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Abstract Background Finite element analysis (FEA) could advance the understanding of fracture fixation and guide the choice of surgical treatment. This study aimed to compare two internal fixation methods in the treatment of displaced proximal humeral fracture (PHF) through FEA. Methods Three-dimensional FEA model based on the left shoulder joint of a 67-year-old female patient with PHFs and osteoporosis was adopted, in order to analyze the fixation effect and load stress distribution of internal fixation plates with open reduction and intramedullary nails without opening the fracture in the treatment of Neer III-VI PHF. Results The displacement of the distal humerus with intramedullary nail fixation was more obvious than that of the distal humerus with bone plate fixation, and the resistance of intramedullary nail fixation was less than that of bone plate fixation under the same stress load. Maximum stress on the screw when adopting the intramedullary nail fixation was smaller than that when adopting the internal fixation with the internal fixation plates. The strain data indicate that the strain of both the fixation device and the bone when adopting the internal fixation with the intramedullary nails is less than that when adopting the internal fixation with the internal fixation plates. Conclusions Biomechanical analysis demonstrated that for complex fracture types with osteoporosis intramedullary nail system without opening the fracture had better stress dispersion than internal fixation plates with open reduction, and the risk of failure of central fixation was lower.

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Introduction: Surgical treatment of distal femoral fractures (DFFs) in osteoporotic bone is challenging despite improvements in hardware and surgical techniques. The occurrence and degree of secondary displacement during healing after bridging plate fixation are still unknown. This study aimed to assess the occurrence and degree of secondary displacement in healing DFFs in elderly patients and correlate the secondary displacement to body mass index, bone density, and weight-bearing regimen. Patients and Methods: The study involved 32 patients, 65 years or older, with a DFF of AO/OTA types 33 A2-3, B1-2, C1-2, and 32(c) A-C,1-3, including peri-prosthetic fractures with stable implants. Twenty-seven patients had at least 8 weeks of follow-up, and 21 patients had a complete 1-year follow-up. Minimally invasive surgery was performed using a distal anatomical femoral plate as a long bridge-plating construct. Secondary displacement was assessed with computed tomography of the entire femur postoperatively and at 8, 16, and 52 weeks. Femoral length, coronal angulation (varus/valgus), and subsidence as the change in distance between the distal joint surface and a specified locking screw were measured. Results: There was a statistically significant mean femoral shortening at 52 weeks of 4.7 mm (SD 3.9, (95% CI 2.9–6.5), P < 0.001) mainly by subsidence of the distal fragment. Most patients experienced limited coronal angulation. There was no correlation between body mass index or bone density and secondary displacement. At the 1-year follow-up, no patient needed revision surgery for non-union or plate breakage. Restricted weight-bearing for 8 weeks did not prevent secondary displacements or adverse events such as cut-outs. Conclusion: Modern dynamic plate osteosynthesis could not prevent commonly occurring fracture subsidence in DFF in an elderly cohort. Restricted weight-bearing for 8 weeks did not prevent secondary displacements or mechanical adverse events. [ABSTRACT FROM AUTHOR]

Purpose: We aim to compare interfragmentary compression with the position osteosynthesis in the fixation of different femoral neck fractures (FN) in synthetic bones subjected to vertical load. Methods: Forty-two synthetic femurs were subjected to neck fractures and separated into 3 groups according to the Pauwels classification: Pauwels I had 6 units (PI); Pauwels II, 24 units, with and without comminution (PII); and Pauwels III, 12 units, with and without comminution (PIII). After, they were fixed with 2 different ways: three 7, 0 mm cannulated lag screws (CSs) versus three 6, 5 mm solid fully threaded screws (SSs). Screws positioning was oriented by the Pauwels classification: inverted triangle or crossed screws. All specimens were submitted to vertical loading until failure. Results: The average force was 79.4 ± 22.6 Kgf. The greatest one was recorded in model 1 (135.6 Kgf), and the lowest in model 41 (39.6 Kgf). CSs and SSs had similar resistance until failure (p = 0.2). PI showed heightened resistance and PIII showed a worse response (p < 0,01). CSs had better performance in PIII (p = 0.048). Comminution and screws orientation caused no difference on peak force (p = 0.918 and p = 0.340, respectively). Conclusions: In synthetic bones, the resistance of a femoral neck fracture osteosynthesis using a 7, 0 mm cannulated lag screw or 6, 5 mm solid fully threaded screw are similar. There was no loss of efficiency with comminution in the femoral neck. Osteosynthesis resistance decreased with the verticalization of the fracture line and, in the more vertical ones, interfragmentary compression with CSs was more resistant than positional osteosynthesis with SSs. [ABSTRACT FROM AUTHOR]

Background/aim: This study evaluates anatomical reduction and rigid internal fixation of mandibular condyle fractures using the preauricular retroparotid approach. It also discusses advantages, deficiencies, and associated complications of the technique. Materials and methods: This retrospective study reviewed the medical records of a total of 52 mandibular condyle fractures from 42 patients who were treated with open surgery using the preauricular retroparotid approach between January 2019 and January 2024. Preoperative and postoperative assessments included measurements of mouth opening (maximum interincisal distance), vertical mandibular movement, and facial paralysis. Moreover, the Vancouver Scar Scale (VSS) was used to evaluate scar quality at the surgical site. Descriptive statistics were used to summarize patient demographics, preoperative findings, and postoperative outcomes. Results: Anterior open bite was the most common finding, detected in 83% of the patients before surgery. The mean mouth opening of the patients increased significantly from 29 ± 4.94 mm to 37.76 ± 2.12 mm. Vertical mandibular movement exceeding 4 cm was a finding in more than half (52.3%) of the patients. The mean VSS score, indicating scar quality, was 1.64 ± 0.70, suggesting overall good cosmetic outcomes. Plate breakage in two patients was noted as a complication during follow-up. Conclusion: Several surgical techniques have been described for mandibular condyle fractures, each with its own benefits and limitations. [ABSTRACT FROM AUTHOR]

Background: A variety of options including titanium elastic nails (TENs) and locking plates (LPs) are available for the internal fixation of subtrochanteric fractures (STFs). However, the preferred treatment option among children and adolescents is still controversial. Methods: We report four cases of STFs in school-aged pediatric patients, treated with an adult proximal humerus LP. Results: Based on the Flynn scoring system at the last follow-up visit, all patients exhibited excellent clinical outcomes, along with satisfactory radiological outcomes based on the Beaty scoring system. There were no complications. Conclusion: Our findings suggest the efficacy of using adult proximal humerus LPs in treating pediatric STFs. The advantage of these plates lies in their ability to accommodate many screws at appropriate positions and angles without damaging the physis. This approach holds promise for the management of pediatric STFs. [ABSTRACT FROM AUTHOR]

The treatment for humeral shaft fractures (HSFs) is still controversial, consisting of a wide variety of orthopedic osteosynthesis materials that imply different grades of invasiveness. The aim of this study is to investigate the correlation between inflammatory blood-derived markers and the magnitude of the surgical procedure in young and middle-aged patients who sustained these fractures. Observational, retrospective research was conducted between January 2018 and December 2023. It followed patients diagnosed with recent HFSs (AO/OTA 12−A and B) and followed operative treatment. They were split in two groups, depending on the surgical protocol: group A, operated by closed reduction and internal fixation (CRIF) with intramedullary nails (IMNs), and group B, operated by open reduction and internal fixation (ORIF) with dynamic compression plates (DCPs). Statistically significant differences (p < 0.05) between the two groups could be observed in injury on the basis of surgery durations, surgical times, pre- and postoperative neutrophil-per-lymphocyte ratio (NLR), postoperative platelet-per-lymphocyte ratio (PLR), monocyte-per-lymphocyte ratio (MLR), systemic inflammatory index (SII), systemic inflammatory response index (SIRI) and aggregate inflammatory systemic index (AISI). The multivariate regression model proposed revealed that NLR > 7.99 (p = 0.007), AISI > 1668.58 (p = 0.008), and the surgical times (p < 0.0001) are strongly correlated to the magnitude of the surgical protocol followed. Using receiver operating characteristic (ROC) curve analysis, a balanced reliability was determined for both postoperative NLR > 7.99 (sensitivity 75.0% and specificity 75.6) and AISI > 1668.58 (sensitivity 70.6% and specificity 82.2%). Postoperative NLR and AISI as inflammatory markers are highly associated with the magnitude of surgical trauma sustained during humeral shaft fracture osteosynthesis in a younger population. [ABSTRACT FROM AUTHOR]

