Open Reduction Research Articles

Surgical intervention for distal radial fractures with concurrent ulnar styloid fractures may be beneficial for the elderly patients: a retrospective study

BackgroundDistal radius fractures are highly prevalent among older adults. Ulnar styloid fractures frequently accompany distal radius fractures, raising concerns about treatment outcomes due to the risk of distal radioulnar joint (DRUJ) instability. This study investigated the necessity of surgical intervention (open reduction internal fixation; ORIF) for distal radius fractures in very old patients with coexisting ulnar styloid fractures.Materials and methodsA retrospective analysis of 96 patients aged ≥ 80 years with AO classification 23-A2 to 23-B3 distal radius fractures with concomitant ulnar styloid fracture between 2019 and 2022 was performed. Patients were excluded if they were aged < 80 years, had a preinjury Barthel index of < 90, or had high-energy multiple trauma. The primary outcome was the Disabilities of the Arm, Shoulder, and Hand (DASH) score assessed at 3, 6, and 12 months. We compared the DASH score and their trajectories between the ORIF and conservative treatment groups.ResultsORIF group demonstrated significantly better DASH functional scores (25.31 ± 4.71) at the 12-month follow-up compared with the conservative group (34.42 ± 8.03; p < 0.001). Treatment choice was identified as a significant predictor of DASH scores at 12 months, with ORIF significantly improved patient’s wrist function and demonstrated a β coefficient of − 9.11 (95% confidence interval: −11.95 to − 6.27, p < 0.001). The other factors investigated, namely age, lowest T-score, and medical history of diabetes mellitus, hypertension, coronary artery disease, cerebrovascular accidents, cancer, and dementia, did not exhibit a significant association with the 12-month DASH scores in the adjusted model (p > 0.05).ConclusionsOur findings suggest that very old patients with distal radius fracture accompanied by ulnar styloid fractures may benefit from ORIF to achieve optimal long-term functional recovery.

Functional Outcomes of Clavicle Open Reduction and Internal Fixation (ORIF)

Functional Outcomes of Clavicle Open Reduction and Internal Fixation (ORIF)

Ring Opening Reduction of Cyclic Anhydrides Catalyzed by Tris(pentafluorophenyl)borane Using Hydrosilanes as a Hydride Source.

Hydrosilanes are widely used as reducing agents in the reduction of carbonyl groups, and various catalysts have been developed for the activation of hydrosilanes, the majority of them being transition metal-based. A main-group-based Lewis acid tris(pentafluorophenyl)borane (BCF) has gained increasing attention due to its Lewis acidity and versatility, along with being nonmetal. Herein, we describe the BCF-catalyzed ring opening reduction of cyclic anhydrides using hydrosilanes as a source of hydrides. The reduction affords unsymmetrical bis(silyl) protected hydroxy acids, leading to an efficient way for the synthesis of silyl ester functionalities. The capability of forming protected hydroxy acids under mild conditions with high yields in one step is also advantageous. A range of hydrosilanes and cyclic anhydrides can be employed with quantitative conversion, high yields, relatively fast reaction time, and mild reaction conditions. NMR spectroscopy is used in the characterization of the products, along with gaining insight into the potential mechanism.

Outcomes of Surgical Repair of Adult Naso-Orbital-Ethmoid Fractures: A Systematic Review and Meta-Analysis.

Adult naso-orbital-ethmoid (NOE) fractures are estimated to account for 5% of all adult facial fractures without published consensus on management. The purpose of this investigation was to assess the available literature regarding the treatment and outcomes of adult naso-orbital-ethmoid fractures. Cochrane Library, PubMed, Scopus, and CINAHL. Following PRISMA guidelines, databases were searched from inception through July 25, 2024 for studies pertaining to the treatment of NOE fractures. Measures of interest included patient demographics, associated fractures, type of intervention, and complications. A total of 16 studies were included for meta-analysis, consisting of 459 patients. The patients included in the analysis had a mean age of 30.6 years (95% CI: 26.9-34.3 years) with a male-to-female gender ratio of 2.7:1. Operative intervention, specifically open reduction and internal fixation (ORIF) (90.1%; 95: CI: 76.6-98.1%), was the most commonly performed management. Closed reduction has been reported for all three types. The most frequently reported complications included nasolacrimal duct obstruction (38.6%; 95% CI: 10.6-71.7%), postoperative epiphora (24.9%; 95% CI: 6.4-50.4%), and telecanthus (20.9%; 95% CI: 1.7-53.5%). Surgical intervention can be considered for all NOE types. Despite surgical intervention, NOE fractures remain difficult to treat, and inadequate repair may result in complications. Laryngoscope, 2024.

