Fluoroscopy Frequency Research Articles

Research on Locating Device for the Entry Point of Intramedullary Nail Based on Inertial Navigation

To introduce a locating device for the entry point of intramedullary nail based on the inertial navigation technology, which utilizes multi-dimensional angle information to assist in rapid and accurate positioning of the ideal direction of femoral anterograde intramedullary nails' entry point, and to verify its clinical value through clinical tests. After matching the locating module with the developing board, which are the two components of the locating device, they were placed on the skin surface of the proximal femur of the affected side. Anteroposterior fluoroscopy was performed. The developing angle corresponding to the ideal direction of entry point was selected based on the X-ray image, and then the yaw angle of the locating module was reset to zero. After resetting, the locating module was combined with the surgical instrument to guide the insertion angle of the guide wire. The ideal direction of entry point was accurately located based on the angle guidance. By setting up an experimental group and a control group for clinical surgical operations, the number of guide wire insertion times, surgical time, fluoroscopy frequency, and intraoperative blood loss with or without the locating device was recorded. Compared to the control group, the experimental group showed significant improvement in the number of guide wire insertion times, surgical time, fluoroscopy frequency, and intraoperative blood loss, with a statistically significant difference (P<0.01). The locating device can assist doctors in quickly locating the entry point of intramedullary nail, effectively reducing the fluoroscopy frequency and surgical time by improving the success rate of the guide wire insertion with one shot, improving surgical efficiency, and possessing certain clinical value.

Bilateral Endoscopic Debridement Combined with Local Antituberculosis Drugs for Thoracic Tuberculosis with Large Paravertebral Abscess: A Multicenter Study with 4-year Follow-Up

BackgroundParavertebral abscess represents a prevalent manifestation of thoracic tuberculosis, often necessitating surgical intervention. In this study, we introduced a novel approach by employing bilateral endoscopic debridement to address large Paravertebral abscesses associated with thoracic tuberculosis, a method not previously proposed in the literature. The clinical efficacy was examined through a comprehensive 4-year follow-up. MethodsWe conducted a retrospective analysis on patients diagnosed with thoracic tuberculosis and paravertebral abscess (TB-PA) who underwent bilateral endoscopic debridement combined with local antituberculosis drugs (BED+LAD) between February 2015 and February 2019. A total of 29 eligible patients (12 males and 17 females) with a median (interquartile ranges, IQR) of 59.0(16.5) years were included in the study. All patients received the BED+LAD treatment. After the surgery, the patients were treated with a 4-drug antituberculosis therapy (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol). All relevant indicators were meticulously recorded and analyzed. ResultsThe surgical procedures were successfully completed for all subjects, with an average intraoperative bleeding volume of (25.2 ± 8.9) ml, an average surgical time of (68.4 ± 14.0) minutes, an average fluoroscopy frequency of (21.7 ± 8.2) times, an average hospital stay of (14.2 ± 4.3) days, and an average medication period of (42.1 ± 9.6) weeks. All subjects completed at least a 4-year follow-up period. At the final follow-up, ESR and CRP levels returned to normal, and there was no significant increase in the Cobb angle (P>0.05). ConclusionThe application of BED+LAD in the treatment of TB-PA proved to be a safe, effective, and feasible approach.

Comparison of rehabilitation outcomes between robot-assisted and freehand screw placement in treatment of femoral neck fractures: a systematic review and meta-analysis

PurposeTo compare the postoperative rehabilitation of femoral neck fractures treated with robot-assisted nailing and freehand nailing.MethodsWe systematically searched the PubMed, EMBASE, Cochrane, China National Knowledge Infrastructure(CNKI), WanFang database, China Science and Technology Journal Database (VIP) and Web of Science databases to identify potentially eligible articles. Indispensable data such as the year of publication, country, study type, robot type, age, number of patients, sex distribution, study design, and outcome indicators were extracted. The outcome indicators of interest included healing rate, length of healing time, Harris score, operation time, frequency of X-ray fluoroscopy, frequency of guide pin insertion, and intraoperative blood loss. RevMan 5.4.1 was used for the meta-analysis.ResultsFourteen studies with 908 participants were included in this meta-analysis. The results showed that in terms of healing rate (SMD = 2.75, 95% CI, 1.03 to 7.32, P = 0.04) and Harris score (SMD = 2.27, 95% CI, 0.79 to 3.75, P = 0.003), robot-assisted screw placement technique scores were higher than the traditional freehand technique. Additionally, operative time (SMD = -12.72, 95% CI, -19.74 to -5.70, P = 0.0004), healing time (SMD = -13.63, 95% CI, -20.18 to -7.08, P < 0.0001), frequency of X-ray fluoroscopy (SMD = − 13.64, 95% CI, − 18.32 to − 8.95, P < 0.00001), frequency of guide pin insertion (SMD = − 7.95, 95% CI, − 10.13 to − 5.76, P < 0.00001), and intraoperative blood loss (SMD = − 17.33, 95% CI, − 23.66 to − 11.00, P < 0.00001) were lower for patients who underwent robotic-assisted screw placement than those for patients who underwent the conventional freehand technique.ConclusionCompared to the freehand nailing technique, robot-assisted nailing helps improve postoperative healing rates in patients with femoral neck fractures; shortens healing times; better restores hip function; reduces the number of intraoperative fluoroscopies, guides pin placements; reduces intraoperative bleeding; and increases perioperative safety.

