Radiological Alignment Research Articles

Clinical and radiological outcomes of surgically treated medial malleolus fractures in skeletally immature patients.

Medial distal tibial Salter-Harris Type 3 and Type 4 epiphyseal injuries, also known as McFarland fractures, pose significant risks due to their potential to damage the growth plate and cause long-term joint deformities. Surgical treatment is commonly performed to restore joint congruity; however, there is no clear consensus on whether surgical or conservative treatment yields better outcomes. This study aimed to evaluate the mid-term clinical and radiological outcomes of surgical treatment in patients with McFarland fractures. This retrospective study analyzed outcomes of 13 patients, aged 6-17 years, who underwent surgical treatment for McFarland fractures between 2021 and 2023 at a Level 1 Trauma Center. Surgical methods included screw fixation, K-wire fixation, and tension wire fixation. Outcome measures included radiological deformity assessments (lateral distal tibial angle [LDTA], anterior distal tibial angle [ADTA]), range of motion (ROM), Foot and Ankle Ability Measure (FAAM) scores for functional assessment, and Visual Analogue Scale (VAS) scores for pain. Comparisons were made between the operated and non-operated limbs. LDTA and ADTA values showed minimal differences between the operated and non-operated limbs, indicating successful surgical realignment (p<0.05). Although slight ROM limitations were observed in the operated limb, high FAAM scores and low VAS scores reflected good functional recovery and effective pain management. Correlation analysis revealed a moderate positive correlation (r=0.45) between FAAM scores and ROM, and a weaker correlation (r=0.32) between FAAM scores and radiological alignment. Surgical treatment of McFarland fractures resulted in favorable clinical and radiological outcomes, with minimal limitations in ROM and significant improvements in alignment and functional recovery. However, ongoing follow-up is essential, particularly in younger patients, to monitor and manage the risk of potential growth disturbances.

Correction of Ankle Malalignment in Severe Fibular Hemimelia.

Management of ankle joint deformity and instability are challenging issues in congenital fibular hemimelia (FH). This study aims to assess how much the SUPERankle procedure improves ankle alignment and provides durable ankle stability in patients with severe FH. Seventeen children aged 53.4±44.1 months with severe form of FH, equinovalgus foot deformation, ankle instability, and tibial curvature (Paley type IIIC), affecting 19 limbs, underwent the SUPERankle procedure. Foot and ankle position was evaluated clinically and radiologically before surgery, immediately after, and at follow-up of 63.0±19.7 months. Mechanical lateral distal tibial angle (mLDTA), tibiocalcaneal angle (mTCA), and tibiocalcaneal distance (mTCD) were measured on the AP radiograms, while the anterior distal tibial angle (mADTA) and lateral tibiocalcaneal angle (mLTCA) were measured on the lateral radiograms. Recurrences, additional procedures, and complications were documented based on medical records. Quality of life was evaluated with Limb Deformity-SRS questionnaire. On clinical examination, the normal tibia and ankle alignment, along with a plantigrade foot were achieved in all limbs after the first surgery. In 11 limbs (58%) this result was maintained at follow-up. Due to recurrence, additional procedures were necessary to provide durable ankle alignment in 7 limbs (37%), while in 1 limb (5%) the ankle joint remained in equinus at the last follow-up. Significant improvement of radiologic alignment was found in all parameters (preoperative vs. postoperative vs. FU) as follows-mLDTA: 71.4±11.2 versus 88.7±5.6 versus 88.1±2.7 degrees, P=0.0001; mTCA: 41.4±14.9 versus 8.7±8.4 versus 11.6±8.9 degrees, P=0.0001; mTCD: 22.3±7.9 versus 4.0±3.6 versus 7.7±6.5mm, P=0.0001; mADTA: 99.5±19.4 versus 82.3±4.2 versus 81.5±5.9 degrees, P=0.0002; mLTCA: 116.7±23.9 versus 95.8±11.7 versus 93.5±15.1 degrees, P=0.0002. The mean follow-up LD-SRS score was 4.03. In children with severe fibular hemimelia, the SUPERankle procedure provided clinically and radiologically fully corrected ankle joint and plantigrade foot, suitable for further lengthening procedure. The 40% rate of deformity recurrence was managed with additional surgical intervention to achieve a good clinical, radiologic, and functional outcome in 95% of children at 5-year follow-up. Level IV.

