Treatment Of Fractures Research Articles

The Effect of Lag Time Between Injury and Treatment of Zygomatic Complex Fractures on the Neurosensory Disturbances of the Infraorbital Nerve

The Effect of Lag Time Between Injury and Treatment of Zygomatic Complex Fractures on the Neurosensory Disturbances of the Infraorbital Nerve

Effectiveness of sacroiliac screw implantation assisted by three-dimensional printed faceted honeycomb guide plate in treatment of posterior pelvic ring fracture

To investigate the effectiveness of sacroiliac screw implantation assisted by three-dimensional (3D) printed faceted honeycomb guide plate in the treatment of posterior pelvic ring fracture. The clinical data of 40 patients with posterior pelvic ring fractures treated with sacroiliac screw implantation between December 2019 and December 2022 were retrospectively analyzed. Among them, 18 cases were treated with sacroiliac screws fixation assisted by 3D printed faceted honeycomb guide plate (guide plate group), and 22 cases were treated with sacroiliac screws percutaneously fixation under fluoroscopy (conventional group). There was no significant difference in baseline data ( P>0.05) such as gender, age, time from injury to operation, and Dennis classification between the two groups. The implantation time, frequency of C-arm X-ray fluoroscopy, frequency of guide pin adjustment of each sacroiliac screw, and postoperative complications and bone healing were recorded. Majeed score was used to evaluate the functional recovery at 6 months after operation, and CT was used to observe whether the screw penetrated the bone cortex. The deviation between the virtual position and the actual position of the screw tip, the sacral foramen, and the screw entry point was measured on the sagittal CT images of the guide plate group. The number of screws implanted in S 1 and S 2 vertebral bodies was 14 and 16 respectively in the guide plate group, and 17 and 18 respectively in the conventional group. The implantation time of each sacroiliac screw, the frequency of C-arm X-ray fluoroscopy, and the frequency of guide pin adjustment in S 1, S 2, and all vertebrae in the guide plate group were significantly less than those in the conventional group ( P<0.05). Patients in both groups were followed up 8-48 months, with an average of 19.7 months. There was no incision infection, screw displacement, or internal fixation loosening in both groups. Callus growth was observed in all patients at 12 weeks after operation, and bone healing was achieved in all patients. The healing time ranged from 12 to 24 weeks, with an average of 15.7 weeks. No sacroiliac screw penetrated the bone cortex in the guide plate group; 2 patients in the conventional group had sacroiliac screws penetrating the bone cortex without damaging blood vessels or nerves. In the guide plate group, the deviation between the virtual position and the actual position of the screw tip, the sacral foramen, and the screw entry point were (2.91±1.01), (2.10±0.74), and (1.67±0.70) mm, respectively, with an average deviation of (2.19±1.22) mm. There was no significant difference in Majeed function evaluation between the two groups at 6 months after operation ( P>0.05). The application of 3D printed faceted honeycomb guide plate in sacroiliac screw implantation for posterior pelvic ring fracture can shorten the screw implantation time, reduce the frequency of fluoroscopy and guide pin adjustment, and reduce the risk of screw penetration through the bone cortex.

Effectiveness of unilateral biportal endoscopy technique combined with percutaneous pedicle screw fixation in treatment of lumbar burst fractures

