External Fixation Methods Research Articles

Canine pillar bone bearing traction method of skull external fixator combined with nickel-titanium memory alloy spring for unilateral cleft lip and palate with severe facial skeletal hypoplasia

Background: For unilateral cleft lip and palate severe midfacial skeletal dysplasia, external skull fixator combined with nickel titanium memory alloy spring was used to treat canine pillar bone bearing traction. Methodology: Patients (n = 200) with unilateral cleft lip and palate and severe midfacial skeletal hypoplasia who were treated in our hospital within three years were divided into control group (treated with trans suture traction osteogenesis) while the observation group was treated with skull external fixator combined with nickel titanium memory alloy spring supporting force traction of canine bone. Results: After applying significantly different traction forces to the maxillary tissues on both sides of the patient, the patient was treated with appropriate traction correction, orthodontic treatment and moderate traction on the facial arch to effectively reduce the recurrence of the disease after surgery. Compared with the control group, the curative effect in all aspects was better and the asymmetry rate was lower. Conclusion: Canine strut bone traction method of external skull fixation combined with nickel-titanium memory alloy spring was applied for severe facial skeletal dysplasia caused by unilateral cleft lip and palate. For this purpose, reasonable and scientific treatment methods were provided for early correction and treatment of the disease. Keywords: External fixator of skull; nickel titanium memory alloy spring; bone bearing traction of canine pillar; unilateral cleft lip and palate; severe midfacial skeletal dysplasia; clinical research.

Methods and Strategies of Microsurgery Combined with Ilizarov Technique in the Treatment of Amputation of Limbs in Renji Hospital: A Report of 51 Cases.

Severe limb amputation trauma often results in bone and soft tissue defects after debridement. Traditional replantation aims to save the limb by shortening the ischemic period and using autologous transplantation for repair, but it can lead to surgical trauma, donor site damage, and prolonged operation time. Due to contusion, pollution, and complex injury, there is no unified standard for replantation and fixation. Improper operation can easily lead to complications such as bone infection, nonunion, bone defect, and joint stiffness. This study introduces the Ilizarov technique into microsurgery to improve limb lengthening after reconstruction and standardizes the steps of replantation fixation for complex limb avulsion injuries, with a focus on clinical efficacy. A retrospective analysis was performed on 51 patients with complex limb amputation who were treated in Zhengzhou Renji Hospital from June 2009 to March 2021. On the basis of microsurgical limb replantation, Ilizarov technology was introduced to innovate the internal and external combined stepwise fixation method for replantation. Patients' gender, age, height, weight, BMI, and other general information were collected. X-ray films were reviewed regularly to observe the surgical healing of fracture, that is, the degree of limb shortening. The lengthening time, carrying time after lengthening, follow-up time, Dahl classification, Paley fracture healing classification, and Chen Zhongwei's replantation function score were used to evaluate the recovery of the affected limb. A total of 51 patients were included in this group, including 36 male patients and 15 female patients. All the amputated wounds were single limb amputation. In this group of patients, the hind limbs were shortened by 2-12.5 cm (5.32 ± 2.24) after replantation. A total of 44 patients whose hind limbs were shortened by more than 2.5 cm were treated with two-stage Ilizarov lengthening for 1.5-5.5 months (3.19 ± 1.03). The carrying time was 3-7.5 months (4.25 ± 0.94), and the follow-up time was 1-7.8 years (3.76 ± 1.69). Among the 49 survived patients, the Dahl grade of external fixation was less than Grade 2 in 89.8%. The excellent and good rate of Paley fracture healing classification was 89.8%. The excellent and good rate of Chen Zhongwei's limb replantation function classification was 79.6%. Microsurgery combined with Ilizarov technique in the treatment of limb amputation injury, limb salvage reconstruction with internal and external combined step-by-step combined fixation, and one-stage shortening and two-stage limb lengthening can reduce the occurrence of osteomyelitis, bone defect and nonunion, expand the indications of limb replantation, improve the success rate of limb replantation, with satisfactory results, and facilitate the promotion of clinical techniques.

