Background: Perilunate fracture dislocation (PLFD) and perilunate dislocation (PLD) are wrist injuries, which are commonlymissed. Meanwhile, the delay in the treatment of these injuries is leading to a more complicated situation. One of the acceptabletreatments for old cases is open reduction and internal fixation. Objectives: The purpose of this study was to determine the mid-term results of open reduction and internal fixation (ORIF) treatmentfor old unreduced perilunate injury that had been unreduced and untreated for a minimum of 6 weeks after injury. Methods: Between 2011 and 2016, 12 patients with old PLFD and PLD, untreated for a minimum of 6 weeks after injury, were treatedby ORIF. A retrospective review was performed with a minimum 12 months of follow-up. During the final follow up visit, the patientswere evaluated for pain, range of motion, and grip strength. TheMAYO wrist score was used for functional assessment. The patientswere assessed using a validated Persian questionnaire Quick DASH score. Radiological outcomes were classified using the Herzbergclassification. Results: All of patients were males with a mean age of 25 years (18 to 32 years). Perilunate Fracture Dislocation injury was found in 7cases and PLD in 5 cases. Mean time from injury to surgery was 14. 3 weeks (6 to 26 weeks) and mean follow-up after the surgery was33. 5 months (12 to 60 months). The mean MAYO wrist score was 77. 5 (55 to 85). According to the Mayo wrist score, 42% of patients(5 patients) had good, 50% (6 patients) had satisfactory, and 8% (1 patient) had poor results. The active range of flexion-extensionaveraged 107. 5° (range 80 to 155° ), and grip strength averaged 84% (range 53% to 100%) of the intact extremity. According to theHerzberg classification, 5 (42%) patients were radiologically located in group A and 7 (58%) in group B. Patients’ satisfaction ratebased on the Persian Quick DASH score had an average of 12. 5. Conclusions: Open reduction and internal fixation is an appropriate treatment with acceptable functional and clinical results inold unreduced perilunate injuries up to 6 months after trauma.

The scapula is a complex bone. It involves the scapular body, scapular spine, acromion, and glenoid. While the majority of it is flat and the site of muscle attachments, it also includes the glenoid and is involved with shoulder joint mechanics. Scapula fractures are uncommon, and their treatment depends on the fracture location, amount of displacement, and other patient and fracture characteristics. This publication aims to briefly present the approach for scapular fracture open reduction internal f ixation...

Background: Given its low incidence, the management of deep infection following distal radius open-reduction internal fixation (ORIF) has not been well reported. In an effort to expand our current understanding, the purpose of this case series is to present the treatment strategies and functional outcomes associated with deep infection after distal radius ORIF. Methods: All patients with deep infections after distal radius ORIF over a ten-year period were identified and their treatment courses asessed. Results: The cohort consisted of three women and one man with an average age of 55. 5 ± 17. 6 years. Mean time from infection presentation to irrigation and debridement (I&D) with removal of hardware (ROH) was 16 days (Range: 3 – 44 days). The identified bacterial species in all cases was Staphylococcus aureus (MRSA = 2, MSSA = 2). Three patients were treated with intravenous antibiotics, while one patient was treated with oral antibiotics. Mean time from infection presentation to final clinical follow-up was 11 months (Range: 3 – 20 months). Two patients required repeat I&D. A clinical determination of successful infection eradication was made in all cases. Conclusion: The reported rate of deep infection after distal radius ORIF is less than 1%. There is no well-defined treatment algorithm for patients with deep infection after distal radius ORIF. However, removal of hardware and postoperative oral or intravenous antibiotic therapy appears effective, and is consistent with the standard practices of treating infection after other orthopaedic surgeries.

Background: Implant removal due to infection is one of the major causes failure following open reduction and internal fixation (ORIF). The aim of this study was to determine trends and predictors of infection-related implant removal following ORIF of extremities using a nationally representative database. Methods: Nationwide Inpatient Sample data from 2006 to 2017 was used to identify cases of ORIF following upper and lower extremity fractures, as well as cases that underwent infection-related implant removal following ORIF. Multivariate analysis was performed to identify independent predictors of infection-related implant removal, controlling for patient demographics and comorbidities, hospital characteristics, site of fracture, and year. Results: For all ORIF procedures, the highest rate of implant removal due to infection was the phalanges/hand (5. 61%), phalanges/foot (5. 08%), and the radius/ulna (4. 85%). Implant removal rates due to infection decreased in all fractures except radial/ulnar fractures. Tarsal/metatarsal fractures (odds ratio (OR)=1. 45, 95% confidence interval (CI): 1. 02-2. 05), and tibial fractures (OR=1. 82, 95% CI: 1. 45-2. 28) were identified as independent predictors of infection-related implant removal. Male gender (OR=1. 67, 95% CI: 1. 49-1. 87), Obesity (OR=1. 85, 95% CI: 1. 34-2. 54), diabetes mellitus with chronic complications (OR=1. 69, 95% CI: 1. 13-2. 54, P<0. 05), deficiency anemia (OR=1. 59, 95% CI: 1. 14-2. 22) were patient factors that were associated with increased infection-related removals. Removal of implant due to infection had a higher total charge associated with the episode of care (mean: $166, 041) than non-infection related implant removal (mean: $133, 110). Conclusion: Implant removal rates due to infection decreased in all fractures except radial/ulnar fractures. Diabetes, liver disease, and rheumatoid arthritis were important predictors of infection-related implant removal. The study identified some risk factors for implant related infection following ORIF, such as diabetes, obesity, and anemia, that should be studied further to implement strategies to reduce rate of infection following ORIF.

Regarding the fact that lateral compression is usually not the underlying mechanism of fracture, Locked pubic symphysis is a very rare injury. At most times it can be managed with closed reduction method,however, open reduction with or without internal fixation may sometimes be required. In rare cases, osteotomy is the only choice. Urethral or bladder damage can occasionally be found. In this study, we presented a case of locked pubic symphysis with failed closed reduction who underwent successful open reduction with internal fixation.

Background: Unstable Pelvic fracture, a result of high energy antero-posterior compression injury, has been managed based on internal fixation and open reduction. The mode of fixation in Unstable Pelvic fracture has, however, been a subject of controversy and some authors have proposed a need to address the issue of partial breach of the pelvic ring elements in these injuries. This study was performed to evaluate the functional and radiological results of treatment of pelvic ring fractures by open reduction, internal fixation.Methods: Thirty eight patients with unstable pelvic fractures, treated from 2002 to2008 were retrospectively reviewed. The mean age of patients’ was 37 years old (range 20 to 67). Twenty six patients were men and 12 women. The most common cause was a road traffic accident (N=37, 97%). There were 11 type-C and 27 type-B fractures according to Tile’s classification. Thirty six patients sustained additional injuries. The most prevalent additional injuries were lower extremity fractures. Open reduction, internal fixation as a definite management was applied for all patients. Quality of reduction was graded according to the grades proposed by Matta and Majeed’s score was used to assess the clinical outcome. The mean period of follow-up was 25 months (ranged from 6 to 109 months). About 81.6% of patients had either good or excellent radiological reduction.Results: The functional outcome was excellent in 66%, good in 15%, fair in 11% and poor in 7% of the patients. There were 4 postoperative infections. No sexual function problem was reported. Nerve deficits recovered completely in 2 and partially in 3 of 11 patients with preoperative neurologic deficiency. There was no significant relation between functional outcome and the site of fractureConclusion: Unstable pelvic ring fracture injuries should be managed surgically by rigid stabilization that must be carried out as soon as the general condition of the patient permits, and even up to two weeks.