Technique For Fixation Of Fractures Research Articles

Fixation techniques for periprosthetic femur fractures around total knee arthroplasty: a systematic review

There is no consensus regarding the treatment algorithm for the fixation of periprosthetic femur fractures (PFFs) around a total knee arthroplasty (TKA). Established methods of fracture fixation include locking plate (LP) or retrograde intramedullary nail (RIN) techniques. Newer fixation methods include the dual plate (DP) and the nail-plate combination (NPC) techniques. The purpose of this study is to review the literature on the outcomes of PFF fixation following TKAs over the past two decades. A systematic review was undertaken in the MEDLINE, Embase, and Cochrane databases in accordance with the PRISMA standards. Selection criteria included: patient cohort > 5 cases and minimum follow-up of 12 mo. Risk of bias was assessed with the Joanna Briggs Institute Critical Appraisal Checklists for Cohort Studies and Case Series. Combined data analysis was performed with linear models and linear mixed effect models to compare the post-operative outcomes of the LP, RIN, and DP techniques. Our search identified 1086 studies and 31 were selected for final analysis. The number of the studies for the LP, RIN, DP, and NPC techniques were 23, 15, 4, and 1, respectively. There were no differences in the time to union, Knee Society Knee Score, or range of motion among the LP, RIN, and DP techniques. Although analysis did not demonstrate significant differences, it is limited by the lack of the available studies using the DP technique. Additionally, only one study for the NPC technique was retained after screening and data analysis was therefore not possible.

Distal femoral replacement for the treatment of periprosthetic distal femoral fractures around a total knee arthroplasty: a meta-analysis.

Periprosthetic fracture is a rare complication of arthroplasty but can have devastating consequences for the patient and presents a complex surgical challenge. Locking compression plate and retrograde intramedullary nail are both widely accepted surgical fixation techniques for distal femoral periprosthetic fractures around a total knee arthroplasty. Although there is still a need for further high-quality research into both techniques, there is even less literature concerning the use of distal femoral replacement to treat distal femoral periprosthetic fractures. Interest has been piqued in distal femoral replacements for the treatment of distal femoral periprosthetic fractures due to the theoretical advantages of immediate post-operative weight-bearing and lack of dependence on fracture union, but there are still understandably reservations about performing such an extensive and invasive procedure when an accepted alternative is available. This meta-analysis aims to evaluate the current literature to compare the complication rates and return to pre-operative ambulatory status of distal femoral replacement and locking compression plate. A literature search was performed to identify articles related to the management of distal femoral periprosthetic fractures around a total knee arthroplasty in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Methodological quality was assessed using the methodological index for non-randomized studies (MINORS) criteria. Articles were reviewed, and data extracted for analysis. Five articles met the inclusion criteria, reporting on 345 periprosthetic fractures. The overall rates of complications for distal femoral replacement and locking compression plate were: re-operation (6.1% vs 12.1%), infection (3.0% vs 5.3%), mortality (19.7% vs 19.3%), and return to pre-operative ambulatory status (60.9% vs 71.8%) (respectively). This meta-analysis shows no statistically significant difference in the rates of re-operation, infection, mortality or return to pre-operative ambulatory status when comparing distal femoral replacement to locking compression plate.

Pelvic Ring Fractures: A Biomechanical Comparison of Sacral and Lumbopelvic Fixation Techniques.

