Pathwise synchronization of global coupled system with linear multiplicative rough noise.

This paper focuses on achieving pathwise synchronization in stochastic differential equations with linear multiplicative rough noises, which are fractional Brownian rough paths with Hurst parameter H∈(13,12). Using rough paths theory, a useful transformation is introduced to convert the equations into random differential equations. Stability and dynamical behavior of the solutions to the equations are discussed, and pathwise synchronization of the solutions to the coupled system is proven. Also we have verified the synchronization results in Hölder space. And at the end, two alternative forms of noises are considered, and synchronization results are presented. Moreover, numerical simulations are provided to illustrate the results.

Enhanced Outcomes in Femoral Subtrochanteric Fractures Using Long INTERTAN Nails with Titanium Cable Cerclage: A Retrospective Analysis.

BACKGROUND The evidence on use of supplementary titanium cable cerclage (TCC) in treating femoral subtrochanteric fractures (FSF) remains scarce. Therefore, this study aimed to investigate the potential therapeutic effects for FSF patients using TCC. MATERIAL AND METHODS A retrospective study of 68 FSF patients treated by a long intramedullary (IM) nailing with (Observation group, n=41) or without (Control group, n=27) TCC was conducted from January 2020 to December 2021. The primary outcome measure was time to postoperative full weight-bearing. Secondary outcome measures were operation time, intraoperative blood loss, number of blood transfusions needed, varus angle loss, excellent and good rate of fracture reduction, Harris score, and survival rate. RESULTS Patients were followed up for 13 to 36 months. The excellent and good rate of fracture reduction was 100% in the Observation group versus 92.6% in the Control group (P=0.013), and the varus angle loss and time to postoperative full weight-bearing in the Observation group were significantly less than in the Control group (P<0.05). The intraoperative blood loss in the Observation group was significantly higher than in the Control group (P<0.001). No differences were noted between groups for Harris scores and survival rates at last follow-up. CONCLUSIONS TCC fixation combined with IM nailing can improve the excellent and good rate of fracture reduction and reduce varus angle loss, as well as shorten the time to full weight-bearing and promote early functional exercise, which offers an effective treatment option for FSF patients who have failed closed reduction.

Intelligent robot-assisted minimally invasive reduction system for reduction of unstable pelvic fractures.

OBJECTIVE: Currently, minimally invasive internal fixation is recommended for the surgical treatment of unstable pelvic fractures. The premise and difficulty of minimally invasive internal fixation are minimally invasive reduction of fractures. This review aimed to investigate the indications, surgical strategy and techniques, safety, and efficacy of intelligent robot-assisted fracture reduction (RAFR) system of pelvic ring injuries. METHODS: This retrospective study reviewed a case series from March 2021 to November 2021. A total of 22 patients with unstable pelvic fracture injuries underwent minimally invasive internal fixations. All pelvic ring fractures were reduced with our intelligent RAFR system. The robot system intelligently designs the optimal position and reduction path based on the patient's preoperative 3D CT. During the operation, the three-dimensional visualization of the fracture is realized through image registration, and the Robot completes the automatic reduction of the fracture. The global 3D point cloud error between the preoperative planning results and the actual postoperative reduction results was calculated. The postoperative reduction results of residual displacement were graded by the Matta Criteria. RESULTS: Minimally invasive closed reduction procedures were completed in all 22 cases with our RAFR system. The average global 3D point cloud reduction error between the preoperative planning results and the actual postoperative reduction results was 3.41mm±1.83mm. The mean residual displacement was 4.61mm±3.29mm. Given the Matta criteria, 16 cases were excellent, five were good, and one was fair, with an excellent and good rate of 95.5%. CONCLUSION: Our new pelvic fracture reduction robot system can complete intelligent and minimally invasive fracture reduction for most patients with unstable pelvic fractures. The system has intelligent reduction position and path planning and realizes stable pelvis control through a unique holding arm and a robotic arm. The operation process will not cause additional damage to the patient, which fully meets the clinical requirements. Our study demonstrated the safety and effectiveness of our robotic reduction system and its applicability and usability in clinical practice, thus paving the way towards Robot minimally invasive pelvic fracture surgeries.

