Fixation Procedures Research Articles

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

Objective: 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. Methods: 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. Results: 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). Conclusion: 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. doi: https://doi.org/10.12669/pjms.40.10.9154 How to cite this: Ahmad T, Muhammad ZA, Zehra F. Effect of patient factors and procedure on proximal tibia fracture recovery - A retrospective analysis. Pak J Med Sci. 2024;40(10):2281-2286. doi: https://doi.org/10.12669/pjms.40.10.9154 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

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.

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).

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.

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.

Evaluation of iliococcygeal fixation procedure for pelvic organ prolapse: preoperative properties and short term postoperative outcomes

Aim: The aim of this study was to evaluate the short-term outcomes of patients who underwent iliococcygeal fixation (ICF) for the surgical treatment of pelvic organ prolapse (POP) and to assess the safety and feasibility of the ICF procedure. Patients and Methods: Our study is retrospectively done with the data of 50 POP patients who underwent ICF in our clinic within the dates 01.04.2022 and 31.03.2024. A total of 44 women were found to be eligible for follow-up. Demographic data and pre- and post-operative clinical data at 3 months were assessed. Results: According to the findings of our study, the difference between the median duration of surgery in NSD and CS patients is statistically significant, and the duration of surgery is longer in NSD patients (80 minutes (70-85) vs 60 minutes (50 -67,5), (p<0,05)). Only one recurrence, one hematoma and infection, and one bladder injury had occurred. Conclusion: According to our study, ICF is a safe, durable and surgically feasible procedure that can be done concomitantly with other procedures. Thus, we strongly advocate this procedure until the ideal mesh is found since it avoids many serious complications of SSLF.

Biomechanical Effects of Multi-segment Fixation on Lumbar Spine and Sacroiliac Joints: A Finite Element Analysis.

Spine fixation surgery affects the biomechanical environment in the sacroiliac joint (SIJ), which may lead to the SIJ pain or degeneration after surgery. The purpose of this study is to determine the impact of the number and position of fixed segments on the SIJs and provide references for surgeons to plan fixation levels and enhance surgical outcomes. The intact lumbar-pelvis finite element (FE) models and 11 fixation FE models with different number and position of fixed segments were developed based on CT images. A 400N follower load and 10° range of motion (ROM) of the spine were applied to the superior endplate of L1 to simulate the flexion, extension, bending and torsion motion after surgery. The peak stress on the SIJs, lumbar intervertebral discs, screws and rods were calculated to evaluate the biomechanical effects of fixation procedures. With the lowermost instrumented vertebra (LIV) of L5 or S1, the peak stress on SIJs increased with the number of fixed segments increasing. The flexion motion led to the greater von Mises stress on SIJ compared with other load conditions. Compared with the intact model, peak stress on all fixed intervertebral discs was reduced in the models with less than three fixed segments, and it increased in the models with more than three fixed segments. The stress on the SIJ was extremely high in the models with all segments from L1 to L5 fixed, including L1-L5, L1-S1 and L1-S2 fixation models. The stress on the segment adjacent to the fixed segments was significant higher compared to that in the intact model. The peak stress on rods and screws also increased with the number of fixed segments increasing in the flexion, extension and bending motion, and the bending and flexion motions led to the greater von Mises stress on SIJs. Short-term fixation (≤2 segments) did not increase the stress on the SIJs significantly, while long-term segment fixation (≥4 segments) led to greater stress on the SIJs especially when all the L1-L5 segments were fixed. Unfixed lumbar segments compensated the ROM loss of the fixed segments, and the preservation of lumbar spine mobility would reduce the risks of SIJ degeneration.

Integrating visual and molecular approaches for fish eggs analysis: A study on formaldehyde fixation and storage procedures

Integrating visual and molecular approaches for fish eggs analysis: A study on formaldehyde fixation and storage procedures

Fundoplication vs. gastric fixation for the management of emergency hiatal hernia repairs: aretrospective cohort study.

