Anatomical Fixation Research Articles

ОПЫТ ОПЕРАТИВНОГО ЛЕЧЕНИЯ ОТКРЫТОГО МНОГООСКОЛЬЧАТОГО ВНУТРИСУСТАВНОГО ЧРЕЗМЫЩЕЛКОВОГО ПЕРЕЛОМА ПЛЕЧА СО СМЕЩЕНИЕМ ОТЛОМКОВ (КЛИНИЧЕСКИЙ СЛУЧАЙ)

Complex intra-articular fractures require active patient management tactics and almost always the use of surgical treatment. For intra-articular fractures, it is extremely important to restore the normal anatomical structure, precise reposition and fixation of the fracture, without which it is impossible to restore the full function of the joint and limb. Surgical treatment should be carried out as early as possible in order to prevent the development of contractures. The purpose of this publication is to demonstrate the successful experience of treating a patient with an open comminuted intra-articular transcondylar fracture of humerus with displaced fracture fragments and the validity of the choice of an operative method of treatment of this pathology. Materials and methods : description of a clinical case and a brief analysis of the literature on this issue. Presented case of open reposition of a comminuted intra-articular transcondylar fracture of the shoulder and extra-cortical osteosynthesis with two reconstructive plates is successful. The effectiveness of treatment was evaluated based on the data of X-ray examination methods, as well as assessing the function of the limb and the amplitude of movement in the elbow joint. Results : performed open reposition of a comminuted intra-articular transcondylar fracture of shoulder and extra-cortical osteosynthesis with two reconstructive plates. Complete restoration of limb function and anatomical integrity of the distal metaepiphysis of the humerus has been achieved, the patient’s ability to work has been restored.

Talar Arthroscopic Reduction and Internal Fixation (TARIF): A Novel All-Inside Soft-Tissue-Preserving Technique.

Talar Arthroscopic Reduction and Internal Fixation (TARIF): A Novel All-Inside Soft-Tissue-Preserving Technique.

The relationship between surgical treatment results of AO type-C radius distal end fractures in adults and patient age

Aim: To evaluate the results of the locking anatomic plate fixation method with volar intervention according to age groups in the surgical treatment of unstable radius distal end fractures involving the joint. Materials and Methods: In this study, 72 adult patients with distal radius fractures who were treated with open reduction and locked volar plate fixation due to radius distal end fracture in group C according to AO classification between August 2010 and August 2018 were evaluated retrospectively. All our patients were evaluated for a post-op range of motion. We divided the age ranges into four groups: Group 1 for ages 17-30, Group 2 for ages 30-45, Group 3 for ages 45-60, and Group 4 for ages over 60. Results: The mean values of joint range of motion and grip strength in all our patients were; flexion 70.95° (Group 1 76.87°, Group 2 74.00°, Group 3 66.96°, and Group 4 64.16°), extension 67.38° (Group 1 71.87°, Group 2 68.33°, Group 3 61.15° and, Group 4 61.16°), radial deviation 27.02° (Group 1 32.50°, Group 2 29.67°, Group 3 23,08° and, Group 4 21.67°), ulnar deviation 32.86° (Group 1 38.75°, Group 2 36.33°, Group 3 28.46°, and Group 4 25.83°), supination 77.74° (Group 1 85.0°, Group 2 79.67°, Group 3 74.62°, and Group 70.0°), pronation 82.50° (Group 1 85.62°, Group 2 84.33°, Group 3 82.69°, and Group 4 73.33°). Analysis of the data revealed a negative correlation between patient age and post-operative joint range of motion. Our findings indicate a statistically significant difference in joint range of motion among Group 4, Group 1, and Group 2 patients. Conclusion: Volar locking plate surgery in AO type C radius distal fractures is suitable for all age groups thanks to rigid fixation and early mobilization.

