Displacement Of Bone Fragments Research Articles

Retrospective Review and Analysis on Outcome of Cranioplasty: A Series of 38 Cases

Background: Cranioplasty (CP) is a straightforward procedure, it may result in a significant number of complications. These include infections, seizures, intracranial hematomas, and others. Objective: This was a retrospective study on outcome of Cranioplasty. Materials and Methods: This retrospective study included patients who underwent decompressive craniectomy due to traumatic brain injury with raised ICP, acute subdural hematoma, compound comminuted skull fracture & ICH, between January January 2019 to December 2020 at Enam Medical College & Hospital, Savar, Dhaka. Data were collected in pre-designed data collection sheet and were analyzed using computerbased programme statistical package for social science (SPSS) windows version 25. Results: This study showed maximum patients (34.2%) were between 21-30 years age. Majority were male (89.5%) and only 5.9% were female. Overall rate of complications was 10.5%. Among them new onset seizure (n = 4), indrawing of skin through bone gap (n=4), hemorrhage (n=2), infection (n = 1), HCP (n = 1), and exposed implant (n=1). Conclusion: We have found the outcome of cranioplasty was better with titanium mesh plate and screw than conventional fixation of bone with polyglactin, polypropylene suture and titanium miniplate and screw. With polypropylene and polyglactin there is more chance of inward displacement of bone fragment and with miniplate and screw there is still chance of indrawing of bone fragment through the bone gap. Bang. J Neurosurgery 2023; 13(1): 20-23

Magnetic Resonance Imaging in the Evaluation of Avulsion Injuries of the Pelvis and Hip in Adolescent Professional Footballers: A Case Series.

Pelvic apophyseal avulsion fractures are uncommon injuries that frequently affect adolescents while participating in sports. This occurs because the enthesis cannot withstand the tractional force applied because the apophysis has not yet fully fused. Due to its complex muscular structure, being the origin of several muscles that cross two lower extremity joints, the pelvis has an increased risk for such injuries. The diagnosis of pelvic avulsion injuries depends heavily on imaging. The best way to detect soft-tissue changes, including tendon or muscle strain, bone marrow edema, hematomas, and soft tissue avulsion injuries, is with an magnetic resonance imaging . It is also the best at showing tendon retraction and can help the clinician spot patients who might benefit from surgical treatment. We report six cases of adolescents professional footballers that suffered avulsion injuries while playing football. The patients had painfully restricted hip range of motion and were unable to bear weight. Some of them on physical examination felt pain at the palpation of the injured area. Magnetic resonance revealed apophysis growth plate avulsion with or without displaced bone fragments that were treated conservatively with an excellent clinical and radiological outcome. For an accurate diagnosis of pelvic avulsion injuries and clinical management, it is important that everyone caring for this patient population is aware of the common injury mechanisms, radiographic findings, and available treatments.

Combined osteosynthesis for tibial shaft fracture treatment

Introduction Widespread use of intramedullary and extramedullary implants, as well as external fixation devices, has demonstrated that current surgical methods are not always successful.The study aimed to assess the efficiency of a combination of transosseous osteosynthesis with intramedullary reinforcement using elastic titanium hydroxyapatite-coated rods (HA-rods) in long bone fracture treatment.Material and methods Medical records of 40 patients aged from 18 to 55 years with closed diaphyseal tibia fractures of A1-A3 type (AO/ASIF) treated with the Ilizarov transosseous osteosynthesis method combined with intramedullary elastic HA-coated wires were analysed. Result Ilizarov fixator removal was performed on average 45.3 ± 14.7 days after surgery. Radiological signs of bone union (immature callus, patterns of periosteal and endosteal stratifications overlapping the fracture line) were visible by week 3 to 4.Discussion Соmbination of the external fixator and intramedullary elastic HA-coated wires overcomes shortcomings of both external and internal means of fixation. External osteosynthesis provides advantages of the Ilizarov method: preservation of blood supply, absence of soft tissue injury, joint function and early weightbearing. Elastic intramedullary wires do not injure a. nutricia and mechanically stimulate endosteal and periosteal bone formation.Conclusion The advantages of combined osteosynthesis provide reduction of Ilizarov apparatus fixation time, reduction in the number of wires and half-pins in the frame assembly, stimulation of bone callus formation and prevention of secondary bone fragment displacement.

