Method Of Osteosynthesis Research Articles

A preoperative planning method for long tubular bone osteosynthesis

Objectives the development of a preoperative planning method for long tubular bone osteosynthesis using the contralateral healthy bone.
 Material and methods.To justify the usage of the opposite limbs intact segment model in order to reconstruct the damaged one, their matching in shape and size was analyzed. We built three-dimensional models of the right and left segments of the upper limbs of 20 people and compared them using the Hausdorff distance calculation algorithm. For treatment of a 24-year-old patient with a closed humerus fracture, an individual stereolithographic surgical template with fracture lines was created with the help of computed tomography data of the healthy humerus bone processed by AUTOPLAN EXPERT software. This template was used for pre-bending the plate for osteosynthesis. The plate positioning on the template defined the surgical approach, taking into account the anatomical structures located in the projection of the fracture line and the plate. The technique of "reverse bone reposition" on the prepared plate was applied.
 Results.With the help of the created 3D models we revealed the size differences of the symmetrical segments of upper limbs. The greatest difference in the limits was registered in the area of the epiphyses (heads of the humeri) up to 6.8 mm, and the smallest throughout the entire diaphysis, less than 1.5 mm. Due to preoperative planning there were no intraoperative and postoperative complications, the installation of the plate and osteosynthesis was convenient. The fracture consolidation took place in 3 months.
 Conclusion.The proposed method has a number of advantages. It is possible to make a stereolithographic template even for a seriously damaged bone with a copied fracture line. This allows the surgeon to plan the details of osteosynthesis, to model the plate according to the template, to determine the required length and shape of the surgical approach, thus reducing the surgical risks and injury for the patient.

X-ray and macromorphological evaluation of reparative osteogenesis by implantation of hydroxyapatite composite doped with germanium

Fragmentary fractures require not only the use of complex methods of osteosynthesis, but also the replacement of the defect site with implants to optimize reparative osteogenesis. A large number of osteosubstitute materials are used, including hydroxyapatite ceramics. To enhance its osteointegration properties, microelements with osteoinductive properties are added. The aim of the work is X-ray and macromorphological evaluation of the influence of hydroxyapatite ceramics doped with germanium on reparative osteogenesis in model fractures of the femur and radius in rabbits. Model defects were formed in the radial diaphysis and femur metaphysis in rabbits with a drill with a diameter of 3 mm and 4.2 mm, respectively. Anesthesia included acepromazine, thiopenate, and lidocaine infiltration anesthesia. In the experimental group (n=12) defects were replaced by granules of hydroxyapatite ceramics doped with germanium, and in the control group (n=12) – undoped. The use of hydroxyapatite ceramics doped with germanium is accompanied by a moderate course of the inflammatory-resorptive phase of reparative osteogenesis. At the same time on the radiographs of animals of the experimental group on the 14th day the periosteal reaction is moderate, and on the 30th day it is barely noticeable with increased radiological density. In control animals after trauma to the compact bone proximal and distal to its location showed a thickened and compacted periosteum with a contrasting composite material. On the 60th day in the cancellous bone of experimental animals, the area of injury acquired an X-ray density close to normal, in the control – it remained elevated. Hydroxyapatin composite doped with germanium acquires osteoinductive properties and may be promising for the replacement of bone defects and correction of reparative osteogenesis in animals. Key words: bioceramics, germanium, bone fractures, compact and spongy bone tissue, rabbits.

Evaluation of usage of silicon-doped hydroxyapatite ceramics for treatment of fragmented bone fractures in dogs

