Closed Fractures Research Articles

Analysis of the treatment of comminuted fractures of tubular bones of the extremities in cats and dogs

Surgical resolution of comminuted fractures of tubular bones is an urgent issue for practicing veterinarians. Comminuted fractures account for 52%, transverse fractures for 8.7%, oblique fractures for 26.1%, and compression fractures for 13.0% of total canine fractures. Thus, comminuted fractures of the tubular bones of the extremities are the most frequent. There are several types of bone fixation in comminuted fractures. Many authors do not recommend using of intramedullary osteosynthesis in the treatment of this type of fracture since it is not possible to connect all bone fractures. The aim of this study was to compare the methods of surgical treatment of comminuted fractures in dogs and cats admitted to the clinics and to choose the most optimal ways of treatment. In total, 4,396 cats and dogs were admitted to the clinic, excluding those admitted for vaccination. The surgical department received 35% of the total number of animals. Patients with bone and joint pathology accounted for 19% of all surgical causes and to 7% of all animals admitted to the clinic. In the group of 9 cats and 9 dogs three main types of fracture were diagnosed: transverse fracture in 6 animals (4 dogs and 2 cats), oblique fracture in 4 animals (3 dogs and 1 cat) and comminuted fracture in 8 animals (2 dogs and 6 cats). The article is illustrated with X-rays images of the clinical cases presented. In order to perform osteosynthesis using a single-plane bilateral external fixator, the authors injected 2-3 Kirchner spokes each into the proximal and distal bone fragments by drilling through the bone while perforating soft tissue on both sides. The ends of the spokes on both sides were bent towards the opposite fragment, parallel to the bone axis, at a distance of 1.0 to 3.0 cm from the skin surface. The ends of the spokes form the rods of a bilateral single-plane fixator. The rod-forming spokes are tightened with wire serrations on 3-4 levels and additionally fixed with fast hardening plastic (turbocast) or bone cement (Palacos, GMW, Osteobond) while controlling the fracture reposition. Combination with wire serclages, sutures, compression screw or intramedullary Kirschner wire osteosynthesis is possible.

Prevalence of surgical wound infection and related factors in patients after long bone surgery: A systematic review and meta-analysis.

The goal of this systematic review and meta-analysis is to provide an overview of the prevalence of surgical wound infection and related factors in patients after long bone surgery. A comprehensive, systematic search was conducted in different international electronic databases, such as Scopus, PubMed, Web of Science and Persian electronic databases such as Iranmedex and Scientific Information Database using keywords extracted from Medical Subject Headings such as "Prevalence", "Surgical wound infection", "Surgical site infection" and "Orthopedics" from the earliest to the May 1, 2023. The appraisal tool for cross-sectional studies (AXIS tool) evaluates the quality of the included studies. A total of 71 854 patients undergoing long bone surgery participated in 12 studies. The pooled prevalence of surgical wound infection in patients who underwent long bone surgery reported in the 12 studies was 3.3% (95% CI: 1.5%-7.2%; I2 = 99.39%; p < 0.001). The pooled prevalence of surgical wound infection in male and female patients who underwent long bone surgery was 4.6% (95% CI: 1.7%-11.7%; p < 0.001; I2 = 99.34%) and 2.6% (95% CI: 1.0%-6.3%; I2 = 98.84%; p < 0.001), respectively. The pooled prevalence of surgical wound infection in patients with femur surgery sites reported in nine studies was 3.7% (95% CI: 2.1-6.4%; I2 = 93.43%; p < 0.001). The pooled prevalence of surgical wound infection in open and close fractures was 16.4% (95% CI: 8.2%-30.2%; I2 = 95.83%; p < 0.001) and 2.9% (95% CI: 1.5%-5.5%; I2 = 96.40%; p < 0.001), respectively. The pooled prevalence of surgical wound infection in patients with diabetes mellitus (DM), hypertension (HTN) and cardiovascular disease (CVD) was 4.6% (95% CI: 2.3%-8.9%; I2 = 81.50%; p < 0.001), 2.7% (95% CI: 1.2%-6.0%; I2 = 83.82%; p < 0.001) and 3.0% (95% CI: 1.4%-6.4%; I2 = 69.12%; p = 0.006), respectively. In general, the different prevalence of surgical wound infection in patients undergoing surgical treatment after long bone fracture may be caused by underlying factors (gender and co-morbidity) and fracture-related factors (surgery site and type of fracture).

