Full Weight Bearing Research Articles

Immediate full weight-bearing, reduced perioperative morbidity and mortality after surgery in the treatment of distal femur fractures using a standard lateral plate plus a helical moulded medial plate ostheosynthesis.

To describeour clinical and functional experience in treating distal femur fractures using double helical plating with immediate full weight-bearing. A retrospective, unicentric, case series study, based on data from patients withdistal femur fractures who underwent surgery between 1 November 2019 and 31 January 2024. All patients who had a distal femur fracture and fulfil the criterion of previous ambulation were surgically treated using a standard lateral plate plus a helical moulded medial plate osteosynthesis through a MIPO technique with immediate full weight-bearing. We assessed length of surgery, blood loss during surgery, ambulation at 48h after surgery; andat 6months:clinical ('excellent'ambulation)and functional success (motion and malalignment),mortalityandradiological outcome.A descriptive analysis was performed. Seventy-three patients were diagnosed with distal femur fracture, of which 68 (7 men, 61 women, with a median age of 84 (range, 50-99) years old) were included in the study. Median length of surgery was 132 (range, 69-235) min, median blood loss during surgery was - 2.2 (range, 0.2-5) g/dL. At 4days, all (100%) patients ambulated.At 6months, clinical and functional success were 59.68% (95% CI 47.3-71.0%) and 98.38% (95% CI 91.4-99.7%), respectively;6 (8.8%, 95% CI 4.1-17.9%) patients died, all the remaining had anexcellent/goodradiological assessment. Double helical plating for treating distal femur fractures is a stable and minimally invasive osteosynthesis technique, which enables immediately full weight-bearing with a minimum risk of secondary displacement or fixation failure. This technique could be considered as a good option for the fixation ofdistal femur fractures in frail patients.

The effects of the positioning of a bolt in the femoral neck system on the short-term outcomes of middle-aged and young adults with displaced femoral neck fractures

BackgroundTo analyze the effects of the positioning of a bolt in the femoral neck system (FNS) on the short-term outcomes of middle-aged and young adults with displaced femoral neck fractures (FNFs).MethodsThis was a retrospective study involving 114 middle-aged and young adults with displaced FNFs who were surgically treated with internal fixation via the FNS in the Department of Orthopedics, Suzhou Municipal Hospital, from December 2019 to January 2023. The degree of deviation of the central axis of the femoral head and neck from the tip of the bolt (W), the tip‒apex distance (TAD) and the length of femoral neck shortening (LFNS) were measured on postoperative X-ray and computed tomography (CT) scan images. Clinical efficacy was assessed with the Harris Hip Score (HHS) and the EuroQol five-dimensional questionnaire-5L (EQ-5D-5L) utility index. The enrolled patients were divided into the central group (W ≤ 20%) and deviation group (W > 20%) on the basis of postoperative W value. The quality of fracture reduction, time to postoperative weight-bearing of the affected limb, time to fracture healing, and the TAD, LFNS, HHS and EQ-5D-5L utility index at the last follow-up visit were compared between the groups. Postoperative complications and cases of revision surgery were recorded.ResultsPreoperative baseline characteristics, the quality of fracture reduction, the need for auxiliary reduction and the follow-up time were comparable between the central group and deviation group (all P > 0.05). No significant difference in the time to postoperative partial weight-bearing of the affected limb was detected between the groups (P > 0.05). Patients in the central group presented with a significantly shorter time to full weight-bearing of the affected limb, time to fracture healing, and TAD and LFNS at the last follow-up visit but a greater HHS and EQ-5D-5L utility index than those in the deviation group did (all P < 0.05). The incidence of revision surgery was significantly lower in the central group than in the deviation group (P < 0.05).ConclusionPositioning of the FNS bolt closer to the central axis of the femoral head and neck favors a shorter time to fracture healing, greater hip function and a lower incidence of revision surgery in middle-aged and young adults with displaced FNFs.

Isolated Tibial Tubercle Fracture With and Without Combined Patellar Tendon Avulsion: Early Outcomes, Complications, and Reoperations.

