Satisfactory Fracture Reduction Research Articles

Clinical efficacy of arthroscopic high-intensity suture binding combined with button plate suspension fixation in the treatment of posterior cruciate ligament tibial avulsion fractures

PurposeTo assess the clinical efficacy of arthroscopic treatment for posterior cruciate ligament (PCL) tibial avulsion fractures using high-intensity suture binding combined with button plate suspension fixation.MethodsWe retrospectively analyzed clinical data from 32 patients with PCL tibial avulsion fractures treated at our hospital from July 2020 to August 2023. We recorded operation time, intraoperative and postoperative complications, and used imaging to assess fracture reduction and healing. Pain and knee function were evaluated using the Visual Analogue Scale (VAS), range of knee motion, Lysholm score, and International Knee Documentation Committee (IKDC) score.Study DesignCase series; Level of evidence, 4.ResultsAll patients were followed for 6 to 18 months, averaging 13.6 months. All incisions healed successfully without postoperative complications. X-rays taken on the first postoperative day showed satisfactory fracture reduction. Three-month post-surgery imaging confirmed healed fractures and no internal fixation failures. At the final follow-up, knee function was well recovered, with only one patient exhibiting a positive posterior drawer test of degree I. Furthermore, the mean VAS score was 0. 5 (range 0.0 to 1.0), active knee extension was 2. 2° (range 0.0 to 5.0), and active knee flexion was 137.7° (range 130.0 to 145.0). The mean Lysholm score was 91.5(range 89.3 to 94.0), and the IKDC score averaged 83.8 ± 3.7, and these outcomes showed statistically significant improvement from preoperative levels (P < 0.001).ConclusionsArthroscopic high-intensity suture binding combined with button plate suspension fixation for PCL tibial avulsion fractures offers several benefits: it is minimally invasive, results in less postoperative pain, enables earlier functional exercise, and provides satisfactory clinical outcomes with fewer complications.

A Countertraction Closed Reduction Technique in Minimally Invasive Fixation of Recent Type C Pelvic Ring Injuries.

Closed reduction of pelvic injuries is a prerequisite and critical step in minimally invasive treatment. Achieving non-invasive closed reduction of pelvic injuries is a challenging clinical problem. This study demonstrated a non-invasive traction technique for closed reduction called countertraction closed reduction technique (CCRT) and evaluated its effectiveness for type C pelvic ring injuries. The data of patients with unstable pelvic fractures treated with CCRT and minimally invasive fixation were retrospectively reviewed from January 2017 to February 2022. Sacroiliac screws were placed to fix the posterior pelvic ring, and internal or external fixation was used to fix the anterior pelvic ring. Operation time, intraoperative blood loss, duration of hospital stay, fracture union and postoperative complications were recorded. Fracture reduction quality was evaluated using the Matta scoring criteria. Functional recovery and general quality of life were evaluated using the Majeed functional scoring criteria. Thirteen patients (nine males and four females), with an average age of 49.6 years were treated with CCRT and followed up for a mean of 18.5 months. The average operation time was 137.2 minutes (range 92-195 minutes), the average intraoperative blood loss was 31.2 mL (range 10-120 mL) and the average duration of hospital stay was 14.3 days (range 4-32 days). All patients achieved bony union with an average union time of 11.9 weeks (range 10-16 weeks). According to the Matta radiographic criteria, the quality of fracture reduction was excellent in eight patients, good in four, and fair in one. The average Majeed functional score was 89.7 (range 78-100). The functional evaluation revealed that the outcomes were excellent in nine patients, and good in four patients. Complications included incision fat liquefaction in one patient, and heterotopic ossification in another patient. There were no surgical complications as a result of CCRT. CCRT is a non-invasive closed reduction method for minimally invasive fixation of fresh Tile C1 and C2 pelvic fractures. The advantages of CCRT combined with minimally invasive treatment include a small surgical incision, reduced intraoperative bleeding, satisfactory fracture reduction, bone healing and functional recovery.

Comparison of midterm efficacy of Kirschner wires and elastic intramedullary nails after closed reduction of Judet type 3 radial neck fractures in children: a multicenter study.

