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
Background of the Study: Femoral shaft fracture is the most common pediatric injury requiring hospitalization. For children less than 5 years old, non-surgical approach is recommended. For pediatric patients 5 - 14 ye...Background of the Study: Femoral shaft fracture is the most common pediatric injury requiring hospitalization. For children less than 5 years old, non-surgical approach is recommended. For pediatric patients 5 - 14 years old, the most common mode of treatment is flexible intramedullary nailing with a known complication of pain at post-op site, inflammatory reaction/bursitis at the entry site, superficial and deep infection, knee synovitis, knee stiffness, leg length discrepancy, proximal nail migration, angulation or malunion, delayed and non-union, implant breakage. This study aims to present a rare complication of a femoral fracture fixed with flexible intramedullary nail. Methodology: We report the outcome of a 12-year-old male with peri implant fracture of the left femur. He underwent removal of plates and screws and subsequently fixed with flexible intramedullary nails. Patient was followed up at 1, 3, 7, and 10 months post-operatively. Varus-valgus, sagittal angulation, and limb shortening were measured pre- and post-operatively. Complications were recorded on each visit. Results: Pre-operative varus angulation was 10˚, pro-curvatum of 55˚ with limb shortening of 4 cm. Postoperatively, varus was maintained to 10˚ but pro-curvatum was corrected to 4˚ and limb shortening was reduced to 1 cm. However, after 1 month the varus angulation increased to 30˚ while maintaining sagittal pro-curvatum. Limb shortening also increased to 2 cm. New bone formation started to appear along the mechanical axis of the left femur which is apparent at 3 months post-op and pro-curvatum increased to 20˚. At 7 and 10 months post-op no signs of union was noted at the fracture site but the callus formation along the mechanical axis gradually matured and appeared as a new femoral shaft. Conclusion: Formation of new bone in response to unstable flexible intramedullary fixation in pediatric femoral shaft fracture is a very rare complication.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
The primary goal of this study is to provide an efficient numerical tool to analyze the seismic performance of nailed walls.Modeling such excavation supports involves complexities due partly to the interaction of supp...The primary goal of this study is to provide an efficient numerical tool to analyze the seismic performance of nailed walls.Modeling such excavation supports involves complexities due partly to the interaction of support with soil and partly because of the amplification of seismic waves through an excavation wall.Consequently,innovative modeling is suggested herein,incorporating the calibration of the soil constitutive model in a targeted range of stress and strain,and the detection of a natural period of complex systems,including soil and structure,while benefiting from Rayleigh damping to filter unwanted noises.The numerical model was achieved by simulating a previous centrifuge test of the excavation wall,manifested at the pre-failure state.Notably,the calibration of the soil constitutive model through empirical relations,which replaces the numerical reproduction of an element test,more accurately simulated the soil-nail-wall interaction.Two factors were crucial to a successful result.First,probing the natural period of the complicated geometry of the model by applying white noises.Second,considering Rayleigh damping to withdraw unwanted noises and thus assess their permanent effects on the model.Rayleigh damping was applied instead of filtering the obtained results.展开更多
Thermal runaway(TR)in lithium-ion batteries(LIBs)involves a complicated multiphysics process with potentially catastrophic consequences,highlighting the importance of investigating effective prevention strategies.This...Thermal runaway(TR)in lithium-ion batteries(LIBs)involves a complicated multiphysics process with potentially catastrophic consequences,highlighting the importance of investigating effective prevention strategies.This study employs a lumped model integrating electrochemical and decomposition reaction kinetics to predict the evolution of the TR of LIBs triggered by axial nail penetration,validated by experimental tests.A computational fluid dynamics(CFD)-based turbulent flow model is further employed to simulate the thermal runaway propagation(TRP)behavior induced by high-temperature gases within the battery module.A parameterized analysis based on numerical simulation is conducted to quantify the impact of thermal insulation material properties on thermal diffusion and heat accumulation within the module.The results indicate that damage to the battery vent significantly increases the risk of sidewall rupture during TR.The incorporation of thermal barriers is essential in the thermal design of battery modules to prevent heat transfer via convection from the thermal exhaust caused by sidewall rupture to adjacent cells.In addition,a reduction in the thermal diffusivity of the thermal barrier material is required to minimize thermal exchange between battery cells.By adopting insulating materials with thermal diffusivity lower than 0.3 mm^(2)/s,the TRP of batteries can be mitigated under non-enclosed conditions.These findings contribute to improved battery safety and inform the development of more effective thermal protection measures and safety standards.展开更多
BACKGROUND Unstable intertrochanteric fractures in elderly patients require effective surgical management,with both cementless bipolar hemiarthroplasty(CBHA)and proximal femoral nail anti-rotation(PFNA)being valid tre...BACKGROUND Unstable intertrochanteric fractures in elderly patients require effective surgical management,with both cementless bipolar hemiarthroplasty(CBHA)and proximal femoral nail anti-rotation(PFNA)being valid treatment options to reduce morbidity and mortality.AIM To evaluate and compare the outcomes of CBHA and PFNA in treatment of unstable intertrochanteric fractures.METHODS A comprehensive search was conducted to identify relevant studies discussing the outcomes of using both CBH and PFNA in treatment of unstable intertrochanteric fractures.Studies published up to January 1,2025 were searched across multiple databases,including PubMed,EMBASE,Scopus,Web of Science,Cochrane Library,and Google Scholar.Full texts of the selected articles were retrieved,reviewed,and independently assessed by the investigators.Discrepancies were resolved by consensus,with any remaining disagreements being arbitrated by a third author.RESULTS This meta-analysis included three studies,all of which were retrospective,involving a total of 240 patients.The follow-up period for participants was at least 12 months.CBHA was associated with significantly higher blood loss compared to PFNA[mean differences(MD):129.14,95%CI(52.51,205.77),P=0.001],though heterogeneity was high(I²=97%).Operative time showed no significant difference initially[MD:6.10,95%CI(-13.34,25.54),P=0.54],but after excluding one study,BHA had longer operative times[MD:21.51,95%CI(18.60,24.41),P<0.00001].Hospital stay and Harris scores showed no significant differences between groups.CBHA facilitated faster progression to weight-bearing[MD:-11.92,95%CI(-22.46,-1.39),P=0.03]and a lower incidence of prosthetic loosening[risk ratio:0.21,95%CI(0.05,0.92),P=0.04].Refracture and thrombus formation rates were comparable between the two groups.CONCLUSION CBHA offers shorter weight-bearing duration and reduced prosthetic loosening but incurs greater blood loss and longer operative times compared to PFNA.Both techniques show comparable functional recovery,hospital stay,refracture,and thrombus risks.Clinical choice should prioritize early mobilization or surgical minimalism,guided by patient needs.Further prospective studies are warranted.展开更多
