Fracture Type Research Articles

Simultaneous clavicular hook plate fixation in bilateral distal clavicle fractures (Neer type II): A case report.

Bilateral distal clavicle fractures (BDCF) are exceedingly rare types of fractures. This study aimed to evaluate the surgical treatment under a single anesthesia for trauma-induced BDCF (Neer type II) through a case report. The patient brought to the emergency department due to a motor vehicle accident exhibited severe pain, tenderness, swelling, and deformity in both shoulder regions upon physical examination. No significant pain or tenderness was detected in other areas of the body. There were also no signs of additional neurological deficits or vascular pathology in the extremities. Radiographic examinations led to a diagnosis of BDCF (Neer type II). Surgical intervention involved the simultaneous application of a neutral-angled hook plate to both clavicles via open reduction. Postoperative radiographs taken at the 12th week demonstrated complete healing in both fractures and no functional limitations in shoulder movements. BDCF can compromise the stability of the shoulder girdle, necessitating surgical intervention with anatomical reduction and rigid fixation.

Calcaneus Fractures, Epidemiology and Treatment– data on 3 949 fractures from the Swedish Fracture Register

BackgroundDue to changing population demographics and evolving treatment strategies updated epidemiological data are needed. This study aims to provide nationwide epidemiology data regarding calcaneus fractures of all types and treatment. MethodsThe study is based on data from the Swedish Fracture Register and include patients ≥18 with a calcaneus fracture sustained between April 2012 and June 2022. Patient characteristics, injury mechanism, fracture classification and primary treatment were analysed. With access to data on each separate fracture, all bilateral fractures, n=320, could be identified and were studied in a separate analysis. ResultsThe study included 3629 unilateral calcaneus fractures in 3618 patients. The mean age was 48 years (SD ± 18) and 2178 (60%) were men. Fall from height was the most common mechanism of injury (n=1683; 46%) and high-energy trauma was documented in 887(28%) patients. Overall, AO/OTA type A fractures (avulsion), and type C fractures (intra-articular) was equally common, but the type C fracture was the most common fracture type in men. The vast majority of type A (n=1105; 89%) and B (n=717; 93%) fractures were treated non-surgically, while surgical treatment was more common in type C (n=499; 43%) fractures. Fracture fixation with plate and screws was the most common surgical method. Arthrodesis as a primary treatment was rarely used.Of the patients with bilateral fractures 80% were male, (n=128). They were generally younger (mean age of 38 years (SD±14.5, p<0,001) and had a larger proportion of high-energy traumas, n=107 (67%) compared with patients with unilateral fractures. ConclusionCalcaneus fractures occur most frequently in the middle-aged population, and the majority of patients are male. The difference in prevalence between men and women is less pronounced than previous studies have shown. In male patients the fractures were more severe, more often caused by high-energy trauma, and more frequently treated surgically. Level of evidenceIV, retrospective observational cohort study

[Translated article] Retrospective survival analysis of the use of uncemented modular tapered stems for revision in periprosthetic Vancouver B-type fractures. Is instability a threat to survival

Introduction and objectives: Periprosthetic hip fractures show increasing incidence and complexity, representing a challenge for the surgeon. We aimed to evaluate the survival of uncemented modular tapered stems in the treatment of periprosthetic Vancouver B2 and B3 type fractures and review the main complications and factors associated with decreased survival.Materials and methods: We performed a retrospective study of patients submitted to revision arthroplasty for treatment of periprosthetic femoral stem Vancouver B2 and B3 type fractures with an uncemented modular fluted tapered stem (MRP-Titan). Demographic and radiographic parameters were analyzed. The survival rate (free of reoperation) was calculated at 2- and 5-years using the Kaplan–Meier survivorship analysis.Results: Thirty-nine patients were included with a mean age of 73.5 years and a mean follow-up of 5 years. Arthroplasty survivorship at 2 years was 73.7% and at 5 years was 67.5% (mean 8.4 years; range 6.7–10.2). Survivorship was inferior in the patients with episodes of instability (mean 2.5 years; range 0–5.42) (p < 0.001). At least one episode of instability occurred in 26.3% of patients and 60% of these patients had a femoral head size 32 mm or lower. At least one episode of instability occurred in 71.4% of patients with a greater trochanter fracture (p = 0.008). The consolidation rate was 90.6% and the mortality rate was 23.7%. In the group of patients that died, 55.6% were submitted to at least one revision surgery (p = 0.044).Conclusion: Survivorship of an uncemented modular stem (MRP-Titan) in revision for PHF is significantly reduced by episodes of instability.

