Hardware Removal Research Articles

The Association Between Social Determinants of Health and Distal Radius Fracture Outcomes

The purpose of this study was to determine if adverse social determinants of health (SDOH) are associated with differential complication rates following surgical fixation of distal radius fractures and assess which SDOH domain (economic, educational, social, health care, or environmental) is most associated with postoperative complications. Using a national administrative claims database, we conducted a retrospective cohort analysis of patients undergoing open treatment for an isolated distal radius fracture between 2010 and 2020. Patients were stratified based on the presence/absence of at least one SDOH code and propensity score matched to create two cohorts balanced by age, sex (male or female), insurance type, and comorbidities. Social determinants of health examined included economic, educational, social, health care, and environmental factors. Multivariable logistic regression analyses were performed to assess the isolated effect of SDOH on 90-day and 1-year complication rates. After propensity matching, 57,025 patients in the adverse SDOH cohort and 57,025 patients in the control cohort were included. Patients facing an adverse SDOH were significantly more likely to experience 90-day complications, including emergency department visits (Odds ratio (OR): 3.18 [95% confidence interval (CI): 3.07-3.29]), infection (OR: 2.37 [95% CI: 2.12-2.66]), wound dehiscence (OR: 2.06 [95% CI: 1.72-2.49]), and 1-year complications, including complex regional pain syndrome (OR: 1.35 [95% CI: 1.15-1.58]), malunion/nonunion (OR: 1.18 [95% CI: 1.08-1.29]), and hardware removal (OR: 1.13 [95% CI: 1.07-1.20]). Additionally, patients facing an adverse SDOH had a significantly increased risk of 90-day complications, regardless of fracture severity, and patients with economic and social challenges had the highest odds of both 90-day and 1-year postoperative complications. Social determinants of health are associated with increased complications following distal radius fracture fixation, even when controlling for demographic and clinical factors. We recommend routine screening for adverse SDOH and inclusion of SDOH data into health records to not only inform quality improvement initiatives and risk adjustment for outcome-based quality measurements but also to allow providers to begin to discuss and address such barriers during the perioperative period. Prognosis II.

Hardware removal is a must with endocarditis.

Hardware removal is a must with endocarditis.

Factors Associated with Return to Sport After Anterior Cruciate Ligament Reconstruction: A Focus on Athletes Who Desire Preinjury Level of Sport.

In most previous studies investigating return to preinjury level of sport (RTPS) after anterior cruciate ligament reconstruction (ACLR), whether patients continue aiming for RTPS not only before but also after ACLR was unclear because environmental and social factors were not considered. Herein, we aimed to evaluate factors associated with RTPS among athletes who desired to achieve RTPS even after ACLR, excluding patients who no longer desire this goal owing to environmental and social factors. Ninety-two patients who underwent primary double-bundle ACLR with a minimum 2-year follow-up and desired to achieve RTPS before surgery were retrospectively enrolled. Twelve (13%) patients who no longer desired to achieve RTPS after ACLR owing to environmental and social factors were excluded. Sixty-nine patients were included in the final cohort. At the final follow-up, the patients were split into two groups: those who achieved (R group) or did not achieve (N group) RTPS based on patient self-assessment. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and Lysholm scores were also determined. The anterior tibial translation in the Lachman test and acceleration and external rotational angular velocity (ERAV) in the pivot shift test were measured at the hardware removal operation. Significant differences were observed for preinjury level of sports between the groups (p < 0.05). The rate of RTPS in competitive athletes was lower than that in recreational athletes (20/46: 43% vs. 16/22: 73%; p =.037). Lysholm score, KOOS symptom, pain, and quality of life showed higher values in the R group than in the N group (p < 0.050). Acceleration was significantly lower in the R group than in the N group (p = 0.028). Competitive level of sports is a risk factor for failure to achieve RTPS. The postoperative functional outcomes in the group that achieved RTPS showed more favorable results. These results provide important information to enable the surgeons to consider the appropriate surgical plan for competitive athletes who desire to achieve RTPS after ACLR.

