Fractures

Functional Outcomes in the Distal End of Radius Fracture: A Prospective Study in a Tertiary Care Center (2024)

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Type of publication:

Journal article

Author(s):

*Thusoo, Varun; Chakrapani, Arjun S; Nehru, Ashish; Kudyar, Sachin; Nagpal, Brahmpreet; Kv, Alok; S, Ebin; Jose, Akhil.

Citation:

Cureus. 16(11):e74226, 2024 Nov.

Abstract:

OBJECTIVES: The objectives of this study are to determine the functional outcomes and compare them between conservative and surgical management in patients managed for closed-type intra-articular distal end of radius fractures.

METHODS: A prospective observational study was done on 150 patients who underwent treatment for closed-type intra-articular distal end of radius fractures. As per Frykman Classification, they were type III. patients were either managed conservatively, i.e. 100 patients out of 150 and surgical management was done in 50 cases. For surgical management, implants used were K-wires, Schanz pins, and Ellis Plate. The functional outcomes were noted in terms of pain and range of motion, in the follow up of six months. Union was noted clinically and radiologically.

RESULTS: The mean age of the study patients was 42.32 +/- 15.77 years. Out of 150 patients, there were 100 (66.67%) male patients. Compared to conservative management, surgical management had significantly lesser time of union (12 vs. 20 weeks, P<0.0001); significantly more excellent results (44% vs. 30%), more good results (32% vs. 15%) (P=0.003); comparable pain score (P=0.236); and comparable functional score (P=0.661). Regarding radiological outcomes, surgical management had significantly more volar tilt (9.6+/-2.5degree vs. 8+/-5degree, P=0.035); lesser Ulnar variance (3+/-2 vs. 4+/-2 mm, P=0.004), lesser grip strength <50% (26% vs. 65%, P<0.0001); comparable radial inclination (21+/-4degree vs. 20+/-5degree, P=0.661); and comparable radial height (11+/-3 vs. 10+/-5 mm, P=0.195)

CONCLUSION: To conclude, surgery for distal radius fractures promotes faster healing, lesser pain, lesser malunion, and better functional outcomes. However, it is not without potential risks. Non-surgical treatment is still a suitable option, for patients with contraindications to surgery or having lower need for functional improvement.

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Functional Outcomes and Complications After Open Reduction and Internal Fixation of Mid-shaft Clavicle Fractures: A Retrospective Study (2024)

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Type of publication:

Journal article

Author(s):

Hamid, Muhammad A; *Younis, Zubair; Mannan, Muhammad; Shrivastava, Nayan; Prabhu, Rudra M.

Citation:

Cureus. 16(11):e74302, 2024 Nov.

Abstract:

INTRODUCTION: Clavicle fractures are routinely encountered in orthopedic clinical practice and have often been the subject of debate when it comes to optimal treatment. Clavicle fracture surgery has come a long way with excellent pre-contoured superior locking plates available for fixation. This study aimed to evaluate a cohort of patients operated for displaced mid-shaft clavicle fractures by open reduction and internal fixation using superior clavicle locking plates.

MATERIALS AND METHODS: This is a retrospective cohort study of mid-shaft clavicle fracture patients who were operated on and had their fractures fixed using superior clavicle locking plates. We identified a total of 29 patients to be included in this study. The primary outcome measure was the quickDASH score at the time of discharge (12 weeks from surgery). Secondary outcome measures were the pattern and frequency of complications, and the need for metalwork removal.

RESULTS: Our study had a male preponderance, with 19 (65.5%) patients being male. The most common mode of trauma was fracture secondary to a road traffic accident in 12 (41.4%) patients. All but one fracture united uneventfully. The mean quickDASH score was 0.94 at 12-week follow-up. Complications were noted in 12 (41.4%) patients, and the most common complication was hardware irritation in seven (24.1%) patients, followed by dysesthesia around the surgical scar in five (17.2%) patients.

CONCLUSION: Open reduction and internal fixation of the clavicle give a high likelihood of fracture union along with good shoulder function. In a particular cohort of patients, this offers a quick recovery and earlier return to activity. However, this must be balanced with the risk of complications in a considerable proportion of operated patients, some of which might necessitate a second surgery.

