Early Full Weight Bearing Research Articles

NCB-PP® locking plates outcomes in the treatment of periprosthetic femoral fractures. Analysis of a retrospective cohort of 89 patients

IntroductionThe management of periprosthetic femoral fractures is particularly complex in an elderly, frail population, with an increasing incidence due to the increase in femoral prosthesis surgery. The use of locking plates is now widely recommended. The primary objective of this study was to present the results of NCB-PP® locking plates in the management of periprosthetic femoral fractures. The secondary objective was to determine the influence of weight-bearing time on morbidity and mortality and on walking ability. The hypothesis of this study was that NCB-PP® plates would provide radio-clinical results equivalent to those reported in the literature with no influence of time to re-weighting on complication rate and walking level at 1 year post-operatively. Materials and methods89 patients (mean age 81 ± 11.9 (28−99), with a female predominance 62/89 (69.7%)) underwent 89 periprosthetic femur fractures (74 THA, 11 TKA and 4 interprosthetic) and treated with NCB-PP® plates were retrospectively included between January 2014 and September 2022. Patients were then divided into 2 groups according to the time to postoperative full weight bearing: "immediate" (n = 30) and "delayed" (n = 59) (a minimum of 6 weeks post-operatively). ResultsThe mean follow-up time was 14.6 months. At 6 months post-operatively, 91.8% of patients were consolidated. At 1 year, 36.2% had resumed independent walking, 8.7% required one crutch, 13% two crutches, 33.3% walked with a walker and 8.7% were considered non-walkers. There were 12 complications (13.5%), including 7 mechanical (7.9%) and 5 infections (5.6%), with 10 patients (11.2%) requiring a revision surgery. Mortality at 6 months and 1 year was respectively 9 and 12.4%. There was no significant difference between pre- and post-operative walking levels (p = 0.45). There was no influence of the time to reweighting on the level of walking at 1 year (p = 0.874), on complications (p = 0.17) or on mortality at 1 year (p > 0.99). ConclusionThis study confirms the initial hypothesis and the results of preliminary studies on a smaller sample size regarding bone union of periprosthetic femoral fractures with NCB-PP® plates, with a low rate of mechanical complications. The proportion of patients returning to their previous walking level remains low, but early full weight bearing is still possible without increasing the rate of mechanical complications. Level of evidenceIV; retrospective cohort study.

Management of zone 2 fifth metatarsal fractures varies based on treating specialty.

This study evaluated the effect of treating clinician speciality on management of zone 2 fifth metatarsal fractures. This was a retrospective cohort study of patients with acute zone 2 fifth metatarsal fractures who presented to a single large, urban, academic medical centre between December 2012 and April 2022. Zone 2 was the region of the fifth metatarsal base bordered by the fourth and fifth metatarsal articulation on the oblique radiograph. The proportion of patients allowed to bear weight as tolerated immediately after injury was compared between patients treated by orthopaedic surgeons and podiatrists. The effects of unrestricted weightbearing and foot and/or ankle immobilization on clinical healing were assessed. A total of 487 patients with zone 2 fractures were included (mean age 53.5 years (SD 16.9), mean BMI 27.2 kg/m2 (SD 6.0)) with a mean follow-up duration of 2.57 years (SD 2.64). Overall, 281 patients (57.7%) were treated by orthopaedic surgeons, and 206 patients (42.3%) by podiatrists. When controlling for age, sex, and time between symptom onset and presentation, the likelihood of undergoing operative treatment was significantly greater when treated by a podiatrist (odds ratio (OR) 2.9 (95% CI 1.2 to 8.2); p = 0.029). A greater proportion of patients treated by orthopaedic surgeons were allowed to immediately bear weight on the injured foot (70.9% (178/251) vs 47.3% (71/150); p < 0.001). Patients treated by podiatrists were immobilized for significantly longer (mean 8.4 weeks (SD 5.7) vs 6.8 weeks (SD 4.3); p = 0.002) and experienced a significantly longer mean time to clinical healing (12.1 (SD 10.6) vs 9.0 weeks (SD 7.3), p = 0.003). Although there was considerable heterogeneity among zone 2 fracture management, orthopaedic surgeons were less likely to treat patients operatively and more likely to allow early full weightbearing compared to podiatrists.

Intraoperative Complications in Medial Opening Wedge High Tibial Osteotomy.