Tibial tubercle fractures (TTF) are uncommon injuries, comprising <3% of proximal tibial fractures. Rarely, they occur in conjunction with patellar tendon avulsion (PTA). We aimed to compare reoperation rates and short-term postoperative outcomes in patients with TTF versus combined injuries. A retrospective review of patients presenting to a single tertiary pediatric hospital with a TTF who underwent open treatment and fixation of tibial tuberosity fractures was performed. Demographics, operative details, injury patterns, complications, and postoperative milestones were analyzed. Operative reports were reviewed to identify concomitant PTA. Outcomes analyzed included reoperation rates, weeks to full weight-bearing (FWB), full range of motion (FROM), and return to sport (RTS). Patients with <4 months of clinical follow-up were excluded from the analysis. We identified 117 fractures in 111 patients (mean age: 13.75 ± 1.27, 5% female). One-hundred and one fractures were isolated TTF and 16 were combined TTF with PTA. There was no significant difference in secondary surgery (P=0.13) or complication rates (P=0.20). The duration in the hinged knee brace was significantly higher in the combined injury group (12.95 wk) than in the isolated injury group (9.77 wk) (P=0.0024). There was no significant difference in time to FWB (P=0.25), FROM (P=0.86) or time to RTS (P=0.40). No current postoperative guidelines exist for combined TTF and PTA. Our data suggest that combined injury can be largely managed similarly to isolated TTF. However, combined injuries may require a longer bracing period. Level II prognostic study.

Risk factors for one-year mortality in 440 femoral peri-implant fractures: insights from the PIPPAS prospective, multicentre, observational study.

The Peri-Implant and PeriProsthetic Survival AnalysiS (PIPPAS) study aimed to investigate the risk factors for one-year mortality of femoral peri-implant fractures (FPIFs). This prospective, multicentre, observational study involved 440 FPIF patients with a minimum one-year follow-up. Data on demographics, clinical features, fracture characteristics, management, and mortality rates were collected and analyzed using both univariate and multivariate analyses. FPIF patients were elderly (median age 87 years (IQR 81 to 92)), mostly female (82.5%, n = 363), and frail: median clinical frailty scale 6 (IQR 4 to 7), median Pfeiffer 4 (1 to 7), median age-adjusted Charlson Comorbidity Index (CCI) 6 (IQR 5 to 7), and 58.9% (n = 250) were American Society of Anesthesiologists grade III. Overall, 90.5% (n = 398) of the patients were treated surgically, 57.0% (n = 227) retained the implant, and 88.7% (n = 353) managed with fixation. Mortality rates were 8.2% (n = 3.6) in-hospital, 11.4% (n = 50) at 30 days, 21.1% (n = 93) at six months, and 21.6% (n = 95) at 12 months. Medical complications, mainly delirium, were common in the acute setting (52.7%, n = 215). The nonunion rate was 4.1% (n = 18). Mortality risk factors in the univariate analysis were age, living at a nursing home, no walking outdoors, frailty variables, fractures in the distal epiphysis, fractures around a proximal nail, discharge to a healthcare facility, and no osteoporotic treatment at discharge. Protective factors against mortality in the univariate analysis were surgical treatment by an experienced surgeon, management without an arthroplasty, allowing full weightbearing, mobilization in the first 48 hours postoperatively, and geriatric involvement. Risk factors for mortality in the multivariate analysis were cognitive impairment (Pfeiffer's questionnaire) (hazard ratio (HR) 1.14 (95% CI 1.05 to 1.23), p = 0.002), age-adjusted CCI (HR 1.18 (95% CI 1.07 to 1.30), p = 0.001), and antiaggregant or anticoagulant medication at admission (HR 2.00 (95% CI 1.19 to 3.38), p = 0.009). Haemoglobin level at admission was protective against mortality (HR 0.85 (95% CI 0.74 to 0.97), p = 0.018). Mortality in FPIFs occurs mainly within the first six months of follow-up. Early co-management and clinical optimization, particularly targeting frail older patients, is crucial in reducing mortality following these fractures.

Exploring Outcomes of Tibial Rigid Intramedullary Nailing in Adolescent Patients.