A clinical study on the effect of axillary approach in the treatment of Ideberg type II scapular glenoid fractures

BackgroundDue to its deep position and complex surrounding anatomy, the scapular glenoid fracture was relatively difficult to deal with especially in cases of severe fracture displacement. Improper treatment may lead to failure of internal fixation and poor fracture reduction, severely affecting the function of the shoulder joint. Inferior scapular glenoid fracture was Ideberg type II fracture, and posterior approach was commonly used to deal with inferior scapular glenoid fracture. However, there are shortcomings of above surgical approach for inferior scapular glenoid fracture, such as insufficient exposure of the operative field, significant trauma, and limited screw fixation direction. This study adopts the axillary approach for surgery, which has certain advantages.MethodsThe clinical data of 13 patients with Ideberg type II scapular glenoid fractures treated from December 2018 to January 2024 were retrospectively analyzed. There were 8 males and 5 females, with an age range of 19 to 58 years and an average age of 38 years. The causes of injury were falls from heights in 7 cases and car accidents in 6 cases. There were 5 cases on the left side and 8 cases on the right side. The time from injury to surgery was 2 to 11 days, with an average of 5.5 days. All cases underwent open reduction and internal fixation through the axillary approach. Postoperative X-ray and CT three-dimensional reconstruction were performed on the next day to evaluate the fracture reduction and the position of internal fixation. During the follow-up period, follow-up examinations were performed every two months in the first half of the year and every three months in the second half. CT scans were performed during the examinations to assess the glenohumeral joint congruence, fracture healing, and position of internal fixation. The shoulder joint function was evaluated at 6 months postoperatively according to the Constant-Murley value score.ResultsThe patients all achieved primary wound healing after surgery, without any complications such as infection or nerve injury. Re-examination on the second day after operation, all fractures obtained excellent reduction, and the internal fixation was in excellent position, and no screw was found to enter the joint cavity. All patients in this group were followed up for 6 to 25 months, with an average follow-up time of 11.7 months. All fractures were bony unioned, and the healing time ranged from 4 to 6 months, with an average healing time of 4.8 months. At 6-month follow-up, according to the Constant-Murley score, 11 cases were excellent and 2 case was good.ConclusionOpen reduction and internal fixation through the axillary approach is an feasible and safe surgical method for the treatment in scapular Ideberg type II glenoid fractures with less stripping of soft tissue, minimal surgical trauma, and the incision is concealed and beautiful. It can provide a strong internal fixation for fractures, so patients can perform functional exercise early after operation, and the clinical results is satisfactory.

Effect of patient factors and procedure on proximal tibia fracture recovery - A retrospective analysis

Objective: Tibia plateau fractures account for 1-2% of all fractures and might adversely affect the knee joint. The current research aimed to evaluate the effect of surgical procedures, age, and gender on proximal tibia fracture functional outcomes. Methods: The present data for the retrospective analysis was obtained from an observational longitudinal cohort trauma registry study, initiated at a tertiary care hospital in June 2015. A total of 51 isolated tibia plateau fracture patients were routinely treated with open reduction internal fixation or external fixator and assessed for functional outcomes till twelve months by the Rasmussen scoring scale. Patients were divided into five age groups. The functional outcome association to gender, age groups, and surgical procedures was assessed by the Fisher Exact test and logistic regression analysis. Results: The mean age of the total 51 patients was 40±11 years. Patients operated with Open Reduction and Internal Fixation (74.5%) or with an external fixator (25.5%). Road traffic accidents were the common mechanism of injury. There were non-significantly different functional outcomes observed among age groups or between surgical procedures at all follow-ups but significantly different between genders at three-month follow-ups. Males recovered better than females (p=0.02). Conclusion: Tibia Plateau fracture patients respond almost equally to both external fixation and Open Reduction Internal Fixation procedures. Age does not influence the outcome. However, males had better functional outcomes at three months post-surgery indicating that gender could affect the outcomes. Further exploration might assist in planning gender-based proximal tibia fracture treatment strategies for optimum outcomes. doi: https://doi.org/10.12669/pjms.40.10.9154 How to cite this: Ahmad T, Muhammad ZA, Zehra F. Effect of patient factors and procedure on proximal tibia fracture recovery - A retrospective analysis. Pak J Med Sci. 2024;40(10):2281-2286. doi: https://doi.org/10.12669/pjms.40.10.9154 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Melatonin Rinsing Treatment Associated with Storage in a Controlled Atmosphere Improves the Antioxidant Capacity and Overall Quality of Lemons.

