Evaluation of the Surgical Treatment of Patella Fractures in 17 Cases in the Orthopedic-Traumatology Department of the University Hospital Center of Donka, Republic of Guinea

Objectives: To determine the epidemiological, therapeutic and evolutionary aspects. Methodology: This was a retrospective study, from January 1, 2016 to December 31, 2018, on the files of patients aged 16 and over, admitted for patella fractures, treated surgically and followed up in our service. Results: The study involved 17 patients including 15 men (88.24%) and 02 women (11.76%) with an average age of 36.65 years. Workers were the most represented (29.42%);AVP were the leading cause of these fractures (52.94%). The fractures were open in 70.58% of cases. Associated lesions were dominated by femur fractures in 29.42%. Duparc type II was the most encountered bone lesion with 47.06% of cases. All our patients benefited from regional anesthesia. Bracing was the most used surgical treatment in 58.83%;the anterior approach was performed in all our patients. Four (04) cases of knee stiffness, two (02) postoperative infections and skin necrosis complicated the short and medium term consequences. After a two-year follow-up, radiologically one case of pseudarthrosis and one case of patellofemoral osteoarthritis were noted. According to the Bosman score, we found 17.65% excellent, 47.06% good and 35.29% poor functional results. Conclusion: Patella fractures are relatively rare. Treatment is primarily surgical for transverse and/or displaced fractures;Bracing is the osteosynthesis technique of choice. However, knee stiffness, pseudarthrosis and patellofemoral osteoarthritis are not uncommon.

Clinical study of polydloxanone suture tension band fixation for treatment of patellar fractures

To explore biomechanic characteristics and clinical outcome of absorbable polydloxanone (PDS) treating patellar fractures.Methods The tensile strength test of PDS 0-0 or PDS 1-0 sutures were made in WDW305 electro-universal tester.A total of 60 cases were classified randomly and equally into two groups:treatment group (treated with the absorbable PDS tension hand) and Kirschner wire metals tension band control group (control group).Anatomy reduction was performed with towel clip fixation during operation.Treatment group was managed with diameter 1.5 mm Kirschner wires drilling two pores on the near or distal segment of patellar fracture end are penetrating through two strands of absorbable PDS 0-0 or PDS 1-0 sutures for a satisfactory fracture fixation.Control group was treated with Kirschner wires (2.0 mm in diameter) and steel wire (1.0 mm in diameter) of type “8” tension band fixation.Results Tensile strength testing showed that the biggest tensile of a strand PDS 0-0 sutures was 71.50 N and that of PDS 1-0 97.48 N,when the length was three times more than the initial.Two groups were followed up and the mean fracture healing time was two months,without broken wire or dislocation.Treatment group showed excellent clinical results in 21 cases,good in six and fair in three;while control group showed excellent clinical results in 19 cases,good in seven and fair in four,with no statistical difference compared with treatment group (χ2=0.32,P>0.05).Conclusion Absorbable PDS tension band has better characteristics of mechanics and creepage in treating patellar fractures.It can avoid defects of secondary operation and complications like needle-tail pain and sharped skin resulted from metal tension band fixation.Meanwhile,it is economic and worthy of further clinical application.16 refs,4 figs.

Effect of heat treatment on the microstructure,mechanical properties and fracture behaviors of ultra-high-strength SiC/Al-Zn-Mg-Cu composites

A high-zinc composite,12vol%SiC/Al-13.3 Zn-3.27 Mg-1.07Cu(wt%),with an ultra-high-strength of 781 MPa was success-fully fabricated through a powder metallurgy method,followed by an extrusion process.The effects of solid-solution and aging heat treat-ments on the microstructure and mechanical properties of the composite were extensively investigated.Compared with a single-stage sol-id-solution treatment,a two-stage solid-solution treatment(470℃/1 h+480℃/1 h)exhibited a more effective solid-solution strengthen-ing owing to the higher degree of solid-solution and a more uniform microstructure.According to the aging hardness curves of the com-posite,the optimized aging parameter(100℃/22 h)was determined.Reducing the aging temperature and time resulted in finer and more uniform nanoscale precipitates but only yielded a marginal increase in tensile strength.The fractography analysis revealed that intergranu-lar cracking and interface debonding were the main fracture mechanisms in the ultra-high-strength SiC/Al-Zn-Mg-Cu composites.Weak regions,such as the SiC/Al interface containing numerous compounds and the precipitate-free zones at the high-angle grain boundaries,were identified as significant factors limiting the strength enhancement of the composite.Interfacial compounds,including MgO,MgZn2,and Cu5Zn8,reduced the interfacial bonding strength,leading to interfacial debonding.