To explore outcomes after tibial rigid intramedullary nailing (RIMN) in skeletally immature patients, with a focus on post-operative complications and iatrogenic changes in tibial slope due to anterior physeal arrest. Design: Retrospective case series. A large, tertiary care health system in the rural Mid-Atlantic United States, including two Level 1 trauma centers and one Level 2 trauma center. Included were skeletally immature patients within 2 years of skeletal maturity undergoing tibial RIMN for OTA/AO 42 A to C fractures between March 2009 and January 2024 with post-operative follow-up more than 1-year. The primary outcome was change in tibial slope after RIMN. Secondary outcomes included post-operative weight-bearing status and complications. Thirty-seven skeletally immature patients were included (mean age 15.2 ± 1.3 years, 76% male). For 22 patients with minimum 6-month post-operative radiographs (mean 18.4 ± 12.7 months), there was no significant change from pre- to post-operative tibial slope (80.0 ± 1.9° vs 80.1 ± 1.6°, p=0.86). Time to achievement of full weightbearing across the series averaged 45.4 ± 35.6 days. Five (14%) of patients necessitated hardware removal, and 89% of patients reported they had returned to "normal" activity at latest follow-up (mean 56.2 ± 42.5 months). This study demonstrated that RIMN for tibial shaft fractures in skeletally immature pediatric patients within 2 years of maturity was not associated with iatrogenic physeal injury and resultant changes in tibial slope. Additional favorable clinical outcomes, the potential for early weight-bearing, and few associated post-operative complications, indicate that RIMN is a safe option for skeletally immature patients with tibial shaft fractures. Caution should be exercised when extrapolating these results to younger pediatric patients with >2 years of skeletal growth remaining. IV.

Surgical options for Evans-Jensen type IV intertrochanteric femur fractures in the elderly over 65: a comparison between total hip arthroplasty and proximal femoral nail antirotation.

Currently, there is no clear standard for the surgical options for Evans-Jensen Type IV intertrochanteric femur fractures in elderly patients over 65 years old. This study aims to retrospectively analyze and compare the early postoperative limb function and quality of life of patients treated with total hip arthroplasty (THA) and proximal femoral nail antirotation (PFNA) for this type of fracture. We hypothesize that there is no significant difference in complications and postoperative recovery between the two surgical methods. A retrospective analysis was conducted on patients over 65 years old with Evans-Jensen Type IV intertrochanteric femur fractures who were treated between 2020 and 2023. The patients were divided into two groups based on the treatment method: the PFNA group (20 cases) and the THA group (20 cases). General patient information, operative time, intraoperative blood loss, time to postoperative mobilization, time to weight-bearing on the affected limb, Harris hip scores at 1, 3, and 6 months postoperatively, excellent and good rates, SF-36 scores, and postoperative complications were recorded. Compared to the PFNA group, the THA group had a longer operative time (86.7 ± 9.6 vs. 51.5 ± 5.3 min, p < 0.001) and more intraoperative blood loss (212.0 ± 35.5 vs. 76.5 ± 16.1 ml, p < 0.001). However, the THA group had an earlier time to first postoperative mobilization (3.1 ± 1.4 vs. 43.3 ± 13.09 days, p < 0.001) and earlier time to full weight-bearing on the affected limb (33.5 ± 3.1 vs. 77.9 ± 12.0 days, p < 0.001). The Harris hip scores and SF-36 scores at 1, 3, and 6 months postoperatively were higher in the THA group (p < 0.05 for all). There was no significant difference in the overall incidence of postoperative complications between the two groups (p = 0.41). For elderly patients over 65 years old with Evans-Jensen Type IV intertrochanteric femur fractures, especially those with underlying diseases who cannot tolerate prolonged bed rest, hip replacement surgery (THA) may be preferred. Postoperative patients can begin rehabilitation exercises earlier, preventing the exacerbation of internal medical conditions. Early recovery of hip function on the affected side is faster, and the quality of life of patients is higher.

Retaining Severely Damaged Talar Body and Medial Malleolar Cartilage for Diabetic Ankle/Hindfoot Charcot Arthrodesis Using Intramedullary Nail: A Short Report

