Fracture Displacement Research Articles

Strengthened and toughened SiHfBCN-based high-temperature resistant adhesive with SiC NWs

To further improve the performance of binders, a SiHfBCN-based high-temperature resistant adhesive was successfully synthesized by Polymer-Derived Ceramics (PDC) route using TiB2, Polysiloxane (PSO) and short SiC nanowires as fillers. The effect of short SiC nanowires on the adhesive strength at room temperature and high temperature, as well as the reinforcing mechanism was studied. Compared with the adhesive without SiC nanowires, after curing (at 170 °C) and pyrolysis (at 1000 °C) in air, the appropriate adding of SiC nanowires upgrades the room temperature and high temperature (at 1000 °C in air) adhesive strength to (12.50 ± 0.67) MPa (up by about 32%) and (13.11 ± 0.79) MPa (up by about 106%), respectively. Attractively, under the synergistic impact of the nanowire bridging, nanowire breaking, nanowire drawing and crack deflection, the optimized adhesive exhibits multi-stage fracture, causing the increscent fracture displacement.

Isolated fracture of the coronoid process following a molar extraction: A rare case report.

Isolated coronoid process fractures are uncommon, and iatrogenic isolated fractures are extremely rare. This case describes a displaced fracture of an isolated coronoid process thought to be due to excessive force applied by a dentist that had been overlooked and left untreated for about a month. The patient was a woman in her late 50's and she had undergone a molar extraction. Her dentist had confused her symptoms of trismus, pain, and facial oedema with the complex tooth extraction procedure. Following a cone-beam computed tomography (CBCT) scan we showed that the mandibular coronoid process on her right side had suffered a longitudinal fracture, and the fractured fragment had rotated upwards and inwards. Following successful surgical elimination of the fragmented coronoid process, the patient received targeted physiotherapy sessions that yielded excellent results. At the five-month follow-up, the ability of the patient to open her mouth had improved enormously, and her facial appearance almost recovered to its original state.

The Occurrence of Sustentaculum Tali Displacement in Intra-articular Calcaneal Fracture and Its Effect on Operation

The Occurrence of Sustentaculum Tali Displacement in Intra-articular Calcaneal Fracture and Its Effect on Operation

The Role of Arthroscopy in Contemporary Glenoid Fossa Fracture Fixation.

Glenoid fossa fractures are rare injuries accounting for 10 to 29% of all intra-articular scapula fractures. They are usually the result of high-energy trauma, and concomitant injuries are not uncommon. Patients with glenoid fractures are admitted with shoulder pain and restricted range of motion. Although shoulder plain radiographs could establish the diagnosis, a computed tomography scan is necessary to adequately define the fracture pattern and characteristics. The most commonly used classification system is that of Ideberg (modified by Goss), which includes five glenoid fossa fracture types according to the location, extension, and complexity of the lesion. Articular surface displacement and step-off are the most important factors that should be taken under consideration when deciding for conservative or surgical management. Operative treatment includes open reduction and internal fixation through a posterior or anterior approach depending on fracture morphology and displacement. However, open surgical techniques are related to extensive soft-tissue disruption, risk of neurovascular injury, and inadequate exposure of the entire glenoid cavity. Introduction of arthroscopy could facilitate better visualization of the glenoid articular surface and improved fracture reduction. However, it is a technically demanding procedure with many challenges and pitfalls. The aim of this review is to summarize the current evidence regarding the treatment of glenoid fossa fractures and present the beneficial effect of arthroscopy in improving the quality of fracture fixation and overall functional outcomes.

