Hoffa’s fracture in an adolescent treated with an innovative surgical procedure:A case report

BACKGROUND Hoffa fracture is rare,especially in adolescents,and has a high rate of complications such as avascular necrosis and osteoarthritis;moreover,there are no definitive guidelines for its treatment.This report could provide a new potential treatment for Hoffa fracture.CASE SUMMARY A 16-year-old girl presented to the orthopedic emergency department of No.2 People’s Hospital of Yibin City with persistent pain following a right knee injury sustained during a sprint race.Her knee was swollen and tender,and the range of motion was restricted by the pain.X-ray and computed tomography revealed a Hoffa fracture in the right knee.After consultation,surgical treatment was performed,and the fracture was fixed with three 3.5-mm cannulated cancellous screws;osteochondral plugs that were harvested from the screw insertion site were re-implanted to cover the screw head.The patient’s fracture and osteochondral plug healed 6 mo postoperatively,and she presented a knee range of motion of 0–135 without pain,and was walking without support with a normal gait.CONCLUSION Here,we describe an innovative surgical procedure for Hoffa fracture that could provide a new possibility for the treatment of similar fractures,and further improve their management.

Hoffa's fracture in a five-year-old child diagnosed and treated with the assistance of arthroscopy:A case report

BACKGROUND Hoffa’s fracture is a coronal-oriented fracture of the femoral condyle.It is rarely observed in pediatric patients that isolated coronal fracture of the medial femoral condyle accompanies an intact lateral femoral condyle.Only a few cases involving Hoffa’s fracture of the medial femoral condyle have been reported in patients with undeveloped skeletons.Such a fracture cannot be observed by routine imaging examinations,thus resulting in possible misdiagnosis and further treatment challenges.CASE SUMMARY A 5-year-old boy with Hoffa’s fracture of the medial femoral condyle suffered from right knee pain and severe swelling after being hit by a heavy object.The patient was misdiagnosed and initially treated in a local primary healthcare center.No improvement in his right knee’s extension was observed following conservative treatment for 2 wk.The patient was transferred to our hospital,rediagnosed using arthroscopy,and underwent open reduction and internal fixation.The therapeutic outcome was satisfactory with the screws removed 7 mo after fixation.At the final follow-up of 40 mo,the range of motion in the knee had recovered.There was no varus-valgus instability.CONCLUSION Hoffa’s fracture is rarely seen in children aged 5 years,let alone in the medial condyle,and can easily be misdiagnosed due to limited physical and imaging examinations.Suspected Hoffa’s fracture in preschool children should be confirmed based on arthroscopic findings.Open reduction and internal fixation should be performed to protect the articular surface and prevent long-term complications.

螺钉内固定与侧方支撑钢板内固定治疗LetenneurⅢ型Hoffa骨折的有限元分析

目的通过建立健康成年人膝关节三维模型,用有限元方法分析比较空心拉力螺钉(A模型)与侧方支撑钢板联合螺钉(B模型)在治疗LetenneurⅢ型Hoffa骨折的生物力学差异。方法采集健康成年人膝关节薄层CT图像,通过Mimics21.0软件提取初步模型、GeomagicWrap2021软件中对模型进一步进行光滑处理、Solidworks 2023软件中建立2种LetenneurⅢ型Hoffa骨折模型中所需内固定零件,并在Solidworks2023软件中将各零件进行拼装,模拟完成骨折内固定治疗、在Ansys2021软件中对模型进行网格划分,对膝关节模型进行有效性验证后,分别对两个内固定模型模拟施加人单腿站立载荷,计算2种模型的内固定Vonmises应力分布、骨折端及螺钉移位大小。比较2种模型的生物力学效应。结果①在对胫骨上端后方施加134N向前的力后,胫骨髁间嵴向前移位4.52mm,与前人结果相似。②A模型骨块最大移位为0.452mm,大于B模型骨块最大移位(0.357mm)。③A模型中内螺钉最大应力为73.3MPa,B模型中最大应力为119MPa,B模型中螺钉应力大小整体高于A模型;在A模型中,螺钉应力大小由远及近螺钉应力呈现降低的趋势;B模型中,螺钉应力大小由远及近呈“U”形。A模型中螺钉最大移位距离为0.52mm,B模型中螺钉最大移位距离为0.69mm,A、B模型中螺钉移位趋势均为由远及近螺钉移位逐渐增大,A、B两模型中螺钉移位大小相近。结论空心拉力螺钉结合侧方钢板在治疗LetenneurⅢⅡ型Hoffa骨折中具有更好的生物力学效果,更加利于患者术后康复.

