Distal Fragment Research Articles

Talar body and posterior talar process fracture combined with peritalar luxation (clinical case)

The uniqueness of this clinical case is due to a rare combination of peritalar luxation of the talus with a fracture of its body and posterior process. No description of the same clinical case was found in the literature, however, it has been proven that such injuries have an unfavorable prognosis and are fraught with multiple complications. Also, the limited information associated with the low incidence of this type of severe injury puts practitioners in front of the difficulties of diagnosis and treatment. A 35-year-old man was injured while playing basketball. Upon admission, computed tomography (CT) revealed a fracture of the body of the talus with displacement of the distal fragment and its dislocation in the talonavicular, subtalar and talo-tibial joints, as well as a fracture of the posterior process of the talus. After an unsuccessful attempt at closed reduction, open removal of the dislocation and reposition of fragments were performed, followed by osteosynthesis of the fracture of the body of the talus. In the postoperative period, additional immobilization in the ANF was performed, followed by replacement with a functional orthosis. 6 months after the injury, the patient restored the level of his daily activities almost completely, the control CT showed no signs of post-traumatic arthrosis of the subtalar and ankle joints, how-ever, there were signs of the development of partial aseptic necrosis of the talus. This injury is unique, and despite its severity, the use of the correct treatment tactics can provide a satisfactory clinical and functional outcome.

Anthropometric Analysis of Distal Femur Parameters in the Eastern Uttar-Pradesh Population.

Anthropometric measurements of the distal femoral fragment play a crucial role in prosthesis design during arthroplastic knee surgeries and offer valuable clues for stature estimation in forensic investigations. The present study is an attempt to assess various anthropometric parameters of the distal femur in this regard. A total of 96 intact dry femora were anthropometrically assessed using digital Vernier calipers. The femoral length was measured using an osteometric table. The torsion angle was calculated with an analog goniometer. The various parameters studied included: medial condyle length and thickness, lateral condyle length and thickness, bicondylar width, intercondylar width, intercondylar depth, torsional angle, and femoral length. The data obtained were statistically analyzed using SPSS software (IBM Corp., Armonk, NY, USA). Mean medial condyle length was 57.38±4.47mm and thickness was 24.53±2.27mm. Mean lateral condyle length and thickness were found to be 58.49±4.3mm and 25.33±3.15mm respectively. Mean bicondylar width was 71.96±6.73mm, mean intercondylar width 21.86±2.71mm, and the intercondylar depth 27.04±2.59mm respectively. The average femur length was 41.87±3.31mm and the average torsion angle was 20.19°±6.99°. Significant correlations were observed between distal femoral parameters. Lateral condyle length showed maximum correlation with other parameters. Femur length was found to correlate significantly with all parameters except medial condyle thickness. Torsion angle was significantly correlated with lateral condyle length and femur length only. The findings of this study show considerable variation from those of other studies done within India. This proves that distal femoral anthropometry has regional variations. These data can aid sports physicians and orthopedic surgeons with implant designing and forensic experts during investigations.

The Akin osteotomy without fixation in open hallux abducto-valgo correction surgery – A single center retrospective analysis of 286 cases

BackgroundDescription of a large cohort of Akin osteotomies without fixation (286 feet), to depict the mean angular correction, to analyze complication rates and to pull over with rates described in the literature with other techniques. MethodsRetrospective single-center cohort study. Five radiologic measurements analyzed preoperatively and postoperatively until fusion was completed. Evaluation of all peri- and postoperative complication rates. Evaluation of correlation between complications and the presence of diabetes mellitus (DM), smoking and rheumatic disease. ResultsBetween 2011 and 2018, 222 patients, 286 feet (147 left, 139 right) met the inclusion criteria. We found an average difference between pre-op and post-op at 3 months of distal articular set angle (DASA) of 7.0 degrees and average interphalangeal joint obliquity angle (IPOA) of 12.0 degrees (p < 0.001).All cases achieved fusion but in 5.9 % (17/289 cases) of cases, we observed delayed consolidation. The average union time in these cases was 22.1 weeks.Hyperextension of the distal fragment (mal union in plantar flexion) was observed in 7 cases (2.4 %). None of the 7 cases required correction.Out of 286 surgeries, 8 (2.7 %) required reoperation, but only one case for a hypocorrection required Akin's re osteotomy. Regarding the inter- and intra-observer correlations, good and excellent reliability are observed for all parameters under consideration. ConclusionThe absence of internal fixation would appear not to impair osteotomy healing and complication rates compared with techniques with fixation would not appear to be worse. The results are encouraging; nevertheless, we believe that further studies need to be performed in order to confirm the data. Level of evidenceIV retrospective cases series