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
This study examined the positive changes that water-based nail treatments can bring to emotions and behavior in children who do not attend school and use a place for school-refusing children.Children who do not attend...This study examined the positive changes that water-based nail treatments can bring to emotions and behavior in children who do not attend school and use a place for school-refusing children.Children who do not attend school and use a place for school-refusing children were given water-based nail treatments about once a week for three months.In addition,the parents of these children were asked to respond to questions about their children’s daily activities.The results showed that natural communication through nail treatments significantly increased positive emotions.However,continued nail treatments did not reduce the children’s problem behaviors.Some children returned to school,while others continued not attending school.Increased frequency of visits and number of treatments confirmed the promotion of communication.It was suggested that building positive relationships with family and supporters is important for achieving sustained effects from nail treatments.This study showed that nail treatments are a useful tool for promoting positive emotions,self-acceptance,and social skills,and may contribute to the emotional growth and social interest of children who do not attend school.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 Among the most frequent hip fractures are trochanteric fractures,which usually occur from low-energy trauma like minor falls,especially in older people with osteoporotic bones.AIM To evaluate the treatment ...BACKGROUND Among the most frequent hip fractures are trochanteric fractures,which usually occur from low-energy trauma like minor falls,especially in older people with osteoporotic bones.AIM To evaluate the treatment efficacy of dynamic condylar screws(DCS)and proximal femoral nails(PFN)for unstable intertrochanteric fractures.METHODS To find pertinent randomized controlled trials and retrospective observational studies comparing PFN with DCS for the management of unstable femoral intertrochanteric fractures,a thorough search was carried out.For research studies published between January 1996 and April 2024,PubMed,EMBASE,Scopus,Web of Science,Cochrane Library,and Google Scholar were all searched.The complete texts of the papers were retrieved,vetted,and independently examined by two investigators.Disputes were settled by consensus,and any disagreements that persisted were arbitrated by a third author.RESULTS This study included six articles,comprising a total of 173 patients.Compared to the DCS,the PFN had a shorter operation time[mean difference(MD):-41.7 min,95%confidence interval(95%CI):-63.04 to-20.35,P=0.0001],higher success rates with closed reduction techniques[risk ratio(RR):34.05,95%CI:11.12-104.31,P<0.00001],and required less intraoperative blood transfusion(MD:-1.4 units,95%CI:-1.80 to-1.00,P<0.00001).Additionally,the PFN showed shorter fracture union time(MD:-6.92 wk,95%CI:-10.27 to-3.57,P<0.0001)and a lower incidence of reoperation(RR:0.37,95%CI:0.17-0.82,P=0.01).However,there was no discernible variation regarding hospital stay,implant-related complications,and infections.CONCLUSION Compared to DCS,PFN offers shorter operative times,reduces the blood transfusions requirements,achieves higher closed reduction success,enables faster fracture healing,and lowers reoperation incidence.展开更多
In this editorial,I present my comments on the article by Solarino et al.Conversion hip arthroplasty,which is an optional salvage procedure performed following unsuccessful fixation of intertrochanteric femur fracture...In this editorial,I present my comments on the article by Solarino et al.Conversion hip arthroplasty,which is an optional salvage procedure performed following unsuccessful fixation of intertrochanteric femur fractures in elderly pati-ents,entails more complex processes and higher rates of operative complications than primary arthroplasty.Hence,it is important to consider the appropriateness of the primary treatment choice,as well as the adequacy of nailing fixation for intertrochanteric fractures.This article briefly analyzes the possible factors contributing to the nailing failure of intertrochanteric fractures and attempts to find corresponding countermeasures to prevent fixation failures.It also analyzes the choice of treatment between nailing fixation and primary arthroplasty for intertrochanteric fractures.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
With the aging population,intertrochanteric femur fracture in the elderly has become one of the most serious public health issues and a hot topic of research in trauma orthopedics.Due to the limitations of internal fi...With the aging population,intertrochanteric femur fracture in the elderly has become one of the most serious public health issues and a hot topic of research in trauma orthopedics.Due to the limitations of internal fixation techniques and the insufficient mechanical design of nails,the occurrence of complications delays patient recovery after surgical treatment.Design of a proximal femur bionic nail(PFBN)based on Zhang’s N triangle theory provides triangular supporting fixation,which dramatically decreases the occurrence of complications and has been widely used for clinical treatment of unstable intertrochanteric femur fracture worldwide.In this work,we developed an equivalent biomechanical model to analyze improvement in bone remodeling of unstable intertrochanteric femur fracture through PFBN use.The results show that compared with proximal femoral nail antirotation(PFNA)and InterTan,PFBN can dramatically decrease the maximum strain in the proximal femur.Based on Frost’s mechanostat theory,the local mechanical environment in the proximal femur can be regulated into the medium overload region by using a PFBN,which may render the proximal femur in a state of physiological overload,favoring post-operative recovery of intertrochanteric femur fracture in the elderly.This work shows that PFBN may constitute a panacea for unstable intertrochanteric femur fracture and provides insights into improving methods of internal fixation.展开更多
