Comparison of the clinical efficacy of full-endoscopic large-channel interbody decompression and fusion with unilateral versus bilateral pedicle-screw fixation in the treatment of lumbar degenerative disease.

AimsThis study aimed to evaluate the differences in postoperative internal fixation system failure between two distinct pedicle screw designs, and to examine how variations in the transitional segment and thread distribution of these screws influence the bending mechanical properties of the rod-screw system.MethodsA retrospective analysis was performed on 81 cases of thoracolumbar posterior internal fixation surgery from January 2020 to December 2023, focusing on comparing the postoperative fracture and loosening rates associated with the two pedicle screw designs. Finite element analysis was employed to assess the impact of different transitional segment and thread distribution designs of pedicle screws on stress distribution within the rod-screw system under physiological stress conditions in a T10-L2 fracture model. Dynamic and static bending performance tests were conducted on pedicle screws and rod-screw systems featuring various transition segment and thread distribution designs.ResultsThe clinical analysis revealed significant variations in postoperative fracture rates among rod-screw systems with different pedicle screw designs (p < 0.05), while the rates of loosening remained largely consistent postoperatively. Finite element analysis and mechanical testing demonstrated that extending the transitional segment can mitigate the maximum stress across the entire rod-screw system and enhance the uniformity of stress distribution. This modification improves the bending performance of the pedicle screw and its rod-screw system, shifting the failure point from the pedicle screw to the connecting rod. Conversely, variations in thread distribution design exhibited minimal impact on the stress distribution and bending performance of the entire rod-screw system.ConclusionPedicle screws with optimally extended transitional segments can effectively alleviate local stress concentrations and enhance the bending performance of the screw and its rod-screw system, thereby reducing the risk of postoperative screw fracture.Cite this article: Bone Joint Res 2026;15(4):383–396.

Clinical Outcome of Transpleural Extreme Lateral Interbody Fusion Combined with Posterior Open Internal Fixation for the Treatment of One-Segment Thoracic Spondylodiscitis.

Background: The proximal humerus fractures are becoming quite frequent, especially among the aging population, and are linked with considerable functional disability. Locking compression plate (LCP) fixation has been popular because it provides angular stability, particularly in osteoporotic bone. Nonetheless, the inconsistency of the functional results and the occurrence of complications make it necessary to further assess them in clinical practice. Objective: To compare the functional and radiological results of locking compression plate fixation in adult patients with proximal humerus fractures. Methods: It was a prospective observational study that was carried out at General Hospital, Lahore, Pakistan, between March 2023 and February 2025. Ninety-two patients (80 adults) were involved in the study with a displaced proximal humerus fracture (Neer 2-, 3-, and 4-part). Open reduction and internal fixation surgery was performed in the case of fractures using a locking compression plate. Constant-Murley Score (CMS) and DASH score were used to determine functional outcomes, whereas fracture union and time to healing were used as radiological outcomes. The data were measured with SPSS 26, and the p-value was taken to be 0.05. Results: The average age of patients was 56.3 ± 11.8 years, and there was an overrepresentation of males (58.8%). The rate of radiological union was 93.8% with an average healing time of 15.2 ± 2.9. There was a great improvement in functional outcome, where CMS rose by 31.8 ± 5.9 at 6 weeks to 76.4 ± 8.6 at 6 months (p &lt; 0.001). The complications were reported in 18.7% of patients, as usual, shoulder stiffness. Conclusion: The fixation of proximal humerus fractures with locking compression plates is a good method that ensures an effective fracture union and a considerable functional restoration of the situation in simpler fractures.

