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Background Open reduction and internal fixation (ORIF) represents a standard surgical technique for the management of patellar fractures, with tension band fixation serving as the commonly employed method. To enhance fixation strength, wires are frequently threaded through the medullary canal of the bone. This study aims to evaluate the potential benefits of utilizing transosseous wire fixation in the treatment of patellar fractures and its impact on patient outcomes. Method In this study, 223 patients with patellar fractures who had undergone open reduction and tension band surgery at our hospital were included, and a retrospective case-control study was conducted. The patients were divided into two groups: fixation using pin-tail bolt locking intramedullary Kirschner wires was received by one (observation group), while the standard treatment protocol was received by the other (control group). Both groups were followed regularly for one year, and postoperative complications were recorded. A comparative analysis was performed to evaluate differences in postoperative functional recovery and knee joint range of motion between the two groups. All statistical analyses were carried out using SPSS (version 26.0). Results A total of 223 patients were included in the study; 72 of these were assigned to the observation group and received transosseous wire placement, while the remaining patients were assigned to the control group. No significant differences were observed between the two groups in terms of gender, age, or fracture type. No statistically significant difference was found in the number of intraoperative X-ray fluoroscopies ( P  = 0.11). However, the operative time was significantly longer in the observation group compared with the control group ( P  < 0.05). No significant differences were detected in the incidence of nonunion ( P  = 0.56), refracture ( P  = 0.58), internal fixator fracture ( P  = 0.32), or wound infection ( P  = 0.96) between the two groups. In contrast, a statistically significant difference was observed in the incidence of internal fixation loosening ( P  < 0.05). Among patients with internal fixation loosening, no significant difference was noted in Bostman scores between the control and observation groups ( P  = 0.60). Conclusion It is indicated by findings that although postoperative complication rates are not increased by the use of transosseous wire fixation in patellar fractures, no significant benefits are provided by this technique in terms of functional scores, knee range of motion, or the rate of fracture healing.

Background Stable intertrochanteric fractures of the hip are common injuries, particularly among the elderly population. Effective surgical intervention is crucial for improving patient outcomes and recovery. Two widely used fixation techniques are the Dynamic Hip Screw (DHS) and Proximal Femoral Nailing (PFN). Both methods aim to provide stability and help early mobilization, yet they differ in their biomechanical properties and clinical implications. Objective This review article aims to compare the efficacy and outcomes of DHS and PFN in the treatment of stable intertrochanteric fractures, focusing on key metrics such as the Harris Hip Score (HHS), pain management, functional recovery, and complication rates. By synthesizing findings from recent studies, the review seeks to provide a comprehensive understanding of the advantages and limitations of each technique. Results Comparative analysis demonstrated that proximal femoral nailing (PFN) was associated with shorter hospital stays (average: 7.8 days compared to 12.4 days), earlier mobilization (7.93 weeks compared to 11.80 weeks to full weight-bearing), and better early postoperative functional results (Harris Hip Scores: 90.33 compared to 89.08 at the 12-month follow-up) compared to dynamic hip screw (DHS). However, PFN was associated with a longer fluoroscopy exposure and higher rates of implant cut-out complications, whereas DHS was associated with higher intraoperative risks of lateral wall fractures (32% rate), higher blood loss, and reoperation rates. Economic evaluation revealed comparable overall costs for both modalities, although the initial implantation costs were greater for PFN. Fracture union timelines were statistically comparable (mean: ~130 days). Conclusion The diagnosis and management of intertrochanteric fractures remain a subject of considerable debate, both techniques have their distinct sets of benefits and drawbacks, highlighting the necessity for a tailored approach depending on patient-specific factors and surgical settings. Ultimately, these multifaceted findings underscore the need for further comparative studies to better understand these differences and aid in improving surgical approaches for intertrochanteric fractures. This will enable more informed decision-making, potentially improving patient outcomes and optimizing resource use in healthcare settings.

