Early Full Weight Bearing Research Articles

COMPARATIVE STUDY BETWEEN INTRAMEDULLARY FIXATION AND ARTHROPLASTY FOR THE MANAGEMENT OF UNSTABLE TROCHANTERIC FRACTURE IN ELDERLY

Background: Intertrochanteric fractures involve those occurring in the region extending from the extra capsular basilar neck region to the region along the lesser trochanter proximal to the development of the medullary canal, these fractures account for forty percent of proximal femoral fractures in elderly.Aim of the Work: is to compare intramedullary fixation and hip arthroplasty in treatment of unstable trochanteric fracture in elderly in terms of surgical techniques, clinical and radiological outcome, complications, functional outcome and patient satisfaction.Patients and Methods: The thesis is a prospective comparative randomized study between PFN and Hemiarthroplasty for the treatment of unstable trochanteric fractures in elderly. Patients were followed up at 1, 3, 6, 12 month postoperative, clinical and radiological data collected and documented starting from perioperative data (operative time, blood loss, transfusion).Results: We compared intramedullary fixation and hip arthroplasty in treatment of unstable, comminuted trochanteric fracture in elderly in terms of surgical techniques, clinical and radiological outcome, complications, functional outcome. We did our best to execute it in an objective unbiased scientific manner by allocating patients randomly into two groups using closed opaque envelops. This was confirmed by the mean personal data (Age, sex), side of the fracture, pre-existing comorbidities, and fracture type according to AO classification, both groups were comparable, with no significant difference. Comparison of operative data showed significant difference in operative time, mean operative time was [78.4 min for group 1 Vs 112.6 min for group 2], favoring group 1 as less operative time.Conclusion: Hemiarthroplasty could be valid option in management of unstable trochanteric fractures in elderly, giving the advantage of early full weight bearing, yet it is more technically demanding, require higher surgical experience.

Is early full weight bearing safe following locking plate ORIF of distal fibula fractures?

BackgroundIn the modern western world appraisal of economical points such as treatment and disability after trauma present a financial burden. In this context open reduction internal fixation techniques allowing for early full weight bearing might not only improve the clinical outcome but also shorten the period of disability in working life. The aim of the study was to analyze whether ORIF of ankle fractures using either a standard semitubular plate or a new polyaxial locking plate system result in a better clinical outcome.MethodsIn this prospective study, all patients with distal fibula fractures (AO 44 B1.1, B1.2, B1.3), with indication for surgery were included. Patients were randomized to either the DePuy Synthes® one-third semitubular plate (Group I) or NEWCLIP TECHNICS, Active Ankle® polyaxial locking plate (Group II). Primary outcome parameter was function of the ankle joint, assessed by the Olerud and Molander ankle score, Foot and Ankle outcome score and Karlsson and Peterson Scoring System for Ankle function. Secondary outcome parameter were postoperative complications. Superficial wound infection, delayed wound healing, mechanically prominent implant, skin irritations were considered as minor and deep wound infection, material loosening, loss of reduction were regarded as major complications requiring revision surgery. Clinical and radiological follow-up were performed 6 and 12 weeks, 6 months and 1 year postoperatively.ResultsFifty-two patients (31 W/21 M) with a mean age of 43 yrs. (range 22–64 yrs.) were enrolled. Seven patients (13.5%) were excluded, so that 45 patients were available for follow up. Twenty-five patients were treated with DePuy Synthes® one-third semitubular plate (55.6%; group I) while 20 patients received an anatomically preformed polyaxial locking plate (44.4%, group II). Four minor complications occurred in Group I (16%) compared to two minor complications in group II (10%). Significant better clinical results regarding OMAS (p < 0.02, < 0.04), KPSS (p < 0.04) and FAOS (p < 0.02, < 0.03) were observed 6 and 12 weeks after surgery in group II.ConclusionsThe results of the presented study demonstrate a significant better clinical functional outcome in the early postoperative follow-up in patients treated with a polyaxial locking plate. Furthermore, our data show that ORIF using polyaxial locking plates in combination with an early postoperative weight bearing presents a safe, stable treatment option for ankle fractures so that patients benefit especially in the early stages of recovery.Trial registrationRegistered 20 April 2020, retrospectively on ClinicalTrails.gov (NCT04370561).