Study of outcome of distal humerus fracture treated with plating

Background and Aim: Bicondylar intraarticular fractures of the distal humerus, because of their rarity and often associated significant displacement, comminution, and osteopenia, present the orthopaedician with a difficult injury to treat successfully. But modern techniques of open reduction and internal fixation provide stable construct to allow early post-operative motion without compromising bone healing. The aim of the present study is to evaluate the functional outcome of surgical management of the distal humerus with extra and intraarticular extension in adults using plating.Material and Method: A total of 20 patients were included in the study. All the included patients had fractures of the distal humerus, aged >18 during the period of 2020-2021 in our hospital. Fracture is classified according to AO-OTA Classification. All are treated by open reduction and plating. Length and type of plate were selected as per fracture pattern. Post-Operatively above elbow cast was given to decrease pain and edema. The patients are followed up at regular intervals of 4,8,12 and 16 weeks and results were evaluated using the Mayo Elbow Performance Score for the results of treatment.Results: We had 25% excellent, 50% good results, 10% fair & 15% poor results.Discussion and Conclusion: Open reduction internal fixation should be done as early as possible. Delay in open reduction internal fixation with delayed soft tissue dissection leads to increased chances of elbow stiffness due to periarticular fibrosis. For a successful internal fixation of the closed distal humeral fracture, it is necessary to maintain anatomic and stable reconstruction of the articular surface and of both humeral columns using two 90-90° plates. Operative treatment with rigid anatomical internal fixation should be the line of treatment for all grades of extra and Intercondylar fractures, more so in young adults, as it gives the best chance to achieve good elbow function.

Clinical Study of Surgical Management of Olecranon Fracture.

Road Traffic Accidents, falls while walking and running, and Sports are the major causes of the Olecranon fracture. Early intervention is of utmost importance for the mobility of the elbow joint for early recovery of the patients so they can report to their job as soon as possible. The present study aimed to compare the clinical application of cast and surgical intervention. It is a prospective study carried out in Bapuji Hospital and Chigateri General Hospital attached to J. J. M Medical College, Davangere, with the technical assistance of ESIC hospital. Ten cases of fractures of the olecranon treated by Kirschner wire with tension band wiring technique for Transverse and Oblique fractures and Olecranon hook plate for Comminuted fractures. The early elbow mobility is observed in surgical intervention group when compared to cast application as yielded better results. Ten cases of fractures of the olecranon treated by Kirschner wire with tension band wiring technique for Transverse and Oblique fractures and Olecranon hook plate for Comminuted fractures at the Chigateri General Hospital and Bapuji Hospital, attached to J. J. M. Medical College, Davangere, have been presented. Special attention was made to mobilize the affected elbow early. Surgical fixation for Olecranon fractures will helps in early mobility of joints and anatomical fixation of the fractures.

Isokinetic Muscle Strength and Knee Function in Anatomical Anterior Cruciate Ligament Reconstruction With Hamstring Autografts: A Prospective Randomized Comparative Study Between Suspensory and Expandable Femoral Fixation in Male Patients.

Background Clinical performance, anterior knee stability, and isokinetic strength after anterior cruciate ligament (ACL) reconstruction with hamstring autografts are mainly influenced by graft selection, femoral tunnel preparation, and type of femoral fixation.Expandable femoral fixation devices are expected to provide a stronger initial fixation with circular graft compression, a blind-ended tunnel in the femur with less enlargement, and a theoretical double-band ACL equivalent through graft rotation. This study aimed to evaluate isokinetic strength and functional capacity after ACL reconstruction with hamstring tendons using two different anatomical femoral fixation techniques (expandable vs fixed-looped button). Methodology A total of 48 male patients with ACL deficient knees were randomized to two different femoral fixation groups, namely, the expandable (AperFix) and the standard cortical (Button) group. The primary outcome measures were isokinetic hamstrings and quadriceps strength capabilities and the hamstrings/quadriceps ratio at 60 degrees/second (°/s) and 180°/s using a Cybex before and at three, six, nine, 12, and 24 months after surgery. Secondary measurements were anteroposterior knee stability at two years (using KT-1000 arthrometer) and the functional outcome using the International Knee Documentation Committee (IKDC 2000) form, the Tegner activity scale, and the Lysholm knee score. Data were compared using a paired t-test and analysis of variance, with a p < 0.05 level of significance. Results Most patients regained the 60°/s quadriceps strength between three and 12 months (62.5% for the Button group vs. 50% for the AperFix group), as well as the 180°/s strength (79.17% vs 70.83%); however, at the 24-month evaluation, seven (29.17%) patients in the Button group and five (20.83%) in the AperFix group had significant deficits. The 60°/s flexor strength was regained in the first six months in 19 (79.17%)patients in the Button group and in 16 (66.7%)patients in the AperFix group, whereas the percentages for the 180°/s strength were 79.17% and 75%, respectively. Beyond the 24-month evaluation, only three (12.5%) patients in the Button group and four (16.67%) in the AperFix group had significant flexor deficits. Regarding the H/Q ratio, at 60°/s, the mean recovery time was six and 7.5 months for the Button and AperFix groups, respectively, whereas 15 and 12 patients, respectively, did not recover during the two-year duration. At 180°/s, a mean recovery time of six months was needed for the button group, and nine patients did not recover two years later. For the AperFix group, nine months were needed, and 12 patients did not recover in two years. Clinical performance and anterior knee stability showed no statistically significant differences between groups. Conclusions Although there were no significant differences in clinical performance, knee stability, and isokinetic strength testing between expandable and cortical button femoral fixation groups, return to play was doubtful at two years postoperatively.

