Technique and clinical results of a new intramedullary support nail and plate system for fixation of 3- or 4- part proximal humeral fractures in older adults.

BACKGROUND: Internal fixation of complex proximal humeral fractures (PHF) with osteoporosis is associated with a high incidence of complications. This study introduces the technique and clinical results of a novel intramedullary support nail and plate system (ISNPs) for the internal fixation of 3- or 4- part PHF in older adults. The ISNPs combines the concept of intramedullary support and dynamic fixation into a locking plate fixation system that can be applied using a minimally invasive surgical approach. METHODS: A total of 46 consecutive patients diagnosed with 3- or 4-part PHF that met the criteria were included in this study, including 18 in the ISNPs group and 28 in the conventional locking plate (LP) group. Clinical results, including operative time, intraoperative bleeding, reduction quality, subjective outcome ratings, and complications, were compared between the two groups. Functional outcomes were evaluated using the Constant score and disability of the arm, shoulder, and hand (DASH) questionnaire at 1-year follow-up. RESULTS: There were no significant differences in age, sex, local bone quality, Neer-fracture type, and follow-up time between the ISNPs and LP groups. For clinical analysis, there were no significant differences in intraoperative bleeding and operation time between the ISNPs and LP groups. Significant differences were observed in the percentage of the malreduced cases, Constant and DASH score analysis, and the patients' subjective evaluation ('excellent' and 'good' %) between the two groups. CONCLUSION: The ISNPs technique proposed in this study provides a novel hybrid internal fixation model for complex PHF with osteoporosis. The clinical results at 1-year follow-up confirmed the advantage of applying it to 3- or 4- part PHF in older patients. Further studies are required to optimize its design and explore its optimal indications.

Is the reconstruction of medial support important for revision following failed treatment of femoral trochanteric fractures? a retrospective comparative study.

BACKGROUND: Hip-preserving revision in patients with failed treatment of femoral trochanteric fracture is still a major challenge. Whether the medial support reconstruction could benefit the patients and improve the success rate of hip-preserving revision is still controversial. Hence, the purpose of this study was to evaluate the clinical significance and prognosis of medial support reconstruction during the hip-preserving revision of failed femoral trochanteric fracture treatment. METHODS: Patients with failed femoral trochanteric fractures treatments addressed by hip-preserving revision at our hospital from January 2014 to December 2020 were analyzed retrospectively. 31 patients were included and divided into a medial support group (n = 16) and a non-medial support group (n = 15). The fracture healing rate was the primary measurement. In addition, the differences in Oxford Hip Score (OHS), quality of life, surgical trauma, and complications were also evaluated. RESULTS: The fracture healing rate (100%, 16/16 vs. 66.67%, 10/15), the OHS (42.06 ± 4.12 vs. 30.93 ± 11.56, M ± SD), and the mental component score of the 12-item Short-Form Survey (SF-12) (54.48 ± 5.38 vs. 47.90 ± 3.47, M ± SD), were significantly better and the incidence of complications [0(0/16) vs. 40%(6/15)] was significantly lower in the medial support group than the non-medial support group (p < 0.05). No significant differences in the physical component score of the SF-12, surgical trauma and reduction in collodiaphyseal angle of affected femur were observed between groups. CONCLUSIONS: The reconstruction of medial support seems important for revision following failed treatment of femoral trochanteric fractures. Due to the medial augmentation and improvement of the mechanical stability for proximal femur, the patients might benefit from fracture healing prognosis and functional.

Treatment of elderly comminuted proximal humeral fracture using endosteal anatomical support system: A case report.

