Caracterización de las fracturas supracondíleas del húmero en niños que requirieron manejo quirúrgico en un hospital de Santander, Colombia / Characterization of Supracondylar Fractures of the Humerus in Children who Required Surgical Management at a Hospital in Santander, Colombia / Caracterização das fraturas supracondilianas do úmero em crianças que precisaram de tratamento cirúrgico em um hospital de Santander, Colômbia

Introducción. El objetivo del estudio fue describir las características sociodemográficas, tratamiento y complicaciones pre y posquirúrgicas de las fracturas supracondíleas del húmero distal en niños que requirieron manejo quirúrgico en un hospital de Santander, Colombia. Metodología. Se trata de un estudio observacional, descriptivo, de corte transversal con 58 pacientes que cumplieron los siguientes criterios de inclusión: edad entre 3 a 14 años, fracturas supracondíleas de manejo quirúrgico; como criterios de exclusión se tomó: antecedente de enfermedad ósea o neurológica previa y fracturas de más de 7 días de evolución. Para las variables continuas se usó medidas de tendencia central y dispersión, las categóricas en porcentajes y frecuencias absolutas. Resultados. La edad media de presentación fue de 6.2 años, el principal mecanismo de trauma fue caídas de altura con un 96.5%. El 65.5% provenía de zonas urbanas. El 13.8% se asoció con fracturas de antebrazo, y el 3.4% de epitróclea. La fijación se realizó en un 75% con técnica cruzada y un 17.2% se asoció con lesión iatrogénica del nervio ulnar. Discusión. En el estudio no se informaron lesiones vasculares; sin embargo, se documentó una alta prevalencia de lesión neurológica con la fijación medial, similar a lo descrito en la literatura (1.4%-17.7%); algunos autores describen técnicas que disminuyen estas lesiones hasta en un 0%. Conclusión. Las características sociodemográficas de nuestra población coinciden con la estadística publicada mundialmente; la principal complicación fue la lesión iatrogénica nervio ulnar, que se puede disminuir con un uso racional del pin medial y con el empleo de técnicas que busquen rechazar directamente el nervio. Palabras clave: Fracturas del Húmero; Fijación Interna de Fracturas; Clavos Ortopédicos; Codo; Niño; Nervio Cubital.

Introduction. The objective of this study was to describe sociodemographic characteristic, treatment, and pre- and post-surgical complications of supracondylar fractures of the distal humerus in children who required surgical management at a hospital in Santander, Colombia. Methodology. This was an observational, descriptive, and cross-sectional study involving 58 patients who met inclusion criteria: age between 3 and 14 years old, supracondylar fractures with surgical management; exclusion criteria include previous bone or neurological illness and fractures with more than 7 days of evolution. Central tendency and dispersion measures were used for continuous variables, and categorical variables in percentages and absolute frequencies. Results. The average age at presentation was 6.2 years old, the main mechanism of trauma was fall from height (96.5%). 65.5% came from urban zones. The 13.8% were associated with forearm fractures, and 3.4% with epitrochlear fractures. Pinning was performed at 75% with crossed technique and 17.2% were associated with iatrogenic ulnar nerve injury. Discussion. Study didn't inform vascular injuries. However, a high prevalence of neurological injury with medial pinning was documented, similar to that describe in the literature (1.4%-17.7%); some author described techniques that reduce these lesions by 0%. Conclusion. The sociodemographic characteristics of our population match with worldwide published statistics; the main complication was iatrogenic ulnar nerve injury, which can be reduced with the rational use of medial pin and with the application of techniques that seek to directly spare the nerve. Keywords: Humeral Fractures; Fracture Fixation, Internal; Bone Nails; Elbow; Child; Ulnar Nerve.

Introdução. O objetivo do estudo foi descrever as características sociodemográficas, o tratamento e as complicações pré e pós-cirúrgicas das fraturas supracondilianas do úmero distal em crianças que precisaram de tratamento cirúrgico em um hospital de Santander, Colômbia. Metodologia. Trata-se de um estudo observacional, descritivo e transversal com 58 pacientes que atenderam aos seguintes critérios de inclusão: idade entre 3 e 14 anos, fraturas supracondilianas tratadas cirurgicamente. Os critérios de exclusão foram: histórico de doença óssea ou neurológica prévia e fraturas com duração superior a 7 dias de evolução. Para variáveis contínuas foram utilizadas medidas de tendência central e dispersão, as categóricas em percentuais e frequências absolutas. Resultados. A média de idade de apresentação foi de 6.2 anos, o principal mecanismo de trauma foi a queda de altura com 96.5%. 65.5% vieram de áreas urbanas. 13.8% estavam associados a fraturas de antebraço e 3.4% a epitróclea. A fixação foi realizada em 75% com técnica cruzada e 17.2% esteve associada à lesão iatrogênica do nervo ulnar. Discussão. Nenhuma lesão vascular foi relatada no estudo. No entanto, foi documentada alta prevalência de lesão neurológica com fixação medial, semelhante à descrita na literatura (1.4%-17.7%). Alguns autores descrevem técnicas que reduzem essas lesões em até 0%. Conclusão. As características sociodemográficas da nossa população coincidem com as estatísticas publicadas mundialmente. A principal complicação foi a lesão iatrogênica do nervo ulnar, que pode ser reduzida com o uso racional do pino medial e com o uso de técnicas que buscam rejeitar diretamente o nervo. Palavras-chave: Fraturas do Úmero; Fixação Interna de Fraturas; Pinos Ortopédicos; Cotovelo; Criança; Nervo Ulnar

Fracturas supracondíleas en pacientes pediátricos tratados quirúrgicamente con Técnica de Cruzada. Hospital Central San Cristóbal / Supracondylar humerus fractures in childrens surgically treated by Crossed Wiring Technique. San Cristóbal Central Hospital

Las fracturas supracondíleas en niños se asocian con algunas complicaciones. Su tratamiento estándar es la reducción cerrada y la fijación con alambres en distintas configuraciones. Se realizó un estudio observacional, analítico, prospectivo y longitudinal con pacientes pediátricos que ingresaron con fracturas supracondíleas de húmero tratados quirúrgicamente con alambres de Kirschner con "Técnica Cruzada" en el Hospital Central San Cristóbal enero a junio de 2022. Se incluyeron 30 pacientes. La edad promedio fue 6,3±2,2(3-10) años. La causa más frecuente del traumatismo fue la precipitación de altura en 63,3% de los casos. La posición del codo al momento del accidente fue en extensión en 90%. Todas las fracturas fueron cerradas. El tiempo promedio desde el accidente hasta su atención en emergencia fue de 8,5±13,4(2-72) horas. Los signos clínicos más frecuentes fueron dolor en 100,0%, limitación funcional en 96,7%, aumento de volumen 73,3% y deformidad 50,0%. Según la clasificación AO la más frecuente fue del tipo 13-M/3. 1 III en el 50% de los casos y según Gartland, las tipo IIIA en 53,3%. A las 4 semanas, 100,0% de las fracturas consolidaron, 13,3% presentó valgo y 6,7% varo en la radiografía anteroposterior. Mientras que, en la lateral, 33,3% antecurvatum. La media del ángulo de Baumann fue de 20,27±1,39 grados. La tasa de complicaciones fue de 16,66%, 2(6,7%) casos presentaron neuropraxia y 3(10,0%) granuloma. En conclusión, la Técnica Cruzada es segura en términos de reducción, funcionalidad y tasas de complicaciones en el seguimiento a medio plazo(AU)

