Combined Fixation Research Articles

Posterior pelvic ring injuries: classification, diagnosis, methods of treatment

This article aimed to familiarize the reader with the features of classification, diagnosis, and treatment methods of posterior pelvic ring injuries. It presents a review of literatures from PubMed (MEDLINE) and eLibrary investigating posterior pelvic ring injuries. A total of 67 scientific papers were covered. Modern aspects of classification, diagnostics, and surgical methods of treatment of the posterior pelvic ring injuries were analyzed. However, the classification of posterior pelvic injuries remains a difficult problem. Currently, various classifications of sacral fractures have been proposed, but sacral fractures cannot be considered separately from the entire pelvic ring because it is not only a part of the spine but also of the pelvis. The gold standard diagnostic modality of a patient with suspected pelvic ring damage is computed tomography, which reduces the frequency of missed or delayed diagnosis of pelvic injuries. Spino-pelvic fixation in combination with iliosacral screws or plate (triangular osteosynthesis) is the most stable technique for the stabilization of the dorsal pelvic ring. However, the higher risks of failure of the postoperative wound and the risks of deep infection with subsequent removal of the metal fixator should be considered. In the absence of clinically significant displacement, but in the presence of pelvic ring instability, minimally invasive methods of the stabilization of the posterior pelvic ring are preferred.

Bridged combined fixation system versus locking plate in the treatment of patients with implant periprosthetic refracture following proximal femoral fracture surgery: A retrospective observational study

Locking plate (LP) re-fixation is mainly used to treat postoperative implant periprosthetic refractures; however, the extensive trauma and the fixation form of LP make the operation difficult. The bridge combined fixation system (BCFS) is a new clip-rod internal fixation system, and its clinical application is in its infancy. To compare the clinical effect of BCFS and LP in the treatment of geriatric postoperative implant periprosthetic refracture following proximal femoral fracture surgery. Thirty-two patients (14 with BCFS and 18 with LP) with postoperative implant periprosthetic refracture following proximal femoral fracture surgery, who underwent surgery in our hospital, were analyzed retrospectively. The incision length, operation time, intraoperative bleeding volume, postoperative drainage volume, postoperative hospital stay, fracture healing time and complications of each patient were recorded. Regular radiographs were taken after the operation to evaluate the fracture reduction and fixation. All the patients were followed for 12 months to evaluate their limb function by Johner-Wruhs scoring criteria. The patients were followed for an average of 24.1 months, and all achieved bony union, with no complications such as infection, nonunion, and internal fixation instrument falling off and loosening after the operation. Delayed healing occurred in two cases in the LP group. The average value of surgical incision length, operation time, postoperative hospitalization time and fracture healing time in the BCFS group were significantly smaller than those in the LP group, accompanied by a decrease in intraoperative bleeding and postoperative drainage volumes (P < .05). The rate of limb function in the BCFS group (85.7%) was higher than that in the LP group (83.3%), with no significance (P > .05). The BCFS in the refracture around the implant of the proximal femoral fracture exhibited many advantages such as simple operation, strong plasticity, effective reduction of surgical trauma, promotion of fracture healing and early functional rehabilitation, etc, making it an advantageous clinical application.

Treatment and outcome in combined scapula and rib fractures: a retrospective study.

The primary aim was to describe the population characteristics of patients with combined scapula and rib fractures and outcomes associated with different treatment strategies. All adult (≥ 18years) patients with concurrent ipsilateral scapula and rib fractures admitted to the study hospital between 1st January 2010 and 31st June 2021 were retrospectively reviewed. A total of 223 patients were admitted with concurrent ipsilateral rib and scapula fractures. A total of 160 patients (72%) were treated conservatively, 63 patients (28%) operatively. Among operatively treated patients, 32 (51%) underwent rib fixation (RF) only, 24 (38%) underwent scapula fixation (SF) only, and seven patients (11%) underwent combined fixation of scapula and ribs (SRF). In general, more severely injured patients were treated with more extensive surgery. RF patients had a median hospital length of stay of 16days, the SF patients 11days and SRF patients 18days. There were no significant differences in complications (pneumonia, recurrent pneumothorax and revision surgery) between groups. Injury severity resulted in different treatment modalities. As a result, different patient characteristics between treatment groups were observed, which makes direct comparison between treatment modalities impossible. All treatment modalities seem feasible; however, the additional value of both rib and scapula fixation has yet to be proven in large multicentre studies.

