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Tibial pilon fractures are uncommon; however, they are considered highly complex. Generally, they occur due to high-energy trauma mechanisms, such as axial forces on the talus, which cause an impact on the tibia and result in its fracture. These fractures are associated with severe soft tissue damage, making them prone to complications. Therefore, meticulous management of these tissues is crucial, posing a challenge for their fixation, as they often hinder access. Despite surgical advancements and staged protocols, along with the introduction of temporary external fixation during the acute period to achieve an optimal state of the soft tissues, the rate of infections and complications has been reduced. Nevertheless, their prognosis remains unfavorable., Las fracturas de pilón tibial son poco comunes; sin embargo, se consideran de alta complejidad. En general, se producen por mecanismos de trauma de alta energía, como fuerzas axiales sobre el astrágalo, lo que provoca impacto en la tibia y su fractura. Estas fracturas están asociadas con una grave afectación de los tejidos blandos, lo que las predispone a complicaciones. Por tanto, se debe tener un manejo meticuloso de estos tejidos, lo que representa un desafío para su fijación, dado que en múltiples ocasiones dificultan su abordaje. A pesar de los avances quirúrgicos y los protocolos por etapas, así como la introducción del uso de la fijación externa provisional en el período agudo, hasta lograr un adecuado estado de los tejidos blandos, se ha reducido la tasa de infecciones y complicaciones. Sin embargo, su pronóstico continúa siendo deficiente

Introduction: Intra-articular fractures are a major cause of post-traumatic osteoarthritis (PTOA). Despite adequate surgical treatment, the long-term risk for PTOA is high. Previous studies reported that joint injuries initiate an inflammatory cascade characterized by an elevation of synovial pro-inflammatory cytokines, which can lead to cartilage degradation and PTOA development. This review summarizes the literature on the post-injury regulation of pro-inflammatory cytokines and the markers of cartilage destruction in patients suffering from intra-articular fractures. Methods: We searched Medline, Embase, and Cochrane databases (1960-February 2020) and included studies that were performed on human participants, and we included control groups. Two investigators assessed the quality of the included studies using Covidence and the Newcastle-Ottawa Scale. Results: Based on the surveyed literature, several synovial pro-inflammatory cytokines, including interleukins (IL)-1β, IL-2, IL-6, IL-8, IL-12p70, interferon-y, and tumor necrosis factor-α, were significantly elevated in patients suffering from intra-articular fractures compared to the control groups. A simultaneous elevation of anti-inflammatory cytokines such as IL-10 and IL-1RA was also observed. In contrast, IL-13, CTX-II, and aggrecan concentrations did not differ significantly between the compared cohorts. Conclusions: Overall, intra-articular fractures are associated with an increase in inflammation-related synovial cytokines. However, more standardized studies which focus on the ratio of pro- and anti-inflammatory cytokines at different time points are needed.

The article presents the results of the biomechanical modeling of axial loads on the “implant-bone” system in type C3 distal radius fracture. The analysis of stress and strains arising during the formation of fragments of the distal radius and implant at the time of rehabilitation has been carried out. The aim of the study was to improve the treatment outcomes in patients with unstable, severe, intra-articular type 23-C3 distal radius fractures. The task of the study was to determine the dependence of the value of fragment displacement on the magnitude of the applied load when fixing with different fixing systems; to evaluate the stabilization properties of different types of fixation (wires 2.0 mm, plates without angular stability, plates with angular stability and fixed angles and plates with polyaxial angular stability) when modeling type C3 distal radius fracture, to determine the optimal type of fixation for type C3 distal radius fracture., В статье представлены результаты биомеханического моделирования осевых нагрузок на систему «имплантат — кость» в условиях перелома дистального метаэпифиза (ДМЭ) лучевой кости (ЛК) по типу С3. Проведен анализ напряжения и деформаций, возникающих при образовании обломков ДМЭ ЛК и имплантата, во время реабилитации. Цель исследования — улучшение результатов лечения больных с нестабильными, тяжелыми, внутрисуставными переломами ДМЭ ЛК по типу 23-С3. Задачей исследования является определение: зависимости величины смещения осколков от величины приложенной нагрузки при фиксации различными фиксирующими системами; стабилизирующих свойств различных видов фиксации (спицы 2,0 мм, пластины без угловой стабильности, пластины с угловой стабильностью и фиксированным углом, пластины с полиаксиальной угловой стабильностью) при моделировании перелома ДМЭ ЛК по типу С3; оптимального варианта фиксации перелома ДМЭ ЛК по типу С3., У статті наведено результати біомеханічного моделювання осьових навантажень на систему «імплантат — кістка» в умовах перелому дистального метаепіфіза (ДМЕ) променевої кістки (ПК) за типом С3. Проведено аналіз напруження та деформацій, які виникають при утворенні уламків ДМЕ променевої кістки та імплантату, під час реабілітації. Мета дослідження — покращення результатів лікування хворих із нестабільними, тяжкими, внутрішньосуглобовими переломами ДМЕ ПК за типом 23-С3. Завданням дослідження було визначення: залежності величини зміщення уламків від величини прикладеного навантаження при фіксації різними фіксуючими системами; стабілізуючих властивостей різних видів фіксації (спиці 2,0 мм, пластини без кутової стабільності, пластини з кутовою стабільністю та фіксованим кутом, пластини з поліаксіальною кутовою стабільністю) при моделюванні перелому ДМЕ ПК за типом С3; оптимального варіанта фіксації перелому ДМЕ ПК за типом С3.