This article provides information on the use of minimally invasive percutaneous plate osteosynthesis (MIPPO) for treating pilon fractures, which are fractures of the distal tibia. The article explains that pilon fractures are often caused by high-energy traumatic events and discusses the goals of treatment, including limb alignment and secure fixation. The article presents a case study and highlights the advantages of the MIPPO technique, such as reduced surgical trauma and improved fracture healing. Other treatment options, such as intramedullary nailing and external fixation, are also mentioned. The article compares different techniques for treating distal tibia fractures and recommends MIPPO as the primary option due to its minimally invasive nature and potential biological benefits. The drawbacks of open reduction and internal fixation methods are also discussed. [Extracted from the article]

Purpose: Nondisplaced femoral neck fractures have traditionally been treated with in situ fixation. However, poor surgical and clinical outcomes have been reported for fractures with valgus deformity >15°, and the reduction of valgus impaction has recently been emphasized. In addition, early degenerative osteoarthritis can be caused by cam-type femoroacetabular impingement after healing of femoral neck fractures. This study was designed with the objective of confirming the difference in progression of radiographic osteoarthritis according to the severity of the valgus deformity. Materials and Methods: Patients who underwent internal fixation using multiple cannulateld screws for management of nondisplaced femoral neck fractures were divided into two groups: high valgus group (postoperative valgus angle =15°) and low valgus group (postoperative valgus angle <15°). Evaluation of demographic data and changes in the joint space width from the immediate postoperative period to the latest follow-up was performed. Results: A significant decrease in joint space width in both hip joints was observed in the high valgus group when compared with the low valgus group, including cases with an initial valgus angle less than 15° and those corrected to less than 15° of valgus by reduction. No complications requiring surgical treatment were observed in either group; however, two cases of avascular necrosis, one in each group, which developed in the low valgus group after reduction of the fracture, were followed for observation. Conclusion: Performing in situ fixation in cases involving a valgus deformity =15° in non-displaced femoral neck fractures may cause accelerated narrowing of the hip joint space. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to determine whether normal plating yields comparable outcomes to plating using additional bioabsorbable screws or wires for complex distal radial fractures. Methods: Among 80 patients with complex distal radius fractures treated between January 2018 and March 2021, 45 were studied retrospectively and divided into two groups as follows: group A (n=23) received a plate, and group B (n=22) received a plate with a bioresorbable screw or wire. Radiological studies evaluated the period of bone union, radial length, inclination, and resorption of the bioresorbable screws or wires after surgery. The Disabilities of the Arm, Shoulder, and Hand (DASH) score was examined for clinical evaluation, and complications were compared between the two groups. Results: The two groups showed similar distributions in sex, age, injury mechanism, diabetes mellitus, smoking, and mean follow-up period; however, there were no statistically significant differences in the period of bone union and maintenance of reduction (radial length, inclination, and volar tilt). The DASH score averaged 14.8 and 13.2 points in groups A and B, respectively, showing no significant difference in complications (nonunion, malunion, infection, and arthritis). Conclusion: Regardless of the use of additional bioresorbable screws or wires, reduction in distal radius fractures in both groups yielded good results. Plating with additional bioresorbable screws or wires may be a suitable fixation method to compensate for the shortcomings of metal implants in complex distal radius fractures. [ABSTRACT FROM AUTHOR]

Objective In complicated Neer three‐ and four‐part proximal humerus fracture (PHF), greater tuberosity (GT) fragments are often comminuted, and the currently widely used locking plate may not fix GT fragments effectively. A further understanding of morphological characteristics of the GT fragments may help explore new fixation devices. This study aimed to determine the fracture line morphology of the GT fragment of Neer three‐ or four‐part PHF and analyze the location relationship between the locking plate and the GT fragment. Methods Seventy‐one three‐dimensional computed tomography scans of Neer three‐ and four‐part PHF were retrospectively reviewed between January 2014 and June 2019. Fracture fragments were reconstructed and virtually reduced in the Mimics software, and fracture lines of GT fragments were depicted on a humerus template in the 3‐matic software and then were superimposed altogether. The common sites of the GT fracture were identified, and the location relationship between the locking plate and GT fragments was analyzed in a computer‐simulated scenario. Results The fracture line morphology of GT fragments was similar between Neer three‐ and four‐part PHF. The overall morphology of GT fragments was in a fan shape, which could be summarized as anterior, superior, posterior, and middle lines. Of these, we identified 51 split and 29 avulsion type GT fragments based on the Mutch classification, and they could occur simultaneously in a PHF. The overall morphology of split type fragments was in a fan shape, and avulsion type fragments showed a quite distinguishable distribution pattern. A GT fragment could be classified as anterior‐split, posterior‐split, complete‐split, anterior ‐avulsion, and posterior‐avulsion type based on its morphology and location. The median percentage of fragment area covered by the plate was 32.3% in all of the fragments, and it was 69.4%, 23.0%, 37.2%, 21.8%, 0.0% in anterior‐split, posterior‐split, complete‐split, anterior‐avulsion, and posterior‐avulsion type GT fragments. We defined the posterior‐split, anterior‐avulsion, and posterior‐avulsion type GT fragments as the risky GT fragments, and they occurred in 43 (60.6%) Neer three‐ and four‐part PHFs. Conclusion The fracture line morphology of GT fragments of Neer three‐ and four‐part PHF was in a fan shape. GT fragments could be classified based on their location and morphology. The extent of GT fragment coverage provided by the locking plate differed in various fragment types, and we identified the anterior‐avulsion, posterior‐avulsion, and posterior‐split type fragments as the risky GT fragments with a high incidence rate in Neer three‐ and four‐part PHFs.

Complex both-column acetabulum fractures are severe injuries, often with associated injuries and complications with uncertain clinical and functional outcome. Modern traumatological protocols point to early surgical treatment, with anatomical reduction and stable internal fixation of fragments as a prerequisite for achieving a good treatment outcome. This retrospective-prospective multicenter cohort study was conducted during the 2014-2020 period and included 24 cases that met the input parameters, using the Letournel and Judet classification, and application of a combined surgical approach, a modified Stoppa and Kocher-Langenbeck approach. The results of treatment with complications, associated injuries and functional outcome are described. Fractures were caused by high kinetic energy trauma, and the cause was traffic accident in 17/24 (70.84%), fall from a height in 5/24 (20.83%) and crash injuries in 2/24 (8.33%) cases. The sample included 18 (75.00%) male and 6 (25.00%) female, with 10/24 (41.67%) right sided and 14/24 (58.33%) left sided fractures. Their mean age was 45.06 (range, 24-62) years. The mean follow-up time was 2.8 (range, 1-5) years. Postoperative complications were detected in 14/24 (58.33%) cases, including wound infection in 4/24 (16.67%), deep vein thrombosis in 2/24 (8.33%), heterotopic ossification in 2/24 (8.33%), hip osteoarthrosis in 3/24 (12.50%), avascular necrosis of femoral head in 2/24 (8.33%), total hip arthroplasty procedures in 3/24 (12.50%), abdominal complications in 2/24 (8.33%), urologic complications in 2/24 (8.33%), iatrogenic nerve lesion in 3/24 (12.50%), and fatal pulmonary embolism in 2/24 (8.33%) cases; there was no loss of reduction or non-union acetabular fracture. Associated injuries that we recorded as major trauma were presented in 13/24 (54.17%) study patients. The final functional results according to the Harris Hip Score (HHS) were excellent in 7/22 (31.82%), good in 10/22 (45.45%), moderate in 4/22 (18.18%) patients, and poor in 1/22 (4.55%) patient. The mean HHS was 84 (range 34-98). Complications and results have led us to a conclusion that primary injuries significantly affect the clinical and functional results. A good diagnostic procedure, assessment of the general condition and application of the trauma scoring system, surgical treatment that includes early hip reduction, open reduction internal fixation and physical rehabilitation are necessary.

