Fractures Of Distal End Research Articles

Preparation of adaptive bifunctional reconfigurable polymers and their sand carrying and drag reduction behaviour

AbstractIn order to solve the problem of drag reduction at the front end of shale fractures and sand carrying at the tail end with increased viscosity, the molecular dynamics simulation (MD) method was used to design polymer molecules and simulate the steric resistance, interaction potential energy, mean square displacement, and radial distribution function of the polymer. The polymer AM‐AMPS‐LMA‐DiC12AM (ASLC12) with better solubility, diffusion, and resistance reduction potential was obtained and synthesized. By scanning electron microscope (SEM) and viscoelastic analysis, ASLC12 has a stable mesh structure, good viscoelasticity, and shear resistance, and the mesh structure formed by it is in a dynamic equilibrium state of fracture‐reorganization under shear. We then analyzed the drag reduction, sand carrying, and salt resistance of ASLC12. When the concentration of ASLC12 is 0.09%, the sand‐carrying requirement is satisfied. When the concentration is 0.05%, the drag reduction rate can reach 74.1%, and the resistance reduction rate of ASLC12 in salt ion solution can still reach more than 62%. This shows that the polymer ASLC12 has better sand carrying, drag reduction, and salt resistance.

Comparative Outcomes of Percutaneous K-Wires Versus Plate Fixation in the Treatment of Distal Radius Fractures: A Focus on Stability in Osteoporotic Patients and Both-Bone Distal End Fractures.

Background Distal radius fractures (DRFs) are commonly treated with percutaneous K-wire or plate fixation. The relative efficacy and stability of these methods, particularly in osteoporotic patients and in cases involving both distal radius and ulna fractures, remain subjects of clinical debate. Objective This study aims to compare the outcomes of percutaneous K-wire fixation versus plate fixation in patients with distal end radius fractures, focusing on postoperative stability in osteoporotic conditions and both-bone distal end fractures. Methods A total of 50 patients were retrospectively analysed and divided into two groups: 25 underwent percutaneous K-wire fixation, and 25 underwent plate fixation. Outcomes measured included bone healing time, complication rates, functional recovery using the DASH score, and radiological outcomes through standard X-ray imaging. Results Preliminary data suggest that plate fixation offers better stability, especially in osteoporotic patients and cases with both-bone involvement. Complications with K-wire fixation were more frequent in these subgroups. Conclusion Plate fixation may provide superior stability and functional outcomes in treating DRFs, particularly in complex cases involving osteoporosis or bone injuries. Further research with larger sample sizes and prospective design is recommended.

The effect of pin distractor assistance on the reduction of fibular fractures in the treatment of ankle fracture: A retrospective case-control study.

This study will evaluate the therapeutic effect of pin distractor assisted reduction of fibular fracture on ankle fracture. A retrospective analysis was performed on 98 patients diagnosed as ankle fracture or pilon fracture. These patients were all combined with fibular fracture. Retrospective analysis included 48 patients in the experimental group (distractor assisted reduction) and 48 patients in the control group (without pin distractor). The statistical indexes include: the time spent in fracture reduction and fixation, the length of surgical incision, the operative blood loss of fracture operation, the incidence of incision skin necrosis, the incidence of fracture end splitting during reduction, the quality of fracture reduction, the time of fracture healing, infection rate, and The American Orthopedic Foot and Ankle Society score at the last follow-up. There were statistical differences between the 2 groups in the time spent in the reduction and fixation of fractures, the incidence of fracture end splitting during reduction, the quality of anatomical reduction of fractures, and the healing time of fractures. The experimental group was better than the control group. In addition, for patients with long spiral fracture, comminuted fracture, osteoporotic fracture and preoperative delay time for operation more than 2 weeks, the time spent in the reduction and fixation of fracture, the operative blood loss of fracture operation, the incidence of fracture end splitting during reduction, the quality of anatomical reduction of fracture, and the healing time of fracture in the experimental group are also better than those in the control group. The pin distractor assisted reduction of fibular fracture has the advantages of simple operation, less trauma, short operation time, less operative blood loss, and fewer complications. It is especially suitable for patients with long spiral fibular fracture, comminuted fracture, osteoporotic fracture, and long preoperative delay time in ankle fracture.

