Tibial Plate Research Articles

Modular Tibial Stem Use and Risk of Revision for Aseptic Loosening in Cemented Primary Total Knee Arthroplasty

BackgroundModular tibial stem extensions in total knee arthroplasty (TKA) are designed to reduce the risk of aseptic loosening of the tibial base plate. However, these implants add significant cost and an evaluation of their effectiveness in reducing this risk of loosening has not been studied in a large cohort. We sought to evaluate modular tibial stem utilization in primary TKA. MethodsWe conducted a cohort study using our integrated healthcare system’s Total Joint Replacement Registry. Patients who underwent cemented primary TKA were identified (2009-2019). Propensity scores were used to 1:1 match patients without to those with a stem extension. Cox proportional-hazards regression was used to evaluate the risk for revision due to aseptic loosening. ResultsTen thousand four hundred seventy six TKA with a modular tibial stem were matched to 10,476 TKA without a tibial stem. Stem utilization associated with a lower risk of revision for loosening across all postoperative follow-up (hazard ratio = 0.38, 95% confidence interval = 0.17-0.85). ConclusionIn a matched cohort study, we observed presence of a stem extension was associated with a lower risk of revision for aseptic loosening. Further study to identify specific risk factors for aseptic loosening and confirm the findings presented here are warranted. Level of EvidenceLevel III.

Are asymmetric tibial baseplates superior in primary total knee arthroplasty? A systematic review of clinical studies

Background: Despite the asymmetric nature of the native tibial condyles, traditional primary total knee arthroplasty (TKA) has overwhelmingly employed the use of symmetric tibial baseplates. However, designs exist utilizing an asymmetric tibial baseplate that mimics normal tibial anatomy. The purpose of this review was to assess the functional and radiographic outcomes of asymmetric tibial base plates. Methods: Embase, MEDLINE, and Web of Science were searched for relevant literature from database inception until September 2019, and after screening by two reviewers, studies investigating the use of asymmetric tibial baseplates in primary TKA were included. Demographic data as well as data on revision rates, functional and radiographic outcomes, and complications were recorded. A risk of bias assessment was performed for all studies. Results: Overall, 24 studies were identified with a total of 4776 patients (4937 knees). Seventeen studies (1895 knees) reported a pooled revision rate of 2.4% (45/1845) at a mean follow-up of 72.9 mo. TKA with an asymmetric baseplate resulted in improvement of range of motion and functional outcome scores postoperatively, as well as radiographic evidence of good tibial component positioning and bone coverage. Lastly, the overall pooled complication rate of reporting studies was 12.7%. Conclusions: The use of an asymmetric tibial baseplate in primary TKA is a safe and effective option, with the potential for improved component alignment and tibial coverage. However, more evidence is needed to determine if there are significant differences in failure rates and postoperative functional outcomes before justifying the implementation of a new and potentially more costly technology. Level of Evidence: Level IV.

Computed Tomography Image Analysis of Neuromuscular Electrical Stimulation in the Treatment of Knee Osteoarthritis with Different Radiologic Characteristics Based on Iterative Reconstruction Algorithm

To use computed tomography image analysis of iterative reconstruction algorithm to understand effect of neuromuscular electrical stimulation of quadriceps on motor function rehabilitation after total knee arthroplasty. After total knee arthroplasty, 104 patients were randomly divided into 2 groups. The treatment group comprised 52 patients. The quadriceps femoris was stimulated by neuromuscular electrical stimulation, and patients were required to actively extend the knee along with the current stimulation. In the second group, which received cutaneous nerve electrical stimulation, 2 sets of electrodes were placed on knee pain points. All patients participated in conventional rehabilitation and were discharged from the hospital a mean 14.89 ± 3.65 days after treatment. Visual analog scale, range of motion of knee joint, and Knee Injury and Osteoarthritis Score were evaluated before discharge. The mean interval between follow-up evaluations after discharge was 9.5 months. Knee Society Score and Knee Injury and Osteoarthritis Score were assessed during follow-up. Visual analog scale scores of treatment and control groups at discharge were 18.11 ± 9.66 and 16.13 ±4.25, and active range of motion of the knee joint was 103.21° ± 15.44° and (99.21° ± 15.19°, respectively. Limitation of active knee extension in the treatment group was 1.93° ± 3.47°, which was significantly smaller than in the control group (6.26° ± 4.28°). Neuromuscular electrical stimulation of the quadriceps muscle early after total knee arthroplasty helps to improve the function of the knee extension device and accelerate functional rehabilitation. Computed tomography has found that changes in tibial subchondral bone plate and subchondral cancellous bone in patients with knee osteoarthritis are mainly due to destruction of ultrastructural homeostasis. This change may be the cause of knee osteoarthritis.