INTRODUCTION: Intramedullary anatomical medial strut with allograft bone (IAMSAB), which accommodates the shape of the proximal humeral cavity and provides rotational stability and direct support to the medial column, was successfully introduced to augment Lateral locking plate (LLP) in the treatment of elderly comminuted proximal humeral fractures. Based on the LLP-IAMSAB construct, a newly titanium endosteal anatomical support system (EASS) was developed. CASE PRESENTATION: Reported here is a single case of a highly comminuted proximal humeral fracture. The fractures were treated with EASS. The patient's fracture healed properly. The 24-month follow-up demonstrated no pain and a good functional outcome, with no signs of reduction loss, absorption of greater tuberosity, varus displacement and avascular necrosis of humeral head. CLINICAL DISCUSSION: The newly developed EASS had several special considerations contributing to satisfactory surgical outcome. The flat plane construct of the proximal end of the EASS directly support humeral head to prevent varus displacement of the humeral head, instead of the purchase between the screw thread and the cancellous bone inside the humeral head in the nail or plate fixation. Medial anatomical shape of proximal end helps to reduce medial cortex reduction. Greater tuberosity support block with rotator cuff suture fixation might promote greater tuberosity healing and prevent its absorption. However, there is no similar construct in the nail or plate fixation. CONCLUSION: The newly developed endosteal anatomical support system might be a promising option in the treatment of elderly comminuted proximal humeral fractures. Although the effectiveness of this system requires additional evaluation upon more patients being treated with this surgical method, the newly developed EASS may serve as a humeral head-preserving method for elderly patients with comminuted proximal humeral fractures.

Age-Related changes in the morphological features of medial column of the proximal humerus in the Chinese population.

Background: Age-related changes in the medial column (MC) of the proximal humerus have a major impact on fracture management; however, the changes in the morphological features remain unclear. This study aimed to investigate the age-related changes in the morphological features of MC and present the morphological grading. Methods: One hundred computed tomography (CT) images of the proximal humerus of 100 individuals (19-95 years) were retrospectively obtained. The individuals were categorized into five age groups to quantify the differences among different ages; the youngest group (18-44 years) served as the baseline group. Parameters of the morphological features were measured on CT images with multiplanar reconstruction based on an explicit definition of MC, including length, thickness, width, oblique thickness (DSM), humeral head diameter (DHM), and ratio (RSM) of DSM to DHM. The morphological grading of MC was presented based on the value of RSM deviating different standard deviations (SD) from the mean value in the baseline group. Results: Significant negative correlations were observed between age and the morphological parameters of MC (r ranged from -0.875 to -0.926; all P < 0.05), excluding DHM (r = 0.081, P = 0.422). Significant differences in the values of morphological feature parameters were detected among the five age groups (all P < 0.001). The highest mean values of morphological feature parameters were observed in the youngest group (18-44 years), which decreased gradually with increasing age until the lowest mean values were observed in the oldest group (≥90 years) (all P < 0.05). The morphological features of MC were categorized into three grades based on the value of RSM deviating 1.5 SD or 3 SD from the mean value in the baseline group. Conclusion: Our study shows that the parameter values of morphological features of MC decreased with increasing age. The morphological features of MC could be categorized into three grades. Our findings may provide a more comprehensive insight into age-related changes in the morphological features of MC that facilitate risk stratification and optimize the management of proximal humeral fractures.

Augmented Stability in Leaving Original Internal Fixation with Multidimensional Cross Locking Plate through Mini-Open Femoral Anterior Approach for Aseptic Femoral Shaft Nonunion: A Retrospective Cohort Study.

