Large Bone Fragments Research Articles

Large Felid Tracks and Bones From Chilly Bowl Cave, Arkansas

Multiple large cat tracks were found within Chilly Bowl Cave, Arkansas, representing at least two individuals of the genus Panthera. Large felid bone fragments were also found in a passageway near the tracks. These poorly preserved skeletal remains primarily consist of metapodials and phalanges and represent the North American Pleistocene jaguar, Panthera onca. Fusion of metapodial epiphyses indicate adult foot size had been reached for this large jaguar. One set of tracks is also consistent with the size and morphology of P. onca. The other tracks are much larger than is known for extant or prehistoric jaguars, and are here attributed to Panthera atrox, the American lion. An alternate hypothesis for the smaller tracks is that they could represent a younger P. atrox instead of P. onca. Regardless of the inability to identify the smaller feline prints to species, these remains and tracks from Chilly Bowl Cave record cave utilization by two separate Pleistocene felids, interpreted here as jaguar and American lion.

Is preoperative glenoid defect size a reliable indicator of postoperative recurrence after arthroscopic Bankart repair in teenage competitive athletes?

Being younger than 20 years old at the time of arthroscopic Bankart repair (ABR) is known to be one of the most important risk factors for postoperative recurrence of instability. When deciding on the appropriate surgical approach, surgeons generally consider only the size of a critical glenoid defect, and most of them do not take into account factors such as the size of bone fragments and possible bone union after arthroscopic bony Bankart repair (ABBR). Therefore, this retrospective study aimed to clarify the risk factors for postoperative recurrence after ABR in teenage competitive athletes by focusing on glenoid rim morphologies and bone union. Participants were 115 teenage competitive athletes without a capsular injury who underwent primary ABR for chronic traumatic anterior instability and were followed for a minimum of 2 years. Possible risk factors for postoperative recurrence were investigated by univariate and multivariate analysis. In shoulders with a glenoid defect and bone fragment, the influence of glenoid defect size and bone fragment size on bone union after ABBR was also investigated. Postoperative recurrence was seen in 16 patients (13.9%). Regarding glenoid defect size, recurrence was seen in 1 (3.2%) of 31 shoulders with a glenoid defect smaller than 5% (including those with a normal glenoid), 15 (22.1%) of 68 shoulders with a glenoid defect of 5% to 20%, and 0 (0%) of 16 shoulders with a glenoid defect of 20% or larger (p=0.009). Regarding bone union, recurrence was seen in 4 (6.9%) of 58 shoulders with complete or partial bone union after ABBR and 8 (40%) of 20 shoulders with non-union or disappearance of the bone fragment (p=0.001). Regarding bone fragment size, recurrence was seen in 12 (20.7%) of 58 shoulders with a small or no bone fragment (<7.5%) and in 3 (8.6%) of 35 shoulders with a large bone fragment (>7.5%; p=0.154). Multivariate analysis identified non-union or disappearance of the bone fragment after ABBR as a significant risk factor for recurrence. Complete or partial bone union was seen in 25 (58.1%) of 43 shoulders with a small bone fragment (<7.5%) and 33 (94.3%) of 35 shoulders with a large bone fragment (>7.5%; p<0.001). In teenage competitive athletes, bone union after ABBR affects postoperative recurrence after ABR, regardless of the preoperative glenoid defect size, and bone union rate after ABBR is significantly influenced by bone fragment size.

Glenoid rim morphology in young athletes with unstable painful shoulders: primarily painful vs. frankly unstable

