Treatment of open tibial fractures remains a major challenge in clinical settings. The conventional method of temporary fracture fixation is external fixation. In this study, we aimed to evaluate the clinical efficacy and safety of antibiotic-loaded cement-coated plate (ACLP) internal fixation in the emergency management of patients with severe open tibial fractures undergoing delayed flap coverage. We hypothesized that emergency ACLP internal fixation can reduce the incidence of deep infection. This retrospective study involved 73 patients with Gustilo type IIIB tibial fractures treated at our hospital between June 2016 and December 2023. Patients were divided into two groups based on the method of emergency temporary fixation: Group A (n = 34) received ACLP internal fixation and Group B (n = 39) received external fixation. Definitive internal fixation and wound repair were performed 2–7 d later. Bone union and soft-tissue repair were achieved in both groups. The incidence of deep infection was 11.76

This study evaluated the effectiveness of a combination technique for managing severe composite tibial and soft-tissue defects, without requiring complex soft-tissue procedures. A retrospective analysis was conducted on 33 patients with tibial and soft-tissue defects and Gustilo type IIIB open fractures treated between April 2017 and December 2023. The management protocol for all patients consisted of two stages. The first stage involved thorough debridement in the emergency department, removal of all free tibial bone fragments, and fixation with an external frame. The second stage involved Ilizarov bone transport, utilizing chess-shaped polymethyl methacrylate (PMMA) cement (thickness: approximately 1 cm) to fill the tibial bone defect. The PMMA was gradually removed until bone union was achieved. Bone union and soft-tissue healing were achieved in all patients, without the need for additional flap transplantation. The mean bone-union time was 7.5 ± 1.4 months, and the mean soft-tissue healing duration was 70.9 ± 24.1 days. The mean traction period was 105.3 ± 48.2 days, the mean external fixation time was 444.0 ± 137.2 days, and the mean external fixation index was 58.2 ± 23.1 days/cm. Using the Lower Extremity Functional Scale (LEFS) and 36-Item Short-Form Health Survey to evaluate functional scoring, the mean LEFS, physical health component, and mental health component scores were 59.8±13.9, 70.5±17.7, and 77.8±20.1, respectively. According to Paley's classification of complications, there were 14 problems, 6 obstacles, and no sequelae. The chess-shaped PMMA-Ilizarov technique effectively treated composite tibial and soft-tissue defects. This approach facilitated the gradual regeneration and repair of bone and soft-tissue defects, avoided the need for additional skin flap transplantation, and achieved satisfactory clinical results.

A classic posterior starting point of sacral-alar-iliac screw (SAIS) for spinopelvic fixation may not be optimal for sacroiliac joint fixation. We aimed to compare the safety and biomechanical performance of SAIS/reverse SAIS (RSAIS) implanted via the classic (lateral S1–S2 dorsal foramina border) versus modified (medial S1–S2 dorsal foramina border) posterior starting point for sacroiliac joint fixation. Eighty normal pelvic CT scans were used to measure the outer widths (OWs) of the SAIS/RSAIS posterior starting point of the classic and modified methods. 7.3 mm SAIS were implanted using the two methods on each side of 20 3D-printed models to examine sacral-side screw trajectory penetration. Fourteen Tile C1 injury models were divided into two groups and fixed with S2AIS implanted using either the classic (penetrating) or modified (non-penetrating) method to compare the stiffness and maximum loads of the final fixations. Six patients received percutaneous SAIS/RSAIS fixation using the modified method. Screw positions (Smith criteria), pain (visual analogue scale, VAS) and function (Majeed score) were assessed. The modified method gave larger OWs for both S1AIS (7.80 vs. 5.11 mm) and S2AIS (5.85 vs. 3.04 mm) and reduced sacral-side screw trajectory penetration (S1AIS: 2.5

