Objective To compare clinical outcomes between the performed titanium locking plate and nickel-titanium memory alloy embracing fixator for the treatment of multiple rib fractures, and to select a better internal fixator for multiple rib fractures. Methods A total of 206 consecutive patients with multiple rib fractures were admitted to Department of Cardiothoracic Surgery in Beijing Luhe Hospital of Capital Medical University from October 2011 to September 2016. According to different treatment strategies, the patients were divided into 2 groups: a performed titanium locking plate group (a titanium plate group, n=105) and a nickel-titanium memory alloy embracing fixator group (an embracing fixator group, n=101). There were 82 males and 23 females with a mean age of 46.5±9.7 years ranging from 23 to 65 years in the titanium plate group, and 83 males and 18 females with a mean age of 44.7±10.3 years ranging from 19 to 63 years in the embracing fixator group. The preoperative data, curative outcomes, visual analogue scale (VAS) and postoperative complications were compared between the two groups. Results There was no statistical difference in the preoperative data between the two groups, and all patients successfully completed the operation. Compared with the embracing fixator group, the incision length and operation time were shorter, intraoperative bleeding and VAS score were less, and curative outcome was better in the titanium plate group. Conclusion The performed titanium locking plate has a great advantage in the clinic, which can be preferred.
Objective To investigate the effectiveness of nickel-titanium shape memory staples in treating multiple metatarsal fractures. MethodsThe clinical data of 27 patients with multiple metatarsal fractures who were treated between January 2022 and June 2023 and met the selection criteria were retrospectively analysed. The cohort consisted of 16 males and 11 females, aged 33-65 years (mean, 47.44 years). The causes of injury included heavy object impact in 11 cases, traffic accidents in 9 cases, and crush in 7 cases. Simultaneous fractures of 2, 3, 4, and 5 bones occurred in 6, 6, 4, and 8 cases, respectively, with tarsometatarsal joint injury in 3 cases. Fixation was performed using staples for 16, 22, and 9 fractures in the metatarsal neck, shaft, and the base, respectively, and 5 tarsometatarsal joint injuries. Preoperative soft tissue injuries were identified in 8 cases and classified according to the Tscherne-Oestern closed soft tissue injury classification as type Ⅰ in 5 cases and type Ⅱ in 3 cases. One case of type Ⅱexhibited preoperative skin necrosis. The patients were treated with fixation using nickel-titanium shape memory staples. Complications and fracture healing were documented. At last follow-up, the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score was used to evaluate the function, and the visual analogue scale (VAS) score was used to evaluate the pain. Results The 27 patients were followed up 9-19 months (mean, 12.4 months). Postoperative X-ray films revealed no loss of fracture reduction, and all fractures achieved bony union. No internal fixator loosening, breakage, or other mechanical failures was observed. The mean fracture healing time was 3.13 months (range, 3-4 months). Postoperatively, 4 cases (2 of Tscherne-Oestern type Ⅰ, 2 of type Ⅱ) developed superficial skin necrosis, which resolved with dressing changes. No infection was observed in the remaining patients, and all wounds healed. At last follow-up, the AOFAS forefoot score ranged from 70 to 95, with an average of 86.6, of which 19 cases were excellent, 6 cases were good, and 2 cases were fair, with an excellent and good rate of 92.6%; the VAS score ranged from 0 to 3, with an average of 0.9, of which 24 cases were excellent, and 3 cases were good, with an excellent and good rate of 100%. Conclusion The use of nickel-titanium shape memory staples in the treatment of multiple metatarsal fractures can effectively protect local skin and soft tissues and minimize secondary damage associated with internal fixator insertion. It is a viable surgical option for management of multiple metatarsal fractures.