Achieved Bone Union Research Articles

RhBMP7 use for treating scaphoid non-union: 5 cases assessed at 10 years’ follow-up

The scaphoid is the most common non-union site in the wrist. Fixation with vascularised or non-vascularised autograft is the gold standard when it comes to treating these non-unions. But, what can we offer if the autograft fails? Using osteoinductive proteins in difficult cases of long bone non-union yields good results. However, only a few studies have been published on their use for scaphoid non-union. In our study, five patients with an average age of 32 years (ranging from 21 to 44 years) with old non-union (more than 24 months) of the scaphoid were treated after autograft treatment had failed. The procedure consisted of reaming the non-union site, then adding bone autograft combined with BMP-7 (Osigraft®) in the defect and fixing it all with a screw or K-wire. Postoperative immobilisation was prescribed. Only one patient achieved bone union (20%) despite an average follow-up of 10 years (80–143 months). The average flexion-extension loss was 16.6° (0–30) relative to the contralateral side. The average strength deficit was 450 grams (0–2000) for pinch and 12.1kg (0–29) for grip compared to the contralateral side. Self-assessment questionnaires had an average PRWE at 28.9 (10.5–49) and an average QuickDASH at 28.6 (9.09–61.36). Our study could not demonstrate any real benefit of using BMP-7 for treating old scaphoid non-union despite an elevated cost. Further research is needed to look at other treatment approaches, for instance, the use of new scaffolds combining VEGF and BMP.

Intercalary Allograft to Reconstruct Large-Segment Diaphysis Defects After Resection of Lower Extremity Malignant Bone Tumor.

AimTo evaluate the clinical effect of intercalary allograft transplantation and reconstruction in the treatment of diaphyseal defect after resection of lower extremity malignant bone tumor.MethodsClinical data of 17 patients diagnosed with malignant lower-limb bone tumors and having undergone segmental allograft reconstruction with a mean follow-up of 49.8 (26–78) months were included. Segmental allografts of average 17-cm length preserved by deep-freezing were used and fixed using intramedullary nail, double plate, and intramedullary nail and plate combination in 2, 5, and 10 patients, respectively. Host–donor junctions were perfectly and roughly matched in 5 and 12 patients, respectively. Allograft union, local recurrence, and complications were assessed using clinical and radiological tests. Allograft union was evaluated using the International Society of Limb Salvage (ISOLS) scoring system. The functional prognosis was evaluated using the Musculoskeletal Tumour Society (MSTS) scoring system.ResultsIntercalary allograft reconstruction of femoral shaft, tibial shaft, and distal tibia with ankle arthrodesis was performed in eight, four, and five patients, respectively. Two patients had local recurrence and underwent amputation; one died of metastasis. Host–donor junctions in two patients showed nonunion; 12 patients achieved bone union. The average union time was 12.1 months. No allograft fracture or infection occurred. Union rates were 100% and 88.2% at metaphyseal and diaphyseal junctions, respectively. Healing time differed significantly between the precisely and roughly matched groups (p<0.01). The incidence of nonunion was higher after intramedullary nailing than after the other two methods (p<0.05). The mean MSTS score was 24.2 (14–29) at the end of follow-up.ConclusionIntercalary allograft transplantation is an effective strategy for diaphyseal defect following post-tumor resection in the lower extremity. Good bone healing after allograft reconstruction is achieved with stable internal fixation and perfectly matched host–donor interfaces.

