Unstable Joint Research Articles

Ligament reconstruction for distal radioulnar joint instability with the biomechanical analysis: A case report.

The aim of the study is to evaluate the clinical effects and feasibility on chronic distal radioulnar unstable joint (DRUJ) under wrist arthroscope triangular fibrocartilage complex (TFCC) repair and reconstruction. The biomechanical characteristics of the recovery process after treatment were analyzed using finite element modeling. A patient with chronic DRUJ instability was treated with reconstruction of the distal radioulnar ligament using the Adams Berger method. Piano sign and forearm rotation tests were used to evaluate the function of the DRUJ. Grip power, range of motion, and visual analog scale scores were recorded at the last follow-up. Joint function was evaluated by the disability of the arm, shoulder, and hand score. A geometric model for the surgical repair of TFCC damage, meshing in finite element simulation, and stress distribution of the repaired ligament during forearm rotation were analyzed by finite element simulation. The diagnosis was confirmed as chronic DRUJ instability. The patient had no postoperative complications and was followed-up for 6 months. Stability was achieved in all patients. The results of the stress and forearm rotation tests are negative. At the last follow-up, the grip power, disability of the arm, shoulder, and hand score, visual analog scale score, and range of motion of the wrist were significantly improved compared with the preoperative values (P < .05). TFCC repair and reconstruction under wrist arthroscopy can effectively treat chronic DRUJ and improve wrist function. Our study established a three-dimensional finite element model of the entire DRUJ, which provided a digital visual platform for simulating the biomechanical features of the TFCC, DRUJ, and other structures in different states. This study demonstrated that the rotation angle of the wrist joint should be confined within 75° for a short period after surgery to avoid tearing the tendon as a result of excessive force. It also provides an intuitive simulation tool for the design of TFCC repair and the evaluation of curative effects.

PARAMETERS OF THE INTERCONDYLAR FOSSA OF THE FEMUR IN CHILDRENIN NORMAL CONDITIONS AND WITH CONGENITAL MALFORMATIONS OF THE LOWER LIMBS

According to literature sources, radiography can indirectly visualize congenital insufficiency of the cruciate ligaments both in isolated form and in combination with other congenital malformations of the lower extremities. Objective. To study the parameters of the intercondylar fossa of the femur in children of different age groups with stable/unstable knee jo ints due to congenital malformations of the lower limbs using instrumental imaging methods. Methods. A prospective diagnostic study was conducted of 359 knee joints of 217 children who were treated at the pediatric orthopedics clinic from 2019to 2022 and with a retrospective control group (2010–2021). limbs, as well as with congenital malformations of the lower limbs. X-ray examinations were performed on the OPERA T90cex X-ray and fluoroscopic system. Results. 217 patients took part in the study, including 105 patients without knee jointpathology and 112 with congenital malformations of the lower limbs. Comparison of the accuracy of radiological diagnostic indicators was performed using the Studentʼs t-test with the results of computer and magnetic resonance imaging studies, which showed the absence of a statistically significant differencein the results research. A diagnostic study was also conducted to find the regularity of the development of the knee joints and to identify the parameters of the radiological norm of the development of the intercondylar fossa of the femur in children of different age categories. Conclusions. Using the resultsof instrumental studies, the parameters of the intercondylar fossa of the femur in children of different age categories with stable and unstable knee joints due to congenital malformations of the lower limbs were investigated. The results of the study should be taken into account for the diagnosis of congenital defects of the knee joint.

