Shorter Fracture Healing Time Research Articles

Application of internal fixator system for anterior pelvic ring with simultaneous application of sacroiliac screw internal fixation of the posterior pelvic ring in Tile C-type unstable pelvic fractures

Background/Aim. The number of pelvic traumas is increasing globally, mostly due to car accidents but also due to an increasing number of sports and recreational traumas. Tile C-type unstable pelvic trauma (TCUPT) is a kind of high-energy trauma that occurs during traffic accidents or accidents when falling from big heights. The aim of our study was to explore the application of the internal fixation (INFIX) system for the anterior pelvic ring (APR) with simultaneous application of sacroiliac screw (SS) INFIX of the posterior pelvic ring (PPR) in TCUPT. Methods. The subjects (89 of them in total) were recruited among patients with TCUPT from December 2020 to December 2023. A retrospective analysis of the subjects? data was performed, after which the subjects were divided into two groups based on different therapeutic regimens applied: group A (INFIX system for the APR + SS IN-FIX of the PPR, n = 46) and group B (external fixator for the APR + SS INFIX of the PPR, n = 43). Results. In comparison with group B, group A had a shorter period before the commencement of the first activity after surgery, shorter fracture healing time and joint function recovery time, as well as length of hospital stay (t = 6.623, 4.796, 7.992, and 5.227, respectively, p < 0.05). The surgery duration and bleeding volume showed no significant differences between the two groups (t = 1.433, 1.123, respectively, p > 0.05). The fracture reduction outcomes were better in group A than in group B (Z = 2.058, p < 0.05). The incidence rate of complications was lower in group A than in group B (2.17% vs. 18.60%) (?2 = 4.917, p < 0.05). Conclusion. For patients with TCUPT, the INFIX system for the APR with simultaneous application of SS INFIX of the PPR achieves good fracture reduction outcomes.

Treatment of proximal humeral fractures accompanied by medial calcar fractures using fibular autografts: A retrospective, comparative cohort study.

Severe proximal humerus comminuted fractures are often accompanied by medial calcar comminuted fractures and loss of medial support, which are important factors that lead to internal fixation failure. The appropriate treatment for proximal humerus comminuted fractures has not been established. Therefore, this study assessed the outcomes of using a fibular autograft with locking plates to treat severe proximal humerus comminuted fractures. To investigate the outcomes of using a fibular autograft with locking plates to treat severe proximal humerus comminuted fractures. This retrospective, comparative cohort study included two groups of patients. Group 1 comprised 22 patients and group 2 comprised 25 patients with complete follow-up data. Group 1 was treated with a fibular autograft with open reduction and locking plates to enable internal fixation. Group 2 was treated with open reduction and locking plates to enable internal fixation. The intraoperative blood loss volume from the shoulder wound, operative time, shoulder wound pain, bone fracture healing time, Constant-Murley score of the shoulder joint, preoperative Holden walking function score, Mallet score of the shoulder joint, and humeral neck-shaft angle during surgery of the two groups were compared, and the differences were analysed using an independent sample t-test. Group 1 had a shorter mean operative time than group 2 (2.25 ± 0.30 h vs 2.76 ± 0.44 h; P = 0.000). Group 1 had a lower shoulder wound pain score on the first day after surgery than group 2 (7.91 ± 1.15 points vs 8.56 ± 1.00 points; P = 0.044). Group 1 had a shorter fracture healing time than group 2 (2.68 ± 0.48 mo vs 3.64 ± 0.64 mo; P = 0.000). Group 1 had higher Constant-Murley scores of the shoulder joint at 3, 6, and 12 mo after surgery than group 2 (76.64 ± 4.02 points vs 72.72 ± 3.02 points, 86.36 ± 3.53 points vs 82.96 ± 3.40 points, and 87.95 ± 2.77 points vs 84.68 ± 2.63 points, respectively; P = 0.000, 0.002, and 0.000, respectively). Group 1 had higher Mallet scores of the shoulder joint at 3, 6, and 12 mo after surgery than group 2 (10.32 ± 0.57 points vs 9.96 ± 0.54 points, 13.36 ± 1.00 points vs 12.60 ± 0.87 points, and 13.91 ± 0.75 points vs 13.36 ± 0.70 points, respectively; P = 0.032, 0.007, and 0.013, respectively). Using locking plates with a fibular autograft can recreate medial support, facilitate fracture healing, and improve shoulder function; therefore, this may be an effective treatment option for severe proximal humerus comminuted fractures.

