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

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

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

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

Application of our self-made Kirschner wire connecting rod in difficult extraction of intramedullary implants / 中华创伤骨科杂志

Objective:To report the application of our self-made Kirschner wire connecting rod combined with a conventional intramedullary nail extractor in difficult extraction of intramedullary devices.Methods:From January 2012 to August 2017, 10 patients with a hard-to-remove intramedullary device were treated at Department of Orthopaedics, The Fifth Hospital Affiliated to Xinjiang Medical University. They were 7 males and 3 females with a mean age of (40.0±9.0) years. In cases where no relevant extractor was available for the intramedullary device or it was impossible to connect the extractor connecting rod to the tail of the intramedullary device, the Kirschner wire was bent and pulled through the screw hole or the hole newly drilled at the tail of the intramedullary device to be tied or fixed with a conventional extractor connecting rod to form an effective connection. Next, our self-made Kirschner wire connecting rod was used to pull out the intramedullary device. In this cohort, 7 intramedullary nails in the tibia, 1 femoral intramedullary nail, 1 humeral intramedullary nail, and 1 tibial elastic nail were removed. The difficult extraction was due to "cold welding" of the tail cap of the intramedullary nail in 3 cases, mismatch between the screw rod of the extractor and the tail screw hole of the intramedullary nail in 4 cases, and unavailability of relevant removal tools in 3 cases. The time for intramedullary device removal, blood loss and postoperative adverse reactions were recorded.Results:Of this cohort, 9 patients underwent simple removal of the intramedullary device and 1 patient replacement of the intramedullary device. The total time for removal of an intramedullary device was (2.3±0.8) h, ranging from 1.0 to 3.2 h. The amount of blood loss was (159.0±61.0) mL, ranging from 80 to 250 mL. The follow-up was (14.5±2.2) months, ranging from 11 to 18 months. There was no infection or fracture associated with implant removal.Conclusion:Application of our self-made Kirschner wire connecting rod in combination with a conventional intramedullary nail extractor is an easy operation to successfully extract hard-to-remove intramedullary implants, requiring no more special instruments.

Comparison of three surgical fixation methods for fracture of distal radial metaphyseal diaphyseal junction in children / 中华创伤骨科杂志

Objective:To compare the effects of anterograde elastic stable intramedullary nailing (ESIN-A), retrograde K-wires fixation (KW-R) and retrograde precision shaping of elastic stable intramedullary nailing (ESIN-RPS) in the treatment of fractures of distal radial metaphyseal diaphyseal junction (DRMDJ) in children.Methods:A retrospective study was conducted to analyze the data of 112 eligible children with DRMDJ fracture who had been treated at Department of Orthopedics, Children's Hospital, Anhui Medical University and Department of Orthopedics, The People's Hospital of Fuyang City,Anhui Medical University, from January 2016 to May 2022. There were 64 males and 48 females, with an age of (8.4±2.3) years. The children were divided into 3 groups according to different surgical fixation methods: group ESIN-A of 36 cases, group KW-R of 52 cases, and group ESIN-RPS of 24 cases. The operation time, intraoperative bleeding, fluoroscopy times, alignment rates and residual angulations by the anteroposterior and lateral X-ray films immediately after reduction were compared among the 3 groups. The Gartland-Werley evaluation of wrist function and complications were compared at the last follow-up.Results:There was no statistically significant difference in the preoperative general data among the 3 groups, indicating comparability ( P>0.05). In the operation time, group KW-R [(71.2±9.2) min] > group ESIN-A [(65.1±13.1) min] > group ESIN-RPS [(51.7±17.1) min]; in the fluoroscopy times, group KW-R [(13.9±6.3) times] > group ESIN-A [(9.0±2.8) times] > group ESIN-RPS [(6.4±2.0) times]; in the alignment rates by the anteroposterior and lateral X-ray films immediately after reduction, group ESIN-RPS (93.1%±4.6% and 95.2%±3.3%) > group KW-R (82.1%±11.0% and 88.1%±7.4%) > group ESIN-A (80.4%±9.9% and 86.7%±6.9%); in the residual angulations by the anteroposterior and lateral X-ray films immediately after reduction, group ESIN-RPS (3.3°±1.8° and 2.9°±2.1°) < group ESIN-A (5.2°±1.0° and 5.0°±3.2°) < group KW-R (6.6°±1.6°and 7.5°±2.7°). Pairwise comparisons in the above items were statistically significant ( P<0.05). In group ESIN-A, the incision length [(1.8±0.3) cm] was significantlylonger than that in group ESIN-RPS [(1.4±0.2) cm], and the intraoperative blood loss [(8.3±2.2) mL] significantly larger than that in group ESIN-RPS [(5.5±1.6) mL] ( P<0.05). One year after operation, the excellent and good rate by the Gartland-Werley evaluation of wrist function in groups ESIN-RPS, ESIN-A and KW-R, respectively, were 95.8% (23/24), 86.5% (31/36) and 86.1% (46/52), showing no statistically significant difference between the 3 group ( P>0.05), and the major incidence of complications in group KW-R (25.0%, 13/52) and in group ESIN-A (25.0%, 9/36) were significantly higher than that in group ESIN-RPS (4.2%, 1/24) ( P<0.05). Conclusion:In the treatment of DRMDJ fractures in children, compared with ESIN-A and KW-R, ESIN-RPS is an effective choice due to its advantages of shorter operation time, less intraoperative blood loss, less radiation, better alignment, and fewer complications.