Background: Fractures of humeral shaft in adults are common injuries. Humeral shafts non-union either from late presentation after initial treatment by traditional bone setters or failed non-operative orthodox care is...Background: Fractures of humeral shaft in adults are common injuries. Humeral shafts non-union either from late presentation after initial treatment by traditional bone setters or failed non-operative orthodox care is a major problem in this part of the world. This non-union is a major treatment challenge with increased cost of care and morbidity in this part of the world. Humeral shaft non-union can be treated with locked intra-medullary nailing (LIMN) or dynamic compression plating (DCP). Study on comparison of these methods of fixation in this part of the world is scarce in literature search, hence the reason for this study. Objective: The objectives of this study are: (1) to compare early clinical outcome following fixation of humeral shaft fracture nonunion with DCP versus LIMN;(2) to compare the time of radiologic fracture union of DCP with LIMN;(3) to compare complications following fixation of humeral shaft fracture nonunion with DCP versus LIMN. Patients and Methods: This was a randomized control study done for 2 years in which fifty adult patients with humeral shaft non-union were recruited. The patients were grouped into 2 (P = DCP & N = LIMN). Forty five of the patients completed the follow up periods of the study and then analyzed. The P group had ORIF with DCP while the N group had ORIF with LIMN. Both groups had grafting with cancellous bones. Each patient was followed up for a period of 6 months at the time which radiographic union is expected. Any patient without clinical and/or radiographic evidence of union after six months of surgery was diagnosed as having recurrent non-union. The data generated was analyzed using SPSS Version 23. The results were presented in charts and tables. The paired t-test was used while considering p value Result: Forty five patients completed follow up. There was a male preponderance (4:1), right humerus predominated (3:2). Motor vehicular accidents were the commonest cause of the fractures (62%). Most non-union fractures occurred at the level of the middle 3<sup>rd</sup> of the humeral shaft (60%). Failed TBS treatment was the commonest indication for the osteosynthesis (71%). More patients had plating (53%) compared to 47% who had LIMN. Most patients (93.4%) had union between 3 to 6 months irrespective of fixation type with no significant statistical difference between the union rate of DCP and LIMN (p value 0.06) with similar functional outcome and complication rates irrespective of the type of fixation. Conclusion: This study showed that the success rates in term of fracture union, outcome functional grades and complication rates were not directly dependent on the types of the fixation: plating or locked intra-medullary nailing.展开更多
BACKGROUND The traditional Gamma3 nail is a mainstream treatment for femoral intertrochanteric fractures.Literature reports that the Gamma3U-blade system can increase the stability of the Gamma3 nail and reduce compli...BACKGROUND The traditional Gamma3 nail is a mainstream treatment for femoral intertrochanteric fractures.Literature reports that the Gamma3U-blade system can increase the stability of the Gamma3 nail and reduce complication incidence.However,comparative studies between the Gamma3U-blade and Gamma3 systems are limited;hence,this meta-analysis was performed to explore the clinical efficacy of these two surgical methods.AIM To investigate the clinical efficacy of Gamma3 and Gamma3 U-blade for intertrochanteric fractures.METHODS A computerized search for Chinese and English literature published from 2010 to 2022 was conducted in PubMed,Cochrane,CNKI,Wanfang,and VIP databases.The search keywords were gamma 3,gamma 3 U blade,and intertrochanteric fracture.Additionally,literature tracking was performed on the references of published literature.The data were analyzed using Revman 5.3 software.Two individuals checked the inputs for accuracy.Continuous variables were described using mean difference and standard deviation,and outcome effect sizes were expressed using ratio OR and 95%confidence interval(CI).High heterogeneity was considered at(P<0.05,I2>50%),moderate heterogeneity at I2 from 25%to 50%,and low heterogeneity at(P≥0.05,I2<50%).RESULTS Following a comprehensive literature search,review,and analysis,six articles were selected for inclusion in this study.This selection comprised five articles in English and one in Chinese,with publication years spanning from 2016 to 2022.The study with the largest sample size,conducted by Seungbae in 2021,included a total of 304 cases.Statistical analysis:A total of 1063 patients were included in this meta-analysis.The main outcome indicators were:Surgical time:The Gamma3U blade system had a longer surgical time compared to Gamma3 nails(P=0.006,I2=76%).Tip-apex distance:No statistical significance or heterogeneity was observed(P=0.65,I2=0%).Harris Hip score:No statistical significance was found,and low heterogeneity was detected(P=0.26,I2=22%).Union time:No statistical significance was found,and high heterogeneity was detected(P=0.05,I2=75%).CONCLUSION Our study indicated that the Gamma3 system reduces operative time compared to the Gamma3 U-blade system in treating intertrochanteric fractures.Both surgical methods proved to be safe and effective for this patient group.These findings may offer valuable insights and guidance for future surgical protocols in hip fracture patients.展开更多
Treatment of reverse oblique trochanteric femoral fractures poses a lot of challenges. There have been proponents of intramedullary devices as well as extramedullary devices. We present the results of proximal femoral...Treatment of reverse oblique trochanteric femoral fractures poses a lot of challenges. There have been proponents of intramedullary devices as well as extramedullary devices. We present the results of proximal femoral nailing surgery performed for reverse obliquity intertrochanteric fractures using two proximal lag screws and a nail of 250 mm. There is prospective study of fifty three patients with AO/OTA 31 A-A3 fractures being treated by proximal femoral nailing in our institute after seeking approval from the Hospital ethics board. The quality of the reduction, the operative time, complications and the functional status of the patients were the parameters on which the results were evaluated. The mean Harris hip score was 76.66 (range 70 - 93) and the mean Barthel activity score was 16.21 (range 12 - 20). The average surgical time was 50 minutes and the mean consolidation time was 11.5 weeks. Intramedullary nailing with proximal femoral nails seems to be a good option in the treatment of reverse obliquity intertrochanteric fractures as against the various existing options available for the management.展开更多