Treatment of traumatic elbow luxation and radius fracture with non-rigid transarticular external fixation and paraosseous clamp cerclage in a cat

An 8-year-old, female, neutered mixed-breed cat presented with traumatic elbow luxation and radius fracture due to high-rise syndrome. According to the anamnesis, the trauma had occurred 10 days prior. Therefore, the patient was treated with an open reduction technique. The reduction of the elbow joint was performed with the cerclage transarticular external fixation (CTEF) method. Fixation of the radius fracture was performed using the paraosseous clamp cerclage method. The follow-up time for the patient was 1 year, and the functional outcome was considered fair due to humero-ulnar ankylosis of the elbow joint with 110° of extension. In this case report, post-operative long-term clinical and radiographic results were not as desired. This can be explained by the inability to perform surgery at the desired time, the severity of the trauma, and cartilage damage. However, further cases are required to determine whether this procedure is optimal for the treatment of traumatic elbow luxation in cats.

Finite element analysis of modified Slongo's external fixation in the treatment of supracondylar humeral fractures in older children.

Older children over 8 years old are at higher risk of elbow joint stiffness after treatment of supracondylar humeral fractures. The objective of this study was to improve the Slongo's external fixation system for treating supracondylar humeral fractures in older children. This would be achieved by increasing fixation strength and providing a theoretical basis through finite element analysis and mechanical testing. A 13-year-old female patient with a history of previous fracture was selected for CT data processing to create a three-dimensional model of the distal humerus fracture. Two internal fixation models were established, using the Slongo's external fixation method with Kirschner wire (Group A) and modifying the Slongo's external fixation (Kirschner wire tail fixation) (Group B). The fracture models were then subjected to mechanical loading analysis using Finite Element Analysis Abaqus 6.14 software to simulate separation, internal rotation, and torsion loads. A PVC humeral bone model was used to create a supracondylar fracture model, and the A and B internal fixation methods were applied separately. The anterior-posterior and torsional stresses were measured using the Bose Electroforce3510 testing system, followed by a comparative analysis. The finite element simulation results showed that under the same tensile, torsion, and inversion forces, the osteotomy model fixed with Kirschner wire at the distal end in Group B exhibited smaller tensile stress and deformation compared to the unfixed osteotomy model in Group A. This indicated that the fixation strength of Group B was superior to that of Group A. According to the test results of the Bose Electroforce3510 testing system, a simple linear regression analysis was conducted using SPSS software. The K values of rotation angle-torque tests and front and rear displacement-stress tests were calculated for Groups A and B, with Group B showing higher values than Group A. The results of this study supported the significantly enhanced biomechanical reliability and stability of fracture fixation in Group B, which utilized the modified Slongo's external fixation (Kirschner wire tail fixation). This optimized method provides a new choice for the clinical treatment of supracondylar humeral fractures in older children, backed by both clinical evidence and theoretical basis.

The Clinical Application of Double Taylor Spatial Frame in Segmental Tibial Fracture.

Multi-planar external fixation has been used for the management of segmental tibial fractures with severe soft tissue injuries. However, fewer specialized studies have been reported. The primary aim of this study was to describe our experience of treating fractures of this type using the Taylor Spatial Frame and Ilizarov external fixation methods. We retrospectively analyzed 33 patients with segmental tibial fracture treated at our institution between January 2016 and December 2020. The patients were divided into double Taylor Spatial Frame (D-TSF) and Ilizarov groups based on the external fixation structure. Baseline demographic data included sex, age, injury side and cause, open or closed fracture, time from injury to surgery, complications, and external frame removal and fracture healing time. The hip-knee-ankle angle (HKA) was measured from preoperative, immediate postoperative, and final follow-up full-length X-rays of bilateral lower limbs. We determined the degree of deviation in the HKA by calculating the difference between the measured angle and the ideal value of 180°; the absolute value was used to assess recovery of the lower limb force line. At the final follow-up, Johner-Wruhs tibial fracture outcome criteria (J-W TFOC) were used to classify the postoperative function of the affected limb as excellent, good, moderate, or poor. Count data were analyzed with the chi-square test or Fisher's exact test; the Mann-Whitney U test was used for rank data. No statistically significant differences were observed between the two groups in terms of sex, age, side of injury, cause of injury, closed or open fracture, or time between injury and surgery, which indicates that the groups were comparable (p > 0.05). A statistically significant difference was observed in external frame removal and fracture healing time between the D-TSF and Ilizarov groups (36.24 ± 8.34 vs 45.42 ± 10.21 weeks, p = 0.009; 33.33 ± 8.21 vs 42.00 ± 9.78 weeks, p = 0.011). The Johner-Wruhs criteria were used to assess the function of the affected limb, the D-TSF group performed better in correcting the lower limb force line than the Ilizarov group. A statistically significant difference in terms of excellent ratings was observed between the two groups (18/2/1/0 vs 5/5/1/1, p = 0.010). Postoperative follow-up X-rays demonstrated a significant improvement in the HKA in both groups immediately after surgery and at the final follow-up compared to the angle before surgery. At the final follow-up, a statistically significant difference was observed in the degree of deviation in the HKA between the two groups (1.58° ± 0.84° vs 2.37° ± 1.00°, p = 0.023). The D-TSF treatment is associated with minimal secondary damage to soft tissue, a straightforward and minimally invasive procedure, multiplanar stable fracture fixation, and optimization of fracture alignment and lower limb force lines, therefore, it is highly effective therapeutic option for segmental tibial fracture.