Comparison of percutaneous compression plate to parallel screws in the treatment of nondisplaced femoral neck fractures in elderly patients: a prospective, randomized study.

The optimal internal fixation for non-displaced femoral neck fractures remains controversial. This study aimed to compare the clinical results of the percutaneous compression plate (PCCP) with parallel screws (PS) in treating femoral neck fractures in elderly patients. A total of 218 patients who underwent internal fixation were randomized to receive either a percutaneous compression plate (PCCP group) or parallel screws (PS group) using a computerized random sequence generator which was used to assign the order of randomization. Patients were assessed by the operating time, intraoperative blood loss, hemoglobin level drop, postoperative hospital stay, the time to full weight-bearing, reduction quality, fracture healing time, Harris hip score, and postoperative complications. There was no significant difference between PCCP and PS groups regarding operative time, intraoperative blood loss, hemoglobin level drop, postoperative hospital stays, reduction quality, and Harris hip score (p > 0.05). The time to full weight-bearing and the fracture healing time in the PCCP group were shorter than those in the PS group (p < 0.05). The overall complication rates were slightly lower in the PCCP compared to the PS patients, but there was no significant difference (p > 0.05). However, the implant failure rate was significantly higher in the PS group compared to the PCCP group (p < 0.05). The present study suggests that the PCCP is superior to the parallel screws fixation in the treatment of non-displaced elderly femoral neck fractures in terms of earlier full weight-bearing, shorter fracture healing time, and lower implant failure rate. Therefore, it may be a better therapeutic strategy for non-displaced femoral neck fractures in elderly patients.

Clinical observation and finite element analysis of femoral stable interlocking intramedullary nail in intertrochanteric fractures.

This study was designed to compare clinical outcomes of the femoral stable interlocking intramedullary nail (FSIIN) with proximal femoral nail anti-rotation (PFNA) for the treatment of intertrochanteric fractures (OTA 31A1 + A2). This study retrospectively analyzed a registered sample of 74 intertrochanteric fractures (OTA 31A1 + A2) surgically treated using FSIIN (n = 36) or PFNA (n = 38) from January 2015 to December 2021. The intra-operative variables (operation time, fluoroscopy time, intra-operative blood loss, length of incision) and fracture healing time were compared between the two groups in this study. Harris hip score (HHS) and visual analog scale (VAS) were used to evaluate the functional states. At the last follow-up, the incidence of related complications in patients was calculated. Eventually, the 3D finite element model was established to analyze the stress of FSIIN and PFNA. The distribution of all basic characteristics was similar between the two groups (p > 0.05). The operation time, fluoroscopy time, intra-operative blood loss, and length of incision were significantly decreased in the FSIIN group (p < 0.001). The FSIIN group had a shorter fracture healing time than the PFNA group (p < 0.001). There is no significant difference between the two groups in the Harris and VAS (p > 0.05). The incidences of post-operative anaemia, electrolyte imbalance, varus malalignment, and thigh pain were significantly lower in FSIIN than in PFNA groups (all p < 0.05). The finite element results show that the stress shielding effect of FSIIN is smaller. Our study revealed that FSIIN seemed to be superior to PFNA in the treatment of intertrochanteric fractures (OTA 31A1 + A2) due to less surgical damage and shorter fracture healing time.

Titanium elastic nails vs locking plate in pediatric subtrochanteric femur fractures: A systematic review and meta-analysis.

