Eliminating rote postoperative radiographs for surgically managed pediatric supracondylar humerus fractures.

BACKGROUND: Use of postoperative radiographs after surgical management of supracondylar humerus (SCH) fractures is often based on rote practice rather than evidence. The purpose of this study was to determine the frequency with which 3-week postoperative radiographs at the time of pin removal altered management plans in pediatric SCH fractures that were intraoperatively stable after closed reduction and percutaneous pinning (CRPP). METHODS: We prospectively recruited pediatric patients with SCH fractures managed by CRPP at our institution from June 2020 until June 2022, and reviewed retrospective data on pediatric SCH fractures managed surgically at our institution between April 2008 and March 2015. Patients were assessed for post-CRPP fracture alignment and stability. For prospective patients, we asked clinicians to document their management decision at the 3-week follow-up visit before evaluating the postoperative radiographs. Our primary outcome was change in management because of radiographic findings. RESULTS: Overall, 1066 patients in the retrospective data and 446 prospectively recruited patients met the inclusion criteria. In the prospective group, radiographic findings altered management for 2 patients (0.4%). One patient had slow callus formation and 1 patient was identified as having cubitus varus. Altered management included prolonged immobilization or additional radiographic follow-up. Radiographic findings altered management in 0 (0%) of 175 type II fractures, in 2 (0.9%) of 221 type III fractures, and in 0 (0%) of 44 type IV fractures. We obtained similar findings from retrospective data. CONCLUSION: Rote use of 3-week postoperative radiographs after surgical management of SCH fractures that are intraoperatively stable has minimal utility. Eliminating rote postoperative radiographs for SCH fractures can decrease the time and financial burdens on families and health care systems without affecting patient outcomes.

Refraining from closed reduction of displaced distal radius fractures in the emergency department-in short: the RECORDED trial.

BACKGROUND: With roughly 45,000 adult patients each year, distal radius fractures are one of the most common fractures in the emergency department. Approximately 60% of all these fractures are displaced and require surgery. The current guidelines advise to perform closed reduction of these fractures awaiting surgery, as it may lead to post-reduction pain relief and release tension of the surrounding neurovascular structures. Recent studies have shown that successful reduction does not warrant conservative treatment, while patients find it painful or even traumatizing. The aim of this study is to determine whether closed reduction can be safely abandoned in these patients. METHODS: In this multicenter randomized clinical trial, we will randomize between closed reduction followed by plaster casting and only plaster casting. Patients aged 18 to 75 years, presenting at the emergency department with a displaced distal radial fracture and requiring surgery according to the attending surgeon, are eligible for inclusion. Primary outcome is pain assessed with daily VAS scores from the visit to the emergency department until surgery. Secondary outcomes are function assessed by PRWHE, length of stay at the emergency department, length of surgery, return to work, patient satisfaction, and complications. A total of 134 patients will be included in this study with follow-up of 1 year. DISCUSSION: If our study shows that patients who did not receive closed reduction experience no significant drawbacks, we might be able to reorganize the initial care for distal radial fractures in the emergency department. If surgery is warranted, the patient can be sent home with a plaster cast to await the call for admission, decreasing the time spend in the emergency room drastically. TRIAL REGISTRATION: This trial was registered on January 27, 2023.

The midterm psychological effect of cast removal procedures in children.

