Fracture Fixation Research Articles

Ankle fracture surgery in patients experiencing homelessness: a national evaluation of one-year rates of reoperation.

To evaluate the impact of homelessness on surgical outcomes following ankle fracture surgery. Retrospective cohort study. Mariner claims database. Patients older than 18 years who underwent open reduction and internal fixation (ORIF) of ankle fractures between 2010 and 2021. A total of 345,759 patients were included in the study. Study patients were divided into two cohorts (homeless and nonhomeless) based on whether their patient record contained International Classification of Disease (ICD)-9 or ICD-10 codes for homelessness/inadequate housing. One-year rates of reoperation for amputation, irrigation and debridement, repeat ORIF, repair of nonunion/malunion, and implant removal in isolation. Homeless patients had significantly higher odds of undergoing amputation (adjusted odds ratio [aOR] 1.59, 95% confidence interval [CI] 1.08-2.27, P = 0.014), irrigation and debridement (aOR 1.22, 95% CI 1.08-1.37, P < 0.001), and repeat ORIF (aOR 1.16, 95% CI 1.00-1.35, P = 0.045). Implant removal was less common in homeless patients (aOR 0.65, 95% CI 0.59-0.72, P < 0.001). There was no significant difference between homeless and nonhomeless patients in the rate of nonunion/malunion repair (aOR 0.87, 95% CI 0.63-1.18, P = 0.41). Homelessness is a significant risk factor for worse surgical outcomes following ankle fracture surgery. The findings of this study warrant future research to identify gaps in surgical fracture care for patients with housing insecurity and underscore the importance of developing interventions to advance health equity for this vulnerable patient population. Prognostic Level III.

Rates of interlock screw back-out are high with the retrograde femoral nailing advanced system for distal femur fractures.

The retrograde femoral nailing advanced (RFNA) system (DePuy synthes) is a commonly used implant for the fixation of low distal femur and periprosthetic fractures. There is concern that the rate of distal interlock screw back-out may be higher for the RFNA compared to other nails (ON). The purpose of this study was to evaluate the incidence of interlock screw back-out and associated screw removal for RFNA versus ON, along with associated risk factors. A retrospective comparative study of patients who underwent retrograde nailing for a distal femur fracture at an academic level one trauma center was performed. The incidence of distal interlock screw back-out and need for screw removal were compared for RFNA versus a propensity score matched cohort who received other nails. One hundred and ten patients underwent retrograde nailing with the RFNA for a distal femur fracture from 2015 to 2022 (average age: 66, BMI: 32, 52.7% smokers, 54.5% female, 61.8%). There was a significantly higher rate of interlock back-out in the RFNA group compared to the ON (27 patients, 24.5% vs 12 patients, 10.9%, p = 0.01), which occurred 6.3weeks postoperatively. Screw removal rates for back-out were not significantly different for the RFNA group versus ON (8 patients, 7.3% vs 3 patients, 2.7%, p = 0.12). In this retrospective comparative study of distal femur fractures treated with retrograde nailing, the RFNA implant was associated with an increased risk of distal interlock screw back-out compared to other nails.

Multi‐Functional Design of TPMS‐Structures for Temporary Paediatric Fixation Devices

Fracture fixation and limb deformity correction in paediatric orthopaedics often use temporary metallic fixation devices. These devices’ higher stiffness compared to cortical bone leads to stress shielding, causing significant bone density reduction, periprosthetic loosening, and bone growth interference. 3D‐printed triply periodic minimal surface (TPMS) structures present a promising engineering solution to match bone stiffness while ensuring reliable implant strength. This study employs finite element modelling and experimental testing to identify optimal multi‐functional TPMS‐based lattices that meet the required design constraints of (1) stiffness in the range of cortical bone, (2) strength in the range of cortical bone, (3) minimum osteointegration to facilitate the implant removal after healing, and (4) manufacturability with limited defect sensitivity. Six different types of Ti‐6Al‐4V material TPMS structures manufactured via Laser Powder Bed Fusion were evaluated for their ability to target the lower and upper bounds of paediatric cortical bone stiffness. Lattices based on the Primitive unit cell design were superior, demonstrating the highest strength/stiffness ratio, best manufacturability, and potentially reduced osteointegration due to larger pore size, smaller surface area, and lowest negative Gaussian curvature compared to other investigated TPMS types.This article is protected by copyright. All rights reserved.

