Complications Of Fractures Research Articles

Хирургическое лечение аневризмальных костных кист поясничного отдела позвоночника: описание клинического случая

Introduction Pediatric and adolescent patients with aneurysmal bone cyst of the spine are normally treated by orthopaedic, neuro surgeons and oncologists. There is no consensus on the strategy and volume of preoperative and surgical treatment of the condition. There is a higher risk of pathological fracture and secondary neurological complications, tumor recurrence if open surgery is not performed in time. A second surgical intervention can hardly be avoided in such cases. The objective was to report the result of surgical treatment of a patient with aneurysmal bone cyst of the spine. Material and methods Outcome of a patient with an aneurysmal bone cyst of the L3 vertebra is presented. The technique of using therapeutic punctures as a preoperative preparation to be followed by an open surgical treatment is described. Absence of complaints and tumor recurrence, stability of the metal construct and bone fusion were the evaluation criteria. Results The patient was followed for 17 months after open surgery and CT scans showed no recurrence and demonstrated bone fusion at a long term. Discussion Many aspects of the course of the disease are to be considered in the treatment of children and adolescents with aneurysmal bone cyst of the spine. In our opinion, the step in the treatment of aneurysmal bone cyst of the spine should be considered Puncture for therapeutic and diagnostic purposes is to be performed to reduce pathological process is reduced, and the procedure to be followed by surgical intervention to remove the tumor. The strategy of surgical treatment would rely on impaired supporting columns of the spine, the degree of neural structure compression and a secondary spinal deformity. The need and extent of metal fixation is to be evaluated, potential vertebral growth identified, expediency of bone grafting after tumor removal, radical excision of the pathological focus to be considered. Conclusion The clinical case showed an effective combination of surgical techniques in the treatment of an aneurysmal bone cyst of the spine. Preoperative therapeutic puncture of the cyst allowed for reduction of the pathological process (decreasing pressure inside the cyst, thickening the cortical layer of the cyst and delimiting the tumor from the surrounding tissues), decreased volume of surgical intervention and blood loss due to a decreased activity of the pathological process compared to cases of untimely performed open surgery. Metal fixation in combination with bone auto- and allograft was practical for bone fusion.

Experimental study on hydraulic fracture propagation behavior of horizontal well on multilayered rock

A series of true axial hydraulic fracturing experiments were conducted to understand the complex hydraulic fracture initiation and propagation behavior of multilayered rocks. Moreover, a new and convenient grid measurement method was presented to describe hydraulic fracturing effectiveness. The experimental results revealed that transverse vertical and non-planar axial fractures could be created in the hydraulic fracturing of multilayered rocks. Moreover, the fracture area scanning results by the grid measurement method match the results indicated by the traditional Geomagic method. The fracture behavior close to the layer contact determines how complex the produced fishbone structure fracture system is. Near the hole zones, secondary axial and deviated transverse fractures were found due to multiple layers. The fracture system can be managed by modifying the fracturing treatment parameters. Low-principle horizontal stress contrast and low-viscosity fracturing fluid can produce complicated fractures, and an increase in perforation numbers can make the fracture more complex and produce abnormally high breakdown pressure. Larger fracture areas benefit from high perforation rates and pump rates, but larger fracture areas may not always benefit from a decreased fracturing fluid viscosity. The breakdown pressure was the highest for the samples with two sets of oriented perforations, and the stress shadowing effect should be considered in the multiple fracture treatment. The increase in the pump rate generates a more complex fracture path in the horizontal well despite the fracturing fluid types but also yields a high breakdown pressure. The increased fracturing fluid viscosity can constrain the random fracture extension, which is beneficial for decreasing the near-wellbore tortuosity. The occurrence of shear fracture along the interface in a multilayered formation could be a risk for proppant injection and placement.