Supracondylar fractures in children are associated with some complications. Its standard treatment is closed reduction and fixation with wires in different configurations. An observational, analytical, prospective and longitudinal study was made, with pediatric patients admitted with supracondylar humeral fractures surgically treated with Kirschner wires with the "Cross Technique" at the Hospital Central San Cristóbal from January to June 2022. 30 patients were included. The mean age was 6,3±2,2(3-10) years. The most frequent cause of trauma was high altitude precipitation in 63,3% of the cases. The position of the elbow at the time of the accident was 90% extended. All fractures were closed. The mean time from the accident to emergency care was 8,5±13,4(2-72) hours. The most frequent clinical signs were pain in 100,0%, functional limitation in 96.7%, volume increase in 73,3%, and deformity in 50,0%. According to the AO classification, the most frequent was type 13-M/3. 1 III in 50% of cases and according to Gartland, type IIIA in 53,3%. At 4 weeks, 100,0% of the patients consolidated, 13,3% presented valgus and 6,7% varus on the anteroposterior radiograph. While, on the side, 33,3% antecurvatum. The mean Baumann angle was 20,27 ± 1.39 degrees. The rate of complications was 16,66%, 2 (6,7%) cases presented neuropraxia and 3 (10,0%) granuloma. In conclusion, the Crossover Technique is safe in terms of reduction, functionality, and complication rates in medium-term follow-up(AU)

Epidemiología de las infecciones post osteosíntesis detectadas por baño de ultrasonido en el Servicio de Traumatología del Hospital Universitario de Caracas / Post osteosinthesis infections epidemiology by ultrasound bath in the trauma service of the University Hospital of Caracas

El objetivo de este trabajo es determinar la epidemiología de la infección post osteosíntesis a través de cultivos de fluidos sonicados en los pacientes del Hospital Universitario de Caracas en el período comprendido entre noviembre 2021-noviembre 2022. Se realizó un estudio observacional de tipo, serie de casos, a través de la revisión de historias médicas de todos los casos que acudieron con diagnóstico de infección post osteosíntesis a fin de determinar cuál agente causal fue el más común, factores de riesgo asociados y tratamiento de elección. Se incluyeron 10 pacientes, 70% de sexo masculino y edad promedio de 40,6±17,9 años. Los gérmenes aislados en el cultivo convencional fueron el SAMS, SAMR, Enterobacter cloacae, Staphylococcus coagulasa negativo (10,0% cada uno), el 60,0% de los cultivos en esta modalidad fueron negativos, en el cultivo de fluidos por baño de ultrasonido, el germen más frecuente fue el SAMR en el 30% de los casos, seguido del SAMS con 20%, en menor medida un caso de Staphylococcus coagulasa negativo y una infección polimicrobiana compuesta por K. pneumoniae, E. cloacae y Enterococo sp. El tratamiento médico consistió en antibioticoterapia vía endovenosa, se realizó de acuerdo al antibiograma obtenido del cultivo, el más empleado fue la cefazolina en 30% (en casos de SAMS), seguido de la vancomicina + meropenem y la vancomicina aislada en 20%. Todos los pacientes cumplieron tratamiento al menos por 4 semanas con evolución satisfactoria(AU)

The objective of this work is to determine the epidemiology of post-osteosynthesis infection through sonicated fluid cultures in patients at the Hospital Universitario de Caracas in the period between November 2021 and November 2022. An observational study of type, series of cases, through the review of the medical records of all the cases that presented with a diagnosis of post-osteosynthesis infection in order to determine which causative agent was the most common, associated risk factors and treatment of choice. 10 patients were included, 70% male and mean age 40.6 ± 17.9 years. The germs isolated in the conventional culture were SAMS, SAMR, Enterobacter cloacae, coagulase-negative Staphylococcus (10.0% each), 60.0% of the cultures in this modality were negative, in the culture of fluids by bath of On ultrasound, the most frequent germ was MRSA in 30% of cases, followed by SAMS with 20%, to a lesser extent a case of coagulase-negative Staphylococcus and a polymicrobial infection made up of K. pneumoniae, E. cloacae and Enterococcus sp. The medical treatment consisted of intravenous antibiotic therapy, it was carried out according to the antibiogram obtained from the culture, the most used was cefazolin in 30% (in cases of SAMS), followed by vancomycin + meropenem and vancomycin alone in 20%. All patients complied with treatment for at least 4 weeks with satisfactory evolution(AU)

Fijación interna combinada con artroplastia total de cadera en fracturas acetabulares inveteradas complejas en ancianos. Reporte de caso / Internal fixation combined with total hip arthroplasty in complex inveterate acetabular fractures in the elderly. Case report

La fijación interna combinada con artroplastia en pacientes de edad avanzada, está indicada en fracturas acetabulares complejas inveteradas, artrosis preexistente, luxación inveterada, Impactación supero-medial de la cúpula acetabular, la finalidad de la cirugía es lograr la fijación de la columna anterior, columna posterior, lamina cuadrilátera y pared posterior para proporcionar estabilidad adecuada al componente acetabular y restaurar el centro de rotación de la cadera. Debido a la complejidad de estas lesiones, se decide presentar el siguiente caso clínico, que corresponde una paciente femenina de 70 años, quien posterior a traumatismo de baja energía presenta fractura inveterada compleja con patrón en T de Acetábulo de 8 meses de evolución. El Objetivo es: Evaluar los resultados del tratamiento de las fracturas acetabulares complejas en pacientes de edad avanzada con reducción abierta más fijación interna combinada con artroplastia total de cadera. Se realiza en un 1er tiempo: Abordaje Ilioinguinal, ORIF con placa de reconstrucción 3,5 mm para CA, 2do Tiempo: Abordaje de Kocher Langenbeck, ORIF con placa de reconstrucción 3,5 mm para CP y PP. 3er Tiempo: ATC izquierda primaria no cementada, con aporte biológico de injerto óseo autologo. Resultado: Se restableció la integridad de las líneas acetabulares, reducción anatómica según Matta, índice de Harris hip score de 88 puntos. Se concluye que el procedimiento combinado de ORIF mas ATC es el tratamiento ideal de las fracturas acetabulares complejas inveteradas en pacientes de edad avanzada(AU)