Low Rates of Hardware Removal and Tendon Rupture for the Acu-Loc 2 Volar Distal Radius Plate: A Minimum One-Year Follow-Up Study.

Volar locking plates designed for far distal radius fracture fixation can have a significant hardware removal rate and risk of tendon rupture.Plate design has a role in the rate of complications. This study assessed the hardware removal and tendon rupture rate of the Acu-Loc 2 volar distal radius (VDR) plate often used in the treatment of far distal radial fractures. We searched our electronic healthcare records system for all patients who had undergone fixation with an Acu-Loc 2 VDR plate (Acumed, Hillsboro, OR, USA) at a tertiary center between January 2017 and December 2021. Patients were excluded if their follow-up time was less than one year or if they could not be contacted by telephone follow-up. Pre-operative radiographs were examined for fracture classification. Follow-up time was defined as the last contact in the clinic or by telephone. A total of 92 patients underwent an open reduction and internal fixation (ORIF) with an Acu-Loc 2 VDR plate. A total of 85 patients met the inclusion criteria for this study. Our cohort included 33 males (38.8%) and 52 females (61.2%). The mean age was 50 years. Twenty-seven fractures (31.0%) were extra-articular, and 60 fractures (69.0%) were intra-articular. The mean follow-up time for the patients was 593.3 days (range 369 to 1185 days).Four patients (4.7%) had their hardware removed. Three (3.5%) patients underwent removal due to tendon irritation and one patient (1.2%) due to a peri-prosthetic fracture around the plate. There were no tendon ruptures recorded. The Acu-Loc 2 VDR plate had a low medium-term hardware removal rate and no tendon ruptures. These rates are lower than would be expected when compared with other far distal plate designs.

Risk of Acute Compartment Syndrome in Pediatric Patients With Tibial Tubercle Avulsion Fractures: A Retrospective Review.

Tibial tubercle avulsion fractures (TTAFs) represent 0.4% to 2.7% of pediatric physeal injuries. These injuries are thought to confer a risk of acute compartment syndrome (ACS), and these patients are often admitted for compartment monitoring and, in many cases, undergo prophylactic fasciotomy. This study sought to review our institution's experience with TTAF and associated compartment syndrome in pediatric patients. All patients aged 8 to 18 years with TTAF at our institution from January 1, 2017 to January 1, 2023 were retrospectively reviewed. Patient demographics, injury mechanism, fracture morphology, and postinjury course were reviewed. ACS was diagnosed by clinical exam or necessitating therapeutic compartment fasciotomy. A total of 49 TTAFs in 47 patients were included in the final analysis. The mean age was 14.5 ± 1.2 years (range: 11 to 17), and males were significantly older than females (14.6 ± 1.1 vs 13.3 ± 1.3 y, P = 0.01). The average body mass index was 27.1 ± 7.0, and males had a significantly lower body mass index than females (26.3 ± 6.5 vs 34.1 ± 8.5, P = 0.03). Basketball was the most common mechanism of injury (49%), followed by soccer (13%), football (11%), trampoline (6%), fall (6%), jumping (4%), lacrosse (4%), running (4%), and softball (2%). The Ogden fracture types were as follows: I: 10%; II: 16%; III: 41%; IV: 24%; V: 8%. Thirty-four patients (69%) were admitted to the hospital for at least one night after presentation. Forty-six (96%) underwent surgical fixation an average of 3.5 days after injury. No patients developed ACS during their post-injury or postoperative course. Three patients underwent the removal of hardware. No other complications were observed. The average follow-up duration was 238 days. The results of this study suggest that the risk of ACS in pediatric patients with TTAF may be small enough to allow for same-day discharge after diagnosis or operative management in patients deemed to be sufficiently low risk by clinical judgment. Level III-retrospective comparative study.

