Objective To compare the clinical outcomes of retrograde pubic ramus intramedullary nail(RPRIN)and percutaneous cannulated screw(PCS)in the treatment of anterior pelvic ring fractures(APRFs).Methods This retrospective...Objective To compare the clinical outcomes of retrograde pubic ramus intramedullary nail(RPRIN)and percutaneous cannulated screw(PCS)in the treatment of anterior pelvic ring fractures(APRFs).Methods This retrospective cohort study included 45 patients with APRFs treated between February 2019 and October 2022 in our trauma center.Patients were divided into two groups based on the surgical method:20 received RPRIN fixation,and 25 received PCS fixation.Key variables including operation time,fluoroscopic time,blood loss,and postoperative complications were analyzed.Fracture reduction quality was assessed using the Matta score system,and pelvic functional recovery was evaluated using the Majeed score system at the final follow-up.Quantitative variables were compared using the independent sample t test,while categorical variables were analyzed using Chisquare and Fisher’s exact tests.Results The RPRIN group had significantly shorter operation time(36.3±5.6 min vs.49.5±6.9 min,P<0.01),fluoroscopic time(32.0±2.8 s vs.48.4±3.6 s,P<0.01),and less blood loss(20.4±7.6 mL vs.34.0±5.7 mL,P<0.01)than the PCS group.Fracture reduction quality(Matta outcome)and pelvic functional recovery(Majeed outcome)were comparable between the two groups(P>0.05).No significant complications were reported in either group.Conclusions Both RPRIN and PCS are effective for treating APRFs.However,RPRIN offers distinct advantages by reducing operation time,fluoroscopic time,and blood loss,making it a more efficient and less invasive option.Further multicenter studies and biomechanical analyses are warranted to confirm these findings.展开更多
Traditional diagnostic techniques including visual examination,ultrasound(US),and magnetic resonance imaging(MRI)have limitations of in-depth information for the detection of nail disorders,resolution,and practicality...Traditional diagnostic techniques including visual examination,ultrasound(US),and magnetic resonance imaging(MRI)have limitations of in-depth information for the detection of nail disorders,resolution,and practicality.This pilot study,for thefirst time,evaluates a dualmodality imaging system that combines photoacoustic tomography(PAT)with the US for the multiparametric quantitative assessment of human nail.The study involved a small cohort offive healthy volunteers who underwent PAT/US imaging for acquiring the nail unit data.The PAT/US dual-modality imaging successfully revealed thefine anatomical structures and microvascular distribution within the nail and nail bed.Moreover,this system utilized multispectral PAT to analyze functional tissue parameters,including oxygenated hemoglobin,deoxyhemoglobin,oxygen saturation,and collagen under tourniquet and cold stimulus tests to evaluate changes in the microcirculation of the nail bed.The quantitative analysis of multispectral PAT reconstructed images demonstrated heightened sensitivity in detecting alterations in blood oxygenation levels and collagen content within the nail bed,under simulated different physiological conditions.This pilot study highlights the potential of PAT/US dual-modality imaging as a real-time,noninvasive diagnostic modality for evaluating human nail health and for early detection of nail bed pathologies.展开更多
Introduction: The management of fractures of the tibia shaft is an important aspect of orthopaedic care, and the selection of the surgical method for fixation can substantially impact patient outcomes. The current rev...Introduction: The management of fractures of the tibia shaft is an important aspect of orthopaedic care, and the selection of the surgical method for fixation can substantially impact patient outcomes. The current review aims to compare the outcomes of adult tibia fractures treated with solid nails to those treated with hollow nails. Methods: A search on Scopus, PubMed, and Cochrane Library, using three keywords (Outcome, Tibia shaft fractures, Nail) was conducted in April 2023. Results were compiled and two independent reviewers screened and selected eligible articles After removing duplicates, titles and abstracts were read to exclude ineligible studies. Full-text articles of the remaining papers were read to select eligible studies which were further critically appraised to ascertain their methodological quality. The data extracted from the selected papers were synthesized using a combination of pooling of results, tests of statistical difference (t-test and chi-square) and narrative synthesis methods. Results: A total of 2295 articles were obtained from the databases and citation searching. A total of 9 papers were identified as eligible and included in the review. Findings revealed that there is no statistical difference in the outcomes of tibia fractures treated with either solid or hollow nail groups such as duration of surgery (p = 0.541), rate of delayed and non-union (p = 0.342), and rate of surgical site infections (p = 0.395). Conclusion: Intramedullary nailing of tibia shaft fractures with either solid or hollow nails have similar functional outcomes.展开更多
BACKGROUND Femoral lengthening is a procedure of great importance in the treatment of congenital and acquired limb deficiencies.Technological advances have led to the latest designs of fully implantable motorized intr...BACKGROUND Femoral lengthening is a procedure of great importance in the treatment of congenital and acquired limb deficiencies.Technological advances have led to the latest designs of fully implantable motorized intramedullary lengthening nails.The use of these nails has increased over the last few years.AIM To review and critically appraise the literature comparing the outcome of femoral lengthening in children using intramedullary motorized lengthening nails to external fixation.METHODS Electronic databases(MEDLINE,CINAHL,EMBASE,Cochrane)were systematically searched in November 2019 for studies comparing the outcome of femoral lengthening in children using magnetic lengthening nails and external fixation.The outcomes included amount of gained length,healing index,complications and patient reported outcomes.RESULTS Of the 452 identified studies,only two(retrospective and non-randomized)met the inclusion criteria.A total of 91 femora were included.In both studies,the age of patients treated with nails ranged from 15 to 21 years compared to 9 to 15 years for patients in the external fixation group.Both devices achieved the target length.Prevalence of adverse events was less in the nail(60%-73%)than in the external fixation(81%-100%)group.None of the studies presented patient reported outcomes.CONCLUSION The clinical effectiveness of motorized nails is equivalent or superior to external fixation for femoral lengthening in young patients.The available literature is limited and does not provide evidence on patient quality of life or cost effectiveness of the interventions.展开更多
The microstructure,mechanical properties and corrosion behavior of quaternary degradable Mg−1Zn−0.2Ca−xAg(x=1,2,4 wt.%)alloy wires,intended as anastomotic nails,were investigated.It was found that these Ag-containing ...The microstructure,mechanical properties and corrosion behavior of quaternary degradable Mg−1Zn−0.2Ca−xAg(x=1,2,4 wt.%)alloy wires,intended as anastomotic nails,were investigated.It was found that these Ag-containing alloy wires mainly consist of Mg matrix and Ag17Mg54 phase,characterized by SEM,EDS,XRD and TEM.Tensile and knotting tests results demonstrate the superior mechanical properties of these alloy wires.Especially,Mg−1Zn−0.2Ca−4Ag alloy exhibits the highest mechanical properties,i.e.an ultimate tensile strength of 334 MPa and an elongation of 8.6%.Moreover,with increasing Ag content,the corrosion rates of these alloy wires remarkably increase due to the formation of more micro-galvanic coupling between Mg matrix and Ag17Mg54 phase,shown by mass loss and scanning Kelvin probe force microscopy(SKPFM)results.The present alloy can be completely degraded within 28 d,satisfying the property requirements of anastomotic nails.展开更多
