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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]

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]

Introduction: The modified pedicle screw fixation (PSF) was designed to simulate an integrated framework structure to ameliorate the resistance to vertical and shearing forces of the disrupted sacroiliac complex, and the aim of this study was to compare the biomechanical characteristics of PSF and traditional lumbopelvic fixation (LPF) for the treatment of sacroiliac joint disruption. Methods: The digital computer simulation model of an intact spine-pelvis-femur complex with main ligaments was built from clinical images. A left sacroiliac joint disruption model was mimicked by removing the concerned ligaments. After model validation, the two fixation models (modified PSF and traditional LPF) were established, and assembled with the disruption model. Under five loading scenarios (compression, flexion, extension, right bending, and left twisting), the finite element simulation was implemented. The maximum von Mises stress (VMS) of internal fixations and pelvises, maximum deformations on the Z-, Y-, X-axes and overall deformation of the sacrum were evaluated and compared. Results: Under all loading conditions, the maximum VMS of internal fixations and pelvises in the modified PSF model were lower than those in the traditional LPF model. Under flexion, right bending, and left twisting, the maximum Z-axis deformation of the sacrum for the modified PSF model was smaller than that of the traditional LPF model. For compression, the maximum Y-axis deformation of the sacrum was smaller than that of the traditional LPF model. During various loading modes, the maximum X-axis, and overall deformations of the sacrum for the modified PSF model were smaller than those in the traditional LPF model. Conclusions: Compared with the traditional LPF, the modified PSF shows superior biomechanical stability, with satisfied resistance to vertical and shearing forces, which might be potentially suitable for treating sacroiliac joint disruption. [ABSTRACT FROM AUTHOR]

Background: There is currently no consensus on the surgical treatment of lumbar spondylolysis in young adults, and the nonunion rate remains relatively high even after surgery. Therefore, in this study, we proposed a modified intravertebral screw-rod fixation technique within a single vertebral segment and investigated the clinical efficacy of this modified fixation system combined with autologous cancellous bone grafting in the treatment of lumbar spondylolysis in young adults. Methods: This study included 28 young adults with lumbar spondylolysis who were treated at our center between 2021 and 2023. All patients underwent modified intravertebral screw-rod fixation within a single vertebral segment combined with autologous cancellous bone grafting. We performed postoperative follow-ups regularly to assess the patient's pain status using the visual analog scale (VAS), Oswestry Disability Index (ODI), and radiological findings. Results: All 28 patients successfully underwent the surgery with an average operation time and blood loss volume of 96.01 ± 21.3 min and 186.78 ± 63.43 mL, respectively. Postoperatively, patients experienced significant symptom relief, with notable decreases in VAS scores and ODI indices at 1, 3, 6, and 12 months compared with preoperative conditions. These differences were statistically significant (P < 0.05). Radiological findings revealed a healing rate of 92.86% for the 56 fractured pars interarticularis among the 28 patients. No implant-related complications, such as fracture, loosening, or pseudarthrosis, were observed. Conclusions: The modified intravertebral screw-rod fixation system within a single vertebral segment combined with autologous cancellous bone grafting is a safe and effective treatment for lumbar spondylolysis in young adults. It significantly improves pain and functional disability as it promotes bone healing. [ABSTRACT FROM AUTHOR]

Background: This study is aimed to compare the differences in clinical outcomes between the crossed rod configuration and the parallel rod configuration applied in posterior occipitocervical and atlantoaxial fixations, and to assess the clinical applicability of crossed rods. Methods: From January 2015 to December 2021, 21 patients with craniocervical junction disorders were treated surgically with the crossed rod technique (CR group). Meanwhile, 27 corresponding patients treated with the conventional parallel rod technique were included as control (PR group). Clinical data, internal fixation type, neurological status, clinical symptoms relief, image parameter, complications and bone fusion conditions were retrospectively analyzed and evaluated. Results: No statistically significant differences were found in baseline characteristics, fixation type and postoperative complications between the two groups. Although the postoperative ADI was significantly reduced in both groups, the ADI was significantly greater in the CR group than that in the PR group after surgery and at the final follow-up (P < 0.05). All patients achieved bone fusion at 1-year postoperative follow-up except for one case in the PR group. However, patients in the CR group had a significantly higher fusion rate than those in the PR group at 3 months postoperatively (P < 0.05). Conclusions: The application of a crossed rod configuration in posterior occipitocervical and atlantoaxial fixations provides good clinical applicability. Although this technique has a relatively weaker reduction force, it has greater fixation stability and a higher rate of early bone fusion. This technique could be an easy and viable alternative to the current parallel rod configuration for upper cervical surgery. [ABSTRACT FROM AUTHOR]

Objective: This study evaluates the effectiveness and timeliness of posterior decompression and internal fixation in the emergency management of thoracolumbar fractures complicated by spinal cord injuries. Methods: We retrospectively analyzed 40 patients treated at our hospital from January 2019 to February 2022. Each patient underwent posterior decompression and internal fixation, with preoperative and postoperative assessments including vertebral body height, American Spinal Injury Association (ASIA) score, Visual Analog Scale (VAS) score, and urodynamic indices. Results: Postoperative improvements were noted in vertebral body height, with anterior and posterior heights increasing to 12.82 (± 1.23) mm and 3.21 (± 0.64) mm, respectively, and kyphosis angle improving to 14.26 (± 0.32). Significant enhancements were also observed in motor (from 40.78 [± 4.32] to 59.86 [± 1.37]) and sensory (from 45.98 [± 3.20] to 66.92 [± 1.28]) function scores, and a reduction in VAS score from 6.89 (± 0.78) to 1.78 (± 0.32). Urodynamic measurements showed increased maximum urine flow and detrusor pressure postintervention. All surgical wounds healed within two weeks without significant complications. Conclusion: Posterior decompression and internal fixation significantly improve spinal stability, pain, motor, and sensory functions in patients with thoracolumbar fractures and spinal cord injuries, demonstrating its effectiveness and clinical utility. [ABSTRACT FROM AUTHOR]

Objective: Femoral neck fractures (FNFs) are a common orthopedic type, and there are many treatment methods for it, and cannulated screw internal fixation is currently one of the main treatment methods. The choice of fully threaded cannulated screw (FCS) or partially threaded cannulated screw (PCS) remains controversial. Therefore, we performed this meta-analysis to evaluate the outcomes of FCS and PCS in the treatment of FNF. Methods: Articles published before 29 April, 2024 were selected from PubMed, Embase, the Cochrane Library, and CNKI, using the PRISMA guidelines. Two independent reviewers searched and assessed the literature. The PICOS criteria were used to ensure that the included studies met the inclusion criteria. We used RevMan 5.3. Software to perform analysis. Results: Compared with the PCS group, the FCS group had a lower femoral head necrosis rate (OR 0.60, 95% CI 0.37–0.98, P = 0.04), lower internal fixation failure rate (OR 0.37, 95% CI 0.22–0.62, P = 0.0002) and lower femoral neck shortening rate (OR 0.27, 95% CI 0.19–0.40, P < 0.00001). There was no statistically significant difference between the two groups in terms of the Harris hip score or nonunion rate. Conclusions: The results of this meta-analysis revealed that compared with PCS, FCS had a lower incidence of postoperative complications and better postoperative outcomes in the treatment of FNF. Therefore, we believe that FCS may be a more effective treatment for FNF. [ABSTRACT FROM AUTHOR]

ABSTRACT 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. [ABSTRACT FROM AUTHOR]

