Fracture Patterns Research Articles

Changing Trends in Maxillofacial Trauma: A Single-Center Retrospective Study in India

Abstract Background Maxillofacial trauma is quite commonly encountered either in isolation or in association with polytrauma. The present observational study aims to analyze the changing trends of maxillofacial injuries and mull over some probable reasons for the same. Materials and Methods This is an observational retrospective study done at a tertiary care center in Mumbai, India, for a period of 12 years (2008–2019) after getting clearance from the institutional ethics committee. All patients who were admitted in the plastic surgery unit with maxillofacial trauma were included in the study and data were collected from case record sheets in the archives of the department. The data obtained were tabulated and analyzed. Results A total 1,046 patients were included in the study. The most common age group involved was 21 to 30 years (50.19%). Males outnumbered females in terms of hospital admissions (92.7 vs. 7.3%). Road traffic accidents (RTA) were found to be the major etiological factor (72.27%). Out of 756 RTA victims, 533 (70.5%) were due to two-wheeler accidents. In the present study, the zygomaticomaxillary complex (middle third) was most commonly fractured (40.73%) followed by the mandible (38.91%). Panfacial fractures (i.e., those involving at least two facial thirds) comprised 10.71% of all the cases. Conclusion The incidence of maxillofacial trauma is showing an increasing trend in the recent past. The majority of the patients are victims of RTAs and two-wheeler accidents are increasingly responsible for such injuries. The classical injury patterns and the fracture patterns that were described in the past are not routinely observed now. The injury and fracture pattern itself has become more complex. We observed a statistically significant raise in midface fractures in our study.

Which screw corridors can be used for bilateral fragility fractures of the pelvis with a transverse fracture component (FFP IVb)?

Fragility fractures of the pelvis are becoming increasingly important in an ageing society. However, they are under-represented in the current research literature. In particular, unstable bilateral fragility fractures of the sacrum (FFP IVb) benefit from surgical treatment, but individual fracture patterns need to be considered in the surgical decision. This study describes the sacral anatomy in patients with FFP IVb pelvic fractures, with particular emphasis on the identification and evaluation of possible trans-sacral screw corridors, with particular emphasis on the transverse fracture components. Design: Retrospective clinical study. Level 1 trauma center. Patient Selection Criteria: The study reviewed 100 patients admitted for bilateral FFP with a transverse fracture between 01 / 2013 and 11 / 2023 that had a preoperative computed tomography (CT) of the pelvis including the fifth vertebra, treated with FFP IVb using preoperative multiplanar CT scans to analyze sacral anatomy. Outcome Measures and Comparisons: Sacral types and transitional abnormalities were classified, and corridor dimensions for S1 and S2 were measured, including estimated bone density using Hounsfield units. Bone corridors ≥ 8 mm were considered adequate. In addition, possible trans-sacral screw corridors were evaluated, taking into account the transverse fracture component. While large trans-sacral screw corridors (≥ 8 mm) for S1 and S2 were identifiable in most cases, the actual feasibility for screw placement was limited due to the transverse fracture component's location, resulting in meaningful corridors in only 80 % for S1 and 47 % for S2. Additionally, in 4 % of patients without an S1 corridor, trans-sacral screw fixation was deemed inadequate due to the fracture line passing through S2. These results indicate that not all FFP IVb fractures can be effectively stabilized using trans-sacral screw or bar fixation, necessitating alternative techniques for some cases. Furthermore, precise preoperative planning is essential for the management of these fractures due to complexity of anatomy. To identify the most suitable treatment approaches, further clinical studies are required. III.

Reliable and streamlined model setup for digital twin assessment of fracture healing.