Predictors of opioid use for rib fractures in a regional Australian hospital

BackgroundRib fractures (RFs) are the leading type of single serious injury in New South Wales trauma patients. Uncontrolled pain drives the sequelae of atelectasis, pneumonia, respiratory failure, and death in severe cases. Opioids are the mainstay of management; however, they carry numerous adverse effects. Understanding patient or injury factors which predict opioid requirement is important to tailor management. Existing evidence is limited to metropolitan trauma centres (MTCs). MethodsWe conducted an observational, retrospective, single-centre cohort study of all admissions to Albury Wodonga Health diagnosed with one or more RFs and discharged between January 1st, 2017, and December 31st, 2022, inclusive. Data collected included demographics, injury characteristics, and management, including analgesia. LASSO regression was performed to determine predictors of average daily opioid use for the first five days of admission in oral morphine equivalents (mg). R2 and root mean square error (RMSE) were calculated to assess model performance. ResultsWe included 624 patients. LASSO selected number of RFs, fracture displacement score, pulmonary contusion, new injury severity score, age, chest tube use, chronic pain history, opioid history and upper or middle lateral RF location categories as predictors. Sex, middle anterior, middle posterior, and lower RF location categories were excluded by LASSO. The out of sample R2 was 28.6 %. On the scale of log OME, the RMSE was 1.08. ConclusionThe model is effective at identifying predictors of opioid use in this regional centre, which are similar to those described in evidence from MTCs. However, the low R2 with wide prediction intervals limits its utility on an individual level.

Automating the determination of low-temperature fracture resistance curves of normal and rubberized asphalt concrete in single-edge notched beam tests using convolutional neural networks

As materials undergo large-scale yielding or exhibit large sizes of fracture process zone in the crack tip region, multi-parameter fracture concepts should be employed to describe the complex crack-tip stress-strain fields. Fracture resistance curves (R-curves) are an established tool in characterizing the entire fracture process of such materials. However, for complex materials such as bituminous mixtures, the development of these curves is subject to experimental and computational intricacies. In this research, a framework is developed to automate the construction of R-curves for normal and rubberized asphalt concrete (AC) mixtures. AC mixtures are produced using PG58–22 and PG58–28 binders. Limestone and siliceous aggregates are used, and three binder contents are considered for the mixtures. Single-edge notched beam (SE(B)) fracture testing is conducted on AC beams with two different notch patterns. A convolutional neural network (CNN) model is developed and trained over 1260 test images with varying temperatures, notch geometries, and setups. The CNN model was used to detect the growing crack on the beam surface and each crack-detected image was sent to an image processing framework to measure the crack length. Crack extension increments were calculated and synchronized with test time and magnitude of load, load-line displacement, and cumulative fracture energy, and the R-curve could be constructed. A training accuracy of 0.91 was obtained for the model and a loss of below 0.10 as a result of a hyperparameter tuning indicating reliable classifications by the CNN architecture. The R-curves showed desirable agreement for control mixtures at temperatures of 0 °C and −15 °C. As the mixtures are rubberized, the R-curves showed favorable agreement in the crack blunting phase, transition zone, as well as the unstable propagation phase at −20 °C. Cohesive energy magnitudes were compared for the two methods with a Pearson coefficient of 0.81 while fracture rate and fracture energy magnitudes showed favorably close magnitudes with coefficients of 0.89 and 0.98 respectively.

Comparison of acute outcomes from elective total hip replacements and after fragility femoral neck fractures in nonagenarians

BackgroundHip hemiarthroplasty has traditionally been used to treat displaced femoral neck fractures in older, frailer patients whilst total hip replacements (THR) have been reserved for younger and fitter patients. However, not all elderly patients are frail, and some may be able to tolerate and benefit from an acute THR. Nonagenarians are a particularly heterogenous subpopulation of the elderly, with varying degrees of independence. Since THRs are performed electively as a routine treatment for osteoarthritis in the elderly, its safety is well established in the older patient. The aim of this study was to compare the safety of emergency THR to elective THR in nonagenarians.MethodsA retrospective 10-year cohort study was conducted using data submitted to the National Hip Fracture Database (NHFD) across three hospitals in one large NHS Trust. Data was collected from 126 nonagenarians who underwent THRs between 1st January 2010 – 31st December 2020 and was categorised into emergency THR and elective THR groups. Mortality rates were compared between the two groups. Secondary outcomes were also compared including postoperative complications (dislocations, revision surgeries, and periprosthetic fracture), length of stay in hospital, and discharge destination.ResultsThere was no significant difference in mortality between the two groups, with 1-year mortality rates of 11.4% and 12.1% reported for emergency and elective patients respectively (p = 0.848). There were no significant differences in postoperative complication rate and discharge destination. Patients who had emergency THR spent 5.56 days longer in hospital compared to elective patients (p = 0.015).ConclusionThere is no increased risk of 1-year mortality in emergency THR compared to elective THR, in a nonagenarian population. Therefore, nonagenarians presenting with a hip fracture who would have been considered for a THR if presenting on an elective basis should not be precluded from an emergency THR on safety grounds.Trial registrationNot necessary as this was deemed not to be clinical research, and was considered to be a service evaluation.