Clinical outcome of distal tibiofibular arthrodesis with plate fixation for the treatment of chronic frank syndesmosis instability.

BACKGROUND: Numerous treatment strategies have been reported for the treatment of chronic frank distal tibiofibular syndesmosis instability, including several small case series treated by syndesmosis arthrodesis. The aim of this study is to report the treatment of this condition using a specially contoured plate and the associated clinical outcomes. METHODS: Over a period of 8 years, patients presented in our institution with chronic frank distal tibiofibular syndesmosis instability were eligible to participate. All patients were managed with plating and screw fixation. The average follow-up period was 58 months (range, 12-99). Clinical outcome was evaluated using the American Orthopaedic Foot & Ankle Society ankle-hindfoot score. RESULTS: In total, 8 patients met the inclusion criteria and formed the basis of this study. All patients could tolerate full weightbearing 3 months after surgery. The mean Visual Analog Scale pain score and the American Orthopaedic Foot & Ankle Society ankle-hindfoot score were significantly improved at the last follow-up (P<0.05). All patients were satisfied with the result and 7 patients returned to sports. 4 patients had mild limitation of ankle range of motion compared with the unaffected side. CONCLUSION: Syndesmosis arthrodesis was a feasible method for the treatment of chronic frank syndesmosis instability according to our findings. Syndesmosis arthrodesis with plate and screw stabilization is another viable option to be considered into the surgeon's armamentarium. Larger scale studies are desirable to provide further evidence of this method of treatment.

Correction to: A biomechanical comparison of different fixation techniques for fractures of the acetabular posterior wall.

In the original publication, the following authors have been omitted due to a technical error in the original article.

Modeling of unstable pelvic fractures for 20 ° sagittally rotated pelvic displacement.

Early and accurate assessment of unstable pelvic fractures decreases mortality and morbidity by improving the outcomes of closed reduction surgery. In some circumstances (such as in developing countries or in acute trauma), accurate computed tomography (CT) 3D reconstructions are difficult to obtain and plain radiography must be relied upon for surgical planning. Therefore, a simulation model of pelvic displacement was evaluated as a basis for improving the assessment of pelvic fracture displacement from plain radiography images. The simulated model was based on a modified anteroposterior (AP) view of the pelvis constructed using anatomical data. Plain radiography imaging data of sagittal 20 ° hemipelvic rotation, similar to that observed in trauma, was obtained from the simulated model and were compared with normal pelvic rings from 10 cadaveric specimens (actual model). For each data set, the anterior superior iliac spine and ipsilateral pubic symphysis were measured on both sides. There was no significant difference between pelvic sides in the simulated and actual models (P = 0.870). Furthermore, no significant difference was found between the rotational degree of each pelvis based on calculated or simulated degrees and the 20 ° rotational angle (P = 0.322). A simulation model based on plain radiography of pelvic displacement could contribute to the optimal surgical management of unstable pelvic fractures without relying on CT.

Surgical resection of severe heterotopic ossification after open reduction and internal fixation of acetabular fractures: a case series of 18 patients.

OBJECTIVE: To evaluate the clinical results of surgical resection of severe heterotopic ossification (HO) after the open reduction and internal fixation (ORIF) of acetabular fractures. METHODS: A retrospective chart review was performed between October 2005 and November 2010 on patients undergoing severe HO resection following an acetabular fracture ORIF. Our primary outcome was functional status evaluated by the Harris hip score (HSS). HO resection and hip release was performed using a Kocher-Langenbeck approach in all cases, and a combined radiation and indomethacin regimen was used to prevent HO recurrence. Plain radiographs were also used to evaluate the hip joint for arthritic changes and HO recurrence. RESULTS: A total of 18 patients (17 males and 1 female) were included in our study analysis. The mean patient age was 36.8 (range: 22-54 years old) when HO resection surgery was performed. The mean time interval between acetabular fracture ORIF and HO resection was 9.9 months (range: 3-30 months): it was within 6 months in 7 patients, 6-12 months in 8 patients, and >12 months in 3 patients. The HO was graded as Brooker grade III in 8 patients and grade IV in 10 patients. The mean time interval between HO resection and the latest follow-up was 4.5 years (range: 2.1-7.8 years). The mean Harris hip score (HHS) was 84.5 (range: 38-100), with a clinical outcome rating of excellent in 9 patients, good in 3 patients, fair in 4 patients, and poor in 2 patients (good and excellent rating accounted for 66.7%). The mean hip joint motion arc was 194° (range: 90-260°). Complications included one intraoperative femoral neck fracture, 1 sciatic nerve injury, 2 femoral head avascular necrosis, and 6 mild HO recurrences (33.3%). There was 28.6% recurrence if HO resection was within 6 months and 36.4% if >6 months. There were no cases of severe HO recurrence, wound infections, deep vein thrombosis, or pulmonary embolism. CONCLUSION: The early surgical resection of severe HO after an acetabular fracture ORIF can provide satisfactory results, however the complication rate is relatively high.

