Complications Of Fixation Research Articles

Comparison of spinopelvic fixation and iliosacral screw fixation for posterior pelvic ring injuries.

There is no consensus in the literature regarding the optimal treatment method for posterior pelvic ring injuries. This study aims to compare the radiologic and clinical outcomes, as well as complications of spinopelvic fixation (SPF) and iliosacral screw fixation (ISF) in patients with posterior pelvic ring injuries. This retrospective study analyzed 54 patients (37 females, 17 males; mean age 38.9±18.7 years) with pelvic ring injuries classified as Tile type B and type C involving the posterior pelvic ring. These patients were treated with either SPF or ISF and followed for at least one year at two centers between 2016 and 2023. Of these, 28 patients comprised the SPF group, and 26 patients were in the ISF group. Comparisons were made regarding perioperative data (hemoglobin loss, blood product replacement, hospitalization duration, intensive care unit stay, surgery time, and fluoroscopy duration) and clinical outcomes (limb length discrepancy, Majeed score, visual analogue scale (VAS) score, and Short Form-36 (SF-36) score). Radiological outcomes were assessed using Matta outcome grading. Complications were also investigated. Hemoglobin loss (median 2.2 vs. 1 g/dL; p=0.027) and surgery time (67±10.6 vs. 37.7±11.3 minutes; p<0.001) were higher in the SPF group, whereas fluoroscopy duration (median 2 vs. 51.5 seconds; p<0.001) was higher in the ISF group. Other perioperative parameters did not differ between the groups. At a minimum follow-up of one year, clinical scores (Majeed score, VAS, SF-36), limb length discrepancy, and Matta outcome grades were similar between the groups. The SPF group had higher total complication rates (46.4% vs. 19.2%; p=0.034) and infection rates (42.9% vs. 3.8%; p<0.001), while rates of neurological deficits, screw malposition, and other hospitalization complications (e.g., thromboembolic or cardiovascular events, pulmonary complications, sepsis) were not significantly different. Both spinopelvic fixation and iliosacral screw fixation techniques are similarly effective in terms of clinical and radiological outcomes, with both methods demonstrating a low rate of complications. However, SPF was associated with higher infection rates and greater hemoglobin loss, while ISF required increased fluoroscopy exposure.

Clinical outcomes of open reduction and internal fixation combined with sartorius muscle iliac bone graft transplantation for displaced femoral neck fractures in middle-aged and young adults: a retrospective analysis of 24 cases

ObjectiveThis study aimed to evaluate the clinical outcomes and complications of open reduction and internal fixation (ORIF) combined with sartorius muscle iliac bone graft transplantation (SIBFT) in the treatment of displaced femoral neck fractures in middle-aged and young adults.MethodsA retrospective analysis was performed on 26 patients under the age of 60 with displaced femoral neck fractures (Pauwels III or Garden III-IV) treated at our institution between April 2019 to July 2022. All patients underwent open reduction and internal fixation (ORIF) through the Smith-Petersen (S-P) approach, augmented with a sartorius muscle iliac bone graft transplantation.The fractures were secured with either three cannulated screws or three cannulated screws combined with a medial support steel plate. Postoperative follow-ups were scheduled at 1, 2, 3, 6, and 12 months to record bone healing time, complications, and assess Harris Hip Scores.ResultsTwo patients were lost to follow-up, resulting in 24 patients who completed the follow-up with an average duration of 25.7 months. Bone healing was observed in 95.8% (23/24) of the patients, with a mean healing time of 5.0 months. Avascular necrosis of the femoral head occurred in 8.3% (2/24) of the patients after fracture healing. Harris Hip Score at the last follow-up was 89.75 (range 73–98).ConclusionOur preliminary results suggest that ORIF combined with sartorius muscle iliac bone graft transplantation for the treatment of displaced femoral neck fractures in middle-aged and young adults achieved satisfactory clinical outcomes.

Postoperative complications of intrascleral intraocular lens fixation: A systematic review and meta-analysis.

