Recently, some studies on the efficacy of the femoral neck system (FNS) in treating femoral neck fractures (FNFs) have been published. Therefore, a systematic review was performed to clarify the ...efficacy and safety of FNS versus cannulated screws (CS) for the treatment of FNFs.
The PubMed, EMBASE, and Cochrane databases were systematically searched for studies comparing FNS and CS fixations in FNFs. Intraoperative indicators, postoperative clinical indicators, postoperative complications, and postoperative scores were compared between the implants.
A total of eight studies were included in the study, involving 448 FNFs patients. The results showed that patients in FNS group were significantly lower than the CS group in the number of X-ray exposures (WMD = -10.16; 95% CI, -11.44 to -8.88; P < 0.001; I
= 0%), fracture healing time (WMD = -1.54; 95% CI, -2.38 to -0.70; P < 0.001; I
= 92%), length of femoral neck shortening (WMD = -2.01; 95% CI, -3.11 to -0.91; P < 0.001; I
= 0%), femoral head necrosis (OR = 0.27; 95% CI, 0.08 to 0.83; P = 0.02; I
= 0%), implant failure/cutout (OR = 0.28; 95% CI, 0.10 to 0.82; P = 0.02; I
= 0%), and Visual Analog Scale Score (WMD = -1.27; 95% CI, -2.51 to -0.04; P = 0.04; I
= 91%). And the Harris Score was significantly higher in the FNS group than in the CS group (WMD = 4.15; 95% CI, 1.00 to 7.30; P = 0.01; I
= 89%).
Based on this meta-analysis, FNS shows better clinical efficacy and safety in treating FNFs compared to CS. However, due to the limited quality and number of included studies and the high heterogeneity of the meta-analysis; large samples and multicenter RCTs are needed to confirm this conclusion in the future.
II, Systematic review and Meta-analysis.
PROSPERO CRD42021283646.
Distal femur fractures (DFFs) are common injuries with significant morbidity. Surgical options include open reduction and internal fixation (ORIF) with plates and/or intramedullary devices or a ...distal femur endoprosthesis (distal femur replacement DFR). A paucity of studies exist that compare the two modalities. The present study utilized a 1:2 propensity score match to compare 30-day outcomes of geriatric patients with DFFs who underwent an ORIF or DFR. The National Surgical Quality Improvement Program data from 2008 to 2019 were utilized to identify all patients who sustained a DFF and underwent either ORIF or DFR. This yielded 3,197 patients who underwent an ORIF versus 121 patients who underwent a DFR. A final sample of 363 patients (242 patients with ORIF vs. 121 with DFR) was obtained after a 1:2 propensity score match. Costs were obtained from the National Inpatient Sample database using multiple regression analysis and validated with a 7:3 train-test algorithm. Independent samples
-tests and chi-square analysis were conducted to assess cost and outcome differences, respectively. Patients who received a DFR had higher transfusion rates than ORIF (
= 0.021) and higher mean inpatient hospital costs (
= 0.001). Subgroup analysis for patients 80 years of age or older revealed higher 30-day unplanned readmission (0 vs. 18.2%;
< 0.001) and 30-day mortality (0 vs. 18.2%;
< 0.001) rates for patients undergoing ORIF compared with DFR. The total number of DFR cases needed to prevent one ORIF-related 30-day mortality for DFR for patients 80 years of age was 6 (95% confidence interval: 3.02-19.9). The mean hospital costs associated with preventing one case of death within 30 days from operation by undergoing DFR compared with ORIF was $176,021.39. Our results demonstrate higher rates of transfusion and increased inpatient costs among the DFR cohort compared with ORIF. However, we demonstrate lower rates of mortality for patients 80 years and older who underwent DFR versus ORIF. Future studies randomized controlled trials are necessary to validate the results of this study.
We assessed operatively treated closed distal radial fractures to identify independent risk factors for surgical site infection after treatment. A retrospective review was carried out of 531 ...operatively treated closed distal radial fractures over a 5-year period. Multiple logistic regression was performed with infection as the dependent variable, using a stepwise regression procedure to select variables to construct the final model. In total, 19 (3.6%) fractures were complicated by postoperative surgical site infection. Uncontrolled diabetes with HbA1c >7, the presence of external fixation or external Kirschner wires, and tobacco use were significant independent predictors of infection. Age and time in the operating room were also statistically significant predictors but deemed to be not clinically meaningful.
