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Background: This study aims to describe a new surgical technique for the treatment of ping-pong skull fractures and to evaluate its efficacy in a realistic simulation model compared to the dissector elevation technique. Methods: A total of 64 fractures were obtained using 16 model units, each with four fractures (two frontal and two parietal). The hammer puller technique was applied for left-sided fractures and the dissector technique for rightsided fractures. The variables evaluated were fracture repair time, fracture volume, fracture corrected volume, and fracture correction percentage. Fractures were separated into groups according to the surgical technique used (hammer or dissector) and the bone fractured (frontal or parietal). Statistical analysis was performed with Jamovi® software (version 2.3) using Student's t-test. Results: A complete degree of fracture correction was achieved with both techniques, demonstrating a sufficient performance in the correction of the deformity. The hammer technique was shown to be faster in correcting frontal bone depressions with 20.1 ± 7.8 s compared to 31.3 ± 4.7 s for the dissector technique, P < 0.001. There was no statistically significant difference for parietal applications (P = 0.405). Conclusion: This study describes a new minimally invasive surgical technique for the treatment of ping-pong fractures. Comparative analysis showed that both techniques were equally effective but that the hammer puller technique was more efficient than the dissector elevation technique, especially for frontal bone fractures. [ABSTRACT FROM AUTHOR]

Background and Objectives: Korean and traditional Chinese medicine state that pyrite is effective for fracture treatment, but supporting clinical data are limited. This systematic review aimed to investigate the therapeutic role of Chinese patent medicine containing pyrite (CPMP) in clinical treatment for fractures. Materials and Methods: Seven electronic databases were searched using the keywords "pyrite", "pyritum", and "zirantong" between inception and December 2022, yielding 29 published clinical studies. Randomized controlled trials that included CPMP were considered eligible regardless of the fracture type. Quality assessment and meta-analysis of the included RCTs were also performed. Results: Most studies showed high heterogeneity (I2 > 50%) and significant results (p < 0.05). Compared to the results of the control group, CPMP was more effective in terms of the primary outcome related to the efficacy rate, including the total effective rate, callus growth rate, bone union, and edema disappearance time (all p < 0.00001) and in terms of secondary outcomes related to pain reduction, namely pain intensity and pain disappearance time, than the control group (both p < 0.01). CPMP was more effective than the control group in terms of erythrocyte sedimentation rate (p < 0.01), hematocrit (p < 0.01), erythrocyte aggregation (p < 0.05), and plasma viscosity (p < 0.05). CPMP did not cause serious side effects, and the incidence of complications was significantly less than that in the control group. Conclusions: CPMP may be a safe and effective alternative treatment for fractures and may be beneficial in preventing postoperative complications, reducing pain, relieving symptoms, and accelerating healing. [ABSTRACT FROM AUTHOR]

Introduction: Orthopaedic doctors see many cases of distal tibial fractures every year. Our goal is to investigate and contrast the healing, functional, and complication rates of extra articular distal tibia fractures treated with multidirectional interlocking intramedullary nails and anterolateral locking compression plates. Materials and Methods: Our study utilized a sample size of 20 individuals who presented with distal tibial fractures. The age range of participants in the nail group was 33 to 55 years, whereas in the plating group, the age range was 27 to 60 years. The current investigation was carried out from August 2022 to July 2023 at the Department of Orthopaedics, King George Hospital, Visakhapatnam, Andhra Pradesh, India, utilizing both retrospective and prospective methodologies. Results: The average time for union in the multidirectional interlocking intramedullary group was found to be 4.5 months, but in the plating group, it was 6.4 months. This difference was statistically significant. Additionally, the mean duration for partial and full weight bearing in the nailing group was 4.2 weeks and 9.6 weeks, respectively, which exhibited a statistically significant reduction compared to 7.12 weeks and 13.42 weeks in the plating group. The interlocking group had reduced instances of implant discomfort, ankle stiffness, and infection in comparison to the plating group. Conclusion: Our research led us to conclude that closed intramedullary interlocking nailing is the treatment of choice for distal tibia fractures because it allows for early weight bearing, promotes early fracture union, and reduces implant-related complications. For distal tibiofibular fractures, intramedullary nailing or locking plate fixation is advised. [ABSTRACT FROM AUTHOR]

Background: Both bone forearm fractures in adults are the most commonly encountered fractures in day-to-day practice, accounting for almost 31% of all upper limb fractures. Objectives: Evaluation of the functional outcome of surgical management of both bones for a forearm fracture with a locking compression plate. Materials & Methods: The present prospective study consisted of 60 patients of both genders presenting with fractures of both bones of the forearm presented in the orthopaedic department. Approval was given by the institutional ethical committee, and informed consent was obtained from each patient. Results: Out of 60 patients, 39 (65%) were males and 21 (35%) were females. The patients' ages ranged from 18 to 70 years were included in the present study. The mean age of patients was 34.50 years. The incidence of mode of injury causing both bone forearm fractures was found to be maximum in motorbike accidents 33(55%); 12 patients (20%) sustained fractures due to falls from height; and the minimum caused by physical assault was 3 patients (5%). Conclusion: The present study indicates that open reduction and internal fixation of fractures in both bones of the forearm with a locking compression plate are safe and effective options for fixation and provide excellent functional outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Intertrochanteric fractures are the most common, especially in elderly people with osteoporotic bones. They typically occur as a result of low-energy trauma, such as a simple fall. There is a bimodal age distribution for hip fractures. Only 3% of patients under the age of 50 years, while 97% of patients over 50 years of age. The goal of this study is to compare PFN and DHS outcomes and complications when treating patients with unstable intertrochanteric fractures. Methods and Methodology: This study consists of 30 cases of intertrochanteric fractures of femur that met the inclusion exclusion criteria, which randomly divided into group A and group B. Results: Anatomical results were assessed by the presence or absence of shortening, the range of movements and deformities.73.33% of these cases had good results in PFN series as compared to 66.66% in DHS series. Functional results were assessed in the 30 cases based on modified harris hip scoring system. These constituted of 15 cases in PFN series and 15 cases in DHS series. In PFN Series, results were excellent results in 11 cases, good in 4 cases. In DHS Series, results were excellent in 7 cases, good in 6 cases and poor in 2 cases. Conclusion: In the light of these results, one can conclude that the proximal femoral nail, despite a few unfavorable results and complications, it is a satisfactory method of treatment in intertrochanteric fractures, with Comminution and instability. Results with intramedullary devices have been very good with union ratesupto 100% compared with other extra medullary devices which show union upto 80% only. The nail in the medullary canal provides a physical block to a significant shortening of the head and neck segments in the fractures. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study was to assess the management with interlocked nail in treatment of acute fracture shaft humerus and to compare its effectiveness with well-established method of plate fixation. Methods: The present study of management of acute humeral shaft fractures by antegrade interlocking nail fixation and dynamic compression plating was undertaken in the Department of Orthopaedic for the period of 2 years. The average follow-up period was one year (range 10-24 months). 100 patients were included in the study. Results: There was preponderance of male over female with majority population in 31-40 years age group. The youngest patient was of 28 years and oldest was of 65 years male. Mean age was 38.62 years. In our study, majority of cases were of road traffic accident (85%) followed by history of fall from height (10%) and only 4 cases of assault. Middle third shaft fractures were more common (53%) followed by lower and upper third respectively. Transverse fractures were maximum in number (45%) followed by oblique (29%). There were 13 spiral and 13 comminuted fractures. There were 75 (75%) close fractures and 25 (25%) open fractures. There were 25 cases (25%) of preoperative radial nerve palsy. Out of 25 cases, 23 had recovered completely. There was no iatrogenic nerve palsy seen in our study. Out of 25 cases explored nerve was found to be intact in 23 cases and contused in 2 cases. Most of cases (16) of radial nerve palsy were associated with fracture of middle third shaft humerus. Conclusion: For patients requiring surgical treatment of humeral shaft fractures, both dynamic compression plating and interlock nailing provide predictable methods for achieving fracture stabilization and ultimate healing. Plating requires extensive dissection, more blood loss and duration of surgery as compared to nailing. Antegrade interlock nailing performed properly is safe, effective and quick method. [ABSTRACT FROM AUTHOR]