Management of Humeral Fracture in a Dog at Klinik Bersama Dokter Hewan Jungle Bekasi

A humeral fracture is a discontinuity of the humeral bone due to an injury or illness. A three-year-old black mongrel female dog weighing 12.5 kg was brought to the Jungle Veterinary Clinic in Bekasi City, Indonesia, due to lameness and swelling in the left front limb. The radiological examination indicated an oblique fracture of the distal diaphysis of the left humerus. Haematological and biochemistry tests indicated neutrophilia, leukocytosis, and decreased erythrocyte, haemoglobin, hematocrit, MCV and MCH levels, while the levels of globulin and ALP were elevated. An orthopaedic surgery was performed using cerclage wires in conjunction with the intramedullary pin approach to immobilize the fracture. Post-surgery medical treatments were oral Amoxicillin 20 mg/kg, tramadol 5 mg/kg, meloxicam 0.1 mg/kg, Curcuma™ ½ tablet, Sangobion™ ½ tablet, and Kalmicetin™ ointment for topical wound dressing twice a day. The surgical wound healed and front leg function improved seven days after surgery

Paper 56: Dual Plate Fixation of Midshaft Clavicle Fractures May Reduce Reoperation Rates Compared to Single Plating with Anterior or Superior Fixation Techniques

Objectives: Dual plate fixation has been proposed as a solution to the high rates of reoperation secondary to operative management of displaced midshaft clavicle fractures. Previous studies have recommended dual plating for patients specifically at higher risk of reoperation. Therefore, the purpose of this study was to compare reoperation rates among patients who underwent single superior, single anterior, and dual plating while adjusting for risk factors including age, smoking status, and high-risk fracture morphology. We hypothesized lower rates of reoperation among patients who underwent dual plate fixation. Methods: This was a retrospective cohort study of all patients who presented with a midshaft clavicle fracture and underwent ORIF between 2007 and 2021 to our trauma/sports divisions. Patient demographics, fracture pattern, plating technique, postoperative complications, date of surgery, reoperation status, date of last follow up, and date of reoperation were documented. We report hazard ratio (HR) estimates using a multivariate multilevel mixed-effects parametric survival model, which accounted for patients with multiple reoperations and adjusted for covariates. Results: A cohort of 395 patients (mean age 38.5±14.4 years, 81.7% male) were identified with average follow-up of 5.5±8.6 months. There were 77 z-type, 157 transverse, and 161 oblique fractures. With regards to plating technique, 152 underwent single superior plating, 149 experienced single anterior plating, and 94 had dual plating. After initial operation, there were 8 total instances of non-union (2.0%), 0 in the dual plating cohort (0%), 4 in the superior plating cohort (2.6%), and 4 in the anterior plating cohort (2.7%) (p=0.35). A total of 28 reoperations took place among 19 patients (4.8%), with 6 patients experiencing multiple reoperations. Single plating with superior placement revealed the highest reoperation rate of 0.26 per person-years, followed by anterior placement with 0.17 per person-years, and finally dual plating with 0.02 per person-years ( Figure 1). Patients who underwent single plating (either anterior or superior placement) revealed a greater rate of reoperation when compared to patients who underwent dual plating (HR: 8.3, p=0.045). Patients who underwent single plating with superior placement had a rate of reoperation ten- times greater than patients who underwent dual plating (HR:10.1, p=0.03). Patients who underwent single plating with anterior placement had a rate of reoperation six-times greater than patients who underwent dual plating (HR: 6.4, p=0.09), although not statistically significant. Conclusions: Dual plate fixation of displaced midshaft clavicle fractures has an eight-fold lower risk of reoperation compared to single plate fixation, while accounting for age, smoking, and high-risk fracture morphology. More specifically, dual plating had lower rates of reoperation than both single plating with anterior and superior placement. When operative management is indicated for a midshaft clavicle fracture, dual plating may be an excellent treatment alternative in patients at high risk for reoperation.