Titanium elastic nails (TENs) and locking plates (LPs) are currently the main internal fixation for treating pediatric subtrochanteric femur fractures, and the optimal choice of internal fixation is controversial. This study aimed to systematically evaluate the effectiveness and safety of TENs and LPs in treating subtrochanteric fractures in children to provide a theoretical basis and reference for clinical treatment. The literature related to TENs and LPs for treating subtrochanteric fractures in children was searched using the CNKI, PubMed, Cochrane, Embase, and Web of Science, and the search time frame was from the establishment of the database to October 2022. Two evaluators screened the literature according to the inclusion and exclusion criteria and extracted relevant data. Meta-analysis was performed using Stata14.0 software. A total of 9 studies with 407 patients with subtrochanteric femur fractures were included in the final screening, including 210 cases with TENs and 197 cases with LPs. Meta-analysis results showed that compared with the locking plate, TEN had a shorter operative time [WMD = -1.3, 95%CI(-1.94,-0.66), p < 0.01], less intraoperative bleeding [WMD = -84.45, 95%CI(-111.09, -57.82), p < 0.01], shorter fracture healing time [WMD = -1.3, 95%CI(-1.94,-0.66), P < 0.01], shorter hospital stays [WMD = -2.80, 95% CI(-4.63,-0.98), p < 0.01], and earlier full weight bearing [SMD = -0.48, 95% CI(-0.91,-0.04), p < 0.05] but more intraoperative fluoroscopy [WMD = 28.23, 95% CI(15.22,41.25), p < 0.05]. The overall complication rate was high [OR = 3.52, 95% CI(1.96,6.34), p < 0.05], and the postoperative period was prone to angulation, rotation, and inversion deformity [OR = 3.68, 95% CI(1.40, 9.68), p < 0.05]. No significant difference in the incidence of lower limb inequality between the two types of internal fixation [OR = 0.83, 95% CI(0.38, 1.85), p > 0.05] and no significant difference in the Harris score of the hip at the last follow-up between the two types of internal fixation [WMD = -0.67, 95% CI(-2.01,0.67), p > 0.05] were found. In comparison to LPs, TENs have a shorter operation time, less intraoperative bleeding, and a shorter fracture healing time, and the child can be fully weight-bearing earlier. Locking plates can reduce the operator's x-ray exposure, and the incidence rate of postoperative angulation, rotation, and inversion deformity is low. Therefore, TENs and LPs are the best internal fixation methods for treating subtrochanteric fractures in children.

Modified internal fixator combined with sacroiliac screws in treatment of Tile C1.3 pelvic fracture

To investigate the effectiveness of modified internal fixator (INFIX) to fix the anterior pelvic ring for Tile C1.3 pelvic fracture by comparing with the traditional INFIX. The patients with Tile C1.3 pelvic fractures admitted between April 2018 and June 2021 were taken as the study objects. Of them, 55 cases were included in the study according to the selection criteria. During operation, the anterior pelvic ring was fixed with the modified INFIX in 30 cases (modified group) and with the traditional INFIX in 25 cases (control group). The posterior pelvic ring in 55 cases was fixed with sacroiliac screws. There was no significant difference between the two groups in gender, age, cause of injury, time from injury to operation, and combined injury ( P>0.05). The operation time, intraoperative blood loss, and complications were recorded and compared between the two groups. The X-ray film was taken to evaluate the reduction of the anterior pelvic ring after operation, grade the reduction according to the Matta scoring standards, and observe the fracture healing and healing time. The function was evaluated according to Majeed scoring standards during follow-up. The operation time of the modified group was significantly longer than that of the control group ( Z=-3.837, P<0.001), but there was no significant difference in the intraoperative blood loss between the two groups ( t=-1.831, P=0.076). All patients were followed up 12-18 months (mean, 14 months). X-ray film reexamination showed that the excellent and good rate of Matta scoring for anterior pelvic ring reduction in the modified group was 88.00%, which was significantly better than that in the control group (63.33%) ( χ 2=4.373, P=0.037). All fractures healed, and the fracture healing time of the modified group and the control group was (12.04±3.59) and (14.83±4.83) weeks respectively, with a significant difference ( t=2.401, P=0.020). At last follow-up, the excellent and good rates of Majeed scoring were 80.00% in the modified group and 76.67% in the control group, with no significant difference ( χ 2=0.089, P=0.766). In the modified group, 2 cases (8%) had complications, all of which were incision infection above pubic symphysis. In the control group, 9 cases (30%) had complications, including 5 cases of lateral femoral cutaneous nerve injury, 2 cases of femoral nerve paralysis, and 2 cases of delayed fracture healing. The incidence of complications was significantly lower in the modified group than in the control group ( χ 2=4.125, P=0.042). Compared with the traditional INFIX, the modified INFIX to fix the anterior pelvic ring for Tile C1.3 pelvic fracture has fewer complications, better stability, shorter fracture healing time, and lower risk of nerve injury.

Surgical Versus Conservative Management for Treating Unstable Atlas Fractures: A Multicenter Study.

