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Abstract Introduction Proximal humerus fractures are usually treated with rigid angle-stable plates or nails. As an alternative, semi-rigid, minimally invasive systems have been developed for supportive fixation. A new system uses this principle with 2.5 mm partially threaded pins and external fixation. Aim This study aimed to compare the fracture stability of the fixator with an angular stable plate about whether the mechanical stability is sufficient for early postoperative mobilisation. Materials and methods Human proximal humeri (paired, female, age ≥ 60, n = 8) were cut to a 3-part fracture and treated with an external fixator (Galaxy Shoulder, Orthofix) or an angular stable plate (Philos, DePuy Synthes). A physiological load was simulated in vitro based on a 45° abduction motion. The load level was continuously increased from 10 to 320 N within 10,000 cycles simulating the loads during rehabilitation. This was followed by another 10,000 cycles at 320 N for fatigue testing. Fracture motion was recorded with a 3D camera. Fracture stability was evaluated at a partial load of 160 N and 240 N (simulating loads during early mobilisation). Results The fracture motion at the lateral aspect was significantly (p

BACKGROUND: The C1 type fracture of the distal radius is an intraarticular unstable fracture, which is difficult to treat. At present, there are few clinical studies about the comparison of the biomechanical differences of different internal fixation plates for distal radius fractures under different loading conditions, and there are still controversies in the selection of internal fixation plates. OBJECTIVE: To compare the biomechanical properties of different internal fixation plates for C1 type fractures of distal radius using a finite element analysis method. METHODS: The distal radius model of a healthy female volunteer was used, and the files were sequentially imported into Mimics 21.0, Geomagic Wrap 2017, and Solid Works 2021 for processing. The C1 type fracture of the distal radius was modeled. According to the plate data provided by the manufacturer, the volar oblique T-locking plate, volar fixed-angle anatomical plate, volar variable-angle locking plate and screws three-dimensional model were created and assembled with the fracture model. The material properties were given in ANSYS 19.0 to set up the relationship of interaction between the contact surfaces, and to define the loads and boundary conditions. Four load cases, including compression, dorsal flexion, palmar flexion and torsion, were applied to compare the biomechanical properties. RESULTS AND CONCLUSION: (1) In the three groups of internal fixation models, the overall displacement of the internal fixation model was mainly concentrated on the articular surface of the distal radius under four load conditions. The maximum displacement of the model under the dorsal, palmar and torsion load conditions was 2-6 times that of the displacement under the axial load, indicating that the internal fixation system was the most stable under the axial load condition. (2) The stress on the internal fixation was much greater than the stress on the bone fracture fragments. The stress of the internal fixation was mainly concentrated in the area that near to the fracture end of the bone plate, among which the stress distribution of the volar fixed-angle anatomical plate, volar variable-angle locking plate was relatively uniform, and the stress concentration of the oblique T-locking plate was the most obvious. (3) Under compressive and torsional loads, the stress of the fracture fragments was mainly concentrated in the area that around the screw holes. Under dorsal and palmar flexion, it gradually expanded from the distal end to the proximal radius. Under the same load condition, the stress of the fracture block in the oblique T-locking plate fixation state was the highest, and the peak stress of the fracture fragments in the volar variable-angle locking plate fixation system was the lowest. The difference between the peak stress of the bone fracture fragments in the fixed state of the volar fixed-angle anatomical plate and the volar variable-angle locking plate was only in the range of 0.2-6.0 MPa. (4) It is indicated that compared with the oblique T-locking plate and the volar fixed-angle anatomical plate, the volar variable-angle locking plate has more uniform stress distribution, less displacement of articular surface, and the best stability in the internal fixation in the C1 type fracture of the distal radius. [ABSTRACT FROM AUTHOR]

Purpose: Does the cylindrical shaped bone block allow a stable construct for the arthrodesis of the pubic symphysis compared to a rectangular shaped bone block. The cylindrical shaped bone block stabilized by a 3.5 symphyseal plate is inferior to the stabilization with an internal fixator. Methods: This study analyzed the arthrodesis of the pubic symphysis on 24 synthetic pelvises, using a rectangular shaped bone block (control group) or a cylindrical shaped bone block, stabilized with a symphysis locking plate (n = 8) as the standard clinical procedure. Additionally we analyzed the stability using an internal fixator. Results: This study showed that utilizing a cylindrical shaped synthetic bone graft results in a significant higher contact area and compression force compared to the classical rectangular shaped graft. Furthermore, the stabilization with an internal fixator had the tendency for increases of compression force and contact area, yet without a statistical significance, when compared to the plate fixation. Conclusion: The novel method of cylindrical symphysis resection and cylindrical bone block implantation allowed an increased biomechanical stability compared to using a classical rectangular bone graft, also resulting in higher contact area. Moreover, this technique would also allow a minimally invasive approach for this purpose, which in turn could preserve perisymphyseal ligaments, thereby improving healing in a clinical context. [ABSTRACT FROM AUTHOR]

Aim: To assess radiological and functional outcomes of transilial internal fixator (TIFI) for treatment of sacral complete transforaminal fractures with a novel implantation technique that decrease wound irritation problems in addition to facilitating easy application of reduction methods beside showing the best entry points, screw trajectories and angles. Methods: A Prospective case series from 2019 to 2021 was conducted at university hospital including 72 patients with Denis type 2 sacral fractures. The operative and fluoroscopy time, reduction, implantation techniques, postoperative radiological and functional data were collected and evaluated with minimum follow-up of 12 months. Results: The mean initial fracture displacement was 4.42 mm while mean postoperative maximum residual fracture displacement was 2.8 mm, Radiological outcome assessed using Matta's grading at the final follow-up visit with 63 cases scored as Excellent,7 cases as Good, 2 cases as fair. Functional outcome using Majeed scoring shows 64 cases of Excellent grading and 8 cases were Good. Short operative and fluoroscopy time, easy reduction techniques, few skin problems were recorded. Conclusion: TIFI through a minimally invasive technique represents a valid method for dealing with transforaminal sacral fractures. TIFI provides a rigid fixation for posterior ring injuries with few risks regarding iatrogenic nerve injury, avoiding different variations of upper sacral osseous anatomy or sacral dysmorphism. In addition, there is no necessity for high quality fluoroscopy for visualization of sacral foramina intraoperatively, decreasing risk of radiation exposure, unlike other methods of fixation as iliosacral screws. Our novel modification for implantation technique provides few risks for postoperative and wound complications. [ABSTRACT FROM AUTHOR]

