Segmental Fractures Research Articles

Tertiary Care Orthopedic Hospital Experience to Find Effect of Dynamisation in Delayed Union Tibia Shaft Fracture

Objective: Our study was designed to evaluate the effect of dynamisation in delayed union tibia shaft fractures.
 Methodology: This prospective study was conducted at the Orthopedic Department, Shaheed Mohtarma Benazir Bhutto Medical College, from March 2020 to March 2021. During this timeframe total of 20 patients who underwent dynamisation for reamed intramedullary nailing were recruited. After two successive visits, those patients whose fracture failed to show progressive signs of callus formation underwent dynamisation. We removed the single static screw from the longer fracture segment to perform the dynamisation procedure. We inserted a poller screw slightly medial to the nail from anterior to posterior to provide additional stability to the proximal fragment. Statistical analysis was performed by using SPSS 23.0. For evaluating the success of dynamisation Chi-square test was used.
 Results: The mean age of recruited patients was reported as 35.92 years ranging from 16 years to 63 years old. Out of these twenty cases, 17 were male (85%). The mean time duration of nailing was reported as 35.4 hours. Total fourteen patients were immediately treated with nailing within 20 hours of injury, while the rest six underwent delayed nailing. Total four cases of tibial fracture were turned out as failure because the patient failed to achieve union after dynamisation and underwent augmentation plating with bone grafting for the complete union.
 Conclusion: Delayed dynamisation is a convenient and cost-effective technique to achieve union in femoral shaft fractures. Overall, our study reported an 80% success rate but failed to achieve early dynamisation in comminuted fractures.

Video-Assisted Thoracoscopic Internal Rib Fixation.

Rib fractures result in serious morbidity and mortality after trauma. Although there is ongoing debate about surgical rib fixation, it is increasingly important for some patients. Minimally invasive techniques for rib fixation are gaining traction within the trauma community. We present an observational experience at our level 1 trauma center with our first 10 cases of video-assisted thoracoscopic surgery (VATS) internal rib fixation. Video-assisted thoracoscopic surgery internal plates are especially helpful for rib fractures under the scapula, which are difficult to access traditionally. This technique is also excellent at reducing complex segmental fractures as the bridge can span across multiple fractures with a single post on either side. They also work well for posterior fractures where multiple screws cannot be placed. Video-assisted thoracoscopic surgery internal rib fixation is a viable and exciting option for surgical fixation. The plates work particularly well for certain fracture patterns.

Case report: Trans-clavicular plating and pedicled rectus abdominis flap for treatment of an open segmental clavicle fracture and scapulothoracic dissociation

Scapulothoracic dissociation, particularly in combination with open fractures of the shoulder girdle, can be associated with significant soft tissue injury and present challenges with coverage and fixation. A single case of an open scapulothoracic dissociation was reviewed. Case presentation, clinical course and initial outcomes are discussed. A 22-year-old patient presented with an open left segmental clavicle fracture, sternoclavicular dislocation and scapulothoracic dissociation after being ejected in a motor vehicle collision. The shoulder girdle was initially stabilized with trans-clavicular trans-manubrial plating followed by staged pedicled rotational rectus abdominis flap. Follow-up at 1 month revealed well healed wounds and 90 degrees of forward flexion. Patients with open fractures and scapulothoracic dissociation can present multiple challenges when considering fixation and soft tissue coverage. A viable option in these patients is a pedicled rotational rectus abdominis flap when more typical coverage options are precluded from associated injuries. • Scapulothoracic dissociation in conjunction with open fractures can present challenges for fixation and soft tissue coverage. • Trans-clavicular trans-manubrial plating is a fixation strategy that can be helpful in scapulothoracic dissociation. • Pedicled rotational rectus abdominis flap can be utilized when patient characteristics preclude other coverage options.