COMPARING THE OUTCOMES OF DIFFERENT EXTERNAL FIXATION TYPES FOR KNEE ARTHRODESIS FOLLOWING INFECTED TOTAL KNEE ARTHROPLASTY: A SYSTEMATIC REVIEW

IntroductionKnee arthrodesis is a useful limb salvage technique to maintain function in patients with complex and infected total knee arthroplasties (TKA). There are a number of commonly used external fixators, but no consensus on which of these are optimal.The aim of this study was to synthesise the current literature to guide clinical decision making and improve patient outcomes. We systematically review the literature to compare outcomes of external fixators in arthrodesis following infected TKA.Materials & MethodsA systematic review of the literature of primary research articles investigating the use of external fixators for knee arthrodesis after an infected TKA was conducted. Relevant articles were identified with a search strategy on online databases (EMBASE and Medline) and reviewed by two independent reviewers.Clinical outcome measures were independently extracted by two reviewers which included union rate, infection eradication rate, complication rate, time to fusion, and time in frame.ResultsCircular frames were more likely to result in union compared to biplanar (OR 1.40 p=0.456) and monoplanar frames (OR 2.28 p=0.018). Infection recurrence was least likely in those treated by circular frames when compared to monoplanar (OR 0.12 p=0.005) and biplanar external fixators (0.41 P=0.331). Complication rates were highest in the circular fixator group, followed by the monoplanar fixator group and biplanar fixator group at 34%, 31% and 11% respectively.ConclusionsAnalysis of the available literature suggests higher union and infection eradication rates with circular frames over the other two fixation methods despite a higher complication rate. There is a paucity in the literature and therefore, no firm conclusions can be drawn. Further research investigating the variations and biomechanical properties between different external fixation methods for knee arthrodesis is necessary. Further clarity in reporting and pooled data would be useful for future analysis.

Is Using a Ring External Fixator in the Treatment of Congenital Pseudarthrosis of the Tibia Associated With Better Results or Using a Locking Plate?

Congenital pseudarthrosis of the tibia (CPT) is a rare disease. CPT is often unilateral and occurs between the middle and distal third of the tibia. Concurrent involvement of the fibula is present in more than half of cases. histologic studies indicate the presence of fibrous hamartoma tissue and a sick periosteum, which leads to recalcitrant bone fracture and, eventually, pseudoarthrosis. Although there are various surgical techniques, we intend to compare the 2 methods of external fixation versus internal plating. Demographic data were collected from 26 patients with frank pseudoarthrosis. After exclusion criteria, patients were compared in groups A (12 patients) and B (11 patients). Resection of hamartoma and sclerotic bone, intramedullary rodding and autologous bone, and periosteal grafting were performed for all patients. In group A, we used a ring external fixator for compression and rotational stability, but in group B, a locking plate was used for these purposes. Plating takes less time to use during surgery. In group A, the primary bony union was obtained in 67% of patients, while in group B, 82% of patients had a primary union. Meanwhile, the average time till the final union in group A was 6 months, while in group B, this time was 3.5 months. Positive union mass was obtained in 58% of the patients in group A and 82% of group B. In addition, plating prevented ankle valgus deformity in group B. Permanent intramedullary rodding is a surgical requirement for correction of deformity and refracture prevention, but additional stability can be achieved with the use of a ring external fixator or internal plate. Cross union and positive union mass are 2 important factors in the treatment of pseudoarthrosis; these results are achieved to a greater extent and in a shorter period of time using the plate. level IV - case series.

The Outcomes of Isolated Tibiocalcaneal Arthrodesis: A Systematic Review.

