Comparación Placas de Titanio vs. Placas Reabsorbibles en Fracturas de Orbita: Revisión de literatura / Comparison of Titanium Plates vs. Resorbable Plates in Orbital Fractures: Literature Review

RESUMEN Introducción: Los tratamientos para fracturas de órbita se basan en la corrección del defecto de las lesiones orbitarias de tipo blow in y blow out (o de estallido), mediante diversas placas y mallas biocompatibles con el organismo, dándose una cicatrización de primera generación evitando un callo óseo y una fijación más rígida. Para el diagnóstico de este tipo de lesiones tenemos inflamación periorbitaria, enoftalmos, diplopía, equimosis, hemorragia subconjuntival. Existen diversos materiales reconstructivos siendo estos compuestos por distintas materias primas, como son los aloplásticos y autógenos; donde encontramos varios tipos como placas de titanio y las placas reabsorbibles siendo estas las más comunes y usadas actualmente, por su bajo estímulo a reabsorciones óseas y evitando efectos secundarios a largo plazo. Estas placas presentan diversos grados de ductilidad y resistencia. Se informó sobre varias complicaciones según el tipo de placas como es la cicatrización, las cirugías postquirúrgicas en caso de placas de titanio, etc. El objetivo de esta revisión es la evaluación de la eficacia las placas reabsorbibles versus placas de titanio en fracturas de órbita. Materiales y métodos: La investigación es de carácter documental, descriptivo y no experimental. En el cual se emplea una metodología de identificación e inclusión de artículos científicos tipo prisma. Resultados y conclusiones: Se verificaron las ventajas y desventajas tanto de las placas reabsorbibles como las de titanio siendo estas similares en la biocompatibilidad con el organismo humano, así como también varias diferencias como el soporte, fuerzas, resistencia de estas, concluyendo que es debatible el material ideal para tratar fracturas de órbita. Se seleccionaron artículos tomando en cuenta el título y objetivos; considerando estudios comparativos, revisiones sistemáticas, revisiones de literatura, los cuales comprendían criterios con respecto a fracturas de órbita y tratamientos quirúrgicos. La búsqueda arrojó 55 artículos en PubMed, 65 en Google, 4 en Scielo y 29 en Science direct, de los cuales se excluyeron libros, monografías, estudios experimentales, dando como resultado 21 artículos para el desarrollo de esta revisión bibliográfica. Y que fueron leídos y analizados en su totalidad, estudiando los objetivos, metodología y conclusión de cada uno de ellos para la posterior comparación.

ABSTRACT Introduction: Treatments for orbit fractures are based on the correction of the defect of blow in and blow out orbital injuries, by means of various plates and meshes biocompatible with the organism, giving a first-generation healing avoiding a bony callus and a more rigid fixation. For the diagnosis of this type of lesions we have periorbital inflammation, enophthalmos, diplopia, ecchymosis, subconjunctival hemorrhage. There are several reconstructive materials being these composed of different raw materials, such as alloplastic and autogenous, where we find several types such as titanium plates and resorbable plates being these the most common and currently used, for its low stimulus to bone resorption and avoiding long-term side effects. These plates have different degrees of ductility and resistance. Several complications have been reported depending on the type of plates, such as scarring, post-surgical surgeries in the case of titanium plates, etc. The objective of this review is to evaluate the efficacy of resorbable versus titanium plates in orbital fractures. Materials and methods: This research are a documentary, descriptive and non-experimental nature. A prism-type methodology of identification and inclusion of scientific articles was used. Results and conclusions: The advantages and disadvantages of both resorbable and titanium plates were verified, being these similar in biocompatibility with the human organism, as well as several differences such as support, forces, resistance of the same, concluding that it is debatable. The ideal material to treat orbital fractures. Articles were selected considering the title and objectives; considering comparative studies, systematic reviews, literature reviews, which included criteria regarding orbital fractures and surgical treatments. The search yielded 55 articles in PubMed, 65 in Google, 4 in Scielo and 29 in Science direct, from which books, monographs, experimental studies were excluded, resulting in 21 articles for the development of this bibliographic review. The 21 articles were read and analyzed in their entirety, studying the objectives, methodology and conclusion of each one of them for subsequent comparison.

Removal Rate of the Tomofix® System after High Tibial Osteotomy is Higher Than Reported / A taxa de remoção do sistema Tomofix® após a osteotomia tibial alta é superior à relatada

Abstract Objective Medial open wedge high tibial osteotomy (MOWHTO) significantly relieves pain in the medial joint line in medial compartment osteoarthritis of the knee. But some patients complain of pain over the pes anserinus even 1 year after the osteotomy, which may require implant removal for relief. This study aims to define the implant removal rate after MOWHTO due to pain over the pes anserinus. Methods One hundred and three knees of 72 patients who underwent MOWHTO for medial compartment osteoarthritis between 2010 and 2018 were enrolled in the study. Knee injury and osteoarthritis outcome score (KOOS), Oxford knee score (OKS), and visual analogue score (VAS) were assessed for pain in the medial knee joint line (VAS-MJ) preoperatively, 12 months postoperatively, and yearly thereafter; adding VAS for pain over the pes anserinus (VAS-PA). Patients with VAS-PA ≥ 40 and adequate bony consolidation after 12 months were recommended implant removal. Results Thirty-three (45.8%) of the patients were male and 39 (54.2%) were female. The mean age was 49.4 ± 8.0 and the mean body mass index was 27.0 ± 2.9. The Tomofix medial tibial plate-screw system (DePuy Synthes, Raynham, MA, USA) was used in all cases. Three (2.8%) cases with delayed union requiring revision were excluded. The KOOS, OKS, and VAS-MJ significantly improved 12 months after MOWHTO. The mean VAS-PA was 38.3 ± 23.9. Implant removal for pain relief was needed in 65 (63.1%) of the103 knees. The mean VAS-PA decreased to 4.5 ± 5.6 3 months after implant removal (p < 0.0001). Conclusion Over 60% of the patients may need implant removal to relieve pain over the pes anserinus after MOWHTO. Candidates for MOWHTO should be informed about this complication and its solution.