Background: Mandibular condylar fractures are among the most common fractures of the facial skeleton, and their surgical management remains a topic of considerable debate in maxillofacial trauma surgery. Numerous studies in the literature internationally have explored optimal treatment approaches, with a growing preference for open reduction and internal fixation (ORIF). While conservative treatment has traditionally been the standard for intra-articular fractures, recent research suggests that ORIF may also be appropriate for selected cases of these fractures. Methods: This study presents a 14-year review (2009–2023) of the authors' experience in the surgical management of intra-articular condylar fractures. Data were collected on surgical techniques, early and late complications, clinical and radiological outcomes, and comparisons with conservative treatment. Results: The analysis included evaluations of both short-term and long-term outcomes following ORIF, identifying specific scenarios where ORIF demonstrated advantages over conservative management. Clinical and radiographic assessments provided valuable insights into patient recovery and functional outcomes, while complication rates were documented for both treatment methods. Conclusions: Findings indicate that ORIF can be a beneficial treatment option for intra-articular condylar fractures in select patient groups, offering improved outcomes in cases where conservative treatment may be insufficient. However, conservative management remains a valid approach when surgical risks exceed potential benefits. This study adds to the ongoing discussion, supporting a tailored approach that considers individual patient factors when choosing between ORIF and conservative treatment. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare the effect of varying screw lengths on load to failure and retention of the dorsal ulnar corner fragment after fixation of comminuted intra-articular distal radius fractures in a cadaveric model. Twenty-four fresh frozen cadaveric forearms were subjected to a standardized distal radius osteotomy to mimic an intra-articular fracture pattern. Dual X-ray absorptiometry scans were performed to ensure minimal variability in bone density. All fractures were fixed with a volar locking plate and distal locking screws. Three different lengths of distal locking screws were used in each group of eight specimens to simulate the clinical decision of different distal screw lengths. The screw lengths tested were bicortical, 100% of the width of the bone but unicortical, and 75% of the width of the bone and unicortical. All specimens were preconditioned with cyclic axial loading and then axially loaded using matching acrylic resin molds to clinical failure and fragment displacement as detected by a motion analysis system. Retention or loss of the dorsal ulnar corner fragment during loading was recorded as a binary variable. Between the three groups, there were no statistically significant differences in precycling stiffness, postcycling stiffness, load at 2 mm displacement of the dorsal ulnar corner, or force at failure. The group with 75% length screws had a significantly higher loss of reduction of the dorsal ulnar corner (86%) compared with the other groups (0%). Varying screw lengths did not affect the stiffness or overall loads to failure of axially loaded specimens. However, the 75% length screws did not reliably secure the dorsal ulnar corner fragments. Although this did not significantly affect the overall load to failure of the construct, displacement of this fragment may have implications for rotation of the forearm through the distal radioulnar joint. Surgeons should consider the utilization of full-length unicortical locking screws to ensure adequate fixation of the dorsal ulnar corner. [ABSTRACT FROM AUTHOR]

In clinical practice, internal fixation (IF) is a commonly utilized technique for metastatic bone disease (MBD) to the distal femur. Additionally, distal femoral reconstruction (DFR) has shown to be an effective surgical technique for primary tumors and MBD in the distal femur. The existing body of research comparing these methods has not focused on MBD or pathological fractures and thus does not guide surgical approach in the case of distal femoral MBD. A multi-institutional retrospective review of musculoskeletal oncology patients treated surgically with IF (n = 29) or DFR (n = 34) for distal femoral MBD between 2005 and 2023. Overall survival, revision risk, and functional status were assessed. 5-year patient overall survival was 47.9 % (CI, 29.5–77.6 %) and 46.6 % (CI, 31.5–68.8 %), for DFR and IF, respectively (p = 0.91). After competing risk analysis, the 5-year risk of implant revision for DFR was 18 % (95 % CI: 5.1–37 %) and 11 % for IF (95 % CI: 2.4–28 %) (p = 0.3). DFR had longer operative times (p = 0.002), higher blood loss (p < 0.001), and greater postoperative (p = 0.006) complications than IF. In addition, patients undergoing DFR had more distal lesions than patients who received IF (p = 0.003). Despite similar overall survival and revision rates, IF may be preferable for patients due to its shorter operative time and lower rates of complication than DFR. However, specific anatomic location in the distal femur must be considered prior to deciding which procedure is optimal. [ABSTRACT FROM AUTHOR]

BACKGROUND: Satisfactory clinical results have been achieved in the treatment of Sanders III calcaneal fractures by percutaneous compression fixation with three-dimensional frame screws. However, whether the stability of minimally invasive plate internal fixation can be achieved in terms of biomechanics, and the advantages and disadvantages after comparison are still unknown. OBJECTIVE: To investigate the fixation effect of different internal fixation devices on Sanders III calcaneal fractures by finite element analysis. METHODS: A finite element model of Sanders III calcaneal fracture was made based on CT data of a 26-year-old healthy male volunteer. The calcaneal fracture models were fixed by minimally invasive three-dimensional frame screws and minimally invasive Y-plate. The longitudinal loads of 350 and 700 N were applied respectively. The displacement and stress distribution of the two models were analyzed, and the stability of each model was compared. RESULTS AND CONCLUSION: (1) The peak stress of bone block and implant in the minimally invasive three-dimensional frame screw model was significantly lower than that in the minimally invasive minimally invasive plate model. The average stress of bone block and implant in the three-dimensional frame screw model was also significantly lower than that in the minimally invasive plate model. (2) The maximum displacement of the two models was located at the medial side of the articular surface of the posterior talus, and the maximum displacement of the three-dimensional frame screw model was smaller than that of the minimally invasive plate model. (3) The longitudinal displacement between the anterior fragment and the medial fragment of the minimally invasive plate model was smaller, and the transverse and vertical displacement between the medial fragment and the middle fragment of the three-dimensional group screw model was smaller. (4) It is concluded that both of the two internal fixation models can provide satisfactory fixation effect. The three-dimensional frame screw model can provide better transverse and vertical stability with more uniform stress distribution and smaller comprehensive displacement of bone fragments, while the minimally invasive plate has more advantages in maintaining longitudinal stability. [ABSTRACT FROM AUTHOR]

BACKGROUND: Rib fractures are one of the most common blunt injuries, accounting for approximately 10% of all trauma patients and 60% of thoracic injuries. Multiple rib fractures, especially flail chest, can cause local chest wall softening due to the loss of rib support, leading to paradoxical breathing, severe pain, and a high likelihood of accompanying lung contusions. OBJECTIVE: This study investigates the mechanical properties of a new polymer material rib internal fixator to provide theoretical data for its clinical use. METHODS: We conducted in vitro mechanical tests on 20 fresh caudal fin sheep ribs, using different fracture models across four randomly assigned groups (five ribs per group). The fixators were assessed using non-destructive three-point bending, torsion, and unilateral compression tests, with results averaged. Additionally, finite element analysis compared stress and strain in the polymer fixators and titanium alloy rib plates during bending and torsion tests. RESULTS: In vitro tests showed that the polymer fixators handled loads effectively up to a maximum without increase beyond a certain displacement. Bending and torsion tests via finite element analysis showed the polymer material sustained lower maximum equivalent stresses (84.455 MPa and 14.426 MPa) compared to titanium alloy plates (219.88 MPa and 46.47 MPa). CONCLUSION: The polymer rib fixator demonstrated sufficient strength for rib fracture fixation and was superior in stress management compared to titanium alloy plates in both bending and torsion tests, supporting its potential clinical application. [ABSTRACT FROM AUTHOR]

BACKGROUND: Femoral neck fractures, which are fractures occurring from the femoral head to the base of the femoral neck, are prevalent in the elderly population. With the progression of societal aging, the incidence of femoral neck fractures has been steadily increasing, making it a significant global issue that urgently needs to be addressed. OBJECTIVE: To compare the efficacy and safety of dynamic hip screw (DHS) with anti-rotation screw and femoral neck system (FNS) internal fixation for the treatment of Garden II–IV type femoral neck fractures. METHODS: A total of 90 patients with Garden II–IV type femoral neck fractures were randomly assigned to either the control group (n = 45) treated with DHS and anti-rotation screw or the experimental group (n = 45) treated with FNS. Surgical outcomes, including incision size, blood loss, operation time, fluoroscopy frequency, and fracture healing time, were compared. Postoperative complication rates, reoperation rates, Harris scores, and visual analogue scale (VAS) scores were also assessed. RESULTS: The experimental group demonstrated significantly reduced incision length, blood loss, operation time, and fluoroscopy frequency compared to the control group (P < 0.01). No significant differences were observed in fracture healing time, Garden classification, or fracture reduction outcomes between the two groups (P > 0.05). At 6 months post-treatment, both groups showed significant improvements in Harris scores and VAS scores compared to pre-treatment (P < 0.05), with no significant differences between the groups (P > 0.05). The rates of internal fixation failure, nonunion, and avascular necrosis of the femoral head, as well as overall incidence of postoperative complications and reoperation rates, showed no significant differences between the two groups (P > 0.05). CONCLUSIONS: Both DHS with anti-rotation screw and FNS internal fixation demonstrated comparable efficacy and safety profiles in the treatment of Garden II–IV type femoral neck fractures. The experimental group showed advantages in terms of reduced incision length, blood loss, operation time, and fluoroscopy frequency, while maintaining similar clinical outcomes and complication rates. [ABSTRACT FROM AUTHOR]

