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Aims: The optimal management of posterior malleolar ankle fractures, a prevalent type of ankle trauma, is essential for improved prognosis. However, there remains a debate over the most effective surgical approach, particularly between screw and plate fixation methods. This study aims to investigate the differences in outcomes associated with these fixation techniques. Methods: We conducted a comprehensive review of clinical trials comparing anteroposterior (A-P) screws, posteroanterior (P-A) screws, and plate fixation. Two investigators validated the data sourced from multiple databases (MEDLINE, EMBASE, and Web of Science). Following PRISMA guidelines, we carried out a network meta-analysis (NMA) using visual analogue scale and American Orthopaedic Foot and Ankle Score (AOFAS) as primary outcomes. Secondary outcomes included range of motion limitations, radiological outcomes, and complication rates. Results: The NMA encompassed 13 studies, consisting of four randomized trials and eight retrospective ones. According to the surface under the cumulative ranking curve-based ranking, the A-P screw was ranked highest for improvements in AOFAS and exhibited lowest in infection and peroneal nerve injury incidence. The P-A screws, on the other hand, excelled in terms of VAS score improvements. Conversely, posterior buttress plate fixation showed the least incidence of osteoarthritis grade progression, postoperative articular step-off ≥ 2 mm, nonunions, and loss of ankle dorsiflexion ≥ 5°, though it underperformed in most other clinical outcomes. Conclusion: The NMA suggests that open plating is more likely to provide better radiological outcomes, while screw fixation may have a greater potential for superior functional and pain results. Nevertheless, clinicians should still consider the fragment size and fracture pattern, weighing the advantages of rigid biomechanical fixation against the possibility of soft-tissue damage, to optimize treatment results. Cite this article: Bone Jt Open 2024;5(3):227–235.

Abstract Purpose This study aimed to evaluate the effects and interactions of training level and different joints on the outcomes of cadaveric arthroscopic training courses for orthopaedic residents. Methods This prospective study enrolled 16 orthopaedic residents who voluntarily participated in a cadaveric training programme involving the shoulder, elbow, wrist, knee and ankle joints. Outcomes were quantitatively assessed using task‐specific checklists and the Arthroscopic Surgery Skill Evaluation Tool. Two‐way analysis of variance (ANOVA) was conducted to determine the significance of the interactions between joint and years of training. Results Resident scores significantly increased after the dedicated lectures in all five joints (p = 0.003 for the shoulder module, p

Abstract Background The definition of irreparable rotator cuff tear (IRCT) is controversial. This scoping review provides definitions used to describe IRCT in the literature. This scoping review (1) identified criteria used in the definition of IRCT and (2) investigated the current state of those criteria in prospective surgical therapeutic trials. Methods This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. PubMed, Scopus, and Web of Science were searched in March 2023. Studies were screened against predetermined inclusion and exclusion criteria. Criteria regarding clinical symptoms, preoperative images, and intraoperative findings were captured respectively. Results A total of 41 prospective studies were eligible for inclusion, and 35 studies (85.4%) defined IRCT. IRCT was defined on the basis of the following main criteria: preoperative image findings (28/35), intraoperative findings (24/35), and symptoms (16/35). With regard to preoperative images, IRCT was mainly defined on the basis of retraction of the tendon in the coronal plane (22/28), the severity of fatty degeneration (19/28), and ruptured tendon number or width of the defect in the sagittal plane (17/28). Conclusion This scoping review highlights the lack of a standardized definition for IRCT in clinical practice, with common predictive criteria including a duration of over 6 months, retraction beyond 5 cm, Goutallier grade 3 fatty infiltration, and the rupture of two or more tendons. However, surgeons should apply more than one criterion when examining preoperative images and confirm reparability during surgery. A more objective manner of evaluating intraoperative reparability is necessary.

Abstract The multitude of fixation options for radial neck fractures, such as pins, screws, biodegradable pins and screws, locking plates, and blade plates, has led to a lack of consensus on the optimal implant choice and associated biomechanical properties. This study aims to evaluate the biomechanical strength of various fixation constructs in axial, sagittal, and torsional loading directions. We included biomechanical studies comparing different interventions, such as cross/parallel screws, nonlocking plates with or without augmented screws, fixed angle devices (T or anatomic locking plates or blade plates), and cross pins. A systematic search of MEDLINE (Ovid), Embase, Scopus, and CINAHL EBSCO databases was conducted on September 26th, 2022. Data extraction was carried out by one author and verified by another. A network meta-analysis (NMA) was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Primary outcomes encompassed axial, bending, and torsional stiffness, while the secondary outcome was bending load to failure. Effect sizes were calculated for continuous outcomes, and relative treatment ranking was measured using the surface under the cumulative ranking curve (SUCRA). Our analysis encompassed eight studies, incorporating 172 specimens. The findings indicated that fixed angle constructs, specifically the anatomic locking plate, demonstrated superior axial stiffness (mean difference [MD]: 23.59 N/mm; 95% CI 8.12–39.06) in comparison to the cross screw. Additionally, the blade plate construct excelled in bending stiffness (MD: 32.37 N/mm; 95% CI − 47.37 to 112.11) relative to the cross screw construct, while the cross-screw construct proved to be the most robust in terms of bending load failure. The parallel screw construct performed optimally in torsional stiffness (MD: 139.39 Nm/degree; 95% CI 0.79–277.98) when compared to the cross screw construct. Lastly, the nonlocking plate, locking T plate, and cross-pin constructs were found to be inferior in most respects to alternative interventions. The NMA indicated that fixed angle devices (blade plate and anatomic locking plate) and screw fixations may exhibit enhanced biomechanical strength in axial and bending directions, whereas cross screws demonstrated reduced torsional stability in comparison to parallel screws. It is imperative for clinicians to consider the application of these findings in constraining forces across various directions during early range of motion exercises, taking into account the distinct biomechanical properties of the respective implants.