To evaluate the outcome of posterolateral plate in distal humerus fracture

Abstract Background: Extra-articular distal humerus fracture accounts for approximately 16% of humerus fractures and 3% of all fractures in adults. There is good evidence that the overall incidence of distal humerus fractures is increasing worldwide. There is a bimodal distribution concerning age and gender, with peaks of incidence in males aged 12–30 years and females aged 60 years and over. Fractures of the distal third of the humerus are challenging injuries due to their peri-articular location, the small size of the distal bone fragments, and the osteopenic quality of the bone in older adults. In this era of modern orthopedics, despite various advances, distal humeral fractures remain one of the most challenging injuries to treat. Extraarticular fractures of the distal humerus occur at an anatomical watershed between the humerus shaft and the intercondylar region. These injuries are often displaced and have complex fracture patterns with associated comminution. The aim of our study is to evaluate the outcome of the posterolateral plate in distal humerus fracture. Materials and Methods: This prospective study will be hospital based, and will be conducted at our center from September 2021 to May 2023. Patients will be selected from the emergency and outpatient departments of our college. Assessment of functional status will be done using Mayo Elbow Performance Score at 6 months postoperatively. Assessment and analysis of any complications were done in terms of loss of reduction, problems of union, and implant failure. Results: Out of 35 operated patients only 30 qualified to be included in this study. Patient demographics, mode of injury, side involved, soft tissue status, pre-operative radial nerve status, AO type of the fracture, associated injuries, and the time interval between injury and surgical intervention were recorded. During follow-up, the course of fracture healing will be documented radiologically (with a minimum of 6 weeks between successive radiographs). Evaluation of any possible loss of reduction that might occur, compared with the immediate post of radiographs. Assessment of functional status will be done using Mayo Elbow Performance Score at 6 months postoperatively. Radiological misalignment, especially varus deformities followed by apex posterior angulations was the most common deformity, though not clinically evident. Surgical fixation carries the advantage of restoration and maintenance of alignment of the fracture fragments and quick return of function. However, surgical fixation is plagued with complications like non-union, radial nerve palsy, infection, and hardware symptoms. Conclusion: In summary, treating extraarticular distal humeral fractures with plate osteosynthesis is often challenging because of the risk of centrally located posterior plates impinging on the olecranon fossa limiting distal inadequate fixation and leading to loss of fixation many times. The use of these posterolateral locking compression plate obviates this problem. The distal aspect of the plate contour around the lateral column allows for the insertion of up to five locking screws into the distal fragment. Out of 35 patients, 30 patients had complete follow-up, and only two patients needed revision of plating and bone grafting.

Use of poller screw in proximal and distal metaphyseal fractures of tibia treated with intra-medullary inter-locking nail: A prospective study of 25 patients

Introduction: Treatment of tibia metaphyseal fractures is still difficult. Interlocking tibial fractures is preferred because it allows for some load sharing, preserves extraosseous blood flow, avoids major soft tissue dissection, and is well-known by most surgeons. Nailing of metaphyseal fractures with a short proximal or distal fragment is linked to increased malalignment, especially in the coronal plane, non-union, and the necessity for subsequent treatments to accomplish union. Blocking screws (poller screws), temporary unicortical plating, alternative nail designs with variable proximal bends (proximal third fractures), and fibular plating have all been proposed to better nailing metaphyseal fractures (distal third fractures).''The study's goal was to see if poller screws might be used as a supplement to stability in tibia metaphyseal fractures treated with a statically locked intramedullary nail. Materials and Methods: It was a prospective trial in which 25 patients with extraarticular Tibia metaphyseal fractures presented between July 2020 and December 2021 were treated with an Intra-Medullary Inter-Locking nail augmented with Poller screws and observed for six months. Results: The average age was 45.92 years, with a male majority.