To compare the effectiveness of unilateral biportal endoscopy (UBE) technique assisted spinal canal decompression combined with percutaneous pedicle screw internal fixation versus traditional open decompression and internal fixation for treatment of lumbar burst fractures. A retrospective study was conducted on the clinical data of 61 patients with single-segment lumbar burst fractures who met the selection criteria and were admitted between October 2022 and December 2023. Of them, 25 patients received UBE technique assisted decompression combined with percutaneous pedicle screw fixation (UBE group), while 36 patients were treated with traditional posterior unilateral hemilaminectomy decompression and internal fixation (open group). There was no significant difference in baseline data between the two groups ( P>0.05), including gender, age, body mass index, fracture segment, cause of injury, AO classification of lumbar fractures, and preoperative height ratio of the anterior margin of injured vertebra, segmental kyphosis angle, rate of spinal canal invasion, the classification of American Spinal Injury Association (ASIA) grading, visual analogue scale (VAS) score, and Oswestry disability index (ODI). The operation time, intraoperative blood loss, and postoperative complications were recorded and compared between the two groups. VAS score, ODI, and ASIA grading were used to evaluate the effectiveness before operation, at 1 week after operation, and at last follow-up. Lumbar anteroposterior and lateral X-ray films and CT were performed to measure the segmental kyphosis angle, height ratio of the anterior margin of injured vertebra, and the rate of spinal canal invasion. Surgery was successfully completed in both groups. No complication such as dural sac, nerve root, or vascular injury was found during operation, and all incisions healed by first intention. There was no significant difference in operation time between the two groups ( P>0.05), the UBE group revealed significant less intraoperative blood loss when compared with open group ( P<0.05). Patients in both groups were followed up 6-20 months, with an average of 13 months. There was no loosening, breakage, or failure of internal fixation in all patients. The ASIA grading, VAS score, ODI of the two groups significantly improved at 1 week after operation and further improved at last follow-up ( P<0.05). There was no significant difference in ASIA grading at 1 week after operation and last follow-up between the two groups ( P>0.05), but the VAS score and ODI in the UBE group were significantly superior to the open group ( P<0.05). At 1 week after operation, the height ratio of the anterior margin of injured vertebra, segmental kyphosis angle, rate of spinal canal invasion significantly improved when compared to preoperative ones ( P<0.05), the height ratio of the anterior margin of injured vertebra and segmental kyphosis angle significantly decreased at last follow-up when compared to the values at 1 week after operation ( P<0.05), but the rate of spinal canal invasion was further significantly improved, and there was no significant difference between the two groups at different time point postoperatively. UBE technique assisted spinal canal decompression combined with percutaneous pedicle screw fixation is a safe and effective treatment for lumbar burst fractures, which with little trauma and faster recovery when compared with traditional open decompression and internal fixation.

Diagnostics and classification of fractures of the thoracic and lumbar spine in adults : Approach depending on the bone structure

The epidemiology, treatment and prognosis of thoracolumbar vertebral fractures are fundamentally influenced by the bone quality of the patient. In individuals with healthy bone structure, ahigh-energy trauma is typically required to cause afracture. In contrast, osteoporosis can cause fractures and also be present as acomorbid pathology in traumatic fractures. Comprehensive diagnostics and a precise classification are essential for appropriate treatment. This narrative review outlines the diagnostic approach and classification of thoracolumbar vertebral fractures depending on the bone quality as the basis of treatment. In addition to aphysical examination, conventional radiographs with the patient in a standing position and computed tomography (CT) scans of the affected region serve as the foundation for fracture classification. Supplementary magnetic resonance imaging (MRI) primarily assesses discoligamentous and neurological structures of the spine as well as the age of the fracture. In suspected cases of osteoporotic fractures, ashort-tau inversion recovery (STIR) sequence of the entire thoracic and lumbar spine is recommended for reliable detection of bone marrow edema. For patients with healthy bone structure, the AOSpine classification is used, whereas the osteoporotic fracture (OF) classification and the OF score are applied in cases of osteoporosis.

Reoperations After Operatively and Non-Operatively Treated Periprosthetic Knee Fractures: A Nationwide Study on 1,931 Fractures After Primary Total Knee Arthroplasty.