Background: The tibiotalocalcaneal (TTC) arthrodesis using an intramedullary nail (IMN) is a common method used to treat advanced diabetic ankle/hindfoot Charcot deformity. The talus is usually resected when severe loss of its body is present and the medial malleolar cartilage excised. We report our initial results with talar retention and absence of medial ankle gutter cartilage debridement. Methods: Four patients with type 2/3A Brodsky classification and stage 2/3 as Eichenholtz classification, presenting with a hindfoot varus deformity were treated with TTC using IMN. The talus was retained after excision of its proximal and distal cartilages while the medial malleolus cartilage was not touched. Bone union was the primary outcome. The minimum follow-up period was 12 months. Results: Bone union was achieved radiologically in all 4 cases within 6 months. No signs of postoperative infection was noted. The mean limb length difference between the pre- and postoperative values was 0.5 ± 0.2 cm. At the final follow-up, all patients were able to walk pain-free with full weightbearing. All 4 patients were very satisfied at 12 months with a mean American Orthopaedic Foot &amp; Ankle Society (AOFAS) ankle-hindfoot score of 87 ± 3.1. Conclusion: When performing TTC arthrodesis for diabetic Charcot, preserving the talus even when the body is severely damaged could add to the stability of the construct resulting in bone healing and some leg length preservation. Including the medial malleolus in the fusion surgery might not be necessary. Level of Evidence: Level IV, case series.

Double-Barreled Vascularized Fibula Free Flap in Pediatric Tibial Bone Defect Reconstruction: A 20-Year Monocentric Experience.

Reconstructing large bone defects for lower limb salvage in the pediatric population remains challenging due to complex oncological or septic issues, limited surgical options, and lengthy procedures prone to complications. The vascularized double-barreled fibula free flap is pivotal for reconstructing large bones. In this article, we report our experience with this technique in the surgical management of pediatric tibial bone defects. We conducted a retrospective analysis of patients under 18 years of age who underwent tibial reconstruction using a double-barreled fibula free flap at our center between 2004 and 2023. Collected data included demographic information, operative details, time to bone consolidation and full weight-bearing, and functional outcomes using the Musculoskeletal Tumor Society (MSTS) score. Eight patients (5 females, 3 males) with a mean age of 12.5 years (range 5-17) were included. The average tibial defect length was 11.2 cm (range 7-14 cm), affecting the proximal tibia in 4 cases (50%), the middle third in 3 cases (37.5%), and the distal third in 1 case (12.5%). Reconstruction followed oncologic resection in 7 patients (87.5%) and addressed congenital pseudarthrosis in 1 patient (12.5%). One patient died of sarcoma. Six patients (75%) achieved full weight-bearing within a median of 7 months (range 6-16) and a bone consolidation at 9 months in median (range 6-18). One reconstruction (12.5%) failed due to septic pseudarthrosis leading to a below-knee amputation. The mean MSTS score was 81.65 (range 63.3-100). This study is the first to focus on pediatric tibial reconstructions using the double-barreled vascularized fibula free flap. It highlights the technique's reliability for reconstructing tibial defects, particularly in intermediate-sized cases (7-14 cm). This single-stage procedure minimizes stress fracture risk, enables earlier weight-bearing, and is an alternative to the Capanna technique without requiring an allograft.

Novel application of an imageless robotic system in simultaneous unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction.

This technical note explores the novel use of an imageless robotic surgical system for simultaneous unicompartmental knee arthroplasty (UKA) and anterior cruciate ligament reconstruction (ACLR). Knee osteoarthritis (OA) and anterior cruciate ligament (ACL) insufficiency are common conditions that traditionally require separate management. The integration of robotic assistance offers enhanced precision in surgical procedures, addressing both medial compartment OA and ACL insufficiency in a single operation. We present a case involving a 47-year-old patient with medial compartment osteoarthritis and complete ACL rupture. The patient underwent a simultaneous robotic-assisted UKA and ACLR using the CORI Surgical System (Smith&Nephew, London, UK). This approach enables accurate tibial tunnel placement and precise soft tissue balancing. The robotic system facilitates real-time gap assessment and balancing, reducing the risk of over- or under-constraint during ACL graft tensioning. The procedure was performed with a standard medial parapatellar approach. Key steps included hamstring autograft harvesting, femoral and tibial tunnel creation, and robotic-assisted implant positioning. Post-operative rehabilitation allowed full weight-bearing by the third week. This case represents the first reported instance of using an imageless robotic system for simultaneous UKA and ACLR, highlighting its potential to standardize and improve results in complex knee surgeries. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Cross-Bridge Free Vascularized Fibular Graft for Reconstruction of Extensive Traumatic Tibial Defects

