Implants For Fractures Research Articles

The occurrence of dental implant malpositioning and related factors: A cross-sectional cone-beam computed tomography survey.

PurposeDental implants are widely used for the rehabilitation of edentulous sites. This study investigated the occurrence of dental implant malpositioning as shown on post-implantation cone-beam computed tomography (CBCT) and to identify related factors.Materials and MethodsSamples with at least 1 malpositioned dental implant were collected from a central radiology clinic in Tehran, Iran from January 2017 to January 2019. Variables such as demographic characteristics, length and diameter of implants, type of implant, sites of implant insertion, different types of implant malpositioning problems (cortical plate perforation, interference with anatomical structures), angulation of the implant, and the severity of malpositioning were assessed. In addition, the incidence of implant fracture and over-drilling was evaluated. Data were statistically analyzed using the chi-square test, 1-sample t-test, and Spearman correlation coefficients.ResultsIn total, 252 patients referred for implant postoperative CBCT evaluations were assessed. The cases of implant malpositioning included perforation of the buccal cortical plate (19.4%), perforation of the lingual cortical plate (14.3%), implant proximity to an adjacent implant (19.0%), implant proximity to an adjacent tooth (3.2%), interference with anatomical structures (maxillary sinus: 18.3%, mandibular canal: 11.1%, nasal cavity: 6.3%, mental foramen: 5.6%, and incisive canal: 0.4%). Implant fracture and over-drilling were found in 1.6% and 0.8% of cases, respectively. Severity was categorized as mild (9.5%), moderate (35.7%), severe (37.7%), and extreme (17.1%), and 52.4% of implants had inappropriate angulation.ConclusionCBCT imaging is recommended for detecting dental implant malpositioning. The most common and severe type of malpositioning was buccal cortex perforation.

Manufacturing of customized implants for orbital fractures using 3D printing

An orbital fracture is a traumatic injury to the bone in the eye socket. These fractures modify the orbital bone dimensions and the functioning of the intraorbital contents. In this study, a surgical method that includes positioning, aligning and fixing implants to restore orbital fractures was adapted. Notably, it is difficult to achieve an original three-dimensional orbital shape through the process of forming and cutting implants; however, this problem was solved by creating customized implants using computed tomography (CT) images of the patient. The objective of this work is to reconstruct the damaged orbital floor defects by means of a 3D printed implant and restore the orbital floor to its original shape. A case study of an orbital fracture has been included in this study. CT images were used to create a computer-aided design (CAD) model of orbital floor implants, which were designed to maintain orbital floor symmetry from right to left and vice versa. Furthermore, the designed implants were manufactured through a material extrusion process with biocompatible material. The application of the material extrusion process with biocompatible material resulted in the fabrication of implants at a minimal cost. Therefore, the customized models used in the patient’s intra-operation can minimize the operational time and maximize surgical safety.

Effect of crown to implant ratio and implantoplasty on the fracture resistance of narrow dental implants with marginal bone loss: an in vitro study

BackgroundPeri-implantitis is a biological complication that affects soft and hard tissues around dental implants. Implantoplasty (IP) polishes the exposed implant surface, to decontaminate it and make it less prone to bacterial colonization. This study investigates whether a higher clinical crown-to-implant-ratio (CIR) reduces implant fracture resistance and whether implants are more fracture-prone after IP in the presence of 50% of bone loss.MethodsForty-eight narrow platform (3.5 mm) 15 mm long titanium dental implants with a rough surface and hexagonal external connection were placed in standardized bone-like resin casts leaving 7.5 mm exposed. Half were selected for IP. The IP and control groups were each divided into 3 subgroups with different clinical CIRs (2:1, 2.5:1 and 3:1). The implant wall width measurements were calculated using the software ImageJ v.1.51 through the analysis of plain x-ray examination of all the samples using standardized mounts. A fracture test was performed and scanning electron microscopy was used to evaluate maximum compression force (Fmax) and implant fractures.ResultsIP significantly reduced the implant wall width (P < 0.001) in all reference points of each subgroup. Fmax was significantly higher in the 2:1 subgroup (control = 1276.16 N ± 169.75; IP = 1211.70 N ± 281.64) compared with the 2.5:1 (control = 815.22 N ± 185.58, P < 0.001; IP = 621.68 N ± 186.28, P < 0.001) and the 3:1 subgroup (control = 606.55 N ± 111.48, P < 0.001; IP = 465.95 N ± 68.57, P < 0.001). Only the 2.5:1 subgroup showed a significant reduction (P = 0.037) of the Fmax between the controls and the IP implants. Most fractures were located in the platform area. Only 5 implants with IP of the 2:1 CIR subgroup had a different fracture location (4 fractures in the implant body and 1 in the prosthetic screw).ConclusionsIP significantly reduces the fracture resistance of implants with a 2.5:1 CIR. The results also suggest that the CIR seems to be a more relevant variable when considering the resistance to fracture of implants, since significant reductions were observed when unfavorable CIR subgroups (2.5:1 and 3:1 CIR) were compared with the 2:1 CIR samples.