OBJECTIVES: This study aimed to compare the course of anxiety change in children who used headphones during cast removal with controls in midterm follow-up. PATIENTS AND METHODS: Sixty-six patients who underwent forearm fracture treatment with closed reduction and long arm casting between June 2021 and March 2023 were retrospectively reviewed. Patients were divided into two groups based on the use of headphones (n=27; 21 males, 6 females; mean age: 8.0±1.8 years; range, 6 to 12 years) or not (n=39; 27 males, 12 females; mean age: 8.9±1.8 years; range, 6 to 12 years) during cast removal with an oscillating saw. Primary outcome measures included preprocedure, postprocedure, and six-month anxiety assessments with the State-Trait Anxiety Inventory. RESULTS: There was an acute increase in the mean state anxiety scores after the procedure, which returned to below baseline at the six-month follow-up in the headphone (31.4±8.3, 33.3±8.7, and 25.1±4.1, respectively) and control groups (34.9±11.1, 37.4±9.5, and 27.3±5.3, respectively). The mean trait anxiety scores before the procedure, after the procedure, and at six months remained similar in the headphone (33.6±3.0, 34.6±3.2, and 32.4±2.8; p>0.05) and control groups (34.1±2.7, 33.7±3.0, and 33.7±3.0, p>0.05). CONCLUSION: This study suggests that the acute anxiety during cast removal did not create anxiety sequelae in the sixth month regardless of headphone use.

Positive buttress reduction in femoral neck fractures: a literature review.

BACKGROUND: Femoral neck fractures (FNFs) in young adults are usually caused by high-energy trauma, and their treatment remains a challenging issue for orthopedic surgeons. The quality of reduction is considered an important factor in improving the poor prognosis of patients with FNFs. In recent years, positive buttress closed reduction technique has received widespread attention in the treatment of FNFs. This comprehensive literature review is designed to encapsulate the impacts of both non-anatomic and anatomic reduction on the biomechanical stability, clinical outcomes, and postoperative complications in the management of FNFs, conjecture the efficacy of positively braced reduction techniques and provide a thorough summarization of the clinical outcomes. METHODS: In this literature review, we have examined all clinical and biomechanical studies related to the treatment of FNFs using non-anatomical reduction or positive and negative buttress reduction. PubMed, Web of Science, Google Scholar and Embase Library databases were searched systematically for studies published before September 1, 2023. Published literature on fracture reduction techniques for treating FNFs was reviewed. In addition, we evaluated the included literature using the MINORs tool. RESULTS: Although the "arch bridge" structure formed by the positive buttress reduction technique improved the support to the cortical bone and provided a more stable biomechanical structure, no significant differences were noted in the clinical efficacy and incidence of postoperative complications between the positive buttress reduction and anatomical reduction. CONCLUSION: Positive buttress reduction is an effective treatment method for young patients with FNFs. When facing difficult-to-reduce FNF, positive buttress reduction should be considered first, followed by anatomical reduction. However, negative buttress reduction should be avoided.

Pediatric Type I Open Both Bone Forearm Fractures: Predicting Failure of Nonoperative Management.

BACKGROUND: In recent years, nonoperative treatment of pediatric type I open both bone forearm fractures (OBBFFs) with bedside irrigation, antibiotics, closed reduction, and casting has yielded low infection rates. However, risk factors for failure of type I OBBFF closed reduction have not been well described. Our purpose was to describe management of patients with type I OBBFFs at our institution and determine what factors are associated with failure of closed reduction in this population. METHODS: This was a review of patients between 5 and 15 years of age who received initial nonoperative management for type I OBBFFs at one institution between 2015 and 2021. Primary outcome was success or failure of nonoperative management (defined as progression to surgical management). Secondary outcomes included infections, compartment syndromes, and neuropraxias. Other variables of interest were demographic information, prereduction and postreduction translation and angulation of the radius and ulna, cast index, and antibiotic administration. RESULTS: Sixty-one patients (67.7% male) with 62 type I OBBFFs were included in this study. Following initial nonoperative management, 55 injuries (88.7%) were successfully treated in casts, while the remaining 7 (11.3%) required surgical intervention following loss of acceptable reduction in cast. Median cast index (0.84, IQR 0.8 to 0.9 vs. 0.75, IQR 0.7-0.8, P =0.020) and postreduction radius translation on anteroposterior films (32.0%, IQR 17.0% to 40.0% vs. 5.0%, IQR 0.0% to 26.0%, P =0.020) were higher among those who failed nonoperative management. Multivariable logistic regression models identified increased odds of failure for every SD (0.7) increase in cast index (OR 3.78, P =0.023, 95% CI: 1.4-14.3) and 25% increase in postreduction radius translation on anteroposterior films (OR 7.39, P =0.044, 95% CI 1.2-70.4). No infections or compartment syndromes and 2 transient ulnar neuropraxias occurred. CONCLUSIONS: Closed reduction of type I OBBFFs was successful in 88.7% of cases. There were no infections after nonoperative management. Increases in cast index of 0.7 and postreduction radius translation on anteroposterior radiographs of 25% were associated with increased likelihood of failure, thus requiring surgery; age was not. LEVEL OF EVIDENCE: Level IV-retrospective comparative study.