Management of frontal sinus fractures requiring surgical intervention: An analysis of a case series.

<b><br>Introduction:</b> Isolated frontal bone fractures constitute 5-15% of traumatic facial fractures cases, with frontal sinus fractures categorized into anterior wall, posterior wall, or complex fractures. The approach is tailored to fracture type and bone fragment displacement. This paper presents the summary of surgical management in patients with isolated and complex fractures of the anterior wall of the frontal sinus.</br> <b><br>Material and Methods:</b> Five patients with different frontal sinus fractures were treated surgically. The same management protocol - diagnosis and surgical intervention was implemented in all cases The retrospective analysis included fracture assessment, surgical approach, and long-term outcomes evaluation.</br> <b><br>Results:</b> The most common cause of fractures was falls, while two complex fractures involved the anterior and posterior walls. External approach, bone fragment removal, endoscopy, and external stabilization were employed in all cases. One patent required delayed revision surgery due to retaining metallic foreign body. Follow-up radiological examinations showed proper healing and cosmetic outcomes were satisfactory in all of the cases.</br> <b><br>Conclusion:</b> Surgical management of isolated fractures of the frontal sinus anterior wall, involving bone fragment removal, realignment, and endoscopy, yielded satisfactory functional and cosmetic outcomes without internal or external stabilization. Long-term monitoring and symptom assessment are crucial, especially in cases with penetrating injuries and foreign body risk.</br&gt.

Outcomes of Odontoid Process Fracture Surgery

Background. Odontoid fractures are found in two age groups. In younger patients, they occur following traffic accidents, falls from a height and during sports. In older patients with poor bone quality, they are usually caused by falls from one’s own height. Most fractures are stable and do not require surgical treatment. Unstable, severely displaced fractures with neurological deficits require surgical treatment. The aim of the study was to evaluate the surgical and functional outcomes of treatment of odontoid fractures with a cannulated screw. Materials and methods. The study enrolled 20 patients that underwent surgery in the years 2020-2022. The patients were divided into two groups: below 60 (group A) and over 60 years of age (group B). Patients were assessed at one day pre-op, one day post-op, 6 weeks following surgery and 3 months following surgery. Imaging studies were performed to assess the angulation and degree of displacement of bone fragments. After the fracture was surgically fixed with a cannulated screw, bone union and the stability of fracture fixation were assessed. Preoperative and postoperative pain intensity as per a VAS, functional status assessed with the NDI questionnaire, quality of life (EQ-VAS) and neurological status (ASIA scale) were compared. Results. Good functional and surgical results were obtained in both groups of patients. Performance and quality of life improved, while pain intensity decreased in all patients. In 3 patients with post-traumatic paresis, the dysfunctions gradually subsided. No general medical or perioperative complications were observed. Bone union of the fracture was achieved in 40% of patients in group B and in 80% in group A. Achieving union did not determine the functional status of patients. On functional radiographs, all places of fixation were stable. Conclusions. 1. Odontoid fracture fixation with a single cannulated screw is a safe method of treatment. It provided a high union rate and good stability of the fracture. 2. Fracture non-union was noted more often in the group of older patients, but it did not negatively impact quality of life and performance.