In large animal models of bone fracture repair, postmortem torsional testing is commonly used to assess healing biomechanics. Bending and axial tests are physiologically relevant, but much less commonly performed. Virtual torsional testing using image-based finite element models has been validated to postmortem bench tests, but its predictive value for capturing whole-bone mechanics and fracture healing quality under other physiologically relevant loading modes has not yet been established. Accordingly, the purpose of this study was to evaluate the association between mechanical biomarkers derived from virtual torsion, axial, and bending tests under strict alignment and malalignment conditions. Computed tomography (CT) scans from 24 intact and operated sheep tibiae and 29 human tibial fractures were used to create digital twins that were subjected to torsion, axial, and bending tests. The results indicated that torsional rigidity is a strong surrogate for bending flexural rigidity in both ovine and human bones. Torsional rigidity and axial stiffness were strongly correlated in the ovine data, but only moderately in human fractures due to the complex fracture patterns. Axial testing was highly prone to stiffness estimation errors as high as 50% if the applied load and anatomic axis were not perfectly aligned. In contrast, torsional rigidity had errors <1.3% for all malalignment scenarios. Based on this study, virtual torsional rigidity is the recommended summary mechanical biomarker of bone healing because it captures variations in healing biomechanics that are present in other loading modes with a simple setup that is insensitive to alignment error.

Conventional and machine learning-based analysis of age, body weight and body height significance in knot position-related thyrohyoid and cervical spine fractures in suicidal hangings.

The thyrohyoid complex and cervical spine fracture distribution patterns may reflect the knot position as the force distribution by the noose to different neck regions may vary depending on it. Recently, machine learning models (MLm) were used to classify knot position through these fractures. The contribution of aging on the fracture susceptibility is better demonstrated, but data on body weight (BW) and height (BH) significance on this is more doubtful and MLm did not consider them. A retrospectively obtained autopsy data on sex, age, BW, BH and distribution of greater hyoid bone horn (GHH), superior thyroid cartilage horn (STH), and cervical spine fractures in 368 suicidal hangings were analyzed by standard statistics to determine association of the anthropometrics (age, BW, and BH) with the fracture occurrence, and by machine learning algorithms to determine if body weight and height improved MLm classification of hanging cases with typical and atypical knot positions. In the sample, unilateral GHH fracture was significantly more common in atypical hangings, while isolated STH fractures were more common in typical hangings. Age was a predictor of GHH fractures and BW of STH fractures, but BW poorly correlated with their number. BH was not a predictor of any thyrohyoid fracture. On the ROC curve analysis, the MLm that considered BW and BH did not perform statistically better than MLm that did not consider them. The study indicates that body weight and height are of no detrimental value in assessing the thyrohyoid and cervical spine fracture patterns in suicidal hangings.

Translated article] Nailing intertrochanteric fractures in geriatric population: Do we know it all?

Pertrochanteric fractures constitute an important part of the daily activity of the orthopedic surgeon. The aim of this study was to carry out an analysis of pre-, intra- and post-operative radiographic parameters and to analyze the results of stable and unstable intertrochanteric fractures treated with short nails with dynamic distal locking. Retrospective study in our center, between the years 2017-2021 of patients over 65 years of age with pertrochanteric fracture. We included 272 patients treated with Gamma3 Nail (Stryker®) with bloqueo distal dinámico. As variables, we recorded: age, medical comorbidities, fracture pattern according to AO/OTA, osteopenia according to Singh's classification, pre-operative (such as diaphyseal extension), intra-operative (such as tip-to-the-apex or medial cortical support) and post-operative radiographic parameters (such as time to consolidation or loss of reduction), pre- and post-operative Barthel, quality of life and complications and reinterventions, such as non-union or cut-out. The mean age was 83.28 years (65-102). Two hundred four cases were women (75%). The average follow-up was 18.2 months (12-24). The distribution according to AO/OTA classification was 85.7% 31.A1; 12.5% 31.A2; 1.9% 31.A3. Radiographic consolidation was obtained in 97.4% of cases. Tip to apex distance was less than 25 mm in 95.6% of cases. Medial cortical support was positive or neutral in 88.6% of cases. Sixty cases (22.1%) of screw back-out were recorded. Eight reinterventions (2.9%) were performed, corresponding to three cut-outs (1.1%), three non-unions (1.1%), one avascular necrosis (0.4%) and one secondary hip osteoarthritis (0.4%). Short nail with bloqueo distal dinámico offers good clinical, radiological and functional results in all types of AO/OTA patterns, without increasing the complication rate, as long as there is an appropriate tip-to-the-apex distance and good medial cortical support.

