Search

BACKGROUND: Stand-alone oblique lateral interbody fusion has a high rate of complications of fusion segment sink. Oblique lateral interbody fusion with posterior fixation can provide stable support, but intraoperative position changes and double incisions weaken the advantages of this technique. Oblique lateral interbody fusion combined with lateral plate fixation can achieve one-stage decompression in the same incision, while the lateral internal fixation provides stable support. OBJECTIVE: To analyze the short-term efficacy of oblique lateral interbody fusion combined with lateral plate fixation in the treatment of single-level lumbar degenerative disease. METHODS: The clinical data of 34 patients with single-level lumbar degenerative disease treated with oblique lateral interbody fusion combined with lateral plate fixation were collected from May 2020 to October 2022. Among them, 14 were males and 20 were females aged from 41 to 72 years at the mean age of (58.6 ±9.9) years. There were 11 cases of lumbar spondylolisthesis (I°), 7 cases of lumbar disc herniation with segmental instability, and 16 cases of lumbar spinal stenosis. Operation time, blood loss, and complications were recorded. Visual analog scale scores of lumbago, radiative pain of both lower limbs, and Oswestry disability index scores were evaluated before surgery, 3 months after surgery, and the last follow-up. Dural sac cross-sectional area, intervertebral height, and intervertebral fusion were measured and observed. RESULTS AND CONCLUSION: (1) The 34 patients were followed up for 14-36 months, with an average of (21.3±5.2) months. (2) The operation time ranged from 50 to 92 minutes, with an average of (68.5±11.1) minutes. Intraoperative blood loss was 50-170 mL, with an average of (71.6±25.3) mL. (3) Compared with the preoperative results, the visual analog scale scores and Oswestry disability index scores were significantly decreased at 3 months after surgery and at the last follow-up (P < 0.001), and the maximum Oswestry disability index scores were improved by nearly 50%. (4) Bone fusion was achieved in all patients during half-year follow-up. The overall complication rate was 21% (7/34), including 1 case of plate displacement, 3 cases of cage subsidence, 1 case of psoas weakness, and 2 cases of anterior thigh pain. (5) It is concluded that oblique lateral interbody fusion combined with lateral plate fixation for the treatment of lumbar degenerative diseases has the characteristics of less blood loss, short operation time, rapid postoperative recovery, and significant short-term clinical efficacy with the stable support to a certain extent. The long-term curative effect needs further follow-up observation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Palmar locking plate fixation is the most commonly used fixation method for distal radius fractures. However, when the fracture line involves the dorsal articular surface, palmar plate fixation carries a higher risk of postoperative displacement of the dorsal bone mass, especially the dorsal sigmoid notch bone mass. OBJECTIVE: To analyze the fracture line characteristics of distal radius fracture involving the dorsal articular surface, and further investigate the risk factors of postoperative displacement of the dorsal bone mass involving the sigmoid notch, so as to provide evidence for improving the success rate of surgery. METHODS: Retrospective analysis was performed on patients with distal radius fracture who were admitted to Third Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2021 to September 2022. The number of dorsal fractures of the distal radius of 1, 2, 3 and above was divided into types I, II, and III based on preoperative CT images. The fracture line maps were drawn respectively to analyze the morphological characteristics of the dorsal fracture lines. Patients with dorsal sigmoid notch fracture were followed up for more than 3 months and divided into displaced group and non-displaced group according to whether the dorsal sigmoid notch bone mass displacement occurred after surgery. Age, sex, preoperative and postoperative CT anatomical parameters were compared between the two groups. RESULTS AND CONCLUSION: (1) 145 patients with type C of AO/OTA involving the dorsal articular surface were analyzed by fracture line map. According to the number of dorsal fractures, there were 25 cases of type I fracture (17.2%), 82 cases of type II fracture (56.6%), and 38 cases of type III fracture (26.2%). Fracture line map showed that the fracture line of type I fracture block mainly involved sigmoid notch; type II mainly involved sigmoid notch and lister tubercle, and type III involved sigmoid notch, lister tubercle, and dorsal radial column. Among the 145 patients, 86.2% (125/145 cases) were involved in sigmoid notch, of which type III was involved as high as 94.7% (36/38 cases); type II was involved as high as 88.0% (72/82 cases), and type I was involved as high as 68% (17/25 cases). (2) 76 cases