Double Fixation Research Articles

The linked nail/plate construct for the management of distal femur fractures in the elderly.

Distal femoral fractures represent a challenging injury, with many different factors such as the method of fixation, complexity of fracture pattern, and patient co-morbidities affecting the outcome. Lots of surgical treatment options have been described, but recently double construct fixation, using a nail/plate combination, has received lots of attention, a technique that leads to faster weight-bearing, low risk of metalwork failure, and non-union. The purpose of this study was to investigate the effectiveness of the linked nail/plate construct in the management of complex distal femur fractures and to investigate if the above technique leads to faster recovery and earlier radiographic union. In total 15 cases were included in the study, that underwent a combined nail/plate construct for a distal femur fracture between January 2021 and December 2022. Only cases with a linked nail/plate construct were included, with a minimum follow-up of 1 year. Open femur fractures, single implant fixation cases, and revision procedures were excluded. In this cohort study, 11 cases were periprosthetic distal femur features, and 4 cases were distal femur fractures around a native knee joint. The mean age group was 74 years, 86.6% of the patients had a BMI>25 and the mean time to fracture union was 24 weeks (range from 20 to 26 weeks). All cases healed uneventfully and the complication rate was 6.6%, including 1 case of superficial infection which resolved completely with oral antibiotics. The increasing age population, the complexity of distal femoral fractures along with the increasing physiological demands of the elderly population, drive the need for double fixation constructs that allow early mobilization and enhance fracture stability. In our study, the linked nail/plate construct seems to provide adequate stability and excellent union rates (100%) with no associated increased risk of complications.

Phenolic Determination in Proembryogenic Cell Complexes of Buckwheat Morphogenic Cell Culture with Osmium Tetroxide, Toluidine Blue O Dye, and Iron Chloride.

The study of the localization of secondary metabolites in both plants and the cell cultures on the intravital sections is hampered by the difficulty of obtaining thin, correctly oriented sections. Techniques for fixing tissues in resins allow these difficulties to be overcome. Properly selected tissue fixation techniques allow using different dyes to identify the compound of interest. In addition, some components of tissue fixation can act as fixatives and as a dye for identifying secondary metabolites. For example, osmiumtetroxide, which fixes lipids in tissues, stains phenolic compounds black. This paper describes methods for the detection of phenolic compounds in morphogenic callus culture of buckwheat using osmium tetroxide, ToluidineBlue O dye, and ferric chloride as dyes in epoxy resin-embedded cell culture with double fixation of the material and when material fixed in Karnovsky's fixative.

Dual fixation for coracoid fracture with acute acromioclavicular joint disruption: a case series

Abstract Introduction The management of acute disruption of the acromioclavicular joint (ACJ) in conjunction with a concomitant coracoid fracture has been discussed. This combined orthopedic injury is uncommon because radiographs alone may not always be enough to identify the coracoid component clearly. There are different options for management, ranging from nonsurgical, single, or double fixation strategy. The purpose of this study was to evaluate the results of a clavicular hook plate combined with a coracoid screw fixation in patients who engage in high-demand activities and athletes over a minimum of a year of follow-up. Patients and methods Following the dual fixation strategy, seven patients were followed clinically and radiologically with a mean follow-up 16 weeks, through which a rehabilitation program was adhered to. The range of motion around the shoulder, American Shoulder & Elbow Surgeons, and constant scores were utilized to evaluate patients clinically during their last follow-up visit. Furthermore, radiological assessment of the reduction of the ACJ according to coracoclavicular distance (CCD) and CCD ratio. Results The findings in this study showed a statistically significant improvement between the 3, 6, and 12-month American Shoulder & Elbow Surgeons scores, which were 39.1 ± 14, 67.4 ± 1, and 86.7 ± 5, respectively (P<0.001). The mean range of motions for active shoulder abduction and forward elevation was 171.4 ± 6.3° and 156.4 ± 12.8°, respectively. 9 ± 0.9 mm was the mean CCD, and 1.07% was the mean CCD ratio. Conclusion A stable fixation construct with significant functionality can be successfully achieved through the dual fixation strategy using a coracoid screw and hook plate with no coracoclavicular ligament reconstruction in the treatment of concomitant coracoid fracture and acute ACJ injuries in athletes and high-demand patients.

