Fixation Failure Research Articles

Hip Replacement Following Intertrochanteric Osteosynthesis Failure: Is It Possible to Restore Normal Hip Biomechanics?

Introduction: Intertrochanteric femoral fractures (IFFs) are the most common traumatic injuries in elderly people and significantly impact the patient’s health status. The current evidence indicates that short intramedullary nails may be a better choice than dynamic hip screws in IFF management, being less invasive and biomechanically superior, providing a buttress to limit fracture collapse. On the other hand, an unstable fracture may collapse even after adequate reduction and fixation. This paper aims to describe the surgical complexity of the nail-to-total hip arthroplasty (THA) conversion, focusing on the restoration of normal hip geometry. Material and Methods: Patients referred to our level I trauma center with failed cephalomedullary nailing following IFFs and managed with the nail-to-THA conversion were retrospectively recruited. The anteroposterior postoperative pelvis radiographs were analyzed to establish whether the normal biomechanics of the involved hip were restored. The following radiographic parameters were recorded and compared to the contralateral unaffected side: hip offset, cervical–diaphyseal angle, and limb length discrepancy. Clinical assessment was performed using the following scores: the Harris hip score (HHS) and the visual analog scale for pain (VAS). The independent samples t-test and the Pearson correlation test were performed. The tests were two-tailed; a p < 0.05 was considered significant. Results: A total of 31 patients met the inclusion and exclusion criteria (10 males and 21 females; mean age: 76.2 years; range: 66–90 years) and were included in this study. The modes of trochanteric nail failure included the following: cut-out in 22 cases (70.97%), non-union in 4 cases (12.9%), peri-implant fracture in 1 case (3.23%), cut-through in 2 cases (6.45%), and femoral head avascular necrosis (HAN) in 2 cases (6.45%). Long stems were used in 21 patients out of 31 (67.74%), while dual-mobility cups were implanted in 24 patients out of 31 (77.41%). A significant mean neck shaft angle (NSA) increase (p < 0.001) and a significant mean femoral offset reduction (FO, p 0.001) compared to the contralateral hip were recorded; a mean limb length discrepancy (LLD) of 8.35 mm was observed. A significant correlation between HHS and ∆NSA (p = 0.01) and ∆FO (p = 0.003) was recorded. Conclusions: Conversion from a cephalomedullary nail to THA is a complex procedure that should be considered a revision surgery, rather than a primary surgery. Surgeons must be aware that normal hip geometry may not be obtained during this surgical procedure; thus, a patient undergoing the nail-to-THA conversion for intertrochanteric fixation failure may have an increased risk of implant-related complications.

Prior Femoral Canal Instrumentation is a Major Risk Factor for Fixation Failure after Distal Femoral Replacement.

Prior Femoral Canal Instrumentation is a Major Risk Factor for Fixation Failure after Distal Femoral Replacement.

Finite Element Analysis of Additive Manufactured Porous PEEK Artificial Vertebral Bodies in Lumbar Total En Bloc Spondylectomy

Finite Element Analysis of Additive Manufactured Porous PEEK Artificial Vertebral Bodies in Lumbar Total En Bloc Spondylectomy

Application of biphasic mineralized collagen/polycaprolactone scaffolds in the repair of large load-bearing bone defects: A study in a sheep model.

Application of biphasic mineralized collagen/polycaprolactone scaffolds in the repair of large load-bearing bone defects: A study in a sheep model.

Optimal surgery sequence in the treatment of degenerative hip-spine syndrome: a propensity score-based inverse probability of treatment weighting analysis

