Internal Fixation Of Fractures Research Articles

Comparison of Hemiarthroplasty, total hip arthroplasty, and internal fixation for hip fractures in patients over eighty years of age: factors affecting mortality: a nationwide cohort study of fifty three thousand, four hundred and ninety five patients from Türkiye

Abstract Purpose Hip fractures are a common cause of mortality in elderly patients. This study aimed to determine the predictive factors affecting mortality among patients over the age of 80 who underwent surgical treatment for hip fractures. Methods We searched the Turkish Ministry of Health’s e-health database to identify patients over 80 years old who had undergone surgery for proximal femoral fractures from 2016 to 2022. This process yielded 53,495 patients. Demographic data as well as comorbidities, blood transfusions, postoperative 90 days medical complications, and mortality was investigated. Multivariate logistic regression analysis was performed to identify risk factors for one year mortality in patients undergoing surgical treatment for proximal hip fractures. Results The mortality rate was 37.2% in the first year. The mean Charlson comorbidity index(CCI) was 6.8 (range: 4–22). In the postoperative period, 68.6% of the patients received blood transfusions. Logistic regression analysis identified significant predictors of one-year mortality in surgical patients, including male gender, increased age, higher CCI scores, AKI, PE, pneumonia, electrolyte imbalance, gastrointestinal bleeding, blood transfusion, and increased mortality risks with hemiarthroplasty and internal fixation compared to total hip arthroplasty. (p < 0.001 for all). Conclusions This large cohort study demonstrated that the mortality rate is high and that the type of surgery, male gender, older age, blood transfusion requirements, and high CCI score are associated with mortality in patients over 80 years of age who have undergone surgery for hip fractures. Preoperative optimization and postoperative care are critical for these vulnerable elderly patients.

Is routine Gram-negative antibiotic coverage required for optimum antibiotic prophylaxis in open reduction and internal fixation of fractures? A multicenter analysis of bacteria pathogens in fracture-related infections.

Measures directed at infection prevention, particularly perioperative systemic antibiotic prophylaxis, have received widespread implementation and are considered a standard of care for patients undergoing operative management of fractures, especially with implant use. This study aimed to review the microbiology profile of patients with fracture-related infections (FRIs) in a sub-Saharan African country in order to establish the necessity or otherwise of Gram-negative cover in the selection of antibiotics for perioperative prophylaxis. This study retrospectively reviewed records of adult patients (aged 18years and above) diagnosed with FRI from January 2018 to December 2022 in ten tertiary hospitals in Nigeria. Data related to demographics, fracture and FRI classification as well as pathogenic bacteria were obtained while data were analyzed with SPSS version 23. Over the study period, 137 cases met the inclusion criteria and their data were obtained for analysis. Gram-positive and Gram-negative bacteria species accounted for 70 (51%) and 67 (49%), respectively, of the entire microorganisms identified by bacteriological culture. The most common organisms isolated from culture include Staphylococcus aureus (62, 45.3%), Escherichia coli (29, 21.2%), Klebsiella pneumonia (17, 12.4%) and Pseudomonas aeruginosa (11, 8.1%). The distribution of pathogenic bacteria isolated from positive cultures of infected closed and open fractures revealed a predominance of Gram-negative bacteria in closed fractures accounting for 45(55.6%) of the 81 organisms isolated; however, Gram-negative organisms accounted for only 22 (39.3%) of the 56 organisms isolated in open fractures (P = 0.061). The findings in this study suggest that Gram-negative cover may be necessary for optimal perioperative antibiotic coverage, particularly in the sub-Saharan Africa setting in patients undergoing internal fixation of fractures. We recommend that individual institutions should establish local prophylactic protocols that provide Gram-positive and Gram-negative pathogen coverage guided by local microbiological flora.