Characteristics and Management of Neck and Trochanteric Femur Fractures at a Tertiary Hospital in Indonesia: A Retrospective, Single-Center Study

Background: Although hip fractures are common among the elderly population, there are still limited studies on neck-trochanteric fractures, one of the less common types of hip fractures. This study aims to describe the characteristics of patients and their management in patients with neck trochanteric fractures. Methods: This retrospective cross-sectional study analyzed medical records of patients aged &gt;18 years with trochanteric fractures from a tertiary hospital in Central Java, Indonesia, between January and December 2021. Fracture types were identified and classified using the Garden, Pauwels, and AO/OTA classifications. Demographic data, risk factors, fracture locations, and treatment types were also collected. Statistical analysis was performed using SPSS 21.0 to describe patient characteristics. Results: The total sample was 77 patients, most were female (n = 55 (71.4%)) and aged &gt; 60 years. More than a third of diagnosed fractures were neck of the femur fractures in 33 patients (42.9%). Among the most common classification types of fractures were Garden Type 3, Pauwels Type 3, and AO/OTA type A1.1. A total of 33 patients (42.9%) underwent open reduction of the fracture with internal fixation. Conclusions: Our findings show that the prevalence of neck-trochanteric fractures mostly occurs in patients &gt; 60 years of age and in females. Although open reduction with internal fixation is generally performed, there are several cases of fractures that are not classifiable due to limited imaging examinations. Further research on a wider population is needed to confirm the findings of this study.

Effect of Rotational Speed on Microstructure and Properties of Al‐Based Composite Reinforced with High‐Entropy‐Alloy Particles Fabricated by Friction Stir Processing

In the present investigation, the production of composites based on 7075Al is involved, reinforced with particles of high‐entropy alloy (AlCoCrFeNi), using the friction stir processing (FSP) technique. The primary objective is to examine how varying the rotational speed during processing affects the uniformity of the composite microstructure, the strength of the bonding between different materials, and the mechanical properties of the composite. In these findings, it is indicated that higher processing rotational speeds lead to enhanced homogeneity of the composite material and promote strong bonding with the matrix. The Al13Co4 phase is generated at the interface before the formation of the Al5Co2 phase. The microhardness of the composites exhibits an increase in hardness of 78%, 84%, 86%, and 83% compared to the hardness of the 7075Al. Similarly, the tensile strength is enhanced by 26%, 36.7%, 49%, and 40%, respectively. The broken surface shows an even spread of particles with many small depressions, which is a clear sign of a common type of fracture that can stretch without breaking. The primary processes that enhance the strength of the FeCoNiCrAl/7075Al composite manufactured by FSP include the load‐transfer effect, dispersion strengthening, grain refinement strengthening, and thermal mismatch strengthening.

Management of pediatric ankle fractures: comparison of biodegradable PLGA implants with traditional metal screws

IntroductionThe relevance of biodegradable implants has gained more importance in modern clinical practice. The study aimed to evaluate the effects and outcomes of ankle fracture treatment with absorbable implants compared to metal screws. These implants are made from poly l-lactic-co-glycolic acid (PLGA), however, there are several other materials available on the market.MethodsIn a retrospective review, a total of 128 patients were under observation, with distal tibial fracture types ranging from Salter-Harris II-IV. In the absorbable group, patients were treated with the implants (n = 76). The metal group included patients treated with titanium or steel screws (n = 52). The extremities were placed in a cast for six weeks after surgery and were utilized for another 6–8 weeks. Patients were followed up for 12–30 months and were evaluated accordingly. The authors examined several aspects such as age, gender, open or closed repair, mechanism of injury, length of hospitalization, type of fracture, time of recovery, and complications.ResultsThere were no statistically significant differences between the groups regarding demographic qualities, such as age, type of fracture, side of injury, and length of cast application (p &amp;gt; 0.05 in all cases). Out of 76 patients in the PLGA group, only two presented with complications, so reoperation took place. The rest healed without complications or refractures. Two of those treated with metal screws (n = 52) had minor, and four had major complications with reoperation.DiscussionIn pediatric cases, PLGA implants may present excellent results for treating ankle fractures. They do not disturb the growth plate and do not require reoperation. For this reason, they reduce the burden on the patient and the healthcare provider while simultaneously decreasing the risk of complications, such as infections or problems due to general anesthesia.