Background/Aim. Cephalomedullary and extramedullary methods are used for the internal fixation of trochanteric fractures. The usage of the third generation Gamma Nail (GN) is a gold standard in this kind of treatments. Self-dynamisable Internal Fixator (SIF) is an extramedullary implant for trochanteric fractures’ treatment. The aim of this study was to compare these two methods regarding operation time and intraoperative fluoroscopy time. Methods. A total of 89 patients with a surgical treatment of a trochanteric fracture were included in this study. There were two groups of patients – GN group (43 patients) and SIF group (46 patients). Results. Average operation times were 67.5 min (GN group) and 56.0 min (SIF group). Average intraoperative fluoroscopy times were 84.8 s (GN group) and 36.7 s (SIF group). The difference between the groups was statistically significant for both of the given parameters (p < 0.05). The correlation between operation time and intraoperative fluoroscopy time was confirmed in the SIF group (p < 0.05; r = 0.405), while it was not confirmed in the GN group (p > 0.05). There was a higher variability in the GN method than in the SIF method regarding the duration and type of repeated surgical maneuvers followed by X-ray checks. Conclusion. The number of planned surgical interventions per day could depend on the type of trochanteric fracture internal fixation (intramedullary or extramedullary). Certain additional analyses including radiation dose assessment are desirable to clarify if shorter intraoperative fluoroscopy time in the SIF method can have the influence regarding intraoperative X-ray protection clothing. If there is the need to activate dynamization in long femoral axis after initial static fixation in that axis, the SIF method provides its spontaneous activation several weeks after the surgery without the need neither for additional surgery nor for additional intraoperative fluoroscopy

Abstract Purpose Does the cylindrical shaped bone block allow a stable construct for the arthrodesis of the pubic symphysis compared to a rectangular shaped bone block. The cylindrical shaped bone block stabilized by a 3.5 symphyseal plate is inferior to the stabilization with an internal fixator. Methods This study analyzed the arthrodesis of the pubic symphysis on 24 synthetic pelvises, using a rectangular shaped bone block (control group) or a cylindrical shaped bone block, stabilized with a symphysis locking plate (n = 8) as the standard clinical procedure. Additionally we analyzed the stability using an internal fixator. Results This study showed that utilizing a cylindrical shaped synthetic bone graft results in a significant higher contact area and compression force compared to the classical rectangular shaped graft. Furthermore, the stabilization with an internal fixator had the tendency for increases of compression force and contact area, yet without a statistical significance, when compared to the plate fixation. Conclusion The novel method of cylindrical symphysis resection and cylindrical bone block implantation allowed an increased biomechanical stability compared to using a classical rectangular bone graft, also resulting in higher contact area. Moreover, this technique would also allow a minimally invasive approach for this purpose, which in turn could preserve perisymphyseal ligaments, thereby improving healing in a clinical context.

BACKGROUND: Anterior cervical discectomy and fusion is performed with anterior cervical auxiliary plate. However, due to the large volume of traditional plate, protruding at the anterior edge of vertebral body, and high elastic modulus caused by steel plate material, postoperative patients often have complications, such as swallowing discomfort and adjacent segment degeneration. OBJECTIVE: Three-dimensional finite element method was used to compare and analyze the stress distribution characteristics of three new types of selfdeveloped anterior cervical discectomy and elastic internal fixation alloy plates after operation, so as to provide the reference for the improvement and clinical application of implants. METHODS: Three kinds of inner plants were designed by using Ni-Ti alloy: alloy plate A was ladder type; alloy plate B was arc surface ladder type; and alloy plate C was arc surface type. The thin slice CT images of C5 and C6 segments of a 21-year-old healthy female volunteer were randomly collected and processed by Mimics 21.0, Geomagic Studio 2013, and Abaqus 2020 to construct the finite element models of three new types of anterior cervical alloy plates. The C5 was loaded with 50 N vertical force and 1.5 N·m pure torque load to simulate seven motion states of cervical vertebra: neutrality, flexion, extension, left and right flexion, and left and right rotation. The stress values of six stress concentration areas of three kinds of alloy plates were collected. RESULTS AND CONCLUSION: (1) In the neutral position, the stress distributed in each stress concentration area of the three kinds of alloy plates was the smallest relative to the other working conditions. Under the flexion and extension conditions, the average stress of the upper part of the alloy plate A was higher than that of the alloy plate B (P < 0.05). The average stress of the lower part of the alloy plate C was higher than that of the alloy plate B (P < 0.05). Under the lateral flexion condition, the average stress of the flexion side was larger than that of the extension side (P < 0.05). Under the rotating condition, the average stress of the upper part of the rotating opposite side and the lower part of the same side was relatively larger (P < 0.05). During lateral flexion and rotation, the average stress in most areas of alloy plate A was much lower than that of alloy plates B and C (P < 0.05). (2) The average stress of the three kinds of alloy plates was smaller in the neutral position and larger in the rotation, and the maximum stress was almost concentrated around the threaded hole. (3) Alloy plate A was more suitable for patients who need to do a variety of similar lateral flexion and rotation movements. Alloy plate B had little effects on the vertebral body and was suitable for patients with underlying diseases of the vertebral body. Alloy plate C could appropriately increase the lower thickness under the premise of considering related complications. The new alloy plate still needs further experimental and clinical research. [ABSTRACT FROM AUTHOR]

The management of unstable pelvic ring fractures, typically resulting from high-energy trauma, presents a significant clinical challenge due to the complexity of injuries. While effective in many cases, the traditional stabilization methods are fraught with various complications that can significantly impact patient recovery and quality of life (QOL). This study aims to evaluate the efficacy and precision of the anterior subcutaneous internal fixator (INFIX) technique when used with intraoperative computed tomography (CT) navigation, a novel approach intended to mitigate the limitations of conventional treatment modalities. Our retrospective case series encompasses 43 patients who sustained traumatic pelvic injuries and were subsequently treated with the INFIX technique from December 2020 to January 2024. The focus of this analysis was to assess the accuracy of INFIX screw placement facilitated by intraoperative CT navigation. A total of 81 INFIX screws were inserted, and our study findings reveal a high level of precision in screw placement, with only one screw deviating, resulting in an inaccuracy rate of merely 1.2 %. This highlights the significant advantage provided by intraoperative CT navigation. The high level of accuracy not only enhances the stability of the pelvic fixation but also substantially reduces the risk of complications commonly associated with screw misplacement, such as abdominal damage, vascular injury, and issues related to incorrect hardware positioning. In conclusion, the integration of the INFIX technique with intraoperative CT navigation in the treatment of unstable pelvic ring fractures represents a significant advancement in orthopedic trauma surgery. This study provides compelling evidence supporting the efficacy and precision of this approach, suggesting its potential as a superior alternative to traditional fixation methods. Further research, ideally through prospective studies involving larger patient cohorts, is needed to validate these findings and explore the long-term implications of this technique on patient recovery and QOL. [ABSTRACT FROM AUTHOR]