Tibiocalcaneal arthrodesis (TCA) can be achieved by internal fixation (intramedullary nail or plate), external fixation, or a combination. Evidence for the optimal approach is limited. This systematic review examines the outcomes of these different approaches to guide surgical management. A MEDLINE and Oxford SOLO search was performed using "tibiocalcaneal," "ankle," "fusion OR arthrodesis." The primary outcome was union. Secondary outcomes included rates of postoperative complications, weightbearing status, rates of revision surgery, and PROMs. We included any studies with follow-up greater than 6 months that contained our primary outcome and at least 1 secondary outcome. The initial search yielded 164 articles, of which 9 studies totaling 53 cases met the criteria. The majority of articles were excluded because they were nonsurgical studies, or were not about isolated TCA but were for tibiotalocalcaneal arthrodesis, more complex reconstructions (eg, Charcot), case reports, and/or did not include the predetermined outcome measures.TCA union rate was 86.2% following external fixation, 82.4% for intramedullary nail fixation, and 83.3% for plate fixation. One patient underwent a hybrid of external and internal fixation, and the outcome was nonunion. The rate of complications following TCA was 69.8%. There is limited evidence on the best operative approach for isolated tibiocalcaneal arthrodesis. Both external and internal fixation methods had comparable union rates. External fixation had frequent complications and a more challenging postoperative protocol. Novel techniques such as 3D-printed cages and talus replacement may become a promising alternative but require further investigation.

Comparative Analysis of Complication Rates in Tibial Shaft Fractures: Intramedullary Nail vs. Ilizarov External Fixation Method.

Background: The external fixation (EF) Ilizarov method, shown to offer efficacy and relative safety, has unique biomechanical properties. Intramedullary nail fixation (IMN) is an advantageous alternative, offering biomechanical stability and a minimally invasive procedure. The aim of this study was to assess outcomes in patients undergoing tibia fracture fixation, comparing the Ilizarov EF and IMN methods in an early phase of IMN implementation in Serbia. Methods: This was a retrospective study including patients with radiologically confirmed closed and open (Gustilo and Anderson type I) tibial diaphysis fractures treated at the Institute for Orthopedic Surgery "Banjica'' from January 2013 to June 2017. The following demographic and clinical data were retrieved: age, sex, chronic disease diagnoses, length of hospital stay, surgical wait times, surgery length, type of anesthesia used, fracture, prophylaxis, mechanism of injury, postsurgical complications, time to recovery, and pain reduction. Pain intensity was measured by the Visual Analog Scale (VAS), a self-reported scale ranging from 0 to 100 mm. Results: A total of 58 IMN patients were compared to 74 patients who underwent Ilizarov EF. Study groups differed in time to recovery (p < 0.001), length of hospitalization (p = 0.007), pain intensity at the fracture site (p < 0.001), and frequency of general anesthesia in favor of intramedullary fixation (p < 0.001). A shorter surgery time (p < 0.001) and less antibiotic use (p < 0.001) were observed when EF was used. Additionally, we identified that the intramedullary fixation was a significant predictor of pain intensity. Conclusions: The IMN method offers faster recovery and reduced pain intensity in comparison to EF, while the length of surgery predicted the occurrence of any complication.

Is the Ankle Fusion the Single Salvage Procedure and the Best Result for the Massive Distal Tibial Loss: Surgical Techniques and Clinical Results

Background. Management of high-energy injuries with extensive soft tissue damage and massive distal tibial loss is challenging and often lead to severe dysfunction. In these complex situations ankle fusion procedure is the most commonly performed surgery. Publications devoted to treatment options and outcomes in these surgical challenging conditions are relatively rare. Objective The purpose of this work is to present our clinical experience in using staged external fixation protocol in the treatment of six patients who suffered from complex open fractures of the distal tibial segment with severe bone and soft tissue loss due to high-energy trauma. Methods. The retrospective analysis of six patients (Gustilo-Anderson III B and III C fractures) with massive distal tibial loss and treated using a staged protocol of external fixation between 1998 and 2010, was carried out. Mean bone loss was 11.5 cm (range, 9 – 15 cm). Results. All patients had reconstructive surgery using circular external fixation frames. The outcome in three of them was solid ankle fusion – two patients had acute distal shortening and proximal tibial elongation by distraction osteogenesis and one had acute fibular transfer to replace distal tibial loss with fixation using Ilizarov circular frame. In other three patients, the functional and the radiological outcome was pain-free ankle joint pseudoarthrosis – one had proximal tibial elongation, one had a combination of bone transport with distal fibular transfer and one had acute limb shortening without tibial elongation. All six patients were pain-free and satisfied with functional outcomes, regardless of the final solid bone fusion or pseudoarthrosis. Conclusions. The method of circular external fixation combined with proximal tibial elongation by distraction histogenesis is recommended for limb reconstruction in high-energy injuries with massive distal tibial loss including articular surface. Level of Evidence: Diagnostic Level Ⅳ.

