Low-energy Injuries Research Articles

Patient-Reported Outcome Measures After Surgical Management of Unstable Lisfranc Injuries in Athletes.

Athletes sustaining Lisfranc joint instability after a low-energy injury often undergo surgical fixation. Limited studies report validated patient-reported outcome measures (PROMs) for this specific patient population. Our purpose was to report PROMs of athletes experiencing instability after a low-energy Lisfranc injury and undergoing surgical fixation. Twenty-nine athletes (23 competitive, 6 recreational) sustained an unstable Lisfranc injury (14 acute, 15 chronic) and met our inclusion criteria. Injuries were classified as acute if surgically managed within 6 weeks. All athletes completed validated PROMs pre- and postoperatively. The cohort underwent various open reduction internal fixation methods. We evaluated outcomes with the Foot and Ankle Ability Measure (FAAM) activities of daily living (ADL) and sports subscales. Fourteen of 29 (48%) athletes reported PROMs at ≥2 years with a median follow-up time of 44.5 months. Substantial improvement for both FAAM ADL (50% vs 93%; P < .001) and sports (14.1% vs 80%; P = .002) subscales were found, when comparing preoperative to postoperative scores at ≥2 years. This study provides outcomes information for the young athletic population that were treated operatively for low-energy Lisfranc injury with apparent joint instability. Based on the FAAM sports subscale, these patients on average improved between their 6-month evaluation and their final ≥2 years but still scored 80% of the possible 100%, which indicates continued but "slight" difficulty with lower extremity function. Level IV, case series.

Olecranon Fractures: A Critical Analysis Review.

Olecranon fractures account for 10% of all elbow fractures and are more likely to result from a low-energy injury. A displaced fracture with a stable ulnohumeral joint (Mayo type 2) is the most common type of injury. The management of an isolated olecranon fracture is based on patient factors (age, functional demand, and if medically fit to undergo surgery) and fracture characteristics including displacement, fragmentation, and elbow stability. Nonoperative management can be successfully used in undisplaced fractures (Mayo type 1) and in displaced fractures (Mayo type 2) in frail patients with lower functional demands. Patients with displaced olecranon fractures with a stable ulnohumeral joint without significant articular surface fragmentation (Mayo type 2A) can be managed with tension band wiring, plate osteosynthesis (PO), intramedullary fixation, or suture repair. PO is advocated for multifragmentary fractures and fractures that are associated with ulnohumeral instability. It is essential to consider the variable anatomy of the proximal ulna during surgery.

Firearm-Related Injuries-Wound Management, Stabilization, and Associated Injuries: A Critical Analysis Review.

Gun violence-related and firearm-related injuries are a public health crisis with increasing rates, particularly among younger demographics, in the United States despite a decline in incidence worldwide. There exists limited high-quality evidence to guide the management of firearm-related orthopaedic injuries. Associated injuries (i.e., neurological and vascular) are common in ballistic injuries to the extremity. Where indicated, low-energy orthopaedic injuries can be managed successfully with standard fixation and management strategies with similar complications to closed fractures.

Circular External Fixation of Ankle and Pilon Fractures Using Novel Polyaxial Locking Struts.

Ankle fractures and pilon fractures are common injuries and can range in severity from low-energy rotational injuries to high-energy fractures of the articular surface. External fixation can be used in a staged treatment strategy to allow for a closed reduction and soft tissue rest before definitive internal fixation or as a definitive treatment method. We describe a technique that involves the use of novel polyaxial locking struts in conjunction with circular external fixation that can be used as a temporary form of external fixation or as definitive treatment of high-energy ankle and pilon fractures.

Research Progress in Surgical Treatment of Proximal Humeral Fractures in Elderly Osteoporotic Humerus

Proximal humeral fracture is a common injury in middle-aged and elderly people, especially elderly patients with osteoporosis due to bone loss, which can lead to fractures due to low-energy injury. As the population ages, the prevalence of proximal humeral fractures is likely to continue to increase. In the absence of open or neurovascular injury, the indications for surgery for proximal humeral fractures are controversial. Typically, the same fracture type can be treated non-surgically, with open reduction internal fixation, or joint replacement, depending on several variables including patient age, comorbidities, activity level, and treatment expectations. The purpose of this paper is to review surgical considerations in the surgical treatment of proximal humeral fractures in older adults with osteoporosis.