The objective of this study was to compare the midterm efficacy of Kirschner wires and elastic intramedullary nails after the closed reduction treatment of Judet 3 radial neck fractures in children. This was a retrospective multicenter study of patients diagnosed with Judet type 3 radial neck fractures who underwent closed reduction and internal fixation at four tertiary hospitals from January 2019 to December 2021. Gender, age, fracture type, operation time, follow-up time, x-ray results and complications were collected. The recovery of elbow joint between the two internal fixation methods, elbow motion and complications at the last follow-up were compared. The average operation time of EIN group was statistical significantly increased compared with KW group. There were no significant differences in MEPS score and ROM 3 months after surgery between the two groups, but the ROR Angle of EIN group was statistical significantly increased compared with KW group 3 months after surgery. There were no significant differences in MEPS score, ROM and ROR at the last follow-up. The incidence of complications in EIN group was significantly lower than that in KW group. The use of elastic intramedullary nails fixation or Kirschner wires fixation in the treatment of radial neck fractures in children can both achieve satisfactory fracture reduction and healing. Compared with elastic intramedullary nails, the operation time of Kirschner wires fixation is shorter, and the internal fixation does not need to be removed under anesthesia again, but the complication rate is higher.

How to Apply Intraoperative Ultrasound when Spinal Trauma Surgery Is Performed in the Lateral Decubitus Position?

At present, intraoperative ultrasound was widely used in spinal surgery. But there have been no reports on the use of intraoperative ultrasound in lateral decubitus position spinal surgery. The authors' research objective was to describe the applications of intraoperative ultrasound in spinal trauma surgery when performed in the lateral decubitus position. Six patients with polytrauma who underwent surgery for spinal trauma between June 2020 and March 2022 and could not be operated on using a posterior approach in the prone position. All six patients underwent surgery in the lateral decubitus position. During surgery, a capsular bag had been designed and surgical field can be filled with normal saline for acoustic coupling, and then ultrasound was used to observe and guide decompression, and assess injuries of the neural elements such as the spinal cord. The data of preoperative and postoperative (12 months) American Spinal Injury Association impairment scale (AIS), follow-up time, operation time, blood loss, ultrasound signal change of spinal cord, ultrasound guide decompression, internal fixation (12 months), and fracture healing(12 months) were collected. The study included four males and two females whose ages ranged from 19 to 56 years old (41.5 ± 13.06 years old). Follow-up times ranged from 12 to 20 months (14.33 ± 2.75 months). The operation times ranged from 195 to 248 mins (222.16 ± 16.86 mins). The estimated volume of blood loss ranged from 280 to 450 mL (383.33 ± 55.58 mL). The six cases' AIS (preoperative vs. postoperative) were A versus A, C versus D, A versus B, B versus B, B versus C, and B versus C. Intraoperative ultrasound was performed successfully in all patients using our designed method. Intraoperative ultrasound observation revealed varying degrees of changes in spinal cord echo in all patients. Intraoperative ultrasound provided excellent assistance in spinal cord decompression during surgery. The surgery was completed successfully with no surgery-related complications till the last follow-up. At the time of last follow-up (median time of 12 months) satisfactory fracture reduction and good internal fixation was confirmed on postoperative computed tomography scans and radiographs. The authors represented the technology of intraoperative ultrasound in spinal trauma surgery when performed in the lateral decubitus position. This technology solves how to apply intraoperative ultrasound in lateral decubitus position.

Treatment of tibial insertion avulsion fracture of anterior cruciate ligament involving anterior root of lateral meniscus with multi-point fixation with anchor and suture

To investigate the effectiveness of arthroscopic multi-point fixation with anchor and suture in the treatment of tibial insertion avulsion fracture of anterior cruciate ligament (ACL) involving the anterior root of lateral meniscus (LM). A retrospective analysis was conducted on the clinical data of 28 patients with tibial insertion avulsion fracture of ACL involving the anterior root of LM who were treated with arthroscopic multi-point fixation with anchor and suture between October 2017 and January 2023. There were 12 males and 16 females with the mean age of 26 years (range, 13-57 years). There were 20 cases of sports injury and 8 cases of traffic accident injury. In 2 cases of old fracture, the time from injury to operation was 45 days and 90 days, respectively; in 26 cases of fresh fracture, the time from injury to operation was 3-20 days (mean, 6.7 days). According to the Meyers-McKeever classification, there were 4 cases of type Ⅱ, 11 cases of type Ⅲ, and 13 cases of type Ⅳ. The preoperative Lysholm knee function score was 42.1±9.0, the International Knee Documentation Committee (IKDC) score was 40.0±7.3, and the Tegner score was 0.7±0.7. All operations were successfully completed, and the incisions healed by first intention. All the 28 patients were followed up 5-60 months (mean, 20.4 months). During the follow-up, there was nocomplication such as infection, vascular or nerve injury, loosening or breakage of internal fixator, or stiffness of knee joint. Postoperative X-ray films showed satisfactory fracture reduction and firm fixation. All fractures healed clinically, and the healing time was 8-16 weeks (mean, 10.3 weeks). At last follow-up, Lachman test and anterior drawer test were negative. At last follow-up, Lysholm knee function score was 92.4±5.5, IKDC score was 91.6±4.4, and Tegner score was 5.2±1.1, which significantly improved when compared with preoperative scores ( t=-22.899, P<0.001; t=-29.870, P<0.001; t=-19.979, P<0.001). Multi-point fixation with anchor and suture in the treatment of tibial insertion avulsion fracture of ACL involving the anterior root of LM can not only fix the LM, but also effectively reduce and fix the avulsion fracture, which can obtain good effectiveness.

