<p><strong>Purpose: </strong>To retrospectively compare the clinical outcomes of intra-capsular vs. extra-capsular release of the lateral patellar retinaculum using 2 novel surgical techniques: the capsule-uncut immaculate lateral retinacular release (CUI method), and the L-shaped lateral retinacular release (L-shaped release).</p><p><strong>Methods: </strong>This is a retrospective comparative study. The clinical data of patients admitted to our department between October 2010 and October 2020 were retrospectively analyzed. Patients diagnosed with excessive lateral pressure syndrome and treated with arthroscopic retinacular release, with complete imaging data, and followed up for >1 year were included in the study. Previous history of knee surgery, cruciate ligament or collateral ligament ruptures, neoplastic diseases of the knee, patellar instability, history of knee fracture, varus/valgus of the knee joint, or Q angle >20° were exclusion criteria. All the included cases were divided into 2 groups based on the surgical method and subsequently stratified by age. The visual analogue pain scale was used to evaluate the degree of knee pain. Lysholm score and the International Knee Documentation Committee knee evaluation form score were used to evaluate knee function and activity. The preoperative and postoperative patellar tilt angles of the affected knee were measured. Comparison between groups was performed by the Wilcoxon test or the Mann-Whitney U test. Count data was represented by frequency, and comparison between groups was performed by χ<sup>2</sup> test. Mann-Whitney U test and multiple linear regression model were used for univariate and multivariate analysis.</p><p><strong>Results: </strong>The clinical data of 200 patients were retrospectively analyzed. After screening by inclusion and exclusion criteria, 90 cases met the inclusion and exclusion criteria and were included in this study. The postoperative visual analogue scale scores of both groups were significantly lower than those before operation (p<0.001), and the postoperative Lysholm score and the score of the postoperative International Knee Documentation Committee knee evaluation form of the 2 groups were significantly higher than those before operation (p<0.001). The L-shaped release group was significantly higher than the CUI method group in Lysholm score (p=0.008). In the age ≥50 years group, the Lysholm score of the CUI method group was significantly lower than the L-shaped release group (p<0.001), and the changes in patellar tilt angle were significantly larger in the CUI method group than in the L-shaped release group (p=0.016). In the age <50 years group, there was no significant difference.</p><p><strong>Conclusions: </strong>Both the surgical methods have good clinical effects. L-shaped release is superior to the CUI method in improving knee function in the elderly patients (≥50 years old), while the CUI method is superior to L-shaped release in correcting patellar tilt
{"title":"To compare the clinical outcomes of intra-capsular vs. extra-capsular lateral retinacular release in the treatment of excessive lateral pressure syndrome of patella using two novel surgical techniques: A retrospective comparative study.","authors":"Minghao Li, Weili Shi, Jianli Gao, Yueyang Hou, Yuping Yang, Guoqing Cui","doi":"10.1016/j.cjtee.2025.01.004","DOIUrl":"https://doi.org/10.1016/j.cjtee.2025.01.004","url":null,"abstract":"<p><strong>Purpose: </strong>To retrospectively compare the clinical outcomes of intra-capsular vs. extra-capsular release of the lateral patellar retinaculum using 2 novel surgical techniques: the capsule-uncut immaculate lateral retinacular release (CUI method), and the L-shaped lateral retinacular release (L-shaped release).</p><p><strong>Methods: </strong>This is a retrospective comparative study. The clinical data of patients admitted to our department between October 2010 and October 2020 were retrospectively analyzed. Patients diagnosed with excessive lateral pressure syndrome and treated with arthroscopic retinacular release, with complete imaging data, and followed up for >1 year were included in the study. Previous history of knee surgery, cruciate ligament or collateral ligament ruptures, neoplastic diseases of the knee, patellar instability, history of knee fracture, varus/valgus of the knee joint, or Q angle >20° were exclusion criteria. All the included cases were divided into 2 groups based on the surgical method and subsequently stratified by age. The visual analogue pain scale was used to evaluate the degree of knee pain. Lysholm score and the International Knee Documentation Committee knee evaluation form score were used to evaluate knee function and activity. The preoperative and postoperative patellar tilt angles of the affected knee were measured. Comparison between groups was performed by the Wilcoxon test or the Mann-Whitney U test. Count data was represented by frequency, and comparison between groups was performed by χ<sup>2</sup> test. Mann-Whitney U test and multiple linear regression model were used for univariate and multivariate analysis.</p><p><strong>Results: </strong>The clinical data of 200 patients were retrospectively analyzed. After screening by inclusion and exclusion criteria, 90 cases met the inclusion and exclusion criteria and were included in this study. The postoperative visual analogue scale scores of both groups were significantly lower than those before operation (p<0.001), and the postoperative Lysholm score and the score of the postoperative International Knee Documentation Committee knee evaluation form of the 2 groups were significantly higher than those before operation (p<0.001). The L-shaped release group was significantly higher than the CUI method group in Lysholm score (p=0.008). In the age ≥50 years group, the Lysholm score of the CUI method group was significantly lower than the L-shaped release group (p<0.001), and the changes in patellar tilt angle were significantly larger in the CUI method group than in the L-shaped release group (p=0.016). In the age <50 years group, there was no significant difference.</p><p><strong>Conclusions: </strong>Both the surgical methods have good clinical effects. L-shaped release is superior to the CUI method in improving knee function in the elderly patients (≥50 years old), while the CUI method is superior to L-shaped release in correcting patellar tilt","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01DOI: 10.1016/j.cjtee.2023.11.007
Tilak Rommel Pinto , Chiranjeevi Srinivasa Gowda , Anston Vernon Braggs , Kiyana Mirza , Aravinda Hegde K
Purpose
Ultrasonography has been used increasingly in orthopaedic practice credited to its low cost, easy accessibility, non-invasiveness, reproducibility, and safety from radiation. The purpose of this study was to test the validity and efficacy of ultrasonography as an adjunct in the assessment of fracture healing in long bones treated with intramedullary interlocking devices and its predictive value in determining the need for a secondary surgical procedure.