Objective: Minimal invasive temporary spanning plate (SP) fixation of the wrist has been described as an alternative treatment method in complex distal radius fractures (DRFs). The purpose of this study is to conduct an outcome analysis of all consecutive DRFs treated by SP fixation representing the so far largest published patient cohort outside the United States. Methods: Indication for SP fixation include DRFs with severe metaphyseal comminution, radiocarpal fracture dislocations with concomitant ligamentous injuries and very distal intra-articular fractures lacking the possibility of adequate plate anchoring. All consecutive patients undergoing SP fixation of DRFs were prospectively included in a single level I trauma centre between 01/01/2018 and 31/12/2020. For functional and patient-rated outcome analysis only patients who completed the 12 month follow-up were included. Results: In the mentioned timeframe, a total of 562 DRFs were treated operatively of which 28 underwent SP fixation. Average age was 58.1 years (range 22–95 years). The fracture type ranged from AO/OTA type B1.1 to C3.3 and included 8 fracture dislocations. SP removal was performed on average 3.7 months after the initial operation (range 1.4–6.5 months). Twenty-five patients completed the 12 month follow-up (mean 14.5 months, range 12–24). Radiological evidence of fracture healing appeared on average 9.9 weeks (range 5–28 weeks) after the initial operation. One patient experienced asymptomatic non-union. Mean radial inclination, volar tilt and ulnar variance at 1 year were all within the acceptable limit predictive of symptomatic malunion. Complications included two patients with tendon rupture and one patient with extensor tendon adhesions needing tenolysis at the time of plate removal leaving an overall complication rate of 12%. There was no implant failure and no infection. Mean satisfaction score was 8.3 (range 4–10) and mean visual analogue scale for resting pain was 0.8 (range 0–5). The mean PRWE score was 17.9 (range 0–59.5) and the mean DASH score was 16.6 (range 0–60.8). Grip strength averaged 23 kg (range 4–74 kg) amounting to 68% of the opposite side. Range of motion regarding the extension/flexion, radial/ulnar abduction and pronation/supination arc reached 72%, 77% and 95% compared to the unaffected side, respectively. Conclusions: The radiological, functional and patient-rated outcomes in this study are remarkably good considering the complexity of the included fractures. Therefore, this method represents a valuable alternative for the treatment of complex DRFs in selected patients. [ABSTRACT FROM AUTHOR]

Background: Pantarsal arthrodesis is a salvage procedure performed for the treatment of tarsal joint disease, including severe osteoarthritis with intractable pain in the tarsocrural joint, tarsal fractures, shearing injuries, tarsocrural joint instability, and failure of the common calcanea tendon. Although medial plating is preferable, the high incidence of post-surgery complications is possible. Using thin, pre-contouring, or easy contouring locking plates might reduce the incidence of such complications. However, to date, there are no pre-contouring and dedicated locking plates for pantarsal arthrodesis with medial placement. Case Description: The case of an 18-month-old female stray European cat has been referred because of a severe tibio-tarsal injury improperly treated with an intramedullary pin. The patient was submitted for medial pantarsal arthrodesis, performed with the Compact UniLock 2.0™ locking plate systema (DePuy Synthes, Oberdorf, Switzerland). The authors hypothesised that this particularly innovative osteosynthesis system could present advantages compared with the systems already in use for medial pantarsal arthrodesis and therefore reduce the risk of complications. Conclusion: This innovative titanium locking system, because of its versatile contour function and thinness, allowed the good functional recovery of the limb and showed numerous advantages over traditional systems.

Background and purpose: Femoral neck fracture is associated with a high rate of side effects, especially in young people, who are usually affected by severe energy shocks. Results after injury depend on some factors, including displacement, fragility, bleeding rate, proper placement, and stable and strong fixation. The aim of this study was to compare dynamic hip screw (DHS) or multiple cannulated screws (MCS) in fractures of the femoral neck base. Materials and methods: In this cross-sectional study, 78 patients with femoral neck fracture were treated by internal fixation: MCS (n= 26) and DHS (n= 52) in Babol Shahid Beheshti Hospital, 2016-2018. Complications, including pain and lameness, infection, avascular necrosis (AVN), and nonunion were investigated in both groups. The visual analog scale (VAS) score and Harris Hip Score (HHS) were also compared between the two groups. Results: Mean ages of the patients in MCS group and DHS group were 54.19 ± 23.35 and 58.50 ± 21.06 years, respectively. In patients treated by MCS, infection, AVN, no welding, and pain and lameness were seen in 3, 2, 3, and 6 patients, respectively, while these complication were observed in 1, 1, 1, and 4 patients in the DHS group, respectively. The rate of complications were not found to be significantly different between the two group (P>0.05). The mean VAS score was significantly lower in the DHS group compared to that in the MCS group (P

Abstract Background EFECE systems are newly defined internal fixation systems, which are suitable for patella fracture fixation. The aim of this study was to compare the fixation strength of EFECE Systems with tension band wiring for transverse patellar fracture simulation on fresh frozen cadaver models. Methods Quadriceps tendon-patella-patellar tendon (QT-P-PT) complex was prepared from human cadavers. After simulation of a transverse patella fracture, in group 1, 5 patella were fixed with a pair of 1.2 mm EFECE wires and 4 EFECE devices. In group 2, 5 patella were fixed with a pair of 1.2 mm Kirschner wires (K-wire) and a cerclage wire according to the tension band technique. Using a testing device with custom-made jaws, increasing distraction force was applied to these QT-P-PT complexes. Extension of these complexes with the distraction forces was observed. The maximum distraction force and the elongation during maximum force were evaluated. Results After 5 experiments with the EFECE systems, there was no EFECE wire breakage or EFECE wire-EFECE device catching failure. The median maximum force was 740 N (720-810 N). During maximum distraction force the median extension was 2.5 mm (1.6-2.5 mm). After 5 experiments with the tension band technique, there was no K-wire breakage. The median maximum force was 330 N (240-510 N). During this maximum distraction force the median extension was 3.4 mm (2.2-3.8 mm). Conclusions Based on the biomechanical advantages, patella fracture treatment with EFECE systems may constitute a reasonable alternative in the treatment of patella fractures.

