Methods Of Internal Fixation Research Articles

Biomechanical analysis of different internal fixation methods for special Maisonneuve fracture of the ankle joint based on finite element analysis

ObjectiveThe objective of this study was to evaluate the biomechanical properties of different internal fixation methods for Maisonneuve fractures under physiological loading conditions. MethodsFinite element analysis was used to numerically analyze various fixation methods. The study focused on high fibular fractures and included six groups of internal fixation: high fibular fracture without fixation + distal tibiofibular elastic fixation (group A), high fibular fracture without fixation + distal tibiofibular strong fixation (group B), high fibular fracture with 7-hole plate internal fixation + distal tibiofibular elastic fixation (group C), high fibular fracture with 7-hole plate internal fixation + distal tibiofibular strong fixation (group D), high fibular fracture with 5-hole plate internal fixation + distal tibiofibular elastic fixation (group E), and high fibular fracture with 5-hole plate internal fixation + distal tibiofibular strong fixation (group F). The finite element method was employed to simulate and analyze the different internal fixation models for the six groups, generating overall structural displacement and Von Mises stress distribution maps during slow walking and external rotation motions. ResultsGroup A demonstrated the best ankle stability under slow walking and external rotation, with reduced tibial and fibular stress after fibular fracture fixation. Group D had the least displacement and most stability, while group A had the largest displacement and least stability. Overall, high fibular fracture fixation improved ankle stability. In slow walking, groups D and A had the least and greatest interosseous membrane stress. Comparing 5-hole plate (E/F) and 7-hole plate (C/D) fixation, no significant differences were found in ankle strength or displacement under slow walking or external rotation. ConclusionCombining internal fixation for high fibular fractures with elastic fixation of the lower tibia and fibula is optimal for orthopedic treatment. It yields superior outcomes compared to no fibular fracture fixation or strong fixation of the lower tibia and fibula, especially during slow walking and external rotation. To minimize nerve damage, a smaller plate is recommended. This study strongly advocates for the clinical use of 5-hole plate internal fixation for high fibular fractures with elastic fixation of the lower tibia and fibula (group E).

Research hotspots and trends in internal fixation of femoral neck fractures from 2010 to 2022: A 12-year bibliometric analysis.

This study endeavors to scrutinize the hotspots and trends in the literature concerning the internal fixation of femoral neck fractures (INFNF) through a comprehensive bibliometric analysis. Notably, this analytical process encompasses both qualitative and quantitative components. The present study has utilized the Science Citation Index-Expanded from the Web of Science Core Collection to extract datasets ranging from January 1, 2010, to August 31, 2022. Quantitative analysis was carried out using sophisticated analytical tools such as the Bibliographic Item Co-Occurrence Matrix Builder, the Online Analysis Platform of Literature Metrology, and CiteSpace software. Further, the major Medical Subject Headings terms and their subheading counterparts associated with INFNF were extracted from the PubMed2XL website using the corresponding PMIDs. These Medical Subject Headings terms were employed in conducting a co-word clustering analysis. Ultimately, the Graphical CLUstering TOolkit program was utilized to execute a co-word biclustering analysis to discern the prevailing hotspots in this domain. Between January 1, 2010, and August 31, 2022, a total of 463 publications were issued on INFNF. The INJURY-INTERNAL JOURNAL OF THE CARE OF THE INJURED stood out as the most extensively perused journal in this area. Notably, China emerged as the foremost contributor to publishing articles within the last 12 years, followed by the United States and Canada. McMaster University was identified as the leading institution in INFNF research, while Bhandari M emerged as the most prolific author in this field. Moreover, the study identified five notable research hotspots within the domain of INFNF. This study has identified five critical areas of research in the field of INFNF. It suggests that the primary focus of future research is likely to center on advancing internal fixation methods and robot-assisted instrumentation for femoral neck fractures. As such, this study provides valuable insights into future research directions and ideas for those working in this field.

Comparison of the results of the synthesis of Schatzker II and III tibial plateau fractures by screwing versus plate.

