Fracture Research Articles

Surgery for a case of femoral fracture complicated with suspected COVID-19

Surgery for a case of femoral fracture complicated with suspected COVID-19

Surgical treatment of hip fracture complicated with suspected COVID-19: a case report

Surgical treatment of hip fracture complicated with suspected COVID-19: a case report

Advantages of percutaneous minimally invasive plate internal fixation in the treatment of complex proximal humeral fractures

Objective To explore the clinical advantages of minimally invasive percutaneous plate osteosynthesis (MIPPO) in the treatment of proximal humerus fractures of Neer typeⅢ andⅣ. Methods From May 2015 to May 2018, 78 cases of proximal humerus fractures of Neer type Ⅲ and Ⅳ were treated with MIPPO and open reduction and internal fixation (ORIF). There were 36 cases in MIPPO group, 20 males and 16 females, including 21 cases of Part Ⅲ fractures and 15 cases of Part Ⅳ fractures; and 42 cases in ORIF group, 24 males and 18 females, including 26 cases of Part Ⅲ fractures and 16 cases of Part Ⅳ fractures. The length of incision, the amount of bleeding, the time of operation, the time of fracture healing, the UCLA score of shoulder joint before and 3, 6 months after operation, the Constant-Murley score of shoulder joint function at 3, 6, 12 months after operation, the classification of joint function at the last follow-up, the axillary nerve injury and other complications were compared. The shoulder joint function of MIPPO group was evaluated after fracture healing. Results All the 78 patients were follow-up for (17.3±2.8) months. The incision length, fracture healing time and intraoperative bleeding in MIPPO group were significantly shorter than those in ORIF group. The UCLA scores of shoulder joint in MIPPO group were 29.04±1.63 and 30.95±1.69 at 3 and 6 months after operation, which were higher than those in ORIF group 22.11±2.33 and 25.96±2.01. The shoulder function Constant-Murley scores of MIPPO group were 55.64±2.83 and 75.01±5.71 at 3 and 6 months after operation, which were higher than those of ORIF group 45.03±6.32 and 64.61±6.77. However, there was no significant difference between the two groups in the shoulder function Constant-Murley score and the last shoulder function grade at 12 months after operation. After fracture healing, the shoulder function of MIPPO group was further evaluated: the average flexion angle was 170.5 ° (ranged, 161° to 180°), the average external rotation angle was 71° (ranged, 63.5° to 83.5°), the average internal rotation angle was 73.6 ° (ranged, 68° to 79°) and the recovery of mobility was good. The complication rate of MIPPO group was 5.56%, which was better than that of ORIF group 11.90% (P<0.05). Conclusion Both MIPPO and ORIF can treat proximal humerus fractures of Neer type Ⅲ and Ⅳ. The former is superior to the latter in incision length, bleeding volume, fracture healing time, shoulder joint function recovery at 3 and 6 months after operation, complications and other aspects, which is worth clinical promotion. Key words: Humeral fractures; Fracture fixation,internal; Axillary nerve injury; Minimal invasive

Closed percutaneous reduction by leverage and Kirschner wire fixation for treatment of irreducible phalangeal neck fractures in children

Objective To investigate the clinical efficacy of closed percutaneous reduction by leverage and Kirschner wire fixation in the treatment of irreducible phalangeal neck fractures in children. Methods From January 2016 to March 2019, 12 children with irreducible phalangeal neck fractures ware treated. The time from injury to operation was 1 to 46 days, including 5 cases of old fracture. Closed Kirschner wire puncture was used to clear callus and closed percutaneous reduction by leverage and Kirschner wire fixation were performed. The fracture healing time of the children was followed up after operation. Total active motion (TAM) system was used to evaluate the recovery of finger function. Results All the operations were completed successfully, and no infection, skin necrosis and fracture malunion occurred. All the children were follow-up for 6 to 36 months, with an average of 15.3 months. The fracture healing time was (4.2±0.2) weeks. The Kirschner wire was removed and functional exercises were performed 4 weeks after operation. The finger joint function was evaluated as excellent according to TAM system. Conclusion Closed percutaneous reduction by leverage and Kirschner wire fixation in the treatment of irreducible phalangeal neck fractures in children has the advantages of simple operation, less trauma and definite curative effect. It is necessary to strictly grasp the operative indications for old fracture. Key words: Finger phalanges; Fractures,bone; Fracture fixation; Kirschner wire