Effects of load waveforms on stress corrosion behavior of pipeline steel

The effects of different load waveforms on stress corrosion cracking (SCC) of X70 pipeline steel were studied by means of fluctuating slow strain rate tensile test (F-SSRT). The results show that the SCC sensitivity of F-SSRT specimens with square wave loading is weak, and the fracture is straight; the SCC sensitivity of F-SSRT specimens with superimposed triangular wave loading is in the middle, and the fracture edge is serrated; The F-SSRT specimens with superimposed sine wave loading own the strongest SCC sensitivity, and the fracture is an oblique section fracture extending along the 45° direction. Different superimposed loads with different waveforms result in different SCC test results including different fracture morphology and change rules, which are caused by the change of the direction and magnitude of the applied force of the superimposed load, not only attributing to the different superimposed load energy.

Locking plate for periprosthetic femoral fractures according to Vancouver C: Outcome and radiological subanalysis of 40 patients.

Periprosthetic femoral fractures (PFF) according to type Vancouver C are less common and outcome is limited reported. Therefore, we conducted this retrospective single center study. We performed analysis of patients who underwent open reduction and internal fixation (ORIF) with locking plates for PPF occurring distally of a primary standard hip stem. Data on demographics, revisions, fracture patterns, and mortality were evaluated. At least two years after operation, we examined outcome using the Parker and Palmer mobility score. Primary aim of this study was revision, outcome and mortality. Secondary aim was evaluation of fracture subtypes within type Vancouver C fractures. Between 2008 and 2020, 383 patients with periprosthetic femoral fracture after hip replacement were surgically treated according to our database. Among them, 40 patients (10.4%) with type Vancouver C fractures were enrolled for this study. The mean patient age was 81.5years (59-94) at the time of fracture. Thirty-three patients were women, and 22 fractures were on the left side. Without exception, locking plates were used. The 1-year mortality rate for the sample was 27.5% (n = 11). Three revisions (7.5%) were performed for plate breakage. Rate of infection and non-union was zero. Three different fracture patterns were assessed: (1) transverse or oblique fractures below the tip of the stem (n = 9); (2) spiral-shaped fractures within the diaphysis (n = 19); and (3) burst fractures at the supracondylar region (n = 12). Demographic or outcome effects between fracture patterns were not found. On average of 4.2years (2.0-10.4) after treatment, the mean reported Parker score was 5.5 (1-9). ORIF with a single lateral locking plate is safe for type Vancouver C fractures with a well-fixed hip stem. Therefore, we do not recommend routinely revision arthroplasty or orthogonal double plating. Three subtypes of fractures within Vancouver C demonstrated no significant differences in baseline data and outcome.

Comparison of Proximal Femoral Nail versus Dynamic Condylar Screw in Treating Reverse Oblique Intertrochanteric Femoral Fractures

Aim: Comparison of proximal femoral nail versus dynamic condylar screw in treating reverse oblique intertrochanteric femoral fractures. Study Design: Retrospective study Place and duration of study: CMH Kharian, Allama Iqbal International Hospital Kharian and Madni Hospital Gujrat from 1st January 2020 to 31st December 2022. Methodology: Sixty five patients who had suffered from reverse oblique intertrochanteric femoral fractures and were either treated through proximal femoral nail or by dynamic condylar screw were included. Patients who were treated with proximal femoral nail were placed in group 1 while those treated with dynamic condylar screw were placed in group 2. The comparative outcomes between both groups were than analyzed and documented in a well-structured questionnaire. Results: There was no significant variance in the mean age of the patients in group 1 (proximal femoral nail) and group 2 (dynamic condylar screw) with a value as 65.53±3.1 and 59.35±3.2 years respectively. There were more females in both groups than males however with no significant variance. Non-union and implant breakage observed in the dynamic condylar screw cases were 5/32 and PFN cases 2/33 respectively; with a significant p value difference. The fixation revision was required in 5case with dynamic condylar screw implant failure while it was 2 in cases of proximal femoral nail. The rate of infection was higher in dynamic condylar screw patients. Practical Implication: There was no advantage of open reduction by dynamic condylar screw over the closed proximal femoral nail reduction. Proximal femoral nail reduction and fixation presented to be a better option for treating reverse oblique intertrochanteric femoral fractures. Conclusion:A high rate of non-union is presented in dynamic condylar screw treated cases.Proximal femoral nail fixation presented to be a better option for treating reverse oblique intertrochanteric Femoral Fractures Keywords: Intertrochanteric, Intramedullary, Femur, Reverse Oblique fractures

