Hardware Removal Research Articles

Postoperative Pain Level Following Surgery of the Hand and Wrist in the Ambulatory Setting

Surgical procedures of the hand are increasingly performed in an ambulatory setting. Postoperative analgesia is based empirically on the painfulness of individual surgical procedures without these having been examined systematically. The painfulness (visual analogue scale) of 722 surgical procedures of the hand and wrist (1 July 2021 to 30 June 2023) was assessed until day 5. Analgesia was conducted empirically in accordance with WHO principles. The primary endpoint was the pain sensation on the first postoperative day in bone and joint procedures compared with soft tissue or endoscopic procedures as well as hardware removals. Secondary endpoints were pain sensation in correlation with gender, age, duration of the procedure and preoperative analgesia. Bone and joint procedures were associated with significantly (p<0.001) more pain (5.42±2.8) compared with other procedures (3.47±2.6). Female (p=0.001) and younger patients (R>0.2) as well as longer procedure duration (R>0.2) showed a weak association with higher postoperative pain, whereas preoperative consumption of opioids was moderately associated with higher opioid intake (R=0.34). Overall, pain decreased continuously from the evening of the procedure (4.4±2.8) until day 5 (3.7±2.7; 2.8±2.4; 2.1±2.1; 1.6±1.9; 1.3±1.7) CONCLUSION: This data provides a scientific basis for pain medication supply following surgical procedures of the hand and wrist in an ambulatory setting. A broad range of pain perception must be considered, even in seemingly minor surgical procedures.

Clinical and surgical factors influencing screw breakage during hardware removal following periacetabular osteotomy

Abstract Periacetabular osteotomy (PAO) is a procedure used to treat patients with hip dysplasia. Current literature reports symptomatic hardware removal (HWR) rates of 13.6% following PAO. No reports have examined the incidence of or factors relating to screw breakage during HWR. This study reports the incidence of screw breakage in patients undergoing HWR following PAO and examines the associated clinical and surgical factors. Patients who underwent PAO by a single surgeon from 2012 to 2022 were retrospectively reviewed. Demographic, surgical, and implant information was collected. Constructs were stratified by number (three-screw and four-screw) and type (3.5 mm only, 4.5 mm only, and mixed). Incidence rates of HWR and screw breakage were calculated. Three hundred and two hips from 254 patients undergoing PAO were included. Seventy-one hips from 58 patients underwent HWR (23.5%). Eighteen of 259 screws (6.9%) were broken upon removal in 10/71 hips (14.1%). Significantly more 3.5-mm screws were removed (24.7% vs 21.2%; P = .05) and broken than 4.5-mm screws (10.5% vs 3.8%; P = .04). Time to removal was significantly longer in broken screws (16.8 ± 12.7 months vs 33 ± 18.2 months, P &amp;lt; .001). The use of 3.5-mm screws and increased time from implantation to removal are associated with higher rates of screw breakage during HWR following PAO. The use of 4.5-mm screws and earlier time to removal (less than 12 months) both decrease the probability of breakage.

Surgical Treatment and Outcomes of Trans-Ulnar Basal Coronoid Fracture-Dislocations