To investigate the characteristics of glenoid rim morphology in young athletes (<40 yr) with unstable painful shoulder. This was a retrospective case series. The inclusion criteria were as follows: (1) shoulder pain during sports activity, (2) traumatic onset, (3) no complaint of shoulder instability, and (4) soft tissue or bony lesions confirmed on imaging examinations (computed tomography and magnetic resonance imaging). The above-mentioned painful cohort was then compared (in a 2:1 ratio) to a match-paired control group of patients with similar demographics but with frank anterior glenohumeral instability as defined by imaging and physical findings. The pain (not apprehension) was reproduced during the anterior apprehension test in supine position and relieved by relocation test in all patients. Glenoid rim morphology, bone union in shoulders with a fragment-type glenoid, glenoid defect size, bone fragment size, medial displacement of bone fragments (MDBF), and medial distance of erosion (MDE) were compared between painful shoulders and unstable shoulders. There were 79 painful shoulders and 165 unstable shoulders. The glenoid rim morphology was normal in 33 shoulders, erosion-type in 15 shoulders, and fragment-type in 31 shoulders among painful shoulders, whereas the respective shoulders were 19, 33, and 113 among unstable shoulders (P<.001). Bone union was complete in 15 shoulders, partial in 14 shoulders, and nonunion in 2 shoulders among painful shoulders, whereas the respective shoulders were 43, 31, and 39 among unstable shoulders (P=.001). The mean glenoid defect size was 6.0±7.2% and 12.7±7.4%, respectively (P<.001), and the mean bone fragment size was 5.8±6.4% and 5.4±4.6%, respectively, (P=.591). The mean MDBF was 1.4±1.5 mm and 3.0±2.2 mm, respectively (P<.001), and the mean MDE was 2.3±1.2 mm and 5.2±2.4 mm, respectively (P<.001). In shoulders with a smaller glenoid defect (<13.5%), the prevalence of shoulders with MDBF (<2 mm) and shoulders with MDE (<2 mm) was more frequent in painful shoulders. On the other hand, in shoulders with a larger glenoid defect (≥13.5%), erosion-type glenoid, nonunion in fragment-type glenoid and bone fragment smaller than 7.5% was not recognized in painful shoulders. Shoulders with MDBF (<2 mm) were significantly more frequent in painful shoulders (P=.009). In painful shoulders normal or erosion-type glenoid was predominant, and glenoid defect size was significantly smaller than unstable shoulders. On the other hand, a large bone fragment (≥7.5%) remained and united completely or partially in all shoulders with a larger glenoid defect (≥13.5%). Bone union was obtained within 2 mm from the articular surface in most of them.

The prevalence of shoulders with a large glenoid defect and small bone fragment increases after several instability events during conservative treatment for traumatic anterior instability

Unstable shoulders with a large glenoid defect and small bone fragment are at higher risk for postoperative recurrence after arthroscopic Bankart repair. The purpose of the present study was to clarify the changes in the prevalence of such shoulders during conservative treatment for traumatic anterior instability. We retrospectively investigated 114 shoulders that underwent conservative treatment and computed tomography (CT) examination at least twice after an instability event in the period from July 2004 to December 2021. We investigated the changes in glenoid rim morphology, glenoid defect size, and bone fragment size from the first to the final CT. At first CT, 51 shoulders showed no glenoid bone defect, 12 showed glenoid erosion, and 51 showed a glenoid bone fragment [33 small bone fragment (<7.5%) and 18 large bone fragment (≥7.5%); mean size: 4.9±4.2% (0-17.9%)]. Among patients with glenoid defect (fragment and erosion), the mean glenoid defect was 5.4±6.6% (0-26.6%); 49 were considered a small glenoid defect (<13.5%) and 14 were a large glenoid defect (≥13.5%). While all 14 shoulders with large glenoid defect had a bone fragment, small fragment was solely seen in 4 shoulders. At final CT, 23 of the 51 shoulders persisted without glenoid defect. The number of shoulders presenting glenoid erosion increased from 12 to 24, and the number of shoulders with bone fragment increased from 51 to 67 [36 small bone fragment and 31 large bone fragment; mean size: 5.1±4.9% (0-21.1%)]. The prevalence of shoulders with no or a small bone fragment did not increase from first CT (71.4%) to final CT (65.9%; P=.488), and the bone fragment size did not decrease (P=.753). The number of shoulders with glenoid defect increased from 63 to 91 and the mean glenoid defect significantly increased to 9.9±6.6% (0-28.4%) (P<.001). The number of shoulders with large glenoid defect increased from 14 to 42 (P<.001). Of these 42 shoulders, 19 had no or a small bone fragment. Accordingly, among a total of 114 shoulders, the increase from first to final CT in the prevalence of a large glenoid defect accompanied by no or a small bone fragment was significant [4shoulders (3.5%) vs. 19 shoulders (16.7%); P=.002]. The prevalence of shoulders with a large glenoid defect and small bone fragment increases significantly after several instability events.

