Search

Purpose Preoperative prediction of mortality in femoral neck fracture patients aged 65 years or above may be valuable in the treatment decision-making. A preoperative clinical prediction model can aid surgeons and patients in the shared decision-making process, and optimize care for elderly femoral neck fracture patients. This study aimed to develop and internally validate a clinical prediction model using machine learning (ML) algorithms for 90 day and 2 year mortality in femoral neck fracture patients aged 65 years or above. Methods A retrospective cohort study at two trauma level I centers and three (non-level I) community hospitals was conducted to identify patients undergoing surgical fixation for a femoral neck fracture. Five different ML algorithms were developed and internally validated and assessed by discrimination, calibration, Brier score and decision curve analysis. Results In total, 2478 patients were included with 90 day and 2 year mortality rates of 9.1% (n = 225) and 23.5% (n = 582) respectively. The models included patient characteristics, comorbidities and laboratory values. The stochastic gradient boosting algorithm had the best performance for 90 day mortality prediction, with good discrimination (c-statistic = 0.74), calibration (intercept = − 0.05, slope = 1.11) and Brier score (0.078). The elastic-net penalized logistic regression algorithm had the best performance for 2 year mortality prediction, with good discrimination (c-statistic = 0.70), calibration (intercept = − 0.03, slope = 0.89) and Brier score (0.16). The models were incorporated into a freely available web-based application, including individual patient explanations for interpretation of the model to understand the reasoning how the model made a certain prediction: https://sorg-apps.shinyapps.io/hipfracturemortality/ Conclusions The clinical prediction models show promise in estimating mortality prediction in elderly femoral neck fracture patients. External and prospective validation of the models may improve surgeon ability when faced with the treatment decision-making. Level of evidence Prognostic Level II.

Operative intervention for distal radius fractures is typically reserved for patients with displaced fractures that may result in bothersome compromises in function, although patient-specific factors (age, activity level, and preference) are considered. Operative intervention is associated with earlier improvement in function but exposes the patient to the risk of anesthesia and surgery. Although surgery is associated with an initial increase in cost of care, the benefits of earlier return to activity may offset these increases. Efforts to contain cost through implant selection, use of ambulatory surgical centers, and judicious referrals for postoperative therapy can aid surgeons in delivering high-value care.

Background: Proximal humerus fractures are the 2nd most common fractures of upper extremity and one of the most common fractures in osteoporotic bone. 85% of these fractures are undisplaced or minimal displaced fractures which can be treated with conservative management. 15% fractures are displaced and unstable and which may need surgical management. The surgical procedure remains a challenging and unsolved problem to the surgeon especially because of its high complication rate. Internal locked plating becoming more popular, to maximize clinical outcome with our experience of surgical procedure in using system pate. In our study, the plate provides stable fixation with a goal of early restoration of a painless shoulder. Methods: A prospective study was conducted in department of orthopaedics in Adichunchanagiri institute of medical sciences, B.G. Nagara, mandya from June 2018 to August 2020. Displaced Neer’s part 2, part 3 or part 4 with age not less than 18 years and not more than 75 years. Twenty patients with proximal Humerus fractures were taken into study, all patients were fixed with PHILOS plate. Results: Functional outcome evaluated with CONSTANT – MURLEY score, we got excellent results in 04 cases, satisfactory in 09 cases, unsatisfactory in 05 and failure in 02 cases with a mean Constant-Murley score at the end of final follow-up period was around 80.2. Conclusion: Proximal humeral fractures managed by internal fixation with anatomic locking compression plates yields satisfactory results when provided the correct surgical technique. The anatomic locking compression plate is suitable for the stabilization of proximal humeral fractures (Neer’s 2-part, 3-part and 4-part fractures and osteoporotic fracture) and can lead to a good functional outcome.