Methods
This was a descriptive longitudinal study of 40 skeletally mature patients from November 2016 to February 2019, who sustained long bone fractures of the tibia or femur treated using intramedullary interlocking nails. Patients with comminuted and segmental fracture patterns were excluded from the study. Each patient was evaluated at 6- and 12-week post-surgery using standard orthogonal radiographs and ultrasonography to assess fracture healing. Patients were then followed up until fracture union. Quantitative data was analyzed using frequency statistics and descriptive data with inferential statistics.
Results
Ultrasonography predicted 87.5% union and 12.5% delayed or non-union as early as 6 weeks after surgery, while radiographs predicted 22.5% union as late as 3 months of follow-up. The sensitivity and specificity of ultrasonography in assessing fracture healing were 100% and 97.2%, respectively, with a positive predictive value of 80.0%. Vascular resistance index was less than 0.5 in all patients who developed delayed or non-union.
Conclusion
Ultrasonography is able to predict fracture outcomes much earlier than standardized radiographs with comparable sensitivity and specificity. Vascular resistance index is an objective parameter in assessing callus quality and predicting fracture outcomes.
{"title":"The value of ultrasonography in predicting the outcomes of simple long bone fractures treated by closed intramedullary nail fixation","authors":"Tilak Rommel Pinto , Chiranjeevi Srinivasa Gowda , Anston Vernon Braggs , Kiyana Mirza , Aravinda Hegde K","doi":"10.1016/j.cjtee.2023.11.007","DOIUrl":"10.1016/j.cjtee.2023.11.007","url":null,"abstract":"<div><h3>Purpose</h3><div>Ultrasonography has been used increasingly in orthopaedic practice credited to its low cost, easy accessibility, non-invasiveness, reproducibility, and safety from radiation. The purpose of this study was to test the validity and efficacy of ultrasonography as an adjunct in the assessment of fracture healing in long bones treated with intramedullary interlocking devices and its predictive value in determining the need for a secondary surgical procedure.</div></div><div><h3>Methods</h3><div>This was a descriptive longitudinal study of 40 skeletally mature patients from November 2016 to February 2019, who sustained long bone fractures of the tibia or femur treated using intramedullary interlocking nails. Patients with comminuted and segmental fracture patterns were excluded from the study. Each patient was evaluated at 6- and 12-week post-surgery using standard orthogonal radiographs and ultrasonography to assess fracture healing. Patients were then followed up until fracture union. Quantitative data was analyzed using frequency statistics and descriptive data with inferential statistics.</div></div><div><h3>Results</h3><div>Ultrasonography predicted 87.5% union and 12.5% delayed or non-union as early as 6 weeks after surgery, while radiographs predicted 22.5% union as late as 3 months of follow-up. The sensitivity and specificity of ultrasonography in assessing fracture healing were 100% and 97.2%, respectively, with a positive predictive value of 80.0%. Vascular resistance index was less than 0.5 in all patients who developed delayed or non-union.</div></div><div><h3>Conclusion</h3><div>Ultrasonography is able to predict fracture outcomes much earlier than standardized radiographs with comparable sensitivity and specificity. Vascular resistance index is an objective parameter in assessing callus quality and predicting fracture outcomes.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 3","pages":"Pages 181-186"},"PeriodicalIF":1.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139022719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01DOI: 10.1016/j.cjtee.2024.01.006
Xiang-Ping Luo, Jian Peng, Ling Zhou, Hao Liao, Xiao-Chun Jiang, Xiong Tang, Dun Tang, Chao Liu, Jian-Hui Liu
Purpose
Intertrochanteric fractures undergoing proximal femoral nail antirotation (PFNA) surgery are associated with significant hidden blood loss. This study aimed to explore whether intramedullary administration of tranexamic acid (TXA) can reduce bleeding in PFNA surgery for intertrochanteric fractures in elderly individuals.
Methods
A randomized controlled trial was conducted from January 2019 to December 2022. Patients aged over 60 years with intertrochanteric fractures who underwent intramedullary fixation surgery with PFNA were eligible for inclusion and grouped according to random numbers. A total of 249 patients were initially enrolled, of which 83 were randomly allocated to the TXA group and 82 were allocated to the saline group. The TXA group received intramedullary perfusion of TXA after the bone marrow was reamed. The primary outcomes were total peri-operative blood loss and post-operative transfusion rate. The occurrence of adverse events was also recorded. Continuous data was analyzed by unpaired t-test or Mann-Whitney U test, and categorical data was analyzed by Pearson Chi-square test.