Long-term outcome of operative management of delayed acetabular fractures.

BACKGROUND: Surgical treatment of acetabular fracture has long been a challenging area in the field of orthopedic trauma. The aim of this research was to investigate the operative methods for delayed acetabular fractures and to assess the operation results. METHODS: The operative approaches, procedures, results, and complications of the delayed acetabular fractures between 1995 and 2005 were retrospectively evaluated at Beijing Jishuitan Hospital. Quality of life was assessed for each patient with the Merle d'Aubingne and Postel fracture function rating scale and the radiological result was assessed using the Matta radiological score. RESULTS: Sixty-eight cases (70 hips) were followed up with a minimal duration of five years (average of 5.8 years). Excellent functional results were observed in 10 hip joints, good results in 40, fair results in 11, and poor results in nine. The risks of poor prognosis include impact fracture or osteochondral fracture of femoral head, a time beyond 42 days from injury to operative management, and dislocation of femoral head during the injury. Some of the problems, which were observed included postoperative infection in two hips, iatrogenic sciatic nerve injury in eight hips, traumatic arthritis in 15 hips, heterotopic ossification in 17 hips, and necrosis of the femoral head in six hips. CONCLUSION: A careful selection of operative indications for delayed acetabular fractures in combination with a proper operative approach and appropriate reduction and fixation could guarantee relatively good results.

[Posterior monteggia fracture-dislocations of proximal ulna].

OBJECTIVES: To discuss the diagnosis and differential diagnosis, and to establish an effective protocol to treat the posterior Monteggia fracture-dislocations of proximal ulna in adult according to our experience. METHODS: Between April 2004 and December 2007, 16 patients with posterior Monteggia fracture-dislocations were treated surgically, 13 were followed up at a mean of 28 months (range, 12 - 58 months). All the operations were through the posterior midline approach. The fractures of radial head and coronoid process were reduced and fixed, if possible. The proximal ulna fractures were fixed with a single plate in 7 cases, plate combined with K-wires in 2, plate combined with K-wires tension band in 3, and K-wires tension band combined with screws in 1. RESULTS: No elbow was painful or unstable at the last follow up examination. They had an average of 100 degrees (range, 0 degrees to 145 degrees ) of flexion-extension of elbow. The average motion of forearm rotation was 119 degrees (range, 0 degrees to 170 degrees ). The mean Mayo Elbow Performance Score (MEPS) was 93.1 points (67 - 100 points), excellent and good results were achieved in 92.3%. The mean system of Broberg and Morrey score was 88.8 points (53 - 100 points), excellent and good results were achieved in 76.9%. CONCLUSIONS: Attention should be paid to the diagnosis and differential diagnosis of the posterior Monteggia fracture-dislocation of proximal ulna. Anatomically reduction and stable fixation of proximal ulna is the keystone for the surgical treatment.

[Trans-sacroiliac joint with plate via the anterior approach in management of posterior pelvic injuries].

