ObjectiveTo compare the postoperative tibial malrotation between traditional minimally invasive plate osteosynthesis (MIPO) and three-dimensional printing-assisted MIPO (3D-MIPO) for different types of tibial fractures, and explore the change of these differences.MethodsA prospective randomized controlled trial was conducted. The 120 patients with unilateral tibial fracture who met the selection criteria between January 2016 and October 2018 (40 patients in each of AO types A, B, and C) into the trial group (20 patients, 3D-MIPO) and the control group (20 patients, traditional MIPO) at ratio of 1∶1. There was no significant difference between the two groups (P>0.05) in gender, age, fracture site, and other general information. The bilateral tibial rotation angles were measured on the CT images within 1 week after operation, and the difference of tibial rotation angle between affected and unaffected sides was calculated. The tibial malrotation was defined when the difference exceeded 10°. The degree of tibial rotation and the incidence of malrotation between the two groups in different types of tibial fractures were compared. ResultsPostoperative infection occurred in 1 case, and improved after the dressing change and anti-inflammatory treatment. No complications such as loosening and displacement of internal fixation occurred. There was no significant difference in the difference of bilateral tibial rotation angles between the two groups in type A fractures after operation (t=0.559, P=0.580); while in types B and C fractures, the differences of bilateral tibial rotation angles in control group were significantly higher than those in trial group (P<0.05). There was no significant difference in distribution of internal or external rotation between the two groups in types A, B, and C fractures (P>0.05). No malrotation occurred in type A fractures, and there was no significant difference in the incidence of malrotation between the two groups in type B fractures (P=1.000). The incidence of malrotation in control group was significantly higher than that in trial group in type C fractures (P=0.044).Conclusion3D-MIPO has the same anti-malrotation effect as traditional MIPO for type A tibial fracture, but for types B and C tibial fractures, the anti-malrotation effect of 3D-MIPO is significantly better than that of traditional MIPO. The more complex the fracture type is, the more significant this advantage is.
Objective To investigate the clinical characteristics and injury mechanisms of lateral segment floating clavicle (LSFC), and to establish a comprehensive classification system for this specific triple injury of the superior shoulder suspensory complex (SSSC), so as to provide a reference for clinical diagnosis and treatment. Methods A retrospective analysis was performed on 354 patients with midclavicular fractures who underwent surgical treatment between January 2021 and December 2024. Among them, 11 patients met the diagnostic criteria for LSFC, defined as a combination of midclavicular fracture, ipsilateral coracoid process fracture or coracoclavicular ligament rupture, and ipsilateral acromioclavicular ligament rupture, distal clavicular fracture, or acromial fracture. There were 9 males and 2 females, with an age range of 21-53 years (mean, 39.3 years). LSFC was classified into two main types: Type Ⅰ was characterized by coracoclavicular ligament rupture, and type Ⅱ by coracoid process fracture. According to the injury pattern at the acromioclavicular joint-distal clavicle complex, each type was further subdivided into three subtypes: subtype a (acromioclavicular ligament rupture or acromioclavicular joint dislocation), subtype b (distal clavicular fracture), and subtype c (acromial fracture). Of the 11 patients, 4 were classified as type Ⅰa, 5 as type Ⅱa, and 2 as type Ⅱb. All patients underwent open reduction and internal fixation. Missed diagnosis occurred in 3 cases (27.3%), intraoperative revision of the surgical plan was required in 1 case, and postoperative delayed diagnosis was found in 2 cases during follow-up, with 1 patient undergoing reoperation. Results All 11 LSFC patients were followed up 13-26 months (mean, 17.8 months). Bony union was achieved in all fractures at last follow-up. A total of 7 complications were noted: 3 cases of acromioclavicular joint subluxation, 3 cases of periprosthetic osteolysis around the clavicular hook plate, and 1 case of wire breakage. The incidence of ipsilateral multiple rib fractures in LSFC patients was 45.5% (5/11), which was significantly higher than that in patients with isolated midclavicular fractures (1.7%, 6/343) (P<0.001). Conclusion LSFC is mostly caused by high-energy trauma, with a high rate of missed diagnosis and frequent associated injuries. In particular, ipsilateral multiple rib fractures are a highly suggestive sign of LSFC. The classification system proposed in this study summarizes the characteristics of this triple injury of SSSC, which is conducive to improving clinicians’ understanding of the injury and reducing the rate of missed diagnosis.
ObjectiveTo compare the predictive value of the two concepts for complications by comparing the incidences of surgical complications associated with different tip-apex distance (TAD) and calcar referenced tip-apex distance (Cal-TAD) in the treatment of femoral intertrochanteric fractures with Asian type proximal femoral nail (APFN) fixation. MethodsA total of 188 cases of femoral intertrochanteric fractures treated with APFN fixation between January 2014 and December 2018 were collected according to inclusion criteria. TAD and Cal-TAD were measured on the X-ray film at immediate after operation; the patients were divided into two groups according to the measurement results: <25 mm and ≥25 mm. Gender, age, and fracture side and AO type were recorded. The patients in each group were reviewed whether there was delayed fracture union or nonunion, whether the screw blade moved axially, whether the femoral neck collapsed or even screw blade cut out, whether the internal fixator became loose or broken within 12 months after operation. Then statistical analysis was performed. ResultsThere were 119 patients with TAD<25 mm and 69 patients with TAD≥25 mm, and 142 patients with Cal-TAD<25 mm and 46 patients with Cal-TAD≥25 mm. There was no significant difference in gender, age, or fracture side and AO type between groups (P>0.05). During the follow-up, 6 patients (5.04%) with TAD<25 mm, 10 patients (14.49%) with TAD≥25 mm had complications, and 1 patient (0.70%) with Cal-TAD<25 mm and 15 patients (32.61%) with Cal-TAD≥25 mm had complications. There were significant differences in the incidence of complication between the patients with different TAD, between the patients with different Cal-TAD, and between patients with TAD<25 mm and Cal-TAD<25 mm (P<0.05). ConclusionIn the operation of femoral intertrochanteric fracture with APFN fixation, surgical complications can be significantly reduced when TAD or Cal-TAD was controlled within 25 mm, Cal-TAD is more significant in the prediction of postoperative complications.