None of the methods of osteosynthesis provides the consolidation of bone fragments which have lost contact with soft tissues. It makes extremely difficult treating of this type fractures. Bone defect between the fragments and absence of a primary biological matrix complicates revascularization, causes long-term life of the connective tissue and cells of cartilaginous phenotype in the fracture zone. It is leads to a long-term consolidation of the fracture. Composites of hydroxyapatite and calcium phosphates are considered as bioactive and therefore the most promising for bone defects replacing. The aim of this investigation was clinical, radiological and hematological evaluation using of silicon-doped ceramics for fragmented bone fractures in dogs. For study was chosen dogs with accidental fragmented fractures of tubular bones which treated by extracortical osteosynthesis method. Animal was divided into two groups. A bone defects were filled with ceramics (GTlKg-3) for experimental animal group (n = 7), while no filling of bone defects in control animal group(n = 7) was performed. Protocol of anesthesia included medetomidine, butorphanol tartrate and epidural anesthesia with 2 % lidocaine solution. Animals of the control group began to lean on the injured limb from the 12–15th day after surgery, while the animal of research group from the 8-9th day. Complete limb repair in dogs of the control group occurred on the 38–42th day, but such period for experimental group animals was shorter – 25–27th day after the osteosynthesis. X-ray investigation (60th day) of experimental group dogs showed new formed bone tissue with osteosclerotic zones without a periosteal reaction, bone tissue, with a normal view of the epiphyseal areas and the bone marrow cavity. This is evidence of localized reparative osteogenesis (within bone trauma only), and completed fracture consolidation. At the same time in cases of the control group we found lower X-ray density of new bone, periosteum was thickened with excessive proliferation of the endosteum, especially below the site of bone injury. Thus, in case the absence of hydroxyapatite matrix in bone defects there were compensatory increasing proliferation of periosteum and endoosteum. Fragmented fractures of tubular bones in dogs have occurred by erythrocytopenia, that quickly disappear due to the reparative osteogenesis in dog of experimental group. These animals have had leukocytosis increasing due to the first three days after osteosynthesis as a reaction to the implantation of a calcium-phosphorus composite material. Dogs of control group have had second wave of leukocytosis increasing on forty-second day associated with elongated remodeling process. Areparative osteogenesis can be accelerated in 1.5 times in case of replacement of bone defects with silicon doped hydroxyapatite ceramics. It is possibility realized thru moderate reduction of active phase of inflammation and acceleration of proliferative phase, mainly from endosteum side with early mineralization of bone regenerate. The dynamics of hematology parameters is a typical for the tubular bone consolidation that indicates about moderate inflammation and demonstrate biological tolerance of silicon-doped hydroxyapatite ceramics.

Surgical treatment of severe posttraumatic foot deformity

The surgical treatment of a 17-year-old patient with posttraumatic complex and rigid foot deformity by the transosseous osteosynthesis method by Ilizarov (original frame) is presented in the article. Previously, the patient incurred a fracture of the left tibia. He was treated by open reduction and internal fixation with a plate in the private clinic. Within four years, an equinovarus adductus foot deformity had developed. During our treatment, the deformity of the foot was eliminated without resection of the bones of this segment. After one year of treatment, the patient was satisfied with the functional condition of the foot, its cosmetic appearance, and the absence of pain in the foot. The American Orthopedic Foot and Ankle Society scale score increased significantly from 30 points preoperatively to 82 postoperatively, whereas the visual analog scale (VAS)-pain scale score decreased from 7 to 1. His ankle motion increased from 10 preoperatively to 29 postoperatively. This case demonstrates the possibilities of the Ilizarov method and our approach in the treatment of severe rigid foot deformities by the Ilizarov technique.

Longitudinal-cross-linking method of the sternum osteosynthesis – an additional way for the prophylaxis of deep sternal infection in cardiac surgery patients

The OBJECTIVE of the study was to compare the results of using the longitudinal – cross-linking method of sternum osteosynthesis with other methods (single wire stitches, 8-shaped wire stitches) for cardiosurgery patients.METHODS AND MATERIALS. The study included 3,150 patients, which were operated on in Samara cardiology dispensary named after V. P. Poliakov from 2012 to 2018. Patients were divided into 2 groups. Group 1 (1397 patients, operated on from 2012 to 2014) used single wire stitches or 8-shaped wire stitches for sternum osteosynthesis. Group 2 (1753 patients, operated from 2015 to 2018) used the longitudinal -cross-linking method of sternum osteosynthesis. The incidence of instability of the sternum without infection, superficial postoperative wound infection, deep sternal infection and hospital mortality were evaluated.RESULTS. Groups (1–68 % of men, average age (59.4±9,9) years; 2–68 % of men, average age 62.3±8.5) were significantly different in obesity patients (25.6 & 29.3 %, p=0.02), amount of smokers (50.5 & 64.2 %, p<0.001) and amount of urgent cases (3 & 10 %, p<0.001). The incidence of sternal instability without infection was less in group 2 (0.64 & 0.29 %; OR, 2.29; 95 % CI, 0.76 to 6.8; p=0.1). The amount of deep sternal infection was significant less in group 2 (1.6 & 0.6 %; OR, 2.53; 95 % CI, 1.2 to 5.2; p=0.009). The hospital mortality was 3.9 % in group 1 and 2.96 % in group 2 (OR, 1.34; 95 % CI, 0.9 to 1.9; p=0.1).CONCLUSION. The longitudinal-cross-linking method of sternum osteosynthesis is the available method that can significantly reduce the incidence of deep sternal infection in cardiosurgery.

