Objectives: Surgical management of comminuted patella fractures remains a major challenge for the surgeon. We developed a suture reduction (SR) technique to better preserve the comminuted patella. The study aimed to compare the suture reduction technique with conventional reduction (CR) technique in the management of comminuted patellar fractures using the modified Kirschner-wire (K-wire) tension band. Methods: From May 2016 to September 2020, a total of 75 patients with comminuted patellar fracture were reviewed retrospectively. Among these cases, 35 patients were in the suture reduction group with a mean age of 52 years, while 40 patients were in the conventional reduction group with a mean age of 53 years. All cases were closed fractures. Comminuted patellar fractures were classified as type 34-C3 according to the AO/OTA classification. Radiographs of the knee were obtained at routine follow-up to evaluate the reduction quality and fracture union. Clinical outcomes including range of motion (ROM), visual analog scale (VAS), Lysholm, and Böstman grading scales were measured at the last follow-up. Postoperative complications were also recorded. Results: The average time from injury to surgery was 5.4 days in suture reduction group and 3.7 days in conventional reduction group (p < 0.05). The surgical time of suture reduction group was less than that of conventional reduction group, but there was no significant difference (p = 0.110) regarding surgical time between the two groups. The average blood loss in suture reduction group was 42.9 ml, while the average blood loss in conventional reduction group was 69.3 ml (p < 0.001). There was no difference regarding fracture union, ROM and knee function score (Lysholm score and Böstman scale) between the two groups. The complication rates were 17.1% in suture reduction group and 12.5% in conventional reduction group respectively (p > 0.05). Conclusions: In the treatment of comminuted patellar fractures with modified K-wire tension band, the use of suture reduction technique can shorten the surgical time, reduce the surgical trauma, and obtain satisfactory results. This new surgical technique may be particularly effective in management of comminuted patellar fractures when patellectomy would otherwise be considered.

Objective: Type III hemipelvectomy and reconstruction are challenging. Several reconstruction options, including autologous soft tissue, prosthesis patch, autologous, or allograft, were reported, but a variety of shortcomings limited their application. Three‐dimensional (3D)‐printed prosthesis was designed to reconstruct the unilateral Type III pelvic defect and had favorable clinical outcomes. However, the reconstruction method for bilateral Type III pelvic defect was few reported. This study aims to design a bilateral pubis prosthesis and evaluate the early clinical outcomes and complications.Methods: We retrospectively collected patients receiving 3D‐printed bilateral pubis prosthesis reconstruction after malignant tumor resection between 2017 and 2021. Demographics, anatomic data, operation time, blood loss, and clinical outcomes of patients were analyzed. The Musculoskeletal Tumor Society‐93 (MSTS‐93) score was performed to evaluate the function and complications were recorded.Results: Four patients, including three for females and one for males, were enrolled in this study. Prosthesis was designed according to the pelvic anatomical data. The mean operation time and blood loss were 308.8 min (range, 240–400 min) and 655 mL (range, 400–1100 mL), respectively. The average follow‐up was 15.5 months (range, 12–16 months). The mean MSTS was 28.5 (28–29). One patient had incision necrosis postoperatively. No hernia, prosthesis displacement, or implant failure occurred during follow‐up. Four patients with 15 interfaces showed good osteointegration.Conclusions: 3D‐printed bilateral pubis prosthesis could restore the integrity and stability of pelvic ring and improve limb function. Meanwhile, this reconstruction option provided a rigid bony‐soft support to prevent the development of hernia. In all, 3D‐printed bilateral pubis prosthesis is recommended to be a favorable selection for Type III pelvic defect reconstruction.

. The purpose of this study was to compare the reduction effect and clinical outcomes of anterior subcutaneous internal fixation (INFIX) and steel plate-screw internal fixation in the treatment of anterior ring injury in Tile C pelvic fractures. . In this retrospective study, the clinical outcomes of 46 patients treated using INFIX and 44 patients treated with steel plate-screw internal fixation were analyzed and compared. All patients underwent anterior and posterior fixation. The Matta imaging scoring system was used to evaluate the postoperative reduction accuracy; the Majeed scoring system was applied to obtain functional outcomes in clinical follow-up. All potential complications were identified and evaluated accordingly. Both groups of patients were followed up for a period of 13–36 months, with an average of 27 months. The procedure time and blood loss in the INFIX group were significantly lower than those in the plate group(t = − 2.327, P = 0.023;t = − 4.053, P = 0.000; there was no statistically significant difference in the Majeed score and Matta score between the two groups after surgery (P > 0.05). . INFIX treatment for anterior ring injury in Tile C pelvic fractures can achieve good therapeutic effects. Compared to internal fixation with plates and screws, it has advantages such as shorter surgical time and less blood loss. INFIX may be more suitable for obese patients, young women of childbearing age, or patients with urinary system injuries.

Background: Tranexamic acid (TXA) is commonly used to reduce perioperative bleeding in various surgeries, including acetabular and pelvic fractures treated with open reduction and internal fixation (ORIF). However, research on TXA’s effectiveness and safety in this context is conflicting. To address this, we conducted a systematic review and meta-analysis on TXA’s efficacy and safety in patients with acetabular and pelvic fractures undergoing ORIF. Methods: We systematically searched Cochrane, PubMed, and EMBASE databases until August 30, 2023. Our evaluation of TXA focused on 6 domains: estimated blood loss (EBL), blood transfusion units, transfusion rates, thromboembolic events, other complications, and surgery duration. Data from these studies were analyzed using RevMan Manager 5.4. Results: This study included 4 randomized controlled trials with 179 patients with acetabular and pelvic fractures treated with TXA. The analysis showed that TXA did not significantly reduce EBL, packed red blood cell transfusion units, blood transfusion rates, or surgery duration. There was no significant difference in thromboembolic events or other postoperative complications, like surgical wound issues, pneumonia, heterotopic ossification, and sciatic nerve injuries, between the TXA and control groups. Conclusion: TXA did not demonstrate a significant benefit in reducing perioperative bleeding or complications in patients treated with ORIF for acetabular and pelvic fractures. The utilization of TXA in such clinical scenarios remains a topic necessitating further rigorous investigation to delineate its role in this clinical setting.

Bilateral acetabular fracture is a very rare presentation among the trauma patients, as the pattern and the degree of the forces required to fracture both acetabula is very unique. The primary purpose of this study is to report a series of adult patients presenting with post-traumatic bilateral acetabular fracture without any history of pathological or metabolic bone disease. In this retrospective study, 18 cases of traumatic bilateral acetabular fracture were included. There was predominance of both column (four patients on left and six on right) followed by anterior column (two patients left and four on right) and posterior wall (three patients left and right). They were treated surgically through open reduction and internal fixation. All cases were followed up for at least 13 months. Matta’s criteria were used for radiological evaluation on plain radiographs. Functional outcome was evaluated using the Merle d’Aubigne and postel score at final follow-up. No patients were lost during the follow-up period; there was one case of surgical site infection. There were three cases of postoperative osteoarthritis, one case of heterotrophic ossification, one case of persistent sciatic nerve palsy and one case of lateral femoral cutaneous nerve palsy. The radiological evaluation according to Matta’s criteria revealed anatomic reduction in 12 patients, imperfect reduction in three patients while other three patients had poor reduction. According to modified Merle d’Aubigne and Postel score, 10 cases were rated as excellent, five cases as good and three cases presented fair (one case) to poor (two cases) results. We report an unusual case series of bilateral acetabular fracture successfully managed surgically with good clinical outcome. With the increasing incidence of route traffic accidents, such cases would probably be recurrent in the upcoming years.

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.