Recurrent torsion of otherwise normal adnexa: oophoropexy does not prevent recurrence.

Recurrence of adnexal torsion involving otherwise normal adnexa is not rare. Various oophoropexy (ovarian fixation) procedures have been suggested to prevent recurrence; however, long-term information of their efficacy is lacking. The aim of this study was to investigate the recurrence rate of adnexal torsion following oophoropexy. Retrospective cohort study, including all consecutive patients who underwent an oophoropexy procedure for the prevention of recurrent torsion of "normal adnexa" in our department from 2008 to 2019 by shortening of the utero-ovarian ligament. Nineteen patients (age range 7-35years) with a mean follow-up of 90.9 ± 57.7months were identified. Fifteen of them (78.9%) were re-operated for recurrent torsion following an oophoropexy procedure, while four (21.1%) did not experience recurrence. Nine torsion recurrences following an oophoropexy occurred within the first 2 postoperative years. There were no differences in mean age and menarcheal status )pre- or post-menarcheal) at the time of the first torsion event, age at the time of oophoropexy, oophoropexy side, number of adnexal torsion events before oophoropexy, and follow-up duration between those with and those without post-oophoropexy recurrences. Oophoropexy procedure by shortening of the utero-ovarian ligament may not prevent recurrent torsion of otherwise normal adnexa. Further studies to determine whether combined fixation (utero-ovarian and round ligament plication) is more efficacious than isolated utero-ovarian plication for the prevention of recurrent torsion are warranted.

Efficacy of Abductor Pollicis Longus Suspension Arthroplasty Combined With Mini TightRope for Osteoarthritis of Thumb Carpometacarpal Joint.

We aimed to evaluate the efficacy of abductor pollicis longus (APL) suspension arthroplasty with trapeziectomy combined with first and second metacarpal fixation using suture button device. Thirteen patients (14 thumbs) who underwent APL suspension arthroplasty combined with suture button device for osteoarthritis of the carpometacarpal joint of the thumb (Eaton grade III: 6 and IV: 8 thumbs) at our institution between 2015 and 2019 and were followed up for more than 24 months were included in the study. Preoperative and postoperative range of motion (ROM) of radial and palmar abduction, grip and key pinch strength, visual analog scale (VAS) scores for pain, and the trapezial space ratio (TSR) on radiographic images before and after surgery were statistically examined. The mean age of the patients was 59.6 ± 8.1 years, and the mean follow-up period was 45.4 ± 12.2 months. While grip and pinch strength did not significantly change between preoperative and final follow-up measurements, the ROM of radial and palmar abduction and the VAS score at the latest follow-up were significantly better than the preoperative values (P < .05). The mean TSR immediately after surgery and at the latest follow-up was 0.28 ± 0.089 and 0.22 ± 0.084, respectively, indicating a mean reduction rate of 23.3 ± 15.2%. This surgical technique showed significant improvement in the ROM of radial and palmar abduction and the VAS score for pain, and the combined fixation of the first and second metacarpals with suture button device suppressed the subsidence of the first metacarpal.

The clinical outcomes and complications of combined fixation with cannulated screws and the modified Pyrford technique for the treatment of transverse patellar fractures: a case series study

BackgroundTransverse patellar fractures can be fixed using various techniques. The purpose of the current study was to assess the clinical outcomes and complication rate of a combined fixation technique using cannulated screws and the modified Pyrford technique with nonabsorbable polyester sutures.Methods and patientsBetween January 2015 and February 2021, 26 transverse patellar fractures were fixed with this combined technique. Preoperative data were collected from patients with transverse patellar fractures who were followed up for at least 12 months. At each follow-up visit, plain radiographs were taken. At the 12-month postoperative follow-up, range of motion of the affected knee joint and clinical outcomes, as evaluated by the Bostman scoring system, were recorded.ResultsThe average Bostman score at the 12-month postoperative follow-up was 28.3 ± 1.5. Furthermore, the average extension and flexion of the knee joint were 1.2 ± 2.1 and 125.6 ± 6.7 degrees, respectively. One patient experienced delayed bone union and one experienced superficial wound infection. There were no other postoperative complications. One patient required removal of the device for social-psychological reasons.ConclusionsThe combined fixation technique with cannulated screws and the modified Pyrford technique with suture materials produced excellent clinical outcomes and a low rate of complications in the treatment of transverse patellar fractures.