Objective: In complicated Neer three‐ and four‐part proximal humerus fracture (PHF), greater tuberosity (GT) fragments are often comminuted, and the currently widely used locking plate may not fix GT fragments effectively. A further understanding of morphological characteristics of the GT fragments may help explore new fixation devices. This study aimed to determine the fracture line morphology of the GT fragment of Neer three‐ or four‐part PHF and analyze the location relationship between the locking plate and the GT fragment. Methods: Seventy‐one three‐dimensional computed tomography scans of Neer three‐ and four‐part PHF were retrospectively reviewed between January 2014 and June 2019. Fracture fragments were reconstructed and virtually reduced in the Mimics software, and fracture lines of GT fragments were depicted on a humerus template in the 3‐matic software and then were superimposed altogether. The common sites of the GT fracture were identified, and the location relationship between the locking plate and GT fragments was analyzed in a computer‐simulated scenario. Results: The fracture line morphology of GT fragments was similar between Neer three‐ and four‐part PHF. The overall morphology of GT fragments was in a fan shape, which could be summarized as anterior, superior, posterior, and middle lines. Of these, we identified 51 split and 29 avulsion type GT fragments based on the Mutch classification, and they could occur simultaneously in a PHF. The overall morphology of split type fragments was in a fan shape, and avulsion type fragments showed a quite distinguishable distribution pattern. A GT fragment could be classified as anterior‐split, posterior‐split, complete‐split, anterior ‐avulsion, and posterior‐avulsion type based on its morphology and location. The median percentage of fragment area covered by the plate was 32.3% in all of the fragments, and it was 69.4%, 23.0%, 37.2%, 21.8%, 0.0% in anterior‐split, posterior‐split, complete‐split, anterior‐avulsion, and posterior‐avulsion type GT fragments. We defined the posterior‐split, anterior‐avulsion, and posterior‐avulsion type GT fragments as the risky GT fragments, and they occurred in 43 (60.6%) Neer three‐ and four‐part PHFs. Conclusion: The fracture line morphology of GT fragments of Neer three‐ and four‐part PHF was in a fan shape. GT fragments could be classified based on their location and morphology. The extent of GT fragment coverage provided by the locking plate differed in various fragment types, and we identified the anterior‐avulsion, posterior‐avulsion, and posterior‐split type fragments as the risky GT fragments with a high incidence rate in Neer three‐ and four‐part PHFs. [ABSTRACT FROM AUTHOR]

Abstract Objective A micromotion-based balanced drilling system was designed based on a locking plate (LP) and far cortical locking (FCL) concept to maintain the balance of micromotions of the cortex on both sides of a fracture region. The system was tested by axial compression test. Methods The fracture gap was set to 2 cm, and locking screws with a diameter of 5 mm and a locking plate were used to fix it. The diameters of the two sections of the stepping drill were 3.5 mm and 5.0 mm, respectively. One of the matching drilling sleeves was a standard sleeve (eccentricity, 0 mm) and the other was an eccentric sleeve (proximal eccentricity, 1 mm). A model of the fixed locking plate (AO/ASIF 33-A3) for distal femoral fractures with a gap of 2 cm was established based on data from 42 artificial femurs (SAWBONE). According to the shape of the screw holes on the cortex, the fixed fracture models were divided into a control group (standard screw hole group X126, six cases) and an experimental group (elliptical screw hole group N, 36 cases). The experimental group was further divided into six subgroups with six cases in each (N126, N136, N1256, N1356, N12356, N123456), based on the number and distribution of the screws on the proximal fracture segment. The control, N126, and N136 groups were subjected to an axial load of 500 N, and the other groups were subjected to an axial load of 1000 N. The displacements of the kinetic head, far cortex, and near cortex were measured. The integral structural stiffness of the model and the near cortical strain were calculated. The data of each group were analyzed by using a paired t-test. Results When the far cortical strains were 2%, 5%, and 10%, the near cortical strains in group N126 were 0.96%, 2.35%, and 4.62%, respectively, significantly higher than those in the control group (X126) (p 0.05). For different numbers of screws, the near cortical strains in the three-screw groups were significantly higher than those in the four-screw groups (p 0.05). Conclusion The proposed drill and matching sleeves enabled a conventional locking compression plate to be transformed into an internal fixation system to improve the balanced motion of the near and far cortices. Thus, strain on a fracture site could be controlled by adjusting the diameter of the drill and the eccentricity of the sleeve.

Displaced femoral neck fractures in the young are difficult to treat. The complexity of the fractures for closed or open reduction requires careful surgical planning and experience. Acceptable reduction criteria in this fracture is crucial and should be followed strictly in order to get the favorable outcomes. Various reduction techniques have been described ranging from closed reduction by traction table or closed reduction with minimal direct manipulation with instruments to direct open reduction. This manuscript describes the mini open reduction, Watson-Jones and Smith-Petersen approaches, and some modifications in terms of indications, advantages, and disadvantages of each approach for the decision-making in these complex fractures.

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Abstract Introduction Schatzker type III fractures of the tibial plateau require elevation of the depressed portions to regain articular congruity. Balloon tibioplasty has been used as an alternative to conventional metal instruments for elevation of the lateral tibial plateau. This study compared functional outcomes following balloon tibioplasty or conventional osteosynthesis techniques in patients with type III fractures of the tibial plateau. Materials and methods A systematic literature search was performed using PubMed, EMBASE, and Cochrane Library to identify studies published through March 29, 2021, pertaining to balloon tibioplasty or conventional osteosynthesis techniques for type III fractures. Non-human studies, opinion or editorial pieces, systematic reviews, case series (

Abstract Background Application of a posterior plate for tibia plateau fractures associated with posterior column involvement is becoming a widespread standard practice as previous studies have shown that additional fixation of the posterior column with a posteromedial buttress plate creates strongest fixation in terms of fracture stabilization This study evaluated the clinical and radiological results of patients undergoing surgery for complex tibial plateau fractures involving the posterior column with a posteromedial plate applied via a medial midline incision. Methods Medical records of patients undergoing surgery for Schatzker type IV, V, and VI tibia plateau fractures involving the posterior column in our institution were reviewed retrospectively. Patients with a follow-up of less than 1 year, pathological fractures, posterolateral column fractures requiring separate fixation, and open fractures were excluded from the study. Three-dimensional computed tomography (3D CT) was performed in all patients before surgery. The study population consisted of 25 patients (21 males and 4 females) with a mean age of 41.5 (19–66) years. The etiologies of the fractures were traffic accidents in seven cases, pedestrian falls in five cases, falls from a height in seven cases, and motor vehicle accidents in six cases. Results The mean follow-up period was 15.9 months (12–25), mean time to union was 14.32 (9–20) weeks, mean Knee Society score (KSS) was 88 (81–95), and range of movement (ROM) was 123° (95°–140°). Loss of reduction was detected in only one patient (4%). A superficial incisional infection occurred in an anterolateral incision in only one patient (4%), and it recovered after oral antibiotic therapy. None of the patients required early implant removal and none had vascular or nerve complications in the postoperative period. Postoperatively, 23 (92%) patients had anatomical reduction and 2 (8%) had acceptable reduction in the sagittal plane CT sections. Acceptable reduction was achieved in 6(24%) patients and anatomical reduction was achieved in 19 (76%) in the coronal plane CT sections (Table 2). Conclusions Clinical results of posteromedial plate application using a single medial midline incision is promising as complication rates were very low and knee scores were high.