Unilateral biportal endoscopic technique combined with percutaneous transpedicular screw fixation for thoracolumbar burst fractures with neurological symptoms: technical note and preliminary report

BackgroundPrevious studies on thoracolumbar fractures with neurological symptoms have focused on how to achieve satisfactory fracture reduction, adequate nerve decompression, and stable spinal alignment. With the development of the minimally invasive spine surgery technique, achieving satisfactory treatment results and reducing iatrogenic trauma at the same time has become a new goal of spinal surgery. This research used percutaneous transpedicular screw distraction to partially reduce the fractured vertebrae, followed by completing nerve decompression and reducing residual displacement bone fragments with the assistance of the unilateral biportal endoscopic (UBE) technique to achieve full protection of bone-ligament tissue and obtain good clinical efficacy.MethodsGuide wires were safely inserted into the fractured vertebra and adjacent upper and lower vertebra under the surveillance of anteroposterior and lateral X-ray fluoroscopy. Transpedicular screws were implanted via guide wires on the side with mild neurological deficits or bone fragment compression (the opposite side of the endoscopic operation). A titanium rod was installed and moderately distracted to reduce the fractured vertebra. Then, under the guidance of the endoscopic view, the laminectomy and ligamentum flavum resection were completed according to the position of the protruding bone fragment into the spinal canal, and the compressed dural sac or nerve root was fully exposed and decompressed. An L-shaped replacer was used to reduce residual bone fragments. The ipsilateral transpedicular screws and rod were installed and adjusted to match the contralateral side. The drainage tube was indwelled, and the incision was closed. The preoperative and postoperative images of the patients were evaluated, and the recovery of neurological symptoms was observed.ResultsSurgery was successfully completed on all six patients, and no intraoperative conversion to open surgery was performed. Postoperative images showed good reduction of the protruding bone fragment and good placement of all screws. At the last follow-up, the neurological symptoms of all patients returned to normal.ConclusionThe UBE technique combined with percutaneous transpedicular screw fixation in the treatment of thoracolumbar fractures with neurological symptoms can effectively achieve the reduction of displaced bone fragments, improve damaged nerve function, stabilize spinal alignment, and protect the integrity of bone-ligament tissue.

A novel suture bridge anchor fixation technique to treat inferior pole fractures of patella: A retrospective clinical study.

The traditional surgical methods to the fracture of the inferior patellar fracture include steel wire tension band fixation and inferior patellar resection, which have many disadvantages. In order to overcome the disadvantages of traditional surgery, we innovated and improved the double row anchor suture bridge technology to the treat the inferior patellar fracture. This study is to investigate the method, technique and clinical efficacy of double-row anchor suture bridge technique in the treatment of inferior pole fractures of patella. Between January 2019 and March 2021, 36 patients with inferior pole fractures of patella underwent the surgery with the double-row anchor suture bridge technique. 28 injury cases were caused by falls while 8 injury cases were from car crashes. The operation time, amount of intraoperative bleeding and complications were recorded. Radiological assessments and Bostman score were performed 1, 3, and 6 months post-operation and at the most recent follow-ups. The study sample consisted of 19 males and 17 females, aged 31 to 72 years old. The operation time was (54-76) minutes. All incisions healed in 1 stage. No complications such as incision infection, flap necrosis and nerve injury occurred. Patients in this group were followed up for 10 to 18 months, with an average follow-up of 12 months. All fractures healed in 10 to 20 weeks, with an average healing time of 12 weeks. At the last follow-up, the Bostman score was (27.5 ± 3.3), excellent in 32 cases and good in 2 cases, with an excellent rate of 94.4%. The range of motion of the knee joint was (-2.6 ± 2.0)° when the knee was extended and (122 ± 5.0)° when the knee was bent. The muscle strength of quadriceps femoris was grade 5. Double-row anchor suture bridge technique is applied to inferior pole fractures of patella by virtue of its various effects, such as the complete preservation of the inferior pole fragments during the operation, satisfactory fracture reduction, firm fixation, and meeting patients' requirements for early postoperative ambulation. In summary, double-row anchor suture bridge technique is an ideal surgical procedure for the treatment of the inferior pole fracture of patella with safety, reliability and high satisfaction.