Internal fixation combined with arthroplasty in elderly patients is indicated in inveterate complex acetabular fractures, preexisting osteoarthritis, inveterate dislocation, supero medial impaction of the acetabular dome, the purpose of surgery is to achieve fixation of the anterior column (AC), posterior column (PC), quadrilateral plate, and posterior wall (PP) to provide adequate stability to the acetabular component and restore the hip center of rotation. Due to the complexity of these injuries, it is decided to present the following clinical case, which corresponds to a 70-year-old female patient, who, after a low-energy trauma, presents a complex inveterate fracture with a T-pattern of the acetabulum of 8 months of evolution. The Objective is: To evaluate the results of the treatment of complex acetabular fractures in elderly patients with open reduction plus internal fixation (ORIF) combined with total hip arthroplasty (THA). It is performed in a 1st stage: Ilioinguinal approach, ORIF with 3.5 mm reconstruction plate for (CA), 2nd Stage: Kocher Langenbeck approach, ORIF with 3.5 mm reconstruction plate for (CP) and (PP). 3rd Time: Uncemented primary left THA, with biological contribution of autologous bone graft. Result: The integrity of the acetabular lines was restored, anatomical reduction according to Matta, Harris hip score index of 88 points. It is concluded that the combined procedure (ORIF plus ATC) is the ideal treatment of inveterate complex acetabular fractures in elderly patients(AU)

Fractura triplanar de tibia distal: Reporte de un caso y revisión de la literatura / Triplanar fracture of proximal tibia: A case report and literature review

Las fracturas triplanares de tibia distal, son fracturas complejas caracterizadas por afectación multiplanar, clasificándose como Salter Harris tipo IV, en el periodo de cierre fisiario. Son poco frecuentes, representando el 5-15% de las fracturas pediátricas. El mecanismo de lesión que ocurre con mayor frecuencia, consiste en supinación y rotación externa. La tomografía computarizada es actualmente el Gold Standard para el diagnóstico de este tipo de fractura, nos permite evaluar todos los planos, siendo la radiografía simple insuficiente para el diagnóstico ya que puede pasar desapercibida. Paciente de 14 años de edad con fractura triplanar en 2 partes de tibia distal, con resolución quirúrgica. Nuestro caso es un ejemplo de una fractura triplanar de tibia distal, la cual es de baja frecuencia, difícil diagnostico e interpretación. Presentamos imágenes preoperatorias, intraoperatorias y postoperatorias del manejo de esta lesión, obteniendo resultados satisfactorios clínicos, funcionales y en estudios de imágenes. Es indispensable lograr una reducción anatómica de la superficie articular para lograr una evolución satisfactoria. Se recomienda una tomografía computarizada para diagnosticar y manejar esta lesión de manera adecuada. El seguimiento postoperatorio es crucial para el manejo de este paciente, ya que se espera una discrepancia en la longitud de las extremidades y/o deformidad(AU)

Triplane fractures of the distal tibia are complex fractures characterized by multiplane effects. They are classified in the Salter-Harris system as type IV in the period of physeal closure. These fractures are rare and represent 5-15% of pediatric fractures. The most common mechanism of injury is supination and external rotation. Computed tomography is currently the Gold Standard for the diagnosis of this type of fracture since it allows us to evaluate all planes, while plain radiography is insufficient because the fracture can go unnoticed. The objective is to report the clinical case of a 14-year-old patient with triplanar fracture in 2 parts of the distal tibia with surgical resolution. This case is an example of a triplanar fracture of the distal tibia, which is of low frequency, and difficult to diagnose and interpret. Preoperative, intraoperative and postoperative images of the management of this lesion are presented, obtaining satisfactory clinical, functional and imaging study results. It is essential to achieve an anatomical reduction of the joint surface to achieve a satisfactory evolution. A CT scan is recommended to properly diagnose and manage this injury. Postoperative follow-up is crucial for the management of this patient, as a limb length discrepancy and/or deformity is expected(AU)

Child Fractures: Are We Getting More Surgical? / Fraturas na criança: Estamos ficando mais cirúrgicos?

Abstract Historically, surgeries on the immature skeleton were reserved for open or articular fractures. In recent years, the improvement in the quality and safety of anesthesia, new imaging equipment, implants designed especially for pediatric fractures, associated with the possibility of shorter hospitalization time and rapid return to social life has demonstrated a new tendency to evaluate and treat fractures in children. The purpose of this update article is to answer the following questions: (1) Are we really turning more surgical in addressing fractures in children? (2) If this is true, is this surgical conduct based on scientific evidence? In fact, in recent decades, the medical literature demonstrates articles that support better evolution of fractures in children with surgical treatment. In the upper limbs, this is very evident in the systematization of the reduction and percutaneous fixation of supracondylar fractures of the humerus and fractures of the forearm bones. In the lower limbs, the same occurs with diaphyseal fractures of the femur and tibia. However, there are gaps in the literature. The available published studies show low scientific evidence. Thus, it can be inferred that, even though the surgical approach is more present, the treatment of pediatric fractures should always be individualized and conducted according to the knowledge and experience of the professional physician, taking into account the presence of technological resources available for the care of the small patient. All possibilities, non-surgical and/or surgical, should be included, always instituting actions based on science and in agreement with the family's wishes.

Resumo Historicamente, as cirurgias no esqueleto imaturo eram reservadas às fraturas expostas ou articulares. Nos últimos anos, a melhora na qualidade e segurança das anestesias, novos equipamentos de imagem, implantes desenhados especialmente para fraturas pediátricas, associados à possibilidade de menor tempo de hospitalização e rápido retorno ao convívio social vêm demonstrando uma nova tendência de avaliar e tratar fraturas na criança. O objetivo deste artigo de atualização é responder às seguintes questões: (1) estamos realmente ficando mais cirúrgicos na abordagem das fraturas em crianças? (2) Caso isto seja verdadeiro, esta conduta cirúrgica está baseada em evidências científicas? De fato, nas últimas décadas, a literatura médica demonstra artigos que suportam melhor evolução das fraturas na criança com o tratamento cirúrgico. Nos membros superiores, isto fica muito evidente na sistematização da redução e fixação percutânea das fraturas supracondilianas do úmero e das fraturas de ossos do antebraço. Nos membros inferiores, o mesmo ocorre com fraturas diafisárias do fêmur e tíbia. No entanto, há lacunas na literatura. Os estudos publicados são geralmente com baixa evidência científica. Assim, pode-se deduzir que, mesmo sendo a abordagem cirúrgica mais presente, o tratamento de fraturas pediátricas deve ser sempre individualizado e conduzido de acordo com o conhecimento e experiência do médico profissional, levando em conta a presença de recursos tecnológicos disponíveis para o atendimento do pequeno paciente. Deve-se incluir todas as possibilidades, não cirúrgicas e/ou cirúrgicas, sempre instituindo ações baseadas na ciência e em concordância com os anseios da família.

