Osteosynthesis Technique Research Articles

Técnica quirúrgica del manejo de las fracturas de calcáneo a través de un abordaje del seno del tarso.

Calcaneal articular fractures are fractures classically associated with a high rate of complications and poor outcomes. Osteosynthesis of the calcaneus through a sinus tarsi approach has shown results equal to or superior to those of the extended approach, having become the new gold standard.The objective: of this article is to detail step by step the surgical technique of osteosynthesis of intra-articular fractures of the calcaneus through a sinus tarsi approach, from the selection of the fracture, positioning of the patient, layout of the operating room and the fluoroscope, the entire surgical process until postoperative treatment.The surgical technique described below is described in 6 steps.Layout of the operating room. Patient and Fluoroscope Positioning.Reduction of the posterior tuberosity (correct height and varus).Sinus tarsi approach.Reduction of the articular surface and correct visualization. Arthroscopy.Fixation of the articular surface.Fixation of the posterior tuberosity.Anatomical reduction of complex calcaneal fractures through an Sinus Tarsi Approach requires an understanding of the fracture and its associated deformities. Following the described sequence step by step will help to achieve a better reduction in order to achieve better functional results.

Ex Vivo Biomechanical Comparison of Four Techniques to Tibiotarsus Osteosynthesis in Adult Laying Hens (Gallus gallus domesticus).

To assess the biomechanical parameters of intact tibiotarsi (INT) and tibiotarsi with a 5-mm segmental diaphyseal defect repaired using four osteosynthesis techniques: a locking plate (LP), a plate-rod combination, an external skeletal fixator (one end-threaded positive-profile pin per fragment) with an intramedullary pin tie-in (TIF 1), and an external skeletal fixator (two end-threaded positive-profile pins per fragment) with an intramedullary pin tie-in (TIF 2). Sixty tibiotarsi from 30 adult laying hens were allocated into five groups for nondestructive dynamic torsion and four-point bending tests, followed by failure tests. Nondestructive dynamic tests evaluated stiffness over time in torsion and bending. Torsion destructive tests provided maximum torque and rotation values, whereas the four-point bending tests provided the yield load, maximum bending load, and maximum displacement. The INT group showed higher torsional stiffness and maximum torque but similar bending stiffness, torsional strength, and bending strength in one or more groups. LP and TIF 2 exhibited the highest similarity frequencies among the treatment groups, whereas the TIF 1 group displayed lower stiffness and strength for most of the evaluated parameters. Similar results for LP and TIF-2 groups suggest the biomechanical equivalence of these methods for tibiotarsal osteosynthesis in adult hens.

Treatment of diametaphyseal forearm fractures in children and adolescents : Antegrade intramedullary nail osteosynthesis and its alternatives

Osteosynthesis in dislocated diametaphyseal forearm fractures is intended to restore anatomy and function. Antegrade intramedullary nailing in the radius is used to restore length, rotation, and axis within the age-specific correction limits. Sufficient stability ensures early functional postoperative treatment without load. Dislocated diametaphyseal forearm or radius fractures that cannot be closed, stably reduced, or remain outside the age-specific correction limits. Radius or forearm fractures located distal or proximal to the defined area. Soft tissue defects, contamination or infections located in the access path. In the course of the Thompson approach, the soft spot between the extensor digitorum and extensor carpi radialis brevis muscles is located and an approx. 3-4 cm skin incision is made. Then blunt preparation down to the bone, sparing the profundus and superficial radial nerve. Retraction of the musculature with two Langenbeck hooks. Opening of the cortex with an awl. If necessary, a2.5 mm drill with tissue protection can be used beforehand if the cortex is very hard. Atitanium elastic nail (TEN) diameter is selected so that it fills approximately 2/3 of the medullary canal. It is recommended to flatten the TEN runner with parallel flattening forceps. After closed reduction, the TEN is then brought up in front of the growth plate with slightly rotating movements. The TEN is bent over at the proximal end and pinched off above the muscle bellies. Alternative procedures include Kirschner wire osteosynthesis or retrograde TEN from radial or dorsal, with or without bending. The aim of osteosynthesis is early functional follow-up without load. Sports abstinence is recommended for 8weeks. Metal removal can be performed after consolidation between 3and 6months. Clearly dislocated or outside the correction limits infantile radius and forearm fractures show very good treatment results with alow risk profile after the described osteosynthesis technique. Pseudarthrosis and nerve damage were not observed. Secondary dislocation has not occurred.