Successful fixation of supraglenoid tubercle fracture in a horse with a customised distal femoral locking plate

AbstractAn 18‐month‐old Standardbred colt, referred for hock joint arthroscopy, presented a severe left forelimb lameness immediately after recovery from general anaesthesia. The horse was found in the recovery box with a ‘dropped elbow’, and it was dragging the leg. Radiographic examination of the shoulder showed a displaced avulsion fracture of the supraglenoid tubercle of the scapula. A human distal femoral locking plate was customised using measurements taken from a computed tomography scan of a 2‐year‐old horse specimen. An internal fixation of the fracture was performed using the designed distal femoral locking plate. Rehabilitation techniques were passive manipulations and neuromuscular electrical stimulation. Six months post‐operatively, the horse was sound and had made a complete functional recovery. The distal femoral locking plate fitted well to the supraglenoid tubercle and scapula in the operated horse, leading to a stable fixation. The recovery time was shortened using internal fixation, which facilitated a faster return to mobility.

Impaired synaptic plasticity and decreased glutamatergic neuron excitability induced by SIRT1/BDNF downregulation in the hippocampal CA1 region are involved in postoperative cognitive dysfunction

BackgroundPostoperative cognitive dysfunction (POCD) is a common complication after anesthesia/surgery, especially among elderly patients, and poses a significant threat to their postoperative quality of life and overall well-being. While it is widely accepted that elderly patients may experience POCD following anesthesia/surgery, the exact mechanism behind this phenomenon remains unclear. Several studies have indicated that the interaction between silent mating type information regulation 2 homologue 1 (SIRT1) and brain-derived neurotrophic factor (BDNF) is crucial in controlling cognitive function and is strongly linked to neurodegenerative disorders. Hence, this research aims to explore how SIRT1/BDNF impacts cognitive decline caused by anesthesia/surgery in aged mice.MethodsOpen field test (OFT) was used to determine whether anesthesia/surgery affected the motor ability of mice, while the postoperative cognitive function of 18 months old mice was evaluated with Novel object recognition test (NORT), Object location test (OLT) and Fear condition test (FC). The expressions of SIRT1 and other molecules were analyzed by western blot and immunofluorescence staining. The hippocampal synaptic plasticity was detected by Golgi staining and Long-term potentiation (LTP). The effects of SIRT1 and BDNF overexpression as well as chemogenetic activation of glutamatergic neurons in hippocampal CA1 region of 18 months old vesicular glutamate transporter 1 (VGLUT1) mice on POCD were further investigated.ResultsThe research results revealed that older mice exhibited cognitive impairment following intramedullary fixation of tibial fracture. Additionally, a notable decrease in the expression of SIRT1/BDNF and neuronal excitability in hippocampal CA1 glutamatergic neurons was observed. By increasing levels of SIRT1/BDNF or enhancing glutamatergic neuron excitability in the CA1 region, it was possible to effectively mitigate synaptic plasticity impairment and ameliorate postoperative cognitive dysfunction.ConclusionsThe decline in SIRT1/BDNF levels leading to changes in synaptic plasticity and neuronal excitability in older mice could be a significant factor contributing to cognitive impairment after anesthesia/surgery.Graphical

Femoral neck osteosynthesis using interfragmentary compression or position screw in synthetic bones. What are the mechanical differences?

We aim to compare interfragmentary compression with the position osteosynthesis in the fixation of different femoral neck fractures (FN)in synthetic bones subjected to vertical load. Forty-two synthetic femurs were subjected to neck fractures and separated into 3 groups according to the Pauwels classification: Pauwels I had 6 units (PI); Pauwels II, 24 units, with and without comminution (PII); and Pauwels III, 12 units, with and without comminution (PIII). After, they were fixed with 2 different ways: three 7, 0mm cannulated lag screws (CSs) versus three 6, 5mm solid fully threaded screws (SSs). Screws positioning was oriented by the Pauwels classification: inverted triangle or crossed screws. All specimens were submitted to vertical loading until failure. The average force was 79.4 ± 22.6Kgf. The greatest one was recorded in model 1 (135.6Kgf), and the lowest in model 41 (39.6Kgf). CSs and SSs had similar resistance until failure (p = 0.2). PI showed heightened resistance and PIII showed a worse response (p < 0,01). CSs had better performance in PIII (p = 0.048). Comminution and screws orientation caused no difference on peak force (p = 0.918 and p = 0.340, respectively). In synthetic bones, the resistance of a femoral neck fracture osteosynthesis using a 7, 0mm cannulated lag screw or 6, 5mm solid fully threaded screw are similar. There was no loss of efficiency with comminution in the femoral neck. Osteosynthesis resistance decreased with the verticalization of the fracture line and, in the more vertical ones, interfragmentary compression with CSs was more resistant than positional osteosynthesis with SSs.