Percutaneous hollow nail internal fixation treatment for fractures of the pubic symphysis and its adjacent areas

PurposeTo explore the percutaneous minimally invasive treatment of pubic symphysis and its adjacent fractures.MethodSince May 2021, 13 cases of fractures involving the pubic symphysis and its adjacent parts were treated with x-ray fluoroscopic localization and percutaneous cannulated screw fixation across the symphysis pubis, the guide pin pierced the symphysis pubis and the fracture end and stopped at the inner edge of the acetabulum. Visual analogue scale (VAS) was used to evaluate the effect of the operation, and the patients were followed up.ResultThe screw insertion operation time was 25–40 min, with an average of 31.45 min; The number of perspectives is 20–40, with an average of 28.75. The average intraoperative blood loss was 10 ml, and there were no puncture complications such as nerve or vascular damage. The initial stability of the fractured end of the patient after surgery was good. The VAS score decreased from preoperative 8–10 points to postoperative 1–2 points (average of 1.5 points). The follow-up time was 3–25 months, with an average of 8.5 months. At the last follow-up, the excellent and good rate of pelvic function according to Majeed pelvic function scoring system was 100%. One patient had screws removed 1.5 years after surgery, while the remaining twelve patients did not have screws removed. All patients did not experience any discomfort symptoms caused by pubic symphysis fixation.ConclusionPercutaneous hollow nail internal fixation is an effective method for treating fractures of the pubic symphysis and its adjacent parts.

Distraction osteogenesis application in bone defect caused by osteomyelitis following mandibular fracture surgery: a case report and literature review

BackgroundOsteomyelitis secondary to mandibular fracture surgery is rare and complete surgical debridement of necrotic infected tissues is an optimal treatment for it. Subsequent reconstruction is required for bone defect caused by operation. Autogenous, allograft and synthetic bone graft substitutes have become widespread in bone defect treatment. Distraction osteogenesis (DO) was also applied in bone defect reconstruction, even it wasn’t conventional therapy in jaw.Case presentationHere we report a case of a 40-year-old aged man who presented with chronic swelling and pain on the right mandibular masseteric region after mandibular angle and Le Fort II fracture surgery. In six weeks after surgery, CBCT images showed that the fracture ends hadn’t heal and the fracture gap had widened significantly. The clinical diagnosis of the patient was right mandibular angle osteomyelitis. After controlling the symptoms of pain and infection with local rinses and systemic antibiotic therapy, the patient underwent segmental resection of the infected bone and DO reconstruction for bone defect simultaneously. Encouragingly, well bone healing and normal occlusion restoration was observed finally.ConclusionsDO could be a valuable alternative therapy to bone grafts for bone defect, even in the case of infection.

Rib Fracture Nonunion

Rib fracture nonunions are uncommon after traumatic chest wall injury. Patients with symptomatic nonunions typically present with persistent rib pain, although some will have dyspnea or popping sensations. Surgical fixation can be considered for symptomatic patients who radiographically demonstrate nonunion 3 months after injury. The surgical approach is still evolving; the most common approach is debridement of the callous and non-viable fracture ends followed by stabilization of the fracture with a plating system. Published reports have found this approach decreased pain and improved the quality of life for most patients. Future studies must delineate who will benefit most from operative management and expand our understanding of patient outcomes after surgery.

Dual-channel minimally invasive percutaneous cerclage for femoral shaft and metaphysis fractures during the internal fixation with intramedullary nails: case reports and technical description.

