Manual reduction in testicular torsion and subsequent treatment after successful reduction: a series of reports in a single institution

Introduction

To explore the factors affecting the success of testicular torsion manual reduction and the safety of subsequent conservative treatment after successful reduction.

Methods

Clinical data of 66 patients with testicular torsion treated in our emergency department from February 2017 to February 2022 were retrospectively collected. Manual reduction without anesthesia was performed in 19 patients. Patients with successful manual reduction chose different subsequent treatments according to the wishes of themselves and their guardians, including continuing conservative treatment and surgical exploration. Relevant clinical data were collected and analyzed.

Results

Manual reduction was successful in 11 patients (11/19). Seven of them chose to continue conservative treatment, and four underwent surgical exploration immediately. Among the 7 patients who were treated conservatively, 3 underwent surgical treatment due to scrotal discomfort or testicular torsion at different stages, and the remaining 4 patients showed no recurrence of torsion during follow-up. Compared with other patients, patients with successful manual reduction had the shorter duration of pain (p < 0.05). The time from visiting our hospital to surgery in patients who attempted manual reduction was slightly shorter than those who underwent surgery directly (p > 0.05). The testes of these 11 patients were all successfully preserved.

Conclusions

The short duration of pain may contribute to the success of manual reduction, and manual reduction did not increase the preparation time before surgery. Due to the unpredictable risk of recurrence, immediate surgical treatment is still recommended, or postponed elective surgical treatment should be offered in the next days or weeks.

Manual Reduction of Strangulated Internal Hemorrhoids Using Sugar: A Case Report

Emergency hemorrhoidectomy for strangulated internal hemorrhoids should be avoided when possible. Manual reductions can relieve pain and prevent the need for emergency surgery. Herein, we present a 51-year-old female patient. Over the preceding 20 years, she experienced prolapsed internal hemorrhoids every time she defecated and had been performing manual reductions herself. Due to significant pain and difficulty during the manual reduction of the hemorrhoids, she was transported to the emergency room. Anal inspection revealed prolapsed internal hemorrhoids and partial congestion. After 10 minutes of applying Lidocaine Hydrochloride Jelly 2% and Escherichia coli culture suspension/hydrocortisone ointment, the manual reduction was still difficult. Based on previous reports of using sugar to reduce stomal prolapse, we applied sugar directly to the hemorrhoids. Ten minutes later, the number of prolapsed hemorrhoids decreased, and manual reduction was possible. After one day of hospitalization for bed rest, the patient was discharged once it was confirmed that there was no prolapse of the internal hemorrhoids and that her pain had improved. Two weeks later, a grade III internal hemorrhoid was observed, which had markedly reduced in size compared with the time of admission. Using sugar to reduce strangulated internal hemorrhoids manually can be useful due to its simplicity, minimal invasiveness, and cost-effectiveness.

Penile traumatic testicular dislocation: a case report

Traumatic testicular dislocation is rare and usually occurs in patients after a traumatic motor accident. Manual reduction or surgical exploration is the main treatment for this condition. We report a rare case of unilateral traumatic testicular dislocation in a man with an ectopic testis in the middle of the penis after a motorcycle crash injury. On the sixth day of hospitalization, the patient found a lump in the middle of his penis. Doppler ultrasound showed an ectopic testicle in the middle of the penis with good blood flow. After consultation, a manual reduction was successfully performed. A careful physical examination should be performed in patients with multiple injuries from the first medical exam. Early detection and timely reduction are critical to protect testicular function.

Management of Adult Atlantoaxial Rotatory Fixation: Case Series with Literature Review

Background

Atlantoaxial rotatory fixation (AARF) is extremely rare in adults, and there is no consensus on the ideal treatment of adult AARF because of its rarity. We presented a case series of three adult AARFs and reviewed the literature on adult AARFs. We suggest treatment guidelines for the injury based on the literature review.