Comparison of Maximum Mouth Opening Following Mandibular Bilateral Sagittal Splitting Ramus osteotomies in Class III Females Using Two Different Osteosynthesis Methods

Limitation of mouth opening is a common complaint following orthognathic surgery. This investigation reports on the progress of maximum incisal opening following orthognathic surgery and compares the impact of two different osteosynthesis methods on mouth opening in female patients with Class III dentofacial deformities. Forty cases of skeletal class III malocclusion were divided into twenty cases treated using the conventional single miniplate osteosynthesis method (P1) and twenty cases using the additional L-shaped miniplate osteosynthesis method (P2). No significant differences in pre-operative clinical status were detected between the P1 and P2 group, and all patients were managed with elastics in the post-operative period. Independent mouth opening exercises were initiated seven days after surgery, and inter-incisal distance was measured as maximum mouth opening (MMO) at 1week, 2weeks, and 1, 2, 3, 6months. Statistical analysis was performed in order to analyse differences in MMO between the P1 and P2 groups (Prism 7 GraphPad software, San Diego, CA). Values of P<.05 were considered to be significant. MMO significantly increased from 2weeks after surgery in both groups. The MMO of P2 was significantly larger than that of P1 in all experimental periods after surgery. MMO was statistically improved in P2 at 2months after surgery, while MMO in P1 was significantly smaller than the pre-operative MMO, even at 6months post-operative. A minimum MMO of 40mm was achieved by all patients. L-shaped miniplate osteosynthesis was more useful for early limitation of mandibular opening improvement than conventional single miniplate osteosynthesis.

Application of Finite Element Analysis in Oral and Maxillofacial Surgery-A Literature Review.

In recent years in the field of biomechanics, the intensive development of various experimental methods has been observed. The implementation of virtual studies that for a long time have been successfully used in technical sciences also represents a new trend in dental engineering. Among these methods, finite element analysis (FEA) deserves special attention. FEA is a method used to analyze stresses and strains in complex mechanical systems. It enables the mathematical conversion and analysis of mechanical properties of a geometric object. Since the mechanical properties of the human skeleton cannot be examined in vivo, a discipline in which FEA has found particular application is oral and maxillofacial surgery. In this review we summarize the application of FEA in particular oral and maxillofacial fields such as traumatology, orthognathic surgery, reconstructive surgery and implantology presented in the current literature. Based on the available literature, we discuss the methodology and results of research where FEA has been used to understand the pathomechanism of fractures, identify optimal osteosynthesis methods, plan reconstructive operations and design intraosseous implants or osteosynthesis elements. As well as indicating the benefits of FEA in mechanical parameter analysis, we also point out the assumptions and simplifications that are commonly used. The understanding of FEA’s opportunities and advantages as well as its limitations and main flaws is crucial to fully exploit its potential.

