Clinical Study of Tianji Robotic-Assisted Surgery for Upper Cervical Spine Fractures

Object: To compare the safety, clinical efficacy, and complication rate of “Tianji” robot-assisted surgery with traditional open surgery in the treatment of cervical vertebrae fracture. Methods: 60 patients with upper cervical vertebrae fracture admitted to Baise People’s Hospital between November 2018 and April 2024 were retrospectively analyzed. Among these patients, 29 underwent “Tianji” robot-assisted surgery (Robot group), and 31 underwent traditional C-arm fluoroscopy-assisted open surgery (Open group). Statistical analysis of the data was performed using SPSS 27.0 software to compare general data (gender, age, BMI), preoperative and postoperative visual analogue scale (VAS) scores, neck disability index (NDI), intraoperative blood loss, accuracy of screw placement on imaging, and the number of complications in both groups for comprehensive evaluation. A P value < 0.05 was deemed to have achieved statistical significance. Results: There was no significant difference in preoperative VAS scores between the two groups (Robot group: 8.34 ± 0.61;Open group: 8.26 ± 0.68, P = 0.317). There was also no significant difference in VAS scores at 1 week postoperatively (Robot group: 6.90 ± 0.31;Open group: 6.94 ± 0.36, P = 0.3237). Preoperative NDI scores showed no significant difference between the two groups (Robot group: 43.31 ± 2.67;Open group: 43.84 ± 2.67, P = 0.2227), and the difference in NDI scores at 1 week postoperatively was also not significant (Robot group: 35.69 ± 4.24;Open group: 37.35 ± 3.48, P = 0.0509). Intraoperative blood loss in the Robot group was significantly lower than in the Open group (246.21 ± 209 ml vs 380.65 ± 328.04 ml, P = 0.0308), with a statistically significant difference. The operation time was longer in the Robot group (3.75 ± 0.74 h) compared to the Open group (2.74 ± 0.86 h). In terms of screw placement accuracy, the Robot group had a higher accuracy rate for Class A screws compared to the Open group (102 screws vs 94 screws, P = 0.0487), and the accuracy rate for Class B screws was also higher in the Robot group (13 screws vs 29 screws, P = 0.0333), with both differences being statistically significant. There was no significant difference in the number of complications between the two groups (Robot group: 8 cases;Open group: 10 cases, P = 0.6931). Conclusion: Patients treated with “Tianji” robot-assisted surgery for upper cervical vertebrae fracture had lower intraoperative blood loss and higher screw placement accuracy compared to those undergoing traditional C-arm fluoroscopy-assisted open surgery, indicating that this robot-assisted surgery can effectively reduce intraoperative blood loss and improve screw placement accuracy.

Time of surgery and surgeon level in supracondylar humerus fractures in pediatric patients:A retrospective study

BACKGROUND Supracondylar humerus fractures account for more than 60%of all elbow fractures and about 1/5 of all pediatric fractures.Unfortunately,these fractures can be associated with risk of complications including neurovascular injuries,malunions and limb deformities.Controversy exists regarding the effect of time of surgical intervention and/or level of surgeon performing the surgery on outcome of these fractures.AIM To determine whether time of surgical intervention and/or surgeon level influence the outcomes of surgically managed pediatric supracondylar humerus fractures.METHODS We retrospectively studied 155 pediatric patients presenting with a supracondylar humerus fracture in a level 1 trauma center from January 2006 to December 2019.The data extracted included demographic data,fracture characteristics,surgical data,and follow-up outcomes.The collected data was analyzed and P values of<0.05 were considered statistically significant.RESULTS Of the cohort,11%of patients had documented post-operative complications,of which the majority occurred in surgeries performed after day time working hours and in fractures requiring open reduction.While the lowest complication rate was found in surgeries performed by pediatric orthopaedic surgeons,this did not reach statistical significance.CONCLUSION In pediatric patients undergoing surgery for supracondylar fractures,we found a higher complication rate when surgeries were not performed during working hours.Surgeon level and training had no significant effect on the risk of post-operative complications.

