Orthopaedic Trauma – Relevant articles in 2016

Vol 1 | Issue 1 |  July – Dec 2016 | Page 36-37 | Rohan Gala, Sanjay Dhar

Authors: Rohan Gala [1], Sanjay Dhar1 [1].

[1] Department of Orthopaedic Surgery, Dr D.Y.Patil Medical college, New Bombay, Maharashtra, India

Address of Correspondence
Dr Sanjay Dhar,
Department of Orthopaedic Surgery, Dr D.Y.Patil Medical college, New Bombay, Maharashtra, India
E-mail: drsanjaydhar@gmail.com

Over the years, there has been a constant attempt of orthopaedic surgeons worldwide to come up with newer techniques & improve the standard techniques of fracture fixation, reduce the risk of postoperative infection & to help patients achieve a good functional outcome to lead a better life.

“Die-punch” fractures of the distal end of radius have always been difficult to classify due their complex nature. Scheck et al defined it as a dorsal fracture fragment of the lunate fossa at the distal end of radius in 1962. As per the current concepts Zhang et al devised a new classification system in which they classified die punch fractures into 5 types which showed good inter-observer reliability and intra observer reproducibility, thus aiding the clinician to assess these injuries with relative ease [1].
Speaking of classifications, a recently devised classification system for proximal tibial fractures described by LUO et al [2], also known as the three column classification was applied and anatomical locking plates to treat complex three column fractures were invented. These plates proved to be far superior to the standard locking plates.
This year seemed to have more emphasis on tibial plateau fractures as Reza Firoozabaadi et al [3] identified a subset of bicondylar plateau fractures with a hyperextension varus deformity known as HEVBTP and they found a higher incidence of associated injuries like compartment syndrome and neurovascular injuries in this type. They laid down the radiographic hallmarks of this pattern, which were, loss of posterior slope of tibial articular surface, tension failure of posterior cortex, compression of the anterior cortex and varus deformity on the coronal plan
Open tibial fractures in adults have existing protocols outlining treatment strategies in detail. However, Ramsabbu et al [4] in their study on open tibial fracture management in paediatric age group concluded that more research is needed to determine an optimum treatment guideline as the existing literature of poorer quality.

Intra articular calcaneal fractures are one of the most difficult fractures to treat due to associated complications. One important complication is the peroneal tendon instability, which is clinically difficult to evaluate due to pain and swelling. Ketz et al [5] in their study concluded that intra operative evaluation of the superficial peroneal retinaculum as well as pre operative imaging (CT scan) is useful in the operative management of intra articular calcaneal fractures. SPR and its confluence with the peroneal tendon sheath represent the primary restraint against displacement of peroneal tendons. They also suggested a new technique of reparing the superficial peroneal retinaculum with intra-osseus suture anchor placement into the posterolateral fibula.

Sacral fractures with spinopelvic dissociation are highly unstable injuries which often require surgical intervention with Iliosacral screw fixation &/or lumbopelvic fixation from L4 to Pelvis which is often associated with life threatening complications and higher infection rate due to the prolonged surgery and increased blood loss. Seth K. Williams et al [6] developed a minimally invasive percutaneous lumbopelvic fixation technique to reduce and stabilize these fractures. They concluded that this technique is not only time saving but the intra operative blood loss is less. The ability to immediately weight bear without restriction made the author use this technique in cases where sacro iliac screw fixation alone would have sufficed.

Fracture spine is a subtype of fracture that relies heavily on radiological imaging ( X-Ray MRI, CT- Scan) in assessment and planning. The treatment strategies of thoracolumbar fractures are largely dependant on the classification system, and recently most of them have stressed on the importance of assessing then integrity of posterior ligament complex due to the high instability of the fractures and the resultant functional deterioration. Rajasekaran et al [7] formulated an interesting radiological index based on plain radiographs and CT scan to detect PLC injury without the actual need for MRI. The injury was assessed with parameters like Superior Inferior End plate Angle (SIEA), Vertebral body Height (VBH), Local Kyphosis (LK), Inter Spinous distance (ISD), and Interpedicular distance (IPD).



1. Zhang J, Ji XR, Peng Y, Li JT, Zhang LH, Tang PF. New classification of lunate fossa fractures of the distal radius. J Orthop Surg Res. 2016 Oct 21;11(1):124.
2. Lin W, Su Y, Lin C, Guo W, Wu J, Wang Y, Zhang S, Liu S, Liu W, Chen L. The application of a three-column internal fixation system with anatomical locking plates on comminuted fractures of the tibial plateau. Int Orthop. 2016 Jul;40(7):1509-14.
3. Firoozabadi R, Schneidkraut J, Beingessner D, Dunbar R, Barei D. Hyperextension Varus Bicondylar Tibial Plateau Fracture Pattern: Diagnosis and Treatment Strategies. J Orthop Trauma. 2016 May;30(5):e152-7.
4. Ramasubbu RA, Ramasubbu BM. Surgical stabilization for open tibial fractures in children: External fixation or elastic stable intramedullary nail – which method is optimal? Indian J Orthop. 2016 Sep;50(5):455-463.
5. Ketz JP, Maceroli M, Shields E, Sanders RW. Peroneal Tendon Instability in Intra-Articular Calcaneus Fractures: A Retrospective Comparative Study and a New Surgical Technique. J Orthop Trauma. 2016 Mar;30(3):e82-7.
6. Williams SK, Quinnan SM. Percutaneous Lumbopelvic Fixation for Reduction and Stabilization of Sacral Fractures With Spinopelvic Dissociation Patterns. J Orthop Trauma. 2016 Sep;30(9):e318-24
7. Rajasekaran S, Maheswaran A, Aiyer SN, Kanna R, Dumpa SR, Shetty AP. Prediction of posterior ligamentous complex injury in thoracolumbar fractures using non-MRI imaging techniques. Int Orthop. 2016 Jun;40(6):1075-81.

How to Cite this article: Gala R, Dhar SB. Orthopaedic Trauma – Relevant articles in 2016. Journal of Clinical Orthopaedics July – Dec 2016; 1(1):36-37.

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