Surgical treatment outcomes of the Ilizarov and internal osteosynthesis methods in posttraumatic pseudarthrosis of the tibia\u2014a retrospective comparative analysis

IntroductionThis study compared surgical treatment outcomes of the Ilizarov and internal osteosynthesis methods in posttraumatic pseudarthrosis of the tibia.Material and methodsIn a retrospective comparative study, 75 patients were treated with the Ilizarov technique for aseptic posttraumatic pseudarthrosis of the tibia in the period 2000–2016. We compared them with the 51 patients from the control group, treated for tibial bone union disturbances using internal osteosynthesis methods, i.e., internal-fixation plates and intramedullary nails. The study groups were compared in terms of the rates of union, time to union, and the baseline-to-postoperative difference in lower leg deformity.ResultsUnion rate in the Ilizarov group was 100% and the control group was 51.92% (p < 0.001). The median time to union suggests that patients from the Ilizarov group needed a shorter time to achieve bone union (203.00 days vs. 271.00 days) (p = 0.091). The effect size in the Ilizarov group was larger both in terms of reducing both limb deformity and shortening (it is worth noting, however, that the Ilizarov treatment was used in patients with higher baseline values of both these parameters). We observed no significant difference in terms of time to union between the group of patients with at least one risk factor for disturbance in fracture healing and the group with no risk factors. The following risk factors were considered: diabetes mellitus, corticosteroid therapy, smoking, alcohol dependence, and advanced lower-extremity vascular disease (p = 0.827).DiscussionOur study demonstrated a high effectiveness of the Ilizarov method in the treatment of aseptic posttraumatic pseudarthroses of the tibia. The Ilizarov method seems to be worth considering in all cases where either the patient or the nature of injury is associated with additional risk factors and whenever there is a need for leg deformity correction or leg elongation.

Locked wires fixator for fractures of the distal third of the radius and ulna in children.

Prevention of redisplacement is an issue after the treatment of fractures of the distal third of the radius in children. In this study, we used a locked wires fixator for this type of fracture and achieved favorable treatment outcomes. The subjects were 8 children with fractures of the distal third of the radius (male: 7, female: 1, mean age: 9.0years old) who underwent surgery with locked wires fixators and were able to be evaluated 12months after surgery. Immobilization was not applied after surgery. The locked wires fixator or K-wire was removed when the bridging callus was observed on plain radiography 4-6 (mean 5.5) weeks after surgery in all patients. The presence of bone union, functional outcomes, and complications were investigated postoperatively. All patients achieved bone union without redisplacement excellent function. The pin site infection was observed in two patients. The locked wires fixator may be a new useful treatment method for fractures likely to cause postoperative redisplacement.

Impact of Rigid Fixation of the Pubic Symphysis for Spinopelvic Fixation in Two Cases of Lumbosacral Agenesis.

Introduction In patients with lumbosacral agenesis (SA), Renshaw type III or IV, lumbosacral instability is the primary cause of major clinical complications. Although they are usually treated with spinopelvic fusion, nonunion at the spinopelvic junction is a major complication due to the congenital sacropelvic abnormalities. The purpose of this study was to evaluate whether a combination of lumbosacral fixation and rigid fixation at the pubic symphysis could lead to postoperative bone union in patients with SA (Renshaw type III). Methods Retrospective case series study. We present the cases of two patients with SA, Renshaw type III, who were surgically treated by lumbosacral fusion using a posterior approach, and they exhibited nonunion at the lumbosacral junction. Results Case 1. A 10-year-old male underwent T8-S posterior fixation followed by multiple augmentations using allografts at the lumbosacral junction for delayed union. All additional procedures with bone graft using a posterior approach failed to achieve bone union; however, additional rigid fixation at the pubic symphysis resulted in a successful lumbosacral bone union. Case 2. A 6-year-old male underwent vertical expandable prosthetic titanium rib (VEPTR) surgery with multiple rod extension procedures. Subsequently, at the age of 10 years, a combined two-stage anterior (L1-3) and posterior (T8-iliac) fixation with T9 hemivertebrectomy was performed. As a result of subsequent nonunion with screw loosening, additional rigid fixation at the pubic symphysis was performed 1 month after posterior fixation. Bone union was finally achieved 1 year after all the surgical interventions. Conclusions Rigid fixation at the pubic symphysis may play a significant role in achieving rigid bone union for unstable lumbopelvic connection, such as SA, Renshaw type III or IV.

