Fixation Of Fragments Research Articles

Different modifications of minimally invasive osteosynthesis in pilon fractures: comparative study results

Background. Minimally invasive surgical techniques can reduce the degree of surgical injury during osteosynthesis in peri- and intraarticular pilon fractures. However, these techniques do not always achieve anatomical reduction of the articular component and stable fixation of all columns of the distal tibia. Aim of the study — to test the hypothesis regarding the clinical advantages of multicolumn fixation for comminuted pilon fractures over traditional single-column fixation. Methods. The study enrolled 55 patients with extra- and intraarticular fractures of the distal tibia and fibula, all of whom underwent minimally invasive osteosynthesis. Patients were divided into two groups based on the number of fixed columns. These groups were comparable in terms of gender and age. The first group consisted of 28 patients who underwent osteosynthesis with one anatomically precontoured plate. The second group consisted of 27 patients who underwent osteosynthesis with two or more plates placed on different tibial columns. The quality of bone fragment reduction was analyzed using control X-rays performed the day after the operation. Functional outcomes were evaluated according to the AOFAS scale at 6 and 12 months post-operation. The incidence of early and delayed complications of osteosynthesis was also determined. Results. No statistically significant difference was found between the two study groups in terms of quality of reduction (p = 0.23). The median functional outcome score in the first group at 6 months was 63 points [IQR 50.00-73.00] and at 12 months was 74 points [IQR 65.00-83.25]. In the second group, the median scores were 75 points [IQR 67.50-81.00] and 85 points [IQR 71.00-94.50], respectively. Multicolumn fixation of the pilon fracture resulted in statistically significantly higher functional outcome scores at both follow-up periods: at 6 months (p = 0.015) and at 12 months (p = 0.028). The probability of complications in the first group was 4.4 times higher than in the second group: OR = 4.444 (95% CI 1.066-18.528). Conclusion. Multicolumn fixation of complete periarticular and intraarticular pilon fractures leads to better functional results compared to single-column fixation. It also reduces the risk of complications due to increased stability of the fragment fixation and the resistance of the implant-bone system to physiological stress.

Low rate of growth disturbance after posterior cruciate ligament reconstruction or repair in skeletally immature patients: a systematic review.

The management of posterior cruciate ligament (PCL) injuries in children is complex and varies depending on the specific nature of the injury. Avulsions of the PCL can often be addressed with proximal or distal repair, while intra-substance tears and cases with persistent instability generally require more extensive reconstruction. Despite the prevalence of such cases, the literature is predominantly composed of case reports, indicating a lack of comprehensive research in this area. The purpose of this systematic review was to analyze growth disturbance in skeletally immature patients after PCL reconstruction or repair. A systematic review was conducted on the basis of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The following search terms were used in the title, abstract, and keyword fields: "PCL" or "posterior cruciate ligament" AND "children" or "open physis" or "immature". The main outcome data extracted from the studies was to assess growth disturbance at a minimum 1-year follow-up after surgery. A total of 34 patients, from 17 articles, were included of which 30 (88.24%) male and 4 (11.76%) female. Mean age at surgery was 10.18 ± 2.88 years. The mean interval from injury to surgery was 178.9 ± 288.04 days. Average follow-up duration was 50.64 ±22.69 months. Six studies reported on PCL reconstructions using various grafts, including autologous allografts (hamstring or tibialis anterioris), Achilles tendon allografts with bone plugs, and parental donated hamstrings allografts. Only one study reported the use of internal brace to repair PCL, while in all the other studies was performed a repair of the PCL with fixation of the bone fragment (to the femur or tibia) with screws or suture. Growth disturbances (≥ 10mm) were reported in 2 of the 13 (15.38%) patients underwent PCL, while in PCL repair was noted in 2 of the 21 patients (9.52%) (p=0.63). Only 1 patients belonging to PCL reconstruction reported a slight increase in the valgus alignment of the operated knee compared to the contralateral knee, representing medial overgrowth at the distal femur (p=0.33). There is scarce literature on the risk of growth disturbance in skeletally immature patients after PCL reconstruction or repair. Nevertheless, posterior cruciate ligament reconstruction in children indicate a low risk of growth disturbance, in particular for length leg discrepancy (<15%) in the mid-long term follow-up, and a low rate of angular deviations (<8%). This surgery remains a major challenge for orthopaedic surgeons, and many unknowns remain regarding ideal grafts, technique, and time for surgery to prevent growth disturbance. Systematic review of Level IV.

