Fixation Procedures Research Articles

Assessment of failure risks during C2 vertebra pedicle screw insertion using three-dimensional computed tomography angiography analysis: the role of high-riding vertebral artery and narrow pedicles.

Cervical fixation is a common treatment for conditions like vertebral fractures, osteosarcoma, osteomyelitis, arthritis, and congenital disorders. The study was designed to assess the occurrence of high-riding vertebral artery (HRVA), narrow C2 pedicles (NC2P) and ponticulus posticus (PP), which pose risks of injuring vertebral artery (VA) during screw placement in cervical fixation procedures. The study examined the prevalence of HRVA, NC2P and PP in 382 pedicle sides of the C2 vertebra using computed tomographic angiography scans. Specific measurements were taken, including the internal height (C2InH), and isthmus height (C2IsH) of C2, as well as NC2P width. HRVA was identified by specific measurements: C2IsH of ≤ 5mm and/or C2InHof ≤ 2mm. NC2P was defined as NC2P width ≤ 4mm. The reliability between observers and within the same observer, along with the consistency across different software, was assessed. At least one HRVA was found in 9.6% of patients and at least one NC2P in 13% of patients. Females demonstrated higher rates of HRVA and NC2Ps on the left side, with right-side figures at 10.5% and 11.7% for HRVA and NC2Ps respectively, and left side figures at 14.1% for both. Males exhibited a reserve pattern, with higher rates on the right side, marked by 10.3% HRVA and 15% NC2Ps, compared to 5.6% and 11.3% on the left. Furthermore, males showed a significantly higher occurrence of NC2Ps over HRVA on both sides. The presence of PP with NC2Ps detected in 44% of cases, and with HRVA in 16% of cases, a difference found to be statistically significant. The digital models incorporating HRVA, NC2P, and PP facilitated a comprehensive analysis of the VA pattern, assessment of the virtual screw trajectory line for VA pedicles, and the designation of specific regions during the procedure, ensuring increased safety planning instrumentation.

Effects of two posterior procedures for treatment of cervical hyperextension injury with multilevel spinal stenosis: A retrospective study

BackgroundCervical hyperextension injuries (CHI), commonly resulting in central cord syndrome and spinal instability, often affect the elderly with preexisting degenerative spinal changes, leading to a need for surgical interventions that address both the compression and stability of the cervical spine. This study compares the clinical outcomes of two posterior decompression and fixation procedures for treating cervical hyperextension injury in patients with preexisting multilevel spinal canal stenosis.MethodsPatients suffering from cervical hyperextension injury combined with multilevel spinal stenosis were divided into two groups. They received laminoplasty combined with selective unilateral pedicle screw fixation or laminectomy combined with bilateral lateral mass screw fixation. The clinical records including demographic data, operation time, length of hospital stay, estimated blood loss and surgical complications were collected, and clinical outcomes were evaluated using the American Spinal Injury Association (ASIA) impairment scale. Preoperative and postoperative cervical lordosis were measured.ResultsPostoperative AISA scores were significantly increased compared with that before surgery in both groups, there was no significant differences between groups. The intraoperative blood loss in the laminoplasty group was significantly less than that in the laminectomy group and there were no significant differences in operation time and length of hospital stay between the two groups. No significant difference was found in the incidence of overall surgical complications between the two groups. There was no significant difference in the cervical lordosis after surgery compared with that before surgery in both groups.ConclusionsFor patients suffering from cervical hyperextension injury combined with preexisting multilevel spinal stenosis, both cervical laminoplasty with selective unilateral pedicle screw fixation and laminectomy with bilateral lateral mass screw fixation could achieve satisfactory clinical outcomes.

Acute treatment of elderly patients with acetabular fractures by open reduction, internal fixation, and total hip arthroplasty: a 1-10-year follow-up of 48 patients.