Proximal femoral bionic nail versus proximal femoral nail antirotation in treatment of femoral intertrochanteric fracture: a comparison of short-term efficacy / 中华创伤骨科杂志

Objective:To compare the short-term effects of proximal femoral bionic nail (PFBN) and proximal femoral nail antirotation (PFNA) in the treatment of intertrochanteric fracture.Methods:Retrospectively analyzed were the data of 56 patients with intertrochanteric fracture of the femur who had been admitted to Department of Orthopedic Trauma, The People's Hospital of Juye County and Trauma Center, Central Hospital Affiliated to The First Medical University of Shandong from August 2020 to April 2022. The patients were divided into 2 even groups according to their internal fixation methods ( n=28). In the PFBN fixation group, there were 12 males and 16 females with an age of (70.4±7.8) years; by AO classification, there were 4 cases of type 31-A1, 16 cases of type 31-A2, and 8 cases of type 31-A3. In the PFNA fixation group, there were 10 males and 18 females with an age of (73.0±8.9) years; by AO classification, there were 2 cases of type 31-A1, 16 cases of type 31-A2, and 10 cases of type 31-A3. The operation time, intraoperative blood loss, fracture reduction, fracture healing time, Harris hip score, and complications were compared between the 2 groups. Results:There was no statistically significant difference between the 2 groups in the preoperative general data, showing comparability ( P>0.05). The follow-up time was (7.3±0.9) months for the PFBN group and (7.4±1.1) months for the PFNA group, showing no significant difference ( P>0.05). There was no significant difference either between the 2 groups in operation time, intraoperative blood loss or quality of fracture reduction ( P>0.05). The PFNA group had significantly shorter fracture healing time [(3.9±0.9) months] than the PFNA group [(4.7±1.1) months], and a significantly higher Harris hip score at the last follow-up [(83.9±4.3) points] than the PFNA group [(81.0±3.4) points] (both P<0.05). Fixation failed in one patient in the PFNA group due to cut-out of the head and neck screws while no complications were observed in the PFBN group. Conclusion:In the treatment of intertrochanteric fracture of the femur, PFBN fixation may result in stronger fixation to effectively avoid cut-out of the head and neck screws, and faster fracture healing and functional recovery of the hip than PFNA fixation.

Minimally invasive percutaneous anterior column screwing assisted by blocking screws for pelvic and acetabular fractures / 中华创伤骨科杂志

