Fixation Of Fragments Research Articles

Lateral tibial plateau fractures with posterior comminution. Can a rim plate offer sufficient support?

Tibial plateau fractures with posterior comminution are difficult to reduce and stabilise. Standard lateral approach doesn't offer adequate visualisation. Posterior approach is suitable for isolated posterior fractures. The addition of a specifically contoured rim plate can enable fixation of posterior fragments through a modified lateral approach.The purpose of this study was to evaluate the advantages and limitations of this novel technique. We present a prospective series of 16 tibial plateau fractures with posterolateral depression, operated over a period of 7 years (04.2014-09.2021). The mean age of the patients was 52 years .They were followed for an average period of one year.Clinical and functional assessment was performed according to the criteria of Knee Society Clinical Rating Score. The lateral and posterior component of the fracture was stabilised by a horizontal rim plate, through a posterolateral approach, with or without fibular osteotomy. 9 patients had excellent, 5 had good, 2 had average ratings. The average objective rating was 87,5 (70- 97), and the average functional rating was - 74,4 (40-100). The average ROM was 110° (100°-120°). Two of the fractures healed in 5° varus and 8° valgus respectively. One knee joint ended up with 10° flexion deficit. Three knees had medio- lateral instability, with no functional impairment. In 4 cases the K wires of the weber fibular osteotomy fixation migrated. The absence of late articular collapse of the treated fractures may be attributed to the initial stability of fixation.The addition of a rim plate addresses the posterior comminution and makes early rehabilitation safe.

Device for transosseous osteosynthesis at thefractures of the clave

The article presents a technical solution to the issues of external osteosynthesis in the treatment of clavicle fractures, which is mainly characterized by insufficient capabilities inherent in the structures to move fragments in different directions and planes. Purpose: to establish the distinctive features of the known external devices used in the osteosynthesis of clavicle fractures, and to develop a design taking into account the identified shortcomings. Material and methods: based on the identified shortcomings in various author's designs, an original device was developed for the treatment of patients with fractures of the considered localization. The use of the device involves the use of stabilizing and repositioning screw rods, which are inserted through the proximal and distal fragments of the clavicle. A feature of the introduction of these screw rods is that they are located relative to each other at an angle of 90°, which ensures stable fixation of fragments of the clavicle in all planes. The method of rod fixation developed in the clinic allows for controlled reposition using repositioning nodes, the mobility of which is possible in three planes. Stable fixation of fragments of the clavicle is maintained until the fracture heals, while ensuring the function of the shoulder and elbow joints. Conclusions: evaluation of the technical results of the device showed that external osteosynthesis can be the method of choice for treatment and have practical application in trauma departments.

Combined quadriceps medial patellofemoral ligament reconstruction and osteochondral fixation offers good patient-reported outcomes and low rates of recurrent instability for osteochondral defects secondary to acute patella dislocation.

Chondral injuries secondary to traumatic patella dislocation are common, and a subgroup of these are significant defects with fragments amenable to fixation. There is a paucity of published evidence assessing patients managed with combined acute patellofemoral stabilisation and osteochondral fixation. The purpose of this study is to report the outcomes of patients with osteochondral injuries secondary to acute traumatic patella dislocation treated with combined early fragment fixation and MPFL reconstruction using a quadriceps tendon turndown technique which has distinct advantages for this cohort, including preventing chondral overloading and non-violation of the patella bone. Patients who underwent combined quadriceps tendon MPFL reconstruction and osteochondral fixation were included. Patient demographics, defect characteristics, complications and reoperations were evaluated. Patients were assessed with Lysholm, Kujala, KOOS-PF scores and satisfaction scale at follow up. Pre-operative MRI was assessed for presence of radiological risk factors for patella dislocation and post-operative MRI was used to assess cartilage quality with MOCART 2.0 score. A total of 19 patients (63.2% female) were included. The mean age was 17.4 ± 4.8years and patients were followed up at a mean 15.8 ± 5.1months post-surgery. The mean defect size was 2.4 cm2 ± 1.3 cm2, with the most common defect location being the patella (13/19; 68.4%) followed by the lateral femoral condyle (5/19; 26.3%). At final follow up, the overall mean Lysholm, Kujala, and KOOS-PF scores were 84.9 ± 11.1, 89.7 ± 5.8 and 80.6 ± 13.6, respectively. Seventeen patients (89.5%) were satisfied with their outcome. The mean MOCART 2.0 score at final follow-up was 72.5. One patient required medial capsular plication with removal of a loose chondral body and microfracture and 3 knees required minor reoperations. Combined acute osteochondral fragment fixation and MPFL reconstruction using a quadriceps tendon graft offers good radiological and patient-reported outcomes with high satisfaction and low rates of recurrent patella dislocation. To our knowledge, this is currently the largest series of its kind in the literature and the results of this study provide a rationale for a combined approach using a quadriceps tendon graft for this cohort. Level IV.

