Stable Fixation Research Articles

The effect of pleoptic treatment on the stability of visual fixation in children and adolescents with amblyopia of various degrees

This study assesses the effect of pleoptic treatment on the stability of visual fixation in children and adolescents with amblyopia of various degrees. The effect of the treatment in 35 children (35 eyes) with amblyopia of various degrees was evaluated using the MP-1 Microperimeter. The stability was determined by two criteria - number of fixation point hits in the 2° zone and the width of the field of fixation. Children underwent a standard course of treatment. There was an improvement in the stability of visual fixation after treatment. The number of fixation point hits in the 2° zone increased from 44.8±4.1% to 52.6±3.8%. At the same time, the width of the field of fixation after treatment decreased from 6.5±0.7° to 5.2±0.5°. Visual acuity with correction in children with amblyopia correlates with the number of fixation point hits in the 2° zone (direct high correlation "+0.7") and width of the field of fixation (inverse high correlation "-0.7") both before and after the treatment. Stabilization of visual fixation was observed in patients with amblyopia of varying degrees after the pleoptic treatment.

Failed nonunion subtrochanteric femur fracture managed with uncemented total hip replacement

Abstract Subtrochanteric fracture is a fracture between the lesser trochanter and 5 cm distal to the lesser trochanter. It accounts approximately for 10%–30% of all hip fractures and affects persons more than 60 years of age. Bimodal distribution has greater incidences in 20–40 years of age and persons more than 60 years of age. Deforming forces on the proximal fragment are abduction by the gluteus medius and minimus, flexion by iliopsoas, and external rotation by short external rotators; whereas, deforming forces on the distal fragment are adduction and varus by adductors. Failure of subtrochanteric fracture treatment is frequently associated with unstable fracture patterns, poor bone quality, or suboptimal position of fixation devices. Such complications following treatment failure may result in nonunion, leading to pain or malunion, severe bone defects, infection, articular cartilage damage, and even post-traumatic arthritis hip, which poses a significant challenge in subsequent surgeries. Therefore, in this particular case, we were left with only two options, such as (1) re-osteosynthesis using limb reconstruction surgeries (LRS) and (2) and prosthetic replacement. We opted for uncemented long stem total hip replacement to get diaphyseal hold as it has many advantages over LRS like a high success rate, a better quality of life, improved early mobility, and life-long lasting results. LRS was not opted as a choice of surgery as it has some disadvantages like pin-tract infection, more maintenance and compliance needed, the frame being bulky and cumbersome, and the risk of fracture at the pinhole site. Moreover, in this particular case, bone grafts from all accessible sites were used from previous surgeries. Uncemented long-stem total hip replacement can serve as an efficient salvage procedure in such cases. Post-operatively on follow-up at 2 months, the patient was able to fully bear weight without support. The range of motion at the right hip joint where the patient was able to do flexion 100ʹ, abduction 50ʹ, and adduction 30ʹ. We were able to correct limb length discrepancy by 5 cm (pre-operative discrepancy was 7 cm). Our achievement shows that uncemented long stem total hip replacement is a beneficial and effective procedure for salvaging the failed treatment of subtrochanteric fractures. Such procedures have shown satisfactory functional outcomes, stable fixation, and survival rates for these complex situations.

Functional Outcome of Distal Femoral Fractures using NEER Scoring Managed by Distal Femoral Locking Plate versus Retrograde Intramedullary Nail: A Cross-sectional Study

