Age-Related Patterns of Traumatic Facial Fractures in the Appalachian Tri-state Area: A Five-Year Retrospective Study.

Introduction Traumatic facial injuries, leading to facial fractures represent a significant subset of traumatic events, with age emerging as a crucial determinant influencing both their etiology and outcomes. Understanding the age-related patterns of traumatic facial fractures is essential for developing targeted prevention and management strategies. In this context, the Appalachian tri-state area stands as an underexplored region concerning this issue, necessitating comprehensive research to elucidate the nuances of age-related traumatic facial fractures within this geographic context. Methods This retrospective study delves into the age-related patterns of traumatic facial fractures within the Appalachian tri-state area, drawing upon patient records from Cabell Huntington Hospital and Saint Mary's Medical Center spanning a five-year period. The study cohort encompasses 623 patients categorized into three age groups: individuals aged <22 years, those aged 22-65 years, and individuals over 65 years. Data analysis involves meticulous examination of mechanisms of injury, injury severity scores (ISSs), hospital length of stay, and the prevalence of surgical interventions across different age cohorts. Results Out of 623 patients, 104 (16.7%) were under 22 years old, 367 (58.9%) were between 22 and 65 years old, and 152 (24.4%) were over 65 years old. The majority were male (70%). Falls were the most common cause of facial fractures in patients over 65 (78%), while assaults were predominant in the 22-65 age group (24%), and motor vehicle collisions (MCVs) in those under 22 (34%). The median ISS and hospital stay durations were similar across age groups. 28% of patients underwent surgery, with significant variation among age groups (p<0.001): 38% for <22 years, 33% for 22-65 years, and 11% for >65 years. Mandibular fractures were more prevalent in younger patients, with rates of 12% for <22 years compared to 5.3% for >65 years. Logistic regression analysis revealed that patients aged 22-65 had 4.10 times higher odds (95% CI=2.38, 7.45, p<0.001) of undergoing surgery, while those under 22 had 5.14 times higher odds (95% CI=2.73, 10.0, p<0.001) compared to those over 65. Significant associations were found for mandibular and bilateral mandibular outcomes in patients aged 22-65 years. Discussion These findings underscore the imperative for tailored prevention strategies and age-specific treatment protocols to optimize patient outcomes. Fall prevention initiatives for the elderly and interventions addressing sports-related injuries for younger individuals are paramount. Moreover, the study highlights the necessity of specialized care protocols for elderly patients to minimize hospital stay durations and manage age-related comorbidities effectively. Moving forward, further research should address limitations, validate findings, and explore the efficacy of specific interventions, thereby paving the way for enhanced preventive measures and management strategies tailored to the diverse age cohorts affected by traumatic facial fractures in the Appalachian region.

Optimizing Root Canal Therapy: An In Vitro Comparative Study of Innovative File Systems on Mandibular Premolar Fracture Resistance.

INTRODUCTION AND AIM:  Root canal therapy is a vital procedure for saving teeth by removing infection and cleaning the complex root canal system. However, a delicate balance exists between thorough cleaning and preserving tooth strength. The study aims to evaluate the instrumentation effect of three innovative file systems, XP-endo® shaper, Reciproc®, and Self-adjusting file (SAF) on fracture resistance of mandibular premolars. MATERIALS AND METHODS: Thirty single-rooted mandibular premolars were collected; a standard access cavity was prepared and the working length was established 1 mm short of the apex. The teeth were randomly divided into three groups(n=10). In Group 1, the shaping of the specimens was achieved using XP-endo® shaper; in Group 2, it was instrumented using Reciproc® file; and in Group 3, it was instrumented using SAF. All samples were decoronated and the roots were mounted vertically in acrylic resin and subjected to fracture resistance under a universal testing machine. RESULTS: Intergroup analysis was done by one-way ANOVA followed by Bonferroni post hoc test, which did not report a statistically significant difference (p>0.05). CONCLUSION: All three tested file systems were similar in fracture resistance. XP-endo® shaper exhibited better fracture resistance on root canal instrumentation when compared to Reciproc® and SAF although they are not statistically significant.

