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

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

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

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

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

Research progress on biomechanics for internal fixation in tibial plateau fracture / 中国修复重建外科杂志

OBJECTIVE@#To review the biomechanical research progress of internal fixation of tibial plateau fracture in recent years and provide a reference for the selection of internal fixation in clinic.@*METHODS@#The literature related to the biomechanical research of internal fixation of tibial plateau fracture at home and abroad was extensively reviewed, and the biomechanical characteristics of the internal fixation mode and position as well as the biomechanical characteristics of different internal fixators, such as screws, plates, and intramedullary nails were summarized and analyzed.@*RESULTS@#Tibial plateau fracture is one of the common types of knee fractures. The conventional surgical treatment for tibial plateau fracture is open or closed reduction and internal fixation, which requires anatomical reduction and strong fixation. Anatomical reduction can restore the normal shape of the knee joint; strong fixation provides good biomechanical stability, so that the patient can have early functional exercise, restore knee mobility as early as possible, and avoid knee stiffness. Different internal fixators have their own biomechanical strengths and characteristics. The screw fixation has the advantage of being minimally invasive, but the fixation strength is limited, and it is mostly applied to Schatzker typeⅠfracture. For Schatzker Ⅰ-Ⅳ fracture, unilateral plate fixation can be used; for Schatzker Ⅴand Ⅵ fracture, bilateral plates fixation can be used to provide stronger fixation strength and avoid the stress concentration. The intramedullary nails fixation has the advantages of less trauma and less influence on the blood flow of the fracture end, but the fixation strength of the medial and lateral plateau is limited; so it is more suitable for tibial plateau fracture that involves only the metaphysis. Choosing the most appropriate internal fixation according to the patient's condition is still a major difficulty in the surgical treatment of tibial plateau fractures.@*CONCLUSION@#Each internal fixator has good fixation effect on tibial plateau fracture within the applicable range, and it is an important research direction to improve and innovate the existing internal fixator from various aspects, such as manufacturing process, material, and morphology.

O-arm navigation versus C-arm navigation for guiding percutaneous long sacroiliac screws placement in treatment of Denis type Ⅱ sacral fractures / 中国修复重建外科杂志

OBJECTIVE@#To compare the effectiveness of O-arm navigation and C-arm navigation for guiding percutaneous long sacroiliac screws in treatment of Denis type Ⅱ sacral fractures.@*METHODS@#A retrospective study was conducted on clinical data of the 46 patients with Denis type Ⅱ sacral fractures between April 2021 and October 2022. Among them, 19 patients underwent O-arm navigation assisted percutaneous long sacroiliac screw fixation (O-arm navigation group), and 27 patients underwent C-arm navigation assisted percutaneous long sacroiliac screw fixation (C-arm navigation group). There was no significant difference in gender, age, causes of injuries, Tile classification of pelvic fractures, combined injury, the interval from injury to operation between the two groups ( P>0.05). The intraoperative preparation time, the placement time of each screw, the fluoroscopy time of each screw during placement, screw position accuracy, the quality of fracture reduction, and fracture healing time were recorded and compared, postoperative complications were observed. Pelvic function was evaluated by Majeed score at last follow-up.@*RESULTS@#All operations were completed successfully, and all incisions healed by first intention. Compared to the C-arm navigation group, the O-arm navigation group had shorter intraoperative preparation time, placement time of each screw, and fluoroscopy time, with significant differences ( P<0.05). There was no significant difference in screw position accuracy and the quality of fracture reduction ( P>0.05). There was no nerve or vascular injury during screw placed in the two groups. All patients in both groups were followed up, with the follow-up time of 6-21 months (mean, 12.0 months). Imaging re-examination showed that both groups achieved bony healing, and there was no significant difference in fracture healing time between the two groups ( P>0.05). During follow-up, there was no postoperative complications, such as screw loosening and breaking or loss of fracture reduction. At last follow-up, there was no significant difference in pelvic function between the two groups ( P>0.05).@*CONCLUSION@#Compared with the C-arm navigation, the O-arm navigation assisted percutaneous long sacroiliac screws for the treatment of Denis typeⅡsacral fractures can significantly shorten the intraoperative preparation time, screw placement time, and fluoroscopy time, improve the accuracy of screw placement, and obtain clearer navigation images.

