Fracture Side Research Articles

Effectiveness of proximal femur bionic nail for intertrochanteric fracture in the elderly

To evaluate effectiveness of proximal femur bionic nail (PFBN) in treatment of intertrochanteric fractures in the elderly compared to the proximal femoral nail antirotation (PFNA). A retrospective analysis was made on 48 geriatric patients with intertrochanteric fractures, who met the selection criteria and were admitted between January 2020 and December 2022. Among them, 24 cases were treated with PFBN fixation after fracture reduction (PFBN group), and 24 cases were treated with PFNA fixation (PFNA group). There was no significant difference in baseline data such as age, gender, cause of injury, side and type of fracture, time from injury to operation, and preoperative mobility score, American Society of Anesthesiologists (ASA) score, Alzheimer's disease degree scoring, self-care ability score, osteoporosis degree (T value), and combined medical diseases between the two groups ( P>0.05). The operation time, intraoperative blood loss, number of blood transfusions, transfusion volume, length of hospital stay, occurrence of complications, weight-bearing time after operation, and postoperative visual analogue scale (VAS) score, walking ability score, mobility score, self-care ability score were recorded and compared between the two groups. And the radiographic assessment of fracture reduction quality and postoperative stability, and fracture healing time were recorded. The operations in both groups were successfully completed. All patients were followed up 6-15 months with an average time of 9.8 months in PFBN group and 9.6 months in PFNA group. The operation time was significantly longer in PFBN group than in PFNA group ( P<0.05), but there was no significant difference in intraoperative blood loss, number of blood transfusions, transfusion volume, length of hospital stay, change in activity ability score, and change in self-care ability score between the two groups ( P>0.05). The weight-bearing time after operation was significantly shorter in PFBN group than in PFNA group ( P<0.05), and the postoperative VAS score and walking ability score were significantly better in PFBN group than in PFNA group ( P<0.05). Radiographic assessment showed no significant difference in fracture reduction scores and postoperative stability scores between the two groups ( P>0.05). All fractures healed and there was no significant difference in fracture healing time between the two groups ( P>0.05). The incidence of complications was significantly lower in PFBN group (16.7%, 4/24) than in PFNA group (45.8%, 11/24) ( P<0.05). Compared with PFNA, PFBN in the treatment of elderly intertrochanteric fractures can effectively relieve postoperative pain, shorten bed time, reduce the risk of complications, and facilitate the recovery of patients' hip joint function and walking ability.

Recovery of Gait in Children and Adolescents After Pediatric Femoral Shaft Fracture Treated with Intramedullary Nail Fixation: A Longitudinal Prospective Study.

Femoral shaft fractures in school-aged children are commonly treated with intramedullary nail fixation. Outcomes such as time to healing, alignment and non-union, leg length discrepancy, and refractures, and other complications are often reported based on radiographic findings. There are limited reports on physical function, including objective quantitative measures. The aim was to study the progress and recovery of gait after femoral shaft fracture in children and adolescents. Inclusion criteria were individuals 6 to 16 years of age with a femoral shaft fracture treated with intramedullary nails. Exclusion criteria were pathologic fractures and other physical impairments or injuries that influenced gait.At 6 and 12 weeks, assessments of mobilization and weight bearing were performed at clinical hospital follow-ups.At 3, 6, 9, and 12 months, physical examinations of passive range of motion, stair walking, and three-dimensional gait analysis, including temporospatial, movement (kinematics), and force (kinetics) data, were performed. Seventeen participants, with a median of 9.2 (interquartile range 6.5 to 11.3) years of age were included. At 6 weeks, 14 of 16 (88%) used walking aids and at twelve weeks, 25% did. Sixty-nine percent could walk up and down stairs at 6 weeks and 100% at 12 weeks. At 3 months, 3 participants walked with a speed below 100cm/second and had clear deviations in gait pattern compared with the control group. Three participants had no deviations in gait patterns at 3 months. Gait patterns had normalized in most participants at 6 months. Hip and knee extension moments were decreased up to 6 months compared with the control group. Hip extensor muscle work was increased on the fractured side compared with the control group. Early recovery, between 6 and 12 weeks postoperatively, was noted in basic performance tests after femoral shaft fractures in children and adolescents. Three-dimensional gait analysis revealed normalization of gait patterns at 6 months. Information on the expected time and degree of recovery of physical function could guide the rehabilitation process. Level III.