Comparative Analysis of Secondary Outcomes in Treatment of Charcot Neuropathy: A Systematic Review.

Charcot neuroarthropathy (CN) is commonly associated with diabetic neuropathy and can predispose patients to amputations. Management remains a challenge, with no definitive treatment. This study examines major postoperative complications associated with open reduction with internal (intramedullary) nails, fixation, external fixation, or combined internal and external fixation for correction of the deformity. We reviewed available literature using PubMed, OvidSP, Scopus, and Cochrane and searched bibliographies of the included studies to identify additional pertinent references. After review and agreement among 4 raters, a total of 15 studies were included in this analysis. Hardware removal rates were 0.133 for intramedullary nails, 0.007 for external fixators, and 0.050 for combined fixation. Rates of hardware complication were 0.182 for intramedullary nails and 0.007 for external fixators. Wound dehiscence occurred at rates of 0.059 for intramedullary nails and 0.216 for combined fixation. The rate of deep infections was 0.031 for intramedullary nails, 0.032 for external fixators, and 0.113 for combined fixation. The rate of irrigation and debridement was 0.007 for external fixators. Rates of hardware removal (13.3%) and complications (18.2%) were high with intramedullary nails. Dehiscence (21.6%) and deep infection (11.3%) were high in combined fixation. Other complications occurred relatively rarely. Level III.

Hybrid Treatment of Osteochondral Fracture of the Patella With Particulated Juvenile Cartilage and Fragment Fixation

Acute patellar dislocation can result in osteochondral fracture of the patella, resulting in multiple osteochondral fragments, with only one fragment able to be fixated into the defect effectively. In these cases, we propose a hybrid procedure to repair the defect using the fixation of one of the osteochondral fragments and particulated juvenile articulate cartilage to fill the remaining defect in the patella. This technique maximizes the amount of native articular surface that we can preserve on the patella. The use of fragment fixation in combination with particulated juvenile articulate cartilage will help prevent further articular damage to the patella and reduce the risk of developing osteoarthritis in patients suffering from an osteochondral fracture as a result of acute patellar dislocation.

Treatment and outcome in combined scapula and rib fractures

Abstract Objective The primary aim was to describe the population characteristics of patients with combined scapula and rib fractures and outcomes associated with different treatment strategies. Secondarily, a systematic literature review was conducted to provide an overview of the available literature on this population. Methods All adult (≥18 years) patients with concurrent ipsilateral scapula and rib fractures admitted to the study hospital between 1st January 2010 and 31st June 2021 were retrospectively reviewed. Secondarily, the Pubmed, EMBASE and CENRTAL databases were searched to identify studies reporting on this patient population. Results A total of 243 patients were admitted with concurrent ipsilateral rib and scapula fractures. 160 patients (72%) were treated conservatively, 63 patients (28%) operatively. Among operatively treated patients, 32 (51%) underwent rib fixation (RF) only, 24 (38%) underwent scapula fixation (SF) only and 7 patients (11%) underwent combined fixation of scapula and ribs (SRF). In general, more severely injured patients were treated with more extensive surgery. RF patients had a median hospital length of stay of 16 days, the SF patients 11 days and SRF patients 18 days. There were no significant differences in complications (pneumonia, recurrent pneumothorax, and revision surgery) between groups. The systematic review included 9 studies of which none reported on outcomes or treatment strategy for this combined injury. Conclusion Injury severity resulted in different treatment modalities. As a result different patient characteristics between treatment groups were observed, which makes direct comparison between treatment modalities impossible. All treatment modalities seem feasible, however the additional value of both rib and scapula fixation has yet to be proven in large multicentre studies.