Introduction: Distal femur fractures are a group of fractures that have been a topic of debate for the past decade, were traditionally treated mainly using conservative methods. However, with advancements in surgical techniques and implants, operative intervention has now become the preferred treatment approach. There are various methods for treating distal femur fractures and the present study compares the treatment of distal femoral fracture using distal femur nailing versus the use of locking plate. Aim: To compare the functional outcomes of stabilising distal femur fractures using locking compression plating versus retrograde nailing and to evaluate the merits and drawbacks of each procedure. Materials and Methods: A cross-sectional comparative study was conducted in the Department of Orthopaedics at Calcutta National Medical College and Hospital, Kolkata, West Bengal, India, over a one-year period from (January 2021 to January 2022. Total 46 patients with distal femur fractures were included, with six lost to follow-up. Two groups were divided in which total 20 patients underwent distal femoral nailing, while 20 were treated with distal femoral locking plates. Functional outcomes were assessed using the NEER Score, aiming for perfect restoration of the articular surface, stable fixation, full knee range of motion, and good functional results. Data were entered into a Microsoft Excel spreadsheet for statistical analysis using Statistical Packages for Social Sciences (SPSS) (version 27.0; SPSS Inc., Chicago, IL, USA). Numerical variables were summarised as mean and standard deviation, while categorical variables were presented as counts and percentages. A p-value of ≤0.05 was considered statistically significant. Results: The study population consisted of 70% males with a mean age of approximately 55 years. Road traffic accidents were the most common mode of injury. The mean time for radiological union in the nailing group was 14.05 weeks, significantly shorter than the 16 weeks in the plating group. The mean range of knee flexion was 111° in the nailing group and 114.5° in the plating group. The average NEER score was 84.10 for the plating group and 83.30 for the nailing group. There was no statistically significant difference in functional outcomes between the two groups. Conclusion: Both retrograde intramedullary nailing and the use of locking compression plates can be considered as suitable treatment options. Early weight-bearing can be initiated with retrograde nailing. No significant difference was observed in terms of outcome, fracture healing, or NEER score. The time taken for radiological union of fractures using both techniques was comparable. Proper operative planning, execution, and adherence to a strict rehabilitation protocol play crucial roles in the overall patient outcome.

Intertrochanteric Fracture Fixation Using a Traction Table in a Patient with Ipsilateral Above-knee Amputation – A Case Report and Review of Reduction Techniques

Introduction: Although commonly encountered in clinical practice and considered among the “bread and butter” cases in trauma and orthopedics, intertrochanteric fractures of the femur in certain scenarios pose a challenge to the orthopedic surgeon. Good reduction and stable fixation are a key for good outcome, and certain anatomical limitations such as amputations make that difficult to achieve. Ipsilateral above-knee amputation is a scenario where positioning of the patient on an orthopedic fracture table and reduction of the fracture becomes challenging. Case Report: An active 59-year-old female with good functional baseline and ipsilateral above-knee amputation presented with an intertrochanteric fracture of the right proximal femur. The fracture was treated operatively and fixed with a dynamic hip screw (DHS). This case report highlights the technique of positioning of the patient and reduction of the fracture on a traction table using skeletal traction though the amputation stump with a Denham pin connected to the traction device. Conclusion: This technique provides a reliable and stable means of reducing the fracture using skeletal traction through the bone itself and will be helpful to any orthopedic surgeon faced with a similar situation. This report also sheds light on current literature regarding different ways of overcoming the challenge of positioning and reducing intertrochanteric/intracapsular neck femur fractures using the orthopedic traction table in patients with ipsilateral limb amputations. Keywords: Intertrochanteric fracture, above-knee amputation, reduction techniques, traction table

Порівняльний аналіз стану опорних тканин при використанні різних ортопедичних конструкцій для негайного навантаження на дентальних імплантатах при втраті зубів на одній із щелеп

Abstract. The use of fixed prosthetic structures supported by implants in case of partial or complete tooth loss remains relevant. Thanks to the use of intraoral welding of temporary prosthesis elements, the method of manufacturing temporary prosthetic structures has been integrated into the practice of prosthetic dentistry, which allows them to be fixed during dental implantation surgery. The aim of the study is to compare the condition of supporting tissues when using different orthopedic structures for immediate loading on dental implants in case of partial or complete loss of teeth in one of the jaws. For the comparative evaluation of different orthopedic structures on implants for immediate loading, temporary structures made of polymethyl methacrylate, composite structures reinforced with metal beams using intraoral welding, acrylic structures with dentures reinforced with a cast beam were selected. Computed tomography and orthopantomography were used to assess the condition of the bone tissue before implantation, 3 days and 1, 6, months after implantation. The study resulted in the following conclusions. Restoration of complete tooth loss in one of the jaws with fixed orthopedic composite structures reinforced with metal beams using intraoral welding is a promising method that allows to reduce the time of patient rehabilitation, the number of surgical stages and the trauma of the surgical stage of treatment. In this regard, soft and bone tissue trophism is less disturbed, which affects the subsequent osseointegration and functioning of implants. At the same time, the risks of bone resorption are minimized. Clinical evaluation of the tissues around the implants and X-ray analysis of the bone in patients with acrylic structures with set teeth reinforced with cast metal beams showed almost similar results. However, the technique involves additional surgical intervention, which negatively affects the trophism and healing of soft and bone tissues, increases the risk of complications, and extends the rehabilitation period. The use of temporary structures made of polymethyl methacrylate is less appropriate due to their less stable fixation, which can lead to inflammation of the soft tissues surrounding the implants and bone resorption. Key words: fixed structures, occlusal relations of the jaws, digital technologies, dental implantation.