Results of Open Surgical Treatment of Humeral Paddle Fractures about 63 Cases

Fractures of the humeral paddle, common to young adults, are most often complex, linked to violence and an increase in road accidents. The objective of our work is to evaluate our functional results, in the medium term, correlated with a review of the literature. This is a retrospective study of 63 patients, carried out in the traumatology-orthopedics department 1 of the IBN EL JAZZAR hospital in KAIROUAN, over a period of 7 years from January 2015 to December 2021. The average age of patients was 39 years (17 - 68 years). Predominantly male. The etiologies are dominated by falls and accidents on public roads. Fractures are classified according to the Müller and Allgöwer classification where type C is found in 51% of cases. All our patients undergo an olecranon osteotomy in 71% of cases. Osteosynthesis using a Lecestre plate combined with screwing or plugging is used in 84% of cases. The evolution is marked by complications observed in eight patients (16%), including two cases of sepsis, four cases of elbow stiffness (8%), one case of joint callus and one case of pseudarthrosis. Our results are evaluated according to the Mayo Elbow Performance Score, they are excellent and good in 71% of cases, average in 18% of cases and poor in 11% of cases. Fractures of the humeral paddle are fractures with a satisfactory functional prognosis, requiring ad integrum anatomical restoration and solid osteosynthesis allowing early rehabilitation of the elbow. One case of joint callus and one case of pseudarthrosis.

Imaging characteristics and treatment strategies for carotid artery occlusion caused by skull base fracture

The internal carotid artery occlusion caused by head and neck trauma,also known as traumatic intracranial artery occlusion,is relatively rare clinically.Traumatic skull base fracture is a common complication of traumatic brain injury.Traumatic skull base fracture is one of the causes of traumatic internal carotid artery occlusion.If not detected early and treated in time,the prognosis of patients is poor.This editorial makes a relevant analysis of this disease.

Treatment Analysis of Limb Fractures Combined with Traumatic Shock

Objective:To evaluate the treatment regimen and efficacy for limb fractures combined with traumatic shock(TS).Methods:A total of 88 patients with limb fractures combined with TS,admitted between January 2021 and December 2023,were selected.Patients were divided randomly using a numerical grouping method.The observation group underwent restricted fluid resuscitation combined with comprehensive treatment,while the reference group received conventional fluid resuscitation combined with comprehensive treatment.Recovery time,fracture prognosis,complications,severity of the condition,and post-fracture joint function were compared between the two groups.Results:The observation group showed shorter symptom recovery times,a higher rate of anatomical fracture reduction,and a lower complication rate compared to the reference group(P<0.05).After one week of treatment,the severity score of the condition in the observation group was lower than that of the reference group,and all joint function scores were higher in the observation group(P<0.05).Conclusion:Restricted fluid resuscitation combined with comprehensive treatment for limb fractures with TS can alleviate symptoms,improve fracture prognosis,reduce related complications,decrease the severity of trauma,and enhance joint function.The therapeutic effect is excellent.

Treatment and Sequelae of Panfacial Fractures in the Maxillofacial Surgery and Stomatology Department of the Hospital University of Treichville-Abidjan (Cote d’Ivoire)

Introduction: The treatment of panfacial fractures is complex and constitutes a challenge for the maxillofacial surgeon, who, despite therapeutic progress, frequently suffers functional and aesthetic sequelae. This study aimed to describe the treatment and evaluate the functional and aesthetic sequelae of panfacial fractures in the stomatology and maxillofacial surgery department of the Treichville University Hospital. Materials and Methods: We conducted a retrospective study over a 6 years in the stomatology and maxillofacial surgery department of Treichville University Hospital. Forty-two patients with panfacial fractures were included in the study. Results: Forty-two patients were registered. The average time to osteosynthesis was 12.4 days. Nasotracheal intubation was used most often (88%), and in the majority of cases, mixed osteosynthesis combining a screwed plate and steel wire was performed (64.29%). The “Bottom-up and Outside-in” surgical sequence was the most commonly used (64.29%). All patients had at least one functional and/or cosmetic sequela after treatment. Functional sequelae were dominated by occlusal problems and aesthetic sequelae by nasal deformities. Discussion: Panfacial fractures are characterised by their complexity, presenting maxillo-facial surgeons with a therapeutic and evolutionary challenge. The quality of the initial, often multidisciplinary, management of panfacial fractures is an essential factor in both functional and aesthetic prognosis. Conclusion: The treatment of panfacial fractures, even if well managed, is sometimes a source of sequelae, requiring often complex secondary management.