Methods

We compiled a series of three adult AARFs seen in our hospital. We also utilized the NCBI library to retrieve literature on adult AARF from 2000 to 2021. We included articles on adult AARF, which described the number of days from injury to diagnosis, Fielding classification, occurrence of associated cervical injuries, and details of treatment and the results.

Results

Thirty adult AARFs reports fulfilled the criteria and 32 patients were analyzed. Eighteen patients had Fielding Type 1 AARF and were diagnosed within 1 month of injury. Among them, 13 cases healed with conservative treatment. Patients with acute AARF of Fielding Type 1 who underwent manual reduction healed successfully. All patients that required more than 1 month from injury to diagnosis underwent surgery. All cases with AARF Fielding Types 2, 3, and 4 failed conservative treatment.

Conclusion

The case series and literature review suggest that early diagnosis of adult AARF is essential for successful closed reduction, and the Fielding classification may help determine treatment strategy. Furthermore, this study showed that not only traction but also manual reduction may be a useful treatment for early diagnosed AARF Fielding Type 1 without complications. Level of Evidence: III.

How long does it to achieve sagittal realignment of the displaced epiphysis in Salter-Harris type II distal radial fracture when treated by manual reduction?

This study aimed to investigate how long it takes for the dorsally displaced distal radial epiphysis to achieve realignment. We retrospectively reviewed 56 patients with dorsally displaced Salter-Harris type II distal radial epiphyseal fractures who were aged ≤15 years at the time of injury. All fractures were treated with closed reduction and immobilised using a sugar tong splint for 6 weeks. We evaluated the change in the displaced epiphysis position (%) until 12 weeks and the long-term clinical and radiological outcomes. We analysed significant differences in demographic factors and epiphyseal displacement according to the required period for epiphyseal realignment. The estimated area of the receiver operating characteristics (ROC) curve was calculated, and cut-off values were suggested to predict the required period for epiphyseal realignment. Sixteen (28.6%) and 42 (75%) patients achieved realignment of the epiphysis within 8 and 12 weeks, respectively. The cut-off values of 13.1 and 22.9% displacement at the 1-week follow-up were the best predictors of epiphyseal realignment within 8 and 12 weeks, respectively. Patients with a residual displacement of up to 51.3% in the sagittal plane at the 1-week follow-up achieved complete realignment of the epiphysis at the 6-month follow-up. From this study, we could predict the timing of epiphyseal realignment, and expect epiphyseal realignment even if re-displacement occurred up to 51.3% at the 1-week follow-up.

[A prospective randomized controlled study of the difference between BPPV manual reduction and automatic device reduction]

Objective:To investigate the difference between manual reduction and automatic device reduction in the treatment of benign paroxysmal positional vertigo（BPPV）, and to provide evidence-based medicine for the clinical choice of BPPV treatment. Methods:Two hundred and two BPPV patients who came to the hospital for diagnosis and treatment were collected and divided into two groups by random number table method. Group A had 102 cases for manual reduction, and group B had 100 cases for automatic device reduction. Both groups were given the same medicine-assisted treatment. All patients were followed up 7 to 10 days after reduction treatment. To evaluate the differences in the overall effective rate of treatment, visual analog scale（VAS）, incidence of adverse reactions, treatment time were compared between the two groups. Results:The overall effective rate was 98.03% and 91.00% in group A and group B, respectively, group A was slightly higher than group B（P=0.027）; the difference in VAS scores before and after treatment: group A was 6（4） points, group B was 5（3） , group A is greater than group B（P=0.002）; adverse reaction rates in groups A and B were 4.90% and 8.00%, respectively, group B was slightly higher than group A（P=0.37）; treatment time: group A 6.0（1.0） min in group A and 8.0（2.0） min in group B, group A was significantly shorter than group B（P<0.01）. Conclusion:Both manual and fully automatic device reduction can effectively improve the clinical symptoms of BPPV patients, but for physicians with extensive clinical experience it is recommended to choose manual reduction.