Acute Open Reduction and Internal Fixation versus Non-Operative Treatment of Scapular Spine Fractures after Reverse Shoulder Arthroplasty: A Propensity Score-Matched Study

Acute Open Reduction and Internal Fixation versus Non-Operative Treatment of Scapular Spine Fractures after Reverse Shoulder Arthroplasty: A Propensity Score-Matched Study

The clinical frailty scale is associated with an increased risk of postoperative complications and the development of post-traumatic osteoarthritis in elderly patients with trimalleolar ankle fractures - a retrospective study

BackgroundThe Clinical Frailty Scale (CFS) is a tool to assess the overall health of older adults. There are few reports of CFS and prognosis of ankle fracture. The objective of this study was to determine the predictive power of the CFS for adverse clinical and radiographic outcomes after surgery in elderly patients with trimalleolar fractures.MethodAll patients aged 65 and older underwent open reduction and internal fixation for trimalleolar fractures between January 2015 to January 2023 were selected. Follow-up time was at least 1 year. Patients with post-traumatic osteoarthritis, bone tumors, bone infection, and other diseases before surgery were excluded. According to the CFS score, the patients were divided into three groups: not frail, vulnerable, and frail. Multivariate logistic regression analysis was used to evaluate the effect of the clinical frailty scale on postoperative complications.ResultExcluding 3 cases of death during the follow-up process, and 4 cases lost to follow-up, the study included a total of 146 patients, who were grouped based on their degree of frailty: the Healthy Group (CFS = 1–3, n = 69), the Vulnerable Group (CFS = 4, n = 50), and the Frail Group (CFS = 5–9, n = 47). In comparison with the not frail group, frail (CFS 5–9) emerged as an independent predictor of any complications (OR = 6.90, CI: 1.43–11.56, P = 0.009), adverse discharge destination (OR = 7.53, CI: 2.06–77.50, P = 0.006), and post-traumatic osteoarthritis (OR = 8.90, CI: 1.94–24.66, P = 0.003).ConclusionsThe frailty assessed by the CFS is associated with adverse discharge destination, any complications, and post-traumatic osteoarthritis in elderly patients undergoing open reduction and internal fixation for trimalleolar fractures.

Feasibility of the preauricular transparotid approach in open reduction and internal fixation of intracapsular mandibular condyle fracture.

Mandibular condyle fractures pose surgical challenges owing to their proximity to the facial nerve and the complex temporomandibular joint anatomy. Traditional approaches limit exposure and hinder effective fracture management. The preauricular transparotid approach is a potential alternative. We aimed to assess the feasibility of this approach and the postoperative complications. A retrospective analysis of 45 patients who underwent open reduction/internal fixation (OR/IF) for intracapsular condylar fractures using a preauricular transparotid approach was conducted. Patient demographics, surgical procedures, radiological assessments, and postoperative complications were analyzed. The preoperative computed tomography analysis revealed the fractured segment's location: 17.0±2.6mm anteriorly, 24.0±4.0mm medially, and 17.8±3.7mm inferiorly from the remaining condyle end. A cubic space of 17-24mm from the condylar stump is necessary to reach the fractured segment end. Postoperative facial nerve weakness occurred in 14 patients but resolved within 4.5 weeks. At 5.5 months of follow-up, the mean interincisional mouth opening measured 40.5±5.1mm, without malocclusion. The approach enhances visualization, facilitates precise fixation, and results in inconspicuous scarring during OR/IF of intracapsular condylar fractures. It requires careful surgical techniques and increases the risk of transient facial nerve weakness. Further research should compare its outcomes with those of traditional approaches and optimize surgical outcomes.

Predicting surgical site infections after open reduction and internal fixation for ankle fractures