Background: Our study assessed the effectiveness of a traditional bonesetter (TBS) educational program that was designed to increase knowledge, reduce complications, and promote the referral of patients to local hospitals by TBSs when necessary. Methods: From April to December 2021, TBSs from the Northern Sector (the Northern, Savannah, and North East regions) and the Ashanti region of Ghana underwent a 4-day training course that had been designed to teach basic principles of fracture care with the use of local tools. We assessed the levels of knowledge of the TBSs both before and after training. The change in practice of the trained TBSs also was assessed at 6 months using a structured questionnaire and a checklist. Results: In total, 157 TBSs were trained in 5 training sessions over a 9-month period. There was an improvement in knowledge in all of the modules of training, with an overall knowledge gain of 19.7% (from 67.2% to 86.9%). At 6 months of follow-up, the practices of TBSs that had most improved were record-keeping, hand hygiene, and patient rehabilitation. As a result of the referral system that was established by the training project, a total of 37 patients were referred to local hospitals in the 6 months following the training. Conclusions: Formal training for TBSs that was provided by a multidisciplinary team with use of a locally developed curriculumand tools was effective in improving the practice and outcomes of treatment by TBSs. There was marked knowledge retention by the trained TBSs at 6 months after training in fracture management. Clinical Relevance: Education, training, and the establishment of referral pathways between TBSs and local hospitals could improve trauma care in Ghana. [ABSTRACT FROM AUTHOR]

Intertrochanteric Femur fractures comprise approximately 50% of all hip fracture caused by low intensity injury. Intertrochanteric fractures are difficult to manage and associated with many complications. Aims and Objectives: To evaluate effectiveness and strength of Short PFN with early mobilization and functional recovery of patient in management of fracture intertrochanteric femur Materials and Methods: Forty patients with Fracture Intertrochanteric Femur visiting Orthopaedic Casualty and OPD were studied. Fractures are evaluated as stable and unstable fractures according to Modified Evan-Jensen classification. Elderly patients with unstable intertrochanteric fractures, Short PFN was applied and followed up for a period of 6 months at regular intervals. The clinical data collected and evaluated with pre injury activity and present functional levels with Harris Hip Score. Results: Majority of the patients were males (65%) and had age between 61-80 years (52.5%) with mean age of 71.58 ± 12.37 years. Majority of the patients had operative time more than equal to 1 hour. Harris Hip Score at 1 month was 71.10 ± 5.52, while at 3 months it was 80.13 ± 7.97. There was a statistically significant increase in the mean Harris Hip Score at 3 months in comparison to 1 month. The mean Harris Hip Score at 1 month was 71.10 ± 5.52. There was a statistically significant increase in the mean Harris Hip Score at 6 months in comparison to 3 months. Conclusion: For Intertrochanteric fractures the Short PFN is a good minimal invasive implant which gives significant functional result with good anatomical reduction. [ABSTRACT FROM AUTHOR]

Aim: To study the result of surgical management of distal humerus fractures using distal humerus plates. Methodology: This is a prospective study done in the Department of Orthopaedics, Guntur Medical college, Guntur for a period of 2 years i.e., from May 2018 to April 2020. Sample of study was 12 patients. Results: In the present study, mean age was 37 years. Majority of the patients (33) belonged to the age group of 17-33 years. 50% of the patients were above 44 years of age. Equal number of male and female patients. 5 patients have Rt side and 7 patients had Lf side involvement. e) 8 patients had RTA and 4 patients had self-fall. Fracture union seen in 10 (83%) patients by 12 weeks, 2 patients (17%) had nonunion due to complications. 1 patient (8.3%) reported elbow stiffness and 1 patient (8.3%) reported infection after 24 weeks of ORIF. The infection was superficial. Conclusion: We conclude as per AO principles that early operative intervention with distal humerus bicolumnar plating for distal humerus fracture results in good functional outcome. [ABSTRACT FROM AUTHOR]

Background and objectives: One of the common osteoporotic fractures being the proximal humerus fractures accounts for nearly 4% of all fractures. Undisplaced fractures are usually managed conservatively. But here we study the outcome of 3part and 4part proximal humerus fractures managed conservatively. Materials and methods: This is a observational study of 30 patients with 3 part and 4 part proximal humerus fractures above the age 50years, who are managed conservatively with U-slab. Functional outcome was evaluated with constant scoring system. Results: In our study among the 30 patients, most common age group was 50-60years, with female preponderance (60%). Most common mode of injury was slip and fall with 76.7%. mean constant score at the end of 6months follow up was found to be 77.9. Conclusion: significant improvement was seen in the functional outcome compared from 1month follow up to final follow up at 6months. [ABSTRACT FROM AUTHOR]

3D printed plastic casts can be used for healing bone fractures. The main requirements for these cases are: they should be light, require little printing time, have good mechanical properties, and ensure proper skin ventilation. We present a density-based topology optimization algorithm for obtaining optimal cast shapes that fulfil these requirements. The algorithm uses a linear stress model and simplified boundary conditions to model the contact problems. The cast shapes were optimized against the influence of several sharp corners. The parametric studies showed that the mass of optimized casts was reduced by 20 %–25 % in comparison with original industrial casts, and the printing time is reduced by 1.4–1.7 h for the largest cast. A major model drawback is the use of 3D numerical volume to model the density distribution. The density distribution should be homogenized across the cast layer. The overhang problem should also be addressed. We also suggest that the cast producers collect more experimental data on the cast breakages for a better calibration of the numerical model. [ABSTRACT FROM AUTHOR]

This study investigates the outcomes and complications associated with the management of ankle fractures in diabetic patients. A total of 44 diabetic patients with ankle fractures were enrolled, and they were randomly assigned to either conservative or operative treatment groups. The study evaluated demographic characteristics, diagnosis, complications, functional outcomes, and correlation with HbA1c and ankle brachial index. The results revealed a 29.5% complication rate among the patients, including superficial infections, Charcot neuroarthropathy, arthritic changes, loss of reduction leading to ankle fusion, and stiffness. Functional outcome scores (AOFAS and SF36) did not significantly differ between the conservative and operative groups. Correlation analysis showed a significant negative relationship between HbA1c levels and functional scores in the conservative group. Ankle brachial index demonstrated a negative correlation with the SF36 score in the conservative treatment group. The study emphasizes the importance of diabetic control and vascular assessment in guiding treatment decisions for diabetic ankle fractures. [ABSTRACT FROM AUTHOR]

Purpose: Displaced supracondylar humerus fractures in children are known for their high rate of complications and require urgent surgical treatment. Basically, there are two methods of fracture fixation: the lateral pin technique and the crossed pin technique. However, the best technique remains debated. The aim of this study was to evaluate the clinical and radiographic outcomes of our method of fixation using combined intramedullary and lateral wires for treatment of displaced supracondylar humeral fractures in paediatric patients. Method: Fifty-one paediatric patients were treated for displaced supracondylar humeral fractures. The method of fracture fixation used consists of two Kirschner wires inserted one intramedullary and the other laterally. Clinical and radiographic outcomes were assessed at last follow-up. Results: According to Gartland's classification, 17 fractures (33%) were type 2 and 34 (67%) were type 3. The mean follow-up period was 7.8 months. Functional outcome according to Flynn's criteria was satisfactory in all cases with 92% graded as excellent or good. Cosmetic outcome according to Flynn's criteria was satisfactory in all cases. Radiologically, at last follow-up, the mean Baumann angle was 69° (63–82°) and the mean lateral capitellohumeral angle was 41° (32–50°). Conclusion: Patients managed with combined intramedullary and lateral wires experience satisfactory results. Moreover, this technique, without risk for the ulnar nerve, can be interesting in the treatment of infrafossal fractures and fractures with anterior displacement. [ABSTRACT FROM AUTHOR]