Incarcerated Gravid Uterus: Spontaneous Resolution Is Not Rare

Aim: Incarcerated gravid uterus is a rare obstetrical complication that leads to adverse outcomes, especially if the uterus remains incarcerated and the condition goes undiagnosed until delivery. However, there is no consensus regarding the optimal management of this complication because of its rarity. In this study, we aimed to elucidate the incidence of incarcerated gravid uterus, as well as its natural courses and perinatal outcomes. Methods: We retrospectively reviewed medical records of patients who had incarcerated gravid uterus and managed at Osaka City University Hospital between April 2011 and March 2021. Incarcerated gravid uterus was defined as a retroverted or retroflexed uterus after 16 weeks of gestation. Results: There were 14 incarcerated cases among 6958 pregnant women, and 13 of them had some kind of gynecological complication and/or history. Spontaneous resolution of incarcerated gravid uterus after 16 gestational weeks was observed in six cases before the late second trimester and five cases at the late second trimester to early third trimester. Three cases remained incarcerated at term or near-term. One case with adenomyosis had severe abdominal pain, although it was difficult to ascertain whether the cause of pain was triggered by adenomyosis and/or incarceration. One case was misdiagnosed as placenta previa, and the uterine cervix was subsequently injured during cesarean delivery, resulting in massive hemorrhaging. Conclusions: Approximately 1 in 2300 pregnancies continued to be in an incarcerated condition at term or near-term, and 78.5% of cases showed a spontaneous resolution after 16 weeks of gestation. Expectant management with careful attention to the incarcerated gravid uterus may be one option in situations where there are no severe symptoms related to the incarceration itself.

Nonsurgical reduction of prolapsed colocolic intussusception in 2 puppies

OBJECTIVE

To describe the nonsurgical management of prolapsed colocolic intussusception in 2 puppies.

CASE SUMMARY

Two 3-month-old male intact puppies (Pug and Labrador Retriever) developed intussusceptions that had prolapsed from the anus after they had suffered from tenesmus with soft feces or diarrhea. Reduction of the prolapsed tissue was performed and colocolic intussusception was diagnosed ultrasonographically in 1 dog. Rectal manipulation and saline enema were performed in both dogs, and reduction of the intussusception was confirmed endoscopically or ultrasonographically. Bupivacaine and prednisolone foam enemas were administered to reduce tenesmus. Abdominal ultrasonography the following day in 1 dog confirmed a normal appearing colon. No further tenesmus was noted in 1 dog; the other had a brief rectal prolapse after an episode of tenesmus that was manually reduced. Intussusception had not recurred 4 months and 1 year following manual reduction procedures.

NEW OR UNIQUE INFORMATION PROVIDED

This is the first report of successful nonsurgical management of colocolic intussusception in a companion animal. Nonsurgical management is a first-line treatment of intussusception in children and could be considered in dogs with colocolic intussusception. Further investigation is required to define specific aspects, including rectal manipulation, saline enema, or anesthesia, that aid in resolution of this type of intussusception.

Reduction techniques for intramedullary nailing of tibial shaft fractures: a comparative study

Objectives:

To assess the impact of various reduction techniques on postoperative alignment following intramedullary nail (IMN) fixation of tibial shaft fractures.

Design:

Retrospective comparative study.

Setting:

Level I trauma center.

Patients:

Four hundred twenty-eight adult patients who underwent IMN fixation of a tibial shaft fracture between 2008 and 2017.

Intervention:

IMN fixation with use of one or more of the following reduction techniques: manual reduction, traveling traction, percutaneous clamps, provisional plating, or blocking screws.

Main outcome measures:

Immediate postoperative coronal and sagittal plane alignment, measured as deviation from anatomic axis (DFAA); coronal and sagittal plane malalignment (defined as DFAA >5° in either plane).