Criteria of ultrasound-guided closed reduction with percutaneous pinning in unstable humeral lateral condylar fractures: a three-center retrospective cohort study.

Interventions using ultrasound-guided closed reduction and percutaneous pinning (UG-CRPP) of humeral lateral condylar fractures (HLCFs) have been increasingly applied; however, their effectiveness for unstable HLCFs and the criteria for ultrasound outcomes remain unclear. This study assessed the outcomes of UG-CRPP for HLCFs and evaluated the success criteria in children. Data were retrospectively collected from 106 patients with unstable HLCFs admitted to three hospitals between January 2021 and August 2022. Fifty-five cases were left-sided and 51 cases were right-sided: 74 male patients and 32 female patients were included. Perioperative data, elbow function, complications, and criteria for UG-CRPP were analyzed. The mean rate of UG-CRPP was 88%. The mean surgical time was 54.56 ± 21.07 min, and the mean fluoroscopy frequency was 9.25 ± 2.93 times. At the last follow-up, there were significant differences in elbow flexion between the affected side (135.82° ± 6.92°) and the unaffected side (140.58° ± 5.85°) (p = 0.01). The Mayo score of the affected side was 90.28° ± 4.97°, the Baumann angle was 71.4° ± 5.4°, condylar shaft angle was 39.9° ± 6.4°, and the carrying angle was 8.4° ± 3.6°. Seventy patients presented mild lateral spurs and 16 patients exhibited moderate spurs. Fourteen patients presented with pin infection, and one patient exhibited postoperative re-displacement. There was no premature physeal closure, varus, or valgus elbow deformity, delayed union, or non-union. Successful ultrasound-based outcome criteria for UG-CRPP were defined as follows: (i) absent or less than a cartilage thickness step on the cartilage hinge on coronal plane parallel articular surface scanning, (ii) no lateral displacement and intact distal end of the condylar and capitellum on coronal plane vertical articular surface scanning, (iii) no anteroposterior displacement and absent or less than a cartilage thickness step on sagittal plane vertical articular surface scanning, and (iv) intact posterior fracture line or less than a cortex step on posterolateral sagittal plane vertical articular surface scanning. UG-CRPP is a procedure with minimal blood loss, less invasive, cosmetic, and no radiation exposure. It yielded good outcomes in unstable HLCFs. The successful criteria make it suitable for clinical application.

Orthopaedic robot assisted femoral neck dynamic cross fixation system for the treatment of femoral neck fractures

To explore and compare the clinical efficacy of orthopedic robot assisted femoral neck system （FNS） and traditional manual FNS in the treatment of femoral neck fractures in middle-aged and young people. The clinical data of 62 consecutive patients with femoral neck fracture and age less than 65 years old admitted to the Intelligent Orthopaedic Department of Beijing Jishuitan Hospital from June 2021 to June 2022 were retrospectively analyzed. According to whether orthopedic robot-assisted surgery the patients were divided into two groups：30 patients aged 34 to 56 years old were treated with orthopedic robot assisted FNS internal fixation after closed or limited open reduction（experimental group）； 32 patients aged 33 to 54 years old underwent FNS internal fixation after closed or limited open reduction（control group）. The age, gender, time from injury to admission, average hospital stay, surgical duration, intraoperative bleeding volume, and intraoperative fluoroscopy frequency of two groups of patients were analyzed and compared. The hip joint function in both groups of patients was evaluated using the Harris hip joint scoring standard at 6 months after surgery. All 62 patients with femoral neck fractures successfully completed the surgery. There was no significant difference（P>0.05） between the experimental group and the control group in terms of baseline data such as age, gender, time from injury to admission, time from admission to surgery and the intraoperative bleeding. The surgical duration of the experimental group was significantly shorter than that of the control group [42.1（28.5, 50.7）min vs. 53.4（36.9, 62.5） min, Z=-2.338, P=0.019]. The intraoperative X-ray fluoroscopy frequency of the experimental group was significantly lower than that of the control group[8.0 （6.0, 11.0） times vs. 15.0（13.0, 17.0） times, Z=-5.960, P<0.001]. In terms of postoperative hip joint function, there was no significant difference in Harris score between the two groups of patients at 6-month follow-up（P>0.05）. Compared with manual operation of FNS, orthopedic robot assisted FNS in the treatment of femoral neck fractures can help shorten surgical time, reduce intraoperative fluoroscopy frequency, and have similar therapeutic effects on long-term hip joint function recovery.

Comparison between minimally invasive and open transforaminal lumbar interbody fusion for the treatment of multi‑segmental lumbar degenerative disease: A systematic evaluation and meta‑analysis.