Antioxidant capacity is one of the most important biological activities in fruits and vegetables and is closely related to human health. In this study, 'Eureka' lemons were used as experimental materials and stored at 7-8 °C MT (melatonin, 200 μmol, soaked for 15 min) and CA (controlled atmosphere, 2-3% O2 + 15-16% CO2) individually or in combination for 30 d. The changes in lemon fruits' basic physicochemical properties, enzyme activities, and antioxidant capacities were studied. Comparing the combined treatment to the control, the outcomes demonstrated a significant reduction in weight loss, firmness, stomatal opening, and inhibition of polyphenol oxidase (PPO) and peroxidase (POD) activities. Additionally, the combined treatment maintained high levels of titratable acidity (TA), vitamin C (VC), total phenolic content (TPC), and antioxidant capacity and preserved the lemon aroma. Meanwhile, the correlation between fruit color, aroma compounds, and antioxidant capacity was revealed, providing valuable insights into the postharvest preservation of lemons. In conclusion, the combined treatment (MT + CA) was effective in maintaining the quality and antioxidant capacity of lemons.

Outcomes of operative fixation of loose trochlear osteochondral defects: A case series with subgroup analysis

Objectives To evaluate results of open reduction and internal fixation (ORIF) of loose osteochondritis dissecans (OCD) fragments of the trochlea including identification of any cases of fixation failure and assessment of post-operative patient-reported outcomes and activity level. Methods A retrospective chart review of OCD fixation surgeries performed between 2010 and 2021 identified 12 patients who underwent ORIF of loose OCD trochlear fragments. Patient demographics, history, imaging findings, surgical factors, and skeletal maturity were all collected. Primary outcome measures included reoperation for fixation failure, Knee Osteoarthritis Outcome Scores (KOOS), and Marx scores. Results The 12 patients (12 knees) with a mean age of 17.7 ± 6.4 years (range, 13-37 years) were included in the case series. Mean trochlear OCD size was 3.20 cm2 (range, 1.69-5.06 cm2) with mean follow-up of 78.9 months (range, 8 – 145). Failure of fixation occurred in. Failure of fixation occurred in 2 patients (17%). Of the 10 patients (83%) who completed PROs, the mean KOOS global score for all patients was 86.8 ± 16.3, symptoms/stiffness sub score 90.0 ± 11.0, pain 91.2 ± 12.1, Functions of daily living 95.5 ± 8.3, Sports/recreation 82.0 ± 23.9, quality of life 75.7 ± 28.6, and a mean Marx activity score of 10.5 ± 4.9. Conclusion ORIF of loose OCD lesions of the trochlea is associated with a low risk of failure of fixation and acceptable patient-reported outcomes.

Excellent clinical and radiological outcomes after arthroscopic reduction and double row-suture bridge for large-sized greater tuberosity fractures of the humerus.