Syndesmotic fixation in Weber B ankle fractures: A systematic review.

Weber Type B fractures often arise from external rotation with the foot supinated or pronated. Altered tibiofibular joint kinematics in Weber B fractures are responsible for syndesmotic damage seen in Weber B fractures. Weber B fractures are managed using open reduction and internal fixation if displaced. The syndesmosis is injured in up to 40% of cases resulting in an unstable injury with a syndesmotic diastasis. This systematic review aimed to evaluate the current literature on syndesmotic fixation in Weber B fractures, assess the outcomes and complications of syndesmotic fixation and assess the necessity of syndesmotic fixation in Weber B fractures. A search was carried out on the EMBASE, PubMed and CINAHL databases and eight studies assessing the outcomes of syndesmotic fixations versus no syndesmotic fixation with 292 Weber B ankle fractures were included in this systematic review. Results showed significant heterogeneity so a narrative review was conducted. Results of these studies showed that functional, radiological, and quality-of-life outcomes and incidences of post-traumatic osteoarthritis in patients with syndesmotic screws were similar to those of patients not managed with syndesmotic screws. Only one favoured syndesmotic fixation in all cases of diastasis. As such, syndesmotic fixation with screws may not be necessary in the management of Weber B fractures. Screws are also associated with breakage, loosening, local irritation and infections. Suture button devices and antiglide fixation techniques appear to be valid alternatives to syndesmotic screws. It was found that there was no need for routine hardware removal unless the hardware was causing significant side effects for the patient.

Outcomes and complications of orthognathic surgery in older patients

PurposeSeveral studies have described the outcomes and complications following orthognathic surgery. However, the average patient age in these studies is 20–40 years. It is unclear whether results from these age groups can be extrapolated to older patients. MethodsThis retrospective observational study included 54 patients over 50 years of age, who underwent orthognathic surgery. From these patients’ medical records, we retrieved data regarding patient characteristics, surgery characteristics, outcomes, and complications. ResultsThe patients’ mean age was 56 years (range, 50–69 years), and mean ASA score was 2. A bad split occurred in one patient, and immediate postoperative complications occurred in two patients. There were no long-term sequelae. Neurosensory disturbances (NSD) occurred in 30 patients. Preoperative temporomandibular dysfunction (TMD) was present in 9 patients—among whom, five were cured after surgery. Four patients postoperatively developed de novo TMD. Hardware removal was performed in 22 patients. The mean length of stay was two days for monomaxillary procedures, and three days for bimaxillary procedures. ConclusionsThis study demonstrated apparent differences between patients over 50 years of age and the general orthognathic population. In particular, neurosensory disturbances and hardware removal were more prevalent in our study population.

Minimally invasive technique for acute fixation and subtalar fusion of displaced intra-articular calcaneus fractures.

Displaced intra-articular calcaneus fractures (DIACFs) are difficult injuries to treat and are often encountered by orthopedic surgeons. For DIACFs treated nonoperatively or with open reduction internal fixation (ORIF), a common complication is painful subtalar arthritis and the need for a secondary subtalar fusion, which prolongs the overall recovery time. One treatment option to address this sequela involves ORIF with subtalar fusion as the primary treatment. We describe a reproducible, minimally invasive surgical technique for primary ORIF with subtalar fusion when the calcaneal tuberosity is amendable to cannulated screw fixation to treat these complex calcaneal fractures. Our technique offers advantages compared to other techniques in that it avoids screw traffic, allows easy bony compression of the subtalar joint, and minimizes soft tissue damage via percutaneous screw fixation. Fourteen fractured calcanei in 12 patients underwent our technique and all achieved bony union with a median time to fusion of 107.5days (range, 54-530days). Eight patients returned to work with the remaining 4 patients having an unknown work status at last follow-up, although 2 of these 4 patients resumed normal activities. Only 1 patient experienced a complication, which was an infection after achieving bony union, and was treated with successful hardware removal and our infection protocol. Overall, we conclude our surgical technique offers a successful option in the treatment of DIACFs when the calcaneal tuberosity is amendable to cannulated screw fixation.

