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Purpose: Non-cement total hip arthroplasty for unstable intertrochanteric fracture in elderly patients is regarded as another surgical technique preventing complications such as non-union, long term limitation of weight bearing, pressure sore, pulmonary thromboembolism after open reduction or closed reduction with intramedullary nailing, or plate fixation. We would like to announce the short-term results of primary noncement total hip arthroplasty with double strands and double loops figure of 8 wiring for unstable intertrochanteric fracture in elderly patients. Materials and Methods: All of the 20 patients admitted to the hospital between April 2010 and February 2012 who underwent non-cement total hip arthroplasty with double strands and double loops figure of 8 wiring for unstable intertrochanteric fractures were evaluated. The mean age was 71.1(57-86), there were nine males, and 11 females, with an average follow up period of six months. The post-operative state was evaluated by Harris hip score. Results: The mean operation time was 95 min, and the average blood loss was 800 cc. Mean Harris hip score at the last available follow-up was 92.7, and, among the patients, 15 had all functions of daily life without limitation of walking distance, one had hip dislocation, one had breakage of strands. Pressure sore, deep vein thrombosis, and pulmonary thromboembolism were absent. Radiography at the last available follow-up showed no loosening of the femoral stem in any of the patients, and 13 patients had osteogenesis around the fracture site, and there was no osteolysis. Conclusion: Primary non-cement total hip arthroplasty with double strands and double loops figure of 8 wiring in elderly patients with unstable intertrochanteric fractures showed satisfactory results. These results are expected to be useful for further studies with a long-term follow-up and in development of a reduction method. [ABSTRACT FROM AUTHOR]

Background: Stainless steel is one of the most widely used biomaterials for internal fixation devices, but is not used in cementless arthroplasty implants because a stable oxide layer essential for biocompatibility cannot be formed on the surface. We applied a Ti electron beam coating, to form oxide layer on the stainless steel surface. To form a thicker oxide layer, we used a microarc oxidation process on the surface of Ti coated stainless steel. Modification of the surface using Ti electron beam coating and microarc oxidation could improve the ability of stainless steel implants to osseointegrate. Questions/purposes: The ability of cells to adhere to grit-blasted, titanium-coated, microarc-oxidated stainless steel in vitro was compared with that of two different types of surface modifications, machined and titanium-coated, and microarc-oxidated. Methods: We performed energy-dispersive x-ray spectroscopy and scanning electron microscopy investigations to assess the chemical composition and structure of the stainless steel surfaces and cell morphology. The biologic responses of an osteoblastlike cell line (SaOS-2) were examined by measuring proliferation (cell proliferation assay), differentiation (alkaline phosphatase activity), and attraction ability (cell migration assay). Results: Cell proliferation, alkaline phosphatase activity, migration, and adhesion were increased in the grit-blasted, titanium-coated, microarc-oxidated group compared to the two other groups. Osteoblastlike cells on the grit-blasted, titanium-coated, microarc-oxidated surface were strongly adhered, and proliferated well compared to those on the other surfaces. Conclusions: The surface modifications we used (grit blasting, titanium coating, microarc oxidation) enhanced the biocompatibility (proliferation and migration of osteoblastlike cells) of stainless steel. Clinical Relevance: This process is not unique to stainless steel; it can be applied to many metals to improve their biocompatibility, thus allowing a broad range of materials to be used for cementless implants. [ABSTRACT FROM AUTHOR]