Among all pediatric fractures, femoral neck fracture is an infrequent injury that occurs due to high-energy trauma. The high risk of complications, such as avascular necrosis (AVN), which is the most common and serious complication, coxa vara, nonunion, premature physeal closure and infections, turns this fracture into an orthopedic emergency and increases the need for early treatment and intervention. Among the classifications of femoral neck fractures, which are known as the Delbet classification, type 1 is the least common but with the highest risk of AVN. Therapeutic action for these patients is close or open reduction with internal fixation under general anesthesia, which according to the evidences, open reduction is a more successful method. Due to the high probability of complications and the urgent need for treatment of femoral neck fracture, early intervention and timely treatment should be performed. Here, we report a 14-year-old boy who was brought to the emergency department with a Delbet type 1B fracture of the left femoral neck with detached epiphyseal portion of the femoral head due to a car accident. After one failed attempt to closed reduction, open reduction and internal fixation with a posterolateral (Kocher) approach was performed under general anesthesia. The reduction was maintained with guide pins and fixed with cannulated screws. After 8 months of follow-up, AVN was noticed.

Objective: A micromotion-based balanced drilling system was designed based on a locking plate (LP) and far cortical locking (FCL) concept to maintain the balance of micromotions of the cortex on both sides of a fracture region. The system was tested by axial compression test. Methods: The fracture gap was set to 2 cm, and locking screws with a diameter of 5 mm and a locking plate were used to fix it. The diameters of the two sections of the stepping drill were 3.5 mm and 5.0 mm, respectively. One of the matching drilling sleeves was a standard sleeve (eccentricity, 0 mm) and the other was an eccentric sleeve (proximal eccentricity, 1 mm). A model of the fixed locking plate (AO/ASIF 33-A3) for distal femoral fractures with a gap of 2 cm was established based on data from 42 artificial femurs (SAWBONE). According to the shape of the screw holes on the cortex, the fixed fracture models were divided into a control group (standard screw hole group X126, six cases) and an experimental group (elliptical screw hole group N, 36 cases). The experimental group was further divided into six subgroups with six cases in each (N126, N136, N1256, N1356, N12356, N123456), based on the number and distribution of the screws on the proximal fracture segment. The control, N126, and N136 groups were subjected to an axial load of 500 N, and the other groups were subjected to an axial load of 1000 N. The displacements of the kinetic head, far cortex, and near cortex were measured. The integral structural stiffness of the model and the near cortical strain were calculated. The data of each group were analyzed by using a paired t-test. Results: When the far cortical strains were 2%, 5%, and 10%, the near cortical strains in group N126 were 0.96%, 2.35%, and 4.62%, respectively, significantly higher than those in the control group (X126) (p < 0.05). For a different distribution of the screws, when the far cortical strains were 2%, 5%, and 10%, the near cortical strains in group N126 were significantly higher than those in group N136 (p < 0.05). However, there was no significant difference between the near cortical strains in the two groups with four screws (p > 0.05). For different numbers of screws, the near cortical strains in the three-screw groups were significantly higher than those in the four-screw groups (p < 0.05), and there was no significant difference in near cortical strains among the four-, five-, and six-screw groups (p > 0.05). Conclusion: The proposed drill and matching sleeves enabled a conventional locking compression plate to be transformed into an internal fixation system to improve the balanced motion of the near and far cortices. Thus, strain on a fracture site could be controlled by adjusting the diameter of the drill and the eccentricity of the sleeve. [ABSTRACT FROM AUTHOR]

Objective: A micromotion-based balanced drilling system was designed based on a locking plate (LP) and far cortical locking (FCL) concept to maintain the balance of micromotions of the cortex on both sides of a fracture region. The system was tested by axial compression test.Methods: The fracture gap was set to 2 cm, and locking screws with a diameter of 5 mm and a locking plate were used to fix it. The diameters of the two sections of the stepping drill were 3.5 mm and 5.0 mm, respectively. One of the matching drilling sleeves was a standard sleeve (eccentricity, 0 mm) and the other was an eccentric sleeve (proximal eccentricity, 1 mm). A model of the fixed locking plate (AO/ASIF 33-A3) for distal femoral fractures with a gap of 2 cm was established based on data from 42 artificial femurs (SAWBONE). According to the shape of the screw holes on the cortex, the fixed fracture models were divided into a control group (standard screw hole group X126, six cases) and an experimental group (elliptical screw hole group N, 36 cases). The experimental group was further divided into six subgroups with six cases in each (N126, N136, N1256, N1356, N12356, N123456), based on the number and distribution of the screws on the proximal fracture segment. The control, N126, and N136 groups were subjected to an axial load of 500 N, and the other groups were subjected to an axial load of 1000 N. The displacements of the kinetic head, far cortex, and near cortex were measured. The integral structural stiffness of the model and the near cortical strain were calculated. The data of each group were analyzed by using a paired t-test.Results: When the far cortical strains were 2%, 5%, and 10%, the near cortical strains in group N126 were 0.96%, 2.35%, and 4.62%, respectively, significantly higher than those in the control group (X126) (p < 0.05). For a different distribution of the screws, when the far cortical strains were 2%, 5%, and 10%, the near cortical strains in group N126 were significantly higher than those in group N136 (p < 0.05). However, there was no significant difference between the near cortical strains in the two groups with four screws (p > 0.05). For different numbers of screws, the near cortical strains in the three-screw groups were significantly higher than those in the four-screw groups (p < 0.05), and there was no significant difference in near cortical strains among the four-, five-, and six-screw groups (p > 0.05).Conclusion: The proposed drill and matching sleeves enabled a conventional locking compression plate to be transformed into an internal fixation system to improve the balanced motion of the near and far cortices. Thus, strain on a fracture site could be controlled by adjusting the diameter of the drill and the eccentricity of the sleeve. [ABSTRACT FROM AUTHOR]

This study aimed to determine the incidence of maxillary sinus pathology in patients with a midfacial fracture who underwent osteosynthesis surgery and evaluate the associated risk factors. We conducted a retrospective case-control analysis of patients with midfacial fractures involving a maxillary sinus wall who were treated with open reduction and internal fixation (ORIF) between January 2015 and December 2020. Fracture reduction, the number of screws implanted in the maxillary sinus, and the number of screws penetrating the maxillary sinus, etc., were examined as potential risk factors. Maxillary sinus pathology on postoperative CT was considered the primary outcome for case-control analysis. Binary logistic regression was used to identify variables associated with postoperative maxillary sinus pathology. Thereafter, propensity score matching (PSM) was used to extract confounding factors. A total of 262 patients (totaling 372 maxillary sinuses) were included for analysis. PSM yielded 178, 246, and 70 matched sinuses, respectively, depending on the potential risk factors. Postoperative maxillary sinus pathology was visualized in 218 of the 372 maxillary sinuses (58.60%). The risk factors for postoperative maxillary sinus pathology included the number of screws penetrating the maxillary sinus (odds ratio (OR), 1.124; p = 0.007), an imperfect maxillary sinus wall fracture reduction (OR, 2.901; p = 0.021), and the number of sinus walls involved (OR, 1.383; p = 0.011). After PSM, postoperative maxillary sinus pathology was still more prevalent in sinuses with multiple maxillary sinus wall fractures (64.04% vs. 48.31%, p = 0.034), sinuses with more screws penetrating the maxillary sinus (64.23% vs. 50.41%, p = 0.028), and sinuses with an imperfect reduction (80% vs. 51.43%, p = 0.012). In conclusion, maxillary sinus pathology is common after the ORIF of midfacial fractures. Patients with a fracture of multiple maxillary sinus walls require a close follow-up. Screw penetration of the maxillary sinus should be avoided to prevent maxillary sinus pathology after a midfacial fracture ORIF. [ABSTRACT FROM AUTHOR]