When treating femoral fractures with closed reduction intramedullary nail fixation, excessive residual displacement of the fracture end can affect the fixation effect and prolong the healing time, which is difficult to manage intraoperatively. This article introduces a simple steel wire cerclage fixation technique, which is percutaneous and can control the incision within 1 cm without excessive reliance on specially designed surgical instruments. It is suitable for the reduction and fixation of oblique femoral metaphysis fractures and butterfly-shaped femoral shaft fracture blocks.

Impact of augmentation strategy variations on the mechanical characteristics of patients with osteoporotic proximal humerus fractures with medial column instability.

Low bone density and lack of medial support are the two most important factors affecting the stability of locking plate fixation for osteoporotic proximal humeral fractures (PHFs). This study aimed to compare the biomechanical characteristics of PHILOS locking plates combined with calcar screws, bone cement, fibular allografts, and medial locking plate support strategies for treating osteoporotic PHFs with medial column instability. A three-part osteoporotic PHF (AO 11-B3.2) model with metaphyseal loss was generated using 40 synthetic humeri and fixed via four distinct medial support strategies. All models were mechanically tested to quantify the mechanical characteristics. Subsequently, finite element models were created for each biomechanical test case. The stress distribution and displacement of the four different fixation structures were analyzed using finite element analysis. The results demonstrated that the PHILOS locking plate combined with the medial locking plate, exhibited the greatest stability when subjected to axial, shear, and torsional loading. Furthermore, the PHILOS locking plate combined with bone cement showed structural stability similar to that of the PHILOS locking plate combined with fibular allograft but with lower stress levels on the fracture surface. In conclusion, the PLP-MLP fixation structure showed superior biomechanical properties under axial, shear, and torsional loading compared to other medial support methods. Repairing the medial support when treating osteoporotic PHFs with medial column instability can enhance the mechanical stability of the fracture end in both the short and long term.

Effect of Huoxue Jiegu compound capsule on osteoblast differentiation and fracture healing by regulating the PI3K/Akt/mTOR signaling pathway in rabbits

ObjectiveTo examine and talk about the mechanism of the Huoxue Jiegu compound capsule's effects on osteoblasts and the PI3K/Akt/mTOR signal pathway in rabbits suffering from tibial fractures. MethodIn vitro, CCK8 was used to assess the survival rates. Alizarinred staining was used to evaluate mineralized nodules. ALP staining was used to observe the osteoblasts. qRT-PCR was used to determine the mRNA expression of the bone formation-related factors BMP-2, bFGF, and TGF-β. In vivo, three groups of nine male rabbits each were randomly assigned to three groups: the Model group, the Huoxue Jiegu compound capsule group (HXJGC group), and the inhibitor group (HXJGC+3-MA), four weeks following the intervention. HE staining was employed to examine the rabbits' bone histology. immunohistochemistry was employed to examine the relative expression of the proteins VEGF and LC3-II. Western Blot was utilized to examine the relative expression of the proteins Beclin-1, LC3-II/Ⅰ, p62, p-PI3K, p-AKT, and p-mTOR. ResultsCompared to the control group, the medium- and high-dose groups exhibited considerably higher survival rates (P < 0.05), as well as enhanced cell proliferation and differentiation (P < 0.05) and more pronounced mineralized nodules. (P < 0.05), but the low-dose groups showed no appreciable variation. In the low, medium, and high-dose groups, there was a substantial reduction in the expression of bFGF mRNA, whereas the levels of BMP-2 and TGF-β mRNA were considerably higher than in the control group (P < 0.05). In vivo, after four weeks of treatment, the model control group and inhibito group had a large amount of fibrous hyperplasia accompanied by bleeding and a small amount of inflammatory cell infiltration. But in the HXJGC group, new cartilage appeared, and the surface of the cartilage was smooth and flat. Beclin-1 and LC3-II/I expression in the HXJGC+3 MA group was significantly lower than in the HXJGC and Model groups (P < 0.05). The HXJGC group showed lower p62 expression than the HXJGC+3 MA and model groups (P < 0.05). The HXJGC group exhibited significantly reduced levels of p-PI3K, p-AKT, and p-mTOR expression in comparison to HXJGC+3 MA groups (P < 0.05). ConclusionRabbits with tibial fractures can be treated with HXJGC, which can control the expression of the PI3K/Akt/mTOR signal pathway. It can promote the differentiation and maturation of osteoblasts at the fracture end of rabbits, accelerate the recovery of fractures, and achieve the purpose of treating the disease.