Enhanced Biomechanical Stability in Proximal Humeral Fractures: Finite Element Analysis of a Novel Endosteal Anatomical Support Nail for Improved Fixation in Elderly Patients.

Intramedullary nailing is preferred for treating elderly proximal humeral fractures, but secondary reductions are common, particularly in elderly and osteoporotic patients. This occurs due to the intramedullary nail fixation's insufficient anti-varus and anti-rotational capacities and high stress at the bone-implant interface. We aim to enhance the anti-varus and anti-rotational stability of the fixation structure while reducing the stresses on the bone and internal fixation through structural design. We developed a novel endosteal anatomical support nail (EASN) that integrates an endosteal torus construct into the proximal portion of the angle-stable proximal humerus nail. The endosteal torus construct includes endosteal anatomical support (EAS) with a flat plane that allows direct fixation of the humeral head fragments and is shaped to conform to the medial side of the medullary cavity of the proximal humerus. We conducted finite element analysis to assess the biomechanical stability of four constructs: EAS with a calcar screw (CS), EAS without CS, non-EAS with CS, and non-EAS without CS. This analysis determined the contribution of the EAS to the mechanical stability of the proximal humerus in two-part PHF with medial column disruption. Specimens were subjected to loads simulating partial-weight-bearing (as in rising from a chair or using crutches) and full-weight-bearing (as in rising from bed). We evaluated the stiffness of the construct, displacement at the fracture site, von Mises stress, and stress distribution. Under compressive or rotational loads, the EAS construct, with or without CS, was significantly stiffer than the non-EAS construct. Displacement at the fracture site was significantly less with the EAS fixation than with the non-EAS fixation. However, the stiffness and displacement at the fracture site of the EAS fixation without CS were comparable to those of the non-EAS construct with CS. The EAS construct reduced the load on the nail and decreased the risk of implant failure. Both von Mises stress and stress distribution were significantly lower following fixation with the EAS constructs. This study introduces a novel EAS concept to enhance the anti-varus and anti-rotational capabilities of the humeral head and distribute stress at the bone-implant interface in treating elderly PHFs. This strategy shows promise based on our limited analysis.

Design Modification and Finite Element Analysis of Stainless Steel 316L Locking Compression Plates for Mid-Transverse Fractures

Bone fracture is the most common orthopedics problem. To achieve stability in the internal fixation of bone fragments, apply a Locking Compression Plate (LCP), which consists of a set of plates and screws. Common materials used for the bone fixation plate are stainless steel, titanium, and other metal alloys. Those materials are stiffer than cortical bone, causing a stress shielding effect. The stress shielding phenomenon takes place during bone remodelling, which affects the growth of bone and bone loss upon the healing process. The purpose of this study is to design the best LCP to minimize or eliminate the stress shielding issue for tibia shaft fracture. A reverse engineering process is used to obtain the solid part using 3D scanning, and data clean-up is done in CATIA V5, which is then used to be imported into the finite element software ANSYS 23R2. The fracture simulation is on transverse type fractures with the creation of a gap of 1 mm around the mid-tibial shaft region. Several boundary conditions will be parametrized, such as material properties, contact definitions, meshing, and loading conditions in preprocessing. This paper examines and simulates the behaviour of LCP under a load via finite element analysis (FEA). Design 2 was selected due to its superior stress distribution,resulting in the LCP bearing only 177.98 MPa with a total deformation of 0.57 mm

Return to Activity After Patellofemoral Osteochondral Fracture: A Comparison of Metallic Screw and Bioabsorbable Fixation.