Acetabular fractures in osteoporotic bone are associated with substantial joint impaction and comminution, previously shown to be prognostic for a poor result. A combined procedure of open reduction, internal fixation (ORIF), and total hip arthroplasty (THA) can be a good option, allowing for immediate weightbearing as tolerated. We report short- to medium-term outcome and complications of the results of patients treated with this combined procedure. 48 cases treated with ORIF and acute THA from 2000 to 2019 were identified from our local pelvic fracture registry, from which follow-up data was extracted. Descriptive statistics were used and Kaplan-Meier survival curves were calculated. Primary outcome was HHS at 1 year. Secondary outcomes were implant survival, complications requiring surgery, and mortality at 3 months. There were 37 men and 11 women treated in the study period. Mean age was 68 (37-87) years. 6 patients died within 3 months of surgery, leaving 42 cases available for follow-up. Mean follow-up (FU) was 2.8 (1-16) years. The most common mechanism of injury was fall from standing height (n = 36). Medical comorbidities were common. Mean Harris Hip Score (HHS) was 83 (51-100) at 1-year follow-up. There were 7 reoperations: 6 for postoperative infection and 1 closed reduction of implant dislocation. 38 had their implant intact at latest FU. At the latest FU, 28 patients were ambulatory without a walking aid. Our results indicate that ORIF and acute THA can be performed with good functional results in patients with unreconstructable displaced acetabular fractures, but with a significant risk of infection and revision.

Enhancing Pedicle Screw Fixation Training: A Novel Approach Using Head-Mounted Devices for Video-Assisted Debriefing

BackgroundVideo-assisted debriefing (VAD) is promising for medical skill training, but its effectiveness requires further exploration. The aim of this study was to investigate the effectiveness of point-of-view VAD in spinal surgery training. MethodsForty surgical residents were randomly divided into control and video-assisted (VA) groups, both of which underwent pedicle screw fixation procedures while being graded by a consulting surgeon in terms of their technical skills (primary outcome). On the second day, both groups received verbal debriefing and coaching from a senior consultant surgeon; for the VA group, this step was performed while watching a recorded point-of-view video of the procedure alongside the resident surgeon. Both groups then underwent a new testing round and participated in a questionnaire survey regarding their debriefing experience. ResultsAfter the debriefing session, the residents in the VA group had significantly greater technical skills than did those in the control group did (37±9.7 vs. 25±8.5, p<0.001). The VAD method was better than the traditional method in terms of steps such as recognizing anatomical structures, piloting holes in the bone, tapping, screw insertion and judging the location of the pedicle screws. ConclusionsVAD is more effective than traditional verbal debriefing for improving residents’ surgical skills, particularly for obtaining a more comprehensive understanding of anatomical structures, imitating detailed surgical techniques as well as promoting initiative. However, in terms of mastery of surgical skills, VAD is not significantly beneficial for tactile perception of the surrounding tissue, indicating that a certain amount of practice is still necessary.

Artefacts in tissue processing: A review

An artificial feature in tissue sections that is self-colored and unrelated is called an artefact. This has been an age long cause of misinterpretation that leads to misdiagnosis. It can result in alteration of normal morphologic and cytologic features that may occur as a result of the way the tissue has been handled, right from the time the biopsy, which is surgically obtained till the entire histopathological procedures of fixation, processing, embedding, sectioning and staining are performed on it. This article reviews the common artefacts encountered during tissue processing.

103. The Impact of COVID-19 restrictions on Open Fracture Emergency Fixation Procedures in eight institutions around South and Southeast Asia

Introduction: Around the time COVID-19 was declared a global pandemic, various restrictions and measures were implemented at all levels to limit disease spread and preserve healthcare capacity. Data is lacking in many low and middle-income countries on how these measures impact healthcare utilization and outcomes. This study aims to determine the impact of COVID-19 restrictions on volumes of the open fracture emergency fixation procedures in South and Southeast Asia. Methods: This was a retrospective cohort study of patients who underwent open fracture fixation from 1 January 2018 to 31 December 2021 at one of 8 institutions in Singapore, Malaysia, Indonesia, India and Vietnam. We compared the weekly volumes, baseline characteristics and outcomes of each procedure across different time periods in each institution defined by different level of COVID-19 restrictions using selected indicators from a city-level and hospital-level response index. Results: A total of 74 (AMH) to 299 (SGH) open fracture fixations were performed over the 4-year period. Weekly volumes decreased significantly at GNRC (p = 1.33 x 10-5), AMH (p = 1.68 x 10-6) and UGH. At UGH there was a drop in the proportion of males during HR1 (66.7%) and HR3 (46.7%) compared to pre-COVID (83.0%) and HR2 (82.4%) (p = 2.02 x 10-4). None of the outcomes were significantly different in any of the institutions. Conclusions: COVID-19 restrictions on the city and hospital level were associated with a decrease in surgical volumes of the open fracture fixation emergency procedures in some of the institutions. There was some suggestion of surgical capacity limitations in UGH and MH175 during periods of more stringent COVID-19 restrictions.