Acute anterior cruciate ligament rupture: can repair become an alternative to reconstruction: a meta-analysis of randomized controlled trials and cohort studies

PurposeTo perform a meta-analysis to compare clinical outcomes of anterior cruciate ligament (ACL) repair and ACL reconstruction for acute ACL rupture.MethodWe searched Pubmed, Embase, the Cochrane Library, and Web of Science databases to seek relevant studies. Clinical outcomes included failure rate, hardware removal rate, anteroposterior (AP) knee laxity, and patient-reported outcomes. In addition, subgroup analysis was carried out according to repair techniques, rupture locations, and study designs. Funnel plots were used to detect publication bias. All statistical analysis was performed using STATA (version 14.2, StataCorp).ResultsA total of 10 articles were included in this study, comprising 5 randomized controlled trials (RCTs) and 5 cohort studies, involving a total of 549 patients. We found no statistical differences between the ACL repair and ACL reconstruction in the following outcomes: failure rate, AP knee laxity, International Knee Documentation Committee (IKDC) score, Lysholm score, Knee Injury and Osteoarthritis Outcome (KOOS) Score, and Tegner score. However, the ACL repair group had a higher hardware removal rate. Except for AP knee laxity results on different repair techniques, there was no statistical difference in other subgroup analyses.ConclusionCompared with ACL reconstruction, ACL repair shows similar results in clinical outcomes, and it is promising to be an effective alternative treatment for acute ACL rupture. Larger samples and higher-quality studies are needed to support our results and further explore the advantages of ACL repair in other aspects.Level of evidenceLevel III.

Secondary Surgery Following Lapidus Bunionectomy

While the Lapidus bunionectomy is a common procedure utilized to address hallux valgus, the incidence of secondary surgery is not well established. Our primary goal was to determine the incidence of revision surgery and hardware removal following the Lapidus bunionectomy in addition to the risk factors associated with each. A retrospective nested case-control study of adult patients who underwent a Lapidus bunionectomy for symptomatic hallux valgus over a 9-year period was performed. The incidence rates and 95% confidence intervals (CI) of secondary surgery in the 3 years following the procedure along with the estimated independent associations and odds ratios between baseline demographic, clinical, and radiographic characteristics were calculated. Of the original cohort of 2540 patients, 127 were identified (5.0%; CI: 4.1%, 5.8%) who underwent revision surgery and 165 (6.5%; CI: 5.5%, 7.5%) who underwent hardware removal following Lapidus bunionectomy. Initially, the hallux valgus angle, intermetatarsal angle, and tibial sesamoid position were risk factors for revision surgery. However, in adjusted analyses for revision surgery, using a screw for third point of fixation emerged as the only independent risk factor (odds ratio [OR] = 3.01; CI: 1.59, 5.69). In adjusted analyses for hardware removal, female sex (OR = 2.33; CI: 1.08, 5.00) and third point of fixation (OR = 2.92; CI: 1.82, 4.69) emerged as independent risk factors. While the overall risks associated with Lapidus bunionectomy are low and the need for revision surgery are low, this study helps to identify specific risk factors for secondary surgery and hardware removal to help in evaluation and discussion with patients.

Clinical Results of Primary Repair Versus Reconstruction of the Anterior Cruciate Ligament: A Systematic Review and Meta-analysis of Contemporary Trials.