Surgical strategy of the treatment of atypical femoral fractures

The atypical femoral fracture(AFF)has been attracting significant attention because of its increasing incidence;additionally,its treatment is challenging from biological and mechanical aspects.Although surgery is often required to manage complete AFFs,clear guidelines for the surgical treatment of AFFs are currently sparse.We reviewed and described the surgical treatment of AFFs and the surveillance of the contralateral femur.For complete AFFs,cephalomedullary intramedullary nailing spanning the entire length of the femur can be used.Various surgical techniques to overcome the femoral bowing common in AFFs include a lateral entry point,external rotation of the nail,and the use of a nail with a small radius of curvature,or a contralateral nail.In the case of a narrow medullary canal,severe femoral bowing,or pre-existing implants,plate fixation may be considered as an alternative.For incomplete AFFs,prophylactic fixation depends on several risk factors,such as a subtrochanteric location,presence of a radiolucent line,functional pain,and condition of the contralateral femur;the same surgical principles as those in complete AFFs can be applied.Finally,once AFF is diagnosed,clinicians should recognize the increased risk of contralateral AFFs,and close surveillance of the contralateral femur is recommended.

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.

Effects of surgical treatment modalities on postoperative cognitive function and delirium in elderly patients with extremely unstable hip fractures

BACKGROUND As the perioperative risk of elderly patients with extremely unstable hip fractures(EUHFs)is relatively high and therapeutic effect is not satisfactory,new therapeutic strategies need to be proposed urgently to improve the efficacy and clinical outcomes of such patients.AIM To determine the influence of two surgical treatment modalities on postoperative cognitive function(CF)and delirium in elderly patients with EUHFs.METHODS A total of 60 elderly patients consecutively diagnosed with EUHF between September 2020 and January 2022 in the Chongqing University Three Gorges Hospital were included.Of them,30 patients received conventional treatment(control group;general consultation+fracture type-guided internal fixation),and the other 30 received novel treatment(research group;perioperative multidisciplinary treatment diagnosis and treatment+individualized surgical plan+risk prediction).Information on hip function[Harris hip score(HHS)],perioperative risk of orthopedic surgery[Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity(POSSUM)],CF[Montreal cognitive assessment scale(MoCA)],postoperative delirium[mini-cognitive(Mini-Cog)],adverse events(AEs;internal fixation failure,infection,nonunion,malunion,and postoperative delirium),and clinical indicators[operation time(OT),postoperative hospital length of stay(HLOS),ambulation time,and intraoperative blood loss(IBL)]were collected from both groups for comparative analyses.RESULTS The HHS scores were similar between both groups.The POSSUM score at 6 mo after surgery was significantly lower in the research group compared with the control group,and MoCA and Mini-Cog scores were statistically higher.In addition,the overall postoperative complication rate was significantly lower in the research than in the control group,including reduced OT,postoperative HLOS,ambulation time,and IBL.CONCLUSION The new treatment modality has more clinical advantages over the conventional treatment,such as less IBL,faster functional recovery,more effectively optimized perioperative quality control,improved postoperative CF,mitigated postoperative delirium,and reduced operation-related AEs.