3D‐printed model of a femur fracture and treatment with plate osteosynthesis in a red‐eared slider (Trachemys scripta elegans)

AbstractA 7‐year‐old, female, red‐eared slider turtle was presented with proximal diaphyseal oblique femoral fracture due to falling out of bed. A preoperative evaluation with computed tomography was performed to evaluate the fracture anatomy of the femur. The appropriate implant selection was decided upon the three‐dimensional printed model before the plate osteosynthesis. Follow‐up time for the patient was 6 months and the functional outcome was considered excellent. In conclusion, three‐dimensional printing before plate osteosynthesis has many advantages on the success rate by shortening the operation time in extraordinary orthopaedic patients, such as the red‐eared slider turtle.

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.

Spontaneous distal migration of Kuntscher intramedullary nail into leg from malunited distal femur fracture: A rare case report

Kuntscher cloverleaf nail, also called as K-nail, is an intramedullary nail (IMN), made from stainless steel with a slot along the longitudinal axis. It is used in fixation of short oblique, simple transverse, Winquist- I and II comminuted fractures of femur. This was a case in which the Kuntscher nail spontaneously migrated distally, and was extruded completely from the femur into the leg along the posterior aspect till the ankle with the most probable cause being malunion of an oblique distal femur fracture. There were no recent reports on this type of distal migration till date. A 72-year-old male, who is working as farmer in a rural area, came to our institution with pain and swelling on &amp; off around the left ankle for last two months during May 2022. Local examination of left lower limb revealed that there was swelling around the left ankle. There was a palpable hard metallic object posterior to the left medial malleolus. There is a single well healed surgical scar of length 10 cms on the lateral aspect of left distal thigh. Radiological workup was done accordingly. Final diagnosis was – Postoperative spontaneous migration of Kuntscher nail into the leg from a malunited fracture of lower 1/3 of left femur. Treatment plan was implant removal. After implant removal, the patient was discharged in a stable condition and follow-up till 6 months revealed no complaints around the ankle or knee joints. Distal migration of K-nail across the knee joint after femur diaphyseal fracture fixation is a rare and preventable complication. It is recommended that K-nails should be routinely removed as soon as radiological union and consolidation of the fracture is confirmed, to avoid rare postoperative complication of distal migration of the K-nail.

Three-dimensional morphological study of type B lateral malleolar fractures with special reference to the end-tip location of proximal apexes.