BackgroundThe coexistence of spinal degenerative diseases and hip joint degeneration is common among middle-aged and elderly individuals, causing significant suffering and economic burden for patients. Total hip arthroplasty (THA) and lumbar fusion (LF) are primary treatment options for this combined condition, but the impact of the surgical sequence on patient outcomes remains unclear. Hence, this study aims to evaluate the effects of the surgical sequence of THA and LF on symptom recovery, changes in sagittal spine-pelvis parameters, and the incidence of long-term complications in patients.MethodsA retrospective analysis was conducted on 104 patients diagnosed with hip-spine syndrome (HSS) who underwent THA and LF at the Chinese PLA General Hospital. IPTW was implemented to control potential confounding factors. The impact of surgical sequence on clinical function scores, radiological parameters, and long-term complications was evaluated before and after conducting IPTW. Patients who underwent THA surgery first, followed by LF surgery, were categorized as the THA→LF group; conversely, those who underwent LF surgery first, followed by THA surgery, were categorized as the LF→THA group. Clinical function scores included the Oswestry Disability Index (ODI), Japanese Orthopedic Association (JOA) score, and Harris Hip Score for both groups. Long-term complications assessed in this study included instances of Proximal Junctional Kyphosis (PJK), internal fixation loosening or failure, as well as hip prosthesis dislocation. Radiological parameters included Pelvic Tilt (PT), Pelvic Incidence (PI), Pelvic Incidence minus Lumbar Lordosis (PI-LL), Sacral Slope (SS), and Lumbar Lordosis (LL).ResultsBefore conducting IPTW, there were significant differences between the two groups across multiple variables, including age (P = 0.035), fixation stage (P = 0.042), preoperative PT (P = 0.005), preoperative PI-LL (P = 0.004), and preoperative LL (P = 0.040). After conducting IPTW, all baseline data variables had P-values greater than 0.50, indicating that the baseline characteristics between the two groups were comparable. Following IPTW, the study found significant improvements in postoperative ODI, JOA score, and Harris Hip Score for both groups (P < 0.001), indicating that both surgical sequences were effective in enhancing clinical functional activity. However, there were no significant differences between the groups. Additionally, there was no significant difference in the long-term complication rates between the two groups. Regarding radiological parameters, the PT in the THA→LF group was significantly lower than that in the LF→THA group (P = 0.043), while the SS was significantly higher (P = 0.028) at the last follow up after conducting IPTW.ConclusionCompared to preoperative assessments, both surgical sequences significantly improve postoperative clinical function scores and radiological parameters for patients. When comparing between the two groups, the surgical sequence exhibits equivalent effects on functional improvement and complication rates. The radiological outcomes indicate that the THA→LF group shows more pronounced effects on PT and SS, suggesting a more favorable impact on pelvic alignment in patients undergoing this sequence. The use of the IPTW method successfully eliminates differences in baseline characteristics, enhancing the reliability of the results. Future research is warranted to further explore these findings and their implications for surgical decision-making in HSS patients.

AO Spine Clinical Practice Recommendations: Spinopelvic Fixation - What are the Key Items to Understand Performance?

Study DesignLiterature review with clinical recommendations.ObjectiveTo highlight important studies related to spinopelvic fixation and provide recommendations to practicing clinicians on interpretation and utilization of the evidence included in these studies.MethodsImportant literature related to spinopelvic fixation was reviewed and clinical recommendations were formulated. Recommendations were graded as strong or conditional.ResultsThree articles were selected and reviewed for the strength of methodology and scientific evidence. Article 1: Biomechanical analysis of lumbosacral fixation in Lumbar Fusion and Stabilization was granted conditional recommendation to consider biomechanical factors associated with different pelvic constructs. Article 2: Low profile pelvic fixation: anatomic parameters for sacral alar-iliac fixation vs traditional iliac fixation was granted strong recommendation to consider risk and benefits in choosing S2AI vs traditional iliac screw for pelvic fixation. Article 3: Rates of loosening, failure, and revision of iliac fixation in adult deformity surgery was granted a conditional recommendation, for taking into account different potential failure mechanisms in S2AI vs traditional iliac screws in pelvic fixation.ConclusionsCurrently evolving strategies have included multiple points of pelvic fixation, multiple rods to the pelvis and strategies with concomitant fusion of the sacro-iliac joints. The high mechanical failure rate at the lumbosacral junction indicates that there is still further opportunity for optimization. It is important to consider the risks and benefits of different pelvic fixation methods to optimize the outcomes for individual patients.

Clinical Effect of Button Plate Fixation in the Treatment of Anterior Sternoclavicular Joint Dislocations.

