Background: The fractures of femoral neck account for 50% among hip fractures with around 3%-10% occurring in younger population of below 65 years. The newly introduced FNS as management approach appears to be a potential alternative to the traditional CCS. The aim of this study was to compare the clinical efficacy and outcome of the femoral neck system (FNS) and the cannulated cancellous screw (CCS) in the treatment of femoral neck fractures in adult below 65 years of age. Methods: Data of 114 patients between 18–65 years, admitted in our department for femoral neck fracture from January 2019 to March 2021 were retrospectively studied and ranged into two groups based on the surgical methods: FNS group (56 patients) and CCS group (58 patients). The variables of interest including demographic and clinical variables (age, gender, fracture mechanism, injury side and classification), perioperative parameters(operation time, intraoperative bleeding, incision length and hospitalization time), postoperative outcomes and complications (fracture healing time, nonunion rate, femoral neck avascular necrosis, aseptic screw loosening and the Harris Hip Score), were analyzed and compared between the two groups. Results: All 114 patients presented satisfactory reduction and were followed-up for a period of 12 to 36 months (mean 27 ± 2.07 months); there were no significant differences between both groups in terms of age, gender, fracture classification, side of injury, mechanism of injury, the operative time, intraoperative blood loss and the hospital length of stay. However, the fracture healing time between FNS group and CCS group was statistically significant (p < 0.05), respectively 2.86 ± 0.77 and 5.10 ± 0.81 months. The significant differences were also found in terms of numbers of fluoroscopies 8.34 ± 1.38 Vs 17.72 ± 2.19, the HHS 87.80 ± 1.92 Vs 84.28 ± 2.24, postoperative complications 8 (14.28%) Vs 26 (44.82) respectively in FNS and CCS group. Conclusion: FNS presented satisfactory outcomes had significantly lower complications rate, therefore, can be one of the alternatives for internal implantation devices in treatment of femoral neck fracture in non-geriatric population.

The primary goal of this study was to create a frequency map of a series of surgically treated both-column fractures and to explore its implications on surgical management. We used a consecutive series of 71 both-column fractures to create 3-dimensional reconstruction images, which were superimposed and oriented to fit a model hemipelvis template by aligning specific pelvis landmarks. Fracture lines were identified and traced to create a fracture map of both-column fractures. Then the possible clinical implications of fracture line map were explored. Fracture location is closely related to the distribution of fracture line. Of 71 fractures that met the criteria for inclusion, we found the most common pattern demonstrated by coexisting fracture lines. The anterior column was involved by 66% of the fractures extending obliquely from the anterior superior spine to the ischial spine, while 62% of the fractures involved the anterior column extending approximately vertically from the iliac crest to the acetabular roof. Additionally, 39% of the fractures involved the posterior column traversing posterior wall. Furthermore, the high fracture line intensity (n = 65, 92%) formed a Y-shaped pattern, which highlighted the consistency of the patterns. Surgically treated both-column fractures display very common patterns. The most common pattern is the low anterior column fracture in nearly two thirds of cases, the high anterior column fracture in three fifths of cases and the posterior column fracture with posterior wall involvement in nearly two fifths of cases. These study results may help surgeons to yield insight relevant to surgical approaches, reduction, fixation strategies and even implant design for both-column fractures.

Background: Quadrilateral plate fractures are a challenging group of acetabular fractures to manage. However, there is little literature that describes the fracture lines of the quadrilateral plate. The aim of this study was to explore the fracture lines of the quadrilateral plate and relevant clinical significance. Methods: CT data from a series of acetabular fractures were retrospectively analyzed. According to the X-ray, CT, and operative records of the patients, Judet-Letournel classification was carried out for acetabular fractures involving quadrilateral plate. Then, the fracture maps of different types of acetabular fractures in the quadrilateral plate were drawn. To facilitate the characterization of fracture maps, we defined six basic fracture lines. Results: The fracture lines of the three types of acetabular fractures (double-column fracture, T-type fracture, and anterior column with posterior hemitransverse fracture) mainly included upper transverse lines and upper oblique lines. Although the fracture lines of posterior wall fracture and anterior column fracture were mainly upper transverse lines, the fracture lines of the former were in a low position. The fracture lines of transverse fracture and transverse with posterior wall fracture were similar, both of which were mainly upper oblique lines. The fracture lines of posterior column fractures mainly included posterior vertical lines. Conclusions: The fracture lines of different types of acetabular fractures have certain regularity respectively. Observation of the fracture lines of the quadrilateral plate based on fracture mapping can help orthopedic surgeons to enhance the understanding of the Judet-Letournel classification, which may have some significant guidance on the choice of operation approach and the design of internal fixation devices.