Radiologic, clinical, and functional evaluation of children with displaced T-condylar fractures treated by closed reduction and percutaneous fixation using the Mayo Elbow Performance Score.

PURPOSE: T-condylar (T-C) fractures of the distal humerus are rare in children. There is no accepted treatment for such an injury, and there is a lack of reports evaluating the outcome of T-C fractures treated by closed reduction and percutaneous fixation. The aim of this study was to evaluate the feasibility of closed reduction and percutaneous K-wire and screw (CRPKS) fixation in patients with type II and III T-C fractures according to the Toniolo-Wilkins classification modified by Canavese et al. (TWC classification). METHODS: The clinical data of 12 consecutive patients (8 males, 4 females) who were younger than 14 years of age and who had a T-C fracture that was managed by CRPKS were retrospectively evaluated. Fractures were classified according to the TWC classification. The baseline information of the patients, carrying angle (CA) and Mayo Elbow Performance Score (MEPS) were used to evaluate clinical and functional outcomes; related complications were recorded. Statistical analysis was performed. RESULTS: The mean age at the time of injury was 11.6 ± 1.8 years (range, 8-14). The time from injury to surgical treatment was 1.5 ± 1.0 days (range, 0-3), and the mean follow-up duration was 33.7 ± 12.3 months (range, 18-61). Surgery lasted 45.7 ± 7.6 min on average (range, 35-58). All fractures healed in 4.9 ± 1.0 weeks on average (range, 4-7). At the last follow-up visit, the CA was 12.6° ± 5.8° on the injured side and 13.8° ± 1.8° on the uninjured side (p=0.432). The MEPS was 100 (95, 100) on the injured side and 100 (100, 100) on the uninjured side (p=0.194). Three complications were recorded. CONCLUSION: Good functional and radiological outcomes can be expected in pediatric patients with type II and III T-C fractures treated by CRPKS. The technique is relatively simple to perform and has a lower rate of complications.

Four weeks versus six weeks of immobilization in a cast following closed reduction for displaced distal radial fractures in adult patients: a multicentre randomized controlled trial.

Aims: There is no level I evidence dealing with the optimal period of immobilization for patients with a displaced distal radial fracture following closed reduction. A shorter period might lead to a better functional outcome due to less stiffness and pain. The aim of this study was to investigate whether this period could be safely reduced from six to four weeks. Methods: This multicentre randomized controlled trial (RCT) included adult patients with a displaced distal radial fracture, who were randomized to be treated with immobilization in a cast for four or six weeks following closed reduction. The primary outcome measure was the Patient-Rated Wrist Evaluation (PRWE) score after follow-up at one year. Secondary outcomes were the abbreviated version of the Disability of Arm, Shoulder and Hand (QuickDASH) score after one year, the functional outcome at six weeks, 12 weeks, and six months, range of motion (ROM), the level of pain after removal of the cast, and complications. Results: A total of 100 patients (15 male, 85 female) were randomized, with 49 being treated with four weeks of immobilization in a cast. A total of 93 completed follow-up. The mean PRWE score after one year was 6.9 (SD 8.3) in the four-week group compared with 11.6 (SD 14.3) in the six-week group. However, this difference of -4.7 (95% confidence interval -9.29 to 0.14) was not clinically relevant as the minimal clinically important difference of 11.5 was not reached. There was no significant difference in the ROM, radiological outcome, level of pain, or complications. Conclusion: In adult patients with a displaced and adequately reduced distal radial fracture, immobilization in a cast for four weeks is safe, and the results are similar to those after a period of immobilization of six weeks.

