Conventional Fixation Research Articles

An efficient and simple method for enriching metaphase cells for dicentric chromosome assay.

As compared to peripheral blood mononuclear cell (PBMC) culture, a lower mitotic index (MI) is seen in whole blood (WB) culture, but WB can be directly used for culture in dicentric chromosome assay (DCA). The purpose of this study is to develop a simple protocol for metaphase enrichment to improve the metaphase frequency of WB culture. Fixed cells were obtained after performing WB and PBMC cultures for DCA after conventional fixation. An additional low-speed centrifugation of 200×g for 1min was performed, separating the fixed cells of WB culture into a pellet and a supernatant fraction. The additional low-speed centrifugation enriched metaphase frequency and provided an MI comparable to the PBMC culture in the pellet fraction. Our study suggests that it is possible to increase the number of metaphase cells on slides using the slow centrifugation method, which could contribute to the efficiency of chromosome aberration analysis in biodosimetry.

Utilization of Computer-Assisted Navigation Technology Within Craniomaxillofacial Fracture Surgery: A Systematic Review.

Use of intraoperative computer-assisted navigation (iCAN) has been well-established in otolaryngology and neurosurgery; however, its use in surgical management of facial fractures is yet to be reported on a large scale. This study aimed to review the existing literature to determine the outcomes, limitations, risks, and benefits of iCAN use in facial fracture management. A systematic review of iCAN use in craniomaxillofacial fracture surgery was performed by 2 authors in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search was conducted on 3 databases, PubMed, Cochrane Library, and Embase, using the search terms "navigation," "intraoperative," and "brain lab" in combination with "facial fractures" or "facial reconstruction." Study type, demographics, fracture characteristics, surgery characteristics, iCAN devices, intraoperative fracture fixation accuracy, postoperative outcomes, complications, navigation limitations, and risks and benefits were analyzed. There were 909 studies identified in the initial search, of which 42 were chosen for final use. iCAN use was most commonly reported in unilateral (57.1%) and complex (50%) facial fracture cases. Surgical accuracy ranged from 0.7 to 4 mm and postoperative discrepancy ranged from 0.05 to 8 mm. Benefits included improved intraoperative surgical accuracy (95.2%), improved postoperative surgical discrepancy (52.4%), and decreased total surgical time (35.7%). Limitations reported with iCAN device use included operative technical difficulties (23.8%) and persistent systematic errors during device registration (21.4%). None of the studies discussed cost analysis or risks compared to conventional fixation methods. Advancements in and increasing familiarity with iCAN technology have preliminarily shown favorable surgical outcomes in facial fracture fixation, which include improved operative accuracy and discrepancy and decreased surgical time.

Percutaneous External Fixation of Redistributed Orbital Fat in Transcutaneous Lower Eyelid Blepharoplasty.

While percutaneous external fixation has gained popularity in transconjunctival blepharoplasty due to its simplicity and minimal incision, internal fixation remains the standard approach in transcutaneous blepharoplasty. This study aims to assess the safety and effectiveness of percutaneous external fixation specifically in transcutaneous fat repositioning blepharoplasty. From May 2022 to December 2023, a consecutive cohort of 97 patients underwent this surgical technique. Building upon the principles of transconjunctival fat repositioning, the procedure involved a minimal incision targeting the muscle layer, a conservative release of the tear trough ligament, and the repositioning of fat secured with percutaneous external fixation. Surgical outcomes were evaluated using the Barton grading system and FACE-Q scales for patient-reported outcomes. Following a mean follow-up of 7.2 months (ranging from 6 to 17 months), a resolution of tear trough deformities and eyelid bags was achieved in over 92% of cases. Notably, significant improvements (P < 0.05) were observed in lower eyelid aesthetics as measured by the FACE-Q scale, with a concomitant enhancement in patients' social confidence (P < 0.05). Overall, patients expressed satisfaction with their decision to undergo the procedure (71.0±19.1). Complications necessitating revision surgery included isolated cases of hematoma evacuation, fat injection, excision of excess fat, and skin excision. External fixation in transcutaneous blepharoplasty is technically less complex and minimally invasive, effectively securing transposed fat pedicles safely, presenting a viable alternative to conventional fixation techniques.

"Revolutionizing retrosigmoid surgical precision: AI in free bone flap reconstruction".

