Metaphyseal Fractures Research Articles

Proximal Tibia Fractures.

Proximal tibia fractures in children pose challenges in management due to the complex anatomy in this region. The relationship between the proximal tibial physis, proximal tibial apophysis, extensor mechanism, and nearby vascular structures allows for potential injuries from toddler-aged children through adolescence. The most common injuries include tibial tubercle fractures, proximal tibia physeal fractures, and proximal tibia metaphyseal fractures; they may result from both low-energy and high-energy mechanisms. Nonoperative treatment is indicated for nondisplaced or adequately reduced fractures, while operative treatment is indicated for irreducible fractures or fractures with loss of adequate reduction. Complications of these injuries may include growth arrest, limb length discrepancy, angular deformity, vascular compromise, and compartment syndrome.

Treatment of Diaphyseal and Metaphyseal Fractures of the Upper Limbs (Humerus, Radius, Ulna) Using Extension Casts

Fractures occur more often in the pediatric age group than in healthy adults. One reason for this is that children and adolescents are less skilled at-risk assessment. Humeral fracture comprises approximately 7-8% of all adult fractures in the western world. Adult humeral diaphysis fractures account for roughly 3% of all fractures and 20% of all humerus fractures. The aim of this study is to evaluate results of Management of Upper Limb Diaphysis and Metaphyseal Fractures (Humerus, Radius and Ulna) with Application of Extension Cast in closed fractures in adults to assess the functional acceptance of the procedure. The present study was carried out at Department of Orthopaedic Surgery BSMMU from June 2022 to July 2023. This hospital-based study is conducted to manage diaphysis and metaphyseal fractures by applying extension cast to improve range of motion. The study included upper arm fracture patients. Forty- two newly diagnosed cases of the fracture of upper extremities whose radiological and clinical record were intact, constituted the study cases. So, the individual was registered as a "case" after clinical diagnosis was confirmed. During follow-up after casting two patients never showed up so only 60 patients were chosen for the extension casting method. Patients in extension casting group were followed up from 14 to 22 months, with an average of (17.34±2.61) months. The full-length cast was applied from 4 to 6 weeks with a mean of 5 weeks. All casts were converted to the above elbow cast when the fracture became sticky. Radiological evidence of a fluffy callus appeared at an average of 35 days and bony union was achieved at a mean of (3.48±0.59) months. In current study after 1 year of treatment, the mean range of motion of all joints of affected limb became normal the mean VAS score after 6 weeks was 8 after 3 months the mean VAS score was 4 and after 6 months the mean was score was 1. Extension cast allows gravity to work all the time which is especially beneficial for comminuted fractures. This reduces the chances of limb shortening.

Dual-channel minimally invasive percutaneous cerclage for femoral shaft and metaphysis fractures during the internal fixation with intramedullary nails: case reports and technical description.

When treating femoral fractures with closed reduction intramedullary nail fixation, excessive residual displacement of the fracture end can affect the fixation effect and prolong the healing time, which is difficult to manage intraoperatively. This article introduces a simple steel wire cerclage fixation technique, which is percutaneous and can control the incision within 1 cm without excessive reliance on specially designed surgical instruments. It is suitable for the reduction and fixation of oblique femoral metaphysis fractures and butterfly-shaped femoral shaft fracture blocks.

Management of Pediatric Distal Humerus Metaphyseal Diaphyseal Junction Fracture; A Systematic Review and Meta-analysis

