Clinical Effectiveness of the Plate Screw Internal Fixation Technique in the Treatment of Patients with Traumatic Fractures of Long Bones in the Lower Extremities

Objective: To investigate the effectiveness of the plate screw internal fixation technique on the clinical outcomes of patients with traumatic fractures of long bones in the lower extremities. Methods: From January 2022 to December 2023, 70 patients with traumatic fractures of long bones in the lower extremities were admitted to the hospital and randomly divided into two groups: the control group and the observation group, each consisting of 35 cases. The control group underwent traditional closed interlocking intramedullary nailing, while the observation group received internal fixation with steel plates and screws. Relevant surgical indicators, treatment effectiveness, and postoperative complication rates were compared between the two groups. Results: The observation group exhibited significantly short surgical duration (80.65 ± 5.01 vs. 88.36 ± 5.26 minutes), fracture healing time (13.27 ± 0.32 vs. 15.52 ± 0.48 weeks), and hospitalization days (10.49 ± 1.13 vs. 16.57 ± 1.15 days) compared to the control group (P = 0.000). The effective treatment rate was significantly higher in the observation group (29/82.86%) than in the control group (21/60.00%), with a significant difference observed (χ2 = 4.480, P = 0.034). Additionally, the complication rate in the observation group (2/5.71%) was significantly lower than that in the control group (8/22.86%), with a correlated difference (χ2 = 4.200, P = 0.040). Conclusion: The plate screw internal fixation technique demonstrates significant clinical efficacy in treating traumatic fractures of long bones in the lower extremities. It improves the healing rate, reduces complications, and represents a safe and effective treatment strategy worthy of widespread use and application.

Clinical Outcome of Internal Fixation and Fusion in the Treatment of Spinal Fractures by Paraspinal Muscular Space Approach

Objective:To explore the clinical effect of internal fixation and fusion with the paraspinal muscle gap approach in the treatment of spinal fracture patients.Methods:104 spinal fracture patients admitted to Central Hospital of TCM from October 2022 to April 2024 were selected as the study subjects and were randomly divided into the control group(n=52)and the observation group(n=52)according to the random number table method.The control group was treated with the conventional approach of internal fixation surgery,and the observation group was treated with the paraspinal muscular interspace approach of internal fixation fusion.The two groups’general data,surgical indexes,pain,lumbar spine function,and postoperative complications were observed.Results:The baseline data of the two groups of patients were not statistically significant(all P>0.05)while the intraoperative bleeding,the first postoperative time getting up from bed,and the length of hospital stay of the patients in the observation group were shorter than that of the control group(all P=0.000<0.001),and the duration of the operation was longer than that of the control group(t=2.644,P=0.010<0.05);at 3 months postoperatively,the VAS scores of the patients in the observation group were significantly lower than those in the control group(t=10.768,P=0.000<0.001),and the JOA score was higher than that of the control group(t=6.498,P=0.000<0.001);the total complication rate of patients in the observation group(3/5.77%)was significantly lower than that of the control group(12/23.08%)(χ^(2)=6.310,P=0.012<0.05).Conclusion:In the treatment of spinal fracture patients,compared with the conventional approach to internal fixation surgery,the paraspinal muscular gap approach to internal fixation and fusion treatment is less traumatic,postoperative lumbar spine function recovery is faster,and can reduce the incidence of postoperative complications.

Effect of external and internal cues on core muscle activation during the Sahrmann five-level core stability test