Background This study aims to systematically evaluate and compare the intraoperative outcomes, postoperative efficacy, and clinical prognosis of Nice knot versus lag screw in augmenting locking plate fixation for comminuted clavicular fractures. Through comprehensive assessment of different therapeutic approaches, we endeavor to provide more scientific and effective therapeutic options for patients with comminuted clavicular fractures. Methods From January 2020 to December 2022, 123 patients with unilateral midshaft comminuted clavicular fractures were enrolled, including 58 cases in the Nice knot (NK) group and 65 cases in the lag screw (LS) group. The general information, intraoperative conditions, postoperative clinical outcomes, and imaging results of patients in both groups were recorded and compared. The Visual Analog Scale (VAS) score, Constant-Murley score, Disabilities of the Arm, Shoulder and Hand (DASH) score and incidence of complications were assessed between the two groups. Results There were no significant differences in general information between the two groups. The NK group demonstrated significantly shorter operation time and less intraoperative blood loss compared to the LS group ( P  < 0.01). Both groups had one case of implant failure, while two cases of nonunion were observed in the LS group ( P  > 0.05). Follow-up results revealed no significant differences in VAS score, QuickDASH score, or Constant-Murley score between the two groups ( P  > 0.05). Conclusion This study demonstrated that both the Nice knot and lag screw achieved favorable clinical outcomes in augmenting locking plate fixation for Robinson IIB clavicle fractures. However, the NK group exhibited advantages of decreased intraoperative blood loss and shorter operation time, which makes it a valuable, effective, and safe surgical approach for managing Robinson IIB clavicle fractures, worthy of clinical promotion.

Introduction This study compared the clinical and radiologic outcomes of well-fixed periprosthetic femoral fractures after hip arthroplasty according to the use of single plate fixation with additional attachment plate device (group 1) or not (group 2). Materials and methods Retrospective data were obtained from a single center by reviewing medical records of patients who underwent reduction and internal fixation of Vancouver type B1 and C periprosthetic femoral fractures between June 2006 and June 2021. The study analyzed patient demographics, fracture characteristics, surgical details, functional outcomes (Harris hip score [HHS] and Koval score at 1-year follow-up), reoperation rates, and radiologic findings. In this study, nonunion and malunion were defined as indicators of “healing problems.” Results Among the 32 included patients (group 1: 15; group 2: 17), fractures resulted from high-energy (six cases) and low-energy (26 cases) injuries, with no open fractures. The fractures included 21 cases of Vancouver type B1 and 11 cases of type C. One patient (6.7%) in group 1 required revision surgery. Excellent or good outcomes were observed in 100% of group 1 and 88.2% of group 2 patients according to Beals–Tower criteria ( p  = 0.031). Healing problems occurred in 6.7% and 41.2% of patients in groups 1 and 2, respectively ( p  = 0.03). HHS score, Koval score, union time, or femoral alignment did not differ significantly between the two groups ( p  > 0.05). Conclusions Using an additional plate in the treatment of well-fixed periprosthetic femoral fractures yielded better clinical outcomes compared to cases without an additional plate. Lower rates of nonunion or delayed union and improved overall healing were observed in the augmented group.

Background Humeral shaft fractures, accounting for 1–3% of adult fractures, increasingly require surgical intervention due to high nonunion rates. This study compares outcomes of intramedullary nailing and plate fixation in older adults. Methods A retrospective analysis was conducted on 55 patients with humeral shaft fractures treated at the Mohamed Taieb Kassab Orthopedic Institute between 2014 and 2022. The cohort included 32 patients managed with intramedullary nailing (IMN) and 23 with dynamic compression plating (DCP). Demographics, fracture characteristics (AO classification), operative duration, union duration, functional outcomes (modified Stewart and Hundley criteria, Constant-Murley score), and complications were evaluated. Statistical analysis used SPSS v19.0. Results Mean age was 64.7 years, with male predominance (40 male, 15 female and a gender ratio of 2.6). IMN was preferred for middle-third (58%) and AO type A fractures (79.4%), while DCP dominated complex fractures (76.2% type B/C with p  < 0.05).IMN demonstrated shorter operative duration (60.2 ± 4.4 vs. 105.9 ± 7.7 min and p  < 0.001). Fracture union averaged 19.9 ± 7.9 weeks, with no intergroup difference ( p  = 0.360). Functional outcomes (76.4% good or excellent) were comparable between techniques ( p  > 0.05), but DCP yielded superior Constant-Murley scores (91.1 ± 10.5 vs. 80.6 ± 15.4 and  p  = 0.007). Complications included shoulder stiffness (25% IMN, 0% DCP and  p  = 0.015), complex regional pain syndrome (CRPS) (15.6% IMN, 0% DCP), sepsis (4.3% DCP, 0% IMN), and radial nerve palsy (4.3% DCP, 0% IMN). Conclusion IMN offers faster surgery and lower infection risk but higher shoulder morbidity. Plate fixation excels in complex fractures with better functional scores but longer operative duration and infection risk. Considering these factors, DCP may be the preferred approach in older adults compared to IMN, particularly when functional optimization is a priority. The choice of surgical technique should be guided by fracture characteristics, patient’s specific factors, and surgeon expertise.