Retrospective study on the treatment of phalanx fractures with absorbable materials / 中国医师进修杂志

Objective:To investigate the effect of absorbable material internal fixation in the treatment of phalanx fracture and its effect on the complications related to hypersensitive C-reactive protein (hs-CRP), interleukin-10 (IL-10), adrenocorticotropic hormone (ACTH) and foreign body reaction.Methods:The clinical data of 98 patients with phalangeal fracture in Huishan District People′s Hospital of Wuxi City from January 2018 to January 2020 were divided into absorbable group (49 cases, treated with absorbable material internal fixation) and microplate group (49 cases, treated with minimally invasive plate internal fixation). The rates of excellent and good treatment, operation conditions, serum inflammatory stress response indexes levels before and 1 d and 1 week after surgery were compared, and recovery at 3 and 6 months after surgery, the incidence of complications and the degree of treatment satisfaction were counted.Results:The rates of excellent and good treatmentin the absorbable group were higher than that in the micro plate group: 95.92%(47/49) vs. 81.63%(40/49), χ2 = 5.02, P<0.05. The duration of operation in the absorbable group was longer than that in the microplate group: (43.28 ± 12.18) min vs. (31.29 ± 11.69) min; and the duration of hospital stay, fracture healing time and recovery time were shorter than those in the microplate group: (4.09 ± 1.18) d vs. (6.89 ± 2.12) d, (4.35 ± 1.05) weeks vs. (5.69 ± 1.38) weeks, (4.89 ± 1.10) d vs. (6.20 ± 2.01) d; the differences were statistically significant ( P<0.05). The levels of serum hs-CRP, IL-10 and ACTH in absorbable group were lower than those in microplate group at 1 d and 1 week after surgery ( P<0.05). At 3 and 6 months after surgery, the range of motion of metacarpophalangeal joint in the absorbable group was greater than that in the microplate group, and the loss of grip strength of the healthy side was less than that in the microplate group ( P<0.05). The incidence of complications in absorbable group was lower than that in microplate group: 6.12%(3/49) vs. 20.41%(10/49), χ2 = 4.35, P<0.05. Conclusions:The absorbable material internal fixation can achieve good results in the treatment of phalanx fracture, the postoperative recovery is fast, the incidence of complications is lower.

Effects of metacarpal inclination angle and ulnar deviation angle on radius length shortening after distal radius fracture combined with internal fixation of ulnar styloid fracture / 国际外科学杂志

Objective:To investigate the effects of metacarpal inclination angle and ulnar deviation angle on radius length shortening after internal fixation of distal radius fracture combined with ulnar styloid fracture.Methods:A retrospective case-control study was conducted to analyze the clinical data of 84 patients with distal radius fracture complicated with ulnar styloid fracture treated by Beijing Daxing District People′s Hospital from February 2018 to January 2022. According to whether the ulnar styloid fracture was fixed or not, the patients were divided into two groups: 18 patients with ulnar styloid fractures who were surgically fixed were in the fixation group, and 66 patients with ulnar styloid fractures who were not surgically fixed were in the non-fixation group. The perioperative indexes (operation time, intraoperative blood loss, surgical incision length), wrist joint function indexes [Gartland-Werley score, disability of the arm, shoulder, and hand (DASH) score, forearm rotation, ulnar deviation, metacarpal flexion, radial deviation, dorsal extension, grip strength] and complications (bone nonunion, osteolysis, ulnar pain, internal fixation failure, lower ulnar and radial instability, postoperative infection) were compared between the two groups. The changes of metacarpal inclination angle, ulnar deviation angle and distal radius distance of the two groups were analyzed by generalized estimation equation (GEE). The patients were followed up for 12 months, they were divided into two groups: non-shortening group (radius shortening distance < 4 mm, n=61) and radius shortening group (radius shortening distance ≥ 4 mm, n=23) according to whether the radius shortening distance was ≥ 4 mm at the last follow-up. The influencing factors of postoperative radius shortening were evaluated by Logistic regression analysis. Results:Compared with the non-fixation group, the Gartland-Werley score(1.79±0.62 vs 4.65±0.97), DASH score (16.43±4.71 vs 28.72±6.06) and the incidence of complications (11.11% vs 39.40%) in the fixation group were significantly lower, and the forearm rotation angle [(81.29±6.60)° vs (70.79+ 5.15)°], ulnar deviation angle [(21.36±2.35)° vs (16.77±2.11)°], metacarpal flexion angle [(45.84±2.80)° vs (37.55±2.45)°] and dorsal extension angle [(50.23±5.16)° vs (40.65±3.580°] were significantly larger in the fixation group, all the differences were statistically significant ( P<0.05). GEE analysis and evaluation showed that treatment time, treatment plan and their interaction had significant effects on metacarpal inclination, ulnar deviation and distal radius ( P<0.05). The change of metacarpal inclination angle and ulnar deviation angle were independent influencing factors of radius shortening after internal fixation ( P<0.05). Conclusions:In the treatment of distal radius fracture combined with ulnar styloid fracture, internal fixation of distal radius combined with ulnar styloid process can improve wrist joint function, reduce the incidence of complications, and improve metacarpal inclination angle and ulnar deviation angle. A certain degree of radius shortening will occur after internal fixation. The changes of metacarpal inclination angle and ulnar deviation angle are the independent influencing factors of radius shortening after internal fixation.

Volumetric measurement to diagnose syndesmotic injury in Danis-Weber B type ankle fractures / 国际外科学杂志

Objective:To investigate the change of syndesmotic volume via CT scan in Danis-Weber B type ankle fracture, aiming to provide a non-invasive diagnostic method for Danis-Weber B type ankle fracture combined with syndesmotic injury.Methods:Retrospective analysis was performed on 48 patients with Danis-Weber B type ankle fractures in Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2018 to March 2022, including 30 males and 18 females, aging (43.71±19.41) years. Ankle CT scans and three-dimensional reconstructions were performed before surgery and at the last follow-up, measuring the syndesmotic volume between the tibiotalar joint and 1, 3 and 5 cm above the ankle and compared with each other. Intraoperative exploration was used as the gold standard for the syndesmotic injury. Based on the results of exploration of the syndesmotic injury, patients were divided into simple ankle fracture group (fracture group, 25 cases) and ankle fracture combined with syndesmotic injury group (fracture + ligament group, 23 cases). The sensitivity and specificity of this diagnostic method were statistically evaluated. The assessments at the last follow-up were performed to value the clinical effect of surgery. The metric data conforming to the normal distribution were expressed as mean ± standard deviation ( ± s), and the t-tests were used for comparison between groups. The measurement data of skewed distribution were expressed as quartile M( Q1, Q3), and nonparametric tests were used for intergroup comparison. Counting data were expressed as number of cases and percentage (%), and Chi-square test were used for intergroup comparison. Results:In the fracture group, there were no statistically significant differences of the syndesmotic volume at 1, 3, and 5 cm above the ankle joint before surgery and at the last follow-up ( P=0.219, 0.269, 0.103). On the contrary, the volume above were statistically significant in the fracture + ligament group ( P<0.001). There were statistically significant differences in syndesmotic volume between the two groups at 1, 3, and 5 cm above the ankle joint preoperatively ( P=0.005, 0.004, 0.038). By contrast, there were no statistical differences between the two groups postoperatively ( P=0.082, 0.155, 0.249). For the sensitivity and specificity of Danis-Weber B type ankle fractures combined with syndesmotic injury, they were 92% and 67% at 1 cm above the ankle joint, 69% and 87% at 3 cm above the ankle joint, and 62% and 87% at 5 cm above the ankle joint, respectively. The last follow-up clinical function score indicated a good surgical outcome. Conclusions:Volumetric measurement via CT scan is one of the diagnostic methods for evaluating Danis-Weber B type ankle fracture combined with syndesmotic injurys. Open resection internal fixation combined with elastic fixation of the ankle fracture combined with syndesmotic injurys can significantly reduce the lower tibiofibular volume, and the efficacy is definite.