The process of bone union after arthroscopic bony Bankart repair in younger athletes with a subcritical glenoid defect: An advantage of remained large bone fragment

BackgroundThe purpose of the present study was to investigate the bone union process after arthroscopic bony Bankart repair (ABBR) in shoulders with a subcritical glenoid defect of 13.5% or larger. MethodsBone union process after ABBR performed from 2011 to 2018 were retrospectively investigated in 47 athletes younger than 30 years with a subcritical glenoid defect, who underwent CT at least twice postoperatively. The change of bone union between first CT within 6 months and final CT later than 6 months was investigated, especially noticing bone fragment size (≥7.5% versus <7.5%). ResultsThe mean period at first CT and at final CT was 4.1 ± 0.6 months (3–6 months) and 16.8 ± 11.6 months (7–71 months), respectively. From the first to final CT, among 15 shoulders with a small bone fragment (<7.5%), complete union increased from 4 shoulders (26.7%) to 8 shoulders (53.3%), while among 32 shoulders with a large bone fragment (≥7.5%), complete union increased from 15 shoulders (46.9%) to 25 shoulders (78.1%). On the other hand, while non-union or disappeared bone fragment was recognized in 8 shoulders (53.3%) with a small fragment and in 2 shoulders (6.3%) with a large fragment at first CT, it was solely recognized in 4 shoulders (26.7%) with a small fragment and in no shoulders with a large fragment at final CT. While postoperative glenoid fracture at the site of bone union was recognized in 7 shoulders, complete union was finally obtained after conservative treatment in 5 shoulders. So, final complete union was obtained in 9 (60%) of 15 shoulders with a small fragment and in 29 (90.6%) of 32 shoulders with a large fragment (p = 0.021). ConclusionsIn shoulders with a subcritical glenoid defect, when a large bone fragment (≥7.5%) was repaired, complete union rate was higher and complete union could be obtained earlier.

Allogeneic osteoplastic materials for reconstructive surgery of combat injuries

The number of operations with the use of osteoplastic materials is increasing annually, which is explained by the increasing number of high-tech operations, reconstructive interventions for bone pathology, oncoorthopedics, bone deformities, as well as tissue defects resulting from combat trauma. Bone as an object of transplantation and is preferable because the use of bone tissue and materials made on its basis creates the necessary conditions for biological restoration of bone as an organ.&#x0D; The modern trend is the development of regenerative medicine technologies and the development of modified materials with improved and predetermined properties osteoplastic materials ceased to be static structures and their inertness gave way to functional activity.&#x0D; The article describes the basic advantages of bone tissue and allogenic osteoplastic materials for their prospective use in reconstructive and reconstructive surgery of the musculoskeletal system. Data on the experience in the use of donor bone tissues for homoplasy at the clinic of military traumatology and orthopedics of the Kirov Military Medical Academy are presented. The advantages of allogeneic decellularized tissues for use in clinical and scientific practice are considered. The importance of preserving the architecture of native tissue for successful bone transplantation is shown. Decellularization is a method that allows the removal of immunogenic agents from tissues and organs, including cells and residual DNA, preserving the natural composition and architecture of the extracellular matrix for the most effective use of allogeneic bone tissue. The use of decellularized allogenic bone tissue purified to a mineral-collagen matrix or demineralized is the most practical option among other osteoplastic materials when large bone fragments need to be replaced.

Second-look arthroscopic and magnetic resonance analysis after internal fixation of osteochondral lesions of the talus

The purpose of this study was to evaluate cartilage quality after internal fixation of osteochondral lesion of the talus (OLT) using second-look arthroscopies and MRIs. Thirty-four patients underwent internal fixation of OLTs involving large bone fragments. Twenty-one of these patients underwent second-look arthroscopies and 23 patients underwent MRIs postoperatively. The arthroscopic findings were assessed using the International Cartilage Repair Society (ICRS) grading system, and the MRI findings were evaluated using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. Five of the patients who underwent second-look arthroscopies showed normal cartilage, 12 showed nearly normal cartilage, 3 showed abnormal cartilage, and 1 showed severely abnormal cartilage, according to the overall ICRS repair grades. All the patients who achieved bone fragment union showed normal, or nearly normal cartilage upon second-look arthroscopy. The ICRS and MOCART scores were significantly higher for the patients with bone fragment union compared to those with nonunion (ICRS scores: 10.3 ± 1.5 vs. 6.0 ± 2.0, p < 0.001, MOCART score: 88.3 ± 10.0 vs. 39.0 ± 20.4, p < 0.001). Low signal intensities of the bone fragments on preoperative T1-weighted MRIs were not associated with nonunion (Fisher's exact test, p = 0.55), and the signal intensities increased postoperatively to levels similar to the underlying talus when bone union was achieved. Second-look arthroscopy and MRI showed normal, or nearly normal, cartilage after internal fixation of OLTs when bone union was achieved. The nonunion of bone fragments resulted in inferior cartilage quality.