PECULIARITIES OF REVASCULARIZATION (OR ANGIOGENESIS) OF THE ALVEOLAR AGES USING DIFFERENT BONE-PLASTIC MATERIALS

Secondary anodontia, as a consequence of diseases of the dentoalveolar apparatus is the most common pathology among the population. The results of medical and statistical studies show an increase in the incidence of acquired anodontia in both adults and children.&#x0D; When teeth are lost, bone resorption occurs and this leads to a decrease in the thickness and height of the alveolar processes of the jaws by an average of 25-30%. In addition, there is a loss of bone walls of the dental alveolus, which causes a tissue defect. To eliminate defects and deformations of the walls of the alveolar processes of the jaws, the method of osteosynthesis of autografts in the form of a block of the bone of appropriate volume or controlled bone growth is used.&#x0D; Angiogenesis and blood supply to the cavitary defects of the jaw bones is one of the important indicators of bone graft integration and restoration of the authentic structure of bone tissue at the defect site.&#x0D; However, blood supply recovery depending on the type of graft has not yet been fully elucidated, which is why the study of angiogenesis in limited defects after their replacement by different types of grafts remains relevant.&#x0D; The aim of the research is to study of the features of revascularization of bone regenerates depending on the type of osteoplastic material used.&#x0D; Material and methods of experimental research&#x0D; Experimental studies were performed on 50 male Wistar rats weighing 270-380 g in the vivarium of the State Research Control Institute of Veterinary Drugs and Feed Additives (Lviv).&#x0D; The experimental animals were divided into 5 experimental groups.&#x0D; In groups 2 and 3, we used xenogenic bone-plastic materials:&#x0D; group 1 - healing took place under a blood clot (10 animals);&#x0D; group 2 - Bio-Oss® (Switzerland), a bone mineral of natural origin derived from bovine bone (10 animals);&#x0D; group 3 - Osteoplast-K (Russia), highly purified non-demineralized bone collagen isolated from cancellous bone, which contains sulfated glycosaminoglycans. (10 animals);&#x0D; In groups 4 and 5, we used bone-plastic materials based on calcium phosphate:&#x0D; group 4 - Easy-Graft) (Switzerland), material based on beta-tricalcium phosphate (10 animals);&#x0D; group 5 - Collapan-L (Russia), biocomposite material based on synthetic hydroxyapatite, collagen and antibiotic (lincomycin hydrochloride) (10 animals).&#x0D; The method of bone defect formation in experimental conditions. Under ether anesthesia in aseptic conditions after depilation of the operating field, we made an incision in the dorsal surface of the tibia, created access to the bone surface and formed two defects with a spherical boron (one on each side) according to the topographic and anatomical features of the tibia structure of experimental animals.&#x0D; The formed bone defect on one side was filled with osteoplastic material; on the opposite side, healing took place under a blood clot.&#x0D; It was found that when using osteoplastic materials Bio-Oss® and Osteoplast-K, the most active formation of blood vessels occurred from the 30th to the 60th day of the experiment (from 79.13 ± 2.67% to 81.83 ± 3.68% of vessels caliber 0-20 μm). When using materials Easy-Graft ™ and Collapan-L, the most active formation of vessels was observed from the 60th to the 90th day (from 45.24 ± 3.84% to 90.63 ± 1.63% of vessels of caliber 0-20 μm2). In the control group, where healing took place under a blood clot, the most active vascular formation was observed up to the 14th day (84.28 ± 1.36% of vessels of caliber 0-20 μm2) and up to the 60th day (82.01 ± 1.95%).

Complications associated with volar locking plate fixation for distal radius fractures in 1955 cases: A multicentre retrospective study.

Since volar locking plates (VLPs) have the benefits of more stable fixation and fewer complications, VLP osteosynthesis is now the preferred osteosynthesis method in the operative management of distal radius fractures (DRF). Along with the increases in operative management of VLP, the character and frequency of complications have changed. Thus, this multicentre study aimed to identify the characteristics of patients with DRFs who were treated with VLP fixation, describe the complication types and rates related to the procedure, and compare the results with those found in the literature. This retrospective multicentre study was conducted between January 2008 and December 2017. In total, data from 2225 patients over 17years old who underwent VLP fixation for DRF were screened. Patients with closed reduction and pinning, external fixation, dorsal plate fixation, and screw-only fixation were excluded. Finally, 1955 wrists from 1921 patients (86.3%) were included. The following types of complications were investigated: (1) tendon injury, (2) nerve-related, (3) fixation- and instrument-related, (4) osteosynthesis-related, (5) infection, and (6) others. The mean age of the patients was 60.3 ± 14.6years with 587 males (30.6%). Distal ulnar fractures were found in 940 wrists (48.1%). The mean interval between fracture and surgery was 6.2days, while the mean operative time was 68.3 ±30.3 minutes. The following complications were found: (1) nine (0.46%) and 12 (0.61%) cases of flexor pollicis longus and complete extensor pollicis longus tears, respectively; (2) nine cases (0.46%) of palmar sensory median nerve branch damage, 15 cases (0.77%) of complex regional pain syndrome, and 36 cases (1.84%) of carpal tunnel syndrome; (3) five cases (0.26%) of fracture displacement even after plate fixation, six cases (0.31%) of screw breakage, 26 cases (1.33%) of radiocarpal joint screw penetration, and 511 cases (26.14%) of implant removal; (4) five cases (0.26%) of delayed union and three cases (0.15%) of non-union; (5) 83 (4.25%) and two (0.1%) cases of superficial and deep infection, respectively; and (6) two cases (0.1%) of compartment syndrome and three cases (0.15%) of radial artery damage. After 10years of experience performing VLP fixation for DRFs in a multicentre setting, the results regarding complication types and rates support its use as a reasonable treatment option with low rates of complication.

