Application of medial column classification in treatment of intraarticular calcaneal fractures

BACKGROUND There are many types of treatments for calcaneal fractures,including conservative treatment,conventional surgical treatment,and minimally invasive surgery.The choice of specific treatment options is still controversial.Open reduction and internal fixation are currently the most commonly used surgical procedures in the clinic.A good fracture reduction effect can be achieved by using the lateral extension incision of the calcaneus;however,many studies have reported a high incidence of postoperative incision complications.Although there are many methods for the classification of intra-articular calcaneal fractures,it is generally believed that the computed tomography(CT)classification proposed by Sanders has high application value in the selection of treatment methods and evaluation of prognosis of calcaneal fractures.However,this method has no clear guiding significance for the choice of surgical incision and surgical plan.AIM To explore the application and clinical efficacy of medial column classification in the treatment of intra-articular calcaneal fractures.METHODS From July 2017 to July 2018,91 patients,including 60 males and 31 females aged 27 to 60 years,were enrolled.All participants had closed intra-articular calcaneal fracture,and their surgical options were selected under the guidance of medial column classification.The patients'fractures were classified according to the Sanders classification:Type II,35 cases;Type III,33 cases;and Type IV,23 cases.Among them,53 patients had medial column displacement(shortened varus)and underwent open reduction and internal fixation with L-lateral incision of the calcaneus;38 patients had no displacement of the medial column and underwent open reduction and internal fixation with tarsal sinus incision.The calcaneus Bohler angle,Gissane angle,length,width,height,and step thickness of the articular surface were evaluated by X-ray and three-dimensional CT before and after surgery and at the last follow-up.Foot function recovery was assessed by the Maryland foot scoring criteria.RESULTS All patients were followed for 5 to 14 mo,with an average of 10.5±2.9 mo.The fractures of all patients healed,and the healing time was 10 to 19 wk,with an average of 10.8±1.5 wk.One patient developed wound infection 1 wk after surgery and was actively debrided and implanted with antibiotic calcium sulfate to control the infection.The patient's fracture healed 5 mo after surgery.One patient developed a sural nerve injury,and the symptoms disappeared 3 mo after surgery.The patients were assessed according to the Maryland foot scoring system:Excellent in 77 cases,good in 10,and fair in 4.The excellent and good rate was 95.6%.CONCLUSION Medial column classification can effectively guide the surgical selection for intraarticular fractures of the calcaneus.

Clinical Classification and Treatment Strategy of Hamate Hook Fracture

To explore the clinical classification of hamate hook fracture and the treatment strategy for different type of fractures,12 patients who suffered from hamate hook fractures were followed up retrospectively.According to the fracture sites and the prognosis,we classified the hamate hook fractures into 3 types.Type Ⅰ referred to an avulsion fracture at the tip of hamate hook,type Ⅱ was a fracture in the middle part of hamate hook,and type Ⅲ represented a fracture at the base of hamate hook.By the classification,in our series,only 1 fell into type Ⅰ,7 type Ⅱ,and 4 type Ⅲ.The results were evaluated with respect to the functional recovery,recovery time and the association among the clinical classification,pre-operative complications and treatment results.The average follow-up time of this group was 8.4±3.9 months.Two cases were found to have fracture non-union and both of them were type Ⅱ fractures.Six patients had complications before operation.Five cases were type Ⅱ fractures and 1 case type Ⅲ fracture.All the patients were satisfied with the results at the time of the last follow-up.Their pain scale and grip strength improved significantly after treatment.All the pre-operative complications were relieved.The recovery time of hamate hook excision was significantly shorter than that of the other two treatments.The incidences of both pre-operative complications and non-union in type Ⅱ fractures were higher than those in type Ⅰ and type Ⅲ fractures.It was concluded that,generally,the treatment effects with hamate hook fracture are quite good.The complication incidence and prognosis of the fracture are closely related to the clinical classification.Early intervention is critical for type Ⅱ fractures.