Satisfactory outcomes from the double-row fixation procedure for ankle lateral ligaments injury with os subfibulare

BackgroundOssicles of avulsed fractures of the lateral malleolus can result in pain or chronic ankle instability. The purpose of this study was to evaluate and compare the arthroscopic double-row fixation procedure with anatomic ankle lateral ligaments reconstruction for the treatment of ankle lateral ligaments injury with os subfibulare. MethodsThis retrospective study included 38 patients with ankle lateral ligaments injury with concomitant os subfibulare who were treated between July 2016 and November 2021. The patients were divided into a double-row fixation group (n = 19) and an ankle lateral ligaments reconstruction group (n = 19). The Karlsson and Peterson Scoring System for Ankle Function (KAFS), American Orthopedic Foot and Ankle Society (AOFAS) score, Tegner score, visual analog scale (VAS), and anterior drawer test (ADT) were obtained preoperatively and at the last post-operative follow-up. Magnetic resonance imaging (MRI) was also performed at the last post-operative follow-up. ResultsThe KAFS, AOFAS, VAS, and Tegner scores increased significantly after the surgery. Furthermore, the pre- and post-operative functional scores were comparable between the two groups. The ADT was negative in all participants post-operatively. There were no significant differences between the double-row fixation and ligaments reconstruction groups regarding the proportions of patients who achieved a minimally clinically important difference (MCID) in KAFS, AOFAS, and Tegner scores. There was no significant difference in T2 mapping values for the tibial and talar side post-operatively between the two groups. Moreover, there were no significant differences in functional scores post-operatively between bony fusion and non-fusion patients in the double fixation group. ConclusionThe double-row fixation procedure provided similar satisfactory clinical outcomes when compared with lateral ligaments reconstruction for the treatment of ankle lateral ligaments injury with os subfibulare over a short follow-up duration.

Varying Distance Between Suture-Endobuttons Does Not Improve Stability of the Transected Syndesmosis in a Motion Tracking Cadaveric Model

Category: Ankle; Sports Introduction/Purpose: A growing body of evidence favors the use of dynamic fixation techniques such as suture endo button over rigid screw fixation for syndesmotic injuries. However, specific dynamic fixation techniques have been poorly evaluated. The purpose of this study was to compare single suture-endobutton fixation (single) to double fixation with suture-endobuttons placed one centimeter (cm) apart (double 1 cm) and double fixation with suture-endobuttons placed three cm apart (double 3 cm). Methods: Twenty-four lower leg specimens from twelve cadavers were tested using a custom biaxial apparatus. Internal rotation, external rotation, and anterior and posterior translation of the tibia and fibula were examined using motion tracking systems after transection of deltoid and syndesmotic ligaments to compare three syndesmotic repair techniques: 1) a single suture-endobutton placed 1 cm above the joint line, 2) two suture suture-endobuttons placed 2 and 3 cm above the joint line, and 3) two suture- endobuttons placed 1 and 4 cm above the joint line. Results: All three endobutton constructs improved the stability of the syndesmosis by reducing aberrant motion after transection. There was no clear superiority of either single suture-endobutton (SEB), double suture-endobuttons placed 2 and 3 cm above the joint line (DSEB 1), or double suture-endobuttons placed 1 and 4 cm above the joint line (DSEB 3). DSEB 3 and DSEB 1 showed equal median laxity for tibia internal rotation (2.7 degrees, DSEB 1 (2.0 – 3.2) degrees, DSEB 3 (2.3 – 2.8) degrees), tibia external rotation (-0.2 degrees, DSEB 1 (-0.4 - 0.4) degrees, DSEB 3 (-0.4 - 0.3) degrees), and fibula external rotation (-0.3 degrees, DSEB 1 (-0.7 - 0.3) degrees, DSEB 3 (-0.7 - 0.7) degrees). Conclusion: Cadaveric biomechanical studies are critical to evaluate various suture-endobutton constructs prior to widespread use in patients. Our results demonstrate that the added cost of a second suture-endobutton may not confer substantial additional stability to the syndesmosis. Likewise, increased spread between suture-endobuttons appears to have minimal impact of syndesmotic stability.

