Osteosynthesis In Patients Research Articles

Long term clinico-radiological outcome of osteosynthesis in patients with femoral neck fracture: A retrospective study

Introduction: Fracture of the neck of femur continues to be one of the major orthopaedic injuries. It occurs in elderly patients with osteoporosis or in young patients suffering high energy trauma. Aims and Objectives: To evaluate long term clinico-radiological outcome of osteosynthesis in patients with femoral neck fracture. Material and Methods: Fifty patients of femoral neck fracture who underwent osteosynthesis with lag screw fixation or with valgus intertrochanteric osteotomy were studied. The patients were divided into 2 groups; Group-I (n=16) comprised of patients in whom osteosynthesis with lag screws was done and Group-II (n=34) patients had undergone valgus intertrochanteric osteotomy. Results: In Group-I at an average follow up of 41.8 weeks no patient had non-union or AVN, all heads were viable, 6.25% had OA hip & intraarticular implant penetration, 93.7% had Harris hip score from good to excellent, d’Aubigne & Postel score from good to very good & SF-36 score below 10 whereas at an average follow up of 142.37 weeks 6.25% had non-union, 75% heads were viable, 25% had AVN & OA hip, 6.25% had intraarticular implant penetration, 75% had Harris hip score from good to excellent, d’Aubigne & Postel score from good to very good & SF-36 score below 10. In Group-II at an average follow up of 55.44 weeks 2.94% had non-union, 94.12% heads were viable, 5.88% had AVN, 8.82% had OA hip, no intraarticular implant penetration, 88.23% had Harris hip score from good to excellent, 91.17% had d’Aubigne & Postel score from good to very good & 79.41% had SF-36 score below 10 whereas at an average follow up of 159.3 weeks 2.94% had non-union, 82.36% heads were viable, 17.64% had AVN, 41.17% had OA hip, 2.94% had intraarticular implant penetration, 73.53% had Harris hip score from good to excellent, 72.22% had d’Aubigne & Postel score from good to very good & 70.58% had SF-36 score below 10. Conclusion: Rate of union was found to be better in patients managed with valgus intertrochanteric osteotomy than with lag screw osteosynthesis. The incidence of avascular necrosis seems to be higher in patients of group-I as compared to group-II patients. The overall clinical & radiological outcomes in both groups became worse on long term follow up.

Avulsion Fractures Osteosynthesis in Patients with Normal Bone Mineral Density and Osteoporosis

Objective: to compare the effectiveness of osteosynthesis for avulsion fractures using bioabsorbable versus titanium implants in patients differing in bone mineral density.Material and Methods. In the experimental phase of study, two groups of bone blocks were singled out from patients' femoral heads to assess the anchoring properties of the implant in osteoporotic and healthy bone. The first group included blocks of 31 patients with osteoporosis, the second one — 27 blocks of patients without osteoporosis. In the first group, cortical bioabsorbable Poly-L-Lactic/ co-glycolic acid (PLGA) screws were implanted into 13 bone blocks, titanium screws — into 10 bone blocks, and bioabsorbable pins (PLGA) — into 8 bone blocks. In the second group, 10 titanium screws, 10 bioabsorbable screws and 7 bioabsorbable pins were implanted. The anchorage of the implant in bone was evaluated by a pull-out test. Then, depending on the anchorage used, the studied bone blocks with osteoporosis, newly obtained from the first group, were divided into three groups for the purpose of evaluating the resistance to the damaging effects of the implant. In experiment, the osteosynthesis for avulsion fracture was simulated on these bone blocks. In the first group (11 bone blocks), the transosseous osteosynthesis of the bone fragment was carried out with a titanium screw, in the second group (9 bone blocks) with a bioabsobable screw, in the third group (11 bone blocks) with a bioabsorbable pin. The results of osteosynthesis were assessed based on how often a small bone fragment was damaged by an implant and on stability of the anchored implant. In the clinical phase of study, a comparative analysis of 65 surgical interventions (38 people with osteoporosis and 27 without osteoporosis) in patients with avulsion fractures was performed. In 24 cases, bioabsorbable screws were used for osteosynthesis, AO/ASIF titanium screws were used in 31 cases, and pins were used in 10 cases.Results. Experimental studies showed that the resistance to pull-out test of a bioabsorbable screw anchored in osteoporotic bone is 25.7% higher than a titanium screw. No statistically significant difference was found in bone without osteoporosis. Resistance to pull-out test of a bioabsorbable pin is 3% higher than a titanium screw. The model-based experiment with an avulsion fracture in osteoporotic bone using a titanium screw showed lower effectiveness of osteosynthesis: in 27.2% of cases the cortical titanium screw damaged a small bone fragment. Based on the clinical trial findings, no negative results were obtained using bioabsorbable anchorage. In 12.5% cases of osteosynthesis with a titanium screw, migration of a bone fragment was noted. The data obtained during the clinical study correlated with the experimental data. This makes the use of bioabsorbable implants advantageous.Conclusion. For avulsion fracture osteosynthesis in patients with normal bone mineral density, it is possible to use both titanium and biodegradable fixators with equivalent strength of fragment fixation. n osteosynthesis of fractures in patients with osteoporosis it is preferable to use bioabsorbable implants