IntroductionSurgical site infections (SSI) are one of the more severe complications following ankle surgery. It is associated with worse outcomes and re-admissions. Therefore, identification of risk factors is essential. The aim of this study was to identify risk factors for SSI in patients undergoing surgery for ankle fractures.Materials and methodsA retrospective study was performed in a large cohort (n = 929) of patients who underwent open reduction and internal fixation (ORIF) of ankle fractures between 2015 and 2020 in the Netherlands. The primary outcome variables included rate of SSI (superficial or deep) and deep SSI. Prediction factors were categorized as patient-related, injury-related and treatment-related.ResultsThe incidence rate was 9.36% for SSI and 3.55% for deep SSI. Univariate analysis showed significant associations for higher age (p < 0.001), DM (p = 0.018), ASA 2 and 3 (p = 0.013 and p < 0.001), bi- and trimalleolar fractures (p = 0.021 and p = 0.013), open fractures (p = 0.004) and small size plate compared to screw fixation (p = 0.027). The only independent significant risk factor for SSI in multivariate analysis was open fracture. For deep SSI the significant risk factors were DM (p = 0.039), ASA 3 and 4 (p = 0.001 and p = 0.005) and open fracture (p = 0.002). After multivariate analysis, the independent significant risk factors were open fracture and ASA 3 and 4.ConclusionsHigher age, DM, ASA 2 and 3, bi- and trimalleolar fractures, open fractures and standard plate-size implant placement were identified as significant risk factors for SSI. Open fracture was the only significant independent risk factor for SSI after ORIF of ankle fractures. In deep SSI, there were different risk factors. DM, ASA 3 and 4, and open fractures were significantly associated. Although, open fracture and ASA 3 and 4 were the significant independent risk factors.

Dexmedetomidine as a Neuroprotective Sedative Agent in Ultrasound-Guided Ulnar Nerve Block for a Patient with Traumatic Brain Injury: A Case Report

Introduction: Traumatic brain injury (TBI) often presents alongside extracranial injuries requiring surgical intervention. General anesthesia in such cases poses significant challenges, particularly in patients with concomitant pulmonary complications. This case report describes the successful use of ultrasound-guided ulnar nerve block combined with dexmedetomidine sedation for a patient with moderate TBI and pulmonary contusion undergoing open reduction and internal fixation (ORIF) of a left-hand finger fracture. Case presentation: A 50-year-old male presented with moderate TBI, pulmonary contusion, and an open fracture of the fifth digit of his left hand following a motor vehicle accident. Due to the risks associated with general anesthesia, an ultrasound-guided ulnar nerve block was performed using levobupivacaine 0.375%. Dexmedetomidine was used as a sedative agent due to its neuroprotective properties and minimal respiratory depressant effects. The procedure was successful, with the patient maintaining stable hemodynamics and adequate sedation throughout the surgery. Conclusion: This case highlights the feasibility and safety of ultrasound-guided peripheral nerve block combined with dexmedetomidine sedation as an alternative to general anesthesia in patients with TBI and pulmonary contusion. Dexmedetomidine's neuroprotective effects and minimal respiratory depression make it a valuable tool in managing such complex cases.

Social Determinants of Health in Patients Undergoing Open Reduction and Internal Fixation for Distal Radius Fractures

Social Determinants of Health in Patients Undergoing Open Reduction and Internal Fixation for Distal Radius Fractures

Clinical Efficacy of Three-Dimensional-Printed Pure Titanium Fracture Plates with Locking Screw Systems in Distal Tibia Fractures.

Background and Objectives: Distal tibia fractures are high-energy injuries characterized by a mismatch between standard plate designs and the patient's specific anatomical bone structure, which can lead to severe soft tissue damage. Recent advancements have focused on the development of customized metal plates using three-dimensional (3D) printing technology. However, 3D-printed metal plates using titanium alloys have not incorporated a locking system due to the brittleness of these alloys. Therefore, this study aimed to determine whether a locking mechanism can be effectively implemented using 3D-printed pure titanium and further evaluate the clinical outcomes of such implants in patients with distal tibia fractures. Materials and Methods: Between March 2021 and June 2022, nine patients who underwent open reduction and internal fixation for distal tibia fractures using 3D-printed pure titanium plates were enrolled. Pure titanium powder (Ti Gr.2, Type A, 3D Systems, USA) was spread to a thickness of 30 μm and partially sintered using a 500 W laser to produce the 3D-printed metal plates. The locking screws were fabricated using a milling process. Open reduction and internal fixation were performed on the nine patients using 10 customized plates. The clinical efficacy was analyzed using the union rate, and complications, such as infection and skin irritation, were evaluated to ensure a comprehensive outcome assessment. Results: Surgical treatment was successfully performed on nine patients, with nine of ten plates remaining stable and undamaged. However, one patient with neurofibromatosis experienced a fractured metal plate, which necessitated revision surgery using a metal rod. No screw loosening or surgical wound complications occurred. Conclusions: This study showed that 3D-printed pure titanium plates with integrated locking screw systems provide a viable and effective solution for managing distal tibia fractures. Three-dimensional printing and pure titanium show promise for orthopedic advancements.

