Effectiveness of the Lace Method in Osteosynthesis for Hand Fractures in the...

[Full title: Effectiveness of the Lace Method in Osteosynthesis for Hand Fractures in the Kyrgyz Republic]

Asian Journal of Pharmaceutic s • Jul-Sep 2024 • 18 (3) | 956 Effectiveness of the Lace Method in Osteosynthesis for Hand Fractures in the Kyrgyz Republic Sultan Tukeshov 1,2 , Urmat Alybaev 3 , Burulai Emilbekova 3 , Rohini Kaku 4 , Tugolbai Tagaev 5 1 Department of Plastic and Reconstructive Surgery Named after M. A. Mateev, I.K. Akhunbaev Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan, 2 Department of Science, National Surgical Center of the Ministry of Health of the Kyrgyz Republic Named after Academician M.M. Mamakeev, Bishkek, Kyrgyzstan, 3 Department of Science, Green Clinic Medical Center, Bishkek, Kyrgyzstan, 4 Department of General Medicine, I.K. Akhunbaev Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan, 5 Honorary International Faculty, AJ Research Centre, AJ Institute of Medical Sciences and Research Centre, Mangaluru, Karnataka, India Abstract Introduction: Hand fracture management remains complex, with treatment approaches varying based on fracture type, patient characteristics, and healthcare system constraints. Objectives: This retrospective study aimed to determine the effectiveness of the lace method of osteosynthesis in the Kyrgyz Republic and the anesthetic aspects of this method Materials and Methods: Patients aged 3–71 years with confirmed wrist fractures were divided into two groups: Group 1 ( n = 90) underwent cord osteosynthesis, while Group 2 ( n = 34) received standard osteosynthesis treatment. The study compared general and administrative indicators of medical care quality between the groups. Results: Domestic injuries were prevalent in all groups and categories, while work injuries had a more stable distribution. Conductor cells accounted for the majority of anesthesia types in both groups (42.20% in Group 1 and 50.00% in Group 2). Group 1 had a higher percentage of local and general anesthesia, whereas Group 2 had a higher content of conductive anesthesia. The age distribution differed between the groups, with Group 1 primarily composed of children of primary and secondary school age, while Group 2 had a higher proportion of adults aged 18–50 years. Conclusion: The findings suggest differences in the composition of anesthesia used and age distribution between the two groups, which may have implications for treatment outcomes and functional activity. Further research is needed to establish standardized guidelines for hand fracture management and to evaluate the effectiveness of the lace method of osteosynthesis in various patient populations Keywords: Anesthesia, hand fractures, lace method, osteosynthesis, surgical treatment, traumatic injuries Address for correspondence: Sultan Tukeshov, Department of Plastic and Reconstructive Surgery Named after M. A. Mateev, I.K. Akhunbaev Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan. E-mail: sultantukeshovksma@gmail.com Received: 04-08-2024 Revised: 18-09-2024 Accepted: 24-09-2024 INTRODUCTION C urrent hand fracture treatments involve balancing conservative and surgical methods, with surgical techniques specific to the fracture type [1] Thumb fractures, due to their unique anatomy and functional significance, require particular attention, but no universal standards exist [2] Senior surgeons typically opt for non-operative or minimally invasive methods, reserving invasive procedures for complex cases [3] Global practice patterns vary significantly and are influenced by resources, geography, social factors, and surgeon experience [4] In pediatric care, efficient management of simple hand fractures and improved parental education are essential, emphasizing streamlined referrals and multidisciplinary connections [5] Early mobilization post-stabilization is critical for successful treatment; [6] however, a survey of Canadian plastic surgeons revealed inconsistencies, with a preference for immobilization post-splinting [7] ORIGINAL AR TICLE