Biomechanical Analysis of a Modified Triangular Osteosynthesis Technique for Treatment of Spinopelvic Dissociation.

The purpose of this study was to evaluate the biomechanical stability of a modified triangular osteosynthesis construct with S1 pedicle screws compared with other described lumbopelvic fixation constructs in a U-type sacral fracture model. U-type sacral fractures were created in validated fourth-generation spinopelvic models. Four different constructs were cyclically loaded with displacement measured in all planes: (1) bilateral L5 pedicle screws with rods attached to iliac bolts, (2) bilateral L5 and S1 pedicle screws with rods attached to iliac bolts, (3) bilateral L5 pedicle screws with rods attached to iliac bolts with a transsacral-transiliac screw, and (4) bilateral L5 and S1 pedicle screws with rods attached to iliac bolts with a transsacral-transiliac screw. The bilateral L5 and S1 pedicle screws with rods attached to iliac bolts with a transsacral-transiliac screw construct had significantly decreased horizontal, vertical, and angular displacement compared with all other constructs. From a biomechanical perspective, a modified triangular osteosynthesis construct with S1 pedicle screws improves stability in fixation of U-type sacral fractures.

Extra-Articular Distal Femoral Fractures Retrograde Nailing Versus Locked Plating A Systematic Review and Meta-Analysis

Abstract Background Extra-articular Distal femoral fractures remain a challenging matter due to the high energy trauma causing the injury and the association with soft tissue injury, vascular injury and physical disability. Different methods of fixation exist depending on a lot of factors; patient related factors, type of fractures, surgeon’s preferences. Aim of the Work to evaluate the outcome & complications of retrograde intramedullary nailing versus locked plating in management of extra-articular distal femur fractures. Patients and Methods The standard method of management of extra-articular distal femur fractures including either internal fixation by intramedullary nailing (Antegrade or Retrograde) or distal femur locked plate (LP). Results Retrograde nailing shows superiority over the Antegrade nailing especially the very distal fractures and the associated intra-articular extension. However every methods comes with its own advantage and disadvantage. Retrograde nailing gaining its popularity due to minimal insertion point and maintaining the fracture hematoma. Distal femur locked plate witnessed a lot of development including; multidirectional locking mechanism which comes very handy especially with osteoporotic bone and intra-articular extension; also the development of minimally invasive percutaneous osteosynthesis technique and system reducing time, blood loss and soft tissue dissection. Conclusion The present review shows lesser mean fracture union time and a lesser overall complication favoring the Retrograde Intramedullary Nailing (RIMN) over the Locked Plating (LP). We didn’t find a statistical significant difference between the two groups in non-union, delayed-union, mal-union, knee stiffness, knee pain, superficial/deep infection; implant related complication, re-operation rate and duration of surgery. But a less intra- operative blood loss and a better post-operative knee range of movement was seen in the LP group. Both the options of fixation appear to be feasible options, and specific indications should be considered for making the final choice.

SUCCESSFUL LEFT PELVIC LIMB AMPUTATION IN A WHITE-HEADED MARMOSET (Callithrix geoffroyi) FOLLOWED BY RELEASE INTO THE WILD