Fracture edge features of diaphyseal clavicular fractures: A morphologic study.

Previous researchers used transverse fractures centered over the midpoint of the clavicle as the diaphyseal clavicular fracture models. However, as a result of shear stress concentration in sigmoid-shaped structures, most diaphyseal clavicular fractures have coronal fracture edges and are located distal to the midpoint. The purpose of this study was to quantify the morphology and utilize these parameters to establish clinically relevant fracture models. The computed tomographic DICOM data of 100 consecutive patients were included. We investigated the morphologic characteristics of the fracture edges after virtual fracture reduction. The fracture orientation was determined based on the normal vectors of the best-fit plane of the fracture edges. The fracture location was measured by the extreme points of the edges. The fracture configuration was evaluated using fracture maps. There were 28 simple, 43 wedge, and 29 multifragmentary types. Coronal oriented fracture edges accounted for more than 70% of the simple, wedge, and multifragmentary types. The most proximal point of the proximal edge was located at 46.7 (42.0-56.5), 47.6 (42.5-50.1), and 46.3 (42.0-49.3)% of the endpoint line in the simple, wedge, and multifragmentary types, respectively (P = 0.548). The most distal point of the distal edge was located at 72.2 (68.4-75.0), 73.2 (69.5-76.9), and 74.0 (69.6-77.1)% of the endpoint line (P = 0.353). The longest proximal main fragments occurred in the simple types at 71.9 (66.3-75.4)% of the endpoint line (P < 0.001), and the shortest distal main fragments occurred in the multifragmentary types at 55.8 (49.8-59.3)% of the endpoint line (P = 0.001). The heatmaps showed a high concentration of anteriorly distributed wedge fragments (88%; n=38/43) and coronally distributed multifragmentary fragments (62%; n=18/29). We showed that typical diaphyseal clavicular fractures have coronal fracture edges and are located within the distal half of the diaphyseal segment. The fractured fragments were initiated anteriorly in the wedge types and then propagated coronally in the multifragmentary types. The features of these fracture edges could be useful in designing osteotomy models and provide different perspectives of anterior and superior plating techniques.

Early results of intramedullary nail fixation in distal tibia oblique osteotomy for the reduction of soft tissue complications.

During distal tibial oblique osteotomy, external fixators can increase pin site infection risk, whereas plates can cause wound necrosis, necessitating a compromise between soft-tissue position and length. We provide the first report of the early results of intramedullary nail fixation in these osteotomies for avoiding soft tissue complications. Ten ankles, classed as Takakura-Tanaka stages 3a to 4 and unclassified and treated via distal tibial oblique osteotomy for ankle osteoarthritis between 2017 and 2021, were included. Osteotomy was performed obliquely from the distal medial tibia to the tibiofibular joint. The distal tibial fragment was rotated distally in the coronal plane for realignment. An intramedullary nail fixation was applied for stabilization. The resulting gap was filled with iliac bone graft. Ankles were evaluated on the Japanese Society for Surgery of the Foot ankle-Hindfoot Scale and Self-Administered Foot Evaluation Questionnaire before surgery and at final follow-up. Radiographic assessments were performed. Bone union was achieved within 3 months in all patients. There were no cases of wound necrosis or correction loss postsurgery. Japanese Society scale scores significantly improved from 40.3 ± 15.9 to 87.5 ± 12.6 (P < 0.01). Mean self-evaluation scale scores (pain and pain-related, physical functioning and daily living, social functioning, general health and well-being) improved significantly. shoe-related scores did not change significantly but improved. There was no correction loss after surgery, with an average widening of 24.2 mm and opening angle of 22.6° at the osteotomy site. Our study showed that intramedullary nail for fixation of the osteotomy site in distal tibial oblique osteotomy effectively prevents soft tissues complications even in osteotomy sites with large openings.

Clinical and Radiological Characteristics of Lesser Trochanter Splitting Irreducible Intertrochanteric Fractures.