Comminuted Fibular Head Fractures With Posterolateral Knee Instability: A Novel Repair Technique Using a Tension-Slide Device.

Comminuted proximal fibula fractures or arcuate fractures (OTA/AO 4F1B fractures) can defunction the posterolateral corner (PLC) and result in posterolateral knee instability. Ongoing posterolateral knee instability can limit function, cause significant pain, and lead to early knee arthrosis. The anatomy of the PLC and proximal fibula limits the options for repair of this injury. The ideal method for osteosynthesis of these injuries has not been established. The goals of treatment include reconstitution of posterolateral stability, restoration of the anatomic relationship of PLC structures, and restoration of bone stock that would permit future reconstruction. This article characterizes the injury pattern, outlines the technique, and provides the clinical and radiographic outcomes of osteosynthesis of comminuted fibular head fractures using a novel application of the tension-slide technique.

Finite element analysis of stress distribution on reconstructed mandibular models for autogenous bone grafts.

There are several challenges in terms of mandibular reconstruction. The defect size, graft materials, and plate combinations should be taken into consideration in surgical planning. The aim of this study was to evaluate the effect of different reconstruction variations on the stress distribution of segmental resected mandibles with two different defect sizes using finite element analysis (FEA). Computerized tomography images of a human mandible, fibula, and iliac crest were used as references to build three-dimensional (3D) models on a PC. The virtual plates and screws were used to simulate reconstruction of the mandibular defects. The models were divided into two groups based on the longitudinal defect size. Different osteosynthesis variations and autogenous graft material combinations were used to reconstruct the mandibles. In all models, higher von Mises stress values occurred on the mandibles reconstructed with the fibula than those with the iliac crest. Fixation of the bone grafts with a reconstruction plate for the 10-mm defects and using a mini-plate in addition to the reconstruction plate for the 30-mm defects decreased stresses on the grafted bones. Mandibular reconstruction with the iliac grafts is biomechanically superior to that with the fibular grafts. In addition, osteosynthesis methods and the defect size affect the stress distribution.

Surgical treatment outcomes of the Ilizarov and internal osteosynthesis methods in posttraumatic pseudarthrosis of the tibia\u2014a retrospective comparative analysis

IntroductionThis study compared surgical treatment outcomes of the Ilizarov and internal osteosynthesis methods in posttraumatic pseudarthrosis of the tibia.Material and methodsIn a retrospective comparative study, 75 patients were treated with the Ilizarov technique for aseptic posttraumatic pseudarthrosis of the tibia in the period 2000–2016. We compared them with the 51 patients from the control group, treated for tibial bone union disturbances using internal osteosynthesis methods, i.e., internal-fixation plates and intramedullary nails. The study groups were compared in terms of the rates of union, time to union, and the baseline-to-postoperative difference in lower leg deformity.ResultsUnion rate in the Ilizarov group was 100% and the control group was 51.92% (p < 0.001). The median time to union suggests that patients from the Ilizarov group needed a shorter time to achieve bone union (203.00 days vs. 271.00 days) (p = 0.091). The effect size in the Ilizarov group was larger both in terms of reducing both limb deformity and shortening (it is worth noting, however, that the Ilizarov treatment was used in patients with higher baseline values of both these parameters). We observed no significant difference in terms of time to union between the group of patients with at least one risk factor for disturbance in fracture healing and the group with no risk factors. The following risk factors were considered: diabetes mellitus, corticosteroid therapy, smoking, alcohol dependence, and advanced lower-extremity vascular disease (p = 0.827).DiscussionOur study demonstrated a high effectiveness of the Ilizarov method in the treatment of aseptic posttraumatic pseudarthroses of the tibia. The Ilizarov method seems to be worth considering in all cases where either the patient or the nature of injury is associated with additional risk factors and whenever there is a need for leg deformity correction or leg elongation.