Results:

Four hundred twenty-eight patients met inclusion criteria. Manual reduction (MR) alone was used in 11% of fractures, and adjunctive reduction aids were used for the remaining 89%. After controlling for age, BMI, and fracture location, the use of traveling traction (TT) with or without percutaneous clamping (PC) resulted in significantly improved coronal plane alignment compared to MR alone (TT: 3.4°, TT+PC: 3.2°, MR: 4.5°, P = .007 and P = .01, respectively). Using TT+PC resulted in the lowest rate of coronal plane malalignment (13% vs 39% with MR alone, P = .01), and using any adjunctive reduction technique resulted in decreased malalignment rates compared to MR (24% vs 39%, P = .02). No difference was observed in sagittal plane alignment between reduction techniques. Intraclass correlation coefficient (ICC) results indicated excellent intraobserver reliability on both planes (both ICC>0.85), good inter-observer reliability in the coronal plane (ICC = 0.7), and poor inter-observer reliability in the sagittal plane (ICC = 0.05).

Conclusions:

The use of adjunctive reduction techniques during IMN fixation of tibia fractures is associated with a lower incidence of coronal plane malalignment when compared to manual reduction alone.

Level of evidence:

Therapeutic Level III.

Acute testicular ischemia following manual reduction of inguinoscrotal hernia

Testicular ischemia caused by inguinal hernia repair, and even the presence of the hernia itself, has been recognized in the medical literature, with the latter more commonly in children, but such an event after manual reduction has never been reported before. We present the case of a 67-year-old man who presented to the emergency department with a painful left groin lump. A left inguinoscrotal hernia was diagnosed and reduced "en masse" with manual pressure at the bedside. The patient was discharged but developed acute-onset left scrotal pain as soon as he got home and then re-presented 2 days later with increasing severity of the pain and swelling ever since the hernia reduction. On examination, he was febrile, with a hard, tender, and swollen left testis. Serum inflammatory markers were elevated. Conservative management with intravenous antibiotics and analgesia was commenced. An ultrasound of the testes demonstrated lack of Doppler flow to the left testis, suggestive of acute ischemia. Three days later, there were persistent temperature spikes and significant pain; therefore, the patient underwent an acute left scrotal exploration where a necrotic, black left testis was discovered and excised. He was discharged on the 1^st postoperative day; histological analysis confirmed testicular infarction.

[The curative effect of manual reduction combined with vestibular rehabilitation exercise in the treatment of benign paroxysmal positional vertigo]

Objective:To investigate the effect of vestibular rehabilitation exercise combined with manual reduction in the treatment of benign paroxysmal positional vertigo（BPPV）. Method:A total of 186 patients with benign paroxysmal positional vertigo were selected and randomly divided into experimental group and control group . The control group was treated with manual reduction, while the experimental group was treated with manual reduction combined with vestibular rehabilitation exercises. Patients with posterior semicircular canal BPPV carried out Brandt-Daroff exercises, while patients with horizontal semicircular canal BPPV carried out Cawthorne-Cooksey exercises and position restriction. To analyze the clinical curative effect, DHI score, residual dizziness and recurrence of the two groups. Result:There was no significant difference in total efficiency rate and DHI score between the two groups at the first diagnosis（P>0.05）. After 1 week, 2 weeks and 1 month of follow-up, the total efficiency rate of the experimental group were 90.3%, 91.4% and 93.5% respectively, which were significantly higher than those of the control group（P<0.05）. Synchronously, the scores of DHI in experimental group were respectively 14.33±5.71, 12.25±4.98 and 9.45±3.70, which were significantly lower than the control group（P<0.05）. For the experimental group, in the first diagnosis, 1 week, 2 weeks and 1 month after follow-up, residual dizziness patients were 29 cases, 13 cases, 8 cases and 0 cases. The mean duration of residual dizziness was （5.86±4.71） days, which was significantly lower than that in the control group（P<0.05）. One month after follow-up, the recurrence of patients in the experimental group were 5 cases, while the control group were 11 cases, significant difference between the two groups（χ²=4.704, P=0.030）. Conclusion:Manual reduction combined with vestibular rehabilitation exercise can significantly improve the therapeutic effect of BPPV, ameliorate the residual dizziness symptoms and reduce the recurrence rate, meanwhile improve the balance function and quality life of patients.

