Comparison of a minimally invasive osteosynthesis technique with conventional open surgery for transverse patellar fractures.

PURPOSE: The study aims to compare the efficacy and safety of a new minimally invasive osteosynthesis technique with those of conventional open surgery for transverse patellar fractures. METHODS: It was a retrospective study. Adult patients with closed transverse patellar fracture were included, and with open comminuted patellar fracture were excluded. These patients were divided into minimally invasive osteosynthesis technique (MIOT) group and open reduction and internal fixation (ORIF) group. Surgical time, frequency of intraoperative fluoroscopy, visual analogue scale score, flexion, extension, Lysholm knee score, infection, malreduction, implant migration and implant irritation in two groups were recorded and compared. Statistical analysis was performed by the SPSS software package (version 19). A p < 0.05 indicated statistical significance. RESULTS: A total of 55 patients with transverse patellar fractures enrolled in this study, the minimally invasive technique was performed in 27 cases, and open reduction was performed in 28 cases. The surgical time in the ORIF group was shorter than that in the MIOT group (p = 0.033). The visual analogue scale scores in the MIOT group were significantly lower than those in the ORIF group only in the first month after surgery (p = 0.015). Flexion was restored faster in the MIOT group than that in the ORIF group at one month (p = 0.001) and three months (p = 0.015). Extension was recovered faster in the MIOT group than that in the ORIF group at one month (p = 0.031) and three months (p = 0.023). The recorded Lysholm knee scores in the MIOT group were always greater than those in the ORIF group. Complications, such as infection, malreduction, implant migration, and implant irritation, occurred more frequently in the ORIF group. CONCLUSION: Compared with the ORIF group, the MIOT group reduced postoperative pain and had less complications and better exercise rehabilitation. Although it requires a long operation time, MIOT may be a wise choice for transverse patellar fractures.

Patellar tendon autograft versus patellar tendon allograft in anterior cruciate ligament reconstruction: a systematic review and meta-analysis.

OBJECTIVE: This review aims to compare the clinical results of bone-patellar tendon-bone (BPTB) autograft and BPTB allograft in primary anterior cruciate ligament (ACL) reconstruction. METHODS: PubMed Medline, EMBASE, and the Cochrane Library were systematically searched for prospective or retrospective cohort studies that compared BPTB autograft with BPTB allograft in ACL reconstruction. The results of the eligible studies were independently extracted and analyzed according to the following: one-leg test, range of motion (ROM), overall International Knee Documentation Committee (IKDC), Lachman test, pivot shift test, Lysholm scores, Tegner scores, KT-1000 test, anterior knee pain, crepitus, and clinical failure. Random-effect and fixed-effect models were adopted to calculate the weight mean difference and the odds ratio for continuous and dichotomous variables with 95% confidence interval. RESULTS: Thirteen studies met the inclusion criteria, resulting in 1,046 (484 autografts and 562 allografts) patients available for the present study. A meta-analysis showed no significant differences between the two treatment groups in terms of the following: one-leg test (p = 0.21), ROM (p = 0.41), overall IKDC (p = 0.25), Lysholm scores (p = 0.25), Tegner scores (p = 0.09), KT-1000 (p = 0.69), Lachman test (p = 0.89), positive pivot shift test (p = 0.18), anterior knee pain (p = 0.93), and crepitus (p = 0.96). However, a significant difference in clinical failure (p = 0.01) in favor of autograft was observed. In the fresh-frozen subgroup, no difference in the evaluations, except for Tegner scores, were found between autograft and allograft. CONCLUSIONS: Therefore, BPTB autograft shows potential as an optimal choice for ACL reconstruction on the basis of earlier functional recovery and fewer graft failure.

Comparison operative and conservative management for primary patellar dislocation: an up-to-date meta-analysis.

PURPOSE: The aim of this review was to compare the clinical outcomes between operative and conservative management for primary patella dislocation (PPD). METHODS: PubMed Medline, EMBASE, Google scholar, and the Cochrane Library were systematically searched for randomized controlled trials that compared operative technique versus conservative technique for PPD. The results of eligible studies were independently extracted and analyzed according to the following: patient's satisfaction, Kujala score, Tegner score, and redislocation rate. Random-effect and fixed-effect models were adopted to calculate the weight mean difference and the odds ratio for continuous and dichotomous variables with 95 % confidence interval. RESULTS: Seven studies met the inclusion criteria, resulting in 402 (216 surgery and 186 conservation) patients available for the present study. A meta-analysis showed no significant differences between the two treatment groups in terms of patient's satisfaction and Kujala score. However, significant differences in Tegner score (P < 0.00001) and redislocation rate (P = 0.002) were observed in favor of surgical treatment. In the subgroup analysis, surgical intervention achieved higher (P = 0.002) Kujala score in short term (<5 years), while conservation gained advantage (P = 0.003) in long term (>5 years). There was no significant difference in dislocation rate in long term. CONCLUSIONS: Surgical treatment might provide better clinical results in short term. More persuasive evidence is still needed to proof the effect of surgical management in long time.

