Unstable Fractures Research Articles

Comparison of ultrasound-guided closed reduction and percutaneous pinning fixation for unstable humeral lateral condylar fractures

ObjectiveUltrasound-guided techniques have become popular in severe humeral lateral condylar fractures (HLCFs). This study compared the results of ultrasound-guided closed reduction and percutaneous pinning (UG-CRPP) for Song types 4 and 5 and dislocation type of HLCFs.MethodsThis retrospective study was conducted in patients with HLCFs treated between January 2021 and October 2022 at three hospitals. The patients were divided into three groups according to Song's classification and elbow dislocation. The surgical time, reduction failure rate, and outcomes of the three groups were compared.ResultsThe mean surgical time of the 94 patients across the three groups (Song 4 group, 42 cases; Song 5 group, 38 cases; and dislocation group, 14 cases) was the longest for Song 4 (66.14 ± 23.05 min), followed by the dislocation group (59.71 ± 21.07 min) and Song 5 (52.16 ± 14.94 min) (for all, P = 0.009). The failure rate decreased in the following order: dislocation group (5/14), Song 4 group (7/42), and Song 5 group (2/38). The failure rate of closed reduction in Song 4 was 3.2-fold higher than that in Song 5, and for the dislocation group, it was 7.6-fold higher than that in Song 5. Significant differences were observed between the Song 4, Song 5, and dislocation groups in terms of shaft-condylar angle and supination (P = 0.015, P = 0.043). No significant differences (P > 0.05) were observed in the carry angle, flexion, extension, or pronation of the three groups. Two cases of delayed healing, four cases of superficial infection, one case of trochlear necrosis, and 39 cases of lateral spur in the Song 4 group were observed. In the Song 5 group, five had a superficial infection, one had re-displacement, and 26 had a lateral spur. In the dislocation group, there were two cases of superficial infection and 10 of lateral spurs.ConclusionsSong 4 HLCFs require longer surgical time and present more postoperative complications than Song 5 and dislocation-type HLCFs and can easily lead to lateral spurs. The failure rates of closed reduction in Song 4 and the dislocation type were higher than those in Song 5. Thus, UG-CRPP can be used to treat patients with unstable HLCFs.

Evaluating Fibular Intramedullary Nails vs Traditional Plating in Geriatric Ankle Fractures: A 12-Year Single-Center Retrospective Study

Background: This study evaluates the outcomes of fibular intramedullary nails (IMNs) compared to traditional plates and screws (PS) in the surgical treatment of unstable ankle injuries in patients aged ≥65 years. Method: We conducted a retrospective study involving 32 elderly patients with unstable ankle fractures treated with IMNs from 2010 to 2022. A comparison was made with 125 case-control patients treated with PS during the same period. Outcomes compared included postoperative wound and nonwound complications, surgical reduction, union rates, implant removal rates, and the Olerud Molander Ankle Score (OMAS) at a minimum follow-up of 2 years. Results: The IMN group had a higher incidence of high-energy injuries, open fractures, concomitant surgery, and perioperative transfusion requirements than the PS group. Additionally, the IMN group developed fewer wound-related (3.1% vs 20% in the PS group, P = .043) and non–wound-related complications (18.8% vs 39.2% in the PS group, P = .030). Both groups had similar initial weightbearing restrictions, fracture union times, mean OMAS scores, rates of malunion or nonunion, and delayed implant removal times. Notably, there were significant differences in the quality and adequacy of mortise alignment between the groups (good: 53.1% in IMN group vs 79.2% in PS group, fair: 46.9% in IMN group vs 20.8% in PS group, P = .006). Conclusion: Although the IMN group had an inferior outcome in the quality and adequacy of mortise reduction compared with the PS group, elderly patients with ankle fractures treated with IMN showed comparable functional outcomes to those treated with PS but with lower complication rates. Future research in this area will provide vital information for developing optimal treatment strategies, thereby improving the overall care of elderly patients with ankle fractures. Level of Evidence: Level III, case-control study.

Transmalar Kirshner Wire Fixation Under Ultrasound Scanning is Useful for Unstable Zygomatic Arch Fracture Combined With Zygomatic Body Fracture.

