Abordagem cirúrgica em fratura de sínfise e côndilo mandibular bilateral em paciente pediátrico: um relato de caso / Surgical approach for syphysis and bilateral mandibular condyle fracture in a pediatric patient: a case report

As indicações de tratamento das fraturas mandibulares em paciente pediátrico variam em conservador, fixação não rígida e interna rígida. Alterações no crescimento ósseo, disfunções na articulação temporomandibular e assimetrias faciais podem ser decorrentes ao insucesso do tratamento. O objetivo deste trabalho consiste em relatar abordagem cirúrgica em fratura de sínfise e côndilo mandibular bilateral em paciente pediátrico. Paciente gênero feminino, 09 anos de idade, foi encaminhada ao Hospital Geral do Estado - Bahia vítima de queda de nível, cursando com trauma em face. Apresentou queixa principal, referida pela progenitora, de dificuldades em fechar a boca. Ao exame físico, a paciente apresentou mobilidade atípica à manipulação da mandíbula, mordida aberta anterior, equimose sublingual, ausência das unidades dentárias 74 e 75, com abertura bucal regular e suturas em posição em região de mento. Ao exame de imagem de tomografia computadorizada da face, pôde-se notar sinais sugestivos de fratura em região de sínfise e côndilos mandibulares bilateral. Após diagnóstico das fraturas, a paciente foi submetida à cirurgia sob anestesia geral para redução e fixação das mesmas. Realizou-se acessos em ferimento na região mentual e retromandibular bilateral com posterior síntese das fraturas utilizando fixação interna rígida com placas do sistema 2.0mm, associada a odontossíntese na fratura de sínfise. Ao acompanhamento periódico, a eleição do tratamento cirúrgico para fraturas mandibulares em pacientes pediátricos, pode permitir segurança no crescimento ósseo mandibular e facial(AU)

The indications for treatment of mandibular fractures in pediatric patients vary from conservative, non-rigid fixation and rigid internal fixation. Changes in bone growth, temporomandibular joint disorders and facial asymmetries may be due to treatment failure. The objective of this work is to report a surgical approach to bilateral symphysis and mandibular condyle fractures in a pediatric patient. Female patient, 9 years old, was sent to the State General Hospital - Bahia, victim of a fall in level, suffering from trauma to the face. She presented a main complaint, mentioned by her mother, of difficulties in closing her mouth. On physical examination, the patient presented atypical mobility when manipulating the jaw, anterior open bite, sublingual ecchymosis, absence of dental units 74 and 75, with regular mouth opening and sutures in position in the chin region. When examining the computed tomography image of the face, signs suggestive of fracture in the region of the symphysis and bilateral mandibular condyles were noted. After diagnosis of the fractures, the patient underwent surgery under general anesthesia to reduce and fix them. Access was performed on a wound in the mental and bilateral retromandibular region with subsequent synthesis of the fractures using rigid internal fixation with 2.0mm system plates, associated with odontosynthesis in the symphysis fracture. With periodic monitoring, the choice of surgical treatment for mandibular fractures in pediatric patients can allow for safe mandibular and facial bone growth(AU)

Femoral fracture in the elderly: dependence on nursing care

Introduction: Due to the aging of the population, nursing processes have been adapted to these patients, who require a high level of care and guidance. Objective: Analyzing the degree of dependence on nursing care by elderly patients (65 years or older) with femur fractures. Materials and Methods: retrospective, with a quantitative approach, carried out in a private hospital from April 2021 to April 2022. The sample comprehends 41 patients, analyzed epidemiological data and degree of dependence Study of nursing care during hospitalization, environment of hospitalization and discharge, according to the SCP. Results: Composed of 41 patients, mean age of 84 years and female predominance (75.61%). With regard to fractures, there was a greater occurrence due to falls from standing height and predominance of neck fractures, with an average time until surgery of less than 16 hours. Systemic Arterial Hypertension and Diabetes Mellitus were predominant. The average of the SCP estimates presented 24.26 in the 1st, 26.12 in the 2nd and 26.24 in the 3rd. The length of hospital stay was 7 days and no deaths were reported. Discussion: The findings on sociodemographic data, reasons for falls, location, comorbidities, degree of dependence and length of hospital stay are similar to those available in databases. They differ, in better quality, under time until surgery and clinical. Conclusions: The study presents specific knowledge to carry out the care of the intra-hospital nursing process, thus allowing the systematization of the team's assistance.

Meta-analysis of Distribution Frequency of Traditional Chinese Medicine Syndrome in Primary Osteoporosis / 中国实验方剂学杂志