Three-dimensional(3D) Printing Technology Assisted by Minimally Invasive Surgery for Pubic Rami Fractures

The feasibility of three-dimensional (3D) printing technology cgmbined with minimally invasive surgery in the treatment of pubic rami fractures was explored.From August 2015 to October 2017,a series of 30 patients who underwent surgical stabilization of their anterior pelvic ring (all utilizing the 3D printing technology)by one surgeon at a single hospital were studied.The minimally invasive incisions were made through anterior inferior cilia spine and pubic nodule.Data collected included the operative duration,the blood loss,the damage of the important tissue,the biographic union and therecovery of the function after the operation.Measurements on inlet and outlet pelvic cardiograph were made immediately post-operation and at all follow-up clinic visits.The scores of reduction and function were measured during follow-up.Results showed that the wounds of 30 patients were healed in the first stage,and there was no injury of important structures such as blood vessels and nerves.According to the Matta criteria,excellent effectiveness was obtained in 22 cases and good in 8 cases.According to the functional evaluation criteria of Majeed,excellent effectiveness was obtained in 21 cases and good in 9 cases.It was suggested that the 3D printing technology assisted by minimally invasive surgery can better evaluate the pelvic fracture before operation,which was helpful in plate modeling, and can shorten surgery duration and reduce intraoperative blood loss and complications. The positioning accuracy was improved,and better surgical result was finally achieved.

Therapeutic Strategies and Evolution in the Short Term: Fractures by Firearms in Civilian Practice about 35 Operated Lesions

Fracture by firearms is a surgical emergency. The aim of our study was to report our experience in the management of open fractures by firearms and monitoring with a decline of 6 months the lesions observed in peacetime. This retrospective study over 3 years (January 2007-November 2010), supplemented by a prospective (December 2010-November 2011) is based on an analysis of operative reports and clinical records of patients admitted to the Yaoundé Central Hospital. 29 cases were selected, including 35 lesions were observed. Our series consists of 27 men and 2 women, mean age 30 years. 40% of our patients were initially supported (debridement) before the 6th hour and 51.42% between the 6th and 24th hours. In terms of internal fixation, these figures were 66% between the 25th and 96th hours. The type of material was used as the external fixate (64.9%). Conversion processing by the establishment of an internal hardware, after 3 - 6 weeks and control NFS (numeration of blood count or blood count), VS (rate of sedimentation), CRP (C reactive protein). Unfortunately this has been possible only in two cases because of financial means. In 40% of cases, surgical outcome was simple, and complications to a type of osteomyelitis, shortening, suppuration in 42.7% of cases.

Two surgical pathways for isolated hip fractures:A comparative study

BACKGROUND Hip fractures(HF)are common among the aging population,and surgery within 48 h is recommended.Patients can be hospitalized for surgery through different pathways,either trauma or medicine admitting services.AIM To compare management and outcomes among patients admitted through the trauma pathway(TP)vs medical pathway(MP).METHODS This Institutional Review Board-approved retrospective study included 2094 patients with proximal femur fractures(AO/Orthopedic Trauma Association Type 31)who underwent surgery at a level 1 trauma center between 2016-2021.There were 69 patients admitted through the TP and 2025 admitted through the MP.To ensure comparability between groups,66 of the 2025 MP patients were propensity matched to 66 TP patients by age,sex,HF type,HF surgery,and American Society of Anesthesiology score.The statistical analyses included multivariable analysis,group characteristics,and bivariate correlation comparisons with theχ^(2)test and t-test.RESULTS After propensity matching,the mean age in both groups was 75-years-old,62%of both groups were females,the main HF type was intertrochanteric(TP 52%vs MP 62%),open reduction internal fixation was the most common surgery(TP 68%vs MP 71%),and the mean American Society of Anesthesiology score was 2.8 for TP and 2.7 for MP.The majority of patients in TP and MP(71%vs 74%)were geriatric(≥65-years-old).Falls were the main mechanism of injury in both groups(77%vs 97%,P=0.001).There were no significant differences in pre-surgery anticoagulation use(49%vs 41%),admission day of the week,or insurance status.The incidence of comorbidities was equal(94%for both)with cardiac comorbidities being dominant in both groups(71%vs 73%).The number of preoperative consultations was similar for TP and MP,with the most common consultation being cardiology in both(44%and 36%).HF displacement occurred more among TP patients(76%vs 39%,P=0.000).Time to surgery was not statistically different(23 h in both),but length of surgery was significantly longer for TP(59 min vs 41 min,P=0.000).Intensive care unit and hospital length of stay were not statistically different(5 d vs 8 d and 6 d for both).There were no statistical differences in discharge disposition and mortality(3%vs 0%).CONCLUSION There were no differences in outcomes of surgeries between admission through TP vs MP.The focus should be on the patient’s health condition and on prompt surgical intervention.