Validation of a novel large animal intra-articular tibial plafond fracture model

BackgroundLarge animal fracture models that allow for anatomic fracture fixation are currently lacking. It was hypothesized that a compressed air impaction system can generate a reproducible tibial plafond fracture and be adjustable to create fractures consistent with high and low energy fractures seen in humans. MethodsPilot testing of the impaction system was done by impacting polyurethane foam blocks at varying compressed air pressures. A guillotine impaction test was performed on the same foam blocks to create an energy conversion. A total of 12 porcine hindlimb hindlimbs were subjected to low-energy (42.2 J) and high-energy (73.9 J) impact to create tibial plafond fractures. FindingsGuillotine impaction test demonstrated strong correlations between potential energy and foam block impaction depth (R2 = 0.99). Compressed air impaction system test strongly correlated with foam block impaction depth (R2 = 0.99). All six porcine hindlimbs in the low-energy group developed simple coronal split tibial plafond fractures. All six porcine hindlimbs in the high-energy group developed complex, multi-fragmentary tibial plafond fractures. InterpretationThis porcine fracture model created tibial plafond fracture patterns with similar fracture morphology as human patients without violation of the soft tissue structures or adjacent joints. This model would allow for anatomic fixation, the study of post-traumatic osteoarthritis, or the delivery of locally targeted therapeutics to the ankle joint.

Comparing the Efficacy of Anatomical Locked Plate Fixation with Coracoclavicular Ligament Augmentation to Hook Plate Fixation in Treating Distal Clavicle Fractures.

Hook plate fixation is the traditional method for treating distal clavicle fractures. However, in recent years, locked plate applications have emerged as a promising treatment method. This study aimed to compare the short- and mid-term clinical efficacy of anatomical locked plate fixation with coracoclavicular ligament augmentation using anchor nails to that of hook plate fixation in treating distal clavicle fractures. This was a retrospective single-center cohort study investigating patients with distal clavicle fractures treated between January 2016 and February 2019 in Zhongnan Hospital of Wuhan University. Fifty-nine eligible patients who underwent either anatomical locked plate fixation with coracoclavicular ligament augmentation using anchor nails (LPF&CLA group; 20 patients) or clavicle hook plate fixation (CHPF group; 39 patients) were included. The visual analog scale (VAS) and Constant-Murley shoulder scores were used to assess shoulder function. In addition, the coracoclavicular distance between the affected and unaffected shoulders (ΔCC distance) was measured to assess the reduction. Patients were followed up at 3 months, 6 months, and 1 year postoperatively. The comparisons between the two groups were made using Student's t-test, chi-square test, or Fisher's exact test, if appropriate. Preoperative VAS scores were similar in both groups. At 3- and 6-month follow-up, the VAS score was significantly higher in the CHPF group than in the LPF&CLA group. In contrast, the Constant-Murley shoulder score was significantly lower in the CHPF group than in the LPF&CLA group. When the hook plates were removed, there was no statistical difference in both VAS (0.2 ± 0.4 in LPF&CLA group vs. 0.5 ± 0.5 in CHPF group, p= 0.05) and Constant-Murley shoulder (96.1 ± 3.1 in LPF&CLA group vs. 93.8 ± 5.2 in CHPF group, p= 0.08) scores at the last follow-up. Postoperatively, the ΔCC distance was 2.37 ± 1.93 mm in the LPF&CLA group and -1.56 ± 1.34 mm in the CHPF group. One year after surgery, ΔCC distance increased to 3.96 ± 1.17 mm in the LPF&CLA group and to -0.89 ± 1.39 mm in the CHPF group. For distal clavicle fractures in which the coracoclavicular ligament is disrupted, anatomical locked plate fixation with coracoclavicular ligament augmentation achieved better functional recovery and less pain than hook plate fixation at the 6-month follow-up. However, the hook plate provided better reduction throughout the follow-up period and shoulder pain could be relieved using removal surgery. Therefore, locked plates with coracoclavicular ligament augmentation favors post-surgery pain relief while harvesting similar functional outcomes to hook plate fixation.