ObjectiveTo systematically evaluate the distribution of traditional Chinese medicine（TCM） syndromes of primary osteoporosis（POP） in China by using evidence-based medicine methods， and to understand the distribution law of the syndromes. MethodChina National Knowledge Infrastructure（CNKI）， VIP Chinese Science and Technology Journal Database（VIP）， WanFang Data Knowledge Service Platform（WanFang） and China Biology Medicine（CBM） were searched to obtain representative literature， and each database was searched from the 1994 World Health Organization defined diagnostic criteria for osteoporosis until May 1， 2023. Two researchers independently screened literature according to the criteria， extracted data， and cross-checked them. Meta analysis was conducted using R4.1.3， and subgroup analysis was performed. ResultA total of 56 Chinese papers were included， involving 14 415 patients. After standardized classification of syndromes， 11 articles were excluded， and Meta analysis results of the ultimately included 45 Chinese articles showed that the distribution frequencies of liver-kidney Yin deficiency syndrome， spleen-kidney Yang deficiency syndrome and kidney deficiency and blood stasis syndrome in 12 723 patients were 27%［95% confidence interval（CI） 0.24-0.31］， 32%（95% CI 0.29-0.36）， 36%（95% CI 0.30-0.42）. Subgroup analysis showed that there was a statistically significant difference in the distribution of the three TCM syndromes in the north and south（P<0.05）. In addition， the incidence of TCM syndrome fractures in different types of POP was 15%（95% CI 0.09-0.24） for liver-kidney Yin deficiency syndrome， 20%（95% CI 0.12-0.30） for spleen-kidney Yang deficiency syndrome， and 31%（95% CI 0.25-0.39） for kidney deficiency and blood stasis syndrome. ConclusionThe distribution of syndromes in POP patients is mainly kidney deficiency， accompanied by liver and spleen dysfunction. Liver-kidney Yin deficiency syndrome， spleen-kidney Yang deficiency syndrome and kidney deficiency and blood stasis syndrome are all the main syndromes of POP and osteoporotic fractures， and kidney deficiency and blood stasis syndrome is most closely related to the development of osteoporotic fractures. The reference standards for syndrome determination among the included studies are inconsistent， and in the future， it is necessary to focus on their determination standards to obtain consensus research results， at the same time， conduct large-scale syndrome research to obtain representative research results， providing a basis for clinical practice and research.

Research progress of finite element method in the biomechanics of the orbit / 国际眼科杂志(Guoji Yanke Zazhi)

The finite element method(FEM)is a widely employed mathematical technique in mechanical research that divides an object into discrete and interacting finite elements. Medically, finite element analysis(FEA)enables the simulation of biomechanical experiments that are challenging to conduct. Orbital surgery poses significant challenges to ophthalmologists due to its inherent difficulty and steep learning curve. FEM enables the simulation and analysis of the mechanical properties of orbital tissue, offering a novel approach for diagnosing and treating orbital-related diseases. With technological advancements, FEM has significantly matured in the diagnosis and treatment of orbital diseases, becoming a popular area of research in orbital biomechanics. This paper reviewed the latest advancements in orbital FEM, encompassing the development of orbital FEA models, simulation of orbital structure, and its application in orbital-related diseases. Additionally, the limitations of FEM and future research directions are also discussed. As a digital tool for auxiliary diagnosis and treatment, orbital FEA will progressively unlock its potential for diagnosing and treating orbital diseases alongside technological advancements.

Risk analysis of re⁃fracture after percutaneous kyphoplasty in elderly patients with osteoporotic thoracolumbar compression fractures and construction of a columnar graph prediction model / 解剖学报

Objective To investigate the risk factors for re-fracture after percutaneous kyphoplasty (PKP) in elderly patients with osteoporotic thoracolumbar compression fractures and to construct a line graph prediction model. Methods One hundred and eighty-two elderly patients with osteoporotic thoracolumbar compression fractures treated with PKP from January 2016 to November 2019 were selected for the study‚ and the patients were continuously followed up for 3 years after surgery. Clinical data were collected from both groups; Receiver operating characteristic (ROC) curve analysis was performed on the measures; Logistic regression analysis was performed to determine the independent risk factors affecting postoperative re-fracture in PKP; the R language software 4. 0 “rms” package was used to construct a predictive model for the line graph‚ and the calibration and decision curves were used to internally validate the predictive model for the line graph and for clinical evaluation of predictive performance. Results The differences between the two groups were statistically significant (P0. 22‚ which could provide a net clinical benefit‚ and the net clinical benefit was higher than the independent predictors. Conclusion BMD‚ number of injured vertebrae‚ single-segment cement injection‚ cement leakage‚ pre-and post-PKP vertebral height difference‚ and posterior convexity angle change are independent risk factors affecting the recurrent fracture after PKP in elderly patients with osteoporotic thoracolumbar compression fracture‚ and this study constructs a column line graph model to predict the recurrent fracture after PKP in elderly patients with osteoporotic thoracolumbar compression fracture as a predictor for clinical. This study provides an important reference for clinical prevention and treatment‚ and has clinical application value.

