Good Bone Stock Research Articles

Three- or four-part proximal humeral fractures in middle-aged and active elderly group of patients: a narrative review of treatment options.

Proximal humerus fractures (PHFs) occur in all age groups but more in elderly population with variety of treatment options. The choice of treatment of PHFs is rather controversial in the middle-aged and active elderly population. This review article highlights the current literature on the efficacy of treatment options for PHFs in middle-aged and active elderly patients which could help surgeons in decision making in clinical practice. PubMed and Scopus databases from January 1953 to February 2024 were searched and screened for studies, including systematic reviews, on the treatment of PHFs in middle-aged and elderly that served for narrative review of rationale behind such design. Patients with minimally displaced fractures should be treated nonoperatively. Internal fixation with intramedullary nailing is a viable option in cases of two-part surgical neck fractures, those with diaphyseal involvement and no significant displacement of the tuberosities, or pathologic fractures. Those elderly patients with displaced three- or four-part PHFs fractures with intact rotator cuff muscles should be treated with locking plate fixation if anatomical reduction of fracture fragments including tuberosity is possible, as the results after union despite avascular necrosis are favorable. Moreover, patients with failed fixation treated with salvage reverse shoulder arthroplasty (RSA) have similar outcomes to RSA for acute PHFs. Hemiarthroplasty should be reserved for select group of young active patients with unconstructable fracture, intact rotator cuff, and good tuberosity bone stock. RSA should be offered as first option for elderly patients with poor bone stock, rotator cuff insufficiency, fracture dislocations, head-split fractures, and severely displaced 3- and 4-part PHFs. The treatment of choice in middle-aged and active elderly patients with three- or four-part PHFs depends on several factors such as fracture pattern, bone quality, possibility of anatomical reduction, status of rotator cuff, and patient expectations. The success of treatment is based on patient selection while setting correct patient expectations.

Pilot study of three novel implants–GSK triangular system, locking hip screw and controlled sliding dynamic hip screw, for fixation of fracture of the neck of femur

Background and objectiveIntra capsular fracture of the neck of femur (FNF) treated traditionally with a dynamic hip screw (DHS) or three cancellous screws (3CS) has a high incidence of complications with reoperation rates between 20 % and 45 %. We hypothesized that FNF unites by primary healing. Therefore, intra-operative compression and absolute stability post-operatively until healing are essential. We postulated that FNF requires 2 types of implants- those which provide absolute stability for young patients with good bone stock and another with sliding mechanism for elderly patients with osteoporosis. We developed three novel fixation systems at our research institute in India using a modified DHS. In patients with good bone stock, locking DHS, called LHS and GSK triangular system (GSKT) provided intra-operative compression and absolute stability during the post-operative period. In those with poor bone stock, the controlled sliding DHS (CSDHS)was used as a locking implant might penetrate the hip joint. Materials and method42 patients of FNF <55 years of age were studied. Among 39 patients with good bone stock, LHS was used in five patients and GSKT system was used in 34 patients. CSDHS was used in three patients with poor bone stock or communition. The patients were followed up for a minimum of eight months up to a maximum of two years, with the average follow up duration of 14 months. Results32 out of 34 fractures treated by GSKT system united. Five cases managed by LHS and three by CSDHS, all united. The union rate was 95.2 %. Of the two failed cases, one patient had nonunion (NU), the other had deep infection. Avascular necrosis of the head (AVN) was detected in three patients treated with GSKT system in the second year following surgery. Two of them had hip pain while one was asymptomatic. Eight cases of FNF Pauwels type III underwent a primary valgus osteotomy. All of them united without complications. ConclusionIn patients with good bone stock, LHS and GSKT system allowed intra-operative compression and absolute post-operative stability without sliding of head fragment as the triangle construct is biomechanically the strongest. When bones are osteoporotic, a CSDHS provided controlled sliding (1 to 5 mm only). This pilot study showed a promising success rate of 95.2 %. We propose that the GSKT system may be used to treat intertrochanteric and other metaphyseal fractures as well. Further biomechanical studies are underway to strenghten the evidence needed for the widespread use of these implants.