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.

Background: This study aimed to evaluate the radiographic and clinical outcomes of anterior subcutaneous internal fixation (INFIX) with or without posterior fixation for the treatment of unstable pelvic fractures. Methods: Intraoperative blood loss, operation time, and duration of hospital stay were recorded, and fracture union and postoperative complications were evaluated. The fracture reduction quality was evaluated using the Matta score, pelvic deformity index (PDI), and pubic symphyseal width (PSW). In addition, the functional recovery and general quality of life were evaluated using the Majeed score and the 12-Item Short-Form Survey (SF-12), respectively. Furthermore, sacral nerve injury was evaluated using the Gibbons classification. Results: Twenty-seven patients (14 males and 13 females) with an average age of 37.4 years were followed up for a mean of 22 months. The average operation time, median intraoperative blood loss, and average duration of hospital stay were 129 ± 47 min, 100 mL, and 22 ± 13 days, respectively. All patients achieved bony union with an average union time of 13.3 weeks. Furthermore, the average PDI and PSW were 0.07 ± 0.04 vs. 0.04 ± 0.03 (P = 0.009) and 1.15 ± 1.36 vs. 0.54 ± 0.17 (P = 0.048) before and after the operation, respectively. In 78% of the patients, the Matta or Majeed scores were excellent or good. The SF-12 physical and mental health scores were 45.1 ± 10.2 and 53.2 ± 6.3, respectively. Furthermore, one superficial surgical site infection, one loosening of INFIX, one lateral femoral cutaneous nerve irritation, one femoral nerve injury, and two implant discomforts due to the bar were noted. Among five patients with sacral nerve injuries, four were asymptomatic, and one just had paresthesia at the last follow-up. Conclusion: INFIX with or without sacroiliac screws can achieve satisfactory radiographic and functional outcomes in the treatment of unstable pelvic ring fractures. Trial registration: ChiCTR2000038812. Registered 04 October 2020. Retrospectively registered.

Background: At present, the choice of surgical approach for both-column fractures is still controversial. The purpose of this study was to explore the efficacy of the Stoppa combined with iliac fossa (S+IF) approach in the treatment of both-column fractures. Methods: In this retrospective case series, 76 patients were included in the study from 2014 to 2018. They were divided into two groups according to the surgical approaches. The differences of intraoperative blood loss, operative time, quality of reduction, clinical outcome, and perioperative complications were compared between the two groups. Results: All patients had undergone the IL approach or the S+IF approach. The average operative time was 156.2 min (110~210 min) in group I and 126.5 min (80~180 min) in group II (P < 0.001). The average blood loss in group I was 784.1 ml, while the average blood loss in group II was 625.3 ml (P = 0.007). According to Matta’s criteria, 28 cases obtained anatomic reduction and 12 cases got imperfect reduction in group I; 21 cases obtained anatomic reduction and 7 cases got imperfect reduction in group II (P > 0.05). The clinical outcome (excellent to good) was 66% in group I versus 69% in group II (P > 0.05). The complication rates were 18.2% in group I and 12.5% in group II (P > 0.05). Conclusions: As a minimally invasive surgical approach, the S+IF approach is a valuable alternative to the IL approach for the treatment of both-column acetabular fractures if these two anterior approaches can achieve fracture exposure, reduction, and fixation.