Early Posttraumatic Arthritis Research Articles

Isolated, displaced, talar body fracture: a case report and literature review.

Talar body fractures are uncommon fractures of the foot and its management results to be very hard due to retrograde vascularization and wide articular cartilage coverage of talar surface, which could easily lead to poor functional outcomes, avascular osteonecrosis and early post traumatic arthritis. We describe a case of displaced, vertical, talar body fracture in a 41-year-old patient treated with reduction and fixation by talar anteromedial approach coupled to medial malleolar osteotomy to better expose the fracture. Our literature review has found few studies, in addition with a low level of statistical evidence. We advocate for more studies with a bigger sample and with a design of randomized control trials.

Multiple Reconstructive Osteotomy Treating Malunited Calcaneal Fractures Without Subtalar Joint Fusion.

Various surgical techniques have been reported in treating calcaneal malunions over the decades, while the operations on single plane were accompanied by respective limitations. The purpose of this study is to evaluate the efficacy of a novel multiple reconstructive osteotomy for treating malunited calcaneal fractures without subtalar joint fusion. From March 12, 2010, to August 17, 2017, 10 patients (10 feet) with malunited calcaneal fractures were treated with multiple reconstructive osteotomy with subtalar joint-preserving operations. All patients were treated with a corrective osteotomy, joint realignment, soft tissue balancing, and secondary internal fixation at a mean of 5.6 ± 2.41months since the initial injury. With the utilization of the multiple reconstructive osteotomy, the posterior facet was restored to preserve the subtalar joint. All patients were evaluated clinically and radiographically at a mean follow-up of 3.04 ± 1.21 years. All patients were subjectively satisfied with the treatment. The average time to union was 12.2 ± 1.11 weeks. The American Orthopedic Foot and Ankle (AOFAS) ankle and hind foot score was 86.3 ± 4.45 (t=27.64, P < 0.0001, paired t-test), which was significantly higher than the preoperative assessment. Postoperative radiographic assessment revealed great improvement in Böhler's angle (from 25.4° to 86.3°), talocalcaneal height (65.15-72.68 mm) and Calcaneus-talus angle (from 34.46° to 39.7°). One patient had mild discomfort after a 1-h brisk walk. One patient was suspected to have early posttraumatic arthritis of the subtalar joint based upon radiographic evidence during the follow-up, but the patients could walk normally for a long time without pain. Multiple reconstructive osteotomy is an effective way to restore the calcaneal morphology and preserve the subtalar joint for selected calcaneal malunion.

Лечение переломов проксимального отдела лучевой кости у детей и подростков

In children’s traumatology, traumatic epiphysiolyses and osteoepiphysiolyses of the proximal part of radius are among the most widely spread traumas, constituting from 10,7% to 78% [1, 2]. The consequences of lesions of the proximal part of radius are chronic instability, heterotopic ossification (14,3%), early posttraumatic arthritis, contarctures, (62–82%) aseptic necroses of the radius head with trochlea defects, false joints, neuropathies (13%) of radial and cubital nerves, and elbow joint deformations [3, 4]. Material and metods. The authors analyzed treatment of 102 patients with fractures of the proximal part of radius in children and adolescents aged 4–17 treated at Children’s Traumatology and Orthopedic Department. 82 patients underwent closed or open reposition of fractures of the proximal part of radius under general anesthesia. 64 patients with angular deflection of 15 to 60 degrees underwent closed manual reposition of the fracture of the radius neck by N.P. Svinukhov technique. 12 patients with unstable fractures of the proximal part of radius with angular deflection of more than 60 degrees underwent author’s treatment technique. 8 patients underwent open reposition due to unsuccessful conservative treatment.