Resumo Objetivo A osteotomia tibial alta com cunha de abertura medial (MOWHTO, do inglês medial open wedge high tibial osteotomy) alivia de forma significativa a dor na linha articular medial em casos de osteoartrite do compartimento medial do joelho. Alguns pacientes, porém, se queixam de dor nos tendões dos músculos sartório, grácil e semitendinoso (pata de ganso) mesmo 1 ano após a osteotomia, o que pode exigir a remoção do implante. Este estudo define a taxa de remoção do implante após a MOWHTO devido à dor nos tendões dos músculos sartório, grácil e semitendinoso. Métodos Cento e três joelhos de 72 pacientes submetidos à MOWHTO para tratamento da osteoartrite do compartimento medial entre 2010 e 2018 foram incluídos no estudo. A pontuação de desfecho de lesão no joelho e osteoartrite (KOOS, do inglês Knee Injury and Osteoarthritis Outcome Score), a pontuação dejoelho de Oxford (OKS, do inglês Oxford Knee Score) e a escala visual analógica (EVA) de dor na linha articular medial do joelho (EVA-MJ) foram avaliados antes da cirurgia. A EVA nos tendões dos músculos sartório, grácil e semitendinoso (EVA-PA) foi adicionada a essas avaliações, também realizadas 12 meses após o procedimento e, a seguir, anualmente. A remoção do implante foi recomendada em pacientes com EVA-PA ≥ 40 e consolidação óssea adequada em 12 meses. Resultados Trinta e três (45,8%) pacientes eram homens e 39 (54,2%), mulheres. A média de idade foi de 49,4 ±8,0, e o índice de massa corpórea (IMC) médio foi de 27,0 ± 2,9. O sistema placa-parafuso tibial medial Tomofix (DePuy Synthes, Raynham, MA, EUA) foi utilizado em todos os casos. Três (2,8%) casos foram excluídos devido ao retardo de consolidação e à necessidade de revisão. Os resultados nas escalas KOOS, OKS e EVA-MJ melhoraram significativamente 12 meses após a MOWHTO. A EVA-PA média foi de 38,3 ± 23,9. A remoção do implante para alívio da dor foi necessária em 65 (63,1%) dos 103 joelhos. Três meses após a remoção do implante, a EVA-PA média diminuiu para 4,5 ± 5,6 (p < 0,0001). Conclusão A remoção do implante pode ser necessária em mais de 60% dos pacientes para alívio da dor nos tendões dos músculos sartório, grácil e semitendinoso após a MOWHTO. Os candidatos à MOWHTO devem ser informados sobre esta complicação e sua resolução.

Masquelet induced membrane technique combined with an external locking plate for treatment of infectious bone defects of the tibia / 中华创伤骨科杂志

Objective:To investigate the efficacy of Masquelet induced membrane technique combined with an external locking plate in the treatment of infectious bone defects of the tibia.Methods:A retrospective study was conducted to analyze the data of 32 patients with infectious bone defects of the tibia who had been treated by Masquelet induced membrane technique combined with an external locking plate at Department of Orthopaedic Surgery, The Fourth Hospital of Wuhan from January 2011 to January 2021. There were 22 males and 10 females, with an age of (43.2±13.1) years. The length of bone defects was (5.1±1.3) cm. By the Cierny-Mader classification, there were 12 cases of type Ⅲ and 20 cases of type Ⅳ. The defects were located at the proximal tibia in 11 cases, at the middle tibia in 12, and at the distal tibia in 9. At the last follow-up, the lower limb function was evaluated by the Paley scale, and the quality of life by the 36-Item Short Form Health Survey (SF-36).Results:All the 32 patients were followed up for (21.2±5.7) months. Normal healing was achieved in 30 cases but delayed healing occurred in 2 cases. The external plate and screws were removed at (23.1±4.6) weeks after operation. There was no infection in the original surgical incision or no injury to the nerve, blood vessel or tendon after operation, but nail tract infection occurred more or less in 3 cases. According to the Paley scale at the last follow-up, the lower limb function was evaluated as excellent in 22 cases, as good in 8, and as fair in 2, giving an excellent and good rate of 93.75% (30/32). The SF-36 quality of life score was (88.9±3.8) points.Conclusion:In the treatment of infectious bone defects of the tibia, Masquelet induced membrane technique combined with an external locking plate can achieve satisfactory clinical outcomes due to its effective control of infection, reduction in delayed healing, good stability and good patient tolerance.

The pubic symphysis orthotic compression anatomic plate for treatment of fractures and dislocations around the pubic symphysis / 中华创伤骨科杂志

Objective:To evaluate our self-designed pubic symphysis orthotic compression anatomic plate (PSOCAP) in the treatment of fractures and dislocations around the pubic symphysis.Methods:A retrospective study was conducted to analyze the 16 patients with fracture or dislocation around the pubic symphysis who had been treated by our self-designed PSOCAP at Department of Traumatic Surgery, Center for Orthopaedic Surgery, The Third Hospital Affiliated to Southern Medical University from January 2021 to June 2022. There were 8 males and 8 females with an age of (41±19) years. According to the Tile classification for pelvic fractures, there were 3 cases of type B1, 2 cases of type B3, 1 case of type C1.2, 4 cases of type C1.3, 3 cases of type C2, and 3 cases of type C3. There were 8 cases of pubic symphysis separation and 8 fractures of the pubic ramus (2 ones at Nakatani zone Ⅰ and 6 ones at Nakatani zone Ⅱ). Time from injury to surgery was 16 (11, 53) days, ranging from 4 to 348 days. The fractures or dislocations around the pubic symphysis were exposed by the modified Stoppa approach, reduced with the assistance of PSOCAP and fixated with PSOCAP; the posterior pelvic ring was reduced and fixated by corresponding surgical methods. Recorded were the surgical time, intraoperative bleeding, postoperative quality of fracture reduction, surgical complications, and functional recovery at the last follow-up concerning the pelvic anterior ring.Results:Surgery went on successfully in the 16 patients. Their surgical time was (58±15) min, ranging from 40 to 90 min, and their intraoperative bleeding 85 (63, 150) mL, ranging from 50 to 250 mL. According to the Matta scoring, the fracture reduction was evaluated as excellent in 10 cases, as good in 3 cases and as fair in 3 cases. The (10±3)-month follow-up for the 16 patients revealed complete fracture union for all after (12±2) weeks. According to the Majeed scoring at the last follow-up, the pelvic function was evaluated as excellent in 5 cases, as good in 7 cases, and as fair in 4 cases. No such postoperative complications as fracture displacement or internal fixation failure occurred.Conclusion:Owing to the biplane and integrated structure, our self-designed PSOCAP can help reduce the fractures or dislocations around the pubic symphysis to achieve anatomical reduction and strong internal fixation, leading to good clinical efficacy.

Anterior percutaneous minimally invasive internal fixation with proximal humerus internal locking system inverted versus with a posterior single plate for distal humeral shaft fractures / 中华创伤骨科杂志