of type C of AO/OTA involving the dorsal sigmoid notch were included for further study, of which 65 cases were not displaced after operation and 11 cases were displaced. In univariate analysis, there were no statistically significant differences between the two groups in age, sex, injury site, preoperative CT dorsal sigmoid notch bone mass length (d1), ulnar length (d2), dorsal height of dorsal sigmoid notch bone mass (d4), and ulnar edge distance between steel plate and radius (d5) (P > 0.05). The proportion of dorsal sigmoid notch involving the radioulnar joint: [d2/(d2+d3)], the proportion of articular surface of dorsal sigmoid notch (s1/s2), the distance between the ulnar screw tail and the edge of dorsal sigmoid notch (d6), and the number of screw fixation of dorsal sigmoid notch were statistically significant (P < 0.05). (3) Multivariate Logistic regression analysis showed that the number of screw fixation of sigmoid notch was the only risk factor affecting the displacement of sigmoid notch on dorsal ulnar side (P < 0.05). (4) It is indicated that type II is the most common intra-articular fracture of distal radius involving the back of the radius, followed by type III and type I with dorsal sigmoid notch bone mass. However, the dorsal sigmoid notch bone mass is prone to postoperative displacement due to the influence of the inferior radioulnar joint ligament, and the fixation of at least one effective screw during the operation can reduce the risk of displacement and help to improve the treatment effect. [ABSTRACT FROM AUTHOR]

BACKGROUND: There is still no consensus on the optimal internal fixation for the treatment of Pauwels III femoral neck fracture, and most of the related finite element analyses have been performed using a single simplified loading condition, and the biomechanical properties of commonly used internal fixation devices need to be further investigated. OBJECTIVE: To analyze the biomechanical characteristics of Pauwels III femoral neck fractures treated with cannulated compression screw, dynamic hip screw, and femoral neck system by finite element method under different loading conditions of single-leg standing loads and sideways fall loads. METHODS: The DICOM data of healthy adult femur were obtained by CT scanning, imported into Mimics 15.0 software to obtain the rough model of bone tissue. The data exported from Mimics were optimized by Geomagics software, and then three internal fixation models were built and assembled with the femur model according to the parameters of the clinical application of the cannulated compression screw, dynamic hip screw, and femoral neck system by using Pro/E software. Finally, the three internal fixation models were imported into Ansys software for loading and calculation to analyze the stress distribution and displacement of the femur and the internal fixation under different working conditions of single-leg standing loads and sideways fall loads, as well as the stress characteristics of the calcar femorale and Ward's triangle. RESULTS AND CONCLUSION: (1) Under the single-leg standing load and the sideways fall load, the proximal femoral stress of the three internal fixation models was mainly distributed above the fracture end of the femoral neck. The peak stress of the proximal femoral end, fracture end, Ward triangle, and calcar femorale of the three internal fixation models were the smallest in the femoral neck system model and the largest in the cannulated compression screw model. (2) Under the single-leg standing load and the sideways fall load, the peak displacement of the proximal femur of the three internal fixation models was all located at the top of the femoral head, and the peak displacement was the smallest in the femoral neck system model and the largest in the cannulated compression screw model. (3) The peak displacement of the three internal fixation models was all located at the top of the internal fixation device under the single-leg standing and sideways fall loading conditions, and the peak displacement values were the smallest in the femoral neck system internal fixation model and the largest in the cannulated compression screw internal fixation model. (4) The internal fixation stress of the three internal fixation models was mainly distributed in the area near the fracture end of the internal fixation device under the single-leg standing and sideways fall loads, and the peak value of internal fixation stress was the smallest in the femoral neck system model and the largest in the cannulated compression screw model. (5) These results suggest that the mechanical stability of the femoral neck system is the best, but there may be a risk of stress shielding of the fracture end and calcar femorale. The stress of the internal fixation device of the femoral neck system is more dispersed, and the risk of internal fixation break is lower. [ABSTRACT FROM AUTHOR]

