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.

Is there a Difference in Interfragmentary Compression Strength Between Fully or Partially Threaded Screws? Results of an Experimental Biomechanical Pilot Study / Há diferença na força de compressão interfragmentar entre parafusos com rosca total ou parcial? Resultados de um estudo biomecânico experimental piloto

Abstract Objective This study assessed differences between fully- and partially-threaded screws in the initial interfragmentary compression strength. Our hypothesis was that there would be an increased loss in initial compression strength with the partially-threaded screw. Methods A 45-degree oblique fracture line was created in artificial bone samples. The first group (FULL, n = 6) was fixed using a 3.5-mm fully-threaded lag screw, while the second group (PARTIAL, n = 6) used a 3.5-mm partially-threaded lag screw. Torsional stiffness for both rotational directions were evaluated. The groups were compared based on biomechanical parameters: angle-moment-stiffness, time-moment-stiffness, maximal torsional moment (failure load), and calibrated compression force based on pressure sensor measurement. Results After loss of one PARTIAL sample, no statistically significant differences in calibrated compression force measurement were observed between both groups: [median (interquartile range)] FULL: 112.6 (10.5) N versus PARTIAL: 106.9 (7.1) N, Mann-Whitney U-test: p = 0.8). In addition, after exclusion of 3 samples for mechanical testing (FULL n = 5, PARTIAL n = 4), no statistically significant differences were observed between FULL and PARTIAL constructs in angle-moment-stiffness, time-moment-stiffness, nor maximum torsional moment (failure load). Conclusion There is no apparent difference in the initial compression strength (compression force or construct stiffness or failure load) achieved using either fully-or partially-threaded screws in this biomechanical model in high-density artificial bone. Fully-threaded screws could, therefore, be more useful in diaphyseal fracture treatment. Further research on the impact in softer osteoporotic, or metaphyseal bone models, and to evaluate the clinical significance is required.

Resumo Objetivo Este estudo avaliou diferenças entre parafusos com rosca total ou parcial na resistência à compressão interfragmentar inicial. Nossa hipótese era de que haveria maior perda de resistência à compressão inicial com o parafuso de rosca parcial. Métodos Uma linha de fratura oblíqua de 45 graus foi criada em amostras de osso artificial. O primeiro grupo (TOTAL, n = 6) foi fixado com um parafuso de 3,5 mm de rosca total, enquanto o segundo grupo (PARCIAL, n = 6) usou um parafuso de 3,5 mm de rosca parcial. Avaliamos a rigidez à torção em ambas as direções de rotação. Os grupos foram comparados com base nos seguintes parâmetros biomecânicos: momento de rigidez-ângulo, momento de rigidez-tempo, momento de torção máxima (carga de falha) e força de compressão calibrada com base na medida do sensor de pressão. Resultados Depois da perda de uma amostra PARCIAL, não foram observadas diferenças estatisticamente significativas na força de compressão calibrada entre os 2 grupos [mediana (intervalo interquartil)]: TOTAL: 112,6 (10,5) N e PARCIAL: 106,9 (7,1) N, com p = 0,8 segundo o teste U de Mann-Whitney). Além disso, após a exclusão de 3 amostras para testes mecânicos (TOTAL, n = 5, PARCIAL, n = 4), não foram observadas diferenças estatisticamente significativas entre os construtos TOTAL e PARCIAL quanto ao momento de rigidez-ângulo, momento de rigidez-tempo ou momento de torção máxima (carga de falha). Conclusão Não há diferença aparente na força de compressão inicial (força de compressão ou rigidez do construto ou carga de falha) com o uso de parafusos de rosca total ou parcial neste modelo biomecânico em osso artificial de alta densidade. Parafusos de rosca total podem, portanto, ser mais úteis no tratamento de fraturas diafisárias. Mais pesquisas são necessárias sobre o impacto em modelos ósseos osteoporóticos ou metafisários de menor densidade e avaliação do significado clínico.

Reporte de caso de una niña de 9 años de edad con una fractura acetabular fisaria desplazada tratada quirúrgicamente: 5 años de seguimiento / Case report of an acetabular displaced physeal fracture in a 9-year-old girl treated surgically: follow-up of 5 years / Relato de caso de uma menina de 9 anos com fractura de acetábulo desviada tratada cirurgicamente: seguimento de 5 anos

Las fracturas acetabulares con compromiso del cartílago trirradiado (CTR) en pacientes pediátricos son muy poco frecuentes, difíciles de diagnosticar y complejas de tratar; pudiendo dejar graves secuelas. Generalmente son producto de accidentes de tránsito de alta energía cinética. Debido a su baja prevalencia no hay grandes series en la bibliografía y por ende tampoco existe un consenso terapéutico. Realizamos una puesta a punto del tema a propósito de un atípico caso de una niña de 9 años con una fractura del acetábulo con compromiso del CTR, producido por un traumatismo de baja energía cinética. Registramos su diagnóstico y tratamiento quirúrgico, evaluamos su resultado clínico - radiológico y funcional mediante el Hip Harris Score (HHS) al final de su seguimiento de 5 años.