Tukeshov, et al .: Efficacy of the Lace Method in Osteosynthesis for Hand Fractures Asian Journal of Pharmaceutic s • Jul-Sep 2024 • 18 (3) | 957 Non-operative techniques are generally preferred, but operative fixation may be required in certain cases, with various surgical options available [8] Hand fracture management is complex and is influenced by fracture type, patient characteristics, and healthcare system constraints. Despite a trend toward less invasive methods and early mobilization, inconsistencies remain, underscoring the need for standardized guidelines [7,8] The literature lacks direct evidence for the effectiveness of the lace method in osteosynthesis. The purpose of this study was to determine the effectiveness and anesthetic aspects of the lace method of osteosynthesis in the Kyrgyz Republic MATERIALS AND METHODS This is a retrospective analysis of patient data from the hand microsurgery department of the National Hospital of the Ministry of Health of the Kyrgyz Republic for the period spanning from 2018 to 2023. To be eligible for inclusion in the study, patients had to meet the following criteria: Age between 3 and 71 years (excluding children and older adults with hand fractures that may have unique characteristics), a confirmed clinical and/or radiological diagnosis of wrist fracture, provision of informed consent to participate in the study and receive treatment, and absence of serious complications or concomitant diseases The selected patients were then divided into two groups: Group 1 ( n = 90) comprised patients with a traumatic hand fracture who underwent cord osteosynthesis, and Group 2 ( n = 34) consisted of patients who received standard osteosynthesis treatment. This study compared general and administrative indicators of medical care quality in hospitals between the two groups. This study was conducted in compliance with the principles outlined in the Declaration of Helsinki, 2013, and was approved by the Bioethical Committee of the International Higher School of Medicine (Protocol No. 12, dated May 12, 2022) Statistical analysis, version 11.5 of the Statistical Package for the Social Sciences, was employed. The results are presented as mean ± standard deviation and n (%), and a paired t -test was used to evaluate the variations in treatment and outcomes across the participating sites. The test assumed equal variances for both samples, and the findings indicated statistically significant differences in platelet count, length of therapy, hospitalization duration, and demographic characteristics ( P < 0.05) RESULTS Figure 1 shows the percentage distribution of injuries according to source and category. There are four main categories of injuries: Domestic, industrial, and street injuries. Each category was further divided into three groups. For each injury category, the percentage of cases in each of the three groups (1 st , 2 nd , and 3 rd ) is presented, as well as the number of cases in each of the two categories (3 and 4) From Figure 1, it is evident that the largest percentage of injuries in any category occurred in Group 1. Domestic injuries are prevalent in all groups and categories, whereas work injuries have a more stable distribution between groups than street and other injuries that have a more variable distribution. Given these data, it can be inferred that it is important to pay more attention to the prevention of domestic injuries because they constitute a significant proportion of the total number of traumatic cases. It is also worth focusing on factors that influence workplace injuries to reduce their incidence and improve workplace safety Figure 2 shows the distribution percentages of the different anesthesia types in the samples. The measurements included local, general, conductor, and other types of cells. The results are presented for the two groups: Group 1 and Group 2. In Group 1, conductor cells accounted for the majority (42.20%) of the cells, indicating their significant presence. Local anesthesia was also present (26.60%) and general cells constituted 31.10% of the total anesthesia. Other types of anesthesia comprised only a small portion (4.40%). Group 2 Figure 2: Percentage of anesthesia methods in groups according to the use of the studied methods of surgical treatment Figure 1: Percentage of causes of hand injury in groups according to the use of the studied methods of surgical treatment