Does Femoral Arterial Calcification Have an Effect on Mortality in Patients Who Underwent Hemiarthroplasty Due to Hip Fracture?

We aimed to investigate the effect of femoral arterial calcification on mortality in patients who underwent hemiarthroplasty due to hip fracture. In our study, 481 patients who were operated for hip fracture between 01.01.2015 and 01.01.2021 were evaluated retrospectively. Femoral arterial calcification on the fractured side was evaluated in the preoperative pelvic anteroposterior (AP) X-ray, and the patients were divided into two subgroups according to the presence or absence of femoral arterial calcification. The overall survival and first-month and first-year survival of the patients were evaluated. Patients' age, gender, side, fracture type, treatment method, time between fracture and operation date, presence of femoral arterial calcification and type of anesthesia (regional, general) were recorded. Of the 481 patients included in the study, 299 were female and 182 were male, and the mean age was calculated as 80.5. Of the patients, 187 were diagnosed with femoral neck fractures and the remaining 294 with pertrochanteric fractures. It was observed that the mortality rate in the first month after surgery was 58 (12%) for both groups, and the mortality rate in the first year was 173 (35.9%) for both groups. The overall postoperative mortality was calculated as 302 (62.7%) for both groups. Femoral arterial calcification was detected in 191 of 481 patients, and femoral arterial calcification was not observed in the remaining 290 patients. Similarly, when both groups were compared in terms of mortality in the first month after surgery, mortality in the first year and overall mortality rates, no significant difference was found between the groups (p>0.05). In our study we showed that femoral arterial calcification has no effect on mortality in acute hip fractures treated by hemiarthroplasty in people over 65 years of age.

Changing Patterns of Zygomaticomaxillary Complex Fractures: A Retrospective Study

Limited research exists regarding the incidence and variations of zygomaticomaxillary complex (ZMC) fracture patterns and their correlation with the mechanism of injury. Hence, further research is indicated. The purpose of this study was to analyze the different ZMC fracture patterns in relation to its etiology using computed tomography scans. This retrospective cohort study was conducted at a single institution. The medical records of maxillofacial trauma patients from 2016 to 2020 were analyzed. Patients from any gender and all age groups with complete records diagnosed with isolated ZMC fractures were included in the study. The primary predictor variable was the etiology of trauma. It was categorized as road traffic accidents (RTAs), falls, interpersonal violence, fall from height, sports injuries, etc. MAIN OUTCOME VARIABLES: The primary outcome variable was the ZMC fracture patterns observed and was defined as similar to or different from the classical fracture patterns. Any type of variation noted from the classical fracture lines was defined as the secondary outcome variable. Covariates included demographic variables such as age, gender, the type of vehicle involved, the type of RTA, side of fracture, associated orbital fractures, and number of ZMC points fractured. Descriptive and bivariate statistics were used to measure association between the predictor and outcome variables using multiple proportions χ2 test. Statistical significance was defined at P value of <.05. Out of the 232 scans assessed, a total of 163 cases were included in this study. A majority of the cases belonged to a range of 21 to 30years and showed a male predilection. The most common mode of injury was found to be RTAs (88.3%). Most cases had fracture patterns different from the classical fracture patterns (65.64%). A statistically significant association was found between the types of ZMC fracture patterns and etiology of trauma (RTA P= <.0001, falls P=.0001, and interpersonal violence P=.0001). Five different variations in ZMC fracture patterns were found and had a statistically significant association with the classical fracture lines (P<.0001). The authors conclude that the variations in fracture patterns encountered today may be attributed to the mechanism of injury. With due consideration to the limitations of this study, the authors suggest that the treatment plan may require slight modification based on the variation of the fracture pattern. Additional intervention may also be indicated.

Prevalence and Predictors of Peroneal Tendon Instability Accompanying Calcaneal Fractures.