The impact of distal tibiofibular synostosis (DTS) on ankle range of motion (ROM) following surgical fixation of distal lower leg fractures remains controversial. Crucially, the potential influence of a reduced distal tibiofibular interval (DTI) on ROM in patients with DTS has been overlooked in previous studies. This study aimed to investigate the role of reduced DTI in limiting motion in patients with DTS. We conducted a retrospective review of 61 patients diagnosed with DTS after internal fixation for distal lower leg fractures (43 males, 18 females; mean age 47.3 years). A reduced DTI was defined as ≤ 2 mm. Active/passive dorsiflexion/plantarflexion ROM was measured. Between-group comparisons and Spearman rank bivariate correlation analysis were performed. Functional outcomes were assessed using the Olerud–Molander Ankle Score (OMAS) and the American Orthopaedic Foot Ankle Society (AOFAS) score. At the 1-year follow-up, significant reductions in active/passive dorsiflexion/plantarflexion were observed on the affected side compared to the healthy side (P < 0.05). Among the patients, 33 exhibited reduced dorsiflexion, with 6 of these also showing reduced plantarflexion. Spearman rank bivariate correlation analysis demonstrated that DTI was positively correlated with active dorsiflexion and plantarflexion (P < 0.01). The group with reduced DTI showed greater reductions in active and passive dorsiflexion and plantarflexion than the group with normal DTI (P < 0.05). However, there were no significant differences in OMAS, AOFAS, or baseline characteristics between the two groups (P > 0.05). The formation of DTS after surgical fixation of distal lower leg fractures poses a risk of limited ankle dorsiflexion and plantarflexion. DTI was positively correlated with dorsiflexion and plantarflexion, i.e., a critical role of reduced DTI in limiting ankle motion. The primary limitation is dorsiflexion, whereas plantarflexion is affected only in cases of severe dorsiflexion restriction. As the reduction in ROM is generally mild, the functional impact on most patients is not significant.

OBJECTIVE:Current classifications inadequately address distal clavicle fracture instability due to their coronal plane focus, neglecting multiplanar displacement and underestimation of complexity on routine radiographs. This study aimed to bridge this gap by employing three-dimensional (3D) fracture mapping to characterize injury patterns, offering mechanistic insights to optimize surgical strategies. METHODS:A retrospective analysis was conducted on 81 patients diagnosed with acute distal clavicle fractures at Wuxi Ninth People's Hospital between 2019 and 2022. Axial and sagittal CT planes were utilized to demonstrate fracture line alignment. Manual simulated repositioning was performed for all fracture lines, which were subsequently graphically superimposed onto a standard template of the intact distal clavicle. A 3D map was generated and subsequently transformed into a heatmap. The classification of distal clavicle fractures was determined based on the updated and modified Neer classification. Two points were designated at the distal end of the fracture block and at the repositioned counterpart to assess the three-dimensional spatial position, including shortening along the x-axis, horizontal displacement along the y-axis, vertical displacement along the z-axis, as well as the displacement angles in the three planes, thereby quantifying the displacement of each distal clavicle fracture. RESULTS:This study included 81 cases of distal clavicle fractures (43 cases on the left side and 38 cases on the right side). The distribution included 8 cases (9.88%) of Neer I, 5 cases (6.17%) of Neer IIA, 31 cases (38.27%) of Neer IIB, 11 cases (13.58%) of Neer IIC, 14 cases (17.28%) of Neer III, and 12 cases (14.81%) of Neer V. Fracture mapping revealed that the fracture lines were predominantly located in the distal one-third of the distal clavicle, with the highest concentration at the acromion end. The majority of displaced distal clavicle fractures exhibit multidirectional displacement, mainly posterior, superior, and shortening, along with angulation in the corresponding directions. CONCLUSIONS:Most displaced distal clavicle fractures involve multiple displacements and angulations, necessitating three-dimensional analysis during fracture reduction. A comprehensive 3D assessment of displacement patterns is essential for evaluating stability and guiding treatment. Fracture line analysis further enhances classification accuracy and informs imaging protocols and fixation strategies tailored to specific fracture types.