FEATURES OF MANDIBULAR FRACTURES

In order to prevent some of the observed complications from the above-mentioned methods of treatment, i.e. Kirschner needle, bone sutures, during the development of medicine, titanium microscrews and miniplates are being used for modern treatment. By using microscrews and miniplates, it has been possible to achieve stable fixation of fracture fragments and treatment of mandibular fractures by non-burning method.

In vitro/ in vivo evaluation of double crosslinked bone glue with different degrees

ABSTRACT Successful bone fragment fixation is a crucial factor in bone fracture healing, the fixation of crushed bone fragments could hinder bone fracture healing. Thus, ideal bone glues to effectively adhere and splice comminuted bone fragments are needed in clinical. Herein, an osteoinductive and biodegradable double cross-linked bone glue (GelMA-oDex-AMBGN) was constructed through Schiff’s base reaction between commercial GelMA (with different substitution degrees of amino groups) and Odex mixed with amine-modified mesoporous bioactive glass nanoparticles (AMBGN), followed by crosslink with blue light irradiation. The GelMA-oDex-AMBGN bone glue successfully adhered and spliced the comminuted bone fragments of isolated rat skulls. GelMA-oDex-AMBGN promoted the proliferation of 3T3 cells and enhanced the expression of osteogenic proteins Runx2 and OCN in vitro. In rat cranial critical-sized defect models, GelMA-oDex-AMBGNs with different substitution degrees significantly increased the new bone contents at the fracture defect sites and promoted bone tissue regeneration in vivo. In conclusion, the double cross-linked bone glue (GelMA-oDex-AMBGN) was successfully constructed and can induce bone regeneration. Additionally, there was no significant difference in osteogenic activity among GelMA-oDex-AMBGNs with different substitution degrees and the equal content of AMBGN.

Middle-sized posterior malleolus fractures: Fixed versus non-fixed – A prospective randomized study

PurposeThis study aimed to assess the impact of fixation on functional and radiological outcomes of ankle fractures involving the posterior malleolus. We hypothesized that fixation of the posterior malleolus would be associated with improved radiological and functional outcome. MethodsA prospective randomized controlled study was planned and 40 consecutive ankle fractures involving middle-sized (10–25%) posterior fragment were included. Posterior fragments in Group 1 were not fixated while Group 2 underwent posterior malleolus fixation. The patients were evaluated both functionally and radiologically at minimum 2-years. ResultsDemographics and fracture type distributions were similar between the groups. Despite the slightly better functional outcome in Group 2, no significant functional or radiological outcome difference could be detected. Articular step-off> 1 mm was more common in Group 1 (p = 0.04) and the patients with articular step-off showed significantly worse functional outcome in all functional parameters (p < 0.05). Radiological and functional outcome parameters were positively correlated when all patients were evaluated together. Lateral radiographs caused an overestimation in the size of posterior fragment compared to CT (p < 0.001). ConclusionAlthough there was a slightly better clinical outcome in patients with fixed posterior fragments, it was not significant at short to mid-term follow-up. However, posterior fragment fixation contributed to functional outcomes by decreasing the incidence of articular step-off> 1 mm, which was found to be a negative prognostic factor. Level of evidenceLevel I; prospective randomized controlled study.