Pelvic ring fractures are becoming more common in the aging population and can prove to be fatal, having mortality rates between 10% and 16%. Stabilization of these fractures is challenging and often require immediate internal fixation. Therefore, it is necessary to have a biomechanical understanding of the different fixation techniques for pelvic ring fractures. A previously validated three-dimensional finite element model of the lumbar spine, pelvis, and femur was used for this study. A unilateral pelvic ring fracture was simulated by resecting the left side of the sacrum and pelvis. Five different fixation techniques were used to stabilize the fracture. A compressive follower load and pure moment was applied to compare different biomechanical parameters including range of motion (contralateral sacroiliac joint, L1-S1 segment, L5-S1 segment), and stresses (L5-S1 nucleus stresses, instrument stresses) between different fixation techniques. Trans-iliac-trans-sacral screw fixation at S1 and S2 showed the highest stabilization for horizontal and vertical displacement at the sacral fracture site and reduction of contralateral sacroiliac joint for bending and flexion range of motion by 165% and 121%, respectively. DTSF (Double transiliac rod and screw fixation) model showed highest stabilization in horizontal displacement at the pubic rami fracture site, while the L5_PF_W_CC (L5-Ilium posterior screw fixation with cross connectors) and L5_PF_WO_CC (L5-Ilium posterior screw fixation without cross connectors) showed higher rod stresses, reduced L1-S1 (approximately 28%), and L5-S1 (approximately 90%) range of motion. Longer sacral screw fixations were superior in stabilizing sacral and contralateral sacroiliac joint range of motion. Lumbopelvic fixations displayed a higher degree of stabilization in the horizontal displacement compared to vertical displacement of pubic rami fracture, while also indicating the highest rod stresses. When determining the surgical approach for pelvic ring fractures, patient-specific factors should be accounted for to weigh the advantages and disadvantages for each technique.

IPSILATERAL NON-UNION FRACTURE NECK AND SHAFT OF FEMUR WITH BROKEN IMPLANT IN SITU TREATED BY ORTHO-FIX LIMB RECONSTRUCTION SYSTEM AND EXTERNAL FIXATOR WITHOUT BONE GRAFTING OR CORTICOTOMY: A CASE REPORT

Non-union is a well-known complication of fractures of the femoral neck. The concurrence of non-union of the femoral shaft and the femoral neck is a rare combination that will cause significant challanges during surgery. There are controversies in the literature regarding fracture fixation techniques, such as intramedullary versus extramedullary implants and single versus double implants for both fractures, especially in youthful patients. We discuss our experience in treating a juvenile patient with non-union fracture neck of femur and ipsilateral femoral shaft, and a broken implant in situ.Orthofix limb reconstruction system (LRS) is utilised for non-union fracture shaft of femur, while fracture neck of femur is provisionally stabilised by external fixator. The radiological union of the femoral neck occurred at 6 weeks and the femoral shaft at 7 months. At 9 months, the LRS was removed, and at 10 months, the patient had nearly full hip and knee range of motion. Orthofix LRS is a viable option for the treatment of ipsilateral non-union fractures of the shaft and neck of the femur, especially when infection is present or suspected.

Novel illuminoss photodynamic bone stabilization system: normal and post-operative complication imaging findings in the emergency setting.

The mainstay orthopedic surgical technique for fracture fixation involves metal plates, screws, and rods. While these methods are effective, they exhibit high rates of complications within specific populations, particularly among patients with pathologic and insufficiency fractures. IlluminOss represents a novel photodynamic bone stabilization system, approved for use in multiple countries, that serves as an alternative to traditional fracture fixation approaches for patients experiencing pathologic, traumatic, and fragility fractures. Despite the initial success of the system in fostering fracture healing, no study has comprehensively examined the radiological attributes of the IlluminOss Stabilization system thus far. The emergency radiologist is often the first point of imaging identification and interpretation for patients presenting with suspected postoperative complications, requiring evolving knowledge of both expected and atypical appearances for novel surgical implants. This manuscript's objective is to delve into the design and clinical application of IlluminOss, scrutinize relevant normal imaging findings across various modalities, and delineate potential complications associated with the IlluminOss Stabilization system for traumatic, pathologic, and fragility fractures that are increasingly encountered in the emergency department setting.

