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Zhongguo Xiu Fu Chong Jian Wai Ke Za... Jan 2024To review the biomechanical research progress of internal fixation of tibial plateau fracture in recent years and provide a reference for the selection of internal... (Review)
Review
OBJECTIVE
To review the biomechanical research progress of internal fixation of tibial plateau fracture in recent years and provide a reference for the selection of internal fixation in clinic.
METHODS
The literature related to the biomechanical research of internal fixation of tibial plateau fracture at home and abroad was extensively reviewed, and the biomechanical characteristics of the internal fixation mode and position as well as the biomechanical characteristics of different internal fixators, such as screws, plates, and intramedullary nails were summarized and analyzed.
RESULTS
Tibial plateau fracture is one of the common types of knee fractures. The conventional surgical treatment for tibial plateau fracture is open or closed reduction and internal fixation, which requires anatomical reduction and strong fixation. Anatomical reduction can restore the normal shape of the knee joint; strong fixation provides good biomechanical stability, so that the patient can have early functional exercise, restore knee mobility as early as possible, and avoid knee stiffness. Different internal fixators have their own biomechanical strengths and characteristics. The screw fixation has the advantage of being minimally invasive, but the fixation strength is limited, and it is mostly applied to Schatzker typeⅠfracture. For Schatzker Ⅰ-Ⅳ fracture, unilateral plate fixation can be used; for Schatzker Ⅴand Ⅵ fracture, bilateral plates fixation can be used to provide stronger fixation strength and avoid the stress concentration. The intramedullary nails fixation has the advantages of less trauma and less influence on the blood flow of the fracture end, but the fixation strength of the medial and lateral plateau is limited; so it is more suitable for tibial plateau fracture that involves only the metaphysis. Choosing the most appropriate internal fixation according to the patient's condition is still a major difficulty in the surgical treatment of tibial plateau fractures.
CONCLUSION
Each internal fixator has good fixation effect on tibial plateau fracture within the applicable range, and it is an important research direction to improve and innovate the existing internal fixator from various aspects, such as manufacturing process, material, and morphology.
Topics: Humans; Biomechanical Phenomena; Bone Plates; Fracture Fixation, Internal; Fracture Fixation, Intramedullary; Tibial Fractures; Tibial Plateau Fractures
PubMed: 38225850
DOI: 10.7507/1002-1892.202309077 -
Journal of Children's Orthopaedics Dec 2023We retrospectively analyzed the data of patients who underwent external fixation treatment for unstable pelvic fractures and evaluated the clinical effects of this...
PURPOSE
We retrospectively analyzed the data of patients who underwent external fixation treatment for unstable pelvic fractures and evaluated the clinical effects of this treatment and factors influencing pelvic function recovery.
METHODS
The data of patients with unstable pelvic fractures treated with an external fixator between January 2006 and December 2018 were retrospectively analyzed. The analyzed parameters included demographic data, fracture healing, pelvic asymmetry, deformity index, and complications. Fractures were categorized using the Tiles classification. Pelvic function was evaluated using the Cole score. Pelvic risk factors were identified using univariate and multivariate logistic regression analyses.
RESULTS
Fifty-six patients (29 and 27 with type B and C fractures, respectively) were included. All fractures were healed at the time of the final follow-up. Nine and three patients had pin tract infections and loosened external fixators postoperatively, respectively. Pelvic asymmetry was reduced from 1.34 ± 0.15 cm to 0.70 ± 0.19 cm (p < 0.01), and the deformity index decreased from 0.13 ± 0.03 to 0.07 ± 0.02 (p < 0.01). The Cole score was excellent and good in 41 and 15 patients, respectively. Risk factors for pelvic function recovery included injury severity score > 25.5, age > 11.3 years, and lower-extremity fractures.
CONCLUSIONS
External fixation is an effective method for treating unstable pelvic fractures in children, with the advantages of a simple operation, short surgical time, no interference with treatments for associated injuries, and avoidance of re-trauma caused by open reduction. An ISS > 25.5, patient age > 11.3 years, and associated lower-extremity fractures are predictors of pelvic function recovery.
LEVEL OF EVIDENCE
Level IV.
PubMed: 38050591
DOI: 10.1177/18632521231201163 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Oct 2023To evaluate effectiveness of proximal femur bionic nail (PFBN) in treatment of intertrochanteric fractures in the elderly compared to the proximal femoral nail...