This multicenter study compared radiological parameters and clinical outcomes between surgical and nonsurgical management and investigated treatment characteristics associated with the successful management of unstable atlas fractures. We retrospectively evaluated 53 consecutive patients with unstable atlas fracture who underwent halo-vest immobilization (HVI) or surgical fixation. Clinical outcomes were assessed using neck visual analogue scale and disability index. The radiological assessment included total lateral mass displacement (LMD) and the anterior atlantodental interval (AADI). Thirty-two patients underwent surgical fixation and 21 received HVI (mean follow-up, 24.9 months). In the surgical fixation, but not in the HVI, LMD, and AADI showed statistically significant improvements at the last follow-up. The osseous healing rate and time-to-healing were 100% and 14.3 weeks with surgical fixation, compared with 71.43% and 20.0 weeks with HVI, respectively. Patients treated with HVI showed poorer neck pain and neck disability outcomes than those who received surgical treatment. LMD showed an association with osseous healing outcomes in nonoperative management. Clinical outcomes and osseous healing showed no significant differences according to Dickman's classification of transverse atlantal ligament injuries. Surgical internal fixation had a higher fusion rate, shorter fracture healing time, more favorable clinical outcomes, and a more significant reduction in LMD and AADI compared to nonoperative management. The pitfalls of external immobilization are inadequate maintenance and a lower probability of reducing fractured lateral masses. Stabilization by surgical reduction with interconnected fixation proved to be a more practical management strategy than nonoperative treatment for unstable atlas fractures.

Effect of Different Reduction Intramedullary Nails on Spiral Fracture of Middle and Lower Tibia.

Objective To compare the efficacy of different reduction and intramedullary nailing in the treatment of spiral fracture of middle and lower tibia. Method A total of 96 patients with spiral fractures of middle and lower tibia treated with intramedullary nails were retrospectively analyzed. The patients were divided into closed functional reduction group, open anatomical reduction group, and closed anatomical reduction group according to different treatment methods. The operation time, intraoperative blood loss, intraoperative fluoroscopy times, fracture healing time, fracture nonunion, wound complications, and healing conditions of the three groups were compared. Results The operation time and intraoperative fluoroscopy times of patients in the closed anatomical reduction group were significantly increased compared with those in the closed functional reduction group, while the fracture healing time was significantly reduced. However, patients in the open reduction group had significantly more intraoperative blood loss than those in the closed reduction group. The mean follow-up duration of patients was 15.81 ± 3.25 months. Open anatomical reduction was found to have a higher complication rate during follow-up. Specifically, a total of 3 cases recovered after 2 times of surgical treatment. 6 cases showed a small gap at the fracture end which did not affect the function. Conclusion In the treatment of middle and lower spiral fracture of tibia, closed anatomical reduction and intramedullary nail internal fixation have shorter fracture healing time, less blood loss, and fewer complications, which can act as the first surgical choice. However, open reduction and intramedullary nailing have a high complication rate, which is not recommended.

Locking plate external fixation combined with membrane induction technology for the treatment of open and comminuted tibial fractures with bone defects

To explore clinical effect of locking plate external fixation combined with membrane induction technology in treating open and comminuted tibial fractures with bone defects. Totally 92 patients of open and comminuted tibial fractures with bone defects were chosen form January 2018 to July 2019, and randomly divided into external fixation group and internal fixation group, 46 patients in each group. In external fixation group, there were 29 males and 17 females, aged from 25 to 62 years old, with an average of (37.45±10.92) years old;according to AO classification, 15 patients were type A, 22 patients were type B and 9 patients were type C;according to Gustilo classification, 21 patients were typeⅡ, 10 patients were type ⅢA, 10 patients were type ⅢB, 5 patients were type Ⅲ C;treated by fracture reduction with locking plate external fixation. In internal fixation group, there were 31 males and 15 females, aged from 23 to 60 years old, with an average of(36.88±10.64) years old;according to AO classification, 18 patients were type A, 20 patients were type B and 8 patients were type C; according to Gustilo classification, 22 patients were typeⅡ, 11 patients were type ⅢA, 7 patients were type ⅢB, 6 patients were type Ⅲ C;treated by traditional open reduction with plate internal fixation. Operation time, intraoperative blood loss, incision length, hospital stay, fracture healing time and lower limb full weight-bearing time and postoperative complications between two groups were observed and compared, bone mineral density, osteocalcin, blood calcium and phosphorus before operation and 1 month after operation. All patients were followed up from 12 to 18 months with an average of (14.92±2.46) months. Operation time, intraoperative blood loss, incision length, hospital stay, fracture healing time and lower limb full weight-bearing time of external fixation group were significantly better than that of internal fixation group(P<0.05). Postoperative bone mineral density, osteocalcin, blood calcium and phosphorus at 1 month in external group were higher than that of internal fixation group (P<0.05). Four patients in external fixation group occurred complications, 13 patients in internal fixtaion group, and occurrence rate of complications in external fixation group (8.70%) was lower than that of internal fixtaion group (28.26%)(χ2=4.618, P=0.032). Locking plate external fixation combined with membrane induction technology in treating open and comminuted tibial fractures with severe post-traumatic bone defects has advantages of less trauma, reliable fixation, shorter fracture healing time, and could improve bone metabolic activity with less postoperative complications.