Robot-assisted versus traditional surgery in the treatment of intertrochanteric fractures: a meta-analysis

Intramedullary nail fixation of intertrochanteric fractures assisted by orthopedic surgical robot navigation is a new surgical method, but there are few studies comparing its efficacy with traditional intramedullary nail fixation. We aimed to assess whether robot-assisted internal fixation confers certain surgical advantages through a literature review. PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI) and Wan fang Data Knowledge service Platform were searched to collect randomized and non-randomized studies on patients with calcaneal fractures. Five studies were identified to compare the clinical indexes. For the clinical indexes, the technology of robot-assisted is generally feasible, in time to operation, intraoperative fluoroscopy times, blood loss, pine insertion, tip apex distance (TAD), and Harris score (P < 0.05). However, on the complication and excellent and good rate after operation did not show good efficacy compared with the traditional group (P > 0.05). Based on the current evidence, For the short-term clinical index, the advantages of robot-assisted are clear. The long-term clinical effects of the two methods are also good, but the robot-assisted shows better. However, the quality of some studies is low, and more high-quality randomized controlled trials (RCTs) are needed for further verification.

Biomechanical assessment of mandibular fracture fixation using finite element analysis validated by polymeric mandible mechanical testing

The clinical finite element analysis (FEA) application in maxillofacial surgery for mandibular fracture is limited due to the lack of a validated FEA model. Therefore, this study aims to develop a validated FEA model for mandibular fracture treatment, by assessing non-comminuted mandibular fracture fixation. FEA models were created for mandibles with single simple symphysis, parasymphysis, and angle fractures; fixated with 2.0 mm 4-hole titanium miniplates located at three different configurations with clinically known differences in stability, namely: superior border, inferior border, and two plate combinations. The FEA models were validated with series of Synbone polymeric mandible mechanical testing (PMMT) using a mechanical test bench with an identical test set-up. The first outcome was that the current understanding of stable simple mandibular fracture fixation was reproducible in both the FEA and PMMT. Optimal fracture stability was achieved with the two plate combination, followed by superior border, and then inferior border plating. Second, the FEA and the PMMT findings were consistent and comparable (a total displacement difference of 1.13 mm). In conclusion, the FEA and the PMMT outcomes were similar, and hence suitable for simple mandibular fracture treatment analyses. The FEA model can possibly be applied for non-routine complex mandibular fracture management.

Cannulated screws fixation for nondisplaced femoral neck fractures: early versus late weight-bearing-a prospective analysis.

Nondisplaced intracapsular fractures (Garden I/II) are predominantly treated with an internal fixation technique. The purpose of the study is to identify the best rehabilitation protocol after internal fixation with 3 parallel cannulated screws. All patients operated on from 2016 to 2021 for femoral neck fractures by internal fixation with 3 cannulated screws were enrolled into this prospective study. The population was divided into two groups: Group A (n = 34) who followed a postoperative rehabilitation protocol involving full and immediate loading, and Group B (n = 22) who followed a postoperative rehabilitation protocol involving late full loading (after 30days). The two groups were compared with each other by mortality rate, postoperative complications and need for re-interventions. Functional outcome and quality of life were assessed at the minimum follow-up of 1year using the modified Harris Hip Score(HHS) and the Short form health survey (SF-12) questionnaire. Group A showed a lower complication rate (2.9% vs. 18.2%), a lower 1-year mortality rate (5.9% vs. 9.1%), a better perception of mental health status (SF12-MCS 56.2 vs. 51.4, p = 0.03) but a worse perception of one's physical health status (SF12-PCS 48.1 vs. 56.7, p < 0.01). The two groups were also statistically overlapping in terms of the functional outcome achieved after the intervention (HHS was 90.94 in Group A vs. 93.15 in Group B, p = 0.32). Postoperative complications, mortality and revision rate were higher in patients who followed a late-loaded rather than early loaded rehabilitation protocol. Functional outcome at 1-year survival is not significantly different. In nondisplaced intracapsular hip fractures treated with cannulated screws, an immediate full load should be preferred. Query.