Easily missed nondisplaced fractures accompanying complete fractures in the lower extremity and pelvis: a narrative review

Nondisplaced fractures accompanying complete fractures are often difficult to detect on plain radiographs or computed tomography scans, posing a diagnostic challenge. The diagnosis of these frequently overlooked injuries can be delayed, potentially leading to suboptimal patient outcomes. This review discusses four commonly missed fracture patterns in the lower extremity and pelvis, including posterior involvement in fragility fractures of the pelvis, intertrochanteric extensions in isolated greater trochanter fractures, ipsilateral femoral neck fractures in high energy femoral shaft fractures, and posterior malleolar fractures in distal spiral tibial shaft fractures. An accurate diagnosis of these accompanying nondisplaced fractures is critical for optimizing surgical outcomes. Surgeons should incorporate thorough preoperative evaluations into their clinical practice to facilitate early detection and appropriate treatment strategies. Prompt identification and comprehensive management remain essential for improving patient outcomes.

Clinical and Radiographic Outcomes of Distal Radius Fractures Following Dorsal Bridge Fixation to the Second Versus Third Metacarpal.

Dorsal bridge plating (DBP) can effectively treat complex distal radius fractures (DRFs); however, techniques for metacarpal fixation vary. The purpose of our study was to compare range of motion (ROM), grip strength, patient-reported outcomes, radiographic parameters, and complication rates between patients undergoing DBP with fixation to the second versus third metacarpal for DRFs. We retrospectively analyzed 432 patients with DRFs. Wrist ROM and radiographic data were calculated at the 6-month follow-up. We calculated Patient-Reported Outcomes Measurement Information System (PROMIS) upper-extremity, physical function, and pain interference at each visit. Additional data collected included surgical complications and demographic data. Statistical analysis was conducted via multivariate analysis, t tests, and chi-square tests. A total of 329 patients underwent DBP to the second metacarpal, whereas 103 patients underwent DBP to the third. Demographics and comorbidities were similar between the groups. Tendon rupture was more common in the third metacarpal group (3.9% vs 0.9%), with two extensor pollicis longus and one extensor indicis proprius ruptures in each group and an unspecified tendon in the third metacarpal cohort. All other complication rates were similar. The second metacarpal group demonstrated greater wrist flexion (57.8° vs 56.2°), ulnar deviation (23.9° vs 20.7°), and grip strength (62.3% vs 57.8%). All other ROM measurements were similar. There was no difference in PROMIS metrics at the 6-month follow-up. The second metacarpal group demonstrated greater radial inclination (21.3° vs 19.5°) and less volar tilt (6.8° vs 7.1°). Dorsal bridge plating to the second metacarpal demonstrated greater ROM, grip strength, and radial inclination, similar PROMIS scores, and lower extensor tendon rupture rates than third metacarpal fixation. Although there were differences between techniques, their clinical relevance is unclear. Dorsal bridge plating to the second or third metacarpal both result in acceptable outcomes and can be considered based on the fracture pattern and surgeon preference. Therapeutic IV.

Fracture Resistance of Glass-Fiber-Reinforced Direct Restorations on Endodontically Treated Molar Teeth with Furcal Perforation

This in vitro study evaluated short-fiber-reinforced composite materials and fiber-reinforced restorations of endodontically treated molars with furcal perforation. The endodontic treatment and mesio-occlusal–distal cavity preparation of 126 two-rooted mandibular third molars were performed. Eighteen non-perforated teeth were restored with resin composite as the control group. Furcal perforations and repair were performed on 108 teeth that were divided into six experimental groups: resin composite (RC), everX Flow (EXF), everX Posterior (EXP), Bioblock (BB), modified transfixed (MT), and horizontal glass-fiber (HGF) groups (n = 18). Fracture resistance tests were performed at an angle of 30◦ using a universal testing machine under static loading, and fracture patterns were classified. Welch’s analysis of variance, Pearson chi-square, and Tamhane post hoc tests (p = 0.05) were used to analyze the data (p = 0.05). The highest fracture resistance values were seen with the HGF (596.305 N), followed by MT (540.365 N), BB (477.906 N), EXP (476.647 N), EXF (414.462 N), control (413.811 N), and RC (335.325 N) groups (p &lt; 0.001). There was no significant difference between the BB and EXP groups or between the EXF and control groups (p &gt; 0.05). In terms of the dominant fracture pattern, the HGF and MT groups were repairable and possibly repairable, whereas the control, RC, and EXP groups were unrepairable. The EXF and BB groups were almost equally divided between possibly repairable and unrepairable. Restorations using horizontal fiber techniques and short-fiber-reinforced materials increased the fracture resistance of endodontically treated teeth with furcal perforation.