Avaliação da fixação dos avanços maxilares pela técnica de osteotomia Le Fort I / Evaluación de la fijación de avances maxilar mediante la técnica de osteotomía Le Fort I / Evaluation of the fixation of maxillary advancements by the Le Fort I osteotomy technique

Introdução: A osteotomia Le Fort I possibilita a correção de deformidades dentofaciais que envolvem o terço médio da face. Para sua fixação, convencionou-se o emprego de quatro mini-placas nos pilares zigomático-maxilar e nasomaxilar. Propôs-se então, a dispensa da fixação do segmento posterior, surgindo questionamentos relacionados à capacidade biomecânica do sistema. Objetivos: Comparar o estresse biomecânico gerado em três meios distintos de fixação da osteotomia Le Fort I frente ao movimento de avanço sagital linear maxilar de 7mm. Metodologia: Trata-se de uma pesquisa experimental laboratorial, utilizando-se da análise de elementos finitos como ferramenta analítica, a fim de constatar qual das técnicas sofrerá maior estresse biomecânico. Resultados: Constatou-se que o estresse biomecânico gerado é maior quando aplicado em 4 pontos do que quando aplicado em apenas 2 pontos. Conclusão: Os resultados obtidos fornecem informações aos cirurgiões sobre a real necessidade do uso de fixação adicional de acordo com o método de fixação planejado. No entanto, deve ser interpretado de forma cautelosa, considerando-se as limitações deste estudo. Sendo assim, uma análise incipiente, que tem como intuito o fornecimento de evidência científica de grande significância.

Introducción: La osteotomía Le Fort I permite la corrección de deformidades dentofaciales que involucran el tercio medio de la cara. Para su fijación se acordó utilizar cuatro miniplacas en los pilares cigomaticomaxilar y nasomaxilar. Entonces se propuso prescindir de la fijación del segmento posterior, planteando interrogantes relacionados con la capacidad biomecánica del sistema. Objetivos: Comparar el estrés biomecánico generado en tres medios diferentes de fijación de la osteotomía Le Fort I frente a un movimiento de avance sagital lineal maxilar de 7mm. Metodología: Se trata de una investigación experimental de laboratorio, utilizando como herramienta analítica el análisis de elementos finitos, con el fin de comprobar cuál de las técnicas sufrirá un mayor estrés biomecánico. Resultados: Se encontró que el estrés biomecánico generado es mayor cuando se aplica en 4 puntos que cuando se aplica solo en 2 puntos. Conclusión: Los resultados obtenidos brindan información a los cirujanos sobre la necesidad real de utilizar fijación adicional de acuerdo al método de fijación planificado. Sin embargo, debe interpretarse con cautela, considerando las limitaciones de este estudio. Por tanto, un análisis incipiente, que pretende aportar evidencias científicas de gran trascendencia.

Introduction: The Le Fort I osteotomy allows the correction of dentofacial deformities involving the middle third of the face. For its fixation, it was agreed to use four mini plates on the zygomaticomaxillary and nasomaxillary pillars. It was then proposed to dispense with the fixation of the posterior segment, raising questions related to the biomechanical capacity of the system. Objectives: To compare the biomechanical stress generated in three different means of fixation of the Le Fort I osteotomy against a 7mm maxillary linear sagittal advancement movement. Methodology: This is an experimental laboratory research, using finite element analysis as an analytical tool, in order to verify which of the techniques will suffer greater biomechanical stress. Results: It was found that the biomechanical stress generated is greater when applied to 4 points than when applied to only 2 points. Conclusion: The results obtained provide information to surgeons about the real need to use additional fixation according to the planned fixation method. However, it should be interpreted with caution, considering the limitations of this study. Therefore, an incipient analysis, which aims to provide scientific evidence of great significance.

Comparison Between Surgical and Conservative Treatment for AOSpine Type A3 and A4 Thoracolumbar Fractures without Neurological Deficit: Prospective Observational Cohort Study / Comparação entre tratamento cirúrgico e conservador para fraturas toracolombares AOSpine tipo A3 e A4 sem déficit neurológico: Estudo de coorte prospectivo observacional

Abstract Objective To compare the clinical results between conservative (CS) and surgical treatment (CXS) of A3 and A4 fractures without neurological deficit. Methods Prospective observational study of patients with thoracolumbar fractures type A3 and A4. These patients were separated between the surgical and conservative groups, and evaluated sequentially through the numeric rating scale (NRS), Roland-Morris disability questionnaire (RMDQ), EuroQol-5D (EQ-5D) quality of life questionnaire, and Denis work scale (DWS) up to 2.5 years of follow-up. Results Both groups showed significant improvement, with no statistical difference in pain questionnaires (NRS: CXS 2.4 ± 2.6; CS 3.5 ± 2.6; p> 0.05), functionality (RMDQ: CS 7 ± 6.4; CXS 5.5 ± 5.2; p> 0.05), quality of life (EQ-5D), and return to work (DWS). Conclusion Both treatments are viable options with equivalent clinical results. There is a tendency toward better results in the surgical treatment of A4 fractures.