Management of a complicated fracture by coxo-femoral disarticulation in a domestic short hair cat

Management of a complicated fracture by coxo-femoral disarticulation in a domestic short hair cat

Osteoporosis: Recent Advances

Osteoporosis is characterized by low bone mass, microarchitectural disruption, and skeletal fragility, resulting in decreased bone strength and an increased risk of fracture. Decreased bone strength is related to many factors in addition to bone mineral density (BMD), including rates of bone turnover, bone geometry, and microarchitecture.Osteoporosis has no clinical manifestations until there is a fracture. Complications of fractures include pain, deformity, disability, and loss of height. A clinical diagnosis of osteoporosis may be made in the presence of a fragility fracture, particularly at the spine, hip, wrist, humerus, rib, and pelvis, without measurement of BMD.In the absence of a fragility fracture, BMD assessment by dual-energy x-ray absorptiometry (DXA) is the standard test to diagnose osteoporosis, according to the classification of the World Health Organization. A DXA T-score d”-2.5 is consistent with osteoporosis, whereas a T-score between -1 and -2.5 isosteopenia.All postmenopausal women with osteoporosis should have a history, physical examination, and basic laboratory evaluation. Initial laboratory studies should include a complete blood count (CBC), biochemistry profile, and 25- hydroxyvitamin D (25[OH]D).The need for additional laboratory evaluation depends upon the initial evaluation and Z-score. Women who have abnormalities on initial laboratory testing, suspicious findings on history and physical examination suggesting a secondary cause of osteoporosis, or Zscores d”-2 may require additional evaluation for these secondary causes.Lifestyle measures should be adopted universally to reduce bone loss in postmenopausal women. Lifestyle measures include adequate calcium and vitamin D, exercise, smoking cessation, counseling on fall prevention, and avoidance of heavy alcohol use. In general, 1200 mg of elemental calcium daily, total diet plus supplement, and 800 international units of vitamin D daily are advised. Many patients require vitamin D supplementation as it is difficult to achieve goals with diet alone. Postmenopausal women with established osteoporosis (T-score d”-2.5) or fragility fracture be treated with a pharmacologic agent. For the treatment of high-risk postmenopausal women with T-scores between -1.0 and -2.5, better to start pharmacologic therapy. Most women, for the initial treatmentoral bisphosphonates is good choice.For severe osteoporosis, some experts prefer initial treatment with an anabolic agent, whereas other experts prefer initial treatment with bisphosphonates. Teriparatide and abaloparatide are good anabolic agent. Romosozumab is an alternative. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 194

CALCANEAL FRACTURE, EPIDEMIOLOGY, ANATOMY, MECHANISM OF INJURY, CLASSIFICATION, IMAGING PRESENTATION, CLINICAL PRESENTATION, MANAGEMENT AND COMPLICATIONS

Introduction: Throughout time, calcaneal burst fractures have been referred to as lovers fractures because the injury occurred when a suitor jumped off a lovers balcony to avoid detection. The calcaneus is part of the 7 tarsal bones, calcaneus, talus, cuboid, navicular, first, second and third cuneiform. Calcaneal fractures are infrequent, however, they have a high potential to weaken the limb. Objective: to detail current information related to calcaneal fractures, epidemiology, anatomy, mechanism of injury, clinical evaluation, imaging evaluation, classification, treatment and complications. Methodology: a total of 30 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 21 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: calcaneal fracture, calcaneus, calcaneal osteosynthesis, foot fractures. Results: The calcaneus is the most commonly fractured tarsal bone, representing 2% of all fractures. Calcaneal fractures are bilateral in 5 to 10%, and are usually related to fractures of the lumbar spine and other fractures of the lower limb caused by high-impact trauma. About 10 % of calcaneal fractures are open. Conclusions: The calcaneus is the most commonly fractured tarsal bone, accounting for 2 % of all fractures. Calcaneal fractures are bilateral in 5 to 10% and are usually related to fractures of the lumbar spine and other fractures of the lower limb caused by high impact trauma. About 10% of calcaneal fractures are open, and neurovascular injuries are infrequent in calcaneal fractures. Calcaneal fractures are more related to high energy impacts that generate axial loading of the bone, however they can occur with any injury to the foot and ankle. The main characteristics of individuals affected with a calcaneal fracture are pain, swelling, widening, deformity, ecchymosis and functional impotence. To make the radiological diagnosis of calcaneal fracture in the first instance it is recommended to request an anteroposterior projection of the foot, lateral projection of the rearfoot, Harris axial projection and an ankle series; if necessary, a computed tomography can be performed. In practice, calcaneal fractures can be classified as intra-articular or thalamic and extra-articular; in addition, classification systems such as Sanders and Essex-Lopresti are used. Treatment is controversial. Even with adequate reduction and management, calcaneal fractures can become extremely disabling injuries, presenting a mutable prognosis with various types of functional limitation and pain. Currently, some factors have been found to be related to better outcomes, however, the literature comparing various methods of surgical versus conservative treatment show that surgical management has increased complication rates, however, it may lead to optimal functional outcomes in some individuals. Generally, the incidence of complications of calcaneal fractures is high and increases the worse the wound. Among the most common are calcaneal osteomyelitis, post-traumatic osteoarthritis, wound dehiscence, increased heel width, loss of subtalar mobility, chronic peroneal tendonitis, and complex regional pain syndrome. KEY WORDS: fracture, calcaneus, osteosynthesis, foot.

