Rate Of Fracture Healing Research Articles

Treatment of Unstable Sacral Fractures with Robotically-aided Minimally Invasive Triangular Fixation.

The treatment of unstable sacral fractures is huge challenge to surgeons. Robotically-aided minimally invasive triangular fixation (RoboTFX) is the most advanced technique up to now. This study is to evaluate the clinical outcomes of unstable sacral fractures treated with RoboTFX. From March 2017 to October 2021, 48 consecutive patients with unstable sacral fractures were included in the study. All patients received surgical treatment with triangular fixation (TFX). Patients were divided into four groups according to the number of fractures (uni- or bilateral) and surgical method employed (RoboTFX or traditional open TFX). Between these four groups, clinical data on operation time, intraoperative bleeding, intraoperative fluoroscopy time, infection rate, fracture healing rates, insertion accuracy, Majeed pelvic outcome score, Mears' criterion, and Gibbons score were compared. Quantitative data were expressed as mean ± standard deviation and compared using Student's t-test. Categorical variable were compared using the Pearson's χ2 test. Comparing unilateral RoboTFX versus open TFX, neither fracture healing rate, infection rate, Majeed pelvic outcome score, Mears' radiological evaluation criterion, nor Gibbons score of the two groups were statistically significantly different (p > 0.05). However, operation time, intraoperative bleeding, intraoperative fluoroscopy time, and insertion accuracy in the RoboTFX group were all significantly better than those of the traditional open group (p < 0.05). Likewise, operation time, intraoperative bleeding, intraoperative fluoroscopy time, and accuracy of fixation insertion of the bilateral RoboTFX group were significantly better than those of the bilateral open group (p < 0.05). Meanwhile infection rate, fracture healing rate, Majeed score, Mears' criterion, and Gibbons score of two groups were not significantly different (p > 0.05). RoboTFX has the advantages of less operation time, less intraoperative bleeding and fluoroscopy, more accurate fixation insertion, and a higher healing rate compared to traditional open methods in the treatment of unstable sacral fractures. However, RoboTFX requires a few critical considerations, and the indications of its operation should be strictly evaluated.

Treatment of tibial traumatic osteomyelitis with negative pressure closure drainage combined with open bone grafting or bone migration and its effect on the levels of CRP, TNF-α and IL-6 in the serum.

To observe the effect of negative pressure closure drainage combined with open bone grafting or bone migration in the treatment of tibial traumatic osteomyelitis. Eighty-six (86) cases of tibial traumatic osteomyelitis admitted to Hospital of the Chinese people's Liberation Army from September 2017 to September 2018 were randomly divided into control group and observation group, forty-three (43) cases each. Debridement, open bone grafting or bone migration was given to the control group.The observation group was treated with negative pressure closed drainage on the basis of the control group. In addition, the serum components such as CRP, TNF-α, IL-6 of the control group and observation group were detected respectively after surgery. Observation group granulation cover wound, fracture healing time was shorter than the control group, fracture healing rate was better than the control group, the difference has statistical significance (P<0.05). By comparing serum CRP, TNF-α, IL-6 levels before and after treatment in the two groups, it was found that the observation group was lower than the control group (P<0.05, respectively). Serum CRP, TNF-α, IL-6 levels were significantly (P<0.05). The treatment of tibial traumatic osteomyelitis with negative pressure closure drainage combined with open bone grafting or bone displacement has a good effect on fracture healing and is worth popularizing.

Treatment of Distal Third Humeral Shaft Fracture with Intramedullary Nail Combined with Anterior Minimally Invasive Plate Osteosynthesis.

