Post-traumatic Osteoarthrosis Research Articles

Dynamic hip screw in proximal femoral fractures followed by “single-stage” hip arthroplasty—retrospective analysis

The aim of this study is to present the results of single-stage total hip arthroplasty (THA) after Dynamic Hip Screw (DHS) failure, or secondary posttraumatic osteoarthrosis. From 2003 to 2020, 15 THAs were performed in group of 15 patients for the treatment of DHS failure, or for late complications following femoral neck and pertrochanteric fractures. The mean follow-up period after arthroplasty was 46.9 months (range 7–139). The patients were evaluated retrospectively—both clinically and radiographically, focussing on the demography, infection rate and other complications (revision surgery), during the year 2023. 9 males and 6 females were included in the study, with a mean age of 56.5 years (range 29–93) at the time of primary osteosynthesis. Each of them had proximal femoral fracture treated primarily with a DHS and then late one-stage revision surgery, with hardware removal and THA implantation. The median time between DHS osteosynthesis and THA was 41.2 months (range 4–114). Four patients (26.6%) had complications after THA, with the need for revision in two cases (13.3%). Dislocation rate was 6.6% (one case), with the need for repeated-revision of THA. The infection rate was 6.6% (one patient) with the need for revision of THA. Peroperative periprosthetic femoral fracture was observed in 13.3% (two patients) without any other problems. Six patients (40%) died during the follow-up period. Single-stage total hip arthroplasty with concomitant hardware removal bears a high- mortality rate, with a higher incidence of postoperative complications compared to elective THA.

High Prevalence of Persistent Measurable Postoperative Knee Joint Laxity in Patients with Tibial Plateau Fractures Treated by Open Reduction and Internal Fixation (ORIF).

The development of post-traumatic osteoarthrosis after tibial plateau fracture (TPF) is multifactorial and can only be partially influenced by surgical treatment. There is no standardized method for assessing pre- and postoperative knee joint laxity. Data on the incidence of postoperative laxity after TPF are limited. The purpose of this study was to quantify postoperative laxity of the knee joint after TPF. Fifty-four patients (mean age 51 ± 11.9 years) were included in this study. There was a significant increase in anterior-posterior translation in 78.0% and internal rotation in 78.9% in the injured knee when compared to the healthy knee. Simple fractures showed no significant difference in laxity compared to complex fractures. When preoperative ligament damage and/or meniscal lesions were present and surgically treated by refixation and/or bracing, patients showed higher instability when compared to patients without preoperative ligament and/or meniscal damage. Patients with surgically treated TPF demonstrate measurable knee joint laxity at a minimum of 1 year postoperatively. Fracture types have no influence on postoperative laxity. This emphasizes the importance of recognizing TPF as a multifaceted injury involving both complex fractures and damage to multiple ligaments and soft tissue structures, which may require further surgical intervention after osteosynthesis.

Free Radical Oxidation and Metabolic Processes of Cartilage and Bone Tissues in Animals with Surgical Model of Posttraumatic Osteoarthrosis