Internal Fixation of Unstable Osteochondritis Dissecans of the Knee: Long-term Outcomes in Skeletally Immature and Mature Patients

Background: Osteochondritis dissecans (OCD) is a disorder originating in the subchondral bone, leading to focal lesions with risk of fragmentation and secondary damage of the articular cartilage. It remains controversial if surgical treatment of such lesions is equally successful in skeletally immature and mature patients. Purpose: To determine (1) the long-term clinical success rate after internal fixation of unstable OCD in skeletally immature and mature patients based on physeal status, (2) if patient-specific and procedural variables influence the risk of failure, and (3) patient-reported outcome measures over time. Study Design: Cohort study; Level of evidence, 3. Methods: A multicenter retrospective cohort study was conducted investigating skeletally immature and mature patients treated for unstable OCD lesions of the knee between 2000 and 2015. The healing rate was assessed by radiological imaging and clinical follow-up. Failure was defined as any definitive reoperation for the initially treated OCD lesion. Results: A total of 81 patients met inclusion criteria, including 25 skeletally immature patients and 56 patients with closed physes at the time of surgery. After a mean follow-up time of 11.3 ± 4 years, 58 (71.6%) patients had healed lesions, whereas the lesions failed to heal in 23 (28.4%) patients. No significant difference in risk of failure was observed based on physeal maturation status (hazard ratio, 0.78; 95% CI, 0.33-1.84; P = .56). Lateral versus medial condylar lesion location conferred an increased risk of failure (P < .05) for both skeletally immature and mature patients. Multivariate analysis of skeletal maturity status showed that a lateral femoral condylar location was an independent risk factor for failure (hazard ratio, 0.22; 95% CI, 0.1-0.5; P < .05). The mean patient-reported outcome scores (International Knee Documentation Committee [IKDC] score and Knee injury and Osteoarthritis Outcome Score [KOOS]) increased significantly after surgery and remained high at the final follow-up (P < .05). The final scores (mean ± SD) at a mean follow-up of 135.8 months (range, 80-249 months) were IKDC, 86.6 ± 16.7; KOOS Pain, 88.7 ± 18.1; KOOS Symptoms, 89.3 ± 12.6; KOOS Activities of Daily Living, 89.3 ± 21.6; KOOS Sport and Recreation, 79.8 ± 26.3; and KOOS Quality of Life, 76.7 ± 26.3. Conclusion: The long-term results after internal fixation of OCD fragments show high rates of healing and sustainable subjective improvement of knee function and quality of life. A healing rate of 72% was noted at a mean follow-up of 11.3 years. The stage of skeletal maturity had no significant influence on the rate of failure. Lateral femoral condylar lesion location is an independent risk factor for failure in skeletally mature and immature patients.

Fixace osteochondrálních fragmentů kolena biodegradabilními implantáty z hořčíkové slitiny u dětských pacientů

PURPOSE OF THE STUDY Fixation of osteochondral fragments are relatively common procedures in pediatric orthopaedic surgery. The use of biodegradable magnesium implants in these indications appears to be a promising alternative to polymer implants due to their favorable mechanical properties and biological behavior. The purpose of this study is to evaluate the short-term clinical and radiological outcomes of the fixation of unstable or displaced osteochondral fractures and osteochondritis dissecans lesions in the knee joint using MAGNEZIX® screws and pins in pediatric patients. MATERIAL AND METHODS In this study, 12 patients (5 girls, 7 boys) were included. The inclusion criteria were as follows (1) age below 18 years; (2) unstable or displaced osteochondral fragments secondary to trauma or as a result of osteochondritis dissecans, Grades III and IV in the ICRS (International Cartilage Repair Society) score, confirmed by imaging methods and indicated for surgical fixation; (3) fixation performed using screws or pins made of the magnesium-based MAGNEZIX® alloy; (4) minimum postoperative interval of 12 months. X-rays and clinical evaluation were assessed 1 day, 6 weeks, 3, 6, and 12 months after the operation. MRIs were performed 1-year postoperatively for evaluation of bone response and degradation behavior of implants. RESULTS The mean age at surgery was 13.3 ± 1.6 years. A total of 25 screws were used in 11 patients, a mean of 2.4 ± 1 per patient, 4 pins were used in 1 patient. In 2 patients, fixation with screws was complemented with fibrin glue. The mean follow-up was 14.2 ± 3.3 months. All patients exhibited complete functional recovery while showing no signs of pain at 6 months postoperatively. No adverse local reactions were observed. At 1-year follow-up, no implant failure has been reported. Complete radiographic healing occurred in 12 cases. Mild radiolucent zones were observed around the implants. CONCLUSIONS The use of screws and pins MAGNEZIX® has been found to provide satisfactory outcomes in terms of fracture healing and very good functional outcomes at 1 year postoperatively. Key words: biodegradable implants, magnesium-based implants, osteochondral fracture, osteochondritis dissecans, MAGNEZIX®.

