Comparison between intramedullary nail and conventional plate for displaced intra-articular calcaneal fractures: A meta-analysis.

OBJECTIVES: This study aimed to compare the efficacy and safety of the intramedullary nail and conventional plate for the treatment of displaced intra-articular calcaneal fractures from clinical comparative trials. MATERIALS AND METHODS: A comprehensive search of English databases was carried out in the Springer, PubMed, ScienceDirect, Web of Science, and Cochrane Library databases until September 2023. Studies on calcaneal fractures treated by an intramedullary nail or a plate were considered for inclusion. Endpoints included duration of operation, length of hospital stay, the Visual Analog Scale (VAS) score, postoperative functional score, radiological parameters, and complications. The mean difference (MD) and risk difference (RD) as the combined variables, as well as the 95% confidence intervals, (CIs) were calculated. RESULTS: Five retrospective controlled studies covering 473 feet at the one-year follow-up met the inclusion criteria. The meta-analysis demonstrated that there were significant differences in the duration of operation (MD: -10.81; 95% CI: -16.32, -5.31; p=0.0001), length of hospital stay (MD: -3.65; 95% CI: -4.35, -2.95; p<0.00001). No significant differences were found regarding postoperative American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale (MD: 0.36; 95% CI: -3.89, 4.61; p=0.87), VAS (MD: 1.95; 95% CI: -0.30, 4.21; p=0.09), or postoperative Böhler angle (MD: 0.94; 95% CI: -0.04, 1.92; p=0.06) between the two groups. The incidence of total complications (RD: -0.31; 95% CI: -0.46, -0.17; p<0.0001) and wound-healing complications (RD: -0.16; 95% CI: -0.30, -0.03; p=0.02) were lower in the intramedullary nail group. There were no significant differences in the incidences of revision surgery, implant removal, superficial wound infection, deep infection, and nonunion. CONCLUSION: Compared to conventional plates, the intramedullary nail showed a shorter duration of operation, reduced length of hospital stay, and fewer postoperative total complications and wound-healing complications in treating displaced intra-articular calcaneal fractures.

Comparison of different internal fixation implants in the treatment of talar neck fractures: A finite element analysis.

OBJECTIVES: This study aimed to analyze the biomechanics of cannulated screws (CS) with or without a lateral locking plate (LLP) in talar neck fractures through a finite element analysis. PATIENTS AND METHODS: The computed tomography image of the talus from a healthy volunteer (adult male) was used to reconstruct a three-dimensional talar model. The method for fixing talar neck fractures with CS and an LLP was planned using computer-aided design software. Afterward, the three-dimensional models of comminuted talar neck fractures were used to simulate fixation with anteroposterior parallel dual CS, single CS+LLP, and dual CS+LLP. Finally, finite element analysis was carried out to compare the outcomes of dual CS+LLP to those of single CS+LLP and to those of using dual CS alone. The displacement and von Mises stress values of the three groups with different internal fixation were analyzed. RESULTS: For a simple talar neck fracture, the lowest amount of displacement was obtained with CS+LLP (0.407 mm), while dual CS (0.459 mm) showed the highest amount of total displacement; the lowest amount of peak stresses was obtained with CS+LLP (5.38 MPa), while dual CS (8.749 MPa) showed the highest amount of total peak stresses. For a comminuted talar neck fracture, the lowest amount of displacement was obtained with CS+LLP (0.398 mm), while dual CS (0.408 mm) showed the highest amount of total displacement; the lowest amount of peak stresses was obtained with CS+LLP (129.9 MPa), while dual CS (205.9 MPa) showed the highest amount of peak stresses. CONCLUSION: Compared to the other two groups, the dual CS+LLP group had better biomechanics properties in the displacement and stress peak of the talus and implant. Thus, the use of dual CS+LLP fixation is recommended for the surgical treatment of comminuted talar neck fractures.

Comparison between bioabsorbable magnesium and titanium compression screws for hallux valgus treated with distal metatarsal osteotomies: A meta-analysis.