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Evaluation of Patient-Initiated Follow-Up (PIFU) Service in a Fracture Clinic: A Comprehensive Service Evaluation and Patient Satisfaction Audit (2024)

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Type of publication:

Journal article

Author(s):

*Younis, Zubair; Hamid, Muhammad A; *Khan, Muhammad Murtaza; Sapra, Rahul; *Gurukiran, Gurukiran; *Singh, Rohit.

Citation:

Cureus. 16(11):e73461, 2024 Nov.

Abstract:

Background Outpatient clinics are increasingly challenged by high patient volumes and rising "did not attend" (DNA) rates, leading to extended wait times and declines in patient satisfaction. Traditional follow-up (FU) models with routinely scheduled appointments contribute to inefficiencies, as stable patients may attend unnecessary visits, thus straining clinic resources. The patient-initiated follow-up (PIFU) model offers an alternative where patients schedule appointments only when necessary. This study evaluates PIFU's efficacy in improving outpatient services and patient satisfaction by reducing routine appointments and prioritizing patient-driven follow-up. Methods This service evaluation and patient satisfaction audit was conducted at the fracture clinic of Royal Shrewsbury Hospital over three months (December 2023-March 2024). Out of 3828 patients seen, 203 were assigned to PIFU based on criteria indicating stable conditions with minimal follow-up requirements. The remaining patients were either scheduled for routine follow-ups or discharged. Data were collected retrospectively from clinic records, and a structured
questionnaire assessed patient satisfaction with the PIFU service. Results Among the 203 patients assigned to PIFU, 183 (90.15%) patients received an informational leaflet, with all respondents finding it easy to understand. However, only 41 (20.2%) of patients utilized the PIFU service, primarily for concerns about pain, healing, or complications. Satisfaction among PIFU users was high, with 163 (80.3%) patients rating the service 5/5. Non-users mostly cited no perceived need for follow-up. Demographic analysis indicated that patients aged 40-60 were predominant (n=132; 65.02%) among the PIFU cohort. Conclusion The PIFU model demonstrated the potential to alleviate clinic workload by reducing routine follow-ups while maintaining high patient satisfaction. Although utilization rates were low, those who engaged found the service beneficial, suggesting PIFU's value for patients comfortable with self-management. Improved patient education may enhance engagement, supporting the broader implementation of PIFU in outpatient settings. Further research is warranted to explore barriers to patient-initiated follow-up and refine eligibility criteria for optimal outcomes.

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Proximal Humerus Fractures: A Review of Anatomy, Classification, Management Strategies, and Complications (2024)

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Type of publication:

Journal article

Author(s):

Younis, Zubair; Hamid, Muhammad A; Amin, Jebran; *Khan, Muhammad Murtaza; *Gurukiran, Gurukiran; Sapra, Rahul; *Singh, Rohit; Wani, Kubra Farooq; Younus, Zuhaib.

Citation:

Cureus. 16(11):e73075, 2024 Nov.

Abstract:

Proximal humerus fractures are prevalent in older adults, particularly women, primarily due to osteoporosis and increased fall risk. These fractures often result from low-energy falls in elderly patients, while in younger individuals, they are more likely to occur with high-energy trauma, which may involve additional injuries to soft tissue and neurovascular structures. Proper anatomical understanding, including key structures and blood supply, is crucial for effective management and to prevent complications. Several classification systems assist in guiding treatment for proximal humerus fractures, including Codman's, Neer's, Arbeitsgemeinschaft fur Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) system, and the Codman-Hertel system, which helps predict ischemia risk. Evaluation of proximal humerus fractures begins with Advanced Trauma Life Support (ATLS) protocols, emphasizing a thorough shoulder assessment, particularly focusing on skin integrity in elderly patients. Neurological and vascular examinations are essential due to the common occurrence of nerve injuries, especially involving the axillary nerve. Imaging typically includes multiple standard views, with advanced imaging reserved for complex cases and for assessing associated soft tissue injuries. Treatment options range from conservative management for stable fractures to surgical intervention for more complex cases. Surgical choices include techniques like fixation, nailing, and various arthroplasty options, with some procedures potentially offering advantages for older adults with bone quality or soft tissue challenges. Rehabilitation is a vital component of recovery, with emphasis on early mobility and gradual strengthening to restore function, especially in older patients. Complications following open reduction and internal fixation (ORIF) for proximal humerus fractures can include issues such as non-union, malunion, osteonecrosis, infection, joint stiffness, and fixation failure. In cases where non-union or fixation failure occurs, revision surgery or arthroplasty may be necessary. Joint stiffness may require further intervention if physical therapy is insufficient, while symptomatic osteonecrosis might also need surgical management. Malunion is generally better tolerated in older patients but may require correction in younger individuals. Other surgical options, such as hemiarthroplasty (HA) and reverse shoulder arthroplasty (RSA), share similar risks, including infection, fractures, complications at the tuberosity, stiffness, and instability. RSA may be favored when there are tuberosity or rotator cuff issues. Closed reduction with percutaneous pinning carries a high risk of pin migration and malunion, which can result in deformities, pain, and dysfunction. Proper anatomical knowledge is essential to avoid neurovascular injury and to manage common issues such as pin-site infections effectively.