Surgical reports involving wild animals are still scarce in the literature, particularly those documenting successful survival through surgery and postoperative handling stress in captivity. This study aims to present a case of Callithrix geoffroyi following total pelvic limb amputation. A young female white-headed marmoset weighing 395 grams, rescued by highway patrol in Guarapari – ES, with anatomical and functional deformities of the pelvic limb, including a multi-fragmented femoral shaft fracture. Given the severity of the fractures and limitations in applicable osteosynthesis techniques, amputation was necessary, considering spinal canal size, animal behavior, and potential for successful release. The white-headed marmoset resumed activity three hours post-surgery and was transferred to the Wildlife Sector at the Veterinary Hospital, housed in a wireframe cage with balanced nutrition, water, and environmental enrichment. Daily monitoring over 10 days assessed behavior, pain, nutrition, and surgical site healing. Upon complete wound recovery, the marmoset was transferred to wildlife management authorities for planned release. During this process, no aggressive behavior was observed from other white-headed marmosets, prompting the opening of the cage and the white-headed marmoset's voluntary movement towards a fruit tree among conspecifics.

Comparison of biodegradable and metallic tension-band fixation for paediatric lateral condyle fracture of the elbow

IntroductionIn our retrospective study we compared the outcomes of paediatric lateral condyle fractures of the elbow fixed by bioabsorbable pins and tension-band sutures or by metallic tension-band with K-wires. Materials and methodsWe reviewed the data of children operated on for lateral condyle fractures between 2010 and 2020. Patients were classified as follows: 1. fractures treated with metallic (KW group), 2. fractures treated with resorbable implants (BR group). We compared the distribution of age, sex and fracture type in each group. Operative times of the two techniques were also recorded and compared. We analysed the X-rays taken one year after the injury and measured the following parameters: presence of possible non-union, varus or valgus deviation, lateral spur formation. Patients whose follow-up period was less than one year were excluded. For categorical data, group comparisons were performed with Chi-square test or Fisher's exact test, depending on the sample size. The evaluation of discrete variables was performed with Mann-Whitney U test. Results42 patients met the above criteria. We found 19 children in the Kirschner -wire + tansion band wire (KW) group and 23 in the Bioresorbable pin + tension band suture (BR) group. There were no significant differences between the study groups in terms of age, sex, left-right ratio, number of complications, operation time, number of Jacobs II and III cases or follow-up time. The operation time was on average 5 min longer in the bioresorbable group (K-wire mean = 62.1 min, Bioresorbable mean = 67 min), this difference, however, is not statistically significant (P = 0.177). In terms of minor and major complications, there was no statistically significant difference between the two groups. (P = 0.729). ConclusionsWe did not notice any difference between the complication rates of the two methods, so the real advantage of the absorbable implant technique is that no second intervention is necessary.The benefits of using biodegradable implants in various osteosynthesis techniques need further confirmation by randomised trials.

External Fixators as a Tool for Damage Control Orthopedics in Severely Injured or Polytrauma Patients.

The purpose of this study is to explore the use of damage control techniques in the emergency surgical management of polytrauma patients - those with traumatic injuries affecting at least two anatomical regions - at a District General Hospital in Greece. We conducted a retrospective review of medical records from patients who visited the orthopedic emergency department between 2021 and 2024. From approximately 10,000 injured patients treated annually in our emergency department, we selected a sample of 29 polytrauma patients who required surgical intervention. We utilized the Injury Severity Score (ISS) to evaluate these patients. For 16 patients, the initial surgical intervention was also the definitive treatment, utilizing intramedullary nailing or internal osteosynthesis techniques. In the remaining 13 patients, damage control techniques, including external osteosynthesis (ExFix), were employed. The ISS was the primary criterion for deciding between definitive management and damage control procedures. Data on the 13 patients managed with damage control techniques were further analyzed and are presented in this study. External osteosynthesis was used to stabilize fractures and control bleeding, particularly in patients with multiple orthopedic injuries such as femoral or diaphyseal tibial fractures. This approach facilitated resuscitation and recovery. Our findings suggest that stabilizing long bone fractures with external fixation in patients with an ISS greater than 9 is both safe and likely contributes to overall recovery. This study demonstrates that a damage control approach for polytrauma patients with significant orthopedic trauma is effective for fracture stabilization and bleeding control. Additionally, in three cases, this approach also served as the definitive treatment.