Persian Fixation - A Novel Surgical Method for Intra-articular Distal Radius Fractures.

Background: Intra-articular distal radius fracture treatment options include Kirschner wires (K-wire) fixation, external fixation and plate fixation, however, fixation of small bone fragments in distal radius fractures in a secure and anatomical manner was a challenging issue with several limitations. In this study, we present a novel surgical method that we have called the Persian Fixation for intra-articular distal radius fracture and describe a short-term clinical result. Methods: We described the surgical procedure and clinical result of 15 patients between 2019 and 2020 in whom the Persian Fixation technique was utilised. Through clinical examination and questionnaires, objective and subjective clinical results were determined. Results: At the final follow-up, the mean Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) score for our patients was 17.6 ± 12.1, the mean WOrk-Related Questionnaire for UPper extremity disorders (WORQ-UP) score was 20.7 ± 4.4 and the mean Visual Analogue Scale (VAS) score was 27.8 ± 16.5, indicating a good to excellent clinical result. Conclusions: We recommended the Persian Fixation technique for intra-articular distal radius fractures, which is a low-cost and readily accessible procedure that provides stable fixation of a tiny bone piece. Level of Evidence: Level IV (Therapeutic).

The application of intramedullary nails and transmedullary support screws in surgical treatment of distal tibia fracture

Introduction. Fractures of the distal tibia are a difficult treatment problem due to the specific anatomy of this area and the soft tissue injuries resulting from trauma. A distal fracture is short, has a wide marrow cavity, and the asymmetric muscle forces acting on it can cause secondary displacements despite the originally correct positioning. Against the background of the problems presented above, the fixation with an intramedullary nail (IMN) with the use of TMS (trans medullary support) screws directional screws seems to be the best alternative for treatment. Aim. The aim of this study was to evaluate the bone fracture repositioning after surgical treatment of tibia fracture, the time of bone healing and the function of the upper ankle joint. Materials and methods. Forty patients treated surgically due to a fracture of the distal tibia with the use of an intramedullary nail and TMS screws were included in this study. The mean follow-up time was 25.3 months. The function of the ankle joint of the injured limb was evaluated using the AOFAS, VAS and SF-36 questionnaires. Radiological documentation was assessed in terms of correct bone fragment repositioning, placement of directional screws and correct union of the fibula. Post-operative X-rays as well as X-rays taken at the end of treatment in AP and lateral projection were also assessed, evaluating LDTA (lateral distal tibial angle) and ADTA (anterior distal tibial angle). Results. The function of the ankle joint after surgical treatment of a distal tibia fracture using the IMN + TMS method is as follows: AOFAS score 91.5, VAS 2.2 / 10 points. The range of motion of the ankle joint: the angles of ankle movement were significantly greater in the case of the uninjured limb compared to the injured one. Bone union was obtained in all patients. In 80% of patients, it was achieved in less than 6 months. Assessment of repositioning after surgery – mean LDTA angle after surgery was 89 and mean ADTA angle after surgery was 86 (standard LDTA 90, ADTA 85). Conclusions. The function of the ankle joint after treatment of a distal tibial fracture with an intramedullary nail and TMS screws according to the AOFAS and VAS scale was very good and allowed for the anatomical bone fragment fixation. The bone healing after fixation of the distal tibial fracture with an intramedullary nail and TMS screws was shorter than 6 month in most cases.

Mechanical Evaluation of Commercially Available Fibrin Sealants for Cartilage Repair.