Effects of combined adjustable Halo-pelvic fixation brace on cervical spine alignment in patients with severe rigid spinal deformity

ObjectiveTo evaluate the effect of continuous traction with a combined adjustable Halo-pelvic fixation brace on the cervical spine alignment in patients with severe rigid spinal deformity and analyze its related factors.MethodsWe conducted a retrospective cohort study of 21 patients with severe rigid spinal deformity treated in our department between 2015 and 2019. All subjects received combined adjustable Halo-pelvic fixation brace traction before secondary orthopedic surgery. The influence of the Halo-pelvic fixation brace on the cervical spine alignment was evaluated by measuring the parameters of lateral cervical X-ray at three time points: before traction, at the end of traction, and 6 months after orthopedic surgery. The correlation between parameter changes and total traction duration was analyzed to explore factors influencing cervical alignment.ResultsThe C2L-C7L angle was 22.40 ± 15.91° before traction, which decreased to 5.91 ± 6.78° at the end of traction but increased to 14.51 ± 10.07° after orthopedic surgery (BT vs ET p < 0.005, ET vs AOS p < 0.005, BT vs AOS p < 0.005). Accordingly, C2L-C7U angle, C2L-C6L angle, C2L-C6U angle, C2L-C5L angle, C7 or T1 slope, C2-C7 SVA, SCA, C2-T1 Ha, C0 slope, and C0-C2 angle also changed similarly to C2L-C7L angle. Furthermore, moderate correlation was observed between C2L-C7L angle and total traction volume (r = 0.563, p = 0.008) and SCA and traction duration (r = 0.525, p = 0.015). However, no significant correlation was found between other cervical alignment parameters and total traction volume and traction duration.ConclusionsThe continuous traction of a combined adjustable Halo-pelvic fixation brace can affect the cervical spine alignment of patients with severe rigid spinal deformity and straighten the physiological curvature of the cervical spine. However, the sagittal alignment gradually recovers after the traction, without any adverse effects on the orthopedic surgery and global balance after the operation; therefore, this apparatus is worthy of wide application.

Team Approach: Management of Geriatric Acetabular Fractures.

Geriatric acetabular fractures are defined as fractures sustained by patients who are ≥60 years old. With the rapidly aging American populace and its increasingly active lifestyle, the prevalence of these injuries will continue to increase. An interdisciplinary approach is necessary to ensure successful outcomes. This begins in the emergency department with hemodynamic stabilization, diagnosis of the fracture, identification of comorbidities and concomitant injuries, as well as early consultation with the orthopaedic surgery service. This multifaceted approach is continued when patients are admitted, and trauma surgery, geriatrics, and cardiology teams are consulted. These teams are responsible for the optimization of complex medical conditions and risk stratification prior to operative intervention. Treatment varies depending on a patient's preinjury functional status, the characteristics of the fracture, and the patient's ability to withstand surgery. Nonoperative management is recommended for patients with minimally displaced fractures who cannot tolerate the physiologic stress of surgery. Percutaneous fixation is a treatment option most suited for patients with minimally displaced fractures who are at risk for displacing the fracture or are having difficulty mobilizing because of pain. Open reduction and internal fixation is recommended for patients with displaced acetabular fractures who are medically fit for surgery and have a displaced fracture pattern that would do poorly without operative intervention. Fixation in combination with arthroplasty can be done acutely or in delayed fashion. Acute fixation combined with arthroplasty benefits patients who have poorer bone quality and fracture characteristics that make healing unlikely. Delayed arthroplasty is recommended for patients who have had failure of nonoperative management, have a fracture pattern that is not favorable to primary total hip arthroplasty, or have developed posttraumatic arthritis.

Deltoid ligament repair versus trans-syndesmotic fixation for bimalleolar equivalent ankle fractures