Research on clinical efficacy of robot navigation assistance in the treatment of elderly femoral tuberosity fractures / 国际外科学杂志

Objective:To compare the clinical effects robot navigation assisted and conventional proximal femoral nail antirotation (PFNA) implantation and fixation in the treatment of elderly femoral trochanteric fractures.Methods:A total of 86 elderly patients with tuberosity fracture of the femur were admitted as research samples from January to March in 2022 in the Department of Trauma Orthopaedic, Xi′an Honghui Hospital Affiliated to Xi′an Jiaotong University, including 37 males and 49 females, who aged from 63 to 92 years, with an average age of (79.6 ± 6.9) years. All patients were treated with intramedullary nails (PFNA), 32 with dimensity robotic-assisted therapy (robot group) and 54 with traditional methods (conventional group). The length of incision, the number of intraoperative fluoroscopy, the amount of intraoperative blood loss, and the operation time were recorded. The occurrence of postoperative complications in the two groups was observed. The rate of excellent hip Harris score at 3 month after surgery was compared between the two groups. Measurement data with normal distribution were represented as mean ± standard deviation( ± s), and the comparison between groups was conducted using the t-test; the comparison of count data were represented as [ n(%)], and was conducted by Chi-square test or Fisher exact probability between groups. Results:All patients were followed up for 9 to 12 months, with an average of (10.6 ± 0.9) months. The incision length and tip apex distance (TAD) of the robot group were (3.40±0.82) cm and (21.85±1.44) mm, which were smaller than (4.82±0.75) cm and (26.83±1.75) mm in the conventional group ( P<0.05 for all). The number of intraoperative fluoroscopy and guide needle adjustment [(14.53±3.26) and 0 times] in the robot group were less than those in the conventional group [(20.67±4.84) and (2.83±1.42)] ( P<0.05). The intraoperative blood loss and drainage rate of the robot group were (87.03±9.41) and (46.40±8.91) mL, which were smaller than that of the conventional group [(110.00±12.52) and (69.62±10.22) mL] ( P<0.05). There was no significant difference in the number of days of hospitalization and operation time between the two groups ( P>0.05). The postoperative complication rate in the robot group was 9.4%, which was lower than that in conventional group (42.6%), and the difference was statistically significant ( χ2=11.88, P=0.036). The excellent rate of postoperative hip joint function in the robot group was 75.0%, and the conventional group was 66.7%, and there was no significant difference between the two groups ( χ2=0.66, P=0.416). Conclusion:Robot-assisted navigation downward PFNA surgery can have good clinical effect in the treatment of femoral tuberosity fracture in the elderly, which can reduce the number of surgical incisions and intraoperative fluoroscopy, and reduce the incidence of postoperative complications, which is helpful to achieve minimally invasive surgery and rapid recovery of elderly patients with femoral tuberosity fracture.

Meta-analysis of the effect of hollow nail and bone plate on Lisfranc injury / 中国骨伤

OBJECTIVE@#To compare the clinical efficacy of screw and bone plate internal fixation in the treatment of Lisfranc injury.@*METHODS@#The databases of Wanfang, CNKI, Pubmed, EMBASE, VIP, BIOSIS and other databases were retrieved by computer, and the clinical trial literature from January 1, 2000 to August 1, 2021 was retrieved, the methodological quality of the included studies was strictly evaluated and the data were extracted, and the obtained data were meta-analyzed by Revman 5.4 software.@*RESULTS@#Nine randomized controlled trial literature and 10 retrospective cohort studies were included, of which 416 patients in the experimental group were treated with screw internal fixation, and 435 patients in the control group were treated with bone plate internal fixation. Meta-analysis showed that the surgical time of the bone plate internal fixation group was longer than that of the screw internal fixation group [MD=-14.40, 95%CI(-17.21, -11.60), P<0.000 01], the postoperative X-ray anatomical reduction of the bone plate internal fixation group [MD=0.47, 95%CI(0.25, 0.86), P=0.01], the excellent and good rate of postoperative American orthopedic foot and ankle society(AOFAS) foot function score[MD=0.25, 95%CI(0.15, 0.42), P<0.000 01], postoperative AOFAS foot function score [MD=-5.51, 95%CI(-10.10, -0.92), P=0.02] of the bone plate fixation group was better than those of the screw internal fixation group. Two kinds of operation method had no statistical different for postoperative fracture healing time[MD=1.91, 95%CI(-1.36, 5.18), P=0.25], postoperative visual analgue scale(VAS)[MD=0.38, 95%CI(0.09, 0.86), P=0.11], postoperative complications [MD=1.32, 95%CI(0.73, 2.40), P=0.36], the postoperative infection [MD=0.84, 95%CI(0.48, 1.46), P=0.53], the postoperative fracture internal fixation loosening [MD=1.25, 95% CI(0.61, 2.53), P=0.54], the postoperative incidence of traumatic arthritis [MD=1.80, 95%CI(0.83, 3.91), P=0.14].@*CONCLUSION@#Bone plate fixation has better short-term and medium-term results and lower reoperation rate in the treatment of Lisfranc injury, so it is recommended to use bone plate fixation in the treatment of Lisfranc injury.