Subtalar and Chopart Dislocations in Children and Adolescents

Subtalar and Chopart dislocations are extremely rare in childhood but become slightly more common in older children and adolescents. Subtalar dislocation involves dislocation of the subtalar and talonavicular joints, with intact tibiotalar and calcaneocuboid joints, in the absence of a talar neck fracture. It should be differentiated from the Chopart dislocation and from traumatic entities presenting radiographically as isolated talonavicular dislocations. Chopart joint injury involves the talonavicular and calcaneocuboid joints of the foot. The injury may appear as sprain, fracture, subluxation or dislocation. Diagnosis is made on plain radiographs; although initial views may not reveal the severity of the lesion, since spontaneous reduction may occur. The radiographic detection of an isolated talonavicular dislocation is probably indicative of a Chopart joint injury, in which a momentary subluxation or dislocation of the calcaneocuboid joint has occurred. The differential diagnosis of a radiographically detected isolated talonavicular dislocation should also include traumatic entities associated with intact calcaneocuboid joint, such as the swivel talonavicular dislocation and the isolated displacement of only the medial part of the Chopart joint. The swivel talonavicular dislocation is a subtype of the Chopart joint injury, in which the foot with the calcaneus is rotated beneath the talus, producing subtalar subluxation but not dislocation. In the isolated displacement of only the medial part of the Chopart joint the subtalar joint is not injured. The injury is usually associated with a fracture of the body of the tarsal navicular and it is believed to be the result of severe abduction or adduction of the forefoot. Subtalar dislocations and Chopart joint injuries in children and adolescents seem to be comparable with their adult counterparts in the mechanism of injury, classification, treatment, complications and outcome. The challenges in treating these injuries are to achieve adequate diagnosis and prompt treatment. It appears mandatory that obtaining and maintaining an early anatomic reduction remains the key factor in achieving good outcomes. However, a high incidence of complications, such as compartment syndrome, soft tissue compromise, avascular necrosis of bone, bone growth deformities and debilitating early post-traumatic arthritis, have been reported. The purpose of this report is to review the relevant publications on subtalar and Chopart dislocations in children and adolescents and to present illustrative cases treated at our institution.

An analysis of surgical management of acetabular fractures

With increase in number of high-speed road traffic accidents the incidence of acetabular fracture is increasing. Historically satisfactory results after non operative treatment of acetabular fractures were obtained only in a minority of cases (13-30%). Non operative treatment options include traction and early mobilization with progressive weight bearing. Unsuccessful outcomes after non operative treatment were mostly related to early posttraumatic arthritis likely due to articular incongruity, hip joint instability, and muscle dysfunction. In our study, all the acetabular fractures are classified using standard investigations, operatively managed in indicated cases and followed up post-operatively with regards to improvement in clinical and radiological outcome. Out of 50 patients, 12 patients had excellent result, 24 patients had good result, 9 patients had fair result, and 5 patients had a poor result. Aims and Objectives 1. To study and analyze the outcomes of open reduction and internal fixation in patients with acetabular fractures in terms of radiology, clinical and functional outcomes. 2. To study the role of early range of motion exercises in the functional outcome.3. To study the complications associated with the surgical approaches. Materials and Methods 1. Type of study: Descriptive, case series, comparison study, partly retrospective and prospective. 2. The study was done to assess the clinical, radiological and functional outcome of patients with acetabular fractures treated with open reduction and internal fixation at Goa Medical College. 3. Study setting: Inpatient ward no 103,104,105, under Department of Orthopaedics, Goa Medical College. 4. Methods: All fractures have been classified using the Letournel and Judet classification. All the cases were followed up post operatively and were analyzed for radiological, functional and clinical outcome. The radiological outcome was evaluated with radiograph pelvis AP view, Obturator oblique view and Iliac oblique views. The functional outcome was evaluated with Merle d’Aubigne and Postel modified clinical grading system and Harris hip score.

Autologous Osteochondral Graft for Early Posttraumatic Arthritis of Tibiotalar Joints After Comminuted Pilon Fractures in Young Patients