All arthroscopic coracoclavicular button fixation is efficient for Neer type II distal clavicle fractures.

Neer type II distal clavicle fractures are associated with a high rate of non-union or malunion due to impaired coracoclavicular ligament stability. The purpose of this study was to assess the clinical and radiological outcomes of arthroscopically assisted indirect osteosynthesis for type II distal clavicle fractures using a cortical suture button device. Seventeen patients Neer type II fractures of the distal clavicle were treated surgically using cortical suture button fixation between 2012 and 2017. The clinical and radiological results were assessed using the American Shoulder and Elbow Surgeons Shoulder Score (ASES), Constant-Murley score and visual analogue scale (VAS) score. Anatomic reduction and bone healing were achieved in all patients at the final follow-up. The median age of the patients was 31years (range 19-57). The mean follow-up was 25.9months (range 14-64). The average delay before surgery was 2days (range 1-4). At the final follow-up, the mean ASES, Constant-Murley score and VAS score were 92.6 ± 3.2 (range 84.9-96.6), 96.2 ± 2.4 (range 92-100) and 0.47 ± 0.51 (range 0-1), respectively. All patients were able to resume work as well as sport activities. The postoperative complications included two coracoid process fractures, and none of the patients required additional surgery related to the index procedure. All arthroscopic coracoclavicular button fixation of Neer type II distal clavicle fractures would provide sufficient stability and union with satisfactory radiological and clinical outcomes. This arthroscopic fixation technique would be more efficient than other osteosynthesis methods because it is a minimally invasive surgery with a low complication rate. III.

Modern treatment approaches in patients with false joints and lower extremities long bones defects: analytical review

Research of effective treatment methods in patients with pseudoarthrosis and lower extremities long bones defects remains today very relevant. In the structure of traumatological patients general disability it takes up to 33.1% of cases. Surgical techniques are used, such as: intramedullary osteosynthesis, method of open reposition and bone fragments fixation by metal structures, method of transcutaneous osteosynthesis. They are recognized as effective treatment methods in patients with pseudoarthrosis and lower extremities long bones defects, that greatly improves treatment outcomes. Unfortunately, when they are used as single intervention, unsatisfactory therapy results occur in up to half of the cases. Concomitant structural and functional changes of the limb - such as regional blood circulation insufficiency, presence of extensive cicatrical soft tissues defects, changes in bone segment length, joints contractures, etc. - interferes bone consolidation and requires an application of additional treatment methods. Thus, the generally accepted treatment approach in patients with pseudoarthrosis and lower extremities long bones defects is a combination of surgery, pharmacotherapy, methods of physical therapy and physiotherapy in order to optimize the processes of osteoregeneration in non-union area.

Topographic-Anatomical Validation of a New Method for Minimally-Invasive Extra-Cortical Osteosynthesis Using Plastinated Transverse Shoulder Cuts

The aim of the studywas to assess capability and benefits of this method, its technical feasibility and safety regarding a damage of the most essential anatomical structures.Material and methods.The study involved 15 natural humeral bones; their parameters - the length and shape of the plates – were measured for osteosynthesis. Bone osteosynthesis was further performed on 14 intact upper limbs taken from 7 non-fixed corpses of people died at the age of 63–77 using the discussed method; after that, the operated limbs were studied using preparating technique. Furthermore, after plate application on two shoulder sections, 12 transverse cuts with their epoxy plastination were made at three levels according to the original technology; this was followed by the preparation of histotopographic sections.Results.The results obtained have demonstrated that for the new method of bone osteosynthesis it is advisable to use metal plates 220–260 mm long with spiral twisting clockwise for the right humerus and counterclockwise for the left. Average distances from the fixed plate to the humerus, tendon of the long head of the biceps of the shoulder muscle, large blood vessels and peripheral nerves were determined using precision preparation and measurements; the measurements were also performed on transparent plate-shaped shoulder cuts. All the above validates safety of the discussed method regarding a damage of the most essential anatomical structures and allow to successfully use it in the clinical practice.Conclusion.The discussed technique of plastinated transverse shoulder cuts with further experimental fixation of metal implants for osteosynthesis ensures safety of the initial topographic and anatomical relationships of these structures with anatomical structures. In addition, high transparency of the tissues created by epoxy plastination allows determining distances between implants and important anatomical structures with high precision, the fact being of great significance in applied anatomical studies.