OBJECTIVE: Aseptic femoral shaft nonunion constitutes approximately 1%-10% of all femoral shaft fractures treated with intramedullary nail (IMN) fixation, possibly attributable to the lack of anti-rotational stability. Although a lateral locking plate (LP) with retainment of original IMN has shown the most success, lateral LP inflicts significant surgical trauma on patients. Therefore, the Multidimensional Cross Locking Plate (MDC-LP) was designed based on a mini-open femoral anterior approach. We aim to report and compare the technical aspects and clinical outcomes of using anterior MDC-LP or lateral LP with retention of original IMN for the treatment of aseptic femoral shaft nonunion. METHODS: In this single center retrospective cohort study, records of 49 patients who had undergone revision of femoral shaft aseptic nonunion with anterior MDC-LP or lateral LP while retaining the original IMN from January 2015 to October 2019 were retrospectively reviewed. Information on patients' demographics, clinical data, and surgical outcomes were gathered and analyzed. X-ray and CT scans were used for bone union evaluation and the lower extremity functional scale (LEFS) was used for follow-up functional evaluation. For quantitative data, the Student's t-test was used if the data were normally distributed. The Mann-Whitney U-test was used for non-normally distributed data. For qualitative data, the Chi-square test was used for comparisons. RESULTS: Twenty-seven patients were treated with anterior MDC-LP, and 22 patients were treated with lateral LP. There are no significant differences in age, sex, BMI, time since initial femoral shaft fracture, initial fracture type (close/open), nonunion type, or nonunion location between patients' group. Among patients treated with anterior MDC-LP, an average of 2-months advantage in time to union was observed (4.09 months vs. 6.8 months in the lateral LP group: P = 0.000), smaller incision was required for MDC-LP installment (7.7 cm vs 17.1 cm in lateral LP group: P = 0.000). CONCLUSIONS: For the treatment of aseptic femoral shaft nonunion with retainment of original IMN, anterior MDC-LP via mini-open femoral anterior approach described in this study is a better option than lateral LP for achieving faster bone union and satisfactory functional outcome with less surgical trauma.

How to improve the biomechanical stability of endosteal augmentation for proximal humerus fracture with osteopenia? A cadaveric study.

BACKGROUND: Endosteal augmentation enhances the stability of osteoporotic proximal humeral fracture fixation, but the optimal configuration is unknown. The purpose of this study was to compare the biomechanical properties of different lengths of fibula with or without calcar screw in osteoporotic proximal humeral fracture. METHODS: Three-part proximal humeral fractures with osteopenia were created on 20 pairs of fresh-frozen humeri specimens and allocated to four groups: (1) locking plate with a 6-cm fibular strut allograft, (2) locking plate with a 6-cm fibular strut allograft and additional calcar screws, (3) locking plate with a 12-cm fibular strut allograft，and (4) locking plate with a 12-cm fibular strut allograft and additional calcar screws. Specimens were loaded to simulate the force at 25° abduction. Thereafter, an axial stiffness test and a compound cyclic load to failure test were applied. Structural stiffness, number of cycles loaded to failure and relative displacement values for 5000 cycles at predetermined measurement points were recorded using a testing machine and a synchronized 3D video tracking system. FINDINGS: In terms of initial stiffness, number of cycles loaded to failure, and relative displacement values, the groups with 12-cm fibular strut showed obvious improvement compared to the groups with 6-cm fibular strut irrespective of the influence of calcar screw implementation. Further, the groups implemented with calcar screws also showed promising biomechanical stability irrespective of fibular length. INTERPRETATION: Lateral locking plate with longer endosteal fibular augmentation and calcar screw can significantly improve biomechanical stability for elderly proximal humeral fractures with posteromedial comminution.

[Effectiveness of three-dimensional visible technique without fluoroscopy versus two-dimensional fluoroscopy in reduction of unstable pelvic fractures].

Objective: To compare the reduction qualities of three-dimensional visible technique without fluoroscopy and two-dimensional fluoroscopy for unstable pelvic fractures during operations. Methods: The clinical data of 40 patients with unstable pelvic fractures, who met the selection criteria in three clinical centers between June 2021 and September 2022, were retrospectively analyzed. According to the reduction methods, the patients were divided into two groups. Twenty patients in trial group were treated with unlocking closed reduction system combined with three-dimensional visible technique without fluoroscopy; 20 patients in control group with unlocking closed reduction system under two-dimensional fluoroscopy. There was no significant difference in the gender, age, injury mechanism, Tile type of fracture, Injury Severity Score (ISS), and the time between injury to operation between the two groups ( P>0.05). The qualities of fracture reduction according to the Matta criteria, operative time, intraoperative blood loss, fracture reduction time, times of fluoroscopy, and System Usability Scale (SUS) score were recorded and compared. Results: All operations were successfully completed in both groups. According to the Matta criteria, the qualities of fracture reduction were rated as excellent in 19 patients (95%) in trial group, which was better than that in the control group (13 cases, 65%), with a significant difference ( χ 2=3.906, P=0.048). The operative time and intraoperative blood loss had no significant differences between the two groups ( P>0.05). The fracture reduction time and times of fluoroscopy were significantly less in trial group than in control group ( P<0.05), and SUS score in trial group was significantly higher in trial group than in control group ( P<0.05). Conclusion: Compared to using unlocking closed reduction system under two-dimensional fluoroscopy, three-dimensional visible technique without fluoroscopy can significantly improve the reduction quality of unstable pelvic fractures without prolonging the operative time, and is valuable to reduce iatrogenic radiation exposure for patients and medical workers.

