Intramedullary nail fixation versus open reduction and internal fixation for treatment of adult diaphyseal forearm fractures: a systematic review and meta-analysis.

BACKGROUND: Diaphyseal radius and ulna fractures require surgical fixation in adults. Open reduction and internal fixation (ORIF) have been considered the gold standard of treatment. The recent development of an interlocking intramedullary nail (IMN) has provided an alternative treatment method for these fractures. The objective of this meta-analysis is to compare the outcomes and complications of IMN versus ORIF for diaphyseal forearm fractures in adults. METHODS: MEDLINE and Embase were searched from January 1, 2000, through January 7, 2024. All English-language studies were included comparing radiographic and functional outcomes for interlocking IMN fixation and ORIF of diaphyseal forearm fractures in adults (age ≥ 18 years). Study demographics, fracture data, functional outcomes, radiographic outcomes, and complications were extracted. Study quality was determined using the ROBINS-I criteria for cohort studies and the Cochrane risk of bias 2.0 (RoB 2) tool for randomized controlled trials. Meta-analysis of included studies used odds ratios and standardized mean difference when appropriate. Data was analyzed using subgroups of all diaphyseal fractures (including isolated radius or ulna fractures) and those with BBFFs. RESULTS: Nine studies were included for analysis. There were 42 isolated radius, 80 isolated ulna, and 116 both-bone fractures (BBFF) treated with IMN and 36 radius, 81 ulna, and 116 both-bone fractures treated with ORIF. Compared to ORIF, IMN of diaphyseal forearm fractures appeared to be associated with shorter operative times and a lower overall complication rate. Time-to-union and the rate of nonunion following IMN were similar to ORIF. According to the Grace-Eversmann score, functional outcomes tended to be better following IMN, but DASH scores were similar between fixation strategies. CONCLUSIONS: Our findings suggest that interlocking IMN can be a safe and effective treatment option for simple and complex diaphyseal forearm fractures in adults. Further high-quality studies are needed to define indications for treating diaphyseal fractures with an interlocking IMN. LEVEL OF EVIDENCE: Therapeutic Level IV.

Kirschner wire intramedullary fixation combined with improved nice knot-end cerclage temporarily fixation-assisted reduction before plate osteosynthesis in treating displaced and comminuted clavicle fractures.

BACKGROUND AND OBJECTIVE: Nice knots have been used as an assisted reduction technique in surgery for displaced and comminuted fractures. This study aims to investigate the clinical efficacy of Kirschner wire intramedullary fixation combined with improved Nice knot-end cerclage temporarily fixation-assisted reduction before plate osteosynthesis in treating displaced and comminuted clavicle fractures. METHODS: A retrospective study selected 210 patients with comminuted displaced clavicle fractures (January 2017-December 2020) in our hospital. The patients were divided into two groups via the fracture reduction method: the observation group (intramedullary Kirschner's wire fixation combined with modified Nice node-to-end cerclage temporarily fixation-assisted reduction; n = 42) and the control group (including four subgroups with 42 cases in each subgroup, with assisted reduction methods of clamp fixation, screw fixation, square knot fixation and Kirschner wire fixation; each subgroup n = 42). The operation time, intraoperative bleeding, visual analogue scale (VAS) score at 24 h after the operation, healing time, postoperative limb functional activities, patients' self-perception, subjective satisfaction and shoulder joint function were compared. RESULTS: The operation time and the intraoperative blood loss of the observation group was significantly lower than that of each subgroup in the control group (p < 0.05). The VAS score of the observation group 24 h after the operation was significantly lower than that of each subgroup in the control group apart from the screw fixation group (p < 0.05). The Neer score of the observation group was significantly higher than that of each subgroup in the control group apart from the square knot fixation group (p < 0.05). The square knot is relatively better than the other four methods. Patients were generally satisfied with the modified Nice treatment. CONCLUSION: The use of a Kirschner wire intramedullary fixation combined with improved Nice knot-end cerclage temporarily fixation-assisted reduction before plate osteosynthesis in treating displaced and comminuted clavicle fractures can achieve satisfactory postoperative clinical results.