Unilateral biportal endoscopic technique combined with percutaneous transpedicular screw fixation for thoracolumbar burst fractures with neurological symptoms: technical note and preliminary report

BackgroundPrevious studies on thoracolumbar fractures with neurological symptoms have focused on how to achieve satisfactory fracture reduction, adequate nerve decompression, and stable spinal alignment. With the development of the minimally invasive spine surgery technique, achieving satisfactory treatment results and reducing iatrogenic trauma at the same time has become a new goal of spinal surgery. This research used percutaneous transpedicular screw distraction to partially reduce the fractured vertebrae, followed by completing nerve decompression and reducing residual displacement bone fragments with the assistance of the unilateral biportal endoscopic (UBE) technique to achieve full protection of bone-ligament tissue and obtain good clinical efficacy.MethodsGuide wires were safely inserted into the fractured vertebra and adjacent upper and lower vertebra under the surveillance of anteroposterior and lateral X-ray fluoroscopy. Transpedicular screws were implanted via guide wires on the side with mild neurological deficits or bone fragment compression (the opposite side of the endoscopic operation). A titanium rod was installed and moderately distracted to reduce the fractured vertebra. Then, under the guidance of the endoscopic view, the laminectomy and ligamentum flavum resection were completed according to the position of the protruding bone fragment into the spinal canal, and the compressed dural sac or nerve root was fully exposed and decompressed. An L-shaped replacer was used to reduce residual bone fragments. The ipsilateral transpedicular screws and rod were installed and adjusted to match the contralateral side. The drainage tube was indwelled, and the incision was closed. The preoperative and postoperative images of the patients were evaluated, and the recovery of neurological symptoms was observed.ResultsSurgery was successfully completed on all six patients, and no intraoperative conversion to open surgery was performed. Postoperative images showed good reduction of the protruding bone fragment and good placement of all screws. At the last follow-up, the neurological symptoms of all patients returned to normal.ConclusionThe UBE technique combined with percutaneous transpedicular screw fixation in the treatment of thoracolumbar fractures with neurological symptoms can effectively achieve the reduction of displaced bone fragments, improve damaged nerve function, stabilize spinal alignment, and protect the integrity of bone-ligament tissue.

Glenoid rim morphology in young athletes with unstable painful shoulders: primarily painful vs. frankly unstable

To investigate the characteristics of glenoid rim morphology in young athletes (<40 yr) with unstable painful shoulder. This was a retrospective case series. The inclusion criteria were as follows: (1) shoulder pain during sports activity, (2) traumatic onset, (3) no complaint of shoulder instability, and (4) soft tissue or bony lesions confirmed on imaging examinations (computed tomography and magnetic resonance imaging). The above-mentioned painful cohort was then compared (in a 2:1 ratio) to a match-paired control group of patients with similar demographics but with frank anterior glenohumeral instability as defined by imaging and physical findings. The pain (not apprehension) was reproduced during the anterior apprehension test in supine position and relieved by relocation test in all patients. Glenoid rim morphology, bone union in shoulders with a fragment-type glenoid, glenoid defect size, bone fragment size, medial displacement of bone fragments (MDBF), and medial distance of erosion (MDE) were compared between painful shoulders and unstable shoulders. There were 79 painful shoulders and 165 unstable shoulders. The glenoid rim morphology was normal in 33 shoulders, erosion-type in 15 shoulders, and fragment-type in 31 shoulders among painful shoulders, whereas the respective shoulders were 19, 33, and 113 among unstable shoulders (P<.001). Bone union was complete in 15 shoulders, partial in 14 shoulders, and nonunion in 2 shoulders among painful shoulders, whereas the respective shoulders were 43, 31, and 39 among unstable shoulders (P=.001). The mean glenoid defect size was 6.0±7.2% and 12.7±7.4%, respectively (P<.001), and the mean bone fragment size was 5.8±6.4% and 5.4±4.6%, respectively, (P=.591). The mean MDBF was 1.4±1.5 mm and 3.0±2.2 mm, respectively (P<.001), and the mean MDE was 2.3±1.2 mm and 5.2±2.4 mm, respectively (P<.001). In shoulders with a smaller glenoid defect (<13.5%), the prevalence of shoulders with MDBF (<2 mm) and shoulders with MDE (<2 mm) was more frequent in painful shoulders. On the other hand, in shoulders with a larger glenoid defect (≥13.5%), erosion-type glenoid, nonunion in fragment-type glenoid and bone fragment smaller than 7.5% was not recognized in painful shoulders. Shoulders with MDBF (<2 mm) were significantly more frequent in painful shoulders (P=.009). In painful shoulders normal or erosion-type glenoid was predominant, and glenoid defect size was significantly smaller than unstable shoulders. On the other hand, a large bone fragment (≥7.5%) remained and united completely or partially in all shoulders with a larger glenoid defect (≥13.5%). Bone union was obtained within 2 mm from the articular surface in most of them.