OBJECTIVE
To evaluate effectiveness of proximal femur bionic nail (PFBN) in treatment of intertrochanteric fractures in the elderly compared to the proximal femoral nail antirotation (PFNA).
METHODS
A retrospective analysis was made on 48 geriatric patients with intertrochanteric fractures, who met the selection criteria and were admitted between January 2020 and December 2022. Among them, 24 cases were treated with PFBN fixation after fracture reduction (PFBN group), and 24 cases were treated with PFNA fixation (PFNA group). There was no significant difference in baseline data such as age, gender, cause of injury, side and type of fracture, time from injury to operation, and preoperative mobility score, American Society of Anesthesiologists (ASA) score, Alzheimer's disease degree scoring, self-care ability score, osteoporosis degree (T value), and combined medical diseases between the two groups ( >0.05). The operation time, intraoperative blood loss, number of blood transfusions, transfusion volume, length of hospital stay, occurrence of complications, weight-bearing time after operation, and postoperative visual analogue scale (VAS) score, walking ability score, mobility score, self-care ability score were recorded and compared between the two groups. And the radiographic assessment of fracture reduction quality and postoperative stability, and fracture healing time were recorded.
RESULTS
The operations in both groups were successfully completed. All patients were followed up 6-15 months with an average time of 9.8 months in PFBN group and 9.6 months in PFNA group. The operation time was significantly longer in PFBN group than in PFNA group ( <0.05), but there was no significant difference in intraoperative blood loss, number of blood transfusions, transfusion volume, length of hospital stay, change in activity ability score, and change in self-care ability score between the two groups ( >0.05). The weight-bearing time after operation was significantly shorter in PFBN group than in PFNA group ( <0.05), and the postoperative VAS score and walking ability score were significantly better in PFBN group than in PFNA group ( <0.05). Radiographic assessment showed no significant difference in fracture reduction scores and postoperative stability scores between the two groups ( >0.05). All fractures healed and there was no significant difference in fracture healing time between the two groups ( >0.05). The incidence of complications was significantly lower in PFBN group (16.7%, 4/24) than in PFNA group (45.8%, 11/24) ( <0.05).
CONCLUSION
Compared with PFNA, PFBN in the treatment of elderly intertrochanteric fractures can effectively relieve postoperative pain, shorten bed time, reduce the risk of complications, and facilitate the recovery of patients' hip joint function and walking ability.
Topics: Humans; Aged; Retrospective Studies; Fracture Fixation, Intramedullary; Bionics; Blood Loss, Surgical; Treatment Outcome; Bone Nails; Hip Fractures; Femur
PubMed: 37848313
DOI: 10.7507/1002-1892.202305083 -
Journal of Orthopaedics and... Jul 2023Ollier's disease can cause severe length discrepancy of the lower extremities and deformity in children. Osteotomy and limb lengthening with external fixation can...
BACKGROUND
Ollier's disease can cause severe length discrepancy of the lower extremities and deformity in children. Osteotomy and limb lengthening with external fixation can correct the limb deformity. This study evaluated (1) whether the duration of external fixation was reduced in patients with Ollier's disease, and (2) the incidence of complications such as pin tract infection, external fixation loosening, and joint stiffness.
METHODS
Two groups were compared with respect to age, angular correction (AC), lengthening gap (LG), distraction index (DI), lengthening length (LL), lengthening length percentage (L%), lengthening index (LI), bone healing index (BHI), and external fixation index (EFI). Group 1 (Ollier's disease) comprised nine patients undergoing 11 lower limb lengthening procedures using external fixators; group 2 (control, normal lengthened bone) comprised 28 patients undergoing 29 lengthening procedures with external fixators.
RESULTS
In patients with Ollier's disease, full correction of the deformity and full restoration of length were achieved in all cases. In the femur, the mean AC (15.97° vs. 6.72°) and DI (1.11 mm/day vs. 0.78 mm/day) were significantly larger, while the LI (9.71 days/cm vs. 13.49 days/cm), BHI (27.00 days/cm vs. 42.09 days/cm), and EFI (37.86 days/cm vs. 56.97 days/cm) were all significantly shorter in group 1 than in group 2 (p < 0.05). In the tibia, the mean AC and L% were larger, while the LG, LI, BHI, and EFI were all shorter in group 1 than in group 2. There was no significant difference between the two groups in the incidence of complications.
