Analysis of the associated factors in postoperative wound infection following open reduction and internal fixation for elbow fracture.

Postoperative wound infections (PWIs) following open reduction and internal fixation (ORIF) for elbow fractures can significantly affect patient outcomes. Identifying associated risk factors is crucial for improving clinical practices and patient care. A retrospective analysis (June 2020-June 2023) at our institution involved 90 patients who underwent elbow ORIF. Thirty patients developed PWIs (case group), compared to 60 who did not (control group). Variables like anaemia, operation duration, hospital stay, blood loss, body mass index (BMI), age, hypoalbuminemia, smoking status, diabetes mellitus and open fractures were examined. Univariate and multivariate analyses determined the impact of these variables on PWI incidence, with statistical significance set at p < 0.05. The main pathogens identified were Escherichia coli among Gram-negative bacteria (59.46%) and Staphylococcus aureus among Gram-positive bacteria (40.54%). In the univariate analysis, hypoalbuminemia, anaemia, and lifestyle factors such as smoking showed higher prevalence in patients with PWIs. However, age and length of hospital stay did not significantly influence infection rates. The multivariate analysis further elucidated that anaemia, smoking, diabetes mellitus and open fractures were independent, significant predictors of PWIs. These findings highlight the complexity of factors influencing infection risk post-ORIF, underscoring the importance of both individual health conditions and surgical complications in patient outcomes. Anaemia, smoking, diabetes mellitus and open fractures significantly increase the risk of PWI after elbow ORIF. Early identification and management of these risk factors are imperative to reduce infection rates and improve postoperative recovery.

TiRobot-Assisted Percutaneous Cannulated Screw Fixation for Elderly Patients with Fragility Fractures of the Pelvis: A Retrospective Study.

OBJECTIVE: The incidence of fragility fractures of the pelvis (FFPs) is increasing in the elderly population, and FFPs that require fixation are a challenge for orthopedic surgeons. The insertion of implants is not risk free due to the complex anatomical and osteoporotic bones and requires a steep learning curve. This study aimed to investigate the clinical efficacy of TiRobot-assisted percutaneous cannulated screw fixation in the treatment of elderly FFP patients. METHOD: The clinical data of 46 elderly FFP patients who had been treated with percutaneous cannulated screw fixation from May 2020 to September 2022 were retrospectively analyzed. Twenty-four patients were treated with percutaneous cannulated screw fixation assisted by the TiRobot (TiRobot-assisted group) and 22 patients were treated with conventional freehand surgery (freehand group). Postoperative outcomes, including Matta value, excellent and good rate (EGR) of fracture reduction, and accuracy of screw placement (ASP), were compared. Changes in the Visual analog scale (VAS) pain score and the Majeed score were recorded and compared between groups before and after surgery and during the 24-week follow-up. Repeated-measures analysis of variance (ANOVA) and effect sizes were used as analysis methods. RESULTS: A total of 90 screws were implanted, 51 screws in the TiRobot-assisted group and 39 screws in the freehand group. The operation time of the two groups was 34.1 ± 2.67 min versus 64.5 ± 4.19 min (p < 0.001). There were no screw-related complications or revision surgeries in any group. The Matta value of the TiRobot-assisted group was 5.13 ± 3.52, which was significantly lower than that of the freehand group (9.00 ± 3.68, p < 0.001), while the EGR was 91.67% versus 72.73%, with statistical significance (p < 0.001). The ASP was 100% in the TiRobot-assisted group, better than that in the freehand group, where it was 85.7% (p = 0.043). At each timepoint in the early postoperative period, the VAS score of the TiRobot-assisted group was significantly lower than that of the freehand group and was close to consistent by the last follow-up; the Majeed score of the former was significantly higher than that of the latter at each timepoint of follow-up, with statistical significance (p < 0.001). CONCLUSION: TiRobot-assisted percutaneous cannulated screw fixation of elderly FFP patients is advantageous over conventional freehand surgery, with less invasion, more accurate screw placement, better fracture reduction, early pain relief, and rapid recovery, suggesting that Freehand method to stabilize FFP in the elderly population.

Malicious Tumor? Pathological Fracture of the Femur in Children Caused by Myelolipoma: A Case Report and Review of Literatures.

Myelolipoma is a kind of benign lipoma containing myeloid cells. It is a rare type of tumor that typically presents as an occasional adrenal tumor, generally manifesting as a nonfunctional adrenal mass. Although it can occur in extra-adrenal tissues, its occurrence in bone tissue is extremely rare. Most cases are discovered accidentally during physical examinations of adults, and there are currently no reports of cases with pathological fractures as the main symptoms. We present a case of a 15-year-old teenager who developed a pathological fracture caused by femoral myelolipoma. The diagnosis of the specific type of bone tumor of the patient was determined through pathology and imaging. To treat the condition, we utilized a technique known as the "soft drill" to fully access the tumor space, remove the bone septum, and scrape away the diseased tissue. The fracture was then stabilized using a hybrid external fixation. After a 2-year follow-up period, there was no recurrence of the bone tumor. This case is the first case of intraosseous myelolipoma that occurred in a minor with the initial symptom of pathological fracture, filling the gap in our existing body of knowledge and providing a reference for the treatment of this type of intraosseous myelolipoma.