The present study aimed to compare the differences between minimally invasive transforaminal lumbar fusion (MIS-TLIF) and open transforaminal lumbar fusion (TLIF) for multi-segmental lumbar degenerative disease regarding intraoperative indices and postoperative outcomes. PubMed, Web of Science, Embase, CNKI, Wanfang and VIP databases were searched for literature on MIS-TLIF and open TLIF in treating multi-segmental lumbar degenerative diseases. Of the 1,608 articles retrieved, 10 were included for final analysis. The Newcastle-Ottawa Scale and Review Manager 5.4 were used for quality evaluation and data analysis, respectively. The MIS-TLIF group was superior to the open TLIF group regarding intraoperative blood loss [95% confidence interval (CI): -254.33,-157.86; P<0.00001], postoperative in-bed time (95%CI: -3.49,-2.76; P<0.00001), hospitalization time (95%CI: -5.14,-1.78; P<0.0001) and postoperative leg pain Visual Analog Scale score (95%CI: -0.27,-0.13; P<0.00001). The fluoroscopy frequency for MIS-TLIF (95%CI: 2.07,6.12; P<0.0001) was significantly higher than that for open TLIF. The two groups had no significant differences in operation time, postoperative drainage volume, postoperative complications, fusion rate, or Oswestry Disability Index score. In treating multi-segmental lumbar degenerative diseases, MIS-TLIF has the advantages of less blood loss, shorter bedtime and hospitalization time and improved early postoperative efficacy; however, open TLIF has a lower fluoroscopy frequency.

Single Kocher-Langenbeck approach combined with anterograde channel screw technique in treatment of acetabular transverse and posterior wall fractures

To assess the effectiveness of the single Kocher-Langenbeck approach combined with anterograde channel screw technique for the treatment of acetabular transverse and posterior wall fractures. Between March 2020 and October 2022, 17 cases of acetabular transverse and posterior wall fractures were treated with the single Kocher-Langenbeck approach combined with anterograde channel screw technique. There were 11 males and 6 females, with an average age of 53.6 years (range, 42-64 years). Causes of injury included traffic accident in 12 cases, and falling from height in 5 cases. The time from injury to operation ranged from 4 to 16 days with an average of 8.8 days. The operation time, intraoperative blood loss, and fluoroscopy frequency were recorded; X-ray films were reviewed regularly after operation to observe the fracture healing, and postoperative complications were recorded. At last follow-up, Matta score was used to evaluate the reduction of fracture, Harris score and modified Merle D'Aubigné-Postel scores system were used to evaluate the hip joint function. The operation time was 150-230 minutes (mean, 185.9 minutes), the intraoperative blood loss was 385-520 mL (mean, 446.2 mL), and the fluoroscopy frequency was 18-34 times (mean, 27.5 times). Postoperative fat liquefaction occurred in 1 case and the other incisions healed by first intention; 3 cases had limb numbness after operation, and the symptoms disappeared after active symptomatic treatment; no urogenital system and intestinal injury occurred. All patients were followed up 12-28 months (mean, 19.9 months). Bone union was achieved in all cases with an average healing time of 10.8 weeks (range, 8-14 weeks). There was no complication such as loosening and breakage of internal fixators. At last follow-up, according to Matta score, 12 cases achieved anatomic reduction, 3 satisfactory reduction, and 2 fair reduction, the satisfactory rate was 88.2%; according to Harris hip function score, 12 cases were excellent, 3 good, and 2 fair, the excellent and good rate was 88.2%; according to the modified Merle D'Aubign Aubigné-Postel scoring system, the results were excellent in 11 cases, good in 3 cases, and fair in 3 cases, with an excellent and good rate of 82.4%. The single Kocher-Langenbeck approach combined with anterograde channel screw technique is a minimally invasive method for the treatment of acetabular transverse and posterior wall fractures with less complications, simple operation, and satisfactory effectiveness.

Comparative study of orthopaedic robot-assisted minimally invasive surgery and open surgery for limb osteoid osteoma

To compare the accuracy and effectiveness of orthopaedic robot-assisted minimally invasive surgery versus open surgery for limb osteoid osteoma. A clinical data of 36 patients with limb osteoid osteomas admitted between June 2016 and June 2023 was retrospectively analyzed. Among them, 16 patients underwent orthopaedic robot-assisted minimally invasive surgery (robot-assisted surgery group), and 20 patients underwent tumor resection after lotcated by C-arm X-ray fluoroscopy (open surgery group). There was no significant difference between the two groups in the gender, age, lesion site, tumor nidus diameter, and preoperative pain visual analogue scale (VAS) scores ( P>0.05). The operation time, lesion resection time, intraoperative blood loss, intraoperative fluoroscopy frequency, lesion resection accuracy, and postoperative analgesic use frequency were recorded and compared between the two groups. The VAS scores for pain severity were compared preoperatively and at 3 days and 3 months postoperatively. Compared with the open surgery group, the robot-assisted surgery group had a longer operation time, less intraoperative blood loss, less fluoroscopy frequency, less postoperative analgesic use frequency, and higher lesion resection accuracy ( P<0.05). There was no significant difference in lesion resection time ( P>0.05). All patients were followed up after surgery, with a follow-up period of 3-24 months (median, 12 months) in the two groups. No postoperative complication such as wound infection or fracture occurred in either group during follow-up. No tumor recurrence was observed during follow-up. The VAS scores significantly improved in both groups at 3 days and 3 months after surgery when compared with preoperative value ( P<0.05). The VAS score at 3 days after surgery was significantly lower in robot-assisted surgery group than that in open surgery group ( P<0.05). However, there was no significant difference in VAS scores at 3 months between the two groups ( P>0.05). Compared with open surgery, robot-assisted resection of limb osteoid osteomas has longer operation time, but the accuracy of lesion resection improve, intraoperative blood loss reduce, and early postoperative pain is lighter. It has the advantages of precision and minimally invasive surgery.