The treatment of displaced midshaft clavicle fractures (MCFs) is still controversial. The aims of our study were to evaluate clinical and radiological outcomes and complications of patients with displaced MCFs managed nonoperatively and to identify potential predictive factors of worse clinical outcomes. Seventy-five patients with displaced MCFs were enrolled and treated nonoperatively with a figure-of-eight bandage (F8-B). Initial shortening (IS) and displacement (ID) of fragments were radiographically evaluated at the time of diagnosis and immediately after F8-B application by residual shortening (RS) and displacement (RD). The clavicle shortening ratio was evaluated clinically at last follow-up. Functional outcomes were assessed using Constant (CS), q-DASH, DASH work and DASH sport scores. Cosmetic outcomes and rate of complications were evaluated. Good to very good mid-term clinical results were achieved by using the institutional treatment protocol. Multiple regression identified RS as an independent predictor of shoulder function, while RD affects fracture healing. These findings support the efficacy of our institutional protocol and thus could be useful for orthopedic surgeons during the decision-making process.

Locked anterior plating remains the most common form of surgical fixation for displaced fractures of the distal radius. We hypothesized that delayed surgical fixation later than 2 weeks after injury contributes to poorer patient outcomes for patients with displaced or intra-articular fractures of the distal radius. We conducted a retrospective cohort study of 158 patients who underwent locked anterior plating for an intra-articular or displaced fracture of the distal radius using multiple regression analysis to identify any relationship between patient, injury or treatment factors with the patient-rated wrist and hand evaluation score or finger and wrist stiffness. There was no significant correlation between timing of surgery and functional scores. A delay in time to surgery of more than 2 weeks did correlate significantly with increased finger and thumb stiffness. However, this relationship was not seen for wrist stiffness. Our study supports the consensus that early recovery and function is facilitated by surgical fixation within 2 weeks and that delayed fixation beyond this may contribute to protracted finger stiffness. Level of evidence: IV

Proximal humeral fractures account for 4-5% of all fractures. The optimal management of displaced fracture remains controversial. This study was designed to assess the surgical management of displaced fractures of the proximal humerus and its functional outcome. A total of 35 cases with displaced humeral fractures underwent surgical management above 18 years age were recruited. The clinical and radiological examination was conducted and post-operative assessment was done to evaluate pain, function and rotation of fractured location and radiological evaluation for fracture union. Majority cases were in between 51-60 years (34.2%) and 41-50 years (28.47%). Majority cases had fractures by road traffic accidents (62.8%) followed by falling injuries (31.4%) and by other causes (8.57%). 51.4% of cases had no pain, 28.5% cases had mild pain, 8.57% cases had pain with activity and 8.57% of cases had pain during rest. 82.85% of cases had excellent functional outcome, 14.28% of cases had moderate and 2.85% cases had a poor functional outcome. The overall outcome was excellent in 68.57% cases, good in 20% cases, moderate in 8.57% cases and poor in 2.85% cases. The Surgical approach in the management of displaced proximal humeral fractures had less pain, greater range of motion and less stiffness of fracture site. Functional outcome was better in 2 part fractures.

Radial neck fractures are common injuries in children. Surgery is necessary for displaced fractures that cannot be closed reduced; however, open surgery is associated with suboptimal outcomes and potential complications. Arthroscopic fixation of radial neck fractures is a minimally invasive technique for repositioning the radial head in correct alignment. Reduction of the radial head is performed under direct visualization to restore the congruency of proximal radioulnar and radiocapitellar joints and K-wires can be passed under visualization via safe portals for fixation.

The fracture avulsion of the greater tuberosity (GT) represents 2% of all humerus fractures, but the true incidence is likely to be higher, being challenging the initial diagnosis on radiograph. The fracture avulsion of the GT could have different treatments: nondisplaced or minimally displaced fractures are treated conservatively, whereas for displaced or comminuted fractures surgical treatment is preferred. The most important finding of this study is the employment of an all-arthroscopic transosseous augmented technique for the treatment of a displaced humeral GT fracture avulsion. This technique shows all the advantages of the transosseous fixation and arthroscopic approach., Technique Video Video 1 The video shows a novel transosseous arthroscopic technique for the treatment of fracture avulsion of the greater tuberosity.

