Treatment Of Fractures Research Articles

Open Reduction and Internal Fixation with Plate and Screw versus Triplanar External Fixation in the Surgical Treatment of Calcaneal Fractures: A Retrospective Cohort Study

Background: The treatment of displaced intra-articular calcaneal fractures (DIACF) is debated. This study compares open reduction and internal fixation (ORIF) with minimally invasive osteosynthesis (MIOS). Methods: We conducted a retrospective study on 70 patients with DIACF treated between January 2018 and September 2022, divided into ORIF (n = 50) and MIOS (n = 20) groups. Functional outcomes were assessed using the Maryland Foot Score (MFS) and the Creighton-Nebraska Health Foundation Assessment Scale (CNHFAS). Radiographic outcomes, complication rates, and reintervention rates were evaluated. A chi-square analysis examined the correlation between Sanders classification and treatment choice. Results: The chi-square analysis indicated no significant correlation between the complexity of the fracture and the type of treatment chosen (χ2 = 0.175, p = 0.916). Additionally, the Cochran–Armitage test for trend showed no significant trend in the choice of treatment based on fracture complexity (statistic = 0.048, p = 0.826). A Kaplan–Meier analysis showed a longer time to reintervention for MIOS (p = 0.029). Complication rates were similar, with specific complications varying between groups. Quality-of-life outcomes were comparable. Conclusions: ORIF is preferable for high-demand patients due to better anatomical outcomes, while MIOS suits high-risk patients by reducing reinterventions and complications. Further randomized trials are needed to confirm these findings.

Successful Treatment of Olecranon Fracture with Tie-in External Fixator in a Cat

In this case report, A 4-months-old, male, British shorthair cat was presented with lameness and swelling in the forelimb and loss of appetite after a fall from a height. On the orthopedic examination, pain, lameness, abnormal mobility, local sensitivity, crepitation, and deformation findings were observed in the forelimb. Clinical and radiological examinations revealed an avulsion fracture of the left olecranon. The fracture was treated with an external fixator. Clinical and radiological controls were performed on the 10th, 21st, 30th, and 45th postoperative days. The external fixator was removed on the 62nd postoperative day under sedation. This case report aimed to contribute to the literature on the successful treatment of fracture of the olecranon with an external fixator in a 4-months-old young cat.

COMPLICATIONS OF CONSERVATIVE AND SURGICAL TREATMENT OF FRACTURES OF THE MANDIBULAR CONDYLAR PROCESS (LITERATURE REVIEW)

One of the most pressing problems in modern maxillofacial surgery is the treatment and rehabilitation of patients with fractures of the condylar process of the mandible. According to various statistical data, the incidence of fractures at this site is 19-37%, and these fractures are the most controversial in terms of diagnosis and treatment. In recent years, there has been an increase in severe forms of mandibular condyle fractures: bilateral, combined, intra-articular, leading to serious complications that affect the functioning of the temporomandibular joint. The data obtained indicated the need for a detailed study of this pathology in order to make a qualitative diagnosis and improve the available treatment methods. The aim of the study – to analyse and summarise current data from the scientific literature on possible complications in the treatment of the condylar process fractures of the mandible. Materials and methods. The bibliosemantic method was used to clarify the state of the problem, to study the analysis of the results of previous scientific research based on the literature sources and electronic resources. Results and discussion. The management of patients with mandibular condylar fractures is widely discussed in the literature due to their high prevalence, but there is still no consensus on the optimal management of patients with this pathology. To date, there are many studies that highlight certain complications of conservative and surgical treatment, but they are not generalised or systematised. Conclusions. Summarizing, we can conclude that complications occur during both conservative and surgical treatment of patients with mandibular condyle fractures. Complications are most often associated with incomplete diagnosis, incorrect choice of treatment method, and depend on the method of access and fixation in surgical treatment.

