Chinese Journal of Traumatology最新文献

Purpose: It is often difficult for surgeons to accurately implant the cannulated screws for fixing femoral neck fractures under C-arm fluoroscopy. Our simulation study attempts to help surgeons identify the optimal positions of screws on anteroposterior and lateral radiographs.

Methods: Softwares were used for 3-dimensional reconstruction and cross-sections construction of 60 femoral necks. The contours of all cross-sections along the axis of the femoral neck were stacked to identify a safe zone for screws placement. A simulation experiment was carried out with 3 circles of diameter 6.5 mm in the safe zone. The absolute and relative positions of every screw in the anteroposterior radiographs and lateral radiographs were measured.

Results: The morphologies of the safe zones for screws placement were anteriorly flat ellipses. The best dispersion was obtained with the inverted triangle shape in this zone: the inferior was positioned near the lower 1/10 on the anteroposterior view and near the anterior 3/5 on the lateral view. The anterosuperior and posteriosuperior screws were positioned near the upper 1/5 and 1/4, respectively, on the anteroposterior view, and near the anterior 1/10 and posterior 1/5, respectively, on the lateral view.

Conclusion: Simulated screws implantation demonstrates the distribution characteristics of screws in anteroposterior and lateral radiographs. This can help decrease the risk of perforation and iatrogenic injury.

Purpose: Transverse-posterior wall (TPW) fractures of the acetabulum are complex injuries that require surgical fixation. The transverse component's major fracture line traverses the weight-bearing area and passes over the acetabular dome. The key to a successful outcome is anatomical reduction and rigid internal fixation. The treatment of TPW fractures has shown significant advancements, but there is still debate regarding the best surgical approach.

Methods: The study was conducted in a level 1 tertiary trauma care center, involving patients with an associated TPW fracture of the acetabulum. Between January 2015 and January 2023, a total of 512 acetabulum fractures were treated surgically. Out of which, 87 patients had a TPW fracture. Fifty-five patients who underwent surgical fixation using a single approach-Kocher-Langenbeck (KL) with a minimum 1-year follow-up-were included in this study. The exclusion criteria were patients with isolated transverse fractures, isolated posterior wall fractures, undisplaced fractures that were treated conservatively, TPW of acetabulum fractures treated using a combined surgical approach due to major displacement at the anterior column, open acetabulum fractures, and individuals who were unfit for surgery. Demographic details, epidemiology, fracture patterns, and associated skeletal and non-skeletal injuries were collected. Post-operative radiological results were graded according to the Matta score. Functional outcome analysis was done using the EuroQOL-5D score. The occurrence and rate of complications were evaluated.

Results: TPW fractures had an incidence of 17% among acetabulum fractures. The male-to-female ratio was 50:5, with an overall mean age of 40 years (range: 20-71 years). The mean follow-up was 32 months (range: 12-81 months). Among them, 41.8% had multiple injuries, 36.4% were polytraumatized. On arrival, 63.6% had hip dislocation, 14.5% had sciatic nerve injury. Anatomic reduction was achieved in 84.0% of the patients. Excellent to good functional outcomes were seen in 88.0%. An iatrogenic sciatic nerve injury was seen in 1 patient. Avascular necrosis, heterotrophic ossification, and post-traumatic osteoarthritis were seen in 16.4%, 21.8%, and 20.0% respectively. The rate of conversion to total hip replacement was 10.9%.

Conclusion: Single-approach fixation is adequate for TPW fractures of the acetabulum, where the anterior-column is well reduced, to provide satisfactory radiological results as well as an excellent-to-good functional outcome. Whenever the intraoperative roof-arc-angle is more than 45° and the displacement is less than 2 mm, the anterior column need not be addressed; however, if the roof arc angle is less than 45° and the displacement of more than 2 mm, an additional-lag-screw should be added.

Immune dysregulation is one of the leading causes of mortality in patients with sepsis. T cell immunoglobulin and mucin domain-containing protein 3 (TIM-3), a negative costimulatory molecule, is pivotal for immune regulation during sepsis. The effects of TIM-3 appear to be bidirectional: in the early stages of sepsis, upregulation of TIM-3 may help attenuate inflammation, whereas its sustained overexpression in later stages and ligand binding promotes immune apoptosis or exhaustion, which suppresses immune responses. Furthermore, TIM-3 synergizes with other immune checkpoint molecules (e.g., programmed cell death receptor-1), exacerbates immunosuppression, and increases the risk of secondary infections. Blocking the TIM-3 signaling pathway can restore immune cell function and may be a novel therapeutic strategy for sepsis. Although TIM-3 holds promise as both a biomarker and a therapeutic target, its mechanisms are complex and may vary across disease stages, which necessitates further research to optimize targeted interventions. Future studies should focus on elucidating the dynamic signaling pathways of TIM-3, developing combination immunotherapies, and conducting clinical trials to validate its safety and efficacy in sepsis treatment.