Plate fixation to zygomatic arch fractures carries the risk of facial nerve palsy and scarring of the cheek; however, without plate fixation, bone deviation or displacement may reoccur after surgery. Furthermore, zygomatic arch fractures combined with zygomatic body fractures are more postoperatively unstable than single zygomatic arch fractures. Few reports have focused on this combined fracture type, and no consensus has been reached regarding treatment. Because plate fixation for slight deviation of the zygomatic body has little advantage for stabilization, the authors, usually opt for transmalar pinning alone instead of plate fixation at the hospital. This study is a retrospective case series of 7 patients, among 100 zygomatic fractures excluding isolated zygomatic arch fractures, treated using transmalar pinning under ultrasound scanning. The reduction was performed through the oral and temporal incision as a surgical procedure. Under ultrasound observation, a Kirshner wire was inserted into the zygomatic body from the unaffected side while maintaining the reduced position. The wire was removed at an outpatient visit 2 to 3 months following surgery. In all cases, the zygomatic body was of the laterally rotated type, and postoperative morphologic evaluation showed improvement without postoperative complications. Scores were higher in middle-aged and older than in young people. Correction of zygomatic rotation also scored higher than zygomatic arch morphology. Transmalar Kirshner wire fixation under ultrasound observation is a simple and minimally invasive method for zygomatic arch fractures, which avoids the possible complications related to plate fixation.

MANAGEMENT OF THE TIBIAL SHAFT FRACTURES WITH A SUPRAPATELLAR APPROACH

Objectives: Tibia fractures are the most common long bone fractures, among which diaphyseal fractures are more common. Tibial diaphyseal fractures have a significant risk of non-union and malunion among all long bone fractures. Among adults, IMILN is the treatment of choice for unstable and displaced fractures. The traditional surgical method is the infrapatellar approach, which has its own drawbacks. Here, we are studying the suprapatellar approach. Methods: The prospective study was conducted on 25 patients in the Department of Orthopedics, Government General Hospital, Kurnool for 1 year from November 2022 to November 2023. Patients were examined clinically and functional outcomes were noted. Results: The suprapatellar approach shows an average operative time was 40–80 min and blood loss was around 70–90 mL. The mean time of union was 15–16 weeks. Conclusion: For tibial diaphyseal fractures, the suprapatellar approach is a safe and effective alternative nail insertion.

Ankle fracture surgery performed by orthopaedic residents without supervision has comparable outcomes to surgery performed by fellowship trained orthopaedic surgeons.

Unstable fractures often necessitate open reduction and internal fixation (ORIF), which generally yield favourable outcomes. However, the impact of surgical trainee autonomy on healthcare quality in these procedures remains uncertain. We hypothesized that surgery performed solely by residents, without supervision or participation of an attending surgeon, can provide similar outcomes to surgery performed by trauma or foot and ankle fellowship-trained orthopaedic surgeons. A single-center cohort of an academic level-1 trauma center was retrospectively reviewed for all ankle ORIF between 2015 and 2019. Data were compared between surgery performed solely by post-graduate-year 4 to 6 residents, and surgery performed by trauma or foot and ankle fellowship-trained surgeons. Demographics, surgical parameters, preoperative and postoperative radiographs, and primary (mortality, complications, and revision surgery) and secondary outcome variables were collected and analyzed. Univariate analysis was performed to evaluate outcomes. A total of 460 ankle fractures were included in the study. Nonoperative cases and cases operated by senior orthopaedic surgeons who are not trauma or foot and ankle fellowship-trained orthopaedic surgeons were excluded. The average follow-up time was 58.4 months (SD ± 12.5). Univariate analysis of outcomes demonstrated no significant difference between residents and attendings in complications and reoperations rate (p = 0.690, p = 0.388). Sub-analysis by fracture pattern (Lauge-Hansen classification) and the number of malleoli involved and fixated demonstrated similar outcomes. surgery time was significantly longer in the resident group (p < 0.001). The current study demonstrates that ankle fracture surgery can be performed by trained orthopaedic surgery residents, with similar results and complication rates as surgery performed by fellowship-trained attendings. These findings provide valuable insights into surgical autonomy in residency and its role in modern clinical training and surgical education. Level III - retrospective cohort study.