IntroductionThe role of deltoid ligament repair is controversial in the treatment of bimalleolar equivalent ankle injuries. Our purpose was to compare midterm functional outcomes and reoperation rates of unstable distal fibula fractures treated with open reduction internal fixation (ORIF) of the fibula and either deltoid ligament repair, trans-syndesmotic fixation, or combined fixation. MethodsSkeletally mature subjects were retrospectively identified after fixation of isolated unstable distal fibula fractures treated at a single academic level 1 hospital from January 2005 to May 2019. The AAOS Foot and Ankle Module outcomes questionnaire (AAOS-FAM) was obtained at a mean time from surgery of 4.6 +/- 3.1 years. Subjects underwent one of three methods of fixation including distal fibula ORIF and one of the following: trans-syndesmotic fixation (N = 66), deltoid ligament repair (N = 16), or combined trans-syndesmotic fixation and deltoid ligament repair (N = 26). Outcomes scores and Charlson Comorbidity Index scores were compared between groups by Kruskal-Wallis testing for non-normally distributed data. Rates of reoperation were compared by Fisher's exact test. Statistical significance was set to P < 0.05 for all comparisons. ResultsThere was no significant difference in AAOS-FAM scores between the three groups (P = 0.18). No subjects in the deltoid ligament repair group underwent reoperation compared to 17 (26%) in the trans-syndesmotic fixation group and six (23%) in the combined fixation group. The most common reason for reoperation was removal of hardware, which was performed in 12 (18%) subjects in the trans-syndesmotic fixation group and three (12%) subjects in the combined fixation group. ConclusionsDirect deltoid ligament repair yields similar functional scores and fewer reoperations compared to trans-syndesmotic fixation at midterm follow up. Deltoid ligament repair may be a favorable treatment strategy when considering trans-syndesmotic fixation in the surgical treatment of unstable distal fibula fractures.

Comparative analysis of the results of surgical correction of idiopathic thoracic scoliosis in patients with active bone growth

Objective. To conduct a comparative analysis of surgical treatment results for idiopathic thoracic scoliosis in patients during active bone growth and to identify the most effective methods of scoliosis correction for the considered age group.Material and Methods. The results of surgical treatment of 343 patients aged 10–14 years with continued active growth and progressive idiopathic thoracic scoliosis were analyzed. The patients were operated on in 1998–2018 using five surgical techniques: hybrid fixation with and without anterior stage, transpedicular fixation, and laminar fixation with and without anterior stage.Results. Statistically significant deformity progression was observed in patients operated on using laminar (Group IV) and hybrid (Group I) fixation. An additional anterior stage (discectomy and interbody fusion) in combination with laminar fixation (Group V) does not prevent deformity progression after surgery. In patients who underwent hybrid fixation in combination with the anterior stage (Group II) or total transpedicular fixation (Group III), no statistically significant progression of scoliotic deformity was observed in the postoperative period. Patients operated on with total transpedicular fixation (Group III) show improvement in all domains of the SRS-24 questionnaire: no increase in pain throughout the entire follow-up period, higher assessment of appearance after surgery and satisfaction with the treatment result. In groups II and III, there was no negative dynamics of topographic parameters in the long-term period after treatment; the initial correction of the deformity was maintained throughout the entire postoperative follow-up.Conclusion. Total transpedicular fixation provides the best correction of scoliosis in the absence of progression in the long-term postoperative follow-up in children during the period of active bone growth (age 10–14 years). According to the survey data, patients operated on with total transpedicular fixation demonstrate improvement in the following domains: the absence of pain syndrome throughout the entire postoperative follow-up period, the highest assessment of appearance after surgery and satisfaction with the result of surgical treatment. Hybrid fixation in combination with the anterior stage and total transpedicular fixation ensure the absence of negative dynamics of topographic parameters in the long term after surgery with maintenance of the initial surgical correction of spinal deformity.

Effectiveness analysis of medial buttress plate augmented hollow lag screws fixation in combination with sartorius pedicled iliac flap for the treatment of femoral neck fractures in young adults