Multiple reconstruction approaches for the anterior sternoclavicular joint have been described. No gold standard technique has been established. Owing to the well-established role of open reduction and internal fixation by means of plates and/or screws, rigid fixation is associated with the risk of implant failure, migration, and need for removal. This study aimed to evaluate the safety and efficacy of using button plates for the treatment of anterior sternoclavicular joint dislocation. From January 2018 to May 2021, seven patients with a median age of 47 (range 37-57) years were treated for traumatic anterior sternoclavicular joint dislocations. The American Shoulder and Elbow Surgeons score (ASES), the visual analog scale (VAS) for pain and abduction, and forward elevation of the shoulder were used to evaluate clinical outcomes before the index surgery, at the removal of the implant, and at the latest follow-up. The satisfaction of patients was measured with the standard of Marsh. Open surgical reduction and sternoclavicular joint repair were successfully achieved in all the patients. They were also followed up, for a mean duration of 16.14 months. The mean postoperative abduction angle of the glenohumeral joint was 165.43 (range, 149°-173°), and the angle of one glenohumeral joint was less than 160 (149). The mean posterior extension angle of the glenohumeral joint was 26° (range, 24°-30°). The mean forward flexion was 161.25° (range, 150°-168°), and the horizontal extension was 39.57° (range, 35°-45°), respectively. According to the ASES scoring system, the mean postoperative physical function was 89.58, which was an improvement from the mean preoperative function, which was 25.48. There were no complications, wound infections, blood vessel or nerve injuries, or fixation failure. The patient satisfaction rate was 100%. Button plate fixation technique is safe, simple, and effective and has been successfully used in treating sternoclavicular joint dislocation, with excellent functional outcome.

Minimally Invasive Surgery For Posterior Temporary Fixation Through Intermuscular Approach in the Treatment of Odontoid Fractures: A Retrospective Cohort Study.

Retrospective study. This study aims to evaluate the effectiveness of temporary fixation through intermuscular approach in reducing intraoperative blood loss, postoperative pain, and preserving suboccipital musculature. Odontoid fractures pose significant treatment challenges, particularly regarding the preservation of cervical range of motion and minimizing disruption to the occipitocervical muscles. Conventional posterior open approaches are associated with a high incidence of postoperative occipitocervical pain, dysfunction, and substantial perioperative blood loss. We hypothesized that minimally invasive posterior temporary fixation through an intermuscular approach, which avoids significant disruption of the suboccipital musculature, would offer advantages over the standard open approach. This study included patients aged less than 65 years old and without osteoporosis who underwent posterior temporary fixation for odontoid fractures between 2015 and 2023. Outcomes measured included fracture healing rate, surgery duration, blood loss, Visual Analog Scale (VAS) scores, narcotic use, postoperative complications, hospital stay duration, and changes in muscle cross-sectional area (CSA). 45 patients were included (26 in the intermuscular group and 19 in the open group). No significant differences were found in fracture healing time or postoperative complications between the groups. The intermuscular group showed significantly lower intraoperative blood loss, shorter hospital stays, reduced postoperative VAS scores, and a decreased need for supplementary narcotics. Additionally, the intermuscular approach better preserved key occipitocervical muscles, with less CSA reduction compared to the open approach. No failures of internal fixation were observed in either group. Minimally invasive posterior temporary fixation through the intermuscular approach offers substantial benefits over traditional open surgery for odontoid fractures. These include reduced blood loss, lower postoperative pain, shorter recovery time, and better preservation of suboccipital musculature, all without compromising fracture healing. This technique provides an effective, muscle-sparing alternative for open temporary fixation in the treatment of odontoid fractures.

Clinical study of reverse total shoulder arthroplasty versus open reduction and internal plate fixation for treatment of Neer three/four-part proximal humeral fractures in elderly