Evaluation of open reduction and internal fixation with closed reduction and external fixation in distal radial fracture

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Radial fracture frequently occurs in osteoporotic disorders, or in low-energy injuries. It is most frequent fracture of the upper extremity. Open reduction or closed reduction is done but there is debate between the two about its efficacies. Aims and objectives were to find out the efficacy and safety of open reduction and internal fixation (ORIF) with that of closed reduction and external fixation (CREF) among patients with distal radial fracture of all ages.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective study was conducted with patients of distal radial fracture. They underwent interventions, namely, ORIF (Open reduction group) or CREF (Closed reduction group). DASH score was measured before the intervention and during several follow ups at 4&lt;sup&gt;th&lt;/sup&gt; week to 15&lt;sup&gt;th&lt;/sup&gt; week. DASH score was statistically analyzed between the two groups. Additionally, the complications of the patients in each group were evaluated and sick leaves of the patients was recorded to assess their quality of life.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; The study has found that the number of days taking patients took sick leave from field work is significantly more in "closed reduction" group as compared to "open reduction" group (p&amp;lt;0.05). The number of days patients took sick leave is significantly higher in “closed reduction” group as compared to “open reduction” group (p&amp;lt;0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The study has concluded that the disability of the patients who received ORIF decreased significantly as compared to those who received external fixation and the patients who received open reduction significantly improved from the fracture.&lt;/p&gt;

Sensory change and recovery of infraorbital area after zygomaticomaxillary and orbital floor fractures.

To compare the sensory change and recovery of infraorbital area associated with zygomaticomaxillary and orbital floor fractures and their recoveries and investigate the factors that affect them. We retrospectively reviewed 652 patients diagnosed with zygomaticomaxillary (n= 430) or orbital floor (n= 222) fractures in a single center between January 2016 and January 2021. Patient data, including age, sex, medical history, injury mechanism, Knight and North classification (in zygomaticomaxillary fracture cases), injury indication for surgery (in orbital floor cases), combined injury, sensory change, and recovery period, were reviewed. The chi-square test was used for statistical analysis. Orbital floor fractures occurred more frequently in younger patients than zygomaticomaxillary fractures (p< 0.001). High-energy injuries were more likely to be associated with zygomaticomaxillary fractures (p< 0.001), whereas low-energy injuries were more likely to be associated with orbital floor fractures (p< 0.001). The sensory changes associated with orbital floor and zygomaticomaxillary fractures were not significantly different (p= 0.773). Sensory recovery was more rapid and better after orbital floor than after zygomaticomaxillary fractures; however, the difference was not significantly different. Additionally, the low-energy group showed a higher incidence of sensory changes than the high-energy group, but the difference was not statistically significant (p= 0.512). Permanent sensory changes were more frequent in the high-energy group, the difference was statistically significant (p= 0.043). The study found no significant difference in the incidence of sensory changes associated with orbital floor and zygomaticomaxillary fractures. In case of orbital floor fractures and high-energy injuries, the risk of permanent sensory impairment should be considered.