Comparison of clinical efficacy of two different pin arrangements for external fixation of femoral neck fracture

To retrospectively analyze the clinical efficacy of external fixation in the treatment of femoral neck fracture with two different pin layout. From April 2000 to April 2018, 140 cases of femoral neck fracture were treated with closed reduction and percutaneous pin external fixation, among them 121 cases were followed up for more than 1 year, including 31 cases in traditional group, 12 males and 19 females, aged 45 to 74(65.4±8.4) years;90 cases in modified group, 39 males and 51 females, aged 12 to 75 (64.5±7.8) years. In traditional group, the first needle was put on the femoral talus, the second and third needles were put under the tension line, and the three needles were not on the same line in the lateral phase; in modified group, the first needle was drilled into the lateralcortex of the femur, obliquely penetrating the distal and proximal end of the femoral talus fracture, and the other two needles were drilled into the medial cortex of the femoral neck and the femoral talus, respectively. The operation time, hospital stay, postoperative ambulation time, femoral neck shortening rate, fracture healing time, fracture healing rate and femoral head necrosis rate of the two groups were observed and compared. Harris hip function score was used one year after operation. These 121 patients were followed-up, the follow up time of traditional group was 13 to 45(30.5±11.4) months;the follow-up time of modified group was 14 to 120(34.5±12.5) months. There was no significant difference in operation time, hospital stay and femoral head necrosis rate between two groups (P>0.05). There were significant differences between two groups in the time of going to the ground, shortening rate of femoral neck, fracture healing time, fracture healing rate and Harris functional score of the hip 1 year after operation (P<0.05). Compared with the traditional group, the modified group has the advantages of lower femoral neck shortening rate, shorter fracture healing time, higher fracture healing rate and higher Harris hip function score.

Intramedullary nails in combination with reconstruction plate in the treatment of unstable intertrochanteric femoral fractures with lateral wall damage.

The unstable intertrochanteric femur fracture remains a challenge for surgeons. However, few studies have compared the clinical effectiveness of intramedullary nail in combination with a reconstruction plate and intramedullary nail alone in the treatment of patients with unstable intertrochanteric femoral fractures with lateral wall damage. This study retrospectively analyzed 16 patients with 31 A3 intertrochanteric fractures treated with the intramedullary nail in combination with reconstruction plate (the study group) and 19 patients with 31 A3 intertrochanteric fractures treated with intramedullary nail alone (the control group) between January 2012 and January 2018. The operation time, intra-operative blood loss, time of fracture healing, and complication rates of post-operative fixation failure were assessed between the two groups. At the follow-up of post-operative six and 12 months, Harris hip score (HHS) and the Parker-Palmer mobility score (PPMS) were used to evaluate the functional states and mobility levels. The distribution of all basic characteristics was similar between the two groups (P ˃ 0.05). The study group had longer operation time and more intra-operative blood loss in comparison with the control group (P < 0.001), while the study group had shorter fracture healing time (P = 0.03) and lower fixation failure rate as compared with the control group. Regarding the functional outcome, the study group had higher HHSs and PPMS than the control group (P = 0.003). Although intramedullary nails in combination with reconstruction plates had longer operation time and more intra-operative blood loss, it might be superior to intramedullary nail alone in terms of fracture healing time, fixation failure complication rate, and post-operative functional recovery.

Treatment of irreducible femoral intertrochanteric fractures using a wire-guided device

PurposeTreatment of irreducible femoral intertrochanteric fractures often requires open reduction. However, the technique unavoidably causes patients to suffer greater trauma. As such, minimally invasive techniques should be employed to reduce the surgical-related trauma on these patients and maintain a stable reduction of the fractures. Herein, a minimally invasive wire introducer was designed and used for the treatment of femoral intertrochanteric fractures. The effectiveness of using a wire-guided device to treat irreducible femoral intertrochanteric fractures was evaluated. MethodsBetween 2013 and 2018, patients with femoral intertrochanteric fractures who were initially treated by intramedullary nail fixation but had difficult reduction using the traction beds were retrospectively reviewed. Decision for an additional surgery was based on the displacement of the fracture. The patients were then divided into two groups: those in the control group received an open reduction surgery while those in the observation group received a closed reduction surgery using a minimally invasive wire introducer to guide the wire that could assist in fracture reduction. The operation time, blood loss, visual analogue scale scores, angulation, reduction, neck-shaft angle, re-displacement, limb length discrepancy, and union time were then recorded and analyzed to determine the efficiency of the wire introducer technique. Categorical variables were analyzed by using Chi-square test, while continuous variables by independent t-test and the Mann-Whitney test accordingly. ResultsThere were 92 patients included in this study: 61 in the control group and 31 in the observation group. There were no significant differences in baseline demographic factors between the two groups. All surgeries were successful with no deaths within the perioperative period. The average follow-up time for the patients was 23.8 months. However, the observation group had a significantly shorter operation time, lower visual analogue scale score, less intraoperative bleeding, and shorter fracture healing time. There were no significant differences in the angulation, reduction, neck-shaft angle, and limb length discrepancy between the two groups. ConclusionThe minimally invasive wire guide achieved a similar effect to that of open reduction in the treatment of intertrochanteric fractures with difficult reduction. Moreover, the minimally invasive wire introducer is a good technology that accurately guides the wire during reduction. Indeed, it is an effective technique and achieves good clinical outcomes in restoration of irreducible femoral intertrochanteric fractures.