Abstract Background Fracture at the distal humerus metaphyseal diaphyseal junction (MDJ) in children is less frequently found in literature. Until this moment, there is no gold standard technique regarding its management and most surgeons treat it as a regular supracondylar humerus fracture by conventional pinning. This systematic review explores the relevant literature to assess the efficacy of different techniques. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for this review. We searched online databases including PUBMED/MEDLINE, Scopus, Web of Science Core Collection, and Google Scholar. Data from papers that met our general inclusion criteria were extracted and categorized into treatment method groupings. Functional and cosmetic outcomes, demographic characteristics, and complications were the main parameters used to analyze the data. Results Ten (10) retrospective studies met our inclusion criteria with a total of 178 participants of unilateral pediatric distal humerus metaphyseal diaphyseal junction fractures. Most literature chose closed reduction and percutaneous pinning (CRPP) in 7 papers, followed by Elastic Stable Intra-medullary Nails (ESIN) used in 3 papers, then conservative treatment was chosen in 2 papers, while only one paper used lateral miniplate and assisted K-wire and another paper used combined CRPP and Intra- medullary (IM) K-wire. As regards the operation time; ESIN had the lowest time with a mean of 39.7 min (range: 37.5 – 41.9 min), while CRPP had the most prolonged time with a mean of 75.47 min (range: 55.9 – 92.1 min). The lowest healing time was observed in ESIN with a mean of 7.9 weeks (range: 6.8 – 9 weeks) while the most prolonged was in conservative management with a mean of 12 weeks and CRPP lies in between with a mean of 10 weeks. Regarding Flynn’s criteria, all participants received excellent and good except in CRPP; 13 cases were fair and 2 cases were poor. Regarding complications the most commonly observed complication after MDJ fracture was cubitus varus, the highest incidence was in conservative management 33% of cases, followed by CRPP 10.9% of cases, the least incidence was observed in ESIN 3.77% of cases, and none of the cases treated with mini plate developed this complication. Other complications were observed only with CRPP; 8.5% of cases developed fixation loss, 6.2% of cases had significantly reduced range of motion and one case refractured. Conclusion Pediatric distal humerus MDJ fracture should be differentiated from supracondylar fracture regarding management, as conventional pinning techniques are associated with a higher incidence of complications and increased both operative and healing times.

Functional outcome of tibial metaphyseal fractures treated with intramedullary nailing with blocking screws (Poller Screws)

Functional outcome of tibial metaphyseal fractures treated with intramedullary nailing with blocking screws (Poller Screws)

Metaizeau technique in stabilizing Monteggia equivalent 1b associated proximal radial physeal injury in a rural setting: a case report

Introduction: The Monteggia equivalent type 1b fracture, consisting of an ulnar shaft fracture and radial head dislocation, is a rare condition first described by Giovanni Battista Monteggia. The Metaizeau technique, emphasizing percutaneous intramedullary fixation to preserve bone healing and prevent growth plate damage, has gained prominence in managing these fractures. Case report: A 10-year-old boy presented with left forearm pain, swelling, and deformity following a fall while playing football. X-rays revealed a proximal fourth ulnar fracture with dorsal and lateral angulation, along with a proximal radial metaphyseal fracture showing anterior rotation and physeal extension. This fracture pattern resembled a Monteggia fracture type III but differed in the lateral proximal radial disruption via a Salter–Harris type II fracture rather than radial epiphysis dislocation. Satisfactory reduction achieved for ulna was managed with standard nailing system but could not be achieved for radial physeal injury, which was managed with Metaizeau technique. Discussion: Type 1b Monteggia equivalents involving a Salter–Harris type 2 fracture of the proximal radius with an associated proximal ulnar fracture, adherence to Monteggia fracture reduction principles is vital. Closed reduction and internal fixation are preferred treatments, with the Metaizeau technique offering advantages such as minimal invasiveness and avoidance of implant-related complications. The Metaizeau technique is particularly beneficial for displaced radial neck fractures in children, providing stable fixation while preserving the fracture environment necessary for optimal healing. Conclusion: In cases of Monteggia fracture equivalents, most proximal radial fractures typically reduce to an acceptable level following ulnar reduction. However, proximal radial physeal fractures may require specific attention to achieve satisfactory reduction. The Metaizeau technique, commonly employed in the management of isolated radial neck fractures, can be utilized to achieve this reduction to an acceptable level.

Salvage of a comminuted proximal tibial polymicrobial infected non-union with antibiotic loaded bio-composite and intramedullary nailing: a case report

