Seguridad de la cirugía de luxofracturas vertebrales toracolumbares según la oportunidad quirúrgica / Safety of surgical treatment for thoracolumbar fracture-dislocations according to surgical timing

Introducción: Las luxofracturas vertebrales toracolumbares se producen por traumatismos de alta energía, representan el 10% de las lesiones traumáticas de la columna vertebral y se asocian frecuentemente con otras lesiones. El objetivo de este estudio fue comparar las complicaciones tempranas en pacientes con una luxofractura toracolumbar según la oportunidad quirúrgica, antes o después de las 24 h del trauma. Materiales y métodos: Estudio multicéntrico, analítico, observacional y retrospectivo de una cohorte de pacientes operados por una luxofractura toracolumbar, desde el 1 de enero de 2014 hasta el 1 de enero de 2023. Se inclu-yó a pacientes de ambos sexos, >18 años, operados por una luxofractura vertebral de alta energía. Se los agrupó según si habían sido operados de columna antes o después de las 24 h del trauma. Se registraron las complicaciones totales y agrupadas. Resultados: Se evaluó a 72 pacientes, 64 hombres (88,9%) y 8 mujeres (11,1%), con una edad promedio de 35.94 años. Predominaron las instituciones laborales (n = 60; 83,3%). El mecanismo de lesión más frecuente fueron los accidentes de tránsito (n = 42; 58,3%), seguidos de las caídas de altura (n = 26; 36,1%). El 86% sufrió una o más lesiones asociadas. Se registraron 283 complicaciones en 67 (93,1%) pacientes y 45 complicaciones quirúrgicas en 26 pacientes (36,1%). La mediana de complicaciones fue mayor en pacientes operados tardíamente (p = 0,004). Conclusiones:Los pacientes con luxofractura toracolumbar operados después de las primeras 24 h presentaron una mediana de complicaciones totales significativamente mayor que los operados precozmente. Nnivel de Evidencia: IV

Introduction: Thoracolumbar fracture-dislocations account for 10% of traumatic spinal injuries and typically occur in the context of high-energy trauma. Our objective is to compare early complications in patients with thoracolumbar fracture-dislocation based on surgical timing, either before or after 24 hours from the trauma.materials and methods: This is a multicenter, retrospective cohort study of patients surgically treated for thoracolumbar dislocations, from January 1, 2014 to January 1, 2023. We included adult patients (>18 years old) of any gender, surgically treated for high-energy thoracolumbar fracture-dislocations. Patients were grouped based on when they underwent spinal surgery: before or after 24 hours following trauma. Total and grouped complications were recorded. Results: Our sample comprised 72 patients, with 64 men (88.9%) and 8 women (11.1%) at an average age of 35.94 years. Occupational health care centers were predominant (n=60; 83.3%). Road traffic accidents (n=42; 58.3%) were the most frequent cause of injury, followed by falls from height (n=26; 36.1%). Furthermore, 86% of patients had one or more associated injuries. In total, 283 complications were recorded, with 67 patients (93.1%) suffering at least one complication, and 26 patients (36.1%) experiencing surgical complications. The median number of complications was significantly higher in late-operated patients (p=0.004). Conclusions: Patients with thoracolumbar dislocations who underwent surgery after the first 24 hours following trauma had a significantly higher median rate of complications than those who underwent early surgery. Level of Evidence: IV

Luxación periastragalina posterior genuina cerrada sin fractura ni mala alineación asociada. Reporte de un caso y revisión bibliográfica / True closed posterior subtalar dislocation without fracture or associated malalignment. Case report and literature review

La luxación periastragalina es un tipo de luxación infrecuente. Se clasifica según la relación del calcáneo con respecto al astrágalo, y las más comunes son las formas medial y lateral; y hay casos aislados de las variantes posterior y anterior. Presentamos el caso de un paciente con una luxación periastragalina cerrada posterior sin fractura asociada, el video de la técnica para la reducción cerrada bajo anestesia y también una revisión bibliográfica de esta infrecuente variedad de luxación. Nivel de Evidencia: IV

Subtalar dislocation is a rare type of dislocation that is characterized based on the relationship of the calcaneus to the talus, with the medial and lateral forms being more prevalent and the posterior and anterior forms appearing only in isolated cases in the literature. We present the case of a patient with a closed posterior subtalar dislocation without an associated fracture, as documented clinically and radiologically. We also include a video of the technique for closed reduction under anesthesia, as well as a review of the existing literature on this rare type of dislocation. Level of Evidence: IV

A case of closed isolated medial subtalar dislocation / Un caso de luxación subastragalina medial aislada y cerrada