Effectiveness of arthroscopic long head of biceps tendon transposition combined with Swivelock anchor double fixation for massive and irreparable rotator cuff tears

To investigate the effectiveness of arthroscopic long head of biceps tendon (LHBT) transposition combined with Swivelock anchor double fixation in treatment of massive and irreparable rotator cuff tears. Between June 2019 and November 2021, 25 patients with massive and irreparable rotator cuff tears were treated by arthroscopic LHBT transposition combined with Swivelock anchor double fixation. There were 12 males and 13 females. The age ranged from 47 to 74 years (mean, 62.4 years). The disease duration ranged from 1 to 62 months (median, 7 months). The rotator cuff tears were classified as Hamada grade 2 in 25 cases and Goutallier grade 1 in 2 cases, grade 2 in 22 cases, and grade 3 in 1 case. Pre- and post-operative shoulder range of motion (ROM), visual analogue scale (VAS) score, University of California Los Angeles (UCLA) score, and Constant-Murley score were recorded. Postoperative complications were observed. The reconstructed tissue integrity was confirmed by MRI. All operations were successfully completed. The operation time was 120-330 minutes (mean, 189.6 minutes). All incisions healed by first intention. All patients were followed up 10-36 months (mean, 22.0 months). At last follow-up, the ROM in forward flexion, abduction, and external rotation, VAS score, UCLA score, and Constant-Murley score were superior to those before operation, and the differences were significant ( P<0.05). According to UCLA scoring standard, shoulder joint function was rated as excellent in 5 cases, good in 18 cases, and poor in 2 cases, with an excellent and good rate of 92.0%. No other complications occurred except shoulder joint adhesion in 2 cases. At last follow-up, MRI examination showed no retear of rotator cuff, and LHBT was intact. For massive and irreparable rotator cuff tears, arthroscopic LHBT transposition combined with Swivelock anchor double fixation can increase the force of pressing the humeral head, effectively relieve the pain, improve the ROM of joints, maximize the recovery of shoulder function, and do not increase the number of anchor nails.

High performance rechargeable aqueous zinc-iodine batteries via a double iodine species fixation strategy with mesoporous carbon and modified separator

With the increasing requirement for high capacity energy storage systems, a large amount of recent work has focused on the development of zinc-iodine batteries (ZIBs) on account of high energy density, fast redox kinetics, and excellent reversibility. Nevertheless, low electron conductivity, the shuttle effect, and highly soluble iodine species (I2, I−, and I3−) have impeded their widespread application. In this study, metal organic framework-5 (MOF-5)-derived mesoporous carbon (MPC) loaded iodine (MPC/I2) cathode and the single-sided ketjen black modified cotton fiber (KB@CF) separator are designed to solve the problems mentioned above. That is, the double fixation strategy using MPC and KB@CF separators for iodine species suppresses the shuttle effect. Therefore, the ZIBs constructed with the MPC/I2 cathode and the KB@CF separator can exhibit excellent electrochemical performance. At the current density of 0.1 A g−1, a high discharge specific capacity of 137 mAh g−1 is still available after 300 cycles. Meanwhile, it exhibits a low capacity decay rate at long cycling (0.030% per cycle over 2000 cycles).

Can Patella Instability After Total Knee Arthroplasty be Treated With Medial Patellofemoral Ligament Reconstruction?

