Comparative efficacy of proximal femoral nail vs dynamic condylar screw in treating unstable intertrochanteric fractures

BACKGROUND Among the most frequent hip fractures are trochanteric fractures,which usually occur from low-energy trauma like minor falls,especially in older people with osteoporotic bones.AIM To evaluate the treatment efficacy of dynamic condylar screws(DCS)and proximal femoral nails(PFN)for unstable intertrochanteric fractures.METHODS To find pertinent randomized controlled trials and retrospective observational studies comparing PFN with DCS for the management of unstable femoral intertrochanteric fractures,a thorough search was carried out.For research studies published between January 1996 and April 2024,PubMed,EMBASE,Scopus,Web of Science,Cochrane Library,and Google Scholar were all searched.The complete texts of the papers were retrieved,vetted,and independently examined by two investigators.Disputes were settled by consensus,and any disagreements that persisted were arbitrated by a third author.RESULTS This study included six articles,comprising a total of 173 patients.Compared to the DCS,the PFN had a shorter operation time[mean difference(MD):-41.7 min,95%confidence interval(95%CI):-63.04 to-20.35,P=0.0001],higher success rates with closed reduction techniques[risk ratio(RR):34.05,95%CI:11.12-104.31,P<0.00001],and required less intraoperative blood transfusion(MD:-1.4 units,95%CI:-1.80 to-1.00,P<0.00001).Additionally,the PFN showed shorter fracture union time(MD:-6.92 wk,95%CI:-10.27 to-3.57,P<0.0001)and a lower incidence of reoperation(RR:0.37,95%CI:0.17-0.82,P=0.01).However,there was no discernible variation regarding hospital stay,implant-related complications,and infections.CONCLUSION Compared to DCS,PFN offers shorter operative times,reduces the blood transfusions requirements,achieves higher closed reduction success,enables faster fracture healing,and lowers reoperation incidence.

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

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

Development of Technology and Equipment for Non-destructive Testing of Defects in Sewing Mandrels of a Three-roll Screw Mill 30-80

The conditions of heating and cooling of piercing mandrels made of 4X5MFS steel of a three-roll screw mill 30-80 in the production of a closed cavity of steel vessels of small volume are determined.It is established that multiple cycles of heating up to 600℃ and cooling with water up to 80℃ for about 7 seconds/1 cycle lead to the formation of ridges,shells and cracks on the surface and in the volume of the tool.The loss of structural strength of the material leads to the breakdown of the mandrel during the stitching process.The technique and equipment of magnetic powder control have been developed to establish the dynamics of the growth of internal and external defects of mandrels.An equation is obtained that allows determining the increase in the number of defects in the sewing tool of a screw rolling mill.The technology of non-destructive testing made it possible to develop a rational plan for replacing the sewing mandrels,which allows for predicting the appearance of defects leading to a complex breakdown of the deforming tool at the NPO Pribor machine-building enterprise.

Metallurgical analysis of a failed maraging steel shear screw used in the band separation system of a satellite launch vehicle

Maraging steels have excellent combination of strength and toughness and are extensively used for a variety of aerospace applications. In one such critical application, this steel was used to fabricate shear screws of a stage separation system in a satellite launch vehicle. During assembly preparations, one of the shear screws which connected the separation band and band end block has failed at the first thread. Microstructural analysis revealed that the crack originated from the root of the thread and propagated in an intergranular mode. The failure is attributed to combined effect of stress and corrosion leading to stress corrosion cracking.