Level of evidence: IV
•Integrating FE analysis and topology optimization to design a novel hybrid dorsal double plating (HDDP) for distal radius fracture.•The novel HDDP profile was presented as a “Y” shape and retained ...three-column features to enhance biomechanical strength.•The novel HDDP demonstrated better resistance to functional loads and provided enough screw fixations at the articular surface.•The novel HDDP can be placed through the standard dorsal approach to use minimal invasive surgical technique and eliminated tendon irritation.
Currently available dorsal locking plates for the treatment of distal radius fractures are far less then volar locking plates, and there is limited evidence about biomechanical strength of dorsal plates. The aim of this study is to develop a novel hybrid dorsal double plating, which enhance biomechanical strength in the articular fixation region and achieve the minimally invasive surgical technique requirement of distal radius fracture treatment by combining weighted topology optimization and finite element (FE) analysis
A dorsal template bone plate design (based on dorsal double plating (DDP)) was constructed to perform weighted topology optimization and FE analysis under six fracture models with 50%, 30%, and 20% weighting of the joint subjected to axial, bending, and torsion moments, respectively. A novel hybrid dorsal double plating (HDDP) was generated using the union of six single dorsal plates to subtract the intersection of the original template dorsal model. A 100 N axial load with 1 Nm bending and torsion moments were applied at the end of the distal radius onto six fracture FE models to investigate the biomechanical differences between the DDP and HDDP approaches.
Results of weighted topology optimization showed that the profile of the HDDP presented a “Y” shape. Simulation results showed that the bone plate stress values for the distal radius fractures fixed with HDDP was much smaller than those with DDP regardless of the type of bone fractures and load conditions. The maximum bone stress value of the DDP approach was much higher than that of HDDP when the distal radius was a complete sagittal articular fracture and partial articular fracture involving lunate fossa. The corresponding maximum bone stress values for different loads might be higher than the ultimate strength of bone (150 MPa) and induced the risk of future bone fractures.
It is concluded that the novel HDDP demonstrated better resistance to functional loads, provided sufficient screw fixation at the articular surface, and can be placed on the dorsal site of the distal radius through the standard dorsal approach to minimize invasive surgeries and eliminate tendon irritations.
Olecranon fractures are rare conditions in childhood. The aim of this study was to investigate the factors affecting the results in surgically treated pediatric and adolescent olecranon fractures.
...The orthopaedic trauma database of a large academic tertiary center was retrospectively searched for patients who had sustained an olecranon fracture and were treated surgically between 2005 and 2021. Data related to demographic features, additional fractures, and the presence of any disease were obtained from the patient files. Mayo elbow performance score and the Turkish-language version of the shortened version of the disabilities of arm, shoulder, and hand scale were the main functional outcome measurements.
The study included 37 elbows of 34 patients with an average age at the time of surgery of 10.9±3.1 years. The mean follow-up period was 78.2±48.0 months (range, 12 to 196 mo). The 1-year fracture rate of contralateral olecranon was 75% in osteogenesis imperfecta patients. Concomitant fractures were 7 proximal radius, 1 medial epicondyle, and 2 capitellum fractures. The surgical treatment methods were tension band wiring (TBW), open reduction and isolated K-wire fixation, closed reduction and percutaneous fixation (CR-PP), and open reduction-plate fixation. The mean implant removal time in patients treated with closed reduction and percutaneous fixation was 2.2 months, open reduction and isolated K-wire fixation 4.7 months, and TBW 12.7 months ( P =0.004). The mean disabilities of arm, shoulder, and hand scale was 1.9. The mean Mayo elbow performance score was 100. Grade 1 elbow arthritis was determined in 3 patients. No patient underwent revision surgery.
All treatment modalities provided excellent long-term functional results and low complication rates without the need for revision. Closed reduction-percutaneous fixation and open reduction-isolated K-wire fixation were associated with shorter implant removal times compared with TBW.
Level III.
BACKGROUND:The aim of this study was to determine if fracture reduction, fracture pattern, and patient-related factors influence clinical outcome after locked-plate fixation of displaced proximal ...humeral fractures.