Objective: This study investigated the neuromuscular control of increasing and releasing force in patients with chronic lateral epicondylitis (CLE).Methods: Fifteen patients with CLE (10 males, 5 females, 46.5 ± 6.3 years) and fifteen healthy participants (9 males, 6 females, 45.3 ± 2.5 years) participated in this study. In addition to power grip and maximal voluntary contraction (MVC) of wrist extension, force fluctuation dynamics and characteristics of inter-spike intervals (ISI) of motor units (MUs) with various recruitment thresholds in the extensor carpi radialis brevis (ECRB) and extensor carpi radialis longus (ECRL) during a designated force-tracking task with a trapezoidal target (0%–75%–0% MVC) were assessed.Results: Besides a smaller MVC of wrist extension, the patients exhibited significantly greater task errors (p = 0.007) and force fluctuations (p = 0.001) during force increment than the healthy counterparts. Nevertheless, no force variables significantly differed between groups during force release (p > 0.05). During force increment, the amplitudes of the motor unit action potential of the ECRB and ECRL muscles of the patients were smaller than those of the heathy counterparts (p < 0.001). The patient group also exhibited a higher percentage of motor units (MU) with lower recruitment threshold (40% MVC) in the ECRB muscle, compared to the healthy group. During force increment, the patient group exhibited a higher rate of decrease in inter-spike intervals (ISIs) of motor units with lower recruitment thresholds (

Abstract Aim The incidence and characteristics of iatrogenic comminution (IC) are unknown, and the influence of IC on fracture union is unclear. This study was aimed to investigate the (1) incidence and characteristics of IC and (2) the outcomes of IC following antegrade interlocking nailing of simple femoral shaft fractures. Methods We retrospectively collected data on patients who experienced simple femoral shaft fractures and underwent antegrade interlocking nailing between February 2009 and December 2016. The incidence and characteristics of IC were examined. According to the presence of IC, patients were divided into two groups: an IC group and a non-IC (NIC) group. Demographic information and nonunion rates were compared between the two groups. Potential risk factors for IC (age, gender, body mass index (BMI), nail fit ratio, reduction technique, and greater trochanter nail entry) were analyzed using univariate and multivariate logistic regression. The aforementioned variables, along with IC occurrence, were also assessed as potential risk factors for nonunion at 12 and 24 months after operation using multivariate logistic regression. Results Of the 211 total patients, IC occurred in 20.9% (n = 44) of patients. Most ICs were found at the level of the isthmus, and involved the medial cortex. Compared with the NIC group, higher nonunion rates were observed in the IC group at 12 months (31.8% vs. 12.5%, p = 0.002) and 24 months (18% vs. 6.5%, p = 0.017) after surgery. Age older than 35 years old was related with the occurrence of IC in univariate analysis. Multivariate analysis found no risk factor associated with IC. Open reduction technique, IC occurrence and higher BMI were identified as the risk factors of nonunion at 12 months and 24 months after surgery in multivariate analysis. Conclusion IC is a non-rare complication in antegrade interlocking nailing of simple femoral shaft fractures and was associated with higher nonunion rate. Age older than 35 years old showed a trend toward increasing risk of iatrogenic fracture comminution. In multivariate analysis, open reduction technique, IC occurrence and higher BMI significantly correlated with fracture nonunion. Level of evidence Level IV.

Abstract Purpose To investigate the relationship between the lateral femoral notch sign as well as the coronal lateral collateral ligament (LCL) sign and anterior tibial translation using the GNRB arthrometer in patients with anterior cruciate ligament (ACL) injuries. Methods Forty-six patients with ACL injuries were retrospectively included from May 2020 to February 2022; four patients were excluded due to incomplete data. Magnetic resonance imaging (MRI) were reviewed for the lateral femoral notch sign and the coronal LCL sign. The GNRB arthrometer was used to evaluate the dynamic anterior tibial translation of the knee, and the side-to-side differences (SSDs) in tibial translation between the injured knee and healthy knee were calculated at different force levels. Two types of slopes for displacement-force curves were acquired. Results Six patients (14.3%) had the positive lateral femoral notch sign (notch depth > 2.0 mm), and 14 patients (33.3%) had the positive coronal LCL sign. The SSD of the anterior tibial translations under different loads as well as the slopes of displacement-force curves were the same in the positive and negative notch sign groups (p all > 0.05) and between the positive and negative coronal LCL sign groups (p all > 0.05). Meanwhile, the measured notch depth and notch length were also not significantly correlated with the anterior tibial translation SSD in the GNRB. Conclusion The presence of the lateral femoral notch sign and the coronal LCL sign did not indicate greater dynamic tibial laxity as measured using the GNRB.