ЛЕЧЕНИЕ ОСТЕОПОРОТИЧЕСКИХ ПОВРЕЖДЕНИЙ ЗАДНЕГО ПОЛУКОЛЬЦА ТАЗА БЕЗ СУЩЕСТВЕННОГО СМЕЩЕНИЯ

Relevance. The prevalence of osteoporosis and, as a result, the risk of life-threatening pathological fractures increases. At the same time, the optimal treatment tactic for low-energy injuries of the posterior half-ring of the pelvis without significant displacement has not been determined, which actualizes further studies of this type of damage. The aim of the study was to analyze the experience of diagnosing and treating osteoporotic injuries of the posterior pelvic half-ring without significant displacement. Materials and methods. The prospective controlled study included 63 patients aged 60-93 years who were treated in 2018-2020 for osteoporotic fractures of the posterior half-ring of the pelvis without significant displacement. Comprehensive examination of patients was carried out, including standard radiography and X-ray computed tomography (CT) of the pelvis, correction of comorbid conditions, analgesia, prevention of thromboembolism. In one outpatient observation based on standard radiography, pelvic ring injury was not detected in a timely manner. In 57 patients hospitalized up to 5 days after injury, early functional conservative treatment was used. In 33 of them, this treatment led to restoration of function, fusion. In 24 of 57 patients, in the conditions of early functional conservative treatment, a significant pain syndrome persisted and pelvic ring instability was determined, they underwent prompt minimally invasive pelvic stabilization followed by early activation. Intensive therapy for advanced heart and renal failure was performed in 2 patients 86 and 82 years hospitalized up to 5 days after the injury. In 4 patients hospitalized within more than 5 days after injury with significant pain syndrome and pelvic ring instability, its urgent operative minimally invasive stabilization was carried out with subsequent early activation. For minimally invasive stabilization of the rear half-ring, cannulated screws were used, the front half-ring - cannulated screws, lockable rods, in two - plate osteosynthesis. The outcome was assessed using the S.A. Majeed scale 6 months after hospitalization. Results. Three patients (4.8%) died due to decompensation of severe comorbid somatic pathology. There were no nonunions, thromboembolic and infectious complications. The terms of restoration of motor activity of patients with conservative treatment amounted to 8-24 weeks, with operative - 8-16 weeks. One patient had a screw migration from the anterior pelvic half-ring under the skin. The results were evaluated in 52 patients (82.5%): excellent - 26 (50%), good - 22 (42%), satisfactory - 1 (2%), bad - 3 (6%). Conclusions. 1. post-traumatic pelvic pain, impaired motor activity, and no detection of bone traumatic changes with standard pelvic radiography should be an indication for performing pelvic computed tomography. 2. The low mortality rate - 4.8% - and the high level of excellent and good results - 92% - in the group of elderly, senile and long-lived patients with osteoporotic fractures of the posterior half-ring of the pelvis without significant displacement indicate the adequacy of the applied protocol of multidisciplinary, early functional treatment of these injuries. 3. Minimally invasive osteosynthesis using blockable rods and cannulated screws of the front and rear half-rings of the pelvis in case of their instability allows early activation of elderly, senile and long-lived patients, accompanied by a low risk of complications.

Is Time Truly of the Essence? Outcomes of Open Distal Radius Fracture Management

BACKGROUND: The standard of care of open distal radius fractures is urgent irrigation and debridement along with operative fixation. Herein, we investigate if open distal radius fractures (ODRF) treated after 24 hours from time of injury have an increased risk of infection or overall complication profile compared to open distal radius fractures treated urgently. METHODS: An IRB-approved retrospective chart review was performed of all patients treated for ODRF over a 6-year period at an academic institution in a large metropolitan city. Post-operative complications included: surgical site infections, need for revision irrigation and debridement, delayed soft tissue healing, loss of reduction, non-union, and malunion. For statistical analyses, nominal data were compared for distributional equality between complication dichotomy via Pearson chi-square or Fisher’s exact test depending on sample size distribution. Ordinal data were tested for ordinal association via exact Kendall’s tau test. Rank equivalency between complication dichotomy was determined for numeric data via Mann-Whitney U tests. All statistical tests were two-sided with p<0.05 considered statistically significant. RESULTS: Ninety-four patients were treated for ODRF with 62% female and 38% male patients included in the cohort. The mean (SD) age at time of injury was 58.6 (17.41) years. Notably, 28% of patients had a history of smoking. Overall, there were 16 patients (16.8%) with post-operative complications: 2 infections, 8 re-operations, 4 wound healing complications, 2 loss of reductions, 7 non-unions, and 1 malunion. Regarding energy and mechanism of injury, 74.4% had a low energy injury and 26.6% had a high energy injury, and this was not statistically significant for any post-operative complications (0.352). Likewise, age (p = 0.197) and fracture grade (p = 0.068) were not statistically significant factors for any surgical complications. The overwhelming majority of patients were treated with irrigation, debridement, and ORIF with volar locking plates. The mean (SD) open wound size was 1.6 (1.66) cm, ulnar sided, and did not correlate with any post-operative complications (p = 0.093). The mean (SD) time from injury presentation to the ER to the first dose of intravenous antibiotics was 4.7 (14.88) hours, and was not statistically significant for any post-operative complications (p = 0.186). The mean (SD) time from presentation to the ER to operative treatment was 19.1 (30.57) hours, and was not statistically significant for the presence of any post-operative complications (p = 0.092). There were 11 patients (11.7%) treated greater than 24 hours after presentation to the ER, which was not significantly distinct from those treated prior to 24 hours (p=1.000). CONCLUSION: Patients with open distal radius fractures treated after 24 hours did not have a greater risk of post-operative complications, including surgical site infections and non-union. Regarding factors that may influence urgent treatment, age, energy and mechanism of injury, and fracture grade were all not statistically significant for any post-operative complications in ODRF management.