Free bone flap reconstruction is essential to the retrosigmoid method of microvascular decompression (MVD) and can completely transform surgical methods worldwide. According to studies like Liao et al. (2023), 92.3% of patients report feeling better after receiving treatment. The study by Shize Li et al. emphasizes the affordability and accessibility of free bone flap reconstruction, demonstrating shorter recovery times, lower expenses, and similar rates of complications to those of conventional fixation techniques. With benefits like fewer headaches and a quicker recovery in the free bone flap group, their retrospective analysis of 189 patients showed no significant differences in hospital stay or complication rates between the fixed and unfixed bone flap groups.Despite these results, larger sample sizes and longer-term studies are needed to confirm these findings and address issues such as leakage of cerebrospinal fluid. Furthermore, adding Artificial Intelligence (AI) to this method may improve accuracy and results. AI has the potential to enhance MVD procedures and patient outcomes through its capacity to create 3D models, direct bone flap placement, and track postoperative progress. Standardizing AI's application in clinical practice still presents difficulties, though. In the end, even though Shize Li et al.'s research significantly advances the body of knowledge already in existence, more creativity and investigation are required to maximize free bone flap reconstruction in MVD.

Sugar-binding Profiles of the Mesothelial Glycocalyx in Frozen Tissues of Mice Revealed by Lectin Staining

The mesothelium is a non-adhesive protective surface that lines the serosal cavities and organs within the body. The glycocalyx is a complex structure that coats the outer layer of the mesothelium. However, due to the limitations of conventional fixation techniques, studies on glycans are limited. In this study, lectin staining of frozen tissues was performed to investigate the diversity of glycans in the glycocalyx of mesothelial cells in mice. Datura stramonium lectin (DSL), which recognizes lactosamine and binds to Galectin-3 and -1, was broadly bound to the mesothelial cells of the visceral and parietal peritoneum but not to the pancreas, liver, intestine, or heart. Furthermore, human mesothelial cells in the omentum and parietal peritoneum were positive for DSL. Erythrina cristagalli lectin binding was specific to mesothelial cells in the parietal peritoneum, that is, the pleura, diaphragm, and peritoneum. Intriguingly, surface sialylation, the key element in reducing peritoneal dissemination and implantation, and promoting ascites formation by ovarian carcinoma cells, was much higher in the parietal peritoneum than in the omentum. These findings revealed slight differences in the glycans of mesothelial cells of different organs, which may be related to clinical diseases. These results also suggest that there may be differences in the functions of parietal and visceral mesothelial cells.

Patient satisfaction of computer guided reduction of Zygomatico-Maxillary Complex (ZMC) fractures using Patient Specific Guide (PSG) versus conventional reduction: a randomized clinical trial

Background and objectives. This study was conducted to evaluate of the patient satisfaction of computer guided reduction of Zygomatico-Maxillary Complex (ZMC) fractures using Patient Specific Guide (PSG) Versus Conventional reduction. Materials and methods. In this clinical trial patients were classified into two groups; each group consist of eight patients where the study group represented the use of patient specific guide for reduction and fixation of zygomatic fracture while the Control group represents conventional reduction and fixation of zygomatic fracture. The primary outcome is patient satisfaction while intraoperative time is the secondary outcome. Results. There was no statistical significancy in the overall satisfaction level between CR and GR, also there was no significancy between time consumed in CR and GR as guided reduction technique could save only about 8 minutes. Conclusions. Patient-specific guided reduction is an satisfactory technique for the reduction of Zygomatico-Maxillary Complex (ZMC) fractures. Moreover, this technique decreased the operation time without a statistically significant difference from the conventional technique.

Dataset of aquatic insects acquired using field-emission scanning electron microscopy and the NanoSuit method

A simple surface modification, called NanoSuit, by electron beam or by plasma irradiation can form a nanoscale layer, allowing to keep small animals alive and hydrous under the high vacuum required for field-emission scanning electron microscopy (FE-SEM). We previously applied NanoSuit to aquatic insects, Dixa longistyla larvae (Diptera: Dixidae), which always lie on their ventral surface just under the water surface. We found that the crown-like structures on the ventral side of the hind segments enable the larvae to reside in such ecological niche. Moreover, fine structures in the crown protected with NanoSuit appeared intact, unlike those subjected to conventional sample fixation. However, a fundamental understanding of these structures (living and/or not treated with conventional fixation) interacting directly with water should be established using FE-SEM. This data descriptor introduces a rich dataset of images acquired using NanoSuit for various aquatic insects. The image data can be accessed and viewed through Figshare.