Objective: We aimed to describe the morphological characteristics of Danis-Weber type B lateral malleolar fractures, with special attention given to the end-tip locations of fracture apexes, and to construct a 3D (three-dimensional) fracture line map. Methods: A total of 114 surgically treated cases of type B lateral malleolar fractures were retrospectively reviewed. The baseline data were collected, and computed tomography data were reconstructed in a 3D model. We measured the morphological characteristics and the end-tip location of the fracture apex on the 3D model. All the fracture lines were superimposed on a template fibula to generate a 3D fracture line map. Results: Among these 114 cases, 21 were isolated lateral malleolar fractures, 29 were bimalleolar fractures, and 64 were trimalleolar fractures. All the type B lateral malleolar fractures demonstrated a spiral or oblique fracture line. As measured from the distal tibial articular line, the fracture started at -6.22 ± 4.62mm anteriorly and terminated at 27.23 ± 12.32mm posteriorly, and the average fracture height was 33.45 ± 11.89mm. The fracture line inclination angle was 56.85° ± 9.58°, and the total fracture spiral angle was 269.81° ± 37.09°, with fracture spikes of 156.20° ± 24.04°. The proximal end-tip location of the fracture apex was classified into four zones in the circumferential cortex: zone I (lateral ridge) in seven cases (6.1%), zone II (posterolateral surface) in 65 cases (57%), zone III (posterior ridge) in 39 cases (34.2%), and zone IV (medial surface) in three cases (2.6%). Altogether, 43% (49 cases) of fracture apexes were not distributed on the posterolateral surface of the fibula, as 34.2% (39 cases) were located on the posterior ridge (zone III). The aforementioned morphological parameters in fractures with zone III, sharp spikes, and further broken spikes were greater than those in zone II, blunt spikes, and fractures without further broken spikes. The 3D fracture map suggested that the fracture lines with the zone-III apex were steeper and longer than those with the zone-II apex. Conclusion: Nearly half of type B lateral malleolar fractures had their proximal end-tip of apexes not on the posterolateral surface, which may impair the mechanical application of antiglide plates. A steeper fracture line and longer fracture spike indicate a more posteromedial distribution of the fracture end-tip apex.

Successful Medical Management of an Acute Traumatic Sternal Luxation in a Cat.

A 5 yr old indoor-outdoor domestic longhair red tabby cat presented for evaluation of a 1-day history of hiding, urinating and defecating outside the litterbox, and vocalizing when picked up. Physical examination revealed significant pain on palpation of the caudal sternum where an approximately 8 × 6 cm contusion was noted. Sedated thoracic radiographs revealed a luxated fifth intersternebral joint with the sixth sternebra being cranioventrally displaced (along with the seventh and eight sternebrae) to the level of the mid fourth sternebra. There were sharply marginated, short oblique fractures of the distal sixth costal cartilages bilaterally with mild dorsal displacement of the distal segment. The sternal luxation was palpated more aggressively once the patient was sedated and deemed to be stable. Because of the stability of the luxation and absence of sternebral fractures, conservative medical management in the form of analgesics and rest was instituted. Repeat thoracic radiographs 2 wk after presentation revealed an unchanged sternal luxation. Twelve months after presentation, the patient presented for an unrelated lameness and, in that timeframe, has exhibited no sequelae to the sternal luxation, which still palpates stable and is radiographically unchanged.

Outcome and Evaluation of Distal Tibial Close Fractures with Locking Compression Plate (LCP): A Prospective Study (MIPO) Approach

Background: Fractures of the distal tibia have historically proved difficult to treat. The distal tibia is less deeply covered by muscle and has a poorer blood supply. Therefore, problems are possible during the surgical treatment. We hope to evaluate the outcomes of LCP with minimally invasive plate osteosynthesis (MIPO) for the fixation of distal tibial fractures. Materials and Methods: A Multicentered based quasi-experimental prospective study was performed in 250 Beded District Hospital, Chapainawabganj, Rajshahi, Bangladesh, from January 2020 to December 2022. A Total Twenty-one patients were prospectively analyzed. Included were AO types 43A, 43B, and 43C. There were 21 patients (14 men and 7 women, with a mean age of 51). Results: The Mean time to union duration was 11 months (range, 3-35). There was a high perceived result for 17 fractures. The union of one patient was delayed. Nonunion, in one case, necessitated revision surgery, but the fracture healed with a satisfactory good functional outcome. Two patients had minor infections at the wound's surface, but their fractures subsequently healed. Conclusion: The MIPO procedure for the distal tibia has proven effective and offers many benefits over more traditional approaches. Stiffness and contracture can be avoided by early mobility without the potential of subsequent displacement.