The purpose of this study was to investigate the demographic factors and radiological characteristics of lesser trochanter splitting (LTS) irreducible intertrochanteric fractures and to report the clinical results of patients who underwent open reduction and internal fixation using dynamic hip screws (DHS). Inclusion criteria were as follows: AO/Orthopedic Trauma Association type 31A1.2, a fracture line originating from the outside of the greater trochanter that passes through the lesser trochanter, and patients who were followed up for more than 1 year with a confirmed presence or absence of bone union. A total of 13 cases were identified, accounting for 3.1% (13/416 intertrochanteric fractures). Patients were classified according to posterior sagging of the distal shaft fragment relative to the head-neck fragment (posterior sagging group, 6; non-sagging group, 7). Demographic data, comorbidities, injury mechanism, type of anesthesia, operation time, blood loss, tip-apex distance, reduction quality, leg length discrepancy (> 5 mm), long lesser trochanter sign, postoperative complications, and presence of bony union were obtained by reviewing medical records and radiological findings. The mean age of the patients was 50.4 ± 10.4 years, and 12 were men. Except for 1 case (slip down), all were induced by high-energy trauma. According to the grade of reduction quality, 5 cases (38.5%) had good reduction quality and 8 cases (61.5%) had acceptable reduction quality. There were no postoperative complications, and bony union was observed in all cases. The long lesser trochanter sign was observed in 5 cases (38.5%) and leg length discrepancy greater than 5 mm was not observed. Compared with the non-sagging group, the posterior sagging group had more head-neck fragments containing more than 1/2 of the lesser trochanter length, longer operation time, and more blood loss (p < 0.05). Compared to the non-sagging group, the posterior sagging group had worse reduction quality and more long lesser trochanter signs (p < 0.05). Open reduction and internal fixation using DHS for the LTS irreducible intertrochanteric fractures can achieve good clinical and radiological outcomes. However, in the posterior sagging type, reduction can be more difficult with a longer operation time and higher likelihood of blood loss.

Fibular Fixation in Same-Level Distal Third Tibiofibular Fractures: Is Fibular Fracture Regarded as a Secondary Importance?

Although most studies focused on the alignment or union of the tibia in same-level distal third tibiofibular fractures, the outcome of a concomitant fibular fracture is generally regarded as being of secondary importance in the literature. This study aimed to assess the outcomes of fibular fractures in same-level distal third tibiofibular fractures. In this retrospective study, we enrolled 111 patients with same-level distal third tibiofibular fractures treated at our institute between January 2016 and August 2020. Tibial fractures were stabilized with intramedullary nailing, and the cases were divided into two groups based on whether they additionally underwent fibular fixation (group 1, 57 cases) or not (group 2, 54 cases). Clinical and radiographic outcomes were used for the evaluation of tibial and fibular alignments, union of the tibia and fibula, number of interlocking screws in the distal tibial fragment, range of motion of the ankle joint, and complications. No statistically significant differences in the tibial union rate or mean tibial alignment were observed between the two groups on either the immediate postoperative or final radiographs. The fibular union rate in group 1 was significantly higher than that in group 2 (fibular nonunion, 0 vs. 15; p < 0.001). Statistically significant differences in fibular displacement were observed on immediate postoperative radiographs between patients with fibular union and those without it. At the final follow-up, the mean range of ankle motion and lower extremity functional scale scores did not differ between the two groups. Regardless of whether fibular fixation was performed, the overall tibial alignment with intramedullary nailing was well restored and the union rate of the tibia was comparable in the two groups. Fibular nonunion is not uncommon in unfixed fibula fractures. Displacement of the fibula as seen on immediate postoperative radiographs was related to fibular nonunion.

Neglected Patellar Fracture Treated Using Ipsilateral Hamstring Autograft Augmentation: A Case Report