Objective:To compare the clinical effects between proximal humerus internal locking system (PHILOS) inverted and a posterior single plate in the anterior percutaneous minimally invasive internal fixation for distal humeral shaft fractures.Methods:A retrospective study was conducted to analyze the data of 65 patients with distal humeral shaft fracture who had been treated from January 2018 to May 2021 at Department of Orthopaedics, The Second Hospital of Fuzhou. The patients were assigned into 2 groups according to different treatment methods. In the observation group of 30 cases subjected to anterior percutaneous minimally invasive internal fixation with PHILOS inverted: 20 males and 10 females with an age of (41.5±11.6) years; type A in 5 cases, type B in 14 cases, and type C in 11 cases by AO fracture classification. In the control group of 35 cases subjected to anterior percutaneous minimally invasive internal fixation with a posterior single plate: 23 males and 12 females with an age of (39.9±11.2) years; type A in 7 cases, type B in 17 cases, and type C in 11 cases by AO fracture classification. The preoperative general data, operation time, intraoperative blood loss, total incision length, fracture healing time, and shoulder and elbow VAS scores, Constant-Murley shoulder function score, Mayo elbow performance score (MEPS), and complications at the last follow-up were recorded and compared between the 2 groups.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). There were no significant differences either in operation time, fracture healing time, or shoulder or elbow VAS pain score, Constant-Murley shoulder function score, or MEPS at the last follow-up between the 2 groups ( P>0.05). The intraoperative blood loss was (59.7±26.6) mL in the observation group and (165.7±86.4) mL in the control group, and the total incision length was (10.7±2.1) cm in the observation group and (18.6±2.7) cm in the control group, showing statistically significant differences between the 2 groups ( P<0.01). There was no injury to the radial nerve or musculocutaneous nerves, incision infection or fracture nonunion in the observation group. There were 4 cases of iatrogenic radial nerve injury, 2 cases of incision infection and 1 case of fracture nonunion in the control group, yielding a complication rate of 20.0% (7/35). The difference in the incidence of complications was significant between the 2 groups ( P<0.01). Conclusion:In the treatment of distal humeral shaft fracture with anterior percutaneous minimally invasive internal fixation, PHILOS inverted has advantages of less soft tissue damage, less intraoperative bleeding, and a lower risk of iatrogenic radial nerve injury than the posterior single plate.

Design of an anatomic plate of ulna coronoid process by 3D printing and computer software / 中华创伤骨科杂志

Objective:To design an anatomical plate of ulna coronoid process using 3D printing and computer model design software based on a collection of CT scanning data of the ulna coronoid process.Methods:The CT scans of the elbow joint with no obvious anatomic variation, no fracture, or no history of elbow operation were collected which had been taken at Trauma Center, The First Affiliated Hospital of Kunming Medical University from September 2017 to January 2022. There were 52 males and 50 females. RadiAnt DICOM Viewer and Mimics Medical 21.0 were used to visualize the CT data of the elbow joint of 102 volunteers. The software was used to measure the angle between the tip of the ulna coronoid process and the tuberosity of the ulna, the width at 1/2 height of the ulna coronoid process, the distance between the tip of the ulna coronoid process and the horizontal plane of the ulna tuberosity, and the safety angle for screw placement. After the values were measured, Siemens Ungraphics NX12.0 software was used to design the anatomical plate and the screw guide device of the ulna coronoid process. After the plate model was designed, a 1:1 actual plate model of the ulna coronoid process was produced by 3D printing. The actual plate model was placed onto an adult model of the ulna coronoid process and an adult cadaveric specimen of the ulna coronoid process to verify its matching degree. An in vitro operation was simulated using the plate model to verify its operability. Results:There were no significant differences between the left and right sides in the angle between the tip of the ulna coronoid process and the tuberosity of the ulna, the width at 1/2 height of the ulna coronoid process, the distance between the tip of the ulna coronoid process and the horizontal plane of the ulna tuberosity, or the safety angle for screw placement in either males or females ( P>0.05). There were no significant differences between males and females in the angle between the tip of the ulna coronoid process and the tuberosity of the ulna or in the safety angle for screw placement ( P>0.05). There were statistically significant differences between males and females in the width of 1/2 height of the ulna coronoid process and the distance between the tip of the ulna coronoid process and the horizontal plane of the ulna tuberosity ( P<0.05). However, the experiments on computer simulative adaptation and plate model simulative adaptation found that the anatomical plates of the ulna coronoid process designed on various parameters of males and females were exchangeable, leading to similarly good marching degrees and safe angles for screw placement. Conclusions:The anatomical plate of the ulna coronoid process designed in this study demonstrates a good fit and a safe angle for screw placement, basically achieving the goal expected to provide a basis for fabrication of a titanium alloy plate. In design of an anatomical plate of ulna coronoid process, it is not necessary to differentiate males from females or to differentiate the left side from the right one, because only a general plate can be used for both males and females and for both the left and the right sides.

Fixation of Mallet Fractures Using a Modified Hook Plate Technique: A Prospective Case Series of 17 Patients / Fixação de fraturas em martelo com técnica de placa de gancho modificada: Uma série de casos prospectivos de 17 pacientes

Abstract Objective Various modalities have been suggested to manage mallet fractures; however, inappropriate treatment can lead to extension lag, a swan neck deformity, or arthritis of the distal interphalangeal joint (DIPJ). The current study aimed to evaluate the results (functional, radiological, and complications) of open reduction and internal fixation (ORIF) of mallet fractures using low-cost hook plates fabricated from low-profile titanium mini plates. Methods A prospective case series of 17 consecutive patients (average age of 32.3 years) with mallet fractures (six were Wehbe Type IB and 11 were Wehbe Type MB). Eleven (64.7%) were males. The affected hand was dominant in all patients, and the affected digit was the index in 6 (35.3%), the ring in 5 (29.4%), the small in 3 (17.65%), and the middle in 3 (17.65%) patients. The same fellowship-trained hand surgeon performed all surgeries. Results The average operative time was 37.65 minutes. After an average follow-up of 10.94 months (range 6-27), the average DIPJ motion was 50º º (range 20º-70º), the extensor lag was noted in 4 (23.5%) patients, and complications were reported in 6 (35.29%) patients. According to Crawford criteria, 6 (35.3%) patients achieved excellent results, 7 (41.2%) achieved good results, and 4 (23.5%) achieved fair results. Conclusion The modified hook plate technique for fixation of mallet fractures is a beneficiai, economical, yet demanding technique that adequately provides stable fixation to allow early DIPJ motion with acceptable functional outcomes.

Resumo Objetivo Diversas modalidades têm sido sugeridas para o tratamento de fraturas em martelo; no entanto, o tratamento inadequado pode causar retardo de extensão, deformidade em pescoço de cisne ou artrite da articulação interfalangiana distal (AIFD). Este estudo teve como objetivo avaliar os desfechos (funcionais, radiológicos e complicações) da redução aberta e fixação interna (RAFI) das fraturas em martelo com placas de gancho de baixo custo fabricadas com mini placas de titânio de baixo perfil. Métodos Série de casos prospectivos de 17 pacientes consecutivos (idade média de 32,3 anos) com fraturas em martelo (seis do tipo IB e 11 do tipo IIB de Wehbe). Onze (64,7%) pacientes eram do sexo masculino. A mão acometida era a dominante em todos os pacientes, com acometimento do dedo indicador em seis (35,3%), anelar em cinco (29,4%), mínimo em três (17,65%) e médio em três (17,65%) pacientes. O mesmo cirurgião de mão experiente realizou todas as cirurgias. Resultados O tempo operatório médio foi de 37,65 minutos. Após um acompanhamento médio de 10,94 meses (intervalo de 6 a 27), observou-se movimento médio da AIFD de 50º (intervalo de 20º a 70º), retardo de extensão em quatro (23,5%) pacientes e complicações em seis (35,29%) pacientes. De acordo com os critérios de Crawford, os desfechos foram excelentes em seis (35,3%), bons em sete (41,2%) e regulares em quatro (23,5%) pacientes. Conclusão A técnica da placa de gancho modificada para fixação de fraturas em martelo é benéfica e econômica, mas exigente; permite fixação estável e adequada para permitir a movimentação precoce da AIFD com desfechos funcionais aceitáveis.