Failure of osteosynthesis is a common complication of the nailing of trochanteric fractures which typically occurs through form of cut-out. Tip-Apex distance (TAD), Calcar Tip-Apex distance (CalTAD), and Chang criteria are validated variables to predict failure of cephalomedullary nailing. This is a retrospective study which analyzes treatment of trochanteric fractures from 2018 to 2020 (n = 296) evaluating postoperative radiographs and factors of mechanical failure. Our objective was to assess correlation among these variables and their influence on mechanical failure, either individually or creating a new score. Our results support the CalTAD and Chang's criteria as valid predictors of mechanical failure. Furthermore, they empathize the importance of fracture reduction and proper placement of cervical screw. To our knowledge, this is the first study performing multivariate analysis including these 3 variables. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the biomechanical performance of 6 pedicle screw internal fixation strategies for the treatment of burst fractures of the thoracolumbar spine using finite element (FE) analysis. A finite element model of the T11-L3 thoracolumbar segment was established to simulate L1 vertebral burst fractures, and 6 models were conducted under multidirectional loading conditions: P2-D2, P1-D1, P2-D1,P1-D, P1-BF-D1, and P1-UF-D1. The range of motion (ROM) in the T12-L2 region and the von Mises stresses of pedicle screws and rods under the 6 internal fixation models were mainly analyzed. The maximum ROM and von Mises stress were obtained under flexion motion in all models. The P1-BF-D1 model had the least ROM and screw stress. However, when the injured vertebra was not nailed bilaterally, the P1-UF-D1 model had the smallest ROM; the maximum von Mises stress on the screw and rod was remarkably higher than that recorded in the other models. Moreover, the P2-D1 model had a ROM similar to that of the P1-D2 model, but with lower screw stress. The 2 models outperformed the P1-D1 model in all 6 conditions. The P2-D2 model had a similar ROM with the P2-D1 model; nevertheless, the maximum von Mises stress was not substantially reduced. The P1-BF-D1 model exhibited better stability and less von Mises stress on the pedicle screws and rods, thereby reducing the risk of screw loosening and fracture. The P2-D1 internal fixation approach is recommended when the fractured vertebrae are not nailed bilaterally. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study is to examine the utilization of kyphoplasty/vertebroplasty procedures in the management of compression fractures. With the growing elderly population and the associated increase in rates of osteoporosis, vertebral compression fractures have become a daily encounter for spine surgeons. However, there remains a lack of consensus on the optimal management of this patient population. Methods: A retrospective analysis of 91 million longitudinally followed patients from 2016 to 2019 was performed using the PearlDiver Patient Claims Database. Patients with compression fractures were identified using International Classification of Disease, 10th Revision codes, and a subset of patients who received kyphoplasty/vertebroplasty were identified using Common Procedural Terminology codes. Baseline demographic and clinical data between groups were acquired. Multivariable regression analysis was performed to determine predictors of receiving kyphoplasty/vertebroplasty. Results: A total of 348,457 patients with compression fractures were identified with 9.2% of patients receiving kyphoplasty/vertebroplasty as their initial treatment. Of these patients, 43.5% underwent additional kyphoplasty/vertebroplasty 30 days after initial intervention. Patients receiving kyphoplasty/vertebroplasty were significantly older (72.2 vs. 67.9, p < 0.05), female, obese, had active smoking status and had higher Elixhauser Comorbidity Index scores. Multivariable analysis demonstrated that female sex, smoking status, and obesity were the 3 strongest predictors of receiving kyphoplasty/vertebroplasty (odds ratio, 1.27, 1.24, and 1.14, respectively). The annual rate of kyphoplasty/vertebroplasty did not change significantly (range, 8%-11%). Conclusion: The majority of vertebral compression fractures are managed nonoperatively. However, certain patient factors such as smoking status, obesity, female sex, older age, osteoporosis, and greater comorbidities are predictors of undergoing kyphoplasty/vertebroplasty. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to determine the contribution of 3-dimensional computer tomography (3D-CT) in the diagnosis of the articular fractures compared with X-rays and computer tomography (CT), and to establish if 3D-CT can confirm or modify the preoperative plans. Methods: We have conducted a retrospective study between 2020 - 2022, 46 patients with articular fractures. We have asked 5 independent surgeons to make comparative analyses of the information required for a correct diagnosis and preoperative planning, obtained from X-ray, CT and 3D-CT. Each time, the surgeon was requested to categorize the fracture using specific classification systems and articulate their recommended treatment approach. Results: The study showed us the importance of 3D-CT to achieve a correct diagnosis for the articular fractures by ana-lyzing the discrepancies between X-ray, CT and 3D-CT, with direct influence upon the presurgical plan. In 37% of the cases, fracture lines were not apparent on X-rays but were visible on CT scans. However, in more than 27% of these instances, specific bone injuries, like central articular depression or unique split-comminution patterns, were not evident on standard CT scans but could be identified using 3D-CT scans. Conclusions: To establish the correct diagnosis and the proper therapeutical plan for the articular fractures, it is necessary to make a complete ra-diological evaluation, which consists of X-ray, CT and 3D-CT. [ABSTRACT FROM AUTHOR]

Aims: To assess post‐initiation predictors of discontinuation of sodium‐glucose cotransporter‐2 (SGLT2) inhibitors compared to dipeptidyl‐peptidase‐4 (DPP‐4) inhibitors in the United Kingdom. Materials and Methods: We conducted a comparative population‐based retrospective cohort study using primary care data from the UK Clinical Practice Research Datalink (CPRD) with linked data to hospital and death records. We included new metformin users who initiated either SGLT2 inhibitors or DPP‐4 inhibitors between January 2013 and October 2019. The main outcome was treatment discontinuation, defined as the first 90‐day gap after the estimated treatment end date. We used a series of extended Cox models to assess which time‐dependent predictors were associated with treatment discontinuation. To test if the hazard ratio of discontinuation for each predictor was statistically different between SGLT2 and DPP‐4 inhibitors, an exposure‐predictor interaction term was added to each model. Results: There were 2550 new users of SGLT2 inhibitors and 8195 new users of DPP‐4 inhibitors. Approximately 69% of SGLT2 inhibitor and 74% of DPP‐4 inhibitor users had discontinued treatment by the end of follow‐up. Occurrence of fractures after treatment initiation was a significant predictor of discontinuation of SGLT2 inhibitors (hazard ratio [HR] 4.13, 95% confidence interval [CI] 2.12‐8.06) but not DPP‐4 inhibitors (HR 0.93, 95% CI 0.79‐1.11). The rate of treatment discontinuation was significantly higher for those with low estimated glomerular filtration rate and minimal contact with the healthcare system. Efficacy endpoints, such as heart failure and glycated haemoglobin level, were not associated with treatment discontinuation. Conclusions: Our findings reflect some discrepancy between the available evidence and prescribing behaviour for SGLT2 inhibitors. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the healing effect and mechanism of Mongolian medicine alcohol spray therapy on fracture healing process in rabbits. Methods: Thirty New Zealand white rabbits were randomly divided into normal, fracture, and treatment groups, with 10 rabbits in each group. Fracture and treatment groups underwent bone-fracture modeling, with the latter receiving daily alcohol spraying and stroking for six weeks. Serum calcium and phosphorus were measured using an automatic biochemical analyzer. Enzyme-linked immunosorbent assay (ELISA) was used to measure the levels of BMP-2, ALP, and TGF-β. Biomechanical testing was performed to assess callus properties, and real-time polymerase chain reaction (PCR) and western blot were performed to assess BMP-2, Runx2, and p-Smad1/5 expressions in callus. Results: There were low serum calcium, phosphorus, BMP-2, ALP, and TGF-β levels in fracture and treatment groups, compared to normal group. Similarly, treatment group showed significantly increased levels of serum calcium, phosphorus, bone morphogenetic protein 2 (BMP-2), alkaline phosphatase (ALP), and transforming growth factor-β (TGF-β) (p < 0.05) compared to fracture group. Biomechanical testing revealed that maximum load, stiffness, and deflection of callus in the fracture and treatment groups were significantly lower compared to normal group (p < 0.05). Expressions of BMP-2, Runx2, and p-Smad1/5 mRNA in the callus significantly decreased in both fracture and treatment groups compared to normal group (p < 0.05). However, treatment group showed significantly increased expression levels compared to fracture group (p < 0.05). Conclusion: Mongolian medicine alcohol spray therapy promotes fracture healing in rabbits and increases maximum load of the callus, possibly through upregulation of the BMP-2 signaling pathway. Further research is necessary to confirm the exact mechanism by which alcohol spray therapy regulates BMP-2 signaling pathway. [ABSTRACT FROM AUTHOR]

