High Union Rate Research Articles

Functional Outcomes in Aseptic Humeral Shaft Nonunion Treated With Plate Osteosynthesis: A Retrospective Cohort Study.

Aseptic nonunion is prevalent in orthopedic practice, causing persistent pain and functional impairment. Humeral shaft fractures, accounting for 3-5% of all fractures, have nonunion rates of 2-33% in nonoperative and 5-10% in surgical management. This study, the largest case series on operative management of aseptic humeral shaft nonunion (AHSN), treated with plate osteosynthesis. This retrospective study, conducted at a referral center in eastern India, included 132 patients with aseptic humeral shaft nonunion from May 2002 to April 2012 and May 2015 to December 2020. Patients aged 20-70years with nonunion more than 6months post-trauma were included. Exclusions were open fractures, infections, gap nonunions, pathologic fractures, and concomitant upper limb injuries. Surgical techniques involved excising fibrous and unhealthy tissue, compressing the nonunion site, decorticating, shingling, autologous bone grafting, and stable fixation with dynamic or locking compression plates. Outcomes were assessed using Quick DASH, VAS, Constant Shoulder score at a minimum follow-up of 24months. The study included 132 patients, 84 males and 48 females, with a mean age of 42.3years. Fractures were due to high-energy trauma in 78 cases and low-energy trauma in 54 cases. All patients with atrophic type of AHSN received autologous bone grafts and plating techniques. Quick DASH scores improved from 77 to 5 on average. Constant Shoulder score improved from 22 to 88 and VAS score improved from 6.7 to 1.3. Union was achieved in 21weeks on an average, with minimal complications. Despite variations in time intervals, treatments, and follow-up durations, consistent management strategies emphasize stable fixation, bone grafts, and careful management of complications to achieve high union rates and satisfactory outcomes. Complications included seven infections, one failure needed refixation and two case of transient radial nerve palsy. Absolute stability using plate with or without autologous bone grafting for aseptic humeral shaft nonunion results in high union rates and satisfactory radiologic and functional outcome.

Minimally Invasive Plate Osteosynthesis Using Locking Plates for Distal Femur Fractures: A Retrospective Analysis of 40 Cases.

Distal femur fractures present significant surgical challenges due to their complex anatomy and limited soft tissue coverage. Minimally invasive plate osteosynthesis (MIPO) has emerged as a promising alternative to traditional open techniques, aiming to reduce soft-tissue damage while maintaining stable fixation, particularly when used with locking plates. This retrospective study analyzed 40 consecutive patients with distal femur fractures treated with MIPO and locking plates. The results showed a high union rate of 92.5%, with fractures healing within 16-24 weeks (mean: 19.2 weeks). Complications occurred in 12.5% of cases, including three cases of malalignment, one case of screw breakage, and one infection. Functional outcomes were positive, with 85% of patients achieving excellent or good results based on the Knee Society Score, indicating satisfactory postoperative mobility and joint function. MIPO using locking plates is a reliable and effective treatment for distal femur fractures, offering high union rates, manageable complication rates, and favorable functional outcomes while minimizing soft-tissue disruption.

Palmar Plate Fixation in Scaphoid Nonunions—Surgical Technique and Review of the Literature

AbstractEven today, the treatment of scaphoid nonunions remains challenging for the treating hand surgeon. Considering the biomechanical principles of wrist kinematics, especially the three-dimensional movement of the scaphoid, it is evident that a single headless compression screw does not provide sufficient stability to counteract all these forces, particularly rotational forces. Palmar plate fixation was initially introduced as a salvage procedure after failed screw fixation. It ensures very high rotational stability but also supports correction of the humpback deformity, reconstruction of scaphoid length, and prevents bone graft extrusion. However, indications have since been extended to include primary nonunion treatment in cases with humpback deformity or comminuted fractures. Even in recalcitrant cases (substantial bone loss, prior surgery failure, avascular necrosis, or durations exceeding 2 years), high union rates and favorable functional outcomes have been reported. This article attempts to summarize the biomechanical principles, indications, surgical techniques, and results following palmar angular stable plate fixation in scaphoid nonunions.