Background. Management of open proximal metaphyseal fractures poses a significant challenge and is fraught with complications. These injuries are severe, often accompanied by extensive soft tissue and vascular damage, leading to high risks of infection and long-term disability. Case presentation. A 72-year-old male was severely injured in a road traffic accident. Plain X-rays and CT angiogram identified a comminuted proximal tibial fracture with transection of the popliteal artery and vein. Initial emergency treatment included fasciotomies, external fixation, and vascular primary repair. On the 12th day of admission, the patient underwent open reduction and internal fixation (ORIF) with dual plate fixation using a two incision technique. A plastic surgeon performed skin grafting, harvested from the patient’s thigh, to allow closure of his fasciotomy wounds immediately following ORIF. Four weeks post-operatively, the patient developed a wound breakdown over the lateral fasciotomy site, exposing the metal plates with a small defect developing on the medial fasciotomy wound in tandem. The patient’s course was further complicated by persistent polymicrobial infections. Over 6 months of antibiotic regimes, operative intervention was ultimately required. All of the infected metal implants were removed, the non-union sites were aggressively debrided. The tibial canal was reamed to prepare for a tibial nailing. An antibiotic loaded bio-composite was then inserted through the non-union sites into the canal followed by an intramedullary nail. A blocking screw was used to address the procurvatum deformity in the sagittal plane. The patient currently shows signs of recovery, mobilizing over short distances, weight-bearing with assistive aids and with healing wounds and early signs of callus formation on recent CT scans and plain X-rays. Conclusions. The management of complex tibial fractures with vascular involvement demands an aggressive multidisciplinary approach and continuous adaptability in treatment plans to address the evolving challenges of such severe injuries. This case exemplifies the utility of injectable antibiotic-loaded bio-composites in a limb-salvage setting and their ability to provide high doses of local antibiotics to an infection site which, in conjunction with appropriate stable fixation and systemic antibiotics, can aid in eradicating and treating fracture-related infections.

Predictive Factors for Poor Prognosis in Non-Surgical Treatment of Proximal Humerus Fractures in Elderly Patients.

Proximal humerus fractures (PHF) are common in the elderly, accounting for significant morbidity and mortality. Non-surgical treatment is a common option for low-demand elderly patients, but it can lead to unsatisfactory functional outcomes in some cases.The identification of predictive factors for poor prognosis in non-surgical management remains unclear. This study aimed to determine the predictive factors for poor prognosis in elderly patients treated non-surgically for displaced PHF and to assess associated complications. A retrospective cohort study was conducted involving patients aged 60 years or older with displaced PHF treated non-surgically from May 2020 to January 2023 at a reference hospital for orthopedic trauma. The primary outcome was functional assessment using the American Shoulder and Elbow Surgeons (ASES) scale at 12 months. Predictive factors such as metaphyseal fracture comminution, Pain Catastrophizing Scale (PCS) scores, and radiographic criteria were analyzed. Multivariate regression analyses were performed to identify independent predictors of poor outcomes. Out of 140 initially selected patients, 103 met the inclusion criteria and completed the follow-up. The mean ASES score was 71.3±25.4 points. Multivariate analysis identified metaphyseal comminution (p < 0.001) and PCS scores ≥ 30 (p < 0.001) as significant predictors of poorer functional outcomes. Complications were observed in 17.4% of patients, including osteonecrosis (6.7%), nonunion (4.9%), and persistent pain and stiffness (5.8%). Metaphyseal comminution and high PCS scores are significant predictors of poor prognosis in elderly patients undergoing non-surgical treatment for displaced PHF. These findings highlight the importance of considering both biomechanical and psychological factors when managing proximal humerus fractures in this population. Further studies with larger sample sizes and prospective designs are needed to validate these findings and refine treatment strategies.

Management of traumatic fracture-dislocation of the shoulder in children: A systematic review of published case reports

Proximal humerus fracture with simultaneous shoulder dislocation in children is a rare occurrence, with few reported cases. This systematic review of case reports aimed to document the outcomes of different treatment methods. A comprehensive literature search from 1980 to 2024 included case reports on traumatic shoulder fracture-dislocation in children. Eighteen studies were included, with a mean follow-up of 1.5 years. The cases comprised 7 boys and 11 girls, aged between 11 months and 16 years (median 6 years). The cases were divided into two groups based on epiphyseal involvement. Group A had 11 cases (61%) with epiphyseal involvement, while Group B had 7 cases (38%) with metaphyseal fractures without epiphyseal involvement. Treatments included closed or open reduction, with or without internal fixation. All fractures healed in an average of 7 weeks, with full function restored in an average of 21.58 weeks. The review suggests that open reduction with K-wire fixation is optimal for Group A, whereas closed reduction with intramedullary fixation is more effective for Group B, offering satisfactory clinical and radiological results in a shorter time efficiently.