To evaluate the effectiveness of medial buttress plate augmented hollow lag screws fixation in combination with sartorius pedicled iliac flap for the treatment of femoral neck fractures in young adults. The clinical data of 11 young adult patients with femoral neck fractures between February 2013 and February 2019 were analyzed retrospectively. There were 7 males and 4 females with a mean age of 45 years (range, 32-58 years). Fractures were caused by falling from height in 6 cases, by traffic accident in 4 cases, and by sports injury in 1 case. There were 7 cases in the left hip and 4 cases in the right hip. The mean Pauwels angle was 64° (range, 55°-75°). All patients were treated by medial buttress plate augmented hollow lag screws fixation and sartorius pedicled iliac flap. The X-ray film of pelvis, lateral X-ray film of hip joint, CT scan and three-dimensional reconstruction of hip joint were taken after operation to assess fracture healing and position of the internal fixators. The postoperative hip function was evaluated according to the Harris score. All the incisions healed by first intention, and no complication such as incision infection and lateral femoral cutaneous nerve injury happened. Re-examination on the second day after operation showed that reduction and fixation of fractures was good. All patients were followed up 18-36 months (mean, 29 months). All fractures achieved bony union. The time of bony union was 16-23 weeks, with an average of 18.2 weeks. One patient (9.1%) got osteonecrosis of the femoral head (ONFH) at 30 months after operation. At last follow-up, Harris score was used to evaluate hip joint function, 9 cases were excellent, 1 case was good, 1 case was fair, and the excellent and good rate was 90.9%. Medial buttress plate augmented hollow lag screws fixation in combination with sartorius pedicled iliac flap for the treatment of femoral neck fractures in young adults has the advantage of strong biomechanical stability and can effectively improve the blood supply of femoral head and neck, which subsequently reduce the incidence of ONFH. However, the surgical indication should be fully considered.

Tactics of surgical treatment of spondylolisthesis

The results of surgical treatment of 133 patients with spondylolisthesis are analysed. In 60 patients III degree, in 69 IIIIV degree, in 4 patients V degree (spondyloptosis) was diagnosed. Preoperative management included traditional and functional roentgenography of lumbosacral spine, myelography, CT and MRT. Tactics of surgical treatment depended on the degree of spondylolisthesis and clinical-roentgenologic manifestations of the disease. In 32 patients bone plasty was performed (posterior and anterior spondylodesis) without additional metal fixation, in 101 patients bone plastic operations were combined with the metal fixation of the lumbosacral spine. Various types of fixatives were used: external fixation device by Byzov (6 cases), Wilson plates (23), Kazmin distractors (20) and different types of transpedicular constructions (52). Vertebral canal revision was performed only in case of persistent neurologic symptomatology. In patients with III-IV degree of spondylolisthesis either interlaminectomy or laminectomy (in marked spondylolisthesis) was performed under the visual control of the dural sac and roots at the moment of reduction. In cases of high degree of dislocation the surgical treatment was performed in two steps posterior metal fixation was supplemented with the anterior spondylodesis. It is concluded that transpedicular fixation in combination with bone plasty is the method of choice for the surgical treatment of spondylolisthesis. In Ш-IV degree of spondylolisthesis transpedicular fixation is to be combined with the anterior spondylodesis.

Weightbearing after combined medial and lateral plate fixation of AO/OTA 41-C2 bicondylar tibial plateau fractures: a biomechanical study

BackgroundCombined medial and lateral plate fixation is recommended for complex tibial plateau fractures with medial fragments or no cortical bone contact. Although such fixation is adequate to resist forces during range of motion, it may be insufficient to support immediate postoperative weightbearing. Here, we analyzed displacement, stiffness, and fixation failure during simulated full weightbearing of bicondylar tibial plateau fractures treated with combined medial and lateral locking plate fixation.MethodsWe used 10 fresh-frozen adult human cadaveric tibias and mated femurs. Osteotomies were performed with an oscillating saw and cutting template to simulate an AO Foundation and Orthopaedic Trauma Association (AO/OTA) 41-C2 fracture (simple articular, multifragmentary metaphyseal fracture). Specimens were anatomically reduced and stabilized with combined medial and lateral locking plates (AxSOS, Stryker, Mahwah, NJ). Specimens were loaded axially to simulate 4 weeks of walking in a person weighing 70 kg. The specimens were cyclically loaded from 200 N to a maximum of 2800 N. Then, if no failure, loading continued for 200,000 cycles. We measured displacement of each bone fragment and defined fixation failure as ≥5 mm of displacement. Construct stiffness and load at failure were calculated. Categorical and continuous data were analyzed using Chi-squared and unpaired t-tests, respectively.ResultsMean total displacement values after 10,000 loading cycles were as follows: lateral, 0.4 ± 0.8 mm; proximal medial, 0.3 ± 0.7 mm; distal medial, 0.3 ± 0.6 mm; and central 0.4 ± 0.5 mm. Mean stiffness of the construct was 562 ± 164 N/mm. Fixation failure occurred in 6 of 10 specimens that reached 5 mm of plastic deformation before test completion. In the failure group, the mean load at failure was 2467 ± 532 N, and the mean number of cycles before failure was 53,155. After test completion, the greatest displacement was found at the distal medial fracture site (2.3 ± 1.4 mm) and lateral fracture site (2.2 ± 1.7 mm).ConclusionsAlthough combined medial and lateral plate fixation of complex tibial plateau fractures provides adequate stability to allow early range of motion, immediate full weightbearing is not recommended.

