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This paper explores the role of botulinum neurotoxin in aiding fracture recovery through temporary muscle paralysis. Specifically, it investigates the effects of botulinum neurotoxin-induced paralysis of the sternocleidomastoid muscle on clavicle fractures in rats. The research aims to assess safety, effectiveness, and the impact on fracture healing. Healthy male Albino Wistar rats were divided into four groups: clavicle fracture, botulinum neurotoxin injection, both, and control. Surgeries were conducted under anaesthesia, and postoperatively, animals were monitored for 28 days. Euthanasia and radiological assessment followed, examining fracture healing and muscle changes, while tissues were histopathologically evaluated. The modified Lane–Sandhu scoring system was used for the radiographic evaluation of clavicle fractures, and the results varied from complete healing to nonunion. Histopathological examination at 28 days postfracture showed fibrous tissue, mesenchymal cells, and primary callus formation in all groups. Despite varied callus compositions, botulinum neurotoxin administration did not affect clavicle healing, as evidenced by similar scores to the control group. Several studies have explored botulinum neurotoxin applications in fracture recovery. Research suggests its potential to enhance functional recovery in certain types of fractures. Theoretical benefits include managing muscle spasticity, aiding reduction techniques, and preventing nonunion. However, botulinum neurotoxin's transient effect and nonuniversal applications should be considered. The present study found that botulinum toxin had no clear superiority in healing compared to controls, while histological evaluation showed potential adverse effects on muscle tissue. Further research is essential to understand its risk-benefit balance and long-term effects. [ABSTRACT FROM AUTHOR]

Background: Percutaneous transpedicular screw fixation was recently introduced as a minimally invasive approach for the treatment of thoracolumbar spine fracture. This approach is superior to the traditional open surgical approaches in decreasing intraoperative blood loss, infection rates, and paraspinal muscle damage with less hospital stay. Objective: This study aims to report our surgical experience, the feasibility and safety of percutaneous transpedicular screw fixation of thoracolumbar spine fractures. Method: we retrospectively reviewed the charts of all adult patients with thoracolumbar spine fractures who underwent percutaneous transpedicular screw fixation during the period between January 2020 to January 2023 at Ain Shams University Hospitals and Prince Mohamed Ibn Abdelaziz Hospital. Collected data included: demographics, pre- and postoperative neurological assessment, radiological data including type of fracture and cobb's angle pre- and postoperatively, operative time and amount of intraoperative blood loss. Results: Forty-three percutaneous pedicle screw fixation procedures were done for 42 patients. Thirty patients were males. Dorsal spine fractures accounted for 18 cases. Preoperative American spinal injury Association score was E in 37 cases. Mean operative time was 133 min (± 46.5), and mean intraoperative blood loss was 107.1 ml (± 84). The mean follow-up period was 8 months, and the average hospital stay was 7.7 days. Radiological complete bony fusion was achieved in 77% of fractures, and 93% had improved kyphotic angle with a mean correction degree of 7.9 (± 9). Conclusion: Percutaneous transpedicular screw fixation is a safe and effective treatment option for the management of thoracolumbar spine fractures with or without spine decompression that provides satisfactory functional outcomes. [ABSTRACT FROM AUTHOR]

Understanding the fracture behavior of rock after coupled water and thermal environment is important for many geotechnical projects. This study examines the influence of coupled water and thermal treatments on the fracture toughness and characteristics of a typical sandstone under mode I and mode II loading conditions. Notched deep beam (NDB) specimens were utilized and subjected to soaking treatments at various water temperatures (23 °C, 60 °C, and 99 °C). The experimental results indicate a significant reduction in both mode I and mode II fracture toughness values, with reductions ranging from 15.4% to 13.2% for mode I and 26.1% to 8.9% for mode II respectively. As the water temperatures increase, a slightly rising trend is observed in both mode I and mode II fracture toughness within the examined temperature range. Sandstone specimens displayed typical brittle fracture characteristics at lower soaking temperatures. For mode I specimens, an increase in ductility was evident with higher soaking temperatures, while the ductile behavior is less pronounced in the mode II specimens. Based on the Maximum Tangential Stress (MTS) criterion and the Generalized Maximum Tangential Stress (GMTS) criterion, the predicted values of mode II fracture toughness and the fracture process zone (FPZ) were discussed. The results show that both the GMTS and MTS criteria exhibit inaccuracies in predicting the mode II fracture toughness of sandstone treated at different soaking water temperatures. However, the GMTS criterion, which incorporates T-stress, demonstrates smaller errors compared to the MTS criterion. The study shows that the radius r0 of the fracture process zone is not a constant under both mode I and mode II loading conditions. The calculation of the fracture process zone radius r0 in the GMTS criterion requires further theoretical and experimental study. [ABSTRACT FROM AUTHOR]

Background: The recommendation on whether to bury or expose the Kirschner wire (K-wire) for the management of fractures has still been controversial with inconsistent results in the published studies due to the potential issue associated with exposed K-wire is the heightened risk of infection, as it comes into direct contact with the external environment and air. This study aims to summarize the specific outcomes between buried and exposed K-wire for the management of hand and forearm fractures. Methods: We conducted relevant literature searches on Europe PMC, Medline, Scopus, and Cochrane Library databases using specific keywords. This investigation focuses on individuals of any age diagnosed with hand or forearm fractures who underwent surgery involving Kirschner wire (K-wire) fixation. It examines the comparison between buried and exposed K-wire fixation, emphasizing primary outcome pin infection, along with secondary outcomes such as early pin removal, days to pin removal, and surgical duration. The study includes observational studies (cohort/case-control) or randomized clinical trials (RCTs). The results of continuous variables were pooled into the standardized mean difference (SMD), while dichotomous variables were pooled into odds ratio (OR) along with 95% confidence intervals using random-effect models. The quality of included studies was assessed with Cochrane Collaborations, Risk of Bias version 2 (RoB v2). Results: A total of 11 studies were included. Our pooled analysis revealed that buried K-wire was associated with a lower risk of pin site infection [RR 0.49 (95% CI 0.36–0.67), p < 0.00001, I2 = 0%] and 33.85 days longer duration until pin removal [MD 33.85 days (95% CI 18.68–49.02), p < 0.0001, I2 = 99%] when compared with exposed K-wire. However, the duration of surgery was 9.98 minutes significantly longer in the buried K-wire [MD 6.98 minutes (95% CI 2.19–11.76), p = 0.004, I2 = 42%] with no significant difference in the early pin removal rate [RR 0.73 (95% CI 0.36–1.45), p = 0.37, I2 = 0%]. Further regression analysis revealed that sample size, age, sex, and duration of follow-up did not affect those relationships. Conclusion: Buried K-wire may offer benefits in reducing the infection rate with a longer duration until pin removal. However, further RCTs with larger sample sizes are still needed to confirm the results of our study. [ABSTRACT FROM AUTHOR]

Background: External fixation is widely used in the treatment of traumatic fractures; however, orthopedic surgeons encounter challenges in deciding the optimal time for fixator removal. The axial load-share ratio (LS) of the fixator is a quantitative index to evaluate the stiffness of callus healing. This paper introduces an innovative method for measuring the LS and assesses the method's feasibility and efficacy. Based on a novel hexapod LS-measurement system, the proposed method is to improve the convenience and precision of measuring LS in vivo, hence facilitating the safe removal of external fixators. Methods: A novel hexapod system is introduced, including its composition, theoretical model, and method for LS measurement. We conducted a retrospective study on 82 patients with tibial fractures treated by the Taylor Spatial Frame in our hospital from September 2018 to June 2020, of which 35 took LS measurements with our novel method (Group I), and 47 were with the traditional method (Group II). The external fixator was removed when the measurement outcome (LS < 10%) was consistent with the surgeon's diagnosis based on the clinical and radiological assessment (bone union achieved). Results: No significant difference was found in the fracture healing time (mean 25.3 weeks vs. 24.9 weeks, P > 0.05), frame-wearing duration (mean 25.5 weeks vs. 25.8 weeks, P > 0.05), or LS measurement frequency (mean 1.1 times vs. 1.2 times, P > 0.05). The measurement system installation time in Group I was significantly shorter compared to Group II (mean 14.8 min vs. 81.3 min, P < 0.001). The LS value of the first measurement in Group I was lower than that of Group II (mean 5.1% vs. 6.9%, P = 0.011). In Group I, the refracture rate was 0, but in Group II it was 4.3% (2/47, P > 0.05). Conclusion: The novel hexapod LS-measurement system and involved method demonstrated enhanced convenience and precision in measuring the LS of the external fixator in vivo. The LS measurement indicates the callus stiffness of fracture healing, and is applicable to evaluate the safety of removing the fixator. Consequently, it is highly recommended for widespread adoption in clinical practice. [ABSTRACT FROM AUTHOR]

Objective • This retrospective cohort study is aimed to provide a certain reference for the clinical prevention and treatment of nasal bone fracture, and further formulated a more perfect diagnosis and treatment plan. Methods •In detailed cases, 2881 patients with nasal bone fracture were recorded. Its general clinical data, cause of injury, fracture site, and fracture typing were collected through the database. All hospitalized patients admitted to the Ninth People’s Hospital Affiliated to the School of Medicine of Shanghai Jiao Tong University with integrated medical records could be retrospectively included from June 2013 to July 2018 and comprehensively analyzed for their gender, age, fracture type and cause of injury. Results • The sex ratio of nasal bone fracture was 2.44:1. The most patients with nasal bone fracture were 19-29 years old (35.6%). The injury rate of traffic accidents was the highest, 33.8%, followed by violent strikes, 24.1%. Statistical analysis showed that the number of patients with nasal bone combined with maxillary frontal bone fracture and type II nasal bone fracture was significantly higher than other fracture types. Logistic multiple regression analysis showed that the relative risk of nasal bone fracture in men was lower (odds ratio, OR = 0.807, P < .05), and the risk of nasal bone fracture decreased with age (OR = 0.978, P < .001). Compared with car accident injury, the relative risk of simple nasal bone fracture comes from violence, exercise or collision [OR = 1.244, P < .05; OR = 1.410, P < .05; OR = 1.453, P < .05]). Conclusion • Given these findings, it’s evident that nasal bone fractures exhibit distinct patterns based on individual characteristics, causes of trauma, and injury site, and relevant strategy research should be conducted. [ABSTRACT FROM AUTHOR]