Surgical access route and choice of implant in the region of the clavicle shaft

Clavicle fractures are among the most frequent injuries of the shoulder girdle. Nondisplaced fractures are generally treated conservatively, whereas dislocated fractures require surgical reduction and stabilization. A variety of implants and surgical techniques with reliable results are available. While all techniques provide similar healing rates, they share acommon disadvantage with the high incidence of implant irritation and correspondingly high rates of second interventions for material removal. The various surgical techniques for clavicle shaft fractures with their specific areas of application as well as advantages and disadvantages are presented. This review also provides an aid for deciding which surgical technique is most appropriate based on the fracture morphology. Furthermore, an overview of current research activities is presented, with aspecific focus on new implants which could help to reduce implant irritation. Open superior and anteroinferior plate osteosyntheses each show similar reliable results. The minimally invasive plate osteosynthesis (MIPO) technique offers an alternative for multifragmented fractures as it has alower complication rate compared to the open procedure. Double plate osteosynthesis using minifragment plates shows promising results with respect to the incidence of implant-related irritation. Larger prospective studies are still pending. Intramedullary nailing offers agood alternative, especially if material removal is planned anyway, e.g., in the pediatric setting.

Two-screw osteosynthesis is biomechanically superior to single-screw osteosynthesis for type II odontoid fractures

The data on the use of a one- or two-screw technique (1S, 2S) for ventral osteosynthesis of type II dens fractures are contradictory. The aim was to design an apparatus to mimic the physiological conditions and test stability with 1S, 2S, and a headless compression screw (HCS) for osteosynthesis of artificially created type II odontoid fractures. The apparatus was mounted on a Zwick materials testing machine. A total of 18 C1–2 specimens were stratified into three groups (1S, 2S, HCS). Odontoid fractures were artificially created, and osteosynthesis was performed. Each specimen was tested at loads increasing from 1 to 40 N. Screw loosening was observed visually, by fatigue data, and by a camera tracking system. Analysis of the Zwick data and the camera data revealed a significant higher stability after 2S compared to 1S and HCS treatment (Zwick data: p = 0.021, camera data: p < 0.001), while visible screw loosening showed a superiority of the 2S only over HCS (p = 0.038). The developed apparatus allowed the dynamic study of the atlantoaxial joint with a high approximation to physiological conditions. The results demonstrated superiority of the 2S over the 1S and HCS in biomechanical stability in the treatment of type II odontoid fractures.

Influence of age on pelvic inlet and outlet radiographic views

Background. Unstable fractures of the posterior pelvic ring represent a pressing concern in trauma surgery. Minimally invasive osteosynthesis techniques have gained widespread acceptance in contemporary practice. Accurate radiographic visualization is a critical component for the precise and successful placement of iliosacral and transsacral screws. Obtaining and accurately interpreting X-ray images can pose challenges in specific clinical situations, particularly those involving age-related skeletal changes. The aim of the study is to assess the influence of the patient’s age on the measures of pelvic radiographic inlet and outlet views angles for performing a sacral fracture fixation using cannulated screws. Methods. A retrospective analysis of CT data was conducted on 106 patients with posterior pelvic ring injuries requiring cannulated screw fixation. Preoperative CT scans were reconstructed into sagittal projections. We performed construction and measurement of the true inlet angle, super-inlet angle, pelvic outlet angle, sacral concavity angle, promontory angle, S1 and S2 outlet view angles. Statistical correlation between sacral tilt angle and the patient’s age was assessed. Results. A two-step cluster analysis divided the patient cohort into two groups with significant differences in pelvic outlet angles and age (N1 = 64, N2 = 42). Statistically significant differences were found between the two clusters in all the studied parameters: median values of true pelvic inlet angles were 27.2° [23.2-32.2] and 18.2° [11.4-26.6] respectively (p0.001); super-inlet angles were 42.5° [39.3-47.8] and 36.2° [28.7-42.8] respectively (p0.001); promontory angles were 128.1° [123.3-133.2] and 122.1° [115.6-129.3] respectively (p = 0.003); pelvic outlet angles were 62.6° [58.4-69.6] and 50.3° [45.9-53.5] respectively (p0.001); S1 outlet angles were 51.8° [48.9-56.5] and 46.8° [43.1-50.2] respectively (p0.001); S2 outlet angles were 40.8° [37.3-44.6] and 35.7° [30.9-38.6] respectively (p0.001); the mean of the sacral concavity angles was 174.8°±10.5 and 152.1°±38.2 respectively (p0.001); and the main age was 41.6±18.7 and 69.2±16.1 years respectively (p0.001). A statistically significant inverse correlation between age and pelvic tilt angle (ρ = 0.534; p0.001) was found. A novel diagnostic method for identifying sacral dysmorphism using angle measurement within the S1 bone corridor is presented. The sacrum was considered dysmorphic if the angle was equal to or less than 5°. Conclusions. As the patient’s age increases by one year, pelvic outlet angle decreases by 26°. If pelvic inlet angles are equal to or less than 14.45°, the difficulties in visualizing S1 and S2 outlet views during surgery are to be expected. The median of angles difference before and after anterior sacral tilt correction using a coccyx pad was 9.4° with interquartile range from 7.8° to 11°. Significant anatomical variations in posterior pelvic ring structure were observed among the study cohort. Preoperative CT sagittal reconstructions allow appropriate planning of intraoperative visualization considering expected intraoperative radiographic inlet and outlet views.