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An overview of bone cement: Perioperative considerations, complications, outcomes and future implications. (2023)

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Type of publication:
Journal article

Author(s):
*Patel, Ravi; Mcconaghie, Greg; Webb, Jeremy; Laing, Georgina; *Roach, Richard; Banerjee, Robin.

Citation:
Journal of Perioperative Practice. 2023 May 26. [epub ahead of print]

Abstract:
Polymethyl methacrylate is commonly known as bone cement and is widely used for implant fixation in various orthopaedic arthroplasty and trauma surgery. The first bone cement use in orthopaedics is widely accredited to the famous English surgeon, John Charnley, who in 1958, used it for total hip arthroplasty. Since then, there have been many developments in cementing techniques in arthroplasty surgery. This overview aims to cover the perioperative considerations of bone cement, including cementing techniques, current outcomes and complications such as bone cement implantation syndrome. The overview will additionally consider future developments involving bone cement in orthopaedic arthroplasty.

Is pain properly managed in children presenting with fractures? A retrospective audit of children presenting to the emergency department (2020)

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Type of publication:
Conference abstract

Author(s):
*Rafie A

Citation:
British Journal of Surgery; Jun 2020; vol. 107 ; p. 68

Abstract:
Aim: Pain is a common problem in the surgical field, especially when treating children – but how well is it managed, and documented? In this audit we aim to answer a few key questions. Is analgesia administered prehospital? Are pain scores recorded, and re-evaluated? And is analgesia offered and/or administered in the Emergency Department(ED)? Method: A retrospective audit was carried out between two hospitals on 100 patients aged between 5-15 presenting to the ED. A search was carried out using SNOMEDand ICD10 codes, to find patients presenting with fractures – and the ED CAS cards reviewed.
Result(s): The data showed poor compliance between both hospitals – pain scores were seldom recorded, or reevaluated; and in 58% of cases analgesia was not offered and no reason was documented. 28% of patients were given pre-hospital analgesia and only 2% of patients had an analgesia review.
Conclusion(s): Adequate pain management is vital, especially in children – as they often don't self-report pain. The study found that the worst compliance was in documentation of pain scores, and their re-evaluation. However, more concerningly analgesia was only administered in 19% of cases – and in many cases there was no documentation as to why it wasn't offered.

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Use of recombinant parathyroid hormone in treatment of bisphosphonate related osteonecrosis leading to spontaneous healing (2019)

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Type of publication:
Conference abstract

Author(s):
*Chundoo S.; *Pilkington R.; *Bhatia S.; *Garton M.

Citation:
British Journal of Oral and Maxillofacial Surgery; Dec 2019; vol. 57 (no. 10)

Abstract:
Introduction: Case presentation of 61 year old female patient who developed BRONJ (bisphosphonate related osteonecrosis of the jaw) and a pathological triple fracture of the anterior mandible. She had underlying vitamin D deficiency and secondary hypoparathyroidism. She also suffers from anca positive rheumatoid arthritis and is under the active care of rheumatology.
Method(s): Patient was treated with conservative measures which failed to give a good quality of life outcome. Under special license, with involvement from rheumatology, the patient was started on monthly injections of recombinant parathyroid hormone (teriparatide).
Result(s): Over 12-18 months, the serial radiographs reveal bony union of all fracture sites. Patient now has good quality of life and patient is back on disease modifying drugs to control their active rheumatoid arthritis.
Conclusions/Clinical Relevance: Novel approach to using teriparatide for patients with end-stage BRONJ. License of the drug as well as current NICE guidelines for its use and patient specific requirements such as fragility fracture risks age and DEXA scores are also discussed. The action of the drug on osteoblastic formation and bone turnover is discussed. This will help practitioners have another agent to add to their treatment options in treating the effects of BRONJ.