Primary anterior cruciate ligament (ACL) repair has gained renewed interest in select centers for patients with proximal or midsubstance ACL tears. Therefore, it is important to reassess contemporary clinical outcomes of ACL repair to determine whether a clinical benefit exists over the gold standard of ACL reconstruction (ACLR). To (1) perform a meta-analysis of comparative trials to determine whether differences in clinical outcomes and adverse events exist between ACL repair versus ACLR and (2) synthesize the midterm outcomes of available trials. Systematic review; Level of evidence, 3. The PubMed, OVID/Medline, and Cochrane databases were queried in August 2023 for prospective and retrospective clinical trials comparing ACL repair and ACLR. Data pertaining to tear location, surgical technique, adverse events, and clinical outcome measures were recorded. DerSimonian-Laird random-effects models were constructed to quantitatively evaluate the association between ACL repair/ACLR, adverse events, and clinical outcomes. A subanalysis of minimum 5-year outcomes was performed. Twelve studies (893 patients; 464 ACLR and 429 ACL repair) were included. Random-effects models demonstrated a higher relative risk (RR) of recurrent instability/clinical failure (RR = 1.64; 95% confidence interval [CI], 1.04-2.57; P = .032), revision ACLR (RR = 1.63; 95% CI, 1.03-2.59; P = .039), and hardware removal (RR = 4.94; 95% CI, 2.10-11.61; P = .0003) in patients who underwent primary ACL repair versus ACLR. The RR of reoperations and complications (knee-related) were not significantly different between groups. No significant differences were observed when comparing patient-reported outcome scores. In studies with minimum 5-year outcomes, no significant differences in adverse events or Lysholm scores were observed. In contemporary comparative trials of ACL repair versus ACLR, the RR of clinical failure, revision surgery due to ACL rerupture, and hardware removal was greater for primary ACL repair compared with ACLR. There were no observed differences in patient-reported outcome scores, reoperations, or knee-related complications between approaches. In the limited literature reporting on minimum 5-year outcomes, significant differences in adverse events or the International Knee Documentation Committee score were not observed.

Complications after volar plate synthesis for distal radius fractures.

Distal radius fractures (DRFs) represent up to 18% of all fractures in the elderly population, yet studies on the rate of complications following surgery are lacking in the literature. This systematic review aimed to quantify the rate of complications and reinterventions in patients treated with volar plate for distal radius fractures, and analyze if there was any predisposing factor. A comprehensive literature search was performed on three databases up to January 2023, following PRISMA guidelines. Studies describing volar plate complications and hardware removal were included. A systematic review was performed on complications and rate of reintervention. Assessment of risk of bias and quality of evidence was performed with the 'Down and Black's Checklist for measuring quality'. About112 studies including 17 288 patients were included. The number of complications was 2434 in 2335 patients; the most frequent was carpal tunnel syndrome (CTS), representing 14.3% of all complications. About 104 studies reported the number of reinterventions, being 1880 with a reintervention rate of 8.5%. About 84 studies reported the reason of reintervention; the most common were patient's will (3.0%), pain (1.1%), CTS (1.2%), and device failure (1.1%). The complication rate after DRFs is 13.5%, with the main complication being CTS (14.3%), followed by pain and tendinopathy. The reintervention rate is 8.5%, mainly due to the patient's willingness, and all these patients had plate removal. Correct positioning of the plate and correct information to the patient before surgery can reduce the number of hardware removal, thereby reducing costs and the risk of complications associated with VLP for distal radius fractures.

Factors Associated With Pelvic Infection After Pre-Peritoneal Pelvic Packing for Hemodynamically Unstable Pelvic Fractures.