Comparison of the modified Wiltse’s approach with spinal minimally invasive system and traditional approach for the therapy of thoracolumbar fracture

Thoracolumbar fractures are usually treated by open posterior pedicle screw fixation.However,this procedure involves massive paraspinal muscle stripping,inflicting surgical trauma,and prolonged X-ray exposure.In this study,we observed 127 patients with single-segment injury thoracolumbar fractures.Thirty-six patients were treated by the modified Wiltse’s paraspinal approach with minimally invasive channel system,while 91 patients were treated via traditional posterior approach.Operation time,intraoperative blood loss,intraoperative fluoroscopy frequency,screw placement accuracy,visual analogue scale score,and Cobb’s angle of two groups were compared.The X-ray exposure times were notably reduced(4.2±1.6) in the new approach group(P<0.05).The pedicle screw placement accuracy and Cobb’s angle after surgery were similar in the two groups.We conclude that modified Wiltse’s paraspinal approach w ith spinal minimally invasive channel system surgery can significantly reduce the X-ray exposure times and is an alternative therapy for the thoracolumbar fracture.

Experimental study on the e ect of fracture scale on seismic wave characteristics

In fractured reservoir beds, fracture characteristics affect seismic wave response. Fractured models based on the Hudson＇s fractured medium theory were constructed in our laboratory by a backfilling technique. For the same fracture density, the variations of the velocity and amplitude of the primary wave and shear wave parallel and perpendicular to the fracture were observed by altering the diameter （scale） of the penny-shaped fracture disk. The model test indicated that an increase of fracture scale increased the velocity and amplitude of the primary wave by about 2%. When the shear wave propagated parallel to the fracture, the velocity of the fast shear wave hardly changed, while the velocity of slow shear wave increased by 2.6% with increasing fracture scale. The results indicated that an increase of fracture scale would reduce the degree of anisotropy of the shear wave. The amplitudes of slow shear waves propagating parallel and perpendicular to fractures decreased with increasing fracture scale.

Bennett's fracture associated with fracture of Trapezium——A rare injury of first carpo-metacarpal joint

Association of fracture of trapezium with Bennett'sfracture is very rare and makes reduction and stabilisation more difficult. We are reporting a rare case of Bennett's fracture with fracture of the trapezium and subluxation of the carpo-metacarpal joint(CMC) joint. The patient was a 47-year-old school teacher who fell from his motorbike on his outstretched right dominant hand. Radiographs and computed tomography showed fracture of the trapezium with subluxation of the CMC joint, associated with Bennett's fracture. Open reduction and internal fixation was carried out. Trapezium was reduced first and secured with a 2 mm diameter screw. Bennett's fracture was then reduced and fixed with two per-cutaneously placed Kirchner's wires. CMC was stabilised with percutaneous Kirchner's wires. Latest follow up at 12 mo showed a healed fracture with good reduction of the CMC joint. Clinically patient had no pain and normal extension, abduction and opposition of the thumb. QuickD ASH score was 3.9/100. Thus, fracture of trapezium associated with a Bennett's fracture is a rare injury and if ignored it may lead to poor results. This injury is more challenging to manage than an isolated Bennett's fracture as anatomical reduction of the trapezium with reduction of the first CMC is needed. Fracture of the trapezium should be fixed first as this will provide a stable base for reduction of the Bennett's fracture.