Patellofemoral osteochondral fractures (OCFs) have the potential to hinder patients' function and quality of life. Several fragment fixation techniques have been described, with both metallic screw and bioabsorbable fixation showing favorable functional outcomes. Despite the promising results associated with both fixation methods, no study has directly compared their functional outcomes. To compare the functional and radiographic outcomes between bioabsorbable and metallic screw patellofemoral OCF fixation in an adolescent cohort. Cohort study; Level of evidence, 2. A retrospective review was conducted identifying surgically treated pediatric patients (<18 years of age) with OCFs of the patellofemoral joint. Inclusion criteria were treatment with metallic screw or bioabsorbable fixation (bioabsorbable compression screw, suture bridge, or chondral darts), with preoperative radiographs and operative notes available for review. Patient information, injury characteristics, treatments, and outcomes were collected with a specific focus on return-to-activity time and postoperative complications. Univariate analyses were conducted to compare radiographic and functional outcomes between groups. According to the study criteria, 37 knees in 37 patients (84% male), with a mean age of 14.2 ± 1.8 years, were identified. A total of 24 patients were injured during sports participation, with basketball and football being the most common sports. OCF fixation cohorts consisted of 12 patients treated with metallic screw fixation and 25 with bioabsorbable fixation. No statistically significant differences were appreciated when comparing median time to full activity between the fixation groups (P = .427). However, time to full activity was unequally distributed, with 66.7% of the metallic screw fixation group returning to activity later than the total cohort's median, compared with 42.9% of the bioabsorbable fixation group (P = .04). Two-thirds (8/12) of patients treated with metallic screws required return to the operating room for hardware removal compared with no patient treated with bioabsorbable fixation (P < .001). Two complications occurred with no significant differences appreciated between groups (P = .202). However, both postoperative complications were recorded in the metallic screw fixation group: 1 patient with osteochondral malunion and another with arthrofibrosis. This study demonstrated that pediatric patellofemoral OCFs had good outcomes with high healing and low complication rates regardless of fixation type. Because of the high rate of secondary hardware removal procedures, metallic screw constructs delayed the return to sports and activity time. Patients treated with bioabsorbable fixation did not require a secondary operation for hardware removal and thus were more likely to recover sooner. Future studies are necessary to assess the potential outcome differences between different types of bioabsorbable fixation methods. Based on these findings, surgeons can consider bioabsorbable fixation as an option for the management of OCF lesions.

A differentiated approach to the surgical treatment of intraarticular fracture of the proximal tibia

Background. For a long time, the question of optimal ways and methods of surgical treatment of fractures of the proximal part of the tibia (PPT) remains debatable. The purpose was to study the results of surgical treatment of fractures of the PPT using differentiated use of minimally invasive techniques. Materials and methods. The work consisted of a prospective analysis of the treatment outcomes of 87 patients who were treated 2018 to 2023. Fractures were classified according to Schatzker. The tactics of surgical treatment depended on the type of fracture, the age of the patients and the presence of concomitant diseases. A comprehensive assessment of knee function was performed using the Knee Society Score. For X-ray assessment of the degree of progression of post-traumatic arthritis, the Resnik/Niwoyama system was used. ­Results. The results of surgical treatment were studied in terms from 6 to 24 months. 19.8 % of excellent, 57.5 % good, 15.6 % sa­tisfactory and 7.1 % unsatisfactory treatment results were obtained. Progression of post-traumatic arthritis was observed in 36 patients (28 patients at one stage, 4 subjects at 2 stages and 5 patients at 3 stages). Of the complications, 7 (8.0 %) were surgical site infections, which required debridement of the focus and longer antibiotic therapy. Over time, loss of reposition and secondary displacement were identified in 5 (5.7 %) cases. The most common complications were the progression of knee osteoarthritis, the development of contractures in 11 (12.6 %) patients. Conclusions. The use of a differential approach to the surgical treatment of intra-articular fractures of PPT, based on the severity of injuries according to Schatzker, allowed to obtain positive functional results in 77.3 % of the victims. The negative consequences of intra-articular fractures of the tibial plateau that worsen the functional outcomes of treatment include the progression of knee osteoarthritis. The degree of its manifestations is largely determined by the severity of the injury, the quality of reduction, the stability of fragment fixation, and the rationality of restorative treatment and rehabilitation.

Spring-Wire Technique as a Cost-Effective Alternative for Volar Rim Fragment Fixation in Distal Radius Fractures.