Early Surgery in Femoral Neck Fractures in Elderly: Does Preoperative ASA Score Matter?

Introduction: Early surgical treatment (within 48 hours) has been recommended for femoral neck fractures in order to avoid complications and reduce mortality rate, regardless of presence and severity of comorbidity and preoperative status (ASA score). However some studies evidenced that early surgery doesn’t always have a beneficial effect on mortality and complications. Therefore further studies could be useful in order to better assess risk related factors of patients requiring surgical treatment for femoral neck fracture. The purpose of this study is to evaluate the effect of preoperative ASA score and timing of surgery on mortality, complications and clinical outcome. Methods: All 336 patients operated in our center from January 2013 to December 2014 were selected for this retrospective study. Patients were divided in three groups as follows: group 1 patients treated within 48 hours;group 2 patients treated between 48 to 96 hours;group 3 patients treated over 96 hours. The preoperative ASA score was recorded for each patient. Complication, clinical outcome and mortality at one-year follow-up were evaluated. At follow-up ambulation was graded as: confined to bed, assisted ambulation, and normal ambulation. Complications both local (infections, malunion, dislocation) and systemic (deep vein thrombosis, pulmonary embolism, lung infections, ischemic disorders of heart) were recorded as well as number of transfusions. Statistical analysis was performed with chi square test and P value Results: 308 patients’ data were fully available for this study. At one-year follow-up return to normal ambulation was higher for patients of group 1 as compared with group 2 and 3 and in group 2 as compared with group 3 (P = 0.04). There was no difference in mortality and return to ambulation between patients with ASA score 1 and 2 (P = 0.06);patients with ASA score ≥ 3 showed a statistically significant higher mortality (P = 0.004) and rate of complications (0.0008) regardless of timing of surgery. There was no statistically significance in blood transfusion among the three groups. Discussion and Conclusion: Clinical outcome, complications and mortality have been previously reported from many authors and most studies agreed that early surgical treatment is recommended regardless of age and preoperative status of the patient. The present study suggests that early surgical treatment is actually able to reduce mortality and complications and to improve clinical outcome in patients with better preoperative conditions, while for patients with ASA score ≥ 3 treatment within 48 hours seems not to prevent mortality and complications and improve clinical outcome.

The analysis of relevant risk factors of traumatic arthritis resulting from the surgery of acetabular fractures

Objective To explore the relevant risk factors of tramatic arthritis resulting from the surgery of acetabular fractures. Methods From January 2000 to January 2009,88 patients aged from 20 to 60 years old with acetabular fractures

Surgical Treatment of Olecranon Fractures Using a Medartis Screw-Locked H-Shaped Plate (Medartis Trilock Olecrane Plate) at the Moulins Yzeure Hospital Center (France)