Clinical application of TriGen interlocking intramedullary nail combined with suture anchor in the treatment of Neer type III and IV proximal humeral fractures

Objective To analyze the clinical efficacy of TriGen interlocking intramedullary nail combined with suture anchor in the treatment of Neer typeⅢ andⅣ proximal humeral varus fractures. Methods From June 2015 to June 2017, 23 patients with proximal humeral varus fractures of Neer type Ⅲ and Ⅳ were treated with TriGen interlocking intramedullary nail combined with suture anchor technique, including 15 cases of Neer type Ⅲ and 8 cases of Neer type Ⅳ. The fracture healing time was followed up. The range of motion of shoulder joint was measured one year after operation. American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score and visual analogue scale (VAS) were performed. Results All the patients were follow-up for 12 to 16 months, with an average of 14 months. All fractures healed 2 to 4 months after operation, with an average of 3 months. No complications such as wound infection, rotator cuff injury and axillary nerve injury occurred. The ASES score, Constant-Murley score and VAS were (91.00±3.04), (90.00±3.21) and (0.42±0.38) respectively. Conclusion For Neer type Ⅲ and Ⅳ complex proximal humerus varus fractures, TriGen interlocking intramedullary nail combined with suture anchor technique is used to treat it, which increases the strength of fixing the humeral nodules, conforms to the concept of overall fixation, is conducive to early functional rehabilitation, and achieves good results after operation. It is a reliable minimally invasive treatment method. Key words: Humeral fractures; Surgical procedures, operative; Proximal; Intramedullary nail; Anchor

Study on micro-hardness distribution characteristics of human metacarpal bones

Objective To report the micro-hardness of human metacarpal bones, compare and analyze the hardness values between different anatomical parts, and explore the distribution characteristics of micro-hardness of human metacarpal bones. Methods The metacarpal bones were collected from three fresh healthy frozen specimens. The soft tissue of the right metacarpal bone was dissected. These metacarpal bones were cut into 3 mm-thick slices perpendicular to the long axis with a low-speed saw in metacarpal base, shaft and head. The Vickers method was used to measure the hardness of different areas of the palmar, dorsal, medial and lateral site of bone slices, and the standard operation method with 50 g force loading for 50 s and maintenance for 12 s was used to determine the hardness. The hardness value was compared by one-way ANOVA, and P<0.05 was statistically significant. Results Totally, 45 specimens and 900 indentations at different bones and anatomic sites were involved. The overall hardness of metacarpal bone was (38.23±7.15) HV. The third metacarpal bone had the highest hardness (41.04±6.75) HV, followed by the second metacarpal bone (39.62±7.64) HV, the first metacarpal bone (37.83±6.52) HV, the fifth metacarpal bone (36.69±7.30) HV, and the fourth metacarpal bone (35.97±6.28) HV. The metacarpal shaft hardness (43.45±6.35) HV was higher than metacarpal basal (35.82±6.17) HV and metacarpal head (35.43±5.85) HV (F=16.415, P<0.01). There was no significant difference in palmar (37.58±7.35) HV, dorsal (38.93±7.08) HV, medial (38.26±7.00) HV and lateral site (38.15±7.14) HV in hardness (F=1.352, P=0.256). Conclusion The results of this study have deepened the understanding of metacarpal micro-biomechanical properties, and can guide the placement, direction and number of internal fixators in metacarpal fracture surgery, and provide data support for 3D printing of artificial metacarpophalangeal joint for the treatment of comminuted metacarpal fracture or defect. Key words: Metacarpal bones; Biomechanics; Vickers hardness; Micro-hardness

Application of psychological nursing combined with syndrome differentiation and nursing in children with supracondylar fracture of humerus after internal fixation with closed puncture