Treatment of Acute Acromioclavicular Joint Dislocation Using Hook Plate: A Systematic Review and Meta-Analysis and Update of Current Literature

Abstract Background the hook plate metallic device showed early promise as an alternative implant to treat unstable acromioclavicular joint dislocation injuries. The hook plate can be used to provide an indirect reduction of a distal clavicle fracture. This indirect reduction technique is useful for comminuted fractures or fractures with very small distal fragments in which conventional reduction and fixation is difficult. Aim of the Work to evaluate the treatment of acute acromioclavicular joint dislocation and radiographic outcomes. Materials and Methods Studies were considered eligible if they expressed treatment of acromioclavicular joint dislocation using the hook plate and described the patient's clinical and functional outcomes; intra-operative, post-operative complications, full-text articles were available, randomized controlled trials, including cluster RCTs, controlled (non-randomized) clinical trials or cluster trials, prospective and retrospective comparative cohort studies, and case-control or nested case-control studies. We will exclude cross-sectional studies, case series, case reports and literature not in English. All items that didn't match the above criteria were excluded. Results The total studies included 270 patients with average mean age 35.5 years and mean follow up 25.33 months. The Constant Murely score average 84 points (The CMS was developed for the evaluation of shoulder function with subjective and objective components) and the p value &amp;lt;.05 that means all patients had significant improvement. Full range of motion could be achieved in the patients. Patients with restrictions of range of motion mainly showed limitations in abduction and external rotation. These limitations are most probably caused by the post-operative immobilization, which is necessary after implantation of hook plates to ensure healing of the ligament structures and avoid damage of the acromion by the hook itself. Other studies also showed restrictions of range of motion for abduction and external rotation after hook plate implantation. Conclusion it has a good to excellent Constant Murely score (full range of motion) that enables quick return to activities. It is useful for (Rockwood III-VI). So good clinical results can be achieved with hook plate.

The role of different acetabular morphologies on patient-reported outcomes following periacetabular osteotomy in borderline hip dysplasia

IntroductionThe treatment option for borderline hip dysplasia (BHD) includes hip arthroscopy and periacetabular osteotomy (PAO). To the present day the controversial discussion remains, which intervention to prefer. Literature reports supporting an educated choice are scare, based on small patient cohorts and do not address the variability of acetabular morphology. Consequently, we intended to report PAO outcomes, from patients diagnosed with BHD, dependent on acetabular morphology, in a large patient cohort and aimed to define risk factors for poor clinical results and patient satisfaction.Materials and methodsA prospective monocentre study was conducted. Patients enrolled underwent PAO for symptomatic BHD (LCEA, 18°–25°). A total of 107 hips were included with 94 complete data sets were available for evaluation with a minimum follow-up of 1 year and a mean follow-up of 2.3 years. The mean age was 31 ± 8.2 years, and 81.3% were female. As the primary outcome measure, we utilized the modified Harris hip score (mHHS) with minimal clinically important change (MCID) of eight to define clinical failure. Results were compared after a comprehensive radiographic assessment distinguishing between lateral deficient vs. anterior/posterolateral deficient acetabular and stable vs. unstable hip joints.ResultsOverall, clinical success was achieved in 91.5% of patients and the mHHS improved significantly (52 vs. 84.7, p < 0.001). Eight hips failed to achieve the MCID and four had radiographic signs of overcorrection. Comparing variable joint morphologies, the rate of clinical success was higher in patients with an anterior/posterolateral deficient acetabular covarage compared to lateral deficient acetabular (95.2% vs. 90.4%). tThe highest rate of clinical failure was recorded in unstable hip joints (85.7% vs. 92.5% in stable hips).ConclusionsThis study demonstrates that PAO is an effective means to treat symptomatic BHD with variable acetabular morphologies, achieving a clinical success in 91.5% of all patients. To maintain a high level of safety and patient satisfaction technical accuracy appears crucial.