Introduction: Olecranon fractures represent approximately 10% of upper limb fractures, orthopedic treatment is often doomed to failure and surgical treatment consists of fixing the fracture sites. Patients and Methods: This study retrospectively analyzed 130 patients, 90 men and 40 women, aged on average 48.7 ± 11.9 years (30 to 65) treated between 2018 and 2020 in the Orthopedics and trauma department at the Moulins-Yzeure hospital center, for olecranon fracture using the Medartis H-locked plate. The study aimed to evaluate the results of this surgical method, particularly with regard to postoperative complications. Results: Among the 130 patients, there were 90 men and 40 women, with an average age of 48.7 ± 11.9 years (30 to 65). 50% of all patients were aged over 51 years. The plate used was standard, the same for the 130 patients with the same operating technique. The left side was more affected at 53.8%, the dominant side was less affected at 46%;the majority of patients had been temporarily immobilized with a posterior cast splint before surgery. The average time between trauma and operation was 9 days with a minimum time of 1 day and a maximum of 30 days. At a maximum follow-up of 2 years postoperatively, all patients reported satisfactory results with a return to their previous activities within 60 days after surgery. Conclusion: Medartis H-locked plate osteosynthesis is a reliable solution for the surgical treatment of olecranon fractures.

Full-endoscopic spine surgery treatment of lumbar foraminal stenosis after osteoporotic vertebral compression fractures:A case report

BACKGROUND Few reports have described lumbar foraminal stenosis-induced radiculopathy after treatment by full-endoscopic spine surgery(FESS)combined with percutaneous vertebroplasty(PVP)in patients with vertebral compression fractures.We herein report such a case,including the patient’s treatment process and doctor’s surgical experience.CASE SUMMARY A 79-year-old man presented with symptoms of radiculopathy after sustaining L4 vertebral compression fractures.Imaging and physical examination revealed L4 vertebral compression fractures combined with L3/4 Lumbar foraminal stenosis(LFS).The patient’s symptoms were low back pain with pain in the lateral left leg.Although many reports have described radiculopathy induced by osteoporotic vertebral compression fractures,the use of FESS combined with PVP has rarely been reported.This case report indicates that the combination of FESS and PVP is a safe and effective approach for the treatment of LFS-induced radiculopathy after vertebral compression fractures.This minimally invasive technique has great potential to replace traditional lumbar fixation and decompression surgery.Thus,we suggest the continued accumulation of similar cases to discuss the wider application of FESS.CONCLUSION For patients with osteoporotic vertebral compression fracture(OVCF)and LFS,PVP and FESS can be used to restore the vertebral height and reduce the pressure around the intervertebral foramen.Additionally,the combination of FESS and PVP can treat the pain or numbness of the low back and lower limbs and allow for recovery in a short time with excellent postoperative effects.In general,FESS is a good treatment for radiculopathy caused by foraminal stenosis after OVCF.

Effectiveness and postoperative rehabilitation of one-stage combined anterior-posterior surgery for severe thoracolumbar fractures with spinal cord injury

BACKGROUND Thoracolumbar fractures are generally combined with spinal cord injury to varying degrees,which may cause deterioration of the patients’condition and increase the difficulty of clinical treatment.At present,anterior or combined anterior-posterior surgery is preferred for severe thoracolumbar fractures.AIM To investigate the effectiveness and postoperative rehabilitation of one-stage combined anterior-posterior surgery for severe thoracolumbar fractures with spinal cord injury.METHODS One-hundred-and-twenty patients who received surgery for severe thoracolumbar fractures with spinal cord injury at our hospital from February 2018 to February 2020 were randomly enrolled.They were randomly divided into group 1(one-stage combined anterior-posterior surgery,n=60)and group 2(onestage anterior-approach surgery,n=60).Treatment efficacy was compared between the two groups.RESULTS Blood loss was greater and the operation time was longer in group 1 than in group 2,and the differences were statistically significant(P<0.05).Incision length,intraoperative X-rays,and length of hospital stay were not significantly different between the two groups(P>0.05).Preoperative function of the affected vertebrae was not significantly different between the two groups(P>0.05).In each group,the patients showed significant improvement after surgery.The anterior vertebral height ratio and the posterior vertebral height ratio in group 1 after surgery were significantly higher than those in group 2.The Cobb angle after surgery was significantly lower in group 1 than in group 2(P<0.05).The canal-occupying ratio of the affected vertebrae was not significantly different between the two groups(P>0.05).Before surgery,there was no significant difference in the quality of life scores between the two groups(P>0.05).The above indicators were significantly improved after surgery compared with before surgery in each group.In addition,these indicators were markedly better in group 1 than in group 2 after surgery(P<0.05 for each).CONCLUSION One-stage combined anterior-posterior surgery effectively improves the function of the affected vertebrae and the life quality of patients with severe thoracolumbar fractures and spinal cord injury.This surgical approach is worthy of popularization in clinical use.