A PROSPECTIVE RANDOMIZED CONTROLLED MULTICENTRE TRIAL OF DISPLACED METACARPAL FRACTURES COMPARING NONOPERATIVE WITH OPERATIVE TREATMENT

Metacarpal fractures represent up to 33% of all hand fractures; of which the majority can be treated non-operatively. Previous research has shown excellent putcomes with non-operative treatment yet surgical stabilisation is recommended to avoid malrotation and symptomatic shortening. It is unknown whether operative is superior to non-operative treatment in oblique or spiral metacarpal shaft fractures.The aim of the study was to compare non-operative treatment of mobilisation with open surgical stabilisation.42 adults (≥ 18 years) with a single displaced oblique or spiral metacarpal shaft fractures were randomly assigned in a 1:1 pattern to either non-operative treatment with free mobilisation or operative treatment with open reduction and fixation with lag screws in a prospective study. The primary outcome measure was grip-strength in the injured hand in comparison to the uninjured hand at 1-year follow-up. The Disabilities of the Arm, Shoulder and Hand Score, ranges of motion, metacarpal shortening, complications, time off work, patient satisfaction and costs were secondary outcomes.All 42 patients attended final follow-up after 1 year. The mean grip strength in the non-operative group was 104% (range 73–250%) of the contralateral hand and 96% (range 58–121%) in the operatively treated patients. Mean metacarpal shortening was 5.0 (range 0–9) mm in the non-operative group and 0.6 (range 0–7) mm in the operative group. There were five minor complications and three revision operations, all in the operative group.The costs for non-operative treatment were estimated at 1,347 USD compared to 3,834USD for operative treatment; sick leave was significantly longer in the operative group (35 days, range 0–147) than in the non-operative group (12 days, range 0–62) (p=0.008).When treated with immediate free mobilization single, patients with displaced spiral or oblique metacarpal shaft fractures have outcomes that are comparable to those after operative treatment, despite some metacarpal shortening. Complication rates, costs and sick leave are higher with operative treatment. Early mobilisation of spiral or long oblique single metacarpal fractures is the preferred treatment.Trial registration number: ClinicalTrials.gov NCT03067454

Clinical outcome of locking plate fixation in distal tibia fractures.

A study was conducted to assess the outcome of close distal tibial fractures fixed with pre-contoured locking-plate using Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO) technique in terms of union and infection, at the Department of Orthopaedic Surgery King Edward Medical University/Mayo Hospital, Lahore from August 2013 to May 2017. Fourty cases with close distal tibial fractures were enrolled. Fractures were managed with locking compression plate using MIPPO technique. Patients were followed for 12 months post-fracture stabilisation. Of the 40 patients 24 were males and 16 females, with male to female ratio of 1.5:1. The mean age of the patients was 44.70±13.67 years with minimum and maximum ages of 18 and 60 years, respectively. All fractures united with the mean union time of 16±4 weeks. The infection rate was 5%. Locking compression plate when used with MIPPO technique provides early bone union and low infection rate.

Research on the cone-beam CT of the fracture morphology and location of a single oblique complicated crown-root fracture of maxillary incisors

Objective: To study the morphological pattern of single oblique complex crown fracture and its relative location to periodontal hard tissues from a three-dimensional perspective by using cone-beam CT, which provides a more intuitive and comprehensive understanding for the pathological features and rules of single oblique complex crown fracture. Methods: Primary cone-beam CT images of 56 maxillary permanent anterior teeth with oblique complex crown root fractures were collected from the Department of Integrated Emergency Dental Care, Capital Medical University School of Stomatology during January 2015 to January 2019. Fracture pattern, fracture angle, fracture depth, fracture width, and the relative location of the fracture line to the crest of the adjacent alveolar ridge were retrospectively analyzed. Independent samples t-test was used to compare the differences in angle, depth and width of fractures between sexes and tooth locations, as well as the pre-and post-fracture crown-to-root ratios between different tooth locations. Then the affected teeth were divided into juvenile group (≤18 years), young group (19-34 years) and middle-aged and elderly group (≥35 years). One-way ANOVA was applied to compare the differences in angle, depth and width of fracture between age groups, and Fisher exact test to compare the differences in fracture pattern of the teeth and the relative position of the fracture line to the crest of the adjacent alveolar ridge. Results: There were 35 males and 21 females in 56 patients, aged (28.2±13.2) years. Among the 56 affected teeth, forty-six were maxillary central incisors and 10 were lateral incisors. According to the patients' age and growing stage, they could be divided into the juvenile group (19 cases), the young group (14 cases), and the middle-aged and elderly group (23 cases). Forty-six (82%) affected teeth had an S-shaped fracture pattern, and ten (18%) had a diagonal pattern, in which the fracture angle of the S-shaped fracture line (47.85°±10.02°) was significantly greater than that of the diagonal line (28.30°±8.07°) (P<0.001). The fracture nadir was flush with or below the top of the alveolar crest in 98% (55/56) of cases. The fracture depth was significantly greater in the juvenile group [(1.75±0.73) mm] than in the young group [(1.21±0.68) mm](P=0.042) and in the middle-aged and elderly group [(1.12±0.90) mm] (P=0.001). The width of fractures among 56 patients was (4.75±1.44) mm, which had no statistically significant differences between different age, sex and tooth location groups (P>0.05). There were no statistically significant differences in the crown-to-root ratios after fracture of maxillary central incisors (1.18±0.13) compared to maxillary lateral incisors (1.14±0.20) (t=1.90, P=0.373). Conclusions: The fracture patterns of single oblique complex crown fracture were mainly S-shaped and oblique alignment; the fracture nadir was mostly located within 2.0 mm below the palatal alveolar crest.