Currently, there is limited information on the clinical outcomes of arthroscopic reduction and double-row suture bridge fixation for large greater tuberosity fractures of the proximal humerus. This study aimed to evaluate the radiological and clinical outcomes of arthroscopic reduction and double-row suture bridge fixation for these fractures, hypothesizing that arthroscopic reduction and double-row suture bridge fixation is a safe, effective and minimally invasive treatment for large greater tuberosity fractures. This retrospective study analysed patients with large greater tuberosity fractures (fracture fragment ≥30 mm in diameter) who underwent arthroscopic reduction and double-row suture bridge fixation and had a follow-up period exceeding 2 years. The anatomic reduction was confirmed by assessing the step-off on radiographs immediately after surgery, and the radiologic union time was recorded. At the final follow-up, range of motion and functional outcome scores were evaluated. Additionally, any surgery-related complications were evaluated. Fifteen patients with a mean follow-up of 57.7 ± 23.1 months were included in the study. The mean fracture fragment size was 32.5 ± 2.4 mm, with a mean displacement of 5.1 ± 1.6 mm. Immediately postsurgery, 13 of 15 patients (86.7%) had a fracture step-off of <3 mm, with an average union time of 3 months. At the final follow-up, patients demonstrated excellent outcomes, with an average forward flexion of 167 ± 9.7° and external rotation of 70 ± 16.3. Functional outcome scores showed significant improvement compared with preoperative scores (p < 0.001). No major surgery-related complications were reported. Arthroscopic reduction and double-row suture bridge fixation for large-sized greater tuberosity fractures is safe and shows good fracture reduction and excellent clinical outcomes. Therefore, this surgical method can be considered an alternative to open reduction for large greater tuberosity fractures. Level IV.

Outcomes of open reduction for hip dislocations in children with connective tissue disorders*

Purpose: While children with hypermobility and/or ligamentous laxity due to coexisting connective tissue disorders might be expected to have worse outcomes after open reduction for hip dislocations, there is minimal prior research on this topic. Methods: All open reduction surgeries for hip dislocations performed at a single urban, tertiary-care children’s hospital from 2009 to 2023 were reviewed retrospectively. Those with connective tissue disorders secondary to a diagnosed syndrome or genetic disorder were included. Patients with &lt;1 year of follow-up or hip instability in the setting of Trisomy 21 were excluded. Clinical and radiographic data was collected. Instances of re-dislocation, proximal femoral growth disturbance, residual acetabular dysplasia, and arthrofibrosis were recorded. Results: Twenty-three hips (15 patients) were included. Mean age at the time of surgery was 19.6 months (Range: 8.2–36.0 months), and mean follow-up was 4.3 years. The most common connective tissue disorder condition included was Ehlers-Danlos syndrome (13%). A majority of open reductions were performed via an anterior approach (96%). Seven hips (30%) underwent a concomitant pelvic osteotomy without femoral osteotomy and seven hips (30%) underwent both pelvic and femoral osteotomies. Twenty-two hips (96%) were International Hip Dysplasia Institute grade 1 at the final follow-up. Re-dislocation occurred in four hips (17%); eight hips (35%) demonstrated residual acetabular dysplasia, five hips (22%) demonstrated proximal femoral growth disturbance, and nine hips (39%) developed stiffness postoperatively. Conclusions: Patients with connective tissue disorders and ligamentous laxity have comparable rates of residual acetabular dysplasia, proximal femoral growth disturbance, and (surprisingly) stiffness as typical developmental dysplasia of the hip following open hip reduction surgery. Although the re-dislocation rate in the connective tissue disorders group was approximately 2–3 times higher, the difference did not reach statistical significance. Given that the study was limited by a low sample size, however, it is possible that the findings of no difference in residual acetabular dysplasia and proximal femoral growth disturbance were potentially due to a lack of power. Level of evidence: IV.

Minimally Invasive Plate Osteosynthesis with Mini-Open Technique and Supraclavicular Nerve Preservation Reduces Postoperative Numbness in Acute Displaced Midshaft Clavicle Fracture