Percutaneous endoscopic transforaminal vs. interlaminar discectomy for L5–S1 lumbar disc herniation: a retrospective propensity score matching study

ObjectivePercutaneous endoscopic lumbar discectomy (PELD) is a safe and effective minimally invasive surgery for treating lumbar disc herniation (LDH); however, the comparative clinical efficacy of percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID) in treating L5–S1 LDH remains unclear. This study compared the clinical advantages of PEID and PETD for treating L5–S1 LDH.MethodsThis was a single-centre retrospective study analysing clinical data from 120 patients with L5–S1 LDH between February 2016 and May 2020. Propensity score matching (PSM) was used to adjust for imbalanced confounding variables between the two groups. Perioperative data were recorded, and clinical outcomes, including functional scores and imaging data, were compared between groups. Functional scores included visual analogue scale (VAS) for back and leg pain, Oswestry disability index (ODI), and modified MacNab criteria. Imaging data included disc height index (DHI), ratio of greyscale (RVG), and range of motion (ROM) of the responsible segment.ResultsAfter PSM, 78 patients were included in the study, and all covariates were well balanced between the two groups. In the matched patients, the PEID group showed significantly shorter surgical time (65.41 ± 5.05 vs. 84.08 ± 5.12 min) and lower frequency of fluoroscopy (2.93 ± 0.63 vs. 11.56 ± 1.54) compared with the PETD group (P < 0.001). There were no statistically significant differences in intraoperative blood loss, postoperative hospital stay, total incision length, and incidence of complications between the two groups (P > 0.05). After surgery, both groups showed significant improvement in back and leg pain based on VAS and ODI scores (P < 0.05). There were no statistically significant differences in clinical functional scores and imaging data between the two groups at various time points after surgery (P > 0.05). According to the modified MacNab criteria, the excellent and good rates in the PEID group and PETD group were 91.89% and 89.19%, respectively, with no statistically significant difference (P > 0.05).ConclusionPEID and PETD have similar clinical efficacy in treating L5–S1 disc herniation. However, PEID is superior to PETD in reducing operation time and frequency of fluoroscopy.

Robot-assisted percutaneous vertebroplasty for osteoporotic vertebral compression fracture treatment and risk factor screening for postoperative refracture.

Osteoporotic vertebral compression fracture (OVCF) is a serious complication of osteoporosis, and percutaneous vertebroplasty (PVP) is a major therapeutic method for OVCF. This study aimed to evaluate the clinical efficacy and postoperative complications of robot-assisted targeted PVP for the treatment of OVCF. The data from 202 OVCF patients were analyzed in this study, including 72 cases received traditional PVP (PVP group), 68 cases received robot-assisted PVP (R-PVP group), and 62 cases underwent robot-assisted PVP combined with targeted plugging (R-PVP + TP group). The fluoroscopic exposure conditions, operative duration, lengths of stay, postoperative bone cement leakage, refracture, Visual Analog Scale (VAS) score, and Oswestry Disability Index (ODI) score were obtained and compared between the three groups. The Kaplan-Meier method and logistic regression model were adopted to screen the risk factors related with postoperative refracture. R-PVP and R-PVP + TP group had significantly reduced fluoroscopic frequency and radiation dose, and reduced cement leakage compared with PVP group. R-PVP + TP not only showed more obvious advantages in these aspects, but also had a lower probability of postoperative refracture. In addition, BMD, fracture vertebral distribution, cement leakage, and surgery methods were independent related with refracture. All the results demonstrated robot assistance could improve the application of PVP in the treatment of OVCF, and robot-assisted PVP combined with targeted plugging showed significantly reduced fluoroscopic exposure, bone cement leakage, and rate of postoperative refracture. BMD, fracture vertebral distribution, cement leakage, and operation methods were identified as four risk factors for the onset of refracture after PVP.

Application of Kirschner wire placement guided technology in paediatric supracondylar humerus fractures

BackgroundTo analyze the clinical efficacy of K-wire placement guided technology in paediatric supracondylar humerus fractures.MethodsA retrospective study was conducted in 105 patients who underwent closed reduction and percutaneous pinning surgeries in our hospital from June 2019 to August 2022. 54 patients treated with a assisted reduction fixation device to assist in closed reduction and percutaneous K-wire cross-fixation were allocated into the Non-guided group, and 51 patients with K-wire placement guided technology to guide K-wire placement were assigned into the Guided group. The operation duration, number of disposable K-wire placement, intraoperative fluoroscopy frequency, Baumann angle, carrying angle, fracture healing time and Flynn score of elbow joint function at the final follow-up were compared between two groups. The postoperative complications of two groups were recorded.ResultsThere were significant differences between two groups in terms of operation duration, intraoperative fluoroscopy frequency, and disposable K-wire placement rate (p < 0. 05), while no significant differences of Baumann angle, carrying angle and the fracture healing time between two groups were observed (p > 0. 05). In the control group, ulnar nerve injury in 2 case, pin site infection in 4 cases, mild cubitus varus in 2 cases and loss of reduction in 4 cases were detected. In the study group, ulnar nerve injury in 1 case, pin site infection in 2 cases and loss of reduction in 1 case was observed. There was no significant difference in Flynn scores between two groups.ConclusionK-wire placement guided technology is simple and convenient. The application of K-wire placement guided technology could relatively improved disposable K-wire placement rate, shorten the intraoperative fluoroscopy frequencies and reduce complication rates.