The impact of enhanced early postnatal nutrition on the histomorphological features of the ovaries in fat-tailed Sanjabi ewe lambs.

This study aimed to investigate whether providing additional ad libitum feeding could improve reproductive characteristics in prepubertal ewe lambs. Twelve Sanjabi ewe lambs, approximately one-month-old and with an average initial weight of 11.6 ± 1.3kg, were monitored over a 3-month period, which was divided into three distinct periods of 30 days each. The first period spanned from the lambs' age of one to two months, the second period covered their age range of two to three months, and the third period encompassed their age range of three to four months. The lambs were randomly assigned to either a control group (C) or a treatment group (T). The control group received a basal diet consisting of hay and milk, whereas the treatment group received an enhanced diet comprising hay, milk, and concentrate. Live weight (LW) and average daily gain (ADG) were measured weekly, and blood samples were collected from the jugular vein at days 30, 60, and 90 of the experiment to determine the concentrations of progesterone (P4) and estrogen (E2). Following the 90-day experiment, the lambs were humanely euthanized in accordance with established protocols. Subsequently, both ovaries from each animal were removed, weighed and subjected to a comprehensive histological analysis. The ovaries underwent fixation, embedding, and sectioning procedures, followed by staining with hematoxylin and eosin (H&E) to facilitate microscopic examination. Ovary microscopic sections from both C and T groups were examined to assess follicles at various developmental stages, including primordial follicle number (PreFN) and diameter (PriFD), primary follicle number (PriFN) and diameter (PriFD), secondary follicle number (SFN) and diameter (SFD), antral follicle number (AFN) and diameter (AFD), and granulosa layer thickness of secondary (GLTSF) and antral follicles (GLTAF). The impact of diet and three experimental periods on ADG and LW exhibited significant variations. There was a significant increase (P < 0.05) in LW in the T group compared to the T group, with noticeable differences in LW fluctuations observed during distinct periods. However, ADG was more prominent in the initial and second observation periods than in the third. The impact of diet and experimental periods on P4 and E2 concentrations was found to be negligible. The T group showed significant improvements (P < 0.05) in PreFD, PriFN, and GLTAF compared to the C group. This study suggests that ad libitum concentrate feeding may promote reproductive characteristics in prepubertal ewe lambs. Further research is needed to explore its potential impact on the age of puberty.

Exploring cortical trajectory of the lumbar vertebrae: a morphometric study in dry skeletons: a retrospective study in Thailand.

Retrospective cohort study. This study aimed to explore the morphometry of the Thai lumbar vertebrae. The cortical bone trajectory (CBT) is a novel approach for vertebral screw fixation aimed at addressing spinal instability associated with spinal disorders. The morphometry of the lumbar vertebrae is crucial in tailoring screw design for each CBT application, given the significant variations in optimal screw sizes, lengths, and angles among populations. A total of 300 dried lumbar columns were used to measure the pedicle height (PH) and width (PW), length for cortical bone trajectory (LCT), cephalad screw angle (CSA), axial cortical bone trajectory angle (ACA), and possible cortical zones for the CBT. The following average values were calculated: PH in L1, 15.09±1.44 mm; PW in L5, 16.96±2.42 mm; LCT in L3, 35.75±2.61 mm; CSA in L1, 20.85°±2.30°; and ACA in L5, 21.83°±2.49°. Women generally had shorter PH and PW than men, with significant differences across lumbar levels. The LCT was significantly shorter in women and was notably different between the left and right sides. The CSA and ACA varied significantly between sexes and sides, with specific lumbar levels showing wider angles in one sex over the other. The most common cortical zones for screw tips were Z3 and Z10, with high incidences across all lumbar levels. This study presents detailed lumbar vertebral morphometry data specific to the Thai population. The results are essential for CBT application in screw fixation procedures. This information will contribute to the production of optimally designed screws for Thai patients in the future.