We compared outcomes in elderly patients with intra-articular distal radius fractures treated by closed reduction and plaster immobilization or open reduction and internal fixation with a volar plate. Ninety-seven patients older than 60 years were randomly allocated to conservative (47 patients) or surgical (50 patients) treatment. Over a 2-year period, we assessed patient-rated wrist evaluation score, DASH (disability arm, shoulder and hand) questionnaire, pain, wrist range of motion, grip strength, and radiological parameters. The functional outcomes and quality of life were significantly better after volar plating fixation compared with conservative treatment. We found that restoration of the articular surface, radial inclination, and ulnar variance affected the outcomes, but the articular step-off did not. Twenty-five per cent of the patients with conservative treatment had secondary loss of reduction. We conclude that surgical plating leads to better outcomes than conservative treatment for elderly patients with intra-articular distal radius fractures.

Purpose: The objective was to assess the ability of the volar locking plate to maintain the radiographic parameters over the time in elderly patients with complex intra-articular distal radius fractures. Methods: Prospective cohort of 66 consecutive patients with mean age of 68 (range 60–81) years and AO type C fractures treated with volar locking plate. Radiographic measurements were performed pre and post-operatively at each follow-up. Clinical assessment was made by Patient-Rated Wrist Evaluation scores, Disabilities of the Arm, Shoulder and Hand score, range of motion, and grip strength. Results: The mean post-operative follow-up was 31 (range, 24–47) months. The most difficult parameters to restore intra-operatively were volar tilt and radial height, while radial inclination and ulnar variance were restored in a high rate of patients. There was significant loss of reduction within four post-operative months in volar tilt (p = 0.001) and radial height (p = 0.029). Mean radiographic parameters had no changes from four months to final evaluation. At final follow-up, 50.1% of the patients had all radiographic parameters restored in comparison with the noninvolved wrist, but 83.3% had all radiographic parameters within a functional range (p = 0.001). No significant relationship between radiographic and functional outcomes was found (p = 0.474). Conclusions: This study found that volar locking plate fixation for displaced intra-articular distal radius fractures in elderly patients was an effective procedure to obtain success functional outcomes. Although reduction loss in volar tilt and radial height occurred within four first months, volar plate was able to maintain fracture stabilization with radiographic parameters within functional range over the time in most patients of these elderly patients.

Purpose: The objective was to assess the ability of the volar locking plate to maintain the radiographic parameters over the time in elderly patients with complex intra-articular distal radius fractures. Methods: Prospective cohort of 66 consecutive patients with mean age of 68 (range 60–81) years and AO type C fractures treated with volar locking plate. Radiographic measurements were performed pre and post-operatively at each follow-up. Clinical assessment was made by Patient-Rated Wrist Evaluation scores, Disabilities of the Arm, Shoulder and Hand score, range of motion, and grip strength. Results: The mean post-operative follow-up was 31 (range, 24–47) months. The most difficult parameters to restore intra-operatively were volar tilt and radial height, while radial inclination and ulnar variance were restored in a high rate of patients. There was significant loss of reduction within four post-operative months in volar tilt (p = 0.001) and radial height (p = 0.029). Mean radiographic parameters had no changes from four months to final evaluation. At final follow-up, 50.1% of the patients had all radiographic parameters restored in comparison with the noninvolved wrist, but 83.3% had all radiographic parameters within a functional range (p = 0.001). No significant relationship between radiographic and functional outcomes was found (p = 0.474). Conclusions: This study found that volar locking plate fixation for displaced intra-articular distal radius fractures in elderly patients was an effective procedure to obtain success functional outcomes. Although reduction loss in volar tilt and radial height occurred within four first months, volar plate was able to maintain fracture stabilization with radiographic parameters within functional range over the time in most patients of these elderly patients.