Transmediastinale migratie van een Kirschner-pin na fixatie van een proximale humerusfractuur: een casus

Transmediastinal migration of a Kirschner pin after fixation of a proximal humeral fracture: a case report Fractures of the proximal humerus are common lesions in the elderly population. In some cases, they are surgically stabilized via a minimally invasive technique, namely percutaneous osteosynthesis with fixation pins. Intrathoracic migration of these pins or wire is a rare complication after percutaneous osteosynthesis of a proximal humeral fracture. In this article, the authors describe an extremely rare transmediastinal migration of a Kirschner pin from the humeral head. The purpose of this case report is to call for awareness and to open a debate in which appropriate prevention can be freely discussed. The consideration of a conservative management, the choice of alternative osteosynthesis techniques, the use of a sling bandage to restrict the shoulder movement, the use of fixation pins with a threaded tip, bending of the external free end of the pin and an appropriate time to remove the pin are possible recommendations from the literature. Furthermore, it is important to provide additional information and awareness to health care providers in rehabilitation centers, geriatricians and orthopedists concerning the possibility of such a life-threatening postoperative complication. Thus, specific policies for clinical and radiographic monitoring of the position of fixation pins should be developed in hospitals and rehabilitation centers with the aim of prevention, early detection and prompt action when this life-threatening complication is suspected.

A recent update on the fixation techniques for femoral neck fractures: A narrative review

Femoral neck fractures present significant challenges in orthopedic surgery, particularly due to technical difficulties and a high complication rate. Surgical intervention is generally recommended, with osteosynthesis and arthroplasty being the main treatment options. Osteosynthesis techniques, including dynamic hip screw (DHS), multiple cannulated screws (MCS), and the femoral neck system (FNS), aim to achieve stable fixation and facilitate fracture healing. Factors influencing the choice of osteosynthesis include fracture displacement, bone quality, patient age, and the presence of posterior tilt. While DHS offers high stability, MCS is preferred in stable type fractures with minimal invasive procedures. FNS, a newer technique, combines the advantages of DHS and MCS, providing strong fixation with minimal soft tissue damage. Considering the comprehensive findings of biomechanical and clinical studies to date, when performing osteosynthesis for unstable femoral neck fractures, caution should be exercised with MCS as it may have slightly inadequate fixation strength compared to DHS and FNS. FNS, being the newest technique, demonstrates superior fixation strength comparable to DHS and is as minimally invasive as MCS. However, it is essential to remember that long-term follow-up results are lacking for FNS.