BackgroundThe aim of this study was to describe outcomes of patients who had undergone medial patellofemoral ligament reconstruction (MPFLr) to treat patellofemoral instability (PFI) following total knee arthroplasty (TKA). Material and methodsThis is a retrospective case series of consecutive patients treated for PFI after TKA. Patients were included if they had radiographic documentation of patella dislocation or subluxation and component position was adequate. MPFLr was performed using a quadriceps tendon autograft. The graft was fixed with either an interference or additional suspensory fixation. A tibial tubercle osteotomy was performed in select indications. Patients were assessed with Kujala and International Knee Score (IKS) at a minimum 12-month follow-up and radiographically with plain radiographs. ResultsA total of 22 patients (23 procedures) were included. The mean follow-up period was 38 months (range 12-72). Average preoperative femoral component rotation on computed tomography was 0.10° external rotation (range 3° internal rotation to 3° external rotation). All patients had improved clinical and radiographic outcomes postoperatively. At the last follow-up, the mean IKS knee score was 77.6 ± 13.1, mean IKS function score was 75.2 ± 23.3, and mean Kujala score was 60.2/100 ± 10.9. There was 1 mechanical failure, which occurred following MPFLr with interference fixation. There were 6 complications (28.1%) postoperatively. Patients receiving double fixation of the MPFLr graft had higher clinical and radiographic scores; however, this difference was not statistically significant. MPFLr had a patella-lowering effect, 0.97 preoperatively to 0.74 postoperatively (P = .069). ConclusionMPFLr in appropriately selected patients is a satisfactory option to treat PFI following TKA.

Comparative characteristics of the physical and mechanical properties of the self-etchangeable self-adhesive composite cement for indirect restorations "Maxcem Elite TM"

Summary. The article deals with an actual problem of orthopedic dentistry: the choice of a reliable material for fixing indirect restorations by comparing the physical and mechanical properties of self-adhesive self-etching composite cements.&#x0D; The aim of the study – to carry out a comparative analysis of self-etching self-adhesive double-fixation cements for indirect restorations in terms of physical and mechanical properties.&#x0D; Materials and Methods. For comparison, in terms of physical and mechanical parameters, a self-etching self-adhesive composite cement for indirect restorations "Maxcem Elite", Kerr, California, USA was taken. "Maxcem Elite" refers to self-etching self-adhesive composite cements of double fixation, which has a number of positive qualities, such as high physical and mechanical properties, good aesthetic properties, radiopacity. We analyzed the following physical and mechanical parameters: the appearance of the paste, depth of hardening, mm, diametric strength, MPa, conical yield point according to Heppler, MPa, hardness according to Heppler, MPa, water absorption in 7 days, μg/mm3, water solubility in 7 days μg/mm3, adhesive strength, MPa, peel strength, MPa.&#x0D; Results and Discussion. According to the average test depth of hardening (mm) material "Maxcem Elite" is inferior to others: material Bifix QV by 14.9 % and Relyx U 100 by 13.3 %. This does not significantly affect the quality of the connection of the adhesive structure with the hard tissues of the tooth, especially due to the method we have developed for the preparation of abutment teeth in the manufacturing of adhesive pads. On the other hand, according to the average value of the index of diametrical strength (MPa), the studied material "Maxcem Elite" is by 17.2 % better than Bifix QV, and by 17.3 % better than Relyx U 100. Comparing these and other physical and mechanical properties of materials on average, one must bear in mind the random nature of these values. From the results of the study, it can be seen that the difference between the indicators of the Maxcem Elite material and analogues is confirmed at a very high level of significance. The study of the level of water absorption indicates the probable absence of variability of the indicator of the studied material in comparison with comparable analogs. The value of the water solubility index of all the composites under study practically does not differ from the value of "Maxcem Elite" (within (2.5±0.1) %), and corresponds to the requirements of ISO 4046.&#x0D; Conclusions. The research results show that the investigated composite material "Maxcem Elite" in the main parameters corresponds to analogs, in most of the indicators it combines their best characteristics. In it, the adhesive strength of the connection with the hard tissues of the tooth is noticeably enhanced and better peel strength makes it possible to profitably use this material "Maxcem Elite" for fixing the adhesive structures.