Lateral tibial plateau fractures with depression are the most common. Their treatment is currently surgical. Many therapeutic procedures have been described. Our aim is to evaluate the results of open surgery and to compare the two internal fixation methods used: lag screw versus plates. This is a retrospective comparative study of two series of tibial plateau fractures Schatzker types II and III treated surgically over a period of tenyears with two different methods: Group A: Internal fixation using screws for 86 patients. Group B: Internal fixation using plates for 71 patients. Functional and anatomical results were assessed according to Rasmussen's clinical and radiological scores. The patients' average age was 44years (range from 18 to 76). The male gender was predominant (104 males and 53 females). Road traffic accidents were the most common aetiology with over two thirds of the cases. The fractures were type Schatzker II in 61% of the cases. The mean follow-up was fiveyears. Although the clinical and radiological Rasmussen scores were better in group A (internal fixation with lag screws), those differences were statistically insignificant (p = 0.6 and p = 0.8). Group A clinical and radiological scores were 26.06 and 16.57, respectively and those of group B were 25.72 and 16.45. We noticed more sepsis and skin complications and a longer operating time (95min versus 70min) in group B patients with a statistically significant difference. None of the patients of our series had bone grafting. For Schatzker II and III fractures, an internal fixation with lag screws would be preferable when possible especially in the case of a pure depression fracture. It yields satisfactory results with a shorter operating time and less complication rate.

Efficacité de la fixation interne précoce associée à un lambeau libre pour le traitement des fractures ouvertes de l’avant-bras Gustilo IIIB

IntroductionGustilo IIIB open forearm fractures are severe injuries often associated with extensive bone and soft tissue injuries. The treatment of Gustilo IIIB open forearm fractures remains a challenging problem, with a high morbidity rate such as infection, nonunion, even amputation. External fixation is preferred for open lower limb fractures. However, there are significant differences between open bone injuries of the upper and lower extremity in terms of treatment plans. Use of internal fixation methods for open fractures is a controversial issue, as it requires early coverage of skin and soft tissue defects after radical debridement and irrigation. The optimal approach for open forearm fractures remains to be determined. The present study evaluated whether early internal fixation combined with free flap placement is effective for the treatment of Gustilo IIIB open forearm fracture. HypothesisEarly internal fixation combined with the free flap technique in the treatment of Gustilo IIIB open forearm fracture provides good consolidation results. Material and methodsFrom January 2015 to January 2020, 20 patients with Gustilo IIIB open forearm fracture treated with early internal fixation combined with free skin flap placement were retrospectively analyzed. There were 9 males and 11 females, with an average age of 40years. In all cases, the injuries were classified as Gustilo type IIIB. The area of the wounds ranged from 9×3cm to 27×10cm. Fist-stage plate fixation was adopted in 16 cases. Four patients presenting with major contamination received first-stage fixation with Kirschner wires and external fixation, and the second-stage surgery of surgical treatment included flap placement and internal fixation within 10days. The rates of limb salvage and complications were recorded. The Anderson scoring system was utilized to assess limb function. ResultsLimb salvage was successful in all 20 cases. The average length of hospital was 19 days (range, 7–28days). Four patients developed superficial infections. After debridement, the wounds were covered with skin grafts. No deep infections or osteomyelitis occurred. Three patients developed nonunion, and bone grafts achieved bone healing later. The donor skin flaps healed well, with partial pigmentation. No complete necrosis of the flaps occurred. Only the distal part of flaps became necrotic in two cases, which were then successfully treated by debridement and skin grafting. The average follow-up duration was 14.7months (range, 8–24months). According to the Anderson scoring system, 7 cases were graded as excellent, 6 cases as good, 5 cases as fair, and 2 cases as poor. ConclusionFor Gustilo IIIB type injuries, early and thorough debridement along with early internal fixation and skin flap coverage of the wound can achieve satisfactory clinical results, shorten the treatment cycle, and maximize limb function recovery. Level of evidenceIV; retrospective study without control group.

Efficacy of micro steel plate and Kirschner needle oblique and transverse internal fixation of adjacent metacarpal bone in the treatment of metacarpal diaphyseal oblique fracture

