Functional outcome among patients treated by percutaneous cannulated screw with tension band for transverse patella fracture

Introduction: Tension band wiring is the most commonly used treatment method for transverse patella fracture. Tension band construct can be achieved by various modifications. Percutaneous cannulated screw with tension band is a minimally invasive technique with stiffer fixation that follows tension band principle. This study aims to assess the clinical and radiological outcome using percutaneous cannulated screw with tension band for the management of transverse patella fracture. Methods: This was a prospective study among 30 adult patients who had closed displaced transverse patella fracture. Patients with polytrauma, comminuted fracture, neurovascular injury and prior injury to the limb were excluded from the study. Each patient was followed up at 2 weeks, 4 weeks, 3 months and 6 months postoperatively. Results: Among all surgically treated patients using this technique, Pain gradually decreased over time and was less than VAS score of 1 in all patients at 6 months follow-up with an average score of 0.3. The final range of motion at 6 months was: flexion ranging from 122 to 145 degrees and extension lag from of 0 to 8 degrees. There was significant improvement in range of motion of knee in each follow up. The mean duration for fracture union was 11.4±2.3 weeks. There were no cases of nonunion and hardware failure. The mean Lyshom score was 82.5 at final follow up. Conclusions: The percutaneous fixation of transverse patella fracture with cannulated screw and SS wire is safe and effective method which gives good functional outcome.

Multiple Cannulated Screw Fixation of Femoral Neck Fractures with Comminution in Young and Middle Age Patients

Objective To investigate the distribution and influence of comminutions on femoral neck fracture (FNF) patients after cannulated screw fixation (CSF). Methods From January 2019 to June 2020, a total of 473 patients with FNF treated by CSF, aged 23–65 years, were included in present study. Based on location of the cortical comminution, the FNF patients were assigned as comminution group (anterior comminution, posterior comminution, superior comminution, inferior comminution, multiple comminutions) and without comminution group. The incidence of postoperative complications, quality of life and functional outcomes were recorded in different groups at 1 year-follow up. Results The comminution was more likely to appear in displaced FNF patients (86.8%) compared with non-displaced FNF patients (8.9%), while occurrence rate of comminution was also closely associated with Pauwels classification (3.2% vs 53.5% vs 83.9%, P<0.05). Besides, the incidence of osteonecrosis of femoral head (ONFH, 11.3% vs 2.9%, P<0.05), nonunion (7.5% vs 1.7%, P<0.05), femoral neck shortening (21.6% vs 13.4%, P<0.05) and internal fixation failure (11.8% vs 2.9%, P<0.05) in FNF patients with comminutions, especially with multiple comminutions, was significantly higher than those in FNF patients without comminution. Furthermore, there was a prominently difference in Harris hip score (HHS, 85.6±15.6 vs 91.3±10.8, P<0.05) and EuroQol five dimensions questionnaire (EQ-5D, 0.85±0.17 vs 0.91±0.18, P<0.05) score between FNF patients with comminution and FNF patients without comminution, whereas there was seem to be no significantly difference in Visual analogue scale (VAS, 1.46±2.49 vs 1.13±1.80, P>0.05) score between two groups at 1 year after surgery. Conclusion In our view, the comminution, easily happened in displaced FNF and Pauwel type III FNF, which was deemed to be a risk factor for postoperative complications in young and middle-aged patients underwent CSF, consequently causing an influence on recovery of hip function and life quality. However, further evaluation with better study design, larger sample and long-term follow-up was still imminently applied.

Computer-assisted cannulated screw internal fixation versus conventional cannulated screw internal fixation for femoral neck fractures: a systematic review and meta-analysis

Objective To compare the effects between computer-assisted and traditional cannulated screw internal fixation on treating femoral neck fracture. Methods The search was conducted in Embase, Pubmed, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI) and Wanfang Database from the beginning to August 2020. RevMan5.4 software, which was provided by the International Cochrane Group, was used for the meta-analysis comparing the differences in operation time, intraoperative bleeding volume, fluoroscopy frequency, fracture healing time, total drilling times, Harris score, fracture healing rate, and femoral head necrosis rate between computer-assisted and traditional methods groups. Results A total of 1028 patients were included in 16 studies. Primary outcome indicators: Compared with the traditional method group, the computer-assisted group had less operative time (2RCTs, P < 0.00001; 8 non-RCTs, P = 0.009; Overall, P < 0.00001), intraoperative bleeding (1 RCTs, P < 0.00001; 9non-RCTs, P < 0.00001; Overall, P < 0.00001), femoral head necrosis rate (1 RCT, P = 0.11;7 non-RCTs, P = 0.09; Overall, P = 0.02) and higher Harris scores (1 RCT, P < 0.0001; 9 non-RCTs, P = 0.0002; Overall, P < 0.0001), and there were no significant differences in fracture healing rate between the two groups (5 non-RCTs, P = 0.17). Secondary outcomes indicators: The computer-assisted group had a lower frequency of intraoperative fluoroscopy and total number of drills compared with the traditional method group, while there was no significant difference in fracture healing time. Conclusion Compared with the traditional hollow screw internal fixation on the treatment of femoral neck fracture, computer-assisted percutaneous cannulated screw fixation can shorten the operation time and improve the operation efficiency and reduce the X-ray injury of medical staff and help patients obtain a better prognosis. Therefore, computer-assisted percutaneous cannulated screw fixation is a better choice for the treatment of femoral neck fracture. Study registration PROSPERO registration number CRD42020214493.

Selected aspects of proximal femoral epiphysis fixation in children with early stages of slipped capital femoral epiphysis

BACKGROUND: Epiphyseodesis of the femoral head in the early stages of slipped capital femoral epiphysis using auto-, allografts, and synthetic implant may result in deformities of the femur leading cam-type femoroacetabular impingement and dysfunction of the gluteal muscles. Most surgeons refused this intervention and favor in situ fixation of the epiphysis with modern metal instrumentation and, in particular, cannulated screws with proximal threading. However, the number of screws that provide stable fixation and how to reduce their negative effect on the enchondral growth of the femur remain controversial. AIM: To improve the results of surgical treatment in children with early stages of slipped capital femoral epiphysis. MATERIALS AND METHODS: The radiological results of surgical treatment of 40 patients (80 affected joints) aged from 11 to 14 years with slipped capital femoral epiphysis of stage 1 in one joint and stage 2 in the other joint were analyzed. 20 children were divided into two groups. In each group, the epiphysis was fixed with a 7.0 mm cannulated screw. In the first group, the screw head was held on the cortical layer. In the second group, the screw head was held 510 millimeters away from the cortical layer. Long-term results were evaluated at the age of 1718 years when no signs of enchondral and ecchondral growth of the proximal femur were noted. The obtained data were subjected to statistical analysis. RESULTS: The fixation of the epiphysis was stable in all 80 joints. The shape of epimetaphysis in the joints of stage 2 did not change in most patients by the end of femoral growth. However, the correction recorded in 32.5% of cases was more often observed in children of the second group. The shape of epimetaphysis in all 40 joints with stage 1 of the disease remained normal. The mean length of the epimetaphysis was greater in the second group than in the first group by the end of growth regardless of the stage of the pathologic process during surgery. CONCLUSIONS: The considered method of proximal femoral epiphysis fixation, which excludes the compressive effect of a cannulated screw with proximal threading on the epiphyseal growth cartilage, provides reliable epiphysis retention in the early stages of slipped capital femoral epiphysis. It has a less negative effect on the enchondral growth of the femoral component of the joint.