The treatment of distal third humeral shaft fracture is difficult. Studies have shown that anterior minimally invasive plate has lower probability of complication and higher healing rate. However there is no applicable anatomical plate at present. This study is to investigate the clinical effect of intramedullary nail combined with anterior minimally invasive plate in the treatment of distal humeral shaft fractures. The data of 83 patients with lower humerus shaft fracture treated from September 2015 to January 2020 were analyzed. According to different treatment methods, they were divided into two groups: 40 patients were treated with intramedullary nailing combined with minimally invasive anterior plate fixation (group A), and 43 patients were treated with double plate fixation through posterior approach (group B). General preoperative data, operative time, intraoperative blood loss, total incision length, fracture healing time, shoulder and elbow visual analogue scale (VAS) score, Constant-Murley shoulder function score, Mayo elbow function score, and complications were recorded and compared between the two groups. Two independent sample t-tests was used for follow-up, age, BMI, operation time, intraoperative bleeding, total incision length, fracture healing time, Constant-Murley score and Mayo score, and rank sum test was used for VAS score of shoulder and elbow. There was no significant difference in preoperative general data between the two groups (p > 0.05), indicating comparability. There were no significant differences in operation time, total incision length, fracture healing time, Constant-Murley shoulder function score at the last follow-up, Mayo elbow function score, and shoulder and elbow VAS pain score between 2 groups (p > 0.05). The amount of intraoperative blood loss in observation group was 76.98 ± 16.46, which was significantly less than that in control group, and the difference was statistically significant (p < 0.01). There were no radial nerve injury, musculocutaneous nerve injury, incision infection and fracture nonunion in the observation group. In the control group, four cases of iatrogenic radial nerve injury, three cases of incision infection and three cases of fracture nonunion were found. The complication rate was 23.3% (10/43). There was statistical difference in the incidence of complications between the two groups (p < 0.01). A humeral intramedullary nail combined with an anterior minimally invasive plate in the treatment of distal humeral shaft fracture has the advantages of less soft tissue damage, less blood transfusion, high fracture healing rate and low risk of iatrogenic radial nerve injury, which is an effective method for clinical treatment of this type of fracture.

Waterproof Hip Spica Casts for Pediatric Femur Fractures.

Hip spica casting is the treatment of choice for femur fractures in children ages 6 months to 5 years. Traditional spica (TS) casting utilizes cotton padding that precludes patient bathing. Waterproof (WP) casting has inherent advantages, including clearance for bathing and improved family satisfaction. This study examines the safety and efficacy of WP hip spica casting for the treatment of pediatric femur fractures. This is a retrospective, matched cohort study of patients ≤5 years with a femur fracture treated with hip spica casting. Patients with WP casts were matched to patients with TS casts by age, sex, and fracture type. TS casts utilize a Goretex liner and cotton padding, while WP spicas utilize fully WP materials and can be completely submerged in water. Fifty patients were included (25 WP, 25 TS) without differences between cohorts in age, weight, or sex. There were no differences in operative time, length of stay, or length of time in cast. Patient charges were significantly lower in the WP group ($230 vs. $301, P<0.001). At cast-off, coronal/sagittal alignment and shortening were similar, while 9 TS patients had minor skin and/or cast complications that required outpatient repair versus only 1 WP patient (P<0.001). In a matched comparison, WP spica casting significantly reduces skin and cast complications traditionally associated with cotton-based spica casting, with significantly lower charges for WP cast materials. Fracture healing rate, alignment, and shortening at cast-off are similar in WP versus TS casts. WP spica casting is safe and efficacious for pediatric femur fractures, with the inherent advantage of clearance for bathing. Level 3.

Bundled Bone Grafting Effectively Promotes Callus Growth and Accelerates Fracture Healing in the Operation of Nonunion or Bone Defects

This study aims to investigate the clinical application potential of bundled bone grafting in the management of nonunion or bone defects after internal fixation. A total of 34 patients with nonunion or partial bone defects after internal fixation of femoral shaft fracture at our hospital from March 2018 to January 2020 were included in this study. They were randomly divided into a control group treated with filling/compressed bone grafting (n = 17) and a test group receiving bundled bone grafting (n = 17) patients receiving bundled bone grafting. The healing rate of fracture, the length and healing time of callus growth, and the lower extremity function were assessed in the two groups. The test group exhibited a significantly higher fracture healing rate compared to the control group (100% vs. 76.47%, P &lt; 0.05). Moreover, the test group demonstrated superior callus growth length when compared to the control group [(2.64±0.48) cm vs. (1.72 ±0.35) cm, P &lt; 0.05]. Additionally, the test group exhibited a significantly shorter healing time than the control group [(6.73 ± 1.24) months vs. (8.12 ± 1.48) months, P &lt; 0.05]. The total efficacy rate for lower extremity function in the test group was significantly higher at 94.12% compared to the control group’s rate of 64.71%. In conclusion, the utilization of bundled bone grafting can promote callus growth and accelerate fracture healing in the management of nonunion or bone defects after internal fixation.