A STUDY OF FUNCTIONAL OUTCOME IN THREE COLUMN FIXATION OF COMPLEX TIBIAL PLATEAU FRACTURES

Introduction: The treatment of complex tibial plateau fractures (TPF), especially those caused by high-energy trauma, remains a challenge in many respects. Tibial plateau fractures are one of the commonest periarticular fractures. These fractures include 1% of all fractures and 8% of fractures in elderly. Motor vehicle accidents account for the majority of these fractures in younger individuals with good bone stock, but in elderly individuals these fractures may result from simple fall due to osteopenic bone. Conservative methods may result in malunion and articular congruity cannot be restored. Surgical treatment can regain articular congruity and restore mechanical alignment, and can allow early range of motion. Open reduction and internal fixation techniques had been associated with wound complications. Aim Of The Study: To evaluate functional outcome in patients of complex tibial plateau fractures treated by three column fixation. Materials and Methods: In our institution 20 patients with displaced tibial plateau fractures with posterior column involvement were selected for the study. This is a prospective study done from AUGUST 2023 to APRIL 2024(9 months).Patients were evaluated with X rays (AP and lateral views) and Computed Tomography (axial, coronal, sagittal with 3D reconstruction views). Fractures classified based on 3 column concept classification. Mean follow up period was 6 months .Functional and radiological outcome was assessed using functional knee score , modified rasmussen score and WOMAC score. Inclusion Criteria: 1. Patients admitted with complex tibial plateau fractures involving medial, lateral and posterior column of tibia. 2. Both sexes 3. Age 20-60 yrs. Exclusion Criteria: 1) Bad skin status of the fractured site. 2) Patients with co morbidities not fit for surgery. 3) Patients with neurovascular deficit. 4) Patients not willing for surgery. Results:In our study, 70% of the patients were in active productive age group (30-50 years). 85% of the patients were male. The fractures were left sided in 75% patients. 85% patients in study sustained injury due to road traffic accident. 80% cases in the study were type 5 schatzker type 5 fractures and all the cases included in the study were 3 column fractures. 8 cases out of 20 cases in the study required epidural analgesia instead of a repeat spinal as the duration of the surgery was longer. Conclusion: To conclude,3 column fixation in high energy displaced tibial plateau fractures with three column fractures resulted in Good clinical and radiological outcomes.

An isoelastic monoblock cup versus a modular metal-back cup: a matched-pair analysis of clinical and radiological results using Einzel-Bild-Röntgen-Analyse software

IntroductionBone preservation and long-term survival are the main challenges in cementless total hip arthroplasty (THA). A good bone stock is especially important for adequate anchorage of the cup in revision cases. However, the optimal acetabular cup design for preserving good bone stock is still unclear. We aimed to compare clinical outcome, radiological alterations, migration, and wear at mid-term for two different cup types.Materials and methodsThis retrospective matched-pair study was performed using the data for 98 THA cases treated with a monoblock cup composed of vitamin E-blended highly cross-linked polyethylene (VEPE; monoblock group) or a modular cup composed of a highly cross-linked polyethylene (HXLPE) without an antioxidant (modular group). Clinical results were evaluated using the Harris Hip Score (HHS). The obtained radiographs were analyzed for radiological alterations, migration, and wear using Einzel-Bild-Röntgen-Analyse (EBRA) software.ResultsThe mean follow-up duration was 73.2 ± 19.2 months (range: 32–108 months) and 60.5 ± 12.2 months (range: 20–84 months) in the monoblock and modular groups, respectively. HHS improved to 95.7 points in the monoblock group and 97.6 points in the modular group, without significant differences (p = 0.425). EBRA measurements were obtained in all cases. Acetabular bone alterations were not detected on radiological assessments. Mean cup migration was 1.67 ± 0.92 mm (range: 0.46–3.94 mm) and 1.24 ± 0.87 mm (range: 0.22–3.62 mm) in the monoblock and modular groups. The mean wear rate was 0.21 ± 0.18 mm (range: 0.00–0.70 mm) and 0.20 ± 0.13 mm (range: 0.00–0.50 mm) in the monoblock and modular groups. Both migration and wear pattern showed no significant differences (p = 0.741 and 0.243). None of the cases required revision surgery, yielding an implant survival rate of 100% in both groups.ConclusionThe isoelastic press-fit monoblock VEPE cup and modular metal-back HXLPE cup showed equivalent mid-term wear and cup migration. Long-term studies are required to determine the effects of modularity, isoelasticity, and polyethylene stabilization with vitamin E on cup loosening and survival rates.

Aptis Distal Radioulnar Joint Arthroplasty: A Multicenter Evaluation of Functional Outcomes, Complications, and Patient Satisfaction.