INTRODUCTION:The study aims to explore whether asymmetrical bone healing occurs after bone grafting for segmental bone defects using the Masquelet technique, and to analyze the underlying causes and potential prevention strategies. The hypothesis was that bone healing after bone grafting for tibial segmental bone defects is asymmetrical. METHODS:A retrospective analysis was conducted on 67 patients with tibial segmental bone defects treated using the Masquelet technique. After all the bone defects healed, the healing time difference and incidence of local cortical bone loss of the four sides of the bone graft were analyzed, along with the associated causes. The correlation and regression analysis between the patient-specific and surgery-related factors and the difference in anterior versus posterior healing times was performed. RESULTS:Mean healing times (months) differed significantly (P < 0.05): posterior (7.2 ± 0.6), lateral (8.4 ± 0.8), medial (9.0 ± 1.0), and anterior (9.6 ± 1.1). The incidence of anterior cortical bone loss (7.46%) was significantly higher than that of posterior and lateral losses (0; P < 0.05). Bivariate correlation and multiple linear regression analyses identified four significant risk factors for differences in healing time (P < 0.05): defect length (β = 0.215), bone graft quantity (β = 0.450), induced membrane (IM) integrity (β = 0.637), and early-stage activity levels (β = 0.597). The regression equation was: Y = -1.954 + 0.637×IM integrity + 0.450×early-stage activity levels + 0.597×bone graft quantity + 0.215×defect length. CONCLUSION:Bone healing after bone grafting for tibial segmental bone defects exhibits asymmetry, with fastest posterior healing, slowest anterior healing and even anterior cortical bone loss. Objective factors (biomechanical environment, graft settling) and subjective factors (defect length, graft stability and quantity, early-stage activity levels) both contribute. These findings inform optimized grafting protocols and rehabilitation strategies to improve clinical outcomes through more balanced healing promotion. LEVEL OF EVIDENCE:IV; retrospective study without a control group.

BACKGROUND:Research on open tibiofibular fractures is limited. We compared clinical outcomes of Gustilo - Anderson type IIIB/C open tibial fractures using orthopedic and orthoplastic approaches, and identified poor prognosis predictors. MATERIALS AND METHODS:The clinical data of 746 patients with Gustilo - Anderson type IIIB/C open tibial fractures (420 and 326 treated using the orthopedic and orthoplastic approach, respectively) were retrospectively analyzed. We evaluated infection rates, nonunion incidence, arthritis incidence, number of surgeries, fracture healing time, amputation rate, wound closure duration, and Lower Extremity Functional Scale (LEFS) score, and identified risk factors affecting prognosis. RESULTS:Significant differences in infection rates (deep infection, 8.0% vs. 29%; superficial infection, 8.0% vs. 41%; all P <0.001), nonunion incidence (11% vs. 2.5%, P <0.001), arthritis incidence (27% vs. 2.1%, P < 0.001), number of surgeries (4.6 ± 1.07 vs. 10.7 ± 3.33, P < 0.001), and wound coverage time (11.27 ± 5.14 vs. 3.98 ± 1.98, P < 0.001) were observed between the groups. LEFS scores from 3 to 24 months after injury were higher in the orthoplastic group. No difference in fracture healing time was observed (7.0 ± 1.99 vs. 7.0 ± 1.98, P = 0.987). The orthoplastic group required a lower amount of bone graft when using intramedullary nail fixation (6.8 ± 1.42 vs. 19.0 ± 2.88, P < 0.001). Smoking (odds ratio [OR], 0.24 for nonunion; 95% confidence interval [CI], 2.29-5.34; P = 0.008 and OR, 0.26 for deep infection; 95% CI, 0.10-0.71; P = 0.009), bone cement block formation (OR, 1.54; 95% CI, 2.06-4.73; P = 0.007), and local antibiotic use (OR, 4.89; 95% CI, 1.93-12.37; P < 0.001) were predictors of poor prognosis. CONCLUSION:The orthoplastic approach offers advantages in the treatment of Gustilo - Anderson type IIIB/C open tibial fractures. Smoking should be avoided, bone cement block molding should be actively adopted, and systemic and local antibiotics should be administered as early as possible. The Flap and Open Reduction Internal Fixation and Masquelet technique reduces the amount of bone graft without increasing deep infection risk.