Comparison of clinical effects of minimally invasive femoral head replacement and proximal femoral nail antirotation in the treatment of comminuted intertrochanteric fracture in the elderly / 中国骨伤

OBJECTIVE@#To analyze the clinical effect of minimally invasive femoral head replacement and proximal femoral nail antirotation(PFNA) internal fixation at the same time in the treatment of elderly patients with comminuted intertrochanteric fracture.@*METHODS@#From April 2020 to October 2020, 76 elderly patients with comminuted intertrochanteric fracture treated by minimally invasive femoral head replacement and PFNA were analyzed retrospectively. There were 35 patients in the prosthetic group, including 24 females and 11 males with an average age of (86.2±6.1) years old. There were 41 patients in PFNA group including 28 females and 13 males with an average age of (84.6±5.3) years old. The operation time, intraoperative blood loss, postoperative ambulation time, hospitalization time and complications were observed and compared between two groups. Harris hip score was performed at 1, 6 and 12 months after operation.@*RESULTS@#All patients were followed up for 13 to 17 months with an average of (14.3±1.4) months. The operation time of the prosthesis group was longer than that of the PFNA group (P<0.05);the amount of bleeding in PFNA group was less than that in prosthesis group (P>0.05);the time of ambulation in prosthetic group was earlier than that in PFNA group(P<0.05);the number of complications in the prosthesis group was less than that in the PFNA group(P<0.05); the Harris score of prosthesis group was significantly higher than that of PFNA group at 1 and 6 months after operation (P<0.05), but there was no significant difference in Harris score between two groups at 12 months after operation(P>0.05);the number of complications in the prosthesis group was less than that in the PFNA group (P<0.05).@*CONCLUSION@#Minimally invasive femoral head replacement is a good choice for the elderly patients with commuited intertrochanteric fracture. It can improve the quality of life and reduce the burden of family members and society.

Analysis of three minimally invasive methods in the treatment of the fifth metacarpal neck fracture / 中国骨伤

OBJECTIVE@#To explore the effective method of applying Chinese medicine manipulative repositioning Kirschner wire fixation for minimally invasive treatment of fractures of the neck of the fifth metacarpal.@*METHODS@#From January 2018 to November 2021, 90 patients with closed fractures of the neck of the fifth metacarpal bone were treated minimally invasively with closed repositioning Kirschner wires, all fractures AO type was type A. All patients were divided into three groups according to the mode of internal fixation involving 30 cases in the crossed Kirschner's wire group, 30 cases in the transverse Kirschner's wire group, 30 patients in the intramedullary Kirschner's wire group. By comparison, gender, age, disease duration, and preoperative neck-stem angle were not significant. The postoperative fifth metacarpal neck-stem angles, postoperative fifth metacarpophalangeal joint flexion mobility and fifth metacarpophalangeal joint extension hyperextension angles were compared among three groups. The overall clinical efficacy was evaluated according to the patient outcomes of surgery-hand/arm(POS-Hand/Arm) scoring system.@*RESULTS@#All patients had 12-month follow-up and achieved bony union without malunion. There was no significant difference in the 5th metacarpal neck-stem angle, the fifth metacarpophalangeal joint flexion angle and the fifth metacarpophalangeal joint extension hyperextension angles among three groups at 12 months after surgery(P>0.05). There was no significant difference in physical activity and symptom scores in POS-Hand/Arm scores at 12 months after surgery(P>0.05), psychological status and aesthetic score among three groups(P<0.05) and between cross and transverse Kirschner wire groups(P>0.05). The three POS-Hand/Arm total scores were statistically different(P<0.05), between the crossed and transverse(P>0.05), and the intramedullary group had the highest POS-Hand/Arm scores.@*CONCLUSION@#All three techniques of Kristener's wire fixation could achieve minimally invasive treatment, and patients have need for cosmetic and early activity, and the author recommend minimally invasive intramedullary fixation with manipulative repositioned Kristen wires as the preferred procedure.

Posterior cervical pedicle screw rod short-segment internal fixation for the treatment of atlantoaxial fracture and dislocation / 中国骨伤

OBJECTIVE@#To investigate the clinical efficacy of posterior cervical pedicle screw short-segment internal fixation for the treatment of atlantoaxial fracture and dislocation.@*METHODS@#The clinical data of 60 patients with atlantoaxial vertebral fracture and dislocation underwent surgery between January 2015 and January 2018 were retrospectively analyzed. The patients were divided into study group and control group according to different surgical methods. There were 30 patients in study group, including 13 males and 17 females, with an average age of (39.32±2.85) years old, were underwent short-segment internal fixation with posterior cervical pedicle screws. There were 30 patients in control group, including 12 males and 18 females, with an average age of (39.57±2.90) years old, were underwent posterior lamina clip internal fixation of the atlas. The operation time, intraoperative blood loss, postoperative ambulation time, hospitalization time and complications between two groups were recorded and compared. The pain visual analogue scale(VAS), Japanese Orthopedic Association(JOA) score of neurological function, and fusion status were evaluated between two groups.@*RESULTS@#All patients were followed up for at least 12 months. The study group was better than control group in operation time, intraoperative blood loss, postoperative off-bed activity time, and hospital stay (P=0.000). One case of respiratory tract injury occurred in study group. In control group, 2 cases occurred incision infection, 3 cases occurred respiratory tract injury, and 3 cases occurred adjacent segmental joint degeneration. The incidence of complications in study group was lower than that in control group (χ2=4.705, P=0.030). At 1, 3, 7 days after operation, VAS of study group was lower than that of control group(P=0.000). At 1, 3 months after operation, JOA score of study group was higher than that of control group(P=0.000). At 12 months after operation, all the patients in the study group achieved bony fusion. In control group, there were 3 cases of poor bony fusion and 3 cases of internal fixation fracture, the incidence rate was 20.00%(6/30). The difference between two groups was statistically significant (χ2=4.629, P=0.031).@*CONCLUSION@#Posterior cervical short-segment pedicle screw fixation for atlantoaxial fracture and dislocation has the advantages of less trauma, shorter operation time, fewer complications, and less pain, and can promote the recovery of nerve function as soon as possible.

Surgical treatment for ipsilateral femoral neck and shaft fracture / 中国骨伤

OBJECTIVE@#To retrospectively analyze efficacy of single structure internal fixation and double structure internal fixation in the treatment of ipsilateral femoral shaft and neck fracture, and analyze their indications.@*METHODS@#From June 2015 to December 2020, 21 patients with ipsilateral femoral shaft and femoral neck fracture were treated, including 14 males and 7 females, aged 23 to 69 years old with an average of(38.1±12.9) years old. According to different femoral shaft fracture sites, some patients were fixed with cephalomedullary implant for both femoral neck and the femoral shaft(single structure, InterTan or PFNA Ⅱ), some patients were fixed with cannulated screws for the femoral neck and a retrograde locking nail for the femoral shaft (dual structure), and postoperative function and complications were recorded during follow-up. In 10 cases of single-structure fixation, the femoral necks were all basicervical fractures, and the femoral shaft fractures were located in the proximal isthmus;11 cases were double-structure fixation, 9 cases in 11 were basal type of femoral neck, 2 cases in 11 were neck type, and the femoral shaft fractures were located in the isthmus and the distal isthmus.@*RESULTS@#All patients were followed up for 12 to 27 months. No femoral head necrosis, deformity, delay or nonunion occurred in the patients with single-structure fixation, and no delayed union or nonunion occurred in femoral shaft fractures;At the final follow-up, Harris score of patients with single-structure fixation was 91.8±4.1, with 8 cases were excellent and 2 cases were good. The fractures of patients with dual-structure fixation achieved good union without femoral head necrosis, except 1 case of femoral shaft fracture had delayed union;At the final follow-up, Harris score of patients with dual-structure fixation was 92.4±5.9, 7 cases were excellent, 3 cases were good, and 1 case was fair.@*CONCLUSION@#Good reduction and fixation is the key to the treatment of such fractures. Both the single-structure fixation and the dual-structure fixation are good methods, and it should be selected according to the locations of femoral shaft and femoral neck fractures. Single-structure fixation is a good choice for femoral shaft fractures located at the proximal isthmus and basal femoral neck fractures. For isthmus and distal femoral shaft fractures combined with ipsilateral femoral neck fractures, dual-structure fixation is recommended.