Tukeshov, et al .: Efficacy of the Lace Method in Osteosynthesis for Hand Fractures Asian Journal of Pharmaceutic s • Jul-Sep 2024 • 18 (3) | 958 had conductor cells in the largest proportion (50.00%), indicating their dominance in this group. Local cells were the second highest (29.40%), followed by general cells (20.60%). Other types of anesthesia were administered in 5.90% of patients. In general, these results showed differences in the composition of the anesthetic used between the two groups. Group 1 had a higher percentage of local and general anesthesia, whereas Group 2 had a higher percentage of conductive anesthesia. This difference may suggest differences in functional activity or tissue type between the two groups Figure 3 depicts the age distribution of the two distinct groups (Groups 1 and 2) by showing the percentage of individuals falling within five age categories (<10 years, 11–17 years, 18–30 years, 31–50 years, and >50 years). Group 1 consists of the following age groups: The largest proportion of individuals <10 years of age (35.50%), followed by those aged 11–17 years (7.70%), 18–30 years (17.70%), 31–50 years (32.20%), and those over 50 years of age (6.70%). Group 2, on the other hand, had a significantly different age distribution, with a lower proportion of individuals <10 years of age (8.80%), a slightly higher proportion of those aged 11–17 years (5.80%), a higher proportion of 18–30 yearolds (29.40%), a much higher proportion of 31–50 year-olds (38.20%), and a lower proportion of those over 50 years of age (17.60%) The age distribution in Group 1 suggests that it is primarily composed of children of primary and secondary school age as well as middle-aged individuals (31–50 years old), whereas Group 2 appears to be dominated by middle and mature individuals (18–50 years old). This difference in age distribution suggests that the two groups likely represent different demographic segments or have different goals and interests Figure 4 illustrates the time distribution for task completion across four groups (Groups 1, 2, 3, and 4). The time intervals were categorized as <5 days, 6–10 days, and >10 days, with an additional “Other” category for outliers. Group 1:26.60% of tasks were completed <5 days, 73.40% within 6–10 days, and none in >10 days. In addition, 4.40% of the cases fell into the “Other” category. Group 2: No tasks were completed <5 days, 79.40% within 6–10 days, 20.60% in >10 days, and 5.90% fell into the “Other” category. Group 3: Average completion times were 3.5 days for <5 days, 1.8 days for 6–10 days, and 3 days for >10 days. Group 4: Average times were 4.5 days for <5 days, 2.8 days for 6–10 days, and 5 days for >10 days. Most tasks in both groups required 6–10 days, Group 1 had more tasks completed within this range, whereas Group 2 had a higher proportion of tasks that took >10 days. Categories 3 and 4 had similar timescales, indicating that the tasks in these categories generally took less time to complete Table 1 compares the anesthetic scales and wound characteristics between the two study groups: 90 patients in Group 1 and 34 in Group 2. The National Nosocomial Infections Surveillance (NNIS) index, assessing infection risk post-surgery, was significantly lower in Group 1 (0.38 ± 0.067) than in Group 2 (0.74±) ( P = 0.005). The American Society of Anesthesiologists (ASA) scale, which evaluates pre-operative physical status, was also significantly lower in Group 1 (1.41 ± 0.066) than in Group 2 (2.63±) ( P = 0.018). While no significant difference was found in the wound class ( P = 0.5), wound size was significantly smaller in Group 1 (2.01 ± 0.148 mm) than in Group 2 (4.93 ± 0.588 mm) ( P = 0.05). These findings indicate that patients in Group 1 had a lower infection risk, better pre-operative physical condition, and smaller wound sizes, potentially Figure 4: Percentage of hospital bed days in groups according to the use of the studied methods of surgical treatment Figure 3: Percentage of age categories in groups according to the use of the studied methods of surgical treatment Table 1: Comparison of anesthetic scales and wound characteristics in the study groups Characteristics Group 1 ( n =90) Group 2 ( n =34) P 1 NNIS index 0.38±0.067 0.74±0.156 0.005 2 ASA scale 1.41±0.066 2.63±0.148 0.018 3 Wound class 2.0±0.055 0.06±0.103 0.5 4 Wound dimensions in mm 2.01±0.148 4.93±0.588 0.05 NNIS: National Nosocomial Infections Surveillance, ASA: American Society of Anesthesiologists. Values are expressed as mean±standard deviation. * P <0.05