Is Acoustic modal analysis a reliable substitution for Osstell® device in dental implant stability assessment? An experimental and finite element analysis study.

Different methods have been proposed to investigate the fixation stability of dental implants, each of which has its limitations. Among these methods, resonance frequency analysis (RFA) has been widely utilized to measure dental implant stability. This study aimed to assess dental implants with two non-destructive RFA and acoustic modal analysis (AMA) validated with a finite element simulation of the fundamental natural frequency (NF) of the bone analog-implant structure. A total number of 18 implants were inserted into two Polyurethane (PU) bone blocks with different densities (0.16 g/cc and 0.32 g/cc). AMA was used to measure NF; First, the sound originating from the axial tapping of the implant was recorded with a simple microphone. Secondly, a fast Fourier transformation algorithm was conducted to determine the NF of the implant-bone analog structure. In parallel, the ISQ (Implant Stability Quotient) value was measured using the Osstell® device. Finally, using finite element analysis (FEA), the implant-bone analog structure was modeled for validation. Doubling the bone analog density resulted in an average increase of 82% and 47% in the NF and ISQ using AMA and Osstell®, respectively (P-value<0.05). Furthermore, a strong linear relationship (R2= 0.93) was observed between the measured NF and ISQ values in the linear regression analysis. The NF of the dental implant predicted by FEA was overestimated by about 15.2% and 15.0% than those in the low- and high-density PUs, respectively. Moreover, the FEA predicted an increase of 83% in NF by increasing the bone analog density from 0.16 to 0.32 g/cc. Having required the minimum process combined with easily available equipment makes it an ideal method for fixation strength studies. The good correspondence between the ISQ values and NFs, in addition to the good accuracy and reliability of the later method, confirms its application for fixation stability assessment.

Changes in macular sensitivity in long‐term type 1 diabetic patients without diabetic retinopathy after 5 years of follow‐up

Aims/Purpose: To compare macular sensitivity measured with microperimetry in patients with Type 1 diabetes mellitus (DM1) without signs of diabetic retinopathy (DR) after 5 years of follow‐up.Methods: Twenty‐six eyes from 26 long‐term DM1 patients without DR signs were included. All participants underwent a complete ophthalmic examination including best corrected visual acuity (BCVA), intraocular pressure, fundoscopy, axial length and microperimetry examination using macular integrity assessment (MAIA) microperimeter (Topcon Corporation, Tokyo, Japan). The data wERE compared with the macular sensitivity results obtained 5 years ago. Nonparametric tests were used for the comparison (Mann–Whitney U test).Results: The mean age of the DM1 patients was 43.04 ± 11.03 years and their disease evolution time was 29.69 ± 9.25 years with good glycaemic control (HbA1c = 7.47 ± 0.84%). Regarding sex distribution, 11 eyes were from women (42.3%) and 15 were from men (57.7%). The DM1 patients did not show statistically significant changes in macular sensitivity in any of the macular rings between 2018 and 2023 with p &gt; 0.05. Central macular sensitivity had no significant changes with p = 0.378, and a mean of 27.38 ± 2.55 dB in 2018 versus a mean of 27.77 ± 2.46 dB in 2023. Macular integrity, fixation stability P1 and fixation stability P2 remained unchanged, p = 0.292, p = 0.861 and p = 0.529, respectively, showing no decrease in retinal sensitivity.Conclusions: Long term DM1 patients with no DR lesions show no changes in macular sensitivity after 5 years of follow‐up.

Impact of blade direction on postoperative femoral head varus in PFNA fixed patients: a clinical review and biomechanical research.