Structural design and evaluation of bone remodeling effect of fracture internal fixation implants with time-varying stiffness

The stiffness of an ideal fracture internal fixation implant should have a time-varying performance, so that the fracture can generate reasonable mechanical stimulation at different healing stages, and biodegradable materials meet this performance. A topology optimization design method for composite structures of fracture internal fixation implants with time-varying stiffness is proposed, considering the time-dependent degradation process of materials. Using relative density and degradation residual rate to describe the distribution and degradation state of two materials with different degradation rates and elastic modulus, a coupled mathematical model of degradation simulation mechanical analysis was established. Biomaterial composite structures were designed based on variable density method to exhibit time-varying stiffness characteristics. Taking the bone plate used for the treatment of tibial fractures as an example, a composite structure bone plate with time-varying stiffness characteristics was designed using the proposed method. The optimization results showed that material 1 with high stiffness formed a columnar support structure, while material 2 with low stiffness was distributed at the degradation boundary and inside. Using a bone remodeling simulation model, the optimized bone plates were evaluated. After 11 months of remodeling, the average elastic modulus of callus using degradable time-varying stiffness plates, titanium alloy plates, and stainless steel plates were 8 634 MPa, 8 521 MPa, and 8 412 MPa, respectively, indicating that the use of degradable time-varying stiffness plates would result in better remodeling effects on the callus.

Does Early Treatment With Teriparatide Prevent the Need for Surgical Intervention in Osteoporotic Vertebral Compression Fractures.

Retrospective Cohort Study. The primary objective of this study is to evaluate the efficacy of early administration of Teriparatide in preventing the necessity of surgical intervention in individuals with osteoporotic vertebral compression fractures. In a 24-month follow-up retrospective analysis, 191 OVCF patients from January 2016 to October 2020 were randomly assigned to Non teriparatide Group A (n = 104) or Group B teriparatide (n = 87). At baseline, 6months, 1year, and 2years following treatment, demographic data and need of surgical intervention, VAS, ODI, union rates, and kyphosis development, were examined. Our study found that non-teriparatide group individuals had an 11.53% higher risk of non-union formation that required surgery. Only 8.63% of teriparatide group patients needed surgery. Both groups had significant VAS score reductions. Non-teriparatide group scores declined from 8.38 ± 0.74 to 3.15 ± 1.40, while teriparatide group scores decreased from 8.49 ± 0.73 to 1.11 ± 0.31. The 2-year follow-up ODI scores significantly decreased, with values of 25.02 ± 13.94 for non-teriparatide patients and 15.11 ± 2.17 for teriparatide patients. The kyphosis progression angles in the teriparatide group were considerably lower (4.97 ± 0.78°) compared to the other group (8.09 ± 1.25°). With increasing elderly populations, it is necessary to take measures to prevent surgical intervention in osteoporotic spinal compression fractures. Teriparatide can be employed as an early medication in the management of these fractures to avert non-union and the minimise the progression of kyphosis.

Evaluación, diagnóstico diferencial y tratamiento de la osteoporosis vertebral: cómo evitar la aparición de nuevas fracturas

Osteoporosis is a highly prevalent and multifactorial disease whose main manifestation is the appearance of fragility or low-impact fractures. The most frequent locations of osteoporotic fractures occur at the vertebrae, femoral, distal end of the radius and humerus. Osteoporotic vertebral fracture deserves special mention among them due to its prevalence, importance as it often goes unnoticed and medium-long term consequences are: pain, deformity, disability and deterioration in quality of life. In this review we will focus on the classification and initial evaluation of the patient with osteoporosis, estimation of risk factors, laboratory and imaging studies for an adequate assessment using simple radiography, dual densitometry and magnetic resonance imaging. We will also address the main aspects of the differential diagnosis, treatment and prevention of vertebral fragility fracture, briefly reviewing the main therapeutic agents currently used for its prevention and treatment.

Assessment of radiation exposure risks in patients undergoing elastic stable intramedullary nailing: Insights from intraoperative fluoroscopy