Background: Minimally invasive plate osteosynthesis (MIPO) for clavicular shaft fracture yields favorable functional outcomes and results in less surgery-related soft tissue injury than other techniques. Anterior chest and shoulder skin numbness, a common complication after open reduction and plate fixation, is related to injury to the supraclavicular nerves. We propose MIPO combined with a mini-open approach without fluoroscopy for nerve preservation to minimize the risk of postoperative numbness compared with traditional open plating without nerve preservation. Methods: A total of 59 patients were retrospectively identified, with a follow-up period of 6 months. Thirty-two patients underwent MIPO with mini-open and nerve preservation technique (MIPO group), and 27 patients underwent traditional open plating without nerve preservation (open group). Constant–Murley shoulder outcome score, operation time, wound length, skin numbness, and number of implant removals were compared between the groups. Results: The MIPO group had significantly lower rates of anterior chest and shoulder skin numbness than the open group (MIPO: 12.5% vs. open: 55.6%; p &lt; 0.001). Operation time was significantly longer in the MIPO group than in the open group (MIPO: 109.38 ± 18.83 vs. open: 81.48 ± 18.85; p &lt; 0.001). Wound length was significantly shorter in the MIPO group than in the open group (MIPO: 4.73 ± 0.79 vs. open: 9.76 ± 1.64; p &lt; 0.001). Both groups had similarly excellent Constant–Murley shoulder scores. There were significantly fewer implant removals in the MIPO group than in the open group (MIPO: 6.3% vs. open: 25.9%; p = 0.036). Neither group experienced any infection, implant failure, or nonunion. Conclusions: Our technique combining MIPO with the mini-open approach and supraclavicular nerve preservation yields a lower incidence of skin numbness than traditional open plating without nerve preservation.

NEGLECTED BOTH-BONE FOREARM FRACTURE WITH DISTAL RADIOULNAR JOINT DISLOCATION: A CASE REPORT AND BRIEF LITERATURE REVIEW

Introduction: In this case, we discuss a patient with a neglected and malunited both-bone forearm fracture with distal radioulnar joint dislocation. This pattern of fracture by itself is uncommon, but the initial negligence of this trauma makes it even more rare and challenging for surgical treatment. Case report: The main aim of the surgery was to restore the forearm's function and anatomy. After thorough preoperative preparation, including planning the level of resections, the patient was treated with open reduction and internal fixation with a limited contact dynamic compression plate. The distal radio-ulnar joint was fixed with 2 K-wires. On control follow-up six months later, the resection sites were fully consolidated, with no visible deformation of the forearm. Pronosupination was restored up to 60% of normal functional arc. Conclusion: This case has shown that even with careful restoration of forearm anatomy, results of the surgical treatment in neglected and malunited both-bone forearm fracture with distal radioulnar dislocation will not be a priori good or excellent. Surgeons need to remind the patients that the return of the function of the upper limb to the degree before the trauma cannot be guaranteed.

SIMULTANEOUS VERSUS STAGED TOTAL HIP ARTHROPLASTY FOLLOWING ACETABULAR FRACTURE FIXATION: A COMPARISON OF OUTCOMES

Acetabular fractures present a challenge. Anatomical reduction can be achieved by open reduction and internal fixation (ORIF). However, in elderly patients with complex fracture patterns and osteoporotic bone stock, “fix and replace” has become an option in the management of these injuries. This involves ORIF of the acetabulum to enable insertion of a press fit cup and subsequent cemented femoral stem at the index surgery.A Retrospective analysis of all operatively managed acetabular fractures by a regional Pelvic and Acetabular Trauma service (01/01/2018-30/05/2023) STATA used for analysis. 34 patients undergoing “fix and replace” surgery. Of the 133 patients managed with ORIF, 21 subsequently required Total Hip Arthroplasty (THA). Mean follow up was 2.7 years versus 5.1. There was no statistical significance between the two groups with regards to BMI or sex. Mean age in the “fix and replace” group was 68 compared to 48 in the ORIF and subsequent THA group. This reached statistical significance between the two groups (p=0.001).ASA and Charlson Comorbidity Index (3 and 3 in “fix and replace” and 2 and 1.2 in ORIF to THA group) and Charlson Comorbidity Index both were statistically significantly different (p=0.006 and p=0.027, respectively). High energy mechanism of injury accounted for 56% of the “fix and replace” group compared to 48% in the ORIF to THA. 74% of “fix and replace” were associated fractures compared to 53% of ORIF to THA. Wait to surgery was 3 days for “fix and replace” while 186 days was the mean wait time from listing to THA for the ORIF to THA group. Complication rate was 41% versus 43% in the two groups. 14% in the ORIF to THA group developed PJI versus 6% in “fix and replace”.Fix and replace allows early mobilisation in frailer, elderly patients. Our results show fewer returns to theatre and less PJI in patients having arthroplasty as part of “fix and replace” than subsequent to Open reduction internal fixation.