Results of open reduction and internal fixation of proximal humerus fractures using a proximal humeral plating system with smooth pegs.

The aim of this study was to evaluate clinical results and complication rate in patients with proximal humeral fracture treated with Anatomical Locking Plate System (A.L.P.S.) Proximal Humeral Plating System with smooth pegs. Retrospective evaluation of 116 consecutive patients treated with A.L.P.S. Proximal Humeral Plating System. Shoulder function was evaluated by Constant score and disabilities of arm, shoulder and hand (DASH). Furthermore, European Quality of life 5 Dimensions (EQ-5D) and single shoulder value (SSV) were assessed. Fractures were classified according to Neer. Fifty-two patients were included with a mean follow-up of 49 months. Mean Constant score was 62.8. Mean DASH was 17, and the mean EQ-5D was 0.91. According to Neer classification 63% (n = 33) of the fractures were two-part, 31% (n = 16) three-part, and 6% (n = 3) four-part fractures. Peg penetration was registered in 13 cases (25%, n = 52). In total a reoperation rate of 23% (n = 12) and an overall complication rate of 37% (n = 19) were recorded. Open reduction and plate fixation with the A.L.P.S. Proximal Humeral Plating System with smooth pegs provides a stable fixation with good clinical outcome and complication and reoperation rates in line with previous studies with plates using screws in the humeral head.

Mid to long term follow up of early weightbearing after open reduction internal fixation of ankle fractures.

Studies have demonstrated successful outcomes with early weightbearing following open reduction internal fixation (ORIF) of specific ankle fractures. The external validity of an early weightbearing protocol and its effects on patient-reported outcome information scores (PROMIS) has yet to be investigated. This study aimed to investigate the effects of an early weightbearing protocol for all operatively treated ankle fractures and its impact on clinical outcomes and complications. This retrospective cohort study included 229 patients (≥ 16 years) with OTA/AO 44 A-C fractures who underwent open reduction and internal fixation (ORIF). Patients were divided into groups based on early (2-3 weeks postoperative) or delayed (>6 weeks postoperative) weightbearing protocols. Primary outcomes included PROMIS score subsets including physical function, depression, and pain interference and ankle range of motion (ROM) at each follow up visit. Secondary outcomes included complications such as implant removal for pain, prominence, or surgical site infection, revision surgery for failure of fixation or loss of reduction, and post-operative sensory or motor deficits. There were 96 patients in the early weightbearing cohort and 133 patients in the delayed weightbearing cohort. The median follow-up time of the early weightbearing cohort was 471.47 ± 389.69 days while the delayed cohort was 459.82 ± 358.21 days. Demographics and comorbidities were distributed equally between both groups, except the presence of peripheral neuropathy which was observed more frequently in the delayed weightbearing cohort (8 versus 0, p = 0.022). Results indicated no statistically significant differences in PROMIS scores at final follow up, ankle ROM, or post-operative complications between the early and delayed weightbearing cohorts. Multivariable regression analysis identified smoking as a factor associated with worse ankle ROM at final follow-up. This study found that early weightbearing after ORIF of unstable ankle fractures leads to similar PROMIS scores and ankle ROM without increased complications. In addition, smokers were found to have worse ankle ROM when compared to nonsmokers at final follow-up.

Comparative Evaluation of Effect of Therapeutic Nutrition on Serum Albumin Levels and Nutritional Indices in Patients Undergoing Open Reduction and Internal Fixation for Maxillofacial Fractures - A Prospective Clinical Trial.