Robotic-assisted systems for the safe and reliable treatment of femoral neck fractures: retrospective cohort study

BackgroundRobots are being used in a wide range of surgical procedures. However, in clinical practice, the efficacy of orthopedic robotic-assisted treatment of femoral neck fractures is still poorly reported, particularly in terms of screw placement accuracy, femoral neck fracture healing rates and postoperative functional recovery. Moreover, there is a lack of comparative analysis between robot-assisted surgery and traditional surgical approaches.PurposeThe purpose of this study was to compare the clinical outcomes of patients with femoral neck fractures treated with TiRobot-assisted hollow screw fixation with those of patients with femoral neck fractures treated with traditional surgical approaches.MethodsThis study included 112 patients with femoral neck fracture who were treated from March 2017 to October 2021 with percutaneous hollow screw internal fixation. These included 56 cases in the TiRobot-assisted surgery group and 56 cases in the standard surgery group. After at least 1 year of follow-up, the treatment outcomes of the two groups were compared, including the amount of intraoperative bleeding, the duration of intraoperative fluoroscopy, the number of guide pin positioning adjustments, the length of hospital stay, the accuracy rate of screw placement, the final Harris Hip Score, the fracture healing rate, and the rate of femoral head necrosis. Statistical analysis software was used to process and analyze the result.ResultsThe TiRobot-assisted group had a statistically significant improvement over the control group in terms of intraoperative bleeding, the duration of intraoperative fluoroscopy, the number of guide pin positioning adjustments, length of hospital stay, accuracy of screw placement and incidence of femoral head necrosis (P < 0.05). There was no statistically significant difference in time to surgery, final Harris hip score and fracture healing rate (P > 0.05).ConclusionThis study shows that TiRobot-assisted surgery has the advantages of short hospital stay, high safety, minimally invasive, high success rate of nail placement, and can reduce the amount of intraoperative radiation and the incidence of femoral head necrosis, thus achieving satisfactory clinical outcomes, and is worthy of clinical promotion.

Study on effectiveness of treating femoral neck fractures based on theory of "positive support"

To explore effectiveness of positive support reduction and internal fixation in the treatment of femoral neck fractures. A clinical data of 74 patients with femoral neck fractures treated with hollow screw internal fixation between September 2017 and September 2021 was retrospectively analyzed. Based on the quality of fracture reduction, they were divided into positive support reduction group (group A, n=25), negative support reduction group (group B, n=21), and anatomical reduction group (group C, n=28). There was no significant difference in baseline data such as gender, age, cause of injury, disease duration, fracture side, Garden classification, and fracture line position classification between groups (P>0.05). The occurrence of complications such as early fixation failure, femoral neck shortening, non-union of fractures, and femoral head necrosis in three groups, as well as the Harris score of the hip joint were recorded and compared. All patients had primary healing of incisions after operation and were followed up more than 12 months. The follow-up time for groups A, B, and C was (21.1±5.7), (22.6±4.3), and (21.9±4.1) months, respectively; there was no significant difference between groups (P>0.05). There was no significant difference in the incidences of non-union of fractures, early internal fixation failure, and the femoral head necrosis between groups (P>0.05). The incidence and length of femoral neck shortening, and the hip Harris score at last follow-up in groups A and C were all superior to those in the group B, with significant difference (P<0.05). There was no significant difference in the above indicators between groups A and C (P>0.05). Positive support reduction can provide a good biomechanical environment for the healing of femoral neck fractures, thereby achieving a higher fracture healing rate, reducing the occurrence of femoral neck shortening, minimizing the function of hip joint, and achieving effectiveness similar to anatomical reduction.