Objective To explore the effect of psychological nursing combined with syndrome differentiation in children with supracondylar fracture of humerus. Methods A total of 86 cases of supracondylar fractures of the humerus received by the hospital from March 2017 to May 2018 were selected as the study objects.All the patients were treated with internal fixation with closed needle perforation by means of manipulation, and were grouped by single and even numbers of inpatient beds, with single numbers as the control group for a total of 43 cases. Routine nursing was given after the operation, while double numbers as the observation group for a total of 43 cases. Psychological nursing combined with TCM syndrome differentiation and nursing were given after the operation.The postoperative recovery effect of the two groups was compared. Results There was no significant difference in VAS and FLACC scores between the two groups before and 12 hours after surgery(P>0.05). The VAS and FLACC scores in the two groups were decreased from 12 to 24 hours after surgery, and the scores in the observation group were lower than those in the control group, with statistically significant differences(P<0.05). The incidence of postoperative complications in the observation group was significantly lower than that in the control group, and the difference was statistically significant(P<0.05). The postoperative compliance and satisfaction of the observation group were significantly higher than that of the control group, and the difference was statistically significant(P<0.05). Conclusions Psychological nursing combined with syndrome differentiation has a significant effect on the application of closed puncture needle internal fixation for children's supracondylar humerus fractures, effectively reducing the degree of postoperative pain and the incidence of complications, which is worthy of clinical promotion. Key words: Psychological nursing; Dialectical nursing; Supracondylar fracture of humerus in children; Manual reduction; Fixation

Femur Fracture Caused by Falling of a Boy with Osteogenesis Imperfecta

Osteogenesis imperfecta (OI) is the most common hereditable cause of bone fragility in children. A Japanese 2-year-old boy fell accidentally from a slide, sustaining a femur shaft fracture. Several maternal family members had experienced episodes of hearing impairment and bone fracture. The injury mechanism was clear and competent. Child abuse was unlikely. Strong family history and presence of blue sclera confirmed the OI diagnosis. Any doctor treating pediatric femur fractures should recall the rare cause of OI. Clinical evaluation alone without a family interview might not complete the diagnosis with OI. We continued proposing to his parents the benefit of receiving bisphosphonate treatment.

Arthroscopic fixation with figure of 8 suture versus ladder mesh suture for anterior cruciate ligament tibial avulsion fracture

Objective To compare the primary clinical results of arthroscopic figure of 8 suture and ladder mesh suture fixations in treating anterior cruciate ligament (ACL) tibial avulsion fractures. Methods From August 2013 to November 2016, a total of 37 patients with ACL tibial avulsion fracture who had closed epiphyses underwent arthroscopy. By the Meyers-McKeever-Zaricznyj classification, 10 cases were type II, 22 type III and 5 type IV. There were 25 cases in the figure of 8 suture fixation group with two No.2 high-strength sutures crossed to form a 8 figure to pull out and fix the fracture through the tibial tunnels, including 17 males and 8 females with an average age of 18.91±9.34 years (range 14-36 years). The ladder mesh suture fixation group with three No.2 high-strength sutures woven into a mesh to pull out and fix the fracture through the tibial tunnels had 12 cases, including 8 males and 4 females with an average age of 19.63±7.85 years (range 15-33 years). At the latest follow-up, the Lysholm and International Knee Documentation Committee (IKDC) scores were used to estimate knee joint function, while the Lachman test and Pivot-shift test were used to estimate knee joint instability. The operation duration, knee range of motion (ROM) and the number of case with flexion contracture were evaluated. Results All 37 cases were followed up. The average follow-up duration was 16.35±5.27 months (range 10-22 months) in figure of 8 suture fixation group and 14.06±7.18 months (range 10-21 months) in ladder mesh suture fixation group. In figure of 8 suture fixation group, the Lysholm and IKDC average scores were 95.86±5.74 and 90.53±4.61, respectively. However, they were 96.53±3.17 and 92.15±5.54 in ladder mesh suture fixation group with no significant difference between the two groups after operation (t=0.723, P=0.462; t=1.018, P=0.279). The percentage of negative Lachman test and Pivot-shift test in the figure of 8 suture group was 92% (23/25) . There was no significant difference in the negative rate in the ladder mesh suture fixation group 100% (12/12, χ2=0.904, P=0.265). The average operation duration of ladder mesh suture fixation group was 61.8±6.3 minutes, which was longer than that of figure of 8 suture fixation group 43.5±5.9 minutes (t=2.714, P=0.025). Flexion contracture of ≥5° occurred in 4 cases in the figure of 8 suture group and 0 case in the ladder mesh suture fixation group with significant difference between the two groups (χ2=0.450, P=0.032). Conclusion In treating ACL tibial avulsion fractures, arthroscopic figure of 8 suture fixation and ladder mesh suture fixation can achieve satisfied functional recovery and stability. The ladder mesh suture fixation can effectively achieve reduction of fracture fragments and knee flexion contracture. It may have more advantages in treating rotational type III and type IV comminuted fractures. However, some disadvantages in this technique, such as high technical requirements and long operation time, have to be considered. Key words: Arthroscopy; Sutures; Fracture fixation, internal; Anterior cruciate ligament