To assess effect of therapeutic nutrition on serum albumin levels, nutritional indices and on recovery of patients who have undergone open reduction and internal fixation for maxillofacial fractures. A total of 82 patients were included in this prospective study with 41 patients each in therapeutic and non-therapeutic nutrition group. Pre-operative serum albumin, prognostic nutritional index (PNI) and nutritional risk index (NRI) were calculated. Early wound healing index (EHI) was taken along with serum albumin on day 0 and follow-up day 10 and were compared. There was statistically significant difference (p < 0.001) between pre- and post-mean serum albumin levels and mean EHI score in both groups. In non-therapeutic group, there was decrease in serum albumin whereas increase in therapeutic group. There was increase in EHI score on follow-up day 10 which indicated improvement in healing in both the groups. Addition of protein supplement increased post-operative serum albumin level. Regardless of type of nutrition, an improvement in healing was seen in both the groups. Special nutrition counselling and care must be given for maxillofacial fracture patients who have additional injuries as this may benefit overall post-operative recovery of the patients.

A novel load-sensing sliding hip screw to aid in the assessment of intertrochanteric fracture healing.

Bone healing after sliding hip screw internal fixation of intertrochanteric hip fractures is difficult to monitor with radiography. In this study, we describe and evaluate a device to non-invasively determine the loading on the screw implant as a possible qualitative indicator of bone healing. A novel load-sensing sliding hip screw (LS-SHS) was fabricated containing a radio-dense tungsten indicator rod that moves and can be measured within the screw cannulation when the screw bends under load via plain radiography. Screw bending was assessed in intact femurs and unstable A1 intertrochanteric fractures using experimental axial loading of femoral composite Sawbones® and femoral human cadaveric specimens. Sensor readings were visually tracked using plain radiographs at each load state. The sensor exhibited linear response to implant strain in the unstable fracture indicating that the implant supported the major component of the applied load. This was consistently measurable using radiography throughout loading cycles across the mechanical and cadaveric fracture models. Sensor readings indicated that the implant was mostly unloaded in the intact models. The slope of the curve was approximately equal in the composite and cadaveric models (1.0µm/N and 0.08µm/N, respectively). Sensor noise levels were sufficient to detect 10% of the applied load of 80kg, which has the potential to qualitatively assist clinicians in tracking fracture healing progression. Clinicians must carefully monitor their patients for signs of SHS implant failure after surgery. This device quantitively measures implant loading which could qualitatively assist clinicians in the assessment of fracture healing.

Effective treatment of non-union after internal fixation of femoral neck fracture using integrated traditional Chinese and western medicine.

Hip fractures, particularly femoral neck and intertrochanteric fractures, represent approximately 6.37 % of all fractures, with incidence rates showing an upward trend annually. This report presents a case of a 55-year-old female with a femoral neck fracture who underwent internal fixation. One-year post-surgery, the patient continued to experience hip pain, and computed tomography (CT) scans revealed non-union of the fracture. The patient received an integrated treatment approach combining traditional Chinese and Western medicine, involving the alternating administration of osteopeptide tablets and Guijia Jiangu capsules, a proprietary herbal formulation. No additional pharmacological or surgical interventions were employed. Seven months after initiating the treatment, digital radiography (DR) examinations showed that the fracture had largely healed. At the seven-month follow-up, and nearly four years thereafter, the patient reported no discomfort in the hip region. Subsequent DR examinations revealed no signs of avascular necrosis of the femoral head, and no adverse events were noted. The internal fixation device was removed five years post-fracture. The results indicate that integrated traditional Chinese and Western medicine may effectively treat non-union after internal fixation of femoral neck fractures, though further studies are warranted to confirm these outcomes.

Surgical hip dislocation for posterior hip dislocation with femoral head fracture pipkin classification type II: A case report

