Stabilization Of Fractures Research Articles

Comparative evaluation of proximal femoral nail anti-rotation versus dynamic hip screw for stable intertrochanteric femoral fractures: A meta-analysis of clinical outcomes

In this study, a meta-analysis was conducted to compare the efficacy of proximal femoral nail anti-rotation (PFNA) and dynamic hip screw (DHS) as the treatment of stable intertrochanteric femoral fractures (AO type 31-A1). The comparison was focused on perioperative outcomes, Harris hip scores (HHSs), and major orthopedic complications. PubMed, Cochrane, ProQuest, and ScienceDirect were searched for studies comparing PFNA and DHS for stable intertrochanteric femoral fractures. The authors conducted separate screenings to determine eligible studies for this meta-analysis. The risk of bias was assessed using the Risk of Bias Tool for Randomized Trials 2 and the Risk of Bias in Non-randomized Studies–of Interventions-I. All outcomes were analyzed using Review Manager software version 5.4 and presented as forest plots. Ten studies were included in this analysis (three randomized controlled trials and seven observational studies) with 1149 patients. For the intraoperative parameters, PFNA had shorter mean operative time (mean difference [MD] −18.63, 95% interval [CI] [−27.92–−9.34], P < 0.0001) and led to less intraoperative blood loss (MD −88.84, 95% CI [−158.03–−19.65], P = 0.01). No significant differences in HHSs and complications were found between PFNA and DHS, and leg length discrepancy (risk ratio 0.40, 95% CI [0.17–0.92], P < 0.03) favoring PFNA. Overall, these two surgical methods have no meaningful differences in long-term functional outcomes and complications. The PFNA may be more beneficial in the perioperative aspect, including shorter surgical duration and lesser blood loss due to its minimally invasive nature.

Is stability of femoral neck fractures in the inverted triangle configuration related to the angle between the fracture line and the cannulated compression screws? A finite element analysis

Purpose Currently, treating femoral neck fractures (FNFs) with the inverted triangle configuration requires alignment between the femoral neck’s long axis and the axis of cannulated compression screws (CCS). To address whether the ‘parallel’ alignment is the most effective approach for fractures with varying Pauwels angles, we employed finite element analysis (FEA) to investigate how different angles between fracture line and CCS affect stability, based on various Pauwels angles. This study aims to offer improved guidance for treating FNFs with the inverted triangle configuration. Methods FNF models with Pauwels angles of 40°, 50°, 60°, and 70° were developed. The CCS were positioned in an inverted triangle configuration based on the angle between the fracture line and CCS. Using FEA, we compared the biomechanical properties of each model to evaluate the stability by evaluating five key parameters: maximal stress in the proximal femoral fracture fragment (MPFS) and implants (MIS), maximal displacement of the bone (MBD) and implants (MID), and maximal relative displacement of the fragments (MRD). Results For Pauwels angles of 40°, 50°, 60°, and 70° across different FNF models, various parameters exhibited similar results. The MPFS showed an upward trend with a decrease in the angle, whereas the MIS, MBD, MID, and MRD all exhibited downward trends. Conclusion The FEA results suggest that decreasing the angle between the fracture line and the CCS for the treatment of FNF can increase the tension resistance of the model, thus increasing the model’s stability.

Medial Closing Wedge High Tibial Osteotomy Accurately Corrects Genu Valgum without Iatrogenic Deformity or Complications: A Consecutive Series of Thirty-one Procedures.