Background: Surgical exploration and closure of the tunica albuginea is the recommended treatment for penile fractures. The recovery of sexual function is the main result that surgeons and patients pursue. Objective: We sought to evaluate the sexual health effects of a surgically corrected penile fracture. Secondarily, we sought to identify risk factors that may influence long‐term sexual function and their effects on genital body image satisfaction. Methods: A retrospective analysis of patients who underwent surgical correction of penile fractures between 2007 and 2022 in a tertiary center was performed. Lesion characteristics, weeks until the resumption of sexual activity, and post‐operative sexual function were recorded. The presence of glans hypoesthesia, penile deformation, penile nodule palpation, and self‐satisfaction with body image were assessed. Results: Sixty‐nine patients with a mean age of 42.30 ± 12.98 years and a median follow‐up of 70 (20–134) months were identified. Sexual intercourse was recorded as a percentage. Penile deformation was the most common complication, appearing in 14.5% of patients, erectile dysfunction in 5.8%, penile nodules in 4.3%, and glans hypoesthesia in 2.9%. The median post‐operative International Index of Erectile Function‐5 was 24 (21.5–24). Self‐satisfaction with body image had a median of 9 and was negatively associated with bilateral lesions and penile deformation. Discussion and conclusion: Distal fractures could be linked to erectile dysfunction and glans hypoesthesia. Surgical correction of penile fractures shows positive functional and self‐reported outcomes, and the potential andrological complications rarely necessitate specific treatment. [ABSTRACT FROM AUTHOR]

Although tension band wiring (TBW) is popular and recommended by the AO group, the high rate of complications such as skin irritation and migration of the K-wires cannot be ignored. Ding's screw tension band wiring (DSTBW) is a new TBW technique that has shown positive results in the treatment of other fracture types. The objective of this study was to evaluate the stability of DSTBW in the treatment of olecranon fractures by biomechanical testing. We conducted a Synbone biomechanical model by using three fixation methods: DSTBW, intramedullary screw and tension band wiring (IM-TBW), and K-wire TBW, were simulated to fix the olecranon fractures. We compared the mechanical stability of DSTBW, IM-TBW, and TBW in the Mayo Type IIA olecranon fracture Synbone model using a single cycle loading to failure protocol or pullout force. During biomechanical testing, the average fracture gap measurements were recorded at varying flexion angles in three different groups: TBW, IM-TBW, and DSTBW. The TBW group exhibited measurements of 0.982 mm, 0.380 mm, 0.613 mm, and 1.285 mm at flexion angles of 0°, 30°, 60°, and 90° respectively. The IM-TBW group displayed average fracture gap measurements of 0.953 mm, 0.366 mm, 0.588 mm, and 1.240 mm at each of the corresponding flexion angles. The DSTBW group showed average fracture gap measurements of 0.933 mm, 0.358 mm, 0.543 mm, and 1.106 mm at the same flexion angles. No specimen failed in each group during the cyclic loading phase. Compared with the IM-TBW and TBW groups, the DSTBW group showed significant differences in 60° and 90° flexion angles. The mean maximum failure load was 1229.1 ± 110.0 N in the DSTBW group, 990.3 ± 40.7 N in the IM-TBW group, and 833.1 ± 68.7 N in the TBW group. There was significant difference between each groups (p < 0.001).The average maximum pullout strength for TBW was measured at 57.6 ± 5.1 N, 480.3 ± 39.5 N for IM-TBW, and 1324.0 ± 43.8 N for DSTBW. The difference between maximum pullout strength of both methods was significant to p < 0.0001. DSTBW fixation provides more stability than IM-TBW and TBW fixation models for olecranon fractures. [ABSTRACT FROM AUTHOR]

This study provides a comprehensive examination of the current methodologies and potential strategies for the treatment of articular fractures of the foot. In the field of orthopedic healthcare, these fractures present a significant challenge due to their complex nature and the fact that they affect the routines of patients. The motivation behind this study is based on two main concepts. The first one is represented by the use of emerging medical technologies and personalized medicine to bring a significant transformation in the management of foot fractures and give a better quality of treatment that is accepted by the patient. However, because there are inequities in the availability of the necessary medical care and equipment, as well as uneven incorporation in clinical settings, new technologies cannot be used to treat these types of fractures. Regarding the second concept behind this study, it is indicated that although current treatment methods are essential, they have a number of shortcomings when it comes to properly addressing these types of injuries. An approach is needed that takes into account the biomechanical points of view and the particularities of each patient. This approach could be applied in all hospital settings. Through this study, we want to highlight the progress made in recent years in surgical techniques such as 3D printing, minimally invasive surgery (MIS), and biological products. However, in the application of this new discovery, new obstacles have been discovered that prevent the efficient treatment of these types of injuries. This study examines the effectiveness and limitations of current treatments, as well as how differences in healthcare, such as available equipment, training of medical staff, and technological advances, affect patient outcomes in everyday life. This research wishes to emphasize that continuous innovation, interdisciplinary collaboration, and the use of an optimal approach that is appropriate for each patient, are essential. This study aims to provide new insights and useful recommendations for future research and clinical practice. The main role of this research is to improve the quality of life of patients and increase the standards of care in this complex field, which is in permanent evolution. [ABSTRACT FROM AUTHOR]

Atypical fractures are caused by the combined effects of severe suppression of bone metabolism (SSBT) due to long-term bisphosphonate therapy and chronic repetitive bone microdamage. Atypical ulnar fractures (AUFs) due to SSBT are rare, and there is no standard treatment strategy for such fractures. The relevant literature was reviewed, and the treatment strategy for AUF is discussed. A systematic review was conducted. All studies on ulnar fractures in individuals with a history of bisphosphonate use were included, and the data were extracted and analyzed from the perspective of the therapeutic strategy. Forty limbs of 35 patients were included. As for the treatment of AUF, 31 limbs were treated surgically, and conservative treatment with casting was performed for 9 limbs. The bone fusion rate was 22/40 (55.0%), and non-union was seen in all patients treated conservatively. There was a significant difference in the bone fusion rate between patients with surgical treatment and those with conservative treatment. The bone fusion rate of patients with parathyroid hormone (PTH) and surgery was 82.3% (14/17 limbs); the bone fusion rate with PTH and bone graft was 69.2% (9/13 limbs). However, there were no significant differences in the fusion rate in the groups with or without PTH, with or without bone grafting, or the combination of the two treatments. There was also no significant difference in the bone fusion rate in the groups with or without low-intensity pulsed ultrasound (LIPUS) treatment. Based on the literature review, surgery is necessary to achieve bone union, but surgery alone is not adequate to achieve bony union. Bone grafting and the administration of PTH and LIPUS may promote early bone fusion, but the present study did not show significant advantages of these additional treatments for bone union. [ABSTRACT FROM AUTHOR]

This paper addresses the effective management of water resources during the hydraulic fracturing process used for natural gas extraction. With increasing demand and scrutiny on shale gas production due to economic, environmental, and social factors, effective water management strategies are needed to address the challenges of flow-back water usage during hydraulic fracturing. This research contributes to the existing literature from a multi-period reverse logistics network design perspective with realistic modeling approaches. A mathematical formulation is developed for optimizing the design of a multi-period reverse logistics network for effective water resource management that incorporates production scheduling of a hydraulic fracturing process. This mixed integer programming model determines the optimal locations and capacities of impoundments, treatment facilities, and disposal sites while minimizing fixed and operational costs under constraints such as freshwater withdrawal limits, production schedules, inventory balance, and treatment and disposal options. A two-stage stochastic programming formulation is further developed as a means to address the uncertainty associated with water flows during the fracturing operation. The strategic location and capacity decisions are given in the first stage of this formulation, whereas operational decisions such as water flows are handled in the second stage under independently sampled scenarios. A sample average approximation algorithm is proposed to solve the stochastic formulation. The model is tested on a case study from the United States that explores potential impacts on water resource management due to cost variations, changes in operational parameters, and uncertainty in demands and supplies. The base case setup delivers a 12.8% reduction in freshwater usage. The benefit of multi-period reverse logistics network design is further demonstrated through variations in water demand and equipment degradation. The managerial insights derived through sensitivity analysis highlight the values of the proposed multi-period formulation, capacity expansions, and parameter estimations. • Developed models for multi-period reverse logistics network design. • The model optimizes water resource management during hydraulic fracturing. • Implemented the models on a case study from the United States. • Analyzed the effects of problem parameters on optimal water management strategies. • Derived managerial insights from extensive computational experiments. [ABSTRACT FROM AUTHOR]

