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Introduction. Proximal humerus fractures, resulting from direct or indirect trauma, pose a significant clinical challenge. The choice of surgical intervention is influenced by various factors including patient age, comorbidities, bone quality, activity level, fracture characteristics, and the surgeon’s expertise. This study aims to assess the frequency and nature of complications arising from the surgical treatment of proximal humerus fractures. Material and Methods. In this retrospective analysis, 51 patients were included, with 22 males and 29 females. Two surgical techniques were employed: osteosynthesis using locking plates in 27 patients (average age 54.6 years) and intramedullary nailing in 24 patients (average age 58.4 years). The assessment of outcomes was conducted using the Constant Shoulder Score, and statistical analysis was performed using the Student’s T-test. Results. Complications were observed in 12 patients (23.5%), comprising 7 males and 5 females. In the locking plate group, where 8 complications occurred, the mean Constant score was 77.44, while the intramedullary nail group, with 4 complications noted, had a mean Constant score of 70.25. No statistically significant difference was found in the incidence of complications based on gender or the type of surgical technique used. Conclusion. The study found a higher incidence of complications in male patients and those treated with locking plates, though these differences were not statistically significant. These findings emphasize the need for personalized surgical planning and highlight the complexity of managing proximal humerus fractures. [ABSTRACT FROM AUTHOR]

ObjectiveTo compare the clinical efficacy and application value of a novel operative approach of anterograde elastic intramedullary needling versus traditional Kirschmann wiring for junction fractures of radius trunk and metaphyseal in children. MethodsRetrospective analysis was performed for 50 children with fractures at junction of distal radial diaphysis and metaphysis from January 2019 to January 2022.They were assigned into two groups of anterograde elastic intramedullary acupuncture (n=17) and Kirschmann acupuncture (n=33) according to different surgical approaches.The relevant clinical data included gender, age, concurrent distal ulnar fracture, operative duration, fracture angulation and alignment status at Week 2 post-operation.Duration of external fixation, wrist motion, good/excellent rate of wrist function, good/excellent rate of elbow function and complications were recorded at Month 3 post-operation. ResultsOperative duration was longer in anterograde elastic intramedullary acupuncture group than that in Kirschner's needle group[(81.8±38.4) vs.(59.4±26.1) min]and the difference was not statistically significant (P>0.05). The mean contraction of fractures was higher in anterograde elastic intramedullary acupuncture anterograde elastic intramedullary acupuncture group than that in anterograde elastic intramedullary acupuncture Kirschner's needle group (92% vs.88%) and the difference was not statistically significant (P>0.05). The removal time of external plaster fixation was shorter in anterograde elastic intramedullary acupuncture anterograde elastic intramedullary acupuncture anterograde elastic intramedullary acupuncture group than that in anterograde elastic intramedullary acupuncture anterograde elastic intramedullary acupuncture Kirschner's needle group[(31.5±5.1) vs.(39.0±9.2) day]and the difference was statistically significant (P<0.05). The wrist range of motion was higher in anterograde elastic intramedullary acupuncture anterograde elastic intramedullary acupuncture group than that in anterograde elastic intramedullary acupuncture Kirschner's needle anterograde elastic intramedullary acupuncture groupt Month 3 post-operation and the difference was statistically significant (P<0.05). The recovery rate of wrist joint was higher in anterograde elastic intramedullary acupuncture anterograde elastic intramedullary acupuncture group than that in anterograde elastic intramedullary acupuncture Kirschner's needle group (94.12% vs.66.67%) and the difference was statistically significant (P<0.05). The good/excellent recovery rate of elbow joint was lower in anterograde elastic intramedullary acupuncture anterograde elastic intramedullary acupuncture group than that in anterograde elastic intramedullary acupuncture Kirschner's needle group (82.35% vs.87.88%) and the difference was not statistically significant (P>0.05). ConclusionCompared with traditional Kirscher wiring, anterograde elastic intramedullary needling can effectively shorten the time of postoperative removal of plaster external fixation and facilitate the postoperative recovery of wrist joint activity.It is ideal for children with distal radial diaphyseal junction fractures and worth wider clinical promotions. [ABSTRACT FROM AUTHOR]