[Clinical features and recurrence rate on benign paroxysmal positional vertigo]

Objective:To study the characteristics and the recurrence rate of manual reduction of BPPV. Method:The clinical characteristics of 735 patients with BPPV were analyzed retrospectively. The posterior semicircular canal BPPV（PC-BPPV） was treated with the Epley maneuver therapy; the horizontal semicircular canal BPPV（HC-BPPV） was treated with the Barbecue therapy; the anterior semicircular canal BPPV（AC-BPPV） was treated with the Yacovino therapy; the combined semicircular canal was treated with the Epley and the Barbecue therapy; and for the bilateral lesions, first treat the more severe side with manual reduction then the lighter side was treated with manual reduction after the more severe side nystagmus or vertigo completely disappears. Result:①Of the 735 patients with BPPV, 455（61.90%） were PC-BPPV, 272（37.01%） were HC-BPPV, 3（0.41%） were AC-BPPV, and 5（0.68%） were combined BPPV. ②A total of 455 patients with BPPV were followed up by telephone. 51 patients recurred within 3 years, the recurrence rate was 11.21%; the male recurrence rate was 25.68%（38/148）, and the female recurrence rate was 28.66%（88/307）. The recurrence rate was the highest in 51-60 years old, and the recurrence rate was 29.67%. ③300 patients with PC-BPPV were followed up by telephone, 81 cases（27.00%） recurred, and the recurrence rates of one month, six months, one year, two years, and three years were 0.67%（2/300）, 3.33%（10/300）, 6.67%（20/300）, 9.33%（28/300） and 11.67%（35/300） respectively; 155 patients with HC-BPPV were followed up by telephone, 45 cases（29.03%） recurred, the recurrence rates of one months, six months, one year, two years, and three years were 0（0/155）, 2.58%（4/155）, 3.23%（5/155）, 7.10%（11/155） and 9.68%（15/155） respectively. Conclusion:PC-BPPV is the most common disease in BPPV patients. Manual recurrence can effectively treat the recurrence rate of BPPV, female patients is slightly higher than that of male patients. The long-term recurrence rate of PC-BPPV is consistent with that of HC-BPPV. The BPPV were most common in posterior semicircular canal. Manual reduction is effective to treat BPPV cases. BPPV recurrence was not correlated with age and gender. The long-term recurrence rate of PC-BPPV and HC-BPPV is consistent.

[Anxiety and depression in patients with idiopathic tinnitus and its relative factors analysis]

Objective: To investigate the psychological status of anxiety and depression in patients with idiopathic tinnitus, and to analyze its relative factors. Method: One hundred and sixty seven patients with idiopathic tinnitus were assessed by Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS) and general condition questionnaire. Patients with anxiety or depression were reassessed after corresponding treatment for 6 weeks. Result: Fifty-five patients(32.93%) were in anxiety state and 43 patients(25.75%) were in depression state. Twenty-seven patients(16.17%) were in both anxiety and depression state. The multivariate logistic regression analysis found that the incidence of anxiety and depression in patients with idiopathic tinnitus were related to sleep disorders, course of disease and THI score(P<0.05). Treatment scores(SAS and SDS) were statistically significantly different between pre- and post-treatment(P<0.01). Conclusion: The anxiety and depression state is highly prevalent in idiopathic tinnitus patients and is related to course of disease, severity of tinnitus and sleep disorders. In clinical practice, we should pay close attention to the psychological status of patients with idiopathic tinnitus, and take timely psychological intervention.