Sexual Dysfunction in Women After Tibial Fracture: A Retrospective Comparative Study.

BACKGROUND Tibial fractures, common in adults, are often treated with external or internal fixation methods. While effective, external fixation (EF) can lead to sexual dysfunction (SD), especially in young patients. This study aimed to assess SD in women undergoing EF versus internal fixation for tibial fractures. MATERIAL AND METHODS Sexual function and frequency of monthly sexual intercourse (SI) were evaluated using the Female Sexual Function Index (FSFI) before surgery, with the fixator, after at least 6 months following fixator removal in EF group, and after achieving bone union for at least 3 months in the IF group. RESULTS The EF group consisted of 107 (mean age 28.5 years; 19-40 years) and IF group consisted of 106 patients (mean age 32.1 years; 18-40 years). The duration of EF was an average of 4.7 months (range, 2.5-13 months). FSFI scores were significantly lower in the EF group compared to the IF group (9.33 versus 27.3, P<0.001). Also, there was no significant difference between the FSFI scores before EF and after EF was removed (34.22 versus 33.8, P=0.413). FSFI sub-group scores such as desire, arousal, lubrication, and orgasm were significantly lower in the EF group (P<0.001). The monthly average frequency of SI before surgery and after the removal of EF was 10.2 and 9.1, respectively, while this frequency was 2.56 when EF was present (P<0.001). CONCLUSIONS The quality and frequency of SI in women significantly deteriorate and decrease during the period of extremity fixation following tibial diaphyseal fractures treated with EF, but return to normal after removal.

Outcomes following surgical fixation of Gustilo-Anderson IIIb open tibial fractures.

There is no consensus as to the optimal skeletal fixation method for Gustilo-Anderson IIIb fractures. External fixation methods have previously shown higher rates of superficial infection, whilst internal fixation has shown higher risk of deep infection, but lower risk of other complications. This paper investigates outcomes in open tibial fractures based on fixation method. A retrospective review was performed for patients presenting to an ortho-plastic unit with GA IIIb tibial fractures between June 2013 and October 2021. 85 patients were identified. The most common implant was an intramedullary nail (IMN), used in 29 patients (34.1%); open reduction and internal fixation (ORIF) was performed in 16 patients (18.8%). 18 patients (21.2%) were definitively managed with a frame alone. Mean follow-up from was 18 months (2-77). Patients with ORIF needed a mean of 3.37 operations; it was 2.48 for IMN which was significantly different from frames at 5.00 (p=0.000). The mean time to bony union after definitive fixation was 11.4 months. This differed depending on the implant used for fixation, with ORIF at 7.1 months, 10.1 for IMN, and frames at 17.2 months; ORIF significantly differed from frames (p=0.009). Superficial infection was common, seen in 38.8% of patients, and only 3 patients (4%) developed deep infections involving metalwork, with no difference in rates of either based on fixation method This study supports that ORIF has faster healing times, with less time to union compared to frames. It also shows that no implant was superior to another in terms of outcomes.

Selection Of Treatment Methods For Patients With Multiple Fractures Of Lower Extremity Bones

The aim of the study is to improve the results of treatment of patients with multiple lower extremity fractures by optimizing complex diagnostics and minimally invasive methods of external and internal fixation. The experience of treating 220 patients with multiple fractures of the long bones of the lower extremities in the clinic of the Republican Scientific and Practical Center of Traumatology and Orthopedics from 2016 to 2022 is presented.

