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Iliosacral screw osteosynthesis is a widely recognized technique for stabilizing unstable posterior pelvic ring injuries, offering notable advantages, including enhanced mechanical stability, minimal invasiveness, reduced blood loss, and lower infection rates. However, the procedure presents technical challenges due to the complex anatomy of the sacrum and the proximity of critical neurovascular structures. While conventional fluoroscopy remains the primary method for intraoperative guidance, precise preoperative planning using multiplanar reconstructions and three-dimensional volume rendering is crucial for ensuring accurate placement of iliosacral or transsacral screws. Particular attention must be given to the preoperative evaluation of both the iliosacral and transsacral corridors, as anatomical variations may restrict the available space for screw insertion. This review aims to highlight the essential aspects of sacroiliac osteosynthesis, with a focus on the critical role of thorough preoperative planning and its impact on achieving successful surgical outcomes.

Purpose Humeral shaft fractures (HSFs) can be treated non-operatively (Non-OP), with open reduction and plate osteosynthesis (ORPO), minimally invasive plate osteosynthesis (MIPO), or with intramedullary nails (IMN). However, the best treatment for HSFs still remains controversial.We performed a network meta-analysis to explore which should be the best method for HSFs. Methods The computerized search had been conducted on electronic databases PubMed, EMBASE, Cochrane Library, and Medline from the establishment of the database to the end of December 2022. The quality evaluation of the included literature had been completed by Review Manager (version 5.4.1). Stata 17.0 software (Stata Corporation, College Station, Texas, USA)was used for network meta-analysis.We included randomized controlled trials (RCTs) comparing different treatments to treating HSFs. Results The pairwise comparison results demonstrated that there was no statistical difference between IMN, MIPO, Non-OP, and ORPO in terms of radial nerve injury and infection, and Non-OP presented significantly more nonunion than ORPO, IMN, and MIPO. However, no statistically significant difference between ORPO, IMN, and MIPO was discovered. The results of the network meta-analysis displayed that surface under the cumulative ranking curve (SUCRA) probabilities of IMN, MIPO, Non-OP, and ORPO in radial nerve injury were 46.5%, 66.9%, 77.3%, and 9.3%, respectively, in contrast, that in infection were 68.6%, 53.3%, 62.4%, and 15.4%, respectively, and that in nonunion were 51.7%, 93.1%, 0.7%, and 54.5%, respectively. Conclusion We came to the conclusion that MIPO is currently the most effective way to treat HSFs. Trial registration Name of the registry: Prospero, 2. Unique Identifying number or registration ID: CRD42023411293.

The paper refers to presenting the current state of scientific research in the field of Ilizarov fixators used in orthopedic surgeries. The approach is not exhaustive, as the aim of the paper is to outline the general coordinates that can form the basis for structuring the information in the specialized literature in this field. To provide a scientific presentation of the current state of research, a logical-combinatorial technical creation method was used, the idea diagram method. In this way, the variety of technical solutions developed to date can be visualized in a single view. The method also presents the advantage that information is classified by fields and subfields, which allows the systematization and coding of information. The paper presents two concept diagrams, in which technical solutions are classified according to mechanical functionality and the anatomical area in which they are located on the patient’s limbs. Given the open and critical nature of the method, the paper concludes by defining future avenues for development in the field.

ObjectivesThe aim of the present study was to compare conventional (CSP) versus customized virtual surgical planning (VSP) in bimaxillary orthognathic surgery. The primary goal was to compare the accuracy of defined angles. The secondary purpose was to analyze the accuracy of the splints, the time required for surgery, and the costs of both methods.Materials and methodsA total of 21 patients (nCSP = 12; nVSP = 9) treated by two-jaw orthognathic surgery were analyzed prospectively between the years 2014 and 2016. Customized VSP consisted of virtual planning as well as CAD/CAM printing of splints and pre-bent osteosynthesis plates. The evaluated parameters were the difference between planned and postoperative situation (SNA/SNB/ANB), accuracy of splints, time required for surgery (min), and total costs of planning (€).ResultsWhen compared to CSP, VSP appears to be a more accurate method for orthognathic treatment planning with significant differences in the angle outcome (SNA p < 0.001; SNB p = 0.002; ANB p < 0.001). There were significant differences in splint accuracy in favor of CAD/CAM splints (p = 0.007). VSP significantly reduced the duration of operation (p = 0.041). Nevertheless, VSP increased the total costs (481.80 € vs. 884.00 €).ConclusionsWhen using virtual 3D technology in combination with printed acrylic splints, 3D models of the jaws and pre-bent osteosynthesis, there is a noticeable reduction in the duration of the operation in conjunction with an improvement in accuracy.Clinical relevanceVirtual model surgery and the prefabrication of splints and plates may replace traditional orthognathic surgery as it becomes cost-effective.