CRANIOTOMY WITH A HERMETIC CLOSURE OF THE CRANIAL CAVITY

Surgical intervention on the contents of the cranial cavity is universally carried out by applying several burr holes, which remain uncovered and serve as a site for the development of a number of postoperative complications. The lack of hemeticity of the skull in some cases require repeated intervention. The purpose of the proposal is to create a trepanation method that excludes the formation of burr holes and promotes hermetic closure of the cranial cavity, excluding the possibility of postoperative complications.The goal is achieved by sawing out conical holes in the skull with the simultaneous formation of small bone flaps in the form of a truncated cone. A large bone fragment of a derivative form is cut out with the proposed tool or in the usual way with a Gigli or Olivecrona saw. In the absence of contraindications, a large bone flap is placed in place, and small bone fragments are combined with the place of their sawing, thereby restoring the integrity of the skull, which is closed at the end of the intervention.The hermetic craniotomy method eliminates the possibility of developing postoperative complications inherent in craniotomy methods, carried out by applying burr holes.The method of craniotomy, which provides for hermetic closure of the cranial cavity, among other things, returns the brain to its natural state, protected from all kinds of external influences, including postoperative complications

Comparative study of Iselin's technique for the treatment of Bennett's fracture with large and small fragments.

Objective:The thumb is very exposed to trauma due to its position and function. Fractures of the base of the first metacarpal bone are very frequent in hand traumatology. Most Bennett’s fractures are treated surgically. However, the optimal surgical approach is controversial. The aim of this study is to compare the results of closed reduction and percutaneous pinning in the treatment of Bennett’s fracture of the base of firsthand metacarpal in fractures with both small and large fragments.Methods:We studied retrospectively the data of 40 patients treated for a Bennett’s fracture in the department of orthopaedic and traumatologic surgery between January 2016 and December 2018. The purpose of this study was to compare the functional (pain, grip strength, first web space opening and thumb opposition) and radiological (quality of reduction and arthritic changes) results of the Iselin’s technique for the treatment of Bennett’s fractures in two groups of patients with large and small bone fragments according to the size of articular surface detached with the antero-medial fragment (superior or inferior to 25%).Results:The average age of the patients was 34 (range = 19–66) years. Males were by far the most affected (90%). We noted 24 cases of large fragment fractures (60%) and 16 cases of small fragment fracture (40%). An excellent overall functional result was found in 68.8% of cases of small fragment fractures versus 50% of cases of large fragment fractures. Radiological results were roughly similar.Conclusion:All surgical techniques aim to restore the articular congruence to the best, maintain the opening of the first web space and obtain a stable and painless trapezo-metacarpal joint. The Iselin’s technique is simple, inexpensive and easy to perform even by inexperienced surgeons. It yields satisfactory results in most cases of Bennett’s fracture regardless of the size of the fragment.

Remaining Large Bone Fragment of a Bony Bankart Lesion in Shoulders With a Subcritical Glenoid Defect: Association With Recurrent Anterior Instability

Background: A preoperative glenoid defect of 13.5% or larger is recognized as a subcritical glenoid defect at arthroscopic Bankart repair (ABR) for collision/contact athletes or military personnel. Purpose: To clarify the prevalence and size of remaining bone fragments in shoulders with a subcritical glenoid defect at recurrent anterior instability and to investigate the influence on postoperative recurrence after ABR for younger competitive athletes. Study Design: Cohort study; Level of evidence, 4. Methods: The study included 96 shoulders with recurrent instability that underwent ABR between July 2011 and March 2018 for shoulders with a subcritical glenoid defect. The patients were divided into 2 groups according to the glenoid defect size (13.5%-<20%, medium; ≥20%, large). The bone fragment size in each defect group was retrospectively investigated and classified into 4 groups (no, 0%; small, >0%-<5%; medium, 5%-<10%; large, ≥10%). The postoperative recurrence rate for each combination of glenoid defect size and bone fragment size was investigated for competitive athletes aged <30 years. The fragments, when present, were repaired to the glenoid. Results: The glenoid defect size was 13.5%-<20% in 60 shoulders (medium defect group) and ≥20% in 36 shoulders (large defect group). The mean bone fragment size was 6.7% ± 5.1% and 8.9% ± 4.9%, respectively (P = .042). In the medium defect group, there were 15 shoulders (25%) without a bone fragment, 6 shoulders (10%) with a small fragment, 23 shoulders (38.3%) with a medium fragment, and 16 shoulders (26.7%) with a large fragment. In the large defect group, the respective numbers were 2 shoulders (5.6%), 6 shoulders (16.7%), 14 shoulders (38.9%), and 14 shoulders (38.9%). A medium or large bone fragment was more common in the large defect group (P = .252). Among 64 younger competitive athletes who underwent ABR with a minimum of 2 years of follow-up, postoperative recurrence was recognized in 7 of 38 (18.4%) athletes in the medium defect group, but it was not recognized in any of the 26 athletes in the large defect group (P = .036). Postoperative recurrence was recognized in 4 of 12 (33.3%) athletes with a small fragment or no fragment and in 3 of 52 (5.8%) athletes with a medium or large fragment (P = .019). Conclusion: A larger bone fragment frequently remained in shoulders with a subcritical glenoid defect at recurrent instability. The postoperative recurrence rate after ABR for younger competitive athletes was low when a remaining larger bone fragment was repaired.