Medial opening wedge high tibial osteotomy has been established for treatment of medial symptomatic knee arthrosis with varus malalignment in young and elderly but active patients. To obtain satisfactory results, it is essential for surgeons performing osteotomy to identify, prevent, and treat potential intraoperative adverse events. Lateral hinge fracture (LHF) is the most common intraoperative complication while popliteus artery injury is rare but limb-threatening. Computed tomography is the benchmark to detect LHF, the risk of which increased markedly with the opening gap larger than 11 mm. Setting the lateral hinge in a safe zone is the most important preventive measure. Medial long locking plate fixation may allow patients even with unstable hinge fractures to start early full weight bearing. Additional fixation of LHF is optional, and bone void filling is not routinely used. For protection of popliteus artery injury, flexing the knee joint is unreliable. It is paramount to place a protective retractor just behind the posterior tibial cortex toward the proximal tibiofibular joint before osteotomy, particularly in case of aberrant artery. A repertoire of surgical pearls is described in detail in this review to identify, prevent, and manage those intraoperative complications.

Osteotomy Site Venting Enhances Femoral Bone Consolidation With Magnetic Intramedullary Lengthening Nails.

Magnetic intramedullary lengthening nailing has demonstrated benefits over external fixation devices for femoral bone lengthening. These include avoiding uncomfortable external fixation and associated pin site infections, scarring, and inhibition of muscle or joint function. Despite this, little has changed in the field of biologically enhanced bone regeneration. Venting the femoral intramedullary canal at the osteotomy site before reaming creates egress for bone marrow during reaming. The reamings that are extruded from vent holes may function as a prepositioned bone graft at the distraction gap. The relationship between venting and the consolidation of regenerating bone remains unclear. (1) Do bone marrow reamings extruded through venting holes enhance the quality of bone regeneration and improve healing indices and consolidation times? (2) Is venting associated with a higher proportion of complications than nonventing? We performed a retrospective study of femoral lengthening performed at one hospital from December 2012 to February 2022 using a magnetic intramedullary lengthening nail with or without venting at the osteotomy site before reaming. This was a generally sequential series, in which the study groups were assembled as follows: Venting was performed between July 2012 and August 2016 and again from November 2021 onward. Nonventing was used between October 2016 and October 2021 because the senior author opted to create drill holes after the reaming procedure to avoid commitment to the osteotomy level before completing the reaming procedure. Outcomes were evaluated based on bone healing time, time to achieve full weightbearing, and complications. Sixty-one femoral lengthening procedures were studied (in 33 male and 28 female patients); two patients were excluded because of implant breakage. The mean age was 17 ± 5 years. The mean amount of lengthening was 55 ± 13 mm in the venting group and 48 ± 16 mm in the nonventing group (mean difference 7 ± 21 [95% CI 2 to 12]; p = 0.07). The healing index was defined as the time (in days) required for three cortices to bridge with new bone formation divided by the length (in cm) lengthened during the clinical protocol. This index signifies the bone formation rate achieved under the specific conditions of the protocol. Full weightbearing was allowed upon bridging the regenerated gap on three sides. Consolidation time was defined as the total number of days from the completion of the lengthening phase until adequate bone union (all three cortices healed) was achieved and full weightbearing was permitted. This time frame represents the entire healing process after the lengthening is complete divided by the amount of lengthening achieved (in cm). Patient follow-up was conducted meticulously at our institution, and we adhered to a precise schedule, occurring every 2 weeks during the distraction phase and every 4 weeks during the consolidation phase. There were no instances of loss to follow-up. Every patient completed the treatment successfully, reaching the specified milestones of weightbearing and achieving three cortexes of bone bridging. The mean healing index time in the venting group was faster than that in the nonventing group (21 ± 6 days/cm versus 31 ± 22 days/cm, mean difference 10 ± 23 [95% CI 4 to 16]; p = 0.02). The mean consolidation time was faster in the venting group than the nonventing group (10 ± 6 days/cm versus 20 ± 22 days/cm; mean difference 10 ± 23 [95% CI 4 to 15]; p = 0.02). No medical complications such as deep vein thrombosis or fat or pulmonary embolism were seen. Two patients had lengthy delays in regenerate union, both of whom were in the nonventing group (healing indexes were 74 and 62 days/cm; consolidation time was 52 and 40 days/cm). Femoral lengthening with a magnetic intramedullary lengthening nail healed more quickly with prereaming venting than with nonventing, and it allowed earlier full weightbearing without any major associated complications. Future studies should evaluate whether there is a correlation between the number of venting holes and improvement in the healing index and consolidation time. Level III, therapeutic study.