Potential of Titanium Pins Coated with Fibroblast Growth Factor-2–Calcium Phosphate Composite Layers to Reduce the Risk of Impaired Bone–Pin Interface Strength in the External Fixation of Distal Radius Fractures

Potential of Titanium Pins Coated with Fibroblast Growth Factor-2–Calcium Phosphate Composite Layers to Reduce the Risk of Impaired Bone–Pin Interface Strength in the External Fixation of Distal Radius Fractures

Anterior internal versus external fixation of unstable pelvis fractures was not associated with discharge destination, critical care, length of stay, or hospital charges.

Determine if anterior internal versus supra-acetabular external fixation of unstable pelvic fractures is associated with care needs or discharge. A retrospective cohort study was performed at two tertiary trauma referral centers. Adults with unstable pelvis fractures (AO/OTA 61B/61C) who received operative fixation of the anterior and posterior pelvic ring by two orthopedic trauma surgeons from October 2020 to November 2022 were included. The primary outcome was discharge destination. Secondary outcomes included intensive care unit (ICU) or ventilator days, length of stay, and hospital charges. Eighty-three eligible patients were 38.6% female, with a mean age of 47.2 ± 20.3years and BMI 28.1 ± 6.4kg/m2. Fifty-nine patients (71.1%) received anterior pelvis internal fixation and 24 (28.9%) received external fixation. External fixation was associated with weight-bearing restrictions (91.7% versus 49.2%, p = 0.01). No differences in demographic, functional status, insurance type, fracture classification, or injury severity measures were observed by treatment. Internal versus external anterior pelvic fixation was not associated with discharge to home (49.2% versus 29.2%, p = 0.10), median ICU days (3.0 [interquartile range (IQR) 7.8 versus 5.5 [IQR 4.3], p = 0.14, ventilator days (0 [IQR 6.0] versus 0 [IQR 2.8], p = 0.51), length of stay (13.0 [IQR 13.0] versus 17.5 (IQR 20.5), p = 0.38), or total hospital charges (US dollars 180,311 [IQR 219,061.75] versus 243,622 [IQR 187,111], p = 0.14). Anterior internal versus supra-acetabular external fixation of unstable pelvis fractures was not significantly associated with discharge destination, critical care, hospital length of stay, or hospital charges. This sample may be underpowered to detect differences between groups. Therapeutic Level IV.

The clinical efficacy of Medial Sustain Nail(MSN) and Proximal femoral nail anti-rotation(PFNA) for fixation of medial comminuted trochanteric fractures: a prospective randomized controlled trial.

To evaluate the clinical efficacy of the Medial Sustain Nail (MSN) for medial comminuted trochanteric fractures fixation in comparison to Proximal Femoral Nail Antirotation (PFNA) through a clinical study. A non-inferiority randomized controlled trial was conducted at a single centre between July 2019 and July 2020. Fifty patients diagnosed comminuted trochanteric fractures were randomly assigned to either the MSN group (n = 25) or the PFNA group (n = 25). A total of forty-three patients were included in the final study analysis. The primary outcome measure was Short Form 36 health surgery physical component summary (SF-36 PCS) score. Secondary outcomes included the Oxford Hip Scores (OHS), weight bearing, complication relate to implant and so on. This study was not blined to surgeons, but to patients and data analysts. The MSN demonstrated significantly better functional outcomes as measured by SF-36 PCS and OHS at sixmonths postoperative compared to PFNA (p < 0.05). Union of fractures in the MSN group reached 90.9% at threemonths after surgery, whereas the PFNA group achieved a union rate of 57.1% (p < 0.05). Furthermore, weight-bearing time of MSN group was earlier than PFNA group (p < 0.05). Additionally, complications related to implant usage were more prevalent in the PFNA group (33.3%) compared to the MSN group (4.5%) (p < 0.05). MSN exhibited superior quality of life outcomes compared to PFNA at sixmonths postoperative. This indicates that MSN effectively reconstructs medial femoral support in patients with comminuted trochanteric fractures, which facilitates early weight-bearing and accelerates the recovery process. Trial registration number: NCT01437176, Date of the trial registration:2011-9-1, Date of commencement of the study:2011-9, Date of enrolment/recruitment of the study subjects:2019-7.