To compare the effectiveness and shoulder function of reverse total shoulder arthroplasty (RTSA) and open reduction and internal fixation (ORIF) in the treatment of Neer three/four-part proximal humeral fractures in the elderly. Randomized controlled analysis was conducted on 68 patients over 70 years old with Neer three/four-part proximal humeral fractures treated with RTSA or ORIF between January 2020 and June 2022. The patients were randomly divided into RTSA group ( n=32) and ORIF group ( n=36). There was no significant difference ( P>0.05) in the baseline data such as age, gender, body mass index, injured side, Neer classification, and preoperative Charlson comorbidity index, visual analogue scale (VAS) score, Constant shoulder score, Oxford shoulder score (OSS), and hemoglobin (Hb). The operation time, intraoperative blood loss, reduction of Hb on the 3rd day after operation, hospital stay, total cost of hospitalization, complication incidence, range of motion of shoulder joint at 2 years after operation, VAS score before operation and at 5 days and 1 month after operation, Constant shoulder score and OSS score before operation and at 2 years after operation, and imaging results during follow-up were recorded and compared between the two groups. Compared with the ORIF group, the RTSA group had longer operation time, less intraoperative blood loss, and higher total cost of hospitalization ( P<0.05). There was no significant difference in Hb reduction on the 3rd day after operation between the two groups ( P>0.05). The VAS scores significantly improved in both groups at 5 days and 1 month after operation ( P<0.05), but there was no significant difference between the two groups ( P>0.05). All patients were followed up 26-35 months, with an average of 31.2 months. In the RTSA group, there were 2 cases of poor healing of superficial incision and 1 case of transient nerve injury. There was no complication such as bone resorption around the prosthesis, lucent band, prosthesis loosening, or periprosthetic fracture in all patients. In the ORIF group, there was 1 case of poor healing of superficial incision, 3 cases of nonunion of fracture, 1 case of arthritis secondary to humeral head necrosis, and 1 case of bone absorption of large tuberosity, and no displacement or fracture failure of internal fixation was found in all patients. There was no significant difference in the incidence of complications [9.4% (3/32) vs 16.7% (6/36)] between the two groups [ OR (95% CI): 0.828 (0.171, 4.014), P=0.814]. In the RTSA group, 28 cases were graded 0 and 4 cases were graded 1 at 2 years after operation. Constant and OSS scores of RTSA group were significantly better than those of ORIF group ( P<0.05). The Constant score was significantly better than ORIF group in activity and strength, range of motion, lifting, abduction, and external rotation ( P<0.05), and there was no significant difference in pain, daily function, and internal rotation between the two groups ( P>0.05). The RTSA group had a significantly greater range of motion in lifting, abduction, and external rotation than ORIF group ( P<0.05), but there was no significant difference in internal rotation between the two groups ( P>0.05). Application of RTSA as the initial treatment of Neer three/four-part proximal humeral fractures in the elderly can achieve better rehabilitation of joint activity and lower risk of early reoperation, and improve the quality of life of elderly fracture patients. However, the difficulty of revision and the high cost of treatment require the surgeon to pay full attention and strictly grasp the indications.

Use of controlled nail dynamization technique for femoral shaft hypertrophic nonunion.

Femoral nonunion after intramedullary nailing (IMN) of a diaphyseal long bone fracture is a severe complication that requires effective management. The IMN dynamization has been used to treat hypertrophic nonunions previously. However, routine nail dynamization has only a low success rate and the risk of limb shortening. Two patients with femoral shaft fracture hypertrophic nonunion at 4 or 5 months after intramedullary nailing were treated with the therapeutic paradigm named "controlled nail dynamization". In this paradigm, the interlocking nails are removed but the dynamic hole nails are retained. At the same time, four Poller screws were used to limit the movement of the intramedullary nail in the coronal and sagittal planes. The intramedullary nail can only generate compressive stress along the axial direction of the femoral shaft, thereby promoting fracture healing. So this technique was named "controlled nail dynamization". Here, we describe two cases of delayed healing of the femoral diaphysis, which were successfully treated through controlled nail dynamization. Followed up for more than 12 months. Bone union was achieved in both patients, and there were no complications such as nonunion and internal fixation failure. The controlled nail dynamization is feasible for safe and effective treatment for femoral shaft hypertrophic nonunion.

Interlocking screw backout from a preassembled polymer inlay in a retrograde femoral nail system: A retrospective review.

Interlocking screw backout from a preassembled polymer inlay in a retrograde femoral nail system: A retrospective review.

Fusion Rate of Biphasic Calcium Phosphate Bone Graft with Needle-Shaped Submicron Surface Topography in Interbody Lumbar Fusion for Degenerative Disc Disease: A Single-Center Retrospective Review.

Fusion Rate of Biphasic Calcium Phosphate Bone Graft with Needle-Shaped Submicron Surface Topography in Interbody Lumbar Fusion for Degenerative Disc Disease: A Single-Center Retrospective Review.