Abstract Background In treatment of chronic acromioclavicular (AC) joint dislocations, both the Weaver–Dunn procedure (WD) and CC ligament reconstruction (CCR) are recommended options due to the low possibility of healing of the coracoclavicular (CC) ligaments. The aim of this review was to determine whether CCR will yield favorable clinical and radiographic outcomes in the treatment of chronic AC dislocations. Method The Cochrane Library, EMBASE, and PubMed databases were searched for literature on chronic AC dislocations from data inception to June 30, 2021. Patient data were pooled using standard meta-analytic approaches. The Cochrane-Mantel–Haenszel method and variance-weighted means were used to analyze the outcomes. The Review Manager version 5.3 software (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark) was used to calculate the heterogenicity, mean difference, and relative risk (RR) for all outcomes in the meta-analysis. Results The current analysis included four trials on this topic, and all AC joint dislocations were classified as Rockwood types III to VI. The pooled data showed that the CCR group had significantly better post-operative American Shoulder and Elbow Surgeons Shoulder (ASES) scores, Oxford Shoulder Scores (OSSs), and Nottingham Clavicle Scores (NCSs) than the WD group, with a significant difference (p

Abstract Purpose To compare the anterior translation and internal rotation of tibia on magnetic resonance imaging (MRI) between adult and adolescent patients with anterior cruciate ligament (ACL) tears. Methods Patients who underwent isolated ACL reconstruction from January 2013 to May 2021 were retrospectively reviewed. The exclusion criteria included incomplete data, poor image quality, a prior ACL surgery, and concomitant fractures or other ligament injuries. The enrolled patients were divided into two groups based on their ages: an adult group (age > 19 years) and an adolescent group (15 to 19 years of age). Anterior tibial translation and femorotibial rotation were measured on MRI. A Student’s t-test was used for the statistical analysis comparing the adult and adolescent groups. Results A total of 365 patients (279 adults and 86 adolescents) were enrolled in the present study. The anterior tibial translation in the adult group (4.8 ± 4.4 mm) and the adolescent group (5.0 ± 4.2 mm) was not significantly different (p = 0.740). On the other hand, the tibial internal rotation in the adult group (5.6 ± 5.0 degree) was significantly greater compared to the adolescent group (4.2 ± 5.6 degree) (p = 0.030). The intraclass correlation coefficients (ICC) of the measured data from two independent observers showed excellent reliability (0.964 and 0.961 for anterior tibial translation and tibial internal rotation, respectively). Conclusion The adult patients with ACL tears exhibited significant greater tibial internal rotation compared to the adolescent patients, whereas the magnitude of the anterior tibial translation was similar in both groups. Care should be taken if clinicians plan to establish the cutoff point values for diagnosis of ACL tears using the femorotibial internal rotation angle.

Abstract Purpose Suture anchors are commonly used to repair rotator cuff tendons in arthroscopy surgery, and several anchor materials have been created to maximize pull‐out strength and minimize iatrogenic damage. We hypothesized that all‐suture anchors have biomechanical properties equivalent to those of conventional anchors. Our purpose is to compare the biomechanical properties of different anchors used for rotator cuff repair. Methods The Embase, PubMed, Cochrane, and Scopus databases were searched for biomechanical studies on various suture anchors. The search keywords included rotator cuff tears and suture anchors, and two authors conducted study a selection, risk of bias assessment, and data extraction. The failure load, stiffness, and displacement were calculated using the mean differences with 95% confidence intervals (CIs). Failure modes were estimated using summary odds ratios with 95% CIs. The surface under the cumulative ranking curve was used for the relative ranking probabilities. A sensitivity analysis was performed by excluding studies using synthetic bones. Results The polyetheretherketone (PEEK) (p

Abstract Purpose This study aimed to comprehensively review the existing evidence concerning surgical treatment of inferior pole fractures of the patella and to report the outcomes and complications of different fixation techniques. Method This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Searches of PubMed, Scopus, and Web of Science were conducted in March 2023. Studies were screened against predecided inclusion and exclusion criteria. The extracted data included fracture characteristics, surgical techniques, and radiographic and functional outcomes. The Methodological Index for Non‐Randomized Studies (MINORS) quality assessment tool was used to assess the eligible literature. The primary outcome was postoperative range of motion of different surgical methods, and the secondary outcomes were other clinical results and complications. Results A total of 42 studies satisfied all the inclusion criteria and were deemed suitable for review. Fourteen case–control studies and 28 case series were selected, for a total of 1382 patients with a mean age of 51.0 years (range = 11–90). The follow‐up period ranged from 6 to 300 months. The surgical techniques were categorized based on the device used as follows: (1) rigid fixation device; (2) tensile fixation device; (3) mixed device; and (4) extra‐patella device. Conclusion Regarding the outcomes following surgical treatment of inferior pole fractures of the patella, the postoperative range of motion (ROM) of each technique ranged from 120° to 135°, with the exception of that involving the patellotibial wire which had poorer outcomes. The lowest functional score was also found in those using the patellotibial wire. Complications after surgery are rare, but approximately half of the patients required additional surgery for implant removal, particularly those whose initial surgery involved rigid fixation devices. It's worth noting that bony fragment excision is no longer recommended, and the combined use of multiple surgical devices is now more common.