Introduction: Inferior pole patellar fractures occur in relatively young patients after eccentric contraction of the quadriceps or direct trauma. Early diagnosis and adequate treatment lead to excellent outcomes and prevent tendon retraction and scarring. The aim of surgical treatment is to restore of extensor mechanism rather than anatomical articular reduction. We propose a cerclage wire technique using ipsilateral hamstring augmentation for the patellar tracking restoration. Case Description: A forty nine-year-old female, presented to our sport clinic with chief complaint of pain in the left knee and difficulty in walking and standing in long period of time following a direct trauma falling from the stairs to the knee one year back. Clinical examination revealed gap in the left knee cap and the patient could not able to straighten the knee actively. Plain radiographs of knee were taken in anteroposterior and lateral views show fracture of the inferior pole of the left patella. Magnetic resonance imaging (MRI) of the knee confirmed inferior pole patellar fracture with the proximal migration of patella with no other intraarticular injuries with partial tear of left patellar tendon. Patellar tendon reconstruction was planned using ipsilateral semitendinosus (ST) and Gracillis (G) autograft and ORIF cerclage wire augmentation. Follow-up was performed after one month post-operation. Patient was able to straighten the left knee and fully weight bearing mobilized without any pain. Range of motion was 0/100 compared to the contralateral knee. Muscle atrophy was not found. Xray was performed and shows callus formation with stable fixation. Conclusion: Neglected patellar fracture is a rare occurrence, the treatment of which is a difficult challenge for orthopaedic surgeons. Therefore, the goal of surgical treatment of inferior pole fractures is restoration of extensor mechanism rather than anatomical articular reduction. In inferior pole fracture of the patella, comminution in fractured distal fragment is common and secure fixation to allow early motion is difficult to achieve. The advantage of the described technique is the possibility of immediate weightbearing and early mobilization. A parallel could be drawn with the biological augment for patellar tendon repair, in which semitendinosus augmentation allows immediate postoperative mobilization with excellent functional results. This allows patients with early functional exercise and has a positive significance for the smooth recovery of the articular surface of the patella and recovery of knee extensor device function. Functional impairment of the extensor mechanism and postoperative complications triggers the quest for finding the ideal technique.

Quiste gigante acromioclavicular en paciente mayor. Hasta cuando tratar la causa.

Introduction: Acromioclavicular joint cysts are a rare entity, generally present in elderly patients with chronic injuries or arthropathies of the rotator cuff. There are several causes of cyst formation, there are generally two of the most frequent, which we will talk about in this article. Clinical case: We present the case of an 82-year-old male patient with a giant acromioclavicular cyst, more than 20 cm in diameter, with rapid growth in recent months and with associated rotator cuff tendon injury. Discussion: These cysts are not very frequent injuries, mainly caused by degeneration of the acromioclavicular joint, most of the cases associated with rotator cuff injuries. Diagnosis is based on clinical examination, ultrasound and magnetic resonance imaging. Treatment by cyst aspiration and corticosteroid infiltration is not usually very effective and has a high recurrence rate, so surgical removal of the cyst is more indicated. Conclusions: The surgical indication for these cysts is pain, sometimes associated with resection of distal fragments of the clavicle; when a rotator cuff injury is present, reverse shoulder arthroplasty can be an alternative; however, in patients with poor symptoms, simple excision of the cyst can be an effective treatment.

CAN THE PERCUTANEOUS CHEVRON AND AKIN (PECA) TECHNIQUE CORRECT THE PRONATION OF THE FIRST METATARSAL IN HALLUX VALGUS?

Pronation of the first metatarsal in hallux valgus has recently been discussed among foot and ankle surgeons. This study aimed to evaluate the potential radiographic correction of moderate and severe hallux valgus using the percutaneous Chevron and Akin (PECA) technique. We evaluated 45 feet in 38 patients (mean age 65.3 years old [36 - 83]; 4 men; 34 women; 7 bilateral) who underwent surgical correction using the PECA technique. The radiographic images evaluated were anteroposterior radiographs obtained pre- and postoperatively at least 6 months after surgery, including the metatarsophalangeal angle, the intermetatarsal angle, pronation of the first metatarsal, displacement of the distal fragment, medial sesamoid position and bone union. All parameters evaluated showed significant postoperative improvement, including correction of pronation of the first metatarsal (p < .05) and position of the sesamoid (p < .05). There was a union of osteotomies in all feet. No complications were observed, such as screw loosening or necrosis of the first metatarsal head. The PECA technique can correct pronation of the first metatarsal in moderate and severe hallux valgus, and other deformity-associated parameters. Level of Evidence IV; Case Series.

Anterior Screw Fixation for Odontoid Fractures - A Case Series.