Treatment of Complex Proximal Tibial Fractures (Types V &VI of Schautzker Classification) by Double Plate Fixation with Single Anterior Incision

Background: complex proximal tibial fractures (Types V & VI of Schautzker classification) are the major problems in orthopedic surgery and associated with high complication rates. There are many alternatives in treatment of these fractures. Aim: to evaluate the results of double plating with single anterior incision in complex proximal tibial fractures (Types V& VI of Schautzker classification).Methods and Materials: 22 patients (16 males and 6 females) with Types V and VI of Schautzker classification of proximal tibial fractures (14 cases were Type V and 8 cases were Type VI) were treated by double plating with single anterior incision method between May 2006 and May 2011. The bony and functional outcome was evaluated according to Knee Society Score. Results: According to Knee Society Score, the results were as follows: excellent in 19 patients (86.4%), good in 2 patients (9.1%), fair in 1 patient (4/5%), and poor in no patient (0%).Conclusion: the double plate fixation with single anterior incision is the best, effective and simple procedure in treatment of complex proximal tibial fractures (Types V and VI of Schautzker classification).

Inter-and intra-rater reliability of vertebral fracture classifications in the Swedish fracture register

AIM To investigate the inter-and intra-rater reliability of the vertebral fracture classifications used in the Swedish fracture register.METHODS Radiological images of consecutive patients with cervical spine fractures(n = 50)were classified by 5 raters with different experience levels at two occasions. An identical process was performed with thoracolumbar fractures(n = 50). Cohen's kappa was used to calculate the inter-and intra-rater reliability.RESULTS The mean kappa coefficient for inter-rater reliability ranged between 0.54 and0.79 for the cervical fracture classifications, between 0.51 and 0.72 for the thoracolumbar classifications(overall and for different sub classifications), and between 0.65 and 0.77 for the presence or absence of signs of ankylosing disorder in the fracture area. The mean kappa coefficient for intra-rater reliability ranged between 0.58 and 0.80 for the cervical fracture classifications, between 0.46 and0.68 for the thoracolumbar fracture classifications(overall and for different sub classifications) and between 0.79 and 0.81 for the presence or absence of signs of ankylosing disorder in the fracture area.CONCLUSION The classifications used in the Swedish fracture register for vertebral fractures have an acceptable inter-and intra-rater reliability with a moderate strength of agreement.

Quadrilateral plate fractures of the acetabulum:Classification,approach,implant therapy and related research progress

The quadrilateral plate(QP)is an essential structure of the inner wall of the acetabulum,an important weight-bearing joint of the human body,which is often involved in acetabular fractures.The operative exposure,reduction and fixation of QP fractures have always been the difficulties in orthopedics due to the special morphological structure and anatomical features of the QP.Fortunately,there have been many effective methods and instruments developed for QP exposure,reduction and fixation by virtue of the combined efforts of numerous orthopedists.At the same time,each method presents with its own advantages and disadvantages,resulting in different prognoses.It is necessary to have a thorough understanding of the anatomy,radiology and fixation techniques of the QP in terms of patient prognosis optimization.In this paper,the anatomical features,definition and classification of QP,operative approach selection,implant internal fixation methods and efficacy were reviewed.

A Simple Classification System for Hip Fractures

Background: We have developed a Hip Fracture Classification which stratifies patients into 4 groups upon admission according to fracture complexity. This classification considers patho-anatomic and physiologic parameters and was developed to help identify high-risk patients, with more surgical demands and consequently higher incidence of morbidity. Materials and Methods: Data was gathered prospectively for a cohort of 273 consecutive patients admitted over a 12- month period between 2008 and 2009 and classified according to the Hip Fracture Complexity Classification (C0 - C3). The following outcome measures (mortality and length of hospital stay) were reviewed at thirty days and one year. Result: The overall mortality was 4.4% at 30 days and 20% at 1 year. There were significant differences in 1-year mortality between all stratified groups

