Partial Fracture Research Articles

Enhanced Cross-Tension Property of the Resistance Spot Welded Medium-Mn Steel by In Situ Microstructure Tailoring

Medium Mn steels, one of the most promising 3rd generation advanced high strength steels (AHSS), achieve an encouraging trade-off between the outstanding mechanical property and the production cost. As a typical medium Mn steel, 7Mn steels have superior mechanical property but their poor cross-tension property becomes the Achilles' heel, hindering the application in the automotive industry. The current study focuses on the cross-tension property of the resistance spot weld of 7Mn steel. Generally, martensite is produced in the nugget during the resistance spot welding (RSW). However, the microstructure in the weld nugget can be correspondingly tuned by directly optimizing the welding parameters. With post-weld pulses, in situ tempering occurs, which can decrease the segregation of Mn existing along martensite lath boundaries and facilitate the microstructure transition from martensite to tempered martensite. The tuning on the nugget microstructure facilitates the increase of cross-tension strength (CTS) from 1.5 to 3.7 kN. Although both cases fail in an interfacial fracture mode, a partial ductile fracture is demonstrated in the specimen with post-weld treatment, which is attributed to the occurrence of low-carbon α phase and second phase particles. This study elucidates that the decrease of segregation and the microstructure transition in the nugget are the dominant factor determining the CTS. It is therefore demonstrated that the reduction of Mn segregation and the formation of tempered martensite can increase the weldability of RSW joints of the medium Mn steels.

Latest Trends in the Current Treatment of Proximal Humeral Fractures - an Analysis of 1162 Cases at a Level-1 Trauma Centre with a Special Focus on Shoulder Surgery.

The management of proximal humeral fracture (PHF) is not only complex but ever changing. Published epidemiological data are often dated and do not factor in demographic changes or the latest developments in implant material and surgical techniques. The primary aim of this study was to evaluate changes in the epidemiology and actual treatment of PHF at a level-1 trauma centre, with a special focus on shoulder surgery. 1. Between 2009 to 2012 and 2014 to 2017, an increase in complex PHF entities can be observed. 2. In correlation with fracture complexity, an increasing number of comorbidities, especially osteoporosis, can be observed. Between 2014 and 2017, a total of 589 patients (73% female; mean age: 68.96 ± 14.9 years) with 593 PHFs were treated. Patient records and imaging (XRs and CTs) of all patients were analysed. Fractures with ad latus displacement of a maximum of 0,5 cm and/or humeral head angulation of less than 20° were classified as non-displaced. Patients with displaced fractures were included in the analysis of the therapeutic algorithm. These results were compared to those of a cohort 2009 to 2012 (566 patients, 569 PHFs), which used the same inclusion criteria. The two cohorts showed comparable patient numbers, as well as gender and age distributions. Between 2009 to 2012 and 2014 to 2017, a decrease in 2-part fractures (13.9 to 8.6%) and a simultaneous increase in 4-part fractures (20.4 to 30%), and thus fracture complexity was observed. Further decreases were observed in conservative therapy (27.8 to 20.6%), nail osteosynthesis (10.7 to 2.7%) and anatomic shoulder arthroplasty (5,4 to 1%). Furthermore, there was an increase in the use of locking plate osteosynthesis (43.2 to 56.7%) and reverse shoulder arthroplasty (9 to 18.4%). The general trend shows an increase in surgical therapy between the years (72.2 to 79.4%), as well as an increase in osteoporosis incidence (13 to 20.6%). The greatest numbers of comorbidities were found in 3- and 4-part fractures. There is an increase in both the complexity of fractures and the number of surgically treated fractures between 2009 and 2012. Furthermore, an increase in osteoporosis numbers can be observed. New implants (PEEK, fenestrated screws for cement augmentation) and new surgical techniques (double plating osteosynthesis) were used as a result of increasing fracture complexity. Moreover, reverse total shoulder arthroplasty was used more commonly.