Fibrin sealants are routinely used for intra-articular surgical fixation of cartilage fragments and implants. However, the mechanical properties of fibrin sealants in the context of cartilage repair are unknown. The purpose of this study was to characterize the adhesive and frictional properties of fibrin sealants using an ex vivo model. Native bovine cartilage-bone composites were assembled with a single application of Tisseel or Vistaseal. Composites were tested in tension and lap shear. In addition, the coefficient of friction (COF) was measured in a native cartilage annulus model alone and with minced cartilage. Finally, the effect of a double application of fibrin sealant was evaluated. There were no significant differences in tensile modulus, ultimate tensile strength (UTS), shear modulus, or ultimate shear strength (USS) between the 2 fibrin sealants. Both fibrin sealants demonstrated a UTS and USS of <8 and <30 kPa, respectively. There were no differences in COF between the sealants when tested alone or with minced cartilage. A double application of fibrin sealant did not alter the mechanical properties compared with a single application of fibrin sealant. Fibrin sealant adhesive properties are not affected by the sealant type studied or the number of applications in a bovine cartilage-bone model. Fibrin sealant tribological properties are not affected by sealant type or the addition of minced cartilage. The adhesive properties of Tisseel and Vistaseal were less than those desired for the in vivo fixation of cartilage repair implants. These findings motivate the development of an improved cartilage-specific adhesive for cartilage repair applications.

TREATMENT OF PURULOUS-INFLAMMATORY COMPLICATIONS OF INJURIES AND DISEASES OF PELVIC BONES

Summary. Purulent-inflammatory complications of fractures of pelvic bones represent up to currently one of the most difficult and little-studied sections of traumatology. Complexity anatomical structure and topographic relations of the pelvic region, deep location a significant part of the bones under the muscle mass create objective difficulties for surgical treatment of bone damage and later in the diagnosis of purulent processes. Osteomyelitis of the pelvis is accompanied by high mortality and is from 2.5 to 52% as in acute and in the chronic stage of the disease.&#x0D; Purpose: by analyzing clinical mistakes and the possibility of purulent-inflammatory complications during operative treatment and postoperative management of patients with fractures bones of the pelvis, as well as to determine methods of diagnosis, treatment and ways of prevention traumatic sacroiliitis.&#x0D; Materials and methods. In the period from 2017 to 2022 in the bone-purulent surgery department of Zaporizhzhia city clinical hospital №9 treated 9 patients with purulent processes in of the pelvic region, 6 (66.3%) of them were men, and 3 (33.4%) were women. With postoperative osteomyelitis, which occurred after osteosynthesis with plates of multiple pelvic bone fractures, 4 (44.5%) patients were treated. Conservative therapy with sacroiliitis, the cause of which was abortion, received by 2 (22.2%) women, 1 (11.1%) patient suffered from right-sided sacroiliitis since childhood and repeatedly operated, and 2 (22.2%) men were treated with cause of sacroiliitis, which occurred after slaughter of the sacroiliac joint area.&#x0D; Results. All patients who were treated in the bone-purulent surgery department for purulent-inflammatory processes of pelvic bones, recovered and were discharged for outpatient treatment. While treatment in the ward, patients received complex treatment, which included conservative therapy and surgical intervention. Despite the introduction of modern methods of treatment of osteomyelitis of the pelvis, a trend of steady growth in the number is noted exits of patients with disabilities, which is confirmed by world statistics.&#x0D; Conclusions. Lack of hard fixation of bone fragments by implants increases the risk of purulent complications in the postoperative period. Use of additional diagnostic methods and complex treatment, which includes radical purulent sanitation foci, creation of favorable conditions for tissue regeneration, prevention of relapses suppuration, targeted antibacterial therapy, correction of homeostasis indicators and increases the protective forces of the body during purulent processes of the bones and joints of the pelvis achieving positive results in 80.2% of patients.