Classification of femoral neck fractures according to pauwels: interpretation and confusion ——Reinterpretation: a simplified classification based on mechanical considerations

ABSTRACT The Pauwels Classification of femoral neck fractures, initially published in 1935, is used world-wide. Unfortunately, modern textbooks give varying angle and anatomic specifications between the classified fracture grades. This inconsistency is perpetuated in the literature, so that it is difficult to compare conclusions made by different authors. Pauwels himself left room for interpretation. He published two studies, one in 1935 and one in 1973, each including 3 diagrams. The 1935 version cited an angle of 8° representing the vector of static forces acting on the femoral head. The 1973 diagrams, however, cited an angle of 16° to represent dynamic forces, without changing the angle from horizontal. This already complex sche- me is complicated by the fact that it depends on other factors such as femoral neck shaft (CCD) angle, femoral neck and head diameter, and/or distance of the fracture from the center of the femoral head. The multitude of factors argues against a rigid classification based on fixed angles from horizontal. Pauwels himself did not establish fixed critical angles between the fracture grades. In his own explanation of the system, he placed more value on mechanical considerations such as compression stress, shear stress, tensile force, shearing force, and torque. We propose therefore a simplified version of the Pauwels Classification: Grade I for fractures impacted in valgus, Grade II for fractures without free torque, and Grade III for fractures with free torque.

Classification and Management of Mandibular Condyle Fractures in a Tertiary Health Center

Background: Condyle fractures are not common but could lead to detrimental effects of growth disturbance of the mandible, ankylosis of temporomandibular joint and facial asymmetry especially in children, if not promptly and adequately managed, the aim of this study was to document our experience in the management of mandibular condyle fractures. Method: The fractures were classified based on the age of the patient, unilateral/bilateral, location on the condyle, presence of displacement and dislocation, for those displaced, whether there was medial or lateral overlap, and features presented. Treatment done for each patient was documented. Both clinical and radiological assessments were done to ascertain the outcome of treatment. Result: 11 patients presented with 14 condyle fractures, 3 patients with bilateral and 8 with unilateral condyle fractures out of which 5 cases were on the right side. Age range of patients was between 13 and 44 years with a mean (SD) of 25.3 (10.7) years. Nine (81.8%) of the patients were males and 2 (18.2%) were females. Eight (72.7%) of the patients with condyle fracture had associated fractures affecting other sites of the mandible while 3 (27.3%) patients had isolated condyle fractures. Intracapusular fractures recorded were 2 (14.2%), while extracapsular accounted for 12 (85.8%) cases. Conservative treatment was not applied in any patient, 9 (81.8%) patients had IMF and 2 (18.2%) patients had ORIF. Conclusion: Most fractures of the condyle were extracapsular and, closed surgical treatment (IMF) was very useful to manage most of the cases.

Ankle Fractures, Short Term Operative Outcome: A Retrospective Case Series

Introduction and Background: Ankle injury is one of the most frequent presenting injuries to the emergency room and ankle fractures are common fracture in the lower limbs injuries that may require operative treatment with variable outcomes. Materials and Methods: Sixty-three patients were included in my retrospective study, and all with a displaced fracture of the ankle caused by high energy trauma were treated by open reduction and rigid internal fixation. Results: After follow-up at six weeks and twelve weeks, the results were satisfactory in fifty-five percent out of all the sixty-three patients. Conclusions and Recommendations: Ankle fractures occur mainly in young males of the age group between 26 and 35 years, mostly caused by fall down and motor vehicle accident.