Biphasic plating improves the mechanical performance of locked plating for distal femur fractures

Internal fixation by plate osteosynthesis is the gold standard treatment for distal femur fractures. Despite improvements that preserve the biological conditions for bone healing, there are concerns standard locked plating constructs may be overly stiff. Biphasic plating is a novel concept designed to provide suitable fracture motion and increased implant strength to support early full weight-bearing. This study aims to demonstrate that the Biphasic Plate can be incorporated into a pre-contoured distal femur plate while providing adequate flexibility and increased implant strength.The mechanical performance of the Biphasic Plate (BP) was investigated in comparison to a standard locking plate for the distal femur (LCP-DF). Constructs were formed by mounting the implants on a bone substitute. The construct stiffness and strength under axial loading and the magnitude of interfragmentary movement were determined using finite element analysis.The Biphasic Plate exhibited a bi-linear stiffness response; at low loads, the BP construct was 55% more compliant and at high loads 476% stiffer than the LCP-DF. The Biphasic Plate provided more consistent interfragmentary movement over a wider loading range. At partial weight-bearing loads, the Biphasic Plate produced larger interfragmentary movements (0.18 vs. 0.04 mm). However, at loads equivalent to full weight-bearing, the maximum movements were substantially smaller than the LCP-DF construct (1.5 vs. 3.5 mm). The increased flexibility at low loads was provided without sacrificing implant strength with peak stress in the Biphasic Plate 63% lower than the LCP-DF construct.The biphasic plating concept can be successfully incorporated into anatomically contoured distal femur plates while providing adequate flexibility and increasing implant strength.

Knee arthroplasty for acute fractures around the knee.

Results of open reduction and internal fixation for complex articular fractures around the knee are poor, particularly in elderly osteoporotic patients.Open reduction and internal fixation may lead to an extended hospital stay and non-weight-bearing period.This may lead to occurrence of complications related to decubitus such as thrombo-embolic events, pneumonia and disorientation.Primary arthroplasty can be a valuable option in a case-based and patient-specific approach. It may reduce the number of procedures and allow early full weight-bearing, avoiding the above-mentioned complications.There are four main indications: 1) Elderly (osteoporotic) patients with pre-existing (symptomatic) end-stage osteoarthritis.2) Elderly (osteoporotic) patients with severe articular and metaphyseal destruction.3) Pathological fractures of the distal femur and/or tibia.4) Young patients with complete destruction of the distal femur and/or tibia.The principles of knee (revision) arthroplasty should be applied; choice of implant and level of constraint should be considered depending on the type of fracture and involvement of stabilizing ligaments. The aim of treatment is to obtain a stable and functional joint.Long-term data remain scarce in the literature due to limited indications.Cite this article: EFORT Open Rev 2020;5:713-723. DOI: 10.1302/2058-5241.5.190059

Minimally invasive surgical treatment of minimally displaced acetabular fractures does not improve pain, mobility or quality of life compared to conservative treatment: a matched-pair analysis of 50 patients

BackgroundCurrently available procedures for the treatment of minimally displaced acetabular fractures include conservative treatment and minimally invasive percutaneous screw fixation. Screw fixation of acetabular fractures allows patients’ early full-weight bearing due to improved biomechanic stability. Can the range of motion, pain and mobility and quality of life in patients with acetabular fractures be improved by minimally invasive screw fixation, compared to conservative treatment in the long term?MethodsPatients treated for a minimally displaced acetabular fracture, either conservatively or by closed reduction percutaneous screw fixation, in the period from 2001 to 2013 were included in this retrospective study. Minimal displacement was considered to be less than 5 mm. As well as the collection and analysis of baseline data, Harris Hip Score, Merle d’Aubigné score and Short Form 12 (SF-12) questionnaire data were recorded in the context of a clinical study. To better account for confounding factors, patients of each group were matched. The matched-pair criteria included age, BMI, Letournel fracture classification and the presence of associated injuries.ResultsTwenty-five patients from each group were matched. On the Harris Hip Score, conservatively treated patients obtained 96 points (52–100, SD 17) vs. 89 points (45–100, SD 17, p = 0.624). On the Merle d’Aubigné score, conservatively treated patients obtained 17 points (10–18, SD 2) vs. 17 points (11–18, SD 2, p = 0.342).Patients with acetabular fractures treated by minimally invasive screw fixation did not result in improved quality of life, measured by SF-12 questionnaire, compared to conservatively treated patients (PCS 47, SD 9 vs. 44, SD 10; p = 0.294 and MCS 51, SD 7 vs. 53, SD 7; p = 0.795).ConclusionsThe clinical results of the two groups revealed no statistically significant differences. From the data, it cannot be deduced that minimally invasive surgical therapy is superior to conservative treatment of minimally displaced acetabular fractures. Prospective randomised studies are recommended to allow reliable evaluation of both treatment options.Trial registrationRetrospectively registered