Objective:To investigate the feasibility and clinical efficacy of percutaneous anterior column screwing assisted by blocking screws for pelvic and acetabular fractures.Methods:A retrospective analysis was conducted of the 13 patients who had been admitted from July 2019 to April 2022 for pelvic and acetabular fractures. There were 8 males and 5 females with an age of (49.1±13.3) years, 7 acetabular fractures (6 on one side and 1 on both sides; by the Letournel-Judet classification: 5 anterior column fractures on 6 sides, and 2 transverse and posterior wall fractures on 2 sides), and 6 pelvic fractures (5 complicated with pelvic posterior ring fracture; by the Tile classification: 1 case of type B2, 3 cases of type C1, and 2 cases of type C2). According to the anatomic zones of the anterior column, 5 fractures were at zone Ⅲ, 3 ones at zone Ⅳ, and 6 ones at zone Ⅴ. The time from injury to surgery ranged from 3 to 14 days, averaging (8.2±2.9) days. Anterograde anterior column screwing assisted by blocking screws was performed for all the 13 patients; the posterior ring was fixated with percutaneous sacroiliac joint screws for the 5 patients complicated with pelvic posterior ring fracture. The surgical time, intraoperative fluoroscopy frequency, and intraoperative bleeding volume for insertion of anterior column screws, fracture reduction quality, and hip joint function at the last follow-up were recorded.Results:A total of 14 anterior column screws were inserted percutaneously in the 13 patients. For insertion of anterior column screws, the surgical time was (65.0±10.2) min, the intraoperative fluoroscopy frequency (63.5±14.5) times, and the intraoperative bleeding volume for each screw less than 30 mL. All the incisions healed primarily after surgery, without such complications as iatrogenic neurovascular injury or poor wound healing. All the 13 patients were followed up for (11.1±2.2) months after surgery. In the patient with bilateral acetabular anterior column fractures for which 2 anterior column screws had been inserted, one screw had to be removed due to its displacement at 1 month after surgery; no such complications as loosening of internal fixation or fracture re-displacement was found in the other patients. All fractures healed after (10.2±2.1) months. According to the Matta scoring for quality of fracture reduction, 7 sides were excellent, 5 sides good, and 2 sides poor; according to the Majeed scoring for the 6 patients with pelvic fracture at the last follow-up, the efficacy was rated as excellent in 4 cases and as good in 2 ones; according to the modified Merle d'Aubigné & Postel scoring for the 7 patients with 8 acetabular fractures at the last follow-up, the efficacy was rated as excellent in 4 hips, as good in 3 hips, and as fair in 1 hip.Conclusion:For pelvic and acetabular fractures, minimally invasive percutaneous anterior column screwing assisted by blocking screws can result in fine clinical efficacy, in addition to its easy procedures, safety and reliability.

Research into the fixation stability of the glenoid baseplate in reverse shoulder arthroplasty / 中华创伤骨科杂志

Reverse shoulder arthroplasty (RSA) was proposed to deal with rotator cuff tear arthropathy in the 1970s and improved from 1985 to 1995 by Dr. Grammont who designed the contemporary type of reverse shoulder prosthesis successfully. The number of RSAs has grown rapidly over the past decade. Currently, the indications for RSA include, in addition to rotator cuff tear arthropathy, massive rotator cuff tears which can not be repaired, proximal humerus fractures or their sequelae, inflammatory shoulder disease, osteoarthritis with abnormal glenoid morphology, anatomic revision after failed total shoulder arthroplasty or hemiarthroplasty, and shoulder tumors. Absolute contraindications to RSA include infection, complete axillary nerve palsy, neuropathic shoulder arthropathy, and glenoid bone loss. At present, the stability of the glenoid baseplate, an important factor affecting the incidence of postoperative complications, is mainly achieved by implantation of the screws for the glenoid baseplate base. Therefore, correct implantation of the screws is of great significance to reduce the complications in RSA.

The effect of medial calcar screws on the treatment of Neer type Ⅲ proximal humeral fracture with Multiloc intramedullary nailing / 中华创伤骨科杂志

Objective:To investigate the effect of the use of medial calcar screws on the treatment of Neer type Ⅲ proximal humeral fracture with Multiloc intramedullary nailing.Methods:A retrospective study was conducted to analyze the data of 36 patients with Near type Ⅲ fracture of the proximal humerus who had received Multiloc intramedullary nailing at Department of Upper Limbs, Sichuan Orthopedic Hospital from January 2016 to December 2021. There were 6 males and 30 females with an age of (63.9±5.3) years. They were divided into 2 groups according to whether medial calcar screws had been used or not. There were 17 cases in the group without medial calcar screws and 19 cases in the group with medial calcar screws. The 2 groups were compared in terms of flexion and lifting, external rotation, internal rotation and back touch, visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score for shoulder function (Constant score), neck shaft angle, and incidence of complications at the last follow-up.Results:There were no statistically significant significances in the preoperative general data between the 2 groups, indicating comparability between the groups ( P>0.05). The 36 patients were followed up for 13.5(12.0,19.8) months after surgery. The flexion and lifting, external rotation, internal rotation and back touch, VAS, ASES score, Constant score, neck shaft angle at the last follow-up in the group without medial calcar screws were, respectively, 134.1°±8.4°, 32.1°±5.3°, 14.0 (13.0, 15.5) , 0.0 (0.0, 1.0), 78.2±5.2, 78.0±5.8, and 137.6°±8.1°, insignificantly different from those in the group with medial calcar screws [134.7°±6.1°, 35.0(30.0, 35.0)°, 14.0(13.0, 15.0), 1.0 (0.0, 1.0), 78.2±5.4, 76.7±4.5, and 136.9°±6.4°] ( P>0.05). Postoperative complications occurred in 6 patients in each group, showing no statistically significant difference between the 2 groups ( P=1.000). Conclusion:The use of medial calcar screws has no significant impact on the postoperative shoulder function and incidence of complications in the treatment of Neer type Ⅲ fractures of the proximal humerus with Multiloc intramedullary nailing.