The study aimed to compare the effectiveness of low-molecular-weight heparins (LMWH) followed by Rivaroxaban with no anticoagulant treatment in preventing deep vein thrombosis (DVT) after open reduction and internal fixation surgery (ORIF) for posterior cruciate ligament (PCL) avulsion fractures. This quasi-experimental study enrolled 37 patients with posterior cruciate ligament (PCL) avulsion fractures. Following surgery, four patients were excluded for not meeting the inclusion criteria, and the remaining 33 participants were allocated into Group A (n = 16) and Group B (n = 17). Surgical methods involved standard open reduction and internal fixation surgery (ORIF) protocols and anatomical alignment restoration using absorbable Bone Anchor Nails. Group A received prophylactic anticoagulation with LMWH followed by Rivaroxaban, while Group B did not received any anticoagulant. All patients received standard postoperative care included standardized rehabilitation protocols and monitoring for DVT using Color Doppler Ultrasound examinations. Patients underwent follow-up ultrasound examinations at 7 days and 1-month post-operation to assess DVT presence and condition. This comprehensive methodology allows for a thorough evaluation of the efficacy and safety of prophylactic anticoagulation in patients with PCL avulsion fractures and complications were observed between the two groups. The study included 33 patients who had undergone surgical treatment for PCL avulsion fractures, divided into Group A (LMWH followed by Rivaroxaban) and Group B (No anticoagulant treatment). No statistically significant differences were observed in the demographic and preoperative laboratory data between Group A (LMWH followed by Rivaroxaban) and Group B (no anticoagulation). Postoperatively, ESR, CRP, ALB, and Hb levels showed no significant differences between the two groups (P > 0.05). At 1 month postoperatively, the overall incidence of DVT was significantly lower in Group A (6.25%) than in Group B (35.29%) (P = 0.041). The percentage of DVT-free patients was 93.75% in Group A and 64.71% in Group B (P = 0.041). During the first seven postoperative days, the DVT incidence was 6.25% in Group A and 17.65% in Group B (P = 0.316), with a higher percentage of DVT-free patients in Group A (P = 0.041). From day 8 to 1 month postoperatively, no DVT cases were detected in Group A, while the incidence in Group B was 21.43% (P < 0.01). LMWH followed by Rivaroxaban significantly reduced DVT after PCL avulsion surgery. In addition, the D-D levels postoperatively were lower in the group of LMWH followed by Rivaroxaban group at 7 and 10 days after the operation. As for other inflammatory markers, there was no significant difference between the two groups. The reduction in DVT risk and D-Dimer levels suggests that the LMWH-rivaroxaban regimen may offer a clinically beneficial approach to anticoagulation therapy in patients undergoing PCL avulsion surgery.

Background: Patients undergoing open reduction and internal fixation surgery frequently opt for spinal anesthesia, which preserves intraoperative consciousness. This conscious state may trigger significant anxiety during surgical procedures. Despite the clinical relevance of this phenomenon, intraoperative anxiety among conscious patients remains under-recognized in Chinese surgical populations. Many scholars have conducted extensive research on preoperative and postoperative anxiety levels. However, a study on the level of intraoperative anxiety and its’ related factors is still lacking. This knowledge gap motivated the current investigation. Objectives: To examine the level of intraoperative anxiety and the relationship between gender, age, waiting time, surgical time and intraoperative anxiety among patients with closed-leg fracture undergoing conscious surgery. Methods: A total of 112 participants were recruited during February 2025 to April 2025 by selecting samples as per the inclusion criteria and using random sampling. Research instruments include the demographic questionnaire and the Visual Analog Scale for Anxiety (VAS-A). Data were analyzed using descriptive statistics, the independent t test, and the Pearson correlation coefficient. Results: The mean (SD) intraoperative anxiety was 6.3 (2.2), which indicates a clinically-relevant level of anxiety. There was a significant difference in the experience of intraoperative anxiety between female and male patients (t = -3.92, P &lt; .001). Age, waiting time, and surgical time had a positive correlation with intraoperative anxiety among the patients undergoing conscious surgery (r = 0.221, P &lt; .05; r = 0.307, r = 0.346, P &lt; .001, respectively). Conclusions: The findings provide a reference for healthcare providers to better understand the factors contributing to intraoperative anxiety of patients with closed-leg fracture undergoing conscious surgery, allowing for early identification of high-risk individuals, and targeted interventions, thereby preventing and alleviating intraoperative anxiety, reducing anxiety-related physiological response, minimizing complication risk, and promoting postoperative recovery.