Comparison of the therapeutic efficacy of hip arthroplasty and proximal femoral nail antirotation internal fixation for unstable intertrochanteric femur fractures.

To compare the therapeutic efficacy of total hip arthroplasty (THA) versus proximal femoral nail antirotation (PFNA) internal fixation for treating unstable intertrochanteric femur fractures (UIFF). In this retrospective study, the clinical data of 86 patients with intertrochanteric femur fractures (IFF) treated in Hangzhou Fuyang Hospital of Orthopedics of Traditional Chinese Medicine from January 2022 to December 2023 were collected and analyzed. Patients were categorized into two groups based on their treatment modality: the THA group (n=45, treated with THA) and the PFNA group (n=41, treated with PFNA internal fixation). The two groups were compared in terms of surgery-related indicators (operative time, incision length, intraoperative blood loss, postoperative drainage volume, and intraoperative fluoroscopy frequency), postoperative recovery indicators (time to first ambulation, length of stay, time until full weight-bearing ambulation), and the incidence of postoperative complications. The pain indicators (Wong-Baker Faces Pain Rating Scale) and hip joint function indicators (Harris Hip Scores) of patients in the two groups were assessed preoperatively and at 1, 3, and 6 months postoperatively. The hip joint function recovery outcomes of the two groups of patients were recorded at the last follow-up. The PFNA group had significantly shorter operative time, shorter incision length, lower intraoperative blood loss, lower postoperative drainage volume, and higher intraoperative fluoroscopy frequency compared to the THA group (all P < 0.05). The PFNA group also had significantly longer time to first ambulation, length of stay, and time until full weight-bearing ambulation (all P < 0.05). There was no statistically significant difference in the incidence of postoperative complications between the two groups (P > 0.05). Postoperative Wong-Baker scores in both groups decreased compared to preoperative levels. At 1 and 3 months postoperatively, the PFNA group had significantly higher Wong-Baker scores than the THA group (P < 0.05), but at 6 months postoperatively, the difference was not statistically significant (P > 0.05). Postoperative Harris scores increased in both groups compared to preoperative scores. At 1 month postoperatively, the PFNA group had significantly lower Harris scores than the THA group (P < 0.05); however, at 3 and 6 months postoperatively, the differences were not statistically significant (all P > 0.05). There was no significant difference in the rates of excellent recovery of hip joint function between the two groups at the last follow-up (P > 0.05). Both THA and PFNA internal fixation yield favorable outcomes in treating IFF with no significant difference in complications. The difference lies in the shorter operative time and lesser trauma inflicted by PFNA internal fixation, despite it involving prolonged radiation exposure and bed rest. Conversely, THA requires longer operative time and causes greater trauma but results in shorter postoperative recovery periods, allowing earlier ambulation.

Comparison of the clinical effect of unilateral transverse process extrapedicular and bilateral transpedicular percutaneous kyphoplasty for thoracolumbar osteoporotic vertebral compression fracture.

Osteoporosis vertebral compression fractures (OVCF) are common with the aging process. This study aimed to compare the effects of unilateral transverse process extrapedicular (UEPKP) and bilateral transpedicular percutaneous kyphoplasty (BTPKP) for patients with thoracolumbar OVCF. Data from 136 patients with OVCF treated with single-level PKP in our hospital between May 2019 and April 2021 were studied. Patients were grouped based on surgical procedure: there were 62 patients in the UEPKP group and 74 in the BTPKP group. All clinical and radiological data were collected from medical records. Clinical outcomes, including visual analog scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores of the lumbar spine, were evaluated preoperatively, postoperatively, and at the follow-up visit. The radiological evaluations (anterior vertebral height rate and local kyphosis angle) and complications were also collected. All patients had successfully improved after surgery. In the UEPKP group, patients showed a significantly shorter operating time and lower fluoroscopy frequency than patients in the BTPKP group (p < 0.05). However, a significantly better distribution score and cement volume were found in the BTPKP group (p < 0.05). The UEPKP group achieved a significantly better VAS score (0.6 ± 0.5 vs. 0.9 ± 0.8) and ODI (24.7 ± 3.1 vs. 27.5 ± 1.8) at the final follow-up visit than the BTPKP group (p < 0.05). The UEPKP group showed significantly worse radiological outcomes (anterior height rate and local kyphosis angle) at the 6- and 12-month follow-ups (p < 0.05). As for complications, the UEPKP group showed significantly fewer facet joint violations and intraspinal leakages (p < 0.05). UEPKP could be a safe and effective alternative procedure for patients with thoracolumbar osteoporotic vertebral compression fracture, which possesses an apparent advantage in reducing intraspinal leakage and facet joint violation over BTPKP.