Background The Aptis distal radioulnar joint (DRUJ) implant has been commonly used to replace the DRUJ and restore wrist function in patients with a severely destroyed DRUJ. Objective Promising results have been described in the literature. However, the clinical results in a multicenter setting are sparse and variable. This study evaluates the short- to midterm clinical results of 53 patients with a (mean) follow-up of 51 months. Patients and Methods Fifty-three patients (59 implants) treated between 2011 and 2020 in three different institutions were retrospectively identified in a prospectively collected database. The main indication for Aptis DRUJ arthroplasty was a destroyed DRUJ and gross distal radioulnar instability and isolated DRUJ osteoarthritis. Functional outcome, complications, and patient satisfaction were evaluated. Patients completed the Patient-Rated Wrist Evaluation (PRWE) questionnaire and an additional questionnaire about patient satisfaction and return to hobby/work. Results Implant survival was 92%, the surgical follow-up showed many complications (64,4%), and revision surgery was needed frequently (40.7%). In 13 cases, the follow-up was longer than 5 years. Three reimplantations had to be performed and two implants were permanently explanted. In spite of this all, wrist and forearm motion as well as pain reduction was adequate and patient satisfaction was reasonable (72.2%). Conclusion The Aptis DRUJ arthroplasty is a viable option that can provide adequate wrist and forearm function after secure patient selection and surgical placement of the implant in the wrist with a good bone stock of the radius. The complication rate was found to be high, yet patient satisfaction was reasonable. In the case of secondary surgery, additional surgery seems to be needed. For primary surgery, the implant seems to be successful without complications. Different complications have been described, but further analysis is warranted to find the causes of complications and to objectify the performance of the Aptis DRUJ implant. Level of Evidence IV.

Change in CT-measured acetabular bone density following total hip arthroplasty: a systematic review and meta-analysis.

Assessing peri-acetabular bone quality is valuable for optimizing the outcomes of primary total hip arthroplasty (THA) as preservation of good quality bone stock likely affects implant stability. The aim of this study was to perform a meta-analysis of peri-acetabular bone mineral density (BMD) changes over time measured using quantitative computer tomography (CT) and, second, to investigate the influence of age, sex, and fixation on the change in BMD over time. A systematic search of Embase, Scopus, Web of Science, and PubMed databases identified 19 studies that measured BMD using CT following THA. The regions of interest (ROI), reporting of BMD results, and scan protocols were extracted. A meta-analysis of BMD was performed on 12 studies that reported measurements immediately postoperatively and at follow-up. The meta-analysis determined that periacetabular BMD around both cemented and uncemented components decreases over time. The amount of BMD loss increased relative to proximity of the acetabular component. There was a greater decrease in cortical BMD over time in females and cancellous BMD for young patients of any sex. Peri-acetabular BMD decreases at different rates relative to its proximity to the acetabular component. Cancellous BMD decreases more in young patients and cortical bone decreases more in females. Standardized reporting parameters and suggested ROI to measure peri-acetabular BMD are proposed, to enable comparison between implant and patient variables in the future.

THE CEMENTED DOUBLE MOBILITY CUP IN HIP REVISION: DIFFERENT POSSIBILITIES OF USE.

The aim of our work is to review those patients who underwent prosthetic hip revision surgery in our hospital considered to be patients at high risk of dislocation or recurrent dislocation, and who underwent a double mobility cemented cup (CMD). Analyzing the different ways to place these cups and the clinical results and reluxations. The 69 cases comprised 34 men and 35 women with a mean age of 77,39 years. The mean follow-up was 4.7536 years. The type of intervention performed varied according to the cause of the intervention, the acetabular bone stock and the state of the primary cup. In the cases in which there was a good fixation of the primary metalback, we opted to carry out a cementation of the cemented DMC into the existing well-fixed metal acetabular shell, this occurred in 23 cases. In the cases where there was loosening of the primary cup but there was a good bone stock, a CMD was cemented into the bone (21 cases). In the cases where there was a Paprosky type III we cemented a DMC to a Bursch-Schneider reinforcement ring together with the placement of a cancellous bone graft (25 cases). The clinical evaluation at the end of the follow-up, according to the MD Scale, showed the mean value was 16.454 (SD 0.79472), with a survival at the end of the follow-up of 100% of the placed DMC. The use of cemented DMC is a good solution in the replacement of THA, especially in cases of reluxation or risk of dislocation due to personal or technical predisposing factors. The use of these DMC cemented can be directly to the bone, into the existing well-fixed metal Shell, or cemented to a reinforcing ring, depending on the acetabular defect. Evidence Level III; Comparative Case Series .

Outcomes of the Surgical Treatment of Periprosthetic Fractures Around the Knee with Locking Plates: A Single Centre Experience.