In recent times,there had been reported cases of Pb poisoning in Anka gold mining area,Northwest Nigeria.Therefore,this study was carried out to determine the extent of bioaccumulation of heavy metals in the hairs and...In recent times,there had been reported cases of Pb poisoning in Anka gold mining area,Northwest Nigeria.Therefore,this study was carried out to determine the extent of bioaccumulation of heavy metals in the hairs and nails of children in the area.Forty samples(twenty nails and twenty hairs)samples were collected from ten boys and ten girls of ages 5–9 residing in the area.To ascertain the sources of heavy metals in children,15 soils samples,15 groundwater samples,5 samples of mine tailings,and 5 plants samples were collected.Hair and nails of the subjects were collected using internationally acceptable techniques.All samples were kept in uncontaminated ziplock bags prior to laboratory preparation and analysis.The samples were cleaned using nonionic detergent(triton X-100)and deionized water.The hairs and nails were digested with 10 mL of 6:1 mixture of nitric acid and perchloric acid.The soils,mine tailings,and plants were air-dried at room temperature,sieved,and chemically digested using the aqua regia method.The concentrations of metals in all the samples were determined using highperformance liquid chromatography–inductively coupled plasma–mass spectrometry.Statistical analysis was employed to unravel potential sources of metals in the media.Results showed that heavy metals in children of the area are above results from similar studies and pathological ranges for heavy metals in hairs and nails.Also,heavy metals in environmental media are above the recommended standards.Multivariate analysis showed that the metals are mainly from mining and other anthropogenic sources.Results of correlation between heavy metals in hairs and nails with those in geological samples revealed that heavy metal that bioaccumulates in the children of this area are mostly from contaminated environmental media.It is recommended that complete remediation and effective health education be carried out in the area.展开更多
Tests of the capacity of shear connections consisting of nails in a row placed at distances 7, 10 and 14d, “d” being the cross-sectional dimension of the nail, versus single nail capacities, were executed. The perfo...Tests of the capacity of shear connections consisting of nails in a row placed at distances 7, 10 and 14d, “d” being the cross-sectional dimension of the nail, versus single nail capacities, were executed. The performed tests do support the connotation that no reduction should be required for nails of diameter 2.8 mm or less in a row, provided that nails are spaced sufficiently far apart for wood cracking not to occur. At the ultimate capacity of the joint, all such thin nails in a row will be yielding, having developed plastic hinges, i.e. each single nail will have developed its ultimate capacity. Hence, the ultimate capacity of the connection will be each nail’s capacity times the number of nails in the row. The force pr. nail increases subsequent to the development of a plastic hinge. This is likely due to the axial pullout-force, i.e. the ultimate capacity of a shear connection is higher than the force required for developing plastic hinges in the nails. This additional capacity-reserve may also partly be attributed to the rotational resistance of nails. The number of nails in a row should make insignificant difference in the pr. nail capacity, as long as no wood cracking takes place. Thus, applying elastic theory to nails in a row does not seem relevant. This is in contrast to bolt-connections.展开更多
Objective： To report 32 cases of femur supracondylar fracture treated with retrograde interlocking intramedullary nails in elderly patients. Methods： According to the AO classification, all of 32 cases were classifi...Objective： To report 32 cases of femur supracondylar fracture treated with retrograde interlocking intramedullary nails in elderly patients. Methods： According to the AO classification, all of 32 cases were classified as extra-articular type A. 32 cases were treated with interlocking intramedullary nail by closed insertion from intercondylar fossa of the knee. All cases accepted CPM exercise as early as possible after operation. Results： Following up 5 to 15 months, all fractures united within an average duration of 5.3 months （4-7 months）. According to the Shelbourne scale, the excellent rate of the knee function was 86.3%. Conclusion： Retrograde interlocking intramedullary nail is useful alternative implant for the treatment of osteoporotic supracondylar fracture of femur, particularly of the type A fracture in the elderly population. Its merits include stable fixation, high rate of fracture union and few complications.展开更多
In the present work, elements concentration in fingernails samples of volunteers of different ages (males, females) were determined using atomic absorption spectroscopy (AAS) Perkin-Elmer, spectrophotometer. Fingernai...In the present work, elements concentration in fingernails samples of volunteers of different ages (males, females) were determined using atomic absorption spectroscopy (AAS) Perkin-Elmer, spectrophotometer. Fingernails samples of different groups were analyzed to determine the trace elements Ca, Mg, Mn, Fe, Ni, Cu, Co, Zn and Pb. Standards materials were prepared for concentration assessment that adjacent to samples from two cities in different location in eastern province of Sudan for elements concentrations finding. In addition, samples of hands fingernails and toenails were analyzed for comparison and method validation. Consequently, the significant levels of elements concentration in nails samples of Jabiat residents compared to Port Sudan resident’s area due to soil dispersion are supporting the possibility of external contamination. The data of component matrix and rotated component matrix of varimax normalization using principal component analysis revealed important predictors of nails elements Mg, Mn, Fe, Cu and Zn concentrations in soil of both areas under study. However, the Pb, Ni, Ca, and Co are possible to be indication of different sources associated with environmental contamination. The significant correlation and principal component analysis of the elements of nails concentrations in the two categories supported the probability of different expose environmental contamination.展开更多