Application of 3D Printing in Hip and Knee Arthroplasty: A Narrative Review.

Ideal surgical positioning and placement of implants during arthroplasty are crucial for long-term survival and optimal functional outcomes. Inadequate bone stock or defects, and anatomical variations can influence the outcomes. Three-dimensional printing (3DP) is an evolving technology that could provide patient-specific instrumentation and implants for arthroplasty, taking into account anatomical variations and defects. However, its application in this field is still not adequately studied and described. The present review was conceptualised to assess the practicality, the pros and cons and the current status of usage of 3DP in the field of hip and knee arthroplasties and joint reconstruction surgeries. A PubMed database search was conducted and a total number of 135 hits were obtained, out of which only 30 articles were relevant. These 30 studies were assessed to obtain the qualitative evidence of the applicability and the current status of 3D printing in arthroplasty. Currently, 3DP is used for preoperative planning with 3D models, to assess bone defects and anatomy, to determine the appropriate cuts and to develop patient-specific instrumentation and implants (cages, liners, tibial base plates, femoral stem). Its models can be used for teaching and training young surgeons, as well as patient education regarding the surgical complexities. The outcomes of using customised instrumentations and implants have been promising and 3D printing can evolve into routine practice in the years to come. 3D printing in arthroplasty is an evolving field with promising results; however, current evidence is insufficient to determine significant advantages that can be termed cost effective and readily available.

Abordaje transfibular modificado para fracturas del platillo tibial posterolateral. Serie de Casos

BackgroundFractures of the posterolateral tibial plateau require an approach that allows a good visualization of the articular surface for its anatomical restitution, restoration of height and an adequate space for the application of osteosynthesis material and stable fixation. There are several approaches described in the literature that do not provide the desired visualization or involve multiple limitations and / or complications. The purpose of this study is to describe a modification to the surgical technique of the fibula osteotomy for the management of posterolateral tibial plate fractures. MethodsWe present the clinical results of a retrospective case series of 15 patients with posterolateral tibial plate fractures that at the time of the study had an average follow-up of 6 months. ResultsFunctional results in Lysholm scale were excellent in 3 patients, good in 8 and regular in 4. Good results were obtained in all patients with a reduction of the tibia articular surface, without loss of height of the same, with alignment adequate, without symptoms of instability, all with consolidation of the fibula that did not delay rehabilitation, there were no peroneal nerve injuries or problems with the skin; There was a case of superficial infection that was managed with oral antibiotics without complications. DiscussionThe described approach facilitates a broad exposure of the articular surface, is technically easy and reproducible, allows the necessary reduction and fixation, with a lower risk of complications, with which the vascular supply of the proximal tibia is conserved, the damage is avoided to the proximal tibiofibular joint and a greater area of consolidation of the osteotomy is favored. This technique can be used alone or in combination with other approaches, for acute or chronic fractures with poor union.We consider that the approach with the described technique is an alternative for the management of posterolateral fractures, with encouraging results.Evidence Level: IV

Effect of Foot Reflexology on Postoperative Pain in Patients Undergoing Tibia Plating Surgery: A Randomized Clinical Trial