Coin in the Oesophagus Cloaked over the Other - A Rare Case Report.

Coins continue to be the most common foreign body that kids swallow, especially younger children. There are still extremely few documented instances of children ingesting several coins in the literature, making these occurrences uncommon. It is quite uncommon to see a case of multiple coin ingestion with perfect radiological alignment. This report describes a rare case of two coins lodged in the oesophagus at the same site and the steps taken for successful removal.

Comparing Multipin Clamps With Outriggers With Standard Clamps for Lower Extremity Periarticular External Fixation: Similar Radiographic and Clinical Outcomes.

Staged treatment of high-energy periarticular tibia fractures involves temporization with closed reduction and external fixation, aiming to provide early reduction and stabilization while mitigating soft-tissue complications. Various external fixator configurations exist, including those that use a "multipin" clamp capable of holding multiple pins but limiting pin placement to a single plane. The purpose of this study was to compare clinical and radiographic outcomes and associated costs of standard and multipin outrigger clamp constructs in tibial plateau and pilon fractures treated with temporary external fixation. We hypothesized that use of the multipin clamp may be associated with poorly aligned reductions and increased complication rates. A retrospective review of 100 patients with periarticular tibial plateau (AO/OTA: 41B/C) or pilon (43B/C) fracture at a Level 1 trauma center from 2014 to 2023 was conducted. Patient, injury, and complication characteristics were collected. Patients were categorized based on the external fixator clamp used: multipin (MP) or standard (S). Clinical outcomes and complication rates were assessed. Radiographic alignment was evaluated by the change in anterior and lateral distal tibial angles, and sagittal plane translation for pilon fractures, and medial and posterior proximal tibial angles for plateau fractures. 70 patients underwent standard (25 pilon, 45 plateau) and 30 multipin (10 pilon, 20 plateau) external fixation. MP and S groups showed no notable differences in demographics or injury characteristics. Both groups demonstrated comparable complication rates and radiological alignment outcomes, with no notable differences observed. MP constructs were more costly than standard systems. In this retrospective study of 100 patients, there was no difference in radiographic or clinical outcomes between the standard frame and multipin frame groups. Typical costs for the multipin frame constructs were $635 to $1249 more than the standard frame constructs.

Clinical and radiological outcome of extended lateral approach via epicondyle osteotomy in complex lateral tibia plateau fractures involving the central and postero-lateral segments

Clinical and radiological outcome of extended lateral approach via epicondyle osteotomy in complex lateral tibia plateau fractures involving the central and postero-lateral segments

EVALUATING THE EFFECTIVENESS OF PERCUTANEOUS PINNING VS. COLLES’ CAST IN UNSTABLE DISTAL RADIUS FRACTURES: A PROSPECTIVE ANALYSIS OF FUNCTIONAL AND RADIOLOGICAL OUTCOME

Objective: Distal radius fractures are among the most prevalent orthopedic emergencies, significantly impacting patient quality of life. This study aimed to compare the effectiveness of closed reduction with percutaneous pinning (CRPP) versus Colles’ cast application (CRCI) in managing unstable distal radius fractures. Methods: A prospective, randomized comparative study was conducted at the Department of Orthopaedic Surgery, Indira Gandhi Medical College and Hospital, involving 80 patients with unstable distal end radius fractures. Participants were systematically randomized into two groups for treatment with CRPP or CRCI. Functional and radiological outcomes were assessed using the Mayo Wrist Score, the Modified Gartland and Werley Scoring System, the Green and O’Brien Score, and Sarmiento’s Modification of lindstrom Criteria. Results: The study found significant improvements in radial length, radial inclination, and volar tilt in the CRPP group compared to the CRCI group. The CRPP group demonstrated superior radiological outcomes and functional recovery metrics, indicating enhanced effectiveness over CRCI in managing unstable distal radius fractures. Conclusion: Closed reduction with percutaneous pinning offers better radiological alignment and functional recovery than Colles’ cast application in the treatment of unstable distal radius fractures, suggesting it as a preferable treatment strategy.