A clinical and biomechanical comparison of INFIX plus single versus double sacroiliac screw fixation for unstable pelvic ring injury

BackgroundThe aim of this study is to compare the clinical and biomechanical outcome of INFIX plus single with two sacroiliac screw fixation for unstable pelvic fractures of Type C.MethodsSixteen cadavers were randomly subjected to INFIX plus single or double sacroiliac screw fixations and then mounted onto the ElectroForce loading machine under different vertical loads. To investigate the clinical outcomes of the two techniques, nineteen patients were retrospectively analyzed. The main outcome measures were postoperative radiographic reduction grading (using the Tornetta and Matta grading system), functional outcome (using the Majeed scoring system), and incidence of complications.ResultsIn the biomechanical study, INFIX plus double sacroiliac screw fixation showed better biomechanical stability than fixation with a single sacroiliac screw (p < 0.05). In our clinical case series, all 19 patients had bony union 6 months after the operation. INFIX plus double sacroiliac screw fixation also demonstrated a better functional outcome and a higher radiographic satisfactory rate than INFIX plus single sacroiliac screw fixation (79.25 ± 5.47; 91.33 ± 4.97; p < 0.05), (77.78% vs. 60%; p = 0.05). One patient in INFIX plus single-screw fixation group had screw loosening at 6-month follow-up postoperatively. One case in each group suffered heterotopic ossification and the lateral femoral cutaneous nerve paralysis, and one patient suffered from infection.ConclusionINFIX plus double sacroiliac screw fixation demonstrated more stability in cadaveric biomechanical analysis and better clinical outcomes than INFIX plus single sacroiliac screw fixation.

Double fixation for complex distal femoral fractures.

For complex distal femoral fractures, a single lateral locking compression plate or retrograde intramedullary nail may not achieve a stable environment for fracture healing.Various types of double fixation constructs have been featured in the current literature. Double-plate construct and nail-and-plate construct are two common double fixation constructs for distal femoral fractures.Double fixation constructs have been featured in studies on comminuted distal femoral fractures, distal femoral fracture with medial bone defects, periprosthetic fractures, and distal femoral non-union.A number of case series reported a generally high union rate and satisfactory functional outcomes for double fixation of distal femoral fractures.In this review, we present the state of the art of double fixation constructs for distal femoral fractures with a focus on double-plate and plate-and-nail constructs.

Characteristics of the Physical and Mechanical Properties of Self-Etching Self-Adhesive Cements for Indirect Restorations in a Comparative Aspect

The purpose of the study was to carry out a comparative analysis of self-etching self-adhesive double-fixation cements for indirect restorations in terms of physical and mechanical properties. Materials and methods. For comparison, in terms of physical and mechanical parameters, a self-etching self-adhesive composite cement for indirect restorations "Maxcem Elite", Kerr, California, USA was taken. "Maxcem Elite" refers to self-etching self-adhesive composite cements of double fixation, which has a number of positive qualities, such as high physical and mechanical properties, good aesthetic properties, radiopacity. We analyzed the following physical and mechanical parameters: the appearance of the paste, depth of hardening, mm, diametric strength, MPa, conical yield point according to Heppler, MPa, hardness according to Heppler, MPa, water absorption in 7 days, μg/mm3, water solubility in 7 days μg/mm3, adhesive strength, MPa, peel strength, MPa. Results and discussion. According to the average test depth of hardening (mm) material "Maxcem Elite" is inferior to others: material Bifix QV by 14.9% and Relyx U 100 by 13.3%. This does not significantly affect the quality of the connection of the adhesive structure with the hard tissues of the tooth, especially due to the method we have developed for the preparation of abutment teeth in the manufacturing of adhesive pads. On the other hand, according to the average value of the index of diametrical strength (MPa), the studied material "Maxcem Elite" is by 17.2% better than Bifix QV, and by 17.3% better than Relyx U 100. Comparing these and other physical and mechanical properties of materials on average, one must bear in mind the random nature of these values. From the results of the study, it can be seen that the difference between the indicators of the Maxcem Elite material and analogues is confirmed at a very high level of significance. The study of the level of water absorption indicates the probable absence of variability of the indicator of the studied material in comparison with comparable analogs. The value of the water solubility index of all the composites under study practically does not differ from the value of "Maxcem Elite" (within (2.5±0.1) %), and corresponds to the requirements of ISO 4046. Conclusion. The research results show that the investigated composite material "Maxcem Elite" in the main parameters corresponds to analogs, in most of the indicators it combines their best characteristics. In it, the adhesive strength of the connection with the hard tissues of the tooth is noticeably enhanced and better peel strength makes it possible to profitably use this material "Maxcem Elite" for fixing the adhesive structures