Results
The total peri-operative blood loss (mL) in the TXA group was significantly lower than that in the saline group (577.23 ± 358.02 vs. 716.89 ± 420.30, p = 0.031). The post-operative transfusion rate was 30.67% in the TXA group and 47.95% in the saline group (p = 0.031). The extent of post-operative deep venous thrombosis and the 3-month mortality rate were similar between the 2 groups.
Conclusion
We observed that intramedullary administration of TXA in PFNA surgery for intertrochanteric fractures in elderly individuals resulted in less peri-operative blood loss and decreased transfusion rate, without any adverse effects, and is, thus, recommended.
目的：接受股骨近端钉抗旋转（PFNA）手术的转子间骨折与大量隐性失血有关。本研究旨在探讨髓内注射氨甲环酸（TXA）能否减少老年人股骨转子间骨折 PFNA 手术中的出血量：方法：2019年1月至2022年12月进行了一项随机对照试验。年龄在60岁以上、接受PFNA髓内固定手术的转子间骨折患者均符合纳入条件，并根据随机编号进行分组。共有249名患者被初步纳入，其中83人被随机分配到TXA组，82人被分配到生理盐水组。TXA组在骨髓扩孔后接受髓内TXA灌注。主要结果是围手术期总失血量和术后输血率。此外，还记录了不良事件的发生情况。连续数据采用非配对 t 检验或 Mann-Whitney U 检验，分类数据采用 Pearson Chi-square 检验：TXA组的围手术期总失血量（毫升）明显低于生理盐水组（577.23 ± 358.02 vs. 716.89 ± 420.30，P = 0.031）。TXA 组的术后输血率为 30.67%，生理盐水组为 47.95%（P = 0.031）。两组的术后深静脉血栓形成程度和 3 个月死亡率相似：我们观察到，在老年转子间骨折的 PFNA 手术中，髓内注射 TXA 可减少围手术期失血，降低输血率，且无任何不良反应，因此值得推荐。
{"title":"Intramedullary administration of tranexamic acid reduces bleeding in proximal femoral nail antirotation surgery for intertrochanteric fractures in elderly individuals: A randomized controlled trial","authors":"Xiang-Ping Luo, Jian Peng, Ling Zhou, Hao Liao, Xiao-Chun Jiang, Xiong Tang, Dun Tang, Chao Liu, Jian-Hui Liu","doi":"10.1016/j.cjtee.2024.01.006","DOIUrl":"10.1016/j.cjtee.2024.01.006","url":null,"abstract":"<div><h3>Purpose</h3><div>Intertrochanteric fractures undergoing proximal femoral nail antirotation (PFNA) surgery are associated with significant hidden blood loss. This study aimed to explore whether intramedullary administration of tranexamic acid (TXA) can reduce bleeding in PFNA surgery for intertrochanteric fractures in elderly individuals.</div></div><div><h3>Methods</h3><div>A randomized controlled trial was conducted from January 2019 to December 2022. Patients aged over 60 years with intertrochanteric fractures who underwent intramedullary fixation surgery with PFNA were eligible for inclusion and grouped according to random numbers. A total of 249 patients were initially enrolled, of which 83 were randomly allocated to the TXA group and 82 were allocated to the saline group. The TXA group received intramedullary perfusion of TXA after the bone marrow was reamed. The primary outcomes were total peri-operative blood loss and post-operative transfusion rate. The occurrence of adverse events was also recorded. Continuous data was analyzed by unpaired <em>t</em>-test or Mann-Whitney <em>U</em> test, and categorical data was analyzed by Pearson Chi-square test.</div></div><div><h3>Results</h3><div>The total peri-operative blood loss (mL) in the TXA group was significantly lower than that in the saline group (577.23 ± 358.02 <em>vs.</em> 716.89 ± 420.30, <em>p</em> = 0.031). The post-operative transfusion rate was 30.67% in the TXA group and 47.95% in the saline group (<em>p</em> = 0.031). The extent of post-operative deep venous thrombosis and the 3-month mortality rate were similar between the 2 groups.</div></div><div><h3>Conclusion</h3><div>We observed that intramedullary administration of TXA in PFNA surgery for intertrochanteric fractures in elderly individuals resulted in less peri-operative blood loss and decreased transfusion rate, without any adverse effects, and is, thus, recommended.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 3","pages":"Pages 201-207"},"PeriodicalIF":1.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140013740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01DOI: 10.1016/j.cjtee.2024.04.003
Jiang-Hong Wu , Quan-Wei Bao , Shao-Kang Wang , Pan-Yu Zhou , Shuo-Gui Xu
The Masquelet technique, also known as the induced membrane technique, is a surgical technique for repairing large bone defects based on the use of a membrane generated by a foreign body reaction for bone grafting. This technique is not only simple to perform, with few complications and quick recovery, but also has excellent clinical results. To better understand the mechanisms by which this technique promotes bone defect repair and the factors that require special attention in practice, we examined and summarized the relevant research advances in this technique by searching, reading, and analysing the literature. Literature show that the Masquelet technique may promote the repair of bone defects through the physical septum and molecular barrier, vascular network, enrichment of mesenchymal stem cells, and high expression of bone-related growth factors, and the repair process is affected by the properties of spacers, the timing of bone graft, mechanical environment, intramembrane filling materials, artificial membrane, and pharmaceutical/biological agents/physical stimulation.