Resumo Objetivo Comparar os resultados clínicos entre os tratamentos conservador (CS) e cirúrgico (CXS) das fraturas A3 e A4 sem déficit neurológico. Métodos Estudo prospectivo observacional de paciente com fraturas toracolombares tipo A3 e A4. Esses pacientes foram separados entre os grupos cirúrgico e conservador e avaliados sequencialmente através da escala numérica de dor (NRS), do questionário de incapacidade de Roland-Morris (RMDQ), do EuroQol-5D (EQ-5D) e da escala de trabalho de Denis (DWS) até 2,5 anos de acompanhamento. Resultados Ambos os grupos apresentaram melhora significante, sem diferença estatística nos questionários de dor (NRS: CXS 2,4 ± 2,6; CS 3,5 ± 2,6; p> 0,05), funcionalidade (RMDQ: CS 7 ± 6,4; CXS 5,5 ± 5,2; p> 0,05), qualidade de vida (EQ-5D) e retorno ao trabalho (DWS). Conclusão Ambos os tratamentos são opções viáveis e com resultados clínicos equivalentes. Há uma tendência a melhores resultados no tratamento cirúrgico das fraturas A4.

3D-printing-assisted surgery versus conventional surgery for treatment of Schatzker VI tibial plateau fractures: a multi-center clinical study / 中华创伤骨科杂志

Objective:To compare 3D-printing-assisted surgery and conventional surgery in the treatment of Schazker type Ⅵ tibial plateau fractures.Methods:A retrospective study was conducted to analyze the clinical data of 50 patients with type Ⅵ tibial plateau fracture who had been treated from January 2019 to December 2021 at the 5 Departments of Orthopedics in The First Affiliated Hospital of Nanchang University, The First People's Hospital of Jiujiang, Pingkuang General Hospital, Ganzhou People's Hospital, and Nanchang Hongdu Hospital of Traditional Chinese Medicine. The patients were divided into 2 groups according to their different treatment methods. In the 3D printing group of 25 cases treated by 3D-printing-assisted surgery, there were 14 males and 11 females, with an age of (42.5±9.1) years; in the conventional group of 25 cases treated by conventional surgery, there were 13 males and 12 females with an age of (42.2±9.3) years. The 2 groups were compared in terms of operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, fracture healing time, postoperative complications, the Rasmussen radiological scores and the American Hospital for Special Surgery (HSS) knee function scores at 6 and 12 months after operation.Results:There was no significant difference in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). The operation time [(125.4±10.6) min], intraoperative blood loss [(206.2±16.3) mL], intraoperative fluoroscopy frequency [(9.2±2.7) times] and fracture healing time [(3.0±0.7) months] in the 3D printing group were all significantly less than those in the conventional group [(168.2±14.1) min, (303.2±20.4) mL, (15.5±3.5) times and (4.1±0.8) months] while the Rasmussen radiological scores (17.6±1.2 and 17.9±0.6) and HSS knee scores (90.8±6.4 and 91.5±5.6) at 6 and 12 months after operation in the 3D printing group were all significantly higher than those in the conventional group (16.2±2.6 and 16.7±2.2; 84.5±9.2 and 87.6±8.0) (all P<0.05). In the 3D printing group, there were 1 case of wound infection and 1 case of wound dehiscence after operation. In the conventional group, there were 2 cases of wound skin necrosis, 3 cases of wound dehiscence, 1 case of traumatic arthritis, 2 cases of wound infection, and 1 case of screw loosening. The incidence of complications in the 3D printing group (8.0%, 2/28) was significantly lower than that in the conventional group (36.0%, 9/25) ( P<0.05). Conclusion:In the treatment of Schatzker type VI tibial plateau fractures, compared with conventional surgery, 3D-printing-assisted surgery can lead to better curative outcomes, because it is conducive to lowering surgical difficulty, reducing postoperative complications, and promoting fracture union and functional recovery of the knee.

Arthroscopic minimally invasive reduction for talus posterior process fractures / 中华创伤骨科杂志

Objective:To evaluate the efficacy of arthroscopic minimally invasive reduction in the treatment of talus posterior process fractures.Methods:The clinical data were retrospectively studied of the 42 patients with talus posterior process fracture who had been admitted to Department of Orthopedics, The Fourth Hospital of Wuhan from January 2010 to June 2021. There were 25 males and 17 females, aged from 21 to 60 years (average, 40.5 years). They were assigned into 2 groups according to their different treatments. In the arthroscopic group of 15 cases, arthroscopic reduction and internal fixation (ARIF) were conducted via the posteromedial and posterolateral approaches; in the open reduction group of 27 cases, open reduction and internal fixation (ORIF) were conducted via the posteromedial para-Achilles approach. The 2 groups were compared in terms of operation time, blood loss, hospital stay, fracture clinical healing time, postoperative complications, and the American Society for Foot and Ankle Surgery (AOFAS) ankle-hindfoot score at one year postoperation.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P> 0.05). The arthroscopic group incurred significantly less blood loss [(32.0±11.5) mL], hospital stay [(5.3±1.8) d], and fracture clinical healing time [(4.6±1.0) months], and a significantly lower incidence of postoperative complications [20.0% (3/15)] than the open reduction group did [(80.0±15.2) mL, (8.4±2.4) d, (6.3±2.2) months, and 29.6% (8/27)], but significantly longer operation time [(74.0±8.9) min] than the open reduction group [(62.9±5.1) min] ( P<0.05). The AOFAS ankle-hindfoot scores at one year postoperation in both groups were higher than those before operation. The AOFAS ankle-hindfoot scores in the arthroscopic group [(83.0±13.0) points] were significantly higher than those in the open reduction group [(72.3±16.0) points] ( P<0.05). Conclusion:ARIF is a preferred minimally invasive treatment for talus posterior process fractures, because it leads to a smaller incision, less blood loss, shorter hospital stay, quicker clinical healing, a lower incidence of postoperative complications, and better functional improvement of the ankle and hindfoot than ORIF.