OBJECTIVES: In this review, we discuss the efficacy and safety of biodegradable magnesium screws compared to titanium screws in the treatment of hallux valgus (HV) in patients undergoing distal metatarsal osteotomy (DMO). MATERIALS AND METHODS: Eligible scientific articles published prior to October 2022 were retrieved from the PubMed, Springer, ScienceDirect, and Cochrane Library databases. The terms used for searching included "hallux valgus", "distal metatarsal osteotomies", and "bioabsorbable magnesium screw" which were limited in the title or abstract through the text. The title and abstract were checked one by one to exclude the non-related studies. For primary identified studies and relevant systematic reviews, the full texts were accessed and browsed to finally include the eligible studies. No restriction was set on publication language and publication status. RESULTS: Two randomized-controlled trials (RCTs) and three non-RCTs that met the inclusion criteria were included. There was no significant difference in the American Orthopaedic Foot and Ankle Society (AOFAS) score, postoperative HV angle (HVA), intermetatarsal angle (IMA), Visual Analog Scale (VAS) score, soft tissue irritation, implant fracture, reoperation, and infection rates between two groups. CONCLUSION: Bioabsorbable magnesium compression screws show comparable clinical or radiological results to titanium compression screws in the treatment of HV in patients undergoing DMO.

Rare pattern of Maisonneuve fracture: A case report.

BACKGROUND: Maisonneuve fracture is a special type of ankle fracture that consists of proximal fibular fracture, a lesion of the inferior tibiofibular syndesmotic complex (interosseous ligament, anterior inferior tibiofibular ligament and posterior inferior tibiofibular ligament), and injury of the medial structure of the ankle (deltoid ligament tear or medial malleolar fracture). The accepted mechanism of Maisonneuve fracture is pronation external rotation according to the Lauge-Hansen classification. In this paper, we report a rare pattern of Maisonneuve fracture, which has the characteristics of both pronation external rotation ankle fracture and supination adduction ankle fracture. CASE SUMMARY: A 31-year-old female patient accidentally sprained her right ankle while walking 5 d before hospitalization in our hospital. The patient was initially missed in other hospitals and later rediagnosed in our outpatient department. Full-length radiographs of the lower leg revealed proximal fibula fracture, inferior tibiofibular joint separation, and medial malleolar fracture involving the posterior malleolus, which was also revealed on computed tomography scans. Magnetic resonance imaging revealed rupture of the anterior inferior tibiofibular ligament and anterior talofibular ligament. We diagnosed a rare pattern of Maisonneuve fracture with proximal fibular fracture, inferior tibiofibular joint separation, medial malleolar fracture and ruptures of the anterior inferior tibiofibular ligament and anterior talofibular ligament. The patient underwent open reduction and internal fixation in our hospital. A 6-mo postoperative follow-up confirmed a good clinical outcome. CONCLUSION: To our knowledge, this rare pattern of Maisonneuve fracture has not been previously described. The possible mechanism of injury is supination adduction combined with pronation external rotation. Careful analysis of the injury mechanism of Maisonneuve fracture is of great clinical significance and can better guide clinical treatment.

Pathoanatomy and Injury Mechanism of Typical Maisonneuve Fracture.

OBJECTIVE: Maisonneuve fracture is a special type of injury which are rare in clinic. The manifestation of such fractures is variable. The aim of this study is to describe the pathoanatomical features of typical Maisonneuve fracture on the basis of radiographs, computed tomography (CT) scans, magnetic resonance imaging (MRI), and intraoperative exploration findings, and to investigate the injury mechanism of this variety. METHODS: The data of 41 patients with Maisonneuve fracture from April 2014 to September 2019 were retrospectively analyzed. There were 32 males and nine females, the average age was 37.9 years (range, 18 to 61 years), the fractures occurred on the left side in 20 patients and on the right side in 21 patients. The cause of injuries were traffic accident in five patients, sprain injury in 20 patients, and falling injury from height in 16 patients. All patients underwent posteroanterior and lateral X-ray examinations of the ankle and calf. CT scan of the ankle was performed in 38 patients, including three-dimensional reconstruction in 33 patients. MRI examination of the ankle and calf was performed in 28 and five patients, respectively. Forty patients were treated with open reduction and internal fixation. The features of proximal fibular fracture, injuries of the medial and posterior structures of the ankle, injuries of the anterior inferior tibiofibular ligament and the interosseous membrane were recorded and analyzed. RESULTS: Forty-one patients had proximal one-third fractures of the fibula including six patients with fracture involving the fibular neck, 30 with proximal one-third fractures of the fibular shaft, and five with proximal-medial one-third junction fracture of the fibular shaft. Thirty-five patients (35/41, 85.37%) with injury of posterior structures, 34 patients had posterior malleolar fracture (34/41, 82.93%), and one patient had posterior inferior tibiofibular ligament rupture (1/41, 2.44%). There were 20 patients with type I fracture, four patients with type II fracture, and 10 patients with type III fracture according to the Haraguchi classification of posterior malleolus fracture. The fracture of the medial malleolus was in 30 patients (30/41, 73.17%), rupture of the deltoid ligament was in 10 patients (10/41, 24.39%), and medial structures intact were in one patient (1/41, 2.44%). All 41 patients had injury of the anterior inferior tibiofibular ligament. CONCLUSIONS: Maisonneuve fracture is characterized by fractures of the proximal fibula and the complete rupture of the anterior inferior tibiofibular ligament. Pronation-external rotation is the main injury mechanism. The manifestations of typical Maisonneuve fracture including that the fibular fracture located in proximal one-third diaphysis and the fracture line was from anterosuperior to posteroinferior.