Background: Controversy continues regarding the best treatment for compression and burst fractures. The axial distraction reduction utilizing the technique employing the long straight rod or curved short rod without derotation to reduce fracture are practised together with short segment posterolateral fusion (PLF). Effects of the early postoperative mobilization without posterolateral fusion on reduction maintenance and fracture consolidation were not evaluated so far. The present prospective study is designed to assess the effectiveness of i) reduction and restoration of sagittal alignment, ii) no posterolateral fusion on the reduced, fractured vertebral body and injured disc, iii) fracture consolidation and iv) the fate of the unfused cephalad and caudal injured motion segments of the fractured vertebra. Materials and Methods: The study includes 15 Denis burst and two Denis type D compression fractures between T12 and L3. The lordotic distraction technique was used for ligamentotaxis utilizing the contoured short rods and pedicle screw fixator. Three vertebrae including the fractured one were fixed. The patients after surgery were braced for ten weeks with activity restriction for 2-4 weeks. The patients were evaluated for change in vertebral body height, sagittal curve, reduction of retropulsion, improvement in neural deficit. The unfused motion segments, residual postoperative pain and bone and metal failure were also evaluated. Results: The preoperative and postreduction percentile vertebral heights at, zero (immediate postoperative), at three, six and 12 months followup were 62.4, 94.8, 94.6, 94.5 and 94.5%, respectively. The percentages of the intracanal fragment retropulsion at preoperative, and postoperative at zero, 3, 6 and 12 months followup were 59.0, 36.2,, 36.0, 32.3, and 13.6% respectively. The preoperative and postreduction percentile loss of the canal dimension and at zero, three, six and 12 months were 52.1, 45.0, 44.0, 41.0 and 29% respectively suggesting that the under-reduced fragment was being resorbed gradually by a remodeling process. The mean initial kyphosis of 33° became mean 2° immediately after reduction and mean 3° at the final follow-up. The fractured vertebral bodies consolidated in an average period of ten weeks (range 8-14 weeks). The restored disc heights were relatively well maintained throughout the observation period. All paraparetic patients recovered neurologically. There were no postoperative complications. Conclusion: Instrument-aided ligamentotaxis for compression and burst fractures utilizing the short contoured rod derotation technique and the instrumented stabilization of the fractured spine are found to be effective procedures which contribute to the fractured vertebral body consolidation without recollapse and maintain the motion segment function. [ABSTRACT FROM AUTHOR]

Background: After open wed±ge high tibial osteotomy (OWHTO), the proximal fragment resembles the anatomy of the proximal tibia that is aligned in the anterior-posterior direction and the distal fragment resembles the anatomy of the mid shaft that is aligned in the proximal-distal direction. In addition, the medial portion of the proximal fragment becomes aligned medially and the medial portion of the distal fragment, laterally, depending on the magnitude of the posterior opening gap. Therefore, there would be a mismatch between the post-correction bony surface and the previous pre-contoured plate geometry. The purpose of this study was to devise a new plate that best fit the post-contoured anatomy of the tibia by evaluating the surface geometry of the plate positioning site after OWHTO. Methods: Thirty-one uni-planar and 38 bi-planar osteotomies were evaluated. Surgical indications were age of under 70 years, relatively active patient who performs recreational sports activities. Other indications were similar with general recommendation of HTO. Computed tomography (CT) of the operated knees was performed and it was used for the reconstruction of the 3D model. Bone model axis re-alignment was performed with coronal, sagittal, and axial plane. Morphologic analysis of the proximal tibia was performed using the following parameters: (1) radii in axial plane, 2) radii in coronal plane, and 3) angle and horizontal distance (Distance X) between the proximal and distal fragments. These were also analyzed according to the correction degree. The Analysis of Variance (ANOVA) test was conducted to verify the change depending on the correction amount of the posterior opening gap. The values obtained for the uniand bi-planar osteotomy were compared by the independent t-test. Results: There were 9 male and 60 female patients were recruited to this study; the mean age was 58.3 ± 8 and 56.9 ± 7.6 years, respectively. Preoperative weight bearing line (WBL) was 21.59 ± 11.36 and 22.32 ± 10.55 %, respectively. Mean correction degree was 10.9 ± 2.7 and 11.1 ± 2.6 mm, resp±ectively. The radii of the tibial cross-sectional contour at the head portion tended to increase from the proximal to distal direction. The radii of the tibial cross-sectional contour at the neck portion tended to decrease from the proximal to distal direction. The radii of the coronal plane tended to increase from the proximal to distal direction. The angle between the proximal fragment and the distal one varied with the correction amount of the posterior opening gap. Shaft_Mid and Distance X of GroupI (110.08 mm and 6.11 mm, respectively) which had lower correction angle were lower than those of GroupII (130.05 mm and 6.41 mm, respectively) and those of GroupIII (136.35 mm, 8.01 mm, respectively) in coronal plane. There were significant differences (p = 0.023 < 0.05 and p = 0.009 < 0.01, respectively). Conclusion: Current plate design should be modified to the surface geometry of the post-correction for the proper fitting. As the correction degree increases, the plate should be bended at the both end of the opening gap in coronal plane. [ABSTRACT FROM AUTHOR]