Effect of welding parameters on resistance thermocompression microwelded joint of insulated copper wire

Insulated copper wire has been widely used in many industries, but the insulating coating must be removed before welding because it will hinder the formation of joints. Therefore, in this work, the resistance thermocompression microwelding process for insulated wire without removing the coating in advance was proposed. Through detailed mechanical testing and metallurgical examination, the effects of welding voltage on the joint appearance, joint macro-/microstructure, joint breaking force, and joint fracture mode were investigated. The results showed that joints were achieved by solid-state bonding. As the welding voltage was further increased, the joint breaking force increased first and then decreased. Corresponding to the change of the welding voltage, the fracture mode of the joints changed from interfacial fracture to partial pullout fracture. The fracture position also moved backwards gradually, which was caused by the expansion of the bonding area, the improvement of the interfacial strength, and the amount of heat input. Finally, an orthogonal experiment was conducted to investigate the significance level of three parameters. Under the optimal for joint breaking force parameters (2.1 V, 24 ms, and 12 N), the average achievable force was 1.1723 N, which was about 83.7% of the breaking force of the as-received wire.

Overdrilling increases the risk of screw perforation in locked plating of complex proximal humeral fractures – A biomechanical cadaveric study

Locked plating of proximal humerus fractures (PHF) is associated with high failure rates (15–37%). Secondary screw perforation is a prominent mode of failure for PHF and typically requires reoperation. The anatomical fracture reduction is an essential factor to prevent fixation failure. However, recent studies indicate that the risk of secondary screw perforation may increase if the articular surface is perforated during predrilling of the screw boreholes (overdrilling). This study aimed to determine whether overdrilling increases the risk of secondary screw perforation in unstable PHF.Nine pairs of human cadaveric proximal humeri were osteotomized to simulate a malreduced and highly unstable 3-part fracture (AO/OTA 11 B1.1), followed by their assignment to two study groups for overdrilling or accurate predrilling in paired design, and fixation with a locking plate. Overdrilling was defined by drilling the calcar screw’s boreholes through the articular surface. All humeri were cyclically loaded to screw perforation failure. Number of cycles to initial screw loosening and final perforation failure were analysed.The accurately predrilled group revealed a significantly higher number of cycles to both initial screw loosening (p < 0.01) and final screw perforation failure (p = 0.02), compared to the overdrilled one.This is the first study reporting that drilling to the correct depth significantly increases endurance until screw perforation failure during cyclic loading after locked plating in a highly unstable PHF model. Prevention of overdrilling the boreholes could help reduce failure rates of locked plating. Future work should investigate the prevalence and consequences of overdrilling in clinics.

Cancellous bone allograft is comparable to fibular strut allograft for augmentation in three-or four-part proximal humeral fractures.

Bone grafts have been used for augmentation and improving stability of reduced fractures in proximal humeral fractures. The aim of this study was to analyze the clinical and radiological outcomes after the use of cancellous bone allografts (CAs) for augmentation in 3- or 4-part proximal humeral fractures, and compare with fibular strut allografts (FAs). Between November 2016 and February 2018, 55 patients, followed for at least 1 year, with 3- or 4-part proximal humeral fractures fixed with locking plates were included and grouped according to the type of allograft bone used for augmentation. In this retrospective analysis, we assessed and compared the clinical and radiological outcomes of the 2 groups, using the visual analog scale score, the Constant-Murley score (CMS), the disability of the arm, shoulder, and hand (DASH) score, the range of movement, neck-shaft angle (NSA), humeral head height (HHH), and the changes of NSA and HHH, as well as recording any complications. The repeatedly measured clinical and radiological outcomes were analyzed by linear mixed models. The differences in outcomes betweengroups at the final follow-up were compared using Student's t test. There were 28 patients in the CA group and 27 patients in the FA group with an average follow-up of 14.5 months. The mean age of all patients was 64 (36-86). Nonsignificant group effects were observed on CMS (β = -8.792, P = .216), DASH (β = 1.329, P = .094), NSA (β = 1.432, P = .752), and HHH (β = 1.660, P = .628). At the final follow-up, the patients in the CA group showed no significant differences in visual analog scale (1.8 vs. 2.2, P = .276), CMS (81.5 vs. 75.4, P = .072), and DASH (11.0 vs. 13.5, P = .235) scores compared with the FA group. There were no significant differences in the change of NSA (6 vs. 4, P = .387) or HHH (1 vs. 2, P = .261). Patients with 3- or 4-part proximal humeral fractures treated with locking plates combined with CAs have good clinical and radiographic outcomes, similar to those treated with FAs.

Reverse or Hemi Shoulder Arthroplasty in Proximal Humerus Fractures: A Single-Blinded Prospective Multicenter Randomized Clinical Trial.