Long-Term Functional Consequences of Treatment of Fractures of the Distal Metaepiphysis of the Radius

Summary. The frequency of damage to the distal metaepiphysis of the radius reaches from 16% to 33% of all fractures of the bones of the skeleton, and the increase in the incidence of osteoporosis definitely maintains the tendency to increase the frequency of damage to this localization. About 53.3% of the injured need repositioning; half of them (26.6%) have large unstable fractures of type B and C, which are subject to surgical treatment.&#x0D; Materials and Methods. The study was carried out based on the materials of the trauma centers and trauma departments of the “City Clinical Hospital No. 2” of the DCC (Dnipro) and the MNPE “City Clinical Hospital No. 6” of the DCC (Dnipro). To assess the long-term consequences, a retrospective analysis of archive records of 318 patients with damage to the distal metaepiphysis of the radius was performed, including 271 radiographs of females (85.2%) and 47 males (14.8%).&#x0D; Results. The conducted analysis gives grounds to state that remote manifestations depend on the nature and severity of fractures, the quality of reposition or surgical treatment. Fractures of type A and C have a pronounced tendency to develop manifestations of deforming arthrosis of the radiocarpal joint in the remote period after the injury, which may be due to the presence of incongruity of the articular surfaces against the background of residual “permissible” displacements of the fragments.&#x0D; Conclusions. Ensuring accurate repositioning of fractures and expanding the indications for surgical treatment in case of “permissible” displacement of bone fragments in fractures of the distal metaepiphysis of the radial bone will reduce the frequency and severity of arthrosis in the remote period after the injury.

Анализ осложнений интрамедуллярного остеосинтеза титановыми гибкими стержнями при переломах костей нижних конечностей у детей

INTRODUCTION: The introduction of minimally invasive methods in clinical practice has significantly expanded the indications for surgical treatment of bone fractures in children. The method of osteosynthesis with titanium elastic nails is widely used at the age of 7 to 14 years and has many advantages. At the same time, the elastic-stable osteosynthesis has a number of probable complications and limitations. AIM: To analyze probable complications of the method of intramedullary osteosynthesis with titanium elastic nails in children of different age categories. MATERIALS AND METHODS: The results of treatment of 98 children with fractures of the long bones of the lower extremities were analyzed. All the patients underwent osteosynthesis with titanium elastic nails. The patients were divided to three age groups: 2 to 6 years, 7 to 13 and 14 to 16 years. Clinical and X-ray examinations of the patients were conducted. RESULTS: In young children, excellent results of treatment were obtained in 82.6% and satisfactory results in 17.4% of cases, no poor results were noted. In patients of the group 7 to 13 years, the results of treatment were considered excellent in 82.3%, and satisfactory in 17.7% of cases. In older children, outcomes of treatment were excellent in 62.5%, satisfactory in 29.2%, and poor outcomes that required repeated surgical interventions, were observed in 8.3% of cases. CONCLUSION: The most preferable age for osteosynthesis with titanium elastic nails was found to be from 6 to 14 years. There exist technical difficulties in use of this method in children of 2 to 4 years of age with "unstable in length" femoral bone fractures, nevertheless, the displacement of bone fragments was leveled out in all the observed cases. The greatest number of complications are associated with the use of TEN in the treatment of adolescents of 15 to 16 years due to insufficient rigidity of fracture fixation.