Estimation of Atraumatic Hip Microinstability Among Long Distance Truck Drivers in Western Maharashtra : A Cross-Sectional Study

Introduction: Hip micro-instability is an upcoming concern and is gaining acceptance as an important contributing factor for hip joint dysfunction among adults and is a major risk factor for the development of early osteoarthritis. Around 20-25% of people at the age of 50 suffer hip pain and knee pain because of chronic wear and tear of joint articular cartilage. is typically described as painful extra-physiologic hip movements, either alone or in combination with symptoms of unstable hip joints. Truck drivers travel long routes for an extensive duration of time with their hips in an ergonomically compromised position. Occupational stress can cause pain which is an effect of vibrational forces and postural stress. Investigation suggests that hip musculoskeletal pain as a whole is one of the main causes of hip micro-instability. Hence, it is important to evaluate the presence of hip micro-instability among long-distance truck drivers. Methods: A cross-sectional study was conducted from 4 May 2023 in a rural tertiary care hospital in Karad for about 6 months. Wherein a total of 103 long-distance truck drivers were randomly selected based on the inclusion criteria which included truck drivers by occupation within the age group of 35-45 years, working for more than 12 hours in a day and for 5 days/week with no history of trauma. They were assessed by using the Anterior Apprehension Test, Prone Apprehension Test, and AB-HEER test. The data was then analyzed using statistical procedures, and the results were obtained. Results: The present study shows that over 12% of participants showed positive results for hip micro-instability. A significant positive correlation was observed between the number of years of driving in relation to pain (P value &lt; 0.0001). On assessment, there was an increase in flexion, adduction, and internal rotation ranges which hence revealed anterior hip micro-instability (P value = 0.0121) as compared to extension, abduction and external rotation ranges which revealed posterior instability. Conclusion: The study concluded that over 12% of participants showed positive results for hip micro-instability. Also, anterior hip micro-instability was more as compared to posterior hip micro-instability amongst the truck drivers due to capsular relaxation which was affected due to prolonged hours of poor ergonomics. This study also showed the existence of micro-instability despite the presence or absence of ligamentous laxity.

Shoulder Impingement Syndrome, A Common Shoulder Disease: A Comprehensive Review

The shoulder joint is a flexible but unstable joint in the human body. Also, it has complex structures including coracoacromial arch, synovial bursa, head of femur and so on. Based on these traits, shoulder joints have a wide range of activity, but some lesions accompany with, especially some overhand motions like throwing baseball, swimming, lifting the weight above head repetitively. Diversification of pathogenic factors are significant traits of this kind of injury. In addition, lesions of shoulder impingement syndrome (SIS) can occur in multiple locations even happening at same time. Under normal conditions, this type of disease is often delimited by rotator cuff. Because of the complexity of this injury, different tests of diagnosis can be applied, including Hawkins-Kennedy test, Neer sign, Jobe test, Painful arc of motion. For treatment options, these can be divided into conservative treatment including conservative methods and surgical treatment like arthroscopic subacromial decompression (ASD). SIS causes shoulder pain to disrupt and reduce life’s quality of patients. Based on relevant research and literature, this article is designed to offer a general review of the above content.

MmPose-FK: A Forward Kinematics Approach to Dynamic Skeletal Pose Estimation Using mmWave Radars.

In this paper, we propose mmPose-FK, a novel millimeter wave (mmWave) radar-based pose estimation method that employs a dynamic forward kinematics (FK) approach to address the challenges posed by low resolution, specularity, and noise artifacts commonly associated with mmWave radars. These issues often result in unstable joint poses that vibrate over time, reducing the effectiveness of traditional pose estimation techniques. To overcome these limitations, we integrate the FK mechanism into the deep learning model and develop an end-to-end solution driven by data. Our comprehensive experiments using various matrices and benchmarks highlight the superior performance of mmPose-FK, especially when compared to our previous research methods. The proposed method provides more accurate pose estimation and ensures increased stability and consistency, which underscores the continuous improvement of our methodology, showcasing superior capabilities over its antecedents. Moreover, the model can output joint rotations and human bone lengths, which could be further utilized for various applications such as gait parameter analysis and height estimation. This makes mmPose-FK a highly promising solution for a wide range of applications in the field of human pose estimation and beyond.