Radiographic effects observed in the coronal view after medial malleolar osteotomy at total ankle arthroplasty in rheumatoid arthritis cases

BackgroundWhen soft tissue balance is not acceptable at total ankle arthroplasty (TAA) for rheumatoid varus deformity, medial malleolar osteotomy has been performed. At the same time, the shape of the ankle joint changes after soft tissue balancing with such an osteotomy, however there is few information for the radiographic findings after the osteotomy. Thus, radiographic changes in the coronal view of such cases were investigated. MethodsJSSF-RA foot and ankle scale and SAFE-Q scores were determined along with pre/postoperative radiographic parameters of the ankle joint in 70 ankles (65 patients) with rheumatoid arthritis followed for a mean of 7.9 years (range, 2–16 years) after TAA. Seven ankles were excluded because those underwent lateral or lateral/medial malleolar osteotomy. Twenty-seven ankles underwent medial malleolar osteotomy, and compared with 36 ankles without osteotomy. ResultsAll ankles achieved bone union after medial malleolar osteotomy, and the tibial medial malleolus (TMM) angle was significantly decreased [30.3°–19.1°] following significant valgus correction [TC angle: −2.7° to 0.5°]. The gap due to medial soft tissue tightness was significantly improved by medial malleolar osteotomy [4.95° to 0.7°]. Lateral malleolar fractures sometimes occurred (19%: 5/27 ankles) at valgus correction, but they healed completely without any internal fixation. ConclusionMedial malleolar osteotomy was useful in rheumatoid varus ankle for not only controlling the soft tissue balance, but also providing a stabilized shape of the ankle joint. Lateral malleolar fractures were caused by valgus correction following medial malleolar osteotomy in some cases, but all fractures were completely healed without any internal fixation.

Management of forearm bone loss with induced membrane technique

There are very few published studies describing the treatment of segmental bone defects of the forearm using the induced membrane technique. The objectives of this study were to evaluate the time to bone union, the function of the joints above and below the treated bone segment and the patients’ quality of life over the long-term. We performed a retrospective study in all patients treated by the induced membrane for a forearm bone defect over at 13-year period. Demographics, bone union, complications, functional outcomes and occupational status were collected. Six patients were included: 2 posttraumatic injuries, 1 osteomyelitis, 1 septic arthritis, 1 aseptic nonunion, 1 tumor. The average defect length was 64mm (48–110). All defects were treated with internal fixation. Bone graft was harvested from the iliac crest in two patients, the femur (using the Reamer Irrigator Aspirator technique) in three patients and the radius in one patient. Five patients achieved bone union after a mean of 4months (3–6). Three complications were observed: 1 radioulnar instability, 1 infection of the fixation device, 1 abscess. At an average 8½ years’ follow-up, the pain level on the VAS was 0.6 (0–3), the Mayo Elbow Performance Score was 98 (90–100), the Herzberg score was 108 (85.6–140) and the QuickDASH was 14.9 (2.7–35). All patients returned to work. Using the induced membrane technique avoids the complications associated with vascularized autograft and yields good functional outcome and quality of life.

Management of Infected Bone Defects of the Lower Extremities by Three-Stage Induced Membrane Technique.

BackgroundInfected bone defects are therapeutic challenges. Although the induced membrane technique has been used for this problem, there is a 3% to 20.7% failure to eradicate infection, and there have been few reports about its use in tuberculous infection. We present our three-stage induced membrane technique (TSIMT) for treating infected bone defects of the lower extremity.Material/MethodsForty-one adult patients with infected bone defects of the lower extremities treated by TSIMT were included in a retrospective case-series study between January 2013 and June 2018. The clinical, imaging and laboratory assessment outcomes were analyzed.ResultsIn the first stage, 3 patients had ankle tuberculous bone defects and 17 patients underwent 2–4 debridements. In the second stage, the average bone defect was 6.0 cm; 1 patient needed an anterolateral thigh flap to cover the wound. In the third stage, 10 patients underwent autograft mixed allograft, and 18 cases used internal fixation. The mean follow-up period was 23.3 months. All patients achieved bone union and clinical eradication of infection. Changes in Lower Extremity Functional Scale (LEFS) scores after 1 year of TSIMT and bone union time are associated with advanced age, longer duration of infected bone defects, active smoking, and external fixation (p<0.05), but are not dependent on bone defect size, debridement times, type of bone graft, or spacer-placing time (p>0.05).ConclusionsTSIMT is effective in treating infected bone defects of the lower extremities. Advanced age, longer duration of infected bone defects, active smoking, and external fixation adversely affect bone union and recovery of infected extremities in a limited time span.