Surgical treatment ofpatients with severe non-flail chest rib fractures

BACKGROUND Many patients have inadequate long-term analgesia,respiratory distress,and hypoxemia due to a long-standing substantial smoking history or the presence of primary pulmonary diseases;analgesic treatment is not valid in these patients.Even if the imaging findings of rib fractures are relatively mild,rib fractures may cause severe position limitation,respiratory distress,and hypoxemia.AIM To investigate the curative effect of surgical treatment for patients with severe non-flail chest rib fractures.METHODS A total of 78 patients from our hospital with severe noncontinuous thoracic rib fractures from September 2016 to September 2018 were enrolled in our study.Thirty-nine patients underwent surgical treatment,and 39 underwent conservative treatment.The surgical treatment group received surgery performed with titanium plates,and the screws were inserted with open reduction and internal fixation.The conservative treatment group received analgesia and symptomatic treatment.The pain scores at 72 h,1 wk,2 wk,4 wk,6 wk,3 mo,and 6 mo were compared,and the SF-36 quality of life scores were compared atthe 3rd and 6th months.RESULTS Pain relief in the surgical group was significantly better than that in the conservative group at each time point(72 h,1 wk,2 wk,4 wk,6 wk,3 mo,and 6 mo after surgery,P<0.001).The SF-36 scores were significantly higher in the surgical group than in the conservative group at 1 mo and 6 mo(P<0.05).CONCLUSION Patients with severe non-flail chest rib fractures have a better quality of life following surgical treatment than following conservative treatment,and surgical treatment is also useful for relieving pain.We should pay more attention to the physiological functions and clinical manifestations of patients with severe rib fractures.In patients with non-flail chest rib fractures,surgical treatment is feasible and effective.

Combined Use of Percutaneous Canulated Screws and External or Internal Fixation for Less Invasive Treatment of Tibial Plateaux Fractures

The classic way of treatment of tibial plateau fractures with an extensive approach, opening of the knee and compressive internal fixation can lead to major complications such as infection, skin necrosis and knee stiffness. Here we present a less invasive and thus safer surgical technique, and its indications and results. Twenty patients with various types of fractures according to Schatzker’s classification (mainly V and VI) were treated during a time period of seven years. Surgical treatment usually consisted of a combination of percutaneous canulated screws with a hybrid external fixator. In three cases canulated screws were combined with a laterally applied anatomic locking plate. Patients were followed up for six months to three years postoperatively. Indications as well as intra and postoperative parameters such as surgical time, stability of fixation, blood loss, wound healing, infection, fracture healing and final result were studied. No major complications were recorded either early or later. The use of external οr less invasive internal fixation in combination with percutaneous canulated screws appears to be an adequate method for the treatment of most types of these fractures.

Algorhythm for Use of Percutaneous Short Fixation of Fractures Involving the Thoracolumbar Junction and Lumbar Spine