Delivery Technique for Fibular Strut Bone Grafting to Proximal Humerus Nonunion Fractures

Introduction: The prevalence of proximal humerus fractures will continue to increase as the population ages. Although the use of fibular strut grafts to treat these fractures is well established and has been used for many years, the authors present an alternative technique that aligns the graft within the intermedullary canal, and proximal segment, allowing for greater fragment and reduction control throughout the procedure. Materials and Methods: The technique involves intramedullary reaming and the usage of a #5 suture through the strut graft proximally that allows for easy placement of the graft across the fracture and into the humeral head after reduction. Results: The representative case described in this paper demonstrates a simplified technique for placement of a fibular allograft and fracture reduction with locking plate fixation for the treatment of proximal humerus nonunions. Discussion: The technique is an effective and simple method for the placement of a fibular strut allograft within the intramedullary canal of the distal and proximal segments of a proximal humeral fracture. The use of an endosteal fibular allograft strut addresses the need to re-establish the medial column of the humerus, provides local bone stock, and helps avoid varus angulation, and allows for improved fixation of the plate in poor quality bone.

Minimally invasive plate osteosynthesis without floating segment fixation for segmental fracture of femur.

Segmental fractures of the femur are technically difficult to manage by intramedullary nailing, the gold standard treatment. We specifically describe minimally invasive plate osteosynthesis (MIPO) without floating segment fixation for this particular fracture pattern. Twenty patients with segmental fractures of the femur were operated on by the MIPO technique. Data were collected on operative time, postoperative complications, union times, and clinical outcomes. The mean operative time was 63.5 minutes (range 50-90). There were no peri-operative complications. All fractures were united with a mean union time of 16.1 weeks (range 12-20). Regarding postoperative malalignment, limb shortening was demonstrated in 4 patients, valgus angulation in 2 and varus angulation in 3. One patient had a bent plate with 7°varus angulation. According to the Thoresen score, 13 were determined to be excellent values, 6 to be good and 1 to be fair. MIPO without floating segment fixation is a safe and effective alternative for segmental fractures of the femur especially in circumstances that are unsuitable or unfeasible for intramedullary nailing.

Unusual Occurrence of Incarceration and Breakage of the Coiled Shaft of the Intramedullary Reamer during Closed Intramedullary Nailing of Tibia.

Introduction:Intramedullary (IM) nailing is a well-established method of treating closed tibia shaft fracture. We hereby describe an unusual incidence of the incarceration of the flexible IM reamer in the distal fracture fragment with breakage of the coiled shaft of the reamer in the proximal third of tibia during closed IM nailing. This case report highlights the usefulness of making a small window in the tibia to aid retrograde removal of incarcerated reamer.Case Presentation:A 26-year-old male patient had road traffic accident and sustained a close fracture of the right distal 3rd tibia along with segmental fracture of the adjacent fibula. The tibia nailing was done under combined spinal and epidural anesthesia. The proximal tibia was approached by a midline incision with splitting of the patellar tendon. The reduction of the fracture fragments was done and the guide wire was inserted. The medullary canal was narrow and hence the initial reaming was started with the smallest available, that is, 8 mm reamer. After crossing the fracture site, we noticed that reamer coiled shaft got broken into multiple pieces in the medullary cavity at proximal 3rd tibia. The fracture site was exposed and a linear osteotomy was done in distal tibial fragment. Through this window, the broken reamer was pushed in the retrograde manner and was delivered out. Most of the broken metal pieces of the reamer shaft were removed with pituitary rongeur. An 8 mm solid IM nail was passed in antegrade manner across the fracture site and was locked distally and proximally. The operative wounds were irrigated and closure was done in layers. The patient was allowed partial weight bearing at 3 weeks post-surgery with gradually progressing to full weight bearing at 10 weeks after confirming clinical and radiological union.Conclusion:To handle this unusual occurrence one needs to stay calm, make a small window to aid retrograde removal of reamer and remove the fragmented pieces of the coiled shaft of the reamer. In tight medullary canal, it is desirable to have smaller diameter reamers, that is, 6 mm during the surgery.

X-Ray Film under Artificial Intelligence Algorithm in the Evaluation for Nursing Effect of Gamma Nail Internal Fixation in Elderly Patients with Intertrochanteric Fracture of Femur.