The use of a novel reduction plate in transoral anterior C1-ring osteosynthesis for unstable atlas fractures.

Transoral anterior C1-ring osteosynthesis has been reported as an effective treatment for unstable atlas fracture, which aims to preserve important C1-C2 motion. However, previous studies have shown that the anterior fixation plates used in this technique were not suitable for the anterior anatomy of the atlas and lacked an intraoperative reduction mechanism. This study aims to evaluate the clinical effects of a novel reduction plate used in transoral anterior C1-ring osteosynthesis for unstable atlas fractures. 30 patients with unstable atlas fractures treated by this technique from June 2011 to June 2016 were included in this study. The patients' clinical data and radiographs were reviewed, and the reduction of the fracture, internal fixation placement, and bone fusion were assessed using pre- and postoperative images. The patients' neurological function, rotatory range of motion, and pain levels were evaluated clinically during follow-up. All 30 surgeries were successfully performed, and the average follow-up duration was 23.5 ± 9.5 months (range 9-48 months). One patient suffered atlantoaxial instability during the follow-up and was treated with posterior atlantoaxial fusion. The remaining 29 patients had satisfactory clinical outcomes, with ideal fracture reduction, good screw and plate placement, well-preserved range of motion, neck pain alleviation and solid bone fusion. There were no vascular or neurological complications during the operation or follow-up. The use of this novel reduction plate in transoral anterior C1-ring osteosynthesis is a safe and effective surgical option in the treatment of unstable atlas fractures. This technique offers an immediate intraoperative reduction mechanism, which provides satisfactory fracture reduction, bone fusion, and preservation of C1-C2 motion.

Robot-Assisted Percutaneous Lag Screw Osteosynthesis for C1 Lateral Mass Fractures: Case Series and Technical Note.

C1 lateral mass fractures (LMF) cause abnormal alignment of the upper cervical joints. Conservatively treated cases can develop into late cock-robin junction, requiring a reconstructive surgical procedure of the occipitocervical junction. Partial coronal C1 LMF could be effectively fixed with lag screws. Navigation and robot-assisted techniques have made percutaneous fixation possible and are gradually being used in the upper cervical spine. Five consecutive patients with C1 LMF who underwent percutaneous lag screw osteosynthesis under the guidance of a new robotic system were reviewed retrospectively. Preoperative and postoperative computed tomography scans were used to specify the fracture types and to assess the efficacy of fracture reduction. The medical records were reviewed. Among the 5 patients, 4 underwent percutaneous lag screw reduction and fixation with the assistance of the robotic system through a posterior approach and 1 patient underwent a transoral approach. No intraoperative complications, such as screw malposition, neurologic deficit, and vertebral artery injury, occurred. Satisfactory fracture reduction and bone healing were achieved at postoperative follow-up. Robot-assisted percutaneous lag screw osteosynthesis is a viable option for C1 LMF. Different approaches can be selected according to the distribution of the fracture lines. With the posterior approach, the guidewire tends to deviate from the entry point because of skiving, and the technical problems need to be further solved. Screw implant by a transoral approach is comparatively easy to achieve, but the possibly of infection exists and should be monitored.

Effectiveness analysis of minimally invasive safe approach to knee joint for treatment of avulsion fractures of tibial insertion of posterior cruciate ligament

To analyze the effectiveness of minimally invasive safe approach of the knee joint in the treatment of avulsion fractures of the tibial insertion of the posterior cruciate ligament (PCL). The clinical data of 26 patients with avulsion fractures of tibial insertion of PCL treated with open reduction and internal fixation via minimally invasive safe approach of the knee joint between February 2019 and March 2022 were analyzed retrospectively. There were 18 males and 8 females with an average age of 45.5 years (range, 33-58 years). The causes of injury were traffic accident in 14 cases, falling from height in 7 cases, and sports injury in 5 cases. There were 15 cases of left knee and 11 cases of right knee. The preoperative Lysholm score of knee joint was 34.4±7.3 and the flexion range of motion of knee joint was (69±12)°. According to Meyers classification, there were 8 cases of type Ⅱ and 18 cases of type Ⅲ. The time from injury to operation ranged from 1 to 5 days, with an average of 2 days. The operation time was 40-70 minutes, with an average of 55 minutes; the intraoperative blood loss was 10-30 mL, with an average of 15 mL. Delayed incision healing occurred in 1 case after operation, and the incision healed after conservative treatment, and the incisions of the other patients all healed by first intention. Postoperative X-ray films showed satisfactory fracture reduction. All 26 patients were followed up 3-30 months, with an average of 22 months. No complication such as neurovascular injury, infection, and knee extension disorder occurred after operation. X-ray films at 3 months after operation showed that all fractures healed without displacement of the fracture ends; the posterior drawer test was negative. At last follow-up, the flexion range of motion of knee joint was (120±9)°, the Lysholm score was 90.7±3.8, which were significantly improved when compared with those before operation (t=16.376, P<0.001; t=47.665, P<0.001). The minimally invasive safe approach of the knee joint for the treatment of PCL tibial insertion avulsion fractures is easy to operate, with minimal surgical trauma, safe and reliable approach, and satisfactory recovery of knee joint function after operation.