Study Design: Original article. Objective: Guidelines for deciding whether to perform open or percutaneous surgery in burst fractures. Summary of Background Data: The authors propose an algorithm for deciding whether to perform open surgery or percutaneous surgery with short fixation in patients with fractures of the thoracolumbar junction and lumbar spine. Methods: Between July 2005 and July 2009, 72 patients underwent surgical stabilization by posterior route for fractures of the thoracolumbar junction and lumbar spine. In 44 the lesion involved the thoracolumbar junction, in 28 the lumbar spine (L2 in6 cases, L3 in15 cases, L5 in7 cases). The fractures were assessed morphologically according to Magerl’s classification (52 type A, 12 type B, 8 type C). All patients were analyzed according to the algorithm proposed, according to which patients must fulfil certain criteria: the fracture must be Magerl type A.3, it must involve one level, McCormack score must be 6 or less, invasion of the spinal canal must be 25% or less according to Hashimoto’s formula, Magnetic Resonance Imating (MRI) must confirm discoligamentous integrity. Neurologically, the patient must be ASIA E. 25 patients (17 thoracolumbar junction, 8 lumbar spine) fulfilled these criteria and were treated by percutaneous short fixation. Results: The average length of the surgical procedure was 80 minutes and the loss of blood 10 cc. All patients were dismissed without brace and were submitted to follow-upComputed Tomography CTscan 3 and 6 months after surgery. Follow-up ranged from 6 months to 4 years. In all cases CT scan confirmed fusion and there were no cases of rupture of the device. None of the patients presented neurological deficits. Conclusion: The algorithm described permits a proper selection of patients with thoracolumbar fractures who can be treated by percutaneous short fixation, thus avoiding the risks connected with failure of the stabilization system.

Radiography of Clavicle Fractures— A Review of the Literature —Do Various Radiographic Views of Clavicle Fractures Affect the Management Plan?

Introduction: Fractures of the clavicle are common and make up 5% - 10% of all fractures. Treatment options in part depend on the location of the fracture along the bone and degree of displacement. These two parameters are best determined by good quality, standardized radiographs of the clavicle. We reviewed the literature to determine the optimal radiographs of clavicle fractures and their influence on the treatment plan. Methods: A comprehensive search of Medline? database was undertaken with the following search terms and MeSH headings: clavicle, fractures, bone, radiography, and X-ray. We included articles in English published from 1950 to present. We ruled out fractures in children, fracture dislocations, open fractures, those with neurological and vascular injuries and fractures involving the acromioclavicular or sternoclavicular joints. Findings: Of the 821 citations obtained, only four studies proved eligible. In the most pertinent, four orthopaedic surgeons were shown standard views (antero-posterior and 20&#176;cephalic tilt) of 50 clavicle fractures and then additional two views (45&#176;cephalic and caudal tilt), and found that alternative views influenced their decision making, with more surgeons opting for surgical fixation. In a different study, it was shown that orthogonal views of the clavicle increased surgeons’ understanding and improved their treatment of these fractures. The third paper was a case series on clavicle fractures that were missed on the initial antero-posterior radiograph, and the fourth paper postulated that postero-anterior views of the thorax were most accurate in determining length of the clavicle. Conclusion: Studies showing an optimal view for assessment of clavicle fractures with a decision to then progressing to operative fixation are few, but the evidence points towards surgical fixation when alternative views of mid-shaft clavicle fractures are present.

Influence of different operation methods on vertebral body parameters and GH-IGF axis of patients with thoracolumbar bursts fractures

Objective:To observe the influence situation of different operation methods on the vertebral body parameters and GH-IGF axis of patients with thoracolumbar bursts fractures.Methods:A total of 50 surgical patients with thoracolumbar bursts fractures from February 2014 to January 2016 were selected as the research object, and 50 patients with fractures were divided into two groups by the principle of random allocation, then the group A were treated with surgical treatment by anterior approach, the group B were treated with surgical treatment by posterior approach, then the vertebral body parameters and the serum expression levels of GH-IGF axis indexes of two groups before the surgery and at different time after the surgery were compared.Results: The vertebral body parameters and the serum expression levels of GH-IGF axis indexes of two groups before the surgery were compared (allP>0.05), while the vertebral body parameters and the serum expression levels of GH-IGF axis indexes of two groups at different time after the surgery were all significantly better than those before the surgery, and the results of group B were all better than those of group A (allP<0.05).Conclusions:The influence of surgical treatment by posterior approach for the vertebral body parameters and GH-IGF axis of patients with thoracolumbar bursts fractures are obviously better than those of surgical treatment by anterior approach, so the application value of surgical treatment by posterior approach in the patients with fractures is higher.