Nail connection is widely used in engineering and construction fields.In this study,bamboo nail was proposed as a novel connector for timber assemblies.Penetration depth of bamboo nail into wood was predicted and test...Nail connection is widely used in engineering and construction fields.In this study,bamboo nail was proposed as a novel connector for timber assemblies.Penetration depth of bamboo nail into wood was predicted and tested.The influence of nail parameters(length,radius and ogive radius)on penetration depth were verified.For both tested and predicted results,the penetration depth of bamboo nail increased with the increasing length,radius or ogive radius.In addition,the effect of densification on penetration depth or mechanical properties was evaluated.1.12 g/cm^(3) was a critical density when densification was needed,and further increment of density would decrease the penetration depth of nail.The results of this study manifests that the proposed model is capable to predict the penetration depth of bamboo nail.These findings may provide new insight into efficiently utilization of bamboo resources.展开更多
BACKGROUND There are few studies in the literature comparing the clinical outcomes and radiographic results of proximal femoral nail(PFN)and proximal femoral nail antirotation(PFNA)for pertrochanteric femoral fracture...BACKGROUND There are few studies in the literature comparing the clinical outcomes and radiographic results of proximal femoral nail(PFN)and proximal femoral nail antirotation(PFNA)for pertrochanteric femoral fracture(PFF)in elderly patients.AIM To evaluate both clinical and radiographic outcomes after fixation with PFN and PFNA in an elderly patient population.METHODS One hundred fifty-eight patients older than 65 years with PFF who underwent fixation with either PFN or PFNA were included.Seventy-three patients underwent fixation with PFN,whereas 85 were fixed with PFNA.The mean follow-up was 2.4 years(range,1-7 years).Clinical outcome was measured in terms of operation time,postoperative function at each follow-up visit,and mortality within one year.Radiographic evaluation included reduction quality after surgery,Cleveland Index,tip-apex distance(TAD),union rate,time to union,and sliding distance of the screw or blade.Complications including nonunion,screw cutout,infection,osteonecrosis of the femoral head,and implant breakage were also investigated.RESULTS Postoperative function was more satisfactory in patients who underwent PFNA than in those who underwent PFN(P=0.033).Radiologically,the sliding difference was greater in PFN than in PFNA patients(6.1 and 3.2 mm,respectively,P=0.036).The rate of screw cutout was higher in the PFN group;eight for PFN(11.0%)and two for PFNA patients(2.4%,P=0.027).There were no differences between the two groups in terms of operation time,mortality rate at one year after the operation,adequacy of reduction,Cleveland Index,TAD,union rate,time to union,nonunion,infection,osteonecrosis,or implant breakage.CONCLUSION Elderly patients with PFF who underwent PFNA using a helical blade demonstrated better clinical and radiographic outcomes as measured by clinical score and sliding distance compared with patients who underwent PFN.展开更多
Treatment of fragility fractures of the distal tibia in the elderly is demanding because of osteopenic bone quality, the delicate soft tissue cuff and </span></span></span></span><span style...Treatment of fragility fractures of the distal tibia in the elderly is demanding because of osteopenic bone quality, the delicate soft tissue cuff and </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">frequent</span></span></span></span></span><span><span><span><span><span style="font-family:""><span style="font-family:Verdana;"> crit</span><span style="font-family:Verdana;">ical circulation. We report the case of two-level tibial pseudarthroses in an</span><span style="font-family:Verdana;"> 83</span></span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">- </span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">year</span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span></span></span><span><span><span><span><span style="font-family:""><span style="font-family:Verdana;">old woman caused by multiple myeloma successfully stabilized by a long </span><span style="font-family:Verdana;">ankle arthrodesis nail combined with locking compression plate</span> <span style="font-family:Verdana;">osteosynthesis. This case is unique</span></span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> as to our best knowledge</span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> herein</span></span></span></span></span><span><span><span><span><span style="font-family:""><span style="font-family:Verdana;"> diaphyseal fractures were </span><span style="font-family:Verdana;">treated for the first time using a technique reported hitherto primarily for</span><span style="font-family:Verdana;"> fragility ankle and pilon fractures.展开更多
Secondary fractures around femoral nails placed for the management of hip fractures are well known. We report, two cases of a fracture of the femur at the interlocking screw site in the subtrochanteric area after retr...Secondary fractures around femoral nails placed for the management of hip fractures are well known. We report, two cases of a fracture of the femur at the interlocking screw site in the subtrochanteric area after retrograde femoral nailing of a femoral shaft fracture. Only a few reports in the existing literature have described these fractures. Two young men after sustaining a fall presented to us with pain, swelling and deformity in the upper thigh region. On enquiring, examining and radiographing them, peri-implant fractures of subtrochanteric nature through the distal interlocking screws were revealed in both patients who also had histories of previous falls for which retrograde intramedullary nailing was performed for their respective femora. Both patients were managed with similar surgical routines including removal of the existing hardware, open reduction and ace cephallomedullary antegrade nailing. The second case did show evidence of delayed healing and was additionally stabilized with cerclage wires. Both patients had uneventful postoperative outcomes and union was evident at the end of 6 mo postoperatively with a good range of motion at the hip and knee. Our report suggests that though seldom reported, peri-implant fractures around the subtrochanteric region can occur and pose a challenge to the treating orthopaedic surgeon. We suggest these be managed, after initial stabilization and resuscitation, by implant removal, open reduction and interlocking intramedullary antegrade nailing. Good results and progression to union can be expected in these patients by adhering to basic principles of osteosynthesis.展开更多
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.
