A novel reduction device for the minimally invasive treatment of femoral shaft fractures.

OBJECTIVE: In this study, a new type of reduction device for femoral shaft fractures was developed and designed. The reduction procedure was also standardized and is expected to be useful in clinical practice. METHODS: A bone traction retractor that consisted of a special traction needle, a resistant sleeve, a crossbar and an arc-adjusting bar was designed. Forty-eight patients (32 males and 16 females, mean age 33.21±7.03 years old) with femoral shaft fractures treated in our hospital from January 2016 to December 2017 were selected. According to the AO classification, there were 15 patients with type A, 24 patients with type B and 9 patients with type C fractures. All patients were treated with transverse bone traction for closed reduction of femoral shaft fractures and femoral reconstruction with intramedullary nails for final fixation. The injured side, preoperative delay time, reduction and operative times, operative blood loss, drilling frequency, number of open reduction cases, hospitalization days, fracture healing time, postoperative HSS function score and complications were recorded. RESULTS: All 48 patients were treated with transverse bone traction using our novel device to obtain reduction. The average time needed for reduction was 19.98±4.66 min. The operating time was 60-100 min, with an average of 78.65±16.81 min, and the average intraoperative blood loss was 131.91±30.22 ml. Open reduction was performed in 8 patients: 1 patient in the experimental group and 7 patients in the control group. The average hospitalization days was 7.78±2.81 days, the fracture healing time was 10 to 15 weeks, with an average of 12.44±2.63 weeks, and the postoperative HSS score was 80-95 points, with an average of 86.52±6.03 points. None of the patients had coxa vara, nonunion, internal fixation failure, infection, nerve injury, limb length discrepancy or other complications. CONCLUSION: In this study, the transverse bone traction reduction technique and the design of a proprietary reduction device system were proposed, with high clinical application. The transverse bone traction reduction technique has the advantages of simple operation, reliable reduction and limited intraoperative fluoroscopy in the minimally invasive treatment of femoral shaft fractures.

Meta-analysis of differences in Constant-Murley scores for three mid-shaft clavicular fracture treatments.

There is no consensus on the optimal treatment for mid-shaft clavicular fracture. We conducted a meta-analysis to compare the effectiveness of non-operative treatment, plate fixation, and intramedullary pin fixation in terms of the Constant-Murley Score (CMS) for treatment of mid-shaft clavicular fracture. Comprehensive search of the Embase, Cochrane Library and PubMed was conducted to retrieve relevant randomized controlled trials (RCTs). A random-effect network meta-analysis was conducted within a Bayesian framework using Markov Chain Monte Carlo (MCMC) in OpenBUGS 3.2.2. Differences in CMS among the three treatments analyzed were evaluated with weighted mean difference (WMD) and surface under the cumulative ranking curves (SUCRA). Eleven studies met our inclusion criteria and were included in our network meta-analysis. Our results revealed that in terms of CMS followed-up for six months, the efficacies of plate fixation and intramedullary pin fixation were higher than non-operative treatment (plate fixation: WMD = 4.70, 95% CI = 1.21 ∼ 7.83; intramedullary pin fixation: WMD = 6.71, 95% CI = 3.20 ∼ 10.39), and intramedullary pin fixation had better efficacy than plate fixation, had better efficacy. However, no differences were found between the efficacies of the three treatments in pairwise comparisons with respect to CMS followed-up for six weeks, three months, 12 months and 24 months. In addition, the cluster analysis showed that intramedullary pin fixation had the best efficacy for patients with mid-shaft CF, followed by plate fixation and non-operative treatment. These analyses suggest intramedullary pin fixation may be the optimal therapeutic approach for mid-shaft clavicular fracture patients.

Biomechanical assessment and 3D finite element analysis of the treatment of tibial fractures using minimally invasive percutaneous plates.

The aim of the present study was to investigate the biomechanical effects of varying the length of a limited contact-dynamic compression plate (LC-DCP) and the number and position of screws on middle tibial fractures, and to provide biomechanical evidence regarding minimally invasive plate osteosynthesis (MIPO). For biomechanical testing, 60 tibias from cadavers (age at mortality, 20-40 years) were used to create middle and diagonal fracture models without defects. Tibias were randomly grouped and analyzed by biomechanic and three-dimensional (3D) finite element analysis. The differences among LC-DCPs of different lengths (6-, 10- and 14-hole) with 6 screws, 14-hole LC-DCPs with different numbers of screws (6, 10 and 14), and 14-hole LC-DCPs with 6 screws at different positions with regard to mechanical characteristics, including compressing, torsion and bending, were examined. The 6-hole LC-DCP had greater vertical compression strain compared with the 10- and 14-hole LC-DCPs (P<0.01), and the 14-hole LC-DCP had greater lateral strain than the 6- and 10-hole LC-DCPs (P<0.01). Furthermore, significant differences in torque were observed among the LC-DPs of different lengths (P<0.01). For 14-hole LC-DCPs with different numbers of screws, no significant differences in vertical strain, lateral strain or torque were detected (P>0.05). However, plates with 14 screws had greater vertical strain compared with those fixed with 6 or 10 screws (P<0.01). For 4-hole LC-DCPs with screws at different positions, vertical compression strain values were lowest for plates with screws at positions 1, 4, 7, 8, 11 and 14 (P<0.01). The lateral strain values and vertical strain values for plates with screws at positions 1, 3, 6, 9, 12 and 14 were significantly lower compared with those at the other positions (P<0.01), and torque values were also low. Thus, the 14-hole LC-DCP was the most stable against vertical compression, torsion and bending, and the 6-hole LC-DCP was the least stable. However, the use of 14 screws with a 14-hole LC-DCP provided less stability against bending than did 6 or 10 screws. Furthermore, fixation with distributed screws, in which some screws were close to the fracture line, provided good stability against compression and torsion, while fixation with screws at the ends of the LC-DCP provided poor stability against bending, compressing and torsion.