OC-007 RELIABLE AND COST-EFFECTIVE METHOD OF GROIN HERNIA SURGERY, BASED ON OPEN PRE-PERITONEAL APPROACH AND ORIGINAL MESH FIXATION

Abstract Aim To analyze the results of original technique for groin hernia (GH) repair, via open preperitoneal approach (OPPA) had proposed by L.M.Nyhus. Material &amp; Methods There were 161 patients 22–87 years old; in 25 cases GH were recurrent. After OPPA, the spermatic cord, inguinal ligament, interior inguinal ring and abdominal wall defect were always in full vision. GH sack was removed into abdominal cavity. The mesh, having spermatic cord got through a special orifice in it, was fixed to inguinal ligament along it full length, and to rectus abdominis muscle’ lateral edge. Inguinal abdominal wall defect was covered from within by mesh under visual and palpable control. Results Operation time takes 42.5±9.1 minutes for simple GH, and 103.5±21.4 minutes for irreducible inguinal-scrotal hernia. General burden of surgery was correspondent to minimal invasive. Follow-up to work became from 3–5th day. For 12 months 107 (60.9%) patients were followed, no hernia recurrence was found. Conclusions Our method has basic prevalence over: i) possibility of one-day surgery (longer hospitalization if comorbidities); ii) cost-saving because needn't in laparoscopic equipment; iii) simplicity and high reliability because of visual anatomic controlled mesh fixation and positioning for the total closing of groin gap. It may pretend for a proper approval at EHS guidelines. The learning curve and additional points, such as type and quantity of fixation points, best of mesh to be used, should be discussed after the further evaluation.

Clinical Outcomes of Fifth Metatarsal Fractures using Jones Fracture-Specific Screw vs Intramedullary Fixation

Category: Midfoot/Forefoot Introduction/Purpose: Fractures of the proximal fifth metatarsal (Jones fractures) are common foot injuries in both athlete and nonathlete populations, given repetitive loading of the lateral column during gait. Intramedullary screw fixation is the current most common surgical management for Jones fractures, but high rates of nonunion and refracture as well as hardware prominence are reported with existing implant options for this fracture pattern. The Jones bolt is a novel surgical treatment for Jones fractures which aims for more anatomic fixation of this injury. The purpose of this study was to compare the Jones bolt to intramedullary screw fixation with regard to complication rates and patient reported outcomes. Methods: A retrospective single-surgeon case series was approved by our institutional review board. A sample of both athletes as well as nonathletes with proximal fifth metatarsal fractures treated with either intramedullary screw fixation or the Jones bolt was collected. Demographic data, patient reported outcomes, and complication rates were analyzed. Results: Patients reported significant improvements in both visual analog scale (VAS) and the American Orthopaedic Foot &amp; Ankle Society (AOFAS) scores following operative fixation of Jones fractures (Table 1). The average VAS score improved from 5.4+-2.6 preoperatively to 1.4+-1.7 postoperatively (p&lt;0.0001). The average AOFAS score improved from 59.0+-13.2 preoperatively to 186.0+-11.2 postoperatively (p&lt;0.0001). There was no difference in final postoperative VAS (1.4 vs. 1.4; p=0.9702) or AOFAS (87.7 vs 85.7; p=0.4262) or overall change of VAS (3.8 vs. 3.5; p=0.8219) or AOFAS (20.5 vs. 25.0; p=0.6613) for Jones bolt versus all other types of fixation. Conclusion: The Jones bolt is a novel treatment for proximal fifth metatarsal fractures, with noninferior outcome scores and complication rates when compared with intramedullary screw fixation. Long-term follow-up and larger sample sizes are indicated to assess for superiority of the Jones bolt.

Surgical Classification for Preclinical Rat Femoral Bone Defect Model: Standardization Based on Systematic Review, Anatomical Analysis and Virtual Surgery.