[Minimally-invasive internal fixation for mid-lateral 1/3 clavicle fracture with distal clavicular anatomic locking plate].

OBJECTIVE: To investigate clinical effects of minimally-invasive internal fixation for mid-lateral 1/3 clavicle fracture with distal clavicular anatomic locking plate. METHODS: From February 2016 to March 2017, 32 patients with mid-lateral 1/3 clavicle fractures treated by minimally-invasive internal fixation with distal clavicular anatomic locking plate, including 24 males and 8 females with an average of (42.3±12.7) years old (ranged from 22 to 68 years old). According to Robinson classification, 6 patients were type 2A2, 18 patients were type 2B1 and 8 patients were type 2B2. No vessel and nerve injury occurred before operation. The time from injury to operation ranged from 0 to 6 days with an average of (3.1±1.4) days. Length of bilateral clavicule were compared before and after operation to evaluate fracture reduction. Constant score at 6 months after operation was applied to assess recovery of shoulder function. RESULTS: Thirty patients were followed up from 11 to 18 months with an average of (13.3±2.2 ) months. No vessel and nerve injury, implant failure, nonunion or delayed union occurred after operation, and facture wound healed at stage I, the time ranged from 8 to 12 weeks with an average of(10.2±1.1) weeks. Shortened length of clavicle decreased from(11.2±3.6) % before operation to (0.4±0.3)% after operation at 2 days. Ten patients removed internal fixation at 8 months after operation without re-fracture occurred after remove plate. Constant score increased from 23.53±5.21 before operation to 94.30±5.60 after operation at 6 months, and 26 patients got excellent results, and 4 good. Patients were satisfied aesthetic degree of scar and shoulder joint function. CONCLUSIONS: Minimally-invasive internal fixation for mid-lateral 1/3 clavicle fracture with distal clavicular anatomic locking plate, which has advantages of less trauma, rapid recover, less scar, could receive good clinical effects and not effect beauty.

Cotreatment of MSWI Fly Ash and Granulated Lead Smelting Slag Using a Geopolymer System.

Municipal solid waste incineration fly ash (MSWI FA) and granulated lead smelting slag (GLSS) are toxic industrial wastes. In the present study, granulated lead smelting slag (GLSS) was pretreated as a geopolymer precursor through the high-energy ball milling activation process, which could be used as a geopolymeric solidification/stabilization (S/S) reagent for MSWI FA. The S/S process has been estimated through the physical properties and heavy metals leachability of the S/S matrices. The results show that the compressive strength of the geopolymer matrix reaches 15.32 MPa after curing for 28 days under the best parameters, and the physical properties meet the requirement of MU10 grade fly ash brick. In addition, the toxicity characteristic leaching procedure (TCLP) test results show that arsenic and heavy metals are immobilized effectively in the geopolymer matrix, and their concentrations in the leachate are far below the US EPA TCLP limits. The hydration products of the geopolymer binder are characterized by X-ray diffraction and Fourier transform infrared methods. The results show that the geopolymer gel and Friedel's salt are the main hydration products. The S/S mechanism of the arsenic and heavy metals in the geopolymer matrix mainly involves physical encapsulation of the geopolymer gel, geopolymer adsorption and ion exchange of Friedel's salt.

Co-treatment of flotation waste, neutralization sludge, and arsenic-containing gypsum sludge from copper smelting: solidification/stabilization of arsenic and heavy metals with minimal cement clinker.

Flotation waste of copper slag (FWCS), neutralization sludge (NS), and arsenic-containing gypsum sludge (GS), both of which are difficult to dispose of, are major solid wastes produced by the copper smelting. This study focused on the co-treatment of FWCS, NS, and GS for solidification/stabilization of arsenic and heavy metals with minimal cement clinker. Firstly, the preparation parameters of binder composed of FWCS, NS, and cement clinker were optimized to be FWCS dosage of 40%, NS dosage of 10%, cement clinker dosage of 50%, mill time of 1.5 h, and water-to-binder ratio of 0.25. On these conditions, the unconfined compressive strength (UCS) of the binder reached 43.24 MPa after hydration of 28 days. Then, the binder was used to solidify/stabilize the As-containing GS. When the mass ratio of binder-to-GS was 5:5, the UCS of matrix can reach 11.06 MPa after hydration of 28 days, meeting the required UCS level of MU10 brick in China. Moreover, arsenic and other heavy metals in FWCS, NS, and GS were effectively solidified or stabilized. The heavy metal concentrations in leachate were much lower than those in the limits of China standard leaching test (CSLT). Therefore, the matrices were potential to be used as bricks in some constructions. XRD analysis shows that the main hydration products of the matrix were portlandite and calcium silicate hydrate. These hydration products may play a significant role in the stabilization/solidification of arsenic and heavy metals.