Introduction: Monteggia fracture-dislocations are infrequent in children accounting for approximately 2% of childhood elbow fractures, and diagnosis, mechanism of injury, treatment, and outcome are still challenging. We present a type III Monteggia equivalent lesion with fracture of the ulna, lateral condylar fracture, and lateral dislocation of radius in an 8-year-old girl. Case report: The patient presented with pain, swelling, and inability to move her right arm. No neurovascular injuries were detected. The patient was given analgesics, and the radial head was fixed with closed reduction in the emergency department. Her elbow was immobilized with a long arm splint, and she underwent surgery the day after. The lateral condylar fracture was fixed by using three 1.5 mm Kirchner wires (K-wires) to treat the humeral fracture. One 3.5 mm reconstruction plate was used to fix the ulnar fracture; however, it was not reduced properly, and the patient was referred to our hospital. She underwent surgery two days after the first surgery, the reconstruction plate was removed, and the ulnar fracture was fixed with a 3.5 mm 4-hole dynamic compression plate with cortical screws and three K-wires, and a long arm cast was applied. The patient was visited every two weeks with no complaints or complications. Six weeks after the surgery, the cast was split, and the three humeral and two ulnar K-wires were removed. Two weeks later, the other K-wire, which managed the medial facet involvement, was removed too. She had no complaints, and no complication was noted in the physical examination or radiographs.Her range of motion and rotation had returned completely two weeks later, and radiographs showed no complications.

ABSTRACT This study aimed to evaluate the effectiveness of bridge plating of simple tibial fractures in dogs by minimally invasive plate osteosynthesis (MIPO). Medical and radiographic records of twenty-nine dogs with simple tibial fractures that underwent bridge fixation by MIPO were retrospectively evaluated. The clinical outcome was classified considering the presence of lameness at the end of the treatment. The tibial mechanical joint angles were measured and compared with the values described in the literature. Additionally, fragment apposition and implant disposition were evaluated. Based on the modified Radiographic Union Scale for Tibial fractures, the moment of clinical union was determined. Clinically, at the end of treatment, only one patient presented lameness at a trot. While there was no significant difference between the bone alignment in the frontal plane values and the values described in the literature (P>0.05), the caudal proximal tibial angle was significantly higher (P=0.001). The median fragment apposition was considered acceptable. The average bridge plate ratio, plate working length, and plate screw density were 0.8, 0.57, and 0.48, respectively. The median time to clinical union was 30 days. Bridge plating in simple tibial fractures resulted in fast healing and low complication rates.

Introduction: The pectoralis major is a muscle that covers the upper portion of the anterior chest wall and is the first option for reconstruction of the chest wall and aesthetic purposes. Case Report: Male patient, 20 years old, presenting dehiscence of surgical wound, recurrent for three consecutive times, with exposure of the left clavicle osteosynthesis plate. Reconstruction was performed with the pectoralis major muscle to cover the plaque. Conclusion: This flap showed to be an excellent option for covering synthetic material exposure after multiple dehiscences of surgical wounds. The reconstruction was effective, with no complications and a satisfactory aesthetic result.

Introduction: Schatzker type III fractures of the tibial plateau require elevation of the depressed portions to regain articular congruity. Balloon tibioplasty has been used as an alternative to conventional metal instruments for elevation of the lateral tibial plateau. This study compared functional outcomes following balloon tibioplasty or conventional osteosynthesis techniques in patients with type III fractures of the tibial plateau. Materials and methods: A systematic literature search was performed using PubMed, EMBASE, and Cochrane Library to identify studies published through March 29, 2021, pertaining to balloon tibioplasty or conventional osteosynthesis techniques for type III fractures. Non-human studies, opinion or editorial pieces, systematic reviews, case series (< 5 patients), and articles published in a non-English language were excluded. Primary outcomes were Rasmussen clinical score, range of motion, and Knee Society Score (KSS). A Joanna Briggs Institute (JBI) risk of bias assessment was performed for all studies. Results: A total of 95 studies were identified, with 10 studies (and 132 total patients) meeting inclusion criteria: 1 study focused on balloon tibioplasty, 8 studies reported outcomes following conventional osteosynthesis, and 1 study compared outcomes of the two techniques. Mean follow-up times varied widely, from 4 to 76.3 months. Where reported, balloon tibioplasty resulted in good to excellent functional outcomes as indicated by Rasmussen clinical scores (mean 28.3 in a case series; mean 28.9 in a randomized controlled trial) and range of motion (≥ 140° in both studies) 1–2 years following surgery. KSS was not reported consistently enough for comparison. Studies ranged from low to high risk of bias according to the JBI assessment. Conclusions: Balloon tibioplasty can lead to excellent functional outcomes in patients with depression fractures of the lateral tibial plateau. More research is needed to directly compare outcomes following treatment with balloon tibioplasty or conventional osteosynthesis techniques. [ABSTRACT FROM AUTHOR]

Introduction and Aim Periprosthetic femoral fractures (PFF) represent an increasing clinical and economic burden. This study aims to determine the optimal configuration of a bridge-combined internal fixation system in the treatment of Vancouver type B1 PFF, using finite element analysis. Materials and methods A three-rod ortho-bridge system (OBS) fixation model was used to evaluate the optimal configuration of four target parameters: position of the third rod; intersection angle between the proximal screws; connecting rod diameter; and number of screws used. Femoral displacement and the maximum von Mises stress of the OBS were used as the evaluation indices, to analyze the PFF and to determine the optimal use of an OBS. For each parameter, various candidate options were tested. Results Finite element analysis revealed that the rate of femoral displacement and the maximum von Mises stress of the OBS were at a minimum when there was a 35 mm downward movement of the third rod from the baseline. Therefore, the optimal position of third rod fixation was 35 mm below the fovea capitis of the femur. The optimal intersection angles between the proximal screws were found to be 71.92° or 84°. A 6 mm diameter connecting rod proved to be most effective. Configuration d, utilizing 7 screws, represented the most clinically appropriate screw number configuration, despite configuration f, utilizing 9 screws, eliciting the best evaluation indices. Conclusion An OBS used in the above-described configuration is well suited to the characteristics of PFF and provides an effective and reliable means for their treatment. [ABSTRACT FROM AUTHOR]

Backgroud: Internal fixation has been established as a treatment of choice in relatively young patients with femoral neck fractures. Due to the characteristics of femoral neck anatomy and blood supply, complications such as malunion, nonunion, avascular necrosis, and femoral neck shortening can occur after internal fixation of femoral neck fractures. Unlike other complications such as avascular necrosis or nonunion, femoral neck shortening has not been relatively well studied. This study aimed to investigate the risk factors and clinical outcomes of femoral neck shortening after internal fixation of femoral neck fractures., Methods: From June 2012 to July 2022, among 102 patients who underwent internal fixation of femoral neck fractures, 94 patients who met inclusion and exclusion criteria were retrospectively analyzed. Internal fixation of the femoral neck was done with cannulated compression screws or a femoral neck system. Patients were divided into 2 groups; femoral neck shortening (≥ 5 mm) and no shortening (< 5 mm) according to measurement on follow-up hip anteroposterior (AP) simple radiographs compared with postoperative hip AP simple radiographs. Demographic and radiographic data were compared between the 2 groups. The modified Harris Hip Score (mHHS) and a visual analog scale (VAS) were used to evaluate the clinical outcomes., Results: Among 94 patients, femoral neck shortening was observed in 33 (35.1%). In chi-square test, Pauwels angle, Garden type III or IV (displacement), and cortical comminution were significantly correlated with neck shortening ( p < 0.05). In the multifactorial logistic regression test, cortical comminution was significantly correlated with femoral neck shortening ( p < 0.01). The shortening group showed significantly lower clinical scores in terms of mHHS and VAS ( p < 0.01)., Conclusions: The femoral neck shortening group showed significantly lower clinical scores of mHHS and VAS than the no-shortening group. The presence of cortical comminution in preoperative hip computed tomography is a risk factor of femoral neck shortening after internal fixation of femoral neck fractures., Competing Interests: CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported., (Copyright © 2024 by The Korean Orthopaedic Association.)