Large-scale structure of the Doldrums multi-fault transform system (7-8ºN Equatorial Atlantic): preliminary results from the 45th expedition of the R/V A.N. Strakhov

The Equatorial portion of the Mid Atlantic Ridge is displaced by a series of large offset oceanic transforms, also called “megatransforms”. These transformdomains are characterized by a wide zone of deformation that may include different conjugated fault systems and intra-transform spreading centers (ITRs).Among these megatransforms, the Doldrums system (7-8oN) is arguably the less studied, although it may be considered the most magmatically active. Newgeophysical data and rock samples were recently collected during the 45th expedition of the R/V Akademik Nikolaj Strakhov. Preliminary cruise results allowto reconstruct the large-scale structure and the tectonic evolution of this poorly-known feature of the Equatorial Atlantic. Swath bathymetry data, coupled withextensive dredging, were collected along the entire megatransform domain, covering an area of approximately 29,000 km2. The new data clearly indicate thatthe Doldrums is an extremely complex transform system that includes 4 active ITRs bounded by 5 fracture zones. Although the axial depth decreases toward thecentral part of the system, recent volcanism is significantly more abundant in the central ITRs when compared to that of the peripheral ITRs. Our preliminaryinterpretation is that a region of intense mantle melting is located in the central part of the Doldrums system as consequence of either a general transtensive regimeor the occurrence of a more fertile mantle domain. Large regions of basement exposure characterize the transform valleys and the ridge-transform intersections.We speculate that different mechanisms may be responsible for the exposure of basement rocks. These include the uplift of slivers of oceanic lithosphereby tectonic tilting (median and transverse ridges formation), the denudation of deformed gabbro and peridotite by detachment faulting at inner corner highs, andthe exposure of deep-seated rocks at the footwall of high-angle normal faults at the intersection of mid-ocean ridges with transform valleys

Risk factors related to contralateral hip fracture following hip fracture in elderly patients: a meta analysis and review

Objective To evaluate the factors related to contralateral hip fracture in the elderly patients with hip fracture by meta analysis. Methods Pubmed, Cochrane, CBMdisc, CNKI Chinese Journal Full Text Database and Wan Fang Database were searched for publications at home and abroad from January 2005 to April 2018 on factors related to contralateral hip fracture after hip fractures in the elderly. The publication quality was strictly evaluated before the data were extracted concerning gender and age(>65 years) of the patients, concomitant osteoporosis (Singh sign ≥4), primary fracture type, concomitant Parkinson disease, concomitant stroke, concomitant senile dementia, concomitant cataract, concomitant rheumatoid arthritis, concomitant diabetes, type of internal fixation for primary fracture and therapeutic compliance. Revman5.0 was used to perform the statistical analysis and the OR value and 95% CI were calculated fore each index. Results A total of 17 studies were included involving 1,504 patients with contralateral hip fracture among 13,717 elderly patients with hip fracture. The factors related to the refracture of the contralateral hip were the age of the patients (OR=-3.55, 95% CI:-5.60~-1.50, P<0.001), osteoporosis (OR=2.38, 95% CI: 1.36~4.17, P=0.002), Parkinson disease (OR=4.54, 95% CI: 2.74~7.53, P<0.001), stroke (OR=0.33, 95% CI: 0.18~0.59, P<0.001), senile dementia (OR=0.43, 95% CI: 0.29~0.62, P<0.001), cataract (OR=0.37, 95% CI: 0.22~0.63, P< 0.001), rheumatoid arthritis (OR=0.32, 95% CI: 0.21~0.50, P<0.001), diabetes (OR=0.65, 95% CI: 0.47~0.91, P=0.01), type of internal fixation for primary fracture (OR=0.51, 95% CI: 0.30~0.85, P=0.01), and therapeutic compliance (OR=0.36, 95% CI: 0.21~0.64, P<0.001). However, the refracture of the contralateral hip was not related to gender (OR=1.07, 95% CI: 0.45~2.56, P=0.88), smoking (OR=0.86, 95% CI: 0.40~1.86, P=0.70), fracture type (OR=0.97, 95% CI: 0.60~1.57, P=0.90), or hypertension (OR=0.70, 95% CI: 0.41~1.21, P=0.20). Conclusions In elderly patients with hip fracture, the risks for contralateral hip fracture may be advanced age, concomitant osteoporosis, Parkinson disease, stroke, senile dementia, cataract, rheumatoid arthritis and diabetes, type of internal fixation for primary fracture, and poor therapeutic compliance. However, no sufficient evidence has suggested that gender, smoking, type of hip fracture or concomitant hypertension might be associated with the contralateral hip fracture. Key words: Elderly; Hip fracture; Meta-analysis; Contralateral hip fracture; Related factors