LONG-TERM RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH PROXIMAL HUMERUS FRACTURE

The aim of the study – evaluation of the surgical treatment effectiveness of fractures inthe proximal metaepiphysis of the humerus, the analysis and generalization of the surgerylong-term results of the surgical intervention.Materials and methods. The study has examined and analyzed the results of surgicaltreatment of the proximal humerus fractures in 76 patients who were treated in thetraumatology department of the regional municipal institution «Chernivtsi EmergencyHospital» in the period from 2015-2020. The average age of patients was 52 years old.The results of treatment were evaluated clinically, radiologically and by questionnaire(according to the QuickDASH scale) for 1 year after osteosynthesis. In order toeliminate the influence of individual, age and gender factors, the results of treatmentof the injured limb were compared with the function of a healthy limb of the patient.The QuickDASH scale (brief scale for assessing the inability to use the upper limb)consists of 11 questions that are offered to the patient. The answer to each questionis rated from 0 (best result) to 5 (worst). Using a special formula, the total result iscalculated, which can range from 0 (no violations) to 100 (complete inability to usethe limb). The QuickDASH scale is a brief version of the DASH scale that retains therepresentativeness of the full version.Results. It has been established that the choice of different methods of surgicalinterventions for fractures of the proximal humerus requires consideration of variousfactors, including the patient’s age, type of fracture, the presence of comorbidities,osteoporosis and the patient’s social needs. It has been shown that the long-termconsequences of surgical interventions may also be due to those factors. A methodfor ensuring stable fixation of fragments, which involves holding the spokes throughthree points: acromion-bone fragment- distal metaepiphysis of the humerus, has beenproposed and described.Conclusions. The tactics of surgical treatment of patients with the proximal humerusfractures depends on many factors, including: type of fracture, age of the patient, thepresence of comorbidities, the presence of osteoporosis and social needs of the patient.Closed reposition under the control of EOA (Electron- optical X-ray image amplifier) andfixation with needles allows to improve the results of treatment and reduce the duration ofdisability. Long-term results of treatment of patients with the proximal humerus fractureshave shown that closed reposition and fixation of fractures with needles leads to bettertreatment results compared to bone osteosynthesis.

Pipkin Type I and II femoral head fractures: internal fixation or excision?-from the hip arthroscopy perspective.

The treatment of patients with femoral head fractures with regard to fixation versus excision is controversial. This study aimed to compare the results of fixation and excision in hip arthroscopy-assisted surgery. This retrospective study included adult patients with femoral head fractures who were treated with hip arthroscopy surgery from March 2016 to April 2020, with a minimum follow-up of 24 months. The patients were divided into two groups: Group 1 (fixation group) and Group 2 (excision group). To compare the therapeutic effects between the two groups, clinical and radiographic outcomes, operative time, pain score, length of hospital stay after surgery and related complications were investigated. There were 13 (mean duration, 47.5 months; range, 24-72 months) and 8 (mean duration, 48.6 months; range, 26-74 months) patients in the fixation and excision groups, respectively. The excision group had better functional results than the fixation group in terms of the median modified Harris hip score (P = 0.009). No significant differences were observed in operative time, pain score or hospital stay after surgery between the two groups. Further, no osteonecrosis of the femoral head or traumatic arthritis occurred in either group. A piece of fracture fragment >2 cm can be considered for hip arthroscopy-assisted internal fixation, whereas the others can be removed. The excision group had better outcomes than the fixation group. Hence, hip arthroscopy-assisted internal fixation or excision of bony fragments led to satisfactory short-term clinical and radiological results for the treatment of Pipkin Type I and II femoral head fractures.

Experimental modeling of mandibular defect and analysis of the functional efficiency of the jaw exoskeleton

Modeling of jaw bone defects after bisphosphonate administration is presently an urgent task of oral surgery. Methods for virtual modeling of pathological processes and ways for their elimination are becoming increasingly popular in experimental studies. However, biomedical research with experimental animals, which is strictly regulated by law, does not lose its relevance. The choice of a model for our study has been based on the assumption that bisphosphonate-associated osteonecrosis and jaw defect in experimental animals are identical to human clinical presentations. In addition, this study considers the development of devices for correcting biomechanical problems and positioning the jaw bone fragments. Simulated subtotal mandibular defects are accompanied by restricted mouth opening, malnutrition and, as a result, inhibited habitual functional activity in the experimental animals. This has served as a guide for incorporating the simultaneous fixation of fragments with a multifunctional device, such as with the mandibular exoskeleton, into the protocol of surgical intervention. Positive changes in the early postoperative period have been characterized by restoration of the biomechanical balance of the dentition. The findings provide evidence that it is necessary to modernize the device and to test the exoskeleton in patients with subtotal mandibular defects.