Introduction: Closed isolated subtalar dislocations are very rare and major cause of subtalar dislocation remains to be road traffic accidents. Objective: Identify isolated medial subtalar closed dislocations and their forms a management. Presentation of case: 22-year-old male sustained road traffic accident following which he had deformed foot with inability to bear weight. On evaluation he was found to have medial subtalar dislocation reduced with manual traction. One year follow up showed, no residual deformity or pain and had very good functional outcome. Conclusions: It is of great importance to identify the difference between medial subluxation or dislocation and medial swivel injury which have different mechanisms as well as different reduction maneuvers(AU)

Introducción: Las luxaciones subastragalinares aisladas cerradas son muy raras y la principal causa de luxación subastragalina resultan los accidentes de tráfico. Objetivo: Identificar las luxaciones cerradas subastragalina medial aisladas y su tratamiento. Presentación del caso: Un paciente hombre de 22 años sufrió un accidente de tránsito tras el cual quedó deformado el pie sin poder soportar peso. En la evaluación se encontró la luxación subastragalina medial que se redujo con tracción manual. El seguimiento al año no mostró deformidad residual ni dolor y tuvo muy buen resultado funcional. Conclusiones: Es de gran importancia identificar la diferencia entre subluxación o luxación medial y lesión por giro medial, las cuales tienen diferentes mecanismos, así como diferentes maniobras de reducción(AU)

Multidirectional Instability in a Neglected Elbow Dislocation Managed with Circumferential Ligament Reconstruction. A Case Report / Instabilidade multidirecional em uma luxação negligenciada do cotovelo gerenciada com reconstrução do ligamento circunferencial. Um relato de caso

Abstract Neglected elbow dislocation is an uncommon condition and its treatment remains challenging. We present a case of a middle-aged woman presenting with neglected elbow dislocation and multi-direction instability in whom open reduction of the elbow joint and circumferential ligamentous reconstruction with a gracilis tendon graft was done. The functional outcome assessed with the Mayo elbow performance index was excellent. This circumferential technique is undoubtedly a viable technique and the indications can be extended to even manage a neglected dislocation. This procedure reduces the need or diminishes the duration of external fixation requirement and thereby encourages early mobilization.

Resumo A luxação negligenciada do cotovelo é uma condição incomum e seu tratamento permanece desafiador. Apresentamos o caso de uma mulher de meia-idade que apresentou luxação negligenciada do cotovelo e instabilidade multidirecional, na qual foi realizada redução aberta da articulação do cotovelo e reconstrução ligamentar circunferencial com enxerto de tendão gracilis. O resultado funcional avaliado com o índice de desempenho do cotovelo de Mayo foi excelente. Essa técnica circunferencial é, sem dúvida, uma técnica viável e as indicações podem ser estendidas para gerenciar até mesmo um deslocamento negligenciado. Este procedimento reduz a necessidade ou diminui a duração da exigência de fixação externa e, assim, incentiva a mobilização precoce.

Congenital Knee Dislocation at Birth - An Extraordinary Case of Spontaneous Reduction / Luxação congênita do joelho no nascimento - Um caso extraordinário de redução espontânea

Abstract Congenital knee dislocation (CKD) is a rare malformation characterized by hyperextension deformity of the knee with anterior tibia displacement, present at birth. Rarely reported, CKD might occur as an isolated deformity or commonly associated with musculoskeletal abnormalities, with the most common ones being developmental dysplasia of the hip (DDH) and clubfoot. The etiology is unknown, but CKD has been associated with certain intrinsic and extrinsic factors. Treatment with conservative methods at an early stage is most likely to yield successful results. We report here a rare case of successful spontaneous reduction of CKD in an infant within 24 hours of life.

Resumo A luxação congênita do joelho (LCJ) é uma malformação rara caracterizada por deformidade de hiperextensão do joelho com deslocamento anterior da tíbia, presente ao nascimento. Raramente relatada, a LCJ pode ocorrer como uma deformidade isolada ou comumente associada a anormalidades musculoesqueléticas, sendo as mais comuns a displasia do desenvolvimento do quadril (DDQ) e o pé torto congênito (PTC). A etiologia é desconhecida, mas a LCJ foi associada a certos fatores intrínsecos e extrínsecos. O tratamento com métodos conservadores em um estágio inicial tem maior probabilidade de produzir resultados bem-sucedidos. Relatamos aqui um caso raro de redução espontânea bem-sucedida de LCJ em um bebê nas suas primeiras 24 horas de vida.