Proximal humerus fractures are common injuries that are increasing in incidence with the increasing life expectancy and associated rise in osteoporosis. Majority of the proximal humerus fractures are minimally displaced and can be treated non-operatively with good functional results. However unstable displaced fractures have high morbidity especially in older patients. These unstable and displaced fractures may require operative intervention to ensure a successful outcome. Evaluation of both patient and fracture characteristics is important in deciding the appropriate type of surgical intervention. The aim of surgical fixation is to restore articular congruency, alignment and the proper positioning of tuberosities with respective to humeral head. Hemiarthroplasty is indicated in fracture dislocations, head splitting fractures and some three or four part fractures. In the elderly, especially with more complex four-part fractures and fracture dislocations, hemiarthroplasty and reverse total shoulder arthroplasty are indicated to decrease complication rates and improve functional outcomes. Restoration of proper humeral height, version and tuberosity position are key to success in hemiarthroplasty. Fractures in which the tuberosities are unlikely to unite or cannot be reconstructed well, reverse total shoulder arthroplasty should be considered.

Clavicle fractures are common injuries which any orthopaedic surgeon encounters in the clinical practice. There are ongoing debates about the optimal treatment for displaced fractures and a consensus is yet to be agreed. This article aims to present an overview on current concepts and suggest some recommendations for the management of these injuries.

Fractures of the proximal humerus account for 4% to 5% cases out of all fractures, and about 85% of them are minimally displaced. The purpose of the study was to observe the effectiveness of physiotherapeutic methods used in the proximal fractures of the humerus. Material and method: the research was performed on a group of 13 patients who have been orthopedically treated for fractures at the proximal end of the humerus. Five subjects followed the TECAR therapy and physical exercise, and eight subjects followed classical physiotherapy and physical exercise. The evaluations have been performed at the beginning of the recovery, after 14 days, after 28 days and after 42 days of treatment. Pain intensity (VAS score), joint amplitude (goniometry), muscle strength and functionality (the PENN questionnaire) were assessed in all patients. The results of the evaluations showed a decrease in pain, after the first 14 days, especially for the patients who underwent the Tecar therapy. Also, the results showed that the patients with surgical neck fractures had the best evolution in cases of goniometry evaluation, compared to the rest of the patients. In conclusion, physical therapies for proximal humerus fractures play an important role in the recovery and reintegration of the patients into family and at work.

Background: Cancellous screw fixation is commonly performed procedures for the management of fracture neck of femur in adults. Cancellous screw fixation is associated with high percentage of excellent and good results and is associated with reduced invasion and short operative time.Objectives 1. To study the incidence of fracture neck of femur according to various grades of Garden’s classification.2. To study the quality of life after screw fixation using Modified Harris Hip Scoring (MHHS) system.3. To evaluate the results of screw fixation in various grades of Garden’s classification. Patients and Methods: Adult patients ranging from 20-50 years those suffering from fracture neck of femur were treated by cancellous screw fixation. The study was carried out to evaluate the immediate and early results of cancellous screw fixation for intracapsular fracture neck of femur in young adults.Results: Study conducted on 50 patients of both sex and age between 20 yrs and 50 yrs within the period of 2 years those suffering from fracture neck of femur and treated by cancellous screw fixation and follow up was done at 6 weeks, 3 months, 6 months and 9 months and Modified Harris Hip Score was noted. Data was tabulated and statistically analysed.Conclusions: Our study showed 76% having excellent results, 18% having good results, 2% having fair and 4% poor results. It was found that there is correlation between initial displacement and the final functional scores. In our study, undisplaced fractures (grade I and II) consistently showed excellent and good results whereas displaced fractures (grade III and IV) were associated with fair and poor results also.

To assess the use of CT with unfolded cylindrical projection (UCP) for rib fracture detection and characterization.The images from 60 polytraumatized patients who underwent whole body CT were evaluated for the presence and characterization of rib fractures (displaced or not, single or multiple). Two readers independently evaluated conventional CT images and UCP images in two readout sessions at least one month apart. All readouts were timed. A gold standard was established by two radiologists with 12 and 22 years of clinical experience based on the combined analysis of conventional and UCP reformats.Using UCP, the mean evaluation time was 27%-54% shorter (P = 0.01 and0.0001) while maintaining a comparable diagnostic performance (sensitivity and specificity of 68.4-79.1% and 99.5-99.6% for conventional reformats and 70.6-91.0% and 96.8-97.7% for UCP) and a good reproducibility (Kappa of 0.71). The multiple fracture detection ratio of UCP was similar to that of conventional reformats (80%). There were more false positives and false negatives using UCP and displaced fractures were harder to characterize.UCP yielded a diagnostic performance similar to that of conventional reformats for the detection of rib fractures with a good reproducibility and a noticeable reduction in evaluation time.