Introduction: Trapdoor fractures of the orbital floor occur almost exclusively in the paediatric population. Despite being widely discussed in the literature, their management remains controversial. The objective of this retrospective study was to analyse the surgical experiences on paediatric trapdoor fractures in the maxillofacial centres participating in the WORMAT project., Materials and Methods: 14 centres collected data for patients aged ≤16 years operated between January 2011 and December 2022. The demographic, cause and type of fracture, timing from injury to surgery, surgical approach, type of floor repair and outcomes were recorded. Diplopia, surgical wound infection, hardware loosening and dysesthesia in the infraorbital nerve area were recorded at follow-up., Results: 43 patients were included: 25 children (0-12 y) and 18 adolescents (13-16 y) (mean age, 11.1 years). Surgical treatment was performed within 24 h in 51 % of the patients, within 24-72 h in 33 %, and beyond 72 h in the remaining. The orbital floor was repaired with a resorbable implant/membrane in 63 % of the patients, open reduction without an implant in 30 %, a titanium mesh implant in 3 adolescent patients. At follow-up (mean 16.3 months), 14 patients had residual diplopia in the upper fields, only two of these resolved within 6 months., Discussion: A tendency toward an increased incidence of postoperative diplopia with longer intervals between trauma and surgery was observed. This study showed different choices regarding the material placed on the floor, with a preference for open reduction without implants in children, compared to the use of resorbable implants or membranes in adolescents., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Introduction: Lateral locking plates are commonly employed for the fixation of distal femur fractures. However, scenarios involving medial comminution, extremely distal fractures, periprosthetic fractures, or nonunion could necessitate medial augmentation. This study explores the possibility of using lateral distal femoral locking plate systems for medial fixation by employing the contralateral plate., Methods: This study presents a technical note on the application of lateral distal femur locking systems for medial augmentation in patients as indicated by current literature findings. Postoperative imaging modalities, including radiography and computed tomography (CT), were used to assess the plates' fit to the distal femur. Three cases following the specified technical note are presented., Results: The various plate systems, all comprising distal femur locking systems, demonstrated adaptability to the medial femur anatomy as confirmed by intraoperative visualization and postoperative radiographs, including two-dimensional and three-dimensional CT scans. It has also been possible to achieve at least 3 independent fixation points regardless of the size of the medial condyle., Conclusions: Locking distal femoral plates can be a viable option for medial augmentation in indicated cases, achieving anatomical adaptation to the distal femur. This provides robust augmentation without the need for additional instruments beyond those used for the lateral cortex., Competing Interests: The author reports no conflict of interest., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Orthopaedic Trauma Association.)

BACKGROUND: For Sanders type II calcaneal fractures, the “L-shaped” incision with locking plate internal fixation often causes complications such as necrosis of the surgical incision flap. The internal fixation with hollow screws after prying and resetting can well avoid this problem, but there is still a lack of evaluation of the effect of internal fixation. OBJECTIVE: To compare and study the fixation effect and mechanical stability of the two fixation methods for Sanders II type calcaneal fractures based on the finite element analysis method. METHODS: One male volunteer (25 years old, height 175 cm, weight 75 kg) was screened, and a full-thickness continuous scan was performed from the middle part of the tibia to the whole foot by tomographic CT scan. Based on CT scan data, a complete three-dimensional finite element analysis model of the calcaneus was established. The Sanders II type calcaneal fracture was simulated, and locking plate fixation (locking plate group) and hollow screw compression fixation (hollow screw group) were performed after prying reduction. The stress distribution, displacement and fracture displacement performance of the two fixation methods were compared under the same constraints and loads on the two sets of models. RESULTS AND CONCLUSION: (1) The stress of hollow screw internal fixation was concentrated near the fracture line contact, and maximum Von Mises stress reached 53.948 MPa. The displacement of the horizontal hollow screw was larger than that of the longitudinal screw, and the maximum displacement was up to 0.175 37 mm. The fixed stress and displacement of the locking steel plate were concentrated near the screw hole in the middle of the steel plate. The maximum Von Mises stress reached 129.95 MPa. The fracture line displacement of the hollow screw group (0.015 77 mm) was smaller than that of the locking plate group (0.021 03 mm). (2) The maximum stress of the two sets of internal fixation was lower than the yield strength of the material. (3) The two groups of calcaneal models had the largest displacement near the subtalar joint. (4) It is concluded that hollow screws and locking plate internal fixation for the treatment of Sanders II type calcaneal fractures have good stability. Pry reduction hollow screw internal fixation has the advantages of reducing postoperative complications. It is the recommended method of internal fixation for Sanders II type calcaneal fractures. [ABSTRACT FROM AUTHOR]

Abstract Background The clinical effect of the three-incision combined approach for complex fracture of tibial plateau involving the posterior tibial plateau was discussed. Methods A retrospective analysis was performed for 13 cases receiving surgery for complex fracture of tibial plateau from July 2015 to June 2019. They received surgery via the three-incision combined approach, and regular postoperative reexamination was performed at the outpatient clinic. During the last follow-up, Hospital for Special Surgery (HSS) Knee Scoring System was used to assess the knee joint function; the Lysholm score was used to assess the knee mobility. The anterior, posterior, and rotational stabilities of the knee joint were assessed by the Lachman test and pivot-shift test. Results There was no nonunion and delayed union, implant loosening and fracture, or refracture, and neither were there neurological symptoms or restricted mobility in daily life. During the follow-up, none of the cases were found with restriction of knee mobility caused by internal fixation or apparent pain. The HSS score during the last follow-up was 86–100 (average, 90.2 ± 6.8), and the excellent and good rate was 100%; the Lysholm score was 86–100 (average, 95.7 ± 2.6). All cases were negative for the Lachman test and pivot-shift test. The knee flexion mobility was 100~140° (average, 127.2° ± 11.4°). Postoperative X-ray indicated anatomical reduction of bone fractures in all cases. Loss of reduction or loosening and fracture of internal fixation was not observed by postoperative regular reexaminations. The posterior tibial slope at 6 months after surgery was 6~16° (average, 10.66 ± 2.58°), the varus angle was 84~89° (average, 86.52 ± 1.46°), the Rasmussen radiological score was 12~18 (average, 16.12 ± 1.35), and the excellent and good rate was 100%. Conclusion The three-incision combined approach proved safe and reliable for complex fracture of tibial plateau involving the posterior tibial plateau and is worthy of further popularization.