Luxación medial y plantar del hueso navicular asociada a fractura-subluxación calcaneocuboidea. Presentación de un caso / Medial and plantar dislocation of the navicular bone associated with a calcaneocuboid fracture-subluxation. Case report

Las luxaciones del escafoides aisladas y sin fractura son poco frecuentes. Por lo general, se presentan asociadas a fracturas del escafoides o a diversos patrones de lesión de la columna lateral. Presentamos el caso de un paciente con luxación medial y plantar del hueso navicular y fractura conminuta del proceso anterior del calcáneo y subluxación calcaneocuboidea. En el Servicio de Urgencia, se procedió a la reducción cerrada y la estabilización con agujas de Kirschner y, como tratamiento diferido, se colocaron placas en puente astragalonaviculo-cuneiforme y calcaneocuboidea de 2,0 mm, en forma transitoria, y el material de osteosíntesis se retiró a los 5 meses. El puntaje de la escala de la AOFAS fue excelente al año de seguimiento. Conclusiones: Es necesario llegar a un diagnóstico adecuado descartando lesiones de la columna lateral y reducir esta lesión en la atención de urgencia. La estabilización con placas en puente es una opción válida que podría evitar la pérdida de la reducción que se observa al retirar los clavos de Kirschner y permite una carga precoz. Nivel de Evidencia: IV

Isolated navicular dislocations are unusual. They are frequently associated with navicular fractures or diverse patterns of lateral column injuries. We report a case of a patient with medial and plantar navicular dislocation with a comminuted intra-articular fracture of the anterior process of the calcaneus and associated subluxation at the calcaneocuboid joint. The patient underwent closed reduction and Kirschner wire stabilization in the Emergency Service. As part of the deferred treatment, talonavicular-cuneiform and calcaneocuboid 2.0 mm bridge plates were temporarily placed and osteosynthesis material was removed 5 months later. The AO-FAS score was excellent in the one-year follow-up. Conclusion: An accurate diagnosis, ruling out lateral column injuries, should be done in the Emergency Service. Bridge plate stabilization is a valid option to prevent loss of reduction, which is observed when removing Kirschner wires, allowing early weight-bearing. Level of Evidence: IV

Resultados iniciales del uso de cotilos de doble movilidad en pacientes >65 años con fractura de cadera. Análisis retrospectivo de 102 casos / Preliminary outcomes with dual mobility cups in patients older than 65 with hip fractures. A retrospective analysis of 102 patients

Objetivo: El objetivo de este estudio retrospectivo fue evaluar los resultados funcionales y la tasa de luxación en pacientes >65 años con fractura de cadera operados con prótesis de doble movilidad. materiales y métodos: Se analizó a los pacientes tratados por una fractura de cadera entre 2017 y 2021. Se incluyó a pacientes >65 años, tratados con copas de doble movilidad y un seguimiento mínimo de 24 meses. Se analizaron los datos demográficos, las comorbilidades, los resultados funcionales (Parker y puntaje de Harris), las complicaciones (infección, luxación, aflojamiento), las reoperaciones y revisiones. Resultados: Se trataron 102 fracturas de cadera (75 mediales y 27 intertrocantéricas) en 102 pacientes. El 72,5% eran mujeres (media de la edad 80.59 ± 6.92 años), el Índice de Comorbilidad de Charlson promedio fue de 4,71 y el puntaje ASA, 2,47. El 93,1% comenzó a caminar al segundo día de la cirugía. Según el puntaje de Harris, los resultados fueron excelentes o muy buenos en el 94,1%; los puntajes de Parker preoperatorio y posoperatorio no difirieron significativamente (p <0,05). El seguimiento promedio fue de 30 meses. Hubo 8 (7,84%) complicaciones: 2 (1,9%) casos de trombosis venosa profunda, 4 (3,9%) de tromboembolismo pulmonar, tres infecciones (2,9%) y una (0,9%) luxación. La tasa de reoperaciones fue del 2,9%. Conclusiones: Con el empleo de copas de doble movilidad se obtuvieron resultados funcionales aceptables y una tasa de luxación relativamente baja (0,9%). Esto sugiere que estos implantes representan una opción en el tratamiento de estas lesiones. Nivel de Evidencia: IV