BackgroundSpinal tuberculosis remains a significant clinical challenge in high-prevalence regions. Despite advances in medical treatment, surgical interventions, such as debridement, decompression, and fusion, are often required, but their complexity increases perioperative morbidity and prolongs hospitalization. Identifying preoperative predictors of extended hospital stay may improve patient management and resource allocation.MethodsIn this retrospective study, 256 patients with confirmed spinal tuberculosis who were treated between January 2021 and December 2024 were included. Prolonged hospitalization was defined as a postoperative stay > 21 days. Univariate and multivariate logistic regression analyses were performed, and significant predictors were integrated into a nomogram. Model performance was evaluated by receiver operating characteristic (ROC) analysis, calibration plots with bootstrap resampling, and decision curve analysis (DCA).ResultsThe patients were divided into a modeling group (n = 170) and a validation group (n = 86). Baseline characteristics were comparable between groups. Multivariate analysis identified increasing age (OR 1.042, 95% CI 1.013–1.071, P = 0.005), concomitant TB at other sites (OR 2.875, 95% CI 1.168–7.100, P = 0.022), and a higher preoperative American Society of Anesthesiologists score (OR 1.537, 95% CI 1.010–2.340, P = 0.046) as independent predictors of prolonged hospitalization. The nomogram demonstrated good discriminative ability (AUC: 0.771 and 0.718) and satisfactory calibration (corrected C index 0.787; Hosmer–Lemeshow P = 0.895). DCA confirmed its clinical utility.ConclusionsAdvanced age, extra-spinal TB involvement, and elevated preoperative ASA score are significant predictors of prolonged hospitalization after spinal TB surgery. The developed nomogram is a practical tool for preoperative risk assessment, warranting further prospective multicenter validation.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40001-025-03805-8.

BackgroundRevision surgery for femoral peri-trochanteric fractures is a complex and high-risk intervention. This study aimed to systematically examine the multifaceted etiologies of primary internal fixation failures, classify them into distinct categories, and develop tailored revision strategies to enhance overall management and optimize clinical outcomes in peri-trochanteric fracture cases.MethodsWe conducted a retrospective study of 141 peri-trochanteric fractures with failed internal fixation surgery between 2013 and 2023. The cohort comprised 87 males and 54 females, with a mean age of 60.34 ± 16.02 years. Of these, 96 were intertrochanteric fractures classified by the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (AO/OTA) system (28 type A1, 20 type A2, and 48 type A3), and 45 were subtrochanteric fractures classified by the Seinheimer system. We conducted an in-depth analysis of failure mechanisms and subsequently categorized the patients into four groups, each with distinct revision procedures.ResultsThe average follow-up time was 15.96 ± 5.61 months. The joint replacement group had a significantly higher mean age (72.13 ± 13.00 years) than the revision internal fixation group (P < 0.05). The average revision surgery duration was 143.06 ± 57.29 min, with the joint replacement group having significantly shorter operation times (107.50 ± 41.40 min, P < 0.01), which were comparable to those of the type I revision group. Intraoperative blood loss averaged 344.26 ± 335.43 ml, with the type I and joint replacement revision group showing the least blood loss (P < 0.01). The mean healing duration was 7.08 ± 3.33 months. Harris hip scores improved from 24.78 ± 6.08 pre-operatively to 80.59 ± 4.54 post-operatively. Patients who underwent type IV revisions had significantly lower scores (P < 0.05).ConclusionsWe classified peri-trochanteric fracture surgical failures into four distinct categories based on age, presence of infection, integrity of the femoral head and acetabulum, varus deformity, and implant condition. We developed detailed diagnostic and treatment protocols for each category. Adhering to our established protocols, the imaging results and functional scores of all patients were consistently favorable. Our comprehensive treatment strategy can serve as a critical reference for standard revision procedures in the management of peri-trochanteric fractures.