{"title":"Mechanisms of the Masquelet technique to promote bone defect repair and its influencing factors","authors":"Jiang-Hong Wu , Quan-Wei Bao , Shao-Kang Wang , Pan-Yu Zhou , Shuo-Gui Xu","doi":"10.1016/j.cjtee.2024.04.003","DOIUrl":"10.1016/j.cjtee.2024.04.003","url":null,"abstract":"<div><div>The Masquelet technique, also known as the induced membrane technique, is a surgical technique for repairing large bone defects based on the use of a membrane generated by a foreign body reaction for bone grafting. This technique is not only simple to perform, with few complications and quick recovery, but also has excellent clinical results. To better understand the mechanisms by which this technique promotes bone defect repair and the factors that require special attention in practice, we examined and summarized the relevant research advances in this technique by searching, reading, and analysing the literature. Literature show that the Masquelet technique may promote the repair of bone defects through the physical septum and molecular barrier, vascular network, enrichment of mesenchymal stem cells, and high expression of bone-related growth factors, and the repair process is affected by the properties of spacers, the timing of bone graft, mechanical environment, intramembrane filling materials, artificial membrane, and pharmaceutical/biological agents/physical stimulation.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 3","pages":"Pages 157-163"},"PeriodicalIF":1.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140786844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hoffa fracture is a femoral condyle fracture in the coronal plane. The lateral condyle is more commonly involved. The diagnosis is often difficult to detect with routine radiographs. Conservative management in this type of fracture resulted in nonunion, malunion, and other complications, such as stiff knee. Therefore, surgical management is mandatory in displaced fractures. Previous studies suggest only application of cancellous screw fixation, but these are not enough to counter vertical shear stress. Therefore, this study will evaluate the clinical outcomes of open reduction and internal fixation of Letenneur type I Hoffa fracture using cancellous screws with posterior buttressing plate.
Method
This was a prospective cohort study conducted from March 2017 to July 2022 in orthopaedics department of tertiary care center after approval of institutional ethical committee. The study included 36 patients with Letenneur type I fractures treated by open reduction and internal fixation using posterior buttress plate and cancellous screws. Radiographs and clinical outcomes, range of movement (ROM), bone union, and knee society score (KSS) of patients were assessed at the end of 4 and 12 months in the follow-ups. All statistical analysis was done using Epi info version 7.2.1.0.
Results
In the 36 patients with Letenneur type I fracture, the majority belong to younger age group between 25 and 54 years with 22 males and 14 females. The modes of injury were road traffic accidents in 25 patients and fall from height in 11 patients. The right knee was involved in 21 cases and left was involved in 15 cases. Lateral condyle involvement was seen in 27 cases and medial condyle in 9 cases. All 36 patients with Letenneur type I Hoffa fracture were evaluated 4 months after surgical intervention. The notable improvements were observed in terms of ROM 120.4° ± 5.0° and KSS 85.0 ± 4.2. At the 12-month follow-up, considerably better outcomes were maintained regarding ROM 128.1° ± 5.2° and KSS 89.3 ± 4.8 with p < 0.05 which was statistically significant. At the final follow-up, all patients had routine fracture healing with a union time of (3.2 ± 3.4) months.
Conclusions
Fixation of Letenneur type I Hoffa fracture with cancellous screws and posterior buttress plate is effective, reliable and capable of providing adequate stability. Buttress plate assisted fixation is a valuable enhancement of the conventional technique of lag screw fixation of Hoffa fractures.
目的：Hoffa 骨折是冠状面上的股骨髁骨折。外侧髁更常受累。常规X光片往往难以诊断。保守治疗会导致骨折不愈合、错位和其他并发症，如膝关节僵硬。因此，对于移位骨折必须进行手术治疗。以往的研究建议仅应用松质骨螺钉固定，但这不足以对抗垂直剪切应力。因此，本研究将评估使用松质骨螺钉与后托板对Letenneur I型Hoffa骨折进行切开复位内固定的临床效果：这是一项前瞻性队列研究，经机构伦理委员会批准后，于2017年3月至2022年7月在三级医疗中心骨科开展。研究共纳入36例Letenneur I型骨折患者，均采用后托钢板和松质骨螺钉进行切开复位内固定治疗。随访4个月和12个月后，对患者的X光片和临床疗效、活动范围（ROM）、骨结合情况和膝关节社会评分（KSS）进行评估。所有统计分析均使用 Epi info 7.2.1.0 版进行：在36名Letenneur I型骨折患者中，大多数年龄在25至54岁之间，其中男性22人，女性14人。受伤方式为道路交通事故（25 例）和高空坠落（11 例）。21例患者右膝受累，15例患者左膝受累。外侧髁受累 27 例，内侧髁受累 9 例。所有 36 例 Letenneur I 型霍法骨折患者均在手术治疗 4 个月后接受了评估。患者的活动度（ROM）为120.4°±5.0°，KSS为85.0±4.2，均有明显改善。在 12 个月的随访中，在 ROM 128.1° ± 5.2°和 KSS 89.3 ± 4.8（P）方面保持了更好的结果：用松质骨螺钉和后托板固定 Letenneur I 型 Hoffa 骨折是有效、可靠的，并能提供足够的稳定性。对接钢板辅助固定是对传统的 Hoffa 骨折滞后螺钉固定技术的重要改进。