Efficacy of open reduction and internal fixation in management of senile osteoporotic ankle fractures

Objective To explore the efficacy of open reduction and internal fixation in the treatment of senile osteoporotic ankle fractures. Methods A retrospective case series study was conducted to analyze the data of 26 elderly patients with osteoporotic ankle fractures which all caused by sprain from June 2012 to June 2018 in Changhai Hospital, including 10 male and 16 female patients aged from 60 to 93 years (mean, 69.72 years). In these 26 patients, three had medial malleolus fractures, four had lateral malleolus fractures, six had double ankle fractures and 13 had cotton's fractures. According to the Lauge-Hansen type, all 26 patients can be classified into four types: 5 with supination external rotation type, 4 supination adduction type, 16 with pronation-external rotation type and 1 with pronation abduction type. All the patients received open reduction and internal fixation. Plate fixation was used for lateral and posterior malleolus fractures, plate fixation and cannulated screws were applied to fix the comminuted posterior malleolus fracture while in the comminuted internal malleolus fracture, the steel plate was used only when needed. Early professional functional rehabilitation training and active anti-osteoporosis treatment were applied. All the operation time and bleeding volume were recorded, and the reduction of fracture plus the healing of wounds were observed. At last follow-up, American Orthopedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Scale was used to evaluate the treatment effect and the Visual Analogue Scale (VAS)to evaluate the therapeutic effect and the subjective satisfaction of the patients. Complications were recorded as well. Results All patients were followed up for 12-48 months (mean, 23.6 months). Operation time ranged from 30 to 95 minutes (mean, 70 minutes) and bleeding volume ranged from 10 to 150 ml (mean, 70 ml). All patients got satisfied reduction of fracture within 25 patients' incision healing in first intention, although one has fat liquefaction. AOFAS Ankle Hindfoot Scale improved from preoperative (84.4±10.8)points to (31.9±11.4)points at last follow-up (P<0.01), and the results were excellent in five patients, good in 17, fair in three and poor in one, with the excellent and good rate of 85%. VAS improved from preoperative(1.85±0.73)points to (9.23±0.28)points at last follow-up (P<0.01). Among 26 patients, 5 with ankle stiffness of different degree recovered after rehabilitation care, and 2 with internal malleolus fractures had bone displacement when receiving rehabilitation care, with no side effect on basic function. No serious complications such as wound infection or skin necrosis were found. Conclusion For osteoporotic ankle fractures in the elderly, open reduction and internal fixation can promote functional recovery and relieve pain. Key words: Ankle injuries; Osteoporotic fractures; Fracture fixation, internal

Reconstruction of talus model with Mimics software for treatment of talar posterior process fracture through posteromedial malleolar approach

Objective To evaluate the advantages of reconstructing by mimics software before operation a three-dimensional model of talar posterior process fracture which is to be used in the treatment of talar posterior process fracture through the posteromedial malleolar approach. Methods From May 2015 to February 2019, 7 patients with talar posterior process fracture were treated at Department of Orthopaedic Trauma, Jishuitan Hospital. They were 5 men and 2 women, aged from 20 to 70 years (mean, 39 years). They underwent routine CT examination preoperatively. Their posterior process of talus was reconstructed by Mimics software based on their CT scanning data before operation to determine the size, number and displacement of fracture fragments. Their fractures of posterior process of talus were treated by open reduction and screw fixation in prone position through the posterior ankle approach. The American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scoring system was used to evaluate functional recovery. Results The operation time for this group ranged from 70 min to 105 min, averaging 87.1 min. Early after operation, the wounds healed well with no injury to nerves or tendons. All patients were followed up for 4 to 24 months (average, 12 months). Follow-up by X-ray examination after 10 to 16 weeks revealed fracture union with no complications like screw breakage, nonunion, malunion or traumatic arthritis. Their AOFAS ankle-hindfoot scores at the final follow-up ranged from 80 to 98 points. Conclusion Preoperative three-dimensional reconstruction of talar posterior process fracture based on CT images using Mimics software can accurately determine the entry point and direction of screw insertion, yielding advantages of clear exposure, easy reduction and convenient screwing in the treatment of talar posterior process fracture through the posteromedial malleolar approach. Key words: Talus; Os trigonum; Fractures, bone; Materialise’s interactive medical image control system; Surgical approach