AO distractor and manual traction reduction techniques repair in distal tibial fractures: a comparative study

BackgroundMinimally invasive plate osteosynthesis (MIPO) via percutaneous plate placement on the distal medial tibia can be performed with minimizes soft tissue injury and produces good clinical results. However, the difficulty with MIPO lies in how to achieve satisfactory fracture reduction and maintain that reduction via indirect reduction techniques to facilitate internal fixation. The purpose of this study was to compare the effects of AO distractor and manual traction reduction techniques combined with MIPO in the treatment of distal tibia fractures.MethodsBetween January 2013 and December 2019, 58 patients with a distal tibia fracture were treated using MIPO. Patients were divided into two groups according to the indirect reduction method that was used: 26 patients were reduced with manual traction(group M), and 32 were reduced with an AO distractor (group A).Time until union and clinical outcomes including AOFAS ankle-rating score and ankle range of ankle motion at final follow-up were compared. Mean operative time, incision length, blood loss and postoperative complications were recorded via chart review. Radiographic results at final follow-up were assessed for tibial angulation and shortening by a blinded reader.ResultsMean operative time, incision length, and blood loss in group A were significantly lower than in group M(p = 0.019, 0.018 and 0.016, respectively).Radiographic evidence of bony union was seen in all cases, and mean time until union was equivalent between the two groups (p = 0.384).Skin irritation was noted in one case(3.1%) in group A and three cases(11.5%)in group M, but the symptoms were not severe and the plate was removed after bony union. There was no statistically significant difference in postoperative complications between the two groups(p = 0.461). Mean AOFAS score and range of ankle motion were equivalent between the two groups, as were varus deformity, valgus deformity, anterior angulation and posterior angulation. No patients had gross angular deformity. Mean tibial shortening was not significantly different between the two groups, and no patients had tibial shortening > 10 mm.ConclusionBoth an AO distractor and manual traction reduction techniques prior to MIPO in the treatment of distal tibial fractures permit a high fracture healing rate and satisfying functional outcomes with few wound healing complications. An AO distractor is an excellent indirect reduction method that may improve operative efficiency and reduce the risk of soft tissue injury.

The Use of Fluoroscan in Hand Clinic During the Covid Pandemic to Optimise Conservative Treatment.

IntroductionThe study assessed the use of Fluoroscan (Hologic, Inc., Marlborough, MA) in hand clinic as advised by the British Orthopaedic Association (BOA) during the COVID-19 pandemic to facilitate treatment of fractures requiring manipulation and reduce admissions to evaluate if this should be embedded in practice permanently.MethodEighty-three wrist and hand fractures requiring manipulation were identified between April 2020 and March 2021. Demographics, mechanism of injury, timing of intervention, radiological outcome, further intervention and functional assessment by QuickDASH scoring were recorded.ResultsSixty-eight cases were manipulated within the first week of fracture, simple pain control measures were used, and dose area product (DAP) averaged 1.3 Gy cm2 well below the dose limit set by the trust. Satisfactory fracture reduction was achieved in 59 cases avoiding admission. Further surgical intervention was offered to 24 patients: five re-manipulated while 19 had operation, all with a good functional outcome.ConclusionFluoroscan use in fracture clinics achieved effective fracture control in 77% of cases. The use of Fluoroscan avoided admissions for surgery during the pandemic and lengthy clinic visits, four out of five did not need admission.