Objective: One of the major problems of patients after orthopedic surgeries is acute pain. The present study aims to evaluate the effect of foot reflexology massage on postoperative pain in patients undergoing plating surgery for tibia fracture. Methods: This study is a randomized clinical trial conducted on 96 patients who were candidates for tibia plating surgery referred to Imam Ali Hospital in Bojnourd, Iran, randomly divided into intervention and control groups. Foot reflexology massage in the intervention group was performed on patients’ healthy feet for 10 minutes, one hour before surgery. In the control group, the foot sole was touched for one minute without any pressure. Pain intensity was measured using the standard Visual Analog Scale before and immediately after the intervention and 2, 4, 6, 12 and 24 hours after surgery. Data were analyzed using chi-square test, t-test, repeated measures ANOVA, Mann-Whitney U and Friedman tests. Results: The baseline pain scores in the intervention and control groups were reported 8.1±0.9 and 8.4±0.9, respectively. After the intervention, the pain score in these groups was reduced to 6.9±1.1 and 8.1±1.0, respectively (P<0.001). At other times, up to 24 hours after surgery, the pain reduction was higher in the intervention group (P<0.05). Conclusion: Foot reflexology massage reduces postoperative pain of patients undergoing tibia plating surgery. Therefore, this method can be used to reduce pain and anxiety in orthopedic surgery patients.

Effect of periosteal resection on longitudinal bone growth in a mouse model of achondroplasia

Achondroplasia (ACH) is the most common form of short-limbed skeletal dysplasia. Patients with ACH sometimes undergo lower limb lengthening to get functional and psychological achievements. The periosteal resection (PR) is a known mechanism to increase longitudinal bone growth without osteotomy, although the results are not predictable. It could be alternative for limb lengthening in a minimally invasive technique. The purpose of this study is to evaluate the effect of PR on acceleration of bone growth in a mouse model of ACH (Fgfr3ach). We performed a circumferential resection of periosteum on the proximal tibia to both wild-type and Fgfr3ach mice at the age of four weeks. The second PR was done one week later in each mouse, which was subsequently sacrificed at the age of six weeks for micro-computed tomography (micro-CT) scan and histological examinations. We measured tibial bone length, bone volume, and metaphyseal trabecular bone parameters, including bone volume/tissue volume (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N) by reconstructed micro-CT images. We also quantified the entire width of the growth plate of the proximal tibial from the sections stained with hematoxylin and eosin. Tibial bone length and bone volume of the PR side were significantly larger than the sham side in wild-type mice, while they were not statistically significant in Fgfr3ach mice. The BV/TV and Tb.N in the metaphysis were significantly decreased in the PR side of both mice. The histological analysis revealed that the growth plate of the proximal tibia was significantly wider in the PR side of wild-type mice while it showed no difference in width between the PR side and the sham side in Fgfr3ach mice. PR promoted longitudinal bone growth in wild-type mice, but it exhibited only a marginal effect on bone growth in Fgfr3ach mice.

Mechanical performance and implications on bone healing of different screw configurations for plate fixation of diaphyseal tibia fractures: a computational study

Diaphyseal tibia fractures may require plate fixation for proper healing to occur. Currently, there is no consensus on the number of screws required for proper fixation or the optimal placement of the screws within the plate. Mechanical stability of the construct is a leading criterion for choosing plate and screws configuration. However, number and location of screws have implications on the mechanical environment at the fracture site and, consequently, on bone healing response: The interfragmentary motion attained with a specific plate and screw construct may elicit mechano-transduction signals influencing cell-type differentiation, which in turn affects how well the fracture heals. This study investigated how different screw configurations affect mechanical performance of a tibia plate fixation construct. Three configurations of an eight-hole plate were considered with the fracture in the center of the plate: eight screws-screws at first, fourth, fifth and eighth hole and screws at first, third, sixth and eighth hole. Constructs' stiffness was compared through biomechanical tests on bone surrogates. A finite element model of tibia diaphyseal fracture was used to conduct a stress analysis on the implanted hardware. Finally, the potential for bone regeneration of each screw configuration was assessed via the computational model through the evaluation of the magnitude of mechano-transduction signals at the bone callus. The results of this study indicate that having screws at fourth and fifth holes represents a preferable configuration since it provides mechanical properties similar to those attained by the stiffest construct (eight screws), and elicits an ideal bone regenerative response.