To compare the clinical efficacy of micro steel plate and Kirschner needle oblique and transverse internal fixation of adjacent metacarpal bone in the treatment of metacarpal diaphyseal oblique fracture. Fifty-nine patients with metacarpal diaphyseal oblique fractures admitted between January 2018 and September 2021 were selected as the study subjects and divided into the observation group (29 cases) and the control group (30 cases) based on different internal fixation methods. The observation group was treated with Kirschner wire oblique and transverse internal fixation of adjacent metacarpal bones, while the control group was treated with micro steel plate internal fixation. Postoperative complications, operation time, incision length, fracture healing time, treatment cost, and metacarpophalangeal function were compared between the two groups. No incision or Kirschner wire infections occurred in the 59 patients, except for one in the observation group. No fixation loosening, rupture, or loss of fracture reduction occurred in any of the patients. The operation time and incision length in the observation group were (20.5±4.2) min and (1.6±0.2) cm, respectively, which were significantly shorter than those in the control group (30.8±5.6) min and (4.3±0.8) cm (P<0.05). The treatment cost and fracture healing time in the observation group were (3 804.5±300.8) yuan and (7.2±1.1) weeks, respectively, which were significantly lower than those in the control group (9 906.9±860.6) yuan and (9.3±1.7) weeks (P<0.05). The excellent and good rate of metacarpophalangeal joint function in the observation group was significantly higher than that in the control group at 1, 2, and 3 months after operation (P<0.05), but there was no significant difference between the two groups at 6 months after operation (P>0.05). Micro steel plate internal fixation and Kirschner wire oblique and transverse internal fixation of adjacent metacarpal bones are both viable surgical methods for treating metacarpal diaphyseal oblique fractures. However, the latter has the advantages of causing less surgical trauma, shorter operation time, better fracture healing, lower cost of fixation materials, and no need for secondary incision and removal of internal fixation.

Design of well-matched end-structure of anatomical proximal femoral locking plate based on computer-assisted imaging combined with 3D printing technology: a quality improvement study.

The extramedullary locking plate system was the common internal fixation method for hip fractures. However, common plates were poorly matched to femur, which was because they were designed based on anatomical parameters of the Western populations. Therefore, the aim was to design an end-structure of the anatomical proximal femoral locking plate that closely matched the anatomy of the Chinese population. From January 2010 to December 2021, consecutive patients aged 18 years and older who underwent a full-length computed tomography scan of the femur were included. The end-structure (male and female model) of the anatomical proximal femoral locking plate was designed based on anatomical parameters of femurs that were measured in three-dimensional space using computer-assisted virtual technology. The match degree between the end-structure and femur were evaluated. Inter-observer and intra-observer agreement for the evaluation of match degree was assessed. The matching evaluation based on a three-dimensional printing model was regarded as the gold standard to assess the reliability. A total of 1672 patients were included, with 701 men and 971 women. Significant differences were seen between male and female for all parameters of the proximal femur (all P <0.001). All match degree of end-structure was over 90%. Inter-observer and intra-observer agreement was almost perfect (all kappa value, >0.81). The sensitivity, specificity, and percentage of correct interpretation of matching evaluation in the computer-assisted virtual model was all greater than 95%. From femur reconstruction to completion of internal fixation matching, the process takes about 3min. Moreover, reconstruction, measurement, and matching were all completed in one system. The results showed that based on the larger sample of femoral anatomical parameters, a highly matching end-structure of anatomical proximal femoral locking plate for Chinese population could be designed with use of computer-assisted imaging technology.

Comparison of the clinical efficacy of three internal fixation methods in the treatment of Edinburgh type IB fractures of the proximal clavicle

ABSTRACT Clavicle fractures are one of the most common fractures and usually occur in the medial third of the clavicle. The study explored the efficacy of three internal fixation methods to treat Edinburgh IB fractures of the proximal clavicle. 68 patients with Edinburgh IB fractures of the proximal clavicle were divided into T-shaped plate group, double-miniature steel plate group and memory alloy embracing device group. Postoperative complications, return time to work, and fracture healing time were recorded. The clinical efficacy was evaluated by Constant-Murley score of shoulder joint, Visual Analogue Scale (VAS) score of pain, and arm-shoulder-hand dysfunction score. The operative time of the memory alloy embracing device group was significantly better than T-shaped plate group and double-miniature steel plate group. The length of surgical incision in the double-miniature steel plate group was significantly shorter than that in the T-shaped plate group and the memory alloy embracing device group. The hospitalization cost and recovery time of the double-plate and memory alloy hug groups were lower than those of the T-plate group. The double-miniature steel plate group and the memory alloy embracing device group were significantly better than the T-shaped plate group at two weeks after operation. Satisfactory clinical results can be obtained by using T-shaped plate, double-miniature steel plate and memory alloy embracing device in the treatment of Edinburgh IB fracture of proximal clavicle. However, the double-miniature steel plate group has the advantages of small incision, low cost, and quick postoperative recovery, and has more early advantages.