INTRODUCTION: Posttraumatic osteoarthrosis (PTOA) resulting from injuries of connective-tissue components of the joint, is accompanied by formation of free radicals activating chondro- and osteoresorption, which leads to fragmentation of biopolymers of the extracellular matrix of the joint tissues.
 AIM: To study the peculiarities of free radical oxidation and metabolic processes of cartilage and bone tissues in animals with a surgical model of PTOA of the knee joint.
 MATERIALS AND METHODS: The study was conducted on 31 rats (11 intact animals and 20 animals with PTOA model). The metabolic processes of the connective tissue were evaluated by the changes in the content of biomarkers of the cartilage (hyaluronan, aggrecan) and bone (fibroblast growth factor-23, osteprotegerin, sclerostin, osteocalcin) tissues. The condition of the free radical oxidation processes was evaluated by the level of lipid hydroperoxides, and the activity of antioxidant system by the parameters of the total antioxidant and thiol statuses.
 RESULTS: In rats with the PTOA model, an increase in cartilage tissue biopolymers aggrecan and hyaluronan (p 0.001) was noted with a negative change in the marker of bone formation (a tendency to increase in the content of osteocalcin) and markers of regulation of bone homeostasis (increased fibroblast growth factor-23, p 0.001), with a tendency to decrease in the content of osteoprotegerin and sclerostin, in comparison with intact animals of the control group. In parallel with this, an increase in lipid hydroperoxides (p 0.01) in the systemic bloodstream was detected with a decrease in the thiol status index (p 0.01) with preserved normal total antioxidant activity (p 0.05).
 CONCLUSION: The data of the conducted study evidences intensification of free radical oxidation and derangement of metabolic processes in the bone and cartilage tissues in animals with a surgical model of PTOA of the knee joint. A negative change in the metabolism of the bone tissue was manifested by the loss of balance of remodeling processes, and metabolic disorders in the cartilage tissue consisted in the destruction of its biopolymers in conditions of intensification of free radical oxidation processes and relative tension of the thiol system with the total antioxidant activity remaining within the physiological norm. The established facts are promising from the point of view of using the studied biomarkers both for the identification of pathogenetic triggers of PTOA of the knee joint, and for the determination of the direction of therapeutic measures.

Evaluation of functional outcome by modified mayo wrist score in intra- articular distal end radius fracture managed by plate osteosynthesis

<p class="abstract"><strong>Background:</strong> Fractures of distal end of radius continue to pose a therapeutic challenge. Intra articular and extra articular malalignment can lead to various complications like post traumatic osteoarthrosis, decreased grip strength and endurance, as well as limited motion and carpal instability.</p><p class="abstract"><strong>Methods:</strong> A prospective study of forty patients with intra-articular distal end radial fractures treated under the department of orthopaedics, PIMS, Udaipur, were included in this study. All patients managed by plate osteosynthesis were followed up to 9 months.<strong></strong></p><p class="abstract"><strong>Results:</strong> When outcome according to modified Mayo wrist scoring system was assessed, only one patient (2.50%) scored with poor grade. 11 (27.50%) were graded as excellent, 19 (22.50%) as grade good, 9 (22.50%) as grade fair. 32 (80%) patients had union within 2-3 months and 06 (15%) patients had union in 3-4 months. There were 2 (5%) case of delayed union.</p><p class="abstract"><strong>Conclusions:</strong> Assessment of functional outcome by modified mayo wrist score in intra-articular distal end radius fracture managed by plate osteosynthesis gives an excellent scoring system to assess outcome of communited intrarticular distal radius fractures with reference to function of the hand and wrist of the individual. Also, it will help to predict the likely functional outcome in relation to fracture pattern of distal radius.</p><p> </p>

Хирургическое лечение импрессионного перелома наружного мыщелка большеберцовой кости (клинический случай)

INTRODUCTION: Treatment of intra-articular fractures of the proximal tibial metaepiphysis can often cause difficulties in accurate restoring of the congruence of the articular surfaces of the knee joint. Such fractures may be accompanied by subsidence of the articular surface and the formation of a subchondral defect. In the absence of displacement of bone fragments and preservation of congruence of the articular surfaces of the knee joint, such fractures can be treated conservatively. In the opposite case, there is a need for a complete restoration of the articular surface of the tibia. It should be noted that among all fractures of the tibial plateau, more than half are fractures of the lateral condyle, also accompanied by the presence of an impression. A clinical case of surgical treatment of a 62-year-old patient, BMI (body mass index) 39, with an intra-articular multi-comminuted impression fracture of the lateral condyle of the tibia with displacement of bone fragments is presented. The patient gave her written consent to the use of her clinical data for scientific purposes. Upon admission to hospital, a closed intra-articular fracture of the external condyle (Schatzker II) was diagnosed with fragmentation and articular surface impression of more than 5 mm, and the presence of a spongy bone defect with a volume of about 4 cm3 as a result of the impression. Surgical treatment was performed that consisted of open reposition and restoration of the congruence of the articular surface, with simultaneous plasty of the defect of the external condyle with an autograft taken from the iliac crest, followed by osteosynthesis of the external condyle with a plate and screws. On the follow up examination 9 months after the surgical treatment, the patient developed post-traumatic osteoarthrosis of the knee joint with severe pain. Some probable errors in the preparation of the patient for surgical treatment, preoperative planning, surgical treatment, recovery in the postoperative period, as well as functional and radiological results of treatment are presented for discussion. CONCLUSION: The development of post-traumatic osteoarthrosis in the treatment of tibial condylar fractures still remains an important problem in modern traumatology. Special attention in the treatment of such fractures should be given to preoperative planning, surgical technique and implant selection. It is important not to lose communication between the patient and the surgeon throughout the entire recovery period.