Background: To compare the biomechanical performance of three internal fixation constructs for AO/OTA 33-A3 distal femoral fractures. Methods: Thirty AO/OTA 33-A3 synthetic distal femoral fracture models were constructed and randomly divided into three groups. Group A (dual-plate construct) was fixed with a medial locking plate combined with a less invasive stabilization system (LISS). Group B was fixed with a retrograde femoral nail (RFN) combined with an LISS (RFN + LISS construct), and Group C was fixed with a retrograde tibial nail (RTN) combined with an LISS (RTN + LISS construct). The axial displacement, axial stiffness, torsional displacement, torsional stiffness and maximum failure load of different internal fixation constructs were recorded and statistically analyzed. Results: In the axial compression test, the average stiffness of Group C was significantly higher than that of Groups A and B, and the average displacement of Group C was significantly smaller than that of Groups A and B. In the torsion test, the torsion degree of Group C was significantly lower than that of Groups A and B, and Group C had a higher torsional stiffness than Groups A and B. In the axial compression failure test, the average ultimate load (a displacement greater than 5 mm) of Group C was significantly higher than that of Groups A and B. Conclusion: The biomechanical strength of the RTN combined with a plate is higher than that of the RFN combined with plate and dual-plate constructs, which can be used as an internal fixation option for the treatment of comminuted distal femoral fractures. [ABSTRACT FROM AUTHOR]

To analyze and compare the clinical efficacy of absorbable screws versus metal screws for internal fixation in treating acute tibiofibular syndesmosis injury. We conducted a retrospective analysis on the clinical data of 86 patients with acute distal tibiofibular syndesmosis injuries who underwent surgical treatment at our hospital from September 2022 to October 2023. According to the treatment methods, the patients were divided into an experimental group (absorbable screws, 43 cases) and a control group (metal screws, 43 cases). We observed and compared perioperative indicators, Berg Balance Scale (BBS) ankle joint scores, X-ray examination results, and incidence of adverse reactions between the two groups. We observed and compared perioperative indicators, BBS ankle joint scores, X-ray examination results, and the incidence of adverse reactions between the two groups. Before surgery, there was no significant difference in the tibiofibular gap and overlap width between the two groups (p > 0.05). After surgery, the study group had less intraoperative blood loss, lower postoperative pain scores, smaller tibiofibular gap, and lower incidence of adverse reactions. Moreover, the study group had earlier postoperative weight-bearing recovery and resumption of daily activities. Additionally, the study group showed significantly higher overlap width of the tibiofibular bones, joint stability, activity scores, walking, running, workability and imaging results scores (p < 0.05). Absorbable screws for internal fixation demonstrate superior clinical efficacy in treating acute tibiofibular syndesmosis injury. [ABSTRACT FROM AUTHOR]

This study was designed to investigate the application value of shape memory alloy embracing fixator in the treatment of proximal clavicle fracture. From April 2018 to October 2020, the fracture data of patients with proximal clavicle fractures treated with shape memory alloy embracing fixator were retrospectively analyzed, including 12 males and 8 females. The age of patients ranged from 34 to 66 years (mean, 43.4 years). According to Craig's classification, the patients were divided into the following groups: type CII (eight cases), type CIII (five cases), type CⅤ (seven cases), all of which were closed fractures without nerve or vascular injury. The fracture healing time and postoperative complications were observed, and the shoulder joint function was evaluated by Constant score. All patients were followed up for 13–19 months (average 15.6 months). The clavicle radiographs showed that all the 20 patients had bone union, and the fracture union time was 6–10 months (average 7.2 months). There were no complications such as internal fixation fracture and displacement. According to the Constant criterion, 13 cases were excellent and 5 cases were fair and 1 case was good. The treatment of proximal clavicle fracture with shape memory alloy embracing fixator is an effective treatment method with simple operation with satisfactory fixation effect and low complication rate, which is worthy of being widely used in clinical practice. [ABSTRACT FROM AUTHOR]

Background: The clinical efficacy of cancellous screws (CS) and femoral neck system (FNS) internal fixation in the treatment of femoral neck fracture (FNF) was compared in this research. Methods: Ninety-six patients with FNF were enrolled in this study. There were 47 cases in FNS group and 49 cases in CS group. The data of operation time, intraoperative bleeding, bed days and complication were recorded. Patients' joint function was evaluated by Harris score. At the last follow-up, the cost-effectiveness analysis of the two methods was analyzed according to the total cost of patients and hip function. Results: The intraoperative blood loss of the patients in FNS group was significantly higher than that in the CS group, but the length of hospitalization was significantly lower. There was no significant difference in the incidence of complications between FNS and CS. The joint function of FNS group was significantly better than that of CS group at 3 months after operation. There was no significant difference in Harris score between the two groups at the last follow-up. The overall medical cost of FNS group in 1 year is high. Cost-effectiveness analysis showed that compared with CS group, FNS group needs to pay 5761.1 yuan more for each additional Harris score. Conclusion: FNS and CS internal fixation can achieve satisfactory clinical results in the treatment of FNF. FNS treatment is helpful to the early functional recovery of patients, but the overall medical cost is high. [ABSTRACT FROM AUTHOR]

Aims: Lower limb fractures are common in low- and middle-income countries (LMICs) and represent a significant burden to the existing orthopaedic surgical infrastructure. In high income country (HIC) settings, internal fixation is the standard of care due to its superior outcomes. In LMICs, external fixation is often the surgical treatment of choice due to limited supplies, cost considerations, and its perceived lower complication rate. The aim of this systematic review protocol is identifying differences in rates of infection, nonunion, and malunion of extra-articular femoral and tibial shaft fractures in LMICs treated with either internal or external fixation. Methods: This systematic review protocol describes a broad search of multiple databases to identify eligible papers. Studies must be published after 2000, include at least five patients, patients must be aged > 16 years or treated as skeletally mature, and the paper must describe a fracture of interest and at least one of our primary outcomes of interest. We did not place restrictions on language or journal. All abstracts and full texts will be screened and extracted by two independent reviewers. Risk of bias and quality of evidence will be analyzed using standardized appraisal tools. A random-effects meta-analysis followed by a subgroup analysis will be performed, given the anticipated heterogeneity among studies, if sufficient data are available. Conclusion: The lack of easily accessible LMIC outcome data, combined with international clinical guidelines that are often developed by HIC surgeons for use in HIC environments, makes the clinical decision-making process infinitely more difficult for surgeons in LMICs. This protocol will guide research on surgical management, outcomes, and complications of lower limb shaft fractures in LMICs, and can help guide policy development for better surgical intervention delivery and improve global surgical care. Cite this article: Bone Jt Open 2024;5(11):1020–1026.

BACKGROUND: Pelvic fractures encompass a range of types, and the utilization of a pelvic reduction frame for restoration often lacks a systematic repositioning method. Instead, it relies on the operator's experience in conjunction with fluoroscopic findings, which can lead to uncertainty and non-reproducibility. OBJECTIVE: To investigate the clinical efficacy of combining computer-simulated repositioning techniques with a pelvic reduction frame for the treatment of anteroposterior compression-III pelvic fractures. METHODS: A retrospective analysis was conducted on 19 patients with anteroposterior compression-III pelvic fractures who underwent preoperative repositioning via computer simulation and intraoperative repositioning with the assistance of a pelvic reduction frame between January 2018 and December 2021. Among them, 7 cases were fixed with double plate in anterior ring and 12 cases were fixed with single plate combined with anterior subcutaneous internal fixation (INFIX). All patients received posterior ring fixation with two sacroiliac screws. Operative duration, intraoperative reduction time, the frequency of intraoperative fluoroscopy use, blood loss, and follow-up duration were documented. These data were utilized to monitor fracture healing time and postoperative complications. Fracture reduction quality was evaluated according to the Matta scale, and the Majeed Pelvic Function Score was employed to assess patient function during the final follow-up. RESULTS AND CONCLUSION: (1) Surgery was successfully completed in all 19 patients. The anterior ring was secured with double plates in 7 cases, while a single plate combined with INFIX was utilized in 12 cases. The posterior ring was stabilized with two sacroiliac screws, specifically targeting the S1 and S2 cones. (2) The operation duration ranged from 74 to 147 minutes, with a mean of (101.63±19.55) minutes. Intraoperative repositioning took place over a period of 26 to 41 minutes, with a mean of (38.11±3.31) minutes. The number of intraoperative fluoroscopies conducted ranged from 35 to 81, with a mean of (62.68±13.11) times. Intraoperative bleeding volumes varied from 60 to 130 mL, with a mean of (85.37±20.57) mL. (3) All the patients were diligently monitored for a duration of 12 to 26 months. Fracture healing was observed within a time frame of 12 to 20 weeks, with a mean of (16.37±2.50) weeks. (4) The evaluation according to Matta's criteria one day post-surgery revealed excellent outcomes in 14 cases and good outcomes in 5 cases. At the final follow-up, the Majeed function score indicated excellent results in 16 cases and good results in 3 cases. (5) Two patients experienced localized fat liquefaction phenomena, characterized by redness, swelling, and oozing at the incision site, which gradually resolved with proactive dressing changes. None of the patients encountered complications such as internal fixation loosening, loss of fracture reduction, or nerve injuries post-surgery. It is concluded that the combined approach of using computer-simulated repositioning techniques in conjunction with pelvic reduction frames for the treatment of anteroposterior compression-III pelvic fractures has advantages in enhancing repositioning efficiency and improving pelvic function. [ABSTRACT FROM AUTHOR]

