IntroductionThis study compared emergency department hip spica casting under procedural sedation with operating room casting under general anesthesia and fluoroscopic guidance for femoral shaft fractures in children aged 2-5 years.MethodsThis retrospective comparative cohort included 87 children treated between January 2021 and December 2025: 42 in the emergency department (Group 1) and 45 in the operating room (Group 2). Clinical, radiological, functional, and healthcare-related outcomes were compared.ResultsRadiological union was achieved in all patients. Mean time to union did not differ significantly between groups (7.0 ± 1.1 vs. 6.6 ± 0.9 weeks; p = 0.067). Post-casting sagittal angulation was significantly greater in Group 1 (15.2 ± 5.4° vs. 12.1 ± 5.8°; p = 0.012), whereas coronal angulation did not differ significantly (12.8 ± 4.9° vs. 10.7 ± 5.2°; p = 0.060). Malunion occurred in 23.8% and 8.9%, respectively (p = 0.058). No patient required repeat reduction or corrective surgery. PedsQL Physical Health Summary Scores (92.07 ± 3.34 vs. 92.16 ± 3.47; p = 0.909) and overall complication rates (23.8% vs. 15.6%; p = 0.332) were similar. Procedure time, hospital stay, and inflation-adjusted direct hospital charges were significantly lower in Group 1 (all p < 0.001).ConclusionEmergency department casting achieved similar union and late parent-reported physical functioning but greater immediate post-casting sagittal angulation. Although this difference required no further intervention, its clinical relevance remains uncertain. In appropriately selected children and centres with experienced practitioners and suitable sedation and monitoring facilities, emergency department casting may reduce hospital resource use and direct hospital charges.

Distal radius fracture (DRF) usually adopts static fixation method, which often leads to complications such as abnormal fracture healing and pressure injury. The reason lies in the lack of real-time regulation of fixed pressure and biomechanical feedback, which affects the functional recovery. Our team designed an intelligent and adaptive orthopedic equipment. Based on the patient's personalized three-dimensional (3D) printing architecture, the equipment system realizes light and accurate adaptation, and embeds a series of thin film pressure sensors in key anatomical parts to continuously quantify biomechanical values. Relevant data are uploaded to the cloud platform through the Internet of Things module for real-time remote monitoring by clinicians. The innovation of the system is to construct a closed-loop feedback controller by using interval type Ⅱ fuzzy logic (IT2-FLC) algorithm, which can automatically adjust the servo drive belt and dynamically adjust the pressure to adapt to the changes of limb swelling. Preliminary clinical evaluation showed that the patients in the treatment group who received intelligent splint of traditional Chinese medicine performed better in anatomical reduction and functional recovery, with a higher Cooney score (91.65 vs. 83.15) and a lower visual analogue scale pain score (VAS) (1.15 vs. 1.88). This proof-of-concept study provides a new technical paradigm for adaptive orthopedic equipment and shows a good clinical transformation prospect.

As a life-saving procedure, limb amputation is frequently indicated in severe war injuries, especially in suboptimal medical supply. We report of a 56-year-old Ukrainian male who was wounded on the battlefield by an air attack during Russian early invasion in Zaporizhzhia. The blast injury caused a critical soft-tissue defect of the lower leg combined with comminuted fractures of the tibia and fibula. Although indicated, the patient refused the amputation of the lower leg. Initially closed reduction and stabilization by an external fixator, local debridement as well as soft-tissue coverage by a porcine skin were performed at a local field hospital. Due to destroyed infrastructure and missing escape corridors, further evacuation was difficult. Thus, it took 15 days to transfer the patient by ground transportation to our institution. Based on the massive tissue loss, superinfection necrosis and questionable blood supply, the indication for amputation was confirmed, but the patient insisted on limb preservation. To save the lower leg, a brought spectrum of regenerative strategies was applied, accompanied by standard trauma treatment regimens (debridement, vacuum sealing, antibiotics, intramedullary nailing, suralis flap).

Distal radius fractures (DRFs) are among the most common upper extremity fractures encountered in clinical practice. Closed reduction followed by external immobilization remains a fundamental treatment approach; however, the procedure is highly operator-dependent and lacks standardization. This article presents a step-by-step protocol for manual reduction and four-splint immobilization using volar, dorsal, radial, and ulnar splints for acute DRFs. The protocol encompasses patient selection, anesthesia administration, patient positioning, sustained longitudinal traction with countertraction, restoration of radial length, correction of dorsal or volar translation and angulation, controlled adjustment of wrist position and forearm rotation, and secure four-splint immobilization. A representative case of a 53-year-old woman with a dorsally displaced fracture of the left distal radius is presented. Pre-reduction radiographs showed a volar tilt of approximately -15°, a radial inclination of approximately 1.74°. Immediate post-reduction radiographs showed a volar tilt of 11.4° and a radial inclination of 17.7°. Follow-up radiographs obtained 6 and 15 days after reduction showed volar tilts of 11.7° and 11.4° and radial inclinations of 15.8° and 15.2°, respectively. This article provides a structured visual protocol describing the direction and sequence of reduction forces and the application of four-splint immobilization. The representative case illustrates procedural feasibility and short-term maintenance of alignment; however, it does not establish comparative effectiveness, safety, superiority, or generalizability. These outcomes require evaluation in larger prospective studies.

Burns combined with fractures are uncommon and become particularly challenging when the burn overlies the surgical corridor. We report a 51-year-old woman with an intra-articular distal radius fracture and an overlying deep volar ulnar wrist burn (deep partial-thickness to full-thickness) after jumping from a second floor during a house fire. A spanning external fixator was applied through unburned skin on the day of injury while the burn was managed conservatively by plastic surgeons. Ten days later, definitive fixation was performed through an intact dorsal approach with articular reduction, bone substitute filling, and fragment-specific fixation using two low-profile 2.0-mm dorsal mini-plates; the extensor retinaculum was interposed at closure to reduce tendon irritation. Although intraoperative stress testing after plating showed no gross instability, the spanning fixator was retained for 4 weeks because construct rigidity was a concern and volar splinting would interfere with burn dressing care. At 14 months after injury (3 months after plate removal), the patient had good wrist motion, 80.3% grip strength versus the contralateral side, PRWE 16.5, and QuickDASH 20.5, without infection or pin-tract problems. Staged stabilization that avoids burned skin and uses a dorsal safe corridor may be a feasible option in selected patients while facilitating ongoing burn management.

Although early mobilization is essential for functional recovery after phalangeal fractures, many fixation methods still require prolonged immobilization, increasing the risk of joint stiffness. We herein describe a simple, safe, and low-cost technique that combines intramedullary Kirschner wires (K-wires) with external connection, adapted from the Ulson method, which was originally developed for distal radius fractures. The procedure consists of closed reduction under fluoroscopy followed by the insertion of two 1.0-mm intramedullary wires. The external ends of these wires are bent and connected, forming a stable frame that enables immediate mobilization without the need for immobilization. The technique provided stable fixation, reliable bone healing, and early rehabilitation, with a low complication rate. It represents a practical and reproducible option, especially useful in resource-limited settings.