Background: Preperitoneal pelvic packing (PPP) and external fixation has led to improved mortality after devastating pelvic trauma. However, there is limited literature on infection after this intervention. We aim to study the risk factors associated with pelvic infection after PPP. Patients and Methods: A retrospective review of patients who underwent PPP at a single level 1 trauma center was performed. Results: Over the 18-year study period, 222 patients were identified. Twenty-three percent of patients had an open fracture. Pelvic angiography was performed in 24% of patients with 16% requiring angioembolization (AE). The average time to packing removal was two (one to two days) days, although 10% of patients had their pelvis re-packed. Overall infection rate was 14% (n = 31); if pelvic re-packing was performed, the infection rate increased to 45%. Twenty-two of the patients with an infection required additional procedures for their infection, and ultimately hardware removal occurred in eight patients. On univariable analysis, patients with pelvic infections had more open fractures (55% vs. 17%; p < 0.01), underwent AE more frequently (29% vs. 14%; p = 0.04), were more likely to undergo repacking (32% vs. 6%; p < 0.01), and had packing in place for longer (2 [1,2] vs. 2 [2,3]; p = 0.01). On logistic multivariable regression analysis, open fracture (odds ratio [OR], 5.8; 95% confidence interval [CI], 2.4-14.1) and pelvic re-packing (OR, 4.7; 95% CI, 1.2-18.5) were independent risk factors for pelvic infection. Conclusions: Pelvic infection after PPP is a serious complication independently associated with open fracture and re-packing of the pelvis. Re-intervention was required in most patients with infection.

Staged Hip Arthroscopy With Labral Repair, Femoroplasty, and Capsular Plication Followed by Periacetabular Osteotomy for Hip Dysplasia Results in Improved Outcomes and 100% Survivorship at Minimum 2-Year Follow-Up

PurposeTo assess patient-reported outcomes (PROs), clinically significant outcomes (CSOs), and survivorship following staged hip arthroscopy with labral repair, femoroplasty, and capsular plication followed by periacetabular osteotomy (PAO) for the management of femoroacetabular impingement syndrome (FAIS) and hip dysplasia (lateral center edge angle ≤25°). MethodsA prospectively maintained database was queried to retrospectively identify patients who underwent staged primary hip arthroscopy and PAO between 1/2018–10/2021 and had a minimum 2-year follow-up. PROs collected included, Hip Outcome Score Activities of Daily Living/Sports Subscale (HOS-ADL/SS), international Hip Outcome Tool-12 item questionnaire (iHOT-12), and Visual Analog Scale for Pain (VAS Pain). CSO achievement for minimal clinical important difference (MCID) and patient acceptable symptom state (PASS) were determined through cohort specific thresholds. Rates of reoperation, including, revision hip arthroscopy and conversion to total hip arthroplasty (THA) were evaluated to determine short-term survivorship. ResultsThirty-nine hips met criteria for inclusion, of which 35 hips had minimum 2-year follow up (89.7% compliance). Mean age was 25±9.1 years and 91.7% of patients were female. Respective pre- and postoperative radiographic outcomes were: Alpha angle 59.8±5.9 to 39.7±2.6°, Tönnis angle 14.6±5.6° to -1.0±2.9°, lateral center-edge angle 16.6±5.5° to 36.6±4.6°, and anterior center-edge angle 15.6±9.1° to 36.1±3.8°, with statistically significant differences pre- to postoperatively for all (P<0.001). Patients demonstrated significant improvement in all PROs pre- to postoperatively (P ≤0.004). MCID and PASS achievement rates for any PRO were 93.9% and 78.8%, respectively. There were no revision hip surgeries or conversion to THA at a mean 2.7±1.0-year follow-up. Four patients (11.1%) underwent hardware removal. One patient (2.8%) experienced a postoperative infection treated with incision and drainage. ConclusionsStaged hip arthroscopy and PAO for the management of hip dysplasia demonstrated improvement in PROs, high CSO achievement rates, and 100% survivorship at minimum 2-year follow-up.