[Clinical analysis for 16 cases with atypical nystagmus of posterior semicircular canal benign paroxysmal positional vertigo]

Objective:To study clinical features and evaluate the efficacy of manual reduction in treatment of atypical nystagmus in patients with posterior semicircular canal benign paroxysmal positional vertigo(PSC-BPPV). Method:Sixteen cases of atypical nystagmus in patients with PSC-BPPV were retrospectively analyzed. The results were compared with 28 patients of typical nystagmus with PSC-BPPV.All the patients were followed up for 3 months. Statistical data analysis was carried out with SPSS 20.0. Result:Sixteen cases of atypical nystagmus patients with PSC-BPPV included 5 cases of left 31.25%(5/16) and 11 cases of right 68.75%(11/16), 5 patients showed typical nystagmus in the straight-head hanging position and without vertical down-beating in returning to the sitting positions with torsional component pointed to intact side,4 patients showed same nystagmus in hanging position and vertical down-beating in returning to the sitting positions without torsional component, one patient showed nystagmus of vertical up-beating and vertical down-beating in Dix-Hallpike test without torsional component,2 patients showed unobservable nystagmus in Dix-Hallpike test but showed nystagmus of vertical up-beating with torsional component pointed to affected side in the roll test position,4 patients showed nystagmus of vertical down-beating in the straight-head hanging position with torsional component pointed to intact side and reversible direction nystagmus in returning to the sitting positions.One patient's nystagmus time of duration was longer than 1 min,while 15 patients' nystagmus duration were shorter than 1 min.Twenty-eight patients with typical nystagmus in PSC-BPPV nystagmus duration were shorter than 1 min.No patient had been affected bilateral in two groups. All patients received manual reduction treatment according to the nystagmus direction and time of duration. The effective rate after the first day was 62.50%(10/16) in atypical nystagmus patients with PSC-BPPV group and 92.86%(26/28) in typical nystagmus with PSC-BPPV group, the difference was significant(χ²=5.134,P=0.015). The total effective rate was 93.75%(15/16)after more than once in atypical group and 100.00%(28/28) in typical group, the difference was not significant(χ²=2.780,P=0.095).The numbers of circulation of first success in manual reduction management were(2.76±1.13)times in atypical group and (1.68±0.61)times in typical group.The difference was significant(t=4.293,P=0.000). The recurrence rate was 18.75% in atypical group and 14.28% in typical group after during follow-up for 6 months, the difference was not significant(χ²=1.681,P=0.509). Conclusion:It showed that clinical manifestation with atypical nystagmus in patients with PSC-BPPV was complicated. Some patients' nystagmus could change to typical after treatment.The manual reduction was an effective treatment.The effective rate after first manual reduction was lower than typical group, it's needed more circulation of first success in manual reduction management. The recurrence rate was not significant in two groups.

Comparison of Clamp Reduction and Manual Reduction of Syndesmosis in Rotational Ankle Fractures: A Prospective Randomized Trial

An optimal outcome of surgical treatment for a syndesmotic injury depends on accurate reduction and adequate fixation. It has been suggested that the use of a reduction clamp for reduction of the syndesmosis results in better reduction and a lower rate of redisplacement than manual reduction. However, these concepts have never been scientifically evaluated. We compared these 2 methods in a prospective randomized trial. A total of 85 acute ankle rotational fractures combined with syndesmotic injury were randomized to syndesmosis reduction with either a reduction clamp or manual manipulation. Reduction of the syndesmosis was assessed radiographically by measuring the tibiofibular clear space, tibiofibular overlap, and the medial clear space immediately postoperatively and at the final follow-up examination. Ankle joint range of motion, visual analog scale score, Olerud-Molander ankle scoring system, and complications were obtained at the last follow-up visit to assess the clinical outcomes. Of the 3 radiographic measurements, the tibiofibular clear space and tibiofibular overlap differed significantly between the 2 groups (p < .05). The clinical outcomes did not differ significantly between the 2 groups (p > .05). Although differences were found in the radiographic measurements, most syndesmoses in both groups were within the normal range at the final follow-up visit, and the 2 methods of syndesmosis reduction provided similar clinical outcomes. Accordingly, the results of the present study suggest that both of these methods are effective and reliable for reduction of the syndesmosis in rotational ankle fractures.