This study was conducted to evaluate the outcomes of closed reduction of different types of nasal bone fractures depending on time between onset of injury and reduction and comparing the outcomes of early closed reduction (within 6 h) of nasal bone fracture with late closed reduction (after 2 weeks). A hospital based Prospective cohort type of study was conducted among cases of nasal bone fracture attending the outpatient department of Otorhinolaryngology at Chettinad Hospital and Research Institute, Chennai during the months of August 2021 to January 2022. A total of 54 participants were included in the study. Primary outcome was to assess the effectiveness of closed reduction of different types of nasal bone fractures postoperatively. The second objective was to compare the outcomes of early closed reduction (within 6 h) of nasal bone fracture with late closed reduction (after 2 weeks). Using chi square test, the association of factors such as age, sex, mode of injury, external framework deformity, type of fracture and treatment was analyzed with outcome measures such as post op degree of deviation, arch irregularity, malalignment, bony irregularity, bony displacement, olfactory disturbances and result. We analyzed the sample data statistically and measured the outcomes which showed that post operatively after undergoing closed reduction, some degree of deviation was present in 17(31.48./.), arch irregularity present in 12(22.2./.), malalignment in 11(20.37./.), bony irregularity in 24(44.44./.), bony displacement in 19(35.19./.), olfactory disturbances in 2(3.70./.). Comparing the outcome factors between early and late reduction, we found that the outcome was better in early closed reduction when compared with late closed reduction. Among the 54 patients studied, the results of closed reduction were found to be excellent in 27(50./.), Fair in 16(29.63./.), Good in 10(18.52./.) and poor in 1(1.85./.) We could thus conclude from this study that early closed reduction of nasal bone fracture gave better results than a late closed reduction in terms of post operative deformity, arch irregularity, malalignment, bony irregularity, bony displacement and olfactory disturbances. [ABSTRACT FROM AUTHOR]

Objectives: As currently there is no existing biomechanical work on the topic of interest, the aim of the current study was to investigate the effect of cerclage banding distally to an intraoperatively occurring proximal periprosthetic femoral clamshell fracture versus a non-fractured femur after total hip arthroplasty. Methods: A diaphyseal anchoring stem was implanted in twenty paired human cadaveric femora, assigned to a treatment and a control group. In the treatment group, each specimen was fitted with a cerclage band placed 3 mm distally to a clamshell fracture, created with an extent of 40% of the anchoring length of the stem. The resulting fragment was not treated further. The contralateral specimens were left with the stems without further fracture creation or treatment. All constructs were tested under progressively increasing cyclic axial loading until failure. Relative bone-implant movements were monitored by motion tracking. Results: Number of cycles and the corresponding load at stem loosening, defined as 1 mm displacement of the stem along the shaft axis, were 31,417 ± 8870 and 3641.7 ± 887 N in the control group, and 26,944 ± 11,706 and 3194.4 ± 1170.6 N in the treatment group, respectively, with no significant differences between them, p = 0.106. Conclusion: From a biomechanical perspective, cerclage banding distally to an intraoperative clamshell fracture with an extent of 40% of the anchoring length of the stem demonstrated comparable resistance against hip stem loosening versus a non-fractured femur. It may therefore represent a valid treatment option to restore the full axial stability of a diaphyseal anchoring stem. In addition, it may be considered to keep the medial wall fragment unfixed, thus saving operative time and minimizing associated risks. [ABSTRACT FROM AUTHOR]

Hahn–Steinthal fractures are rare and often neglected. Their initial management should be early, given the relatively high complication rate. We report eight cases of type I capitellum fractures treated by Herbert screw fixation. Between 2019 and 2022, we selected eight patients (six men and two women) with a mean age of 25 years (18–40 years). The mean follow-up was 2 years (1–3 years). Clinical results were assessed using the Mayo Clinic Elbow Performance Score (MEPS). The mean arc of mobilitý was 135° (105°–150°) for flexion/extension and 161° (150°–175°) for pronosupination. The mean MEPS was 90.6 points, with seven excellent results and one good result. The aim of this study was to highlight the good results of Herbert screw fixation technique in the management of Hahn–Steinthal fractures. [ABSTRACT FROM AUTHOR]

Nasal bone fracture is more common because it is a prominent structure on the face. It can occur as an isolated injury or in combination with other soft tissue and bony facial injuries. While isolated fractures are more common, they can also be associated with fractures of the zygomatic-orbital-maxillary complex and the skull base. Typically, nasal bone fractures are treated with closed reduction or open reduction and fixation. This involves internal fixation using nasal packing and external fixation using plaster splinting. However, in this technique, we utilised an internal teflon splint and an external thermoplastic splint for the fixation of comminuted nasal bone fractures. One advantage of this technique is that it keeps the nostrils open, allowing for unobstructed breathing. Additionally, the internal splint helps lift the nasal bone back into its anatomical position. The present case report presents the management of a 40-year-old male patient who sustained nasal and maxillary dentoalveolar fractures as a result of a road traffic accident. The fractures were further managed using intranasal teflon splints, an external thermoplastic splint, and Kirschner’s wires. This splint pattern prevents displacement and promotes healing in the desired alignment. This technique employs a logical tripod arrangement of a rigid support system that incorporates all these elements into one interconnected unit, providing support, stability, and tension for optimal results. It focuses on the keystone area of the nose, which requires the most support. [ABSTRACT FROM AUTHOR]

Post-traumatic orbital meningoencephaloceles related to orbital roof fractures are a challenging clinical entity because of their rarity and difficult differential diagnosis. We report a case of post-traumatic intra-orbital meningoencephalocele in a 69-year-old man, secondary to a likely trapdoor mechanism, treated with a modified one-piece orbitozygomatic craniotomy. We also performed an extensive literature review of traumatic Intra-Orbital Encephalocele related to Orbital Roof Fracture focused on adult patients on electronic databases including Scopus, MEDLINE/PubMed, and Google Scholar. Patient well recovered after surgery with immediate exophthalmos resolution and discharged without visual or neurological deficits. The literature review included 22 papers with a total of 28 patients: 22 males (78.6%) and 6 females (21.4%), with a median age of 34.7 years. Twenty-six patients (92.9%) reported ocular injuries, with associated intracranial complications in 16 cases (61.5%). Twenty-seven patients (96.4%) were surgically treated, 18 of those underwent unilateral or bilateral frontal approach. Most orbital roof fractures can be managed nanoperatively if asymptomatic. Indeed, when the intra-orbital volume decreases, for example due to an encephalocele, the intra-orbital pressure could increase and determine an orbital compartment syndrome. In our case, we performed a one-piece modified orbitozygomatic approach, which has several advantages in comparison to the frequent unilateral or bilateral frontal craniotomy like the better exposure of the brain and orbit and a minimum brain retraction. [ABSTRACT FROM AUTHOR]

Background/Aim: Mandibular condylar fractures represent 25%–35% of all mandibular fractures. Despite profound research, there is still a controverse debate about treating these fractures conservatively or by open reduction and internal fixation (ORIF). The aim of this study is to analyse the outcome after open and closed treatment of extracapsular mandibular condyle fractures regarding general characteristics, post‐treatment malocclusion, facial nerve palsy (FNP), maximum mouth opening (MMO) and parotid complications. Methods: A retrospective cohort of 377 fractures (350 open, 27 closed treatment) was reviewed by reference to clinical and radiological pre‐ and postoperative documentation. Follow‐up period was 12 months. Pearsons' chi‐square‐test, correlations, Kruskal–Wallis test and t‐test were carried out for statistical analysis. Results: The dominant type of fracture was type II in Spiessl and Schroll classification (50.1%). In the open treated fractures, the most common approach was retromandibular transparotid (91.7%). Post‐treatment malocclusion occurred in 18.0% and was significantly increased in bilateral fractures (p =.039), in luxation fractures (p =.016) and in patients with full dentition (p =.004). After open reduction and internal fixation (ORIF), temporary FNP was documented in 7.1% whereas a permanent paresis occurred in 1.7%. FNP was significantly associated with high fractures (p =.001), comminution (p =.028) and increased duration of surgery (p =.040). Parotid complications were significantly associated with revision surgery (p =.009). Post‐treatment reduction of MMO mainly occurred in female patients (p <.001) as well as in patients with bilateral fractures (p <.001), high fractures (p =.030) and concomitant mandibular (p =.001) and midfacial fractures (p =.009). Conclusion: Malocclusion seems to be the most frequent long‐term complication after open reduction and osteosynthesis of extracapsular mandibular condyle fractures. We suggest ORIF by a transparotid approach to be an appropriate treatment with a low complication rate regarding especially FNP for extracapsular fractures of the mandibular condyle. [ABSTRACT FROM AUTHOR]