The effect of pin distractor assistance on the reduction of fibular fractures in the treatment of ankle fracture: A retrospective case-control study.

This study will evaluate the therapeutic effect of pin distractor assisted reduction of fibular fracture on ankle fracture. A retrospective analysis was performed on 98 patients diagnosed as ankle fracture or pilon fracture. These patients were all combined with fibular fracture. Retrospective analysis included 48 patients in the experimental group (distractor assisted reduction) and 48 patients in the control group (without pin distractor). The statistical indexes include: the time spent in fracture reduction and fixation, the length of surgical incision, the operative blood loss of fracture operation, the incidence of incision skin necrosis, the incidence of fracture end splitting during reduction, the quality of fracture reduction, the time of fracture healing, infection rate, and The American Orthopedic Foot and Ankle Society score at the last follow-up. There were statistical differences between the 2 groups in the time spent in the reduction and fixation of fractures, the incidence of fracture end splitting during reduction, the quality of anatomical reduction of fractures, and the healing time of fractures. The experimental group was better than the control group. In addition, for patients with long spiral fracture, comminuted fracture, osteoporotic fracture and preoperative delay time for operation more than 2 weeks, the time spent in the reduction and fixation of fracture, the operative blood loss of fracture operation, the incidence of fracture end splitting during reduction, the quality of anatomical reduction of fracture, and the healing time of fracture in the experimental group are also better than those in the control group. The pin distractor assisted reduction of fibular fracture has the advantages of simple operation, less trauma, short operation time, less operative blood loss, and fewer complications. It is especially suitable for patients with long spiral fibular fracture, comminuted fracture, osteoporotic fracture, and long preoperative delay time in ankle fracture.

Simultaneous clavicular hook plate fixation in bilateral distal clavicle fractures (Neer type II): A case report.

RATIONALE: Bilateral distal clavicle fractures (BDCF) are exceedingly rare types of fractures. This study aimed to evaluate the surgical treatment under a single anesthesia for trauma-induced BDCF (Neer type II) through a case report. PATIENT CONCERNS: The patient brought to the emergency department due to a motor vehicle accident exhibited severe pain, tenderness, swelling, and deformity in both shoulder regions upon physical examination. No significant pain or tenderness was detected in other areas of the body. There were also no signs of additional neurological deficits or vascular pathology in the extremities. DIAGNOSES: Radiographic examinations led to a diagnosis of BDCF (Neer type II). INTERVENTIONS: Surgical intervention involved the simultaneous application of a neutral-angled hook plate to both clavicles via open reduction. OUTCOMES: Postoperative radiographs taken at the 12th week demonstrated complete healing in both fractures and no functional limitations in shoulder movements. LESSONS: BDCF can compromise the stability of the shoulder girdle, necessitating surgical intervention with anatomical reduction and rigid fixation.

Trans-Achilles percutaneous fixation technique for posterior malleolus fracture: a cadaveric study.

BACKGROUND: It has been reported that 43.6% of ankle fractures are accompanied by posterior malleolus fractures. The aim of this study is to define a safe zone for posterior malleolus fractures by determining the locations of the important anatomical structures in this region. Additionally, it aims to identify the trans-Achilles passage line for Kirschner wire insertion through a posteroanterior approach for posterior malleolus fragments. METHODS: Six below-knee amputee fresh-frozen leg cadavers were used in this study. A trans-Achilles Kirschner wire was applied to the cadavers in the posteroanterior direction under the guidance of fluoroscopy. The areas where the Kirschner wire passed were dissected, and their proximity to vital anatomical structures was measured. RESULTS: In all cadavers, the transverse thickness of the Achilles tendon at the level of the trans-Achilles Kirschner wire was 15.5 mm and the trans-Achilles Kirschner wire application was 18.6 mm from the sural nerve, 16 mm from the posterior tibial tendon, and 12.16 mm from the flexor digitorum longus muscle. It was performed 15.16 and 14.6 mm from the posterior tibial artery and vein, 12.3 mm from the tibial nerve, 13.6 mm from the tibiofibular joint, and 55.5 mm from the insertion site of the Achilles tendon to the calcaneus and at a sufficient distance from vital anatomical structures. CONCLUSIONS: The proposed trans-Achilles percutaneous surgical technique is safe from neurovascular structures for fixing posterior malleolar fractures. However, the long-term clinical outcomes of this technique need to be explored. LEVEL OF EVIDENCE: Level III, A cadaveric study.