Trans-ulnar fracture-dislocations of the elbow are complex injuries that can be difficult to classify and treat. Trans-ulnar basal coronoid injuries, in which the coronoid is not attached to either the olecranon or the metaphysis, present substantial challenges to achieve anatomic reduction and stable internal fixation. The purpose of this study was to analyze the outcome of surgical treatment of trans-ulnar basal coronoid fracture-dislocations. Between 2002 and 2019, 32 consecutive trans-ulnar basal coronoid fracture-dislocations underwent open reduction and internal fixation (ORIF) at our institution. Four elbows were lost to follow-up within the first 6 months after surgery and were excluded. Among the 28 elbows remaining, there were 13 females and 15 males with a mean age of 56 (range 28-78) years at the time of injury. The mean clinical and radiographic follow-up times were 37 months and 29 months, respectively. Radiographs were reviewed to determine rates of union, Hastings and Graham heterotopic ossification (HO) grade, and Broberg and Morrey arthritis grade. Union occurred in 25 elbows. Union could not be determined for 1 elbow at most recent follow-up and the remaining 2 elbows developed nonunion of the coronoid. Complications occurred in 10 elbows (36%): deep infection (4), ulnar neuropathy (2), elbow contracture (2), and nonunion (2). There were reoperations in 11 elbows (39%): irrigation and débridement with hardware removal (4), hardware removal (2), ulnar nerve transposition (2), contracture release with HO removal (2), and revision ORIF with iliac crest autograft (1). At most recent follow-up, the mean flexion-extension arc was 106° (range 10-150°), and the mean pronation-supination arc was 137° (range 0-170°). The mean Quick Disabilities of Arm, Shoulder, and Hand score was 11 (range 0-39) points with a mean Single Assessment Numeric Evaluation-Elbow score of 81 (range 55-100) points. At final radiographic follow-up, 16 elbows (57%) had HO (8 class I and 8 class II), and 20 elbows (71%) had arthritis (8 grade 1, 6 grade 2, and 6 grade 3). Trans-ulnar basal coronoid fracture dislocations are severe injuries associated with high rates of reoperation, heterotopic ossification, and post-traumatic arthritis. However, the majority of elbows achieve union, a functional range of motion, and reasonable patient reported outcome measures. Over the study period, surgeons were more likely to utilize multiple deep approaches and separate fixation of the coronoid (either with lag screws or anteromedial plates) to ensure anatomic reduction.

Computer-Aided Design and Manufacturing in Free Fibula Reconstruction of the Mandible: Comparison of Long-Term Outcomes with the Conventional Technique.

Pre-operative computer-aided design and manufacturing (CAD/CAM) revolutionized head and neck reconstruction after extirpative surgery. However, studies performing head-to-head comparison to the conventional technique have limited long-term follow-up. We aimed to compare short and long-term outcomes between conventional and CAD/CAM approaches for mandibular reconstruction with free fibula flaps. Patients undergoing free flap reconstruction from 2012 to 2021 were included. Data regarding patient demographics, past medical history, surgical details, complications, and reconstructive outcomes were collected. Patients who had CAD/CAM were compared with the patients who underwent reconstruction with the conventional technique. The cumulative incidence of hardware maintenance was displayed using the Kaplan-Meier method. A total of 215 patients (n=79 conventional, n=136 CAD/CAM) were included. Both cohorts had similar demographics except the CAD/CAM cohort was younger (p=0.043). The mean operative duration was 54 minutes shorter with the use of CAD/CAM (p=0.014). Total and partial flap loss rates were similar. Patients with CAD/CAM had significantly lower rates of early wound dehiscence (p=0.037). Median [interquartile range] follow-up duration was similar (931 [1854] days in conventional vs 728 [841] days in CAD/CAM, p=0.084). After excluding patients with major surgical complications in the first 30-days, CAD/CAM cohort had a lower hardware removal rate (28.8% vs 13.9%, p=0.011). The significance persisted after including only the patients with more than 2 years of follow-up. The use of preoperative CAD/CAM may reduce operative duration, while allowing for longer maintenance of hardware with reduced removal rates due to complications.

Hardware Removal After Lisfranc ORIF Results in Improved Physical Function.

The purpose of this study was to investigate whether HWR after Lisfranc ORIF resulted in significant impact via PROMIS physical function (PF) and pain intensity (PI) scores. Design: Retrospective cohort. Level-1 trauma center. Adult patients with isolated Lisfranc injuries who were treated via ORIF between 2002-2023 that had PROMIS PF and PI scores through 6 months follow-up were included. Patients were excluded if they received index treatment other than ORIF or underwent secondary surgical intervention prior to HWR. A sub analysis was performed at 1 year follow- up. Primary outcomes were PROMIS PF and PI scores. The Wilcoxon signed-rank test compared differences between PROMIS scores within the HWR group. The Wilcoxon ranked-sum test compared differences between HWR vs no HWR. Distributive MCID was calculated using the 0.5 SD method. There were 482 patients (489 feet) identified with isolated Lisfranc injuries. Seventy-seven feet underwent ORIF followed by HWR. Thirty feet underwent ORIF without HWR. The average age of the no HWR group was 45.8 (18.0-81.3) versus the HWR group which was 38.7 (18.3-74.1) (p=0.053). Nineteen (63.3%) were female in the no HWR group compared to 33 (42.9%) in the HWR group (p=0.084). HWR occurred an average of 4.43 months after ORIF. Patients who underwent HWR had a statistically significant increase in average PF scores (39.7 to 45.9, p<0.001) at their standard 6 week (1.5 month) postoperative visit. HWR patients had a non-significant decrease in average PI scores (56.5 to 53.9, p=0.24). Compared to those with retained hardware, the HWR group demonstrated a statistically significant net improvement in PF and PI scores from surgery, with an average improvement of 5.6 and 1.7, respectively (P=0.002, 0.008). Patients experienced significant improvement in PROMIS PF scores for Lisfranc ORIF at 6 weeks after HWR. Compared to patients with retained hardware, they also experienced significant improvement in PROMIS PF and PI scores. III.