Novel Technique for Degenerative Lumbar Spine Fusion: Unilateral Pedicle Screw Fixation Combined with Contralateral Interbody Cage Fusion for Posterior Lumbar Interbody Fusion

Abstract Objective The common traditional surgical techniques for posterior lumbar interbody fusion (PLIF) and fixation are bilateral pedicle screw fixation with or without interbody cage fusion and unilateral pedicle screw fixation with ipsilateral cage fusion. However, the novel unilateral pedicle screw fixation combined with the contralateral interbody cage fusion technique may provide the benefits and avoid the hazards of those traditional techniques. This prospective randomized comparative clinical trial aims to compare pedicle screw fixation with contralateral interbody cage fusion and unilateral pedicle screw fixation with ipsilateral cage fusion in single-level PLIF and fixation. Methods This comparative prospective study was conducted on 60 patients subjected to a single-level PLIF and unilateral pedicle screw fixation during the period from January 2022 to July 2022 to compare two different surgical modalities: group A (unilateral pedicle screw fixation with contralateral interbody cage fusion) and group B (unilateral pedicle screw fixation with ipsilateral cage fusion). Results Operative time, blood loss, operative complications, and visual analog scale improvements showed insignificant differences between the two groups, while group A showed significant improvements in the Oswestry Disability Index and wider coronal disc heights contralateral to the screw, which is the side of the cages, during postoperative follow-up. Conclusion Unilateral pedicle screw fixation with contralateral cage fusion during the PLIF and pedicle screw fixation procedure is preferred to maintain bilateral coronal disc heights and thus better clinical and mechanical results without affection of the preceding disc.

Effect of patient factors and procedure on proximal tibia fracture recovery - A retrospective analysis.

Tibia plateau fractures account for 1-2% of all fractures and might adversely affect the knee joint. The current research aimed to evaluate the effect of surgical procedures, age, and gender on proximal tibia fracture functional outcomes. The present data for the retrospective analysis was obtained from an observational longitudinal cohort trauma registry study, initiated at a tertiary care hospital in June 2015. A total of 51 isolated tibia plateau fracture patients were routinely treated with open reduction internal fixation or external fixator and assessed for functional outcomes till twelve months by the Rasmussen scoring scale. Patients were divided into five age groups. The functional outcome association to gender, age groups, and surgical procedures was assessed by the Fisher Exact test and logistic regression analysis. The mean age of the total 51 patients was 40±11 years. Patients operated with Open Reduction and Internal Fixation (74.5%) or with an external fixator (25.5%). Road traffic accidents were the common mechanism of injury. There were non-significantly different functional outcomes observed among age groups or between surgical procedures at all follow-ups but significantly different between genders at three-month follow-ups. Males recovered better than females (p=0.02). Tibia Plateau fracture patients respond almost equally to both external fixation and Open Reduction Internal Fixation procedures. Age does not influence the outcome. However, males had better functional outcomes at three months post-surgery indicating that gender could affect the outcomes. Further exploration might assist in planning gender-based proximal tibia fracture treatment strategies for optimum outcomes.

T1- and T2-weighted MRI signal and histology findings in suboptimally fixed human brains

Neuroscientific research that requires brain tissue depends on brain banks that provide very small tissue samples fixed by immersion in neutral-buffered formalin (NBF), while anatomy laboratories could provide full brain specimens. However, these brains are generally fixed by perfusion of the full body with solutions other than NBF generally used by brain banks, such as an alcohol-formaldehyde solution (AFS) that is typically used for dissection and teaching. Therefore, fixation quality of these brains needs to be assessed to determine their usefulness in post-mortem investigations through magnetic resonance imaging (MRI) and histology, two common neuroimaging modalities. Here, we report the characteristics of five brains fixed by full body perfusion of an AFS from our Anatomy Laboratory suspected of being poorly fixed, given the altered signal seen on T1w MRI scans in situ. We describe 1- the characteristics of the donors; 2- the fixation procedures applied for each case; 3- the tissue contrast characteristics of the T1w and T2w images; 4- the macroscopic tissue quality after extraction of the brains; 5- the macroscopic arterial characteristics and presence or absence of blood clots; and 6- four histological stains of the areas that we suspected were poorly fixed. We conclude that multiple factors can affect the fixation quality of the brain. Nevertheless, cases in which brain fixation is suboptimal, consequently altering the T1w signal, still have T2w of adequate gray-matter to white-matter contrast and may also be used for histology stains with sufficient quality.