IntroductionElastic stable intramedullary nailing (ESIN) is a well-defined and appropriate treatment of choice for long bone fractures. Despite its benefits, the risk of cancer from imaging devices is of particular concern for younger adults. So, this survey was conducted to estimate the doses administered to patients undergoing ESIN of long bone fractures utilizing a 2-dimensional (2D) C-arm fluoroscopy machine during surgery, as well as the carcinogenic risk associated with the use of the machine. MethodsThis study was conducted on 147 patients who required ESIN for long-bone fractures. Patients' demographic data, surgical data and imaging information were collected. For each patient, the organ doses and the effective doses were computed with the Monte Carlo PCXMC 2.0 simulation software. The cancer risk models proposed in the Biological Effects of Ionizing Radiation VII (BEIR VII) Phase 2 report were used to evaluate the risk of exposure-induced cancer death (REID) values. ResultsFor all patients, the highest organ dose was delivered to the gonads. The mean effective dose was 0.026 ± 0.015 mSv and 1.3E-04 ± 1E-04 mSv for ESIN of femur and tibia fractures, respectively. Males had a mean REID of 1 per million, while females had a mean REID of 0.19 per million. The younger males had considerably higher REID values. The effective dose was significantly correlated with age, gender, and irradiation time. ConclusionLow levels of effective doses and cancer risks associated with the utilization of the fluoroscopy machine in current practice were found in ESIN treatment of long-bone fractures. Implications for practiceThis outcome will help to raise surgeons' awareness of radiation risks and encourage them to initiate measures to keep radiation dose and exposure time as low as reasonably achievable.

Surgical outcomes of robotic-assisted percutaneous fixation for thoracolumbar fractures in patients with ankylosing spondylitis

BackgroundSpinal fractures in patients with ankylosing spondylitis (AS) mainly present as instability, involving all three columns of the spine, and surgical intervention is often considered necessary. However, in AS patients, the significant alterations in bony structure and anatomy result in a lack of identifiable landmarks, which increases the difficulty of pedicle screw implantation. Therefore, we present the clinical outcomes of robotic-assisted percutaneous fixation for thoracolumbar fractures in patients with AS.MethodsA retrospective review was conducted on a series of 12 patients diagnosed with AS. All patients sustained thoracolumbar fractures between October 2018 and October 2022 and underwent posterior robotic-assisted percutaneous fixation procedures. Outcomes of interest included operative time, intra-operative blood loss, complications, duration of hospital stay and fracture union. The clinical outcomes were assessed using the visual analogue scale (VAS) and Oswestry Disability Index (ODI). To investigate the achieved operative correction, pre- and postoperative radiographs in the lateral plane were analyzed by measuring the Cobb angle.ResultsThe 12 patients had a mean age of 62.8 ± 13.0 years and a mean follow-up duration of 32.7 ± 18.9 months. Mean hospital stay duration was 15 ± 8.0 days. The mean operative time was 119.6 ± 32.2 min, and the median blood loss was 50 (50, 250) ml. The VAS value improved from 6.8 ± 0.9 preoperatively to 1.3 ± 1.0 at the final follow-up (P < 0.05). The ODI value improved from 83.6 ± 6.1% preoperatively to 11.8 ± 6.6% at the latest follow-up (P < 0.05). The average Cobb angle changed from 15.2 ± 11.0 pre-operatively to 8.3 ± 7.1 at final follow-up (P < 0.05). Bone healing was consistently achieved, with an average healing time of 6 (5.3, 7.0) months. Of the 108 screws implanted, 2 (1.9%) were improperly positioned. One patient experienced delayed nerve injury after the operation, but the nerve function returned to normal upon discharge.ConclusionPosterior robotic-assisted percutaneous internal fixation can be used as an ideal surgical treatment for thoracolumbar fractures in AS patients. However, while robot-assisted pedicle screw placement can enhance the accuracy of pedicle screw insertion, it should not be relied upon solely.

Fixation or Revision for Periprosthetic Fractures: Epidemiology, New Trends, and Projections in the United States.