Nonanatomic healing of the greater tuberosity after plating in proximal humeral fractures: a case control study

BackgroundOpen reduction and plate internal fixation (ORIF) is one of the most common treatment methods for proximal humeral fractures. Complications associated with the greater tuberosity (GT) are rarely reported, therefore, the purpose of this study was to analyze the complications associated with the GT and the risk factors after locked-plate internal fixation.MethodsWe retrospectively analyzed the medical and radiographic data of patients with proximal humeral fractures involving the GT treated with locking plates between January 2016 and July 2019. We divided all patients into two groups, the anatomic GT healing group and the nonanatomic GT healing group, depending on the radiographic outcomes of the GT. Clinical outcome was assessed by the Constant scoring system. Potential risk factors included preoperative and intraoperative factors. Preoperative factors included sex, age, body mass index, fracture type, fracture-dislocation, proximal humeral bone mineral density, humeral head extension, hinge integrity, comminuted GT, volume and surface area of the main GT fragment, and displacement of the main GT fragment. Intraoperative factors were adequate medial support, residual head-shaft displacement, head-shaft angle and residual GT displacement. Univariate logistic regression and multivariate logistic regression were used to identify risk factors.ResultsThere were 207 patients (130 women and 77 men; mean age, 55 years). GT anatomic healing was observed in 139 (67.1%) patients and nonanatomic healing in 68 (32.9%). Patients with GT nonanatomic healing had significantly inferior Constant scores than those with GT anatomic healing (75.0 ± 13.9 vs. 83.9 ± 11.8, P < 0.001). Patients with high GT malposition had worse Constant scores than patients with low GT malposition (73.3 ± 12.7 vs. 81.1 ± 11.4, P = 0.039). The multivariate logistic model showed that GT fracture characteristics were not risk factors for nonanatomic GT healing, while residual GT displacement was.ConclusionsNonanatomic healing of the GT is a high-rate complication of proximal humeral fractures, resulting in inferior clinical outcomes, especially for high GT malposition. Fracture characteristics of the GT are not risk factors for GT nonanatomic healing and GT comminution should not be regarded as a contraindication to ORIF for proximal humeral fractures.

Postoperative clinical outcome and complications of combined cannulated cancellous screw with Kirschner wire in adolescent femoral neck fractures.