Biomechanical evaluation of novel intra- and extramedullary assembly fixation for proximal humerus fractures in the elderly.

Purpose: A novel intra- and extramedullary assembly fixation method was introduced, which achieved good clinical results in complex proximal humeral fractures; however, evidence of its comparability with traditional fixation is lacking. This biomechanical study aimed to compare it with traditional fixation devices in osteoporotic proximal humeral fractures. Methods: Three-part proximal humeral fractures with osteopenia were created on 12 pairs of fresh frozen humerus specimens and allocated to three groups: 1) lateral locking plate, 2) intramedullary nail, and 3) intra- and extramedullary assembly fixation. The specimens were loaded to simulate the force at 25° abduction. Thereafter, an axial stiffness test and a compound cyclic load to failure test were applied. Structural stiffness, number of cycles loaded to failure, and relative displacement values at predetermined measurement points were recorded using a testing machine and a synchronized 3D video tracking system. Results: In terms of initial stiffness and the number of cycles loaded to failure, the intra- and extramedullary assembly fixation group showed notable improvements compared to the other groups (p <0.017). The mean relative displacement value of measurement points in the intra- and extramedullary assembly fixation group was smaller than that in the other two groups. However, there was no significant difference until 10,000 cycles. The mean relative displacement of the intramedullary nail group (3.136 mm) exceeded 3 mm at 7,500 cycles of loading. Conclusion: In this test model, axial fixation can provide better mechanical stability than non-axial fixation. The intra- and extramedullary assembly fixation is better able to prevent the varus collapse for elderly proximal humeral fractures with posteromedial comminution.

[Application of channel-assisted minimally invasive repair system in Myerson types â and â ¡ chronic Achilles tendon rupture].

OBJECTIVE: To investigate the effectiveness of channel-assisted minimally invasive repair system (CAMIR) in treatment of the Myerson types Ⅰ and Ⅱchronic Achilles tendon rupture. METHODS: Between May 2016 and August 2017, 19 patients with Myerson types Ⅰ and Ⅱchronic Achilles tendon ruptures were treated with CAMIR. There were 14 males and 5 females, aged from 21 to 48 years, with an average age of 34.5 years. The disease duration was 5-9 weeks (mean, 7.5 weeks). The preoperative Thompson tests of affected ankles showed positive. There were 11 cases of Myerson type Ⅰwith the gaps of Achilles tendon defect of 1-2 cm (mean, 1.58 cm), and 8 cases of Myerson type Ⅱwith the gaps of Achilles tendon defect of 2.5-4.0 cm (mean, 3.16 cm). The ankle dorsiflexion and plantarflexion range of motion were measured before and after operation; the American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot score was used to assess the patients' ankle joint function. RESULTS: No major blood vessels, nerves, and other tissue structures were damaged during the operation; 3 cases of Myerson type Ⅰ were converted to Myerson type Ⅱ according to the gaps of the defect after the scar tissue was removed during the operation. After operation, the depressed part of the Achilles tendon disappeared, the continuity of the tendon was restored, and the Thompson tests were negative. All 19 patients were followed up 12-25 months, with an average of 14 months. All incisions healed by first intention, and no infection and skin necrosis occurred; all the pre-injury activities and exercise were restored at 6 months after operation. During the follow-up period, no heel pain or re-rupture occurred. At last follow-up, except that there was no significant difference in ankle dorsiflexion range of motion of Myerson type Ⅰ patients ( t=2.118, P=0.071), the AOFAS ankle and hindfoot score, ankle plantarflexion range of motion of Myerson types Ⅰ and Ⅱ patients, and ankle dorsiflexion range of motion of Myerson type Ⅱ patients were significantly improved when compared with preoperative values ( P<0.05). According to AOFAS ankle and hindfoot function score, the ankle joint function of type Ⅰ patients was excellent in 7 cases and good in 1 case, and of type Ⅱ patients were excellent in 8 cases, good in 2 cases, and fair in 1 case. CONCLUSION: CAMIR is safe and effective in the treatment of Myerson types Ⅰ and Ⅱ chronic Achilles tendon rupture with fewer complications and better functional recovery of ankle joint.

