Distal Shaft Research Articles

Easily missed nondisplaced fractures accompanying complete fractures in the lower extremity and pelvis: a narrative review

Nondisplaced fractures accompanying complete fractures are often difficult to detect on plain radiographs or computed tomography scans, posing a diagnostic challenge. The diagnosis of these frequently overlooked injuries can be delayed, potentially leading to suboptimal patient outcomes. This review discusses four commonly missed fracture patterns in the lower extremity and pelvis, including posterior involvement in fragility fractures of the pelvis, intertrochanteric extensions in isolated greater trochanter fractures, ipsilateral femoral neck fractures in high energy femoral shaft fractures, and posterior malleolar fractures in distal spiral tibial shaft fractures. An accurate diagnosis of these accompanying nondisplaced fractures is critical for optimizing surgical outcomes. Surgeons should incorporate thorough preoperative evaluations into their clinical practice to facilitate early detection and appropriate treatment strategies. Prompt identification and comprehensive management remain essential for improving patient outcomes.

Morphological, Morphometrical and Radiological Features of the Pelvic Limb Skeleton in African Green Monkeys (Chlorocebus sabaeus) from Saint Kitts and Nevis Islands.

The paper presents a detailed gross anatomical description of the elements of the pelvic limb in the African green monkey and provides comparative and differential elements on pelvic limb monkey osteology. The osteometric investigation adds value to the gross morphological and radiological investigation, adjoining metric data to the gross descriptive data set. The main methodology used was the gross morphological investigation, doubled by regular osteometrical and radiographical assessments. For each of the elements, several morphological aspects are described, pointing to the specific and differential aspects that might serve as landmarks in the specific diagnosis of different adaptative changes, related to the type of locomotion. For the pelvis, the aspect of the symphysis, the overall shape of the pelvic inlet, the iliac wing aspect and the acetabular shape are listed as significant elements. The femur has a spherical head with an inferior position of the femoral fovea and a well-developed (tall) greater trochanter, lacking the third trochanter. The medial condyle of the femur is better developed than the lateral one and an evident extensor's fossa is noted at the level of the distal shaft. The proximal lateral condyloid surface in the tibia is slightly larger than the medial one, with noticeable intercondilar eminences. The fibula is long and unfused with the tibia. Some specific anatomical features are listed only for the talus and calcaneus from tarsals. The study revealed the presence of the gastrocnemius sesamoid bones and the proximal sesamoidi bones as well. Investigation presents a series of osteometrical data with an attempt to show some basic metrical differences among the investigated specimens.

Technological innovation and revolution with single-use digital flexible ureteroscopes: a review from section of EAU Endourology.

Numerous scope-related innovations have taken place in the field of endourology. The presented analytical review is aimed at studying the technical innovations of the single-use digital flexible ureteroscopes. In November 2024, a comprehensive search was done for information on latest disposable flexible digital ureteroscopes, as well as their various unique characteristics. A thorough examination was conducted for image qualities; sizes and channels; and deflection capabilities. Furthermore, supplementary features about the latest advances were assigned to a separate group including 'Unique' solutions. Using the last search query, various innovations in flexible ureteroscopy in general were also searched and sorted into appropriate groups. Modern single-use flexible digital ureteroscopes are characterized by advanced technologies for transmitting light and images, miniaturization, as well as by a number of unique solutions that were previously characteristic only of semi-rigid or fiberoptic endoscopes. These include features such as integrated buttons for data recording, self-locking mechanism, separate ports, rotating shaft, direct-in-scope suction, pressure monitoring, enhanced tip control and customizable settings. Since their introduction in urology, endoscopes have undergone many changes, as illustrated by the example of single-use flexible digital ureteroscopes. The imaging quality has improved, the dimensions of both the distal tip and shaft have decreased, with over 15 manufactures producing and distributing these scopes. A lot of new additional new features are likely to enhance the efficacy and safety of ureteroscopic procedures.

Bone mass distribution of 892 distal tibiae and implications for the treatment of medial malleolar fractures.