Supracondylar ostectomy and shortening (S.O.S.) for distal humerus nonunions

Many distal humerus nonunions are associated with bone loss, and rigid internal fixation is difficult to obtain, especially for low transcondylar nonunions and those with severe intra-articular comminution. The purpose of this study was to analyze the results of a strategy to address this challenge utilizing internal fixation using the Supracondylar Ostectomy+Shortening (S.O.S.) procedure for distal humerus nonunions. The goals of this procedure are to (1) optimize bony contact and compression through re-shaping the nonunited fragments at the supracondylar level with selective humeral metaphyseal shortening, (2) maximize fixation using parallel-plating, and (3) provide biologic and structural augmentation with bone graft. Between 1995 and 2019, 28 distal humerus nonunions underwent internal fixation using the S.O.S. procedure at a single Institution. There were 14 males and 14 females with mean age of 47 (range 14-78) years at the time of the S.O.S procedure and an average of 1.7 prior surgeries. Medical records and radiographs were reviewed to determine rates of union, reoperations, complications, and Mayo Elbow Performance Scores (MEPS). Patients were also prospectively contacted to update their MEPS and gather additional information on complications and reoperations. Mean clinical exam follow-up was 17months, mean clinical contact follow-up was 19months, and mean radiographic follow-up was 32months. Four patients did not have adequate follow-up to determine union. Of the remaining 24 elbows, 22 achieved union. Two elbows developed collapse of the articular surface and were converted to a total elbow arthroplasty. There were complications in 10 elbows: contracture (5), superficial infection (2), ulnar neuropathy (1), deep infection (1), and hematoma (1). Twelve elbows underwent reoperation: 4 for contracture release, 3 for hardware removal, 2 for total elbow arthroplasty, 1 for bone grafting, 1 for hematoma evacuation, and 1 for ulnar nerve neurolysis. Compared to preoperative data, there was a significant improvement in postoperative flexion, extension and pronation (P<.01). The mean range of motion was 21° of extension, 119° of flexion, 79° of pronation, and 77° of supination. The mean MEPS was 80 points (range, 25-100 points) and 19 elbows (76%) rated as excellent or good. Stable fixation and high union rates are possible in distal humerus nonunions with bone loss using a technique that combines supracondylar humeral shortening, parallel plating, and bone grafting. Secondary procedures are commonly needed to restore function in this challenging patient population.

Painful Peroneal Tendon Subluxation in a Patient With a Prior Ankle Fusion.

This case report describes a patient who underwent an ankle fusion using a lateral approach and fibular-onlay strut 14 years ago. She presented with increasing lateral ankle pain and giving way. Despite bracing and steroid injections, she had continued symptoms and surgery for hardware removal was recommended. While under anesthesia, she was found to have subluxation of her peroneal tendons. Operative findings included impingement of the peroneal brevis on the screw head from her fibular-onlay strut and a peroneal tendon tear. Hardware removal, a peroneal tenodesis, and reconstruction of the peroneal retinaculum were performed with a good clinical result.Level of Evidence: V (case report).

Survival and complications of transfibular trabecular metal total ankle replacement − A systematic review

BackgroundIn the past decade, the transfibular approach to Total Ankle Replacement (TAR) has emerged as an alternative to anterior approach with reduced bone resection. The purpose of this systematic review is to report survival, complications, and reoperation rates of transfibular TAR. MethodsWe conducted a systematic search of studies that evaluated complications, reoperations, and survival of transfibular TAR following PRISMA guidelines across PubMed, Scopus and Web of Science. ResultsOur review included data from 12 cohorts, comprising 919 patients across 7 countries, with an average age of 62 years (59% posttraumatic). Over an average follow-up period of 3 years, adverse events occurred in 23% of cases, with 18% requiring surgical reintervention, mostly due to hardware removal. The survival rate of the transfibular TAR metal components was 97% at the final follow-up. ConclusionTransfibular TAR demonstrates a 97% survival rate at a 3-year follow-up. Level of evidenceLevel II

Implants removal in children: results of a survey among Italian orthopaedic surgeons.