METHODS:Ninety-eight patients (mean age, 61.1 ± 11.2 years) with a proximal humeral fracture involving the anatomical neck (type C according to the OTA/AO classification system) were included. Clinical outcome was determined by age and sex-adjusted Constant score (CS%) and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Fracture reduction was quantitatively determined by 3 parameters (head-shaft displacement, head-shaft alignment, and cranialization of the greater tuberosity), and patients were divided into groups according to anatomical reduction, acceptable reduction, or malreduction. Relative risk (RR) for complications, revision surgery, and inferior clinical outcome (CS of <50%) was determined according to the quality of fracture reduction and fracture pattern (disruption of the medial hinge; type-C3 fracture) and patient-related factors (age; comorbidities).
RESULTS:After a mean of 3.1 ± 1.5 years, the mean CS% and DASH score were 54.8% ± 28.0% and 31.9 ± 24.8, respectively. The complication rate was 32.7% (n = 32), and 27 patients (27.6%) required revision surgery. Anatomical or acceptable fracture reduction was achieved in 40 (40.8%) of the patients. This resulted in a significantly lower complication rate (20.0% compared with 41.4% among the patients with malreduction; p = 0.027), a trend of lower revision rate (20% compared with 32.8%; p = 0.165), and better clinical outcome (mean CS% of 65.4% ± 28.2% compared with 47.6% ± 25.7%; p = 0.002) without a higher risk for osteonecrosis of the humeral head (5% compared with 10.3%). Cranialization of the greater tuberosity of >5 mm (n = 25), head-shaft displacement of >5 mm (n = 50), and valgus head-shaft alignment (n = 12) all increased the RR for inferior clinical outcome by twofold to threefold. Conversely, a patient age of >65 years (n = 31) and an OTA/AO type-C3 fracture pattern (n = 38) were not significantly associated with complications and inferior clinical outcome (RR, 0.9 to 1.8).
CONCLUSIONS:Anatomical fracture reduction with a locked plate significantly improved the clinical outcome of unstable and displaced proximal humeral fractures involving the anatomical neck.
LEVEL OF EVIDENCE:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
OBJECTIVES:To describe the incidence and magnitude of femoral neck fracture shortening in patients age younger than 60 years. Secondarily, to examine predictors of fracture shortening.
...DESIGN:Retrospective chart review.
SETTING:Level I trauma centre.
PATIENTS/PARTICIPANTS:Sixty-five patients with a median age of 51 years (interquartile range42–56 years) were included. Seventy-one percent were male, 75% were displaced fractures, and 78% were treated with cancellous screws.
INTERVENTION:Internal fixation with multiple cancellous screws or sliding hip screw (SHS) + derotation screw.
MAIN OUTCOME MEASUREMENTS:Radiographic femoral neck shortening at a minimum of 6 weeks after fixation.
RESULTS:Fifty-four percent of patients had ≥5 mm of femoral neck shortening (22% had between ≥5 and <10 mm and 32% ≥10 mm). Initially, displaced fractures shortened more than undisplaced fractures (mean8.1 vs. 2.2 mm, P < 0.001), and fractures treated with SHS + derotation screw shortened more than fractures with cancellous screws alone (10.7 vs. 5.5 mm, P = 0.03). Even when adjusting for initial fracture displacement, fractures treated with SHS + derotation screw shortened an average of 2.2 mm more than fractures treated with screws alone (P = 0.03).
CONCLUSIONS:The incidence of clinically significant shortening in our young femoral neck fracture population was higher than anticipated, and 32% of patients experienced severe shortening of >1 cm. Our findings highlight the need for further research to determine the impact of severe shortening on functional outcome and to determine if implant selection affects fracture shortening.
LEVEL OF EVIDENCE:Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
•Fixation strategies of superior or inferior triangle configuration consisting of one PTS and two FTSs showed mechanical advantage over other screws configuration.•Superior triangle fixation model ...underwent the largest area of stress concentration around the screw holes.•Fixation type of inferior triangle configuration should be the recommended choice if multiple screws removal after fracture union maybe required.
In the present study, we evaluated the mechanical outcome of different configurations formed by partially threaded screws (PTS) alone or combined screws consisting of PTS and fully threaded screws (FTS) in the treatment of unstable femoral neck fracture.