Progress in research into the wedge effect during cephalomedullary nailing for intertrochanteric fractures / 中华创伤骨科杂志

Surgical intervention is the first choice treatment for intertrochanteric fractures that are common in clinical practice. Cephalomedullary nailing with two parts inserted respectively into the femoral medullary cavity and femoral head has been the mainstream protocols for the elderly patients with intertrochanteric fracture, but insertion of the cephalomedullary nail may likely lead to the outward displacement of the femoral shaft and the inversion and rotation of the head and neck bone mass, namely the so-called wedge effect. However, few reports have dealt with how to prevent the wedge effect and reduce the complications it may cause such as coxa vara deformity. The present review expounds and analyzes the concept, biomechanical mechanism, influencing factors, measurements, and prevention methods of the wedge effect, hoping to help the surgeons who try to avoid the wedge effect in surgical treatment.

Resection of ankle tumor lesion and reconstruction with the use of allograft / Ressecção de lesão tumoral do tornozelo e reconstrução com uso de aloenxerto

RESUMO A reconstrução do terço distal da tíbia devido à ressecção de tumor maligno apresenta alguns fatores que dificultam sua realização, como camada subcutânea delgada, feixes neurovasculares que transpassam os compartimentos, tempo cirúrgico prolongado, material ortopédico específico e equipe multidisciplinar treinada. O aloenxerto de banco de tecido faz parte deste arsenal ortopédico. Objetivo: Descrever o protocolo realizado no Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad. Métodos: Série de seis casos submetidos à ressecção com margens oncológicas, reconstrução com aloenxerto e uso de haste retrógrada de tornozelo como cirurgia preservadora do membro. Três dos seis pacientes eram do sexo feminino, as lesões tinham em média 9,3 cm de comprimento e o tempo cirúrgico médio foi de 3,25 horas. Resultados: A principal complicação de curto prazo (≤ 30 dias) foi a paralisia do nervo fibular, enquanto a principal complicação de longo prazo (> 30 dias) foi a infecção do sítio cirúrgico (dois casos). A consolidação dos dois focos ocorreu em três pacientes, e dois pacientes evoluíram para pseudoartrose assintomática do foco proximal com consolidação do foco distal. Conclusão: Apesar das complicações, a cirurgia proposta permite ao paciente a chance de preservar seu membro diante de uma cirurgia radical imediata. Nível de Evidência IV, Série de Casos.

ABSTRACT Reconstruction of the distal third of the tibia due to resection of a malignant tumor has some hindering factors, such as a thin subcutaneous layer, neurovascular bundles that cross compartments, prolonged operative duration, specific orthopedic material, and a trained multidisciplinary team. Allografting with material from tissue banks is part of this orthopaedic arsenal. Objective: To describe the protocol used at Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad. Methods: Series of six cases subjected to resection with oncologic margins, allograft reconstruction, and use of a retrograde ankle nail as limb-salvage surgery. Three of the six patients were women, the lesions were on average 9.3 cm long, and the average operative duration was 3.25 hours. Results: The main short-term complication (≤ 30 days) was peroneal nerve palsy, while the main long-term complication (> 30 days) was surgical site infection (two cases). Consolidation of the two foci occurred in three patients, and two patients developed asymptomatic pseudoarthrosis of the proximal focus with consolidation of the distal focus. Conclusion: Despite the complications, the proposed surgery gives patients the chance to preserve their limb in the face of immediate radical surgery. Level of Evidence IV, Case Series.

