Comparison between open reduction and internal fixation and minimally invasive surgery in management of Sanders type II calcaneal fracture: A randomized controlled trial protocol.

BACKGROUND: The minimally invasive surgery possesses an essential and growing function in treating the calcaneal fractures, but the related literature on this topic is limited. For our study, the main purpose was to compare the early prognosis of a group of the patients with Sanders type II fracture of calcaneus treated via minimally invasive surgery and open reduction and internal fixation (ORIF). METHODS: This is a prospective randomized controlled trial in the patients who suffer from displaced intra-articular calcaneal fractures. This current study was carried out in accordance with the guidelines of "CONSORT statement" for the randomized controlled studies. All patients were randomly assigned into 2 groups on the basis of a random number table, namely the minimally invasive treatment group and the ORIF group using conventional methods. Inclusion criteria included the followings: aged between 18 to 59 years old; closed and unilateral fracture; patients with displaced intra-articular calcaneal fracture (>2 mm) involving Sanders Type IIC and Type IIB; and patients have enough mental capacity to understand and answer questions in the evaluation scale. In the process of outpatient follow-up, the radiographs were taken at 1, 3, 6, and 12 months. The functional results involved the American Orthopaedic Foot and Ankle Score, Foot Function Index, and the pain score. CONCLUSIONS: This protocol will give us research directions in future work. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry6261).

Open Reduction and Internal Fixation Plus Total Hip Arthroplasty for the Acute Treatment of Older Patients with Acetabular Fracture: Surgical Techniques.

Open reduction and internal fixation of displaced acetabular fractures has been the gold standard for treatment of these complex injuries. The subset of older patients with dome impaction, femoral head impaction, or a posterior wall component are considered for treatment with concomitant open reduction and internal fixation and total hip arthroplasty. Little has been written on the surgical techniques to perform concomitant open reduction and internal fixation plus total hip arthroplasty safely. This article describes the important intrinsic factors for acetabular component stability, choice of surgical approach for management of these injuries, and surgical technique for anterior and posterior approaches.

Is there a need for standardized postoperative radiographs after operative treatment of wrist or ankle fractures?

PURPOSE: The purpose of this study was to evaluate the frequency of changes in treatment plan due to standardized postoperative radiographs. A secondary aim was to compare our results with a national benchmark. METHODS: This is a single-center retrospective case series of 167 consecutive patients, operated with open reduction and internal fixation (ORIF) for distal radius or ankle fractures in 2014. Changes in the treatment protocol were defined as additional CT-imaging, reoperation or other changes as stated in the postoperative instructions. In addition, a national survey was conducted assessing differences between surgeons in different hospitals concerning revision rates. RESULTS: In 7.2% (12/167) of the patients, a change in the treatment plan was recorded after the standardized postoperative radiographs. 10 patients (6%) were reoperated (three without additional imaging, seven after additional imaging with CT). The results from our survey showed a good assessment concerning the quality of intraoperative imaging (7.85 on a scale from 0 to 10). Concerning the revision rate, there was a trend to lower revision rate of 8.1% in the six observers. CONCLUSIONS: Standard postoperative radiographs could improve quality of care. Intraoperative standardized radiographic documentation is needed and the perception and acceptance of quality may vary between hospitals.

Return to Duty Following Open Reduction and Internal Fixation of Unstable Ankle Fractures in the Active Duty Population.

INTRODUCTION: Literature on functional outcomes after ankle surgery is for the most part limited to return to sport studies. The purpose of this study was to determine occupational and functional outcomes following operative treatment of unstable ankle fractures in the active duty military population. MATERIALS AND METHODS: All ankle fractures treated with open reduction internal fixation at a single institution from 2013 to 2015 were reviewed. Inclusion criteria included active duty personnel with a single-sided injury requiring operative management. All patients had a minimum of 6 months follow-up. Forty-seven records were reviewed with 43 patients fitting these criteria. Patients were predominantly male (91%) with an average age of 26 years at the time of fracture. Functional outcomes were evaluated using AOFAS and SANE scores. Occupational outcomes were determined in reference to a service member's ability to return to full duty. RESULTS: Of the 43 subjects, 81% (n = 35) returned to active duty. Of the eight individuals who did not return to active duty, six were medically boarded out of the military. Looking at demographic, surgical, and functional variables, only the SANE and AFAOS scores functional outcomes showed a significant correlation with individual return to duty. Individuals who reported less pain and increased functional outcomes had increased return to duty rates. CONCLUSION: This study sought to determine predictors for return to duty within an active duty military population after ORIF of unstable ankle fractures. Given the paucity of military literature on this subject, the end goal was to provide realistic recovery expectations for both injured service members and their command teams. Overall, 81% of patients were able to return to active duty following operative treatment of unstable ankle fractures. There were no associations found between age, gender, military rank, or fracture patterns and return to duty.

Percutaneous versus open reduction and fixation for Tillaux and triplane fractures: a multicenter cohort comparison study.