Pediatric Subtrochanteric Fracture Treated with Adult Proximal Humerus Locking Plate: A Case Series and Literature Review

Background: A variety of options including titanium elastic nails (TENs) and locking plates (LPs) are available for the internal fixation of subtrochanteric fractures (STFs). However, the preferred treatment option among children and adolescents is still controversial. Methods: We report four cases of STFs in school-aged pediatric patients, treated with an adult proximal humerus LP. Results: Based on the Flynn scoring system at the last follow-up visit, all patients exhibited excellent clinical outcomes, along with satisfactory radiological outcomes based on the Beaty scoring system. There were no complications. Conclusion: Our findings suggest the efficacy of using adult proximal humerus LPs in treating pediatric STFs. The advantage of these plates lies in their ability to accommodate many screws at appropriate positions and angles without damaging the physis. This approach holds promise for the management of pediatric STFs.

Study of the Healing of Tibial Fractures Treated with Dynamic Intramedullary Nailing

Background: Dynamic nailing by placing only one screw on one side of the nail shortens the surgical time and reduces the complications during surgery and secondary dynamization. This study aimed to investigate the healing of dynamic intramedullary nailing (IMN) of tibial fractures. Methods: This cross-sectional study was done on 67 patients with dynamic IMN in 5th Azar Hospital, Gorgan, Iran, in 2015-2018. Complications, union time, Radiographic Union Score of Tibia Fracture (RUST) score, and Johner-Wruhs criteria were analyzed based on their grouping in AO classification. Results: The average age of the patients was 33.2 ± 13.0 years. Most of the fractures were closed type (71.6%), type C (43.4%). The mean healing time was 14.62 ± 4.38 weeks and RUST score was 8.90 ± 1.26. There was no significant difference between locations of fracture and the healing time or RUST score (P &gt; 0.05). The healing time in the comminuted fractures (e.g., type C) and open tibial fractures was statistically longer than the simpler type (e.g., type A or B) and the mean radiological score in type C fractures was significantly lower (P &lt; 0.05). The mean Johner-Wruhs criteria score of fractures was 46.31 ± 4.49, so that 61 patients had excellent results, four patients had good results, and two patients had fair results. Conclusion: Dynamic IMN of closed and middle third tibial fractures and simpler types of fractures (e.g., type A or B) have faster healing. Nevertheless, it is better to be more cautious for fixation of open or comminuted fracture (e.g., type C).

Comparative study of different extendable intramedullary rods combined with surgery in the treatment of congenital pseudarthrosis of the tibia

BackgroundWhen using traditional extensible intramedullary rods to treat congenital pseudarthrosis of the tibia (CPT), there were cases of re-fracture and internal fixation fracture. Therefore, the authors propose a research hypothesis that a thicker distal extensible intramedullary rod can better protect the tibia and reduce the incidence of refracturePurposeTo investigate the clinical efficacy of new and traditional extensible intramedullary rods in the treatment of CPT in childrenMethodsFrom January 2017 to December 2021, the clinical data of 49 children with CPT who were treated with traditional extensible intramedullary rod combined surgery (group A) and new extensible intramedullary rod combined surgery (group B) in our hospital were collected. Inclusive criteria: ① Crawford type IV CPT children; ② The operation was performed by the same team. Exclusion criteria: patients with multiple tibial angulation. During follow-up, the initial healing, proximal tibial valgus, tibial length, ankle valgus, refracture and intramedullary rod displacement of CPT children in the two groups were evaluatedResultsIt was a retrospective investigation. In group A, 26 cases met the inclusion criteria, 24 cases achieved primary healing, with an primary healing rate of 92%, including 1 case of nonunion due to osteomyelitis complications after surgery, and 1 case of delayed healing, with an average healing time of 4.7 ± 0.8 months. 17 cases (68%) had unequal tibia length, with an average difference of 1.6 ± 0.8 cm. Ankle valgus occurred in 10 cases (40%) with an average of 14.4°±4.8°; Proximal tibial valgus occurred in 6 cases (24%) with an average of 7 °± 1.8 °. 20 cases (80%) had tip of the rod migration.10 cases (40%) had re-fracture; The average follow-up time was 2.4 ± 0.4 years. In group B, 22 patients achieved primary healing, and the primary healing rate was 95%, including 1 case with delayed healing. The average healing time was 4.7 ± 1.7months. 14 cases (61%) had unequal tibia length, with an average difference of 1 ± 0.5 cm. Ankle valgus occurred in 4 cases (17%) with an average of 12.3 °±4.9°; The proximal tibia valgus occurred in 9 cases (39%), with an average of 7.7 °±2.5 °. 14 cases (61%) had new type of intramedullary rod displacement. 3 cases (13%) had re-fracture; The average follow-up time was 2.3 ± 0.6yearsConclusionCompared with the traditional extended intramedullary rod combined operation, the new type of extended intramedullary rod combined operation has a lower incidence of re-fracture after CPT, but it still needs to be verified by large sample and multi-center research