Complications following surgical treatment of ankle fractures in the elderly: can they be avoided?

Background Following surgical treatment of ankle fractures, geriatric patients face high complication rates (CR) in literature. Commonly used diagnostic and treatment algorithms fail to consider requirements of ageing patients which increases the risk of postoperative complications. Objective Present study critically evaluated surgical management of ankle fractures in patients over 65 years old, with focus on identifying modifiable risk factors and effective comorbidity management strategies. Methods We conducted a retrospective single-center study on patients who underwent surgical treatment of an ankle fracture. Based on their age, participants were divided into non-geriatric patients (NGP<65y) and geriatric patients (GP≥65y). We analyzed overall CR and number of minor and major complications in relation to timing of surgery, biological sex, injury pattern, osteosynthesis, pre-existing medical conditions, and postoperative care. Results 402 patients were included. GP encountered significantly higher overall (p<0.001), minor (p<0.001) and major (p=0.003) complications. They presented more complex, displaced and open fractures. Predominant factor contributing to higher CR in NGP and markedly in GP was concomitant diseases, presenting a strong OR of 19,290 (p<0.001) and 17,022 (p<0.001). Delaying surgery and managing comorbidities preoperatively had a favorable impact. Conclusion We revealed a high significant correlation between pre-existing medical conditions and postoperative results. To ascertain viability of delayed surgery in facilitating additional diagnostics and treatment of comorbidities, further comparative trials with a larger cohort are imperative.

Pediatric foot fractures on radiographs: distribution and predictors of surgery.

To examine the distribution and characteristics of pediatric foot fractures on radiographs with respect to age and skeletal maturation, and to identify predictors of surgery. This retrospective study included children (≤ 18 years) with foot fractures, who underwent radiographic examinations (2020-2022). Electronic medical records were reviewed to obtain demographic and clinical data. Fracture characteristics, including anatomic location, presence of displacement, angulation, articular involvement, and, if skeletally immature, physeal involvement and Salter-Harris fracture pattern were collected. Logistic regression models were used to identify predictors of surgery. 1,090 (596-boys, 494-girls; mean age, 11.0 ± 4.0 years) patients with 1,325 (59.8% metatarsal, 33.8% phalangeal, and 6.4% tarsal) fractures were included. Fractures of 1st metatarsal were more common among younger children whereas fractures of 2nd-4th and 5th metatarsals were more common among older children (median ages: 5.9 years vs. 10.3 years and 12.4 years, p < 0.001). Intra-articular fractures were more common among maturing and mature than immature bones (25.3%and 20.4% vs. 9.9%, p < 0.001). Physeal involvement was uncommon (162/977, 16.6%) and the most common pattern was Salter-Harris type II (133/162, 82.1%). A minority (47/1090, 4.3%)of patients required surgery and independent predictors of surgery included physeal involvement (OR = 5.12, 95%CI: 2.48-10.39, p < 0.001), multiple fractures (OR = 3.85, 95%CI: 1.67-8.53, p = 0.001), fracture displacement (OR = 9.16, 95%CI:4.43-19.07, p < 0.001), and articular involvement (OR = 2.72, 95%CI:1.27-5.72, p = 0.008). Using these predictors, the likelihood for surgery ranged between 8.0% with 1 and 86.7% with 3 predictors. Pediatric foot fracture patterns differed based on age and regional skeletal maturation. Physeal involvement, multiple fractures, fracture displacement, and articular involvement were independent predictors of surgery in our study group.