Effect of heat treatment on stress corrosion cracking, fracture toughness and strength of 7085 aluminum alloy

The influences of heat treatment on stress corrosion cracking （SCC）, fracture toughness and strength of 7085 aluminum alloy were investigated by slow strain rate testing, Kahn tear testing combined with scanning electron microscopy （SEM） and transmission electron microscopy （TEM）. The results show that the fracture toughness of T74 overaging is increased by 22.9% at the expense of 13.6% strength, and retrogression and reaging （RRA） enhances fracture toughness 14.2% without reducing the strength compared with T6 temper. The fracture toughness of dual-retrogression and reaging （DRRA） is equivalent to that of T74 with an increased strength of 14.6%. The SCC resistance increases in the order： T6〈RRA〈DRRA≈T74. The differences of fracture toughness and SCC were explained on the basis of the role of matrix precipitates and grain boundary orecioitates.

Role of orthoptics and scoring system for orbital floor blowout fracture:surgical or conservative treatment

AIM:To assess the role of orthoptics in referring patients with orbital floor blowout fracture(OFBF)for conservative or surgical treatment and based on the results,to propose a scoring system for such decision making.METHODS:A retrospective analysis of 69 patients with OFBF was performed(35 treated conservatively,34 surgically).The role of orthoptics in referring to surgery or conservative treatment was retrospectively evaluated,the factors with the highest significance for decision making were identified,and a scoring system proposed using Logistic regression.RESULTS:According to defined criteria,the treatment was unsuccessful in 2(6%)surgically treated and only in one(3%)conservatively treated patient.The proposed scoring system includes the defect size and several values resulting from the orthoptic examination,the elevation of the eyebulb measured on Lancaster screen being the most significant.CONCLUSION:The study demonstrates the benefits of orthoptic examination when making decisions on conservative or surgical treatment and for diagnosing ocular motility disorder(with or without binocular diplopia)in OFBF patients.The proposed scoring system could,following verification in a prospective study,become a valuable adjunctive tool.

Research Progress in the Treatment of Thoracolumbar Fractures

The thoracolumbar junction is the junction of the thoracic and lumbar spine and is subjected to high biomechanical stress.With the rapid development of the society,the morbidity of thoracolumbar spine increases every year.Thoracolumbar fracture may affect the stability of the spine and even result in paralysis via the compression of the spinal cord.As a result of advancements in modern medicine,the theoretical and practical aspects concerning thoracolumbar fracture have made great progress.However,due to the complexity of thoracolumbar fracture,controversy still exists in the treatment strategies and methods for thoracolumbar fractures.In order to provide reference for clinical practice,the research progress in the treatment of thoracolumbar fracture is reviewed in this paper.

Coronal shear fractures of distal humerus: Diagnostic and treatment protocols

Coronal shear fractures of distal humerus involving the capitellum and the trochlea are rare injuries with articular complexity, and are technically challenging for management. With better understanding of the anatomy and imaging advancements, the complex nature of these fractures is well appreciated now. These fractures involve metaphysealcomminution of lateral column and associated intraarticular injuries are common. Previously, closed reduction and excision were the accepted treatment but now preference is for open reduction and internal fixation with an aim to provide stable and congruent joint with early range of motion of joint. Various approaches including extensile lateral, anterolateral and posterior approaches have been described depending on the fracture pattern and complexity. Good to excellent outcome have been reported with internal fixations and poor results are noted in articular comminution with associated articular injuries. Various implants including headleass compression screws, minifragment screws, bioabsorbable implants and column plating are advocated for reconstruction of these complex fractures. Inspite of articular fragments being free of soft tissue attachments the rate of osteonecrosis and osteoarthritis is reported very less after internal fixation. This article summarizes the diagnostic and treatment strategies for these rare fractures and recommendations for management.

Cable Pin System versus K-wire Tension Band Fixation for Patella Fractures in Chinese Han Population: A Meta-analysis