BACKGROUND: For thoracolumbar spine fractures with developmental stenosis of the vertebral arch, accurate nail placement is difficult using traditional fluoroscopy-assisted techniques. O-arm navigation assistance systems offer higher precision in general vertebral arch nail placement, but there is scarce literature on the application of O-arm navigation-assisted nail placement in thoracolumbar spine fractures with developmental stenosis of the vertebral arch both domestically and abroad. OBJECTIVE: To explore the accuracy of percutaneous vertebral arch nail placement assisted by O-arm navigation in patients with thoracolumbar spine fractures complicated by developmental stenosis of the vertebral arch. METHODS: A retrospective analysis was conducted on 53 patients who underwent percutaneous vertebral arch screw fixation surgery at Department of Orthopedics, General Hospital of Central Theater Command of PLA for thoracolumbar spine fractures complicated by developmental stenosis of the vertebral arch from January 2021 to March 2023. Totally 208 cases of vertebral arch developmental stenosis were found (cases with multiple vertebral arch developmental stenosis were counted separately). Based on the surgical approach, the patients were divided into two groups: O-arm navigation group (n=98) and C-arm fluoroscopy group (n=110). Postoperative imaging data were compared between the two groups, including anatomical perforation score, functional perforation score, actual vs. expected nail trajectory in the horizontal plane, and sagittal plane angle differences. RESULTS AND CONCLUSION: (1) There was no significant difference in the narrowest width of the pedicle isthmus (pow) between the two groups of patients (P > 0.05). The proportions of different degrees of narrowing (mild: 6 mm≤pow<7 mm, moderate: 5 mm≤pow<6 mm, severe: pow<5 mm) were also not significantly different between the two groups (P > 0.05). (2) The overall grade and scores of anatomical perforation and functional perforation were lower in the O-arm group compared to the C-arm group, and these differences were statistically significant (P < 0.001). In terms of the angular deviation between the actual and planned screw trajectories, the O-arm group had smaller deviations, and these differences were statistically significant (P < 0.05). (3) In the mild and moderate narrowing groups, the O-arm group showed significant advantages in anatomical perforation, functional perforation, and angular deviation between actual and planned screw trajectories, and these differences were statistically significant (P < 0.001). (4) The O-arm group demonstrated better performance in anatomical perforation and functional perforation, especially in the T12-L2 segment, with more significant advantages. Additionally, the O-arm group had better angular deviations in actual and planned screw trajectories in all segments compared to the C-arm group. (5) Therefore, the use of O-arm navigation-assisted percutaneous screw placement for the treatment of thoracolumbar fractures with developmental pedicle isthmal narrowing provides higher accuracy and safer surgery. [ABSTRACT FROM AUTHOR]

BACKGROUND: Types II, IIA, and III of Hangman fractures often require surgical treatment, and the selection of surgical methods is controversial. Current surgeries have shortcomings such as incomplete reduction and malunion after surgery. In the early stage, our team used C2-3 lag screws combined with a bucking bar. Intermittent pushing of the C2 vertebral body in the oropharynx has achieved satisfactory clinical results. However, the preliminary studies included few samples and lacked a control group for comparison. OBJECTIVE: To compare the clinical efficacy of posterior C2-3 fixation combined with the bucking bar technique and posterior C2-3 fixation alone in the treatment of unstable Hangman fractures. METHODS: The clinical and imaging data of 55 patients with unstable Hangman fractures who underwent posterior C2-3 internal fixation in Affiliated Hospital of Southwest Medical University were retrospectively analyzed. According to the surgical plan, the patients were divided into two groups. Among them, 23 patients received posterior cervical C2-3 internal fixation combined with the bucking bar technique (group A), and 32 patients received simple posterior C2-3 internal fixation (group B). Operation time, intraoperative blood loss, complications, pain visual analog scale score, neck disability index, American Spinal Injury Association classification, and patient satisfaction (Odom's classification) preoperation and during follow-up were compared between the two groups. The changes in C2-3 displacement and angulation and other imaging indicators were compared at each observation time point. RESULTS AND CONCLUSION: (1) There was no statistically significant difference in operation time, intraoperative blood loss, and postoperative complications between the two groups (P > 0.05). (2) The neck pain visual analog scale and neck disability index scores of the two groups of patients at the final follow-up were significantly improved compared with those before surgery (P < 0.05). The Odom standard classification showed that 21 cases (91%) in group A were excellent and 29 cases (91%) were excellent and good in group B. There was no statistically significant difference in the clinical efficacy indicators between the two groups (all P > 0.05). (3) There was no significant difference in C2-3 angulation and displacement between the two groups before operation (P > 0.05). Postoperation and at the last follow-up, the angle and displacement of C2-3 in both groups were significantly smaller than before surgery, and the difference was statistically significant (P < 0.01). There was no statistically significant difference in the above indicators after surgery and at the last follow-up (P > 0.05). After surgery and at the last follow-up, the displacement and angle of C2-3 in group A were significantly smaller than those in group B (P < 0.05). (4) At the last followup, no patients in group A had residual deformity, and 4 cases (13%, 4/32) in group B had residual deformity. (5) Therefore, posterior C2-3 fixation combined with transoral bucking bar technology may be beneficial to the reduction and stabilization of the vertebral body, reduces malunion, and can achieve better reduction. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To compare the short-term efficacy of plate combined with Suture tape versus plate combined with headless compression screw in the treatment of Lisfranc injury with comminuted fractures of the 1st and 2nd proximal metatarsal bones. METHODS: A retrospective analysis was performed on 48 patients with Lisfranc injury due to comminuted fractures of the 1st and 2nd proximal metatarsal bones in Seventh Department of Orthopedics, Dongguan Hospital of Traditional Chinese Medicine from January 2019 to June 2022. Among them, 25 were fixed with plate combined with Suture tape (observation group) and 23 were fixed with plate combined with headless compression screw (control group). Preoperative classification was performed according to Myerson classification system based on preoperative imaging data. Postoperative follow-up was performed according to fracture healing time, visual analog scale, and American Orthopaedic Foot and Ankle Society (AOFAS) criteria to assess the recovery of foot functions. Postoperative complications were compared and analyzed between the two groups. RESULTS AND CONCLUSION: (1) All cases completed the operation successfully and obtained follow-up in the two groups. The postoperative follow-up time of the two groups was 12-36 months, with a mean of (18.0±5.42) months. (2) There were no significant differences in operation time and intraoperative blood loss between the two groups (P > 0.05). (3) The fracture healing time of observation group was slightly longer than that of control group (P < 0.05). (4) After 3, 6, and 12 months of follow-up, the visual analog scale score of the observation group was significantly lower than that of the control group (P < 0.05). (5) At 6 and 12 months after operation, AOFAS score of foot function in the observation group was significantly improved compared with the screw group at various time points after operation (P < 0.05), and was significantly higher than that before operation (P < 0.05). (6) The postoperative complications were 1 case of traumatic arthritis in the observation group and 1 case of incision infection, 1 case of screw fracture, and 2 cases of traumatic arthritis in the control group. There was no significant difference between the two groups (P > 0.05), considering the correlation with a small sample size. (7) It is indicated that as for the surgical method of Lisfranc injury with comminuted fractures of the 1st and 2nd proximal metatarsal bones, the application of plate combined with Suture tape internal fixation has a reliable effect in the treatment of Lisfranc joint injury, which can improve the function of the foot joint of patients, and has the advantages of less surgical trauma, fewer postoperative complications, and lower risk of long-term iatrogenic traumatic arthritis. Compared with headless compression screw, it is more beneficial to the recovery of foot function. [ABSTRACT FROM AUTHOR]