Intertrochanteric femur fracture is a common type of osteoporotic fracture in elderly patients, and postoperative femoral head varus following proximal femoral nail anti-rotation (PFNA) fixation is a crucial factor contributing to the deterioration of clinical outcomes. The cross-angle between the implant and bone might influence fixation stability. Although there is a wide range of adjustment in the direction of anti-rotation blades within the femoral neck, the impact of this direct variation on the risk of femoral head varus and its biomechanical mechanisms remain unexplored. In this study, we conducted a retrospective analysis of clinical data from 69 patients with PFNA fixation in our institution. We judge the direction of blade on the femoral neck in on the immediate postoperative lateral X-rays or intraoperative C-arm fluoroscopy, investigating its influence on the early postoperative risk of femoral head varus. p < 0.05 indicates significant results in both correlation and regression analyses. Simultaneously, a three-dimensional finite element model was constructed based on the Syn-Bone standard proximal femur outline, exploring the biomechanical mechanisms of the femoral neck-anti-rotation blade direction variation on the risk of this complication. The results indicated that ventral direction insertion of the anti-rotation blade is an independent risk factor for increased femoral head varus. Complementary biomechanical studies further confirmed that ventral angulation leads to loss of fixation stability and a decrease in fixation failure strength. Therefore, based on this study, it is recommended to avoid ventral directional insertion of the anti-rotation blade in PFNA operation or to adjust it in order to reduce the risk of femoral head varus biomechanically, especially in unstable fractures. This adjustment will help enhance clinical outcomes for patients.

Analysis of fixation patterns among glaucoma patients using a superfast eye tracking system

Aims/Purpose: The effect of glaucoma on eye movements is not well understood, so it is extremely important to be able to quantitatively characterize eye movement data which could accelerate glaucoma diagnosis. The aim of the study was to determine differences in eye movements among glaucoma patients and healthy subjects, using a superfast eye tracking system, FreezEye Tracker (FET).Methods: To study eye movements during a 30‐second fixation task, we used a prototype device FET, which was designed and assembled in our laboratory (Bartuzel et al., 2020). The unique capability of this device is to provide precise information (with an accuracy of about 1 μm on the retina) on eye movements during the fixation task (and other visual tasks) collected at high frequency (more than 1240 eye position measurements per second). We conducted a study on 13 glaucoma patients and 13 healthy subjects of similar age (69 ± 67). The participants' task was to look at the fixation point displayed in the centre of the screen for the period of 30 s.Results: During the fixation task, we reconstructed the trajectory of the eye movements (in the horizontal and vertical axis) and calculated area of the fixation points, called bivariate contour area (BVRCA) as a measure of fixation stability. Results show that in glaucoma patients the horizontal axis trajectory length (H) and BVRCA were smaller compared to healthy subjects. In glaucoma patients the avg. horizontal axis trajectory length was 60.91° [deg] and BVRCA parameter was 0.19°2. In a healthy group, the average horizontal axis trajectory length was 71.80° and BVRCA parameter was 0.36°2.Conclusions: The results of the study indicate that the glaucoma patients had greater fixation stability during the task, and their microsaccades showed smaller deviation from the centre of fixation, compared to healthy subjects. The results of the study show that the device has the potential to differentiate basic eye movement parameters in glaucoma patients and healthy subjects.Reference Bartuzel MM, Wróbel K, Tamborski S et al. High‐resolution, ultrafast, wide‐field retinal eye‐tracking for enhanced quantification of fixational and saccadic motion. Biomedical Optics Express, 2020, 11(6), 3164–3180.

Glenoid bone loss in shoulder arthroplasty: a narrative review.

Crucial to the success of any total or reverse shoulder arthroplasty (RSA) is the stability of the glenoid component fixation. Instability can lead to early implant failure and unsatisfactory results. Patients often present with varying forms of glenoid bone loss (GBL) in both the primary and revision settings, which can be a challenge for the treating surgeon. Severe cases of GBL can increase the risk of potential complications and diminish implant longevity. The use of the reverse total shoulder replacement has been particularly helpful when addressing significant glenoid bony defects. Various approaches have been proposed to deal with GBL, all of which require an individualized assessment of the specifics of the defect in order to provide maximal fixation and thereby optimize the longevity of the shoulder arthroplasty. This article aims to review the recent literature on GBL in shoulder arthroplasty to provide guidance when considering treatment based on the best available evidence. PubMed, MEDLINE, EMBASE, AccessMedicine, ClinicalKey, DynaMed, and Micromedex were queried for publications utilizing the following keywords: "glenoid bone loss" AND "glenoid bone deficiency" AND "shoulder arthroplasty" AND "classification". The search was restricted to research published between 2004 and 2023. There were no restrictions on study type or language. GBL should be critically evaluated prior to undertaking total shoulder arthroplasty (TSA). The treating surgeon should be aware of various methods of addressing bone defects. The use of TSA is increasing to address various shoulder pathologies. Addressing glenoid bone defects is of critical importance to maximize the longevity and outcome of TSA.