The medial malleolus is involved in up to 50 % of ankle fractures. When surgery is required, a thorough understanding of bone mass distribution within the distal tibia is crucial for selecting and positioning screws to ensure stable fixation. Despite its clinical significance, data on the bone mass distribution in the distal tibia remains limited. A total of 892 anonymized computed tomography data sets were analyzed to assess bone mass distribution in the distal tibia. Patients were categorized based on age, sex and stratified into those with normal (Hounsfield units (HU) ≥ 122) and reduced (HU < 122) bone density. Utilizing color-coded thermal maps, bone density and bone mass distribution in the distal tibia was visualized. Subsequently, simulation of potential screw trajectories for medial malleolar fracture treatment were conducted and bone density along those trajectories measured. Patients exhibiting reduced bone density (n = 442) were significantly older (69 (IQR 60-78)) than those with regular bone density (n = 450) aged (62 (IQR 47-72)) and more often female (p < 0.0001). The highest bone density was located within the proximal one centimeter from the distal tibial articular surface. Another region of dense bone was found at the transition from the distal tibia to the medial malleolus. Bone density was lowest at the distal tibial shaft region beginning at around 30 mm (in females) and 33 mm (in males) from the tip of the medial malleolus. Our data highlights the areas with the highest bone density in the distal tibia. When fixing medial malleolar fractures with unicortical partially threaded screws, this data suggests that screws with a length between 36 and 41 mm should be used at the anterior colliculus and intercollicular. However, regardless of our findings, fracture morphology must be considered, and the AO principles of fracture fixation should be adhered to. III.

Characteristics of femur morphology and proximal femur bone mineral density in Japanese females with bisphosphonate-related atypical femur fractures.

To determine which parameters, including femur morphology, proximal femur bone mineral density, or patient characteristics, are associated with bisphosphonate-related atypical femur fractures (AFFs) and to investigate the relationships between AFF location and these parameters. Sixteen females with a history of bisphosphonate use who presented with AFFs and 38 females without AFFs, even those with long-term bisphosphonate use of > 5years, were compared. Patient characteristics; physique, gait ability, and history of pain and medication, were recorded. In terms of femur morphology, the mechanical lateral distal femoral articular angle (mLDFA), femoral bowing angle, femoral neck - shaft angle, and ratio of the femoral lateral cortex:neck width were measured via anteroposterior femur radiographs. Bone mineral density values of the femur neck, trochanter, inter, and Ward's triangle were used. Logistic regression analysis was conducted to determine independent factors for the AFF. In the 16 AFF patients, AFF locations were divided into 1: subtrochanteric, 2: proximal, 3: middle, and 4: distal femur diaphysis. The Spearman correlation coefficients (rs) between the AFF locations and the parameters were calculated. Logistic regression analysis revealed that the mLDFA and Ward's triangle values were significantly independently associated with AFF patients (odds ratios = 1.4 and 0.0, respectively). A more distal AFF location was significantly correlated with a shorter body height and greater BMI (rs = -0.69 and 0.67, respectively). An evaluation combining the mLDFA and Ward's triangle value could be used to predict the risk of bisphosphonate-related AFFs. Body height or BMI may be helpful for predicting AFF location.

Comparative Analysis of Surgical Methods for Distal, Mid-, and Proximal Shaft Hypospadias in Young Males: A Prospective Study on Postoperative Outcomes.

Background and Objectives: The purpose of this study is to report on the results of hypospadias surgery in boys using newly developed methods compared with traditional methods of urethroplasty. Materials and Methods: A total of 136 patients were divided into two groups. Fifty patients with coronal, subcoronal, and distal penile types of hypospadias were allocated to Group I. These patients were treated with a new method of SMU I and urethroplasty according to the Snodgrass procedure and MAGPI. Group II consisted of 86 patients with mid- and proximal shaft penile types of hypospadias who underwent urethroplasty using the new SMU II method and urethroplasty according to the Snodgraft and Bracka procedures. The outcomes were assessed according to the level of postoperative wound healing and the presence of complications. Results: The mean age of the patients was 41 to 60 months. After urethroplasty using the SMU I and SMU II methods, recovery was noted in 92.9% of the patients, and repeated surgery was performed in 7.1%. In the patients undergoing operations utilizing the SMU I and SMU II methods, neomeatus dystopia was not detected and postoperative fistulas were observed in 16.7% of incidence. With the standard urethroplasty method, the rate of complications was higher (p < 0.05). Even though the duration of surgery in the group undergoing a procedure using the standard urethroplasty method was lower (p < 0.001), the frequency of primary wound healing was higher in the SMU I and SMU II groups (p < 0.001). Conclusions: The proposed new methods of distal and shaft hypospadias surgery, in comparison with traditional surgical techniques, have the following advantages: good cosmetic appearance of the penis, complete straightening of the shaft, and right outflow of urine through the slit-like neomeatus at the apex of the glans penis.