THE ROLE OF HYDRO-KINESIOTHERAPY IN THE REHABILITATION OF ARTICULAR PATHOLOGY

The aim of the study was to determine influence and mechanism of action of rehabilitation complexes and therapeutic exercises in the bath and in the gym for patients with osteoarthrosis gave the best results on the second stage after the analgetic and relaxing effects had been received. Direct and late results were more expressed using rehabilitation in spa conditions with two stage and longer period of treatment. On the first stage use therapeutic exercises for patients with primary osteoarthrosis in not advisable. A use of therapeutic exercise is recommended for patients with posttraumatic osteoarthrosis and congenital dysplasia of femoral head.

Hindfoot Fractures: Injury Patterns and Relevant Imaging Findings.

The hindfoot consists of the talus and calcaneus, spans the tibiotalar to transverse tarsal joints, and is critical for support of body weight and absorption and transfer of physiologic loads during bipedal movements. Hindfoot fractures account for approximately 17% of foot and ankle fractures, with calcaneal fractures being more common than talar fractures. Hindfoot fractures are usually caused by high-impact axial loads such as falls from heights and motor vehicle accidents, and understandably, they are often seen in patients with polytrauma. Long term, these fractures have implications in development of posttraumatic osteoarthrosis with associated pain and stiffness, affecting daily living activities. An overview of the talus and calcaneus is presented, with emphasis on fractures with articular involvement-namely, the tibiotalar and subtalar joints. Articular talar and calcaneal injuries can also alter hindfoot alignment, causing ankle and foot function abnormalities. Optimal treatment-that is, restoration of articular surfaces and hindfoot alignment followed by rigid fixation until fracture union-is dependent on an accurate understanding of the injury that is well depicted with imaging, radiography and CT in particular. The discussion of talar and calcaneal fractures includes a review of the normal anatomy, epidemiologic factors, classification systems, and imaging and pathologic-anatomic features of common injury patterns. This review is intended to aid surgical management and restoration of articular and hindfoot alignment for optimal ankle and foot function, thereby reducing patient morbidity in these often devastating injuries. ©RSNA, 2022.

Fresh Osteochondral Allograft in a Complex Hoffa Fracture - Case Report.

Hoffa fracture (HF) typically involves the posterior femoral condyle in the sagittal plane, with an estimated incidence of 0.65% among femoral fractures. It usually occurs at the lateral femoral condyle in high-energy trauma with axial load force over the distal third of the femur and the knee positioned in more than 90° of flexion. The case reported involved a patient with a complex medial HF and associated knee dislocation after a high-energy trauma. At two years of follow-up radiologic analysis showed a complete bone healing and allograft integration. Transplantation of osteochondral allografts should be considered in cases of complex HF, and it aims at restoring the anatomy of the joint surface to prevent early post-traumatic osteoarthrosis in young patients.