Background: Mandibular fractures lead to complications if improperly treated. The management of mandibular fractures includes open reduction and internal fixation (ORIF) or closed reduction. Associated complications include malocclusion, infection, hardware extrusion, and nerve injury. Aims and Objectives: The aims of this study were to evaluate the functional outcome of various treatment modalities of mandibular fracture and to identify the factors affecting the outcome. Materials and Methods: The study included patients admitted in the trauma care center, between 13 and 70 years of age, and having mandibular fracture. Patients underwent ORIF or closed reduction according to the type of fracture. Mandibular injury severity score (MISS), Mandibular functional impairment questionnaire (MFIQ) score, and pain visual analog score were used to assess the functional outcome of treatment and complications. Results: Majority of the patients were male and were in the age group 21-30 years. The most common cause of fracture was road traffic accident (RTA). Majority of the patients underwent ORIF. Patients having higher injury severity scores, severe MFIQ scores and pain visual analog scores had more complications. Overall, complications in open reduction cases were higher than closed reduction ones. However, weight loss and time to functional improvement were more in closed reduction cases. Conclusion: Young males are most commonly affected with fracture of mandibles and mostly due to RTAs. There should be minimal delay from presentation to operative intervention in case of patients who require ORIF. Scoring systems such as MISS, MFIQ, and pain visual analog scale scores may help in the early prognostication of injury and warn against imminent complications. [ABSTRACT FROM AUTHOR]

This study evaluated the resistance to fracture of endodontically treated premolars (ETPs) with mesio-occluso-distal (MOD) cavities filled with nanohybrid composite (NHC), fiber-reinforced composite (FRC), horizontal glass fiber posts (HFP), and ceramic inlays (CI). Eighty-four intact maxillary premolars were taken, and endodontic treatment was performed followed by MOD cavity preparations (except in the control group). They were distributed into 7 groups based on type of restoration: intact teeth (control group), ETP + MOD (not restored), NHC, FRC + NHC, HFP + NHC, FRC + HFP + NHC, and CI groups. Samples were subjected to universal testing machine until the fracture occurred and failure mode was visually inspected. Mean and standard deviation of fracture resistance of the 7 groups ranged from 265.6 ± 68.0 N to 1023.7 ± 76.5 N. The highest reading was noted for intact teeth followed by FRC + HFP + NHC group and then the CI group, with no significant difference among the 3 groups. The lowest reading was noted for the ETP + MOD group. Maximum unrepairable fractures were seen in the ETP + MOD and CI groups. FRC + HFP + NHC combination and CIs increased the resistance to fracture of ETPs significantly. [ABSTRACT FROM AUTHOR]

Acute dental trauma is unscheduled and presents infrequently to the majority of practitioners. Therefore, a consistent, logical and systematic process for examination, prioritisation and management is imperative for all sustained injuries to have an optimal outcome. Fractures are a frequent sequela to dental trauma and can involve any aspect of the tooth structure or supporting alveolar bone. While some minor crown fractures may initially seem inconsequential, they may be a subtle indication to a more serious underlying root fracture. Concomitant injuries and injuries that have been initially missed are generally associated with poorer outcomes. The time sensitive management of traumatic dental injuries aims to preserve pulpal and periodontal health where possible. The follow up period for tooth or alveolar fractures are important to allow for early intervention if pathology develops. [ABSTRACT FROM AUTHOR]

This study conducted a triaxial stress cycle loading–unloading experiment on anthracite coal samples to investigate the effect of different cycle numbers of liquid nitrogen cold dips (LNCDs) on the permeability characteristics of coal bodies under repeated loading–unloading conditions. The permeability of anthracite coal samples treated by LNCD and repeated loading–unloading was enhanced by 2–4 times, and the permeability evolution patterns of LNCD-damaged samples for different numbers of loading–unloading cycles were obtained. To evaluate the permeability enhancement effect of coal samples under single and multiple loading–unloading cycles, the permeability enhancement efficiency index and the LNCD influence coefficient were determined, indicating that the compound effect of LNCD treatment and repetitive stress loading–unloading significantly increased the coal's permeability. The greater the number of liquid nitrogen fracturing is, the higher the permeability of coal samples is under repetitive loading–unloading conditions. LNCD treatment advanced the transition point of coal samples from the compaction state to the enhanced permeability state. The composite repeated loading–unloading-LNCD treatment fracture was subdivided into four stages according to the internal structural changes of the coal body. The model of the composite fracture of the coal seam under the LNCD cycles and loading–unloading was constructed and experimentally validated. [ABSTRACT FROM AUTHOR]

Introduction: Time-efficiency of individually wrapped screws versus screws in a screw rack is not well established. Materials and methods: We performed a prospective single-center clinical study timing the interval between the surgeon asking and receiving a screw during plate and screw osteosynthesis of distal radius fractures. Patients were randomized for individually wrapped screws or screws in a screw rack. The study was conducted in a Level 1 Trauma Center and surgeries were performed between March and June 2023. Results: Average handling time for screws from a screw rack was 9 s (SD 5.5; range 3–28) and 22 s for individually wrapped screws (SD 6.1; range 6–38). This average difference of 13 s is significant (p < 0.0001). Conclusion: There is a significant increase in handling time using individually wrapped screws over using a screw rack. Level of evidence: Level I (therapeutic, randomized controlled trial). [ABSTRACT FROM AUTHOR]

The anatomical characteristics and the cortico-cancellous nature of bone disrupted by the presence of teeth make the mandible more vulnerable to fractures during traumatic injuries of the face. Fractures of the angle region constitute about 30% of mandibular fractures due to the change in dentate bone to the lateral flare of ramus, change in grain pattern of the bone, and presence of third molars all weakening the region making it fragile and thus fracture. Several studies corroborated the effectiveness of Champy's technique as to have the lowest complication rate when compared to the other techniques. Though a well-sequenced procedure, fixing an angle fracture is practically challenging and here we describe our experience, with a modification of the sequence to aid in better surgical outcome. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the impact of different extents of misfit between a restoration and the supporting implant on veneer fractures in screw-retained implant-supported metal-ceramic fixed dental prostheses (FDPs).Materials and Methods: A finite element analysis (FEA) model of a five-unit screw-retained metal-ceramic FDP supported by three implants was constructed, replicating a previous in vitro study. Eight different gap configurations at the single terminal implant, ranging from 0 to 150 μm, were tested. All setups were tested after clamping and with a load of 200 N applied. Maximum stress within the FDP was calculated.Results: The stress increased with each increase in misfit size above 30 μm, with the relationship between gap size and stress being linear up to 100-μm misfit. Above 100 μm, the stress increase accelerated. The stress pattern within the FDP changed with increasing gap size, confirming the findings of a previously conducted in vitro experiment for a misfit of 150 μm.Conclusion: The results of the FEA were in agreement with in vitro observations, validating the predictive value of FEA for technical complications. A misfit between an FDP and a supporting implant implies an increased risk of veneer fracture. Above a misfit of 30 μm, the stress levels are likely to be high enough to cause veneer fracture, and the risk increases disproportionately for misfit above 100 μm. [ABSTRACT FROM AUTHOR]