Application of Ortho-Bridge System after Femoral Bone Transport.

The bone transport technique uses the principle of distraction-osteogenesis and fill bone defects with the aid of an external fixator. In order to evaluate the clinical effect of femoral internal fixation with Ortho-Bridge System after bone transport, 4 patients after femoral bone transport from October 2020 to October 2022 are studied in this paper. Among them, 3 patients ran refracture of femur after removal of the Limb reconstruction system, 1 patient just finish femoral bone transport and request internal fixation. The surgery results show that Ortho-Bridge System can be used in the situation that conventional Locking compression plate and intramedullary nail are not suitable due to anatomical variation after femoral bone transport. Key words: femoral fracture; Ortho-Bridge System; bone transport; postoperative complications of bone transport.

Results of Subtrochanteric Femoral Fractures Fixation by Proximal Femoral Locking Compression Plate.

The treatments of subtrochanteric femoral fractures are a challenge. It accounts about 10.0% to 34.0% of all hip fractures with a high complication rate. This area consists of mostly cortical bone with high stress generation thus heal slowly. The fracture is too proximal to adequately control with implants for femoral shaft and too distal to control with implants for intertrochanteric fractures. The intrinsic insecurity of this fracture and forces of the muscles with comminuted medial calcar is giving the fracture a tendency to varus crumple. Extramedullary implants are associated with higher rate of implant failure while intramedullary nails are not suitable for short proximal segment and wide medullary canal. Recently proximal femoral locking compression plate (PF-LCP) has been applied in treatment of proximal femur including subtrochanteric fractures. It has an excellent result in respect of union, fewer complications and early rehabilitation. The aim of this study was to assess the rate and time taken for union of fractures by PF-LCP and determine perioperative parameters. This prospective study was conducted from March 2019 to September 2020 at Mymensingh Medical College Hospital through non randomized purposive sampling. Total 25 patients aged above 18 years irrespective of sex with closed subtrochanteric fracture were included but pathological fractures, multiple injuries were excluded from the study. Union status evaluated by Radiographic Union Score for Tibial (RUST) fracture of Whelan; where antero-posterior and lateral radiographs (X-ray) based assessment of healing of the four cortices done. The entity cortical scores were added to give an entire score; 4 being the least amount demonstrating fracture are positively not healed and 12 being the highest score representing that the fracture is positively healed. The mean age of the patients was 42.04±14.97 years with range 22-70 years. Majority of patients were male (60.0%) and most of injury (64.0%) due to road traffic accident with most fractures was Seinsheimer type III (48.0%). Average operative time was 121.92 minutes, follow up period was 41.12 weeks (24-48 weeks) and time taken for union was 14.16 weeks (11-28 weeks). According to RUST scores; fracture union rate 88.0% with delayed union 12.0% and no nonunion. There were two patients with superficial wound infection and no implant failure. This study concludes that PF-LCP is a safe and reliable implant for the treatment of subtrochanteric femoral fractures.

Biomechanical Study on the Comparison of Synthetic Materials for Cranio-Orbital Fracture Repair.

OBJECTIVE: For analyzing the mechanical properties of 2 cranio-orbital repair materials under distinct external impacts by finite element analysis and evaluating the stability of various repair materials. METHODS: Based on the computed tomography images of the patients with cranio-orbital fractures, three-dimensional models of the normal craniomaxillofacial models were established by segmenting them with Mimics 19.0, Geomagic Studio 12.0, and UG 12.0, respectively, to build the finite element models of titanium repair fixation and the poly-ether-ether-ketone repair fixation. The models were then simulated by Ansys 19.2, with divergent impact forces to analyze the stresses and displacements of the repair materials, as well as the internal fixation system, and to make a comparison on the stability of the distinct repair materials. RESULTS: The titanium mesh is stable at impact forces ≤1500 N. Furthermore, the poly-ether-ether-ketone mesh and the internal fixation system are resistant to fracture and displacement at impact forces of up to 3000 N. CONCLUSION: By simulating distinct mechanical environments, the biomechanical finite element analysis method can digitally assess the mechanical properties of cranio-orbital repair materials and objectively evaluate the stability of the repair materials and the internal fixation system.