Study of double button plate fixation in treatment of inferior pole of patella fracture

ObjectiveTo investigate effect of double button plate fixation in the treatment of inferior patella fracture MethodsPatients with inferior pole of patella fracture were treated with double button plate fixation. The perioperative and postoperative outcomes of MPIF with those of KWIF patients with metacarpal and phalangeal fractures were included. ResultsThe average operation and hospital stay time was 55 min and 8 days respectively. Range of motion (ROM) and knee society scores(KSS) was related to a greater increase. No patients have nonunion, infection and revision. ConclusionIn this study, double button plate fixation technology for the treatment of comminuted fracture of the inferior patellar pole has the advantages of simple operation, rapid recovery, early full weight bearing, better ROM and KSS, without incidence of nonunion, infection and revisions or reoperation.

Time to Bone Union after Hybrid Closed-Wedge High Tibial Osteotomy.

Medial open- and lateral closed-wedge high tibial osteotomy (hybrid CWHTO) can overcome the limitations of conventional CWHTO and open-wedge HTO (OWHTO) for medial compartmental osteoarthritis (OA) of the knee. Hybrid CWHTO increases stability by using a rigid locking plate and allows early full weight-bearing. However, the literature contains no information about time to bone union after this new procedure. The aim of this study is to evaluate the time to bone union after hybrid CWHTO. We reviewed 44 knees treated with hybrid CWHTO. Patients were able to stand on both legs on the day after surgery and walked with full weight-bearing within 4 weeks of the procedure. The time to achievement of bone union at the osteotomy site was defined as the number of months until bone union was confirmed on radiographic imaging. The mean time to radiographic confirmation of bone union was 4.5±1.5 months after surgery. Eleven knees (25.0%) required 6 months or more. Radiographic analysis and JOA score improved significantly between before and 1 year after surgery (p<0.01). Hybrid CWHTO is a very useful method for treating medial OA, but radiographic bone union requires 4.5 months on average. We must be aware of bone union after hybrid CWHTO.

Is cemented revision total hip arthroplasty a reasonable treatment option in an elderly population?

Revision THA is increasingly performed especially in the elderly population. The surgeon’s challenge is to provide a solution that supports immediate full weight-bearing, despite poor bone quality. Shape-closed revision stems facilitate that by combining cement fixation with additional press-fit anchoring. The design tolerates varying cement mantle thickness and inconsistent cancellous bone lining of the femoral canal. Following that philosophy, we present our mid-term results using a long version of a cemented Charnley- Kerboull type stem. From 2010 to 2017, 38 long Charnley-Kerboull revision stems (Centris®, Mathys European Orthopaedics, Bettlach, Switzerland) were implanted and followed prospectively. Surgery was performed via a Hardinge approach in supine position with a third generation cementing technique. Patients were mobilized using full-weight bearing as early as possible. Survival was determined for stem revision for aseptic loosening and stem and/or cup revision for any reason. 20 stems had a minimum follow-up (f/u) of 2 years and were included for further radiological analysis. Detailed subsidence analysis as an early predictor for later aseptic loosening was performed using EBRA-FCA software. Further, the presence of osteolysis and cement debonding was evaluated. Mean follow- up was 4 years. No patient was lost to f/u.18 died of causes unrelated to THA. Stem survival was 100%. Survival for any re-operation was 82.2% (two early infections, one soft-tissue debridement, one cup exchange for recurrent dislocations). None of the cases revised for septic loosening showed signs of persistent infection at final f/u. EBRA-FCA revealed two oligosymptomatic cases of subsidence of 5mm and 6mm over a course of 2 and 12 months, respectively, with stable implants thereafter. Neither required revision. There was no development of osteolysis or debonding. The stem provides a reliable early fullweight bearing solution for revision THA with excellent mid-term survival in an elderly population. Even in two cases where subsidence was present, mobility was not impaired and re-revision could be avoided.