BACKGROUND: The optimal surgical technique for treating posterior cruciate ligament tibial attachment point avulsion injuries is debatable. With the application and maturity of arthroscopic surgery, it has great prospects in the diagnosis and treatment of posterior cruciate ligament tibial attachment point avulsion fractures. OBJECTIVE: To summarize the application and progress of arthroscopic technology in the treatment of posterior cruciate ligament tibial attachment point avulsion fractures, including different arthroscopic treatment methods, surgical approach, tibial tunnel design, suture material selection, and internal fixation implant selection. METHODS: Relevant literature was retrieved from PubMed, Web of Science, and ScienceDirect databases through computers. The search period was from January 2003 to November 2023. Chinese search terms were "posterior cruciate ligament, posterior cruciate ligament, avulsion fracture, arthroscopy". English search terms were "posterior cruciate ligament, injury, fracture, tibia, arthroscopic, operation, fixation, treatment". Totally 97 articles were included for review. RESULTS AND CONCLUSION: Arthroscopic technology provides a reliable treatment for posterior cruciate ligament tibial attachment point avulsion fractures. Arthroscopic treatment for avulsion fractures of the tibial attachment point of the cruciate ligament can be divided into several categories based on the type of approach, suture material, and the number of approaches used for suture and fixation of the tibial tunnel: arthroscopic suture fixation combined with autologous graft enhancement and reconstruction, arthroscopic multi cross band suture bridge fixation, arthroscopic strong thread fixation, and arthroscopic direct anterior posterior suture suspension fixation. In various studies, commonly used outcome measures include knee range of motion, Lysholm scale, International Knee Documentation Committee, and KT-2000 arthrometer. Studies have shown that at the last follow-up, the score results showed significant improvement compared to surgery. In the radiological follow-up results of various arthroscopic techniques, all studies have shown satisfactory results. During the follow-up process, all types of patients who received arthroscopic treatment for cruciate ligament tibial attachment point avulsion fractures did not experience serious complications, such as traumatic arthritis, neurovascular injury, perioperative wound infection, thrombosis, and nonunion of fractures. [ABSTRACT FROM AUTHOR]

Background: Skin preparation in the operating room is important to prevent infection after open fracture surgery. The present study was conducted with the aim of investigating the effect of the simultaneous use of betadine and vancomycin powder for the preparation of damaged skin in preventing wound infection in open fractures of the lower limb undergoing internal fixation surgery. Materials and Methods: The present study was a double-blind clinical trial on 40 men with open fractures of the lower limb who underwent open reduction surgery and internal fixation. Patients were randomly divided into control and intervention groups. In order to prepare the damaged skin before surgery, betadine 10% was used in the control group and betadine 10% plus 2 grams of vancomycin powder in the intervention group. Open wounds caused by the removal of bone from the skin and surgical incisions within 30 days (days 1, 2, 14 and 30) after surgery were scored in terms of infection using the ASEPSIS scoring method. The results were analyzed in SPSS 22 software (p0.05). Conclusion: The simultaneous use of betadine and vancomycin powder has no effect on wound infection after open reduction surgery and internal fixation in patients with open lower limb fractures.

Abstract Objective This study aims to analyze the differences in mechanical stability of OTA/AO 31A1.3 intertrochanteric fractures under various reduction conditions. Methods Twenty standard synbone artificial femur test bones were selected for the OTA/AO 31A1.3 intertrochanteric fracture model. The models were divided into five groups according to their reduction state: positive support, neutral support, negative support, varus fixation, and valgus fixation, with four specimens in each group. All models were fixed using PFNA intramedullary fixation and subjected to static axial compression tests. The subsidence displacement of the proximal femur under different loads and the axial stiffness of the model were measured to verify the mechanical stability of the OTA/AO 31A1.3 intertrochanteric fracture under different reduction conditions. Results After the static axial compression test, the proximal femoral subsidence displacement in the positive support and neutral support groups was lower than that in the negative support, valgus fixation, and varus fixation groups (p

Abstract Based on the characteristics of Kummell’s disease (KD) and related anatomical structures of the thoracolumbar spine, a novel bone cement screw system has been designed to effectively avoid the cement loosening and displacement. This experiment aimed to assess the biological effects of the novel bone cement screw system in KD on fresh cadaveric thoracolumbar spine specimens, thereby discussing its potential application value and providing a foundation for clinical implementation. This study employed a total of 50 fresh female adult cadaver specimens. Each specimen underwent extraction of the T12 to L2 segment followed by the creation of an artificial KD model at the L1 segment and subsequent establishment of five distinct types of bone cement repair models. Model A represents the percutaneous vertebroplasty (PVP) model, Model B combines PVP with unilateral percutaneous pediculoplasty (PPP), Model C combines PVP with bilateral PPP, Model D introduces the novel bone cement screw combined with unilateral PVP, and Model E combines the novel screw with bilateral PVP, each group consists of 10 specimens. Subsequently, the six-axis spine robot was employed to execute cement three-dimensional biomechanical strength tests in six directions, including anterior flexion and posterior extension, left and right lateral bending, as well as left and right rotation. The novel bone cement screw, whether used unilaterally or bilaterally in combination with the PVP model, exhibits significantly reduced bone cement mobility and superior biomechanical stability during anterior flexion, posterior extension, left lateral bending, and right lateral bending (P 0.05).When comparing the novel bone cement screw combined with PVP unilaterally and bilaterally, no statistically significant difference was observed in the stability of bone cement across all six directions of motion (P>0.05). To conclude, this novel bone cement bridging screw system exhibits superior biomechanical stability compared to commonly used treatments. Furthermore, both unilateral and bilateral implementations of the novel bone cement screw system yield without significant differences observed. These findings present a reliable and innovative approach for clinical management of KD.

Abstract Background Displaced femoral neck fractures frequently result in considerable patient morbidity, with complications such as postoperative femoral neck shortening occurring in up to 39.1% of cases. This shortening is associated with reduced hip function and mobility. The Femoral Neck System (FNS), which allows for controlled sliding to facilitate fracture reduction and healing, may mitigate these issues. However, the ideal sliding distance to balance fracture healing and minimize complications is not well defined. Methods We performed a retrospective cohort study of 179 patients who underwent FNS fixation for displaced femoral neck fractures at our institution from September 2019 to September 2023. Patients were categorized into three groups based on the intraoperative sliding distance allowed by the FNS: the Minimal Slide group (≤ 5 mm), the Moderate Slide group (> 5 to ≤ 10 mm), and the Extensive Slide group (> 10 to 20 mm). Primary outcomes included postoperative femoral neck shortening, the incidence of moderate to severe shortening, time to fracture union, and hip joint function as assessed by the Harris Hip Score (HHS) and the Parker Mobility Score. Secondary outcomes included complication rates such as implant cut-out, nonunion, avascular necrosis of the femoral head, and the need for secondary surgery. Results The Extensive Slide group of moderate to severe shortening at 32.31%, which was 1.59-fold and 8.88-fold that of the Moderate Slide (20.34%) and Minimal Slide group’s (3.64%), respectively (P

Abstract This study was aimed to compare the clinical and radiographic outcomes of patients with intercondylar fractures of the humerus treated with orthogonal and parallel plating methods via precontoured plates. This was a retrospective comparative study conducted on 50 adult patients with intercondylar humerus fractures that were surgically treated over an eleven-year period. The patients were divided into two groups: Group A underwent internal fixation via parallel plating, whereas Group B received orthogonal plating. Clinical outcomes were evaluated via the Mayo Elbow Performance Score (MEPS), and the radiographic assessments included time to consolidation, pseudoarthrosis, malunion and hardware removal. Both groups presented similar demographic and preoperative characteristics. The functional outcomes assessed by the MEPS were not significantly different between the groups. Radiographically, comparable healing times and rates of complications, including pseudoarthrosis, malunion and hardware removal, were observed. The study findings suggest that both orthogonal and parallel plating methods yield comparable clinical and radiographic outcomes in the treatment of intercondylar humerus fractures. These results underscore the effectiveness of both techniques and emphasize the importance of further research to elucidate the optimal plating method for specific fracture patterns.