Fixing Cho Type IIC Distal Clavicle Fractures with Hook Plates Leads to a High Incidence of Subacromial Osteolysis: A Retrospective Study and Literature Review.

Background: This retrospective study investigates the complications, particularly subacromial osteolysis (SAO), associated with hook plate (HP) fixation, in the treatment of unstable distal clavicle fractures characterized by complete coracoclavicular (CC) ligament rupture. The decision-making process for employing HP in fractures of this nature, such as Neer types IIB and V and Cho classification IIC, involves considerations of distal fragment size and displacement. While HP offers advantages in clinical practice, it is not without complications, with SAO being a notable concern. Factors such as non-anatomic hook tip placement and fracture classification may influence the risk of SAO. Methods: The study comprises a retrospective analysis of unstable distal clavicle fractures treated with HP at our institution from 2019 to 2022. Exclusions include non-displaced fractures, those treated with other locking plates, and pathologic fractures. A total of 91 patients with displaced distal clavicle fractures underwent open reduction and internal fixation with HP. Cho classification was employed to differentiate cases with CC ligament rupture. Patient demographics, classifications, postoperative radiographs, distal fragment size, plate position, timing of implant removal, and complications, including SAO, were recorded. Results: Among the 91 patients, 32 were classified as Cho IIB, 43 as Cho IIC, and 16 as Cho IID. Ninety-one percent exhibited solid union before implant removal. The prevalence of SAO was 43.8%, 76.7%, and 62.5% in Cho IIB, IIC, and IID, respectively. Univariate analysis revealed a significant difference only in Cho classification (p = 0.014). Binary logistic regression identified Cho classification type IIC as the sole risk factor for SAO (p = 0.021; odds ratio, 4.48; 95% confidence interval, 1.56-12.87). Conclusions: Cho type IIC fractures, characterized by CC ligament deficiency causing horizontal instability, demonstrated the highest SAO rate. In contrast, Neer type IIB fractures retained the trapezoid ligament, and Neer type V fractures had intact CC ligaments, resulting in lower SAO rates. Biomechanically, combining HPs with CC ligament reconstruction provided better structural stability than using HPs alone in treating Cho type IIC fractures.

Biomechanical Evaluation of Suture Augmentation of Dorsal Locking Plate Fixation in Transverse Patella Fractures.

INTRODUCTION: Adjunctive suture augmentation of patellar plate fixation has yet to be investigated. Our biomechanical study sought to evaluate whether suture augmentation improves dorsal patellar locking plate fixation. Our hypothesis was that suture augmentation would improve fixation of this construct. METHODS: A transverse patella fracture in six matched cadaveric pairs was stabilized using a patellar locking plate with or without suture augmentation. Specimens were tested at 60° knee flexion with load placed through quadriceps. Cyclic loading followed by load to failure was done. Stiffness, deformation at peak, and nonrecoverable deformation were calculated. RESULTS: During cyclic loading, suture augmentation demonstrated a higher average stiffness throughout all loads. At the final cycle, deformation was markedly higher without suture augmentation. Average load to failure was higher with suture augmentation. Maximum load to failure occurred at 2500 N in both groups. CONCLUSION: Suture augmentation in a transverse patellar fracture model improved dorsal plate fixation, leading to less fracture displacement at the final load. Although suture augmentation demonstrated higher stiffness and lower deformation, these trends were not statistically significant. In both groups, plate fixation sustained very high loads, which reflects the fixation strength of the dorsal locking plate and screw construct in this fracture model.