Risk factors for infection in severe open tibial shaft fractures

ObjectiveTo evaluate risk factors for infection in severe open tibial shaft fractures. MethodsA secondary analysis of a multicenter prospective study investigated internal versus external fixation of severe open tibia fractures at 20 US Level I trauma centers. Adult patients, aged <65 years, with a Gustilo-Anderson Type IIIB or severe IIIA metaphyseal or diaphyseal tibia fracture were included. All fractures underwent definitive fixation with either a modern ring external fixator, intramedullary device, and/or plate. Fourteen variables previously identified as risk factors for infection were included in the analysis. Deep surgical site infection was defined as an infection treated with surgical debridement within 1 year of index surgery. ResultsThe study cohort included 430 patients. Deep surgical site infection requiring reoperation occurred in 108 (25 %) patients. The final model identified four risk factors for infection: age >40 years (OR, 2.00; 95 % CI, 1.3–3.1), Gustilo-Anderson Type IIIB (OR, 1.80; 95 % CI, 1.1–3.0), embedded wound contamination (OR, 1.69; 95 % CI, 1.1–2.7), and wound length (OR, 1.02/cm; 95 % CI, 1.0–1.05). The model performed poorly at distinguishing infected from uninfected patients (Area Under the Curve=0.57; 95 % CI, 0.51–0.63). ConclusionsSurgeons can now counsel patients with these risk factors that they are at a markedly higher risk of infection. The identification of these risk factors may direct future research aimed at mitigating the risk of deep surgical site infection in this patient population.

Pilot study of three novel implants–GSK triangular system, locking hip screw and controlled sliding dynamic hip screw, for fixation of fracture of the neck of femur

Background and objectiveIntra capsular fracture of the neck of femur (FNF) treated traditionally with a dynamic hip screw (DHS) or three cancellous screws (3CS) has a high incidence of complications with reoperation rates between 20 % and 45 %. We hypothesized that FNF unites by primary healing. Therefore, intra-operative compression and absolute stability post-operatively until healing are essential. We postulated that FNF requires 2 types of implants- those which provide absolute stability for young patients with good bone stock and another with sliding mechanism for elderly patients with osteoporosis. We developed three novel fixation systems at our research institute in India using a modified DHS. In patients with good bone stock, locking DHS, called LHS and GSK triangular system (GSKT) provided intra-operative compression and absolute stability during the post-operative period. In those with poor bone stock, the controlled sliding DHS (CSDHS)was used as a locking implant might penetrate the hip joint. Materials and method42 patients of FNF <55 years of age were studied. Among 39 patients with good bone stock, LHS was used in five patients and GSKT system was used in 34 patients. CSDHS was used in three patients with poor bone stock or communition. The patients were followed up for a minimum of eight months up to a maximum of two years, with the average follow up duration of 14 months. Results32 out of 34 fractures treated by GSKT system united. Five cases managed by LHS and three by CSDHS, all united. The union rate was 95.2 %. Of the two failed cases, one patient had nonunion (NU), the other had deep infection. Avascular necrosis of the head (AVN) was detected in three patients treated with GSKT system in the second year following surgery. Two of them had hip pain while one was asymptomatic. Eight cases of FNF Pauwels type III underwent a primary valgus osteotomy. All of them united without complications. ConclusionIn patients with good bone stock, LHS and GSKT system allowed intra-operative compression and absolute post-operative stability without sliding of head fragment as the triangle construct is biomechanically the strongest. When bones are osteoporotic, a CSDHS provided controlled sliding (1 to 5 mm only). This pilot study showed a promising success rate of 95.2 %. We propose that the GSKT system may be used to treat intertrochanteric and other metaphyseal fractures as well. Further biomechanical studies are underway to strenghten the evidence needed for the widespread use of these implants.

Idiopathic juvenile osteoporosis-a polygenic disorder?

Idiopathic juvenile osteoporosis (IJO) is a rare condition presenting with vertebral and metaphyseal fractures that affects otherwise healthy prepubertal children. Bone mineral density (BMD) measurements are very low. The primary problem appears to be deficient bone formation, with a failure to accrue bone normally during growth. The onset in childhood suggests IJO is a genetic disorder, and a number of reports indicate that some children carry heterozygous pathogenic variants in genes known to be associated with defective osteoblast function and low bone mass, most commonly LRP5 or PLS3. However, a positive family history is unusual in IJO, suggesting the genetic background can be complex. We describe a young man with classical IJO who was investigated with a bone fragility gene panel and whole genome sequencing. The proband was found to carry four variants in three different genes potentially affecting osteoblast function. From his mother he had inherited mutations in ALPL (p.Asn417Ser) and LRP5 (p.Arg1036Gln), and from his father mutations in LRP5 (p.Asp1551Alsfs*13) and activating transcription factor 4 (ATF4) (p.Leu306Ile). His sister had also inherited the LRP5 (p.Asp1551Alsfs*13) from her father, but not the ATF4 mutation. Their spinal BMD z-scores differed substantially (sister -1.6, father -3.2) pointing to the potential importance of the ATF4 mutation. Activating transcription factor 4 acts downstream from RUNX2 and osterix and plays an important role in osteoblast differentiation and function. This case, together with others recently published, supports the view that IJO can result from clustering of mutations in genes related to osteoblast development and function. Novel genes in these pathways may be involved. Our case also emphasizes the value of detailed study of other family members. After a bone biopsy had excluded a mineralization defect due to hypophosphatasia, the proband was treated with zoledronate infusions with good clinical effect.