Preparation and performance of self-healing SBS modified bitumen based on dynamic disulfide bonds

In this study, self-healing SBS (S-SBS) was first synthesized by introducing dynamic disulfide bonds into the molecular structure of SBS. Subsequently, a self-healing SBS modified bitumen (S-SMB) was prepared by blending of S-SBS and bitumen. The chemical structure of S-SBS and S-SMB was charactered by Fouriertransform infrared spectrometer (FTIR) and Raman spectrometer. The physical properties, low-temperature rheological properties and self-healing performance of S-SMB were investigated. The results of FTIR and Raman showed that dynamic disulfide bonds were successfully introduced into the molecular structure of SBS. With the increase of dynamic disulfide bonds content in SBS molecular structure, the softening point and ductility of S-SMB enhanced, and the penetration was decreased. Fluorescence microscope showed that the S-SBS in S-SMB formed a complete crosslinking network structure compared to SMB. The bending beam rheometer illustrated that the low-temperature rheological properties and the cracking resistance of SMB were improved by introducing dynamic disulfide bonds. The fluorescence microscopy observation indicated that the crack in S-SBS can self heal. The fracture healing test and fatigue healing test demonstrated that dynamic disulfide bonds endow S-SMB with great self-healing performance. The fracture healing rate of S-SMB reached 58.7% after 4 h of healing, and the fatigue healing index reached 0.93 after 1 h of healing.

Achieving Rapid Healing and Low Complication Rates in Patellar Fracture Fixation: The Benefits of Cerclage and Figure-of-Eight Configuration.

Background and objective Patellarfractures account for around 1% of all fractures. Conservative treatment is advised in patients without any incompatibility of articular surfaces or those with intact extensor mechanisms. More than a 2-mm articular gap due to fracture warrants surgical intervention. Tension band wiring (TBW) is a commonly used practice for fixation, However, there is still controversy about its effectiveness and complications arising due to the hardware. Modification of this technique by using K-wires has been considered a method of choice, but this technique is associated with complications due to K-wires. The Pyrford technique is a method for patellar fracture fixation by circumferential cerclageand anterior TBW. We employed the figure-of-eight configuration over the circumferential wire. This study aimed to analyze the outcomes ofTBW of the patella without K-wires by assessing the rate of complication and functional outcomes. Materials and methods A total of 38 patientswithOTA 34C type, simple and comminuted type of patella fractures aged between22 and 70 years were treated with circumferential cerclage and figure-of-eight TBW.All patients underwent patellar fixation with cerclage and through direct purchase of SS wire via quadriceps and patellar tendon. Patients were followed up for one to three years. We analyzed differences in the range of motion, fracture reduction, fracture healing time, Bostman score for knee function, and complications. Results The mean age of the patients was 45 years. After TBW without K-wires, fracture healing and functional outcomes were satisfactory according to patient feedback and clinocoradiological examinations. Of note, 35 out of 38 patients (92%) had gained up to 90 degrees of active flexion at the end of one week. One patient (2.42%) developed a superficial infection. All fractures had achieved union at the end of 16 weeks. Malunion or nonunion was not noted in any of the cases. There was no case of implant removal. The average Bostman score at the 12-month follow-up was 28.5 ±1.5. The incidence of complications due to K-wire was nullified. Conclusion Based on our findings, the described method leads to better functional outcomes, decreasing hardware-related complications, and can be used in simple as well as comminuted fractures. The fracture healing and functional outcomes and rate of complications were satisfactory.

Incidence and factors influencing neck shortening after screw fixation of femoral neck fractures with the femoral neck system