Comparative analysis of two double-plate fixation techniques for intercondylar fractures of the distal humerus

This study was aimed to compare the clinical and radiographic outcomes of patients with intercondylar fractures of the humerus treated with orthogonal and parallel plating methods via precontoured plates. This was a retrospective comparative study conducted on 50 adult patients with intercondylar humerus fractures that were surgically treated over an eleven-year period. The patients were divided into two groups: Group A underwent internal fixation via parallel plating, whereas Group B received orthogonal plating. Clinical outcomes were evaluated via the Mayo Elbow Performance Score (MEPS), and the radiographic assessments included time to consolidation, pseudoarthrosis, malunion and hardware removal. Both groups presented similar demographic and preoperative characteristics. The functional outcomes assessed by the MEPS were not significantly different between the groups. Radiographically, comparable healing times and rates of complications, including pseudoarthrosis, malunion and hardware removal, were observed. The study findings suggest that both orthogonal and parallel plating methods yield comparable clinical and radiographic outcomes in the treatment of intercondylar humerus fractures. These results underscore the effectiveness of both techniques and emphasize the importance of further research to elucidate the optimal plating method for specific fracture patterns.

Primary Arthrodesis or Open Reduction and Internal Fixation for Lisfranc Injuries: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Lisfranc injuries are often managed surgically with primary arthrodesis (PA) or open reduction and internal fixation (ORIF); however, neither approach has been shown to be superior. This systematic review and meta-analysis assessed randomized controlled trials (RCTs) to compare the functional and surgical outcomes of PA and ORIF in the treatment of Lisfranc injuries. This study was performed as per the PRISMA protocol. Database searches were conducted on Cochrane, Embase, and PubMed libraries. Five RCTs were identified for inclusion involving 241 patients, of which 121 underwent PA and 120 underwent ORIF. Statistically significant differences in visual analog scale pain score at 2 years (mean difference 0.89, 95% CI 0.18-1.59), patient satisfaction (OR 10.04, 95% CI 1.78-56.76), and all-cause return to surgery (OR 27.31, 95% CI 12.72-58.63) were observed, all favoring PA. There were no statistically significant differences between PA and ORIF with regard to American Orthopaedic Foot & Ankle Society midfoot scores at 2 years, 36-Item Short Form Health Survey (SF-36) scores, and unplanned return to surgery. This study showed significant improvement in pain at 2 years, patient satisfaction, and all-cause return to surgery favoring PA in all instances. Given ORIF often necessitates a second operation for hardware removal, it is to be expected that all-cause return to surgery is higher in ORIF groups. Overall, these results do not have the power to confer an advantage to a particular approach because of significant heterogeneity. Further studies should focus on larger patient cohorts and longer follow-up, or analysis stratified by patient demographics and injury presentation. In the absence of clinically significant differences, cost-benefit analyses should be considered to answer the question of whether to "fix or fuse" for Lisfranc injuries.

Comparison of Clinical and Radiographic Outcomes Between Solid Headless and Headed Screws in the Treatment of Zone II and III Fifth Metatarsal Fractures in Elite Athletes