Outcome of Internal Fixation by Cephalomedullary Nail versus Outcome of Bipolar Hemiarthroplasty in the Treatment of Unstable Pertrochanteric Femoral Fractures in Elderly: Systematic Review and Meta-analysis

Abstract Background Pertrochanteric femoral fractures are extracapsular metaphyseal fractures of proximal femur that involve the region between the femoral neck and shaft. Intertrochanteric femur fractures, the most common type of fragility fractures in the elderly, account for 55% of proximal femoral fractures. Intertrochanteric femur fractures have high fatality and disability rates, resulting in a huge burden on the economy and on society. Objective To compare the advantages and disadvantages of the PFN and BHA to provide reliable evidence for clinicians in selecting the optimal treatment for unstable pertrochanteric fractures. Patients and Methods This systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2022. Data Extraction Data were independently extracted by two reviewers and cross-checked. Results This study included 12 samples which recruited 1019 patients with unstable intertrochanteric fractures, form which 515 patients underwent bipolar hemiarthroplasty (BHA) and 504 patients underwent proximal femoral nail (PFN). No significant difference between BHA and PFN in operative time and post-operative hospital stay was found. Intra-operative blood loss and incidence of blood transfusion was higher in BHA compared with PFN. HHS was higher after PFN than after BHA. Patients underwent PFN required larger period for partial weight bearing compared with who underwent BHA. There were no statistically significant difference between both groups regarding postoperative mobility scores, reoperation rate, incidence of infection and limb length alteration. The overall mortality rate risk ratio revealed that the incidence of mortality was higher after BHA than PFN. Conclusion Both PFN and BHA can be used in managing fractures of the Intertrochanteric in elderly patients. PFN establishes itself as a better modality than BHA due to lower postoperative mortality and better functional outcomes. BHA should ideally be reserved for lower life expectancies and those requiring immediate weight bearing patients.

Physeal and metaphyseal fractures of the distal radius in pediatric patients

Background: This article aims to summarize the available information and present treatment recommendations. The scope of this discussion is limited to physeal and metaphyseal fractures of the pediatric distal radius.Current Concepts: Pediatric distal radial fractures are common among children and adolescents. The mechanism of injury is usually a fall on an outstretched hand, and fractures typically occur during sports-related activities. Children with distal radial fractures initially present with pain, swelling, and distal forearm deformities. Plain radiographs are essential for evaluating the fracture type and degree of displacement. Complete wrist, forearm, and elbow views should also be assessed, especially for high-energy injuries, to identify ipsilateral fractures. Fractures typically involve the distal radial metaphysis or physis. Metaphyseal fractures are classified as torus, buckle, and bicortical fractures. Most displaced Salter-Harris types I and II and non-displaced metaphyseal fractures can be treated with closed reduction and casting. Operative treatment is recommended if irreducibility or soft-tissue neurovascular compromise is suspected. Operative options include closed reduction, percutaneous pinning, or open reduction, followed by pin or plate fixation. Malunion, nonunion, physeal arrest, ulnocarpal impaction, and nerve injury are possible complications of distal radial fractures in pediatric patients.Discussion and Conclusion: Metaphyseal and physeal fractures of the distal radius are common in children. Most cases are best treated with closed reduction and cast immobilization. Clinicians should be aware of delayed complications and understand how to manage them to ensure successful long-term outcomes.

Pediatric and Adolescent Distal Radius Fractures: Current Concepts and Treatment Recommendations.