7581 Periodic Administration of Quercetin and Dasatinib Alleviates Skeletal Fragility in the INS2AKITA Mouse Model of Type 1 Diabetes

Abstract Disclosure: R. Dresner-Pollak: Consulting Fee; Self; Opko Biologics LTD.. Speaker; Self; Medison Pharma. N. Lishinsky: None. I. Gurt: None. J. Stokar: None. V. Temkin: None. P. Shivam: None. G. Zatarah: None. J. Milgram: None. R. Shahar: None. Skeletal fragility is a recognized complication of type 1 diabetes (T1D). The risk of hip and non-vertebral fractures is significantly higher in people living with T1D compared to age- and sex-matched non-diabetic controls and those living with type 2 diabetes (T2D). Hip fracture risk is up to six-fold higher in T1D patients; hip fractures occur 10-15 years earlier and the outcome is poorer compared to non-diabetics. Alterations in bone quality are considered major contributors to T1D-related skeletal fragility. As people with T1D live longer, there is a growing need to discover new therapeutics to reduce fracture risk. TID is associated with accelerated biological aging. Cellular senescence is a fundamental mechanism of aging. Senescent cells stop dividing, are resistant to apoptosis and acquire a distinct phenotype that includes secretome changes termed “senescence-associated secretory phenotype” (SASP). Clearing senescent cells with senolytics is recognized as a promising therapeutic approach for multiple conditions in mice and humans We explored the ability of senolytics dasatinib (D), a tyrosine kinase inhibitor, and quercetin (Q), a flavanol, present in fruit and vegetables, drug combination, to alleviate femur fragility in mice with T1D. Ins2Akita mice show a sexual dimorphic effect of the mutant Ins2 allele causing severe hyperglycemia in males. We treated Ins2Akita male and female mice and C57BL/6 wild type (WT) male mice with D + Q administered once monthly for four months beginning at age 3 months. 3-month-old Ins2Akita male mice had higher blood levels of the SASPs components HMGB1, PAI-1, MMP12, and increased gene expression of p53 and senescence effectors p16, p15 and SASPs Il1b, Mmp3, Mmp9, Mmp13, Serpineb2 at the femur diaphysis and in bone marrow mesenchymal stem cells, respectively compared to age-matched WT male mice. In vitro, exposure to glucose levels equivalent to those observed in blood in Ins2Akita male mice induced cellular senescence in IDG-SW3 osteocyte-like cells including a 4-5-fold increase in gene expression of p16INK4a, p21Cip[1], p53, double percentage of SA-β-gal+ cells and P21 protein level. Ingenuity pathway analysis of differentially expressed proteins revealed enrichment for the senescence pathway (Z=1.213; P=1.11E-05). D+Q administration did not affect bone microarchitecture at the spine (L2), distal femur metaphysis and diaphysis assessed by µCT. D+Q administration significantly increased femur resistance to fracture assessed by the 3-point-bending test by increasing whole femur work-to-fracture, the ultimate parameter of bone resistance to failure, and post-yield displacement, an index of matrix composition, organization, and bone quality in Ins2Akita males. No effect was observed in Ins2Akita females or WT male mice, indicating that the intervention is specific for T1D. Senolyitcs D+Q show promise in improving bone health in T1D. Presentation: 6/1/2024

Preoperative CT Scans Prior to Distal Tibial Intramedullary Nailing Do not Change Treatment Decisions or Surgical Outcomes.