Acute Retrograde Tibiotalocalcaneal Nailing for Osteoporotic Ankle Fractures in Fragile Patients

Category:Ankle, TraumaIntroduction/Purpose:With the rising aging of the population, osteoporotic ankle fractures represent a frequent scenario in daily practice. The coexistence of comorbidities such as poorly controlled diabetes mellitus, vascular insufficiency, and poor condition of the surrounded soft tissues, means that conventional open reduction and internal fixation methods often fail. On the other hand, conservative or orthopaedic treatments in such population are badly tolerated. Our study aims to study the short- term outcome of retrograde tibiotalocalcaneal (TTC) nailing in a selected series of fragile patients.Methods:This study included 15 patients who underwent primary retrograde TTC nailing from January 2016 to July 2018. The mean age of the patients was 83,5 years (range, 75 to 88), and the mean follow-up period was 11,5 months (range, 6 to 24 months) with no patient lost to follow-up. All patients but one were diabetic; 2 were non-ambulatory; and 13 walked with walking aids. The authors implemented a primary nailing without addressing tibiotalar or subtalar joint and without using a tourniquet. Complete weight bearing was allowed early as tolerated. Alignment and healing of the fracture were evaluated. American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score were recorded preoperatively and at the final follow-up.Results:One of the patients died 8 months after the treatment. Radiographic healing of the fractures were identified in 100% of the cases. In 2 cases, a complete arthrodesis of the ankle joint was achieved by simple nail reaming (Figure 1). No infection or any scarring problems was recorded. Of the 13 patients who walked with difficulty, 4 remained prostrate to a wheelchair, but the rest maintained their previous autonomy. The mean AOFAS score improved from 48 (range, 14 to 71) preoperatively to 71 (range, 44 to 81) postoperatively.Conclusion:In the view of these results, we suggest that primary retrograde TTC nailing is a valid option in selected patients with fragility ankle fractures, high comorbidity, poor condition of the soft tissues and with difficulties to walk before the fracture. This option allows an early full weight bearing, avoids complications due to joint off-loading, and achieves acceptable functional results.

Results of a Prospective Randomized Study Following Osteosynthesis Using 1/3 Tubular Plate in AO Technique vs Osteosynthesis Using Polyaxial Locking Plates in Distal Fibula Fracture

Category:Ankle, TraumaIntroduction/Purpose:In modern economies health care comprising treatment and disability after trauma is a financial burden. In this context techniques of ORIF that allow for early full weight bearing might not only improve the clinical outcome but also shorten the period of working disability. The aim of the study is to analyze whether ORIF of ankle fractures using a new polyaxial locking or a standard tubular plate allow for a better outcome and reduction of complications.Methods:In this prospective study, all patients with a distal fibula fracture (AO 44 B1.1, B1.2, B1.3), who met the criteria for surgical treatment were included. Patients were randomized to either the group A (tubular plate, Depuy Synthes) or group B (polyaxial locking plate, NEWCLIP TECHNICS, Active Ankle®). First outcome parameter was functionality of the ankle joint, assessed by the Olerud and FAOS score. Secondary outcome parameter were postoperative complications. These were divided into minor complications: Superficial wound infection, delayed wound healing, mechanically prominent implant, skin irritations and major complications requiring surgical revision: Deep wound infection, material loosening, loss of reduction. Clinical and radiological controls were performed 6 weeks, 12 weeks, 6 months and 1 year postoperatively.Results:52 patients (31W/21 M) with an age of 43y (range 22-64) have been included. 7 Patients (13.5%) dropped out. 45 patients were available for follow up. 20 patients were treated with polyaxial locking plates (44.4%), 25 patients by 1/3 tubular plate in AO technique (55.6%). Two minor complications (16%) occurred in the Active Ankle® group, four minor complications (16%) in the AO arm. At the first two control stages after six and 12 weeks a significant distinctions in the Olerud and FAOS score could be obtained in between the two study arms. Mean Olerud score after 6 weeks AA 56,05/AO 45,22 p=0,02, after 12 weeks AA 69,47/AO 59,79 p=0,04. Mean FAOS in week 6 AA 66,7/AO 56,08 p=0,02, in week 12 AA 75,1/AO 66,12 p=0,03.Conclusion:Our results are quite positive. We could demonstrate that a significant better clinical function during the early postoperative stages, after 6 weeks and 12 weeks, presented in the group treated with polyaxial locking plates. Further we proved that ORIF with polyaxial locking plates is a safe and stabile osteosyntheses and could promote an early weight bearing postoperative regime. That has the consequence that we could shorten the absence from work, the patient’s mobility can be restored faster and the costs for the health care system decrease significantly.

Biomechanical study between 4.5 mm and 3.5 mm distal locking screws in tibial plateau fractures

Treatment of tibial plateau fractures needs stable fixation in order to allow early mobilization and then early full weight bearing. Nowdays, the surgery gestures are been more and more minimally i...