A Prospective Randomized Study on Whether Computer Navigation Is Better Than Conventional Total Knee Replacement in Terms of Short-Term Functional and Clinical Outcomes.

Computer navigation results in better radiological alignment in total knee replacement (TKR). However, functional and clinical outcomes are equally good in conventional TKR. This study aims to compare the functional and clinical outcomes in patients undergoing navigated and conventional TKR. A prospective randomized study between navigated TKR (NKR/Group I) and conventional TKR (CKR/Group II) was carried out. Functional outcome was analyzed using the Oxford Knee Score (OKS) and Western Ontario and McMaster UniversitiesArthritis Index (WOMAC) score. Clinical outcome was evaluated as knee range of motion. Thirty-nine patients (68 knees) were randomized into two groups: I and II. The mean follow-up was 26 months. There was no statistically significant difference between the two groups with respect to knee range of motion, OKS, and WOMAC score at the final follow-up. We concluded that there is no difference in clinical and functional outcomes between navigated and conventional TKR.

Radiologic Alignment after Total Knee Arthroplasty.

Radiologic Alignment after Total Knee Arthroplasty.

Robotic-assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials

ObjectivesRobotic knee arthroplasty procedures have emerged as a new trend, garnering attention from orthopedic surgeons globally. It has been hypothesized that the use of robotics enhances the accuracy of prosthesis positioning and alignment restoration. The objective of this study was to provide a high-level, evidence-based comparison between robotic total knee replacements and conventional methods, focusing on radiological and functional outcomes.MethodsWe searched five databases from their inception until June 1, 2022, specifically targeting randomized controlled trials (RCTs) that compared the outcomes of robotic and conventional total knee replacements. We were interested in outcomes such as knee range of motion, clinical and function knee society scores, the Western Ontario and McMaster University score (WOMAC), the Hospital of Special Surgery score, complications, and radiological alignment. This review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guidelines. We assessed the risk of bias using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2).ResultsOur search returned seven RCTs suitable for our analysis, which included a total of 1942 knees; 974 of these knees were implanted using robotic arms while the remaining 968 utilized jig-based knee systems. Our findings indicated that robotic knees had significantly better post-operative anatomical (OR − 0.82; 95% CI, − 1.027 to − 0.58, p value < 0.00001) and mechanical restoration (OR − 0.95; 95% CI, − 1.49 to − 0.41, p value < 0.0006). While knee range of motion (OR − 2.23; 95% CI − 4.89–0.43, p value 0.1) and femoral prosthesis position (OR − 0.98; 95% CI, − 2.03–0.08, p value 0.07) also favored robotic knees, these differences did not reach statistical significance. Both clinical and functional outcomes, as well as the rate of complications, were found to be statistically similar between the groups undergoing robotic and traditional knee replacement surgeries.ConclusionThis meta-analysis indicates that robotic total knee replacements offer superior post-operative anatomical and mechanical alignment compared to conventional total knee replacements. Despite this, clinical and functional outcomes, as well as complication rates, were similar between the two. These findings should be considered in light of potential confounding factors. More randomized controlled trials with the latest robotic systems are needed to confirm any superior functional and clinical outcomes from robotic-assisted surgeries.Level of evidenceI.

Fracturing the Lateral Hinge Improves Radiographic Alignment and Does Not Affect Clinical Outcomes of the Minimally Invasive Akin Osteotomy.