Acetabular fractures with compromise of the triradiate cartilage (TRC) in pediatric patients are very rare, difficult to diagnose and complex to treat, also can leave serious consequences. They are generally product of high energy kinematics. Due to its low prevalence, there are no large series in the literature and therefore there is no therapeutic consensus. We carried out a recapitulation of the subject regarding an atypical case of a 9-year-old girl with an acetabulum fracture with compromise of the TRC, produced by a low kinetic energy trauma. We recorded the diagnosis and surgical treatment, and also, we evaluated the clinical-radiological and functional results through the Hip Harris Score (HHS) at the end of their 5-year follow-up.

As fraturas acetabulares com compromisso da cartilagem trirradiada (TRC) em pacientes pediátricos são muito poco frecuentes, de difícil diagnóstico e complexas de tratar; e podem deixar sérias consequências. Geralmente são o produto de acidentes de trânsito de alta energia cinética. Devido à sua baixa prevalência, não há grandes séries na literatura e, portanto, não há consenso terapêutico. Realizamos uma atualização do tema referente a um caso atípico de uma menina de 9 anos com fratura de acetábulo com comprometimento do CTR, produzida por um trauma de baixa energia cinética. Registramos seu diagnóstico e tratamento cirúrgico, avaliamos seus resultados clínico-radiológicos e funcionais por meio do Hip Harris Score (HHS) ao final de seu seguimento de 5 anos.

Combined anterior and posterior ring fixation versus posterior ring fixation alone in the management of unstable Tile B and C pelvic ring injuries: A randomized controlled trial / 中华创伤杂志(英文版)

PURPOSE@#Combined anterior and posterior ring (APR) fixation is classically performed in Tile B2 and C1 injuries to achieve superior biomechanical stability. However, the posterior ring (PR) is the main weight bearing portion that is responsible for weight transmission from the upper parts of the body to the lower limbs through the sacrum and the linea terminalis. It is hypothesized that isolated PR fixation can achieve comparable radiological and clinical outcomes to APR fixation. Therefore, we conducted this study to compare the two fixation principles in managing Tile B2 and C1 injuries.@*METHODS@#Our study included 20 patients with Tile B2 injuries and 20 patients with Tile C1 injuries. This study was a randomized control single-blinded study via computerized random numbers with a 1:1 allocation by using random block method. The study was performed at a level one trauma center. A total of 40 patients with Tile B2 and C1 injuries underwent combined APR or isolated PR fixation (Group A and B, respectively). Matta & Tornetta radiological principles and Majeed pelvic scoring system were used for the assessment of primary outcomes and postoperative complications. Secondary outcomes included operative time, amount of blood loss, intraoperative assessment of reduction, need of another operation, length of hospital stay, ability to weight bear postoperatively and pain control metrics. We used student t-test to compare the difference in means between two groups, and Chi-square test to compare proportions between two qualitative parameters. We set the confidence interval to 95% and the margin of error accepted to 5%. So, p ≤ 0.05 was considered statistically significant.@*RESULTS@#The mean follow-up duration was 18 months. The operative time (mean difference 0.575 h) and the intraoperative blood loss (mean difference 97.5 mL) were lower in Group B. Also, despite the higher frequency of rami displacement before union in the same group, there were no significant differences in terms of radiological outcome (excellent outcome with OR = 2.357), clinical outcome (excellent outcome with OR = 2.852) and postoperative complications assessment (OR = 1.556) at last follow-up.@*CONCLUSION@#The authors concluded that isolated PR fixation could favorably manage Tile B2 and C1 pelvic ring injuries with Nakatani zone II pubic rami fractures and intact inguinal ligament. Its final radiological and clinical outcomes and postoperative complications were comparable to combined APR fixation, but with less morbidity (shorter operation time, lower amount of blood, and no records of postoperative wound infection).

Double-pulley combined with suture bridge technique for fixation of comminuted fractures of distal patella pole / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of double pulley combined with suture bridge in the treatment of comminuted fracture of the lower pole of the patella.@*METHODS@#From January 2018 to June 2020, 15 patients with comminuted fracture of the lower pole of the patella were treated with double pulley and suture bridge technology, including 9 males and 6 females, aged 28 to 68 years old with an average of (42.4±9.6) years old. All patients had obvious knee joint pain and limited movement after injury. All knee joints were examined by X-ray and CT, which confirmed that they were all comminuted fractures at the lower level of the patella. After operation, X-ray films of the knee joint were taken regularly to understand the fracture healing, the Insall Salvati index was measure, the range of motion of the joint was recorded, and the function of the knee joint was evaluateed by the Bostman scoring system.@*RESULTS@#All the 15 patients were followed up for 7 to 24 months with an average of (11.4±4.2) months, and there was no obvious anterior knee pain. At the last follow-up, the knee joint range of motion of the affected limb was 105° to 140° with an average of (128.5±12.8) °, and the Insall Salvati index was 0.79 to 1.12 with an average of (0.92±0.18). The X-ray film showed that the patella was bone healing, and no anchor fell off, broken, or displaced fracture block was found. Bostman patellar fracture function score was 27.85±2.06, 13 cases were excellent, 2 cases were good.@*CONCLUSION@#Double pulley technique combined with suture bridge technique is reliable for reduction and fixation of comminuted fracture of the lower pole of patella, and patients can start functional exercise early after operation.

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.