Risk Factors Contributing to Early Implant Fracture in Silicone Metacarpophalangeal Joint Arthroplasty for Patients With Rheumatoid Arthritis

To identify the risk factors associated with early implant fracture of silicone metacarpophalangeal (MCP) joint arthroplasty using the volar hinge silicone implant for patients with rheumatoid arthritis. We retrospectively reviewed 113 fingers of 31 hands that underwent MCP joint arthroplasty between 2008 and 2014, with a minimum follow-up of 3 years,. An implant fracture within 3 years after surgery was regarded as an early implant fracture. Patient records were reviewed for potential risk factors of age, affected fingers, ulnar drift angle, and range of motion of the MCP joint before surgery and 1 year after surgery. Candidate risk factors were compared at the level of the digit and at the patient level. With fracture of the implants as the end point, Kaplan-Meier estimated survival rate was 74.3% at 3 years and 67.9% at 5 years. Early implant fracture was detected in 29 fingers. Bivariate analyses showed significant associations between early implant fracture and MCP joint arc of motion before surgery, MCP joint flexion range 1 year after surgery, and MCP joint arc of motion 1 year after surgery. Multiple logistic regression analysis showed that increased MCP joint flexion range 1 year after surgery was an independent risk factor for early implant fracture. Increasing MCP joint flexion range was associated with increased fractures of the implants. We propose that the MCP joint flexion range should be restricted to less than 60° in postoperative rehabilitation; it is necessary to educate the patient to permanently avoid excessive flexion of the MCP joint. Therapeutic IV.

Screw placement in two different implants for proximal humeral fractures regarding regional differences in bone mineral density: An anatomical study

BackgroundThe aim of this study was to investigate proximal humerus plating regarding drill depth and over penetration of the glenohumeral joint and to find a relation between these findings and different areas of bone mineral density (BMD) in the humeral head. Material & MethodsThe study sample involved 45 upper extremities from human adult cadavers. Two different plates (HOFER; PHILOS) were applied to the proximal humerus. Each hole was drilled until the respective participant thought to have placed the drill bit subchondral. Next, penetration of the far cortex was conducted to determine the residual bone stock. Additionally, the point of screw penetration of the far cortex was identified for each hole of the plates and allocated to five regions with different bone mineral density as described by Tingart et al. ResultsThe screw penetration rate and the residual bone stock were compared within the 5 BMD regions. A significantly thicker residual bone stock was found at the central region (SD ± 13.1 mm) than in the anterior region (SD ± 9.5 mm) and in the posterior region (SD ± 8.5 mm). The anterior region revealed a significantly higher penetration rate than the posterior region (p = 0.01) and the central region (p = 0.03). ConclusionThe anterior region of the humeral head was associated with a higher over penetration rate of the far cortex into the glenohumeral joint and a decreased bone stock after subchondral drilling representing a reduced bone mineral density (BMD). Level of evidenceCadaver Study