Retrospective clinical outcomes in the definitive treatment of high-energy tibial diaphyseal fractures using hexapod external fixator versus monolateral external fixator

BackgroundExternal fixation, which can preserve the biomechanical microenvironment of fracture healing, plays an important role in managing the high-energy fractures with poor surrounding soft tissues. The purpose of this study was to determine the differences of clinical outcomes, if any, between hexapod external fixator and monolateral external fixator in the definitive treatment of high-energy tibial diaphyseal fractures.MethodsA total of 53 patients with high-energy tibial diaphyseal fractures and definitively treated by the hexapod external fixator (HEF) or monolateral external fixator (MEF) were retrospectively collected and analyzed, from March 2015 to June 2019. There were 31 patients in the HEF treatment, and the other 22 patients were managed by the MEF. The demographic data, surgical duration, external fixation time, final radiological results, complications, and clinical outcomes were documented and analyzed. Difficulties that occurred during the treatment were classified according to Paley. The clinical outcomes were evaluated by the Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) at the last clinical visit.ResultsThe mean surgical duration in the HEF group (62.4 ± 8.3 min) was shorter than that in the MEF group (91.4 ± 6.9 min) (P < 0.05). All patients acquired complete bone union finally. Patients in the HEF group (24.2 ± 3.1 weeks) underwent a shorter average external fixation time than that in the MEF group (26.3 ± 3.8 weeks) (P < 0.05). Satisfactory alignment was achieved in all patients without the need for remanipulation. The residual sagittal plane deformities in the HEF group were all less than that in the MEF group (P < 0.05). The complication rate was 35.5% in the HEF group, while 45.5% in the MEF group. There was no statistically significant difference between the two groups in ASAMI scores (P > 0.05).ConclusionThere is no statistically significant difference in finally clinical outcomes between hexapod external fixator and monolateral external fixator in the definitive treatment of high-energy tibial diaphyseal fractures. The hexapod external fixation treatment is a superior effective method, including advantages of stable fixation, less surgical duration, postoperatively satisfactory fracture reduction, and fewer complications.

Staged correction trajectory with hexapod external fixator for the satisfactory reduction of long bone shaft fracture

BackgroudWhen the reduction of long bone shaft fracture fragments is performed by a hexapod external fixator, the collision and interference between bony ends often results in an incomplete reduction and a time-consuming procedure. The purpose of this study was to present and determine the clinical effectiveness of staged correction trajectory with hexapod external fixator in the reduction of a long bone shaft fracture.MethodsA total of 57 patients with tibial shaft fractures treated by hexapod external fixator were retrospectively analyzed from June 2016 to February 2020. Thirty-one cases (Group I) underwent a conventional one-step reduction trajectory from June 2016 to July 2018. Starting in September 2018, the other twenty-six patients (Group II) underwent staged correction trajectory (three key points reduction trajectory of “distraction-derotation-reduction”). The demographic data, residual deformities before and after correction, number of repeated X-rays after the first postoperative X-ray, duration of deformity correction process, and external fixation time were analyzed. Johner-Wruhs criteria were used to evaluate the final clinical outcomes.ResultsAll the 57 patients achieved satisfactory fracture reduction and bone union. There were no significant differences between the two groups in demographic data, residual deformities before and after correction, external fixation time, and final clinical outcomes (p > 0.05). The average number of repeated X-rays after the first postoperative X-ray and mean duration of deformity correction process in Group II (1.3 times, 2.9 days) were all less than those in Group I (2.3 times, 5.1 days) (p < 0.05).ConclusionCompared with the conventional one-step reduction trajectory, there is no differences in final clinical outcomes, but the staged correction trajectory provides less repeated X-rays and shorter reduction process duration.

Intracortical screw insertion plus limited open reduction in treating type 31A3 irreducible intertrochanteric fractures in the elderly.

BACKGROUNDIn most elderly patients with intertrochanteric fractures, satisfactory fracture reduction can be achieved by closed reduction using a traction table. However, intertrochanteric fractures cannot achieve satisfactory reduction in a few patients, which is called irreducible intertrochanteric fractures. Especially for type 31A3 irreducible intertrochanteric fractures, limited open reduction of the broken end with different intraoperative reduction methods is required to achieve satisfactory reduction and fixation.AIMTo discuss clinical efficacy of intracortical screw insertion plus limited open reduction in type 31A3 irreducible intertrochanteric fractures in the elderly.METHODSA retrospective analysis was performed on 23 elderly patients with type 31A3 irreducible intertrochanteric fractures (12 males and 11 females, aged 65-89-years-old) who received treatment at the orthopedics department. After type 31A3 irreducible intertrochanteric fractures were confirmed by intraoperative C-arm, all of these cases received intracortical screw insertion plus limited open reduction in the broken end with intramedullary screw internal fixation. The basic information of surgery, reduction effects, and functional recovery scores of the hip joint were assessed. RESULTSAll patients were followed up for 13.8 mo on average. The operation time was 53.8 ± 13.6 min (40-95 min). The intraoperative blood loss was 218.5 ± 28.6 mL (170-320 mL). The average number of intraoperative X-rays was 22.8 ± 4.6 (18-33). The average time to fracture union was 4.8 ± 0.7 mo. The reduction effect was assessed using Kim’s fracture reduction evaluation. Twenty cases achieved grade I fracture reduction and three cases grade II fracture reduction. All of them achieved excellent or good fracture reduction. Upon the last follow-up, the functional recovery scores score was 83.6 ± 9.8, which was not significantly different from the functional recovery scores score (84.8 ± 10.7) before the fracture (t = 0.397, P = 0.694). CONCLUSIONWith careful preoperative preparation, intracortical screw insertion plus limited open reduction contributed to high-quality fracture reduction and fixation. Good clinical outcomes were achieved without increasing operation time and intraoperative blood loss.