Fractures of the femoral neck account for less than 1% of pediatric and adolescent fractures. Due to the high incidence of complications, and the age of the patients, the choice of fixation approach remains controversial among orthopedic surgeons. This study aimed to evaluate the postoperative outcomes and complications of femoral neck fracture in adolescents with open physis, following transphyseal fixation using a combined cannulated cancellous screw and Kirschner wire fixation. Data of 19 patients aged between 12 and 19 years from January 2010 to January 2021 were retrospectively studied. The follow-up period was 1-11 years (5.83 ± 3.76 years). The variables of interest including demographic and clinical variables [age, BMI, gender, side of injury, fracture classification, operation time, time to surgery, and length of hospital stay (LOS)], postoperative outcomes, and complications (fracture healing time, nonunion, coxa vara, osteoarthritis, avascular necrosis, screw loosening, and femoral shortening) were analyzed. The assessment of the hip function was done on the final follow-up using the Ratliff scoring system. There was a male predominance of 76%; the mean age was 16.14 ± 1.57 years and the most frequent mechanism of injury was fall from a height. Delbet type II and III were the most encountered. The mean intraoperative time was 54.71 ± 7.85 min, the LOS was 8.34 ± 1.81days, and the time to surgery was 2.60 ± 1.16 days; the fracture healing time was 3.31 ± 1.04 months. The postoperative complications encountered were coxa vara osteoarthritis, spontaneous dislocation, and neck shortening. Clinical assessment revealed good results in 89% of patients and fair results in 11% of patients. Transphyseal fixation using cannulated cancellous screw combined with Kirschner wire in our patients provided acceptable results. Thus, this approach can be a viable alternative in the management of adolescent femoral neck fracture with open physis.

Treatment of orbital fractures – a critical analysis of ophthalmic outcomes and scenarios for re-intervention

Malplaced implants in orbital reconstruction may lead to serious complications and necessitate re-intervention. The aim of this study was to describe outcomes, complications and scenarios of re-intervention in a historical case series of orbital fractures treated with free-hand orbital wall reconstruction. The main hypothesis was that early re-interventions are mainly because of malplaced implants in the posterior orbit. Retrospective review of 90 patients with facial fractures involving the orbit, reconstructed with radiopaque orbital wall implants, from 2011 to 2016. Data were obtained from medical records and computed tomography images. Recorded parameters were fracture type, ocular injury, ocular motility, diplopia, eye position, complications and re-interventions. Secondary reconstructions because of enophthalmos were volumetrically evaluated. Early complications requiring re-intervention within 1 month were seen in 12 (13%) patients, where all except two were because of malplaced implants. The implant incongruence was without exception found in the posterior orbit. Late complications consisted of four (4%) cases of ectropion and five (5%) cases of entropion that needed corrective surgery. The majority of the patients with eye-lid complications had undergone repeated surgeries. Secondary orbital surgeries were performed in nine (10%) patients. Five of these patients had secondary reconstruction for enophthalmos and associated diplopia. None of these patients became completely free from either enophthalmos or diplopia after the secondary surgery. Re-intervention after orbital reconstruction is mainly related to malplaced implants in the posterior orbit. Incomplete results in patients requiring secondary surgery for enophthalmos infer the importance of accurate restoration of the orbit at primary surgery. Abstract presented at: Swedish surgery Week 2021 and SCAPLAS 2022.

A peridynamic model for electromechanical fracture and crack propagation in piezoelectric solids

This paper presents for the first time an approach to the problem of electromechanical fracture and crack propagation in piezoelectric solids with peridynamics. Fracture in piezoelectric ceramics is an important problem in engineering due to its complexity. The majority of the computational models available on the literature rely on sharp crack representations, which have difficulties dealing with complex crack patterns, or rely on diffusive crack models, such as the phase-field fracture model, that can predict complex patterns but does not represent cracks in a discrete way. On the other hand, peridynamics has been designed to solve this problems and is able to simulate discrete cracks as well as complex crack phenomena like fragmentation and branching. We present a novel approach to the implementation of different electric crack face boundary conditions in a peridynamic way, by a field selective bond breaking approach. Moreover, it is also presented the first electromechanical failure criterion for fracture in piezoelectric ceramics. We develop an energy based failure criterion due to its generality and wide range of applications. These approaches are presented in a way such that they are valid for any type of peridynamic formulation. The used numerical model is implemented using correspondence-based peridynamics with the linear piezoelectricity constitutive setting, using a meshfree discretization and solved quasi-statically with an implicit incremental-iterative scheme. Numerical examples are presented to demonstrate the capabilities of these new approaches and assess the performance of the model against experimental results. The model is capable of numerically predicting complicated fracture behaviour and crack propagation in an intrinsic/autonomous way, as demonstrated by the results.