Radial Nerve Supracondylar Block Versus Fracture Hematoma Block. Comparison of Their Efficacy in Cases of Fractures of the Distal Third of the Radius / Bloqueio supracondilar de nervo radial versus bloqueio de hematoma de fratura. Comparativo de sua eficácia em casos de fraturas do terço distal do rádio

Abstract Objective The present study compares the analgesic efficacy of two techniques to perform non-surgical reduction: fracture hematoma block and radial nerve supracondylar block. Methods Forty patients with fractures of the distal third of the radius, who required reduction, were selected in a quasi-randomized clinical trial to receive one of the anesthetic techniques. All patients signed the informed consent form, except for those who did not wish to participate in the study, had neurological injury, had contraindication to the procedure in the emergency room, or with contraindication to the use of lidocaine. To measure analgesia, the numerical pain rate scale was used at four different moments: preblock, postblock, during reduction, and after reduction; then three differences were calculated: the first between before and after blocking; the second between during reduction and after blockade; and the third between before blocking and after reduction. Results The fracture hematoma and supracondylar block groups showed the following mean values, respectively: 3.90 (1-10) and 3.50 (-6-10) in difference 1; 4.35 (-5-10) and 5.00 (-3-10) in difference 2; and 4.65 (1-10) and 3.80 (-3-10) in difference 3. Conclusion Both techniques proved to be efficient for analgesia, with mild superiority of hematoma block, but without statistical significance.

Resumo Objetivo O estudo compara a eficácia analgésica de duas técnicas para realizar redução incruenta: o bloqueio de hematoma da fratura e o bloqueio supracondilar de nervo radial. Métodos Quarenta pacientes com fraturas do terço distal do rádio, que necessitassem redução, foram selecionados em um ensaio clínico quasi-randomizado, para receber uma das técnicas anestésicas. Todos os pacientes assinaram o termo de consentimento ou assentimento, com exceção daqueles que não desejassem participar do estudo, tivessem lesão neurológica, com contraindicação ao procedimento na sala de emergências, ou com contraindicação ao uso da lidocaína. Para aferir a analgesia foi utilizada a escala numérica da dor em quatro momentos distintos: pré-bloqueio, pós-bloqueio, durante a redução e após a redução; em seguida, foram calculadas três diferenças: a primeira entre antes e após o bloqueio; a segunda entre durante a redução e após o bloqueio; e a terceira entre antes do bloqueio e após a redução. Resultados Os grupos do bloqueio de hematoma de fratura e bloqueio supracondilar apresentaram respectivamente os seguintes valores médios: 3.90 (1-10) e 3.50 (-6-10) na diferença 1; 4.35 (-5-10) e 5.00 (-3-10) na diferença 2; e 4.65 (1-10) e 3.80 (-3-10) na diferença 3. Conclusão As duas técnicas se provaram eficientes para analgesia, com discreta superioridade do bloqueio de hematoma, mas sem significância estatística.

Fracturas supracondíleas en pacientes pediátricos tratados quirúrgicamente con Técnica de Cruzada. Hospital Central San Cristóbal / Supracondylar humerus fractures in childrens surgically treated by Crossed Wiring Technique. San Cristóbal Central Hospital

