) is below the international data. The treatment of panfacial fractures requires designated centers with experienced teams and good interdisciplinary cooperation.

The Incidence of Common Complications, Including Ectropion and Entropion, in Transconjunctival and Subciliary Approaches for Treatment of ZMC Fractures.

STATEMENT OF THE PROBLEM: Treating zygomaticomaxillary complex fractures (ZMC Fx) can result in postoperative complications that should be minimized by choosing the best surgical approach. PURPOSE: This study compared incidence rates of some common postoperative complications with emphasis on ectropion (an outward curling of the lower eyelid) and entropion (an inward curling of the lower eyelid) occurring with transconjunctival or subciliary approaches for the treatment of ZMC fractures. MATERIALS AND METHOD: This prospective study enrolled 80 patients with ZMC Fx who had been surgically treated. Patients were visited within one month and five months postoperatively by the same surgeon. An information checklist was completed for each patient for clinical assessment of postoperative complications. RESULTS: There was no significant difference between the two groups in the type of trauma (simple or comminuted) (p= 0.1) or the frequency of ectropion and entropion one month and five months postoperatively (p> 0.05). The same results were observed for history of massage under the eye or around the field of surgery (p= 0.151), scleral show (p= 0.414), history of post-surgical epiphora (overflow of tears and accumulation of tear) (p= 0.059), duration of the use of suspension/frost sutures (used to prevent eyelid distortion secondary to wound injury applied at the skin inferior to the incision to help elevate the lid) (p= 0.057), and the use of porex (an alloplastic material over the defect in the orbital floor) (p= 0.91). CONCLUSION: There was no significant difference between the transconjunctival approach and the subciliary approach in terms of common postoperative complications such as ectropion and entropion.

Complex fracture reduction by exact identification of the fracture zone.

Planning of a fracture reduction is important in order to reduce the surgery time, with the consequent improvement of the recovery process. There are no fully automatic methods that solve an adequate fracture reduction without the intervention of a specialist. Usually there are parameters that must be supervised or adjusted by the specialist, in order to obtain a satisfactory reduction. Furthermore, most of the studies in the literature focus on a certain type of bone and area on it. This paper presents an approach that tries to reduce to some extent the intervention of the specialist, so that it can be closer to an automatic approach. The proposed method can be applied to a wide variety of bones and areas, based on the identification of the complete fracture zone and the use of an ICP algorithm modified to work with the distance between fragments. The cases in which it has been tested are clinical cases of real fractures obtained from CT scan. This method allows working with a wide range of fractures, as well as complex fractures or deformed fragments. Unfortunately, all possible cases and situations could not be obtained and proved, but the method can be successfully applied to cases that meet a set of characteristics. The proposed technique has been validated by experts, both visually and empirically, using a framework based on virtual reality (VR). This VR framework has allowed comparing the reduction performed by the method with a reduction made virtually by specialists. This technique has also been compared with other existing techniques, obtaining a significant improvement over these.

Determination of outcomes of complex upper end tibial fractures in squatting and cross leg sitting South Asian population.

INTRODUCTION: Treatment of complex upper end tibial fractures has always been a challenge to orthopaedic surgeons. Though the roentgenogram results are satisfactory, the clinical and functional outcomes especially in terms of squatting/cross-leg sitting after long term follow-up are little known. Hence, we have done this study with a primary aim to assess the clinico-radiological and functional outcomes after operative fixation (mostly by locking plates) in complex upper end tibial fractures and a secondary aim to analyze correlation between functional outcome scores/range of motion (ROM) and the ability to squat & sit cross-legged in post-operative period. MATERIALS AND METHODS: This prospective study included a total of 33 patients who were mainly treated with locking plates. In the follow-up, patients were assessed clinico-radiologically and outcome measurements were determined using the Tegner-Lysholm (T-L) Knee Score. Patients were categorized according to their ability to squat/sit cross-legged and a subgroup analysis was performed by comparing mean ROM and T-L score in each group. RESULTS: Majority of patients were in young and adult age group with a male to female ratio of 4.5:1. The average age was 42.39 ±14.64 years. Road traffic accident was the most common mode of injury. Average time interval between injury and surgery was 5.8±4.4 days. All the fractures united by 5-9 months. Mean ROM and T-L score at last follow-up were 120.94°±13.63° and 88.12±7.24 respectively. Average shortening, varus and valgus deformity were 0.43±0.09 cm, 2.12°±0.62° and 1.06°±0.45° respectively. 14 patients (42.42%) were able to squat and 15 (45.45%) were able to sit cross-legged postoperatively. Upon subgroup analysis, difference of mean ROM in those who could squat/sit cross-legged was found statistically significant (p≤0.05), however the difference in mean functional scores was not significant (p≥0.05). CONCLUSION: Complex upper tibial fractures are a difficult entity to deal with. Anatomical locking plates take care of the alignment, articular congruity as well as ligamentous balancing thus giving good mid-term outcomes after ORIF/MIPO. However, applicability of the present functional outcome scores in assessing squatting/cross leg sitting remains doubtful. More weightage needs to be given to these activities to evaluate the outcome in South Asian population.

Clinical Signs and Intraocular Pressure Changes in Patients with Orbitozygomatic Complex Fractures.

OBJECTIVES: The study investigated the association between intraocular pressure changes and clinical ocular signs in 51 patients with orbitozygomatic complex fractures. Diplopia, chemosis, enophthalmos, subconjunctival haemorrhage, periorbital ecchymosis and extraocular muscles entrapment were assessed. STUDY DESIGN: Intraocular pressure was measured in mmHg at different time intervals with Perkins and Goldman tonometers; within first 3 days of injury (T1), 24 h post-elevation within 3-14 days of injury (T2), 1 month after initial treatment assessment (T3), 2 months after initial treatment assessment (T4), and 3 months after initial treatment assessment (T5). Intraocular pressure changes between T2/T1 and T3/T1 were analysed as change 1 and change 2, respectively, with paired t test. Significance was set at p < 0.05. RESULTS: Minimum intraocular pressure recorded in the affected eye was 5 mmHg at T1 and T2, while maximum intraocular pressure was 28 mmHg at T1. Mean intraocular pressure at T1 and T2 was 15.90 ± 4.73 mmHg and 16.80 ± 4.43 mmHg, respectively. All eye signs had completely resolved at T3 except enophthalmos, which persisted till T5. Statistical significant relationship exist between orbitozygomatic complex fracture and enophthalmos (T1: p = 0.04). subconjunctival haemorrhage (T2: p = 0.003), periorbital ecchymosis (T2: p = 0.005),and T3: p = 0.001). CONCLUSION: Chemosis, diplopia, enophthalmos, periorbital ecchymosis and subconjunctival haemorrhage showed positive contributory effect to intraocular pressure elevation in orbitozygomatic complex fracture.