Functional, Oncological, and Radiological Outcomes Following Safe Surgical Dislocation for the Treatment of Locally Aggressive Proximal Femoral Lesions

Abstract Study Type: Retrospective cohort study. Background and Purpose: Locally aggressive lesions of the proximal femur represent a spectrum of pathologies in the younger age group, which result in large defects. Safe surgical dislocation (SSD) is one of the viable surgical approaches to achieve optimal visualization and clearance of tumor. This study looks at the functional, oncological, and radiological outcomes following SSD for the treatment of locally aggressive proximal femoral lesions. Materials and Methods: A retrospective study was done in Orthopedics Unit 3 at our tertiary care center between 2015 and 2021 on patients who underwent SSD for the treatment of biopsy confirmed locally aggressive proximal femur lesions. The inclusion criteria were age more than 15 years, with biopsy confirmed symptomatic locally aggressive lesions of the proximal femoral region with a minimum 1 year follow-up. The clinical parameters were reduction in pain, restoration of hip movements, abductor strength, and ability to weight bear and resumption of activities of daily living. Graft consolidation, status of implant, local recurrence, trochanteric nonunion, and appearance of avascular necrosis included as radiological parameters. The functional parameters were assessed through the modified Musculoskeletal Tumor Society Score and the nonarthritic Young Hip Score. Results: Ten cases of biopsy-proven proximal femoral lesions (out of 15 such cases) fulfilling the inclusion criteria were enrolled. All ten underwent intralesional excision/extended curettage of lesion, followed by auto/allograft reinforcement to fill the defect and internal fixation using SSD as surgical approach. The choice of graft and fixation method was based on surgeon’s preference. Functional and radiographic assessment was done on follow-up, with an average follow-up of 13 months (range 12–14 months). The mean nonarthritic Young Hip Score improved from 49 (±8.96) preoperatively to 85.4 (±11.95) at the time of review, and the modified Musculoskeletal Tumor Society Score improved from a mean of 23.3 (±0.83) preoperatively to 28.4 (±1.07) at the time of review. There was no tumor recurrence and avscular necrosis at the time of follow-up. Allograft consolidation was seen in 8 out of 10 cases at the time of review. Conclusion: SSD is an excellent approach to achieve optimal tumor clearance. Good functional and radiological outcomes are seen if adequate tumor clearance is obtained and reconstruction with stable internal fixation is achieved. Tumor recurrence and avascular necrosis were not noted in any of the cases at 1-year (intermedial) follow-up.

A Technique for Arthroscopic Fixation of Tibial Eminence Avulsion Fractures: A Physeal-Sparing Construct With All-Suture Anchor Bridge Fixation

Arthroscopic or open surgical treatment is indicated for displaced tibial spine fractures to obtain anatomic reduction and restore the functionality of the anterior cruciate ligament. Numerous open and arthroscopic techniques for the treatment of tibial spine fractures have been described. The purpose of this technical note is to describe a minimally invasive arthroscopic physeal- and ligament-sparing surgical technique using knotless all-suture anchors to provide stable bridge fixation over displaced tibial spine fractures.

Combined Elastic Stable Intramedullary Nail and External Fixation Versus Elastic Stable Intramedullary Nail Alone in the Management of Length-Unstable Pediatric Femoral Fractures: A Prospective Randomised Controlled Clinical Study

Combined Elastic Stable Intramedullary Nail and External Fixation Versus Elastic Stable Intramedullary Nail Alone in the Management of Length-Unstable Pediatric Femoral Fractures: A Prospective Randomised Controlled Clinical Study

Last generation fluted modular titanium stem in revision hip arthroplasty: a narrative review of mid- and long-term outcomes.

