Efficacy of Femoral Neck System Fixation vs KHS Femoral Neck Dynamic Compression Locking Plate System in Femoral Neck Fracture.

Background: Femoral neck fracture is acknowledged as one of the common injuries in clinical orthopedics. Our study was aimed at investigating the efficacy of femoral neck fixation vs the KHS dynamic compression locking plate system in the treatment of femoral neck fracture. Methods: This was a prospective study. A toteal of 90 patients with femoral neck fracture who were admitted to The Third Hospital of Hebei Medical University in Shijiazhuang, China from August 2017 to March 2020 were enrolled in our study. The patients were randomly divided into the control group (45 patients allocated to intervention with the novel femoral neck dynamic compression locking plate system) and the study group (45 patients who underwent femoral neck system fixation). Intraoperative blood loss, surgery duration, fracture healing time and related complications in the 2 groups were monitored and evaluated. The recovery of hip joint function at different times in the 2 groups were closely monitored. Results: The 2 groups completed the surgery process, and the incision healed. All patients were followed up for 6 to 8 months, with an average follow-up time of 7.01 ± 0.21 months. Surgery duration, length of hospital stay and fracture healing time in the study group were significantly lower than in the control group (P < .05), while no significant difference was found in intraoperative blood loss between the 2 groups (P > .05). At 1 and 3 months after surgery, hip joint function in the study group was significantly higher than in the control group (P < .05), but 6 months after surgery, there was no significant difference between the 2 groups (P > .05). There were no complications in the study group, whereas 1 patient had a complication in the control group. The total incidence of complications in the study group was lower than in the control group, but the difference was not significant (P > .05). Conclusion: Femoral neck system fixation demonstrated superior efficacy to the KHS femoral neck dynamic compression locking plate system in femoral neck fracture, and is considered as a valid method for wide application.

Comparative study of Pauwels type III femoral neck fractures managed by short dynamic hip screw with fibula bone graft or cannulated screws in young adults.

BACKGROUND: The aim of our study was to compare the clinical effect of short dynamic hip screw (DHS) combined with fibula bone graft and short DHS combined with cannulated screws (CS) on the treatment of femoral neck fracture in young adults. METHODS: Thirty-five Pauwels type III femoral neck fracture patients between January 2014 and May 2019 were divided into two groups: group A (patients treated with DHS combined with fibula bone graft) and group B (patient treated with DHS combined with CS). The operative time, intraoperative blood loss, fracture healing time and complication of two groups were recorded. RESULTS: There were no significant differences in operative time, intraoperative blood loss in two groups. Fracture healing time in group A (5.28±1.07) was significantly shorter than group B (7.31±1.65). The rate of fracture nonunion (0), femoral head necrosis (0) and withdrawal rate (0) in group A were significantly lower than that in group B (4, 23.5) (4, 23.5) (6, 35.3) (P<0.01). Postoperative Harris function score in group A (95.44±2.57) was higher than group B (87.82±7.79) (P<0.01). CONCLUSIONS: DHS combined with fibula bone graft can shorten the healing time of fracture, reduce the rate of bone nonunion and femoral head necrosis, and provide a new treatment method for Pauwels type III femoral neck fracture in young adults.

Step-advanced rectangular flap: A novel technique for the reconstruction of soft-tissue defects overlying the Achilles tendon in children (an observational study).

Soft-tissue defects overlying the Achilles tendon are common complications after bicycle or motorcycle spoke injuries in children and usually require surgical management by various flaps. There is no apparent consensus on the optimal choice of flaps for these injuries. We designed a novel step-advanced rectangular flap to reconstruct small to moderate soft-tissue defects around the Achilles tendon. This study was performed to review our experience and evaluate the clinical effectiveness of the step-advanced rectangular flap.From May, 2014 to September, 2016, 12 consecutive children with soft-tissue defects overlying the Achilles tendon caused by spoke injuries were treated with the step-advanced rectangular flap. The patients' general information, surgical details, and postoperative complications were recorded. The Mazur evaluation system was used to assess clinical outcomes.All patients were followed up for ≥12 months (range 12-38 months). All flaps survived completely. Superficial infection occurred in 2 patients and healed by second intention after dressing changes; the other patients' surgical wounds healed by primary intention. The scars around the flaps in 2 patients were remarkable, and all others showed good results in terms of flap color and texture. Ankle function was normal, and satisfactory results were obtained in all cases. According to the Mazur evaluation system, the results were excellent in 9 patients and good in 3, with an excellent and good rate of 100% at 12 months postoperatively.The rectangular advancement flap appears to be a simple and reliable method for small to moderate soft tissue defects overlying the Achilles tendon in children.