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.

Surgical treatment methods and classification of proximal clavicle fracture / 中国骨伤

OBJECTIVE@#To summarize the surgical treatment of different proximal clavicle fractures, and discuss the classification of proximal clavicle fractures.@*METHODS@#Total of 24 patients with displaced proximal clavicle fractures were treated from January 2017 to December 2020 including 16 males and 8 females, aged 28 to 66 years old. Among them, 20 cases were fresh fractures and 4 cases were old fractures. According to the Edinburgh classification, 14 cases were type 1B1 fractures and 10 cases were type 1B2 fractures. The different internal fixation methods were selected for internal fixation treatment according to different fracture types.The operation time, blood loss, preoperative and postoperative displacement difference, fracture healing time and Rockwood scoring system were recorded.@*RESULTS@#All patients were followed up for 12 to 24 months. There were no patients with infection or loss of reduction after the operation. Three patients had internal fixation failure after operation, and the internal fixation device was removed. Results The operation time was 30 to 65 min, and the blood loss was 15 to 40 ml. No important nerves, blood vessels, or organs were damaged. The imaging healing time was 3 to 6 months. According to the Rockwood functional score, the total score was (13.50±1.86), pain (2.57±0.50), range of motion (2.78±0.41), muscle strength (2.93±0.28), restricted daily activity (2.85±0.35), subjective results (2.63±0.61);the results were excellent in 20 cases, good in 3 cases, fair in 1 case.@*CONCLUSION@#Proximal clavicular fracture is a type of fracture with low incidence. According to different fracture types, different internal fixation methods and treatment methods can be selected, and satisfactory surgical results can be achieved.

Clinical effect of Kirschner wire intramedullary fixation in the treatment of pediatric both-bone forearm fractures at high altitude area / 中国骨伤

OBJECTIVE@#To explore the clinical effect of Kirschner wire intramedullary fixation in the treatment of both-bone forearm fractures in children of high altitude area.@*METHODS@#From August 2020 to December 2021, 19 children were treated with Kirschner wire intramedullary fixation including 11 males and 8 females, aged from 4 to 13 years old with an average of (8.16±2.71) years old. The course of disease was 1 to 10 days, with a mean of (4.11±2.51) d. First, close reduction was performed. If the reduction was unsuccessful, limited open reduction was performed, followed by Kirschner wire intramedullary fixation of the radius and ulna. The fracture healing was evaluated by X-ray after operation, and the curative effect was evaluated by Anderson forearm function score standard.@*RESULTS@#The wound healed well after operation, 2 cases had clinical manifestations of needle tail irritation after operation, and the symptoms disappeared after removing the internal fixation. The average follow-up time was(7.68±3.50) months (3 to 14 months). X-ray showed that all fracture healing in follow-up, Anderson forearm function score showed excellent in 16 cases, good in 2 cases and fair in 1 case at the final follow-up.@*CONCLUSION@#Children with fractures in plateau areas often have delayed medical treatment, lack of medical conditions and insufficient compliance. Based on these characteristics, Kirschner wire intramedullary fixation for the treatment of children's double forearm fractures has the advantages of small injury and rapid recovery. It is a kind of operation method that can be popularized.

Efficacy of micro steel plate and Kirschner needle oblique and transverse internal fixation of adjacent metacarpal bone in the treatment of metacarpal diaphyseal oblique fracture / 中国骨伤

OBJECTIVE@#To compare the clinical efficacy of micro steel plate and Kirschner needle oblique and transverse internal fixation of adjacent metacarpal bone in the treatment of metacarpal diaphyseal oblique fracture.@*METHODS@#Fifty-nine patients with metacarpal diaphyseal oblique fractures admitted between January 2018 and September 2021 were selected as the study subjects and divided into the observation group (29 cases) and the control group (30 cases) based on different internal fixation methods. The observation group was treated with Kirschner wire oblique and transverse internal fixation of adjacent metacarpal bones, while the control group was treated with micro steel plate internal fixation. Postoperative complications, operation time, incision length, fracture healing time, treatment cost, and metacarpophalangeal function were compared between the two groups.@*RESULTS@#No incision or Kirschner wire infections occurred in the 59 patients, except for one in the observation group. No fixation loosening, rupture, or loss of fracture reduction occurred in any of the patients. The operation time and incision length in the observation group were (20.5±4.2) min and (1.6±0.2) cm, respectively, which were significantly shorter than those in the control group (30.8±5.6) min and (4.3±0.8) cm (P<0.05). The treatment cost and fracture healing time in the observation group were (3 804.5±300.8) yuan and (7.2±1.1) weeks, respectively, which were significantly lower than those in the control group (9 906.9±860.6) yuan and (9.3±1.7) weeks (P<0.05). The excellent and good rate of metacarpophalangeal joint function in the observation group was significantly higher than that in the control group at 1, 2, and 3 months after operation (P<0.05), but there was no significant difference between the two groups at 6 months after operation (P>0.05).@*CONCLUSION@#Micro steel plate internal fixation and Kirschner wire oblique and transverse internal fixation of adjacent metacarpal bones are both viable surgical methods for treating metacarpal diaphyseal oblique fractures. However, the latter has the advantages of causing less surgical trauma, shorter operation time, better fracture healing, lower cost of fixation materials, and no need for secondary incision and removal of internal fixation.