CONCLUSION
In children with Ollier's disease, new bone formation accelerated and the healing speed of the lengthened segments was faster throughout the whole lengthening period with external fixation, and full correction of the deformity and full restoration of length could be achieved.
Topics: Osteogenesis; Humans; Male; Female; Infant; Child, Preschool; Child; Lower Extremity; Enchondromatosis; Bone Lengthening; Leg; Treatment Outcome; Femur; Tibia; Leg Length Inequality
PubMed: 37524995
DOI: 10.1186/s10195-023-00717-3 -
BioRxiv : the Preprint Server For... Mar 2024Irisin, released from exercised muscle, has been shown to have beneficial effects on numerous tissues but its effects on bone are unclear. We found significant sex and...
Irisin, released from exercised muscle, has been shown to have beneficial effects on numerous tissues but its effects on bone are unclear. We found significant sex and genotype differences in bone from wildtype (WT) mice compared to mice lacking (KO), with and without calcium deficiency. Despite their bone being indistinguishable from WT females, KO female mice were partially protected from osteocytic osteolysis and osteoclastic bone resorption when allowed to lactate or when placed on a low-calcium diet. Male KO mice have more but weaker bone compared to WT males, and when challenged with a low-calcium diet lost more bone than WT males. To begin to understand responsible molecular mechanisms, osteocyte transcriptomics was performed. Osteocytes from WT females had greater expression of genes associated with osteocytic osteolysis and osteoclastic bone resorption compared to WT males which had greater expression of genes associated with steroid and fatty acid metabolism. Few differences were observed between female KO and WT osteocytes, but with a low calcium diet, the KO females had lower expression of genes responsible for osteocytic osteolysis and osteoclastic resorption than the WT females. Male KO osteocytes had lower expression of genes associated with steroid and fatty acid metabolism, but higher expression of genes associated with bone resorption compared to male WT. In conclusion, irisin plays a critical role in the development of the male but not the female skeleton and protects male but not female bone from calcium deficiency. We propose irisin ensures the survival of offspring by targeting the osteocyte to provide calcium in lactating females, a novel function for this myokine.
PubMed: 37986762
DOI: 10.1101/2023.11.06.565774 -
Orthopedic Research and Reviews 2024This review compares internal fixation versus arthroplasty in the treatment of nondisplaced femoral neck fractures (FNFs) calling attention to evolving areas of... (Review)
Review
This review compares internal fixation versus arthroplasty in the treatment of nondisplaced femoral neck fractures (FNFs) calling attention to evolving areas of consensus that influence clinical decision-making. The Garden classification system, typically dichotomized into nondisplaced (types I and II) and displaced (types III and IV) fractures, has been used as a guide for surgical decision-making. Conventionally, treatment of nondisplaced FNF in the elderly has been with internal fixation, and treatment of a displaced FNF has been hemi-, or more recently total hip, arthroplasty. Studies over the last decade have raised concern over the appropriate treatment of nondisplaced FNFs due to high rates of reoperation of nondisplaced FNFs treated with internal fixation. Avascular necrosis (AVN), failure of internal fixation, secondary malunion, and pin/nail penetration through the femoral head have all been observed. Several studies have attributed fixation failure to a degree of femoral neck tilt ≥20°, either posteriorly or anteriorly as seen on the lateral X-ray. Because of these observations of fixation failures, the suggestion has been made that arthroplasty be used when the degree of posterior tilt exceeds a threshold of ≥20° tilt with the expectation of diminishing failure of fixation, decreasing the risk of reoperation and preserving function without increasing mortality rate. Frustrating additional analyses are uncertainties over the mechanisms of failure of internal fixation with ≥20° tilt and the persistently substantial 1-year mortality rate after FNF, which has not been influenced by fixation or replacement type. Due to the lack of consensus regarding the determination of the appropriate surgical intervention for nondisplaced FNFs, an improved algorithm for surgical decision-making for these fractures may prove useful.
PubMed: 38192746
DOI: 10.2147/ORR.S340535 -
Orthopaedic Journal of Sports Medicine Jul 2023It is clinically challenging to accurately drill femoral and tibial tunnels to reconstruct the anterior cruciate ligament (ACL). Mixed reality (MR) technology, a further...