Distal tibia shaft fractures have a high association with posterior malleolar fractures (PMFs); hence, a preoperative ankle CT scan is commonly obtained. The purpose of this study was to determine whether a CT scan for distal third tibia shaft fractures is associated with differences in recognition of a posterior malleolus fracture (PMF), treatment of an identified PMF, outcomes, and postoperative complications. We retrospectively reviewed cases of adult patients with distal third tibia shaft fractures treated with an intramedullary nail between 2018 and 2020. Patients were divided into 2 groups based on whether they received a preoperative ankle CT scan. Outcomes included surgical time, the rate of missed PMFs or postoperative PMF displacement, the treatment of the PMFs, postoperative weight-bearing restrictions, Patient-Reported Outcomes Measurement Information System Global-10 (PROMIS Global-10) scores, and unplanned revision surgeries. 124 patients (age 45 ± 18 years; 39.5% female) with distal third tibia shaft fractures treated with intramedullary nailing and with minimum 6 months of follow-up were reviewed. 26 patients received preoperative CT scans, and 98 patients did not have CT scans. The rate of detected PMF was 69.2% (N = 18) in patients with CT and 55.1% (N = 54) in patients without CT (P = 0.19). No significant differences were observed in all outcomes between the 2 groups (P > 0.05). 3 PMFs not visible on radiographs were identified on CT, and they did not require fixation and did not displace. PMFs that were greater than one-third of the joint surface were more likely to have a preoperative CT (P < 0.01). Preoperative CT scans for distal third tibia shaft fractures may be useful in characterizing large PMFs; however, this knowledge does not translate into shorter surgical time, increased fixation rates, decreased unplanned revision surgery, or improved patient-reported outcomes. Discovery of PMFs did not always lead to fixation, and PMFs without fixation did not become further displaced.

Distal Radioulnar Synostosis Following Greenstick Fracture of the Ulnar Diaphysis

Case: We discuss a 16-year-old adolescent boy presenting with a minimally displaced greenstick fracture of the distal third ulnar diaphysis sustained during a fall playing football. Initial treatment consisted of in situ casting followed by removable forearm splinting. The patient returned 3 months postinjury with complete forearm motion loss. Imaging demonstrated a post-traumatic radioulnar synostosis. Surgical management of the synostosis restored forearm motion without recurrence. Conclusion: Clinicians should be aware of this atypical presentation of a radioulnar synostosis when evaluating stiffness in the post-treatment setting even for fractures that are minimally displaced and do not require reduction or surgery.

Total Hip Replacement in a Patient with Erdheim-Chester's Disease: A Case Report.

Erdheim-Chester's disease (ECD) is a rare multisystem disorder considered as a neoplasm of non-Langerhans cell histiocytes. We report a case of uncemented total hip arthroplasty in a 74-year-old patient with ECD for femoral neck fracture with pathological involvement of distal metaphysis and diaphysis. We reviewed the literature on bony involvement. Adequate osseointegration was achieved in our case; however, longer follow-up is essential. Vigilant reporting of bony involvement, such as pathological fractures, fracture healing, deformities, osteosynthesis, and outcome of joint replacement surgeries, is needed in ECD-like bone diseases.

Understanding the variability of the proximal femoral canal: A computational modeling study.

Statistical shape modeling (SSM) offers the potential to describe the morphological differences in similar shapes using a compact number of variables. Its application in orthopedics is rapidly growing. In this study, an SSM of the intramedullary canal of the proximal femur was built, with the aim to better understanding the complexity of its shape which may, in turn, enhance the preoperative planning of total hip arthroplasty (THA). This includes the prediction of the prosthetic femoral version (PFV) which is known to be highly variable amongst patients who have undergone THA. The model was built on three dimensional (3D) models of 64 femoral canals which were generated from pelvic computed tomography images including the proximal femur in the field of view. Principal component analysis (PCA) was performed on the mean shape derived from the model and each segmented canal. Five prominent modes of variations representing approximately 84% of the total 3D variations in the population of shapes were found to capture variability in size, proximal torsion, intramedullary femoral anteversion, varus/valgus orientation, and distal femoral shaft twist/torsion, respectively. It was established that the intramedullary femoral canal is highly variable in its size, shape, and orientation between different subjects. PCA-driven SSM is beneficial for identifying patterns and extracting valuable features of the femoral canal.

(248) GRAYSCALE ULTRASOUND ASSESSMENT OF PATIENTS WITH ERECTILE DYSFUNCTION FROM CRURAL FIBROSIS SECONDARY TO BLUNT PERINEAL TRAUMA OR PELVIC FRACTURE