Objective: This retrospective study aimed to assess the functional outcomes and dislocation rate in the treatment with dual mobility prostheses in patients older than 65 with hip fractures. materials and methods: We analyzed all patients treated between 2017 and 2021 for hip fractures in our service. We included patients older than 65 years, treated with dual mobility cups, and a minimum follow-up of 24 months. We analyzed demographic data, comorbidities, functional outcomes (Parker score and Harris Hip Score, HHS), complications (infection, dislocation, loosening), reoperations, and revisions. Results: We included 102 hip fractures (75 medial and 27 intertrochanteric) in 102 patients. Seventy-four (72.5%) were women, the mean age was 80.59 ± 6.92 years, the mean Charlson index was 4.71 (range 3-10), and ASA was 2.47 (1-4). 93.1% started walking on the second postoperative day. 94.1% presented excellent or very good outcomes according to the HHS, the postoperative Parker index did not show significant differences in comparison to the preoperative one (p < 0.05). The average follow-up was 30 months (range 24-60). There were 8 (7.84%) complications: 2 (1.9%) deep vein thrombosis, 4 (3.9%) pulmonary thromboembolism, 3 infections (2.9%), and 1 (0.9%) dislocation. The reoperation rate was 2.9%. Conclusions: We obtained acceptable functional outcomes using dual mobility cups with a relatively low dislocation rate (0.9%). This suggests that these implants are an option to consider in treating these lesions. Level of Evidence: IV

Application of modified articular disc anchorage in treating the perforation and rupture of temporomandibular joint disc / 华西口腔医学杂志

OBJECTIVES@#This study aimed to use modified articular disc anchorage in treating old irreducible temporomandibular joint (TMJ) disc displacement with perforation and rupture, as well as to explore its efficacy.@*METHODS@#A total of 31 patients (34 sides) with 47 TMJ disc perforations who underwent surgical treatment in the Affiliated Stomatolo-gical Hospital of Nanchang University from January 2018 to December 2021 were selected. According to the location of disc perforation, it has five types: posterior disc perforation (typeⅠ), anterior disc perforation (typeⅡ), lateral disc perforation (type Ⅲ), composite disc perforation, and destruction disc perforation. The modified methods of disc anchoring were divided into two types according to the location of the perforation. TypesⅠandⅢ disc perforation were trea-ted by posterior anchoring method. For posterior ancho-ring, a screw was implanted into the posterolateral side of the condylar neck, and the disc was fixed on the screw by horizontal mattress suture. TypeⅡdisc perforation and compo-site disc perforation combined typeⅡperforation were treated by anterior and posterior double-anchoring method. For anterior anchoring, anchor screws or holes were placed at the anterior edge of the condylar neck, and horizontal mattress suture was performed at the posterior edge of the anterior perforation with an anchor wire. The articular disc was then fixed on the anchor screws or holes. For the posterior anchoring method, it was the same as the previous one. Paired t test was used to analyze the visual analog scale (VAS), maximum interincisal opening (MIO), and TMJ disorder index (CMI) of the patient before surgery and 1, 3, and 6 months after surgery. Disk-condyle position relationship by magnetic resonance imaging and postoperative quality of life in postoperative were analyzed.@*RESULTS@#The incidence of perforation was 41.2% (14/34) in typeⅠ, 11.8% (4/34) in typeⅡ, 8.8% (3/34) in typeⅢ, 29.4% (10/34) in composite type, and 8.8% (3/34) in destruction type. The VAS, MIO, and CMI at 3, 6 months after operation significantly improved compared with those before operation (P<0.05). The effective reduction rate of disc was 96.77% (30/31). The quality of life at 6 months after surgery was 47.22±2.13, and the rate of excellent evaluation was 96.4% (27/28).@*CONCLUSIONS@#Modified articular disc anchorage achieves a good curative effect for treating temporomandibular joint disc perforation and rupture. Nevertheless, its long-term effect requires further observation.

Complicated Bosworth fracture-dislocation: A case report and review of the literature / 中华创伤杂志(英文版)

Bosworth fracture and dislocation is relatively rare, accounting for about 1% of ankle fractures. It is characterized by the proximal fibula fracture embedded in the posterolateral distal tibia. Due to an insufficient understanding of this fracture, it is easy to cause missed diagnosis and misdiagnosis in clinical practice. Due to the insertion of the fracture, it is challenging to perform closed reduction, and improper treatment is easy to cause complications. Surgical treatment is recommended for this type of fracture. In order to improve the understanding of orthopedic surgeons about Bosworth fracture and dislocation, this paper reports the diagnosis and treatment of 2 cases of Bosworth fracture and dislocation, and reviews the literature on Bosworth fracture's mechanism, diagnosis, classification, complications, and treatment options in recent years.