BACKGROUND Proximal femoral nails(PFNs)are the most common method for the treatment of unstable intertrochanteric femoral fractures(IFFs),but postoperative bed rest is required.There is a large amount of blood loss du...BACKGROUND Proximal femoral nails(PFNs)are the most common method for the treatment of unstable intertrochanteric femoral fractures(IFFs),but postoperative bed rest is required.There is a large amount of blood loss during the operation.Osteoporosis in elderly patients may cause nonunion of fractures and other complications.Arthroplasty can give patients early weight bearing and reduce financial burden,but whether it can replace PFNs remains controversial.AIM To compare the clinical outcomes of arthroplasty and PFNs in the treatment of unstable IFFs in elderly patients.METHODS A search was conducted in the PubMed,Embase,and Cochrane Library databases and included relevant articles comparing arthroplasty and PFN.The search time was limited from January 1,2005 to November 1,2020.Two investigators independently screened studies,extracted data and evaluated the quality according to the inclusion and exclusion criteria.According to the research results,the fixed effect model or random effect model were selected for analysis.The following outcomes were analyzed:Harris Hip score,mortality,complications,operation time,blood loos,hospital stay,weight-bearing time,fracture classification and type of anesthesia.RESULTS We analyzed four randomized controlled trials that met the requirements.A total of 298 patients were included in these studies.According to the AO/OTA classification,there are 20 A1 types,136 A2 types,42 A3 types and 100 unrecorded types.Primary outcome:The Harris Hip Score at the final follow-up of the PFN group was higher[mean difference(MD):9.01,95%confidence interval(CI):16.57 to 1.45),P=0.02].There was no significant difference between the two groups in the rate of overall mortality[risk ratio(RR):1.44,P=0.44]or the number of complications(RR:0.77,P=0.05).Secondary outcomes:blood loss of the arthroplasty group was higher(MD:241.01,95%CI:43.06–438.96,P=0.02);the operation time of the PFN group was shorter(MD:23.12,95%CI:10.46–35.77,P=0.0003);and the length of hospital stay of the arthroplasty group was shorter[MD:0.97,95%CI:1.29 to 0.66),P<0.00001].There was no difference between the two groups in the type of anesthesia(RR:0.99).There were only two studies recording the weight-bearing time,and the time of full weight bearing in the arthroplasty group was significantly earlier.CONCLUSION Compared with PFN,arthroplasty can achieve weight bearing earlier and shorten hospital stay,but it cannot achieve a better clinical outcome.Arthroplasty cannot replace PFNs in the treatment of unstable IFFs in elderly individuals.展开更多
Pullout resistance of a soil nail is a critical parameter in design and analysis for geotechnical engineers. Due to the complexity of field conditions, the pullout behaviour of cement grouted soil nail in field is not...Pullout resistance of a soil nail is a critical parameter in design and analysis for geotechnical engineers. Due to the complexity of field conditions, the pullout behaviour of cement grouted soil nail in field is not well investigated. In this work, a number of field pullout tests of pressure grouted soil nails were conducted to estimate the pullout resistance of soil nails. The effective bond lengths of field soil nails were accurately controlled by a new grouting packer system. Typical field test results and the related comparison with typical laboratory test results reveal that the apparent coefficient of friction （ACF） decreases with the increase of overburden soil pressure when grouting pressure is constant, but increases almost linearly with the increase of grouting pressure when overburden pressure （soil depth） is unchanged. Water contents of soil samples at soil nail surfaces show obvious reductions compared with the results of soil samples from drillholes. After soil nails were completely pulled out of the ground, surface conditions of the soil nails and surrounding soil were examined. It is found that the water content values of the soil at the soil/nail interfaces decrease substantially compared with those of soil samples extracted from drillholes. In addition, all soil nails expand significantly in the diametrical direction after being pulled out of ground, indicating that the pressurized cement grout compacts the soil and penetrates into soil voids, leading to a corresponding shift of failure surface into surrounding soil mass significantly.展开更多
Objective:To compare the outcomes of dynamic hip screws(DHS)and intramedullary nailing(IMN)in the treatment of extra-capsular metastatic carcinoma of the proximal femur.Methods:A retrospective case analysis method was...Objective:To compare the outcomes of dynamic hip screws(DHS)and intramedullary nailing(IMN)in the treatment of extra-capsular metastatic carcinoma of the proximal femur.Methods:A retrospective case analysis method was used to examine data of patients with proximal metastatic cancer of the femur who were treated with internal fixation in Department of Orthopaedics,Beijing Friendship Hospital,from January 2007 to December 2018.Blood loss,postoperative pain,functional score,length of stay,and survival rates were compared,and postoperative complications were assessed.Results:Complete follow-up data were available for 33 patients.The mean follow-up period was 12.2±3.6(range:9-32)months and the average age was 72.3±4.7(range:59-83)years old.There were 20 females and 13 males.Twenty-three patients had undergone IMN and 10 DHS,according to bone defects and the patient’s overall condition.The median survival time was 10 months in the IMN group and 11 months in the DHS group.Duration of surgery(t=-7.366,P<0.001)and length of hospital stay(t=-3.509,P<0.001)differed significantly between the two groups.There was one case of breakage of internal fixation in the IMN group.Conclusions:There was no significant difference between DHS and IMN in terms of surgical efficacy.IMN and DHS were different in terms of surgical time and hospital stay.However,due to the limited number of cases in this study,multi-factor analysis has not been performed and needs to be further verified in future analysis.When developing a surgical plan,it is recommended to consider the patient’s condition and the surgeon’s experience.展开更多
Background: Management of femoral diaphyseal fractures in the age group 616 years is controversial. There has been a resurgence worldwide for operative fixation. Material and methods: Twenty children (15 boys, 5 girls...Background: Management of femoral diaphyseal fractures in the age group 616 years is controversial. There has been a resurgence worldwide for operative fixation. Material and methods: Twenty children (15 boys, 5 girls) aged 616 years with femoral diaphyseal fractures (20 fractures, one in each) were stabilized with Titanium Elastic Nail (TEN). Patients underwent surgery within ten days of their injury. The results were evaluated using Flynn’s Scoring Criteria.Two nails were used in each fracture. Results: All 20 patients were available for evaluation and follow up for a mean duration of 24 months (1532 months). Radiological union in all cases was achieved in a mean time of 8 weeks. Full weight bearing was possible in a mean time of 10 weeks (812 weeks). The results were excellent in 14 patients (70%) and successful in 6 patients (30%). Few complications that occurred were infection (in 2 cases), knee joint stiffness(in 4 cases), angulation less than 10 degrees( in 4 cases), shortening less than 10 mm(in 4 cases). Conclusion: Intramedullary fixation by TEN is an effective treatment of fracture of femur in properly selected patients of the 616 years age group.展开更多
The aim of this article was to report a case of toe nails disorder associated with metformin use in an elderly patient with type2diabetes. Two years ago, after receiving metformin 0.5 g three times daily for 6 months,...The aim of this article was to report a case of toe nails disorder associated with metformin use in an elderly patient with type2diabetes. Two years ago, after receiving metformin 0.5 g three times daily for 6 months, a 60-year-old Chinese man found his ten toe nails gradually thickened and yellowed (especially two thumbs). The symptoms improved and recovered after metformin discontinuance. Half year ago, metformin 0.5 g three times daily adopted again and toe nails disorder occurred again. Physician modified the therapy plan and replaced metformin with acarbose to control blood glucose level of this patient. According to the follow up 3 months after his discharge, ten toe nails recovered significantly and new parts of the nails were normal. Nail disorder was rarely reported in the worldwide, but the physicians should keep awareness of this adverse drug reaction (ADR), proper actions should be taken once it occurred to avoid unnecessary suffering of the patient.展开更多