MEDIUM- TO LONG-TERM OUTCOMES AFTER NON-FIXATION OF THE SMALLER POSTERIOR MALLEOLAR FRAGMENT: A RETROSPECTIVE COHORT STUDY

Treatment of posterior malleolar (PM) ankle fractures remain controversial. Despite increasing recommendation for small PM fragment fixation, high quality evidence demonstrating improved clinical outcomes over the unfixated PM is limited. We describe the medium-to-long term clinical and radiographical outcomes in younger adult patients with PM ankle fractures managed without PM fragment fixation.A retrospective cohort study of patients aged 18-55 years old admitted under our orthopaedic unit between 1st of April 2009 and 31st of October 2013 with PM ankle fractures was performed. Inclusion criteria were that all patients must mobilise independently pre-trauma, have no pre-existing ankle pathologies, and had satisfactory bimalleolar and syndesmotic stabilisation. Open fractures, talar fractures, calcaneal fractures, pilon fractures, subsequent re-injury and major complications were excluded. All PM fragments were unfixated. Clinical outcomes were evaluated using Foot and Ankle Ability Measure (FAAM) with activities of daily living (ADL) and sports subscale, visual analogue scale (VAS) and patient satisfaction ratings. Osteoarthrosis was assessed using modified Kellgren-Lawrence scale on updated weightbearing ankle radiographs.61 participants were included. Mean follow-up was 10.26 years. Average PM size was 16.19±7.39%. All participants were evaluated for clinical outcomes, demonstrating good functional outcomes (FAAM-ADL 95.48±7.13; FAAM-Sports 86.39±15.52) and patient satisfaction (86.16±14.42%), with minimal pain (VAS 1.13±1.65). Radiographical outcomes were evaluated in 52 participants, showing no-to-minimal osteoarthrosis in 36/52 (69.23%), mild osteoarthrosis in 14/52 (26.92%) and moderate osteoarthrosis in 2/52 (3.85%). Clinical outcomes were not associated with PM fragment size, post-reduction step-off, dislocation, malleoli fractured or syndesmotic injury. PM step-off and dislocation were associated with worse radiographical osteoarthrosis. Other published medium-to-long term studies reported overall good outcomes, with no differences after small fragment fixation.The unfixated smaller posterior malleolus fragment demonstrated overall satisfactory clinical and radiographical outcomes at 10-year follow-up and may be considered a valid treatment strategy.

Comparison of Craniosynostosis Surgery Outcomes Using Resorbable Plates and Screws versus Absorbable Sutures in Children with Craniosynostosis.

Previously, absorbable screw and plate systems were widely used in craniosynostosis surgery in Iran, but now, due to the establishment of economic sanctions, the importation of these tools into the country has become difficult. In this study, we compared the short-term complications of cranioplasty surgery in craniosynostosis using absorbable plate screws with absorbable sutures. In this cross-sectional study, 47 patients with a history of craniosynostosis who underwent cranioplasty at Tehran Mofid Hospital, Tehran, Iran from 2018 to 2021 were divided into two groups. For first group (31 patients) we used absorbable plate and screws, and for the second group (16 patients) absorbable sutures (PDS). All operations in both groups were performed by the identical surgical team. Patients followed up for consecutive post-operative examinations in the first and second weeks and 1, 3, and 6 months. Data were analyzed using SPSS software version 25. The results did not show any short-term or medium-term complications in either group. No recurrences were observed. In Whittaker classification, 63.8% were Class I, 29.8% were Class II, 6.4% were Class III, and 0% were Class IV. There was no statistically significant relationship between the type of treatment (screw and plate or absorbable suture) and higher Whitaker. There was also no statistically significant relationship between type of craniosynostosis and higher Whittaker. The absorbable sutures can be considered as valuable and cost-effective tools in the fixation of bone fragments in craniosynostosis surgeries by surgeons.