A comparison of one point versus two point fixation in the management of zygomatico-maxillary complex fractures

The zygomaticomaxillary complex (ZMC) fractures are highly frequent injuries. There is a variety of operative techniques for fixation of ZMC fractures, with no consensus about the best technique. We aim to compare one-point versus two-point fixation of tripodal zygomatic fractures. This study was carried out on 34 patients admitted to the trauma unit in Sanjay Gandhi Institute of Trauma and Orthopaedics in the period from September 2022 to August 2023. Patients were divided into two groups (group 1; one-point fixation, and group 2; two- point fixation). When compared to the one-point fixation group, only 14 patients had substantial stability with a P-value of <0.05 being statistically significant. In contrast, nearly all patients in the two-point fixation group had higher stability. In the two-point fixation group, nearly all patients had a post-operative scar; in the one-point fixation group, however, only two patients had the same scar, and the mouth opening was also improved. In two-point fixation, paraesthesia was observed in nearly seven patients, while in one-point fixation, it was present in only two patients.The one-point fixation technique for tripodal ZMC fractures is considered effective as the two-point fixation technique; and it offers advantages of scarless operation, reduced operation time, fewer complications, and lower cost.

Comparison Between Intramedullary Nail and Percutaneous Pin Fixation in Proximal Phalanx Fractures.

Percutaneous pinning has been the predominant technique for fixation of proximal phalanx fractures, but stiffness is a reported complication. The introduction of intramedullary (IM) nail fixation of proximal phalanx fractures provides a stronger biomechanical fixation for amenable fracture patterns with the added benefit of not tethering the soft tissue. The goal of this study was to compare the surgical outcomes of IM nail and percutaneous pin fixation in isolated proximal phalanx fractures. A retrospective review was performed at our institution between the years 2018 and 2022 for patients treated for proximal phalanx fractures. Patients that underwent fixation with IM nails or percutaneous fixation for isolated extraarticular proximal phalanx fractures were included. Patients were excluded if they had concomitant hand fractures, tendon injury, or intraarticular extension. A total of 50 patients were included in this study. Twenty-eight patients received percutaneous pin fixation, and 22 patients underwent IM nail or screw fixation. There was no significant difference in injury patterns or demographics between these two groups. Patients that underwent IM nail fixation had a significantly quicker return to active motion, shorter duration of orthosis treatment, and fewer occupational therapy visits. In addition, patients in the IM fixation group had significantly improved range of motion (ROM) at 6 weeks postoperatively. This study demonstrates that patients receiving percutaneous pin or IM nail fixation have equivocal union and complication rates. The IM nail fixation group was able to have quicker return to mobilization, fewer required occupational therapy visits, and improved early ROM.

A NOVEL TECHNIQUE OF MULTIPLE CANTILEVER K-WIRING FOR FRACTURE FIXATION IN SEVERELY COMMINUTED METAPHYSEAL FRACTURES

The management of comminuted metaphyseal fractures is a technical challenge and satisfactory outcomes of such fixations often remain elusive. The small articular fragments and bone loss often make it difficult for standard fixation implants for proper fixation. We developed a novel technique to achieve anatomical reduction in multiple cases of comminuted metaphyseal fractures at different sites by employing the cantilever mechanism with the help of multiple thin Kirschner wires augmented by standard fixation implants.We performed a retrospective study of 10 patients with different metaphyseal fractures complicated by comminution and loss of bone stock. All patients were treated with the help of cantilever mechanism using multiple Kirschner wires augmented by compression plates. All the patients were operated by the same surgeon between November 2020 to March 2021 and followed up till March 2023. Surgical outcomes were evaluated according to the clinical and radiological criteria.A total of 10 patients were included in the study. Since we only included patients with highly unstable and comminuted fractures which were difficult to fix with traditional methods, the number of patients in the study were less. All 10 patients showed satisfactory clinical and radiological union at the end of the study with good range of motion. One of the patient in the study had post-operative wound complication which was managed conservatively with regular dressings and oral antibiotics.Comminuted metaphyseal fractures might differ in pattern and presentation with every patient and there can be no standard treatment for all. The cantilever technique of fracture fixation is based on the principle of cantilever mechanism used in bridges and helps achieve good anatomical reduction and fixation. It provides a decent alternative when standard modes of fixation don't give desired result owing to comminuted nature of fractures and deficiency of bone stock.