ObjectiveTo investigate the effects of postoperative femoral neck shortening in patients with femoral neck fractures fixed with femoral neck system screws (FNS) and to explore the factors influencing femoral neck shortening.MethodTo retrospectively analyze the data of 113 patients with femoral neck fractures admitted to the Second Hospital of Fuzhou City, affiliated with Xiamen University, between December 2019 and January 2022. Of these, 87 patients were followed up for more than 12 months, 49 men and 38 women: 36 cases of Garden I and II fractures and 51 cases of Garden III and IV fractures, to record the patient's hip Harris score at 12 months postoperatively. Patients were divided into femoral neck shortening group and femoral neck no shortening group according to their regular postoperative follow-up radiographic measurements. To count the incidence of femoral neck shortening, a comparison of postoperative complication rates and hip Harris scores between the two groups was made. Statistical comparison of the two groups and a multifactorial logistic regression analysis were also performed to analyze the factors affecting femoral neck shortening.ResultsAll 87 patients were followed up for more than 12 months after surgery. In 34 of these cases, neck shortening occurred, and the incidence rate was 39.1%. 15 cases of severe shortening, incidence of 17.2%; fracture healing 84 cases, fracture healing rate of 96.5%. The hip Harris score was 83.99 (81.95, 89.20) in the neck shortening group at 12 months postoperatively, 90.87 (87.95, 94.80) for the group without neck shortening; the difference between the two groups was statistically significant (P < 0.01). 32 cases of fracture healing in the neck shortening group at 12 months after surgery, fracture healing rate of 94.1%; 52 cases healed without neck shortening group, fracture healing rate of 98.1%. The difference between the two groups was not statistically significant (P = 0.337). High incidence of neck shortening after FNS fixation of femoral neck fractures, cortical comminution of the severed end, fracture fractionation and quality of reduction were significantly correlated with neck shortening.ConclusionHigh incidence of postoperative neck shortening after internal fixation of femoral neck fractures with the femoral neck system, the cortical comminution, the type of fracture, and the quality of fracture reduction are the influencing factors; femoral neck shortening can affect postoperative hip function, but does not affect fracture healing.

Evaluation of surgical outcomes in elderly patients with rib fractures: A single-centre propensity score matching study.

Rib fractures are the most common injuries in chest trauma. Compared with younger patients, elderly patients with rib fracture have a higher incidence of complications and mortality. A retrospective study was conducted to investigate the effect of internal fixation compared with conservative treatment on the outcome of rib fracture in elderly patients. We used a 1:1 propensity score matching method to perform a retrospective analysis of 703 elderly patients with rib fractures treated in the Thoracic Surgery Department of Beijing Jishuitan Hospital between 2013 and 2020. After matching, the length of hospital stay, death, symptom relief and rib fracture healing were compared between the surgery and the control group. The study included 121 patients receiving SSRF in the surgery group and 121 patients receiving conservative treatment in the control group. The length of hospital stay in the surgery group was significantly longer than that in the conservative group (11.39d vs. 9.48d, p = 0.000). After 9 months of follow-up, the fracture healing rate in the surgery group was significantly higher than that in the control group (96.67% vs. 88.89%, p = 0.020). The fracture healing time (p = 0.000), improvement in pain score (p = 0.000) and duration of pain medication use (p = 0.000) were also significantly better in the surgery group than in the control group. Compared with conservative treatment, surgical treatment can prolong hospital stay to some extent. However, it has the advantages of more rapid healing and lessened pain. For rib fractures in elderly individuals, surgical treatment is a safe and effective option under strict surgical indications and is recommended.

Percutaneous Osteosynthesis in Tibial Pilon Fractures: A Study Concerning a Serie of 8 Patients

Minimally invasive medial plate osteosynthesis is a reliable method of treatment for tibial pilon fractures. This technique provides a high fracture healing rate and satisfying functional outcome with minimal wound healing complications. Sagittal plan deformity remains a common complication with minimally invasive medial plate osteosynthesis. The aim of this study was to evaluate the long-term follow-up and functional and radiological outcomes of minimally invasive medial plate osteosynthesis in distal tibia fractures concerning a serie of 8 patients.

Functional outcomes of periprosthetic and non-periprosthetic distal femur fractures: a comparative study

Aim: The purpose of this study was to compare the outcomes of locked plating in closed distal femur periprosthetic, and non-periprosthetic fractures. We hypothesized that the outcomes would be superior in the non-periprosthetic distal femur fracture group.&#x0D; Material and Method: Patients who underwent surgery for distal femur fractures between January 2019 and January 2022 were retrospectively reviewed. Patients aged under 18 years, who had multiple fractures, pathological fractures, follow-up less than 6 months, previous history of revision knee arthroplasty, interprosthetic fractures between hip and knee arthroplasties, fixation performed other than distal locking femoral plate and intra-operative periprosthetic fractures were excluded. Patients’ age, gender, laterality, length of hospital stay, and follow-up duration were obtained from hospital registry notes. Fractures were classified using the AO classification system. At the last follow-up, visual analogue scale (VAS), Tegner activity score, Lysholm knee score, and short form 36 (SF-36) scores were noted.&#x0D; Results: A total of 30 patients met the inclusion criteria and were included in the study. There were 14 patients in the non-periprosthetic fracture group and 16 patients in the periprosthetic fracture group. The periprosthetic group had significantly lower mean VAS score (p=0.047), Tegner activity score (p=0.015), and Lysholm knee score (p=0.034) than the non-periprosthetic group. The periprosthetic fracture group had significantly inferior quality of life scores compared to non-periprosthetic groups based on SF-36 sub-parameters.&#x0D; Conclusion: Periprosthetic distal femoral fractures have inferior clinical outcomes and quality of life than non-periprosthetic fractures despite having similar fracture healing rate. Orthopaedic surgeons should be aware of the frailty of the patients caused by prior total knee arthroplasty surgery.