Acute injuries of the midfoot are uncommon and can be challenging to diagnose and manage. These injuries are frequently overlooked, as the initial plain radiographs, can be difficult to interpret or are misleading. As the consequences of a missed midfoot injury can be devastating for the patient and are so difficult to treat, all orthopaedic surgeons should be highly suspicious when managing patients with midfoot trauma. This article summarizes the current literature about the midfoot injuries and focuses in their management. Non-displaced fractures and stable injuries can be treated conservatively with immobilization for 4–6 weeks. Displaced fractures, unstable or high-energy complex injuries should be treated surgically. Extra care should be given to maintain the length of the medial and lateral columns, in order to avoid long-term deformity and disability. In general the achievement of anatomic reduction and stable fixation of these injuries leads to good functional long term outcomes.

Purpose The section for the skeletal trauma and sport's injuries of the European Society for Trauma and Emergency Surgery (ESTES) appointed a task force group to reach a consensus among European countries on proximal humeral fractures. Material/Methods The task force group organized several consensus meetings until a paper with final recommendations was confirmed during the ESTES Executive Board meeting in Berlin on 25 October 2018. Conclusion The Recommendations compare conservative and four possible operative treatment options (ORIF, nailing, hemi- and total reverse arthroplasty) and enable the smallest common denominator for the surgical treatment among ESTES members.

Aims The management of completely displaced fractures of the distal radius in children remains controversial. This study evaluates the outcomes of surgical and non-surgical management of ‘off-ended’ fractures in children with at least two years of potential growth remaining. Methods A total of 34 boys and 22 girls aged 0 to ten years with a closed, completely displaced metaphyseal distal radial fracture presented between 1 November 2015 and 1 January 2020. After 2018, children aged ten or under were offered treatment in a straight plaster or manipulation under anaesthesia with Kirschner (K-)wire stabilization. Case notes and radiographs were reviewed to evaluate outcomes. In all, 16 underwent treatment in a straight cast and 40 had manipulation under anaesthesia, including 37 stabilized with K-wires. Results Of the children treated in a straight cast, all were discharged with good range of mo (ROM). Five children were discharged at six to 12 weeks with no functional limitations at six-month follow-up. A total of 11 children were discharged between 12 and 50 weeks with a normal ROM and radiological evidence of remodelling. One child had a subsequent diaphyseal fracture proximal to the original injury four years after the initial fracture. Re-displacement with angulation greater than 10° occurred for 17 children who had manipulation under anaesthesia. Four had a visible cosmetic deformity at discharge and nine had restriction of movement, with four requiring physiotherapy. One child developed over- granulation at the pin site and one wire became buried, resulting in a difficult retrieval in clinic. No children had pin site infections. Conclusion Nonoperative management of completely displaced distal radial fractures in appropriately selected cases results in excellent outcomes without exposing the child to the risks of surgery. This study suggests that nonoperative management of these injuries is a viable and potentially underused strategy. Cite this article: Bone Joint J 2021;103-B(5):902–907.

Purpose: Tension band wiring technique has been widely used for treating patellar fracture. Conventional techniques are associated with some complications and several modifications have been introduced to increase stabilization. The purpose of this study was to compare two different fixation techniques, the one-end and both-ends Kirschner wire bending fixation methods. Methods: We retrospectively reviewed patient data from 2013 to 2017, including the age, sex, body height, body weight, BMI, lesion of injury, trauma mechanism, fracture displacement and classification, type of fixation, fracture healing duration, length of follow-up, clinical results and complications. The surgical outcome was assessed using the pain score (VAS), Lysholm knee score, and knee joint ROM. Plain radiographs were used to evaluate radiographic outcomes and assess the fracture union duration and hardware complications. We performed statistical analysis to compare these two different fixation techniques. Results: There were no significant differences between the two groups in terms of demographic data, fracture healing duration, level of the K-wires, distance between the K-wires, or length of the K-wires over the patella length (all p > 0.05). There were significant differences in the VAS score, K-wire migration, flexion degree, ROM, and Lysholm score (all p < 0.001) between the two different fixation methods. Conclusion: The both-ends K-wire bending fixation method has a lower complication rate and results in a better clinical outcome than the one-end K-wire bending fixation method. This revised technique can effectively control both ends of the K-wires, thus eliminating the possibility of K-wire migration and improving the fixation stability.