Periprosthetic knee fracture (PPKF) following total knee arthroplasty (TKA) can be difficult to treat. A PPKF can be treated both operatively and non-operatively, and the treatment varies between fracture sites. This study aimed to assess the risk of reoperation according to the fracture site and treatment of the PPKF. This study is a nationwide cohort study using register data from 1997 to 2022. Cruciate-retaining or posterior-stabilized primary TKA were identified from the Danish Knee Arthroplasty Register (DKR). Subsequent PPKFs, fracture treatments, and later reoperations were identified through the International Classification of Diseases (ICD-10) diagnosis and procedure codes in the Danish National Patient Register. Additionally, indications for revision TKA (rTKA) in the DKR were used to identify PPKFs and the reason for reoperation. We included 1,931 PPKFs (1,494 femoral, 207 patellae, and 230 tibial) with an overall two-year reoperation risk of 20% (95% CI [confidence interval]: 18 to 23). Femoral PPKFs had a two-year reoperation risk of 16% (12 to 22) after non-operative treatment and 21% (18 to 24) after operative treatment. Patellar PPKFs had a two-year reoperation risk in five to 17 after non-operative treatment and 46% (30 to 69) after operative treatment. Tibial PPKFs had a two-year reoperation risk of 17% (11 to 27) after non-operative treatment, and 36% (25 to 53) after operative treatment. The overall two-year reoperation risk was 20% (18 to 23). Operative-treated PPKFs had a higher risk of reoperation across all fracture locations. The highest reoperation risk was found after operatively treated patella and tibial PPKFs (46 and 36%, respectively), and the lowest reoperation risk was found after non-operative treated patella PPKFs.

Clinical efficacy of three plating systems in management of mandibular parasymphyseal fractures: a retrospective study.

The main goal of management of the mandibular fracture is to obtain the pre-injury contour of the bone and pre-injury occlusion as well as regain function early. For Parasymphyseal fractures, the ideal fixation method is still debatable. It could range from rigid to semi-rigid fixation. The current study aimed to compare the clinical and radiographic effect of two miniplates, 2.3 high-profile Miniplates, and three-dimensional (3D) Miniplates for internal fixation treatment of mandibular para-symphyseal fractures. The study reviewed 240 medical records, dividing 60 patients into three treatment groups: Group I (25 patients received 2.0 mini plates), Group II (22 patients received 2.3 high profile miniplate), and Group III (13 patients received 3D miniplate). Data included demographics, fracture diagnosis, radiographs, maxillomandibular fixation use, surgical time, intervention, postoperative stability, and complications. The present study included 60 patients with mandibular parasymphyseal fractures, divided into three treatment groups: Group I (n = 25, 41.67%), Group II (n = 22, 36.67%), and Group III (n = 13, 21.67%). The study found no significant differences in age and sex distribution among the three groups, but the mean surgery time varied significantly. Group II had the highest rate of complications at 22.73%, followed by Group I at 20% and Group III at 7.69%. In conclusion, the (3D) Miniplates could provide better internal fixation treatment of mandibular para-symphyseal fractures in terms of easy use, short surgery time and less complication such as malocclusion and infection.

The Use of Osteogenon as an Adjunctive Treatment in Lower Leg Fractures

The Use of Osteogenon as an Adjunctive Treatment in Lower Leg Fractures

Treatment of diametaphyseal forearm fractures in children and adolescents : Antegrade intramedullary nail osteosynthesis and its alternatives

Osteosynthesis in dislocated diametaphyseal forearm fractures is intended to restore anatomy and function. Antegrade intramedullary nailing in the radius is used to restore length, rotation, and axis within the age-specific correction limits. Sufficient stability ensures early functional postoperative treatment without load. Dislocated diametaphyseal forearm or radius fractures that cannot be closed, stably reduced, or remain outside the age-specific correction limits. Radius or forearm fractures located distal or proximal to the defined area. Soft tissue defects, contamination or infections located in the access path. In the course of the Thompson approach, the soft spot between the extensor digitorum and extensor carpi radialis brevis muscles is located and an approx. 3-4 cm skin incision is made. Then blunt preparation down to the bone, sparing the profundus and superficial radial nerve. Retraction of the musculature with two Langenbeck hooks. Opening of the cortex with an awl. If necessary, a2.5 mm drill with tissue protection can be used beforehand if the cortex is very hard. Atitanium elastic nail (TEN) diameter is selected so that it fills approximately 2/3 of the medullary canal. It is recommended to flatten the TEN runner with parallel flattening forceps. After closed reduction, the TEN is then brought up in front of the growth plate with slightly rotating movements. The TEN is bent over at the proximal end and pinched off above the muscle bellies. Alternative procedures include Kirschner wire osteosynthesis or retrograde TEN from radial or dorsal, with or without bending. The aim of osteosynthesis is early functional follow-up without load. Sports abstinence is recommended for 8weeks. Metal removal can be performed after consolidation between 3and 6months. Clearly dislocated or outside the correction limits infantile radius and forearm fractures show very good treatment results with alow risk profile after the described osteosynthesis technique. Pseudarthrosis and nerve damage were not observed. Secondary dislocation has not occurred.