Objective To explore the causes and outcomes of delayed fracture union after elastic stable intramedullary nailing (ESIN) for pediatric long bone fractures of extremities to minimize the occurrence of this complication and provide clinical rationales for managing delayed fracture union. Methods From July 2015 to April 2020, clinical data were retrospectively reviewed for 233 children with long bone fractures of extremities after ESIN.Nine cases of delayed fracture union were found during follow-ups.Age, injury mechanism, fracture site, surgical approach, post-discharge management and subsequent rehabilitation were recorded.For various causes of delayed fracture union, the corresponding treatment was offered. Results Two cases of delayed fracture union of double fracture of radius and ulna healed after prolonged plaster fixation and immobilization.Two cases of delayed tibial fracture union received proper weight bearing under brace protection.One case of delayed fracture union of femoral fracture healed after external fixation of hip with heriform plaster and removal of elastic intramedullary nail.One case of delayed fracture union of tibia (n=1), humerus (n=1) and femur (n=1) healed after anti-infection and immobilization of affected limb.One case of delayed tibial union underwent autologous bone grafting and plaster fixation. Conclusion Treatments of delayed bone union vary for different and different types of fractures.In this cohort, strengthened fixation, greater stress stimulation at broken end, anti-infection, bone graft reconstruction and other means have been adopted for attaining bone union.Removing the influencing factors of delayed healing and re-stabilizing fracture end are vital for successful treatments. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical efficacy of elastic stable intramedullary nailing (ESIN) for long spiral tibial shaft fractures in school-age children. Methods From October 2014 to October 2019, retrospective analysis of tibial shaft fractures was conducted for 7-12-year-old school-age children using elastic intramedullary nails.According to fracture type, they were divided into two groups of long spiral fracture (n=37) and horizontal/short oblique fracture (n=76). Basic profiles, intraoperative findings, hospitalization length, treatment outcomes and postoperative complications of two groups were compared. Results No significant inter-group differences existed in gender, age, sideness, injury cause, fracture site, fibula fracture or not, operative duration, intraoperative blood loss, hospitalization length or medical expenditure (P>0.05). No significant inter-group difference existed in Flynn efficacy evaluation of ESIN (P>0.05). There was no significant inter-group difference in fracture healing time, complete weight bearing time or intramedullary nail removal time (P>0.05). Complication rate was 2.70% in long spiral fracture group and 3.94% in transverse/short oblique fracture group.There was no statistically significant inter-group difference (P>0.05). Conclusion ESIN has an excellent therapeutic efficacy for school-age children with long spiral tibial shaft fractures.With minimal invasiveness, there is a low risk of postoperative complications.It is worthy of widespread clinical applications. [ABSTRACT FROM AUTHOR]

• Elbow to thumb + 3.5 cm can be used to predict nail length for greater trochanteric entry. • Elbow to thumb + 1.4 can be used to predict nail length for piriform fossa entry. • Surgeons can be confident that the appropriate nail will be selected from a range of three, including that predicted by the "rule of thumb" and one increment to either side. Intramedullary femoral nails are measured intraoperatively using fluoroscopy. This study aims to investigate whether distance from the olecranon to fingertips can be used to estimate nail length preoperatively by evaluating agreement of the two measurements. Such preoperative measurements may provide a likely range of nails needed for theatre and serve as an adjunct to intraoperative measurements. In 70 patients, long leg radiographs were used to make linear measurements from the piriformis fossa and greater trochanter to the distal physeal scar of the femur. These were compared to measurements from the olecranon to the tip of each digit and Bland-Altman agreement analysis was performed. Train and Trial groups were formed to develop models for estimation and to then test their accuracy. Bland-Altman analysis revealed a fixed bias, indicative of average difference between measurements, of 1.4 cm when comparing the elbow-thumb length to maximum femoral nail length for piriformis fossa entry and 3.5 cm using greater trochanter entry, informing the "rule of thumb". Elbow-thumb length plus 1.4 cm or 3.5 cm predicts nail length to a range of ± one nail increment. The rule can be used to preoperatively predict a range of three nails from which there is a 94–97% likelihood the appropriate intramedullary nail would be selected. The "rule of thumb" may serve as a simple to use tool for preoperative planning and a technical check to assess the "reasonableness" of intraoperative measurements before implantation of the device. It has the potential to reduce operating time and nail wastage. [ABSTRACT FROM AUTHOR]