Results of extensively coated femoral stem in revision hip replacement

Introduction: Revision hip replacement following failed previous hip arthroplasty or internal fixation (dynamic hip screw for intertrochanteric fractures) presents a major surgical challenge. Proximal fitting revision stems do not achieve adequate fixation. Distal fixation with long-stemmed extensively coated cementless implants (like the Solution™ system) affords a suitable alternative. We present our results of 25 patients treated with extensively coated cementless revision stems. Materials and Methods: Twenty five patients with severely compromised proximal femora following either failed hip arthroplasty or failed internal fixation (dynamic hip screw fixation for intertrochanteric fractures) were operated by the senior author over a two-year period. six patients had aseptic loosening of their femoral stems following cemented hip replacements, with severe thinning of their proximal cortices and impending stress fractures. Ten patients had secondary hip arthritis following failure of implants for comminuted intertrochanteric or subtrochanteric femoral fractures. Nine patients had peri-implant fracture following previous primary hip replacement. All patients were treated by removal of implant (cemented or uncemented stems/DHS implants) and insertion of long-stemmed extensively coated cementless revision (‘Solution™ DePuy, Warsaw (IN), US’) stems along with press-fit acetabular component (Duraloc Cup, DePuy, Warsaw (IN), US). Nine patient with peri-implant fracture and five having compromised proximal femora after inter trochanteric fracture needed osteotomy and undergone encerclage wiring. One patient had protrusion of acetabular cup with deficient acetabular wall in which anti protrusion cage was used. Results: All patients were primarily kept in bed on physiotherapy for six weeks and then gradually progressed to weight-bearing walking over the next six to eight weeks. The Harris Hip Scores and patient satisfaction were used for final evaluation. We achieved good results in the two years duration of study. Out of 25 patients, cerclage wiring was done for peri-implant fractures and osteotomy in 14 patients. One patient had a intraoperative fracture extending into subtrochantric area while hammering in the stem. Post cerclage wiring, she was put on a long knee brace and her mobilization was delayed to 12 weeks. Conclusions: The extensively coated cementless (‘Solution™’) femoral stem provides a reasonable ‘solution’ to the deficient femur in hip revision. The proximal femoral deficiences can be relatively easily adressed and distal fixation can be achieved with this stem. Extreme care needs to be taken to avoid fractures and penetration of the femoral shaft, which can, however, be managed by cerclage wiring. successful outcome can be assured by preservation of the functional continuity of the abduction apparatus, care to recognize and prevent distal extension of fracture while inserting the stem and supervised gradual rehabilitation post operatively.

Orbital Implants in Orbital Fracture Reconstruction: A Ten-Year Series.

Retrospective comparative interventional series of all patients who had undergone orbital fracture repair by 2 senior orbital surgeons in a single tertiary trauma center from January 2005 to December 2014. To compare the outcomes of different implants used for various types of orbital fractures. Patients were evaluated by age, gender, etiology of fracture, clinical findings, type of fractures, and implant used. Main outcome measures included restoration of premorbid state without morbidity and complications including enophthalmos, diplopia, infraorbital hypoesthesia, and ocular motility restriction 1 year after fracture repair. Implant-related complications were collected for analysis. There were a total of 274 patients with 307 orbits reconstructed. Thirty-three (12.0%) patients sustained bilateral injuries; 58.0% (n = 178) of orbits had simple fractures (isolated orbital floor, medial wall, or combined floor and medial wall). The distribution of implants used were bioresorbable (n = 117, 38.1%) and prefabricated titanium plates (n = 98, 31.9%) depending upon the nature of fracture. Bioresorbables, titanium plate, and porous polyethylene were used significantly more than titanium mesh for simple fractures, and prefabricated anatomic titanium implants were used significantly more than the other implants for complex fractures. There was a statistically significant improvement in diplopia, enophthalmos, ocular motility, and infraorbital hypoesthesia (p-value < 0.001) 1 year following orbital fracture reconstruction. When used appropriately, diverse alloplastic materials used in orbital fracture repair tailored to the indication aid orbital reconstruction outcomes with each material having its own unique characteristics.