Gravity-Based Kinetostatic Modeling of Parallel Manipulators Using Screw Theory

The pose accuracy of parallel manipulators(PMs)is a key index to measure their performance.Establishing the grav-ity-based kinetostatic model of a parallel robot provides an important basis for its error composition and accuracy improvement.In this paper,a kinetostatic modeling approach that takes real gravity distribution into consideration is proposed to analyze the influence of gravity on the infinitesimal twist and actuator forces of PMs.First,the duality of the twist screw and constraint wrenches are used to derive the gravity-attached constraint wrenches independent of the external load and the limb stiffness matrix corresponding to the kinematics-based constraint wrenches.Sec-ond,the gravity model of the mechanism is established based on the screw theory and the principle of virtual work.Finally,the analytical formulas of the infinitesimal twist and the actuator force of PMs are obtained,and the influences of the external load,platform gravity,and rod gravity on the stiffness of the mechanism are decoupled.The non-overconstrained 3RPS and overconstrained 2PRU-UPR PMs are taken as examples to verify the proposed method.This research proposes a methodology to analyze the infinitesimal deformation of the mechanism under the influence of gravity.

Task-Oriented Topology System Synthesis of Reconfigurable Legged Mobile Lander Integrating Active and Passive Metamorphoses

To explore hostile extraterrestrial landforms and construct an engineering prototype,this paper presents the task-oriented topology system synthesis of reconfigurable legged mobile lander(ReLML)with three operation modes from adjusting,landing,to roving.Compared with our preceding works,the adjusting mode with three rotations(3R)provides a totally novel exploration approach to geometrically matching and securely arriving at complex terrains dangerous to visit currently;the landing mode is redefined by two rotations one translation(2R1T),identical with the tried-and-tested Apollo and Chang'E landers to enhance survivability via reasonable touchdown buffering motion;roving mode also utilizes 2R1T motion for good motion and force properties.The reconfigurable mechanism theory is first brought into synthesizing legged mobile lander integrating active and passive metamorphoses,composed of two types of metamorphic joints and metamorphic execution and transmission mechanisms.To reveal metamorphic principles with multiple finite motions,the finite screw theory is developed to present the procedure from unified mathematical representation,modes and source phase derivations,metamorphic joint and limb design,to final structure assembly.To identify the prototype topology,the 3D optimal selection matrix method is proposed considering three operation modes,five evaluation criteria,and two topological subsystems.Finally,simulation verifies the whole task implementation process to ensure the reasonability of design.

Experimental Investigation on the Strength and Ductility Performance of Steel-Timber-Steel Joints with Screw and Steel-Tube Fasteners

This article presents experimental results of steel-timber-steel(STS)joints loaded parallel to grain.Eight groups of specimens were designed,and tensile tests were performed.The fastener types and fastener numbers were considered to evaluate the tensile strengths and ductility performances of the STS joints.The screws with 6 mm diameter and the innovative steel-tubes with 18 mm diameter were adopted as connecting fasteners.The experimental results were discussed in terms of yielding and ultimate strengths,slip stiffness,and ductility factors.The ductility classification and failure mechanisms of each group of specimens were analyzed.It was demonstrated that the STS joint with large diameter steel-tubes showed acceptable ductility,which was close to the ductility of the STS joint with small diameter screws,thanks to the hollow structure of the steel-tube.The theoretical strengths of various failure modes for the joints with small diameter screws or large diameter steel-tubes were calculated and compared with the experimental results.The ductile performance of the STS joint was discussed by comparing the theoretical strengths of various failure modes.The effective number of the STS joint with multifasteners was also analyzed by considering the failure mechanisms in aspects of tensile strength and slip stiffness.

Nail Holding Performance of Self-Tapping Screws on Masson Pine and Chinese Fir Dimension Lumbers

Screw connection is a type most commonly applied to timber structures.As important commercial tree species in China,Masson pine and Chinese fir have the potential to prepare wood structures.In this study,the effects of the diameter of the self-tapping screw and the guiding bores on the nail holding performance on different sections of Masson pine and Chinese fir dimension lumbers were mainly explored.The results showed that:(1)The nail holding strength of the tangential section was the maximum,followed by that of the radial section,and that of the cross section was the minimum.(2)The nail holding strength of Masson pine was higher than that of Chinese fir.(3)The nail holding strength grew with the increase in the diameter of self-tapping screws,but a large diameter would lead to plastic cracking of the timber,thus further affecting the nail holding strength.Masson pine and Chinese fir reached the maximum nail holding strength when the diameter of self-tapping screws was 3.5 mm.(4)Under a large diameter of screws,prefabricated guiding bores could mitigate timber cracking and improve its nail holding strength.(5)Prefabricated guiding bores were more necessary for the screw connection of Masson pine.The results obtained could provide a scientific basis for the screw connection design of Masson pine and Chinese fir timber structures.