Evaluation of The Treatment of Open Intercondylar Fracture Distal Femur by Transosseous Osteosynthesis Technique with Ilizarov External Fixator

Objectives: Treatment of Distal femoral fractures cannot be done following simple set of rules and when it is an open fracture the treatment is more difficult. Several methods were studied by different authors both at home and abroad, but none were conclusive. Methods: This prospective study was done between January 2011 to December 2012, 15 patients of the open intercondylar fractures of Distal femur were treated by transosseous osteosynthesis technique by Ilizarov External Fixator in NITOR (National Institute of Traumatology and Orthopaedic rehabilitation), Dhaka. 2 of the patients were not available for final follow up after removal of the fixator frame. So ultimately the final result based on the results of 13 Cases. Minimum 6 months follow up was done from the date of injury. No patient below age 16, no type IIIB or IIIC fractures and no patients having less than 6 months follow up were included in the study. Patients with severe injuries (Head injury, Abdomen and chest injury) were excluded from the study. Patients with medical illness such as Diabetes Mellitus, Peripheral Vascular diseases were not included in the study. Results: 12 male and 01 female patient between 16 and 56 years were studied. Most common age group in this series were 16-30 year age group (53.85%) and average age of the patients was 31.15 years. Most of the patients were male and road traffic accident was the leading cause of injury (92.31%). Right side involved in (69.23%) most of the cases. All patients were C3 type of fractures and G-II and G-IIIA types were same (38.46%). Most of the patients (53.85%) were operated within 1-2 weeks of admission. Average duration of hospital stay was 22 days ranging from 10 day to 45 days. Most of the patient had soft tissue healing by granulation tissue formation. Others were treated by primary closure, Delayed primary closure or secondary closure. Various complications were observed among them pintract infection, wire breakage, wire loosening, stiffness of joints, angulations and rotations, deep infection of the tissue, leg length discrepancy was observed in this study. According to the criteria of Neer et al, 1967 final results of the treatment were analyzed. Acceptable result was found in 61.54% of cases (Excellent 7.69% and good 53.85%). Results of the rest of 38.46% cases were not acceptable (Fair 23.08% and poor 15.38%). The result is similar with others done for open fractures of distal femur by Ilizarov External Fixator or other methods of fixation. Conclusion: So it can be concluded that transosseous osteosynthesis technique is a satisfactory method for treating open intercondylar fracture of distal femur as a primary and definite mode of treatment.

Midcarpal Arthrodesis with or without Excision of Triquetrum: A Systematic Review

Abstract Purpose The purpose of this systematic review is to compare the clinical outcomes of midcarpal arthrodesis with triquetrum excision against midcarpal fusion without the excision of triquetrum performed using modern osteosynthesis technology. Methods A systematic review of publications in PubMed, Medline, EMBASE, and Cochrane Database of Systematic Review was conducted. The studies that utilized osteosynthesis techniques other than Kirshner wire, with at least 10 patients, and had a minimum one-year follow-up period in English language were included. The quality of studies were evaluated using validated tools for assessing observational studies. Union rate, functional outcomes and revision/complication rates were collected and analyzed. Results A meta-analysis was not possible. Based on pooled data the flexion-extension arc improved by 6 degrees for midcarpal arthrodesis group with triquetrum excision, but decreased by 11 degrees in the group without. The radial-ulnar arc improved by 5 degrees in the triquetrum excision group, but decreased by 3 degrees in the triquetrum preserving group. Improvement in grip strength appears to be better in the triquetrum preserving group (10 kg as opposed to 1 kg), while there were no observable difference in pain score. Conclusions The literature lacked good comparison studies to examine the role of triquetrum excision in midcarpal fusion. While midcarpal fusion with triquetrum excision appeared to yield better ROM in the pooled data, studies with direct comparison of the two techniques are required to fill in the gap. Type of Study/Level of Evidence Therapeutic IV.