Design and analysis of solid ankle foot orthosis by employing mechanical characterization and a low-cost scanning approach for additive manufacturing

PurposeThis study aims to investigate the fabrication of solid ankle foot orthoses (SAFOs) using fused deposition modeling (FDM) printing technology. It emphasizes cost-effective 3D scanning with the Kinect sensor and conducts a comparative analysis of SAFO durability with varying thicknesses and materials, including polylactic acid (PLA) and carbon fiber-reinforced (PLA-C), to address research gaps from prior studies.Design/methodology/approachIn this study, the methodology comprises key components: data capture using a cost-effective Microsoft Kinect® Xbox 360 scanner to obtain precise leg dimensions for SAFOs. SAFOs are designed using CAD tools with varying thicknesses (3, 4, and 5 mm) while maintaining consistent geometry, allowing controlled thickness impact investigation. Fabrication uses PLA and PLA-C materials via FDM 3D printing, providing insights into material suitability. Mechanical analysis uses dual finite element analysis to assess force–displacement curves and fracture behavior, which were validated through experimental testing.FindingsThe results indicate that the precision of the scanned leg dimensions, compared to actual anthropometric data, exhibits a deviation of less than 5%, confirming the accuracy of the cost-effective scanning approach. Additionally, the research identifies optimal thicknesses for SAFOs, recommending a 4 and 5 mm thickness for PLA-C-based SAFOs and an only 5 mm thickness for PLA-based SAFOs. This optimization enhances the overall performance and effectiveness of these orthotic solutions.Originality/valueThis study’s innovation lies in its holistic approach, combining low-cost 3D scanning, 3D printing and computational simulations to optimize SAFO materials and thickness. These findings advance the creation of cost-effective and efficient orthotic solutions.

Fractures of the lateral condyle of the humerus in children : High risk of secondary dislocation with conservative treatment

Fractures of the lateral condyle of the humerus in children are articular fractures with difficult diagnostics due to the incompletely ossified elbow joint. The aim of this study was to evaluate the method of treatment at initial presentation and to analyze the frequency of subsequent displacement during follow-up. Retrospective analysis of the frequency of primary fracture dislocation and subsequent displacement of fractures of the lateral condyle of the humerus in children under 16years of age between 2004 and 2021. Conventional radiographs in two planes at the time of the accident and in the follow-up after 5-7days were evaluated. Atotal of 285 fractures of the lateral condyle of the humerus were evaluated. The average age was 5.3years. Of the fractures 109 (38.3%) were directly surgically treated in cases of primary displacement and 176 fractures (61.7%) were not primarily displaced and were initially treated conservatively. During follow-up, subsequent displacement was evident in 46fractures (26.1%). Atotal of 130 fractures (45.6%) were treated conservatively and 155 fractures (54.4%) were treated surgically using open joint visualization and screw osteosynthesis or K‑wire osteosynthesis. Fractures of the lateral condyle of the humerus occur more frequently in acertain age group and require targeted radiological diagnostics. Nondisplaced fractures can be treated conservatively but essential radiological follow-up shows ahigh number of subsequent displacements, so that open surgical stabilization is often necessary.

Determination of the ideal plate for medial femoral condyle fracture fixation: an anatomical fit and biomechanical study

BackgroundThe aim of this study is to determine the best plate to use as a substitute to fix a medial femoral condyle fracture.Materials and methodsThe first part is to measure the best fit between several anatomical plates including the Proximal Tibia Anterolateral Plate (PT AL LCP), the Proximal Tibia Medial Plate (PT M LCP), the Distal Tibia Medial Locking Plate (DT M LCP) and the Proximal Humerus (PHILOS) plate against 28 freshly embalmed cadaveric distal femurs. Measurements such as plate offset and number of screws in the condyle and shaft shall be obtained. The subsequent part is to determine the compressive force at which the plate fails. After creating an iatrogenic medial condyle fracture, the cadavers will be fixed with the two plates with the best anatomical fit and subjected to a compression force using a hydraulic press.ResultsThe PT AL LCP offered the best anatomical fit whereas the PHILOS plate offered the maximal number of screws inserted. The force required to create 2 mm of fracture displacement between the two is not statistically significant (LCP 889 N, PHILOS 947 N, p = 0.39). The PT AL LCP can withstand a larger fracture displacement than the PHILOS (LCP 24.4 mm, PHILOS 17.4 mm, p = 0.004).Discussion and conclusionBoth the PT AL LCP and the PHILOS remain good options in fixing a medial femoral condyle fracture. Between the two, we would recommend the PT AL LCP as the slightly superior option.