Angular deformities of the tibia and femur lead to mechanical axis deviation (MAD) of the lower limb and malorientation of the joints adjacent to the deformity. The current study analyses the outcomes of using a medial closing wedge high tibial osteotomy (MCWHTO) for the management of genu valgum with high medial proximal tibial angle (MPTA), and combined MCWHTO with lateral opening-wedge distal femoral osteotomy (LOWDFO) in the setting of concomitant genu varum with low lateral distal femoral angle (LDFA). There were 18 high tibial osteotomy (HTO)-only and 13 combined HTO + distal femoral osteotomy (DFO) procedures performed. The primary radiographic outcome variables included postoperative MPTA and MAD (in mm). The accuracy of MAD correction was expressed as a percentage. The postoperative posterior proximal tibial angle (PPTA) and limb length discrepancy (LLD) were also measured as secondary radiographic outcome variables. The clinical outcome variables included intraoperative surgical complications (e.g., hinge fracture), all-causes for revision, union rate, time to union, and postoperative knee range of motion. Functional outcomes used included the LDSRS, PROMIS, and EuroQOL scores. The mean preoperative MPTA was 92.9° (SD = 1.81, range: 88-96). After surgical correction, the mean MPTA was 86.0° (SD = 1.80, range: 83-90) (p < 0.0001). The mean preoperative MAD was 32.5 mm (SD = 20.16, range: 10-77) lateral to the centre of the knee joint. The mean postoperative MAD was 2.44 mm medial to the centre of the joint (SD = 7.13, range: 13 medial - 15 lateral) (p < 0.0001). The mean change in MAD achieved through surgical correction was 38.16 mm (SD = 17.94, range: 13-77). The accuracy of MAD correction was 96.1% (SD = 0.06%, range: 81.25-100%). The time to unassisted WB was a mean of 75 days (SD = 44.5, range: 44-242).There was a single stable hinge fracture and one case of chronic regional pain syndrome diagnosed. There were no cases of non-union and no indications for revision surgery in any case. Medial closing wedge high tibial osteotomy is an effective surgical procedure for the management of genu valgum deformity. The MPTA, LDFA, and MAD can be accurately corrected without significantly altering PPTA or limb length. It may be combined with open lateral distal femoral osteotomy for cases with femoral and tibial contributions to deformity without significantly impacting clinical outcomes. Functional outcomes, specifically relating to self-image are significantly improved after the MCWHTO has been performed. Sheridan GA, Page BJ, Greenstein MD, et al. Medial Closing Wedge High Tibial Osteotomy Accurately Corrects Genu Valgum without Iatrogenic Deformity or Complications: A Consecutive Series of Thirty-one Procedures. Strategies Trauma Limb Reconstr 2024;19(2):82-86.

Prevalence of pelvic CT angiography (CTA) and angiographic embolization in geriatric patients with pelvic ring fractures presenting to two level I trauma centers

ObjectivesHemorrhage in osteoporotic pelvic ring fractures is a rare, but serious complication. Most bleeding comes from the bone or venous plexuses, but arterial injury does occur. The purpose of this study was to characterize a large geriatric pelvic fracture cohort and determine the prevalence of pelvic CT angiography (CTA) and subsequent need for arterial embolization. MethodsA cohort of geriatric pelvic fracture patients at two level 1 trauma centers was reviewed. Many epidemiologic and patient factors were collected for cohort characterization. The primary outcome was if patients underwent a CTA of the pelvis and subsequently underwent arterial embolization. ResultsThere were 457 patients included and mean age was 83.1 years (range 65–100). Most patients had a low energy mechanism (91.4 %). In-hospital mortality was recorded for 30 cases (6.6 %). Of these deaths, two received a pelvic CTA and two had an embolization procedure. Pelvic CTA was performed on 33 patients (7.2 %). Fourteen patients (3.0 %) had an arterial embolization procedure. A high energy mechanism of injury was associated with receiving a pelvic CTA (p = 0.0067). Mechanism of injury was not associated with undergoing an embolization procedure (p = 0.685). DiscussionIn the geriatric population, even patients with stable pelvic fractures can present with life-threatening arterial bleeding. A non-insignificant percentage of patients will require CTA for suspected bleeding (7.2 %) and embolization to treat confirmed arterial bleeding (3.0 %). ConclusionsBleeding events in geriatric pelvic ring injuries is a previously under researched area of orthopedic trauma. Further research is needed to elucidate the exact pathomechanisms of arterial injury and what patients or injury patterns are most significantly associated. Specifically, larger cohort sizes and evaluating our existing cohort with different injury classification systems may yield useful results.

Virtual surgical planning and use of a 3D-printed, patient-specific reduction system for minimally invasive plate osteosynthesis of diaphyseal tibial fractures in dogs: A historic case control study.