Strategy for prevention of hip fractures in patients with Parkinson's disease

Hypovitaminosis D and K due to malnutrition or sunlight deprivation,increased bone resorption due to immobilization,low bone mineral density(BMD)and an increased risk of falls may contribute to an increased risk of hip fractures in patients with Parkinson’s disease.The purpose of the present study was to clarify the efficacy of interventions intended to prevent hip fractures in elderly patients with Parkinson’s disease.Pub Med was used to search the literature for randomized controlled trials(RCTs)regarding Parkinson’s disease and hip fractures.The inclusion criteria were 50 or more subjects per group and a study period of 1 year or longer.Five RCTs were identified and the relative risk and95%confidence interval were calculated for individual RCTs.Sunlight exposure increased serum hydroxyvitamin D[25(OH)D]concentration,improved motor function,decreased bone resorption and increased BMD.Alendronate or risedronate with vitamin D supplementation increased serum 25(OH)D concentration,strongly decreased bone resorption and increased BMD.Menatetrenone(vitamin K2)decreased serum undercarboxylated osteocalcin concentration,decreased bone resorption and increased BMD.Sunlight exposure(men and women),menatetrenone(women),alendronate and risedronate with vitamin D supplementation(women)significantly reduced the incidence of hip fractures.The respective RRs(95%confidence intervals)according to the intention-to-treat analysis were 0.27(0.08,0.96),0.13(0.02,0.97),0.29(0.10,0.85)and 0.20(0.06,0.68).Interventions,including sunlight exposure,menatetrenone and oral bisphosphonates with vitamin D supplementation,have a protective effect against hip fractures elderly patients with Parkinson’s disease.

Outcome of application of primary versus secondary Illizarov＇s fixator in open tibial shaft fractures

BACKGROUND: The present study aimed to compare outcome of primary and secondary Illizarov's fi xator application as a treatment method for type III open tibial fractures in terms of nonunion and wound infection.METHODS: This prospective study was done in a tertiary care center. Forty-eight type III tibial fractures were treated with Illizarov's apparatus between 2008 and 2011. The patients were divided into two groups depending on the treatment protocol, timing of wound closure and Illizarov's application, primary(n=28) and secondary(n=20).RESULTS: In the primary group, healing was achieved in all 28 patients. The median time to recovery was 24 weeks, and the median number of operations was 3. There were 6 patients with a bone defect. In the secondary group, complete recovery was achieved in 18 out of 20 patients. The median time to recovery was 30 weeks, and the median number of operations 5. There were 9 patients with a bone defect. The median time to recovery and the number of operations were signifi cantly smaller in patients undergoing primary operation. Union was 100% in the primary group and more than 95% in the secondary group. Chronic osteomyelitis persisted in one patient and below amputation was done in one patient in the secondary group.CONCLUSION: Primary wound closure and Illizarov's fixation required a smaller number of operations and shorter time to recovery than secondary wound closure and Illizarov's fi xation, mostly due to a signifi cantly less number of patients with a bone defect in the primary group.