文摘Background of the Study: Femoral shaft fracture is the most common pediatric injury requiring hospitalization. For children less than 5 years old, non-surgical approach is recommended. For pediatric patients 5 - 14 years old, the most common mode of treatment is flexible intramedullary nailing with a known complication of pain at post-op site, inflammatory reaction/bursitis at the entry site, superficial and deep infection, knee synovitis, knee stiffness, leg length discrepancy, proximal nail migration, angulation or malunion, delayed and non-union, implant breakage. This study aims to present a rare complication of a femoral fracture fixed with flexible intramedullary nail. Methodology: We report the outcome of a 12-year-old male with peri implant fracture of the left femur. He underwent removal of plates and screws and subsequently fixed with flexible intramedullary nails. Patient was followed up at 1, 3, 7, and 10 months post-operatively. Varus-valgus, sagittal angulation, and limb shortening were measured pre- and post-operatively. Complications were recorded on each visit. Results: Pre-operative varus angulation was 10˚, pro-curvatum of 55˚ with limb shortening of 4 cm. Postoperatively, varus was maintained to 10˚ but pro-curvatum was corrected to 4˚ and limb shortening was reduced to 1 cm. However, after 1 month the varus angulation increased to 30˚ while maintaining sagittal pro-curvatum. Limb shortening also increased to 2 cm. New bone formation started to appear along the mechanical axis of the left femur which is apparent at 3 months post-op and pro-curvatum increased to 20˚. At 7 and 10 months post-op no signs of union was noted at the fracture site but the callus formation along the mechanical axis gradually matured and appeared as a new femoral shaft. Conclusion: Formation of new bone in response to unstable flexible intramedullary fixation in pediatric femoral shaft fracture is a very rare complication.
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.
基金supported by the International Institute of Earthquake Engineering and Seismology(IIEES) as technical project No.760
文摘The primary goal of this study is to provide an efficient numerical tool to analyze the seismic performance of nailed walls.Modeling such excavation supports involves complexities due partly to the interaction of support with soil and partly because of the amplification of seismic waves through an excavation wall.Consequently,innovative modeling is suggested herein,incorporating the calibration of the soil constitutive model in a targeted range of stress and strain,and the detection of a natural period of complex systems,including soil and structure,while benefiting from Rayleigh damping to filter unwanted noises.The numerical model was achieved by simulating a previous centrifuge test of the excavation wall,manifested at the pre-failure state.Notably,the calibration of the soil constitutive model through empirical relations,which replaces the numerical reproduction of an element test,more accurately simulated the soil-nail-wall interaction.Two factors were crucial to a successful result.First,probing the natural period of the complicated geometry of the model by applying white noises.Second,considering Rayleigh damping to withdraw unwanted noises and thus assess their permanent effects on the model.Rayleigh damping was applied instead of filtering the obtained results.
基金the Faraday Institution’s SafeBatt(https://www.safebatt.ac.uk/)project[grant numbers:EP/S003053/1,FIRG061]DSIT and the Royal Academy of Engineering,under the Chair in Emerging Technologies Scheme(CiET1718/59)。
文摘Thermal runaway(TR)in lithium-ion batteries(LIBs)involves a complicated multiphysics process with potentially catastrophic consequences,highlighting the importance of investigating effective prevention strategies.This study employs a lumped model integrating electrochemical and decomposition reaction kinetics to predict the evolution of the TR of LIBs triggered by axial nail penetration,validated by experimental tests.A computational fluid dynamics(CFD)-based turbulent flow model is further employed to simulate the thermal runaway propagation(TRP)behavior induced by high-temperature gases within the battery module.A parameterized analysis based on numerical simulation is conducted to quantify the impact of thermal insulation material properties on thermal diffusion and heat accumulation within the module.The results indicate that damage to the battery vent significantly increases the risk of sidewall rupture during TR.The incorporation of thermal barriers is essential in the thermal design of battery modules to prevent heat transfer via convection from the thermal exhaust caused by sidewall rupture to adjacent cells.In addition,a reduction in the thermal diffusivity of the thermal barrier material is required to minimize thermal exchange between battery cells.By adopting insulating materials with thermal diffusivity lower than 0.3 mm^(2)/s,the TRP of batteries can be mitigated under non-enclosed conditions.These findings contribute to improved battery safety and inform the development of more effective thermal protection measures and safety standards.