{"title":"Novel approach of plate assisted buttressing in Hoffa fracture","authors":"Amit Singh , Nirottam Singh , Gaurav Siwach , Mohit Bansal , Hemant Jain , Kishore Raichandani","doi":"10.1016/j.cjtee.2024.02.003","DOIUrl":"10.1016/j.cjtee.2024.02.003","url":null,"abstract":"<div><h3>Purpose</h3><div>Hoffa fracture is a femoral condyle fracture in the coronal plane. The lateral condyle is more commonly involved. The diagnosis is often difficult to detect with routine radiographs. Conservative management in this type of fracture resulted in nonunion, malunion, and other complications, such as stiff knee. Therefore, surgical management is mandatory in displaced fractures. Previous studies suggest only application of cancellous screw fixation, but these are not enough to counter vertical shear stress. Therefore, this study will evaluate the clinical outcomes of open reduction and internal fixation of Letenneur type I Hoffa fracture using cancellous screws with posterior buttressing plate.</div></div><div><h3>Method</h3><div>This was a prospective cohort study conducted from March 2017 to July 2022 in orthopaedics department of tertiary care center after approval of institutional ethical committee. The study included 36 patients with Letenneur type I fractures treated by open reduction and internal fixation using posterior buttress plate and cancellous screws. Radiographs and clinical outcomes, range of movement (ROM), bone union, and knee society score (KSS) of patients were assessed at the end of 4 and 12 months in the follow-ups. All statistical analysis was done using Epi info version 7.2.1.0.</div></div><div><h3>Results</h3><div>In the 36 patients with Letenneur type I fracture, the majority belong to younger age group between 25 and 54 years with 22 males and 14 females. The modes of injury were road traffic accidents in 25 patients and fall from height in 11 patients. The right knee was involved in 21 cases and left was involved in 15 cases. Lateral condyle involvement was seen in 27 cases and medial condyle in 9 cases. All 36 patients with Letenneur type I Hoffa fracture were evaluated 4 months after surgical intervention. The notable improvements were observed in terms of ROM 120.4° ± 5.0° and KSS 85.0 ± 4.2. At the 12-month follow-up, considerably better outcomes were maintained regarding ROM 128.1° ± 5.2° and KSS 89.3 ± 4.8 with <em>p</em> < 0.05 which was statistically significant. At the final follow-up, all patients had routine fracture healing with a union time of (3.2 ± 3.4) months.</div></div><div><h3>Conclusions</h3><div>Fixation of Letenneur type I Hoffa fracture with cancellous screws and posterior buttress plate is effective, reliable and capable of providing adequate stability. Buttress plate assisted fixation is a valuable enhancement of the conventional technique of lag screw fixation of Hoffa fractures.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 3","pages":"Pages 175-180"},"PeriodicalIF":1.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140133248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Road traffic accidents (RTA), assaults, falls, and sports-related injuries are the leading causes of maxillofacial trauma. Due to quite different geographical environment and fast urbanization, the use of various protective equipment is restricted in India. Thus, compared to other countries, there might be a significant difference in the pattern and frequency of associated injuries among subjects with maxillofacial trauma. The present study was conducted to identify the causes and pattern of various maxillofacial fractures and the frequency of other related injuries among subjects with maxillofacial trauma.
Methods
This is a cross-sectional retrospective study recording 2617 subjects with maxillofacial trauma from October 2017 to October 2022. The patient demographics, causes of trauma, types of maxillofacial injury, and associated soft and hard tissue injuries were recorded. The types of maxillofacial and associated injuries were diagnosed from details of clinical examinations and the interpretation of various radiographs available in the file. The associated injuries were divided into head injury, other bony injuries, and soft tissue and vital structure injuries. Descriptive statistics and the test of proportion were used. A p value < 0.05 was considered as a level of significance.
Results
The maxillofacial injuries were significantly common in patients aged 16 – 45 years (66.7%) than in patients aged ≤ 15 and > 46 years (33.3%) (p < 0.001). The RTA was the most common cause of maxillofacial injury (n = 2139, 81.7%), followed by fall (n = 206, 7.9%), other causes of injury (n = 178, 6.8%), and assaults (n = 94, 3.6%). The maxillofacial injury by 2-wheel vehicle accidents was significantly higher than that by 4-wheel vehicle and other vehicle accidents (p < 0.001). There was a significant correlation between alcohol and RTA (p < 0.001). The head injury (n = 931, 61.1%) was the most common associated injury, followed by soft tissue and vital structures injuries (n = 328, 21.5%) and other bone injuries (n = 264, 17.3%).
Discussion
Head injury was the most common associated injury followed by soft tissue and vital structures and bone injuries among subjects with maxillofacial trauma. Clavicle fracture and injury to the lower extremities were the most common hard and soft tissue-associated injuries.