Clinical development of ileofemoral thrombosis caused by malposition of the ileosacral screw

Introduction Treatment of unstable injuries of the pelvic bones is one of the unsolved problems in modern traumatology. The instability of the injuries is determined by the nature of the destruction of the posterior semi-ring of the pelvis. The most used technique for osteosynthesis of sacral fractures for unstable pelvic injuries is ileosacral screw fixation.The purpose of the work was to demonstrate a clinical case of an iatrogenic complication: ileofemoral thrombosis caused by compression of the internal iliac vein due to malposition of the ileosacral screw.Materials and methods Medical records of a 34-year-old patient injured in a traffic accident (front seat passenger) were studied, who was referred from a district hospital on the fourth day after the injury diagnosed with a fracture of the transverse process of L2 vertebra on the left, closed fracture of the pubic and ischial bones on the left, fracture of the lateral mass of the sacrum on the right. Alcohol intoxication. Traumatic shock stage 1. Treatment results were monitored throughout the inpatient and outpatient treatment periods. Long-term follow-up was 6 months.Results Timely suspicion of the complication based on physical examination data with CT angiography that assisted to exclude internal bleeding and urgently carry out repeated surgical intervention to correct the implant malposition, reosteosynthesis of S1 body without loss of reduction, to achieve regression of the clinical picture of ileofemoral thrombosis, and also to mobilize the patient in the shortest possible time. During inpatient treatment, regression of the symptoms of the complication was achieved, the patient was fully activated, and was discharged for outpatient follow-ups.Discussion Variability in the anatomy of the sacrum and the characteristics of fractures hinder the navigation while inserting iliosacral screws, which in some cases result in malposition. Compression of the common iliac vein without damaging it causes difficulty in blood outflow and the development of a clinical picture of ileofemoral thrombosis in the early postoperative period.Conclusion This clinical case shows that X-ray images in standard views are not a reliable method for diagnosing sacral injuries and are not sufficient for preoperative planning. The use of standard C-arm did not provide sufficient intraoperative visualization to correctly assess the position of the iliosacral screw, especially in cases with sacral dysmorphia. The 3D volumetric image reconstruction significantly influenced the correct perception of the anatomical structure of the bony structures of the pelvis. Malposition of the screw and its exit to the anterior surface of the sacrum caused disruption of the iliac vein outflow and development of thrombosis in the early postoperative period.

A Dilemma in the Management of Distal Tibia Fractures Solved by Minimally Invasive Percutaneous Plate Osteosynthesis Technique: A Prospective Study.

Introduction Managing distal tibia fractures is challenging for trauma surgeons because of their peculiar anatomy with less soft tissue coverage and poor blood supply. There are various treatment options for distal tibia fractures such as open reduction and plating, minimally invasive percutaneous plate osteosynthesis, and intramedullary interlocking nailing. Open reduction and internal fixation can lead to excessive soft tissue dissection and devascularization of fracture fragments. We conducted a study on the functional outcome of distal tibia fractures treated by biological fixation with minimally invasive percutaneous plate osteosynthesis. Methods A total of 23 patients with distal one-third tibia fractures, fulfilling the inclusion criteria, who were treated at St. John's Medical College Hospital with minimally invasive percutaneous plate osteosynthesis between November 2020 and November 2022 were studied using the American Orthopaedic Foot & Ankle Society (AOFAS) score at six weeks, three months, and six months postoperative follow-up. Results This study included 17 males and six females. The mean age of the study participants was 43.78 years, with most of the participants being in the age group between 51 and 60 years (29.2%, n = 7). All the study participants were employed. The mean operative time was two hours and 10 minutes. The mean duration for the radiological union was 22 weeks. The mean AOFAS score at six months was 92.43 + 5.696. There was only one case of superficial infection, which was treated with intravenous antibiotics. There were no cases of malunion/nonunion. Conclusion Minimally invasive percutaneous plate osteosynthesis is an effective treatment for distal tibia fractures avoiding most of the complications such as wound dehiscence and malunion/nonunion involved in conventional open reduction and internal fixation with plating. Therefore, we recommend this technique for all distal tibia fractures.