Morphofunctional changes of Jurkat T lymphoblasts upon short-term contact with a relief calcium phosphate surface

Human leukemic T lymphoblastoid cells (hereinafter, Jurkat T cells) have been used to model the morphofunctional reaction of T lymphocytes to 24-h in vitro contact with relief (roughness index Ra = 2.2–2.7 μm) pure titanium substrates (12 × 12 × 1 mm3) covered by a calcium phosphate (CP) bilateral coating prepared by the microarc method. Jurkat T cells placed in plastic multiwall plates (2D control of culture growth), as well as cells in contact for 24 h with oxide (TiO2) microarc coating on pure titanium substrate (3D control), served as comparison tests. From 27 to 98% of immortalized cells in the 2D control culture had the CD3+CD4+CD71+CD45RA+ immunophenotype and secreted IL-2, IL-4, IL-8, IL-10, and TNFα, but not IL-1b and IL-6. Other markers of cell activation, differentiation, maturation, and death (CD8, CD16, CD56, CD25, and CD95) were found in 0–2.5% of cells. IL-8 release elevated by the microtextured CP surface by 183 and 160% relative to 2D- and 3D-control cultures, respectively. The CD4/CD8 ratio dropped to 9: 1 (13: 1 and 82: 1 in 2D and 3D controls, respectively) due to CD4+ cell depletion and an increase in CD8+ cell number. The total cell number (TCN) in Jurkat T cell culture after 24-h contact with CP coating was decreased to 88% compared to 2D control (p < 0.04), which indicated cell division suppression. A drop in total cell number was accompanied with accelerated IL-8 secretion (r = −0.97, p < 0.00009). Low concentrations of IL-8 (pg/mL) induced apoptosis (r = 0.94, p < 0.0001). These results show that CP, rather than TiO2, coating is a preferential surface material for endoprosthesis replacement and fracture osteosynthesis in patients suffering from hematological and bone malignancies.

Theoretical and practical problems of optimization the long bone fractures osteosynthesis in patients with varying degrees of trauma severity.

Theoretical and practical problems of optimization the long bone fractures osteosynthesis in patients with varying degrees of trauma severity.

Risk factors of avascular necrosis of the femoral head and fixation failure in patients with valgus angulated femoral neck fractures over the age of 50 years

IntroductionThe aim of our study was to identify the risk factors for avascular necrosis of the femoral head (AVN) and fixation failure (FF) after screw osteosynthesis in patients with valgus angulated femoral neck fractures. Patients and methodsWe conducted a retrospective study of 308 patients (mean age, 72.5 years, range, 50–97 years), with a mean follow-up of 21.4 months (range, 12–64 months). The risk for failure in treatment (FIT) associated with patient- and fracture-related factors was evaluated by logistic regression analyses. ResultsFIT was identified in 32 cases (10.3%): 22 cases (7.1%) of AVN and 10 cases (3.2%) of FF. Initial valgus tilt>15° (p=0.023), posterior tilt>15° (p=0.012), and screw sliding distance (p=0.037) were significantly associated with FIT. FIT occurred in 7 patients (5.2%) with B1.2.1 fractures and 17 patients (48.6%) with B1.1.2 fractures (p<0.001). The odds of FIT were 17-fold higher in patients with initial valgus and posterior tilts>15° (B1.1.2) compared to patients with <15° of tilt in both planes (B1.2.1). ConclusionThe severity of initial deformity predicts AVN and FF in patients with valgus angulated femoral neck fractures. Patients with an initial valgus and posterior tilt>15° are reasonable candidates for primary arthroplasty due to high risk of FIT.

