Junlin Zhou

Coronal shear fractures of the distal humerus exhibit complex morphology, presenting substantial challenges in clinical management. Fracture mapping techno

Injuries to the distal tibiofibular joint are often associated with ankle fractures, sports‐related injuries, or instability, whereas proximal tibiofibular joint injuries are more commonly present with lateral‐ or posterolateral‐compartment lesions of the knee. These conditions may be related to the relative motion between the tibia and fibula; however, precise movement patterns have yet to be fully elucidated. This study analyzes the relative motion of the tibia and fibula in 16 healthy adults (32 bones; 8 males and 8 females) throughout a normal gait cycle. CT scan data were initially acquired to construct 3D models of the tibia and fibula. X‐ray images were taken at seven points during the gait cycle for 3D‐2D and 3D‐3D model registration, facilitating the calculation of relative degrees of freedom (DOF) movements between these bones. Our results demonstrate that from the heel strike to the single‐legged stance phase, the fibula transitions from plantarflexion to dorsiflexion, reaching up to 0.41°. It shifts from inversion to eversion, increasing to 0.06°, while internal rotation decreases to 0.5°. From the single‐legged stance to the toe‐off phase, changes in plantarflexion/dorsiflexion are minimal, eversion decreases to 0.02°, and internal rotation increases to 0.63°. The proximal fibula exhibits anterior‐posterior, medial‐lateral, and inferior‐superior movements, with similar patterns observed in the distal fibula. During a standard gait cycle, internal/external rotational movements, along with anterior‐posterior and medial‐lateral shifts, are predominant. Orthopaedic Research Society.

Purposes: The aim of this study was to compare clinical outcomes of dual-plate fixation and volar locking plate fixation in high-energy intra-articular distal radius fractures.Methods: In this study, 168 patients with high-energy intra-articular distal radius fractures with either volar fragments, dorsal fragments, or radial styloid fragments, who were treated with one of three kinds of fixation methods (volar locking plate fixation, volar + radial plating fixation, and dorsal + radial plating fixation) were retrospectively reviewed and divided into three groups. Functional evaluations included DASH score, Mayo wrist score, wrist joint ROM, and grip strength percentage relative to the healthy side. Radiographic parameters assessed were volar tilt, radial inclination, radial height, and ulnar gap/step distance. Any complications were documented.Results: Significant differences were found in volar tilt, radial inclination, and gap/step distance 1 month postoperatively between the volar locking plate fixation group, the volar + radial plating group, and the dorsal + radial plating group. And the volar + radial plating group showed significant difference from the dorsal + radial plating group for the gap/step distance 1 month postoperatively (p < 0.01). Forty-six complications were recorded for 15 cases of the volar locking plate fixation group, 16 cases of the volar + radial plating group, and 15 cases of the dorsal + radial plating group.Conclusions: For high-energy distal radius fractures, volar locking plate fixation and dual-plate fixation achieved similarly positive functional and radiological outcomes. The dual-plate fixation method has the advantage of achieving better reduction quality.

Objective: To evaluate the reliability of the new Comprehensive Classification in clinical practice by comparing it with Evans-Jensen (1975), AO/OTA (2007), and AO/OTA (2018). Methods: A total of 192 patients with intertrochanteric fractures were included in the study. The fractures were classified using the Comprehensive Classification system and the three traditional methods by eight observers, consisting of four high-experienced and four less-experienced surgeons. Interobserver and intraobserver agreements were assessed using kappa statistics and compared across the different classification systems. Results: The study included 192 patients. The average inter-observer Kappa values using CT scan for Evans-Jensen (1975), AO/OTA (2007), AO/OTA (2018), and Comprehensive Classification were 0.361 ± 0.06, 0.348 ± 0.05, 0.408 ± 0.06, and 0.492 ± 0.02, respectively. The average inter-observer Kappa values based on 3DR were 0.411 ± 0.04, 0.396 ± 0.03, 0.442 ± 0.03, and 0.524 ± 0.03, respectively. The average intra-observer Kappa values using CT scan were 0.467 ± 0.05, 0.453 ± 0.06, 0.542 ± 0.04, and 0.631 ± 0.02, respectively. The average intra-observer Kappa values using 3DR were 0.503 ± 0.05, 0.482 ± 0.03, 0.561 ± 0.03, and 0.672 ± 0.02, respectively. The mean kappa value of Inter- and intra-observer for the Comprehensive Classification were higher than Evans-Jensen (1975) and AO/OTA (2007/2018) using CT scans and 3DR (P < 0.05). Additionally, the high-experienced group using 3DR had the highest agreement, at approximately 75.86%, when comparing the implant type corresponding to the fracture classification evaluated by the observer with the implant type selected by the observer. Conclusion: The Comprehensive Classification system emerges as a reliable and superior tool for the classification of intertrochanteric fractures, offering improved agreement rates and practical treatment insights compared to traditional methods. This classification has guiding significance for treatment.