Functional outcome of non-vascularized fibula in gap non union

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Gap non-union is one of the most perplexing problems facing the orthopedic surgeon today. Fibula is the preferred site of non-vascularized bone graft due to its easy accessibility to surgical resection and minimal donor site complications.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The study comprised 11 patients of gap non-union between 13 to 80 years (mean=34.9 years). The fibular graft was harvested from the mid shaft and cortico-cancellous bone graft taken from the iliac crest was applied at both ends of the fibular graft to aid in union.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The average bone gap was 7 cm (4-13 cm). 64% of the patients achieved bone union after the first procedure, of the remaining 4 patients, 1 patient showed union after secondary cortico-cancellous bone grafting, while two are planned for the same. The remaining one patient has only completed 16 weeks follow-up at present and is not showing signs of union at present. Functional range of motion was achieved in both the proximal and distal joints in all cases.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Non-vascularized fibular bone grafting is a simple and effective treatment option which does not require any special skill, has a very low complication rate and has very high patient compliance.&lt;/p&gt;

Effect of Single Injection of Recombinant Human Bone Morphogenetic Protein-2-Loaded Artificial Collagen-Like Peptide in a Mouse Segmental Bone Transport Model.

This study aimed to investigate whether a single injection of recombinant human bone morphogenetic protein-2-loaded artificial collagen-like peptide gel (rhBMP-2/ACG) accelerates consolidation at the bone defect site and bone union at the docking site in a mouse segmental bone transport (SBT) model. A critical sized bone defect (2 mm) was created in the femur of mice and subsequently reconstructed using SBT with an external fixator. Mice were divided into four treatment groups: Group CONT (immobile control), Group 0.2 (bone segments moved 0.2 mm/day for 10 days), Group 1.0 (bone segments moved 1.0 mm/day for 2 days), and Group 1.0/BMP-2 (rhBMP-2/ACG injected into the bone defect and segments moved 1.0 mm/day for 2 days). Consolidation at the bone defect site and bone union at the docking site was evaluated radiologically and histologically across eight weeks. Bone volume and bone mineral content were significantly higher in Group 0.2 than in Group 1.0. Group 0.2 showed evidence of rebuilding of the medullary canal eight weeks after surgery at the bone defect site. However, in Group 1.0, maturation of regenerative bone at the bone defect site was poor, with the central area between the proximal and distal bone composed mainly of masses of fibrous and adipose tissue. Group 1.0/BMP-2 had higher bone volume and bone mineral content compared to Group 1.0, and all mice achieved bone union at the bone defect and docking sites. Single injection of rhBMP-2/ACG combined with SBT may be effective for enhancing bone healing in large bone defects.

Outcomes of Combined Neck and Trochanter Fractures of the Femur Treated with Cephallomedullary Nail in Elderly.