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Introduction: Osteoporosis-related fragility fractures of the pelvic ring (FFP) differ fundamentally from pelvic fractures in younger patients. However, very little is known about biomechanical stability of different osteosynthesis procedures addressing the anterior pelvic ring in these fractures. The aim of this study was to compare standard external fixation with internal fixation using a novel screw-and-rod system in osteoporotic fractures of the pelvic ring in terms of stiffness, plastic deformation and maximum load under cyclic loading in a human cadaveric model.Materials and Methods: A total of 18 embalmed osteoporotic cadaver pelvis specimens were randomized based on the T-score into a group for external fixation and a group for internal fixation. FFP type-IIB fractures were created. In addition to the external or internal fixator, a cement-augmented sacroiliac screw was implanted. Afterwards, axial cyclic loading was performed in a testing setup simulating one-leg stand.Results: Mean plastic deformation and stiffness both were significantly better in the internal fixation group than in the external fixation group (plastic deformation: 0.37 mm (SD: 0.23) versus 0.71 mm (SD: 0.26), p = 0.011; stiffness: 43.69 N/mm (SD: 18.39) versus 26.52 N/mm (SD: 9.76), p = 0.029). Maximum load did not differ significantly between internal fixator (506.3 N; SD: 129.4) and external fixator (461.1 N; SD: 147.4) (p = 0.515).Conclusions: Submuscular internal fixation might be an interesting alternative to external fixation in clinical practice because of better biomechanical properties as well as several advantages in clinical use. [ABSTRACT FROM AUTHOR]

Background: Pantarsal arthrodesis is a salvage procedure carried out for the treatment of tarsal joint disease, including severe osteoarthritis with intractable pain in the tarsocrural joint, tarsal fractures, shearing injuries, tarsocrural joint instability, and failure of the common calcaneal tendon. Although medial plating is preferable, the high incidence of post-surgery complications is possible. Using thin, pre-contouring or easy contouring, locking plates might reduce the incidence of such complications. However, to date, there are no pre-contouring and dedicated locking plates for pantarsal arthrodesis with medial placement. Case Description: The case of an 18-month-old female stray European cat has been referred because of a severe tibiotarsal injury improperly treated with an intramedullary pin. The patient was submitted for medial pantarsal arthrodesis, performed with the Compact UniLock 2.0™ locking plate systema (DePuy Synthes, Oberdorf, Switzerland). The authors hypothesized that this particularly innovative osteosynthesis system could present advantages compared to the systems already in use for medial pantarsal arthrodesis and therefore reduce the risk of complications. Conclusion: This innovative titanium locking system, because of its versatile contour function and thinness, allowed the good functional recovery of the limb and showed numerous advantages over traditional systems. [ABSTRACT FROM AUTHOR]

Background and purpose: Femoral neck fracture is associated with a high rate of side effects, especially in young people, who are usually affected by severe energy shocks. Results after injury depend on some factors, including displacement, fragility, bleeding rate, proper placement, and stable and strong fixation. The aim of this study was to compare dynamic hip screw (DHS) or multiple cannulated screws (MCS) in fractures of the femoral neck base. Materials and methods: In this cross-sectional study, 78 patients with femoral neck fracture were treated by internal fixation: MCS (n= 26) and DHS (n= 52) in Babol Shahid Beheshti Hospital, 2016-2018. Complications, including pain and lameness, infection, avascular necrosis (AVN), and nonunion were investigated in both groups. The visual analog scale (VAS) score and Harris Hip Score (HHS) were also compared between the two groups. Results: Mean ages of the patients in MCS group and DHS group were 54.19 ± 23.35 and 58.50 ± 21.06 years, respectively. In patients treated by MCS, infection, AVN, no welding, and pain and lameness were seen in 3, 2, 3, and 6 patients, respectively, while these complication were observed in 1, 1, 1, and 4 patients in the DHS group, respectively. The rate of complications were not found to be significantly different between the two group (P>0.05). The mean VAS score was significantly lower in the DHS group compared to that in the MCS group (P<0.05). The HHS scores were not significantly different between the two groups (P<0.05). Conclusion: According to this study, MCS is more appropriate in the treatment of femoral neck fractures due to less bleeding and shorter operation time. [ABSTRACT FROM AUTHOR]

Background: EFECE systems are newly defined internal fixation systems, which are suitable for patella fracture fixation. The aim of this study was to compare the fixation strength of EFECE Systems with tension band wiring for transverse patellar fracture simulation on fresh frozen cadaver models. Methods: Quadriceps tendon-patella-patellar tendon (QT-P-PT) complex was prepared from human cadavers. After simulation of a transverse patella fracture, in group 1, 5 patella were fixed with a pair of 1.2 mm EFECE wires and 4 EFECE devices. In group 2, 5 patella were fixed with a pair of 1.2 mm Kirschner wires (K-wire) and a cerclage wire according to the tension band technique. Using a testing device with custom-made jaws, increasing distraction force was applied to these QT-P-PT complexes. Extension of these complexes with the distraction forces was observed. The maximum distraction force and the elongation during maximum force were evaluated. Results: After 5 experiments with the EFECE systems, there was no EFECE wire breakage or EFECE wire-EFECE device catching failure. The median maximum force was 740 N (720-810 N). During maximum distraction force the median extension was 2.5 mm (1.6-2.5 mm). After 5 experiments with the tension band technique, there was no K-wire breakage. The median maximum force was 330 N (240-510 N). During this maximum distraction force the median extension was 3.4 mm (2.2-3.8 mm). Conclusions: Based on the biomechanical advantages, patella fracture treatment with EFECE systems may constitute a reasonable alternative in the treatment of patella fractures. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical effect of robot-assisted treatment of unstable pelvic fractures through a percutaneous iliac lumbar double rod fixation combined with a percutaneous pelvic anterior ring INFIX (internal fixator) fixation.Methods: This was a retrospective analysis of 17 cases of unstable anterior and posterior pelvic ring fractures treated between April 2016 and October 2018 by the third Ti-robot system produced in China. The posterior ring was supported with an iliac lumbar double rod fixation and the anterior ring with an INFIX fixation. Operation time and peri-operative bleeding were recorded. The reduction of pelvic fracture displacement was evaluated by Matta score, the post-operative results were evaluated according to Majeed score, and the complications were recorded.Results: Twelve males and five females, aged 21-71 years (mean 40.1 ± 3.8 years) were followed up for three to 12 months, (median 6.7 months). Tile typing showed seven B1 type, two B2 type, and eight C1 type cases. Operation time was 90-160 minutes (mean 112.9 ± 16.8 minutes), bleeding was 80-150 mL (mean 105.9 ± 20.6 mL). X-ray three to five  days after operation was evaluated by Matta score as excellent in 15 and good in two cases. Majeed score at last follow-up was 85-98 points, excellent in 17 cases. Two cases of lower extremity deep vein thrombosis received an inferior vena cava filter. The filters were removed after two  weeks. One case showed incision fat liquefaction healing and the wound healed three  weeks after surgery.Conclusion: Orthopedic robot-assisted treatment of unstable pelvic fractures by a percutaneous iliac lumbar double rod fixation and a percutaneous pelvic anterior ring INFIX fixator was minimally invasive and feasible. A prospective study is needed. [ABSTRACT FROM AUTHOR]