Our systematic review and meta-analysis elucidates the postoperative complication rates associated with 3 major surgical approaches, including the scleral tunnel, glued, and flanged techniques, for sutureless intrascleral intraocular lens (IOL) fixation. An online search was performed for articles published in PubMed and EMBASE between January 1, 1975, and January 7, 2023. Original studies reporting postoperative complications of sutureless intrascleral IOL fixation were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The initial search yielded 1854 articles, from which 1797 were excluded; 57 and 51 were included in the qualitative synthesis and meta-analysis, respectively. Based on the meta-analysis, the postoperative complication rates of cystoid macular edema (5.7 %), retinal detachment (3.5 %), vitreous hemorrhage (8.8 %), and hypotony (5.5 %) were highest with the scleral tunnel technique. The glued technique had the highest complication rate for corneal edema (14.2 %). The rates of temporarily elevated intraocular pressure (9.9 %), iris capture (5.4 %), haptic exposure (6.5 %), and IOL decentration (7.3 %) were the highest with the flanged technique. The flanged technique had a significantly shorter operative time (median, 17.1 min) compared with the scleral tunnel (42.7 min) and glued (56.5 min) techniques. Postoperative best-corrected visual acuity with the flanged technique was significantly better than that with the other techniques (P = 0.017). This meta-analysis identified high postoperative complication rates related to the impact of surgical manipulations with the scleral tunnel technique and IOL placement stability with the flanged technique. These findings enable surgeons to minimize postoperative complications in high-risk patients.

Oral Commissure Ulcer in an Extremely Preterm Infant: A Complication of Endotracheal Tube Fixation at Contralateral Oral Commissure During Lateral Positioning

Oral Commissure Ulcer in an Extremely Preterm Infant: A Complication of Endotracheal Tube Fixation at Contralateral Oral Commissure During Lateral Positioning

Optimizing surgical management of acetabulum fractures involving both columns using buttress plating of posterior column through AIP approach

IntroductionAcetabulum fractures involving both columns are complicated injuries to treat, and achieving satisfactory post operative reduction with less extensile approaches is difficult. These injuries often require dual approaches, associated with their own share of complications. The anterior intrapelvic approach (AIP) addresses both columns through a single approach, minimizing these complications. Specifically, posterior column fixation is of utmost importance. This study aims to evaluate functional outcomes and complications of posterior column fixation using medial surface buttress plate in fractures involving both columns. Materials and methodsBetween 2017 and 2024, 366 patients had fractures involving both columns, out of which 64 were operated using the AIP approach. Excluding patients with displaced posterior wall fractures, transverse fractures, delayed treatment, or aged under 18 years. Out of 64, we collected data from 60 patients, as 4 patients could not be followed up. All patients were operated using the AIP approach, and posterior column fixation was done using 3.5 mm reconstruction plates. Patients were followed for minimum 6 months–70 months, with an average of 29 months. The associations between variables and functional outcomes were examined using the Chi-Square Test or Fisher's Exact Test. ResultsThe study included 60 patients, with 48.3 % under 40 years old and 51.7 % older. Males comprised 68.3 % of the cohort. 46.7 % sustained road traffic accidents and 53.3 % had fall from height. T-type fractures were most common (50.0 %), with high posterior column fractures in 66.7 % of patients. Post-operative reductions less than 1 mm were achieved in 80.0 % of patients. Functional outcomes using the Harris hip Scores were found to be excellent to good in 90.0 % of patients. ConclusionWe conclude that medial surface buttress plating of the posterior column using the standard AIP approach can be utilised to treat even the most complex of acetabular fracture patterns involving both anterior as well as posterior columns, excluding those that contain a displaced posterior wall.