Surgical strategy and complication management of osteotomy around the painful degenerative varus knee: ESSKA Formal Consensus Part II.

The purpose of the European consensus was to provide recommendations for the treatment of patients with a painful degenerative varus knee using a joint preservation approach. Part II focused on surgery, rehabilitation and complications after tibial or femoral correction osteotomy. Ninety-four orthopaedic surgeons from 24 countries across Europe were involved in the consensus, which focused on osteotomies around the knee. The consensus was performed according to the European Society for Sports Traumatology, Knee Surgery and Arthroscopy consensus methodology. The steering group designed the questions and prepared the statements based on the experience of the experts and the evidence of the literature. The statements were evaluated by the ratings of thepeer-review groups before a final consensus was released. The ideal hinge position for medial opening wedge high tibial osteotomy (MOW HTO) should be at the upper level of the proximal tibiofibular joint, and for lateral closing wedge distal femoral osteotomy (LCW DFO) just above the medial femoral condyle. Hinge protection is not mandatory. Biplanar osteotomy cuts provide more stability and quicker bony union for both MOW HTO and LCW DFO and are especially recommended for the latter. Osteotomy gap filling is not mandatory, unless structural augmentation for stabilityis required. Patient-specific instrumentation should be reserved for complex cases by experienced hands. Early full weight-bearing can be adopted after osteotomy, regardless of the technique. However, extra caution should be exercised in DFO patients. Osteotomy patients should return to sports within 6 months. Clear recommendations for surgical strategy, rehabilitation and complications of knee osteotomies for the painful degenerative varus kneewere demonstrated. In Part 2of the consensus, high levels of agreement were reached by experts throughout Europe, under variable working conditions. Where science islimited, the collated expertise of the collaborators aimed at providing guidance for orthopaedic surgeons developing an interest in the fieldand highlighting areas for potential future research. Level II, consensus.

Augmented Articulating Spacers in Infected Total Knee Arthroplasty: Surgical Technique.

Periprosthetic joint infections (PJIs) are a prominent subject of discussion in orthopedics and are frequently debated at conferences and congresses. In the context of PJIs affecting the knee, the decision between following a one-stage or two-stage treatment approach has historically been a pivotal consideration. The first option is limited by indications and potentially devastating complications in case of failure, whereas the second is widely accepted as the gold standard. Initially, the spacer was conceived solely to restore and maintain knee space after removal of the implant. An articulating spacer was introduced to mitigate patient limitations and improve knee function and quality of life. Two main types of articulating spacers are utilized in knee PJI treatment: the mold spacer and the metal-on-poly spacer. This text outlines a technique for metal-on-poly spacer implants. Based on our experience and the existing literature, this approach facilitates early full weight bearing and faster recovery of the knee's range of motion, ultimately improving the quality of life after surgery, thus allowing the spacer retention for an extended period, as suggested by the 1.5-stage revision.

Hexaxial external fixator versus intramedullary nail in treating segmental tibial fractures: a retrospective study