Overall Evaluation of the Effect of Residual Stress Induced by Shot Peening in the Improvement of Fatigue Fracture Resistance for Metallic Materials

Before 1980s,the circular suspension spring in automobile subjected to torsion fatigue load,under the cyclic normal tensile stresses,the majority of fatigue fracture occurred was in normal tensile fracture mode（NTFM）and the fracture surface was under 45°diagonal.Because there exists the interaction between the residual stresses induced by shot peening and the applied cyclic normal tensile stresses in NTFM,which represents as＂stress strengthening mechanism＂,shot peening technology could be used for improving the fatigue fracture resistance（FFR）of springs.However,since 1990s up to date,in addition to regular NTFM,the fatigue fractures occurred of peened springs from time to time are in longitudinal shear fracture mode（LSFM）or transverse shear fracture mode（TSFM）with the increase of applied cyclic shear stresses,which leads to a remarkable decrease of FFR.However,LSFM/TSFM can be avoided effectively by means of shot peening treatment again on the peened springs.The phenomena have been rarely happened before.At present there are few literatures concerning this problem.Based upon the results of force analysis of a spring,there is no interaction between the residual stresses by shot peening and the applied cyclic shear stresses in shear fracture.This;means that the effect of＂stress strengthening mechanism＂for improving the FFR of LSFM/TSFM is disappeared basically.During shot peening,however,both of residual stress and cyclic plastic deformed microstructure are induced synchronously like＂twins＂in the surface layer of a spring.It has been found for the first time by means of force analysis and experimental results that the modified microstructure in the＂twins＂as a＂structure strengthening mechanism＂can improve the FFR of LSFM/TSFM.At the same time,it is;also shown that the optimum technology of shot peening strengthening must have both＂stress strengthening mechanism＂and＂structure strengthening mechanism＂simultaneously so that the FFR of both NTFM and LSFM/TSFM can be improved by shot peening.

Ankle Fractures: A Literature Review of Current Treatment Methods

Ankle fracture is one of the most common lower limb fractures for they account for 9% of all fractures representing a significant portion of the trauma workload. Ankle fractures usually affect young men and older women, however, below the age of 50;ankle fractures are the commonest in men. Two commonly used classification systems for ankle fractures include the danis weber AO classification and the Lauge-Hansen classification. There is biomechanical evidence that posterior non-locking plates are superior in stability than laterally placed plates;however there is little clinical evidence. There are several different methods of ankle fracture fixation, however the goal of treatment remains a stable anatomic reduction of talus in the ankle mortise and correction of the fibula length as a 1 mm lateral shift of the talus in the ankle mortise reduces the contact area by 42%, and displacement (or shortening) of the fibula more than 2 mm will lead to significant increases in joint contact pressures. Further research both biomechanically and clinically needs to be undertaken in order to clarify a preferable choice of fixation.

Influence of data analysis when exploiting DFN model representation in the application of rock mass classification systems

Discrete fracture network(DFN) models have been proved to be effective tools for the characterisation of rock masses by using statistical distributions to generate realistic three-dimensional(3 D) representations of a natural fracture network. The quality of DFN modelling relies on the quality of the field data and their interpretation. In this context, advancements in remote data acquisition have now made it possible to acquire high-quality data potentially not accessible by conventional scanline and window mapping. This paper presents a comparison between aggregate and disaggregate approaches to define fracture sets, and their role with respect to the definition of key input parameters required to generate DFN models. The focal point of the discussion is the characterisation of in situ block size distribution(IBSD) using DFN methods. An application of IBSD is the assessment of rock mass quality through rock mass classification systems such as geological strength index(GSI). As DFN models are becoming an almost integral part of many geotechnical and mining engineering problems, the authors present a method whereby realistic representation of 3 D fracture networks and block size analysis are used to estimate GSI ratings, with emphasis on the limitations that exist in rock engineering design when assigning a unique GSI value to spatially variable rock masses.