Complications and morbidity of the extended delto-pectoral approach in treating complex humeral shaft fractures with proximal metaphyseal extension using a long locking plate for internal fixation

Background Humeral shaft fractures account for up to 3% of all fractures, but complex forms of those fractures (type AO/OTA B or higher) are rare. Plate and screw fixation of the fracture are rated as consolidated from 80 to 97%. Reported complications include non-union, secondary radial nerve palsy and infection. Minimally invasive plate osteosynthesis (MIPO) should provide the same union rate as open reduction and internal fixation (ORIF) but potentially with fewer complications. The aim of our study was to review patients treated for complex humeral fractures with ORIF through an extended delto-pectoral approach using a long pre-contoured locking plate. The morbidity of the open approach, complication rates, union rate and clinical outcomes were assessed.Methods We performed a retrospective analysis of 26 consecutive complex humeral shaft fractures (7 males, mean age 59 years; 19 females, mean age 67 years) treated in our institution with a long pre-contoured locking plate between June/2011 and December/2017. Fracture healing was evaluated with standard radiographs. Eventual complications and the morbidity of the approach were assessed through chart review. The final clinical outcome and quality of life were assessed via telephone interview with DASH score and EQ-5D-3 L in 25 of the 26 patients included.Results There were no complications related to the open approach with uneventful wound healing in all cases without any infections. Mechanical complications occurred in 3 cases (11%): one tuberosity dislocation (revised) and two plate failures (one revised). Postoperative radial nerve palsy was observed in two patients (7%), of which one was transient, the other was persistent. The plate was removed in 4 cases (15%). The average radiological and clinical follow-up was 21 months (range: 12–56). At 12 months follow-up complete fracture healing was confirmed in 22 out of 26 cases and in three more patients after 18 months. After an average of 44 months, the mean DASH score was 35 (SD ± 15.83) points; the EQ-5D-3 L score 0.7 (SD ± 0.31).Conclusion ORIF with a long locking plate though an extended delto-pectoral approach is certainly still a viable option to treat complex humeral shaft fractures with good soft tissue and bone healing as well as good functional recovery. No increased morbidity was attributed to the open surgical approach. In our series, radial nerve palsy could not be completely avoided, accentuating the potential risk of this specific fracture in close proximity to the radial nerve.Trial registrationEthics Committee: Ethikkommission Ostschweiz (EKOS), Project ID: 2019-00323.

Our Experience with Surgical Treatment of Scaphoid Fractures with Headless Compression Screw

BACKGROUND: Fractures of the scaphoid bone are quite common, and they come with their own set of challenges due to the specific shape of the fractures and the delicate blood supply to the scaphoid bone. Failing to diagnose and treat acute scaphoid fractures promptly can result in failure of the bone to heal and subsequent development of wrist arthritis. Advances in diagnosis, surgery, and implant materials have led to a growing inclination towards early surgical fixation, even for non-displaced scaphoid fractures that could potentially be treated without surgery. AIM: The study's goal was to assess the effectiveness of headless compression screws for treating acute scaphoid fractures and, in two cases, nonunion following previous conservative therapy. METHODS: Between January 2022 and March 2024 ten patients with scaphoid fractures were surgically treated at the University Clinic of Traumatology Skopje, within twelve months follow-up. All of them were male with mean age of 27,3 years. All were diagnosed with X-rays and CT scans. Six of the fractures were on the right hand and four on the left. RESULTS: All the patients were surgically treated with open reduction and internal fixation with headless compression screw. Volar approach was used in 9 cases and dorsal approach in only one of them. Six of the patients were surgically treated within 4-14 days after injury and four of them were surgically treated due to non union after previous conservative treatment, two of them after three and two of them after seven months of injury. All fractures united after a mean time of 9,5 weeks, without secondary displacement. Throughout the follow-up period, there were no incidences of developing osteoarthritis of the wrist. CONCLUSIONS: It is crucial to understand that achieving a positive result is not guaranteed for every patient and relies on selecting the right patients and fractures. However, our study shows favorable results in sooner surgical treatment with the headless compression screw, rather than delayed treatment of scaphoid fractures. Surgical treatment with headless compression screw showed both functional and radiographic results. While it is beneficial for the screw to be positioned in the subchondral area, it is important to be cautious to avoid cortical penetration, as this will require the screw to be removed later.