Introduction Volar rim fragment fixation is difficult to manage, as it is distal to the watershed line, rendering normal volar plates unable to securely capture it. This fragment must be precisely addressed as volar carpal subluxation is unavoidable when fixation is not efficient. The spring-wire technique maintains a stable fixation of this key fragment, which has been previously described in a small series. Materials and methods This is a prospective study of 20 patients who presented to El-Hadara University Hospital in Alexandria between the years 2020 and 2022, with complex distal radius fractures and small volar rim fragments, who were treated by open reduction and internal fixation using the spring-wire technique. The study was approved by the institutional review board of Alexandria Main University Hospital, and informed consent was taken from all patients in this study ensuring compliance with ethical standards. All patients underwent open reduction and internal fixation using the spring-wire technique. The procedure was performed by the same surgical team to ensure consistency. Postoperative radiographs were taken to assess reduction quality and fixation. Postoperative radiographic parameters, range of motion, grip strength and the El-Hadara wrist function scoring system were obtained after one year of follow-up, to evaluate results of fixation. Results All patients achieved a functional range of motion and grip strength and showed radiological union of the volar rim fragment with no volar carpal subluxation or escape of the volar rim fragment. The El-Hadara wrist function average score was 18.85±2.66, which represented a good overall result. No complications occurred during follow-up, and none of the patients required removal of the implant. Conclusion The spring-wire technique maintains a stable fixation of the volar rim fragment that cannot be held securely by volar plating alone. This method offersa low-profile implant that is readily available and simple to apply. Also, the fragment is stabilized by a dual effect by both the spring wire and the volar plate that act as a buttress to volar displacement.

Suture Bridge Fixation in Treating Traumatic Femoral Osteochondral Injuries in Adults: A Case Study and Review of the Literature.

Achieving anatomic reduction, securing fixation, and ensuring adequate compression are crucial steps in the internal fixation process for traumatic osteochondral defects. A variety of fixation methodologies have been in use, e.g., metal pins, bioabsorbable screws, and glue tissue adhesives, each of them yielding different outcomes. This study presents the outcomes of utilising the concept of suture bridge fixation for traumatic femoral osteochondral injury in a 34-year-old patient. Following a three-year follow-up, the patient demonstrated a return to normal activities with complete and pain-free knee mobility. In conclusion, it can be stated that suture bridges offer an alternative approach for the fixation of osteochondral fragments in the knee attributable to traumatic injuries.

METHODS OF PERCUTANEOUSFIXATION OF FRAGMENTS IN SUPRACONDYLAR HUMERUS FRACTURES IN CHILDREN AND ADOLESCENTS

The aim of this study is to conduct a meta-analysis and evaluate the clinical efficacy and safety of crossed and lateral fixation of fragments in supracondylar humerus fractures in children and adolescents. Methods. A comprehensive literature search was conducted in the PubMed and EMBASE databases from 2015 to December 2023 using the following search terms: "supracondylar fractures of distal humerus in pediatric patients", "treatment", "methods of fixation", "pinning configuration", "biomechanical analysis of pin placement". According to the inclusion and exclusion criteria, the literature sources of anatomic-biomechanical and clinical studies related to the use of crossed and lateral fixation of fragments in the case of supracondylar fractures of the humerus in children and adolescents were selected and analyzed. The review was prepared in accordance with the recommendations of the "Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines." Results. A comparison of results from experimental studies investigating the degree of stabilization achieved in the crossed and lateral configurations of fixation structures reveals conflicting conclusions due to the heterogeneity of designs implemented. The principal limitation of lateral fixation is the increased risk of failure of fixation. The outcomes of clinical trials (Flynn criteria) demonstrate that both types of fracture fixation yield equivalent clinical outcomes. One disadvantage of crossed fixation is the risk of iatrogenic ulnar nerve damage, while another disadvantage is the increased complexity of the surgical technique. Conclusions. The results of anatomical and biomechanical studies indicate that cross-fixation provides more rigid fixation of fragments in supracondylar humerus fractures in children and adolescents. Nevertheless, clinical outcomes based on radiological and functional data (including Flynn's score) demonstrate no significant distinction between the two types of fixation configurations. However, they do indicate a notable risk of iatrogenic ulnar nerve damage in cross fixation, which justifies the necessity to utilise a mini-open technique in the medial fixation construct.

Use of porous adhesive cement for fixation of fragments in fractures of the lower jaw