Comparison between computed tomography and magnetic resonance imaging in clinical diagnosis and treatment of tibial platform fractures

BACKGROUND Tibial plateau fracture is one of the common fracture types.It occurs mainly in teenagers and is usually caused by a fall.After the occurrence of fracture,knee swelling,pain,limited activity,etc.greatly affect the patient’s exercise habits and lifestyle.X-ray,computed tomography(CT)and magnetic resonance imaging(MRI)were used in this examination.X-rays are relatively new and easy to operate.However,there are some errors in the observation of fracture collapse and fracture displacement.In recent years,CT and MRI have been actively used to diagnose various types of clinical fractures.They have more diagnostic power than X-ray film.However,some scholars believe that CT is also prone to errors in clinical application.The volume effect leads to missed diagnosis and misdiagnosis in some cases,while the multidirection scanning of MRI technology can effectively overcome the shortcomings of CT.To facilitate the selection of clinical examination regimens,this study further observed the diagnostic ability of these two regimens in the diagnosis of tibial plateau fractures.AIM To explore the value of nuclear MRI and CT in the clinical diagnosis of tibial plateau fractures.METHODS A total of 120 patients with tibial plateau fractures admitted from September 2017 to August 2019 were included.All patients were examined by nuclear MRI and CT scanning.The results were sent to senior physicians in our hospital to complete the diagnosis.RESULTS Nuclear magnetic resonance showed the same effects as CT in four aspects:fracture displacement,bone defect,fracture site and fracture comminution.There was no significant difference in the score data(P>0.05).Nuclear magnetic resonance and CT tended to be consistent in the B3,C2 and C3 fracture diagnosis coincidence rate,combined injury detection rate and fracture detection rate.The diagnostic coincidence rate of type B1,B2 and C1 fractures and the accuracy rate of overall fracture classification indicated that the MRI technique was significantly better than that of CT(P>0.05).CONCLUSION MRI and CT have good diagnostic typing in the diagnosis of tibial plateau fractures,but MRI is more accurate and may be preferred.

Reliability of the pronator quadratus fat pad sign to predict the severity of distal radius fractures

AIM To evaluate the reliability of pronator quadratus fat pad sign to detect distal radius fracture and to predict its severity.METHODS Retrospectively we identified 89 consecutive patients(41 female, mean age 49 ± 18 years) who had X-ray(CR) and computed tomography(CT) within 24 h following distal forearm trauma. Thickness of pronator quadratus fat pad complex(PQC) was measured using lateral views(CR) and sagittal reconstructions(CT). Pearson's test was used to determine the correlation of the PQC thickness in CR and CT. A positive pronator quadratus sign(PQS) was defined as a PQC > 8.0 mm(female) or > 9.0 mm(male). Frykman classification was utilized to assess the severity of fractures.RESULTS Forty-four/89 patients(49%) had a distal radius fracture(Frykman Ⅰ n = 3, Ⅱ n = 0, Ⅲ n = 10, Ⅳ n = 5, Ⅴ n = 2, Ⅵ n = 2, Ⅶ n = 9, Ⅷ n = 13). Mean thickness of the PQC thickness can reliably be measured on X-ray views and was 7.5 ± 2.8 mm in lateral views(CR), respectively 9.4 ± 3.0 mm in sagittal reconstructions(CT), resulting in a significant correlation coefficientof 0.795. A positive PQS at CR was present in 21/44 patients(48%) with distal radius fracture and in 2/45 patients(4%) without distal radius fracture, resulting in a specificity of 96% and a sensitivity of 48% for the detection of distal radius fractures. There was no correlation between thickness of the PQC and severity of distal radius fractures.CONCLUSION A positive PQS shows high specificity but low sensitivity for detection of distal radius fractures. The PQC thickness cannot predict the severity of distal radius fractures.

Chinese expert consensus on echelons treatment of pelvic fractures in modern war

The characteristics and treatment of pelvic fractures vary between general conditions and modern war. An expert consensus has been reached based on pelvic injury epidemiology and the concepts of battlefield treatment combined with the existing levels of military medical care in modern warfare. According to this consensus, first aid, emergency treatment and early treatment of pelvic fractures are introduced in three separate levels. In Level Ⅰ facilities, simple triage and rapid treatment following the principles of advanced trauma life support are recommended to evaluate combat casualties during the first-aid stage. Re-evaluation, further immobilization and fixation, and hemostasis are recommended at Level Ⅱ facilities. At Level Ⅲ facilities, the main components of damage control surgery are recommended, including comprehensive hemostasis, a proper resuscitation strategy, the treatment of concurrent visceral and blood vessel damage, and battlefield intensive care. The grading standard for evidence evaluation and recommendation was used to reach this expert consensus.