Сцинтиграфічні кількісні параметри операбельності при ендопротезуванні у хворих на післятравматичний остеоартроз колінних суглобів

Актуальність. Аналіз статистичних даних про поширеність остеоартрозу свідчить, що в різних регіонах Европи вiн уражає від 8 до 25 % дорослого населення. Тенденцієй останнього часу є зменшення середнього віку пацієнтів iз цiєю патологією. У популяції остеоартроз реєструється в 3,5 % пацієнтів віком до 39 років, а після 50 років їх кількість значно зростає. Мета: визначити кількісні сцинтиграфічні параметри операбельності при ендопротезуванні колінних суглобів у пацієнтів iз післятравматичним остеоартрозом. Матеріали і методи. Остеосцинтиграфію проводили на томографічній сцинтиляційній однодетекторній гамма-камері «Тамара-301Т» після внутрішньовенного введення 99mTc-пірофосфату активністю 550–770 МБк. Результати. Усіх хворих розподілили на три діагностичні групи. До першої групи включено 25 (45 %) пацієнтів, у яких накопичення радіофармпрепарату в проекції ураженого суглоба становило +10–120 %, а в проекції проксимального відділу великогомілкової кістки — +5–50 %; до другої групи — 19 (34 %) хворих, у яких включення індикатору в проекції ураженого суглобового комплексу дорiвнювало +121–200 %, а в проекції проксимального відділу великогомілкової кістки — +51–80 %; третя група нараховувала 11 (21 %) пацієнтів iз включенням індикатору в проекції ураженого суглоба більше ніж +200 %, а в проекції проксимального відділу великогомілкової кістки — понад +80 %. Через 1 рік після ендопротезування у хворих першої групи післяопераційних ускладнень зафіксовано не було. У 14 (56 %) пацієнтів другої і у 7 (63 %) — третьої групи через 1 рік після ендопротезування були виявлені імплантасоційовані інфекційні ускладнення. Висновки. Для виконання ендопротезування колінних суглобів без ризику виникнення післяопераційних ускладнень накопичення радіофармпрепарату при остеосцинтиграфії в проекції ураженого остеоартрозом суглоба повинно бути в межах +10–120 %, а в проекції проксимального відділу великогомілкової кістки — +5–50 % відносно симетричної ділянки дослідження.

Metabolism of Subchondral Bone Tissue in Posttraumatic Osteoarthrosis in Rats.

In rats with modeled posttraumatic knee osteoarthrosis, negative changes in subchondral bone metabolism were revealed: a tendency to an increase in osteocalcin concentration, a decrease in sclerostin and osteoprotegerin levels, and a significant increase in FGF-23 concentration accompanied by a slight elevation of inorganic phosphorous and significant increase in total calcium levels in comparison with the corresponding parameters in intact controls. These findings demonstrate crucial importance of structural integrity of the subchondral bone, because its protection improves the results of reconstructive therapy for local cartilage defects.

Morphological Changes in Articular Cartilage and Free-Radical Lipid Peroxidation in Rats with Posttraumatic Osteoarthrosis.

Using the rat model of posttraumatic osteoarthrosis of the knee joint induced by surgical transection of their anterior cruciate ligaments, we showed that irreversible loss of hyaluronan by the extracellular matrix of the joint cartilage tissue against the background of oxidative stress accompanied by accumulation of intermediate LPO products in blood serum and formation of thiol system incompetence was one of the key patterns of dystrophic degeneration of the cartilage tissue. Considerable metabolic shifts were associated with structural modification of the articular hyaline cartilage: its thinning and a decrease of chondrocyte density and their abnormal spatial distribution in the matrix with predominance of solitary isolated cells with signs of karyopyknosis and karyolysis.

Minimally Invasive Interphalangeal Arthrodesis.