Enhancing systematic review efficiency in hand surgery using artificial intelligence (natural language processing) for abstract screening.

The aim of the present study was to train a natural language processing model to recognize key text elements from research abstracts related to hand surgery, enhancing the efficiency of systematic review screening. A sample of 1600 abstracts from a systematic review of distal radial fracture treatment outcomes was annotated to train the natural language processing model. To assess time-saving potential, 200 abstracts were processed by the trained models in two experiments, where reviewers accessed natural language processing predictions to include or exclude articles. The natural language processing model achieved an overall accuracy of 0.91 in recognizing key text elements, excelling in identifying study interventions. Use of the natural language processing reduced mean screening time by 31% without compromising accuracy. Precision varied, improving in the second experiment, indicating context-dependent performance. These findings suggest that natural language processing models can streamline abstract screening in systematic reviews by effectively identifying original research and extracting relevant text elements.Level of evidence: IV.

Operative treatment and postoperative complications of a frontal sinus fracture: a case report

Frontal sinus fractures are significant injuries; they represent approximately 5-15% of all maxillofacial trauma cases. These fractures can cause complications and present important challenges. The type of surgical technique used, such as sinus reconstruction or obliteration, depends on the severity of the trauma and the general condition of the patient. The surgical treatment for frontal sinus fractures may include a coronal approach. The outcomes associated with frontal sinus fractures can range from mild headaches to severe complications, including cerebrospinal fluid (CSF) leakage; in cases of ineffective conservative treatment, surgical intervention may be necessary. TachoSil is used as a sealing agent during surgery to mitigate potential complications.

Perioperative Antibiotic Choice Does Not Affect Wound Complications in the Operative Treatment of Ankle Fractures

Perioperative Antibiotic Choice Does Not Affect Wound Complications in the Operative Treatment of Ankle Fractures

Validity and reliability of the osteoporotic fracture treatment score (OF score) and outcomes across various treatments in osteoporosis vertebral compression fracture patients.

Osteoporotic vertebral compression fractures (OVF) are prevalent and substantially impact healthcare systems and patients' quality of life. The osteoporotic fracture treatment score (OF score), developed by the German Society of Orthopedics and Trauma (DGOU), guides surgical decisions, but its reliability and validity are underexplored. This study assessed the OF score's inter- and intraobserver reliability, validated its treatment recommendations, and investigated intermediate outcomes of different DGOU-recommended surgical strategies for OVF. A retrospective cohort study was conducted. Inter- and intraobserver reliability of the OF score and its subcomponents were analyzed using clinical and radiographic data. Validity was assessed by comparing the OF score's recommended treatments with actual treatments received. Outcomes at the final follow-up were back pain visual analog scale, Oswestry Disability Index, EQ-VAS, EQ-5D-5L, adjacent fracture incidence, local kyphotic angle, and reoperation rates. Patients with at least 1-year follow-up were included. A total of 157 patients (84.7% female; mean age 74.2 ± 10.5 years) were evaluated. The most frequent osteoporotic fracture (OF) types were OF4 (49.0%) and OF3 (40.8%). The OF score demonstrated good interobserver reliability (ICC = 0.77, 95% CI: 0.65-0.86) and intraobserver reliability (ICC = 0.83, 95% CI: 0.72-0.90). Kappa values for subcomponents ranged from 0.57 to 0.89. Excluding patients with indeterminate recommendations (OF score = 6), 82.9% received treatments concordant with OF score recommendations. Receiver operating characteristic curve analysis showed an area under the curve of 0.77 (95% CI: 0.67-0.86); an OF score cutoff > 6.5 predicted actual treatment with 87.9% sensitivity and 61.0% specificity. All surgical treatments showed comparable improvements in clinical outcomes. However, patients treated with stand-alone cement augmentation (CA) had less local kyphotic angle correction (P = 0.004) and greater postoperative kyphotic progression (P < 0.001) than those undergoing short-segment (SS-PI) or long-segment instrumentation (LS-PI). No significant differences in adjacent fractures or complications were observed. The OF score is a reliable and valid system with good discriminative ability for surgical decision-making in OVF patients. CA, SS-PI, and LS-PI are viable options with comparable functional outcomes. However, in OF3 or OF4 fractures, caution is advised due to lesser kyphosis correction and greater kyphotic progression with CA compared to SS-PI or LS-PI, as recommended by the DGOU.