Objective: The treatment of comminuted inferior pole patellar fractures has long posed a challenge for orthopedic surgeons. This study aims to compare the biomechanical stability and clinical efficacy of Kirschner wire tension band combined with anchor cross-suture fixation versus traditional partial patellectomy in the treatment of comminuted inferior pole patellar fractures. Methods: A retrospective analysis was conducted on 14 patients who underwent Kirschner wire tension band combined with anchor cross-suture fixation (Group A) in our department of orthopedics from September 2020 to April 2022. Additionally, we matched 14 patients with similar baseline characteristics who received inferior pole patellectomy combined with patellar tendon repair (Group B). The two groups were compared in terms of operative time, intraoperative blood loss, postoperative complications, and at the final follow-up, knee range of motion (ROM), visual analogue scale (VAS) score, Bostman knee function score, peak knee torque, and Insall-Salvati (IS) ratio. Results: All patients were followed up for more than 12 months. At the final follow-up, Group A showed significantly better outcomes than Group B in terms of knee range of motion (ROM), Bostman knee function score, knee VAS score, and average peak knee torque, with statistically significant differences (P < 0.05), indicating faster postoperative recovery and better clinical results in Group A. The IS ratio of the injured knee in Group B was 0.71 ± 0.66, less than 0.8, suggesting a decrease in patellar height. There were no significant differences between the two groups in terms of operative time, intraoperative blood loss, or incision length (P > 0.05). In Group A, one patient experienced complications from hardware irritation, while in Group B, one patient had postoperative knee pain, and two patients experienced knee extension weakness after cast removal and rehabilitation. Conclusion: Kirschner wire tension band combined with anchor cross-suture fixation for the treatment of inferior pole patellar fractures yields satisfactory results. This technique provides reliable fixation, restores the original extensor mechanism, promotes early postoperative rehabilitation, and reduces the incidence of complications, making it suitable for clinical application and widespread use. Evidence level: Level III (retrospective comparative study) [ABSTRACT FROM AUTHOR]

Before patients begin out-of-bed exercises following internal fixation surgery for acetabular fractures, turning over in bed serves as a crucial intervention to mitigate complications associated with prolonged bed rest. However, data on the safety of this maneuver post-surgery are limited, and the biomechanical evidence remains unclear. This study aims to introduce a novel loading protocol designed to preliminarily simulate the action of turning over in bed and to compare the biomechanical properties of two fixation methods for acetabular fractures under this new protocol. A RNJ-500 microcomputer-controlled electronic torsion tester was utilized to simulate the action of turning over in bed and to conduct a dynamic torsion loading test. Initially, the torque values and torsional stiffness of six intact pelvis specimens (Group A) were measured. A double-column acetabular fracture model was then created and stabilized using two different fixation methods: the Dynamic Anterior Plate-Screw System for the Quadrilateral plate (DAPSQ, Group B) and the traditional anterior reconstruction titanium plate plus a 1/3 tubular buttress plate (Group C). All specimens underwent cyclic torsion loading ranging from 2° to 8°. The medial displacement and strain values of the quadrilateral plate were recorded and analyzed. As the torsion angles increased from 2° to 8°, Groups A and B exhibited significantly higher torque values compared to Group C (all P < 0.05). Group C demonstrated notably lower torsional stiffness (1.51 ± 0.20) relative to Group A (2.33 ± 0.25, P < 0.05) and Group B (2.21 ± 0.29, P < 0.05). Additionally, the medial displacement of the quadrilateral plate was significantly reduced in Group B compared to Group C at all measured time points (P < 0.05). And Group C exhibited significantly higher maximum tensile and compressive strain than Group B (all P < 0.05). The DAPSQ plate with quadrilateral screws provides superior anti-rotational stability in a double-column acetabular fracture model under the newly established torsion loading protocol. [ABSTRACT FROM AUTHOR]