Intraoperative fracture of the lateral cortex is common during Akin osteotomy. In a recent study, lateral cortex fracture did not impede healing or result in loss of correction in a combined cohort of open and percutaneous osteotomies stabilized by K-wire fixation. We hypothesize that undesired lateral cortex fracture will not affect radiographic correction and patient-reported outcomes in a percutaneous cohort stabilized by permanent, rigid screw fixation. Consecutive patients with hallux valgus who underwent first metatarsal osteotomy and percutaneous Akin osteotomy stabilized by permanent, rigid screw fixation between May 2020 and January 2022 were retrospectively reviewed. Patients were stratified based on fractured lateral cortex (FC) or its absence (nonfractured cortex [NFC]). Visual analog scale (VAS) and Foot Function Index (FFI) were used to assess pain and patient-reported outcomes at 1-year follow-up. Patients were polled for satisfaction at 1-year follow-up by yes/no survey. Ninety-eight patients (89% female) were reviewed (98 feet; 43 NFC, 55 FC). Mean age was 48.3 years (range, 18-83 years). Mean preoperative VAS score was 7.5 and 7.7 in NFC and FC groups, which significantly decreased to 0.6 (P < .01) and 0.6 (P < .01), respectively. Mean total FFI was 53.9 and 54.2 and decreased to 17.9 (P < .01) and 17.2 (P < .01) in the NFC group and FC group, respectively. Overall, 97.8% of the NFC group and 96.4% of the FC group reported satisfaction.Mean HVA improved from 27.2 (16-42) degrees to 10.7 degrees (4-12) postoperatively in the NFC group. And in the FC group, HVA improved from 29.3 (19-39) degrees to 7.1 (4-12) degrees postoperatively. Postoperative HVA was significantly lower in the FC group (P < .05). In an exclusively percutaneous surgical cohort with correction maintained by rigid screw fixation, fracture of the lateral cortex is associated with improved postoperative radiologic alignment without detriment to patient-reported outcomes. Level III, retrospective cohort study.

Repercusión de la alineación mecánica en el tiempo de supervivencia de prótesis total de rodilla primaria.

Introduction: Currently, there is no consensus among authors on how radiological alignment influences the survival of the primary total knee prosthesis implant. Methods: Retrospective study analyzing radiological measurements in the coronal and sagittal plane in patients who underwent primary total knee arthroplasty in our center who required revision surgery. Results: The percentage of cases within the correct angle range in the femoral component were 93.9% coronal, 69% sagittal, and in the tibial component 81.6% coronal, 85.7% sagittal. The mean mechanical alignment of the limb was 179º. Conclusion: Although there is a trend for the time interval between prosthesis implantation and revision surgery to be longer if these angles are within the range, mechanical alignment does not seem to influence survival time in our sample.

Suprapatellar intramedullary nail combined with screw fixation has comparable surgical outcomes to minimally invasive locking plate fixation in ipsilateral tibial plateau and shaft fractures.

To compare union rate, union time, alignment, and complication rate in ipsilateral tibia plateau and shaft fractures treated via suprapatellar intramedullary nailing with screw fixation and minimally invasive locking plate fixation. A retrospective study was conducted on 48 patients who underwent minimally invasive plate fixation (n = 35) or suprapatellar intramedullary nailing with screw fixation (n = 13), for the treatment of ipsilateral tibial plateau and shaft fractures with at least 1-year follow-up. Union rate, union time, radiologic alignment, and complication rate such as malalignment, nonunion, and fracture-related infection (FRI) were investigated. Demographic data were not different between the two groups. Coronal plane alignment was 0.17 ± 4.23 in the plate group and -0.48 ± 4.17 in the intramedullary nail group (p = 0.637). Sagittal plane alignment was -0.13 ± 5.20 in the plate group and -1.50 ± 4.01 in the suprapatellar intramedullary nail group (p = 0.313). Coronal and sagittal malalignment recorded equal results: (p > 0.99), FRI (p = 0.602), nonunion and union times recorded (p = 0.656) and (p = 0.683, 0.829), respectively, and showed no significant difference between the two groups. Suprapatellar intramedullary nailing with screw fixation had similar surgical outcomes with minimally invasive locking plate fixation in ipsilateral tibial plateau and shaft fractures in terms of union rate, union time, alignment, and complication rate. Thus, frequent use of intramedullary nailing combined with screw fixation is anticipated in patients with ipsilateral tibial plateau and shaft fractures when the soft tissue condition is not desirable. Level III.