There is a paucity of literature comparing safety outcomes between formal fundoplication and gastric fixationproceduresfor hiatal hernia repairs, especially in the emergency setting. The objective of this study was to evaluate 30-day clinicaloutcomes between fundoplication and gastric fixation performed in emergency hiatal hernia repairs. A retrospective cohort study using the National Surgery Quality Improvement Program(NSQIP) database from 2011 to 2021 was conducted. The study population was determined usingICD9/10 codes describing diaphragmatic hernia without obstruction or gangrene, with obstruction,and with gangrene. Elective cases were excluded. CPT codes were used to group fundoplicationprocedures and gastric fixation procedures. The primary outcome was the 30-day complication rate. Secondary outcomes included 30-day readmission, reoperation and mortalityrates. A multivariablelogistic regression analysiswas used to adjust for clinically relevant confounding variables. A total of 971 and 346 were in the fundoplication and gastric fixation groups, respectively.Fundoplication was associated with a significantly lower (p < 0.05) 30-day complication, reoperation and mortality rates. There was no statistically significantdifference with respect to readmission. After adjustment, fundoplication was significantlyassociated with a decrease in odds of 30-day complications (OR 0.53,p < 0.001 95% CI0.40-0.71) and mortality (OR 0.55,p = 0.033 95% CI 0.32-0.95). However, there was nosignificant difference with respect to 30-day readmission (OR 0.86,p = 0.449 95%CI 0.59-1.27) and reoperation (OR 0.66,p = 0.063 95% CI 0.42-1.02). Patients with hiatal hernias that underwent emergent repair with fundoplication had asignificantly lower 30-day complication and mortality rates compared to those who underwent gastricfixation procedures. Fundoplication is a safe and feasible approach to manage hiatal hernias in the emergency setting for select patients.

Short-term complication rates of open reduction and plate fixation and intramedullary nailing in the treatment of humeral shaft fractures: a propensity score matched analysis

IntroductionThis is a retrospective cohort study designed to compare short-term postoperative complication rates between closed humeral shaft fractures treated by open reduction and internal fixation (ORIF) versus intramedullary nailing (IMN), as well as secondary independent risk factors for adverse outcomes.Materials and methodsThe American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried using CPT codes to identify patients that underwent an open reduction and plate fixation or intramedullary nailing procedure for a closed humeral shaft fracture from 2010 to 2021. Cohorts were matched using propensity scores to account for demographic differences and rates of complications were compared between the two groups.ResultsFrom the database, a total of 4,222 patients were identified who met inclusion criteria, with 3,326 and 896 undergoing ORIF and IMN respectively. After propensity score matching, 866 of the nearest-neighbor matches were included in each cohort for a total of 1,732 patients in the final analysis. The rate of any adverse event (AAE) was significantly higher in the ORIF cohort (16.3%) than the IMN cohort (12.1%, p = 0.01). The ORIF group had higher rates of postoperative transfusion (p = 0.002), return to OR (p = 0.005), and surgical site infection (SSI, p = 0.03). After multivariate analysis, ASA class 4, increasing age, increasing operative time, and history of bleeding disorder were found to increase the risk of AAE in both ORIF and IMN patients.ConclusionsWhile prior studies have claimed higher complication rates in IMN patients, this study found a significantly higher short-term risk of AAE in ORIF patients when compared in matched cohorts. However, individual 30-day complication rates do not differ significantly between procedures, and both have been shown to be safe and effective tools in the management of humeral shaft fractures.

Vowel harmony preferences in infants growing up in multilingual Ghana (Africa).