A multi-centre retrospective study of long-term outcomes of spinal re-irradiation with SABR.

INTRODUCTION: Stereotactic ablative body radiotherapy (SABR) is a highly conformal technique utilising a high dose per fraction commonly employed in the re-treatment of spinal metastases. This study sought to determine the safety and efficacy of re-irradiation with SABR to previously treated spinal metastases. METHODS: This was a retrospective analysis of patients at three Australian centres who have undergone spinal SABR after previous spinal radiotherapy to the same or immediately adjacent vertebral level. Efficacy was determined in terms of rates of local control, while safety was characterised by rates of serious complications. RESULTS: Thirty-three spinal segments were evaluated from 32 patients. Median follow-up for all patients was 2.6 years, and median overall survival was 4.3 years. Eleven of 33 (33.3%) treated spinal segments had local progression, with a local control rate at 12 months of 71.4% (95% C.I. 55.2%-92.4%). Four patients (16.7%) went on to develop cauda equina or spinal cord compression. Thirteen out of 32 patients (40.6%) experienced acute toxicity, of which 12 were grade 2 or less. Five out of 30 spinal (16.7%) segments with follow-up imaging had a radiation-induced vertebral compression fracture. There was one case of radiation myelitis which occurred in a patient who had mediastinal radiotherapy with a treatment field which overlapped their prior spinal radiation. CONCLUSION: The patients in this study experienced long median survival, durable tumour control and high rates of freedom from long-term sequelae of treatment. These results support the use of SABR in patients who progress in the spine despite previous radiotherapy.

Biomechanical Design Optimization of Distal Humerus Fracture Plates: A Review.

The goal of this article was to review studies on distal humerus fracture plates (DHFPs) to understand the biomechanical influence of systematically changing the plate or screw variables. The problem is that DHFPs are commonly used surgically, although complications can still occur, and it is unclear if implant configurations are always optimized using biomechanical criteria. A systematic search of the PubMed database was conducted to identify English-language biomechanical optimization studies of DHFPs that parametrically altered plate and/or screw variables to analyze their influence on engineering performance. Intraarticular and extraarticular fracture (EAF) data were separated and organized under commonly used biomechanical outcome metrics. The results identified 52 eligible DHFP studies, which evaluated various plate and screw variables. The most common plate variables evaluated were geometry, hole type, number, and position. Fewer studies assessed screw variables, with number and angle being the most common. However, no studies examined nonmetallic materials for plates or screws, which may be of interest in future research. Also, articles used various combinations of biomechanical outcome metrics, such as interfragmentary fracture motion, bone, plate, or screw stress, number of loading cycles to failure, and overall stiffness (Os) or failure strength (Fs). However, no study evaluated the bone stress under the plate to examine bone "stress shielding," which may impact bone health clinically. Surgeons treating intraarticular and extraarticular distal humerus fractures should seriously consider two precontoured, long, thick, locked, and parallel plates that are secured by long, thick, and plate-to-plate screws that are located at staggered levels along the proximal parts of the plates, as well as an extra transfracture plate screw. Also, research engineers could improve new studies by perusing recommendations in future work (e.g., studying alternative nonmetallic materials or "stress shielding"), clinical ramifications (e.g., benefits of locked plates), and study quality (e.g., experimental validation of computational studies).

Comparison of Twin Screw Derotation Type Versus Single Helical Blade Type Cephalomedullary Nail in the Management of Unstable Intertrochanteric Fractures.