Abstract Background The cross-bridge free flap technique has been described for salvage of cases of traumatic lower limb defects when adequate recipient vessels in the same limb are lacking. While previous accounts mainly focused on utilizing muscle, myocutaneous, or perforator skin flaps, this study presents a series of cross-bridge free vascularized fibular transfer for reconstruction of traumatic tibial defects with extensive soft tissue loss. Methods The study included 22 cases with an average age at surgery of 24 ± 8 years and an average tibial bone defect of 14.2 ± 3.3 cm. In this technique, the fibula was inset into the tibial defect and vascularization was performed using the posterior tibial artery of the contralateral leg through a radial forearm flap. The two legs were coimmobilized using Hoffmann external fixator and subsequently separated after 6 weeks. Results All flaps survived. Follow-up averaged 44.4 months. Union occurred in all cases within an average of 4.5 ± 1.9 months and Full weight-bearing was achieved at an average of 9.0 ± 2 months. Stress fractures occurred in eight patients (36.3%) after an average of 12 months. Mean graft hypertrophy at the final follow-up was 67.6%. Six patients showed an average limb length discrepancy of 4.2 cm. Two patients required corrective osteotomy, one ankle fusion, and another Achilles tendon lengthening. Functionally, 20 patients were able to walk without crutches. Conclusion The cross-bridge free vascularized fibular graft is a viable option for reconstruction of complex and extensive tibial defects when no other reconstructive options are available.

Combined interdisciplinary treatment of metastatic bone lesions using 3D robot-assisted image-guided navigation : Embolization, biopsy, ablation, and surgery in one operative session.

To maximize local tumor control, stabilize affected bones, and preserve or replace joints with minimal interventional burden, thereby enhancing quality of life for empowered living. Suitable for patients with bone metastases, particularly those with severe pain and/or fractures and appropriate life expectancy. In primary bone tumors, refer to the sarcoma surgery team for evaluation of wide resection. For patients with poor general condition and/or limited life expectancy (< 6weeks), consider best supportive care. Radiological interventions involve angiography and embolization for hypervascularized metastases, followed by precise biopsy and local tumor control through radiofrequency ablation or cryoablation using navigated imaging. The surgical treatment aims to create adurable, minimally invasive construct for stability, considering various options from percutaneous screws with cement augmentation to joint replacement. Intraoperative imaging and 3D scans guide the procedure, ensuring accurate placement of implants and confirming optimal results. Postoperative care involves immediate mobilization with pain-adapted full weightbearing and daily physiotherapy. The goal is to regain preoperative mobility. Follow-up with regular clinical and radiographic assessments and CT in the case of tumor progression and complications. Since introducing the combined surgical and interventional therapy in October 2021, 16patients have undergone successful procedures. Complications included material failure, component loosening, and surgical site infection. Five patients (31%) died during observation, while surviving patients surpassed their estimated survival, emphasizing the advantages of minimally invasive treatment with durable constructs.

Minimally invasive screw fixation of the anterior pelvic ring and the distal ilium : Tips and tricks to be successful.

Minimally invasive percutaneous techniques are used to stabilize fractures of the anterior pelvic ring. Stabilization of the fracture facilitates early mobilization and rehabilitation, while percutaneous techniques reduce complications such as infection and bleeding. Indicated for patients with non- or minimally displaced fractures of the anterior pelvic ring, or if fracture displacement can be reduced using minimally invasive techniques. Contraindications include infection at the surgical site, anatomical inability to place screws, or patients unfit for surgery due to health risks. The technique involves the insertion of ante- and retrograde transpubic screws and lateral compression (LC)II screws in supine position. Precise reduction of fractures is achieved using minimally invasive techniques. In younger patients, partial weight bearing for 6weeks is recommended, with full weight bearing in older patients. Literature reports ahigh union rate of up to 95% for these procedures, with low rates of nonunion and infection (around 2%). Screw loosening or loss of reduction occurs in 8-18% of cases, with better outcomes using bicortical screws.