Las fracturas supracondíleas en niños se asocian con algunas complicaciones. Su tratamiento estándar es la reducción cerrada y la fijación con alambres en distintas configuraciones. Se realizó un estudio observacional, analítico, prospectivo y longitudinal con pacientes pediátricos que ingresaron con fracturas supracondíleas de húmero tratados quirúrgicamente con alambres de Kirschner con "Técnica Cruzada" en el Hospital Central San Cristóbal enero a junio de 2022. Se incluyeron 30 pacientes. La edad promedio fue 6,3±2,2(3-10) años. La causa más frecuente del traumatismo fue la precipitación de altura en 63,3% de los casos. La posición del codo al momento del accidente fue en extensión en 90%. Todas las fracturas fueron cerradas. El tiempo promedio desde el accidente hasta su atención en emergencia fue de 8,5±13,4(2-72) horas. Los signos clínicos más frecuentes fueron dolor en 100,0%, limitación funcional en 96,7%, aumento de volumen 73,3% y deformidad 50,0%. Según la clasificación AO la más frecuente fue del tipo 13-M/3. 1 III en el 50% de los casos y según Gartland, las tipo IIIA en 53,3%. A las 4 semanas, 100,0% de las fracturas consolidaron, 13,3% presentó valgo y 6,7% varo en la radiografía anteroposterior. Mientras que, en la lateral, 33,3% antecurvatum. La media del ángulo de Baumann fue de 20,27±1,39 grados. La tasa de complicaciones fue de 16,66%, 2(6,7%) casos presentaron neuropraxia y 3(10,0%) granuloma. En conclusión, la Técnica Cruzada es segura en términos de reducción, funcionalidad y tasas de complicaciones en el seguimiento a medio plazo(AU)

Supracondylar fractures in children are associated with some complications. Its standard treatment is closed reduction and fixation with wires in different configurations. An observational, analytical, prospective and longitudinal study was made, with pediatric patients admitted with supracondylar humeral fractures surgically treated with Kirschner wires with the "Cross Technique" at the Hospital Central San Cristóbal from January to June 2022. 30 patients were included. The mean age was 6,3±2,2(3-10) years. The most frequent cause of trauma was high altitude precipitation in 63,3% of the cases. The position of the elbow at the time of the accident was 90% extended. All fractures were closed. The mean time from the accident to emergency care was 8,5±13,4(2-72) hours. The most frequent clinical signs were pain in 100,0%, functional limitation in 96.7%, volume increase in 73,3%, and deformity in 50,0%. According to the AO classification, the most frequent was type 13-M/3. 1 III in 50% of cases and according to Gartland, type IIIA in 53,3%. At 4 weeks, 100,0% of the patients consolidated, 13,3% presented valgus and 6,7% varus on the anteroposterior radiograph. While, on the side, 33,3% antecurvatum. The mean Baumann angle was 20,27 ± 1.39 degrees. The rate of complications was 16,66%, 2 (6,7%) cases presented neuropraxia and 3 (10,0%) granuloma. In conclusion, the Crossover Technique is safe in terms of reduction, functionality, and complication rates in medium-term follow-up(AU)

The Efficacy of Sequential Intranasal Packing Removal in Overcorrected Nasal Bone Fracture: Evaluation With Computed Tomography.

BACKGROUND: Despite the evolution of new techniques to treat nasal bone fractures, closed reduction with appropriate palpation and inspection is one of the critical basic tools to treat nasal bone fractures properly. Despite its rarity, overcorrection after closed reduction of the nasal bone fracture could happen even with experienced surgeons. This study hypothesized that sequential packing removal is mandatory for optimal outcomes based on the preoperative and postoperative Computed Tomography scans in overcorrected cases. This is the first study to evaluate the efficacy of sequential nasal packing removal assessed by facial CT scans. METHODS: In this retrospective study, we evaluated the medical records and preoperative and postoperative facial Computed Tomography scans of 163 patients with nasal bone fractures treated with a closed reduction from May 2021 to December 2022. Preoperative and Postoperative CT scan was routinely used to assess the outcome. Merocels were used for intranasal packing. In overcorrected cases based on immediate postoperative CT scan, we routinely removed the intranasal packing on the overcorrected side first immediately. On postoperative day 3, we removed the remaining intranasal packing on the other side. We assessed additional postoperative CT scans on postoperative two to three weeks. RESULTS: With sequential packing removal starting on the day of surgery, all overcorrected cases were successfully corrected clinically and radiologically without noticeable complications. Two representative cases were presented. CONCLUSION: Sequential nasal packing removal provides significant benefits in overcorrected cases. An immediate postoperative CT scan is also vital to do this procedure. This strategy is advantageous if the fracture is significant and there is a substantial possibility of overcorrection.