Abstract Calcaneal body fractures are often associated with varying degrees of shortening deformities. Restoring calcaneal length is crucial for the functional prognosis of the foot. Through finite element analysis, this study compared the biomechanical effects of multiple fixation schemes for calcaneal fractures. We delineated and assembled the finite element model of the Sanders type II calcaneal fracture and four internal fixation simulations (namely distraction screw, lag screw, frame locking plate, and T-shaped locking plate). Different axial forces (350, 700, and 1400 N) were then applied to simulate various postures. We then compared the inner and outer shortening distances (D1 and D2, respectively), equivalent von Mises stress, and maximum von Mises stress of the calcaneus. In the individual model, with an increase in the pressure, D1, D2, and the maximum von Mises stress gradually increased. At 1400 N, D1 and D2 for the internal fixation schemes were as follows: distraction screw (0.03 mm, 0.1 mm)

Aims: Surgical approaches to cervical ossification of the posterior longitudinal ligament (OPLL) remain controversial. The purpose of the present study was to analyze and compare the long-term neurological recovery following anterior decompression with fusion (ADF) and posterior laminectomy and fusion with bone graft and internal fixation (PLF) based on > ten-year follow-up outcomes in a single centre. Methods: Included in this retrospective cohort study were 48 patients (12 females; mean age 55.79 years (SD 8.94)) who were diagnosed with cervical OPLL, received treatment in our centre, and were followed up for 10.22 to 15.25 years. Of them, 24 patients (six females; mean age 52.88 years (SD 8.79)) received ADF, and the other 24 patients (five females; mean age 56.25 years (SD 9.44)) received PLF. Clinical data including age, sex, and the OPLL canal-occupying ratio were analyzed and compared. The primary outcome was Japanese Orthopaedic Association (JOA) score, and the secondary outcome was visual analogue scale neck pain. Results: Compared with the baseline, neurological function improved significantly after surgery in all patients of both groups (p < 0.001). The JOA recovery rate in the ADF group was significantly higher than that in the PLF group (p < 0.001). There was no significant difference in postoperative cervical pain between the two groups (p = 0.387). The operating time was longer and intraoperative blood loss was greater in the PLF group than the ADF group. More complications were observed in the ADF group than in the PLF group, although the difference was not statistically significant. Conclusion: Long-term neurological function improved significantly after surgery in both groups, with the improvement more pronounced in the ADF group. There was no significant difference in postoperative neck pain between the two groups. The operating time was shorter and intraoperative blood loss was lower in the ADF group; however, the incidence of perioperative complications was higher. Cite this article: Bone Jt Open 2024;5(9):768–775.

Abstract Background Internal fixation for multiple rib fractures is well established. Patients with underlying chronic obstructive pulmonary disease (COPD) have a higher rate of perioperative complications. It is unclear if these patients are suitable candidates for internal fixation and if surgical interventions are harmful to these patients. Study Design and methods Adult patients with ≥ 3 rib fractures and underlying COPD from the Trauma Quality Improvement Program between 2017 and 2019 were eligible for inclusion. The patients were divided into two treatment groups: operative and non-operative. Furthermore, inverse probability treatment weighting was applied to analyze mortality and adverse hospital events. Results Patients with COPD in the operative group had higher ventilator use (odds ratio [OR], 3.211; 95% confidence interval [CI], 1.993–5.175; p

Abstract Background Anatomical reduction and stable fixation of complex tibial plateau fractures remain challenging in clinical practice. This study examines the efficacy of using 3D printing technology combined with customized plates for treating these fractures. Methods We retrospectively analyzed 22 patients treated with 3D printing and customized plates at the Orthopedic Department of the Central Hospital affiliated with Shenyang Medical College from September 2020 to January 2023. These patients were matched with 22 patients treated with traditional plates with similar baseline characteristics. Patients were divided into an experimental group (3D-printed models and customized plates) and a control group (traditional plates). The control group underwent traditional surgical methods, while the experimental group had a preoperative 3D model and customized plates for surgical planning. We compared baseline characteristics and recorded various indicators, including preoperative preparation time, surgical time, intraoperative blood loss, number of intraoperative fluoroscopies, hospital stay duration, fracture healing time, complications, knee joint range of motion (ROM), Rasmussen anatomical and functional scores, and HSS scores. Results All surgeries were successful with effective follow-up. The experimental group had shorter surgical time, less intraoperative blood loss, and fewer intraoperative fluoroscopies (P 0.05). The incidence of complications was slightly lower in the experimental group but not significantly different. Conclusion 3D printing technology combined with customized plates for complex tibial plateau fractures enables precise articular surface reduction, significantly shortens surgical time, and reduces intraoperative blood loss. This method improves knee joint function, offering a more effective treatment option.

Abstract Background Tension band wire fixation (TBW) is a well-described method for treating displaced olecranon fractures. Further surgery is often needed due to wound breakdown or prominent hardware. An all-suture technique has recently been described as an alternative to TBW but radiographic and clinical outcome are not well established. The aim of this single-center retrospective cohort study was to evaluate outcome after treatment with all-suture technique for simple displaced olecranon fractures. Methods A retrospective review of olecranon fractures in patients (> 18 years) treated for displaced olecranon fractures with tension band suture fixation (TBSF) between February and August 2019 was performed in our facility. Primary outcome was revision surgery, which was assessed four years after surgery. Clinical and radiographical follow-up was performed at two weeks, six weeks, three months and six months to assess union rate, fracture displacement, range of motion (ROM), Quick-DASH and Oxford Elbow Score. Results A total of 24 patients were included. Median age was 64 years [IQR:39–73], 9 patients were male and median ASA score was 2 [IQR:1–2]. 15 fractures were Mayo type 2 A and 9 type 2B with minor comminution. At four-year follow-up, three patients had died. None of the remaining 21 patients had undergone revision surgery. At six months, the median Quick-DASH and Oxford Elbow Score were 2.3 [IQR:0-4.5] and 47 [IQR:46–48], respectively. Median elbow extension and flexion deficits were 0° [IQR:0-2.25] and 0° [IQR:0–0], respectively. Radiographic union was achieved in all patients. In two cases radiographic loss of reduction and malunion was observed but both patients were asymptomatic and had no functional deficits. One patient refractured the elbow due to a second trauma and was reoperated. Conclusions TBSF is a promising technique for Mayo type 2 A and 2B fractures with minor comminution. There were no revision surgeries within the first four years. We found good functional outcomes and a high union rate.

Abstract Background There are many options for the surgical treatment of pronation external rotation (PER) type IV ankle fractures, including the use of fibular plates and screws, the aim of this study was to investigate the biomechanical stability and safety of different internal fixation methods for PER type IV ankle fractures via finite element analysis. Methods A three-dimensional finite element model of the ankle joint and the whole foot of a healthy 26-years-old adult male was established and validated based on computed tomography images of his lower limb, and a computer-aided design was used to produce a PER type IV ankle fracture and plate and screw model. Four different internal fixation modes were simulated, including a (all ankle fixation—utilizing a fibular plate and screws for comprehensive stabilization of the ankle), b (inferior tibiofibular joint fixation + all ankle fixation), c (inferior tibiofibular joint fixation + unfixed anterior ankle), and d (inferior tibiofibular joint fixation + unfixed anterior and posterior ankles). The results of the four different fixation methods were compared via finite element analysis, and the von Mises stresses. The displacements of the four different fixation methods were analyzed as the output indices. Results There were no significant differences between the results of using fibular plates and screws and the displacement of fracture breaks among the four internal fixation modalities. The von Mises stress in the tibiotalar joint, median ankle, posterior ankle, and anterior ankle was minimized in the working condition of d, d, b, and d respectively. The von Mises stress in the fibular plate and screws was minimized in the working condition of a. The von Mises stress in the distal fibula was minimized in the working condition of a. However, the stress was mainly concentrated at the attachment point of the inferior tibiofibular anterior ligament, and in the working condition with inferior tibiofibular joint fixation, the stress was significantly concentrated in the inferior tibiofibular joint screw in all the fibular plates and screws. Conclusions The results of this study demonstrate the feasibility of using finite element analysis to compare the biomechanical stability and safety of four configurations of fibular plates and screws for treating PER type IV ankle fractures. All four modalities provided comparable biomechanical stability and safety, showing no significant differences. However, the current limitations of the finite element analysis methodology preclude specific clinical inferences. Further refinement of the methodology in future studies is necessary to enable reliable clinical applications.