ADVANCES IN ORTHOPEDIC SURGERY

Orthopaedic surgery has undergone significant evolution with the development of minimally invasive techniques (MIT) for the treatment of complex lower limb fractures. These innovations have transformed orthopaedic management, offering less traumatic and more effective alternatives to traditional procedures. IMTs are designed to reduce tissue damage, speed up recovery and minimize post-operative complications, making them increasingly relevant in today’s orthopaedic scenario. The aim of this study is to discuss recent advances in minimally invasive techniques in orthopaedic surgery for complex lower limb fractures. The research explores the benefits of these techniques, the challenges faced in clinical practice and the future prospects for their widespread adoption. The research was based on a literature review, with a qualitative approach, using the PubMed, Google Scholar, and Scielo databases. For a comprehensive and relevant analysis of the advances and challenges of minimally invasive techniques in orthopaedic surgery, specific descriptors reflecting the area of study were applied, with a time frame covering publications from 2018 to 2023. The analysis is based on a review of up-to-date literature, including clinical studies and meta-analyses that demonstrate the efficacy and safety of minimally invasive techniques. Innovations such as the use of external fixators, locked intramedullary rods and surgical navigation systems are highlighted. These approaches allow for precise stabilization of fractures with smaller incisions and less impairment of soft tissue vascularization. In addition, advances in intraoperative imaging and surgical instrumentation are discussed, which have improved the precision of procedures and reduced operative time. Challenges such as the learning curve and the cost of the technologies are also addressed. Thus, advances in minimally invasive techniques have revolutionized orthopaedic surgery, offering effective solutions for the treatment of complex lower limb fractures. Despite the challenges, such as the need for specialized training and investment in new technologies, the benefits for patients, including shorter recovery times and better functional results, are undeniable. The future of orthopaedic surgery will continue to benefit from these innovations, with the potential to further increase access and the quality of treatments.

Pathological fractures of the extremities

The diagnostics and treatment of pathological fractures of the extremities differ from the approach for conventional fractures. Metastases from breast, bronchial, renal cell and prostate cancer are the predominant cause. Typically, patients present at over 50years old present after an inadequate trauma. They often report symptoms or swelling in the affected region that already existed before the fracture. An underlying malignant disease is sometimes already known; however, occasionally this is manifested in the form of a fracture. The femur is affected in 74% of cases, followed by the humerus and the tibia. Important indications for the presence of apathological fracture can even be obtained from conventional radiographs. The diagnostics are supplemented with further modalities depending on the treatment goal. Surgical treatment is the first choice as the fractures do not heal using conservative measures. In this context, aprognosis-stratified approach is recommended.

Understanding the Impact COVID-19 Has Had on Traumatic Ankle Fractures in a UK Orthopaedic Department: Should Current Guidelines Be Revised?