BACKGROUND:The Sacral alar-iliac screw (SAIS) has stronger stability for sacroiliac joint fixation compared to the classical sacroiliac screw, making it particularly suitable for osteoporotic patients. However, the spinous process can hinder its percutaneous implantation. To address this, we developed a percutaneous retrograde SAIS (RSAIS) technique. This study aimed to explore the stability and preliminary application effects of percutaneous RSAIS for fixation of sacroiliac joint with low bone density. METHODS:A Tile type C fracture was simulated in fifteen artificial pelvises with low bone density and assigned to three groups. Each group received posterior fixation using one of the following: one sacroiliac screw (SIS) on each side, one transsacral-transiliac screw (TSTIS) on both sides, or one RSAIS on each side. Axial stiffness and maximum load to failure were analyzed. Additionally, two patients with sacroiliac joint pain (SIJP) and three patients with Tile type C pelvic fractures were treated with percutaneous RSAIS fixation. Four males and one female, aged 56 to 68 years with a T-value of -1.6 to -2.5 SD. The study observed screw insertion time, X-ray fluoroscopy time, screw position (Smith criterion), pain (VAS), and functional recovery (ODI and Majeed scores). RESULTS:RSAIS stiffness and maximum load were significantly greater than those of TSTIS and SIS (p < 0.05). The average insertion time was 30 min, intraoperative bleeding averaged 16 ml, and fluoroscopy time was 55 s per RSAIS placement. There were no surgery-related complications, and all screw positions were excellent. At 7-20 months postoperative follow-up, the VAS score recovered from preoperative 5.6-1.6, the ODI improved from 50.4 to 17, and the Majeed score for patients with pelvic fractures recovered from 59.7 to 81. No screw loosening was observed. CONCLUSION:RSAIS fixation stability for sacroiliac joints with low bone density is superior to SIS and TSTIS. The screw placement is simple, safe, and provides satisfactory therapeutic effects, making it suitable for patients with low bone density.

Background:Open fractures are critical injuries that require prompt and accurate diagnosis to optimize treatment outcomes. Traditional methods often rely on manual interpretation of radiological images, which can be prone to human error. With advancements in deep learning, there is a significant opportunity to enhance the precision of fracture classification through automated systems. Methods:Based on this, we developed a deep learning image processing model for the binary classification of tibiofibula open and closed fractures. By incorporating hybrid convolution with multi-scale convolutional kernels, we enhanced the model's feature extraction capabilities. To further optimize the feature selection process for orthopedic images, we integrated a channel attention mechanism, improving feature extraction without significantly increasing computational costs. Results:The results of the comparative experiments with other models show that our model's accuracy (ACC) surpasses that of the state-of-the-art classification models by 4.71%. Additionally, the F1 score of our model demonstrates a 4.77% improvement in precision. Moreover, the results of the ablation experiments indicate that each component of the constructed model effectively enhances performance. Conclusion:The findings of this study suggest that the proposed deep learning model significantly enhances the detection accuracy of open fractures. By integrating advanced feature extraction techniques and leveraging pre-trained models, our approach offers a promising tool for clinical application in orthopedic imaging, potentially leading to improved patient outcomes through more accurate diagnoses. Future work will focus on expanding the model's capabilities to include other fracture types and real-world clinical scenarios.

Managing large bone defects remains a significant clinical problem. We enhanced the osteogenic activity of the induced membrane (IM) by incorporating bone marrow fluid, leading to spontaneous osteogenesis (SO). We aimed to explore the application of this method in tibiofibular fusion (TFF) for reconstructing segmental tibial defects. Forty-two rats with femoral defects were divided into seven groups (n = 6). Defects in groups A1-3 and B1-3 were filled with polymethylmethacrylate spacers while Group B4 was the control. Kirschner wires were used in Groups A1 and B1, plating was used in Groups A3 and B3-4, while the medullary canal was sealed in Groups A2 and B2. In Group A, osteogenic activity was measured using immunohistochemistry, W-B, and qRT-PCR. In Group B, the osteogenic results were measured using X-ray and gross examinations. Ten patients with 4–10 cm segmental defects of the middle and distal tibia underwent reconstruction using the IM technique, and IM and bone marrow fluid-induced SO for TFF, whose effects were assessed. At five weeks, Group A1 showed higher levels of BMSCs and expression of BMP-2 and TGF-β1 than Groups A2 and A3 (p < 0.05). After 12 weeks, Group B1 had more new bone at the bone end than Group B3 (p = 0.009) whereas Groups B2 and B4 did not. All tibial defects and TFF healed. The TFF site and posterior tibia healed faster than the other sides and showed quicker clinical healing (p < 0.05). All patients could fully bear weight before tibial clinical healing, with an excellent-to-good functional rate of 80