BACKGROUND Pain in the back or pelvis or fear of back pain may affect the timing or cocontraction of the core muscles.In both static and dynamic movements,the Sahrmann core stability test provides an assessment of core muscle activation and a person's ability to stabilize the lumbopelvic complex.Preparatory cues and images can be used to increase the activation of these muscles.To attain optimal movement patterns,it will be necessary to determine what cueing will give the most effective results for core stability.AIM To investigate the effects of external and internal cues on core muscle activation during the Sahrmann five-level core stability test.METHODS Total 68 participants(21.83±3.47 years)were randomly allocated to an external(n=35)or internal cue group(n=33).Participants performed the Sahrmann fivelevel core stability test without a cue as baseline and the five-level stability exercises with an internal or external cue.External cue group received a pressure biofeedback unit(PBU),and the internal cue group received an audio cue.A Delsys Trigno^(TM)surface electromyography unit was used for muscle activation from the rectus abdominis,external oblique,and transverse abdominis/internal oblique muscles.RESULTS Linear mixed effects model analysis showed that cueing had a significant effect on core muscle activation(P=0.001);however,there was no significant difference between cue types(internal or external)(P=0.130).CONCLUSION Both external and internal cueing have significant effects on core muscle activation during the Sahrmann five-level core stability test and the PBU does not create higher muscle activation than internal cueing.

Application of internal fixation of steel-wire limited loop in early Achilles tendon rupture

Objective:To explore the clinical effect and safety of internal fixation of steel-wire limited loop in early Achilles tendon rupture.Methods:Seventy-six patients respectively with early transected and avulsed types of Achilles tendon rupture were selected and treated with internal fixation of steel-wire limited loop.The patients began to take exercise for their lower limbs through continous passive motion as early as possible after surgical repair,and the loops were removed after 3-5 months.Six months later,the condition of complications including Achilles tendon re-rupture,wound fistula,wound infection and skin necrosis,cutaneous sensation in sural nerve dominance region,time back to preinjury work or learning as well as time to physical activities were observed.One year later,the therapeutic effect was evaluated,and the maximum circumferences of bilateral legs and raptured plane circumferences of Achilles tendon were measured.Results:The wound of all patients healed well,no complications like Achilles tendon re-rupture,wound fistula,wound infection and skin necrosis occured,and the cutaneous sensation in sural nerve dominance region was normal.The mean time back to preinjury work or learning as well as to pysical activities of all patients were respectively 10 and 22 weeks.Seventy out of 76 patients(92.1%) achieved an excellent effect,and 6(7.9%) good effect.The excellent and good rate came up to 100%.The maximum circumference in the affected leg decreased to 2 mm averagely compared with the offside,while the ruptured plane circumferences of Achilles tendon in the affected side increased to 2.2 mm compared with the offside.Conclusions:Kor early Achilles tendon rupture,internal fixation of steel-wire limited loop can recover the ankle function better,return to the preinjury state in the shortest lime,and has few complications.

Open reduction and internal fixation for radial head fractures: A prospective observational study

Objective: To evaluate the effect of open reduction and internal fixation on radial head fracture and assess the post-operative function. Methods: This prospective observational study was conducted from June 2016 to July 2017 at Liaquat National Hospital and Medical College, Karachi. Altogether, 28 patients with radial head and neck fractures were enrolled in our study. These patients were admitted to the hospital and their fractures were fixed with open reduction and internal fixation. Baseline information of the patients was collected, and patient-rated elbow evaluation scores were calculated. Results: Out of the 28 patients, 21 were male and 7 were female. Besides, 16 fractures were on the right side and 12 were on the left side and 17 involving the dominant hands. In addition, 8 patients had Mason type Ⅱ fracture and 20 had Mason type Ⅲ fracture. The mean age of patients was (31.0 ± 8.0) years, and the mean follow-up is (1.2 ± 0.5) years. The mean average patient-rated elbow evaluation scores were (27.64 ± 1.60) at 1-year follow-up. Conclusions:The majority of the patients who had radial head fractures and treated by open reduction and internal fixation have attained an excellent range of motion postoperatively.