3D printing technology combined with personalized plates for complex distal intra-articular fractures of the trimalleolar ankle

This study investigated the effectiveness of 3D printing technology in combination with personalized custom-made steel plates in the treatment of complex distal intra-articular trimalleolar fractures, with the aim of providing a new approach to improve ankle joint function in patients. The 48 patients with complex distal intra-articular trimalleolar fractures included in the study were randomly divided into two groups: the personalized custom-made steel plate group (n = 24) and the conventional steel plate group (n = 24). A comparison was made between the two groups in terms of preoperative preparation time, hospitalization duration, surgical time, fracture reduction and internal fixation time, intraoperative fluoroscopy instances, surgical incision length, fracture healing time, follow-up duration, degree of fracture reduction, ankle joint functional recovery, and the occurrence of complications. The personalized steel plate group exhibited longer preoperative preparation time and hospitalization duration compared to the conventional steel plate group (p < 0.001). However, the personalized steel plate group demonstrated significantly shorter surgical duration, time for fracture reduction and internal fixation, reduced intraoperative fluoroscopy frequency, and a shorter overall surgical incision length (p < 0.001). Both groups displayed similar fracture healing times and follow-up durations (p > 0.05). The personalized steel plate group showed a higher rate of successful fracture reduction (87.5% vs. 79.2%, p > 0.05) and a lower incidence of complications (8.3% vs. 20.8%, p = 0.22), although these differences did not reach statistical significance. Furthermore, the personalized steel plate group exhibited superior ankle joint function scores during follow-up compared to the conventional steel plate group (p < 0.05). By utilizing 3D printing technology in conjunction with personalized custom-made steel plates, personalized treatment plans are provided for patients with complex comminuted tri-malleolar ankle fractures, enabling safer, more efficient, and satisfactory orthopedic surgeries.

Comparison of effectiveness of lower extremity axial distractor and traction table assisted closed reduction and intramedullary nail fixation in femoral subtrochanteric fracture

To compare the effectiveness of lower extremity axial distractor (LEAD) and traction table assisted closed reduction and intramedullary nail fixation in treatment of femoral subtrochanteric fracture. The clinical data of 117 patients with subtrochanteric fracture of femur treated by closed reduction and intramedullary nail fixation between May 2012 and May 2022 who met the selection criteria were retrospectively analyzed. According to the auxiliary reduction tools used during operation, the patients were divided into LEAD group (62 cases with LEAD reduction) and traction table group (55 cases with traction table reduction). There was no significant difference in baseline data, such as gender, age, injured side, cause of injury, fracture Seinsheimer classification, time from injury to operation, and preoperative visual analogue scale (VAS) score, between the two groups ( P>0.05). Total incision length, operation time, intraoperative blood loss, fluoroscopy frequency, closed reduction rate, fracture reduction quality, fracture healing time, weight-bearing activity time, and incidence of complications, as well as hip flexion and extension range of motion (ROM), Harris score, and VAS score at 1 month and 6 months after operation and last follow-up were recorded and compared between the two groups. There were 14 cases in the LEAD group from closed reduction to limited open reduction, and 43 cases in the traction table group. The incisions in the LEAD group healed by first intention, and no complication such as nerve and vascular injury occurred during operation. In the traction table group, 3 cases had perineal crush injury, which recovered spontaneously in 1 week. The total incision length, operation time, intraoperative blood loss, fluoroscopy frequency, and closed reduction rate in the LEAD group were significantly better than those in the traction table group ( P<0.05). There was no significant difference in the quality of fracture reduction between the two groups ( P>0.05). Patients in both groups were followed up 12-44 months, with an average of 15.8 months. In the LEAD group, 1 patient had delayed fracture union at 6 months after operation, 1 patient had nonunion at 3 years after operation, and 1 patient had incision sinus pus flow at 10 months after operation. In the traction table group, there was 1 patient with fracture nonunion at 15 months after operation. X-ray films of the other patients in the two groups showed that the internal fixator was fixed firmly without loosening and the fractures healed. There was no significant difference in fracture healing time, weight bearing activity time, incidence of complications, and postoperative hip flexion and extension ROM, Harris score, and VAS score at different time points between the two groups ( P>0.05). For femoral subtrochanteric fracture treated by close reduction and intramedullary nail fixation, compared with traction table, LEAD assisted fracture reduction can significantly shorten the operation time, reduce intraoperative blood loss and fluoroscopy frequency, reduce incision length, effectively improve the success rate of closed reduction, and avoid complications related to traction table reduction. It provides a new method for good reduction of femoral subtrochanteric fracture.

Early effectiveness of Ti-Robot assisted femoral neck system for minimally invasive treatment of elderly Garden type Ⅱ and Ⅲ femoral neck fractures