Lower Limb Comprehensive Reconstructive Surgery: Experiences from an Orthopedic Teaching Unit

Abstract Introduction: The burden of open extremity fractures is well recognized in placing a burgeoning demand on an already exhausted medical facility in low- and middle-income countries. This study aims to evaluate the functional outcome following “orthoplastic management” by orthopedic surgeons trained in limb reconstruction surgery. Methodology: Adult patients with open lower limb injuries treated from January 1, 2022, to December 30, 2022, who underwent single or staged fixation and reconstruction procedures were identified. Patients with Gustilo–Anderson type IIIB fractures requiring skeletal stabilization with soft-tissue cover were included. Polytrauma patients requiring multidisciplinary surgical attention were excluded. A team of orthopedic surgeons trained in limb reconstruction was involved in the management. Inpatient and outpatient department follow-up by the treating team was done to document complications (infections, reoperations, and graft failures) and functional outcomes using the Lower Extremity Function Score. The duration of mean follow-up was 1 year since index surgery. Results: A total of 24 adult patients with open lower limb injuries with preoperative Ganga Hospital Score (GHS) were included. Decision toward fixation with primary closure or further reconstruction was made collectively. The gray zone (GHS score of 15–16) of patients was more aggressively managed with emphasis on salvage. Additional reconstructive procedures were carried out based on the assessment at consequent follow-up. Three patients had a suboptimal joint function (less than functional range of motion for the involved joint) due to the resultant loss of compartment(s) and joint contracture. Five patients were retaken to the theater for further supplementary or corrective procedures following the index, definitive surgical procedure (bone grafting, partial flap loss, and fixator readjustment). Conclusion: Good-to-excellent functional outcome was demonstrated with the “orthoplastic approach” where skeletal stabilization as well as soft-tissue reconstruction was performed by trained orthopedic surgeons. This study demonstrated that orthoplastic surgery is a safe and effective method of limb salvage.

Glyoxal-methyl-ethylene sulfonic acid fixative enhances the fixation of cytoskeletal structures for Förster resonance energy transfer measurements.

Förster resonance energy transfer (FRET) serves as a tool for measuring protein-protein interactions using various sensor molecules. The tension sensor module relies on FRET technology. In our study, this module was inserted within the actinin molecule to measure the surface tension of the cells. Given that the decay curve of FRET efficiency correlates with surface tension increase, precise and accurate efficiency measurement becomes crucial. Among the methods of FRET measurements, FRET efficiency remains the most accurate if sample fixation is successful. However, when cells were fixed with 4% paraformaldehyde (PFA), the actinin-FRET sensor diffused across the cytoplasm; this prompted us to explore fixation method enhancements. Glyoxal fixative has been reported to improve cytoskeletal morphologies compared to PFA. However, it was not known whether glyoxal fits FRET measurements. Glyoxal necessitates an acetic acid solution for fixation; however, acidic conditions could compromise fluorescence stability. We observed that the pH working range of glyoxal fixative aligns closely with MES (methyl-ethylene sulfonic acid) Good's buffer. Initially, we switched the acidic solution for MES buffer and optimized the fixation procedure for in vitro and in vivo FRET imaging. By comparing FRET measurements on hydrogels with known stiffness to tumor nodules in mouse lung, we estimated in vivo stiffness. The estimated stiffness of cancerous tissue was harder than the reported stiffness of smooth muscle. This discovery shed lights on how cancer cells perceive environmental stiffness during metastasis.