Periprosthetic fractures can be devastating complications after total joint arthroplasty (TJA). The management of periprosthetic fractures is complex, spanning expertise in arthroplasty and trauma. The purpose of this study was to examine and project trends in the operative treatment of periprosthetic fractures in the United States. A large, public and private payer database was queried to capture all International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes for periprosthetic femoral and tibial fractures. Statistical models were created to assess trends in treatment for periprosthetic fractures and to predict future surgical rates. An alpha value of 0.05 was used to assess significance. A Bonferroni correction was applied where applicable to account for multiple comparisons. In this study, from 2016 to 2021, 121,298 patients underwent surgical treatment for periprosthetic fractures. There was a significant increase in the total number of periprosthetic fractures. The incidence of periprosthetic hip fractures rose by 38% and that for periprosthetic knee fractures rose by 73%. The number of periprosthetic fractures is predicted to rise 212% from 2016 to 2032. There was a relative increase in open reduction and internal fixation (ORIF) compared with revision arthroplasty for both periprosthetic hip fractures and periprosthetic knee fractures. Periprosthetic fractures are anticipated to impose a substantial health-care burden in the coming decades. Periprosthetic knee fractures are predominantly treated with ORIF rather than revision total knee arthroplasty (TKA), whereas periprosthetic hip fractures are predominantly treated with revision total hip arthroplasty (THA) rather than ORIF. Both periprosthetic knee fractures and periprosthetic hip fractures demonstrated increasing trends in this study. The proportion of periprosthetic hip fractures treated with ORIF relative to revision THA has been increasing. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Classification and Treatment Strategies of Tibial Tubercle Fractures in Adults.

Tibial tubercle is a crucial player in maintaining the structural integrity and functional stability of the knee joint. Currently, there is no standardized protocol for the classification and treatment of tibial tubercle fractures in adults. This study analyzed the incidence and treatment strategies of tibial tubercle fractures in adults according to the four-column and nine-segment classification system. Data of patients with proximal tibial fractures involving tibial tubercle fractures who were treated at our hospital from August 2007 to March 2023 were retrospectively reviewed. The fractures were classified using the AO/OTA classification and four-column and nine-segment classification systems, and the treatment protocol (surgically treated or conservatively treated) was recorded. The number and distribution proportion of patients were counted. A two-sided t-test was conducted to determine the significance of differences between the gender and sides. In total, 169 tibial tubercle fractures were found in 1484 proximal tibial fractures. According to the AO/OTA classification, seven of the 169 patients, (4.1%) were type A, 36 patients (21.3%) were type B, and 126 patients (74.6%) were type C. According to the four-column and nine-segment classification, type 1 cleavage without free fragments was the most common type of fracture (93/169, 55.0%), followed by type 2 dissociative segmental fragments (48/169, 28.4%) and type 3 comminuted fractures (28/169, 16.6%). Overall, 139 of the 169 proximal tibial fractures with tuberosity involvement were treated surgically. Among them, additional fixation of the tubercle fragment was performed in 52 fractures. The incidence of tibial tubercle fractures involved in proximal tibial fractures was approximately 11.4% (169/1484) in adults, and approximately one-third of the tubercle bone fragment required additional fixation (30.8%, 52/169). The injury types in the four-column and nine-segment classifications are helpful for accurately judging and making treatment-related decisions for tibial tubercle fractures.

Остеосинтез переломов ключицы и его осложнения. Обзор литературы. Часть 1

Clavicle fractures are one of the most common injuries of the skeleton bones in an adult active, able bodied population. Thus, they are a socially significant injury. The review of the literature is based on Russian language primary sources from 2013 to 2022, containing the results of relevant studies in the field of clavicle fractures. Some earlier studies were also used. Objective To analyze the existing methods of surgical treatment of clavicle fractures with an emphasis on the frequency of postoperative complications, the timing of treatment and rehabilitation. In clinical practice, there are many methods of treating clavicle fractures both conservative and various options for surgical methods. Each of the methods of treatment has both positive and negative qualities, none of them excludes the development of complications, in particular – the non-extension of the collarbone. Complications significantly increase the time of treatment of the patient, make it difficult to rehabilitation and return to active life.

The use of topical tranexamic acid in geriatric fractured hip

Background: Topical tranexamic acid (TXA) is used preoperatively to reduce blood loss. This study evaluated the effect of topical TXA on post-operative transfusion rate and haemoglobin level in geriatric patients with hip fractures. Methods: This retrospective cohort study included 135 patients over 65 years old with hip fractures from June 2020 to June 2023. Their total haemoglobin mass loss, transfusion rate and thromboembolic events were compared based on the fracture type and intervention (10–15 mg/kg of topical TXA). Results: No significant differences were found in total haemoglobin mass, transfusion rate or thromboembolic events. There was no evidence of an association between the use of TXA and post-operative blood transfusion (OR = 0.82, 95% CI: 0.27–2.52, p = 0.734) or thromboembolic events (OR = 0.81, 95% CI: 0.07–9.49, p = 0.866). Conclusion: A 10–15 mg/kg topical TXA did not reduce total haemoglobin mass loss, influence transfusion needs or increase thromboembolic events or 30-day mortality.