A Biomechanical Comparison of the Effect of Baseplate Design and Bone Marrow Fat Infiltration on Tibial Baseplate Pullout Strength

BackgroundEarly clinical results of a new total knee arthroplasty (TKA) implant design show promise for improved outcomes and patellofemoral function scores. However, reports of early tibial component-cement interface debonding requiring revision have been published. This study investigated the biomechanical properties of three different tibial baseplates to understand potential causes of failure. MethodsPFC Sigma (control), Attune (1st generation) and Attune S+ (2nd generation) tibial baseplates were implanted into 4th generation sawbone tibia models using a standardized technique. Three of each baseplate were cemented with and without additional bovine bone marrow fat. All models were tested to failure with measured axial distraction force. Implant type, presence or absence of bovine marrow and load to failure were all recorded and compared. Two-way ANOVA followed by post-hoc pairwise comparisons were used to determine statistical significance, which was set to P < .05. ResultsThe 2nd generation tibial baseplates required significantly more force to failure. The presence of bovine marrow significantly reduced the pullout force of the implant designs overall. No significant difference was detected between the 1st generation and control baseplates. Failure mode for each model was also noted to be different irrespective of the presence or absence of bone marrow fat. ConclusionThe 2nd generation baseplates required significantly more force to failure compared with older designs. The presence of bone marrow during cementation of a tibial base plate significantly decreased axial pullout strength of a tibial baseplate in this laboratory model. All 1st generation baseplates exhibited debonding at the cement-implant interface.

Staged vs Concurrent Hardware Removal During Conversion Total Knee Arthroplasty

BackgroundConversion total knee arthroplasty (TKA) in the presence of periarticular hardware can be associated with increased resource utilization, complications, and revisions. However, little guidance exists on the optimal approach to hardware removal. The purpose of this study is to compare outcomes of conversion TKA with hardware removal performed in either a staged or concurrent manner. MethodsThis is a retrospective study of 155 TKA operations performed with staged (45) or concurrent (110) removal of hardware at the time of TKA. Differences in patient data, case data, complications, reoperations, and revisions were evaluated. Subgroup comparisons of cases involving major hardware (plates, nails, rods), minor hardware (screws, buttons, wires), and tibial plates were performed. ResultsThere were no differences in age, sex, body mass index, or comorbidities between patients who underwent staged or concurrent hardware removal. Rates of complications, reoperations, and revisions did not differ at multiple time points (90 days, 1 year, 2 years, 4 years). Patients who underwent staged hardware removal were more likely to have had prior surgery for fracture reconstruction (68% vs 33%, P < .001), to have had major hardware removed (84% vs 59%, P = .03), and were less likely to have had hardware removal performed through a single incision with TKA (50% vs 92%, P < .001). Subgroup analysis of major and minor hardware cases demonstrated comparable outcomes. ConclusionThere remains no established benefit to either a staged or concurrent approach to hardware removal at the time of TKA. This is true regardless of hardware burden. At this time, a case-by-case approach should be taken to conversion TKA in the presence of periarticular hardware.

Concentrated stress effects of contoured and non-contoured high Tibial osteotomy plates: A finite-element study

BackgroundThe TomoFix plate has been extensively used in high tibial osteotomy surgery to stabilize the distracted tibial bones. However, distal pain related to plate irritation was considered one of the most relevant complications for this fixation device. This study aimed to correlate reports of distal pain with the profiles of the distracted tibia and initial plate and plate contour. MethodsThis study used the finite-element method to investigate the profile-, distraction-, and contour-induced effects on stress distribution of the distal tibia-plate contact. The associations of two tibia profiles (normal and concave), distraction angles, and two plate profiles (contoured and non-contoured) were discussed in this study. The areas and stresses of the distal tibia-plate contact were chosen as comparison indices. FindingsBefore weight-bearing, the non-contoured plates of the normal and concave tibia profiles consistently showed less contact area at the distal tibia-plate region. Consequently, the physiological loads make the non-contoured plate subject to more concentrated bone stresses and thus may induce more pain at the distal tibia-plate region than a contoured plate. When the distraction angle decreases, the tibia-plate gap increases. Prior to fixation, the tibia-plate gap can be evaluated by the profiles of the distracted tibia and non-contoured plate by use of anteroposterior radiograph and computer-aided simulation. InterpretationIn the situations of a lower distraction angle or a large tibia-plate gap, the use of a plate bender or a lag screw is recommended in order to contour the plate for reducing the concentrated stress at the distal tibia-plate region.