Syndesmotic Reduction Landmarks in Healthy Ankle Patients, Comparative Analysis of Weight- Bearing Computed Tomography

Category: Ankle Introduction/Purpose: Introduction: The diagnosis of low-energy syndesmotic injuries continues to be a challenge, and there is no standard for it. Being the dynamic exams, the ones with the best performance. With the development of Weight-Bearing computerized tomography (WBCT), the understanding of their lesion patterns has improved, however, there is high variability in the syndesmotic anatomy between different individuals, with asymmetry parameters in up to 89% of healthy syndesmosis. therefore the best element to evaluate them is the healthy contralateral ankle and compare these parameters. However, what are the normal values in our population, or the possible anatomical differences according to different age groups, in the morphology of the syndesmal notch of our patients, nor that there is a real symmetry between both ankles. Methods: Retrospective analysis of comparative bilateral ankle WBCT in healthy patients from March 2018 to July 2021 according to the parameters: anterior, posterior and central syndesmal distance, fibular rotation, sagittal translation and area. All patients with comparative bilateral ankle weight-bearing CT taken since January 2018 to August 2021, patients without history of ankle injuries, were included in the analysis. That have required a comparative bilateral WBCT to study another pathology. Patients with a history of acute or chronic ankle or syndesmal injuries, patients with degenerative ankle joint injuries, with severe misalignments &gt; 10° in varus or valgus, incomplete or non-comparative study were excluded. Results: 150 patients with comparative bilateral WBCT were evaluated. Among the ankles evaluated with WB CT in a comparative manner, it is established that there were no significant differences between both ankles of subjects with healthy ankles (Wilcoxon Test) in anterior syndesmal distance (SD), posterior SD, central SD, syndesmal area (p &gt; 0.05). While fibular rotation and sagittal translation showed significant differences between the measurements in healthy ankles, evaluated with comparative bilateral WB CT in independent evaluations (p &lt; 0.05). Regarding the differences by age range established for the different syndesmotic reduction parameters, for the different subgroups of patients under 40 years of age, 40 and 60 years of age and over 60 years of age, no significant differences were generated between them (Wilcoxon test). Conclusion: We have established normal ranges for measurements in the syndesmal anatomy in axial slices during weight bearing CT, as well as that there are no differences between the right and left ankle in healthy ankles in anterior, posterior and central syndesmal distance, or syndesmal area. Being these parameters, the most suitable as internal control for patients with suspected syndesmotic injury regardless of the age of the patients.

Bone Fracture Patterns and Distributions according to Trauma Energy.

Background This study investigates the effect of injury mechanism and energy on fracture patterns and distributions. Also, it compares differences in bone fracture patterns based on injury mechanism, gender, and age. Methods Three thousand and sixty-six admitted patients with bone fractures were reviewed retrospectively, and the fractures were analyzed regarding age, gender, and mechanism of injury. Fractures were located in eleven bones. However, the forearm, hand, leg, and foot were considered one bone, and the fracture was then subclassified according to the anatomic position within each bone. Trauma energy was classified according to the mechanism of injury where simple falls were considered low-energy injury while falling from a height, road traffic accidents, bullet, and industrial injuries were considered high energy. Results Males represented most of the patients, and most injuries occurred in adults. However, the male patients were more prone to injuries than females across all age groups below fifty years, women above fifty years were more frequent, and a third of females' injuries occurred in the elderly. Simple falls represent two-thirds of the trauma mechanism, and falling from a height and road traffic accidents are the most common high-energy injuries and more prevalent in males. Scapular, clavicular, distal humerus, and shaft of long bones fractures were more prevalent in males. In contrast, females had a higher frequency of proximal humerus, proximal and distal femur, distal leg, and thoracic spine fractures. Industrial injuries are more frequent in males; thus, hand injuries are more frequent. Pathological fractures were higher in females, and spine and pelvic fractures were more associated with high-energy injuries. Conclusions The trauma's energy determines the bone injury's extent and nature. Knowing the trauma mechanism is essential to expect the extent of injuries and construct preventive measures accordingly.