Analysis of the therapeutic effect of asymmetric T1 pedicle osteotomy in the treatment of stiff cervical thoracic lateral kyphosis deformity

Objective: To analyze the clinical efficacy of asymmetric T1 transpedicular wedge resection Smith-Petersen osteotomy (T1 SPO) in the treatment of stiff cervical thoracic lateral kyphosis deformity. Methods: This is a retrospective case series study. The clinical data of nine patients with stiff cervical thoracic kyphosis who underwent asymmetric T1 SPO corrective treatment from June 2012 to October 2022 were collected. There were 7 males and 2 females, aged 45 to 68 years. The surgery time, intraoperative blood loss, and complications were recorded. The chin brow vertical angle (CBVA), cervical thoracic kyphosis Cobb angle, cervical thoracic scoliosis Cobb angle, and cervical thoracic sagittal axis (C2-T1 sagittal vertical axis, SVA) before surgery, after surgery, and at the last follow-up were measured and correction rate were calculate. Results: All 9 patients successfully completed the surgery. The operation time ranged from 245 to 320 minutes, and the intraoperative blood loss was 1 400 to 2 200 ml. All patients were followed up for 24 to 48 months. The preoperative CBVA was 93.7° to 112.0°, which improved to 25.2° to 31.7° at the last follow-up, with an correction rate of 73.4%. The preoperative cervicothoracic kyphosis Cobb angle was -57.0° to -16.6°, which improved to -10.3° to -18.5° at the last follow-up, with an correction rate of 166.7%. The preoperative scoliosis Cobb angle was 13.8° to 16.5°, which improved to 2.2° to 3.8° at the last follow-up, with an correction rate of 84.9%. The preoperative SVA was 7.8 to 12.2 cm, which improved to 4.5 to 6.8 cm at the last follow-up, with an correction rate of 42.3%. One patient experienced numbness and weakness in the left hand after surgery, which recovered after 3 months. One patient had poor healing of the surgical incision, which healed after symptomatic treatment. During the follow-up, the coronal and sagittal balance of all patients was maintained, and no other neurological complications occurred. There were no cases of screw loosening, broken screws, or broken rods, or other internal fixation failures. Conclusion: The application of asymmetric T1 SPO technique in the treatment of stiff cervical thoracic lateral kyphosis deformity can achieve relatively satisfactory correction effects.

Fixation of the Volar Ulnar Corner in Distal Radius Fractures: A Comparative Study.

The purpose of this study was to compare outcomes of distal radius fractures with a volar ulnar corner (VUC) component treated with standard volar plating or by specific VUC fixation. This study investigated outcomes, radiographic measures, and specialty-based preference associated with surgical treatment of VUC injuries using VUC-specific fixation versus nonspecific VUC fixation. We retrospectively analyzed outcomes for 39 patients with a distal radius fracture with VUC component at a level-1 trauma center over 10 years, 2011-2021. Patients underwent either VUC-specific fixation with implants such as a volar rim plate, or with a standard volar plate. The primary outcome of this study was fixation failure and need for revision. Secondary outcomes included complication rate, radiographic alignment, and differences in fixation based on fellowship training. Sixteen of the 39 patients studied had undergone VUC-specific fixation, with a significantly higher rate of use of VUC-specific fixation in fellowship trained hand surgeons compared with fellowship-trained trauma surgeons. There was no significant difference in loss of reduction, revision surgery, or complications. Radiographic measures were statistically similar between both groups postoperatively. Trauma trained surgeons had a significantly increased postoperative radial inclination versus hand-trained surgeons. This study suggests that not all VUC injuries require specific VUC fixation, and we may be overtreating distal radius fractures that have a VUC component. Fellowship-trained hand surgeons are more likely to employ VUC-specific fixation methods. Additional studies are warranted to determine whether other considerations such as dynamic testing intraoperatively are worthwhile.

Effectiveness of guide plate with mortise-tenon joint structure combined with off-axis fixation in treatment of Pauwels type Ⅲ femoral neck fractures