As orthopedic surgeons we have a strong inclination towards bringing broken bones together. Traditionally, in displaced fractures the anatomy should be restored and the success of surgery should su...

Forearm fractures are the most common fractures among children. When treating pediatric forearm fractures, the basic principle is to accurately align, angularly and rotationally, both the radius and the ulna. Both bone diaphyseal forearm fractures which are minimally displaced can be treated nonoperatively. Displaced fractures need reduction and unstable fractures after reduction need additional fixation.

The fracture-avulsion of the greater tuberosity represents the 2% of all humerus fracture, but the true incidence is likely to be higher, being challenging the initial diagnosis on X-ray. The fracture-avulsion of the greater tuberosity could have different treatment: Non-displaced or minimal displaced fractures are treated conservatively, while for the displaced or comminuted ones the surgical treatment is preferred.

Clavicle fractures are common injuries encountered by orthopedic surgeons. Improper fracture healing following a displaced midshaft fracture of the clavicle can lead to the development of a symptomatic clavicular malunion. Clavicular malunion is a distinct clinical entity that generally develops in higher-demand patients with more severely displaced fractures and has orthopedic, neurologic, cosmetic, and functional symptoms. It is therefore important to know how to prevent and especially treat patients presenting with clavicular malunion. This chapter shows in a detailed manner not only the special features and predisposing factors of clavicular malunions but also how to diagnose and evaluate them. A special highlight is on the management including indications, contraindications, best timing of surgery, and detailed surgical options to help guide orthopedic surgeons facing the challenge of a clavicular malunion.

Displaced fractures of the zygomatic bone that require surgical treatment are accessed transcutaneously but these accesses to the skin can cause a hypertrophy scar in patients with this predisposition. This paper indicates a modification in the lateral canthotomy that aim to minimize the hypertrophic scar in the treatment of zygomatic fracture.