Objective: To analyze the combined application effects of the joint line incision approach, precise pre-bent plates via three-dimensional reconstruction of the proximal tibia in vitro, and transparent retractors in the clinical treatment of Schatzker types III to VI tibial plateau fractures, and their impact on the functional recovery of the knee joint. Methods: A retrospective analysis was conducted on the surgical treatment outcomes of 28 patients with tibial plateau fractures admitted from January 2023 to January 2025. All patients underwent internal fixation surgery via the joint line incision approach after admission, with the combined use of precise pre-bent plates via three-dimensional reconstruction of the proximal tibia in vitro and transparent retractors for auxiliary treatment during surgery. Surgical treatment indicators, treatment outcomes, and the occurrence of complications were analyzed. Knee joint range of motion and knee joint function scores [New York Special Surgery Hospital Score (HSS), International Knee Documentation Committee Score (IKDC)] were compared before and after surgery. Results: At six months post-surgery, the overall excellent and good reduction rate of tibial plateau fractures in 28 patients was 89.29%. The overall incidence of surgical complications within six months post-surgery was 14.29%, with no cases of severe complications observed. The average surgical duration was 145.32 ± 15.07 minutes, the average intraoperative blood loss was 53.52 ± 6.71 ml, and the average time to fracture healing post-surgery was 14.65 ± 2.21 weeks. Compared to pre-surgery, the range of motion of the knee joint, as well as the HSS and IKDC scores of the knee joint, significantly increased at three and six months post-surgery, with statistically significant differences (P &lt; 0.05). Conclusion: The application of three-dimensional reconstruction-based precise pre-bent plates for the proximal tibia and fluoroscopically visible retractors in internal fixation surgery via a joint line incision approach for patients with Schatzker type III–VI tibial plateau fractures can actively enhance surgical efficiency and the effectiveness of internal fixation. Additionally, it can assist in optimizing postoperative fracture reduction and the rehabilitation of knee joint function in patients.

Introduction: Although internal fixation surgery of displaced ankle fractures is amongst the most commonly performed operations, there is little published on long-term outcomes. The true incidence of posttraumatic osteoarthritis (PTOA) requiring further intervention is not well known. This study aims to establish the incidence of complications and long-term outcomes, specifically the development of arthritis. Furthermore, it aims to determine the effect of patient characteristics on these outcomes. Method: All patients who underwent ankle fixation at Glasgow Royal Infirmary between January 2009 and December 2010 were retrospectively identified through our departmental database. Patient demographics, comorbidities and complications including infection, non-union, further surgery, and development of PTOA were recorded. Two proportion hypothesis testing was used to establish whether patient characteristics affected outcomes. Results: 330 patients underwent ankle fixation surgery during the study period. There was a 1.2% and 1.5% incidence of superficial and deep infection respectively. Revision fixation surgery was necessary in 5/330 patients (1.5%), however 21.5% underwent further surgery including removal of metalwork. The latest clinical information showed 3.6% (12/330) developed PTOA and only 5 required surgeries including 3 ankle fusions. There was a statistically significant increase in the rate of delayed unions (P=0.041) in smokers. There was also a higher rate of deep infection, delayed union and revision surgery in diabetic patients and a higher rate of PTOA and requirement for surgical management of PTOA in overweight patients, although these did not reach statistical significance. Conclusion: Our results show that internal fixation surgery for ankle fractures is associated with low incidences of both short-term complications and development of arthritis in the long-term. In our study, smokers had higher rates of delayed union but there was no significant correlation between patient characteristics and comorbidities on other outcomes.