BACKGROUND:The preferred method of treating mandibular fractures is surgical, but it also has problems due to a number of complications associated with the presence of a metal structure in the surgical wound. AIM:To improve the efficiency of surgical treatment for mandibular fractures by developing and experimentally testing amethod for fixing mandibular fragments using porous adhesive cement. MATERIAL AND METHODS:The experiments were performed on 30male Agouti guinea pigs, which were divided into two groups: the main group— 20animals, the comparison group— 10guinea pigs. A mandible fracture was modeled in all animals. In the main group, the fragments were fixed with porous glue-cement “Rekost”, in the comparison group— with abone wire suture. All animals received prophylactic antibacterial therapy. All manipulations were performed under combined anesthesia. The statistical significance of the differences in the compared groups was assessed using Fisher's criterion. For all comparisons, the selected level of statistical significance was 5% (p≤0.05). RESULTS:The use of the method developed by us for fixation of bone fragments in mandible fractures allowed us to achieve a positive result in all 20laboratory animals included in the study. This was confirmed by the results of histological studies in the dynamics of observation: a reliable difference was established between the main group and the comparison group in the severity of inflammation signs on the 14th day, as well as the severity of regeneration signs. It was found that the use of porous glue-cement for fixation of mandible fragments, in contrast to bone wire suture, allows for reliable consolidation of bone fragments for the entire period of treatment (according to X-ray diagnostic data) and to stop by the 14th day (according to histological studies) signs of inflammation in the bone wound (no leukocyte infiltration and vascular congestion). In this case, the glue allows filling the fusion area with developing bone tissue by the 90th day of observation (according to histological studies) and excluding repeated surgical intervention to remove the fixing structure, since the porous adhesive cement, according to histological studies, was absorbed by the 90th day of observation, which indicates its biodegradable properties. CONCLUSION:The use of porous adhesive cement for fixation of mandibular fragments demonstrated better properties compared to bone wire suture.

Functional reliability of means of fixation for complex pelvic fractures. Part 3. Experimental studies under cyclic loads

Fixation of fragments of human pelvic bones by standard and new means of osteosynthesis, in addition to clinical indicators, should have sufficiently high mechanical characteristics. In particular, the “bone with a fracture - osteosynthesis system” system must be sufficiently strong, rigid and stable during long-term treatment, which may be accompanied by certain physiological loads. Today, in traumatology and orthopedics, two methods of fixation are used to fix complex fractures of the pelvic bones caused by high-velocity wounding projectiles: parallel insertion of spongy screws (osteosynthesis of the posterior pelvic ring) and stabilization with a rod apparatus of external fixation and fixation by means of reinforced with application of extramedullary reconstructive plate (osteosynthesis of the anterior pelvic ring). The anterior pelvis is stabilized more often because this technique is simpler, does not require much time and high qualification of the surgeon. However, this method of fixation does not provide sufficient stability of the connection of the pelvic ring bone fragments. This work is devoted to the study of the processes of occurrence and development of mutual displacements of fracture points of pelvic bones under the action of long-term cyclic loads. Experimental studies were carried out under the action of bending cyclic loads, which are close to physiological ones. Calculated creep deformations and irreversible displacements of fracture points. The stiffness characteristics of pelvic fracture fixation systems were studied.

Дослідження напружено-деформованого стану моделей плечової кістки при надвиросткових косих переломах у дітей та підлітків за різних варіантів черезшкірної фіксації

Fractures of the distal epimetaphysis of the humerus in children and adolescents are one of the most common injuries, accounting for 16 to 50% of all bone fractures. Among the injuries of this location, supracondylar (3-18%) and transcondylar fractures (57.5-70%) prevail, mainly in children aged 6-7 years. A significant problem when using a crossed fixation structure is iatrogenic damage to the ulnar nerve (2-8%), which requires a mini-open technique of medial spica or sonographic monitoring. Aim - to compare the level of stresses in the model of the humerus with a supracondylar oblique fracture with different options of percutaneous fixation under the influence of different loads. Materials and methods. A basic finite-element model of the humerus was developed, on the basis of which a model of an oblique supracondylar fracture was created. Two versions of osteosynthesis were modeled: with two spikes arranged crosswise and a bundle of three spikes. The stress-strain state of the models was studied under the influence of tensile, bending and twisting loads. Results. The presence of an oblique epicondylar fracture of the humerus leads to asymmetric changes in the distribution of stresses in the epicondyles above and below the fracture line during cross fixation with two spikes. With lateral fixation with three spikes under the influence of tensile load, the tension in the medial epicondylum is reduced to a minimum and their level on the lateral one is doubled. This is related to the one-sided conduction of a bundle of spikes. At the same time, the medial epicondyle remains unfixed and, accordingly, the loads on it are practically not transferred. The bone regenerate for this is too soft to prevent movement of the distal fragment. At the same time, a tighter fixation of the lateral epicondyle than in the version with two needles across, causes an increase in the level of stress in the lateral epicondyle. The total size of the cross-sectional area of the spike bundle with lateral fixation ensures a twice lower stress level in them, compared to cross fixation. Under bending loads, cross fixation with two spikes and lateral fixation with a bundle of three spikes work about the same. Under torsional loads, both methods of fixation of fragments of the humerus showed approximately the same results. In favor of the method of lateral fixation with a bundle of three spikes, the low level of stresses in the spikes can be attributed. The asymmetric arrangement of the bundle of three spokes during lateral fixation is compensated by the asymmetry of the passage of the fracture line. All this indicates that in the treatment of oblique supracondylar fractures of the humerus, both methods of fixation are equivalent from the point of view of stress distribution in the bone tissue, and the choice of one of them can be determined by other criteria. Conclusions. Mathematical modeling of the humerus with a supracondylar oblique fracture did not determine significant advantages of one or another method of fixation. The asymmetric location of the spikes during lateral fixation of bone fragments is compensated by the asymmetry of the fracture line. In favor of the method of lateral fixation with a bundle of three spikes, the low level of stresses in the spikes can be attributed. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors.