A Technique for Arthroscopic Fixation of Tibial Eminence Avulsion Fractures: A Physeal-Sparing Construct With All-Suture Anchor Bridge Fixation

Arthroscopic or open surgical treatment is indicated for displaced tibial spine fractures to obtain anatomic reduction and restore the functionality of the anterior cruciate ligament. Numerous open and arthroscopic techniques for the treatment of tibial spine fractures have been described. The purpose of this technical note is to describe a minimally invasive arthroscopic physeal- and ligament-sparing surgical technique using knotless all-suture anchors to provide stable bridge fixation over displaced tibial spine fractures.

Constructing an Osseointegrated Prosthetic Leg.

Constructing an osseointegrated prosthetic leg is the necessary subsequent phase of care for patients following the surgical implantation of an osseointegrated prosthetic limb anchor. The surgeon implants the bone-anchored transcutaneous implant1,2 and the prosthetist constructs the prosthetic leg, which then attaches to the surgically implanted anchor. An osseointegration surgical procedure is usually considered in patients who are unable to use or are dissatisfied with the use of a socket prosthesis. This present video article describes the techniques and principles involved in constructing a prosthetic leg for transfemoral and transtibial amputees, as well as postoperative patient care. Preoperatively, as part of a multidisciplinary team approach, the prosthetist should assist in patient evaluation to determine suitability for osseointegration surgery. Postoperatively, when approved by the surgeon, the first step is to perform an implant inspection and to take patient measurements. A temporary loading implant is provided to allow the patient to start loading the limb. When the patient is approved for full-length leg to begin full weight-bearing, the implant and prosthetic quality are evaluated, including torque, implant position, bench alignment, static alignment in the standing position, and initial dynamic alignment. This surgical procedure also requires long-term, continued patient care and prosthetic maintenance. For patients who are dissatisfied with the use of a socket prosthesis, adjustments can often be made to improve the comfort, fit, and performance of the prosthesis. Non-osseointegration surgical options include bone lengthening and/or soft-tissue contouring. Osseointegration can be provided for amputees who are expressing dissatisfaction with their socket prosthesis, and typically provides superior mobility and quality of life compared with nonoperative and other operative options3,4. Specific differences between the appropriate design and construction of osseointegrated prostheses versus socket prostheses include component selection, component fit, patient-prosthesis static and dynamic alignment, tolerances and accommodations, and also the expected long-term changes in patient joint mobility and behavior. Providing an osseointegrated prosthesis according to the principles appropriate for socket prostheses may often leave an osseointegrated patient improperly aligned and provoke maladaptive accommodations, hindering performance and potentially putting patients at unnecessary risk for injury. Review articles describing the clinical outcomes of osseointegration consistently suggest that patients with osseointegrated prostheses have improved prosthesis wear time, mobility, and quality of life compared with patients with socket prostheses. Importantly, studies have shown that osseointegrated prostheses can be utilized in patients with short residual limbs that preclude the use of a socket prosthesis, allowing them to regain or retain function of the joint proximal to the short residuum5,6. Osseoperception improves patient confidence during mobility7. Because there is an open skin portal, low-grade soft-tissue infection can occur, which is usually treated with a short course of oral antibiotics. Much less often, soft-tissue debridement or implant removal may be needed to treat infection8. Periprosthetic fractures can nearly always be treated with familiar fracture fixation techniques and implant retention9,10. Falls can lead to periprosthetic fractures.Malalignment can lead to unnecessary pathologic joint forces, soft-tissue contractures, and an accommodative gait.Inadequately sophisticated components can leave patients at a performance deficit.Wearing the prosthetic leg while sleeping may lead to rotational forces exerted on the limb, which may cause prolonged tension on the soft tissue. QTFA = Questionnaire for Persons with a Transfemoral AmputationLD-SRS = Limb Deformity Modified Scoliosis Research SocietyPROMIS = Patient-Reported Outcomes Measurement Information SystemEQ-5D = EuroQol 5 Dimensions.