The dorsal interosseous muscles (DIM) are intrinsic muscles of the hand located dorsally between metacarpal bones, which play a role in finger abduction. Anatomical variations of these muscles in terms of form and length have been well documented, but variations regarding sex and laterality are underexplored. The aim of this study was to investigate the morphology and morphometry of the DIM of the hand regarding sexual dimorphism and laterality. Twenty human cadavers belonging to the white individuals (n = 40 hands) with known sex and laterality were used for this study. DIMs were dissected and observed for morphology. Also, a digital calliper was used to measure the midpoint length of the DIM. The origin and insertion of all the DIM were normal with the left hand having no additional, supernumerary, and absent muscles in each compartment. The variations were only found on the right side and predominant in females: 2 out of 11 (18.18%) hands containing a space with a supernumerary muscle; 1 out of 11 (9.09%) hands having a space with a double muscle; and 1 out of 11 (9.09%) hands having a compartment with a unipennate muscle. In males, 1 out of 9 (11.11%) hands had a compartment with a supernumerary muscle. The mean midpoint length of each muscle in females and males in both hands from the first to the fourth muscle, respectively, was documented. In females on the left: 46.79 ± 3.56; 42.62 ± 3.57; 49.02 ± 4.21; 41.66 ± 2.15 and right: 47.30 ± 2.49; 39.27 ± 4.14; 45.69 ± 4.64; 38.12 ± 4.08. In males, it was on the left: 50.01 ± 3.95; 41.98 ± 3.79; 47.90 ± 4.83; 41.79 ± 4.25, and on the right: 46.65 ± 2.09; 39.01 ± 4.25; 47.47 ± 3.41; 38.31 ± 4.40. The mean midpoint length of the DIM was relatively higher on the left hand compared to the right hand in both females and males. In this study, variations regarding the supernumerary muscle, double interosseous space, and unipennate muscles were only observed on the right-hand side and predominantly in females, an insight that may guide in the treatment of fractures, stiffness of the hand, and compartment syndromes. [ABSTRACT FROM AUTHOR]

Background: Use of postoperative radiographs after surgical management of supracondylar humerus (SCH) fractures is often based on rote practice rather than evidence. The purpose of this study was to determine the frequency with which 3-week postoperative radiographs at the time of pin removal altered management plans in pediatric SCH fractures that were intraoperatively stable after closed reduction and percutaneous pinning (CRPP). Methods: We prospectively recruited pediatric patients with SCH fractures managed by CRPP at our institution from June 2020 until June 2022, and reviewed retrospective data on pediatric SCH fractures managed surgically at our institution between April 2008 and March 2015. Patients were assessed for post-CRPP fracture alignment and stability. For prospective patients, we asked clinicians to document their management decision at the 3-week follow-up visit before evaluating the postoperative radiographs. Our primary outcome was change in management because of radiographic findings. Results: Overall, 1066 patients in the retrospective data and 446 prospectively recruited patients met the inclusion criteria. In the prospective group, radiographic findings altered management for 2 patients (0.4%). One patient had slow callus formation and 1 patient was identified as having cubitus varus. Altered management included prolonged immobilization or additional radiographic follow-up. Radiographic findings altered management in 0 (0%) of 175 type II fractures, in 2 (0.9%) of 221 type III fractures, and in 0 (0%) of 44 type IV fractures. We obtained similar findings from retrospective data. Conclusion: Rote use of 3-week postoperative radiographs after surgical management of SCH fractures that are intraoperatively stable has minimal utility. Eliminating rote postoperative radiographs for SCH fractures can decrease the time and financial burdens on families and health care systems without affecting patient outcomes. [ABSTRACT FROM AUTHOR]

About half of hip fractures in the elderly are caused by intertrochanteric fractures, of which more than 50% are unstable. Restoring mobility safely, effectively, and as close to the patient's pre-operative state as possible are the main objectives of treatment for any intertrochanteric fracture. Over the past 20 years, the dynamic hip screw (DHS) has become widely accepted and is now the gold standard for outcome comparison. Recently, proximal femoral nailing (PFN) is the intramedullary device that has frequently been claimed to have helped with these fractures, hence reducing the lever arm aspect on the implant. The Objectives of the present study is to compare the functional outcomes between dynamic hip screw versus proximal femoral nailing for the treatment of inter-trochanteric fractures of hip. Methods: The present study was conducted in the department of orthopedics, the study included a total of 80 patients presented with hip fractures based on inclusion and exclusion criteria after taking informed consent. These patients were randomized by simple random sampling into two groups DHS and PFN group. The functional outcomes using HHS was compared between the two groups at 6th, 12th and 24 weeks respectively. Results: The comparison of mean scores between DHS and PFN group at 6th, 12th and 24 week followup shows that the mean scores were statistically significantly better in PFN group at 12 weeks and 24 weeks, there was no significant differences found between the two groups at 6th week, as presented in Table 3. The functional outcomes were evaluated between the two groups, it is found that 12 (30%), 18 (45%), 8 (20%) and 2 (5%) patients had Excellent, Good, Fair and Poor outcomes in DHS group, whereas in PFN group 17 (42.5%), 19 (47.5%), and 4 (10%) patients had Excellent, Good and Fair outcomes in PFN group and none of them had poor outcome in PFN group as represented in Table 4. Discussion and conclusion: It can be inferred from the study that PFN performed better in intertrochanteric fractures than DHS fixation, based on the functional outcome determined by the Harris Hip Score. This was determined by looking at the end result, movement range, and HHS. Comparing the PFN group to the DHS group, the PFN group's subjects had a higher percentage of excellent to good results, and none of them had poor results. At 12 weeks, 24 weeks, and the Conclusion: of the follow-up, the PFN group's HHS scores were higher. With fewer complications, PFN offers a quicker recovery and a better functional outcome for all kinds of intertrochanteric fractures. [ABSTRACT FROM AUTHOR]

The purpose of this study was to use a large claims database to determine if there is a difference in opioid use after operative intervention for proximal humerus fractures in patients with known cannabis use compared with those who do not report cannabis use. The PearlDiver database was queried to find all patients who underwent proximal humerus open reduction and internal fixation. A group of patients with reported cannabis use or dependence was matched to a cohort without known cannabis use. Between the two groups, differences in the number of opioid prescriptions filled in the postoperative period (within 3 days), the morphine milligram equivalents (MMEs) prescribed in total and per day, and the number of opioid prescription refills were explored. There were 66,445 potential control patients compared with 1260 potential study patients. After conducting the propensity score match, a total of 1245 patients were included in each group. The patients in the cannabis group filled fewer opioid prescriptions (P=.045) and were prescribed fewer total MMEs (P=.044) in the first 3 days postoperatively. Results of this study indicate that patients who use cannabis products may use fewer opioids after proximal humerus open reduction and internal fixation. [Orthopedics. 2024;47(3):147–151.] [ABSTRACT FROM AUTHOR]

Background and Objectives: Patella baja is a common complication after operative treatment for patellar fracture. This study aimed to investigate (1) the serial changes in patellar height and (2) the potential predictive factors for patellar height changes after tension band wiring (TBW) for patellar fractures. Materials and Methods: Forty-one patients who underwent TBW for patellar fracture between March 2019 and September 2022 were enrolled. To identify serial changes in patellar height, modified Blackburne–Peel index (mBPI) was assessed at just after surgery, at 3 months, at 6 months, at 1 year and at the final follow-up. Multiple regression analysis was conducted to identify factors correlated with mBPI difference between the contralateral side (considered as preoperative status) and injured side. Results: The postoperative mBPI exhibited a decline over time (mean mBPI immediately post operation/3 months/6 months/1 year/final follow-up: 0.69/0.63/0.63/0.62/0.61) Specifically, mBPI showed a significant reduction immediately post operation to 3 months (p < 0.001), although comparisons at other time points did not reveal significant differences. A lower position of the fracture was associated with a decrease in patellar height after surgery. Conclusions: Patellar height was mainly decreased from immediately post operation to 3 months. A fracture in a lower position of associated with decreased patellar height after the TBW of the transverse patellar fracture. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic affected the control of many chronic conditions, including hip fractures, worldwide. This study was to examine the impact of the COVID-19 pandemic on the management of hip fractures in a referral orthopedic hospital in Iran. By understanding how the pandemic has influenced the care of hip fracture patients, we can gain valuable insights into the challenges, adaptations, and potential improvements in orthopedic healthcare during such public health crises. Methods: Data was collected on hip fracture patients aged 50 and above who were admitted to the hospital before and during the pandemic. The number of admissions and operations, length of hospital stay, and time from admission to surgery were recorded from the hospital information system (HIS) and compared between the two periods. Results: The median number of admitted hip fracture patients per month increased slightly during the pandemic (11%), although this increase was not statistically significant (p = 0.124). After adjusting for potential confounders, the mean length of hospital stay was significantly lower during the pandemic period, indicating that patients were discharged sooner (p = 0.019) and the time from admission to surgery was shorter during the pandemic (p = 0.004). Although the increase in the number of hip fracture surgeries per month during the pandemic was not statistically significant (P = 0.132), a higher percentage of patients underwent surgery during the pandemic compared to before (84.8% VS. 79.4%). Conclusion: The study suggests that the COVID-19 pandemic did not have a negative impact on hip fracture management in the investigated orthopedic hospital in Iran. further research is needed to explore the effects of the pandemic on other aspects of healthcare services, particularly in general hospitals. [ABSTRACT FROM AUTHOR]