Research and experimental analysis of precision degradation method based on the ball screw mechanism

As a key transmission component in computer numerical control(CNC) machine tools,the ball screw mechanism(BSM) is usually investigated under working load conditions. Its accuracy degradation process is relatively long,which is not conducive to the design and development of new products. In this paper,the normal wear depth of the BSM nut raceway is calculated under the variable speed operation condition using the fractal wear analysis method and the BSM’s accelerated degradation proportional wear model. Parameters of the acceleration degradation model of the double-nut preloaded ball screw pair are calculated based on the physical simulation results. The accelerated degradation test platform of the BSM is designed and manufactured to calculate the raceway wear model when the lubrication condition is broken under the variable-speed inertial load and the boundary lubrication condition under the uniform speed state. Three load forces and two samples are selected for the accelerated degradation test of the BSM. The measured friction torque of the BSM is employed as the evaluation index of the accuracy degradation test. In addition,the life cycle of the accuracy retention is accurately calculated by employing the parameters of the physical simulation model of the BSM. The calculations mentioned above can be used to estimate BSM’s accuracy performance degradation law under normal operating conditions. The application of the proposed model provides a new research method for researching the precision retention of the BSM.

Accuracy of screw placement in the apical region of Lenke 1 adolescent idiopathic scoliosis surgery using a calibration technique for the intraoperative navigation error

Objective:To study the position and the grade of screw perforation in the apical region of adolescent idiopathic scoliosis(AIS)surgery using a calibration technique for the intraoperative navigation error,and to analyze the related factors of navigation deviation and the clinical significance of the calibration technique.Methods:From 2017 to 2020,a total of 60 Lenke 1 AIS surgical cases were enrolled in this research.The 30 cases received surgery using the intraoperative navigation system(Navigation group)and another 30 cases were assisted with intraoperative navigation system with calibration technique(Calibration group)for the intraoperative navigation error.The basic information and radiological data of the both groups were all recorded.According to the Fu Chang-feng’s pedicle channel classification system,the pedicle on the apical region of the two groups was classified.And then the accuracy of screw placement of the two groups was evaluated according to the Rao’s classification.Results:A total of 600 screws were placed in the two groups.The 297 and 303 pedicle screws were implanted in the navigation group and the calibration group,respectively.In the apical region of the calibration group,the rates of the grade 0 screw placement in type A,B and C pedicle were 95.7%,86.7%and 68.9%respectively.It was a statistically significant difference from the 73.9%,66.9%and 30.0%in the navigation group respectively(P<0.05).In the calibration group,the rates of the medial cortical perforation in the type A,B,C and D pedicle were 0%,1.6%,1.6%and 0%,respectively.The corresponding rates were 16.3%,16.9%,30.0%and 47.6%in the navigation group,respectively.Moreover,in the concave side of the apical region of the calibration group,the rates of the medial cortical perforation in the type A,B,C and D pedicle were 0%,3.6%,2.6%and 0%,respectively.Compared with the calibration group,the corresponding rates were higher in the navigation group(34.4%,25.9%,37.2%and 60.0%,respectively).No serious complications such as spinal cord or neurovascular injury occurred for the two groups.Conclusion:Compared with the intraoperative navigation system,the calibration technique for the intraoperative navigation error could provide the higher accuracy of pedicle screw placement in the apical region of the major curve,the lower medial cortical perforation rate,the less screws misplacement rate on the concave side and the less complication rate of the severe Lenke 1 AIS patients.