Introduction:Surgical treatment options for periprosthetic fractures (PPF) include internal fixation with plate, intramedullary nailing and revision arthroplasty. We aimed at evaluating the surgical outcomes of patients who we had treated PPF with locking compression plates (LCP).Materials and methods:Twenty patients with PPF after primary total knee arthroplasty (TKA) between 2009 and 2016 were included in to the study. Knee Society Knee Scoring System (KSKSS) was used in the evaluation of radiologic and functional outcomes. There were periprosthetic supracondylar femoral fractures in 15 patients, and that of tibial fractures in 5 patients. For internal fixation, locking compression plate was preferred.Results:The mean age was 69 (range 61 to 78) years and the mean follow-up period was 72.25 (range 24 to 110) months. Union was achieved by 15.8 weeks in all the cases. Superficial infection and implant fracture were each seen in two patients. Revision operations were done to those patients with implant fracture. Mean KSKSS was 81.4 (75-87) and the mean functional score was 78.75 (75-85). Degenerative osteoarthritis patients were found to have higher age values than post-traumatic osteoarthritis patients (p = 0.001). When the union times were compared, it was found that the degenerative osteoarthritis patient group had a significantly shorter union than the post-traumatic osteoarthritis patient group (p = 0.036).Conclusion:Internal fixation with LCP is an effective treatment method in managing of PPF for patients with good bone stock. Rigid fixation should be done with the right surgical technique and an early movement must be initiated so that a good function can be achieved.

Long-term outcomes of cementless femoral stem revision with the Wagner cone prosthesis

BackgroundThe procedure of femoral stem revision is challenging, and bone conservation with less stress shielding is a mandatory effort in these cases. Although there are several reports of stem revision with stems designed for primary total hip arthroplasty (THA), there is no report on stem revision with the Wagner cone prosthesis.MethodsBetween 1996 and 2008, 41 hips of 41 consecutive patients were subjected to femoral revision THA using the Wagner cone prosthesis. The mean age during revision surgery was 56.1 years, and the mean follow-up period was 14.8 years. The clinical results were evaluated, and the femoral component was assessed radiologically.ResultsThe results showed that the average period from the first operation to revision THA was 8.0 years. Additionally, the mean Harris hip score improved from 52 points preoperatively to 83 points at the final follow-up. All stems showed bone integration in the radiological evaluation. A subsidence of more than 5 mm was observed in 3 out of 28 (10.7%) femoral stems. Two patients needed an acetabular revision for acetabular cup loosening during the follow-up period. Furthermore, one patient had recurrent dislocation and had to undergo revision surgery for soft tissue augmentation.ConclusionsWe achieved favorable clinical and radiological long-term outcomes in femoral stem revision using the Wagner cone prosthesis. This cementless femoral stem could be an option for femoral stem revision in cases with relatively good bone stock.

High Survivorship of Short-Cemented Femoral Stems in Condylar Revision Total Knee Arthroplasty Without Significant Metaphyseal Bone Loss: Minimum 5-Year Follow-Up

BackgroundWe aimed to evaluate the outcomes of hybrid fixation technique in condylar revision total knee arthroplasty (rTKA) using cementless metaphyseal tibial sleeves and short-cemented femoral stems with a rotating platform articulation. MethodsRetrospective consecutive study of all condylar rTKAs with a cemented femoral stem between 2009 and 2016 was conducted. Patients were identified using a local prospective database and linkable data obtained from the National Joint Registry for rTKA. Demographic, clinical, and surgical data were collected from patients’ electronic health records. The primary outcome measure was mechanical failure and implant survivorship using a nationally collected data, complications, re-operations, and “any-cause revision” were also recorded. ResultsThere were 72 consecutive patients (72 knees) with minimum 5-year follow-up: 33 (45.8%) females and 39 (54.2%) males with a median age of 70 years (range 47-88). The indication for revision surgery was aseptic loosening (n = 34, 47.2%), instability (n = 17, 23.6%), infection (n = 14, 19.5%) with 10 patients having 2-stage approach and 4 patients with single-stage approach, stiffness (n = 4, 5.6%), and malalignment (n = 3, 4.1%). At mean follow-up of 6.87 years (median 6.7; range 5-11.8), only 2 patients required revision for infection. Using “any-cause implant revision” as an end point, implant survivorship for this construct was 97.2% at median 6.7 years. To date, none of the femoral stems have been revised for mechanical failure. ConclusionIn rTKA with good femoral condylar bone stock, we have shown excellent survivorship with a short-cemented femoral stem, in conjunction with a mobile-bearing and a tibial sleeve. This has the advantage of reducing the length of the revision construct of this complex surgery. Level of EvidenceLevel IV.