Unusual caudal cervical fracture in a dog

AbstractA 14‐month‐old entire male Saint Bernard dog was presented at the emergency department for paralysis after a head trauma. Computed tomography examination revealed an atypical fracture of C6 with a large free bone fragment in the dorsolateral part of the vertebral canal, originating from the vertebral body. A C6–C7 Funkquist B dorsal laminectomy was performed to remove this intracanalar fragment. A dorsal stabilization using lag screws inserted into the articular facets of C5–C6 and C6–C7 was also performed. The surgical procedure maintained vertebral column stability and allowed a complete functional recovery. The present article exposes the diagnosis and therapeutic management of an original cervical fracture, discusses the choice of a stabilization technique for the caudal cervical spine and the possible underlying predisposing factors that could have led to this unusual fracture.

A Glenoid Defect of 13.5% or Larger Is Not Always Critical in Male Competitive Rugby and American Football Players Undergoing Arthroscopic Bony Bankart Repair: Contribution of Resultant Large Bone Fragment

To investigate bone union and postoperative recurrence after arthroscopic bony Bankart repair (ABBR) in male competitive rugby and American football players with a subcritical glenoid defect of ≥13.5% and to compare findings with those in players with a glenoid defect of <13.5%. Participants were male competitive rugby or American football players with a glenoid defect and bone fragment who underwent ABBR from July 2011 to December 2018 and were followed for a minimum of 2 years. We investigated the influence of glenoid defect and bone fragment size on bone union and postoperative recurrence after ABBR. We included 45 rugby players and 35 American football players. A total of 38 shoulders were assigned to the small defect group (<13.5%) and 42 to the large defect group (≥13.5%). The complete bone union rate was 47.4% in the small defect group and 71.4% in the large defect group (P= .040), and postoperative recurrence was seen in 13 (34.2%) and 5 shoulders (11.9%), respectively (P= .030). In the small defect group, the bone fragment size was <7.5% in 30 shoulders and ≥7.5% in 8 shoulders; in comparison, the respective numbers were 12 and 30 shoulders in the large defect group, and large fragments (>7.5%) were significantly more common in this group (P < .001). The complete union rate was significantly higher in shoulders with a large fragment (≥7.5%) than in those with a small fragment (<7.5%; 78.9% versus 42.9%, respectively; P= .001). The recurrence rate was 33.3% in shoulders with a small fragment (<7.5%) and 10.5% in shoulders with a large fragment (≥7.5%; P= .017) and was significantly lower in shoulders with a complete union than in those without a complete union (6.3% versus 46.9%, respectively; P < .001). The postoperative recurrence rate after ABBR was lower in male competitive rugby and American football players with a large glenoid defect (≥13.5%) than in those with a small glenoid defect (<13.5%) and might be associated with a higher rate of complete bone union of the resultant large bone fragment (≥7.5%). III, case-control study.