Distal radius fractures are the most common skeletal injuries requiring intervention in children. These injuries are classified by fracture pattern, location, displacement, and angulation. While each unique fracture pattern warrants slightly modified treatment plans and follow-up, the goals of treatment remain constant. Successful outcomes depend on restoration of motion and function, and attaining acceptable sagittal and coronal alignment is a necessary first step. For displaced fractures, closed reduction is often necessary to restore alignment; well-molded cast application is important to maintain fracture alignment. Fractures with bayonet apposition, if well aligned, may not need formal reduction in some patients. Special attention should be paid to the physis-not only for physeal-involving fractures but also for all distal radius fractures-given that the proximity to the physis and amount of remaining skeletal growth help guide treatment decisions. Casting technique is essential in optimizing the best chance in maintaining fracture reduction. Surgical intervention may be indicated for a subset of fractures when acceptable alignment is not achieved or is lost at subsequent follow-up. Even among experts in the field, there is little consensus as to the optimal treatment of displaced metaphyseal fractures, illustrating the need for prospective, randomized studies to establish best practices.

Locked Posterior Shoulder Dislocation with Accompanying Fracture: A Debilitating Rare Injury for Athletes?

Shoulder dislocation is undoubtedly one of the most common injuries in traumatology. Posterior dislocation of the shoulder is regarded as comparatively rare compared to anterior dislocation, whilst it is strikingly extraordinary for this type of injury to be accompanied by a concomitant fracture. Accurate diagnosis and appropriate treatment can be considerably demanding, while being vitally important in this exceedingly rare condition. These injuries are broadly considered to be under-reported in the existing literature, especially among high-demand athletes. We present a rare case of a high-demand athlete sustaining a traumatic locked posterior shoulder dislocation with an accompanying fracture treated in our Institution. A detailed clinical examination and plain radiography revealed the peculiar condition, and a CT scan was subsequently performed for more thorough evaluation of the injury. The patient underwent surgery on the day following admission for repair of the extensive shoulder damage, and a deltopectoral approach was utilized. Reduction of the metaphyseal fracture and the dislocation was accomplished with gentle manipulations, and stabilization was obtained with an anatomic plate. A modified McLaughlin procedure was carried out to address the reverse Hill-Sachs lesion. The postoperative period was uneventful, followed by a painstaking physical rehabilitation program, and the patient returned successfully to his sporting activities 6 months postoperatively. By presenting this thought-provoking case, we stress the challenging nature of these immensely infrequent injuries while also highlighting the requirement for more sensitive factor-specific studies regarding their optimal treatment.

Is reduction necessary in overriding metaphyseal distal radius fractures in children under 11years: a systematic review and meta-analysis of comparative studies.

To determine the necessity of reduction in the treatment of overriding metaphyseal distal radius fractures (DRF) in children under 11years. In this systematic review and meta-analysis, PubMed, Embase, and Cochrane databases were searched to retrieve studies published from inception to 2023. Two reviewers independently screened for studies with observational or randomized control design comparing two treatments for overriding metaphyseal DRF in patients under 11years: simple casting without reduction (SC group) versus closed reduction plus casting or pin fixation (CRC/F group); with varying outcomes reported (CRD471761). The risk of bias was assessed using the ROBINS-I tool. Out of 3,024 screened studies, three met the inclusion criteria, 180 children (mean age 7.1 ± 0.9years) with overriding metaphyseal DRF: SC-group (n = 79) versus CRC/F-group (n = 101). Both treatment groups achieved 100% fracture consolidation without requiring further manipulation. The SC-group showed significantly fewer complications (mean difference [MD] 0.08; 95% CI [0.01, 0.53]; I2 = 22%;P < 0.009) and trends towards better sagittal alignment (MD 5.11; 95% CI [11.92, 1.71]; I2 = 94%; P < 0.14), less reinterventions (MD 0.31; 95% CI [0.01, 8.31]; P < 0.48), and fewer patients with motion limitation at the end of follow-up (MD 0.23; 95% CI [0.03, 1.98]; P < 0.18), although these findings were not statistically significant. Despite a limited number of studies comparing SC versus CRC/F in overriding DRF in children under 11years, this study suggests that anatomical reduction is not necessary. Treating these fractures with SC, even when presenting with an overriding position, leads to reduced complications, shows a trend towards fewer reinterventions, improved sagittal alignment, and less limitation in patient motion. Level III, Systematic review of Level-III studies.

The evolution of poller screws.