The Effect of Vitamin D Supplementation for Bone Healing in Fracture Patients: A Systematic Review.

While most literature on vitamin D supplementation in fracture patients focuses on fracture prevention, the effect of vitamin D on bone healing is a much less studied concept. The primary aim of this systematic review was to assess whether vitamin D supplementation in fracture patients improves clinical or radiological union complications. The secondary aims were to assess supplementation effect on patient functional outcome scores and bone mineral density (BMD). A systematic search of all relevant articles was performed using the following databases: MEDLINE, Embase, Google Scholar, and Web of Science. The population selection included human patients with a fresh fracture treated conservatively or operatively. The intervention included any form of vitamin D supplementation, compared to no supplementation or a placebo. The primary outcomes assessed were clinical or radiological union rates or complications arising from the nonunion. The secondary outcomes assessed were functional outcome scores, BMD scores after treatment, and pain scores. A total of fourteen studies, assessing a total of 2734 patients, were included. Eight studies assessed the effect of vitamin D on clinical or radiological union. Five studies reported no significant difference in complication rates when supplementing fracture patients. Alternatively, three studies reported a positive effect with supplementation between the groups. One of these studies found a difference only for early orthopaedic complications (<30 days), but no differences in late complications. The other two studies found significant differences in clinical union; however, no changes were observed in radiological union. Six studies investigated functional outcome scores after supplementation. Four of these studies found no significant differences between most functional outcome scores. Only three studies reported BMD outcomes, one of which found limited effect on total hip BMD. The overall findings are that vitamin D alone does little to influence fracture healing and subsequent union rates or functional outcome. The studies suggestive of a positive effect were generally of a lower quality. Further high quality RCTs are needed to justify routine supplementation at the time of fracture.

Prospective randomized multicenter noninferiority clinical trial evaluating the use of TFN-advancedTM proximal femoral nailing system (TFNA) for the treatment of proximal femur fracture in a Chinese population

PurposeTo evaluate whether the 24-weeks postoperative fracture union rate for the investigational TFNA intramedullary nail was non-inferior compared to the control product PFNA-II.MethodsThe study was a prospective, randomized, single-blind, noninferiority dual-arm study drawing from 9 trauma centers across China, between November 2018 and September 2020, with follow-up measurements at 24 weeks after internal fixation. The full analysis data set (FAS [Intent-to-Treat]) was analyzed and is summarized here. The primary outcome was fracture union rate, a composite score combining clinical and radiographic assessment. Secondary endpoints comprised (a) clinical outcomes including (1) SF-12, (2) Harris Hip, and (3) EQ-5D Scores, (b) radiographic incidence of complications such as loosening or cut-out requiring revision, (c) revision rates, (d) reoperation rates, and (e) adverse events, including 24-weeks revision and reoperation rates.ResultsBoth TFNA and PFNA-II group fracture healing rates were 100% at 24 weeks; TFNA was therefore shown to be non-inferior to PFNA-II. With baseline data matched in all parameters except age in both the TFNA and PFNA-II groups, comparisons of union rates, SF-12, Harris Hip, and EQ-5D Scores yielded p values > 0.05 indicating no significant difference between the two groups, further supporting the noninferiority of TFNA. In both groups, revision and re-operation rates were 0, and the incidences of serious adverse events were 19.4% and 17.4%, respectively.ConclusionIn terms of fracture union rate at 24 weeks, the DePuy Synthes Trochanteric Fixation Nail Advanced (TFNA) was not inferior to the marketed Proximal Femoral Nail Antirotation (PFNA-II) device produced by the same manufacturer. Secondary and safety outcomes showed no significant differences between the two groups.RegistrationRegistration was completed at ClinicalTrials.gov NCT03635320.