Background: Zone II and III fifth metatarsal (5-MT) fractures among athletes are typically managed with percutaneous fixation following anatomic reduction. However, screw head discomfort and refracture after bone union can occur because of the loads placed on the foot during play. Several hardware systems that use a smaller screw head compared to traditional hardware systems have been developed to minimize the rate of postoperative hardware complications. This study compares clinical and radiographic outcomes of 5-MT fractures in elite athletes treated with a solid headless screw vs a solid headed screw. We hypothesized that the headless screw would be associated with faster union rates, faster clearance times, and lower incidence of symptomatic hardware compared to the headed screw. Methods: Athletes competing at a collegiate level or higher treated for a zone II or III 5-MT fracture between 2016 and 2022 by 2 surgeons fellowship-trained in foot and ankle orthopaedics were screened. Operative notes were reviewed to determine the hardware system used. Subjects were divided based on the hardware system used during operation: headed screw and headless screw. Time to radiographic union, time to full clearance, and return to competition were determined. Postoperative complications, including nonunions, need for revision, need for hardware removal, and refractures were also noted. Results: Forty eligible patients (44 feet) were identified. The solid headed screw group included 20 patients (21 fractures), and the solid headless screw group included 20 patients (23 fractures). Average time to union for the headed screw group was 11.78 (range, 5.86-19.00) weeks; average time to union for the headless screw group was 11.65 (range, 6.00-22.57) weeks ( P = .93). Nineteen out of twenty (95%) patients were able to return to competition in both groups. Average time to return to competition for the headed screw group was 26.9 (range, 10.00-47.86) weeks, while average time for the headless screw group was 21.2 (range, 6.86-55.00) weeks ( P = .55). The overall complication rate for the headed screw was 23.8%, which was not statistically different from the overall complication rate for the headless screw of 13.0% ( P = .35). Conclusion: In this relatively small sample of elite athletes undergoing operative fixation of a 5-MT fracture, fixation using either a headless or headed screw system had similar good outcomes in regard to times to union, return to competition, and complication rate regardless of solid screw head type used. Level of Evidence: Level III, retrospective cohort study.

Two versus three magnesium screws for osteosynthesis of mandibular condylar head fractures: a finite element analysis

ObjectivesPrevious finite element analyses (FEA) have shown promising results for using two titanium screws in treating mandibular condylar head fractures but limited mechanical stability of a two-screw osteosynthesis with magnesium screws. Given the potential benefits of magnesium screws in terms of biocompatibility and resorption, this study aimed to compare two- and three-screw osteosynthesis solutions for a right condylar head fracture (AO CMF type p) with magnesium screws with a FEA.Materials and methodsA previously validated finite element model simulating a 350 N bite on the contralateral molars was used to analyze von Mises stress within the screws, fragment deformation, and fracture displacement. All screws were modeled with uniform geometric specifications mirroring the design of Medartis MODUS® Mandible Hexadrive cortical screws.ResultsThe three-screw configuration demonstrated lower values for all three parameters compared to the two-screw scenario. There was a 30% reduction in maximum von Mises stress for the top screw and a 46% reduction for the bottom screw.ConclusionsFracture treatment with three magnesium screws could be a valuable and sufficiently stable alternative to the established treatment with titanium screws. Further studies on screw geometry could help improve material stability under mechanical loading, enhancing the performance of magnesium screws in clinical applications.Clinical relevanceThe use of magnesium screws for osteosynthesis of mandibular condylar head fractures offers the benefit of reducing the need for second surgery for hardware removal. Clinical data is needed to determine whether the advantages of resorbable screw materials outweigh potential drawbacks in condylar head fracture treatment.

Minimally Invasive vs Open First Ray Dorsiflexion Osteotomy: Radiographic Outcomes and Early Complications Report.

There is limited literature comparing open and minimally invasive surgical (MIS) techniques for first ray dorsiflexion osteotomy (DFO). This study is the first of its kind to report early healing and complication rates of patients undergoing MIS vs open first ray DFO. A retrospective cohort review of 28 patients who underwent a first ray DFO procedure at an academic medical center between 2015 and 2024 was conducted. Demographic factors and medical comorbidities were recorded. Radiologic parameters were measured along with healing. Postoperative healing and outcomes were identified through medical record review. Thirteen open and 15 MIS DFO procedures were performed. At follow-up, all osteotomies were healed with no wound or infection complications. There was no significant difference in hardware removal rates, 7.7% for open and 6.7% for MIS. The change in lateral Meary angle was 10.5 ± 3.9 and 9.7 ± 4.3 for the open and MIS groups, respectively (P = .61). The calculated dorsal closing wedge resection was 3.5 mm and 4.1 mm for open and MIS, respectively (P = .26). This study showed no significant differences in healing or complication rates in the short term between MIS and open surgery, with comparable magnitude of correction, suggesting similar ability for the MIS technique to correct first ray alignment. Further studies are needed to determine long-term outcomes.