Biomechanical comparison of an intramedullary nail combined with a reconstruction plate combination versus a single intramedullary nail in unstable intertrochanteric fractures with lateral femoral wall fracture: A finite element analysis

Biomechanical comparison of an intramedullary nail combined with a reconstruction plate combination versus a single intramedullary nail in unstable intertrochanteric fractures with lateral femoral wall fracture: A finite element analysis

Immediate management of a stable patient with unstable pelvis.

The diagnosis of a traumatic unstable pelvis in a stable patient is a temporary concept depending on when we see the patient, as all patients presenting with hemorrhagic shock have hemodynamic stability until they become unstable. As a rule, the more unstable the pelvic fracture is, the higher the risk of bleeding and hemodynamic instability it has. Therefore, in unstable pelvic fractures, hemodynamic stability should be a diagnosis by exclusion. For bleeding detection in stable patients, an immediate one-stage contrast-enhanced CT scan is the appropriate diagnosis test; however, since CT scan radiation is always an issue, X-rays should be considered in those cases of hemodynamically stable patients in whom there is a reasonable suspicion that no unsafe bleeding is going on. Pelvic fracture classification is essential as usually there is an association between the injury mechanism, the fracture displacement, and the hemodynamic stability. Anteroposterior and, particularly, vertical traumatisms have much more proclivity to provoke major pelvic displacement and bleeding. The use of a pelvic binder, as early as possible including pre-hospital management, should be standard in high-impact blunt trauma patients independently of the trauma mechanisms. External fixation is the preferred method of stabilization in case of open fractures, and, in closed ones, when the schedule for definite osteosynthesis prolongs because of the patient's general condition. If possible, immediate percutaneous sacroiliac screw insertion for unstable pelvic fractures produce excellent results even in open fractures.

Effects of Cerclage Cabling on Preventing Periprosthetic Femoral Fractures When Using Cementless Stems for Unstable Femoral Neck Fractures

BackgroundPeriprosthetic femoral fractures (PFFs) are serious complications in hip arthroplasty for femoral neck fractures. The rates of intraoperative and postoperative PFFs are higher in cementless stem cases than in cemented cases. This study aimed to investigate the effects of cerclage cabling on PFF prevention in cementless arthroplasty for femoral neck fractures. MethodsThis retrospective study included 329 consecutive patients who underwent hip arthroplasty using a cementless stem for femoral neck fractures. A total of 159 and 170 patients were in the non-cabling and cabling groups, respectively. Patient characteristics were comparable in both groups. The PFF occurrence (intraoperative PFF [iPFF] and postoperative PFF [pPFF]) rates, reoperation rates, operative time, and blood loss volume were compared between the groups. ResultsThe iPFF rate was significantly higher in the non-cabling group (6.3%) than in the cabling group (0%, P < 0.001). The rate of pPFF was significantly higher in the non-cabling group (5.1%) than in the cabling group (0.6%; P = 0.016). All patients in the non-cabling group required reoperation (5.1%), whereas the patient in the cabling group was an ambulatory case and required no reoperation (0%, P = 0.003). No significant difference in either operative time or blood loss volume was observed between the non-cabling (50 minutes, 133 mL) and cabling (52 minutes, P = 0.244; 149 mL, P = 0.212, respectively) groups. ConclusionWhen a cementless stem is used to treat unstable femoral neck fractures, cerclage cabling effectively prevents iPPF and pPPF without increasing surgical time or blood loss volume.

Clinical efficacy of Femoral Neck System for treatment of unstable femoral neck fractures in young adults.

This study was performed to evaluate the mid-term clinical efficacy of the Femoral Neck System (FNS) (DePuy Synthes, Zuchwil, Switzerland) in treating young patients with unstable Pauwels type III femoral neck fractures. We performed a retrospective observational analysis of 21 young adults treated with the FNS. Clinical outcomes were assessed based on fracture reduction quality, Harris hip scores, and postoperative complication rates. The study comprised 21 patients with a mean age of 35 years (range, 20-50 years) who were followed for a mean duration of 22.8 months (range, 16-30 months). Closed reduction was unfeasible in three (14.3%) patients, each of whom required open reduction. Notable postoperative complications were avascular necrosis in two (9.5%) patients, nonunion in one (4.7%), and implant failure in one (4.7%). Each of these complications led to the requirement for total hip arthroplasty. The favorable mid-term clinical outcomes of this study indicate that the FNS is a potentially effective treatment modality for young individuals with unstable Pauwels type III femoral neck fractures.

