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Os acromiale open reduction and internal fixation: a review of iliac crest autogenous bone grafting and local bone grafting

Surgical management of the symptomatic os acromiale

Olecranon fractures are relatively common injuries, accounting for approximately 10% of upper extremity fractures in adults [26]. These fractures may result from a direct blow to the proximal ulna, or indirectly, via the forceful contraction of the triceps against resistance (typically, during a fall onto an outstretched hand). Less commonly, the olecranon may fracture when the elbow is hyperextended, as the bone is impacted against the olecranon fossa of the distal humerus. For unstable injuries, operative fixation typically is required. Even after recovery, loss of ROM is not uncommon. This article provides an overview of olecranon fractures in adults; therefore, discussion of olecranon fractures in skeletally immature patients is beyond the scope of this article.

Objective To investigate the effects of open reduction and internal fixation plus calcium sulfate artificial bone graft for the treatment of Sanders type III and IV calcaneal fractures. Methods The clinical data of patients with Sanders type III and IV calcaneal fractures treated from January 2012 to December 2015 were retrospectively reviewed by case-control study. The patients were divided into two groups as bone graft group (open reduction and internal fixation combined with artificial bone graft) and control group (open reduction and internal fixation). The bone graft group was composed of 17 cases, among which there were 12 males and five females with age range of 19-62 years [(41.6±12.9) years]. In bone graft group, there were 12 cases of Sanders III and five cases of Sanders IV. The control group was composed of 13 cases, among which there were eight males and five females with age range of 20-59 years [(39.4±11.8) years]. In control group, there were ten cases of Sanders III and three cases of Sanders IV. The follow-up visits were done at 1, 2, 3, 6, and 12 months after surgery with record of complication occurrence. The changes of Bohler's angle and Gissan's angle were observed preoperatively as well as at 2 days and 12 months after surgery. The function recovery was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) score at final follow-up visit. Results Five cases of marginal necrosis of the incision and two cases of superficial soft tissue infection were seen in bone graft group, while there were two cases of marginal necrosis of the incision and one cases of superficial soft tissue infection in control group. In early postoperative comparison between two groups, the variation of Bohler's angle and Gissan's angle had no significant difference (P>0.05). At 12 months after surgery, Bohler's angle of bone graft and control groups were (23.2±9.0)° and (19.5±11.1)°, respectively. The losses of Bohler's angle were (3.6±2.7)°and (6.9±3.1)°, respectively. The difference in the losses of angle in two groups had statistical significance (P 0.05). At the final follow-up, bone union was found in all cases, and there was no significant difference in AOFAS score between the two groups (P>0.05). Conclusions Open reduction and internal fixation can attain good treatment results for Sanders type III and IV calcaneal fractures, no matter whether bone graft is carried out. However, artificial bone graft may have good effects to sustain the stability of fracture fragments and provide early mechanical support for the subtalar joint. Key words: Calcaneus; Fracture fixation, internal; Bone transplantation; Calcium sulfate artificial bone

Objective To systematically evaluate the postoperative complications following open reduction and internal fixation combined with vascularized bone flap graft versus only reduction and internal fixation for femoral neck fractures. Methods CNKI, Wan Fang Chinese database, Pubmed, EMBASE and Google Scholar English database were searched for the randomized controlled trials from January 1, 2000 through October 31, 2017 which compared open reduction and internal fixation combined with vascularized bone flap graft (combined surgery group) with only reduction and internal fixation (simple surgery group) for femoral neck fractures. The data concerning postoperative nonunion and avascular necrosis of the femoral head were extracted. The 2 surgical treatments of the patients with femoral neck fracture were compared in terms of the 2 complications. Statistical analyses were conducted using software Stata 12 by relative risk (RR) and corresponding 95% confidence intervals (95%CI). Results According to our inclusion and exclusion criteria, a total of 23 studies were included, involving 2,162 cases (1,048 cases receiving combined surgery and 1,114 cases simple surgery). The Meta analyses showed that the fracture nonunion rate for the combined surgery group was significantly lower than that for the simple surgery group [RR=0.27, 95%CI(0.19, 0.38), P<0.001] and the rate of avascular necrosis was also significantly lower for the former than for the latter [RR=0.31, 95%CI(0.24, 0.42), P<0.001]. Conclusion In the treatment of femoral neck fractures, open reduction and internal fixation combined with vascularied bone graft may lead to lower rates of nonunion and avascular necrosis of the femoral head than simple open reduction and internal fixation. Key words: Femoral neck fractures; Fracture fixation, internal; Fractures, ununited; Femur head necrosis; Meta-analysis