The goal of this study was to compare open reduction versus percutaneous fixation of adolescent ankle fractures with regards to the incidence of growth disturbance. We performed a retrospective cohort analysis of adolescent patients with triplane or Tillaux fractures. There was an even distribution of triplane fractures and mean initial displacement between cohorts. Analysis of follow-up radiographs revealed no instances of growth disturbance in the percutaneous fixation group and six in the open reduction group (P=0.29). Growth disturbance does not pose a significant concern when selecting a surgical approach. Owing to the rarity of these fractures this study was underpowered.

Costs and Radiographic Outcomes of Rotational Ankle Fractures Treated by Orthopaedic Surgeons With or Without Trauma Fellowship Training.

INTRODUCTION: We evaluated the radiographic outcomes and surgical costs of surgically treated rotational ankle fractures in our health system between providers who had completed a trauma fellowship and those who had not. METHODS: We grouped patients into those treated by trauma-trained orthopaedic surgeons (TTOS) and non-trauma-trained orthopaedic surgeons (NTTOS). We graded the quality of fracture reductions and calculated implant-related costs of treatment. RESULTS: A total of 208 fractures met the inclusion criteria, with 119 in the TTOS group and 89 in the NTTOS group. Five patients lost reduction during the follow-up period. The adequacy of fracture reduction at final follow-up did not differ (P = 0.29). The median surgical cost was $2,940 for the NTTOS group and $1,233 for the TTOS group (P < 0.001). DISCUSSION: We found no notable differences in radiographic outcomes between the TTOS and NTTOS groups. Cost analysis demonstrated markedly higher implant-related costs for the NTTOS group, with the median surgical cost being more than twice that for the TTOS group. LEVEL OF EVIDENCE: Level III.

Pediatric supracondylar humerus fractures: is surgeon experience a surrogate for the need of open reduction?

Although there are many factors that are likely to influence the need for open reduction and percutaneous pinning (ORPF) in the treatment of pediatric supracondylar humerus fractures (SCHFs), the role of surgeon's experience (as represented by the total number of surgically treated SCHFs) on the need for ORPF has seldom been investigated. We reviewed the data on all completely displaced, pediatric SCHFs that were treated surgically by a single, fellowship-trained, pediatric orthopedic surgeon over the first 10 years of the surgeon's clinical practice. The incidence of ORPF was calculated as the percentage of open reductions among surgically treated, completely displaced, consecutive SCHFs at any given time during the 10-year period. From September 2005 to August 2015, a total of 212 completely displaced SCHFs were treated surgically at our institution by a single surgeon. When analyzing the incidence of ORPFs among surgically treated, completely displaced SCHFs at any given time, a bimodal curve was found: there was an increasing slope over the first 30 surgically treated SCHFs, with a progressive decreasing slope afterward. The incidence of ORPF within the first 10, 20, and 30 surgically treated, completely displaced SCHFs was 10.0, 30.0, and 26.7%, respectively, decreasing to 16.0, 9.0, 6.7, and 5.0% within the first 50, 100, 150, and 200 surgeries, respectively. The incidence of ORPF was almost 17-fold higher within the first 30 surgically treated, completely displaced SCHFs (17%), when compared with the following 182 (1.1%) cases (P<0.00001). Although it is likely that many factors influence the need for ORPF in the treatment of completely displaced SCHFs, surgeon's experience appears to play a significant role. Strategies aimed to accelerate the learning curve in the treatment of pediatric SCHFs should be undertaken.

Comparison of daytime and after-hours surgical treatment of supracondylar humeral fractures in children.

Reports on different types of surgical procedures show that night-time surgeries are often associated with a high number of complications than daytime surgeries. However, there are no data, and hence evidence that relate the outcome of supracondylar humeral fractures in children to the time of the day when the respective surgical procedure is implemented. In this study, we analyze the clinical and radiological outcomes of pediatric supracondylar humeral fractures surgically treated during daytime and night-time hours. In total, 91 patients with Gartland type-3 fractures were included; 47 patients treated between 0800 and 1700 h were defined as the daytime group and 44 patients treated between 1701 and 0759 h were defined as the after-hours group. Age, sex, affected side, fracture type, and day and time of operation were recorded. Any preoperative neurovascular injuries, open fractures, or ipsilateral fractures were noted. The surgical method, use of a medial pin or pins, operation time, any postoperative neurovascular complications, extent of successful reduction, fixation rate, any resultant deformity, and functional loss rate were evaluated. The two groups did not differ significantly in terms of operation time, open reduction rate, rate of poor reduction, extent of poor functional outcomes, or induction of deformity (P>0.05). The poor fixation rate was significantly greater in the after-hours group than in the daytime group (P<0.05). No significant between-group differences were evident in age, sex, affected side, or length of postoperative follow-up (all P-values>0.05). After-hours treatment of displaced supracondylar humeral fractures in children is associated with a higher poor fixation rate compared with daytime procedures. LEVEL OF EVIDENCE: therapeutic study (retrospective comparative study), Level III.