Combined plate versus external fixation for distal radius fractures / Placa combinada versus fixação externa para fraturas do rádio distal

ABSTRACT Objectives: This study aimed to compare the functional and radiological results of patients who had intra-articular comminuted distal radius fractures and were operated on with external fixation percutaneous pinning or the volar-dorsal combined plate osteosynthesis. Methods: In this study, 49 patients operated on and followed up for the comminuted distal radius fractures between May 2015 and January 2019 were retrospectively evaluated. The surgical outcomes of the patients, who were operated on with combined dorsal-volar plate osteosynthesis or external fixation percutaneous pinning, were compared in this study. Functional and radiological scores were evaluated and analyzed statistically. Results: There was no statistical difference between external fixation and volar-dorsal combined plate groups regarding the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, the Visual Analog Scale (VAS), the Mayo scoring system, range of motion, and grip strength values. Discussion: Although the combined volar-dorsal plate osteosynthesis technique had a longer operation time and a more complicated surgical procedure, the combined volar-dorsal plate osteosynthesis had lower complication rates and permitted early mobilization. The combined volar-dorsal plate osteosynthesis could be an alternative to external fixation percutaneous pinning. Level of Evidence III, Therapeutic Studies Investigating the Results of Treatment.

RESUMO Objetivo: O objetivo deste estudo foi comparar os resultados funcionais e radiológicos de pacientes portadores de fraturas intra-articulares cominutivas do rádio distal, operados com fixação externa percutânea ou com osteossíntese volar-dorsal de placa combinada. Método: Foram avaliados 49 pacientes operados e acompanhados por fraturas cominutivas distais do rádio entre maio de 2015 e janeiro de 2019 retrospectivamente. Os resultados cirúrgicos dos pacientes operados com osteossíntese de placa volar-dorsal combinada ou fixação externa percutânea foram comparados. Os escores funcionais e radiológicos foram avaliados e analisados estatisticamente. Resultados: Não houve diferença estatística entre os grupos de fixação externa e placa combinada volar-dorsal em relação ao questionário Deficiências do braço, ombro e mão (DASH), à Escala Visual Analógica (VAS), ao sistema de pontuação Mayo, à amplitude de movimento ou à avaliação de força de preensão. Conclusão: Embora a técnica combinada de osteossíntese da placa volar-dorsal tenha um tempo cirúrgico mais longo e procedimento mais complicado, a osteossíntese combinada da placa volar-dorsal apresentou menores taxas de complicações, permitindo a mobilização precoce. A osteossíntese combinada da placa volar-dorsal pode ser uma alternativa à fixação externa percutânea. Nível de Evidência III, Estudos terapêuticos - Investigação dos resultados do tratamento.

Outcomes of the Management of Distal Radius Fractures in the Last 5 Years: A Meta-analysis of Randomized Controlled Trials / Resultados do manejo de fraturas do rádio distal nos últimos 5 anos: metanálise de ensaios clínicos controlados e randomizados

Abstract Objective Over the last decades, volar locking plates (VLPs) have been the mainstay treatment for distal radius fractures (DRFs). With the growing body of evidence, we systematically reviewed studies on recent VLP modifications. Methods A systematic search was performed in the PubMed/MEDLINE database for studies published in English in the past five years. The inclusion criteria were randomized controlled trials (RCTs) on the operative treatment of DRFs. We excluded ongoing trials and studies not directly addressing DRF. The primary outcomes assessed were subjective (such as the scores on the Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire, the Patient-rated Wrist Evaluation [PRWE], the European Quality of Life-5 Dimensions [EQ-5D], the 36-item Short Form Health Survey [SF-36], and the Visual Analog Scale [VAS]) and objective clinical outcomes (the complication rate). Results We identified 29 articles published from 2016 to 2020 with high quality of evidence, except for one, which had evidence of moderate quality. In total, 3,079 DRFs were analyzed in the present study. All studies except one had a greater proportion of female participants, and only in 1 study the mean age of the sample was < 40 years old. There were no significant differences between the VLP and external fixation (EF) in terms of the scores on the DASH (p= 0.18) and PRWE (p= 0.77). The VLP alone without pronator quadratus (PQ) repair yielded significantly better outcomes. Conclusion In unstable fractures, the VLP and EF yielded comparable long-term results. There is no clear benefit of adding PQ repair to current the VLP surgical technique. Level of EvidenceLevel I

Resumo Objetivo Nas últimas décadas, a placa volar bloqueada (PVB) tem sido o tratamento principal para fraturas do rádio distal (FRDs). Com o crescente conjunto de evidências, revisamos sistematicamente estudos sobre modificações recentes na PVB. Métodos Uma pesquisa sistemática foi realizada utilizando o banco de dados PubMed/MEDLINE por estudos publicados em inglês nos últimos cinco anos. Os critérios de inclusão foram ensaios clínicos controlados e randomizados (ECCRs) sobre o tratamento cirúrgico de FRDs. Excluímos ensaios e estudos em andamento que não abordavam diretamente a FRD. Os desfechos primários avaliados foram desfechos clínicos subjetivos (como as pontuações no questionário de Deficiências do Braço, Ombro e Mão [Disabilities of the Arm, Shoulder and Hand, DASH, em inglês], na Avaliação do Punho Classificada pelo Paciente [Patient-rated Wrist Evaluation, PRWE, em inglês], no questionário Qualidade de Vida Europeia - 5 Dimensões [European Quality of Life-5 Dimensions, EQ-5D, em inglês], na Pesquisa de Saúde por Formulário Curto de 36 Itens [36-item Short Form Health Survey, SF-36, em inglês], e na Escala Visual Analógica [EVA]) e objetivos (taxa de complicações). Resultados Identificamos 29 artigos publicados entre 2016 e 2020 com alta qualidade de evidência, exceto por um, de qualidade moderada. Ao todo, foram analisadas 3.079 FRDs neste estudo, Todos os estudos analisados, exceto por um, tinham maior proporção de participantes do gênero feminino, e somente em 1 estudo a idade média da amostra foi < 40 anos. Não houve diferença significativa entre a PVB e fixação externa (FE) em termos das pontuações no DASH (p= 0,18) e na PRWE (p= 0,77). Os resultados da PVB isolada, sem qualquer reparo do pronador quadrado (PQ), foram significativamente melhores. Conclusão Em fraturas instáveis, a PVB e a FE produziram resultados comparáveis no longo prazo. Não há um benefício claro em se adicionar reparo do PQ à técnica cirúrgica atual da PVB. Nível de EvidênciaNível I

Minimally-Invasive Plate Osteosynthesis for Clavicle Fractures / Osteossíntese minimamente invasiva com placa para fraturas de clavícula

