Plaster immobilization versus anterior plating for dorsally displaced distal radial fractures in elderly patients in Pakistan

This prospective, multi-centred, randomized trial examined outcomes of 3- and 12-month follow-ups of 159 elderly participants aged more than 75 years with isolated distal radial fractures, treated by anterior locking plate or closed reduction and cast immobilization. The primary outcome was the patient-rated wrist evaluation (PRWE) score. The PRWE score at 12 months was not significantly different between the two groups; however, the radiological outcomes and complications rates were worse in the casting group. Level of evidence: III

Early mobilization versus plaster immobilization of simple elbow dislocations: a cost analysis of the FuncSiE multicenter randomized clinical trial

Introduction The primary aim was to assess and compare the total costs (direct health care costs and indirect costs due to loss of production) after early mobilization versus plaster immobilization in patients with a simple elbow dislocation. It was hypothesized that early mobilization would not lead to higher direct and indirect costs. Materials and methods This study used data of a multicenter randomized clinical trial (FuncSiE trial). From August 25, 2009 until September 18, 2012, 100 adult patients with a simple elbow dislocation were recruited and randomized to early mobilization (immediate motion exercises; n = 48) or 3 weeks plaster immobilization (n = 52). Patients completed questionnaires on health-related quality of life [EuroQoL-5D (EQ-5D) and Short Form-36 (SF-36 PCS and SF-36 MCS)], health care use, and work absence. Follow-up was 1 year. Primary outcome were the total costs at 1 year. Analysis was by intention to treat. Results There were no significant differences in EQ-5D, SF-36 PCS, and SF-36 MCS between the two groups. Mean total costs per patient were €3624 in the early mobilization group versus €7072 in the plaster group (p = 0.094). Shorter work absenteeism in the early mobilization group (10 versus 18 days; p = 0.027) did not lead to significantly lower costs for loss of productivity (€1719 in the early mobilization group versus €4589; p = 0.120). Conclusion From a clinical and a socio-economic point of view, early mobilization should be the treatment of choice for a simple elbow dislocation. Plaster immobilization has inferior results at almost double the cost.

Clinical and Anatomical Aspects of Anterior Dislocation of the Pisiform Bone

Introduction The pisiform bone is the fourth bone of the proximal row of the carpal bones, and it is located in the tendon of the flexor carpi ulnaris muscle, being considered a sesamoid bone. Traumatic dislocation of the pisiform bone is a rare condition, which usually results from a trauma in dorsal flexion of the wrist. Its treatment can be conservative or surgical, ending or not with the removal of the pisiform bone. Objective To report a case of a child who fell from his own height and presented wrist pain, diagnosed with dislocation of the pisiform bone. We emphasize the importance of anatomy knowledge in the evaluation of wrist trauma. Case Report The anamnesis confirmed that the fall occurred with the wrist in hyperextension. The physical examination showed a slight limitation of movement due to pain. Radiographic exams and a computed tomography (CT) scan of the wrist were performed, in which an anterior deviation/luxation of the pisiform bone was evidenced. A conservative treatment with plaster immobilization for analgesia was performed for 1 week. As there were no symptoms and no signs of trauma consistent with the images, such as edema and local ecchymosis, in addition to the early complete disappearance of pain, the responsible team proposed the hypothesis of asymptomatic chronic dislocation of the pisiform bone. Conclusion Imaging exams in orthopedic traumatology are fundamental for an accurate diagnosis. Nevertheless, they must be associated with knowledge of the anatomy to correlate the image findings with the anamnesis, leading to a better understanding of silent, asymptomatic, and preexisting conditions in the clinical practice.