To investigate the early effectiveness of the Ti-Robot assisted femoral neck system (FNS) in the treatment of elderly Garden type Ⅱ and Ⅲ femoral neck fractures. A retrospective analysis was conducted on the clinical data of 41 elderly patients with Garden type Ⅱ and Ⅲ femoral neck fractures who were admitted between December 2019 and August 2022 and met the selection criteria. Among them, 21 cases were treated with Ti-Robot assisted FNS internal fixation (study group), and 20 cases were treated solely with FNS internal fixation (control group). There was no significant difference in baseline data, including gender, age, side, cause of injury, time from injury to surgery, fracture Garden classification, and fracture line classification, between the two groups ( P>0.05). Surgical effectiveness was evaluated based on parameters such as operation time (including incision time and total operation time), reduction level, number of dominant pin insertions, intraoperative fluoroscopy frequency, incision length, whether to extend the incision, need for assisted reduction, postoperative hospital stay, fracture healing time, incidence of osteonecrosis of the femoral head, postoperative visual analogue scale (VAS) score at 1 day, and Harris hip score at last follow-up. The study group showed significantly shorter incision time, fewer dominant pin insertions, fewer instances of extended incisions, fewer intraoperative fluoroscopy frequency, and smaller incisions than the control group ( P<0.05). There was no significant difference in total operation time, reduction level, and assisted reduction frequency between the two groups ( P>0.05). Both groups achieved primary wound healing postoperatively, with no complications such as incision leakage or skin infection. All patients were followed up 12-24 months with an average of 14.6 months. Fractures healed in both groups, with no significant difference in healing time ( P>0.05). There was no significant difference in postoperative hospital stay between the two groups ( P>0.05). The study group showed significantly better VAS score at 1 day after operation and Harris hip score at last follow-up when compared to the control group ( P<0.05). No complication such as internal fixation failure, fracture displacement, or hip joint varus occurred in both groups during the follow-up. Osteonecrosis of the femoral head occurred in 1 patient of the control group, while no was observed in the study group, and the difference in the incidence of osteonecrosis of the femoral head between the two groups was not significant ( P=0.488). Compared to sole FNS internal fixation treatment, Ti-Robot assisted FNS internal fixation for elderly Garden typeⅡ and Ⅲ femoral neck fractures can reduce incision time, achieve minimally invasive and accurate nail implantation, and decrease intraoperative fluoroscopy frequency, leading to improved postoperative hip joint function recovery.

Short-term effectiveness of ultrasound-guided Kirschner wire provocation technique in treatment of Salter-Harris types Ⅰ and Ⅱ periosteal entrapment of distal tibial epiphyseal fractures in children and adolescents

To investigate the short-term effectiveness of ultrasound-guided closed reduction by Kirschner wire provocation technique in the treatment of Salter-Harris types Ⅰ and Ⅱ periosteal entrapment of distal tibial epiphyseal fractures in children and adolescents. Between May 2019 and May 2022, 41 patients with Salter Harris types Ⅰ and Ⅱ distal tibial epiphyseal fractures were admitted, all of whom had periosteal entrapment on preoperative MRI, and 38 cases (92.7%) were confirmed to have periosteal entrapment by intraoperative ultrasound. There were 24 males and 14 females, the age ranged from 6.8 to 15.7 years, with an average of 10.7 years; and there were 20 cases of Salter Harris type Ⅰ and 18 cases of type Ⅱ. The time from injury to operation was 22-76 hours, with an average of 28.4 hours. The preoperative imaging examination showed excellent alignment in 4 cases, good in 20 cases, and poor in 14 cases. The ultrasound guided Kirschner wire provocation technique for closed reduction and percutaneous Kirschner wire internal fixation were performed. The operation time, intraoperative fluoroscopy frequency, fracture healing time, and complications were recorded. Anteroposterior and lateral X-ray films of the affected ankle joint were taken before operation, at 3 months after operation, and at last follow-up to observe the healing of the fracture, and anteroposterior X-ray films of the whole length of both lower limbs were taken to evaluate the alignment of the force lines of the affected limbs. The range of motion (ROM), visual analogue scale (VAS) score, and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were used to evaluate ankle function. The mechanical lateral distal tibia angle (mLDTA) and the anatomic anterior distal tibia angle (aADTA) were measured. The operation time ranged from 17 to 52 minutes, with an average of 22.6 minutes, and the intraoperative fluoroscopy frequency ranged from 3 to 11 times, with an average of 4.2 times. X-ray examination during operation and at 2 days after operation showed that anatomical reduction was achieved. All patients were followed up 10-24 months, with an average of 16.4 months. All fractures healed in 6.1-7.2 weeks, with an average of 6.3 weeks; no fracture displacement occurred, and the patients recovered to their pre-injury level of motion at 6 months after operation. Needle tail irritation occurred in 2 cases at 4 weeks after operation, and they recovered after symptomatic treatment. During the follow-up, there was no serious complication such as incision deep infection, bone nonunion, delayed union, and malunion. At last follow-up, the patients' alignment were all excellent, and the difference was significant when compared with preoperative one ( Z=-7.471, P<0.001). The VAS score, AOFAS ankle-hindfoot score, dorsiflexion-plantar flexion ROM, varus-valgus ROM, mLDTA, and aADTA significantly improved at 3 months after operation and last follow-up when compared with preoperative ones ( P<0.05). Ultrasound-guided closed reduction by Kirschner wire provocation technique for treating Salter-Harris types Ⅰ and Ⅱ periosteal entrapment of distal tibial epiphyseal fractures in children and adolescents is minimally invasive and safe.