Non-thermal atmospheric-pressure plasma (NTAPP) is attracting widespread interest for use in medical applications. The tissue repair capacity of NTAPP has been reported in various fields; however, little is known about its effect on fracture healing. Non-union or delayed union after a fracture is a clinical challenge. In this study, we aimed to investigate how NTAPP irradiation promotes fracture healing in a non-union fracture model and its underlying mechanism, in vitro and in vivo. For the in vivo study, we created normal and non-union fracture models in LEW/SsNSlc rats to investigate the effects of NTAPP. To create a fracture, a transverse osteotomy was performed in the middle of the femoral shaft. To induce the non-union fracture model, the periosteum surrounding the fracture site was cauterized after a normal fracture model was created. The normal fracture model showed no significant difference in bone healing between the control and NTAPP-treated groups. The non-union fracture model demonstrated that the NTAPP-treated group showed consistent improvement in fracture healing. Histological and biomechanical assessments confirmed the fracture healing. The in vitro study using pre-osteoblastic MC3T3-E1 cells demonstrated that NTAPP irradiation under specific conditions did not reduce cell proliferation but did enhance osteoblastic differentiation. Overall, these results suggest that NTAPP is a novel approach to the treatment of bone fractures. [ABSTRACT FROM AUTHOR]

Introduction: German-speaking surgeons have left a deep imprint on the history of diagnostics and treatment of proximal femur fractures. Some of the studies published in German have fell into oblivion, others are cited until today, although sometimes quite inaccurately. The cause of such inaccuracies are citations from secondary sources due to unavailability of the original or inability to read it because of a language barrier. In the current literature, globally predominated by English articles, the "German history" of treatment of proximal femur fractures remains undervalued. The aim of the present article is to point out its contribution. Materials and methods: Literature search was performed in original publications and historical sources. Results: The German-speaking surgeons have considerably contributed to the development of the treatment of proximal femur fractures. The analyzed period between 1847 and 1970 may be divided into three basic periods. In the first period (1847–1896), the German-speaking surgeons (Langenbeck, Trendelenburg, König, Heine, Dolinger) were the first worldwide to start treating the fractures of proximal femur operatively. In the second period (1897–1935), mainly in the 1930s, the initiative in Europe was taken over by surgeons publishing studies in France and in Belgium. Overseas, American surgeons were coming to the forefront. In Germany, only Pauwels developed the first biomechanical classification of femoral neck fractures. In the third period (1936–1970), mainly in the 1940s and 1950s, implants were designed (Pohl, Künstcher), based on close collaboration between German engineers and surgeons, that served as a model for a dynamic hip screw and a proximal femoral nail, which are currently the implants of choice in the treatment of trochanteric fractures. Conclusion: The historical contribution of German-speaking surgeons to understanding the issue of proximal femur fractures and their operative treatment is far more significant than presented in the historical studies published in English. [ABSTRACT FROM AUTHOR]

Background: Among the risk factors for nonunion are unchangeable patient factors such as the type of injury and comorbidities, and factors that can be influenced by the surgeon such as fracture treatment and the postoperative course. While there are numerous studies analyzing unchangeable factors, there is poor evidence for factors that can be affected by the physician. This raises the need to fill the existing knowledge gaps and lay the foundations for future prevention and in-depth treatment strategies. Therefore, the goal of this study was to illuminate knowledge about nonunion in general and uncover the possible reasons for their development; Methods: This was a retrospective analysis of 327 patients from 2015 to 2020 from a level I trauma center in Germany. Information about patient characteristics, comorbidities, alcohol and nicotine abuse, fracture classification, type of osteosynthesis, etc., was collected. Matched pair analysis was performed, and statistical testing performed specifically for atrophic long-bone nonunion; Results: The type of osteosynthesis significantly affected the development of nonunion, with plate osteosynthesis being a predictor for nonunion. The use of wire cerclage did not affect the development of nonunion, nor did the use of NSAIDs, smoking, alcohol, osteoporosis and BMI; Conclusion: Knowledge about predictors for nonunion and strategies to avoid them can benefit the medical care of patients, possibly preventing the development of nonunion. [ABSTRACT FROM AUTHOR]

To investigate the effect of sevoflurane inhalation anesthesia on hemodynamics in children undergoing lower limb fracture surgery. Between January 2019 and December 2021, 187 kids at our hospital were randomly divided into two distinct categories: the experimental category (95 cases) and the control category (92 cases). Sevoflurane inhalation anesthesia was administered to the experimental cohort whereas Ketamine basic anesthesia was administered to the control cohort. Comparisons were made among the two categories’ hemodynamic indices, anesthetic quality, and VAS ratings. When the eyelash reflex vanished, immediately after skin incision, as well as 5 min after skin incision, the SaO2, as well as MAP in the experimental group, were higher than those in the control category, while HR, SBP, as well as DBP were less than those in the control category. These variations were statistically noteworthy (P < .05). The onset of the experimental group’s sensory blocks and the awakening of patients was faster than the control category, and the variations were of statistical importance (P < .05). At 24 hours, 48 hours, and 72 hours, the VAS score in the experimental category was substantially distinct from that in the control category (P < .05). In addition to lowering postoperative discomfort and stabilizing hemodynamics, sevoflurane inhalation anesthesia helps speed up the onset and recovery of anesthesia block in children having lower extremity fracture surgery. [ABSTRACT FROM AUTHOR]

Purpose: To provide the first meta-analysis of the impact of magnetic resonance imaging (MRI) on thoracolumbar fractures (TLFs) classification and decision-making. Methods: A systematic review was conducted following PRISMA guidelines. We searched PubMed, Scopus, Cochrane, and Web of Science from inception to June 30, 2023 for studies evaluating the change in TLFs classification and treatment decisions after MRI. The studies extracted key findings, objectives, and patient population. A meta-analysis was performed for the pooled frequency of change in AO fracture classification or treatment decisions from surgical to conservative or vice versa after MRI. Results: This meta-analysis included four studies comprising 554 patients. The pooled frequency of change in TLFs classification was 17% (95% CI 9–31%), and treatment decision was 22% (95% CI 11–40%). An upgrade from type A to type B was reported in 15.7% (95% CI 7.2–30.6%), and downgrading type B to type A in 1.2% (95% CI 0.17–8.3%). A change from conservative to surgery recommendation of 17% (95% CI 5.0–43%) was higher than a change from surgery to conservative 2% (95% CI 1–34%). Conclusions: MRI can significantly change the thoracolumbar classification and decision-making, primarily due to upgrading type A to type B fractures and changing from conservative to surgery, respectively. These findings suggest that MRI could change decision-making sufficiently to justify its use for TLFs. Type A subtypes, indeterminate PLC status, and spine regions might help to predict a change in TLFs' classification. However, more studies are needed to confirm the association of these variables with changes in treatment decisions to set the indications of MRI in neurologically intact patients with TLFs. An interactive version of our analysis can be accessed from here: https://databoard.shinyapps.io/mri_spine/. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The indications for operative treatment and type of stabilization procedures for the treatment of thoracolumbar fracture remains controversial. Long-segment pedicle screw fixation permits correction of kyphotic deformity while short -segment pedicle screw fixation preserves motion segments, reduces costs and time of surgery. Our aim is to study the correlation and comparison between clinical and radiological outcome of both fixations and identify factors that might contribute to the outcome. MATERIALS AND METHODS: 60 patients with thoracolumbar spine fracture from 2017 to 2022 were identified. Age, gender, mechanism of injury, classification of fracture, duration of hospital stays and one-year post-operative outcome of Visual Analogue (VAS) pain score, and Oswestry Disability Index (ODI) score were documented. Pre- and post-operative AP/Lateral radiographs measurements of local kyphotic angle, Cobb angle were measured. Signs of fixation failure were examined at follow-up. RESULTS: Subjects mean age is 42.4, male predominance (85%) and workrelated. The highest incidence was at level of L1 (56.7 %) in the long-segment and 46.7 % in short-segment. Most common injury was burst fracture (AO classification A3 A4 group) due to fall from height. There is shorter hospital stay documented in the short-segment fixation. Radiological outcome measured in both groups were comparable with no signs of fixation failure. Short-segment fixation group also resulted in better clinical and functional outcome at one-year follow-up. CONCLUSION: There is no significant difference in radiologic outcome of Cobb and kyphotic angle in both fixation groups. Short-segment fixation has significantly better clinical and functional outcome post-operative and at 1-year follow up. [ABSTRACT FROM AUTHOR]