Effectiveness analysis of percutaneous parallel screw fixation via posterolateral "safe zone" for Hawkins type Ⅰ- Ⅲ talar neck fractures / 中国修复重建外科杂志

OBJECTIVE@#To explore the effectiveness of the percutaneous parallel screw fixation via the posterolateral "safe zone" for Hawkins type Ⅰ-Ⅲ talar neck fractures.@*METHODS@#A retrospective analysis was conducted on the clinical data from 35 patients who met the selection criteria of talar neck fractures between January 2019 and June 2021. According to the surgical method, they were divided into a study group (14 cases, using percutaneous posterolateral "safe zone" parallel screw fixation) and a control group (21 cases, using traditional open reduction and anterior cross screw internal fixation). There was no significant difference in gender, age, affected side, Hawkins classification, and time from injury to operation between the two groups ( P>0.05). The operation time, bone healing time, complications, and Hawkins sign were recorded, and the improvement of pain and ankle-foot function were evaluated by visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score at last follow-up. The overall quality of life was assessed by the short form of 12-item health survey (SF-12), which was divided into physical and psychological scores; and the satisfaction of patients was evaluated by the 5-point Likert scale.@*RESULTS@#The operation time in the study group was significantly shorter than that in the control group ( P<0.05). All patients werefollowed up 13-35 months, with an average of 20.6 months; there was no significant difference in the follow-up time between the two groups ( P>0.05). The time of bone healing in the study group was shorter than that in the control group, and the positive rate of Hawkins sign (83.33%) was higher than that in the control group (33.33%), and the differences were significant ( P<0.05). In the control group, there were 2 cases of incision delayed healing, 7 cases of avascular necrosis of bone, 3 cases of joint degeneration, 1 case of bone nonunion, and 3 cases of internal fixation irritation; while in the study group, there were only 2 cases of joint degeneration, and there was a significant difference in the incidence of complications between the two groups ( P<0.05). At last follow-up, there was no significant difference in VAS score between the two groups ( P>0.05), but the SF-12 physical and psychological scores, AOFAS ankle and hindfoot scores, and patients' satisfaction in the study group were significantly better than those in the control group ( P<0.05).@*CONCLUSION@#The treatment of Hawkins type Ⅰ-Ⅲ talar neck fractures with percutaneous parallel screw fixation via the posterolateral "safe zone" can achieve better effectiveness than traditional open surgery, with the advantages of less trauma, fewer complications, faster recovery, and higher patient satisfaction.

Clinical application and effectiveness of patellar tunnel locator in medial patellofemoral ligament reconstruction surgery / 中国修复重建外科杂志

OBJECTIVE@#To evaluate the operability and effectiveness of a self-developed patellar bone canal locator (hereinafter referred to as "locator") in the reconstruction of the medial patellofemoral ligament (MPFL).@*METHODS@#A total of 38 patients with recurrent patellar dislocation who met the selection criteria admitted between January 2022 and December 2022 were randomly divided into study group (the patellar canal was established with a locator during MPFL reconstruction) and control group (no locator was used in MPFL reconstruction), with 19 cases in each group. There was no significant difference in baseline data between the two groups ( P>0.05), such as gender, age, body mass index, disease duration, patella Wiberg classification, constituent ratio of cartilage injury, Caton index, tibia tubercle-trochlear groove, and preoperative Lysholm score, Kujal score, Tegner score, visual analogue scale (VAS) score, and so on. The Lysholm score, Kujal score, Tegner score, and VAS score were used to evaluate knee joint function before operation and at 3 days,1 month, 3 months, and 6 months after operation. The ideal prepatellar cortical thickness and canal length were measured before operation, and the actual prepatellar cortical thickness and canal length after operation were also measured, and D1 (the distance between the ideal entrance and the actual entrance), D2 (the ideal canal length minus the actual canal length), D3 (the ideal prepatellar cortical thickness minus the actual prepatellar cortical thickness) were calculated.@*RESULTS@#Patients in both groups were followed up 6-8 months (mean, 6.7 months). The incision length and intraoperative blood loss in the study group were smaller than those in the control group, but the operation time was longer than that in the control group, the differences were significant ( P<0.05). There was no complication such as incision infection, effusion, and delayed healing in both groups, and no further dislocation occurred during follow-up. One patient in the study group had persistent pain in the anserine area after operation, and the symptoms were relieved after physiotherapy. The VAS score of the two groups increased significantly at 3 days after operation, and gradually decreased with the extension of time; the change trends of Lysholm score, Kujal score, and Tegner score were opposite to VAS score. Except that the Lysholm score and Kujal score of the study group were higher than those of the control group at 3 days after operation, and the VAS score of the study group was lower than that of the control group at 3 days and 1 month after operation, the differences were significant ( P<0.05), there was no significant difference in the scores between the two groups at other time points ( P>0.05). Patellar bone canal evaluation showed that there was no significant difference in preoperative simulated ideal canal length, prepatellar cortical thickness, and postoperative actual canal length between the two groups ( P>0.05). The postoperative actual prepatellar cortical thickness of the study group was significantly smaller than that of the control group ( P<0.05). D1 and D3 in the study group were significantly higher than those in control group ( P<0.05), but there was no significant difference in D2 between the two groups ( P>0.05).@*CONCLUSION@#The locator can improve the accuracy of MPFL reconstruction surgery, reduce the possibility of intraoperative damage to the articular surface of patella and postoperative patellar fractures.