Abstract Background A coracoid process fracture combined with an acromioclavicular (AC) joint dislocation is an uncommon injury that typically causes significant pain and limits shoulder movement. Open reduction and internal fixation have been the traditional treatment approach. However, arthroscopic techniques are emerging as a promising alternative for managing these injuries. Case representation A 35-year-old woman presented with right shoulder pain following an accidental fall. Imaging studies revealed a coracoid process fracture along with an AC joint dislocation. The fracture was classified as an Eyres Type IIIA, which warranted surgical intervention. Our team performed arthroscopic coracoid fracture reduction and internal fixation surgery, as well as AC joint dislocation repair using Kirschner wires. Six months after surgery, the patient demonstrated a satisfactory functional outcome with complete bone healing. Conclusion This case report highlights the potential of arthroscopic reduction and fixation as a novel treatment option for fractures of the coracoid base.

Objective Most both‐column acetabular fractures are combined with posterior wall fragments. However, the morphology of this posterior wall is varied, and how to fix this posterior wall remains a controversial topic. To investigate the morphological characteristics of posterior wall fragments of both‐column acetabular fractures and select corresponding fixation methods. Methods Data from 352 patients with acetabular fractures admitted to the level one trauma centre in our hospital between January 2006 and December 2022 were collected. The morphology of posterior wall fragments was observed and analyzed in 83 cases of both‐column acetabular fractures and classified according to the consistency of posterior wall morphology. A fracture map of the posterior wall was created on a normal template according to the three morphological types of posterior wall fragments. Finally, the high‐incidence area of the posterior wall fracture was projected onto the iliac fossa and the medial side of the posterior column to guide the fixation of the posterior wall fragment using the anterior intrapelvic approach. Results Fractures were divided into four types: I, large posterior wall fragment which was high in the ilium bone (34 cases, 41.0%); II, posterior wall fragment in the acetabular parietal region (18 cases, 21.7%); III, posterior wall marginal fracture (10 cases, 12.0%); and IV, non‐combined posterior wall fracture (21 cases, 25.3%). The most common morphologies of the posterior wall fragments of the first two types were mapped and projected onto the anterior iliac inner plate and medial side of the posterior column, where the corresponding area could be used to guide the insertion of the internal fixation. Conclusion Both‐column acetabular fractures combined with posterior wall fractures can be divided into four types according to the morphology of the posterior wall fragment. Understanding the corresponding three‐dimensional morphology and projection position of different types of these fragments can help surgeons determine the position and orientation of internal fixation of posterior wall fractures.

Objective: This study aims to analyze the differences in mechanical stability of OTA/AO 31A1.3 intertrochanteric fractures under various reduction conditions. Methods: Twenty standard synbone artificial femur test bones were selected for the OTA/AO 31A1.3 intertrochanteric fracture model. The models were divided into five groups according to their reduction state: positive support, neutral support, negative support, varus fixation, and valgus fixation, with four specimens in each group. All models were fixed using PFNA intramedullary fixation and subjected to static axial compression tests. The subsidence displacement of the proximal femur under different loads and the axial stiffness of the model were measured to verify the mechanical stability of the OTA/AO 31A1.3 intertrochanteric fracture under different reduction conditions. Results: After the static axial compression test, the proximal femoral subsidence displacement in the positive support and neutral support groups was lower than that in the negative support, valgus fixation, and varus fixation groups (p < 0.001). The axial stiffness of the model was highest in the positive support group. Significant differences in subsidence displacement and axial stiffness were found between the groups (p < 0.001). The positive support group demonstrated the best mechanical stability, while the varus fixation group showed the poorest performance. Conclusion: Positive support of the medial cortex can be regarded as the best reduction state for OTA/AO 31A1.3 intertrochanteric fractures, suggesting that this approach should be preferred during surgery to enhance mechanical stability and improve clinical outcomes. Conversely, varus fixation should be avoided due to its inferior stability. [ABSTRACT FROM AUTHOR]

Background: Displaced femoral neck fractures frequently result in considerable patient morbidity, with complications such as postoperative femoral neck shortening occurring in up to 39.1% of cases. This shortening is associated with reduced hip function and mobility. The Femoral Neck System (FNS), which allows for controlled sliding to facilitate fracture reduction and healing, may mitigate these issues. However, the ideal sliding distance to balance fracture healing and minimize complications is not well defined. Methods: We performed a retrospective cohort study of 179 patients who underwent FNS fixation for displaced femoral neck fractures at our institution from September 2019 to September 2023. Patients were categorized into three groups based on the intraoperative sliding distance allowed by the FNS: the Minimal Slide group (≤ 5 mm), the Moderate Slide group (> 5 to ≤ 10 mm), and the Extensive Slide group (> 10 to 20 mm). Primary outcomes included postoperative femoral neck shortening, the incidence of moderate to severe shortening, time to fracture union, and hip joint function as assessed by the Harris Hip Score (HHS) and the Parker Mobility Score. Secondary outcomes included complication rates such as implant cut-out, nonunion, avascular necrosis of the femoral head, and the need for secondary surgery. Results: The Extensive Slide group of moderate to severe shortening at 32.31%, which was 1.59-fold and 8.88-fold that of the Moderate Slide (20.34%) and Minimal Slide group's (3.64%), respectively (P < 0.01). The sliding predominantly occurred within the first three months postoperatively and had substantially ceased by six months. At one year postoperatively, the median shortening was 2.7 mm (IQR, 0.7 to 3.5 mm) for the Minimal Slide group, a value that was notably lower compared to the 3.2 mm (IQR, 2.4 to 4.6 mm) for the Moderate Slide group and the 3.5 mm (IQR, 1.3 to 8.1 mm) for the Extensive Slide group. The average time to achieve union was similar across all groups, with no significant differences. Functional outcomes, as assessed by the Harris Hip Score (HHS) and the Parker Mobility Score, the Harris Hip Score (HHS) demonstrated statistical significance, the Parker Mobility Score did not reach statistical significance. Conclusions: Restricting FNS slide to ≤ 5 mm in surgery may reduce shortening, improve hip function, and not hinder fracture healing or implant stability. Considering the key 3-month sliding timeline postoperatively is advisable in clinical practice. Further research with a broader patient cohort is vital to confirm these findings and to anchor them in evidence-based practice. [ABSTRACT FROM AUTHOR]

BACKGROUND: Fractures of the fifth metacarpal shaft are common in the clinic, and surgical treatment is mostly performed with open reduction plate fixation, but postoperatively, most patients require removal of the internal fixation and require secondary hospitalization. Transcutaneous fixation with a Kirschner wire has many advantages, such as less trauma, small incision, and no need for reoperation. OBJECTIVE: To comparatively analyze the clinical efficacy of percutaneous fixation of a Kirschner wire with miniplate placement in the transverse plane for treatment of the fifth metacarpal shaft fracture. METHODS: A total of 60 patients who underwent surgery for the fifth metacarpal shaft fracture at Binzhou Medical University Hospital between May 2018 and May 2020 were retrospectively analyzed and divided into two groups according to the operation method. 30 patients in the plate group were treated with open reduction miniplate internal fixation; 30 patients in the Kirschner wire group were treated with closed reduction and percutaneous fixation with a Kirschner wire (of which 5 patients were treated with mini-incision incision assisted fixation). The length of hospital stay, operation time, incision healing grade, incision length, intraoperative blood loss, intraoperative fluoroscopy number, and postoperative complications were compared between the two groups. The fracture healing time, grip strength, and the motion range of the fifth metacarpophalangeal joint were recorded in the two groups, and the functional outcomes of the fingers were evaluated by the total active movement method. RESULTS AND CONCLUSION: (1) Patients in both groups were followed up for 13-18 months. The differences in hospital stay, operation time, and incision healing grade between the two groups were not statistically significant (P > 0.05). (2) The amount of intraoperative blood loss and incision length in the Kirschner wire group were less than those in the plate group (P < 0.05). The number of intraoperative fluoroscopies in the plate group was less than that in the Kirschner wire group (P < 0.05). There was no significant difference in the fracture healing time between the two groups (P > 0.05). (3) At the last followup, the efficacy was evaluated according to the total active movement method. The excellent and good rate was 87% in the Kirschner wire group and 90% in the plate group, with no significant difference. There were no significant differences between the two groups in the motion range and grip strength of the fifth metacarpophalangeal joint at the last follow-up (P > 0.05). (4) Pin tract infection occurred in one case after Kirschner wire placement, which improved after giving iodophor to enhance the dressing change. There was 1 case of pin tail irritating skin symptoms, which resolved after the removal of the Kirschner wires. There were 12 patients in the plate group who were hospitalized after 12 months for personal reasons for plate removal, and all in the Kirschner wire group were removed on an outpatient basis. In the plate group, three patients developed sensory numbness of the skin on the dorsal side of the distal fifth metacarpal and the dorsal side of the little finger, which resolved gradually with oral administration of mecobalamin after surgery. There were no instances of nonunion and refracture with internal fixation in either group. (5) Our results showed that both of these surgical procedures achieved good results in the treatment of fifth metacarpal shaft fracture with excellent functional recovery of the fingers, but the transverse fixation with percutaneous Kirschner wire has many advantages, such as less trauma, small incision, low cost, and convenient removal of internal fixation. [ABSTRACT FROM AUTHOR]