BackgroundIt’s difficult to treat segmental tibial fractures (STFs), which are intricate injuries associated with significant soft tissue damage. The aim of this study was to compare the clinical effect of hexaxial external fixator (HEF) and intramedullary nail (IMN) in treatment of STFs.MethodsA total of 42 patients with STFs were finally recruited between January 2018 and June 2022. There were 25 males and 17 females with age range of 20 to 60 years. All fractures were classified as type 42C2 using the Arbeitsgemeinschaftfür Osteosythese/Orthopaedic Trauma Association (AO/OTA) classification. 22 patients were treated with HEF and 20 patients were treated with IMN. The condition of vascular and neural injuries, time of full weight bearing, bone union time and infection rate were documented and analyzed between the two groups. The mechanical medial proximal tibial angle (mMPTA), mechanical posterior proximal tibial angle (mPPTA), mechanical lateral distal tibial angle (mLDTA), mechanical anterior distal tibial angle (mADTA), hospital for special surgery (HSS) knee joint score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle joint score, range of motion (ROM) of flexion of keen joint and ROM of plantar flexion and dorsal flexion of ankle joint were compared between the two groups at the last clinical visit.ResultsThere were no vascular and neural injuries or other severe complications in both groups. All 22 patients in HEF group underwent closed reduction but 3 patients in IMN group were treated by open reduction. The time of full weight bearing was (11.3 ± 3.2) days in HEF group and (67.8 ± 5.8) days in IMN group(P < 0.05), with bone union time for (6.9 ± 0.8) months and (7.7 ± 1.4) months, respectively(P < 0.05). There was no deep infection in both groups. In the HEF group and IMN group, mMPTA was (86.9 ± 1.5)° and (89.7 ± 1.8)°(P < 0.05), mPPTA was (80.8 ± 1.9)° and (78.6 ± 2.0)°(P < 0.05), mLDTA was (88.5 ± 1.7)° and (90.3 ± 1.7)°(P < 0.05), while mADTA was (80.8 ± 1.5)° and (78.4 ± 1.3)°(P < 0.05). No significant differences were found between the two groups at the last clinical visit concerning HSS knee joint score and AOFAS ankle joint score, ROM of flexion of keen joint and ROM of plantar flexion of ankle joint (P > 0.05). The ROM of dorsal flexion of ankle joint in IMN group was (30.4 ± 3.5)°, better than (21.6 ± 2.8)° in HEF group (P < 0.05).ConclusionIn terms of final clinical outcomes, the use of either HEF or IMN for STFs can achieve good therapeutic effects. While HEF is superior to IMN in terms of completely closed reduction, early full weight bearing, early bone union and alignment. Nevertheless, HEF has a greater impact on the ROM of dorsal flexion of the ankle joint, and much more care and adjustment are needed for the patients than IMN.

Efficacy of Cal-Cemex as bone substitute for tibial plateau fractures

BackgroundVarious factors influence treatment and outcomes in tibial plateau fractures. Bone defects are among them. Many materials have been proposed to address this problem: allograft, bone–cements and various bone substitutes (BSM). Cal-Cemex (β-tricalciophosphate and polymethylmethacrylate) is a new hybrid bi-component BSM. A retrospective multicenter study was conducted based on the clinical experience of three European Hospitals, to demonstrate its clinical effectiveness, versatility and safety.Materials and MethodsFrom December 2016 to March 2022, 45 displaced tibial plateau fractures were treated with internal fixation and augmentation using Cal-Cemex. The average age was 55.9 years. According to Schatzker classification, we included 13 type II, 24 type III, 3 type V and 4 type VI fractures. The postoperative follow-up (FU) consisted of clinical and radiological examinations at 6 and 12 weeks and 1 year after surgery. A CT scan was performed preoperatively and 1 year after surgery. Full weight bearing was permitted after less than 6 weeks. Clinical data were collected from patient charts, while functional data were evaluated using the Rasmussen knee function score, the KOOS score and the Hospital for Special Surgery knee rating score (HSS), to evaluate the range of motion, axis and functionality of the knee.ResultsThe average FU was 42.8 months. CT scans taken at 1 year demonstrated a good surface osteointegration without radiolucent lines or osteolysis with good evidence of interdigitation and even bone ingrowth. At 1-year FU, the mean Rasmussen score was 24.7, the mean KOOS score was 90.7 and the mean HSS was 89.9 and the average full weight-bearing period 34.9. No patients had hardware failure or fracture secondary displacement.DiscussionCal-Cemex combines biological features and good mechanical performances. It guarantees biocompatibility and osteoconductivity, although it is not fully reabsorbable; β-tricalciophosphate component gives macro- and microporosity that allow fluids to penetrate inside the material, to stimulate bone ingrowth.ConclusionsThe study suggests that Cal-Cemex is an option for tibial plateau fractures, where augmentation and support are necessary for early full weight bearing. The absence of major complications, ease of application, the possibility to cut and perforate this material support its extensive use in bone augmentation for trauma cases.