Surgical Methods of Chest Stabilization in Multiple Rib Fractures

Closed chest injury occupies one of the leading places among all injuries. Rib fractures can lead to the formation of floating fragments of the chest wall, the “costal valve”. With multiple rib fractures, surgical methods of chest stabilization have been used since the beginning of the 20th century, which have become more popular in recent decades. Surgical treatment can significantly reduce pain, accelerate the recovery of respiratory function. In turn, a decrease in pain reduces the incidence of pneumonia, the need for mechanical ventilation and tracheostomy, and the period of hospitalization. There are four main surgical methods of treatment: 1) chest traction methods; 2) external fixation devices; 3) methods of permanent internal fixation; 4) plate osteosynthesis. We also separated the group of techniques performed via thoracoscopic access and the technique using biodegradable materials. Surgical options in the treatment of patients with multiple rib fractures have not been exhausted and are likely to improve with advances in technology.

A Retrospective Analysis of Distal Fibula Fractures Treated With Intramedullary Fibular Nail Fixation

There is growing literature supporting the use of intramedullary fixation for fracture care because of its smaller incisions, improved biomechanical outcomes, and faster time to weightbearing than traditional internal fixation methods. The aim of this study is to investigate the postoperative outcomes in ankle fractures treated with intramedullary nail fixation in the largest patient cohort to date. From 2015 to 2021, 151 patients were evaluated following surgical treatment of fibular fractures with intramedullary nail fixation. Patients were identified through a medical record database search for appropriate ankle fracture procedure codes. Patient information was reviewed for fracture type, adjunct procedures, time to weightbearing and postoperative complications. Radiographs were assessed for quality and time to radiographic union. The mean time to weightbearing was 4.8 weeks. Minor wound dehiscence was identified in 2 patients (1.3%). Superficial infection was present in 4 patients (2.6%) and a deep infection developed in 2 patients (1.3%). Two patients developed a nonunion (1.5%). There were no DVTs reported, although 1 patient developed a PE postoperatively. Radiographic quality of reduction and time to union is comparable to literature reported plate and screw construct outcomes. Reduction was classified as good in 86.1% of patients and radiographic union was appreciated in 98.5% of patients. This is the largest cohort study evaluating the outcomes of intramedullary nail fixation for ORIF of ankle fractures. These data reinforce that intramedullary nailing provides a minimally invasive approach with accurate anatomic reduction, excellent fracture union rates, low complication rates, and an early return to weightbearing.

Functional Outcome After Internal Fixation Combined with External Fixation in Severe Comminuted Distal Radius Fracture: A Case Report

Introduction: It has been 192 years since Colles first demonstrated distal end fracture of radius. Nowadays, this type of fracture still became challenging fractures treated by orthopaedic surgeons. Even this type of fractures were common of the upper limb, the appropriate management still remain debateable. Various type of management have been demonstrated, it’s included immobilized with cast, closed reduction and fixation with percutaneous Kirschner wires and other methods for external and internal fixation. Case Presentation: Patient is female 16 years old complained pain on her left wrist after traffic accident on (October 2019). Patient was diagnosed in Singaraja Hospital with Open Fracture Left Distal Radius and Ulna distal third grade 3A, Patient was performed debridement and open reduction external fixation at the distal radius. Patient was referred to Orthopaedic polyclinic at Prof IGNG Ngoerah hospital due to inadequate alignment after evaluation of 3 weeks post operation. In Prof IGNG Ngoerah Hospital, we performed additional ORIF T-Plate 6 holes with 6 screws on radius and ulnar percutaneous pinning in order to provide additional stability to the comminuted distal radius fracture. Conclusion: Combination of external fixator with T-plate internal fixation decreased re-shifting postoperatively of broken bones chances and kept the stability of fractures to sustain radial height and prevent radial shortening. Thus, it is a safe and effective method for comminuted-type fracture of distal radius. Keywords: External Fixation, Comminuted Fracture, Distal Radius

Recent Progress in the Classification and Operation of Sacral Fractures.

Most sacral fractures are caused by high-energy, violent injuries, often accompanied by lumbosacral plexus injuries, which can cause instability of the posterior pelvic ring or lumbosacral junction in severe cases. Currently, the most commonly used clinical classification methods are Denis classification, Tile classification, Isler classification, and Denis II classification. In recent years, lumbosacral vertebral injury classification and injury degree scoring systems have often been applied clinically as the choice of treatment methods. At present, the internal fixation and implantation methods of sacral fracture are developing in the direction of positive, efficient, safe, and minimally invasive. But different fixation methods have their own indications, which should be strictly followed. This article reviews the classification of sacral fractures and the latest progress in surgical treatment.