An Evidence-Based Update on Fixation Procedures for Acute and Chronic Osteochondral Lesions of the Talus.

Osteochondral lesions of the talus (OLT) involve the subchondral bone and the overlying articular cartilage. Various surgical treatments for these lesions are available, such as bone marrow stimulation (BMS), autologous osteochondral grafting, and fixation of an osteochondral fragment. Treatment choice depends on the condition of the lesion, which includes lesion size, morphology, location, and the presence of cysts. Among the surgical procedures available to date, in situ fixation of the osteochondral fragment has the advantage of restoring the articular surface while preserving the native hyaline cartilage and its subchondral bone. Fixation for OLT has been shown to be clinically successful for the treatment of both acute and chronic lesions. Moreover, the indication for osteochondral fragment fixation is expanding as recent studies have found good clinical outcomes in relatively small-sized lesions. The present article describes the current evidence on fixation for acute and chronic OLT.

Treatment and clinical outcome in patients with femoral head fractures: a long-term follow-up.

A femoral head fracture (Pipkin fracture) is a rare but severe injury. The optimal treatment is controversial, and there is a lack of research focusing on treatment strategies. The study aimed to analyze the treatment strategies in comparison to the outcome in patients after traumatic hip joint dislocation (THD) with concomitant femoral head fractures. A retrospective multicenter study at three Level I Trauma Centers was performed over a 12year period from January 2009 to January 2021. Epidemiological data, associated injuries, and treatment were recorded. Patients were followed up for further treatment, re-operations, complications, and long-term functional outcomes using patient-reported outcome measures (PROMs), specifically the modified Harris Hip Score (mHHS) and the Tegner Activity Scale (TAS). 45 patients with a mean age of 44 ± 16.11years were finally evaluated. The majority of 38 patients (84%) were treated surgically. The mean follow-up time was 5.75years (range 2-12years). 8 patients (31%) developed post-traumatic osteoarthritis and 4 patients (15%) developed osteonecrosis of the femoral head. 7 patients (27%) underwent total hip arthroplasty (THA). Fixation of the Pipkin fracture was more common in younger patients but had no statistically significant impact on PROMs. Patients with a higher BMI were significantly less likely to undergo fragment fixation (p < 0.05). TAS was significantly worse in patients who underwent THA (p < 0.05). A femoral head fracture is a severe injury with overall limitations in activities of daily living and a high rate of post-traumatic osteoarthritis and osteonecrosis of the femoral head. Fragment fixation had no statistically significant impact on the outcome and PROMs. Treatment strategies should be guided by the fracture type, the patient's condition, and associated injuries. However, concomitant and life-threatening injuries may affect the treatment and limit the outcome.

Three-Dimensional Morphometric Analysis of the Volar Cortical Shape of the Lunate Facet of the Distal Radius.

In cases of distal radius fractures, the fixation of the volar lunate facet fragment is crucial for preventing volar subluxation of the carpal bones. This study aims to clarify the sex differences in the volar morphology of the lunate facet of the distal radius and its relationship with the transverse diameter of the distal radius. Sixty-four CT scans of healthy wrists (30 males and 34 females) were evaluated. Three-dimensional (3D) images of the distal radius were reconstructed from the CT data. We defined reference point 1 as the starting point of the inclination toward the distal volar edge, reference point 2 as the volar edge of the joint on the bone axis, and reference point 3 as the volar edge of the distal radius lunate facet. From the 3D coordinates of reference points 1 to 3, the bone axis distance, volar-dorsal distance, radial-ulnar distance, 3D straight-line distance, and inclination angle were measured. The transverse diameter of the radius was measured, and its correlations with the parameters were evaluated. It was found that in males, compared to females, the transverse diameter of the radius is larger and the protrusion of the volar lunate facet is greater. This suggests that the inclination of the volar surface is steeper in males and that the volar locking plate may not fit properly with the volar cortical bone of the lunate facet, necessitating additional fixation.