Treatment of closed calcaneal fractures by open reduction and internal fixation with bone plate through a small posterior heel plus tarsal canal incision

Objective To report the treatment effects of open reduction and internal fixation with bone plate through a small posterior heel plus tarsal canal incision on closed calcaneal fractures. Methods A retrospective study was done of the 20 patients (25 feet) who had been treated at Ward One, Department of Orthopaedics, People's Hospital of Yunfu from February 2016 to February of 2019 for closed calcaneal fractures by open reduction and internal fixation with bone plate through a small posterior heel plus tarsal canal incision. They were 16 males and 4 females, aged from 16 to 60 years. According to the Sanders classification, there were 3 cases of type Ⅱ, 15 cases of type Ⅲ and 2 cases of type Ⅳ. Their fractures were reduced by traction, extruding, prying and direct visualization through the tarsal canal window; the bone plates were inserted through a small incision at the back of the heel and fixated by screws. Postoperative observation was done to address fracture healing, and length, width, height, Bohler angle and Gissane angle of the affected calcaneus, as well as functional recovery of the ankle-hindfoot by the American Orthopaedic Foot and Ankle Society (AOFAS) evaluation. Results The operation time for a single foot ranged from 45 min to 70 min, averaging 64.5 min; the intraoperative fluoroscopy for a single foot ranged from 3 times to 6 times, averaging 4.5 times. Local skin necrosis of about 0.5 cm×0.3 cm appeared in one foot after operation but responded to dressing change. No other wound complications occurred. Their follow up was carried out for 6 to 36 months (average, 17.3 months). The fractures healed well with well-shaped bony callus and flat articular surface after 4 to 6 months. The length (80.5 mm±4.2 mm), width (44.8 mm±5.2 mm), height (44.4 mm±3.0 mm), Bohler angle (25.0°±5.1°) and Gissane angle (113.8°±8.6°) of the calcaneus at the last follow up were significantly improved than the preoperative values (79.4 mm ± 4.5 mm, 50.5 mm ± 6.3 mm, 40.0 mm±4.4 mm, 12.0°±13.8° and 107.0°±13.3°) (all P<0.05). By the AOFAS ankle-hindfoot scale, functional recovery of the foot was excellent in 20, good in 3 and fair in 2 cases, giving an excellent to good rate of 92%. Conclusion In the treatment of closed calcaneal fractures, open reduction and internal fixation with bone plate through a small posterior heel plus tarsal canal incision may lead to fine outcomes due to its advantages of small incision and fine fracture reduction. Key words: Calcaneus; Fractures, bone; Fracture fixation, internal; Tarsal Canal; Small incision

Research progress in effect of alendronate on healing of osteoporotic fracture

Fracture healing is a complex physiological process involving osteoblasts, osteoclasts and other cells and molecules. Typical fracture healing can be divided into four stages: inflammatory response, soft callus formation, hard callus formation, and bone remodeling. Osteoclasts play a leading role in hard callus formation and bone remodeling. Alendronate can inhibit osteoclast activity and bone loss in patients with osteoporosis, but it may also inhibit fracture healing. Therefore, whether alendronate can be used after osteoporotic fracture is controversial. In recent years, it has been found that alendronate can not affect the fracture healing, but also reduce the risk of secondary fracture and improve the prognosis of patients. In this article, the mechanism of alendronate and its effect on osteoporotic fracture healing by systemic and local use are reviewed, which can provide a reference for clinical selection of therapeutic drugs. Key words: Osteoporotic fractures; Fracture healing; Alendronate

Attach great importance to treatment of fractures in the elderly

China has the largest aging population in the world and is facing unprecedented challenges from aging, with fracture of the elderly as one example. The bone density of the elderly is significantly reduced, which mostly combined with osteoporosis. Osteoporosis can lead to fragile fractures, with hip fracture as the most commonly seen type. The incidence of complications and mortality of the elderly patients with fractures is very high, which is the rather serious challenge for the clinical management. In accordance with the main topic of bone trauma in the elderly for the whole year of 2020, the author briefly analyzes the characteristics, treatment and prevention of fractures of the elderly so as to arouse attention to the fractures in the elderly. Key words: Aged; Fractures, bone; Osteoporotic fractures