Management of LC Type I (LC-1) Pelvic Injuries with Complete Sacral Fracture: Comparison of Solitary Anterior Fixation with Combined Anterior-Posterior Fixation.

Background Management of LC-1 type pelvic injuries, particularly in patients with complete sacral fracture (LC-1 PICSF, OTA type 61-B2.1), remains controversial. Specific indications for solitary fixation remain unclear, and there is a paucity of outcomes data in comparison to combined fixation. We undertook a retrospective study in patients with LC-1 PICSFs to compare outcomes between solitary anterior fixation and combined anterior-posterior fixation. Methods A retrospective cohort study was conducted with enrollment from 2016 to 2018 at a single tertiary-referral center in China. Adults with operatively managed LC-1 PICSFs were enrolled. Patients with sacral displacement < 1 cm as assessed by axial CT received solitary anterior ring fixation (group A); patients with displacement ≥ 1 cm received combined fixation of both the anterior and posterior rings (group B). Reduction was confirmed by manipulation under anesthesia. Patients followed up for at least 24 months postoperatively. Primary outcome was function (Majeed score). Secondary outcomes included intraoperative characteristics, pain (VAS score), quality of fracture reduction (Tornetta and Matta radiographic grading), rate of nonunion, early weight-bearing status, and complication rate. Results 68 (89%) of 76 enrolled patients completed follow-up. Patients in group A exhibited improved operative times, less time under fluoroscopy, and less blood loss as compared to group B. There were no significant differences between groups A and B regarding quality of fracture reduction, rate of union, functional outcomes, or rate of complications. Notably, group B patients were more likely to achieve full early weight-bearing. Conclusion LC-1 PFCSFs can get benefits from ORIF; the treatment algorithm should be differently made following the degree of the sacral fractures displacement. Less than 1 cm sacral fracture displacement may get good functional outcomes from solitary anterior fixation. However, for the sacral fractures displacement greater or equal to 1 cm, both the anterior and posterior pelvic rings should be surgical stabilization.

Breakage of intramedullary femoral nailing or femoral plating: how to prevent implant failure

IntroductionIntramedullary (IM) fixation is the dominant treatment for pertrochanteric and femoral shaft fractures. In comparison to plate osteosynthesis (PO), IM fixation offers greater biomechanical stability and reduced non-union rates. Due to the minimally invasive nature, IM fixations are less prone to approach-associated complications, such as soft-tissue damage, bleeding or postoperative infection, but they are more prone to fat embolism. A rare but serious complication, however, is implant failure. Thus, the aim of this study was to identify possible risk factors for intramedullary fixation (IMF) and plate osteosynthesis (PO) failure.Materials and methodsWe searched our trauma surgery database for implant failure, intramedullary and plate osteosynthesis, after proximal—pertrochanteric, subtrochanteric—or femoral shaft fractures between 2011 and 2019. Implant failures in both the IMF and PO groups were included. Demographic data, fracture type, quality of reduction, duration between initial implantation and nail or plate failure, the use of cerclages, intraoperative microbiological samples, sonication, and, if available, histology were collected.ResultsA total of 24 femoral implant failures were identified: 11 IMFs and 13 POs. The average age of patients in the IM group was 68.2 ± 13.5 years and in the PO group was 65.6 ± 15.0 years, with men being affected in 63.6% and 39.5% of cases, respectively. A proximal femoral nail (PFN) anti-rotation was used in 7 patients, a PFN in one and a gamma nail in two patients. A total of 6 patients required cerclage wires for additional stability. A combined plate and intramedullary fixation was chosen in one patient. Initially, all intramedullary nails were statically locked. Failures were observed 34.1 weeks after the initial surgery on average. Risk factors for implant failure included the application of cerclage wires at the level of the fracture (n = 5, 21%), infection (n = 2, 8%), and the use of an additional sliding screw alongside the femoral neck screw (n = 3, 13%). In all patients, non-union was diagnosed radiographically and clinically after 6 months (n = 24, 100%). In the event of PO failure, the placement of screws within all screw holes, and interprosthetic fixation were recognised as the major causes of failure.ConclusionIntramedullary or plate osteosynthesis remain safe and reliable procedures in the treatment of proximal femoral fractures (pertrochanteric, subtrochanteric and femoral shaft fractures). Nevertheless, the surgeon needs to be aware of several implant-related limitations causing implant breakage. These may include the application of tension band wiring which can lead to a too rigid fixation, or placement of cerclage wires at the fracture site.