Application of intermittent flap opening in L-shaped surgical incision of calcaneal fracture / 中国骨伤

OBJECTIVE@#To explore clinical effect of intermittent flap opening technique in L-shaped incision of calcaneal fracture.@*METHODS@#From January 2017 to January 2019, 48 patients with Sanders typeⅡ to Ⅳ calcaneal fractures were treated by open reduction and internal fixation. According to different flap opening techniques, the patients were divided into control group and observation group, 24 patients in each group. In observation group, there were 17 males and 7 females, aged from 20 to 60 years old with an average of(45.12±9.56) years old;7 patients were typeⅡ, 10 patients were type Ⅲ and 7 patients were type Ⅳ according to Sanders classification;3 patients were C0, 16 patients were C1 and 5 patients were C2 according to Tscherne-Gotzen soft-tissue assessment;treated with intermittent flap technique. In control group, there were 19 males and 5 females aged from 20 to 60 years old with an average of (47.32±10.67) years old;7 patients were typeⅡ, 11 patients were type Ⅲ and 6 patients were type Ⅳ according to Sanders classification;2 patients were C0, 18 patients were C1 and 4 patients were C2 according to Tschemc-Gotzen soft-tissue assessment;treated with static flap opening technique. Operation time, flap retraction time, changes of Böhler angle and Gissane angle before and after operation at 3 days, and occurrence of incision complications were observed and compared between two groups.@*RESULTS@#All patients were followed up from 3 to 6 months with an average of(4.52±1.01) months. There were no significant differences in operation time, changes of Böhler angle and Gissane angle before and after operation at 3 days between the two groups(P>0.05);there was statistical difference in flap retraction time between two groups(P<0.05). Occurrence of incision complications in observation group was significantly lower than that in control group (P<0.05).@*CONCLUSION@#Intermittent flap opening technique is superior to static opening technique in reducing incision complications of lateral "L" approach of calcaneus. Single Kirschner wire opening does not affect the exposure, reduction and fixation of fracture during operation.

Treatment of Sanders typeⅡto Ⅲ calcaneal fractures with percutaneous reduction and minimally invasive calcaneal screw fixation / 中国骨伤

OBJECTIVE@#To investigate clinical effect of percutaneous reduction combined with internal fixation of calcaneal nail in treating Sanders typeⅡto Ⅲ calcaneal fractures.@*METHODS@#From July 2017 to August 2019, clinical data of 98 patients with Sanders typeⅡto Ⅲ calcaneal fractures treated were retrospectively analyzed, and divided into observation group and control group according to different surgical methods. In observation group, there were 35 males and 21 females, aged from 23 to 58 years old with an average of (34.50±7.81) years old;29 patients with Sanders typeⅡand 27 patients with Sanders type Ⅲ;30 patients on the left side and 26 patients on the right side;the time from fracture to operation ranged from 1 to 4 days with an average of (3.45±0.54) days;and treated with percutaneous reduction combined with internal fixation of calcaneal nail system. In control group, there were 25 males and 17 females, aged from 25 to 60 years old with an average of (35.27±7.64) years old;23 patients with Sanders type Ⅱ and 19 patients with Sanders type Ⅲ;24 patients on the left side and 18 patients on the right side;the time from fracture to operation ranged from 2 to 5 days with an average of (3.42±0.62) days;and treated with open reduction and internal fixation. Operation time, blood loss, hospital stay, fracture healing time, and postoperative visual analogue scale (VAS) at 1 day, preoperative and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Böhler angle, Gissane angle and calcaneus width, and postoperative complications were compared between two groups.@*RESULTS@#All patients were followed up from 13 to 18 months with an average of (15.6±2.2) months. There were significant differences in operation time, blood loss, hospital stay, fracture healing time and postoperative VAS at 1 day between two groups (P<0.05). There was statistical difference in postoperative AOFAS score at 12 months between two groups (P<0.05), and AOFAS score at 12 months after operation was higher than that before operation (P<0.05). According to AOFAS score, 21 patients got excellent result, 30 good and 5 moderate in observation group, and 10 excellent, 22 good, 7 moderate and 3 poor in control group, which had statistical difference between two groups (P<0.05). Postoperative Böhler angle, Gissane angle and calcaneus width at 6 months were better than that before operation between two groups(P<0.05). One patient in observation and 20 patients in control group occurred skin numbness after operation, and 14 patients occurred skin necrosis in control group, there were obvious difference between two groups(P<0.01).@*CONCLUSION@#Compared with open reduction and internal fixation, percutaneous reduction combined with internal fixation system in treating Sanders typeⅡto Ⅲ calcaneal fractures is feasible for fracture repair without waiting for foot deswelling, which could accurately restore normal shape and position of the fractured heel bone, completely eliminate fracture malunion, and reduce postoperative complications. Therefore, it could shorten operation time, hospital stay, fracture healing time, reduce amount of blood loss, promote postoperative recovery, and less complications, high safety, which could be used as a choice of orthopedic surgery for foot and ankle trauma.