Comparative analysis of two double-plate fixation techniques for intercondylar fractures of the distal humerus.

This study was aimed to compare the clinical and radiographic outcomes of patients with intercondylar fractures of the humerus treated with orthogonal and parallel plating methods via precontoured plates. This was a retrospective comparative study conducted on 50 adult patients with intercondylar humerus fractures that were surgically treated over an eleven-year period. The patients were divided into two groups: Group A underwent internal fixation via parallel plating, whereas Group B received orthogonal plating. Clinical outcomes were evaluated via the Mayo Elbow Performance Score (MEPS), and the radiographic assessments included time to consolidation, pseudoarthrosis, malunion and hardware removal. Both groups presented similar demographic and preoperative characteristics. The functional outcomes assessed by the MEPS were not significantly different between the groups. Radiographically, comparable healing times and rates of complications, including pseudoarthrosis, malunion and hardware removal, were observed. The study findings suggest that both orthogonal and parallel plating methods yield comparable clinical and radiographic outcomes in the treatment of intercondylar humerus fractures. These results underscore the effectiveness of both techniques and emphasize the importance of further research to elucidate the optimal plating method for specific fracture patterns.

Evaluation of functional outcome using dual plating in treatment of intraarticular distal humerus fractures in adults.

Of all the humerus fractures in adults, 30% are of the distal end of the bone. The dual plate is strong biomechanically. The current study was conducted at Al-Yarmouk Teaching Hospital, Baghdad, Iraq, between July 1, 2019 to July 1, 2021 to study the role of dual plating in intra-articular distal humerus fractures. Included were 20 adult patients, all with intra articular fracture of the distal humerus and treated and evaluated by open reduction and internal fixation technique using dual locking plating. Clinically the final results were assessed using the Mayo Elbow Performance Score (MEPS). The final results were observed to be excellent in 12 (60 %), good in 6 (30%), fair in 2 (10 %) patients, with no poor results recorded. One patient had transient ulnar neuropraxia which recovered spontaneously after six weeks and one patient developed superficial skin infection which responded to antibiotic treatment. The mean of MEPS was significantly higher after six months and one year than that after two weeks, two months, and four months of operation.

Minimally Invasive Pelvic and Acetabular Surgery: Case Report of a Robot-Assisted Osteosynthesis of an Open-Book Injury of the Pelvic Ring.

BACKGROUND: In recent years, endoscopic treatment of pelvic ring injuries has emerged. In addition to the complex 3D anatomy of the bony pelvis, a particular challenge is its embedding in the surrounding soft tissue structures. It is known from other surgical specialties that the preparation can be facilitated by using surgical robot systems. MATERIALS AND METHODS: In a patient with an open-book injury of the pelvic ring, a symphysis plate was performed using the DaVinci system. RESULTS: We describe the robotic-assisted osteosynthesis on the anterior pelvic ring with available instruments. CONCLUSION: The further development of minimally invasive surgical techniques is always linked to the development of new instruments. For trauma surgery, this means in particular the reduction of dislocated fractures. If appropriate techniques and instruments are developed here, minimally invasive treatment of injuries to the pelvic ring or acetabulum may represent an alternative to open procedures in the future.

A clinical study on the effect of axillary approach in the treatment of Ideberg type II scapular glenoid fractures.