Cyto-architecture of Byblis glands and leaf cells based on freeze-substitution and conventional TEM.

Byblis liniflora (Byblidaceae) is a carnivorous plant that has developed sticky fly paper traps with two types of glandular trichomes producing digestive enzymes and sticky mucilage. This study aimed to analyze the ultrastructure of these glandular leaf trichomes based on rapid freeze fixation and conventional chemical fixation in the attempt to understand their functional contribution to the carnivorous performance of the plants. The Byblis cells were studied in TEM, SEM and STEM using cryo techniques for fixation and substitution in addition to conventional chemical fixation. We show in detail the architecture of both the digestive glands and the mucilage glands with their relevant sets of organelles. Both mitochondria and plastids have a conspicuous plasticity, with branches and constrictions, and they associate to form clusters. The glandular cells appear to be transfer cells with cell wall ingrowths. Digestive glands occur in different states of development. Their cuticle forms discontinuities which are unique among glands of carnivorous plants. They look like cuticular holes -- the cuticle separates from the cell wall in only one spot and then ruptures. Cuticular discontinuities thus differ from cuticular gaps and cuticular pores so far described in carnivorous plants. We therefore propose for them the term cuticular holes. Application of cryo-techniques made it possible to show the true structure of the cell wall and the relationship between cell wall ingrowths and organelles, as well as the morphology and structure of organelles and their associations.

Single-Plate versus Dual-Plate Utilization for Treatment of Humeral Shaft Fractures: A Retrospective Clinical Series

Objectives Dual plating is the current standard of care for displaced distal humerus fractures and even some metadiaphyseal humeral fractures. Single plate fixation is the current standard of care for humeral shaft fractures when performing open reduction and internal fixation (ORIF). A role may exist for dual plating of humeral shaft fractures. This study aims to compare clinical outcomes of single versus dual-plating when performing ORIF procedures on humeral shaft fractures. Methods A retrospective study of 143 patients (81 females, 62 males; mean age 47.3) who sustained humeral shaft fractures (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (OTA/AO) type 12A, B, and C) and received either dual or single plating via ORIF between March 2010 and May 2022. Of the 143 patients, 79 (55%) received single plating, while 64 (45%) received dual plating. To account for possible confounders, we collected data on patient characteristics, mechanism of injury, and intra-surgical variables. Primary outcome measurements compared radiographical x-ray imaging (3-months, 6-months, and 12-months), complications, and visual analog scale (VAS) score. Results There was no statistically significant difference between VAS scores, union rates, post operative radial nerve injury, infections, or hardware failure for primary surgical outcomes. Patients were allowed to bear weight as tolerated more quickly in the dual-plating group. An association was observed between the usage of dual plates and osteoporosis. Conclusion In conclusion, we found dual-plate fixation for ORIF of humerus fractures to be not statistically significantly different compared to single plate fixation. Dual-plating has satisfactory radiograph and clinical outcomes compared to conventional single-plate fixation. While we are not advocating for the routine use of dual-plating, the results of our study suggest that the use of dual-plating produces similar outcomes when compared to single-plating for ORIF of a humerus shaft fracture.

Clinical value and risk factors of compression supporting screwsin patients with femoral neck fractures

BackgroundThis study was performed with attempt to explore the clinical value and risk factors of compression supporting screws for the treatment of femoral neck fractures.MethodsThis retrospective analysis enrolled 102 patients with femoral neck fractures who admitted to our hospital from June 2020 to June 2022. Based on different screws during the operation, the participants were allocated into hollow screw group (52 cases, conventional fixation of parallel partial-thread hollow screw) and compression screw group (50 cases, compression screw fixation).ResultThe incidence of complications (including internal fixation failure, nonunion, a vascular necrosis of the femoral head, shortening of the femoral neck by less than 10 mm, and lateral screw withdrawal, of the affected limb) in the compression screw group were significantly lower than those in the hollow screw group (P < 0.05). Patients enrolled in this study were followed up for 9 to 14 months, with an average follow-up time of (12.09 ± 1.87) months.The pain degree at 3 days, 10 days, and the last follow-up after operation in the compression screw group was evidently lower than that in the hollow screw group (P < 0.05). At the last follow-up, the improvment in hip joint function was more significant in the compression screw group than in the hollow screw group (P < 0.05). Univariate logistic regression analysis showed that the risk factors for complications in the treatment of femoral neck fractures with compression supporting screws were age, Pauwels type III fracture (modified Pauwels classification), and hip joint (≥ 90 points). In addition, the result of multivariate logistic regression analysis showed that the risk factors for complications in the treatment of femoral neck fractures with compression supporting screws were age, Pauwels type III fracture (modified Pauwels classification).ConclusionOur findings demonstrated beneficial outcomes obtained by using compression supporting screw, in terms of effectively enhancing the recovery of patients with femoral neck fracture and reducing the associated complications.