Comparison of clinical effect and postopertaive incisions between No-touch technique and traditional retractor in treating calcaneal fracture / 中国骨伤

OBJECTIVE@#To compare clinical efficacy of No-touch technique and traditional retractor in treating calcaneal fracture.@*METHODS@#Clinical data of 74 calcaneal fracture patients with closed Sanders typeⅡ to Ⅳ were retrospectively analyzed from July 2019 to June 2021. According to different treatment methods, the patients were divided into No-touch group and conventional group, 37 patinets in each group. In No-touch group, there were 25 males and 12 females, aged from 19 to 70 years old with an average of (42.64±14.16) years old;17 patients were typeⅡ, 14 patinets with type Ⅲ, 6 patients with type Ⅳ according to Sanders fracture classification;three 2.0 mm Kirschner wires were implanted into the talus body, talus neck, and cuboid bone, and the flap was turned upward to expose the operation area. In conventional group, there were 30 males and 7 females, aged from 19 to 67 years old with an average of (41.56±11.38) years old;17 patients with typeⅡ, 12 patients with type Ⅲ, 8 patients with type Ⅳ according to Sanders fracture classification;the operation was completed by exposing the operation area with traditional retractor. Operation time, postoperative incision complications, postoperaive American Orthopedic Foot and Ankle Society (AOFAS) ankle hind foot score at 6 months between two groups were compared.@*RESULTS@#Seventy-four patients were followed up, and follow-up time in No-touch group ranged from 6 to 17 months with an average of(9.57±2.72) months, while in conventional group ranged from 6 to 16 months with an averge of(9.14±2.71) months, and no difference in follow-up between two groups (P>0.05). Operation time in No-touch group (55.67±7.94) min was shorter than that in conventional group (70.16±9.41) min (P<0.05);four patients in No-touch group occurred incision complications, while 8 patients in normal group, and had statistically difference(P<0.05). Daily activities and support, maximum walking distance (block), ground walking, limited degree of flexion, extension and valgus, foot alignment and total score of AOFAS scores in No-touch group was significantly higher than that of conventional group (P<0.05). There were no significant difference in pain degree, abnormal gait and ankle hind foot stability between two groups(P>0.05). According to AOFAS score, 19 patients got excellent result, 16 good and 2 poor in No-touch group;while 9 excellent, 24 good, and 4 poor in conventional group, and no difference between two groups (P>0.05).@*CONCLUSION@#Compared with traditional retractor in treating calcaneal fracture, No-touch technology could significantly shorten operation time, reduce incidence of postopertive complications, while two methods could improve excellent and good rate of ankle joint function recovery after operation.

Effectiveness of suture anchor fixation combined with Nice knot strapping via longitudinal patellar drilling in treatment of patellar inferior pole fracture / 中国修复重建外科杂志

OBJECTIVE@#To investigate effectiveness of suture anchor fixation combined with Nice knot strapping via longitudinal patellar drilling in the treatment of patellar inferior pole fractures.@*METHODS@#A clinical data of 37 patients with unilateral patellar inferior pole fracture who met the selection criteria between June 2017 and June 2021 was retrospectively analyzed. Among them, 17 cases were treated with the suture anchor fixation combined with Nice knot strapping via longitudinal patellar drilling (group A), and 20 cases were treated with the traditional Kirschner wire tension band technique (group B). There was no significant difference in terms of gender, age, body mass index, fracture side, combined medical disease, and preoperative hemoglobin between the two groups ( P>0.05). Operation time, intraoperative blood loss, postoperative complications, fracture healing time, knee range of motion, and knee function Bostman score (range of motion, pain, daily work, muscle atrophy, walking aids, knee effusion, soft leg, and stair climbing) and grading were recorded in both groups at last follow-up.@*RESULTS@#There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05). All incisions healed by first intention. All patients were followed up 1-2 years, with an average of 1.7 years. X-ray films reexamination showed that all fractures in group A healed, while 2 cases in group B did not heal. There was no significant difference in bone healing time between the two groups ( P>0.05). At last follow-up, the knee range of motion, the range of motion score of Bostman score, total score and effectiveness grading in group A were significantly better than those in group B ( P<0.05). There was no significant difference in the other items of Bostman scores between the two groups ( P>0.05). During follow-up, 2 cases of internal fixation failure and 1 case of internal fixator irritation occurred in group B, and no complication related to internal fixation occurred in group A. The occurrence of complications was significantly lower in group A than in group B ( P<0.05).@*CONCLUSION@#Compared with the traditional Kirschner wire tension band technique, the suture anchor combined with Nice knot strapping via longitudinal patellar drilling for the patellar inferior pole fractures has the advantages of simple operation, reliable fixation, early flexion and extension activity, and better functional recovery of knee joint.