Osteochondritis dissecans of the knee: Imaging, instability concept, and criteria.

Osteochondritis dissecans of the knee is an idiopathic, focal, subchondral-bone abnormality that can cause instability or detachment of a bone fragment and overlying articular cartilage, with subsequent progression to osteoarthritis. The degree of lesion instability is best assessed by magnetic resonance imaging. Unstable lesions require operative management with fragment fixation. Level of evidence: V.

Comparative characteristics of the regeneration of the femur bone of rats at intramedullary osteosynthesis using medical steel and carbon-carbon composite material

The aim of this study was to compare the morphological features of rat femoral bone regeneration during intramedullary osteosynthesis using medical steel and carbon-carbon composite material. Materials and methods. All animals were divided into two groups. A fracture of the thighbone was simulated by surgical intervention. In the first group, medical steel was used for intramedullary fixation of fragments; in the second group, fragments were fixed using a carbon-carbon composite material. The morphological, morphometric, histological, histochemical, immunohistochemical and X-ray methods was used, the bone regenerate was studied on the 30th day, 6 and 12 months after the surgical intervention. There were established expression of immunohistochemical markers CD-34 and Ki-67 using the ImageJ program. The statistical analysis of the obtained results was performed by the methods of variational statistics using the program Statistica 13.0. Results. In the group of animals where composite material was used, on the 30th day after surgery, a statistically significant increase in the expression of the relative area occupied by CD-34+ structures compared to the second group of animals was established (4.80 ± 0.40 in the group in which the composite material was used and 2.80 ± 0.30 in group in which the medical steel was used). Also a statistically significant increase in the expression of the Ki-67+ marker was established (5.20 ± 0.36 in the group in which the composite material was used and 2.48 ± 0.32 in group in which the medical steel was used). With inspection microscopy, faster rates of osseointegration and regeneration of the fracture site were observed in the group of animals in which the composite material had been used compared to the other group of animals due to the stimulation of vascular endothelium growth. The data of the histological examination coincide with the data of the X-ray examination at all the periods of observation. Conclusions. The use of carbon-carbon composite material during intramedullary osteosynthesis accelerates bone regeneration pace due to the angiogenic effect, which is confirmed by increase in the expression of markers of proliferative activity Ki-67+ and the marker of vascular endothelium CD-34+ in the group of experimental animals in 30 days.

"Fragment Width Ratio" as a Predictor of Nonunion for Femoral Shaft Fracture With Third Fragments.

Previous studies have reported that large fracture fragment with displacement might cause nonunion of femoral shaft fractures. We therefore intended to delineate significant risk factors for developing a nonunion predisposed by a major fracture fragment. We analyzed 61 patients who were operated on using interlocking nails for femoral shaft fractures from 2009 to 2018. We classified patients with modified Radiographic Union Scale for Tibia fractures scores of less than 11 or needing reoperations by 1 year postoperatively as nonunion. We thereafter measured parameters of the displaced fracture fragment and fracture site to identify the significant difference between the union and non-union groups. We also applied the receiver operating characteristic curve to demonstrate a threshold value for the fragment width (FW) ratio. Among 61 patients with complete follow-up, no significant difference was found regarding length, displacement, and angulation of fragments between patients with and without union. Except for higher mean FW (P=.03) and the FW ratio (P=.01) in patients with nonunion, the logistic regression analysis demonstrated that FW ratio significantly affected union (P=.018; odds ratio, 0.21; 95% CI, 0.001-0.522). Although a fracture fragment greater than 4 cm with displacement greater than 2 cm was reported to significantly cause nonunions, our study showed that an FW ratio greater than 0.55 instead of fragment size or displacement was predictive for the occurrence of nonunion adjoining to the fracture site. Fixation of the third fracture fragment should not be ignored for preventing a nonunion. More attention should be paid to achieve a better fixation for a major fracture fragment with an FW ratio greater than 0.55 to avoid the development of non-union following the use of interlocking nail for femoral shaft fracture. [Orthopedics. 2023;46(3):169-174.].