Comparative Study of Exchange Nailing and Augmentative Plating for Treating Aseptic Nonunion of Femoral Shafts Post Intramedullary Nailing: A Single-Blind, Multicentric Randomized Clinical Trial.

Background: Aseptic nonunion of femoral shafts after intramedullary nailing (IMN) can be a challenging condition that may lead to long-term disability and the need for multiple surgical procedures. This study compared the clinical and radiological outcomes between exchange nailing and augmentative plating with bone grafting. Methods: In this multicenter, prospective, single-blind, randomized controlled trial, patients with aseptic nonunion of the femoral shaft after IMN were randomly assigned to receive exchange nailing or augmentative plating. The primary outcomes measured were the time to bone union and union rate 12 months after revision surgery. The secondary outcomes included operative time, blood loss, hospitalization duration, pain level using the visual analog scale (VAS), knee range of motion (ROM), and complication rates. Results: The augmentative plating group had a significantly shorter mean time to union (5.39 ± 1.29 months) compared with the exchange nailing group (7.38 ± 1.97 months; p < 0.001). The union rates at 12 months were 100% in the augmentative plating group and 89.65% in the exchange nail group. Augmentative plating resulted in a shorter operation time (99.46 ± 11.08 min vs. 106.45 ± 12.22 min; p = 0.025) and reduced blood loss (514.79 ± 45.87 mL vs. 547.72 ± 54.35 mL; p = 0.016). Significant pain reduction was observed in the augmentative plating group, with preoperative VAS scores decreasing from 6.04 ± 2.28 to 2.64 ± 1.50, compared with a decrease from 5.66 ± 2.21 to 3.66 ± 2.19 in the exchange nailing group (p = 0.047). Knee ROM improved significantly in the augmentative plating group (p = 0.0176). The complication rate was lower in the augmentative plating group (3.57%) than in the exchange nail group (17.24%). Conclusions: Augmentative plating with autologous bone grafting is superior to exchange nailing for treating aseptic nonunion of femoral shafts. It is associated with faster healing, higher union rates, better clinical and functional outcomes, and fewer complications. We recommend this technique as the preferred treatment option for such complex cases.

Comparative outcomes of operative treatment for two and three-part proximal humerus fractures with or without ipsilateral shaft fractures and head-split patterns: intramedullary nail versus open reduction internal fixation.

To investigate whether the outcomes, including union rates, complications, reoperations, blood loss, operative time, and range of motion, differed following intramedullary nailing (IMN) or open reduction internal fixation (ORIF) of two- and three-part proximal humerus fractures with or without ipsilateral shaft fractures and head-split patterns. This was a retrospective multicenter study at three community centers and one level 1 trauma center. Inclusion criteria were two- and three-part proximal humerus fracture treated with either IMN or ORIF from 2015 to 2022 with at least three months of postoperative follow-up. 228 patients. No significant differences in preoperative subject characteristics were observed. IMN was significantly more common with ipsilateral shaft fractures (p = 0.011). The number of fracture parts was significantly associated with treatment (p < 0.001). IMN had significantly less blood loss in two-part fractures (p = 0.016) and concomitant shaft fractures (p = 0.029), but operative time was not significantly less in any group. Union rates, complications, reoperation, postoperative humeral neck shaft angle, and postoperative range of motion were not significantly different. IMN and ORIF result in similar outcomes for proximal humerus fractures. Both treatments result in high union rates, the potential for near anatomic postoperative humeral neck shaft angles, and sufficient postoperative range of motion. IMN has lower blood loss than ORIF. IMN is a viable option for two-part proximal humerus fractures and may be effective in select three-part fractures as well. Concomitant humeral shaft fractures can be treated with either IMN or ORIF. Head-split patterns should be treated with ORIF.