Stem subsidence in total hip arthroplasty: retrospective investigation of a short stem using a simple measurement approach

BackgroundUncemented total hip arthroplasty (THA) is a successful treatment for advanced hip joint diseases. More recently, short stems became increasingly popular, but stem subsidence remains a concern. This study investigates early short stem subsidence in a large patient cohort using a simple measurement approach for everyday practice.MethodsThis retrospective, single center, single implant design study included 1000 patients with primary THA. Subsidence was evaluated using standardized weight-bearing radiographs taken 3–5 days and 2–3 weeks postoperatively with full weight-bearing (FWB). A novel Subsidence Index (SID) was introduced to quantify stem subsidence in a simple and reproducible manner. The SID is calculated by averaging four distinct linear measurements between defined anatomical landmarks on the femur and the implant, captured on standard radiographs without additional software.ResultsOut of all analyzed patients 6% (60/1000) had subsidence of more than 3 mm. The mean subsidence was 1.3 mm (range, 0 to 16.25 mm).There were 0.6% (6) who underwent stem revision for symptomatic subsidence. Men and obese patients had greater subsidence. However, patient age, BMI, stems without lateral bone contact and other demographic factors were not associated with subsidence.ConclusionEarly subsidence is relatively frequent with this uncemented short stem, however revisions are rare. Patients with risk factors should be counseled regarding FWB and radiographic controls should be performed. The SID provides an easy, non-invasive and inexpensive tool for early subsidence assessment; however, its simplicity limits its accuracy. Further research is needed in comparison to more elaborate methods.

Outcomes of Unrestricted Weight-Bearing During Interval Period With Cement-on-Cement Articulating Antibiotic-Loaded Spacers in Two-Stage Revision for Knee Prosthetic Joint Infection.

Two-stage revision is known as the gold-standard method for knee prosthetic joint infection (PJI), but the most suitable treatment method remains controversial. Typically, weight-bearing is restricted during the interval between the stages. The aim of this study was to evaluate the clinical outcomes of unrestricted weight bearing with cement spacers fabricated using the Knee Articulating Spacer Mold (KASM®; Ortho Development Corporation, Draper, UT, USA) for knee PJI. We retrospectively reviewed 16 patients who underwent two-stage revision surgery for knee PJI between April 2015 and March 2020. The procedure involved the removal of the infected prosthetic joints and the insertion of cement spacers made using KASM®. The evaluation focused on the possibility of full-weight bearing gait during the interval between the first and second stages, surgical time, blood loss, complications, and postoperative outcomes, including the Knee Society Score (KSS), Knee Society Function Score, and range of motion (ROM). All patientswere able to walk with full weight-bearing. However,cement spacer dislocationoccurred in one patient(6.3%). During the interval between stages, infection occurred in one patient (6.3%) and debridement was performed. Average interval between the stages was 92.7 days (range, 55-166 days). After the reimplantation, reinfection occurred in two patients (12.5%) out of the 16. Among the 14 patients with successful reimplantation, the average operative time was 116.1 min (range, 76-153 min) and the average perioperative blood loss was 476.1 mL (range, 89.5-859 mL). The KSS was 86.4 (range, 62-100), the Knee Society Function Score was 73.6 (range, 45-100), and flexion ROM was 111.8° (range, 95°-130°) at the latest follow-up.The mean follow-up period was 871 days (range, 117-1103 days). Unrestricted weight-bearing gait using cement spacers during the waiting period for two-stage revision surgery for knee PJI led to favorable outcomesin this case series, which lacked a control group.Further studies are needed to assess whether the benefits of weight-bearing outweigh the risks and improve overall outcomes.

Percutaneous sacroiliac screw fixation with a3D robot-assisted image-guided navigation system : Technical solutions.

Presentation and description of percutaneous sacroiliac (SI) screw fixation with the use of a3D robot-assisted image-guided navigation system and the clinical outcome of this technique. Pelvic fractures involving the posterior pelvis. Patients not suited for surgery. Planning the screws on the diagnostic computer tomogram (CT). Matching with alow-dose CT in the operating room. Lateral incision. Verify the guidewire position with the personalized inlet and outlet views. After correct positioning, place acannulated screw over the guidewire. For fragility fractures, augmentation is recommended. Finish the surgery with afinal 3D scan to confirm correct placement of the screws and cement. Direct postoperative mobilization with pain-adapted full weight-bearing. Data of 141 patients between January 2018 and August 2022 were analyzed (average age82 ± 10years, 89% female). Most of the fractures were typeII fragility fractures of the pelvis (FFP; 75%). The median hospital stay was 12 ± 7days and the median surgery duration for a unilateral SI screw was 26 min. In total 221 S1screws and 17S2 screws were applied. No screws showed signs of loosening or migration. Of the five suboptimally placed screws, one screw was removed due to sensory impairment. All patients with cement leakage remained without symptoms. The surgical technique with the use of a3D robot-assisted image-guided navigation system is a technique for safe fixation of dorsal fragility fractures of the pelvis and is associated with fewer complications.