Though surgical techniques profoundly influence in vivo experiments, significant heterogeneity exists in current surgeries for inducing rat femoral bone defects. Such variations reduce the reproducibility and comparability of preclinical studies, and are detrimental to clinical translation. The purposes of this study were: (1) to conduct a systematic review of rat femoral defect models, summarizing and analyzing the surgical techniques; (2) to analyze surgical design and potential pitfalls via 3D anatomy and virtual surgeries for fostering future precision research; and (3) to establish a surgical classification system, for improving the reproducibility and comparability among studies, avoiding unnecessary repetitive experiments. The online database PubMed was searched to identify studies from January 2000 to June 2022 using keywords, including rat, femur, bone defect. Eligible publications were included for a review of surgical methods. Anatomical analysis and virtual surgeries were conducted based on micro-CT reconstruction of the rat femur for further investigation and establishment of a classification system. A total of 545 publications were included, revealing marked heterogeneity in surgical methods. Four major surgical designs were reported for inducing defects from the proximal to distal femur: bone tunnel, cortical window, segmental defect, and wedge-shaped defect. Anatomical analysis revealed potential pitfalls hindering efficient clinical translation. A classification system was established according to the anatomical region, surgical design, and fixation devices. This systematic review in combination with 3D analysis and virtual surgery provides a general overview of current surgical approaches to inducing femoral defects in rats, and establishes a surgical classification facilitating preclinical research of quality and translational value.

Characteristics of femoral neck fractures in young and middle-aged adults based on fracture mapping technology

To analyze the characteristics of femoral neck fractures in young and middle-aged adults by means of medical image analysis and fracture mapping technology to provide reference for fracture treatment. A clinical data of 159 young and middle-aged patients with femoral neck fractures who were admitted between December 2018 and July 2019 was analyzed. Among them, 99 patients were male and 60 were female. The age ranged from 18 to 60 years, with an average age of 47.9 years. There were 77 cases of left femoral neck fractures and 82 cases of right sides. Based on preoperative X-ray film and CT, the fracture morphology was observed and classified according to the Garden classification standard and Pauwels' angle, respectively. Mimics19.0 software was used to reconstruct the three-dimensional models of femoral neck fracture, measure the angle between the fracture plane and the sagittal plane of the human body, and observe whether there was any defect at the fracture end and its position on the fracture surface. Through reconstruction, virtual reduction, and image overlay, the fracture map was established to observe the fracture line and distribution. According to Garden classification standard, there were 6 cases of type Ⅰ, 61 cases of type Ⅱ, 54 cases of type Ⅲ, and 38 cases of type Ⅳ. According to the Pauwels' angle, there were 12 cases of abduction type, 78 cases of intermediate type, and 69 cases of adduction type. The angle between fracture plane and sagittal plane of the human body ranged from -39° to +30°. Most of them were Garden type Ⅱ, Ⅳ and Pauwels intermediate type. The fracture blocks were mainly in the form of a triangle with a long base and mainly distributed below the femoral head and neck junction area. Twenty-six cases (16.35%) were complicated with bone defects, which were mostly found in Garden type Ⅲ, Ⅳ, and Pauwels intermediate type, located at the back of femoral neck and mostly involved 2-4 quadrants. The fracture map showed that the fracture line of the femoral neck was distributed annularly along the femoral head and neck junction. The fracture line was dense above the femoral neck and scattered below, involving the femoral calcar. The proportion of displaced fractures (Garden type Ⅲ, Ⅳ) and unstable fractures (Pauwels intermediate type, adduction type) is high in femoral neck fractures in young and middle-aged adults, and comminuted fractures and bone defects further increase the difficulty of treatment. In clinical practice, it is necessary to choose treatment plan according to fracture characteristics. Anatomic reduction and effective fixation are the primary principles for the treatment of femoral neck fracture in young and middle-aged adults.

Are screws enough? functional outcome in surgically treated posterior acetabular wall fracture using cannulated cancellous screws

Background: Posterior wall fractures of acetabulum are the commonest type of acetabular fractures 1,2. These fractures are usually associated with posterior dislocation of hip. Anatomical reduction and fixation are important to restore congruity and stability of joint, to decrease the risk of secondary arthritis and thus attain good functional outcome 3. Fixation modalities comprise of both recon plates in buttress mode, lag screw fixation or combination of both.In our study, we aimed to assess the functional outcome and complications following the use of only cannulated screws as fixation mo Material and methods: A total of 11 patients with a diagnosis of posterior acetabular wall fracture were treated with surgical fixation of posterior acetabular wall using only cannulated cancellous screws. The patients were followed up strictly for 6 weeks, 3 months, 6 months, as well as 1 year and thereafter at yearly intervals as long as possible. Functional and radiological assessment were done using Merle D’Aubigne and Postel grading system and Matta’s radiological criteria. Result:In our study, we noticed excellent outcome in 100% of the patients who had posterior wall fractures without hip dislocation.