Assessing functional and radiological outcomes: open reduction and internal fixation vs. minimally invasive plate osteosynthesis for humerus shaft fractures-a prospective comparative study.

To analyse and compare the functional and radiological outcome of different methods of surgical management of humerus shaft fractures in 30 patients treated by conventional open reduction and internal fixation (ORIF) or minimally invasive plate osteosynthesis (MIPO). This prospective interventional study was conducted among 30 patients by dividing into two equal groups over oneyear and sixmonths. All patients were followed up for a minimum of at least sixmonths. Radiological outcome was assessed using fracture union in serial radiographs and functional outcome was measured using DASH scoring. The majority of patients (26.7%) were between 18 to 30years, overall mean age was 44.4years, most of the patients (50%) had 12A3 AO type fractures, and 73.3% of patients had injuries following two-wheeler road traffic accidents. On comparing multiple factors, we found a statistically significant reduction of intra-operative blood loss in MIPO compared to ORIF. Though time taken for fracture union, functional outcome and complication rate were better in MIPO when compared to ORIF, these differences were not statistically significant. two patients in the MIPO group and one patient in the ORIF group had a peri-implant fracture following slip and fall again within the study period and underwent Revision plating. Excluding cases of peri-implant fractures, out of 13 patients in the MIPO group, only one patient developed fracture non-union. Of 14 patients in the ORIF group, three developed fracture non-union. MIPO is a safe, reproducible, efficient and good if not a better alternative to ORIF as it offers good radiological and functional outcomes with advantages of minimal soft tissue damage, minimal blood loss, better cosmesis, no incidence of radial nerve palsy and with few concerns such as the need for fluoroscopy, and a learning curve.

Robot-assisted internal fixation of calcaneal fractures versus conventional open reduction internal fixation: a systematic review and meta-analysis.

The aim of the study was to compare the efficacy and safety of robot-assisted (RA) percutaneous hollow screw fixation with traditional open reduction internal fixation (ORIF) for the treatment of calcaneal fractures through a systematic review and meta-analysis. An extensive search was conducted in the following databases-PubMed, CNKI, Embase, and the Cochrane Library-to gather research on patients with calcaneal fractures published up to July 2024. This search focuses on studies comparing the effectiveness of robot-assisted percutaneous cannulated screw fixation versus ORIF. We will include studies published in both English and Chinese. Our screening process adhered strictly to predefined inclusion and exclusion criteria, emphasizing randomized controlled trials (RCTs) and cohort studies. The ROBINS-I tool was utilized to evaluate the risk of bias in non-randomized studies. Meta-analysis was conducted using Review Manager 5.4.1. The final analysis incorporated six retrospective cohort studies comprising 247 patients-122 treated with robotic-assisted percutaneous cannulated screw fixation and 125 with conventional open reduction and internal fixation. The findings indicated that patients undergoing robotic-assisted percutaneous cannulated screw fixation experienced advantages over those receiving conventional treatment in terms of reduced hospital stay, lower estimated blood loss, and higher AOFAS scores at both 3 and 6months. No statistically significant differences were observed between the two methods concerning operative time, fracture healing duration, or the frequency of intraoperative fluoroscopies. Robotic-assisted percutaneous cannulated screw fixation is a safe and viable treatment approach for patients with calcaneal fractures. When compared to ORIF methods, this robotic-assisted technique demonstrated significant benefits, including reduced hospital stay, lower estimated blood loss, and improved AOFAS scores at both 3 and 6months.