Femoral Neck System versus Three Cannulated Screws for Fixation of Femoral Neck Fractures in Younger Patients: A Retrospective Cohort Study

Objective To compare the clinical results of a new femoral neck system (FNS) and cannulated compression screws (CCS) for the treatment of femoral neck fractures in younger patients. Methods Retrospective study was performed in younger patients with femoral neck fractures that were treated with FNS or CCS from August 2017 to August 2022. The hip functional outcomes were assessed with the Harris hip score (HHS). Secondary outcomes included the surgical time, surgical blood loss, satisfaction visual analog scale (VAS), fluoroscopy frequency, fracture healing time and complications. Results A total of 49 patients (22 FNS and 27 CCS) with a minimum follow-up of 12 months were included. There was also no significant difference in HHSs (p = 0.27) and satisfaction VAS (p = 0.10) between them. Patients with FNS had more blood loss (50.45 ± 5.28 mL vs. 20.67 ± 4.71 ml, p < 0.01), lower fluoroscopy frequency (16.64 ± 3.32 vs. 23.59 ± 3.39, p < 0.01) and lower fracture healing time (3.76 ± 0.42 vs. 4.46 ± 0.59 months, p < 0.01). The femoral neck shortening and incidence of nail withdrawal in the FNS group was significantly lower than CCS group (2.91 ± 1.95 vs. 4.44 ± 1.52 mm, p < 0.01; 4.5% vs. 22.2%, p = 0.03). Conclusions The FNS and CCS get similar hip functions. The FNS can reduce fluoroscopy exposure and the complications such as femoral neck shortening and nail withdrawal. Thus, FNS can be an alternative to CCS for the fixation of femoral neck fractures in younger patients.

A New Technology Using Mixed Reality Surgical Navigation with the Unlocking Closed Reduction Technique Frame to Assist Pelvic Fracture Reduction and Fixation: Technical Note.

Pelvic ring disruption (PRD) is a serious trauma associated with high mortality and disability rates. Poor reduction can lead to complications such as pelvic deformity and delayed fracture healing. Here, we introduce a new technology using mixed reality surgical navigation (MRSN) with an unlocking closed reduction technique (UCRT) frame to assist pelvic fracture reduction and fixation. Thirty patients with PRD were enrolled in this study. All of the patients underwent preoperative CT scans, with the pelvis and tracker segmented into three-dimensional models. Under MRSN guidance, auxiliary reduction screws were inserted to grasp the pelvic bone. An ideal trajectory for closed reduction was planned, and suitable CS screws were used for stable fixation after good reduction. Operation time, fluoroscopy frequency, and both Matta and Majeed scores were analyzed. The mean follow-up period was 10.8 months (7.5, 12.25 months) (range 6-24 months). The average duration of operation was 212.5 min (187.5, 272.8 min) (range 133-562 min), and the average reduction time was 23.0 min (15.0, 42.5 min) (range 10-70). The average fluoroscopy frequency was 34.0 times (31.5, 52.5 times) (range 23-68 times). One hundred and fifty screws were successfully inserted on the first attempt. All the fractures healed well with no complications. Excellent reduction quality (Matta score ≤4 mm) was achieved in 29/30 cases, and good reduction quality (Matta score between 4 and 10 mm) was achieved in 1/30 cases. All patients achieved bone healing after an average of 4.0 months (3.5, 5.9 months) (range 3-6), as well as good function recovery with an average Majeed score of 91.0 (87.8, 95.0) (range 71-100). The MRSN technique described improved reduction accuracy and radiation exposure without considerable extension of operation time.

Learning curve of tibial cortex transverse transport: a cumulative sum analysis

ObjectiveThis study aimed to describe the learning curve of surgeons performing tibial cortex transverse transport (TTT) and explore its safety and effectiveness during the initial stages of surgeon’s learning.MethodsThe clinical data of patients with diabetic foot ulcers classified as Wagner grade ≥ 2, who underwent TTT at our hospital from January 2020 to July 2021, were included in this retrospective analysis. The same physician performed all procedures. Patients were numbered according to the chronological order of their surgery dates. The cumulative sum and piecewise linear regression were used to evaluate the surgeon's learning curve, identify the cut-off point, and divide the patients into learning and mastery groups. A minimum follow-up period of 3 months was ensured for all patients. Baseline data, perioperative parameters, complications, and efficacy evaluation indicators were recorded and compared between the two groups.ResultsSixty patients were included in this study based on the inclusion and exclusion criteria. After completing 20 TTT surgeries, the surgeon reached the cut-off point of the learning curve. Compared to the learning group, the mastery group demonstrated a significant reduction in the average duration of the surgical procedure (34.88 min vs. 54.20 min, P < 0.05) along with a notable decrease in intraoperative fluoroscopy (9.75 times vs. 16.9 times, P < 0.05) frequency, while no significant difference was found regarding intraoperative blood loss (P = 0.318). Of the patients, seven (11.7%) experienced complications, with three (15%) and four cases (10%) occurring during the learning phase and the mastery phase, respectively. The postoperative ulcer area was significantly reduced, and the overall healing rate was 94.8%. Significant improvements were observed in postoperative VAS, ABI, and WIFI classification (P < 0.05). There were no significant differences in the occurrence of complications or efficacy indicators between the learning and mastery groups (P > 0.05).ConclusionSurgeons can master TTT after completing approximately 20 procedures. TTT is easy, secure, and highly efficient for treating foot ulcers. Furthermore, TTT’s application by surgeons can achieve almost consistent clinical outcomes in the initial implementation stages, comparable to the mastery phase.