We aimed to find the prevalence of peroneal tendon instability (PTI) accompanying different types of calcaneal fractures and to determine predictors of PTI based on preoperative CT scanning. In a retrospective cross-sectional study, preoperative CT scans of 400 consecutive calcaneal fractures undergoing surgery were reviewed for comminuted fragments in the lateral gutter of the ankle, fractures at the tip of the lateral malleolus, dislocated peroneal tendons, excessive displacement of the lateral calcaneal wall, calcaneal fracture-dislocation, superior peroneal retinaculum (SPR) avulsion fracture (fleck sign), and shape of the retromalleolar groove. The correlation of these variables with intraoperative SPR stress test, defined as the diagnostic criteria for PTI in calcaneal fractures, was evaluated. In total, 369 patients (mean age, 39 ± 13; range, 11-72 years), with 321 (87.0%) of them male, were included. Among all calcaneal fractures, 67 cases (16.7%) had associated PTI as confirmed intraoperatively by an SPR stress test. A statistically significant association was found between PTI in calcaneal fractures and comminuted fragments in the lateral gutter of the ankle (P = .03), dislocated peroneal tendons (P < .001), calcaneal fracture-dislocation (P < .001), SPR avulsion fracture (P < .001), and Sanders type IV of calcaneal fracture (P = .02). There was no statistically significant relationship between PTI and the mechanism of injury (P = .98), side of fracture (P = .30), uni- or bilateral calcaneal fractures (P = .27), a fracture at the tip of lateral malleolus (P = .69), shape of the retromalleolar groove (P = .78), or excessive displacement of the lateral calcaneal wall (P = .06). The most specific CT finding to predict PTI accompanying calcaneal fractures was calcaneal fracture-dislocation (99.1%). Following calcaneal fracture fixation, PTI was confirmed with intraoperative SPR stress test in one-sixth of cases. With the exception of calcaneal fracture-dislocation, preoperative findings on CT scanning and calcaneal fracture pathoanatomy are insufficient to diagnose PTI accompanying calcaneal fractures. Level III, retrospective case control study.

Standardization of global hip fracture audit could facilitate learning, improve quality, and guide evidence-based practice.

National hip fracture registries audit similar aspects of care but there is variation in the actual data collected; these differences restrict international comparison, benchmarking, and research. The Fragility Fracture Network (FFN) published a revised minimum common dataset (MCD) in 2022 to improve consistency and interoperability. Our aim was to assess compatibility of existing registries with the MCD. We compared 17 hip fracture registries covering 20 countries (Argentina; Australia and New Zealand; China; Denmark; England, Wales, and Northern Ireland; Germany; Holland; Ireland; Japan; Mexico; Norway; Pakistan; the Philippines; Scotland; South Korea; Spain; and Sweden), setting each of these against the 20 core and 12 optional fields of the MCD. The highest MCD adherence was demonstrated by the most recently established registries. The first-generation registries in Scandinavia collect data for 60% of MCD fields, second-generation registries (UK, other European, and Australia and New Zealand) collect for 75%, and third-generation registries collect data for 85% of MCD fields. Five of the 20 core fields were collected by all 17 registries (age; sex; surgery date/time of operation; surgery type; and death during acute admission). Two fields were collected by most (16/17; 94%) registries (date/time of presentation and American Society of Anesthesiologists grade), and five more by the majority (15/17; 88%) registries (type, side, and pathological nature of fracture; anaesthetic modality; and discharge destination). Three core fields were each collected by only 11/17 (65%) registries: prefracture mobility/activities of daily living; cognition on admission; and bone protection medication prescription. There is moderate but improving compatibility between existing registries and the FFN MCD, and its introduction in 2022 was associated with an improved level of adherence among the most recently established programmes. Greater interoperability could be facilitated by improving consistency of data collection relating to prefracture function, cognition, bone protection, and follow-up duration, and this could improve international collaborative benchmarking, research, and quality improvement.