This study aims to introduce an innovative technique for placing pedicle screws in patients with extremely small lumbar pedicles using an oblique view from a C-arm x-ray machine, achieving a comparable gripping force to conventional implanting for the treatment of thoracolumbar vertebral fractures. A retrospective analysis was conducted on 11 patients with extremely small lumbar pedicles and thoracolumbar vertebral body fractures. The height of the vertebral body and Cobb angle were measured on computed tomography radiographs, and comparisons were made between pre- and postoperative values. Scores from the visual analog scale, Oswestry Disability Index, and Short Form-36 were recorded to evaluate the surgical outcomes. All patients successfully underwent the surgery without intraoperative complications such as pedicle collapse, cerebrospinal fluid leakage, or nerve damage. The height of the anterior margin of the vertebral body and the compression rate of the anterior margin of the injured vertebrae showed significant improvement, as did the Cobb angle, with statistically significant differences (P < 0.05). The patients' visual analog scale, Oswestry Disability Index, and Short Form-36 scores were all significantly reduced compared to preoperative levels (P < 0.05). All cases demonstrated excellent reconstruction and maintenance of spinal stability, with the longest follow-up reaching 2 years postoperatively. No issues such as screw loosening or extraction were observed during this period. The C-arm x-ray machine oblique radiograph-assisted external pedicle implanting approach offers a simple, accurate, and safe alternative for internal fixation surgery in patients with extremely small lumbar pedicles, without the need for an O-arm navigation system. This retrospective cohort study confirms that the technique is a highly effective modality for managing thoracolumbar vertebral fractures with extremely narrow lumbar pedicles, reliably restoring and maintaining spinal stability, and thus offering a novel therapeutic option for clinicians.

Minimally invasive stabilization of osteoporotic fractures of the posterior pelvic ring to ensure rapid and low-pain mobilization and timely fracture healing while avoiding progressive fracture instability. Primarily unstable osteoporotic fractures of the posterior pelvic ring, in particular sacroiliac fracture dislocations (OF5) and bilateral sacral fractures (OF4), unilateral sacral fractures (OF3) in constellations indicating ahigher degree of instability. In addition to the type of fracture, important clinical parameters and modifiers that indicate greater instability should be taken into account when deciding on treatment options. An important aid for decision-making is the OF Pelvis Score, in which ascore above 8indicates surgical treatment. Major soft tissue damage, decubital ulcers or infections at the surgical site; voluminous implants or defect zones/osteolysis in the transiliac screw corridor; sacroiliac dislocation fractures with alarge crescent fragment, which are treated similarly to iliac fractures; high degree of vertical instability with the need for spinopelvic support. Fluoroscopically assisted minimally invasive implantation of long large-caliber polyaxial screws in both transiliac screw corridors, subfascial insertion of aconnecting rod, fixation on both sides with set screws. Rapid mobilization with weight-bearing as tolerated (WBAT). Between 5/2024 and 3/2025, 10patients underwent transiliac internal fixation (TIFI) surgery for unstable fractures of the posterior pelvic ring: in 8cases alone and in the remaining 2cases in combination with osteosynthesis of the anterior pelvic ring. In 1patient, the wound had to be revised due to asuture granuloma, otherwise there were no complications requiring revision. In all cases, postoperative computed tomography (CT) imaging confirmed the correct position of the implant. Stabilization of the posterior pelvic ring using TIFI is aminimally invasive, safe and highly stable osteosynthesis with arelatively simple surgical technique.

