Joint Fracture Research Articles

A meta-analysis of deltoid ligament on ankle joint fracture combining deltoid ligament injury.

Ankle fracture combined with deltoid ligament (DL) injury results in decreased stability of ankle mortise, reduced contact surface between tibial and talus, increased local stress, and increased postoperative complications. The purpose of this meta-analysis was to evaluate the postoperative effects of repairing ligaments in ankle fractures with DL rupture. According to the steps of the Cochrane systematic review, the related literatures from PubMed, Embase and the Cochrane Library Databases were retrieved as of September 1, 2021, and all relevant randomized controlled trials and retrospective studies were collected. The evaluation indicators include medial clear space (MCS), visual analogue scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS), complications rate. Meta-analysis was conducted by RevMan® 5.3 provided by the Cochrane collaboration. A total of 388 patients (195 patients in the ligament repair group and 193 patients in the non-repair group) were included in 7 clinical trials. Meta-analysis data showed there were no statistically significant differences between the ligament repair group and non-repair group in final follow-up VAS, final AOFAS and postoperative MCS (P = 0.50, P = 0.04, P = 0.14, P = 0.14, respectively). Final follow-up MCS and complications rate in ligament repair group were smaller than those in the non-repair group and were statistically significant (P < 0.00001, P = 0.006, respectively). Although there was no difference in in final follow-up VAS, final follow-up AOFAS and postoperative MCS between experimental group and control group, It's statistically significant in final follow-up MCS and complications rate. Ligament repair could reduce the width of MCS, restore ankle stability, reduce the incidence of complications and lead to a better prognosis.

Ultrasonic vibration induced the improvement of mechanical properties and fracture behavior of Inconel 690 alloy joint during laser welding

The ultrasonic vibration (UV) assisted laser welding was employed to weld Inconel 690 alloy. The microstructure evolution, the tensile strength, the elongation and the fracture behavior of the weld joint were studied through a scanning electron microscopy, an electron back-scatter diffraction and a universal testing machine. The results indicated that there produced an equiaxed crystal region in the center of the weld joint where a great deal of the low angle grain boundary distributed due to the cavitation effect caused by adding the UV. In addition, the proportion of the equiaxed crystal tended to increase, the grain size seemed to be finer. Moreover, the tensile strength and the elongation of the weld joint with UV were significantly improved with an increase in the UV because of the grain refinement. The maximum tensile strength increased to be the same as that of the matrix, and the maximum elongation was about 70% of that of the matrix. The joint without UV fractured with necking, nevertheless, the fracture of joint with UV occurred in the dendrite region of the weld joint and happened in the direction of 45° to the tensile direction due to the appearance of the similar direction between slip surface and the direction of the maximum shear stress, and the change in Taylor factor and Schmid factor distribution of the dendrite in the weld joint. Besides, the ductile fracture was still the main fracture feature because of the formation of the dimples and micro-voids.

Percutaneous balloon calcaneoplasty versus open reduction and internal fixation (ORIF) for intraarticular SANDERS 2B calcaneal fracture: Comparison of primary stability using a finite element method

IntroductionFractures of the calcaneus are common, with 65% being intra-articular, which can lead to a major impairment of the patient's quality of life. Open reduction and internal fixation with locking plates can be considered as gold-standard technique but has a high rate of post-operative complications. Minimally invasive calcaneoplasty combined with minimally invasive screw osteosynthesis is largely drawn from the management of depressed lumbar or tibial plateau fractures. The hypothesis of this study is that calcaneoplasty associated with minimally invasive percutaneous screw osteosynthesis presents biomechanical characteristics comparable with conventional osteosynthesis. Materials and methodsEight hind feet were collected. A SANDERS 2B fracture was reproduced on each specimen, while four calcanei were reduced by a balloon calcaneoplasty method and fixed with a lateral screw, four others were manually reduced and fixed with conventional osteosynthesis. Each calcaneus was then segmented for 3D finite element modeling. A vertical load was applied to the joint surface in order to measure the displacement fields and the stress distribution according to the type of osteosynthesis. ResultsAnalyses of the intra-articular displacement fields showed lower overall displacements in calcaneal joints treated with calcaneoplasty and lateral screw fixation. Better stress distribution was found in the calcaneoplasty group with lower equivalent joint stresses. These results could be explained by the role of the PMMA cement as a strut, enabling better load transfer. ConclusionBalloon Calcaneoplasty combined with lateral screw osteosynthesis has biomechanical characteristics at least comparable to locking plate fixation in the treatment of SANDERS 2B calcaneal joint fractures in terms of displacement fields and stress distribution under the premise of anatomical reduction.