Compared to other techniques, poller screws with intramedullary nailing are technically simple, practical, and reproducible for the fixation of metaphyseal fractures. In addition, poller screws do not require special instruments or hardware and are minimally invasive. This review takes a historical perspective to evaluate poller screws holistically. A non-systematic search on PubMed was performed using 'Poller screw' or 'Blocking screw' to find early use of poller blocking screws. Relevant references from these primary studies were then followed up. In 1999, Krettek et al. first coined the term poller screws after the small metal bollards that block and direct traffic. Poller screws were introduced as an adjunct to aid the union of metaphyseal long bone fractures during intramedullary nailing. However, as more evidence was published, the true effectiveness of poller screws was not appreciated, leading to split opinions. Through our research, we have built upon our understanding of poller screws, and we present a novel classification of poller screws over the years while exploring our novel technique and what we believe to be the fourth generation of poller screws. Currently, there is a paucity of research focussing on poller screws. However, studying the original evidence regarding poller screws through the most recent articles has demonstrated a confusion of research in this field. Therefore, we suggest a more organised approach to classify the use of poller screws.

Far cortical locking constructs for fixation of distal femur fractures in an Asian population: A prospective observational study

BackgroundThe stiffness of locked plates suppresses healing process, prompting the introduction of far cortical locking to address this issue. This study aimed to demonstrate the clinical efficacy of far cortical locking constructs in treating distal femoral fractures in an Asian population. MethodsThis multicenter prospective observational study was conducted at four university hospitals between February 2018 and February 2021. Demographic data, the presence of metaphyseal comminution, and surgical fixation details were recorded. Clinical outcomes, including single-leg standing, EQ-5D, and EQ-VAS scores, and radiologic outcomes, including the RUST score of each cortex, were evaluated and compared according to the presence of metaphyseal comminution. ResultsThere were 37 patients (14 men and 23 women) with a mean age of 67.3 ± 11.8 years. Twenty-two patients had metaphyseal comminution (59%), and 15 presented simple fractures in metaphyseal areas. Four patients (13%) could stand on one leg > 10s at 6 weeks, and 24 patients (92%) at 1 year. EQ-5D increased from 0.022 ± 0.388 to 0.692 ± 0.347, and the mean EQ-VAS 51.1 ± 13.1 to 74.1 ± 24.1 between discharge (n = 37) and post-operative 1 year (n = 33), respectively. RUST score presented increment for time, from 6.2 ± 1.8 at 6 week to 11.6 ± 1.1 at 1 year. Radiological healing demonstrated rapid increase from week 6 (16/28, 43%) to month 3 (27/31, 87%), with no obvious increase was observed in 6 months (23/26, 89%) or 12 months (25/28, 89%). Simple metaphyseal fractures presented significantly higher RUST scores at 6 weeks and 3 months, but there was no difference in RUST scores at 6 months or 1 year according to metaphyseal comminution. ConclusionsPlate constructs with far cortical locking screws provided safe and effective fixation for distal femoral fractures, with consistent radiological and clinical results, regardless of metaphyseal comminution.

Modified elastic intramedullary nail internal fixation for distal tibial metaphyseal junction fracture.

To investigate the application of modified elastic intramedullary nail and the outcomes between modified elastic stable intramedullary nailing and traditional elastic stable intramedullary nailing in children with distal tibial metaphyseal junction fracture. A retrospective study was conducted. From January 2018 to January 2021, a total of 36 children with distal tibial metaphyseal junction fracture were treated in our hospital. All of them were treated with closed reduction and elastic stable intramedullary nailing internal fixation. A total of 18 children were treated by modified elastic stable intramedullary nailing and 18 children were treated by traditional elastic stable intramedullary nailing. Postoperative imaging, clinical efficacy, and complications were analyzed. The mean follow-up time was 20 (15-36) months in modified group and 22 (16-33) months in traditional group. There were no complications such as infection, loss of reduction, and unequal length of lower limbs in modified group while loss of reduction occurred in two cases in traditional group. In these two cases of loss of reduction, we preformed manual reduction and replacement of long leg casts, and there was no loss of reduction, and the patient achieved a good prognosis. In the last follow-up, American Orthopaedic Foot & Ankle Society score was used. In modified group, excellent outcome achieved in 17 cases, good outcome achieved in 1 case, and satisfactory therapeutic effect was achieved. In traditional elastic stable intramedullary nailing group, excellent outcome achieved in 14 cases, and good outcome achieved in 4 cases. There was no statistical difference in the scores between the two groups. It was concluded that modified elastic stable intramedullary nailing fixation is a safe and effective treatment.