Purpose Short-segment minimally invasive percutaneous spinal osteosynthesis has now become one of the treatments of choice to treat thoracolumbar fractures. The question of implant removal once the fracture has healed is still a matter of debate since this procedure can be associated with loss of sagittal correction. Therefore, we analyzed risk factors for kyphosis recurrence after spinal implants removal in patients treated with short-segment minimally invasive percutaneous spinal instrumentation for a thoracolumbar fracture. Methods A total of 32 patients who underwent implant removal in percutaneous osteosynthesis for post-traumatic thoracolumbar fracture were enrolled in our study. Patient’s medical record, operative report and imaging examinations carried out at the trauma and during the follow-up were analyzed. Results Every patient experienced fracture union. Vertebral kyphotic angle (VKA) and Cobb angle (CA) improved significantly after stabilization surgery. VKA, CA, upper disk kyphotic angle (UDKA) and lower disk kyphotic angle (LDKA) significantly gradually decreased during follow-up. Traumatic disk injury ( p : 0.001), younger age ( p : 0.01), canal compromise ( p : 0.04) and importance of surgical correction ( p  < 0.001) were significantly associated with kyphosis recurrence after implant removal. Anterior body augmentation did not affect loss of correction (CA and VKA) during the follow-up period ( p : 0.57). Conclusion Despite correction of the fracture after stabilization, we observed a progressive loss of correction over time appearing even before implant removal. Particular attention should be paid to post-traumatic disk damage or canal invasion, to young patients and to surgical overcorrection of the traumatic kyphosis.

Metal fixation is currently the standard of care for treating bone fractures surgically, as it provides ample stability to the healing bone. However, metal components have been associated with soft tissue adhesions and are generally not patient specific. A novel light-curable bone fixation method, called AdhFix, overcomes these disadvantages by allowing for in situ customizability and demonstrating a lack of soft tissue adhesions. Previous studies on this fixation technique have demonstrated the maximum bending and torsional moments in monotonic failure tests in dry conditions. However, this fixation has yet to be tested cyclically in a more physiological environment, which would represent an important step to assessing the clinical efficacy of this technology. This study aims to test the novel fixation method cyclically at relevant force levels in a controlled near-physiological environment. Midshaft osteotomies were performed on ovine proximal phalanges which were then fixated with the AdhFix osteosynthesis technique. The constructs were tested cyclically in four-point bending for 12,600 cycles, representing 6 weeks of rehabilitation, or until failure, while submerged in Ringer solution at 37°C. The samples were divided into four groups, each tested with a different peak force. The peak forces were based on safety factors (Group 1: 100x, Group 2: 150x, Group 3: 175x, Group 4: 250x) of a physiological bending moment present in a human proximal phalanx osteosynthesis during rehabilitation exercises, determined in a previous study. All samples survived at the lowest peak moment (Group 1), whereas all failed at the highest peak force (Group 4). Kaplan-Meier curves represented the survival probability as a function of the number of cycles for each group, and a log-rank test revealed that the survival curves were significantly different (p < 0.001). The difference in patch height between the failures and survivors was not statistically significant (p = 0.113), but the final cycle displacement amplitude was statistically different (p < 0.001). This study found that this novel osteosynthesis method can survive a clinically relevant number of cycles at a force level 100× the bending loads involved in typical non-weight-bearing rehabilitation exercises. Further studies are needed to confirm safety for other conditions.