Failure Mechanism of the Yizhuxiang Collapse under the Joint Effect of Freeze–Thaw and Mining

At 10:05 a.m. on 4 February 2022, the perilous rock mass Yizhuxiang in Leizu Town, Yuan’an County, Hubei Province, China collapsed on a large scale. The Yizhuxiang collapse was about 35 m in length, 52 m in height, and 29 m in maximum thickness. The volume of the collapse was 5.32 × 104 m3. It threatened the transport of the national trunk road, destroyed the branch road and some cement mixing station workshops, and caused serious economic losses. The rock mass exposed in the collapse was dolomite with developed joint fractures. Under the effects of mining and unloading, fractures occurred in the rock mass; the top of the rock mass was bent and deformed towards the free face; and tension cracks were formed on the rear edge. The safety ore pillar directly below the collapsed body was compressed and deformed under the action of gravity, thus accelerating the internal deformation of the rock mass and leading to the formation of multiple dominant joints inside the rock mass. In the winter of 2021, the weather was extreme, with heavy snowfall and low temperatures. Under the effects of freeze–thaw, the strength of the rock mass declined and the tension cracks further expanded so that the rock mass experienced an accelerated deformation and finally collapsed. Causes of the collapse include mining activity beneath the collapsed mass and heightened extreme weather. The cause of the landslide disaster in this area is, however, freeze–thaw, which deserves the attention of scholars and the vigilance of the local government.

Design of Proposed Software System for Prediction of Iliosacral Screw Placement for Iliosacral Joint Injuries Based on X-ray and CT Images.

One of the crucial tasks for the planning of surgery of the iliosacral joint is placing an iliosacral screw with the goal of fixing broken parts of the pelvis. Tracking of proper screw trajectory is usually done in the preoperative phase by the acquisition of X-ray images under different angles, which guide the surgeons to perform surgery. This approach is standardly complicated due to the investigation of 2D X-ray images not showing spatial perspective. Therefore, in this pilot study, we propose complex software tools which are aimed at making a simulation model of reconstructed CT (DDR) images with a virtual iliosacral screw to guide the surgery process. This pilot study presents the testing for two clinical cases to reveal the initial performance and usability of this software in clinical conditions. This model is consequently used for a multiregional registration with reference intraoperative X-ray images to select the slide from the 3D dataset which best fits with reference X-ray. The proposed software solution utilizes input CT slices of the pelvis area to create a segmentation model of individual bone components. Consequently, a model of an iliosacral screw is inserted into this model. In the next step, we propose the software CT2DDR which makes DDR projections with the iliosacral screw. In the last step, we propose a multimodal registration procedure, which performs registration of a selected number of slices with reference X-ray, and based on the Structural Similarity Index (SSIM) and index of correlation, the procedure finds the best match of DDR with X-ray images. In this pilot study, we also provide a comparative analysis of the computational costs of the multimodal registration upon various numbers of DDR slices to show the complex software performance. The proposed complex model has versatile usage for modeling and surgery planning of the pelvis area in fractures of iliosacral joints.