Fibulo-scapho-lunate fusion after resection of the distal radius: Case series, review of the literature and critical analysis of bone fixation

Fibulo-scapho-lunate fusion is a technique that allows residual movement in the wrist in case of wide bone resection replacing the distal radius by a vascularised fibular transfer. Some authors have used this technique with favourable results but the distal synthesis seems to not be standardised at all, many different osteosynthesis methods have been proposed. This paper reports a complete review of the present day literature about this subject and, evaluating the different proposed osteosynthesis techniques referred in literature, suggests a standardization of the synthesis methods with dorsal plating. We report some technical considerations and results of three cases operated with a stable dorsal osteosynthesis (twice with a double plate and once with a long plate). We evaluate the time of healing and the clinical result.

Результаты хирургического лечения переломов надколенника

Introduction Patella fractures account for one percent of all fractures. Arthritis, non-union and other complications which affect the function of the lower limb may develop in the long term. The aim was to develop the most optimal osteosynthesis techniques for patella fractures. Methods We analyzed longterm treatment results of 78 patients with patella fractures treated from 2017 to 2018 using the KOOS (The Knee Injury and Osteoarthritis Outcome Score) scale, clinical examinations and knee joint X-rays. Based on the methods of surgical treatment for patella fractures, we divided the patients into 5 groups: Weber tension band wiring for two-fragment fractures; cross-like osteosynthesis and other methods of patella osteosynthesis using K-wires and wire loops for multifragmental fractures of the patella; combined osteosynthesis (tension band wiring with an additional screw or cerclage around patella); partial patellectomy and the inferior pole osteosynthesis. Results A comparative analysis of patients’ groups after surgical treatment of patella fractures using the KOOS scale showed the best results after Weber tension band wiring for transversal fractures (72 %). The results of patients with multifragmental fractures of the patella using K-wires and wire loops were positive in 64 %; after the restoration of the inferior pole in 68 %, after partial patellectomy in 57 %. Conclusion For transversal fractures of the patella, tension band wiring is the method of choice. With multifragmental patella fractures, good results are achieved by cross-like osteosynthesis and other methods using K-wires and wire bands. The use of patellectomy followed by wire loop locking should be avoided for all types of patella fractures. In fractures of the inferior pole of the patella, it is preferable to fix it to the main patella fragment.

Analysis of mortality after surgical treatment of periprosthetic distal femur fractures

IntroductionThe incidence of periprosthetic fractures of the knee is increasing due to the increase in the number of total knee arthroplasties performed, together with population aging. We found few studies that analyze mortality in our setting after surgery. Our objective was to evaluate mortality and survival after surgical treatment of periprosthetic fractures of the distal femur in our environment. Material and methodWe conducted a retrospective observational study of a consecutive series of 97 patients surgically treated in our centre for periprosthetic knee fracture between 2007 and 2015, with a minimum follow-up of 12 months. Diverse sociodemographic, clinical and surgical variables were analyzed. A consultation was made to the National Death Index of the Ministry of Health for the analysis of mortality and survival was analyzed using the Kaplan-Meier method. ResultsWe reviewed a total of 97 patients with an average age of 75 years, of which 86 were women and 11 were men. Of the patients, 50.5% of patients had some comorbidity. The average delay until the intervention was 3.1 days. With respect to the treatment, 45 patients were operated by osteosynthesis with plate (49.5%), 40 with intramedullary nail (41.2%) and 9 with revision of the arthroplasty (9.3%). A total of 30 deaths were recorded during the follow-up, with cumulative mortality in the first year, at 3 and at 10 years of 7.2%, 17.5% and 30.9%, respectively, progressively increasing in people over 75 years. There was no significant difference in mortality rates with the osteosynthesis method. The main complication was pseudoarthrosis (6.2%). ConclusionsPeriprosthetic knee fractures are associated with high rates of complications and mortality. The patient's age and the lesion itself are non-modifiable factors that can influence mortality after surgery, while other variables such as the type of intervention or surgical delay did not show differences in mortality rates in our study.