The accumulation of excessive reactive oxygen species (ROS) and recurrent infections with drug-resistant bacteria pose significant challenges in diabetic wound infections, often leading to impediments in wound healing. Addressing this, there is a critical demand for novel strategies dedicated to treating and preventing diabetic wounds infected with drug-resistant bacteria. Herein, 2D tantalum carbide nanosheets (Ta(4)C(3)NSs) have been synthesized through an efficient and straightforward approach, leading to the development of a new, effective nanoplatform endowed with notable photothermal properties, biosafety, and diverse ROS scavenging capabilities, alongside immunogenic attributes for diabetic wound treatment and prevention of recurrent drug-resistant bacterial infections. The Ta4C3 NSs exhibit remarkable photothermal performance, effectively eliminating methicillin-resistant Staphylococcus aureus (MRSA) and excessive ROS, thus promoting diabetic wound healing. Furthermore, Ta4C3 NSs enhance dendritic cell activation, further triggering T helper 1 (T(H)1)/T(H)2 immune responses, leading to pathogen-specific immune memory against recurrent MRSA infections. This nanoplatform, with its significant photothermal and immunomodulatory effects, holds vast potential in the treatment and prevention of drug-resistant bacterial infections in diabetic wounds.

Background: The treatment of bone and soft-tissue defects after open fractures remains challenging. This study aimed to evaluate the clinical efficacy of the Masquelet technique combined with the free-flap technique (MFFT) versus the Ilizarov bone transport technique (IBTT) for the treatment of severe composite tibial and soft-tissue defects. Methods: We retrospectively analysed the data of 65 patients with tibial and soft-tissue defects and Gustilo type IIIB/C open fractures treated at our hospital between April 2015 and December 2021. The patients were divided into two groups based on the treatment method: group A (n = 35) was treated with the MFFT and internal fixation, and group B (n = 30) was treated with the IBTT. Results: The mean follow-up period was 28 months (range 13-133 months). Complete union of both soft-tissue and bone defects was achieved in all cases. The mean bone-union times were 6 months (range 3-12 months) in group A and 11 months (range 6-23 month) in group B, with a significant difference between the two groups (Z = -4.11, P = 0.001). The mean hospital stay was 28 days (range 14-67 d) in group A which was significantly longer than the mean stay of 18 days (range 10-43 d) in group B (Z = -2.608, P = 0.009). There were no significant differences in the infection rate between group A (17.1 %) and group B (26.7%) (chi 2 = 0.867, P = 0.352). The Total Physical Health Scores were 81.51 + 6.86 (range 67-90) in group A and 75.83+16.14 (range 44-98) in group B, with no significant difference between the two groups (t = 1.894, P = 0.063). The Total Mental Health Scores were significantly higher in group A (90.49 + 6.37; range 78-98) than in group B (84.70 + 13.72; range 60-98) (t = 2.232, P = 0.029). Conclusion: Compared with IBTT, MFFT is a better choice of treatment for open tibial and soft-tissue defects with Gustilo IIIB/C fractures. IBTT is the preferred option when the tibial bone defect is large or if the surgeon's expertise in microsurgery is limited.

Abstract Purpose Severe open forearm fractures commonly involve segmental bone defects. Although several methods have been proposed to treat segmental bone defects with such fractures, research comparing the radiological and clinical outcomes of free vascularized fibular grafts (FVFG) and the Masquelet technique (MT) is rare. Methods Data on 43 patients with open forearm fractures and segmental bone defects treated surgically in our hospital from January 2005 to January 2021 were retrospectively analyzed, and these patients were divided into an FVFG group (18 cases) and an MT group (25 cases). Clinical and radiological evaluations were performed regularly, and the minimum follow-up was 18 months. Results All 43 patients were followed up for 18 to 190 months, with a mean of 46.93 months. The mean follow-up time was significantly longer in the FVFG group than in the MT group (p = 0.000). Bone healing time was 3–16 months, with a mean of 4.67 months. The QuickDASH score at the last follow-up was 0–38.6, with a mean of 17.71, and there was no statistically significant difference between the two groups. Operative time, hospital stay, and intraoperative bleeding for bone defect reconstruction were higher in the FVFG group compared to the MT group (p = 0.000), whereas the number of procedures was lower in the FVFG group than in the MT group (p = 0.035). Conclusions FVFG and the MT showed satisfactory clinical results for segmental bone defects of the forearm. Compared with FVFG, the MT exhibited a lower operative time, hospital stay, and intraoperative bleeding. Level of evidence Level IV. Trial registration This study was registered in the Chinese Clinical Trial Registry (registration no. ChiCTR2300067675; registered 17 January 2023), https://www.chictr.org.cn/showproj.html?proj=189458.