Management of Limited Mouth Opening After Open Reduction and Fixation of Mandibular Coronoid Fractures.

Mandibular coronoid process fractures are relatively rare and generally treated conservatively. This paper reports a case of limited mouth opening and pain after open reduction and fixation of the mandibular coronoid fracture. After the loose titanium screws, plates, and absorbed coronoid fracture fragments were removed, the patient's mouth opening was restored immediately. The authors believe that open reduction and fixation for coronoid process fractures can cause postoperative limited mouth opening and pain. Conservative treatment of coronoid process fractures is more beneficial for patients.

Optimal immobilization position for conservative treatment of proximal humerus fractures by fracture type: a biomechanical cadaveric study

In conservative treatment for proximal humerus fractures (PHFs), the immobilization position of the affected arm should not be determined uniformly. The aim of this study is to investigate the optimal immobilization position for conservative treatment of different types of PHFs. We hypothesized that the optimal position minimizing the deforming force in PHFs depends on the fracture components involved. PHF models involving either the surgical neck (SN) or greater tuberosity (GT) were created using 12 fresh-frozen cadaveric shoulders. In the SN model, the deforming forces on the pectoralis major muscle were measured in full adduction by increasing external rotation. In the GT model, the deforming force of the supraspinatus muscle was measured in neutral rotation by decreasing abduction, and the deforming force of the infraspinatus muscle was measured in full adduction by increasing internal rotation, respectively. In the SN model, the deforming force of the pectoralis major muscle increased significantly with external rotation from full internal rotation to neutral rotation (P = 0.006), indicating that the arm should be placed in full internal rotation. In the GT model, the deforming force of the supraspinatus muscle increased significantly with adduction from 45° of abduction to full adduction (P = 0.006); the deforming force of the infraspinatus muscle increased significantly with internal rotation from neutral rotation to full internal rotation (P = 0.006). These findings should be considered when placing the arm in abduction and neutral rotation so as to minimize the deforming force by either the supra or infraspinatus muscle. In conservative treatment for PHFs, the affected arm should be placed in a position that minimizes the deforming force on the fracture components involved.

EFFECT OF FIBULA SHORTENING ON MEDIAL CLEAR SPACE AND LATERAL TRANSLATION OF THE TALUS: AN ANATOMICAL CADAVERIC STUDY

IntroductionFibula shortening with an intact anterior tibiofibular ligament (ATFL) and medial ligament instability causes lateral translation of the talus. Our hypothesis was that the interaction of the AITFL tubercle of the fibular with the tibial incisura would propagate lateral translation due to the size differential.AimTo assess what degree of shortening of the fibular would cause the lateral translation of the talus.MethodologyTwelve cadaveric ankle specimens were dissected removing all soft tissue except for ligaments. They were fixed on a specially-designed platform within an augmented ankle cage allowing tibial fixation and free movement of the talus. The fibula was progressively shortened in 5mm increments until complete ankle dislocation. The medial clear space was measured with each increment of shortening.ResultsThe larger AITFL tubercle interaction with the smaller tibial incisura caused a significant increase in lateral translation of the talus. This occurred in most ankles between 5–10mm of fibular shortening. The medial clear space widened following 5mm of shortening in 5 specimens (mean=2.0725, SD=±2.5338). All 12 specimens experienced widening by 10mm fibula shortening (Mean=7.2133mm, SD=±2.2061). All specimens reached complete dislocation by 35mm fibula shortening. Results of ANOVA analysis found the data statistically significant (p&lt;0.0001).ConclusionThis study shows that shortening of the fibula causes a significant lateral translation of the talus provided the ATFL remains intact. Furthermore, the interaction of the fibula notch with the ATFL tubercle of the tibia appears to cause a disproportionate widening of the medial clear space due to its differential in size. Knowledge of the extent of fibula shortening can guide further intervention when presented with a patient experiencing medial clear space widening following treatment of an ankle fracture.

