Fractures Management in Upper and Lower Limbs

A special issue of Journal of Functional Morphology and Kinesiology (ISSN 2411-5142). This special issue belongs to the section "Sports Medicine and Nutrition".

Deadline for manuscript submissions: closed (1 November 2021) | Viewed by 27648

Special Issue Editor

Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, 95123 Catania, Italy
Interests: knee; orthopaedics; traumatology; fractures; surgery; postoperative rehabilitation; musculoskeletal disorders; pediatric orthopedic
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Special Issue Information

Dear Colleagues,

Bone fracture is a partial or complete break in the continuity of the bone. The pattern of fracture depends on several factors, such as patient age, mechanism and severity of trauma, comorbidities, including conditions that cause bone weakness, such as osteopenia and osteoporosis. Diagnosis is possible through a clinical evaluation and radiographic assessment; CT scan and MRI could be indicated in selected cases, especially in articular and comminuted fractures. Nowadays, conservative treatment is still a frequent option for undisplaced and closed fractures, while surgical approach is mandatory for displaced, comminuted and open fractures. Surgical options include closed or open reduction, followed by internal fixation, using different devices, such as K-wires, plates, screws and intramedullary nails; in some cases, arthroplasty could be indicated. External fixation is usually used for damage control in open fractures or for complications management. Rehabilitation is necessary to achieve an optimal functional recovery.

The aim of this Special Issue is to highlight the modern approach to diagnosis and treatment of upper and lower limbs fractures in different age groups, from childhood to elderly, underlining the importance of an early functional recovery, using appropriate conservative or surgical management and personalized rehabilitative planning.

Prof. Dr. Vito Pavone
Guest Editor

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Keywords

  • hip fractures
  • knee fractures
  • ankle fractures
  • upper limbs fractures
  • conservative treatment
  • close and open reduction
  • reduction and fixation
  • arthroplasty
  • complications
  • rehabilitation

Published Papers (7 papers)