Background Re-fracture is the most serious complication in congenital pseudarthrosis of the tibia (CPT). There are reports that children with small cross-sectional areas in the sections of the pseudarthrosis are more prone to re-fracture. Presently, preventing complications is a challenge. Increasing the cross-sectional area in healed segments may reduce the incidence of re-fracture. Purpose To elucidate the indications, surgical technique, and outcomes of combined surgery and 3-in-1 osteosynthesis in CPT with intact fibula. Methods We retrospectively assessed 17 patients with Crawford Type IV CPT with intact fibula (Type A) who were treated with combined surgical technique and 3-in-1 osteosynthesis between March 2014 and August 2015. The average age of the patients at the time of surgery was 3 years. Incidence of re-fracture, ankle valgus, proximal tibial valgus, and limb length discrepancy (LLD) were investigated over an average follow-up time of 47 months. Results Primary union was achieved in all patients. The average time for primary union was 4.9 months. Fifteen (88%) cases showed LLD with an average limb length of 1.6 cm; 6 (35%) cases exhibited tibial valgus with an average tibial valgus deformity of 7.8°; 2 cases had ankle valgus, wherein the ankle valgus deformity was 12° in one and 17° in another; and the cross-sectional area of the bone graft was enlarged to 1.74 times that of the tibia shaft. No case had re-fracture during the follow-up period. Movement of the ankle joint was restored in 16 patients with an average dorsiflexion of 22° and an average plantar flexion of 41°; the function of the ankle joint was normal. One patient had plantar flexion of 20° but did not have dorsiflexion. Conclusion Combined surgical technique with 3-in-1 osteosynthesis, which is primarily considered for bone union with a large cross-sectional area, results in a high primary union rate. This can provide satisfactory results in short-term follow-up when treating CPT with intact fibula (Type A).

The data on the use of a one- or two-screw technique (1S, 2S) for ventral osteosynthesis of type II dens fractures are contradictory. The aim was to design an apparatus to mimic the physiological conditions and test stability with 1S, 2S, and a headless compression screw (HCS) for osteosynthesis of artificially created type II odontoid fractures. The apparatus was mounted on a Zwick materials testing machine. A total of 18 C1–2 specimens were stratified into three groups (1S, 2S, HCS). Odontoid fractures were artificially created, and osteosynthesis was performed. Each specimen was tested at loads increasing from 1 to 40 N. Screw loosening was observed visually, by fatigue data, and by a camera tracking system. Analysis of the Zwick data and the camera data revealed a significant higher stability after 2S compared to 1S and HCS treatment (Zwick data: p = 0.021, camera data: p < 0.001), while visible screw loosening showed a superiority of the 2S only over HCS (p = 0.038). The developed apparatus allowed the dynamic study of the atlantoaxial joint with a high approximation to physiological conditions. The results demonstrated superiority of the 2S over the 1S and HCS in biomechanical stability in the treatment of type II odontoid fractures.

Objective To evaluate the clinical efficacy and advantages of Minimally Invasive Plate Osteosynthesis (MIPO) for the treatment of displaced midshaft clavicle fractures (DMCFs). Methods A retrospective case–control study was conducted involving 79 patients with DMCFs treated at our institution between January 2021 and December 2024. Patients were divided into two groups based on the surgical technique: MIPO ( n  = 32) and Open Reduction and Internal Fixation (ORIF) ( n  = 47). Key parameters—including operative time, intraoperative blood loss, incision length, complications, patient satisfaction, and functional recovery outcomes—were compared. Results Compared to the ORIF group, the MIPO group demonstrated significantly shorter operative time (54.22 ± 5.14 min vs. 61.15 ± 6.01 min, p  < 0.001), reduced intraoperative blood loss (45.44 ± 4.27 mL vs. 52.81 ± 6.60 mL, p  < 0.001), and shorter incision length (6.42 ± 0.48 cm vs. 12.25 ± 1.60 cm, p  < 0.001). Postoperative supraclavicular nerve injury was less frequent in the MIPO group (12.5% vs. 38.3%, p  < 0.001) and patient satisfaction was higher (90.6% vs. 72.3%, p  = 0.021). No significant differences were observed in functional outcomes, as assessed by the Disabilities of the Arm, Shoulder and Hand (DASH) and Constant-Murley scores. Conclusion While both surgical techniques yielded comparable functional recovery, MIPO demonstrated distinct intraoperative and early postoperative advantages, including shorter incisions, less blood loss, fewer nerve-related complications, and higher patient satisfaction. These findings support the clinical utility and therapeutic efficacy of MIPO in the management of DMCFs.