Background: Preoperative group and save (G&S) testing is routinely ordered for patients undergoing ambulatory peripheral limb orthopedic trauma procedures due to anticipated perioperative blood loss. However, national and local guidance on this protocol is often ambiguous, leading to potentially unnecessary testing with associated economic and environmental costs.​ This study aimed to determine the incidence of red cell transfusion in adult patients undergoing ambulatory peripheral limb trauma surgery, quantify the prevalence of preoperative G&S testing, and identify patient and procedural factors associated with the ordering of G&S tests.Methods: This retrospective cohort study included all adult patients undergoing ambulatory orthopedic procedures (open reduction internal fixation and K-wire surgeries) distal to the shoulder and knee joints at a single NHS trust over a 12-month period (July 2024-July 2025). Data collected included patient demographics, incidence of G&S testing, and perioperative red cell transfusion rates. Statistical analysis used univariable and multivariable models to identify predictors of G&S testing.Results: A total of 459 patients (mean age 50.4+/-19.5 years), 157 (34.3%) had a G&S test performed, resulting in a total of 315 samples. The ankle was the site with the most frequent G&S testing (n=43, 62.6% of ankle procedures). American Society of Anaesthesiologists (ASA) grade 2 was the most frequent ASA grade (n=227, 49.5%). Mean preoperative hemoglobin was 132.1±18.3 g/L. One patient (0.21%) received a preoperative transfusion for pre-existing anemia.No patients received a postoperative red cell transfusion. Multivariable logistic regression found no clinical significance between demographics and the likelihood of G&S testing. Poisson regression analysis found that upper limb procedures were associated with significantly fewer tests (incidence rate ratio (IRR)=0.20, p=0.009), while higher ASA grade (p=0.024) and procedures involving the humerus/shoulder (IRR=3.0, p=0.037) were associated with increased G&S testing.Conclusion: This study demonstrates that routine preoperative G&S testing is not clinically required for many patients undergoing ambulatory peripheral limb orthopedic trauma surgery. Current testing practices, influenced by procedural site and patient comorbidity (ASA grade), contribute to a significant and unnecessary economic and environmental cost. Implementing a selective, risk-based institutional protocol is necessary to align practice with evidence, improve cost-effectiveness, and enhance the sustainability of orthopedic surgical care.

BackgroundThis study investigated the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative recovery in patients undergoing internal spinal-fixation surgery.MethodsSeventy-four patients scheduled for elective internal spinal fixation surgery at the First People's Hospital of Pinghu City between August 2024 and April 2025 were enrolled. Patients were aged 19–78 years, of either gender, with American Society of Anesthesiologists class II or III and a body mass index of 17–33 kg/m2. They were randomly assigned to a TEAS-assisted general anaesthesia group (Group T) or a general anaesthesia-only group (Group G) using a random number table, with 37 patients per group. In Group T, TEAS was initiated 30 min before anaesthesia induction. The Neiguan, Hegu, and Ashansanli acupoints were electrically stimulated at a frequency of 2 Hz/100 Hz and an intensity of 8–12 mA, continuing until completion of incision suturing. In Group G, electrode pads were placed at the same acupoints, but no electrical stimulation was administered. The primary outcome was Quality of Recovery-15 (QoR-15) scores at 24 h postoperatively. The secondary outcomes were intraoperative remifentanil and propofol dosages, QoR-15 scores at 72 h postoperatively, time to first postoperative analgesic pump use, and total opioid consumption during the 72 h postoperative period. Other outcomes were length of hospitalization, satisfaction scores at discharge, and incidence of adverse events during hospitalization.ResultsGroup T had significantly higher QoR-15 scores at both 24 h and 3 d postoperatively, lower intraoperative remifentanil consumption, longer time to first postoperative use of the analgesic pump, lower opioid consumption during the 72 h postoperative period, and higher satisfaction scores at discharge (P < 0.05), than Group G.ConclusionsTEAS improves the quality of postoperative recovery in patients undergoing internal spinal-fixation surgery.Trial registrationITMCTR2025000399. http://itmctr.ccebtcm.org.cnSupplementary InformationThe online version contains supplementary material available at 10.1186/s12871-025-03400-8.