Smile incision and reverse shotgun approach in distal interphalangeal joint arthrodesis

BackgroundArthrodesis serves as the traditional therapeutic approach for advanced distal interphalangeal joint (DIPJ) arthritis. However, the conventional technique may prove insufficient when the excision of pronounced volar and lateral spurs is required. To address this, we innovated the 'smile incision with reverse shotgun approach'. This method enhances joint exposure and yields superior cosmetic results by extending the transverse skin incision over the DIPJ and cleaving the accessory collateral ligament, thereby improving access to the volar and lateral joint margins. This article meticulously elucidates the surgical procedure and presents preliminary results of its implementation.MethodThe clinical data of 22 consecutive patients (36 fingers) who received DIPJ arthrodesis by this procedure during March 2018 to October 2022, with a mean follow-up period of 9.8 months, were reviewed. Patients’ demographics, union rate, complications, radiographic findings, as well as visual analogue scale (VAS) for pain and satisfaction, were collected and analyzed.ResultsThirty-five of 36 fingers achieved uneventful bony union (97.2%). The average VAS for pain and satisfaction as well as he coronal plane deviation of DIPJ significantly improved after the operation (all, P < 0.05). No skin necrosis, nail deformity, or infection were observed during the follow-up period.ConclusionThe smile incision and reverse shotgun approach provided excellent DIPJ exposure, high union rate, and cosmetic appearance for DIPJ arthrodesis surgery. This technique may be a good surgical option for DIPJ arthrodesis when more volar part joint preparation and more volar implant insertion sites are necessary.

A Systematic Review of the Complications Associated with Free Fibular Flaps in Adult and Pediatric Spinal Reconstruction.

Free fibular flaps have been suggested as a modality of reconstruction for complex spinal deformities. However, there is limited data that describes associated postoperative outcomes. The purpose of this systematic review was to characterize outcomes after spinal reconstruction using the free fibular flap for both adults and children. Thirty-nine articles among four databases were identified as having met inclusion criteria. Patient demographics, indications for spinal reconstruction as well as location and anastomosis, history of chemotherapy and radiation therapy, and postoperative outcomes including complications were identified. Major complications were defined as complications requiring reoperation, while minor complications were those that did not require reoperation. Systemic complications were defined as complications affecting sites or organ systems beyond the local donor and recipient sites. Statistical analysis was performed using Fischer's exact, chi-squared, and t-tests. We identified 218 adult patients (mean age 47.7 years, 56.4% male) and 27 pediatric patients (mean age 12.7 years, 55.6% male). While there was no significant difference in the rates of bony union between the two groups (adults: 90.8%, children: 90%, p > 0.9), adults had significantly higher rates of major (27% vs. 7.4%, p = 0.026), minor (26.1% vs. 7.4%, p = 0.032), and systemic (14.2% vs. 0%, p = 0.047) complications. Free fibular flaps are effective for spinal reconstruction for both adults and children, as evidenced by the high rates of bony union. However, adults exhibited significantly higher complication rates. Further research is required to better understand the patient and clinical risk factors associated with increased rate of complications.

Functional Outcomes of Clavicle Open Reduction and Internal Fixation (ORIF).

The clavicle is among the most commonly fractured bones. It can be managed nonoperatively or surgically. Open reduction and internal fixation (ORIF) surgery is thetechnique to help restore the clavicle's anatomy and allow patients to rehabilitate sooner. The current study aims to assess the functional results and problems related to ORIF using plates for displaced midshaft clavicle fracture. This retrospective study was conducted in Heartlands Hospital, Birmingham, United Kingdom. A total of 60 patients who underwent ORIF for displaced midshaft clavicle fracture in Birmingham's Heartlands Hospital from 2016 to 2023 were included in this study. Selected patients were reviewed to determine demographic data, cause of injury, fracture classification, and postoperative complications. All chosen patients were assessed for functional outcomes (Disabilities of the Arm, Shoulder, and Hand Questionnaire [DASH] score-based functional outcome measures). The mean age of patients was 34.75 ± 9.787 years (20-59 years). A total of 60 participants were included in the study, with 43 (71.7%) male and 17 (28.3%) female. In the majority of patients, the left side was affected (34 patients, 56.7%). The mode of injury was a fall from a bike or road traffic accident in 47 (78.3%) patients. The DASH score was excellent (98-100) in 49 (81.7%) patients, good to excellent (93-97) in 10 (16.7%) patients, and fair to good (82-92) in one (1.7%) patient. Of the total patients,48.3% did not experience any complications. Among patients who developed complications, 20% of patients faced adhesive capsulitis or stiffness in the early postoperative period, which was treated with physiotherapy, followed by paresthesia over the surgical site, and anterior chest developed in 13.3%, followed by superficial infection in 3.3%. ORIF for clavicle fractures ensures a high rate of bone union and improved functional outcomes after six months of surgery, with early pain relief and effective anatomical restoration. While it generally offers advantages over conservative methods, it is associated with a risk of adhesive capsulitis or stiffness.