To compare outcomes between hemiarthroplasty (HA) and reversed shoulder arthroplasty (RSA) as a treatment for dislocated 3-part and 4-part proximal humerus fractures in the elderly population. Prospective multicenter randomized controlled trial. Three Level-1 trauma centers. This study included 31 patients of which 14 were randomized into the HA group and 17 into the RSA group. Patients randomized to the HA group were treated with a cemented-stem Aequalis-fracture HA and patients randomized to the RSA group with a cemented-stem Aequalis-fracture RSA. Primary outcomes consisted of range of motion and constant score. Secondary outcomes were the visual analog scale for pain, DASH score, SF-12 scores, and radiographic outcomes. After 6 and 12 months of follow-up, RSA showed a significant higher anterior elevation (105 degrees vs. 80 degrees, P = 0.002 and 110 degrees vs. 90 degrees, P = 0.02, respectively) and constant score (60 vs. 41, P = 0.01 and 51 vs. 32, P = 0.05, respectively) compared with HA. There were no significant differences in external and internal rotation. Also, visual analog scale pain, DASH scores, SF-12 scores, and radiological healing of the tuberosities and heterotopic ossification did not show any significant differences between groups. RSA showed significant superior functional outcomes for anterior elevation and constant score compared with HA for dislocated 3-part and 4-part proximal humerus fractures after short-term follow-up. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

The role of minimally invasive plate osteosynthesis (MIPO) technique for treating 3- and 4-part proximal humerus fractures in the elderly - a case study.

Background and aim of the work:Proximal humeral fractures incidence in the elderly population is increasing. Treatment management is complicated by fracture complexity and patients’ comorbidities. The aim of our prospective study is the outcome evaluation of the role of minimally invasive plate osteosynthesis (MIPO) for elderly patients with a 3- or 4-parts proximal humeral fractures having an intact medial wall.Methods:N=45 patients were selected using inclusion criteria (>75yo, unilateral 3- or 4-parts proximal humeral fracture and with a surgical indication). We analyzed n=42 fractures treated with MIPO (3 patients had been reversed to ORIF and arthroplasty intraoperatively): n=20 4-parts fractures and n=22 were 3-parts. Of the 42 operated patients 17 identified as male and 25 as female (mean age 84yo). A trans-deltoid approach has been used with minimal surgical exposure and tissue damage to preserve the local tissue for early shoulder mobilization.Results:At follow-up, the DASH recorded mean value was 72, while the Constant mean score was 68. Complications have been recorded in 23,8% of patients with 4-parts fractures having the highest complication frequency. Mean shoulder joint ROM was recorded: anterior elevation 75°, lateral elevation 80°, abduction 90°, intra-rotation 50°, extra-rotation 25°. The following factors were identified influencing the outcome: >8mm calcar fragment, head valgus impaction and periosteal medial hinge preservation.Conclusions:The increase in population longevity matches the increase in complex humeral fracture frequency. We strongly for management consensus for proximal humerus fracture, in a similar way as for neck femoral fractures. MIPO is excellent in reducing soft tissue damage and complications for elderly patients with limited functional demand. (www.actabiomedica.it)

Locking plate fixation for unstable proximal humerus fracture: A prospective study

Background: Unstable fractures of the proximal humerus represent a surgical challenge despite the wide range of treatment options available. The proximal humerus locking plate is a good surgical option in the management of unstable proximal humerus fractures. Aim: The purpose of this study is to determine whether locking plate fixation in the treatment of displaced and unstable proximal humerus fractures leads to a good functional outcome. Settings and Design: Medical school hospital, observational study. Subjects and Methods: Thirty-two patients with unstable proximal humerus fractures treated with proximal humerus locking plate between November 2017 and March 2019 were included in the study. The fractures were classified based on the Neer's classification into two-, three-, and four-part fractures. The minimum follow-up was 1 year. The Constant–Murley scoring system was used for functional assessment. Constant scores for two-, three-, and four-part fractures were determined and compared with respect to the age, gender, handedness, and occupation of the study participants. Statistical Analysis Used: Chi-square test was applied for discrete variables and one-way ANOVA was used to compare between the three fracture types. P ≤ 0.05 was taken as significant. Results: Fourteen patients had two-part fractures, 13 patients had three-part fractures, and 3 patients had four-part fractures. The mean follow-up period was 17.5 months (range: 12–24 months). About 65.6% (n = 21) patients had good result, 31.3% (n = 10) had fair, and 3.1% (n = 1) had poor result. Constant scores for 2-part (84.14 ± 2.98) and 3-part fractures (82.15 ± 3.78) were significantly superior to those of 4-part fractures (72.80 ± 3.63) (P = 0.000 and 0.000, respectively). Difference between 2-part and 3-part fractures was not significant (P = 0.142). There was no significant difference in the functional outcome between patients who were employed and unemployed, right and left handed. Complications include stiffness in 6.3% (n = 2) and infection in 3.1% (n = 1) of cases. Conclusion: Proximal humerus locking plate gives stable fixation for 2-part and 3-part fractures. However, in case of Neer's 4 part-fractures, the functional outcome is relatively poor.