Background Due to the patella’s thin overlying skin, metal implants frequently cause local discomfort that necessitates removal. This study aimed to evaluate the intraoperative and early postoperative outcomes of treating comminuted patellar fractures using non-absorbable sutures as the sole internal fixation method via the Nice knot technique. Methods This retrospective study reviewed 25 patients with unilateral closed comminuted patellar fractures who underwent open reduction and internal fixation using either non-absorbable sutures tied with a Nice knot (NK group, n  = 12) or the traditional tension band technique (TB group, n  = 13). Intraoperative surgical time and blood loss were recorded. Postoperative clinical outcomes were evaluated using the Visual Analogue Scale (VAS) for pain, knee range of motion (ROM), and the Böstman scoring system. Radiographic assessments were conducted to evaluate fracture healing. Complications, including infection, implant loosening, and discomfort or irritation, were also documented. Results Although the intraoperative surgical time was slightly longer in the NK group compared to the TB group, the difference was not statistically significant. The difference in blood loss between the NK and TB groups was also not statistically significant. No cases of bone non-union, implant loosening, or internal fixation failure were observed in either group during the follow-up period. One patient in the TB group developed a wound infection one week postoperatively. At the final follow-up, there were no significant differences between the two groups in terms of VAS scores, knee range of motion (ROM), or Böstman scores. However, in the TB group, five patients reported notable discomfort or irritation caused by the internal fixation. Conclusion Compared with traditional tension band fixation, the Nice knot technique reduces soft tissue irritation, avoids implant removal surgery, potentially lowers postoperative infection rates, and achieves comparable fracture healing time and knee function. However, broader validation through multi-center studies is required.

Background Kirschner wire tension band (KWTB) and anatomical plate fixation are the most often used procedures for treating Mayo type II olecranon Fractures, each has its technological advantages. However, there are often some associated complications with single use, the combination of Kirschner-wire tension band reduction and locking plate fixation in treating Mayo type II olecranon fractures has been seldom recorded. This research aims to compare the efficacy of KWTB alone and KWTB combined with anatomical locking plate (ALP) in the treatment of Mayo type II olecranon fractures. Methods Clinical data from 72 individuals who had surgery for Mayo type II olecranon fractures between January 2020 and December 2022 were evaluated retrospectively. Patients were randomized to either KWTB ( n  = 37, 19 males and 18 females; range 36 to 75 years; mean age 49.12 ± 9.51 years) or KWTB + ALP ( n  = 35, 16 males and 19 females; range 37 to 75 years; mean age 50.07 ± 9.45 years). Data including operative duration, intraoperative bleeding, incision length, hospital stay, postoperative complications, and the time to return to work, fracture union time, and follow-up time were documented. Their Disabilities of the Arm, Shoulder and Hand (DASH), Mayo elbow performance score and elbow range of motion (ROM) measures were utilized for functional assessments. Results The mean follow-up time was 28.03 ± 8.14 months, there were no statistical differences in general characteristics, intraoperative blood loss and length of incision between the two groups ( P  > 0. 05).The operative duration of KWTB + ALP group was greater than that of KWTB group ( P  < 0. 05). The average stay in the hospital was 8. 80 ± 2. 62 in the KWTB group and 6. 94 ± 3. 82 in the KWTB + ALP group ( P  = 0.0181). Patients come back to work in 9.6 ± 3.4 weeks in the KWTB group and 7.8 ± 2.7 weeks in the KWTB + ALP group ( P  = 0.0156). The rate of complications was considerably greater in the KWTB group (24.3% compared with 5.8%; P  = 0.0283). The fracture union time was 15.36 ± 3.44 in the KWBT group and 12.28 ± 3.42 in the KWTB + ALP group ( P  = 0.003). The mean flexion-extension ROM values and pronation-supination ROM values showed no statistical difference between the two groups. The mean DASH score was 14.0 ± 2.8 in the KWTB group and 10.7 ± 3.2 in the KWTB + ALP group ( P  = 0.001). The average Mayo score was 84.0 ± 9.3 in the KWTB group and 88.3 ± 9.1 in the KWTB + ALP group ( P  = 0.0171). Mean Mayo score and mean DASH score were statistically different between the 02 groups. Conclusion Both operative procedures effectively treat Mayo type II olecranon fractures. Despite the fact that KWTB therapy is inexpensive and simple to administer, there is a high risk of complications associated with it. KWTB combined with ALP in the management of Mayo type II olecranon fracture, especially type IIB olecranon fracture has satisfactory medium and long-term outcome.