Mortality and burden of cervical spine fractures in the elderly: can we do more? (2017)

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Type of publication:
Conference abstract

Author(s):
*Matthew Chan, *Benjamin Chatterton, *David Ford

Citation:
Spine Journal; Mar 2017; vol. 17 (no. 3), S20

Abstract:
BACKGROUND CONTEXT: Cervical spine fractures in the elderly are a significant injury that poses difficult treatment dilemmas. Despite this little has been done to evaluate the mortality and hospital burden. PURPOSE: Evaluate the mortality and hospital burden associated with cervical spine fractures in elderly patients at district general hospitals. STUDY DESIGN/SETTING: 10-year retrospective analysis of patients over the age of 70 presenting with a cervical spine fracture to two district general hospitals. METHODS: The data was collected from documentation on online hospital database systems. Data recorded included patient demographics, injuries sustained including level and mechanism of cervical injury, length of stay and details on inpatient complications, inpatient mortality and one-year mortality. RESULTS: 153 patients were identified with a mean age of 83, and slight female predominance (55%). Mechanical falls (90%) leading to isolated fractures of upper cervical spine, particularly C2 (52%), were the most common site and mechanism of injury. Inpatient mortality was 22.9%, and 1-year mortality was calculated at 35.3%. Inpatient medical complications, particularly chest infections, were common and occurred in 35.9% of patients. Total average length of stay was 18 days, and critical care input was required in 10.5% of patients. CONCLUSIONS: Cervical spine fractures in the elderly cause significant mortality and hospital burden. Medical complications are common, leading to increased morbidity and length of stay. Consideration should be made to develop national guidance akin to hip fractures. This would encourage a multidisciplinary team approach, including early input from medical and physiotherapy teams to ensure more effective treatment and prevention of complications.

Adult distal radius fractures classification systems: essential clinical knowledge or abstract memory testing? (2016)

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Type of publication:
Journal article

Author(s):
*Shehovych, A, *Salar, O, *Meyer, Cer, *Ford, D J

Citation:
Annals of the Royal College of Surgeons of England, Nov 2016, vol. 98, no. 8, p. 525-531

Abstract:
Classification systems should be tools for concise communication, which ideally can predict prognosis and guide treatment. They should be relevant, reproducible, reliable, properly validated and most importantly simple to use and understand. There are 15 described distal radius classification systems present in the literature in the past 70 years, of which 8 are discussed in this paper. For each classification, we give an insight into its history, strengths and weaknesses, and provide evidence from the literature on reliability and reproducibility. Sadly, on completion of this paper we have not found a distal radius fracture classification that proved to be useful. Failings range from poor reproducibility and reliability, and over-complexity mainly emanating from the inability to classify this spectrum of injury in all of its manifestations. Consequently, we would suggest that classification systems for acute adult distal radius fractures are not useful clinical knowledge but mainly historical and/or research tools. Moreover, we would discourage trainees from spending time learning these classifications, as they serve not as essential clinical knowledge but more as forms of abstract memory testing.

Brachialis muscle tendon insertion avulsion fracture in a 6-year-old child (2014)

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Type of publication:
Journal article

Author(s):
*Crosswell S, *Mbah CA, *Hussain A, *Turner R

Citation:
BMJ Case Reports, 2014, vol./is. 2014/, 1757-790X (2014)

Abstract:
A 6-year-old boy, who fell while playing at school, presented to the fracture clinic with a suspected right distal radius fracture. On examination, the child was tender over the dorsal aspect of the distal radius and also had pain and stiffness around the elbow joint with a lack of the last 25° of elbow flexion. An acute haemarthrosis was also suspected at presentation. Plain anteroposterior (AP) and lateral radiographs of the elbow joint revealed an abnormal calcification superimposed on the anterior aspect of the coronoid process (figure 1A, B), which had not been visualised on plain radiographs in A&E.

Link to more details or full-text: http://casereports.bmj.com/content/2014/bcr-2013-202420.extract