Predictors for 1-year mortality in geriatric patients following fragile intertrochanteric fracture surgery

ObjectiveTo investigate the risk factors influencing 1-year mortality after intramedullary nail fixation for fragile intertrochanteric fracture in elderly individuals.MethodsThe medical records of 622 consecutive elderly patients (aged ≥ 65 years) with fragile intertrochanteric fractures treated with proximal femoral nail anti-rotation (PFNA) and followed-up were retrospectively analyzed. The patients were divided into death and survival groups according to their survival status within 1 year after surgery, and the differences in age, sex, region of residence, tobacco use, alcohol use, body mass index (BMI), comorbidities (hypertension, diabetes mellitus, coronary heart disease, stroke, dementia, chronic obstructive pulmonary disease, pneumonia), preoperative hemoglobin, preoperative albumin, deep vein thrombosis, fracture type (AO classification), injury-to-surgery time, American Society of Anesthesiologists (ASA) score, anesthesia modality, duration of surgery, intraoperative blood loss, and blood transfusion were compared. The Kaplan–Meier method was used for univariate analysis to screen for statistically significant differences between the two groups, and the data were entered into the Cox proportional hazards model for multivariate analysis to determine independent risk factors affecting 1-year postoperative mortality. For subgroup analysis, we explored the varying effects of hypoproteinemia and being underweight in patients of different genders, as well as the effects of different age ranges, different injury-to-surgery times, and different blood transfusion volumes on 1-year postoperative mortality.ResultsThe mortality rates at 1, 3, and 6 months, and 1 year after surgery were 3.9%, 7.2%, 10.1%, and 15.3%, respectively. Univariate analysis showed that advanced age, male sex, tobacco use, underweight (BMI < 18.5), coronary heart disease, stroke, dementia, pneumonia, number of comorbidities ≥ 3, hypoproteinemia and injury-to-surgery time ≤ 2 days were associated with the 1-year postoperative survival status (P < 0.1). Multivariate analysis revealed that advanced age, male sex, dementia, number of comorbidities ≥ 3, hypoalbuminemia, and being underweight were independent risk factors for 1-year postoperative mortality. Subgroup analysis showed that being underweight was associated with 1-year postoperative mortality only in male patients but not in female patients, whereas hypoproteinemia was associated with 1-year postoperative mortality in both male and female patients. Furthermore, an injury-to-surgery time of less than 2 days improved patient survival, and patients more than 80 years old showed an elevated risk of postoperative mortality.ConclusionsPreoperative health status is a critical predictor of postoperative outcomes in elderly patients with fragile intertrochanteric fractures. Priority care should be given to the patients who are elderly, male, have dementia, have comorbidities, or are malnourished. Prompt nutritional reinforcement should be provided to patients with intertrochanteric fractures with comorbid hypoproteinemia and underweight. Furthermore, surgery should be performed as early as possible in patients with fewer comorbidities.

Elastic stable intramedullary nailing in paediatric diaphyseal forearm fractures – a retrospective analysis of 201 cases