{"title":"Frequency of concomitant injuries in maxillofacial trauma in a tertiary health care centre in India: A 5-year retrospective study","authors":"Saubhik Dasukil, Shiwangi Verma, Ashok Kumar Jena, Mounabati Mohapatra","doi":"10.1016/j.cjtee.2024.03.008","DOIUrl":"10.1016/j.cjtee.2024.03.008","url":null,"abstract":"<div><h3>Purpose</h3><div>Road traffic accidents (RTA), assaults, falls, and sports-related injuries are the leading causes of maxillofacial trauma. Due to quite different geographical environment and fast urbanization, the use of various protective equipment is restricted in India. Thus, compared to other countries, there might be a significant difference in the pattern and frequency of associated injuries among subjects with maxillofacial trauma. The present study was conducted to identify the causes and pattern of various maxillofacial fractures and the frequency of other related injuries among subjects with maxillofacial trauma.</div></div><div><h3>Methods</h3><div>This is a cross-sectional retrospective study recording 2617 subjects with maxillofacial trauma from October 2017 to October 2022. The patient demographics, causes of trauma, types of maxillofacial injury, and associated soft and hard tissue injuries were recorded. The types of maxillofacial and associated injuries were diagnosed from details of clinical examinations and the interpretation of various radiographs available in the file. The associated injuries were divided into head injury, other bony injuries, and soft tissue and vital structure injuries. Descriptive statistics and the test of proportion were used. A <em>p</em> value < 0.05 was considered as a level of significance.</div></div><div><h3>Results</h3><div>The maxillofacial injuries were significantly common in patients aged 16 – 45 years (66.7%) than in patients aged ≤ 15 and > 46 years (33.3%) (<em>p</em> < 0.001). The RTA was the most common cause of maxillofacial injury (<em>n</em> = 2139, 81.7%), followed by fall (<em>n</em> = 206, 7.9%), other causes of injury (<em>n</em> = 178, 6.8%), and assaults (<em>n</em> = 94, 3.6%). The maxillofacial injury by 2-wheel vehicle accidents was significantly higher than that by 4-wheel vehicle and other vehicle accidents (<em>p</em> < 0.001). There was a significant correlation between alcohol and RTA (<em>p</em> < 0.001). The head injury (<em>n</em> = 931, 61.1%) was the most common associated injury, followed by soft tissue and vital structures injuries (<em>n</em> = 328, 21.5%) and other bone injuries (<em>n</em> = 264, 17.3%).</div></div><div><h3>Discussion</h3><div>Head injury was the most common associated injury followed by soft tissue and vital structures and bone injuries among subjects with maxillofacial trauma. Clavicle fracture and injury to the lower extremities were the most common hard and soft tissue-associated injuries.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 3","pages":"Pages 216-219"},"PeriodicalIF":1.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140282025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01DOI: 10.1016/j.cjtee.2024.03.001
Cheng Chen , Jin-Rong Lin , Yi Zhang , Tian-Bao Ye , Yun-Feng Yang
Purpose
To comprehensively analyze the geographic and temporal trends of foot fracture, understand its health burden by age, sex, and sociodemographic index (SDI), and explore its leading causes from 1990 to 2019.
Methods
The datasets in the present study were generated from the Global Burden of Diseases Study 2019, which included foot fracture data from 1990 to 2019. We extracted estimates along with the 95% uncertainty interval (UI) for the incidence and years lived with disability (YLDs) of foot fracture by location, age, gender, and cause. The epidemiology and burden of foot fracture at the global, regional, and national level was exhibited. Next, we presented the age and sex patterns of foot fracture. The leading cause of foot fracture was another focus of this study from the viewpoint of age, sex, and location. Then, Pearson's correlations between age-standardized rate (ASR), SDI, and estimated annual percentage change were calculated.
Results
The age-standardized incidence rate was 138.68 (95% UI: 104.88 − 182.53) per 100,000 persons for both sexes, 174.24 (95% UI: 134.35 − 222.49) per 100,000 persons for males, and 102.19 (95% UI: 73.28 − 138.00) per 100,000 persons for females in 2019. The age-standardized YLDs rate was 5.91 (95% UI: 3.58 − 9.25) per 100,000 persons for both genders, 7.35 (95% UI: 4.45 − 11.50) per 100,000 persons for males, and 4.51 (95% UI: 2.75 − 7.03) per 100,000 persons for females in 2019. The global incidence and YLDs of foot fracture increased in number and decreased in ASR from 1990 to 2019. The global geographical distribution of foot fracture is uneven. The incidence rate for males peaked at the age group of 20 – 24 years, while that for females increased with advancing age. The incidence rate of older people was rising, as younger age incidence rate declined from 1990 to 2019. Falls, exposure to mechanical forces, and road traffic injuries were the 3 leading causes of foot fracture. Correlations were observed between ASR, estimated annual percentage change, and SDI.
Conclusions
The burden of foot fracture remains high globally, and it poses an enormous public health challenge, with population aging. It is necessary to allocate more resources to the high-risk populations. Targeted realistic intervention policies and strategies are warranted.