Fractures of the distal femur in elderly patients: retrospective analysis of a case series treated with single or double plate

IntroductionWe evaluated the radiologic and clinical outcomes of a lateral incision single plate with and a single-incision double plating in elderly patients with osteoporotic distal femoral fractures.Materials and methodsWe performed a retrospective study of 82 cases of distal femoral fractures from May 2004 to June 2018. Group A consisted of 42 patients who underwent single-plate fixation. Group B consisted of 40 patients who underwent double-plate fixation. The mean patient age was 77 years (67–87 years) and 76 years (64–86 years) in groups A and B, respectively. All patients were evaluated for procedure duration, time to union, range of knee motion, Lysholm knee score, and presence of complications.ResultsThe average procedure time was 81 min (66–92 min) and 110 min (95–120 min) in groups A and B, respectively (p = 0.33). One case in group B required bone grafting after 5 months. The average time to union was 14 weeks (9–19 weeks) and 12.2 weeks (8–19 weeks) (p = 0.63), and the mean range of knee motion was 105° (90–125°) and 110.7° (90°–130°) (p = 0.37) in groups A and B, respectively. There was no significant statistical difference between the two groups in the Lysholm knee score (p = 0.44) and knee society score (p = 0.53).ConclusionThe clinical and radiological outcomes were similar in the 2 groups. In elderly patients, double plate fixation for distal femoral fractures is an useful method for several advantages such as adequate exposure, easy manipulation, anatomical reduction and stable fixation.

Clinical Analysis of Single and Double Sacroiliac Screws in the Treatment of Tile C1 Pelvic Fracture.

We investigated the difference between fixation of single and double sacroiliac screws in the treatment of Tile C1 pelvic fractures. The data of 54 patients with Tile C1 pelvic fractures who were admitted to the trauma center of the Red Society Hospital Affiliated to Xi'an Jiaotong University between August 2016 and August 2020 were retrospectively analyzed. All patients with posterior pelvic ring injuries underwent fixation with sacroiliac screws assisted by a percutaneous robotic navigation system. The operative time, amount of intraoperative blood loss, and postoperative follow-up time between the two groups (single sacroiliac and double sacroiliac screw groups) were compared. The Matta and Majeed scores at the last follow-up were compared between the groups to evaluate fracture reduction and functional recovery. Forty-nine patients were followed up for 17.2 (±4.5) months and 16.2 (±3.4) months in the single and double sacroiliac screw groups, respectively. All patients had excellent fracture reduction immediately after surgery, according to the Matta score. All fractures healed without complications. There was no statistically significant difference in preoperative general information, amount intraoperative blood loss, intraoperative anterior ring fixation method, and postoperative follow-up time between the two groups (P > 0.05). The operative time of the single sacroiliac screw group was shorter than that of the double sacroiliac screw group (P < 0.05). At the last follow-up, the Matta score of the double sacroiliac screw group was significantly better than that of the single sacroiliac screw group (P < 0.05), and there was no statistically significant difference in the Majeed functional scores (P > 0.05). For Tile C1 pelvic fractures, double sacroiliac screw fixation of posterior ring injuries can provide a more stable treatment with no statistically significant difference in functional recovery.

The comparison of clinical effect, knee function, prognosis of double plate fixation and locking plate internal fixation for tibial plateau fractures.

Objectives:The purpose of this study was to investigate the clinical effect, knee function improvement and prognosis of double plate internal fixation and locking plate internal fixation in the treatment of tibial plateau fractures.Methods:Clinical data from 96 tibial plateau fracture patients treated at our hospital were analyzed retrospectively. Of these, 46 had been treated using locking plate internal fixation and 50 were treated with double T-shaped plate fixation. Clinically related indices, Hospital for Special Surgery (HSS) score of knee function, and ability of daily living (ADL) score were evaluated during postoperative follow-up.Results:No significant differences were observed in pre-operative patient characteristics in both groups. Healing time, time to weight-bearing, tibial plateau angle (TPA) and lateral posterior angle (PA) were all superior in the locking plate fixation group compared to the double plate fixation group. At three months post-operative visit, range of motion, knee function, flexion deformity, muscle strength, pain, and stability metrics were all superior in the locking plate fixation group compared to the double plate fixation group. ADL scores were also higher in the locking plate fixation group than in the double plate fixation group at three and six months follow-up.Conclusions:The clinical effect, knee function improvement and prognosis of locking plate internal fixation in the treatment of tibial plateau fractures are better than those of double plate fixation.