A simple modified technique for screw fixation of displaced intra-articular calcaneus fracture through a sinus tarsi approach: a comparison with plate fixation

BackgroundPlates and screws are frequently used for the fixation of displaced intra-articular calcaneus fracture (DIACF). In this study, we compared the outcomes of a modified screw fixation technique with plate fixation via a sinus tarsi approach (STA).MethodsA series of 187 DIACF patients who were treated via an STA using a plate fixation (n = 81) or a screw fixation (n = 106) were included. Screw fixation was done with two 2.7 mm screws and two 6.5 mm cannulated screws. Outcomes were evaluated radiographically and clinically. Clinical evaluations included pain assessment by Visual Analogue Scale (VAS) and functional assessment by the American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire and Foot Function Index (FFI).ResultsThe mean final VAS was smaller in the screw group (P = 0.01). The mean AOFAS and FFI scores were not significantly different between the two groups (P = 0.17 and P = 0. 19, respectively). The mean improvement of Bohler’s angle, but not the Gissane’s angle, was significantly greater in the screw group (P = 0.014 and P = 0.09, respectively). The mean improvement of calcaneal length and height were not significantly different between the two groups (P = 0.78 and P = 0.22, respectively). The hardware removal rate was 14.8% in the plate group and 3.8% in the screw group (P = 0.007).ConclusionThe modified screw fixation method provides lower pain, better radiographic outcome, and lower rate of hardware removal compared to plate fixation in the treatment of DIACF.

Revision rate of displaced femoral neck fractures in non-elderly adults: a retrospective comparative study of the femoral neck system and cannulated screws

BackgroundDisplaced femoral neck fractures are associated with a high revision rate. The new femoral neck system(FNS) offers advantages in fixation stability, potentially reducing the need for revision. The purpose of this study was to compare the revision rate of patients with different reduction quality treated with the FNS and cannulated screws (CS).MethodsThis retrospective study included patients with Garden III or IV femoral neck fractures who underwent osteosynthesis in a level 1 trauma center between July 2019 and June 2023. A total of 141 cases met the inclusion criteria and received treatment with either the FNS (N = 65) or CS (N = 76). The quality of fracture reduction, surgical complications (such as femoral neck shortening, avascular necrosis of femoral head, nonunion of fracture, implant failure and withdrawal), revision surgery and the reasons for revision were analyzed.ResultsThe mean age of the 141 cases was 52.0 years (range 18–65); with sixty-five cases being male (46.1%). Eighty-four fractures (59.6%) were classified as Garden type III. Reduction quality was good in 71 cases (50.4%) and fair in 70 cases. The mean follow-up period was 25.9 months (range 12–46). A total of 26 cases(18.4%) underwent revision surgery. The revision rate in cases with good reduction was 11.3% (8/71 cases), with seven cases (four hardware removal and three arthroplasty) in the CS group and one case (arthroplasty for fracture nonunion and implant failure) in the FNS group, a significant difference was found between the two groups(P = 0.041). Among the 18 cases (25.7%, 18/70) with fair reduction who underwent revision surgery, nine cases (six hardware removal and three arthroplasty) in the CS group, and nine cases (arthroplasty for implant failure and cut-out) in the FNS group, and there was no significant difference between the two groups (P = 0.672). The total revision rate between the FNS group (15.4%, 10/65) and the CS group (21.1%, 16/76) was not significantly different (P = 0.387).ConclusionsThe total revision rate between the FNS and CS group showed no difference. However, in cases with good reduction, the revision rate was lower in the FNS group compared to the CS group.

Hybrid Fixation for Large Unstable Juvenile Osteochondritis Dissecans Lesions: Midterm Results in Adolescent Patients With Completely or Partially Salvageable Progeny Fragment.