Comparative study between deltoid split approach versus delto pectoral approach for proximal humerus fracture fixation

Background: Proximal humeral fracture is defined as fractures occurring at or proximal to the surgical neck of the humerus. It affects 2.4% of women over the age of 75 years. It is the commonest fracture affecting the shoulder girdle in adults and its incidence is rising. For displaced fractures that meet surgical indications, deltopectoral approach is the most common approach for plate fixation of proximal humeral fractures. Deltoid splitting approach offers advantages of better exposure and implant placement for fixation of the fracture and early mobilization of the shoulder joint. Methods: This is a comparative study of 30 cases of proximal humerus fractures treated by surgical fixation through deltoid splitting approach and 30 cases treated by delto pectoral approach. Patient of both sexes belonging to adult age group in general population presenting with proximal humerus fracture to the orthopaedic department of Bapuji Hospital and Chigateri General hospital attached to J.J.M. Medical College, Davangere. The period of survey extends from December 2020 to December 2022. The final results were evaluated using constant Murley score periodically. This constant Murley score ranges from 0 to 100 points representing worst and shoulder function respectively. Results: No statistically significant difference was observed in outcome with regard to mechanism of injury, side of fracture and type of fracture with both deltoid splitting approach and delto pectoral approach. Conclusions: The treatment of proximal humeral fractures with a proximal locking plate is reliable using both approaches. No significant difference found in functional outcome of proximal humerus fracture following deltoid split and deltopectoral approach on serial follow up.

Contact stress distribution after unilateral condylar fracture with angulation of the fractured part: A finite element model study

After a fracture of the condyle, the head of the condyle is often pulled inwards, which causes the fractured part to angulate medially. This change can cause a disbalance in the masticatory system. The disbalance could lead to contact stress differences within the temporomandibular joints (TMJs) which might induce remodelling within the TMJ to restore the balance. The contact stress in the fractured condyle during open and closing movements is expected to decrease, while the contact stress in the non-fractured condyle will increase. In a clinical situation this is hard to investigate. Therefore, a finite element model (FEM) was used. In the FEM a fractured right condyle with an angulation was induced, which was placed at different degrees, varying from 5° to 50° in steps of 5°. This study shows only minor differences in amount of contact stress between the fractured and the non-fractured condyle. The amount of contact stress in the condyles does not increase with a higher degree of angulation. However, with larger angulations, the contact stress within the fractured condyle is more centralized. Clinically, this more centralized area could be associated with complaints, such as pain. In conclusion, due to the more centralized contact stress in the fractured condyle, one would expect some minor remodelling on the fractured side with more angulation.

Changes in load distribution after unilateral condylar fracture: A finite element model study

ObjectivePremature dental contact on the fractured side and a contralateral open bite are signs of a unilaterally fractured condyle of the temporomandibular joint (TMJ). The lateral pterygoid muscle pulls the condyle inwards, causing angulation of the fractured part and shortening of the ramus. This imbalance after fracture might change the load in both TMJs and consequently induce remodeling. The present study aimed to calculate this change in load. It is hypothesized to decrease on the fractured side and increase on the non-fractured side. DesignFor these calculations, a finite element model (FEM) was used. In the FEM, shortening of the ramus varied from 2 mm to 16 mm; angulation, from 6.25° to 50°. ResultsAfter fracture, load on the non-fractured side increased, but only at maximal mouth opening (MMO). Simultaneously, load on the fractured side decreased, at both timepoints, i.e., MMO and closed mouth. When comparing all simulations at those time points, i.e., from 2 mm and 6.25° to 16 mm and 50°, the load in the fractured condyle declines steadily. However, for both timepoints, a threshold stands out around 6 mm shortening and 18.75° angulation: visualization of the fractured condyle showed, apart from load on the condylar head, a second point of load more medial in the TMJ which was most evident in the 6 mm – 18.75° simulation. ConclusionsThese findings could implicate that the balance between both TMJs is more difficult to restore after a fracture with more than 6 mm shortening and more than 18.75° angulation.

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.

Comparative study on effectiveness of ultrasound- and arthrography-assisted Kirschner wire fixation in treatment of Jakob type Ⅱ lateral condylar humerus fractures in children