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

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

Comparison of Gamma 3 U-blade system and Gamma 3 nails in treatment of elderly patients with osteoporotic unstable femoral intertrochanteric fracture / 中华创伤骨科杂志

Objective:To compare the short-term therapeutic effects of Gamma 3 U-Blade system and Gamma 3 nails in the treatment of elderly patients with osteoporotic unstable intertrochanteric fracture.Methods:The data of 70 elderly patients with osteoporotic unstable intertrochanteric fracture were retrospectively analyzed who had been admitted to the Department of Orthopedics, Wuhan Fourth Hospital from June 2018 to December 2020. They were divided into 2 groups according to their treatments. In the U-Blade group of 35 cases subjected to fixation with Gamma 3 U-Blade system, there were 14 males and 21 females with an age of (77.7 ± 4.8) years; in the Gamma 3 nail group of 35 cases subjected to fixation with Gamma 3 nails, there were 14 males and 21 females with an age of (79.3 ± 5.2) years. The 2 groups were compared in terms of operation time, intraoperative blood loss, apex distance, fracture union time, postoperative complications, timed up and go (TUG) at postoperative 2 weeks, 3 months and 6 months, and hip function at postoperative 9 months.Results:There was no statistically significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). There was no significant difference either in operation time, intraoperative blood loss or apex distance between the 2 groups ( P>0.05). The fracture union time [(12.0 ± 0.2) weeks] and Harris hip score at postoperative 9 months [90 (90, 91)] in the U-Blade group were insignificantly different from those in the Gamma 3 nail group [(12.0 ± 0.3) weeks and 91 (89, 91)] ( P>0.05). The rate of implant-related complications in the U-Blade group [0% (0/35)] was significantly lower than that in the Gamma 3 nail group [17.1% (6/35)] and the TUGs at postoperative 2 weeks and 3 months [(80.2 ± 3.6) s and 45 (43, 49) s] in the former were significantly shorter than those in the latter [(89.3 ± 4.2) s and 56 (54, 59) s] ( P<0.05). Conclusion:In the treatment of elderly patients with osteoporotic unstable intertrochanteric fracture, compared with traditional Gamma 3 nails, Gamma 3 U-Blade system can reduce implant-related complications and facilitate early recovery of walking ability.

A biomechanical analysis of cannulated screws fixation in a configuration of "axial compression and lateral buttress" in treatment of Pauwels type Ⅱ femoral neck fractures / 中华创伤骨科杂志

Objective:To investigate the biomechanical properties of cannulated screws fixation in a configuration of "axial compression and lateral buttress" in the treatment of Pauwels type Ⅱ femoral neck fractures.Methods:Ten specimens of Sawbones artificial femur were first made into models of type Ⅱ femoral neck fracture with a Pauwells angle of 50° and then randomized into 2 equal groups ( n=5). The specimens in the experimental group were subjected to fixation with cannulated screws in a configuration of "axial compression and lateral buttress" in which the axial screw was 8.5 mm in diameter and the lateral screw 6.5 mm in diameter. The specimens in the control group were subjected to conventional fixation with cannulated screws in a configuration of "inverted triangle and parallel compression" in which the 3 screws was 7.3 mm in diameter. Finally, the specimens were placed onto a biomechanical testing machine to determine the parameters of static axial stiffness, displacement under 60 to 600 N load for 5,000 cycles, ultimate load and ultimate stiffness in turn. The 2 groups were compared to find out their differences. Results:The static axial stiffness was (1,492.00 ± 87.86) N/mm, significantly higher than that in the control group [(1,200.22 ± 228.06) N/mm] ( P<0.05). There was no significant difference between the 2 groups in the cyclic load displacement [(0.44 ± 0.01) mm versus (0.57 ± 0.17) mm] ( P>0.05), but the experimental group showed a lower trend. The ultimate load and ultimate stiffness were (4,292.61 ± 804.29) N and (1,623.55 ± 180.94) N/mm in the experimental group and (4,383.64 ± 1,423.24) N and (1,433.77 ± 289.93) N/mm in the control group, showing no significant difference between the 2 groups ( P>0.05). Conclusion:In the treatment of Pauwels type Ⅱ femoral neck fractures, fixation with cannulated screws in a configuration of "axial compression and lateral buttress" may exhibit better biomechanical properties than that in a conventional configuration of "inverted triangle" .