Investigation of the mechanical behaviour of frozen fissured sandstone addressing the role of fissure ice

Due to the existence of ice in rock fissures and the complex ice–rock interactions, the exact role of fissure ice in altering the mechanical behaviour of frozen rock mass remains unclear. In this study a series of uniaxial compression experiments were conducted on frozen sandstone samples that bearing precut fissures of different angles at both freezing and room temperatures. The failure process of samples was recorded using a high-speed camera. Besides, a particle flow code-based simulation, addressing the role of fissure ice, was performed. The results indicate that: (1) Freezing does not alter the trend of strength variation concerning the fissure angle, but it does strengthen the samples significantly. (2) At both room and subzero temperatures, the crack initiation mode of the specimens showed a changing trend of "tensile cracking → shear cracking → tensile cracking" as the fissure angle increased. (3) The change in fissure angle leads to a change in the stress state at the fracture end, while the fissure ice, through ice–rock interaction, further alters the fracture's stress state, thereby affecting the initiation and expansion mode of the fracture. Based on the simulation results, three strengthening mechanisms of fissure ice are proposed: (I) under compression, the ice acts as a filling support; (II) the fissure ice shortens the fracture length, resulting in a reduction of the stress intensity factor at the fracture ends; (III) under tensile or shear states, the ice acts as a binder. The above strengthening effects of fissure ice act simultaneously or alternatively at different fissure angles.

The role and mechanism of β-catenin-mediated skeletal muscle satellite cells in osteoporotic fractures by Jian-Pi-Bu-Shen formula.

Osteoporosis is a metabolic bone disease. β-Catenin is associated with fractures. Jian-Pi-Bu-Shen (JPBS) can promote the healing of osteoporotic fractures (OPF). However, the mechanism of β-catenin-mediated skeletal muscle satellite cells (SMSCs) in OPF by the JPBS is unclear. SMSCs were isolated and divided into five groups. The results showed that the survival rate of SMSCs was significantly higher in the low, medium, and high dose JPBS-containing serum groups after 7 days of incubation. The ALP activity and the number of SMSCs mineralized in the JPBS-containing serum intervention group were elevated. Axin, GSK-3β, β-catenin siRNAs were constructed and transfected into cells. Transfection of siRNAs reduced Axin, GSK-3β, and β-catenin expressions, respectively. β-Catenin-siRNA reversed ALP activity, the number of SMSCs mineralized, and the expression of β-catenin, BMP2, Runx2, COL-I, SP7/Ostrix, Osteocalcin, and BMP-7. Transcriptomic results suggested that the TNF signaling pathway associated with OPF was enriched. SD rats were subjected to the construction of OPF model by removing the ovaries. JPBS decreased the levels of PINP, ALP, CTX, and NTX through β-catenin in OPF rats, while increasing Runx2, β-catenin expressions through β-catenin at the broken end of fractures. Moreover, JPBS decreased BMC, BMD, and BV/TV and improved pathological damage through β-catenin in OPF rats. JPBS decreased the expression of Axin, GSK-3β mRNA, and protein, but increased the expressions of β-catenin, Pax7, COL-II, COL-II, BMP2, and Runx2 through β-catenin in OPF rats. In conclusion, JPBS inhibits Axin/GSK-3β expression, activates the β-catenin signaling, and promotes the osteogenic differentiation of SMSCs.