Osteochondral Fractures in Adolescents With First-time Patellar Dislocation: Three-dimensional Characterization and Association With Radiographic Features.

Consequences of osteochondral fractures associated with patellar dislocation can be severe for younger patients. Precise 3-dimensional characterization of fracture location, size, frequency, and radiographic associations remain undefined in this population. (1) To define the topographic characteristics of osteochondral fractures in pediatric and adolescent patients with first-time patellar dislocations and (2) to determine the relationship between these characteristics and radiographic and patient factors. Cross-sectional study; Level of evidence, 3. A retrospective observational study was conducted between 2015 and 2023 of consecutive patients aged <18 years undergoing surgical intervention for displaced osteochondral fractures in the setting of first-time patellar dislocation. Three-dimensional location and relative injury frequency were quantified with heat map analysis. Subgroup analysis of intraoperative osteochondral fracture size and location was conducted using chi-square testing and an independent t test at an alpha of .05. The study cohort included 82 knees (80 patients) with first-time patellar dislocation and osteochondral fracture. A total of 97 osteochondral fractures were identified, with the lateral femur as the most common fracture site at 55% (n = 53), as compared with 43% (n = 42) for the patella and 2% (n = 2) for the lateral trochlea. Patellar osteochondral fractures were significantly larger than femoral lesions (mean ± SD, 258 ± 168 mm2 vs 126 ± 109 mm2; P < .001) and more amenable to fixation than femoral osteochondral fractures (fixation, 57.1% [n = 24] vs 15.1% [n = 8]; P < .001). Patellar and femoral osteochondral fractures were >100 mm2 in 78.6% (n = 33) and 32.1% (n = 17) of lesions, respectively. Patellar mean fracture size was significantly larger in the group with a tibial tubercle-trochlear groove distance <20 mm (P = .018). The mean osteochondral fracture size of the lateral femoral condyle was significantly larger in the open physis group as compared with the closed physis group (P = .027). We found that the most common site for osteochondral fracture was the femur, although patellar osteochondral fractures were significantly larger. Factors that affect anatomic structure and ligamentous laxity appear to contribute to patterns of osteochondral fractures.

In vitro evaluation of antimicrobial photodynamic therapy with photosensitizers and calcium hydroxide on bond strength, chemical composition, and sealing of glass-fiber posts to root dentin

Investigate the impact of antimicrobial photodynamic therapy (aPDT) using different photosensitizers (PSs) such as indocyanine green (IG), curcumin (CC), and methylene blue (MB), with or without intracanal application of calcium hydroxide (CH), on the push-out bond strength of glass-fiber posts (GFPs) to intraradicular dentin, the chemical composition of the root substrate, and the sealing of the adhesive interface across different thirds of intraradicular dentin. A total of 112 bovine teeth underwent biomechanical preparation and were divided into eight experimental groups (n = 14 each): Negative control with deionized water; positive control with deionized water + CH; IG group with indocyanine green and infrared laser; IG + CH group; CC group with curcumin and blue LED; CC + CH group; MB group with methylene blue and red laser; and MB + CH group. The push-out bond strength was measured using a universal testing machine (n = 8), and scanning electron microscopy characterized the fracture patterns. Energy dispersive spectroscopy (n = 3) analyzed the chemical composition of the dentin substrate, while fluorescence confocal microscopy (n = 3) assessed the adhesive interface sealing between the resin cement and root dentin. Data were analyzed using two-way repeated measures ANOVA and the Tukey test for push-out bond strength and chemical composition comparison, with the Kruskal-Wallis and Dunn’s tests (α = 0.05) for adhesive interface sealing. Significant bond strength differences were noted across root thirds and experimental groups (P < .05), with the IG + CH group showing the highest cervical bond strength and the IG group the lowest. Apical bond strength was highest in the CC group but lower in the NC and PC groups. Mixed failures predominated, except in the MB + CH group, where adhesive failures prevailed. Elemental composition varied among groups treated with different PSs and CH (P < .05), but interface quality, tag formation, and penetration depth showed no significant differences (P > .05). Laser-activated 500 mg/L CC combined with CH emerged as a clinically relevant option for root canal decontamination before GFPs luting. aPDT with different PSs and root canal depth influenced the push-out bond strength of GFPs and the chemical composition of root dentin. Curcumin-mediated aPDT at 500 mg/L proved effective, enhancing bond strength and sealing while maintaining consistent dentin composition across depths.

