Efficacy and safety of volar locking plate versus cast immobilization for distal radius fractures: a systematic review and meta-analysis of randomized controlled trials.

Volar locking plates (VLPs) are increasingly used for distal radius fractures (DRFs), yet their efficacy compared to cast immobilization remains debated. This meta-analysis aimed to compare VLPs versus cast immobilization for DRFs across various follow-up durations. Randomized controlled trials reporting patient-reported functional scores, wrist range of motion (ROM), radiological assessments, and complications were included. Meta-analysis was performed for 6-week, 3-month, 6-month, 12-month, and >12-month follow-ups. Subgroup analysis stratified studies by age group, ≥ 60 years and < 60 years. VLPs showed significantly lower Disabilities of the Arm, Shoulder, and Hand (DASH) scores at 6 weeks (p < 0.001), 3 months (p < 0.001), 12 months (p = 0.012), and > 12 months (p < 0.001), and lower PRWE scores at 6 weeks (p < 0.001), 3 months (p = 0.048), and >12 months (p = 0.032). Wrist ROM favored VLPs at 6 weeks (p < 0.05), with higher flexion and supination at 3 months (p = 0.027) and 12 months (p = 0.003). Radiologically, VLPs showed improved parameters at 3- and 12-month follow-up. Overall complications did not significantly differ. Subgroup analysis in patients < 60 years generally supported these findings, while in patients ≥ 60 years, radiological outcomes aligned, yet only lower DASH scores were observed with VLPs at 3 months (p < 0.001). VLPs may offer superior clinical, functional, and radiological outcomes compared to cast immobilization at 3- and 12-month follow-up for patients < 60 years, with comparable safety profiles. For patients ≥ 60 years, VLPs may yield better radiological outcomes at 3- and 12-month follow-up, though clinical benefits remain uncertain.

The sucker-like end-to-side arterial anastomosis for free flap in extremities reconstruction: a retrospective study of 78 cases.

BACKGROUND: The application of end-to-side (ETS) anastomosis for flap transfer poses challenges, particularly in cases of significant size discrepancy between the donor and flap arteries. Herein, a novel ETS anastomosis technique, termed "sucker-like ETS anastomosis", is developed to mitigate and rectify such vessel discrepancies. This study aims to evaluate the efficacy of this technique in tissue defect reconstruction through free flap transfer. METHODS: Between September 2018 and March 2023, the medical records and follow-up data of 78 patients who underwent free flap transfer using sucker-like ETS anastomosis for significant artery size discrepancies were collected and retrospectively analyzed. RESULTS: Among the 78 cases that received free flap transfer, the range of artery size discrepancy (flap artery vs donor artery) was 1:1.6-1:4 (mean: 1:2.5). Following anastomosis with the sucker-like ETS technique, 75 cases achieved flap survival without requiring additional surgical intervention, yielding a one-stage success rate of 96.2%. Three cases experienced post-operative venous crises, with two cases surviving after vein exploration and one case undergoing flap necrosis, necessitating a secondary skin graft. Seven cases faced delayed wound healing but eventually achieved complete healing following dressing changes. No arterial crisis was observed during hospitalization. With an average follow-up of 13 months, the surviving flaps exhibited excellent vitality without flap necrosis or pigment deposition. Overall, the application of sucker-like ETS arterial anastomosis for flap transfer resulted in a high overall surgical success rate of 98.7% (77/78). CONCLUSION: The application of sucker-like ETS anastomosis for free flap transfer is highly effective, particularly in cases with significant size discrepancy between the recipient and donor arteries.

[Clinical application of nose ring drain in severe diabetic foot infection].

OBJECTIVE: To evaluate the effectiveness of the nose ring drain (NRD) in treatment of severe diabetic foot infection. METHODS: The clinical data of 35 patients with severe diabetic foot infection who were treated with NRD between June 2017 and June 2019 were analyzed retrospectively. There were 24 males and 11 females with an average age of 54.5 years (range, 28-82 years). All of them were type 2 diabetic patients. The diabetes duration was 3-20 years, with an average of 9.4 years. The diabetic foot duration was 4 months to 2 years, with an average of 1.16 years. There were 16 cases of left foot and 19 cases of right foot. According to Wagner's grading, there were 11 cases of grade 2, 20 cases of grade 3, and 4 cases of grade 4, all of which were moderate and severe infection of diabetic foot wound. Postoperative wounds were treated with "nibble-like" debridement until the patient's epidermis regenerated and healed. During the treatment process, the indexes of bacterial culture type of wound secretions, duration of antibiotic therapy, wound healing method, healing time, amputation rate, and other indicators were analyzed and summarized. RESULTS: All 35 patients were followed up 3-6 months, with an average of 4.5 months. Postoperative bacterial culture of wounds showed that 5 cases of Staphylococcus aureus, 4 cases of Pseudomonas aeruginosa, 5 cases of Escherichia coli, 3 cases of Enterobacter cloacae, 3 cases of coagulase-negative Staphylococcus, and 15 cases of other types were detected. The duration of antibiotic therapy ranged from 3 to 15 days, with an average of 9.1 days. The wound was autolytically healed without skin grafting, and the healing time was 62-82 days, with an average of 72.3 days. During the follow-up, 3 cases (8.6%) had amputation due to the patient's poor blood glucose control, which led to a large spread of infection. In addition, among the other patients with wound healing, there was no recurrence of wound infection or new ulcer on the original surface. CONCLUSION: The NRD is a simple operation for treatment of severe diabetic foot infection, which can effectively control wound infections and promote wound healing and regeneration without skin grafting.