To compare the effectiveness of ultrasound- and arthrography-assisted Kirschner wire fixation in the treatment of Jakob type Ⅱ lateral condylar humerus fracture (LCHF) in children. A clinical data of 101 children with Jakob type Ⅱ LCHF, who met the selection criteria and were admitted between April 2021 and April 2022, was retrospectively analyzed. Of them, 47 cases were treated with ultrasound-assisted Kirschner wire fixation (group A), and 54 cases with arthrography-assisted surgery (group B). There was no significant difference in gender, age, cause of injury, fracture side, and disease duration between groups (P>0.05). Intraoperative fluoroscopy times, operation time, and hospital stay, Flynn elbow joint function score, and postoperative complications were recorded and compared between groups. X-ray examination was performed to observe the healing of fracture, and measure the carrying angle and the shaft-condylar angle (SCA). The success rate of closed reduction was significantly higher in group A than in group B (P<0.05), and the intraoperative fluoroscopy times was significantly less in group A than in group B (P<0.05). There was no significant difference in operation time and hospital stay between groups (P>0.05). All children in both groups were followed up 12-18 months, with an average of 13.6 months. X-ray reexamination showed that the fractures of both groups healed, and the difference in healing time was not significant (P>0.05). At last follow-up, there was no significant difference in carrying angle and SCA between unaffected side and affected side in both groups and between groups A and B in affected side (P>0.05). There was no significant difference in Flynn elbow joint function score between groups (P>0.05). There were 18 cases of lateral spurs formation in group A, 1 case of pinning infection and 26 cases of lateral spurs formation in group B, and there was no significant difference in the incidence of the above complications (P>0.05). Compared with the arthrography, the ultrasound-assisted Kirschner wire fixation in the treatment of Jakob type Ⅱ LCHF in children can avoid the open reduction and decrease the number of intraoperative fluoroscopy, and obtain the good effectiveness.

Morphology of Fibular Incisura is a Deciding Factor Between Posterior Malleolus Avulsion Fracture or Syndesmotic Ligament Injury in Ankle Fractures

The bone anatomy of tibiofibular syndesmosis has been a topic of interest. Fibular incisura morphology has been analyzed on cadaver specimens, plain radiographs, or CT images. The aim of this study is to examine the effects of fibula incisura features and fibula morphology in ankle injuries, especially involving posterior malleolus and posteroinferior tibiofibular ligament injuries. From 2017 through 2022, A total of 59 patients with isolated lateral malleolar fracture, Mason-Malloy type 1 posterior malleolar fracture, syndesmosis injury in those without posterior malleolar fracture, supination external rotation type 3 injuries according to Lauge-Hansen classification, and preoperative bilateral ankle computed tomography images were included in the study. Fibula morphologies and syndesmosis measurements were made from preoperative computed tomography images using axial CT images from 1 cm proximal to the tibial plafond. The diagnosis of posterior malleolar fractures was made using the CT classification system of Mason and Malloy, and the diagnosis of syndesmosis injury was made with a cotton test during surgery. Age, gender, fractured side, incisura type, incisor depth, width, anterior and posterior facet lengths, incisor version (antevert-retrovert), the angle between the anterior and posterior facets, and fibula type were recorded. There was a statistically significant difference between the groups in posterior facet length and incisura width. Morphological features of fibular incisura may be the determinant of PITFL injury or PMA injury in fibular fractures caused by an external rotation mechanism.

Sacroiliac versus transiliac–transsacral screw osteosynthesis in osteoporotic pelvic fractures: a biomechanical comparison

IntroductionPelvic fractures were often associated with high-energy trauma in young patients, but data show a significant increase in osteoporotic pelvic fractures in old age due to the progressive demographic change. There is an ongoing discussion about the best fixation techniques, which are ranging from lumbopelvic fixation to sacral bars or long transiliac–transsacral (TITS) screws. This study analyzes TITS screw osteosynthesis and sacroiliac screw osteosynthesis (SI), according to biomechanical criteria of fracture stability in osteoporotic human pelvic cadavers ex vivo.MethodsTen osteoporotic cadaveric pelvises were randomized into two groups of 5 pelvises each. An FFP-IIc fracture was initially placed unilaterally and subsequently surgically treated with a navigated SI screw or a TITS screw. The fractured side was loaded in a one-leg stance test setup until failure. Interfragmentary movements were assessed by means of optical motion tracking.ResultsNo significant difference in axial stiffness were found between the SI and the TITS screws (21.2 ± 4.9 N and 18.4 ± 4.1 N, p = 0.662). However, there was a significantly higher stability of the fracture treatment in the cohort with TITS-screws for gap angle, flexion, vertical movement and overall stability. The most significant difference in the cycle interval was between 6.000 and 10.000 for the gap angle (1.62 ± 0.25° versus 4.60 ± 0.65°, p = 0.0001), for flexion (4.15 ± 0.39 mm versus 7.60 ± 0.81 mm, p = 0.0016), interval 11.000–15.000 for vertical shear movement (7.34 ± 0.51 mm versus 13.99 ± 0.97 mm, p < 0.0001) and total displacement (8.28 ± 0.66 mm versus 15.53 ± 1.07 mm, p < 0.0001) for the TITS and the SI screws.ConclusionsThe results of this biomechanical study suggest a clear trend towards greater fracture stability of the TITS screw with significantly reduced interfragmentary movement. The application of a TITS screw for the treatment of the osteoporotic pelvic ring fracture may be prioritized to ensure the best possible patient care.