Abstract Introduction In individuals with ED, grayscale imaging during B-mode ultrasound (GUS) of the erect penis in the presence of maximal smooth muscle relaxation has been utilized to measure corpora cavernosal (CC) fibrosis. CC fibrosis, with excess connective tissue and reduced smooth muscle content, may occur in ED secondary to atherosclerotic vascular disease, resulting in poor tissue expandability and corporal veno-occlusive dysfunction. GUS images of such individuals reveal multiple hypoechoic, inhomogeneous areas within all regions of the CC, consistent with diffuse CC fibrosis. In contrast, GUS imaging in individuals without ED under similar conditions of maximal smooth muscle relaxation reveals normoechoic, homogenous areas within all regions of the corpora cavernosa. Bertolotto et al reported an ED case in which the GUS revealed both homogeneity and inhomogeneity in the same patient in different locations of the CC. Focal trauma to the perineum from bicycle riding resulted in significant localized crural CC inhomogeneity, consistent with crural CC fibrosis, while GUS of the uninjured penile shaft revealed penile shaft CC homogeneity. Objective To assess both crural and penile shaft CC homogeneity/inhomogeneity by GUS in a cohort of patients with ED from blunt perineal trauma or pelvic fracture. Methods A retrospective chart review was performed of ED patients who met the following inclusion/exclusion criteria: ≤45 years old, history of blunt perineal trauma/pelvic fracture resulting in ED, ≤1 atherosclerotic vascular risk factor exposure, IIEF completed, and GUS of the crura and penile shaft completed. GUS was performed usig a high frequency probe (15.4 mHz) during pharmacologic erection (EHS grade 3-4/4) in the proximal, midportion, and distal penile shaft as well as right and left crura at various B-mode intensities (45%-65%) and dynamic ranges (49-70 dB). A visual grading score was utilized to assess for GUS homogeneity/inhomogeneity: Grade 0 for &amp;lt;10% hypoechoic area, Grade 1 for ≥10% to &amp;lt;25% hypoechoic area, Grade 2 ≥ 25% to &amp;lt;50% hypoechoic area, and Grade 3 ≥ 50% hypoechoic area. Results A total of 22 patients formed the study cohort (mean age 29 ± 11 years). Bicycle or dirt bike riding was reported in 64%, other straddle injuries in 23%, and pelvic fracture in 13%. Mean IIEF-EF domain score was 15 ± 8. No patient in this cohort had hypertension, hyperlipidemia, heart disease, or diabetes; 25% had current/past cigarette smoking. Mean GUS visual grading scores for the crural region was 2.2 ± 0.4, consistent with right/left crural CC fibrosis. Mean GUS visual scores for the proximal, mid-portion, and distal penile shaft were 0.8 ± 0.1, 0.5 ± 0.1 and 0.6 ± 0.1, respectively, consistent with penile shaft CC homogeneity (Fig. 1). Conclusions GUS is a non-invasive imaging strategy for patients with blunt perineal trauma/pelvic fracture-related ED that can be successfully utilized to better understand the underlying ED pathophysiology. In these patients, GUS reveals a signature finding of both crural CC inhomogeneity, consistent with crural fibrosis, and concomitant penile shaft CC homogeneity, consistent with no fibrosis in the uninjured penile shaft. Disclosure No.

Phytase super-dosing modulates bone parameters and the concentration of the calcium epithelial carrier calbindin-D28k in quails (Coturnix coturnix japonica) under thermal stress

Context Thermal stress causes significant changes in the bioavailability of minerals, especially calcium, in laying birds, resulting in reduced egg production, and compromising egg quality. Therefore, it is necessary to use additives that provide better nutrient availability and minimise the negative effects caused by high temperatures. Aims This study aimed to evaluate the effects of super-dosing the diet of laying quails submitted to different temperatures with phytase on their bone parameters and on the epithelial calcium transporter calbindin-D28K positivity. Methods Seven hundred and twenty (720) Japanese quails in the production phase were distributed in a completely randomised design, in a 5 × 3 factorial design, with five supplementation levels of phytase (0, 500, 1000, 1500, and 3000 FTU/kg), and three temperatures (24°C, 30°C and 36°C), totalling 15 treatments, and six replications of eight birds each. The study began at the 8th week of age and continued for two cycles of 21 days, totalling 42 days of experiment. Bone parameters of the tibias and calbindin-D28K positivity were measured by immunohistochemistry. The data were submitted to variance, Tukey, and regression analyses. Key results At 24°C, birds had higher averages for proximal, medial, and distal diaphyses than did birds at 30°C and 36°C, and a greater breaking strength of the tibias than did those at 36°C. There was an increasing linear effect on the medial diaphysis and Seedor index in the tibias with an increasing phytase supplementation level. Calcium (Ca) in the tibias was higher in birds kept at 30°C at a supplementation level of up to 1000 FTU of phytase, than in the birds at 24°C and 36°C, equalling at 1500 FTU, and lower at 3000 FTU. There was a quadratic effect for phosphorus (P) and the Ca:P ratio in the tibias of quails submitted to increasing concentrations of phytase. Quails kept at 30°C showed greater anti-calbindin-D28K positivity in the duodenum and jejunum, when compared to animals subjected to temperatures of 24°C and 36°C. Phytase doses of 500 and 1000 FTU increased calbindin-D28K positivity in the duodenum of quails kept at 30°C. At a supplementation level of 1500 FTU, phytase provided greater eggshell thickness and greater calbindin-D28K positivity in the uterus of quails kept at 36°C. Conclusions Therefore, it is recommended to use 1500 FTU of phytase for Japanese quail exposed to high temperatures. Implications These findings suggest that dietary phytase super-dosing can help alleviate thermal stress in Japanese quail.