Discrepancies in the prevalence, risk factors, diagnosis, and treatment of stress fractures between long-distance runners and sprinters: A qualitative review of systematic reviews

This qualitative review of systematic reviews consolidates current knowledge on stress fractures among endurance athletes and sprinters, including epidemiology, risk factors, diagnosis, and treatment strategies. A search across PubMed, Web of Science, SCOPUS, Science Direct, and Google Scholar, limiting results to articles published within the last year, yielded 90 relevant articles. Initial search results were narrowed down to 56 articles following abstract screening, with an additional article obtained through direct author correspondence. Stress fractures, a subset of bone stress injuries, result from persistent mechanical pressure surpassing bone regeneration capacity. They predominantly affect lower extremities, notably the tibia and metatarsals in endurance runners, and the toe phalanx in sprinters. Various risk factors contribute to stress fracture susceptibility, including gender, nutritional deficiencies, biomechanical factors, and psychological aspects like perfectionism and fear of failure. Diagnosis involves detailed patient history, clinical examination, and imaging modalities such as MRI, which remains the gold standard. Treatment emphasizes rest, gradual return to activity, and addressing underlying risk factors. Surgical intervention is reserved for high-risk fractures or cases of non-union. Preventive measures encompass nutritional optimization, biomechanical assessment, appropriate footwear, and psychological support. Notably, strategies targeting the Female Athlete Triad and ensuring adequate energy availability are crucial in both endurance and sprinting athletes. While more research directly comparing distance runners to sprinters is warranted, along with more sprinting-related research in general, this review provides a comprehensive understanding of stress fractures in endurance athletes and sprinters, aiding clinicians in diagnosis, management, and prevention strategies to optimize athlete health and performance.

Routine Chest X-Ray is Not Cost-Effective After Clavicle ORIF: A Cost Effectiveness Analysis with National Estimations

Introduction Clavicular fractures can be managed surgically or via a non-operative approach. In those electing for surgical fixation, post-operative CXR may be routine practice in the post-anesthesia care unit (PACU) for a rare complication of pneumothorax (PTX), thus driving up the cost for managing these fractures. The value and associated cost of this routine CXR in PACU following open reduction internal fixation (ORIF) of clavicles has not been thoroughly assessed. In this study we investigate the cost effectiveness of obtaining CXR after operative treatment of clavicle fracture. Materials and Methods Study was designed as a healthcare two-way dichotomous model with decision trees built in where a CXR was either obtained or not. Literature review was performed to determine the cost estimates of CXR, the cost of ORIF, and associated hospital stay expenses. Annual volume of clavicle ORIF’s performed were derived from the PearlDiver database, queried for CPT-23515 (Clavicle ORIF). Estimation of CXR rates were performed from 3% to 98% of patients undergoing clavicle ORIF. Net monetary analysis with associated sensitivity analysis of 10,000 repetitions was performed. Results The strategy without CXR proved to be the most cost-effective strategy with a net monetary benefit (NMB) of $32,022.50. At $50,000 willingness to pay (WTP), the no CXR strategy was the preferred option. This strategy was found to be optimal 76% of the time followed by routine CXR 23% of the time and less than 1% being indifferent. The national annual costs of routine CXR after clavicle ORIFs was estimated to range from $7,100 to $349,860, which over 10 years represents anywhere from $81,540 to $2,663,640 in additional expenses. Conclusion The provided study demonstrates that routine CXR after clavicle ORIF is not cost effective. Due to the exceedingly low incidence of PTX as a post-operative complication in clavicle ORIF, we recommend that hospitals and surgeons refrain from ordering radiographs in post-operative patients, with the exception of those displaying concerning clinical signs for PTX or those with known pre-operative pulmonary injury. Adopting this strategy will limit unnecessary healthcare costs accrued by patients and may be the more clinically appropriate management.