This study aimed to describe the midterm clinical and radiographic outcomes of a hybrid fixation technique (HFT) combining interfragmentary compression with screws and biological support provided by the osteochondral autograft transplantation system (OATS) for treating large unstable juvenile osteochondritis dissecans (JOCD) lesions involving the knee in patients aged ≤18 years. Thirteen patients (15 knees, 9 males) with unstable JOCD lesions in the knee underwent treatment. HFT was indicated for lesions that had a completely salvageable (N=10) or partially salvageable progeny fragment (N=5). Patients were evaluated at a minimum follow-up of 1 year. The mean age of the patients was 15.3 years (range, 11 to 18y), with 10 lesions involving the medial femoral condyle and 5 involving the lateral femoral condyle. The mean lesion area were 397.7mm2. The outcome measures included the Pedi-IKDC and Tegner activity scales. Radiographic evaluation consisted of assessing osteochondral graft integration using the MOCART score on MRI and determining the degree of osteoarthritis using the Kellgren-Lawrence system (KL). At a mean follow-up of 51 months (range, 12 to 143mo), the mean Pedi-IKDC and Tegner activity scale were 90.1±7.2 and 94.7±6.7 points, respectively. Patients with unilateral lesions resumed sports activities on average after 7.7 months (range, 6 to 12mo). All patients exhibited progeny fragment integration on MRI, with a mean MOCART score of 85±6.5 (range, 75 to 95). Radiographs indicated grade 1 KL joint space in 13 knees and grade 2 in 2 knees. At the last follow-up, 12 patients were asymptomatic, whereas 1 patient experienced occasional mild discomfort during intense physical activity. Six patients required additional surgery for hardware removal, and 1 patient underwent intra-articular loose body removal. The hybrid fixation technique showed promising outcomes in terms of fragment healing and midterm results for unstable JOCD lesions. These findings suggest that HFT can be considered a valid treatment option for large unstable lesions involving the femoral condyles of the knee in adolescents. Therapeutic study (level of evidence IV).

Investigating Surgical Removal of Plates and Screws in Patients with Maxillofacial Trauma

BACKGROUND The removal of plates and screws in maxillofacial surgery following trauma has emerged as a significant concern. Understanding the primary reasons for hardware removal is crucial to enhance patient outcomes and reduce postoperative complications. METHODS This retrospective cohort study investigated 109 patients who underwent plate and screw fixation at Shahid Rahnemoun Hospital (Yazd, Iran) from 2011 to 2021. The study included 109 patients who met the inclusion criteria. The primary outcome was to identify and classify the causes necessitating plate and screw removal, which were categorized into four main groups: Pain, Complications, Procedural Problems, and Patient-Initiated Factors. Descriptive statistics were used to summarize the data. One-way analysis of variance and Chi-square or Fisher's exact tests were employed to analyze the associations between variables. RESULTS The study population was predominantly male (74.3%), with a mean age of 35.25 ±19.47 years. The time between plate and screw insertion and removal ranged from 14 days to 3 years, while this interval in most of the patients (51.4%) was between six months to one year. The primary reasons for hardware removal were patient-initiated factors (51.4%), followed by procedural problems (24.8%), complications (11.9%), and removals due to pain (11.9%). Except for age, other studied variables were not significantly associated with the removal cause. CONCLUSIONS The high prevalence of patient-initiated removals highlights the importance of considering individual preferences and psychological factors in surgical planning. The study emphasizes the need for age-specific considerations and a focus on preventative strategies to reduce infection-related complications.

A Single-Surgeon 35-Year Experience With ACL Reconstruction Using Patellar Tendon Auto- and Allografts With the Transtibial Technique.

Long-term follow-up for anterior cruciate ligament reconstruction (ACLR) is limited due to heterogeneity in the number of techniques utilized, the number of surgeons included, and attrition bias. To analyze a single surgeon's 35-year experience with ACLR using the transtibial technique, with an emphasis on temporal trends in graft selection and subanalyses on rates of revision surgery, contralateral ACLR, and nonrevision reoperation among different demographic cohorts of patients. Case series; Level of evidence, 4. All patients who underwent arthroscopically assisted single-bundle ACLR between 1986 and 2021 were identified from a prospectively maintained single-surgeon registry. Outcomes of interest included revision, reoperation, and contralateral rupture rates. A total of 2915 ACLRs were performed during the senior surgeon's career. The mean age for primary ACLR was 29.4 ± 14.8 years. During primary ACLR, 98.4% of patients received a central-third bone-patellar tendon-bone (BPTB) graft. Increasing patient age was associated with increasing allograft usage (P < .01), with a significant temporal increase in allograft usage over the senior surgeon's career (P < .01). There was a higher revision rate among younger patients (P < .01), female patients aged 21 to 25 years (P = .01), and patients who received an allograft during the primary procedure (P = .04). The contralateral rupture rate showed no difference between sexes (P = .34); however, patients who underwent ACLR with autograft had a greater rate of contralateral injury compared with those with allograft (P < .01). The contralateral rupture rate was greater than the revision rate (P < .01). The most common causes of nonrevision reoperation were failed meniscal repair, new meniscal tears, arthrofibrosis, and painful hardware removal. The findings of this single-surgeon registry reveal temporal trends in ACLR over a 35-year career. There was a trend toward increasing BPTB allograft use in ACLR, especially in older patients and revision cases. A greater revision rate was observed among younger patients, female patients, and those receiving allografts during primary surgery. Contralateral ACLR was more common than revision surgery.