Is the Diagnosis of fifth Metatarsal Fracture Type Consistent? An Interobserver Reliability Study.

Treatment pathways of fifth metatarsal fractures are commonly directed based on fracture classification, with particular proximal fractures typically requiring closer observation and possibly more aggressive management. Our aim is to investigate the interobserver reliability of assessment of subtypes of fifth metatarsal fractures. We included all patients referred to our virtual fracture clinic with a suspected or confirmed fifth metatarsal fracture. Plain anteroposterior radiographs were reviewed by 2 novice observers, initially trained on the fifth metatarsal classification identification. Eight different zones were defined based on anatomical location. Patients were excluded from analysis if neither observer could identify a fracture. An interobserver reliability analysis using Cohen κ coefficient was carried out, and degree of observer agreement described using Landis and Koch's description. All data were analyzed using IBM SPSS, version 27. A total of 1360 patients who met the inclusion criteria were identified. The 2 observers had moderate agreement when identifying fractures in all zones, apart from zone 1.2 and distal metaphysis (DM) fractures, which only achieved fair agreement (κ = 0.308 and 0.381 respectively). Zone 3 has slight agreement with zone 2 proximally, and there is an apparent difficulty with distal diaphyseal shaft (DS) fractures, resulting in a lot of crossover with DM, achieving a fair level of agreement (DS 312 vs 196; DM 120 vs 237; κ = .398, P < .001). Reliability of subcategorizing fifth metatarsal fractures using standardized instructions conveys moderate agreement in most cases. If the region of the fracture is going to be used in an algorithm to guide a management plan and clinical follow-up during a virtual clinic review, defining fractures of zones 1-3 needs careful consideration. Level III, retrospective cohort study.

Reversed proximal humeral internal locking system (PHILOS) plate for distal humeral shaft fractures through an Anterolateral Approach

Reversed proximal humeral internal locking system (PHILOS) plate for distal humeral shaft fractures through an Anterolateral Approach

Radiological and Functional Consequences of Open Reduction Internal Fixation with Locking Plate Versus Dynamic Condylar Screw in Type C1 Complete Articular Fracture of Distal Femur

Background: One of the body's main joints for bearing weight is the knee. Its issues are likewise difficult to resolve. Damage to this joint can cause abnormalities in the alignment, stability, and motion of the knee, which impairs function. Objective: To compare the functional and radiological outcome in AO type C1 distal femur fractures fixed with locking plate versus dynamic condylar screw. Methods: The study comprised 94 patients aged 18 to 60 years who had an isolated distal femur fracture and an Arbeitsgemeinschaft für Osteosynthesefragen (AO) type C1 closed fracture. Patients with diabetes mellitus, chronic renal disease, chronic liver disease, ischemic heart disease, pathological fractures, head injuries with a Glasgow coma scale of less than 14, and malignancy were excluded from the sample. The patients were assigned by lottery to groups A and B. In groups A and B, they were treated with dynamic condylar screws (DCS) and locking plate fixation, respectively.. Results: Among 94 patients, 30 (63.8%) were men and 17 (36.2%) were women in Group A; similarly, 33 (70.2%) were men and 14 (29.8%) were women in Group B. Patients in group A had an average age of 38.8±6.19 years, whereas those in group B had an average age of 39.5±7.36 years. 02 patients (4.2%) in Group-A and 05 patients (10.6%) in Group-B experienced infection. The union rate was 45 (95.7%) in group A (locking plate fixation technique) and 40 (85.10%) in group B (dynamic condylar screw technique). 35 (74.46%) in group A, 08 (17.1%) in good, 03 (6.38%) in average, and 01 (2.1%) in poor; in group B, 25 (53.2%) in excellent, 09 (19.2%) in decent, and 10 (21.3%) had average and 03(6.3%) had poor functional outcome. Conclusion: In terms of clinical and radiological evaluation, the type C1 distal shaft femur fixation with locking plate performs better than the dynamic condylar screw, which has a lower infection rate and better union and functional success