Postoperative Rehabilitation Protocols May Affect Rates of Achilles Tendon Re-Rupture after Acute Surgical Repair: A Systematic Review

Category: Ankle; Hindfoot Introduction/Purpose: Acute achilles tendon ruptures (AATR) are the most common tendon rupture in the lower limb with an incidence of up to 37 patients per 100,000 patient population annually. Several different guidelines exist on time to full weight bearing after AATR repair. Advantages of surgical management of AATR repairs are to maximize function of the tendon and reduce post-operative complications such as re-ruptures. A systematic review of the literature was performed which evaluated post-operative rehabilitation protocols, their complications and if an optimal post-operative treatment algorithm can be determined. Methods: In October 2022, MEDLINE, EMBASE and Cochrane Library databases were systematically reviewed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The level of evidence (LOE) and quality of evidence (QOE) were evaluated, and statistics on clinical outcomes, post-operative management and complications were calculated. Results: Eleven studies with 437 patients were included. Two studies were LOE I, three were LOE II, three were LOE III and three studies were LOE IV. Mean post-operative follow-up was 33.4 ± 31.2 months. Weighted mean post-operative return to full-weight bearing (FWB) was 4.8 ± 6.4 weeks. Post-operative return to neutral ankle position was achieved at an average of 4.6 ± 3.9 weeks. The overall complication rate was 3.0% (16 of 420 patients) with surgical wound infection (1.9%) and re-rupture (1.2%) the most common. Seven studies described an early rehabilitation protocol that commenced within 4 weeks from surgery. Subgroup analysis showed that early full weight-bearing (≤4 weeks) was associated with a higher re-rupture rate: 1.5% versus 0.7%. Conclusion: This systematic review demonstrated marked heterogenicity in reported rehabilitation protocols after AATR repair. While the risk of re-ruptures after surgical repair are low, we found that rehabilitation protocols that incorporate early weight- bearing within 4 weeks have a markedly increased risk of re-rupture. While there is increasing use of early rehabilitation after surgical repair of achilles tendon ruptures, further study is required to determine the optimal protocol to optimise outcome while decreasing the risk of failure.

Comparison of curative effect between percutaneous compression plate and cannulated compression screw in the treatment of displaced femoral neck fractures in young and middle-aged patients

To compare the efficacy of percutaneous compression plate and cannulated compression screw in the treatment of displaced femoral neck fractures in young and middle-aged patients. From January 2015 to July 2020, 68 young and middle-aged patients with displaced femoral neck fracture were retrospectively analyzed. Among them, 31 cases were fixed by percutaneous compression plate (PCCP), and 37 cases were fixed by cannulated compression screw (CCS). General data such as gender, age, cause of injury, comorbidities, fracture classification and cause of injury of two groups were collected. The operation time, intraoperative blood loss, hospital stay, full weight bearing time, fracture healing time, visual analogue scale(VAS), Harris hip score and complications were compared between two groups. Patients in both groups were followed up for more than 2 years. There were no significant differences in operation time, intraoperative blood loss, fracture reduction quality, hospital stay and VAS between two groups. The fracture healing time in PCCP group was significantly shorter than that in CCS group (t=-4.404, P=0.000). The complete weight bearing time of PCCP group was significantly shorter than that of CCS group (t=-9.011, P=0.000). Harris score of hip joint in PCCP group was better than that in CCS group 2 years after operation (P=0.002). Complications occurred in 3 cases (9.68%) in PCCP group, while 11 cases (29.72%) in CCS group, with a statistically significant difference (P=0.042). Both PCCP and CCS can be used for the treatment of displaced femoral neck fractures in young and middle-aged people. Compared with CCS, PCCP fixation can achieve shorter fracture healing time and create conditions for early full weight bearing. PCCP results in higher hip score and lower complications.

Osteosynthese bei extraartikulärer proximaler Tibiafraktur

The treatment of extra-articular proximal tibial fractures is atherapeutic challenge due to the frequently significant soft tissue injury, the effect of the deforming forces and the need for an exact restoration of the bony alignment. Various methods of osteosynthesis are available for surgical stabilization. The locking plate osteosynthesis is the most frequently used procedure because of its good biomechanical stability, especially in osteoporotic bones, and the protection of the periosteal blood flow. Depending on the extent and stability of the defect zone, especially in the case of amedial comminuted zone and the bone quality, bilateral plate osteosynthesis can be necessary. If the proximal fragment is big enough, closed reduction and intramedullary nailing are possible. In the case of severely compromised soft tissue or very short epiphyseal fragments, the construction of an external fixator, e.g. hybrid external fixator, is recommended, which also allows definitive treatment under early full weight bearing. The most important complications are axial and torsional malalignments.

Opening- and closing-wedge high tibial osteotomy are comparable and early full weight bearing is safe with angular stable plate fixation: a meta-analysis.