The Impact of Banana-Shaped Fragments on Trochanteric Hip Fractures Treated by PFNA.

Regarding trochanteric hip fractures, one type of posterior coronal fragments was described as the "banana-shaped fragment", while the impact of the banana-shaped fragment on mechanical stability has not been further studied. The current study investigated the association between the banana-shaped fragment and mechanical complications after surgery. This retrospective cohort study included 273 patients treated by proximal femoral nail antirotation (PFNA) in the full analysis. The age, the sex, the fracture side, the follow-up time, the American Society of Anesthesiologists classification, the operators, the fracture classification, the tip-apex distance, the blade positions, the reduction quality and the bone mineral density were analyzed in relation to mechanical complications, through univariate and multivariate approaches. Mechanical complications happened in 33 patients. The banana-shaped fragment (adjusted odds ratio 5.240, 95% CI 2.172 to 12.641; p < 0.001), the tip-apex distance and the reduction quality showed significant association with mechanical complications in both univariate and multivariate analysis. Moreover, for 118 patients with the banana-shaped fragment, we found that the use of wire cerclage couldn't significantly lower the rates of mechanical complications (p = 0.648). The banana-shaped fragment had a negative impact on mechanical stability of trochanteric hip fractures treated by PFNA. In the perioperative period, the BSF should be carefully evaluated, and its specific handling deserves further study.

Characteristics of distal radius fractures in east China-an observational cohort study of 1954 individual fractures

ObjectiveTo investigate the characteristics and seasonal patterns of distal radius fractures (DRFs) over the preceding five years, with the aim of establishing a clinical foundation for the prevention and management of such fractures within this region.MethodsUtilizing the Picture Archiving and Communication Systems (PACS), the clinical records of 1954 patients diagnosed with DRFs and admitted to the Affiliated Hospital of Jiangsu University between January 2017 and December 2021 were compiled. The analysis encompassed factors such as age, gender, visitation timing, fracture side, and presence of osteoporosis.ResultsOut of the total 1954 distal radius fractures, 731 were males (37.4%) and the male to female ratio was 0.59:1. The median age of patients with DRFs was 56 years, with the 25th percentile being 38 years and the 75th percentile being 67 years. The average age was 50 years (standard deviation 23.3) and 1033 cases (52.7%) occurred on the left side, 885 cases (45.1%) on the right side, and 36 cases (1.8%) were bilateral, with the left side being the most frequently affected. The age group of 61–70 years (23.9%, 467/1954) exhibited the highest proportion, and the most prominent age group for males was 11–20 years (23.8%, 174/731), whereas for females it was 61–70 years (30.83%, 377/1223). In the 50 years and older group, there were 276 males and 991 females (ratio 1:3.59), with osteoporosis in 536 cases, accounting for 42.03% of the group. In terms of seasonal distribution, the highest incidence occurred during the summer and autumn months (55.1%, 1076/1954) and there were gender differences in different seasons.ConclusionIn east China, DRFs were predominantly female and left-sided, with the highest proportion in the age group of 61–70 years and in summer and autumn. Furthermore, gender differences were observed between the warm and cold seasons.