Procedure-Related Complications in Sham Surgeries for Parkinson's Clinical Trials: A Meta-analysis.

Double-blind, sham-controlled neurosurgical trials for neurodegenerative disorders are debated as an ethical dilemma, particularly regarding subjects randomized to the sham surgery group with general anesthesia. The objective of this study was to examine the safety of sham surgeries in Parkinson's disease (PD) clinical trials through complications related to the procedure. A systematic review and meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Rates and odds ratios (OR) were compared using random effects analysis. Seven studies, all randomized, double-blind, sham surgery-controlled trials, with 309 patients with PD, were qualitatively and quantitatively analyzed: 141 patients in sham groups and 168 patients in the experimental arms of gene or cell therapy trials. Sham subjects had lower rates of gastrointestinal, positioning, incision-site, respiratory (hypoxic or hypercapnic respiratory failure), cardiovascular, thromboembolism, postoperative cognitive decline, skull fracture, and intracranial or spinal complications when compared with active treatment subjects. Sham subjects, however, had a higher rate of perioperative respiratory infections, such as pneumonia or sinusitis. Further, sham subjects were less likely to experience postoperative cognitive decline (OR, 0.23; 95% confidence interval [CI]: 0.11-0.47), intracranial or spinal complications (OR, 0.10; 95% CI: 0.01-0.75), total major morbidity (OR, 0.30; 95% CI: 0.19-0.47), or overall complications (OR, 0.59; 95% CI: 0.47-0.75) when compared with patients receiving experimental therapy. Patients with PD in the sham surgery control arm of cell transplantation or gene therapy clinical trials have a low risk of procedure-related adverse events overall and fewer complications than patients in the experimental groups. There were no reported deaths attributed to sham surgery-controlled PD clinical trials. © 2023 International Parkinson and Movement Disorder Society.

Contribution of Matti-Russe Technique in the Management of Carpal Scaphoid Pseudarthrosis

The scaphoïd pseudarthrosis is the most common complication of fractures of the carpal bones. This is a retrospective study of 16 observations of non-union of the carpal scaphoid, collected at the Department of Traumatology and Orthopedics of Rabat, over a period of 4 years from 2018 to 2022.The average age is 29,8 years, with a male predominance (94%). Initially, it was an orthopedic treatment in 4 cases and the fracture was unknown in 12 cases. In our serie according to Schernberg classification : 1 case was stage I (6%). 8 cases were Stage II (50%). 4 cases were Stage III (25%). 3 cases were stage IV (17 %). According to the classification of Alnot : 3 cases were stage I (19%), 4 cases were stage IIA (25%), 2 cases were stage IIB (12 %), 5 cases were stage III (31%), two cases were stage IV (13%). The consolidation was achieved in 91%. The purpose of this study is to describe the epidemiological and clinical radio carpal scaphoid non-unions and show the interest of MATTI-RUSSE technique. The clinical and radiological results are reported and analyzed according to the literature.

Severe intraoperative vascular bleeding as main complication of acetabular fractures treated with plate osteosynthesis via the modified Stoppa approach

Acetabular fractures are challenging fractures and finding the best supportive treatment is complex. Many operative treatment options exist – one of them is the plate osteosynthesis via the modified Stoppa approach gaining popularity over the last decades. The purpose of this study is to give an overview of this surgical techniques and its main complications.Patients ≥ 18 years between the years 2016 and 2022 with acetabular fractures in our department received a surgical intervention with plate fixation via the modified Stoppa approach. All protocols and documents during a patient's hospital stay were analyzed to find relevant perioperative complications concerning this operative technique.Between 01/2016 und 12/2022 75 patients with acetabular fractures were treated surgically in the author's institution with a plate osteosynthesis via the modified Stoppa approach. In 26.7 % (n = 20) of all cases, patients were confronted with one or more perioperative complications typical for this operation. Intraoperative venous bleedings were the main complication with 10.6 % (n = 8). Postoperative functional impairment of the obturator nerve and deep vein thrombosis occurred with 2.7 % (n = 2) and 9.3 % (n = 7).This retrospective study shows that plate fixation via the Stoppa approach is a good treatment option because of the excellent intraoperative overview of the fracture, but has its pitfalls and complications. Especially severe vascular bleedings must be taken into account and its management well known.