Posttraumatic arthritis of tibiotalar joints after AO/OTA type C3 pilon fractures, especially in young patients with a significant osteochondral defect in the tibial plafond joint surface, is a challenging situation. We report a joint-preserving technique using autologous osteochondral graft in combination with ankle distraction and supramalleolar osteotomy (SMOT), if necessary, to improve its outcome. Seventeen patients with an average age of 32.1 years with Takakura grade 1 to 3A posttraumatic arthritis of the tibiotalar joint after AO/OTA type C3 pilon fractures received osteochondral autograft transplantation, ankle distraction, and SMOT, when supramalleolar malalignment was present, between February 2010 and November 2015. The visual analog scale (VAS), Short-Form 36 (SF-36) score, American Orthopaedic Foot & Ankle Society (AOFAS) score, and ankle range of motion were used for outcome analysis. Radiographic assessment of any SMOT and the apparent joint space was performed. Fourteen patients were followed for an average of 18 months. The VAS, SF-36, and AOFAS scores as well as the ankle range of motion all improved significantly at the last follow-up after the surgery (P < .01). No deep surgical site infection, donor site complication, nonunion, osteochondral block loosening, or resorption was noted. No secondary arthrodesis was needed at the end of follow-up. Autologous osteochondral graft transplantation in combination with ankle distraction and SMOT was a promising joint-preserving technique for early posttraumatic arthritis of tibiotalar joint after severe pilon fractures in young patients. Level IV, case series.

Fragment specific fixation technique using 2.7mm VA LCP for comminuted posterior wall acetabular fractures: a novel surgical technique.

The purposes of the study were to introduce surgical technique of fragment-specific fixation technique using multiple 2.7-mm variable-angle locking compression plates (VA LCPs) in comminuted posterior wall acetabular fractures and reported its clinical results. Among the 68 patients, 23 with comminuted posterior wall factures with ≥ 3 fragments in the CT scan and no column involvement with a minimum follow-up duration of 12months were enrolled in this study. We evaluated the clinical results after the treatment of comminuted posterior wall acetabular fractures via the fragment-specific fixation technique using 2.7-mm variable-angle locking compression plates (VA LCPs) retrospectively. The average duration of follow-up was 26.8months. Anatomical reduction was achieved in eighteen patients. Imperfect reduction was achieved in five patients. 22 patients achieved fracture union and one patient underwent revision surgery owing to acute postoperative infection. There were no complications, including loss of reduction, fixative failures, sciatic nerve palsy, heterotopic ossification, and early posttraumatic arthritis among 22 patients. The average functional outcome was measured as 'very good'. Fragment-specific fixation technique using 2.7-mm VA LCPs for comminuted posterior wall acetabular fractures could be an acceptable alternative means of surgical fixation.

Foot and ankle fractures during childhood: review of the literature and scientific evidence for appropriate treatment

Foot and ankle fractures represent 12% of all pediatric fractures. Malleolar fractures are the most frequent injuries of the lower limbs. Hindfoot and midfoot fractures are rare, but inadequate treatment for these fractures may results in compartment syndrome, three-dimensional deformities, avascular necrosis and early post-traumatic arthritis, which have a significant impact on overall foot and ankle function. Therefore, the challenges in treating these injuries in children are to achieve adequate diagnosis and precise treatment, while avoiding complications. The objective of the treatment is to restore normal anatomy and the correct articular relationship between the bones in this region. Moreover, the treatment needs to be planned according to articular involvement, lower-limb alignment, ligament stability and age. This article provides a review on this topic and presents the scientific evidence for appropriate treatment of these lesions.

Dual locked plating of unstable bicondylar tibial plateau fractures

The operative treatment of displaced bicondylar tibial plateau fractures is challenging. The displaced condyles must be reduced, depressed plateaus must be elevated and adequately supported and early rehabilitation must be encouraged in order to obtain good clinical results. This retrospective study was designed to evaluate the clinical outcomes of patients with bicondylar tibial plateau fractures treated with dual locked plates using raft screws with MIPO technique and autologous bone grafting. We hypothesized that in this group of patients dual locked plating reduces the complication rates by avoiding loss of reduction due to the accomplished rigid fixation. Twenty-two consecutive patients with bicondylar tibial plateau fractures (AO Type C) were included in this study. The mean follow up was 26 months. Bone healing was achieved in all patients with 3 cases of superficial and 1 case of deep infection. Secondary loss of reduction, secondary loss of alignment, early post-traumatic arthritis were not observed in this study. The Lysholm knee score showed an average of 80.5 points (range: 61.5–90) at the final follow up assessment. Optimal fixation of the fracture with dual locked plating which allows immediate motion and partial weight bearing may be an alternative concept to prevent secondary loss of reduction to obtain a good clinical outcome.

Complications and early results after operative fixation of 68 pilon fractures of the distal tibia.