Can tip-apex distance and calcar reference tip-apex distance predict lag screw cut-out in elderly patients with trochanteric femoral fractures treated with gamma3 nails

Background: The most common complication of cephalomedullary nail fixation for femoral fractures is lag screw cut-out. The significance of the tip-apex distance (TAD) in predicting lag screw cut-out is still debated. There has been no study conducted on the calcar reference tip-apex distance (CalTAD) regarding its impact on lag screw cut-out. To compare the average TAD and CalTAD between groups with and without lag screw cut-out and to determine the TAD and CalTAD values associated with the highest risk of lag screw cut-out. Methods: This was a prognostic prediction study utilizing a retrospective cohort of 756 patients with trochanteric femoral fractures treated with Gamma3 nails. This study compared the differences in TAD and CalTAD values between the two groups. Results: The group without lag screw cut-out had lower TAD and CalTAD values compared to the group with lag screw cut-out (TAD; 20.3±5.3 mm vs. 22.1±5.7 mm; p=0.044); (CalTAD 22.3±4.4 mm vs. 25.2±5.3 mm; p&lt;0.001). The cutoff points of TAD &gt;23 mm and CalTAD &gt;25 mm were associated with the highest risk of lag screw cut-out (TAD: OR, 2.91; 95% CI, 1.47-5.77; p=0.002); (CalTAD: OR, 3.43; 95% CI, 1.73-6.80; p&lt;0.001). Conclusions: The lag screw cut-out group had higher TAD and CalTAD values. TAD values greater than 23 mm and CalTAD values greater than 25 mm were associated with the highest risk of lag screw cut-out.

Risk factors for nonunion in femoral neck fracture patients with internal fixation: A multicenter (TRON group) retrospective study

IntroductionFemoral neck fractures (FNFs) are common in elderly individuals. When minimally displaced, they are typically treated with internal fixation. Nonunion is a complication of internal fixation of FNF, that sometimes necessitates reoperation. Radiographic parameters, including the Pauwels angle and posterior tilt angle, are risk factors for nonunion. However, these parameters are assessed solely in a two-dimensional context. We developed a novel radiographic parameter named the “Kindex.” This multicenter investigation aimed to identify risk factors for nonunion following FNF fixation and evaluate the validity of this index. MethodsThis retrospective multicenter study collected data from 939 FNF patients who underwent internal fixation between 2016 and 2020 at 11 facilities (TRON group). The following exclusion criteria were applied: age <65, insufficient data, and Garden Stage III or IV fracture. Patient data, including age, sex, BMI, ASA classification, alcohol and smoking history, and comorbidities, were recorded. Radiographic measurements of the Pauwels angle and posterior tilt angle at the time of injury were used to calculate the Kindex. Correlations between the Pauwels angle, posterior tilt angle, Kindex, and nonunion were evaluated. A multivariate logistic regression analysis was performed to investigate independent risk factors for nonunion. A receiver operating characteristic (ROC) analysis was performed to determine the cutoff value of the Kindex, and the area under the curve (AUC) was calculated. ResultsThe study included 594 patients (males, n = 151; females, n = 443; average age, 80.9 years). Nonunion was observed in 13 cases (2.2 %). While the Pauwels angle and posterior tilt angle did not show significant correlations, the Kindex exhibited strong correlations with both parameters. In the multivariate analysis, the Kindex and renal impairment were independent risk factors for nonunion (Kindex: OR 1.06, p = 0.015; renal impairment: OR 1.48, p = 0.021). In the ROC analysis, a Kindex of 50 was identified as the optimal cutoff value (AUC 0.72). ConclusionThe nonunion rate after internal fixation of FNF was 2.2 %. Renal impairment and the Kindex were identified as independent risk factors. The Kindex at the time of injury may serve as a novel radiographic parameter to consider when evaluating the need for internal fixation in FNF cases.

Internal Fixation of Geriatric Native Distal Femur Fractures: A Systematic Review