Socioeconomic deprivation status predicts both the incidence and nature of Achilles tendon rupture.

The aim of this study was to describe the epidemiology of Achilles tendon rupture (ATR) and its relationship with socioeconomic deprivation status (SEDS). The hypothesis was that ATR occurs more frequently in socioeconomically deprived patients. Secondary aims were to determine variations in circumstances of injury between more and less deprived patients. A 6-year retrospective review of consecutive patients presenting with ATR was undertaken. The health-board population was defined using governmental population data and SEDS was defined using the Scottish Index of Multiple Deprivation. The primary outcome was an epidemiological description and comparison of incidence in more and less deprived cohorts. Secondary outcomes included reporting of the relationship between SEDS and patient and injury characteristics with univariate and binary logistic regression analyses. There were 783 patients (567 male; 216 female) with ATR. Mean incidence for adults (≥ 18years) was 18.75/100,000 per year (range 16.56-23.57) and for all ages was 15.26/100,000 per year (range 13.51 to 19.07). Incidence in the least deprived population quintiles (4th and 5th quintiles; 18.07 per 100,000/year) was higher than that in the most deprived quintiles (1st and 2nd; 11.32/100,000 per year; OR 1.60, 95%CI 1.35-1.89; p < 0.001). When adjusting for confounding factors, least deprived patients were more likely to be > 50years old (OR 1.97; 95%CI 1.24-3.12; p = 0.004), to sustain ATR playing sports (OR 1.72, 95%CI 1.11-2.67; p = 0.02) and in the spring (OR 1.65, 95%CI 1.01-2.70; p = 0.045) and to give a history of preceding tendinitis (OR 4.04, 95%CI 1.49-10.95; p = 0.006). They were less likely to sustain low-energy injuries (OR 0.44, 95%CI 0.23-0.87; p = 0.02) and to be obese (OR 0.25-0.41, 95%CI 0.07-0.90; p ≤ 0.03). The incidence of ATR was higher in less socioeconomically deprived populations and the hypothesis was therefore rejected. Significant variations in patient and predisposing factors, mechanisms of injury and seasonality were demonstrated between most and least deprived groups, suggesting that circumstances and nature of ATR may vary with SEDS and these are not a homogenous group of injuries. Prognostic Study Level III.

948 Traumatic Native Hip Dislocation Without Associated Fracture: A Case Series of 13 Patients Over 9 Years

Abstract Aim Traumatic native hip dislocation (NHD) is rarely without an associated fracture or due to low energy trauma. Posterior dislocation is the most common pattern of hip dislocation. In most cases, closed reduction is successful, but occasionally open reduction is required to achieve appropriate reduction. The aim of our study was to present the 9-year experience from our institution of this rare injury pattern and to comment on how our experience correlates with the current literature. Method This is a retrospective case series of all adult patients (&amp;gt; 16 years old) with a traumatic NHD without fracture presented and/or treated at our institution, between the 1st of January 2012 and 22nd June 2021. Results Thirteen cases of traumatic NHD were identified (38.4% female). The mean age was 26.5 years. Typically, younger patients were involved in lower energy injuries. The direction of hip dislocation was posterior in 10 cases. Associated injuries were seen in 3 patients. 12 cases underwent successful closed reduction, and 1 case was operatively managed. 3 cases had a previous hip pathology including femoroacetabular impingement, cam lesion and childhood slipped upper femoral epiphysis. Conclusions Traumatic NHD without associated fracture is a rare injury pattern, most commonly occurring in patients under the age of thirty. A target of 6 hours for reduction should be employed as this will reduce the risk of AVN in those who have not permanently damaged the vessels at the time of injury.

Analysis of lumbar vertebrae fractures among inpatients in a primary hospital: A 10-year epidemiological study.