Outcome of Knee Joint Arthrodesis as a Salvage Procedure After Periprosthetic Infection: An Analysis of 41 Patients

AIM: There has been little scientific evidence regarding knee joint arthrodesis as a salvage procedure in patients with periprosthetic infections. METHODS: We performed a retrospective clinical and radiological follow-up at least 1-year post-surgery in patients who had received knee joint arthrodesis between 2007 and 2012. Clinical follow-up was conducted using the WOMAC and SF-36 questionnaires. RESULTS: A total of 41 consecutive patients were included with an average age of 69 years (range 36-90). In 24/41 patients (59%), arthrodesis was conducted using a modular prosthesis. In 14 patients (34%) bilateral double-plate osteosynthesis was used, and in 3 patients (7%) an external fixator. During the further course, 15/41 patients (37%) experienced complications that required revision, including subsequent above knee amputation (total 4 patients; 10%). Finally, radiological and clinical follow-up was possible in 18/41 patients (44%) after an average of 42 months (range 12-65) post-surgery. Clinical follow-up was conducted using the WOMAC and SF-36 questionnaires, and there was demonstrated a significant impairment of physical function, which was independent from the type of arthrodesis and leg length differences. Compared to a healthy reference population, the social function and psychological subscore were not impaired. CONCLUSION: Knee joint arthrodesis is a suitable salvage procedure in patients with chronic periprosthetic knee joint infections. We recommend the use of a double-plate osteosynthesis in patients with lesser bone loss and a modular prosthesis in larger defects. Both methods are prone to complications, and it is not always possible to prevent amputation during the further course of events.

Ribs osteosynthesis in patients with isolated and combined chest trauma

Rapid methods of costal fractures fixation using special costal plates are becoming more common. To evaluate the efficacy of ribs osteosynthesis in patients with isolated and combined chest trauma. It is presented an experience of surgical treatment of patients with costal fractures in case of isolated (30) and combined (29) chest injury. System for ribs osteosynthesis was used predominantly in surgical tactics. Immediate surgical results were analyzed. Most patients had increase of blood gas parameters, oxygenation in the postoperative period. In case of isolated chest injury mean duration of mechanical ventilation was 1.3±1.1, incidence of complications - 3.3%, mortality rate - 0%. In group of combined injuries those indexes were 4.6±3.05, 13.8% and 13.8% respectively. The method of ribs osteosynthesis in patients with isolated and combined chest trauma showed high efficiency.

Features of thoracoscopic ribs osteosynthesis in patients with closed chest injury

Features of thoracoscopic ribs osteosynthesis in patients with closed chest injury

Invited Commentary

Invited Commentary

Sternal Talon Offers a Solution for Secondary Sternum Osteosynthesis in Patients With Nonunion

Median sternotomy may be associated with postoperative complications such as nonunion after conventional metal wire closure. The Sternal Talon device (KLS Martin, Jacksonville, FL) has recently been introduced as an alternative for osteosynthesis after median sternotomy and may also be beneficial for patients with persistent sternal nonunion. A consecutive series of 24 patients underwent Sternal Talon repair for sternal nonunion or acute mediastinitis, or both, after sternal wire closure. Patient data--including demographics, surgical history, and indication for operation, as well as outcomes--were obtained and analyzed by retrospective chart review. The average patient age was 61.3 years and 23 patients were men (95.8%). The most common median sternotomy procedure was coronary artery bypass grafting (CABG) in 19 patients (79.2%). Secondary closure using the Sternal Talon was indicated for sternal nonunion or infection, or both, in all patients. Eight patients underwent simultaneous muscle flap procedures during the placement of the Sternal Talon (33.3%). Sternal union was eventually achieved in 23 of 24 patients (95.8%). Subsequent reoperation was required in 4 patients (16.7%). The data presented suggest that the osteosynthesis using the Sternal Talon device is a safe and effective modality for treating symptomatic sternal nonunion or acute dehiscence associated with infection (mediastinitis.).