Double coin ingestion in a child: a rare occurrence

Foreign bodies in the esophagus pose a common ENT emergency, often involving a single coin that typically passes without harm. However, the occurrence of paired coin foreign bodies is exceptionally rare. A notable case involves a 3-year-old child who presented to the ENT emergency department with sudden dysphagia and vomiting. A plain X-ray of the soft tissue in the neck and chest revealed a unique finding-a double circular opacity in the cervical esophagus, indicating the ingestion of two foreign bodies in perfect radiological alignment. Given the rarity of such cases, coupled with the challenges in diagnosis when a comprehensive history is unavailable, this instance stands out. The child underwent a rigid esophagoscopy under general anesthesia to address the situation. This case underscores the importance of considering uncommon scenarios in clinical practice and the necessity for thorough diagnostic approaches, especially in the absence of a detailed patient history. The presentation of dual foreign bodies in precise radiological alignment adds a layer of complexity to the diagnosis, highlighting the need for a nuanced and vigilant approach in managing such infrequent but potentially serious cases in the ENT emergency setting.

Comparison of Unilateral versus Bilateral Instrumented Transforaminal Lumbar Interbody Fusion in Lumbar Degenerative Diseases: A Minimum of 5-Year Follow-Up.

Background and Objective: There is a paucity of literature comparing unilateral instrumented transforaminal lumbar interbody fusion (UITLIF) with bilateral instrumented TLIF (BITLIF) regarding radiological alignment, including the coronal balance, even though UITLIF might have asymmetric characteristics in the coronal plane. This retrospective study aimed to compare the clinical and long-term radiological outcomes of 1-level UITLIF and BITLIF in lumbar degenerative diseases (LDD) including lumbar spinal stenosis with or without spondylolisthesis (degenerative or spondylolytic). Materials and Methods: Patients who underwent 1-level UITLIF with two rectangular polyetheretherketone (PEEK) cages or BITLIF between November 2009 and June 2016 by four surgeons with ≥5 years of follow-up at a single hospital were included. We compared the clinical and radiological outcomes between the UITLIF and BITLIF. Results: In total, 63 and 111 patients who underwent UITLIF and BITLIF, respectively, were enrolled. The median follow-up was 85.55 months (range: 60-130). The UITLIF group had a significantly shorter operation time (185.0 [170.0-210.0] vs. 225.0 [200.0-265.0], p < 0.001) and lower estimated blood loss (300.0 [250.0-500.0] vs. 550.0 [400.0-800.0], p < 0.001) than the BITLIF group. Regarding the clinical outcomes, there were no significant differences in the intermittent claudication score (p = 0.495) and Kirkaldy-Willis criteria (p = 0.707) at 1 year postoperatively. The interval changes in the local coronal Cobb angle at the index level, L1-S1 lordotic angle, and coronal off-balance from the immediate postoperative radiograph to the last follow-up were not significantly different (p = 0.687, p = 0.701, and p = 0.367, respectively). Conclusions: UITLIF with two rectangular PEEK cages may provide comparable clinical outcomes and radiological longevity including coronal alignment to BITLIF in 1-level LDD. In addition, UITLIF has advantages over BITLIF in terms of operative time and blood loss.

Early outcomes of the Exactech Vantage fixed-bearing total ankle replacement.