BACKGROUND: The intertrochanteric fracture is a frequently occurring fracture, often attributed to osteoporosis in older populations. Recently, there has been a proposal to perform early surgical fixation on elderly patients to facilitate early rehabilitation. This approach has been shown to have a beneficial effect in lowering comorbidities. The study aims to compare the efficacy of the twin screw derotation type cephalomedullary nail with that of the single helical blade type cephalomedullary nail in the management of unstable intertrochanteric fractures. METHODOLOGY:  The research sample included patients from the orthopedic outpatient and emergency departments of Adesh Medical College and Hospital, Ambala Cantt, India, who were scheduled for surgery for unstable intertrochanteric femur fractures. The patients were categorized into two groups according to the kind of implant they were given: either a twin screw derotation cephalomedullary nail or a single helical blade cephalomedullary nail. The functional result was evaluated by comparing the modified Harris hip score (HHS). Patients with unstable intertrochanteric fractures, including reverse oblique fractures and fractures with posteromedial comminution, as well as patients who provided consent, were included in this study. RESULTS:  Thirteen individuals received treatment with proximal femoral nail antirotation (PFNA2), whereas 19 individuals received treatment with proximal femoral nail (PFN). The mean age in the PFNA2 group was 69.51, whereas the mean age in the PFN group was 70.804. There were three patients in the PFNA2 group and five patients in the PFN group who had a tip apex distance of more than 25 mm. According to the Cleveland index, nine patients in the PFNA2 group and eight patients in the PFN group had an implant location that was not optimum. Four patients in the PFNA2 group and seven patients in the PFN group had a neck shaft angle difference of more than 10° between their undamaged and operated sides. The mean HHS was 74.55 for the PFNA2 group and 69.88 for the PFN group. The PFNA2 group exhibited four problems, whereas the PFN group had five issues. CONCLUSION:  The study found that both implants offer similar functional outcomes, with adherence to specific radiological parameters optimizing results. While both face similar challenges with osteoporosis, there was no notable distinction between them. Notably, the PFNA2 group showed superior outcomes in perioperative morbidity.

A Comparison of Complication Rates between Early and Delayed Surgery among Filipino Patients with Fragility Fractures of the Hip.

Objectives: Existing standards of care recommend operative management for fragility fractures of the hip. Early intervention has been associated with lower incidence of morbidity and mortality. A lack of consensus remains in the Philippines however, regarding timing of surgery. We sought to determine the effects of surgical timing on in-hospital complications among Filipino patients with fragility hip fractures. Methods: All patients admitted for fragility hip fractures in a single tertiary-care facility from 2014-2016 were analyzed retrospectively. Subjects treated within 72 hours were grouped under "early intervention," while those managed beyond were designated "delayed intervention." Primary outcomes were complications during admission, while secondary outcome was length of hospital stay. A total of 96 patients met our inclusion criteria, of which 41 (42.71%) underwent early intervention. Baseline characteristics for both groups were comparable. Results: A significantly lower incidence of pressure ulcers (2.4% for ≤72hours vs 45.5%; p=<0.0001), pneumonia (7.32% vs 47.27%; p=<0.0001), and urinary tract infection (4.88% vs 40%; p=<0.0001), as well as shorter hospital stay (mean: 8.85 days±5.4 vs 14.6 days±13.3; p=0.01) were seen in the early intervention group. More cases of documented deep vein thrombosis were recorded in the delayed intervention group (83.3% versus 16.6%), as was the only case of in-hospital mortality. Conclusion: Early intervention showed a significantly lower incidence of in-hospital complications among patients with fragility fractures of the hip, suggesting that surgery within 72 hours may lead to better outcomes by helping to reduce the incidence of pressure sores, pneumonia, and urinary tract infection among Filipinos with hip fractures, while reducing length of admission.

Force magnitude and distribution during impacts to the hip are affected differentially by body size and body composition.

Hip fractures are a severe health concern among older adults. While anthropometric factors have been shown to influence hip fracture risk, the low fidelity of common body composition metrics (e.g. body mass index) reduces our ability to infer underlying mechanisms. While simulation approaches can be used to explore how body composition influences impact dynamics, there is value in experimental data with human volunteers to support the advancement of computational modeling efforts. Accordingly, the goal of this study was to use a novel combination of subject-specific clinical imaging and laboratory-based impact paradigms to assess potential relationships between high-fidelity body composition and impact dynamics metrics (including load magnitude and distribution and pelvis deflection) during sideways falls on the hip in human volunteers. Nineteen females (<35 years) participated. Body composition was assessed via DXA and ultrasound. Participants underwent low-energy (but clinically relevant) sideways falls on the hip during which impact kinetics (total peak force, contract area, peak pressure) and pelvis deformation were measured. Pearson correlations assessed potential relationships between body composition and impact characteristics. Peak force was more strongly correlated with total mass (r = 0.712) and lean mass indices (r = 0.510-0.713) than fat mass indices (r = 0.401-0.592). Peak deflection was positively correlated with indices of adiposity (all r > 0.7), but not of lean mass. Contact area and peak pressure were positively and negatively associated, respectively, with indices of adiposity (all r > 0.49). Trochanteric soft tissue thickness predicted 59 % of the variance in both variables, and was the single strongest correlate with peak pressure. In five-of-eight comparisons, hip-local (vs. whole body) anthropometrics were more highly associated with impact dynamics. In summary, fall-related impact dynamics were strongly associated with body composition, providing support for subject-specific lateral pelvis load prediction models that incorporate soft tissue characteristics. Integrating soft and skeletal tissue properties may have important implications for improving the biomechanical effectiveness of engineering-based protective products.