BACKGROUND: Due to its deep position and complex surrounding anatomy, the scapular glenoid fracture was relatively difficult to deal with especially in cases of severe fracture displacement. Improper treatment may lead to failure of internal fixation and poor fracture reduction, severely affecting the function of the shoulder joint. Inferior scapular glenoid fracture was Ideberg type II fracture, and posterior approach was commonly used to deal with inferior scapular glenoid fracture. However, there are shortcomings of above surgical approach for inferior scapular glenoid fracture, such as insufficient exposure of the operative field, significant trauma, and limited screw fixation direction. This study adopts the axillary approach for surgery, which has certain advantages. METHODS: The clinical data of 13 patients with Ideberg type II scapular glenoid fractures treated from December 2018 to January 2024 were retrospectively analyzed. There were 8 males and 5 females, with an age range of 19 to 58 years and an average age of 38 years. The causes of injury were falls from heights in 7 cases and car accidents in 6 cases. There were 5 cases on the left side and 8 cases on the right side. The time from injury to surgery was 2 to 11 days, with an average of 5.5 days. All cases underwent open reduction and internal fixation through the axillary approach. Postoperative X-ray and CT three-dimensional reconstruction were performed on the next day to evaluate the fracture reduction and the position of internal fixation. During the follow-up period, follow-up examinations were performed every two months in the first half of the year and every three months in the second half. CT scans were performed during the examinations to assess the glenohumeral joint congruence, fracture healing, and position of internal fixation. The shoulder joint function was evaluated at 6 months postoperatively according to the Constant-Murley value score. RESULTS: The patients all achieved primary wound healing after surgery, without any complications such as infection or nerve injury. Re-examination on the second day after operation, all fractures obtained excellent reduction, and the internal fixation was in excellent position, and no screw was found to enter the joint cavity. All patients in this group were followed up for 6 to 25 months, with an average follow-up time of 11.7 months. All fractures were bony unioned, and the healing time ranged from 4 to 6 months, with an average healing time of 4.8 months. At 6-month follow-up, according to the Constant-Murley score, 11 cases were excellent and 2 case was good. CONCLUSION: Open reduction and internal fixation through the axillary approach is an feasible and safe surgical method for the treatment in scapular Ideberg type II glenoid fractures with less stripping of soft tissue, minimal surgical trauma, and the incision is concealed and beautiful. It can provide a strong internal fixation for fractures, so patients can perform functional exercise early after operation, and the clinical results is satisfactory.

Biomechanical Analysis of a Modified Triangular Osteosynthesis Technique for Treatment of Spinopelvic Dissociation.

OBJECTIVES: The purpose of this study was to evaluate the biomechanical stability of a modified triangular osteosynthesis construct with S1 pedicle screws compared with other described lumbopelvic fixation constructs in a U-type sacral fracture model. METHODS: U-type sacral fractures were created in validated fourth-generation spinopelvic models. Four different constructs were cyclically loaded with displacement measured in all planes: (1) bilateral L5 pedicle screws with rods attached to iliac bolts, (2) bilateral L5 and S1 pedicle screws with rods attached to iliac bolts, (3) bilateral L5 pedicle screws with rods attached to iliac bolts with a transsacral-transiliac screw, and (4) bilateral L5 and S1 pedicle screws with rods attached to iliac bolts with a transsacral-transiliac screw. RESULTS: The bilateral L5 and S1 pedicle screws with rods attached to iliac bolts with a transsacral-transiliac screw construct had significantly decreased horizontal, vertical, and angular displacement compared with all other constructs. CONCLUSIONS: From a biomechanical perspective, a modified triangular osteosynthesis construct with S1 pedicle screws improves stability in fixation of U-type sacral fractures.

Outcome of flexible fixation for acute isolated syndesmotic injuries.

BACKGROUND: Management of syndesmotic injuries with screw fixation has potential disadvantages, which may lead to the loss of some of the ankle functions. The use of the suture-button system instead can overcome these disadvantages. PATIENTS AND METHODS: In a prospective study, 32 patients with acute isolated syndesmotic injuries were treated with a suture-button device. Follow-up was for a minimum of 2 years, regarding the Visual Analogue Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, patient satisfaction at 3, 12, and 24 months, and radiological assessment. RESULT: A significant improvement regarding pain (VAS during rest 5.6 and during walking 6.1 preoperative improved to 0.1 and 0.2 postoperatively, respectively. (P values were < 0.0001 for both pain during rest and walking) and AOFAS score (improved significantly from 44 ± 7.5 pre- to 99 ± 8.7 points postoperatively (P value was 0.0034). The improved VAS and AOFAS scores of the repaired ankles gradually reached the values of the contralateral uninjured ankle (evaluated at 3,12, and 24 months, postoperatively). Radiographs and CT of both ankles - repaired and healthy ankles - were similar at the 3 months follow-up. Early full weight-bearing and early return to work and sport characterized all patients. There was no need for hardware removal. CONCLUSION: Suture-button treatment for acute isolated ankle syndesmotic injuries leads to favorable clinical and radiological outcomes. Postoperative radiographs and CT denoted maintained ankle stability. Patients can do early full weight-bearing and early return to work and sport.