Purpose: The aim of this study was to evaluate calcaneus angles in dry bones belonging to Turkish population.Materials and Methods: Dry calcaneal bones which age and sex were unknown belonging to Cukurova University Faculty of Medicine were used in this study. The photographs of the bones were taken under fixed light and distance, positioned like lateral direct graph, the Böhler (BA) and Gissane (GA) angles were measured according to the reference points using the digital design program (SketchUp 2016). Calculation sensitivity was 1/10°. Angle value distrubitons and left right relations were examined. After the measurements minimum-maximum, median and standart deviation values were obtained.Results: Total of 67 dry bones were clasified as left and right. The average BA was measured as (minimum-maximum); 29.68°±4.71° (20.00°-39.80°) on the right side and 31.54°±4.88° (20.20°-41.20°) on the left side. GA average was measured as (minimum-maximum); 102.96°±5.25° (93.70°-114.5°) on the right side, 103.89°±7.14° (93.10°-120.4°) on the left side. For both angles no significant difference was found between left and right calcaneus.Conclusions: Calcaneus angles may differ between races and populations. These angular values are important in determining calcaneus fractures. Base values of these angles are especially important in determining the baseline values which will be useful in practice. In literature the risk of fractures (especially displaced fractures) increases as the Böhler Angle and Gissane Angle approach the lower limits. Therefore, values obtained in this study will contribute establishing reference values in Turkish population., Amaç: Türk toplumuna ait kuru kemiklerden os calcaneus açılarının değerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: Çukurova Üniversitesi Tıp Fakültesi Anatomi Anabilim Dalı'na ait yaşı ve cinsiyeti belli olmayan 67 adet os calcaneus kullanıldı. Sabit ışık altında ve sabit mesafeden lateral direkt grafideki pozisyonuna uygun şekilde konumlandırılan kemiklerin fotoğrafları çekildi, referans noktaları deforme olan kemikler ölçümden çıkartıldı, referans çizgiler aracılığı ile Böhler (BA) ve Gissane (GA) açıları dijital tasarım programı (SketchUp 2016) kullanılarak ölçüldü. Ölçümler 1/100 mm duyarlıkta yapıldı. Açıların dağılım özellikleri ve sağ-sol taraf ilişkisi incelendi. Bu ölçümlerden sonra minimum-maksimum, ortalama ve standart sapma değerleri elde edildi. Bulgular: Toplam 67 kuru kemikten sağ ve sol olmak üzere iki grup oluşturuldu. Böhler açısı ortalama (minimum-maksimum) değeri sağ tarafta; 29,68°±4,71° (20,00°-39,80°), sol tarafta; 31,54°±4,88° (20,20°-41,20°), Gissane açısının ortalama (minimum-maksimum) değeri sağ tarafta; 102,96°±5,25° (93,70°-114,5°), sol tarafta; 103,89°±7,14° (93,10°-120,40°) olarak bulundu. Her iki açı için sağ ve sol taraf arasında anlamlı fark bulunmadı.Sonuç: Os calcaneus açıları farklı ırk ve toplumlarda farklı dağılım gösterebilir. Bu açıların değerleri os calcaneus kırıklarının belirlenmesinde önem arz etmaktedir. Özellikle taban değerlerinin belirlenmesi uygulamalarda yarar sağlayacaktır. Literatüre bakıldığında, Böhler ve Gissane açı değerleri alt sınırlara yaklaştıkça kırık (özellikle deplase kırıklar) riskinin arttığı görülmektedir. Çalışmamızda saptadığımız değerler Türk toplumuna ait referans değerlerin belirlenmesine katkı sağlayacaktır.

Supracondylar fractures of the humerus in children are common and can be distressing injuries to the child, the parents and to the surgical team. Type 1 fractures are managed non-operatively, however displaced fractures (Types 2, 3 and 4) are usually managed surgically. Accurate and repetitive neuromuscular assessment is critical not just for medicolegal reasons but also to expedite management with different specialists if needed. The Rock, paper, scissor, OK technique is simple which is easily understood by most children. We discuss the current evidence with regards to pin diameter, number, pin configuration along with a simple algorithm on how to manage a child with a displaced supracondylar fracture with no pulse focussing mainly on the extension-type fracture.

Proximal tibial shaft fractures have vector forces which in combination displace the epiphyseal fragment anteriorly and medially. Surgical treatment is indicated in cases of displaced fractures, associated soft tissues compromise, and compartment syndrome. The goals of the surgical treatment are the restoration of the alignment, rotation, and length of the tibia allowing for early motion of the lower extremity. This chapter explores the authors’ preferred reduction and fixation techniques in the management of proximal tibial fractures.

Purpose Fractures of the proximal pole of the scaphoid are prone to adverse outcomes such as nonunion and avascular necrosis. Distinction of scaphoid proximal pole fractures from waist fractures is important for management but it is unclear if the distinction is reliable. Methods A consecutive series of 29 scaphoid fractures from one tertiary hospital was collected consisting of 5 scaphoid proximal pole and 24 scaphoid waist fractures. Fifty-seven members of the Science of Variation Group (SOVG) were randomized to diagnose fracture location and displacement by using radiographs alone or radiographs and a computed tomography (CT) scan. Results Observers reviewing radiographs alone and observers reviewing radiographs and CT scans both had substantial agreement on fracture location (κ = 0.82 and κ = 0.80, respectively; p = 0.54). Both groups had only fair agreement on fracture displacement (κ = 0.28 and κ = 0.35, respectively; p = 0.029). Conclusion Proximal pole fractures are sufficiently distinct from proximal waist fractures that CT does not improve reliability of diagnosis. Level of Evidence Level IV interobserver reliability case-control study.