Diagnostic accuracy of ultra-low-dose CT compared to standard-dose CT for identification of non-displaced fractures of the shoulder, knee, ankle, and wrist

ObjectivesTo compare the performance of ultra-low-dose computed tomography (ULD-CT) with standard-dose computed tomography (SD-CT) for the diagnosis of non-displaced fractures of the shoulder, knee, ankle, and wrist.MethodsThis prospective study enrolled 92 patients receiving conservative treatment for limb joint fractures who underwent SD-CT followed by ULD-CT at a mean interval of 8.85 ± 1.98 days. Fractures were characterized as displaced or non-displaced. Objective (signal-to-noise ratio, contrast-to-noise ratio) and subjective CT image quality were evaluated. Observer performance for ULD-CT and SD-CT detecting non-displaced fractures was estimated by calculating the area under the receiver operating characteristic (ROC) curve (Az).ResultsThe effective dose (ED) for the ULD-CT protocol was significantly lower than the ED for the SD-CT protocol (F = 422.21~2112.25, p < 0.0001); 56 patients (65 fractured bones) had displaced fractures, and 36 patients (43 fractured bones) had non-displaced fractures. Two non-displaced fractures were missed by SD-CT. Four non-displaced fractures were missed by ULD-CT. Objective and subjective CT image quality was significantly improved for SD-CT compared to ULD-CT. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy of SD-CT and ULD-CT for non-displaced fractures of the shoulder, knee, ankle and wrist were similar: 95.35% and 90.70%; 100% and 100%; 100% and 100%; 99.72% and 99.44%; and 99.74% and 99.47%, respectively. The Az was 0.98 for SD-CT and 0.95 for ULD-CT (p = 0.32).ConclusionULD-CT has utility for the diagnosis of non-displaced fractures of the shoulder, knee, ankle, and wrist and can support clinical decision-making.

Study on fatigue fracture of SW400 fine-grained high-strength steel T-lap joint

The SW400 fine-grained high-strength steel T-lap joints were welded by submerged arc welding. The influence of welding technology on the geometrical characteristics of welds and fatigue performance of the joints were studied by radial fatigue test with different welding parameters. The numerical analysis was used to study the characteristics of the stress distribution. And the fatigue fracture morphology was analyzed by scanning electron microscope. The results show that with the increase of welding line energy, the thickness of the weld increased, and the propagation direction of the fatigue crack changed from the weld to the base metal. When the thickness was less than 4 mm, the high-stress region was in the area of the weld around the weld root, and the fatigue crack propagated to the weld. When the thickness was greater than 4.5 mm, the high-stress region of AE and AS were in the weld around the root, where the crack propagated to the weld, while in the middle of the weld high-stress region was in the area of base metal around the weld root, crack propagated to the base metal. With the increase in the thickness of the weld, the maximum mises stress decreased, and the crack propagation rate decreased. The time of crack initiation was very short, which occurred in the high-stress region of the weld root in the middle of the weld.

Effect of tool pin length on interfacial behaviors and mechanical properties of friction stir-welded lap joints of 430/304 stainless steels

In this study, the effect of tool pin length on friction stir lap welding of 430 and 304 stainless steels has been investigated. The thermal history of interface was measured by thermocouple. The interfacial macro- and micro-structures under different tool pin lengths were analyzed via optical microscope and scanning electron microscope. Also, tensile shear tests were carried out to evaluate the strength of the lap joint. The results show that increasing the pin length from 0.5 to 1.3 mm increases the peak temperature of the interface, which has a significant effect on diffusion layer formation and hook geometry. The fracture mode of the joints shifts from shear fracture to tensile fracture with the increase of the pin insertion depth. When the pin length is 1.0 mm, i.e., a slight penetration into the 304 plate, the joint presents a maximum failure load of 2.86 kN. The findings reveal that the effective top plate thickness (Teff) used to describe the hook geometry is an important factor determining the joint strength and fracture mode.

Interface microstructure and mechanical properties of copper-steel joints with nickel transition layer prepared by ultrasonic additive manufacturing

In order to suppress the problems of intergranular copper infiltration, liquid phase separation and thermal cracks in the process of fusion welding between copper and 304 stainless steel, UAM technology was used to consolidate the nickel transition layer on the surface of stainless steel to achieve surface modification, and then obtained copper-304 stainless steel overlap joints by pulse TIG process. Through the study of the joint interface configuration, microstructure, microhardness distribution and room temperature tensile strength of the control group, it was found that the introduction of the nickel interlayer can realize the metallurgical isolation between copper and steel and relieve the interfacial stress. Stainless steel and copper form the high-quality brazed joint with a nickel interlayer of 0.1 mm thickness, and the ultimate tensile strength of the joint at room temperature reaches 165 MPa. The joint fracture occurred near the fusion line near the copper side, and the fracture showed a ductile fracture mode.