Biomechanical study of internal fixation methods for femoral neck fractures based on Pauwels angle.

Objective: To select the most appropriate internal fixation method based on the Pauwels angle, in order to provide a new concept for clinical accurate treatment of femoral neck fractures (FNFs). Methods: FNFs models of Pauwels ; ; ; were created respectively. For Pauwels ≤ , 1, 2 and 3 Cannulated Compression Screws (CCS) and Porous Tantalum Screws (PTS) were used to fix the fracture for the models. For Pauwels , 3CCS and Medial Buttress Plate (MBP) combined with 1, 2 and 3CCS were used to fix the fracture. Based on the results of the finite element (FE) analysis, the biomechanical properties of each model were compared by analyzing and evaluating the following four parameters: maximal stress of the bone (MBS), maximal stress of the implants (MIS), maximal displacement of bone (MBD), interfragmentary motion (IFM). Results: At Pauwels , the larger parameters were found in 1CCS, which was 94.8MPa (MBS), 307.7MPa (MIS), 0.86mm (MBD) and 0.36mm (IFM). In 2CCS group, the parameters were 86.1MPa (MBS), 254.4MPa (MIS), 0.73mm (MBD) and 0.27mm (IFM), which were similar to those of PTS. At Pauwels ; , with the increase of the number of used CCS, accordingly, the parameters decreased. Particularly, the MIS (Pauwels ) of 1CCS was 1,195.3 MPa, but the other were less than the yield range of the materials. At Pauwels , the MBS of 3CCS group was 128.6 Mpa, which had the risk of failure. In 2CCS + MBP group, the parameters were 124.2MPa (MBS), 602.5MPa (MIS), 0.75mm (MBD) and 0.48mm (IFM), The model stability was significantly enhanced after adding MBP. Conclusion: Pauwels type Ⅰ (< ) fractures can reduce the number of CCS, and PTS is an appropriate alternative treatment. For Pauwels type Ⅱ fractures ( ), the 3CCS fixation method is still recommended. For Pauwels type Ⅲ fractures (> ), it is recommended to add MBP to the medial femoral neck and combine with 2CCS to establish a satisfactory fracture healing environment.

Titanium elastic nails vs locking plate in pediatric subtrochanteric femur fractures: A systematic review and meta-analysis.

Titanium elastic nails (TENs) and locking plates (LPs) are currently the main internal fixation for treating pediatric subtrochanteric femur fractures, and the optimal choice of internal fixation is controversial. This study aimed to systematically evaluate the effectiveness and safety of TENs and LPs in treating subtrochanteric fractures in children to provide a theoretical basis and reference for clinical treatment. The literature related to TENs and LPs for treating subtrochanteric fractures in children was searched using the CNKI, PubMed, Cochrane, Embase, and Web of Science, and the search time frame was from the establishment of the database to October 2022. Two evaluators screened the literature according to the inclusion and exclusion criteria and extracted relevant data. Meta-analysis was performed using Stata14.0 software. A total of 9 studies with 407 patients with subtrochanteric femur fractures were included in the final screening, including 210 cases with TENs and 197 cases with LPs. Meta-analysis results showed that compared with the locking plate, TEN had a shorter operative time [WMD = -1.3, 95%CI(-1.94,-0.66), p < 0.01], less intraoperative bleeding [WMD = -84.45, 95%CI(-111.09, -57.82), p < 0.01], shorter fracture healing time [WMD = -1.3, 95%CI(-1.94,-0.66), P < 0.01], shorter hospital stays [WMD = -2.80, 95% CI(-4.63,-0.98), p < 0.01], and earlier full weight bearing [SMD = -0.48, 95% CI(-0.91,-0.04), p < 0.05] but more intraoperative fluoroscopy [WMD = 28.23, 95% CI(15.22,41.25), p < 0.05]. The overall complication rate was high [OR = 3.52, 95% CI(1.96,6.34), p < 0.05], and the postoperative period was prone to angulation, rotation, and inversion deformity [OR = 3.68, 95% CI(1.40, 9.68), p < 0.05]. No significant difference in the incidence of lower limb inequality between the two types of internal fixation [OR = 0.83, 95% CI(0.38, 1.85), p > 0.05] and no significant difference in the Harris score of the hip at the last follow-up between the two types of internal fixation [WMD = -0.67, 95% CI(-2.01,0.67), p > 0.05] were found. In comparison to LPs, TENs have a shorter operation time, less intraoperative bleeding, and a shorter fracture healing time, and the child can be fully weight-bearing earlier. Locking plates can reduce the operator's x-ray exposure, and the incidence rate of postoperative angulation, rotation, and inversion deformity is low. Therefore, TENs and LPs are the best internal fixation methods for treating subtrochanteric fractures in children.