The purpose of this study was to establish the gold standard for surgical technique, fixation, and rehabilitation for HTO in patients with unicompartmental knee osteoarthritis. Medline, Embase, and SPORTDiscus databases were searched up to April 2022. Included were (1) randomized controlled trials (RCTs) comparing opening-wedge HTO (owHTO) and closing-wedge HTO (cwHTO), (2) biomechanical studies and prospective patient studies comparing biomechanical and clinical results for plate fixators, and (3) RCTs comparing an early versus delayed full-weight-bearing (FWB) protocol. The pooled results for the surgical technique showed no significant differences between owHTO and cwHTO for most PROMs on pain, activity, and risk for conversion to TKA. The cwHTO group showed a slightly better improvement in KOOS/WOMAC pain scores (4.51; 95% CI 1.18-7.85), and a significantly lower change in posterior tibial slope (p = 0.03). The pooled results for the fixation method showed the highest force at maximum failure for the Activmotion (Newclip Technics, France), Aescula (B. Braun Korea, Korea), 2nd generation Puddu (Arthrex Inc., USA), and TomoFix plate (Depuy Synthes, Switzerland). The pooled results for the rehabilitation protocol showed no significant differences between the early full-weight-bearing (FWB) group and the delayed FWB group for functional scores, complication rates, and delayed unions. Both owHTO and cwHTO reduced pain and improved knee function. Locking plate fixation should be used for owHTO. An early FWB protocol has proven to be safe in patients with small corrections, no hinge fractures, and non-smokers. Level II.

Management of Unstable Per-trochanteric Fracture in Old Patient by Primary Prosthetic Replacement

Background: Peritrochanteric fractures are frequent of the proximal femur and represents about half of all proximal femur fractures. They are associated with disability, mainly in elder patients. Its management aiming to achieve immediate ambulation and to regain the pre-operative ambulation.&#x0D; Aim and objectives; to evaluate and assess the functional and radiological outcomes of primary prosthetic replacement in old age cases of unstable per-trochanteric femur fractures,&#x0D; Subjects and methods: The current work was an interrupted time series clinical trial (quasi experimental), included 15 patients suffering from unstable per-trochanteric fracture presented to us within a week of sustaining injury. They were clinically assessed and checked for fitness for surgery. Then and after surgery, they were followed by for functional outcome by Harris Hip Scale and any complications were recorded.&#x0D; Results: Patients age ranged between 61 and 94 years. Females were more affected than males (80.0% vs 20.0%). Associated comorbidities were hypertension, diabetes and both conditions among 33.3%, 6.7% and 33.3%, successively. Falling was the commonest mode of injury (60.0%), and the left side was more affected than the right (60.0% vs 40.0%). Associated injuries were 1(6.7%) fracture surgical neck hummers, 1(6.7%) contralateral both bone leg fracture, 1(6.7%) had fracture mid shaft ulna. Regarding outcome, all cases were free from postoperative complications. However, blood loss was reported among 11(73.3%). Twelve (80%) patients had an excellent, 2 (13.3%) had good and 1(6.7%) had fair functional outcome. There was significant association between functional outcome and patients, gender, associated comorbid medical conditions, mode of trauma, side of trauma, or blood loss.&#x0D; Conclusion: Primary prosthetic replacement is a valid surgical option in management of unstable trochanteric fractures in elderly. The main advantages are the safety, effectiveness and early full weight bearing.

Clinical and radiological results after revision THA with distal locking stem: A cohort study of 44 patients

BackgroundDistal locking stems were developed in response to some complex revision procedures in total hip arthroplasty (THA), providing better axial and rotational stability. The aim of the present study was to assess medium-term clinical and radiological results of treatment with last-generation distal locking stem. HypothesisOur hypothesis was that this implant provided a high survival rate. Material and MethodsA single-center retrospective observational study included all patients who underwent THA revision with distal locking stem between April 2013 and January 2015 in our university hospital. The implant was a curved distal-locking stem fully coated in grit-blasted titanium alloy and hydroxyapatite (HA) with a collar made of TiAlV. This concept is based on primary distal fixation by interlocking screws. The primary endpoint was surgical revision for implant exchange. ResultsA total of 47 procedures with distal locking stem were performed, 44 of which were included. Minimum follow-up was 5 years. Etiologies of revision comprised 25 femoral loosenings, 13 periprosthetic fractures, 3 infections, and 3 modular taper breakages. Six patients underwent re-revision (13%), with only 1 implant change (98% survival rate). Mean Harris and Oxford Hip scores at last follow-up were respectively 81±13.5 [range, 67.4–94.5] and 26±9⋅2 [range, 16.7–35.2]. Radiologically, no stem subsidence occurred, and bone ingrowth was obtained in all cases. DiscussionFully-coated distal locking stems showed a high survival rate. They provided strong initial fixation, allowing early full weight-bearing in these frail patients. Level of evidenceIV; retrospective series.