Long-term Results of the Thrust Plate Prosthesis, 21-year Follow-up: A Case Report and Literature Review

Introduction:The thrust plate prosthesis (TPP) is a type of cementless hip replacement. Aimed to preserve femoral diaphyseal bone, it was favored by some orthopedic surgeons in younger patients as they could potentially undergo multiple revision arthroplasties during their lifetime. Of particular note, the preserved diaphyseal bone allows for the implantation of a subsequent primary total hip arthroplasty (THA).Case Report:We reported on a 64-year-old male patient who underwent thrust plate prosthesis (TPP) implantation 21 years ago (1999) for the treatment of primary osteoarthritis (OA) of the right hip joint. At 21-year follow-up, he had not developed any post-operative complications, and he reported a SF12 score of 32 and Oxford hip score of 47/48.Conclusion:TPP proved to be successful clinically and radiologically, especially in the young patient. It loads directly to the cortex of the proximal femoral metaphysis as in a native hip joint. It is a bone preserving prosthesis which allows for good bone stock in the case of revision surgery that was a victim of commercial considerations.

Hip fractures in cyclist – a six-year cohort study at a single large volume trauma centre

Cycling has gained in popularity as a recreational activity and method or travel, in part due to its recognised health benefits in maintenance of good cardiovascular strength and also for environmental issues. As a consequence of this, there is unfortunately an increased number of cycling related injuries. One particular injury incurred is a proximal femoral fracture, but there is little information in the literature with regarding this and its management. This retrospective, single centre, observation study looks at the number of cycling injuries over a six-year period in those under the age of 80. 50 patients were identified at an occurrence of 4.5% of the hip fracture population. The majority were male (n=37, 74%) with an average age of 60. Operative treatment was used for 48 (96%) patients with the majority being treated with internal fixation (n=42, 84%) and arthroplasty for the remainder. Average hospital stay was 5.6 days. One patient continued to complain of pain and subsequently underwent a total hip arthroplasty. The mean follow up for these patients was 1033 days (range 1 year to 7 years). 47 (94%) had full return back to pre-injury levels. Given that cycling is likely to increase in the future, we recommend that early surgical fixation is a viable and functionally positive treatment management in these particular group of patients. ObjectivesThe aim of this retrospective observational study over a six-year period was to assess the incidence of hip fractures in those under the age of 80 following a cycling related injury, the definitive management and primary index surgery opted and to report the radiological and functional outcome of these patients with at least 1 year of follow up. DesignRetrospective, observational study SettingLarge hip fracture unit, Level 2 Trauma Centre, single centre. PatientsPatients under the age of 80 who sustained a proximal femoral fracture secondary to a fall and not attributable to pathological processes (namely malignancy and Paget's) were identified and followed up after 1 year. Results50 patients were identified over a six-year period of which 74% (n=37) were male and the remaining were female. 48 of these patients subsequently went on for operative management. Two patients presented late (7 days and 42 days from surgery) and were treated conservatively. The average hospital stay for these patients was 5.6 days, with index surgery occurring on average within 22 hours of admission. Mean follow up was 1033 days (range 1 year to 7 years) in all patients. Radiological union had occurred in all patients. One patient showed evidence of avascular necrosis but was asymptomatic.All but three patients had achieved the same level of mobility as pre-injury levels. All patients had the same level of social dependency. One patient continued to complain of pain and subsequently underwent a total hip arthroplasty. ConclusionsWe demonstrate that the majority of our patients undergo surgical fixation and demonstrate good functional and radiological outcomes at a mean follow up of 1033 days. This is likely as a result of good pre-morbid status in these patients and good bone stock at index intervention. This study is one of the first to show this within the literature in this cohort of elderly patients. The number of cycling related injuries in the elderly population is likely to increase and our recommendation is that early surgical fixation provides good functional outcome in this subset of patients.

An Isoelastic Monoblock Cup Retains More Acetabular and Femoral Bone Than a Modular Press-Fit Cup: A Prospective Randomized Controlled Trial.