2021 classification and reduction techniques of irreducible intertrochanteric fractures / 中华创伤骨科杂志

Objective:To revise the 2017 classification of irreducible intertrochanteric fractures and summarize reduction techniques of 2021 classification.Methods:A retrospective analysis was conducted of the 17 patients with irreducible intertrochanteric fracture who had been treated at Department of Orthopaedic Surgery, The Ninth People's Hospital of Shanghai, Shanghai Jiaotong University School of Medicine from January 2015 to December 2019. They were 7 males and 10 females, with an age of (73.2 ± 16.1) years. On the basis of 2017 classification, the irreducible intertrochanteric fractures were classified into 2 types in the present 2021 classification. Type Ⅰ were interlocking fractures which were further classified into 3 subtypes: type ⅠA were sagittal interlocking ones (7 cases), type ⅠB greater trochanter interlocking ones (one case) and type ⅠC lesser trochanter interlocking ones (one case). Type Ⅱ were separating fractures which were further classified into 4 subtypes: type ⅡA were sagittal separating ones (4 cases), type ⅡB coronal separating ones (one case), type ⅡC rotational separating ones(one case) and type ⅡD complete separating ones (2 cases). All patients were treated by closed reduction and intramedullary nailing with different reduction strategies corresponding to their fracture types (application of ejector rods, clamps or prying techniques, etc.). A total of 132 patients with reducible femoral intertrochanteric fracture who had been admitted during the same period were selected as the control group. The fracture reduction time, intraoperative blood loss and Harris hip score at the last follow-up were compared between the 2 groups.Results:The 2 groups were comparable because there was no significant difference in their preoperative general data ( P>0.05). Type ⅠA accounted for the highest proportion of irreducible intertrochanteric fractures [41.3% (7/17)], followed by type ⅡA [23.6% (4/17)]. The fracture reduction time [(44.6 ± 6.7) min] in the irreducible group was significantly longer than that in the control group [(39.2 ± 9.6) min] ( P<0.05). There was no significant difference in intraoperative blood loss or Harris hip score at the last follow-up between the 2 groups ( P>0.05). Conclusions:Compared with the "2017 classification" , the "2021 classification" is more concise and easy to remember, and can directly prompt the corresponding proper fracture reduction techniques. The patients with irreducible intertrochanteric fracture using proper reduction techniques can obtain functional recovery similar to that in the patients with reducible intertrochanteric fracture after reduction and fixation.

Clinical significance of excessive inlet view in fluoroscopy-assisted placement of sacroiliac screws / 中华创伤骨科杂志

Objective:To investigate the clinical significance of excessive inlet view in fluoroscopy-assisted placement of sacroiliac screws.Methods:Included for this prospective study were 47 patients with unstable pelvic fracture who had been admitted to Department of Orthopaedic Trauma, Xi'an Honghui Hospital between January 2020 and January 2021. There were 30 males and 17 females, with a mean age of 39.4 years (from 25 to 66 years). By the Tile classification, 21 fractures were type B and 26 ones type C. The inlet view and the angle of excessive inlet view were measured before operation. The intraoperative placement of sacroiliac screws was assisted by C-arm fluoroscopy navigation in the excessive inlet view. The positions of sacroiliac screws were verified by CT or O-arm fluoroscopy after operation. The screw placement time, fracture reduction quality, fracture healing time, and pelvic function at the last follow-up were recorded.Results:A total of 67 screws were implanted in the 47 patients, including 56 sacroiliac screws. The insertion time for each screw averaged 19.9 min (from 9 to 31 min); the angle of excessive inlet view averaged 17.38° (from 12.1° to 24.8°). Verification by O-arm fluoroscopy or CT revealed that all sacroiliac screws were located in the sacral canal without dislocation or breaking through the cortical bone. By the postoperative Matta scoring, the reduction was excellent in 22 cases, good in 17, acceptable in 6, and poor in 2, giving an excellent to good rate of 83.0%(39/47). The average follow-up time for the 47 patients was 9.5 months (from 5 to 15 months); fracture healing time averaged 10.5 weeks (from 7 to 16 weeks). By the Mejeed scoring at the last follow-up, the pelvic function was excellent in 26 cases, good in 15 and acceptable in 6, giving an excellent to good rate of 87.2% (41/47).Conclusions:Fluoroscopy in the excessive inlet view is a simple and easy intraoperative technique. It can improve accuracy and safety of sacroiliac screw placement because it allows clear identification of the posterior border of the sacrum and effectively avoids iatrogenic injury to the sacral nerve caused by screws breaking through the bone cortex.