Intelligent robot-assisted fracture reduction system for the treatment of unstable pelvic fractures

BackgroundPrecise and minimally invasive closed reduction is the premise of minimally invasive internal fixation. This paper aims to explore the safety and efficacy of a robot-assisted fracture reduction system (RAFR) in the treatment of pelvic fractures and to analyze its clinical advantages and existing problems.MethodsThe RAFR system intelligently designed the optimal reduction path and target position based on a preoperative three-dimensional(3D) CT scan of the patient. The reduction robotic arm automatically reduced the affected hemipelvis according to the pre-planned reduction path.ResultsThe average residual displacement was the 6.65 ± 3.59 mm. According to Matta’s criteria, there were 7 excellent, 10 good, and 3 fair, and the excellent and good rate was 85%. No postoperative complications occurred.ConclusionIn our study, the RAFR system could complete accurate and minimally invasive closed reduction for most patients with unstable pelvic fractures, which could achieve good fracture reduction quality and short-term efficacy.

Unstable trochanteric fractures treated with proximal femoral nail show functional outcomes independent of the fracture type

Background: The proximal femoral nail has replaced the sliding hip screw devices and gamma nails as the implant of choice for unstable trochanteric fracture (AO 31A2-A3). In our study we aimed to find a correlation between fracture type, time taken for radiographic union and their functional outcome according to Harris Hip score at 6 months after PFN fixation of such fractures. Methods: We assessed 38 patients sustaining unstable (AO 31A2-A3) trochanteric fractures. All the fractures were treated with short PFN. Functional outcome was assessed according to the HHS at sixth month follow-up. Results: No statistically significant association was found between HHS with fracture type (p=0.184) and bone union time (p=0.587). The association between bone union time and fracture type was found to be statistically significant (p=0.007). Conclusions: Functional outcome (HHS) does not depend upon the fracture type.

Improved Durability of a Modular Axial Fixator for Stable and Unstable Proximal Femoral Fractures: A Patient-Specific Finite Element Analysis

Abstract Objectives: Femoral neck fractures, comprising 8-10% of all bodily fractures in the elderly, often necessitate alternatives to extensive surgical interventions. Despite limited research, external fixators are considered promising. This study evaluates the design and durability of a novel Modular Axial Fixator (MAF) for stable and unstable proximal femoral fractures, using numerical method-based engineering analysis. Methods: Employing patient-specific CT scan data, 3D solid modelling, and finite element analysis (FEA), the MAF-bone fixation is examined in eight simulation scenarios under static loading conditions. Results: FEA results show a peak femur head displacement of 7.429 mm in FEA 001, with Schanz screw no. 2 reaching the maximum equivalent stress at 431.060 MPa in FEA-006. Notably, the 7.429 mm displacement improves stability compared to previous studies, yet interfragmentary movement surpasses the 100-200 μm reference range for primary fracture healing, posing challenges to direct healing despite enhanced stability. Conclusion: This study validates the durability of the innovative MAF for femoral neck fractures through engineering simulations. It contributes to understanding MAF durability issues, with implications for improving medical implant design in the industry. Simulation results offer opportunities for optimising structure and production, enhancing the MAF's design, and ultimately benefiting medical implant manufacturing.

Less Invasive Triangular Osteosynthesis in the Management of AO Type-B Unstable Sacral Fractures