The aim of this work was to explore the effects of Gamma nail internal fixation for intertrochanteric fracture of femur by X-ray film classification and recognition method based on artificial intelligence algorithm. The study subjects were 100 elderly patients with intertrochanteric fracture of femur admitted to hospital. The cases were diagnosed as elderly (over 60 years old) femoral intertrochanteric fractures by X-ray or CT. They were divided into two groups, with 50 persons in each group: one group used the X-ray film evaluation image guidance based on the artificial intelligence algorithm (research group), and the other group did not use algorithmic guidance (control group). The results showed that the segmentation effect of the proposed algorithm was similar to the gold standard segmentation result, indicating that the algorithm was effective and feasible in the segmentation of fractures and bones. The global level set algorithm was set as the control. The ultimate measurement accuracy (UMA) value of the algorithm group was (1.77 ± 0.22), and the UMA value of the global level set algorithm group was (3.42 ± 0.36), indicating that the image processed by the algorithm group had obvious numerical effect, high accuracy, and good retention of details. The operation time, intraoperative blood loss, incision length, hospital stay, weight-bearing time, and fracture healing time of the two groups were all better than those of the control group. One month after surgery, the Harris score of the algorithm group was 67, and that of the control group was 51, with a 16-point difference between the two groups (p < 0.05). The patient had less pain and fast recovery speed, indicating that it was a good way to treat elderly intertrochanteric fractures with the nursing effect of X-ray Gamma nail internal fixation based on an artificial intelligence algorithm. The artificial intelligence algorithm not only can be applied to the Gamma nail internal fixation of elderly patients with intertrochanteric fractures but also can be applied to the X-ray image processing of other fractures and other surgical methods to provide effective treatment for fracture patients.

Impact of Early Rehabilitation in a Complex Case of Non-union of Tibial Plafond Fracture with Osteosynthesis Associated Infection – A Case Report

Background: Fractures of distal end of tibia associated with soft tissue injuries and fracture of distal fibular end are very complex and forms a total of 1-2% of all fracture of lower limb. These fractures are widely termed as plafond fractures.&#x0D; Case Presentation: A 26- year-old male, a follow up case, gave a history of road traffic accident following which he underwent corticotomy and application of external Ilizarovring fixator. At present due to non-union of the fracture segments patient got readmitted after a year. Further management through a three-step surgical approach was carried out. Rehabilitation program began from post-operative day 1 and was continued for a period of three weeks.&#x0D; Investigations: On the day of examination, the patient’s pain was severe on movement with presence of disuse trophy of lower limb musculature of the affected extremity. Ranges on the right lower limb at all joints were reduced due to pain. The X-ray showed presence of 9-hole recon plate fixed distally over talus and proximally to tibia.&#x0D; Management: Physiotherapeutic intervention began with educating the patient and the caregivers about the condition, the precautions to be taken, the expected time of healing and extent of healing. The exercise program was based on the principles of variability and individuality. The protocol was changed weekly with the observed progression in the patients range, muscles strength and ability to perform more challenging in bed activities.&#x0D; Conclusion: Early rehabilitation in complex cases of tibial plafond fracture facilitates the process of healing as well as maintain the patients level of functioning by maintain muscle properties. Post-operative complications are also reduced.

A nomogram for short-term recurrent pain after percutaneous vertebroplasty for osteoporotic vertebral compression fractures.