Unrecognized glenoid fracture in opposite shoulders with symptomatic anterior instability

BackgroundThe purpose of the present study was to investigate the characteristics of unrecognized glenoid fracture in opposite shoulders with symptomatic anterior instability. MethodsParticipants were 38 patients, who had complaints of instability on only one side (symptomatic shoulder) and had no complaints despite of a glenoid fracture on the other shoulder (asymptomatic shoulder) from 2011 to 2020. Factors that could influence the onset of symptoms including glenoid rim morphology were retrospectively investigated. ResultsAmong the asymptomatic shoulders, 16 had a single traumatic event and 22 had no history of trauma. The glenoid morphology was normal in 6, erosion in 12 and bony Bankart in 20 on the symptomatic side, whereas the respective shoulders were 0, 16 and 22 on the asymptomatic side. Bone union of bony Bankart was complete in 9, partial in 3 and non-union in 8 on the symptomatic side, whereas the respective shoulders were 18, 3 and 1 on the asymptomatic side. The mean glenoid defect size was 10.4% and 7.8%, and the mean bone fragment size was 5.0% and 4.5%, respectively. The mean medial displacement of bone fragments was 2.6 mm and 1.0 mm, respectively (p < 0.001). A larger glenoid defect (≥10%) was recognized in 19 symptomatic shoulders and 10 asymptomatic shoulders. Among them, erosion was solely recognized in 5 symptomatic shoulders. In shoulders with bony Bankart, all 10 asymptomatic shoulders had a completely or partially united fragment with less than 2 mm displacement. On the other hand, among 14 symptomatic shoulders, united fragment was solely recognized in 8 shoulders, in which medial displacement was less than 2 mm in 3 shoulders. ConclusionsEven if a glenoid fracture occurred, symptom such as instability or pain was not always recognized by all patients. Regardless of glenoid defect size, shoulders with a completely or partially united bone fragment and with less than 2 mm displacement were found to be asymptomatic.

Treatment of a Mandibular Diastemal Fracture Using Locking Compression Plate and Cerclage Wire in a Mare.

This report describes the combination of two surgical fracture repair techniques and the postoperative management of a mandibular diastemal fracture in a two-year-old mare. The mare was referred to a veterinary hospital with a laceration over the body of the right mandible. Radiographic assessment revealed two mesial fracture lines involving the second premolar tooth and a ventrally displaced bone fragment. The mare was treated under general anesthesia and the fracture was corrected using open reduction and plate fixation. A 3.5 mm narrow 15-hole locking compression plate with seven locking screws were used in a bridge form. Cerclage wire was also used to anchor the incisor teeth to the second and third premolar teeth. The cerclage wire and incisor teeth were covered with polymethylmethacrylate to prevent implant failure and avoid injury to the oral mucosa. Implants were removed 55 days after surgery and the mare was discharged from hospital five days later. The mare returned for cerclage wire removal after 90 days and was allowed to resume exercise thereafter. The combination of two surgical techniques, proper implant choice and appropriate postoperative management, including use of pelleted feed, contributed to successful bone healing and return to function.

Хирургическое лечение импрессионного перелома наружного мыщелка большеберцовой кости (клинический случай)