The objective of this study was to investigate intra-articular distal radius fractures, aiming to provide a comprehensive analysis of fracture patterns and discuss the corresponding treatment strategies for each pattern. 294 cases of intra-articular distal radius fractures lines were collected and clustered thorough K-means and hierarchical clustering algorithm. The demographic data of patients and the clinical treatment outcomes were recorded. For functional evaluation, quick Disabilities of the Arm, Shoulder, and Hand (DASH) score, visual analog scale (VAS) pain score, range of motion (ROM) of the wrist joint and the percentage of the grip strength relative to the healthy wrist at 12 months follow-up were evaluated and recorded; For radiographic parameters of volar tilt (VT), radial inclination (RI), and ulnar variance (UV) were obtained; The occurrence of complications was carefully assessed and documented. Totally 294 patients were included and divided into the volar side affected group and the dorsal side affected groups. And each group was further categorized into three types: type I, with two parts fractures with either one volar/dorsal side intact; type II, with three parts fractures with volar/dorsal side simply affected; and type III, with four parts fractures with volar/dorsal side communited affected. The volar plate fixation was performed as the standard treatment, while the combined plate fixation was used for comminuted dorsal bone defects of the metaphysis and impaction. There were no differences in the postoperative radiograph parameters, functional outcomes and incidences of complications for each type of volar side group and dorsal side group except that the 3.2 type DRFs showed less range of flexion (75.56±7.48)° and extension (61.65±9.9)° than other dorsal types. A new intra-articular distal radius fractures classification was proposed based on the affection condition of volar or dorsal side. The volar plate fixation is an effective treatment for the intra-articular distal radius fractures, while combined plate fixation can be considered as an alternative treatment for dorsal side comminuted fractures. III a

Radial head fractures are the most common bony injury of the elbow in adults. The current literature does not agree on whether isolated stable type II radial head fractures should be treated operatively or nonoperatively. This review aims to determine the preferred treatment for Mason type II radial head fractures and compare the outcomes of conservative and surgical treatment. Our study used PRISMA guidelines and conducted a thorough search of multiple electronic databases, including PubMed, Cochrane, Embase, Web of Science, CNKI, and Wanfang databases, initially identifying 545 relevant publications on surgical and conservative treatment of Mason type II radial head fractures. The final search date for this study is July 7, 2024.Through a comprehensive meta-analysis, we evaluated several outcomes, including functional scores (DASH, OES, and MEPS scores), clinical outcomes (elbow flexion, elbow extension deficit, elbow pronation, and elbow supination), and complication rate (total complications and elbow pain). The mean difference (MD) was compared for continuous outcomes, and the odds ratios (ORs) were compared for categorical outcomes. A total of 271 patients from 4 studies met the inclusion criteria. Among them, 142 patients received surgical treatment and 129 patients received non-surgical treatment. The study found no statistically significant differences between surgical and non-surgical treatments in DASH, OES, MEPS, elbow flexion, elbow extension impairment, and elbow pain. Compared with surgical treatment, non-surgical treatment was associated with greater elbow pronation (OR = -3.10, 95% CI = [-4.96, -1.25], P = 0.55, I2 = 0%) and a lower complication rate (OR = 5.54, 95% CI = [1.79, 17.14], P = 0.42, I2 = 0%). Based on the current evidence, conservative management of isolated Mason II radial head fractures yields favorable therapeutic outcomes with a low incidence of complications.

Background: This study compared the curative effects of double plates (volar plate combined with radial column plate) and single plate (volar plate) on type C distal radius fractures involved with radial column. Methods: A 5-years retrospective cohort study was conducted in patients with distal radius fractures involved with radial column from January 2016 to January 2021. The single plate group patients were 5:1 matched with the double plates group patients according to the age and sex. Primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Besides, the secondary outcomes were wrist and forearm motion, grip, antiradial deviation muscle strength, visual analog scale, postoperative complications, and radiographic outcomes. Results: A total of 54 patients (double plates group 9 and single plate group 45) were included. All the patients were completed with a 12 months follow-up. There was no statistical difference between the two groups on DASH scores, wrist flexion, extension, ulnar deviation, radial deviation, forearm pronation and supination, grip strength, antiradial deviation muscle strength at 1, 2, 3, 6, and 12 months after surgery (P>0.05). In addition, there was no statistical difference in postoperative visual analog scale scores between the two groups. In radiographic outcomes, the radial inclination and radius height of the double plate group were better than those of the single plate group at 1, 3, and 12 months after operation (P<0.05). Both two groups patients had no postoperative complications occurrence. Conclusions: Double plate fixation did not improve the functional recovery of type C distal radius fractures involved radial column, although the radial column was fixed more firmly.