Intramedullary Fixation vs Arthroplasty Management of Trochanteric Fractures in Elderly Patients a Systematic Review and Meta-Analysis

Abstract Introduction Intertrochanteric fractures of the femur are very common in elderly people. Their incidence has increased due to the increased life expectancy and osteoporosis; fall is the main cause of injuries. Most of the classification systems for intertrochanteric fractures have poor reliability and reproducibility. Intertrochanteric fractures are considered unstable in the presence of a comminuted posteromedial cortex, reverse obliquity, and subtrochanteric extension. Early operation within 12 hours to 48 hours is mandatory in the relatively fit patients. The surgical goal is to achieve a painless and stable lower limb with early return of function, with the lowest rates of mortality and morbidity. The mainstay of treatment of intertrochanteric hip fractures is internal fixation. Compare and contrast different clinical outcomes and provide a meta-analysis study of the data retrieved. This study was conducted aiming to help clinicians and surgeons to provide the best quality of health care to their patients in management of these fractures and help improve their quality of life. Methods We conducted a systematic search on four different databases: PubMed, Web of Science, Cochrane Central, and SCOPUS. The search was done by two independent researchers and differences was sorted out and solved by third independent researcher according to the PRISMA statement and the guidelines mentioned by the Cochrane’s handbook of systematic reviews. Eligibility criteria was predefined with clearly stated inclusion and exclusion criteria of studies. After clear screening of studies between two independent participants and solving contradictions by a third participant, our systematic research yielded 41 eligible studies. Data extraction was done including demographic data of subjects, outcomes to be measured, and data extracted for domains of risk of bias. Quality assessment of retrieved data was performed according to GRADE guidelines. This includes ROB2 bias tool for randomized control trials and ROBIN-1 tool for non-randomized control trials. Statistical analysis of analysis of outcomes were conducted using Review Manager Software. Outcomes to be measured were Operation time, Intraoperative blood loss, duration of hospital stay, time to weight bearing, Harris hip score at (1.5,3,6,12,18,24) month post surgery, General complications, Wound complications, Local major and minor complications, and mortality within (3,6,12,18,24) Month post-surgery, Reoperation rate. Results Study was conducted on 41 studies: 10 Randomized control studies and 31 Non- randomized control study. Collectively retrieving a total of 4782 patients: 2398 patient were allocated to the intramedullary fixation group and 2384 to the arthroplasty group; weighted mean age was 77.49 years and 79.18 years respectively. Our study yielded that arthroplasty and replacement procedures had favorable outcome regarding Harris hip score at 1 year after surgery, earlier time to weight bearing, and lower reoperation rate when compared to intramedullary fixation. However, arthroplasty had less favorable value regarding the operation time, blood loss and need for blood transfusion; while equal value in the length of hospital stays, complication rates, and incidence of mortality in the first year post surgery. Conclusion This study concluded a statistically significant favorable clinical outcome and equal complications of replacement procedures when compared to intramedullary fixation procedures at one year post surgery. However, several limitations were observed in our study which may affect this conclusion and urge the need for further research.

History and formation of “Limb lengthening and reconstruction surgery — LLRS” as a subspecialty of orthopedic surgery

In 1998, the first meeting of members of the Association for the Study and Application of the Methods of Ilizarov (ASAMI) was held in the USA to introduce and popularize the methods developed in Kurgan by Professor G. Ilizarov and his staff. During 2005-2016, other communities worked in parallel with ASAMI, which went beyond the use of only the Ilizarov apparatus. Since 2017, the joint meetings have been called “Combined congress of the ASAMI-BR and ILLRS societies”. This actually became the basis for the definition of “Limb Lengthening and Reconstruction Surgery (LLRS)” as a subspecialty of orthopedic surgery that treats patients with nonunions, congenital and acquired long bone, large joints deformities of the upper and lower extremities. LLRS is based on the Ilizarov method and discovery (“Ilizarov effect”) with the rational use of external and internal fixation, osteotomy and soft tissue procedures. It takes at least three years for an orthopedic surgeon to become a specialist in the field of LLRS, and the education must be staged. A significant role in this is played by the ASAMI-BR ILLRS congresses, ExFix LLRS courses held in many countries, ExFix modules integrated into courses provided as part of the education of AO Trauma, as well as extensive world literature.

Bilateral Sacrospinous Vaginal Vault Fixation With Synthetic Mesh Arms: A Novel Technique

Sacrospinous ligament suspension is used for suspension of apical prolapse; however, it has a high rate of recurrence compared with sacrocolpopexy, and a high rate of pain compared with uterosacral suspension. We developed a novel surgical procedure of bilateral sacrospinous vaginal vault fixation with synthetic mesh arms. We previously demonstrated its safety, and in Supplementary video 1, we describe a step-by-step surgical approach that could be replicated. This technique restores support, creating an anatomically correct midline configuration of the vaginal axis with minimal tension. A randomized controlled trial is underway to examine durability of mesh versus suture techniques for sacrospinous ligament suspension.