臂丛颈丛神经阻滞麻醉联合瑞芬太尼在锁骨骨折中的应用及对OAA/S评分、VAS评分的影响

目的:观察臂丛颈丛神经阻滞麻醉联合瑞芬太尼用于锁骨骨折手术的效果。方法:选取吉安市永丰县中医院2019年1月~2022年11月就诊的锁骨骨折患者140例为研究对象,按照收治的先后顺序随机分为试验组和对照组各70例,对照组予以臂丛颈丛神经阻滞麻醉,试验组在对照组基础上加用瑞芬太尼。记录两组麻醉前(T0)、臂丛颈丛神经阻滞麻醉后15 min(T1)、辅助用药后3 min(T2)、手术开始后5 min(T3)、手术开始后15 min(T4)、手术结束时(T5)的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO 2)。同时观察两组期间的不良反应以及血管活性药麻黄碱、阿托品、尼卡地平以及艾司洛尔的例数。比较两组患者麻醉满意度的差异。结果:对照组T2时血压降低、心率减慢均不明显,与T0比较差异无统计学意义(P>0.05)。试验组T3、T4时血压升高、心率增快明显,与T0和对照组比较差异有统计学意义(P<0.05)。试验组T2血压降低、心率减慢明显,与对照组和T0比较差异有统计学意义(P>0.05),随后趋于平稳。试验组血管活性药物尼卡地平以及艾司洛尔的例数少于对照组,差异有统计学意义(P<0.05)。两组视觉模拟评分(VAS)及镇痛效果满意率比较差异有统计学意义(P<0.05)。结论:臂丛颈丛神经阻滞麻醉联合瑞芬太尼用于锁骨骨折切开复位内固定手术,镇静镇痛效果确切,呼吸循环稳定,患者麻醉满意度高,是一种安全、有效的麻醉方法。

Effect of Plastic Deformation and H_2S on Dynamic Fracture Toughness of High Strength Casing Steel

The effects of plastic deformation and H2 S on fracture toughness of high strength casing steel（C110 steel） were investigated. The studied casing specimens are as follows： original casing, plastic deformation（PD） casing and PD casing after being immersed in NACE A solution saturated with H2S（PD＋H2S）. Instrumented impact method was employed to evaluate the impact behaviors of the specimens, meanwhile, dynamic fracture toughness（JId） was calculated by using Rice model and Schindler model. The experimental results show that dynamic fracture toughness of the casing decreases after plastic deformation. Compared with that of the original casing and PD casing, the dynamic fracture toughness decreases further when the PD casing immersed in H2 S, moreover, there are ridge-shaped feature and many secondary cracks present on the fracture surface of the specimens. Impact fracture mechanism of the casing is proposed as follows： the plastic deformation results in the increase of defect density of materials where the atomic hydrogen can accumulate in reversible or irreversible traps and even recombine to form molecular hydrogen, subsequently, the casing material toughness decreases greatly.

High-cycle Fatigue Fracture Behavior of Ultrahigh Strength Steels

The fatigue fracture behavior of four ultrahigh strength steels with different melting processes and therefore different inclusion sizes were studied by using a rotating bar two-point bending fatigue machine in the high-cycle regime up to 107 cycles of loading. The fracture surfaces were observed by field emission scanning electron microscopy （FESEM）. It was found that the size of inclusion has significant effect on the fatigue behavior. For AtSI 4340 steel in which the inclusion size is smaller than 5.5 μm, all the fatigue cracks except one did not initiated from inclusion but from specimen surface and conventional S-N curve exists. For 65Si2MnWE and Aermet 100 steels in which the average inclusion sizes are 12.2 and 14.9 μm, respectively, fatigue cracks initiated from inclusions at lower stress amplitudes and stepwise S-N curves were observed. The S-N curve displays a continuous decline and fatigue failures originated from large oxide inclusion for 60Si2CrVA steel in which the average inclusion size is 44.4 pro. In the case of internal inclusion-induced fractures at cycles beyond about 1×10^6 for 65Si2MnWE and 60Si2CrVA steels, inclusion was always found inside the fish-eye and a granular bright facet （GBF） was observed in the vicinity around the inclusion. The GBF sizes increase with increasing the number of cycles to failure Nf in the long-life regime. The values of stress intensity factor range at crack initiation site for the GBF are almost constant with Nf, and are almost equal to that for the surface inclusion and the internal inclusion at cycles lower than about 1×10^6. Neither fish-eye nor GBF was observed for Aermet 100 steel in the present study.