Effect of early postoperative comprehensive rehabilitation on children and youth with supracondylar fracture of humerus complicated with ulnar nerve injury / 中国康复理论与实践

ObjectiveTo observe the therapeutic effect of early postoperative comprehensive rehabilitation on elbow joint dysfunction and ulnar nerve injury in children and adolecents with supracondylar fracture of humerus complicated with ulnar nerve injury. MethodsA total of 49 children with supracondylar fracture of humerus complicated with ulnar nerve injury after operation were selected from January, 2016 to December, 2021 in Wangjing Hospital, which were randomly divided into control group (n = 24) and treatment group (n = 25). The control group accepted wax therapy and acupuncture, and the treatment group accepted medicine fumigation, joint mobilization and electromyographic biofeedback, for twelve weeks. They were assessed with The Hospital for Special Surgery Elbow score (HSS) and Medical Research Neurotrauma Society Report (MCRR) before and after treatment. ResultsAfter treatent, the HSS scores increased in both groups (|t| > 8.345, P < 0.001). The HSS score was significantly higher in the treatment group than in the control group (t = 4.536, P < 0.001). The d-value of HSS scores before and after treatment was significantly higher in the treatment group than in the control group (t = 3.717, P < 0.05). The rate of excellent recovery of ulnar nerve function was significantly higher in the treatment group than in the control group (χ2 = 5.975, P < 0.05). ConclusionEarly postoperative comprehensive rehabilitation could romote the recovery of elbow function and ulnar nerve injury in children and youth with supracondylar fracture of humerus complicated with ulnar nerve injury.

Research progress on the mechanical compatibility of restorative materials with dental tissue / 口腔疾病防治

@#As the main means of mastication, teeth can withstand countless functional contacts. The mechanical properties of teeth are closely related to their tissue structure. Enamel and dentin have a high hardness and modulus of elasticity, and their graded structure allows them to withstand bite forces without being susceptible to fracture. When tooth tissue is defective, full crown restoration is often needed to restore the normal shape and function of the tooth. Metal materials, ceramic materials, and polyetheretherketone (PEEK) materials are commonly used for crown restoration. Metal materials have certain disadvantages in terms of aesthetics and are relatively rarely used in clinical practice. Ceramic materials with different compositions exhibit differences in performance and aesthetics, but their elastic modulus and hardness are much higher than those of dental tissue, resulting in mismatching mechanical properties. In contrast, the elastic modulus of PEEK is lower than that of tooth tissue and similar to that of bone tissue, but its properties can be improved by fiber reinforcement. Notably, when the mechanical properties of a restoration material and tooth tissue are not fully matched, the interface between them often forms a potential weak link, which ultimately affects the stability and long-term effect of the restoration. This article introduces the mechanical properties and corresponding structural characteristics of enamel and dentin. On this basis, the advantages and limitations of existing restoration materials are analyzed, and the possibility of biomimetic design of full crowns is further explored.

Research progress on applications and mechanisms of osteogenesis effect of magnetic fields in oral field / 口腔疾病防治

@#Magnetic fields are safe and used in noninvasive physical therapies. Numerous studies have confirmed that magnetic fields have good osteogenic effects and certain value for clinical application in accelerating orthodontic tooth movement, promoting bone-implant integration, promoting fracture healing and improving the effects of distraction osteogenesis. Magnetic fields are expected to become applied as effective auxiliary methods for treating oral diseases. To support the clinical application of magnetic fields, this article reviews the applications of magnetic fields in the oral cavity, the biological effects on bone cells and the molecular mechanisms through which magnetic fields regulate bone metabolism. The biological effects of magnetic fields on bone cells include promoting osteogenesis by osteoblasts and mesenchymal stem cells and inhibiting bone resorption by osteoclasts. At the molecular level, bone cells sense and respond to magnetic stimulation, and through various mechanisms, such as displacement currents, Lorentz forces, and free radical pair effects, stimuli are transformed into biologically recognizable electrical signals that activate complex downstream signaling pathways, such as the P2 purinergic receptor signaling pathway, adenosine receptor signaling pathway, transforming growth factor-β receptor signaling pathway, mammalian target of rapamycin (mTOR) pathway, and Notch pathway. In addition, magnetic parameters, which are the factors affecting the osteogenic effects of magnetic fields, are discussed. However, the mechanisms of the osteogenic effects of magnetic fields are unclear, and further studies of these mechanisms could provide effective strategies for bone regeneration and periodontal tissue regeneration. In addition, considering the target of magnetic field therapies, combination with other drugs could lead to new strategies for the treatment of oral diseases.

A comparison of complication rates between early and delayed surgery among Filipino patients with fragility fractures of the hip

Objectives@#Existing standards of care recommend operative management for fragility fractures of the hip. Early intervention has been associated with lower incidence of morbidity and mortality. A lack of consensus remains in the Philippines however, regarding timing of surgery. We sought to determine the effects of surgical timing on in-hospital complications among Filipino patients with fragility hip fractures.@*Methods@#All patients admitted for fragility hip fractures in a single tertiary-care facility from 2014-2016 were analyzed retrospectively. Subjects treated within 72 hours were grouped under “early intervention,” while those managed beyond were designated “delayed intervention.” Primary outcomes were complications during admission, while secondary outcome was length of hospital stay. A total of 96 patients met our inclusion criteria, of which 41 (42.71%) underwent early intervention. Baseline characteristics for both groups were comparable.@*Results@#A significantly lower incidence of pressure ulcers (2.4% for ≤72hours vs 45.5%; p=<0.0001), pneumonia (7.32% vs 47.27%; p=<0.0001), and urinary tract infection (4.88% vs 40%; p=<0.0001), as well as shorter hospital stay (mean: 8.85 days±5.4 vs 14.6 days±13.3; p=0.01) were seen in the early intervention group. More cases of documented deep vein thrombosis were recorded in the delayed intervention group (83.3% versus 16.6%), as was the only case of in-hospital mortality. @*Conclusion@#Early intervention showed a significantly lower incidence of in-hospital complications among patients with fragility fractures of the hip, suggesting that surgery within 72 hours may lead to better outcomes by helping to reduce the incidence of pressure sores, pneumonia, and urinary tract infection among Filipinos with hip fractures, while reducing length of admission.