Minimally invasive techniques utilizing the “Joy Stick” method for managing irreducible flexion-type supracondylar fractures of the humerus in older children

ObjectiveIn this study, we investigated the efficacy of percutaneous poking reduction and Kirschner wire fixation in older children with irreducible supracondylar flexion-type fractures of the humerus.MethodsThis retrospective investigation included 27 children, comprising 15 males and 12 females, aged between 10 years and 3 months to 14 years and 11 months, all diagnosed with a flexion-type supracondylar fracture of the humerus within one week of trauma. All patients underwent surgery under general anesthesia. Following unsuccessful manual reduction, percutaneous poking reduction with Kirschner wires was performed under C-arm fluoroscopy to achieve fracture reduction. Following successful reduction, three 2.0 mm Kirschner wires were inserted in a cross pattern to secure the fracture ends. Postoperatively, the elbow joint was immobilized in a functional position with a plaster cast for four weeks.ResultsFollow-up in the outpatient department ranged from 9 to 36 months. Clinical functional assessment using Flynn’s criteria rated 24 cases as excellent, 2 as good, and 1 as fair, yielding an overall efficacy of 96.3%. No cases of fracture re-displacement, fracture fragment necrosis, or other complications such as nonunion, iatrogenic nerve injury, myositis ossificans, or long-term elbow joint dysfunction were observed during the postoperative follow-up.ConclusionThe percutaneous poking reduction and Kirschner wire fixation technique is a simple and reliable procedure for treating irreducible flexion-type supracondylar fractures of the humerus in older children, with minimal trauma. This technique offers substantial stability for the fracture and results in excellent long-term recovery of joint function.

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

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

Evaluating three internal fixation techniques for Pauwels III femoral neck fractures via finite element analysis

The selection of implants for fixing unstable femoral neck fractures (FNF) remains contentious. This study employs finite element analysis to examine the biomechanics of treating Pauwels type III femoral neck fractures using cannulated compression screws (3CS), biplane double-supported screw fixation (BDSF), and the femoral neck system (FNS). A three-dimensional model of the proximal femur was developed using computed tomography scans. Fracture models of the femoral neck were created with 3CS, BDSF, and FNS fixations. Von Mises stress on the proximal femur, fracture ends, internal fixators, and model displacements were assessed and compared across the three fixation methods (3CS, BDSF, and FNS) during the heel strike of normal walking. The maximum Von Mises stress in the proximal fragment was significantly higher with 3CS fixation compared to BDSF and FNS fixations (120.45 MPa vs. 82.44 MPa and 84.54 MPa, respectively). Regarding Von Mises stress distribution at the fracture ends, the highest stress in the 3CS group was 57.32 MPa, while BDSF and FNS groups showed 51.39 MPa and 49.23 MPa, respectively. Concerning implant stress, the FNS model exhibited greater Von Mises stress compared to the 3CS and BDSF models (236.67 MPa vs. 134.86 MPa and 140.69 MPa, respectively). Moreover, BDSF displayed slightly lower total displacement than 3CS fixation (7.19 mm vs. 7.66 mm), but slightly higher displacement than FNS (7.19 mm vs. 7.03 mm). This study concludes that BDSF outperforms 3CS fixation in terms of biomechanical efficacy and demonstrates similar performance to the FNS approach. As a result, BDSF stands as a dependable alternative for treating Pauwels type III femoral neck fractures.

Efficacy of the shape-memory alloy ring hugger and microplate in proximal clavicle fractures