Retrograde entry portal for cephalomedullary nailing in difficult subtrochanteric fractures.

An entry point medial to the tip of the greater trochanter is considered optimal for antegrade femur nailing. The deforming forces in a subtrochanteric fracture often make it difficult to establish a perfect entry point during antegrade cephalomedullary nailing. To overcome this problem, we report a simple technique of making a retrograde entry portal for select difficult subtrochanteric fractures. The technique was used in 12 subtrochanteric fractures. Our indications were morbid obesity, revision nailing and atypical fractures. The technique involves creating a nail entry portal through the fracture from distal to proximal taking advantage of the abducted proximal fragment. Fracture reduction and nail insertion then proceeds in a standard manner. Additional reaming of the thick endosteal lateral cortex through the fracture was performed in atypical fractures. Satisfactory fracture reduction was achieved in all patients and 11 out of the 12 fractures united in the series. 1 patient developed an infected nonunion and was considered failure of treatment. The retrograde entry portal is a valuable alternative method that can be considered in nailing of difficult subtrochanteric fractures to establish an ideal entry point and nail trajectory.

Outcomes of Femoral Neck Fractures Treated with Cannulated Internal Fixation in Elderly Patients: A Long-Term Follow-Up Study.

ObjectivesTo evaluate the long‐term efficacy of cannulated internal fixation in patients who sustain femoral neck fracture (FNF) and risk factors influencing the outcomes.MethodsThis retrospective study analyzed data from 73 elderly patients aged ≥60 years old, hospitalized for FNF and treated with cannulated internal fixation between August 2008 and July 2016. The inclusion criteria were: (i) patients aged ≥60 years; (ii) patients with recent femoral neck fracture, with times of injury ranging from 12–72 h; and (iii) patients who underwent Garden II–IV closed reduction and internal fixation. Patients were classified based on the Garden fracture type and Pauwels angle. Clinical data and radiographs before and after the surgery were collected. Subsequently, surgery was performed with the patient in supine position, under general or lumbar epidural anesthesia. Closed reduction was performed until satisfactory fracture reduction quality was achieved. The weight of all included patients were <75 kg, and thus, minimal internal fixation was performed. The ischemic necrosis of the femoral head was diagnosed by considering the symptoms, signs, and radiological findings. Harris hip scores were used to evaluate postoperative recovery of hip function. Furthermore, relationships between Garden fracture type and necrosis rate of the femoral head, Pauwels angle and necrosis rate of the femoral head, Garden fracture type and Harris hip score, and age and Harris hip score were analyzed.ResultsThe mean duration of surgery was 1 ± 0.17 h and blood loss for all the patients was approximately 15 mL. The included patients were followed up for 13–128 months, with an average follow‐up of 61 months. Among the included 73 patients, 65 (89.0%) exhibited satisfactory union, seven (9.6%) had femoral head necrosis, and one (1.4%) had nonunion. For seven patients with femoral head necrosis, there were two, two, and three patients classified as Garden IV, Garden III, and Garden II, respectively, and two and five patients classified as Pauwels II and Pauwels III, respectively. Among the seven cases, four underwent hip replacement. Garden fracture type was not significantly associated with femoral head necrosis (χ2 = 0.44, P > 0.05) or Harris score (χ2 = 1.43, P > 0.05). Patients with Pauwels I (0%) and II (4.3%) fractures exhibited a significantly lower necrosis rate than those with Pauwels III fractures (41.7%) (P < 0.05).ConclusionsCannulated internal fixation was more suitable for older Chinese patients with Pauwels I/II fractures than those with Pauwels III fractures.