Objective To summarize the clinical experience in treatment of the Lisfranc joint injury with open reduction and internal fixation at early stage. Methods Twelve patients ( including ten males and two females at average age of 34 years) with early stage Lisfranc joint injury received open reduction and screw/wire fixation from 2005 to 2010. According to the Myerson classification, there were two patients with type A, eight with type B and two with type C. All the patients received open reduction and internal fixation with screw or Kirschner wire within 17 days after injury. The post-operative function was estimated by mid-foot scoring scale of AOFAS. X-ray and CT scan were used in radiography estimation. Results All the patients were followed up for average 33 months ( range, 6-60 months). The mean score of post-operative mid-foot scoring scale of AOFAS was 74.5 points ( range, 53-96 points), with excellent result in eight patients, good in two and fair in two. The anatomical reduction was observed in eight patients and all the patients obtained bony union according to the results of X-ray and CT scan.There was no any complication found.Conclusions Open reduction and internal fixation is a good choice for the treatment of Lisfranc joint injury at early stage. A preoperative comprehensive analysis combined with clinical X-ray and CT scan is necessary. Key words: Foot injuries; Fracture fixation, internal; Lisfranc joint

Objective: Lisfranc injuries are found in various injury patterns, especially in athletes. These injuries are the second most common type of foot injuries in athletes. However, the treatment decision differs and is essential in athletes for a good outcome. The main controversies in surgical management include whether to execute open or close reduction, fixation technique, and arthrodesis’ role in athletes. Case Report: A previously healthy 21 Years Old Malay gentleman sustained a sports injury diagnosed with pure ligamentous Lisfranc injury with an incomplete, partial lateral dislocation. The patient was treated with Open Reduction and Internal Fixation (ORIF) using a dorsal bridge Lisfranc locking plate. Conclusion: Early diagnosis and appropriate treatment are crucial to achieving stability in unstable Lisfranc injuries. Anatomical reduction and Lisfranc joint restoration are the keys to a good outcome. Open reduction and internal fixation are preferred methods where most athletes can return to their previous level of sports.

BackgroundThe aim of this study was to compare radial head prosthesis replacement with open reduction and internal fixation (ORIF) in the surgical treatment of Mason type III radial head fractures in 72 elderly patients.Material/MethodsSeventy-two elderly patients (mean age, 67.1±1.25 years, range, 62–81 years) with Mason type III radial head fractures were treated from January 2001 to June 2012. Of these, 37 cases received radial prosthesis and 35 cases were treated with ORIF. All patients were followed up for 10 to 15.6 months.ResultsBased on the elbow functional evaluation criteria score by Broberg and Morrey, 29 cases achieved excellent results, 7 were good, and 1 was fair in the replacement group. In the ORIF group, excellent results were seen in 24 cases, good in 9, and fair in 2. The rates of good or excellent results were 78.4% and 68.6% for prosthesis replacement patients and ORIF patients, respectively (P<0.05). The Visual Analogue Scores (VAS) for replacement and ORIF groups were 2.25 and 1.67, respectively (P<0.05).ConclusionsThe radial head prosthesis replacement method is a relatively better surgical approach than ORIF in the treatment of elderly patients with Mason type III radial head fractures.