In the treatment of paediatric limb disorders, the use of metal implants has been increasing over the last decades. Recent studies have addressed the decision of orthopaedic surgeons regarding the removal of implants after the treatment of fracture, and there is a growing consensus within the scientific community supporting the choice of not removing implants in children. This survey aimed to investigate the rationale behind the Italian orthopaedic community's decision regarding metal implant removal in paediatric patients. An electronic questionnaire was sent to all members of the Italian Paediatric Orthopaedic and Traumatology Society, Italian Orthopaedic and Traumatology Society, Italian Club of Osteosynthesis, and South Italy Society of Orthopaedic and Traumatology. The survey comprised 34 questions about hardware removal after the treatment of long bone fractures, epiphyseal growth plate injuries, slipped capital femoral epiphysis (SCFE), and flat foot. Of the 3500 orthopaedic surgeons who received the questionnaire, 5.5% responded. The leading indications for implant removal were the patient's intolerance, pain, ROM limitations, and hardware breakage. Removal of elastic nails for long bone fractures, cannulated screws for growth plate injuries, and SCFE and screws for arthroereisis for flat foot correction were analysed in detail. The consensus among Italian Orthopaedic Surgeons is to remove elastic nails and cannulated screws in cases of pain, intolerance, or breakage and to reduce further risks during patient growth. An increasing number of physicians, however, are endorsing and advocating the growing trend in the literature of not routinely removing the hardware.

Transoral endoscopic assisted reduction and internal fixation of mandibular condylar neck fractures with short condylar segment

This study aimed to assess the reliability and safety of transoral endoscopic-assisted reduction internal fixation (TERIF) for treating short-segment condylar neck fractures (CNF), including hardware removal.Patients with displaced CNF and short condylar segments treated using TERIF were included in the study. Clinical evaluation covered dental occlusion, range of mouth opening, deviation during mouth opening, protrusion, laterotrusion, pain, and chewing. Radiological evaluation was used to assess fracture displacement, angulation, head dislocation, postoperative reduction, fixation stability, and bone healing. The same technique was used to treat 15 patients with 18 CNF and short condylar segments. Hardware removal was performed for nine fractures in eight patients after fracture healing using the same approach.All patients regained satisfactory, pain-free mouth opening with no deviation and complete bone healing. Computed tomographic images displayed adequate reduction and stable fixation during the follow-up period for all patients. No temporary or permanent facial nerve impairment occurred in any of the patients.TERIF is a reliable and safe treatment for CNF with short condylar segments, even in the presence of head dislocation, medial override, and malunited fractures; hardware can be safely removed after healing using the same approach.

Sickle Cell Disease Has No Impact on 10-Year Cumulative Incidence and Indications for Revision Lumbar Fusion.

Retrospective Cohort Study. Patients with sickle cell disease (SCD) experience distinct physiological challenges that may alter surgical outcomes. There has been no research establishing 10-year lumbar fusion (LF) implant survivorship rates among individuals with SCD. This study aims to determine the 10-year cumulative incidence and indications for revision LF between patients with and without SCD. A national database was queried to identify patients with and without SCD who underwent primary LF. SCD patients undergoing LF were propensity-score matched in a 1:4 ratio by age, gender, and Charlson Comorbidity Index (CCI) to a matched LF control. In total, 246 SCD patients were included along with 981 and 100,000 individuals in the matched and unmatched control cohorts, respectively. Kaplan-Meier survival analysis was utilized to determine the 10-year cumulative incidence rates of revision LF. Furthermore, multivariable analysis using Cox proportional hazard modeling was performed to compare indications for revisions and surgical complications between cohorts including hardware removal, drainage and evacuation, pseudoarthrosis, and mechanical failure. No significant differences were found in the cumulative incidence of 10-year all-cause revision LF between patients in the SCD cohort and either of the control cohorts (P > .05 for each). Additionally, there were no significant differences between the SCD cohort and either of the control cohorts in regards to the indications for revision or surgical complications in LF (P > .05 for each). This study indicates that SCD patients do not have increased risk for revision LF, nor any of its indications.