The efficacy and safety of shape-memory alloy (SMA) ring hugger and microplate in the treatment of proximal clavicle fractures were compared to better improve the quality of patient rehabilitation and minimize complications. The mechanical properties of Ni-Ti alloy and Ti64Al4V (compressive strength and elastic modulus) were examined in the physicochemical property tests, while, mouse osteoblasts were cultured to test their biocompatibility. Subsequently, clinical data of patients with clavicle fractures treated at our hospital from January 2012 to January 2022 were retrospectively analyzed. The patients were divided into microplate and SMA groups based on the surgical methods, and the follow-up period was 1 year post-surgery. Clinical treatment, mobility and functional recovery (DASH score and Constant score) of the affected upper limb, numbness, and adverse effects were compared between the two groups. SMA exhibited a compressive strength similar to that of Ti6Al4V, but its modulus of elasticity was significantly lower. Meanwhile, the results of the cellular experiments suggested that the addition of SMA and Ti6Al4V would not markedly decrease the osteoblast activity, suggesting that both internal fixation implants had good biocompatibility. In addition, SMA ring hugger was effective in reducing operative time, intraoperative bleeding, wound size, fracture end healing time, and residual fracture shortening. In terms of postoperative assessment of affected limb mobility, SMA ring hugger better improved the mobility of the affected shoulder in supination, abduction, adduction, and forward flexion, and was more effective in decreasing the DASH score and increasing the Constant score. Meanwhile, SMA ring hugger effectively reduced numbness in the affected area and decreased the incidence of delayed wound healing, exercise restrictions, proliferative scars, and vegetative stimulus. Therefore, SMA ring hugger demonstrates favorable mechanical performance and biocompatibility, meanwhile, it can better promote postoperative functional recovery of the affected limb in clavicle fracture patients with guaranteed safety.

Assessing the Radiological and Functional Outcomes of Colles' Cast Versus Functional Position Cast Immobilization in the Conservative Treatment of Distal End of Radius Fractures.

The distal end radius fracture represents a prevalent orthopedic condition that affects individuals across various age groups, commonly resulting from falls onto outstretched hands. Ongoing research endeavors have delved into diverse methodologies for addressing this condition, encompassing conservative and operative modalities, yielding variable outcomes. While the literature extensively delineates numerous mobilization approaches, such as the functional position cast and Colle's cast, scant comparative studies evaluate these immobilizationforms. Consequently, our study sought to holistically appraise and compare the radiological and functional outcomes associated with Colles' cast and functional position cast immobilization in managing distal end radius fractures. This retrospective study was conducted at a tertiary trauma center over two years, from October 2018 to September 2020. Data was collected from medical records with prior approval from the institutional ethics committee. The study included 64 patients, all above the age of 40, who suffered from distal end radius fractures and received conservative management. Patients with bilateral distal end radius fractures, associated ipsilateral limb injury, open or comminuted fractures, or inadequate medical records were excluded. The patients were divided into two groups based on the type of cast immobilization: group I comprised 30 patients managed with Colles' cast immobilization(volar-flexion and ulnar deviation position). In contrast, group II consisted of 34 patients with functional position cast immobilization (immobilization with dorsiflexion).The clinical (includingpain, thumb swelling, finger swelling, finger stiffness, shoulder stiffness, and tenderness), radiological (including radial deviation, radial height, and volar tilt), and functional (range of motion (ROM), and disability of arm, shoulder, and hand (DASH)) outcomes were evaluated at 6, 12, and 24 weeks. The data analysis was conducted using the IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States). The chi-square test, independent samples t-test, and paired t-test were employed to analyze and compare radiological and functional outcomes between the two groups. A p-value of less than 0.05 indicated a statistically significant association. The radiological parameters, including volar tilt, radial inclination, and radial shortening, were derived from the medical records at various points: pre-reduction, post-reduction, 6-week follow-up, 12-week follow-up, and 24-week follow-up. Upon assessing these parameters, no statistically significant variance was observed between the two groups at specified time points.Comparison of the ROM between the two groups unveiled noteworthy results, indicating superior outcomes in the functional cast group at 6 and 12 weeks as opposed to the Colles' cast group. Grip strength assessment at the 24-week follow-up demonstrated statistically significant differences, with the functional cast group displaying enhanced grip strength. Our study revealed comparable radiological parameters between the two cohorts, yet it demonstrated a notable enhancement in both the ROM and functional outcomes in those subjected to functional cast positioning. These findings underscore the potential advantages of functional immobilization in bolstering patient rehabilitation.

