Olga Bisaccia

Nail or plate in the management of distal extra-articular tibial fracture, what is better? Valutation of outcomes

Introduction: Distal tibial fractures are the most common long bone fractures. Several studies focusing on the methods of treatment of displaced distal tibial fractures have been published. To date, locked plates, intramedullary nails and external fixation are the three most used techniques. The aim of our study was to compare intramedullary nail (IMN) and locked plate (LP) for treatment of this kind of fracture. Materials and methods: We collected data on 81 patients with distal tibial fractures (distance from the joint between 40 and 100 mm) and we divided into two groups: IMN and LP. We compared in the 2 groups the mean operation time, the mean union time, the infection rate the rate of malunion and nonunion, the full weight bearing time. Results: No patient in the two groups developed a nonunion. None of the patients obtained a fair or poor outcome. Overall 52 patients obtained an excellent result (69.3%) and 23 obtained a good result (30.6%). Discussion: Our study results indicate a superiority of IMN over LP in terms of lower rates of infections and statistically significant shorter time to full weight bearing. Whereas LP appeared to be advantageous over IMN in terms of leading to a better anatomical and fixed reductions of the fracture and a lower rate of union complications. The two treatments achieved comparable results in terms of operation time, hospital stay, union time and functional outcomes.

Articular fractures of distal radius: comparison of treatment and clinical and radiological outcomes with volar plate versus Hoffmann bridging external fixator.

The Wrist fractures are one of the most frequent traumatic pathologies. Surgery is now more commonly recommended for this type of fracture as a means to improve the outcome of patients. The objective of this study is to compare treatment with volar plate vs. external fixation in these types of fractures. A total of 158 consecutive patients who had been operated on for distal radius fractures with or without ulnar involvement, were included in this study. 109 were treated with a volar plate and 49 with Hoffmann II external fixator. The exclusion criteria were patients with a history of wrist fractures, with neurological diseases, pathological fractures and polytrauma patients. Clinical and radiographic results were evaluated in both groups of patients. Clinical parameters were: average flexion, average extension, average pronation and supination, and the average radial and ulnar deviation. The radiographic parameters that we considered were the radial tilt and ulnar variance. In both groups, we evaluated the clinical results with the DASH score and the Mayo-Wrist score. The unstable and intra-articular fractures of the distal radius can be treated with different methods, among which the most commonly used are the open reduction and internal fixation with plates or the synthesis with external fixation. Our study shows how both methods provide similar clinical and radiographic results, so the choice of which to use depends more on the surgeons experience and the patients compliance rather than on the type of fracture.

Tubular vs Profile Plate in Peroneal or Bimalleolar Fractures: is There a Real Difference in Skin Complication? A Retrospective Study in Three Level I Trauma Center

Introduction: Not enough literature is available to evalute the wound complication rate of plates type in distal fibular fractures. Aim: The aim of our study was to compare wound complications of using a third tubular plate compared to LCP distal fibula plate. Material and Methods: This study is a retrospective single-centre study in which was performed plating of fibula in closed ankle fractures. 93 patients were included in our study and assigned in two groups, based on using of different implant : in group A 48 patients were treated with one-third tubular and in group B 45 patients were treated with LCP distal fibula plate. There were no significant differences in the baseline characterisctics. Patients received the same surgical procedure and the same post-operative care, then they were radiologically evalueted at 1-3-12 months and clinical examination was made at 12 months using AOFAS clinical rating system. Categorical data, grouped into distinct categories, were evalueted using Chi-square test. We considered a p value < 0.05 as statistically significant. Results: The wound complications rate of the overall study group was 7.6%. There were no statistical differences in the rate of wound complications between the two groups. There were no differences between both group in percentage of hardware removal at follow-up (overall 5.4%); plate removal was performed earlier in the locking plate because of wound complications. Conclusions: Our study has shown no difference in radiographic bone union rate, no significant differences in terms of clinical outcomes, in time of bone reduction and wound complication rate between the LCP distal fibula plate and conventional one-third tubular plate. Controversy still exists about the best method for the fracture reduction.

IS BASELINE STRAIN INDEX A PROGNOSTIC FACTOR FOR SMALL UNILATERAL SUPRASPINATUS TENDON TEARS? A PROSPECTIVE STUDY

Purpose: From prospectively report the 2-year follow-up clinical and real-time sonoelastography (RTSE) outcomes of a group of patients affected by small unilateral supraspinatus tendon tears. Our hypothesis was that patients with lower baseline strain indexes would have worst outcomes at follow-up. Methods: We recruited patients suffering by a unilateral rotator cuff tear. All patients have prospectively scrutinized. Patients were initially managed non-operatively, after at least 3 months of failed conservative treatment patients went under surgery. Our clinical evaluation and follow up was done by: complete physical examination; VAS for pain; Quick DASH; Constant–Murley score; Simple Shoulder Test; ASES score and UCLA score. The mechanical properties of tissues were evalutated by Conventional ultrasounds and RTSE and they were estimated uging the Strain index. Results: Forty-three patients were available for evaluation at 2 years. Fifteen had undergone surgery (operative group), while 28 recovered from pain and dysfunction with conservative management andhad not required surgery (non-operative group). Patients in both groups significantly improved at follow-up, and no differences were found in all considered clinical outcomes. The biomechanical properties of repaired tendons were maintained, while non-operatively treated tendons softened over time. Baseline and follow-up strain indexes were linearly correlated with clinical outcomes at 2 years. Conclusions: Baselinestrain index could be associated with post-operative functional outcomes at 2-year follow-up. The biomechanical properties of surgically repaired tendons were maintained, while non-operatively treated tendons softened over time. At least in this cohort of patients, baseline strain index did not suggest who could be managed conservatively and who will need surgery.

CHRONIC COMPARTMENT SYNDROME OF LOWER LEG. AN UNUSUAL CASE IN NON ATHLETIC PATIENT

Chronic exertional anterior compartment syndrome is debilitating disease of the lower limb. Limited symptomology characterises the clinical picture at rest, pain during sporting activities, tumefaction, and contractures of the limb as well impotency by the pain of the entire forefoot and hypoesthesia. Usually, the most affected patients are athletes. We analyse a case of chronic post-traumatic compartment syndrome of the anterior tibial muscle in an unsportsmanlike patient.

Feasibility and Value of Radiographic Union Score Hip Fracture after Treatment with Intramedullary Nail of Stable Hip Fractures

Introduction: Given the importance of fracture healing on patient outcome in clinical practice, it is critical to assess fracture healing. Aim: The aim of this study was to evaluate the feasibility of the Radiographic Union Score Hip fracture after treatment with intramedullary nail of stable hip fractures. Patients and Methods: We retrospectively collected the data from the clinical records of our institution of the 47 patientswho had undergone intertrochanteric hip fracture treatment using an intramedullary nail. Pain visual analogic score (VAS) was collected the same day that X-rays were taken. Plain hip X-rays were performed, in two radiographic views, at 40 and 90 days after the surgical procedure. The correlation between the RUSH and VAS score was evaluated. Results: Mean RUSH and VAS scores showed a strong statistical improvement between the 40 and 90 day follow-ups. RUSH value at 40 days fitted an inverse linear regression with VAS, p-value of 0.0063 and r2 of 0.15. At 90 days the regression between RUSH and VAS scores was not significant. Conclusion: RUSH could be proposed as an objective system to evaluate union in hip fractures treated with intramedullary nail.