Transcutaneous osseointegrated prosthetic system (TOPS) with an intramedullary prosthesis : Management of the femoral stump with concurrent total hip arthroplasty

Simultaneous implantation of aTOPS (transcutaneous osseointegrated prosthetic system) and THA (total hip arthroplasty) or staged approach. Patients with aTOPS who have coxarthrosis. Patients with an existing THA who have required above-knee amputation and need aTOPS. Patients with an existing TOPS who sustain amedial femoral neck fracture and are not stabilizable with osteosynthesis. Atypical anatomy, osteomyelitis, radiation or chemotherapy to the affected limb in the last 18months, peripheral occlusive arterial disease with critical ischemia, diabetes mellitus with polyneuropathy, local dermal or systemic infection, immunocompromised state or use of immunosuppressants, cognitive impairment or lack of compliance for the system, other significant physical impairments. Individualized preoperative planning based on CT data. Access similar to conventional THA for existing TOPS. Implantation of an artificial acetabulum with amatching inlay. Similar approach for medial femoral neck fractures without reconstructive options. For existing THA and prior above-knee amputation, removal of existing shaft and potentially neck component for modular prosthesis. Subsequent implantation of TOPS stem in conventional manner. Additional THA requires appropriate rehabilitation following endoprosthesis guidelines, tailored to the TOPS situation. For simultaneous implantation of TOPS and THA the patients' load-bearing capacity and mobilization depend on the duration of the implanted stem. Only 4patients have been treated at BGU Murnau making statistical analysis not feasible. Three of the 4patients experienced significant pain relief and improved mobility shortly after surgery. One patient remained as immobile postoperatively as preoperatively due to inability to achieve pain-free full weight-bearing.

Talonavicular arthrodesis

Realignment of the hindfoot by talonavicular arthrodesis. Idiopathic and posttraumatic arthritis of the talonavicular joint with or without malalignment. Optional in flatfoot reconstruction. General medical contraindications to surgical interventions. Medial, dorsomedial, or dorsal skin incision. Exposure of the talonavicular joint and cartilage removal. Decortication. Reposition of the joint if malaligned. Optional transplantation of corticocancellous bone. Temporary stabilization with Kirschner wires and stabilization with screws, optional with cramps or plates. Sixweeks nonweightbearing in along walker boot. Afterwards 2weeks of progressively weight bearing in along walker boot. Then full weightbearing in walking shoes with stiff soles. Physiotherapy. Atotal of 18feet in 18patients with isolated talonavicular arthritis were treated with isolated talonavicular fusion and corticocancellous bone thorough amidline incision. For postoperative management, patients had nonweightbearing for 6weeks in along walker boot. Mean follow-up was 14.5months (range 8-35months). Mean age was 63.2years (range 54-72years). Preoperative Manchester-Oxford Foot Questionnaire (MOXFQ) score was 65.3 (± 5.2); postoperative MOXFQ score was 28.5 (± 7.0). One revision surgery performed due to pseudarthrosis.

Clinical outcomes after extra-articular resection of hip joint tumour using a custom-made osteotomy guide and 3D-printed endoprosthesis with posterior column preserved.