DIPHOS® nail for proximal humeral fractures: our experience with more than 190 procedures and surgical tips.

Aim:evaluate the outcome of proximal humeral nailing over 5 years follow-up, focusing on possible complications. Secondary endpoint is the description and the analysis of some technical notes to simplify the surgical procedure. Materials and Methods: the cohort is composed by 194 fractures fixed with short nail. Neer Classification was used to assess the type of fracture; Deltoid Tuberosity Index (DTI) was applied to verify l ocal bone quality. Follow-up with X-rays and orthopaedic evaluation was conducted on every operated subject. Results: mean follow up of the study was 25.4 months. We registered an average CMS score of 84.66 points for 2-parts fractures, 79.05 points for 3-part fractures and 68.62 points for 4-parts fractures. We obtained radiographic healing in 95.9% of patients (186/194) after 2.7 months on average. We recorded “very good” / “good” results in 90.3% of 2-parts fractures, 88.5% of 3-parts fractures and 46.2% of 4-part fractures. Overall complication rate was 10.3% (20/194 nails). Second surgery was performed in 8.2% (16/194) of cases.Conclusion:intramedullary nailing is an effective treatment for 2 and 3-part fractures with relatively low incidence of complications, small surgical access and short surgical time. Future researches are necessary to analyze the results related to nailing in 4-fragment fractures, still uncertain and influenced by multiple factors. The presence of the intramedullary nail reduces the lever arm of the screws making the osteosynthesis more reliable. Modern nails guarantee angular stability for proximal cancellous screws and allow 1 or 2 screws at calcar level to get a valid medial support. (www.actabiomedica.it)

Arthroscopic reduction and fixation of partial posterior wall acetabular fractures.

Background and aim:Reduction and fixation of partial posterior wall fracture is usually performed with an open posterolateral approach. When the fragment may be fixed without a plate (with screws only), reduction and fixation may be also achieved via hip arthroscopy. To our knowledge no study described this technique. Aim of our study is to describe the surgical technique and to present the achieved outcomes and the occurred complications.Methods:Six cases of arthroscopic fixation of partial posterior wall fracture have been reviewed for the purpose of this study. Patients were treated arthroscopically if the fragment was not bigger than 25% of the posterior wall. Patient demographic, injury, and surgical variables as well as complications were recorded and retrospectively evaluated. Radiographic outcome was scored according to Matta’s criteria on postoperative radiographs and clinical outcomes were evaluated with the modified Harris hip score.Results:Fracture reduction was classified as anatomic on post-operative x-rays in all patients. The mean clinical score was 98 points at one year follow-up. No patient developed symptomatic femoral head AVN, none had heterotopic ossification. In one patients a screw breakage occurred without clinical complications.Conclusions:Arthroscopic reduction and fixation of partial posterior wall fracture is an effective treatment and showed good outcomes if a careful patients’ selection is done. (www.actabiomedica.it)

Functional outcome of operative vs conservative management of 4 part proximal humerus fracture: A prospective comparative study