Objective: This prospective cohort study investigated the clinical and radiological efficacy of triangular osteosynthesis (TO) in the management of AO type-B unstable sacral fractures.Methods: All patients with unstable AO type-B sacral fractures were included in this study. They were evaluated clinically and radiologically and underwent TO. Pre- and postoperative clinical parameters included the visual analogue score (VAS) for back pain, Oswestry Disability Index (ODI), and Gibbon classification. Radiological parameters included x-rays and multislice 3-dimensional computed tomography scans of the pelvis and the Tornetta and Matta criteria for fracture reduction.Results: This study included 30 patients (17 males and 13 females; mean age, 31.63±9.65 years). The reported causes of trauma were a fall from height in 17 patients, road traffic accident in 11 patients, and hard objects falling onto the pelvis in 2 patients. According to the AO spine sacral fracture classification system, 8 cases were type B2 and 22 were type B3. At the last postoperative follow-up, the mean VAS improved from 7.77±1.19 preoperatively to 3.97±1.59 (p&lt;0.001), the mean ODI was 15.27±3.34, and the Gibbon classification of cauda equina injury improved from 2.87±0.97 preoperatively to 1.27±0.52 (p&lt;0.001). According to Tornetta and Matta criteria for fracture reduction, the results were excellent (&lt;4 mm) in 73.3% of patients, good (4–10 mm) in 20%, and fair (10–20 mm) in 6.7%. All patients experienced complete fracture healing.Conclusion: TO is a less invasive, safe, and effective option for the management of unstable AO type-B sacral fractures with good clinical and radiological outcomes.

Overview of Pelvic Ring Fracture Patients: Observational Study in the Emergency Department at Dr. Kariadi General Hospital, Semarang, Indonesia

Background: Although the incidence of pelvic fractures is only 7% of all trauma, the mortality reaches 21.5%. Management of pelvic fractures remains a challenge because it is often a polytrauma that requires multidisciplinary management and large resources. Knowledge of the characteristics of patients with pelvic fractures is expected to help in management and reduce mortality. Methods: This observational study was conducted retrospectively with a population and sample of all pelvic fracture patients in the emergency room at Dr. Kariadi Hospital Semarang for the period January 2021 to December 2023. The characteristics observed included gender, age, fracture classification, etiology, trauma score, fracture pattern, and management. and output. The data obtained is then presented descriptively. Results: A total of 34 patients with pelvic fractures were recorded in this study. There were 16 male patients and 18 female patients. A total of 3 patients were less than 17 years old, 19 patients were 17-34 years old, 7 patients were 35-52 years old and 3 patients were more than 52 years old. The most common cause of pelvic fractures was traffic accidents (KLL) with 28 patients, followed by work accidents (4 patients) and other trauma (2 patients). Based on the Young-Burgess classification, the most common pelvic fracture pattern was LC1 (11 patients), followed by APC1 (3 patients), APC2 (4 patients), APC3 (3 patients), LC2 (2 patients), LC3 (6 patients), VS (4 patients), and CM (1 patient). A total of 4 patients had an ISS score of 1-8, 8 patients had an ISS score of 9-15, 9 patients had an ISS score of 16-25, and 13 patients had an ISS score of more than 25. The most common accompanying injury was long bone fracture (15 patients), head injury in 10 patients, abdominal trauma in 9 patients, and thorax trauma in 4 patients. Operative treatment was carried out in 21 patients, while 13 other patients were treated non-operatively. Of the 34 patients, 8 patients died and 26 others were discharged in good condition. Conclusion: Most pelvic fractures occur at the age of 17-34 years and the most common cause is KLL. All pelvic fracture patients had concomitant injuries and the majority of patients had unstable fractures that required operative treatment. Mortality due to pelvic fracture and/or accompanying injuries is 23.5%.

Minimally invasive surgical technique for unstable supracondylar humerus fractures in children (Gartland type III or IV).

Achieving and maintaining anatomical reduction during the treatment of pediatric humerus fractures, classified as Gartland type III or IV, presents a clinical challenge. Herein, we present a minimally invasive surgical approach using a novel and simple K-wire push technique that aids in achieving and maintaining anatomical reduction. We reviewed data of children receiving treatment for supracondylar fractures of the humerus at our hospital between January 2016 and December 2020. Patients were divided into two groups based on the method of treatment: Group 1 was treated with the K-wire push technique, and Group 2 was treated with the standard technique as described by Rockwood and Wilkins. The medical records and radiographic images were reviewed. In total, 91 patients with Gartland types III and IV fractures were included, with 37 and 54 patients in Groups 1 and 2, respectively. The postoperative reduction radiographic parameters and Flynn scores at final follow-up were not significantly different between the two groups. The minimally invasive K-wire push technique for unstable supracondylar fractures in children is a safe and effective alternative for improving reduction. Using this technique, complications can be minimized, and the requirement for open reduction can be reduced.