Introduction Tissue damage due to ischemia and reperfusion is a critical medical problem worldwide. Studies in this field have made remarkable advances in understanding the pathogenesis of ischemia/reperfusion (I/R) injury and its treatment with new and known drugs. However, no bibliometric analysis exists in this area of research. Methods Research articles and reviews related to skeletal muscle I/R from 1986 to 2022 were retrieved from the Web of Science Core Collection. Bibliometric analysis was performed using Microsoft Excel 2019, VOSviewer (version 1.6.19), Bibliometrix (R-Tool for R-Studio), and CiteSpace (version 6.1.R5). Results A total of 3682 research articles and reviews from 2846 institutions in 83 countries were considered in this study. Most studies were conducted in the USA. Hobson RW (UMDNJ-New Jersey Medical School) had the highest publication, and Korthuis RJ (Louisiana State University) had the highest co-citations. Our analysis showed that, though the Journal of Surgical Research was most favored, the Journal of Biological Chemistry had the highest number of co-citations. The pathophysiology, interventions, and molecular mechanisms of skeletal muscle I/R injury emerged as the primary research areas, with “apoptosis,” “signaling pathway,” and “oxidative stress” as the main keywords of research hotspots. Conclusions This study provides a thorough overview of research trends and focal points in skeletal muscle I/R injury by applying bibliometric and visualization techniques. The insights gained from our findings offer a profound understanding of the evolving landscape of skeletal muscle I/R injury research, thereby functioning as a valuable reference and roadmap for future investigations.

Background This study aims to evaluate the surgical techniques and outcomes of treating elbow dislocations with coronoid and radial head fractures, commonly referred to as the terrible triad of the elbow (TTE), through a single olecranon osteotomy. Methods A retrospective analysis was performed on 73 patients diagnosed with TTE between January 2015 and April 2022. The cohort included 44 men and 29 women, with an average age of 40.0 ± 15.1 years (range, 18–68 years). Among these patients, Mason Type I, II, and III fractures were identified in 11, 42, and 20 cases, respectively, while Morrey Type I, II, and III fractures were observed in 45, 23, and five cases, respectively. All patients underwent treatment via a single olecranon osteotomy. The average interval between injury and surgery was 5.6 ± 1.6 days (range, 3–8 days). Elbow function was assessed using the Mayo Elbow Performance Score (MEPS), pain was measured via the Visual Analogue Scale (VAS), and quality of life was evaluated using the SF-36 questionnaire. Results Patients were followed for 15 to 60 months (mean, 37.1 ± 13.3 months). All coronoid and radial head fractures achieved complete healing, with an average recovery time of 4.3 ± 1.1 months (range, 3–6 months). By the final follow-up, all patients had regained normal elbow function. The mean elbow flexion was 124.4° ± 9.2°, extension was 9.6° ± 6.5°, and the total range of flexion-extension was 114.8° ± 11.7°. Forearm pronation averaged 77.3° ± 4.8°, supination 79.2° ± 6.5°, and total forearm rotation 156.5° ± 8.4°. The mean MEPS was 89.3 ± 6.4, with 36 patients achieving excellent scores and 37 obtaining good scores. Preoperative VAS scores averaged 8.78 ± 1.11, which significantly dropped to 0.97 ± 0.83 at the final follow-up (p = 0.000). The SF-36 preoperative PCS and MCS scores were 45.77 ± 3.59 and 60.67 ± 3.91, respectively, with postoperative improvements to 93.85 ± 2.65 (p = 0.000) and 95.79 ± 3.11 (p = 0.000). Conclusion This retrospective analysis indicates that a single olecranon osteotomy could be a viable treatment option for TTE. However, additional research involving a control group is essential to substantiate the efficacy of this technique.