A Screw Fixation Technique for Calcaneus Fractures: Simplifying Three-dimensional Thinking and Minimal Invasive Surgery

Calcaneus fractures are usually seen in the same pattern of injury, which is characterized by 4 fracture fragments and causes 4 deformities. This article aims to provide a comprehensive guide for the minimal invasive screw fixation method using minimal invasive sinus tarsi incision for calcaneus fractures. The importance of three-dimensional thinking in understanding fracture patterns is emphasized, with suggestions for utilizing computerized tomography scans. The step-by-step surgical procedure is outlined, including reduction maneuvers, fluoroscopic control, and 4 essential x-ray views for accurate assessment. Therefore, it is aimed to identify the proper screw placements for the typical calcaneus fracture fragments. The article concludes by summarizing the presented surgical steps, emphasizing the simplicity and reproducibility of the techniques, and emphasizing the crucial role of three-dimensional thinking in managing calcaneus fractures. Level of Evidence: Level 4, expert opinion.

On the importance of accurate elasto-plastic material properties in simulating plate osteosynthesis failure.

Background: Plate osteosynthesis is a widely used technique for bone fracture fixation; however, complications such as plate bending remain a significant clinical concern. A better understanding of the failure mechanisms behind plate osteosynthesis is crucial for improving treatment outcomes. This study aimed to develop finite element (FE) models to predict plate bending failure and validate these against in vitro experiments using literature-based and experimentally determined implant material properties. Methods: Plate fixations of seven cadaveric tibia shaft fractures were tested to failure in a biomechanical setup with various implant configurations. FE models of the bone-implant constructs were developed from computed tomography (CT) scans. Elasto-plastic implant material properties were assigned using either literature data or the experimentally derived data. The predictive capability of these two FE modelling approaches was assessed based on the experimental ground truth. Results: The FE simulations provided quantitatively correct prediction of the in vitro cadaveric experiments in terms of construct stiffness [concordance correlation coefficient (CCC) = 0.97, standard error of estimate (SEE) = 23.66, relative standard error (RSE) = 10.3%], yield load (CCC = 0.97, SEE = 41.21N, RSE = 7.7%), and maximum force (CCC = 0.96, SEE = 35.04, RSE = 9.3%), when including the experimentally determined material properties. Literature-based properties led to inferior accuracies for both stiffness (CCC = 0.92, SEE = 27.62, RSE = 19.6%), yield load (CCC = 0.83, SEE = 46.53N, RSE = 21.4%), and maximum force (CCC = 0.86, SEE = 57.71, RSE = 14.4%). Conclusion: The validated FE model allows for accurate prediction of plate osteosynthesis construct behaviour beyond the elastic regime but only when using experimentally determined implant material properties. Literature-based material properties led to inferior predictability. These validated models have the potential to be utilized for assessing the loads leading to plastic deformation in vivo, as well as aiding in preoperative planning and postoperative rehabilitation protocols.