Inflammatory response toward a Mg-based metallic biomaterial implanted in a rat femur fracture model.

The immune system plays an important role in fracture healing, by modulating the pro-inflammatory and anti-inflammatory responses occurring instantly upon injury. An imbalance in these responses can lead to adverse outcomes, such as non-union of fractures. Implants are used to support and stabilize complex fractures. Biodegradable metallic implants offer the potential to avoid a second surgery for implant removal, unlike non-degradable implants. However, considering our dynamic immune system it is important to conduct in-depth studies on the immune response to these implants in living systems. In this study, we investigated the immune response to Mg and Mg-10Gd in vivo in a rat femur fracture model with external fixation. In vivo imaging using liposomal formulations was used to monitor the fluorescence-related inflammation over time. We combine ex vivo methods with our in vivo study to evaluate and understand the systemic and local effects of the implants on the immune response. We observed no significant local or systemic effects in the Mg-10Gd implanted group compared to the SHAM and Mg implanted groups over time. Our findings suggest that Mg-10Gd is a more compatible implant material than Mg, with no adverse effects observed in the early phase of fracture healing during our 4-week study. STATEMENT OF SIGNIFICANCE: Degradable metallic implants in form of Mg and Mg-10Gd intramedullary pins were assessed in a rat femur fracture model, alongside a non-implanted SHAM group with special respect to the potential to induce an inflammatory response. This pre-clinical study combines innovative non-invasive in vivo imaging techniques associated with multimodal, ex vivo cellular and molecular analytics. The study contributes to the development and evaluation of degradable biometals and their clinical application potential. The study results indicate that Mg-10Gd did not exhibit any significant harmful effects compared to the SHAM and Mg groups.

Challenges in diagnosis of calcaneal fractures: an examination using the WIDI SIM platform.

INTRODUCTION: The calcaneus is the most commonly fractured tarsal bone. Diagnosis is often challenging due to subtle radiographic changes and requires timely identification to prevent complications, including subtalar arthritis, neurovascular injury, malunion, osteomyelitis, and compartment syndrome. Treatment varies based on fracture type, with non-surgical methods for non-displaced stress fractures and surgical interventions for displaced or intra-articular fractures. METHODS: This study utilized the Wisdom in Diagnostic Imaging Simulation (WIDI SIM) platform, an emergency imaging simulation designed to assess radiology resident preparedness for independent call. During an 8-hour simulation, residents were tested on 65 cases across various imaging modalities of varying complexity, including normal studies. A single, unique case of calcaneal fracture was included within the simulation in four separate years of testing. Cases were assessed using a standardized grading rubric by subspecialty radiology faculty, with errors subsequently classified by type. RESULTS: A total of 1279 residents were tested in five separate years on the findings of calcaneal fractures of 5 different patients. Analysis revealed a consistent pattern of missed diagnoses across all training years, primarily attributed to observational errors. There was limited improvement with training progression as all training years exhibited similar average performance levels. CONCLUSIONS: Calcaneal fractures pose a diagnostic challenge due to their frequent subtle radiographic findings, especially in stress fractures. Simulation-based evaluations using WIDI SIM highlighted challenges in radiology residents' proficiency in diagnosing calcaneal fractures. Addressing these challenges through targeted education and exposure to diverse cases is essential to improve diagnostic accuracy and reduce complications with calcaneal fractures.