The Vantage Total Ankle System is a fourth-generation low-profile fixed-bearing implant that has been available since 2016. We aimed to describe our early experience with this implant. This is a single-centre retrospective review of patients who underwent primary total ankle arthroplasty (TAA) with a Vantage implant between November 2017 and February 2020, with a minimum of two years' follow-up. Four surgeons contributed patients. The primary outcome was reoperation and revision rate of the Vantage implant at two years. Secondary outcomes included radiological alignment, peri-implant complications, and pre- and postoperative patient-reported outcomes. There were 168 patients (171 ankles) included with a mean follow-up of 2.81 years (2 to 4.6) and mean age of 63.0 years (SD 9.4). Of the ten ankles with implant failure (5.8%), six had loosening of the tibial component. In the remaining four failed implants, one was due to periprosthetic joint infection (PJI), one was due to loosening of the talar component, and two were due to loosening of both the tibial and talar components. Seven patients underwent reoperation: irrigation and debridement for superficial infection (n = 4); bone grafting for cysts (n = 2); and open reduction internal fixation (n = 1). Asymptomatic peri-implant lucency/subsidence occurred in 20.1% of ankles, with the majority involving the tibial component (n = 25). There were statistically significant improvements in PROMs in all domains. Short-term results of this implant demonstrate early survival comparable to the reported survivorship of similar low-profile, non-stemmed implants. Radiological lucency occurred more commonly at the tibial component, and revisions occurred primarily due to loosening of the tibial component. Further research is needed to evaluate longer-term survivorship.

Which Knee Phenotypes Exhibit the Strongest Correlation With Cartilage Degeneration?

Although articular wear has been thoroughly investigated, the effects of abnormal limb alignment on cartilage degeneration over time remain poorly understood. An exact assessment of the correlation between lower limb alignment abnormalities and MRI-observed articular degradation may be helpful for understanding the progression of osteoarthritis and planning future treatment. In patients with moderate to advanced osteoarthritis, (1) is there a correlation between overall alignment of the knee and the location of cartilage degradation over time, as measured by cartilage metrics on MRI? (2) Is there a correlation between tibial alignment and the location of cartilage degradation over time, as measured by cartilage metrics on MRI? (3) Is there a correlation between femoral alignment and the location of cartilage degradation over time, as measured by cartilage metrics on MRI? Between April 2020 and September 2022, we retrospectively evaluated 3106 patients aged 45 to 79 years who were at risk of experiencing knee osteoarthritis. Of those, we considered as potentially eligible 600 symptomatic index knees with radiographic evidence of osteoarthritis-Kellgren-Lawrence Grades 2 or 3-at the baseline visit. Of those, 22% (134 of 600) were excluded because of a lack of proper alignment measurements, leaving 466 knees with measurements of radiologic alignment angles and quantitative MRI cartilage measurements of 16 subregions of the femorotibial compartment at baseline and 12 and 24 months, and 64 knees at the 48-month visit for investigation in the current study. Data regarding cartilage measurements of the patellofemoral compartment were not available for analysis. The knees were categorized into one of the possible 25 different phenotypes of the lower extremity established by previous research, based on the neutral, valgus, or varus distal mechanical angle of the femur and proximal tibial mechanical angle on full-limb radiographs. We applied ANOVA to estimate the effect size of the overall, femoral, and tibial alignments on the location of cartilage degradation over time, as measured by cartilage metrics on MRI. We found that the overall combinations of a valgus femur with valgus tibia or a valgus femur with varus tibia were associated with the highest loss of cartilage in the internal medial tibial subregion and anterior lateral tibial subregion (η 2 p = 0.39 and 0.17, respectively). For the tibia, we found that the combination of a valgus femur with valgus tibia was associated with an increase in the area of subchondral bone denuded of cartilage in the central lateral tibial subregion (η 2 p = 0.2). For the femur, we found that the combination of a valgus femur with valgus tibia was associated with loss of cartilage thickness in the central weightbearing lateral femorotibial compartment (η 2 p = 0.15). We found that certain alignment patterns are associated with rapid deterioration of cartilage and exposure of subchondral bone, even over short time periods. In particular, the valgus femur with valgus tibia and valgus femur with varus tibia phenotypes deserve special attention, because they exhibited a strong, atypical correlation with the internal medial tibial subregion and anterior lateral tibial subregion, respectively. This is important because valgus and varus malalignment cause isolated lateral and medial compartment disease, respectively. Therefore, these findings suggest that a more individualized approach for limb axis deformities is valuable, and hint at a more meticulous radiologic and clinical investigation, perhaps using different imaging modalities, especially when assessing the exact cartilage state and planning an intervention. Future studies, ideally biomechanical, might help in assessing the long-term effects of the various phenotypes on cartilage degradation and their relevance in reconstructive surgery. Level II, prognostic study.