A novel anatomical locked medial femoral condyle plate: a biomechanical study.

Fixation with a distal lateral femoral plate is a standard approach in treating osteoporotic or comminuted supracondylar femur fractures. However, in clinical practice, this method may prove inadequate, necessitating the application of a plate on the medial side of the distal femur. The aim of this study is to perform a biomechanical evaluation of the newly manufactured anatomically locked plate applied to the distal medial femoral condyle. The plate underwent 2 biomechanical tests by simulating an AO/OTA 33A3 type supracondylar fracture model on synthetic femur bones. The samples were divided into three groups. Fracture fixations were carried out on the medial side using the distal femur medial anatomical locking plate (DFMALP) in group A samples, on the lateral side using the distal femur lateral anatomical locking plate in group B samples, and on both sides in group C samples. In the axial compression test, stability was preserved 23% more in group C than in group B. During the cyclic axial compression test, total displacement was 21% less in group C than in group B. Group A was collapsed at early cycle degrees. In our study, it was observed that the application of DFMALP in conjunction with the lateral plate in AO/OTA 33A3 fragmented supracondylar femur fractures significantly enhanced biomechanical fracture stability. This is a Level 2 prospective, randomized controlled study.

Head-to-neck screw fixation and radial head arthroplasty result in similar postoperative outcomes for low-comminuted radial head fractures with neck involvement

Background Fixation of radial head fractures with neck involvement presents challenges. It remains unclear whether the outcomes of head-to-neck screw fixation are similar to those of arthroplasty in this scenario. We conducted a retrospective cohort study to evaluate the clinical outcomes of these two methods for treating such fractures. Methods Demographic data, fracture type, number of fragments, and concomitant injuries were recorded. Range of motion, Visual Analogue Scale for pain, Mayo Elbow Performance Score, and Quick-Disabilities of the Arm, Shoulder, and Hand at three-year follow-up, complications, and reintervention were compared. Results A total of 14 patients underwent fixation with head-to-neck screws, and 15 an arthroplasty. Baseline characteristics between groups were similar ( P &gt; .05). Satisfactory range of motion (arc &gt; 100°) was achieved in nine patients (64%) in the fixation group, and eight patients (53%) in the arthroplasty group ( P = .55). The mean Visual Analogue Scale, Mayo Elbow Performance Score, and Quick-Disabilities of the Arm, Shoulder, and Hand were 1.2 ± 1.2, 91.7 ± 10.7, and 9.1 ± 1, respectively, ( P = .651, P = .651, and P = .155). Three patients (21%) in the fixation group underwent a reintervention and three (20%) in the arthroplasty group ( P = .639). Discussion Head-to-neck screw fixation and radial head arthroplasty result in similar postoperative outcomes for low-comminuted radial head fractures with neck involvement.

Clinical differences between periprosthetic and native distal femur fractures: a comparative observational study

