Clinical Union Rate Research Articles

Clinical experience and outcomes using a commercially available micro-plating system for metabone fractures in dogs and cats: 10 cases (2019-2023).

To report the clinical experience and long-term outcome following metabone fracture stabilisation using a commercially available micro-plating system (VetKISS, 1.0-mm, IMEX Veterinary, USA). Consecutive, client-owned cats and dogs weighing <7 kg, with traumatic metabone fractures stabilised using VetKISS micro-plates were prospectively enrolled with informed owner consent. Clinical and radiographic parameters were recorded. Either short-term or long-term clinical and radiographic follow-up was required for study inclusion. Four cats and six dogs were enrolled and operated by one of two board-certified surgeons. Bodyweight ranged from 1.9 to 6.6 kg. Number of metabones fractured: all four (60%), three (30%) and two (10%). Anatomical alignment was restored for each metabone. External coaptation was not used in any case. Radiographic follow-up documented clinical or bony union in all cases. Mean time to clinical union was 51 days. One major complication (screw removal) and two minor complications (partial construct failure) were observed. All patients made a complete functional recovery at the time of documented union. Long-term follow-up was available in five cases. No lameness (evaluated independently by both surgeons) or plate sensitivity was noted. This is the first clinical evaluation of the VetKISS for metabone fracture repair, and includes long-term follow-up. Results demonstrated complete functional recovery and 100% clinical union rates in all patients, with acceptable complication rates. This system can be considered for metabone repair in patients weighing <7 kg without the use of external coaptation.

Outcomes of Tibiotalocalcaneal Arthrodesis with a Femoral Nail.

Retrograde intramedullary nailing for tibiotalocalcaneal arthrodesis (TTCA) is used for severe hindfoot deformities, end-stage arthritis, and limb salvage. The procedure is technically demanding, with complications such as infection, hardware failure, nonunion, osteomyelitis, and possible limb loss or death. This study reports the outcomes and complications of patients undergoing TTCA with a femoral nail, which is widely available and offers an extensive range of lengths and diameters. We performed a retrospective review of 104 patients who underwent 109 TTCAs using a femoral nail as the primary procedure (January 2006 through December 2016). Demographic data, risk factors, and outcomes were evaluated. At final follow-up, the overall clinical union rate was 89 of 109 (81.7%). Diabetes mellitus was negatively associated with limb salvage (P = .03), and peripheral neuropathy (P = .02) and Charcot's neuroarthropathy (P = .03) were negatively associated with clinical union. Only four patients (3.8%) underwent proximal amputation, at an average of 6.1 months, and 11 patients (10.6%) died, at a mean of 38.0 months. The most common complication was ulceration in 27 of 109 limbs (24.8%), followed by infection in 25 (22.9%). Twenty-three patients (22.1%) underwent revision procedures, at a mean of 9.4 months. Thirteen of these 23 patients (56.5%) had antibiotic cement rod spacers/rods for deep infection-related complications. Use of a femoral nail has been shown to provide similar outcomes and limb salvage rates compared with other methods of TTCA reported for similar indications in the literature.

Unlocked Nailing vs. Interlocking Nailing for Winquist Type I and II Femoral Isthmus Fractures. Is there a Difference?

Interlocking intramedullary nailing is suitable for comminuted femoral isthmus fractures, but for noncomminuted fractures its benefit over unlocked nailing is debatable. This study was undertaken to compare outcomes of interlocking nailing versus unlocked intramedullary nailing in such fractures. Ninety-three cases of noncomminuted femoral isthmus fractures (Winquist I and II) treated with interlocking nailing and unlocked nailing from 1 June 2004 to 1 June 2005 were reviewed; radiological and clinical union rates, bony alignment, complication and knee function were investigated. There was no statistical significant difference with regard to union rate, implant failure, infection and fracture alignment in both study groups. Open fixation with unlocked femoral nailing is technically less demanding and requires less operating time; additionally, there is no exposure to radiation and cost of the implant is cheaper. We therefore conclude that unlocked nailing is still useful for the management of non-comminuted isthmus fractures of the femur.

Modern Cervical Spine Instrumentation in Children

A retrospective case series. To determine the safety, efficacy, and feasibility of using modern segmental cervical spine instrumentation in children. With the exception of transarticular screws, there are currently no series in the literature looking at the use of modern cervical spine implants in children. In the adult population, these implants have been shown to be biomechanically superior to traditional wiring methods. These constructs may also decrease the need for postoperative halo immobilization, while at the same time improving arthrodesis rates. A retrospective review of 25 pediatric patients greater than 6 years of age treated at our institution with modern segmental instrumentation of the cervical spine. Computed tomography scans were evaluated to determine containment of screws. Radiographic and chart review was done to determine the clinical outcome with respect to fusion and any complications related to surgery. There were no implant related complications in this series. All screws (n = 112) evaluated by computed tomography scan were fully contained. All patients obtained union and there were no reoperations related to the spinal implants. Complications included: 1 deep infection, 1 superficial infection, and 1 transient radiculopathy. Modern cervical spine instrumentation is safe and feasible to use in children older than 6 years of age. The clinical union rate in our series was 100% with no implant related complications.

Antegrade Versus Retrograde Locked Intramedullary Nailing for Femoral Fractures: Which Is Better?

Locked intramedullary nailing or interlocking nailing (ILN) is a proven mode of treatment for femoral shaft fractures. It can be inserted via the antegrade or retrograde approach. Retrograde approach is technically less demanding especially if the patient is overweight. But there are concerns with regard to the violation of the knee and its effect on subsequent knee function. We studied consecutive cases of femoral shaft fractures treated with locked intramedullary nailing at the Penang General Hospital, from 1st June 2004 to 1st June 2005. We looked at radiological and clinical union rates, union of fractures, alignment of the operated limb, and the knee function, using the Thoresen scoring system. There were a total of 77 cases of femoral interlocking nails during the study period. Forty-two cases were antegrade nails and 35 cases were retrograde nails. Both groups of patients eventually achieved union of the fracture and retrograde nailing group showed significantly earlier union rate (p = 0.032). There is no significant difference between both groups, in regards to knee pain, swelling, and range of motion as well as postnailing femoral alignment. Both methods of nailing achieved excellent union rates with good alignment of the limb. Contrary to popular belief, we found that retrograde nailing does not give rise to a higher rate of knee complications. Therefore, we strongly recommend this approach of nailing as it is technically less demanding.

Early weightbearing after first metatarsophalangeal joint arthrodesis: a retrospective observational case analysis

A retrospective observational study was performed to determine if early ambulation compromised healing in patients who underwent primary first metatarsophalangeal joint arthrodesis. The records of 42 patients undergoing 47 fusions were evaluated to determine time to radiographic union, time to clinical union, and return to regular shoes. Results showed that patients achieved clinical healing at an average of 5.6 weeks, and showed distinct signs of radiographic union at an average 6.1 weeks. The mean time for return to athletic shoes was 6.23 weeks. The patient population reviewed had a 100% radiographic and clinical union rate. These results reinforce the idea that early ambulation is a viable option in patients undergoing primary first metatarsophalangeal joint arthrodesis.