To compare the efficacy and clinical outcomes of computed tomography (CT)-based virtual surgical planning (VSP) and a three-dimensional (3D)-printed, patient-specific reduction system to conventional indirect reduction techniques for diaphyseal tibial fractures stabilized using minimally invasive plate osteosynthesis (MIPO) in dogs. A prospective clinical study with a historic control cohort. Dogs undergoing MIPO stabilization of diaphyseal tibial fractures using a custom 3D-printed reduction system (3D-MIPO; n = 15) or conventional indirect reduction techniques (c-MIPO; n = 14). Dogs were prospectively enrolled to the 3D-MIPO group and CT scans were used to design and fabricate a custom 3D-printed reduction system to facilitate MIPO. Medical records were searched to identify dogs for the c-MIPO group. Pre-, intra- and postoperative parameters were compared between groups. The duration from presentation until surgery was 23 h longer in the 3D-MIPO group (p = .002). Fewer intraoperative fluoroscopic images were acquired (p < .001) and mean surgical duration was 34 min shorter in the 3D-MIPO group (p = .014). Median postoperative tibial length, frontal alignment, and sagittal alignment were within 4 mm, 3° and 3°, respectively, of the contralateral tibia in both groups and did not differ between reduction groups (p > .1). Postoperative complications occurred in 27% and 14% of fractures in the 3D-MIPO and c-MIPO groups, respectively. Both reduction methods yielded comparable results. Although the preoperative planning and guide preparation was time consuming, surgery times were shorter and fluoroscopy use was lessin the 3D-MIPO group. VSP and the custom 3D-printed reduction system facilitated efficient MIPO.

Lisfranc injuries

Lisfranc injuries are rare but severe injuries of the foot. They range from ligament sprain to complex fracture dislocations. Etiologically, adistinction is made between indirect and direct force and between high-energy and low-energy trauma. Inadequate diagnostics (injuries overlooked or misinterpreted) can lead to painful posttraumatic osteoarthritis, chronic instability and deformity of the foot. Afracture, malalignment and unclear findings in conventional radiological diagnostics necessitate computed tomography imaging including 3D reconstruction. Lisfranc injuries are often associated with accompanying pathologies of the foot that also need to be addressed. Only stable non-displaced fractures can be treated conservatively. Depending on the injury pattern, surgical treatment is performed percutaneously, minimally invasive or open. The prognosis following Lisfranc injury is determined by the severity of damage and the quality of reconstruction.

TO COMPARE THE OUTCOME OF FRACTURES OF DISTAL END OF RADIUS TREATED CONSERVATIVELY WITH IMMOBILIZATION IN PALMARFLEXION AND DORSIFLEXION

Fractures of the distal end radius represent one-sixth of all fractures of the human skeleton1 treated in emergency department. Closed reduction and cast immobilization has been the mainstay of treatment of these fractures. Restoration and maintenance of anatomy correlates well with function.5Distal radius fractures are easy to reduce closed when the fractures are recent and the hematoma has not yet organized. All stable distal radial fractures can be treated with closed manipulation and below elbow cast with wrist in slight dorsiflexion. The crux to restoration of normal anatomy and best hand function lies with selectively flexing the dorsally displaced fracture fragment without flexing the carpals. According to the John Charley,10,12 colle’s fracture should be treated in palmar flexion and ulnar deviation as dorsal periosteal hinge provides stability. Traditionally extra-articular fracture of the distal end of radius were classically treated by closed reduction, cast immobilization in palmar flexion and ulnar deviation. But few studies have showed, higher chance of redisplacement with this conventional position. Ajay Gupta11 reported on treatment of colle’s fracture comparing immobilization of the wrist in palmar flexion, neutral position and dorsiflexion. He concluded that immobilization of the wrist in dorsiflexion appears to provide better maintenance of reduction. Fractures immobilized with the wrist in dorsiflexion showed the lower incidence of redisplacement, especially of dorsal tilt and had the best early functional results.In the past, very few studies have compared the results depending on the position of immobilization. Thus we decided to compare the outcome of fracture of the lower end of radius immobilsed in traditional palmar flexion and ulnar deviation and dorsiflexion.

The effect of screw insertion configuration of Sinus Tarsi plate on biomechanical performance using finite element analysis

Sinus Tarsi plates are used as implants for minimally invasive surgery of calcaneus bone fractures. This study evaluated the screw fixation patterns of Sinus Tarsi plates for optimal biomechanical performance. Six three-dimensional (3D) finite element models with different positional screws were evaluated for calcaneus fracture stabilization using Sinus Tarsi plates with 5, 6, and 7 holes. Walking stance conditions as heel strike, midstance, and push-off phases were used to compare loading. Results indicated that the equivalent (EQV) stress exhibited in the implant was higher than in the surrounding bone, with the highest value during the push-off phase. The maximum EQV stress or risk of failure decreased when an insertion screw was placed in the anterior bone using a 7-hole plate, and the most stable strain result at the fracture bone site was recorded for a Sinus Tarsi plate with 7 holes (TT 7-1). The screw insertion pattern and configuration of the Sinus Tarsi plate impacted the biomechanical performance of the calcaneal fracture.