Introduction/purpose: SMART orthopedic systems use fixators with remote monitoring, processing, and communication capabilities to leverage healing progression data for personalized, real-time monitoring of a healing process. The fixators incorporate small and compact piezoelectric sensors that generate electrical signals upon the application of force to the piezoelectric diaphragm. This enables doctors to remotely guide fixation devices using indirectly and remotely controlled stepper motors known for their precision and accuracy. Reliability of stepper motors makes them a viable alternative for the mechanical tools traditionally used by doctors for fixator extension. Methods: This study focuses on the evaluation of sensor-based technology in orthopedic applications. The paper presents a theoretical framework for the application of SMART devices in the bone fracture healing process. It delves into the structure and functionality of piezoelectric transducers, offering a comprehensive insight into this technology and various engineering aspects of SMART systems. Results: The implementation of SMART systems has significantly enhanced doctor-patient communication. This improvement is facilitated through a dual-phase process involving gathering, processing, and transmitting the data wirelessly from the patient’s (sensor) interface to the doctor who uses specialized software for data analysis and wireless transmission to the stepper motor actuator. Subsequently, the data is forwarded to the decoder at the motor site, where a motor controller generates the control signal for the stepper motor driver. Conclusion: SMART implants can provide doctors with quantitative data that can be used in directing a rehabilitation plan. The sensor-based technology offers insights into the stress induced by the callus formation enabling bidirectional communication between the doctor and the patient. The stepper motor is a tool that aids in personalized treatment from the distance. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the feasibility and accuracy of a combined virtual surgical planning (VPS) and short-segment drilling guides (SSDGs) workflow for the treatment of complex mandibular fractures. Consecutive patients with complex mandibular fractures underwent treatment using the VPS and SSDGs workflow from August 2020 to April 2022. Various mandibular landmarks were compared between the preoperative virtual surgical plan and postoperative data, including condylar distance (CoD), mandibular angle width (GoL-GoR), GoMeGo angle (∠GoL-Me-GoR), the difference in mandibular angles between the left and right sides (Δ∠Co-Go-Me), and the difference in length between the left and right mandibular body (ΔGo-Me). Additionally, preoperative preparation time and surgical duration were retrospectively analyzed and compared to conventional surgery. All 14 consecutive patients with complex mandibular fractures achieved successful reduction using the VPS and SSDGs workflow. Three-dimensional comparison revealed a mean deviation distance of 0.91 ± 0.50 mm and a root-mean-square deviation of 1.75 ± 0.47 mm between the preoperative designed mandible model and the postoperative mandible model. The percentage of points with deviation distances less than 2 mm, 1 mm, and 0.5 mm between preoperative and postoperative models were 78.47 ± 8.87 %, 60.02 ± 14.28 %, and 38.64 ± 15.48 %, respectively. There were no significant differences observed in CoD, GoL-GoR, ∠GoL-Me-GoR, Δ∠Co-Go-Me, and ΔGo-Me between preoperative virtual surgical planning and postoperative measurements. Furthermore, no significant differences were found in the injury-to-surgery interval, admission-to-surgery interval, and surgical duration between the workflow and conventional surgery. The combined VPS and SSDGs workflow proved to be an accurate and feasible method for treating complex mandibular fractures. It offers advantages such as minimal preoperative preparation time and the ability to precise transfer screw positions of the pre-bent reconstruction plate during surgery. This approach is particularly suitable for managing complex mandibular fractures. This study assessed the feasibility and accuracy of a combined virtual surgical planning (VPS) and short-segment drilling guides (SSDGs) workflow for treating complex mandibular fractures. From August 2020 to April 2022, 14 consecutive patients with complex mandibular fractures underwent treatment using this workflow. Various mandibular landmarks were compared between the preoperative virtual surgical plan and postoperative data, along with analysis of preoperative preparation time and surgical duration in comparison to conventional surgery.Three-dimensional comparison revealed a mean deviation distance of 0.91 ± 0.50 mm and a root-mean-square deviation of 1.75 ± 0.47 mm between the VSP mandible model and the postoperative mandible model. The percentage of points with deviation distances less than 2 mm, 1 mm, and 0.5 mm between preoperative and postoperative models were 78.47 ± 8.87 %, 60.02 ± 14.28 %, and 38.64 ± 15.48 %, respectively. Additionally, the workflow did not differ significantly from conventional surgery in terms of the injury-to-surgery interval, admission-to-surgery interval, and surgical duration.The combined VPS and SSDGs workflow demonstrated its accuracy and feasibility for treating complex mandibular fractures. It offered benefits such as reduced preoperative preparation time and precise transfer of screw positions during surgery. This approach proves particularly suitable for managing complex mandibular fractures. [ABSTRACT FROM AUTHOR]

A definitive method to predictably treat propagated longitudinal fractures remains elusive. A proof-of-concept case report series documenting nonsurgical removal of propagated longitudinal fractures has shown up to 5 years of clinical and radiographic success. This installment of the case report series further documents these teeth with 7.5-year to 11.5-year recall evaluations. Three previously reported cases of fracture removal were followed at 11.5 years (1 case), 9.75 years (1 case), and 7.5 years (1 case) after treatment to determine the long-term clinical and radiographic success of nonsurgical fracture removal. This case report series has demonstrated 10-year success (clinically and radiographically) for the treatment of progressive longitudinal fractures. Propagated fractures can be nonsurgically removed and the iatrogenic defect repaired with long-term success providing a foundation for treatment and further investigation. [ABSTRACT FROM AUTHOR]

This study describes the age and sex distribution, trauma mechanism, treatment and influence of patient-reported outcomes of 6542 carpal fractures from the Swedish Fracture Registry (SFR). The most commonly fractured carpal bone was the scaphoid (60%), followed by the triquetrum (25%), hamate (5%) and trapezium (4%). The mean age at injury was 41 years, and 69% of patients were male. The age and sex distribution of carpal fractures differed substantially between the different carpal bones. Men were more likely to sustain a carpal fracture after high-energy trauma and were more likely to be treated surgically. Carpal fractures had a small negative effect on the Short Musculoskeletal Function Assessment Hand/Arm Index and EQ-5D scores 1 year after the injury. Level of evidence: IV [ABSTRACT FROM AUTHOR]

Trochanter minor fractures are generally seen in individuals aged 12 to 16 years, commonly associated with sports such as martial arts or self-defense techniques, while the growth plate is still open. The management of trochanter minor fractures in adolescents typically involves conservative methods including early quadriceps and hip exercises; surgery is reserved for a small number of cases. This case report discusses the management of a young patient who sustained a trochanter minor fracture following a scooter accident. The fracture was successfully treated using conservative measures during follow-up. [ABSTRACT FROM AUTHOR]

Purpose: Aim of the present study was to evaluate whether monitoring direct oral anticoagulant (DOAC) levels may improve management of anticoagulated patients who need surgery for hip fracture. Patients and Methods: A total of 147 out of 2231 (7.7%) patients with hip fracture admitted to a tertiary teaching hospital were on DOACs (group A), whereas 206 patients matched for age, sex, and type of fracture not on anticoagulant or P2Y12 platelet inhibitors were considered as control group (group B). Patients on DOACs were divided into two subgroups: A1 in which intervention was scheduled in relation to the last drug intake according to current guidelines, and A2 included patients in whom time of surgery (TTS) was defined according to DOAC levels. Neuraxial anesthesia was considered with DOAC levels < 30 ng/mL, general anesthesia for levels in the range 30– 50 ng/mL. Results and conclusions: TTS was significantly lower in controls than in DOAC patients: surgery within 48 hours was performed in 80.6% of group B versus 51% in group A (p< 0.0001). In A2, 41 patients underwent surgery within 48 hours (56%) in comparison to 32 A1 patients (45.1%; p=0.03). TTS and length of hospitalization were on average 1 day lower in patients with assay of DOAC levels. Finally, 35/39 (89%) patients with DOAC levels < 50 ng/mL had surgery within 48 hours (26 under neuraxial anesthesia, without any neurological complication, and 13 in general anesthesia). Conclusion: DOAC assay in patients with hip fracture may be useful for correct definition of time to surgery, particularly in patients who are candidates for neuraxial anesthesia. Two-thirds of patients with DOAC levels < 50 ng/mL at 48 hours from last drug intake underwent uneventful neuraxial anesthesia, saving at least 24 hours in comparison to guidelines. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the outcomes of early balloon kyphoplasty (BKP) intervention compared with late intervention for osteoporotic vertebral fracture (OVF). Background: Osteoporotic vertebral fracture can lead to kyphotic deformity, severe back pain, depression, and disturbances in activities of daily living (ADL). Balloon kyphoplasty has been widely utilized to treat symptomatic OVFs and has proven to be a very effective surgical option for this condition. Furthermore, BKP is relatively a safe and effective method due to its reduced acrylic cement leakage and greater kyphosis correction. Materials and Methods: A retrospective cohort study was conducted at our hospital for patients who underwent BKP for osteoporotic vertebral fractures in the time frame between January 2020 and December 2022. Ninety-nine patients were included in this study, and they were classified into two groups: in total, 36 patients underwent early BKP intervention (EI) at <4 weeks, and 63 patients underwent late BKP intervention (LI) at ≥4 weeks. We performed a clinical, radiological and statistical comparative evaluation for the both groups with a mean follow-up of one year. Results: Adjacent segmental fractures were more frequently observed in the LI group compared to the EI group (33.3% vs. 13.9%, p = 0.034). There was a significant improvement in postoperative vertebral angles in both groups (p = 0.036). The cement volume injected was 7.42 mL in the EI, compared with 6.3 mL in the LI (p = 0.007). The mean surgery time was shorter in the EI, at 30.2 min, compared with 37.1 min for the LI, presenting a significant difference (p = 0.0004). There was no statistical difference in the pain visual analog scale (VAS) between the two groups (p = 0.711), and there was no statistical difference in cement leakage (p = 0.192). Conclusions/Level of Evidence: Early BKP for OVF treatment may achieve better outcomes and fewer adjacent segmental fractures than delayed intervention. [ABSTRACT FROM AUTHOR]

Aim: The present study examined the effect of bonding the pericervical dentin using resin-modified glass-ionomer cement (RMGIC), nanohybrid composite (Endure Nano), and Biodentine on the fracture resistance of root-filled mandibular premolars. Methods: Twenty-four human single-rooted mandibular premolars were decoronated, cleaned, and shaped with ProTaper Universal till size F3. The roots were obturated with gutta-percha using a single-cone technique. The teeth were randomly grouped into four groups of n = 6 each. After removing the 3 mm coronal gutta-percha in Groups I, II, and III, the intra-orifice barriers of RMGIC, nanohybrid composite (Endure Nano), and Biodentine were placed, respectively. Group IV served as the control. The fracture resistance of the specimens was analyzed using the universal testing machine. The derived data were statistically evaluated using one-way ANOVA and post hoc Tukey's honestly significant difference test. Results: A significantly high fracture strength was exhibited by specimens of Group I, followed by Groups II and III, respectively. The lowest fracture strength was shown by the control group. Conclusion: Within the limitation of the present study, the fracture resistance of an endodontically treated tooth was significantly influenced by the type of intra-orifice barrier. [ABSTRACT FROM AUTHOR]