Fibular fixation improves ankle functional outcomes and alignment in the intramedullary nailing of distal third tibiofibular diaphyseal fractures.

The study aims to determine the effect of fibular fixation on alignment and fracture healing of tibia, and ankle functional outcomes in the treatment of distal third tibiofibular diaphyseal fractures. Consecutive 111 patients (33 females and 78 males) with distal third tibiofibular diaphyseal fracture who met the inclusion criteria were included in the study. Patients were divided into two groups as those who underwent fibular fixation with tibia intramedullary nailing (study group) and those who did not (control group). Groups were compared in terms of demographic features, trauma and fracture characteristics, functional and radiological outcomes. No significant difference was observed between the groups in terms of demographic features, trauma characteristics, complications, and follow-up time (p > 0.05). Surgery time was significantly lower in the control group (p = 0.001). Ankle joint range of motion, AOFAS score, OMAS score, and full weight-bearing time were significantly better in the fibular fixation group (p = 0.023, p = 0.001, p = 0.001 and p = 0.039, respectively). Significantly better coronal alignment and sagittal alignment were found in the fibular fixation group (p = 0.001 and p = 0.001, respectively). Patients who underwent fibular fixation had significantly better radiological outcomes in terms of fibular rotation angle and ankle arthrosis (p = 0.000 and p = 0.022, respectively). Fibular fixation not only contributes to fracture union, early full weight-bearing, and alignment but also improves ankle functional outcomes in the distal third tibiofibular fractures treated with intramedullary nailing for tibia. Level III, retrospective study.

Early Weight Bearing after Distal Femur Fracture Fixation

ObjectivesTo assess outcomes following early weight bearing after distal femur fracture fixation with locked lateral plating.DesignRetrospective cohort studySettingTwo Level 1 Academic Trauma Centers.Patients/ParticipantsPatients 18 years and older with distal femur fractures treated with locked lateral platingInterventionEarly full weight bearing (defined as less than 30 days from date of surgery) versus restricted post-operative weight bearingMain Outcome MeasurementsComposite complication comprising malunion, nonunion, surgical site infection, re-admission, or deathResults270 distal femur fractures were reviewed, with 165 meeting inclusion criteria. 21 patients had been allowed early full weight bearing. Fractures were divided into two groups based on when full weight bearing was allowed post-operatively. The two groups had similar fractures as determined by the distribution of AO distal femur fracture and Su periprosthetic femur fracture classifications. The early weight bearing group was significantly older and more comorbid. Despite being older, more comorbid, and allowed early full weight bearing on their fracture fixation construct, there was no difference in the rate of composite complications between groups.ConclusionOur data contributes to the small, but growing body of literature that has found no increased rate of fracture related complications in surgically treated distal femur fractures allowed early post-operative weight bearing.Level of EvidenceTherapeutic Level III Study.

Hemiarthroplasty in Unstable Intertrochanteric Fractures in Elderly: A Prospective Study

Background: Grossly comminuted intertrochanteric fractures in osteoporotic bones are highly unstable and difficult totreat. Hemiarthroplasty is a popular choice because it provides stability and enables for immediate complete weightbearing.Objectives: The goal of this trial was to see how effective cemented hemiarthroplasty was at treating proximal femoralfractures in older people with severe osteoporosis.Methods: Thirty patients who had bipolar hemiarthroplasty for unstable intertrochanteric fractures were studiedprospectively. The posterior (Moore’s) technique was used to treat all of the patients with cemented bipolar prostheses.The average time of follow-up was 12 months. The modified Harris hip score was used to evaluate the patients.Results: Abductor weakness was present in 5 of the individuals. At the 12-month follow-up, 21 cases (70%) had badresults, while three cases (10%) had poor results. The average length of stay in the hospital was 10.9 days. Excellent to fairresults were observed in 24 patients, as measured by the modified Harris hip score.Conclusion: In older individuals with significant osteoporosis, the therapy of unstable intertrochanteric fractures differsfrom the treatment of other proximal femoral fractures. Internal fixation is not as effective as cemented hemiarthroplastyin treating these fractures. This approach has a clear advantage in terms of early full weight bearing and recovery. Hipsthat have undergone cemented hemiarthroplasty are stable and mobile. Weight bearing can begin earlier than with othertreatment approaches, avoiding any recumbency-related problems.