Investigation of Biomechanical Characteristics of Orthopedic Implants for Tibial Plateau Fractures by Means of Deep Learning and Support Vector Machine Classification

An experimental comparative study of the biomechanical behavior of commonly used orthopedic implants for tibial plateau fractures was carried out. An artificial bone model Synbone1110 was used and a Schatzker V type tibial plateau fracture was created in vitro, then stabilized with three different implant types, classic L plate, Locking Plate System (PLS), and Hybrid External Fixator (HEF). The stiffness of the bone—implant assembly was assessed by means of mechanical testing using an automated testing machine. It was found that the classic L plate type internal implant has a significantly higher value of deformation then the other two implant types. In case of the other implant types, PLS had a better performance than HEF at low and medium values of the applied force. At high values of the applied forces, the difference between deformation values of the two types became gradually smaller. An Artificial Neural Network model was developed to predict the implant deformation as a function of the applied force and implant device type. To establish if a clear-cut distinction exists between mechanical performance of PLS and HEF, a Support Vector Machine classifier was employed. At high values of the applied force, the Support Vector Machine (SVM) classifier predicts that no statistically significant difference exists between the performance of PLS and HEF.

Schatzker II tibial plateau fractures: Anatomically precontoured locking compression plates seem to improve radiological and clinical outcomes

IntroductionThe design of anatomically precontoured locking compression plates (LCP) allows the placement of angular stable screws right underneath the reduced joint surface fragments. To date, there is a lack of evidence supporting the broad utilization of these implants in split depression fractures to the lateral tibial plateau. Thus, aim of the present matched pair retrospective cohort study was to investigate the radiological and clinical outcomes of anatomically precontoured LCP compared to conventional plate and screw osteosynthesis in Schatzker II fractures. Material and methodsThe institutional databank was searched for Schatzker II fractures from 2010 to 2016. Patients that underwent open reduction and internal fixation with anatomically precontoured 3.5 mm LCP or conventional 4.5 mm l-shaped plates and screws were included. CT scans and radiographs were analyzed. Details of the operative procedures and secondary events were collected. A matched pair analyses was conducted in a best fit manner. The primary outcome parameter was the Rasmussen Radiological Score approximately one year postoperatively. Secondary outcome parameters were the medial proximal tibial angle (MPTA), the Rasmussen Clinical Score and the WOMAC Score after a follow up of at least three years. ResultsA total of 50 patients was included. Patient age, gender distribution, size and depression depth of the lateral joint surface fragments, frequency of utilizing bone grafts or substitutes and lateral meniscus repair as well as subsequent implant removal were comparable across the groups. Immediately postoperatively, the Rasmussen Radiological Score revealed no differences. After a mean of 64.2 weeks, the radiological outcome was significantly better in the LCP 3.5 group (RRS 8.2 vs. 6.3 points, p<0.001; MPTA 89.5 vs. 92.0°, p = 0.001). After a mean clinical follow-up of 4.5 years, the Rasmussen Clinical Score (22.9 vs. 27.8 points, p<0.001) and the WOMAC score (24.3 vs. 16.0 points, p = 0.04) revealed significantly impaired results in the conventional group. ConclusionAnatomically precontoured LCP prevent the subsidence of the reduced joint surface fragments more sufficiently and allow for improved patient outcomes compared to conventional plates and screws. The utilization of anatomically precontoured LCP should therefore closely be considered for internal fixation of any split depression fractures to the lateral tibial plateau.

Supracutaneous locking compression plate as an external fixator in compound metaphyseal and diaphyseal fractures of tibia

Background: Most of lower leg external fixation are bulky and cumbersome and provides only temporary bony stabilization. Anatomically pre-contoured supracutaneous LCP has been utilized by many authors as an external fixator in patients with metaphyseal and diaphyseal fractures of tibia. Aim: The aim of this study is to analyse the end result of Supracutaneous LCP as a definitive external fixation and its effect on rate of union in metaphyseal and diaphyseal fractures. Materials and methods: A complete of 30 patients of compound fractures of tibia underwent “supracutaneous plating” of the tibia using an LCP. Average age was 44 years. Regular screw tract dressings were done. Average period of follow-up was 13 months. Results: The plate was kept ex situ for a period of 24-30 weeks. Proximal metaphysis, diaphysis and distal metaphysis united in 14 weeks, 20 weeks and 16 weeks respectively. Total of 30 patients were operated for Supracutaneous LCP of which one complicated with Infected Non-union resulting in implant removal and other complicated with Non-union which later underwent internal fixation. Conclusion: In compound fractures of tibia supracutaneous LCP are often used as a definitive external fixator because it gives good results especially for metaphyseal fractures and fewer complication rates, with Adequate stability. Advantageous effect of LCP in facilitating wound healing, cosmetic surgery procedure. Because it does not strike the contralateral leg therefore cosmetically acceptable and functional while ambulation. Because of nonoverlapping of implants fracture healing is easily assessed on x rays.