Abstract Objective To analyze the radiological, clinical, and functional outcomes of clavicle fractures treated with the minimally-invasive plate osteosynthesis (MIPO) technique. Methods From June 2018 to July 2019, 17 cases of clavicular fractures were managed using the MIPO technique under C-arm fluoroscopy. The functional outcomes were assessed using the Constant-Murley score and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The clinical results of union, the complications, the operative time, the hospital stay, as well as infection, were analyzed. Results The mean follow-up time was of 10.41 1.75 months (range: 8 to 14 months). There were 11 male and 6 female patients, with a mean age of 39.05 10.76 years (range: 22 to 57 years). All fractures united on the mean time of 15.35 3.08 weeks (range: 12 to 20 weeks). The mean operative time was of 98.11 13.83 minutes (range: 70 to 130 minutes), and the mean length of the hospital stay was of 4.7 1.12 days (range: 3 to 7 days). The mean Constant-Murley score was of 74.82 6.36 in 4th postoperstive month, and of 92.35 5.48 in the 8th postoperative month, which was statistically significant. The mean DASH score was of 9.94 1.55 in the 4th postoperative month, and of 5.29 1.85 in the 8th postoperative month, which was also statistically significant. One patient had superficial skin infection at the site of the incision. Conclusions The MIPO technique is an alternative method for the fixation of clavicle fractures, but it is technically more demanding, and requires well-equipped operating room facilities.

Resumo Objetivo Analisar o resultado radiológico, clínico e funcional das fraturas da clavícula, tratadas pela técnica de osteossíntese com placa minimamente invasiva (MIPO). Métodos De junho de 2018 a julho de 2019, um total de 17 casos de fraturas claviculares foram tratadas com a técnica de osteossíntese com placa minimamente invasiva (MIPO), sob fluoroscopia com o braço em C. Os resultados funcionais foram avaliados por meio do escore de Constant-Murley e pelo escore de incapacidade do braço, ombro e mão (DASH). Foram analisados os resultados clínicos de consolidação, complicações, tempo cirúrgico, permanência hospitalar e infecção. Resultados O tempo médio de acompanhamento neste estudo foi de 10,41 1,75 meses (variação, 8 a 14 meses). Havia 11 pacientes do sexo masculino e seis do feminino, com média de idade de 39,05 10,76 anos (variação de 22 a 57 anos). Todas as fraturas se consolidaram no tempo médio de 15,35 3,08 semanas (variação, 12 a 20 semanas). O tempo cirúrgico médio foi de 98,11 13,83 minutos (variação, 70 a 130), sendo a permanência hospitalar média de 4,7 1,12 dias (variação de 3 a 7). O escore de Constant-Murley médio foi de 74,82 6,36 no 4° mês e 92,35 5,48 no 8° mês do pós-operatório, o que foi estatisticamente significativo. O escore DASH médio foi de 9,94 1,55 no 4° mês e 5,29 1,85 na 8ª semana do pós-operatório, também sendo estatisticamente significativo. Um paciente apresentou infecção cutânea superficial no local da incisão. Conclusões A técnica MIPO é um método alternativo para a fixação de fraturas da clavícula, porém é tecnicamente mais desafiador, já que necessita de instalações cirúrgicas mais bem equipadas.

Comparison of cannulated screwing versus plating in combination with interlocking intramedullary nailing for ipsilateral discontinuous fractures of tibial shaft and plateau / 中华创伤骨科杂志

Objective:To compare the clinical effects between cannulated screwing and plating in combination with interlocking intramedullary nailing for the treatment of ipsilateral discontinuous fractures of the tibial shaft and plateau.Methods:A retrospective analysis was performed of the clinical data of 34 patients who had been treated for ipsilateral discontinuous fractures of the tibial shaft and plateau at Department of Orthopedics and Trauma, Honghui Hospital Affiliated to Xi′an Jiaotong University from January 2015 to January 2020. There were 17 males and 17 females, aged from 26 to 60 years (average, of 43.6 years). The left side was affected in 18 cases and the right side in 16. The patients were divided into 2 groups according to their internal fixation methods: a cannulated screw group of 16 cases treated with cannulated screwing and intramedullary nailing and a plate group of 18 cases treated with plating and intramedullary nailing. The 2 groups were compared in terms of operation time, intraoperative blood loss, incision length, tibial plateau collapse, consumables cost, hospital stay, fracture healing time, weight-bearing time, range of knee motion, reduction of tibial plateau fracture by Rasmussen radiology, Lysholm knee function score at the last follow-up and complications.Results:There was no significant difference in the preoperative general data between the 2 groups, showing the 2 groups were comparable ( P>0.05). All the 34 patients were followed up for 12 to 28 months (average, 17.4 months). There was no significant difference either in operation time, hospital stay, tibial plateau healing time, tibial fracture healing time, weight-bearing time or range of knee motion between the 2 groups ( P>0.05). In the cannulated screw group, the intraoperative blood loss [(89.4 ± 14.5) mL] and consumables cost [(2.0 ± 0.2) ten thousand yuan] were significantly less than those in the plate group [(120.8 ± 22.1) mL and (2.6 ± 0.4) ten thousand yuan], the incision length [(4.1 ± 0.8) cm] was significantly shorter than that in the plate group [(7.1 ± 0.9) cm], and the Lysholm knee function score at the last follow-up [(89.8 ± 4.5) points] was significantly lower than that in the plate group [(93.0 ± 4.2 points] (all P<0.05). The difference was statistically significant between the 2 groups in the quality of tibial plateau reduction ( P<0.05). The postoperative tibial plateau collapse in the plate group [0.5 (0, 2) mm] was insignificantly less than that in the cannulated screw group [1.0 (0, 2) mm] ( P>0.05). In the cannulated screw group, one tibial shaft fracture did not achieve union after operation and deep vein thrombosis occurred in 2 cases after operation; in the plate group, 2 cases suffered from delayed wound healing, one from delayed fracture healing, one from deep venous thrombosis of lower extremity, and one from knee discomfort which was relieved after removal of internal fixation. Conclusions:In the treatment of ipsilateral discontinuous fractures of tibial shaft and plateau, both cannulated screwing and plating in combination with interlocking intramedullary nailing can achieve good clinical effects. Although plating in combination with intramedullary nailing lead to more severe trauma and higher costs, it is conducive to improving the reduction quality of the tibial plateau and postoperative functional recovery of the knee joint.