BackgroundForearm shaft fractures are common injuries, often caused by falling from a fully-upright position or falling off a bike. They can be treated nonoperatively or surgically with intramedullary nailing or plates. The method of choice for treating pediatric forearm shaft fractures is the application of elastic stable intramedullary nailing (ESIN)|. The aim of the study was to evaluate ESIN in pediatric patients with forearm shaft fractures based on radiological images, and determine the etiology and complication rate associated with the injury.MethodsThe study included 201 patients, 30.5% female 69.5% male, aged 1 to 17 years (mean 9.1 years; SD = 3.2), all had been diagnosed with a fracture of the forearm shaft and had been treated surgically with ESIN. In addition, all possessed a complete set of X-ray images and had attended a minimum six-month follow-up examination of the forearm. Axial alignment was evaluated retrospectively in the anatomical (AP) and lateral (LAT) positions. In total, 402 radiographs were examined. Of the injuries, 68% occurred during sports activity and 75% involved both the radius and the ulna.ResultsUnion was observed in all cases. Mean axial alignment values in AP and LAT X-ray or both the ulna and radius were satisfactory. Axial alignment values were not influenced significantly by age, type of surgery, type of fracture or etiology. Plaster cast application (9.8% of cases) significantly influenced radius axial alignment. The complication rate was 11.4% (n = 23). Significantly more complications were observed in patients receiving open reduction internal fixation (ORIF) (p = 0.0025).ConclusionThe ESIN technique is an effective treatment for forearm diaphyseal fractures in children, with good results regarding reduction and bone healing, indicated by x-ray.

Single-Stage Conversion of External Fixation into Internal Fixation for Compound Fractures in War-Wounded Patients: A Cohort Study in Iraq

Background: War-induced. Compound fractures cause considerable damage to the limbs, affecting mobility and quality of life; surgeons consider managing compound fractures to be a difficulty. Although multi-stage conversion from external to internal fixation is still common, multiple studies worldwide are promoting single-stage conversion. Objective: To assess the efficacy and safety of a single-stage conversion from external to internal fixation using the functional results of many Iraqi war wounded patients who were initially treated with external fixation. Methods: A retrospective cohort study analyzed the data of 40 war-wounded patients (39 males and 1 female) ranging in age from 18 to 50 years. All patients came with war-related complex fractures, which were stabilized and referred for external fixation. Following a single-stage conversion to internal fixation, the patients were followed up to assess the functional outcomes of this approach using Ketenjian's functional criteria. Results: A study of 40 patients (45 limbs), mostly male (97.8%), demonstrated a statistically significant link between non-union and time to convert from external to internal fixation. However, fracture type, Gustilo categorization, fixation method, and complication rates had no significant impact on Ketenjian's score results. Conclusions: The single-staged external to internal fixation conversion is regarded as a safe and reliable procedure with good overall functional outcomes; it could be performed by experienced surgeons instead of two-staged conversions, taking into account the patient's general health and the state of the local soft tissue.

Digital Arterial Anastomosis as an Outpatient Surgery

Background: In incomplete amputation with a skin bridge, patency of the artery indicates digit survival if sufficient venous return is secured. This study aimed to investigate the effectiveness of digital arterial repair on an outpatient basis without using intravenous anticoagulants. Methods: We identified a total of 34 patients (34 digits) who underwent arterial repair for single vascular bundle injury between January 2000 and December 2022 on an outpatient basis. The following information were obtained from the patients’ medical records: sex, age, comorbidities, active smoking status, number of affected digits, level of amputation, type of the fracture type, mechanism of injury, arterial diameter, needle used, requirement of vein graft and the outcome. Results: Only a few fingertip injuries and severe injuries were included. Arterial patency was achieved in most patients after repair of an outpatient basis. Conclusion: Outpatient arterial repair may be acceptable under inevitable circumstances or to cater to patients’ preferences, when the injury is neither on the fingertip nor severe. Background: In incomplete amputation with a skin bridge, patency of the artery indicates digit survival if sufficient venous return is secured. This study aimed to investigate the effectiveness of digital arterial repair on an outpatient basis without using intravenous anticoagulants. Methods: We identified a total of 34 patients (34 digits) who underwent arterial repair for single vascular bundle injury between January 2000 and December 2022 on an outpatient basis. The following information were obtained from the patients’ medical records: sex, age, comorbidities, active smoking status, number of affected digits, level of amputation, type of the fracture type, mechanism of injury, arterial diameter, needle used, requirement of vein graft and the outcome. Results: Only a few fingertip injuries and severe injuries were included. Arterial patency was achieved in most patients after repair of an outpatient basis. Conclusion: Outpatient arterial repair may be acceptable under inevitable circumstances or to cater to patients’ preferences, when the injury is neither on the fingertip nor severe.