INTRODUCTION: Treatment of intra-articular fractures of the proximal tibial metaepiphysis can often cause difficulties in accurate restoring of the congruence of the articular surfaces of the knee joint. Such fractures may be accompanied by subsidence of the articular surface and the formation of a subchondral defect. In the absence of displacement of bone fragments and preservation of congruence of the articular surfaces of the knee joint, such fractures can be treated conservatively. In the opposite case, there is a need for a complete restoration of the articular surface of the tibia. It should be noted that among all fractures of the tibial plateau, more than half are fractures of the lateral condyle, also accompanied by the presence of an impression. A clinical case of surgical treatment of a 62-year-old patient, BMI (body mass index) 39, with an intra-articular multi-comminuted impression fracture of the lateral condyle of the tibia with displacement of bone fragments is presented. The patient gave her written consent to the use of her clinical data for scientific purposes. Upon admission to hospital, a closed intra-articular fracture of the external condyle (Schatzker II) was diagnosed with fragmentation and articular surface impression of more than 5 mm, and the presence of a spongy bone defect with a volume of about 4 cm3 as a result of the impression. Surgical treatment was performed that consisted of open reposition and restoration of the congruence of the articular surface, with simultaneous plasty of the defect of the external condyle with an autograft taken from the iliac crest, followed by osteosynthesis of the external condyle with a plate and screws. On the follow up examination 9 months after the surgical treatment, the patient developed post-traumatic osteoarthrosis of the knee joint with severe pain. Some probable errors in the preparation of the patient for surgical treatment, preoperative planning, surgical treatment, recovery in the postoperative period, as well as functional and radiological results of treatment are presented for discussion. CONCLUSION: The development of post-traumatic osteoarthrosis in the treatment of tibial condylar fractures still remains an important problem in modern traumatology. Special attention in the treatment of such fractures should be given to preoperative planning, surgical technique and implant selection. It is important not to lose communication between the patient and the surgeon throughout the entire recovery period.

Retrospective analysis of restoration of the anatomy of the damaged thoracic and lumbar spinal motion segment using transpedicular repositioning device

Objective. To carry out a retrospective analysis of the restoration of the anterior and posterior vertebral body heights and the elimination of deformation of the anterior spinal canal wall caused by thoracic and lumbar spine injury, based on the data of spiral computed tomography (SCT).Material and Methods. The study analyzed SCT data and case histories of 50 patients with thoracolumbar spinal cord injury operated on at different times after injury: up to 10 days – Group 1 and 11–30 days – Group 2. All patients underwent spinal reposition using a transpedicular device. The preoperative and postoperative SCT parameters were compared with the initial ones, which were calculated. The restoration of vertebral body heights and the elimination of deformation of the anterior spinal canal wall were compared in two groups depending on the distraction of interbody spaces and changes in the angle of segmental deformity.Results. In Group 1, the anterior and posterior dimensions of the vertebral body were restored, on average, by 95.3 ± 1.9 and 96.9 ± 1.4 % of the initial height; in Group 2 – by 87.4 ± 4.2 and 96.6 ± 1.8 %, respectively. The maximum restoration of the anterior dimensions of the vertebral bodies was achieved with distraction of the anterior interbody spaces closer to 100 % of the original size in the first and second groups. The maximum recovery of the posterior dimensions of the vertebral bodies was obtained by distraction of the posterior interbody spaces by 97 % or more of the original dimensions. The maximum elimination of the displacement of bone fragments from the spinal canal was obtained by distraction of the interbody spaces to a distance close to 100 % of the initial one, and when the obtained angle of segmental deformity coincided with the initial one.Conclusion. In the first 10 days after the injury, a greater percentage of the restoration of the anterior and posterior vertebral body heights and a decrease in the deformation of the anterior wall of the spinal canal were obtained. It was possible to maximally eliminate the deformation of the anterior wall of the spinal canal and restore the height of the anterior and posterior walls of the damaged vertebra by approaching the obtained dimensions of interbody spaces and the angle of segmental deformity to the initial ones.

