Purpose: In soft tissue reconstructive surgery, perforator localization and flap harvesting have always been critical challenges, but augmented reality (AR) has become a dominant technology to help map perforators. Methods: The lateral circumflex femoral artery (LCFA) and its perforators were reconstructed by CTA in consecutive patients (N = 14). Then, the anterolateral thigh perforators and the points from which the perforators emerged from the deep fascia were marked and projected onto the skin surface. As the virtual images were projected onto patients according to bony markers, the courses of the LCFA and its perforators were depicted on the skin surface for intraoperative guidance. Finally, the locations of the emergence points were verified by intraoperative findings and compared to those determined by handheld Doppler ultrasound. Results: The sources, locations, and numbers of perforators were determined by CTA. The perforators and their emergence points were accurately mapped on the skin surface by a portable projector to harvest the anterolateral thigh perforator flap. During the operation, the accuracy of the CTA & AR method was 90.2% (37/41), and the sensitivity reached 97.4% (37/38), which were much higher than the corresponding values of Doppler ultrasound. Additionally, the differences between the AR-marked points and the intraoperative findings were much smaller than those seen with Doppler ultrasound (P < 0.001). Consequently, all of the flaps were well designed and survived, and only one complication occurred. Conclusion: Augmented reality, namely, CTA combined with projection in this study, plays a vital and reliable role in locating the perforator emergence points and guiding the procedure to harvest flaps and has fewer potential risks.

Background: How to treat the posterior cruciate ligament (PCL) tibial insertion small and comminuted avulsion fracture is still challenging. Our study evaluated the clinical and radiological outcomes after ORIF of PCL tibial insertion avulsion fractures through the inverted L-shaped postero-medial approach using a homemade pin-hook. Methods: Between January 2009 and December 2020, twenty-four patients with isolated PCL tibial insertion bony avulsion were enrolled. There were 16 males and 8 females. The age range was 18-48 (32.5 ± 9.3) years. The time from injury to surgery was 1-10 (4.4 ± 2.8) days. There were 11 cases in the left knee and 13 cases in the right knee. The patients received anticoagulant therapy to prevent thrombosis. Preoperative standard X-ray, computerized tomography (CT) and magnetic resonance imaging (MRI) were performed. According to the Meyers-McKeever classification, there were 8 cases of type II and 16 cases of type III. Results: The operation time was 60-120 (89.6 ± 19.8) min. Postoperative follow-up ranged from 3 to 18 months. The average follow-up was 11.4 ± 4.3 months. In all patients, one or two homemade pin-hooks were used to fix different sizes of fracture segments. X-ray or CT scans taken after surgery revealed fracture union. The fractures healed in 9-16 (11.8 ± 1.7) weeks. At the last follow-up, the patients were able to fully straighten. The ROM (132.6° ± 3.9°), the Tegner-Lysholm score (96.2 ± 2.3) and the IKDC scores (95.5 ± 1.6) were all significantly improved compared with the preoperative values (77.5° ± 13.1°, 46.8 ± 8.9, 36.2 ± 7.9). The posterior drawer test was negative. The gastrocnemius muscle strength did not diminish. No internal fixation migration was observed during the follow-up. No neurovascular bundle- or hardware-related complications were reported. Conclusions: The inverted L-shaped postero-medial approach with homemade pin-hook fixation for the treatment of PCL avulsion fractures produces acceptable clinical and radiological results. Moreover, the homemade pin-hook made of K-wires is affordable and reduces patient costs. It is a practical application and worth recommending, especially for community hospitals.

Management the Sanders type II-III displaced intra-articular calcaneus fractures (DIACF) combined with compromised soft-tissue condition is full of challenges. The aim of this study was to validating the clinical efficacy and merits of the closed reduction and sequential frame screw technique for managing Sanders type II-III DIACF in conjunction with compromised soft-tissue conditions. We conducted a retrospective analysis on 13 patients with Sanders type II-III DIACF accompanied by compromised soft-tissue conditions between March 2022 and October 2023, while assessing postoperative complications as well as functional and radiographic outcomes. The fractures healed uneventfully in a single stage (8–12 weeks postoperatively), with no occurrences of infection, impaired wound healing, or necrosis of the skin and soft tissues during the postoperative period and at the last follow-up. The AOFAS score at the final follow-up was 88.38 ± 7.75, with 7 cases rated as excellent, 5 cases rated as good, and 1 case rated as fair, resulting in an overall excellent or good rate of 92.30%. Additionally, the mean VAS score at the final follow-up was recorded at 1.46 points (ranging from 0 to 3 points). The imaging measurements revealed a statistically significant improvement in the postoperative Gissane angle, Bohler angle, and calcaneal height when compared to preoperative values (P0.05). No cases of obvious varus deformity were observed, and although calcaneal width showed improvement at both postoperative and final follow-up assessments compared to preoperative measurements, these changes were not statistically significant (P>0.05). The closed reduction technique utilizing Kirschner wire lever and sequential frame screw technique has demonstrated efficacy in the management of Sanders type II-III DIACF accompanied by compromised soft-tissue conditions.

To compare operative efficiency and safety profiles between a novel C-Flex Traction™ and conventional traction systems during supine intramedullary nailing of geriatric pertrochanteric fractures. This retrospective study analyzed 52 geriatric patients with pertrochanteric fractures treated between January 2021 and December 2023. Participants were allocated to two groups: conventional traction table (TT, n = 29) and C-Flex Traction™ (n = 23). Perioperative metrics assessed included workflow efficiency (positioning duration, operative time), intraoperative parameters (blood loss, fluoroscopy times), radiographic outcomes (reduction accuracy, implant positioning), and postoperative functional recovery (Harris Hip Score) with complication surveillance. The cohorts demonstrated comparable baseline demographics and fracture patterns. Notably, the C-Flex Traction™ cohort exhibited a 50% reduction in preoperative workflow duration compared to conventional traction systems (15.0 ± 2.2 vs. 30.0 ± 2.8 min). No intergroup disparities emerged in operative duration, intraoperative blood loss, or radiographic outcomes (reduction quality: 87% vs. 86.2% anatomic alignment). A single traction-related complication (ankle pain) occurred in the TT group. The C-Flex Traction™ offers a novel alternative to conventional traction tables. By integrating dynamic, surgeon-controlled traction with fluoroscopic guidance, C-Flex Traction™ achieves anatomical reduction and stable fixation comparable to traditional methods while eliminating reliance on specialized equipment. Its streamlined workflow significantly reduces preoperative preparation time and surgical staffing demands, enhancing operational efficiency—particularly valuable in resource-constrained settings.