Functional Electrical Stimulation Combined with Therapeutic Exercise in the Strengthening Phase of Rehabilitation of Distal Forearm Fractures Following Open Reduction Internal Fixation Surgery: a Randomized Controlled Trial

BackgroundClosed reduction and internal fixation is the key to early and minimally invasive treatment of pelvic fractures in patients with severe trauma. Although the pelvic unlocking closed reduction device has been promoted to a certain extent, the therapeutic effect and surgical strategies for treating severe trauma have not been clearly clarified. Our study was aimed to explore the therapeutic effect and surgical strategy skills of the pelvic unlocking closed reduction device in treating severe traumas combined with pelvic fractures.MethodsData were retrospectively collected from 13 patients with severe traumas undergoing pelvic unlocking closed reduction for pelvic fractures in our hospital between July 2021 and December 2022. Seven males and six females aged 48(18~69), 46.4±16.7 years were involved. The operation time, times of fluoroscopy, and blood loss were recorded intraoperatively. Postoperative complications, and fracture healing time were recorded. The Matta and Majeed scales were used to evaluate fracture reduction and clinical efficacy respectively.ResultsThe time from injury to surgery was 7(4~14), 8.2±3 days. No wound infection, loosening or breakage of internal fixation, or loss of reduction occurred. The clinical healing time was 3(3~5), 3.5±0.7 months. Three cases suffered paresthesia on unilateral anterolateral thigh. According to the postoperative imaging Matta scores, 12 cases were excellent and 1 case was good, with an excellent rate of 12/13. At the last follow-up, the Majeed functional scores were excellent in all 13 cases.ConclusionsFor patients with severe trauma combined with pelvic fracture, the pelvic unlocking and reduction device can be used for minimally invasive internal fixation at an early stage as long as their vital signs are stable. In this study, we summarized and advocated the 'turn-back order' reduction and internal fixation philosophy of 'posterior-ring unlocking - anterior ring to posterior ring reduction stabilization - posterior ring to anterior ring internal fixation placement' in pelvic closed reduction and internal fixation surgery.

The treatment of severe mandibular comminuted fractures in children is a challenge. It usually requires open reduction and internal fixation. However, there is no consensus on whether the use of titanium plates will hinder the development of the mandible. This study shows that titanium plates do indeed limit the growth of the mandible. A 4-year-old boy with a comminuted mandibular fracture underwent open reduction and internal fixation surgery. The displaced lingual bone blocks were reduced and fixed. The patient had bilateral submandibular fistulas and local titanium plate exposure in the mandibular vestibular groove for up to 3 months. The titanium plates were removed 3 months after surgery. A large area of bone defect was observed on the labial side of the mandible, which was previously covered by the titanium plates, with uneven cortical bone. After removing the titanium plates, the wounds gradually healed. During the 2-year follow-up, it was observed that the mandibular morphology had recovered well, and the cortical bone was smooth. After the restriction of the titanium plates was lifted, the growth of the mandible was rapidly restored. The presence of titanium plates affects wound healing and limits the growth of the mandible. Metal internal fixation materials need to be removed in a timely manner to avoid hindering the growth and development of the jawbone.