Introduction: Surgical hip dislocation is a powerful and safe approach. It allows for simultaneous treatment of intra-articular pathologies, either preexisting or as a result of trauma, and improves long-term results. It can be used to treat a wide variety of intra-articular pathologies that would be extremely challenging or impossible arthroscopically or with other common open approaches to the hip. Surgical hip dislocation has been used in the trauma setting for open reduction and internal fixation of femoral head fractures and posterior wall acetabular fractures that do not extend into the posterior column. Case Report: A 28-year-old male with a posterior hip dislocation had difficulty flexing and extending his hip, internal rotation, and shortening his leg. During physical examination, we found a prominent head left femur on the posterior gluteus. During an X-ray examination, we found a posterior dislocation of the femoral head with a fracture. Treatment: Open reduction is preferable whenever there is a nonconcentric hip reduction. This reduces the risk of additional trauma, thus avoiding abrasion to the articular cartilage and bone contusion at the head of the femur. The surgeon who performs open reduction must be fully familiar with the surgical anatomy of the hip and must be aware of the fixation techniques used on fractures in this region. The fragment can be fixed both with 2.0-mm Herbert screws or mini fragment screws, taking care of the head of the implant into the articular cartilage. The joint capsule should always be repaired. When femoral head impaction is present, and the patient is an adult, the goal is to save the femoral head. In this situation, it is preferable to use the Watson-Jones or anterolateral approach with greater trochanteric osteotomy to perform the controlled dislocation of the hip.

Quality of Life after Open versus Closed Treatment for Mandibular Condylar Fractures

Objective: To compare the quality of life after surgical management with closed reduction and internal fixation (CRIF) versus open reduction and internal fixation (ORIF) for mandibular condylar fractures. Methodology: This analytical observational study was carried out between January 2024 to June 2024, at the Department of Oral and Maxillofacial Surgery, Jinnah Postgraduate Medical Centre, Karachi, focusing on patients with mandibular condylar fractures. The study assessed their quality of life using the General Oral Health Assessment Index (GOHAI) Questionnaire, with scores ranging from 1 to 3, where 1 denoted "Always," 2 indicated "Sometimes," and 3 represented "Never." Quality of life scores were categorized as high (34-36), medium (31-33), or low (&lt;30) based on the GOHAI results. Results: In this study there were 66.7% neglected patients had high quality of life, 15.4% had moderate, and 27.3% had low GOHAI, (p=0.084). Further, there were only 16.7% patient close reduction management had high quality of life, 5 (38.5%) had moderate, and 545.5% had low GOHAI. According to open reduction management, there were 83.3% patients had high quality of life, 61.5% had moderate, and 45.5% had low GOHAI, (p=0.157). Conclusion: Factors such as age, gender, neglected type, and treatment modality did not significantly affect the post-operative quality of life. However, mandibular fracture patients who underwent surgical treatment with open reduction technique, as assessed by the GOHAI parameter, experienced a high quality of life.

Reduction of the Douleur Neuropathique 4 (DN4) Score in the Supraclavicular Nerve Separation and Disability of the Arm Shoulder and Hand (DASH) Score Third Month and Sixth Month Post Open Reduction Internal Fixation of Clavicular Fracture

Introduction: Clavicle fractures are common injuries to the scapular girdle, with fractures in the middle third of the clavicle being the most prevalent. Non-operative treatment is often used but can lead to unsatisfactory outcomes, including pain, malunion, and thoracic outlet syndrome. As a result, operative fixation using Open Reduction and Internal Fixation (ORIF) Plate and Screw (ORIF PS) has gained popularity. Postoperative complications such as numbness around the surgical incision are frequently observed. This study aims to evaluate the differences in functional outcomes in patients with clavicle fractures post ORIF PS using the preserved supraclavicular nerve and non-preserved supraclavicular nerve methods, assessed by the Disability of the Arm Shoulder and Hand (DASH) score and Douleur Neuropathique 4 (DN4) score at 3 and 6 months post-operation. Methods: This cohort study used medical records data from patients with middle third clavicle fractures at RSUP Prof. Dr. IGNG Ngoerah. Patients were divided into two groups: preserved supraclavicular nerve and non-preserved supraclavicular nerve. Data were collected at 3 and 6 months post-operation to evaluate DASH and DN4 scores. Statistical analysis was performed using SPSS version 25.0, with the Kolmogorov-Smirnov test for normality and appropriate hypothesis tests based on data distribution. Results: This study involved 51 patients with clavicle fractures undergoing ORIF PS surgery. There were no significant differences in baseline characteristics between the two groups. At three months, the difference in DN4 scores between the preserved and non-preserved groups was not statistically significant (p=0.347). However, at six months, the preserved group showed significantly lower DN4 scores (p=0.012). The DASH scores at three months showed a significant difference between the two groups (p&lt;0.001), with the preserved group showing better scores. At six months, the difference in DASH scores was not significant (p=0.210). Longitudinal analysis showed significant reductions in DASH and DN4 scores between three and six months in both groups. Discussion: This study demonstrates that preserving the supraclavicular nerve during ORIF clavicle surgery provides significant benefits in reducing neuropathic pain and improving arm function in the long term. These findings support the importance of this approach in clavicle fracture surgeries to reduce complications and enhance functional outcomes. Conclusion: Preserving the supraclavicular nerve during ORIF clavicle surgery can significantly reduce neuropathic pain and improve arm function in the long term. These findings emphasize the importance of this approach in clinical practice to improve patient outcomes following clavicle fracture surgery. Keywords: Clavicular fracture, Douleur Neuropathique 4 score, supraclavicular nerve separation, DN4 score, DASH score, ORIF.