Acceleration-Dependent Analysis of Vertical Ball Screw Feed System without Counterweight

The distinguishing feature of a vertical ball screw feed system without counterweight is that the spindle system weight directly acts on the kinematic joints.Research into the dynamic characteristics under acceleration and deceleration is an important step in improving the structural performance of vertical milling machines.The magnitude and direction of the inertial force change significantly when the spindle system accelerates and decelerates.Therefore,the kinematic joint contact stiffness changes under the action of the inertial force and the spindle system weight.Thus,the system transmission stiffness also varies and affects the dynamics.In this study,a variable-coefficient lumped parameter dynamic model that considers the changes in the spindle system weight and the magnitude and direction of the inertial force is established for a ball screw feed system without counterweight.In addition,a calculation method for the system stiffness is provided.Experiments on a vertical ball screw feed system under acceleration and deceleration with different accelerations are also performed to verify the proposed dynamic model.Finally,the influence of the spindle system position,the rated dynamic load of the screw-nut joint,and the screw tension force on the natural frequency of the vertical ball screw feed system under acceleration and deceleration are studied.The results show that the vertical ball screw feed system has obviously different variable dynamics under acceleration and deceleration.The influence of the rated dynamic load and the spindle system position on the natural frequency under acceleration and deceleration is much greater than that of the screw tension force.

Management of Isolated Coronal Fractures of Distal Humeral Epiphysis by Herbert Screw

Isolated fractures of the distal humerus are rare. Their diagnosis is often late, and treatment has progressed but serious complications may occur. We conducted a retrospective study of a series of 10 cases at the Department of Orthopedic and Traumatologic Surgery of the Ibn Sina University Hospital in Rabat over a 4-year period, from January 2018 to January 2022. All our cases were treated surgically with Herbert screws. The functional, clinical and radiological outcome was satisfactory with a return to pre-fracture activity in all patients.

Crossed Intralaminar Screws for Fusion of the Cervicothoracic Junction and the Thoracic Spine: The Experience in an Iberic Service with Case Series and Review of the Current Literature with Technique Description

The treatment of pathologies in the thoracic spine is a challenge. The periodic failure of pedicle screw insertion and anatomical variations make the search for an alternative to pedicle screws in thoracic spine surgery necessary. The interlaminar crossed screws is a well-known and secure method for fusion in cervical spine, and in thoracic spine there used to be insufficient clinical data to support this technique, until now. We demonstrate in an initial series of 10 cases treated with interlaminar fusion in association of other fusion techniques in the thoracic spine with good results. Objective: Intralaminar screws have been shown to be a biomechanical salvage technique in the thoracic spine, especially in long cervicothoracic, thoracic and thoracolumbar fixation. The goals of this article are to demonstrate our initial experience and the range of indications for thoracic crossed intralaminar screws. Methods: In this article we describe our initial series performed at S&#227o Teot&#243nio Hospital in Viseu, Portugal, and our results, and also provide a comprehensive review of the recent literature in the use of intralaminar crossed fixation.

How cross screw length influences the stiffness of intramedullary nail systems

Fractures of long bones are commonly treated with intramedullary (IM) nails and they have been shown to have a very high success rate. Recently we have concerns with the use of the newer IM nailing systems, that uses longer cross screws, which have been developed with variation in implant designs. We believe that the newer implants provide less fracture stability, due to decreased stiffness of the IM nailing system. The aim of this study was to biomechanically determine the influence of the length of cross screw on the stiffness of the IM nailing system, using a composite model. Our test results confirmed our suspicion that the newer IM nailing system using longer cross screw-length is less stiff than traditional nailing systems using shorter cross screw length, during axial loading.