PurposeProximal femur fractures are classified into intracapsular neck fractures and extracapsular trochanteric fractures, and several related treatment recommendations in elderly patients have already been introduced. Importantly, we have observed cases of combined intra and extracapsular fractures (i.e., ipsilateral neck and trochanter fractures). The purpose of this study is to report the outcomes of combined neck and trochanter fractures of the femur treated with cephalomedullary nail (CMN) in elderly patients.Materials and MethodsFrom January 2010 to December 2014, 410 patients with proximal femoral fractures were fixed using CMN; among this group, 37 patients with combined neck and trochanter fractures were identified. Two of these patients died fewer than three months after injury and another two did not return for follow-up. Thirty-three patients were included and reviewed retrospectively in this study.ResultsAll patients were injured by simple fall. Bone union was obtained in 28 of 33 patients. Of the five patients who failed treatment, three experienced implant penetration through head (cut-through and cut-out), one had breakage of CMN and the last one had a loosening of internal fixation device with persistent non-union at final follow-up. The former four patients underwent hip replacement surgery and the latter refused surgery because he had low demand in daily life and many medical problems.ConclusionEighty-five percent of elderly patients with combined neck and trochanter fractures of the femur treated with CMN achieved bone union; these complex fractures require more accurate reduction than usual extra-articular intertrochanteric fractures.

Reconstruction osseuse métacarpienne par membrane induite sans ciment

Hand ballistics traumas often produce complex limb injuries and large segmental bone defects. The induced membrane (IM) technique is a simple and effective procedure for reconstruction of segmental bone defects. Usually polymethylmethacrylate (PMMA) cement is required for the first stage of the surgery. We describe four metacarpal bone reconstructions with the IM technique but without PMMA cement after ballistic trauma in a low-resources setting. Two patients were treated in a forward surgical unit for gunshot wounds of the hand. A 33 years old man presented a 4th and 5th metarcarpal bone fracture with critical bone defect and a 25 years old man presented a 2nd and 3rd metacarpal bone and soft tissue defect. In addition to the surgical initial management, we performed the IM technique with a syringe's body in polypropylene (PP) instead of PMMA cement that was not available in this situation. A thick membrane was observable six weeks after the spacer implantation. We performed the bone graft in one case with an iliac crest and in the other with a tibial cortical and cancelous graft. Bone union was achieved in the two cases for the four metacarpal bones. We report cases treated in an austere environment where PMMA cement was not available. This PP induced membrane technique as first been described in a public communication at the SICOT congress by Mozumder et al. It involved critical bone defects from the lower limb. The IM technique has proven its efficiency in hand and wrist bone defect reconstruction but its success is based on strict compliance with technical execution. Our plastic spacers met the requirements of surgical technique. After six weeks, an IM membrane macroscopically similar to cement's IM was found in all cases. The PP spacer shows interesting characteristics: it does not contain antibiotics, it does not heat the surrounding tissues and it is not expensive and easily available. The use of a PP spacer allowed us to achieve bone union in four critical metacarpal bone defects related to ballistic trauma. This procedure respects the technical execution of the IM technique. It is achievable in very low-resources settings. Further biomolecular studies are necessary to assess the PP IM biological properties.

Modified Arthroscopic Latarjet Procedure: Suture-Button Fixation Achieves Excellent Remodeling at 3-Year Follow-up

Background: Some studies have advocated the use of suture-button fixation during the Latarjet procedure to reduce complications associated with screw fixation. However, the sample size of these studies is relatively small, and their follow-up period is short. Purpose: To investigate the efficacy of the suture-button Latarjet procedure with at least 3 years of follow-up and remodeling of the coracoid graft. Study Design: Case series; Level of evidence, 4. Methods: A total of 152 patients who underwent the suture-button Latarjet procedure between February 2013 and February 2016 were selected, and 128 patients who met the inclusion criteria were enrolled in this study. Preoperative and postoperative clinical results were assessed. The position and healing condition of the coracoid graft and arthropathy of the glenoid and humeral head were also assessed using radiography and 3-dimensional computed tomography (CT). Results: The mean follow-up time was 40.3 ± 5.8 months. There were 102 patients included in this study. The mean visual analog scale score for pain during motion, the American Shoulder and Elbow Surgeons score, the Rowe score, and the Walch-Duplay score were improved considerably. A total of 100 grafts achieved bone union. The overall absorption rate was 12.6% ± 4.3%. Graft absorption mostly occurred on the edge and outside the “best-fit” circle of the glenoid. A vertical position was achieved in 98 grafts (96% of all cases) immediately postoperatively, with the mean graft midline center at the 4 o’clock position. In the axial view, CT showed that 89 grafts were flush to the glenoid, whereas 2 and 11 grafts were fixed medially and laterally, respectively. In all cases, the bone graft and glenoid tended to extend toward each other to form concentric circles during the remodeling process. During follow-up observations, the height of the 11 grafts that were positioned laterally (ie, above the glenoid level) exhibited a wave-curved change. No arthropathy was observed in any patient. Conclusion: Patient outcomes were satisfactory after the modified arthroscopic suture-button Latarjet technique. Graft absorption mostly occurred on the edge and outside the “best-fit” circle of the glenoid. The graft exhibited the phenomenon of ectatic growing when it fused with the glenoid and finally remodeled to a new concentric circle with the humeral head analogous to the original glenoid. Grafts positioned laterally did not cause arthropathy of the joints within the period of the study.