Evaluation of Contact Area and Pressure After Malreduction in Isolated Medial Malleolar Fractures With 2 mm of Displacement: A Cadaveric Study

This study was performed to evaluate the changes in contact area and pressure in the tibiotalar joint, with a 2 mm displacement after IMMF(isolated medial malleolar fracture). Ten cadavers with pairs were used to establish a situation in which IMMF occurred during ankle injury. We performed IMMF corresponding to types C and D of the Herscovici classification, and it was displaced by 2 mm. The normal group was defined as a normal tibiotalar joint, the TF(transverse fracture) group as a 2 mm transverse displacement corresponding to the Herscovici classification type C, and the OF(oblique fracture) group as a 2 mm oblique displacement corresponding to the Herscovici classification type D. We measured the contact area and pressure at the tiobiotalar joint. The film was scanned and analyzed using the digital imaging software, Scion Image (Scion Crop. Frederick, MD). In normal group, the average contact area of the tibiotalar joint was 317 mm2 (IQR; interquartile range,256; 347) and 308 mm2 (IQR, 262; 364), average pressure was 2.19 N/mm2 (IQR, 1.94; 2.27) and 2.15 N/mm2 (IQR, 2.06; 2.53). In the TF and OF groups, the average contact area of the tibiotalar joint decreased by 9% and 12%, respectively, and the average pressure increased by 8% and 14%, respectively. There was no statistical difference in peak pressure between the normal, TF, and OF groups. In the case of transverse and oblique fractures, a 2 mm displacement showed significant changes in contact area and contact pressure compared to the normal tibiotalar joint, but there were no significant changes pertaining to type, between the two fractures. Level of Clinical Evidence: 5.

Primary dynamic interlocking nail in femoral shaft fracture: A case series

Introduction and importanceFemoral shaft fracture is one of the most frequent injuries encountered by an orthopedic surgeon. Surgical treatment is commonly needed. Intramedullary nailing remains the gold-standard in surgical treatment of femoral shaft fracture. One of the constant dilemmas in intramedullary nailing is whether to use a static or dynamic locking screw for treating femoral shaft fractures. Case presentationWe reported three cases of simple femoral shaft fracture and surgically fixed with primary dynamic interlocking nail. Closed reduction with reamed nail was performed in 2 cases, and mini open reduction with un-reamed nail was performed to the other one. Early weight bearing was instructed at day 1 post-operative. Mean follow-up period was 12.6 months. A solid bony union was achieved by all patients, and no complications were observed at the final follow up. Clinical discussionIntramedullary nailing can be made static or dynamic. It is thought that in static mode of the intramedullary nailing, the axial weight is transferred through the locking screws rather than the fracture site, thus altering the callus formation and delaying fracture healing. A prompt dynamization of the fragments allows the contact of both fragments during mobilization and promotes early callus formation. ConclusionPrimary dynamic interlocking nail is an effective option for surgical treatment in simple or short oblique femoral shaft fracture.