Simulation and Control Strategies for Longitudinal Propagation of Acid Fracture in a Low-Permeability Reservoir Containing Bottom Water

The reservoir in the Anyue gas field, located in the Sichuan basin of China, belongs to the second member of the Dengying formation and has distinctive geological features. It is characterized by strong heterogeneity, low porosity, low permeability, and locally developed natural fractures. The reservoir space consists primarily of corrosion holes, natural fractures, and similar voids. Moreover, the lower reservoir exhibits high water saturation and a homogeneous bottom-water interface. Since it is a carbonate-based hydrocarbon reservoir with low porosity and permeability, deep acid fracturing has proven to be an efficient method for enhancing individual well production. However, the reconstruction of the second member of the Dengying formation reservoir poses significant challenges. The reservoir contains high-angle natural fractures, small vertical stress differences, and is located in close proximity to the gas–water interface. As a result, it becomes difficult to control the height of the acid break. Improper acid break treatment may easily result in water production affecting gas well production. To explore ways to control the longitudinal extension of acid fractures, 3D numerical models focusing on the initiation and expansion of acid fractures have been developed. This model takes into account geological and engineering factors such as stress differences, acid fracture displacements and scales, and their effects on the longitudinal extension of acid fractures. It was revealed that the pressure difference is the main controlling factor for the acid fracture height, followed by the reservoir thickness, the interlayer thickness, and the viscosity of the working fluid. Technical countermeasures for controlled fracture and high-acid fracturing tailored to different reservoir characteristics have been proposed, and design parameters for controlled fracture and high-acid fracturing can be optimized. By effectively controlling the vertical extension of the acid fracture, it is possible to maximize production from a single well while avoiding interference from the lower water layer. This study provides theoretical guidance for the application of deep-acid-fracturing techniques in low-permeability bottom-water gas reservoirs.

Percutaneous intramedullary screw or rush pin fixation of unstable ankle fractures in patients with fragile soft tissue – retrospective study of 80 cases

IntroductionThe standard surgical procedure for unstable ankle fractures is fixation of the lateral malleolus with a plate and screws. This method has a high risk of complications, especially among patients with fragile skin conditions. The aim of this study was to estimate the re-operation rates and identify complications in patients with an unstable ankle fracture, surgically treated with an intramedullary screw or rush pin.Materials and methodsWe identified all patients who were surgically treated with either a 3.5-mm screw or rush pin at Aarhus University Hospital, Denmark, from 2012 to 2018. Major complications were re-operations within three months. We included 80 patients, of which 55 (69%) were treated with a 3.5-mm intramedullary screw and 25 (31%) with a rush pin. The majority of the study population was female (59) and the mean age was 75 (range 24 to 100) years. Of the 80 patients included, 41 patients had more than 2 comorbidities.ResultsThree patients underwent re-operation within three months due to either fracture displacement or hardware cutout. Radiographs obtained after six weeks showed that nine patients had loss of reduction. Additionally, four patients had superficial wound infections and six patients had delayed wound healing.ConclusionsIntramedullary fixation of distal fibula fractures with either a screw or rush pin has low re-operation rates. However, the high proportion of patients with radiological loss of reduction is concerning.

The small screw-apex distance is potentially associated with femoral head osteonecrosis in adults with femoral neck fractures treated by closed reduction and percutaneous 3 parallel cannulated screws

ObjectiveFemoral neck fractures (FNFs) are among the most common fractures in elderly individuals. Surgery is the main treatment for FNFs, and osteonecrosis of the femoral head (ONFH) is one of the unacceptable complications. This study aimed to assess both the clinical and radiological outcomes in patients with FNFs treated with three parallel cannulated screws and to identify relationship between screws position and ONFH.Patients and methodsA total of 100 patients who were treated with closed reduction and fixed with 3 parallel cannulated screws met the inclusion criteria between January 2014 and December 2020 at authors’ institution. The follow-up duration, age, sex, affected side, and injury-to-surgery interval were collected; the neck-shaft angle of both hips, screw-apex distance (SAD) and the tip-apex distance (TAD)were measured; and the Garden classification, quality of reduction and presence of ONFH were evaluated.ResultsThe sample consisted of 37 males and 63 females, with 60 left and 40 right hips affected. The mean age of patients was 54.93 ± 12.24 years, and the mean follow-up was 56.3 ± 13.38 months. The overall incidence of ONFH was 13%. No significant difference was observed in the incidence of ONFH by affected side, age, fracture displacement, injury-to-surgery interval, neck-shaft angle deviation, or reduction quality. The SAD was significantly shorter in ONFH patients than in normal patients for all three screws (p = 0.02, 0.02, and 0.01, respectively).ConclusionsThe short SAD of all screws is associated with femoral head necrosis of FNFs treated with 3 cannulated screws. The short SAD indicated that screws malpositioning in the weight-bearing area of the femoral head, potentially harming the blood supply and compromising the anchorage of the primary compressive trabeculae in this region.