EARLY BISPHOSPHONATE THERAPY POST PROXIMAL FEMORAL FIXATION DOES NOT IMPACT FRACTURE HEALING

There is conjecture on the optimal timing to administer bisphosphonate therapy following operative fixation of low- trauma hip fractures. Factors include recommendations for early opportunistic commencement of osteoporosis treatment, and clinician concern regarding the effect of bisphosphonates on fracture healing. We performed a systematic review and meta-analysis to determine if early administration of bisphosphonate therapy within the first month post-operatively following proximal femur fracture fixation is associated with delay in fracture healing or rates of delayed or non-union.We included randomised controlled trials examining fracture healing and union rates in adults with proximal femoral fractures undergoing osteosynthesis fixation methods and administered bisphosphonates within one month of operation with a control group. Data was pooled in meta-analyses where possible. The Cochrane Risk of Bias Tool and the GRADE approach were used to assess validity.For the outcome of time to fracture union, meta-analysis of three studies (n= 233) found evidence for earlier average time to union for patients receiving early bisphosphonate intervention (MD = −1.06 weeks, 95% CI −2.01 – −0.12, I2= 8%). There was no evidence from two included studies comprising 718 patients of any difference in rates of delayed union (RR 0.61, 95% CI 0.25–1.46). Meta-analyses did not demonstrate a difference in outcomes of mortality, function, or pain.We provide low-level evidence that there is no reduction in time to healing or delay in bony union for patients receiving bisphosphonates within one month of proximal femur fixation.

Clinical observation on the treatment of ankle fracture with buttress plate and traditional internal fixation and its effect on GQOLI-74 score and Baird-Jackson score.

To explore the curative effect of buttress plate and traditional internal fixation in the treatment of ankle fracture, so as to provide potential reference for the clinical treatment of this disease. This is a clinical comparative study. The subjects of this study were one hundred patients with ankle fracture treated in Mindong Hospital Affiliated to Fujian Medical University from January 2019 to December 2021. Enrolled patients were randomly divided into the control group and the experimental group. Patients in the control group were treated with traditional internal fixation, and those in the experimental group were provided with buttress plate. Patients were compared in several aspects such as the comprehensive quality of life assessment questionnaire (GQOLI-74), Baird-Jackson score and postoperative complications. The experimental group showed improved Baird-Jackson score after treatment, significantly higher fracture healing rate than that of the control group three months after treatment. Besides, there was no significant difference in the complications between the two groups, with good prognosis after timely treatment. Internal fixation with buttress plate has obvious advantages in the treatment of ankle fractures, which can effectively improve the quality of life and promote the rapid healing of fractures. It is worthy of clinical promotion and application.

The optimal design of 3D-printed lattice bone plate by considering fracture healing mechanism.

The biomechanical stimulus is the most important factor for fracture healing and mainly determined by the structural stiffness of bone plate. Currently, the materials commonly used in bone plates are stainless steel and titanium, which often lead to stress shielding effects because of their higher elastic modulus compared with the bone. This article suggests an optimal design method of lattice bone plate based on fracture healing theory. First, the mechanical regulation model with deviatoric strain is established to simulate the tissue differentiation process during fracture healing process. The ratio of the average elastic modulus of callus at the 120th day to the elastic modulus of mature bone is used to characterize the fracture healing rate. Second, the optimal elastic modulus of the design domain is obtained by the optimization mathematical model with the maximum fracture healing rate. Then, the design domain is filled with microstructures, the porosity of which is adjusted to make it possible that the equivalent elastic modulus is equal to the optimized value. And the finite element analysis of the bone plate with microstructure is executed. Finally, the designed lattice bone plates are manufactured through 3D printing, and the mechanical test is carried out. The simulation results indicate that the fracture healing rate is maximum when the elastic modulus of material in design domain is 38 GPa under the constraints of fixation stability. And both the finite element analysis and experiment results show that the designed lattice bone plate meet the strength requirements of fracture internal fixation implants.