Type Synthesis of Self-Alignment Parallel Ankle Rehabilitation Robot with Suitable Passive Degrees of Freedom

The current parallel ankle rehabilitation robot(ARR)suffers from the problem of difficult real-time alignment of the human-robot joint center of rotation,which may lead to secondary injuries to the patient.This study investigates type synthesis of a parallel self-alignment ankle rehabilitation robot(PSAARR)based on the kinematic characteristics of ankle joint rotation center drift from the perspective of introducing"suitable passive degrees of freedom(DOF)"with a suitable number and form.First,the self-alignment principle of parallel ARR was proposed by deriving conditions for transforming a human-robot closed chain(HRCC)formed by an ARR and human body into a kinematic suitable constrained system and introducing conditions of"decoupled"and"less limb".Second,the relationship between the self-alignment principle and actuation wrenches(twists)of PSAARR was analyzed with the velocity Jacobian matrix as a"bridge".Subsequently,the type synthesis conditions of PSAARR were proposed.Third,a PSAARR synthesis method was proposed based on the screw theory and type of PSAARR synthesis conducted.Finally,an HRCC kinematic model was established to verify the self-alignment capability of the PSAARR.In this study,93 types of PSAARR limb structures were synthesized and the self-alignment capability of a human-robot joint axis was verified through kinematic analysis,which provides a theoretical basis for the design of such an ARR.

Additive manufactured osseointegrated screws with hierarchical design

Bone screws are devices used to fix implants or bones to bones.However,conventional screws are mechanically fixed with thread and often face long-term failure due to poor osseointegration.To improve osseointegration,screws are evolving from solid and smooth to porous and rough.Additive manufacturing(AM)offers a high degree of manufacturing freedom,enabling the preparation of predesigned screws that are porous and rough.This paper provides an overview of the problems currently faced by bone screws:long-term loosening and screw breakage.Next,advances in osseointegrated screws are summarized hierarchically(sub-micro,micro,and macro).At the sub-microscale level,we describe surface-modification techniques for enhancing osseointegration.At the micro level,we summarize the micro-design parameters that affect the mechanical and biological properties of porous osseointegrated screws,including porosity,pore size,and pore shape.In addition,we highlight three promising pore shapes:triply periodic minimal surface,auxetic structure with negative Poisson ratio,and the Voronoi structure.At the macro level,we outline the strategies of graded design,gradient design,and topology optimization design to improve the mechanical strength of porous osseointegrated screws.Simultaneously,this paper outlines advances in AM technology for enhancing the mechanical properties of porous osseointegrated screws.AM osseointegrated screws with hierarchical design are expected to provide excellent long-term fixation and the required mechanical strength.

Fixation of Calcaneal Tuberosity Beavis II Fracture in Elderly Patients Using Locking Plate Combined with Tension Screw

Background:Calcaneus is the largest bone of foot and the main load-bearing structure of heel.The incidence of simple calcaneal tubercle avulsion fracture is low,accounting for about 1%to 3%of all calcaneal fractures.Beavis II fracture has large bone fracture,obvious displacement,obvious soft tissue irritation,and often leads to skin necrosis.It needs surgical treatment,reduction and fixation as soon as possible.Although open reduction and tension screw internal fixation is used for Beavis II calcaneal tubercle fracture,but the failure rate is more common.Methods:This study retrospectively analyzed the surgical treatment of calcaneal tubercle Beavis II fracture over 55 years old in our hospital from January 2013 to January 2019.The patients were treated with tension screw combined with locking plate,and followed up and analyzed.Results:12 patients in this group were followed up for 12 to 36 months(mean 20 months).After operation,the fracture healed smoothly in all patients,the healing time was 8 to 12 weeks(mean 10.7 weeks),and there were no complications such as poor incision healing,fracture displacement,internal fixation loosening,fracture and so on.When the patients were followed up 18 weeks after operation,the AOFAS score was 47 to 100,with an average of 91.1,of which 8 cases were excellent,3 good and 1 poor,with an excellent and good rate of 91.7%.Conclusion:Our hospital has been treated with tension screw combined with locking plate,fixed firmly,can early functional exercise,achieved good results.