Microstructural Insights and Composition Analysis of a Fractured Brass Alloy of Unknown Composition Using Advanced Characterization Techniques

This study aims to investigate the microstructural and compositional characteristics of a fractured brass alloy using energy-dispersive X-ray spectroscopy (EDS), scanning electron microscopy (SEM), and X-ray diffraction (XRD). The brass alloy, initially of unknown composition, was determined to consist of 63.65 at% Cu, and 36.35 at% Zn through EDS analysis. Microstructural analysis via SEM revealed a typical ductile fracture pattern with necking and dimple formation, indicative of significant plastic deformation prior to failure. The alloy exhibited a grain size ranging from 10 µm to 80 µm and displayed both α-phase (FCC structure) and possible traces of β-phase, though XRD detected only the α-phase due to the low concentration of β-phase (&lt;5%). A comparison between EDS and XRD results for analyzing chemical composition showed that good assumptions could be made from the lattice parameters of the binary alloy following Nelson-Relay function to predict an approximate composition in binary alloy systems, which was found to be 34 at% Zn in our analysis. Furthermore, the sample’s crystal structure was confirmed as FCC, which supported its observed ductility and plastic deformation prior to fracture. The SEM analysis also confirmed that the material went through an annealing process. The fracture morphology further showed that the FCC structure and the annealing process both contributed to the material’s increased ductility. The analysis further confirms that EDS is more reliable for chemical composition determination in an alloy system. Evidence of annealing twinning in the SEM images suggests the sample underwent an annealing process, contributing to its enhanced ductility.

Study on the Damage Characteristics of Red Sandstone Foundation Under Rainfall Infiltration in the Red-Bed Area of the Sichuan Basin—Taking Zhongjiang County as an Example

The Sichuan Basin in China is one of the most concentrated areas of red beds in China. In the red-bed area, abundant rainfall can easily cause natural disasters, such as landslides, mudslides, collapses, and subsidence. This has had a great impact on the safety of people and property and sustainable modernization in the area. Zhongjiang County of Sichuan Province is a typical red-bed area, and red sandstone is one of the main foundation rocks in this area. Under the influence of rainfall, the strength of red sandstone foundation easily decays, causing disasters such as house collapse. Therefore, in order to explore the influence of rainfall on the mechanical properties of red sandstone, this paper takes the red sandstone in Zhongjiang County, Sichuan Province, China, as the research object and conducts acoustic-emission uniaxial compression experiments under different water contents. The strength characteristics, instability precursor characteristics, fracture types, and damage characteristics of red sandstone in different water-bearing states are obtained. The abovementioned results provide a reference for the Zhongjiang County Government to consider the impact of rainfall on the red sandstone foundation during modernization and emergency management.

Lumbar Spine Orientation Affects Compressive Fracture Outcome.

Understanding how spinal orientation affects injury outcome is essential to understand lumbar injury biomechanics associated with high-rate vertical loading. Whole-column human lumbar spines (T12-L5) were dynamically loaded using a drop tower to simulate peak axial forces associated with high-speed aircraft ejections and helicopter crashes. Spines were allowed to maintain natural lordotic curvature for loading, resulting in a range of orientations. Pre-test X-rays were used to quantify specimen orientation at the time of loading. Primary fracture types were identified (wedge, n = 6; burst, n = 4; hyperextension, n = 4) and compared for loading parameters and lumbar orientation. Fracture type was dependent on peak acceleration, bending moment, Cobb angle, sagittal spinal tilt, and location of the applied load. Lumbar spine orientation under high-rate axial acceleration affected the resulting fracture type. Analysis of pre-test X-rays revealed that spines that sustained wedge and burst fractures were oriented straighter at the time of loading. The load was applied centrally to T12 in spines with burst fractures, and anteriorly to T12 in spines with wedge fractures. Spines that sustained hyperextension fracture had lower peak accelerations, larger Cobb angles at the time of loading, and sustained larger extension moments. Fracture presentation is an important and understudied factor that influences biomechanical stability, clinical course, and long-term patient outcomes.