Distal Radius Osteotomies for Kienbock's Disease—A Minimally Invasive Approach

Abstract Background Negative ulnar variance is a recognized predisposing factor for Kienbock's disease (KD). Radial shortening osteotomy (RSO) reduces radial height, thereby alleviating stress on the lunate. Conversely, radial closed wedge osteotomy (RCWO) involves removing a distal radius wedge to not only decrease radial height but also reduce radial inclination, thereby enhancing lunate coverage. Description This article outlines a straightforward and minimally invasive approach to RSO utilizing a single cut and stabilization with a single screw. Additionally, it introduces a technique for RCWO comprising two cuts, wedge removal from the distal radius, and fixation using a single headless screw. Literature Review Traditionally, RSO and RCWO procedures include a volar approach consistent with distal radius fracture fixation techniques. However, the reliance on “free-hand” cuts may necessitate larger hardware for stabilization. Overcorrection poses risks of suboptimal outcomes and often mandates subsequent hardware removal procedures. Clinical Relevance Both RSO and RCWO techniques offer minimally invasive solutions, which preserve the periosteum, and maintain stability. These techniques only require a single screw and a removable splint. RSO is indicated for KD wrists with negative ulnar variance, while RCWO is preferable for cases with negative ulnar variance and increased radial inclination.

Microbiological Profile of Instrumented Spinal Infections: 10-Year Study at a French Spine Center.

The objective was to compare the microbiological characteristics and treatment of early and late surgical site infections (SSIs) in instrumented spinal surgery. Those patients admitted for SSIs in a single center between January 2010 and December 2022 were included. The subjects were divided into early (eSSIs) and late (lSSIs) SSIs, and demographic, microbiological, treatment, and follow-up data were collected. Instrumented spinal surgery was performed in 2136 patients. Ninety-six cases of infections were identified (prevalence = 4.5%), with 47.9% eSSIs and 52.1% lSSIs. In 58.7% of the cases, the eSSIs were monomicrobial: Staphylococcus aureus (37%) and Enterobacterales (33.3%) were the main bacteria involved. In 66% of the cases, the lSSIs, were monomicrobial: Cutibacterium acnes (30.3%) and staphylococci were predominant. Enterobacterales were isolated in more than 70% of the polymicrobial samples in both the eSSIs and lSSIs. The treatment of the eSSIs mostly consisted of lavage-debridement surgery associated with antibiotic treatment, while the treatment of the lSSIs combined hardware removal or replacement and long-duration antibiotic treatment. A negative outcome was observed in 17.1% of the eSSIs and 5.7% of the lSSIs. Enterobacterales were associated with negative outcomes of eSSIs. Enterobacterales were found in most of the polymicrobial infections regardless of the time of infection onset. Further large studies should be conducted to precisely determine the management and prevention regarding the increasing Gram-negative bacteria SSIs.

Good 5-year results and a low redislocation rate using an á la carte treatment algorithm for patellofemoral instability in patients with severe trochlea dysplasia.