Abstract Background Distal femur fractures account for 4-6% of osteoporosis related fractures of the femur in the elderly population. As life expectancy continues to increase, the population worldwide is ageing, and the number of individuals over 65 years of age is increasing and hence the incidence of distal femur fractures in elderly. Objectives management of geriatric distal femur fractures by surgical fixation whether locked plate or Retrograde intra medullary nail. Data Sources Data Sources: PubMed, Embase, and Cochrane databases were searched for English language articles up to April 24, 2022, identifying 2500 papers Study Selection studies discussing the outcomes and complications of post op fixation of distal femur either by locked plated, double plating, NP or RIMN Data Extraction one study provided Level III evidence, whereas the remaining 16 studies provided Level IV evidence. Studies were formally evaluated for methodological quality using established criteria. Treatment failure between groups was compared using an Odds rate ratio. Data Synthesis Treatment failure was defined for locked plating, double plating and RIMN for reasons such as mechanical failure, nonunion, deep and superficial infection, ROM and extensor mechanism disruption, revision surgeries. There were no significant differences in most of the outcomes and complication rates with some advantageous ROM in plates and lower infection in nails. Conclusions biological fixation overall provides lower complication rates with no significance between RIMN and locked plates in Extra articular fractures. no strong conclusions can be effectively made between the methods of fixations with both offering very good results overall, more prospective research with unified items for data resemblance across different studies should be made.

Global trends of Pauwels type III femoral neck fractures: bibliometric analysis and visualized study.

Pauwels type III femoral neck fractures, as a serious type of femoral neck fractures, have brought about a heavy economic burden on families and society for the high disability rate. Through bibliometric research and visualized analysis, this study aimed at elucidating the global research status of Pauwels type III femoral neck fractures to date, and predicting the future research trends in this field. Publications and associated information on Pauwels type III femoral neck fractures to date were retrieved from Web of Science Core Collection, and by VoSviewer and R package "bibliometrix", bibliometric analysis and visual presentation was conducted. By retrieval, a total of 98 studies were refinedly extracted, and the volume of publications in this field increased year-over-year. China ranked first in terms of total publication volume and H-Index, with its total citation records second only to the United States. The country with the highest average citation frequency was Switzerland. SHANGHAI JIAO TONG UNIVERSITY was the most productive research institution. Among the authors in this field, Li, Jiantao had published the most researches. INJURY INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED and JOURNAL OF ORTHOPAEDIC TRAUMA were the two magazines with the highest publication volume, total citation records, and H-index. According to keywords co-occurrence analysis, the research content in the past 24 years is mainly divided into four different dimensions. Finite element analysis, femoral neck system, medial buttress plate, cannulated screws, hip screw, open reduction, complications are hot topics for future research. According to the global trends analysis of publications production, Pauwels type III femoral neck fractures are receiving increasing attention and input from scholars. China has made the greatest scientific research contribution among countries, but its academic quality should be improved further. The modified therapeutic methods designed for addressing the complications of traditional internal fixation for Pauwels III femoral neck fractures will be the future research hotspot.

Patient-specific finite element analysis of four different fixation methods for transversely unstable radial head fractures

Plate fixation is a common treatment option for radial head fractures (RHFs). Due to the benefits of less invasiveness and fewer complications of internal fixation, the application of small-diameter headless compression screws (HCSs) to treat RHFs has become a new trend. This study aimed to compare the mechanical stability of four distinct internal fixation protocols for transversely unstable RHFs via finite element analysis. Using computed tomography data from 10 patients, we developed 40 patient-specific FE models of transversely unstable RHFs fixed by parallel, crossed, and tripod HCSs and mini-T plate (MTP). Under simulated physiological loading of the elbow joint, the construct stiffness, displacement, and von Mises stresses were evaluated and verified by a biomechanical experiment. Under shear loading, the MTP group exhibited lower construct stiffness, larger displacement, and higher Von Mises stress than the HCSs group. The stiffness of tripod HCSs was greater than parallel and crossed screw fixation techniques. There was a strong relationship between apparent bone density and construct stiffness (R = 0.98 to 0.99). In the treatment of transversely unstable RHFs, HCSs have superior biomechanical stability than MTP. The tripod technique was also more stable than parallel and crossed fixation.

Do Postoperative Surgeon Phone Calls Improve Outcomes Following Mandibular Fracture Repair?