Analysis of risk factors for failed closed reduction in pediatric Gartland Type III supracondylar humerus fracture

PurposeGartland Type III supracondylar humerus fractures are commonly treated using closed reduction followed by percutaneous pin fixation. However, conversion to open reduction may be necessary if closed reduction fails. This study aimed to identify risk factors associated with failed closed reduction and provide a theoretical basis for clinical decision-making in the treatment of Gartland Type III fractures. MethodsA retrospective analysis was conducted on children with Gartland Type III supracondylar humerus fracture who underwent surgical treatment between April 2017 and June 2018. Based on whether or not the closed reduction was successful, patients were split into the open reduction group and the closed reduction group. Within the closed reduction group, subgroup analysis based on surgery duration was carried out. Data were collected from medical records and X-ray images. Univariate and multivariate regression analyses were utilized to evaluate the relationship between variables and failed closed reduction. ResultsThe study included 36 patients in the open reduction group and 135 patients in the closed reduction group. Multivariate analysis revealed that the presence of angle (P=0.024, OR=3.199), rotation (P=0.000, OR=6.359), skin creases (P=0.013, OR=4.077), anterior-posterior displacement ratio (P=0.011, OR=4.337), fracture angle in the anteroposterior view (P=0.014, OR=0.939), and fracture distal displacement direction (P=0.002, OR=5.384) were independent risk factors for failed closed reduction. Subgroup analysis showed that fracture distal displacement direction (P=0.013), skin folds (P=0.013), lateral displacement ratio (P=0.016), and anterior-posterior displacement value (P=0.005) significantly influenced the duration of closed reduction surgery. ConclusionThe presence of sharp angle or rotation at the fracture ends, skin folds on the anterior elbow, minor anterior-posterior displacement of the fracture, higher medial inclination of the fracture plane, and distal fracture displacement towards the radial side are independent risk factors for failed closed reduction in pediatric Gartland Type III supracondylar humerus fracture.

Design and Testing of a Pressure Measurement and Adjustment Device for Fracture Ends

To design and test a device which is capable of accurately measuring and dynamically adjusting the axial pressure at the fracture end in real-time. Upon completion of the design, the pressure measurement and adjustment device was implemented in a canine tibial fracture external fixation model. A pressure sensor was mounted at the fracture end, and the displayed values of the pressure sensor were used as the standard for comparison. The relationship between the displayed values of the measurement and adjustment device and the pressure sensor under identical conditions was examined. The device was utilized in external fixation models of tibial fractures in five beagles. A linear correlation was observed between the displayed values of the device and the pressure sensor at the fracture end. The measurement values from the device could be transformed into fracture end pressure through the application of coefficients, thereby facilitating accurate measurement and dynamic adjustment of the fracture end pressure. The pressure measurement and adjustment device at the fracture end is easy to operate, enabling precise measurement and dynamic regulation of the pressure at the fracture end. It is well-suited for animal experiments aimed at investigating the impact of axial compression on fracture healing, demonstrating promising potential for experimental applications.

Clinical study on the incidence of femoral head posterior tilt angle in non-displaced femoral neck fractures