Application of absorbable anchor combined with Kirschner wire in reconstruction of extension function of old mallet finger / 中国修复重建外科杂志

OBJECTIVE@#To investigate the feasibility and effectiveness of absorbable anchor combined with Kirschner wire fixation in the reconstruction of extension function of old mallet finger.@*METHODS@#Between January 2020 and January 2022, 23 cases of old mallet fingers were treated. There were 17 males and 6 females with an average age of 42 years (range, 18-70 years). The cause of injury included sports impact injury in 12 cases, sprain in 9 cases, and previous cut injury in 2 cases. The affected finger included index finger in 4 cases, middle finger in 5 cases, ring finger in 9 cases, and little finger in 5 cases. There were 18 patients of tendinous mallet fingers (Doyle type Ⅰ), 5 patients were only small bone fragments avulsion (Wehbe type ⅠA). The time from injury to operation was 45-120 days, with an average of 67 days. The patients were treated with Kirschner wire to fix the distal interphalangeal joint in a mild back extension position after joint release. The insertion of extensor tendon was reconstructed and fixed with absorbable anchors. After 6 weeks, the Kirschner wire was removed, and the patients started joint flexion and extension training.@*RESULTS@#The postoperative follow-up ranged from 4 to 24 months (mean, 9 months). The wounds healed by first intention without complications such as skin necrosis, wound infection, and nail deformity. The distal interphalangeal joint was not stiff, the joint space was good, and there was no complication such as pain and osteoarthritis. At last follow-up, according to Crawford function evaluation standard, 12 cases were excellent, 9 cases were good, 2 cases were fair, and the good and excellent rate was 91.3%.@*CONCLUSION@#Absorbable anchor combined with Kirschner wire fixation can be used to reconstruct the extension function of old mallet finger, which has the advantages of simple operation and less complications.

Surgical technique and effectiveness of titanium elastic nail assisted retrograde channel screw implantation in superior pubic branch / 中国修复重建外科杂志

OBJECTIVE@#To investigate the surgical technique and effectiveness of titanium elastic nail (TEN) assisted retrograde channel screw implantation of superior pubic branch.@*METHODS@#The clinical data of 31 patients with pelvic or acetabular fractures treated with retrograde channel screw implantation in superior pubic branch between January 2021 and April 2022 were retrospectively analyzed. Among them, 16 cases were implanted with assistance of TEN (study group) and 15 cases were implanted under the guidance of C-arm X-ray machine (control group). There was no significant difference in gender, age, cause of injury, Tile classification of pelvic fracture, Judet-Letournal classification of acetabular fracture, and time from injury to operation between the two groups ( P>0.05). The operation time, fluoroscopy times, and intraoperative blood loss of each superior pubic branch retrograde channel screw were recorded during operation. X-ray films and three-dimensional CT were reexamined after operation, the quality of fracture reduction was evaluated by Matta score standard, and the position of channel screw was evaluated by screw position classification standard. The fracture healing time was recorded during the follow-up, and the postoperative functional recovery was evaluated by Merle D'Aubigne Postel score system at last follow-up.@*RESULTS@#Nineteen and 20 retrograde channel screws of superior pubic branch were implanted in the study group and the control group, respectively. The operation time, fluoroscopy times, and intraoperative blood loss of each screw in the study group were significantly less than those in the control group ( P<0.05). According to the postoperative X-ray films and three-dimensional CT, none of the 19 screws in the study group penetrated out of the cortical bone or into the joint, and the excellent and good rate was 100% (19/19); in the control group, there were 4 screws of cortical bone penetration, and the excellent and good rate was 80% (16/20); the difference between the two groups was significant ( P<0.05). Matta score standard was used to evaluate the quality of fracture reduction, there was no patient in the two groups with poor reduction results, and the difference was not significant between the two groups ( P>0.05). The incisions of the two groups healed by first intention, and there was no complication such as incision infection, skin margin necrosis, and deep infection. All patients were followed up 8-22 months, with an average of 14.7 months. There was no significant difference in healing time between the two groups ( P>0.05). At last follow-up, the difference in functional recovery evaluated by the Merle D'Aubigne Postel scoring system between the two groups was not significant ( P>0.05).@*CONCLUSION@#TEN assisted implantation technique can significantly shorten the operation time of retrograde channel screw implantation of superior pubic branch, reduce the times of fluoroscopy, and have less intraoperative blood loss and accurate screw implantation, which provides a new safe and reliable method for minimally invasive treatment of pelvic and acetabular fractures.

Tratamiento de las fracturas por herida de arma de fuego: revisión bibliográfica sistematizada / Treatment of gunshot wound fractures: systematic review of the literature / Tratamento de fraturas por arma de fogo: revisão bibliográfica sistematizada

Introducción: Las fracturas por heridas de arma de fuego son un motivo de consulta habitual en nuestro país. Existe gran variabilidad de conductas respecto a su tratamiento. El objetivo principal de este trabajo es analizar los distintos tratamientos y sus indicaciones. Materiales: Se realizó una revisión sistematizada de la literatura en las bases de datos Pubmed y Scielo. Se incluyeron artículos con fracturas por herida de arma de fuego en miembros superiores e inferiores, excluyendo la mano. Se analizó: tratamiento (ortopédico o quirúrgico), debridamiento, antibioticoterapia y complicaciones. Resultados: Se obtuvieron 19 artículos que cumplían los criterios de inclusión y exclusión. Los artículos tuvieron un Nivel de Evidencia tipo 2b, 3 y 4. Conclusiones: Los artículos analizados tienen un bajo nivel de evidencia. La fijación quirúrgica es variable y depende de la topografía ósea, la lesión de partes blandas y las lesiones asociadas. El debridamiento profundo está relacionado con mayores índices de infección. Las fracturas estables de tratamiento ortopédico no deberían debridarse ya que aumenta los índices de infección. Debería realizarse antibioticoterapia intravenosa inicial en todos los pacientes, la terapia posterior es discutida.