Background The treatment of completely displaced midshaft clavicle fractures is still controversial, especially Robinson 2B fractures. Titanium elastic nail (TEN) fixation is a good option for simple fractures, but no reports exist on its use in complex fractures. This study aimed to present a surgical method using the Nice knot-assisted TEN fixation to treat Robinson 2B midshaft clavicular fractures. Methods A retrospective analysis of 29 patients who underwent fixation with TEN and had a 1-year postoperative follow-up between 2016 and 2020 was performed. The fractures were classified as Robinson type 2B1 in 17 cases and type 2B2 in 12 cases. Length of the incision, postoperative shoulder function Disability of Arm Shoulder and Hand (DASH) score and Constant score, complications rate, and second surgical incision length were recorded. Results The length of the incision was 2–6 cm (average 3.7 cm). All incisions healed by first intention, and no infection or nerve injury occurred. The Constant score was 92–100 (average 96) and the DASH score was 0-6.2 (mean, 2.64). TEN bending and hypertrophic nonunion occurred in one case (3.4%) and implant irritation occurred in four cases (13.8%) Fixation implants were removed at 12–26 months (mean, 14.6 months) after surgery, and the length of the second incision was 1-2.5 cm (average 1.3 cm). Conclusions Intramedullary fixation by TEN is approved as a suitable surgical technique in clavicular fracture treatment. Nice knot-assisted fixation provides multifragmentary fracture stabilization, contributing to good fracture healing. Surgeons should consider this technique in treating Robinson 2B midshaft clavicular fractures. Trial registration Retrospectively registered. This study was approved by the Ethics Committee of Wuxi Ninth People’s Hospital (LW20220021).

ObjectiveClinical concerns exist regarding the quality of bony consolidation in the context of the induced membrane technique. This study evaluates the clinical process of bone grafting in the second stage of induced membrane bone union in patients with tibial bone defects to infer the possibility of non‐union and establish a reliable and effective evaluation method combined with computed tomography (CT) to assess fracture healing.MethodsPatients with tibial bone defects who underwent the induced membrane technique at our hospital between February 2017 and February 2020 were retrospectively analyzed. The Hounsfield unit (HU) values of the patients were evaluated at different times during the second stage of bone grafting. Bone healing at the boundary value of the 120 HU output threshold (−1024 HU–3071 HU) was directionally selected, and the changes in the growth volume of union (new bone volume [selected according to HU value]/bone defect volume) were compared with analyzing individual class bone union. Method 1 involved X‐rays revealing that at least three of the four cortices were continuous and at least 2 mm thick, with the patient being pain free. For Method 2, new bone volume (selected according to HU value/bone defect volume) at the stage was compared with analyzing individual class healing. Receiver operating characteristic curve analysis was used for Methods 1 and 2.ResultsA total of 42 patients with a segmental bone defect with a mean age of 40.5 years (40.5 ± 8.3 years) were included. The relationship between bone graft volume and time variation was analyzed by single factor repeated variable analysis (F = 6.477, p = 0.016). Further, curve regression analysis showed that the change in bone graft volume over time presented a logarithmic curve pattern (Y = 0.563 + 0.086 × ln(X), Ra2 = 0.608, p = 0.041). ROC curve analysis showed that Method 2 is superior to Method 1 (AUC: 86.3% vs. 68.3%, p < 0.05).ConclusionThe induced membrane technique could be used to treat traumatic long bone defects, with fewer complications and a higher healing rate. The proposed imaging grading of HU (new bone volume/bone defect volume) can be used as a reference for the quality of bony consolidation with the induced membrane technique.