Tukeshov, et al .: Efficacy of the Lace Method in Osteosynthesis for Hand Fractures Asian Journal of Pharmaceutic s • Jul-Sep 2024 • 18 (3) | 959 aiding in pre-operative and post-operative management strategies Table 2 compares the anesthetic scores and wound characteristics between the local ( n = 89) and general anesthesia ( n = 34) techniques. The parameters included the following: No. (number of parameters), parameters (name), local (average for local anesthesia), general (average for general anesthesia), and P (statistical significance). The NNIS index, assessing post-surgery infectious complications, was 0.4 ± 0.072 for local anesthesia and 0.8 ± 0.121 for general anesthesia ( P = 0.005), indicating a significant increase in complications with general anesthesia. The ASA scale, evaluating pre-surgery physical condition, averaged 1.21 ± 0.059 for local anesthesia and 2.06 ± 0.103 for general anesthesia ( P = 0.001), showing a significant increase in physical activity severity with general anesthesia. Wound class and injury severity rating showed no significant difference ( P = 0.19) between the groups. Mean wound dimensions were 3.54 ± 1.412 mm for local anesthesia and 1.7 ± 0.2 mm for general anesthesia, with no significant difference ( P = 0.44) Thus, general anesthesia is associated with a higher severity of infectious complications and physical condition, whereas injury severity and wound size remain similar between anesthesia methods DISCUSSION Alexandre et al . highlighted the necessity of comprehending bone fracture biomechanics and osteosynthesis, along with understanding implants and their mechanical properties, which could be pertinent if the lace method utilizes specific implants or techniques interacting with biomechanical forces [9] Anesthesia during hand fracture surgery is vital for patient comfort, operational efficiency, and post-operative recovery [10] Several studies have examined anesthesia in orthopedic surgery, including the Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique by Ahmad et al . for distal radius fractures, which could be relevant to the lace method in similar contexts [11] Niempoog et al . reported WALANT’s effectiveness of WALANT in clavicular fracture surgery [12] Gojkovic et al . and Lee et al . highlighted the benefits of spinal and regional anesthesia in orthopedic surgery, such as reduced post-operative complications and suitability for elderly patients [13,14] Chorn and Wang et al . discussed the versatile anesthetic management required in orthopedic surgeries, applicable to the lace method, if relevant [15,16] Wakuno et al . described an anesthetic technique for racehorses in long-term orthopedic surgery, indicating broad considerations in orthopedic anesthesia, although not directly applicable to humans [17] Osteosynthesis biomechanics are well understood, although evidence on the efficacy of the lace method is lacking [9] Anesthetic approaches for orthopedic procedures, including WALANT and regional anesthesia, are well established and adaptable to diverse patient and surgical situations [11-17] Our previous retrospective analysis of cord osteosynthesis versus standard osteosynthesis for treating hand bone fractures in the Kyrgyz Republic indicated that cord osteosynthesis may offer better efficacy in treating these types of fractures than the standard approach [18] CONCLUSION Domestic injuries account for a significant proportion of all trauma cases. Preventing workplace injuries is crucial for enhancing overall safety. The first group used more local and general anesthetics, whereas the second group primarily used conduction anesthesia. This variation suggests different functional activities or tissue types between groups. Demographic characteristics categorized the groups, revealing distinct age distributions and interests. Group 1 was assigned more tasks to be completed in 6–10 days, whereas Group 2 managed more projects exceeding 10 days, indicating that Group 1 had more transient markers. The first group exhibited better infection resistance, superior pre-operative physical condition, and a smaller wound size than the second group. These findings may guide the development of new post-operative care protocols ACKNOWLEDGMENT None REFERENCES 1. Boeckstyns ME. Current methods, outcomes and challenges for the treatment of hand fractures. J Hand Surg Eur Vol 2020;45:547-59 2. Bachoura A, Shin EK. Latest techniques in the management of thumb fractures. Curr Orthop Pract 2012;23:305-12 Table 2: Comparison of anesthetic scales and wound characteristics for different anesthesia methods Characteristics Local ( n =89) General ( n =34) P 1. NNIS index 0.4±0.072 0.8±0.121 0.005 2. ASA scale 1.21±0.059 2.06±0.103 0.001 3. Wound class 2.06±0.058 1.91±0.098 0.19 4. Wound dimensions in mm 3.54±1.412 1.7±0.2 0.44 NNIS: National Nosocomial Infections Surveillance, ASA: American Society of Anesthesiologists. Values are expressed as mean±standard deviation. * P <0.05