Surgical treatment of forefoot and midfoot fractures : Minimally invasive fixation of metatarsal fractures

Minimally invasive stabilization of metatarsal fractures to enable adequate fracture healing in acorrect position to restore anatomy and biomechanics of the foot. A.Dislocated diaphyseal and subcapital fractures of the second to fifth metatarsal (> 3 mm, > 10° dislocation). B.Fifth metatarsal fracture at the metadiaphyseal junction (Lawrence and Botte typeIII). High grade soft tissue damage or infection at the implant insertion site. A.Fluoroscopically assisted closed reduction and antegrade intramedullary fixation of diaphyseal and subcapital fractures of the second to fifth metatarsal. B.Fluoroscopically assisted wire-guided intramedullary screw fixation of fifth metatarsal fractures at the metadiaphyseal junction. A.Mobilization with partial weight bearing (20 kg) for 6weeks wearing astiff sole; implant removal under local anesthesia after 6-8weeks, followed by afree range of movement and weight-bearing as tolerated (WBAT). B.Early mobilization with weight-bearing as tolerated (WBAT); removal of the orthosis after 6weeks, implant removal optional. A.Antegrade nailing of subcapital and shaft fractures of metatarsalsII-V achieves good clinical results with low complication rates both when using prepared Kirschner wires or elastically stable intramedullary nails (ESIN). B.According to current literature, intramedullary screw osteosynthesis of proximal metatarsalV fractures of zoneII andIII according to Lawrence and Botte leads to faster bony healing with alower nonunion rate compared with conservative treatment. It is recommended especially, but not only, for active athletes.

Mechanical comparison of straight and pre-bent interlocking nails used for the stabilization of a tibial gap fracture model.

To compare the mechanical behavior of straight (STRT) and pre-bent (BENT) I-Loc angle-stable interlocking nails (AS-ILN) used for stabilization of canine mid-diaphyseal tibial fractures. In vitro experimental study. Tibial gap fracture models (n = 5/group). Tibial models simulating a comminuted mid-diaphyseal fracture were stabilized with either a STRT or BENT I-Loc AS-ILN. Bent nails were contoured to match the 10° tibial recurvatum of a mid-size dog. Constructs were subjected to cyclic eccentric compressive loads followed by ramp load until failure. Construct compliance, maximum compressive load and resistive torque, yield load and angular deformation at 450 N were statistically compared using t-tests (p < .05). Failure modes were described. Compliance was 45% lower in BENT than STRT groups (p < .0001). Constructs in the BENT group sustained ~20% and 34% greater maximum and yield loads, respectively, than STRT constructs. Maximum resistive torques were similar between groups (p = .16). At 450 N, sagittal plane angular deformation increased from 0° to 4° in procurvatum (STRT group) and decreased from 10° to 8° in recurvatum (BENT group-p < .0001). Construct yield failure occurred at the nail isthmus in both groups. These results demonstrated that, in a tibial gap fracture model, pre-bending I-Loc AS-ILNs provided mechanical advantages by increasing their ability to resist bending resulting from eccentric compressive loads. Pre-bending may reduce the occurrence of tibial nail yield failure. Surgeons should therefore consider pre-bending tibial I-Loc nails to match the bone anatomical recurvatum prior to implantation.

Severe Pilon Fractures: The Role of Quality of Reduction in Clinical and Functional Outcomes.

Introduction The purpose of the current study is to present the outcome of closed reduction and stabilization using an Illizarov ring fixator in severe pilon fractures and to investigate the correlation between reduction quality and clinical and functional outcomes. Materials and methods Thirty-three type III tibial plafond fractures, which had been treated with this method, were retrospectively analysed. Quality of reduction was classified according to the Teeny & Wiss (TW) criteria. Clinical and functional assessment was carried out using the Ovadia & Beals (OB) and Olerud & Molander (OM) scores. Results All fractures were successfully united. The mean time in the fixator was 6.3 months, and the mean follow-up was 50 months after frame removal. There were no major infections. There was no significant relationship between TW and OM (r=-0.34, p=0.13), TW and OB (r=0.35, p=0.23), neither Delay (from injury until surgery) and OM (r=-0.03, p=0.28), and Delay and OB (r=0.30, p=0.31). Conclusions The present study demonstrates that the major problems of open reduction and internal fixation of pilon type III fractures can beavoided by a non-invasive approach to the treatment of these fractures. The articular surface can be reconstituted with olive-tip wires and small fragment washers, early ligamentotaxis and fracture stabilization with the Ilizarov ring fixator. These simple steps couldlead safely to union and a good clinical and functional outcome.