Background:To analyze the epidemiological characteristics and changing trends of lumbar fractures in Xingtai Orthopedic Hospital in the past 10 years, and to improve the prevention and treatment of lumbar fractures.Methods:Using the hospital information system, data on patients with lumbar fractures in our hospital from 2009 to 2018 were collected regarding their age, gender, fracture time, injury mechanism, and the type of fracture. The epidemiological characteristics and trends of lumbar fractures for the period were summarized and analyzed.Results:The age of male patients with a high incidence of lumbar fractures was 61 to 70 years, followed by 51 to 60 years. The age of female patients with the highest incidence rate was 61 to 70 years, followed by 51 to 60 years (19.22%). Lumbar fractures in group A were predominantly of men. The majority of lumbar fractures in group B were of women. In group A, the incidence rate was higher in young men (21–50 years) than in women and higher in women >51 years. Most of the affected individuals were women. In group B, there were more middle-aged and young men (21–50 years) than women; however, there were more women than men aged ≥51 years. Car accident injury was the main cause of fractures, but in group B women, low-energy injuries were the main cause of fractures. The periods of high incidence in groups A and B were 4 to 6 years and 7 to 9 years, respectively. The number of injuries in group A was the highest and burst fracture was the main fracture type. In group B, the number of fall injuries was the highest, followed by car accident injuries, and compression fracture was the main fracture type.Conclusion:The number of lumbar fractures in women caused by low-energy injuries showed an increasing trend. The type of compression fracture increased, which might be related to osteoporosis caused by the decrease in the estrogen level after menopause.

231 Tillaux Fracture in a 40-Year-Old Man: A Rare Case Report

Abstract Tillaux fracture is an intra-articular Salter-Harris III fracture affecting the anterolateral aspect of the distal tibia. It is commonly seen in children and adolescents but rare for adults. As Tillaux fracture can be unstable, misdiagnosis may result in delayed surgical treatment and development of complications such as post-traumatic arthritis and persistent syndesmotic instability. A case of adult Tillaux fracture is reported, involving a 40-year-old gentleman who sustained a low energy injury. He presented to local hospital after being assaulted by a stranger. He tripped over a low fence and sprained his left ankle in external rotation. On examination, he was not able to weight bear. There were swelling and focal tenderness at the triangular concavity of distal fibula. Ankle X-Ray was reported as normal. It required CT scan for diagnosis after reviewed by orthopaedics team at fracture clinic. The patient was subsequently treated with lag screw fixation and recovered after 6 weeks post-operatively. This case highlights the importance of a systematic method to interpret ankle X-Ray. It is essential to observe the tibio-fibular overlap and any change in the outline of bony cortex of the fibular notch. CT scan has a high sensitivity in delineating fracture pattern hence it should be performed when there is difficulty to confirm the diagnosis solely based on X-Ray. In conclusion, Tillaux fracture should be suspected when patients present with external rotation injury. There should be low threshold to perform CT scan when there is any uncertainty with the ankle X-Ray interpretation.

Preliminary application study of dual-robotic navigated minimally invasive treatment by TiRobot and Artis Zeego on pelvic fractures

To summarize the surgical learning curve and preliminary operative experience of dual-robotic navigated minimally invasive treatment on pelvic fractures by TiRobot and Artis Zeego. Between July 2019 and February 2021, 90 patients with pelvic fractures were treated with dual-robotic navigated minimally invasive surgery by TiRobot and Artis Zeego. There were 64 males and 26 females, with an average age of 46.5 years (range, 13-78 years). Body mass index was 14.67-32.66 kg/m 2 (mean, 23.61 kg/m 2). Causes of injuries included traffic accident in 43 cases, falling from height in 37 cases, low-energy injuries such as flat falls in 10 cases. The interval between injury and surgery was 1-36 days (mean, 7.3 days). According to the location of the implanted screws, the patients were divided into sacroiliac screw group ( n=33), acetabular screw group (acetabulum anterior/posterior column, n=24), composite screws group (sacroiliac and acetabulum anterior/posterior column, n=33). According to the screw implantation time and accuracy, the surgical learning curve was plotted, and the differences in the relevant indicators between learning stage and skilled stage were compared. All 90 patients successfully completed the operation, the intraoperative bleeding volume was 5-200 mL (median, 20 mL). There was no vascular or nerve injury. All incisions healed by first intention. The screw implantation time ranged from 7.5 to 33.0 minutes (mean, 18.92 minutes), and the screw implantation accuracy ranged from 1.1 to 1.8 mm (mean, 1.56 mm). According to the learning curve, the practice stage of 3 groups was reached after 7, 10, and 11 cases, respectively. With the accumulation of surgical experience, the screw implantation time had a significant downward trend. Compared with the learning stage, the screw implantation time on skilled stage in 3 groups significantly shortened ( P<0.05), but the difference in the screw implantation accuracy was not significant ( P>0.05). TiRobot and Artis Zeego assisted pelvic fracture surgery is safe and efficient, which helps the surgeon to quickly master the pelvic channel screw surgery, and the operation time is significantly shortened on the premise of ensuring the implantation accuracy.