Natural fractures and wormholes strongly influence the performance of acid fracturing in naturally fractured carbonate reservoirs. This work uses an integrated model to study the effects of treatment parameters in acid fracturing in different reservoir conditions. Hydraulic fracture propagation, wormhole propagation, complex fluid leak-off mediums, and heat transfer are considered in the modeling. The model is validated in several steps by analytical solutions. The simulation results indicated that natural fractures and wormholes critically impact acid fracturing and can change the predicted outcomes dramatically. The high permeability reservoirs with conductive natural fractures or low permeability reservoirs with natural fracture networks showed the highest stimulation potential in applying acid fracturing technology. The optimal acid injection rate depends on natural fracture geometry and reservoir permeability. This study also observed that obtaining a high production index is difficult because natural fractures and wormholes reduce the acid efficiency during acid fracturing. Building an acid-etched fracture system consisting of acid-etched natural fractures and hydraulic fractures may help us better stimulate the naturally fractured carbonate reservoirs. The paper illustrates a better understanding of the effects of the treatment design parameters on productivity. It paves a path for the optimal design of acid fracturing treatment for heterogeneous carbonate reservoirs. [ABSTRACT FROM AUTHOR]

Natural fractures and cavities are the primary spaces for oil and gas accumulation in fracture-cavity carbonate reservoirs. Establishing the connection between these spaces and the wellbore through hydraulic fracturing treatment is important for oil and gas extraction from such reservoirs. Due to the discontinuity and heterogeneity of the existing natural fracture-cavity system, anticipating the viability of hydraulic fracturing treatment is troublesome. A new method to simulate the hydraulic fracturing propagation in fracture-cavity reservoirs is proposed based on the continuous damage theory. The method considers the random spatial distribution of fractures and cavities and can simulate the arbitrary expansion of hydraulic fractures in the three- dimensional direction. Based on this method, the influence of different geological and engineering factors on the propagation patterns of hydraulic fractures in the fracture-cavity reservoirs is investigated. It is found that the increase of reservoir burial depth significantly limits the propagation ranges of hydraulic fractures. The propagation modes of hydraulic fractures encountering natural fractures change with increasing burial depth, undergoing a transition from "penetrate and deflect" to "defect" and then to "penetrate". The reduction of horizontal stress difference increases the complexity of hydraulic fractures, but it is not conducive for hydraulic fractures to connect more natural fractures and cavities. The increase in fracturing pump rate is significantly beneficial for hydraulic fractures to connect more natural fractures and cavities. The viscosity of fracturing fluid has a significant impact on the morphology of hydraulic fracture propagation, which undergoes a transition from simple to complex, and then to simple with the change of the fracturing fluid viscosity from low to high. either too high or too low viscosity of the fracturing fluid is not conducive to the connection of more natural fractures and cavities by hydraulic fractures. The obtained conclusions can provide a reference for the design of hydraulic fracturing treatment for fracture-cavity carbonate reservoirs. [ABSTRACT FROM AUTHOR]

Background: The biomechanical outcomes of intra-articular calcaneal fracture treatment have not been fully explored. The purpose of this study was to analyze pedobarographic assessments of balance and body weight distribution over the lower limbs in patients following calcaneal fracture treatment with the Ilizarov method and to compare the results with those of a control group. Materials and Methods: The data for our retrospective study came from cases of intra-articular calcaneal fractures treated with the Polish modification of the Ilizarov method in the period between 2021 and 2022. The experimental group (21 patients; 7 women, 14 men) included Sanders classification calcaneal fractures type 2 (n = 3), type 3 (n = 5), and type 4 (n = 13). The control group comprised 21 sex-matched healthy volunteers, with no significant differences from the experimental group in terms of age or BMI. The examination included an assessment of balance and weight distribution over the lower limbs. The device used was a FreeMED MAXI pedobarographic platform (SensorMedica). Results: The mean displacement of the center of gravity in the experimental group was significantly higher at 1307.31 mm than in the control group (896.34 mm; p = 0.038). The mean area of the center of gravity was not significantly different between the groups. An analysis of weight distribution over the operated and uninjured limb in the experimental group and the non-dominant and dominant limb, respectively, in the control group revealed no significant differences. We observed no significant differences in the percentage of weight distribution over the lower limbs between the operated limb in the experimental group and the non-dominant limb in the control group, or between the uninjured limb in the experimental group and the dominant limb in the control group. Conclusions: The use of the Ilizarov method in calcaneal fracture treatment helps normalize the percentage weight distribution in the lower limbs, with the results comparable with those obtained in the healthy control group. The mean displacement of the center of gravity was worse in the experimental group than in controls; whereas the mean area of the center of gravity was comparable between the two groups. Treatment of calcaneal fractures with the Ilizarov method does not help achieve completely normal static parameters of lower-limb biomechanics. Patients treated for calcaneal fractures with the Ilizarov method require longer and more intense rehabilitation and follow-up. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the influence of heat treatment on fracture resistance (FR) of different ceramic materials used for CAD/CAM systems. Methods: Eighty monolithic restorations were designed using the same parameters and milled with a CAD/CAM system (CEREC SW 5.0, PrimeMill, Dentsply-Sirona™, Bensheim, Germany), forming five study groups: Group 1 (n = 10), CEREC Tessera (Dentsply-Sirona™, Bensheim, Germany) crystallized (CCT), Group 2 (n = 10), CEREC Tessera uncrystallized (UCT), Group 3 (n = 20), Emax-CAD (Ivoclar Vivadent, Schaan, Liechtenstein) (CEC), Group 4 (n = 20), Vita Suprinity (Vita Zahnfabrik, Bad Säckingen, Germany) (CVS), and Group 5 (n = 20) Cameo (Aidite, Qinhuangdao, China) (CC). Results: The average FR was similar for CCT, CC, and CEC at above 400 N, while CVS and UCT had the lowest values at 389,677 N and 343,212 N, respectively. Conclusion: Among the three ceramic materials that exhibited an FR above 400 N, CCT was considered the first recommended choice for CAD/CAM systems. This material not only demonstrated the highest FR but also exhibited outstanding consistency in the related measurements without the presence of outliers. Although the CC material showed high FR, its high dispersion revealed inconsistencies in the repetitions, suggesting caution in its use. [ABSTRACT FROM AUTHOR]

Featured Application: Interfragmentary movement is crucial in promoting callus formation during secondary fracture healing. Fixation stiffness is a critical factor, with excessive flexibility and rigidity hindering optimal healing. The concepts of flexible fixation, techniques for regulating implant stiffness, and material selection, favoring a lower Young's modulus like titanium alloys, are emphasized. A novel TiNbSn alloy with a low Young's modulus has been introduced as a potential solution that has shown efficacy in promoting osteosynthesis and superior mechanical properties. The bone healing process is influenced by various physiological factors. Fracture fixation traditionally relied on rigid metallic implants. However, excessively rigid constructs can lead to complications, necessitating revision surgery. This review focuses on approaches to improve bone healing by introducing adequate interfragmentary movement (IFM) at the fracture site. IFM promotes secondary fracture healing and callus formation. Studies suggest that rigid fixation may impair fracture healing by inhibiting callus formation and causing stress shielding. Titanium alloy locking plates have been shown to be biomechanically superior to stainless steel. Flexible fixation and techniques to regulate implant stiffness are crucial for managing fractures with bridge plating. Materials with a lower Young's modulus balance biomechanical properties. A novel TiNbSn alloy with a low Young's modulus has been developed to address stress shielding issues. It is effective in promoting osteosynthesis, bone healing, and superior mechanical properties compared with materials with higher Young's moduli. The enhanced formation of bone and callus associated with TiNbSn alloy suggests its promise for use in fracture treatment plates. Understanding the biomechanics of fracture healing, optimizing fixation stiffness, and exploring innovative materials like TiNbSn alloys, are crucial for advancing approaches to accelerate and enhance bone healing. [ABSTRACT FROM AUTHOR]

Purpose: To compare the types of facial fractures and their treatment in bicyclists admitted to a level 1 trauma centre with major and minor-moderate head injury. Methods: Retrospective analysis of data from bicycle-related injuries in the period 2005–2016 extracted from the Oslo University Hospital trauma registry. Results: A total of 967 bicyclists with head injuries classified according to the Abbreviated Injury Scale (AIS) were included. The group suffering minor-moderate head injury (AIS Head 1–2) included 518 bicyclists, while 449 bicyclists had major head injury (AIS Head 3–6). The mean patient age was 40.2 years (range 3–91 years) and 701 patients (72%) were men. A total of 521 facial fractures were registered in 262 patients (on average 2 facial fractures per bicyclist). Bicyclists with major head injury exhibited increased odds for facial fractures compared to bicyclists with minor-moderate head injury (sex and age adjusted odds ratio (OR) 2.75, 95% confidence interval (CI) 2.03–3.72, p < 0.001. More specifically, there was increased odds for all midface fractures, but no difference for mandible fractures. There was also increased odds for orbital reconstruction in cyclist with major head injury compared to bicyclist with minor-moderate head injury (adjusted OR 3.34, 95% CI 1.30–8.60, p = 0.012). Conclusion: Bicyclists with more severe head injuries had increased odds for midface fractures and surgical correction of orbital fractures. During trauma triage, the head and the face should be considered as one unit. [ABSTRACT FROM AUTHOR]