Dynamics-Based Control and Path Planning Method for Long-Reach Coupled Tendon-Driven Manipulator

The Fukushima power station in Japan was affected by a major earthquake and tsunami in March 2011, inspecting the primary containment vessel remains difficult due to high radioactivity. Long-reach robot arms are useful in inspecting such hazardous environments, and a coupled tendon-driven mechanism enables realizing a long, light-weight, and thin manipulator. However, high elastic elongation of tendons due to gravity may lead to unstable joint control. In this paper, we introduce dynamics-based control as a feasible strategy for a long-reach tendon-driven robotic arm. Additionally, a planning method to identify the joint angle path ensuring stability is proposed. Considering stability analysis, the potential due to the tendon elasticity and gravity is evaluated and used as an index of joint stability. The rapidly exploring random tree is used as the planning algorithm. The effectiveness of the proposed method was demonstrated through the successful manipulation of a 5-kg payload by a 10-m long robotic arm.

Secondary Dislocations in Type B and C Injuries of the Subaxial Cervical Spine: Risk Factors and Treatment

Introduction: This study analyzed the incidence of secondary dislocations (sDLs) after surgical stabilization of AO Spine type B and C injuries of the subaxial cervical spine (sCS). Materials and Methods: Patients treated for injuries of the sCS from 2010 to 2020 were retrospectively analyzed for the incidence of sDL within 60 days after first surgery. A univariate analysis of variables potentially influencing the risk of sDL was performed. Patients with solitary anterior stabilization underwent subgroup analysis. The treatment of sDLs was described. Results: A total of 275 patients were included. sDLs occurred in 4.0% of patients (n = 11) in the total sample, most frequently after solitary anterior stabilization with 8.0% (n = 10, p = 0.010). Only one sDL occurred after combined stabilization and no sDLs after posterior stabilization. In the total sample and the anterior subgroup, variables significantly associated with sDL were older age (p = 0.001) and concomitant unstable facet joint injury (p = 0.020). No neurological deterioration occurred due to sDL and most patients were treated with added posterior stabilization. sDL is frequent after solitary anterior stabilization and rare after posterior or combined stabilization. Discussion: Patients of higher age and with unstable facet joint injuries should be followed up diligently to detect sDLs in time. Neurological deterioration does not regularly occur due to sDL, and most patients can be treated with added posterior stabilization.

Role of Ultrasound Guided Platelet Rich Plasma Therapy for Isolated Supraspinatus Tendinopathy

Background: Rotator cuff (RC) injuries are not so uncommon a cause of disability among the population. The RC stabilizes the shoulder, a highly unstable joint owing to great mobility. Supraspinatus (SS) is one of the RC tendons undergoing damage ranging from mild tendinosis to complete tear due to degeneration, trauma, or other causes. Supraspinatus tears (STs) have been classically treated conservatively with physical and pharmacotherapy and later on with the help of surgical repair. Non-surgical treatment with biologics like platelet-rich plasma (PRP) therapy has been tried with positive results but with limited data. We aim to identify the role of PRP therapy in patients with symptomatic supraspinatus tendinopathy (STP) for improving the range of motion as well as reducing the pain and physical disability.Methods: This study was done on fifty symptomatic STP patients who failed medical and physical therapy for at least three months. The improvement in the pain score following two sittings of PRP therapy was evaluated with numerical rating scale (NRS). The improvement of the function of shoulder joint movements for daily activities was assessed with the modified University of California-Los Angeles (UCLA) shoulder score. Moreover, NRS, tear size (TS, assessed with ultrasound), Constant Shoulder Score (CSS), and modified UCLA shoulder score were recorded at baseline, and subsequently at 1-month, 3-months, and 6-months following the second sitting of the PRP therapy.Results: At baseline, the CSS was 36.42±5.12, and was 61.58±6.35, 81.22±6.23, and 87±3.9 at 1-month, 3-months, and 6-months follow-up, respectively. The NRS was 8.18±0.96 before the procedure and 4.26±0.8, 2.02±0.62, 1.84±0.51 at 1-month, 3-months, and 6-months follow-up, respectively. The mean TS pre-procedure was 3.12±0.89, and a significant decrease in TS was seen at 1-month (2.87±0.88), 3-months (2.44±0.79), and 6-months (2.17±0.76). Modified UCLA score was 16.86±3.49 at baseline which improved to 24.66±3.17 at 1-month, 31.64±2.69 at 3-months, and 32.5±1.67 at 6-months.Conclusion: PRP results in healing of the torn SS tendon. It also reduces pain score, improve range of motion and quality of life of the patients.