This meta-analysis compared the therapeutic effect of cable pin system（CPS） with K-wire tension band（KTB） in the treatment of patella fractures among Chinese Han population. The databases of PubM ed, Cochrane library, China National Knowledge Infrastructure（CNKI）, Chinese Wan Fang and Chinese VIP were searched for studies on CPS versus KTB in the treatment of patella fractures among Chinese Han population. Literatures were screened according to the inclusion and exclusion criteria. The quality of the studies was assessed, and meta-analysis was performed using the Cochrane Collaboration＇s REVMAN 5.3 software. A total of 932 patients from 15 studies were included in this meta-analysis（426 fractures treated with CPS and 506 fractures treated with KTB）. There were significant differences in duration of hospital stay [mean difference（MD）=–1.07; 95% confidence interval（CI）： –1.71 to –0.43], fracture healing time（MD=–1.23; 95% CI： –1.68 to –0.77）, flexion degree of knee joint at 6 th month after operation（MD=14.82; 95% CI： 10.93 to 18.71）, incidence of postoperative complication [risk ratio（RR）=0.16; 95% CI： 0.09 to 0.27] and excellent-good rate of B？stman score（RR=1.09; 95% CI： 1.03 to 1.16） between the CPS group and KTB group, while no significant difference was found in operative time between the two groups（MD=–4.52; 95% CI： –11.70 to 2.67）. For the treatment of patella fractures among Chinese Han population, limited evidence suggests that the CPS is more suitable than the KTB when considering the hospital stay, fracture healing time, flexion degree of knee at 6 th month after operation, incidence of postoperative complication and excellent-good rate of B？stman joint score. Due to the limitation of high quality evidence and sample size, more large-scale randomized controlled trials are needed to validate the findings in the future.

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.

Postoperative Fracture Healing Effects of Locking Compression Plate for the Treatment of Limb Fractures

Objectives To study the effects of applying locking compression plates in the treatment of patients with limb fractures on postoperative fracture healing.Methods:115 patients with limb fractures who were treated in our hospital from November 2019 to November 2020 were selected.In order to study the effective treatment method,the random-number table method was used in this study to divide the patients into two groups,namely the experimental group and the control group,and the locking compression plate treatment method and the pure plate and screw internal fixation treatment method were administered respectively to study their clinical application effects.Results:Compared with the control group,patients in the experimental group had a lower incidence of complications,shorter hospitalizations and shorter recovery time.Meanwhile,the experimental group had a better quality of recovery,and all data were significantly different from those of the control group,P<0.05,the intervention effect of the experimental group was better.Conclusion:The application of the locking compression plate in the treatment of patients with limb fractures is more conducive to promoting the postoperative healing of the patients'fractures,reducing the incidence of postoperative complications,and promoting the rapid recovery of patients,which has positive significance for clinical development.

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.

Min-invasive surgical treatment for multiple axis fractures: A case report

BACKGROUND Fractures of the axis are commonly seen in spinal injuries. Upper cervical fractures are usually managed conservatively. However, the complications due to long-term external immobilization cannot be ignored. The traditional open surgery has the disadvantages of too much blood loss and soft tissue injury. The aim of our paper is to introduce a minimally invasive surgical treatment for multiple axis fractures.CASE SUMMARY We report a 40-year-old Chinese male who had severe neck pain and difficult neck movement after falling from 3 meters. X-ray and computed tomography(CT) scan revealed an axis injury consisting of an odontoid Type Ⅲ fracture associated with a Hangman fracture categorized as a Levine-Edwards Type Ⅰ fracture. The patient underwent anterior odontoid screw fixation and posterior percutaneous screw fixation using intraoperative O-arm navigation. Neck pain was markedly improved after surgery. X-rays and CT scan reconstructions of 3-mo follow-up showed good stability and fusion. The range of cervical motion was well preserved.CONCLUSION Anterior odontoid screw fixation and posterior direct C2 percutaneous pedicle screw fixation with the aid of O-arm navigation and neurophysiological monitoring can be an interesting alternative option for complicated multiple axis fractures.

Effect of solution treatment time on plasticity and ductile fracture of 7075 aluminum alloy sheet in hot stamping process

The effect of solution treatment time on the post-formed plasticity and ductile fracture of 7075 aluminum alloy in the hot stamping process was studied.Tensile tests were conducted on the specimens subjected to the hot stamping process with different solution treatment time.The digital image correlation(DIC)analysis was used to obtain the strain of the specimen.Based on the experiments and modeling,the Yld2000-3d yield criterion and the DF2014 ductile fracture criterion were calibrated and used to characterize the anisotropy and fracture behavior of the metal,respectively.Furthermore,the microstructure of specimens was studied.The experimental and simulation results indicate that the 7075 aluminum alloy retains distinct anisotropy after the hot stamping process,and there is no obvious effect of extending the solution treatment time on the material anisotropy.However,it is found that a longer solution treatment time can increase the fracture strain of the aluminum alloy during the hot stamping process,which may be related to the decrease of the second-phase particles size.