Comparative study of various internal fixation methods for treating patellar fractures by three-dimensional photoelasticity

Objective: To compare the biomechanical basis of 3 different internal fixation methods: nitinol patellar concentrator (NT-PC), tension band and wire circle in treating patellar fractures. Methods: The epoxy resin three dimensional photoelasticity patellar models were made by precise moulding, and were fixated by nitinol patellar concentrator (NT-PC), tension band and wire circle respectively. The patellar models with frozen stress stripes were put into the polarized light field and the stress distributions were compared. As for the model fixated by NT-PC, by dividing layer, photographing and tracing, we used the iterative method to calculate the stress value of every internal node of the epoxy resin patellar model, and the character of stress was analyzed. Results: An overall stress field was yielded when the patellar model was fixated by NT-PC, and the stripes were more than that of tension band model and wire circle model, which have only few stress stripes in the fixated layers. Further analysis indicated that there were continuous fixated stresses in the facies articularis and distal pole of patella, and the character of stresses produced by NT-PC were mainly in longitudinal direction, then in transverse direction. The shearing stresses were small. Conclusion: The initiative and continuous memorial stress of NT-PC and its overall stress distribution character are the essence of NT-PC distinguished with tension band and wire circle in treating patellar fractures. The stress character produced by NT-PC is good for the stability of fracture site and prompts fracture healing.

The Use of Calcaneal Anatomic Plate in Arthroscopically-assisted Open Reduction and Internal Fixation of Intra-articular Calcaneal Fractures

To discuss and evaluate the method and effect of using calcaneal anatomic plate in treatment of intra-articular fractures of the calcaneus with assistant of arthroscope, 86 intra-articular fractures of the calcaneus in 78 patients were reduced by open reduction, and rigid fixation was made with calcaneal anatomic plate under assistant of arthroscope. The average follow-up duration was 18 months （range 12-30 months）. The effect of treatment was evaluated according to AOFAS and X-ray before and after operation. The results showed that 86 patients have obtained satisfactory reduction according to X-ray, and there was significant difference before and after operation （P〈0. 01）, the total excellent and fine rate was 91.86%. Treating intra-articular fractures of the calcaneus with calcaneal anatomic plate under arthroscope may provide more chance to achieve anatomical reconstruction, which can lead to satisfied recovery of function and few complication.

Functional Outcomes of Traumatic Complex Acetabulum Fractures with Open Reduction and Internal Fixation: 200 Cases

Objective: Acetabular fractures are common injuries in Iran. We assess the functional outcome of open reduction and internal fixation management of displaced Complex acetabular fractures. Materials and Methods: We analyzed a case series of patients with open reduction and internal fixation (ORIF) for complex acetabular fractures. Two hundred patients (132 men, 68 women) in four age groups including with a mean age of 43.39 ± 6.18 years (range 20 - 59 years) and a mean follow-up of 82.34 ± 12.48 months (range 18 - 109 months) met the inclusion criteria. Functional outcome at final follow-up was graded assessed according to Harris score. Factors affecting were defined. Results: Anatomic reduction was achieved in 192 hips, imperfect in 8 and poor in none. Radiological outcome revealed excellent results in 128 (64%) hips, good in eight, fair in five and none in poor. Harris score were excellent in 139 (69.5%) hips, good in 43 (21.5%) and fair in 18 (9%) and poor in none. The anatomical reduction results had a favorable final functional outcome. (0.003) However, BMI (P Conclusion: Optimal functional and radiological outcomes have been achieved with anatomic postoperative reduction. Also experience of specialist, on time surgery and good recovery lead to receiving excellent functional outcome with at least complications.

APPLICATION OF INTERNAL FIXATION IN THE TREATMENT FOR TUBERCULOSIS OF THE SPINE

This is a study of 18 patients who had surgical treatment for spinal tuberculosis. All patients were admitted with the spinal tuberculosis and treated with a combination of anterior debridement and bone graft with poterior internal fixaton using the Luque or Dick technique. The patients were able to walk within a few days postoperation. Three to seven years follow-ups show no recurrence. kyphosis and/or solid fusinon.

THE SYNTHESIS AND CHARACTERIZATION OFPOLY-L-LACTIDE USED FOR THE INTERNALFIXATION OF BONE FRACTURE

A high Mw of PLLA was synthesized, it intended to be used in the manufacture ofbioabsorbable screw applied in bone fracture internal fixation. The optical reactionconditions have been discussed.