POINT-OF-CARE ULTRASOUND FOR GUIDANCE OF CLOSED REDUCTION OF FIFTH METACARPAL NECK (BOXER'S) FRACTURE.

BACKGROUND: Ultrasound has been used previously in fracture identification, analgesia delivery, and fracture reduction for patients in the emergency department. It has not been previously described as a tool for the guidance of closed fracture reduction in fifth metacarpal neck fractures ("boxer's fractures"). CASE REPORT: A 28-year-old man presented with hand pain and swelling after punching a wall. Point-of-care ultrasound revealed a significantly angulated fifth metacarpal fracture, which was confirmed with a subsequent hand x-ray study. After an ultrasound-guided ulnar nerve block, closed reduction was performed. Ultrasound was used to assess reduction and ensure improvement in bony angulation during the closed reduction attempts. Post-reduction x-ray study confirmed improved angulation and adequate alignment. Why Should an Emergency Physician Be Aware of This? Point-of-care ultrasound has previously had efficacy in fracture diagnosis and anesthesia delivery for fifth metacarpal fractures. Ultrasound can also be used at the bedside to assist in the determination of adequate fracture reduction when performing closed reduction of a boxer's fracture.

Closed reduction evaluation in dysplastic hip with the Ömeroglu system in children aged 24 to 36 months.

Closed reduction (CR) as an initial treatment for developmental hip dysplasia of the hip (DDH) in children aged 24 to 36 months is debatable; however, it could have better results than open reduction (OR) or osteotomies, because it is minimally invasive. The purpose of this study was to evaluate the radiological results in children (24-36 months) with DDH initially treated with CR. Initial, subsequent, final anteroposterior pelvic radiological records were retrospectively analyzed. The International Hip Dysplasia Institute was used to classify the initial dislocations. To evaluate the final radiological results after CR (initial treatment) or additional treatment (CR failed), the Ömeroglu system was used (6 points excellent, 5 good, 4 fair-plus, 3 fair-minus, and ≤2 poor). The degree of acetabular dysplasia was estimated using the initial acetabular index and the final acetabular index, Buchholz-Ogden classification was used to measure avascular necrosis (AVN). A total of 98 radiological records were eligible, including 53 patients (65 hips). Fifteen hips (23.1%) were redislocated, OR with femoral osteotomy and pelvic osteotomy was the preferred surgical treatment 9 (13.8%). The initial acetabular index versus final acetabular index in total population was (38.9º ± 6.8º) and (31.9º ± 6.8º), respectively (t = 6.5, P < .001). The prevalence of AVN was 40%. Overall AVN in OR, femoral osteotomy and pelvic osteotomy were 73.3% versus CR 30%, P = .003. Unsatisfactory results ≤ 4 points on the Ömeroglu system were observed in hips that required OR with femoral and pelvic osteotomy. Hips with DDH treated with CR initially might had better radiological results than those treated with OR and femoral and pelvic osteotomies. Regular, good, and excellent results, ≥4 points on the Ömeroglu system, could be estimated in 57% of the cases, in whom CR was successful. AVN is frequently observed in hips with failed CR.

Distal Radius Salter-Harris II Fracture Loss of Reduction: The Importance of Coronal Plane Angulation in Older Children.