[Research progress on medial support augmentation of plate osteosynthesis for proximal humeral fractures].

OBJECTIVE: To review the literature about the clinical application and research progress on medial support augmentation of plate osteosynthesis for proximal humeral fractures, and to provide reference for clinical treatment. METHODS: The literature concerning medial support augmentation of plate osteosynthesis for proximal humeral fractures in recent years was extensively reviewed, as well as the biomechanical benefit and clinical advantage were analyzed thoroughly. RESULTS: Medial support augmentation of plate osteosynthesis for proximal humeral fractures is very important, especially in osteoporotic and/or comminuted fractures. Many medial support augmentation methods have been proposed which can be divided into extramedullary support and intramedullary support. It can also be divided into autogenous bone support and allogenic bone support according to the material and source, divided into medial column support, calcar support, and humeral head support according to the support site, and divided into fibular shaft support, femoral head support, anatomic fibula support according to the shape of the augmented fixation. At present, clinical and biomechanical researches show that medial support augmentation is an effective treatment for proximal humeral fractures. CONCLUSION: As an important treatment strategy for the treatment of proximal humeral fractures, the medial support augmentation of plate osteosynthesis gets the focus from the biomechanical studies and clinical treatment. However, there are still widespread controversies among orthopedic surgeons regarding the support mode, site, implant shape, and material of medial column support for augmentation of proximal humeral fractures. More high-quality clinical trials and biomechanical researches as well as multi-disciplinary integration, are needed to provide better strategy treatment for the treatment of proximal humeral fractures.

Achieve Closed Reduction of Irreducible, Unilateral Vertically Displaced Pelvic Ring Disruption with an Unlocking Closed Reduction Technique.

OBJECTIVE: To be able to treat irreducible unilateral vertically displaced pelvic ring disruption (UVDPRD) using closed reduction, we introduced a technique named Unlocking Closed Reduction Technique (UCRT) and evaluated its effectiveness with improved pelvic closed reduction system (PCRS). METHODS: A retrospective study was performed in our department. Between January 2014 and December 2017, 43 patients whose UVDPRD were not successfully reduced using transcondylar traction. Subsequently, they were treated with UCRT using improved PCRS. The study included 19 male and 24 female patients, with a mean age at the time of the operation of 46.2 years. During surgery, operation time and blood loss were recorded. Post-surgical reduction quality was evaluated using Matta scoring criteria and patient lower-extremity functional outcome was evaluated using Majeed functional scoring criteria. RESULTS: When used with improved PCRS, UCRT achieved pelvic reduction in all 43 cases of irreducible UVDPRD with postoperative pelvic reduction quality rated excellent and good for 42/43 (97.6%) patients according to the Matta scoring criteria (Matta Score < 10 mm). While no post-surgical complications emerged as the direct result of UCRT in this cohort of patients, 8/37 patients who were treated with subcutaneous supra-acetabular pedicle screw internal fixation (INFIX) for anterior ring fixation developed lateral femoral cutaneous nerve injury but recovered 6 months postoperatively. No revision surgery was performed on any of the recruited patients. All patients' lower-extremity functionality was rated excellent with an average Majeed function score of 94.3 during the last follow-up at an average of 41.6 months postoperatively. CONCLUSION: With excellent surgical and functional outcomes in patients with irreducible UVDPRD, improved PCRS-assisted UCRT proved to be a safe and effective method for the treatment of irreducible UVDPRD.

[Application of three-dimensional navigation template in adult cubitus varus osteotomy].