Aim To demonstrate the effectiveness of early weight bearing with no immobilisation (functional therapy) applied to fractures of the fifth metatarsal. Materials and method A retrospective case and control observational study was performed among 382 fractures on the fifth metatarsal comparing functional, conservative-orthopaedic and surgical treatments. Fractures were classified according to the settlement on the distal, diaphyseal or proximal part of the bone, the recommended therapy and the treatment performed. Influence of age, profession and characteristics of the injury were considered and results were measured using the parameters incapacity for work and number and intensity of complications. Discussion Fractures of the fifth metatarsal are the most common injuries of the foot. Whether conservative or surgical treatment is recommended depends on the sort of fracture, the trend nowadays is to use non-invasive methods. Conclusions Functional treatment for metatarsal fractures provides earlier healing and fewer adverse effects than conventional therapies, and becomes first choice for non-displaced fractures and most displaced fractures of the fifth metatarsal.

Background and Aims:The incidence of olecranon fractures is rising. Displaced fractures are usually operated either by tension band wiring or plate fixation. The aim of this review is to evaluate the best current evidence on the management of displaced olecranon fractures.Materials and Methods:Randomized controlled trials were systematically gathered in May 2018 from CENTRAL, MEDLINE, Embase, CINAHL, Scopus, and PEDro databases. The methodological quality of articles was assessed according to the Cochrane Collaboration’s domain-based framework. Prospero database registration number: CRD42018096650.Results:Of 1518 identified records, finally, 5 were relevant. Four trials were found on tension band wiring: two compared tension band wiring with plate fixation (n = 108), one compared plate fixation with an olecranon memory connector (n = 40), and one trial compared tension band wiring with a modified tension band wiring called Cable Pin System (n = 62). In addition, one trial compared operative and conservative treatment in elderly (n = 19). The risk of bias was considered low in two and high in three of the trials. The follow-up time was 5–36 months, and outcome measures varied from patient-rated and physician-rated measures to radiological outcomes. In the analysis, there was no difference between tension band wiring and plate fixation. The data were insufficient for further quantitative analysis.Conclusion:No differences were found in clinical or patient-rated outcome measures between the two most frequent fixation methods (tension band wiring and plate fixation) of displaced olecranon fractures. Current data are not sufficient to evaluate other treatment methods; however, conservative treatment might serve as an option for selected patients in the elderly population.

Several studies have analyzed the functional recovery after plate fixation of a displaced fracture of the middle third of the clavicle beyond the 6th week. The aim of this study was to assess the early functional recovery in the first 6 weeks, which has not yet been investigated.Functional recovery in the first 6 weeks after surgical treatment is better than in the first 6 weeks of functional (non-operative) treatment.Any patient who had a closed displaced fracture of the middle third of the clavicle - Edinburgh types 2B1 or 2B2 - was informed of the treatment options within a week of their fracture: surgical fixation by anatomic plate or functional treatment. A QuickDASH score was filled out weekly for 6 weeks and at 3 and 6 months. Similarly, the Constant score was determined at 3 and 6 weeks and at 3 and 6 months. Any complications were documented and time to union was determined.Sixty-five fractures in 65 patients were followed for 6 months. Twenty-six patients chose surgical treatment (S) and 39 chose functional treatment (F). The Constant and QuickDASH scores were significantly better in the S group from the 2nd to the 6th week. At 3 weeks, we found a Constant score of 57.7 in group F versus 74.9 in group S (p0.01) and a QuickDASH of 55.9 in group F versus 27.4 in group S (p0.001). At 6 weeks, the Constant score was 71.3 versus 86.1 (p0.001) and the QuickDASH was 28.3 versus 10.6 (p0.01), respectively. At 3 and 6 months, the recovery was comparable in both groups for these two scores. Return to work was earlier in the S group (34.3 versus 59.7 days; p0.05).This is the first study reporting the functional results during the first 6 weeks after a displaced fracture of the middle third of the clavicle in adults. Further studies should be conducted to better identify target patients for whom fracture fixation may be beneficial.This study supports open reduction and internal fixation with an anatomical plate of displaced fractures of the middle third of the clavicle since the functional recovery is better in the first 6 weeks.III; prospective case-control study.