Antegrade Elastic Intramedullary Nailing Insertion Technique Results in Higher Incidence of Symptomatic Implants in Pediatric Ulnar Fractures.

Introduction:Retrograde and antegrade nailing techniques are the two options available to a surgeon when using elastic stable intramedullary nailing; however, the literature comparing these two nailing techniques is scarce. Thus, we conducted a retrospective review of all pediatric and adolescent ulnar fractures treated with elastic stable intramedullary nailing at our facility. We hypothesize that the clinical outcomes (implant and wound complications) and the time between surgery and radiographic union will be similar for both techniques.Methods:A retrospective chart review of pediatric ulnar fracture patients treated at our facility was performed. Demographic and health information associated with the injury were collected, and the clinical outcomes of the two techniques were compared.Results:A total of 53 patients with 54 fractures were included in this study. Antegrade nail insertion was used to treat 59.2% fractures. Radiographic union was achieved in all patients. Nail insertion technique was not associated with postoperative wound complications, time to radiographic union or implant removal, or significant deficits in upper extremity rotation (P > 0.05). Antegrade nailing resulted in a symptomatic implantation 3.97 times more frequently than compared with retrograde nailing (P = 0.036).Discussion:Antegrade nailing demonstrates a similar healing profile but higher implant complications compared with the retrograde nailing technique in pediatric ulnar fractures.

Definition of a drilling protocol for mini dental implants in different bone qualities

Mini dental implants (MDI) have proven to be a good alternative of the conventional implants to support lower overdentures in elderly edentulous patients with narrow residual ridge. The aim of the present study was to define drilling protocols for each diameter of the MDI in each bone quality. The number and the diameter of the drilling bur and the drilling depth was investigated.A total of 48 MDIs with a ball head and transgingival collar were used to the drilling protocol in four different bone qualities (Q1–Q4). All available four diameters of the implants were included: 1.8mm, 2.1mm, 2.4mm, and 2.9mm. The length of all implants was 15mm. Three different protocols were prepared for each of the four bone qualities and for each implant diameter. The insertion torques and the primary stability of the implants were measured in their final position.Regardless of implant diameter and bone quality, the insertion torque was significantly higher using drilling protocol 1 than 3 and using drilling protocol 2 than 3 as well. The insertion torque was significantly higher in bone quality Q1 than in Q2–Q4. The unscrewing resulted in considerably increase in the torque, which exceeded the insertion torques by up to two times. This repeatedly led to the bending and fractures of implants.

Osteosynthesis of the Mandibular Condyle With Magnesium-Based Biodegradable Headless Compression Screws Show Good Clinical Results During a 1-Year Follow-Up Period

The use of titanium-based implants in mandibular condyle fractures can require implant removal because of screw penetration through the condylar surface. The use of biodegradable implants can avoid a second operation for implant removal and the associated possible complications. We investigated the clinical and radiologic outcomes of osteosynthesis of mandibular condyle fractures (MCFs) with biodegradable magnesium-based compression screws. We performed a retrospective observational study of 6 patients who had been treated at our department. We recorded the changes in jaw movements over time, occlusion, and possible complications at defined intervals of 1, 3, 6, and 12months postoperatively. We also compared the preoperative computed tomography (CT) scans with the postoperative cone-beam CT (CBCT) scans at 6 and 12months postoperatively to evaluate mandibular condyle healing and screw degradation. Of the 6 patients, 4 were men and 2 were women, with a mean age of 43.2years (range, 30 to 66years). All 6 patients had unilateral MCFs. All the patients showed well-restored function of the temporomandibular joint with significant improvement in mouth opening (46.17±6.49mm), right (10.67±1.03mm) and left (10.67±1.97mm) laterotrusion, and protrusion (10.17±1.33mm) distances to physiologic values. The CBCT scans showed the remodeling processes of the mandibular condyle and a few radiolucencies indicating the magnesium-based screws. Although penetration of 1 screw tip through the condylar surface had occurred, no implant removal was necessary owing to biodegradation of the implant. The results of the present study have shown that biodegradable magnesium-based compression screws provide good clinical results and avoid implant removal.