Osteochondral fractures in childhood and adolescence

Osteochondral fractures (OCF) are traumatic shearing injuries to portions of cartilage and bone. The most common cause is patellar dislocation, with the main localisation being the medial patellar facet and the lateral femoral condyle. They can occur in all age groups. Clinically, there is apainful knee joint effusion (haemarthrosis) with a"dancing patella". This is usually accompanied by restricted movement and/or alocking phenomenon. In addition to the standard X‑ray of the knee in three planes (lateral, anterior-posterior and tangential patella), an MRI should be performed promptly in the case of haemarthrosis and suspicious symptoms, as concomitant injuries are present in up to 70% of cases. The aim of treatment is to restore joint congruence in order to prevent the risk of secondary osteoarthritis. Small chondral and stable osteochondral fractures can be treated conservatively. Surgery is indicated for all other OCFs. In addition to refixation with various materials (bioresorbable screws, bone plugs, suture material and Kirschner wires), cartilage regeneration procedures (AMIC, MACI, OAT, etc.) are available for late diagnosed or non-refixable fragments. However, the number of cases is small. Osteochondral fractures are rare injuries in children and adolescents. Prompt MRI is recommended for diagnosis in cases of suspected OCF. Refixation is the preferred treatment method, with bioresorbable implants showing promising results in reducing the need for additional surgery. The risk of secondary osteoarthritis can be reduced with regular treatment.

Exploring the impact of rehabilitation on post-surgical recovery in elbow fracture patients: a cohort study.

Elbow fractures, characterized by their complexity, present significant challenges in post-surgical recovery, with rehabilitation playing a critical role in functional outcomes. This study explores the efficacy of rehabilitative interventions in enhancing joint range of motion (ROM) and reducing complications following surgery for both stable and unstable elbow fractures. A cohort of 15 patients, divided based on the stability of their elbow fractures and whether they received post-operative rehabilitation, was analyzed retrospectively. Measurements of ROM-including flexion, extension, pronation, and supination-were taken at three follow-ups: 15-, 30-, and 45-day post surgery. The study assessed the impact of rehabilitation on ROM recovery and the resolution of post-surgical complications. The findings indicated no statistically significant differences in ROM improvements between patients who underwent rehabilitation and those who did not, across all types of movements measured. However, early rehabilitative care was observed to potentially aid in the mitigation of complications such as joint stiffness, especially in patients with stable fractures. While rehabilitation did not universally improve ROM recovery in elbow fracture patients, it showed potential in addressing post-operative complications. The study underscores the importance of individualized rehabilitation plans and highlights the need for further research to establish evidence-based guidelines for post-surgical care in elbow fractures.

A comparative study of proximal femoral nail and dynamic hip screw for intertrochanteric fractures of the femur

Introduction: Intertrochanteric fracture is one of the most common fractures of the hip. However, the implant of choice for type II intertrochanteric fracture is still under debate. The aim of this study was to compare the functional outcomes of proximal femoral nail (PFN) and dynamic hip screw (DHS) in treatment of intertrochanteric fractures. Material and Methods: We did a prospective comparative study on 60 patients of type II intertrochanteric fractures operated with closed/open reduction and internal fixation with either DHS or PFN between October 2018 and March 2023. During each follow-up, the functional outcome of patients was calculated using the Harris hip score. Results: There was a statistically significant difference present in average functional scores between the two groups at 1 month, 3 months and 6 months; however, no difference was seen at the end of 12th month follow-up. Functional outcomes in the DHS group were excellent in 34.78%, fair in 17.39%, good in 43.48% and poor in 4.35%. In the PFN group, results were excellent in 56.52%, fair in 8.70% and good in 34.78% and no poor results were seen. Conclusion: In stable two-part intertrochanteric femur fractures, both PFN and DHS are equally effective but due to minimal invasiveness. PFN is a better implant of choice than DHS in the treatment of elderly patients with intertrochanteric fractures.