Predicting factors for extremity fracture among border-fall patients using machine learning computing.

Background: The factors causing the injuries sustained from falls at US-Mexican border include falls from border wall or fence, fleeing from border patrols, ejecting from vehicle, and others. This study aimed to determine the factors leading to anatomical injuries and to identify the importance of factors leading to limb fracture and internal organ injuries. Methods: A total of 178 patients who sustained musculoskeletal injuries or internal organ injuries and were admitted to our hospital were included in this retrospective study. Factors indexed for analysis included demographics, comorbidities, and falling mechanic factors. Correlations between anatomical injuries and mechanical injuries were analyzed. Multilayer perceptron neural network (MPNN) was used to identify predictive factors and to stratify the importance of these factors leading to injuries. The SPSS software was used for statistical analysis and predictive factor analysis. Results: The extremity fracture was associated with border wall/fence fall (p = 0.001) and fleeing (p = 0.002). The spine fracture was correlated with bridge jump/fall (p = 0.007), fence jump/fall (p = 0.026). The vehicle ejecting/MVA was correlated with head injury (P < 0.001), chest injury (P < 0.001), and abdominal injury p < 0.001). MNPP stratify the importance of factor causing injury with multiple factor considered. Conclusion: The various injury factors caused different anatomical injuries. Multifactorial assessment associated with these injuries can improve the accuracy of diagnosis and develop a predictive model for clinical applications.

Clinical Associated Factors of Tile B/C Type of Pelvic Ring Fractures; a Retrospective Cross-sectional study.

Introduction: Pelvic ring fractures categorized under Tile Categories B and C denote partially and fully unstable fractures, respectively. This study aimed to identify the clinically associated factors of Tile B/C pelvic ring fractures. Methods: This retrospective cross-sectional study reviewed medical records from the Emergency Medicine department at Ramathibodi Hospital in Bangkok, Thailand. The study included individuals aged ≥ 15 who experienced accidents from 2012 to 2021. To investigate the associations between the clinical variables and three critical outcomes, including Tile B/C pelvic ring fractures, major vascular injuries, and the necessity for surgical or radiological interventions, multivariable logistic regression analysis was employed. Results: A total of 198 patients were included in the study, among whom 34.8% were diagnosed with Tile B/C pelvic ring fractures. The analysis revealed several significant predictors of Tile B/C fractures, including the presence of pelvic tenderness (adjusted odds ratio [aOR] = 15.25, 95% confidence interval [CI] = 5.86-39.66, p < 0.001), and a shock index (SI) ≥1 (aOR = 4.2, 95% CI = 1.24-14.22, p = 0.021). Moreover, Tile B/C pelvic ring fractures were associated with an increased incidence of major vascular events and the imperative requirement for surgical or radiological interventions. Conclusion: Clinical findings of pelvic tenderness and an SI ≥1 are strong predictive clinical factors associated with Tile B/C pelvic fractures. Early diagnosis, application of an pelvic binder, provision of initial resuscitation, and prompt transportation to a definitive care facility are crucial components of management.

Tenofovir-Associated Kidney Dysfunction and Bone Fracture: A Case Report and Literature Review.

Tenofovir is an integral part of antiretroviral therapy used to treat HIV. Long-term use of tenofovir has been associated with decreased glomerular filtration rate, leading to chronic kidney disease, as well as acidosis, electrolyte imbalances, and tubular dysfunction. Tenofovir can also disrupt bone health by decreasing renal phosphate absorption, contributing to osteomalacia. This leads to disruption in mineral metabolism, elevated parathyroid hormone levels, and ultimately, low bone mineral density. Replacing tenofovir with alternative antiretroviral therapy can improve kidney function if done early in the course of the disease. Here, we discuss a case of a 65-year-old woman with HIV who presented with advanced renal failure and hypophosphatemia-induced bone fracture attributed to long-term use of tenofovir. We conclude monitoring kidney function and considering alternative antiretroviral therapy is important to prevent and manage these side effects in patients on long-term tenofovir therapy.

Biomechanical analysis of the tandem spinal external fixation in a multiple-level noncontiguous lumbar fractures model: a finite element analysis.