Introduction Ankle fractures are commonyet debilitating injuries. Surgery is the mainstay treatment for ankle fractures displaying a high suspicion of instability. During the coronavirus disease 2019 (COVID-19) pandemic, conservative management became prominent in patients with ankle fractures. This study assesses the variation in ankle fracture management during the COVID-19 versus pre-COVID-19 pandemic and alsohighlights how the lockdown affected patient's behaviour. Methods Data for patients with acute ankle fractures during the COVID-19 pandemic (March-June 2020) were retrieved using an electronic trauma database (eTrauma, OpenMedical, London, UK). Patients were categorised as operative versus non-operative. The same data were extrapolated from eTrauma for pre-COVID times (March-June 2019). Data were cross-checked with inpatient notes. Patient demographics, mechanism of injury, patient outcomes (Foot and Ankle Outcome Score(FAOS)) and delay in presentation were also analysed. Result There was an increased number of acute ankle fractures referred to the orthopaedic department during the COVID-19 pandemic (n=161,78.9% increase). However, 52% more cases were managed conservatively when compared with pre-COVID times. We also identified an increased presentation time from the date of injury to the orthopaedic review, along with a non-statistically significant decreased delay to surgery during the COVID-19 pandemic (p=0.131). Compared to 2019, FAOS scores were greater during the COVID-19 pandemic (p=0.049), despite no difference in the American SocietyofAnesthesiologists(ASA) grade between the two time periods. Conclusion Compared to the pre-COVID-19 pandemic period, more ankle fractures were managed conservatively in 2020, despite no significant difference found in baseline morbidity. In addition, patient outcomes were greater in 2020. Based on the data analysed, it would be prudent to review current ankle fracture management guidelines and consider a lower threshold for conservative management.

Short-term adverse event rates and risk factors following total elbow arthroplasty for fracture and arthropathy: a matched analysis of nationally representative data

BackgroundTotal elbow arthroplasty (TEA) is a mainstay treatment for elbow arthropathy and elbow fracture that can relieve pain and restore functional motion. The purpose of this study was to determine the role of surgical indication in the incidence of short-term adverse events and risk factors influencing complications in TEA to treat arthropathy compared to TEA for fracture. Matched cohorts were created to better isolate the impact of the surgical indication.MethodsThe study identified patients within the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database that underwent TEA to treat arthropathy or fracture from 2010 to 2020. Matched cohorts were created to analyze the incidence of 30 day adverse events and risk factors for complications.ResultsThe study included 599 patients for analysis. The overall incidence of any adverse event was 9.7%. In matched cohorts of 218 patients, the fracture group experienced a higher incidence of overall adverse events (13.8% vs. 6.0% in the arthropathy group, p = 0.009) and postoperative transfusions (9.6% vs. 1.8% in the arthropathy group, p < 0.001). Logistic regression revealed an increased risk of any adverse event in the combined matched cohort with longer operative times (OR = 1.007, CI: 1.002–1.012, p = 0.006) and those undergoing fracture treatment (OR = 2.447, CI: 1.047–5.717, p = 0.039). Outpatient status was associated with a lower risk of adverse events in the combined matched cohort (OR = 0.207, CI: 0.058–0.739, p = 0.015).ConclusionsEven when controlling for comorbidities, patients undergoing TEA for fracture have a greater likelihood of short-term complications, particularly requiring a blood transfusion. Treatment of a fracture and increased operative time were risk factors for all patients, while outpatient status was protective.Level of evidenceIII.

Efficacy of four internal fixation devices on femoral neck fractures in young adults: A systematic review and network meta-analysis.

The primary treatment of femoral neck fracture in young adults is internal fixation. The high complication rate after femoral neck fracture greatly affects the life of patients. There are many internal fixation devices for femoral neck fracture, but each has its advantages and disadvantages. Our aim was to determine the best internal fixation for young people with femoral neck fractures. We searched 5 databases from January, 2016 to December, 2023. Randomized controlled trials and cohort studies that met the inclusion criteria were assessed for quality using the RoB.2 and ROBINS-I scales, respectively. The network meta-analysis was conducted within a Bayesian framework utilizing a random effect model. Data analysis was performed using the "multinma" package within the R 4.2.0 software. A network meta-analysis of 34 studies involving 2291 patients was conducted. Results indicated that the inverted triangular cannulated screws demonstrated the lowest intraoperative bleeding volume (surface under the cumulative ranking curve [SUCRA] = 0.8732) based on the SUCRA. The medial buttress plate (MBP) exhibited superior efficacy in improving the Harris hip score (SUCRA = 0.8465), reducing complications (SUCRA = 0.9251), and accelerating fracture healing time (SUCRA = 0.8111). Additionally, the femoral neck system was ranked highest in terms of operation time (SUCRA = 0.7749) and femoral neck shortening (SUCRA = 0.7933). This network meta-analysis findings indicated that MBP resulted in superior postoperative hip function, reduced complication rate, faster fracture healing time. Considering the good physical condition of young adults, surgeon may consider utilizing MBP to achieve improved postoperative outcomes.