Multicenter Study of the Incidence and Fracture-associated Factors of Dental Implant Fractures in 10 Private Dental Clinics in Kyushu

Multicenter Study of the Incidence and Fracture-associated Factors of Dental Implant Fractures in 10 Private Dental Clinics in Kyushu

A study of an operative outcome of a basitrochanteric fractures of the hip treated by dynamic hip screw and enders nail with percutaneous canulated cancellous screw

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Basicervical or cervicotrochanteric fracture of the femur is considered stable variety of fracture pattern. Most common incidence is seen in elderly patient and in young patient with probably high energy trauma. Appropriate Osteosynthesis confers excellent outcome when reduction is optimally achieved.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 86 basitrochanteric fractures had been treated with enders nail or dynamic hip screw (DHS) at our institute by a single surgeon. Implant selection was done purely based on plain radiograph, associated co-morbidities and fracture geometry. Patients had been followed up at 1 month, 3 month and 6 month.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study there were 86 patients out of which 63 patients (73.25%) were treated with enders nail and 23 patients (26.74%) were treated with DHS. Mean age of patients was 57 years. We noted minimum follow up of 8 months while maximum follow up of 4.5 years where as mean follow up duration is 18 months. We almost noted excellent to fair results in both groups.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Most of the implants in basitrochanteric fractures worked on control collapse principle. Both DHS and enders nail with percutaneous cc screw follow this principle and when used with a proper technique, optimal reduction usually fetch the favourable outcomes with minimalistic approach.&lt;/p&gt;

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Introduction The severity of intra-articular fractures of the distal tibia results from the morphological features of this segment, and therefore, bone injury is combined with trophic soft tissue disorders. Open reduction and internal fixation have a negative effect on reparative processes in the local morphological structures, and complications such as soft tissue necrosis, infection, infected and deforming osteoarthritis, or nonunion may develop. The aim was to show a clinical case of a stage-by-stage treatment of an intra-articular fracture of the distal tibia using minimally invasive methods, reduction with the Ilizarov apparatus and closed intramedullary osteosynthesis with a modified ChM nail. Results and discussion The Ilizarov apparatus was used for primary reduction and stabilization of the fracture that enabled to eliminate gross displacements and to align the axis of the segment. After the edema had ceased and soft tissue condition improved, closed intramedullary osteosynthesis was implemented with a modified ChM nail. Conclusion A staged approach to manage intra-articular fractures of the distal tibia enables to avoid additional soft tissue trauma and results in good clinical outcomes. The available metal intramedullary implants for intra-articular fractures are imperfect, but their modification may improve stability and decrease the risks of postoperative complications if the number of holes for locking is increased.

Symptomatic cystic lesions as late post-operative complications of silicone implantation for orbital wall fracture reconstruction: A long-term follow-up study

Although complications of silicone implants and development of new materials have led to a decline in the use of silicone implants for orbital wall fractures, their advantages are still reported. The overall incidence, risk factor and treatment of silicone implant complications, especially those caused by cystic lesions, remain unclear. We aimed to report our experiences of patients with orbital wall fractures that were reconstructed with silicone implants and followed up for a long period. We retrospectively analysed 56 patients who underwent surgical repair of the orbital wall fractures with a silicone implant from January 2006 to December 2017 and were followed up for more than 6 months. A chart review and the assessment of demographic and surgical factors, among others, were performed. There were 47 eligible patients in this study, and the mean post-operative follow-up period was 83.1 months. When comparing the results obtained 6 months post-operatively with those obtained at the final follow-up, the overall complication rate increased from 5/47 to 13/47, and the silicone implant removal rate increased from 0/47 to 10/47. The symptoms caused by the cystic lesions were managed through silicone implant removal. The immediate post-operative bleeding was significantly associated with silicone implant survival (p = 0.008). Silicone implants used for orbital wall fractures were never stabilised during the long-term study. Much attention should be paid during the follow-up of high-risk patients. Most late complications were caused by cystic lesions, and only silicone implant removal would be sufficient and considered safe as the initial intervention.