RESORBABLE WE43 VERSUS TITANIUM FIXATION DEVICES- EVALUATION OF TREATMENT OUTCOMES: A SYSTEMATIC REVIEW

Background: Internal fixation of mandibular fractures with Titanium (Ti) plates has become the gold standard for treatment in the adult population. Unfortunately, Ti plates had a tendency to undergo corrosion causing inflammation of surrounding bone that often led to failure of treatment. Magnesium (Mg) based newer materials such as WE43 alloy have been studied extensively for its ability to resorb in the presence of living tissue. Mg based WE43 alloy has demonstrated superior corrosion resistance and mechanical properties comparable to standard Titanium devices. The aim of this systematic review was to know whether WE43 based fixation devices can be used as an alternative to Ti based fixation devices for osteosynthesis. Materials and Methods: PubMed, Cochrane, Google Scholar, Web of Science, were searched to find the studies comparing the WE43 fixation devices and Ti based fixation devices for osteosynthesis. No filters were applied. Search terms related to WE43, titanium, fixation, osteosynthesis, corrosion resistance, fracture fixation, complications of treatment, etc, were used to search relevant studies. Data extraction, quality assessment, and summary synthesis for treatment outcomes including corrosion resistance,stability, osteosynthesis, adverse effects were carried out. Results: 5 studies consisting of 3 in-vivo animal studies and 2 clinical trials were included after the screening of search results. In the animal studies, i)16 rabbit specimens were divided into 2 groups -Group I received Ti based implants, while Group II received Mg based WE43 implants. ii)10 beagle dogs were divided into 2 groups and evaluated at 4, 12, and 24 weeks after implant placement. iii)18 hemi mandibles of sheep were tested to check the outcome of fracture fixation between Mg and Ti based fixation devices. Group I used Ti1.0, Group II used Mg 1.75, and Group III used Mg 1.5. In the clinical trials, i) fixation of mandibular head fracture was done in 31 using WE43 screws and 29 patients using Mg screws and ii) 11 patients treated with Mg compression screws and 10 patients with Ti compression screws. Conclusions: Comparison of properties of WE43 with Ti in the animal models has shown a non-inferiority of the Mg based material. Biomechanically, the human studies revealed promising results concerning the use of WE43 as a potential alternative to Ti in fracture fixation. Further evaluation is warranted under biomechanical loading conditions to verify the clinical performance of the material.

Association Between the Treatment Modality of Pediatric Subcondylar Fractures and Functional Outcomes at the Six-Month Follow-Up: A Retrospective Pilot Study.