OBJECTIVES: To assess factors affecting the loss of reduction (LOR) in a large cohort of children with Salter-Harris Type II (SH II) distal radius physeal fractures treated with closed reduction. DESIGN: Retrospective chart review. SETTING: Pediatric Level I Trauma Center. PATIENTS/PARTICIPANTS: A total of 141 pediatric patients (73% male, average age: 12.15 ± 2.55 years) that had undergone closed reduction and casting for distal radius physeal fractures from 2006 to 2019 were included in this study. INTERVENTION: Closed reduction and casting. MAIN OUTCOME MEASUREMENTS: Five different radiographic measurements were analyzed at 4 different time points. Follow-up radiographs were assessed in relation to initial reduction. LOR was defined as >5 degrees change of angulation on PA radiographs, >10 degrees change of angulation on lateral radiographs, and/or >25% translation on PA or lateral radiographs. RESULTS: LOR was seen in 28.4% of the patients, most often (68%) in the first 2 weeks after initial reduction. Seven (17.5%) of these patients (average age: 15.2 ± 2.0 years) were treated surgically with closed reduction and percutaneous pinning (CRPP). Patients undergoing CRPP for LOR were an average of 3.4 years older ( P < 0.001) than those who underwent nonoperative treatment of LOR. Patients with initial angulation more than 5 degrees on the PA view to be twice as likely to have LOR ( P = 0.03). CONCLUSIONS: LOR was seen in nearly 1/3 of these patients. Patients with initial higher degree of angulation on the coronal plane are at higher risk for LOR. Age, not the degree of angulation, is the main predictor for potential surgical treatment. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Displaced posterior pelvic ring fractures treated with an unlocking closed reduction technique: Prognostic factors associated with closed reduction failure, reduction quality, and fixation failure.

PURPOSES: This study aimed to evaluate the clinical effect of the unlocking closed reduction technique (UCRT) for the displaced posterior pelvic ring fractures and to analyze the factors associated with failure of closed reduction and fixation. PATIENTS AND METHODS: Data from patients admitted with displaced posterior pelvic ring fractures initially treated with the URCT from July 2017 to January 2020 were extracted. Clinical and radiological factors including fracture classification, interval days from injury to surgery, number of screws, and type of fixation for the posterior pelvic ring were analyzed to evaluate their correlation with closed reduction failure, reduction quality, and fixation failure. Then a logistic regression model was used for statistical analysis to eliminate confusion factors. RESULTS: Ninety-seven patients with displaced posterior pelvic ring fractures were followed for a mean of 1.7 years after surgery. Successful closed reduction and percutaneous fixation were achieved for 89 patients (91.8%), of which 82 patients (92.1%) achieved an excellent or good reduction. Closed reduction failure which converted to open reduction was recorded for eight patients (8.2%). AO/OTA type C3 fracture (p = 0.036) and osteoporosis (p = 0.012) were significant factors for closed reduction failure. Excellent was recorded for 76 patients (78.4%) and acute (1-21 days) interval days from injury to surgery was an associated factor for reduction quality. For AO/OTA type C1 fractures, no more than two short screws (unilateral iliosacral screws) or a single long screw (transiliac-transsacral screws) were independent prognostic factors of fixation failure (p = 0.026). CONCLUSIONS: Displaced posterior pelvic ring fractures treated with the UCRT are associated with excellent/ good radiological results. However, in patients with AO/OTA type C3 pelvic fracture and osteoporosis, the backup plan of open reduction should be routinely prepared. The patient should be brought to the operating room within three weeks to get a good reduction result. Two long screws or one long screw combined with two short screws are required to create a strong construct for AO/OTA type C1 pelvic fractures.

Precisely Closed Reduction of Nasal Bone Fracture Assisted With Plain Film Measurements Under the Picture Archiving and Communication System.