Osteoporotic(OP)fractures remain a tough clinical challenge owing to their impaired healing outcome,which requires novel biomaterials with osteogenicity for effective healing.Metallic zinc(Zn)is attracting increasing ...Osteoporotic(OP)fractures remain a tough clinical challenge owing to their impaired healing outcome,which requires novel biomaterials with osteogenicity for effective healing.Metallic zinc(Zn)is attracting increasing attention for biodegradable intramedullary nails(IMNs)for OP fracture healing thanks to their comprehensive mechanical properties,biosafety,and bioactivity.However,the multiple biofunctions required for OP fracture healing have not been fully met by Zn.Herein,a zoledronate(ZA)-mediated calcium-zinc silicate(Ca(Zn)Si)metal-organic/inorganic hybrid coating was fabricated on Zn-based IMN by coordination chemistry driven via interactions between ZA and Ca^(2+)/Zn^(2+)as well as in-situ directional growth of Ca(Zn)Si phase.The ZA&Ca(Zn)Si hybrid coating exhibited a homogeneous micro/nanostructure with a granular morphology,which prevented premature fracture failure of IMN in rat femur by ameliorating corrosion mode and decreasing degradation rate of the Zn matrix.More importantly,this hybrid coating enabled sustained release of Zn^(2+)/Ca^(2+)/Si4+and ZA in the long term,achieving a remarkable effect on vascularized bone regeneration.The coated IMN enhanced angiogenesis-osteogenesis coupling through autocrine and paracrine effects between endothelial cells and bone marrow mesenchymal stem cells.Osteoclastogenesis was repressed by Zn^(2+)and ZA.This approach offers a new strategy for surface-engineering of biodegradable metals for bone fracture healing.展开更多
We investigated the psychological effects of nail treatments on children living in child welfare facilities.We performed a single nail treatment on children living in child welfare facilities.As a result,we found that...We investigated the psychological effects of nail treatments on children living in child welfare facilities.We performed a single nail treatment on children living in child welfare facilities.As a result,we found that feelings of“energy”,“relaxation”,and“comfort”tended to increase more strongly after the treatment than before.Furthermore,these feelings increased even more after the nail treatment.The effects of nail treatments were unrelated to gender or previous nail experience.Furthermore,nail treatments increased communication and interaction with facility staff and other children residing in the facility,promoting self-expression,and,as a result,increasing a sense of accomplishment,acceptance from others,and self-esteem.This suggests that positive emotions persisted even after nail treatments,leading to positive changes in daily life.展开更多
Mueller matrices were measured for natural （or reference） samples of human nails and samples irradiated by a 2 Gy ionizing radiation dose. The elements of the total Mueller matrix as a function of scattering angle w...Mueller matrices were measured for natural （or reference） samples of human nails and samples irradiated by a 2 Gy ionizing radiation dose. The elements of the total Mueller matrix as a function of scattering angle were measured in backscattering mode at a wavelength of 632.8 nm. Several types of depolarizing Mueller matrix decompositions, namely, Ossikovsky, Williams, and Chipman, were calculated as a function of scattering angle for each nail sample. A comparative analysis of the sensitivity of the Mueller matrix decompositions in relation to the problem of emergency dose assessment in nails was performed.展开更多
BACKGROUND In intertrochanteric fractures,the positive medial cortex support reduction is considered to provide a non-anatomical buttress that helps in controlled collapse.AIM To analyze the concept of medial cortical...BACKGROUND In intertrochanteric fractures,the positive medial cortex support reduction is considered to provide a non-anatomical buttress that helps in controlled collapse.AIM To analyze the concept of medial cortical reduction(MCR)and its clinical and radiological association in geriatric intertrochanteric femur fractures.METHODS Geriatric patients who presented with AO/OTA 31A1 and 31A2 femur fractures and treated with proximal femoral nailing between July 2021 and June 2023 were include in this prospective cohort study.Based on the degree of MCR,they were divided into positive,neutral,or negative MCR groups.The demographic baseline characteristics,postoperative radiographic femoral neck-shaft angle and neck length were analyzed at 6,12 and 24 weeks post-surgery.Functional outcomes such as modified Harris Hip Score(HHS)and time to full-weight bearing were also analyzed.RESULTS 47 patients(Male:Famale 35:12)with mean age of 65.8±4.2 years were included in this study.Twenty-two cases had neutral support,nine had negative support,and sixteen had positive support in the medial cortex postoperatively.Baseline characteristics of the three groups were comparable.No significant differences were found in the femur neck length and femur neck-shaft angle changes post-surgery between the groups.The modified HHS was not found to be significant between the groups(P=0.883)as that of the time to full weight bearing(P=0.789).CONCLUSION The type of reduction achieved based on medial cortical alignment does not affect the femur neck length shortening or varus collapse.Future randomized controlled trials are needed to validate the findings noted in the study.展开更多
Intertrochanteric fractures,prevalent among older adults,pose significant clinical challenges due to high morbidity,mortality,and complication rates.Despite advancements in surgical methods and implant technology,one-...Intertrochanteric fractures,prevalent among older adults,pose significant clinical challenges due to high morbidity,mortality,and complication rates.Despite advancements in surgical methods and implant technology,one-year mortality remains between 20%and 30%,with up to 20%of survivors requiring revision surgery due to mechanical complications.Accurate fracture reduction and precise implant positioning are critical determinants of successful outcomes.This review synthesizes current literature on key radiographic parameters essential for evaluating fracture reduction quality and implant placement in intertrochanteric fracture fixation.Standardized intraoperative imaging techniques,such as correct anteroposterior and lateral fluoroscopic views,are fundamental for identifying malalignment.Important radiographic measures include the neck shaft angle,greater trochanter orthogonal line,anterior cortical line,and calcar displacement assessment.Reduction quality indices,notably the Baumgaertner and Chang Reduction Quality Criteria,provide reliable frameworks for predicting mechanical complications.Additionally,implant positioning parameters—including tip-apex distance,Calcar-referenced tip-apex distance,Cleveland zones,and Parker’s ratio index—are discussed as predictors of mechanical complications.Enhanced understanding and application of these radiographic criteria can improve surgical precision,reduce complications,and ultimately optimize patient outcomes in intertrochanteric fracture management.展开更多
基金supported by Clinical Application-oriented Medical Innovation Foundation from National Clinical Research Center for Orthopedics,Sports Medicine&Rehabilitation and Jiangsu China-Israel Industrial Technical Research Institute Foundation(No.2021-NCRC-CXJJ-ZH-24)National Key R&D Plan of the 14th Five-Year Plan(No.2022YFC2504303).