Clinical effect of arthroscopic reduction and suture for tibial intercondylar eminence fractures by perforated Kirschner wire / 中华实用儿科临床杂志

Objective:To investigate the clinical effect of arthroscopic reduction of tibial intercondylar ridge fractures in children using a 2.0 mm perforated Kirschner wire to establish bone tunnels and the Krackow-" 8" suture.Methods:From January 2018 to December 2020, 24 children (14 males and 10 females, aged 6-15 years) with tibial intercondylar ridge fractures admitted to Children′s Hospital of Nanjing Medical University were retrospectively recruited for analyses.All patients were treated with arthroscopic reduction, non-absorbable Krackow-" 8" suture for the base of the anterior cruciate ligament, and establishment of bone tunnels by 2.0 mm perforated Kirschner wire from the proximal tibial epiphysis for inserting a suture to fix the fractures.The affected limb was immobilized with a cast for 4 weeks, followed by active exercises postoperatively.Knee function was assessed using the Lysholm score and IKDC 2000 subjective score.Knee stability was evaluated using the Lachman test.X-rays were taken at 3 and 6 months postoperatively to evaluate fracture healing.Growth retardation of epiphyseal plate at 2 years of follow-up was assessed by bilateral knee X-rays.Results:All the 24 cases were successfully operated, with the operation time of (63.1±20.2) (40-115) min.All children were followed up for 24-36 months[(28.7±3.4) months]. All children achieved an anatomical reduction of the fracture postoperatively.No complications like fracture displacement, suture rupture, or infection were reported.All fractures healed completely at 3 months postoperatively.At the last follow-up, the Lysholm score and IKDC 2000 subjective score were (94.4±4.8) points and (93.8±5.6) points, respectively.The positive Lachman test was detected in 2 patients.No inhibition of proximal tibial epiphyseal growth was observed.Conclusions:Arthroscopic reduction with non-absorbable Krackow-" 8" suture and establishment of bone tunnels using a 2.0 mm perforated Kirschner wire for the treatment of tibial intercondylar ridge fractures in children has the advantages of simple surgical procedures, minimal invasiveness, which is an effective treatment method.

Biomechanical Comparison of Internal Fixation by Traditional and Cortical Bone Trajectory Pedicle Screw / 医用生物力学

Objective To compare the effects of cortical bone trajectory ( CBT) and traditional trajectory ( TT)pedicle screw internal fixation on the range of motion (ROM) and rod system stress of normal and osteoporotic(OP) spines. Methods The L3-S1 finite element models of normal and OP spines were established. The screwrod system with two kinds of trajectory was used for internal fixation of the L4-5 segment, so as to simulate sixphysiological loads, namely, flexion, extension, left / right bending, left / right rotation. The effects of two internalfixation methods on ROMs and maximum equivalent stress of screws in normal and OP spines were compared.Results For both bone conditions, CBT and TT significantly reduced ROM of the fixed segment (L4-5) and theentire segment of lower lumbar spine ( L3-S1). However, the ROM decline of CBT group was slightly smaller than that of TT group, and their ROMs were similar under flexion and extension, but the ROM differences were significant under lateral bending and axial rotation. In addition, for both the normal and OP spine models, themaximum equivalent stress of screws in CBT group was significantly higher than that in TT group. Compared withTT group, the screw stress of CBT group in normal spine model under flexion and extension, lateral bending,axial rotation was increased by 27% , 268% and 58% , respectively. However, when CBT technique was used atthe same time, the OP spine model had a smaller screw stress distribution than the normal spine model.Conclusions Compared with TT technique, CBT technique can achieve higher screw stress under OP conditionand reduce screw stress concentration under normal bone condition. In addition, CBT slightly increases ROMs of each segment, which is conducive to recovery of spinal physiological function after surgery. Lateral bending and axial rotation can produce negative mechanical effects, and these two physiological loads should be avoided.