Three-step Reduction Therapy of Integrated Chinese and Western Medicine for Thoracolumbar Burst Fracture

Objective: To investigate and compare the efficacy of three-step reduction (TSR) therapy of integrated Chinese and Western Medicine and posterior open (PO) surgery for thoracolumbar burst fracture. Methods: We selected 60 patients diagnosed with thoracolumbar burst fracture and received treatment in our hospital from December 2014 to March 2017. According to randomized digital table, they were randomly divided into TSR and PO groups. VAS pain grade, Oswestry disability index, height of centrum front, Cobb's angle of spine, bleeding, and complication of internal fixation of the two groups were compared. Results: Postoperative reduction of injured centrum, regained volume of canalis vertebralis, volume of bleeding, and early functional rehabilitation of TSR group were better than that of PO groups (P < 0.05). Conclusion: Through three-step reduction combined pedicle screw fixation surgery, we can achieve satisfied reduction of thoracolumbar burst fracture, rebuild the height of centrum, recover the biomechanics function of spine, and reduce bleeding. Three-step reduction therapy is an effective therapy for thoracolumbar burst fracture.

Simultaneous double dislocation of the interphalangeal joint of the same finger: a report of two cases

Simultaneous dislocation of both the proximal and distal interphalangeal (PIP and DIP) joints in a finger is uncommon. Two patients were treated conservatively. Both two patients fell from a step-ladder and X-rays revealed dorsal dislocations of both PIP and DIP joints of their right little fingers. Manual reduction was easily achieved with gentle longitudinal traction. The mechanism of the injury is believed to be hyperextension of both the DIP and PIP joints. Closed reduction is the treatment of choice and early active range of motion to prevent joint contracture should be recommended.

Transpedicle body augmenter in painful osteoporotic compression fractures

Osteoporotic compression fractures (VCFs) can result in progressive kyphosis and chronic pain. Polymethylmethacrylate has been used for augmentation of VCFs; however, there are cement complications, and long-term fracture healing is unknown. The transpedicle body augmenter (TpBA), a porous titanium spacer, has been reported as an internal support to reconstruct the vertebral body combining short segment fixation in burst fracture. We retrospectively reviewed radiographic and clinical results of TpBA vertebroplasty for single symptomatic VCF in 80 patients. Manual reduction and TpBA vertebroplasty via a paramedian incision with blunt dissection was done. Mean age was 72.3 years (range 51-87 years), and female-male ratio was 66:14. The mean symptom duration was 5 months, and follow-up 44 months. Peri-operative variables and radiographic and clinical results were evaluated. The average operation time was 26.1 min, blood loss 92 cc, and hospitalization 2.3 days. No patient had neurological deterioration. TpBA was found sinking into vertebral body initially, then locked by residual cortex, and finally stabilized within the vertebra. There was no dislodgement of TpBA in the final visit. Sixty-two patients (77.5%) could walk within 3-6 h after operation and the others within 24 h. The anterior vertebral restoration was 8.0 mm initially and 6.1 mm at final follow-up. Wedge angle correction was 11.5 degrees initially and 9.4 degrees at final follow-up. Pain, by the visual analog scale, was 8.6 pre-operatively, 2.5 at day 7 follow-up, and 2.9 at final follow-up. By the questionnaire, 72 of 76 respondents reported a decrease in discomfort after TpBA vertebroplasty, and 63 of 76 patients reported a return to normal activity after operation. The final satisfaction rate was 93.4%. TpBA vertebroplasty led to early and medium-term clinical improvement and anatomic restoration of painful VCFs.