The Pauwels type III unstable femoral fracture and screw models of PTS and FTS were created in 3-matic software and UG-NX software respectively. We assembled the different screw fixation types to the fracture model separately to form the fixation models. We used Abaqus software to perform the finite element analysis.
Our results indicated that the peak von Mises stresses of screws increased when some PTSs changed into FTSs in all groups except for the inferior triangle group. FTS in each group underwent the most stress while PTS underwent a little bit of stress. The combined screws fixation types were less likely to be cut-out and was more stable than PTPs alone fixation strategy. Less yielding regions around the screw tunnels for the superior and inferior triangle configuration fixed by combined screws was indicated. Superior triangle fixation model underwent the largest area of stress concentration around the screw holes after screws removal.
For unstable femoral neck fractures, superior results were obtained by stabilizing the fracture with superior or inferior triangle configuration consisting of one PTS and two FTSs. If screws removal was taken into account after fracture union, fixation type of inferior triangle configuration should be the recommended choice.
Ulna coronoid fracture is a complicated injury and occurred in the coronal plane. Undeniably, there is no universally accepted approach for treating ulna coronoid fractures. Therefore, this study ...aimed at exploring the efficacy of different surgical treatments for Regan-Morrey type II and III ulna coronoid fractures.
A total of 164 patients with ulna coronoid fractures were admitted and treated in department of orthopedics at Yiwu Central Hospital, the Affiliated Yiwu Hospital of Wenzhou Medical University for retrospective analysis. The baseline features (age, gender, time from injury to surgery and so on) before the surgery and different conditions during the surgery were compared. Following that, the Visual Analogue Scale (VAS) pain score was employed to evaluate the severity of preoperative and postoperative pain experienced by the patients in each group. Afterwards, Broberg and Morrey elbow score was used to evaluate elbow joint function and surgical effect of the patients. Lastly, the postoperative recovery and complications were compared.
It was firstly observed that internal fixation with mini plate and hollow screw compelled to lower average operation time and blood loss than Kirschner wire and steel wire suture. Next, the severity of postoperative pain was lessened in comparison with preoperative pain. Afterwards, mini plate and hollow screw improved elbow joint function more notable than Kirschner wire and steel wire suture, and Kirschner wire and steel wire suture resulted in higher incidence of complications and worse postoperative recovery.
Collectively, this study clarified that for the treatment of Regan-Morrey type II and III ulna coronoid fractures, internal fixation with mini plate and hollow screw has an overall superior surgical effect than internal fixation with Kirschner wire and steel wire suture.
The Neer type II distal clavicle fracture is notorious for its high nonunion rate, and surgical treatment is usually recommended. We reviewed articles from January 1990 to September 2009, and among ...them, 425 cases from 21 studies were included. According to the 425 cases in the literature, sixty patients were treated nonsurgically and 365 surgically. From 365 patients who were treated surgically, 105 were identified as receiving the coracoclavicular stabilization, 162 hook plate, 42 intramedullary fixation, 16 interfragmentary fixation, and 40 K-wire plus tension band wiring. The nonsurgical treatment resulted in 20 (33.3%) nonunions and 4 (6.7%) other complications. The surgical treatment resulted in 6 (1.6%) nonunions, 81 (22.2%) complications other than nonunion. The nonunion rate was significantly high with nonsurgical treatment (
p
< 0.001), and the complication rate was statistically high with surgery (
p
= 0.002). With surgical treatment, the nonunion rate was not significantly different among the modalities (
p
= 0.391). The complication rate was significantly higher in cases of the hook plate (40.7%) and the K-wire plus tension band wiring (20.0%) than those of the coracoclavicular stabilization (4.8%), the intramedullary (2.4%) and the interfragmentary fixation (6.3%). For the nonsurgical treatment, the functional outcomes were generally acceptable despite the high nonunion rate. The nonsurgical treatment could be considered as the first line treatment after sufficient counsel with the patient. The nonunion rate is high, however, the functional outcome is acceptable in most of the cases with nonunion. If the surgical treatment is considered, the intramedullary screw fixation, CC stabilization and interfragmentary fixation would be preferred because of their low complication rate.
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