Purpose: To study the clinical effectiveness of the topical application of tranexamic acid in hand tendon release. Methods: This was a randomized controlled trial conducted after receiving approval from the local ethics committee according to guidelines from the Helsinki Declaration. Eighty patients who underwent hand tendon release operation in our hospital from January 2021 to December 2022 were included and randomly divided into 2 groups. Patients in the tranexamic acid group (40 cases) received intraoperative topical application of 2 g of tranexamic acid after tendon release, while patients in the conventional group (40 cases) did not receive topical application of tranexamic acid during operation. The operation time, perioperative hemoglobin changes, total blood loss, incidence of early postoperative complications, and total active movement (TAM) before surgery and 6 months after surgery were compared between the 2 groups. The continuous variable which follows normal distribution expressed by mean +/- SD and used t-test to compare between groups. Meanwhile, categorical variables were used by Chi-square test, and a p < 0.05 indicated that the differences were statistically significant. Results: Both groups were followed up for 7 - 18 months, with a mean of 10.3 months. Postoperative decrease in hemoglobin was significantly less in the tranexamic acid group than in the conventional group (t = 7.611, p < 0.001). The total blood loss in the tranexamic acid group (74.33 +/- 20.50) mL was less than that in the conventional group (83.05 +/- 17.73) mL, and the difference was statistically significant (p < 0.05). Both groups showed improvement in thumb/finger flexion and extension range of motion after surgery, and the TAM improved compared with those before surgery, and the difference was statistically significant (p < 0.001). The TAM improved more significantly in the tranexamic acid group (87.68 degrees +/- 10.44 degrees) than in the conventional group (80.47 degrees +/- 10.93 degrees) at 6 months after surgery, with a statistically significant difference (t = 3.013, p < 0.001). There was no significant difference in operation time and incidence of early postoperative complications between the 2 groups (p = 0.798, 0.499, respectively). Conclusion: The topical application of tranexamic acid during hand tendon release can significantly reduce postoperative bleeding and improve surgical efficacy, which is worth promoting. (c) 2023 Chinese Medical Association. Production and hosting by Elsevier B.V.

Objective:To explore the effectiveness of using antibiotic bone cement-coated plates internal fixation technology as a primary treatment for Gustilo type ⅢB tibiofibular open fractures.Methods:The clinical data of 24 patients with Gustilo type ⅢB tibiofibular open fractures who were admitted between January 2018 and December 2021 and met the selection criteria was retrospectively analyzed. Among them, there were 18 males and 6 females, aged from 25 to 65 years with an average age of 45.8 years. There were 3 cases of proximal tibial fracture, 6 cases of middle tibial fracture, 15 cases of distal tibial fracture, and 21 cases of fibular fracture. The time from injury to emergency surgery ranged from 3 to 12 hours, with an average of 5.3 hours. All patients had soft tissue defects ranging from 10 cm×5 cm to 32 cm×15 cm. The time from injury to skin flap transplantation for wound coverage ranged from 1 to 7 days, with an average of 4.1 days, and the size of skin flap ranged from 10 cm×5 cm to 33 cm×15 cm. Ten patients had bone defects with length of 2-12 cm (mean, 7.1 cm). After emergency debridement, the tibial fracture end was fixed with antibiotic bone cement-coated plates, and the bone defect area was filled with antibiotic bone cement. Within 7 days, the wound was covered with a free flap, and the bone cement was replaced while performing definitive internal fixation of the fracture. In 10 patients with bone defect, all the bone cement was removed and the bone defect area was grafted after 7-32 weeks (mean, 11.8 weeks). The flap survival, wound healing of the affected limb, complications, and bone healing were observed after operation, and the quality of life was evaluated according to the short-form 36 health survey scale (SF-36 scale) [including physical component summary (PCS) and mental component summary (MCS) scores] at 1 month, 6 months after operation, and at last follow-up.Results:All 24 patients were followed up 14-38 months (mean, 21.6 months). All the affected limbs were successfully salvaged and all the transplanted flaps survived. One case had scar hyperplasia in the flap donor site, and 1 case had hypoesthesia (grade S3) of the skin around the scar. There were 2 cases of infection in the recipient area of the leg, one of which was superficial infection after primary flap transplantation and healed after debridement, and the other was sinus formation after secondary bone grafting and was debrided again 3 months later and treated with Ilizarov osteotomy, and healed 8 months later. The bone healing time of the remaining 23 patients ranged from 4 to 9 months, with an average of 6.1 months. The scores of PCS were 44.4±6.5, 68.3±8.3, 80.4±6.9, and the scores of MCS were 59.2±8.2, 79.5±7.8, 90.0±6.6 at 1 month, 6 months after operation, and at last follow-up, respectively. The differences were significant between different time points ( P<0.05).Conclusion:Antibiotic bone cement-coated plates internal fixation can be used in the primary treatment of Gustilo type ⅢB tibiofibular open fractures, and has the advantages of reduce the risk of infection in fracture fixation, reducing complications, and accelerating the functional recovery of patients.