Limb position influences component orientation in Oxford mobile bearing unicompartmental knee arthroplasty: an experimental cadaveric study.

AimsThe mobile bearing Oxford unicompartmental knee arthroplasty (OUKA) is recommended to be performed with the leg in the hanging leg (HL) position, and the thigh placed in a stirrup. This comparative cadaveric study assesses implant positioning and intraoperative kinematics of OUKA implanted either in the HL position or in the supine leg (SL) position.MethodsA total of 16 fresh-frozen knees in eight human cadavers, without macroscopic anatomical defects, were selected. The knees from each cadaver were randomized to have the OUKA implanted in the HL or SL position.ResultsTibial base plate rotation was significantly more variable in the SL group with 75% of tibiae mal-rotated. Multivariate analysis of navigation data found no difference based on all kinematic parameters across the range of motion (ROM). However, area under the curve analysis showed that knees placed in the HL position had much smaller differences between the pre- and post-surgery conditions for kinematics mean values across the entire ROM.ConclusionThe sagittal tibia cut, not dependent on standard instrumentation, determines the tibial component rotation. The HL position improves accuracy of this step compared to the SL position, probably due to better visuospatial orientation of the hip and knee to the surgeon. The HL position is better for replicating native kinematics of the knee as shown by the area under the curve analysis. In the supine knee position, care must be taken during the sagittal tibia cut, while checking flexion balance and when sizing the tibial component.

Reliability and concurrent validity of angle measurements in lower limb: EOS 3D goniometer versus 2D manual goniometer.

S U M M A R YBackgroundIn clinical routine, preoperative radiographic assessment of lower extremity geometry relies on conventional X-rays. However, the plane goniometric measuring has several limitations in accurately locating anatomical landmarks. The purpose of this study is to propose a fast and accurate 3D-reconstruction-method based on biplanar X-rays with clinical measurements assessment in standing position.Methods50 candidates for HTO or DFO with deformity of the lower extremities were included in this study. Biplanar X-rays were performed using the EOS imaging system in conventional double-stance full weight-bearing position (DS) and shifted-foot standing position (SF). The results of hip-knee-ankle angle (HKAA), lateral distal femoral angle (LDFA), and medial proximal tibial angle (MPTA) were evaluated by either 2D manual goniometer (MG) based on X-ray in DS standing position or 3D-reconstruction goniometer based on X-rays in SF standing position.ResultsFor the reproducibility study, MG and EOS goniometer were both reliable in repeated measures of HKAA, LDFA, and MPTA, with average concordance correlation coefficients (CCCs) all above 0.910. The agreements between MG and EOS measurements were high for HKAA and LDFA with CCCs all above 0.90, while the agreement was low for MPTA with CCC below 0.75. Further linear regression model analysis also revealed a significant correlation between MG and EOS measurements for HKAA (all R2 ≥ 0.93) and LDFA (all R2 ≥ 0.90), but not for MPTA (all R2 ≤ 0.522).ConclusionIn comparison with the traditional 2D manual goniometer, EOS 3D reconstruction based goniometric measuring could provide equivalent results of HKAA and LDFA, and potentially a more accurate result of MPTA. These findings suggest that EOS 3D reconstruction based goniometric measuring is suitable for preoperative evaluation and planning for HTO/DFO. However, future improvements of the 3D reconstruction method are needed for better detection of the femoral condyles and tibial plates without the requirement of shifted-foot standing position.The translational potential of this articleEOS 3D reconstruction based goniometric measuring could provide equivalent or even more accurate results of HKAA, LDFA, and MPTA, in comparison with the traditional 2D manual goniometer, making it suitable for preoperative evaluation and planning for HTO/DFO.