Adjustment of X-ray angle intraoperation based on the anatomic shape of femoral neck section / 解剖学报

[Abstract] Objective To investigate the appropriate X-ray angle which image can represent total proximal of femur according to the anatomic shape of the femoral neck section. Methods The anatomic parameter of the femoral neck section was observed and measured. Found the femoral neck was contained with three main surfaces of anterior surface, posterosuperior surface and posteroinferior surface. A model of surface fluoroscopy has been made by covering aluminum foil papers on the three surfaces of femoral neck. Taking the midpoint of the femoral neck as the fluoroscopy center, the C-arm was rotated at an interval of 10° between 0° and 170°, and the three aluminum foil paper models were taken for X-ray projection respectively. The X-ray angle with the smallest image of aluminum foil paper was taken as the appropriate X-ray angle of the surface. A penetrating model of the femoral neck internal fixation was made of three Kirschner wires penetrating through the anterior, posterosuperior and posteroinferior surfaces of femoral neck. The images of the penetrating Kirschner wires were observed through the traditional anteroposterior, lateral view and the three appropriate X-ray angle views obtained from the above test. Results The length of the three main surfaces accounts for 80. 95% of the circumference of the femoral neck. The anterior surface coronal angle was 18°, the posterosuperior surface coronal angle was 65°, and the posteroinferior surface coronal angle was 165°. The Appropriate X-ray angle of the three surfaces were 20°, 70° and 170° respectively. In the images of the three appropriate X-ray angles, the penetrating Kirschner wires of anterior surface, posterosuperior surface and posteroinferior surface of the femoral neck could be clearly observed respectively, while the penetrating Kirschner wire could not be completely found in the traditional anteroposterior and lateral images. Conclusion Traditional anteroposterior and lateral fluoroscopy can not accurately display the three-dimensional structure of femoral neck. By increasing the appropriate X-ray angle of 20°, 70° and 170°, the reduction quality and bony violation from internal fixation implants on the anterior surface, posterosuperior surface and posteroinferior surface of the femoral neck could be observed respectively.

Effect of titanium plate internal fixation combined with titanium nail intermaxillary traction on jaw fractures / 中华医学美学美容杂志

Objective:To observe the difference in the effect of simple titanium plate internal fixation and titanium plate internal fixation combined with titanium nail intermaxillary traction in the treatment of jaw fractures and their impact on the oral and maxillofacial function of patients.Methods:From August 2016 to May 2021, 94 patients with jaw fractures admitted to the Department of Stomatology, Linyi Central Hospital, Shandong (supplementing the gender, age range and average age of the patients), were divided into 47 cases in the control group, and the titanium plates were used alone, combined operation group 47 cases, titanium plate internal fixation combined with intermaxillary traction with titanium nails. The changes of oral and maxillofacial function and fracture healing were measured before operation and 3 months after operation, and the perioperative indicators and postoperative complications were recorded.Results:Three months after operation, the scores of maxillofacial function, mouth function and masticatory function in the combined operation group (0.52±0.09 points, 0.67±0.12 points, 0.58±0.08 points) were significantly lower than those in the control group (1.05±0.21 points, 1.14±0.22 points, 1.02±0.21 points) ( t=15.90, 12.86, 13.42, P<0.05). The effective rate of the combined operation group was 95.74% (45/47), which was significantly higher than that of the control group (80.85%, 38/47) (χ 2=5.05, P<0.05); there was no significant difference in operation time and hospitalization time between the groups ( P>0.05), the fracture healing time in the combined surgery group (65.02±7.06) d was significantly shorter than that in the control group (82.69±10.25) d ( t=9.73, P<0.05). The postoperative complication rate of combined treatment group was 6.38% (3/47), which was significantly lower than the control group 21.28% (10/47) (χ 2=4.37, P<0.05). Conclusions:In the treatment of jaw fractures, titanium plate internal fixation combined with titanium nail intermaxillary traction treatment can significantly improve the oral and maxillofacial function of patients, promote postoperative fracture healing, improve curative effect and reduce the incidence of complications compared with simple titanium plate internal fixation.

Analysis of Revision Content and Evaluation Attentions on Guidance for Registration of Metallic Bone Plate Internal Fixation System (Revised in 2021) / 中国医疗器械杂志

This study briefly introduces the revised content of Guidance for Registration of Metallic Bone Plate Internal Fixation System (Revised in 2021) compared to the original guidance, mainly including the principles of dividing registration unit, main performance indicators of standard specification, physical and mechanical performance research, and clinical evaluation. At the same time, in order to provide some references for the registration of metallic bone plate internal fixation system, this study analyzes the main concerns in the review process of these products based on the accumulation of experience combining with the current review requirements.