Clinical significance for new type of coracoid process fractures associated with acromioclavicular dislocation on CT three-dimensional reconstruction

To observe the computerized tomography (CT) imaging manifestations of coracoid process fractures associated with acromioclavicular(AC) joint dislocation and make classification and summary, and explore a new classification of coracoid process fracture combined with acromioclavicular joint dislocation. The medical records of patients with the acute traumatic coracoid process fractures associated with AC joint dislocation who had undergone surgical management with clavicular hook plate fixation between May 2012 and June 2021 were retrospectively reviewed. Patients with fractures or dislocations of other parts of the ipsilateral upper limb, which affect the treatment and prognosis, or with chronic shoulder diseases on the affected side, which affect the function of the shoulder joint, were excluded. Eighteen patients were enrolled, including 10 males and 8 females, aged from 16 to 54 years old at the time of injury. The causes of injury were fall in 15 cases, traffic accident in 2 cases, and high fall in 1 case. The time from injury to operation ranged from 1 to 7 days. The morphology of coracoid process fracture and its corresponding relationship with scapula were observed on CT three-dimensional reconstruction images, and the reduction of coracoid process fracture was observed. The results were classified according to different manifestations and outcomes. A total of 18 patients with 18 shoulders were included according to the Inclusion and exclusion criteria. Three manifestations of coracoid process fracture associated with acromioclavicular joint dislocation were observed on CT three-dimensional reconstruction images. One case was typeⅠ(avulsion fracture, coracoid process shape remained general intact), and the coracoid process fracture failed to self-reduction after AC joint reduction and fixation;Fifteen patients with type Ⅱ(hinged fracture, in which one side of the coracoid process fracture remained attached to the scapula or was less displaced than the other side of the fracture) had spontaneous reduction after AC joint reduction and fixation, even 7 of them had coracoid process fracture anatomical reduction;In 2 cases of type Ⅲ (translational fracture, coracoid process fracture with approximately parallel profile), coracoid process fracture failed to self-reduce after AC joint reduction and fixation. The new type of coracoid process fractures associated with acromioclavicular dislocation on CT three-dimensional reconstruction provides an overview of the injury involvement of coracoid process fracture associated with AC joint dislocation, better understand of the nature of the disease, and a reference for clinical diagnosis, treatment and prognosis to the surgeon. Based on the fact that most coracoid fractures especially hinged fractures have spontaneous reduction after AC joint reduction and fixation, we believe that simple fixation of the AC joint is feasible and satisfactory for coracoid process fractures with acromioclavicular joint dislocation, and no surgical intervention is required for coracoid process fractures.

Cast-OFF 2: one week versus three to five weeks of plaster cast immobilization for non-or minimally displaced distal radius fractures, a stepped wedge cluster randomized controlled trial.

Implementation of one week of cast immobilization followed by gradually increasing wrist mobilization for non- or minimally displaced DRF and comparison of the functional outcomes and pain scores with the usual care (three to five weeks of cast immobilization). Design: A randomized stepped wedge cluster design, prospective cohort. Academic and peripheral hospitals in level 1, 2, and 3 trauma centers. All patients between 18 and 85 years old with an isolated non- or minimally and nonreduced DRF were eligible for inclusion. Participating hospitals were randomized to transition from usual care (three to five weeks of cast immobilization) to one week of cast immobilization, following the stepped wedge design. Patient characteristics, secondary dislocation, surgical treatment, visual analog scale (VAS), Patient Rated Wrist Evaluation (PRWE), Patient Reported Outcomes Measurement Information System Pain Interference (PROMIS-PI), Pain Catastrophizing Scale 4 (PCS-4), and patient satisfaction were compared between control, and intervention group at week 1, 3-5, 6, month 3, 6, and 12. A difference around 11 points on the PRWE scale was considered clinically significant. 402 patients were included (control n=197 vs intervention n=205, 267/135, female/male). There were no differences in age (53.7 ± 18.6 vs 53.3 ± 19.5, P = 0.27), sex (66% vs 67% female, P 0.44), dominant hand fractured (44% vs 53%, P 0.39), and type of fracture (39% vs 41% extra-articular, P = 0.44) After six weeks, the PRWE score showed no clinically significant differences (-4.5 [CI -12.9, 4.02], P = 0.30). No significant differences were observed for function, pain scores, and patient satisfaction between groups (all P > 0.05). Furthermore, there was no significant difference in secondary dislocation rate (control 1.5% vs intervention 1.0%, p=0.32, P = 0.32) and operation rate (control 1.5% versus 1.5% intervention P = 0.92). This study compared one week of cast immobilization followed by gradually increasing wrist mobilizationto the usual care of three to five weeks for nonreduced DRF. No clinically significant differences in function, pain scores, patient satisfaction, secondary dislocation, and operations were observed. Therefore, one week of plaster immobilization can be safely recommended for the non- or minimally displaced and nonreduced DRF treatment. Level II. See Instructions for Authors for a complete description of levels of evidence.