Complications of open reduction and internal fixation (ORIF) of mandibular fractures are influenced by several patient factors. A postoperative surgeon phone call could modify these factors through education and reinforcement of instructions, but its effect has not been studied. The purpose of this study was to measure and compare the frequencies of postoperative inflammatory complications (POICs) following ORIF of mandibular fractures in patients who did and did not receive a postoperative surgeon phone call. The authors conducted an ambispective cohort study consisting of patients with mandibular fractures treated with ORIF at a large urban trauma hospital with the prospective cohort from January 1, 2021 to March 31, 2022 and a retrospective cohort from April 1, 2020 to December 31, 2020. Prisoners and patients with gunshot wounds were excluded. The primary predictor variable was the surgeon call group. After January 2021, a postoperative call was implemented 1-3days following fracture repair to review instructions, such as nonchew diet and oral hygiene, and provide education, such as reviewing expectations. Prior to January 2021, patients were not called. This resulted in 3 categories: Not Called, Called and Answered, and No Answer. The primary outcome variable was POICs, defined as the occurrence of exposed or infected hardware, abscess formation, recurrent swelling/pain, nonunion, osteomyelitis, or fistula formation. Demographic variables, injury-related variables, and treatment-related variables were also measured. Statistical analysis was performed using Fisher's exact and Wilcoxon rank-sum tests, as well as multivariable logistic regression. A P value was considered significant if<.05. Of the 178 patients in the study, 137 (77%) were male and the average age was 39.9±12.6years. Sixty-five patients (36.5%) were not called. Of the patients called, 79 (44.4%) answered and 34 (19.1%) did not answer. POICs occurred in 9.2% of the Not Called group and 8.9% of the Called and Answered group (P=.99). In the No Answer group, 29.4% had POICs, which was higher than the other 2 groups (P=.01). A surgeon phone call was not associated with complication rates; however, patients in the No Answer group were significantly more likely to experience a POIC.

Cannulated compression screws with cable technique leads to a dramatic reduction in patella fracture fixation complications compared to tension band wiring.

The aim of this study was to compare the clinical, radiological and functional outcomes between cannulated compression screw with cable construct (CS) and tension band wiring (TBW) in transverse patella fractures. A retrospective study was conducted on patients surgically treated for AO/OTA 34C1 or 34C2 transverse patella fractures with CS or TBW technique between January 2019 and January 2023. Clinical outcomes included complications related to the implant, wound and fracture at 6 months and 1 year, time to achieving full weight bearing status and early perioperative clinical outcomes. Radiological outcomes included the time to fracture heals and delayed union. Functional outcome measures using the Oxford Knee Scale, 36-short form questionnaire and the Bartlett Anterior Knee Score were assessed. 73 patients were treated with CS (n = 33) or TBW (n = 40). TBW had higher complication rates: 25.0% (n = 10) required implant removal, 12.5% (n = 5) had wire breakage, 12.5% (n = 5) experienced fracture displacement while 52.5% (n = 21) experienced implant migration. In contrast, no CS patients had implant removals, wire breakage or fracture displacement and 3.0% (n = 1) experienced implant migration. At 1day post-operatively, 87.9% (n = 29) CS group patients were able to ambulate as compared to the 55.0% (n = 22) of TBW patients. Furthermore, CS patients ambulated further distances at 11.8 ± 10.6m than the TBW group (6.4 ± 7.4m). The CS group (25.9 ± 24.6 days) also achieved full weight bearing status faster than the TBW group (43.6 ± 39.4 days). The time taken for the fracture to heal and functional outcomes were comparable among the two groups. The CS technique demonstrated lower complications, in particular, no CS patient had implant removals, wire migration or fracture displacement. Additionally, CS technique showed a faster return to ambulation and time to achieving full weight bearing status.

Transiliac-Transsacral Screw Fixation is Superior to Lumbopelvic Stabilization in the Treatment of Minimally Displaced Sacral H-/U-Type Fragility Fractures.