Incidence of postoperative complications in patellar fractures related to different methods of osteosynthesis procedures - a retrospective cohort study

BackgroundPatellar fractures have a comparatively low incidence compared to all fracture frequencies of the musculoskeletal system. However, surgical management is crucial to prevent postoperative complications that affect the knee joint. The purpose of the present study was to evaluate the incidence of postoperative complications and onset of postoperative osteoarthritis related to the chosen technique of patellar fracture management.MethodsIn a retrospective cohort study consecutive managed, isolated patella fractures were reviewed for demographic data, trauma mechanism, patella fracture type, fixation technique and postoperative complications. The results were documented radiographically and clinically and analysed statistically. The reporting followed the STROBE guidelines.ResultsA total of 112 patients were eligible for data evaluation. Surgical management of comminuted patellar fractures with small fragment screws showed significant fewer postoperative complications compared to other fixation techniques (8%, p < 0.043). The incidence of posttraumatic infection was significantly higher following the hybrid fixation technique with cannulated screws and tension wire than following the other analysed techniques (p = 0.024). No postoperative wound infection was observed after screw fixation or locking plate fixation. Symptomatic hardware was most frequently seen after tension-band fixation. Onset of posttraumatic osteoarthritis was most often found after the hybrid fixation technique (55%).ConclusionSurgical management of patellar fractures remains crucial but fracture fixation using plating systems or small fragment screws is least associated with postoperative complications.Trial registrationTrial registration number (DRKS):00027894.

Biomechanical evaluation of different posterior fixation techniques for treating thoracolumbar burst fractures of osteoporosis old patients: a finite element analysis.

Objective: To investigate the biomechanical characteristics of different posterior fixation techniques in treatment of osteoporotic thoracolumbar burst fractures by finite element analysis. Methods: The Dicom format images of T10-L5 segments were obtained from CT scanning of a volunteer, and transferred to the Geomagic Studio software, which was used to build digital models. L1 osteoporotic burst fracture and different posterior fixation techniques were simulated by SolidWorks software. The data of ROM, the maximum displacement of fixed segment, ROM of fractured L1 vertebrae, the stress on the screws and rods as well as on fractured L1 vertebrae under different movement conditions were collected and analysed by finite element analysis. Results: Among the four groups, the largest ROM of fixed segment, the maximum displacement of fixed segment and ROM of fractured vertebrae occurred in CBT, and the corresponding data was 1.3°, 2.57mm and 1.37°, respectively. While the smallest ROM of fixed segment, the maximum displacement of fixed segment and ROM of fractured vertebrae was found in LSPS, and the corresponding data was 0.92°, 2.46mm and 0.89°, respectively. The largest stress of screws was 390.97Mpa, appeared in CBT, and the largest stress of rods was 84.68MPa, appeared in LSPS. The stress concentrated at the junction area between the root screws and rods. The maximum stress on fractured vertebrae was 93.25MPa, appeared in CBT and the minimum stress was 56.68MPa, appeared in CAPS. And the stress of fractured vertebrae concentrated in the middle and posterior column of the fixed segment, especially in the posterior edge of the superior endplate. Conclusion: In this study, long-segment posterior fixation (LSPF) provided with the greatest stability of fixed segment after fixation, while cortical bone screw fixation (CBT) provided with the smallest stability. Cement-augmented pedicle screw-rod fixation (CAPS) and combined using cortical bone screw and pedicle screw fixation (CBT-PS) provided with the moderate stability. CBT-PS exhibited superiority in resistance of rotational torsion for using multiple connecting rods. CAPS and CBT-PS maybe biomechanically superior options for the surgical treatment of burst TL fractures in osteoporotic patients.