Functional evaluation of unstable intertrochanteric fractures treated with proximal femoral nailing

In this study the functional outcome of proximal femoral nailing (PFN) in patients with unstable intertrochanteric fractures is studied and outcome is assessed with Modified Harris Hip Score. A post-operative analysis of unstable intertrochanteric fractures treated with PFN is done for its functional assessment. Various national &amp; international studies are taken into consideration and our institutional study is compared with them. Between September 2020 to March 2022, 20 patients with unstable intertrochanteric fractures of the hip joint who were operated with PFN were functionally and clinically evaluated as per the Modified Harris Hip Score. Patients who satisfied the inclusion criteria were included in the study and follow-up was done up to 9 months. Fracture pattern, operative details and post-operative complications were documented. This study of 20 patients of unstable intertrochanteric fractures fixed with PFN showed excellent results in 9 patients (45 %), good functional outcome in 6 patients (30 %) and fair functional outcome in 3 patients (15 %). 2 patients showed a poor outcome accounting for 10%. The study showed that PFN is a reliable and effective device for the treatment of unstable intertrochanteric fractures. It provides a satisfactory fixation, but success is dependent mainly on fracture type, bony architecture, operative technique, postoperative care and rehabilitation. In view of the fewer post-operative complications, early union of fracture, early weight bearing and early return to work, we concluded the PFN to be a versatile, stable and acceptable implant in fixation of unstable intertrochanteric fractures which leads to a better functional outcome.

Clinical outcomes of post-surgery osteoporosis treatment in elderly intertrochanteric fracture patients: a prospective study

Background: This study aims to evaluate the clinical and functional outcomes of administering zoledronic acid in elderly patients undergoing surgical management of hip fractures. The goal is to assess the impact on mortality, postoperative complications, and functional recovery as measured by the modified Harris hip score. Methods: A prospective study was conducted over 18 months at a tertiary care center in New Delhi, India, involving 42 patients aged 60 and above with intertrochanteric femur fractures. Patients received surgical fixation and standard postoperative care. Zoledronic acid (5 mg) was administered intravenously three months post-surgery. Data on demographics, injury-to-surgery interval, fracture type, DEXA score, and functional outcomes were collected at follow-ups of 6 weeks, 3 months, 6 months, and 12 months. Results: The mean age of participants was 72.67 years. Zoledronic acid administration was associated with a 9.5% mortality rate. Functional outcomes, measured by the modified Harris hip score, significantly improved from a mean of 42.14 at 6 weeks to 77.68 at 12 months (p&lt;0.001). Younger patients (&lt;70 years) had significantly better scores at 3 months compared to older patients (&gt;80 years). However, no significant differences were observed at 6 and 12 months. The mean modified Harris hip scores did not differ significantly between patients with osteopenia and osteoporosis at any time point. Additionally, the type of surgical fixation (intramedullary versus extramedullary) showed no significant impact on functional outcomes. Conclusions: Zoledronic acid administration in elderly hip fracture patients may reduce mortality and enhance functional recovery. The study supports its use in postoperative care to improve outcomes, although larger, randomized controlled studies are needed to confirm these findings. The results suggest that zoledronic acid can be an effective adjunct therapy in managing osteoporosis-related hip fractures in the geriatric population.