Comparisons of ankle arthrodesis with different internal fixation methods in the treatment of post-traumatic osteoarthritis

BackgroundThe aim of this study was to explore the clinical efficacy of ankle arthrodesis with different internal fixation methods in the treatment of post-traumatic osteoarthritis. MethodsWe collected 85 patients with post-traumatic osteoarthritis who underwent different ankle arthrodesis between December 2015 and December 2020. The operation performance, complication rate, hindfoot alignment, talus tilt angle, visual analogue scale (VAS), and American Orthopedic Foot and Ankle Society (AOFAS) score were preoperatively and postoperatively evaluated. ResultsIn an anterior approach, the locking plate-fixation exhibited a similarity in operation time, incision length, postoperative drainage, bone fusion, hindfoot alignment, and talus tilt angle with fibula support compression screw-fixation, but it was better in increasing postoperative AOFAS. The locking plate-fixation in the anterior approach had lower operation time, incision length, and postoperative drainage than that in the lateral approach. In addition, the lateral locking plate combined with posterolateral compression screw fixation (LLPPCSF) presented shorter bone fusion time, higher AOFAS score, and lower complication rate than either plate- or screw-fixation alone. ConclusionLateral locking plate fixation was better than fibula support compression screw fixation in relieving postoperative pain. Anterior locking plate fixation was more time-saving and less invasiveness than lateral locking plate fixation, but its application was limited in low degree of ankle deformation. LLPPCSF was the most effective in improving bone fusion and postoperative pain, considering an optimal option for the treatment of post-traumatic osteoarthritis.

Comparison of open reduction internal fixation by lateral extensile approach versus conservative management in sanders type 2 and 3 calcaneum fractures: a prospective, two-arm, parallel group study

Background: Calcaneum bone is the most common tarsal bone to get fractured. It accounts for 50-60% of all fractured tarsal bones. Calcaneum fractures are always debilitating and are challenging and cumbersome to treat. There is a paucity of Indian studies to assess the comparative treatment outcomes of calcaneal fractures treated by non-operative conservative procedure and open reduction internal fixation by lateral extensile approach. Methods: Adult patients with closed intra-articular calcaneum fractures of Sanders type 2 and 3 were enrolled. Patients managed by cast application (non-operative) or open reduction internal fixation (operative) were separated into two groups. The VAS score for pain, range of motion, radiological angles (Bohler’s and Crucial angle of Gissane) and parameters, functional scores American orthopedic foot and ankle society and Maryland foot score were evaluated sixth month and 1-year post-intervention and compared between the study groups. Descriptive statistics were used for statistical analysis. Results: 29 patients managed with open reduction internal fixation (N=15) or cast application (N=14) were enrolled. The mean age of patients was 39.54±7.81 years, 22 being males and 7 females. Mean VAS score was significantly lower in the plating group at sixth month (4.31+0.69 vs. 5.01+0.66, p&lt;0.05) but not significant at 1 year (1.25+1.09 vs. 1.86+0.77, p&lt;0.05). Range of movements at the ankle and subtalar joints were higher in the operative group. Mean Bohler’s angle was significantly higher and Gissane’s angle lower in the operative group (p&lt;0.05). Significantly higher AOFAS and Maryland scores were noted in the operative group (p&lt;0.05). Subtalar arthritis with malunion was more common in the non-operative group. Conclusions: Operative open reduction and internal fixation methods were found to be significantly better than the conservative management of calcaneus fracture based on clinical, radiological and functional outcomes. Results are most favourable if wound complications are minimized.