OBJECTIVES: To prevent aesthetic and functional deformities, precisely closed reduction is crucial in the management of nasal fractures. Plain film radiography (PF), ultrasonography (USG), and computed tomography can help confirm the diagnosis and classification of fractures and assist in performing closed reduction. However, no study in the literature reports on precisely closed reduction assisted with PF measurements under the picture archiving and communication system (PACS). METHODS: We retrospectively evaluated 153 patients with nasal bone fracture between January 2013 and December 2017. Surgeons conducted precisely closed reduction assisted with PF measurement of the distance between the fracture site and nasal tip under PACS on 34 patients (group A). Another group on 119 patients were reduced under surgeon's experience (group B). RESULTS: No significant differences in age, gender, Arbeitsgemeinschaft fur Osteosynthesefragen (AO) classification, and reduction outcome were observed between group A and group B (P > .05). The operative time of the group A was significantly lower (12.50 ± 4.64 minutes) compared to group B (23.78 ± 11.20 minutes; P < .001). After adjusted age, gender, and AO classification, patients in group A scored 10.46 minutes less on the operative time than those in group B (P < .001). In addition, the severity of nasal bone fracture (AO classification, ß = 3.37, P = .002) was positive associated with the operative time. CONCLUSIONS: In this study, closed reduction in nasal bone fracture assisted with PF measurements under PACS was performed precisely, thereby effectively decreasing operative time and the occurrence of complications. This procedure requires neither the use of new instruments or C-arm nor USG or navigation experience. Moreover, reduction can be easily performed using this method, and it requires short operative time, helps achieve great reduction, less radiation exposures, and is cost-effective.

Autonomous path planning for robot-assisted pelvic fracture closed reduction with collision avoidance.

BACKGROUND: Robot-assisted pelvic fracture closed reduction (RPFCR) positively contributes to patient treatment. However, the current path planning suffers from incomplete obstacle avoidance and long paths. METHOD: A collision detection method is proposed for applications in the pelvic environment to improve the safety of RPFCR surgery. Meanwhile, a defined orientation planning strategy (OPS) and linear sampling search (LSS) are coupled into the A* algorithm to optimise the reduction path. Subsequently, pelvic in vitro experimental platform is built to verify the augmented A*algorithm's feasibility. RESULTS: The augmented A* algorithm planned the shortest path for the same fracture model, and the paths planned by the A* algorithm and experience-based increased by 56.12% and 89.02%, respectively. CONCLUSIONS: The augmented A* algorithm effectively improves surgical safety and shortens the path length, which can be adopted as an effective model for developing RPFCR path planning.

Risk Factors for Failure of Closed Forearm Fracture Reduction in the Pediatric Emergency Department.

OBJECTIVES: This study aimed to explore risk factors for failure of forearm fracture closed reduction in the pediatric emergency department (ED) and to suggest indications for initial surgery. METHODS: This retrospective cohort study included all patients aged 0 to 18 years who presented to our pediatric ED with an extraarticular forearm fracture treated with closed reduction between May 2017 and April 2021. We explored risk factors for procedural failure, defined as a need for surgical intervention within 6 weeks of the closed reduction attempt. RESULTS: Of 375 patients (median age 8.1 years, 294 [78.2%] boys), 44 (11.7%) patients sustained a reduction failure, of whom 42 (95.5%) had both radius and ulna fractures. Of the 259 patients with fractures of both bones, the following parameters were independent predictors for reduction failure: refracture (adjusted odds ratio [aOR] 17.6, P < 0.001), open fracture (aOR 10.1, P = 0.007), midshaft fracture (aOR 2.6, P = 0.004), radial translation rate 37% and higher in either plane (aOR 5.1, P = 0.004), and age of 10 years and older (aOR 2.9, P = 0.01). CONCLUSIONS: Most pediatric forearm fractures can be successfully managed by closed reduction in the ED. Two-bone fractures had the strongest association with reduction failure. Refracture, open fracture, midshaft location, initial radius bone translation of 37% and higher (and not initial angulation), and patient age of 10 years and older are independent risk factors for reduction failure in two-bone fractures. We propose a risk score for reduction failure that can serve as a decision-making tool.