Análisis de la mortalidad tras el tratamiento quirúrgico de las fracturas periprotésicas de fémur distal

IntroductionThe incidence of periprosthetic fractures of the knee is increasing due to the increase in the number of total knee arthroplasties performed, together with population aging. We found few studies that analyze mortality in our setting after surgery. Our objective was to evaluate mortality and survival after surgical treatment of periprosthetic fractures of the distal femur in our environment. Material and methodWe conducted a retrospective observational study of a consecutive series of 97 patients surgically treated in our centre for periprosthetic knee fracture between 2007-2015, with a minimum follow-up of 12months. Diverse sociodemographic, clinical and surgical variables were analyzed. A consultation was made to the National Death Index of the Ministry of Health for the analysis of mortality and survival was analyzed using the Kaplan-Meier method. ResultsWe reviewed a total of 97 patients with an average age of 75years, of which 86 were women and 11 were men. Of the patients, 50.5% of patients had some comorbidity. The average delay until the intervention was 3.1days. With respect to the treatment, 45 patients were operated by osteosynthesis with plate (49.5%), 40 with intramedullary nail (41.2%) and 9 with revision of the arthroplasty (9.3%). A total of 30 deaths were recorded during the follow-up, with cumulative mortality in the first year, at 3 and at 10 years of 7.2%, 17.5% and 30.9%, respectively, progressively increasing in people over 75years. There was no significant difference in mortality rates with the osteosynthesis method. The main complication was pseudoarthrosis (6.2%). ConclusionsPeriprosthetic knee fractures are associated with high rates of complications and mortality. The patient's age and the lesion itself are non-modifiable factors that can influence mortality after surgery, while other variables such as the type of intervention or surgical delay did not show differences in mortality rates in our study.

Étude biomécanique comparative des ostéosynthèses mini invasives pour le traitement des fractures instables de l’anneau pelvien de type Tile C

BackgroundThe definite treatment of pelvic C-fractures presents a widely discussed issue and undergoes continuous evolution. While the stabilization of the posterior ring has been studied extensively, the fixation of the anterior pelvic ring continuous to be rarely investigated. The importance of the simultaneous stabilization however lays in the earlier mobilization and prevention of long-term damage to the pelvis. Therefore we investigated four combinations of minimally invasive fixation techniques for unstable type C1-3 pelvic injuries and aimed to answer the following research questions: (1) what combination of fixation methods yields the highest stiffness and the least displacement? (2) Is the combination of a single sacroiliac screw (SI-screw) with a transiliac internal fixator (TIFI) a reasonable alternative to two SI-screws? (3) Is a modified unilateral anterior fixation comparable to a retrograde transpubic screw? HypothesisMinimally invasive fixation techniques provide sufficient biomechanical stability for type C pelvic fractures. MethodsThirty synthetic full pelvises were divided into 5 groups, of which 4 groups were assigned a different osteosynthesis method and one was an intact pelvis used as reference (group 1: internal fixator+2 sacroiliac screws, group 2: internal fixator+transiliac internal fixator+1 sacroiliac screw, group 3: retrograde transpubic screw+2 sacroiliac screws, group 4: retrograde transpubic screw+transiliac internal fixator+1 sacroiliac screw). The pelvises underwent a protocol of cyclic loading between 100N and 200N, during which they were subjected to compression loads while the position of the fracture fragments was measured every 30 milliseconds. Displacement and stiffness were calculated for statistical analysis. ResultsThe minimally invasive fixation methods investigated in this study all provide sufficient biomechanical stability without one method being superior to the others (p [anterior displacement]=0.61 and p [posterior displacement]=0.88). Group 3 was allowed the least displacement (1.8±0.2mm for anterior and posterior fracture) for the treatment of a C1.3 fracture. The other fixation methods displayed the following dislocations (mm) of the anterior pelvic ring: group 1: 1.9±0.3, group 2: 2.1±0.4, group 4: 2.0±0.5. Posteriorly, the displacements (mm) were the following: group 1: 1.8±0.6, group 2: 1.9±0.2, group 4: 2.0±0.5. DiscussionThe minimally invasive fixation methods investigated in this study all provide sufficient biomechanical stability without one method being superior to the others since differences were not significant regarding anterior and posterior displacements. Even if not significantly, we could reveal that out of all the methods tested the combination of 2 SI-screws with a retrograde transpubic screw (group 3) displayed the least displacement and highest stiffness. These techniques could therefore potentially improve patient's clinical outcome by reducing the surgical invasiveness and procedure time while providing sufficient biomechanical stability. Level of evidenceIII, comparative in vitro study.