Fractures of the odontoid process are common cervical spine injuries, accounting for 10-20% of all cervical spine fractures. Anterior screw fixation of odontoid fractures is an osteosynthetic technique that can give immediate stability and preserve normal mobility. The study was conducted in Government Mohan Kumaramangalam Medical college in the period 2017-2020. Five patients with Anderson and D'Alonzo type II odontoid Fractures were included in the study. Through anterior approach, using a horizontal skin incision, a K wire is inserted from the inferior edge of C2 through the incision and impacted into the odontoid process. A cannulated screw with non-threaded proximal shaft is inserted and tightened firmly to allow the distal fragment to compress on the body of C2. All the patients were reviewed postoperatively at 3, 6, and 12 months. Out of the five patients, all the patients had successful anatomical union at the end of 16 weeks. No neurological sequelae were reported. Anterior screw fixation provides a reasonable approach to odontoid fractures. Posterior stabilization using multiple techniques has been described with good union rates but has several disadvantages. Anterior screw fixation provides direct fracture fixation without the need for bone grafts. In addition, it reduces post-operative discomfort and length of hospital stay. Anterior odontoid screw fixation was associated with relatively low complication rates and a high union rate in our study. We conclude that this shall be the preferred treatment method for Type II odontoid fractures.

Does rotational deformity cause poor outcomes after pediatric supracondylar humerus fractures?

We aimed to show the effect of rotational deformity on the development of cubitus varus deformity (CVD) com-plication after supracondylar humerus fracture surgery. Patients with Gartland type II, and more severe fractures treated with Closed reduction and percutaneous pinning alone were included in the study. Rotational deformity was assessed with the formula described by Henderson et al. Patients with rotational deformity >10° were included in Group 1, and patients with deformity <10° in Group 2. In terms of CVD development, patients were evaluated with the Baumann angle measurements made on the carrying angle and final follow-up radiographs. Patients who developed CVD were divided into two groups: Group A included patients who developed CVD and Group B included patients who did not develop CVD. The cosmetic and functional results were evaluated using Flynn criteria. Eighty-eight patients who met the inclusion criteria were enrolled in the study, 32 were female and 56 were male. The mean age at the time of surgery was 6.0±2.8 years and the mean follow-up time was 5.1±2.5 years. Based on measurements, Group 1 had 13 patients and Group 2 had 75 patients. Only four of the 88 had developed CVD. Three of these patients had a rotational deformity of ≥20°. The mean age of patients in group A was 2.1 years and the mean carrying angle was 5.7°±1.5° varus (P<0.001). According to the Flynn cosmetic criteria, Group A and Group 1 had significantly worse outcomes (P<0.001). In conclusion, fixation of the distal fragment in rotation may be associated with CVD and intraoperative assessment is of great value to avoid long-term deformity and cosmetic degradation.

Angulation and Translation Capabilities of a Minimized Orthopedic Hexapod Ortho-SUV Frame: An Experimental Study

Introduction Orthopedic hexapods demonstrated effectiveness and accuracy in deformity correction of limbs in both adults and children. Previous studies demonstrated the best reduction capabilities of the orthopedic hexapod Ortho-SUV Frame (OSF) versus other models of this group of external fixation devices. Minimized version of this hexapod (minimized Ortho-SUV Frame (OSFm)) was created to reduce common for this group disadvantages: large bulkiness and weight and limitation on working with “short segments”. However, the reduction capabilities of the OSFm have not yet been studied. Aim To evaluate translation and angulation capabilities of OSFm with standard struts size and to compare results to OSF with short struts size. Materials and Methods The experimental study was performed using plastic models of the tibia with osteotomy at the middle third of the shaft. Proximal and distal bone fragments were fixed with one-ring modules. The reduction capabilities of OSFm in the first series and OSF in the second series of the experiment were studied. According to the method of fixing the struts to the rings, experiments were divided into three groups: directly to the ring, using straight plates, and using Z-shaped plates. Translation and angulation capabilities were evaluated by the maximum displacement of the distal bone fragment relative to the proximal one until any of the struts reached its minimum or maximum possible length. Results In translation OSFm outperforms OSF by 2.8-9.5% fixed the struts directly to the rings, by 4.8-9.7% using straight plates, and by 27.3-29.3% using Z-plates. In angulation OSFm with struts fixed directly to the rings outperforms OSF by 33.9-55.4%, by 36.9-47.3% using straight plates, and by 29.6-36% using Z-plates. Conclusion OSFm exceeds OSF in translation and angulation capabilities in all series of experiment. Distraction and rotation capabilities and the bone fragments fixation rigidity should be evaluated as further research to prove application of OSFm as a possible better candidate for deformity correction of limbs in children and foot deformity correction.