Reliability analysis of novel 3D classification of intertrochanteric fractures

Objective To verify the reliability of novel 3D classification of intertrochanteric fractures by comparing the consistency between conventional and novel classifications. Methods Included for the present study were the preoperative X-ray and CT images of 189 patients with intertrochanteric fracture who had been hospitalized at Department of Orthopaedics, Beijing Chao Yang Hospital, Capital Medical University from 1 January, 2017 to 1 January, 2019. The patients’ intertrochanteric fractures were classified by 6 orthopedic surgeons independently using Evans classification, Jensen classification, AO classification and novel 3D classification, respectively. One month later, the original images of the 189 patients were renumbered and classified again in the same way. The Kappa values between observers and within observers were calculated for the classifications of intertrochanteric fractures based on X-ray and CT images. Results In Evans classification, Jensen classification, AO classification and novel 3D classification, the interobserver Kappa values of X-ray films were 0.54±0.03, 0.53±0.03, 0.45±0.03 and 0.63±0.02, respectively, and the interobserver Kappa values of the CT images were 0.49±0.03, 0.49±0.03, 0.44±0.04 and 0.63±0.03. The intraobserver Kappa values of the X-ray films were 0.53±0.02, 0.54±0.03, 0.44±0.04 and 0.65±0.02, respectively, and the intraobserver Kappa values of the CT images were 0.52±0.03, 0.52±0.03, 0.41±0.02 and 0.64±0.03. In the novel classification based on X-ray and CT images, the interobserver and intraobserver Kappa values were both significantly higher than those in Evans, Jensen and AO classifications (P<0.05). Conclusion The novel 3D classification of intertrochanteric fractures is more reliable than the conventional ones. Key words: Femur; Fractures, bone; Reproducibility of results; Fracture classification

A modified posterolateral approach for lateral and posterior malleolar fractures: a preliminary report

Objective To observe the clinical efficacy of internal fixation through a modified posterolateral approach in the treatment of lateral and posterior malleolar fractures. Methods From January 2015 to January 2018, 25 patients with fracture involving the lateral and posterior malleolus were treated at Department of Orthopedics, The Second Affiliated Hospital to Wenzhou Medical University. They were 13 males and 12 females, aged from 18 to 70 years (mean, 43.1 years). By the Lauge-Hansen classification for ankle injury, 9 cases belonged to supination-supination type of degree Ⅲ, 11 to supination-supination type of degree Ⅳ, and 5 to pronation-supination type of degree Ⅳ. By the Haraguchi classification, all the posterior malleolar fractures in this series belonged to type Ⅰ. Internal fixation through a modified posterolateral approach was performed for all the lateral and posterior malleolar fractures. Their operation time, fracture healing time and postoperative complications were observed. At the last follow-up, ankle joint function was assessed by the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale. Results In the 25 patients, the operation time ranged from 50 to 100 min (mean, 70 min). Of this group, 21 patients were followed up for 12 to 18 months (mean, 14 months). Bony union was achieved after 3 to 5 months after operation. Superficial wound infection was observed in 3 cases. No such complications occurred like postoperative adhesion, deep infection, contracture of flexor hallucis longus tendon, or loosening or breakage of implants. By the AOFAS ankle-hindfoot scale at the last follow-up, the ankle function was excellent in 13 cases, good in 6 and fair in 2. Conclusion The modified posterolateral approach is worth popularizing in clinic because it provides possibilities of fixating the lateral and posterior malleolar fractures by the same incision, not stripping the muscular origins of the flexor hallucis longus and reducing postoperative adhesion of the flexor hallucis longus. Key words: Fractures, bone; Ankle joint; Fracture fixation, internal; Approach

Minimally invasive treatment of calcaneal fractures of Sanders II&III with subtalar arthroscopy assisted by self-designed retractor and reducer