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

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

Fixation with S 2 alar iliac screws for unstable injury to posterior pelvic ring / 中华创伤骨科杂志

Objective:To explore the fixation with S 2 alar iliac screws (S 2AI) for unstable injury to the pelvic posterior ring. Methods:The clinical data of 18 patients were analyzed retrospectively who had been treated for unstable injury to the posterior pelvic ring by S 2AI screw fixation at Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University and at Department of Orthopaedics and Traumatology, The First Affiliated Hospital to University of South China from September 2017 to December 2020. They were 8 males and 10 females, with an average age of 40 years (from 20 to 64 years). According to Tile classification, there were 3 cases of type B2, 10 cases of type C1 and 5 cases of type C2. Sacral nerve injury was complicated in 3 patients (2 cases of Gibbons grade Ⅱ and one of Gibbons grade Ⅲ). Short-segment S 1-S 2AI fixation was used in 6 cases, contralateral S 1-S 2AI fixation in one case, lumbar-pelvic fixation in 5 cases, and sacroiliac triangle fixation in 6 cases. The accuracy of S 2AI placement was evaluated by CT after operation according to the Shillingford method; the reduction quality of pelvic fractures and complications were documented. Results:All the 18 patients were followed up for 19.8 months (from 12 to 36 months). Bony union was achieved in all fractures. A total of 21 S 2AI were implanted in the 18 patients without intraoperative neurovascular injury. Postoperative CT found penetration into the iliac cortex by S 2AI in 2 cases. According to the Matta criteria, the fracture reduction was excellent in 10 cases, good in 7 and fair in one. Of the 3 patients with preoperative sacral nerve injury, 2 with grade Ⅱ injury recovered to grade Ⅰ and one with grade Ⅲ injury recovered to grade Ⅱ after operation. Superficial infection occurred at the incision site in 2 patients after operation, and complications such as protrusion, rupture or loosening of implants were observed in none of the patients. Conclusion:S 2AI fixation can be flexibly applied to various types of posterior pelvic ring injury and can provide the pelvic ring and the lumbosacral junction with rigid fixation, leading to a low complication rate.

Efficacy of TiRobot-assisted minimally invasive percutaneous screw fixation for pelvic fractures / 中华创伤骨科杂志

Objective:To investigate the clinical efficacy of TiRobot-assisted minimally invasive percutaneous screw fixation for pelvic fractures.Methods:The clinical data of 44 patients with pelvic fracture were retrospectively analyzed who had undergone TiRobot-assisted minimally invasive percutaneous screw fixation from May 2018 to April 2021 at Department of Orthopedic Traumatology, The First Hospital of Jilin University. There were 30 males and 14 females, aged from 11 to 78 years (average, 40.6 years). According to the Tile classification, there were 20 type C1 fractures, 23 type C2 fractures and one type C3 fracture. The time from injury to operation averaged 8.2 days (from 1 to 41 days). The minimally invasive percutaneous screw fixation was assisted by the orthopaedic TiRobot in all patients. Operation time, fluoroscopy time, reduction quality, complications and functional recovery at the final follow-up were recorded and analyzed.Results:A total of 96 screws were implanted in this cohort. The total fluoroscopy time ranged from 17 to 66 s, with an average of 17.8 s for each single screw. The operation time ranged from 50 to 355 min, averaging 179.7 min. According to the Matta criteria, the reduction quality was rated as excellent in 36 cases, as good in 5 and as fair in 3, yielding an excellent and good rate of 93.2%(41/44). All the 44 patients were followed up for 6 to 42 months (average, 20.4 months). The fracture healing time ranged from 2 to 6 months, averaging 3.3 months. The Majeed scores at the final follow-up ranged from 51 to 100 points (average, 83.7 points); there were 28 excellent, 8 good, 7 fair and one poor cases, giving an excellent to good rate of 81.8% (36/44). Follow-up found no such complications as iatrogenic neurovascular injury, incision infection, malunion, implant loosening or fracture re-displacement in all the 44 patients.Conclusion:TiRobot-assisted minimally invasive internal fixation can result in fine clinical efficacy for pelvic fractures, showing advantages of accuracy, minimal invasion and safety.

