Articular Compression Research Articles

Articular compression molding techniques for acetabular posterior wall fracture

Objective To evaluate the efficacy of articular compression molding techniques in the surgery for acetabular posterior wall fracture. Methods A retrospective study was conducted of the 28 patients (28 hips) with fracture of acetabular posterior wall plus comminuted compression of articular surface who had been treated using the articular compression molding techniques at Department of Orthopedics, The Hospital of 81 Group Army of PLA from January 2014 to January 2018. They were 25 males and 3 females, aged from 26 to 63 years (average, 49.3 years). The time from injury to surgery ranged from 4 to 12 days (average, 7.8 days). According to the Letournel-Judet classification, all were single element (simple) posterior wall fractures combined with posterior dislocation of the femoral head and articular compression of different degrees; transient sciatic nerve injury was complicated in 12 cases. The posterior hip dislocations were timely and successful reset at emergency treatment. The compression fractures of the posterior wall and hip joint were treated by open reduction and internal fixation via the acetabular posterior (K-L) approach. The articular compression was treated by 4 stabilization techniques: absorbable screwing and blocking technique in 10 cases, indwelling screwing in 12 cases, indwelling Kirschner wiring in 2 cases and die push and squeeze tamping in 4 cases. The operation time, intraoperative bleeding and complications were recorded. The therapeutic efficacy was evaluated by the modified Merle d’Aubigne & Postel scoring criteria at the final follow-up. Results The operation time lasted from 76 to 118 minutes (average, 94.2 minutes); the intraoperative bleeding ranged from 100 to 320 mL (average,220.8 mL). No incision liquefaction, infection or other complications occurred. The 28 patients were followed up for 10 to 36 months (average, 17.6 months). According to the Matta scoring criteria, 24 cases achieved anatomical reduction but 4 dissatisfactory reduction. By the modified Merle d’Aubigne & Postel scoring criteria at the final follow-up, the efficacy was evaluated as excellent in 26 cases and as good in 2. Heterotopic ossification was observed in 3 cases and microscopic free dense shadow in the joint cavity (about 2 mm in the round ligament) in 3 cases. There were no cases of obvious traumatic arthritis or osteoarthritis, femoral head necrosis, walking pain, lameness or hip abduction weakness. The 12 patients complicated with preoperative transient sciatic nerve injury recovered within 3 months after surgery. Conclusion The articular compression molding techniques can effectively treat severely comminuted articular compression in the acetabular posterior wall fracture and improve reduction of articular surface and hip joint matching, leading to stability and good joint function. Key words: Acetabulum; Hip fractures; Fracture fixation, internal; Articular compression; Reduction molding

Fisioterapia motora na prevenção e tratamento da osteopenia da prematuridade: uma revisão integrativa

Introdução: A cada ano, um em cada 10 bebês, em todo o mundo, nasce prematuro os quais são suscetíveis a osteopenia da prematuridade. A osteopenia da prematuridade é caracterizada por alterações de mineralização esquelética decorrentes do deficiente acréscimo do conteúdo mineral ósseo.Objetivo: Revisar na literatura atual os ensaios clínicos randomizados sobre os efeitos da fisioterapia motora nos recém-nascidos prematuros em relação à prevenção e/ou tratamento da osteopenia da prematuridade, bem como, observar quais as técnicas mais utilizadas nessa assistência.Materiais e Métodos: Trata-se de uma revisão integrativa da literatura, incluindo ensaios clínicos randomizados que utilizaram técnicas de fisioterapia motora como intervenção. Buscou-se nas principais bases de dados (Pubmed, Cochrane Central, Lilacs e PEDro), estudos publicados de 2005 até 2016, utilizando os descritores: “prematuro”, “mineralização óssea”, “fisioterapia”, “osteopenia da prematuridade” e seus equivalentes em inglês.Resultados: Foram incluídos sete estudos e as técnicas utilizadas foram mobilizações passivas nas articulações dos membros superiores e inferiores, com suaves compressões articulares e um protocolo de estimulação tátil-cinestésica, massagem atividade física previne o desequilíbrio entre a formação e absorção da matriz óssea.Conclusão: Embora haja poucos ensaios clínicos randomizados, pode-se observar que a fisioterapia motora utiliza técnicas que são efetivas no ganho de peso, crescimento, massa muscular e na prevenção do desequilíbrio entre a formação e absorção da matriz óssea em prematuros, tendo um papel importante na prevenção e no tratamento da osteopenia da prematuridade.

Are Locking Constructs in Distal Femoral Fractures Always Best? A Prospective Multicenter Randomized Controlled Trial Comparing the Less Invasive Stabilization System With the Minimally Invasive Dynamic Condylar Screw System.