For cup revision after total hip arthroplasty, sufficiently good periacetabular bone stock is a prerequisite for fixation of the revision implant. Cementless cups can lead to a relevant reduction of peri-implant bone mineral density (BMD) through stress-shielding. Fifty patients were included in this prospective randomized controlled trial. Group 1 (RM group) received an isoelastic monoblock cup (RM Pressfit vitamys; Mathys). Group 2 (IT group) received a modular titanium cup (Allofit-S IT Alloclassic with a polyethylene liner; Zimmer). Periacetabular BMD was determined and subdivided into 4 regions of interest by dual x-ray absorptiometry at 1 week (baseline) and at 4 years postoperatively. Our primary outcome was reduction in periacetabular BMD. Periacetabular BMD was reduced by an average of 15.1% in the RM group and 16.5% in the IT group at 4 years postoperatively. No significant difference was found between the 2 groups over the periacetabular structure as a whole. However, the decrease of BMD in the polar region was significantly different in the RM group (4.9% ± 10.0%) compared with the IT group (15.9% ± 14.9%, p = 0.005). Use of the isoelastic RM cup showed significantly less bone loss than the modular IT cup. Relevant loss of BMD at 4 years after surgery was identified in the periacetabular region in both groups. No differences between the 2 cup systems were found when looking at the overall periacetabular region. As a secondary outcome, less postoperative periacetabular bone loss occurred in the polar region when an isoelastic cup was used. Longer follow-up is required to allow for conclusions to be drawn about the long-term course of the 2 cup systems. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Comparison of Two Surgical Techniques for Periprosthetic Supracondylar Femoral Fractures: Minimally Invasive Locking Plate Versus Retrograde Femoral Nails.

Objectives:This study aimed to compare minimal invasive locking plate and retrograde intramedullary nailing in the treatment of supracondylar femur fracture following total knee arthroplasty (TKA) in respect of fracture healing, complications, and functional results.Methods:A retrospective analysis was made of 32 supracondylar femur fractures comprising 20 cases treated with minimal invasive locking plate fixation and 12 with retrograde femoral nailing. The two techniques were compared in respect of range of motion (ROM), functional scores, intraoperative blood loss, surgery time, and radiological examination findings.Results:The mean functional scores did not differ between the nailing and plate fixation groups. In the minimal invasive locking plate group, 2 (10%) patients had delayed union, so revision surgery was applied. The mean post-operative ROM was comparable between two groups (86.2° vs. 86°). Reduction quality in the sagittal plane and maintenance of the initial reduction were better in the minimal invasive locking plate group. Greater shortening of the lower extremity was seen in the retrograde femoral nailing group than in the minimal invasive locking plate group (20.3 vs. 9.3 mm). Perioperative blood loss was greater (2 units vs. 1.2 units) and mean operating time was longer in the minimal invasive locking plate group (126.5 min vs. 102.2 min).Conclusion:In patients with good bone stock, supracondylar femur fracture following TKA can be treated successfully with retrograde nailing or minimal invasive locking plate. Retrograde femoral nailing has the advantage of less blood loss and a shorter operating time. Reduction quality may be improved with the minimal invasive locking plate fixation technique. Both surgery techniques can be successfully used by orthopedic surgeons taking a case-by-case approach.

Cemented short-stem total hip arthroplasty: Characteristics of line-to-line versus undersized cementing techniques using a validated CT-based finite element analysis.

Short stems are becoming increasingly popular in total hip arthroplasty as they preserve the bone stock and simplify the implantation process. Short stems are advised mainly for patients with good bone stock. The clinical use of short stems could be enlarged to patients with poor bone stock if a cemented alternative would be available. Therefore, this study aimed to quantify the mechanical performance of a cemented short stem and to compare the "undersized" cementing strategy (stem one size smaller than the rasp) with the "line-to-line" technique (stem and rasp with identical size). A prototype cemented short stem was implanted in eight pairs of human cadaveric femora using the two cementing strategies. Four pairs were experimentally tested in a single-legged stance condition; stiffness, strength, and bone surface displacements were measured. Subject-specific nonlinear finite element models of all the implanted femora were developed, validated against the experimental data, and used to evaluate the behavior of cemented short stems under physiological loading conditions resembling level walking. The two cementing techniques resulted in nonsignificant differences in stiffness and strength. Strength and stiffness as calculated from finite element were 8.7 ± 16% and 9.9 ± 15.0% higher than experimentally measured. Displacements as calculated from finite element analyses corresponded strongly (R 2 ≥ .97) with those measured by digital image correlation. Stresses during level walking were far below the fatigue limit for bone and bone cement. The present study suggests that cemented short stems are a promising solution in osteoporotic bone, and that the line-to-line and undersized cementing techniques provide similar outcomes.

Systemic Lupus Erythematosus Does Not Worsen Outcomes of Patients Admitted for Heart failure Exacerbation: Analysis of the National Inpatient Sample