Failed intertrochanteric fracture managed with hemiarthroplasty: Guide on surgical technique

Introduction: There have been many advances in internal fixation techniques to deal with poor quality of bone and severely comminuted intertrochanteric fractures so as to allow early ambulation. Failure rates with an internal fixation range between 3% and 12%. There have been a number of technical issues to convert these fractures into hip arthroplasty such as extraction of implants, bone deformity, bone loss, poor bone quality and associated trochanteric nonunion. Intertrochanteric fractures in osteoporotic bones which are grossly comminuted are highly unstable and difficult to treat. Rate of failure with internal fixation, with dynamic hip screws and with nail has been found to be high, especially in osteoporotic bones. Weak purchase of the internal fixation device because of osteoporosis and comminution of the fracture increases the incidence of failure of internal fixation such as cutting out the screws and displacement of the bone fragments. Case summary: 75 years male previously operated with proximal femoral nail later had fall due to which implant failed, which were manged with implant removal with bipolar hemiarthroplasty. Conclusion: Management of intertrochanteric fractures depends on age, stability of fracture, bone density. Young patient with good bone density should managed with proximal femoral nail, but in older individuals with osteoporotic bone stock hemiarthroplasty is good option. As we cannot rely on internal fixation devices to allow early full weight bearing of patients in the presence of severe osteoporosis and marked comminution at the fracture site, partial weight bearing is very difficult to be followed by these patients; thus, they shift to full weight bearing on the operated limb, causing mechanical failure. Hemiarthroplasty using bipolar prostheses for the unstable intertrochanteric fractures of the femur in elderly yields good clinical results in terms of early postoperative ambulation. This will have a direct effect on the general condition and postoperative rehabilitation.

In vivo heterotopic culturing of prefabricated tendon grafts with mechanical stimulation in a sheep model

BackgroundThe goal of this study is to investigate the biomechanical and histological properties of in vivo heterotopically prefabricated cruciate ligament replacement grafts with and without mechanical stimulation. The clinical goal is to heterotopically prefabricate a bone–tendon–bone graft for anterior cruciate ligament reconstruction, which allows rapid ingrowth and early full weight bearing. MethodsIn a sheep model, eight quadriceps tendon grafts were harvested and introduced into culture chambers at their proximal and distal ends. In group S, four tendon-chamber constructs were mechanically stimulated by direct attachment to the quadriceps tendon and patella. In group NS, the same constructs were cultured without proximal attachment. All sheep were sacrificed six weeks postoperatively and the constructs were examined biomechanically and histologically. The healthy contralateral ACL and quadriceps tendon were used as controls. ResultsMacroscopically, no obvious ossification could be observed at the ends of the tendon-chamber constructs six weeks postoperatively. Histologically, the tendon tissue from the mechanically stimulated constructs revealed higher counts of cells and capillaries. However, there was less regular cell distribution and collagen fiber orientation compared to the control group. In addition, osteoblasts and osteogenesis were observed in the prefabricated constructs both with and without mechanical stimulation. Biomechanically, there were no significant differences in stiffness, elongation and ultimate failure load between the groups. ConclusionIn vivo heterotopic culture of prefabricated tendon grafts may have the potential to stimulate osteoblasts and induce osteogenesis. Future studies with longer follow-up and modifications of the surgical technique and culture conditions are desirable.

Results of distal femur locking plate in communited distal femur fractures

Introduction: A fracture of the distal femur is a grave injury that for years represented an unsolved problem in trauma and was considered to result almost always in varying degrees of permanent disability. Incidence is bimodal with one peak in adolescent boys and men from 15 to 24 [high energy trauma] and second peak in elderly women 75yrs[low energy trauma].In the past closed procedures consisting primarily of traction and splinting had drawbacks like knee stiffness and prolonged immobilisation. Recent advances led to development of Locking Compression Plate (LCP) which is a single beam construct. Further when applied via Minimal Invasive Technique it lowers rate of infection and favours biological fixation. Materials and Methods: Prospective study of 30 patients with minimum 6 months follow up were included. Communited fractures of distal femur were included in the study. Implants Used: Plates-The Distal Femur LCP.Classification used: AO Classification.Clinical and functional outcomes were assessed using Rasmussen’s Functional Knee Score.Major Complications: like flexion deformity, non union, malunion were assessed. Results and Observations: 18 patient had excellent result, 10 patient had good result, 1 patient had fair result & 1 patient had poor result. According to rassamussen’s knee score 67.67% patients had no pain at rest and others had mild to moderate pain at rest. The average time for union was 16.56 weeks with 1delayed union and no nonunion no malunion. The range of motion in affected knee was 120 degrees in 40%. Upto 90 degrees knee flexion in 24 out of 30 patients. Superficial infection was found in 4 patients. Angulation and plate bending was found in 1 patient due to early full weight bearing. Conclusion: Thus we can safely recommend the distal femur locking compression plate as a very useful implant in osteoporotic fractures.