Distal interphalangeal joint fusion is usually the surgical treatment for primary or posttraumatic osteoarthrosis when conservative measures fail. All fusion techniques aim for solid fusion with joint chondral resection, bone to bone contact and stable fixation in an adequate position. This is performed with an open dorsal approach considering the risks of soft tissue complications. We describe a technique of resecting bone cartilage and getting stable fixation with 2 mini incisions, 1 lateral and 1 in the digital pulp. Using a digital block anesthesia and under fluoroscopy, a small round burr is introduced into the joint by a lateral joint line stab incision. The joint space is enlarged by manual traction on the finger. After adequate cartilage resection, good bone to bone contact in an adequate position is fixed with a cannulated Herbert screw inserted percutaneously by the finger pulp. We describe 4 cases operated with this technique, 3 for pain and 1 for esthetics. All 4 demonstrated good results and were satisfied. X-rays showed solid fusion in 8 to 12 weeks. There was one complication with skin burning because of the burr heating and the authors describe how to avoid it. Minimally invasive distal interphalangeal joint fusion is a simple, reproducible technique that maintains the important steps for a solid arthrodesis with the advantage of preserving the soft tissue envelope.

Impact of Psychosocial and Economic Factors on Functional Outcomes After Operative Calcaneus Fractures.

To report functional outcome scores after operative intraarticular calcaneus fracture and to determine risk factors associated with worse outcomes. Retrospective study. Urban Level 1 trauma center. Ninety-six patients with 114 calcaneus fractures treated by a single surgeon over a 14-year period. Surgical treatment with open reduction and internal fixation with lateral extensile approach or percutaneous reduction and fixation. Functional outcome scores as assessed by the Musculoskeletal Function Assessment (MFA) and the Foot Function Index (FFI) after mean 56 months follow-up. Seventy-two patients (75%) completed functional outcome questionnaires. Patients with functional outcome data were more often employed (86% vs. 67%, P = 0.07), but were no different in terms of age, sex, medical history, mechanism of injury, or injury characteristics. The mean FFI score was 30 (range: 2-89), and the mean MFA score was 28 (range: 2-80). One-third of patients reported scores >30 on the FFI, MFA, or both. Age, sex, tobacco use, mechanism of injury, fracture pattern, open injury, and postoperative infection were not associated with outcome scores. Alcohol abuse and failure to return to work were associated with worse (higher) FFI scores. Alcohol abuse, psychiatric illness, unemployment (before and after injury), polytrauma, and posttraumatic osteoarthrosis were associated with worse (higher) MFA scores. Polytrauma, alcohol abuse, psychiatric illness, work status, and posttraumatic osteoarthrosis were predictors of poor functional outcomes. The findings of this study add to previous literature that has demonstrated the importance of social, behavioral, and environmental factors on recovery after orthopaedic injury. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Морфологические изменения суставного хряща и процессы свободнорадикального окисления липидов у крыс с посттравматическим остеоартрозом

Using the rat model of posttraumatic osteoarthrosis of the knee joint induced by surgical transection of their anterior cruciate ligaments, we showed that irreversible loss of hyaluronan by the extracellular matrix of the joint cartilage tissue against the background of oxidative stress accompanied by accumulation of intermediate LPO products in blood serum and formation of thiol system incompetence was one of the key patterns of dystrophic degeneration of the cartilage tissue. Considerable metabolic shifts were associated with structural modification of the articular hyaline cartilage: its thinning and a decrease of chondrocyte density and their abnormal spatial distribution in the matrix with predominance of solitary isolated cells with signs of karyopyknosis and karyolysis.