Evaluation of distal femur fractures in cats by hybrid external fixator

In this study, clinical and radiological findings obtained from the treatment of distal femur fractures in cats with hybrid external fixator were evaluated. A total of 10 cats of different ages, breeds and genders with clinically diagnosed femur fractures were used as research material. In the study, hybrid external fixators consisting of circular and linear fixators were used as osteosynthesis material. Closed reduction and external fixation methods were used in 2 cases diagnosed with closed fractures, while limited open reduction and external fixation methods were used in 8 cases diagnosed with open fractures or excessive dislocations. In the radiological examination findings, it was determined that fracture consolidation started on the post-operative 7th day in 9 cases and on the 10th day in 1 case, respectively. Fracture healing was completed in 4 weeks in 2 cases, in 5 weeks in 2 cases, and in 6 weeks in 6 cases (osseous callus was detected). Fixators were removed one week after healing was completed in all patients. In the study, soft tissue complications such as edema in the extremities in 3 cases, mild pin infection in 3 cases and open wounds in 4 cases were determined. However, it was observed that these complications did not adversely affect the recovery time. As a result, with the data obtained from the study, it was concluded that the distal femur fractures in cats of the age and weight scales examined in the study can be successfully treated with the hybrid external fixator system.

Factors Associated with Re-Displacement after Nonsurgical Treatment of Distal Radius Fractures in Adults: A Retrospective Study.

Closed reduction combined with external fixation is a frequently utilized approach for treating distal radial fractures in adults. Nonetheless, the potential for re-displacement following external fixation remains. Analyzing the factors influencing re-displacement after nonsurgical treatment of distal radial fractures in adults is vital for preventing re-displacement and making prognostic assessments. A retrospective analysis was performed on 884 patients who underwent nonsurgical treatment for distal radius fractures in the reduction room of the Orthopedics and Traumatology Department of Integrated Traditional Chinese and Western Medicine at Tianjin Hospital, Tianjin, China, between July 2019 and December 2022. Patients were categorized into two groups, namely displaced and nondisplaced, based on radiographic outcomes. Factors affecting fracture re-displacement were examined, including sex, age, side, AO/OTA type, external fixation, and radiographic outcomes at pre-reduction and immediate reduction. Logistic regression analysis was employed to identify the risk factors for fracture re-displacement, and ROC curves were constructed. Among the 884 patients, 563 (63.69%) experienced re-displacement after fracture reduction. There were no statistically significant differences (p > 0.05) between the two groups in terms of gender, external fixation method, and palmar tilt angle at pre-reduction and immediate reduction, while significant differences (p < 0.05) were observed in age, side, AO/OTA type, and radial inclination, radial length, and radiographic outcomes of ulnar variance at pre-reduction and immediate reduction. Multifactorial logistic regression analysis revealed that age (odds ratio [OR] = 1.027, p < 0.001), AO/OTA type (OR = 2.327, p = 0.005), ulnar variance at pre-reduction (OR = 1.142, p = 0.048), and ulnar variance at immediate reduction (OR = 1.685, p < 0.001) were significant factors (p < 0.05) associated with re-displacement following nonoperative treatment of adult distal radius fractures. For patients aged ≥60 years, the amount of missing radiographic outcomes was positively correlated with age. The receiver operating characteristic curve demonstrated that age ≥65.5 years, ulnar variance >3.26 mm at pre-reduction, and ulnar variance >2.055 mm at immediate reduction were high-risk factors for fracture re-displacement. Nonsurgical treatment of distal radius fractures exhibits a higher rate of re-displacement. Age, AO/OTA type, pre-reduction, and immediate reduction ulnar variance are key factors predicting fracture re-displacement.

Single-Stage Externalized Locked Plating for Treatment of Unstable Meta-Diaphyseal Tibial Fractures

(1) Background: Unstable meta-diaphyseal tibial fractures represent a heterogeneous group of injuries. Recently, good clinical results have been reported when applying a technique of externalized locked plating in appropriate cases, highlighting its advantage in terms of less additional tissue injury compared with conventional methods of fracture fixation. The aims of this prospective clinical cohort study were, firstly, to investigate the biomechanical and clinical feasibility and, secondly, to evaluate the clinical and functional outcomes of single-stage externalized locked plating for treatment of unstable, proximal (intra- and extra-articular) and distal (extra-articular), meta-diaphyseal tibial fractures. (2) Methods: Patients, who matched the inclusion criteria of sustaining a high-energy unstable meta-diaphyseal tibial fracture, were identified prospectively for single-stage externalized locked plating at a single trauma hospital in the period from April 2013 to December 2022. (3) Results: Eighteen patients were included in the study. Average follow-up was 21.4 ± 12.3 months, with 94% of the fractures healing without complications. The healing time was 21.1 ± 4.6 weeks, being significantly shorter for patients with proximal extra- versus intra-articular meta-diaphyseal tibial fractures, p = 0.04. Good and excellent functional outcomes in terms of HSS and AOFAS scores, and knee and ankle joints range of motion were observed among all patients, with no registered implant breakage, deep infection, and non-union. (4) Conclusions: Single-stage externalized locked plating of unstable meta-diaphyseal tibial fractures provides adequate stability of fixation with promising clinical results and represents an attractive alternative to the conventional methods of external fixation when inclusion criteria and rehabilitation protocol are strictly followed. Further experimental studies and randomized multicentric clinical trials with larger series of patients are necessary to pave the way of its use in clinical practice.