BACKGROUND: The non-fusion system of lumbar interspinous process distraction device provides a new treatment option for lumbar degenerative diseases. However, at present, the clinical application and research of lumbar interspinous process distraction device are reported insufficiently in China, especially for the domestic lumbar interspinous process distraction device. OBJECTIVE: To verify the scientific nature and effectiveness of the new domestic lumbar interspinous process distraction device through finite element analysis and in vitro biomechanical experiment of goat lumbar spine. METHODS: (1) Finite element analysis of new domestic lumbar interspinous process distraction device: L2-L5 three-dimensional model of vertebral body was established based on normal adult lumbar CT data. From then on, new domestic lumbar interspinous process distraction device model, new lumbar interspinous process distraction device model of lumbar non fusion system were successively built. The mechanical conditions were given under the physiological conditions of lumbar spine. Biomechanical analysis was carried out before and after the new domestic lumbar interspinous process distraction device was implanted. (2) In vitro biomechanical analysis of new domestic lumbar interspinous process distraction device: the lumbar vertebrae (L1-L5) of 24 adult male goats were obtained, and the new domestic lumbar interspinous process distraction device was implanted between the L3-4 spinous process. Before and after the placement of the lumbar interspinous process distraction device, the lumbar motion range and the pressure of the intervertebral disc under the flexion, extension, lateral bending and rotation of the lumbar specimens were detected. RESULTS AND CONCLUSION: (1) After the new lumbar interspinous process distraction device was implanted, the motion range and the pressure of the intervertebral disc of responsible segment were reduced, while the adjacent segments' mobility and the pressure of the intervertebral disc were almost unaffected. It was theoretically verified that the new domestic lumbar interspinous process distraction device could provide the biomechanical basis for the treatment of the lumbar degenerative diseases, and contribute to the theoretical reference for the prevention of the clinical diseases. (2) In the state of extension, the motion range of L3-4 vertebral body after implanting the new lumbar interspinous process distraction device was significantly lower than that before implantation (P < 0.05). There was no significant difference between L2-3 and L4-5 vertebral body after implanting the new lumbar interspinous process distraction device and that before implantation (P > 0.05). In the state of flexion, lateral bending and rotation, there was no significant difference between L2-3, L3-4 and L4-5 vertebral body after implanting the lumbar interspinous process distraction device and that before implantation (P > 0.05). In the state of extension, the pressure of intervertebral disc after L3-4 vertebral body implantation was significantly lower than that before implantation (P < 0.05). There was no significant difference between L2-3 and L4-5 vertebral body implantation and that before implantation (P > 0.05). In the state of flexion, lateral bending and rotation, there was no significant difference between L2-3, L3-4 and L4-5 vertebral body implantation and that before implantation (P > 0.05). (3) The results showed that the scientific nature and validity of the new domestic lumbar interspinous process distraction device was verified by three-dimensional finite element analysis and in vitro animal lumbar specimens experiment, which provided a strong basis for the animal experiment, clinical experiment, clinical application and clinical production of the new domestic lumbar interspinous process distraction device. [ABSTRACT FROM AUTHOR]

BACKGROUND: At present, most of the treatment of unstable dislocation of sternoclavicular joint is to insert the hook plate of acromioclavicular joint into the cavity of sternal bone marrow or put it behind the sternum. The difficulty of operation Is Increased because of the insufficient application of steel plate, which reduces the effect of joint reduction. OBJECTIVE: The research team has developed a new type of sternoclavicular hook plate (Patent No. ZL201520515237 .3), and compared the blomechanlcal properties of acromioclavicular hook plate and new sternoclavicular hook plate to fix sternoclavicular joint from the aspect of biomechanics. METHODS: The sternum and clavicle at both ends of the sternoclavicular joint were replaced with a rectangular artificial bone. Eighteen pairs of artificial sternoclavicular joints were randomly divided into two groups. In control group (n=6), the plate screw hole section of the shortest segment 3-hole common acromioclavicular hook plate was fixed to the artificial clavicle end; and the hook end was placed on the back side of the artificial sternum. Load and displacement changes in artificial sternal fractures were measured with MTS biomaterial test system. In the experimental group (n=12), the plate screw hole section of the shortest rod section 2 hole new sternoclavicular hook plate was fixed to the artificial clavicle end; and the hook end was inserted into the artificial sternum. The MTS biomaterial test system was used to detect changes In load and displacement of the anterior cortical bone (n=6) and posterior cortical bone (n=6). RESULTS AND CONCLUSION: In the control group, the mean of maximum destructive force was (390±51) N. The mean of maximum destructive force of anterior cortical bone was (421±55) N. In the experimental group, the mean of maximum destructive force of posterior cortical bone was (437±56) N. There were no significant differences between the three groups (P > 0.05). Results indicated that the new sternoclavicular hook plate did not increase the risk of sternum fracture, and it was a safe and effective Internal fixation material. [ABSTRACT FROM AUTHOR]

BACKGROUND: Traditional complex of diagnosis and treatment of distal radius fractures, did not get the repair in time and clinical misdiagnosis is not uncommon, become an important reason for the wrist joint pain and dysfunction. Wrist joint complexity assisted treatment of distal radius fractures can more accurately judge complexity of the distal radius fracture damage. The microscopic surgery can protect the blood supply, can also repair intra-articular ligament, cartilage injury, and along with all the dislocation, fracture of carpal bone fixed effectively. OBJECTIVE: To retrospectively analyze clinical effects of distal radial anatomical locking plate for complex distal radius fractures by joint arthroscopy. METHODS: Totally 19 patients with complex distal radius fractures, who were treated in the Department of Trauma and Hand Surgery, Sichuan Provincial Orthopedic Hospital from September 2016 to May 2018, were included in this study. According to AO classification, there were B2 type in 1 patient, B3 type in 2 patients, C1 type in 5 patients, C2 type in 7 patients and C3 type in 4 patients. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. Open reduction and internal fixation with anatomical locking plate of distal radius assisted by wrist arthroscopy were used to repair the intercarpal interosseous ligaments and triangular fibrocartilage complex, and to fix the wrist fracture. At 1 year after treatment, the range of wrist motion, grip strength, radial height, palm inclination angle and ulnar angle were compared with the healthy side, and the functional evaluation was conducted with Mayo wrist score. RESULTS AND CONCLUSION: (1) Nineteen patients received postoperative follow-up. The healing time of distal radius was 5-12 months, with an average of 7 months. (2) At 1 year after surgery, no significant difference was detected in the range of wrist motion, grip strength, radial height, palm inclination angle and ulnar angle (P > 0.05). (3) The Mayo wrist score was excellent in 9 cases, good in 8 cases, and average in 2 cases, with the excellent and good rate of 90%. (4) Treatment of complex distal radius fractures with distal radial anatomical locking plate by wrist arthroscopy can accurately restore the stability of the joint, and simultaneously repair the fracture with cartilage damage and intra-articular ligament, which is conducive to early functional exercise and has a satisfactory effect. [ABSTRACT FROM AUTHOR]