Retrospective Cohort Study. To compare the outcomes and complications of transiliac-transsacral screw fixation (TIS) and lumbopelvic fixation (LPS), the 2 most common fixation methods for nondisplaced and minimally displaced H-/U- type sacral fragility fractures. Medical records of patients treated with TIS or LPS for nondisplaced and minimally displaced H-/U-type sacral fragility fractures at 2 level A trauma centers between 2012 and 2022 were analyzed. Postoperative low back pain and mobility levels were assessed as primary outcomes before discharge and at 6weeks and 6months postoperatively. Surgery time, blood loss, and surgical complication rates were assessed as secondary outcomes. Statistical analyses consisted of Fisher's exact tests for frequency distributions and Mann-Whitney-U tests and t-tests for group comparisons. 52 patients undergoing TIS (mean age: 78 ± 9years) and 36 patients undergoing LPS (74 ± 10years) with no discrepancy in demographic parameters were identified. There were no differences in low back pain levels between the 2 groups before surgery, before discharge, at 6weeks postoperatively, and at 6months postoperatively (P > 0.05). There were no differences in mobility levels before surgery, before discharge, at 6weeks postoperatively, and at 6months postoperatively (P > 0.05). Duration of surgery was shorter after TIS (36 ± 13min) compared to LPS (113 ± 31min) (P < 0.0001). Intraoperative blood loss was lower for TIS (median <20mL) compared to LPS (median 125mL) (P < 0.0001). Postoperative radiculopathy was less frequent after TIS (n = 1) compared to LPS (n = 3) (P > 0.05). Median length of stay was shorter after TIS (11days) compared to LPS (14days) (P < 0.05). Rates of reoperations directly related to the index surgery were lower after TIS (n = 2) compared to LPS (n = 10) (P < 0.01). Implant failures were observed only after LPS (n = 1). Patients with nondisplaced and minimally displaced H-/U- type sacral fragility fractures may preferably be treated using TIS, as it is equivalent to LPS in terms of low back pain reduction and restoration of mobility, but allows for shorter operative time, less blood loss and lower reoperation rates. Prospective randomized studies should be conducted to substantiate our findings and develop distinct treatment recommendations.

Functional outcomes and complications of anatomical plate and screw fixation in closed olecranon fractures: A prospective case study

Functional outcomes and complications of anatomical plate and screw fixation in closed olecranon fractures: A prospective case study

Syndesmotic fixation in Weber B ankle fractures: A systematic review.

Weber Type B fractures often arise from external rotation with the foot supinated or pronated. Altered tibiofibular joint kinematics in Weber B fractures are responsible for syndesmotic damage seen in Weber B fractures. Weber B fractures are managed using open reduction and internal fixation if displaced. The syndesmosis is injured in up to 40% of cases resulting in an unstable injury with a syndesmotic diastasis. This systematic review aimed to evaluate the current literature on syndesmotic fixation in Weber B fractures, assess the outcomes and complications of syndesmotic fixation and assess the necessity of syndesmotic fixation in Weber B fractures. A search was carried out on the EMBASE, PubMed and CINAHL databases and eight studies assessing the outcomes of syndesmotic fixations versus no syndesmotic fixation with 292 Weber B ankle fractures were included in this systematic review. Results showed significant heterogeneity so a narrative review was conducted. Results of these studies showed that functional, radiological, and quality-of-life outcomes and incidences of post-traumatic osteoarthritis in patients with syndesmotic screws were similar to those of patients not managed with syndesmotic screws. Only one favoured syndesmotic fixation in all cases of diastasis. As such, syndesmotic fixation with screws may not be necessary in the management of Weber B fractures. Screws are also associated with breakage, loosening, local irritation and infections. Suture button devices and antiglide fixation techniques appear to be valid alternatives to syndesmotic screws. It was found that there was no need for routine hardware removal unless the hardware was causing significant side effects for the patient.

Biomechanical Properties of Novel Porous Scaffold Core and Hollow Lateral Hole Pedicle Screws: A Comparative Study in Bama Pigs.