Surgical treatment of sacral fractures following lumbosacral arthrodesis: Case report and literature review

Sacral fractures following posterior lumbosacral fusion are an uncommon complication. Only a few case series and case reports have been published so far. This article presents a case of totally displaced sacral fracture following posterior L4-S1 fusion in a 65-yearold patient with a 15-year history of corticosteroid use who underwent open reduction and internal fixation using iliac screws. The patient was followed for 2 years. A thorough review of the literature was conducted using the Medline database between 1994 and 2014. Immediately after the revision surgery, the patient's pain in the buttock and left leg resolved significantly. The patient was followed for 2 years. The weakness in the left lower extremity improved gradually from 3/5 to 5/5. In conclusion, the incidence of postoperative sacral fractures could have been underestimated, because most of these fractures are not visible on a plain radiograph. Computed tomography has been proved to be able to detect most such fractures and should probably be performed routinely when patients complain of renewed buttock pain within 3 mo after lumbosacral fusion. The majority of the patients responded well to conservative treatments, and extending the fusion construct to the iliac wings using iliac screws may be needed when there is concurrent fracture displacement, sagittal imbalance, neurologic symptoms, or painful nonunion.

Update on diagnosis and management of cuboid fractures

Cuboid fractures due to the particular bone anatomy and its protected location in the midfoot are rare, and they are usually associated with complex injuries of the foot. Clinical examination to diagnose these fractures should be detailed and the differential diagnosis, especially in the case of vague symptoms, should include the exclusion of all lateral foot pain causes. Conventional radiographs do not always reveal occult fractures, which can be under diagnosed especially in children. In this case, further investigation including magnetic resonance imaging or scintigraphy may be required. The treatment of these injuries depends on the particular fracture characteristics. Non-displaced isolated fractures of the cuboid bone can be effectively treated conservatively by immobilization and by avoiding weight bearing on the injured leg. In the case of shortening of the lateral column> 3 mm or articular displacement > 1 mm, surgical management of the fracture is mandatory in order to avoid negative biomechanical and functional consequences for the foot and adverse effects such as arthritis and stiffness as well as painful gait. In this review, an update on diagnosis and management of cuboid fractures is presented.

Effect of weekend admission on geriatric hip fractures

BACKGROUND The care discrepancy for patients presenting to a hospital on the weekend relative to the work week is well documented.With respect to hip fractures,however,there is no consensus about the presence of a so-called“weekend effect”.This study sought to determine the effects,if any,of weekend admission on care of geriatric hip fractures admitted to a large tertiary care hospital.It was hypothesized that geriatric hip fracture patients admitted on a weekend would have longer times to medical optimization and surgery and increased complication and mortality rates relative to those admitted on a weekday.AIM To determine if weekend admission of geriatric hip fractures is associated with poor outcome measures and surgical delay.METHODS A retrospective chart review of operative geriatric hip fractures treated from 2015-2017 at a large tertiary care hospital was conducted.Two cohorts were compared:patients who arrived at the emergency department on a weekend,and those that arrived at the emergency department on a weekday.Primary outcome measures included mortality rate,complication rate,transfusion rate,and length of stay.Secondary outcome measures included time from emergency department arrival to surgery,time from emergency department arrival to medical optimization,and time from medical optimization to surgery.RESULTS There were no statistically significant differences in length of stay(P=0.2734),transfusion rate(P=0.9325),or mortality rate(P=0.3460)between the weekend and weekday cohorts.Complication rate was higher in patients who presented on a weekend compared to patients who presented on a weekday(13.3%vs 8.3%;P=0.044).Time from emergency department arrival to medical optimization(22.7 h vs 20.0 h;P=0.0015),time from medical optimization to surgery(13.9 h vs 10.8 h;P=0.0172),and time from emergency department arrival to surgery(42.7 h vs 32.5 h;P<0.0001)were all significantly longer in patients who presented to the hospital on a weekend compared to patients who presented to the hospital on a weekday.CONCLUSION This study provided insight into the“weekend effect”for geriatric hip fractures and found that day of presentation has a clinically significant impact on delivered care.