Short-term outcomes of mere modified Stoppa approach or in addition to ilia fossa approach for acetabular fractures / 中华创伤骨科杂志

Objective:Toevaluate the short-term outcomes of mere modified Stoppa approach or in addition to ilia fossa approach for acetabular fractures.Methods:From January 2016 to October 2019, 36 patients with acetabular fracture were treated at Department of Traumatology and Orthopaedics, Beijing Jishuitan Hospital. They were 28 males and 8 females with an average age of 45.2 years (from 27 to 78 years). The left side was affected in 15 cases and the right side in 21. By the Judet-Letournel classification, there were 13 anterior column fractures, 3 anterior column and wall fractures, 12 both-column fractures, 6 anterior and posterior hemitransverse fractures, and 2 T-shaped fractures.The time from injury to surgery averaged 6 days(from 2 to 12 days).All the patients were treated by open reduction and plate-screw fixation through the mere modified Stoppa approach or in addition to the ilia fossa approach.The quality of postoperative fracture reduction was evaluated according to the Matta score.The pain scores of visual analogue scale (VAS) for the patients before operation and 18 months after operation were recorded and compared. The fracture healing time, Harris hip score at the last follow-up and complications in the patients were recorded.Results:The average operation time in this cohort was 213.2 min (from 110 to 340 min). By the Matta scores, anatomical reduction was achieved in 28 cases and satisfactory reduction in 8.The 36 patients were followed up for an average of 20 months (from 18 to 25 months). Their VAS pain scores at 18 months after operation were(0.7 ± 0.6) points, significantly lower than those before operation [(6.7 ± 1.3) points] ( P<0.05). Their fracture healing time averaged 3.2 months (from 1.5 to 6.0 months). Their Harris hip scores at the last follow-up averaged 90.6 points (from 80 to 95 points), yielding 26 excellent and 10 good cases.There were no serious complications like internal fixation failure or neurovascular injury during the follow-up period. Conclusions:In the treatment of acetabular fractures, simple modified Stoppa approach or in addition to ilia fossa approach may lead to fine short-term outcomes, because fractures involving both anterior and posterior columns can be handled safely and effectively at the same time.

Minimally invasive adjustable plate and anterior ring distraction reduction for fresh Denis type ⅡB sacral fracture with sacral nerve injury / 中华创伤骨科杂志

Objective:To explore the surgical techniques and clinical effects of minimally invasive adjustable plate (MIAP) together with distraction reduction by minimally invasive anterior pelvic ring internal fixator (INFIX) in the treatment of fresh Denis type ⅡB sacral fracture with sacral nerve injury.Methods:From June 2017 to June 2020, 12 fresh Denis type ⅡB sacral fractures were treated by anterior-posterior distraction reduction and fixation with MIAP and INFIX. There were 8 males and 4 females, with an average age of 30 years (from 16 to 44 years). Preoperatively, imaging found Denis ⅡB fracture of the sacrum and magnetic resonance neurography of the lumbosacral plexus showed injury to the sacral nerve root at the sacral foramen. All patients had symptoms of S 1 nerve root injury on the affected side after injury, with 9 cases of grade M0 and 3 cases of grade M1. The time from injury to operation averaged 11 days (from 5 to 19 days). INFIX combined with MIAP was used to distract and fixate the compressed sacral fracture. The quality of fracture reduction and recovery of sacral nerve function were evaluated postoperatively. Results:According to the criteria proposed by Lindahl et al., the quality of fracture reduction was excellent in 8 cases, good in 2 and fair in 2. The 12 cases were followed up for an average of 20 months (from 12 to 36 months). All sacral fractures got united after an average of 6 weeks (from 5 to 8 months). At one-year follow-up, according to the criteria proposed by the Nerve Injuries Committee of the British Medical Research Council, the postoperative muscle strength recovery was evaluated as complete recovery in 10 cases and as partial recovery in 2 cases.Conclusion:In the treatment of fresh Denis type ⅡB sacral fracture, MIAP combined with INFIX can obtain satisfactory clinical effects because the compressed sacrum can be effectively distracted, the sacral foramen be expanded and the sacral nerve be decompressed indirectly.

Comparison of anatomical locking plate fixation with versus without reconstruction of coracoclavicular ligament in treatment of acute and old Neer Ⅱb distal clavicle fractures / 中华创伤骨科杂志

Objective:To compare anatomical locking plate fixation with versus without reconstruction of the coracoclavicular ligament in the treatment of acute and old Neer Ⅱb unstable distal clavicle fractures.Methods:From January 2015 to November 2020, 80 Neer Ⅱb distal clavicle fractures were treated at Department of Orthopaedics, The First Hospital Affiliated to China Pharmaceutical University. There were 49 males and 31 females, aged from 32 to 78 years (average, 47.8 years). Of the 50 fresh fractures, 25 were treated by internal fixation with anatomical locking plate of distal clavicle plus reconstruction of the coracoclavicular ligament with suture anchor (reconstruction group A) while the other 25 by only internal fixation with anatomical locking plate of distal clavicle (non-reconstruction group A). Of the 30 old fractures which had not got united over 3 weeks after injury, 15 were treated by internal fixation with anatomical locking plate of distal clavicle plus reconstruction of the coracoclavicular ligament with suture anchor (reconstruction group B) while the other 15 by only internal fixation with anatomical locking plate of distal clavicle (non-reconstruction group B). At 1, 3 and 6 months postoperatively, Constant-Murley scale and visual analogue scale (VAS) were used to evaluate shoulder function and pain. X-ray follow-ups were conducted to measure the coracoclavicular distance and observe fracture union and complications at the last follow-up.Results:All the 80 patients were followed up for 6 to 24 months (average, 13.8 months). For reconstruction group A and non-reconstruction group A, respectively, the union time for fresh fractures was (11.7±2.8) weeks versus (13.4±1.3) weeks, the rate of coracoclavicular distance increase 12.7%±6.2% versus 14.2%±8.0%, the Constant-Murley score 92.2±4.4 versus 90.9±5.7, showing no statistically significant difference between the 2 groups (all P>0.05). For reconstruction group B and non-reconstruction group B, respectively, the union time for old fractures was (12.8±1.9) weeks versus (19.4±6.7) weeks, the rate of coracoclavicular distance increase 12.3%±6.7% versus 21.5%±13.1%, the Constant-Murley score 93.0±5.9 versus 83.5±8.5, showing statistically significant differences between the 2 groups (all P<0.05). Conclusions:For fresh Neer Ⅱb distal clavicle fractures, simple anatomical locking plate fixation can achieve satisfactory curative efficacy without additional reconstruction of the coracoclavicular ligament. However, for old Neer IIb distal clavicle fractures, additional reconstruction of the coracoclavicular ligament can better maintain the stability of the acromioclavicular joint, reduce the risk of internal fixation failure, and achieve better outcomes.