Experience of proximal femoral osteosynthesis in patients after renal transplantation

Experience of proximal femoral osteosynthesis in patients after renal transplantation

Anatomical frame plate osteosynthesis in Ada-Miller Type 2 or 4 scapula fractures

The aim of this prospective study was to evaluate the results of anatomical frame plate osteosynthesis in patients with Ada and Miller Type 2 or 4 scapula fractures. Eleven Ada and Miller Type 2 or 4 scapula fractures in nine patients were treated with anatomical frame plate osteosynthesis. The mean follow-up time was 39.8 (12-77) months. The results were evaluated using the Herscovici score. No complications, such as neurovascular injury, postoperative hematoma, infection, delayed wound healing, implant failure, delayed union, or nonunion occurred. Based on the Herscovici score, the results were excellent. Osteosynthesis with anatomical frame plates appears to be a safe method that allows early range of motion and that provides excellent results in Ada and Miller Type 2 or 4 scapula fractures.

Osteosynthesis for Nonunion of the Lateral Condyle of the Humerus

Purpose: Although nonunion of the lateral humeral condyle is a rare complication in children, it can result in a number of complications, and treatment is controversial. Our study shows the results of using osteosynthesis in patients whose lateral humeral condyle was not united. Materials and Methods: We studies 16 patients (M : F=13 : 3; Age: years) who were diagnosed with nonunion of the lateral humeral condyle and who underwent osteosynthesis. The mean period of nonunion was 56.2 months (5-132 months). Outcome measures were range of movement, bone union, functional score, and carrying angle and were assessed both before and after surgery. Results: Bones of all patients were united within 3 months of the operation; there were no complications. After surgery, a decreased range of movement was observed for 3 of 16 patients. However, the functional index for all patients was improved. In other words, the range of movement could be reduced while the functional index was improved so that the deformity would be lessened. Conclusion: Osteosynthesis was successful in repairing the nonunion of the humeral lateral condyle. Therefore, osteosynthesis is suggested for patients who have had no treatment for nonunion of lateral humeral condyle for a long time.

USE OF THE PFO® NUT IN TREATING FRACTURES OF THE PROXIMAL THIRD OF THE HUMERUS IN PATIENTS WITH BONE FRAGILITY

Objective: To evaluate the clinical results from application of the PFO® bone fixation nut, which was developed for use with 4.5 mm cortical screws, and to analyze any complications or bone reactions caused by this synthesis in porotic bone. Method: Between May 1999 and November 2007, the PFO® nut was used on 23 patients who underwent osteosynthesis with a PFS 80® plate in the proximal segment, to treat acute fractures, pseudarthrosis or defective consolidations. The average age of the patients was 69 years, and the average length of follow-up was 40 months. Results: Only one patient did not present consolidation. The complications observed were: two cases of medial cortical fracture; one case of loosening of the nut; three cases of bone reabsorption around the PFO®, but two of these without clinical repercussions; and one case in which the fracture failed to consolidate, with consequent loosening of the fracture. Conclusion: The authors conclude that the use of the PFO® nut is a practical and effective alternative for osteosynthesis in patients with fractures of the proximal segment or sequelae from fractures of the humerus associated with bone fragility

Utilização da porca PFO® no tratamento de fraturas do terço proximal do úmero em pacientes com fragilidade óssea