All-epiphyseal versus trans-epiphyseal screw fixation for tillaux fractures:Does it matter?

BACKGROUND Tillaux fractures occur primarily in adolescents due to the pattern of physeal closure and are classified as Salter-Harris type III physeal fractures.Operative management with screw fixation is recommended for more than 2 mm of displacement or more than 1 mm of translation.However,the efficacy and complications of trans-physeal vs all-physeal screw fixation have not been investigated extensively.AIM To compare the clinical and functional outcomes of trans-physeal(oblique)and all-epiphyseal(parallel)screw fixation in management of Tillaux fractures among pediatric patients.METHODS This was an ethics board approved retrospective review of pediatric patients who presented to our tertiary children’s care facility with Tillaux fractures.We included patients who had surgical fixation of a Tillaux fracture over a 10 year period.Data analysis included demographics,mode of injury,management protocols,and functional outcomes.The patients were divided into group 1(oblique fixation)and group 2(parallel fixation).Baseline patient characteristics and functional outcomes were compared between groups.Statistical tests to evaluate differences included Fisher’s Exact or Chi-squared and independent samples t or Mann Whitney tests for categorical and continuous variables,respectively.RESULTS A total of 42 patients(28 females and 14 males)were included.There were no significant differences in body mass index,sex,age,or time to surgery between the groups[IK2].Sports injuries accounted for 61.9%of the cases,particularly non-contact(57.1%)and skating(28.6%)injuries.Computed Tomography(CT)scan was ordered for 28 patients(66.7%),leading to diagnosis confirmation in 17 patients and change in management plan in 11 patients.[GRC3]Groups 1 and 2 consisted of 17 and 25 patients,respectively.For mid to long-term functional outcomes,there were 14 and 10 patients in groups 1 and 2,respectively.Statistical analysis revealed no significant differences in the functional outcomes,pain scores,or satisfaction between groups.No infections,non-unions,physeal arrest,or post-operative ankle deformities were reported.Two(4.8%)patients had difficulty returning to sports post-surgery due to pain.One was a dancer,and the other patient had pain while running,which led to hardware removal.Both patients had parallel fixation.Hardware removal for groups 1 and 2 were 4(23.5%)and 5(20.0%)patients,respectively.The reasons for removal was pain in 2 patients,and parental preference in the remaining.CONCLUSION This is the largest reported series of pediatric patients with Tillaux fractures comparing functional outcomes of different methods of screw fixation orientation to the physis,which showed no difference regarding functional outcomes.

Minimally Invasive Open Reduction and Internal Fixation for Osteoporotic Vertebral Compression Fractures: Technical Report and Mid-Term Outcomes

Background: Traditional open instrumentation may cause surgical complications due to fragile bones and induce medical comorbidities in senile patients. Vertebroplasty and kyphoplasty are palliative augmentation procedures that have been associated with increased risks of cement leakage, adjacent fractures and non-union. Objective: The aim of this study was to describe a novel approach for the union of osteoporotic vertebral compression fractures with minimally invasive open reduction and internal fixation. Patients and Methods: Seven consecutive patients with intractable back pain without neurological deficits due to osteoporotic vertebral compression fractures were treated using minimally invasive fixation with intra-vertebral expandable pillars and artificial bone substitute. The clinical symptoms and image findings were recorded. Results: All of the patients reported relief of back pain, and the height of the vertebral bodies was well restored. X-ray findings obtained 2 to 4 years after the procedures showed fracture healing and favorable formation of the callus confirmed in the anterior longitudinal ligament. Conclusion: This mini-open procedure with intravertebral devices is an effective and reliable technique for osteoporotic vertebral compression fractures and may avoid complications related to traditional open spinal instrumentation procedures and augmentation with bone cement.