Trans-olecranon fracture posterior dislocation: a novel type of elbow injury

BackgroundBased on our experiences, we found that a kind of elbow injury is characterized by an olecranon fracture accompanied by elbow joint posterior dislocation with the proximal radioulnar joint intact. The aim of this study was to better define this kind of severe elbow instability, which has not been previously reported.MethodsWe retrospectively analyzed all patients with olecranon fractures who were treated at our institution from January 2013 to April 2021. Data on these patient demographics, injury characteristics, preoperative and postoperative imaging, surgical management, and outcomes were recorded and analyzed. We also made the inclusion criteria and exclusion criteria.ResultsA total of 309 patients were diagnosed olecranon fractures in our institution, and ten patients met the inclusion criteria, 9 males and 1 female, with an average age of 40.6 ± 12.7 years (26–68 years). Eight patients (80%) were comminuted, and two were oblique olecranon fracture. Nine patients (90%) suffered coronoid process fractures, eight fractures were type III, and one was type II. Eight patients (80%) suffered radial head fractures, seven fractures were type II, and one was type III. All patients suffered lateral collateral ligament complex injury. All patients underwent surgical management and were followed up on average for 15.8 ± 3.2 months (12–20 months). The motion of the elbow and functional outcome were evaluated with several methods. The mean arc of the elbow movement was 131.6° ± 6.0° (124°–140°), and the mean arc of the forearm rotation was 158.5° ± 17.8° (128°–180°). Nine patients’ functional results according to the Mayo Elbow Performance Score (MEPS) were excellent with a mean score of 96.5 ± 5.3 points (85–100 points), and another was good. The mean score according to the Broberg and Morrey functional rating index was 98.8 ± 2.5 points (92–100 points), nine patients were excellent, and another was good. The mean Disabilities of the Arm, Shoulder, and Hand (DASH) score was 0.75 ± 1.2 points (0–3.3 points).ConclusionsTrans-olecranon fracture posterior dislocation is a rare injury and has unique characteristics, and it is a kind of complex elbow instability involving the coronoid process and radial head fractures. After bony structure is restored, the repairment of lateral collateral ligament complex is also important to the stability of the elbow joint. Correct understanding of this kind of injury and reasonable treatment plan can achieve good function.

The Comparison of Dynamic Condylar Screw Plate to Proximal Femoral Nail in Reverse Oblique and Transverse Intertrochanteric Fractures: A Retrospective Study on 61 Patients.

Reverse oblique (RO) and transverse intertrochanteric fracture patterns constitute a challenge for the operating surgeon. Currently, no gold standard fixation method exists. This study aimed to retrospectively compare proximal femoral nail (PFN) to dynamic condylar screw (DCS) plating in the treatment of RO and transverse intertrochanteric fractures. A total of 61 patients fixated by PFN or DCS were included. Of these, 36 were treated with PFN (21 females and 15 males; mean age: 65.52 years), and 25 were treated with DCS (12 females and 13 males; mean age: 59.36 years). The mean follow-up time was 33.8 and 42.6 months (range: 24-108). Radiological evaluation included the quality of fracture reduction, neck-shaft angle change, posteromedial support presence, and bone union time. Complications such as mechanical failure, nonunion, and infection were noted. The only significant differences between the fixation methods were the superiority of DCS over PFN in earlier fracture union time (mean values: 8.9 versus14.1 weeks) and the superiority (p=0.007) of PFN in shorter hospital stay (3.4 days versus5.1 days). No significant difference was observed in radiological parameters. While similar mechanical complication rates were found, a significantly higher nonunion rate was detected with the DCS. The most crucial disadvantage of DCS was the high rate of nonunion. Closed fracture reduction in PFN seems to be the most critical parameter to prevent severe complications. The open reduction using DCS showed no advantages over closed reduction and PFN fixation in providing a more anatomical alignment in AO/Orthopaedic Trauma Association (OTA) 31-A3 fractures. However, we recommend PFN application in this type of fracture, since nonunion is more common in DCS.