Objective The treatment of comminuted inferior pole patellar fractures has long posed a challenge for orthopedic surgeons. This study aims to compare the biomechanical stability and clinical efficacy of Kirschner wire tension band combined with anchor cross-suture fixation versus traditional partial patellectomy in the treatment of comminuted inferior pole patellar fractures. Methods A retrospective analysis was conducted on 14 patients who underwent Kirschner wire tension band combined with anchor cross-suture fixation (Group A) in our department of orthopedics from September 2020 to April 2022. Additionally, we matched 14 patients with similar baseline characteristics who received inferior pole patellectomy combined with patellar tendon repair (Group B). The two groups were compared in terms of operative time, intraoperative blood loss, postoperative complications, and at the final follow-up, knee range of motion (ROM), visual analogue scale (VAS) score, Bostman knee function score, peak knee torque, and Insall-Salvati (IS) ratio. Results All patients were followed up for more than 12 months. At the final follow-up, Group A showed significantly better outcomes than Group B in terms of knee range of motion (ROM), Bostman knee function score, knee VAS score, and average peak knee torque, with statistically significant differences ( P  < 0.05), indicating faster postoperative recovery and better clinical results in Group A. The IS ratio of the injured knee in Group B was 0.71 ± 0.66, less than 0.8, suggesting a decrease in patellar height. There were no significant differences between the two groups in terms of operative time, intraoperative blood loss, or incision length ( P  > 0.05). In Group A, one patient experienced complications from hardware irritation, while in Group B, one patient had postoperative knee pain, and two patients experienced knee extension weakness after cast removal and rehabilitation. Conclusion Kirschner wire tension band combined with anchor cross-suture fixation for the treatment of inferior pole patellar fractures yields satisfactory results. This technique provides reliable fixation, restores the original extensor mechanism, promotes early postoperative rehabilitation, and reduces the incidence of complications, making it suitable for clinical application and widespread use. Evidence level Level III (retrospective comparative study)

Background/objectives This study aimed to compare the clinical outcomes of parallel and orthogonal plating in the surgical treatment of AO/OTA type 13-C distal humerus fractures in patients over 50 years of age and to evaluate the predictive role of local bone quality, measured using Hounsfield Unit (HU), on these outcomes. Methods In this retrospective study, 80 patients over the age of 50 who underwent surgery for AO/OTA type 13-C distal humerus fractures between 2012 and 2022 were analyzed. Patients were categorized into two groups according to the plating technique: parallel( n  = 33) or orthogonal( n  = 47). Functional and radiological outcomes were compared, including elbow range of motion, Mayo Elbow Performance Score (MEPS), QuickDASH, time to union, complication and reoperation rates, and presence of post-traumatic osteoarthritis. Bone quality was stratified based on HU measurements obtained from preoperative CT scans, specifically from the largest intact slice of the capitellum and trochlea in the sagittal view and from the axial slice just above the proximal fracture line, using a threshold value of 124.5 HU corresponding to the median HU value of the patient cohort. MEPS and QuickDASH were evaluated at the 12-month postoperative follow-up. Results Orthogonal plating was associated with longer union times ( p  < 0.001), higher complication rates ( p  = 0.008), and greater incidence of post-traumatic arthrosis ( p  = 0.027) compared to parallel plating. Subgroup analysis revealed that in patients with HU ≤ 124.5, orthogonal plating was linked to significantly increased nonunion risk ( p  = 0.03) and longer union times ( p  < 0.001), whereas parallel plating yielded more consistent results regardless of bone quality. Nonunion was significantly higher in the HU ≤ 124.5 subgroup ( p  = 0.031), and particularly more frequent in orthogonal plating within this group ( p  = 0.04). Conclusion While both plating techniques provided comparable functional outcomes, orthogonal plating was associated with higher complication and nonunion rates, especially in patients with poor bone quality. This may be attributed to the reduced mechanical stability of orthogonal constructs in osteoporotic bone, which may compromise fixation strength and lead to higher failure rates. HU assessment from routine CT scans may aid in preoperative decision-making to optimize surgical outcomes.

Despite numerous available treatment strategies, the management of complex proximal humeral fractures remains demanding. Impaired bone quality and considerable comorbidities pose special challenges in the growing aging population. Complications after operative treatment are frequent, in particular loss of reduction with varus malalignment and subsequent screw cutout. Locking plate fixation has become a standard in stabilizing these fractures, but surgical revision rates of up to 25% stagnate at high levels. Therefore, it seems of utmost importance to select the right treatment for the right patient. This article provides an overview of available classification systems, indications for operative treatment, important pathoanatomic principles, and latest surgical strategies in locking plate fixation. The importance of correct reduction of the medial cortices, the use of calcar screws, augmentation with bone cement, double-plate fixation, and auxiliary intramedullary bone graft stabilization are discussed in detail.