Evaluation of anatomical and radiological measurements of the proximal phalanx of the horse

When performing osteosynthesis by screw fixation, it is important to carry out operational planning (choosing the screw of the optimal length and diameter). Choosing the optimal osteosynthesis tactics and the correct screw size allows you to stimulate regeneration and prevent possible complications. The X-ray examination method is included in the mandatory criterion of preoperative examination, which allows you to determine the size of the deformation and bone parameters. The present study is based on the hypothesis that the lifetime X-ray measurement of the bone of the proximal phalanx of a horse (longitudinal and transverse dimensions of the proximal and distal epiphysis and diaphysis, bone length), allows us to justify the size and technique of fixing the screw in the treatment of fractures. Morphometric studies included macroscopic dissection; morphometry of bone preparations; Xray measurement of the putus bone; documentation of the data obtained, photographing. A morphometric study was performed on 20 bone preparations (10 thoracic and 10 pelvic) and 40 X-ray images (20 in lateromedial and 20 in dorso-palmar/plantar projections) of the proximal phalanx of the horse. As a result of the work performed, it was found that the variability of parameters (longitudinal and transverse size of the proximal epiphysis, longitudinal and transverse size of the distal epiphysis; the longitudinal and transverse size of the diaphysis, bone length) of the fetal bone of the thoracic and pelvic limbs in horses for average values has no significant deviations (up to 1%), while the differences between the minimum and maximum values range from 20.0% to 66.6% for values obtained by anatomical method; from 12.2% and 33.3% for the Xray method.

Ulnar shaft diameter as it relates to plate osteosynthesis: A cadaveric study

BackgroundUlnar shaft fractures are common and the standard of care treatment is with 3.5 ​mm plating. The purpose of this study was to measure diameters along the length of the ulna to provide information on screw length and appropriateness of 3.5 ​mm screws and plate location. MethodsTen embalmed cadaveric ulnas were dissected free of all soft tissues. The length of the ulna was measured and then divided by four. Transverse osteotomies were performed along the length of the ulna at ¼, ½ and ¾ its full length. The diameter of the ulna at these locations was then measured in a radio-ulnar direction as well as a volar-dorsal direction. ResultsThere were five female and five male specimens with an average age of 83.6 and 78.8 respectively. The smallest diameter in both the female and male specimens was in the distal ¾ shaft measured in a volar-dorsal direction with an average of 9.1 ​mm and 12 ​mm. The average volar-dorsal measurement was less than radio-ulnar measurement at all locations. The diameters increased along the ulna heading proximally. ConclusionThis study provides information pertinent to screw width and length with respect to the ulnar shaft and calls in to question the use of 3.5 ​mm screws in the distal and midshaft ulnar diaphysis in females. Removal of 3.5 ​mm screws in the mid and distal ulnar shaft in females can leave a hole corresponding to 23% and 27% of the bone which can be concerning for a stress riser.

Standard or Fin SIGN® nail? which option is better for the treatment of femoral fractures in low and middle-income countries?

PurposeFemoral fractures are common in low and middle-income countries (LMIC), predominantly caused by high-energy trauma. The surgical implant generation network (SIGN®) program offers two different intramedullary nails in LMIC which are designed to be used without image intensifier free of charge for the patients: the SIGN standard nail (SSN®) and the SIGN Fin nail (SFN®). This study aimed to compare the results of the SSN® and the SFN® for the treatment of middle and distal shaft femoral fractures through a retrograde approach.Material and MethodsThis was a retrospective, descriptive, and non-experimental study including all consecutive patients who underwent surgical management of middle or distal shaft femoral fracture between January 2017 and May 2022 in an NGO hospital located in Freetown, Sierra Leone. The duration of surgery, type of reduction, complications like screw loosening, implant migration, anterior knee pain and non-union rate at six months of follow up were evaluated.ResultsA total of 122 patients were included in the study. Group A: 60 patients were managed with SSN® and Group B: 62 patients with SFN®. The mean operative time was 104 min with SSN® and 78 with SFN® (p < 0.001). Open reduction of the fracture was necessary in ten (16.7%) patients with SSN® and 12 (19.4%) patients treated with SFN® (p = 0.69). Non-union was observed in one (1.7%) patient with SSN® and two (3.2%) patients with SFN® (p = 0.57).ConclusionsBoth options seem equally effective in treating midshaft and distal femoral shaft fractures. The SFN® reduces the surgical time, due to this fact, in polytraumatized patients, patients with bilateral femur fracture or patients with ipsilateral tibia fracture, it can be considered as the best option to be used. There was no statistical difference in the complications presented by the two groups.