BACKGROUND
It is clinically challenging to accurately drill femoral and tibial tunnels to reconstruct the anterior cruciate ligament (ACL). Mixed reality (MR) technology, a further development of virtual reality technology, presents virtual scene information in real time and establishes an interactive feedback information loop among the real world, the virtual world, and the user.
PURPOSE/HYPOTHESIS
The purpose of this study was to investigate the structural and early clinical outcomes of ACL reconstruction assisted by MR technology. It was hypothesized that MR technology would improve the accuracy of tunnel localization.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
Included were 44 patients at a single institution who underwent arthroscopic single-bundle ACL reconstruction between June 2020 and March 2022. Reconstruction with the aid of MR technology was performed in 21 patients (MR group), and conventional arthroscopic reconstruction was performed in 23 patients. Postoperatively, the parameters related to the bone tunnel positioning were compared by computed tomography imaging with 3-dimensional (3D) reconstruction, and 12-month postoperative clinical outcomes were assessed with the Lysholm and International Knee Documentation Committee scores.
RESULTS
There was no statistically significant difference in projection angles in the coronal, axial, or sagittal plane between the preoperative virtually created tunnel guide pin and the actual tunnel ( > .05 for all). In the MR group, the center of the femoral tunnel exit was closer to the apex of the lateral femoral condyle along the proximal-distal axis (14.07 ± 4.12 vs 17.49 ± 6.24 mm for the conventional group; < .05) and the graft bending angle was lower (117.71° ± 8.08° vs 127.81° ± 11.91° for the conventional group; < .05). The scatterplot of the femoral tunnel location distribution showed that the entrance and exit points in the MR group were more concentrated and closer to the ideal location of the preoperative design than in the conventional group. Patients in both groups had significant preoperative-to-postoperative improvement based on outcome scores ( < .001 for all), with no significant difference between groups.
CONCLUSION
ACL reconstruction with the aid of MR technology allowed for more accurate positioning and orientation of the femoral tunnel during surgery when compared with conventional reconstruction.
PubMed: 37457048
DOI: 10.1177/23259671231184399 -
Journal of Back and Musculoskeletal... 2024Central sensitization cannot be demonstrated directly in humans. Therefore, studies used different proxy markers (signs, symptoms and tools) to identify factors assumed... (Review)
Review
BACKGROUND
Central sensitization cannot be demonstrated directly in humans. Therefore, studies used different proxy markers (signs, symptoms and tools) to identify factors assumed to relate to central sensitization in humans, that is, Human Assumed Central Sensitization (HACS). The aims of this systematic review were to identify non-invasive objective markers of HACS and the instruments to assess these markers in patients with fibromyalgia (FM).
METHODS
A systematic review was conducted with the following inclusion criteria: (1) adults, (2) diagnosed with FM, and (3) markers and instruments for HACS had to be non-invasive. Data were subsequently extracted, and studies were assessed for risk of bias using the quality assessment tools developed by the National Institute of Health.
RESULTS
78 studies (n= 5234 participants) were included and the findings were categorized in markers identified to assess peripheral and central manifestations of HACS. The identified markers for peripheral manifestations of HACS, with at least moderate evidence, were pain after-sensation decline rates, mechanical pain thresholds, pressure pain threshold, sound 'pressure' pain threshold, cutaneous silent period, slowly repeated evoked pain sensitization and nociceptive flexion reflex threshold. The identified markers for central manifestations of HACS were efficacy of conditioned pain modulation with pressure pain conditioning and brain perfusion analysis. Instruments to assess these markers are: pin-prick stimulators, cuff-algometry, repetitive pressure stimulation using a pressure algometer, sound, electrodes and neuroimaging techniques.
CONCLUSIONS
This review provides an overview of non-invasive markers and instruments for the assessment of HACS in patients with FM. Implementing these findings into clinical settings may help to identify HACS in patients with FM.
Topics: Fibromyalgia; Humans; Central Nervous System Sensitization; Pain Threshold; Biomarkers; Pain Measurement
PubMed: 38073369
DOI: 10.3233/BMR-220430 -
HardwareX Sep 2023Traditionally, surgical head immobilization for neurobiological research with large animals is achieved using stereotaxic frames. Despite their widespread use, these...