Internal fixation of three-dimensional distal metatarsal I osteotomies in the treatment of hallux valgus deformities using biodegradable magnesium screws in comparison to titanium screws

BackgroundVarious implants, for example K-wires, screws, plates or staples, have been introduced for the stabilisation of corrective osteotomies in hallux valgus surgery. To provide high initial stability and to avoid subsequent implant removal, a novel biodegradable magnesium screw (MAGNEZIX® CS, Syntellix AG, Hanover, Germany) has been developed and approved for clinical use. MethodsBetween October 2014 and June 2016, magnesium screws were used in 100 patients with a symptomatic hallux valgus deformity for the fixation of Chevron and Youngswick osteotomies. The results were compared to a retrospective cohort of 100 patients, in which titanium screws were applied to stabilize the osteotomies in a comparable manner. All follow-up data was collected retrospectively. ResultsBoth cohorts showed no differences concerning the age of patients, comorbidities, number of corrected toes and duration of surgery. The median clinical follow up was 12.2 weeks (magnesium) and 11.7 weeks (titanium), respectively. No difference was found between the magnesium screws and the titanium screws in respect to prolonged wound healing or deep infection. One patient complained about a prominent screw head in the titanium group and one screw fracture was noticed in the magnesium group most probably due to early full weight bearing. All patients but four could start full weight bearing in normal shoes at six weeks. ConclusionsEarly results of 100 cases of biodegradable magnesium screws in hallux valgus surgery show non-inferior results concerning clinical outcome and complications compared to titanium alloy screws.To avoid implant removal, while keeping high initial stability, magnesium screws are an excellent option in hallux valgus surgery.

Management of infected supracondylar femoral nonunion with bone loss by primary knee arthrodesis with hybrid Ilizarov frame: a study of 10 cases

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Most of infected nonunion supracondylar femur with bone loss is a challenge to orthopedicians, where amputation is one of the choice. Opinions are divided on the appropriate management of infected nonunion supracondylar femur with bone loss. Evidence supports for both, osteosynthesis with or without salvaging knee joint and above knee amputation.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;10 consecutive patients at Nizam’s Institute of Medical Sciences, from Jan 2013 to December 2016, who underwent limb salvage with knee arthrodesis for infected nonunion supracondylar femur with bone loss were evaluated and followed till union. Treatment option in the form of osteosynthesis with knee arthrodesis was achieved with hybrid Ilizarov fine wire fixator. The hybrid Ilizarov frame comprised of conventional two ring tibial frame and one ring and one Italian arch in the femoral segment with half treaded pins, this construct was chosen because of less weight, less cumbersome without compromising the stability and basic features&lt;/span&gt;.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;All patients went for solid knee arthrodesis in functional position, with a mean fusion time of 22.4 ± 4.97 weeks. The time interval between primary surgery and definitive treatment was 15.6 ± 6.37 weeks. The mean shortening of lower limb was 3.1±1.19 cms. To achieve arthrodesis quickly, it’s necessary to have light weight, compact Ilizarov frame, have good bone to bone contact and allow early full weight bearing. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Osteosynthesis with knee arthrodesis in cases of infected nonunion supracondylar femur with bone loss is a viable option in select cases where the patient is physiologically young, has undergone several procedures around the knee and the knee is stiff. Fusion of the knee enables quick restoration of the patient to his work place.&lt;/span&gt;&lt;/p&gt;

Evaluation of closed multi-axial screws iliosacral fixation system combined with posterior segmental spinal fixation for treatment of unstable sacral fractures