OBJECTIVE: To investigate the effectiveness of three-dimensional (3D) navigation template in the adult cubitus varus osteotomy. METHODS: Between April 2013 and September 2015, 17 patients with cubitus varus were admitted. There were 6 males and 11 females, aged from 19 to 38 years, with an average age of 26.9 years. There were 10 cases of left elbow joints and 7 cases of right elbow joints. The disease duration was 9-30 years (mean, 18 years). Based on the preoperative X-ray film, the humerus-elbow-wrist (HEW) angle was (-13.2 ±3.3)°, the anteversion angle was (-10.5±2.3)°. The preoperative range of motion (ROM) of flexion was (127.3±7.3)° and ROM of extension was (-10.0±2.5)°. Based on the CT 3D reconstruction, the osteotomy navigation template was designed and printed by 3D printing technique. The cubitus varus osteotomy was assisted by 3D navigation template. The postoperative HEW angle, anteversion angle, and ROMs of the elbow joints of both sides were measured. The elbow function was evaluated based on the Oppenheim elbow function score at 1 year after operation. RESULTS: All cubitus varus osteotomies succeeded with the assist of 3D navigation template. All incisions healed by first intention. All patients were followed up 12-15 months (mean, 13 months). X-ray films showed that all osteotomies healed after 9-12 weeks (mean, 11 weeks). At 1 year after operation, the HEW angle was (9.7±1.9)°, the anteversion angle was (20.7±4.3)°, the ROM was (2.6±3.5)° in extension and (139.2±4.8)° in flexion of affected side. The HEW angle, anteversion angle, and ROMs significantly increased compared with preoperative values ( P<0.05). And there was no significant difference between affected and normal elbow joints ( P>0.05). The elbow functions were excellent in 13 cases and good in 4 cases based on the Oppenheim elbow function score at 1 year after operation. There was no complication such as the nerve injury or osteomyositis of elbow joint during follow-up. CONCLUSION: The 3D navigation template can provide a personalized and precise osteotomy treatment for adult cubitus varus deformity and obtain a satisfactory effectiveness.

Comparison of a multidimensional cross locking plate versus a locking compression plate for the treatment of femoral shaft nonunion: Finite element analysis.

The purpose of this study was to explore the advantages and disadvantages of a multi-dimensional cross locking plate (MDC-LP) compared with a locking compression plate (LCP) as the augmentation plate (AP) over an intramedullary nail (IMN) for the treatment of femoral shaft nonunion by using finite element analysis. A finite element model of the femur was developed to analyze the maximum stress, stress distribution, displacement of fixation and nonunion site under increasing axial and torsional loads. Some differences in the stress distribution and stress values on the fixations were observed in the five fixation models. The MDC-LP with eight screw fixation showed the lowest variety of nonunion site displacement under the increasing axial and torsional loads. Models of the MDC-LP were more stable with regard to the bending and torsional forces. The short MDC-LP with eight screw insertion as an augmentation plate over intramedullary nail shows biomechanical advantages compared to the LCP. The MDC-LP may be an appropriate and effective treatment option for femoral shaft nonunion.

Finite element analysis of an intramedulary anatomical strut for proximal humeral fractures with disrupted medial column instability: A cohort study.

BACKGROUND: Lateral locking plate (LLP) fixation has gained popularity for the treatment of proximal humeral fractures (PHFs); however, complications can occur due to loss of the medial cortical buttress from fracture comminution. MATERIALS AND METHODS: We designed a novel intramedullary anatomical medial strut with allograft bone (IAMSAB) using MIMICS software to specifically fill the intramedullary canal of the proximal humeral bone. We used finite element analysis to evaluate the biomechanical characteristics of a LLP, LLP-intramedullary fixation system (IFS), LLP-anatomical medial locking plate (AMLP), or the combined application of a LLP and IAMSAB (LLP-IAMSAB) fixation construct in patients with a PHF and an unstable medial column. RESULTS: For axial or rotational loads, under (normal) Nor or osteoporotic (Ost) bone conditions, the LLP-IAMSAB fixation construct was significantly stiffer than the LLP-IFS fixation construct, and displacement at the fracture site after LLP-IAMSAB fixation was significantly less than after LLP or LLP-IFS fixation (P < 0.05). Stiffness of the LLP-IAMSAB and LLP-AMLP fixation constructs and displacement at the fracture site after LLP-IAMSAB and LLP-AMLP fixation were not significantly different. The IFS, AMLP, and IAMSAB shared the load in the LLP and decreased the risk of implant failure. There were no significant differences in von Mises stress and stress distribution after fixation with the LLP-IFS, LLP-AMLP, and LLP-IAMSAB constructs. CONCLUSION: These data suggest that the IAMSAB can provide direct medial support or resistance to rotation and augment the biomechanics of the LLP. The combined application of the IAMSAB and LLP may achieve functional outcomes that are similar to the LLP-AMLP fixation construct.