Modified Stoppa Approach for Acetabular Fixation

Introduction: When acetabular fractures are intra-articular, correct anatomic reduction is important to achieve an excellent functional outcome. A few of the surgical techniques like ilioinguinal and modified Stoppa techniques are the only available intra-pelvic procedures. Despite the fact that ilioinguinal method is more commonly used, modified Stoppa technique is becoming more popular due to the possibility of visualizing and reducing quadrilateral plate fragments in addition to fixation of posterior column through anterior approach. The goal of our study is to assess the efficacy of various reduction tools/ techniques for reduction and fixation of fractures by use of modified Stoppa technique. Materials and Methods: We have operated on 16 patients with acetabular fractures through modified Stoppa approach within the age group of 19 years to 70 years (mean 42 years) with male female ratio of 13:3. In patients requiring combined method, the anterior approach was performed first. In most of the patient’s, modified Stoppa was combined with a lateral window. we have used various reduction strategies consisting of trans trochanteric Schanze pin, intra-focal elevators, ball spike, bone hook, iliac crest Schanze pin, Farebeat forceps, under contoured plate and many others. Results: Matta’s radiographic reduction criteria showed anatomic reduction in 10 cases. Clinical evaluation using Merle d’ Aubigne scoring showed excellent outcomes in 9 cases and good results in 6 cases. Follow up was done for a most duration of six months. Conclusion: Modified Stoppa technique provides better visualisation of quadrilateral floor and sciatic buttress while compared to the ilioinguinal method. Using suitable reduction strategies gives good reduction of anterior column, at the same time offers possibility to restore the posterior column from the anterior aspect using anterior to posterior column screws, obviating the need for a separate posterior approach.

Biomechanical Variability and Usability of a Novel Customizable Fracture Fixation Technique.

A novel in situ customizable osteosynthesis technique, Bonevolent™ AdhFix, demonstrates promising biomechanical properties under the expertise of a single trained operator. This study assesses inter- and intra-surgeon biomechanical variability and usability of the AdhFix osteosynthesis platform. Six surgeons conducted ten osteosyntheses on a synthetic bone fracture model after reviewing an instruction manual and completing one supervised osteosynthesis. Samples underwent 4-point bending tests at a quasi-static loading rate, and the maximum bending moment (BM), bending stiffness (BS), and AdhFix cross-sectional area (CSA: mm²) were evaluated. All constructs exhibited a consistent appearance and were suitable for biomechanical testing. The mean BM was 2.64 ± 0.57 Nm, and the mean BS was 4.35 ± 0.44 Nm/mm. Statistically significant differences were observed among the six surgeons in BM (p < 0.001) and BS (p = 0.004). Throughout ten trials, only one surgeon demonstrated a significant improvement in BM (p < 0.025), and another showed a significant improvement in BS (p < 0.01). A larger CSA corresponded to a statistically significantly higher value for BM (p < 0.001) but not for BS (p = 0.594). In conclusion, this study found consistent biomechanical stability both across and within the surgeons included, suggesting that the AdhFix osteosynthesis platform can be learned and applied with minimal training and, therefore, might be a clinically viable fracture fixation technique. The variability in BM and BS observed is not expected to have a clinical impact, but future clinical studies are warranted.

Clinical practice and intelligent thinking of minimally invasive and external fixation techniques for fractures based on Chinese Osteosynthesis theory

Clinical practice and intelligent thinking of minimally invasive and external fixation techniques for fractures based on Chinese Osteosynthesis theory

Comparison of Joshi's external stabilization system and Kirschner wire fixation technique for extra-articular metacarpal fractures

Hand fractures, especially metacarpals and phalanges, account for 15% of emergency department admissions. Metacarpal fractures can be treated using various algorithms. Hand fractures have been treated with K wire fixation, micro plates, and external fixator application devices. A successful functional outcome requires surgical intervention with good fixation principles and a rigid system that allows early mobilization. JESS is a simple, lightweight fixation that can be used with splints or converted to dynamic mobilization units. In open fractures, JESS rigidly fixes bones. Compress, neutralize, or distract a fracture fragment to aggressively treat bone and soft tissue injuries. Moving the proximal and distal joints instantly reduces edema, capsular fibrosis, joint stiffness, and muscle atrophy. Kirschner wires are the easiest, cheapest, and most versatile hand injury treatment. They can be percutaneously introduced. It allows early movements without surgical stress This study compares intramedullary Kirschner wires and Joshi’s external fixator device for unstable extra-articular metacarpal fractures.

External fixation versus intramedullary nailing for the management of open tibial fracture: meta-analysis of randomized controlled trials.