The Management of Aseptic Non-unions of Distal Femur Fractures with Anatomical Lateral Locking Plates.

Distal femoral non-unions are challenging, and frequently associated with short distal fragments, poor bone stock, and with issues from previous implants. A retrospective study of 31 patients admitted with distal femoral non-unions treated using anatomical lateral locking plates. Non-union scores were used. The Knee Society and Neer's scores were used for the comparison of results. The mean follow-up was 39.5 months (from 24 months to 60 months). Stable union was accomplished in all. There was a significant improvement in the average Neer's score (24 preoperative to 82 post-operatively at final follow-up), the Part 1 Knee Society score from an average of 46 preoperatively to 84 post-operatively, and Part 2 Knee Society score from 36 preoperatively to 80 post-operatively. Optimal stability, good compression at the non-union site (either by lag screws or a compression device or both), maintaining the axial alignment strictly, freshening of bone ends, using an adequate amount of cortico-cancellous bone graft, respecting the biology along with the correct choice of the implant (including the size) are essential to achieve union at the fracture site. Paying attention to the basic principles of management, good contact, stability and maintaining biology is essential in the treatment of non-union. Mukhopadhaya J, Ranjan R, Sinha AK, et al. The Management of Aseptic Non-unions of Distal Femur Fractures with Anatomical Lateral Locking Plates. Strategies Trauma Limb Reconstr 2022;17(3):137-143.

Біомеханічне обґрунтування вибору засобу фіксації кісткових фрагментів при проксимальній остеотомії першої плеснової кістки

One of the most common pathologies that occurs in static deformities of the anterior joint of the foot in the foot is valgus deformity of the first toe. Distal or diaphyseal osteotomies are used for mild degrees, and proximal osteotomies for severe ones. Spikes, screws or plates with angular stability are most often used to fix bone fragments. Purpose - with the help of biomechanical studies, to study the stress-deformed state of the foot model with different options for osteosynthesis of the first metatarsal bone after the proximal osteotomy. Materials and methods. Mathematical modeling of osteosynthesis of the first metatarsal bone during correction of valgus deformity of the first toe using proximal osteotomy was carried out. Three variants of osteosynthesis were modeled: Kirschner pins, screws, and a bone plate. Results. During osteosynthesis with spikes, maximum stresses of 2.1 MPa occur in distal fragment. In the proximal fragment, the stresses are twice as low - 1.2 MPa. The tension in the resection zone is 0.1 MPa. During osteosynthesis with screws, the stresses in the proximal and distal fragments of the bone are almost the same, and are 0.9 MPa and 0.8 MPa, respectively. The tension in the osteotomy zone is 0.1 MPa. Osteosynthesis with a bone plate provides a low level of stresses in the osteotomy zone - 0.1 MPa, as well as an even distribution of stresses between the proximal and distal fragments of the metatarsal bone - 0.8 MPa and 0.7 MPa, respectively. During osteosynthesis with spikes and screws, the relative deformation of the bone regenerate does not exceed 0.13%. During osteosynthesis with a bone plate, this figure reaches 0.5%. Conclusions. For osteosynthesis of bone fragments during proximal osteotomy of the first metatarsal bone in order to eliminate valgus deformity of the first toe, spikes, screws and a bone plate can be used. All investigated types of osteosynthesis provide a low level of stress in the osteotomy zone of the first metatarsal bone, but, according to the criterion of stress values in the proximal and distal fragments of the bone, osteosynthesis with spikes showed the worst result, and osteosynthesis with a bone plate showed the best. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Metacarpal Shortening with Intramedullary Screw Fixation: A Cadaveric Study.