Effectiveness of new Pilon plate in treatment of type C Pilon fracture

By comparing with traditional L-shaped plate, to explore the effectiveness of new Pilon plate in the treatment of type C Pilon fracture. A clinical data of 57 patients with type C Pilon fractures who met the selection criteria between May 2018 and January 2020 was analyzed retrospectively. Thirty-two patients were treated with new Pilon plate (trial group) and 25 patients with traditional L-shaped plate (control group). There was no significant difference in gender, age, cause of injury, fracture side and type, the interval between injury and operation between the two groups (P>0.05). The operation time and complications of the two groups were recorded. X-ray films were taken after operation to assess the quality of fracture reduction according to the Burwell-Charnley classification and fracture healing. Ankle function was evaluated according to Johner-Wruhs scoring standard and American Orthopaedic Foot and Ankle Society (AOFAS) score. The operations of the two groups were completed successfully, and the operation time of the trial group was significantly shorter than that of the control group (t=-3.025, P=0.005). After operation, the incision necrosis occurred in 2 cases of the control group, and the incisions of other patients in both groups healed by first intention. All patients were followed up 8-16 months, with an average of 10.1 months. There was no significant difference in follow-up time between the two groups (t=0.433, P=0.667). X-ray films showed that the ankle reduction of the trial group was rated as excellent in 28 cases and good in 4 cases, with an excellent and good rate of 100%, while in the control group, the ankle reduction was rated as excellent in 15 cases, good in 5 cases, and fair in 5 cases, with an excellent and good rate of 80.0%. There was a significant difference in the excellent and good rate of fracture reduction between the two groups (Z=-2.565，P=0.010). The fracture healed in both groups, and the healing time was (16.59±3.78) weeks in the trial group and (17.80±3.81) weeks in the control group, and there was no significant difference between the two groups (t=-1.191, P=0.239). At last follow-up, according to Johner-Wruhs scoring standard, the ankle joint function in the trial group was evaluated as excellent in 25 cases and good in 7 cases, with an excellent and good rate of 100%; the AOFAS score was 90.9±4.5. In the control group, 16 cases were excellent, 5 cases were good, and 4 cases were fair, and the excellent and good rate was 84.0%; the AOFAS score was 85.2±10.0. The ankle function scores of the trial group was superior to that of the control group (P<0.05). During follow-up, except for 1 case of ankle traumatic arthritis in the control group, there was no complication such as ankle malunion, plate loosening and fracture, or fracture reduction loss in both groups. Compared with the traditional L-shaped plate, the new Pilon plate in the treatment of type C Pilon fracture has the advantages of high reduction quality, reliable fixation, less irritation to soft tissue, high fracture healing rate, and satisfactory functional recovery of ankle joint.

Application of damage control orthopaedics in treatment of massive hemorrhage in severe traumatic fractures

This study is designed to investigate the clinical application value of the damage control orthopaedics (DCO) concept in guiding the treatment of severe traumatic fractures with massive hemorrhage. Using the introduction of the DCO concept in the hospital in June 2021 as the cut-off point, patients with severe traumatic fractures and major bleeding admitted in the two periods before the introduction of the DCO concept (January 2021~May 2021) and after the introduction of the DCO concept (June 2021~January 2022) were included as control group (n = 39) and observation group (n = 39), respectively. The control group was given conventional surgery and treatment, whereas the DCO group received treatment and surgery under the guidance of the DCO concept. The results of the intervention were compared between the two groups. The time from admission to definitive surgery was longer in the DCO group than that in the control group. Fewer suspended red blood cells, fresh frozen plasma and platelets were used in the DCO group compared to the control group. The total hospital stay was shorter and the rates of postoperative complications and mortality were lower in the DCO group than those in the control group. Patients were followed up for 6–8 months, with an average of (6.87 ± 1.15) months, and the results showed that the fracture healing rate in DCO group was higher than that in the control group. The concept of DCO could correctly guide the treatment of severe traumatic fractures complicated by massive hemorrhage, and improve the therapeutic safety, reduce the incidence of postoperative complications and mortality, and enhance the later fracture healing rate of patients.