Introduction: Fractures due to gunshot wounds are a common reason for consultation in our country. There is great variability of conduct regarding its treatment. The main objective of this work is to analyze the different treatments and their indications. Materials: A systematic review of the literature was carried out in the Pubmed and Scielo databases. Articles with fractures due to gunshot wounds in the upper and lower limbs (excluding the hand) were included. We analyzed: treatment (orthopedic or surgical), debridement, antibiotic therapy and complications. Results: 19 articles were obtained that met the inclusion and exclusion criteria. The articles had a Level of Evidence type 2b, 3 and 4. Conclusions: The articles analyzed have a low level of evidence. Surgical fixation is variable and depends on bone topography, soft tissue injury, and associated injuries. Deep debridement is associated with higher rates of infection. Stable orthopedically treated fractures should not be debrided as this increases infection rates. Initial intravenous antibiotic therapy should be performed in all patients, subsequent therapy is discussed.

Introdução: As fraturas por ferimentos por arma de fogo são motivo comum de consulta em nosso país. Há grande variabilidade de conduta quanto ao seu tratamento. O objetivo principal deste trabalho é analisar os diferentes tratamentos e suas indicações. Materiais: Foi realizada revisão sistemática da literatura nas bases de dados Pubmed e Scielo. Foram incluídos artigos com fraturas por arma de fogo em membros superiores e inferiores, excluindo a mão. Foram analisados: tratamento (ortopédico ou cirúrgico), desbridamento, antibioticoterapia e complicações. Resultados: foram obtidos 19 artigos que atenderam aos critérios de inclusão e exclusão. Os artigos tinham Nível de Evidência tipo 2b, 3 e 4. Conclusões: Os artigos analisados ​​apresentam baixo nível de evidência. A fixação cirúrgica é variável e depende da topografia óssea, lesão de tecidos moles e lesões associadas. O desbridamento profundo está associado a maiores taxas de infecção. Fraturas estáveis ​​tratadas ortopedicamente não devem ser desbridadas, pois isso aumenta as taxas de infecção. A antibioticoterapia intravenosa inicial deve ser realizada em todos os pacientes, a terapia subsequente é discutida.

Evaluar los resultados funcionales, radiológicos y las complicaciones en el tratamiento quirúrgico de las fracturas acetabulares bilaterales / Functional, radiological results and complications evaluation in the surgical treatment of bilateral acetabular fractures

Las Fracturas Acetabulares bilaterales tienen una incidencia extremadamente baja. El objetivo es evaluar los resultados funcionales, radiológicos y las complicaciones en el tratamiento quirúrgico de las fracturas acetabulares bilaterales. Este estudio se basa en datos de 722 Fracturas de Acetábulo tratadas por el autor principal durante 15 años desde enero de 2005 a septiembre de 2020. Se realizó un estudio descriptivo y retrospectivo. Se incluyeron 13 casos correspondientes al 1,8% del universo. El 72,7% de las fracturas se presentaron por accidentes de tránsito, el 69,3% corresponden a fracturas de patrón asociado en relación con el 30,7% de fracturas de patrón simple. En el 56,5% se realizó abordaje de Kocher Langenbeck. La reducción anatómica se logró en el 92,30%, en el 7,69% la reducción no fue satisfactoria. Para la evaluación funcional se utilizó el HHS, 88,46% reportaron buenos resultados y 11,53% insatisfactorios. Respecto a las complicaciones, 7,69% presentaron osteoartrosis Tönnis II y 7,69% neuroapraxia del nervio ciático izquierdo. Se encontró supervivencia del 100%. El tiempo ideal para la resolución quirúrgica es antes de las 3 semanas. Los resultados radiológicos y funcionales están directamente relacionados al tiempo de fijación, es importante tomar en cuenta que debido a la magnitud de la energía del impacto que se transmite por ambos acetábulos los patrones de fractura que coexisten entre ambas superficies articulares son diferentes, por lo que optimizar la planificación preoperatoria es fundamental(AU)

Bilateral Acetabular Fractures have an extremely low incidence. The objective is to evaluate the functional and radiological results and the complications in the surgical treatment of bilateral Acetabular Fractures. This study is based on a data of 722 acetabulum fractures cases treated by the lead author for over 15 years from january 2005 to september 2020. A descriptive, retrospective study was made. 13 cases corresponding to 1,8% of the universe were included. 72,7% of the fractures occurred due to traffic accidents, 69,3% correspond to associated pattern fractures in relation to 30,7% of simple pattern fractures. In 56,5% the Kocher Langenbeck approach was performed. The anatomical reduction was achieved in 92,30%, in 7,69% the reduction was not satisfactory. The functional result was evaluated according to the HHS, obtaining good results in 88,46% of the cases and unsatisfactory results in 11,53%. Regarding complications, we found 7,69% with Tönnis II osteoarthrosis, 7,69% with neuropraxia of the left sciatic nerve. Successful results with 100% survival were found. The ideal time for surgical resolution is before 3 weeks. The radiological and functional results are directly related to the fixation time. It is important to take into account that due to the magnitude of the impact energy that is transmitted by both acetabulums, the fracture patterns that coexist between both articular surfaces are different, so optimizing preoperative planning is essential(AU)