To investigate the effectiveness of using 3 hollow compression screws combined with 1 screw off-axis fixation under the guidance of three-dimensional (3D) printed guide plate with mortise-tenon joint structure (mortise-tenon joint plate) for the treatment of Pauwels type Ⅲ femoral neck fractures. A clinical data of 78 patients with Pauwels type Ⅲ femoral neck fractures, who were admitted between August 2022 and August 2023 and met the selection criteria, was retrospectively analyzed. The operations were assisted with mortise-tenon joint plates in 26 cases (mortise-tenon joint plate group) and traditional guide plates in 28 cases (traditional plate group), and without guide plates in 24 cases (control group). There was no significant difference in the baseline data of gender, age, body mass index, cause of injury, and fracture side between groups ( P>0.05). The operation time, intraoperative blood loss, frequency of intraoperative fluoroscopy, incision length, incidence of postoperative deep vein thrombosis of lower extremity, pain visual analogue scale (VAS) score at 1 week after operation, and Harris score of hip joint at 3 months after operation were recorded and compared. X-ray re-examination was taken to check the quality of fracture reduction, fracture healing, and the shortening length of the femoral neck at 3 months after operation, and the incidences of internal fixation failure and osteonecrosis of the femoral head during operation. Compared with the control group, the operation time, intraoperative blood loss, and frequency of intraoperative fluoroscopy reduced in the two plate groups, and the quality of fracture reduction was better, but the incision was longer, and the differences were significant ( P<0.05). The operation time and intraoperative blood loss were significantly higher in the traditional plate group than in the mortise-tenon joint plate group ( P<0.05), the incision was significantly longer ( P<0.05); and the difference in fracture reduction quality and the frequency of intraoperative fluoroscopy was not significant between two plate groups ( P>0.05). There was 1 case of deep vein thrombosis of lower extremity in the traditional plate group and 1 case in the control group, while there was no thrombosis in the mortise-tenon joint plate group. There was no significant difference in the incidence between groups ( P>0.05). All patients were followed up 12-15 months (mean, 13 months). There was no significant difference in VAS score at 1 week and Harris score at 3 months between groups ( P>0.05). Compared with the control group, the fracture healing time and the length of femoral neck shortening at 3 months after operation were significantly shorter in the two plate groups ( P<0.05). There was no significant difference between the two plate groups ( P>0.05). There was no significant difference in the incidences of non-union fractures, osteonecrosis of the femoral head, or internal fixation failure between groups ( P>0.05). For Pauwels type Ⅲ femoral neck fractures, the use of 3D printed guide plate assisted reduction and fixation can shorten the fracture healing time, reduce the incidence of postoperative complications, and be more conducive to the early functional exercise of the affected limb. Compared with the traditional guide plate, the mortise-tenon joint plate can reduce the intraoperative bleeding and shorten the operation time.

Displaced Femoral Neck Fractures Treated with Percutaneous Compression Plates in Elderly Individuals: An Effect Analysis Based on Imaging.

The effects of percutaneous compression plate (PCP) internal fixation for femoral neck fractures (FNFs) in elderly individuals have rarely been reported. Therefore, this study aimed to investigate the efficacy of PCCP internal fixation for displaced FNFs in elderly individuals based on imaging. The clinical data of 32 elderly patients with FNFs treated with PCCP from January 2015 to December 2022 were retrospectively analyzed. The average age of the participants was 68.7 ± 4.8 years (range, 65-80 years). Nineteen patients had Garden type III, and 13 patients had Garden type IV. Six patients had Pauwels type I, 15 patients had type II, and 11 patients had type III. Twelve patients had Singh index level IV, 14 patients had level V, and 6 patients had level VI. The time from injury to operation ranged from 3-14 days, with an average of 5.8 days. A radiological assessment was conducted. The relationships between efficacy and age, Pauwels classification, the Singh index, and the Garden alignment index were analyzed. At postoperative week 1, fracture reduction was acceptable in 31 patients. The time to start walking was 5.7 ± 3.7 days. The follow-up time ranged from 2.1 to 4 years, with an average of 2.7 years. There were 2 cases of delayed healing and no cases of nonunion or internal fixation failure. The healing time ranged from 4-8 months, with an average of 4.9 months. Fifteen patients (46.9%) showed healing with shortening of the femoral neck, and 3 patients (9.4%) had avascular necrosis (AVN). Correlation analysis revealed that healing with shortening of the femoral neck was positively correlated with age and the Singh index and that AVN was positively correlated with the Pauwels classification (p < 0.05). The efficacy of PCCPs for internal fixation of displaced FNFs in elderly individuals without severe osteoporosis is satisfactory, especially for patients who can ambulate early postoperatively. The main complications are healing with shortening of the femoral neck and AVN, which are prone to occur in patients with severe osteoporosis and Pauwels type III FNFs, respectively.