Screw loosening is a common complication of internal fixation of pedicle screw. Therefore, the development of a pedicle screw with low loosening rate and high biosafety is of great clinical significance. This study aimed to investigate whether the application of a porous scaffold structure can improve the stability of pedicle screws by comparing the biomechanical properties of novel porous scaffold core pedicle screws (PSCPSs) with those of hollow lateral hole pedicle screws (HLHPSs) in a porcine lumbar spine. Thirty-two pedicle screws of both types were implanted bilaterally into the L1-4 vertebrae of four Bama pigs, with our newly designed PSCPSs on the right and HLHPSs on the left. All the Bama pigs were sacrificed 16 weeks postoperatively, and the lumbar spine was freed into individual vertebrae. Biomechanical properties of both the pedicle screws were evaluated using pull-out tests, as well as cyclic bending and pull-out tests, while the mechanical properties were assessed using three-point bending tests. The data generated were statistically analyzed using paired-sample t-tests and two independent sample t-tests. We found that the maximal pull-out forces before and after cyclic bending of the PSCPSs (1161.50 ± 337.98 N and 1075.25 ± 223.33 N) were significantly higher than those of the HLHPSs (948.38 ± 194.32 N and 807.13 ± 242.75 N) (p < 0.05, p < 0.05). In 800 cycles of the bending tests, neither PSCPS nor HLHPS showed loosening or visible detachment, but their maximal pull-out forces after cyclic bending tests decreased compared to those in cycles without cyclic bending tests (7.43% and 14.89%, respectively), with no statistical significance (p > 0.05 and p > 0.05, respectively). Additionally, both screws buckled rather than broke in the three-point bending tests, with no statistically significant differences between the maximal bending load and modulus of elasticity of the two screws (p > 0.05 and p > 0.05, respectively). Compared with the HLHPSs, the PSCPSs have greater pull-out resistance and better fatigue tolerance with appropriate mechanical properties. Therefore, PSCPSs theoretically have significant potential for clinical applications in reducing the incidence of loosening after pedicle screw implantation.

PROPOSAL OF A MODIFIED TIP APEX DISTANCE FOR PREDICTION OF LAG SCREW CUT-OUT IN TROCHANTERIC HIP FRACTURES

Lag screw cut-out is a serious complication of dynamic hip screw fixation in trochanteric hip fractures. Lag screw position is recognised as a crucial factor influencing the occurrence of lag screw cut-out. We propose a modification of the Tip Apex Distance (TAD) and hypothesize that it could enhance the reliability of predicting lag screw cut-out in these injuries.A retrospective study of hip fracture cases was conducted from January 2018 to July 2022. A total of 109 patients were eligible for the final analysis. The modified TAD was measured in millimetres, based on the sum of the traditional TAD in the lateral view and the net value of two distances in the anteroposterior (AP) view. The first distance is from the lag screw tip to the opposite point on the femoral head along the lag screw axis, while the second distance is from that point to the femoral head apex. The first distance is a positive value, whereas the second distance is positive if the lag screw is superior and negative if it is inferior. Receiver operating characteristic (ROC) curve analysis was used to assess the reliability of various parameters for evaluating the lag screw position within the femoral head.Factors such as reduction quality, fracture pattern according to the AO/OTA classification, TAD, Calcar-Referenced TAD, Axis Blade Angle, Parker’s ratio in the AP view, Cleveland Zone 1, and modified TAD were statistically associated with lag screw cut-out. Among the tested parameters, the novel parameter exhibited 90.1% sensitivity and 90.9% specificity for predicting lag screw cut-out at a cut-off value of 25 mm, with a p-value &lt; 0.001.The modified TAD demonstrated the highest reliability in predicting lag screw cut-out. A value of 25 mm may potentially reduce the risk of lag screw cut-out in trochanteric hip fractures.

CEPHALOMEDULLARY NAILING FOR SUBTROCHANTERIC FEMORAL SHAFT FRACTURES: A COMPARISON OF SINGLE LAG SCREW DEVICE WITH AN INTERCALATED DUAL SCREW DEVICE