Patella Fracture Fixation Via Wide Awake Local Anesthesia No Tourniquet (Walant) Technique

Introduction:Fracture of the tibia are the most common long bone fracture, with an incidence greater than 75,000 per year in the US1. With the recent breakthrough of operation under WALANT (Wide Awake Local Anaesthesia No Tourniquet) technique. We reported a patient with midshaft tibia fracture who underwent plating under the WALANT techniqueMethodology:18 yearold gentleman sustained a closed fracture of his left tibia after his motorbike skidded. He wascounselled for the surgery to be done under the wide-awake technique as we have limited operating theatre time for the case to be done under general/regional anaesthesia. Preoperatively, the WALANT solution is prepared using 50 cc lidocaine 2%, 1cc of epinephrine, 10cc of sodium bicarbonate 8.4% then dilute into 50 cc normal saline. Total of 50 cc WALANT solution was injected along the planned skin incision and at subperiosteum 30 minutes before operation started.Result:Pain score patient remain 0-3/10 during and after removal of backslab, throughout the surgery and postoperatively. The use of epinephrine for hemostasis provide good surgical field view since there is minimal bleeding. Postoperatively the anaesthesia effect lasted for 6 hour and was patient able to move the leg straight away without have to keep lying in bed for 6 hours after spinal or drowsiness from sedation.Conclusion:Plating of tibia under WALANT is a good alternative for patient who have financial difficulty, high risk operation under general anaesthesia, hospital which have limited slot for operation under general anaesthesia and etc. Additionally, the strength and stability of the plate can be assessed intraoperatively by asking the patient to actively move his limb.Reference: Praemer A, Furner S, Rice DP. Musculoskeletal Conditions in the United States. Park Ridge, IL: American Academy of Orthopaedic Surgeons; 1992.

Trampoline-related proximal tibia impaction fractures in children: a population-based approach to epidemiology and radiographic findings between 2006 and 2017.

PurposeProximal tibia impaction fractures are specific injuries, usually caused by trampolining. They may associate with later growth disturbances. There is sparse understanding about their recent epidemiology, in particular the changing incidence. Their typical radiographic findings are not completely known.MethodsAll children, aged < 16 years, who had suffered from proximal tibia fracture in Oulu Arc and Oulu between 2006 and 2017 were enrolled (n = 101). Their annual incidence was determined using the official population-at-risk, obtained from the Statistics Finland. The specific characteristics and risk factors of the patients and their fractures were evaluated. Radiographic findings were analyzed, in particular the anterior tilting of the proximal growth plate, due to impaction.ResultsThe annual incidence increased two-fold from 9.5 per 100 000 children (2006 to 2009) to 22.0 per 100 000 (2014 to 2017) (difference: 12.5; 95% confidence interval 5.1 to 20.3 per 100 000; p = 0.0008). The mean annual incidence of trampoline impaction leg fractures was 15.4 per 100 000 children. In 80% of the cases multiple children had been jumping together on the trampoline. Anterior tilting (mean 7.3°, SD 2.5°, 6.1° to 19.1°) ) of the proximal tibial plate was seen in 68.3% of the patients. Satisfactory bone union was found in 92.7% during follow-up. Isolated patients presented delayed bone healing.ConclusionThe incidence of trampoline leg fractures has increased 130% during the 12 years of the study period. Many of these injuries could have been prevented by avoiding having several jumpers on the trampoline at the same time. Anterior tilting of the growth plate was a common finding and should be recognized in the primary radiographs.Level of evidenceIV

Association between knee alignment, articular cartilage degradation, and subchondral trabecular bone remodeling in patients with knee osteoarthritis