With the aging of China's population, the incidence of osteoporotic vertebral compression fractures (OVCF) has increased significantly. Percutaneous vertebroplasty (PVP) has been widely accepted due to its minimally invasive, rapid, and effective characteristics. However, it has been found that some patients have short-term recurrent pain (SRP) in the original site after surgery in practical clinical work. We retrospectively reviewed the clinical data of OVCF patients who were treated with PVP in our center from January 1st, 2019, to December 30th, 2020. A total of 296 patients were enrolled in the study cohort, and patients were randomly divided into the training set (70%) and validation set (30%). Univariate and multivariate logistic regression analyses were used to determine the risk factors of SRP, and a nomogram predictive model was established accordingly. The model was evaluated by calibration curve, receiver operation characteristic (ROC) curve, and decision curve analysis (DCA). Among the 296 patients, 83 (27.85%) patients experienced SRP after surgery. The independent risk factors included fracture segments (OR: 14.148, 95%CI: 1.532-130.661; p < 0.019), number of surgical vertebrae (OR: 7.896, 95%CI: 3.007-20.729; p < 0.001; (OR: 12.563, 95%CI: 2.223-70.993; p = 0.004), and smoking (OR: 3.833, 95%CI: 1.219-12.052; p = 0.022). The AUC of the prediction model was 0.819 in the training set and 0.794 in the validation set. The calibration curve and DCA indicated the good performance of this nomogram. The nomogram prediction model had satisfactory accuracy and clinical utility, which may benefit clinical decision-making for the treatment of OVCF and strengthen patient education.

Complications of Surgical Treatment of Adult Scoliosis

Introduction: With the increase in global life expectancy, the number of patients presenting with progressive spinal deformities is also on rise. The increasing frequency of surgical intervention as a treatment of this group of patients is associated with many complications and also with increasing rate of reoperation.&#x0D; Methodology: Seventy-two cases of adult scoliosis were treated surgically in Ain Shams spine unit with a minimum follow-up of five years (average, 76 months). Preoperative clinical and radiological evaluation was done, with special emphasis on the degree of pains (back and leg), Oswestry Disability Index (ODI), scoliosis angle, lumbar lordosis, any instability, and the level of spinal canal stenosis needing decompression. The pelvic incidence was measured preoperatively to plan the amount of lordosis needed to be restored.&#x0D; Result: The mean preoperative scoliosis angle was 22 ± 10.4º (16 to 34º) and the mean preoperative lordosis angle was 20.3 ± 12.7º (–15 to –28º). The mean preoperative ODI score was 54.7 ± 5.5, and the mean postoperative scoliosis angle improved to 7.4 ± 3.3. The mean postoperative lordosis angle became 37.3 ± 8.6, and the mean postoperative ODI score was 21.3 ± 3.8.&#x0D; Conclusion: The list of complications included seven cases of pseudoarthrosis and screw loosening, adjacent segment fracture in nine cases, and one case of spondylodiscitis at a level just proximal to the fused level. These 17 cases needed reoperations (24%). Additionally, there were five cases of dural tear, prolonged graft side pain in one case, and two cases of superficial wound infections.

Comparison of Effect of Navigation Versus No Navigation on Vertebral Body Screw Placement in Anterior Approach Surgery for Thoracolumbar Burst Fractures: A Randomized Controlled Trial

We evaluated the effects of using a navigation technique with anterior approach surgery for thoracolumbar burst fractures on vertebral body screw placement and discussed its effects on the long-term prognosis of patients. We performed a prospective study of patients who had undergone anterior approach thoracolumbar surgery from May 2018 to August 2019. The 40 patients were randomly divided into the navigation group (NG) and control group (CG). In the NG, vertebral body screw placement was performed with 2-dimensional navigation guidance. For the CG, no navigation guidance was used. The clinical and radiological evaluations of the 2 groups were compared preoperatively, immediately after surgery, and at the final follow-up. Paired t tests and the χ2 test were used to evaluate the clinical and radiological indicators. No differences were found in the hospital stay, operation time, autologous blood recovery, postoperative drainage volume, Cobb angle of the preoperative coronal plane and sagittal plane, postoperative sagittal plane, postoperative Cobb angle of the coronal and sagittal planes measured on radiographs and computed tomography scans between the 2 groups (P > 0.05). The correction of the kyphosis deformity of the fracture segment was better in both groups (P < 0.001). The intraoperative blood loss and Cobb angle of the postoperative coronal plane in the NG was less than that in the CG (P < 0.05). Also, the 4 vertebral body screws in the NG were more parallel to the endplate than were those in the CG. We found that the use of navigation can improve the accuracy of screw placement in anterior approach surgery for thoracolumbar burst fractures and improve patients' long-term prognosis.