Aim To demonstrate validity of a bio-metallic solution in bone healing combined with the quadriceps safe approach in the treatment of nonunions of distal femur while malunions were treated by metallic solution. Methods We treated 57 patients with nonunion or malunion of distal femur at the Orthopaedics and Traumatology Department of a single orthopaedic trauma centre (Italy). A total of 57 patients were divided in two groups: the first (NU) group was composed of 35 patients affected; the second group (MU) was composed of 22 patients affected by malunion of distal femur. Criteria chosen to evaluate the two groups during a clinical and radiological follow-up were: the quality of life measured by the Short Form (12) Health Survey, the knee function and quality of life related to it measured by the Knee Injury and Osteoarthritis Outcome Score KOOS and the Knee Society Score, bone healing measured by modified Radiographic Union Score by X-rays during the follow-up and CT at one year after the surgery, the difference of the limbs length before and after the revision surgery, and postoperative complications. The evaluation endpoint was set at 12 months. Results There were no statistical differences between the two groups. Conclusion The role of bio-metallic solution in the treatment of nonunions and malunions is to recreate the knee anatomy and functionality compatible with a satisfactory quality of life.

Aim Proximal humeral fractures are common and most complex patterns currently represent a challenge for surgeons. Difficulties in obtaining good anatomical reduction (particularly of great tuberosity) often lead to unsatisfactory results; choices often fall onto prosthesis implantation against fixation options. The aim of this study was to compare a new design of proximal humeral plate with the most used plates in the treatment of these injures by analysing outcomes and complications. Methods Two hundred patients with proximal 3 or 4 parts humeral fracture were enrolled (Neer 3-4). First group treated with PGR Plate composed of 98 patients. Second group treated with Philos Plate composed of 102 patients. Evaluation criteria were Non-Union Scoring System, duration of surgery, complications, objective quality of life and elbow function (Constant Shoulder Score), subjective quality of life and elbow function (Oxford Shoulder Score), post-op radiographs, centrum collum diaphyseal angle. Evaluation endpoint was 12 months. Results There was no statistically significant difference between the groups with regard to the selected evaluation parameters. Achievement of good shoulder range of motion and ability to perform normal daily living activities was obtained in both groups. The PGR had a positive impact on treatment results of varus-pattern of proximal humeral fractures. Conclusions The PGR allowed good clinical and radiographic results in the treatment of proximal humeral fractures, comparable to those obtained with Philos. Also, PGR had the advantage to aid and keep the anatomical reduction of patterns of fracture involving the greater tuberosity.

Intertrochanteric femur fractures are common in older patients and often have a significant impact on disability. The treatment aims to achieve a rapid return to the prior functional level with a low rate of complications and mortality. Surgical management by internal fixation is the mainstay of treatment for most of these fractures. Even when treated with intramedullary nails, the overall complication rates are high, especially for unstable or highly comminuted fractures or in the presence of poor bone quality. Hip arthroplasty is an alternative in older patients with intertrochanteric femur fractures at high risk of fixation failure or with concomitant intraarticular pathologies. Especially patients whose condition precludes prolonged bedrest and who are at risk of significant deterioration if their locomotor function cannot be restored rapidly are likely to benefit from hip arthroplasty. The choice of the surgical technique mainly depends on the surgeon's preferences and the fracture characteristics. Bipolar hemiarthroplasty is the most common type of prosthesis used with primary or revision femoral stems. Compared with intramedullary nails, hip arthroplasty has a better early functional outcome and lower rates of surgical complications as well as reoperations. However, the functional outcome and the mortality rate in the longer term tend to favor intramedullary nails, even though the results are inconsistent, and a statistically significant difference cannot always be obtained. Currently, there are no guidelines that define the role of hip arthroplasty in the treatment of intertrochanteric femur fractures in older patients. The literature only offers an overview of the possibilities of the usage of hip arthroplasty, but methodological limitations are common, and evidence levels are low. Further studies are needed to identify the intertrochanteric fractures that are at high risk of internal fixation failure, the characteristics that determine which patients may benefit most from hip arthroplasty, and the optimal surgical technique. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the neuromuscular structures at risk during modified anterior minimally invasive plating osteosynthesis technique (Belangero–Livani) for humeral shaft fractures. Methods: Eight fresh-frozen human specimens ranging from 38 to 82 years old were used. Specimens were positioned supine with the shoulder in 70° abduction and the forearm in full supination. Anterior minimally invasive plating osteosynthesis technique according to Belangero–Livani technique was performed in each specimen. Under radioscopic control, the plate was introduced in retrograde fashion through the subbrachialis path. Anatomical structures were inspected and different anatomical parameters were measured after dissection at the end of the surgical procedures. Measurements were performed using a high digital caliper. Statistical analysis was performed using the Pearson's correlation coefficient test. A p value of < 0.05 was used to define statistical significance. Results: There were no macroscopic lesions of myotendinous or neurovascular structures in any specimen. The mean distance between the radial nerve to the distal lateral end of the plate was 8.63 mm (range 4.14–13.83 mm). The mean total length of the humerus was 328.59 mm. We found a significant direct correlation between the total length of the humerus and both specimen height and weight. Conclusion: The modified Belangero–Livani anterior MIPO technique for humeral shaft fractures performed in retrograde fashion is safe and useful, without major risk to the soft tissue of the anterior compartment of the arm, including the radial nerve in the lateral intermuscular septum. Intraoperative dissection, avoiding deep lateral retraction on the distal approach, minimizes the risk of radial nerve damage. Strict surgical planning and appreciation for the anatomic landmarks can reduce the risk of damage to neuromuscular structures. Level of evidence: Level IV; Case series with no comparison group; Treatment study [ABSTRACT FROM AUTHOR]

Purpose: The aim of the present study was to evaluate the four methods for bilateral sagittal osteotomy fixation. Methods: In this study, 56 replicas of whole mandibles made of rigid polyurethane were used. After simulation of major advancement (11 mm) with clockwise rotation of the mandible (6o) in relation to the occlusal plane, the bone segments were fixed with plates and screws of the 2.0-mm system on both the right and left sides: group I, double "H" plate; group II, two mini-plates; group III, "hybrid technique"; and group IV, three bicortical screws in the "inverted L" pattern. The mandibles were submitted to load on the central incisors and right first molar. Results: The mean value of group I was higher than those of groups IV and II in the displacement of 1 mm (F = 4.705; p = 0.010) with load on the incisor. The mean value of group III was higher than those of groups I and II in the displacement of 1 mm (F = 5.166; p = 0.007) and 3 mm (F = 5.166; p = 0.007). The mean value of group IV was higher than that of group II (F = 3.142; p = 0.044) with load on the molar. Conclusion: Therefore, after the analyses, the hybrid technique was the one that showed the best results. [ABSTRACT FROM AUTHOR]

Background: The nonunion rate for atypical femoral fractures (AFF) is known to be higher than that for typical fractures of the femur. We performed a meta-analysis to determine the incidence of nonunion necessitating reoperation following fixation for AFF and compare the rates according to the fracture site (subtrochanter or midshaft)., Methods: A total of 742 AFFs from 29 studies were included. A proportion meta-analysis utilizing a random-effects model was conducted to estimate the prevalence of nonunion. The outcomes were the incidence of reoperations that included osteosynthesis. To determine the association of nonunion with patient mean age or average duration of bisphosphonate use, meta-regression analysis was done., Results: In proportion meta-analysis, the estimated pooled prevalence of nonunion was 7% (95% confidence interval [CI], 5%-10%) from all studies. There was a significant difference in nonunion rate between the 2 groups (I 2 = 34.4%, p = 0.02); the estimated prevalence of nonunion was 15% (95% CI, 10%-20%) in subtrochanteric AFFs and 4% (95% CI, 2%-6%) in midshaft AFFs. From meta-regression analysis, significant correlations were identified between nonunion rate and patient mean age (coefficient: -0.0071, p = 0.010), but not in the average duration of bisphosphonate use (coefficient: -0.0024, p = 0.744)., Conclusions: A notable disparity existed in the nonunion rate among subtrochanteric AFFs and midshaft AFFs group. Therefore, it is critical for orthopedic surgeons to consider the complexity and challenges associated with AFF and to estimate the proper possibility of nonunion according to the fracture site., Competing Interests: CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported., (Copyright © 2024 by The Korean Orthopaedic Association.)