Modified Closed Reduction and Percutaneous Kirschner Wires Internal Fixation for Treatment of Supracondylar Humerus Fractures in Children

Objective Supracondylar humerus fractures are the most frequent fractures of the paediatric elbow.The present study introduced a modified surgical procedure for treatment of supracondylar humerus fractures in children.Methods From February 2015 to August 2019,73 patients with Gartland’s type II and III supracondylar fractures were treated with this modified method.Totally,68 of all patients were followed up for 3–12 months(mean 8.25 months).The evaluation results included fracture nonunion,ulnar nerve injury,pin track infection,carrying angle and elbow joint Flynn score.Results The results showed that bone union was observed in all children,one case had an iatrogenic ulnar nerve injury,and the symptoms were completely relieved in 4 months after removing of the medial-side pin.All children had no cubitus varus deformity and no pin track infection,and the rate of satisfactory results according to Flynn’s criteria score was 100%.Conclusion The modified closed reduction and Kirschner wires internal fixation could effectively reduce the rate of open reduction,the risk of iatrogenic ulnar nerve injury,and the incidence of cubitus varus deformity in treatment of supracondylar humerus fractures in children.

Three-dimensional finite element analysis with different internal fixation methods through the anterior approach

BACKGROUND With the modernization of society and transportation in the last decades in China,the incidence of high-energy trauma increased sharply in China,including that of acetabular fractures.AIM To establish different finite element models for acetabular posterior column fractures involving the quadrilateral area of the acetabulum.METHODS The three-dimensional models of the normal and fractured pelvis and the five internal fixations were established using the computed tomography data of the pelvis of a living volunteer.After the vertebral body model was inserted in the way of origin matching and all cancellous bones were copied using the duplicated cancellous bone model as the subtractive entity,the Boolean operation was performed on the pelvis model to obtain the model of the complete pelvis cortical and cancellous bones.RESULTS In the standing position,the maximum stress was 46.21 MPa.In the sitting position,the sacrum bore the simulated gravity load at the upper end.When comparing the five fixations,there were no significant differences in the stress mean values among groups(sitting:P=0.9794;standing:P=0.9741).In terms of displacement,the average displacement of the internal iliac plate group was smaller than that of the spring plate group(P=0.002),and no differences were observed between the other pairs of groups(all P>0.05).In the standing position,there were no significant differences in the mean value of displacement among the groups(P=0.2985).It can be seen from the stress nephogram of the internal fixations in different positions that the stress of the internal fixation was mainly concentrated in the fracture segment.CONCLUSION There were no significant differences among the fixations for acetabular posterior column fractures involving the quadrilateral area of the acetabulum.

Observation on the Efficacy of Autologous Blood Transfusion Combined with Controlled Hypotension in Patients with Spinal Internal Fixation during the Outbreak of New Coronavirus Pneumonia in Western Guangxi (in Guixi)

Objective: To explore the therapeutic effect of autologous blood reinfusion combined with controlled hypotension in surgical spinal fixation during the outbreak of COVID-19. Methods: 30 patients with spinal internal fixation autologous blood transfusion combined with controlled hypotension were selected as the subjects during the epidemic period from December 2019 to June 2020 in our hospital and during the operation, on the basis of routine blood pressure reduction, the American Haemonetice Corporation autologous blood continuous reinfusion system was used to infuse the blood recovered during the operation to the patient through filtration and other procedures. Results: 30 patients had no complications such as fever and hemolysis;And after the operation, the tube was dialed according to the drainage volume, the cervical thoracic and lumbar brace was customized, and the patient walked on the ground for one week;After no abnormalities, the patient was discharged. Intraoperative comparison of white blood cells (WBC), red blood cells (RBC), red blood cell pressure (HCT), hemoglobin (HGB), and coagulation time (PT) of patients with autologous blood before and after transfusion showed statistically significant differences before and after surgery (P < 0.001). Conclusion: During the new coronavirus pneumonia epidemic, the internal fixation of spinal surgery used a recovery machine to collect intraoperative blood for reinfusion. Intraoperative antihypertensive drugs were used to control blood pressure within a certain safe range. The postoperative clinical observation effect was significant and safe;especially at present the clinical significance during the epidemic was significant.