A Simplified Working Classification for Planning and Management of Facial Fractures

AbstractFacial fractures are commonly encountered by plastic and maxillofacial surgeons. Although very diversified in nature, their treatment planning requires a thorough knowledge of the facial anatomy and advanced treatment modalities. With the advent of three-dimensional computed tomography, it has become a lot easier to diagnose and treat them accordingly. It is important to categorize facial fractures for an effective liaison between the radiologists, surgeons, and medical staff involved in their management. Various classification schemes have been made to classify them, but they are cumbersome to remember and communicate among treating doctors. We present a new yet simple facial fracture classification that is based on the facial buttresses involved. This helps in better and uniform management of fracture patterns and also anticipates future complications that may arise from such fractures, if any.

Influence of Mineral Veins on Hydraulic Fracture Propagation

Abstract Fluids are often injected into tight geothermal reservoirs to create conductive fractures and enhance reservoir productivity. Mineral veins are ubiquitous in reservoir rocks because of the hydrothermal mineralisation process. We hypothesize that vein strength anisotropy and geometrical complexity could introduce complex hydraulic fractures through vein–fracture interactions. To test this hypothesis, we develop an improved hydro-mechanical coupled scheme using the Discrete Element Method to examine hydraulic fracture propagation in veined rocks. The coupled scheme considers incremental updates of domain volume and fluid saturation. We follow topology in root architecture to develop a benchmark model with simplified yet representative vein networks. We find that vein strength significantly influences the fracture pattern of the tested veined models during hydraulic fracturing. Cracks are preferentially reactivated in the calcite (soft) veins, leading to much more complex fracture networks compared with those created in quartz (hard) veins. An increase in stress anisotropy (high-stress contrast) leads to a reduction of the maximum aperture of dominant fractures. Under a high-stress contrast, fluid lag is not evident; the number of reactivated cracks in soft-veined models is also reduced. It is interesting to note that the bifurcation angle of veins has negligible influence on fracture patterns and propagation in the model. We also find that high-stress contrast leads to a higher level of the maximum moment magnitude and a lower b value. This research could provide some insights into reservoir stimulation to enhance production and mitigate seismic hazards.

Trauma-Induced Stress Distribution in Primary Incisors Restored With Preformed Zirconia Crowns: 3D Finite Element Analysis.

Preformed zirconia crowns have emerged as the preferred choice for restoring damaged primary incisors. However, they differ from natural teeth in their biophysical properties and can potentially alter the overall response of crowned teeth to a traumatic load. This in silico study aimed to compare the response of three different traumatic loading conditions for the (i) natural (M1) and (ii) zirconia-restored tooth models (M2) models. A 3D dynamic finite element (FE) analysis was performed, and minimum dynamic loads required for fracture and coronal portion disjunction of both tooth models were applied in frontal, oblique, and incisal directions. Stress concentrations, von Mises stresses, fracture patterns, and displacements were compared at different periods of the loading pulse. The computed minimum threshold loads resulting in fracture of the natural tooth model were 82 N, 166 N, and 171 N for the frontal, oblique, and incisal impacts, respectively. Fracture of the coronal portion started at 1.8 and 1.68 ms in natural tooth and zirconia-restored tooth models, respectively. Complete disjunction of coronal and radicular portions occurred earlier in the zirconia-restored tooth model (2.46 ms) than in the natural tooth model (4.5 ms) for frontal impact. The maximum von Mises stresses causing fracture ranged from 254 to 314 MPa for both models, following assigned element erosion criteria. The zirconia-restored tooth model did not experience fracture during an oblique impact. The stress concentration patterns were seen to be altered in the zirconia-restored tooth model. On incisal impact, the permanent tooth germ in the natural tooth model displayed stress concentrations that were not seen in the zirconia-restored tooth model.