Comparative Evaluation of Fixed Functional Cantilever Space Maintainer and Fixed Nonfunctional Space Maintainer: A Randomized Controlled Trial.

Effective way to prevent mesial drift after the early loss of primary first molars is by inserting a durable space maintainer. Several space maintainers are available; fixed nonfunctional (FNF) space maintainer (crown and loop) is commonly used when abutment teeth need full-coronal restoration. Disadvantages of crown and loop space maintainer are nonfunctional, nonesthetic, and fracture of solder loop. To overcome this drawback, new design of fixed functional cantilever (FFC) space maintainer (crown and pontic) using bis-acrly composite resin. The study evaluated the longevity and acceptance of an FFC and compared it with a FNF space maintainer. A total of 20 healthy children, aged 6-9 years, were selected having bilateral premature loss of lower deciduous first molars. FFC space maintainer in one quadrant and FNF space maintainer in the other was cemented. The subject's acceptance of treatment was checked using a visual analog scale after the treatment completion. Criteria for complication leading to the failure was assessed in both the designs in the 3rd, 6th, and 9th month. Cumulative success longevity was obtained at a 9 month evaluation. Patient acceptability was greater in group I (FFC) in comparison to group II (FNF). In group I, fracture of the crown and pontic was the common complication leading to failure, followed by attrition of the crown and loss of material due to abrasion. In group II, fracture of the solder joint was the common complication leading to failure, followed by slippage of the loop gingivally and cement loss. The longevity of groups I and II were 70 and 85%, respectively. FFC can be considered a viable alternative to conventional FNF space maintainers. Sathyaprasad S, Krishnareddy MG, Vinod V, et al. Comparative Evaluation of Fixed Functional Cantilever Space Maintainer and Fixed Nonfunctional Space Maintainer: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2022;15(6):750-760.

A State‐of‐Art Review on Prediction Model for Fatigue Performance of Welded Joints via Data‐Driven Method

Fatigue fracture of welded joints is an important cause for engineering accidents. Due to the coexistence of so many influencing factors, the current prediction model of fatigue behavior cannot be used for all service conditions. The progress of each module (database establishment, data processing, data augmentation, dimension reduction, and comprehensive consideration of influencing factors) during the process of constructing a prediction model is summarized herein. Specifically, the state‐of‐art prediction models of fatigue strength, fatigue crack growth rate, fatigue life, and fatigue reliability are introduced. Moreover, suggestions for future work are given at the end of each section. Finally, according to the influential prediction methods, the establishment of fatigue performance prediction methods of welded joints via data‐driven method is summarized.

Telemedicine in orthopaedics and trauma surgery during the first year of COVID pandemic: a systematic review

PurposePrior to the COVID-19 pandemic, telemedicine in orthopaedics and trauma surgery had mostly developed for joint arthroplasty, fracture management, and general pre- and postoperative care including teleradiology. With the corona-outbreak, telemedicine was applied on a broad scale to prevent assemblage and to guarantee access to medical care protecting critical areas. The purpose of the present study was to give an overview of the spectrum of clinical applications and the efficacy of telemedicine in orthopaedic and trauma surgery as published in times of the COVID-19 pandemic.MethodsAll published studies investigating the application of telemedicine related to orthopaedics and trauma during the COVID-19 pandemic were accessed and screened for suitability. The primary outcome of interest was the efficacy of telemedicine in various clinical applications. The secondary outcome of interest was the spectrum of different applications in which telemedicine applications were investigated.ResultsThe literature search resulted in 1047 articles. After the removal of duplicates, 894 articles were screened of which 31 finally met the inclusion criteria. Dimensions that were described by studies in the literature to have positive effects were preoperative patient optimisation, the usefulness of telemedicine to correctly diagnose a condition, conservative treatment, willingness to and feasibility for telemedicine in patients and doctors, and postoperative/post-trauma care improvement. The efficacy of telemedicine applications or interventions thereby strongly varied and seemed to depend on the exact study design and the research question addressed.ConclusionVarious successful applications of telemedicine have already been reported in orthopaedics and trauma surgery, with a strong increase in scientific output during the COVID-19 years 2020–2021. Whether the advantages of such an approach will lead to a relevant implementation of telemedicine in everyday clinical practice should be monitored after the COVID-19 pandemic.

