The authors evaluated the effectiveness of computerized virtual planning for open reduction and internal fixation (ORIF) of proximal humeral fractures. Between June 2011 and July 2013, a total of 46 patients with proximal humeral fractures were included in the current study. Preoperatively, fracture data were obtained via computed tomography (CT) reconstruction. Based on the dataset obtained from CT scanning, the 3-dimensional model of fractures was constructed and virtual segmentation, restoration, and internal fixation were performed. All eligible cases were treated by ORIF with locking plates. Intraoperatively, operative time, blood loss, and fluoroscope frequency were recorded. Postoperatively, the curative effect was evaluated by quality of fracture restoration reconstruction and plate position. In addition, fracture healing time and complications were recorded in the follow-up period. Average operative time was 85.6 minutes, and intraoperative blood loss ranged from 60 to 150 mL. Postoperatively, 1 patient experienced avascular necrosis, and no cases of screw penetration or screw loosening were observed. The coincidence rate of plate position was 91.3% according to height and 95.7% based on the position of the intertubercular sulcus and greater tuberosity. At the end of the follow-up period, mean shoulder function score was 83.9 (range, 58-96). Eighty-seven percent of patients had an excellent or good outcome. Computerized virtual planning facilitated ORIF and showed good results for patients with complex proximal humeral fractures. It may be a favorable option for treating fractures of the proximal humerus.

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BackgroundFibrodysplasia ossificans progressiva (FOP), an ultra-rare and disabling genetic disorder of skeletal malformations and progressive heterotopic ossification, is caused by heterozygous activating mutations in activin A receptor, type I/activin-like kinase 2 (ACVR1/ALK2). The rarity of the disease makes it common to make a misdiagnosis and cause mismanagement.Case presentationWe reported a case of a sixteen-year-old male patient who had suffered from pain and swelling in the biopsy site for two months. His physical examination presented serious stiffness and multiple bony masses in the body, with his bilateral halluces characterized by hallux valgus deformity and macrodactyly. Imaging examinations showed widespread heterotopic ossification. All laboratory blood tests were normal except for the one on alkaline phosphatase. A de novo heterozygous mutation (c.617G > A; p.R206H) were found in the ACVR1/ALK2 using gene sequencing.ConclusionEven though FOP is a rare disorder of genetic origin, which is generally misdiagnosed, the genetic analysis could provide definitive confirmation of the disease. Awareness of such an important approach can help clinicians to avoid the commonly practiced misdiagnosis and mismanagement of the rare disease.

Background Due to the special anatomy of the lower leg, tibial diaphyseal fracture causes increased intracompartmental pressure (ICP). Not only is this increased ICP the manifestation of skeletal muscle injury, but it induces further deterioration of the injury. The aim of this study was to assess the association between short-term ICP elevation and long-term skeletal muscle recovery after severe limb trauma. Methods In this single-center ambispective cohort study, we retrospectively screened and recruited a cohort of tibial diaphyseal fracture patients with integrated ICP data during the early post-traumatic period, and performed a prospective observational study to evaluate their skeletal muscle recovery through long-term follow-up and MR imaging after the removal of the implants. We analyzed the association between ICP elevation and skeletal muscle recovery using statistical methods. Results A total of 46 patients with healed fractures underwent intramedullary nail removal and MR imaging. The absolute values of the Pearson product-moment correlation coefficients between various ICP parameters and the cross-sectional area ratio (CSAR) ranged from 0.588 to 0.793, and the correlation coefficients between the ICP parameters and the average T2-weighted signal intensity ratio (T2SIR) varied from 0.566 to 0.775. Statistically significant associations were observed between the ICP parameters and the MR imaging parameters when simple linear regression analysis was performed. Among the ICP parameters, the accumulated ΔP (ΔP = diastolic blood pressure minus ICP) had the highest determination coefficient and explained 62.1% and 59.1% of the variance in CSAR and T2SIR, respectively. Conclusions Short-term ICP elevation was associated with long-term skeletal muscle recovery following tibial diaphyseal fracture, especially for ICP data that integrated time factors. Level of evidence Level 3.