Is Atrophic Nonunion a Misnomer - A Hospital-based Prospective Cross-Sectional Study / Pseudoartrose atrófica é um termo incorreto? - Um estudo hospitalar transversal prospectivo

Abstract Objective The present study was conducted to estimate histologically the proportion of avascularity of fracture ends in case of nonunion of long bones. Methods A total of 15 cases of established quiescent nonunion were operated according to the standard protocol and the fracture ends were evaluated histologically. The biopsied tissue was briefly fixed with formalin, embedded with paraffin (FFPE), and 5-micron sections were stained with hematoxylin and eosin according to standard protocols. Immunohistochemistry with anti-CD31 antibody (JC70A clone, DBS) was performed manually using standard protocols. Results All cases of quiescent nonunion were included; radiologically, 2 cases were oligotrophic, and 13 cases were of atrophic nonunion. A total of 20% of the patients were females, 40% were in the age group between 31and 40 years old, and, radiologically, all cases were of atrophic nonunion. All cases showed positivity for CD-31 on immunohistochemistry. The blood vessel density was category I in 13.33% of the cases and category II in 86.67% of the cases. Four cases presented with mild inflammation and two presented with moderate inflammation. The average vessel count was 10 per high power field in the age groups between 20 and 30, 31 and 40, and 41and 50 years old. The age group between 61 and 70 years old showed an average vessel count of 4 per high power field. The difference in the vessel counts of oligotrophic and atrophic nonunion was not significant. No correlation was observed in the density of vessel count and duration of nonunion Conclusion The nomenclature for the classification of nonunion into atrophic, oligotrophic, and hypertrophic needs revision. Our findings do not support that atrophic and oligotrophic nonunion are histologically different.

Resumo Objetivo O presente estudo estimou a proporção de avascularidade histológica das extremidades das fraturas em caso de pseudoartrose de ossos longos. Métodos No total, 15 casos de pseudoartrose quiescente estabelecida foram operados de acordo com o protocolo padrão e as extremidades da fratura foram avaliadas histologicamente. Em resumo, o tecido biopsiado foi fixado em formalina e embebido em parafina (FFPE); secções de 5 mícrons foram coradas com hematoxilina e eosina de acordo com os protocolos padrões. A imunohistoquímica com anticorpo anti-CD31 (clone JC70A, DBS) foi realizada manualmente segundo protocolos padrões. Resultados Todos os casos de pseudoartrose quiescente foram incluídos; 2 eram de pseudoartrose oligotrófica e 13 eram de pseudoartrose atrófica à radiologia. Destes, 20% eram de pacientes do sexo feminino, 40% de indivíduos entre 31 e 40 anos de idade e todos os casos eram de pseudoartrose atrófica à radiologia. Todos os casos eram positivos para CD-31 à imunohistoquímica. A densidade dos vasos sanguíneos era de categoria I em 13,33% dos casos e de categoria II em 86,67%. Quatro casos apresentavam inflamação branda e dois apresentavam inflamação moderada. O número médio de vasos era de 10 por campo de alta potência na faixa etária de 20 a 30, de 31 a 40 e de 41 a 50 anos. A faixa etária de 61 a 70 anos apresentava, em média, 4 vasos por campo de alta potência. A diferença nos números de vasos em pseudoarthroses oligotróficas e atróficas não foi significativa. Não houve correlação entre a densidade de vasos e a duração da pseudoartrose. Conclusão A nomenclatura de classificação da pseudoartrose em atrófica, oligotrófica e hipertrófica precisa ser revista. Nossos achados não indicam que a pseudoartrose atrófica e oligotrófica sejam histologicamente diferentes.

Abordaje rehabilitador de paciente con distrofia facioescapulohumeral y fractura de cadera / Rehabilitative Approach to a Patient with Facioscapulohumeral Dystrophy and Hip Fracture

La distrofia facioescapulohumeral es una miopatía progresiva de base genética, con gran variabilidad fenotípica. Se caracteriza por la progresión de cambios distróficos en la dirección cráneo-caudal con lesiones asimétricas de los músculos faciales, cintura escapular, hombros y piernas. Se expone este caso con el objetivo de demostrar la importancia de la rehabilitación en el manejo integral de pacientes con distrofia muscular y fractura de cadera. Se presenta el abordaje rehabilitador en una paciente con distrofia facioescapulohumeral y fractura de cadera tratada mediante artroplastia total de cadera. El tratamiento rehabilitador precoz contribuyó a mejorar el control del dolor y su recuperación funcional(AU)

Facioscapulohumeral dystrophy is a genetically based progressive myopathy (4q35), with great phenotypic variability. It is characterized by the progression of dystrophic changes in the craniocaudal direction with asymmetric lesions of the facial muscles, shoulder girdle, shoulders, and legs. We report the rehabilitation approach in a female patient with facioscapulohumeral dystrophy and hip fracture treated by total hip arthroplasty. A rehabilitation program was included and improvement in pain control and functionality was observed. Rehabilitation is a fundamental pillar in the comprehensive management of patients with muscular dystrophy and hip fracture(AU)