The New Alternative Technique Outcomes: Atlas Lateral Mass Screw and C2-3 Transfacet Screw Fixation for Complex Atlantoaxial Instability in Patients with Thin C2 Pedicle or High-Riding Vertebral Artery

The study aimed to evaluate the safety, feasibility, effect on fusion, and clinical efficacy of atlas lateral mass and C2-3 transfacet screw fixation technique, serves as an alternative method to traditional posterior atlantoaxial fixation. Patients with atlantoaxial instability who underwent atlas lateral mass and C2-3 transfacet fixation surgery were included. The duration of the surgery and the quantity of blood lost during the operation were recorded. Patients were monitored via X-ray and computed tomography scans to evaluate the degree of fusion at the 1-month and 12-month follow-up. The Neck Visual Analog Scale and Neck Disability Index were evaluated preoperatively, in the postoperative first week, and at the 12-month follow-up for clinical follow-up. A total of 8 patients with atlantoaxial instability due to odontoid fracture or Arnold- Chiari malformation accompanied by bony or vascular abnormalities were included in the study between 2017 and 2024. All 8 patients underwent successful atlas lateral mass and C2-3 transfacet screw fixation, with no neurovascular injury noted during surgery. All patients with fracture exhibited fusion at the 12-month mark, and both the Neck Visual Analog Scale and Neck Disability Index scores demonstrated significant improvement at both the 1-week and 12-month postoperative periods (P < 0.05). The atlas lateral mass and C2-3 transfacet screw fixation technique, an alternative to conventional posterior fixation, has been demonstrated to be an efficacious method for providing adequate stabilization and fusion in patients with atlantoaxial instability, even in the cases of thin C2 pedicle, high-riding vertebral artery, previous failed surgeries, or reoperation.

Evaluation of the Treatment Efficacy of Bone Traction Combined with Small Splint External Fixation for Tibiofibular Fractures

Objective: To evaluate the clinical efficacy of bone traction combined with small splint external fixation in treating tibiofibular fractures. Methods: 378 patients with tibiofibular fractures who were treated in the Department of Orthopedics of our hospital from January 2019 to January 2023 were selected as study subjects. According to the specific conditions of the patients and the indications for surgery, they were divided into the observation group (bone traction combined with small splint external fixation) and the control group (conventional plaster fixation), with 189 cases in each group. Both groups of patients immobilized the affected limb as instructed by their doctors and were treated with oral anti-inflammatory and pain-relieving medications. The healing of the fractures was monitored using imaging techniques such as X-rays, computed tomography scans, and magnetic resonance imaging, while postoperative complications were also recorded. Results: The incidence rate of non-healing in the control group (7.41%) was significantly higher than that in the observation group (1.06%) (P &lt; 0.05); the complications in the observation group were mainly three cases of limb deformity, three cases of pressure sores, and four cases of skin necrosis, with a total of 10 cases and an incidence rate of 5.29%; while in the control group, there were three cases of fracture nonunion, nine cases of skin necrosis, seven cases of pressure sores, and three cases of limb deformity, with a total of 22 cases and an incidence rate of 5.29%, the difference between the two groups was statistically significant (χ2 = 4.916, P = 0.027). Conclusion: Bone traction combined with small splint external fixation has shown remarkable efficacy in the treatment of tibiofibular fractures, which can not only quickly stabilize the fracture end, reduce pain, and promote fracture healing, but also reduce the occurrence of complications and shorten the treatment period.

Comparison of outcomes between modified double-flanged sutureless scleral fixation and conventional sutured scleral fixation

This retrospective study aimed to compare the outcomes of modified double-flanged sutureless scleral fixation versus sutured scleral fixation. Medical records of 65 eyes from 65 patients who underwent double-flanged scleral fixation (flange group) or conventional scleral fixation (suture group) between 2021 and 2022 were reviewed. Visual and refractive outcomes, as well as postoperative complications, were compared 1, 2, and 6 months after surgery. We included 31 eyes in the flange group and 34 eyes in the suture group. At 6 months postoperatively, the flange group showed better uncorrected visual acuity (0.251 ± 0.328 vs. 0.418 ± 0.339 logMAR, P = 0.041) and a smaller myopic shift (− 0.74 ± 0.93 vs. − 1.33 ± 1.15 diopter, P = 0.007) compared to the suture group. The flange group did not experience any instances of iris capture, while the suture group had iris capture in 10 eyes (29.4%; P < 0.001). In the flange group, all intraocular lenses remained centered, whereas in the suture group, they were decentered in 8 eyes (23.5%; P = 0.005). The double-flanged technique not only prevented iris capture and decentration of the intraocular lens but also reduced myopic shift by enhancing the stability of the intraocular lens.