Hypoxia inducible factor-1α related mechanism and TCM intervention in process of early fracture healing / 中草药·英文版

As a common clinical disease, fracture is often accompanied by pain, swelling, bleeding as well as other symptoms and has a high disability rate, even threatening life, seriously endangering patients' physical and psychological health and quality of life. Medical practitioners take many strategies for the treatment of fracture healing, including Traditional Chinese Medicine (TCM). In the early stage of fracture healing, the local fracture is often in a state of hypoxia, accompanied by the expression of hypoxia inducible factor-1α (HIF-1α), which is beneficial to wound healing. Through literature mining, we thought that hypoxia, HIF-1α and downstream factors affected the mechanism of fracture healing, as well as dominated this process. Therefore, we reviewed the local characteristics and related signaling pathways involved in the fracture healing process and summarized the intervention of TCM on these mechanisms, in order to inspirit the new strategy for fracture healing, as well as elaborate on the possible principles of TCM in treating fractures based on the HIF molecular mechanism.

Fracturas del extremo distal del radio en el esqueleto inmaduro: estudio epidemiológico en el Centro Hospitalario Pereira Rossell / Fraturas da extremidade distal do rádio no esqueleto imaturo: estudo epidemiológico no Hospital Pereira Rossell / Fracture of the distal end of the radius in children: epidemiological study at the Pereira Rossell Hospital Center

Objetivo principal: Conocer la epidemiologia de las fracturas del cuarto distal del radio en el esqueleto en crecimiento y el tratamiento realizado en el CHPR en los años 2017 y 2018. Objetivos específicos: Valorar re-desplazamiento, necesidad de re manipulación, complicaciones, re-fractura. Metodología: Estudio observacional descriptivo retrospectivo. Criterios de inclusión: pacientes de 0 a 14 años con fractura de radio distal (fisaria, metafisaria y suprametafisaria) valorados en el CHPR entre 1 enero del 2017 y 31 diciembre del 2018. Criterios de exclusión: pacientes con radiografía normal, fracturas en miembros con malformaciones, infecciones óseas, patología tumoral maligna o benigna. Obtención de datos: Valoración de radiografías de puño y antebrazo realizadas en el CHPR en 2017 y 18, iniciales y evolutivas. Se analizaron: edad, sexo, fecha fractura, topografía de la fractura, desplazamiento inicial, tratamiento, evolución radiográfica y complicaciones. Resultados: se incluyeron 662 pacientes. Siendo en su mayoría de género masculino (65%), con una media de 9 años, miembro derecho (61%), en los meses de verano (36%). En cuanto a la topografía se evidenció una frecuencia mayor en fracturas tipo rodete y metafisarias (31.72% y 31.57%), seguido por suprametafisaria (18.43%) y fisaria (18.28%). El tratamiento realizado fue ortopédico en el 86.56% de los casos, mientras que quirúrgico fue el 12.84%, en su gran mayoría con alambres de Kirschner (11,2%). El tiempo de inmovilización promedio fue de 6 semanas, con un porcentaje de complicaciones del 14.05% del total de las fracturas. Conclusiones: Se valoraron las características de los pacientes y fracturas de radio distal en el CHPR en los años 2017 y 18, siendo un total de 662 fracturas, en las que su mayoría se realizó tratamiento ortopédico con un índice de complicaciones que ronda el 14%, siendo mayor cuanto mayor es el desplazamiento inicial de la fractura.

Objetivo principal: Conhecer a epidemiologia das fraturas do quarto distal do rádio no esqueleto em crescimento e o tratamento realizado no CHPR nos anos de 2017 e 2018. Objetivos específicos: Avaliar re-deslocamento, necessidade de remanipulação, complicações, refratura. Metodologia: Estudo observacional descritivo retrospectivo. Critérios de inclusão: pacientes de 0 a 14 anos com fratura do rádio distal (fisário, metafisário e suprametafisário) avaliados no CHPR entre 1º de janeiro de 2017 e 31 de dezembro de 2018. Critérios de exclusão: pacientes com radiografias normais, fraturas em membros com malformações, osso infecções, patologia tumoral maligna ou benigna. Coleta de dados: Avaliação das radiografias de punho e antebraço realizadas no CHPR em 2017 e 18, inicial e evolutiva. Foram analisados: idade, sexo, data da fratura, topografia da fratura, deslocamento inicial, tratamento, evolução radiográfica e complicações. Resultados: 662 pacientes foram incluídos. Sendo maioritariamente do sexo masculino (65%), com média de 9 anos, membro direito (61%), nos meses de verão (36%). Em relação à topografia, foi evidenciada maior frequência nas fraturas da borda e metafisárias (31,72% e 31,57%), seguidas das suprametafisárias (18.43%) e fisárias (18.28%). O tratamento realizado foi ortopédico em 86.56% dos casos, enquanto cirúrgico em 12.84%, sendo a maioria com fios de Kirschner (11,2%). O tempo médio de imobilização foi de 6 semanas, com percentual de complicações de 14.05%. Conclusões: Foram avaliadas as características dos pacientes e fraturas do rádio distal no CHPR nos anos de 2017 e 18, com um total de 662 fraturas (0,9 por dia), em que a maioria foi submetida a tratamento ortopédico com índice de complicações que fica em torno de 14%, sendo maior quanto maior for o deslocamento inicial da fratura.