Peculiarities of regeneration of an experimental femur fracture in rats with intramedullary fixation with carbon-carbon composite material implants

the issue of finding modern bioinert materials for use in surgical orthopedics and traumatology, as well as other medical fields related to the surgical treatment of diseases of the musculoskeletal system, is the most urgent today. The aim of the study was to establish the features of the course of regeneration of a femur fracture in rats with intramedullary fixation of fragments with a carbon-carbon composite material. The femur of 12 Wistar rats was studied in the work. Six rats - with simulated transverse diaphyseal fracture and intramedullary fixation with carbon-carbon composite material and six rats - with simulated transverse diaphyseal fracture and intramedullary fixation with medical steel. The last one were used as a comparison group. Histological sections prepared according to standard methods for inspection microscopy were stained with hematoxylin and eosin. To study revascularization processes, an immunohistochemical reaction with CD-34 antibodies was performed. As a result of the study, it was established that in animals with a simulated complete transverse diaphyseal fracture of the femur and intramedullary fixation with implants made of carbon-carbon composite material in the bone regenerate, the relative area of ​​CD-34+ vascular endothelial cells probably increases compared to the group of animals in which fixation was performed using medical stainless steel. Thus, the use of carbon-carbon composite material reveals an angiogenic effect in bone regeneration, which accelerates the rate of repair and remodeling of fractures.

Posterior Malleolus Fracture Fixation In Lateral Decubitus Position: Surgical Technique and Results in 60 Patients

The present study shows how posterior malleolus fractures (PMFs) and distal fibular fractures were fixed using the posterolateral approach with the patient in lateral decubitus position, not previously described in the literature. This technique has been used in 60 consecutive patients (42 women and 18 men; mean age 54.7; range 21-92 years), 33 of which presented as fracture dislocations from March, 2021 to December, 2023. After PMFs fixation in lateral decubitus position, release of the sacral support allowed patients to be placed supine (without de-sterilizing the operative field), in order to proceed with medial malleolus or posteromedial fragment fixation. Fractures were classified according to the Lauge Hansen classification as SER4 (n = 50), PER4 (n = 7), SAD (n = 1), and PAB (n = 2). Fractures were classified according to Rammelt & Bartonicek, as type B (n = 40), C (n = 13), and D (n = 7). During the same period of time 14 fractures involving the PM, classified as type A, were treated with indirect fixation, whilst 6 geriatric and/or poor mobility patients with fracture dislocations were treated with retrograde hindfoot nail fixation. Follow-up period ranged from 4-36 months (mean = 14.4; SD = 8.8). Complications occurred in 5 patients (8.3%; 3 had delayed (medial) wound healing, one developed CRPS and one required implants removal and arthroscopy because of metal irritation and stiffness). No deep infections, thromboembolic events, fracture malreductions or malunions were recorded and all patients returned to the preinjury mobilization status. In conclusion, PM fracture fixation was feasible and safely performed with patients in lateral decubitus position.

Classification and Treatment Strategies of Tibial Tubercle Fractures in Adults.

Tibial tubercle is a crucial player in maintaining the structural integrity and functional stability of the knee joint. Currently, there is no standardized protocol for the classification and treatment of tibial tubercle fractures in adults. This study analyzed the incidence and treatment strategies of tibial tubercle fractures in adults according to the four-column and nine-segment classification system. Data of patients with proximal tibial fractures involving tibial tubercle fractures who were treated at our hospital from August 2007 to March 2023 were retrospectively reviewed. The fractures were classified using the AO/OTA classification and four-column and nine-segment classification systems, and the treatment protocol (surgically treated or conservatively treated) was recorded. The number and distribution proportion of patients were counted. A two-sided t-test was conducted to determine the significance of differences between the gender and sides. In total, 169 tibial tubercle fractures were found in 1484 proximal tibial fractures. According to the AO/OTA classification, seven of the 169 patients, (4.1%) were type A, 36 patients (21.3%) were type B, and 126 patients (74.6%) were type C. According to the four-column and nine-segment classification, type 1 cleavage without free fragments was the most common type of fracture (93/169, 55.0%), followed by type 2 dissociative segmental fragments (48/169, 28.4%) and type 3 comminuted fractures (28/169, 16.6%). Overall, 139 of the 169 proximal tibial fractures with tuberosity involvement were treated surgically. Among them, additional fixation of the tubercle fragment was performed in 52 fractures. The incidence of tibial tubercle fractures involved in proximal tibial fractures was approximately 11.4% (169/1484) in adults, and approximately one-third of the tubercle bone fragment required additional fixation (30.8%, 52/169). The injury types in the four-column and nine-segment classifications are helpful for accurately judging and making treatment-related decisions for tibial tubercle fractures.