Bone and joint injuries of the wrist and forearm

The forearm is a complex quadrilateral structure linked by the proximal and distal radioulnar joints, ligaments, which include the interosseous membrane and triangular cartilage, and several obliquely orientated muscles. A displaced fracture or ligament rupture within this forearm is likely to involve other structures. Treatment requires anatomic recovery of stable function. The ulnar corner can sustain fractures or ligament ruptures which affect stable, pain-free, congruous forearm rotation. The distal radius may fracture after high- or low-energy trauma; anatomic reduction may not be essential in all; inaccuracy may lead to loss of rotation and ulnocarpal abutment but long-term arthritis is unusual. Children’s fractures are managed with consideration of remodeling potential. The scaphoid is vulnerable to non-union; plaster immobilization, early percutaneous fixation, and later bone-grafting all have roles. Salvage for osteoarthritic non-union may reduce pain but compromises function. Rupture of the carpal ligaments may cause substantial disruption and require complex reconstruction.

A prospective study of distal radius fracture management by close reduction, percutaneous Kirschner wire fixation and plaster immobilization

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Distal radius fracture is one of the most common fractures. It may be sustained due to low-energy trauma or high-energy trauma. Objectives: To compare the clinical effectiveness of Kirschner wire fixation with and plaster immobilization for patients with fracture of the distal radius.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">Interventions Kirschner wire fixation: wires are passed through the skin over the dorsal aspect of the distal radius and into the bone to hold the fracture in the correct anatomical position. About 79 patients with Distal Radial Fractures presented to MGM Medical College and LSK Hospital, Kishanganj between November 2012 and June 2014 were included in the study</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">The majority were men (60.4%). Majority of the patients (69.8%) sustained the injury due to fall. The side of involvement was nearly equal and that there was no predominance of the either sides. In our study, according to AO classification, 31 cases were of Type A, 17 were of Type B and 5 were of Type C. The Anatomical evaluation by Sarmiento’s Criteria showed 33 patients with excellent result, 15 patients with good result and 5 with a fair result. At final follow-up by ‘The Gartland and Werley criteria for functional outcome’ 37 patients had excellent result, 13 had good result, 2 had fair result and 1 had a poor result. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">This study demonstrates that percutaneous Kirschner<strong> </strong>wire pinning is a minimally invasive technique that provides an effective means of maintaining the anatomical<strong> </strong>fracture reduction. It does not required highly skilled<strong> </strong>personnel or sophisticated tools for application. It is a<strong> </strong>suitable method for fixation of displaced Colles fracture with minimal intra-articular involvement. The technique involves a minimal procedure that provides anatomic reduction, fracture fixation, and maintenance of reduction with an adequate method of immobilization.</span></p>

ESTIMATION OF THE EFFECTIVENESS OF SURGICAL TREATMENT OF PATIENTS WITH OLD RUPTURE OF HEEL TENDON WITH SHORT PLASTER SPLINT IMMOBILIZATION

Heel tendon injuries is the most common trauma of tendomuscular apparatus. Old ruptures of heel tendon occur in 58 % of cases in humans. The aim of the research was to estimate the effectiveness of treatment of the patients with old ruptures of heel tendon with Myerson type III defects who had tendon reconstruction on Chernavsky and short plaster splint immobilization of lower extremity for 4 weeks. We operated 10 patients using reconstruction on Chernavsky in our clinic from 2012 to 2014 (average age – 47,6 ± 12,0 years, 8 males and 2 females). All patients had old ruptures of heel tendon. Average time from the moment of trauma till the operation was 112,6 ± 80,4 days. Diastasis between the ends of tendon was 5,8 ± 0,7 cm that corresponds to Myerson type III. Average term of staying at hospital was 10 ± 2 days. We didn’t register any complications in postoperative period. Term of plaster immobilization of the operated extremity was 4 weeks. AOFAS score was 34,2 ± 6,8 points at the control examination in 1,5 months that corresponds to bad functional result. We registered good functional results (88,6 ± 3,5 points) in 3 months. In 6 months, functional results were 95,9 ± 1,6 points. In 12 months after the operation average score was 97,9 ± 2,1 points that corresponds to excellent functional result. Using heel tendon reconstruction on Chernavsky at the Myerson type III defects in combination with short plaster immobilization and early activization of patients allows to decrease term of rehabilitation of patients after the operation.