Clinical comparative study of metaphyseal locking intramedullary nail and locking plate in the treatment of humeral surgical neck fracture

Objective To investigate the difference of clinical efficacy between metaphyseal locking intramedullary nail and locking plate in the treatment of humeral surgical neck fracture. Methods 64 patients with Neer II humeral surgical neck fracture who were treated in our hospital from January 2010 to December 2015 were selected. According to the operation plan, the patients were divided into epiphyseal locking intramedullary nail fixation group (observation group, n=42) and locking plate fixation group (control group, n=22). The differences of clinical data (sex, age, time from injury to operation, number of injured cases, follow-up time), clinical indicators (neck-trunk angle, last neck-trunk angle, number of complications, amount of operative bleeding, amount of operative blood transfusion, operation time, fracture healing time): Neer shoulder function score and Constant shoulder score were compared between the two groups. Results There was no significant difference in gender, age, time from injury to operation, number of cases of injury and follow-up time between the two groups, and the subjects were comparable (P>0.05). There was no significant difference in the neck-trunk angle, the last neck-trunk angle and the number of complications between the two groups (P>0.05); the observation group had longer operation time, less operation bleeding volume and blood transfusion volume, shorter fracture healing time (P 0.05). The Constant score, external rotation, abduction and flexion in the observation group were significantly higher than those in the control group (P<0.05). Conclusions The use of metaphyseal locking intramedullary nail in the treatment of humeral surgical neck fracture has a definite clinical effect and a low incidence of complications, which is worthy of clinical application. Key words: Humeral fractures; Shoulder fractures; Fracture fixation, intramedullary; Bone nails; Bone plates

Sliding compression technique with proximal femoral nail antirotation for intertrochanteric fractures in the elderly patients

Objective To observe the clinical efficacy of sliding compression technique with proximal femoral nail antirotation (PFNA) for the treatment of intertrochanteric fractures in the elderly patients. Methods A retrospective study was conducted in the 97 elderly patients with intertrochanteric fracture who had received PFNA internal fixation at Department of Orthopaedics, The Second Fuzhou Hospital Affiliated to Xiamen University from January 2010 to December 2017. They were divided into 2 groups depending on whether the sliding compression technique was used or not in the PFNA fixation. In the sliding compression group of 51 patients, there were 31 males and 20 females with an age of 79.9±6.2 years, and 2 cases of type Ⅰ, 8 cases of type Ⅱ, 21 cases of type Ⅲ, 16 cases of type Ⅳ, 3 cases of type Ⅴ and one case of type Ⅵ according to the modified Evans classification. In the conventional PENA group of 46 cases, there were 27 males and 19 females with an age of 77.5±8.0 years, and 3 cases of type Ⅰ, 6 cases of type Ⅱ, 15 cases of type Ⅲ, 18 cases of type Ⅳ and 4 cases of type Ⅴ according to the modified Evans classification. The 2 groups were compared in terms of the separation of fracture ends at immediate postoperation and 4 weeks postoperation, anesthesia time, operative time, intraoperative bleeding, fracture reduction, fracture healing time, Harris scores of hip function at one year postoperation and postoperative complications. Results There were no significant differences between the 2 group of patients in their preoperative general data, indicating they were compatible (P>0.05). The sliding compression group had significantly shorter separation of fracture ends at immediate postoperation and at 4 weeks postoperation (2.18±0.59 mm and 0.92±0.27 mm) and significantly shorter fracture healing time (5.2±0.9 weeks) than the conventional PENA group (3.91±0.76 mm and 2.15±0.52 mm; 6.5±0.9 weeks) (P 0.05). The sliding compression group had significantly lower incidences in pulmonary infection [9.8% (5/51)], blade loosening or cutout [0 (0/51)] and incision complications [0 (0/51)] than the conventional PENA group [26.1% (12/46), 17.4% (8/46) and 19.6% (9/46), respectively] (P<0.05). Conclusions In the treatment of intertrochanteric fractures in the elderly people, sliding compression technique with PFNA may lead to fewer postoperative complications and faster fracture healing. Key words: Hip fractures; Fracture fixation, intramedullary; Bone nails; Aged; Sliding compression