Background: The incidence of all periprosthetic fractures (PPF), which require complex surgical treatment associated with high morbidity and mortality, is predicted to increase. The evolving surgical management has created a knowledge gap regarding its impact on immediate outcomes. This study aimed to describe current management strategies for PPF and their repercussions for in-hospital outcomes as well as to evaluate their implications for the community. Methods: PIPPAS (Peri-Implant PeriProsthetic Survival Analysis) was a prospective multicentre observational study of 1387 PPF performed during 2021. Descriptive statistics summarized the epidemiology, fracture characteristics, management, and immediate outcomes. A mixed-effects logistic regression model was employed to evaluate potential predictors of in-hospital mortality, complications, discharge status, and weight-bearing restrictions. Results: The study encompassed 32 (2.3%) shoulder, 4 (0.3%) elbow, 751 (54.1%) hip, 590 (42.5%) knee, and 10 (0.7%) ankle PPF. Patients were older (median 84 years, IQR 77–89), frail [median clinical frailty scale (CFS) 5, IQR 3–6], presented at least one comorbidity [median Charlson comorbidity index (CCI) 5, IQR 4–7], were community dwelling (81.8%), and had outdoor ambulation ability (65.6%). Femoral knee PPF were most frequently associated with uncemented femoral components, while femoral hip PPF occurred equally in cemented and uncemented stems. Patients were managed surgically (82%), with co-management (73.9%), through open approaches (85.9%) after almost 4 days (IQR, 51.9–153.6 h), with prosthesis revision performed in 33.8% of femoral hip PPF and 6.5% of femoral knee PPF. For half of the patients, the discharge instructions mandated weight-bearing restrictions. In-hospital mortality rates were 5.2% for all PPF and 6.2% for femoral hip PPF. Frailty, age > 84 years, mild cognitive impairment, CFS > 3, CCI > 3, and non-geriatric involvement were candidate predictors for in-hospital mortality, medical complications, and discharge to a nursing care facility. Management involving revision arthroplasty by experienced surgeons favoured full weight-bearing, while an open surgical approach favoured weight-bearing restrictions. Conclusions: Current arthroplasty fixation check and revision rates deviate from established guidelines, yet full weight-bearing is favoured. A surgical delay of over 100 h and a lack of geriatric co-management were related to in-hospital mortality and medical complications. This study recommends judicious hypoaggressive approaches. Addressing complications and individualizing the surgical strategy can lead to enhanced functional outcomes, alleviating the economic and social burdens upon hospital discharge. Level of Evidence Level IV case series. Trial registration: registered at ClinicalTrials.gov (NCT04663893), protocol ID: PI 20-2041. [ABSTRACT FROM AUTHOR]

Purpose: Many studies have been conducted to evaluate the effects of nail shape, design, or length on the treatment of intertrochanteric fractures. However, the clinical implications of the nail diameter remain unclear. Methods: This study was conducted with 191 patients aged ≥ 50 years with unilateral intertrochanteric fractures treated with the same type of short cephalomedullary nail and followed for at least one year. We recorded the reduction type, tip–apex distance, cortical contact of the nail, and nail/canal diameter ratio (NCR) just distal to the locking screw. The effects of nail diameter on the clinical results were evaluated. Results: The average NCR was 68.7. The average union time was 4.78 months. Delayed union or nonunion was seen in 17 patients. Eight patients underwent additional surgery. The mean change in the modified Koval activity score was –0.84. The NCR did not significantly affect the clinical results. Comparisons of cases with NCRs above and below the average and the average – 1 standard deviation revealed no significant difference. The clinical outcome was not related to any variable associated with the nail diameter. Conclusion: With this specific proximal femoral nail, a small diameter relative to that of the femoral canal had no adverse effect on the union of osteoporotic intertrochanteric fractures, even in patients with unstable fractures and those who had unsatisfactory reductions. [ABSTRACT FROM AUTHOR]

Patella fractures usually occur as a result of direct trauma to the anterior knee joint, indirect injury as a result of eccentric muscle contraction, or rapid knee flexion against a contracted quadriceps muscle. The patella functions as part of the extensor mechanism of the knee, where large forces are transmitted, and its subcutaneous nature has made treatment of patella fractures a challenge. In this review article, we evaluate how the management of these fractures has evolved over time and the advantages associated with the various treatment techniques. There are few comparative studies looking at the different treatment types for fractures of the patella, with the goal of achieving a functional extensor mechanism with low rates of post-traumatic arthritis and metal-work irritation. [ABSTRACT FROM AUTHOR]

Sacroiliac joint (SIJ) pain commonly affects patients with low back pain and can arise from traumatic and degenerative causes. However, the incidence of SIJ pain following lumbar fractures is not well understood. TriNetX, a national network of deidentified patient records, was retrospectively queried. The lumbar fracture cohort included 239,199 adults, while the no lumbar fracture group included 6,975,046 adults. Following a propensity-score match based on demographics and risk factors for SIJ, there were 239,197 patients in each cohort. The incidence of SIJ pain and clinical outcomes were analyzed from 1 day to 1 year following the index event. Moreover, the location and type of single-level lumbar fractures were reported. The incidence of SIJ pain for single-level fractures was compared using a χ2 goodness-of-fit. The lumbar fracture cohort was more likely to develop SIJ pain at 3 months (odds ratio [OR]: 5.3, 95% confidence interval [CI]: 4.8–5.9), 6 months (OR: 4.4, 95% CI: 4.1–4.8), and 1 year (OR: 3.9, 95% CI: 3.6–4.2) postfracture. Among single-level lumbar fractures, the incidence of SIJ pain at 1 month (P = 0.005), 6 months (P = 0.010), and 1 year (P = 0.003) varied significantly, with the highest incidence in the L5 cohort. Our findings suggest that lumbar fractures are a risk factor for developing SIJ pain. Moreover, the incidence of SIJ pain is greater following an L5 fracture than an L1 fracture. Further investigation is warranted to determine how the type and treatment of lumbar fractures affects the incidence of SIJ pain. [ABSTRACT FROM AUTHOR]

This review examined the use of total hip arthroplasty as therapeutic option for management of chronic fracture of acetabulum accompanied by osteoarthritis. The article discussed the epidemiology, risk factors, and potential complications associated with this complex condition, as well as its increasing prevalence among the elderly population. The rationale for combining total hip arthroplasty with fracture fixation was discussed, along with the potential benefits of pain relief, increased stability, enhanced long-term outcomes, and decreased healthcare costs. The article also examined the potential risks and complications associated with this approach, as well as the significance of a multidisciplinary treatment approach that takes each patient's unique requirements and goals into account. Overall, it provided a comprehensive overview of the challenges and considerations involved in managing an old fracture of the acetabulum in conjunction with osteoarthritis and emphasized the potential role of total hip arthroplasty as a treatment option for this complex condition. [ABSTRACT FROM AUTHOR]

Background: Gunshot-related fractures near the elbow are challenging, and available data to guide the practitioner are lacking. This report analyzes injury patterns and treatment strategies in a case series from a high-volume urban trauma center. Methods: All periarticular gunshot fractures near the elbow treated at a level 1 trauma center from 2014 to 2018 were retrospectively reviewed. Fracture location, patient demographics, concomitant injuries, treatment modalities, and complications were analyzed. Results: Twenty-four patients were identified. All patients received prophylactic antibiotics upon admission and underwent urgent surgical debridement. Open reduction and internal fixation (ORIF) was performed with initial debridement in 22 of 24 patients. Seven patients sustained distal humerus fractures, 10 patients sustained isolated proximal ulna or proximal radius fractures, and seven had combined fracture patterns. Eleven patients presented with nerve palsy, and two had transected nerves. Two patients had vascular injury requiring repair. One patient required a temporary elbow-spanning external fixator and underwent staged debridement followed by ORIF. One patient with a grade IIIC fracture developed a deep infection that precluded ORIF. One patient required revision ORIF due to fracture displacement. Conclusions: This investigation reports on management of ballistic fractures near the elbow at a busy urban level I trauma center. Our management centered on rapid debridement, early definitive fixation, and intravenous antibiotic administration. We report on associated neurovascular injury, bone loss, and other challenges in this patient population. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Introduction: As the elderly population grows, the number of hip fractures continues to increase. Aim and Objective: To compare the clinical outcomes of DHS and PFN in the fixation of intertrochanteric fractures of the femur. Material and Method: A comparative study was conducted in the Department of Orthopaedics, MLB Medical College, Jhansi, Uttar Pradesh. 90 inter-trochanteric hip fractures were surgically treated between January 2023 and January 2024 at our institution. Result: A total of 50 patients were included in the study. The mean age in Group DHS was 63 and in Group PFN was 64. In the group of DHS, 13 out of 25 patients were male, and 12 out of 25 patients were female. In a group of PFN, 14 out of 25 patients were male and 11 out of 25 patients were female. The mean six-week score in Group DHS was 34.38 ± 3.27 out of 50, and in Group PFN it was 32.64 ± 2.99 out of 50. The mean Harris hip score in Group DHS was 90.68 ± 5.22 out of 50. The mean Harris hip score in Group PFN was 93.68 ± 3.76 out of 50. In Group DHS, 56% had injuries on the left side and 44% on the right side. In Group PFN, 20% had injuries on the left side and 80% on the right side. In Group DHS, results were excellent in 36% (9 patients), good in 44% (10 patients), fair in 16% (four patients out of 23 patients), and poor in 4% (one patient). In Group PFN, results were excellent in 48 (12 patients), good in 40% (10 patients), and fair in 12% (3 patients). Conclusion: From the study, it can be concluded that PFN had a better outcome in intertrochanteric fractures compared to DHS. The highest percentage of subjects in the PFN group had excellent to good outcomes, and none of them had poor outcomes when compared to the DHS group. [ABSTRACT FROM AUTHOR]