Efficacy and safety of carbon fiber retrograde intramedullary nailing in tibio-talar-calcaneal fusion: a single-centre retrospective study

IntroductionTibio-talar-calcaneal (TTC) fusion is a salvage procedure designated for treating various severe hindfoot pathologies. While traditional methods have been effective, the advantage of carbon fiber (CF) retrograde intramedullary nailing (RIMN) presents a potentially superior technique. This study evaluates the efficacy and safety of CF RIMN in TTC fusion, focusing on union rates, complication rates, and patient-reported outcomes. Materials and methodsConducted as a single-center, retrospective study, this research involved 21 patients who underwent TTC with CF RIMN from 2015 to 2021. Patient selection excluded those with active infections or those needing significant bone allografts. Patient follow-up was conducted at multiple intervals postoperatively, with a minimum follow-up of 24 months, assessing for union complications and using tools like the VAS, SF12, and AOFAS for patient-reported outcomes. ResultsThe study observed a 90% union rate among patients. Complication rates included a 14% incidence of iatrogenic fractures to the anterior tibial cortex and 19% postoperative complications. Significant improvement was noted in VAS scores but not in SF12 and AOFAS scores. The use of 200 mm RIMN was identified as requiring careful consideration due to associated complications. ConclusionCF RIMN in TTC fusion demonstrates a high union rate with notable complications. The significant improvement in VAS scores indicates patient satisfaction, but the lack of statistical significance in SF12 and AOFAS scores warrants attention. The findings advocate for the cautious use of 200 mm RIMN and highlight the need for further research, suggesting prospective, multicenter studies to validate these findings and explore long-term outcomes. Level of evidenceIII.

A Novel Self-Compressing Single Screw for Subtalar Arthrodesis

Category: Hindfoot; Other Introduction/Purpose: Subtalar fusions have become the standard of care for a variety of pathologies of the hindfoot that have failed non-operative management, both as an isolated procedure or combined as a double or triple arthrodesis. Multiple fixation methods exist for this procedure, although newer technology has introduced the ability for sustained dynamic compression via the use of nitinol. The purpose of this work was to assess a new internal compressing screw on subtalar arthrodesis. Methods: We examined 15 patients who underwent subtalar fusion with a single screw utilizing an internal nitinol device. Serial radiographs were reviewed for migration of the nitinol implant over time, spanning from 3 months to up to a year post operatively. We also assessed for post-operative complications including nonunion, infection, and pulmonary embolism. Results: There was an average of 63% of recovered compression, ranging from 26%-88%. The majority of the recovery was within the first three months post operatively. Our follow up averaged 9.5 months (range, 3 months to 1 year 8 months). There was one patient with a nonunion of the subtalar joint and one patient who suffered a post-operative pulmonary embolus. There were no infections requiring surgical treatment. Conclusion: The nitinol element provides sustained compression to combat bone resorption or settling. While the majority of this is seen in the first three months, it is still possible to have more recovery beyond this time. This small case series demonstrates a low complication rate and high union rate with utilization of this implant. Future studies are needed to compare this fixation method to traditional screws and review differences in union rates and complications. Xrays taken at time of surgery, at 3 months post-op, and 1 year post-op of a 7×80mm screw with an available 3.0mm of post-operative compression. The implant had compressed nearly 50% at 3 months with additional compression noted between 3 months to 1 year post implantation.