A STUDY OF MANAGEMENT OF NON UNION BONES BY AUTOLOGUS BONE MARROW INJECTION.

Background : Non union is a serious complication of fracture and has multiple causes of which most common cause is lack of osteoconductive mediators, osteogenic cells and adequate vascularity. As most of the nonunion fractures are treated by open bone graft. we conducted a study on 30 patients with non union fracture treated by autologous bone marrow injection. As autologous bone marrow injections containing mesenchymal stem cells (MSC) increases the osteogenic potential of these non-union sites and can obtain healing of these non-union site. Material and Methods: A total 50 patients with non-union,33 were male and 17 were female,15 were femur nonunion,21 were tibia nonunion,6 were humerus nonunion, 5 were radius nonunion, 3 were ulna nonunion. Study conducted on these patients and were treated with autologous bone marrow injection at the fracture site under regional anaesthesia in supine position. patients were evaluated at pre operative and post operative follow up period with serial radiography at 6 weeks,12 weeks, 6 months and 9 months. average duration of treatment was 9months and outcome was evaluated with ASAMI scoring system. Union occurred in 82% patients. out of 50, 31 (64%) patients outc Results: ome was excellent, followed by 5 (10%) had good outcome, 5 (10%) had fair and 9(18%) had poor long bone and functional outcomes. Manageme Conclusion: nt of nonunion bones by autologous bone marrow injection provides an effective and reliable alternative to open bone grafting. Thus,it is observed that with an adequate amount of autologous bone marrow injection, union can be achieved in non union of bones

PO-01-048 FACTORS INFLUENCING SUBCUTANEOUS IMPLANTABLE CARDIOVERTER DEFIBRILLATOR SCREENING SUCCESS IN PAEDIATRIC POPULATION: A TERTIARY HOSPITAL EXPERIENCE

Implantable cardioverter defibrillators (ICD), used to reduce risk from life threatening ventricular arrhythmia, are important treatments. Subcutaneous ICD (SICD) offers a lower risk of endocarditis, lead fracture and vascular complication. Screening is essential to identify the appropriate candidates and reduce inappropriate shocks, however there are limited data available in the paediatric population. To assess the incidence and associated characteristics of SICD screen failure, and the incidence of inappropriate shocks in a paediatric population. All patients screened for SICD from June 2016 to November 2022 were included. Screening failures were identified from supine, standing and exercise in both left and right sternal positions. Those who passed at least two vectors in all conditions were offered an SICD. The incidence of inappropriate shocks on follow up was assessed. From 74 screened patients (baseline characteristics Table 1), 58 (78%) passed supine and standing and 51(69%) on exercise screening. 59 (67%) had Hypertrophic Cardiomyopathy (HCM), 17 (23%) Inherited arrhythmias (IA) and 8 (11%) Other Cardiomyopathies (OC). Overall, 60(81%) had a primary prevention indication. Of the 45 (61%) who passed screening on the left supine, all passed when standing and 43 (96%) passed on exercise. Those screened on the right, 18 (55%) passed supine, 16(88%) of these passed standing and 14(87%) passed on exercise. Those that failed were younger and had HCM (passed vs failed, age 14±2.6 vs 12±3.7, p=0.009, HCM 56% vs 87%, p=0.008). IA patients were more likely to pass (pass vs failed, 35% vs 8%, p=0.02). Weight, height and BMI did not impact on the failure rate (Table 1). Overall, 40 (78%) had an SICD implanted with a mean follow up 21±15 months. Four patients had inappropriate shocks; One for air in the header and three for T wave oversensing. Those who had T wave oversensing had left sided lead implants, two had HCM and one had AI. In this population the screen failure rate for SICD was high, particularly in younger patients with HCM. The addition of exercise further excluded patients however, the number was small. There was no link between weight, height and BMI and screen failure. The incidence of inappropriate shocks was low.Tabled 1Table 1 – Characteristics of patients who passed and failed Subcutaneous Internal Cardioverter Defibrillator ScreeningCharacteristicsPassed (n=51)Failed (n=23)p-valueAge, years mean (SD)14 ± 2.612 ±3.7p=0.009Sex F(%)17 (34)6 (26)p=0.6Weight kg, mean (SD)57 ±16.953 ±(22)p=0.34Height cm mean (SD)156 ±29.6155 ±17.8p=0.88BMI kg/m2 mean (SD)23 ± 10.421 ± 5.5p=0.39HCM n (%)29 (56)20 (87)p=0.008Inherited n (%)15 (29)2 (8)p=0.02Other Cardiomyopathy n (%)7 (14)1 (4)p=0.26 Open table in a new tab