When the center cannot hold in conventional orthopedic and trauma treatments, things will not fall apart with linear rail system: A hospital based retrospective study

Background: Distraction osteogenesis is a method of producing unlimited quantities of living bone directly from a special osteotomy (cortico to my). Advances in methods of external fixation have made limb lengthening a feasible option achieved by distraction osteogenesis. Complex trauma cases such as failure of fractures to unite after several attempts, significant soft tissue infection, significant bone loss ab initio, the presence of significant soft tissue loss, or chronic osteomyelitis that may warrant significant bone resection are a nightmare to the surgeon the patient and the patients relations as well. The linear rail system and the Ilizarov device oppose other methods of bone gap management permits the realization of compression, distraction, bone-lengthening, and deformity correction, as such improving the quality of life of the patients, good fracture union with insignificant complications.Methods: A hospital based retrospective study conducted at The Potters Specialist Hospital Jos between January 2018 and December 2020. Patients were recruited following a perusal of the operation register. A proforma was filled which included the patient’s demographics, clinical characteristics. Clinical outcomes during the treatment such union at fracture site, length gained and complications during treatment were included in the proforma. Patient’s quality of life after the treatment was also assessed. Data was analyzed using SPSS version 23.Results: Thirty-six patients were enrolled into the study. Patients mean age was 39.36±10.64. Age group 31-40 accounted for 47.2% of those recruited. Males were 83.3% and complications of fracture management were noticed to account for 22 (61.1%) of the indications for surgery. Those who had two surgeries done during treatment were 27.8% with interval corticotomy counting as a separate surgery. Limb lengthening was done in 52.8% of the patients and the leg was found to be operated limb 75% of cases. Though 72.6% did not develop any problems, among those with problems, pin tract infection was noticed in 13.9%. Similarly, 88.9% had no complications but amongst complications noted limb length discrepancy in 5.6%. All of them had their fractures united and limb lengths equalized to an acceptable level. Regarding quality of life most patients (44.4%) rated it as good and the other 22.2% very good and when asked about the satisfaction their current health 50% said they were satisfied and another 19.4% were very satisfied.There was significant association noticed between quality of life and indications for surgery, between complication and aim of surgery and noticed between complication and length gained.Conclusion: The use of the linear rail system in the treatment of complex major limb fractures yielded satisfactory results with improved quality of life and less problems and complications.

Biomass-based hydrogels with high ductility, self-adhesion and conductivity inspired by starch paste for strain sensing

Currently, hydrogel sensors for health monitoring require external tapes, bandages or adhesives to immobilize them on the surface of human skin. However, these external fixation methods easily lead to skin allergic reactions and the decline of monitoring accuracy. A simple strategy to solve this problem is to endow hydrogel sensors with good adhesion. Inspired by the starch paste adhesion mechanism, a biomass-based hydrogel with good conductivity and high repetitive adhesion strength was prepared by introducing modified starch into polyacrylic acid hydrogel system. The properties of biomass-based hydrogels could be controlled by changing the proportion of amylose and amylopectin. The biomass-based hydrogel exhibited a variety of excellent properties, including good stretchability (1290 %), high adhesion strength (pig skin: 46.51 kPa) and conductivity (2.3 S/m). Noticeably, the repeated adhesive strength of biomass-based hydrogel did not decrease with the increase of adhesion times. The strain sensor based on the biomass-based hydrogel could accurately monitor the large-scale and small movements of the human body, and had broad application prospects in the field of flexible wearable devices.

Postoperative radial nerve palsy in humeral shaft nonunion reconstruction: Can the lateral paratricipital approach prevent this common complication?