Osteoperiosteal fibular strut grafting - A technique to improve union rates.

Gap non-union of long bones are challenging problems in orthopaedic patients. Non-vascularized fibular grafting is a simple, cost effective, single stage procedure and is an accepted method of reconstruction for gap non unions in children. However, there is a risk of non-union when a long avascular strut of fibula is used. The periosteum, by itself has high biological activity and is helpful in osteointegration. Harvesting the fibula with the periosteum gives the advantage of mechanical and biological support in a gap non-union. During 2020 to 2022, 13 patients presented to us with gap nonunion of long bones due to various aetiology. The mean age of the patients was sixyears with a mean bone gap of 4.2cm. A modified technique of harvesting the fibula with the periosteum is described. The graft was stabilized with the recipient bone by intra medullary or extra medullary implants. Union occurred in average 12.7weeks in all except one patient with congenital pseudoarthrosis of tibia. The fibula on the harvest site regenerated completely in all other patients. One patient had a superficial infection. Children were followed were an average of 17.5months and there was no incidence of graft resorption or fracture. Osteoperiosteal fibula graft is a simple, effective and cost-effective procedure for the treatment of gap non-unions in children. It offers the advantage of both biological and mechanical support, with high union rates and low complication rates.

Staged Minimally Invasive Osteosynthesis with Nonanatomical T-shaped Locked Plates for Intra-articular Tibial Plafond Fractures

Background: Numerous studies have assessed the outcomes of extra-articular tibial plafond fractures following staged minimally invasive osteosynthesis with various locked plates (LCPs). Recently, the Taiwan National Health Insurance has been contemplating the inclusion of nonanatomical LCPs into a benefit package. For tibial plafond fracture patients, nonanatomical T-shaped LCPs may serve as an alternative choice for those unable to afford anatomical anterolateral LCP. Objectives: This retrospective study was designed to assess the outcomes of intra-articular tibial plafond fractures following staged minimally invasive osteosynthesis with nonanatomical T-shaped LCPs. Materials and Methods: From April 2010 to October 2016, 18 consecutive patients with intra-articular fractures of the tibial plafond underwent treatment through staged minimally invasive nonanatomical T-shaped LCP osteosynthesis. The median patient age of the cohort, comprising nine women and nine men, at the time of surgery was 49 (22–71) years. The first-stage treatment consisted of radical debridement, followed by external skeletal fixation, and the second-stage treatment consisted of minimally invasive osteosynthesis with nonanatomical T-shaped LCPs. In addition, we identified factors predictive of poor results, delayed union, or nonunion of the fractures. Factors such as age, sex, open fracture, fracture severity, concomitant injuries, presence of comorbidities, and arthrosis were analyzed. Results: At 6 months of follow-up, 3 (17%) patients had delayed/nonunion according to the radiographic definition of nonunion. At the final follow-up, 17 (94%) of the 18 patients achieved union, whereas 1 (6%) did not. Patients with open fractures and concomitant injuries tend to exhibit poor clinical and radiographic outcomes. Conclusions: We found a high rate of satisfaction and union and few complications with staged minimally invasive osteosynthesis with nonanatomical T-shaped LCPs for the treatment of patients with intra-articular tibial plafond fractures. We postulate that this technique is an effective and safe alternative for the treatment of tibial plafond fractures.

Ankle Fractures in the Complex Diabetic Patient. Minimally Invasive Surgery and Augmentation with Ring Fixation