Post-stroke Complication of Shoulder Dislocation and Fracture of the Humeral Head Due to Osteoporosis: A Case Report

Post-stroke Complication of Shoulder Dislocation and Fracture of the Humeral Head Due to Osteoporosis: A Case Report

Endoscopic Screw Removal, Debridement of the Peroneal Tendons and Subtalar Joint and Lateral Calcaneal Ostectomy for Management of Chronic Heel Pain after Calcaneal Fracture

Calcaneal fracture is one of the most common foot and ankle fractures, but the best treatment of this fracture is still under debate. No matter the treatment strategy of this intra-articular calcaneal fracture, early and late complications frequently occur. In order to treat these complications, combination of various ostectomy, osteotomy, and arthrodesis techniques have been proposed to re-establish the calcaneal height, restore the talocalcaneal relationship, and create a stable, plantigrade foot. In contrast to this approach of addressing all the deformities, another feasible approach is concentrating on those aspects that are the most clinically pressing.10-15 Different arthroscopic and endoscopic approaches focused on the patient’s symptoms and not the correction of the talocalcaneal relationship or restoration of the height or length of the calcaneus have been proposed to deal with late complications of calcaneal fractures. The purpose of this technical note is to describe the details of endoscopic screw removal, debridement of the peroneal tendons, and subtalar joint and lateral calcaneal ostectomy for management of chronic heel pain after calcaneal fracture. It has the advantage of dealing with various sources of lateral heel pain after calcaneal fracture, including the subtalar joint, peroneal tendons, lateral calcaneal cortical bulge and screws.

Management and prevention of rare complication of mandibular fracture after inferior alveolar nerve transposition in edentulous atrophied mandible in implant dentistry: An unusual case report

Edentulism can be a debilitating handicap. Nowadays, most dental surgeons believe that the most basic restoration for the edentulous mandible should be an implant retained overdenture with two implants placed in the anterior mandible. Treatment options for edentulous mandible range from complete denture to implant supported fixed restorations implant retained and tissue supported overdentures, implant retained and implant supported over dentures and hybrid fixed prostheses or bone anchored bridges. With proper selection and treatment planning, using dental implants to support restoration replacing missing teeth can provide long lasting functional and aesthetic restorations. However, in atrophic mandible many problems can arise. In this rare case report, we are highlighting some of the challenges involved in management of atrophic edentulous mandible in a diabetic old patient with implant retained tissue supported overdentures, (IRTOD) which later required inferior alveolar nerve (IAN) trans positioning due to severely atrophic mandible and resulted in accidental mandibular fracture. The key to prevent these types of failures is proper treatment planning. With this article we want to enlighten some useful keys for preventing these kinds of failures.