[Treatment of Neer IIb distal clavicular fracture with locking plate under arthroscope].

OBJECTIVE: To investigate the feasibility and clinical effect of the treatment of NeerⅡb distal clavicular fracture with locking plate under arthroscopy. METHODS: Between June 2018 and September 2022, the medical records of 15 patients with NeerⅡb distal clavicular fracture treated with locking plate under arthroscope were retrospectively analyzed, including 9 males and 6 females, aged from 25 to 57 years old with an average of (42.50±7.75) years old, 5 left shoulder, 10 right shoulder, and duration of the disease ranged from 4 to 7 days with an average of (5.16±0.98) d. Visual analog score (VAS), Constant-Murley shoulder joint score scale and Neer standard score were used before operation, 1 month after operation and the last follow-up. RESULTS: All patients successfully completed the treatment of NeerⅡb distal clavicular fracture with locking plate under arthroscopy, with the operation time ranging from 0.3 to1.0 h with an average of (0.55±0.24) h. All patients were healed at stageⅠ. The follow-up time ranged from 6 to 15 months with an average of (9.2±2.8) months. The preoperative VAS score was 7.23±0.67, the Constant-Murley shoulder joint score was (19.57±0.91), and the Neer standard score was (11.27±1.12);The VAS score was (1.56±0.81), the Constant-Murley shoulder joint score was (52.62±1.54), and the Neer standard score was (61.98±2.99) in the first month after operation;At the last follow-up, the VAS was (0.42±0.54), the Constant-Murley shoulder joint score was (91.24±1.97), and the Neer standard score was (93.24±3.38). The difference between VAS, Constant-Murley shoulder joint score and Neer standard score was statistically significant at one month postoperative and preoperative (P<0.05), and the difference between the last follow-up visit and one month postoperative was statistically significant (P<0.05). CONCLUSION: The treatment of NeerⅡb distal clavicular fracture with locking plate under arthroscope can restore the function of shoulder joint, with definite curative effect and feasibility.

Application of a posterior anatomical integrated locking compression plate in the treatment of posterior wall acetabular fractures.

BACKGROUND: Traditional fixation methods for posterior wall acetabular fractures (PWAFs) typically require the utilization of multiple plates and intraoperative plate contouring, which are technically demanding and carry the risk of intra-articular screw penetration. A novel posterior anatomical integrated locking compression plate (PAILCP) has been designed to optimize these shortcomings. This study aims to evaluate the feasibility and effectiveness of the PAILCP fixation method for the surgical management of PWAFs. METHODS: A total of 48 patients with PWAFs who were treated surgically in our department between January 2018 and December 2022 were selected for retrospective analysis. The 48 patients were classified into groups A (PAILCP fixation, n = 25) and B (traditional fixation, n = 23) according to different fixation methods. Fracture reduction quality, number of utilized plates, blood loss, surgical time, instrumentation time, hip function, and complications were compared between the two groups. RESULTS: A total of 25 PAILCPs were used in group A, while 34 mini-T plates and 29 reconstruction plates were employed in group B. Compared to the patients in group B, those in group A had significantly shorter instrumentation time (- 16 min) and surgical time (- 23 min) as well as lower blood loss (- 123 ml). However, no significant differences were observed in fracture reduction quality and hip function between the two groups. Additionally, the complication rate was slightly lower in group A (3/25 patients) than in group B (6/23); however, this difference was not statistically significant. Finally, follow-up examination revealed no main plate breakage, miniplate displacement, screw loosening, or intra-articular screw penetration in all patients. CONCLUSION: The surgical treatment of PWAFs using the PAILCP fixation method results in shorter instrumentation and surgical time and lower blood loss than the traditional fixation method. Thus, the PAILCP fixation method is a promising alternative for PWAFs management, offering enhanced surgical ease and safety.