Analysis of the Сauses of the Development of Osteoarthrosis of the Shoulder Joint in Patients After Fractures of the Proximal Epimetaphysis of the Humerus

Summary. Posttraumatic (secondary) arthrosis of the shoulder joint, which develops as a result of fractures of the proximal epimetaphysis of the humerus, accounts for about 10% of all arthrosis cases of the shoulder joint, regardless of therapeutic tactics. Objective: to investigate the main causes of the development of post-traumatic arthrosis of the shoulder joint in patients with fractures of the proximal epimetaphysis of the humerus. Materials and Methods. The clinical group consisted of 295 patients with fractures of the proximal epitaphysis of the humerus, who from 2009 to 2020 were treated at the departments of the SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine” (Kyiv). Of these, 55 (18.64%) were patients who had post-traumatic arthrosis of the shoulder joint. The age of the patients ranged from 27 to 68 years (mean age 42.7±9.5 years); men were 155 (52.5%), women 140 (47.5%). The presence of post-traumatic omarthrosis was determined in terms of 3 to 5 years after the fracture. All patients with post-traumatic osteoarthrosis of the shoulder joint, depending on the treatment, were divided into two groups: group A – patients after metal osteosynthesis of the proximal epimetaphysis of the humerus, group B – patients who underwent conservative treatment. Group A included 35 (63.6%) patients, group B – 20 (36.4%) patients. A general AS/ASIF classification was used to determine the type of a fracture. Conclusions. The highest number of cases of post-traumatic omarthrosis after conservative treatment was found in patients with type A1 fractures – 10.9% and A2 – 14.6%; after surgical treatment, post-traumatic omarthrosis was developed in patients with type C3 fractures – 12.6% and A3 – 14.6% (p≥0.05). The main reason for the development of post-traumatic omarthrosis is aseptic necrosis of the shoulder head – 61.8% (p≤0.05), which is more common in patients with type B and C fractures according to AO. The greatest impact on the development of omarthrosis in patients with fractures of the proximal epimetaphysis of the humerus is the load on the shoulder joint, both during rehabilitation and in daily life, and the presence of contracture in the shoulder joint.

PO 18198 - Treatment of distal tibiofibular syndesmosis injury in ankle fractures with suture button

Introduction: Distal tibiofibular syndesmosis (DTFS) injuries in ankle fractures are conventionally treated by DTFS fixation with stabilizing screws. However, screws may cause problems due to their inherent rigidity. Therefore, the popularity of fixation devices that allow DTFS mobility has increased. The objective of the present study is to describe the outcomes of the surgical treatment of ankle fractures with DTFS injury using suture button syndesmosis fixation. Methods: Forty-four patients surgically treated with a suture button for ankle fractures associated with DTFS injury were retrospectively analyzed. The mean follow-up time was 14.7 months. Patient functioning was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score, the visual analog scale (VAS), the rate of complications and the need for reoperation. Results: The mean AOFAS score at the last follow-up visit was 92 (35-100). The mean VAS was 0.8 (0-7). Eight patients (18%) developed complications, the most common of which were posttraumatic osteoarthrosis and peroneal tendinopathy. Reoperations were performed in 6 patients (13.5%) and included orthopedic hardware removal, peroneal tenoplasty, neurolysis or distal tibiofibular arthrodesis. Only one patient was unable to resume previous activities. Conclusion: Suture button is a reliable alternative for DTFS fixation in ankle fractures, providing excellent functional outcomes with a low rate of complications. This device has the theoretical advantage of allowing physiological mobility of the distal tibiofibular joint and generally requires no subsequent orthopedic hardware removal.

Functional outcome of external fixator application vs volar plating for intrarticular distal radius fractures: A long term prospective study

Fractures of distal end radius are common fractures of the upper limb, and constitute 17% of all fractures and 75% of all forearm fractures. This fracture shows bimodal distribution of age with the fracture more commonly seen in children and elderly. Fractures that involve the articular surfaces of the distal radius can jeopardize the congruence and kinematics of the wrist joint. Anatomical articular reduction greatly reduces the incidence of post-traumatic osteoarthrosis and the quality of reduction relates directly to the final outcome. These types of fractures have been treated by various methods. Many fixation techniques have been described including pin and plaster fixation, percutaneous pinning, intramedullary pinning, external fixation (bridging or nonbridging, static or dynamic) and various forms of internal fixation with customised implants. The advantages of external fixation are the relative ease of application, minimal surgical exposure, and reduced surgical trauma. The disadvantages are prolonged immobilisation of the radiocarpal joint, indirect reduction of fracture fragments, loss of ligamentotaxis over time, and pin related complications. The advantages of plate osteosynthesis are direct fracture reduction, stable rigid fixation, and the possibility of immediate postoperative motion. Open reduction of the fracture allows reduction of the fracture under direct vision and should lead to accurate restoration of anatomy. Dorsal plates were associated with tendon rupture, tenosynovitis, reoperation, and 25% of collapse while the complication of volar plating is relatively low. The volar surface of the distal radius may be biologically more acceptable for open reduction and internal fixation than the dorsal surface because the flexor tendons are not as close to the bone sur faceas the extensor tendons.