Fibular Nail Fixation: Topical Review.

Intramedullary implants have been used historically in long bone fractures with success. In recent years, a variety of intramedullary implants for the treatment of fibular fractures have been investigated. These various implants have not been assessed together in a cohesive manner. In this review, we assess implants used for intramedullary fixation of fibular fractures with respect to implant design and clinical results. A comprehensive systematic literature review for intramedullary implants in fibular fractures was performed. All publications that assessed intramedullary fibular implants were reviewed. In total, 11 different intramedullary nails were found. Clinical results obtained from these studies were reviewed. The intramedullary implants used for fibular fracture fixation generally fell into one of 3 categories: an unlocked longitudinal strut, an implant roughly equivalent to a large screw, or a more traditionally locked intramedullary nail. Reported clinical results were generally good, although inconsistent outcome reporting greatly limited comparison between studies. Complication rates varied with the implants but were generally low. Intramedullary implants for fibular fracture stabilization have changed over the years to improve stability. Although clinical results are limited, data suggest that these implants are safe and can potentially approximate more traditional implants. Level II, systematic review.

Application of Biodegradable Materials in Orthopedics

To compare the advantages and disadvantages of biodegradable and non-degradable implants in orthopedic fractures. Recent original articles about biodegradable and non-degradable implants for fracture fixation were reviewed extensively, and a comprehensive retrospective analysis was performed. Standard orthopedic treatment is to use non-degradable metal implants to fixate the fracture site. This kind of treatment not only causes rejection and stress shielding, but also requires a second surgery to remove the metal implants. In addition, this kind of treatment increases physical pain and is a serious financial burden to patients. However, biodegradable implants do not require a second surgery for removal and have good biocompatibility and osteoconductivity. Biodegradable implants do not require a second surgery for removal and have good biocompatibility and osteoconductivity. Consequently, they are an ideal treatment and are increasingly used for orthopedic surgical patients. The most common indications for biodegradable implants include craniofacial reconstruction, anterior cruciate ligament reconstruction, meniscus repair, ankle fracture treatment, and tibia and fibula fracture treatment.

Re-expansion of Osteoporotic Compression Fractures Using Bilateral SpineJack Implants: Early Clinical Experience and Biomechanical Considerations.

Thoraco-lumbar osteoporotic compression fractures have a higher incidence of continued collapse with development of deformity and progression to vertebra plana when untreated and even after vertebral augmentation (VA) or balloon kyphoplasty (BKP). Even when there is the restoration of height and improvement in angulation, multiple long-term follow-up series have repeatedly documented that over time, many patients lose the initial height correction and in a smaller group the vertebral body re-collapses leading to the development of progressive deformity with an increased risk for adjacent level fractures. At first, larger balloons and more cement were used to try and avoid these problems, but it did not reduce the risk of adjacent fractures. Several procedures were developed to place various types of intervertebral implants combined with bone cement to maintain the initial height correction. Initial studies with these implants showed a reduction in adjacent level fractures but the systems did not proceed to market. The SpineJackR (SJ) system (Stryker Corp, Kalamazoo, MI), consisting of bilateral expandable titanium implants supplemented with bone cement, was first used approximately 10 years ago in Europe and recently gained FDA approval in the United States. This system provides more symmetric and balanced lateral and anterior support and is effective with lesser amounts of bone cement compared to BKP. Follow-up studies have documented that there is equal or better pain control, with better long-term results based both on maintaining vertebral height restoration and deformity correction. Most importantly, statistically it clearly reduces the risk of adjacent level fractures by at least 60%. The biomechanical effects of intravertebral implants for osteoporotic fractures in regard to the risk of adjacent level fractures and preliminary experience with the use of the SJ is reviewed.