Background: In Norway, primary healthcare has first-line responsibility for all medical emergencies, including traumas and fractures. Normally, patients with suspected fractures are referred to specialist care in hospitals. However, the cooperating municipalities of Bykle and Valle have X-ray facilities and handle minor fractures locally. The aim of this study was to estimate the costs of X-ray diagnosis and initial treatment of fractures at the local primary care centre compared with initial transport and treatment in hospital. Methods: We conducted a cost minimisation analysis by comparing expected costs of initial examination with X-ray and treatment of patients with fractures or suspected fractures at two possible sites, in the local municipality or at the hospital. A cost minimisation analysis is an economic evaluation based on the assumption that the outcomes of the two treatment procedure regimens are equal. Costs were estimated in Euros (EUR) using 2021 mean exchange rates. Results: In 2019, we identified a total of 403 patients with suspected fractures in the two municipalities. Among these, 12 patients bypassed the primary care system as they needed urgent hospital care. A total of 391 injured patients were assessed with X-ray at the primary health care centres, 382 received their initial treatment there, and nine were referred to hospital. In an alternative hospital model, without X-ray and treatment possibilities in the municipality, the 382 patients would have been sent directly to hospital for radiological imaging and treatment. The total cost was estimated at EUR 367,756 in the hospital model and at EUR 69,835 in the primary care model, a cost saving of EUR 297,921. Conclusion: Based on cost minimisation analysis, this study found that radiological diagnosis of suspected fractures and initial treatment of uncomplicated fractures in primary care cost substantially less than transport to and treatment in hospital. [ABSTRACT FROM AUTHOR]

Despite the variety of treatment methods, comminuted inferior pole fractures of the patella remain difficult and technically demanding to achieve stable internal fixation. The purpose of this study is to evaluate the clinical outcomes of rim plate-augmented separate vertical wiring with supplementary fixation in the management of comminuted inferior pole fractures, AO/OTA 34-A1, C2, and C3, which has the secondary horizontal fracture line on lower articular boundary. From our study, bony union was achieved in all patients at an average of 3.1 ± 1.4 months after surgery. There was no patient with loss of reduction, fixation failure, or infection during follow-up. The average final range of motion was 131.6° ± 7.2°. Lysholm knee scores gradually increased over 3, 6, 9, and 12 months postoperatively by 58.7, 74.0, 82.9, and 89.4, respectively. Isokinetic peak torque deficit of the knee extensor muscles in 3, 6, 9, and 12 months postoperatively was 59.9%, 49.7%, 35.7%, and 28.1%, respectively. The rim plate-augmented separate vertical wiring with supplementary fixation for the treatment of patellar fracture associated comminuted inferior pole is effective and can be safely applied AO/OTA 34-C2 or C3 with favorable outcomes. [ABSTRACT FROM AUTHOR]

Background: Osteoporotic vertebral compression fracture (VCF) is the third most frequent fragility fracture in the world. Conservative treatment, vertebroplasty, and kyphoplasty are all recognized therapies. However, diagnostic and therapeutic recommendations must be more consistent when comparing clinical guidelines. This study aims to compare the efficacy of vertebral augmentation therapy and conservative management for treating VCFs, the risk of subsequent complications, and the length of hospital stay. Method: All patients over 50 years old with a diagnosis of thoracic or lumbar VCF without underlying oncological process, treated conservatively or surgically, and consecutively attended at our department from January 2017 to June 2021 were retrospectively selected for analysis. Patients who missed follow-up or died during the first three months were excluded. Results: A total of 573 cases were selected for analysis. Most patients were treated conservatively (85.3%). Both groups were homogenous regarding epidemiological and clinical features. The median time elapsed to achieve pain relief was significantly lower in the surgical cohort (4.5 vs. 10 weeks, p < 0.001), and the proportion of patients reporting pain at the first outpatient visit was also significantly lower with a vertebral augmentation procedure (p = 0.004). The new fracture rate and the adjacent level rate did not differ significantly when comparing both treatments, whereas the progression of the diagnosed fracture was more frequent in the conservative group (4.8% vs. 29.7%; p < 0.001). The median hospital stay was significantly lower in the conservative group (3 vs. 10 days; p < 0.001). Conclusion: Surgical treatment (vertebroplasty/kyphoplasty) of VCFs was associated with sooner pain relief without an increased risk of new or adjacent fractures. Moreover, the progression of treated fractures was significantly lower in the surgical cohort. The only unfavorable aspect was the more extended hospital stay compared with the conservative treatment group. [ABSTRACT FROM AUTHOR]

Background: The risk of falls and bone fractures with sodium-glucose cotransporter-2 (SGLT2) inhibitors has been characterized by conflicting evidence. Therefore, we decided to investigate the reporting probability of falls and fractures by comparing SGLT2 inhibitors with DPP4 inhibitors. Methods A retrospective, pharmacovigilance study of the European database of Individual Case Safety Reports (ICSRs) was conducted. Disproportionality analyses (Reporting Odds Ratio, ROR) were conducted to compare the reporting probability of falls or fracture between treatments. Results A total of 507 ICSRs reporting at least one fall or fracture with SGLT2 inhibitors were identified. The most reported SGLT2 inhibitor was canagliflozin (N = 188; 36.9%), followed by empagliflozin (N = 176; 34.5%), and dapagliflozin (N = 143; 28.0%). A total of 653 events related to fall or bone fracture were reported. Fall was the most reported event (N = 333; 51.0%). Among fractures (N = 320; 49.0%), the most reported were foot fractures (N = 40; 6.1%) and hip fractures (N = 32; 4.9%). SGLT2 inhibitors were associated with a lower reporting probability of fall than DPP4 inhibitors (ROR, 0.66; 95%CI, 0.57-0.78). The lower reporting probability of fall was also observed when the single SGLT2 inhibitor was compared to DPP4 inhibitors: dapagliflozin (ROR, 0.67; 95%CI, 0.53-0.83), canagliflozin (ROR, 0.56; 95%CI, 0.45-0.70), and empagliflozin (ROR, 0.77; 95% CI, 0.63-0.94). For fractures, canagliflozin showed a slightly significant increased reporting when compared with DPP4 inhibitors (not confirmed in the sensitivity analysis), whereas all other comparison showed no statistically significant difference. Conclusion SGLT2 inhibitors were associated with a lower reporting probability of fall than DPP4 inhibitors, in accordance with the reassuring evidence about the safety profile of these drugs. Future researches will help to confirm their long-term safety profile. [ABSTRACT FROM AUTHOR]

Cyclic injection hydraulic fracturing is a promising way for the geothermal energy exploitation by reactivating the fractures in geothermal reservoir. However, fracture initiation and growth induced by cyclic injection schemes have been inadequately studied for hot dry rock (HDR), and the cyclic injection fracturing optimized often by experience. For this reason, the initiation and propagation of hydraulic fractures in the HDR under different cyclic injection methods were determined by experiment research for hydraulic fracturing. The results show that the cyclic frequency and injection rate play different roles in the stimulation of HDR. The cyclic injection with low frequency-low pressure can create more branched fractures, forming a short but complex hydraulic fracture network. However, when high flow-high frequency injection method is subjected, the branch fractures formed are significantly reduced, but each branch fracture can be fully expanded. To fully exploit the advantages of different injection methods, a numerical model that contains a fracture network was established with PFC software, and an alternating cyclic injection scheme with synergistic control of the cyclic frequency and injection rate was proposed. The comparison results indicated that the alternating cyclic injection method can effectively improve the fracturing effect in the HDR. The stimulation area of the alternating cyclic injection method is about 2.3 times and 2.7 times that of the low flow-low frequency and high flow-high frequency injection methods, respectively. The method presented here can be adopted to optimize the fracture growth regime and provide a scientific basis for EGS hydraulic fracturing design. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study was to compare the outcome of gartland type IIB and type III supracondylar humerus fracture by non-operative vs operative technique. Methods: This was an observational study that includes both conservative and operative cases conducted in the Orthopaedics department of BRD Medical College Gorakhpur, U.P. (India) during August 2021 to July 2022. Total 56 patients (cases) enrolled for the study, out of which 14 cases were treated conservatively and 42 cases by operative methods. 37 cases underwent closed reduction, and 5 cases were managed by open reduction and k-wire fixation. It was a hospital-based study, and all the patients were selected after fulfilling the Inclusion criteria. Results: There were 23.21% cases in the age group 2-5 years and 50% cases were belonged to the age group 6-10 years. The majority of the cases in this study were from the age group 6-10 years. There were 25% cases were females while 75% cases were males. 57.14% cases were having left side involvement and in 42.86% cases have right side participation. The most of the cases had a left-sided involvement. 46.42% cases got injured due to slip, 41.08% cases due to fall from height and 12.5% cases were from the trauma (RTA cases). The most of the recorded cases were from the injury due to slip. In this study 44.64% cases were Gartland type II B fractures and 55.36% cases belonged to Gartland type III fractures. 80.36% cases had an excellent functional outcome after one year follow-up and 19.64% cases with good functional outcome. Conclusion: Treatment of supra-condylar fracture of humerus in children requires methodical or standard reduction techniques followed by casting or k wire fixation. In our series, Gartland type III is most common supracondylar fracture of humerus, with posteromedial displacement most common. X-rays have given early and accurate knowledge necessary for planning and management of supra-condylar fracture of humerus. In this study, we could find that nearly half of total number of cases of Gartland type IIB are manageable by conservative cast. There was significant remodelling of fracture supracondylar humerus. [ABSTRACT FROM AUTHOR]