[The relation between fasting plasma glucose concentrations and insulin resistance].

OBJECTIVE: To study whether insulin resistance exists in the Chinese individuals with impaired glucose regulation (IGR) defined by the modified cut-point value (5.6 mmol/L) in 2003 version of ADA criteria for impaired fasting glucose (IFG). METHODS: We selected 9 persons [aged (44 +/- 5) years, body mass index (BMI) (24.0 +/- 0.8) kg/m(2)] with normal glucose regulation [NGR, fasting plasma glucose (FPG) < 5.6 mmol/L, plasma glucose-2h (PG2h) < 7.8 mmol/L], 9 [aged (49 +/- 3) years, BMI (29.0 +/- 0.8) kg/m(2)] with isolated IFG defined by the new criteria (n-i-IFG, FPG < 5.6 mmol/L, PG2h < 7.8 mmol/L), 20 with combined impaired glucose tolerance (c-IGT) including 10 [aged (45 +/- 4) years, BMI (26.0 +/- 1.3) kg/m(2)] defined by the new criteria (n-c-IGT, FPG 5.6 - 6.0 mmol/L, PG2 h 7.8 - 11.0 mmol/L) and 10 [aged (49 +/- 3) years, BMI (27.0 +/- 1.1) kg/m(2)] defined by the old criteria (o-c-IGT, FPG 6.1 - 6.9 mmol/L, PG2h 7.8 - 11.0 mmol/L), 10 [aged (43 +/- 5) years, BMI (29.0 +/- 2.8) kg/m(2)] with type 2 diabetes mellitus (DM). Insulin resistance of the subjects was measured by using hyperinsulin-euglycemic clamp in which the glucose infusion rate (GIR) was the major index. Beta-cell function was assessed by intravenous glucose tolerance test. The DM patients only underwent the hyperinsulin-euglycemic clamp. RESULTS: (1) The GIR of n-i-IFG group and n-c-IGT group was significantly lower than that of the NGR group [(7.2 +/- 0.8), (7.0 +/- 1.5) vs (10.3 +/- 0.9) mg.kg(-1).min(-1), P < 0.05]. The GIR of o-c-IGT group was the least [(4.8 +/- 0.4) mg.kg(-1).min(-1)], which was similar to that of the DM group [(5.6 +/- 1.0) mg.kg(-1).min(-1)], the GIR of the two groups was significantly reduced compared with the NGR goup [(4.8 +/- 0.4), (5.6 +/- 1.0) vs (10.3 +/- 0.9) mg.kg(-1).min(-1), P < 0.01]. (2) As compared with the NGR group, the fasting insulin level was increased in all the IGR groups and was decreased in the DM group. (3) The first phase of insulin secretion were similar in NGR and n-i-IFG group [(37.0 +/- 8.6) vs (31.7 +/- 9.2) mU/L, P > 0.05], and the n-i-IFG group had greater amount than the n-c-IGT group [(31.7 +/- 9.2) vs (25.9 +/- 9.8) mU/L, P > 0.05]. But it was the least in the o-c-IGT group that significantly less than the NGR group [(17.2 +/- 4.8) vs (37.0 +/- 8.6) mU/L, P < 0.05]. As compared with the NGR group, the second phase of insulin secretion was slightly increased in the n-i-IFG group [(16.6 +/- 2.9) vs (21.9 +/- 3.6) mU/L, P > 0.05], and was even greater in the n-c-IGT group [(16.6 +/- 2.9) vs (38.7 +/- 13.7) mU/L, P < 0.05]. But it was reduced in the o-c-IGT group [(20.7 +/- 2.9) mU/L]. CONCLUSIONS: (1) The IGR subjects defined by the new cut-point value already has insulin resistance. (2) Deficit in insulin secretion is worsening as the IGR deteriorates.