Motion preservation for open book injuries of the pubic symphysis –a biomechanical cadaver study

IntroductionOpen book injuries are challenging injuries that oftentimes require surgical treatment. Currently, treatment is performed with symphyseal plating requiring extensive surgery and entirely limiting physiological movement of the symphyseal joint, frequently resulting in implant failure. Therefore, we investigated the biomechanical properties of a minimally invasive tape suture construct (modified SpeedBridge™) as an alternative stabilization technique for the treatment of open book injuries in human cadaver pelvic rings.Materials and MethodsThe symphysis of 9 human cadaver pelvises was dissected and dilated to 3 cm creating an open book injury. Next, the two osteosynthesis methods (plating, modified SpeedBridge™) were applied. All specimens then underwent cyclic horizontal and vertical loading, simulating biomechanical forces while sitting, standing and walking. For statistical analysis, 3D dislocation (mm) was calculated.ResultsTotal displacement (mm) of the pubic symphysis displayed the following means and standard deviations: native group 1.34 ± 0.62 mm, open book group 3.01 ± 1.26 mm, tape group 1.94 ± 0.59 mm and plate group 1.37 ± 0.41 mm. Comparison between native and open book (p = 0.029), open book and plate (p = 0.004), open book and tape (p = 0.031), as well as tape and plate group (p = 0.002) showed significant differences. No significant differences were found when comparing the native and tape (p = 0.059), as well as the native and plate (p = 0.999) group.ConclusionWhile both osteosynthesis techniques sufficiently stabilized the injury, symphyseal plating displayed the highest rigidity. The modified SpeedBridge™ as a tape suture construct provided statistically sufficient biomechanical stability while maintaining symphyseal micro mobility, consequently allowing ligamental healing of the injured joint without iatrogenic arthrodesis.

Intramedullary nailing as osteosynthesis technique for the fibula in total ankle arthroplasty via lateral approach

Objective: To describe a variation in the final osteosynthesis technique for total ankle replacement (TAR) implantation through lateralapproach. Methods: We retrospectively reviewed a series of cases dated between January 2022 and May 2023 in which intramedullary nailing was used as the osteosynthesis technique for the fibula during TAR implantation via lateral approach. Results: In all cases, skin scarring and soft tissue recovery to baseline were achieved in one and a half month to three months. Consolidation of the fibula occurred at an average of three months. No material was removed in any of the cases to date. Finally, patients were satisfied, resuming their previous activities. Conclusion: To our knowledge, this study is the first to investigate a modification of the osteosynthesis technique in the lateral approach to TAR. We believe the intramedullary nail for the fibula may be a useful tool to prevent soft tissue complications, requiring prospective and comparative studies to evaluate its efficacy. Level of Evidence IV; Therapeutic Studies; Case Series.

Unstable Distal Tibia Fracture Management By Anatomically Contoured Plate With Mipo Technique

Background: Fracture at distal tibia is a notorious fracture and difficult to manage. This fracture can be managed conservatively or operatively. Minimally invasive percutaneous osteosynthesis (MIPO) technique can be applied in distal tibia fracture and it usually provides better outcome. This technique ensures minimal soft tissue damage, preserves periosteum and hematoma of the fracture. As the fracture site is not opened, indirect fracture reduction technique is applied. This study tries to evaluate the outcome of MIPO technique application in distal tibia fracture management. Methods: The study was cross sectional study and was carried out on 20 patients during the period of January 2019 to July 2021 in orthopaedic department of Combined Military Hospital (CMH), Dhaka. During this tenure all patients who fulfilled the inclusion and exclusion criteria was included in the study. All had close fracture. Follow up interval was at 2 weeks then 06 weeks, thereafter at 3 months, 6 month and 12 months' time from the date of operation. Data were collected and evaluated in terms of bony union and postoperative complications. Results: 12 patients i.e. 60% were male and same percentage of patient had fracture at right lower limb. Mode of trauma was mostly road traffic accidents (RTA) and fall from height. 40 years was mean age of the patients. It was 07 weeks mean partial weight bearing time and 14 weeks mean full weight bearing time. Mean radiological union time was seen at 18 weeks. Non union or delayed union did not happen in any case. But ankle stiffness (3/20) was most commonly found postoperative complications. Conclusion: For distal tibia fracture MIPO technique is a better treatment option as it gives good outcome and fewer complications. Bangladesh Armed Forces Med J Vol 56 No (1) June 2023, pp 1-6