扭紧力矩对SWRM10K螺栓疲劳性能影响的研究

对扭紧力矩分别为0、12.5、22.0、29.5和35.0 Nm的SWRM10K钢螺栓进行轴向加载疲劳实验,获取螺栓的疲劳S-N数据。对比不同扭紧力矩下螺栓疲劳S-N特性,分析扭紧力矩对螺栓疲劳性能的影响。采用SEM观察螺栓试样的断口形貌,结合EDS分析裂纹萌生区元素分布,揭示螺栓疲劳断裂的规律。研究结果表明:增加扭紧力矩能有效提升该螺栓疲劳极限,但增加到一定程度提升效果明显下降,扭紧力矩值接近29.5 Nm较为合理。在该扭紧力矩下,螺栓疲劳极限为141 MPa,与未施加扭紧力矩相比提升了62.1%。螺栓疲劳断口分为3个区域:裂纹萌生区、扩展区和瞬间断裂区。在高应力幅下,裂纹萌生于试样表面,由晶体滑移引起;在低应力幅下,裂纹同样萌生于试样表面,但由晶体滑移或夹杂物引起。

EFFECTS OF POISSON’S RATIO ON SCALING LAW IN HERTZIAN FRACTURE

In this paper the Auerbach＇s scaling law of Hertzian fracture induced by a spherical indenter pressing on a brittle solid is studied. In the analysis, the singular integral equation method is used to analyze the fracture behavior of the Hertzian contact problem. The results show that the Auerbach＇s constant sensitively depends on the Poisson＇s ratio, and the effective Auerbach＇s domain is also determined for a given value of the Poisson＇s ratio.

Fractures in Parkinson’s Disease

Parkinson’s disease is a neurodegenerative disorder that is common in older people and is highly associated with depression, anxiety, apathy, psychosis, cognitive impairment, imbalance and sleep disturbances. These patients have an increased risk of fracture compared to the general population. Comprehensive searches of databases are performed to identify reviews about the risk of fractures in this disease. Parkinson’s patients are at increased risk for low bone mineral density due to the effect of drugs, Parkinson’s disease and age factor, leading to an increased risk of falling down and fractures, especially in the hip. So, improved and innovative treatments with the focus on minimizing inadvertent bone resorption with anti-Parkinson’s disease medication will be highly effective in reducing fear of the disease and providing the patient with a better quality of life.

Seismic and Tectonic Correspondence of Major Earthquake Regions in Southern Ghana with Mid-Atlantic Transform-Fracture Zones

For four centuries now, southern Ghana has been known to be seismically active, and there is no clear geological explanation for the cause of the seismicity. By evaluating new field data and information with re-interpreted historical earthquake data of southern Ghana, the nature of the seismicity of southern Ghana has been elucidated. The mutual connection between the earthquake epicentres and the remote causes by Mid-Atlantic transform faults and fracture zones has been established. The seismic regions of southern Ghana have been linked separately to tectonic faults and activities of the St. Paul’s and Romanche transform-fracture zone systems offshore in the Gulf of Guinea to onshore. It is concluded that the seismicity of southern Ghana is due to tectonic activities of the St. Paul’s and Romanche transform-fracture systems. The Accra region earthquakes originate from reactivation of faults in the Romanche transform-fracture zone, and propagate onshore through Accra and environs. The Axim region earthquakes come from reactivated faults linked to the St Paul’s fracture zone, which go through southern Cote D’Ivoire to Ghana. Seismotectonic movements along the St Paul’s transform and fracture zones have quieted since 1879. But movement along the Romanche Transform fault and Fracture zone is active, causing ongoing seismicity of southern Ghana.

Fracture Femur in a Case of Pyle’s Disease: A Case Report

Pyle’s disease is a rare genetic skeletal disorder also known as Metaphyseal dysplasia. A case of 36 yrs old female with fracture supracondylar femur in Pyle’s disease is presented. She had mild facial dysmorphism, dental malformation & mild genu valgum. Skeletal radiology revealed the characteristic Erlenmeyer flask sign at distal femoral and proximal tibial metaphysis. The fracture supracondylar femur was treated with interlocking nail. The fracture was united in sixteen weeks period. The patient is followed up for two years. The aim of the case report is the rarity of the condition with fracture supracondylar femur in adult female successfully treated with interlocking nail.