Comparison of a minimally invasive osteosynthesis technique with conventional open surgery for transverse patellar fractures / 中华创伤杂志(英文版)

PURPOSE@#The study aims to compare the efficacy and safety of a new minimally invasive osteosynthesis technique with those of conventional open surgery for transverse patellar fractures.@*METHODS@#It was a retrospective study. Adult patients with closed transverse patellar fracture were included, and with open comminuted patellar fracture were excluded. These patients were divided into minimally invasive osteosynthesis technique (MIOT) group and open reduction and internal fixation (ORIF) group. Surgical time, frequency of intraoperative fluoroscopy, visual analogue scale score, flexion, extension, Lysholm knee score, infection, malreduction, implant migration and implant irritation in two groups were recorded and compared. Statistical analysis was performed by the SPSS software package (version 19). A p < 0.05 indicated statistical significance.@*RESULTS@#A total of 55 patients with transverse patellar fractures enrolled in this study, the minimally invasive technique was performed in 27 cases, and open reduction was performed in 28 cases. The surgical time in the ORIF group was shorter than that in the MIOT group (p = 0.033). The visual analogue scale scores in the MIOT group were significantly lower than those in the ORIF group only in the first month after surgery (p = 0.015). Flexion was restored faster in the MIOT group than that in the ORIF group at one month (p = 0.001) and three months (p = 0.015). Extension was recovered faster in the MIOT group than that in the ORIF group at one month (p = 0.031) and three months (p = 0.023). The recorded Lysholm knee scores in the MIOT group were always greater than those in the ORIF group. Complications, such as infection, malreduction, implant migration, and implant irritation, occurred more frequently in the ORIF group.@*CONCLUSION@#Compared with the ORIF group, the MIOT group reduced postoperative pain and had less complications and better exercise rehabilitation. Although it requires a long operation time, MIOT may be a wise choice for transverse patellar fractures.

Discussion on internal fixation of Hoffa fractures / 中国骨伤

Hoffa fracture is an unstable intra-articular fracture with significant redisplacement tendency. It is easy to be missed diagnosis when accompanied by distal intercondylar or supracondylar fracture of femur. CT scan is the gold standard for the diagnosis of Hoffa fracture. The treatment principles are anatomic reduction of the articular surface, reliable internal fixation, and early functional activity. At present, the main treatment is arthroscopic screw fixation. During screw fixation, the tail cap of screw should be buried, resulting in non-healing iatrogenic injury of articular cartilage. In the early postoperative functional activity of knee joint, fracture block was repeatedly subjected to backward and upward shear force under the action of the tibial plateau, which is the main reason for the failure of internal fixation. Plate assisted screw fixation could increase local mechanical stability, but it still cannot avoid the defects of iatrogenic cartilage injury. At the same time, plate molding is required during the operation due to the absence of special anatomical plates, resulting in increased surgical trauma and time-consuming surgery. The ideal fixation method for Hoffa fracture should include:(1) Avoid iatrogenic injury of articular surface cartilage. (2) With the rear anti-shear barrier plate function.(3) The internal fixator is closer to the load interface, so as to obtain greater load and better fixed strength.

Comparative study of the effects of intramedullary nail fixation and minimally invasive percutaneous plate internal fixation technique on platelet activation and serum transforming growth factor-β1(TGF-β) 1 and bone morphogenetic protein-2 (BMP-2) in patients with tibial and fibular fracture / 中国骨伤

OBJECTIVE@#To investigate the effect of intramedullary nail fixation (IMN) and minimally invasive percutaneous plate internal fixation (MIPPO) techniques on tibiofibular fractures and their effect on platelet activation and serum transforming growth factor-β1 (TGF-β1) and bone morphogenetic protein-2 (BMP-2).@*METHODS@#Total of 105 patients with tibiofibular fractures from February 2019 to February 2020 were selected and divided into 53 cases in the MIPPO group and 52 cases in the IMN group. There were 29 males and 24 females with an average age of (41.74±6.05) years old in MIPPO group;in IMN group, 31 males and 21 females with an average age of (40.59±5.26) years old. The perioperative surgical indexes, postoperative complications, ankle function recovery at 12 months postoperatively, platelet activation indexes at 3 and 7 days preoperatively and postoperatively, and serum TGF-β1 and BMP-2 levels at 4 and 8 weeks preoperatively and postoperatively were compared between the two groups.@*RESULTS@#The operating time and fracture healing time in the MIPPO group were shorter than those in the IMN group(P<0.05); Compared with the preoperative period, the levels of GMP-140, PAC-1, CD63, and CD61 increased in both groups at 3 and 7 days after surgery, but were lower in the MIPPO group than in the IMN group(P<0.05);the levels of serum TGF-β1 and BMP-2 increased in both groups at 4 and 8 weeks after surgery compared with the preoperative period, and the postoperative complication rate in the MIPPO group was lower than that in the IMN group(P<0.05);the difference was not statistically significant in the excellent rate of ankle function recovery at 12 months follow-up after surgery between two groups(P>0.05).@*CONCLUSION@#Both intramedullary nail fixation and MIPO technique for treatment of tibia and fibula fractures can improve ankle joint function, but the latter has the advantages of short operation time, fast fracture healing, fewer complications, and light platelet activation. Serum TGF-β1, BMP-2 level improves quickly.