Treatment of Incompletely Displaced Femoral Neck Fractures Using Trochanteric Fixation Nail-Advanced(TFNA) in Patients over 50 years of Age.

To analyze the outcomes of patients with femoral neck fractures aged 50 years or older treated with Trochanteric Fixation Nail-Advanced (TFNA; DePuy Synthes, Paoli, PA) to determine the stability of fracture fixation and the effectiveness of the treatment. Design: Retrospective cohort study. Single level I trauma center. Patients aged 50 years or older who underwent fixation with TFNA helical blade for femoral neck fractures (OTA/AO 31-B) and were followed for more than 1 year were included. Radiological examinations were evaluated to determine bone union, femoral neck shortening, development of avascular necrosis (AVN) of the femoral head, and breakage of metal fixation. A comparison was made between patients with femoral neck shortening (>5 mm) and those without (<5 mm). A total of 45 patients were included in this study. The mean age of the patients was 70.2 (50-89) years, and 68.9% were females. No early postoperative complications, such as postoperative infection, deep vein thrombosis, or pulmonary embolism, were observed. All patients achieved bone union within 23 weeks. The average femoral neck shortening was 2.6 mm (0-16.8), with femoral neck shortening >5 mm observed in 7 patients (15.6%). Significant femoral neck shortening was observed in patients with displaced fractures compared to non-displaced fractures (p=0.006). One patient developed AVN of the femoral head. No metal fixation failure was observed. In patients aged 50 years or older, TFNA fixation for non-displaced femoral neck fractures demonstrated relatively minimal femoral neck shortening and a low complication rate, indicating that it is an effective technique for treating these fractures. However, for displaced fractures, surgeons should be mindful of the potential for excessive neck shortening and carefully select the surgical method. Therapeutic Level III.

Surgical revision after previous failed lateral ulnar collateral ligament (LUCL) reconstruction and persisting posterolateral rotatory instability (PLRI) of the Elbow: a retrospective multicentric analysis.

The aim of this study was to identify causes for recurrent PLRI, compare surgical treatment options, and analyze functional outcomes following revision LUCL reconstruction. A retrospective multicentric case analysis was conducted, including patients who underwent revision LUCL surgery due to recurrent PLRI. Demographic data, surgical techniques (for primary and revision LUCL reconstruction) and postoperative rehabilitation protocols were analyzed, and causes of failure documented. Functional outcomes were assessed using the Patient-Rated Elbow Evaluation (PREE) and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaires. A total of 37 patients with a mean age of 44.3years (± 12.3) and a median follow-up of 40.9months (interquartile range, 20.5-77.0) with revision LUCL surgery were included. Recurrent instability was mainly attributed to graft insufficiency or loosening (59.5%) and rupture of the humeral graft (37.8%). Failure of humeral fixation occurred in 48.7% of cases, often due to loosening or widening of the drill hole. While triceps tendon autografts were most commonly used for primary LUCL reconstruction (89.2%), triceps and hamstring tendon autografts were used in revision procedures (35.1% and 32.4%, respectively). Fixation of the humerus was most commonly performed with tenodesis screws (83.8% in primary procedures and 73.0% in revision procedures), and fixation of the ulnaris was generally performed with biceps buttons in both primary procedures (75.7%) and revision procedures (51.4%). Out of 37 patients, eight complications (21.6%) were reported following revision surgery, including three cases of recurrent instability (8.1%). The median QuickDASH score was 42.5 (IQR, 25.4-80.2), and the median PREE score was 13.0 (IQR, 1.0-41.4). Revision LUCL reconstructions remain challenging. The most common causes of failure are graft insufficiency or loosening, and humeral graft rupture, resulting in recurrent PLRI. Additionally, revision LUCL reconstruction is associated with moderate to poor postoperative outcome scores and a relatively high complication rate.

High failure rates in comminuted patella fractures (AO/OTA 34-C3) fixed with an isolated new patella specific 2.7 mm variable angle locking plate.