Increasing numbers of unstable pelvic ring fractures, due to the ongoing demographic change and improvements in the rescue of high-energy traumatic events, are challenging trauma and orthopedic surgeons. While initial installation of an external fixation device is often necessary, placement of iliac crest pins can be difficult due to the complex osteology of the ilium.We aim to analyze (1) the length, localization and angulation of the iliac pillar and (2) to define the dimensions of the surgical corridor for a better understanding of pin entry point and trajectory, thus preventing shortcomings in anterior external fixation of pelvic ring injuries.Twenty hemipelvises from 10 fresh-frozen cadaveric torsos (3 females, 7 males; mean age 80.2 years) were harvested. The following measurements were taken with digital calipers: location of the iliac pillar in relation to the anterior superior iliac spine and to the acetabulum roof, mean length and diameter of the iliac pillar, maximum diameter of the iliac pillar. In addition, we measured the width of the different bone layers.The mean length of the hourglass shaped iliac pillar was 107.04 mm with a mean width of 17.0 mm (min. 15.1; max. 19.2). The mean distance to the anterior superior iliac spine was 69.00 mm (min. 64.8; max. 73.4). The mean maximum width of the iliac pillar was 12.16 mm (min. 9.4; max. 13.8). Caudally the line describing the iliac pillar intercepts the cranial acetabular rim at 12 o’clock. The smallest mean diameter of the cancellous bone was 7.5 mm ± 2.0.The iliac pillar is part of the complex osteology of the human pelvis. A cohesive description of its location and dimensions has been lacking. Successful treatment of pelvic fracture depends on an optimal preoperative planning, accurate overall reduction, and stable fixation. We described the origin and angulation to provide a good bone stock for external fixation pin and the width of the different bone layers. This study therefore contributes by facilitating a thorough understanding of pelvic osteology and describing the location and dimensions of an optimal osseous pathway.Anatomical descriptive study.

Do Rheumatoid Arthritis Patients Have Worse Outcomes When Hospitalized for Heart Failure Exacerbation?

Increasing numbers of unstable pelvic ring fractures, due to the ongoing demographic change and improvements in the rescue of high-energy traumatic events, are challenging trauma and orthopedic surgeons. While initial installation of an external fixation device is often necessary, placement of iliac crest pins can be difficult due to the complex osteology of the ilium.We aim to analyze (1) the length, localization and angulation of the iliac pillar and (2) to define the dimensions of the surgical corridor for a better understanding of pin entry point and trajectory, thus preventing shortcomings in anterior external fixation of pelvic ring injuries.Twenty hemipelvises from 10 fresh-frozen cadaveric torsos (3 females, 7 males; mean age 80.2 years) were harvested. The following measurements were taken with digital calipers: location of the iliac pillar in relation to the anterior superior iliac spine and to the acetabulum roof, mean length and diameter of the iliac pillar, maximum diameter of the iliac pillar. In addition, we measured the width of the different bone layers.The mean length of the hourglass shaped iliac pillar was 107.04 mm with a mean width of 17.0 mm (min. 15.1; max. 19.2). The mean distance to the anterior superior iliac spine was 69.00 mm (min. 64.8; max. 73.4). The mean maximum width of the iliac pillar was 12.16 mm (min. 9.4; max. 13.8). Caudally the line describing the iliac pillar intercepts the cranial acetabular rim at 12 o’clock. The smallest mean diameter of the cancellous bone was 7.5 mm ± 2.0.The iliac pillar is part of the complex osteology of the human pelvis. A cohesive description of its location and dimensions has been lacking. Successful treatment of pelvic fracture depends on an optimal preoperative planning, accurate overall reduction, and stable fixation. We described the origin and angulation to provide a good bone stock for external fixation pin and the width of the different bone layers. This study therefore contributes by facilitating a thorough understanding of pelvic osteology and describing the location and dimensions of an optimal osseous pathway.Anatomical descriptive study.

A modified transfibular technique of ankle arthrodesis using partial fibular resection and onlay bone graft.

The transfibular approach is a common procedure for tibiotalar fusion. However, this technique has several concerns: inadequate stability to resist rotational and shearing forces, a fibula is suboptimal for bone grafting, and an onlay fibular graft that might prevent impacting and cause distraction. We present a modified transfibular technique using partial fibular resection and onlay bone graft, which may address these potential problems. This study aimed to evaluate whether the ankle joint is well fused with neutral alignment and functionally improved at the final follow-up. For this study, 27 consecutive patients (mean age, 68.5 years; range, 58-83) who underwent tibiotalar fusion with a follow-up period of >1 year were retrospectively included. A modified transfibular lateral approach was performed, in which the distal anterior half fibula was resected and fixed as an onlay graft to achieve fusion between the tibia, fibula, talus, and fibular onlay graft simultaneously. Radiographic outcomes were assessed using computed tomography at 4 months after operation and serial follow-up radiographs. Functional outcomes were assessed using the American Orthopedic Foot and Ankle Society hindfoot scale and Foot and Ankle Outcome Score. The mean follow-up period was 17.3 (range, 12-32) months. Four months after operation, complete union was achieved in 13 patients, near-complete union in 8 patients, and partial union in the remaining 6 patients. At the final follow-up, all the patients achieved complete union and maintained neutral ankle alignment. The functional outcome showed a significant increase between the preoperative and postoperative periods. One minor complication occurred, in which medial side ankle pain was relieved after screw removal. This modified technique is safe and effective, and has several merits, including saving the soft tissue of the anterior ankle, saving the course of the peroneal tendons by leaving the posterior half of the fibula, resected fibula serving as a good bone stock, and reducing the likelihood of valgus deformity after fibulectomy.