Quality of life, functional and radiological outcomes of treatment of three-part and four-part proximal humerus fractures with locking plates and comparison in young versus older than 70years: a retrospective cohort study.

Verify if the use of locking plates in displaced three- and four-part proximal humerus fractures has meant an improvement even in patients over 70years of age. We performed surgery with locking plate fixation in 56 consecutive patients with three- and four-part proximal humerus fractures according to Neer's classification between 1/1/15 and 12/31/20 at our Hospital. Patient satisfaction, quality of life, functionality and radiological variables, as well as the comparison between patients older and younger than 70years were the main outcomes. Likewise, factors and complications that may have influenced these variables were analyzed as secondary outcomes. The analysis of all these variables was performed after a minimum follow-up time of 24months after surgery. 51 patients (92%) ended up satisfied or very satisfied according to the SF-36 test and with no disability or mild disability according to the DASH Score questionnaire. 46 patients (82%) obtained a satisfactory or excellent result according to the Neer scale modified by Cofield and 38 (68%) a good or excellent function according to the Constant Murley questionnaire. In 47 cases (84%) good radiological alignment was observed. Complications occurred in 20 patients (36%). The complications and the results of the SF-36, DASH Score, Neer scale modified by Cofield and Constant Murley tests depended on the radiological alignment (p = 0.009, p = 0.006, p = 0.025, p = 0.0008 and p = 0.0004). There were 37 patients younger than 70years and 19 older than 70years with no statistically significant differences when comparing the two groups. This study demonstrates that satisfactory results can be obtained with osteosynthesis with locking plates in displaced proximal humerus fractures even in patients older than 70years of age. Retrospective Cohort, Treatment Study.

Comparison of suprapatellar intramedullary nailing versus minimal invasive locked plating for proximal tibia fractures.

To compare the radiological alignment, union time, union rate, and complication rate between suprapatellar intramedullary nails and minimally invasive locking plate fixation in the treatment of proximal tibial fractures. We retrospectively analyzed 103 patients who underwent plate fixation (n = 50) or suprapatellar intramedullary nailing (n = 53) for proximal tibial fractures involving the meta-diaphyseal junction between November 2015 and October 2020 at our institution. The union rate, union time, radiologic alignments, and complications, such as malalignment, nonunion, and deep infection, were investigated. The demographic data did not differ between the plate and suprapatellar intramedullary nail groups. The alignment of the coronal plane was 0.24 ± 3.19 in the plate group and - 0.49 ± 2.22 in the intramedullary nail group (p = 0.196). Sagittal plane alignment was - 0.29 ± 4.97 in the plate group and 0.24 ± 4.12 in the intramedullary nail group (p = 0.571), and coronal malalignment (p = 0.196), sagittal malalignment (p = 0.57), deep infection (p = 0.264), nonunion (p = 0.695), union time (p = 0.329), and final union rate (p = 0.699) were not significantly different between groups. Compared with the minimally invasive locking compression plate group, the suprapatellar intramedullary nail group yielded comparable results in terms of radiological alignment and complications. Considering that proximal tibial fractures are associated with high-energy trauma and severe soft tissue damage, we believe that a suprapatellar intramedullary nail may be a good alternative. Level III.

Social determinants of outcomes in nonoperatively treated proximal humerus fractures

Social determinants of outcomes in nonoperatively treated proximal humerus fractures

Feasibility study of juxta-articular-type volar distal radius plate (ARIX Wrist System) for surgically treating marginal distal radius fractures

Feasibility study of juxta-articular-type volar distal radius plate (ARIX Wrist System) for surgically treating marginal distal radius fractures