Purpose: Knee osteoarthritis (OA) is a common disabling disease involving the entire joint tissue, its onset and progression are affected by many factors. However, the current number of studies investigating the relationship between subchondral trabecular bone (STB), knee alignment and articular cartilage degradation is limited. We aimed to investigate the variation in tibial plateau STB remodeling in knee OA patients and their association with knee alignment (hip-knee-ankle, HKA, angle) and articular cartilage degradation. Methods: Forty-three knee OA patients scheduled for total knee arthroplasty (TKA) underwent preoperative radiography to measure the HKA angle and Kellgren-Lawrence grade. Tibial plate specimens collected from TKA was used for histology, histomorphometric measurements, and immunohistochemistry to assess subchondral bone remodeling and cartilage degradation ((OARSI score). Correlations between HKA angle, OARSI score, and STB remodeling parameters were evaluated. Differences in STB remodeling parameters between varus and valgus groups based on the HKA angle were examined. Results: The HKA angle was significantly correlated with all STB remodeling parameters (p<0.01). The HKA angle was more correlated with the medial-to-lateral ratios of the remodeling parameters than with the medial or lateral tibia plateaus. The HKA angle and all STB remodeling parameters are significantly correlated with OARSI score (p<0.01). Conclusions: The variation of tibial plateau STB structural and remodeling indices is associated with the HKA angle and cartilage degradation. Knee malalignment causes the abnormal STB remodeling and microstructural sclerosis potentially affecting transmission of loading stress from the cartilage to the subchondral bone, and then resulting in accelerated OA progression in patients with knee OA. The results indicate that correction of knee malalignment could affect STB remodeling and then intervene the occurrence and development of OA. In addition, the improvement in subchondral bone with bone-metabolism agents may help mitigate OA progression.

A retrospective study of floating knee injuries and various modalities of operative intervention with outcomes

Background: floating knee injuries refers to ipsilateral tibial and femoral shaft fractures with or without involving knee joints articular surface to various extent. This is a high impact injury usually occurs from high velocity RTA. Multiple life-threatening injury to head, chest and abdomen involving multiple soft tissues is a common occurrence with floating knee. Involvement of tibia and femur to variable extent results in huge diversification of fracture patterns and treatment. This study aims at analysis of need for various modes of operative interventions with combination of multiple fixation techniques and their outcome.Methods: This is a retrospective study of 30 cases conducted between 2018 to 2020 with follow-up of 2 years. Study conducted at a tertiary care private hospital. Patients were treated with combination of various implants like external fixator, femoral and tibial plate osteosynthesis, and intramedullary nail as per the fracture pattern. Outcome analysed at the end of study taking in to consideration of type of fracture and implants used in terms of time to union, complications and need for reoperation. Objectively assessed after a 2 year with Karlstrom and Olerud criteria.Results: The mean age of our study population was 32.4 years. The average time for union of femur was 7.5 months, and for tibia is 9.7 months. All thirty patients were involved in road traffic accident. The right side was involved in 24 (80%) patients and left side in 6 (20%) patients. There were 14 Type-I (46.66), 3 Type-IIA (10%), 9 Type-IIB (30%) and 4 Type-IIC (13.33%) Floating knee injuries according to Fraser classification. There were 21 (70%) open in which all patients were with tibia open fractures and 9 (30%) were with closed fractures. Functional assessment was done using Karlstrom and Olerud criteria after complete bony union, which showed excellent results in 8(26.66) patients, good in 10(33.33%), fair in 8 (26.66%) and 4 patients with poor results (13.33%).Conclusions: Floating knee injuries are complex fracture. Needs initial thorough evaluation to roll out other injuries. Early diagnosing and addressing of popliteal artery injuries are limb saving. Initial stabilisation of fractures with external fixator to control damage may follows multiple operative procedures as definitive fixation in many. Anatomical reduction and fixation irrespective of implant with minimal soft tissue insult were proved to be critical. Aggressive rehabilitation process and early joint mobilisation are key to good outcome.