Title: Fractures of the distal end of the radius in the immature skeleton. Epidemiological study at the Pereira Rossell Hospital Center. Main objective: To know the epidemiology of fractures of the distal fourth of the radius in the growing skeleton and the treatment carried out in the CHPR in the years 2017 and 2018. Specific objectives: To assess re-displacement, need for re-manipulation, complications, re- fracture. Methodology: Retrospective descriptive observational study. Inclusion criteria: patients aged 0 to 14 years with distal radius fracture (physeal, metaphyseal and suprametaphyseal) evaluated at the CHPR between January 1, 2017 and December 31, 2018. Exclusion criteria: patients with normal radiographs, fractures in limbs with malformations, bone infections, malignant or benign tumor pathology. Data collection: Assessment of fist and forearm X-rays performed at the CHPR in 2017 and 18, initial and evolutionary. The following were analyzed: age, sex, fracture date, fracture topography, initial displacement, treatment, radiographic evolution and complications. Results: 662 patients were included. Being mostly male (65%), with an average of 9 years, right limb (61%), in the summer months (36%). Regarding the topography, a higher frequency was evidenced in rim and metaphyseal fractures (31.72% and 31.57%), followed by suprametaphyseal (18.43%) and physeal (18.28%). The treatment performed was orthopedic in 86.56% of the cases, while surgical was 12.84%, mostly with Kirschner wires (11.2%). The average immobilization time was 6 weeks, with a percentage of complications of 14.05%. Conclusions: The characteristics of the patients and fractures of the distal radius in the CHPR in the years 2017 and 18 were evaluated, with a total of 662 fractures (0.9 per day), in which the majority underwent orthopedic treatment with an index of complications that is around 14%, being greater the greater the initial displacement of the fracture.

Situaciones transoperatorias en pacientes pediátricos con fractura supracondílea del húmero

Introducción: Las fracturas supracondíleas del húmero en el niño, por lo general, son tratadas de manera quirúrgica, durante esa intervención se pueden presentar situaciones específicas en este tipo de enfermos. Objetivo: Actualizar y brindar información sobre algunas de las situaciones transoperatorias en pacientes con fractura supracondílea del húmero. Métodos: La búsqueda y análisis de la información se realizó en un periodo de 61 días (primero de septiembre al 31 de octubre de 2022) y se emplearon palabras de búsqueda relacionadas con la investigación. A partir de la información obtenida, se realizó una revisión bibliográfica de un total de 245 artículos publicados en las bases de datos: PubMed, Hinari, SciELO y Medline, mediante el gestor de búsqueda y administrador de referencias EndNote, de ellos, se utilizaron 29 citas seleccionadas para realizar la revisión, 28 de los últimos cinco años. Resultados: Se hace referencia a cuatro de las situaciones transoperatorias más frecuentes en este tipo de fractura. Se mencionan la conminución de la pared medial, como identificar esta situación y su conducta. En relación a las lesiones asociadas, se recomienda primero estabilizar el antebrazo y luego la fractura supracondílea. Para las fracturas inestables en flexión se recomienda la técnica a emplear. Por su parte, la conversión de la reducción cerrada a abierta está justificada en ciertas circunstancias que de forma detallada se describen en el trabajo. Conclusiones: Las fracturas supracondíleas del húmero en el niño son tratadas en su mayoría mediante tratamiento quirúrgico. Durante el transoperatorio se pueden presentar situaciones para las cuales el médico tratante debe estar preparado.

Introduction: Supracondylar fractures of the humerus in children are generally treated surgically, during surgery intervention may occur specific situations in this type of patient. Objective: To update and provide information on some of the intraoperative situations in patients with supracondylar fracture of the humerus. Methods: The search and analysis of the information was carried out in a period of 61 days (September 1st to October 31st, 2022) and search words related to the investigation were used. Based on the information obtained, a bibliographic review of a total of 245 articles published in the PubMed, Hinari, SciELO and Medline databases was carried out using the EndNote search manager and reference administrator, of which 29 selected citations were used to carry out the review, 28 of the last five years. Results: Reference is made to four of the most frequent intraoperative situations in this type of fracture. Comminution of the medial wall, how to identify this situation and its behavior are mentioned. In relation to associated injuries, it is recommended to first stabilize the forearm and then the supracondylar fracture. For unstable fractures in flexion, the technique to be used is recommended. For its part, the conversion from closed to open reduction is justified in certain circumstances that are described in the article. Conclusions: Supracondylar fractures of the humerus in children are mostly treated by surgical treatment. During the trans-operative period situations may arise for which the treating physician must be prepared.