Abstract Introduction The role of open cerclage wiring in comminuted femoral shaft fracture treatment with intramedullary nails remains unclear. Here, we analyzed the effect of open cerclage wiring and the risk factors for nonunion after interlocking nailing in comminuted femoral shaft fracture treatment. We hypothesized that open cerclage wiring can be applied in patients with severe comminuted femoral shaft fractures without affecting bone healing. Patients and methods This retrospective cohort study used data from consecutive patients who underwent interlocking nail fixation of a comminuted femoral shaft fracture between January 1, 2009, and December 31, 2016. First, eligible patients were divided into the wire and no wire groups according to the surgical technique used, and their union rate was recorded. The patients were then divided into the union and nonunion groups, and their perioperative data were analyzed. Results In total, 71 comminuted femoral shaft fractures treated with interlocking nail fixation were included: 38 fractures (53.5%) augmented with the open wiring technique and 33 reduced with closed or mini-open techniques without wiring. The wire group demonstrated significant improvements in fracture reduction compared with the no wire group, whereas no significant difference was observed in the union rate between the wire and no wire groups (p = 0.180). Moreover, 46 (65%) of 71 fractures achieved union smoothly, and no significant difference was observed in any perioperative data between the union and nonunion groups. Discussion Augmentation with open cerclage wiring is indicated for comminuted femoral shaft fractures treated with intramedullary nails, even when the fragments are large or greatly displaced. Thus, open cerclage wiring can be used for fracture treatment without decreasing the union rate.

Abstract Background The optimal surgical technique for the fixation of inferior pole patellar fracture remains controversial. The aims of this study were (1) to compare clinical and radiological outcomes following fixation of inferior pole patellar fracture by using tension band wire (TBW) and transosseous reattachment (TOR) without excision of the bony fragment and (2) to determine the risk factors for postoperative radiological loss of reduction. Methods For this retrospective cohort study, consecutive patients with inferior pole patellar fracture between January 2010 and December 2017 were recruited. The patients were grouped according to their fixation method (TBW or TOR), and demographic data, clinical outcomes, and postoperative Insall–Salvati (IS) ratio were analyzed. Then, the patients were grouped according to radiological loss of reduction, the possible risk factors for loss of reduction were identified, and odds ratios were calculated. Result This study included 55 patients with inferior pole patellar fracture; 30 patients were treated using TBW and 25 were treated using TOR. Clinical failure occurred in two patients in the TBW group (7%) and three in the TOR group (12%). The rate of radiological loss of reduction was significant higher in the TOR group, whereas removal of implants was significantly more common in the TBW group. Patella baja was noted immediately after surgery in the TOR group, but the IS ratios of the two groups were similar after 3 months. Fracture displacement of more than 30 mm was the only independent risk factor for postoperative radiological loss of reduction. Conclusion For treating inferior pole patellar fracture, both TWB and TOR were effective and had a low clinical failure rate. In 60% of patients undergoing TBW fixation, however, additional surgery was required to remove the implants. Patella baja occurred immediately following TOR, but the patellar height was similar to that in the TBW group after 3 months. Surgeons should be aware of the high risk of postoperative radiological loss of reduction, especially when the fracture displacement is more than 30 mm.

Abstract Background The posterior plating technique could be used as a clinical alternative to parallel plating for treating comminuted distal humerus fractures (DHFs) successfully with good clinical results. However, the biomechanical characteristics for posterior fixation are still unclear. The purpose of this study is to evaluate the biomechanical properties of the posterior fixation and to make comparisons between the parallel and the posterior fixation systems. Materials and methods We performed a cadaveric biomechanical testing with two posterior plating systems (a posterior two plating and a single posterior pre-contoured Y plating system) and one parallel two plating system to treat AO/OTA type-C2.3 DHFs. Among three groups, we compared construct stiffness, failure strength, and intercondylar width changes after 5000-cycle fatigue loading and failure loads and failure modes after destructive tests in both the axial compression and (sagittal) posterior bending directions. The correlations between construct failure loads and bone marrow density (BMD) were also compared. Results In axial direction, there were no significant differences in the stiffness and failure load between the posterior and the parallel constructs. However, in sagittal direction, the two-plate groups (posterior two plating and parallel plating group) had significant higher stiffness and failure loads than the one-plate group (single posterior Y plating). There was no fixation failure after 5000-cyclic loading in both directions for all groups. Positive correlation was noted between BMD and failure loads on parallel fixation. Conclusions We found that when using two plates for treating comminuted DHFs, there were no significant differences in terms of most biomechanical measurements between posterior and parallel fixation. However, the single pre-contoured posterior Y plate construct was biomechanically weaker in the sagittal plane than the parallel and the posterior two-plate constructs, although there was no fixation failure after the fatigue test for all groups regardless of the fixation methods. Level of evidence Biomechanical study

Abstract Background Poor functional outcome can result from humeral greater tuberosity (GT) fracture if not treated appropriately. A two-screw construct is commonly used for the surgical treatment of such injury. However, loss of reduction is still a major concern after surgery. To improve the biomechanical strength of screw fixation in GT fractures, we made a simple modification of the two-screw construct by adding a cerclage wire to the two-screw construct. The purpose of this biomechanical study was to analyze the effect of this modification for the fixation of GT fractures. Materials and methods Sixteen fresh-frozen human cadaveric shoulders were used in this study. The fracture models were arbitrarily assigned to one of two fixation methods. Group A (n = 8) was fixed with two threaded cancellous screws with washers. In group B (n = 8), all screws were set using methods identical to group A, with the addition of a cerclage wire. Horizontal traction was applied via a stainless steel cable fixed directly to the myotendinous junction of the supraspinatus muscle. Displacement of the fracture fixation under a pulling force of 100 N/200 N and loading force to construct failure were measured. Results The mean displacements under 100 N and 200 N traction force were both significantly decreased in group B than in group A. (100 N: 1.06 ± 0.12 mm vs. 2.26 ± 0.24 mm, p