To investigate the occurrence of posterior femoral head tilt after clinical non-displaced femoral neck fracture, and to provide a reference basis for clinical surgery and improvement of disease prognosis. Total of 165 patients with non-displaced femoral neck fractures of Garden typeⅠandⅡfrom January 2018 to June 2022 were selected as study subjects including 48 males and 117 females, with an average age of (71.5±8.5) years old ranging from 53 to 89, involving 97 cases of typeⅠand 68 of typeⅡ. On the patient's preoperative sagittal or axial CT film of the hip, the angle formed by the radius line of the femoral head and the midline of the femoral neck was used as the posterior tilt angle of the femoral head (α), and the posterior tilt femoral head angle was measured using the method proposed by Palm. The measured data were divided into 6 groups:α<0°, 0°<α< 5°, 5°≤α<10°, 10°≤α<15°, 15°≤α<20°, α≥20°, and the incidence of different ranges of posterior tilt angle was compared. The sex composition ratio of 165 patients were analyzed and compared, and the age of 65 was used as the cut-off point to compare the incidence of fractures between genders. Patients were divided into the posterior tilt <20° group for 135 cases and the posterior tilt ≥20°group for 30 cases according to the preoperative posterior tilt angle, the differences between two groups in terms of gender and age were analyzed. Among 165 patients with non-displaced femoral neck fractures, 143 cases with poaterior tilt of the femoral head occurred with an incidence of 86.7%. Posterior tilt 0°<α<5° accounted for 36 cases with an incidence of 21.8%;5°≤α<10° accounted for 40 cases with an incidence of 24.2%;10°≤α<15° accounted for 27 cases with an incidence of 16.4%;15°≤α<20° accounted for 10 cases with an incidence of 6.1%;posterior tilt angle α≥20° accounted for 30 cases, the incidence was 18.2%, of which the maximum posterior tilt angle was 42.7°. Statistical analysis showed that the percentage of fractures in the 165 patients selected for this study was significantly higher in female than in male, and that the female group was more likely to have fractures before the age of 65 years compared to the male group. However, gender, age and fracture subtypes (GardenⅠ, Ⅱ) were not influential factors for femoral neck fractures with a preoperative posterior femoral head tilt angle >20°(P>0.05). The incidence of femoral head posterior tile in non-displaced femoral neck fractures is relatively high, in which severe posterior tile occurs, and the femoral head posterior tile angle≥20° can reach 18.2%. In patients with closed reduction internal fixation, the fracture end needs to be repositioned as much as possible to reduce the risk of postoperative avascular necrosis of the femoral head. In order to prevent femoral neck fractures, special attention should be paid to anti-osteoporosis treatment for female. Preoperative assessment of posterior tilt is critical for patients of different ages, genders and fracture subtypes (GardenⅠ, Ⅱ).

Early to Mid-term Results of Coracoclavicular Ligament Reconstruction Using the Infinity-Lock Button System in the Management of Traumatic Acromioclavicular Joint Dislocations and Lateral End of Clavicle Fractures.

Background The management of distal clavicle injuries with disruption of the coracoclavicular ligaments (CCLs) is challenging. The aim of this study was to assess the functional results of reconstructing the CCLs with the Infinity-Lock Button System using validated outcome measures, patient satisfaction scores, return to pre-injury activity, and complications. Methods A total of 28 cases of CCL disruption were assessed over a seven-year period, which included 14 lateral end-of-clavicle fractures and 14 acromioclavicular joint (ACJ) dislocations. All patients underwent stabilisation of the CCLs using the Infinity-Lock Button System. Patients were assessed preoperatively and postoperatively using validated outcome measures such as visual analogue scale (VAS), Oxford Shoulder Score (OSS), Quick Disabilities of Arm, Shoulder & Hand (Q-DASH) scores, return to pre-injury level of activities, patient satisfaction scores, and complications were reviewed. Results The mean age of patients was 36.7 years (18-74 years). The mean follow-up was 38.6 months (8-68 months). The mean time to surgery was 75.8 days (3-619 days).There was a statistically significant improvement in postoperative VAS, OSS, and Q-DASH scores compared to the preoperative (p-value <0.001). Out of the 28 participants, 23 (82.1%) returned to pre-injury level of activities, 25 (89.7%) reported 'good' or 'excellent' outcomes following the intervention, and none of the patients reported functional instability postoperatively. None of the patients required revision surgery or implant removal. Conclusion CCL reconstruction is vital in the management of clavicular injuries.This study demonstrates the safe use of the Infinity-Lock Button System in these injuries with statistically significant improvement in early patient-reported outcome measures, return to pre-injury level of activities, and subjective patient satisfaction.