Biomechanical and clinical evaluation of minimal invasive plate osteosynthesis for two-part clavicle shaft fractures

BackgroundMany surgical treatment methods exist for clavicle shaft fractures. A locking compression plate (LCP) fixation with three screws per fracture side is commonly used. For certain fractures a stabilization with 2 screws per side is potentially suitable, offering the advantage of reduced soft tissue approach, while avoiding the disadvantages of minimally-invasive nailing at the same time. This hypothesis was evaluated biomechanically and clinically.MethodsFour treatment procedures were investigated biomechanically using composite human clavicle specimens. A load-to-failure test was performed using a three-point cantilever test. In group 1, a simple shaft fracture was simulated and stabilized with 2 screws per fracture side (5-hole LCP). In the second group 3 screws per side (7-hole LCP) were used. In group 3, a non-reduced fracture zone was simulated and treated with 3 screws per side (7-hole LCP). In group 4, an anatomically reduced fracture zone was simulated and treated with 3 screws per side (7-hole LCP). Furthermore 27 patients treated with a short plate and 2 screws per side (similar to group 1) were assessed after a minimum follow-up of 12 months (Constant and DASH Score).ResultsThe maximum load-to-failure of group 1 was 367N. We observed the highest load-to-failure in group 2 with 497N and the lowest in group 3 with 90N. In group 4 a maximum load-to-failure of 298N could be evaluated. There was no significant difference in load-to-failure between the treatment of a simple clavicle fracture using 5- or 7-hole LCP (p = 0.121). However, we found a significant difference of load-to-failure between the simple and anatomically reduced fracture using a 7-hole plate (p = 0.014). The mean constant score of the surgically treated patients was 95 and the DASH score 3.0. Fracture consolidation was observed in 96.3%.ConclusionsFor certain non-fragmented and well interlocking 2-part fractures, a plate osteosynthesis fixed with only 2 screws per fracture side might offer sufficient biomechanical stability, better soft tissue preservation and comparable fusion rates compared to the operative treatment with 3 screws per side. However, the maximum load-to-failure of the 7-hole LCP was higher than of the 5-hole LCP, but this difference was not statistically significant.Trial registrationApproval from the ethics committee of the Technical University of Dresden was retrospectively obtained (EK 588122019).

Outcome of Early Weight Bearing Cast for the Treatment of Jones Fracture

Objective: To determine the radiological and functional outcome of acute Jones fracture treated conservatively in early weight bearing cast. Study Design and Setting: This study was conducted in Orthopaedic Division Lady Reading Hospital Peshawar. The duration of study extended from 25th August 2018 to 13th November 2022. Methodology: All patients of both gender and age 18 years and above with isolated Jones fracture fulfilling the inclusion criteria were treated in below knee early weight bearing cast. Radiological union was assessed by noting callus and obliteration of fracture line. The functional outcome was determined using American Orthopaedic Foot and Ankle Score(AOFAS) after cast removal. Results: This study included a total of 319 patients of Jones fractures who were treated in early weight bearing cast, the mean age was 34.41±4.29 years. Female patients were 245(76.80%) while male were 74(23.19%). Right foot was involved in 211(66.14%) patients and left in 108(33.85%). The average union time was 6.2±1.2 weeks. Majority(99.0%,n=316) of our patients achieved union. Non union was reported in only 3(0.94%) patients. Excellent functional outcome was documented in our patients as indicated by mean AOFAS score 99.1±1.1. Comparison of AOFAS score for gender, side and type of fracture did not reveal any significant difference.(p&gt;0.05) Conclusion: Early weight bearing cast is an effective modality of conservatively treating acute Jones fractures as shown by higher union rate and excellent functional outcome in majority of our patients

Https://universepg.com/journal-details/ejmhs/outcome-of-early-versus-delay-hip-spica-casting-for-children-with-femoral-shaft-fractures

Femoral shaft fractures are among the most prevalent fractures of the lower extremities in children. Although many approaches and options are available for their treatment, the most appropriate treatment option for school going children is still debatable. In this study 34 children with femoral fractures were recruited between Jan. 2018 and Jan 2019 at the Nangarhar university and public health Hospital. which is divided into two groups: (Group-A) immediate reduction with hip Spica consists 22 children and (Group -B) treatment consist of skin traction for 2-3 weeks precede with hip Spica casting consists 12 children and we studied gender distribution, fracture side, site and type of the fracture, also we note complications include; initial shortening, axial, sagittal and rotational alignment and hospital stay. All patients were under observation for a period of 3 months after removal of Spica cast. The study found that boys were more affected than girls, which the middle third of the femoral shaft was the most common site fracture (58.92%), that the spiral fracture was the most common type of femoral shaft fracture (43.18%), as well as that side way alignment was observed more than other kinds of complications in both treatment modalities; for immediate Spica, four children (18.18%) and three cases (25%).Conclusions: There was minimal difference between early and delayed Spica in terms of treatment complications and functional result. However, early Spica greatly reduced hospitalization time and treatment costs while producing equivalent results as delayed Spica use.