Study to Determine the Outcomes of Closed Tibial Shaft Fractures Treated with Reamed Inter Locking Nails

Aim: The aim of the study is to evaluate the results of treatment of a closed reamed interlocking in the treatment of closed fractures of the tibial shaft. Study design: A Descriptive observational study Venue and Duration: This study was conducted in the Orthopedic department of Ayub Teaching Hospital, Abbottabad for six months duration i.e from September 2020 to February 2021. Patients and methods: The study included 43 patients over 19 years of age. The patients were taken to the emergency and Orthopedic department for surgery of Ayub Teaching Hospital, Abbottabad for six months duration i.e from September 2020 to February 2021. Written approvals were granted from all selectees. Detailed history was asked and each patient was assessed clinically and radiographically. The reamed intramedullary nailing performed according to the protocol. Patients were followed for 1 year and assessed for infection, union, knee and ankle range of motion, and implant problems. 3 patients were excluded from follow-up, and the study was held in 40 patients. Results: All fractures were having complete union without the need for bone grafting. Simple fractures have union at mean of 14 weeks, comminuted and segmented fractures have union for longer than five weeks, and a mean duration of 18.5 weeks. Superficial infection at the screw site occurred in two patients, and the drainage was done, antibiotics were given and distal screw were removed, respectively. While all patients had a full range of knee motion, 37 patients had a full range of ankle movement. The other three patients had a 15-to-20-degree dorsiflexion loss at the ankle joint. No nail fracture, proximal screw end fracture in one patients and distal screw fracture in two patients were observed. Conclusion: We came to the conclusion that closed intramedullary nailing in the case of a closed shaft fracture of the tibia is a safe and satisfactory technique with a high rate of union and a relatively low complication rate and early return to activity. Keywords: Fracture, Internal, Fixation, Interlocking nail.

Study of open versus closed reduction of mandibular condyle fractures

Background: Condylar fractures of the mandible are a commonest occurrence in maxillofacial surgery. Many surgeons prefer closed therapy with maxillomandibular fixation, while open treatment with rigid internal fixation has become more common in recent years. This study provides a comparative evaluation of open and closed reduction of the mandibular condyle.Methods: The 50 patients with condylar fractures were treated with open and closed reduction as per the requirement.Results: A higher incidence of unilateral segmented condylar fractures were seen in young adult males. Open reduction and internal fixation (ORIF) with a combined approach was the preferred treatment of choice with fewer post-op complications.Conclusions: ORIF is a suitable technique in the treatment of condylar fractures as it promises few complications.

The statistical shape model as a quality assurance measure in the treatment of complex midface fractures: a case control study

BackgroundComplex bilateral midface fractures necessitate a surgically challenging procedure to preserve or restore the occlusion and the sensitive eye area. In this case control study, we aim to show the potential of a statistical shape model (SSM) for measuring the quality of the midface reconstruction, compared to the estimated preoperative situation.MethodsAn individualized SSM was postoperatively registered on 19 reconstructed complex bilateral midface fractures. Using this SSM, the distances from the simulated preoperative situation to the postoperative positions of the fracture segments were calculated. The fracture lines for Le Fort II, Le Fort III, and NOE fractures were chosen as reference points for the distance measurements.ResultsThe SSM could be registered on all 19 complex bilateral midface fractures. All analyzed fractures showed a dorsal impaction (negative values) of the midface. Le Fort II fractures showed deviation values of –0.98 ± 4.6 mm, Le Fort III fractures showed values of –3.68 ± 3.6 mm, NOE type 2 fractures showed values of –0.25 ± 4.6 mm, and NOE type 1 fractures showed values of –0.25 ± 4.6 mm.ConclusionsThe SSM can be used to measure the quality of the achieved reduction of complex bilateral midface fractures based on the estimated preoperative situation.Trial registrationDRKS00009719.