Tapered fluted titanium stems (TFTS), were introduced to overcome proximal femur bone defects. They obtain stable fixation even in catastrophic proximal bone loss. Modular ones have the advantage to adjust length, rotation, off-set independently from the distal module. Short-term publications have been showing favorable outcomes burdened by an unacceptably high rate of stem failure. Still, there is a paucity of mid- and long-term reports. This narrative review aims at analyzing recent literature on modular TFTS with at least 5 years of minimum follow-up to gain a better understanding of implant survival, performance, and complications. A search of the PubMed database was performed with selected key terms. Results were screened after the application of strict inclusion and exclusion criteria. Extracted data were subsequently evaluated to obtain an up-to-date overview of the results and complications of TFTS. Modular TFTS showed a consistent increase in patient reported outcomes that persists at 10 years and above. Femoral fractures were the most common intraoperative complication. Despite modularity, dislocation still occurs at a variable rate (1.2-12%). With revision for any cause as an endpoint, overall survival approaches 83% after 10 years of follow-up. If femoral revision only is evaluated, excellent survival rates (>95%) have been published. Stem subsidence over 5 mm was reported in less than 5% of patients, only 1 requiring femoral revision. The mean incidence of stem mechanical failure was 3.39%, although most breakages occurred in stems eventually retired from the market. Satisfactory survival rates were observed, with an acceptable rate of complications. Stem mechanical failure, excluding those stems eventually retired from the market, remains a marginal event. Therefore, the use of modular TFTS in revision surgery is safe and effective even in the long term.

Minimally Invasive Chevron Akin Osteotomy for Hallux Valgus Correction.

Minimally Invasive Chevron Akin Osteotomy for Hallux Valgus Correction.

Results of LRS (Limb Reconstruction System) in Management of Infected Non Unions of Femur

Introduction: Infected non-union needs prolonged treatment and repeated surgeries which significantly impacts patient’s social, financial, physical and mental life. In relation to Ilizarov technique monolateral external fixator is less bulky, more comfortable and better tolerated by patient. In this study we aim to assess the union rates, infection control, alignment, complications and the functional outcome of infected femoral non-union managed with monolateral external fixator. Material and methods: This is a prospective interventional study carried out between June 2017 and June 2021 at tertiary care centre operated by a single surgeon. Patients diagnosed as infected non-union of femur clinically and radiologically and operated with monolateral external fixator were assessed. Functional and radiological assessment was done using ASAMI classification. Results: In our study 21 patients were operated which included 20 males (95.2%) and one female with mean follow up is 29.85 ± 11.42 months. The most common site of non-union is mid-shaft of the femur. The mean bone defect after debridement is 3.52 ± 2.23cm (1 -10cm). The mean time of bony union in our study is 180.65 days (range 95-740 days). The ASAMI classification of bone results is Excellent to good in 90% of patients. Conclusion: Our study suggested that the Limb reconstruction system can be successfully used in the management of infected non-union of femur as a stable fixation modality and achieve satisfactory outcome in terms of bony union and functional results. Pre-operatively planning of the LRS frame, radical debridement and maintaining stability of the LRS frame are key steps of the treatment.

Does early stable fixation reduce complications in paediatric femoral neck fractures?

Does early stable fixation reduce complications in paediatric femoral neck fractures?

Articular Fragment Detachment and Separate Fixation for the Treatment of Comminuted Patellar Fractures with Coronal Split Articular Fragments: Articular Detachment Technique.

Treatment of comminuted patellar fractures accompanied by coronal split articular and inferior pole fragments is a challenge. To treat this difficult fracture, we perform articular fragment detachment and separate fixation for coronal split articular and inferior pole fragments. We aimed to evaluate the radiological and clinical outcomes of our technique in comminuted patellar fractures at least 1 year after surgery. Between January 2019 and June 2022, 15 patients diagnosed with comminuted patellar fractures accompanied by coronal split articular and inferior pole fragments based on preoperative computed tomography underwent surgery using the articular detachment technique. The key point of this technique was anatomical reduction and subchondral fixation of the coronal split articular fragment to the superior main fragment after complete detachment of the coronal split fragment from the inferior pole. The remaining inferior pole was fixed using a separate construct. Postoperative articular gap, articular step-off, and complications, including resorption, reduction loss, and avascular necrosis of fixed articular fragments, were evaluated as radiological outcomes. Range of motion and the Lysholm scores were used to evaluate clinical outcomes. Among the 15 patients, the coronal split articular fragments were fixed using Kirschner wires in 13 patients and headless screws in 2 patients. The inferior poles were fixed using separate vertical wiring in 13 patients and tension-band wiring in 2 patients. A postoperative articular gap was noted in 7 patients, with an average articular gap of 1.0 mm (range, 0.7-1.6 mm). No articular step-off was observed. Bone union and normal range of motion were achieved in all patients. On the 1-year postoperative lateral radiograph, resorption of the articular fracture site was seen in 5 patients. There was no loss of reduction or avascular necrosis of the coronal split articular fragments. The average postoperative Lysholm score at 1 year was 89.3 ± 4.1 (range, 82-95). The technique would be a reliable and safe option for the surgical treatment of comminuted patellar fractures accompanied by coronal split articular and inferior pole fragments in terms of anatomical reduction and stable fixation of articular fragments without risk of avascular necrosis.