Category: Diabetes; Trauma Introduction/Purpose: Ankle fractures in complex diabetic patients (target organ damage, obesity, and HBA1C &gt; 8 mg/dl) are associated with serious complications. Good results have been reported with MIS techniques in patients at risk of soft tissue complications and with the use of early containment frames in patients with diabetic neuroarthropathy. Our objective was to evaluate a novel, minimally invasive management protocol with augmentation using ring external fixation. Methods: Retrospective IRB approved study including 18 complicated diabetic patients with bi- or trimalleolar ankle fractures with a minimum follow-up of one year. Fibular intramedullary fixation was performedand percutaneous screws were used for the medial and posterior malleolar fractures. The stability of the construct was increased by using a ring external fixator. Demographic data, AOFAS scores, and Lower Extremity Functional Score (LEFS) functional scales were obtained, as well as a record of complications during the complete follow-up and visual analog scale (VAS). Results: The mean age and HBA1C were 56 years (R:37-73) and 9.8 ± 2.5 mg/dl. The external fixator time was 12.3 weeks (6-28) with complete healing in of 16/18 patients (89%) at 12.6 weeks (R:8-24). The average AOFAS was 79 (R:67-97), LEFS was 61.8% (R37.5-90). The mean postoperative VAS score was 4.4/10. The most frequent complication was superficial pin infections (38.8%) and there was one case of secondary Charcot Neuroarthropathy. No deep infections or wound dehiscence was observed. Conclusion: This minimally invasive fixation technique with augmentation is a safe alternative for complex diabetic patients with poor metabolic control and high HBA1C values. In our patients, we achieved high union rates according to what is reported in the literature, with a low incidence of major complications and acceptable functional results. Percutaneous fixation and ring augmentation

The Unspoken Complication Following MIS Bunion Surgery

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Hallux valgus (HV) is a common orthopedic foot and ankle condition involving deformity and subsequent pain and dysfunction of the first ray. Surgical interventions, such as open and minimally invasive surgery (MIS), are frequently utilized if nonoperative management is insufficient . In recent years, MIS has been increasingly used and has been regarded as one of the most innovative surgical interventions for HV. As with all new surgical techniques complications can occur. The most common complications after MIS bunion surgery are infections and hardwear removal. Nonunion after MIS bunion correction can be surgically challenging. Recent publications report 1% of non-unions after MIS bunion correction. Despite this prevalence the orthopedic literature is lacking information about how to treat patients who have non-unions after MIS bunion surgeries. Methods: We would like to present our experience and treatment protocol for non- union after MIS bunion surgery. Treatment Protocol: 1. Nonunion definition- No signs or minimal signs on consecutive x-rays or CT scan of bony union at the osteotomy site 6 months or more after index MIS bunion surgery. 2. Rull out reversible causes for nonunion. 3. Surgery- An open surgery is performed. Removal of MIS screws, debridement and refreshing of the osteotomy site, adding bone graft (autologous/synthetic), fixing the nonunion site with a dorsal plate and a lag screw if needed. 4. Post op protocol- non-weight bearing for 2 weeks followed by 4 weeks of partial weight bearing in a post-op shoe. All patients receive Vit D supplements for 3 months after surgery. (1000 IU per day). 5. Follow up in clinic with x rays at 6 weeks, 3 months and 6 months after revision surgery. Results: We would present a case sereis of 6 cases of nonunions following MIS bunion surgery treated according to the presented treatment protocol and achieved full union 3 months after the revision surgery. Conclusion: Nonunion after MIS bunion correction can be surgically challenging. The suggested treatment protocol shows high union rates for revision cases.

One-bone forearm for the treatment of supination contractures secondary to neonatal brachial plexus injury.

The one-bone forearm procedure has been considered as a potential treatment for severe forearm deformities. However, its primary limitation lies in the elevated risks of nonunion and infection. In order to enhance union rates, a technical modification was introduced, aiming not only to establish end-to-end radio-ulnar fixation but also to incorporate an additional overlay and fixation between the proximal and distal radius osteotomy stumps. This technique, initially applied in a heterogeneous patient population including individuals with neurological, tumoral, and congenital conditions, yielded promising results, achieving a consolidation rate of 100% and enabling supination corrections of up to 120°. In this study, we present a retrospective cohort of 28 patients, with an average age of 9 years, all afflicted by forearm supination contracture exceeding 90° secondary to neonatal brachial plexus injury. These patients underwent treatment with the modified technique. The mean correction achieved in forearm rotation was 116°, and the average follow-up period extended to 43 months. Remarkably, all patients exhibited bone union within an average period of 6.6 weeks, without any complications. Our findings underscore the efficacy of this modified technique, which enables substantial rotational corrections, boasts a high union rate, and maintains a low incidence of complications. This approach is particularly valuable for young patients suffering from neonatal brachial plexus injury with severe fixed supination deformities. IV.