Background: The fracture of the calcaneus is the most common traumatic lesion of the hindfoot and can cause severe disability with social and economic sequelae. Since 1980, an increasing number of studies and new technologies have led to an improvement in the management of calcaneal fractures, but treatment is still controversial. The purpose of this review was to investigate the secondary scientific literature to detect the optimal management of calcaneal fracture. Methods: A MEDLINE search via PubMed was conducted. A total of 4856 articles were identified, and only meta-analyses and systematic reviews were included. Results: 59 articles with more than 10,000 calcaneus fractures were examined, and the results were divided into various topics. Most articles agree on the superiority of surgical treatments compared to conservative ones. Moreover, minimally invasive access to the sinus tarsi showed better results and fewer complications than traditional extended lateral access. Also, reduction and osteosynthesis with percutaneous and/or minimally invasive techniques seem to provide better outcomes when compared to open treatments. Conclusions: The management of calcaneal fractures requires an individualized treatment plan based on the functional demands of the patient, the type of fracture, and associated injuries. New technologies and further studies can lead to an improvement in the management of calcaneal fractures. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Patients with condylar fractures were treated with osteopeptide injections as an adjuvant therapy to assess pain control and changes in interleukin-1β (IL-1β) and bone G-gla protein (BGP) levels. MATERIALS AND METHODS: Eighty-two patients with a condylar neck fracture were randomly assigned to two groups. The control group received conventional surgical treatment, while the experimental group received osteopeptide injections in addition to surgery. Pain level, IL-1β, and BGP levels were evaluated at 1, 2, and 4 weeks postsurgery. RESULTS: One and two weeks postsurgery, the experimental group had lower Numeric Rating Scale scores compared to the control group. In addition, the IL-1β level in patients receiving osteopeptide injections was lower than the control group at all three evaluation points (1, 2, and 4 weeks postsurgery) and the BGP level was higher with statistically significant differences (P < 0.05). CONCLUSIONS: The administration of osteopeptide injections as an adjuvant therapy for patients with condylar fractures can effectively reduce pain and facilitate faster initiation of muscle function training. In addition, the reduction of inflammatory factors and promotion of active osteogenesis leads to quicker wound healing. [ABSTRACT FROM AUTHOR]

A large amount of CO 2 will be emitted after the burning of fossil fuels, causing global warming and glacier melting which will bring a huge threat to the living environment. Atmospheric clearance through the capture, utilization or storage of CO 2 is one of the technologies for dealing with global climate change. In order clarify the mechanization of supercritical CO 2 fracturing, the tight sandstone cores in the Jinqiu Gas field, Sichuan Basin were used to carry out the effect research of supercritical CO 2 on fracture toughness. The results show that after the treatment of tight sandstone on supercritical CO 2 , the degradation degree of I-type fracture toughness decreases by 23.6%−33.6% when the soaking days reach 15 days. At the same reaction time, the fracture toughness under 20 MPa and 60 ℃ is lower by 3∼11% than that under 10 MPa and 50 ℃. Meanwhile, the geometric fracture trajectories of sandstone samples before and after the treatment of supercritical CO 2 treatment are observed. Before the treatment, the S max was 1.46 mm and the fracture angle was 10.24°, but after the treatment, the parameters were 0.93 mm and 3.41°, respectively. The fracture trajectories after multiple polishing were observed by SEM imaging, which shows that the fractures can propagate directly through the mineral particles after the supercritical CO 2 treatment, which causes the transcrystalline fracture. It is conducive to initiating, propagating, and destroying I-type fractures under smaller external loads. The results further improve the mechanism of CO 2 on fracture toughness of tight sandstone, which is useful to explore the feasibility of CO 2 fracturing of low-pressure tight sandstone, and provide theoretical support for the safety of CO 2 fracturing and CO 2 geological sequestration of tight sandstone. [ABSTRACT FROM AUTHOR]

Background: Intertrochanteric fractures are a global health concern, especially in aging populations like the Republic of Korea. Surgical treatments like intramedullary nailing are preferred for their benefit. Various hip nails are used worldwide, each with unique features and challenges. This study aims to compare the GS hip nail with the Affixus hip fracture nail for the treatment of intertrochanteric fractures. Material and Methods: This retrospective study, conducted at a single center, included 179 patients who underwent intramedullary nailing for intertrochanteric fractures using the GS hip nail or the Affixus hip fracture nail. Excluding specific cases, 43 patients in the GS group and 46 in the Affixus group met the minimum 6-month follow-up criteria. Result: The GS group exhibited a significantly shorter mean operation time (43.26 min) compared to the Affixus group (51.11 min). Radiographically, both groups showed no significant differences in their reduction quality, tip, and apex distance (TAD), or Cleveland index in the immediate postoperative window. However, the GS group achieved a greater valgus reduction based on the contralateral femoral neck shaft angle (NSA). At 6 months post-operation, there were no significant differences in TAD or advancement and sliding distances. Complication rates were similar between the two groups, with no implant breakages. Clinical outcomes, as measured via mHHS and EQ-5D-5L, showed no significant differences. Despite a slightly higher implant cost, the GS group had a lower total hospital cost than the Affixus group, but this was not statistically significant. Conclusions: This study highlights the efficiency of the GS hip nail in reducing the operation time compared to the Affixus hip fracture nail with comparable radiologic and clinical outcomes. Further research with long-term follow-up and larger patient studies are needed to fully assess its effectiveness in improving patient outcomes in hip fracture treatment. [ABSTRACT FROM AUTHOR]

X-ray examinations are crucial for fracture diagnosis and treatment. However, some fractures do not present obvious imaging feature in early X-rays, which can result in misdiagnosis. Therefore, an ASCNet model is proposed in this study for X-ray femoral fracture classification. This model adopts the self-calibration convolution method to obtain more discriminative feature representation. This convolutional way can enable each spatial location to adaptively encode the context information of distant regions and make the model obtain some characteristic information hidden in X-ray images. Additionaly, the ASCNet model integrates the convolutional block attention module and coordinate attention module to capture different information from space and channels to fully obtain the apparent fracture features in X-ray images. Finally, the effectiveness of the proposed model is verified using the femoral fracture dataset. The final classification accuracy and AUC value of the ASCNet are 0.9286 and 0.9720, respectively. The experimental results demonstrate that the ASCNet model performs better than ResNet50 and SCNet50. Furthermore, the proposed model presents specific advantages in recognizing occult fractures in X-ray images. [ABSTRACT FROM AUTHOR]