文摘Objective To compare the clinical outcomes of retrograde pubic ramus intramedullary nail(RPRIN)and percutaneous cannulated screw(PCS)in the treatment of anterior pelvic ring fractures(APRFs).Methods This retrospective cohort study included 45 patients with APRFs treated between February 2019 and October 2022 in our trauma center.Patients were divided into two groups based on the surgical method:20 received RPRIN fixation,and 25 received PCS fixation.Key variables including operation time,fluoroscopic time,blood loss,and postoperative complications were analyzed.Fracture reduction quality was assessed using the Matta score system,and pelvic functional recovery was evaluated using the Majeed score system at the final follow-up.Quantitative variables were compared using the independent sample t test,while categorical variables were analyzed using Chisquare and Fisher’s exact tests.Results The RPRIN group had significantly shorter operation time(36.3±5.6 min vs.49.5±6.9 min,P<0.01),fluoroscopic time(32.0±2.8 s vs.48.4±3.6 s,P<0.01),and less blood loss(20.4±7.6 mL vs.34.0±5.7 mL,P<0.01)than the PCS group.Fracture reduction quality(Matta outcome)and pelvic functional recovery(Majeed outcome)were comparable between the two groups(P>0.05).No significant complications were reported in either group.Conclusions Both RPRIN and PCS are effective for treating APRFs.However,RPRIN offers distinct advantages by reducing operation time,fluoroscopic time,and blood loss,making it a more efficient and less invasive option.Further multicenter studies and biomechanical analyses are warranted to confirm these findings.
基金supported by the program of Chengdu Fifth people's hospital Fund,No.KYJJ 2021-29the Xinglin Scholars research program,No.YYZX2021037+1 种基金the Chengdu Medical Research Project,Nos.2022055 and 2023022,Chongqing Education Commission,Youth Fund(No.KJQN202000607)Chongqing postdoctoral research project(special funding project,No.2021XM3040).
文摘Traditional diagnostic techniques including visual examination,ultrasound(US),and magnetic resonance imaging(MRI)have limitations of in-depth information for the detection of nail disorders,resolution,and practicality.This pilot study,for thefirst time,evaluates a dualmodality imaging system that combines photoacoustic tomography(PAT)with the US for the multiparametric quantitative assessment of human nail.The study involved a small cohort offive healthy volunteers who underwent PAT/US imaging for acquiring the nail unit data.The PAT/US dual-modality imaging successfully revealed thefine anatomical structures and microvascular distribution within the nail and nail bed.Moreover,this system utilized multispectral PAT to analyze functional tissue parameters,including oxygenated hemoglobin,deoxyhemoglobin,oxygen saturation,and collagen under tourniquet and cold stimulus tests to evaluate changes in the microcirculation of the nail bed.The quantitative analysis of multispectral PAT reconstructed images demonstrated heightened sensitivity in detecting alterations in blood oxygenation levels and collagen content within the nail bed,under simulated different physiological conditions.This pilot study highlights the potential of PAT/US dual-modality imaging as a real-time,noninvasive diagnostic modality for evaluating human nail health and for early detection of nail bed pathologies.
文摘Introduction: The management of fractures of the tibia shaft is an important aspect of orthopaedic care, and the selection of the surgical method for fixation can substantially impact patient outcomes. The current review aims to compare the outcomes of adult tibia fractures treated with solid nails to those treated with hollow nails. Methods: A search on Scopus, PubMed, and Cochrane Library, using three keywords (Outcome, Tibia shaft fractures, Nail) was conducted in April 2023. Results were compiled and two independent reviewers screened and selected eligible articles After removing duplicates, titles and abstracts were read to exclude ineligible studies. Full-text articles of the remaining papers were read to select eligible studies which were further critically appraised to ascertain their methodological quality. The data extracted from the selected papers were synthesized using a combination of pooling of results, tests of statistical difference (t-test and chi-square) and narrative synthesis methods. Results: A total of 2295 articles were obtained from the databases and citation searching. A total of 9 papers were identified as eligible and included in the review. Findings revealed that there is no statistical difference in the outcomes of tibia fractures treated with either solid or hollow nail groups such as duration of surgery (p = 0.541), rate of delayed and non-union (p = 0.342), and rate of surgical site infections (p = 0.395). Conclusion: Intramedullary nailing of tibia shaft fractures with either solid or hollow nails have similar functional outcomes.
基金Supported by Children’s Hospital Charity and Industry(Nuvasive,CA,United States),No.5431.
文摘BACKGROUND Femoral lengthening is a procedure of great importance in the treatment of congenital and acquired limb deficiencies.Technological advances have led to the latest designs of fully implantable motorized intramedullary lengthening nails.The use of these nails has increased over the last few years.AIM To review and critically appraise the literature comparing the outcome of femoral lengthening in children using intramedullary motorized lengthening nails to external fixation.METHODS Electronic databases(MEDLINE,CINAHL,EMBASE,Cochrane)were systematically searched in November 2019 for studies comparing the outcome of femoral lengthening in children using magnetic lengthening nails and external fixation.The outcomes included amount of gained length,healing index,complications and patient reported outcomes.RESULTS Of the 452 identified studies,only two(retrospective and non-randomized)met the inclusion criteria.A total of 91 femora were included.In both studies,the age of patients treated with nails ranged from 15 to 21 years compared to 9 to 15 years for patients in the external fixation group.Both devices achieved the target length.Prevalence of adverse events was less in the nail(60%-73%)than in the external fixation(81%-100%)group.None of the studies presented patient reported outcomes.CONCLUSION The clinical effectiveness of motorized nails is equivalent or superior to external fixation for femoral lengthening in young patients.The available literature is limited and does not provide evidence on patient quality of life or cost effectiveness of the interventions.