Background Intramedullary screw fixation is a commonly used technique for the management of metacarpal fractures. However, compression across the fracture site can lead to unintentional shortening of the metacarpal. Questions/Purposes Our aim was to evaluate the risk of overshortening with differing intramedullary device designs for fixation of metacarpals. Methods The small finger metacarpal of nine fresh-frozen cadavers were included. A metacarpal neck fracture was simulated with a 5-mm osteotomy. Three different intramedullary screw designs were compared. Each screw was placed in a retrograde fashion into the intramedullary canal and the amount of shortening measured. Screws were reversed and the number of reverse turns with the screwdriver needed to release overshortening were measured. Results The average shortening at the osteotomy site was 2.5 mm. The mean shortening was 80%, 58%, and 12% for the partially threaded screw, fully threaded screw, and threaded nail, respectively. The mean differences of the distance shortened were statistically significant for the threaded nail compared with the partially and fully threaded screws. The partially threaded screw had the most shortening, while the threaded nail provided the least amount of shortening. When the screws were reversed, the screws did not disengage until the screw was fully removed from the osteotomy site. Conclusion The fully threaded nail demonstrates less shortening and possibly minimizes overshortening of fractures compared with partially threaded and fully threaded screw designs. Overshortening cannot be corrected by unscrewing the screw unless completely removed from the distal fragment. Clinical Relevance Orthopaedic surgeons may select intermedullary screws based on the design that is suited for the particular metacarpal fracture pattern.

Reverse distal similarity of hapten structure enhancing antibody’s group-specificity: Development of an immunochromatographic strip for tylosin and tilmicosin in milk and water

The most common macrolide veterinary drugs used in animal husbandry are tylosin and tilmicosin. To protect human health, tylosin and tilmicosin residues in animal products and environmental water samples must be monitored on-site. A monoclonal antibody and gold nanoparticle-based lateral flow immunochromatographic strip (LFIS) were used in this study to detect tylosin and tilmicosin simultaneously, allowing for quantitative detection with a portable reader. The four-parameter equation fit produced a standard sigmoid curve under optimized conditions, with IC50 of 17.69 ng/mL and LOD(IC10) of 1.72 ng/mL for tylosin and IC50 of 18.95 ng/mL and LOD(IC10) of 7.07 ng/mL for tilmicosin. Additionally, good linearity results were obtained in the actual concentration range of 3.25–50 ng/mL, with R squares of 0.9946 for tilmicosin and 0.9953 for tylosin. The degree of cross-reactivity with other analogs was less than 0.1%. The average recoveries for tylosin and tilmicosin ranged from 77.5% to 119.7% and from 80% to 126.1% in milk, from 81.1% to 108.0% and from 98.3% to 106.8% in environmental water, respectively. The results could be obtained in 5–8 min. Therefore, the developed lateral flow immunochromatographic strip was met for the rapid detection of tylosin and tilmicosin residues in milk and environmental water samples using group screening. Furthermore, we discovered that the high matching of three dimensional structure at the distal structural fragments of the hapten arm site, as well as the consistency of the frontier orbital distribution, are very critical factors for the analytical performance of antibody against target molecules and should be considered as a universal theoretical guide for hapten design.

Multi-split intra-articular fractures of the distal humeral metaepiphysis in children

Background: The need to minimize the immobilization of the elbow joint in multifragmental fractures of the distal metaepiphysis of the humerus is confirmed by a number of factors, including the complexity of its anatomical structure, the uniqueness of biomechanics, as well as the limited ability of hyaline cartilage to regenerate. The restoration of the motor potential of the limb in multifragmentary fractures of the distal metaepiphysis of the humerus determines the priority of the treatment technique, which allows the patient to return to his usual lifestyle in the near future.Objective: Demonstration of the effectiveness of percutaneous spinal osteosynthesis with wires in fractures of distal metaepiphysis of the humerus in adolescent children.Clinical cases: This paper describes two clinical cases in adolescent children with multifragmentary fractures (open and closed) of the distal part of humerus (12В and 13С according to the AO classification). In both cases, the treatment consisted of sequential application of skeletal traction, for fragments traction and their mobility increase, then closed reposition of fragments under the control of electron-optical converter with metal osteosynthesis with wires. Moreover, taking into consideration the U- and T-shape nature of the fractures, the first stage of reposition included stabilization and fixation of the distal fragments to each other and then to the proximal fragment.Conclusion: In our opinion, it is the combination of traditional methods of treatment (application of skeletal traction system), modern technologies (EOC control), alternative (atypical) options for using metal structures that allow achieving good functional treatment results in this category of patients.