{"title":"A systematic analysis on global epidemiology and burden of foot fracture over three decades","authors":"Cheng Chen , Jin-Rong Lin , Yi Zhang , Tian-Bao Ye , Yun-Feng Yang","doi":"10.1016/j.cjtee.2024.03.001","DOIUrl":"10.1016/j.cjtee.2024.03.001","url":null,"abstract":"<div><h3>Purpose</h3><div>To comprehensively analyze the geographic and temporal trends of foot fracture, understand its health burden by age, sex, and sociodemographic index (SDI), and explore its leading causes from 1990 to 2019.</div></div><div><h3>Methods</h3><div>The datasets in the present study were generated from the Global Burden of Diseases Study 2019, which included foot fracture data from 1990 to 2019. We extracted estimates along with the 95% uncertainty interval (<em>UI</em>) for the incidence and years lived with disability (YLDs) of foot fracture by location, age, gender, and cause. The epidemiology and burden of foot fracture at the global, regional, and national level was exhibited. Next, we presented the age and sex patterns of foot fracture. The leading cause of foot fracture was another focus of this study from the viewpoint of age, sex, and location. Then, Pearson's correlations between age-standardized rate (ASR), SDI, and estimated annual percentage change were calculated.</div></div><div><h3>Results</h3><div>The age-standardized incidence rate was 138.68 (95% <em>UI</em>: 104.88 − 182.53) per 100,000 persons for both sexes, 174.24 (95% <em>UI</em>: 134.35 − 222.49) per 100,000 persons for males, and 102.19 (95% <em>UI</em>: 73.28 − 138.00) per 100,000 persons for females in 2019. The age-standardized YLDs rate was 5.91 (95% <em>UI</em>: 3.58 − 9.25) per 100,000 persons for both genders, 7.35 (95% <em>UI</em>: 4.45 − 11.50) per 100,000 persons for males, and 4.51 (95% <em>UI</em>: 2.75 − 7.03) per 100,000 persons for females in 2019. The global incidence and YLDs of foot fracture increased in number and decreased in ASR from 1990 to 2019. The global geographical distribution of foot fracture is uneven. The incidence rate for males peaked at the age group of 20 – 24 years, while that for females increased with advancing age. The incidence rate of older people was rising, as younger age incidence rate declined from 1990 to 2019. Falls, exposure to mechanical forces, and road traffic injuries were the 3 leading causes of foot fracture. Correlations were observed between ASR, estimated annual percentage change, and SDI.</div></div><div><h3>Conclusions</h3><div>The burden of foot fracture remains high globally, and it poses an enormous public health challenge, with population aging. It is necessary to allocate more resources to the high-risk populations. Targeted realistic intervention policies and strategies are warranted.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 3","pages":"Pages 208-215"},"PeriodicalIF":1.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01DOI: 10.1016/j.cjtee.2023.07.001
Muhammad Rehan , Savera Anwar , Hadia Wali , Aysha Noor , Omer Ehsan , Shayan Shahid Ansari
Injuries deeper than the platysma are considered as penetrating neck injuries, constituting approximately 5% – 10% of all trauma. Many vital organs are at risk from a penetrating neck injury. These injuries in zone 1 have the highest mortality, because the injuries are close to the vital organs and difficult to access surgically. A 41-year-old male, a car mechanic by profession, presented to the emergency department with a penetrating neck injury on the right side. CT scan demonstrated a metallic foreign body in zone 1 between the right internal jugular vein and the common carotid artery. The patient was asymptomatic, and the foreign body was removed surgically. This case shows a rare presentation of a penetrating neck injury with a foreign body located in zone 1, where no vital internal structure was injured. As of now, no previous case report has been identified on such presentation. Thus, it will provide a valuable addition to the pre-existing literature.
{"title":"Shrapnel in carotid sheath: A rare penetrating neck injury","authors":"Muhammad Rehan , Savera Anwar , Hadia Wali , Aysha Noor , Omer Ehsan , Shayan Shahid Ansari","doi":"10.1016/j.cjtee.2023.07.001","DOIUrl":"10.1016/j.cjtee.2023.07.001","url":null,"abstract":"<div><div>Injuries deeper than the platysma are considered as penetrating neck injuries, constituting approximately 5% – 10% of all trauma. Many vital organs are at risk from a penetrating neck injury. These injuries in zone 1 have the highest mortality, because the injuries are close to the vital organs and difficult to access surgically. A 41-year-old male, a car mechanic by profession, presented to the emergency department with a penetrating neck injury on the right side. CT scan demonstrated a metallic foreign body in zone 1 between the right internal jugular vein and the common carotid artery. The patient was asymptomatic, and the foreign body was removed surgically. This case shows a rare presentation of a penetrating neck injury with a foreign body located in zone 1, where no vital internal structure was injured. As of now, no previous case report has been identified on such presentation. Thus, it will provide a valuable addition to the pre-existing literature.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 3","pages":"Pages 231-234"},"PeriodicalIF":1.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9897044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01DOI: 10.1016/j.cjtee.2024.04.004
Cong-Xiao Fu , Hao Gao , Jun Ren , Hu Wang , Shuai-Kun Lu , Guo-Liang Wang , Zhen-Feng Zhu , Yun-Yan Liu , Wen Luo , Yong Zhang , Yun-Fei Zhang
Purpose
To methodically assess the effectiveness of augmentative plating (AP) and exchange nailing (EN) in managing nonunion following intramedullary nailing for long bone fractures of the lower extremity.
Methods
PubMed, EMBASE, Web of Science, and the Cochrane Library were searched to gather clinical studies regarding the use of AP and EN techniques in the treatment of nonunion following intramedullary nailing of lower extremity long bones. The search was conducted up until May 2023. The original studies underwent an independent assessment of their quality, a process conducted utilizing the Newcastle-Ottawa scale. Data were retrieved from these studies, and meta-analysis was executed utilizing Review Manager 5.3.
Results
This meta-analysis included 8 studies involving 661 participants, with 305 in the AP group and 356 in the EN group. The results of the meta-analysis demonstrated that the AP group exhibited a higher rate of union (odds ratio: 8.61, 95% confidence intervals (CI): 4.12 − 17.99, p < 0.001), shorter union time (standardized mean difference (SMD): -1.08, 95% CI: -1.79 − -0.37, p = 0.003), reduced duration of the surgical procedure (SMD: -0.56, 95% CI: -0.93 − -0.19, p = 0.003), less bleeding (SMD: -1.5, 95% CI: -2.81 − -0.18, p = 0.03), and a lower incidence of complications (relative risk: -0.17, 95% CI: -0.27 − -0.06, p = 0.001). In the subgroup analysis, the time for union in the AP group in nonisthmal and isthmal nonunion of lower extremity long bones was shorter compared to the EN group (nonisthmal SMD: -1.94, 95% CI: -3.28 − -0.61, p < 0.001; isthmal SMD: -1.08, 95% CI: -1.64 − -0.52, p = 0.002).