The treatment of pediatric patients in trauma surgery is a special situation in every aspect. For deciding on the correct treatment of fractures of the lower leg and ankle joint, various parameters, such as residual growth rate, skeletal age and height of the patient are decisive. The differences between fractures in children and adolescents are the open epiphyseal plate and the resulting residual growth. The bones of young children have a higher healing tendency and a greater potential for correction than in adolescents. Especially in the lower leg and the ankle joint, the potential for correction is decisive for the healing of fractures and for possible development of growth disorders. The limits of tolerance concerning axial malalignments and the expected spontaneous potential for correction must play an essential role for further treatment with conservative or operative therapy. This article deals with the special features of pediatric fractures of the lower leg and ankle joint. [ABSTRACT FROM AUTHOR]

Fractures in children are a major challenge in everyday clinical practice. The decision about the correct treatment of fractures follows the consideration of individual factors. The age of the child and the resulting residual growth play an essential role. This article aims to facilitate a structured approach with respect to examination, diagnostics and treatment in clinical practice. This first part of this series deals with fractures of the thigh and in the proximity of the knee joint in children. The peculiarity of pediatric bone lies in its growth, which results not only in a much faster healing tendency than in adults but also possesses a greater correction potential. It is therefore very important for fracture healing to include the tolerance limits for existing axis misalignment as well as the expected spontaneous correction potential and the resulting remodeling in the therapy decision. The various operative measures must be used in a targeted manner. Incongruencies of joints as well as significant length differences should be avoided. [ABSTRACT FROM AUTHOR]

Background: Tibial fractures are the most common of all long bone fractures. Although many tibial fractures may be managed conservatively, a certain subset, including unstable fractures and open fractures, require operative stabilization. Intramedullary nails have become the popular choice of implant in the treatment of tibial shaft fractures. The choice between reamed and unreamed intramedullary nailing fort he treatment of open and closed tibial fractures is an ongoing controversy. The aim of this retrospective study was to evaluate the functional and radiological results of open versus closed tibial shaft fractures treated with reamed intramedullary nailing. Methods: The study included 24 patients (5 woman and 19 man) who underwent surgical treatment with intramedullary nailing for tibial shaft fractures. Patients were divided into two groups. Group 1 (Open fracture) included 13 patients (mean age: 31.7±10.7 years). Group 2 (Closed fracture) consisted of 11 patients (mean age: 33.4±11.4 years). Functional and radiologic results were assessed. Johner-Wrush criteria was used for functional assessment. Results: Mean follow-up periods of 25.3±11.5 months and 23.7±12.6 months in group 1 and group 2, respectively. The distribution of fracture types according to AO classification between the two groups was similar. There was no significant difference between the two groups in terms of functional and radiological results. All fractures healed with solid union within a mean of 17.3±6.4 weeks, and there was no complication that was expected to cause permanent disability. Two patients required dynamization because of delayed union without any other additional procedures. Transient sensorial deficit occured in one patient. According to the Johner-Wrush criteria, functional results were very good in 16 patients (67%), and good in 8 patients (33%). Conclusions: Surgical treatment of tibial diaphysis fractures with reamed and locked intramedullary nailing is an appropriate choice with a low complication rate. It can be safely used in moderately contaminated open fractures. However, success of the application, in accordance with, depends on the determination of an accurate indication as well as the surgical technique. [ABSTRACT FROM AUTHOR]

The advantages of fixed angle locking for plates implanted as internal fixators have been widely accepted. Fixed angle locking of intramedullary nails is only an option in exceptional cases, in particular when adjacent to the insertion site. Data from several biomechanical studies clearly show heightened stability and lower failure rates, and animal studies support the assumption of better callus formation. With the angular stable locking system (ASLS) a technique has become available that makes it possible to decide intraoperatively whether fixed angle locking of the in situ intramedullary nail is appropriate or not and how it should be performed. An intramedullary internal fixator can be created. [ABSTRACT FROM AUTHOR]