Partial Avulsion Patterns in the Pediatric Humeral Medial Epicondyle.

The anterior oblique bundle of the medial ulnar collateral ligament (UCL) inserts on the anteroinferior aspect of the humeral medial epicondyle, while the flexor pronator mass (FPM) originates superficial and proximal to the UCL. With valgus stress, these distinct footprints may produce injury patterns that affect only focal areas of the medial epicondyle. The proximal UCL can act on the medial epicondyle either in isolation or in conjunction with the FPM to form partial avulsion fracture patterns within the pediatric medial epicondyle, and the predominant pattern involves only the proximal UCL footprint. Case series; Level of evidence, 4. A retrospective review was performed of medial epicondyle injuries from a single tertiary care institution documented from 2012 to 2022. Inclusion criteria consisted of (1) patients <18 years of age with a diagnosis of medial epicondyle fracture, (2) availability of radiographs within 3 weeks of injury date, and (3) no history of acute medial epicondyle fracture. Data collection included demographics, imaging, mechanisms of injury, associated injuries, and procedural details if operative notes were available. Of the 1951 patients screened, 709 were diagnosed with any form of medial epicondyle fracture. Of these patients, 15.9% (n = 113; mean ± SD age, 11.15 ± 2.56 years; 70% male; 40% throwing mechanism) had radiographic evidence of fragmentation of the inferior aspect of the medial epicondyle, suggesting a partial avulsion fracture/injury. Seventy-eight patients (69%) were noted to have a small, well-corticated fragment off the inferior pole of the medial epicondyle on radiographs, defined as a "proximal UCL avulsion fracture." Magnetic resonance imaging in 24 patients in this group confirmed attachment of the UCL to the avulsed fragment. This configuration was also confirmed by 2 operative reports. Thirty-five patients had a well-defined cortical shell or an indistinct radio-opaque body off the inferomedial aspect of the medial epicondyle on radiographs, defined as a "cortical sleeve avulsion." Magnetic resonance imaging in 8 patients in this group demonstrated the UCL in addition to the FPM origin still attached to the avulsed cortical sleeve. This was confirmed by 2 operative reports. The 2 injury patterns seen in this study-proximal UCL avulsion fracture and cortical sleeve avulsion-represented 15.9% of the patients with a medial epicondyle fracture. The proximal UCL avulsion fracture pattern was the more common of the 2 injury patterns. Accurate identification of these injury patterns and their underlying pathology is likely to be important in ultimately understanding the natural history of these injuries and the outcomes of different treatment strategies.

Morphological Characteristics of Inferior Pole Patellar Fractures and a Finite-Element Analysis Combined With a Retrospective Clinical Study of Anchor Suture and Titanium Cable Cerclage Treatment.