基金The authors are grateful for the financial supports from the National Natural Science Foundation of China(51671017 and 51971020)the Beijing Municipal Natural Science Foundation,China(2202033)+2 种基金Beijing Laboratory of Metallic Materials and Processing for Modern Transportation,China,the Fundamental Research Funds for the Central Universities,China(FRF-IC-19-015)the Major State Research and Development Program of China(2016YFB0300801)the Opening Research Fund of State Key Laboratory for Advanced Metals and Materials,China(2018-Z04).
文摘The microstructure,mechanical properties and corrosion behavior of quaternary degradable Mg−1Zn−0.2Ca−xAg(x=1,2,4 wt.%)alloy wires,intended as anastomotic nails,were investigated.It was found that these Ag-containing alloy wires mainly consist of Mg matrix and Ag17Mg54 phase,characterized by SEM,EDS,XRD and TEM.Tensile and knotting tests results demonstrate the superior mechanical properties of these alloy wires.Especially,Mg−1Zn−0.2Ca−4Ag alloy exhibits the highest mechanical properties,i.e.an ultimate tensile strength of 334 MPa and an elongation of 8.6%.Moreover,with increasing Ag content,the corrosion rates of these alloy wires remarkably increase due to the formation of more micro-galvanic coupling between Mg matrix and Ag17Mg54 phase,shown by mass loss and scanning Kelvin probe force microscopy(SKPFM)results.The present alloy can be completely degraded within 28 d,satisfying the property requirements of anastomotic nails.
基金sponspored by research opening fund of State Key Laboratory of Environmental Geochemistry,Guiyang,Guizhou Province,China with grant No.SKLEG2017910。
文摘In recent times,there had been reported cases of Pb poisoning in Anka gold mining area,Northwest Nigeria.Therefore,this study was carried out to determine the extent of bioaccumulation of heavy metals in the hairs and nails of children in the area.Forty samples(twenty nails and twenty hairs)samples were collected from ten boys and ten girls of ages 5–9 residing in the area.To ascertain the sources of heavy metals in children,15 soils samples,15 groundwater samples,5 samples of mine tailings,and 5 plants samples were collected.Hair and nails of the subjects were collected using internationally acceptable techniques.All samples were kept in uncontaminated ziplock bags prior to laboratory preparation and analysis.The samples were cleaned using nonionic detergent(triton X-100)and deionized water.The hairs and nails were digested with 10 mL of 6:1 mixture of nitric acid and perchloric acid.The soils,mine tailings,and plants were air-dried at room temperature,sieved,and chemically digested using the aqua regia method.The concentrations of metals in all the samples were determined using highperformance liquid chromatography–inductively coupled plasma–mass spectrometry.Statistical analysis was employed to unravel potential sources of metals in the media.Results showed that heavy metals in children of the area are above results from similar studies and pathological ranges for heavy metals in hairs and nails.Also,heavy metals in environmental media are above the recommended standards.Multivariate analysis showed that the metals are mainly from mining and other anthropogenic sources.Results of correlation between heavy metals in hairs and nails with those in geological samples revealed that heavy metal that bioaccumulates in the children of this area are mostly from contaminated environmental media.It is recommended that complete remediation and effective health education be carried out in the area.
文摘Tests of the capacity of shear connections consisting of nails in a row placed at distances 7, 10 and 14d, “d” being the cross-sectional dimension of the nail, versus single nail capacities, were executed. The performed tests do support the connotation that no reduction should be required for nails of diameter 2.8 mm or less in a row, provided that nails are spaced sufficiently far apart for wood cracking not to occur. At the ultimate capacity of the joint, all such thin nails in a row will be yielding, having developed plastic hinges, i.e. each single nail will have developed its ultimate capacity. Hence, the ultimate capacity of the connection will be each nail’s capacity times the number of nails in the row. The force pr. nail increases subsequent to the development of a plastic hinge. This is likely due to the axial pullout-force, i.e. the ultimate capacity of a shear connection is higher than the force required for developing plastic hinges in the nails. This additional capacity-reserve may also partly be attributed to the rotational resistance of nails. The number of nails in a row should make insignificant difference in the pr. nail capacity, as long as no wood cracking takes place. Thus, applying elastic theory to nails in a row does not seem relevant. This is in contrast to bolt-connections.
文摘Objective： To report 32 cases of femur supracondylar fracture treated with retrograde interlocking intramedullary nails in elderly patients. Methods： According to the AO classification, all of 32 cases were classified as extra-articular type A. 32 cases were treated with interlocking intramedullary nail by closed insertion from intercondylar fossa of the knee. All cases accepted CPM exercise as early as possible after operation. Results： Following up 5 to 15 months, all fractures united within an average duration of 5.3 months （4-7 months）. According to the Shelbourne scale, the excellent rate of the knee function was 86.3%. Conclusion： Retrograde interlocking intramedullary nail is useful alternative implant for the treatment of osteoporotic supracondylar fracture of femur, particularly of the type A fracture in the elderly population. Its merits include stable fixation, high rate of fracture union and few complications.
文摘In the present work, elements concentration in fingernails samples of volunteers of different ages (males, females) were determined using atomic absorption spectroscopy (AAS) Perkin-Elmer, spectrophotometer. Fingernails samples of different groups were analyzed to determine the trace elements Ca, Mg, Mn, Fe, Ni, Cu, Co, Zn and Pb. Standards materials were prepared for concentration assessment that adjacent to samples from two cities in different location in eastern province of Sudan for elements concentrations finding. In addition, samples of hands fingernails and toenails were analyzed for comparison and method validation. Consequently, the significant levels of elements concentration in nails samples of Jabiat residents compared to Port Sudan resident’s area due to soil dispersion are supporting the possibility of external contamination. The data of component matrix and rotated component matrix of varimax normalization using principal component analysis revealed important predictors of nails elements Mg, Mn, Fe, Cu and Zn concentrations in soil of both areas under study. However, the Pb, Ni, Ca, and Co are possible to be indication of different sources associated with environmental contamination. The significant correlation and principal component analysis of the elements of nails concentrations in the two categories supported the probability of different expose environmental contamination.