Arthrodesis as Salvage for Failed Metacarpophalangeal Arthroplasty.

Surgical management of failed metacarpophalangeal (MCP) arthroplasties includes revision arthroplasty and arthrodesis. The purpose of this study was to review the indications and outcomes of arthrodesis as a salvage procedure for failed MCP arthroplasties. This was a retrospective cohort study of all patients undergoing salvage MCP arthrodesis at a single institution from 1990 to 2020. Patient charts were reviewed for patient demographics, indication for salvage, surgical technique, revision rate, and time to radiographic union. Patient-reported outcomes, including the Michigan Hand Outcomes Questionnaire and an MCP-specific questionnaire detailing pain, functional, appearance, and patient satisfaction, were also collected. Eleven digits in 9 patients (6 women, 3 men, median age of 66) with median 36-month follow-up were included. The majority (91%) of patients also had concomitant soft tissue deformities, including joint contractures, extension lag, and collateral ligament insufficiency. The overall revision rate following arthrodesis was 45% with 3 digits requiring one revision each, and 2 digits undergoing 3 revisions. The overall union rate was 91% with median time to union of 4 months from most recent arthrodesis. Patient-reported outcomes obtained from 4 patients demonstrated improvements in pain and function. Despite a high revision rate of 45%, salvage MCP arthrodesis following arthroplasty has a high eventual union rate of 91% and is associated with improved pain and function based on 4 patients' experiences. Arthrodesis as a salvage procedure for failed MCP arthroplasties should be considered in patients with persistent joint instability and functionally limiting soft tissue deformities.

Outcomes of Free Vascularized Fibular Grafts in Treating Massive Forearm Skeletal Defects.

Reconstructing long bone defects in the upper limbs, particularly the radius and ulna, poses significant challenges. These defects, resulting from trauma, tumors, infections, or congenital anomalies, require precise surgical intervention for functional restoration. Traditional non-vascularized autogenous bone grafts have limitations, such as resorption and limited biological activity. To address these challenges, free vascularized fibular grafts (FVFGs) have been developed, offering enhanced recovery by supplying nutrients and structural support, particularly in large defects or compromised vascularity. This retrospective study reviewed patients with significant forearm skeletal defects treated with FVFGs at our institution from January 2008 to January 2019. Included were patients with radius or ulna defects exceeding 8 cm due to trauma, tumor excision, or non-union fractures. Data on demographics, clinical details, surgical techniques, and outcomes-including graft union time, complications, range of motion, and the disabilities of the arm, shoulder and hand (DASH) scores-were analyzed. Eight patients, with a mean age of 27.6 years and an average defect length of 9.8 cm, were included. All patients achieved graft union within an average of 4 months, with no tumor recurrence or significant complications. Functional outcomes showed mean forearm pronation of 56.9 degrees, supination of 52.5 degrees, and a mean DASH score of 17.7. FVFG is a safe and effective technique for managing complex forearm bone defects, providing high union rates and good functional outcomes. It should be considered a primary option for large forearm skeletal defects.

Long-term results and patient-reported outcomes after vascularized fibular graft use in the treatment of post-traumatic bone defects of femur shaft and tibia: A retrospective cohort and cross-sectional survey study