Efficacy of oblique lumbar interbody fusion combined with different internal fixation methods in the treatment of degenerative lumbar diseases

Objective: To compare the efficacy among stand-alone oblique lateral lumbar interbody fusion (OLIF-SA), OLIF combined with lateral screw internal fixation (OLIF-AF) and OLIF combined with posterior percutaneous pedicle screw internal fixation (OLIF-PF) in the treatment of degenerative lumbar diseases. Methods: The clinical data of patients with degenerative lumbar diseases who underwent OLIF-SA, OLIF-AF and OLIF-PF in the Department of Neurosurgery, Xuanwu Hospital, Capital Medical University from January 2017 to January 2021 were retrospectively analyzed. Patients' visual analogue score (VAS) and Oswestry disability index (ODI) at 1 week and 12 months postoperatively were recorded, and efficacy of OLIF surgery with different internal fixation methods was evaluated by comparing clinical scores and imaging examinations at preoperative, postoperative and follow-up, and bony fusion and postoperative complications were recorded. Results: A total of 71 patients were included in the study, with 23 males and 48 females, aged (65±11) (34-88) years. There were 25 patients in the OLIF-SA group, 19 patients in the OLIF-AF group, and 27 patients in the OLIF-PF group. Compared with those of OLIF-PF group [(196±46) min and 50 (50, 60) ml], OLIF-SA and OLIF-AF groups had shorter operative time [(97±38) min and (118±48) min] and less intraoperative blood loss [20 (10, 50) ml and 40 (20, 50) ml] (both P<0.001). There was no statistically significant difference in the fusion rate among three groups (P>0.05). No statistically significant differences of VAS and ODI scores were observed among OLIF-SA, OLIF-AF and OLIF-PF groups during preoperative period [VAS: 5.0 (4.0, 6.0), 5.0 (4.0, 6.0) and 5.0 (4.0, 5.3); ODI: 44.0% (35.0%, 47.0%), 46.5% (43.3%, 46.5%) and 43.5% (35.8%, 46.0%)], and at one week postoperatively [VAS: 2.0 (2.0, 3.0), 3.0 (2.0, 3.0) and 2.0 (2.0, 3.0); ODI: 13.0% (12.0%, 18.0%), 21.0% (13.5%, 21.8%) and 16.5%(14.0%, 21.0%)] and final follow-up [VAS: 1.0 (0, 1.0), 1.0 (1.0, 2.0) and 1.0 (1.0, 2.0); ODI: 7.0% (5.0%, 11.0%), 10.0% (7.0%, 14.8%) and 8.0% (6.0%, 12.0%)], respectively (all P>0.05). Conclusion: Compared with OLIF-AF and OLIF-PF, OLIF-SA is a safe and effective surgical method with similar efficacy and fusion rates, decreases the cost of internal fixation, and reduces intraoperative time blood loss.

Treatmant of Malunion Comminuted Fracture Os Tibia in Maltese Dog

A comminuted fracture is a type of fracture where the affected bone is divided into three or more pieces of different sizes. Improper handling of fractures can potentially lead to malunion and chronic pain. In malunion, the fractured bones are fused but in an abnormal position. Malunion occurs due to inaccurate bone reduction or excessive mobilization during the healing period. The purpose of this article is to describe a surgical method in handling a case of comminuted fracture of the tibia in a dog. A Maltese dog, 3 kg weight, was brought to the clinic due to gait immobility with lifting the right hind leg and limping. In the previous month, the dog suffered from a comminuted fracture of the right tibia and had been treated with plates and screws. During the physical examination, the dog showed good general condition, while the rear right leg was raised. Radiographic results at the medio-lateral and caudo-cranial projection showed the malunion bone due to a shift in the fracture fragment of the diaphysis of right tibia after plate and screw implantation in the comminuted fracture. In the present correction, the plate and screw were replaced by intra-medullary pins combined with wire implementing the Open Reduction and Internal Fixation (ORIF) method. Atropine sulfate premedication was given subcutaneously at 0.02 mg/kgBW. Anesthesia was induced using a combination of 10% ketamine and 2% xylazine, and maintained by a 2% isoflurane inhalation. Postoperative therapy given included Penicillin Procaine G®, Dexamethasone® (0.5 mg/kgBW,IM), Tramadol® (5 mg/kgBW,IM), Viccillin® (10 mg/kgBW,IM), and Cyanocobalamin® (100 mcg/ kgBW, IM). There was no postoperative complication observable, and the patient was brought home on the third day post-surgery when its affected feet was able to touch the floor. The study showed that ORIF method could be performed to correct malunion in a case of comminuted tibia fracture.