Forty-one adult patients with displaced olecranon fractures were treated with open reduction internal fixation in a prospective, randomized study comparing tension band wiring (TBW) and plate fixation (PF). Plate fixation required longer operative time, but did not lead to an increased complication rate. Range of elbow motion at six months did not differ significantly between the two groups. Symptomatic metal prominence was frequently observed after TBW (42%), although true Kirschner wire (K-wire) migration was seen in only one patient. Postoperative loss of reduction, leading to a significant articular step-off or gap, was more frequent after TBW (53%) than after PF (5%). Tension band wiring resulted in 37% good clinical and 47% good roentgenographic results, as compared with PF, which resulted in 63% good clinical and 86% good roentgenographic results. Plate fixation should be carefully considered when planning open reduction and internal fixation of displaced olecranon fractures.

Objective To investigate the diagnosis, operation characteristics and clinical effect of anterior Pilon fracture. Methods A retrospective analysis was carried out to analyze 13 patients who had been treated for anterior pilon fracture from September 2012 to March 2014. All had fresh closed fracture. Mean age was 39.8 years(range, 18-61 years). Injury resulted from high falls in 11 patients and falls in 2 patients. According to the preoperative imaging manifestations and four column fracture classification, the fracture type was mainly anterior column fracture. All underwent open reduction and internal fixation with buttress plates, and allograft bone was performed in 8 patients. At the last follow-up, American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot score and visual analogue scale(VAS)were employed for clinical evaluation. Results Mean period of follow-up was 15.7 months(range, 12-30 months). Mean AOFAS score was 91.38 points(range, 74-100 points). Excellent results were found in 10 patients, good in 2 and fair in 1, with the excellent-good rate of 92%. Mean VAS score was 1.08 points(range, 0-3 points). Traumatic arthritis occurred in 1 patient. Skin necrosis occurred in 1 patient, and was cured by dressing change. There were no complications such as infection, refracture or implant failure. Conclusions Mechanism of injury in anterior pilon fracture is vertical violence when the foot in dorsiflexion position. Imaging findings are mainly characterized by the compression in anterior articular surface of the distal tibia, which is often implicated in the anterior medial malleolus but in part is combined with lateral malleolus fracture. The fracture is the result of high energy injury, and can be diagnosed by mechanism of injury and imaging manifestations. Through anterior approach, open reduction and internal fixation with buttress plates plus allogenic bone grafting obtain satisfactory outcomes. Key words: Tibial fractures; Ankle injuries; Fracture fixation, internal

Ninety-five patients with fractures of the tibial plateau have been reviewed. The fractures were grouped, according to the X-ray pattern, into five fracture types. Treatment was grouped into plaster immobilization or traction in the conservative group, and open reduction with internal fixation, open reduction with bone grafting, or open reduction with internal fixation and bone grafting in the operated group. It was concluded from this review that tibial plateau depression or tibial plateau widening of less than 10 mm was usually tolerated well and did not preclude a successful result. Adequacy of reduction was a least as important as early motion in obtaining a satisfactory result regardless of the type of fracture treated. If open reduction is undertaken both internal fixation and bone grafting are required in the most common types of these fractures. The exceptions are Type I or split fractures which do not require a bone graft and Type III or central depression fractures which do not require internal fixation.