Emergency iliosacral screw fixation assisted by TiRobot for unstable posterior pelvic ring fracture / 中华创伤骨科杂志

Objective:To evaluate the emergency iliosacral screw fixation assisted by TiRobot for unstable posterior pelvic ring fracture.Methods:The 26 patients with unstable pelvic fracture were analyzed retrospectively who had undergone emergency iliosacral screw fixation at Department of Orthopedics & Traumatology, Beijing Jishuitan Hospital from June 2018 to December 2020. They were divided into 2 groups depending on whether orthopaedic TiRobot was used to assist screw insertion. In the observation group of 14 cases subjected to TiRobot-assisted insertion of iliosacral screws, there were 10 males and 4 females with an age of (45.9 ± 10.1) years; in the control group of 12 cases subjected to conventional manual insertion of iliosacral screws, there were 9 males and 3 females with an age of (49.2 ± 11.3) years. All the surgeries were conducted within 24 hours after injury. The 2 groups were compared in terms of screw insertion time, pin insertion, intraoperative blood loss, fluoroscopy time, postoperative screw position, fracture reduction and Harris hip score at the final follow-up.Results:The 2 groups were comparable because there was no significant difference between them in their preoperative general clinical data or follow-up time ( P>0.05). The screw insertion time [(16.1 ± 3.4) min] and fluoroscopy time [(8.1 ± 3.3) s] in the observation group were significantly shorter than those in the control group [(26.4 ± 5.4) min and (25.2 ± 7.4) s], and the pin insertions [1 (1, 2) times] and intraoperative blood loss [(10.5 ± 6.4) mL] in the former were significantly less than those in the latter [6 (3, 8) times and (24.8 ± 6.7) mL] (all P<0.05). Postoperatively, the sacroiliac screw position was excellent in 18 cases and good in 2 in the observation group while excellent in 14 cases, good in 2 and poor in 2 in the control group; the fracture reduction was excellent in 12 cases, good in one and fair in one in the observation group while excellent in 10 cases, good in one and fair in one in the control group, showing insignificant differences in the above comparisons ( P>0.05). There was no significant difference either in the Harris hip score at the final follow-up between the 2 groups ( P>0.05). Conclusion:Compared with conventional manual insertion of iliosacral screws, emergency iliosacral screw fixation assisted by TiRobot can effectively decrease surgical time and reduce operative invasion due to a higher accuracy rate of screw insertion.

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

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

Application of enhanced recovery after surgery in perioperative treatment of elderly patients with intertrochanteric fracture in a primary hospital / 中华创伤骨科杂志

Objective:To explore the efficacy of enhanced recovery after surgery (ERAS) in the perioperative treatment of elderly patients with intertrochanteric fracture in a primary hospital.Methods:Retrospectively analyzed were the data of 104 elderly patients with intertrochanteric femoral fracture who had been treated by fixation with proximal femoral nail antirotation (PFNA) at Joint & Trauma Surgery, Shangyu People's Hospital of Shaoxing from January 2017 to January 2019. According to whether the ERAS concept was applied perioperatively, the patients were divided into 2 groups. In the ERAS treatment group of 53 cases, there were 27 males and 26 females with an age of (72.7±1.5) years. By the AO classification, 27 cases were type 31-A1, 16 cases were type 31-A2, and 10 cases were type 31-A3. Internal diseases were complicated in 37 cases. The time from injury to operation was (65.8±3.9) h. In the conventional treatment group of 51 cases, there were 31 males and 20 females with an age of (72.6±1.5) years. By the AO classification, 21 cases were type 31-A1, 19 cases were type 31-A2, and 11 cases were type 31-A3. Internal diseases were complicated in 37 cases. The time from injury to operation was (111.5±5.9) h. The postoperative pain visual analogue scale (VAS), hospital stay, complications, Harris hip score at the last follow-up, and one-year mortality were compared between the 2 groups.Results:Except for the time from injury to operation, there was no significant difference in the other preoperative general data between the 2 groups, showing comparability ( P>0.05). All the 104 patients were followed up for 12 to 24 months (average, 14.8 months) after operation. The VAS pain score [(3.2±1.2) points], hospital stay [(6.6±2.2) d], complication rate [5.7% (3/53)], and hip Harris score at the last follow-up [(90.7±1.3) points] in the ERAS treatment group were significantly better than those in the conventional treatment group [(3.9±1.0) points, (12.7±1.8) d, 19.6% (10/51), and (86.5±3.8) points] ( P<0.05). There was no significant difference in the one-year mortality between the ERAS treatment group [18.9% (10/53)] and the conventional treatment group [27.5% (14/51)] ( P>0.05). No such complications were followed up as injury to nerve or blood vessel, wound infection, fracture nonunion or femoral head necrosis in this cohort. Conclusion:In the perioperative treatment of elderly patients with femoral intertrochanteric fracture in a primary hospital, compared with conventional treatment, application of ERAS concept can shorten the patients' hospital stay, reduce the incidence of postoperative complications, achieve rapid recovery, and improve the patients' satisfaction.