In this cohort study, we present comprehensive injury specific and surgical outcome data from one of the largest reported series of pilon fractures of the distal tibia treated in a UK tertiary referral centre. A series of 68 closed pilon fractures were retrospectively reviewed from case notes, plain radiographs and computed tomography imaging. Patient demographics, injury and fracture patterns, methods and timing of fixation and clinical and radiological outcomes were assessed over a mean follow-up period of 7.7 months (1.5-30). Overall, deep infection occurred in 1.6% with superficial infection and wound breakdown occurring in 6.3% of cases. Rates of nonunion and malunion were 7.8%. Radiological posttraumatic arthritis was present in 26.6%, which was symptomatic and requiring orthopaedic management in 9.4%. Further surgery for all causes occurred in 26.6% of cases. Fixation of these complex fractures in subspecialist units can achieve overall low rates of wound complications, with definitive fixation of selected fractures within 48 h of initial presentation achieving comparable results to those fixed in a delayed fashion. However, this injury continues to have a significant overall complication rate with a high chance of developing early posttraumatic arthritis and of requiring further surgery.

Non surgically managed anteromedial coronoid fractures in posteromedial rotatory instability: three cases with 2 years follow-up

Varus posteromedial rotatory instability refers to one of the complex elbow fracture-dislocation caused by anteromedial coronoid fracture with disruption of lateral collateral ligament (LCL). Recent clinical and biomechanical studies have demonstrated that this unstable complex injury resulted in incongruence of joint, which could lead to early posttraumatic arthritis. With reports of poor result after conservative treatment, surgical treatment including anteromedial fixation and LCL repair has been strongly recommended to achieve stable joint. This case series describes three patients with anteromedial coronoid fracture who were managed conservatively with excellent outcomes. This report suggests that anteromedial coronoid fracture associated with posteromedial rotatory instability might be treated using conservative treatment in selective cases when anteromedial coronoid fracture is minimally displaced and there is no evidence of elbow subluxation.

Fractures of the femoral head: what are the reasons for poor outcome?

In this article, we aimed to discuss treatment strategies in fracture of the femoral head, which is a very rare injury. We reviewed five patients (six fractures) who admitted to our emergency department due to femoral head fracture between March 2006 and December 2007. Functional outcomes of the patients who were treated operatively and nonoperatively were compared. Half of the fractures were treated nonoperatively and half of them surgically. We observed a rate of 50% excellent to good results. Avascular necrosis developed in a patient with bilateral injury. The functional results were poor for this patient. Early posttraumatic arthritis was observed in a patient who was treated surgically; this patient had moderate results. We should aim at anatomic reduction of the fragments with minimum soft tissue injury. The best approach should be chosen for excellent view of the fragments. We should not forget that half of these patients will have a poor outcome despite all treatment strategies.

Chondroitin sulfate epitope (WF6) and hyaluronic acid as serum markers of cartilage degeneration in patients following anterior cruciate ligament injury

Serum chondroitin sulfate epitope (WF6) and hyaluronic acid (HA) levels were determined to be of clinical relevance to an anterior cruciate ligament (ACL) injury. This cross-sectional study recruited participants from two distinct groups. Group A was comprised of 74 healthy controls, and group B consisted of 33 ACL injury patients. Serum samples were taken and assayed by a competitive immunoassay with monoclonal antibody WF6. Serum HA was also determined by an ELISA-based assay using biotinylated HA-binding proteins. Both groups A and B shared similar values of age, body mass index, white blood cell count and percentage of polymorphonuclear cells. ESR levels were also shown to be within normal limits. The serum WF6 epitope levels of group B were significantly higher than those of group A, whereas serum HA levels were not different between the two groups. The serum WF6 epitope level is more sensitive to changes in articular cartilage due to a non-inflammatory instability condition than the serum HA level, and should prove to be one of the most promising assays for early post-traumatic arthritis detection.