Medium term follow up outcomes of uncemented total hip arthroplasty for traumatic arthritis after intramedullary nail fixation of femoral intertrochanteric fracture / 中国骨伤

OBJECTIVE@#To evaluate the effect of uncemented total hip arthroplasty(THA) on treatment of traumatic arthritis caused by intramedullary nailing interfixation of intertrochanteric fractures.@*METHODS@#Total of 22 patients treated with THA due to traumatic arthritis caused by intramedullary nailing interfixation of intertrochanteric fractures from January 2012 to January 2017 were studied retrospectively, including 10 males and 12 females with a mean age of (72.5±9.8) years old ranging from 61 to 84 years old. Initial internal fixation method:14 patients were treated with Gamma nails and 8 patients were treated wit PFNA.The time from internal fixation surgery to THA was 10 to 68 months with an average of (32.2±21.3) months.Harris scores of the hip joint before and after surgery were compared, and the position of the prosthesis through postoperative imaging at 3, 6, 12 months and the last follow-up were evaluated.@*RESULTS@#One patient was died due to heart failure 1 year after operation. Two patients was died to advanced tumor 2 years after operation. The other 19 patients were followed up for 36 to 64 months with an average of (48.5±11.9) months. At final follow up, 14 patients regained the ability to walk independently, 4 patients needed support of a cane, 1 patient needed assistance of a walker. No serious complications such as joint dislocation, periprosthetic fracture and deep venous thrombosis occurred during follow-up. There were no signs of loosening and subsidence of the prosthesis at the final follow-up. Mean Harris hip score increased from (29.2±12.9) points preoperatively to (74.2±11.2) points at the final follow up(P<0.05);the score was excellent in 9 patients, good in 7 and fair in 3.@*CONCLUSION@#Uncemented total hip arthroplasty for traumatic arthritis after intramedullary nail fixation of femoral intertrochanteric fracture can significantly improve hip function and effectively avoid bone cement implantation syndrome. The medium-term effect is satisfactory.

Comparison of clinical efficacy between closed reduction combined with semi-circular external fixator and minimally invasive percutaneous plate osteosynthesis (MIPPO) in the treatment of middle and distal tibia fractures / 中国骨伤

OBJECTIVE@#To compare the clinical efficacy between closed reduction combined with semi-circular external fixator and minimally invasive percutaneous plate osteosynthesis (MIPPO) in the treatment of middle anddistal tibia fractures.@*METHODS@#The clinical data of sixty patients with middle and distal tibia fractures admitted between January 2019 and November 2022, were retrospectively analyzed. These patients were categorized into external fixation group (n=30) and internal fixation group (n=30). There were 18 males and 12 females in the external fixation group, with an average age of (49.29±2.35) years old. Among them, 14 patients presented with fractures on the left side, and 16 patients presented with fractures on the right side. Closed reduction, arched wire, and semi-circular external fixator were used for treatment. There were 20 males and 10 females in the internal fixation group, with an average age of (48.96±1.87) years old. Among them, 15 patients presented with fractures on the left side, and 15 patients presented with fractures on the right side. MIPPO technique was used for the treatment. Perioperative parameters, including time injury to surgery, surgical duration, incision length, intraoperative bleeding, time to active activity, and incision healing level, were compared between the two groups. Clinical outcomes were also assessed, including Johner-Wruhs scores, time to minimum pain-adapted full weight-bearing, visual analog scale (VAS), SF-36 scale, and complications.@*RESULTS@#The external fixation group exhibited a significantly shorter incision length (1.36±0.86) cm and lower intraoperative bleeding (10.83±5.73) ml compared to the internal fixation group (12.74±3.12) cm and (86.47±8.90) ml, respectively(P<0.05). The postoperative active activity time (1.50±0.54) days and minimum pain-adapted full weight-bearing activity time(108.87±3.43) days in the external fixation group were slightly delayed than the internal fixation group(1.15±0.98) days and (105.27±3.68) days, respectively(P<0.05). Over a mean postoperative follow-up duration of (6.23±1.89) months, both groups showed improved VAS and SF-36 scale scores. There were no statistically significant differences in VAS and SF-36 scale scores 1, 3, 6 months post-operatively between the two groups(P>0.05). The intraoperative surgical time in the external fixation group (35.42±9.31) minutes was shorter than that in the internal fixation group(74.22±7.81) minutes (P<0.05). There was no intraoperative vascular or nerve injury, nor postoperative skin necrosis in the external fixation group. However, skin necrosis was observed in 6 patientsin the internal fixation group, representing a statistically significant difference (P<0.05).@*CONCLUSION@#Both external fixation and plate internal fixation are effective methods for the treatment of middle and distal tibia fractures. External fixation exhibits the advantage of less surgical trauma and a lower incidence of complications.