Anatomic variability of the human femur and its implications for the use of artificial bones in biomechanical testing.

Aside from human bones, epoxy-based synthetic bones are regarded as the gold standard for biomechanical testing os osteosyntheses. There is a significant discrepancy in biomechanical testing between the determination of fracture stability due to implant treatment in experimental methods and their ability to predict the outcome of stability and fracture healing in a patient. One possible explanation for this disparity is the absence of population-specific variables such as age, gender, and ethnicity in artificial bone, which may influence the geometry and mechanical properties of bone. The goal of this review was to determine whether commercially available artificial bones adequately represent human anatomical variability for mechanical testing of femoral osteosyntheses. To summarize, the availability of suitable bone surrogates currently limits the validity of mechanical evaluations of implant-bone constructs. The currently available synthetic bones neither accurately reflect the local mechanical properties of human bone, nor adequately represent the necessary variability between various populations, limiting their generalized clinical relevance.

A mechanics and electromagnetic scaling law for highly stretchable radio frequency electronics

Many classes of flexible and stretchable bio-integrated electronic systems rely on mechanically sensitive electromagnetic components, such as various forms of antennas for wireless communication and for harvesting energy through coupling with external power sources. This efficient wireless functionality can be important for body area network technologies and can enable operation without the weight and bulky size of batteries for power supply. Recently, antenna designs have received increased attention because their mechanical and electromagnetic properties significantly influence the wireless performance of bio-integrated electronics, particularly under excessive mechanical loads. These mechanical factors are critical for skin-integrated electronics during human motion, as complex skin deformations can damage the conductive traces of antennas, such as those used for near-field communication (NFC), leading to yield or fracture and affecting their electromagnetic stability. Serpentine interconnects have been proposed as a geometric alternative to in-plane circular or rectangular spiral antenna designs to improve the elastic stretchability of the metallic traces in NFC antennas and prevent mechanical fractures. Despite the use of serpentine interconnects within the physiologically relevant strain range for skin (<20 %), the electromagnetic stability of the antennas decreases. This instability, reflected by shifts in resonance frequency and scattering parameters due to inductance changes, reduces the antennas' wireless power transfer efficiency and readout range. Therefore, maintaining the electromagnetic stability of antennas, specifically NFC antennas, under various mechanical deformations has become a critical challenge in practical wireless skin-integrated applications, such as sensing and physiological monitoring. Here, we establish a new mechanics and electromagnetic scaling law that quantifies the inductance changes under strain in a rectangular-loop serpentine structure typically used for NFC wireless communication in stretchable electronics. We present a systematic analysis of the antenna's geometric parameters, material properties of the antenna and substrate, and the applied strain on the inductance change. Our findings demonstrate that the relative change of inductance is solely influenced by the serpentine structure's width-radius ratio, arc angle, aspect ratio of the NFC antennas, and the applied strain. Additionally, under physiological strain conditions for the skin, the relative change of inductance can be minimized to preserve the NFC antenna's performance and prevent mechanical fracture and electromagnetic stability loss.

Treatment of children with fractures of the distal metaepiphysis of the radius: A literature review

BACKGROUND: Fractures of the distal metaepiphysis of the radius are among the most common injuries in pediatric patients. This results from the peculiarities of the anatomical structure and structure of the radial tissue in this area. AIM: This study aimed to analyze the literature on the treatment of children with fractures of the distal metaepiphysis of the radius. MATERIALS AND METHODS: Literatures on the treatment of children with fractures of the distal metaepiphysis of the radius were extracted from PubMed, eLibrary, and Google Scholar without language restrictions for the period from 1990 to 2024. RESULTS: In fractures of the distal metaepiphysis of the radius without displacement, the limb is immobilized. Displaced fractures require closed reduction and/or surgical treatment. For the treatment of stable fractures, specialists adhere to conservative techniques. The method of choice for the surgical treatment of unstable fractures should be minimally invasive osteosynthesis. The current gold standard for the surgical treatment of fractures of the distal metaepiphysis of the radius in children is closed reduction and intramedullary metal osteosynthesis with Kirschner wires, followed by plaster cast application. CONCLUSIONS: Currently, no consensus has been reached on the method of choice for the surgical treatment of fractures of the distal metaepiphysis of the radius in children. The results of treating children using the presented surgical techniques are contradictory, and high risks of developing intra- and postoperative complications are noted. Thus, conducting more research in this area and developing new and most effective surgical methods that can reduce the risk of complications and optimize the rehabilitation process for these patients remain relevant.