Long-term consequences of osteoporosis therapy with bisphosphonates

ABSTRACT Bisphosphonates (BPs) are medications widely used in clinical practice to treat osteoporosis and reduce fragility fractures. Its beneficial effects on bone tissue have been consolidated in the literature for the last decades. They have a high affinity for bone hydroxyapatite crystals, and most bisphosphonates remain on the bone surface for a long period of time. Benefits of long-term use of BPs: Large and important trials (Fracture Intervention Trial Long-term Extension and Health Outcomes and Reduced Incidence with Zoledronic acid Once Yearly-Pivotal Fracture Trial) with extended use of alendronate (up to 10 years) and zoledronate (up to 6 years) evidenced significant gain of bone mineral density (BMD) and vertebral fracture risk reduction. Risks of long-term use of BPs: The extended use of antiresorptive therapy has drawn attention to two extremely rare, although severe, adverse events. That is, atypical femoral fracture and medication-related osteonecrosis of the jaw are more common in patients with high cumulative doses and longer duration of therapy. BPs have demonstrated safety and effectiveness throughout the years and evidenced increased BMD and reduced fracture risks, resulting in reduced morbimortality, and improved quality of life. These benefits overweight the risks of rare adverse events.

Retrospective clinical study of hip replacement in the treatment of traumatic arthritis secondary to acetabular fracture / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of total hip replacement (THA) in the treatment of traumatic arthritis secondary to acetabular fracture.@*METHODS@#From October 2019 to June 2022, 15 patients with secondary traumatic arthritis of acetabulum fracture were treated with THA. There were 8 males and 7 females, aged from 40 to 76 years old with an average of (59.20±9.46) years old. Prosthesis loosening, dislocation of hip joint, range of motion of hip joint, nerve injury and other conditions were recorded before and after surgery. Harris score, visual analogue scale (VAS) and imaging were used to evaluate hip joint function and surgical effect.@*RESULTS@#Follow-up time ranged 6 to 39 months with an average of (18.33±9.27) months. All the 15 patients successfully completed the operation, no nerve and blood vessel injury during the operation, postoperative wound healing was stageⅠ, no infection, one case of acetabular side prosthesis loosening at half a year after operation, and recovered well after revision surgery, one case of hip dislocation was cured after open reduction treatment, no adverse consequences. Harris score at the last postoperative follow-up was (88.60±4.01) points, compared with the preoperative (47.20±11.77) points, the difference was statistically significant (P<0.05), and VAS at the lateat postoperative follow-up was 1 (1) points, compared with the preoperative 8 (2) points, the difference was statistically significant (P<0.05). At the last follow-up, the pain symptoms were relieved or disappeared, and the joint function was satisfactory. The imaging data of the latest follow-up showed joint was well pseudoradiated, no abnormal ossification occurred, and the prosthesis was not loose.@*CONCLUSION@#THA is effective in the treatment of traumatic arthritis secondary to acetabular fracture and can effectively improve the quality of life of patients. Preoperative comprehensive evaluation and bone defect evaluation of patients, and intraoperative management of acetabulum, femur, internal fixation and bone defect are key factors for the success of surgery.

Meta-analysis of the role of fibular fixation in tibiofibular fractures / 中国骨伤

OBJECTIVE@#To compare the role and importance of fibular fixation in tibiofibular fractures by Meta-analysis.@*METHODS@#The literature related to the comparison of the efficacy of fixation of the fibula with or without fixation on the treatment of tibiofibular fractures was searched through the databases of China Knowledge Network, Wipu, Wanfang, The Cochrane Library, Web of science and Pubmed, and statistical analysis was performed using RevMan 5.3 software. The rates of malrotation, rotational deformity, internal/external deformity, anterior/posterior deformity, non-union, infection, secondary surgery and operative time were compared between the fibula fixation and non-fixation groups.@*RESULTS@#A total of 11 publications were included, six randomised controlled trials and five case-control trials, eight of which were of high quality. A total of 813 cases were included, of which 383 were treated with fibula fixation and 430 with unfixed fibulae.Meta-analysis results showed that fixation of the fibulae in the treatment of tibiofibular fractures reduced the rates of postoperative rotational deformity[RR=0.22, 95%CI(0.10, 0.45), P<0.000 1] and internal/external deformity[RR=0.34, 95%CI(0.14, 0.84), P=0.02] and promoted fracture healing [RR=0.76, 95%CI(0.58, 0.99), P=0.04]. In contrast, the rates of poor reduction [RR=0.48, 95% CI(0.10, 2.33), P=0.36], anterior/posterior deformity[RR=1.50, 95%CI(0.76, 2.96), P=0.24], infection[RR=1.43, 95%CI(0.76, 2.72), P=0.27], secondary surgery[RR=1.32, 95%CI(0.82, 2.11), P=0.25], and operative time[MD=10.21, 95%CI(-17.79, 38.21), P=0.47] were not statistically significant (P>0.05) for comparison.@*CONCLUSION@#Simultaneous fixation of the tibia and fibula is clinically more effective in the treatment of tibiofibular fractures.