Triple Arthrodesis with Internal and External Fixation: Technique Paper

Background: The triple arthrodesis was described early by Myerson in 1923 and has been the gold standard surgical procedure for various conditions with the goal to reduce pain, improve deformity and facilitate function. Methods: The procedure consists of fusion of the subtalar joint, talonavicular joint and calcaneocuboid joint [1]. The procedure is traditionally done with internal fixation, however, Marinet al. has shown it to be performed with external fixation [2]. Dr. Marin and the associates have developed an alternative technique to perform a triple arthrodesis using internal and external fixation. This paper describes a step-by-step technique to perform a triple arthrodesis with both internal and external fixation. It will demonstrate the use of the prefabricated arches on the footplate for more precise and accurate placement of transosseous wires using arch-wire technique [3]. Results/Conclusion: We believe this technique will not only help increase the ability to achieve fusion with a less chance of non-union, but may also decrease healing time, which may allow patients to be mobile from the first week post-operatively and may diminish the risks associated with being non-weightbearing.

Selection of internal fixation method for femoral intertrochanteric fractures using a finite element method

BACKGROUND Failure to fix unstable intertrochanteric fractures impairs return to daily activities.AIM To simulate five different internal fixation methods for unstable proximal femoral fractures.METHODS A three-dimensional model of the femur was established from sectional computed tomography images,and an internal fixation model was established.Finite element analysis of the femur model was established,and three intertrochanteric fracture models,medial defect,lateral defect,and medial-lateral defects,were simulated.Displacement and stress distribution after fixation with a proximal femoral anti-rotation intramedullary nail(PFNA),integrated dual-screw fixation(ITN),PFNA+wire,PFNA+plate,and PFNA+wire+plate were compared during daily activities.RESULTS The maximum displacement and stress of PFNA and ITN were 3.51 mm/473 MPa and 2.80 mm/588 MPa for medial defects;2.55 mm/288 MPa and 2.10 mm/307 MPa for lateral defects;and 3.84 mm/653 MPa and 3.44 mm/641 MPa for mediallateral defects,respectively.For medial-lateral defects,reconstructing the medial side alone changed the maximum displacement and stress to 2.79 mm/515 MPa;reconstructing the lateral side changed them to 3.72 mm/608 MPa,when both sides were reconstructed,they changed to 2.42 mm/309 MPa.CONCLUSION For medial defects,intramedullary fixation would allow early low-intensity rehabilitation exercise,and ITN rather than PFNA reduces the risk of varus and cut-out;for lateral wall defects or weakness,intram-edullary fixation allows higher-intensity rehabilitation exercise,and ITN reduces the risk of varus.For both medial and lateral defects,intramedullary fixation alone will not allow early functional exercise,but locating lateral or medial reconstruction will.For defects in both the inner and outer sides,if reconstruction cannot be completed,ITN is more stable.

Effects of bridge combined internal fixation system internal fixation on fracture healing and shoulder joint function in elderly patients with displaced midshaft clavicle fractures