Tibial shaft fractures are the most common type of long-bone fractures. External fixation (EF) and intramedullary nailing (IMN) are widely used surgical techniques for the definitive fixation of open tibial shaft fractures. The aim of this systematic review and meta-analysis was to compare EF to IMN for the definitive fixation of open tibial fractures. Medline, Embase, and CENTRAL databases were searched for eligible studies. We included randomized controlled trials (RCTs) that compared EF to IMN for skeletally mature adults with open tibial fracture (Gustilo I, II, and III). We evaluated the following outcomes: superficial infection, pin-track infection, deep infection, malunion, nonunion, delayed union, and implant/hardware failure. The risk ratio (RR) was used to represent the desired outcomes. The statistical analysis was performed using the random-effects model. A total of 12 RCTs that enrolled 1090 participants were deemed eligible for the analysis. EF showed a significantly higher rate of superficial infection, pin track infection, and malunion compared to IMN (RR = 2.30, 95% confidence interval (CI): 1.34 to 3.95; RR = 13.52, 95% CI: 6.16 to 29.66; RR = 2.29, 95% CI 1.41 to 3.73, respectively). No substantial difference was found between EF and IMN in terms of deep infection, nonunion, delayed union, or implant/hardware failure (RR = 1.15, 95% CI 0.67 to 1.98; RR = 0.92, 95% CI 0.77 to 1.10; RR = 1.50, 95% CI 0.98 to 3.33; RR = 0.96, 95% CI 0.36 to 2.60, respectively). The findings of our meta-analysis are consistent with the previous systematic reviews excepts for the implant/hardware failure which was found to be significant in favour of IMN by one of the previous reviews. This meta-analysis confirms that IMN is better than EF with respect to clinical outcomes and complication rate for the definitive fixation of open tibial fracture.

Fixation Techniques for Intraarticular Proximal Humeral Fractures

Background. The most severe type of injuries of the proximal epiphysis of the humerus are intraarticular fractures. One of the main complication is the development of avascular osteonecrosis, which is caused by the peculiarities of blood supply of the humeral head and its compromised vascularization as a result of trauma. Current osteosynthesis techniques for intraarticular fractures of the proximal humerus (PH) do not reduce the risk of avascular osteonecrosis of the humeral head (AONHH) and do not reduce the risk of nonunion. To prevent ischemic changes in the humeral head, osteosynthesis with reparative osteogenesis stimulation is recommended.&#x0D; Aim of the study to specify indications for various fixation techniques of intraarticular fractures of the proximal humerus.&#x0D; Methods. The study enrolled 48 patients with AO/ASIF type 11C1 and 11C2 intraarticular PH fractures requiring surgical treatment. All patients were allocated into 2 groups. Retrospective (control) group included 25 patients who were treated using locking plate osteosynthesis or intramedullary locking osteosynthesis with proximal humeral nails. Prospective (main) group included 23 patients who were additionally treated with a vascularized musculoskeletal graft from the coracoid process of the scapula transplanted to the fracture area.&#x0D; Results. Functional treatment results of patients who underwent surgery using vascularized musculoskeletal grafts from the coracoid processes of the scapula (71.50% were excellent and 14.3% were good) were better than those of the control group (35.28% were excellent and 17.64% were good). Consolidation of the fracture in the control group occurred in 92% of cases (23 patients); the remaining 8% (2) of patients had pseudoarthrosis of the anatomical or surgical neck of the humerus developed within 6 months after the surgery. In the main group, the fractures consolidated in all patients.&#x0D; Conclusion. Fractures with no damage to the bicipital groove should be considered an indication for performing plate osteosynthesis without vascularized musculoskeletal grafting. Locking osteosynthesis in case of intraarticular PH fractures makes it much more difficult to reduce the humeral head and the tubercular area. Locking osteosynthesis decreases the rigidity of fixation of fragments, which may contribute to their secondary displacement.