Finite element analysis of the stability of Mason type Ⅲ radial head fracture fixed with three cross-bridge headless compression screw and locking plate / 中国骨伤

OBJECTIVE@#To compare the biomechanical stability of three cross-bridge headless compression screws and locking plates in the fixation of Mason type Ⅲ radial head fractures by finite element method.@*METHODS@#Using reverse modeling technology, the radial CT data and internal fixation data of a healthy 25-year-old male were imported into the relevant software. Three-dimensional finite element model of 3 cross-bridge headless compression screws and locking plates for MasonⅢ radial head fractures were established, and the radial head was loaded with 100 N axial loading. The maximum displacement, maximum Von Mises stress and stress distribution of the two groups were compared.@*RESULTS@#The maximum displacements of the three cross-bridge screws group and locking plate group were 0.069 mm and 0.087 mm respectively, and the Von Mises stress peaks were 18.59 MPa and 31.85 MPa respectively. The stress distribution of the three screws group was more uniform.@*CONCLUSION@#Both internal fixation methods can provide good fixation effect. CoMPared with the locking plate fixation method, the 3 cross-bridge headless compression screws fixation is more stable and the stress distribution is more uniform.

Clinical study of modified suspension reduction method combined with percutaneous vertebroplasty in the treatment of thoracolumbar osteoporotic compression fracture / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of modified suspension reduction method combined with percutaneous vertebroplasty in the treatment of osteoporotic thoracolumbar compression fractures.@*METHODS@#From February 2020 to October 2021, 92 patients with thoracolumbar osteoporotic compression fracture were treated by percutaneous vertebroplasty. According to different treatment methods, they were divided into the observation group and the control group. The observation group was treated with modified suspension reduction and then percutaneous vertebroplasty, while the control group was treated with percutaneous vertebroplasty alone. The observation group (47 cases), including 20 males and 27 females, the age ranged from 59 to 76 years old with an average of (69.74±4.50) years old, fractured vertebral bodies:T10(2 cases), T11(7 cases), T12(19 cases), L1(14 cases), L2(5 cases);the control group(45 cases), including 21 males and 24 females, the age ranged from 61 to 78 years old with an average of (71.02±3.58) years old, fractured vertebral bodies:T10(3 cases), T11(8 cases), T12(17 cases), L1(12 cases), L2(5 cases);The leakage of bone cement were observed, the visual analogue scale (VAS), Oswestry lumbar dysfunction index (ODI), anterior vertebrae height (AVH), Cobb angle of kyphosis and the amount of bone cement injected before and after operation were recorded and compared between the two groups.@*RESULTS@#All patients were followed up, ranged from 6 to10 with an average of (8.45±1.73) months. Two patients ocurred bone cement leakage in observation group and 3 patients in control group. AVH of observation group increased (P<0.05) and Cobb angle of injured vertebrae decreased (P<0.05). Cobb angle of injured vertebrae and AVH of the control group were not significantly changed (P>0.05). Cobb angle of injured vertebrae of the observation group was lower than that of control group (P<0.05) and AVH was higher than that of the control group (P<0.05). In the observation group, VAS before operation and 1 week, 3 and 6 months after operation respectively were(7.32±1.05) scores, (3.56±1.18) scores, (1.83±0.67) scores, (1.27±0.34) scores, and ODI were(40.12±14.69) scores, (23.76±10.19) scores, (20.15±6.39) scores, (13.45±3.46) scores. In the control group, VAS before operation and 1 week, 3 and 6 months after operation respectively were(7.11±5.26) scores, (3.82±0.68) scores, (1.94±0.88) scores, (1.36±0.52) scores, and ODI were(41.38±10.23) scores, (25.13±14.22) scores , (20.61±5.82) scores, (14.55±5.27) scores . The scores of VAS and ODI after operation were lower than those before operation (P<0.05), but there was no significant difference between the two groups (P<0.05).@*CONCLUSION@#Modified suspension reduction method combined with PVP surgery for osteoporotic thoracolumbar compression fractures has achieved good clinical results, which can effectively relieve lumbar back pain, restore vertebral height, correct kyphosis, improve lumbar function and patients' quality of life.

Application value of bone cement containing rhbFGF and RHBMP-2 in PKP treatment of osteoporotic lumbar compression fracture / 中国骨伤