(1) Background: In polytrauma patients, femur fractures are usually stabilised by external fixation for damage control, later being treated with definitive plate or nail osteosynthesis. Screw/rod systems established in spinal surgery might be inserted for internal fixation, providing sufficient fracture stability that subsequent intervention is unnecessary. This was to be investigated biomechanically. (2) Methods: The unilaterally applied spinal internal fixator (IF) was subjected to load and deformation analysis on artificial femurs with 32-A3 fracture according to AO classification. Distance of screws to fracture and rod to cortical bone were analysed as parameters influenced surgically as stiffness and deformation of the treated fracture. In addition, the stability of another construct with a second screw/rod system was determined. The axial load in stance phase during walking was simulated. The results were compared against an established fixed-angle plate osteosynthesis (IP). (3) Results: There were no implant failures in the form of fractures, avulsions or deformations. All unilateral IF combinations were inferior to IP in terms of stability and stiffness. The bilateral construct with two screw/rod systems achieved biomechanical properties comparable to IP. 4) Conclusion: Biomechanically, a biplanar screw/rod system is suitable for definitive fracture stabilisation of the femur, despite a damage control approach.

Introduction: This article reports on three cases of atrophic non-union of the femur after polytrauma, where the very long healing times led to postponement of an intervention. Patients and methods: In all three patients several previous operations with respect to the non-union had already taken place. All patients were treated with a telemetrically instrumented locking plate fixator for mechanical assessment of bone healing, autologous spongiosa and an chain of antibiotics. The monitoring of the healing process took place through telemetric measurements over the entire healing process. Also performed were X‑ray and computed tomography (CT) images during the course. Results: In 1 of the patients the bone healed after 29 months. In the other 2 patients revision surgery was performed after 17 and 8 months, respectively, 1 with cancellous bone grafting and the other with an additional plate. The bones of these patients then healed after 31 and 27 months, respectively. Conclusion: The usual procedure regarding a nonconsolidating non-union after 9 months in X‑ray and CT images is revision surgery, possibly with a change in procedure. The application of a telemetrically instrumented internal fixator for the monitoring of the healing process is a successful procedure to support the physician in decision making. By explanation of the measurement curves by the treating physician, the patient can comprehend that the healing takes longer but the consolidation progresses. [ABSTRACT FROM AUTHOR]

Purpose: Pelvic ring fractures are challenging injuries and require effective treatment due to the frequently compromised patient condition. The aim of this study was to evaluate the outcome of unstable pelvic ring injuries treated with a minimally invasive pedicle screw-rod system.Methods: Retrospective analysis was performed for patients with an unstable pelvic ring injury that were treated with a minimally invasive anterior internal pelvic fixator (INFIX) with or without a posterior pedicle screw-rod fixator (6/2012-4/2015). The quality of reduction was evaluated by the Tornetta and Matta criteria and the clinical outcome was evaluated by the Majeed scores. Further evaluation included the operation time, intraoperative blood loss, and complication rate.Results: A total of 23 patients (12 males and 11 females) with a mean age of 37.6 years (range 10-65 years) and a follow-up of 13.5 months (6-27 months) were evaluated. The Tile classification showed 13 type B (B1 = 6, B2 = 4, and B3 = 3) and 10 type C (C1 = 7 and C2 = 3) fractures. Mean operation time and intraoperative blood loss were 24.8 min (20-30 min) and 20.4 ml (16-29 ml) for an anterior INFIX (n = 13), and 60 min (45-70 min) and 150 ml (115-168 ml) when combined with a posterior pedicle screw-rod fixator (n = 10). Quality of reduction was excellent in 13, good in 6, and fair in 4 patients, with no signs of heterotopic ossification. Clinical results after 6 months were excellent in 14 patients, good in 6, fair in 2, and poor in 1. Unilateral thigh paresthesia was seen in 2 patients which resolved after implant removal.Conclusions: The INFIX appears to be a safe and minimally invasive surgical technique which can effectively be combined with posterior pedicle screw-rod fixation. It also can be applied for the definitive treatment of vertically and/or rotationally unstable pelvic ring injuries, especially in severely compromised patients with a high mortality risk. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical effect of Ni-Ti shape memory alloy embracing internal fixator in the treatment of patients with multiple rib fractures. Methods: A total of 97 patients with multiple rib fractures, who were admitted to Second People’s Hospital of Anhui Province from January 2016 to January 2018 were selected. The patients were divided into control group(n=47) and study group(n=50) according to the different treatment methods. The control group was treated with the external fixation of the chest protective plate, and the study group was treated with Ni-Ti shape memory alloy embracing internal fixator. The clinical effects of 7 d after operation were compared between the two groups, the pain and respiratory function were compared between the two groups before operation and 7 d after operation, and the occurrence of postoperative complications were recorded in the two groups. Results: The total effective rate[92.00%(46/50)] in the study group, which was higher than that[76.60%(36/47)] in the control group(P<0.05). The visual ana-logue pain scale(VAS) scores in the two groups 7 d after operation were lower than those before operation, and the study group was lower than the control group(P<0.05). The maximum voluntary ventilation percent(MVV%) 7 d after operation in the two groups was higher than that before operation, and the study group was higher than the control group(P<0.05). There was no significant difference in the forced expiratory vital capacity at the 1 st second percent(FEV1%) 7 d after operation between the two groups(P>0.05). The total incidence of postoperative complications [8.00%(4/50)] in the study group was lower than that [23.40%(11/47)] in the control group(P<0.05). Conclusion: Ni-Ti shape memory alloy embracing internal fixator for multiple rib fractures is safe and effective, it can reduce the postoperative pain and improve the respiratory function of the patients, with higher clinical application value. [ABSTRACT FROM AUTHOR]

Yi Wang, Muguo Song, Yongqing Xu, Xiaoqing He, YueLiang Zhu Department of Orthopedic Surgery, Kunming General Hospital, Chengdu Military Command, People’s Liberation Army, Kunming, Yunnan, People’s Republic of China Background: The scaphoid is critical for maintaining the stability and movement of the wrist joints. This study aimed to develop a new internal fixator absorbable scaphoid screw (ASS) for fixation of the scaphoid waist after fracture and to test the biomechanical characteristics of ASS.Materials and methods: An ASS was prepared using polylactic acids and designed based on scaphoid measurements and anatomic features. Twenty fractured scaphoid waist specimens were randomly divided into experimental and control groups (n=10/group). Reduction and internal fixation of the scaphoid were achieved with either Kirschner wires (K-wires) or ASS. A moving target simulator was used to test palmar flexion and dorsal extension, with the range of testing (waist movement) set from 5° of palmar flexion to 25° of dorsal extension. Flexion and extension were repeated 2,000 times for each specimen. Fracture gap displacements were measured with a computerized tomography scanning. Scaphoid tensile and bending strengths were measured by using a hydraulic pressure biomechanical system.Results: Prior to biomechanical fatigue testing, fracture gap displacements were 0.16±0.02 mm and 0.22±0.02 mm in the ASS and K-wire groups, respectively. After fatigue testing, fracture gap displacements in the ASS and the K-wire groups were 0.21±0.03 mm and 1.52±0.07 mm, respectively. The tensile strengths for the ASS and K-wire groups were 0.95±0.02 MPa and 0.63±0.02 MPa, respectively.Conclusion: Fixation using an ASS provided sufficient mechanical support for the scaphoid after fracture. Keywords: absorbable scaphoid screw, biomechanics, internal fixator, Kirschner wires

