Objective: This study was designed to examine the clinical efficacy of titanium elastic nail (TEN) fixation in treating pediatric long bone fractures of the limbs and its impact on bone mineral density (BMD) and bone metabolism. Methods: Sixty children with long bone fractures of the limbs were divided into the control group (underwent open reduction and internal fixation with a plate) and the observation group (received TEN fixation) (n = 30 each group). Surgical indicators (operative time, intraoperative blood loss, fracture healing time, and hospital stay), fracture healing excellence rate, complication incidence, and overall clinical effectiveness were compared. BMD, serum basic fibroblast growth factor (bFGF), total type I collagen N-terminal propeptide (TPINP) levels, the Hospital for Special Surgery (HSS) knee function score, Harris hip function score, and Mayo Elbow Performance Score (MEPS) were assessed. Results: The observation group exhibited superior surgical indicators, higher fracture healing excellence rate, overall clinical effectiveness, and lower complication incidence than controls (all p < 0.05). At 3 months postoperatively, BMD and bFGF had increased, and TPINP had decreased compared to preoperative values in both cohorts, with the observation group showing higher/lower measures (all p < 0.05). At 6 months postoperatively, the observation group achieved higher HSS, Harris, and MEPS scores compared with the control group (all p < 0.05). Conclusion: TEN fixation accelerates fracture healing, reduces complications, improves BMD and bone metabolism, and restores joint function in children with long bone fractures of the limbs.
Background: Traditional transarticular distal interphalangeal joint (DIPJ) pinning for bony mallet fingers risks stiffness and iatrogenic cartilage injury. This study compared a modified non-transarticular K-wire external fixator with traditional transarticular pinning for surgically treated bony mallet finger. Methods: This single-center prospective nonrandomized comparative cohort study included 120 adults with acute bony mallet finger. Sixty patients underwent traditional transarticular DIPJ pinning, and 60 underwent modified non-transarticular K-wire external fixation. The primary outcome was overall postoperative complications, including pin tract infection, joint stiffness, loss of reduction, nail deformity, or radiographic degenerative change assessed at 1 year. Secondary outcomes included operative time, hardware removal time, bone union time, DIPJ motion, Crawford grade, pain, QuickDASH score, and return-to-work time. Logistic regression was used to identify predictors of overall complications. Results: Baseline demographic and injury characteristics were comparable between groups. Overall complications were significantly less frequent after modified fixation than after traditional fixation (15.0% vs 48.3%, p < 0.001). The modified technique markedly reduced joint stiffness and nail deformity. It was also associated with shorter operative time, earlier hardware removal, faster bone union, lower extension lag, greater maximum DIPJ flexion, better Crawford grade distribution, lower pain and QuickDASH scores, and earlier return to work. In multivariable analysis, traditional fixation remained independently associated with higher complication risk. Conclusion: Modified non-transarticular K-wire external fixation was associated with fewer complications and better early functional recovery than traditional transarticular DIPJ pinning. This joint-sparing, low-cost technique may be a useful surgical option for selected patients with bony mallet finger.
Background: The volume of the bony orbit increases in facial trauma with a blow-out fracture and may lead to enophthalmos and double vision. The orbit’s volume can be restored surgically. The authors aimed to determine the most accurate and cost-effective method for reconstructing blow-out fractures: virtual surgical planning (VSP) combined with patient-specific implants (PSI) or standard titanium stock implants. Materials and methods: The authors conducted a retrospective study of patients who sustained a blow-out fracture requiring surgical reconstruction. Patients were categorized into two groups: the PSI group (n = 13) and the standard titanium stock implant group (n = 36). The primary aim was to analyze the total cost in each group, with a secondary aim to ensure volumetric restoration was achieved. Postoperative volume, operation time, need for reoperation, surgical and inpatient costs, and cost-effectiveness were calculated. The data were analyzed with Shapiro–Wilk, Mann–Whitney U test, and Fisher’s exact test, using a significance level of 0.05. Results: The operation time was significantly shorter in the PSI group than in the stock implant group, with an average of 89.77 and 122.69 min, respectively (p = 0.008), resulting in lower total costs in the PSI group. The PSI group had better postoperative volumetric restoration than the stock implant group compared to the contralateral side (p = 0.01). Four out of 36 patients (11%) needed reoperation in the stock implant group. Conclusions: Preliminary results suggest that PSI requires a shorter operation time and is therefore cost-effective without compromising surgical outcomes.
Objective: To investigate the association between preoperative glycated hemoglobin (HbA1c) and upper limb function (Disabilities of the Arm, Shoulder and Hand [DASH] score) at 6 months post-surgery in patients with fracture-related infection (FRI) after upper limb trauma, and to test the mediating role of rehabilitation initiation time. Methods: This retrospective cohort study included 100 patients with FRIs after upper limb trauma surgery (September 2020 to August 2025). Demographic characteristics, fracture features, HbA1c levels, time to initiate rehabilitation, and debridement frequency of patients were collected. With the DASH score at 6 months after surgery as the outcome variable, multiple linear regression was used to analyze the association between HbA1c and functional prognosis, and the Bootstrap method was used to test the mediating effect of rehabilitation initiation time. Results: HbA1c was significantly positively correlated with the DASH score (β = 6.90, 95% CI 3.91–9.89, p < 0.001). Recovery initiation time played a partial mediating role between the HbA1c and the DASH scores, with a mediating ratio of 27% (indirect effect 2.04, 95% CI 0.63–3.59, p = 0.004). There was no significant interaction between HbA1c and recovery initiation time or debridement frequency (p > 0.05). Thresholding effect analysis did not find a definite breakpoint (log-likelihood ratio test p = 0.220), and HbA1c was linearly related to the DASH score. Conclusion: Preoperative HbA1c is independently associated with 6-month upper limb function in patients with post-traumatic infection, with rehabilitation initiation time playing a partial mediating role. Clinicians should prioritize glycemic control and initiate rehabilitation as early as safely possible.
PURPOSE:This study aimed to investigate factors influencing outcome in patients who experienced re-rupture after flexor tenorrhaphy. BACKGROUND:Flexor tendon re-rupture following tenorrhaphy remains a significant complication that can adversely affect functional outcomes and require repeated surgical intervention. This study aimed to investigate factors influencing prognosis in patients who experienced re-rupture after flexor tenorrhaphy. MATERIALS AND METHODS:We retrospectively analyzed patients who underwent flexor tendon tenorrhaphy on little fingers between January 2011 and September 2024 and subsequently experienced re-rupture -followed by a primary repair. We analyzed factors such as re-rupture timing, rupture to surgery interval, patient demographics, medical history, and participation in rehabilitation therapy using a simple linear regression model. Patients with underlying diseases, concurrent fractures, thumb or extensor tendon ruptures, or follow-up periods less than 6 months were excluded. The Adjusted Strickland and Whitaker methods were used for evaluation. RESULTS:A total of 17 patients out of 313 who underwent flexor tendon repair experienced re-rupture and met the inclusion criteria. Age and re-rupture period significantly affected prognosis. Older patients showed poorer final range of motion outcomes. In contrast, the initiation date, frequency, and duration of rehabilitation therapy did not demonstrate statistically significant correlations with prognosis. CONCLUSIONS:Older age and delayed re-rupture were associated with poorer postoperative finger range of motion following repeated flexor tenorrhaphy. Therefore, patients should be advised to avoid excessive hand use until adequate tendon healing is achieved, and thorough postoperative education may be particularly important in elderly patients.