Objective To evaluate the minimally invasive treatment of calcaneal fractures of Sanders Ⅱ&Ⅲ by closed reduction or a sacral sinus arc-shaped minimally invasive incision under subtalar arthroscopy assisted by a self-designed cervical retractor and a self-designed reducer to expose and assist the reduction followed by internal fixation with hollow nails and Kirschner wires. Methods From June 2016 to February 2018, 53 patients (60 feet) were treated at Department of Hand and Foot Surgery, Central Hospital of Linyi for closed intra-articular calcaneal fractures. Of them, 24 (28 feet) received the minimally invasive treatment and 29 (32 feet) open surgery via the conventional lateral L-shaped incision. The 2 groups were compared in terms of Bohler angle, Gissane angle, and the width, length and height of the calcaneus before operation, one week after operation and at the final follow-up, as well as in terms of preoperative preparation time, operation time, surgical bleeding volume, incision complications, subtalar joint stiffness, and ankle- hindfoot score of the American Foot and Ankle Surgery Association (AOFAS). Results The 2 groups were comparable because there were no significant differences between them in the preoperative general data (P>0.05). All the patients were followed up for 10 to 22 months (average, 16 months). The Bohler angles, Gissane angles, and the widths, lengths and heights of the calcaneus after operation and at the final follow- up were significantly better than the preoperative values in the minimally invasive group (all P 0.05). Conclusion The minimally invasive treatment of calcaneal fractures of Sanders Ⅱ&Ⅲ by closed reduction or a sacral sinus arc-shaped minimally invasive incision under subtalar arthroscopy assisted by a self-designed cervical retractor and a self-designed reducer to expose and assist the reduction followed by internal fixation with hollow nails and Kirschner wires can lead to satisfactory clinical results, because this method shortens significantly the time for hospitalization and leads to less invasion, fewer complications, accurate reposition and reliable fixation. Key words: Arthroscopy; Calcaneus; Fractures, bone; Fracture fixation, internal

Comparative study of posterior minimally invasive plate and 3D-navigated percutaneous sacroiliac screw internal fixation for treatment of posterior pelvic ring fracture in elderly patients

Objective To compare the clinical efficacy of posterior minimally invasive reconstruction plate and 3D-navigated percutaneous sacroiliac screw fixation of elderly patients with posterior pelvic ring fractures. Methods A retrospective cases control study was performed to analyze the data of 75 elderly patients with posterior pelvic ring fractures admitted from January 2014 to June 2018 in Central Hospital of the PLA. There were 32 males and 43 females, with the age range of 60-83 years (mean, 67.7 years). Twenty-four patients in the plate group were treated by posterior minimally invasive reconstruction plate fixation, and 51 patients in the navigation group were treated by percutaneous sacroiliac screw internal fixation with 3D navigation. The operation time, intraoperative blood loss, X-ray exposure time, complication rate and postoperative visual analogue scale (VAS) were compared between the two groups. Postoperative Matta radiographic criteria was used to assess fracture reduction quality, and Majeed criteria was used to assess pelvic function at the last follow-up. Results All 75 patients were followed up for 6-24 months (mean, 13.5 months). The operation time, intraoperative blood loss and X-ray exposure time in the plate group were (126.1±20.6)minutes, (251.6±50.8)ml, and (15.7±4.4)s, showing significant differences in comparison with the navigation groups [(49.7±17.5)minutes, (22.8±5.1)ml, and (112.8±8.8)s](P 0.05). At day 3, one week, and one month postoperatively, the VAS in the navigation group was (3.3±0.7)points, (3.2±0.7)points, (2.4±0.6)points, better than that in the plate group [(7.2±0.7)points, (6.2±0.8)points and (4.5±0.7)points] (P 0.05). According to the Matta radiographic criteria, the excellent and good rate was 92% in plate group (excellent in 14 cases, good in 8, and fair in 2), and was 82% in the navigation group (excellent in 25 cases, good in 17 and fair in 9). There was no significant difference between the two groups (P>0.05). According to the Majeed criteria at the follow-up, the excellent and good rate was 96% in the plate group (excellent in 15 cases, good in 8 and fair in 1), and was 94% in the navigation group (excellent in 35 cases, good in 13 and fair in 3). The difference between the two groups was not statistically significant (P>0.05). Conclusion For elderly patients with osteoporotic posterior pelvic ring fractures, percutaneous sacroiliac screw fixation under 3D navigation has the advantages of shorter operation time, less bleeding, less radiation dose and less postoperative pain than minimally invasive reconstruction plate internal fixation, and hence deserves clinical application. Key words: Aged; Pelvis; Fracture fixation, internal; Osteoporosis; Surgery, computer aided