For rare cases when a tumour infiltrates into the hip joint, extra-articular resection is required to obtain a safe margin. Endoprosthetic reconstruction following tumour resection can effectively ensure local control and improve postoperative function. However, maximizing bone preservation without compromising surgical margin remains a challenge for surgeons due to the complexity of the procedure. The purpose of the current study was to report clinical outcomes of patients who underwent extra-articular resection of the hip joint using a custom-made osteotomy guide and 3D-printed endoprosthesis. We reviewed 15 patients over a five-year period (January 2017 to December 2022) who had undergone extra-articular resection of the hip joint due to malignant tumour using a custom-made osteotomy guide and 3D-printed endoprosthesis. Each of the 15 patients had a single lesion, with six originating from the acetabulum side and nine from the proximal femur. All patients had their posterior column preserved according to the surgical plan. Postoperative pathological assessment revealed a negative surgical margin was achieved in all patients. At final follow-up, 13.3% (2/15) died and no recurrence occurred. The overall survival was 81.7% at five years. None of the patients showed any signs of aseptic loosening, and no wound healing issues were observed. In total, 20% (3/15) developed complications, with two cases of early hip dislocation and one case of deep infection. The cumulative incidence of mechanical and non-mechanical failure in this series was 13.7% and 9.3%, respectively, at five years. In this cohort, the mean time to full weightbearing was 5.89 (SD 0.92) weeks and the mean Musculoskeletal Tumor Society score was 24.1 (SD 4.4). For patients with a hip joint tumour who met the inclusion criteria and were deemed suitable for posterior column preservation, a custom-made osteotomy guide combined with 3D-printed endoprosthesis is worth performing when treating patients who require extra-articular resection of the hip joint, as it can achieve adequate margin for local control, maximize bone preservation to maintain pelvic ring integrity, reduce the risk of complications by simplifying the surgical procedure, and allow for more precise reconstruction for better function.

Minimally invasive stabilization of acetabular fractures with virtual navigation combined with robot-assisted 3D imaging

Minimally invasive stabilization of non- and minimally displaced acetabular fractures using intraoperative, robot-assisted three-dimensional (3D) imaging and anavigation system. Nondisplaced or only minimally displaced fractures of the acetabulum. Comminuted and highly displaced fractures of the acetabulum, protrusion of the femoral head into the pelvis with the need for open reduction, lack of possibility of intraoperative navigation. After supine positioning the patient, the patient-side navigation reference is attached to the anterior superior iliac spine using aSchanz screw. The 3D scan and registration of the dataset in the navigation system can then be performed. This allows the 7.3 mm screws to be planned using 3D imaging and then implanted through minimally invasive incisions. After successfully implanting the screws using the minimally invasive surgical technique, the patient can be mobilized the following day with pain-adapted physiotherapy exercises. Full weight bearing is usually possible. Between 2015 and 2023, 101 patients were treated using minimally invasive and navigation-assisted screw osteosynthesis for acetabular fractures. In 2patients, asecondary screw dislocation occurred in the hip joint after mobilization, which required revision surgery with repositioning of the screw osteosynthesis and ahip arthroplasty, respectively. Minimally invasive navigated screw osteosynthesis, thus, offers adequate treatment of nondisplaced and minimally displaced acetabular fractures. Attention must be paid to the correct indication and surgical technique.

[Translated article] Surgical treatment of ipsilateral bifocal tibial fractures: A challenge for the surgeon

IntroductionThe association of ipsilateral tibia fractures has a low incidence, being up to 3.2% of total tibia fractures. Currently there is no gold standard regarding the ideal surgical treatment.The objective of this study is to analyze the surgical treatment and the radiographic and functional results, as well as the associated complication rate of ipsilateral bifocal tibia fractures. Material and methodsRetrospective observational study in our hospital from 2010 to 2022 of 24 patients who underwent bifocal fracture of the ipsilateral tibia. Demographic and surgical data and complications during follow-up were included. ResultsThe 24 patients were classified into Group 1 when they presented a fracture of the plateau and distal tibia (25%), Group 2 with a fracture of the plateau and diaphysis (33%) and Group 3 with a fracture of the diaphysis and distal tibia (42%). Three patients underwent surgery with 1 implant and 21 patients with 2 implants. The average follow-up time in outpatient clinics was 2 and a half years. At one year, 22 patients (92%) had full weight bearing and 2 patients had partial weight bearing (8%) due to the sequelae of the fractures. The average time for consolidation of the diaphysis was 7.75±2 months, with no significant differences observed between Group 2 and Group 3 (p=0.06). The average time for consolidation of the metaphysis was 3.50±1.5 months, with no significant differences observed between Group 1 and Group 2 (p=0.065). Seven patients (30%) had complications during follow-up. ConclusionsBifocal tibia fractures can be treated using a combination of intramedullary nailing and plate osteosynthesis with good long-term results, obtaining an optimal union rate and low complications. In addition, it facilitates the reduction of the fracture, thus facilitating the patient's recovery and obtaining good long-term functional results.