Differences in Survival Rates between Different Patterns of Unstable Pertrochanteric Femoral Fractures

Background: Unstable pertrochanter femur fractures are common in orthopedic practice. They pose a surgical challenge in both reduction and fixation. The fixation devices used are based on hip intramedullary nailing with femur head lag screw or blade. The aim of this paper is to compare different types of unstable pertrochanter fractures. Materials & Methods: We retrospectively reviewed 386 unstable pertrochanter femur fractures surgically treated in our hospital from 2000 to 2009. These included 62 (16.1%) unstable pertrochanter fractures with fractured lesser trochanter (31.A2-2, 31.A2-3);63 (16.3%) reverse oblique fractures (31.A3-1), 51 (13.2%) transverse fractures (31.A3-2), 145 (37.6%) comminuted fractures (31.A3-3) and 65 (16.8%) subtrochanter fractures. We compared survival rates between fracture types. The clinical characteristics, surgery immediate outcome (e.g., tip apex distance, reduction quality), and long term results, i.e., complications were also compared between fracture types. Results: Survival analysis showed that the fracture types can be grouped into low and high risk fracture types. The former group included, reverse oblique and comminuted fractures. Lesser trochanter, transverse and subtrochanter fractures were included in the high risk group. The survival estimates for five years were 64.6% and 49.3% for the low and high risk fracture types, respectively (p value = 0.008). Multivariate survival analysis showed that the hazard ratio for the high risk fracture group was 1.9 (95% CI = 1.37-2.67). No differences were found between unstable pertrochanter femur fractures with regards to clinical and epidemiology characteristics. Optimal tip apex distance (TAD) of less than 25 mm was found in 66.7%, 57.1% and 66.7% of lesser trochanter, reverse oblique and sutrochanter fractures, respectively. TAD of less than 25 mm was found in 81.2% of both transverse and comminuted fractures (p value = 0.032). No statistically significant differ-ence was found between fracture types, in regards to complication or revision rates. Conclusions: Survival rates were higher in patients suffering from reverse oblique or comminuted pertrochanteric fractures. No differences were found between fracture types, in regards to clinical and other outcome parameters.

Open reduction and Herbert screw fixation of Pipkin type IV femoral head fracture in an adolescent:A case report

BACKGROUND Femoral head fracture is extremely rare in children.This may be the youngest patient with femoral head fracture ever reported in the literature.There are few pediatric studies that focus on cases treated with open reduction via the modified Hardinge approach.CASE SUMMARY A 14-year-old female adolescent suffered a serious traffic accident when she was sitting on the back seat of a motorcycle.A pelvic radiograph and computed tomography revealed a proximal femoral fracture and slight acetabular rim fracture.This was diagnosed as a Pipkin type IV femoral head fracture.An open reduction and Herbert screw fixation was performed via a modified Hardinge approach.After 1-year follow-up,the patient could walk without aid and participate in physical activities.The X-ray results showed that the fractures healed well with no evidence of complications.CONCLUSION Open reduction and Herbert screw fixation is an available therapy to treat Pipkin type IV femoral head fractures in children.