Reconstruction of orbital wall fractures with superior orbital fissure syndrome using individualized preformed titanium mesh: a pilot study

The aim was to preliminarily evaluate the effect of individualized preformed titanium mesh in the treatment of orbital wall fractures with superior orbital fissure syndrome (SOFS). This study consisted of 10 patients of orbital wall fracture and SOFS who were treated at the Affiliated Stomatology Hospital of Southwest Medical University. On the basis of preoperative computed tomography data, individualized titanium mesh was produced by mirror engineering and rapid prototyping, and it was implanted into defects in the orbital walls to restore the normal anatomy. Early orbital wall reconstruction was performed to improve the SOFS. Postoperatively, the ocular and facial appearance and eye function were evaluated. The orbital structure, volume, and size of the SOF were restored in the 10 patients using the individualized titanium mesh. The symptoms of SOFS completely disappeared in all patients with no severe postoperative complications. Significant recovery of ocular and facial appearance and eye function was reported. This pilot study demonstrated that individualized preformed titanium mesh can accurately restore the orbital walls and the structure and size of the SOF, and it is useful in the treatment of SOFS without intraorbital bone fragment displacement.

Évaluation expérimentale des déplacements des fragments osseux avec un fixateur hexapode au moyen de diodes infrarouge sur os synthétique

BackgroundThe purpose of this study was an experimental assessment of changes in bone fragment position in patients with nonunion of the tibia treated with a hexapod fixator. HypothesisWe hypothesized that the use of hexapod fixators leads to differences between the planned and actual position of bone fragments. MethodsThe study was conducted in physical models of the hexapod fixator–bone fragment system. Bone fragment displacement was measured using the Optotrak Certus Motion Capture System. We assessed differences between the planned and actual position of bone fragments. ResultsAssessment of bone fragment compression demonstrated a difference between the target and actual correction ranging from 1.5% to 13.2% (depending on the force applied to bone fragments) for configuration 1, from 17% to 21.3%for configuration 2,and from 13.2%to17.9% for configuration 3. The achieved varus deformity correction constituted 93.7–98.4%of the target correction for configuration 2 and 98.3–98.9%of the target correction for configuration 3.Torsional deformity correction showed considerable discrepancies between the target and achieved correction, ranging from 65.6% to 83%. DiscussionThe value of the applied compression force had no marked effect on the differences between the target and achieved correction or on the magnitude of unintended rotational and transverse displacement of bone fragments. The use of hexapod fixators helped achieve complete correction of the simulated varus deformity; however, complete correction of torsional deformities was not achieved. Deformity correction in physical models with the use of a hexapod fixator yielded instances of unintended rotational and transverse bone-fragment displacement. The use of hexapod fixators in physical models leads to differences between the planned and actual position of bone fragments. Level of EvidenceIV, case series.

Experimental assessment of changes in bone fragment position using infraread diodes on saw bone models with a hexapod fixator

BackgroundThe purpose of this study was an experimental assessment of changes in bone fragment position in patients with non-union of the tibia treated with a hexapod fixator. HypothesisWe hypothesized that the use of hexapod fixators leads to differences between the planned and actual position of bone fragments. MethodsThe study was conducted in physical models of the hexapod fixator–bone fragment system. Bone fragment displacement was measured using the Optotrak Certus Motion Capture System. We assessed differences between the planned and actual position of bone fragments. ResultsAssessment of bone fragment compression demonstrated a difference between the target and actual correction ranging from 1.5% to 13.2% (depending on the force applied to bone fragments) for configuration 1, from17% to 21.3% for configuration 2, and from 13.2% to 17.9% for configuration 3. The achieved varus deformity correction constituted 93.7–98.4% of the target correction for configuration 2 and 98.3–98.9% of the target correction for configuration 3. Torsional deformity correction showed considerable discrepancies between the target and achieved correction, ranging from 65.6% to 83%. DiscussionThe value of the applied compression force had no marked effect on the differences between the target and achieved correction or on the magnitude of unintended rotational and transverse displacement of bone fragments. The use of hexapod fixators helped achieve complete correction of the simulated varus deformity; however, complete correction of torsional deformities was not achieved. Deformity correction in physical models with the use of a hexapod fixator yielded instances of unintended rotational and transverse bone-fragment displacement. The use of hexapod fixators in physical models leads to differences between the planned and actual position of bone fragments. Level of evidenceIV, case series.