BACKGROUND: At present, there is still controversy in clinical practice about the choice of internal fixation of Pauwels type III femoral neck fracture, and the selection of internal fixation that provides stable fixation strength is the key basis for achieving Pauwels type III fracture fixation. OBJECTIVE: The three-dimensional finite element analysis method was used to test the difference in biomechanical strength of three types of internal fixation in Pauwels type III femoral neck fracture, which provided a reference for its clinical treatment. METHODS: Using the CT data of the left femur of a healthy male volunteer, a complete femur and its cancellous bone were reconstructed in Mimics software, and Geomagic studio software was used for reverse modeling. Cannulated compression screw, dynamic hip screw, and femoral neck system were created in UG-NX software. Three kinds of internal fixation models were assembled on the femur model, and Pauwels type III femoral neck fracture was simulated by Hypermesh software. Finally, Abaqus software was used to carry out finite element experimental analysis to analyze and compare the stress distribution, stress peak, strain, and displacement distribution caused by fixed femoral neck fracture of different internal fixation systems. RESULTS AND CONCLUSION: (1) The stress of the proximal femur bone mass was mainly distributed in the area below the femoral neck near the fracture end, with the highest stress peak in the dynamic hip screw group and the smallest in the femoral neck system group. (2) The stress distribution of the internal fixation device was mainly concentrated on the screw surface near the fracture line, with the highest stress peak in the femoral neck system group and the smallest in the dynamic hip screw group. (3) The main strain field of the proximal femur bone mass was distributed in the upper surface area where the bone and screw contacted, and the yield strain was the smallest in the femoral neck system group and the largest in the cannulated compression screw group. (4) The main strain field of the internal fixation device model was distributed on the upper surface of the femoral neck screw, with the yield strain being the smallest in the femoral neck system group and the largest in the cannulated compression screw group. (5) The displacement distribution values of femur, proximal bone mass, distal bone block, internal fixation device and internal fixation with the femur as a whole in the three femoral neck fracture internal fixation models decreased gradually from proximal to distal, and the peak displacement of the femoral neck system group was the largest and the lowest in the dynamic hip screw group. (6) The results showed that when the Pauwels type III femoral neck fracture was fixed, the stress distribution of femoral neck system was more uniform, the mechanical conduction characteristics were better, and it was subjected to lower yield strain, higher stress and higher displacement. It has relatively better biomechanical stability and can provide a superior mechanical environment for fracture healing. [ABSTRACT FROM AUTHOR]

BACKGROUND: The angle of screw placement in anterior cervical discectomy and fusion plays a crucial role in determining the stability of the internal fixation system. OBJECTIVE: To predict the impact of different screw placement angles on the stress experienced by the internal fixation system in anterior cervical discectomy and fusion utilizing finite element analysis, with the ultimate goal of identifying the optimal screw placement angle. METHODS: A three-dimensional reconstruction method was employed to establish a mechanical model of the cervical spine, enabling the simulation of three distinct working conditions: scoliosis, uprightness, and forward flexion. In SolidWorks 2017, the anterior cervical plate and screw models were built according to different placement angles of the screws, with a as the inward offset, b as the ideal position, c as the outward offset, d as the downward offset, and e as the upward offset. The stress distribution of internal fixation system at different screw placement angles was observed, and the stress and displacement were recorded. RESULTS AND CONCLUSION: (1) By constructing a finite element model of the entire cervical spine and incorporating an anterior titanium plate, it was found that the biomechanical changes in the spine did not significantly differ based on the various angles of screw insertion on the titanium plate under the same working conditions. (2) However, microscopic analysis revealed that the outward offset (c) screw position exhibited the most effective resistance against side bending, while the downward offset (d) screw demonstrated optimal load-bearing capacity in the upright condition. Additionally, the outward deviation (c) screw displayed superior anti-bending effects in the reverse buckling condition. (3) The fixation effect of the internal fixation device remained relatively stable across different motion conditions. Although there was a 10% variation in the internal fixation effect under the three working conditions when the screw was placed inward, outward, downward, or upward, the displacement changes were minimal. These findings suggest that the requirements of load bearing, bending resistance, and flexion resistance could be simultaneously met without a specific optimal screw location in clinical practice. (4) The placement direction of titanium plate screw in anterior cervical disc-resection and fusion has little effect on the mechanical stability of the cervical spine. The screw angles in different directions have little influence on the stability of the internal fixation device in the lateral, upright, and forward flexion movements of the cervical spine. There is no need to pursue the direction of screw placement in clinical operations. [ABSTRACT FROM AUTHOR]

This study was aimed to compare the clinical and radiographic outcomes of patients with intercondylar fractures of the humerus treated with orthogonal and parallel plating methods via precontoured plates. This was a retrospective comparative study conducted on 50 adult patients with intercondylar humerus fractures that were surgically treated over an eleven-year period. The patients were divided into two groups: Group A underwent internal fixation via parallel plating, whereas Group B received orthogonal plating. Clinical outcomes were evaluated via the Mayo Elbow Performance Score (MEPS), and the radiographic assessments included time to consolidation, pseudoarthrosis, malunion and hardware removal. Both groups presented similar demographic and preoperative characteristics. The functional outcomes assessed by the MEPS were not significantly different between the groups. Radiographically, comparable healing times and rates of complications, including pseudoarthrosis, malunion and hardware removal, were observed. The study findings suggest that both orthogonal and parallel plating methods yield comparable clinical and radiographic outcomes in the treatment of intercondylar humerus fractures. These results underscore the effectiveness of both techniques and emphasize the importance of further research to elucidate the optimal plating method for specific fracture patterns. [ABSTRACT FROM AUTHOR]

Calcaneal body fractures are often associated with varying degrees of shortening deformities. Restoring calcaneal length is crucial for the functional prognosis of the foot. Through finite element analysis, this study compared the biomechanical effects of multiple fixation schemes for calcaneal fractures. We delineated and assembled the finite element model of the Sanders type II calcaneal fracture and four internal fixation simulations (namely distraction screw, lag screw, frame locking plate, and T-shaped locking plate). Different axial forces (350, 700, and 1400 N) were then applied to simulate various postures. We then compared the inner and outer shortening distances (D1 and D2, respectively), equivalent von Mises stress, and maximum von Mises stress of the calcaneus. In the individual model, with an increase in the pressure, D1, D2, and the maximum von Mises stress gradually increased. At 1400 N, D1 and D2 for the internal fixation schemes were as follows: distraction screw (0.03 mm, 0.1 mm) < T-shaped locking plate (0.45 mm, 0.26 mm) < frame locking plate (0.50 mm, 0.26 mm) < lag screw (0.66 mm, 0.64 mm). The maximum von Mises stress values for the internal fixation methods were as follows: lag screw (491.0 MPa) < distraction screw (663.1 MPa) < frame locking plate (772.7 MPa) < T-shaped locking plate (931.8 MPa). In patients with calcaneal body fractures, the distraction screw is a potential therapeutic option for resisting calcaneal shortening. [ABSTRACT FROM AUTHOR]