Timing of postoperative weightbearing in the treatment of traumatic chondral injuries of the knee in athletes - A systematic review of current concepts in clinicalpractice

BackgroundSurgery aims to stimulate healing and enable a safe return to sport in athletes with symptomatic cartilage lesions of the knee. Timing of postoperative weightbearing is crucial, balancing a stimulation of the healing and avoiding reinjury.To explore current concepts of timing to partial and full weightbearing and rate of return to sport in athletes after articular cartilage surgery of the knee.Systematic Review of studies with level of evidence I-III MethodsFour databases (Pubmed, Web of Science, Scopus and Embase) were searched using a predetermined keyword strategy. Two independent reviewers screened results according to inclusion and exclusion criteria. Modified Coleman Methodology Score (mCMS) was used for the quality assessment. Results5294 records were found. Data from ten studies was extracted after duplicate removal, title and abstract screening and full-text evaluation. Eight of the ten studies included a detailed rehabilitation protocol, including 336 out of a total athletic population of 401. 62% began partial weightbearing (PWB) 1–2 weeks postoperatively, while 38% began within 3–4 weeks. The studies that had a later PWB all returned to full weightbearing (FWB) within 6–8 weeks. One study with early PWB returned to early FWB, while the other two returned 10–12 weeks postoperatively. “Return to Sport” (RTS) was the most common reported outcome measure, with most studies reporting RTS at 80% or higher. ConclusionThere is no clear evidence that the timing of weightbearing (WB) affects the outcome and return to sport in athletes after surgery for focal full-thickness cartilage lesions of the knee. On the other hand, there seems to be no adverse effects in adopting an early WB strategy, currently defined differently by different authors. Further studies directly comparing the timing of WB for specific surgical procedures in athletes and with relevant control groups is recommended. There is a need for a consensus in regard to more exactly defining “early” vs “late” weightbearing in relation to a universal and precisely defined state of healing.

Ilizarov Method for Acute Paediatric Tibial Fractures.

Aim and backgroundA systemic method for the application of Ilizarov fixators and on-table fracture reduction is described in this instructional article. This technique has been developed from the unit's practice in adult patients. The indications, underlying principles and rationale for the method are also discussed.TechniqueThe basic concept involves the construction of a series of concentric, colinear rings aligned with the mechanical axis of the limb. An orthogonal ring block is initially placed on the proximal segment and extended distally. Wire to ring reduction techniques are used resulting in the contact, alignment and stability required for early full weight-bearing, free movement of knee and ankle, and subsequent healing.Conclusion and clinical significanceOur step-by-step guide takes the reader through a systematic approach to surgery along with tips and tricks on how to achieve reduction and avoid the common pitfalls. With this method, it is possible to achieve an on-table reduction and correction of a multiplanar deformity without the use of expensive hexapod technology. This may allow less experienced users reproduce the technique with a shorter learning curve.How to cite this articleMessner J, Prior CP, Pincher B et al. Ilizarov Method for Acute Paediatric Tibial Fractures. Strategies Trauma Limb Reconstr 2021;16(1):46–52.

Early full weight-bearing in patients with isolated displaced lateral malleolar fracture after rigid internal fixation with locking plates.

The timing of post-operative full weight-bearing in patients of isolated displaced lateral malleolar fractures remains controversial. The aim of this study was to evaluate the outcomes of early full weight-bearing after rigid internal fixation of such fractures with locking plates. From 2012 to 2018, 46 patients who had closed isolated displaced lateral malleolar fractures were included in the study. All fractures were managed with open reduction and internal fixation with locking plates. The patients were allowed to walk bearing their full weight 2 weeks after the operation. The follow-up period was 41.5 months on average (range: 12-70 months). The patients were available to evaluate union conditions, functional results, and complications. The fractures united smoothly with an average union time of 10.5 weeks (range: 8-16). At the final follow-up, the average American Orthopaedic Foot and Ankle Score Ankle-Hindfoot Score was 91 (range: 85-98). No complications were observed. For patients with isolated displaced lateral malleolar fractures, full weight-bearing is safe and effective, without an increase in the rate of complications, 2 weeks after open reduction and rigid fixation with locking plates.