Factors influencing functional outcome of fractures of the anterior process of the calcaneus

IntroductionFractures of the anterior process of the calcaneus (APC) are easily overlooked in clinical practice. Most patients have good to excellent clinical outcome after conservative treatment, while some patients may have persisting symptoms and unfavorable functional outcomes. The aim of this study was to identify the risk factors associated with unfavorable functional outcome after conservative treatment in APC fractures. MethodsAll patients presenting with APC fractures and receiving conservative treatment from April 2019 to April 2020 were retrospectively assessed. The primary outcome measurement was the ankle joint function assessed using Karlsson Scoring System at 2 years post-injury. The risk factors associated with unfavorable functional outcomes (Karlsson score ≤ 80) were evaluated by logistic regression analysis. ResultsIn total, 84 patients were included with a mean age of 40 years. 26 (31%) patients presented with unfavorable functional outcome at 2 years post-injury. In multivariate logistic regression, concomitant fractures of talonavicular (TN) joints and older age were significantly associated with unfavorable functional outcome (p<0.05). Patients with concomitant fractures of TN joints had an odds ratio of 3.623 for unfavorable functional outcome. The optimal cutoff age for an unfavorable outcome was ≥ 47.5 years, with an odds ratio of 5.010. ConclusionMost patients with APC fractures achieved good to excellent results when treated conservatively. Attention should be paid to those with concomitant fractures of TN joints and with age ≥ 47.5 years, which might lead to unfavorable functional recovery. Level of evidenceIV; case series.

A Non-parametric Discrete Fracture Network Model

A discrete fracture network (DFN) model based on non-parametric kernel density estimators (KDE) and directional-linear statistics is developed. The model provides a characterization of the fracture network with distributions of fracture orientation and size jointly. A solution to the Bertrand paradox is used for the calculation of disk sizes from trace lengths, the latter calculated from the intersection of disks and highwall faces by triangulation. A Poisson point process is applied for the generation of the model, with fractures assumed to be flat and circular in shape, the number of fractures per unit volume (P30) adjusted to match the experimental length of fractures per unit area (P21). Length censoring of traces due to the surface dimension is considered in the calculations by including semi-bounded traces, i.e., traces censored in one of their ends. Orientation and size biases are corrected with a weighting function in the random sampling. The truncation effect whereby no traces shorter than some cut-off length are recorded, is addressed by a randomized optimization algorithm. The joint fracture orientation-size distribution model developed is tested with trace maps of discontinuities measured from photogrammetric models of twelve highwall faces of quarry benches, with outstanding results. Computational advantages over traditional parametric fracture models are addressed.

Hemi-hamate arthroplasty for the management of chronic proximal interphalangeal joint fracture dislocations: Analysis of 21 cases in Indian population and review of the literature

BackgroundChronic fracture-dislocations involving the proximal interphalangeal (PIP) joint are challenging cases. We conducted this study to analyze the outcomes following hemi-hamate autograft reconstruction of such injuries and to compare our results with the existing literature. MethodsA retrospective analysis of 21 patients with chronic dorsal PIP fracture-dislocations that were managed with hemi-hamate autograft reconstruction was done. The average articular surface involvement was 64%. The average duration between injury and surgery was 9.4 weeks (range, 6–16). Quick DASH (Disabilities of Shoulder and Hand) scores, VAS (Visual Analog Scale) scores, range of motion of the PIP joints, DIP (distal interphalangeal) joints, and MCP (metacarpophalangeal) joints were measured during serial follow-up visits. ResultsUnion and graft incorporation was seen in all cases. The average Quick DASH score at four weeks post-surgery was 66 and it improved to eight at one year (p-value<0.05). The average VAS score at four weeks post-surgery was 7.66 and it improved to 2.09 at one year (p-value<0.05). The mean flexion of the MCP joint improved from 52.85° at the end of four weeks to 72.38° at one year (p-value<0.05). The average flexion at the PIP joint improved from 10.47° at the end of four weeks to 70.47° at one year (p-value<0.05). The average DIP flexion improved from 38.33° at the end of four weeks to 62.38° at one year (p-value<0.05). The average hand grip strength was 85% of the normal side. ConclusionHemihamate autograft reconstruction is a suitable procedure for the management of chronic PIP joint fracture-dislocations, especially in cases with extensive involvement of the articular surface. Level of evidenceIII.