Objective: This study aimed to investigate the biomechanical characteristics of the tandem spinal external fixation (TSEF) for treating multilevel noncontiguous spinal fracture (MNSF) using finite element analysis and provide a theoretical basis for clinical application. Methods: We constructed two models of L2 and L4 vertebral fractures that were fixed with the TSEF and the long-segment spinal inner fixation (LSIF). The range of motion (ROM), maximum stresses at L2 and L4 vertebrae, the screws and rods, and the intervertebral discs of the two models were recorded under load control. Subsequently, the required torque, the maximum stress at L2 and L4 vertebrae, the screws and rods, and the intervertebral discs were analyzed under displacement control. Results: Under load control, the TSEF model reserved more ROM than the LSIF model. The maximum stresses of screws in the TSEF model were increased, while the maximum stresses of rods were reduced compared to the LSIF model. Moreover, the maximum stresses of L2 and L4 vertebrae and discs in the TSEF model were increased compared to the LSIF model. Under displacement control, the TSEF model required fewer moments (N·mm) than the LSIF model. Compared to the LSIF model, the maximum stresses of screws and rods in the TSEF model have decreased; the maximum stresses at L2 and L4 in the TSEF model were increased. In the flexion condition, the maximum stresses of discs in the TSEF model were less than the LSIF model, while the maximum stresses of discs in the TSEF model were higher in the extension condition. Conclusion: Compared to LSIF, the TSEF has a better stress distribution with higher overall mobility. Theoretically, it reduces the stress concentration of the connecting rods and the stress shielding of the fractured vertebral bodies.

Hearing impairment increases the risk of hip fracture-related mortality and recurrent hip fractures: A propensity score matching analysis.

PURPOSE: Despite the ongoing rise in hip fractures and the adverse effects of hearing impairment (HI) on increased mortality and morbidity, research addressing the influence of HI on mortality risk or complications in patients with hip fractures remains absent. This study aimed to analyze the effects of HI on mortality and treatment outcomes among patients with hip fracture. METHODS: We retrospectively collected data from consecutive patients diagnosed with hip fractures between January 2007 and March 2022 who had auditory examination records. From the initially enrolled 265 patients, data for 58 with HI and 58 without HI (control group) were extracted using a 1:1 propensity score matching. The primary outcome included comparison of mortality rates, and the secondary outcome encompassed the comparison of postoperative medical and surgical complications. RESULTS: The 1-year cumulative mortality rate was not significantly different between the HI and control groups, but the overall cumulative mortality rate was significantly higher in the HI than in the control group (63.0 % and 48.6, respectively; P = 0.046) in a follow-up period of up to 16 years. The HI group had a significantly higher incidence of "second hip fractures due to falls" than the control group (P = 0.016), although no differences in other medical and surgical complications were revealed. CONCLUSIONS: Awareness of the long-term risk of higher mortality when managing patients with hip fracture and HI is important. To reduce the risk of second hip fractures, paying more attention to fall prevention education and taking a more proactive approach, especially for those with HI.

Secondary mandibular osteomyelitis complicated with a pathological fracture.

INTRODUCTION AND IMPORTANCE: Pathological mandibular fractures, defined as fractures that occur in regions where bone has been weakened by an underlying pathological process, are rare, accounting for fewer than 2 % of all fractures of the mandible. Mandibular pathological fractures can have several aetiologies including osteomyelitis, osteoradionecrosis (ORN), surgical interventions, bisphosphonate-related osteochemonecrosis of the jaw and tumoral lesions. CASE PRESENTATION: We present a case of a 13-year-old male patient following a tooth infection with a right facial swelling and limited mouth opening, multiple purulent cutaneous fistulas and mandibular hypoplasia. Intraoral examination revealed the presence of generalized calculus, dental mobility in quadrants 3 and 4. We carried out an orthopantomography which revealed a mandibular angle fracture and the diagnosis of secondary mandibular osteomyelitis with pathological fracture was retained. Sequestrectomy was carried out followed by an open reduction with mini reconstruction plates. CLINICAL DISCUSSION: At 13 years old, this patient with a secondary mandibular osteomyelitis, to the best of our knowledge is the youngest case reported having a secondary mandibular osteomyelitis as etiology of his pathological fracture. Due to the early onset, the patient presented with a bird's profile clinically. His pathological fracture was due to a vicious cycle limiting bone turnover created by the secondary osteomyelitis. CONCLUSION: Pathological mandibular fractures are complex and challenging to treat because of their different aetiologies and also clinicians often have to deal with individuals with grossly infected bone with the fracture management dependent on the resulting bony defect.