Trochlear dysplasia is a major risk factor for recurrent patellar instability, reduced quality of lifeand osteoarthritis of the patellofemoral joint. Patellar instability in patients with trochlear dysplasia can be treated by trochleoplasty, usually in combination with medial patellofemoral ligament reconstruction (MPFL-R). An á la carte treatment algorithm, which also addresses patella alta, lateralisation of the tibial tuberosityand valgus or torsional malalignment when present has been standard in one clinic for treatment of patellar instability patients since 2009, based on the hypothesis that it results in optimal subjective and clinical outcome, normalisation of the lateral trochlea inclination (LTI) angle and a low rate of patellar redislocation. This prospective study reports the 5-year results for consecutive patients with high-grade trochlea dysplasia operated according to the algorithm 2010-2017, evaluated preoperatively and 1, 2and 5 years postoperatively. Clinical information on previous surgery and postoperative patellar stability, range-of-motion (ROM)and subsequent surgery were registered. Subjective outcome was evaluated by four patient-reported outcome measures (PROMs): Kujala, Lysholm, International Knee Documentation Committee and Knee injury and Osteoarthritis Outcome Score. The LTI angle was measured pre- and postoperatively on magnetic resonance imaging scans. There were 131 patients (87 females) with a median age of 22 years (range: 14-38). All had a trochleoplasty and an MPFL-R. Additional procedures (tibial tuberosity medialisation/distalisation and/or femoral/tibial osteotomy) were performed in 52%. All PROM scores improved from preoperatively to 1-year follow-up with further improvement at 2 and 5 years after surgery (p < 0.05). Three patients (2%) had a traumatic patellar dislocation 9, 12and 24 months postoperativelyand 38% underwent subsequent surgery (hardware removal, arthroscopically assisted brisement force, knee arthroscopy). A normalisation of the LTI angle (≥11°) was achieved in 76%. Treatment according to the à la carte algorithm for patients with patellar instability and high-grade trochlear dysplasia resulted in significant clinical and subjective improvement in all PROM scores and a very low redislocation rate (2%) 5years after surgery. Level II.

Open management of condylar head fractures. The first 50 cases: What have we learnt and where are we going?

This study evaluates a single surgeon’s experience in the development of a practice in open treatment of intracapsular condylar fractures over three years at a tertiary maxillofacial trauma centre. An enhanced dynamic, peer-reviewed, longitudinal audit in keeping with the adoption of elements of new clinical practice was instituted. This aimed to record and analyse clinical and functional outcomes at both the surgeon and patient level. A retrospective review of patients treated for AO craniomaxillofacial (AOCMF)-classified intracapsular fractures was conducted, utilising an extended preauricular approach and positional screw fixation with an emphasis on early joint mobilisation and physiotherapy. The cohort consisted of 45 patients with 50 fractures, exhibiting a mean postoperative mouth opening of 32 mm, which increased over time and was noted to be statistically significant. Patient satisfaction was high, and the majority of radiological outcomes were deemed anatomical. No patients had permanent facial nerve injuries. Other postoperative complications were minimal, including one case of Frey syndrome and a 16% re-intervention rate, primarily for hardware removal. The findings suggest that open treatment can achieve satisfactory early function as part of the implementation of an in-part novel procedure. This paper provides insight into the establishment of a new technique in both experiential and governance domains, and looks at the lessons learned. The high levels of patient and surgeon satisfaction confirm increasing levels of evidence supporting open reduction and fixation in these challenging injuries, but the study’s limitations include the absence of a control group and potential non- generalisability due to the single-surgeon perspective. The study highlights the need to support colleagues providing this treatment and establish a national mentoring programme to achieve it. At this point, long-term studies and a multicentre trial are suggested for a comprehensive understanding of the treatment’s efficacy and the formal development of management protocols.

Factors Associated With Reoperation After Distal Radius Nonunion Repair

This study aimed to evaluate the incidence of, and factors associated with, reoperation after distal radius nonunion repair. We conducted a retrospective cohort study at a multicenter academic institution and identified adult patients who underwent open reduction and internal fixation for distal radius nonunion between January 2005 and August 2021. Thirty-three patients were included in this study. The cohort consisted of 13 males (13/33) and had a median age of 56 years (interquartile ranges: 49-64). Median follow-up was 59 months (interquartile ranges: 23-126). Unplanned reoperations occurred in eight of 33 patients. The most common reasons for reoperation were irrigation and debridement for infection, revision surgery for persistent nonunion, and unplanned hardware removal. In total, 10 complications occurred in nine patients. The most common complications were infection and persistent nonunion; both occurred in three cases. Complications after distal radius nonunion repair are common. Reoperation after distal radius nonunion repair is required in approximately one of four cases. Prognosis IV.