Subtrochanteric femoral fractures are a subset of hip fractures generally treated with cephalomedullary nail fixation\[1\]. Single lag screw devices are most commonly-used, but integrated dual screw constructs have become increasingly popular\[2,3\]. The aim of this study was to compare outcomes of fixation of subtrochanteric femoral fractures using a single lag screw (Gamma3 nail, GN) with a dual screw device (InterTAN nail, IN). The primary outcome was mechanical failure, defined as lag screw cut-out, back-out, nail breakage or peri-implant fracture.Consecutive adult patients (18yrs) with subtrochanteric femoral fracture treated in a single centre were retrospectively identified using electronic records. Patients that underwent surgical fixation using either a long GN (2010–2017) or IN (2017–2022) were included. Medical records and radiographs were reviewed to identify complications of fixation. Cox regression analysis was used to determine the risk of mechanical failure and secondary outcomes by implant design. Multivariable regression models were used to identify predictors of mechanical failure.The study included 622 patients, 354 in the GN group (median age 82yrs, 72% female) and 268 in the IN group (median age 82yrs, 69% female). The risk of any mechanical failure was increased two-fold in the GN group (HR 2.44 \[95%CI 1.13 to 5.26\]; _p=0.024_). Mechanical failure comprising screw cut-out (_p=0.032_), back-out (_p=0.032_) and nail breakage (_p=0.26_) was only observed in the GN group. Technical predictors of failure included varus &gt;5° for cut-out (OR 19.98 \[2.06 to 193.88\]; _p=0.01_), TAD;25mm for back-out (8.96 \[1.36 to 58.86\]; p=0.022) and shortening 1cm for peri-implant fracture (7.81 \[2.92 to 20.91\]; _p=&lt;0.001_).Our results demonstrate that an intercalated screw construct is associated with a lower risk of mechanical failure compared with the a single lag screw device. Intercalated screw designs may reduce the risk of mechanical complications for patients with subtrochanteric femoral fractures.

Comparison of complications of intrascleral fixation according to the extent of vitrectomy

BackgroundIntraocular lens (IOL) fixation is performed after intraoperative anterior or total vitrectomy. This study aimed to compare the intraoperative and postoperative complications of these two techniques.MethodsThis retrospective study included 235 eyes that underwent intrascleral fixation surgery at our hospital between July 2014 and January 2021. The eyes were classified into the anterior vitrectomy group (A-vit group; 134 eyes) and the pars plana vitrectomy group (PPV group; 101 eyes). The age, preoperative and postoperative best-corrected visual acuity, observation period, preoperative and postoperative intraocular pressure, and the incidence of intraoperative and postoperative complications were assessed.ResultsIntrascleral fixation was performed more frequently in the PPV group, and a significant difference was observed between the eyes with a history of vitrectomy and eyes with scleral buckles (p = 0.00041). In terms of the incidence of postoperative complications following intrascleral fixation, the incidence of low intraocular pressure postoperative was higher in the PPV group than that in the A-vit group, and a significant difference was observed between the two groups (p = 0.01).ConclusionsThe visual outcome and complications following intrascleral fixation did not differ according to the extent of vitreous excision.

Complications of Open Reduction and Internal Fixation of Mandibular Condyle Fractures in Oman.

This study aimed to report the complication rate associated with open reduction and internal fixation (ORIF) of mandibular condyle fractures in Oman. This retrospective cohort study was conducted among patients who underwent ORIF of mandibular condyle fractures at Al-Nahdha Hospital and the Sultan Qaboos University Hospital in Muscat, Oman, from January 2008 to December 2020. Data collected included patient demographics, fracture aetiology, fracture side and type, surgical approach and recorded complications and outcomes. A total of 68 patients (59 males and 9 females; mean age of 30.1 years) with 83 mandibular condyle fractures underwent ORIF during the study period. Subcondylar fractures were the most common type, occurring in 62.7% of patients, while bilateral fractures were observed in 21 (30.8%) patients. The most common surgical approach was retromandibular, used in 42.2% of patients. The overall complication rate was 42.6%, with the most frequently reported complications being transient facial nerve palsy (18.1%), malocclusion (14.7%) and restricted mouth opening (10.3%). Subsequent surgical interventions to correct malocclusion were performed in 6 cases. There was no statistically significant association between the overall complication rate and the patients' clinical characteristics. Although ORIF of mandibular condyle fractures generally offers favourable outcomes, it carries a risk of complications.