Clinical study on the subchondral screw compression technique assisted reduction of residual or secondary collapse of lateral tibial plateau / 中国修复重建外科杂志

OBJECTIVE@#To explore the reduction and support effect of the subchondral screw compression technique for residual or secondary collapse of the lateral tibial plateau during operation.@*METHODS@#Between January 2020 and June 2021, 11 patients with residual or secondary collapse of the lateral tibial plateau during operation were treated with the subchondral screw compression technique. There were 6 males and 5 females, aged 52.3 years old (range, 27-64 years). The fractures were caused by traffic accident in 10 cases and falling from height in 1 case and located at the left knee in 6 cases and the right knee in 5 cases. According to Schatzker classification, there were 5 cases of type Ⅱ fractures, 4 cases of type Ⅲ fractures, and 2 cases of type Ⅴfractures. According to the three columns classification, there were 5 cases of lateral column, 4 cases of lateral column and posterior column, and 2 cases of three columns. The time from injury to operation was 4.5 days (range, 3-7 days). During the follow-up, X-ray films were obtained and the Rasmussen standard was used to evaluate the quality of fracture reduction, meanwhile fracture healing was observed. The medial proximal tibial angle (mPTA), posterior tibial slope angle (pTSA), and articular surface collapse were measured at immediate and 12 months after operation. The knee joint range of motion was evaluated at last follow-up, and the knee joint function was evaluated using the Hospital for Special Surgery (HSS) score.@*RESULTS@#All operations were successfully completed, with a mean operation time of 71.4 minutes (range, 55-120 minutes), and a mean hospital stay of 8.0 days (range, 5-13 days). The incisions all healed by first intention, without complications such as infection, flap necrosis, or vascular and nerve injury. All patients were followed up 16.5 months on average (range, 12-24 months). X-ray films showed that the fracture reduction score was 14-18 (mean, 16.7) according to Rasmussen score criteria; and 5 cases were rated as excellent and 6 as good. All fractures healed clinically with a mean clinical healing time of 14.9 weeks (range, 12-16 weeks), and there was no complications such as plate or screw loosening. At 12 months after operation, the mPTA and pTSA were (87.5±1.7)° and (6.2±3.1)°, respectively; there was no significant difference when compared to the values at immediate after operation [(87.6±1.8)° and (6.5±3.1)°] ( P>0.05). The articular surface of the tibial plateaus was effectively supported, and it collapsed again by 0-1.0 mm at 12 months, with an average of 0.4 mm. At last follow-up, the knee joint range of motion was 115°-135° (mean, 126.8°) and the HSS score for knee joint function was 87-98 (mean, 93.9). Five patients underwent secondary operation to remove the internal fixator at 12-18 months after operation.@*CONCLUSION@#The subchondral screw compression technique is helpful for the reduction of residual or secondary collapse of the lateral tibial plateau during operation, and can provide good support for osteochondral blocks.

Effectiveness on treatment of metacarpal avulsion fracture with Kirschner wire buckling combined with bone fixation / 中国修复重建外科杂志

OBJECTIVE@#To summarize the effectiveness of Kirschner wire buckling combined with bone fixation in the treatment of metacarpal avulsion fracture.@*METHODS@#The clinical data of 35 patients of metacarpal avulsion fracture admitted between March 2017 and June 2022 were retrospectively analyzed. There were 22 males and 13 females; the age ranged from 20 to 55 years, with an average of 31.6 years. There were 17 cases of the second metacarpal avulsion fracture, 6 cases of the fourth metacarpal avulsion fracture, and 12 cases of the fifth metacarpal avulsion fracture. The causes of injury included 21 cases of strangulation, 8 cases of sprain, and 6 cases of sports injury. X-ray film examination showed that the size of the avulsion fracture of metacarpal bone ranged from 0.30 cm×0.20 cm to 0.55 cm×0.45 cm. The total active motion (TAM) of the injured finger before operation was (154.00±17.38)°. The time from injury to operation was 3-10 days, with an average of 5.8 days. Follow-up regularly after operation, X-ray film and CT examination were performed to evaluate fracture healing and TAM of injured finger was measured. The finger function was evaluated by the trial standard of upper limb function evaluation of Hand Surgery Society of Chinese Medical Association.@*RESULTS@#All the incisions healed by first intention. All 35 patients were followed up 9-36 months, with an average of 28 months. All metacarpal avulsion fractures achieved bony healing, and the healing time was 4-6 weeks, with an average of 4.8 weeks. The metacarpophalangeal joint of the patient was stable, without stiffness, and the flexion and extension activities were good. At last follow-up, the TAM of the injured finger reached (261.88±6.23)°, which was significantly different from that before operation ( t=-35.351, P<0.001). The finger function was evaluated according to the trial standard of upper limb function evaluation of the Society of Hand Surgery of Chinese Medical Association, and 33 cases were excellent and 2 cases were good, with an excellent and good rate of 100%.@*CONCLUSION@#The treatment of metacarpal avulsion fracture with Kirschner wire buckling combined with bone fixation has the advantages of less trauma, firm fixation, and less interference to the soft tissue around metacarpophalangeal joints, which is a good alternative method for the metacarpal avulsion fracture.