Lateral decubitus position assisted plate internal fixation through a lateral incision to assist reduction combined with intramedullary nail in treatment of complicated subtrochanteric femoral fracture

To investigate the effectiveness of lateral decubitus position assisted plate internal fixation through a lateral incision to assist reduction combined with intramedullary nail in the treatment of complicated subtrochanteric femoral fracture. The clinical data of 16 patients with complicated subtrochanteric femoral fractures (Seinsheimer type Ⅲ-Ⅴ) treated with lateral decubitus position assisted plate internal fixation through a lateral incision to assist reduction combined with intramedullary nail between September 2017 and August 2020 were retrospectively analyzed. There were 13 males and 3 females with an average age of 47 years (range, 26-85 years). There were 12 cases of high-energy injury and 4 cases of low-energy injury. According to Seinsheimer classification, there were 3 cases of type ⅢA, 2 cases of type ⅢB, 7 cases of type Ⅳ, and 4 cases of type Ⅴ. The time from injury to operation ranged from 2 to 6 days, with an average of 4.7 days. The operation time, intraoperative blood loss, postoperative drainage volume, hospitalization stay, surgical complications, fracture healing time, and collodiaphyseal angle of the affected and healthy sides before and after operation were recorded. Hip fracture Harris score was used to evaluate hip function. The operation time was 90-180 minutes (mean, 135.9 minutes), the intraoperative blood loss was 200-400 mL (mean, 288.8 mL), the postoperative drainage volume was 120-220 mL (mean, 140.0 mL), and the hospitalization stay was 12-22 days (mean, 15.8 days). All the 16 patients were followed up 9-12 months (mean, 9.9 months). There was 1 case of incision superficial infection after operation, which healed after anti-infection treatment; no complication such as deep venous thrombosis of lower limbs, coxa vara deformity, re-fracture, or broken nails occurred. All the fractures healed successfully, the healing time ranged from 12 to 20 weeks, with an average of 17.5 weeks. At 6 months after operation, the Harris score was 87-96, with an average of 91.5; the results were excellent in 11 cases and good in 5 cases, with the excellent and good rate of 100%. The collodiaphyseal angle of the affected side was (124.0±5.7)°, while that of the healthy side was (132.0±2.1)°, showing significant difference between the two sides ( t=-7.376, P=0.001). At last follow-up, the collodiaphyseal angle of the affected side was (129.0±3.2)°, which significantly improved when compared with that before operation ( t=-6.175, P=0.002), and there was no significant difference between the affected side and the healthy side ( t=-2.648, P=0.181). Lateral decubitus position assisted plate internal fixation through a lateral incision to assist reduction combined with intramedullary nail is a reliable internal fixation method for the treatment of complicated subtrochanteric femoral fractures. The use of plate reduction is conducive to maintaining the force line of the femoral trochanter. The enlargement of the incision is conducive to the accurate implantation of intramedullary nails without affecting fracture healing.

A new classification for combined greater tuberosity fracture and anterior shoulder dislocation: A study of fracture configurations and displacement after reduction.