Postpartum pubic symphysis diastasis is a relatively rare entity. It is usually associated with cephalopelvic disproportion, macrosomia, multiparity, precipitate labor, difficult labor, difficult forceps delivery, any other pelvic bone pathologies, and underlying connective tissue disorders. Management is typically conservative in most cases, but surgical intervention is sometimes required in cases where pubic symphysis is >4 cm and not responding to conservative management. Case with more than 4 cm of pubic diastasis is usually associated with disruption of the symphyseal ligament, sacroiliac joint capsule, and ligaments. Surgical management promotes early ambulation with good functional recovery and decreases the chances of symphyseal sclerosis, functional disability, and chronic pain. Four female patients with postpartum pubic diastasis of more than 7 cm with an age ranging from 20 to 30 years underwent open reduction and internal fixation using plates and screws. In all four cases, the patient got early ambulation and full functional recovery without any pain, discomfort, and disability at 3 months of follow up. Although conservative management has been advocated for postpartum pubic diastasis typically, surgical intervention should be sought for significant pubic diastasis (more than 4 cm) to promote early full functional recovery and avoid chronic pain, functional disability, and symphyseal sclerosis. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to explore the effect of displaced dorsal rim fragments under defined size threshold on the clinical outcome. Materials and methods: Forty patients with an acute distal radius fracture accompanied by a dorsal rim fragment comprising less than 10% of the radiocarpal articular surface were included in the study. The size of the dorsal rim fragment was measured by axial CT scans and three-dimensional (3D) CT scans, and the correlation between these two methods was analyzed to evaluate the reliability of axial CT scan measurements. Based on the displacement (> 2 mm) of dorsal rim fragments measured by sagittal CT scans, the patients were divided into two groups, namely the displaced group (17 patients) and the control group (23 patients). The radiographic parameters and wrist function at final follow-up were compared between the two groups. Results: Mean radiocarpal joint involvement of the included dorsal rim fragment was 8.6%±1.0% (range, 5.7–9.9%) assessed by axial CT scans. There was a strong correlation in the radiocarpal articular involvement of the dorsal rim fragment between axial CT scans and 3D CT models (correlation coefficient r = 0.819). Mean displacement of the dorsal rim fragment was 2.2 (2.1, 2.5) mm (range, 2.0–3.2) in the displaced group and 0.9 (0, 1.5) mm (range, 0–1.9) in the control group. There were no significant differences in any radiographic parameter and wrist function between the two groups. Conclusions: For dorsal rim fragments comprising less than 10% of the radiocarpal articular surface in distal radius fracture, mild displacement does not significantly affect the recovery of wrist function. [ABSTRACT FROM AUTHOR]

It remains inconclusive about the stability and optimal fixation scheme of screw internal fixation for lateral malleolus oblique fractures in clinical practice. In this study, the effects of different screw internal fixation methods on the biomechanics of lateral malleolus oblique fractures were investigated. These efforts are expected to lay a theoretical foundation for the selection of internal fixation methods and rehabilitation training regimens in the treatment of lateral malleolus fractures. A healthy ankle joint model and a lateral malleolus fracture internal fixation model were established based on CT data with the aid of some software. Besides, the effects of screw internal fixation modalities on the fracture displacement of fibula fractures, fibula Von Mises stress, and screw Von Mises stress under different physiological conditions and loading conditions were investigated using finite element methods (FEMs) and in vitro physical experiments. The double screw vertical fibular axis internal fixation approach had the lowest fracture displacement of fibula fractures and screw Von Mises stress values; while the double screw vertical fracture line internal fixation approach had the lowest fibula Von Mises stress values. Under different physiological conditions, the magnitude of the peak Von Mises stress of the fibula and screw was ranked as plantarflexion 20° > plantarflexion 10° > neutral position > dorsiflexion 10° > dorsiflexion 20°; and the magnitude of the peak displacement of the fibula fracture breaks was ranked as plantarflexion 20° > plantarflexion 10° > neutral position > dorsiflexion 20° > dorsiflexion 10°. The results of in vitro physical experiments and finite element analyses were in good agreement, which validated the validity of finite element analyses. The vertical fracture line screw implantation method displays a better load-sharing ability; while the vertical fibular axis screw implantation method exhibits a better ability to prevent axial shortening of the fibula and also reduces the risk of screw fatigue damage. Overall, the double screw achieves better therapeutic effects than the single screw. Given that the ankle joint has high stability in the dorsiflexion position, it is recommended to prioritize dorsiflexion rehabilitation training, rather than dorsiflexion and plantarflexion rehabilitation training with too large angles, in the treatment of lateral malleolus fractures., (© 2024 John Wiley & Sons Ltd.)