Objective To analyze the epidemiologic al features and trends of supracondylar femoral fractures in The Third Affiliated Hospital to Hebei Medical University during a five-year period from 2010 through 2014. Methods The data of supracondylar femoral fractures treated between January 2010 and December 2014 at our hospital were collected through the PACS system and case reports checking system. Their gender, age, fracture side, fracture type, basic demographics, injury causes, operative factors and treatments were analyzed. Results A total of 218 supracondylar femoral fractures were treated, involving 125 males and 93 females(with a male to female ratio of 1. 34∶1). The number of the patients increased year by year from 2010 through 2014. The peak age was from 41 to 50 years in males(25. 26%)and from 51 to 60 years in females(24. 66%). The male to female ratio was 0.79∶1 in the patients over 50 years old. The proportions of famer patients(119, 54. 59%), urban patients(131, 60. 09%), and spring patients(70, 32. 11%)were high. Traffic injury(57. 34%)and high-energy trauma(76. 61%)accounted for the highest proportions. The average age of patients with low-energy injury(fallings)was significantly older than for those with high-energy trauma(P< 0. 05). AO type 33-A3 accounted the largest proportion of the fractures(61. 93%). The most common treatments for the supracondylar femoral fractures were open reduction and internal fixation(88. 07%)and fixation with femoral condylar plate(83. 94%). The most common surgical approach was through the femoral distal lateral one(88. 53%). Conclusions Supracondylar femoral fractures predominated in males 41 to 50 years old and in females 51 to 60 years old. There were more female patients over 50 years old. The fracture occurred more in farmers and in the spring season. Most fractures were AO type 33-A3. High-energy trauma like traffic injury was the main cause. The fractures were mostly treated by open reduction and internal fixation, and femoral condylar plating as well, via the femoral distal lateral approach. Key words: Femoral fractures; Epidemiology; Gender distribution; Age distribution

Thirty-two displaced intra-articular fractures of the calcaneus in 30 patients were treated with open reduction and internal fixation. Fracture classification was based on Sanders computed tomographic classification. There were 18 type II fractures, 10 type III fractures, and 4 type IV fractures. The operations were performed using a standard extended lateral approach, and the fractures were fixed with small-fragment AO T-plates without bone grafting. Average follow-up was 35.4 months (range, 24-53 months). The Creighton-Nebraska Health Foundation Assessment score for fractures of the calcaneus was used for evaluation. The average score was 86.7 for type II, 82.3 for type III, and 59.2 for type IV fractures. There was a clear statistically significant superiority with type II and type III fractures treated with open reduction when compared with type IV fractures (p < 0.0001). On the basis of our result, we recommend that type II and type III fractures be treated with open reduction and internal fixation. Despite the results of type IV fractures being significantly worse than that of type II and type III fractures, we recommend open reduction and internal fixation for type IV fractures to restore the hindfoot architecture and the subtalar joint, if possible. When the disrupted subtalar joint is so comminuted that it is beyond the surgeon's ability to reconstruct, primary subtalar arthrodesis should be performed in addition to open reduction and internal fixation.

Minimum 10-year follow-up after open reduction and internal fixation of radial head fractures Mason type II and III

Aim:-Aim of this study is to assess the outcome after open reduction and internal fixation using a periarticular raft plating with screw fixation without bone grafting for split -depression tibial plateau fractures.Methods:-15 patients with 15 knees in 10 male and 5 female were managed by open reduction & internal fixation with, raft locking plate with raft screws through plate without use of bone graft or bone substitute for split depression fracture (> 5 mm.).Proximal tibial fractures (Schatzker type II or Ao / OTA type 4.1 B3) were treated and the result were assessed by radiographs & clinical examination.The Rasmussen radiological score & clinical score, the Lysholm knee score, and the Tegner activity score were also assessed.Result:-The mean follow was 12.5 (rang, 6 -19) months.All patients achieved bone union after a mean of 12.4 (range 8 -24) weaks.The mean range of motion was 116 degree (100o -130 o).The Rasmussen radiological score was excellent in 10 patients, good in 4, and fair in 1.The Rasmussen clinical score was excellent in 8, good in 6, and fair in 1 patient.The Lysholm was excellent in 9 patients, good in 4, and fair in 2. 13 out of 15 patients recovered to their pre operative Tegner activity scores.Only 1 patients having severe communition had loss of reduction after full weight bearing.Conclusion:-Internal fixation using a periarticular raft locking compression