Balloon kyphoplasty versus percutaneous vertebroplasty for osteoporotic vertebral compression fracture: a meta-analysis and systematic review.

BACKGROUND: This meta-analysis was aimed to explore the overall safety and efficacy of balloon kyphoplasty versus percutaneous vertebroplasty for osteoporotic vertebral compression fracture (OVCF) based on qualified studies. METHODS: By searching multiple databases and sources, including PubMed, Cochrane, and Embase by the index words updated to January 2018, qualified studies were identified and relevant literature sources were also searched. The qualified studies included randomized controlled trials, prospective or retrospective comparative studies, and cohort studies. The meta-analysis was performed including mean difference (MD) or relative risk (RR) and 95% confidence interval (95% CI) to analyze the main outcomes. RESULTS: A total of 16 studies were included in the meta-analysis to explore the safety and efficacy of kyphoplasty versus vertebroplasty for the treatment of OVCF. The results indicated that kyphoplasty significantly decreased the kyphotic wedge angle (SMD, 0.98; 95% CI 0.40-1.57), increased the postoperative vertebral body height (SMD, - 1.27; 95% CI - 1.86 to - 0.67), and decreased the risk of cement leakage (RR, 0.62; 95% CI 0.47-0.80) in comparison with vertebroplasty. However, there was no statistical difference in visual analog scale (VAS) scores (WMD, 0.04; 95% CI - 0.28-0.36) and Oswestry Disability Index (ODI) scores (WMD, - 1.30; 95% CI - 3.34-0.74) between the two groups. CONCLUSIONS: Kyphoplasty contributes especially to decreasing the mean difference of kyphotic wedge angle and risk of cement leakage and increasing the vertebral body height when compared with vertebroplasty. But radiographic differences did not significantly influence the clinical results (no significant difference was observed in VAS scores and ODI scores between the two groups); thus, kyphoplasty and vertebroplasty are equally effective in the clinical outcomes of OVCF. In addition, more high-quality multi-center RCTs with a larger sample size and longer follow-up are warranted to confirm the current findings.

Primary iliopsoas abscess combined with rapid development of septic shock: Three case reports.

RATIONALE: Primary iliopsoas abscess (IPA), an uncommon clinical entity, often has no specific clinical features, and advanced imaging techniques are often required for diagnosis. PATIENT CONCERNS: We successfully treated 3 patients with primary IPA complicated by rapid development of septic shock within 2 months. DIAGNOSIS: All patients were in shock at the time of admission and were diagnosed with primary IPA by history, clinical examination and imaging findings. INTERVENTIONS: All patients were treated by surgical drainage and sensitive antibiotics based on culture results. OUTCOMES: The patients eventually recovered and were discharged within 2 months. LESSONS: An IPA may not be diagnosed in a timely manner because it has no specific symptoms or signs. Therefore, special attention must be given to patients with sudden onset of abdominal pain, hip pain, or high fever without an obvious cause, a primary IPA should be highly suspected in such patients.

Percutaneous Repair Technique for Acute Achilles Tendon Rupture with Assistance of Kirschner Wire.

The aim of this study is to introduce a self-designed, minimally invasive technique for repairing an acute Achilles tendon rupture percutaneously. Comparing with the traditional open repair, the new technique provides obvious advantages of minimized operation-related lesions, fewer wound complications as well as a higher healing rate. However, a percutaneous technique without direct vision may be criticized by its insufficient anastomosis of Achilles tendon and may also lead to the lengthening of the Achilles tendon and a reduction in the strength of the gastrocnemius. To address the potential problems, we have improved our technique using a percutaneous Kirschner wire leverage process before suturing, which can effectively recover the length of the Achilles tendon and ensure the broken ends are in tight contact. With this improvement in technique, we have great confidence that it will become the treatment of choice for acute Achilles tendon ruptures.