The choice of treatment for subcondylar fractures in children and adolescents remains a controversial issue. The aim of this study was to evaluate the association between the treatment modality of subcondylar fractures and functional outcomes at the six-month follow-up. This retrospective study examined a cohort of children and adolescents with unilateral or bilateral subcondylar fractures treated at a level 1 trauma center over a five-year period. Radiological assessments of ramal height shortening (RHS) and subcondylar fracture angulation (SFA) were conducted using cone beam computed tomography. A total of 28 patients met the inclusion criteria, which required participants to be 18 years of age or younger, have a follow-up period of at least six months, and present with an initial SFA of less than 45°. Subcondylar fractures were classified into three categories: Class I (RHS <2 mm and/or SFA <10°), Class II (RHS ≥2 mm and ≤15 mm and/or SFA ≥10° and ≤35°), and Class III (RHS >15 mm and/or SFA >35°). Functional outcomes, including maximal mouth opening, lateral movements, and protrusive movements, were assessed at the six-month follow-up. Reference values specific to children and adolescents were applied to distinguish between normal and limited mandibular motion. The relationship between treatment modality and functional outcomes was analyzed using logistic regression, with adjustments made for age, sex, and fracture classification. Results: Twenty-eight patients (67.9% male; mean age 14.0±4.0 years) met the inclusion criteria. Of these, 53.6% (n=15) were treated with open reduction and internal fixation, while 46.4% (n=13) underwent closed reduction. The choice of treatment modality significantly influenced patient prognosis. Closed reduction was strongly associated with improved functional outcomes, specifically in the vertical range of movement (odds ratio (OR)=16.4; P=0.047), lateral range of movement (OR=18.7; P=0.044), and overall combined functional outcomes of vertical, lateral, and protrusive movements (OR=10.9; P=0.028). This preliminary study suggests a correlation between treatment modality and functional outcomes at the six-month follow-up. Open reduction and internal fixation of subcondylar fractures in children and adolescents may carry a higher risk of poor functional outcomes. The findings support closed reduction as the preferred approach for Class I-III cases with subcondylar fracture fragments angulated between 0° and 45°.

Short-term follow-up of single-port thoracoscopic rib fracture reduction and internal fixation for the treatment of multiple rib fractures

ObjectiveThe objective of this study was to evaluate the short-term outcomes of single-port thoracoscopic rib fracture reduction and internal fixation for the treatment of multiple rib fractures.MethodsThis study included 149 patients with multiple rib fractures admitted to the Second People's Hospital Affiliated with Fujian University of Chinese Medicine between June 2021 and April 2024. The patients were divided into two groups based on the surgical method. The study group, consisting of 84 cases, underwent rib fracture reduction using a single-port thoracoscopy and internal fixation with a memory alloy reverse rib embrace device. The control group, consisting of 65 cases, underwent traditional open surgery for rib fracture internal fixation. Perioperative and follow-up data were collected and analyzed to assess incision length, total operation time, intraoperative blood loss, number of memory alloy embrasures placed, placement success rate, drainage tube placement time, time to mobilization, total hospitalization duration, total cost, preoperative and postoperative pain levels, postoperative complications, and rib CT results three months postoperatively.ResultsThere was no statistically significant difference in general conditions between the study group and the control group. All 149 patients successfully completed the surgery, with 3 to 10 intrathoracic memory alloy embrace devices placed in each patient, achieving a 100% success rate. Compared to the control group, the study group showed significant improvements in incision length (3.5 ± 0.6 vs. 6.5±1.6 cm), intraoperative blood loss (92.5 ± 15.1 vs. 113 ± 18.2 ml), drainage tube placement time (75.4 ± 13.1 vs. 90.6 ± 15.4 h), mobilization time (2.9 ± 1.1 vs. 3.3 ± 1.3 days), and hospital stay (10.8 ± 2.7 vs. 12 ± 3.5 days), with differences being statistically significant (P < 0.05). In terms of preoperative Visual Analogue Scale (VAS) pain scores, the study group had a significantly lower score on the first postoperative day compared to the control group (3.9 ± 1.1 vs. 4.5 ± 1.4, P < 0.05). A follow-up CT and 3D reconstruction at 3 months post-surgery showed that all patients had securely fixed plates, with the study group demonstrating a higher rate of excellent fracture healing (94% vs. 83.1%), which was statistically significant (P < 0.05).ConclusionThe use of a memory alloy reverse rib embrasure device for intrathoracic rib fracture fixation via single-port thoracoscopic surgery is safe and reliable. This method demonstrates a high success rate of internal fixation, excellent clinical fracture healing, and advantages such as minimal trauma, rapid recovery, and the simultaneous treatment of other intrathoracic conditions. It significantly reduces postoperative pain and enhances the quality of life.