Objective:To compare the clinical therapeutic effect of bridge combined internal fixation system and locking compression plate internal fixation in the treatment of displaced midshaft clavicle fractures by emphatically observing fracture healing and shoulder joint function.Methods:Totally 44 elderly patients with Robinson type 2B displaced midshaft clavicle fractures were included from the Department of Orthopaedics,Shenyang Fourth People's Hospital during February 2016 and December 2018,including 23 males and 21 females,mean age(69.8±10.2)years old.The patients were divided into a bridge combined internal fixation system group(bridge group,n=22)and a locking compression plate internal fixation group(plate group,n=22)according to the internal fixation methods.The operation time,intraoperative blood loss,fracture healing time,and postoperative complications were recorded.At 12 months after surgery,the shoulder joint Constant-Murley score and DASH score were used to assess the recovery of joint function.The serum levels of bone turnover biochemical markers procollagen I N-terminal peptide(P1NP),cross-linked Carboxy-terminal telopeptide of typeⅠcollagen(CTX-I),and osteoblast specific factor(OSF)were measured before and 3 months after surgery.Results:The operation time,intraoperative blood loss and fracture healing time of the bridge group were significantly shorter than those of the plate group(P<0.05).Constant scores and DASH scores in the bridge group were significantly better than those of the plate group at 12 months after surgery(P<0.05).Serum levels of CTX-I was significantly decreased,while the P1NP and OSF were significantly increased compared with before surgery in the both groups(P<0.05),and the changes were more obvious in the bridge group(P<0.05).The incidence of complications was similar between the two groups(P<0.05).Conclusion:Compared with the locking plate system,the bridge combined internal fixation system can effectively improve the operation efficiency,have more benefits on fracture healing,better promote the recovery of patients'function,and reduce the failure rate of internal fixation,thus providing a better choice to treat displaced midshaft clavicle fractures by intraoperative internal fixation.

Effect of AXIS lateral mass screw-plate internal fixation system on functional recovery of spinal cord in fracture of lower cervical vertebrae

AIM:To evaluate the methods and results of the AXIS lateral mass screw plate system in the treating of lower cervical spine injury.METHODS:29 cases of lower cervical vertebrae injury were fixed with AXIS system.All of them were followed up for more than 1 year.RESULTS:All cases had a good bone union without malformation.We found no complication of the injury to the vertebral arteries or nerves.There was no loosening of the plate and screw. CONCLUSION:AXIS lateral mass screw plate system has the characteristic of stable,simple and safe and is suitable for the treatment of lower cervical spine injury.

Clinical Effect of Posterior Internal Fixation and Fusion in the Treatment of Thoracolumbar Fractures

Objective:To evaluate the clinical effect of posterior internal fixation and fusion in the treatment of thoracolumbar fractures.Methods:36 patients with thoracolumbar fractures from January 2018 to December 2020 were selected and divided into study group and control group according to the random number table model.The control group was treated with anterior internal fixation,while the study group was treated with posterior internal fixation and fusion.The indexes of the two groups were compared and analyzed.Results:Compared with the operation related indexes of the two groups,the study group had more advantages(P<0.05);The postoperative kyphosis Cobb angle,height of anterior and posterior vertebral body,wedge index of the two groups were better than those before operation(P<0.05),and there was no significant difference between the two groups(P>0.05);There was no significant difference between the two groups(P>0.05).Conclusion:The clinical effect of posterior internal fixation and fusion in the treatment of thoracolumbar fractures is significant,and the body damage is slight,which is worthy of comprehensive promotion.

A Look at Triple Arthrodesis Joint Fusion without Rigid Internal Fixation

Triple arthrodesis is an invasive procedure that involves denuding and fusion of three foot joints;Talocalcaneal (T-C), Talonavicular (T-N) and Calcaneocuboid (C-C). Traditionally, with external fixation triple arthrodesis has been per-formed without corresponding internal fixation. The purpose of this study is to take a scientific look at the compressive forces acting on the joint surfaces using the arch wire technique without the use of rigid internal fixation. Five fresh cadaveric lower-limb specimens were prepared for the triple arthodesis by anatomic dissection. External fixators were applied to the limbs and pressure sensors from the Tekscan 6900C were placed in the three foot joints where tension was applied. After several trials with different variables it was seen that the arched wire technique on the footplate alone does not allow constant compression at the three joints. However weightbearing increased compression across all three joints regardless of the arch wire compression. This study proves that weightbearing alone provides more compression at all 3 joints in a triple arthrodesis.