Acetabular Fractures in the Elderly: Treatment Recommendations

Acetabular fractures in the elderly population are marked by a high degree of variability in terms of patient and fracture characteristics. Successful outcomes depend on application of highly individualized management principles by experienced teams. Reviewed are indications and outcomes associated with various management options, including closed treatment, open reduction internal fixation, and acute or staged total hip arthroplasty. Proper initial management choices are critical, as early failures and subsequent salvage surgery can be accompanied by significant morbidity. Clinical results after ORIF closely follow the quality of articular reduction and the ability to maintain a congruent reduction of the hip joint. Fracture characteristics predictive of anatomic articular reduction should be treated with ORIF. Fracture characteristics predictive of early post-traumatic arthritis should be treated with simultaneous ORIF and THA. Presented is one referral institution's treatment algorithm and management approach.

Complications Associated With the Posterolateral Approach for Pilon Fractures

To review the complication rates of open reduction and internal fixation (ORIF) of tibial pilon fractures using the posterolateral approach. Retrospective review. Two level I trauma centers. Nineteen consecutive pilon fractures at an average of 13 (range, 13-45) months follow-up. Average age 46 (range, 21-72) years. Four of 19 were open fractures. Because of the high incidence of wound complications associated with the anterior approach for pilon fractures, patients were treated with initial temporary external fixation followed by delayed ORIF through the posterolateral approach to the distal tibia. The hypothesis was that the abundant soft-tissue coverage of the posterior distal tibia would decrease the rate of wound complications. The incidence of wound complications, nonunion, and early posttraumatic arthritis. This was a chart and radiograph retrospective review. The mean time to definitive treatment was 13 (range 2-30) days. Nine of 19 patients (47%) developed complications. There were 6 patients with wound problems, 2 patients with aseptic nonunions, 2 patients with infected nonunions, 3 tibiotalar fusions, and 1 patient with a 3-mm step off. In total, there were 14 major complications in 9 patients. Ten of 19 patients did not have any complication. The posterolateral approach does not eliminate the complications common to other approaches, but does offer a potential alternative when soft tissue concerns prevent other approaches. We do not recommend the posterolateral approach for the routine treatment of tibial pilon fractures.

Temporary vertical transarticular-pin fixation of unstable ankle fractures with critical soft tissue conditions

Unstable ankle fractures are demanding injuries to treat. Open reduction and internal fixation are accepted as standard care, however, in patients with severe soft tissue damage or serious medical conditions, this approach may not always be advisable. Closed reduction with temporary fixation using vertical transarticular pins is one method to maintain joint alignment until an open technique is possible. Fourteen patients (median age: 59.5 years) with unstable ankle fractures, including three type-2 open fractures, were included in the study. Open reduction and fixation was delayed because of severe soft tissue damage, and a temporary transarticular pin fixation using two Kirschner wires was performed. After a median of 8.4 days, an open reduction and internal fixation was carried out in all patients. No complications related to the temporary arthrodesis were observed during the acute phase, and follow-up at 24 months revealed no damage to the articular surface attributable to the pin insertion. The median Olerud-score was 33.43, but three patients showed signs of early post-traumatic arthritis which we felt were due to the initial fracture. We conclude that closed reduction and temporary fixation using vertical transarticular pins of unstable ankle fractures is a safe method of maintaining joint alignment until a definitive open approach is feasible.

Repair or Reattachment of the Meniscus After Fixation of a Tibial Plateau Fracture

The intact meniscus provides protection for healing of tibial plateau fractures, prevention of early posttraumatic arthritis, and maintenance of knee stability. However, tibial plateau fractures may have associated meniscal injury that may impair this function. In addition, the meniscotibial ligaments are often divided during submeniscal arthrotomy for exposure. Repair or reattachment of the meniscus can be difficult. We describe the technique of using Kirschner wire holes in proximal tibial plates for anchoring the meniscus.

A comminuted femoral head fracture without hip dislocation

A case report of a 26-year-old man involved in a high-speed motorcycle crash with a comminuted femoral head and neck fracture without hip dislocation is presented. The computed tomography (CT) scan revealed avulsed bone fragments locked in the acetabular cavity that were not amenable to internal fixation. At surgery the capsule was incarcerated, and large fragments where severely crushed. An hemiarthroplasty replacement was performed, but 10 months later the patient developed an early posttraumatic arthritis leading to an inevitable total arthroplasty. The case presented here demonstrates the importance of early recognition and evaluation by a CT scan of this type of injury from a femoral head fracture.