Effect of hollow lag screw combined with calcaneal locking plate in the treatment of Letenneur type III Hoffa fracture / 中华创伤杂志

Objective:To compare the clinical effect of cannulated lag screw combined with calcaneal locking plate versus cannulated lag screw in the treatment of Letenneur type III Hoffa fracture.Methods:A retrospective cohort study was performed on clinical data of 41 patients with Letenneur type III Hoffa fracture admitted to General Hospital of Central Theater Command of PLA from January 2010 to June 2020. There were 22 males and 19 females, aged 28-78 years［(51.9±1.9)years］. A total of 18 patients were treated with cannulated lag screw combined with calcaneal locking plate (plate-screw group) and 23 patients were treated with cannulated lag screw (screw group). The bed rest time, hospital time and bone healing time were compared between the two groups. Range of motion (ROM) of the knee at 3 and 6 months postoperatively, knee society score (KSS) at 3 and 6 months postoperatively and incidence of long-term complications were compared between the two groups.Results:All patients were followed up for 10-24 months［(14.5±2.1)months］. The bed rest time was (37.6±2.4)days in plate-screw group, lower than (45.2±1.6)days in screw group ( P<0.05). The hospital time was (16.7±3.7)days in plate-screw group, and (15.8±3.7)days in screw group ( P>0.05). The bone healing time was (12.2±0.9)weeks in plate-screw group and (12.7±0.7) weeks in screw group ( P>0.05). ROM of the knee at 3 and 6 months after operation was (119.9±2.9)° and (125.4±4.5)° in plate-screw group, greater than (116.6±4.5)°and (122.1±3.9)° in screw group (both P<0.05). KSS at 3 and 6 months after operation was (83.4±3.1)points and (86.2±2.5)points in plate-screw group, greater than (79.5±2.1)points and (82.2±2.2)points in screw group (both P<0.05). ROM of the knee and KSS in two groups increased significantly over time (both P<0.01). The long-term complications in plate-screw group included delayed fracture healing in 1 patient, traumatic arthritis in 1 and stiff joint in 1, showing the complication rate of 17% (3/18). The long-terem complications in screw group included internal fixation failure in 1 patient, delayed fracture healing in 2, nonunion in 1, traumatic arthritis in 2 and stiff joint in 2, showing the complication rate of 35% (8/23). The two groups had no significant difference in the complication rate ( P>0.05) .Conclusion:For Letenneur type III Hoffa fracture, cannulated lag screw fixation combined with calcaneal locking plate is superior to seperate cannulated lag screw fixation in aspects of short bed-term bed rest, early functional exercise, improved ROM and good function recovery.

Treatment of acromioclavicular joint dislocation with double Endobutton internal fixation assisted by orthopaedic robot / 中华骨科杂志

Objective:To investigate the early clinical effects of orthopedic surgery robot-assisted double Endobutton titanium plate internal fixation in the treatment of fresh acromioclavicular joint dislocation.Methods:Thirty-nine patients with fresh acromioclavicular joint dislocation were included from January 2020 to January 2022. A total of 19 patients were treated with double Endobutton suspension internal fixation assisted by the domestic third-generation orthopaedic surgical robot (TiRobot ? 2.0) Dimensity system. There were Rockwood type III in 11 cases, type IV in 8 cases. Twenty cases were treated with conventional incision double Endobutton internal fixation, with Rockwood type III in 13 cases, type V in 7 cases. The operation duration, blood loss volume, incision length and hospitalization time were compared between the two groups. The following CT parameters of acromioclavicular joint at 2 days and 1 year after operation, distance between distal inferior cortex of clavicle and subacromial cortex, distance between upper and lower endobuttons, horizontal distance between anterior edge of distal clavicle and anterior edge of acromion and diameter of coracoid process and diameter of clavicular tunnel were measured. The visual analogue score (VAS), Constant-Murley shoulder function score and shoulder abduction activity were also evaluated before and at 12 months after operation. Results:The follow-up duration was 10.8±2.4 months in the robot group and 11.5±3.1 months in the routine group. The VAS score of the robot group decreased from 5.3±2.1 to 0.3±0.2 at 12 months after operation ( t=10.46, P=0.014). The Constant-Murley score increased from 55.6±6.4 to 92.0±4.2. The range of shoulder abduction increased from 42.2°±5.4° to 172.6°±6.1° ( t=17.24, P<0.001). The operation duation of the robot group was 74.4±6.6 min, which was longer than that of the conventional group 61.7±7.2 min ( t=5.43, P=0.037). There was no significant difference in VAS score, Constant-Murley score, shoulder abduction activity or CT measurement between the two groups ( P>0.05). During the follow-up, two cases in the robot group had cortical osteolysis on the supraclavicular surface, one case in the conventional group had loss of reduction, one case in the supraclavicular cortical osteolysis, and 4 cases in the cortical defect on the side of the coracoid process tunnel. Conclusion:Orthopedic robot-assisted and conventional incision with double Endobutton titanium plate internal fixation in treating fresh acromioclavicular joint dislocation can achieve satisfied early clinical effects. Accurate establishment of clavicle and coracoid bone tunnel assisted by robot can overcome the defects of bone tunnel deviation in conventional incision operation and can prevent reduction and bone loss. However, robot-assisted and conventional incision Endobutton internal fixation could enlarge bone tunnel.

Closed reduction and intramedullary nailing versus open reduction and locking plate fixation in treatment of middle and upper humeral fractures / 中华创伤骨科杂志

Objective:To compare closed reduction and intramedullary nailing versus open reduction and locking plate fixation in the treatment of middle and upper humeral fractures.Methods:A retrospective case-control study was conducted to analyze the clinical data of 62 patients with middle and upper humeral fracture who had been treated at Department of Orthopaedics, The First People's Hospital of Jinmen and at Department of Orthopedics, General Hospital of PLA Central Theater from October 2017 to February 2021. There were 35 males and 27 females, aged from 27 to 86 years. The left side was affected in 24 cases and the right side in 38 cases. All fractures were fresh. According to the AO classification, 16 cases were type A, 32 type B, and 14 type C. Of the patients, 29 were treated with closed reduction and intramedullary nailing (intramedullary nail group) and 33 with open reduction and locking plate fixation (locking plate group). The length of incision, operation time, intraoperative blood loss, hospital stay, fracture healing and complications were recorded and compared between the 2 groups. The pain degree was evaluated by visual analogue scale (VAS) at one week and one month after operation, and the functional recovery of the shoulder was evaluated by Constant-Murley score at one month and 12 months after operation.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). The intramedullary nail group was followed up for 12 to 29 months and the locking plate group for 15 to 50 months. In the intramedullary nail group, the length of incision [(4.1±0.7) cm], operation time [(58.3±7.7) min], intraoperative blood loss [(52.7±6.5) mL], and hospital stay [(7.3±1.5) d] were significantly less than those in the locking plate group [(21.7±2.3) cm, (95.8±11.7) min, (237.4±14.9) ml, and (12.3±1.7) d] ( P<0.05). The fracture healing time in the intramedullary nail group was (5.0±1.9) months, significantly longer than that in the locking plate group [(3.5±1.7) months] ( P<0.05). The VAS scores at one week and one month after operation in the intramedullary nail group [(2.8±0.3) points and (1.2±0.5) points] were significantly lower than those in the locking plate group [(4.3±0.4) points and (1.6±0.5) points], and the Constant-Murley score at one month after operation in the intramedullary nail group [(63.5±7.4) points] was significantly higher than that in the locking plate group [(54.3±6.9) points] ( P<0.05). However, at 12 months after operation, there was no significant difference in the Constant-Murley score between the 2 groups ( P>0.05). In both groups, the VAS score at one month after operation was significantly lower than that at one week after operation while the Constant-Murley score at 12 months after operation was significantly higher than that at one week after operation ( P<0.05). In the intramedullary nail group, intraoperative distal refracture happened in one case; in the locking plate group, incision infection occurred in one case and postoperative radial nerve injury in another. There was no significant difference in the incidence of complications between the 2 groups [3.4% (1/29) versus 6.1% (2/33)] ( P>0.05). Conclusion:In the treatment of middle and upper humeral fractures, compared with open reduction and locking plate fixation, closed reduction and intramedullary nailing shows advantages of a smaller surgical incision, shorter operation time, less intraoperative blood loss, shorter hospital stay and faster functional recovery.