Tukeshov, et al .: Efficacy of the Lace Method in Osteosynthesis for Hand Fractures Asian Journal of Pharmaceutic s • Jul-Sep 2024 • 18 (3) | 960 3. Tang JB, Blazar PE, Giddins G, Lalonde D, Martínez C, Solomons M. Overview of indications, preferred methods and technical tips for hand fractures from around the world. J Hand Surg Eur Vol 2015;40:88-97 4. Bernstein ML, Chung KC. Hand fractures and their management: An International view. Injury 2006;37:1043-8 5. Lafreniere AS, Baykan A, Hartley R, Ronksley P, Love S, Harrop AR, et al. Healthcare providers and parents highlight challenges of pediatric hand fracture care. Plast Reconstr Surg Glob Open 2023;11:e 4815 6. Unnikrishnan PN, Bhalaik V. (ii) Management of acute fractures of the hand. Curr Orthop 2014;28:205-13 7. Retrouvey H, Morzycki A, Wang AM, Canadian Plastic Surgery Research Collaborative, Binhammer P. Are we over treating hand fractures? Plast Surg (Oakv) 2018;26:148-53 8. Hughes TB Jr., Komatsu I. Hand fractures. DeckerMed Plast Surg 2017. Doi: 10.2310/PS.10081 9. Alexandre N, Simões G, Martinho Lopes A, Guerra Guimarães T, Lopes B, Sousa P, et al . Biomechanical Basis of Bone Fracture and Fracture Osteosynthesis in Small Animals. London: IntechOpen; 2024 10. Hyatt BT, Rhee PC. Wide-awake surgical management of hand fractures: Technical pearls and advanced rehabilitation. Plast Reconstr Surg 2019;143:800-10 11. Ahmad AA, Yi LM, Ahmad AR. Plating of distal radius fracture using the wide-awake anesthesia technique. J Hand Surg Am 2018;43:1045.e 1-5 12. Niempoog S, Tanariyakul Y, Jaroenporn W. Wide-awake local anesthesia for clavicle fracture fixation: A case report. Int J Surg Case Rep 2021;79:112-5 13. Gojkovic M, Maricic-Prijic S, Tatic M. Advantages of spinal anesthesia in orthopedic surgery. Med Pregl 2022;75:199-202 14. Lee EH, Yang HS, Do KJ. Anesthesia for orthopedic surgery in patients older than 80 years. Korean J Anesthesiol 2007;52:537-42 15. Chorn R. Anesthetic considerations in orthopedic emergencies. Semin Anesth Perioper Med Pain 1998;17:121-9 16. Wang X, Zhang H, Xie Z, Zhang Q, Jiang W, Zhang J. The effectiveness of additional thoracic paravertebral block in improving the anesthetic effects of regional anesthesia for proximal humeral fracture surgery in elderly patients: Study protocol for a randomized controlled trial. Trials 2020;21:204 17. Wakuno A, Maeda T, Kodaira K, Kikuchi T, Ohta M. Anesthetic management with sevoflurane combined with alfaxalone-medetomidine constant rate infusion in a Thoroughbred racehorse undergoing a long-time orthopedic surgery. J Equine Sci 2017;28:111-5 18. Tukeshov S, Alybaev U, Emilbekova B, Divity S, Tagaev T. Comparison of cord osteosynthesis versus standard osteosynthesis for treating hand bone fractures in the Kyrgyz republic: A retrospective study. Asian J Pharm 2024;18:540-4 Source of Support: Nil. Conflicts of Interest: None declared.

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Wound characteristics, Surgical treatment, Task completion, Local anesthesia, Informed consent, Statistical analysis, Functional activity, Patient population, Treatment outcome, Retrospective study, Post operative, Age distribution, Spinal anesthesia, General anesthesia, Retrospective Analysis, Patient characteristics, Platelet count, Post-operative care, Infectious complications, Plastic and Reconstructive Surgery, Surgical technique, Traumatic injuries, Infection risk, Significant proportion, Age categories, Hospitalization duration, Post-operative management, American Society of Anesthesiologist, Orthopedic surgery, Regional anesthesia, Surgical method, Post-operative recovery, Anesthetic management, Workplace safety, Osteosynthesis, Anesthesia, Early mobilization, General medicine, Anesthetic method, Surgical option, Demographic characteristic, Injury severity, Hospital bed-day, Department of Science, Middle-aged individuals, National Hospital, Healthcare system constraints, Hand fractures, Work injuries, Domestic injuries, Kyrgyz Republic, Tissue type, Medical care quality, National Nosocomial Infections Surveillance, Infection resistance, Bioethical Committee, Wrist fracture, Distinct groups, Time distribution.