(287) INTRACAVERNOSAL BOTULINUM TOXIN USE IN THE TREATMENT OF ERECTILE DYSFUNCTION: A PROSPECTIVE, DOUBLE-BLIND, RANDOMIZED STUDY

Abstract Introduction Erectile dysfunction (ED) is a significant public health issue that greatly impacts patients’ quality of life. Its prevalence increases with age and is associated with several risk factors, including diabetes, hypertension, hypercholesterolemia, smoking, sedentary lifestyle, obesity, and hypogonadism. These factors often lead to vascular endothelial alterations, resulting in atherosclerosis, arterial obstruction, and reduced penile blood flow. Traditional treatments for ED focus on vasodilators to facilitate erections. In the 1980s, intracavernosal injections of vasoactive drugs became prevalent, and the 1990s saw a revolution with the introduction of phosphodiesterase-5 (PDE5) inhibitors, such as sildenafil. Despite their effectiveness, about 30% of patients do not respond adequately to these treatments, prompting the search for more effective alternatives. Botulinum toxin (BT), known for its muscle relaxation properties, emerges as a promising candidate. Preliminary studies, including those by Ghanem (2018) and El-Shaer (2021), show promising results for intracavernosal BT in ED treatment, though further research is needed. Objective The primary objective of this study is to determine the safety and efficacy of intracavernosal botulinum toxin application in the treatment of erectile dysfunction. Specifically, the study aims to assess the improvement in erectile function in patients with ED refractory to standard treatments and evaluate the occurrence of any adverse events associated with BT use. Methods This prospective, double-blind, randomized study involves evaluating botulinum toxin (study drug) versus placebo, alongside standard ED treatments. The study includes male patients aged 18 and above, with an International Index of Erectile Function (IIEF-5) score of 21 or less, and currently undergoing at least one form of standard ED treatment. Exclusion criteria include urogenital neoplasms, radical prostatectomy, testosterone levels below 350 ng/ml, diagnosed depression on antidepressants, genital tract anatomical alterations, and insufficient sexual activity for analysis. Participants will be randomly assigned to either the BT or placebo group. The active treatment involves injecting 100 units of botulinum toxin, diluted in 4 ml of 0.9% saline, into the penile base and distal shaft, with a penile base tourniquet applied for 20 minutes. The placebo group will receive 0.9% saline injections. Patients will be monitored for 12 months, with evaluations at 1, 3, 6, and 12 months post-treatment. These evaluations include the IIEF-5 score, penile length (CRT max), and blood tests. After 6 months, the blind will be lifted, allowing placebo group patients to opt for BT treatment, and active group patients to receive another BT dose if desired. Results Initial findings from the study indicate that of the 15 patients treated, 8 have shown improvements in their IIEF-5 scores. However, it is important to note that the study is still blinded, and we do not yet know which patients receives botulinum toxin and which received the placebo. As such, the observed improvements cannot yet be attributed to the botulinum toxin treatment. The study will continue the 6-month mark, at which point the blind will be lifted, allowing for a more precise evaluation of the treatment’s efficacy. To date, the treatment has been well-tolerated, with no severe adverse events reported, aligning with previous research on the safety and efficacy of BT for ED. Conclusions This study provides evidence supporting the uso of intracavernosal botulinum toxin as a safe and effective treatment for erectile dysfunction, particularly in patients who do not responde to conventional therapies. The results indicate improvements in erectile function and minimal adverse effects, suggesting that BT could become a valuable addition to the current ED treatment options. Further research with larger sample sizes and longer follow-up periods is necessary. Disclosure No.