IntroductionThe incidence of periprosthetic distal femur fractures (PDFF) is increasing as the number of total knee replacements becomes more common. This study compared the demographics, fracture characteristics, treatment, and outcomes of periprosthetic versus native distal femur fractures (NDFF).Materials and methodsThis was a retrospective cohort study of patients ≥ 18 who underwent surgical fixation of NDFF or PDFF from 2012 to 2020 at a level-1 trauma center. The main variables collected included demographics, AO/OTA fracture classification, fixation construct, concomitant fractures, polytrauma rates, bone density, and reduction quality. Primary outcomes were unexpected return to the operating room (UROR), hospital length of stay, and quality of reduction. T-tests, Fisher’s exact tests, and multivariate analyses were used for statistical analysis.Results209 patients were identified, including 70 PDFF and 139 NDFF. PDFF patients were elderly females (81%) with isolated (80%) and comminuted (85%) 33 A.3 (71%) fractures. NDFF patients included 53% females, were commonly middle-aged, and displayed comminuted (92%) 33 C.2 fractures. 48% of NDFF patients had concomitant fractures. Intramedullary nailing was the primary fixation for both groups, followed by nail-plate combination (37%) for PDFF and lateral locking plates (21%) for NDFF. NDFF patients experienced significantly longer hospital stays, higher UROR rates, and worse quality of reduction (p < 0.05). PDFF patients had a significantly greater prevalence of low bone density (p < 0.05).ConclusionPDFF occur as isolated injuries with significant metaphyseal comminution in elderly females with low bone quality. NDFF commonly occurs in younger patients with less metaphyseal comminution and concomitant fractures. Intramedullary nailing was the most common treatment for both groups, although preference for nail-plate combination fixation is increasing. NDFF type 33 C fractures are at greater risk of UROR.

Acetabular fractures in geriatric patients: epidemiology, pathomechanism, classification and treatment options.

The incidence of geriatric acetabular fractures has shown a sharp increase in the last decades. The majority of patients are male, which is different to other osteoporotic fractures. The typical pathomechanism generally differs from acetabular fractures in young patients regarding both the direction and the amount of force transmission to the acetabulum via the femoral head. Geriatric fractures very frequently involve anterior structures of the acetabulum, while the posterior wall is less frequently involved. The anterior column and posterior hemitransverse (ACPHT) fracture is the most common fracture type. Superomedial dome impactions (gull sign) are a frequent feature in geriatric acetabular fractures as well. Treatment options include nonoperative treatment, internal fixation and arthoplasty. Nonoperative treatment includes rapid mobilisation and full weighbearing under analgesia and is advisable in non- or minimally displaced fractures without subluxation of the hip joint and without positive gull sign. Open reduction and internal fixation of geriatric acetabular fractures leads to good or excellent results, if anatomic reduction is achieved intraoperatively and loss of reduction does not occur postoperatively. Primary arthroplasty of geriatric acetabular fractures is a treatment option, which does not require anatomic reduction, allows for immediate postoperative full weightbearing and obviates several complications, which are associated with internal fixation. The major issue is the fixation of the acetabular cup in the fractured bone. Primary cups, reinforcement rings or a combination of arthroplasty and internal fixation may be applied depending on the acetabular fracture type.

Surgical methods of treatment for tibial diaphyseal fractures

Background. Bone fractures are a public health concern. In recent years, there has been an upward trend in body weight of people of all age groups. Obesity has long been thought to help protect against fractures, but recent studies have shown that for every 5 cm increase in waist circumference, the risk of any fracture is 3 % higher. The purpose: according to the meta-analysis of modern medical literature, to determine the main directions of surgical treatment for long bone fractures, their advantages, and disadvantages, including in overweight patients, the features of diaphyseal fracture fixation in overweight patients. Materials and methods. A meta-analysis of special literature from scientific databases was conducted: Cochrane Library, Scopus, National Library of Medicine — National Institutes of Health, ReLAB-HS Rehabilitation Resources Repository. One hundred and thirty articles were analyzed, from them 31 were selected, which, in our opinion, reflect the purpose of the study. Results. All methods of surgical fixation of fractures have their advantages and disadvantages. The frequency of nonunions caused by intramedullary fixation of the femoral shaft can reach 10 %, and varus/valgus and rotational deformities and shortening can also be observed. But the use of locking screws prevents the occurrence of most complications. When fixing the fractures with plates, the main complications are related to superficial and deep infections, which were more often observed in overweight patients. The analysis demonstrated that in overweight and obese patients, the main complicating factor is not the method for fixing the fracture zone, but factors related to the health of the patient himself. So, despite the fact that the results of treatment of fractures in patients with normal weight and obesity did not have a statistically significant difference, an increase in cardiovascular complications, exacerbation of chronic respiratory diseases was observed. Moreover, it is the presence of concomitant diseases that often makes surgical intervention impossible. Conclusions. There is a large amount of research on surgical methods of fixing tibial diaphyseal fractures, but data on the choice of fixation method in overweight and obese patients as a separate approach were not found. There are data on complicating factors of excess weight in the treatment of fractures and surgical interventions. Systematic studies related specifically to the algorithm for choosing the method of fracture fixation and complications have also not been found.