L’isthme iliaque — Définition d’une voie pour la fixation osseuse interne et externe

BackgroundIncreasing numbers of unstable pelvic ring fractures, due to the ongoing demographic change and improvements in the rescue of high-energy traumatic events, are challenging trauma and orthopedic surgeons. While initial installation of an external fixation device is often necessary, placement of iliac crest pins can be difficult due to the complex osteology of the ilium. HypothesisWe aim to analyze (1) the length, localization and angulation of the iliac pillar and (2) to define the dimensions of the surgical corridor for a better understanding of pin entry point and trajectory, thus preventing shortcomings in anterior external fixation of pelvic ring injuries. MethodsTwenty hemipelvises from 10 fresh-frozen cadaveric torsos (3 females, 7 males; mean age 80.2 years) were harvested. The following measurements were taken with digital calipers: location of the iliac pillar in relation to the anterior superior iliac spine and to the acetabulum roof, mean length and diameter of the iliac pillar, maximum diameter of the iliac pillar. In addition, we measured the width of the different bone layers. ResultsThe mean length of the hourglass shaped iliac pillar was 107.04mm with a mean width of 17.0mm (min. 15.1; max. 19.2). The mean distance to the anterior superior iliac spine was 69.00mm (min. 64.8; max. 73.4). The mean maximum width of the iliac pillar was 12.16mm (min. 9.4; max. 13.8). Caudally the line describing the iliac pillar intercepts the cranial acetabular rim at 12 o’clock. The smallest mean diameter of the cancellous bone was 7.5mm±2.0. ConclusionThe iliac pillar is part of the complex osteology of the human pelvis. A cohesive description of its location and dimensions has been lacking. Successful treatment of pelvic fracture depends on an optimal preoperative planning, accurate overall reduction, and stable fixation. We described the origin and angulation to provide a good bone stock for external fixation pin and the width of the different bone layers. This study therefore contributes by facilitating a thorough understanding of pelvic osteology and describing the location and dimensions of an optimal osseous pathway. Level of evidenceAnatomical descriptive study.

The iliac pillar – Definition of an osseous fixation pathway for internal and external fixation

BackgroundIncreasing numbers of unstable pelvic ring fractures, due to the ongoing demographic change and improvements in the rescue of high-energy traumatic events, are challenging trauma and orthopedic surgeons. While initial installation of an external fixation device is often necessary, placement of iliac crest pins can be difficult due to the complex osteology of the ilium. HypothesisWe aim to analyze (1) the length, localization and angulation of the iliac pillar and (2) to define the dimensions of the surgical corridor for a better understanding of pin entry point and trajectory, thus preventing shortcomings in anterior external fixation of pelvic ring injuries. MethodsTwenty hemipelvises from 10 fresh-frozen cadaveric torsos (3 female, 7 males; mean age 80.2 years) were harvested. The following measurements were taken with digital calipers: Location of the iliac pillar in relation to the anterior superior iliac spine and to the acetabulum roof, mean length and diameter of the iliac pillar, maximum diameter of the iliac pillar. In addition we measured the width of the different bone layers. ResultsThe mean length of the hourglass shaped iliac pillar was 107.04mm with a mean width of 17.0mm (min. 15.1; max. 19.2). The mean distance to the anterior superior iliac spine was 69.00mm (min. 64.8; max. 73.4). The mean maximum width of the iliac pillar was 12.16mm (min. 9.4; max. 13.8). Caudally the line describing the iliac pillar intercepts the cranial acetabular rim at 12 o’clock. The smallest mean diameter of the cancellous bone was 7.5mm±2.0. ConclusionThe iliac pillar is part of the complex osteology of the human pelvis. A cohesive description of its location and dimensions has been lacking. Successful treatment of pelvic fracture depends on an optimal preoperative planning, accurate overall reduction, and stable fixation. We described the origin and angulation to provide a good bone stock for external fixation pin and the width of the different bone layers. This study therefore contributes by facilitating a thorough understanding of pelvic osteology and describing the location and dimensions of an optimal osseous pathway. Level of evidenceAnatomical descriptive study.