To evaluate the effectiveness of lumbopelvic fixation using the combination of closed multi-axial screws (CMAS) iliosacral fixation system and the posterior segmental spinal fixation for unstable sacral fractures. Between January 2013 and November 2014, 25 patients (39 sides) with unstable sacral fractures were treated with lumbopelvic fixation using the combination of CMAS iliosacral fixation system and the posterior segmental spinal fixation. There were 17 males and 8 females, aged 19-55 years (mean, 33.9 years). The causes were traffic accident injury in 15 cases, falling injury from height in 8 cases, and crushing injury in 2 cases. The interval of injury and operation was 1-13 days (mean, 3.5 days). Fracture was classified as Denis type I in 2 sides, type II in 20 sides, and type III in 17 sides; nerve injury was rated as Gibbons grade I in 2 cases, grade II in 2 cases, grade III in 7 cases, and grade IV in 9 cases. The reduction quality was evaluated by Matta criterion, the clinical function outcome by Majeed, and nerve function by Gibbons criterion. The average operation time was 110 minutes (range, 80-150 minutes). The average blood loss was 570 mL (range, 250-1 400 mL). Superficial wound infection occurred in 2 patients, and was cured after debridement and antibiotic therapy. All patients were followed up for an average of 18 months (range, 15-22 months). Postoperative X-ray and CT examination showed clinical healing of sacral fractures at 8-12 weeks after operation (mean, 10 weeks). The mean removal time of internal fixation was 13 months (range, 12-20 months). No screw loosening and fracture, adhesion of internal fixation to surrounding tissue, and obvious electrolysis phenomenon occurred. According to Matta criterion, reduction was rated as excellent in 32 sides, good in 6 sides, fair in 1 side, and the excellent and good rate was 97.5%. According to Majeed functional scoring at last follow-up, the mean score was 84.7 (range, 64-98); the results were excellent in 18 cases, good in 5 cases, and fair in 2 cases, and the excellent and good rate was 92.0%. The nerve function was significantly improved when compared with preoperative one; nerve injury was rated as Gibbons grade I in 8 cases, grade II in 8 cases, grade III in 3 cases, and grade IV in 1 case. Lumbopelvic fixation using the combination of CMAS iliosacral fixation system and the posterior segmental spinal fixation is a relatively effective fixation for unstable sacral fractures. Not only is the fracture fixation rigid for early full weight-bearing, but also nerve decompression can be performed which facilitates nerve function recovery.

Partial versus early full weight bearing after uncemented total hip arthroplasty: a meta-analysis

BackgroundThis meta-analysis aimed to investigate the efficacy and safety of partial weight bearing (PWB) versus early full weight bearing (FWB) after uncemented total hip arthroplasty (THA).MethodsWe conducted a search in PubMed, EMBASE, The Cochrane Library, and Web of Science for randomized controlled trials (RCTs) and non-RCTs comparing PWB and early FWB after uncemented THA. Two authors conducted the selection of studies, data extraction, and assessment of risk of bias independently. A pooled meta-analysis was performed using the RevMan 5.3 software.ResultsSix RCTs and three non-RCTs met the inclusion criteria. The meta-analysis indicated that compared with PWB, the FWB group showed greater femoral subsidence at 3-month follow-up (MD = −0.12, 95% CI −0.22 to −0.01, P = 0.03). There were no significant differences in the hip Harris score at 1-year and 2-year follow-up (MD = 1.54, 95% CI −0.83 to 3.90, P = 0.20; MD = 0.08, 95% CI −1.19 to 1.34, P = 0.90, respectively), in femoral subsidence at 2-year follow-up and at two additional years of follow-up (MD = −0.03, 95% CI −0.31 to 0.25, P = 0.84; (MD = −0.02, 95% CI −0.37 to 0.33, P = 0.91, respectively). There were no significant differences in the incidences of bone ingrowth fixation, spot welds, and radiolucent lines.ConclusionsThis meta-analysis shows that early FWB in patients with uncemented THA could be safe and could not increase the incidence of postoperative complications.

Результаты применения интрамедуллярного трансфизарного эластичного армирования у пациентов с тяжелыми формами несовершенного остеогенеза