Determining the Optimal Intramedullary Screw Canal Fill Ratio in Length Unstable Metacarpal Fractures: A Biomechanical Investigation

Intramedullary (IM) screw fixation is gaining popularity in the treatment of metacarpal fractures. Despite its rapid adoption, there is a paucity of evidence regarding parameters to optimize effectiveness. This study aimed to quantify the relationship between stability, IM screw size, and canal fill using a cadaveric model. Thirty cadaveric metacarpals (14 index, 13 middle, and three ring fingers; mean age: 58.3 years, range: 48-70) were selected to allow for canal fill ratios of 0.7-1.1 for screws sized 3.0, 3.5, and 4.5 mm. Metacarpals underwent a 45° volar-dorsal osteotomy at the midpoint before fixation with an IM screw. Specimens were subjected to 100 cycles of loading at 10 N, 20 N, and 30 N before load-to-failure testing. Correlation coefficients for angular displacement on the final cycle at each load, peak load to failure, and average stiffness were assessed. Correlation coefficients for the angular displacement on the 100th cycle were as follows: 10 N, R= 0.62, 20 N, R= 0.57, and 30N, R= 0.58. Correlation values for peak load to failure as a function of canal fit were as follows: 3.0 mm, R= 0.5, 3.5 mm, R= 0.17, and 4.5 mm, R= 0.44. The canal fill ratio that intersected the line-of-best fit at an angular deformity of 10° was 0.74. Average peak forces for 3.0-, 3.5-, and 4.5-mm screws were 79.5, 136.5, and 179.6 N, respectively. Average stiffness for each caliber was 14.8, 33.4, and 52.3 N/mm. Increasing screw diameter and IM fill resulted in more stable fixation, but marginal gains were seen in ratios >0.9. A minimum fill ratio of 0.74 was sufficient to withstand forces of early active motion with angular deformity <10°. An understanding of the relationship of IM fill ratio of metacarpal screws to fracture stability may provide a framework for clinicians to optimally size these implants.

Time to surgical stabilization of rib fractures: does it impact outcomes?

ObjectivesRib fractures are common, morbid, and potentially lethal. Intuitively, if interventions to mitigate downstream effects of rib fractures can be implemented early, likelihood of developing these complications should be reduced....

Biomechanical evaluation of different medial column fixation patterns for valgus pilon fractures

BackgroundThe purpose of this study was to perform a biomechanical analysis to compare different medial column fixation patterns for valgus pilon fractures in a case-based model.MethodsBased on the fracture mapping, 48 valgus pilon fracture models were produced and assigned into four groups with different medial column fixation patterns: no fixation (NF), K-wires (KW), intramedullary screws (IS), and locking compression plate (LCP). Each group contained wedge-in and wedge-out subgroups. After fixing each specimen on the machine, gradually increased axial compressive loads were applied with a load speed of one millimeter per minute. The maximum peak force was set at 1500 N. Load-displacement curves were generated and the axial stiffness was calculated. Five different loads of 200 N, 400 N, 600 N, 800 N, 1000 N were selected for analysis. The specimen failure was defined as resultant loading displacement over 3 mm.ResultsFor the wedge-out models, Group-IS showed less displacement (p < 0.001), higher axial stiffness (p < 0.01), and higher load to failure (p < 0.001) than Group-NF. Group-KW showed comparable displacement under loads of 200 N, 400 N and 600 N with both Group-IS and Group-LCP. For the wedge-in models, no statistical differences in displacement, axial stiffness, or load to failure were observed among the four groups. Overall, wedge-out models exhibited less axial stiffness than wedge-in models (all p < 0.01).ConclusionsFunctional reduction with stable fixation of the medial column is essential for the biomechanical stability of valgus pilon fractures and medial column fixation provides the enough biomechanical stability for this kind of fracture in the combination of anterolateral fixation. In detail, the K-wires can provide a provisional stability at an early stage. Intramedullary screws are strong enough to provide the medial column stability as a definitive fixation. In future, this technique can be recommended for medial column fixation as a complement for holistic stability in high-energy valgus pilon fractures.