Locking plates have led to important changes in bone fracture management, allowing flexible biological fracture fixation based on the principle of an internal fixator. The technique has its indications and limitations. Most of the typical failure patterns arise from basic technical errors. Types of locking plates, material properties and the general principles of locking plate applications are reviewed together with their misapplication. [ABSTRACT FROM AUTHOR]

BACKGROUND: At present, there are many ways to treat acromioclavicular joint dislocation, mainly based on clavicular hook plate, but the anatomical reconstruction of the trapezoid ligament and conoid ligament of the acromioclavicular ligament is the most important trend in the treatment of acromioclavicular joint dislocation. Endobutton plate has been widely promoted in recent years. A large number of randomized controlled trials and retrospective study showed that it has better efficacy and lower incidence of complications compared with the clavicular hook plate. OBJECTIVE: To evaluate the excellent and good rate and the short-term incidence of complication between Endobutton plate and clavicular hook plate in the treatment of acromioclavicular joint dislocation. METHODS: The Cochrane Library (1966-06/2017-05), PubMed (1966-06/2017-05), MEDLINE (1966-02/2017-05), EMbase (1984-01/2017-05), CNKI (1979-01/2017-05), VIP (1989-01/2017-05), and Wanfang (1982-01/2017-05) databases were searched by computer. Simultaneously, six major Chinese orthopedic journals were retrieved by hand, and the references included in the related articles were consulted. Randomized controlled trials addressing Endobutton plates and clavicular hook plates for the treatment of acromioclavicular joint dislocation were collected. The literatures were screened for inclusion criteria, and their qualities were evaluated. Meta-analysis was performed using RevMan 5.3 software. RESULTS AND CONCLUSION: (1) A total of 13 randomized controlled trials containing 800 patients were included in the study. 394 patients were treated with Endobutton plate and 406 patients with clavicular hook plate as controls. Among which, only one study was compared in three different ways; the rest were compared between Endobutton plate and clavicular hook plate. (2) Meta-analysis showed that the excellent and good rate of Endobutton plate was superior to that of clavicular hook plate in the treatment of acromioclavicular joint dislocation (P < 0.000 01). Compared with clavicular hook plate, the incidence of incision infection, acromioclavicular joint pain, limited activity and redislocation were lower in Endobutton plate (P=0.02, < 0.001, < 0.00001, 0.03). (3) These findings suggested that the effect of Endobutton plate was better than that of clavicular hook plate in the treatment of acromioclavicular joint dislocation. The incidences of incision infection, acromioclavicular joint pain, limited mobility, and redislocation were lower in Endobutton plate than in the clavicular hook plate. Although the article included many randomized controlled trials, the qualities of these articles are limited. We still need to design more strictly large-sample randomized controlled trials to increase the credibility of the evidence. [ABSTRACT FROM AUTHOR]

Objective To analyze the early clinical outcome of Zero- P VA during the operation of anterior cervical discectomy and fusion （ ACDF） in the treatment of cervical spondylotic myelopathy retrospectively. Methods A total of 29 patients （33 Zero- P VA has been placed） with cervical spondylotic myelopathy were treated with ACDF with the Zero- P VA from June 2013 to June 2015. The clinical results were evaluated with operation time and bleeding volume，the Bazaz score， the cervical curvature （Cobb angle）， the Visual Analogue Scale （VAS），the Japanese Orthopaedic Association （JOA） scores and the Neck Disability Index （NDI） . Re s ults All patients were followed up for 12 to 24 （average 14.48±3.51） months. During the follow- up， no patient was lost to follow- up and no data was lost. The mean operating time was （84.59±12.14） minutes. The intra- operative bleeding volume was （19.76±6.53） ml， and no postoperative patients developed complications like dysphagia. At the last follow- up， the Cobb angles were improved （P＜0.05）， the VAS scales decreased （P＜0.05）， average JOA scores significantly increased （P＜0.05）， and the NDI scores decreased （P＜0.05） . Conclusion The Zero- P VA has satisfactory short- term clinical result for the treatment of cervical spondylotic myelopathy. [ABSTRACT FROM AUTHOR]

Background: Reconstruction of the pelvic ring anatomy in unstable anterior pelvic ring injuries is a significant step to reduce the mortality rate associated with these injuries efficiently. There is a debate on using either an anterior subcutaneous pelvis internal fixator (INFIX) or an anterior supra-acetabular external fixator (EXFIX) to manage an unstable anterior pelvic ring fracture., Aim: To compare the functional and radiological outcomes and complications of INFIX vs EXFIX in managing unstable pelvic ring injuries., Methods: A prospective cohort study included 54 patients with unstable pelvic ring fractures. The patients were divided into two groups; the INFIX group, in which 30 cases were fixed by INFIX, and the EXFIX group, in which 24 patients were treated by EXFIX. The average age in the EXFIX group was 31.17 years (16-57 years), while in the INFIX group, it was 34.5 years (17-53 years). The study included 20 (66.7%) males and 10 (33.3%) females in the INFIX group and 10 (41.7%) males and 14 (58.3%) females in the EXFIX group. The radiological outcomes were evaluated using Matta and Tornetta's score, and the functional outcomes using the Majeed score., Results: The results revealed a statistically significant difference between both groups ( P = 0.013) regarding radiological outcomes, according to Matta and Tornetta's score in favor of the INFIX group. Sitting, standing, and walking abilities were measured at a 3-mo follow-up visit using Majeed score modules. It was significantly better among the INFIX group than the EXFIX group in all three modules. At the final follow-up, both groups had no statistically significant difference according to the Majeed score; 92.35 in the INFIX group and 90.99 in the EXFIX group ( P = 0.513). A lower surgical site infection rate was noticed in the INFIX group ( P = 0.007)., Conclusion: Anterior subcutaneous pelvis INFIX is associated with better radiological outcomes and a lower infection rate than anterior supra-acetabular EXFIX in managing patients with unstable anterior pelvic ring fractures., Competing Interests: Conflict-of-interest statement: All authors confirm that there is no conflict of interest related to this study., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: The scaphoid is critical for maintaining the stability and movement of the wrist joints. This study aimed to develop a new internal fixator absorbable scaphoid screw (ASS) for fixation of the scaphoid waist after fracture and to test the biomechanical characteristics of ASS.Materials and Methods: An ASS was prepared using polylactic acids and designed based on scaphoid measurements and anatomic features. Twenty fractured scaphoid waist specimens were randomly divided into experimental and control groups (n=10/group). Reduction and internal fixation of the scaphoid were achieved with either Kirschner wires (K-wires) or ASS. A moving target simulator was used to test palmar flexion and dorsal extension, with the range of testing (waist movement) set from 5° of palmar flexion to 25° of dorsal extension. Flexion and extension were repeated 2,000 times for each specimen. Fracture gap displacements were measured with a computerized tomography scanning. Scaphoid tensile and bending strengths were measured by using a hydraulic pressure biomechanical system.Results: Prior to biomechanical fatigue testing, fracture gap displacements were 0.16±0.02 mm and 0.22±0.02 mm in the ASS and K-wire groups, respectively. After fatigue testing, fracture gap displacements in the ASS and the K-wire groups were 0.21±0.03 mm and 1.52±0.07 mm, respectively. The tensile strengths for the ASS and K-wire groups were 0.95±0.02 MPa and 0.63±0.02 MPa, respectively.Conclusion: Fixation using an ASS provided sufficient mechanical support for the scaphoid after fracture. [ABSTRACT FROM AUTHOR]