Treatment of acute non-displaced scaphoid fracture of wrist with syringe needle-guided percutaneous cannulated headless hollow compression screw internal fixation / 中国骨伤

OBJECTIVE@#To investigate the clinical efficacy of needle-guided percutaneous cannulated compression screw fixation in the treatment of acute non-displaced scaphoid fracture of wrist.@*METHODS@#The clinic data of twenty-eight patients with acute non-displaced scaphoid fracture from January 2014 to January 2019 were analyzed retrospectively. According to the intraoperative method of placement of cannulated screw, they were divided into Guide group(16 patients)and Conventional group(12 patients). There were 13 males and 3 females in Guide group, aged from 20 to 60 years old with an average of(31.42±9.71)years old;5 patients were classified as type A2, 3 patients were classified as type B1 and 8 patients were classified as type B2 according to Herbert classification;they were treated with percutaneous cannulated compression screw fixation under the guidance of needle. There were 11 males and 1 female in Conventional group, aged from 23 to 61 years old with an average of(30.51±7.52)years old;5 patients were classified as type A2, 2 patients were classified as type B1 and 5 patients were classified as type B2 according to Herbert classification;they were treated with conventional percutaneous cannulated compression screw fixation. The operation time, screw angle relative to the longitudinal axis of the scaphoid and wrist function score were assessed and compared between the two groups.@*RESULTS@#A total of 28 patients were followed up from 20 to 45 months with an average of (33.00±8.72) months. None of patients had intraoperative complication and incision infection. These patients returned to work gradually 2 weeks after operation, and all fractures healed within 12 weeks. The operation time in the Guide group was significantly less than that in the Conventinal group(P<0.05). Screw angle relative to the longitudinal axis of the scaphoid in the Guide group was significantly smaller than that in the Conventional group(P<0.05). There was no significant difference in Mayo wrist function scores at the last follow-up between the two groups(P>0.05). During the follow-up period, none of the 28 patients showed internal fixation displacement, arthritis, scaphoid necrosis and other complications.@*CONCLUSION@#In the treatment of acute non-displaced scaphoid fractures, the operation time of needle-guided percutaneous cannulated headless compression screw fixation is significantly shorter than that of conventional percutaneous screw fixation, and the screw axis is easier to be parallel to the longitudinal axis of the scaphoid.

Flexible intramedullary nails in pediatric subtrochanteric femur fracture: biomechanical study / Hastes flexíveis na fixação de fratura subtrocantérica de fêmur pediátrico: análise biomecânica

ABSTRACT Objective Evaluate the stability provided by two flexible intramedullary nails (FINs) in a simulation of fractures at the proximal levels in pediatric femur models. Methods Two FINs were inserted in 18 synthetic models of pediatric femurs. Fractures were simulated at one of three levels, and the models were divided into the following groups (n=6): diaphysis (control), subtrochanteric and trochanteric. Flex-compression tests were performed with force up to 85 N. Relative stiffness and the average deformation was obtained. Torsion tests were performed by rotating the proximal fragment until 20°, to obtain the average torque. Results At flex-compression, the set's average relative stiffness and average deformations were: 54.360x103 N/m and 1.645 mm in the control group, respectively. In the subtrochanteric group, the relative stiffness was 31.415x103 N/m (-42.2%) and the deformation was 2.424 mm (+47.3%) (p<0.05). For the trochanteric group, the relative stiffness was 30.912x103 N/m (+43.1%) and the deformation was 2.508 mm (+52.4%) (p<0.05). In torsion, the average torque was 1.410 Nm in the control group; 1.116 Nm in the subtrochanteric group (-20.8%), and 2.194 Nm in the trochanteric group (+55.6%) (p<0.05). Conclusion FINs do not seem to be biomechanically competent for the treatment of proximal femoral fractures. Level of Evidence I; Therapeutic Studies - Investigating the results of treatment.

RESUMO Objetivo avaliar a estabilidade proporcionada por duas hastes intramedulares flexíveis na simulação de fraturas nos níveis proximais em modelos pediátricos de fêmur. Métodos Duas hastes foram inseridas em 18 modelos sintéticos de fêmures pediátricos. As fraturas foram simuladas em um dos três níveis, e os modelos foram divididos nos seguintes grupos (n=6): diáfise(controle), subtrocantérico e trocantérico. Testes de flexão-compressão foram realizados com força de até 85N. A rigidez relativa e a deformação média foram obtidas. Os testes de torção foram realizados girando o fragmento proximal até 20°, para obter o torque médio. Resultados Na flexo-compressão, a rigidez relativa média e as deformações médias do conjunto foram: 54,360x103 N/m e 1,645 mm no grupo controle, respectivamente. No grupo subtrocantérico a rigidez relativa foi de 31,415x103 N/m (-42,2%) e a deformação foi de 2,424 mm (+47,3%) (p<0,05). Para o grupo trocantérico a rigidez relativa foi de 30,912x103 N/m (+43,1%) e a deformação foi de 2,508 mm (+52,4%) (p<0,05). Na torção, o torque médio foi de 1.410 Nm no grupo controle; 1,116 Nm no grupo subtrocantérico (-20,8%) e 2,194 Nm no grupo trocantérico (+55,6%) (p<0,05). Conclusão As hastes intramedulares flexíveis não parecem ser biomecanicamente competentes para o tratamento das fraturas proximais do fêmur. Nível de Evidência I; Estudos terapêuticos - Investigação dos resultados do tratamento.

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.