Conclusion
In the treatment of nonunion in diaphyseal fractures of the long bones in the lower extremity, the AP approach is superior to EN, both intraoperatively (with reduced duration of the surgical procedure and diminished blood loss) and postoperatively (with an elevated union rate, shorter union time, and lower incidence of complications). Specifically, in the management of nonunion of lower extremity long bones with non-isthmal and isthmal intramedullary nails, AP demonstrated shorter union time in comparison to EN.
目的：有条不紊地评估增强钢板（AP）和交换钉（EN）治疗下肢长骨骨折髓内钉后不愈合的有效性：对 PubMed、EMBASE、Web of Science 和 Cochrane 图书馆进行了检索，以收集有关使用 AP 和 EN 技术治疗下肢长骨髓内钉后不愈合的临床研究。搜索一直持续到 2023 年 5 月。对原始研究进行了独立的质量评估，评估采用纽卡斯尔-渥太华量表。从这些研究中检索数据，并利用 Review Manager 5.3.Results进行荟萃分析：这项荟萃分析包括 8 项研究，涉及 661 名参与者，其中 AP 组 305 人，EN 组 356 人。荟萃分析的结果表明，AP 组的骨结合率更高（几率比：8.61，95% 置信区间（CI）：4.12 - 17.99，P 结论：AP 组的骨结合率高于 EN 组：在治疗下肢长骨骺端骨折不愈合时，AP 法在术中（缩短手术时间，减少失血量）和术后（提高愈合率，缩短愈合时间，降低并发症发生率）均优于 EN 法。具体而言，在使用非峡部和峡部髓内钉治疗下肢长骨不愈合时，AP 与 EN 相比，显示出更短的愈合时间。
{"title":"Effectiveness and safety of augmentative plating technique in managing nonunion following intramedullary nailing of long bones in the lower extremity: A systematic review and meta-analysis","authors":"Cong-Xiao Fu , Hao Gao , Jun Ren , Hu Wang , Shuai-Kun Lu , Guo-Liang Wang , Zhen-Feng Zhu , Yun-Yan Liu , Wen Luo , Yong Zhang , Yun-Fei Zhang","doi":"10.1016/j.cjtee.2024.04.004","DOIUrl":"10.1016/j.cjtee.2024.04.004","url":null,"abstract":"<div><h3>Purpose</h3><div>To methodically assess the effectiveness of augmentative plating (AP) and exchange nailing (EN) in managing nonunion following intramedullary nailing for long bone fractures of the lower extremity.</div></div><div><h3>Methods</h3><div>PubMed, EMBASE, Web of Science, and the Cochrane Library were searched to gather clinical studies regarding the use of AP and EN techniques in the treatment of nonunion following intramedullary nailing of lower extremity long bones. The search was conducted up until May 2023. The original studies underwent an independent assessment of their quality, a process conducted utilizing the Newcastle-Ottawa scale. Data were retrieved from these studies, and meta-analysis was executed utilizing Review Manager 5.3.</div></div><div><h3>Results</h3><div>This meta-analysis included 8 studies involving 661 participants, with 305 in the AP group and 356 in the EN group. The results of the meta-analysis demonstrated that the AP group exhibited a higher rate of union (odds ratio: 8.61, 95% confidence intervals (<em>CI</em>): 4.12 − 17.99, <em>p</em> < 0.001), shorter union time (standardized mean difference (SMD): -1.08, 95% <em>CI</em>: -1.79 − -0.37, <em>p</em> = 0.003), reduced duration of the surgical procedure (SMD: -0.56, 95% <em>CI</em>: -0.93 − -0.19, <em>p</em> = 0.003), less bleeding (SMD: -1.5, 95% <em>CI</em>: -2.81 − -0.18, <em>p</em> = 0.03), and a lower incidence of complications (relative risk: -0.17, 95% <em>CI</em>: -0.27 − -0.06, <em>p</em> = 0.001). In the subgroup analysis, the time for union in the AP group in nonisthmal and isthmal nonunion of lower extremity long bones was shorter compared to the EN group (nonisthmal SMD: -1.94, 95% <em>CI</em>: -3.28 − -0.61, <em>p</em> < 0.001; isthmal SMD: -1.08, 95% <em>CI</em>: -1.64 − -0.52, <em>p</em> = 0.002).</div></div><div><h3>Conclusion</h3><div>In the treatment of nonunion in diaphyseal fractures of the long bones in the lower extremity, the AP approach is superior to EN, both intraoperatively (with reduced duration of the surgical procedure and diminished blood loss) and postoperatively (with an elevated union rate, shorter union time, and lower incidence of complications). Specifically, in the management of nonunion of lower extremity long bones with non-isthmal and isthmal intramedullary nails, AP demonstrated shorter union time in comparison to EN.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 3","pages":"Pages 164-174"},"PeriodicalIF":1.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140960786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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