Plate fixation of inferior ramus in pubis-ischium ramus improves mechanical stability in Tile B pelvic injures: a cadaveric biomechanical analysis and early clinical experience

BackgroundManagement of inferior ramus of the pubis-ischium ramus remains controversial, and related research is sparse. The main intention of this study is to describe the biomechanical and clinical outcomes of pubis-ischium ramus fractures in Tile B pelvic injuries and to identify the feasibility and necessity of fixation of the inferior ramus of the pubis-ischium ramus.MethodsThis study comprised two parts: a biomechanical test and a retrospective clinical study. For the biomechanical tests, Tile B-type pelvic injuries were modeled in six cadaver specimens by performing pubis-ischium osteotomies and disruption of the anterior and interosseous sacroiliac ligaments. The superior and/or inferior rami of the pubis-ischium ramus were repaired with reconstruction plates and separated into three groups (A, B, and C). Specimens were placed in the standing position and were loaded axially with two-leg support for three cycles at 500 N. The displacements of sacroiliac joints at osteotomy were measured with Vernier calipers and compared using statistical software. To investigate the clinical outcomes of this technique, 26 patients were retrospectively analyzed and divided into a superior ramus fixation group (Group D) and a combined superior and inferior ramus of the pubis-ischium ramus fixation group (Group E). The main outcome measures were time of operation, blood loss, postoperative radiographic reduction grading, and functional outcomes.ResultsIn the vertical loading test, Group E showed better pelvic ring stability than Group D (P < 0.05). However, the shift of the sacroiliac joints was almost identical among the three groups. In our clinical case series, all fractures in Group E achieved bony union. Group E demonstrated earlier weight-bearing functional exercise (2.54 ± 1.45 vs 4.77 ± 2.09; P = 0.004), earlier bony union (13.23 ± 2.89 vs 16.55 ± 3.11; P = 0.013), and better functional outcomes (89.77 ± 7.27 vs 82.38 ± 8.81; P = 0.028) than Group D. The incidence of sexual dysfunction was significantly lower in Group E than that in Group D (2/13 vs 7/13; P = 0.039). Bone nonunion occurred in two patients in Group D, and two patients in Group E had heterotopic ossification. None of the patients exhibited wound complications, infections, implant failures, or bone–implant interface failures.ConclusionsFixation of the inferior ramus of a pubis-ischium ramus fracture based on conventional fixation of the anterior pelvic ring is mechanically superior in cadaveric Tile B pelvic injury and shows rapid recovery, good functional outcomes, and low incidence of complications.

Treatment of Acute Acromioclavicular Joint Dislocation Using Hook Plate: A Systematic Review and Meta-Analysis and Update of Current Literature

Abstract Background the hook plate metallic device showed early promise as an alternative implant to treat unstable acromioclavicular joint dislocation injuries. The hook plate can be used to provide an indirect reduction of a distal clavicle fracture. This indirect reduction technique is useful for comminuted fractures or fractures with very small distal fragments in which conventional reduction and fixation is difficult. Aim of the Work to evaluate the treatment of acute acromioclavicular joint dislocation and radiographic outcomes. Materials and Methods Studies were considered eligible if they expressed treatment of acromioclavicular joint dislocation using the hook plate and described the patient's clinical and functional outcomes; intra-operative, post-operative complications, full-text articles were available, randomized controlled trials, including cluster RCTs, controlled (non-randomized) clinical trials or cluster trials, prospective and retrospective comparative cohort studies, and case-control or nested case-control studies. We will exclude cross-sectional studies, case series, case reports and literature not in English. All items that didn't match the above criteria were excluded. Results The total studies included 270 patients with average mean age 35.5 years and mean follow up 25.33 months. The Constant Murely score average 84 points (The CMS was developed for the evaluation of shoulder function with subjective and objective components) and the p value &amp;lt;.05 that means all patients had significant improvement. Full range of motion could be achieved in the patients. Patients with restrictions of range of motion mainly showed limitations in abduction and external rotation. These limitations are most probably caused by the post-operative immobilization, which is necessary after implantation of hook plates to ensure healing of the ligament structures and avoid damage of the acromion by the hook itself. Other studies also showed restrictions of range of motion for abduction and external rotation after hook plate implantation. Conclusion it has a good to excellent Constant Murely score (full range of motion) that enables quick return to activities. It is useful for (Rockwood III-VI). So good clinical results can be achieved with hook plate.