Posterior monoaxial screw fixation combined with distraction-compression technology assisted endplate reduction for thoracolumbar burst fractures: a retrospective study

BackgroundThe management of thoracolumbar burst fractures traditionally involves posterior pedicle screw fixation, but it has some drawbacks. The aim of this study is to evaluate the clinical and radiological outcomes of patients with thoracolumbar burst fractures. They were treated by a modified technique that monoaxial pedicle screws instrumentation and distraction-compression technology assisted end plate reduction.MethodsFrom March 2014 to February 2016, a retrospective study including 42 consecutive patients with thoracolumbar burst fractures was performed. The patients had undergone posterior reduction and instrumentation with monoaxial pedicle screws. The fractured vertebrae were also inserted screws as a push point. The distraction -compression technology was used as assisting end plate reduction. All patients were followed up at a minimum of 2 years. These parameters including segmental kyphosis, severity of fracture, neurological function, canal compromise and back pain were evaluated in preoperatively, postoperatively and at the final follow-up.ResultsThe average follow-up period was 28.9 ± 4.3 months (range, 24-39mo). No patients had postoperative implant failure at recent follow-up. The mean Cobb angle of the kyphosis was improved from 14.2°to 1.1° (correction rate 92.1%). At final follow-up there was 1.5% loss of correction. The mean preoperative wedge angle was improved from 17.1 ± 7.9°to 4.4 ± 3.7°(correction rate 74.3%). The mean anterior and posterior vertebral height also showed significant improvements postoperatively, which were maintained at the final follow-up(P < 0.05). The mean visual analogue scale (VAS) scores was 8 and 1.6 in preoperation and at the last follow-up, and there was significant difference (p < 0.05).ConclusionBased on our experience, distraction-compression technology can assist reduction of collapsed endplate directly. Satisfactory fracture reduction and correction of segmental kyphosis can be achieved and maintained with the use of monoaxial pedicle screw fixation including the fractured vertebra. It may be a good treatment approach for thoracolumbar burst fractures.

Comparative evaluation of a single 2.0-mm AO locking reconstruction plate with conventional miniplate osteosynthesis for treatment of linear non-comminuted fractures of symphysis and parasymphsis region of the mandible

The objective of the study was to evaluate and compare the relative efficacy of treating linear non-comminuted mandibular fracture of symphysis and parasymphysis region using single 2.0-mm AO locking reconstruction plate or using two conventional miniplates. In this study, 80 patients of symphysis or parasymphysis fracture were divided randomly in two equal groups and treated with open reduction and internal fixation using two 2.5-mm miniplates or with a single 2.0-mm AO locking reconstruction plate. Operating time in case of open reduction and fixation using a single 2.0-mm locking reconstruction plate was significantly less when compared to open reduction and fixation using two conventional miniplates. Both groups showed satisfactory fracture reduction and healing. No postoperative malocclusion was noted, and both groups showed comparable improvement in masticatory efficiency. In conclusion, fracture fixation using a single 2.0-mm AO locking reconstruction plate without use of a second plate at the superior border for treatment of linear non comminuted mandibular fracture in symphysis and parasymphysis region gives comparable results as with treatment by conventional miniplate system and provides significant savings in operating time, ease of use and decrease in amount of hardware incorporated in the body.

External pelvic reduction frame system combined with tunnel screw fixation for Tile C1 pelvic fracture

Objective To investigate the efficacy of external pelvic reduction frame system combined with tunnel screw fixation in the treatment of Tile C1 pelvic fracture. Methods A retrospective case series analysis of 15 patients with Tile C1 pelvic fractures from January 2014 to October 2016 was performed. Clinical data included seven males and eight females, aged 26-84 years (mean, 48.9 years). According to Tile classification, there were five cases of type C1.1, three cases of C1.2, and seven cases of type C1.3. The average time from injury to surgery was 9.5 days (range, 4-33 days). All patients received the treatment of external pelvic reduction frame system combined with tunnel screw fixation. The operation time, intraoperative blood loss, and complications were recorded. The fracture reduction quality was evaluated according to the Matta criteria, and the clinical function and neurological function were evaluated by the Majeed functional scoring system and the Gibbons sacral nerve injury grading, respectively. Results The patients were followed up for an average of 16 months (range, 12-24 months). The mean operation time was 139 minutes (range, 50-250 minutes), and the mean intraoperative blood loss was 90 ml (range, 20-260 ml). No complications such as wound infection, loose internal fixation, rupture or loss of reduction occurred in the patients. According to the Matta score, 14 patients obtained anatomical reduction, and one obtained satisfactory reduction. At the last follow-up, according to the Majeed functional scoring criteria, the results were excellent in all 15 patients, with an excellent and good rate of 100%. According to Gibbons sacral nerve injury grading, two out of the three patients with neurologic impairment before the operation recovered completely while the remaining one did not recover. Conclusion In the treatment of Tile C1 pelvic fractures, external pelvic frame reduction system combined with tunnel screw fixation can attain satisfactory fracture reduction, reliable fixation, and good functional recovery. Key words: Pelvis; Fracture fixation; Surgical procedures, minimally invasive