文摘BACKGROUND Proximal femoral nails(PFNs)are the most common method for the treatment of unstable intertrochanteric femoral fractures(IFFs),but postoperative bed rest is required.There is a large amount of blood loss during the operation.Osteoporosis in elderly patients may cause nonunion of fractures and other complications.Arthroplasty can give patients early weight bearing and reduce financial burden,but whether it can replace PFNs remains controversial.AIM To compare the clinical outcomes of arthroplasty and PFNs in the treatment of unstable IFFs in elderly patients.METHODS A search was conducted in the PubMed,Embase,and Cochrane Library databases and included relevant articles comparing arthroplasty and PFN.The search time was limited from January 1,2005 to November 1,2020.Two investigators independently screened studies,extracted data and evaluated the quality according to the inclusion and exclusion criteria.According to the research results,the fixed effect model or random effect model were selected for analysis.The following outcomes were analyzed:Harris Hip score,mortality,complications,operation time,blood loos,hospital stay,weight-bearing time,fracture classification and type of anesthesia.RESULTS We analyzed four randomized controlled trials that met the requirements.A total of 298 patients were included in these studies.According to the AO/OTA classification,there are 20 A1 types,136 A2 types,42 A3 types and 100 unrecorded types.Primary outcome:The Harris Hip Score at the final follow-up of the PFN group was higher[mean difference(MD):9.01,95%confidence interval(CI):16.57 to 1.45),P=0.02].There was no significant difference between the two groups in the rate of overall mortality[risk ratio(RR):1.44,P=0.44]or the number of complications(RR:0.77,P=0.05).Secondary outcomes:blood loss of the arthroplasty group was higher(MD:241.01,95%CI:43.06–438.96,P=0.02);the operation time of the PFN group was shorter(MD:23.12,95%CI:10.46–35.77,P=0.0003);and the length of hospital stay of the arthroplasty group was shorter[MD:0.97,95%CI:1.29 to 0.66),P<0.00001].There was no difference between the two groups in the type of anesthesia(RR:0.99).There were only two studies recording the weight-bearing time,and the time of full weight bearing in the arthroplasty group was significantly earlier.CONCLUSION Compared with PFN,arthroplasty can achieve weight bearing earlier and shorten hospital stay,but it cannot achieve a better clinical outcome.Arthroplasty cannot replace PFNs in the treatment of unstable IFFs in elderly individuals.
基金Foundation item： Project（NTF 12015） supported by the Scientific Research Foundation for Talent of Shantou University, China Project（PolyU 5320107E） supported by the Research Grants Committee General Research Fund, China
文摘Pullout resistance of a soil nail is a critical parameter in design and analysis for geotechnical engineers. Due to the complexity of field conditions, the pullout behaviour of cement grouted soil nail in field is not well investigated. In this work, a number of field pullout tests of pressure grouted soil nails were conducted to estimate the pullout resistance of soil nails. The effective bond lengths of field soil nails were accurately controlled by a new grouting packer system. Typical field test results and the related comparison with typical laboratory test results reveal that the apparent coefficient of friction （ACF） decreases with the increase of overburden soil pressure when grouting pressure is constant, but increases almost linearly with the increase of grouting pressure when overburden pressure （soil depth） is unchanged. Water contents of soil samples at soil nail surfaces show obvious reductions compared with the results of soil samples from drillholes. After soil nails were completely pulled out of the ground, surface conditions of the soil nails and surrounding soil were examined. It is found that the water content values of the soil at the soil/nail interfaces decrease substantially compared with those of soil samples extracted from drillholes. In addition, all soil nails expand significantly in the diametrical direction after being pulled out of ground, indicating that the pressurized cement grout compacts the soil and penetrates into soil voids, leading to a corresponding shift of failure surface into surrounding soil mass significantly.
基金Capital’s Funds for Health Improvement and Research(No.2018-1-2072)。
文摘Objective:To compare the outcomes of dynamic hip screws(DHS)and intramedullary nailing(IMN)in the treatment of extra-capsular metastatic carcinoma of the proximal femur.Methods:A retrospective case analysis method was used to examine data of patients with proximal metastatic cancer of the femur who were treated with internal fixation in Department of Orthopaedics,Beijing Friendship Hospital,from January 2007 to December 2018.Blood loss,postoperative pain,functional score,length of stay,and survival rates were compared,and postoperative complications were assessed.Results:Complete follow-up data were available for 33 patients.The mean follow-up period was 12.2±3.6(range:9-32)months and the average age was 72.3±4.7(range:59-83)years old.There were 20 females and 13 males.Twenty-three patients had undergone IMN and 10 DHS,according to bone defects and the patient’s overall condition.The median survival time was 10 months in the IMN group and 11 months in the DHS group.Duration of surgery(t=-7.366,P<0.001)and length of hospital stay(t=-3.509,P<0.001)differed significantly between the two groups.There was one case of breakage of internal fixation in the IMN group.Conclusions:There was no significant difference between DHS and IMN in terms of surgical efficacy.IMN and DHS were different in terms of surgical time and hospital stay.However,due to the limited number of cases in this study,multi-factor analysis has not been performed and needs to be further verified in future analysis.When developing a surgical plan,it is recommended to consider the patient’s condition and the surgeon’s experience.
文摘Background: Management of femoral diaphyseal fractures in the age group 616 years is controversial. There has been a resurgence worldwide for operative fixation. Material and methods: Twenty children (15 boys, 5 girls) aged 616 years with femoral diaphyseal fractures (20 fractures, one in each) were stabilized with Titanium Elastic Nail (TEN). Patients underwent surgery within ten days of their injury. The results were evaluated using Flynn’s Scoring Criteria.Two nails were used in each fracture. Results: All 20 patients were available for evaluation and follow up for a mean duration of 24 months (1532 months). Radiological union in all cases was achieved in a mean time of 8 weeks. Full weight bearing was possible in a mean time of 10 weeks (812 weeks). The results were excellent in 14 patients (70%) and successful in 6 patients (30%). Few complications that occurred were infection (in 2 cases), knee joint stiffness(in 4 cases), angulation less than 10 degrees( in 4 cases), shortening less than 10 mm(in 4 cases). Conclusion: Intramedullary fixation by TEN is an effective treatment of fracture of femur in properly selected patients of the 616 years age group.