Acute Correction of Multiplanar Proximal Tibial Deformity Utilizing Fixator-Assisted Intramedullary Nailing.

The patient is positioned supine on a radiolucent table. The locations of the proximal tibial osteotomy, fibular osteotomy, external fixator pin sites, and intramedullary nail insertion site are marked with use of a surgical marker and fluoroscopic imaging. Large external fixator half-pins are placed proximal and distal to the planned tibial osteotomy in both the anterior-posterior and sagittal planes, avoiding the path of the planned tibial intramedullary nail. A fibular osteotomy and then a low-energy tibial osteotomy are performed with use of multiple drill holes and an osteotome. Next, the bone deformity is fully corrected and held in the corrected alignment with the external fixators. Then, the opening drill for the intramedullary nail is introduced into the proximal aspect of the tibia over a guidewire, and blocking screws are placed in the coronal and sagittal planes of the proximal fragment next to the opening reamer. The intramedullary canal is then reamed over a ball-tipped guidewire to the desired diameter and the selected intramedullary nail is placed and secured with proximal and distal interlocking screws. Finally, the external fixators are removed. Alternative operative treatments include external fixation and gradual or acute deformity correction as well as fixator-assisted acute deformity correction and plate fixation13-16. Typically, a tibial osteotomy with gradual deformity correction with use of a circular fixator is employed for the treatment of these deformities3,17. The literature shows this to be an effective technique for accurate correction of these complex proximal tibial deformities. With the advent of internal motorized lengthening nails, however, there have been increasing efforts to develop safe and accurate techniques for acutely correcting bone deformity so that these nails can be utilized to treat both angular deformities and bone-length differences simultaneously. Deformity at the proximal aspect of the tibia is often multiplanar, and complete correction of these deformities requires translation, angulation, and rotation through the osteotomy. An osteotomy performed at the proximal aspect of the tibia results in the equivalent of a proximal-third tibial fracture, which is more challenging and more demanding to fix than a diaphyseal tibial fracture because of the wide medullary canal and the strong deforming muscular forces at the proximal tibia. Fixator-assisted intramedullary nailing with blocking screws allows for the accurate correction of the mechanical and anatomic axes while avoiding external fixation. The expected outcome is complete bone deformity correction and healing of the osteotomy site(s)2. Careful preoperative planning is essential to accurately correct the anatomic and mechanical axes in all planes.In cases of acute correction of severe bone deformities, consider prophylactic nerve decompression.When possible, avoid the use of a tourniquet in order to minimize tissue trauma, postoperative swelling, and the need for prophylactic fasciotomies.Obtain and hold perfect osseous alignment with use of temporary uniplanar external fixators prior to placing any definitive hardware. AP = anteroposteriorIM = intramedullaryPACS = picture archiving and communication systemK-wire = Kirschner wireCORA = center of rotation and angulationDVT = deep venous thrombosisPE = pulmonary embolism.

Early Return to Daily Life through Immediate Weight-Bearing after Lateral Malleolar Fracture Surgery.

Lateral malleolus fracture is one of the most common fractures. However, there is controversy regarding the rehabilitation protocols used after surgery. In particular, the initiation point for weight-bearing has not been standardized. In the present study, we investigated the prognostic difference between immediate and delayed weight-bearing on lateral malleolus fractures. The medical records of matched patients in the immediate and delayed weight-bearing groups (50 and 50, respectively) were reviewed retrospectively. All patients were treated with open reduction and internal fixation using an anatomical locking compression plate with a lag screw. In the immediate weight-bearing group (IWB), tolerable weight-bearing (i.e., what can be endured immediately after surgery with crutches) was permitted. In the delayed weight-bearing group (DWB), weight-bearing was completely restricted for 4 weeks after surgery. Ankle motion exercise was permitted in both groups, starting from the day after surgery. Radiographic assessment data and clinical outcomes were reviewed between the two groups. No significant differences in radiographic assessments and complications were found between the two groups. Significant differences in terms of a shortened length of hospital stay and time to return to work with the IWB rehabilitation protocol compared with DWB were confirmed (6.0 vs. 9.2 days, p = 0.02 and 6.1 vs. 8.3 weeks, p = 0.02, respectively). A significant difference in sport factor was observed in the Foot and Ankle Outcome Score at 3 months postoperatively (72.3 vs. 67.4, p = 0.02). We found no significant differences between the two groups concerning postoperative radiological outcomes and complications. The benefits of shortening the time to return to work and length of hospital stay associated with the IWB rehabilitation protocol were confirmed. In conclusion, immediate weight-bearing is recommended in patients with lateral malleolus fracture after anatomical reduction and firm fixation by surgery.