Analysis of residual stresses in electron beam welding with filler wire of Ti62A alloy

Residual stress significantly affects the performance of the welded joints and the tensile residual stress easily leads to the joint fracture and failure. A three dimensional nonlinear transient thermo-mechanically coupled finite element model of Ti62A alloy electron beam welding (EBW) with filler wire was established. The influence of the welding parameters, such as welding power, groove angles and number of welding layers on the temperature and residual stress evolutions was predicted and verified against existing literature data. The calculated results indicate that the high tensile stress of heat affected zone is very likely to induce the failure of the welded joints. When the welding power is 2600 W, the longitudinal residual stress along the welding direction is more symmetrical on both sides, and the force and deformation of the weldment will be more uniform. As the groove angle decreases, the transverse residual compressive stress on the joint surface becomes larger, which results in the low risk for cracking tendency of the joint. Increasing the number of welding layers reduces the weld reinforcement and the residual stress. In addition, the decline magnitude of residual stress decreases with the increase in the number of welding layers. Both the smaller groove angle and the multi-layer welding can effectively reduce the residual stress of weldments and improve the joint performance. The findings of this study will provide a good theoretical basis for optimizing welding process.

Outcome of two knots tension band wiring (TBW) in Mayo type-IIA olecranon fracture

Olecranon fracture is relatively common and accounts for approximately 40% of elbow joint fractures. It is an intra-articular fracture, so the aim of treatment is anatomic reduction, stable fixation and early mobilization. Tension band wiring (TBW) may be a popular and widely practiced method using either single knot or two knots techniques. Now two knots TBW are widely accepted by AO foundation as well as various countries. But single knot technique is commonly practiced in Bangladesh. The present study was done to see the clinical, radiologi- cal and functional outcome of two knots Tension band wiring (TBW) in Mayo type IIA olecranon fracture. This observational study was carried out by the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh. A total of 32 patients with Mayo type IIA olecranon fractures were treated with two knots TBW, out of which 30 cases had completed at least 24 weeks of follow-up and analyzed for final functional outcome with Mayo Elbow Performance Score (MEPS). The mean age was 32.58±14.21 years and the male to female ratio was 2.6:1. The mean radiological union time was 8.15±2.25 weeks. In 6 (18.75%) cases, it took 6 weeks, in 18 (56.25%) cases, it took 8 weeks and in 8 (25.0%), it took 12 weeks. Complications were found in 21.9% of patients. At first follow-up after the operation showed that 21 (70.0%) had moderate pain and the final follow-up showed 21 (70.0%) had no pain. The mean arc of elbow motion at first follow-up and final follow-up were 61.090±16.2340 and 122.820±15.2870, respectively. The mean functional score at 1st follow-up was 6.75±5.63 and the last follow-up was 24.76±1.69. The mean total Mayo Elbow Performance Score (MEPS) scores at first and last follow-up were 40.65±14.48 and 94.13±8.35, respectively. Excellent and good outcomes were found among 21 (70.0%) and 9 (30.0%) patients, respectively. Two knots TBW technique is safe regarding overall complication rate, pain status and excellent outcome. BSMMU J 2022; 15(2): 90-95

Joining of SiC ceramics by combining NITE-SiC interlayer and its thickness control

Combined with the thickness control of interlayers (∼10 µm and ∼60 µm), SiC nano-powders with Al2O3-Y2O3-MgO-CaO additive (NITE-SiC) were used as the joining materials to achieve the low-temperature joining of SiC ceramics. Some residual pores were observed in the interlayer with a thickness of ∼60 µm after joining at 1650 ℃, and the shear strength of SiC joints measured was 39.3 ± 5.5 MPa. Observations showed the fracture of joints occurred at the interlayer. When the thickness of the interlayer decreased to ∼10 µm, no cracks or porosity were observed at the interface region after joining at 1650 ℃. The shear strength of SiC joints increased to 69.5 ± 8.9 MPa, and the fracture originated from the matrix. The results demonstrated using NITE-SiC with Al2O3-Y2O3-MgO-CaO additive as the joining layer and reducing the thickness of the interlayer could lower the joining temperature and significantly improve the mechanical strength of joints.