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Tourniquet use during surgery has been thought to yield shorter operating times, reduced bleeding, diminished total blood loss, and enhanced visibility and surgical precision. Despite these proposed benefits, tourniquet use has been linked to complications including nerve damage and postoperative pain. Therefore, an increase in pain following tourniquet use could potentially lead to increased opioid use postoperatively. Additionally, various anesthesia types including regional anesthesia use have the potential to affect postoperative pain and therefore opioid consumption. The purpose of this study was to assess if tourniquet use and anesthesia type are associated with increased postoperative opioid consumption after open reduction and internal fixation (ORIF) surgery of tibial plafond (pilon) fractures. Methods: A retrospective chart review at a level one trauma center was conducted using Current Procedural Terminology codes to identify patients with isolated pilon fractures who underwent open reduction and internal fixation surgery from January 2019 to June 2023. Patient demographic data, tourniquet use, location, and inflation time, anesthesia type, regional anesthesia use/type, and ambulatory opioid prescriptions converted to morphine milligram equivalents (MME) were collected. Prescriptions were tracked from discharge until prescription cessation or complication surgery. Polytrauma patients and patients under 18 years old were excluded. Independent T-test, Mann-Whitney U test, and Fisher’s exact test were used as appropriate. A multiple linear regression model was employed with the natural logarithm of MME as the dependent variable for both the tourniquet and non-tourniquet groups and the tourniquet-only group to achieve normality and constant variance assumptions. A significance level of &lt; 0.05 was used to determine statistical significance. Results: The regression model (n = 71) demonstrated a poor overall fit (R2 = 0.13), suggesting that only 13% of the variance in log-transformed MME is explained by the model. The F-statistic was 1.016 (p = 0.438) indicating that the model was not statistically significant overall. Thus, the model did not effectively clarify the relationship between MME and key predictors. While the analysis suggested possible associations – such as higher MME in males, a history of prior opioid use, and the presence of a tourniquet – these findings were not statistically significant. Similarly, a regression analysis of the tourniquet-only group (n = 53) also yielded a poor model fit (R2 = 0.13) with no statistically significant associations including between MME and tourniquet location or inflation time. Conclusion: The results of this study demonstrated no significant association between tourniquet use or anesthesia type and ambulatory opioid consumption after ORIF of pilon fractures. Tourniquet location and inflation time, general anesthesia type, and regional anesthesia use/type were all not significantly associated with increased post-discharge opioid use. These findings can therefore support surgeon preference for tourniquet and anesthesia use during isolated pilon fracture surgeries.

Reducing proton pump inhibitors overuse with an advisory, risk-based, context-aware electronic alert system: A controlled interrupted time series analysis.

To evaluate the clinical efficacy of the Rossum Robot in assisting full-process closed reduction and internal fixation for low-energy osteoporotic unstable pelvic fractures in elderly patients. We performed a retrospective analysis of the clinical data of 37 patients with osteoporotic unstable pelvic fractures due to low-energy trauma, who underwent robotic reduction and internal fixation surgery between October 2023 and May 2024. Eighteen patients underwent Rossum Robot-assisted full-process closed reduction and internal fixation (RoRobot group), while 19 patients underwent percutaneous screw fixation with TiRobot assistance (TiRobot group). We compared the excellent and good rate of fracture reduction (EGR), the accuracy of screw placement (ASP), and the degree of fracture healing between the two groups. Efficacy indicators included changes in the Visual Analogue Scale (VAS) for pain and the Majeed score at preoperative, 1-week, 1-month, 3-month, and 6-month follow-ups. Statistical correlations were assessed using independent t-tests, chi-square tests, and non-parametric tests. The EGR in the RoRobot assistance group was significantly higher than that in the control group (P = 0.019). No significant difference was observed in fracture healing between the two groups post-surgery (P = 0.157). No significant difference was found in ASP between the RoRobot and TiRobot assistant groups (P = 0.619). No significant difference was observed in the preoperative VAS and Majeed scores between the two groups (P = 0.611, P = 0.939). Both groups showed significant improvement in VAS scores post-surgery. One week and one month after surgery, the VAS score in the RoRobot assisted group was significantly lower than in the TiRobot assisted group (P = 0.000, P = 0.001). Majeed scores significantly increased in both groups post-surgery, and during multiple follow-ups within six months, the RoRobot assisted group showed significantly higher Majeed scores than the TiRobot assisted group. In elderly patients with osteoporotic unstable pelvic fractures resulting from low-energy injuries, Rossum robot-assisted pelvic fracture closed reduction and internal fixation surgery leads to less tissue damage, more effective fracture reduction, better postoperative pain relief, and faster recovery compared to TiRobot-assisted internal fixation surgery.