Comparison of functional and radiological outcome of unstable intertrochanteric femur fractures treated using PFN and PFNA in patients with osteoporosis.

Unstable intertrochanteric fracture poses challenges in terms of obtaining stable fixation and good post-operative outcomes. There is a paucity of clinical data comparing the commonly used proximal femoral nail (PFN) and PFN anti-rotation (PFNA) implants, especially in relation to osteoporosis. The purpose of this study is to assess the comparative performance of PFN and PFNA fixation in the treatment of unstable femur intertrochanteric fractures. This prospective observational study was conducted to understand and analyze the advantages of PFNA over PFN in the management of unstable intertrochanteric fractures from May 2021 to October 2023 at the Department of Orthopaedics, Chettinad Hospital and Research Institute, Kelambakkam. Patients presenting with an unstable intertrochanteric fracture with Singh's Index grades 1, 2, and 3 were included. Boyd and Griffin classification types 2, 3, and 4 were included in the study. The patients were randomized into two types of implant groups. All patients were operated with a standard protocol. Patients were followed up for a minimum of 6 months and any complications were noted. A comparison of functional outcomes was done using the Modified Harris Hip Score. Statistical analysis was done using the unpaired t-test/Mann-Whitney U test and Chi-square test/Fisher's exact test. A P < 0.05 was considered significant. Every follow-up period included a Harris Hip Score assessment. At 3 months, the average score of PFN was 71.9 (range 66-81) and at 6 months it was 77.86 (range 72-90). For PFNA, at 3 months, the average score was 74.87 (range 66-81), and at 6 months, it was 89.3 (range 76-94). The improvement was seen well in the PFNA group which is statistically significant (P = 0.023). The most prevalent fracture was a type 2 fracture. The results showed PFNA has better rotation stability with single screws and better functional outcomes in treating unstable intertrochanteric fractures when compared to PFN.

Dual fixation for coracoid fracture with acute acromioclavicular joint disruption: a case series

Abstract Introduction The management of acute disruption of the acromioclavicular joint (ACJ) in conjunction with a concomitant coracoid fracture has been discussed. This combined orthopedic injury is uncommon because radiographs alone may not always be enough to identify the coracoid component clearly. There are different options for management, ranging from nonsurgical, single, or double fixation strategy. The purpose of this study was to evaluate the results of a clavicular hook plate combined with a coracoid screw fixation in patients who engage in high-demand activities and athletes over a minimum of a year of follow-up. Patients and methods Following the dual fixation strategy, seven patients were followed clinically and radiologically with a mean follow-up 16 weeks, through which a rehabilitation program was adhered to. The range of motion around the shoulder, American Shoulder &amp; Elbow Surgeons, and constant scores were utilized to evaluate patients clinically during their last follow-up visit. Furthermore, radiological assessment of the reduction of the ACJ according to coracoclavicular distance (CCD) and CCD ratio. Results The findings in this study showed a statistically significant improvement between the 3, 6, and 12-month American Shoulder &amp; Elbow Surgeons scores, which were 39.1 ± 14, 67.4 ± 1, and 86.7 ± 5, respectively (P&lt;0.001). The mean range of motions for active shoulder abduction and forward elevation was 171.4 ± 6.3° and 156.4 ± 12.8°, respectively. 9 ± 0.9 mm was the mean CCD, and 1.07% was the mean CCD ratio. Conclusion A stable fixation construct with significant functionality can be successfully achieved through the dual fixation strategy using a coracoid screw and hook plate with no coracoclavicular ligament reconstruction in the treatment of concomitant coracoid fracture and acute ACJ injuries in athletes and high-demand patients.