Infants' preference for vowel harmony (VH, a phonotactic constraint that requires vowels in a word to be featurally similar) is thought to be language-specific: Monolingual infants learning VH languages show a listening preference for VH patterns by 6 months of age, while those learning non-VH languages do not (Gonzalez-Gomez et al., 2019; Van Kampen et al., 2008). We investigated sensitivity to advanced tongue root (ATR) harmony in Akan (Kwa, Niger-Congo) in 40 six-month-old multilingual infants (21 girls) in Ghana, West Africa (an understudied population), all learning Akan, Ghanaian English, and most of them several other understudied African languages (e.g., Ga, Ewe). We hypothesized that infants learning both ATR harmony and nonharmony languages would demonstrate sensitivity to ATR harmony. Using the central fixation procedure, infants were presented with disyllabic nonwords that were either harmonic (e.g., puti) or nonharmonic (e.g., petɔ) based on their ATR features. Infants demonstrated sensitivity to ATR harmony with a familiarity preference, listening longer to harmonic syllable sequences than nonharmonic ones. The relative amount of exposure to (an) ATR harmony language(s) did not modulate the preference. These results shed light on our understanding of early multilingualism: they suggest that early sensitivity to VH in multilinguals may be similar to monolingual infants learning other types of VH, irrespective of simultaneous experience with non-VH languages. We conclude with reflections on studying infant language acquisition in multilingual Africa. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Oncological and functional outcomes of pathological fractures of lower extremities in patients with malignant bone tumors.

As managing pathological fractures of the extremities can be difficult, the present study aimed to present a treatment algorithm for lower extremity bone malignancies. A total of 38 patients with impending and pathological fractures were treated at the Department of Orthopedic Surgery in Kindai University Hospital. Age, sex, fracture site, type of primary malignancy, number of metastases, pre-fracture Eastern Cooperative Oncology Group performance status (ECOG-PS) score, adjuvant therapy, treatment modality, operative time, blood loss, postoperative complications, Musculoskeletal Tumor Society (MSTS) score, outcomes, follow-up period and the MSTS scores and ECOG-PS were compared in cases of primary malignant tumors and those cases of metastatic malignant tumors were retrospectively surveyed. Post-treatment MSTS scores in cases of impending and pathological fractures were compared between intramedullary nail fixation and non-intramedullary nail fixation procedures. Disease sites included the sub-trochanteric femur in 10 patients, trochanteric femur in 8, femoral diaphysis in 7, femoral neck in 5, bilateral trochanteric femur in 3, proximal tibia in 3 and distal femur in 2 patients. A total of 10 patients had metastases between 3-20 sites. The median pre-fracture ECOG-PS score was 1. Adjuvant radiotherapy was administered to 5, chemotherapy to 8 and radiotherapy with chemotherapy to 10 patients. Surgical procedures included intramedullary nails in 18 patients, tumor arthroplasty in 4, plate fixation in 3, artificial head replacement in three, compression hip screw (CHS) in 3, conservative treatment in 2, bilateral intramedullary nail fixation in 2 and artificial bone stem with combined intramedullary nail and plate fixation, right-sided artificial head replacement and left-sided CHS in 1 patient each. The MSTS score was 19.9±8.95 for intramedullary nail fixation and 24.3±7.45 for other procedures, with a negative association between the MSTS score and pre-fracture ECOG-PS. The median follow-up period was 8 months. The outcomes were as follows: Alive with disease, 23 patients; continued disease-free, 1 patient; and dead due to disease, 14 patients. The 1-year postoperative overall survival rate was 60.5%. Moreover, the group with metastatic malignant tumors, which had significantly worse ECOG-PS, had significantly lower MSTS scores than the group with primary malignant tumors. The authors' treatment algorithm for malignant bone tumors of the lower extremity was shown to be useful.

A case report demonstrating the utilization of computer-aided design technology and intramedullary nails for the management of femoral deformity and fracture.

To effectively address severe deformities at the fracture site in patients, meticulous preoperative preparation is essential. This involves ensuring the restoration of the normal structural force line of the affected area and prevention of any residual deformities. By utilizing E3D technology prior to surgery, creating models based on individual patient image data and performing osteotomy, the required surgical parameters can be measured, thereby reducing surgical risks and enhancing precision. This article documents a case involving a fractured femoral shaft resulting in femoral deformation. In this case, computer-aided design technology was employed for preoperative planning and data measurement to guide the corrective osteotomy and fracture fixation procedures. The E3D software utilizes advanced techniques such as customized osteotomy, virtual reduction and internal fixation insertion technology. This enables the software to accurately pre-select the correction of femoral deformities and determine the appropriate specifications and types of internal implants. As a result, the software can create precise, rational, and personalized repair plans tailored to each patient's needs.