Non-fracture acute compartment syndrome in the upper extremity of a 14-year-old boy: A case report and review of the literature.

INTRODUCTION: Acute compartment syndrome (ACS) is an orthopaedic emergency affecting all age groups, yet diagnosis proves particularly difficult within the paediatric population and especially in the absence of fractures. CASE PRESENTATION: In this case report, we detail a rare instance of a non-fracture acute compartment syndrome (NFACS) in a 14-year-old boy, initially missed due to lack of suspicion. Symptoms included swelling, severe pain, and initial paresthesia in the hand. Despite prompt forearm fasciotomy, severe post-traumatic Volkmann contracture ensued, resulting in limited upper extremity function despite multiple corrective surgeries. CLINICAL DISCUSSION: Acute compart syndromes, occurring without fractures, often faces delayed diagnosis, particularly in paediatrics population. Clinical examination remains the diagnostic gold standard, with analgesia refractory pain warranting suspicion. Additional diagnostic criteria like ultrasound, MRI or CK blood values can be evaluated with reservation, especially in the paediatric population. CONCLUSION: This case highlights the importance of increased vigilance in diagnostics for NFACS especially in children, in order to not overlook NFACS, due to the wide variability in the aetiology and clinical appearance. We emphasize the relevance of clinical diagnostics and point out an increased awareness of NFACS in analgesic refractory pain.

A retrospective study of Monteggia fractures in 8 dogs and 1 cat.

Monteggia fractures (MFs) are proximal ulnar fractures with concurrent dislocation of the radial head. This retrospective study aims to report the clinical findings and discuss the treatments and outcomes in MFs cases of 9 cases. Previous medical records of the animals were reviewed for history, clinical features, radiographic findings and choice of treatment. Treatment follow-up was evaluated over the telephone by discussion with the owners. Six animals included in the study were presented 2 days after the initial trauma. Five dogs were presented after common road traffic accidents and two after unknown traumas. All dogs had type I MFs, while the cat had a type III MF. Radiographical findings showed that six animals had extra-articular ulnar fractures, while three animals had intra-articular ulnar fractures. All animals were treated with open reduction of the ulna and internal fixation surgical methods. Six ulnar fractures were stabilized with intramedullary pin(s) with cerclage wire. The clinical outcome was assessed by the owners as full function in 3 dogs, acceptable function in 2 dogs and unacceptable function in 2 dogs with intraarticular ulnar fractures. The cat case was rated as full function. One dog died from a pulmonary fat embolism. The findings presented here provide some support that cerclage wire placement could be a satisfactory method for annular ligament reconstruction as a simple and economical treatment option. Also, to the authors' knowledge, this is the third report of MFs with intraarticular ulnar fractures. In this series, comminuted, intraarticular fractures were related to major postoperative complications.

Percutaneous transverse pinning for metacarpal fractures: a clinical trial.

INTRODUCTION: Metacarpal fractures account for 25%-50% of all hand fractures and may negatively impact hand function and ability to work. Percutaneous transverse pinning of non-articular metacarpal fractures allows mobilisation immediately after the procedure. METHODS: Between March 2017 and February 2022, 56 patients undergoing percutaneous transverse pinning for unstable metacarpal fractures were prospectively recruited. We investigated surgical outcomes in terms of Patient-rated Wrist/Hand Evaluation (PRWHE) and pre-and post-operative radiographic evaluation. The Student t-test was used to compare the means of PRWHE values after surgery. Statistical significance was set at p < 0.05. RESULTS: The mean age was 40.21 ± 17.9 years (range of 16 to 86 years). The average operating time was 27.96 min. The mean follow-up period was 14.3 ± 6.4 months (from 2 to 41 months). The mean PRWHE score was 6.5 ± 1.8. None of the patients had clinically observable rotational deformities, and the functional outcomes were satisfactory. CONCLUSION: Percutaneous transverse pinning for non-articular metacarpal fractures restores excellent function, and imaging results are satisfactory. Further high-quality clinical trials are required to validate these results on a larger scale. LEVEL OF EVIDENCE: II, prospective cohort study.