Post-traumatic critical-sized bone defects pose a reconstructive challenge for reconstructive surgeons. The vascularized fibula graft is a well-described treatment for osseous defects of the femur and tibia. This study aimed to assess long-term patient-reported quality of life, the success-, and complication rates in lower extremity reconstruction with vascularized fibula grafts. A retrospective cohort of 29 patients who underwent fibula graft reconstruction for critical-sized bone defects after post-traumatic tibial and femoral bone loss between 1990 and 2021 was included. To assess the health-related quality of life and return to work and satisfaction, a cross-sectional survey was performed using the short-form-36, lower extremity functional scale, and a self-made questionnaire including the DN4, satisfaction, and subjective ankle function. The median bone defect size was 8cm (IQR 9-7cm). The mental component scores were comparable to the Dutch population norm, whereas the impaired physical function scores were associated with pain (r 0.849, p<0.001). Neuropathic symptoms were reported in 7 out of 19 patients, and 11 out of 19 patients returned to normal daily activity. All respondents reported positive or neutral scores on overall satisfaction with the recovery. Bone healing was uneventful in 19 out of 29 patients. Union was achieved in 25 out of 29 patients. Persistent nonunion was observed in 4 patients, leading to amputation in 2 patients. Vascularized fibula graft use led to high union rates and limb salvage in patients with post-traumatic segmental bone loss of the tibia and femur. Patient satisfaction with the overall recovery was positive; however, functional outcomes remained impaired.

Minimum 10-year follow-up after open reduction and internal fixation of radial head fractures Mason type II and III

The treatment of complex radial head fractures remains controversial with open reduction and internal fixation (ORIF), radial head arthroplasty, and radial head excision being the most common treatment options. While ORIF is the preferred treatment strategy for Mason type II fractures, the optimal treatment of Mason type III fractures is debated. The purpose of this study was to report minimum 10-year outcomes after ORIF of Mason type II and type III radial head fractures. We hypothesized that both Mason Type II and Type III fracture patients would demonstrate satisfactory clinical outcomes at minimum 10-year follow-up. All patients with Mason type II or III radial head fractures who were treated with ORIF by a single surgeon between 2005 and 2010 were included. Fractures with significant bone defects were treated with bone grafts and elbow ligament injuries were treated with either primary ligament repair or reconstruction. Patient reported outcome questionnaires were administered at the time of last clinical follow-up and at a minimum of 10years postoperatively. Twenty-four patients, including 13 male and 11 female patients with an average age of 39 (range 19-60) at the time of surgery met inclusion criteria. Thirteen patients suffered from Mason type II and 11 patients from Mason type III fractures. At initial follow-up, 21 out of 24 fractures (88%) demonstrated radiographic union. Three nonunions, 2 of which were Mason type III fractures, were treated with revision ORIF and iliac crest bone grafting. 11 patients developed postoperative elbow stiffness and required capsular release surgery. At last clinical follow-up, average flexion was 139°, average extension was 4°, average supination was 77°, and average pronation was 81°. The median Disabilities of the Arm, Shoulder and Hand score was 7 (ranging from 0 to 32). Minimum 10-year follow-up (mean: 14.6years) was collected on 18 of 24 (75%) of the patients. At a minimum of 10years postoperatively, the median QuickDASH score was 4.5 (range: 0 to 25) and the median SANE score was 96.5 (range: 75-100). Median satisfaction with the surgical outcome was 10 of 10 (range: 3-10). ORIF of Mason type II and III radial head fractures results in high union rates with good functional outcomes at a mean of 14.6years postoperatively. The study results suggest that ORIF of Mason type II and III radial head fractures leads to long-term positive functional outcomes.

The Ilizarov Technique: A Dynamic Solution for Orthopaedic Challenges.

The Ilizarov technique is one of the most important tools that is currently employed in bone reconstruction surgeries. Its inception dates back to the mid-20th century and involves various bone reconstruction methodologies implemented using a circular external fixator system devised by G. A. Ilizarov. The key advantages of this approach include the generation of viable new bone via distraction osteogenesis, high union rates, and the functional utilization of the limb during the treatment process. The exploration of distraction osteogenesis phenomenon triggered by tensile stress with the Ilizarov device served as a catalyst for progress in bone reconstruction surgery. Subsequently, the original technique has been utilized alongside several adaptations resulting from the introduction of novel fixation tools and methods of their application, such as hexapod external fixators and motorized intramedullary lengthening nails. It is crucial to possess a precise comprehension of the Ilizarov principles of deformity correction in order to effectively utilize this fixation system. In this article, we will discuss the history of Ilizarov frame, the basic sciences behind it, the mechanical principles governing its use, and the clinical application of the fixation system in our daily practice.