Case Report: A Rare Variety of Type 4 Monteggia Fracture Dislocation in A 28 Years Old Man

A Monteggia fracture is a fracture of the proximal ulna coupled with a radial head dislocation. Numerous classification systems have been developed to characterize these fractures. Bado classification is most commonly used. Bado type 1 Monteggia fractures are most common while type 3 & 4 are rare entities. In our case, after confirming the diagnosis as type 4 Bado Monteggia fracture dislocation, patient was posted for open reduction and internal fixation. The ulnar and radial fractures were rigidly fixed with 3.5 compression plate and ulnar length restored. However, the radial head was still found to be dislocated anteriorly on fluoroscopy. An attempt of closed reduction of the radial head failed. Open reduction of the radial head was performed under image intensifier and fixed with a Kirschner’s wire followed by immobilization in hyperflexion for 2 weeks. The patient followed up at the end of 2 weeks, 4 weeks and 6 weeks following injury and gradual mobilisation of the elbow joint was made. Further follow up at 6 months and 1 year showed complete return of routine function. As soon as the ulnar length is restored by rigid internal fixation, radial head is itself reduced in majority of Monteggia fracture dislocation where only ulnar fracture is involved. However, in cases of both bone forearm fracture with radial head dislocation, even after restoring the length of ulna and radius, operative reduction of radial head is essential.

Correlative Factors Research of Tibial Shaft Fracture with Ipsilateral Posterior Malleolar Crack Fractures

Background:Missed diagnosis rate of spiral tibia shaft fracture with posterior malleolus crack fracture(PMCF)is high in the clinical.However,the mechanism and related factors of fracture are still unclear.Moreover,PMCF has been observed in other types of tibial shaft fractures.Objective:To explore the correlative factors of tibial shaft fracture with ipsilateral PMCF,decrease the rate of clinical missed diagnosis,strengthen the effective fixation of PMCF,and reduce the incidence of traumatic arthritis.Methods:From September 2014 to May 2019,we collected 137 tibiofibular fracture.Only 68 cases involved in ankle joint CT examination and were retrospectively analyzed.The patients were divided into posterior malleolus group(30 cases)and non-posterior malleolus group(38 cases)according to whether come up PMCF or not.The posterior malleolus group contained 24 males and 6 females,27-77(47.57±11.79)years old,the non-posterior malleolus group contained 23 males and 15 females,18-85(48.71±13.84)years old.The gender,age,location,fibula fracture and tibial shaft fracture classification were observed for univariate and multivariate analysis.Results:The probability of PMCF was higher with right tibial shaft fracture(OR=3.6995%CI:1.13-12.08 P<0.05);the probability of PMCF following distal fibular fracture was higher than that without fibular fracture(OR=11.3695%CI:1.72-75.05 P<0.05);the probability of PMCF with type A tibial shaft fracture was higher than type C(OR=4.8295%CI:1.19-19.58 P<0.05).Conclusion:Right type A tibial shaft fracture accompanied by distal fibular fracture are very important factors related to PMCF,which needs highly attention to avoid clinical missed diagnosis.

A retrospective study of unfavorable fractures during sagittal split osteotomy:A single surgeon’s experience

Background:Unfavorable fractures are among the most common complications of bilateral sagittal split ramus osteotomy(BSSRO).This study aimed to evaluate unfavorable fracture patterns during BSSRO and assess the related risk factors and treatment measures.Methods:The clinical records and radiographs of 679 patients(1358 sides)who underwent BSSRO at Shanghai Ninth People’s Hospital between September 2013 and December 2021 were examined.Results:Patients with unfavorable fractures who underwent surgical restoration were studied.The incidence of unfavorable fractures was 0.8%(n¼11),with the highest rate in the third year.The unfavorable fractures were divided into three types by location and clinical treatment:(1)SSRO could still be completed after buccal/lingual plate unfavorable fracture(0.6%,n=8);(2)condylar/coronoid process fractures/intermaxillary fixation needed(0.1%,n=2);(3)additional osteotomy required(0.07%,n=1).Conclusion:These results suggest that as a surgeon’s experience increases,the rate of unfavorable fractures may decrease.The novel classification of unfavorable fractures for SSRO might be useful for surgeons to make appropriate treatment choices during orthognathic surgery.