文摘BACKGROUND Unstable intertrochanteric fractures in elderly patients require effective surgical management,with both cementless bipolar hemiarthroplasty(CBHA)and proximal femoral nail anti-rotation(PFNA)being valid treatment options to reduce morbidity and mortality.AIM To evaluate and compare the outcomes of CBHA and PFNA in treatment of unstable intertrochanteric fractures.METHODS A comprehensive search was conducted to identify relevant studies discussing the outcomes of using both CBH and PFNA in treatment of unstable intertrochanteric fractures.Studies published up to January 1,2025 were searched across multiple databases,including PubMed,EMBASE,Scopus,Web of Science,Cochrane Library,and Google Scholar.Full texts of the selected articles were retrieved,reviewed,and independently assessed by the investigators.Discrepancies were resolved by consensus,with any remaining disagreements being arbitrated by a third author.RESULTS This meta-analysis included three studies,all of which were retrospective,involving a total of 240 patients.The follow-up period for participants was at least 12 months.CBHA was associated with significantly higher blood loss compared to PFNA[mean differences(MD):129.14,95%CI(52.51,205.77),P=0.001],though heterogeneity was high(I²=97%).Operative time showed no significant difference initially[MD:6.10,95%CI(-13.34,25.54),P=0.54],but after excluding one study,BHA had longer operative times[MD:21.51,95%CI(18.60,24.41),P<0.00001].Hospital stay and Harris scores showed no significant differences between groups.CBHA facilitated faster progression to weight-bearing[MD:-11.92,95%CI(-22.46,-1.39),P=0.03]and a lower incidence of prosthetic loosening[risk ratio:0.21,95%CI(0.05,0.92),P=0.04].Refracture and thrombus formation rates were comparable between the two groups.CONCLUSION CBHA offers shorter weight-bearing duration and reduced prosthetic loosening but incurs greater blood loss and longer operative times compared to PFNA.Both techniques show comparable functional recovery,hospital stay,refracture,and thrombus risks.Clinical choice should prioritize early mobilization or surgical minimalism,guided by patient needs.Further prospective studies are warranted.
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 a research grant from the Hoyu Science Foundation in 2023.
文摘This study examined the positive changes that water-based nail treatments can bring to emotions and behavior in children who do not attend school and use a place for school-refusing children.Children who do not attend school and use a place for school-refusing children were given water-based nail treatments about once a week for three months.In addition,the parents of these children were asked to respond to questions about their children’s daily activities.The results showed that natural communication through nail treatments significantly increased positive emotions.However,continued nail treatments did not reduce the children’s problem behaviors.Some children returned to school,while others continued not attending school.Increased frequency of visits and number of treatments confirmed the promotion of communication.It was suggested that building positive relationships with family and supporters is important for achieving sustained effects from nail treatments.This study showed that nail treatments are a useful tool for promoting positive emotions,self-acceptance,and social skills,and may contribute to the emotional growth and social interest of children who do not attend school.
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.
文摘BACKGROUND Among the most frequent hip fractures are trochanteric fractures,which usually occur from low-energy trauma like minor falls,especially in older people with osteoporotic bones.AIM To evaluate the treatment efficacy of dynamic condylar screws(DCS)and proximal femoral nails(PFN)for unstable intertrochanteric fractures.METHODS To find pertinent randomized controlled trials and retrospective observational studies comparing PFN with DCS for the management of unstable femoral intertrochanteric fractures,a thorough search was carried out.For research studies published between January 1996 and April 2024,PubMed,EMBASE,Scopus,Web of Science,Cochrane Library,and Google Scholar were all searched.The complete texts of the papers were retrieved,vetted,and independently examined by two investigators.Disputes were settled by consensus,and any disagreements that persisted were arbitrated by a third author.RESULTS This study included six articles,comprising a total of 173 patients.Compared to the DCS,the PFN had a shorter operation time[mean difference(MD):-41.7 min,95%confidence interval(95%CI):-63.04 to-20.35,P=0.0001],higher success rates with closed reduction techniques[risk ratio(RR):34.05,95%CI:11.12-104.31,P<0.00001],and required less intraoperative blood transfusion(MD:-1.4 units,95%CI:-1.80 to-1.00,P<0.00001).Additionally,the PFN showed shorter fracture union time(MD:-6.92 wk,95%CI:-10.27 to-3.57,P<0.0001)and a lower incidence of reoperation(RR:0.37,95%CI:0.17-0.82,P=0.01).However,there was no discernible variation regarding hospital stay,implant-related complications,and infections.CONCLUSION Compared to DCS,PFN offers shorter operative times,reduces the blood transfusions requirements,achieves higher closed reduction success,enables faster fracture healing,and lowers reoperation incidence.
文摘In this editorial,I present my comments on the article by Solarino et al.Conversion hip arthroplasty,which is an optional salvage procedure performed following unsuccessful fixation of intertrochanteric femur fractures in elderly pati-ents,entails more complex processes and higher rates of operative complications than primary arthroplasty.Hence,it is important to consider the appropriateness of the primary treatment choice,as well as the adequacy of nailing fixation for intertrochanteric fractures.This article briefly analyzes the possible factors contributing to the nailing failure of intertrochanteric fractures and attempts to find corresponding countermeasures to prevent fixation failures.It also analyzes the choice of treatment between nailing fixation and primary arthroplasty for intertrochanteric fractures.
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.
基金supported by the National Natural Science Foundation of China(32130052,82072447,and 82272578)the Fundamental Research Funds for the Central Universities,Nankai University(730-C02922112 and 730-DK2300010314).