Abstract Background The patient self-report section of the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASESp) is one of the most validated and reliable assessment tools. This study aimed to establish a validated Chinese version of ASESp (ASESp-CH). Methods A clinical prospective study was performed (ClinicalTrials.gov Identifier: NCT04755049; registered on 2021/02/11). Following the guidelines of forward-backward translation and cross-cultural adaptation, a Chinese version of ASESp was established. Patients older than 18 years with shoulder disorders were included. Patients who could not complete test-retest questionnaires within the interval of 7–30 days and patients who received interventions were excluded. Intraclass correlation (ICC) was calculated for test- retest reliability, whereas internal consistency was determined by Cronbach value. Construct validity was evaluated by comparing the corresponding domains between the ASESp-CH and a validated Chinese version of 36-Item Short Form Health Survey (SF-36). Results A total of 86 patients were included with a mean test-retest interval of 12 ± 5.4 days. Test-retest reliability was excellent with an ICC of 0.94. Good internal consistency was found, with a Cronbach alpha of 0.86. Construct validity of the ASESp-CH questionnaire was good. The major domains of the ASESp-CH were significantly correlated with the respective domains in the SF-36 (p

Background: Degenerative signs on shoulder radiographs, including spur formation and narrow acromiohumeral intervals (AHIs), have been recognized as indicative of atrophic and fat-infiltrated rotator cuff muscles. Past studies have demonstrated that patients with poor quality muscles are prone to retraction of the supraspinatus tendon and failure to repair. However, the association between radiographic signs and tendon retraction has never been elucidated in previous literature. The present study aimed to investigate the association between the degenerative signs on shoulder radiographs and the severity of supraspinatus retraction. Methods: Images of 67 individuals, who had undergone an arthroscopic rotator cuff repair, were retrospectively reviewed. The greater tuberosity (GT) morphology, subacromial spur, AHI, and acromial thickness were evaluated on the radiographs, whereas the retraction of the supraspinatus tendon was assessed via an MRI in accordance with the Patte classification. Simple regression analyses between the radiographic signs and Patte stages were performed, and factors reaching statistical significance were then included in the multiple ordinal logistic regression. Statistically significant predictors from the multiple regression analysis were constructed into combinations, for which the sensitivity and specificity were calculated. Results: The GT morphology (P = .004), AHI (P = .083), subacromial spur (P = .008), and age (P = .004) were associated with supraspinatus retraction in the simple regression analyses. These four parameters were incorporated into the multiple ordinal logistic regression, where the GT spur (adjusted odds ratio 8.63, 95% confidence interval 2.16-34.53, P = .002) and AHI (AOR 0.79, 95% CI 0.63-0.98, P = .032) were demonstrated to be predictive of the Patte stage of supraspinatus retraction. The acromial spur implied a higher risk of severe retraction although this finding was not statistically significant (AOR 2.89, 95% CI 0.90-9.29, P = .075). The presence of concurrent GT spur and narrow AHI was highly specific (sensitivity 27.3% / specificity 91.1%) for advanced supraspinatus retraction. Conclusion: The presence of a radiographic GT spur, narrow AHI, and subacromial spur indicated advanced retraction of the supraspinatus tendon. When patients with clinical suspicion of rotator cuff tear present with combinations of these radiographic signs, a prompt MRI examination and a referral to a shoulder specialist are recommended.

Abstract Background The treatment of Hoffa fractures is challenging, for which the ideal fixation and approach are still controversial. Osteosynthesis with plate or screws fixation in different trajectories have been described in previous literature. The purpose of this study was to compare the biomechanical strength and stability of two types of screw trajectories used to stabilize displaced coronal fractures of the lateral femoral condyle. Methods Sixteen synthetic femurs (Sawbones Pacific Research Laboratories, Vashon, WA) were divided into two groups. A vertical osteotomy was performed to mimic a Letenneur type I Hoffa fracture. Group A (n = 8) was fixed with screw in anteroposterior direction (A-P) screws. Group B (n = 8) was fixed with crossed screws. Both groups were tested with a nondestructive axial compression aligned with the femur axis. After that, 10,000 cyclic loading tests were applied to the specimen with a force ranging between 200 to 600 N, and the interfragmental displacement was recorded, respectively, after 10, 100, 1000 and 10,000 cycles. Finally, a destructive axial compression test was applied until catastrophic failure. Results There were no statistical between-group differences in regard to the average axial stiffness, interfragmental displacement, and ultimate failure load. The average axial stiffness of the A-P screw was comparable to that of the crossed screw (361 ± 113 N/mm vs. 379 ± 65 N/mm, p = 0.753). All specimens completed the entire cyclic loading test without catastrophic failure, and the interfragmental displacement after loading for 10,000 cycles was 1.36 ± 0.40 mm for the A-P screw and 1.29 ± 0.61 mm for the crossed screw, there were no statistical differences between the groups (p = 0.823). The average ultimate failure loads for the A-P and crossed screws were 1214 ± 127 N and 1109 ± 156 N, respectively (p = 0.172). Conclusions Based on our in vitro study, the crossed screws can provide comparable mechanical performance as traditional A-P screws in Hoffa fracture fixation. Considering the screws trajectories are commonly determined by the choice of surgical approach, the current study provides support from a biomechanical perspective for the application of crossed screws in direct lateral approach.