Complications in the Treatment of Mandibular Condylar Fracture, Surgical Versus Non-Surgical Treatment

Background: The facial fractures include Condylar fractures are most common in mandibular fractures, which have the highest fracture incidence after nasal bone fractures. Three different traumatic forces can result in condylar injury: the first is energy imparted to a static person by a moving object, such as a blow to the face from a cricket bat; the second is a moving person striking a static object, such as a child falling and striking the ground; and the third is a combination of the first two forces, such as when a person is moving and an automobile is moving and is hit by an automobile. This kind of force typically has the biggest impact and causes the most severe injury patterns. Objective: To compare frequency of Complications of two procedures for the treatment of mandibular condylar fracture surgical versus conservative treatment. Methodology: This Randomized control trial was held in the Tertiary Care Hospital Karachi for 6 months from 12 Jul, 2019 to 12 Jan, 2020. ERC were taken before data collection. Patients suffering from mandibular condylar fracture and fulfilling exclusion and inclusion criteria and who were ready to give informed consent after explaining study protocol, risk benefit ratio and data usage for research were included in our study. The first group labelled as "A" was treated by closed reduction and immobilization and second group labelled as group "B" was undergone internal fixation and open reduction. Results: The mean age and standard deviation of the 72 patients was determined to be 40.85 ± 12.93 years, respectively, with the 18 years was the minimum age and the 65 years being maximum. Frequency of gender was shown in Graph 1.The minimum duration of fracture was 1 day, and maximum were 7 days. The minimum mouth opening was 15mm and maximum was 35mm (Table 1). Trismus was present in 5/72 (6.9%) patients while it was absent in 67/72 (93.1%) patients (Table 2). Malocclusion was present in 20/72 (27.8%) patients while it was absent in 52/72 (72.2%) patients. Unilateral Side of fracture was present in 40/72 (55.6%) patients while Bilateral was present in 32/72 (44.4%) patients (Table 3) Conclusions: In conclusion, closed reduction had clinically satisfactory results, although open reduction and internal fixation produced more accurate to reduce the complications. Keywords: Closed reduction, Internal fixation, Open reduction,complications

FELLOWSHIP-TRAINED ORTHOPAEDIC TRAUMATOLOGISTS ACHIEVE BETTER POSTOPERATIVE RADIOLOGICAL PARAMETERS AFTER CEPHALOMEDULLARY NAILING OF INTERTROCHANTERIC FRACTURES COMPARED WITH COMMUNITY SURGEONS

Intertrochanteric fractures are common, accounting for nearly 30% of all fracture related admissions. Some have suggested that these fractures should be treated in community hospitals so as not to tax the resources of Level One trauma centers. Since many factors predictive of fixation failure are related to technical aspects of the surgery, the purpose of this study was to compare radiographic parameters after fixation comparing trauma fellowship trained surgeons to non-fellowship trained community surgeons to see if these fractures can be treated successfully in either setting.Using our hospital system's trauma database, we identified 100 consecutive patients treated with cephalomedullary nails by traumatologists, and 100 consecutive patients treated by community surgeons. Quality of reduction, neck shaft angle (NSA), tip-to apex distance (TAD) were compared.The mean TAD for the trauma group was 10mm compared to 21mm for the community group (p&lt;0.001). The mean postoperative NSA for the trauma group was 133 degrees compared to 127 degrees for the community group (p&lt;0.001). The mean difference in the NSA of the fractured side compared to the normal hip was 2.5 degrees of valgus in the trauma group compared to 5 degrees of varus for the community group (p&lt;0.001). There were 93 good reductions in the trauma group compared to 19 in the community group (p&lt;0.001). There were no poor reductions in the trauma group and 49 poor reductions in the community group (p&lt;0.001).Fellowship trained traumatologists achieved significantly more accurate reductions and implant placement during cephalomedullary nailing of intertrochanteric hip fractures.