文摘With the aging population,intertrochanteric femur fracture in the elderly has become one of the most serious public health issues and a hot topic of research in trauma orthopedics.Due to the limitations of internal fixation techniques and the insufficient mechanical design of nails,the occurrence of complications delays patient recovery after surgical treatment.Design of a proximal femur bionic nail(PFBN)based on Zhang’s N triangle theory provides triangular supporting fixation,which dramatically decreases the occurrence of complications and has been widely used for clinical treatment of unstable intertrochanteric femur fracture worldwide.In this work,we developed an equivalent biomechanical model to analyze improvement in bone remodeling of unstable intertrochanteric femur fracture through PFBN use.The results show that compared with proximal femoral nail antirotation(PFNA)and InterTan,PFBN can dramatically decrease the maximum strain in the proximal femur.Based on Frost’s mechanostat theory,the local mechanical environment in the proximal femur can be regulated into the medium overload region by using a PFBN,which may render the proximal femur in a state of physiological overload,favoring post-operative recovery of intertrochanteric femur fracture in the elderly.This work shows that PFBN may constitute a panacea for unstable intertrochanteric femur fracture and provides insights into improving methods of internal fixation.
文摘Background: Fractures of humeral shaft in adults are common injuries. Humeral shafts non-union either from late presentation after initial treatment by traditional bone setters or failed non-operative orthodox care is a major problem in this part of the world. This non-union is a major treatment challenge with increased cost of care and morbidity in this part of the world. Humeral shaft non-union can be treated with locked intra-medullary nailing (LIMN) or dynamic compression plating (DCP). Study on comparison of these methods of fixation in this part of the world is scarce in literature search, hence the reason for this study. Objective: The objectives of this study are: (1) to compare early clinical outcome following fixation of humeral shaft fracture nonunion with DCP versus LIMN;(2) to compare the time of radiologic fracture union of DCP with LIMN;(3) to compare complications following fixation of humeral shaft fracture nonunion with DCP versus LIMN. Patients and Methods: This was a randomized control study done for 2 years in which fifty adult patients with humeral shaft non-union were recruited. The patients were grouped into 2 (P = DCP & N = LIMN). Forty five of the patients completed the follow up periods of the study and then analyzed. The P group had ORIF with DCP while the N group had ORIF with LIMN. Both groups had grafting with cancellous bones. Each patient was followed up for a period of 6 months at the time which radiographic union is expected. Any patient without clinical and/or radiographic evidence of union after six months of surgery was diagnosed as having recurrent non-union. The data generated was analyzed using SPSS Version 23. The results were presented in charts and tables. The paired t-test was used while considering p value Result: Forty five patients completed follow up. There was a male preponderance (4:1), right humerus predominated (3:2). Motor vehicular accidents were the commonest cause of the fractures (62%). Most non-union fractures occurred at the level of the middle 3<sup>rd</sup> of the humeral shaft (60%). Failed TBS treatment was the commonest indication for the osteosynthesis (71%). More patients had plating (53%) compared to 47% who had LIMN. Most patients (93.4%) had union between 3 to 6 months irrespective of fixation type with no significant statistical difference between the union rate of DCP and LIMN (p value 0.06) with similar functional outcome and complication rates irrespective of the type of fixation. Conclusion: This study showed that the success rates in term of fracture union, outcome functional grades and complication rates were not directly dependent on the types of the fixation: plating or locked intra-medullary nailing.
基金Supported by The Clinical Medical Science and Technology Development Fund Project of Jiangsu University,No.JLY2021185.
文摘BACKGROUND The traditional Gamma3 nail is a mainstream treatment for femoral intertrochanteric fractures.Literature reports that the Gamma3U-blade system can increase the stability of the Gamma3 nail and reduce complication incidence.However,comparative studies between the Gamma3U-blade and Gamma3 systems are limited;hence,this meta-analysis was performed to explore the clinical efficacy of these two surgical methods.AIM To investigate the clinical efficacy of Gamma3 and Gamma3 U-blade for intertrochanteric fractures.METHODS A computerized search for Chinese and English literature published from 2010 to 2022 was conducted in PubMed,Cochrane,CNKI,Wanfang,and VIP databases.The search keywords were gamma 3,gamma 3 U blade,and intertrochanteric fracture.Additionally,literature tracking was performed on the references of published literature.The data were analyzed using Revman 5.3 software.Two individuals checked the inputs for accuracy.Continuous variables were described using mean difference and standard deviation,and outcome effect sizes were expressed using ratio OR and 95%confidence interval(CI).High heterogeneity was considered at(P<0.05,I2>50%),moderate heterogeneity at I2 from 25%to 50%,and low heterogeneity at(P≥0.05,I2<50%).RESULTS Following a comprehensive literature search,review,and analysis,six articles were selected for inclusion in this study.This selection comprised five articles in English and one in Chinese,with publication years spanning from 2016 to 2022.The study with the largest sample size,conducted by Seungbae in 2021,included a total of 304 cases.Statistical analysis:A total of 1063 patients were included in this meta-analysis.The main outcome indicators were:Surgical time:The Gamma3U blade system had a longer surgical time compared to Gamma3 nails(P=0.006,I2=76%).Tip-apex distance:No statistical significance or heterogeneity was observed(P=0.65,I2=0%).Harris Hip score:No statistical significance was found,and low heterogeneity was detected(P=0.26,I2=22%).Union time:No statistical significance was found,and high heterogeneity was detected(P=0.05,I2=75%).CONCLUSION Our study indicated that the Gamma3 system reduces operative time compared to the Gamma3 U-blade system in treating intertrochanteric fractures.Both surgical methods proved to be safe and effective for this patient group.These findings may offer valuable insights and guidance for future surgical protocols in hip fracture patients.