Short term efficacy of subtalar arthroscopy combined with medial calcaneal-talar joint distraction in minimally invasive treatment of diabetic patients with calcaneal fractures: a retrospective study.

BACKGROUND: The surgical treatment and management of postoperative soft tissue complications in diabetic patients with displaced calcaneal fractures are still controversial. We aimed to evaluate the short-term efficacy of percutaneous minimally invasive screw fixation in treatment of diabetic patients with Sanders II and III calcaneal fractures under subtalar arthroscopy assisted by preoperative musculoskeletal ultrasonic locating lateral calcaneal branch (LCB) of the sural nerve and calcaneal-talar joint distraction device. METHODS: The clinical data of 52 diabetic patients diagnosed with Sanders II or III calcaneal fractures from March 2016 to August 2020 were followed up and analyzed. There were 23 patients of type II and 29 patients of type III, 34 males and 18 females, with a mean age of 61.7 ± 14.5 years (range: 45-72 years). Preoperative musculoskeletal ultrasonography was routinely examined to locate LCB of the sural nerve. During surgery, we performed arthroscopic percutaneous prying reduction screw fixation assisted by medial calcaneal-talar joint distraction. Incision healing, local skin paraesthesia and other conditions were observed regularly at 3 days, 6, 12 months, and the last follow-up after surgery. Also, we measured the length, width, height, Böhler angle, and Gissane angle of the calcaneus on lateral and axial x-rays. Visual analogue pain scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) score and Maryland score were used to evaluate the efficacy. RESULTS: 52 patients were followed up for 23.7 ± 3.2 months (range: 20-28 months) without incision-related complications. Calcaneal radiographic parameters (length, width, height, Böhler/Gissane angle) were improved after surgery, and the differences were all statistically significant (P<0.05). There was no difference between calcaneal radiographic parameters at 6,12 months and the last follow-up compared with 3 days after surgery without significant loss in overall morphology (P>0.05). Postoperative VAS, AOFAS scores, and Maryland scores were significantly improved compared with those before surgery (P<0.05). CONCLUSIONS: Preoperative ultrasonic locating LCB of the sural nerve and arthroscopic percutaneous minimally invasive screw fixation of Sanders II and III calcaneal fractures with the assistance of calcaneal-talar joint distraction have good short-term efficacy and clinical feasibility in diabetic patients.

Use of a newly developed minimally invasive bilateral fixed angle locking system in the treatment of pathological pelvic fractures: a case series.

BACKGROUND: Metastatic bone disease (MBD) and its complications have a significant impact on patients' quality of life. Pathological fractures are a particular problem as they affect patient mobility and pose a high risk of non-union. The pelvis is frequently affected by MBD and its fixation is challenging. We present a case series of three pathological sacral fractures treated with a new minimally invasive bilateral fixed angle locking system. CASE PRESENTATION: Case 1 and 2 suffered a pathological transforaminal sacral fracture without adequate trauma in stage 4 carcinomas (gastric cancer and breast cancer). Both were initially treated with non-surgical treatment, which had only a limited effect and led to imminent immobility. Both were operated on with fluoroscopic navigation and underwent transsacral SACRONAIL® stabilisation according to CT morphology (S1 + S2 and S1 respectively). Immediately after the operation, pain decreased and mobilisation improved. Case 3 had a pathological transalar sacral fracture during the 2nd cycle of chemotherapy due to non-Hodgkin's lymphoma. He soon became immobile and could only move in a wheelchair. The operation was performed with CT navigation due to the very small corridors and an implant was inserted in S1 and S2. The patient reported immediate pain relief and his ability to walk improved over the following months. Despite continued chemotherapy, no wound complications occurred. CONCLUSIONS: The cases show the advantages of the minimally invasive bilateral fixed angle locking system SACRONAIL® in the treatment of patients with pathological sacral fractures. It allows immediate full weight bearing and the risk of secondary surgical complications is low. All cases showed an improvement in pain scores and mobility.