Study on fracture characteristics of steel fiber reinforced manufactured sand concrete using DIC technique

Incorporation of steel fibers to improve the defects of manufactured sand concrete (MSC) has received a great deal of attention, while the fracture mechanism of the MSC by volume fraction of steel fibers (Vf) has been less studied. To investigate the effects of steel fibers on the fracture characteristics of the MSC, three-point bending tests were conducted on the MSC beams with different Vf (0, 0.5 %, 1.0 % and 1.5 %) using digital image correlation technique. The effects of Vf on the fracture parameters and crack propagation paths of steel fiber reinforced manufactured sand concrete (SFRMSC) were analyzed. In addition, fracture process zone (FPZ) of the SFRMSC was analyzed via the length of the FPZ (lFPZ) and area of the FPZ (AFPZ). The results indicated that the residual strength, initiation fracture toughness, unstable fracture toughness, fracture energy and characteristic length of the SFRMSC increased with the increase of Vf, whereas the crack propagation paths were not sensitive to the changes of Vf. The addition of steel fibers increased the interaction between the aggregate and the matrix, which led to an increase in the number of microcracks. Before approaching the Pc, both the lFPZ and AFPZ showed essentially stable changes. As Vf increased, the lFPZ and AFPZ developed faster to their corresponding maximum values. The AFPZ reached a maximum and increased with the Vf. At the Pc, the lFPZ and AFPZ changed in a similar trend when Vf ≤ 1.0 %. When Vf > 1.0 %, the lFPZ changed slightly while the AFPZ increases sharply.

Intramedullary versus plate fixation of both bone forearm fractures in skeletally immature patients: a systematic review and meta-analysis.

Both bone forearm fractures (BBFFs) are a common injury amongst the pediatric population. The main indications of surgical fixation are open, irreducible, or unstable fractures. The two most commonly used surgical techniques are closed or open reduction with intramedullary fixation (IMF) and open reduction with plate fixation (PF). The aim of this systematic review and meta-analysis was to determine which fixation method is superior for BBFFs. PubMed, Scopus, Web of Science, and CENTRAL were searched to identify studies comparing IMF and PF. We extracted data on union rates, complications, early hardware removal rates, reoperation rates, and radiographic, clinical, and perioperative outcomes. Sixteen studies were included in the analysis, with a total of 922 patients (539 IMF and 383 PF). Similar union rates were achieved by both fixation technique. IMF was associated with a higher incidence of symptomatic hardware, and early hardware removal. Better restoration of the radial bow was observed with the PF group, especially in older children and adolescents. The rate of excellent function was comparable between groups, whereas better cosmesis was reported with the IMF group. Despite shorter fluoroscopy time and immobilization time, PF demonstrated longer tourniquet time, operating time, and hospital stay compared to IMF. We found no significant difference between IMF and PF in terms of union rates and functional outcomes taking in consideration the merits and demerits of each technique. High-quality randomized controlled trials are, therefore, necessary to determine the superiority of one fixation technique over the other. III.

Open reduction and internal fixation versus minimally invasive plate osteosynthesis of unstable proximal humerus fractures treated with locking plate and intramedullary allograft: A retrospective study