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.

Mastication Muscle Function in Mandibular Fracture Patients After Open Reduction Internal Fixation (ORIF) (Improved Masticatory Muscle Function in Mandibular Fracture Patients Post Open Reduction Internal Fixation (ORIF) Procedure: A Systematic Review)

The maxillofacial zone is a common site of traumatic injury, which has a direct impact on the aesthetics and function of the patient's face. The mandible is the main structural skeletal bone associated with the face, and the maxillofacial area is a common site of injury. Mandibular fractures have a significant impact on masticatory function. The main cause could also be the patient's ability to chew vigorously until the strength is below normal. This is related to dental comfort and mental attitude. Treatment consisting of surgery along the length of the mandibular fracture, focuses on restoring the structural shape of the mandible, with the hope of restoring normal form and function. Writing purpose systematic review (SR ) for studied further regarding the improvement of masticatory muscle function in mandibular fracture patients after open reduction internal fixation (ORIF). SR writing is done with search and analyze journal from PMC, Pubmed and Science Direct portals with criteria inclusion and exclusion that have been determined. Nine articles journal Which identified four (4) prospective articles, one (1) retrospective, one (1) cross sectional, one (1) systematic review, one (1) case report, and one (1) case control. Of the ten journal articles that have been reviewed, there are articles, all of which measure masticatory muscle function as an indicator of the success of open reduction procedures. fixation (ORIF). It's just that there are various research specifications that vary, both in terms of the age of the research subjects, part of the injury, method, type of action, data analysis and other indicators that need to be considered in each study. There is an increase in masticatory muscle function in mandibular fracture patients after open reduction internal fixation (ORIF).

CASEMIX study: Assessment of patient factors influencing the subprocedure duration of trauma/orthopaedic surgeries

IntroductionThe social and financial burdens of the operative environment remains to be a major problem in modern society. We analyse the impact of the introduction and application of a perioperative cloud system that cross-analyzes the pre-/intraoperative risks to minimize surgical time and maximize operation theater efficiency through improved planning. MethodsTCC-CASEMIX© was introduced to our Department of Trauma Surgery of the University of Szeged to objectively measure intraoperative time durations according to each essential subprocedure. The study is largely divided into pre-operative assessments and intraoperative measurements. Patient data (age, sex, and ethnicity etc.) was registered preoperatively, and the expected time per each essential intraoperative step (skin incision, reduction, fixation etc.) was entered. The steps were then timed intraoperatively by surveyors, and postoperative cross analysis was performed. Our study was divided into two phases; phase 1, the surveying of general trauma / orthopedic cases, and phase two; the examination of high volume surgeries. ResultsAcute cases of Open Reductions and Internal Fixation (ORIF) procedures depended heavily on the presentation of the fracture, and no clear correlations in the risk factors were found. Arthroscopies were a short, high-volume procedure, but there was a large difference between the surgeon's estimates and the operation duration. In high volume surgeries, although individual factors only slightly influenced surgical duration, patient cohort stratification led to a better understanding of factors that impact surgeries, namely the combination of BMI and surgeon years of experience. While the average (Intraoperative Duration) seemed to increase with BMI, younger surgeons were more influenced by the patients BMI. ConclusionA data filtering algorithm-assisted cloud system can be a reliable way to facilitate the planning of operating theater schedules. Patient stratification according to BMI and surgeon years of experience seems to affect intraoperative duration significantly, and the understanding of the risks and intraoperative steps has the potential to forecast surgeries with high precision.

Management of ZMC Fractures - A Review Article

Fractures of the zygomaticomaxillary complex (ZMC) are frequent face injuries treated with two- or three-point fixation procedures. This review examines the benefits and drawbacks of each strategy. For less complicated fractures, two-point fixation is less invasive and also requires less time during surgery, but it may not provide adequate stability. More structural support is provided with three-point fixation, especially in cases of comminuted or displaced fractures, although the procedure takes longer and may raise the risk of infection. In order to determine the best fixing option based on fracture severity and patient-specific characteristics, this article contrasts clinical and biomechanical investigations. A tailored approach is recommended for the best outcomes.