Abstract Purpose To investigate the functional outcomes for patients who used a novel home‐based rehabilitative system during the postoperative period after anterior cruciate ligament (ACL) reconstructions. Methods Patients undergoing ACL reconstruction surgeries were prospectively enrolled. A home‐based rehabilitation system, which is composed of a knee brace with a motion tracker, a mobile app, and a web portal, was applied. Patients could complete the rehabilitation exercise through the audio guidance and the real‐time tracking system which displayed the achieved motions on the user interface of the app. Feedbacks from the patients, including the International Knee Documentation Committee (IKDC) scores, were collected and uploaded to the web portal. Each patient would meet a specialized physical therapist face‐to‐face once a month. At postoperative 6 months, every patient received a GNRB arthrometer examination and a Cybex isokinetic dynamometer examination. Results A total of 15 patients (10 males and 5 females) were enrolled and followed for at least 6 months. The mean time of return to full knee extension was 1.5 months. The mean difference in laxity measured by GNRB arthrometer at 134 N significantly improved at postoperative 6 months (1.8 ± 1.6 mm) compared to that measured preoperatively (3.4 ± 1.9 mm) (p = 0.024). The peak torques of flexor and extensor muscles measured by Cybex isokinetic dynamometer remained unchanged at postoperative 6 months (p = 0.733 and 0.394, respectively). The patients’ IKDC score became smaller at postoperative 1 month (p = 0.011) and significantly improved at postoperative 6 months (p = 0.002). Conclusion Using a home‐based rehabilitative knee brace system after ACL reconstruction is a viable option as patients maintained their knee muscle strengths maintained their muscle strength and achieve similar or better knee range of motion six months postoperatively.

Abstract Background Occult and missed surgical neck fractures can be found in patients diagnosed with isolated greater tuberosity (GT) fracture during the follow up period. The purpose of this study was to retrospectively assess the incidence rate of occult and missed surgical neck fractures in those initially diagnosed with isolated GT fracture. Methods Records of patients diagnosed as having an isolated GT fracture were retrieved from a database in a medical center. Two senior orthopedic surgeons blindly reviewed all images of these patients three times to classify GT fracture types (split, avulsion and depression types), and recorded any surgical neck fractures found. Then a meeting was help to confirm the fracture types and presence of surgical neck fracture. Results Occult surgical neck fractures were found in 5 out of 68 (7.4%) patients, whereas missed surgical neck fractures were found in 3 out of 68 (4.4%) patients. In total, 32 patients had split type GT fracture, 32 had avulsion type and 4 had depression type. For those with occult surgical neck fractures, 7 had the split type GT fracture, while the remaining one had the avulsion type. Although the proportion of occult surgical neck fracture was higher in the split-type GT fracture (21.9%) than in the avulsion-type GT fracture (3.1%), the difference was not statistically significant (p = 0.056). Conclusion Occult humeral surgical neck fractures occurred in 7.4% of isolated greater tuberosity fractures after re-evaluation, while missed humeral surgical neck fractures occurred in 4.4%.

Abstract Background The optimal insertion angle for suture anchor insertion has long been of great interest. Although greater tuberosity decortication is commonly performed during rotator cuff repair, the effect of decortication on the suture anchor insertion angle remains unclear. The purpose of this study was to compare the pullout strength of threaded suture anchors inserted at 45° and 90° in decorticated and non-decorticated synthetic bone models. Methods Two kinds of synthetic bones were used to simulate the decorticated and non-decorticated conditions, for which 40 metallic suture anchors were used. Anchors were inserted at 45° and 90° in both decorticated and non-decorticated models and tested under cyclic loading followed by load-to-failure testing. The number of completed cycles, ultimate failure load, and failure modes was recorded. Results In the decorticated model, the ultimate failure load of anchors inserted at 45° (67.5 ± 5.3 N) was significantly lower than that of anchors inserted at 90° (114.1 ± 9.8 N) (p

Magnesium-matrix implants can be detected by X-ray, making post-operative monitoring easier. Since the density and mechanical properties of Mg alloys are similar to those of human bones, the stress-shielding effect can be avoided, accelerating the recovery and regeneration of bone tissues. Additionally, Mg biodegradability shields patients from the infection risk and medical financial burden of needing another surgery. However, the major challenge for magnesium-matrix implants is the rapid degradation rate, which necessitates surface treatment. In this study, the ZKX500 Mg alloy was used, and a non-toxic and eco-friendly anodic oxidation method was adopted to improve corrosion resistance. The results indicate that the anodic coating mainly consisted of magnesium phosphate. After anodic oxidation, the specimen surface developed a coating and an ion-exchanged layer that could slow down the degradation and help maintain the mechanical properties. The results of the tensile and impact tests reveal that after being immersed in SBF for 28 days, the anodic oxidation-treated specimens maintained good strength, ductility, and toughness. Anodic coating provides an excellent surface for cell attachment and growth. In the animal experiment, the anodic oxidation-treated magnesium bone screw used had no adverse effect and could support the injured part for at least 3 months.

Trapezoid dislocation is infrequent, and palmar trapezoid dislocation is even more rare. This uncommon injury is associated with high-energy trauma and is often combined with other distracting injuries that may lead to misdiagnosis or delayed diagnosis. We present a case of isolated palmar dislocation of the trapezoid in a 49-year-old man with major trauma following a motor vehicle accident. We identified the dislocation by radiograph and performed open reduction and internal fixation (ORIF) after primary management of his major trauma. The patient recovered with satisfactory hand and wrist function. We share our experience and review the pitfalls in diagnosis and treatment for this rare injury.