OBJECTIVE: To report the clinical experience in trans-sacroiliac joint with plate via the anterior approach in management of posterior pelvic injuries. METHODS: The clinical data of 29 cases (30 sides) with pelvic injury, 16 being of type B, and 13 of type C according to the Tile classification; with the average displacement of the posterior ring injuries of 18 mm; undergoing trans-sacroiliac joint with plate via the anterior approach from January 2002 to June 2007 were analyzed retrospectively, among which 20 sides were fixed by two plates across the sacroiliac joint and 10 sides by single plate. The anterior pelvic injuries of 22 cases were fixed by plates too. Twenty-one cases were followed up for 35 months on average. RESULTS: The average operation time was 3 hours, and the average blood transfusion was 1200 ml. Reduction was excellent in 23 sides (77%), good in 6 sides (20%), and fair in 1 side (3%). Operative injury of lumbosacral trunk occurred in 3 sides (10%) and operative injury of lateral femoral cutaneous nerve occurred in 7 sides (23%). Intra-operative major hemorrhage occurred in 2 cases. The average outcome score according to the Majeed grading system was 93, and the function results all were excellent or good. CONCLUSION: Plating the sacroiliac joint through the anterior approach is an effective method for the management of sacroiliac dislocation or trans-iliac fracture dislocation, while the blood loss of the operation is obvious, and the risk of iatrogenic nerve injury is high.

[The application of computed tomography examination in acetabular fractures].

OBJECTIVE: To study the clinical significance of computed tomography (CT) in diagnosis and treatment of acetabular fractures. METHODS: The plain and CT films of the 66 cases of acetabular fracture from January 2001 to June 2002 were analyzed retrospectively, and the radiological characteristics and results were compared to each other. RESULTS: The diagnosis of 6 cases were changed after CT examination, and the occurrence ratio of marginal impaction, free body in joint, femoral head fracture, sacro-iliac injury and ischial tubersoity fracture involvement were 3:17, 7:29, 6:15, 0:5 and 1:5 in plain and CT examination respectively. CONCLUSIONS: CT examination has the determinative role in detecting weight-bearing zone, marginal impaction, free body, femoral head fracture, sacro-iliac injury, etc., and for completing the diagnosis and guiding the treatment. It should be the routine examination just as the three standard plain examinations in acetabular fractures, and should be carefully read.

[Complications of operative treatment of acetabular fractures].

OBJECTIVE: To improve the effect of operative management of acetabular fractures. METHODS: One hundred and seventy eight acetabular fractures were treated operatively from August 1993 to December 2000. Their functional results and complications were analyzed. RESULTS: One hundred and twelve hips were followed up for an average of 45.7 months. Heterotopic ossification was noted in 26 hips, post-operative osteoarthritis in 22 hips, avascular necrosis of the femoral head in 8 hips, and sciatic nerve injury in 7 hips after operations. No death and infection were found in this series. CONCLUSIONS: Ectopic bone formation develops at extended ilio-femoral and Kocher-Langeneck approaches. Cartilaginous injury of the femoral head is contributable to post-operative osteoarthritis, and imperfect reduction is an important factor in the genesis of osteoarthritis.

[Marginal impaction in acetabular fractures].

OBJECTIVE: To understand the diagnosis and treatment of marginal impaction of acetabular fractures. METHOD: Eighteen of 26 patients with marginal impaction of acetabular fractures were retrospectively reviewed. Marginal impactions was confirmed in 15 patients by CT scan before operation, and in 3 during operation. All patients were treated by ORIF, and the impacted bones were elevated with bone grafts (Bone graft was not used in one patient). All fractures were fixed with a reconstruction plate. RESULTS: The mean follow up was 36.7 months (5 - 71 months). The modified D'Aubingne and Postel score system showed excellent results in 6 patients, good 7, fair 2, and poor 3. CONCLUSION: Posterior fractures and dislocations of acetabular fractures are easily combined with marginal impaction, and can diagnosed by CT scan. Cortical impaction should be recognized as a special type. The impacted bone should be elevated for bone grafting.

[Operative treatment of delayed acetabular fractures].

OBJECTIVE: To assess the operative methods of delayed acetabular fractures and the operative results. METHODS: The operative approaches, procedures, results and complications of the delayed acetabular fractures between August 1993 and August 2001 in Jishuitan Hospital were evaluated retrospectively. RESULTS: Thirty-two patients were followed up 49.6 months on average. Sciatic nerve palsy was found in 1 patient. Excellent functional results of hip joints were found in 3 patients, good in 16, fair in 10, and poor in 3. Ectopic bone formation was observed in 6 patients and necrosis of the femoral head in 3. CONCLUSION: Careful selection of operative indications of delayed acetabular fractures in combination with proper operative approach and appropriate reduction and fixation, good results can be obtained.