Clinical outcomes in patients with scaphoid non-union treated with the vascularized medial femoral condyle technique a case series

IntroductionNon-union is a prevalent complication of scaphoid fractures. Late diagnosis is common and has a clinical impact due to functional limitations for the patient. Multiple treatments have been proposed to manage this complication, ranging from conservative (i.e., orthopedic) to surgical treatment. The vascularized medial femoral condyle technique has shown satisfactory clinical and paraclinical results, mainly in presence of avascular necrosis of the proximal pole but data regarding functional outcomes and patient satisfaction is scarce.This case series aims to describe the clinical and patient-reported outcomes in a consecutive series of patients with non-union of the proximal third of the scaphoid treated with vascularized medial femoral condyle technique. MethodsCase series reporting results for a consecutive – initial cohort of patients who presented with a non united fracture of the proximal pole of the scaphoid, avascular necrosis of the proximal pole was documented by CT od MRI imaging preoperatively in all patients. Measurement instruments include the q-DASH and PRWE questionnaires, radiographic images, goniometry, and assessment of grip strength. ResultsTwelve consecutive patients are included and they represent the initial cases for all surgeons involved; bone union was obtained in 10 patients (83%) after a mean follow-up time of 31 months (6–72), successful improvement in the range of motion and grip strength was documented. A high rate of satisfaction expressed by the patient was obtained, with an average score in Q-DASH of 17.3 and 20.1 in PRWE. ConclusionsThe vascularized medial condyle technique in cases of nonunion of scaphoid fracture is a reproducible treatment in clinical terms, both in imaging and functional terms, and in patient satisfaction. The learning curve is flat for a dedicated multi surgeon team.

Predicting early term complications of ORIF distal radius fracture in outpatient settings using NSQIP data

PurposeThere is no consensus on which risk factors are most predictive for complications following open reduction internal fixation of distal radius fractures (ORIF-DRF) in an outpatient setting. This study is a complication risk analysis for ORIF-DRF in outpatient settings based on data obtained from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). MethodsA nested, case-control study, was conducted in ORIF-DRF cases performed in outpatient settings from 2013 to 2019 obtained from the ACS-NSQIP database. Cases with documented local or systemic complications were age and gender-matched in a 1:3 ratio. The association between patient and procedure-dependent risk factors for systemic and local complications in general and for different subpopulations was examined. Bivariate and multivariable analyses were performed to evaluate the association between risk factors and complications. ResultsFrom a total of 18,324 ORIF-DRF, 349 cases with complications were identified and matched to 1047 Controls. Independent patient-related risk factors included a history of smoking, the American Society of Anesthesiologists (ASA) Physical Status Classification 3 and 4, and bleeding disorder. The intra-articular fracture with three or more fragments was found to be an independent risk factor of all procedure-related risk factors. History of smoking was found to be an independent risk factor for all gender populations, as well as for patients younger the 65 years old. For older patients (age ≥65) bleeding disorder was found to be an independent risk factor. ConclusionComplications of ORIF-DRF in outpatient settings have many risk factors. This study provides surgeons with specific risk factors for possible complications following ORIF-DRF.

A comparison between the finite element method and a kinematic model derived from robot swarms for first and second gradient continua

In this paper, we consider a deformable continuous medium and its discrete representation realized by a lattice of points. The former is solved using the classical variational formulation with the finite element method. The latter, a 2D discrete “kinematic” model, instead is conceived to determine the displacements of the lattice points depending on interaction rules among them and thus provides the final configuration of the system. The kinematic model assigns the displacements of some points, so-called leaders, by solving Newton’s law; the other points, namely followers, are left to rearrange themselves according to the lattice structure and the flocking rules. These rules are derived from the effort to describe the behaviour of a robot swarm as a single whole organism. The advantage of the kinematic model lies in reducing computational cost and the easiness of managing complicated structures and fracture phenomena. In addition, generalizing the discrete model to non-local interactions, such as for second gradient materials, is easier than solving partial differential equations. This paper aims to compare and discuss the deformed configurations obtained by these two approaches. The comparison between FEM and the kinematic model shows a reasonable agreement even in the case of large deformations for the standard case of the first gradient continuum.