Finite element analysis of five internal fixation modes in treatment of Day type Ⅱcrescent fracture dislocation of pelvis / 中国修复重建外科杂志

OBJECTIVE@#To compare the biomechanical differences among the five internal fixation modes in treatment of Day type Ⅱ crescent fracture dislocation of pelvis (CFDP), and find an internal fixation mode which was the most consistent with mechanical principles.@*METHODS@#Based on the pelvic CT data of a healthy adult male volunteer, a Day type Ⅱ CFDP finite element model was established by using Mimics 17.0, ANSYS 12.0-ICEM, Abaqus 2020, and SolidWorks 2012 softwares. After verifying the validity of the finite element model by comparing the anatomical parameters with the three-dimensional reconstruction model and the mechanical validity verification, the fracture and dislocated joint of models were fixed with S 1 sacroiliac screw combined with 1 LC-Ⅱ screw (S 1+LC-Ⅱ group), S 1 sacroiliac screw combined with 2 LC-Ⅱ screws (S 1+2LC-Ⅱ group), S 1 sacroiliac screw combined with 2 posterior iliac screws (S 1+2PIS group), S 1 and S 2 sacroiliac screws combined with 1 LC-Ⅱ screw (S 1+S 2+LC-Ⅱ group), S 2-alar-iliac (S 2AI) screw combined with 1 LC-Ⅱ screw (S 2AI+LC-Ⅱ group), respectively. After each internal fixation model was loaded with a force of 600 N in the standing position, the maximum displacement of the crescent fracture fragments, the maximum stress of the internal fixation (the maximum stress of the screw at the ilium fracture and the maximum stress of the screw at the sacroiliac joint), sacroiliac joint displacement, and bone stress distribution around internal fixation were observed in 5 groups.@*RESULTS@#The finite element model in this study has been verified to be effective. After loading 600 N stress, there was a certain displacement of the crescent fracture of pelvis in each internal fixation model, among which the S 1+LC-Ⅱ group was the largest, the S 1+2LC-Ⅱ group and the S 1+2PIS group were the smallest. The maximum stress of the internal fixation mainly concentrated at the sacroiliac joint and the fracture line of crescent fracture. The maximum stress of the screw at the sacroiliac joint was the largest in the S 1+LC-Ⅱ group and the smallest in the S 2AI+LC-Ⅱ group. The maximum stress of the screw at the ilium fracture was the largest in the S 1+2PIS group and the smallest in the S 1+2LC-Ⅱ group. The displacement of the sacroiliac joint was the largest in the S 1+LC-Ⅱ group and the smallest in the S 1+S 2+LC-Ⅱ group. In each internal fixation model, the maximum stress around the sacroiliac screws concentrated on the contact surface between the screw and the cortical bone, the maximum stress around the screws at the iliac bone concentrated on the cancellous bone of the fracture line, and the maximum stress around the S 2AI screw concentrated on the cancellous bone on the iliac side. The maximum bone stress around the screws at the sacroiliac joint was the largest in the S 1+LC-Ⅱ group and the smallest in the S 2AI+LC-Ⅱ group. The maximum bone stress around the screws at the ilium was the largest in the S 1+2PIS group and the smallest in the S 1+LC-Ⅱ group.@*CONCLUSION@#For the treatment of Day type Ⅱ CFDP, it is recommended to choose S 1 sacroiliac screw combined with 1 LC-Ⅱ screw for internal fixation, which can achieve a firm fixation effect without increasing the number of screws.

Advances in peripatellar osteotomy for treating recurrent patellar dislocation / 中国修复重建外科杂志

OBJECTIVE@#To summarize the progress of research related to the surgical treatment of recurrent patellar dislocation by peripatellar osteotomy in clinical practice, in order to provide reference for clinical treatment.@*METHODS@#The recent literature on peripatellar osteotomy for recurrent patellar dislocation at home and abroad was reviewed, and the bony structural abnormalities, imaging diagnosis, and treatment status were summarized.@*RESULTS@#Abnormalities in the bony anatomy of the lower limb and poor alignment lead to patellofemoral joint instability through the quadriceps pulling force line and play an important role in the pathogenesis of recurrent patellar dislocation. Identifying the source of the deformity and intervening with peripatellar osteotomy to restore the biomechanical structure of the patellofemoral joint can reduce the risk of soft tissue surgical failure, delay joint degeneration, and achieve the target of treatment.@*CONCLUSION@#In the clinical diagnosis and treatment of recurrent patellar dislocation, the factors causing patellofemoral joint instability should be comprehensively evaluated to guide the selection of surgery and personalized treatment.