Clinical Effect of Double Incision and Double Plate Internal Fixation in the Treatment of Complex Tibial Plateau Fracture and Analysis of Its Effect on Load Bearing Time of Affected Limb

Clinical Effect of Double Incision and Double Plate Internal Fixation in the Treatment of Complex Tibial Plateau Fracture and Analysis of Its Effect on Load Bearing Time of Affected Limb

Displaced Distal Radius Fracture in Children, Single vs Double K-Wire Fixation

Introduction: Distal radius fracture in pediatric population is the most common sustained injury1. Treatment often is guided by the amount of displacement, with un-displaced fractures requiring only full cast and displaced fractures requiring fixation following reduction with Kirchner Wire (K-wire). Use of a single or double K-wire fixation technique is mostly dependent on the stability of the fracture as well as surgeon preference. Our study aims to evaluate both the Single vs. double K-wire fixation technique for the fixation of Displaced distal radius fracture in children in terms of time of surgery, fracture re-displacement, functional outcome and rate of complications. Materials &amp; Methods: This was a prospective study conducted at The Children Hospital and Institute of Child Health, Lahore between February 1st, 2020 and July 30th 2021. Following approval from the Institutional Ethical committee, 54 pediatric patients presenting to the Emergency and outpatient department with trauma to affected wrist with Displaced Fracture of Distal Radius were admitted and divided into two equal groups. Closed Surgical Fixation following manipulation under anesthesia (MUA) with single and double cross K-wires was performed in each group and Full Cast below elbow was applied for 4 to 6 weeks. Mean radial shortening, angulation and displacement was measured on radiograph pre-operatively, immediate post operatively and at the time of removal of k-wires. Functional outcome was measured post k-wire removal follow up in terms of normal, mildly reduced, moderately reduced and severely reduced. Results: A total of 54 patients were included in the study with the mean age of 9.61(6-14) years, mean time of surgery was 17.26±3.75 minutes for single k-wire and 23.22±3.48 minutes for double k-wire fixation which was significant (p ≤ 0.05). Mean Follow-up was 6.70±0.76 weeks for single k-wire and 6.19±0.48 weeks for double k-wire fixation. There was a statistically significant increase in mean dorsal angulation immediate post-operatively and at the time of k-wire removal (p ≤ 0.05). There was no statistical difference in mean dorsal angulation between the two groups at the time of k-wire removal (p= 0.55). Seven (29.12%) patients of single k-wire developed complications including 3 (11.11%) pin site infection, 1 (1.85%) loss of reduction and 2 (7.41%) wire migration. In contrast to single k-wire fixation, 13 (48.15%) patients developed complications in double k-wire fixation including 7 (29.12%) pin site infection, 1 (1.85%) loss of reduction, 2 (7.41%) neuropraxia and 2 (7.41%) wire migration. In the single k-wire group, 22 (81.48%) patients had normal, 5 (18.52%) had mildly reduced and none had moderately reduced outcome. In double k-wire group, 21 (77.78%) had normal, 5 (.52%) had mildly reduced and 1 (3.70%) had moderately reduced outcome. Conclusion: We concluded that although functional outcome is similar in both groups, single k wire fixation is superior to double k-wire fixation technique in terms of reduced time of surgery and less post-operative complications specially the pin site infection. Key words: Displaced, Distal radius Fracture, K-wire fixation

Double Cross-Looped Coracoclavicular Suture Fixation For Acute Acromioclavicular Joint Separations: Long Term Follow-Up in 72 Patients

Double Cross-Looped Coracoclavicular Suture Fixation For Acute Acromioclavicular Joint Separations: Long Term Follow-Up in 72 Patients