To compare the outcomes of comminuted patella fractures fixed with a new patella-specific 2.7mm variable angle (VA) locking plate in isolation versus when augmentation of fracture fixation is applied with the plate. Design:Retrospective. Academic Level I Trauma Center. All acute comminuted patella fractures (AO/OTA 34-C3; complete displaced or undisplaced articular, frontal/coronal multifragmentary fractures) in adult patients primarily treated with a new patella-specific 2.7 mm VA locking plate (Synthes, Paoli, PA) between January 2021 and February 2024 at a single academic center were reviewed and divided in those fixed with the patella plate alone and those with additional bony and/or soft tissue augmentation. Excluded were those with < 90 follow-up, set a priori, unless complications occurred <90 days. Comparison of patient age, sex, BMI, ASA, FRAX score, open fracture, polytrauma involvement, length of follow-up and post-operative protocols was made between groups. The primary outcome measure was loss of fixation. Secondary outcomes were mode of failure and other surgical complications. There were a total of 38 included patients, with no lack of or loss of follow-up, with 20 grouped into patella plate alone, and 18 into patella plate plus augmentation. The plate only group had a higher mean age (63.7 vs. 46.9, p=0.024), with no between-group differences in sex (65% vs. 44% female, p=0.20), BMI (p=0.51), 10-year fracture risk (FRAX) (p=0.06), open fractures (p=0.30), polytrauma involvement (p=0.97), or postoperative weight-bearing (p=0.76) or range of motion (p=0.06) protocols. There were eight failures (40.0%) in the plate-only group, and two failures in the plate with augmentation group (11.1%); (p=0.043). When controlling for known risk factors for osteoporosis and poor bone quality using the FRAX 10-year fracture risk on multivariable regression analysis, plate fixation with fracture augmentation was associated with a lower risk of fixation failure (OR=0.14, 95% CI 0.02-0.75; p=0.036). The plate-only group failed by loss of distal (62.5%, n=5) and proximal fixation (37.5%, n=3). Each of the two failures in the plate plus augmentation group had loss of distal fixation. Treatment of comminuted patella fractures with a new patella-specific 2.7mm VA locking plate has a high failure rate when used in isolation. Augmenting fracture fixation with soft-tissue repair and/or independent fracture fragment fixation may significantly decrease failure rates. In particular, augmentation of the tendon avulsion component to restore the extensor mechanism appears critical. Therapeutic Level 3.

Estimation of proximal junctional failure and associated risk factors in adult spine deformity surgery: an observational study from a single institution.

A retrospective observational cohort study. To estimate the proximal junctional failure (PJF) rate and identify associated factors. Proximal junctional pathologies are challenging and common complications of adult spine deformity (ASD) surgery. However, the PJF rate was not accurately defined within the ASD cohort. A correct estimate of PJF incidence and associated factors will inform clinicians on reoperation risk and prevention strategies. This retrospective observational study included patients with degenerative or adult idiopathic thoracolumbar deformity, extended instrumentation, sacropelvic fixation, and more than 2 years of follow-up. Patients with post-traumatic or iatrogenic sagittal malalignment were excluded. Demographic and operative data were obtained from the electronic medical records. Preoperative and followup scoliosis radiographs were reviewed to calculate the spinal alignment parameters. Patients were categorized into the PJF and non- PJF groups using the modified Hart-ISSG criteria, and their demographic, surgical, and radiographic parameters were compared using descriptive statistics. Multivariable logistic regression models were fitted to estimate the association measures of PJF occurrence, and their odds ratios (ORs) were reported with corresponding 95% confidence intervals (CI). Of the eligible 157 patients who underwent surgery between 2011 and 2018, 130 were included. The mean age was 64.6±8 years, and 73% of the patients were female. Moreover, 42 (32%) and 88 patients (68%) were allocated to the PJF and non-PJF groups, respectively. The mean change in the proximal junctional angle (△PJA) in the PJF group was 26°±8.2°, and 33 patients (79%) had a final PJA >20°, 4 (10%) had an additional upper instrumented vertebra (UIV)/UIV+1 fracture, and 5 (12%) had an additional screw dislodgement or fixation failure. Postoperative changes in PJA (OR, 1.23; 95% CI, 1.12-1.37; p <0.001), thoracic kyphosis (TK; OR, 1.06; 95% CI, 1.02-1.11; p =0.004), and the use of a proximal tether (OR, 0.22; 95% CI, 0.04-0.82; p =0.03) were associated with PJF. In this study, the PJF rate was 32%, of which 67% of the patients underwent reoperation. Postoperative PJA and TK changes and the use of proximal tethers were significantly associated with PJF.