A study of the correlation between glenohumeral joint congruence and stability in recurrent shoulder dislocations / 中国修复重建外科杂志

OBJECTIVE@#To investigate the correlation between glenohumeral joint congruence and stability in recurrent shoulder dislocations.@*METHODS@#Eighty-nine patients (89 sides) with recurrent shoulder dislocation admitted between June 2022 and June 2023 and met the selection criteria were included as study subjects. There were 36 males and 53 females with an average age of 44 years (range, 20-79 years). There were 40 cases of left shoulder and 49 cases of right shoulder. The shoulder joints dislocated 2-6 times, with an average of 3 times. The three-dimensional models of the humeral head and scapular glenoid were reconstructed using Mimics 20.0 software based on CT scanning images. The glenoid track (GT), inclusion index, chimerism index, fit index, and Hill-Sachs interval (HSI) were measured, and the degree of on/off track was judged (K value, the difference between HSI and GT). Multiple linear regression was used to analyze the correlation between the degree of on/off track (K value) and inclusion index, chimerism index, and fit index.@*RESULTS@#Multiple linear regression analysis showed that the K value had no correlation with the inclusion index ( P>0.05), and was positively correlated with the chimerism index and the fit index ( P<0.05). Regression equation was K=-24.898+35.982×inclusion index+8.280×fit index, R 2=0.084.@*CONCLUSION@#Humeral head and scapular glenoid bony area and curvature are associated with shoulder joint stability in recurrent shoulder dislocations. Increased humeral head bony area, decreased scapular glenoid bony area, increased humeral head curvature, and decreased scapular glenoid curvature are risk factors for glenohumeral joint stability.

Evaluation of the relationship between the attachment type of lateral pterygoid muscle and the position of temporomandibular joint disc in patients with temporomandibular joint disorders based on wireless amplified MRI detector high resolution imaging / 中华口腔医学杂志

Objective: To explore the correlation between the attachment type of lateral pterygoid muscle (LPM) and the position of temporomandibular joint (TMJ) disc in patients with temporomandibular disorders (TMD) by using wireless amplified magnetic resonance imaging detector (WAND) coupled with conventional head and neck joint coil for high resolution imaging of TMJ. Methods: Eighty-five patients with TMD diagnosed by oral and maxillofacial surgeons of Guizhou Provincial People's Hospital from October 2019 to January 2022 were collected. A total of 160 TMJ were included. There were 16 males and 69 females, aged (32.7±14.2) years. All patients were scanned with open, closed oblique sagittal and coronal WAND coupled head and neck coils with bilateral TMJ. Based on TMJ and LPM high resolution imaging, to explore the correlation between LPM attachment types and the position of TMJ disc in TMD patients, and to evaluate the potential clinical value of LPM attachment types in TMD patients. χ2 test and Pearson correlation analysis were used to evaluate the correlation between LPM attachment type and TMJ disc location. Results: There were three types of LPM attachment: type Ⅰ in 51 cases [31.9% (51/160)], type Ⅱ in 77 cases [48.1% (77/160)] and type Ⅲ in 32 cases [20.0% (32/160)]. There was a significant correlation between the type of LPM attachment and the position of articular disc (χ2=28.20, P=0.002, r=0.776). There was no statistical significance between the type of LPM attachment and the reversible displacement of articular disc (χ2=0.24, P=0.887, r=0.825). Conclusions: There is a correlation between the attachment type of LPM and the position of the disc in TMD patients. WNAD coupled with conventional head and neck joint coil TMJ high resolution scan can provide reliable imaging evidence for TMD patients in evaluating the type of LPM attachment and the location of disc.

Finite element analysis of different reconstruction methods of coracoclavicular ligament for acromioclavicular joint dislocation / 中国骨伤