Развитие женского гаметофита и эмбриогенез интродуцированных видов Picea А. Dietr. в таежной зоне (Карелия)

The aim of the research was to establish features in macrosporogenesis, macrogametogenesis, and embryogenesis in Picea species (native species P. abies and introduced species P. canadensis and P. pungens) in the Botanical Garden of Petrozavodsk State University (middle taiga subzone). To study the development of the generative sphere, shoots with generative buds and strobiles from the southwestern side of the crown were cut from 10 trees and fixed in a mixture of alcohol and glycerin. The development of the female gametophyte and the embryo was studied with constant preparations. Preparations for anatomical examination of the kidneys were prepared according to standard methods. In this case, double fixation in glutaraldehyde and osmium was used, wiring through alcohol and acetone, and encapsulation in epoxy resin. Sections with a thickness of about 1 μm were prepared on an ultramicrotome and stained in a 1% aqueous solution of methylene blue. Studies have established that in mid-May, the female gametophyte is still at a free stage, and by the beginning of June it already has a cellular structure. Embryogenesis begins in late July and ends in the second decade of August. In introduced species, various deviations are observed in the development of the female generative sphere and during embryogenesis. The main ones are the degeneration of the female gametophyte at the free-nuclear stage and the destruction of archegonia at the stage of proembryogenesis. For this reason, from 37 to 51% of the seeds of introducers are devoid of the embryo. The largest percentage of empty seeds and the most recent stages of the passage of the main stages of morphogenesis are observed in P. pungens. This indicates the least degree of adaptability of the generative sphere of this species of introducer to new conditions.

Abdominal infectious complications associated with the dislocation of intraperitoneal part of drainage tube and poor drainage after major surgeries.

Abdominal drainage, serving as a diagnostic and therapeutic tool, has been widely applied to prevent complications after major abdominal surgical procedures. However, dislocation of intraperitoneal portion of drainage tube and poor drainage after major surgery has never been detailed. In this retrospective study, we determined whether postoperative abdominal infectious complications are attributed to dislocation of intraperitoneal portion of drainage tube. Patients were recruited from the Department of General Surgery at Beijing Shijitan Hospital, Capital Medical University, between June 2015 and June 2018. All of the enrolled patients had undergone different major abdominal surgical procedures with abdominal drainage. According to different fixation methods of the drainage tube, the patients were categorised as follows: group 1 as conventional extra-abdominal fixation where the tubes were fixed on abdominal wall; group 2 as double fixation where the tubes were fixed by both extra-abdominal and intra-abdominal fixation. Among 60 patients (40 in group 1 and 20 in group 2) with suspected postoperative abdominal infection, abdominal computed tomography (CT) was performed to determine the presence of abnormality. Dislocation of drainage tubes, morbidity, treatment, and prognosis were compared between the two groups. None of the patients showed slip knot or drainage tube slipping from the abdomen based on physical examination and CT imaging. Drainage tube was fixed firmly on the abdominal wall. In group 1, 18 (45%) patients developed postoperative complications resulting from abdominal infection where severe dislocation of intraperitoneal portion of drainage tubes was confirmed by CT. Drainage tubes of six cases were significantly dislocated to the anterior abdominal wall from the target area; 7 upper abdominal drainage tubes dislocated to the lower abdomen; and 5 lower abdominal drainage tubes dislocated to the upper abdomen. Common complications included localised peritonitis (n = 4), abdominal abscess (n = 8), and anastomotic leakage (n = 6). Among them, 8 patients were cured by abdominal puncture catheter drainage; 5 underwent secondary operation and 5 were cured by conservative treatment. In group 2, no tube dislocation was identified by CT. Five patients (25%) developed complications, including localised peritonitis (n = 1), abdominal abscess (n = 1), and anastomotic leakage (n = 3). All the five patients were cured by conservative treatment. Postoperative abdominal infection complications can stem from dislocation of intraperitoneal portion of drainage tube and poor drainage after major abdominal surgery. Maintaining the intraperitoneal portion of drainage tube at the proper location, for example, by applying intraabdominal fixation, is paramount to decrease the incidence and severity of postoperative complications.