Dynamic Stability of Human Walking in Response to Sudden Speed Changes

Abrupt changes in gait speed can interfere with the symmetry of the overall gait apparatus and result in unstable joint movement patterns. Because unstable joint movements may cause slips, trips, and falls, it is necessary to quantitatively characterize the changes in joint movement patterns in response to sudden speed changes. The purpose of this study is to examine how abrupt changes in gait speed affect gait dynamics. Twenty-two healthy young subjects walked for four minutes, including a warm-up period, under three different speed conditions. Utilizing nonlinear dynamics tools, including the maximum Lyapunov exponent, Sample Entropy, and Detrended Fluctuation Analysis, we quantitatively assessed gait dynamics for the different speed conditions. Our findings highlight how different speed change patterns impact joint instability, notably within the knee joint during gait (p &lt; 0.05). Furthermore, introducing a resting phase during random speed changes exhibited the potential to restore gait symmetry and control movement patterns. This research offers valuable insights into human gait stability dynamics, especially concerning sudden speed changes. Understanding how controlled speed variations affect gait and joint instability informs fall prevention and rehabilitation strategies, emphasizing speed management to improve gait symmetry and reduce joint instability.

Comparison of sacroiliac screw techniques for unstable sacroiliac joint disruptions: a finite element model analysis

Vertically unstable pelvic injuries associated with sacroiliac disruption are challenging. Although percutaneous iliosacral fixation using two screws at S1 vertebral body has been shown beneficial, the use of two transiliac screws at S1 has been proposed to increase the fixation strength of the construct. In the herein study, the finite element method (FEM) was performed to analyse the biomechanical behaviour of five different constructions using iliosacral screws only, transiliac screws only, and combining an iliosacral and a transiliac screw. A vertically unstable AO 61C1.2 type pelvic injury was produced for the evaluation of the posterior pelvic displacement and implant stress, and the anterior implant stress using FEM. The symphysis pubis was fixed with a 3.5-mm reconstruction plate in all cases. The model was axially loaded with 800N applied in the centre of S1 body, perpendicular to the ground (Y-axis), simulating the bipodal stance moment. There was a statistically significant reduction in both posterior displacement and implant stresses in the groups fixed with at least one transiliac screw compared to the groups fixed with iliosacral screws. In our FEM study, the construct using two transiliac screws in S1 is biomechanically superior for stabilizing the sacroiliac joint in vertically unstable pelvic ring injuries compared to the other configurations. Lateral displacement, posterior displacement, and von Mises stress were reduced with this construct. A good option can be the use of one iliosacral screw and one transiliac screw in S1.

Weight-bearing test of traumatic triangular fibrocartilage complex lesion with unstable radioulnar joint