The effect of different treatment protocols on shear bond strength in resin composite restoration repair

BackgroundIt was aimed to investigate the effect of sandblasting and laser surface treatment on shear bond strength in composite restoration repair in vitro.MethodsA micro-hybrid composite (Filtek Z250, 3 M-ESPE, USA) was used to prepare 120 samples. The samples were subjected to a thermal cycle test 5,000 times between 5 and 55 0C, and they were randomly divided into 12 groups (n = 10). No surface treatment was performed in Groups 1 to 4, which were designed as control groups. The surfaces of the samples in Groups 5 to 8 were sandblasted with a Cojet device, and the surfaces of the samples in Groups 9 to 12 were applied Er, Cr: YSGG laser. After the sample surfaces were divided into groups with and without acid etching, universal adhesive was applied, and the repair process was performed using Filtek Z250 or nano-filled resin composite (Filtek Ultimate, 3 M-ESPE, USA). The thermal cycle test was repeated 5,000 times between 5 and 55 0C on all repaired samples. The repair shear bond strength of the samples was measured using a universal testing device (Shimadzu IG-IS, Kyoto, Japan). The fracture types were evaluated by optical microscopy and scanning electron microscopy (SEM). Statistical analyses of the findings were evaluated by the Kruskal Wallis test and Mann Whitney U test at 0.05 significance degree.ResultsThe highest mean shear bond strength values were obtained from the samples sandblasted with CoJet, followed by Er, Cr: YSGG laser, and the control group. It was determined that there was a significant difference between the mean shear bond strength values obtained from the control group and the other surface treatment groups (p < 0.05). In general, significantly higher mean shear bond strength values were obtained when the universal adhesive was applied in total-etch mode compared to the application in self-etch mode (p < 0.05). Additionally, it was determined that higher shear bond strength values were obtained with Filtek Ultimate compared to Filtek Z250 (p < 0.05).ConclusionWithin the limitations of this study, it can be concluded that the use of universal adhesive in total-etch mode, in addition to surface treatments on the resin composite surface in the repair protocol and the use of nano-filled resin composite as repair material can increase the mean shear bond values in repair.

Rotation Preserving Fixation for the Treatment of C1 Burst Fracture Combined With Type II Odontoid Fracture: 2 Case Reports and Literature Review.

This study aimed to evaluate the clinical feasibility and effectiveness of a monoaxial screw-rod system and anterior screw fixation for C1 and type II odontoid fractures. We conducted a retrospective review of 2 consecutive patients with acute C1 and Anderson-D'Alonzo type II odontoid fractures. Both patients underwent treatment using a posterior monoaxial screw-rod system and anterior screw fixation. We reviewed their clinical records, including the visual analog pain scale and Neck Disability Index scores, as well as pre- and postoperative radiographs. Additionally, pre- and postoperative computed tomography images were used to classify the fracture types and assess the C1 to C2 reduction, rotation, and instability. Both patients presented with type II C1 and type II B odontoid fractures, combined with Dickman type II transverse atlantal ligament injuries. All surgical procedures were successfully performed without complications such as vertebral artery injury, neurological deficit, esophageal injury, or wound infection. Both patients achieved almost complete bone healing of the fractures, and C1 to C2 rotation was well preserved (32° and 49°) without atlantoaxial instability after follow-ups of 21 and 25 months, respectively. A monoaxial screw-rod system and anterior screw fixation could be promising surgical strategies for C1 fractures combined with type II odontoid fractures, even in cases involving transverse atlantal ligament injuries. The preservation of C1 to C2 rotation without atlantoaxial instability was observed after fixation. However, extensive case-finding and long-term follow-up are needed to understand the effectiveness of this treatment. In order to preserve the C1-C2 rotation, a monoaxial screw-rod system and anterior screw fixation may be more suitable for patients with C1 fractures combined with type II odontoid fractures.

Algorithms in acetabular fracture classifications.

Acetabular fractures are still challenging fractures. Fracture classification is the basis for understanding these injuries and to gain treatment and to choose a fracture type-based treatment concept. Using a systematic step-wise concept of fracture analysis, based on specific radiographic lines on standard X-rays allow even less experienced surgeons to get a correct classification of the elementary and associated fracture types of Letournel's classification. Algorithmic analysis of the iliopectineal line, (anterior column involvement), ilioischial line (posterior column involvement), presence of a posterior wall fragment, fracture lines involving the iliac wing and inferior ramus, and the spur sign (representing associated both column fractures) allow for approximately 80-90% correct classifications using standard X-rays when integrating these lines into an algorithm. Especially, T-shaped fractures, ABC and ACPHT fractures may be difficult to classify. Thus, advanced imaging, such as CT scans with multiplanar reconstruction and 3D reconstructions is additionally recommended.