OBJECTIVE@#This study aims to examine the biomechanical effects of different reconstruction methods, including single-bundle, double-bundle anatomical reconstruction, and double-bundle truly anatomical reconstruction of the coracoclavicular ligament on the acromioclavicular joint using finite element analysis, to provide a theoretical basis for the clinical application of truly anatomical coracoclavicular ligament reconstruction.@*METHODS@#One volunteer, aged 27 years old, with a height of 178 cm and a weight of 75 kg, was selected for CT scanning of the shoulder joint. Three-dimensional finite element models of single-bundle reconstruction, double-bundle anatomical reconstruction, and double-bundle truly anatomical reconstruction of coracoclavicular ligament were established by using Mimics17.0, Geomagic studio 2012, UG NX 10.0, HyperMesh 14.0 and ABAQUS 6.14 software. The maximum displacement of the middle point of the distal clavicle in the main loading direction and the maximum equivalent stress of the reconstruction device under different loading conditions were recorded and compared.@*RESULTS@#The maximum forward displacement and the maximum backward displacement of the middle point of the distal clavicle in the double-bundle truly anatomic reconstruction were the lowest, which were 7.76 mm and 7.27 mm respectively. When an upward load was applied, the maximum displacement of the distal clavicle midpoint in the double-beam anatomic reconstruction was the lowest, which was 5.12 mm. Applying three different loads forward, backward, and upward, the maximum equivalent stress of the reconstruction devices in the double-beam reconstruction was lower than that in the single-beam reconstruction. The maximum equivalent stress of the trapezoid ligament reconstruction device in the double-bundle truly anatomical reconstruction was lower than that in the double-bundle anatomical reconstruction, which was 73.29 MPa, but the maximum equivalent stress of the conoid ligament reconstruction device was higher than that of the double-bundle anatomical reconstruction.@*CONCLUSION@#The truly anatomical reconstruction of coracoclavicular ligament can improve the horizontal stability of acromioclavicular joint and reduce the stress of the trapezoid ligament reconstruction device. It can be a good method for the treatment of acromioclavicular joint dislocation.

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.

Research progress of the diagnosis and treatment of anterior shoulder instability / 中国修复重建外科杂志

The shoulder joint is the most prone to dislocation in the whole body, and more than 95% of them are anterior dislocation. Improper treatment after the initial dislocation is easy to lead to recurrent anterior dislocation or anterior shoulder instability, and the outcomes following conservative treatment is poor. Anterior shoulder instability can damage the soft tissue structure and bone structure that maintain the stability of shoulder joint, among which bone structure is the most important factor affecting the stability of shoulder joint. Diagnosis should be combined with medical history, physical examination, and auxiliary examination. Currently, three-dimensional CT is the most commonly used auxiliary examination means. However, various bone defect measurement and preoperative evaluation methods based on three-dimensional CT and the glenoid track theory have their own advantages and disadvantages, and there is still a lack of gold standard. Currently, the mainstream treatment methods mainly include Bankart procedure, coracoid process transposition, glenoid reconstruction with free bone graft, Bankart combined with Remplissage procedure, and subscapular tendon binding tamponade, etc. Each of these procedures has its own advantages and disadvantages. For the diagnosis and treatment of anterior shoulder instability, there are still too many unknown, further research and exploration need to be studied.

Estabilização de ombro em um gato ­ Relato de caso / Shoulder estabilization in a cat ­ Case report

A estabilidade da articulação do ombro é garantida por ligamentos, cápsula articular, tendões e músculos, contudo traumas podem causar falência dos mecanismos estabilizadores, com consequente luxação ou instabilidade articular. Objetivou-se relatar o caso de instabilidade medial e lateral de ombro direito em felino sem raça definida, atendido com queixa de claudicação aguda de membro torácico secundária a trauma por confronto com outro animal. Inicialmente foi realizado tratamento clínico por meio de imobilização articular. Contudo, devido ao insucesso da técnica, procedeu-se para o tratamento cirúrgico de estabilização articular com prótese ligamentar sintética. No pós-operatório imediato, evidenciou-se ausência de crepitações e instabilidade articular. Após oito dias da cirurgia, o paciente apresentou retorno total às funções de apoio do membro e sem sinais de dor ou redução de movimentos. Concluiu-se que, embora de reduzida ocorrência, a instabilidade de origem traumática do ombro configura-se como um diferencial para claudicação aguda de membro torácico e que o tratamento cirúrgico pode ser necessário, mostrando-se eficiente na resolução de tais casos com o acesso e técnica de estabilização propostos.

The stability of the shoulder joint is granted by ligaments, joint capsule, tendons and muscles. However, traumatic injuries can cause failure of the stabilization mechanisms, which leads to articular luxation or instability. The aim of the paper is to report a case of medial and lateral right shoulder joint instability in a mixed-breed cat, presenting acute forelimb lameness after a fight trauma with another cat. Initially, it was recommended a conservative treatment through articular immobilization. However, the technique was unsuccessful, and the surgery treatment was performed, to stabilize the joint with synthetic ligament prosthetic. In the postoperative period, no crepitation or instability were identified. After eight days of surgery, the patient returned totally to the normal function of the forelimb, without movement restriction or pain. It was concluded that, although rare, the traumatic shoulder joint instability is a differential diagnosis for acute forelimb lameness and the surgical treatment can be necessary, showing a good result in the resolution of these injuries with the surgical approach and stabilization method proposed.