文摘The aim of this article was to report a case of toe nails disorder associated with metformin use in an elderly patient with type2diabetes. Two years ago, after receiving metformin 0.5 g three times daily for 6 months, a 60-year-old Chinese man found his ten toe nails gradually thickened and yellowed (especially two thumbs). The symptoms improved and recovered after metformin discontinuance. Half year ago, metformin 0.5 g three times daily adopted again and toe nails disorder occurred again. Physician modified the therapy plan and replaced metformin with acarbose to control blood glucose level of this patient. According to the follow up 3 months after his discharge, ten toe nails recovered significantly and new parts of the nails were normal. Nail disorder was rarely reported in the worldwide, but the physicians should keep awareness of this adverse drug reaction (ADR), proper actions should be taken once it occurred to avoid unnecessary suffering of the patient.
基金supported by the Natural Science Foundation of China(No.82202664)Sichuan Science and Technology Program(No.2024YFHZ0310)+1 种基金Guangdong Basic and Applied Basic Research Foundation(No.2022B1515120046,2023A1515012764)Shenzhen Science and Technology Program(No.ZDSYS20220606100602005,JCYJ20220818102815033).
文摘Osteoporotic(OP)fractures remain a tough clinical challenge owing to their impaired healing outcome,which requires novel biomaterials with osteogenicity for effective healing.Metallic zinc(Zn)is attracting increasing attention for biodegradable intramedullary nails(IMNs)for OP fracture healing thanks to their comprehensive mechanical properties,biosafety,and bioactivity.However,the multiple biofunctions required for OP fracture healing have not been fully met by Zn.Herein,a zoledronate(ZA)-mediated calcium-zinc silicate(Ca(Zn)Si)metal-organic/inorganic hybrid coating was fabricated on Zn-based IMN by coordination chemistry driven via interactions between ZA and Ca^(2+)/Zn^(2+)as well as in-situ directional growth of Ca(Zn)Si phase.The ZA&Ca(Zn)Si hybrid coating exhibited a homogeneous micro/nanostructure with a granular morphology,which prevented premature fracture failure of IMN in rat femur by ameliorating corrosion mode and decreasing degradation rate of the Zn matrix.More importantly,this hybrid coating enabled sustained release of Zn^(2+)/Ca^(2+)/Si4+and ZA in the long term,achieving a remarkable effect on vascularized bone regeneration.The coated IMN enhanced angiogenesis-osteogenesis coupling through autocrine and paracrine effects between endothelial cells and bone marrow mesenchymal stem cells.Osteoclastogenesis was repressed by Zn^(2+)and ZA.This approach offers a new strategy for surface-engineering of biodegradable metals for bone fracture healing.
基金This study received a research grant from the Hoyu Science Foundation in 2023.
文摘We investigated the psychological effects of nail treatments on children living in child welfare facilities.We performed a single nail treatment on children living in child welfare facilities.As a result,we found that feelings of“energy”,“relaxation”,and“comfort”tended to increase more strongly after the treatment than before.Furthermore,these feelings increased even more after the nail treatment.The effects of nail treatments were unrelated to gender or previous nail experience.Furthermore,nail treatments increased communication and interaction with facility staff and other children residing in the facility,promoting self-expression,and,as a result,increasing a sense of accomplishment,acceptance from others,and self-esteem.This suggests that positive emotions persisted even after nail treatments,leading to positive changes in daily life.
文摘Mueller matrices were measured for natural （or reference） samples of human nails and samples irradiated by a 2 Gy ionizing radiation dose. The elements of the total Mueller matrix as a function of scattering angle were measured in backscattering mode at a wavelength of 632.8 nm. Several types of depolarizing Mueller matrix decompositions, namely, Ossikovsky, Williams, and Chipman, were calculated as a function of scattering angle for each nail sample. A comparative analysis of the sensitivity of the Mueller matrix decompositions in relation to the problem of emergency dose assessment in nails was performed.
文摘BACKGROUND In intertrochanteric fractures,the positive medial cortex support reduction is considered to provide a non-anatomical buttress that helps in controlled collapse.AIM To analyze the concept of medial cortical reduction(MCR)and its clinical and radiological association in geriatric intertrochanteric femur fractures.METHODS Geriatric patients who presented with AO/OTA 31A1 and 31A2 femur fractures and treated with proximal femoral nailing between July 2021 and June 2023 were include in this prospective cohort study.Based on the degree of MCR,they were divided into positive,neutral,or negative MCR groups.The demographic baseline characteristics,postoperative radiographic femoral neck-shaft angle and neck length were analyzed at 6,12 and 24 weeks post-surgery.Functional outcomes such as modified Harris Hip Score(HHS)and time to full-weight bearing were also analyzed.RESULTS 47 patients(Male:Famale 35:12)with mean age of 65.8±4.2 years were included in this study.Twenty-two cases had neutral support,nine had negative support,and sixteen had positive support in the medial cortex postoperatively.Baseline characteristics of the three groups were comparable.No significant differences were found in the femur neck length and femur neck-shaft angle changes post-surgery between the groups.The modified HHS was not found to be significant between the groups(P=0.883)as that of the time to full weight bearing(P=0.789).CONCLUSION The type of reduction achieved based on medial cortical alignment does not affect the femur neck length shortening or varus collapse.Future randomized controlled trials are needed to validate the findings noted in the study.
基金Supported by the Orthopaedic Research Foundation of Western Australia,Freie Akademische Gesellschaft Baseland Swiss Orthopaedics.
文摘Intertrochanteric fractures,prevalent among older adults,pose significant clinical challenges due to high morbidity,mortality,and complication rates.Despite advancements in surgical methods and implant technology,one-year mortality remains between 20%and 30%,with up to 20%of survivors requiring revision surgery due to mechanical complications.Accurate fracture reduction and precise implant positioning are critical determinants of successful outcomes.This review synthesizes current literature on key radiographic parameters essential for evaluating fracture reduction quality and implant placement in intertrochanteric fracture fixation.Standardized intraoperative imaging techniques,such as correct anteroposterior and lateral fluoroscopic views,are fundamental for identifying malalignment.Important radiographic measures include the neck shaft angle,greater trochanter orthogonal line,anterior cortical line,and calcar displacement assessment.Reduction quality indices,notably the Baumgaertner and Chang Reduction Quality Criteria,provide reliable frameworks for predicting mechanical complications.Additionally,implant positioning parameters—including tip-apex distance,Calcar-referenced tip-apex distance,Cleveland zones,and Parker’s ratio index—are discussed as predictors of mechanical complications.Enhanced understanding and application of these radiographic criteria can improve surgical precision,reduce complications,and ultimately optimize patient outcomes in intertrochanteric fracture management.