Clinical Efficacy of Jiegu San External Application Combined with Small Splint External Fixation Following Closed Reduction in Distal Radius Fracture Patients

Objective: To explore the clinical efficacy of the external application of Jiegu San combined with small splint external fixation after closed reduction in treating patients with distal radius fracture. Methods: A total of 397 cases with distal radius fractures admitted from October 2019 to December 2023 were recruited as study subjects and divided into the control group (n = 180) and the observation group (n = 217) according to the treatment method. The control group was treated with small splint external fixation after closed reduction, while the observation group was treated with Jiegu San external application in addition to small splint external fixation following closed reduction. The clinical efficacy, circumference of the fracture site, and pain level of both groups were observed and compared. Results: The total clinical efficacy rate of patients in the observation group (97.70%) was significantly higher than that of patients in the control group (88.88%; P = 0.000). Additionally, the circumference of the fracture site of the observation group was significantly smaller than that of the control group after 3 weeks of treatment (P = 0.000). Moreover, the pain score of the patients in the observation group was significantly lower than that of the control group after 3 weeks of treatment (P = 0.000). Conclusion: In the treatment of distal radius fracture, the combination of Jiegu San external application combined with small splint external fixation following closed reduction can effectively improve the clinical efficacy of patients, promote the reduction of swelling, and reduce the pain level of patients, which is worthy of further promotion.

Reverse Shoulder Arthroplasty versus Non-Operative Treatment of Three-Part and Four-Part Proximal Humerus Fractures in the Elderly Patient: A Pooled Analysis and Systematic Review.

Background: The treatment of complex proximal humerus fractures in elderly patients is not yet fully elucidated. Of all treatment options, reverse shoulder arthroplasty (RSA) and non-operative treatment (NOT) appear to provide the best results. Evidence to guide the choice between the two is sparse. Therefore, this review provides an overview of the available evidence on RSA versus NOT. Methods: Studies comparing complex proximal humerus fractures in patients aged >65 years treated either with RSA or NOT were included for systematic review and direct comparison via pooled analysis of patient-rated outcome and range of motion. Indirect comparison of case series and non-comparative studies on either treatment was performed separately. Results: Three comparative studies including 77 patients treated with RSA and 81 treated non-operatively were analysed. The RSA group scored better for both the Constant-Murley score (mean difference 6 points) and DASH score (mean difference 8 points). No differences were detected in ASES, PENN score, pain scores, or range of motion between treatment groups. The most common complications for RSA were infection (3%), nerve injury (2%), and dislocation (2%). Reoperation was required in 5%. In the NOT group, common complications included malunion (42%), osteonecrosis (25%), and non-union (3%); no reoperation was required. Patient satisfaction was equal in both groups. Conclusions: The functional outcomes and range of motion after RSA seemed satisfactory and potentially superior to NOT in elderly patients. Patient satisfaction was comparable despite a high malunion and osteonecrosis rate in the non-operative treatment group, which did not require re-interventions.

Navicular bone fractures in horses: Prognosis after conservative and surgical treatment

The aim of this retrospective study is to describe and compare conservative and surgical treatment of navicular fractures in horses. An attempt is made to identify critical points that can favorably influence the prognosis of this orthopedic disease. All horses treated for a navicular fracture at the Equine Clinic, Vetsuisse Faculty, University of Zurich between 2005 and 2017 were included in this study. The severity of lameness at initial examination, radiographic assessment, hoof conformation, treatment (conservative or surgical), complications and outcome were determined from the medical records. Conservative and surgical treatment consisted of stable rest, a controlled exercise program and therapeutic orthopedic shoeing. During surgical treatment, fracture reduction was also carried out with a cortical screw. Computer assisted surgery were used in five horses and computer tomography in three horses. Follow-up examinations included clinical and radiographic examinations. The outcome was divided into three categories: 1 = very good; 2 = good; 3 = poor. Twelve horses met the inclusion criteria; Four horses were treated conservatively and eight were treated surgically. After conservative treatment, two horses (50 %) had a very good outcome and two (50 %) had a good outcome. After surgical treatment, four horses (50 %) had a very good outcome and four (50 %) had a poor outcome. Overall, 67 % of horses had a very good or good outcome, although radiographic signs of bone healing was not present in any of these cases. Various complications were identified, such as the fracture of a screw, the fragmentation of the small navicular bone fragment, the development of osteoarthrosis in the coffin joint and progressive podotrochosis. This study shows that the prognosis of navicular fractures is generally cautious and that degenerative changes to the navicular apparatus worsen the prognosis. In the present study, surgical treatment did not improve the prognosis of navicular fractures despite the intrasurgical use of three-dimensional imaging. However, technical advances could reduce the complication rate in the future.