OBJECTIVE: To evaluate the clinical results of the application of the PFO® bone fixation nut, which was developed for use with 4.5 mm cortical screws, analyzing any complications or bone reaction caused by its synthesis in porotic bone. METHOD: From May 1999 to November 2007, the PFO® nut was used on 23 patients submitted to osteosynthesis with a PFS 80® plate in the humerus proximal segment, for the treatment of acute fractures, pseudarthrosis, or defective consolidations. The average age of the patients was 69 years, and the average follow-up time was 40 months. RESULTS: Only one patient presented no complications. The complications observed were: two cases of medial cortical fracture; one case of loosening of the nut; three cases of bone reabsorption around the PFO®, but two of these without clinical repercussions; and one case in which the fracture failed to consolidate, with consequent loosening of the fracture. CONCLUSION: The authors conclude that the use of the PFO® nut is a practical and effective alternative for osteosynthesis in patients with fractures of the proximal segment or complications of fracture of the humerus associated with bone fragility.

Bone quality measured by the radiogrammetric parameter “cortical index” and reoperations after locking plate osteosynthesis in patients sustaining proximal humerus fractures

To analyse the radiogrammetric parameter "cortical index" (CI) and its predictive value for proximal humerus fractures. Furthermore, to investigate the reoperations and the cause of reoperations after locking plate osteosynthesis of displaced proximal humerus fractures. 113 consecutive patients (73 women and 40 men) with a median age of 66 years (range 18-100 years) were included in this study. The median follow-up time in our database was 4.7 years (range 45-72 months). For a comparative matched-group analysis of the CI, patients with a fall on the shoulder without fracture were selected. Demographic data and all reoperations were recorded after median 58 months postoperatively. The CI was measured at the proximal humeral diaphysis. The CI showed to be significant lower in the fracture group (mean 0.28) when compared to the matched group (mean 0.47, p < 0.01). 39% patients underwent a reoperation within 40 months postoperatively. 24% were reoperated within the first 12 months postoperatively, and 15% were reoperated after 12 months or later. The reoperation was independent of bone quality (p = 0.85). The risk for reoperation is independent of the CI even though the CI may be a predictor for proximal humerus fracture. Younger patients should be aware that surgical treatment of proximal humerus fractures might be a two-stage surgery. Regular follow-up visits for older patients during the first postoperative year must be assured.

Three-dimensional computed tomography evaluation of postsurgical condylar displacement after mandibular osteotomy

Objective. The purpose of this study was to examine both condylar displacement of the temporomandibular joint after sagittal split ramus osteotomy with rigid osteosynthesis and intraoral vertical ramus osteotomy without osteosynthesis in patients with mandibular prognathism by means of three-dimensional computed tomography. Study design. In this pilot study, five patients treated with sagittal split ramus osteotomy and 5 patients treated with intraoral vertical ramus osteotomy were evaluated. A technique to superimpose a postoperative three-dimensional computed tomography image on its corresponding preoperative image was designed. Postoperative condylar displacement, rotation, and tilting were measured in three-dimensional computed tomography images. Results. Within 3 to 6 months after surgery, changes in the inclination of the condylar axes were distinctly seen, although changes in the position of the condyles within the joints were minimal. In particular, outward rotation of the condylar long axes after intraoral vertical ramus osteotomy was a frequent finding. Conclusions. The three-dimensional computed tomography superimposition technique was a practical method of evaluating post-surgical condylar displacement after mandibular osteotomy.

Combination of craniocerebral and skeleton injurieis: diagnosis and management

The study is concerned with the outcomes of the treatment of 364 patients with combined trauma (craniocerebral injuries of different severity and fractures of skeleton bones [453]). Patients management and fracture fixation methods are presented. Primary osteosynthesis (during the first day after trauma) was done in 45.9% of victims and delayed osteosynthesis - in 54.1%. The following fixators were applied: plates (46.6% of victims), external fixation devices (36.6%), rods (9.9%), other types (6.9%). Early osteosynthesis (during the first three days after trauma) did not increase the lethality and complication rate. At follow up period of 12-18 months the long term results were studied in 98 of 364 patients. Good outcome was achieved in 79.6% of cases, satisfactory - in 17.3% and unsatisfactory in 3.1% of cases. The authors consider that primary and early osteosynthesis in patients with the combination of craniocerebral and skeleton injuries enable to improve the outcomes, reduce the lethality rate, shorten the duration of hospitalisation and promote early rehabilitation.