Comparison of the efficacy and safety of vertebroplasty with different pedicle approaches for osteoporotic vertebral.

OBJECTIVE: To compare the efficacy and safety of vertebroplasty through different pedicle approaches in the treatment of osteoporotic vertebral compression fracture osteoporotic vertebral compression fractures (OVCF) by network meta-analysis. METHODS: Pubmed, Embase, Cochrane Library, Web of Science. Database for literature retrieval, retrieval time from the establishment of the database to April 2023, the randomized controlled trials of unilateral vertebroplasty (UVP), bilateral vertebroplasty (BVP), unilateral kyphoplasty (UKP), bilateral kyphoplasty (BKP), curved vertebroplasty (CVP) and curved kyphoplasty (CKP) were screened, evaluated and the data were extracted and included in the analysis. STATA 15.0 and ReMan 5.3 were used for data analysis. This study was registered in the National Institute for Health Research (NIHR) with the registration number CRD42023405181. RESULTS: This study included 16 articles with a total of 1712 patients. The order of visual analogue scale (VAS) improvement from good to bad is CVP > BVP > UVP > CKP > BKP > UKP. The order of kyphotic angles improvement from good to bad is CKP > UKP > UKP > UVP > BVP > CVP. The order of bone cement injection from less to more is UVP > CVP > UKP > CKP > BVP > BKP. The order of bone cement leakage rate from less to more is CKP > CVP > UKP > BKP > UVP > BVP. The order of X-ray exposure time from less to more is CKP > CVP > UVP > BVP > UKP > BKP. The order of operation time from less to more is CVP > UVP > UKP > CKP > BVP > BKP. CONCLUSION: For patients with kyphotic angles, kyphoplasty has unique advantages in improving kyphotic angles. But generally speaking, curved approach can optimize the distribution of bone cement through unilateral approach to achieve the orthopedic effect of bilateral approach, which is a minimally invasive technique with better curative effect and higher safety in the treatment of OVCF.

Establishing surgical volume benchmarks for Orthopaedic Trauma Association (OTA)-accredited fellowship training.

INTRODUCTION: Case volumes of trauma centers and surgeons influence clinical outcomes following orthopaedic trauma surgery. This study quantifies surgical volume benchmarks for Orthopaedic Trauma Association (OTA)-accredited fellowship training in the United States. METHODS: This was a retrospective cross-sectional study of orthopaedic trauma fellows graduating between 2018 and 2019 to 2022-2023. Case volume percentiles were calculated across categories and variability defined as the fold-difference between 90th and 10th percentiles. Temporal trends were assessed with linear regression. RESULTS: 446 orthopaedic trauma fellows were included in this study. Mean reported case volume increased from 898 ± 245 in 2018-2019 to 974 ± 329 in 2022-2023 (P = 0.066). Mean case volume was 924 over the study period and mostly consisted of other (418 cases, 45 %), subtrochanteric/intertrochanteric femoral neck (84 cases, 9 %), open fracture debridement (72 cases, 8 %), pelvic ring disruption / fracture (55 cases, 6 %), acetabular fracture (41 cases, 4 %), tibial shaft fracture (39 cases, 4 %), and femoral shaft fracture (38 cases, 4 %) cases. Overall variability in total reported case volume was 2.0. Variability was greatest in distal radius fracture (14.8), amputation (9.5), fasciotomy (8.0), and proximal humerus repair (5.0). CONCLUSION: Graduates from OTA-accredited fellowship training perform 924 cases on average, which exceeds the current minimum requirement of 600 cases. Case volume benchmarks can assist trainees and faculty align training goals with fellowship program strengths. More research is needed to determine evidence-based case minimum requirements for core competency training in orthopaedic trauma surgery.