Outcomes of dynamic lumbar fixation in young patients with minimal lumbar instability

Background Data: Lumbar instability is considered an essential aetiology of low back pain (LBP) which is always accompanied by considerable disability. The term ‘instability’ remains poorly defined. But it is most broadly explained by any change of the normal mechanism of spinal motion which leads to pain and/or neurological impairment. It was reported that ‘Segmental instability can be defined as a pathological reaction to the applied loads, characterized by motion in motion segments more than normal constraints. The dynamic system can stabilize an unstable segment adequately but permits more mobility in the fixed levels than the conventional fixation systems. Study design: prospective, consecutive study Patients and Methods: This study was conducted in Mansoura University hospitals over one year (starting from September 2019 till August 2020) Twenty patients who presented with back pain fulfilled our criteria and were included in this study and underwent surgery for lumbar fixation using a hybrid performance system with dynamic coupler. The history of all patients was taken and they were subjected to clinical examination and preoperative full radiological examination. Visual Analogue Scale (VAS) was used to evaluate POP. Regular follow-up visits were arranged for our cases 6 weeks, three months and 6 months postoperative. Results: This study included 20 patients (7 males and 13 females). The ages of the studied patients ranged from 20 to 33 years. 9 patients presented with L4- 5 affection, 8 patients with L3- 4 affection and three patients with L2-3 affection. The mean basal VAS score was 5.45 (range=4-6) while the mean six months VAS score was 0.40 (range=0-1) with a statistically significant difference from the basal VAS score (p ? 0.001). Also, the results show that post-operative QoL scale scores was significantly higher (p? 0.001) compared with pre-operative QoL scale scores (Physical function (54.30 vs. 67.10), limitations due to physical health (55.55 vs. 67.90)). Conclusion: The current study suggested that Dynamic lumbar fixation provides favourable and stable clinical mid-term results in patients suffering from a degenerative lumbar spinal disease (DLSD) and can be a considerable alternative to fusion surgery in these patients.

Comment on 'Role of Biplane Double-Supported Screw Fixation (BDSF) in Management of Fracture Neck Femur and Its Comparison with Conventional CC Screw Fixation'.

Comment on 'Role of Biplane Double-Supported Screw Fixation (BDSF) in Management of Fracture Neck Femur and Its Comparison with Conventional CC Screw Fixation'.

A Dilemma in the Management of Distal Tibia Fractures Solved by Minimally Invasive Percutaneous Plate Osteosynthesis Technique: A Prospective Study.

Introduction Managing distal tibia fractures is challenging for trauma surgeons because of their peculiar anatomy with less soft tissue coverage and poor blood supply. There are various treatment options for distal tibia fractures such as open reduction and plating, minimally invasive percutaneous plate osteosynthesis, and intramedullary interlocking nailing. Open reduction and internal fixation can lead to excessive soft tissue dissection and devascularization of fracture fragments. We conducted a study on the functional outcome of distal tibia fractures treated by biological fixation with minimally invasive percutaneous plate osteosynthesis. Methods A total of 23 patients with distal one-third tibia fractures, fulfilling the inclusion criteria, who were treated at St. John's Medical College Hospital with minimally invasive percutaneous plate osteosynthesis between November 2020 and November 2022 were studied using the American Orthopaedic Foot & Ankle Society (AOFAS) score at six weeks, three months, and six months postoperative follow-up. Results This study included 17 males and six females. The mean age of the study participants was 43.78 years, with most of the participants being in the age group between 51 and 60 years (29.2%, n = 7). All the study participants were employed. The mean operative time was two hours and 10 minutes. The mean duration for the radiological union was 22 weeks. The mean AOFAS score at six months was 92.43 + 5.696. There was only one case of superficial infection, which was treated with intravenous antibiotics. There were no cases of malunion/nonunion. Conclusion Minimally invasive percutaneous plate osteosynthesis is an effective treatment for distal tibia fractures avoiding most of the complications such as wound dehiscence and malunion/nonunion involved in conventional open reduction and internal fixation with plating. Therefore, we recommend this technique for all distal tibia fractures.