Open knee dislocation, triple intra-articular fractures and patellar tendon rupture: case report of a knee disaster treated with aggressive irrigation/debridement, early anatomic reduction and internal fixation

BackgroundOpen knee fracture-dislocation is a rare orthopedic injury. However, the importance of its correct management could not be overstated. To the best of our knowledge, this is the fifth study reporting a case with simultaneous Hoffa fracture and knee dislocation and the 1st study describing a patient with open plateau fracture-dislocation accompanied with Hoffa fracture, patella fracture, and patellar tendon tear. In addition, this report is noticeable as our case had no gross ligament injury unlike frequent association of knee dislocation with knee collateral ligament damage.Case presentationIn this study, we describe a 34-year-old motorcyclist referred to our center following a motor car accident. Further work-up revealed an open irreducible posterolateral knee dislocation, type 5 Hohl and Moore plateau fracture, lateral femoral condyle Hoffa’s fracture, patellar fracture, and patellar tendon tear of his right knee. During an open reduction, it turned out that an entrapped lateral meniscus prevented the joint to be reduced by closed means. After applying a temporary external fixator, the patient was finally managed with open reduction and internal fixation.ConclusionIrreducible knee dislocation needs further work up to rule out any interposed soft tissue into the joint. Aggressive irrigation/ debridement, early anatomic reduction, and internal fixation may help reduce open fracture complications including infection, non-union, and stiffness.

Specific Radiologic Risk Factors for Implant Failure and Osteonecrosis of the Humeral Head after Interlocking Nailing with the Targon PH+ of Proximal Humeral Fractures in a Middle to Old Population.

Background: Operative management of proximal humeral fractures is still challenging. While antegrade nailing has become a valid option in fracture fixation, risk factors for adverse events, and failure have not been sufficiently clarified. Methods: All patients of a single trauma center undergoing surgery for proximal humeral fractures with the Targon PH+ nail between 2014 and 2021 were evaluated retrospectively. This included complications, revisions, and failures. Pre- and postoperative radiographic imaging were assessed regarding fracture’s complexity, anatomic reduction, reconstruction of the medial hinge, metaphyseal head extension, and fixation of the implant in the calcar region. Follow-up was at a minimum of 12 months. Results: A total number of 130 patients with a mean age of 74.5 years (range 63–94, SD ± 8.2) are included in this study. Two- and three-part fractures were found in 58 patients, while 14 patients showed four-part fractures. Overall, a complication rate of 34.2% and an implant failure rate of 15.4% was found. Four-part fractures showed a significantly higher complication rate than two- and three-part fractures. Four-part fractures also showed significantly higher revisions (p = 0.005) and implant failures (p = 0.008). The nonsufficient anatomical reduction was found to be a risk factor for complications (p < 0.0001), implant failures (p < 0.0001), and later humeral head osteonecrosis (p < 0.0001). Insufficiently reconstructed medial hinges (p = 0.002) and a metaphyseal head extension of over 8 mm (p = 0.005) were also demonstrated as risk factors for osteonecrosis of the humeral head. Conclusions: Four-part fractures in an elderly population show high complication, revision, and implant-failure rates. Therefore, demonstrated radiologic risk factors should be evaluated for improvements. Anatomical reduction and fixation near the calcar proved to be vital for successful antegrade nailing of complex fractures. To prevent osteonecrosis of the humeral head, reconstruction of the medial hinge and metaphyseal head extension should be evaluated.