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Research

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8 pages, 1131 KiB  
Article
Clinical and Radiological Results after Fracture-Dislocations of the Ankle: A Medium- to Long-Term Followup Study
J. Funct. Morphol. Kinesiol. 2022, 7(2), 30; https://doi.org/10.3390/jfmk7020030 - 25 Mar 2022
Cited by 1 | Viewed by 5031
Abstract
The authors report the long-term outcome in a series of 26 patients surgically treated for a fracture-dislocation of the ankle by open reduction and internal fixation (ORIF), reviewed after an average followup of 5.2 years. The average age of the patients was 46.8 [...] Read more.
The authors report the long-term outcome in a series of 26 patients surgically treated for a fracture-dislocation of the ankle by open reduction and internal fixation (ORIF), reviewed after an average followup of 5.2 years. The average age of the patients was 46.8 years; 17 were female and 9 male; the right side was involved in 22 patients and the left side in 4; 10 patients had a unimalleolar fracture, 11 a bimalleolar fracture, and 5 a trimalleolar fracture. The quality of reduction was excellent in 14 cases and good in 12. The functional results were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score, while radiographic results followed the Van Dijk classification. At followup, the AOFAS score ranged from 75 to 98 points with an average of 87.9, while the radiographic results were evaluated as grade 0 in 16 ankles and grade I in 10. Fracture-dislocations of the ankle occurred more frequently after high-energy traumas in younger patients on the right side, but they were also observed in older females after low-energy trauma. Excellent reduction was correlated with better radiographic results at long term followup. However, these injuries may lead to a poor functional outcome, despite an anatomical reduction and good radiographic results; in fact, in nine of our cases (34.6 percent), the AOFAS score was less than 90 points. Full article
(This article belongs to the Special Issue Fractures Management in Upper and Lower Limbs)
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10 pages, 1141 KiB  
Article
Magnetic Resonance Imaging of the Knee in the Presence of Bridging External Fixation: A Comparative Experimental Evaluation of Four External Fixators, Including Dolphix®
J. Funct. Morphol. Kinesiol. 2022, 7(1), 4; https://doi.org/10.3390/jfmk7010004 - 30 Dec 2021
Cited by 3 | Viewed by 2854
Abstract
Performing MR investigation on patients instrumented with external fixators is still controversial. The aim of this study is to evaluate the quality of MR imaging of the knee structures in the presence of bridging external fixators. Different cadaveric lower limbs were instrumented with [...] Read more.
Performing MR investigation on patients instrumented with external fixators is still controversial. The aim of this study is to evaluate the quality of MR imaging of the knee structures in the presence of bridging external fixators. Different cadaveric lower limbs were instrumented with the MR-conditional external fixators Hofmann III (Stryker, Kalamazoo, MI, USA), Large external Fixator (DePuy Synthes, Raynham, MA, USA), XtraFix (Zymmer, Warsaw, IN, USA) and a newer implant of Ketron Peek CA30 and ERGAL 7075 pins, Dolphix®, (Citieffe, Bologna, Italy). The specimens were MR scanned before and after the instrumentation. The images were subjectively judged by a pool of blinded radiologists and then quantitatively evaluated calculating signal intensity, signal to noise and contrast to noise in the five regions of interest. The area of distortion due to the presence of metallic pins was calculated. All the images were considered equally useful for diagnosis with no differences between devices (p > 0.05). Only few differences in the quantification of images have been detected between groups while the presence of metallic components was the main limit of the procedure. The mean length of the radius of the area of distortion of the pins were 53.17 ± 8.19 mm, 45.07 ± 4.33 mm, 17 ± 5.4 mm and 37.12 ± 10.17 mm per pins provided by Zimmer, Synthes, Citieffe and Stryker, respectively (p = 0.041). The implant of Ketron Peek CA30 and ERGAL 7075 pins showed the smallest distortion area. Full article
(This article belongs to the Special Issue Fractures Management in Upper and Lower Limbs)
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12 pages, 1417 KiB  
Article
Antibiotic-Coated Nail in Open Tibial Fracture: A Retrospective Case Series
J. Funct. Morphol. Kinesiol. 2021, 6(4), 97; https://doi.org/10.3390/jfmk6040097 - 29 Nov 2021
Cited by 17 | Viewed by 3210
Abstract
Implant-associated infections still represent one of the main problems in treatment of open fracture. The role of systemic antibiotic prophylaxis is now agreed and accepted; however, recent literature seems to underline the importance of local antibiotic therapy at the fracture site, and antibiotic [...] Read more.
Implant-associated infections still represent one of the main problems in treatment of open fracture. The role of systemic antibiotic prophylaxis is now agreed and accepted; however, recent literature seems to underline the importance of local antibiotic therapy at the fracture site, and antibiotic nails have been shown to play a role in the treatment of open fractures in terms of fracture healing and lower risk of infection. We retrospectively analyzed our results, from January 2016 to March 2020, with the use of coated nails in the treatment of open tibial fractures, evaluating the rates of infection and fracture healing as primary outcomes and the rate of reoperations, time from trauma to nailing and hospital stay as secondary outcomes. Thirty-eight patients treated with coated nail (ETN ProtectTM, Synthes) were included in the study. Minimum follow-up was of 18 months. Thirty-four of 38 patients achieved bone union and 2 patients underwent septic non-union. In our series, no systemic toxicity or local hypersensitivity to antibiotics were recorded. From this study, use of antibiotic-coated nails appears to be a valid and safe option for treatment of open tibial fractures and prevention of implant-related infections, particularly in tibial fractures with severe soft tissue exposure and impairment. Full article
(This article belongs to the Special Issue Fractures Management in Upper and Lower Limbs)
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8 pages, 4868 KiB  
Article
Salvaging Pull-Out Strength in a Previously Stripped Screw Site: A Comparison of Three Rescue Techniques
J. Funct. Morphol. Kinesiol. 2021, 6(3), 71; https://doi.org/10.3390/jfmk6030071 - 27 Aug 2021
Cited by 3 | Viewed by 1681
Abstract
Screw stripping during bone fixation is a common occurrence during operations that results in decreased holding capacity and bone healing. We aimed to evaluate the rescue of the stripped screw site using screws of different dimensions. Five screw configurations were tested on cadaveric [...] Read more.
Screw stripping during bone fixation is a common occurrence during operations that results in decreased holding capacity and bone healing. We aimed to evaluate the rescue of the stripped screw site using screws of different dimensions. Five screw configurations were tested on cadaveric specimens for pull-out strength (POS). The configurations included a control screw tightened without stripping, a configuration voluntarily stripped and left in place, and three more configurations in which the stripped screws were replaced by a different screw with either increased overall length, diameter, or thread length. Each configuration was tested five times, with each screw tested once. The POS of the control screw, measured to be 153.6 ± 27 N, was higher than the POS measured after stripping and leaving the screw in place (57.1 ± 18 N, p = 0.001). The replacement of the stripped screw resulted in a POS of 158.4 ± 64 N for the screw of larger diameter, while the screws of the same diameter but increased length or those with extended thread length yielded POS values of 138.4 ± 42 and 185.7 ± 48 N, respectively. Screw stripping is a frequent intraoperative complication that, according to our findings, cannot be addressed by leaving the screw in place. The holding capacity of a stripped screw implanted in cancellous bone can successfully be restored with a different screw of either larger diameter, longer length, or extended thread length. Full article
(This article belongs to the Special Issue Fractures Management in Upper and Lower Limbs)
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8 pages, 757 KiB  
Article
Locked Intramedullary Nailing versus Compression Plating for Stable Ulna Fractures: A Comparative Study
J. Funct. Morphol. Kinesiol. 2021, 6(2), 46; https://doi.org/10.3390/jfmk6020046 - 26 May 2021
Cited by 1 | Viewed by 4803
Abstract
Background: Isolated ulna shaft fractures (USFs) are a relatively uncommon, but significant, injury. For unstable USF treatment, open reduction and internal fixation (ORIF) is the gold standard, while for stable USFs several procedures were described. The aim of this study is to compare [...] Read more.
Background: Isolated ulna shaft fractures (USFs) are a relatively uncommon, but significant, injury. For unstable USF treatment, open reduction and internal fixation (ORIF) is the gold standard, while for stable USFs several procedures were described. The aim of this study is to compare the outcomes in patients with stable USFs treated by either ORIF or intramedullary nail (IMN). Methods: According to their surgical treatment, 23 eligible USF-affected patients were divided into ORIF (14 subjects) and IMN (nine subjects) groups. The subjects underwent postoperative clinical follow-up at 1, 3, 6, and 12 months, which included calculation of the Disabilities of the Arm, Shoulder and Hand (DASH) score and radiological follow-up. Time to union, time to return to sporting and occupational activities, duration of physical therapy, and surgical complications were recorded. Results: DASH scores improved in both groups at the 6-month follow-up (p < 0.001). The IMN cohort recorded better DASH scores at the 1- and 3-month follow-ups, while similar results were reported at the 6- and 12-month follow-ups. Earlier fracture union (p = 0.001) and return to sporting activities and work (p = 0.002) were seen in the IMN group, compared with the ORIF group. No complications were observed in the IMN group. Conclusions: The surgical treatment of isolated USF results in excellent functional and radiographic outcomes. IMN may be preferable, compared with ORIF, due to its faster recovery time, expedited union, and reduced likelihood of complications. Full article
(This article belongs to the Special Issue Fractures Management in Upper and Lower Limbs)
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Review