The purpose of this case study is to examine the effects of Korean traditional medicine in the postoperative treatment of proximal humeral fracture. The patient with postoperative pain following proximal humeral fracture surgery was treated with Korean traditional medicine including acupuncture cupping therapy and herbal medicine in hospital for 67 days. The effects of the treatment were evaluated using the Numerical Rate Scale (NRS), Range Of Motion (ROM), and Shoulder Pain and Disability Index (SPADI). As a result of treatment, the NRS score was reduced from 7 to 3, the ROM was improved (on average by 21%), SPADI was reduced from 93 to 25.9. This study proposes that Korean traditional medicine may be effective in postoperative treatment for proximal humeral fracture.

Objectives: Comparison of the mechanical stability of 2.0 plates made of commercially pure titanium (cpTi) and a titanium–molybdenum (Ti–15Mo) alloy and two methods of internal fixation employed mandibular angle fractures, using 3D finite element analysis. Materials and Methods: Four groups were evaluated. For the cpTi: group Eng 1P, one 4-hole plate and 4 screws 6 mm long, in the tension zone of the mandible; group Eng 2P, two 4-hole plates, one in the tension zone of the mandible and the other in the compression zone, both were fixed with 8 screws 6 mm long. The same groups were created for the Ti–15Mo alloy. A 100 N compressive load was applied to the occlusal surface of the mandibular first molar on the plated side. Results: When considering the von Mises equivalent stress (σvM) values for the comparison between both groups with one plate, a decrease of 10.5% in the plate and a decrease of 29.0% in the screws for the Ti–15Mo group was observed. Comparing the same groups with two plates, a decrease of 28.5% in the screws was shown for the Ti–15Mo alloy group. No significant differences were observed when considering maximum and minimum principal stresses (σmax, σmin), and maximum principal strain (εmax) to the mandibular bone. The Ti–15Mo alloy plates substantially decreased the stress concentration in the screws for both internal fixation techniques and in the plate for the Ti–15Mo 1 plate group. Conclusion: From a clinical standpoint, the use of Ti–Mo alloy with reduced stiffness will decrease the stress shielding between the hardware and bone, influencing the outcome of the treatment. [ABSTRACT FROM AUTHOR]

The jaw is considered the strongest bone in the facial skeleton. However, due to their vulnerable position and anatomical configuration, traumatic injuries associated with the mandibular condyle, angular and body fractures are frequently observed. The objective of the treatment of mandibular fractures is to reestablish function, anatomy and aesthetics, through the reduction and often fixation of fragments. The present study aims to report a clinical case of a patient victim of physical aggression presenting a complex fracture of the jaw undergoing surgical treatment, with satisfactory results using intraoral and extraoral access to the fracture line. After a six-month postoperative follow-up, the patient did not report any complaints and the imaging exam did not show any changes, satisfactory occlusion. [ABSTRACT FROM AUTHOR]

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Intertrochanteric femur fractures are common in older patients and often have a significant impact on disability. The treatment aims to achieve a rapid return to the prior functional level with a low rate of complications and mortality. Surgical management by internal fixation is the mainstay of treatment for most of these fractures. Even when treated with intramedullary nails, the overall complication rates are high, especially for unstable or highly comminuted fractures or in the presence of poor bone quality. Hip arthroplasty is an alternative in older patients with intertrochanteric femur fractures at high risk of fixation failure or with concomitant intraarticular pathologies. Especially patients whose condition precludes prolonged bedrest and who are at risk of significant deterioration if their locomotor function cannot be restored rapidly are likely to benefit from hip arthroplasty. The choice of the surgical technique mainly depends on the surgeon’s preferences and the fracture characteristics. Bipolar hemiarthroplasty is the most common type of prosthesis used with primary or revision femoral stems. Compared with intramedullary nails, hip arthroplasty has a better early functional outcome and lower rates of surgical complications as well as reoperations. However, the functional outcome and the mortality rate in the longer term tend to favor intramedullary nails, even though the results are inconsistent, and a statistically significant difference cannot always be obtained. Currently, there are no guidelines that define the role of hip arthroplasty in the treatment of intertrochanteric femur fractures in older patients. The literature only offers an overview of the possibilities of the usage of hip arthroplasty, but methodological limitations are common, and evidence levels are low. Further studies are needed to identify the intertrochanteric fractures that are at high risk of internal fixation failure, the characteristics that determine which patients may benefit most from hip arthroplasty, and the optimal surgical technique.

Background: The clinical effect of the three-incision combined approach for complex fracture of tibial plateau involving the posterior tibial plateau was discussed. Methods: A retrospective analysis was performed for 13 cases receiving surgery for complex fracture of tibial plateau from July 2015 to June 2019. They received surgery via the three-incision combined approach, and regular postoperative reexamination was performed at the outpatient clinic. During the last follow-up, Hospital for Special Surgery (HSS) Knee Scoring System was used to assess the knee joint function; the Lysholm score was used to assess the knee mobility. The anterior, posterior, and rotational stabilities of the knee joint were assessed by the Lachman test and pivot-shift test. Results: There was no nonunion and delayed union, implant loosening and fracture, or refracture, and neither were there neurological symptoms or restricted mobility in daily life. During the follow-up, none of the cases were found with restriction of knee mobility caused by internal fixation or apparent pain. The HSS score during the last follow-up was 86–100 (average, 90.2 ± 6.8), and the excellent and good rate was 100%; the Lysholm score was 86–100 (average, 95.7 ± 2.6). All cases were negative for the Lachman test and pivot-shift test. The knee flexion mobility was 100~140° (average, 127.2° ± 11.4°). Postoperative X-ray indicated anatomical reduction of bone fractures in all cases. Loss of reduction or loosening and fracture of internal fixation was not observed by postoperative regular reexaminations. The posterior tibial slope at 6 months after surgery was 6~16° (average, 10.66 ± 2.58°), the varus angle was 84~89° (average, 86.52 ± 1.46°), the Rasmussen radiological score was 12~18 (average, 16.12 ± 1.35), and the excellent and good rate was 100%. Conclusion: The three-incision combined approach proved safe and reliable for complex fracture of tibial plateau involving the posterior tibial plateau and is worthy of further popularization. [ABSTRACT FROM AUTHOR]

Objectives: Sixty years ago, the Association of Osteosynthesis (AO) was founded with the aim to improve fracture treatment and has since grown into one of the largest medical associations worldwide. Aim of this study was to evaluate AO's impact on science, education, patient care and the MedTech business.Design/methods: Impact evaluations were conducted as appropriate for the individual domains: Impact on science was measured by analyzing citation frequencies of publications promoted by AO. Impact on education was evaluated by analyzing the evolution of number and location of AO courses. Impact on patient care was evaluated with a health economic model analyzing cost changes and years of life gained through the introduction of osteosynthesis in 17 high-income countries (HICs). Impact on MedTech business was evaluated by analyzing sales data of AO-associated products.Results: Thirty-five AO papers and 2 major AO textbooks are cited at remarkable frequencies in high ranking journals with up to 2000 citations/year. The number of AO courses steadily increased with a total of 645'000 participants, 20'000 teaching days and 2'500 volunteer faculty members so far. The introduction of osteosynthesis saved at least 925 billion Swiss Francs [CHF] in the 17 HICs analyzed and had an impact on avoiding premature deaths comparable to the use of antihypertensive drugs. AO-associated products generated sales of 55 billion CHF.Conclusion: AO's impact on science, education, patient care, and the MedTech business was significant because AO addressed hitherto unmet needs by combining activities that mutually enriched and reinforced each other. [ABSTRACT FROM AUTHOR]