Vascular impulse technology versus elevation for reducing the swelling of upper and lower extremity joint fractures

Soft-tissue conditioning due to posttraumatic oedema after complicated joint fractures is a central therapeutic aspect both pre- and postoperatively. On average, 6–10 days pass until the patient is suitable for surgery. This study compares the decongestant effect of vascular impulse technology (VIT) with that of conventional elevation. In this monocentric RCT, 68 patients with joint fractures of the upper (n = 36) and lower (n = 32) extremity were included and randomized after consent in a 1:1 ratio. Variables were evaluated for all fractures together and additionally subdivided into upper or lower extremity for better clinical comparability. Primary endpoint was the time in days from hospital admission to operability. Secondary endpoints were total length of stay, oedema reduction, pain intensity, complications, and revisions. The time from admission until operability was reduced by 1.4 (95% CI − 0.4; 3.1) days in the mITT analysis (p = 0.120) and was statistically significant with 1.7 (95% CI 0.1; 3.3) days in the as-treated sensitivity analysis (pAT = 0.038). Significantly less pain and a faster oedema reduction were found in the intervention group. Due to rare occurrences, nothing can be concluded regarding complications and revisions. Administration of VIT therapy did not lead to a significant reduction in time until operability in the whole population but was superior to elevation for soft-tissue conditioning and pain reduction. However, there was a significant reduction by 2.5 days (95% CI 0.7; 4.3) in the subgroup of lower extremity fractures. VIT therapy therefore seems to be a helpful tool in the treatment of posttraumatic oedema after complex joint fractures of the lower and upper extremity, especially in tibial head and lower leg fractures.

Efficacy and safety of anteriortransposition of the ulnar nerve for distal humerus fractures: A systematic review and meta-analysis.

This systematic review and meta-analysis was performed to summarize available evidence of anterior transposition of the ulnar nerve for patients with distal humerus fractures. The databases were searched from PubMed, Cochrane, Embase, Scopus, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Chongqing VIP Database (VIP), and Wan Fang Database up to June 2022. The clinical outcome included operation time, fracture healing time, hospital stays, elbow joint function, and ulnar neuritis rate. Statistical analysis was performed with Review Manager 5.3 (Cochrane Collaboration). A total of 17 studies were included (8 RCTs and 9 retrospective studies), and 1280 patients were analyzed. The results of this meta-analysis showed anterior transposition group had longer operation time (MD = 20.35 min, 95%CI: 12.56-28.14, P < 0.00001). There was no significant difference in fracture healing time (SMD = -0.50, 95%CI: -1.50-0.50, P = 0.33), hospital stays (MD = -1.23 days, 95%CI: -2.72--0.27, P = 0.11), blood loss (MD = 2.66 ml, 95%CI: -2.45-7.76, P = 0.31), and ulnar neuritis rate (OR = 1.23, 95%CI: 0.63-2.42, P = 0.54) between two groups. Finally, elbow joint motion, elbow joint function, fracture nonunion, and post-operative infection (P > 0.05) between two groups were not significantly statistic difference. This meta-analysis showed that anterior transposition group is not superior to non-transposition group for patients with distal humerus fractures without ulnar nerve injury. On the contrary, non-transposition group have shorter operation time than that of anterior transposition group. Non-transposition group did not increase the post-operative ulnar neuritis rate. Therefore, both anterior transposition group and non- transposition group are the treatment options for patients with distal humerus fractures without ulnar nerve injury. Besides, these findings need to be further verified by multi-center, double-blind, and large sample RCTs.