文摘Treatment of reverse oblique trochanteric femoral fractures poses a lot of challenges. There have been proponents of intramedullary devices as well as extramedullary devices. We present the results of proximal femoral nailing surgery performed for reverse obliquity intertrochanteric fractures using two proximal lag screws and a nail of 250 mm. There is prospective study of fifty three patients with AO/OTA 31 A-A3 fractures being treated by proximal femoral nailing in our institute after seeking approval from the Hospital ethics board. The quality of the reduction, the operative time, complications and the functional status of the patients were the parameters on which the results were evaluated. The mean Harris hip score was 76.66 (range 70 - 93) and the mean Barthel activity score was 16.21 (range 12 - 20). The average surgical time was 50 minutes and the mean consolidation time was 11.5 weeks. Intramedullary nailing with proximal femoral nails seems to be a good option in the treatment of reverse obliquity intertrochanteric fractures as against the various existing options available for the management.
基金This work was financially supported by the National Natural Science Foundation of China(No.32071700).
文摘Nail connection is widely used in engineering and construction fields.In this study,bamboo nail was proposed as a novel connector for timber assemblies.Penetration depth of bamboo nail into wood was predicted and tested.The influence of nail parameters(length,radius and ogive radius)on penetration depth were verified.For both tested and predicted results,the penetration depth of bamboo nail increased with the increasing length,radius or ogive radius.In addition,the effect of densification on penetration depth or mechanical properties was evaluated.1.12 g/cm^(3) was a critical density when densification was needed,and further increment of density would decrease the penetration depth of nail.The results of this study manifests that the proposed model is capable to predict the penetration depth of bamboo nail.These findings may provide new insight into efficiently utilization of bamboo resources.
文摘BACKGROUND There are few studies in the literature comparing the clinical outcomes and radiographic results of proximal femoral nail(PFN)and proximal femoral nail antirotation(PFNA)for pertrochanteric femoral fracture(PFF)in elderly patients.AIM To evaluate both clinical and radiographic outcomes after fixation with PFN and PFNA in an elderly patient population.METHODS One hundred fifty-eight patients older than 65 years with PFF who underwent fixation with either PFN or PFNA were included.Seventy-three patients underwent fixation with PFN,whereas 85 were fixed with PFNA.The mean follow-up was 2.4 years(range,1-7 years).Clinical outcome was measured in terms of operation time,postoperative function at each follow-up visit,and mortality within one year.Radiographic evaluation included reduction quality after surgery,Cleveland Index,tip-apex distance(TAD),union rate,time to union,and sliding distance of the screw or blade.Complications including nonunion,screw cutout,infection,osteonecrosis of the femoral head,and implant breakage were also investigated.RESULTS Postoperative function was more satisfactory in patients who underwent PFNA than in those who underwent PFN(P=0.033).Radiologically,the sliding difference was greater in PFN than in PFNA patients(6.1 and 3.2 mm,respectively,P=0.036).The rate of screw cutout was higher in the PFN group;eight for PFN(11.0%)and two for PFNA patients(2.4%,P=0.027).There were no differences between the two groups in terms of operation time,mortality rate at one year after the operation,adequacy of reduction,Cleveland Index,TAD,union rate,time to union,nonunion,infection,osteonecrosis,or implant breakage.CONCLUSION Elderly patients with PFF who underwent PFNA using a helical blade demonstrated better clinical and radiographic outcomes as measured by clinical score and sliding distance compared with patients who underwent PFN.
文摘Treatment of fragility fractures of the distal tibia in the elderly is demanding because of osteopenic bone quality, the delicate soft tissue cuff and </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">frequent</span></span></span></span></span><span><span><span><span><span style="font-family:""><span style="font-family:Verdana;"> crit</span><span style="font-family:Verdana;">ical circulation. We report the case of two-level tibial pseudarthroses in an</span><span style="font-family:Verdana;"> 83</span></span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">- </span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">year</span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span></span></span><span><span><span><span><span style="font-family:""><span style="font-family:Verdana;">old woman caused by multiple myeloma successfully stabilized by a long </span><span style="font-family:Verdana;">ankle arthrodesis nail combined with locking compression plate</span> <span style="font-family:Verdana;">osteosynthesis. This case is unique</span></span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> as to our best knowledge</span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> herein</span></span></span></span></span><span><span><span><span><span style="font-family:""><span style="font-family:Verdana;"> diaphyseal fractures were </span><span style="font-family:Verdana;">treated for the first time using a technique reported hitherto primarily for</span><span style="font-family:Verdana;"> fragility ankle and pilon fractures.
文摘Secondary fractures around femoral nails placed for the management of hip fractures are well known. We report, two cases of a fracture of the femur at the interlocking screw site in the subtrochanteric area after retrograde femoral nailing of a femoral shaft fracture. Only a few reports in the existing literature have described these fractures. Two young men after sustaining a fall presented to us with pain, swelling and deformity in the upper thigh region. On enquiring, examining and radiographing them, peri-implant fractures of subtrochanteric nature through the distal interlocking screws were revealed in both patients who also had histories of previous falls for which retrograde intramedullary nailing was performed for their respective femora. Both patients were managed with similar surgical routines including removal of the existing hardware, open reduction and ace cephallomedullary antegrade nailing. The second case did show evidence of delayed healing and was additionally stabilized with cerclage wires. Both patients had uneventful postoperative outcomes and union was evident at the end of 6 mo postoperatively with a good range of motion at the hip and knee. Our report suggests that though seldom reported, peri-implant fractures around the subtrochanteric region can occur and pose a challenge to the treating orthopaedic surgeon. We suggest these be managed, after initial stabilization and resuscitation, by implant removal, open reduction and interlocking intramedullary antegrade nailing. Good results and progression to union can be expected in these patients by adhering to basic principles of osteosynthesis.