Morphological and compositional analyses of coprolites from the Upper Cretaceous Bauru Group reveal dietary habits of notosuchian fauna

The fluvial deposits of the Adamantina Formation (Upper Cretaceous, Bauru Group) have produced a rich fossil vertebrate record of fishes, amphibians, lizards, snakes, turtles, dinosaurs and mammals. However, the record of notosuchians (Crocodylomorpha) is remarkable in terms of both diversity and number of findings. Here, we report a large number of new coprolites found in association with skeletons of crocodylomorphs from the Adamantina Formation in the cities of Jales and Fernandópolis, São Paulo State, Brazil, and discuss their meaning for the understanding of feeding habits of their producers. The coprolites from Jales were found mostly together with adult skeletons of baurusuchids and crocodylomorph egg clutches, while the coprolites from Fernandópolis are associated with adult sphagesaurids and juvenile and adult baurusuchid skeletons, and rare crocodylomorph egg clutches. Forty-one coprolites were analysed encompassing different degrees of preservation. The X-ray diffraction showed the coprolites are comprised mainly of fluorapatite. The presence of bone fragments in some coprolites, together with their typical crocodylomorph cylindrical shape with rounded ends, strongly indicates that Baurusuchidae not only are carnivores, but that also ingested large bone fragments. On the other hand, the coprolites assigned to Sphagesauridae generally show a more complex chemical composition and present plant remains within which indicate this group, at least in part, fed on plants. Our results reinforce the importance of these ichnofossils as an independent source of information on the feeding habits of their producers and add new evidence these two groups of crocodylomorphs fed on different food sources.

Arthroscopic Fixation of Os Acetabuli and Labral Repair: Suture-on-Screw Technique

Os acetabuli is thought to be the result of an unfused ossification center or an acetabular rim fracture in the setting of femoral-sided femoroacetabular impingement syndrome. Historically, patients with symptomatic hips have been treated with resection alone; however, in patients with large bone fragments or with reduced acetabular coverage prior to surgical intervention, iatrogenic dysplasia and structural instability may develop after resection. Therefore, for patients with an acetabular os, labral tearing, and cam-type femoroacetabular impingement, internal fixation of the os acetabuli, femoral osteochondroplasty, and labral repair have been described. We propose a “suture-on-screw” arthroscopic technique to simultaneously address both the labral tear and os acetabuli, thereby reducing the number of suture anchors required for labral fixation, leading to an efficient and cost-effective approach for the treatment of these patients.

Internal Fixation of Osteochondral Lesion of the Talus Involving a Large Bone Fragment

Background: Internal fixation of an osteochondral lesion of the talus (OLT) can restore the congruency of the talus and maintain the subchondral bone and innate hyaline cartilage. However, OLT that is indicated for fixation is rarely encountered; hence, not many studies report on the results after the procedure. Purpose: To evaluate the clinical and radiological outcomes after internal fixation of chronic OLT involving a large bone fragment of at least 10 mm in diameter and 3 mm in depth on computed tomography (CT). Study Design: Case series; Level of evidence, 4. Methods: We retrospectively reviewed the data of 26 patients with OLT treated with internal fixation between August 2014 and April 2018. Of the patients, 15 were male and 11 were female, with a mean age of 16 years (range, 11-29 years). The primary radiological outcome measurement was bone union assessed on the 6-month postoperative CT scan. Clinical outcomes were assessed at a mean of 27.7 months postoperatively. Results: Twenty patients (77%) achieved bone union on postoperative CT scan. The mean 100-mm visual analog scale (VAS) improved from 30.5 ± 8.5 preoperatively to 13.4 ± 9.7 postoperatively (P < .001). The mean Foot Function Index (FFI) improved from 30.5 ± 6.7 preoperatively to 13.7 ± 9.8 postoperatively (P < .001). A malleolar osteotomy was not necessary to approach the lesion in 88% of patients. A bone fragment with an irregular margin and low density on the preoperative CT scan was significantly associated with nonunion (odds ratio: 7.67, 95% confidence interval: 2.67 to 22.02, P = .008). The difference in clinical outcomes between patients with skeletally immature ankles and those with skeletally mature ankles was not statistically significant. Patient age did not correlate with postoperative 100-mm VAS (Pearson correlation coefficient, r = −0.07, P = 0.72) or the postoperative FFI (Pearson correlation coefficient, r = –0.05, P = .80). Conclusion: Internal fixation of an OLT involving a large bone fragment resulted in satisfactory clinical and radiologic outcomes. We found that patients with skeletally immature and mature ankles attained healing at comparable rates after the internal fixation of OLT.