Progress in surgical treatment of inferior patellar pole fractures

To summarize the surgical treatment methods and progress of inferior patellar pole fractures and provide reference for clinical application. The literature on surgical treatment of inferior patellar pole fractures was extensively reviewed, and the relevant research progress, advantages, and limitations were summarized. The inferior pole of the patella is an important part of the knee extension device, which can strengthen the force arm of the quadriceps. Inferior patellar pole fractures are relatively rare and often comminuted, usually requiring surgical treatment. At present, there are various methods to treat inferior patellar pole fractures, including patellectomy of inferior pole, tension-band wiring technique, plate internal fixation, suture anchor fixation, claw-like shape memory alloy, separate vertical wiring technique. Different methods have their own characteristics, advantages, and disadvantages. The single internal fixation method has more complications and is easy to cause fixation failure. Therefore, the trend of combining various internal fixation methods is developing at present. When the main fragment of the inferior patellar pole fracture is large and mainly distributed transversely, the combination protocol based on tension-band wiring technique can be regarded as an ideal choice. When the fragments are severely damaged and small, the comprehensive protocol based on suture fixation can result in a better postoperative functional recovery.

Modified minimally invasive laparoscopic peritoneal dialysis catheter insertion with internal fixation

Background Laparoscopic technique is widely used in peritoneal dialysis (PD) catheter placement. We developed a modified minimally invasive laparoscopic PD catheter (PDC) insertion with internal fixation and evaluated the early results by observing the intraoperative and postoperative conditions of the novel technique with those of conventional open surgery. Methods Retrospective research was performed on 59 patients who underwent PDC insertion from June 2019 to January 2022, including 23 patients who received open surgery and 36 patients who received modified minimally invasive laparoscopic surgery. Information such as preoperative conditions, operation time, incision length, incidence of intraoperative complications, time from operation to starting PD, time from operation to discharge, and incidence of catheter-related complications were collected and analyzed. Results The incision length, intraoperative blood loss, catheter migration rates and the total incidence of complications 6 months after operation in the laparoscopic group were lower than those in the conventional group. There were no statistically significant differences between the two groups in operation time, time from operation to starting PD, time from operation to discharge and the incidence of catheter blockage, leakage, exit-site infection, peritoneal dialysis associated peritonitis and hernia. Conclusions Modified minimally invasive laparoscopic PDC insertion and internal fixation method achieved direct vision and reliable fixation of the catheter, significantly reduced incision length and blood loss. The incidence of catheter migration was significantly lower than that of open surgery. Our primary findings reveal that modified minimally invasive laparoscopic PDC insertion with internal fixation is safe, effective and beneficial for PD patients.

Finite Element Analysis of Mechanical Characteristics of Internal Fixation for Treatment of Proximal Femoral Osteolytic Lesions in Children.

Clinically, it is very difficult to prevent pathological fracture caused by high recurrence rate of osteolytic disease of proximal femur in children. At present, there is no consensus in clinical studies of which internal fixation method can significantly reduce the probability of recurrence of pathological fracture. The study aims to research the mechanical properties of different internal fixations in the treatment of osteolytic lesions of proximal femur in children by finite element analysis, and to find out the optimal treatment. Based on finite element analysis, the osteolytic disease models of the femoral neck and intertrochanter in a child (8-year-old, boy) were established respectively, and different internal fixation models (plate and titanium elastic intramedullary nails, TENs) were assembled. For the osteolytic lesion of the femoral neck: model A1 was assembled with a plate; model A2 with two TENs crossing the physis; model A3 with two TENs without crossing the physis. And for pertrochanteric osteolytic lesion: model B1 was assembled with a plate, model B2 with two TENs crossing the physis and model B3 with two TENs without crossing the physis. The Eccentric bearing load, torsional restraintal restraint of calcar femorale and composite load were analyzed for each models. When the yield strain of each model is reached, the stress concentration points are located in the proximal and distal femoral calcar. In the model of femoral neck lesions, the failure load of model A1 and model A2 are the same (1250 N), and the failure load of model A3 (980 N) is significantly lower than that of the former two; in the model of intertrochanteric lesions, the failure load of model B2 is the largest (1350 N), and the failure load of model B1 (1220 N) is lower than that of model B3 (1260 N), but both are smaller than that of model B2. Through finite element analysis, TENs through the epiphyseal plate, is found to be the better internal fixation method for femoral neck lesions and intertrochanteric lesions under two different working conditions. The results of clinical correlation study provide new biomechanical information for orthopedic doctors to consider different treatment options for osteolytic lesions of proximal femur.