Purpose: To compare the biomechanical properties of high-tensile strength tape and a high-tensile strength suture in subpectoral biceps tenodesis using a suture anchor in a porcine tendon model. Methods: A total of 24 artificial composite (polymer and glass fiber) humeri and porcine flexor profundus tendons were used. Two types of suture materials, high-tensile strength sutures (group S) and high-tensile strength tapes (group T), were evaluated. After we inserted metallic suture anchors with either 2 sutures or tapes 5 cm from the superomedial corner of the greater tuberosity, a Krackow suture technique was used to secure the tendons. After a preload of 5 N for 2 minutes, a cyclic loading test from 5 to 70 N was conducted for 500 cycles. Finally, the specimen was loaded to failure at a rate of 1 mm/s. Results: There were no significant between-group differences in elongation after cyclic loading and elongation at failure load for group S and group T (P = .977 and .630, respectively). The ultimate failure loads in group T (278.2 ± 54 N) were significantly greater than those in group S (249.4 ± 32 N) (P = .028). In contrast, the stiffness values in group T (28.5 ± 4.0 N/mm) were significantly lower than those in group S (32.3 ± 4.5 N) (P = .028). Ten specimens in group S and 8 specimens in group T failed, with tendons being cut through by the sutures, whereas the other 2 specimens in group S and 4 specimens in group T failed due to suture breakage. Conclusions: Using high-tensile strength tapes in subpectoral biceps tenodesis using a suture anchor leads to significantly greater ultimate failure load as compared with using high-tensile strength sutures in a porcine model. Although lower levels of stiffness were found in high-tensile strength tape group, the difference in the means were not large between 2 groups. Clinical Relevance: A strong suture–tendon structure may prevent clinical failure of a subpectoral biceps tenodesis using a suture anchor.

Purpose: To compare the biomechanical properties of a high-tensile strength suture and high-tensile strength tape in tendon graft fixation using two needleless suture wrapping techniques, the modified Prusik knot and modified rolling hitch. Methods: Two needleless suture wrapping techniques, the modified rolling hitch (MR) and modified Prusik knot (MP), were utilized. Meanwhile, two kinds of suture materials, a No. 2 braided nonabsorbable high-strength suture (S) and a 1.3 mm high-tensile strength tape (T), were used. A total of 40 porcine tendons were used, which were randomly divided into four groups. Each group was assigned to one of the following groups: MRS, MRT, MPS, and MPT. Each specimen was pretensioned to 100 N for three cycles, cyclically loaded from 50 to 200 N for 200 cycles, and finally loaded to failure. Results: The MRT group (34.1 ± 3.5%) had a significantly higher value compared with the MRS (29.7 ± 2.3%), MPS (27.1 ± 3.6%) and MPT (29.5 ± 4.0%) groups in term of elongation after cyclic loadings ( p = 0.002). In terms of ultimate failure load, there were no significant differences in the MRS (401 ± 27 N), MRT (380 ± 27 N), MPS (398 ± 44 N) and MPT (406 ± 49 N) values ( p = 0.539). All specimens failed due to suture breakage at the knots. Conclusion: Compared with the high-tensile strength suture, using the high-tensile strength tape lead to greater elongation after cyclic loading when the modified rolling hitch was used. No differences in terms of elongation after cyclic loading and load to failure were found between the high-tensile strength suture and tape using the modified Prusik knot.

Purpose: To compare the biomechanical properties of a high-tensile strength suture with the high-tensile strength tape for tendon graft fixation. Methods: A total of 24 porcine tendons were used and were randomly divided into 2 groups. Two kinds of suture materials, a braided nonabsorbable high-strength suture (group S) and a high-tensile strength tape (group T), were used to complete 3 pairs of Krackow stitches on the tendons. Each specimen was pretensioned to 100 N for 3 cycles, cyclically loaded from 50 to 200 N for 200 cycles, and finally loaded to failure. Elongation after cyclic loading, ultimate failure load, and the mode of failure were recorded. Results: The elongation after cyclic loading between group S (26% ± 5%) and group T (24% ± 5%) were not significantly different (P = .378). The ultimate failure loads in group T (400 ± 38 N) were significantly greater than those in group S (358 ± 21 N) (P = .010). All specimens failed because of suture material breakage. Conclusions: Compared with the braided nonabsorbable high-strength suture, the high-tensile strength tape had similar elongation values after cyclic loading, but significantly greater ultimate failure load in this porcine in vitro biomechanical model. Clinical Relevance: A secure suture-tendon construct is especially important when a post-tie fixation technique is used because the mitigating construct may potentially lead to graft loosening and affect graft healing.

Currently, orthopedic metallic implants are mostly made of stainless steel and titanium alloys. After healing, patients are usually required to undergo a secondary surgery for implant removal, which not only poses a medical risk but also costs medical resources. Magnesium-based biodegradable implants that can be absorbed by humans promote osteoblastic activity during the degradation and inhibit the formation of osteoclasts. Moreover, magnesium can be detected by X-ray, and this can help doctors to perform postoperative diagnosis and treatment, which is beneficial for patients. In this study, a ZKX500 Mg alloy bone plate was prepared through rolling. In addition to the microstructure and the mechanical properties of the hot-rolled ZKX500 Mg alloy, its in vitro corrosion behavior under different heat treatment conditions is discussed. A 6-month mini-pig implantation test was conducted using the fabricated ZKX500 Mg alloy bone plate and bone screws. The in vivo degradation mechanism and new bone formation were observed using computed tomography images. The pig recovered well, and the results can serve as an important reference for clinical applications. In addition, another important contribution of this study is that it can help the field of orthopedics to better understand the biodegradable magnesium alloy.