Особенности интрамедулярного остеосинтеза грудных конечностей у кошек

The purpose of the study: to study the features of the treatment of fractures of the metacarpal bones in cats using intramedullary osteosynthesis. The study included 14 cats with injuries to one or more metacarpals. Fractures in each cat were classified after viewing radiographs according to topography and type (transverse, oblique, or comminuted) of fractures. Group 1 (n=8) was treated with a pin. Osteosynthesis was performed for closed fractures involving only one metacarpal bone. Group 2 (n=6) was treated by combined pinning with external coaptation. Intramedullary fixation has been used in Russia for more than 25 years to treat fractures of the ulna and radius, but metacarpal bones in general are rarely treated surgically, so these studies are relevant. Metacarpals III (n=9) and IV (n=13), which carry the main load, were most often affected, metacarpal II (n=6) was less common, metacarpal I was not broken in anyone. Of the 14 cats, 11 (78.5 %) had associated injuries. Intramedullary osteosynthesis or intramedullary osteosynthesis in combination with external co-optation gives positive results. The outcome of intramedullary fixation in combination with external co-option was satisfactory when the fixed bones served as a support for short and fragmented bones and helped to maintain a normal position. As the number of bone fractures increased, so did the incidence of malunion and, in multiple fractures, external coaptation does not maintain proper alignment during the healing period.

Preliminary analysis of the clinical characteristics of 1 012 patients with secondary lower limb deformity of spina bifida from QIN Sihe Orthopedic Surgery Case Data between October 12, 1986 and December 31, 2020

To analyze the characteristics of patients with secondary lower limb deformity of spina bifida based on the QIN Sihe Orthopedic Surgery Case Data, and provide the references for clinical research, diagnosis, and treatment. A clinical data of 1 012 patients with secondary lower limb deformity of spina bifida between October 12, 1986 and December 31, 2020 selected from QIN Sihe Orthopedic Surgery Case Data was retrospectively analyzed. Among them, 231 cases (22.83%) had undergone orthopedic surgery for lower extremity deformities in other hospitals. The gender, age at surgery, indicators related to spina bifida (deformity side, comorbidity, sensory disturbance level), and information related to surgery (operating time, surgical site, postoperative fixation method) were analyzed. Of the 1012 patients, 457 were males and 555 were females. The age was 3-51 years at the time of surgery, with a median of 18.0 years; among them, the 15-30 years old group had the most patients, accounting for 53.16%. Most deformities involved both lower limbs (652 cases, 64.43%). There were 111 cases of ulcers in the weight-bearing area of the foot, 265 cases of gatism, 554 cases of sensory disturbance, and 85 cases of abnormal hair on the waist. From 2010 to 2019, there were significantly more patients undergoing surgery than before 2010, reaching 61.17%. Sensory disturbances mostly occurred in the ankle and foot. A total of 1 149 sites were treated with surgery, of which the most ankle joint deformities were corrected by surgery, accounting for 84.33%. The main fixation methods after orthopedic surgery were external fixation, including Ilizarov external fixation (442 cases), combined external fixation (315 cases), and plaster fixation (189 cases). Spina bifida can be secondary to severe deformities of the lower limbs, mainly in the ankles. Common complications include ulcers in the weight-bearing area, dysfunction of urine and feces, and sensory disturbances; external fixation is the main method of fixation after surgery.