BackgroundUlnar-sided wrist pain might be caused by a lesion of the triangular fibrocartilage complex (TFCC). Patients with TFCC lesion may show an instability of the distal radioulnar joint (DRUJ). Before arthroscopic assessment, conservative therapy using a brace or splint may result in alleviation of symptoms. The results of our previous study showed that patients with a traumatic TFCC lesion and instability of the DRUJ had the smallest weight-bearing capacity and had the largest increase in application of the wrist brace (WristWidget). PurposeIn this prospective study, we wanted to test if the weight-bearing capacity with and without the wrist brace can be used as a diagnostic tool to differentiate between patients with traumatic TFCC lesion and instability of the DRUJ. We tested if patients with traumatic TFCC lesion and instability of the DRUJ (1) have a lower weight-bearing capacity and (2) show a higher increase of weight-bearing capacity after application of a wrist brace compared to all other types of injury. Study DesignThis was a prospective cohort study. MethodsForty-eight patients presented to an outpatient clinic with suspected TFCC lesion. We measured the dynamic weight-bearing capacity of both hands with and without the wrist brace (WristWidget) by letting the patients lean on an analog scale with extended arm and wrist. The stability of the DRUJ was assessed by clinical examination by a hand surgeon preoperatively and intraoperatively. Forty-five patients received an arthroscopy and were included in the analysis. During arthroscopy, the surgeon determined if there was a traumatic TFCC lesion and DRUJ instability. Patients with a traumatic lesion of the TFCC and DRUJ instability were compared to all other cases. We used the t-test for normally distributed values, Mann-Whitney U test for nonnormally distributed values, and the Chi-square test for categorical variables, respectively Fisher’s exact if the expected cell count was less than five. ResultsPatients with a traumatic TFCC lesion and DRUJ instability had a higher weight-bearing capacity (22.8 kg) than all other cases (13.8 kg; p < 0.01). This is in contrast to our previous study, in which patients with a traumatic lesion of the TFCC had the tendency to show lower values of weight-bearing capacity than those with a degenerative lesion. While the wrist brace was worn, the relative gain was not significantly lower in patients with traumatic TFCC lesions and DRUJ instability compared to all other cases (21% vs 54%, p = 0.16). All included cases showed the same absolute increase of about 4 kg in weight-bearing capacity with the wrist brace (p = 0.93) ConclusionsThe weight-bearing test cannot be used to identify patients with traumatic TFCC lesion and DRUJ instability among those with suspected TFCC lesion. The results of our previous study could be confirmed that the weight-bearing capacity on the injured side was higher with brace than without.

A Systematic Review of the Biomechanical Studies on Shoulder Kinematics in Overhead Sporting Motions: Types of Analysis and Approaches

The shoulder is a unique and complex joint in the human body with three bones and four joints, which makes it the most unstable joint in the body due to the amount of motion. To improve approaches toward understanding the performance of overhead throwing movements, this systematic review summarizes the type of analysis related to shoulder biomechanics involving overhead sporting motions. A search of seven databases identified 33 eligible studies, which were subsequently scored using the Modified Coleman Methodology Score scale. A total of nine articles from badminton, seven from baseball, five from volleyball, five from tennis, three from cricket, and one from softball were reviewed. All 33 studies evaluated shoulder kinematics and 12 of them also investigated the forces and torques (kinetics). The most common methods used were 3D motion analysis (76%), digital video cameras (15%), electromagnetic tracking system (6%), and finally 3% used IMU sensors. Overall, shoulder external rotation during the back swing, internal rotation, and elbow extension during the forward acceleration phase were the strongest predictors of high velocity overhead throwing movement. The findings provide some useful insights and guidance to researchers in their future contribution to the existing body of literature on shoulder overhead throwing movement biomechanics.

Upper limb and lower limb radiofrequency treatments in orthopaedics.

Radiofrequency (RF) is a minimally invasive technique for disrupting or altering nociceptive pathways to treat musculoskeletal neuropathic and nociplastic pain. RF has been employed to treat painful shoulder, lateral epicondylitis, knee and hip osteoarthritis, chronic knee pain, Perthes disease, greater trochanteric pain syndrome, plantar fasciitis, and painful stump neuromas; it has also been employed before and after painful total knee arthroplasty and after anterior cruciate ligament reconstruction. The benefits of RF include the following:it is safer than surgery; there is no need for general anaesthesia, thereby reducing adverse effects; it alleviates pain for a minimum of 3-4 months; it can be repeatable if necessary; and it improves joint function and minimizes the need for oral pain medication. RF is contraindicated for pregnant women; unstable joints (hip, knee, and shoulder); uncontrolled diabetes mellitus; presence of an implanted defibrillator; and chronic joint infection (hip, knee, and shoulder). Although adverse events from RF are unusual, potential complications can include infection, bleeding, numbness or dysesthesia, increased pain at the procedural site, deafferentation effect, and Charcot joint neuropathy. Although there is a risk of damaging non-targeted neural tissue and other structures, this can be mitigated by performing the technique under imaging guidance (fluoroscopy, ultrasonography, and computed tomography). RF appears to be a valuable technique for alleviating chronic pain syndromes; however, firm proof of the technique's efficacy is still required. RF is a promising technique for managing chronic musculoskeletal of the limbs pain, particularly when other techniques are futile or not possible.