Purpose: The purpose of this study was to analyze the effects of different intervals between stitch throws on tendon graft fixation with the Krackow stitch. Methods: Forty-four porcine flexor profundus tendons were randomly divided into four groups of 11 specimens each. The Krackow stitch with various stitch intervals (2.5, 5.0, 7.5, and 10.0 mm) were evaluated, and named the K-2.5, K-5.0, K-7.5, and K-10.0 groups, respectively. A braided nonabsorbable suture was used to complete each suture-tendon construct. All specimens were pretensioned to 100 N for three cycles, cyclically loaded from 50 to 200 N for 200 cycles, and then finally loaded to failure. Elongation after cyclic loading, ultimate load to failure, and the mode of failure were recorded. Results: There were significant differences in elongation after cyclic loading among the K-2.5 (31% ± 5%), K-5.0 (32% ± 4%), K-7.5 (34% ± 5%), and K-10.0 (41% ± 8%) groups ( p = 0.004); the post hoc analysis showed significantly smaller values in the K-2.5 and K-5.0 groups than in the K-10.0 group ( p = 0.002 and 0.003, respectively). The stitch interval was correlated with elongation after cyclic loading ( r = 0.52, p < 0.001). Ultimate loads to failure and cross-sectional area were not significantly different across the four groups. Conclusion: The Krackow stitch with stitch intervals of 2.5 and 5.0 mm had significantly smaller elongation after cyclic loading than with an interval of 10.0 mm in this porcine biomechanical study. The stitch interval was moderately correlated with elongation after cyclic loading.

OBJECTIVE: To evaluate the relative efficacy of various physical therapy interventions for chronic ankle instability (CAI). DESIGN: A network meta-analysis of randomized controlled trials. LITERATURE SEARCH: PubMed, Cochrane Library, Embase, Scopus, and CINAHL bibliographic databases were searched up to December 2023. STUDY SELECTION CRITERIA: Randomized controlled trials examining nonsurgical treatments for CAI. DATA SYNTHESIS: We used frequentist network meta-analysis to assess 8 outcomes across 44 trials, including the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) scale or Sport scale, Cumberland Ankle Instability Tool (CAIT), Star Excursion Balance Test (SEBT) in 3 directions (anterior [A], posteromedial [PM], and posterolateral [PL]), dorsiflexion range of motion, and pain. Surface under the cumulative ranking curve (SUCRA) values identified the most effective interventions. RESULTS: Based on SUCRA rankings, a regimen combining balance and strengthening exercises, augmented with either manual therapy or dry needling, was identified as the most effective in enhancing function (SUCRA: FAAM ADL = 95.2% [manual]/83.9% [dry needling]; FAAM Sport = 87.9% [manual]/80.1% [dry needling]), improving dynamic balance (SUCRA [manual]: SEBT-A = 92.1%; SEBT-PM = 98.0%; SEBT-PL = 90.8%), and significantly relieving pain (SUCRA: 99.9%). A multimodal exercise approach combined with manual therapy showed superior efficacy in increasing dorsiflexion (SUCRA: 61.6%). Tai chi emerged as the most promising intervention for improving stability (SUCRA: 99.9%). CONCLUSION: Interventions that emphasized strengthening and balance exercises were the most effective strategy for achieving best function and pain relief for patients with CAI. Multimodal exercises and tai chi might improve ankle range of motion and instability, respectively. [ABSTRACT FROM AUTHOR]

Background: Clubfoot, or congenital talipes equinovarus deformity, is a common anomaly affecting the foot in infants. However, clinical equipoise remains between different interventions, especially those based on the Ponseti method. The aim of this study was to examine the clinical outcomes of the various interventions for treating idiopathic clubfoot. Methods: Searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Scopus, and CINAHL were conducted. Randomized controlled trials comparing different interventions, including the Ponseti method, accelerated Ponseti method, Ponseti method with botulinum toxin type A (Botox) injection, Ponseti method with early tibialis anterior tendon transfer (TATT), Kite method, and surgical treatment, were included. Network meta-analyses (NMAs) were conducted according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) reporting guidelines. The primary outcomes were the change in total Pirani score and maximal ankle dorsiflexion. Secondary outcomes were the number of casts, time in casts, and rates of tenotomy, total complications, relapse, adverse events, and additional required major surgery. Results: Eleven randomized controlled trials involving 740 feet were included. According to the SUCRA (surface under the cumulative ranking curve)-based relative ranking, the Ponseti method was associated with the best outcomes in terms of Pirani score changes, maximal ankle dorsiflexion, number of casts, adverse events, and total complications, whereas the accelerated Ponseti method was associated with the best outcomes in terms of time in casts and tenotomy rate. Early TATT ranked best in terms of relapse rate. The Ponseti method with Botox injection was associated with the best outcomes in terms of the need for additional major surgery. Conclusions: The NMAs suggest that the Ponseti method is the optimal treatment overall, despite potential drawbacks such as longer time in casts and higher rates of tenotomy, relapse, and the need for additional surgery compared with other modified approaches. Therefore, clinicians should consider how treatments can be tailored individually. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]