ASSESSMENT OF THE NATURE OF THE JAW INJURY

Based on the analysis of forensic medical examinations conducted for jaw fractures, it was found that they occurred more often due to domestic trauma (fight) and sharply in a fall from a height. The most typical fracture lines are the neck of the articular process, the angle of the mandible, the mental foramen, and the midline. In the case of impact with a blunt, hard object in the region of the mandible, the mechanism of displacement of fractures under the influence of the traction of the masticatory muscles is characteristic. In all cases, the upper jaw fractures were open as well as unilateral and bilateral. In unilateral upper jaw fractures, the fracture line ran sagittally along the palatal suture. The displacement of bone fragments in the upper jaw fractures depends on the force and direction of the impact; on the weight of the fragments themselves; on the strength of the masticatory (wing) muscles traction.

EXPERIMENTAL STUDY OF OSTEOSYNTHESIS STABILITY OF THE DISTAL PART OF THE HUMERUS

Unresolved issue is improving of the osteosynthesis of extraarticular fractures of the distal humerus. Search for a simplified method of biological fixation, which assumes, with low trauma, to ensure the stable fixation of fragments and movements in the elbow joint in the early postoperative period. Objective.To carry out a comparative analysis of the bone fragments displacement of the distal humerus in extra-articular fractures, stabilized by extraosseous and transosseous osteosynthesis. Methods. Biomechanical study of the distal humerus model was made. Transosseous osteosynthesis was modeled using the author’s external fixation apparatus (EFA). For comparison, we chose an osteosynthesis with a Y-shaped plate. The humeral models were loaded with an interval and a stepwise increased in the load for compression along the axis, flexion in a parallel plane, as well as perpendicular to the fixing elements of the plate and EFA. The magnitude of the load gradually increased from 0 to 250 N with a step of 50 N. The magnitude of the forces at which, due to the action of various loads, a displacement at the level of the fracture appeared. Results. The analysis of experimental studies showed that the rod apparatus and the plate provide the same stability of fixation of the fragments of the humerus under conditions of axial compression load (p &gt; 0.05). Under the influence of bending loads of more than 100 N in a plane parallel to the fixing elements, the plate had a slight advantage (10 %). A significantly better result (p &lt; 0.01) was obtained when an external device was used under the action of bending loads in a plane perpendicular to the fixing elements. Conclusions. In the case of fractures of the distal humerus, the transosseous osteosynthesis using the proposed external fixation rod device ensures the stability of the fragments under all loading options. It is quite reliable and can be recommended for use in clinical practice.

Isolated avulsion fracture of the tibia at the insertion to the posterior cruciate ligament

Three cases of evulsion tibia fractures at the posterior cruciate ligament attachment are presented. The bone fragment displacement was more than 1 cm. All patients were treated surgically. In 1 patient reduction offracture was completed by bone suture, in 2 patients by fixation with screw inserted retrogradely. Follow up from 6 months to 4 years showed no complications, the joint was stable and full volume of motion was noted.

The first experience in the treatment of closed fractures of the metacarpal bones with the use of a short plaster cast

Method of conservative treatment of closed II-V metacarpal bone fractures was suggested. It included closed reposition of bone fragments and fixation by short plaster dressing. That dressing was a sugar-tongs plaster splint spreading from the palm to the back of the wrist via ulnar (radius) margin of hand. Careful modeling of plaster dressing with fulcrums on the palm and the back of the wrist provided stable fixation of bone fragments. That method of treatment was applied in 129 patients with closed fractures of II V metacarpal bones. Complete bone fragments reduction was obtained in 81 patients (62.8%)), significant improvement in 39 patients (30.2%). Secondary displacement of bone fragments in plaster dressing was noted in 8 cases (6.2%)). At 1.52 months follow up the results were excellent in 65% of patients, good results were achieved in 16.5%o of cases and satisfactory results in 18.5%). Unsatisfactory results were not observed.