Background: Proximal humerus fractures are most common injuries involving the shoulder next to clavicle. Most of the injuries are due to high energy impact occurring during RTA, fall from height, fall due to convulsion or epilepsy. Fractures are associated with sever commination and collapse of articular surface leading to dislocation and severe pain, swelling. Generally, these Neers 4-part fractures are managed by surgery with PHILOS plate. However, in our study of 15 patients managed conservatively showed better results compared to patients managed operatively with PHILOS. Methods: This is a prospective interventional study of 30 cohort cases of proximal humerus fracture – Neers 4 part. Patients willing for operations are treated with PHILOS and those non-willing and who were not fit for surgery were managed conservatively with sling. Early rehabilitation and pendulum exercises started at the beginning of 2-week post op. Patients were admitted and followed at our institution from 2015 t0 2017. Outcome analysed at the end taking into consideration of clinical and radiological improvements. Functional outcome will be assessed by Constant Murley score at the end of study. Results: In our series of 30 patients, majority of the patients were males, with RTA and fall from height in field being the commonest mode of injury in young population and domestic fall being the most common mode of injury in elderly. Fractures managed conservatively showed good range of shoulder movements with less complications compared to operated cases. However early mobilisation and pain management were seeming to be well with PHILOS in immediate post-operative days but shoulder strength and long-term pain controlled better in non-operative cases. Majority of the fractures united with a good to moderate outcome in 50% of the patients. Malunions were the only complications in non-operative cases and in PHILOS there were some incidences of screw perforation, AVN, plate impingement and infection along with malunion. Conclusions: though many studies conclude Proximal Humerus locking compression plate is an advantageous implant because of its angular stability, particularly in communited osteoporotic bones in elderly patients, thus allowing early mobilization. It has many complications. In our study non operated Neers 4-part proximal humerus fractures did well at the end of study without suffering any complications. In fact, non-operated group was more confident in shoulder movements during physiotherapy. Hence, it’s better to manage these fractures conservatively.

Management of Proximal Humerus Fractures by JESS

Background and Aims Upper end of humerus fractures fare poorly with non-operative treatment and they are better treated with surgical intervention but results vary. We decided to assess the outcomes with Joshirsquos External Stabilization System JESS in regard to the stabilization of fracture fragments stability leaving the joint free for mobilization.Methods A total of 20 cases were enrolled in the study and treated with closed reduction-internal fixation CRIF with JESS. Neerrsquos criteria was used to analyze all the cases.Results Among these patients with 2-part fractures five had excellent results and one showed satisfactory result. In patients with 3-part fractures four had excellent results and two demonstrated satisfactory results. With 4-part fractures excellent results were found in four cases and two with satisfactory results. In patients with split head fracture of humerus excellent results were found in one case and another one showed satisfactory result.Conclusions CRIF with JESS is a simple good effective economic less time-consuming procedure and can be easily performed by any Orthopaedic Surgeon. The technique developed by Joshi gives good anatomical reduction with stable fixation and good functional results.nbspnbsp

A comparative study of surgical management of surgical neck of humerus fracture in adults by proximal humeral nailing and PHILOS

Fractures of surgical neck of the humerus represent 25% of the proximal part of humerus. Neer described three types of fracture of the surgical neck: angled, translated/separated and comminuted. Proximal humeral nail and PHILOS plate fixation for the surgical neck of humeral fractures offers good anatomic fracture reduction and stable primary fixation to ensure rapid fracture healing and imme­diate post-operative functional therapy without prolonged immobilization. Objective: To assess and compare the functional outcome and the fracture union of surgical neck of humerus fractures using proximal humeral nail and PHILOS plate. Material and Method: Prospective Comparative study was conducted at Bapuji and Chigateri General hospital attached to JJM Medical college, Davangere for a period of two years from July2018 to July 2020.60 adult patients with surgical neck of humerus fractures who were willing for surgery were admitted during the period of study and followed up for 12 months. Result: In our study most patients were Female (60%) out of 60 patient. The mean age being 58 years in Group1 and 47.66 years in Group 2. Most of the case were road traffic accident comprising of 65% in Group 1 and self fall 63% in Group 2. In this study,70% of the patients presented with 2-part fracture, 30% with 3-part fracture in Group 1 and 50% of each fracture pattern in Group 2. In this study, according to Neer’s score of patients had excellent 9(30%), satisfactory outcome 17(56.66%), and unsatisfactory outcome 4(13.33%) in Group 1 patients and, excellent result in 6(20%) cases, 20 cases (66.66%) had satisfactory outcome and unsatisfactory outcome 4(13.33%) in Group 2. Conclusion: Surgical neck of humerus treated with PHN offers minimally invasive, cosmetically acceptable scar, stable and axial fixation with minimal soft tissue damage, early mobilization, where as in PHILOS provide rigid and stable fixation in most of communited fractures.

How Many Proximal Screws Are Needed for a Stable Proximal Humerus Fracture Fixation?