OBJECTIVE@#To investigate the effect of bone cement containing recombinant human basic fibroblast growth factor (rhbFGF) and recombinant human bone morphogenetic protein-2 (rhBMP-2) in percutaneous kyphoplasty(PKP)treatment of osteoporotic vertebral compression fracture(OVCF).@*METHODS@#A total of 103 OVCF patients who underwent PKP from January 2018 to January 2021 were retrospectively analyzed, including 40 males and 63 females, aged from 61 to 78 years old with an average of (65.72±3.29) years old. The injury mechanism included slipping 33 patients, falling 42 patients, and lifting injury 28 patients. The patients were divided into three groups according to the filling of bone cement. Calcium phosphate consisted of 34 patients, aged(65.1±3.3) years old, 14 males and 20 females, who were filled with calcium phosphate bone cement. rhBMP-2 consisted of 34 patients, aged (64.8±3.2) years old, 12 males and 22 females, who were filled with bone cement containing rhBMP-2. And rhbFGF+rhBMP-2 consisted of 35 patients, aged (65.1±3.6) years old, 14 males and 21 females, who were filled with bone cement containing rhbFGF and rhBMP-2. Oswestry disability index (ODI), bone mineral density, anterior edge loss height, anterior edge compression rate of injured vertebra, visual analog scale (VAS) of pain, and the incidence of refracture were compared between groups.@*RESULTS@#All patients were followed for 12 months. Postoperative ODI and VAS score of the three groups decreased (P<0.001), while bone mineral density increased (P<0.001), anterior edge loss height, anterior edge compression rate of injured vertebra decreased first and then slowly increased (P<0.001). ODI and VAS of group calcium phosphate after 1 months, 6 months, 12 months were lower than that of rhBMP-2 and group rhbFGF+rhBMP-2(P<0.05), bone mineral density after 6 months, 12 months was higher than that of rhBMP-2 and group calcium phosphate(P<0.05), and anterior edge loss height, anterior edge compression rate of injured vertebra of group rhbFGF+rhBMP-2 after 6 months and 12 months were lower than that of group rhBMP-2 and group calcium phosphate(P<0.05). There was no statistical difference in the incidence of re-fracture among the three groups (P>0.05).@*CONCLUSION@#Bone cement containing rhbFGF and rhBMP-2 could more effectively increase bone mineral density in patients with OVCF, obtain satisfactory clinical and radiological effects after operation, and significantly improve clinical symptoms.

Improved unilateral puncture PVP based on 3D printing technology for the treatment of osteoporotic vertebral compression fracture / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of unilateral percutaneous vertebroplasty (PVP) combined with 3D printing technology for the treatment of thoracolumbar osteoporotic compression fracture.@*METHODS@#A total of 77 patients with thoracolumbar osteoporotic compression fractures from October 2020 to April 2022 were included in the study, all of which were vertebral body compression fractures caused by trauma. According to different treatment methods, they were divided into experimental group and control group. Thirty-two patients used 3D printing technology to improve unilateral transpedicle puncture vertebroplasty in the experimental group, there were 5 males and 27 females, aged from 63 to 91 years old with an average of (77.59±8.75) years old. Forty-five patients were treated with traditional bilateral pedicle puncture vertebroplasty, including 7 males and 38 females, aged from 60 to 88 years old with an average of(74.89±7.37) years old. Operation time, intraoperative C-arm X-ray times, anesthetic dosage, bone cement injection amount, bone cement diffusion good and good rate, complications, vertebral height, kyphotic angle (Cobb angle), visual analogue scale(VAS), Oswestry disability index (ODI) and other indicators were recorded before and after surgery, and statistically analyzed.@*RESULTS@#All patients were followed up for 6 to 23 months, with preoperative imaging studies, confirmed for thoracolumbar osteoporosis compression fractures, two groups of patients with postoperative complications, no special two groups of patients' age, gender, body mass index (BMI), time were injured, the injured vertebral distribution had no statistical difference(P>0.05), comparable data. Two groups of patients with bone cement injection, bone cement dispersion rate, preoperative and postoperative vertebral body height, protruding after spine angle(Cobb angle), VAS, ODI had no statistical difference(P>0.05). The operative time, intraoperative fluoroscopy times and anesthetic dosage were statistically different between the two groups(P<0.05). Compared with the traditional bilateral puncture group, the modified unilateral puncture group combined with 3D printing technology had shorter operation time, fewer intraoperative fluoroscopy times and less anesthetic dosage. The height of anterior vertebral edge, kyphosis angle (Cobb angle), VAS score and ODI of the affected vertebrae were statistically different between two groups at each time point after surgery(P<0.05).@*CONCLUSION@#In the treatment of thoracolumbar osteoporotic compression fractures, 3D printing technology is used to improve unilateral puncture PVP, which is convenient and simple, less trauma, short operation time, fewer fluoroscopy times, satisfactory distribution of bone cement, vertebral height recovery and kyphotic Angle correction, and good functional improvement.

Research progress on mechanism of traumatic brain injury promoting fracture healing / 中国修复重建外科杂志

OBJECTIVE@#To summarize the research progress on the mechanism related to traumatic brain injury (TBI) to promote fracture healing, and to provide theoretical basis for clinical treatment of fracture non-union.@*METHODS@#The research literature on TBI to promote fracture healing at home and abroad was reviewed, the role of TBI in fracture healing was summarized from three aspects of nerves, body fluids, and immunity, to explore new ideas for the treatment of fracture non-union.@*RESULTS@#Numerous studies have shown that fracture healing is faster in patients with fracture combined with TBI than in patients with simple fracture. It is found that the expression of various cytokines and hormones in the body fluids of patients with fracture and TBI is significantly higher than that of patients with simple fracture, and the neurofactors released by the nervous system reaches the fracture site through the damaged blood-brain barrier, and the chemotaxis and aggregation of inflammatory cells and inflammatory factors at the fracture end of patients with combined TBI also differs significantly from those of patients with simple fracture. A complex network of humoral, neural, and immunomodulatory networks together promote regeneration of blood vessels at the fracture site, osteoblasts differentiation, and inhibition of osteoclasts activity.@*CONCLUSION@#TBI promotes fracture healing through a complex network of neural, humoral, and immunomodulatory, and can treat fracture non-union by intervening in the perifracture microenvironment.