Inferior pole patellar fractures (IPPFs) pose a significant challenge due to their complex fracture patterns and high risk of complications associated with current treatment methods. This study aims to (1) characterize the fracture patterns of IPPFs using fracture mapping and (2) compare the biomechanical stability and clinical outcomes of treatment with anchor suture with patellar cerclage versus Kirschner-wire tension band combined with patellar cerclage. (1) A retrospective analysis was conducted on 61 patients with IPPF. For each case, fracture reduction was manually simulated, with fracture lines and fragments overlaid onto a complete patella template to identify fracture patterns. (2) Finite-element models were used to analyze the mechanical properties of anchor suture and titanium cable cerclage treatment and Kirschner-wire tension band combined with patellar cerclage in treating IPPFs. Additionally, a retrospective analysis of clinical data was performed on 57 patients with IPPF (AO/OTA 34 A1) treated at our institution between January 1, 2023, and December 25, 2023. Of these, 18 patients underwent anchor suture and titanium cable cerclage (Group A), and 39 underwent Kirschner-wire tension band combined with patellar cerclage (Group B). We compared operative time, final knee range of motion, incidence of secondary surgery, postoperative complications, and functional recovery between the two groups based on medical records and follow-up results. (1) IPPFs were predominantly comminuted, with fracture lines on the anterior view concentrated laterally and near the superior surface of the inferior pole. Fracture lines became more sparse as they approached the distal patella. The posterior view was similar to the anterior, with the majority of fractures near the superior surface of the inferior pole. (2) Finite-element analysis revealed no significant differences between the two groups in terms of displacement and stress. Operative time was similar between the groups (p > 0.05), as were final knee range of motion (p > 0.05) and postoperative Bostman scores (p > 0.05). Group A had no postoperative complications or readmissions, while Group B had two cases of hardware irritation and one case of knee joint infection. The fracture lines of IPPF are varied, often comminuted, and correlate with the mechanism of injury. Biomechanical and clinical outcomes suggest that anchor suture with patellar cerclage is a viable option for stabilizing IPPF. ClinicalTrials.gov identifier: NCT06736639.

Consensus statement on the treatment of proximal humerus fractures: a Delphi approach by the Neer Circle of the American Shoulder and Elbow Surgeons.

The treatment of patients who suffer a proximal humeral fracture (PHF) remains controversial. The purpose of this study was to find consensus among experts using a validated iterative process in the treatment of patients after a PHF. The Neer Circle is an organization of shoulder experts recognized for their service to the American Shoulder and Elbow Surgeons. Consensus among 86 identified experts from this group was sought with a series of surveys using the Delphi process. The first three surveys included vignettes with 2-part, 3-part, and 4-part fractures, under two scenarios, (1) a healthy 55-year-old and (2) and a 75-year-old with significant medical comorbidities. Within each vignette, respondents were asked about their preference on CT utilization, and whether they would select operative or nonoperative treatment. A final survey was administered to elicit respondent preferences on general treatment approaches regardless of specific vignette characteristics. Consensus was reached on the value of CT scans with 3D reconstructions, age as an important factor in determining treatment, functional demand, fracture pattern, bone quality, and the presence of more significant medical comorbidities would strongly impact decision making. Experts agreed that medial calcar involvement would have no impact on their decision, and gender and non-dominant arm involvement would have a low impact. Consensus was reached in the following scenarios for an operative treatment in a young and healthy patient: 2-part shaft fracture (V3, 98%); 3-part varus fracture (V5, 98%); 3-part valgus fracture (V7, 98%); 4-part fracture (V9, 100%); 4-part dislocation fracture (V11, 98%) and 4-part valgus impacted fractures (V13, 95%). For older unhealthy patients in 4- part dislocation fractures (V12, 100%). In the remainder of scenarios, there was no consensus reached for preferred treatment, either operative or nonoperative. Finally, there was no consensus on preferred rehab protocols, whether for nonoperative management or postoperative care. In conclusion, this study demonstrates that consensus when managing proximal humerus fractures is limited to specific scenarios, while lack of consensus still exists in others. The presented study advocates non-operative treatment of proximal humerus fractures in the sicker patient and surgical treatment methods for 3-part and 4-part fractures in the young, healthy patient.

Comparative Analysis of Open and Closed Nasal Fractures in Trauma Settings: Mechanisms, Intent, Surgical Interventions, and Outcomes

Objectives: This study aimed to explore nasal fracture patterns, trauma mechanism and intent, treatment approaches, and mortality rates, offering insights for clinical practice and prevention in trauma settings. Design: This retrospective analysis was carried out using trauma data from the National Trauma Data Bank (NTDB) for the years 2013 to 2016. Main outcome measures: Trauma mechanism and mortality rates between closed and open fractures were conducted. Results: This study involved 122,574 closed and 9704 open nasal fractures to elucidate demographic, hospital, and clinical characteristics. Significant risk factors for open nasal fractures included a higher injury severity score, self-inflicted intent, unintentional causes, and firearm mechanism compared to assault injuries. Conclusions: Significant factors associated with open nasal fractures include injury severity, self-inflicted intent, trauma type, and firearm mechanisms, which notably increase the likelihood of open fractures. Findings highlight the need for targeted prevention, efficient resource allocation, and risk screening to enhance the management of complex facial traumas in the national trauma system.