Comparison of hand plating system versus suture anchor fixation in treatment of patellar inferior pole fractures / 中华创伤骨科杂志

Objective:To compare the clinical efficacy between hand plating system (HPS) and classic suture anchor fixation in the treatment of patellar inferior pole fractures.Methods:The clinical data were analyzed retrospectively of the 56 patients who had been treated for patellar inferior pole fractures at Department of Orthopaedics, General Hospital of Northern Theatre Command from January 2018 to December 2019. They were assigned into 2 groups according to their internal fixation methods. In group A of 30 cases subjected to HPS fixation, there were 18 males and 12 females with an age of (61.7±11.3) years; in group B of 26 cases subjected to suture anchor fixation, there were 16 males and 10 females with an age of (60.0±10.5) years. The incision length, operation time, intraoperative bleeding, fracture union time, pain visual analog scale (VAS)and knee function one year postoperation, and follow-up complications were compared between the 2 groups.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability( P>0.05). The operation time in group A [(59.4±10.8) min] was significantly shorter than that in group B [(66.5±12.3) min] ( P<0.05). There was no significant difference in the incision length or intraoperative bleeding between the 2 groups ( P>0.05). The bone union time was respectively(11.2±1.8) weeks and (12.1±2.4) weeks and the postoperative VAS respectively 0.85±0.12 and 0.91±0.14 for groups A and B, showing no significant difference between the 2 groups ( P>0.05). The knee flexion angle (124.5°±14.6°) and knee Bostman score (29.3±3.5) in group A were significantly better than those in group B (113.2°±11.1° and 26.2±2.9) one year postoperation( P<0.05). Follow-up revealed no complication in group A but 2 cases of implant failure in group B. Conclusion:Compared with the classical anchor suture fixation, HPS may obtain stronger fixation, shorter operation time and better knee function.

Comparison of a novel kind of anatomical locking plate versus proximal humeral internal locking system in treatment of proximal humerus fractures / 中华创伤骨科杂志

Objective:To compare a novel kind of anatomical locking plate versus proximal humeral internal locking system (PHILOS) in the treatment of proximal humerus fractures.Methods:A retrospective study was performed in the 35 patients with proximal humerus fracture who had been operatively treated at Department of Orthopedics, The Third Hospital of Peking University from January 2020 to June 2021. They were 13 males and 22 females, aged from 24 to 83 years (average, 56.7 years). Of them, 14 were fixated by the novel anatomical locking plate and 21 by PHILOS. The 2 groups were compared in terms of gender, age, fracture type, operation time, intraoperative blood loss, hospital stay, University of California (UCLA) shoulder scores and Disability of Arm Shoulder and Hand (DASH) scores for the upper limb dysfunction at one month after operation and at the last follow-up, and postoperative complications.Results:There was no significant difference in the preoperative general data between the novel plate group and the PHILOS group, showing comparability between them ( P>0.05). All the patients were followed up for 6 to 21 months (mean, 11.3 months). In the novel anatomical plate group, the operation time was (83.9±29.2) min, the intraoperative blood loss was (36.4±27.1) mL, the hospital stay was (2.3±1.1) d, the UCLA score and DASH score at one month after operation were (20.1±4.7) points and (55.5±19.1) points, the UCLA score and DASH score at the last follow-up were (28.5±4.6) points and (25.1±24.4) points, respectively; 2 patients developed complications after operation. In the PHILOS group, the operation time was (85.0±38.8) min, the intraoperative blood loss was (62.9±46.8) mL, the hospital stay was (2.4±0.9) d, the UCLA score and DASH score at one month after operation were (21.0±3.8) points and (49.6±23.7) points, and the UCLA score and DASH score at the last follow-up were (28.0±5.1) points and (19.1±17.3) points, respectively; 3 patients developed complications after operation. There was no significant difference in all the above items between the 2 groups (all P>0.05). Conclusion:In the treatment of proximal humerus fractures, the novel anatomical locking plate is a feasible internal fixator because it is comparable to PHILOS in fine efficacy, good fracture healing, and satisfactory functional recovery of the shoulder joint.

Comparison of percutaneous cannulated screw fixation and plating via minimally invasive longitudinal approach after closed reduction in treatment of intra-articular tongue-type calcaneal fractures / 中华创伤骨科杂志

Objective:To compare percutaneous cannulated screw (PCS) fixation and plating via a minimally invasive longitudinal approach (MILA) after closed reduction for the treatment of intra-articular tongue-type calcaneal fractures.Methods:A retrospective analysis was conducted of the 67 patients with intra-articular tongue-type calcaneal fracture who had been treated at Department of Orthopedics, The Third Hospital of Peking University from May 2017 to May 2020. They were 56 males and 11 females, 19 to 58 years of age (average, 34.5 years). Of them, 32 were treated by the PCS fixation after closed reduction (PCS group) and 35 by the MILA plating after closed reduction (MILA group). The operation time, preoperative time, post-operative hospital stay, blood loss and postoperative complications were recorded and compared between the 2 groups. The calcaneal length, width and height, Gissane angle, B?hler angle, varus angle, valgus angle and visual analog scale (VAS) were compared between the 2 groups at preoperation, immediate postoperation, 3 months postoperation, and the last follow-up. The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was used at 3 months postoperation and the last follow-up to evaluate the function of the injured hindfoot.Results:There was no significant difference in the preoperative general data between the PCS group and the MILA group, showing they were comparable ( P>0.05). All patients were followed up for an average of 18.5 months (from 15 to 25 months). For the PCS group and the MILA group, respectively, the operation time was 60.5 (51.5, 68.0) min and 86.0 (78.0, 96.0) min, the blood loss 10 (5.0, 20.0) mL and 20 (15, 25) mL, the postoperative hospital stay 1 (1.0, 1.8) d and 2 (2, 3) d, the calcaneal width at immediate postoperation (43.8±4.4) mm and (40.6±2.8) mm, the calcaneal width at 3 months postoperation 43.8 (39.6, 48.3) mm and 41.5 (38.8, 44.5) mm, the calcaneal width at the last follow-up 44.2 (40.2, 48.0) mm and 41.3 (39.0, 44.3) mm, the VAS at the last follow-up 5.0 (5.0, 5.0) and 6.0 (5.0, 6.0). The comparisons of the above items showed significant differences between the 2 groups (all P<0.05). No significant differences were observed between the 2 groups in the calcaneal length or height, Gissane or B?hler angle, AOFAS hindfoot score, or complication rate (all P>0.05). Conclusions:In the treatment of tongue-type calcaneal fractures, after closed reduction, the PCS fixation can shorten operation time and postoperative hospital stay, and reduce intraoperative blood loss and postoperative pain, but the MILA plating is more advantageous in restoring the calcaneal width.