[Intelligent monitoring system assisted pelvic fracture closed reduction for treating one case with complex pelvic fracture].

OBJECTIVE: To introduce the experience of intelligent monitoring system assisted pelvic fracture closed reduction to treat complex pelvic fracture in a minimally invasive method. METHODS: A 30-year-old male patient with complex pelvic fracture caused by a falling injury was treated in December 2019. The pelvic fracture was diagnosed by X-ray film and CT three-dimensional reconstruction. The AO/Orthopaedic Trauma Association (AO/OTA) classification was 61-C3.3 type (H-shaped sacrum fracture with pubic symphysis separation). At 48 hours after injury, the vital signs were stable, and the operation was performed. The pelvic fracture was reduced with the help of pelvic reduction frame and skeletal traction, the intelligent monitoring system, and fixed with the channel screws. RESULTS: The intraoperative blood loss was 50 mL, the operation time was 180 minutes, and the fluoroscopy time was 45 seconds. The incision healed well after operation. The X-ray film of pelvis was taken on the next day after operation, and the fracture reduction was evaluated as anatomical reduction according to Matta standard; CT three-dimensional reconstruction showed that the fixation screws were all located in the cortex of bone, without penetrating the cortex of bone. CONCLUSION: The intelligent monitoring system assisted pelvic fracture closed reduction is reliable in the minimally invasive treatment of complex pelvic fractures, which can achieve good results and reduce intraoperative fluoroscopy.

Treatment of femoral neck nonunion with a new fixation construct through the Watson-Jones approach.

OBJECTIVE: The aim of the study is to explore the clinical effect of a dynamic condylar screw (DCS) system, medial anatomical buttress plate (MABP), and autogenous iliac bone graft through the Watson-Jones approach in the treatment of femoral neck nonunion. METHODS: This prospective study included 15 patients (12 men and 3 women) with nonunion of femoral neck fracture, who were treated with the DCS and MABP with autogenous iliac bone graft through the Watson-Jones approach. The patients were followed up for an average of 16 months (range, 12-24 months). RESULTS: All patients achieved bone healing with an average fracture healing time of 3.4 months (2.8-4.6 months). The Harris score significantly increased from 30 ± 3.9 before the operation to 87.6 ± 7.9 at the last follow-up, and the visual analogue scale significantly decreased from 4 ± 1.3 before the operation to 1 ± 1.7 at the last follow-up. The average limb shortening was reduced from 1.8 cm (range, 0-3.1 cm) before the revision operation to 0.5 cm (range, 0.1-1.3 cm) after the last follow-up. The neck-shaft angle of the injured side was restored from an average of 118° (range, 108-139°) before the revision operation to an average of 132° (range, 127-144°) at the last follow-up. No collapse of the femoral head, wound infections, screw backout, screw or plate breakages, or nerve injury was found. CONCLUSION: TheDCS and MABP with autogenous iliac bone graft through the Watson-Jones approach is an effective option for the treatment of femoral neck nonunion or delayed healing. THE TRANSLATIONAL POTENTIAL OF THE ARTICLE: This article shows that the application of DCS and MABP provides a rigid fixation at the fracture site to promote bone graft integration and bone union. This new kind of technique could be one option of Hip conservation procedures, just special for young patients with femoral neck nonunion.