Novel Pathology Classification System (FEMASK-Score) for Charcot Neuropathic Arthropathy Reveals Intraneural Vasculopathy and Predicts Outcome

Category:Basic Sciences/Biologics; Ankle; Diabetes; Midfoot/ForefootIntroduction/Purpose:Charcot neuropathic arthropathy (CNA) is a debilitating, rapidly destructive degenerative joint disease that occurs in diabetic, neuropathic midfoot. Clinicoradiologic assessment for CNA previously relied on Eichenholtz Stage. There is limited data on CNA histopathology. The goal of this study was to independently develop a histopathologic scoring system for Charcot neuropathic arthropathy.Methods:Retrieval of surgical pathology specimens from neuroarthropathic CNA patients (2012-2019) were analyzed to evaluate joint soft tissue and bone. Considering progression from large to small periarticular bone fragments to resolution, we devised and applied a CNA FEMASK-score (named after coauthors): 0= intraneural arteriolosclerosis; 1= large bone fragments without host histiocytic response; 2= mixed bone fragments with host histiocytic response; 3= small minute bone spicules resorption to fibrosis. Clinical modified Eichenholtz staging and outcome were then compared the CNA FEMASK-score to assess for associations between these three elements.Results:Forty-eight cases of CNA included 34 males and 14 females, mean age 60.3 and age range 28-83 years, with clinical diabetes mellitus (predominantly Type II) and longstanding neuropathy. Elevated HbA1C, Eichenholtz stage, American Society of Anesthesia score, and Charlson comorbidity index were predictive of amputation. Pathologic specimens varied from fixation tissue to amputation. In addition to neurotraumatic, neurovascular and inflammatory findings, a distinctive intraneural hyalinized arteriolosclerosis was observed. FEMASK-scores:1 = 10%, 2= 58%, and 3=32%. FEMASK-score comparisons were 98% accurate compared with the modified Eichenholtz criteria scores of each patient and 98% reproducible among pathologists. FEMASK 2 and 3 correlates strongly with amputation.Conclusion:Our novel CNA FEMASK-score classification, derived from the largest cohort of diabetic neuropathic specimens, is reproducible, explains pathophysiology, correlates with Eichenholtz, and predicts amputation. The unique intraneural vasculopathy observed contributes to CNA etiology.

Novel FEMASK-score, a histopathologic assessment for destructive Charcot neuropathic arthropathy, reveals intraneural vasculopathy and correlates with progression and best treatment

BackgroundCharcot neuropathic arthropathy is a debilitating, rapidly destructive degenerative joint disease that occurs in diabetic, neuropathic midfoot. Clinicoradiologic assessment for Charcot neuropathic arthropathy previously relied on Eichenholtz stage. There is limited histopathologic data on this entity. We wanted to independently develop a histopathologic scoring system for Charcot neuropathic arthropathy. DesignRetrieval of surgical pathology midfoot specimens from Charcot patients (2012–2019) were analyzed to evaluate joint soft tissue and bone. Considering progression from large (≥half 40× hpf) to small (<half 40× hpf) periarticular bone fragments to resolution, we devised and applied a Charcot neuropathic arthropathy novel FEMASK-score (named after coauthors: Fanburg-Smith, Frauenhoffer, Flemming, Fritsche, Elfar, Murie, Aynardi, Stauch, Smith, King, and Klein): 0 (initial) = the observed intraneural arteriolosclerosis in all diabetic neuropathic patient specimens (not observed in other diabetic nerves); and finally scored with the most destruction observed: 1 = large bone fragments without host histiocytic response; 2 = mixed bone fragments with host histiocytic response; 3 = small minute bone spicules resorption to fibrosis. Eichenholtz stage and outcome were then compared. ResultsForty-eight cases of Charcot neuropathic arthropathy included 34 males and 14 females, mean age 60.3 and age range 28–83 years, with clinical diabetes mellitus (predominantly Type II) and longstanding neuropathy. Elevated HbA1C, Eichenholtz stage, American Society of Anesthesia score, and Charlson comorbidity index indicated initial clinical amputation. Pathologic specimens varied from fixation tissue to amputation. In addition to neurotraumatic, neurovascular and inflammatory findings, a distinctive intraneural hyalinized arteriolosclerosis was observed. FEMASK-scores: 1 = 10%, 2 = 58%, and 3 = 32%. Score comparisons were 98% accurate compared with Eichenholtz and 98% reproducible among pathologists. FEMASK 2 and 3 correlate with clinical need for amputation. ConclusionsOur novel Charcot neuropathic arthropathy FEMASK-score classification, derived from the largest cohort of diabetic neuropathic specimens, is reproducible, explains pathophysiologic progression of destructive phase of Charcot, correlates with Eichenholtz, and predicts progression to or clinical need for amputation. The unique intraneural vasculopathy observed contributes to Charcot neuropathic arthropathy etiology.