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16 pages, 3490 KiB  
Review
Coronal Shear Fractures of the Distal Humerus
J. Funct. Morphol. Kinesiol. 2022, 7(1), 7; https://doi.org/10.3390/jfmk7010007 - 06 Jan 2022
Cited by 3 | Viewed by 6257
Abstract
Coronal shear fractures of the distal humerus are rare, frequently comminuted, and are without consensus for treatment. The aim of this paper is to review the current concepts on the diagnosis, classification, treatment options, surgical approaches, and complications of capitellar and trochlear fractures. [...] Read more.
Coronal shear fractures of the distal humerus are rare, frequently comminuted, and are without consensus for treatment. The aim of this paper is to review the current concepts on the diagnosis, classification, treatment options, surgical approaches, and complications of capitellar and trochlear fractures. Computed Tomography (CT) scans, along with the Dubberley classification, are extremely helpful in the decision-making process. Most of the fractures necessitate open reduction and internal fixation, although elbow arthroplasty is an option for comminuted fractures in the elderly low-demand patient. Stiffness is the most common complication after fixation, although reoperation is infrequent. Full article
(This article belongs to the Special Issue Fractures Management in Upper and Lower Limbs)
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Other

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8 pages, 2298 KiB  
Case Report
The Use of Low-Profile Angular-Stability Plates in a “Nutcracker” Tarsal Navicular Fracture Combined with a Cuboid Fracture: ORIF Experience
J. Funct. Morphol. Kinesiol. 2021, 6(4), 99; https://doi.org/10.3390/jfmk6040099 - 06 Dec 2021
Cited by 1 | Viewed by 2682
Abstract
Background: Clear recommendations about the optimal treatment of traumatic tarsal navicular fractures are still very debated in the literature, and this is due to several factors: navicular fractures are rare and often misdiagnosed injuries, they are frequently associated with other fractures or a [...] Read more.
Background: Clear recommendations about the optimal treatment of traumatic tarsal navicular fractures are still very debated in the literature, and this is due to several factors: navicular fractures are rare and often misdiagnosed injuries, they are frequently associated with other fractures or a dislocation of the midfoot, and the current knowledge is based on few papers mainly considering a limited number of cases and dealing with different therapeutic approaches. The treatment of navicular body fractures is controversial and burdened by a high incidence of complications; in particular, Sangeorzan type III comminuted fractures represent a real challenge for the orthopedic surgeon. An accurate preoperative planning, a scrupulous surgical technique aimed at restoring volume and bony anatomy, and the use of low-profile angular-stability plates can lead to optimal clinical and functional results, decreasing the chances of arthritic evolution of mid-foot joints. Full article
(This article belongs to the Special Issue Fractures Management in Upper and Lower Limbs)
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