Pulsed electromagnetic field (PEMF): A potential adjuvant treatment for infected nonunion

Infected nonunion is still a challenge for orthopaedic surgeons. The goal of treatment is to eliminate infection and achieve bone union. Surgery is the only effective method currently. However, it is invasive and the results are still unsatisfactory. Therefore, seeking a noninvasive and effective method to resolve infected nonunion is necessary. Pulsed electromagnetic field (PEMF) has been used for the treatment of nonunion for more than 40 years. PEMF could promote bone formation at tissue, cell and subcellular levels. Furthermore, our study showed that PEMF had bactericidal effect. The hypothesis we proposed herein is that PEMF may be an adjuvant treatment for infected nonunion by controlling infection and inducing bone formation.

Therapeutic Radioprotection by Human Umbilical Cord Derived Wharton’s Jelly Mesenchymal Stem Cells: Role of Cytokines and Nrf-2

Infected nonunion is still a challenge for orthopaedic surgeons. The goal of treatment is to eliminate infection and achieve bone union. Surgery is the only effective method currently. However, it is invasive and the results are still unsatisfactory. Therefore, seeking a noninvasive and effective method to resolve infected nonunion is necessary. Pulsed electromagnetic field (PEMF) has been used for the treatment of nonunion for more than 40 years. PEMF could promote bone formation at tissue, cell and subcellular levels. Furthermore, our study showed that PEMF had bactericidal effect. The hypothesis we proposed herein is that PEMF may be an adjuvant treatment for infected nonunion by controlling infection and inducing bone formation.

Calcaneal insufficiency fractures following total knee arthroplasty: Classification and clinical findings

BackgroundCalcaneal insufficiency fracture (IF) following total knee arthroplasty (TKA) is a rare disorder. This study aimed to examine the prevalence and clinical findings of calcaneal IF following TKA. MethodsWe retrospectively reviewed 3,585 consecutive patients undergoing primary TKA between 2012 and 2017 in four hospitals. Calcaneal IF following TKA was diagnosed by plain radiography or magnetic resonance imaging. First, we investigated the prevalence and clinical findings of calcaneal IF following TKA. Second, we classified calcaneal IF into three types based on its location: type 1, fracture by traction force around the Achilles tendon insertion; type 2, compression fracture around the posterior subtalar joint; and type 3, fracture by ground reaction force at the bottom of the calcaneus. Finally, we compared the clinical findings between calcaneal IF with and without TKA. ResultsCalcaneal IF following TKA was seen in 17 (0.5%) of the 3,585 patients undergoing primary TKA. All patients were female, with a mean age of 76.5 ± 5.9 years, relatively high body mass index (BMI), and osteoporosis. All fractures achieved bone union with conservative treatment. Type 1 fractures were the most common. Calcaneal IFs following TKA were significantly shorter in height and the patients had higher BMI than those without TKA. The locations of calcaneal IF following TKA varied, while only type 1 calcaneal IFs were seen in cases without TKA. However, there were no significant differences with regard to the bone union period or malunion between the two groups. ConclusionsCalcaneal IF should be suspected in patients presenting with ipsilateral foot pain following TKA, particularly in female patients with a relatively high BMI and osteoporosis. Calcaneal IF can be classified into three types based on the fracture location. These variations in calcaneal IF may be due to differences in conditions and changes in mechanical loading of the lower extremity and bone quality following TKA.