The expressions of NGF and VEGF in the fracture tissues are closely associated with accelerated clavicle fracture healing in patients with traumatic brain injury.

BackgroundAngiogenesis and bone formation are vital for fracture healing. Nerve growth factor (NGF) not only promotes neuronal survival but also enhances the proliferation and differentiation of osteoblasts. Vascular endothelial growth factor (VEGF) plays an important role in angiogenesis. However, the potential correlation of NGF and VEGF levels with fracture healing in patients with traumatic brain injury (TBI) remains unclear.MethodsThis study enrolled 22 patients with clavicle fracture and concomitant TBI (CFT group) and 25 patients with clavicle fracture alone (CF group). Serum NGF levels were measured with ELISA. The expressions of NGF, VEGF, and CD31 in callus tissues were measured with immunohistochemistry.ResultsThe fracture healing time in CFT group (82.22±13.61 days) was significantly shorter than that in CF group (127±25.05 days; P<0.001). The expression of CD31, marker of blood vessels, in callus tissues of CFT group was higher compared with that of CF group. Serum NGF levels and the expression of NGF in callus tissues of CFT group were higher than those in CF group (P<0.01). The expressions of CD31, NGF, and VEGF are correlated with shorter fracture healing time.ConclusionThe formation of blood vessels was increased in CFT group compared with CF group. NGF and VEGF levels were higher in CFT group than in CF group and correlated with shorter fracture healing time. Accelerated fracture healing in patients with TBI may be due to NGF- and VEGF-mediated angiogenesis at the fracture site.

Effect of cannulated screws with deep circumflex iliac artery-bone grafting in the treatment of femoral neck fracture in young adults

ObjectivesSurgical treatment of femoral neck fracture in young adults is clinically challenging due to the high incidence of avascular necrosis of femoral head and fracture nonunion. The objective of this study is to evaluate the effectiveness of cannulated screws with deep circumflex iliac artery bone grafting (DCIABG) by comparing to the routinely used method in the treatment of femoral neck fracture in young adults. MethodsFrom March 2006 to December 2012, a total of 185 patients with femoral neck fracture were admitted to the hospital for internal fixation surgery, 103 patients (61 males and 42 females, mean age of 39.1 years) were treated with three cannulated screws with DCIABG (group A), and 82 patients (49 males and 33 females, mean age of 35.5 years) were treated with three cannulated screws without DCIABG (group B). ResultsAll patients were followed up for at least 24 months after the surgery. The patients in group A had a significantly higher Harris Hip Score (p < 0.001), shorter fracture healing time (p < 0.001), lower occurrence rate of avascular necrosis of femoral head (p = 0.008) and fracture nonunion (p = 0.012) compared to the patients in group B. However, the operation time and intraoperative blood loss were significantly lower in patients in group B than those in group A (p < 0.001). ConclusionsCannulated screws with DCIABG significantly reduced femoral head osteonecrosis and fracture nonunion. Therefore, it is a feasible and effective method in the treatment of young adult patients with femoral neck fracture.

Analysis on the clinical efficacy of locking plate fixation with different operative approaches for the treatment of proximal humeral fractures