Early range of motion results in good elbow function following conservative treatment of non-displaced radial head fractures

IntroductionThe aim of this study was to evaluate the range of motion (ROM), elbow function and predictors for good elbow function after conservative treatment of non-displaced radial head fractures.Material and methodsAll patients with non-displaced radial head fractures (displacement < 2 mm), that were diagnosed between January 1st 2017 and December 31st 2021 in a level I trauma center, were included in this retrospective case series and the charts were evaluated for ROM and elbow function. Elbow function was categorized as “good” or “bad” depending on the ROM measured defined by Morrey et al. Overall, 73 patients (33 male, 40 female) with an average age of 38 years (+/- 13 years) could be included.ResultsConservative treatment had good clinical results for ROM and elbow function. After 6 weeks mean flexion was 131° (SD 13°), extension 8° (SD 7°), Pronation 83° (SD 11°) and Supination 83° (SD 13). Patients with a good elbow function after one week showed a good elbow function after completing the treatment.ConclusionsA clinical assessment after one week should always be performed and the study showed that it is a good predictor for good elbow function. In cases of bad elbow function further controls should be considered.

Closed reduction and intramedullary nails for acute completely displaced femoral diaphysis fracture in children aged 2-6.

The management of femoral fractures in children aged two to six years is still controversial. The purpose of this study was to assess the results of closed reduction and elastic stable intramedullary nail (ESIN) fixation in completely displaced fractures of the femoral diaphysis in children in this age group. A retrospective review of all children with acute completely displaced fractures of the femoral diaphysis in children aged 2-6 years treated from 2013 to 2020 was performed. A total of 34 patients were treated who met the inclusion criteria: Group 1: 21 fractures (transverse and short oblique); Group 2: 13 fractures (long oblique and spiral) that underwent closed reduction and elastic stable intramedullary nail (ESIN) fixation. No differences existed between the 2 groups with respect to age, extremity, sex, time to treatment, mechanism of injury, or fracture displacement. Demographic characteristics and radiographs were reviewed, and the following parameters were documented: surgery time, time to union, return to activities, range of motion of knee joints, and complications. Major complications were defined as those with presumptive long-term side effects or those requiring a reoperation. No major complications were observed in the two groups. All included fractures were treated by a single senior paediatric surgeon. The mean follow-up period was 28.4 months (range 24-45 months). The level of significance was set at p < 0.05. Thirty-four children with acute completely displaced fractures of the femoral diaphysis were included: Group 1: 21 fractures; Group 2: 13 fractures. The patients included 15 girls (44.1%) and 19 boys (55.9%), with an average age of 4.4 years (range 2.8 to 6.5 years). The mean follow-up period was 28.4 months (range 24.2-45.0 months). The demographic characteristics did not differ between the two groups of patients. Overall, successful closed reduction and elastic stable intramedullary nail (ESIN) fixation could be achieved in all 34 patients. The mean surgical time was 40.4 and 43.0 min in Group 1 and Group 2, respectively (p = 0.857). Fluoroscopy time was not significantly different between the two groups (37.0 vs. 36.1 s, respectively; p = 0.247). Cosmetic results were described as good and satisfactory by all patients. There were no refractures and no incidences of nonunion or growth arrest in the proximal epiphysis. Only two patients suffered from a superficial infection, which was resolved after the pins were shortened and oral antibiotics were administered. Closed reduction and elastic stable intramedullary nail (ESIN) fixation can be successfully used to treat completely displaced fractures of the femoral diaphysis in children aged two to six years. This technique is efficient and minimally invasive, and the results are satisfactory.

Proximal humerus fracture and acromioclavicular joint dislocation.