斗南锰矿带成矿地质条件及斗南坝心地区明苏断裂(“S”形断裂)研究新认识与探讨

斗南锰矿带是滇东南地区重要的锰矿成矿带,其在地理位置上与明苏断裂(“S”形断裂)基本重合,成矿带上分布有岩子脚、斗南、大箐、老乌、龙潭等一批大、中型锰矿床;前人对“S”形断裂的专题研究较少,仅仅是从锰矿成矿机制方面进行分析、评价。通过对平远斗南锰矿地区进行矿产地质调查工作,及对坝心地段做地质、物探调查工作,结合对该断裂带相关资料的研究分析,认为“S”形断裂可能在不同区域位置不是实质性的同生断裂,主体表现是推覆断裂的形迹,局部有可能存在推覆断裂与同生断裂在地表重合。同时结合工作中的一些新认识,对锰矿深部成矿地质条件进行梳理总结和探讨,希望对本地区锰矿研究和找矿突破提供有价值的参考。

Comparison between Distractor Application on Both Radial &Ulnar Side and Radial Side Only for Fracture Distal Radius with Ulnar Styloid Fracture

Background: Fracture of distal radius with involvement of the ulnar styloid process is a common clinical problem. It can be treated conservatively, usually involving wrist immobilization in plaster cast or surgically. A key method of surgical fixation is external fixation by distractor. Distractor can be applied either only on the radial side or on both ulnar and radial sides. Materials and Methods: A prospective randomized and comparative study of 1 year duration was conducted on 32 patients admitted in the Department of Orthopaedics of BSMC & H in the age group of 20 to 75 years old with AO types B and C distal radius fracture along with involvement of the ulnar styloid process. The parameters studied were restoration of radial length, restoration of radial angle, intracarpal step-off and palmar tilt which were statistically evaluated and Fisher’s exact test was performed. The two tailed P-value was calculated and both the groups were statistically compared. Results: In our study, 37.5% patients in Group A and 81.25% in Group B had a radial difference Table 1, Chart 1). 43.75% patients in Group A and 87.5% in Group B had radial angle Table 2, Chart 2). 31.25% in Group A and 75% had intra carpal step off Table 3, Chart 3). 62.5% had an abnormal palmar tilt in Group A while only 6.25% had an abnormal palmar tilt in Group B which is extremely statistically significant. On an average, 2 mm of distraction was required in 75% patients of Group A while only 30% patients in Group B required distraction (Table 4, Chart 4). Conclusion: In our study, the radial difference, radial angle, intra carpal step off and palmar tilt returned significantly to normal in the patients treated with distractor on radial side only when compared with distractor application on both radial and ulnar sides for distal radius fracture with ulnar styloid process involvement. Also post-operative distraction required under image intensifier was higher in the group treated with distractor on either side than those with distractor only on radial side.

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.

Treatment of Bilateral Proximal Humeral Fracture in Patients with Parkinson’s Disease: A Case Report

There are only a few reports about upper extremity fractures in patients with Parkinson’s disease (PD). This is a case report of a PD patient with severe tremors who had proximal humeral fracture. We performed surgery for the left side and conservative treatment for the right side. The patient was a 73-year-old woman who had been diagnosed with PD 10 years prior to presentation. Open reduction internal fixation was conducted for the left proximal humeral fracture. 7 months after the left shoulder fracture, she fell resulting in a right proximal humeral fracture for which she underwent conservative treatment. Although bone union was obtained bilaterally, anterior subluxation occurred in the operated side 9 months postoperative. Screw remove was performed because perforation of the screw was observed in the humeral head and was causing pain. Currently, restriction in range of motion and subluxation may be seen on the side that received conservative treatment, although pain is absent and patient satisfaction is high. On the operated side, there is a marked restriction in range of motion, subluxation, and pain. Our experience revealed that conservative treatment was effective for proximal humeral fractures and that optimal bone union might be obtained even in patients with suboptimal PD control.