Concomitant ligament injuries can be left untreated during surgery of distal radial fractures.

Instability of the distal radioulnar joint and scapholunate dissociation may cause pain, functional impairment and subsequent arthrosis. There is no consensus about whether these injuries should be treated acutely in patients undergoing surgery for distal radial fractures. We conducted a prospective cohort study to determine whether concomitant distal radioulnar joint instability or scapholunate dissociation negatively influence patient-related outcomes in these patients. The primary outcome was the patient-reported wrist/hand evaluation at 6 and 12 months after surgery. Out of 62 patients, 58% and 27% had intraoperative distal radioulnar joint instability and scapholunate dissociation, respectively. No significant differences were found in patient-reported scores at follow-up between patients with stable and unstable distal radioulnar joints, nor between patients with and without scapholunate dissociation. Sixty-three per cent of patients with an unstable distal radioulnar joint during surgery were stable on retesting after 6 months. Our study suggests that a wait-and-see policy in these patients therefore seems reasonable.Level of evidence: III.

To study the outcome of sacro-iliac percutaneous screw fixation in unstable fractures of pelvic injuries

Percutaneous fixation of sacroiliac joint fractures and closed reduction gives advantages of limited blood loss, minimal invasion of compromised soft tissue, decreased infection rates and reduced operation time. The purpose of this study is to determine the outcome of sacroiliac percutaneous screw fixation of pelvic injuries in unstable fractures.This study was conducted at Tirunelveli medical college hospital from 2017 to 2019 in patients underwent sacro-iliac percutaneous screw fixation in unstable fractures of pelvic injuries. Functional assessment of patients with Pelvic fractures was assessed by Majeed Score Scale. Patients follow up was taken at 4, 8, 12 weeks, 6 months and 1 year. The study included 22 patients with ages ranged from 16-70 years with the mean age range of 39 years with 16 males and 6 females. Mode of injury was a road traffic accident in 86.36% of cases and fall from height in 13.64%. As per the Majeed scoring system all patients were clinically evaluated. The overall Majeed score was excellent in 77.27%, while good in 13.63% and poor in 9.09% of cases. As per Matta and tornetta postoperative radiological evaluation was carried out. Percutaneous iliosacral screw fixation and anatomic reduction give better stability in unstable sacroiliac joint injuries allowing good functional outcomes and early mobility. For sacral fracture and sacroiliac, joint injury with C arm guidance percutaneous iliosacral screw fixation is a minimally invasive and safe technique.

OSTEOCHONDRAL GLENOID LOSS: REMAINING GLENOID DEPTH AND CONCAVITY ARE STRONGER PREDICTIVE PARAMETERS FOR SHOULDER INSTABILITY THAN DEFECT SIZE