Long-term outcomes of Chiari osteotomy for Legg-Calvé-Perthes disease in children

To explore long-term outcomes of Chiari osteotomy for Legg-Calvé-Perthes disease in children with type Catterall III or IV, and to analyze clinical effect of osteotomy angle on clinical and radiographic results. From March 2005 to July 2013, 26 children with Legg-Calvé-Perthes disease with type Catterall III or IV were treated by Chiari osteotomy, including 17 males and 9 females, aged from 4 to 13 years old with an average of (8.9±2.6) years old. Children were divided into low osteotomy angle group and high osteotomy angle group. according to osteotomy angle. There were 10 children in low osteotomy angle group with an osteotomy angle of 10 degrees, including 8 boys and 2 girls, aged from 4 to 13 years old with an average of (9.2±3.3) years old; while there were 16 children in high osteotomy angle group with an osteotomy angle of 15 degress, including 9 boys and 7 girls, aged from 6 to 12 years old with an average of (8.8±2.1) years old. HHS score before operation and at the latest follow-up were recorded to observe clinical results. CE angle of hip joint, acetabular index, Sharp angle, Shenton's line continuity, femoral head coverage, acetabular depth ratio were recorded to compare radiographic results. Stulberg classification was analyzed to compare reshaping ability of femoral head. Twenty-six children were followed up for 4.5 to 12.0 years with an average of (7.9±1.8) years. All incisions were healed at stage I for 10 to 14 days, with an average of(12.3±1.1) days. No inflammation, skin necrosis and injury of vessel and nerve occurred. All osteotomies achieved bone union for 8 to 13 weeks, with an average of(9.8±1.4) weeks. HHS score increased from 75.8±6.5 before operation to 93.5±2.5 at the latest follow-up in low osteotomy angle group(P<0.05), and form 77.6±6.2 to 97.8±1.6 in high osteotomy angle group (P<0.05). HHS score of high osteotomy angle group at the latest follow-up was higher than that of low osteotomy angle group (P<0.05). The acetabular index decreased from (10.1±2.5)° before operation to (4.5±1.3)° at the latest follow-up in low osteotomy angle group (P<0.05), and from (10.7±3.3)° before operation to (2.0±1.1)° in high osteotomy angle group (P<0.05). The acetabular index of high osteotomy angle group at the latest followup was better than low osteotomy angle group(P<0.05). There was no significant difference in CE angle, Sharp angle, Shenton's continuity, femoral head coverage, acetabular depth ratio between two groups. According to Stulberg classification, the femoral head reshaping ability in high osteotomy angle group was better than that of low osteotomy angle group(P<0.05). Chiari osteotomy with 15° for Legg-Calvé-Perthes disease in children with type Catterall III or IV could effectively decrease index of acetabulum, and helpful for femoral head reshaping ability, then in further improve clinical effects.

Acute Surgery vs. Non-union Surgery of Displaced Midshaft Clavicle Fractures: A Case-control Study.