A study of extra articular metaphyseal proximal tibia fractures treated with proximal tibia plate using MIPPO technique

Tibia fractures, by its location and by being subcutaneous in most of its length tend to be open very commonly. Due to its precarious blood supply and scanty soft tissue coverage orthopaedic surgeons around the world have been fighting infections and union problems associated with its fractures. Our aim of this study focuses on the outcome of locking plates used in metaphyseal fractures of tibia in terms of union, complications and functional outcome of patients. An Observational prospective study of 30 patients with close or open grade I fractures of proximal tibia (Metaphyseal) without intra-articular extension, with recent (

Quantitative Assessment of Weight-Bearing Fracture Biomechanics Using Extremity Cone-Beam CT.

We investigate an application of multisource extremity Cone-Beam CT (CBCT) with capability of weight-bearing tomographic imaging to obtain quantitative measurements of load-induced deformation of metal internal fixation hardware (e.g. tibial plate). Such measurements are desirable to improve the detection of delayed fusion or non-union of fractures, potentially facilitating earlier return to weight-bearing activities. To measure the deformation, we perform a deformable 3D-2D registration of a prior model of the implant to its CBCT projections under load-bearing. This Known-Component Registration (KC-Reg) framework avoids potential errors that emerge when the deformation is estimated directly from 3D reconstructions with metal artifacts. The 3D-2D registration involves a free-form deformable (FFD) point cloud model of the implant and a 3D cubic B-spline representation of the deformation. Gradient correlation is used as the optimization metric for the registration. The proposed approach was tested in experimental studies on the extremity CBCT system. A custom jig was designed to apply controlled axial loads to a fracture model, emulating weight-bearing imaging scenarios. Performance evaluation involved a Sawbone tibia phantom with an ~4 mm fracture gap. The model was fixed with a locking plate and imaged under five loading conditions. To investigate performance in the presence of confounding background gradients, additional experiments were performed with a pre-deformed femoral plate placed in a water bath with Ca bone mineral density inserts. Errors were measured using eight reference BBs for the tibial plate, and surface point distances for the femoral plate, where a prior model of deformed implant was available for comparison. Both in the loaded tibial plate case and for the femoral plate with confounding background gradients, the proposed KC-Reg framework estimated implant deformations with errors of <0.2 mm for the majority of the investigated deformation magnitudes (error range 0.14 - 0.25 mm). The accuracy was comparable between 3D-2D registrations performed from 12 x-ray views and registrations obtained from as few as 3 views. This was likely enabled by the unique three-source x-ray unit on the extremity CBCT scanner, which implements two off-central-plane focal spots that provided oblique views of the field-of-view to aid implant pose estimation. Accurate measurements of fracture hardware deformations under physiological weight-bearing are feasible using an extremity CBCT scanner and FFD 3D-2D registration. The resulting deformed implant models can be incorporated into tomographic reconstructions to reduce metal artifacts and improve quantification of the mineral content of fracture callus in CBCT volumes.

Analysis of Association between Morphometric Parameters of Growth Plate and Bone Growth of Tibia in Mice and Humans.

The purposes of this study are to evaluate which growth plate parameters are associated with bone growth in mice and to compare the mouse results with those in humans. The sagittal sections of the proximal growth plate of the mouse tibia from neonate to young adult stages were subjected to histomorphometric and functional analyses. The radiographic images of tibias of human patients until puberty were analyzed to obtain the tibia length and the proximal growth plate height. It was found that a linear correlation best modeled the relationship between the growth plate variables with the tibia growth rate and length. In mice, total height, resting zone height, combined height of the proliferation and prehypertrophic zones, proliferation activity, and the total width of tibia growth plate showed high linear correlation with tibia bone length and bone growth rate, but the hypertrophic zone height and the growth plate area did not. In both mice and humans, the total growth plate width of tibia was found to have the strongest correlation with tibia length and growth rate. The results validated that growth plate total height, the height of the resting zone and cell proliferation activity are appropriate parameters to evaluate the balance between growth plate activity and bone growth in mice, consistent with previous reports. The study also provided a new growth plate parameter candidate, growth plate width for growth plate activity evaluation in both mouse and human tibia bone.