Osteochondral glenoid loss is associated with recurrent shoulder instability. The critical threshold for surgical stabilization is multidimensional and conclusively unknown. The aim of this work was to provide a well- measurable surrogate parameter of an unstable shoulder joint for the frequent anterior-inferior dislocation direction.The shoulder stability ratio (SSR) of 10 paired human cadaveric glenoids was determined in anterior-inferior dislocation direction. Osteochondral defects were simulated by gradually removing osteochondral structures in 5%-stages up to 20% of the intact diameter. The glenoid morphological parameters glenoid depth, concavity gradient, and defect radius were measured at each stage by means of optical motion tracking. Based on these parameters, the osteochondral stability ratio (OSSR) was calculated. Correlation analyses between SSR and all morphological parameters, as well as OSSR were performed.The loss of SSR, concavity gradient, depth and OSSR with increasing defect size was significant (all p&lt;0.001). The loss of SSR strongly correlated with the losses of concavity gradient (PCC = 0.918), of depth (PCC = 0.899), and of OSSR (PCC = 0.949). In contrast, the percentage loss based on intact diameter (defect size) correlated weaker with SSR (PCC=0.687). Small osteochondral defects (≤10%) led to significantly higher SSR decrease in small glenoids (diameter &lt;25mm) compared to large (≥ 25mm) ones (p ≤ 0.009).From a biomechanical perspective, the losses of concavity gradient, glenoid depth and OSSR correlate strong with the loss of SSR. Therefore, especially the loss of glenoidal depth may be considered as a valid and reliable alternative parameter to describe shoulder instability. Furthermore, smaller glenoids are more vulnerable to become unstable in case of small osteochondral loosening. On the other hand, the standardly used percentage defect size based on intact diameter correlates weaker with the magnitude of instability and may therefore not be a valid parameter for judgement of shoulder instability.

Unstable Middle Phalanx Base Fractures Treated With an Internal Joint Stabilizer: Preliminary Results.

Unstable fractures of the base of the middle phalanx are notorious for causing chronic loss of proximal interphalangeal (PIP) joint function, and they remain a challenge for the hand surgeon. We report on a temporary intraoperatively constructed internal joint stabilizer for unstable PIP joint injuries. Across 2 institutions, a retrospective chart review was performed for cases with acute presentation of pilon fracture or fracture-dislocation of the base of the middle phalanx which were surgically treated with an internal joint stabilizer. Information collected included time from injury to surgical intervention, time from implantation to device removal, complications, and preoperative and postoperative range of motion. Seven patients met the inclusion criteria with a mean age of 51 (range: 24-72) years and a mean follow-up of 29 (range: 11-72) months. After removal of the fixator, the mean arc of PIP joint motion was 8° to 88° (range: 0°-100°). There were no infections, no hardware loosening or failures, and no revision procedures. The current findings are comparable to the results for dynamic external fixators. An internal joint stabilizer for unstable injuries to the base of the middle phalanx provides satisfactory functional outcomes, allows early postoperative motion, and mitigates the routine complications which may arise with external fixation.

THE INFLUENCE OF PATELLOFEMORAL STABILIZATION SURGERY ON JOINT CONGRUITY: AN MRI SURFACE-MAPPING STUDY

In the unstable patellofemoral joint (PFJ), the patella will articulate in an abnormal manner, producing an uneven distribution of forces. It is hypothesised that incongruency of the PFJ, even without clinical instability, may lead to degenerative changes. The aim of this study was to record the change in joint contact area of the PFJ after stabilisation surgery using an established and validated MRI mapping technique.A prospective MRI imaging study of patients with a history of PFJ instability was performed. The patellofemoral joints were imaged with the use of an MRI scan during active movement from 0° through to 40° of flexion. The congruency through measurement of the contact surface area was mapped in 5-mm intervals on axial slices. Post-stabilisation surgery contact area was compared to the pre-surgery contact area.In all, 26 patients were studied. The cohort included 12 male and 14 female patients with a mean age of 26 (15-43). The greatest mean differences in congruency between pre- and post-stabilised PFJs were observed at 0-10 degrees of flexion (0.54 cm2 versus 1.18 cm2, p = 0.04) and between 11° and 20° flexion (1.80 cm2 versus 3.45 cm2; p = 0.01).PFJ stabilisation procedures increase joint congruency. If a single axial series is to be obtained on MRI scan to compare the pre- and post-surgery joint congruity, the authors recommend 11° to 20° of tibiofemoral flexion as this was shown to have the greatest difference in contact surface area between pre- and post-operative congruency.