RSD-based high-performance radix-4 Montgomery Modular Multiplication for Elliptic Curve Cryptography

This paper proposes a high-performance radix-4 Montgomery Modular Multiplication (MMM) algorithm and its corresponding hardware architecture for Elliptic Curve Cryptography (ECC), in which the quotient and the partial product accumulation are computed in parallel in each iteration. Additionally, in this MMM, the Redundant Signed Digit (RSD) representation and the Signed Digit Adder (SDA) are used to eliminate the long carry chain and achieve parallel computation, as well as remove pre-computation and integrate modular reduction operations. Our MMM algorithm is implemented in 256-bit and 1024-bit versions on Xilinx Virtex-6 and Virtex-7 FPGAs, respectively. It consumes only 1.55k/10.18k Look-Up Tables (LUTs), takes 133/517 clock cycles, and runs at maximum frequencies of 558.8/641.7 MHz. According to the comparison in terms of Area Time Product (ATP), our design can achieve the ATP of 0.369 over the 256-bit NIST prime domain, which is approximately half of that of the state-of-the-art works. The Scalar Point Multiplication (SPM) scheme using this MMM algorithm consumes 14.19k LUTs and completes a single Scalar Point Multiplication (SPM) operation in 0.217 ms, and it also has a lower ATP than most other SPM algorithms currently in existence.

Impact of teardrop angle correction on functional outcomes in die punch fractures of the distal radius: retrospective study

Background: Anatomic reduction of die punch fractures of the distal radius is crucial to optimize functional outcomes. The teardrop angle, formed by the volar cortex and articular surface, reflects distal radius alignment and articular congruity. This study evaluated the relationship between teardrop angle correction and clinical/functional results following surgical fixation of these injuries. Methods: This retrospective study included patients undergoing open reduction and internal fixation for die punch distal radius fractures between 2015-2020. Patients were divided into two groups based on teardrop angle correction: group 1 (≤10°) and group 2 (&gt;10°). Disabilities of the arm, shoulder and hand (DASH) scores, patient-rated wrist evaluation (PRWE) scores, range of motion, and grip strength were assessed at final follow-up (minimum 12 months). Multivariate analysis identified predictors of functional outcomes. Results: 60 patients were included (32 in group 1, 28 in group 2). Groups were similar in baseline demographics and injury characteristics. Group 2 (&gt;10° correction) had significantly better outcomes including lower DASH scores (14.5 versus 24.6, p=0.003), lower PRWE scores (21.6 versus 36.8, p=0.002), greater grip strength (84.6% versus 71.2%, p=0.005), increased flexion (62.5° versus 52.7°, p=0.004), and extension range of motion (55.8° versus 43.5°, p&lt;0.001). On multivariate analysis, greater teardrop angle correction was an independent predictor of improved DASH and PRWE scores. Conclusions: Obtaining &gt;10° of teardrop angle correction during surgical fixation of die punch distal radius fractures correlated with superior functional outcome scores, grip strength, and mobility compared to ≤10° of correction. These findings emphasize the importance of restoring distal radius anatomy and articular congruity in this injury pattern. Precise intraoperative correction of the teardrop angle deformity should be a key goal.

Arthroscopic reduction internal fixation for glenoid fractures: a systematic review of the outcomes and complications.