We compared outcomes in elderly patients with intra-articular distal radius fractures treated by closed reduction and plaster immobilization or open reduction and internal fixation with a volar plate. Ninety-seven patients older than 60 years were randomly allocated to conservative (47 patients) or surgical (50 patients) treatment. Over a 2-year period, we assessed patient-rated wrist evaluation score, DASH (disability arm, shoulder and hand) questionnaire, pain, wrist range of motion, grip strength, and radiological parameters. The functional outcomes and quality of life were significantly better after volar plating fixation compared with conservative treatment. We found that restoration of the articular surface, radial inclination, and ulnar variance affected the outcomes, but the articular step-off did not. Twenty-five per cent of the patients with conservative treatment had secondary loss of reduction. We conclude that surgical plating leads to better outcomes than conservative treatment for elderly patients with intra-articular distal radius fractures.

Purpose: In vitro studies have shown promising results for balloon-guided inflation tibioplasty. It was our hypothesis that this technique may be safe and effective for use in depressed lateral tibial plateau fracture. Methods: We performed a prospective study of all patients suffering from a depressed lateral tibial plateau fracture, managed in our institution with inflation tibioplasty and a resorbable calcium phosphate bone substitute injection, between January 2012 and December 2013. Twenty patients, mean age 54.3 ± 12. 8 years, suffering from a depressed lateral tibial plateau fracture (Schatzker type II and III) were included. We then aimed to evaluate at a minimum follow-up of one year: (1) the rate of complications, (2) the clinical outcome (Knee Injury and Osteoarthritis Outcome (KOO) and 12-Item Short Form Health Survey (SF-12) scores); and (3) the radiographic outcome (evaluated by CT-scan). Results: No peri-operative complications occurred. In one patient, calcium phosphate substitute was found in the infrapatellar fat pad on post-operative radiography with no clinical or radiographic consequences at one year. At one year after surgery, the KOO subscores were: Pain 80 (range 64—93), other symptoms 81.3 (69–93), daily living activities 81.9 (46–99), sport 65.83 (20–100), and quality of life 67.04 (31–100). The SF-12 activity component was 40.4 (28.6—52.2) and SF-12 mental component 47.71 (28 – 67.1). The mean depressed step-off of the lateral joint decreased from 10.7 ± 4.8 mm pre-operatively to 2.7 ± 1.7 mm post-operatively (p < 0.0001). Conclusion: Our observations suggest that the use of balloon-guided inflation tibioplasty with injection of a resorbable bone substitute is safe, and results in a high rate of anatomic reduction and good clinical outcomes in patients with depressed tibial plateau fractures. Level of Evidence: Therapeutic Level IV.

The primary objective of this project is to develop a novel large animal survival model of intra-articular fracture (IAF) in which all major pathophysiological attributes corresponding to human injuries are realistically replicated, and in which post-traumatic osteoarthritis (PTOA) predictably develops. This final report summarizes all project activities. Initial work included development of hardware to reliably induce a highly repeatable fracture of the Yucatan minipig hock and development of a definitive post-operative treatment protocol. These methods were used in a series of 22 animals to document the natural history of the fractured and repaired joint over a 12 week survival period, focusing on limb loading, joint inflammatory response, bone healing, and cartilage degeneration. After the natural history was established, a short-term study was performed for the purpose of demonstrating that a promising biological treatment could be meaningfully investigated in this new model. In that work an antioxidant/anti-inflammatory cocktail was given immediately after fracture and 24 hours later. Specific measures of whole joint and chondrocyte health were made using direct biological measures and histology. Over the course of this project, the model was fully developed, the natural history (including joint degeneration) was documented, and the model was shown to be an appropriate vehicle for investigation of promising treatments to prevent PTOA., The original document contains color images.