This article delves into the intricate domain of proximal humerus fractures, exploring the efficacy of reverse shoulder arthroplasty as a surgical intervention. Through a meticulous review of literature, we aim to provide a comprehensive understanding of the inclusion and exclusion criteria, investigations, materials, methods, and results associated with this innovative approach. [ABSTRACT FROM AUTHOR]

Background: Preoperative planning is generally performed to simulate the process of reduction as well as to determine the size and placement of implants in patients undergoing distal radius fracture surgery. We previously described a three-dimensional (3D) digital preoperative planning system for the osteosynthesis of distal radius fractures, and we have developed a novel intraoperative referencing system that superimposes preoperative planning (such as plate position and length) onto fluoroscopic images during surgery; however, its efficacy has not been evaluated compared with conventional planning and surgery. Questions/purposes: Does use of a novel intraoperative referencing system result in (1) better Mayo wrist scores at 3 and 6 months after surgery and (2) less loss of reduction in terms of ulnar variance, palmar tilt, and radial inclination on plain radiographs taken 1 week, 3 months, and 6 months after surgery compared with conventional preoperative planning? Methods: Between April 2014 and October 2021, we treated 294 patients with open reduction and volar plate fixation for distal radius fractures. Of 294 patients, 65% (191) underwent surgery using either conventional preoperative planning or a novel intraoperative referencing system. The remaining patients were excluded because they were younger than 18 years, they had some missing medical records related to the clinical outcomes, or they had a previous history of upper extremity injuries. During that time, we generally treated fractures with volar plates when there was: more than 2 mm of stepoff/gap in the articular surface, a dorsal tilt more than 15°, radial inclination less than 15°, or radial shortening more than 5 mm. Generally, we used a flexor carpi radialis approach. In some patients who had dorsal fragments, we added a dorsal approach. At that time, we were developing the new intraoperative referencing system, so it was not used consistently. To arrive at a fair assessment, we opted to perform propensity matching based on age, gender, and AO fracture type. During the period in question, 36% (69 of 191) of patients with distal radius fractures who received a volar plate were treated using our novel intraoperative referencing system, and 64% (122 of 191) had surgery using conventional preoperative planning (control group). Of those, 91% (63 of 69) of patients who were treated with the intraoperative referencing system and 89% (108 of 122) of those in the control group were available for follow-up with all imaging and Mayo wrist scores at least 6 months after surgery. After propensity matching, that left us with two groups of 39 patients, who were well matched in terms of age and fracture type; these were the study groups. We also tried to match them according to gender, but there were fewer patients in the intraoperative referencing group, and the percentage of women for each group differed: 70% (44 of 63) in the intraoperative referencing group and 76% (82 of 108) in the control group. Also, there were fewer men with C3 fractures in the control group. Therefore, 64% (25 of 39) of patients in the intraoperative referencing group were women and 77% (30 of 39) of patients in the control group were women. In the intraoperative referencing group, our novel intraoperative referencing system was used in combination with the 3D digital preoperative planning system for preoperative planning. In the control group, preoperative planning was performed manually in a conventional manner using tracing paper and implant templates or using a digital template. We compared the groups in terms of operative duration, the radiation dose used in surgery, and Mayo wrist scores at 3 and 6 months after surgery. We also compared the groups in terms of loss of reduction on ulnar variance, palmar tilt, and radial inclination on plain radiographs taken 3 months and 6 months after surgery. We considered the plain radiograph taken 1 week after surgery as a baseline. Each item was compared between the image fusion and control groups using a Welch t - test. Results: Mayo wrist scores were no different between the intraoperative referencing system and the control group at 3 months (71 ± 7 versus 72 ± 11, mean difference 1 [95% CI -3.7 to 5.7]; p = 0.07) or at 6 months after surgery (76 ± 6 versus 79 ± 11, mean difference 3 [95% CI -3.5 to 7.9]; p = 0.12). There were no differences in surgical duration or radiation doses between the intraoperative referencing and control groups. We found only a small advantage in favor of the intraoperative referencing system in terms of loss of reduction on ulnar variance (3 months after surgery: 0.2 ± 0.4 mm versus 0.6 ± 0.7 mm, mean difference 0.4 mm [95% CI 0.15 to 0.69]; p = 0.003, 6 months after surgery: 0.4 ± 0.6 mm versus 0.8 ± 0.8 mm, mean difference 0.4 mm [95% CI 0.05 to 0.73]; p = 0.02 for the intraoperative referencing system and the control group, respectively). This difference in radial shortening was so small that it was not likely to have been clinically important. Conclusion: We found no clinically important advantages from the use of our novel intraoperative referencing system except a slight improvement in ulnar variance. Therefore, we recommend against its use in everyday practice at this time. However, future improvements may lead to better clinical outcomes, so we plan further investigations. Level of Evidence: Level III, therapeutic study. [ABSTRACT FROM AUTHOR]

The aim of the present study was to explore the incidence of corrective osteotomies after conservatively treated distal radial fracture and the risk for late correction depending on the patient's age. Based on data from the Finnish National Care Register of Health Care, Specialist Care, on all corrective osteotomies carried out in Finland during 2015–2019 in adults aged ≥20 years, we calculated the mean annual incidence rates per 100,000 person-years, standardized with the European Standard Population 2013. Using multivariable logistic regression, we calculated the risk of corrective osteotomies in various age groups. In total, 41,418 distal radial fractures were identified. Of those, 10,577 received surgical treatment in the acute phase. The incidence rate of primary operations for distal radial fractures was 47.9 per 100, 000 person-years. A total of 321 conservatively treated fractures needed corrective osteoteomy, with a surprisingly low mean annual incidence rate of 1.5 per 100,000 person-years. The risk for this was highest in patients in their fourth or fifth decade. Level of evidence: III [ABSTRACT FROM AUTHOR]

Purpose: The spectrum of firearm injuries (FI) is broad and challenging for physicians in terms of diagnosis and treatment. The bullets and pellet ammunition used in FI exhibit different ballistic patterns and cause quite different damage to the body. The aim of this study was to compare the outcomes of bullet and pellet injuries causing bone fractures in the extremities. Method: The files of patients who were injured in their extremities due to civilian FI between 2016 and 2020 and who were followed up by the orthopedic clinic due to bone fractures were retrospectively analyzed. Age, gender, injured extremity, presence of infection, presence of vascular injury, presence of nerve injury, total number of operations, length of hospital stay and permanent sequelae were evaluated. Cases with missing files were excluded from the study. Evaluation criteria were compared under two main headings for bullet and pellet ammunition types. Results: There were a total of 40 cases with a mean age of 43.5 years. The mean follow-up period was 41.5(24-61) months. 39 of the cases were male and 1 was female. There were 28 bullet injuries and 12 pellet injuries. Thirty-two of the cases were lower extremity injuries and 8 were upper extremity injuries. There were significant differences between ammunition type and number of operations (p=0.032). The length of hospital stay was significantly higher in the pellet group (p=0.024, p=0.024. Overall, 12.5% infection, 10% vascular damage, 17.5% nerve damage and 30% permanent sequelae occurred as a result of treatments. There were no significant differences between the groups in terms of infection, vascular injury, nerve injury and permanent sequelae. Conclusion: It was concluded that pellet injuries require longer hospital stays and a higher number of surgeries compared to bullet injuries. [ABSTRACT FROM AUTHOR]

Purpose: A randomized controlled trial was performed to evaluate the effects of light-emitting diode (LED) therapy on sensory changes in the inferior alveolar nerve after surgical treatment of mandibular fractures. Methods: Patients admitted with surgically treated mandibular fractures between January 2018 and December 2019 were evaluated. Personal data, fracture location, fracture type, and dislocation degree were obtained. The cases were randomly allocated into two groups: LED therapy (LEDT) (57 points of 660 nm and 74 points of 850 nm, 6.4 mV/cm2, and 7.64 J) with the use of a prototype device and control (CTRL). For 6 months, tactile and thermal tests were used in the mental region. Data were analyzed using the Mann─Whitney U test and likelihood ratio test (p ≤ 0.050). Results: The study included 42 patients, 25 of whom had bilateral fractures and 17 had unilateral fractures, totaling 67 fractures. The mean values of the tactile and thermal sensitivity tests were lower in the LEDT group in all evaluation periods. There was a significant difference between the groups in the parasymphysis location, displacement < 5 mm, and intraoral access. Sensory changes were observed in 68.7% of all fractures upon admission, with 91.2% in the LEDT group and 78.8% in the CTRL group demonstrating complete remission during the final period of the study. Conclusion: LED photobiomodulation accelerated the process of sensory change remission. There was an influence of the fracture location, degree of displacement, and surgical access, with a better response in the LEDT group. [ABSTRACT FROM AUTHOR]

Background: Choosing an appropriate course of treatment for midface fracture can be challenging due to the variable presentations of midfacial fractures and concurrent orbital floor injuries. Objectives: To evaluate complications of midface fracture including the orbital floor. Materials and Methods: It was a cross‑sectional study carried out on 456 patients diagnosed with midface fracture, including the orbital floor, clinically and radiographically. The computed tomography radiograph of each study participant was evaluated. There was a thorough clinical assessment of each study participant. Results: There were complications like laceration (47.3%), hematoma (54.2%), infraorbital nerve paraesthesia (13.05%), Contusio bulbi (13.30%), and diplopia (13.35%). No complications were observed in 8.25% of study participants. The most common complication was laceration. Conclusion: The eyeball, orbit, soft tissues, and surrounding structures should be precisely examined clinically and radiologically in midface fractures. [ABSTRACT FROM AUTHOR]