Purpose:This biomechanical study investigates the optimal number of proximal screws for stable fixation of a 2-part proximal humerus fracture model with a locking plate.Methods:Twenty-four proximal humerus fracture models were included in the study. An unstable 2-part fracture was created and fixed by a locking plate. Cyclic loading and load-to-failure tests were used for the following 4 groups based on the number of screws used: 4-screw, 6-screw, 7-screw, and 9-screw groups. Interfragmentary gaps were measured following cyclic loading and compared. Consequently, the load to failure, maximum displacement, stiffness, and mode of failure at failure point were compared.Results:The interfragmentary gaps for the 4-screw, 6-screw, 7-screw, and 9-screw groups were significantly reduced by 0.24 ± 0.09 mm, 0.08 ± 0.06 mm, 0.05 ± 0.01 mm, and 0.03 ± 0.01 mm following 1000 cyclic loading, respectively. The loads to failure were significantly different between the groups with the 7-screw group showing the highest load to failure. The stiffness of the 7-screw group was superior compared with the 6-screw, 9-screw, and 4-screw groups. The maximum displacement before failure showed a significant difference between the comparative groups with the 4-screw group having the lowest value. The 7-screw group had the least structural failure rate (33.3%).Conclusion:At least 7 screws would be optimal for proximal fragment fixation of proximal humerus fractures with medial comminution to minimize secondary varus collapse or fixation failure.Level of Evidence:Basic science study.

Clinical results of 4-part proximal humeral fractures treated with locking plate

Clinical results of 4-part proximal humeral fractures treated with locking plate

Non Vascularised Fibula Strut Graft Augmentation for Fixation of Proximal Humerus 3-Part Fracture using PHILOS Plate and CC Screws in a Young Male

Proximal humerus fracture accounts for 4-5% of all fractures. Locking Compression Plate (LCP) Proximal Humerus Internal Locking System (PHILOS) fixation is currently the most widely used method for the management of unstable proximal humerus fractures. LCP system of the proximal humerus is better than other available implants because of better anatomic design, fixed angulated configuration of locking screws, rotational and angular stability. This case report was of a 35-year-old male who presented with pain, swelling and difficulty in movement at the right shoulder, after a road traffic accident. Plain radiograph of right shoulder (anteroposterior) view revealed displaced 3-part proximal humerus fracture (humeral head with lesser tuberosity, greater tuberosity and shaft). It was managed with philos plate, Cannulated Compression (CC) Screws and non vascularised fibular strut graft. At two years follow-up, patient showed good shoulder range of motion with no complication.

Treatment of 2-Part Proximal Humeral Fractures in Osteoporotic Patients With Medial Calcar Instability Using a PHILOS Plate Plus an Allogeneic Fibula Inserted Obliquely - A Retrospective Study.

IntroductionTo date, there is little research assessing the efficacy of a proximal humeral internal locking system (PHILOS) plate plus an allogeneic fibula inserted obliquely in the treatment of 2-part proximal humerus fractures (PHFs) with calcar comminution in patients >60 years old with severe osteoporosis. The aim of this study was to retrospectively evaluate the outcomes of elderly patients with osteoporotic 2-part PHFs combined with medial column (calcar) instability or disruption who experienced a PHILOS plate plus an allogeneic fibula inserted obliquely.Materials and MethodsOne hundred and twelve consecutive elderly patients with severe osteoporotic 2-part PHFs combined with calcar instability or disruption who were treated with a PHILOS plate plus an allogeneic fibula inserted obliquely were retrospectively identified from 3 tertiary medical centres during 2014–2019. The primary outcomes were the Constant scores and American Shoulder and Elbow Surgeons (ASES) scores; secondary outcome was the rate of key orthopaedic complications.ResultsMedian follow-up was 24 (15.3–27.6) months. Significant improvements in the median Constant scores were observed (39 [26–58 points] prior to surgery vs 81 [67–95 points] at final follow-up). The median ASES scores improved from 43 (26–64 points) prior to surgery to 83 (65–96 points) at final follow-up. The percentage of key orthopaedic complications was 25.6% (22/86). Four (4.7%) cases had loss of reduction, 4 (4.7%) experienced aseptic loosening, 1 (.8%) had non-union, 4 (4.7%) suffered a periprosthetic fracture, 3 (3.5%) experienced a revision surgery, 1 (.8%) had a dislocation and 5 (5.8%) suffered an unbearable shoulder pain.ConclusionFor elderly patients with osteoporotic 2-part PHFs combined with calcar instability or disruption, PHILOS plate combined with an allogeneic fibula inserted obliquely might have recognisable advantages in decreasing the loss of fixation and preventing medial calcar collapse.

