Background: The present study evaluated the effect of INTERNAL mesh FIXATION and EXTERNAL FIXATION (inguinal hernia truss) on postoperative complications in patients with inguinal hernia. Materials and Methods: This randomized clinical trial was performed on 64 patients that were candidates for inguinal hernia repair by laparoscopic method following the totally extraperitoneal procedure. These patients were randomly divided into two groups. In the first group, the mesh was fixed with a maximum of three absorbable tacks. In the second group, the inguinal hernia truss was used as the EXTERNAL FIXATION for 6 weeks immediately after the surgery. Results: The results revealed that seroma, neuralgia, and recurrence were observed with the values of 6. 4%, 19. 4%, and 3. 2% in Group A and 3. 3%, 13. 3%, and 3. 3% in Group B (P > 0. 05). Moreover, patients’,pain scores 1 week and 1 month after the surgery in Group B were significantly lower than those of Group A (P < 0. 05). However, the mean pain score of patients was not different between the two groups 3 and 6 months after the surgery (P > 0. 05). Furthermore, the duration of return to work in Group B with an average of 8. 07 ±,3. 09 days was less than that of Group A with the average of 9. 65 ±,5. 34 days (P > 0. 05). Conclusion: The mentioned findings can trigger the use of EXTERNAL FIXATION and an inguinal hernia truss as a support for the abdominal wall to make the dream of not using a foreign body in the human body come true.

Background: The present study evaluated the effect of INTERNAL mesh FIXATION and EXTERNAL FIXATION (inguinal hernia truss) on postoperative complications in patients with inguinal hernia. Materials and Methods: This randomized clinical trial was performed on 64 patients that were candidates for inguinal hernia repair by laparoscopic method following the totally extraperitoneal procedure. These patients were randomly divided into two groups. In the first group, the mesh was fixed with a maximum of three absorbable tacks. In the second group, the inguinal hernia truss was used as the EXTERNAL FIXATION for 6 weeks immediately after the surgery. Results: The results revealed that seroma, neuralgia, and recurrence were observed with the values of 6. 4%, 19. 4%, and 3. 2% in Group A and 3. 3%, 13. 3%, and 3. 3% in Group B (P > 0. 05). Moreover, patients’,pain scores 1 week and 1 month after the surgery in Group B were significantly lower than those of Group A (P < 0. 05). However, the mean pain score of patients was not different between the two groups 3 and 6 months after the surgery (P > 0. 05). Furthermore, the duration of return to work in Group B with an average of 8. 07 ±,3. 09 days was less than that of Group A with the average of 9. 65 ±,5. 34 days (P > 0. 05). Conclusion: The mentioned findings can trigger the use of EXTERNAL FIXATION and an inguinal hernia truss as a support for the abdominal wall to make the dream of not using a foreign body in the human body come true.

Background: The treatment of open tibial fractures is still an orthopaedic challenge and full of complications. In many cases the use of EXTERNAL fixator that has been known as a nonunion machine is obligatory with a high incidence of pin track infection and other complications. The aim of this study was to compare the use of EXTERNAL FIXATION as a definite method for treatment of open tibial fractures with its subsequent conversion to INTERNAL FIXATION or casting. Methods: Sixty-seven young patients with type III open tibial fractures (Gustilo-Anderson classification) were treated with half pin EXTERNAL FIXATION. Twenty of them were converted into INTERNAL FIXATION after a period of 6-8 weeks. For another twenty-five, EXTERNAL fixator was removed and treatment continued with casting for a period lasting from 16 to 20 weeks. And for twenty two patients the fixator continued until complete union. The patients followed up for 10-16 months and were evaluated in terms of union time, union rate, infection, range of motion, malunion, non-union, nerve injury, and reduction. Results: There was a meaningful difference only in the union time and superficial infection between the first group and the other two groups. Conclusion: The conversion of EXTERNAL to INTERNAL FIXATION can be considered as a safe, effective, less complicated, and more acceptable method for the treatment of open tibial fractures.

Background: Pilon fractures represent one of the most surgically challenging fractures in orthopaedics. Different techniques exist for their management, with open reduction and INTERNAL FIXATION (ORIF) and EXTERNAL FIXATION (ExFix) the most widely used. Whilst there is a plethora of data regarding these strategies for Pilon fractures as a whole, very limited data exists solely on the management of open Pilon fractures. This study aimed to elucidate how surgical management options can influence postoperative complications, and if this can influence future management protocols. Methods: We conducted a search in PubMed, EMBASE and CENTRAL for postoperative complications and functional outcomes in open pilon fractures in those treated with Ex-Fix vs ORIF (PROSPERO-CRD42020184213). The postoperative complications measured included non-union, mal-union, delayed union, bone grafting, amputation, osteoarthritis, deep infection and superficial infection. Functional outcomes in the form of the AOFAS score was also measured where possible. We were able to carry out a meta-analysis for both deep infections and non-unions. Results: The search yielded 309 results and a total of 18 studies consisting of 484 patients were included. All fractures included were open, and consisted of 64 Gustilo-Anderson Type I, 148 Type II, 103 Type IIIa, 90 Type IIIb and 9 Type IIIc. 60 Type III fractures could not be further separated and 12 were ungraded. Both ORIF and Ex-Fix were found to have statistically similar AOFAS scores (P=0. 682). For all included studies, the Ex-Fix group had significantly higher rates of superficial infections (P=0. 001), non-unions (P=0. 001), osteoarthritis (P=0. 001) and bone grafting (P=0. 001). The meta-analysis found no significant difference in non-union (pooled OR=0. 25, 95% CI: 0. 03 to 2. 24, P=0. 44) or deep infection rates (pooled OR=1. 35, 95% CI: 0. 11 to 16. 69, P=0. 12) between the ORIF and Ex-fix groups. Conclusion: Based on our study, while Ex-Fix and ORIF have similar functional outcomes, Ex-Fix appears to have a significantly higher risk of postoperative complications which must be considered by surgeons when choosing surgical management options. Further research, ideally in a randomised control trial format, is required to definitively demonstrate ORIF superiority in the management of open pilon fractures.