Rigid intramedullary nailing of lower limb segments in children and adolescents with metabolic bone disease.

Children and adolescents with metabolic bone disease present to the orthopedic surgeon with pain, fractures (which may be impending), and deformity. Different modalities of orthopedic management are available. Scant literature exists on the use of rigid intramedullary nailing in this population. This study sought to evaluate the utilization of this treatment modality in the pediatric cohort, focusing on indications, techniques, and outcomes of the procedures. A retrospective review was performed over an 11-year period at a single tertiary pediatric institution in the UK. Medical records and radiographs were reviewed. Preoperative surgical and medical management, time to bony union, and complications were specifically ascertained. Twenty-seven patients (63 lower limb segments) had rigid intramedullary nailing over the specified period. The majority of patients had an underlying diagnosis of osteogenesis imperfecta or fibrous dysplasia (including McCune Albright Syndrome). Surgical indications included acute fractures, prophylactic stabilization, previous nonunion and malunions, deformity correction, and limb lengthening. All fractures healed and deformity correction was successful. In one patient, delayed union occurred after deformity correction and was successfully treated with dynamization. Fractures healed faster than corrective osteotomies. Complications included implant prominence, cortical penetrance, and screw loosening. Nonunion occurred with limb lengthening in one patient. Rigid intramedullary nailing is a safe and effective method of treatment for lower limb fractures and deformities in children and adolescents. This technique is, therefore, recommended for patients with metabolic bone disease. However, care must be taken in preoperative surgical planning and a multidisciplinary approach should be utilized.

Fixing of intertrochanteric fractures with proximal femoral nail antirotation 2 by a double incision technique: a retrospective analysis

Background: The incidence of hip fractures is projected to rise from 1.66 million in 1990 to 6.26 million by 2050. Internal fixation is the most prevalent surgical intervention for intertrochanteric fractures. Hip fractures represent a significant healthcare issue amongst the elderly. The aim of this study is to evaluate a double incision technique in comparison to the conventional incision for fixing intertrochanteric fractures using the standard proximal femoral nail antirotation (PFNA2). Methods: This study took place at Dr. D. Y. Patil hospital in Navi Mumbai, India, from May 2023 to May 2024 employing an open-label, retrospective, randomized, and comparative methodology. A total of 100 patients with proven radiographic intertrochanteric fracture having undergone fixation with PFNA2 were analysed, with 50 undergoing the double incision and 50 serving as the stand control group. Results: The minimally invasive technique with a modified incision using the standard proximal femoral nail A2 can reduce bleeding, enhance precision for the entry point of the guidewire, shorten the time required for the entry, decrease soft tissue injuries, and provide better aesthetic outcomes. Conclusions: The current study delineates a minimally invasive surgical technique employing a double incision for the fixation of intertrochanteric fractures using the proximal femoral nail A2, underscoring its benefits.

Mandibular Fractures in Edentulous Patients with Bone Atrophy and Osseointegrated Dental Implants: Therapeutic Management in a Case Series

Background and Objectives: This research describes the management of mandibular fractures in edentulous patients with atrophic mandibles and implant-retained overdentures, exploring etiologies and treatment options. Materials and Methods: A retrospective study (January 2010–December 2023) was conducted on six patients from two hospitals (Hospital Gregorio Marañón y Hospital La Paz, Madrid). The data collected included fracture etiology, treatment type, and complications. Results: All six patients were women, with a mean age of 76.33 years. The most common cause of fracture was peri-implantitis (50%). Surgical treatment (open reduction and internal fixation) was performed in five patients, with different surgical approaches and fixation methods. One patient, due to multiple comorbidities, received conservative treatment. Complications occurred in 50% of cases, including delayed healing and hypoesthesia. The average hospital stay was four days, with a mean follow-up of 34 months. Conclusions: Mandibular fractures in these patients are rare. Surgical treatment using rigid fixation plates is recommended. The rational use of bone grafting should be taken into account. Treatment depends on fracture type, patient condition, and surgeon experience.