One of the biggest genus in the Lauraceae family is Litsea. It is common in sultry and sub-tropical locations including Southerneast Asia, Japan, South part of China and Taiwan as well as in large quantities in the Western Ghats of Bangladesh, Myanmar, Bhutan, Nepal, Vietnam and India. In India it is distributed in north eastern region especially in Assam, Meghalaya, and Nagaland. In the traditional medicine, Litsea species is being used since at least 600 AD. The tribal peoples who lived in the north east part of India are having the practice of using two Litsea species namely Litsea cubebaand Litsea salicifolia. Litsea sal icifolia commonly known as Dighloti by the Assami's and various parts of the plant like fruits, fresh leaves, wood, stem bark has been used for the treatment of bone fracture and as antimicrobial, anti-inflammatory related to rheumatic afflictions, mosquito repellent, phytopesticidal, antibacterial, antimalarial, also used as condiment by the tribal communities. Most of the folk medicinal plants were still unknown for their uses and research to be needed to carry forward them. This review's objective is to examine the plant Litsea salicifoliaand to present updated, thorough, and organized information on its ethnopharmacology and its phytochemistry profile in order to comprehend the need for additional research on this species in order to provide therapeutic applications and research opportunities. [ABSTRACT FROM AUTHOR]

This study aimed to compare open and closed treatment for unilateral mandibular condyle neck and base fractures by final three-dimensional (3D) condylar position at 6 months follow-up. 3D position was associated with mandibular functioning and pain. A total of 21 patients received open (n = 11) or closed (n = 10) treatment. 3D positions were assessed on cone-beam computed tomography scans. Volume differences, root mean square, translations, and rotations were obtained related to the pursued anatomical position and compared between treatment groups by the Mann-Whitney U test. The 3D position parameters were associated with the maximum interincisal opening (MIO), mixing ability test (MAT), Mandibular Function Impairment Questionnaire (MFIQ), and pain based on Spearman correlation coefficients (r s). Translation in the medial-lateral direction was smaller after open treatment (P = 0.014). 3D position was not associated with the MAT; however, worse position was associated with a smaller MIO. A larger pitch rotation was associated with a worse MFIQ (r s = 0.499, P = 0.025). Volume reduction of the affected condyle was associated with more pain (r s = −0.503, P = 0.020). In conclusion, after unilateral condylar fractures, worse 3D position is associated with a smaller mouth opening and worse patient-reported outcomes. This is independent of the chosen treatment, despite a better anatomical reduction after open treatment. [ABSTRACT FROM AUTHOR]

Introduction In this study efficacy of new method for arch bar fixation was compared with conventional technique in facial bone fracture management. Material and Methods 20 Patients with facial bone fracture reported to the Department of Oral and maxillofacial Surgery requiring open reduction were included in the study. The clinical parameters that were evaluated are Oral hygiene and Gingival index. Results The mean OHI-S score in new technique and conventional technique in 1st week was 1.36 ± 1.19 and 0.81±0.53 respectively. In 2nd week the mean OHI-S score in new technique was 1.22 ±0.77 and in conventional technique the mean OHI-S score was 1.39 ± 1.51.In the 3rd week the mean OHI-S scores of new technique and conventional technique were 1.8 ±0.55 and 1.6 ±1.73 respectively. The mean GI score in new technique and conventional technique in 1st week was 0.69 ± 0.5 and 0.38 ± 0.3 respectively. In 2nd week the mean GI score in new technique was 0.63 ±0.4 and in conventional technique the mean GI score was 0.36 ± 0.3. In the 3rd week the mean GI scores of new technique and conventional technique were 0.65 ±0.3 and 0.35 ± 0.3 respectively. Conclusion In a whole we can conclude from this clinical study that both the techniques were equally effective in terms of Oral hygiene, gingival health and stability. [ABSTRACT FROM AUTHOR]

The rudimentary findings associated with the optimum operation of a gas reservoir highlight the interdependence of the network of fractures, rock matrix, and reservoir permeability. However, if due to any drilling issue, the well is drilled in a section where it does not encounter any fracture, or if the fracture network is disconnected from the matrix, productivity is greatly reduced. Stimulation methods (matrix acidizing and acid fracturing) are deployed to restore/enhance the reservoir permeability to improve the productivity of a reservoir. Stimulation methods play a crucial role in addressing the challenge of restoring and enhancing a reservoir's capability to improve production. Acidizing and fracturing are the two stimulation methods commonly used. The selection of these methods mainly depends on the type of reservoir and its characteristics. In this paper, the effects of matrix acidizing and acid fracturing on a carbonate reservoir are presented. STIMPRO® designed for matrix acidizing/analysis and FRACPRO® designed for fracture geometry analysis enabled the convergence of the actual well data. An acid chemical recipe is designed to execute the matrix fracturing treatment. The stimulation diversion technique, maximized pressure differential and injection rates (MAPDIR), is used to inject the cited acid chemical recipe at designed injection rates in the reservoir. Well test analysis using ECRIN® and production optimization through PIPESIM® are carried out to maximize the efficiency of the matrix acidizing and acid fracturing. The well production increased fourfold to 1 MMSCFD post-matrix acidizing job. The overall well production of 14.6 MMSCFD was observed post-acid fracturing employing the designed acid recipe with MAPDIR diversion. The economic viability of both the treatments was evaluated using the decline curve analysis (DCA) technique which showed a considerable increase in low and best estimates (1P, 2P) of reservoirs post-acid fracturing jobs. [ABSTRACT FROM AUTHOR]

In recent years, interventional radiologists have been increasingly involved in the management of bone fractures resulting from benign (osteoporosis and trauma), as well as malignant (tumor-related impending or pathologic fractures) conditions. Interventional techniques used to fix fractures include image-guided osteoplasty, screw-mediated osteosynthesis, or combinations of both. In the present narrative review, we highlight the most common clinical scenarios that may benefit from such interventional techniques with specific focus on spine, pelvic ring, and long bones. [ABSTRACT FROM AUTHOR]

BACKGROUND: Percutaneous long-arm single-axis pedicle screw fixation and minimally invasive percutaneous single-plane pedicle screw internal fixation are both classical minimally invasive surgical options commonly used in clinical practice, but the two surgical methods in the treatment of thoracolumbar fractures are still controversial. OBJECTIVE: To compare the advantages and limitations of two procedures, long-arm single-axis pedicle screw percutaneous approach and minimally invasive percutaneous single-plane pedicle screw internal fixation, in the treatment of thoracolumbar fractures. METHODS: Ninety patients with thoracolumbar fractures admitted to Shenzhen Hospital of Guangzhou University of Chinese Medicine from March 2017 to June 2021 were included and assigned to the control group (n=45) and the trial group (n=45). The control group received minimally invasive percutaneous single-plane pedicle screw internal fixation. The trial group received long-arm single-axis pedicle screw percutaneous approach. The indexes related to perioperative general condition, pain level, and recovery were compared between the two groups. RESULTS AND CONCLUSION: (1) Compared with the control group, the trial group had less intraoperative blood loss, shorter operative time and hospital stay (P < 0.05). (2) At 2 weeks and 1 month after operation, Oswestry dysfunction index score and Cobb angle in the trial group were lower than those in the control group (P < 0.05). The anterior and posterior heights of the injured vertebra were higher in the trial group than those of the control group (P < 0.05). At 2 months after operation, the Oswestry dysfunction index score and Cobb angle in the trial group were lower than those in the control group (P < 0.05). There was no significant difference in the anterior and posterior heights of the injured vertebra between the two groups (P > 0.05). At 2 weeks after operation, the visual analog scale score was lower in the trial group than that in the control group (P < 0.05). (3) Among the 45 cases in the control group, there were 2 cases of incision infection, 2 cases of dyskinesia, and 1 case of implant-related adverse reactions, with a total incidence rate of 11%. Among the 45 cases in the trial group, there were 2 cases of dyskinesia, and the total incidence was 4%. There was no significant difference in the total incidence of complications between the two groups (P > 0.05). (4) Both long-arm single-axis pedicle screw percutaneous approach and minimally invasive percutaneous single-plane pedicle screw internal fixation can achieve better results in the treatment of thoracolumbar fractures. However, the former has shorter operative time and less intraoperative blood loss, so the former is the ideal surgical option for obtaining the same benefit. [ABSTRACT FROM AUTHOR]