Treatment of thoracolumbar fractures by closed reduction via a percutaneous solid pedicle screw / Tratamento de fraturas toracolombares por redução fechada com parafuso de pedículo percutâneo

ABSTRACT Objectives: Investigate the effect of closed reduction and per- cutaneous pedicle screw fixation in treating thoracolumbar fractures. Methods: This retrospective study analyzed 12 cases of single-segment thoracolumbar spine fractures without spinal cord and nerve injury at our department from March 2016 to September 2017. Patients were treated with closed reduction, percutaneous reduction, and internal fixation with solid pedicle screws. The operation time, intraoperative blood loss, anterior vertebral body height ratio (AVHR), Cobb angle (CA) of sagittal kyphosis, and VAS of back pain were determined and statistically compared. Results: The average operation time was 147.2 ± 45.6 min, and the average intraoperative bleeding was 67.8 ± 34.2 mL. All fractured vertebrae were completely reduced, their height was restored, and kyphosis was corrected. The average follow-up period was 10.6 ± 2.7 months, with significant improvements seen in the AVHR, CA of sagittal kyphosis, and VAS score (P < 0.01). One case had a broken rod after three months, and another had a postoperative infection. All the patients achieved bony healing. Conclusion: The treatment of thoracolumbar fractures by closed reduction and internal fixation with a percutaneous solid pedicle screw is simple, effective, and economical. Level of Evidence VI; Therapeutic Study, Case Series.

RESUMO Objetivo: Investigar o efeito da redução incruenta e da fixação com parafuso de pedículo percutâneo no tratamento das fraturas toraco- lombares. Métodos: Este estudo retrospectivo analisou 12 casos de fraturas toracolombares com segmento único sem lesão medular ou neural, encontrados no departamento dentro do período de março de 2016 a setembro de 2017. Os pacientes foram tratados com redução fechada e fixação interna com parafusos de pedículo percutâneo. O tempo de operação, a perda sanguínea intra-operatória, a relação da altura do corpo vertebral anterior (AVHR), o ângulo de Cobb (CA) da cifose sagital e a EVA relativa à dor nas costas foram determinados e comparados estatisticamente. Resultados: O tempo médio da operação foi de 147,2±45,6 min, com sangramento intraoperatório médio de 67,8±34,2 mL. Todas as vértebras fraturadas foram com- pletamente reduzidas, suas alturas foram restauradas e a cifose foi corrigida. O período médio de acompanhamento foi de 10,6±2,7 meses, apresentando melhorias significativas observadas no AVHR, CA da cifose sagital e pontuação VAS (P <0,01). Um caso teve uma haste quebrada após 3 meses, e outro paciente apresentou uma infecção pós-operatória. Todos os pacientes alcançaram a recuperação óssea. Conclusão: O tratamento das fraturas toracolombares por redução fechada com fixação interna pelo parafuso de pedículo percutâneo é simples, eficaz e econômico. Nível de Evidência IV; Estudos Terapêuticos, Série de Casos

Risk of Neurovascular Injury during Screw Fixation of Tibial Tubercle Fractures in Pediatric and Adolescent Patients / Risco de lesão neurovascular durante a fixação com parafuso de fraturas da tuberosidade da tíbia em pacientes pediátricos e adolescentes

Abstract Objective To review knee magnetic resonance imaging (MRI) scans for the analysis of the location of neurovascular structures (NVSs), and to define the risk of bicortical fixation. Methods Distances between the posterior cortex and the popliteal NVSs were measured on the MRI scans of 45 adolescents (50 knees) at 3 levels (C1: center of the proximal tibial epiphysis; C2: 10 mm distal to the physis; and C3: 20 mm distal to the physis). The NVSs located between 5 mm and 10 mm from the incision were considered in a zone of moderate risk for damage, while those less than 5 mm from the incision were considered in a zone of high risk for damage, and those more than 10 mm from the incision were considered to be in a zone of low risk for damage. The independent Student t-test was used for the comparison of the NVS distance 0with gender, skeletal maturity, and the tibial tubercle-trochlear groove (TT-TG) distance. Values of p < 0.05 were regarded as statistically significant. Results The path of the C1 screw posed an increased risk of damage to the popliteal artery and vein compared with other screw paths (p < 0.001). The popliteal artery has a high risk of damage at the level of C1 (4.2 ± 2.2mm), and a moderate risk at C2 (9.6 ± 2.4mm), and the popliteal vein has a moderate risk at C1 (6.0 ± 2.7 mm), and a low risk at C2 and C3 (10.8 ± 3.1mm, and 12.05 ± 3.1mm respectively). The C3 position presented the lowest risk of damage to these structures (p < 0.001). The distance between the posterior tibial cortex and the posterior tibial nerve was < 15 mm at the 3 levels analyzed (C1: 11.0 ± 3.7 mm; C2:13.1 ± 3.8 mm; and C3:13 ± 3.9 mm). Conclusions The present study clarifies that the popliteal vessels are at risk of injury during tibial tubercle screw fixation, particularly when drilling the proximal tibial epiphysis. Monocortical drilling and screw fixation are recommended for the surgical treatment of tibial tubercle fractures. Level of Evidence III Diagnostic study.

Resumo Objetivo Revisar estudos de ressonância magnética (RM) do joelho para análise da localização das estruturas neurovasculares (ENVs) e definição do risco de fixação bicortical. Métodos As distâncias entre o córtex posterior e as ENVs poplíteas foram medidas nas RMs de 45 adolescentes (50 joelhos) em 3 níveis (C1: centro da epífise proximal da tíbia; C2:10 mm distalmente à fise e C3: 20 mm distalmente à fise). Considerou-se que as ENVs entre 5mme10mmda incisão estavam na zona de risco moderado de lesão, as ENVs a menos de 5 mm da incisão, na zona de alto risco de lesão, e as ENVs a mais de 10 mm da incisão, na zona de baixo risco de lesão. O teste t de Student independente foi usado para comparar a distância até as ENVs com o gênero, a maturidade esquelética e a distância entre a tuberosidade tibial e a garganta (fundo) da tróclea (TT-GT). Valores de p < 0,05 foram considerados estatisticamente significativos. Resultados A trajetória do parafuso em C1 apresentou maior risco de lesão à artéria e à veia poplítea em comparação com outras trajetórias (p < 0,001). A artéria poplítea apresenta risco de lesão alto em C1 (4,2 ± 2,2 mm) e moderado em C2 (9,6 ± 2,4 mm), e a veia poplítea tem risco moderado em C1 (6,0±2,7 mm) e baixo em C2 e C3 (10,8±3,1 mm e 12,05±3,1mm, respectivamente). A posição C3 apresentou o menor risco de lesão dessas estruturas (p < 0,001). A distância entre o córtex tibial posterior e o nervo tibial posterior foi inferior a 15 mm nos 3 níveis analisados (C1: 11,0±3,7mm; C2: 13,1±3,8 mm; e C3: 13±3,9mm). Conclusões Este estudo esclarece que os vasos poplíteos correm risco de lesão durante a fixação do parafuso na tuberosidade tibial, principalmente durante a perfuração da epífise proximal da tíbia. A perfuração monocortical e a fixação com parafusos são recomendadas para o tratamento cirúrgico das fraturas da tuberosidade tibial. Nível de Evidência III Estudo diagnóstico.