Introduction The work analyzes the results of using elastic opposite-directional transphyseal reinforcement for treatment of severe orthopedic complications in patients with osteogenesis imperfecta as well as the ways and their effectiveness to overcome the shortcomings of this technique. Material and methods The series included 24 patients. Among them, four patients had osteogenesis imperfecta of Type III, 19 were of Type IV, and one patient had Type VIII. The patients’ mean age was 14.4±2.8 years (range: 2-46 years). A total of 52 reconstructive surgical interventions were performed. Elastic intramedullary reinforcement was used in 83 segments. The combined osteosynthesis technique (the Ilizarov fixator and/or subperiosteal reinforcement) was used in 27 cases. Results Correction of deformities was achieved in all the cases. Consolidation at the osteotomy level was obtained after 26.2±7.8 days on the average (from 3 to 12 weeks postoperatively). The period of follow-ups was from 6 months to 4 years. Twenty-four complications were observed in 8 patients (33.3 % of cases). Twenty three additional interventions due to the problems of correction were performed in 20 patients (unplanned surgeries were necessary in 83.3 % of cases). The ability to stand in the vertical position and bear weight on the lower limbs with the use of auxiliary supports or without them was achieved in 22 cases out of 24 (91.7 %). Patients’ ambulation ability was evaluated with the Gillette scale and improved in 21 cases out of 24 (87.5 %). In all the cases, patient’s care facilitated, self-service capabilities improved, and patients’ social activity increased. A more comfortable position for sitting was achieved in 22 patients. In 100 % of the cases, pain reduced or disappeared by doingexercises or during walking, including exercise therapy or hygiene procedures. Conclusion The technique of transphyseal reinforcement using elastic titanium nails is indicated for deformity correction in children with severe types of osteogenesis imperfecta. Lower limb deformity correction and increased bone strength contributed to patients’ motor activity and improved their quality of life. Complications were not rare after surgical treatment but their timely correction enabled to retain the achieved anatomical and functional results. The use of a minimum fixation, the Ilizarov apparatus following corrective osteotomies and intramedullary reinforcement, assisted in achieving patient’s early verticalization and full weight-bearing on the operated limb as well as helped avoid a number of complications. Osseointegration of intramedullary implants with bioactive coating prevented their migration in the long-term period. Telescopic constructs of such nails should not be used in children under the age of 10 in order to avoid their locking in the medullary canal due to osseointegration.

3D-Navigation Reduces Radiation Exposure and Operative Time in Lumbopelvic Fixations

Introduction Management of unstable sacral fractures has evolved from non-operative treatment to relatively rigid internal fixation. Multidirectional instability of the posterior pelvic ring and lumbopelvic junction may be stabilized by lumbopelvic fixation. This technique decreases the load to the sacrum and SI joint and transfers axial loads from the lumbar spine directly onto the ilium, which allows early full weight bearing and therefore reduces prolonged immobilization. One of the keystones for lumbopelvic fixation is the placement of the iliac screws. The iliac screws are directed from the posterior superior iliac spine (PSIS) to the anterior inferior iliac spine (AIIS). The optimal osseous corridor for iliac screw placement requires multiple posteroanterior and lateral views with additional obturator outlet and obturator inlet views. Obtaining the correct views results in increased OR times, fluoroscopy times, and radiation exposure of the patients and OR personnel. The purpose of this study was to evaluate if a better intraoperative visualization of bony structures utilizing a 3D-navigation system can reduce operative time, fluoroscopy time, and radiation exposure. Material and Methods From one academic trauma center, 44 consecutive patients were retrospectively identified as having been treated with lumbopelvic fixation between July 2011 and June 2015 (4 years). Of these, 10 patients were excluded because of only a unilateral triangular fixation. 34 patients (61.8% female) met the inclusion criteria. Patients had an average age of 58.9 years (range 18–87 years). Lumbopelvic implants (USS II, DepuySynthes, Germany) were inserted as described by Schildhauer. A passive optoelectronic navigation system (Brainlab, Germany) was utilized for navigated iliac screw placement. Surface registration of L4 was performed for the matching procedure. To compare groups, demographics were assessed, operative time, fluoroscopic time, radiation, and screw malpositioning were delineated. Results During the study period, 24 patients underwent bilateral lumbopelvic fixation utilizing conventional fluoroscopic imaging alone and 10 patients underwent the procedure with 3D navigated iliac screw placement. No differences were found between the two groups regarding age (60.3 versus 55.6 years; p = 0,553), BMI (25.65 versus 25.17 kg/m2; p = 0.808), gender (62.5% versus 60% females; p = 0.891), or length of hospital stay (39 versus 26 days; p = 0.089). Comparing screw length and diameter, the median was 110 mm and 8 mm, respectively in both groups. Utilization of 3D navigation led to a fluoroscopy time reduction of more than 50% (3.47 versus 8.32 minute.; p = 0.004) resulting in a significantly reduced radiation (4980 versus 2665 Gy*cm2; p = 0.032). Operative time was reduced in the navigation group (177 versus 234 minute; p = 0.028) despite the necessity of additional surface referencing. Conclusion Fixation of sacral fractures continues to be challenging due to complex local anatomy. Especially in severe comminuted sacral fractures lumbopelvic fixation provides superior stability and allows immediate weight-bearing. For iliac screws, identifying the correct entry point and angle of implantation in all planes requires detailed anatomic knowledge and multiple radiographic views. In the current study, 3D navigation helped to reduce operative time and fluoroscopy time resulting in a significant reduction of radiation exposure for the patient and OR personnel.