The Axial Nonlinear Vibration Analysis of Ball-screw about Machine Tool Feeding System

The forced state of the ball-screw of machine tool feeding system is analyzed. The ball-screw is simplified as Timoshenko beam and the differential equation of motion for the ball-screw is built. To obtain the axial vibration equation,the differential equation of motion is simplified using the assumed mode method. Axial vibration equation is in form of Duffing equation and has the characteristics of nonlinearity. The numerical simulation of Duffing equation is proceeded by MATLAB / Simulink. The effect of screw length,exciting force and damping coefficient are researched,and the axial vibration phase track diagram and Poincare section are obtained. The stability and period of the axial vibration are analyzed. The limit cycle of phase track diagram is enclosed. Axial vibration has two type-center singularity distributions on both sides of the origin. The singularity attracts vibration to reach a stable state,and Poincare section shows that axial vibration appears chaotic motion and quasi periodic motion or periodic motion. Singularity position changes with the vibration system parameters,while the distribution doesn’ t change. The period of the vibration is enhanced with increasing frequency and damping coefficient. Test of the feeding system ball-screw axial vibration exists chaos movement. This paper provides a certain theoretical basis for the dynamic characteristic analysis of machine feeding system ball-screw and optimization of structural parameters.

Peri-articular elbow fracture fixations with magnesium implants and a review of current literature: A case series

BACKGROUND In recent years,the use of Magnesium alloy implants have gained renewed popularity,especially after the first commercially available ConformitéEuropéenne approved Magnesium implant became available(MAGNEZIX®CS,Syntellix)in 2013.AIM To document our clinical and radiographical outcomes using magnesium implants in treating peri-articular elbow fractures.METHODS Our paper was based on a retrospective case series design.Intra-operatively,a standardized surgical technique was utilized for insertion of the magnesium implants.Post–operatively,clinic visits were standardized and physical exam findings,functional scores,and radiographs were obtained at each visit.All complications were recorded.RESULTS Five patients with 6 fractures were recruited(2 coronoid,3 radial head and 1 capitellum).The mean patient age and length of follow up was 54.6 years and 11 months respectively.All fractures healed,and none exhibited loss of reduction or complications requiring revision surgery.No patient developed synovitis of the elbow joint or suffered electrolytic reactions when titanium implants were used concurrently.CONCLUSION Although there is still a paucity of literature available on the subject and further studies are required,magnesium implants appear to be a feasible tool for fixation of peri-articular elbow fractures with promising results in our series.INTRODUCTION In recent years,the use of Magnesium alloy implants in orthopaedic surgeries have gained renewed popularity.Apart from being bioabsorbable,negating the need for implant removal,magnesium also has good osteoconductive properties[1-4].Biomechanically,it exhibits greater biomechanical strength than any pre-existing polymers,and reduces the stress-shielding effect associated with titanium and steel implants as it has a Young’s modulus closer to bone[4].Currently,the main utility of magnesium implants in the orthopaedic community is within the foot and ankle community where satisfactory results have been reported with its utility in forefoot osteotomies[5-7].However,its utility in the setting of orthopaedic trauma has been steadily increasing[8].Our study aims to document our clinical and radiographical outcomes using magnesium implants to treat peri-articular elbow fractures.To our knowledge,our study is the first study analyzing outcomes in radial head and coronoid fractures in the English literature.

Effective time, correction speed and termination time of hemiepiphysiodesis in children

In children with asymmetric growth on the medial and lateral side of limbs,if there still remains growth potential,the guided growth technique of hemiepiphysiodesis on one side of the epiphysis is recognized as a safe and effective method.However,when the hemi-epiphysiodesis start to correct the deformities,how many degrees could hemi-epiphysiodesis bring every month and when to remove the hemi-epiphysiodesis implant without rebound phenomenon are still on debate.This article reviews the current studies focus on the effective time,correction speed and termination time of hemi-epiphysiodesis.