Syndesmosis and Syndesmotic Equivalent Injuries in Tibial Plafond Fractures.

To identify the incidence and fracture characteristics associated with syndesmotic injury in tibial plafond fractures and report the incidence of posttraumatic osteoarthrosis (PTOA). Retrospective comparative study. Two level-1 academic trauma centers. Of the 735 tibial plafond fractures (OTA/AO 43-B3 and 43-C) treated from January 2006 through December 2015, 108 patients (108/735, 15%) were identified with syndesmosis injury. Either acute or missed syndesmotic injury. PTOA. Fourteen fractures (14/735, 2%) had missed syndesmotic injury. Volkmann fragment of ≤10 mm (P = 0.04) and fibular avulsion fracture (P = 0.05) were significantly more common in missed syndesmosis. Ninety fractures (14/14 missed, 76/94 acute) had greater than 12-month follow-up (mean, 26 months; range, 12-102 months). Nearly all patients with missed syndesmosis injury developed arthrosis (13/14, 93%), and 45% (34/76 fractures) of plafond fractures with acute syndesmosis injury developed arthrosis (P < 0.001). Although controlling for malreduction, patients with missed syndesmosis had significantly more PTOA development (P = 0.018). Controlling for malreduction, patients with syndesmotic fixation and a ≤10-mm Chaput or Volkmann fragment or fibular avulsion fracture (8/31, 26%) were less likely to develop PTOA than if they had a similar fracture pattern without syndesmotic fixation (9/10, 90%) (P = 0.011). Fifteen percent of tibia plafond fractures have a syndesmosis or syndesmotic equivalent injury. Missed syndesmosis injury has a high rate of PTOA development. Patients with a ≤10-mm Chaput or Volkmann fragment and/or fibular avulsion fracture benefit from syndesmotic fixation. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Корекційна остеотомія бічної кісточки гомілки при її хибно консолідованих переломах

Мета. Проаналізувати результати застосування модифікованої методики корекційної остеотомії бічної кісточки гомілки при її хибно консолідованих переломах без виражених деструктивно-дистрофічних змін травмованого гомілковостопного суглоба.&#x0D; Матеріали і методи. Дослідження проведено щодо 37 пацієнтів, з них чоловіків - 16, жінок - 21, середній вік яких становив (38 ± 7) років. З моменту травми минуло від 6 до 15 міс, у середньому - (7,8 ± 1,9) міс. Під час рентгенологічного обстеження у пацієнтів виявлено післятравматичний остеоартроз гомілковостопного суглоба І-ІІ стадії за Келгреном - Лоуренсом.&#x0D; Корекційна остеотомія включала поперечну остеотомію бічної кісточки гомілки на рівні суглобової щілини гомілковостопного суглоба, що уможливило виконати трьохплощинну корекцію положення кісточки та відновити співвідношення в гомілковостопному суглобі.&#x0D; Функціональні результати оцінювали за шкалою AOFAS (American Orthopaedic Foot and Ankle Society Score) для гомілковостопного суглоба та заднього відділу стопи до та після хірургічного лікування. Ступінь прогресування остеоартрозу визначали за результатами рентгенографії в навантаженні згідно з класифікацією Келгрена - Лоуренса. Середній термін спостереження з аналізом результатів становив (1,9 ± 0,6) року.&#x0D; Результати. Оцінка функціональних результатів за шкалою AOFAS у межах терміну спостереження зросла з (58,7 ± 2,4) до (86,2 ± 1,8) бала. Під час рентгенологічного обстеження у всіх пацієнтів спостерігали відновлення осі гомілковостопного суглоба, але у 8 (21%) пацієнтів виявили ІІІ стадію остеоартрозу, що свідчило про його прогресування.&#x0D; Висновки. Модифікована методика корекційної остеотомії бічної кісточки гомілки при її хибно консолідованих переломах дає змогу відновити конгруентність та біомеханічну вісь подкодженого суглоба, значно покращити його функціональну здатність та уповільнити прогресування післятравматичного остеоартрозу.

