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Background: Paediatric ankle fractures comprise approximately 4% of all paediatric fractures and 30% of all epiphyseal fractures. Integrity of the ankle "mortise", which consists of tibial and fibular malleoli, is significant for stability and function of the ankle joint. Tibial malleolar fractures are classified as SH III or SH IV intra-articular fractures and, in cases where the fragments are displaced, anatomic reposition and fixation is mandatory.Methods: Type SH III-IV fractures of the tibial malleolus are usually treated with open reduction and fixation with cannulated screws that are parallel to the physis. Two K-wires are used for temporary stabilisation of fragments during reduction. A third "guide wire" for the screw is then placed parallel with the physis. Considering the rules of mechanics, it is assumed that the two temporary pins with the additional third pin placed parallel to the physis create a strong triangle and thus provide strong fracture fixation. To prove this hypothesis, an experiment was conducted on the artificial models of the lower end of the tibia from the company "Sawbones". Each model had been sawn in a way that imitates the fracture of medial malleoli and then reattached with 1.8mm pins in various combinations. Prepared models were then tested for tensile and pressure forces.Results: The least stable model was that in which the fractured pieces were attached with only two parallel pins. The most stable model comprised three pins, where two crossed pins were inserted in the opposite compact bone and the third pin was inserted through the epiphysis parallel with and below the growth plate.Conclusion: A potential method of choice for fixation of tibial malleolar fractures comprises three K-wires, where two crossed pins are placed in the opposite compact bone and one is parallel with the growth plate. The benefits associated with this method include shorter operating times and avoidance of a second operation for screw removal. [ABSTRACT FROM AUTHOR]

Introduction: Non-unions are fractures that do not heal properly, resulting in a false joint formation at the fracture site. This condition leads to major health issues and imposes a burden on national healthcare systems. The etiology of non-unions is still not fully understood; therefore, we aimed to identify potential systemic factors that may contribute to their formation. Materials and methods: We conducted a cross-sectional concomitant proteomic and metabolomic pilot study of blood plasma in patients with non-unions (N = 11) and compared them with patients with bone fracture in the normal active healing phase (N = 12). Results: We found five significantly upregulated proteins in the non-union group: immunoglobulin heavy variable 3–74, immunoglobulin lambda variable 2–18, low-density lipoprotein receptor-related protein 4, zinc-alpha-2-glycoprotein, and serum amyloid A-1 protein; and we found one downregulated protein: cystatin-C. The metabolomic study found differences in alanine, aspartate and glutamate metabolism pathways between two groups. Conclusions: The combined results of proteomic and metabolomic analyses suggest that the dysregulation of lipid metabolism may contribute to non-union formation. [ABSTRACT FROM AUTHOR]

Background A small pilot study was conducted in order to investigate in situ regenerative potential of extracellular vesicles (EVs) in a rat subcutaneous implant model. Material and methods An implant device was implanted in the axillary regions of four animals and consisted of a rat ABC enriched with an EV isolate obtained from human patients 7-21 days post bone fracture, or healthy individuals. Results Upon histological examination of the implanted devices, there were clear evidence of early signs of immature cartilage and bone formation in the implants of fracture-EV treated animals, 21 days post implantation. Conclusion These preliminary results suggest a potential for near-term innovation in the development of an affordable, non-invasive and completely autologous therapeutic device that can potentially enhance the existing regenerative capacity of skeletal tissues. EV can be used to concentrate the body’s inherent regenerative potential and utilise it as a personalised self-healing therapy [ABSTRACT FROM AUTHOR]