Acromion-axillary nerve distance and its relation to the arm length in the prediction of the axillary nerve position: a clinical study

BackgroundBecause of the broad anatomic variation in the course of the axillary nerve, several cadaveric studies have investigated the acromion-axillary nerve distance and its association with the humeral length to predict the axillary nerve location. This study aimed to analyze the acromion-axillary nerve distance (AAND) and its relation to the arm length (AL) in patients who underwent internal plate fixation for proximal humerus fractures.MethodsThe present prospective study involved 37 patients (15 female, 22 male; the mean age = 51 years, age range 19–76) with displaced proximal humerus fractures treated by open reduction and internal fixation. After anatomic reduction and fixation were achieved, the following parameters were measured in each patient before wound closure without making an extra incision or dissection: (1) the distance from the anterolateral edge of the acromion to the course of the axillary nerve was recorded as the acromion-axillary nerve distance and (2) the distance from the anterolateral edge of the acromion to the lateral epicondyle of the humerus was recorded as arm length. The ratio of AAND to AL was then calculated and recorded as the axillary nerve index (ANI).ResultsThe mean AAND was 6 ± 0.36 cm (range 5.5–6.6), and the mean arm length was 32.91 ± 2.9 cm (range 24–38). The mean axillary nerve ratio was 0.18 ± 0.02 (range 0.16 to 0.23). There was a significant moderate positive correlation between AL and AAND (p = 0.006; r = 0.447). The axillary nerve location was predictable in only 18% of the patients.ConclusionDuring the anterolateral deltoid-splitting approach to the shoulder joint, 5.5 cm from the anterolateral edge of the acromion could be considered a safe zone to prevent possible axillary nerve injury.

Comparaison clinique et radiologique des vis d’interférence biorésorbables en verre bioactif versus en acide poly-L-lactique/hydroxyapatite pour la fixation de greffe tibiale dans la reconstruction du ligament croisé antérieur

BackgroundLigament reconstruction is still the main treatment modality for patients with a complete ligament rupture. The semitendinosus tendon, alone quadrupled or double folded and combined with the gracilis tendon is still the most frequently used autologous graft for a reconstructive procedure. Absorbable interference screw usage has gained popularity in the past decade because they create less artifacts during MR imaging and tend to osteointegrate over the years, arguably leading to a more anatomic fixation. The purpose of this study was to compare the 5-year radiological and clinical results of two different tibial graft fixation screws. HypothesisWe hypothesized that bioabsorbable interference screws made of bioactive glass would lead to higher rates of osteointegration, better overall clinical results, less foreign body reaction rates and less tibial tunnel widening when compared to the poly-L-lactic acid/hydroxyapatite (PLLA-HA) screws. Patients and methodsFifty-one patients treated with an anatomic single bundle ACL reconstruction between June 2015 and July 2016 at our institution were included in the study. The tibial graft was fixed with a bioactive glass screw in 24, and with a PLLA-HA in 27 patients. Tibial tunnel widening, foreign body reaction, osteointegration and resorption rates were evaluated and compared on a magnetic resonance scan at a minimum of 5 year postoperatively. Overall clinical results and side-to-side difference on KT-1000 were also analyzed in-between groups. ResultsTibial tunnel widening was similar for both groups. Foreign body reaction, while not statistically significant, was less aggressive when bioactive glass screws were used. Osteointegration and resorption rates of the bioactive glass screws were significantly higher than the PLLA-HA group (p=0.000). While all patients showed an overall improvement on postoperative scores (p=0.000), patients with a bioactive glass interference screw had statistically higher translational stability with KT-1000, compared to the poly-L-lactic acid/hydroxyapatite group (p=0.001). DiscussionAt a minimum of 5years, compared to conventional PLLA-HA interference screws, 45S5 bioactive glass screw provide higher resorption rates, are more highly biodegradable and provide overall good clinical results. Level of evidenceIII.

A novel anatomical self-locking plate fixation for both-column acetabular fractures

PurposeTo compare the stability of the posterior anatomic self-locking plate (PASP) with two types of popular reconstruction plate fixation, i.e. double reconstruction plate (DRP) and cross reconstruction plate (CRP), and to explore the influence of sitting and turning right/left on implants. MethodsPASP, DRP and CRP were assembled on a finite element model of both-column fractures of the left acetabulum. A load of 600 N and a torque of 8 N·m were loaded on the S1 vertebral body to detect the change of stress and displacement when sitting and turning right/left. ResultsThe peak stress and displacement of the three kinds of fixation methods under all loading conditions were CRP > DRP > PASP. The peak stress and displacement of PASP are 313.5 MPa and 1.15 mm respectively when turning right; and the minimal was 234.0 Mpa and 0.619 mm when turning left. ConclusionPASP can provide higher stability than DRP and CRP for both-column acetabular fractures. The rational movement after posterior DRP and PASP fixation for acetabular fracture is to turn to the ipsilateral side, which can avoid implant failure.