Predicting fall parameters from infant skull fractures using machine learning.

When infants are admitted to the hospital with skull fractures, providers must distinguish between cases of accidental and abusive head trauma. Limited information about the incident is available in such cases, and witness statements are not always reliable. In this study, we introduce a novel, data-driven approach to predict fall parameters that lead to skull fractures in infants in order to aid in determinations of abusive head trauma. We utilize a state-of-the-art finite element fracture simulation framework to generate a unique dataset of skull fracture patterns from simulated falls. We then extract features from the resulting fracture patterns in this dataset to be used as input into machine learning models. We compare seven machine learning models on their abilities to predict two fall parameters: impact site and fall height. The results from our best-performing models demonstrate that while predicting the exact fall height remains challenging ( 0.27 for the ridge regression model), we can effectively identify potential impact sites ( between 0.65 and 0.76 for the random forest regression model). This work not only provides a tool to enhance the ability to assess abuse in cases of pediatric head trauma, but also advocates for advancements in computational models to simulate complex skull fractures.

The relationship between soong classification and fracture characteristics with implant removal for distal radius fractures: a comparative study of 795 cases.

Although there is no consensus in the literature, it is believed that the Soong classification system and fracture pattern are risk factors for plate removal in distal radius fractures. The aim of this large-scale study was to evaluate the relationship between Soong classification, fracture pattern, and implant removal in distal radius fractures. We retrospectively evaluated 795 patients who underwent surgery using a volar locking plate for distal radius fractures at our clinic between 2005 and 2022. The patients were divided into two groups: implant removed, and implant retained. The groups were examined for demographic data, follow-up periods, fracture classifications, and radiological parameters. Additionally, the patients were divided into groups and compared according to the Soong classification, which was determined according to implant placement. Indications for implant removal were also included in this study, and their relationships with other parameters were evaluated. A total of 123 and 672 patients were included in the implant removed and retained groups, respectively. The average age of the implant removed group was significantly lower (p = 0.005). There were no significant differences between the two groups in terms of fracture classification or other radiological parameters. In the implant removed group, the rate of grade 2, according to the Soong classification, was statistically higher than that in the other groups (p = 0.019). Flexor tenosynovitis was the most common reason for implant removal. The Soong classification system is an important risk factor associated with implant removal. This risk may increase, particularly among young patients. Surgeons should consider placing the distal radius locking plate as proximally as possible to reduce the frequency of implant removal. III; retrospective comparative study.

Epidemiology of fracture and care in male collegiate Taekwondo athletes by weight class.

The purpose of this study was to examine the occurrence of fracture injuries and post-fracture management practices by weight class. A total of 127 male collegiate Taekwondo athletes (64 lightweight athletes, 63 heavyweight athletes) participated in this study. The athletes were classified into lightweight and heavyweight based on their respective competition weight divisions. Logistic regression was used to estimate the odds ratios (OR) and 95% confidence intervals (CI). Athletes had experienced fracture to 54.3%. Athletes were more likely to experience fractures during training and defensive movements. Of the fractures reported, 31.9% necessitated surgical intervention. Although 65.1% of the athletes were primarily concerned about the possibility of re-injury, only 36.2% received specialized rehabilitation. The heavyweight athletes had a higher prevalence (OR=2.40, 95% CI=1.17-4.90) than the lightweight athletes. The heavyweight athletes had a higher prevalence of fractures during the competition (OR=4.83, 95% CI=1.54-15.17), in offensive situations (OR=4.67, 95% CI=1.38-15.99), and in the lower limbs (OR=3.84, 95% CI=1.12-13.14) than the lightweight athletes. The current evidence that fractures are common in Taekwondo athletes and that fracture patterns may differ between heavyweight and lightweight athletes highlights the need for tailored prevention strategies based on weight class.