Research priorities for the management of complex fractures: a UK priority setting partnership with the James Lind Alliance

ObjectiveTo determine research priorities for the management of complex fractures, which represent the shared priorities of patients, their families, carers and healthcare professionals.Design/settingA national (UK) research priority setting partnership.ParticipantsPeople who have experienced a complex fracture, their carers and relatives, and relevant healthcare professionals and clinical academics involved in treating patients with complex fractures. The scope includes open fractures, fractures to joints broken into multiple pieces, multiple concomitant fractures and fractures involving the pelvis and acetabulum.MethodsA multiphase priority setting exercise was conducted in partnership with the James Lind Alliance over 21 months (October 2019 to June 2021). A national survey asked respondents to submit their research uncertainties which were then combined into several indicative questions. The existing evidence was searched to ensure that the questions had not already been sufficiently answered. A second national survey asked respondents to prioritise the research questions. A final shortlist of 18 questions was taken to a stakeholder workshop, where a consensus was reached on the top 10 priorities.ResultsA total of 532 uncertainties, submitted by 158 respondents (including 33 patients/carers) were received during the initial survey. These were refined into 58 unique indicative questions, of which all 58 were judged to be true uncertainties after review of the existing evidence. 136 people (including 56 patients/carers) responded to the interim prioritisation survey and 18 questions were taken to a final consensus workshop between patients, carers and healthcare professionals. At the final workshop, a consensus was reached for the ranking of the top 10 questions.ConclusionsThe top 10 research priorities for complex fracture include questions regarding rehabilitation, complications, psychological support and return to life-roles. These shared priorities will now be used to guide funders and teams wishing to research complex fractures over the coming decade.

Ilizarov technology in China: a historic review of thirty-one years

Purpose To summarize the evolution of Ilizarov technology in China, highlight important milestones, introduce the atmosphere of the era concerning the first uses and development of this technology, and share Chinese modification and experience in this field. Method A thorough interview with senior ASAMI members of China and literature search and physical books in libraries was undertaken to summarize the history of Ilizarov technology in China. Results The formal development of Ilizarov technology began when professor Ilizarov himself came to Beijing (1991) and gave a speech. In the following 31 years, his technology was rapidly developed through China, with many symposiums held and associations established including ASAMI China (2003) and ILLRS China (2015). Today, Ilizarov technology has become the main treatment of complex fractures, defects, nonunion, infections, deformities, and chronic ischemic ulcers of the limbs. In those years, Chinese scholars also developed some special treatment methods and made many modifications to Ilizarov external fixators. Conclusion Ilizarov technology has developed in China for 31 years. It revolutionized the treatment of complex limb traumas, deformities, and diseases. In the treatment of millions of patients, Chinese scholars had many unique experiences and made modifications to this technology which is worthy to share with the world.

Contemporary Management of Zygomaticomaxillary Complex Fractures

Zygomaticomaxillary complex fracture is one of the most commonly treated facial fractures. Accurate reduction and stable fixation of the zygoma are required to restore facial symmetry and projection and avoid functional sequalae from changes in orbital volume. Achieving optimal outcome is challenging due to the complex three-dimensional anatomy and limited visualization of all affected articulations of the zygoma. This article provides an updated overview of the evaluation and management of zygomaticomaxillary complex fractures based on available evidence and clinical experience at our center. The importance of soft tissue management is emphasized, and approaches to internal orbital reconstruction are discussed. While evidence remain limited, intraoperative imaging and navigation may prove to be useful adjuncts in the treatment of zygomaticomaxillary fractures.

Management of Unilateral Zygomaticomaxillary Complex Fracture - A Case Report

Zygomaticomaxillary complex (ZMC) fractures are relatively common. Zygomatic complex fractures with functional or aesthetic impairments often require surgical intervention. Treatment of ZMC fractures consists of reduction and fixation of the dislocated bone fragments to their original location. The zygomaticomaxillary complex functions as a major buttress for the face and because of its prominent convex shape, is frequently involved in facial trauma.1 ZMC fractures are also called tripod, tetrapod, quadripod, malar or trimalar fractures. They account for approximately 15 % - 23.5 % of maxillofacial fractures.2,3 The aetiology of zygomatic complex fractures primarily includes road traffic accidents (RTA), violent assaults, falls and sports injuries. They are the second most common facial fracture after nasal bone fractures.3-6 ZMC fractures are more common in men than women, and most commonly occur in the third decade of life.7-10 The main clinical features of zygomatic complex fractures include diplopia, enophthalmos, subconjunctival ecchymosis, extraocular muscle entrapment, cosmetic deformity, malocclusion and neurosensory disturbances of the infra-orbital nerve.10 The gold standard radiological investigation for evaluation of ZMC fractures is computed tomography (CT) scan. Surgical intervention is effective in cases of displaced and comminuted fractures involving functional and aesthetic defects, whereas a nonsurgical approach is often used for non-displaced fractures.11 Various surgical approaches and treatment strategies have been proposed to obtain a successful treatment outcome. Based on review of literature, it has been observed that the open reduction with internal fixation using mini plates and screws is the most commonly preferred treatment for displaced and comminuted fractures.10-12 Here, we report a clinical case of right zygomaticomaxillary complex fracture and its management.

Posterior Temporary C1-2 Pedicle Screws Fixation for the Treatment of Unstable C1-2 Complex Fractures: Minimum of 2-Year Follow-Up

Study Design: Retrospective. Objectives: To present rarely reported complex fractures of the upper cervical spine (C1-C2) and discuss the clinical results of the posterior temporary C1-2 pedicle screws fixation for C1-C2 stabilization. Methods: A total of 19 patients were included in the study (18 males and 1 female). Their age ranged from 23 to 66 years (mean age of 39.6 years). The patients were diagnosed with complex fractures of the atlas and the axis of the upper cervical spine and underwent posterior temporary C1-2 pedicle screws fixation. The patients underwent a serial postoperative clinical examination at approximately 3, 6, 9 months, and annually thereafter. The neck disability index (NDI) and the range of neck rotary motion were used to evaluate the postoperative clinical efficacy of the patients. Results: The average operation time and blood loss were 110 ± 25 min and 50 ± 12 ml, respectively. The mean follow-up was 38 ± 11 months (range 22 to 60 months). The neck rotary motion before removal, immediately after removal, and the last follow-up were 68.7 ± 7.1°, 115.1 ± 11.7°, and 149.3 ± 8.9° ( P < 0.01). The NDI scores before and after the operation were 42.7 ± 4.3, 11.1 ± 4.0 ( P < 0.01), and the NDI score 2 days after the internal fixation was removed was 7.3 ± 2.9, which was better than immediately after the operation ( P < 0.01), and 2 years after the internal fixation was removed. The NDI score was 2.0 ± 0.8, which was significantly better than 2 days after the internal fixation was taken out ( P < 0.001). Conclusions: Posterior temporary screw fixation is a good alternative surgical treatment for unstable C1-C2 complex fractures.