Objective To evaluate the clinical efficacy of the dehopectoral approach and and the deltoid lateral longitudinal separate approach of locking plate fixation for the treatment of proximal humeral fractures. Methods Fifty-seven cases of proximal humerus fracture treated in Chaoyang Central Hospital from March 2010 to May 2015 were selected and were divided into the conventional group (30 cases) and the treatment group (27 cases) according to the different operative approaches.The patients in the conventional group were treated with locking plate fixation by dehopectoral approach and the patients in the treatment group were treated with locking plate fixation by deltoid lateral longitudinal separate approach.The operation time, intraoperative blood loss, fracture healing time, postoperative complication rate were observed in the two groups.Constant scores at different times after operation and the evaluation of shoulder function recovery were observed in the two groups. Results All patients were followed up for 10-25 months, with an average of 19 months.The blood loss in the treatment group was (89.7±31.5) ml and the fracture healing time was (79.6±1.8) d, compared with (243.1±65.7) ml and (90.1±2) d in the conventional group, the differences between the two groups were statistically significant (P=0.000, 0.035). There was no significant difference between the two groups in the operation time(P=0.079). Constant scores in the treatment group at 3 weeks and 3 months after operation were better than those in the conventional group, the differences between the two groups were statistically significant (P 0.05). There were significant differences in the incidence of postoperative complications between the conventional group and the treatment group (13.3% vs.3.7%, P=0.045). Conclusion In the treatment of proximal humeral fractures, the deltoid lateral longitudinal separate approach has advantages of less intraoperative blood loss, shorter fracture healing time, faster recovery of shoulder function and less postoperative complications, which is a safe and effective method for the treatment of proximal humeral fractures. Key words: Proximal humeral fractures; Deltoid lateral longitudinal separate approach; Dehopectoral approach; Locking plate fixation

Minimally invasive percutaneous plate osteosynthesis for Neer three-part fractures of proximal humerus in young adults

Objective To evaluate the efficacy of minimally invasive percutaneous plate osteosynthesis (MIPPO) in the treatment of Neer three-part fractures of the proximal humerus in young adults. Methods A retrospective analysis was performed of the 46 patients aged < 65 years with Neer three-part fracture of the proximal humerus from March 2010 to December 2016. MIPPO with locking proximal humerus plate (LPHP) was used in 23 of them who were 12 men and 11 women with an average age of 41.6±1.2 years; open reduction and internal fixation (ORIF) with LPHP was used in the other 23 patients who were 14 men and 9 women with an average age of 42.2±1.6 years. The 2 groups were compared in terms of operation time, intraoperative bleed-ing, fracture healing time and shoulder function by Neer scoring at the last follow-up. Results The average follow-up (13.4±1.2 months) for the MIPPO groups was not statistically different from that for the ORIF group (14.2±2.4 months) (P >0.05). The MIPPO group reported significantly shorter operation time (105±15 min), significantly less intraoperative bleeding (140±50 mL), significantly shorter fracture healing time(4.2±0.6 months), and significantly higher shoulder Neer scores (88.6±3.4) than the ORIF group (120±20 min, 320±40 mL, 5.4±1.2 months, and 81.6±2.2, respectively) (P 0.05). Conclusion MIPPO with LPHP may be obviously advantageous over ORIF with LPHP in the treatment of proximal humeral fractures in young adults. Key words: Shoulder fractures; Fracture fixation, internal; Bone plates; Surgical procedures, minimally invasive

Operation position selection according to types of trimalleolus fractures

Objective To evaluate the curative efficacy of appropriate operation positions selected according to different fracture types of trimalleolus fractures.Methods Twenty-nine patients of trimalleolus fractures were performed open reduction and internal fixation from January 2007 to January 2010 ( the study group).There were 21 males and 8 females at average age of 41 years (range,20-67 years).According to Lauge-Hansen typing,there were nine patients with pronation-external rotation type,one with pronation-abduction type,17 with supination-external rotation type and two with supination- adduction type.Operation positions were selected according to fracture types and CT:prone position was selected in 10 patients,lateral to supine position in 15 and supine position in four.In the control group,there were 29 patients including nine patients with pronation-external rotation type,17 with supination-external rotation type,two with supination- adduction type and one with pronation-abduction type.All the patients were in supine to prone position.The operation time,blood loss,wound healing time and fracture healing time were compared in the two groups.Results All the patients in the study group were followed up for mean duration of 21 months (range,5-36 months).Satisfactory fracture reduction was obtained:the fractures reached anatomy reduction in radiological manifestation; weight beating surface of the ankle was perpendicular to the longitudinal axis of lower leg; the surface of the ankle was smooth.The operation time was 102.5 minutes in the study group and 156.8 min in the control group.The mean operation time,mean blood loss and mean wound healing time were 102.5 min,145.6 ml,14.6 days respectively in the study group,and were 156.8 min,270.3 ml and 19.3 days in the control group,with significant difference (P＜0.05).The fracture healing time was 14.2 weeks in the study group and 15.4 weeks in the control group,with no statistical difference (P ＞ O.05 ).Conclusion Selection of appropriate operation positions according to different fracture types of trimalleolus fractures is contributive to shorter operation time,less blood loss and shorter fracture healing time. Key words: Ankle joint; Fractures; Ankle injuries