Background This retrospective clinical study aims to compare the functional and radiological outcomes after open reduction and internal fixation versus minimally invasive plate osteosynthesis of unstable proximal humerus fractures treated with both locking plate and intramedullary graft. Methods Forty-seven patients with proximal humerus fractures were treated with either open reduction and internal fixation (25 cases) or minimally invasive plate osteosynthesis (22 cases) and evaluated retrospectively with a minimum follow-up of 12 months. Thirty-one fresh-frozen fibulae and 16 lyophilized tibia allografts were used for augmentation. Change of both neck-shaft angle and humeral head height were evaluated radiologically. Functional outcomes were assessed using Disabilities of the Arm, Shoulder and Hand Score (DASH), Absolute Constant–Murley Score (CSabs), Relative Constant–Murley Score (CSrel), and Individual Relative Constant–Murley Score (CSindiv). Results Follow-up period and age for open reduction and internal fixation/minimally invasive plate osteosynthesis were 27.4 ± 16.2/29.6 ± 17.6 months and 60.5 ± 13.7/66.3 ± 11.7 years. CSabs, CSrel, and CSindiv were 57.3 ± 21.2/52.4 ± 18.9, 73 ± 24.1/73.9 ± 23.4, and 69.6 ± 24.8/64 ± 25.5 for open reduction and internal fixation/minimally invasive plate osteosynthesis, p ≥ 0.409. DASH was 14.8 ± 12.5/18.7 ± 14.5 for open reduction and internal fixation/minimally invasive plate osteosynthesis, p = 0.324. Decrease of neck-shaft angle and humeral head height was 7.8 ± 9.4/8.2 ± 15.6° and 0.6 ± 5.5/1.4 ± 2.6 mm for open reduction and internal fixation/minimally invasive plate osteosynthesis, p ≥ 0.380. Surgical time was 165.8 ± 77.6/84.7 ± 38.1 min for open reduction and internal fixation/minimally invasive plate osteosynthesis, p &lt; 0.001. Conclusions Locked plating with intramedullary graft augmentation of unstable proximal humerus fractures demonstrates similar functional and radiological outcomes when comparing open reduction and internal fixation with minimally invasive plate osteosynthesis. However, minimally invasive plate osteosynthesis is related to significantly shorter surgical time versus open reduction and internal fixation.

[Influence of anterior fracture line on anterior cortical reduction loss after cephalomedullary nail fixation in intertrochanteric fractures].

To investigate the position of the anterior fracture line in AO/Orthopaedic Trauma Association (AO/OTA) type A2 unstable intertrochanteric fractures and its impact on the incidence of anterior cortical reduction loss after cephalomedullary nail fixation. A clinical data of 95 patients with intertrochanteric fractures who met the selection criteria between April 2020 and February 2023 was retrospectively analyzed. All patients were treated with cephalomedullary nail fixation, and the intra- and post-operative imaging data were complete. Among them, there were 37 males and 58 females. The age ranged from 61 to 97 years, with an average of 79.6 years. The time from injury to operation ranged from 7 hours to 11 days, with an average of 2.8 days. According to the 2018-AO/OTA classification standard, there were 39 cases of type 31-A2.2 and 56 cases of type 31-A2.3. Intraoperative fluoroscopy was used to record the number of patients with satisfactory fracture alignment. The preoperative CT data were imported into Mimics17.0 software to simulate the fracture reduction and measure the distance between the anterior fracture line and the intertrochanteric line bony ridge. The fractures were classified as transcapsular fractures, extra-capsular fractures, and intra-capsular fractures according to the distance. CT three-dimensional reconstruction was performed within 2 weeks after operation to observe the number of patients with anterior cortical reduction loss. The postoperative anterior cortical reduction loss incidence in patients with satisfactory fracture alignment, and the relationship between postoperative anterior cortical reduction loss and the position of the anterior fracture line were observed. There were 52 cases (54.7%) of transcapsular fractures, 24 cases (25.3%) of extra-capsular fractures, and 19 cases (20.0%) of intra-capsular fractures. Among them, 41 of the 52 transcapsular fractures had satisfactory fracture alignment, and 4 (9.8%) of them experienced anterior cortical reduction loss after operation; 19 of the 24 extra-capsular fractures had satisfactory fracture alignment, and no anterior cortical reduction loss occurred; 16 of the 19 intra-capsular fractures had satisfactory fracture alignment, and 7 (43.8%) of them experienced anterior cortical reduction loss after operation. There was a significant difference in the incidence of anterior cortical reduction loss between groups ( χ 2=8.538， P=0.003). All patients were followed up 3-26 months (mean, 9 months). Among them, 91 cases had fracture healing, and 4 cases had nonunion. In AO/OTA type A2 unstable intertrochanteric fractures, where the anterior fracture line is located within the joint capsule, there is a high risk of anterior cortical reduction loss after operation.

Role of Anteromedial Cortical Support for Unstable Intertrochanteric Fractures Being Treated With Cephalomedullary Nails

Role of Anteromedial Cortical Support for Unstable Intertrochanteric Fractures Being Treated With Cephalomedullary Nails