Treatment of choice for bicondylar tibial plateau fractures between open reduction with internal fixation versus hybrid circular external fixator: a systematic review

The high complication rate is closely related to the incidence of bicondylar tibial plateau fractures (BTPF) due to the involvement of the articular surface. The aim of this study is to compare open reduction with internal fixation (ORIF) and hybrid circular external fixation (HCEF) as the choice of surgical procedure for BTPF because these two procedures is still controversial until now. A systematic review using Cochrane library, PubMed, and Google Scholar was conducted based on PRISMA guideline. Inclusion criteria were studies comparing HCEF and ORIF of BTPF. Studies of only one surgical technique modality, schatzker types I-IV tibial plateau fractures, and case reports were excluded, resulting in six included studies. There is no significant difference in radiographs, functional and anatomical outcomes in both group (ORIF vs HCEF). Complications that measured are higher infection rate found in the ORIF group. Blood loss was higher in the ORIF group, while both procedures have similar operation time and functional outcome. The mean of hospital length of stay (LoS) seems to be higher 6.83 days (95%CI 0.96-12.70; P<0.00001) on ORIF group from the random effect of forest plot evaluation. According to this study, HCEF is more beneficial in terms of blood loss and hospital LoS. But overall ORIF and HCEF carry similar operation time, functional outcome, union rate, and complication

Double plate fixation technique for prolonged non-weight baring induced severe disuse atrophy in hypertrophic non-union of left femur: a case report

Hypertrophic non-union differs from other forms of non-union due to its the biological capacity for union, in which it results from mechanical instability, namely the implant being unable to provide long lasting stability. Non-weight bearing state will cause bone resorption and further bone-mass loss with worsened prognosis. A 64-year-old female patient presented with inability to walk normally resulting from prolonged non-weight bearing-induced severe disuse atrophy in hypertrophic non-union of the left femur. Implant revision and osteoclasis were performed, followed by an urgent implant revision a few days later using double plating technique by placing the second plate on the anterior part of the femur. Post-operative X-ray showed satisfactory two implants placement and physiological alignment was achieved. Inappropriate initial treatment on the acute phase has led to prolonged non weight bearing state, resulting in disuse atrophy of the bone. This should have been predicted during the first implant revision on drilling both cortices, since even the slightest distraction resulted in severe consequences. Double plating system leads to absolute stability so acceptable union can be achieved. Initial treatment on acute setting of fracture should maximize every effort to restore proper functional state and should promote early mobilization. Any maltreatment will result in prolonged morbidity and will require more reconstruction effort with less than normal end result. Robust fixation and alignment can be achieved with double plating system; however, prolonged immobilization should be anticipated

Comparison of mortality rate between bipolar hemiarthroplasty and proximal femoral nail anti-rotation for intertrochanteric fractures in Sanglah hospital, Bali

Introduction: Intertrochanteric fractures occur in about 50% of all hip fracture events, with a mortality rate within 1 year after fracture reaching 15 to 20%. The most common treatment nowadays is either the bipolar hemiarthroplasty procedure or proximal femoral nail anti-rotation (PFNA), although there is still no consensus regarding which is better from the two, especially on patient mortality.Method: This study was an observational study using a retrospective cohort design. A total of 102 study subjects who met the inclusion requirements were grouped into 2 groups, one with bipolar hemiarthroplasty fixation treatment and another with PFNA fixation treatment. Mortality rate was recorded by survey 2 years after surgery.Result: Chi-square test showed that 2-year mortality rate after intertrochanteric fracture treated with bipolar hemiarthroplasty (21.4%) was significantly higher than the PFNA group (10.3%) (p=0.028). Bipolar hemiarthroplasty group also had longer length of stay (LoS) (50%) than the PFNA group (32.4%), albeit statistically insignificant (p=0.13). There was no significant difference between the 2-year mortality rate and LoS (p=0.976).Conclusion: Patients with intertrochanteric fractures who underwent bipolar hemiarthroplasty have significantly higher 2-year mortality rate than similar patients underwent fixation with PFNA, while they did not experience higher LoS than the PFNA group. Future prospective, multi-center study with larger sample size will be likely to validate similar fixation choice needed to decrease the mortality rate in intertrochanteric fractures

The correlation of Singh index and cortical thickness index toward bone mineral density in women older than 60 years old with femoral neck fracture

Background: Femoral neck fracture is one of the most common fractures in elderly. Proximal femur fracture in elderly patients is considered a severe morbidity which has a negative impact on the life expectancy and quality of life. Aim of this study was to find the correlation of cortical thickness index (CTI) and SI toward bone density (BMD) in female patients over 60 years of age with femoral neck fracture.Methods: This is an observational cross-sectional study. Subjects were selected from Sanglah general hospital outpatient department, Denpasar, Bali during the period October 2020 to January 2021 by inclusion requirements and then randomized into two groups. Data were taken through history taking, physical examination as well as supporting investigations such as contralateral hip joint radiograph and BMD measurements. Statistical analysis was done from those data.Results: It has been obtained that there was a positive correlation of Singh index (SI) and CTI toward BMD. The correlation coefficient (r) between SI and BMD was 0.874 (p=0.000). The r between CTI and BMD was 0.854 (p=0.000). Both variables were significant.Conclusions: There were significantly strong correlations between SI and BMD (r=0.874, p=0.00), also CTI and BMD (r=0.854, p=0.00) in female patients over 60 years of age with femoral neck fracture