Finite Element Analysis of Existing and Modified Intramedullary Rod for Orthopedic Applications

Finite Element Analysis (FEA) has been used in the field of biomedical engineering and especially in biomechanics, which helps to predict and validate feasible designs for complex cases. The role of biomechanics has grown steadily in the field of orthopedic surgery. For example, fixation was performed to stabilize a large femoral bone fragment. Femoral injury is analyzed in real time, and the experiment provides a three-dimensional visualization of finite elements designed to explain the mechanical properties of the femur. Modified trapezoidal nail shape is used in the modified intramedullary rod setup in order to obtain additional strength and stability. It also provides resistance to femoral head rotation. Potentially it improves patient mobility and recovery since the modified design is in par with the anatomy of the human femur bone.

Miniplate osteosynthesis in fracture surgeries: Case series with review of concepts

PurposeMiniplates were initially developed as targets for foot and hand fractures, but they have been used in the treatment of fixation of small bone fragments, reduction of long bone fractures and non-union treatment, which have been difficult to treat. In this study, the authors used miniplates to treat fractures of the upper extremities, lower extremities, and pelvis obtained good outcomes. Herein, the authors report these good outcomes and review the current concept of miniplates. Patients and methodsForty-two patients treated with miniplates between March 2012 and March 2017 who attended follow-up for > 1 year were included in this retrospective study. Miniplates were selected according to purpose, which was classified into three categories: fixation, reduction, and stability enhancement. For fixation, miniplates were used to fix distal fibular fractures occurring distal to the syndesmosis and treat patellar and olecranon fractures with severe comminution. For reduction, miniplates were used to reduce the tibia during intramedullary nailing in tibiofibular shaft fractures, while reduction was performed in advance of definitive plating fixation in patients with humeral and pelvic fractures. To enhance stability, the miniplate was inserted after autobone graft for atrophic nonunion at the humeral shaft following nail insertion. The validity of a miniplate was analyzed by reviewing the published literature on the use of miniplates in orthopedic fracture surgeries. ResultsBony union was achieved in all cases. No specific postoperative complications were observed; however, mild pain and limited range of motion observed in two patients were resolved after implant removal. Sixteen studies on fracture treatment using miniplates reported clinically fair outcomes. ConclusionMiniplates are not just small metal plates. Depending on the location and treatment of the fracture, the miniplate can effectively fix small bone fragments, help the main plate to maintain the reduction of large bone fragments, and increase the fixation force for nonunion treatment.

Reliable isolation of human mesenchymal stromal cells from bone marrow biopsy specimens in patients after allogeneic hematopoietic cell transplantation

Isolation of mesenchymal stromal cells (MSCs) from pretreated, hematologic patients is challenging. Especially after allogeneic hematopoietic cell transplantation (HCT), standard protocols using bone marrow aspirates fail to reliably recover sufficient cell numbers. Because MSCs are considered to contribute to processes that mainly affect the outcome after transplantation, such as an efficient lymphohematopoietic recovery, extent of graft-versus-host disease as well as the occurrence of leukemic relapse, it is of great clinical relevance to investigate MSC function in this context. Previous studies showed that MSCs can be isolated by collagenase digestion of large bone fragments of hematologically healthy patients undergoing hip replacement or knee surgeries. We have now further developed this procedure for the isolation of MSCs from hematologic patients after allogeneic HCT by using trephine biopsy specimens obtained during routine examinations. Comparison of aspirates and trephine biopsy specimens from patients after allogeneic HCT revealed a significantly higher frequency of clonogenic MSCs (colony-forming unit–fibroblast [CFU-F]) in trephine biopsy specimens (mean, 289.8 ± standard deviation 322.5 CFU-F colonies/1 × 106 total nucleated cells versus 4.2 ± 9.9; P < 0.0001). Subsequent expansion of functional MSCs isolated from trephine biopsy specimen was more robust and led to a significantly higher yield compared with control samples expanded from aspirates (median, 1.6 × 106; range, 0–2.3 × 107 P0 MSCs versus 5.4 × 104; range, 0–8.9 × 106; P < 0.0001). Using trephine biopsy specimens as MSC source facilitates the investigation of various clinical questions.