Background: Tibial spine fractures involve an avulsion injury of the anterior cruciate ligament (ACL) at the intercondylar eminence, typically in children and adolescents. Displaced fractures are commonly treated with either suture or screw fixation. Purpose: To investigate differences in various outcomes between patients treated with arthroscopic suture versus screw fixation for tibial spine avulsion fractures in one of the largest patient cohorts in the literature. Study Design: Cohort study; Level of evidence, 3. Methods: A search of medical records was performed with the goal of identifying all type 2 and type 3 tibial spine avulsion fractures surgically treated between 2000 and 2014 at a pediatric hospital. All patients had a minimum of 12 months clinical follow-up, suture or screw fixation only, and no major concomitant injury. Results: There were 68 knees in 67 patients meeting criteria for analysis. There were no differences with regard to postsurgical arthrofibrosis ( P = .59), ACL reconstruction ( P = .44), meniscal procedures ( P = .85), instability ( P = .49), range of motion ( P = .51), return to sport ( P >.999), or time to return to sport ( P = .11). Elevation of the repaired fragment on postoperative imaging was significantly greater in the suture group (5.4 vs 3.5 mm; P = .005). Postoperative fragment elevation did not influence surgical outcomes. The screw fixation group had more reoperations (13 vs 23; P = .03), a larger number of reoperations for implant removal (3 vs 22; P < .001), and nearly 3 times the odds of undergoing reoperation compared with suture patients (odds ratio, 2.9; P = .03). Conclusion: Clinical outcomes between suture and screw fixation were largely equivalent in our patients. Postoperative fragment elevation does not influence surgical outcomes. Consideration should be given for the greater likelihood of needing a second operation, planned or unplanned, after screw fixation.

Recent trends have illustrated the benefits of treating displaced fractures of the proximal humerus with reverse total shoulder arthroplasty. Clinical results have demonstrated reliable restoration of function in situations where results following hemiarthroplasty have been variable and difficult to predict. Data have demonstrated landmarks to assist with humeral stem height in hemiarthroplasty. However, intraoperative landmarks to guide placement of the humeral component in reverse shoulder arthroplasty have not been described. In this technique, the superior border of the pectoralis tendon is utilized. A distance of 5.0 cm is used to assist in placement of the most superior aspect of the metallic humeral component and with humeral stem version. This technique can be used as a guide to assist a treating physician in situations where bony fracture and comminution make humeral stem height placement difficult to judge.

AimsTo investigate the use of PCS fixation for acetabular fractures including indications, preoperative planning, operative technique, and complications during the study period. Setting and designA retrospective and prospective study of PCS fixations of several types of acetabular fractures nondisplaced and minimally displaced guided by fluoroscopy.Patients and methodsThe study included 20 patients after obtaining informed consent they were operated and studied for acetabular fixation by anterior column, posterior column, supra-acetabular screws, combination of all and combination of plate and screw between 2015 and 2019.Statistical analysis used The software for statistical package for social sciences for windows 10 was used for all statistical calculations. Each variable was tested for its normal value using the Mann-Whitney Test and exact P values were calculated. Significance was set at the P value of less than 0.05 level.ResultsAll cases had good to excellent functional results according to the modified Merle d’Aubigne Hip Score. We managed to mobilize all patients out of bed from the 2nd day of surgery and managed to avoid double approaches for transverse fractures.ConclusionOur results show that PCS under fluoroscopic control is a safe technique to treat some patterns of acetabular fractures and with some tips and tricks surgical and fluoroscopy time can be minimized.Key-wordsAcetabular fracture - Minimally invasive technique - Percutaneous fixation.Key MessagesPCS fixation of acetabular fractures using fluoroscopic guidance is a safe and relatively easy surgical procedure to treat minimally displaced fractures with several advantages.

Displaced fractures of the distal radius often require reduction and fixation to improve outcome in active patients. The volar locking plate gained ground over pinning, which was the first surgical solution described. But pinning methods have since evolved with fewer complications. The authors present a clinical study of distal radius fracture fixation using the HK2 technique, where subchondral pins are connected to intra-focal pins. The results are satisfactory with a lower complication rate compared to other pinning methods. This technical improvement relaunches the pinning technique, with its two advantages, being faster and significantly cheaper than locking plates, with similar long-term functional results.