Posterior Wall Fragments in Acetabular Both-Column Fractures: Morphology, Type, and the Significance of its Projection.

Most both-column acetabular fractures are combined with posterior wall fragments. However, the morphology of this posterior wall is varied, and how to fix this posterior wall remains a controversial topic. To investigate the morphological characteristics of posterior wall fragments of both-column acetabular fractures and select corresponding fixation methods. Data from 352 patients with acetabular fractures admitted to the level one trauma centre in our hospital between January 2006 and December 2022 were collected. The morphology of posterior wall fragments was observed and analyzed in 83 cases of both-column acetabular fractures and classified according to the consistency of posterior wall morphology. A fracture map of the posterior wall was created on a normal template according to the three morphological types of posterior wall fragments. Finally, the high-incidence area of the posterior wall fracture was projected onto the iliac fossa and the medial side of the posterior column to guide the fixation of the posterior wall fragment using the anterior intrapelvic approach. Fractures were divided into four types: I, large posterior wall fragment which was high in the ilium bone (34 cases, 41.0%); II, posterior wall fragment in the acetabular parietal region (18 cases, 21.7%); III, posterior wall marginal fracture (10 cases, 12.0%); and IV, non-combined posterior wall fracture (21 cases, 25.3%). The most common morphologies of the posterior wall fragments of the first two types were mapped and projected onto the anterior iliac inner plate and medial side of the posterior column, where the corresponding area could be used to guide the insertion of the internal fixation. Both-column acetabular fractures combined with posterior wall fractures can be divided into four types according to the morphology of the posterior wall fragment. Understanding the corresponding three-dimensional morphology and projection position of different types of these fragments can help surgeons determine the position and orientation of internal fixation of posterior wall fractures.

Microfractures, autologous matrix-induced chondrogenesis, osteochondral autograft transplantation and autologous chondrocyte implantation for knee chondral defects: a systematic review and network meta-analysis of randomized controlled trials.

Despite the publication of several randomized controlled trials (RCTs), it is not clear which technique for the treatment of focal chondral and osteochondral defects of the knee grants the best clinical outcome. The aim of this network meta-analysis (NMA) was to compare the efficacy and safety of microfractures (MF), autologous chondrocyte implantation (ACI), autologous matrix-induced chondrogenesis (AMIC), osteochondral autograft transplantation (OCT) at short (< 1 year), intermediate (1-5 years) and long-term (> 5 years). We carried out an NMA with Bayesian random-effect model, according to PRISMA guidelines. The search was performed in MEDLINE, EMBASE, Web of Science, CENTRAL, CINAHL, SPORTDiscus, clinicaltrials.gov, WHO ICTRP, from inception to November 2022. The eligibilities were randomized controlled trials on patients with knee chondral and osteochondral defects, undergoing microfractures, OCT, AMIC, ACI, without restrictions for prior or concomitant surgery on ligaments, menisci or limb alignment, prior surgery for fixation or ablation of osteochondritis dissecans fragments, and prior cartilage procedures as microfractures, drilling, abrasion, or debridement. Nineteen RCTs were included. No difference among treatments was shown in the pooled comparison of patient reported outcome measures (PROMs) at any timepoint. Safety data were not available for all trials due to the heterogeneity of reporting, but chondrospheres seemed to have lower failure and reoperation rates. This NMA showed no difference for PROMs with any technique. The lower failure and reoperation rates with chondrospheres must be interpreted with caution since adverse event data was heterogenous among trials. The standardization of the efficacy and safety outcome measures for future trials on knee cartilage repair and regeneration is necessary.