PHILOS Plate Plus Oblique Insertion of Autologous Fibula for 2-Part Proximal Humerus Fractures With Medial Column Disruption: A Retrospective Study.

Introduction:The aim of this retrospective study was to evaluate the outcomes of older patients with 2-part proximal humerus fractures (PHFs) with medial column disruption stabilized using a proximal humeral internal locking system (PHILOS) plate plus oblique insertion of autologous fibula as a primary procedure.Materials and Methods:Data involving 112 patients (112 shoulders) sustaining 2-part PHFs with medial column disruption treated with PHILOS plate plus oblique insertion of autologous fibula as a primary procedure during 2012-2019 were identified. The median follow-up was 36 months (range: 11.2-43.5 months). The primary endpoint was the Constant scores and American Shoulder and Elbow Surgeons (ASES) scores. The secondary endpoint was the main orthopedic complication rate.Results:The median Constant and ASES scores were 78 (range, 52-95) and 77 (range, 62-96) at the final follow-up, respectively. The main orthopedic complication rate was 10.7% (12/112). Twelve orthopedic complications in 8 patients were detected, and they involved loss of reduction, varus collapse, aseptic loosening, mal-union, revision, and intolerable shoulder pain. Of these complications, 3 (2.6%) involved loss of reduction, 2 (1.7%) involved varus collapse, 3 (2.6%) involved aseptic loosening, 1 (0.8%) involved mal-union, 2 (1.7%) required revision surgery, and 1 (0.8%) presented intolerable shoulder pain.Conclusion:PHILOS plate plus oblique insertion of autologous fibula as a primary procedure may yield good functional outcomes and a low rate of the main orthopedic complications.

Surgical Treatment of the Patients with Cervical Disc Herniation at Clinical Center of University of Sarajevo, Bosnia and Herzegovina.

Backgroud:Intervertebral disc herniations are caused by rupture of the fibrous ring and migration of one part of the nucleus pulposus towards the spinal canal. The most commonly affected levels are C5-C6 and C6-C7. Surgical treatment of cervicobrachialgia is indicated in the presence of long-term intense pain syndrome with or without radicular sensory-motor deficit and magnetic resonance (MRI) verified disc herniation with a compressive effect.Objective:The most common surgical treatment is anterior lateral microdiscectomy with or without the use of implants. In addition to this method, dorsolateral microsurgical treatment can be used for foraminal hernias.Methods:This retrospective study included 110 (58 / 52.7% male and 52 / 47.3% female) patients with cervical disc herniations who were surgically treated at the Neurosurgery clinic of Clinical Center of Sarajevo University (CCUS) in a five-year period. Stability, postoperative curvature, arthrodesis, implants, and changes in adjacent segments were radiographically analyzed. In the outcome assessment, functional outcome and patient satisfaction were analyzed using the Pain Self-Evaluation Scale (VAS), Prolo functional and economic score, and White’s classification of treatment outcomes.Results:The dominant prevalence of changes was recorded at the levels of C5-C6 (58%) and C4-C5 (28%) with a ventrolateral approach performed in 90% of patients. The largest representation is hard dorsolateral discs (n = 77). In the group of patients with placed implant, hard discs were present in 96 (90%) cases (p <0.001), while soft discs were dominant in patients without implant placement (p <0.001). In the group of subjects with implant, the most common are hard dorsolateral discs and those of mixed localization in 41 of 55 patients (65.5%; p = 0.001). The most common implant is PEEK cage (74.5%). From complications, we had partial vertebral body fractures in 4.5% of patients. Furtehr, the most common are sensory disturbances in 2.73% of respondents. Reduction of symptoms and improvement of preoperative neurological status were observed in over 95% of patients.Conclusion:Surgical treatment of cervical disc herniation is a safe method with a minimal percentage of complications. Microsurgical discectomy significantly contributes to the improvement of the functional status of patients, the reduction of pain, and the improvement of neurological deficit and overall mobility.

Repair Bond Strength of High-viscosity Glass-ionomer Cements Using Resin Composite Bonded with Light- and Self-cured Adhesive Systems.

High-viscosity glass-ionomer cements (HVGICs) used with atraumatic restorative treatment can be repaired with light- or self-cured adhesive systems; however, the repair bond strength of two-step, self-etching and one-step adhesives in the light-cure mode surpass one-step self-cure adhesives. Working on a feasible self-cure approach in the absence of such in rural areas as well as in war zones is of prime importance.