Comparative evaluation of biting force in 2mm locking plates with 2mm miniplates in the treatment of mandible fractures: A clinical study

1. To compare efficacy of 2mm locking plates with 2mm miniplates in the fixation of mandible fractures and 2. To evaluate and compare the biomechanical function by measuring the bite force at 1st week, 3rd week, 6th week and 3rd month postoperatively in 20 patients divided equally into two study groups.A prospective randomized study was carried out at Department of Oral and Maxillofacial Surgery, Meghna Institute of Dental Sciences, Nizamabad from 2019 to 2021 to treat consecutive mandibular fractures where patients were randomly divided into two groups each composed of 10 patients where Group A were treated with single 4 holed stainless-steel locking miniplates and Group B with two 4 holed stainless steel conventional mini plates both maintaining a gap of 2.0 mm system. Later assessment was done using bite force recording postoperatively at 1st week, 3rd week, 6th week and 3rd month and with the associated complications like Swelling, Infection, Paresthesia, Mobility between fracture fragments and Hardware failure.When the mean bite force values in right molar region of group A and group B were compared at 1st week, 3rd week, 6th week and 3rd month, there was statistically significant increase in bite force noted in group A when compared to group B at 1st week and 3rd week (P&amp;#60;0.05). But no statistically significant differences were observed at 6th week and 3rd month (P&amp;#62;0.05).When the mean bite force values in the central incisor region of group A and group B were compared at 1st week, 3rd week, 6th week and 3rd month, there was statistically significant increase in bite force noted in group A compared to group B at 1st week and 3rd week (P&amp;#60;0.05). But no statistically significant differences were observed at 6th week and 3rd month (P&amp;#62;0.05).When the mean bite force values in left molar region of group A and group B were compared at 1st week, 3rd week, 6th week and 3rd month, there was statistically significant increase in bite force noted in group A when compared group B at 3rd week (P&amp;#60;0.05). But no statistically significant differences were observed at 1st week, 6th week and 3rd month (P&amp;#62;0.05).The study signifies that both the fixation systems were able to provide stability to fracture segments, but locking plate system has provided better stability when compared to miniplates system, hence recommending for more elaborative studies to arrive at definitive conclusion.

Retrospective study about the postoperative stability of zygomaticomaxillary complex fracture

BackgroundThe aim of this study is to evaluate the postoperative stability of zygomaticomaxillary complex (ZMC) fractures according to the number of fixation sites and to investigate the direction of postoperative displacement of the unfixed part of the fractured segment.MethodsThis study was retrospectively performed on 38 patients who were treated by open reduction and internal fixation of ZMC fractures and were taken postoperative computed tomography (CT) between February 2012 and July 2019. The patients were classified into 3 groups: 1-point fixation, 2-point fixation, 3-point fixation according to the number of fixations. The postoperative displacement of the fractured segment was evaluated by the superimposition between postoperative CT and follow-up CT, and the postoperative stability according to the fixation sites was investigated through the amount of postoperative displacement. In addition, it was investigated in which direction the location of the fractured segment was changed in the unfixed fractured segment according to the fixation sites.ResultsThe amount of postoperative displacement of the fractured segment was 0.75 ± 1.18 mm on average.In the postoperative displacement of the distal area according to the number of fixation of the fracture, there was no statistically significant difference in the amount of displacement of the fracture (p = 0.574).As for the direction of the change in the location of the fractured segment, 12 patients among 38 patients with the change in the location of the fractured segment were investigated, and the displacement in the medial direction (n = 11, 91.67%) was the most common in all three fixation methods.ConclusionIn patients with a ZMC fracture who were treated by open reduction and internal fixation, the number of fixations did not make the difference in the postoperative displacement of the fracture. In addition, the fractured segment mainly changes in the medial direction after surgery, and this fact can be used as a reference for the reduction direction during surgery for the stable prognosis.