The potent anti-inflammatory effect of Guilu Erxian Glue extracts remedy joint pain and ameliorate the progression of osteoarthritis in mice

BackgroundOsteoarthritis (OA) is a slow progressing, degenerative disorder of the synovial joints. Guilu Erxian Glue (GEG) is a multi-component Chinese herbal remedy with long-lasting favorable effects on several conditions, including articular pain and muscle strength in elderly men with knee osteoarthritis. The present study aimed to identify the effects of Guilu Erxian Paste (GE-P) and Liquid (GE-L) extracted from Guilu Erxian Glue in anterior cruciate ligament transection (ACLT)-induced osteoarthritis mice, and to compare the effectiveness of different preparations on knee cartilage degeneration during the progression of osteoarthritis.MethodsMale C57BL/6J mice underwent anterior cruciate ligament transection to induce mechanically destabilized osteoarthritis in the right knee. 4 weeks later, the mice were orally treated with PBS, celecoxib (10 mg/kg/day), Guilu Erxian Paste (100 or 300 mg/kg/day), and Guilu Erxian Liquid (100 or 300 mg/kg/day) for 28 consecutive days. Von Frey and open-field tests (OFT) were used to evaluate pain behaviors (mechanical hypersensitivity and locomotor performance). Narrowing of the joint space and osteophyte formation were examined radiographically. Inflammatory cytokine (IL-1β, IL-6, and TNF-α) levels in the articular cartilage were determined by quantitative real-time PCR. Histopathological examinations were conducted to evaluate the severity and extent of the cartilage lesions.ResultsGuilu Erxian Paste and Guilu Erxian Liquid (300 mg/kg/day) were significantly more effective (p < 0.01) than celecoxib (10 mg/kg/day) in decreasing secondary allodynia when compared to the saline-treated group (#p < 0.05). Open-field tests revealed no significant motor dysfunction between the Guilu Erxian Paste- and Guilu Erxian Liquid-treated mice compared to the saline-treated mice. Radiographic findings also confirmed that the administration of Guilu Erxian Paste and Guilu Erxian Liquid (100 and 300 mg/kg/day) significantly and dose-dependently reduced osteolytic lesions and bone spur formation in the anterior cruciate ligament transection-induced osteoarthritis mice when compared to the saline-treated group. Notably, Guilu Erxian Liquid (100 mg/kg/day) treatment significantly reduced the mRNA levels of IL-1β, IL-6, and TNF-α as well as relative the protein expression of IL-1β and TNF-α to the effect of celecoxib. Guilu Erxian Paste and Guilu Erxian Liquid (300 mg/kg/day) markedly attenuated cartilage destruction, surface unevenness, proteoglycan loss, chondrocyte degeneration, and cartilage erosion in the superficial layers (##p < 0.01 and ###p < 0.001 respectively).ConclusionsAs expected, our findings suggest that the anti-inflammatory effects of Guilu Erxian Liquid (GE-L), following marked decrease on both IL-1β and TNF-α during the early course of post-traumatic osteoarthrosis (OA), may be of potential value in the treatment of osteoarthritis.