IntroductionThere is a lack of information about the results of surgical treatment and complications in midshaft clavicle fracture non-unions. Our hypothesis was that there is no difference in functional outcomes between the surgical treatment of an acute displaced middle-third clavicle fracture and the surgical treatment of a chronic symptomatic non-union of a displaced middle-third clavicle fracture.MethodsThis was a case-control study. Fourteen cases were considered with a displaced midshaft clavicle fracture, initially treated non-surgically, but which developed symptomatic non-union and required surgical treatment. The control group was a cohort of 18 patients with a displaced midshaft clavicle fracture, who had surgical treatment in an acute setting (<3 weeks). Our cases had a median follow-up of 77 months and were retrospectively analyzed. All those in the control group had a 12-month prospective follow-up evaluation. The variables measured were Constant score, time to discharge to work, and bone union rate.ResultsThe median Constant score at final follow-up for surgically treated non-unions was 87.5 (control group 84.5, p > 0.05). The median time to complete return to work was 3.2 months in the control group and 9.7 months in the case group (p=0.001). Hundred percent of those patients who were initially treated with surgery had bone union without other treatment. Two out of 14 cases required a second surgery with a plate and bone graft to achieve bone union.ConclusionSymptoms from displaced midshaft clavicular fracture non-unions are due to related pain and dysfunctional deficits that result from displacement and shortening. According to our study, patients with a displaced midshaft clavicle fracture non-union who needed surgery achieved similar functional results as compared to patients treated in an acute setting for a displaced midshaft clavicle fracture. The median time to discharge and return to work was more than doubled in the non-union surgery group.

Retrograde Intramedullary Absorbable Pin Fixation for Intraarticular Fracture of the Metacarpal Head

Purpose To review retrospectively the outcome of retrograde intramedullary absorbable pin fixation for intra-articular fractures of the metacarpal head. Methods Nine patients with intra-articular fractures of the metacarpal head were treated surgically with 1.5-mm-diameter unsintered hydroxyapatite particles and a poly- l -lactide pin. There were 2 women and 7 men, mean age 28.9 years. Patients were observed for a mean of 13.1 months after surgery. The metacarpophalangeal joint was exposed through a dorsal skin incision. After reduction of the fracture, 2 unsintered hydroxyapatite particles and poly- l -lactide pins were inserted from the articular surface of the distal bone fragment into the medullary canal of the metacarpal. A volar aluminum orthosis was applied in the intrinsic plus position for a mean of 1.8 weeks (range, 0–4 weeks), and range of motion exercises were started after the orthosis was removed. Results Anatomical reduction and bony union were achieved in all patients. Mean period required to achieve bone union was 4.6 weeks. No patients experienced pain after healing; all resumed normal activities at the time of follow-up, when mean flexion and extension of the metacarpophalangeal joint were 82.8° and –2.2°, respectively. There were no malunions or osteoarthritic changes, no breakage of the pin, aseptic inflammation, or avascular necrosis of the metacarpal head, and no foreign body reactions. Conclusions We performed a retrograde intramedullary absorbable pin fixation for intra-articular fracture of the metacarpal head. Using this method, damage to the articular cartilage and surrounding soft tissue was minimized, range of motion exercise could be started early after surgery, and hardware removal surgery was not necessary. Type of study/level of evidence Therapeutic IV.

A novel three-dimensional strapping reduction for the treatment of patellar fractures

ObjectiveThis study aimed to investigate the effectiveness of a three-dimensional strapping reduction in the treatment of patellar fractures.MethodsBetween January 2015 and June 2017, a total of 56 patients were randomly allocated to the three-dimensional strapping reduction group (trial group) and towel clamp reduction group (control group). There were no significant differences in age, gender, injury side, the interval time from injury to surgery, fracture pattern, and cause of injury (P > 0.05). The operation time, fluoroscopy time, bone union time, postoperative Hospital for Special Surgery (HSS) scores, and complications were recorded and analyzed.ResultsAll incisions achieved primary union. All patients in both groups completed a follow-up with an average of 12.5 months (range 11–15 months). Both operation time and fluoroscopy time in the trial group were significantly shorter than those in the control group (P < 0.001). All patellar fractures achieved bone union, and there was no significant difference in bone union time between the two groups (P > 0.05). Bone nonunion, infection, and fixation failure were not found in both groups. HSS scores of the trial group (90.9 ± 4.2) were higher than those of the control group (86.6 ± 5.2) (P < 0.01).ConclusionCompared with towel clamp reduction, the three-dimensional strapping reduction in the treatment of patellar fractures has advantages of shorter operation time and fluoroscopy time, better knee function after surgery, and satisfactory fracture healing.