Dogs and cats with fractures, arthrodeses, or corrective osteotomies (282 fixations) stabilized using the ALPS bone plating system between May 2007 and April 2012 were evaluated retrospectively to describe the author's experience with this system, assess rate of bone union, and evaluate post-operative complications. Cases with follow-up radiographs taken at least 8 weeks postoperatively or cases with bone healing confirmed prior to week 8 were included. Signalment, preoperative infection, fracture location, fracture type, surgical fixation method, implant size, additional fixation, intraoperative complications, and postoperative complications were recorded for each patient. Two hundred eighty-two fixations were performed on 266 patients, including 240 fractures, 26 corrective osteotomies, 14 arthrodesis, and 2 additional procedures. All 10 reported intraoperative complications occurred in the first year; each involved screw failure. Postoperative complications were reported in 9 of the 282 procedures (3.2%), of which seven cases were major complications (2.5%) and two cases were minor complications (0.7%). With the exception of two amputations, all treated cases achieved bone union or progression towards bone union (99.3%). This study demonstrated a high rate of bone union (99.3%), accompanied by a low postoperative complication rate (3.2%), when using the ALPS system in small animal orthopedics. [ABSTRACT FROM AUTHOR]

Copyright of Der Unfallchirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To investigate the curative effect of poly-DL-lactic acid (PDLLA) absorbable screw as a locked intramedullary nail for simple tibia fractures. Methods: In this study, 35 patients treated with the PDLLA screw were observed, and another 35 patients treated with a traditional locking intramedullary nail were treated as controls. Intraoperative blood loss, postoperative complications, fracture-healing time, and Johner-Wruh grade at the last followup time point of the two treatment groups were compared. Results: No patients experienced neurovascular injury during the operation, and no significant difference was observed in the operation and intraoperative blood loss of both two groups (p > 0.05). Postoperative x-ray results showed that the counterpoint and alignment of the fractures were favorable and that no rotational displacement had occurred. The follow-up period for all patients was 6 - 24 months, with a mean of 15.6 ± 6.7 months. All patients treated with PDLLA screw were observed to have well-healed tibia fractures, while three patients in the traditional treatment group appeared to have undesirable fracture healing. No infection, breakage of the internal fixator, or rotational displacement was found in either of the two groups, and no significant difference was observed in complication incidence between the two groups (p > 0.05). Additionally, Johner-Wruh grading showed no statistically significant difference between the two groups (p > 0.05). Interestingly, the fracture-healing time of the PDLLA screw-treated patients was significantly shortened compared with that of traditional treatment patients (p < 0.05). Conclusion: PDLLA screw, as a locked intramedullary nail, is a promising treatment for simple tibia fractures. [ABSTRACT FROM AUTHOR]

Objective To investigate the outcomes of treating middle-up part long-segment fractures of the femur by long proximal femoral nail antirotation ( PFNA-long). Methods From June 2006 to December 2013, 139 cases (35 women, 104 men; mean age 48.8, range, 18−86 years) of long-segment femoral fracture in middle-up part were treated with long proximal femoral nail antirotation ( PFNA, 320-380 mm) by minimally invasive percutaneous fixation and autogenous iliac bone graft. Fifty-eight cases were graded as type IA long-segment femoral fractures (41.73%), 25 type IB (17.99%), four type IC (2.88%), 28 type II (20.14%), 12 type IIIA (8.63%), five type IIIB (3.60%), and seven type IV (5.04%). Clinical efficacy was evaluated with Harris hip function scores and postoperative pain with visual analogue scale. Results The operative time was 35−90 min (mean, 45 min) and mean intraoperative blood loss 78.6 mL (range 30−200 mL). Most patients were walking with assistance 4−10 days postoperatively. All patients were followed up for 3−37 months (mean, 19 months). There were no serious complications. All fractures healed after 2.8-6.8 months (mean, 3.9 months). According to Harris criteria, the clinical results were excellent in 108 patients, good in 22, fair in eight and poor in one. Ninety-three cases had no pain, 33 mild pain, 13 moderate pain and 25 occasionally needed non-steroidal analgesics. Conclusion Closed reduction or limited open reduction with PFNA-long is an effective treatment for long-segment femoral fracture in middle-up part, with good strength in fixation, high rate of fracture union, early functional recovery and low rate of complications. [ABSTRACT FROM AUTHOR]

Copyright of Der Unfallchirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Dogs and cats with fractures, arthrodeses, or corrective osteotomies (282 fixations) stabilized using the ALPS bone plating system between May 2007 and April 2012 were evaluated retrospectively to describe the authors' experience with this system, assess rate of bone union, and evaluate post-operative complications. Cases with follow-up radiographs taken at least 8 weeks postoperatively or cases with bone healing confirmed prior to week 8 were included. Signalment, preoperative infection, fracture location, fracture type, surgical fixation method, implant size, additional fixation, intraoperative complications, and postoperative complications were recorded for each patient. Two hundred eighty-two fixations were performed on 266 patients, including 240 fractures, 26 corrective osteotomies, 14 arthrodesis, and 2 additional procedures. All 10 reported intraoperative complications occurred in the first year; each involved screw failure. Postoperative complications were reported in 9 of the 282 procedures (3.2%), of which 7 cases were major complications (2.5%) and 2 cases were minor complications (0.7%). With the exception of two amputations, all treated cases achieved bone union or progression towards bone union (99.3%). This study demonstrated a high rate of bone union (99.3%), accompanied by a low postoperative complication rate (3.2%), when using the ALPS system in small animal orthopedics. [ABSTRACT FROM AUTHOR]