The aim of this study was to propose a new classification of combined greater tuberosity (GT) fractures and anterior shoulder dislocation and studied the degree of displacement, functional outcomes, and need for additional surgery after reduction. A cross-sectional study was conducted. We evaluated radiographs of patients treated for combined GT fractures and anterior shoulder dislocation. Three morphologies were proposed; type 1 (a small avulsion), type 2 (GT fractures without articular head involvement), and type 3 (GT associated with articular head fractures). Two orthopedic surgeons independently measured all radiographs and classified fractures into three types. Patients were interviewed by telephone to assess functional outcomes (the simple shoulder test (SST) and EQ-5D-5L), and additional shoulder surgery was also performed. There were 52 eligible patients; 32 were male (61.5%) and the mean age was 57.3 · 17.1 years. Most cases were low-energy injuries (61.5%). Of all the cases, 32.7% were type I, 59.6% type II, and 7.7% type III cases. There were differences in the degree of displacement in each group at pre, post-reduction (both horizontal and vertical planes) and at two weeks post-reduction for HD (p < 0.05). Type III had more displacement than type I at pre- and post-reduction with a P value of less than 0.05. Type III also had higher rates of displacement than type II at post-reduction and at two-week postreduction (vertical plane). The intra and inter-rater reliabilities of measurement (ICC > 0.8) were in good to excellent agreement with the kappa value (>0.9). Three out of 52 cases (5.8%) required an additional surgery after closed reduction. Patients had good functional outcomes (SST score of 8) with an excellent utility index of EQ-5D-5L (0.9). This new classification exhibited good-to-excellent intra-and inter-rater reliabilities, with an ability to determine injury type. Type III seems to be linked to higher risk of fracture displacement and may require additional surgery. Level IV, Diagnostic Study.

Bi-columnar locking plate fixation through a combined medial and lateral approach for the treatment of low transcondylar fractures of the distal humerus in the elderly

BackgroundLow transcondylar fractures (LTFs) of the distal humerus are relatively uncommon elbow injuries in elderly patients after low-energy injuries. Although there is still debate regarding the method of fixation, several surgeons prefer bi-columnar fixation using pre-contoured locking plates. However, posterior approaches, which are usually used to perform the above procedure, have disadvantages, such as ulnar nerve neuropathy, damage to the extensor mechanism, and the need for general anesthesia. To solve these problems, the authors designed a combined medial and lateral approach. The purpose of this study was to present the outcomes of bi-columnar internal fixation through a combined medial and lateral approach for the treatment of LTFs of the distal humerus in the elderly. MethodsA total of 46 patients diagnosed with distal humeral fractures between May 2017 and April 2020 were included. Thirty patients were excluded, and 16 patients who underwent open reduction and internal fixation by the medial and lateral approach were selected. We carried out all the surgeries under brachial plexus anesthesia. The clinical outcomes were assessed based on the visual analog scale (VAS) score, Mayo elbow performance score (MEPS), disabilities of the arm, shoulder, and hand (DASH) score, and range of motion (ROM) of the elbow joint. Standardized radiographs were obtained at 3, 6, and 12 months after surgery and at the last follow-up visit to evaluate for bony union and to check for complications, such as ulnar nerve neuropathy and heterotopic ossification.ResultsThe mean age was 81 years (range, 65–91 years). Bony union was achieved in 15 out of 16 patients. The mean VAS score was 2.1 (range, 0–6), the mean MEPS was 84.4 (range, 70–100), and the mean DASH score was 20.6 (range, 9.5–33.6). There were three complications including reduction loss, skin necrosis, and stiffness of the elbow. There was no ulnar nerve neuropathy. The post-operative ROM was 100 degrees or higher in all cases, which did not cause any impairment in daily life.ConclusionLTFs of the distal humerus in the elderly can yield satisfactory results with bi-columnar internal fixation through a combined medial and lateral approach.

Mallet Finger: Two Different Injuries.

Mallet injuries, either tendinous or bony, are common. They are often studied together and typically treated in the same way with extension splintage for 6 to 8weeks. Yet the evidence clearly shows there are different injuries that present in the same way. Tendinous mallet injuries present in older patients usually following a low energy injury; they are often painless. The commonly injured fingers are the middle and ring. The injuries are almost always single digit without concomitant injuries. There is an extensor lag of a mean of 310 (range 3°-590) in the patients treated in my unit. In contrast, bony mallet injuries occur at a younger age (mean 40years) and are always due to high energy injuries. The injuries are always painful. The commonly injured fingers are the ring and little fingers. There are multiple injuries in 3% (range 2%-5%) and in 4% to 8% of cases, there are concomitant (nondigital) injuries according to data in my unit. Radiologically there is an appreciably smaller extensor lag; mean 130 (range 0°-400). In particular, bony mallet injuries are extension compression, not avulsion, fractures which should not logically be treated with an extension splint which will reproduce the direction of injury.