Management of Metaphyseal Tibial Fractures by Expert Tibial Nail System

Background: Metaphyseal tibial fractures contain distal and proximal metaphyseal fractures which account for (3-11%) and (5-11%) of total tibial fractures, respectively. Numerous treatment options exist for treating metaphyseal tibial fractures. Objectives: The aim of the current work was to assess the clinical and radiological functional outcomes of expert tibial intramedullary nail in treatment of metaphyseal tibial fractures in adult. Patients and Methods: This prospective study included a total of 12 patients who had metaphyseal tibial fractures, attending at Zagazig University Hospital and Damietta Specialized Hospital. Patients were operated by closed reduction and internal fixation with expert interlocking tibial nail and followed up for average 6 months from November 2019 to December 2020. Results:All patients underwent full history taking, Clinical examination and Radiographic views were taken for other skeletal injuries if suspected. 2 patients (16.7%) has proximal tibial fracture, 1 (8.3%) of them had excellent final result and 1 (8.3%) had good final result. 2 patients (16.7%) had segmental tibial fracture,1(8.3%) of them had excellent final result and 1 (8.3%) had fair final result. 8 (66.7%) patients had distal tibial fractures, 6 (50%) had excellent final result, 1 (8.3%) had good final result,1 (8.3%) had poor final result. Conclusion: It could be concluded that intramedullary fixation with expert interlocking tibial nail is a safe and effective method for the treatment of metaphyseal tibial fractures. Multiple reduction aids as percutaneous clamps, blocking screws/wires help in obtaining and maintaining reduction. The nail design allows the distal or proximal segment to be controlled through placement of multiple locking screws within a small distance from the articular surface. The alignment can be well maintained despite the short metaphyseal segment. Expert nail showed excellent and good results in more than 83% in this study.

CSR-Net: Cross-Scale Residual Network for multi-objective scaphoid fracture segmentation.

The scaphoid is located in the carpals. Owing to the body structure and location of the scaphoid, scaphoid fractures are common and it is difficult to heal. Three-dimensional reconstruction of scaphoid fracture can accurately display the fracture surface and provide important support for the surgical plan involving screw placement. To achieve this goal, in this study, the cross-scale residual network (CSR-Net) is proposed for scaphoid fracture segmentation. In the CSR-Net, the features of different layers are used to achieve fusion through cross-scale residual connection, which realizes scale and channel conversions between the features of different layers. It can establish close connections between different scale features. The structures of the output layer and channel are designed to establish the CSR-Net as a multi-objective architecture, which can realize scaphoid fracture and hand bone segmentations synchronously. In this study, 65 computed tomography images of scaphoid fracture are tested. Quantitative metrics are used for assessment, and the results obtained show that the CSR-Net achieves higher performance in hand bone and scaphoid fracture segmentations. In the visually detailed display, the fracture surface is clearer and more intuitive than those obtained from other methods. Therefore, the CSR-Net can achieve accurate and rapid scaphoid fracture segmentation. Its multi-objective design provides not only an accurate digital model, but also a prerequisite for navigation in the hand bone.

Influence of fractures in different inferior orbital wall locations on ocular motility disorders.

Influence of fractures in different inferior orbital wall locations on ocular motility disorders.

Sternal Fracture Fixation with a Steel Wire: The New “Timala” Technique

Purpose Traumatic sternal fractures are rare but quite disabling injuries. Timely fixation of sternal fractures reduces pain and prevents respiratory complications. However, the fixation technique should be simple, effective, and readily available in local circumstances. Methods From January 2014 to March 2020, seven patients with sternal fracture/ dislocation underwent steel wire fixation with the new “Timala” technique. In this technique, adjacent ribs are anchored with two steel wires to form an “X” in front of the fractured segment of the sternum. Patients were followed up clinically and radiologically. Results Six of the patients were men and one was a female. Five of them had injuries due to falls and two were injured in road traffic accidents. Their age ranged from 18 years to 76 years, with a median age of 41 years. All seven patients experienced immediate recovery from pain and showed evidence of fracture healing on postoperative chest X-rays and clinical examinations. Conclusions Anchoring ribs to fix the sternum with steel wire is a safe, effective, easily available, and reproducible method to fix sternal fractures or dislocations.