With the advanced arthroscopic technique, arthroscopic-assisted reduction and internal fixation (ARIF) is gaining popularity for Glenoid fractures with and without scapular involvement. ARIF offers a complete view of the articular surfaces and diagnoses and treats other associated injuries. ARIF provides less soft tissue trauma than open reduction internal fixation (ORIF). The aim of this systemic review is to look at the functional outcomes and complications of ARIF. A systematic review of the PubMed, Embase, and Scopus databases was performed. The search terms included "glenoid fracture" OR "scapula fracture" AND "arthroscopic fixation" OR "arthroscopy" OR "arthroscopic-assisted reduction and internal fixation". Studies were limited to English publications with reported functional outcome measures and complications. Patient demographic characteristics, clinical outcomes including range of motion, outcome performance scores including ROWE score, visual analogue scale and American shoulder and elbow surgeons score and complications were extracted. Five studies met the inclusion criteria. The participants ranged in age from 41 to 48, and the mean length of follow-up ranged from 12 to 41months postoperatively. The mean ROWE scores for the ARIF group were significantly better postoperatively. ARIF allows accurate diagnosis of the fracture pattern and associated injuries, in addition to representing a safe option to treat glenoid fractures with or without scapular fractures with fewer complications compared to ORIF. Level of Evidence: Level IV, Systematic review.

Does More Invasive Surgery Result in Higher Patient Satisfaction? A Long-Term Follow-Up of 136 Zygomaticomaxillary Complex Fractures

Study Design Retrospective with follow-up. Objective To evaluate the long-term satisfaction of surgically treated patients with zygomaticomaxillary complex (ZMC) fractures in relation to the use of internal fixation, number of fixation points, and orbital floor (OF) reconstruction. Secondary objectives were to describe the use of antibiotics and post-operative infections. Methods Patients with unilateral ZMC fractures between 2007-2018 and treatment with either open reduction and internal fixation (ORIF) or closed reduction (CR) were identified from medical records and invited to follow-ups between 2018-2020. Patients were examined, photographed, and completed a questionnaire. A review panel of 3 experienced surgeons evaluated photographs and computed tomography (CT) scans pre- and post-surgery. Results The study sample consisted of 136 patients (108 ORIF, 28 CR) with a median follow-up time of 76 months. Patient satisfaction of surgical outcome was high (97.8%), with no significant differences in relation to the use of internal fixation, number of fixation points, or OF reconstruction. Dissatisfaction was primarily related to hypoesthesia. On post-operative CT scans, malar asymmetry was more often predicted in patients with 1-point fixations. On questionnaires and photographs, malar asymmetry was more common in patients with 3-point fixations. Prophylactic antibiotics had no effect on the rate of post-operative infections. Conclusions Patient satisfaction was not influenced by internal fixation, number of fixation points, or OF reconstruction. Selected ZMC fractures can be treated with less invasive approaches. Caution should be observed when predicting long-term malar asymmetry on post-operative CT scans. The findings of this study highlight the importance of a rational and ethical use of surgery.

Epidemiology, Classification and Treatment of Femur and Tibia Fractures around Total Knee Arthroplasty (Literature Review)

Summary. Periprosthetic fractures around total knee arthroplasty (TKA) are difficult to treat due to complex fracture morphology, high proportions of injuries associated with osteopenia, and the variability of injury patterns. Periprosthetic fractures associated with TKA are defined as fractures around the knee joint (femur, tibia, or patella) occurring within 5 cm of the intramedullary stem of the prosthesis or 15 cm of the joint. The incidence is estimated to be between 0.3% and 2.5% after primary TKA and up to 28% after revision TKA. There are several surgical and nonsurgical risk factors associated with postoperative periprosthetic fractures. Distal femoral periprosthetic fractures following TKA are the most common and reported to occur in 0.2–1.8% of patients after primary TKA. Tibial periprosthetic fractures have a reported prevalence of 0.07–0.1% in primary and 0.36% in revision knee arthroplasties. Patella fractures are the second most common periprosthetic fractures following TKA, with prevalence ranging from 0.68% to 1.19%, and are usually associated with a resurfaced patella. Several classification systems of periprosthetic fractures around TKA have been published and some treatment recommendations have been provided. However, most systems are subject to criticism and use different classification systems for the tibia, patella, and the femur.A variety of treatment methods are available for periprosthetic fractures. Conservative treatment can include protected weight bearing, splinting, or traction. Surgical treatment commonly involves closed intramedullary nailing or open reduction and internal fixation by plates. In cases of significant bone loss, a revision TKA may be indicated. In general, treatment must be guided based on the stability of the implant and the remaining bone quality, as determined by the presence of osteolysis and the location of the fracture.