Traditionally, surgical head immobilization for neurobiological research with large animals is achieved using stereotaxic frames. Despite their widespread use, these frames are bulky, expensive, and inflexible, ultimately limiting surgical access and preventing research groups from practicing surgical approaches used to treat humans. Here, we designed a mobile, low-cost, three-pin skull clamp for performing a variety of neurosurgical procedures on non-human primates. Modeled after skull clamps used to operate on humans, our system was designed with added adjustability to secure heads with small or irregular geometries for innovative surgical approaches. The system has six degrees of freedom with skull pins attached to setscrews for independent, fine-tuned depth adjustment. Unlike other conventional skull clamps which require additional mounting fixtures, our system has an integrated tray with mounting bracket for easy use on most operating room tables. Our system has successfully secured primate heads in the supine and lateral position, allowing surgeons to match surgical approaches currently practiced when operating on humans. The system also expands the opportunity for researchers to utilize imaged-guided robotic surgery techniques. Overall, we hope that our system can serve as an adaptable, affordable, and robust surgery platform for any laboratory performing neurobiological research with large animal models.
PubMed: 37680492
DOI: 10.1016/j.ohx.2023.e00472 -
European Review For Medical and... Oct 2023One of the most frequent fractures in children is a double forearm fracture. They make up 26% of children's long bone fractures in the upper extremities and their...
OBJECTIVE
One of the most frequent fractures in children is a double forearm fracture. They make up 26% of children's long bone fractures in the upper extremities and their incidence has increased in recent years. In this study, pediatric patients with double forearm fractures were treated using plate screw, intramedullary K-wire (I-KW), intramedullary titanium elastic nails (TENs), and hybrid fixation (HF) to compare the radiographic and functional results.
PATIENTS AND METHODS
The printed and digital medical records were retrospectively examined from our hospital's archives after receiving consent from the regional ethics committee. Legal guardians of the patients, who were under the age of 18, gave their informed consent. Based on the surgical procedure used, the patients were split into 4 groups. Double plating was the D-P group, hybrid fixation method was the HF group, intramedullary elastic titanium nail was the TEN group, and intramedullary K-wire was the I-KW group. The study comprised 78 patients in total, with 19 patients in the HF group, 21 patients in the TEN group, 20 patients in the I-KW group, and 18 patients in the D-P group.
RESULTS
When the mean operating times of the four approaches were compared, a substantial difference was found. The D-P group's mean operating time (65.2±4.9 minutes) was noticeably longer than those of the other groups (p<0.001). The HF group's mean operating time was 55.93.4 min longer than that of the TENs and I-KW groups, which was statistically significant (p<0.001). In comparison to the other groups, the D-P group's mean intraoperative fluoroscopy time was considerably shorter (6±3 sec) (p<0.001). When compared to the D-P group, it was considerably higher in the HF group (12±2 sec) (p<0.001). In comparison to the TENs (20±4 sec) and I-KW groups (19±5 sec), it was significantly lower in the HF group (p<0.001). In comparison to the HF group, the D-P group's tourniquet use lasted much longer (p<0.001). The TENs and I-KW groups did not use a tourniquet because a mini-incision was made. The D-P group's mean blood loss (110±10 ml) was substantially larger than that of the other groups (p<0.001) in the mean blood loss data. In comparison to the TENs (40±5 ml) and I-KW (40±5 ml) groups, the mean blood loss in the HF group (90±10 ml) was considerably larger (p<0.001). All patients received an above-elbow postoperative cast. The HF group (2 weeks) and the D-P group (2 weeks) experienced significantly less postoperative immobility than the TENs and I-KW groups (4.4 weeks, p<0.001).
CONCLUSIONS
The four fixation techniques used in the current study for juvenile diaphyseal double forearm fractures produced positive clinical and functional outcomes. The hybrid fixation technique was discovered to be comparable to the other techniques and even beneficial in some ways. So, a safe and efficient treatment option for juvenile diaphyseal double forearm fractures is hybrid fixation.
Topics: Humans; Child; Retrospective Studies; Forearm; Titanium; Radius Fractures; Ulna Fractures; Bone Nails; Treatment Outcome; Forearm Injuries; Fracture Fixation, Intramedullary; Upper Extremity
PubMed: 37843319
DOI: 10.26355/eurrev_202310_33931