BackgroundPostoperative radial nerve palsy (RNP) is a well-known complication of nonunion reconstruction of the humerus. The purpose of the current study is to determine if the surgical approach for nonunion reconstruction of the humerus influences the rate of postoperative radial nerve palsy. MethodsA retrospective case-control study of all humeral shaft and extraarticular distal humerus nonunion reconstructions performed between January 1, 2004, and August 31, 2021, was conducted. Patients included were over 18 years of age, had a non-pathologic humerus fracture nonunion and had intact radial nerve function prior to nonunion reconstruction. Exclusion criteria consisted of nonunions involving the proximal humerus, intraarticular fractures, and reconstructive treatment procedures with either intramedullary nail or external fixation methods. Perioperative variables were recorded and analyzed in regard to the development of postoperative RNP. A subgroup analysis was performed to assess the interaction of significant variables on the development of postoperative RNP. ResultsThe overall rate of postoperative RNP in this series was 6/53 (11%). However, no cases of postoperative radial nerve palsy were observed in patients who underwent nonunion reconstruction with a lateral paratricipital approach. A new RNP was seen in 4/9 (44%) of those patients who underwent a triceps splitting approach, which was significantly higher than those utilizing either an anterolateral approach (2/28, 7%) or a lateral paratricipital approach (0/16, 0%, p = 0.007). Discussion and conclusionOur data suggests that the lateral paratricipital exposure decreases the risk of radial nerve injury with nonunion reconstruction of the humerus. The lateral paratricipital exposure offers the benefit of radial nerve exploration, decompression, neurolysis and protection prior to fracture manipulation and instrumentation. This study shows conventional approaches may predispose patients to a high rate of postoperative RNP, similar to that in the literature.

Pediatric Upper Cervical Spine Trauma: A 10-Year Retrospective Review at a Pediatric Trauma Center.

BackgroundTraumatic upper cervical spine injuries (tUCSI) are generally caused by high-impact injuries to the C1-C2 vertebral level. The current literature is limited with regards to comparing epidemiological trends, treatment options, and overall outcomes for tUCSI within the pediatric cohort. The purpose of this study was to analyze pediatric tUCSI epidemiological data, potential variations in treatment and patient outcomes, and to evaluate any specific trends that may be clinically relevant.MethodologyWe conducted a retrospective cohort study on pediatric patients ages 1 day to 16 years old, admitted for tUCSI over the past 10 years (1/2011 to 1/2021) at a Midwest level 1 trauma center. Retrospective data was queried using ICD-9 and ICD-10 diagnosis codes for tUCSI. Children were stratified into three age groups: Group 1 - Infants and Toddlers (children under three years of age); Group 2 - Young Children (children between three and seven years of age); Group 3 - Juveniles and Adolescents (children between the ages of seven and 16). Numerical data and categorical variables were summarized and the normality of the distribution of data was evaluated using the Anderson-Darling normality test. Differences between the age groups were examined using either an unpaired, independent Two-Sample t-test or Unpaired Mann-Whitney U test. Pearson’s chi-squared or Fisher’s exact tests were used to compare categorical data between groups.ResultsForty total patients were included in the final analysis, 23 female (57.5%) and 17 male (42.5%). The mean age was 11 ± 4 (range 2-16). Overall, the most common mechanism of injury was a motor vehicle collision (n=16, 40%), followed by sports injury (n=13, 32.5%), falls (n=6, 15%), and unknown mechanism (n=5, 12.5%). The most common mechanism of injury in young children was a fall (n=4, 57.5%, p<0.001). Adolescents and Juveniles significantly suffer from sports injuries compared to young children (n=13, 39.4%, p=0.043). Mechanisms of injuries presented with unique associated concomitant injuries. The most common associated sites of injuries were lower cervical spine (n=31, 77.5%), and skull injury (n=4, 10%). The vast majority of these cases were managed nonoperatively (pain medication and non-operative cervical orthosis) (n=36, 90%). Mortality and morbidity rates from tUCSI were rare in our cohort (n=1, 2.5%).ConclusionThis study found that the majority of pediatric tUCSI patients can be managed nonoperatively, with dislocations and spinal instability being the most common indications for operative management. Commonly used non-operative external fixation methods include cervical collars and Minerva jackets. Our cohort showed very low mortality and morbidity rates, however, these preliminary results will require validation by future prospective multicenter studies.