The purpose of this clinical study is to determine whether the rate of fracture healing and fracture union, repaired with a locked device, will be as good as or better than standard nonlocking bicortical fixation in distal femoral fractures. Institutional review board-approved, multicenter prospective randomized controlled trial. Seven level 1 trauma centers across Canada. Fifty-two patients with distal femoral fractures (AO/OTA 33A1 to 33C2) were enrolled in the randomized trial. Twelve AO/OTA 33C3 fractures were excluded from the randomized trial but followed up as a nonrandomized cohort. Patients were treated through a standardized minimally invasive approach. Fractures were randomized 1:1 to treatment with the locked Less Invasive Stabilization System (LISS; Synthes, Paoli, PA) or the dynamic condylar screw (DCS). The nonrandomized cohort was treated at the surgeon's discretion. Primary outcomes were time to radiological union and number of delayed/nonunions at 12 months. Secondary outcomes were postoperative function and complications. Fifty-two patients were randomized including 34 women and 18 men. The mean age was 59 years. Twenty-eight patients were treated with the LISS and 24 with the DCS. There was no statistically significant difference between the LISS and the DCS in terms of the number of fractures healed, time to union, or functional scores. Complications and revisions were more common in the LISS group. There were 7 reoperations in the LISS group and one in the DCS group. Only 52% of the LISS group healed without intervention by 12 months compared with 91% in the DCS group. There was no advantage to the locking plate design in the management of distal femoral fractures in this study. The higher cost of the locking plates, challenges in technique, and lack of superiority have led the authors to discontinue the use of this lateral unicortical locking device in favor of other devices that allow locked or nonlocked bicortical fixation, articular compression, and bridging of the comminuted fracture segments. The cost-effective treatment for a subgroup or periarticular fractures may be a fixed-angle nonlocked device in patients with reasonable bone quality. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Biomechanical comparison of interfragmentary compression in transverse fractures of the olecranon

Compression and absolute stability are important in the management of intra-articular fractures. We compared tension band wiring with plate fixation for the treatment of fractures of the olecranon by measuring compression within the fracture. Identical transverse fractures were created in models of the ulna. Tension band wires were applied to ten fractures and ten were fixed with Acumed plates. Compression was measured using a Tekscan force transducer within the fracture gap. Dynamic testing was carried out by reproducing cyclical contraction of the triceps of 20 N and of the brachialis of 10 N. Both methods were tested on each sample. Paired t-tests compared overall compression and compression at the articular side of the fracture. The mean compression for plating was 819 N (sd 602, 95% confidence interval (CI)) and for tension band wiring was 77 N (sd 19, 95% CI) (p = 0.039). The mean compression on the articular side of the fracture for plating was 343 N (sd 276, 95% CI) and for tension band wiring was 1 N (sd 2, 95% CI) (p = 0.038). During simulated movements, the mean compression was reduced in both groups, with tension band wiring at -14 N (sd 7) and for plating -173 N (sd 32). No increase in compression on the articular side was detected in the tension band wiring group. Pre-contoured plates provide significantly greater compression than tension bands in the treatment of transverse fractures of the olecranon, both over the whole fracture and specifically at the articular side of the fracture. In tension band wiring the overall compression was reduced and articular compression remained negligible during simulated contraction of the triceps, challenging the tension band principle.

The role of CT in the diagnosis and treatment of distal radius fracture

To investigate and discuss the role of CT in the diagnosis and treatment of comminutive distal radius fractures. One hundred and eleven consecutive patients (118 cases of fractures) who were admitted to Jishuitan hospital from January 2003 to January 2005 were included in this study. These patients all need operative treatment and accepted CT scans for better understandings of these injuries and helping to make operation plans. after comparing the results of X planes and CT scans, considerable differences existing between the two examinations were found in the measurements of articular compression and step-off, gapping, comminution degree and subdislocation. This difference was manifested not only in the alteration of quantity but also in the change of quality. Computed tomography can provide more vivid and detailed information of fractures for practitioners. Undoubtedly, CT is especially valuable in the evaluation of severity degree and stability of comminutive distal radius fractures, thus it helps us to determine whether operation is obligatory and choose the best method and approach of operation. Moreover, CT can also clearly show the important parts of fractures which need special attention in the process of operation. At the same time, practitioners are required to understand the indications of CT examination completely and know how to choose scan planes properly.

Radiological assessment of the effects of a full rolling motion shoe during asymmetrical bearing.

The authors used a new radiological method to assess asymmetrical articular compression of the interphalangeal joints. This method was based on the measurements of 3 angles obtained on dorsopalmar radiographs. Variations of these angles were studied during experimental asymmetrical bearing on unshod feet. It was concluded that 2 angles were interesting parameters to assess asymmetrical articular compression and to define the position of the phalanx in the horny box. Furthermore, variations of these angles induced by experimental asymmetrical bearing were compared without shoe, with a standard shoe and with an orthopaedic full rolling motion shoe. It was observed that the effects of the asymmetrical bearing were reduced when feet were shod with a full rolling motion shoe.

Sclerosis of Synovial Blood Vessels

Hyaline sclerosis of synovial capillaries and venules was found at autopsy in fifty-two of seventy-two patients who presented no symptoms or anatomical evidence of joint disease. The lesion was found in small and large joints of both the upper and lower extremities, but occurred most frequently in the acetabular fat pad and the peripatellar region. Although apparently a retrogressive phenomenon, the lesion occurred as early as four years of age. Gamma globulin was not present in the walls of affected vessels. It is suggested that the lesion may arise from circulatory alterations in synovial tissues subjected to articular compression. In five elderly individuals, there was, in addition, arterial occlusion associated with focal, apparently healed, infarcts of the acetabular synovial pad.