Proximal humerus fractures and injuries to the acromioclavicular joint are among the most common traumatic diseases of the upper extremity. Fractures of the proximal humerus occur most frequently in older people and are an indicator fracture of osteoporosis. While a large proportion of only slightly displaced fractures can be treated non-operatively, more complex fractures require surgical treatment. The choice of optimal treatment and the decision between joint-preserving surgery by means of osteosynthesis or endoprosthetic treatment is often a difficult decision in which both fracture morphology factors and individual factors should be taken into account. If endoprosthetic treatment is indicated, satisfactory long-term functional and clinical results have been achieved with a reverse shoulder arthroplasty. Injuries to the acromioclavicular joint occur primarily in young, athletic individuals. The common classification according to Rockwood divides the injury into 6 degrees of severity depending on the dislocation. This classification forms the basis for the decision on non-operative or surgical treatment. The indication for surgical treatment for higher-grade injuries is the subject of controversial debate in the latest literature. In chronic injuries, an autologous tendon transplant is also performed. Whereas in the past, treatment was often carried out using a hook plate, which was associated with complications, the gold standard today is minimally invasive treatment using Endobutton systems. This review provides an overview of the two injury patterns and discusses the various treatment options.

Long-term outcome of nonunion of the lateral humeral condyle fracture in children: a multicentre retrospective study.

Lateral humeral condyle nonunion in children is a rare condition. The treatment protocol for nonunion of lateral humeral condyle remains controversial due to the potential complication. This study reports long-term functional outcomes of the nonunion of the lateral humeral condyle fracture. In addition, we identified the prognostic factors for nonunion of the lateral humeral condyle fracture. We conducted a multicentre retrospective cohort study of nonunion of lateral humeral condyle between January 1995 and December 2022. The patient's preoperative demographic information was reviewed. Potential risk factors of poor functional outcome, such as age, duration from initial injury, and fracture displacement, were retrieved. Functional outcomes at the latest follow-up visit were evaluated using the Mayo Elbow Performance Score (MEPS). Multivariable linear regression was deployed to evaluate the association of potential risk factors with the functional outcome. A total of 63 patients from eight medical centers were included, of which 60 were surgically treated. Patients' average age was 7.3years old, with a mean follow-up duration of sevenyears. All nonunion cases were successfully treated, resulting in a normalized humeroulnar angle. The rate of AVN was 16.7%. All patients reported excellent range of motion and MEPS at the latest follow-up. Multivariable linear regression demonstrated that Fracture displacement (β = -0.88, 95% CI -1.55 to -0.22, p = 0.010) and duration from initial injury (β = -0.09, 95% CI -0.17 to -0.02, p = 0.010) were statistically significant factors influencing functional outcome of lateral humeral condyle nonunion. Initial fracture displacement and duration from the initial injury are statistically significantly associated with elbow function in lateral humeral condyle nonunion. However, the effect size for these factors is relatively small and does not reach clinical significance. Despite this, the functional outcome is excellent in all patients, with an average follow-up duration of sevenyears.

Closed reduction and internal fixation for tillaux fractures, based on pre-operative three-dimensional computed tomography.

This study aimed to propose treatment protocol and identify patterns of tillaux fractures using three-dimensional (3D) computed tomography (CT) analysis and to describe an effective reduction technique. Forty-two juvenile patients with tillaux fractures were evaluated with 3D-CT scan for fracture displacement pattern and received surgical treatment. Tillaux fragment was reduced by pushing the superomedial quadrant part of the fragment slightly downward towards the ankle joint from anterolateral to posteromedial through 5-mm skin incisions with mosquito forceps. A 4.0 cannulated screw was subsequently inserted from the anterolateral to the posteromedial side parallel to the ankle joint. We analysed the distance and direction of fracture displacement with 3D-CT before the surgery. Pre-operative and post-operative plain radiographs were evaluated. Pre-operative 3D-CT analysis revealed a common fracture pattern, varus tilt, and external rotation of fragment. We achieved satisfactory reduction with residual fracture gaps less than 2mm in 42 cases. Two cases had a 13-mm anterior gap that was reduced by mini-open reduction because of periosteal impingement. No significant clinical complications were found. The closed reduction technique developed based on the fracture pattern identified by 3D-CT anatomical analysis is safe and effective in treating tillaux fractures.